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HomeMy WebLinkAbout05-29-08 15056041147 REV-1500 EX 06 05 ( - ) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box.28osot INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 010 8 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 186306864 11172007 06191913 Decedent's Last Name Suffix Decedent's First Name MI GRISSINGER ANNA T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN (DUPLICATE WITH THE REGISTER OF'WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust O 8. Total Number of Safe De OSIt Boxes (Attach Copy of Will) (Attach Copy of Trust) p ^ 9. Litigation Proceeds Received ^ 1Q, Spousal Poverty Credit (date of death ^ between 12-31-91 and 1-1-95) 11-Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA:K INFORMATION SHOULD BE DIRECTED TO: N ame Daytime Telephone Number KEITH D. WAGNER 7178386~ 8 ~ Firm Name (If Applicable) r~ -rr - ' REGISTER OF ~l1f1;ti~9 USE~ILY B R I N S E R, WAGNER & Z I MME RMAN - - I First line of address ~ l~ - ~~ 6 E . MAIN STREET ''-'~-'' ~ c --::. _-~ .~~ Second line of address _ - - - t ~ P.O. BOX 323 _ 0 _ City or Post Office State DATE FILED ZIP Code PALMYRA PA 17078 Correspondent's e-mail address: Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corr t and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ERSON RESPO I L OR FILING RETURN DATE Gerald J. Brinser ;; ~~-~/_~ ~ 6 E. Main P.O. Box SIGNATURE OF Imyra, PA 17078 OTHER THAN REPRESENTATIVE Keith D. Wagner ~ ~~~ ~ti ~ ADDRESS `/ 6 E. Main Street, Palmyra, PA 17078 Side 1 15056041147 1~i056041147 J 15056042148 REV-1500 EX Decedent's Social Security Number Decetle~rSName GRISSINGER, ANNA T. 186306864 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. 5 1 4 , 5 4 5 . b 0 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) .................................................................... .... g, 5 1 4, 5 4 5 6 0 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... ..... 9. --- - - 2 3, 5 8 1 6 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... .... 10. 1 6 . 0 0 11. Total Deductions (total Lines 9& 10) ................................................................... .... 11 2 3, 5 9 7 6 0 12• Net Vatue of Estate (Line 8 minus Line 11) .......................................................... .... 12. 4 9 O , 9 4 8 0 0 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................ .... 13. 2 4 5 , 4 7 4 0 0 14. Net Vatue Subject to Tax (Line 12 minus Line 13) ............................................... .... 14, 2 4 5 , 4 7 4 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line t 4 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2} X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 4 5, 4 7 4 0 0 1 s. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................................................................................................................... . 19. 20. (F\ELL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT, \.~~ ~~ ~Cl ` J 11,046.33 11,046.33 Side 2 ~, 15056042148 15056042148 REV-1500 EX Page 3 File Number 21 - 07 - 01 089 Decedent's Complete Address: Grissinger, Anna T. STREET ADDRESS Messiah Village 222 Messiah Circle, Rm 023 W _ CITY STATE ZIP Mechanicsburg ~ PA ~ 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 11,046.33 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 10,000.00_ C. Discount 526.32 Total Credits (A + B + C) (2) 10,526.32 3. Interest/Penalty if applicable _ p, Interest E. Penalty __ Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund _ 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5 2 0.01 A. Enter the interest on the tax due. (SA) g. Enter the total of Line 5 + SA. This is the BALANCE DUE. (56) rj 2 Q , Q Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IIN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :..................................................................................... b retain a rave stionary ineaest'oo shall use the property transferred or its income :....................................... ~~ d. receive the promise for life of either payments, benefits or care?.... ....... .......................................... ~ J ~, 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................................................... ~~ ~~ 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ............... ~~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _ contains a beneficiary designation? ........................................................................................................................ i-~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .. ... .......... ... .. ... ... ......... ...,....... ....... ...... ... ...;;::.;~...;.:o~o. for ~ he~use ~of the;;:::....................... "~.ed ~~n the ~net.value~.of ~transfe s t r t For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate impos o 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 they 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)J. 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. ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEM DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Grissinger, Anna T. FILE NUMBER 21 -07-01089 Include the proceeds of litigation and the date the pproceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. - - - - _ ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Brethren In Christ Foundation -TAP Account #2445A 495,582.12 (Includes accrued interest of $1,008.12) 2 ~ PNC Bank -Checking Account #50-0488-2701 ~ 6,497.93 3 f PNC Bank -Premium Money Market Account #50-0488-3544 I 10,454.04 4 ~ Alert Pharmacy -Refund f 11.51 5 ~ U.S. Treasury/IRS - 2007 Federal income Tax Refund I 2,000.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 514,545.60 '~~-' BICF Brethren iii Christ FOUNDATION POST OFFICE BOX 290 -131 GRANTHAM ROAD GRANTHAM. PA 17027 Ms. Wendy Crawford Brinser, Wagner & Zimmerman P.O. Box 323 Palmyra, PA 17078 RF..: An?na T. Grissinger Estate S.S. #186-30-6864 Dear Ms. Crawford: /~ni~u~c•ir~l.S~~i~virr~s.~~~i~ /~rii~lt~iilS'~~~i~~u•rLs December 4, 2007 At her date of death, November 17, 2007, Anna T. Grissinger had a Thrift Accumulation Plan (TAP) Account, Special TAP #2445A, with the Brethren in Christ Foundation. This account had neither a joint owner nor a beneEciary. The balance of Special TAP #2445A at the date of death was $494,574.00. The accrued interest was S 1,008.12, and the total date of death value was $495,582.12. If I can be of further assistance, please do not hesitate to contact me at 717-796-4788, Extension #420, or at klchmanr~ubictbui~dation.or~~~. Sincerely, r1 Kimberly J. Lehman Account Officer KJL/kj 1 ~-~ Phone: (717) 697-2634 Fax: (717) 697-7714 E-mail: info.~bicfoundation.org Total, Banking Statement For 24-hour information, sign on to PNC Bank Online Banking on pnc.com. Account number: 50d14HS-27111 -continued For the period 11/10/2007 to 12/11/2007 AN~IA T GRISSINGER Primary account number: 50-0488-2701 Page 2 of 3 Activity Detail Deposits and Other Additions Date Amount Description 1 `2/03 ~ 1,228.03 Direct Deposit - RR Ref US Treasury 303 ~V;Lrxsxe3721 I 12; 04 ~ 1,800.22 Direct Deposit - Autopaymnt Bicf Loan Fund .",3ti5 12; 11 1.54 Lrterest Payment Checks and Substitute Checks Check Date Reference Check number Amount paid number number 20(. a,92o.00 11/lt~ o8G38au59 207 " Gap in check sequence Online and Electronic Banking Deductions Date Amount Description 1 l; 13 7,35G.t;0 Direct Pavrnent -Statements Afessiah Flome 103011 1 1,' 14 2G6.00 Direct Pa}•ment - Bankdrafts Bankers Ficleliry `CX~X~X033~1 l?,,''03 1,223.93 Direct Pa}~ment -Reversal L.'S Tre:rsur}' 303 \1'aee,~ee.~t3721 1 There were 3 Deposits and Other Additions totaling $3,120.74. Date Reference Amount paid number 3.13.Iri II~'1~i Oitri2t?tlnl There were 2 checks listed totaling 57.263.1 S. ___ There were 3 Online or Electronic Banking Deductions totaling $8,851.58. Daily Balance Detail _-~_ Date Balance Date Balance Date Balance ~ Date Balance Il!10 21,33:j.ti3 Il!1~1 13,7(11.08 /lfi ti,497.93 ~~ 12/04 8,338.15 11;' l3 11,027.03 1 L/ i."~ 13,417.93 12 ~,~ 9 .~t3 C> 12/ 11 8,38n.ti9 lake }'our holiday shopping easy and m~t•anding this year when you use your PNC Bank ~'isa~ Check Card or I'NC Bank ~-isaa3) I'latintun Credit Cattii. Accepted at mom than 20 million locations ~rorldwide and online. Premium Money Market Account Summary Anna T Grissinger Account number: 50-0488-3544 Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance .~i ~i4.04 .00 10,4 ~i4.0~i .00 Average monthly Charges balance and fees s,11~7.21 .oo Interest Summary Annual Percentage Yield Earned (APYE) 0.00% Number of days Average collected in interest period balance Tor APYE 2."i 1()~~}~j~1.0~t Interest Paid this period .1)O Please see the Activity Detail section for additional information. As of 12/11, a total o` $209A3 in interest was paid this year. Activity Detail Other Deductions Date Amount l2i OS .00 l `2'05 10,=1_"14.0'1 Description Chrtstanding Item Close Debit btemo Reference No 027~i047fi=1 There were 2 Other Deductions totaling $10,454.04. ,~ SCHEDULE H FUNERAL DCPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN /~PIIIAINICT'{~ATI~/~ RESIDENT DECEDENT /'1L/~~~ hI ~ ~ ~~ ~ ~ ~I ~ ESTATE OF Grissinger, Anna T. Debts of decedent must be reported on Schedule I. T__ - ITEM NUMBER ;FUNERAL EXPENSES: DESCRIPTION A. 1 '~ Cocklin Funeral Home 2 Bullock Monument Company 3 ~ Funeral Luncheon B. ADMINISTRATIVE COSTS: 1. ~ Personal Representative's Commissions Gerald J. Brinser FILE NUMBER 21 - 07 - 01089 AMOUNT Social Security Number(s) / EIN Number of Personal Representative(s): 186-34--0218 Street Address 6 E. Main Street, P.O. Box 323 city Palmyra state PA Zip 17078 ' Year(s) Commission paid 2. Attorney's Fees Brinser, Wagner & Zimmerman 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 Register of Wills (Itrs. pd. $460.00 = $400,000 - $500,000) 5. Accountant's Fees 6. ~, Tax Return Preparer's Fees 7, Other Administrative Costs 1 (No Additional Cost of Letters Due) I j TOTAL (Also enter on line 9, Recapitulation) 114.79 130.00 42.00 15,000.00 7,500.00 515.00 0.00 23,551.60 C Schedt,ie H COMMONWEALTH OF PENNSYLVANIA Futlexal INHERITANCE TAX RETURN ~'~ VlJO1~7 L`pl'~~,~ RESIDENT DECEDENT ESTATE OF Grissinger, Anna T. 2 Cumberland County Law Journal -Legal Advertising 3 i The Sentinel -Legal Advertising 4 Postmaster - Book of Stamps 5 Bank Charge for Checks 6 I Register of Wills -Tax Return Filing Fee 7 ~ Register of Wills -Inventory Filing Fee FILE NUMBER 21 - 07 - 01089 75.00 158.62 8.20 7.99 15.00 15.00 Page 2 of Schedule H • j '4'x COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDEM SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF Grissinger, Anna T. Include unreimbursed medical expenses. ITEM NUMBER _.- -- 1 Messiah Village FILE NUMBER 21 - 07 - 01089 > DESCRIPTION AMOUNT 16.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 16.00 R,EV-1513 EX+ 19-00) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Grissinger, Anna T. SCHEDULE) BENEFICIARIES FILE NUMBER 21 -07-01089 I RELATIONSHIP TO i SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) ~ RECEIVING PROPERTY Do Not List Trustee(s) ~ I~ (',TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Arthur D. Grissinger '~ 422 Lynbrook Road Rustburg, VA 24588-3573 Under the terms of the Will Mr. Grissinger was to also receive some tangible personalty. However, the Decedent was a resident of a nursing home and had disposed of her ~ personalty of any value more than a year prior to death. Son 11/2 Residue 245,474.00 .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 !B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 I Brethren In Christ Board for World Missions P.O. Box 290, Grantham, PA 17027-0290 2 ~ Messiah Village 100 Mt. Allen Drive, Mechanicsburg, PA 17055 (2/3 of 1/2 Residue) (1/3 of 112 Residue) 163,649.33 81,824.67 I TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET', 245,474.00 ~~ ~ `J " WILL OF ANNA T. GRISSINGER I, ANNA T. GRISSINGER, currently of Upper Allen Township, Cumberland County, Pennsylvania, being of sound mired and disposing memory, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross, and rose again to justify me and'. give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and ~Co~dicils made by me. I. I direct that all my just debts and funeral expenses, including the cost of a headstone and the inscription thereon, be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate, inheritance and succe:>sion taxes that may be assessed in consequence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of i;he principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxablE~ estate whether or not passing under this Will shall be free and clear thereof. III. I bequeath unto my husband, Arthur L. Grissinger, all tangible personal property which I own at my death. IV. All the rest of my property, of whatsoever nature and wheresoever situate, including property over which I hold a power of appointment, I devise and bequeath unto my husband, Arthur L. Grissinger. V. If my husband, Arthur L. Grissinger, does not survive me, I devise and bequeath my entire estate that would have otherwise passed under Paragraphs III and IV above as follows: A. I bequeath unto my son, Arthur D. Grissinger, any items of tangible personal property, including motor vehicles, that he may desire and select. If he predeceases me this right shall pass unto his wife and if she predeceases me this right shall pass unto their ' ~ children. ~~ ~ ~/ ~"" ~_' f' Any items not so chosen shall pass as part of my residuary estate under Paragraph B below. B. The remainder of my estate shall then be divided into two (2) equal shares. I devise and bequeath one (1) share unto my son, Arthur D. Grissinger. If he predeceases me, this bequest shall pass unto his wife. If she predeceases me, this bequest shall pass unto their issue per stirpes. The other share shall be further divided with two thirds (2/3) passing to the Brethren In Christ Board for World Missions, Mount Joy, Pennsylvania 'and the remaining one third (1/3) unto Messiah Village, Mechanicsburg, Pennsylvania. These organizations shall use this share as they see best for charitable purposes. VI. I appoint my husband, Arthur L. Grissinger, E~;ecutor of this my Wi 11. In the event that he fails to qualify or ceases to act as Executor, I appoint the Administrator Of Messiah Village, Mechanicsburg, Pennsylvania, or his designee, Executor of this my Will. VII. I direct that no bond be required by my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, ANNA T. GRISSINGER herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper, including the attestation clause and signatures of witnesses, this s '" day of Q.,,.~~..~, r- 1985. ~- ~_ ~ ) ANNA T. GRISSINGER Signed by ANNA T. GRISSINGER, by her declared to be her Will in our presence, who have hereunto subscribed our names as -ritnesses in her presence and at her request, this ~ ~=` day of ~~---~ti-;~f 1985. ~~~'~~~_~ ~ ~ r; r~.~ 3~- residing at ~~~ ~.~ I, ~ry .' .~' , G! ~ residing at ~~,,~,,~Q~> ~/ a , -2- .-- COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND We, ANNA T. GRISSINGER,~-~~=~°~<~'~ `'~'~~~rL~ and ~~ ~ ra~ Zc.~•~"=, the testatrix and the witnesses, respectively, whose narnes are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influencE~. ANNA,T. GRIS,~ING~R~ I ( .+ WITNESS ~' WITNESS Subscribed, sworn or affirmed and acknowledged beforE~ me by ANNA T. GRISSINGER, the testatrix, and subscribed and sworn to before me by G~zA ~~ ~ ~1A~,•~~-~ and ;~, ~1. z~ ~~<<f_ witnesses, this day of ~~•~,~ , 1985. ~~ ;~~ (SEAL) NOTARY PUBLIC NO~tAt ~. -~~, ro~~~r Puauc u~P~k ALIEN ~wP., CtJYlifRUND COUNTY MY CCAtd15S14!1 EXPIRES JULY 7, 1987 Mamba, -~nnsyl~~n~~ Ilssoe~ation o1 Noterl~i -3- INVENTORY ~. ~ ~~ ~~~, REGISTER OF WILLS OF CUMBERLAN COUNTY, PENiV~(LVAIA -:,__ -~ - ,: rv _. ~ ~ ' . COMMONWEALTH OF PENNSYLVANIA . -, C COUNTY OF Cumberland } SS File Number 21 - 07 - 01089 ~~ ' ~ ' ;~._ --- -- -- ~ ---t--_-~ Gerald J. Brinser ,_; ~-~ Personal Representative(s) of the Estate of Grissinger, Anna T. o deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a me randum at the end of this invE~ntory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state- 1~ ~ ~-- - --- -- ments herein are made subject to the penalties of erald J. Brinser 18 Pa.C.S. § 4904 relating to unsworn falsification to } authorities. - - -- --- Attorney -- (Name) Keith D. Wagner (Firm) Brinser, Wagner & Zimmerman (Supreme Court LD. No.) 43891 6 E. Main Street (Address) p,0. Box 323 Palmyra, PA 17078 (Telephone) 717/838-6348 DATE OF DEATH LAST RESIDENCE Messiah Village DECEDENTS SOC. SEC. NO. 11/17/2007 Mechanicsburg, PA 17055 186-30-6864 FIGURES MUST BE TOTALED Personal Property Brethren In Christ Foundation -TAP Account #2445A 495,582.12 (Includes accrued interest of $1,008.12 PNC Bank -Checking Account #50-0488-2701 6,497.93 PNC Bank -Premium Money Market Account #50-0488-3544 10,454.04 Alert Pharmacy -Refund 11.51 U.S. Treasury/IRS - 2007 Federal Income Tax Refund 2,000.00 Total Personal Property $514,545.60 (Attach additional sheets if necessary) Total Personal Property and Real Estatle $514,545.60 LAw oFFlces BRINSER, WAGNER & ZIMMERMAN 6 EAST MAIN STREET -SECOND FLOOR (EAST MAIN & SOUTH RAILROAD STRF,ETS) P. O. BOX 323 PALMYRA, PA 17078 PHONE: (717) 838-6348 FAX: (717) 838-6912 GF,RALD J. BRINSER KEI"I'H D. WAGNER JOHN M.I_IMMERMAN KATHY G. WINGERT May 27, 2008 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 In Re: Anna T. Grissinger Estate Dear Register of Wills: MECHANICSBURG OFFICE MESSIAH VILLAGE 100 MT'. ALLEN DRIVE MF,CHANICSBURG, PA 17055 PHONE/FAX (717) 697-4666 ~~ ~~ __ c _, - ~ ~ -a -- -~ -.c -- - ~ __ ~ - - -- ...,, , _ ~ _> -- ~; " . _ =-~ , a Enclosed you will find two (2) copies of the PA Inheritance Tax Return for the above- captioned estate, along with two checks: one in the amount of $520.01 in payment of the balance of inheritance tax due, and one in the amount of $30.00 in payment of the filing fees for the Rev-1500 and the Inventory. If you. have any questions, please feel free to contact me. Thank you. Very truly yours, BRINSER, WAGNER & :~IMMERMAN ~~~~,( ~~°~~.~. Gerald J. 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