HomeMy WebLinkAbout97-0426
-.J
15056051058
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes .
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
397 -10-9448
05/03/1997
06/14/1920
Decedent's Last Name
Suffix
OFFICIAL USE ONLY
County Code Year
File Number
21 97
0426
Gray
Jean
Decedent's First Name
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
FILL IN APPROPRIATE OVALS BELOW
. 1. Original Return
2. Supplemental Return
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
James D. Flower, Jr.
Firm Name (If Applicable)
Saidis, Flower & Lindsa
First line of address
26 West High Street
Second line of address
City or Post Office
Carlisle
State
ZIP Code
PA
17013
3. Remainder Return (date of death
prior to 12.13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(717) 243-6222
r-._<,
MI
L
MI
m..J
Correspondent's e-mail address:
Under penalties of rjury, I deciare that I have examined this return, including accompanying schedules and statements, and to the best of my knowl dge and belief,
it is true, carr d complete. Declaration of preparer other than the personal representative is based on all information of which preparer h s a knowledge.
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REGISTER OF W~S USE ONt..lf1
.,
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DAfE FilED
CI
ADDR
244 Walnut Bottom Road, Carlisle, PA 17013
URE OF PREPARER OTHER THAN REPRESENTATIVE
.- LL')-t-\:
st High Street, Carlisle, PA
Side 1
L
15056051058
DATE
I:' - - 66-
._".d...i'" ....
15056051058
--'
J
..-J
15056052059
REV-1500 EX
Decedent's Name:
Jean
L Gray
RECAPITULATION
1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested. . . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O L 318,122.28
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052059
Side 2
397-10-9448
Decedent's Social Security Number
119,900.00
78,559.62
0.00
0.00
146,017.95
3,500.00
0.00
349,977.57
21,642.88
6,212.41
27,855.29
320,122.28
2,000.00
318,122.28
0.00
19,087.33
0.00
0.00
19,087.33
.
15056052059
..-J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Jean
STREET ADDRESS
820 Forbes Road
File Number
0426
L
Gray
DECEDENT'S SOCIAL SECURITY NUMBER
397 -10-9448
CITY
Carlisle
-- . I STATE-
PA
IZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
19,087.33
20,000.00
Total Credits ( A + 8 + C )
(2)
20,000.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(58)
0.00
912.67
0.00
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~
c. retain a reversionary interest; or.......................................................................................................................... D [iJ
d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)( 1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jean L. Gray
FILE NUMBER
21-97-0426
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Real estate and dwelling located at 820 Forbes Road, Carlisle, Cumberland County, PA
VALUE AT DATE
OF DEATH
119,900.00
Actual Sale price
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
119,900.00
REV-1503EX+ (6:98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Jean L. Gray
FILE NUMBER
21-97-0426
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
VALUE AT DATE
OF DEATH
2.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
3.
DESCRIPTION
U.S. Treasury Note #912827 J45, $5,000, 55/8% Note J 98,dated 2/1/93, due 1/31/98
U.S. Treasury Note #912827 J94, $5,000, 5 1/8% Note, K98, dated 2/29/96, due 2/28/98
U.S. Treasury Note #912827 A44, $4,000, 7 7/8% Note, F 98 dated 4/15/91, due 4/15/98
U.S. Treasury Note #912827B50, $4,000, 8 1/4% Note G 98, dated 7/15/91, due 7/15/98
U.S. Treasury Note #912827P63, $5,000, 6 1/2% Note M 97, dated 5/2/94, due 4/30/99
U.S. Treasury Note #912827X72, $5,000, 6 3/8% Note X 99, dated 5/15/96, due 5/15/99
U.S. Treasury Note #912827025, $4,000, 7 1/2% Note 0 01, dated 2/18/92, due 11/15/01
U.S. Treasury Note #912827T85, $3,000, 61/2% Note B 05, dated 5/15/95, due 5/15/05
4,000.00
5,000.00
5,000.00
4,000.00
3,000.00
5,000.00
5,000.00
4,000.00
$10,000 Series EE Savings Bond #X3446356EE, dated 11/25/92
$5,000 Series EE Savings Bond #V3725036EE, dated 11/25/92
6,456.00
3,228.00
8,000.00
14,147.60
6,210.00
8 - $1,000 Series HH Savings Bonds. See attached list
19 - $1,000 Series EE Savings Bonds. See attached list
13 - $500 Series EE Savings Bonds. See attached list
3 - $200 Series EE Savings Bonds. See attached list
560.64
30 - $100 Series EE Savings Bonds. See attached list
3,196.80
342.84
$100 Series E Savings Bond #C2114014713E, dated 08/01/76
20 - $50 Series EE Savings Bonds. See attached list
1,065.60
$50 Series E Savings Bond #L2222669156E, dated 02/18/92
177.62
2 - $25 Series E Savings Bonds. See attached list
174.52
78,559.62
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1508 C:X+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Jean L. Gray
FILE NUMBER
21-97-0426
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Sale of miscellaneous furniture
1,400.00
2. Sale of 1995 Chevrolet Sedan
13,500.00
3. Proration of 1997 County/Township Real Estate Taxes. See attached HUD-1
1.74
4. Proration of 1997-98 School Real Estate Taxes. See attached HUD-1
719.22
5. Checking Account #182-110-3122, Mellon Bank
42,903.27
I nterest accrued to date of death
39.26
6. Savings Account #26528-00, Members First Federal Credit Union
Interest accrued to date of death
7,098.71
1.28
7. Savings Account #26528-05, Members First Federal Credit Union
55,230.35
Interest accrued to date of death
12.11
8. Checking Account #26528-11, Members First Federal Credit Union
Interest accrued to date of death
8,021.95
0.85
9. 4 year Certificate #26528-40, Members First Federal Credit Union
3,098.22
Interest accrued to date of death
0.96
10. Liberty U.S. Govemment Money Mkt. A, Federated Investors Account #16439632-0,1704.730 sh. @$1/sh.
11. Pa. Tax Free Fund, Scudder Investment Services Account #954960380-4,130.009 shares @ $13.32/share
1,704.73
1,732.92
12. Account #217008, Alaska Federal Credit Union
7,997.86
Interest accrued to date of death
69.45
13. USAA Savings Account #00103-23-84
1,005.07
14. USAA Life Insurance Company #002222100, Contract #0103238402, cash surrender value
1,480.00
TOTAL (Also enter on line 5, Recapitulation) $
146,017.95
(If more space is needed, insert additional sheets of the same size)
REV-150"EX+ (&-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Jean L. Gray
FILE NUMBER
21-97-0426
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Steven C. Gray
923 Alexander Spring Road, Carlisle, PA 17013
Son
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 11/15/85 $5,000 Treasury Bond, Series D-1995, 9 1/2%, dtd. 11/15/85, Ger!. #4237 5,000.00 50% 2,500.00
2. A Interest accrued to date of death 50%
3. A 04/02/85 $1,000 Treasury Bond of 2005,12%, dated 4/2/95, Ger!. #1265 1,000.00 50% 500.00
4. A Interest accrued to date of death 50%
5. A 04/02/85 $1,000 Treasury Bond of 2005,12%, dated 4/2/85, Ger! #1266 1,000.00 50% 500.00
6. A Interest accrued to date of death 50%
TOTAL (Also enter on line 6, Recapitulation) $ 3,500.00
(If more space is needed, insert additional sheets of the same size)
REV-151'. =X+(1'2-99)*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jean L. Gray
FILE NUMBER
21-97-0426
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home, Inc., funeral
4,590.00
B. ADMINISTRATIVE COSTS:
1 . Personal Representative's Commissions
Name of Personal Representative(s) None
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2
Attorney Fees
3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant None
Street Address
City
State
.Zip
Relationship of Claimant to Decedent
4.
Probate Fees
294.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
8.
ReMax Performance Realty, real estate commission on sale of house. See attached HUD-1
Notary fees, sale of house. See attached HUD-1
Flower, Morgenthal, Flower & Lindsay, attorneys fee for sale of house. See attached HUD-1
Saidis, Guido, Shuff & Masland, distribution fee. See attached HUD-1
Recorder of Deeds, 1 % transfer tax, sale of house. See attached HUD-1
Darlene Moyer, Tax Collector, 1997-98 School Real Estate Taxes. See attached HUD-1
7,194.00
4.00
200.00
35.00
1,199.00
1,614.58
7.
9.
10.
11.
12.
TOTAL (Also enter on line 9, Recapitulation) $Continued
(If more space is needed, insert additional sheets of the same size)
REV-151" =X+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jean L. Gray
PAGE 2
FILE NUMBER
21-97-0426
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
,Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
8.
Home Paramount, Pest Certification for sale of house. See attached HUD-1
Borough of Carlisle, final water/sewer bill. See attached HUD-1
Dawn Conversions, modify Suburban seat
Mr. Detail, detail Lumina for sale
Estate checking account, new check fee
The Patriot New, Advertise vehicle for sale
24.00
45.58
265.00
79.50
8.91
16.10
7.
9.
10.
11.
12.
TOTAL (Also enter on line 9, Recapitulation) $ Continued
(If more space is needed, insert additional sheets of the same size)
REV-1511 tX+ (12-99)*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jean L. Gray
PAGE 3
FILE NUMBER
21-97-0426
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State .Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Steven Barrett Real Estate, real estate appraisal
8. Tim Hilterman, painting house for sale
9. Tim Hilterman, hauling carpet for sale of house
10. Herman's Plumbing, repair of toilet for sale of house
11. Ettinger's, replace ruined carpet for sale of house
12. Cumberland Law Journal, advertise Estate Notice
250.00
880.00
100.00
46.65
1,061.56
60.00
TOTAL (Also enter on line 9, Recapitulation) $ Continued.
(If more space is needed, insert additional sheets of the same size)
REV-1511 'tX+ (12-99)*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jean L. Gray
PAGE 4
FILE NUMBER
21-97-0426
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1 . Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. The Sentinel, Advertise Estate Notice
8. Allowance for Closing Costs
75.00
100.00
TOTAL (Also enter on line 9, Recapitulation) $ 21, 64:2 . 9 3
(If more space is needed, insert additional sheets of the same size)
REV-l512 ~+ (12-03)
ESTATE OF
Jean L. Gray
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-97-0426
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Dan Bisker, yard work
240.00
2.
Borough of Carlisle, water bill
94.69
3.
Sprint, final phone bill at nursing home
107.20
4.
Brown Optical,
17.60
5.
Presbyterian HOmes, nursing home
2,686.75
6.
Dan Bisker, yard work
275.00
7.
Sprint, phone bill
69.07
8.
MCI, phone bill
19.61
9.
Moffit, Pease & Lim, medical bill
40.43
10.
Carlisle Pathology, medical bill
7.99
11.
Lakeview, Hospice care
752.89
12.
MCI, phone bill
5.71
13.
Davie Hartzell, MD., medical bill
20.00
14.
Reader's Digest, account
78.98
15.
Sprint, phone bill
20.19
16.
Carlisle Hospital, Account
570.00
17.
Carlisle Digestive Disease Associates, Account
70.68
18.
MCI, phone bill
5.71
19.
Emerald Drug, medical bill
215.77
20.
Borough of Carlisle, water bill
35.82
21.
P. P. & L. Co., Account
266.65
22.
Sprint, phone bill
18.66
23.
Dan Bisker, yard work
200.00
24.
USAA, Homeowners Insurance Premium
122.35
25.
P. P. & L., Account
270.66
6,212.41
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1513I::X+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jean L. Gray
FILE NUMBER
21-97-0426
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Steven C. Gray, 244 Walnut Bottom Road, Carlisle, PA 17013 Son 318,122.28
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. Spay/Neuter Fund of Harrisburg, P. O. Box 516, Camp Hill, PA 17001-0561 1,000.00
2. People for Ethical Treatment of Animals, 680 Eighth Street, Suite 225, San Francisco, CA 94103 1,000.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 2,000.00
(If more space is needed, insert additional sheets of the same size)
c: \wpil I WillslGray.J LIsmr
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fiLE CO Y
1East JIlilI anb Q[tslattttttl
OF
JEAN LENORE GRAY
I, JEAN LENORE GRAY, of 820 Forbes Road, Carlisle, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and
form following:
FIRST: I hereby expressly revoke all Wills and Codicils heretofore made by me.
SECOND: I hereby direct my Executor to pay all my just debts, funeral and
administrative expenses out of my estate, as soon as practicable after my death.
THIRD: I direct that all taxes which may be assessed in consequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid out of my
estate as a part of the administration of my estate.
FOURTH: I give One Thousand Dollars ($1,000.00) to the Spay/Neuter Fund of
Harrisburg.
FIFTH: I give One Thousand Dollars ($1,000.00) to the People for Ethical
Treatment of Animals.
SIXTH: I give all the rest, residue, and remainder of my estate to my son,
STEVEN C. GRAY, of 923 Alexander Spring Road, Carlisle, Cumberland County,
Pennsylvania. Should he fail to survive me by thirty (30) days, I give all the rest, residue,
and remainder of my estate to my grandson, STEVEN CHRISTOPHER GRAY. Should said
STEVEN CHRISTOPHER GRAY not have attained the age of twenty-one (21) at the time
c:\wp51 IWillslGray .]L\smr
that he becomes entitled to a share of my estate, I give such share to the MELLON BANK,
as Trustee for the benefit of said child. As much of the principal and accumulated income
of this Trust as TRUSTEE may from time to time think advisable for the support and
education (including college education, both graduate and undergraduate) of said child, or
during illness or emergency, shall either be paid to him or else applied directly for his
benefit by the TRUS1EE after taking into consideration his other readily available assets
and sources of income. All unpaid principal and interest shall be payable to such child upon
attaining the age of twenty-one (21) years.
SEVENTH: I hereby nominate, constitute and appoint my son, STEVEN C. GRAY
to be the Executor of this my Last Will and Testament. No personal representative shall
be required to file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal this 3> 0+(_
day of ~ ' 1996.
6VJEJ^LEN01El-~RAY
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
2
c:\wp51 \WiIIs\Oray .JL\smr
COMMONWEALTH OF PENNSYLVANIA
55.
COUNTY OF CUMBERLAND
I, JEAN LENORE GRAY, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my Last Will; that I signed it willingly; and that
I signed it as my free and voluntary act for the purposes therein expressed.
~wo~ or affirmed to and aCkn(jledged before me, by JEAN LENORE GRAY, the
Testatnx, thIS ,-:ZU -I::.J\ day of JC_L/VVLKJ1A , 1996.
11"" .~ '!1'~
!JEAN LENORE GRAY, estatnx
~f~~~d
Notary Public .
NOTARIAl SEAL
MERLENE MARHEVKA, Notary Pltllic
Carlisle. Cunilerflnd Counry. PL
My Commission ExpirlIs6nw8
3
c:lwp; l\ W,lIslUray.J L\SWl
COMMONWEALTH OF PENNSYLVANIA
SS.
COUN1Y OF CUMBERLAND
We, James D Flnwpr. .Tr and Krlrpn To Mr.('nnnpll , the witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we are present and saw Testatrix, JEAN LENORE
GRAY, sign and execute the instrument as her Last Will, that she signed willingly and that
she executed it as her free and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the
best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind
and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by James D. Flower, Jr.
and Karen L. McConnell , witnesses this .:3,0 Q"- day of
7'i-u.~ kLe..A . , 1996.
.// .
;?~ '/ me- (!~~
/ '
Witness .
\'-Z~~l&,c~~r~
Notary Public
NOTARIAL SEAl.
'J~RLENE MARHEVKA. Noll/)' PtbIic
;;atllsle, Cumbetland Co~ PI.
',1y Commission Explnt. Mli9s
4
.'1'.1'0.1'1'00\ lL ES 355 (1\-88) I'"e I Form Approved OMB No. 2502-0U5
A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 'B.>." "uV'j'.,t, TYPE nl;'T nAM. .. . ..
1. -- FHA 2 ~FMHA 3. l CONY. UNINS.
4. VA 5. CONV. INS.
Said is, Guido, Shuff & Masland 6. File Number l7. Loan Number
TI 97 -508 03424001
8. Mortgage Ins. Case No.
SETTLEMENT STATEMENT
J. NOTE: This fonn is furnished /0 give you a statemelll of actual settlement costs. Amounts paid to and by the settlement dgent are shown.
Items marked H(P.o.C.)" were paid outside the closin~ they are shown here for infonnational purposes and are not included in the totals.
), NAME AND ADDRESS OF BORROWER: Wl III am E. Corl, Barbara V. Cor 1 , 6108
:. NAME, ADDRESS AND TIN OF SELLER: Estate of Jean L. Gray
: NAME AND ADDRESS OF LENDER: Columbia National Incorporated
,
Oak Brook Offi ce Pav., 2603 W. 22nd St.
Oak Brook, IL 60523
;. PROPERlY LOCATION: 820 Forbes Road Carlisle Pennsylvania 17013
o Property or Services Received Saidis, Guido, Shuff Masland #251694606
t SETTLEMENT AGENT: & TIN
PLACE OF SETTLEMENT: 26 West High Street
Carlisle, PA 17013
SETTLEMENT DATE: 12-30-97
[. $UMM~'V"QE.:l)ORR.Owp~:lS~j~S~t4!'ft~~.':!i(miii:iii\1!i\ii.iiIm::i!iii'!!'!::'!:::': "~!::!:mm'iii\\mt$t3~~'Y;l:>E'~F.lSltJW.'$".TIV.NSA.CTION' : ' ,,,-,0;,,,,, ~:~ "',: :c_
" :". ,;.,.".;;.".,,,.....
, ." ..... .. .... .... .. , .' '.-'. ..-.". " ''''.
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DlJE TO SELLER:
01. Contract sales price 119,900.00 401. Contract sales price 119,900.00
02. Personal Property 402. Personal property
03. Settlement charges to borrower(line 1400) 4,112.09 403.
04. 404.
05. 405. ,
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
06. City/town taxes to 406. City/town taxes to '"
07. County taxes 12-30-97 to TT-31-97 1. 74 407. County taxes 12-30-97 to 12-31-97 1. 74
08. Assessments to 408. Assessments to
09. School 12-30-97 to 0-30-98 719.22 409. -S-choo 1 12-30-97 to 6-30-98 719.22
10. 410.
11. 41 I.
12. 412.
13. 413.
14. 414.
15. 415.
16. 416.
20. GROSS AMOUNT DUE FROM BORROWER 124,733.05 420. GROSS AMOUNT DUE TO SELLER 120,620.96
200. AMOUNTSPAJD BY/OR IN BEHALF'.'OFBO.RR.OwER: . .......' C.,..... '500. REDUCTIONS IN AMOUNT DUE TO SELLER.; ". .
01. Deposit or earnest money 5,000.00 501. Excess deposit(see instructions)
02. Principal amount of new loan(s) 60,000.00 502. Settlement charges to seller (line 1400) 10,316.16
03. Existing loan(s) taken subject to 503. Existing 10an(s) taken subject to
04. 504. Payoff of first mortgage loan
05. 505. Payoff of second mortgage loan
06. 506.
07. 507.
G8. 508.
G9. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
10. City/town taxes to 510. City/town taxes to
11. County taxes to 51 I. County taxes to
12. Assessments to 512. Assessments to
13. 513.
14. 514.
15. 515.
16. 516.
17. 517.
18. 518.
19. 519.
TOTAL PAID BY/FOR TOTAL REDUCTION AMOUNT
20. , BORROWER 65.000.00 520. DUE SELLER 10,316.16
.. "'ifMi'C)t$HATS.B,TTLEMENT.'fO/FROM SELLER .. ." .
" ,..".. ......
31. Gross amount due from borrower(line 120) 124,733.05 601. Gross amount due to seller(line 420) 120,620.96
n. Less amounts paid by/for borrower(line 220) 65,000.00 602. Less reductions in amount due seller(line 520) 10,316.16
'J3. CASH ( X FROM) ( TO) BORROWER 59,733.05 60l CASH ( X TO) ( FROM) SELLER 110,304.80
XPA YER IDENTIFICATION NUMBERSOLlCITATION: SELLER
L1 are required by law to provide Saidis, Guido, Shuff &. Muland with your correct taxpayer identification number. Iryou do not provide Saidis, Guida, Shurr &. Mar.l:and with your correct taxpayer
1tification number, YOLl may be subject to civil or criminal penalties imposed by law. (Seller's oame(s), address and tax identification number(s) is shown in item E above and ,hould be checked for accurat.)'.J
der penalties of perjury, I certify that tbe number shown on this. statement is my correct taxpayer identification number.
':. )n{ormation contained in Bloch E,G,H.l. and line 401 is important taX information and is being furnisbed to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other
c.tion w\U be imposed on you if this item is re.quired to be reponed and the IRS determines that it has not been reported.
T.NO.PFOOI13 ES 355 8-88
P. e 1
HUD
:0:::!;U~i;m;.;i;!!:JOm!;\tl'Qt$E:~A1J;~ISF.Q~~!$\li~MM~$$
BASED ON PRICE $ 119 900.00 @
Division of Commission (line 700) as follows:
01. $ 7,194.00 to ReMax Performance Realty
02. $ to
03. Commission paid at Settlement
'04.
PAID FROM
BORROWER'S
FUNDS AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS AT
SETTLEMENT
SETTLEMENT CHARGES
7 194.00
;01.
\02.
l03.
104.
105.
106.
\07.
\08.
109.
no.
m.
m.
n3.
114.
%
%
Columbia National Incor orated
1 425.00
25.00
225.00
100.00
30.00
001. Hazard Insurance
002. Mortgage Insurance
003. City property taxes
004. County property taxes
005. Annual assessments
006.
007.
008.
months @ $
months @ $
months @ $
months @ $
months @ $
months @ $
months @ $
months @ $
per month
r month
per month
per month
per month
per month
per month
per month
101. Settlement or closing fee to
102. Abstract or title search to
103. Title examination to
104. Title insurance binder to
105. Document preparation to
106. Notary fee to
107. Attorney's fee to
(includes above items numbers;
108. Title insurance to
(includes above items numbers;
109. Lender's coverage
110. Owner's coverage
111.
112.
113.
201. Recording fees: Deed
202. City/county tax/stamps:
203. State tax/starn s
204.
205.
Cash 8.00 4.00
James Flower Es . 200.00
)
Carl. Abst. 918.75
$ 60,000.00
918.75 $ 119 900.00
75.00
Deed
Deed
1 199.00
301. Al r orne Lender Pk
302. Wi re Fee to Sal di s
303. 1997-98 School Tax to Darlene Mo er
304. Pest Certl fi cati on to Home Paramount
305. Final Water to Borou h of Carlisle
306.
307.
308.
1 614.58
24.00
45.58
,
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K)
4 112.09
10 316.16
SELLER 1 SELLER 3
B~~r~V.~ BUYER 3
ettlement Statement wbich I bave prepared la a true and accurate account of lbe funds wblch were received and bave been or will be disbursed by lbe undersigned os port
GE E
UtNIN : t ia a crime to Itnowin&IY ma~e f.be .tatement to lbe United States on lbis or any olber simil.r form. Penalties upon conviction can Include a fine and imprisonment
,detail ee: Title 18 U.s. Code Section. 1001 and Section 1010.
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IS CLAIMED, THE PURCHASER FURTHER CERTIFIES THAT HE/SHE IS AUTHORIZED TO CLAIM THIS EXEMPTION, I/WE ACKNOWLEDGE THAT I/WE MAY LOSE MY lOUR OPERATING
PRIVILEGE(S) OR VEHICLE REGISTRATION(S) FOR FAILURE TO MAINTAIN FINANGIAL RESPONSIBI~'Q.. ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF
REGISTRATION. I/WE ACKNOWLEDGE THAT I/WE MAY BE SUSJECT TO A FINE NOT EXCEEDING $5,00~tnMt''RiS'OKff'i1ENTlJP-NO'f-M0RE-Ull\tLTWO YEARS FOR ANY
FALSE STATEMENT THAT I/WE MAKE ON THIS FORM. ." ,'_ , '_ . . . n~ .
fflnat~re:Jof~ Rrst, Purc~er 0r:,~~th~riZ~~fj~~.:~r (" $ignatu,:~ OJ ~Il~. I~~ /1 ) ~.-+--
1ST, 'I) ,1,(,'_' , "...t ;ciJ;'l_ \, ,i I;_,",""~_ '. k,'J-<""II'^ [,.--"0__'hf,-",,_ ..
A~~~t ~(gnature of Co-~haser/Tille of Authqrized Signer '" ::Signatu~e.pfCo-SeUer J.....
.~;:.:i,-
, ..
;;~f\. i::'t/.I~ p~AJm ITLE~~.~~g~r.E,~.(rs.:,,_~~;~N..~~~JZACH. ED TITL~)~K. E OF~.EHI~LE _~;
'~:!!'~J;iJ~'-fe27X>.7.s0g;Q.1:?:.;':>' ..... .i':,' ....jt~--t:li';'1~~~j!-eH6VY;:tJ-':'
~J.~~: ;~;~)~g~u~t~~g~~I~;~~'54;6";' ,f, -- &i~~'";' []'F~R
.<
""0 ,-
, POOR
MIDDLE INITIAL
.~,',;:~~;~~:E{,;: .
LAST NAME (OR FULL BUSINESS NAME)
Gray.Jean L
CO-SELLER
FIRST NAME .
,1,:>r:P;:;'SPrl
LAST NAME (OR FULL BUSINESS NAME)
Snyder,Larry t:.
CO-PURCHASER
FIRST NAME
MIDDLE INITIAl I iDATE ACQUIREDI
PURCHASED
OS/27/97
STREET
80)( //
CITY
STATE
I TELEPHONE NO,
(71 i7-Q3R-??S
MIDDLE INITIAl_IDA. JE ACQUIREDI
, PURCHASED ' ,
/ /
ZIP CODE
l='tt9,S .PA 17~1 Cl
LAST NAME (OR FULL BUSINESS NAME)
FIRST NAME
CO-PURCHASER
..
,"..'
.
STREET
.
CITY
STATE
'.
ZIP CODE
I TELEPHONE NO,
(000-000-000
MAKE OF VEHICLE
I VEHICLE IDENTIFICATION NUMBER
I.." "."" ",
BODY TYPE (CP, TK, ETC.) I CONDITION
.' I 0 GOOD
o POOR
, .,--,
MODEL YEAR
,
- "
DFAI~
",C:: '..
'oz
"'0,
sti .
fil=
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ORIGINAL PLATE V Check One
o PLATE TO BE ISSUED BY
. BUREAU (PROOF OF IN-' ,
SURANCE MUST BE AT-
TACHED,)
EXCHANGE PLATE TO BE
ISSUED BY BUREAU
TEMPORARY PLATE
ISSUED BY FULL AGENT
,
o
\'h'
-.~ C.:f.
I.
G.
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(,)
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Signature of Second Purchaser or. Authcrized Signer
Signature of Seller
2ND
ASSIGN-
MENT
.;.';,(S'. -
Signature of Co-Seller. .,
.",,-c;'. ,,'" '. ' .- ,,','- ,
Signature of Co-Purchaser !Tille of Authorized Signer
PURCHASE
PRICE
(See noie on rellerse)
1350(; .0 D....
. .
<;ioo
LESS
TRADE-IN
,
c. .0 I
~,.oo
TAXABLE
AMOUNT
1 'j5()(~. f.)()
~ .0:)
Sales Tax Due
x 6% COOl or
x 7% (.07
(See note on reverse).
1A Exemption
Reason Code (must
be. a number fromX',.'
to 23 or. 0)
1 B First Assignment
::~lf:Ii,,()D
(; _ C;.:)
. ","":l'Y:~ . --
,. 1.6 Second Assignment
,
- ".
2, Title Fee
1 .... -" :)i:;
.>> .. 'CJ(;
3, Lien
Fee
r. r-, ,
'--"V
Q ~OC)
4. Registration or
Processing Fee 24 . Ol~ Q .00
F<leExempt Num~r;,"-;"'i" .,",' .'., ;-".' ....
:;~~i0~'i~~,~:X'.I';'-L:;:;.,"::'::;:; I.:?-+y,.: c':.? '.~,
5, Duplicate Reg,
Fee .
No. of Cards _(..1
6, Transfer Fee
7. Increase Fee
c .0 Q .00
Q .0 1 Q C,''''
, .. Jv'
Q .0' , {\ r,r,
, ." .. .. '-' ,-,"
- -
Q .0 1I ^ ^"'.
"Ii .vv
,
8. -Replacement
Fee
,
TOTAL PAID
(Add lthru 8)
10,
'. 8..1'1.0')
Send One
. Check in
This Amount
849.0C
9.
Q .()C
11.GRAND TOTAL
(Add 9 &10)
.
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IF A CO PURCHASER OTHER THAN YOUR SPOUSE IS LISTED ABOVE, CHECK ONE OF THESE BLOCKS, IF NO BLOCK IS CHECKED, TITLE WILL BE ISSUED AS
"TENANTS IN COMMON,"
A 0 JOINT TENANTS WITH RIGHT OF SURVIVORSHIP -ON DEATH OF ONE OWNER, TITLE GOES TO SURVIVING OWNER.
S, 0 TENANTS IN COMMON - ON DEATH OF ONE OWNER, INTEREST OF DECEASED OWNER GOES TO HIS OR HER HEIRS OR ESTATE.
NOTE: IF THE VEHICLE IS BEING LEASED, CHECK THIS BLOCK 0 __ IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV.IL.
MESSENGER NUMBER: .
.-;:,'
-- .-
.
""'0'>'" : MY,::-:4.SJ,( 01-;93 ....,.
2..DEALER{ISSUING AGENT ,':~:J;.ti('"
"',,:":~ "".,"', ,,' I; ;:.: '.
~j
'; ..:~,' ,'; ,
':' ":p.. --.
054006,
OS/28/97
i.;:.__
'*~
t~~
:1
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r.""),,<~"
.~
I~~ I cert,fy as of tne date of issue, the attic,,1 reco",s of the Pennsylvan,a Deoartment
~~-1....J :)f Tror.scm"tiitior. reflect tha.! the person\s; or cotOpc.ny namedj1t~rein is the JawrUl owner
~~]~ of the said vehICle
,~:;"r~1iI ' ..
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DEPARTMENT OF TRANSPORTATION
CERTIFICATE OF TITLE fOR A VEHICLE
----.--.-"-- ._'.'~' .. .~.._..._.._.,-,..
950830066000013-001
2G1WN52M3S1146546
95
CHEVROLET
48270750301 G~
'/EHICLE IDENTIFICATION NUMBER
MAKE OF \/EHICl...E
YEAR
:-:TL:: Nu'~'eE r;
o
I
I
I
I
BODY ,'(PE
OUP SEAT CAP
GVWR
UNLADEN WEIGHT
GCV....R
Till:: 2::l.':""iGS
4/04/95
~/04/95
000116
Q
DATE PA TITLED
DATE OF ISSUE
PRIOR TITLE STATE
ODq~. PRoeD. DATE
ODOM. MILES
000"1. STATUS
ODOMe-IE? 3-r;~TUS
./..
o = AC-:-i..:A'... MllEAG::.
; .. .',':~5::"GE EXCE::::lS ,HE MECr-o,1_.',~c..:._
t.:....tfi:5...__
2 - ~jCT THE ACTUAL I/.;~AGE
3" twr ThE ACTU.-\L "~ILE_i\GE-aDC..!:.:=:=
TAMPERING VERiFE:)
4 - EXE'APT FFOM ODOMETER DISCL2;;'_=:::
REGISTERED oV'mER(S)
TITLE ~RANDS
A - ANTIQUE VEHiCLZ
C - CLASSIC VEHIC~
F .. OUT OF COU,..-rPY
G =- ORiGINALLY MFGD. FOR NON-U:::
DISTRIBunON
H" AGRICULTURAL ',""cHICLE
L = LOGGiNG VEHiCi...E
~ ;: FORMERLY A ;:;cuct:;: VEHiC:....E
P - RECONSTRUCTE,)
S ;: STSEET ROD
T '"' RSCOVERED Ti-l:;::=T VEHiCLE
v .. VEHICLE: CONTAJ~S REISSLJ:::- '.'_',
W -FLOOD VEHICLE
X - FOr:1MERlY A T~XI
JEAN L GRAY
820~FORBES RD
CARLISLE PA 17013
-\"
FIRST UEfoI FAVOR OF:
SECOND UEN FAVOR OF
FIRST UEN RElEASED
If a second lienholder is listed. upon satisfaction of the first lien, the first
lienholder must forward this Title to the Bureau of Motor Vei1~les with t:r.e
appropriate form and fee.
~
-! BY SECOND:UEN RELEASED
=1~-:~~~,:,~~~.t~1t~ji~~0.:"~ik'.Sn.::;~~~-,_c,'7;'.:'$f;. :~~(J.f!~:;a,.~.b..."";':.::~J'!.~7--~~::,::c:.;05',~~f,.
MAJUNG ADDRESS -:;:
DATE
_-c-:,..
DATt:
BY
AUTHOR!ZEO RE?RESENTATIV:::
JEAN L GRAY
820 FORBES RD
CARLISLE PA 17013
B~ADLEY L MALLORY
Secret ary of Transport a (ion
~
f
L
~~
[
~
F-
f
f:-
f
k
F.
F'
l
~
When' applying lor tItle with a co-owner. olner :r-:;:.n your SODUS':. cneCk 0:1,;:0 ::f
these blocks_ If no bk.-ck is cnecked. litle wll! be IS.5ued as '"Tenan:s .n Com!l1O.:1'
A 0 Joint Tenants with Right 01 Survlvorsh.p lOr. de.Jth of ore ~\'.nE'(. title \;.:es
to the SUrvl\.lt'lg owner!
Tenants Ir. C.:-r::mon Ion aeath of c:n~ ow....."'r mterest 01 "-:"'':l?E.seo C.\:-'.;?"
goes 10 ,"'5 .:;r "'IE>~ nelrs or est.Jlel
,NOTARY SEAL
OAVIO.E.',wAHI..::JR.. NOTARY PUBLIC
ME '. ..' ~,
MYCOMMiSSllliJ EXPIRES FEB. 17,2000
CITY
STRE ET i
,.
Th~ unders.tgneQ hi!reby makes appiiclltion tor CertlliC';:lt'" at TIlle to tne .....ehlcle descnbed
aOO"El. sublecf to t~ encumbrances and other legal Claims. set forlh t'li"re
STATE
LIEN
DATE:
SECONQ LIENHOLDER
"
i/
NAME
CITY
<,
STATE 1
ZIP
. -
~" . II
I." ". '''~''
.. . . ~
. ,',:,0,:' 111~1 -.... I .. ..' t I .~
.U
--'1':':-
:.. ~ ~i'h: ~wi"J23::f.:~r~;,~~s;he~~i~'~~jj~~~e o:t.,~eh~le,
O RelleCI3.:tne a~;nt 0"' nllleage" :.~' :. '. 0 -Is NOT the actual mileage - ~.
. in excess of its mechanical limits WARNING: Odometer discrepancy
I V'Ne further certify fhat (he vehicle is free of any encumbrance and that ownership ~ ~rebY
fransierred to the ~~01'l(5),0( the dealef listed. ~
. :~
"
YEAR:
'~
1
lIW.e certify,_ to t~. b~~t.O~ M'Jlour_k~~g~~ ~h?( th~,~o~l~r. ~~ing is. ::1,'
"TEtm<S','" ",'" ',,',', :,'. 'f.
_ __ ,__ X'-~~~ ~a~ ~r~f1ec't; th~'~ctual mi/ea~~ 'Of the~ 'o'et'!~le.-
unless one of the following boxe~:is .checked: 1;
O Rel1ects "the amounfof mileage --" 0 Is NOT the actualmlieage ~-
in excess of its mechanical limits WARNING: Odometer discr'etiancy
lIWe further certify that the ...ehide is free of any encumbrance and that ownership is nereby
transferred to the person(s) or the dealer listed. .J
SUBSCRIBED AND SWORN
TO BEFORE ME:
DAY
YEAR!
MO
SlGNATURE" OF P:RSON ADMINISTERING OATH
;,',_".". ',H., "',-'
.~.- -'--.-.- - -
,,'\-,. ,:;-,,',;,-,.--
'\;.,
.oJ.-
.~,
~
<(
LU
CD
VWe certify. 10. fhe best of my/our knowledge that the odometer reading is t
_ ' TENTHS.. _
___ , __~, X miles and reflects '~he actual mileage of the veh~le,
unless one of the following boxes is checked: . .~
" " - " l
O Reflects (he ainount 01 mileage. 0 b NOT the actual mijeage ,_.~
. in _excess of lis. mechanical tinuts . _ WARNING: Odometer discreiiancy
II't'k further certify that lhe vehicle fa free of any encumbrance and that ownership is I'1ereby
transferred to the oerson(s) 01' the dealer listed.- \ . II
E.
\ :
PURCHASER OR I=ULl
BUSINESS NAME
Co-PURCHASEP.
STREET
ADDRESS
CITY
STATE
ZlP
PURCHASE PRICE
OR DIN
'1
PURCHASER OR FULL
BUSINESS NAME
CO-PURCHASER
STREET
ADDRESS
CITY
STATE
PURCHASE PRICE
OR DIN
ZlP
PURCHASER SIGNAruRE
CO.PURCHASER SlGNATUR!:
~ SIGNATURE OF SELLER
MI
PURCHASER OR !='ULL
BUSINESS NAME
CQ.PURCHASER
STREeT
. ADDRESS
t'
2lP
PURCHASE PRICE
~ OR DIN
.
~- Mellon Bank
PERSONAL BANKING STATEMENT
.
DIRECT INQUIRIES TO: MELLON BANK NA 1
COMMONWEALTH REGION
CARLI SL E SHARON
665 N EAST ST
CARLISLE PA 17013-2004
717-243-5311
1,1.111111111,1",111,111,111111,,111..11.111.1.1111.1,111.1.1
MRS A P GRAY
820 FORBES RD
CARLISLE PA 17013-1716
00810
CLS 0419
182-110-3122
PAGE 1 OF 2
STATEMENT
FROM 05/09/97 THRU 06/09/97
THIS AMENDS YOUR ACCOUNT RULES AND REGULATIONS. YOUR STATEMENT WILL
BE MAILED 1) TO THE LAST ADDRESS THAT YOU PROVIDED TO US, OR 2) TO
THE LAST ADDRESS THAT YOU PROVIDED TO OUR CHECK VENDOR, OR 3) TO THE
FORWARDING ADDRESS THAT YOU PROVIDED TO THE U.S. POSTAL SERVICE.
RELATIONSHIP SUMMARY
DEPOSIT ACCOUNTS
PREMIUM CHECKING HITH INTEREST
TOTAL
BALANCE
0.00
0.00
LOAN ACCOUNTS
OUTSTANDING
PREMIUM CHECKING WITH INTEREST ACCOUNT 182-110-3122
IACCOUNT . SUMMARY
OPENING BALANCE AS OF 05/09/97
TOTAL DEPOSITS AND OTHER ADDITIONS INCLUDING INTEREST CREDITED THIS PERIOD
TOTAL CHECKS AND OTHER HITHDRAHALS INCLUDING FEES AND CHARGES THIS PERIOD
CLOSING BALANCE AS OF 06/09/97
41.912.08
+.00
-41.912.08
.00
AVERAGE ACCOUNT BALANCE
AVERAGE COLLECTED BALANCE FOR ANNUAL PERCENTAGE YIELD EARNED
YOUR ANNUAL PERCENTAGE YIELD EARNED FOR THIS STATEMENT PERIOD IS 1.31X
37,720.87
.00
~UNT ACTIVITY
DATE
POSTED DESCRIPTION
05/09/97 OPENING BALANCE
DEPOSITS
AND OTHER
ADDITIONS
CHECKS
AND OTHER
HITHDRAHALS
DAILY
BALANCE
4],,912.08
OS/27/97 MISCELLANEOUS DEBIT REF #000000021290445
06/09/97 CLOSING BALANCE
. 41,912.08
~
.00
* AN ASTERISK INDICATES A BREAK IN THE LISTING OF CONSECUTIVE CHECK NUMBE~S.
PLEASE USE THE ACCOUNT RECONCILEMENT FORM LOCATED oN THE LAST PAGE OF
THIS STATEMENT TO BALANCE YOUR ACCOUNT.
IF YOU HAVE QUESTIONS ABOUT THE INFORMATION CONTAINED IN THIS STATE-
MENT, PLEASE CALL THE MELLONDIRECT 24 CENTER FOR CUSTOMER SERVICE.
THE NUMBERS TO CALL ARE 1 800 222-9034 OR 222-9034.
@
M,ellon Bank
Balancing Your Checking Account
Before you begin . . .
Compare:
Check off:
Add to your
transaction
register balance:
Subtract from
your transaction
register balance:
00810
Your statement to your transaction register.
182-110-3122
PAGE 2 OF 2
All items in your transaction register that also appear on your statement.
(An asterisk (*) will appear in the check summaty section if there is a break in the listing of
consecutive check numbers,)
Any interest credits and any electronic deposits not already entered
(ATM deposits, Bank-by-Phone transfers, direct deposits, etc.).
Any account charges or fees and any electronic withdrawals not already
entered (ATM withdrawals, Bank-by-Phone transfers, preauthorized payments, etc.),
The result is your Updated Transaction Register Balance.
Step 1:
$
Enter your closing balance from your statement.
Step 2:
Date
Add deposits and transfers made to your account since the
closing date on your statement.
Amount
Date
Amount
Step 3:
$
Step 4:
Date
Total
Enter total + $
Add totals from Step 1 and 2 and enter total here,
Add all the outstanding checks or withdrawals, ATM with-
drawals, preauthorized payments, etc" that are in your
transaction register, but do not appear on your statement.
Amount
Date
Amount
~
LENDER Step 5:
I
I
-'----
I
I
I
I
I
I
I
Total
Enter total - $
Subtract the total in Step 4 from the total in Step 3,
The result should equal your Updated Transaction
Register Balance.
$
Member FDIC
SHARE SAVINGS ACCOUNT:
J Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
CHECKING ACCOUNT:
/ Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
INVESTMENT SAVINGS:
/
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
Estate of JEAN L. GRAY
Date of Death 5/3/97
Social Security Number 396-14-7576
1....-'",..4
--.... .".'......
26528-00 (
3/6/81
$7,098.71
$1.28
None
RECJ:tVEO
MAR 1 8 199B
405'0........". .
26528-11
3/4/83
$8,021.95
$.85
None
26528-05 v
11/8/85
$55,230.35
$12.11
None
~~E~S 1ST FE~EDIT UNlON
;(U~~a
Denise A. Anders --"
Insurance Products Supervisor
March 16, 1998
P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · Fax (717) 795-6024
CERTIFICATES OF DEPOSIT:
) Account Number/Suffix
Date Opened
Rollover Dates, if applicable
Value, including interest at Date
of Death
Name of Co-Owner, if any
Maturity Date
Interest Rate
Accrued Interest to Date of Death
Estate of JEAN L. GRAY
Date of Death 5/3/97
Social Security Number 396-14-7576
26528-40
10/10/96
N/A
,~
$3,098.22
N/A
10/9/00
5.75%
$.96
r~ERS 1 s~
MdcU
Denise A. Anders
Insurance Products Supervisor
March 16, 1998
P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717)697-1161. Fax (717) 795-6024
1 4 7 5 3
Statement Period: 05/01/97 - 05/31/97
Page 1 of 1
11111111111111111111111111111111111111111.11111111111111111111
JEAN L GRAY
STEVEN C GRAY JT TEN
820 FORBES RD
CARLISLE PA 17013-1716
!..........................................................................................................................-......................;
! A RESERVE FOR HOUSEHOLD EMERGENCIES OR PLANNED )
i EXPENSES. WHATEVER THE SITUATION. A MONEY MARKET :
) FUND IS A CONVENIENT WAY TO PURSUE DAILY INCOME ON :
i YOUR READY CASH. ,
\..................................................................................................................................................,
Dealer/Branch: 91601/001
\ 1 I
.....--
A
Customer Service Telephone No: 1 (800) 245-4770
Investment
Category
Government Money Market
Liberty U.S. Government Money Market A
16439632
1 ,704 .730
$1.00
$1 ,704.73
$1,704.73
TOT AL
Fund Account Ordinary Tax Free Long Term
Name Number Income Income Capital Gains
Liberty U.S. Government Money Market A 16439632 $30.91 $0.00 $0.00
TOTAL $30.91 $0.00 $0.00
Post Trade
Date Date
Transaction
Activity
Transaction
Amount
Shares This
Transaction
Total ~
Shares Held Ii
liberty U.S. Government Money Market A NASDAQ: LUGXX
FUND NO: 2 ACCl NO: 16439632 SSN/EIN NO: 397-10-9448
JEAN L GRAY
STEVEN C GRAY JT TEN
PREVIOUS BALANCE
05/31 05/31 INCOME REINVEST
ENDING BALANCE
Thirty day yield as of 05/30/97 is 4.51 %
$6.50
$1.00
$1.00
$1.00
6.500
1,698.230
1,704.730
1,704.730
II11I1I 1IIII11111 111111111111111111
LIBERTY US GOVERNMENT MONEY MARKET - A
PO BOX 8606
BOSTON MA 02266-8606
ACCOUNT
STATEMENT
02/29/1996
~~~:::::
1...111,111111111..111.111...111,,11...11.11,1,1111111..111111
JEAN L GRAY
STEVEN C GRAY JT TEN
820 FORBES RD
CARLISLE PA 17013-1716
LIBERTY LIFEMEMBER ACCOUNT
CALL TOLL-FREE 1-800-245-4770.
CALL FOR YIELD QUOTES AT
1-800-245-2999.
g
~
o
Transaction
!DENT. NO. OR soc. SEC. NO. 397 -1 0-944R
I Fund NO.2 I A~c6r396.32 I Chk;9t I
Dollar Amount Share Shares This
Of Transaction Price Transaction
Total Shares Held
1/31
2/29
BEGINNING BALANCE
1/31 INCOME RE INVEST
2/29 INCOME REINVEST
6.24
5.48
1 .00
1.00
6.240
5.480
1,602.680
1,608.920
1,614.400
THE 7 DAY NET ANNUALIZED YIELD ENDING 02/27/96 WAS 4.22%.
THE COMPOUND EFFECTIVE YIELD WAS 4.39%.
THE 30 DAY NET ANNUALIZED YIELD ENDING 02/27/9b WAS 4.30%.
Your Payment Option
Dividends Cap. Gains
REINVEST REINVEST
YTD Tax-Exempt Dividends
YTD Taxable Dividends
YTD Capital Gains Distributions
YTD Dividends And Other Distributions
Fund Ident. No.
25-1388518
11.72
11. 72
Shares:
In Certificate Form
+ Non-Certificate Form
= Total Shares Held
X Share Price
= Account Value
1 ,614.4000
1,614.4000
$ 1 .0000
$ 1 , 6 1 4 . 40
LIBERTY US GOVERNMENT MONEY MARKET - A
JEAN L GRAY
STEVEN C GRAY JT TEN
820 FORBES RD
CARLISLE PA 17013-1716
Additional Investment Form
~~~
IDENT. NO. OR SOC. SEC. NO. 397-10-9448
I Fund No. 2 I Ac1c643 96 3 2 I Chk ggt I
LIBERTY US GOV'T
MONEY MARKET TRUST
PO BOX 1723
BOSTON MA 02105-9919
1111"1.111,"111111..1.1,1.1"1.1"11I111.1".1..11
To Invest By Mail:
For purchases into this account,
return this stub and your check
in the enclosed envelope.
AMOUNT OF CHECK
To Make Changes Or Corrections:
Complete the reverse side and place an(J9 in the box below.
, 59
91601 082
($
100.00 minimuml
11111111111111111111111111111111111
{} 0000 53148510 000164396320 0000002
SCUDDER
Scudder ServIce Corporation
1'0 Box 22lj j
Boston, MA 02J07-9913
NatJona] Tull-Free Number
tWO 2:?-5 :;] 63
March 2, 1998
Flower, Morgenthal, Flower & Lindsay
Attn: James D. Flower, Jr.
11 East High Street
Carlisle, PA 17013-3016
RE: Scudder Pennsylvania Tax Free Fund
Account Number: 954960380
Jean L. Gray
Dear Mr. Flower:
I am writing in response to your recent letter. I was saddened to hear of the
passing of Mrs. Gray. Please extend my condolences to her family.
As you requested, the account balance on May 3, 1997, was:
FUND NAME
NUMBER OF
SHARES HELD
SHARE
PRICE
BALANCE
Scudder Pennsylvania Tax Free Fund
130.099
$13.32
$1,732.92
In addition, I have listed our requirements for either redeeming or changing the
ownership of this account. We need:
* A certified copy of the appointment of Steven C. Gray as the executor for the
Estate of Jean L. Gray. We need the copy to have an original certification seal
or stamp, dated within 60 days of the request.
* A letter oE instructions that explains what ~1r. Gray wants to do with the
assets in the account. Please have Mr. Gray reference the Fund name and account
number, and be as specific as possible.
* A "Signature Guarantee" on the letter of instructions. This protects Mrs.
Gray's account by assuring us that the person signing the request is authorized
to do so. Before he signs his letter, he should take it to a local BANK, CREDIT
UNION, or BROKER and ask for a "Signature Guarantee." A representative will
verify his identity, witness his signature, stamp the letter, and sign his/her
name and title. Please note that this is different from a notary public's
stamp.
If Mr. Gray wants to change the ownership of this account, we also need:
* A completed New Account Form. All owners need to complete the enclosed Form
and sign it exactly as they want us to list their names on the new account.
Please indicate any account services on this Form.
Please have Mr. Gray return these documents to us in the enclosed postage-paid
envelope.
Our records indicate that this is the only account Ms. Gray has with us.
If you have any questions, please write to us or call us toll-free at
1-800-225-5163. We are available Monday through Friday from 8:00 a.m. to 8:00
p.m. eastern time. We will be happy to help you.
Sincerely, 0
~O-c,L vL"-'L
:.Jack Lane
Service Representative
jl
Encl: New Account Form
Postage-Paid Envelope
20449397
.... ., ,- -',
h'ECE'IVr::.w
MAR 0 1~SJ
...'.... ~.
--'~
AlaskaCJSA
Federal Credit Union
ber 29, 1999
Law Offices of Flower, Flower & Lindsay
Attn: James D. Flower, JI.
11 East High Street
Carlisle, PA 17013-3016
RE: The Estate of Jean Gray
Account number 217008
Dear Mr. Flower:
The above referenced account was held solely in Ms. Gray's name and was the only account she had
at Alaska USA FCU. The balance of the account as of May 3, 1997 was $7,997.86.
If you have any questions regarding this account or this matter, please contact me at (907) 786-2714.
My office hours are 9:00 AM - 5:30 PM, Monday through Friday.
~inG?rely,
57~1t {/ra:cr--/>>
Sara Cray
Sr. Account Control Specialist
NOY 1 0 1999
PO Box 196613 · Anchorage, Alaska 99519-6613 · Administrative Offices: 907-277-5577
Member Service Center In Anchorage: 563-4567 Long Distance Toll Free: 1-800-525-9094 · TOO/Hearing Impaired: 1-800-742-7084
:~
~
t\1ID
JAMES D. FLOWER JR.
ESTATE OF JEAN L. GRAY
11 EAST HIGH STREET
CARLISLE PA 17013-3016
USAA # 103 23 84
April 6, 1998
Mr. Flower:
This is a follow up to your letter dated February 19, 1998. We
are sorry for the delay in responding.
The amount in the Subscriber's Savings Account for the late Jean
L Gray was $1005.07. That was the amount refunded the estate on
September 5, 1997. The account has been closed out and all the
policies are now cancelled.
Please let us know if you need any other information.
Sincerely,
~
Trinidad L. Rivera
Senior Customer Accounting Specialist
Northeast & Overseas Region
USAA 9800 Fredericksburg Road San Antonio Texas 78288-0001
USAA # 103 23 84-22560-17360-GEN.GEN17
~
...
USAA
LIFE
INSURANCE
COMPANY
PAGE 1 OF 2
OWNER:
EST OF MRS JEAN L GRAY
C/O STEVEN C GRAY
923 ALEXANDER SPRING RD
CARLISLE PA 17013-9183
USAA NUMBER:
CONTRACT NUMBER:
INSURED:
ISSUE DATE:
PAID TO DATE:
CONTRACT STATUS:
DIVIDEND OPTION:
PAYMENT METHOD:
002222100
0103238402
STEVEN C GRAY
10-12-73
10-12-98 "
PREMIUM PAYING
PREMIUM REDUCTION
DIRECT
j.CDNTRACT..pREMIUM:..... .$ 53:3B1ANNUAL""'.........
;1
"DIvidends will not be reflected on this statement if the contract premium IS not paid to the anniversary date.
HThe death benefit and net surrender value will be reduced by any due and unpaid premiums.
leURRENTCONTRACTCOVERAGES ... nl
COVERAGE TYPE
FACE AMOUNT
.!iQlli
Juvenile Estate BUilder
$ 5,000.00
Accidental Death Benefit
$ 1,000.00
Paid Up Additions
$ 223.00
cumberland County - Ke~~o~~~ ~~
One Courthouse Square
Carlisle, PA 17013
phone: (717) 240-6345
Date: 4/24/2007
'::-:-: ~
o
;::~
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......,
STEVEN C GRAY
r-".)
923 ALEXANDER SPRING ROAD
CARLISLE, PA 17013
~J::-
-D
RE: Estate of GRAY JEAN LENORE
File Number: 1997-00426
r;;:>
en
--.J
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a statuS Report of completed or uncompleted administration.
This filing is due. by:
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
5/03/2007
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the orphans' Court
cc: File
counsel
~
cumberland County - K~~~O~c~ ~~
One courthouse Square
Carlisle, PA 17013
phone: (717) 240-6345
Date: 4/24/2007
r,)
GRAY STEVEN CORDELL
OFC OF SMALL BUSINESS ADV
300 N SECOND ST STE 1102
....~;
r",)
(J1
--.l
RE: Estate of GRAY JEAN LENORE
File Number: 1997-00426
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
5/03/2007
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
personal Representative(s)
cj
DATE 03-26-2007
ESTATE OF GRAY JEAN L
DATE OF DEATH 05-03-1997
FILE NUMBER 21 97-0426
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 05-25-2007
( See reverse side under Objections)
Amount Remittedll
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REy:is47-EX-AFP-C03:0Sj-NOTicE-OF-iNHERiTANCE-TAX-APPRAisEHENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GRAY JEAN L FILE NO. 21 97-0426 ACN 101 DATE 03-26-2007
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
'APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
, I~. r;()
i' L. 0
/",-,' "
JAMES D FLOWER ~R
SAIDIS ETAL
26 W HIGH ST
CARLISLE PA 17013
'*
REV-1547 EX AFP (06-05)
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2.
3.
4.
5.
6.
7.
8.
119,900.00
78,559.62
.00
.00
146,017.95
3,500.00
.00
(8)
Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Closely Held Stock/Partnership Interest (Schedule C)
Mortgages/Notes Receivable (Schedule D)
Cash/Bank Deposits/Misc. Personal Property (Schedule E)
Jointly Owned Property (Schedule F)
Transfers (Schedule G)
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
21,642.88
6,212.41
(1)
(2)
(3)
(4)
9.
10.
ll.
12.
13.
14.
Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
(9)
UO)
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form. with your
tax payment.
347,977.57
"7.81i1i.?9
320,122.28
2,000.00
318,122.28
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of Ab.b. returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate US) .00 X 00 .00
16. Amount of Line 14 taxable at Lineal/Class A rate (6) 318,122.28 X 06 19,087.33
17. Amount of Line 14 at Sibling rate (7) .00 X 00 .00
18. Amount of Line 14 taxable at Collateral/Class B rate (8) .00 X 15 .00
19. Principal Tax Due (9)= 19,087.33
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-03-1998 AA269720 .00 20,000.00
TOTAL TAX CREDIT 20,000.00
BALANCE OF TAX DUE 912.67CR
INTEREST AND PEN. .00
TOTAL DUE 912.67CR
*
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE
4 ~I'I'IINn_ ~I'I' ~I'VI'~~1' ~Tnl' nl' TIlTC:: I'nDM I"nD TNC::TDIlf'TTn.."
~UE~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-1607 EX AFP (03-05)
JAMES D FLOWER JR
SAIDIS ETAL
26 W HIGH ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-23-2007
GRAY
05-03-1997
21 97-0426
CUMBERLAND
101
JEAN
L
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
.....
RETAIN LOWER PORTION FOR YOUR RECORDS
of-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF GRAY JEAN L FILE NO. 21 97-0426 ACN 101 DATE 04-23-2007
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-19-2007
PRINCIPAL TAX DUE: 19,087.33
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-03-1998 AA269720 .00 20,000.00
04-04-2007 REFUND .00 912.67-
TOTAL TAX CREDIT 19,087.33
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
*
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
\
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
~~
In Re: Estate of
GRAY JEAN LENORE
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 1997-00426
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative: STEVEN C GRAY
Counsel for Personal Representative: GRAY STEVEN CORDELL
Date of Decedent's Death: 5/3/1997
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
Date:
5/22/2007
~~~
~"
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
-
-- -<' .. I ..J
',' : i. r r ~ C' __ : I .
(.
MAY II! 2007 ~
IN RE: ESTATE OF
GRAY JEAN LENORE
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 1997-00426
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: STEVEN C GRAY
Counsel for Personal Representative: GRAY STEVEN CORDELL
Date of Decedent's Death: 5/3/1997
Date of Delinquency Notice:
The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance
with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day
notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court
is hereby notified of such delinquency and the undersigned requests that a Court conduct a
hearing to determine whether sanctions should be imposed upon the delinquent personal
representative or counsel for the delinquent personal representative.
Date:
5/22/2007
~~~
'-"" C)
, -']
(--
----..;
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
,'-)
1'-
. r Tt
w
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
r'-....)
r, "
A hearing is scheduled Julv 16. 2007 at HAM
in Courtroom NO.2. Ifthe Status Report is filed prior to the hearing date, the hearing will
automatically be cancelled.
~.---.-\-
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'i (" ,k /'1 /
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-........~>.../"
CUNTRACT NUMBER: 0103238402
INSURED: STEVEN C GRAY
PAGE 2 OF 2
1......:eURRENTiFUNO:SALANCeS:::m:1
FUND TYPE
FUND BALANCE
$ 0.00
0.00
0.00
0.00
0.00
0.00
Dividend Accumulations
Paid-up Additions Rider Overage
Discount Premium Fund
Pending Overage
Loan Overage
Active Overage
I" j;.:::....:iTEMfzeO..:CONTRACT...A6'rrVJTY ...:.:1
FROM 10/13/96 TO 10/12/97
EFFECTIVE
DATE
ACTIVITY
AMOUNT
10/12/97
Annual Dividend
80.07
10/12/97
Premium Payment
53.38
....:.ITEMfZEDPAID~UPADDITJONSACTfVITY .....1
FROM 10/13/96 TO 10/12/97
TAX
WITHHOLDING
PAID-UP ADDITION
DEATH-BENEFIT
DATE
ACTIVITY
AMOUNT
10/13/96
Beginning Death Benefit
$ 163.00
10/12/97
Annual DIVidend
26.69
60.00
Total Paid-Up Additions Death Benefit
$ 223.00
....< tMPORTA'NT' NonCESi.......1
Activity with an effective date after the report period will be reflected on your next statement.
You should consider requesting more detailed information about your policy to understand how it may perform in the future. You
should not consider replacement of your policy or make changes in your coverage without requesting a current illustration. You
may request annually, without charge, such an illustration by calling 1-800-292-8556, writing to USAA Life Insurance Company at
9800 Fredericksburg Road, San Antonio, Texas 78288, or contacting your USAA Life Account Representative. If you do not
receive a current illustration of your policy within 30 days from your request, you should contact your state insurance department.
iil<[,ii,I~1-=d:41.t_.~1,!lIfJ~l\liE.~ltiiiiii
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
. )eA;-1\J ~f) (L() --
-
Date ofDeath: ..;;,-I~ I' "t'l :1::
I
Estate No.: -l q ~ -::r - 0 0 t-/- 2..-b
Name of Decedent:
~
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether ad1!'inistration of the estate is comnlete:
Yes 0 No ~ .
2. If the answer is No, state when the personal ~epresentative re~onably believes that
the administration will be complete: ~N :7 (Y\()fV!t f
3. If the answer to No.1 is Yes, state the following:
a. Did the person~presentative file a final account with the Court?
Yes 0 No L..f.
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the person~epresentative state an account informally to the parties in
interest? Yes ( No 0 .
c. Copies of receipts, releases, joinders and approval offonnal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
*attaChed to this report \', I _ 1
Date: Cfi.iii---.. '- i!;j
, J Sign~e
!! . J;~~~J C.~
Name
L<f~ tJ,jAiJJur- ~tYl a
Address . ~sLr! fA.
~:1::g:t -J/33' {wkj
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Capacity: ~ Personal Representative
't Counsel for personal representative
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Pa, O,C, Rule 6,12 STATUS REPORT
REGISTER OF WILLS OF
COUNTY, PENNSYL VANLA
Date of Death:
Je.nv L .
11/'f:>r
I
~
Name of Decedent:
File Number:
/qq:;..-txJ </-~,
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . . .
2. If the answeri~ No, state when ~e.pers~nal r~presentative gll!O-:f-
reasonably bebeves thlt the adrimllstratlOn will be complete"" .' . (
. ~ ~"L~ GV(. ...~ dilJ.H'~ - - . ~ (4/: U
3, Iftheall,wertoNo, 1 iSYES~tatethefonowin~k. -iF VIII.. ~
a, Dld the personal representatlve file a final account W1m the Court? , . - , , , . ~y es i:}No
b, The separate Orphans' Court No. (if any) for the~. on ~ (p ~ -to
representative's account is: _~-.. 'l. A In--
_~ ~ IU~()rr ,'.,
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DNo
. ')
DYes ~NO ·
c. Did the personal representative state an account
informally to the parties in interest? ..............,................ DYes
d. Copies of receipts, releases, joinders and approvals of rmal or'informal accounts may be
filed with the Clerk of the Orphans' Court and . attached to this report.
o Counsel
Dale
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Pa. D.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Name of Decedent: JEAN LENORE GRAY
Date of Death: May 3, 1997
File Number: 21-97-0426
Pursuant to Pa. O.c. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . ., IZI Yes D No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . .. DYes DNo
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? ............................... mYes D No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk ofthe Orphans' Court and may be attached to this report.
pacity: DPersonal Representative IZICounsel
Date August 10, 2007
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(.)
James D. Flower, Jr., Esquire
Name of Person Filing this Form
N
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26 West High Street
Address
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Carlisle, P A 17013
717-243-6222
Telephone
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Form RW-1O rev. 10.13.06