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Home My WebLink About09-26-08 (2)i • 15056D41125 REV-1500 EX 06 0 PA Department of Revenue ( - 5) OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 County Code Year File Numt~er INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 2 1 0 8 0 1 5 2 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 5 1 2 7 5 7 9 0 1 2 8 2 0 0 8 1 1 0 8 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI G r i g o n i s L e l a A (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 0 1. Original Return ~ 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) death after 12-12-82) ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received (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. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO Name : Daytime Telephone Number R M a r k T h o m a s E s q u i r e 7 1 7 7 9 6 '? 1 0 0 Firm Name (If Applicable) , ~ ~ ~REGISTE__. ILLSUS~LY First line of address i ';_~ f"! ~ ~ ~I 4' 1 0 1 S o u t h M a r k e t S t r e e t '' ~~ ~- / Second line of address - - i = .^~. _~. City or POSt Office _ti __j - State ZIP Code ~_="bATE FILED C~- M e c h a n i c s b u - r ~ g P A 1 7 0 5 5 Correspondent's a-mail address: rmtesg(a~delazzd.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ~P~RS,~IQy~E- S~gIgLE FOR FILING > DATE (s/ L/"' !~~ CU/pT1~~~I~ Yl ~ cotes, L A FCC / 7'-'-r~3~-=-i ~ ~/~ V~ 2 0 0 8 1636 Lo 1 Lane nn., !. ti, -, ...., _,~ - - -- 101 South Market Street Mechanicsburg PA 17 PLEASE USE ORIGINAL FORM ONLY 15056041125 15056041125 T i 15056042126 REV-1500 EX Decedent's Social Security Number ~ecedenYsName: Lela A. Grigonis 2 0 5 1 2 7 5 7 9 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 0 ~ 0 0 2. Stocks and Bonds (Schedule B) .. . . . . . . .. . ....... 2 1 2 8 6 7 7 , 6 8 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(Line8minusLinel1) ,,,,,,,,,, ,,,,,, 12 13. Charitable and Governmental Bequests/Sec 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 _ 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate x .045 2 9 3 3 5 3, 2 3 16 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042126 2 0 6 9 2 8.5 7 3 3 5 6 0 6, 2 5 3 5 7 1 2, 7 2 6 5 4 0, 3 0 4 2 2 5 3. 0 2 2 9 3 3 5 3. 2 3 2 9 3 3 5 3, 2 3 0, 0 0 1 3 2 0 0. 9 0 0. 0 0 0. 0 0 1 3 2 0 0. 9 0 15056042126 J REV-1500 EX Page 3 File Number Decedent's Complete Address: z1 os 0152 DECEDENT'S NAME Lela A. Griqonis __ STREET ADDRESS 1636 Lowell Lane CITY STATE New Cumberland PA Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 12 000.00 C. Discount 600 00 Total Credits (A + B + C ) 3. InteresUPenalty if applicable D. Interest E. Penalty ZIP 17070 (1) 13 200.90 (2) 12 600.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total InteresUPenalty (D + E) (3) 0 00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 600 90 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 600 90 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: a. retain the use or income of the property transferred : ...................................................................... Yes ^ No b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^ X c. retain a reversionary interest; or ..................................... . ......................................................... ^ X^ d. receive the promise for life of either payments, benefits or care? .................... ................................... ^ a 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? ......... X^ (] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets anti 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)j. Asibling 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-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lela A. Grigonis 21 OS 0152 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1• achovia Securities, LLC, Account No. 3881-4406 5,890.00 ommerce Plaza III, 5050 Tilghonan Street, 4th Floor, Allentown, PA 18014-9114 000 shares, CHC @ $5.89/share 2. achovia Securities, LLC, Account No. 3881-4406 22,071.75 ommerce Plaza III, 5050 Tilghonan Street, 4th Floor, Allentown, PA 18014-9114 ,204.970 shares, TAHYX @ $10.01/share 3. achovia Securities, LLC, Account No. 3881-4406 ommerce Plaza III, 5050 Tilghonan Street, 4th Floor, Allentown, PA 18014-9114 19,914.30 70 shares, AVK @ $22.89/share 4• achovia Securities, LLC, Account No. 3881-4406 ommerce Plaza III, 5050 Tilghonan Street, 4th Floor, Allentown, PA 18014-9114 33,495.48 ,124 shares, CHI @ $15.77lshare 5• achovia Securities, LLC, Account No. 3881-4406 ommerce Plaza III, 5050 Tilghonan Street, 4th Floor, Allentown, PA 18014-9114 6,413.15 35 shares, ERH @ $27.29/share 6• achovia Securities, LLC, Account No. 3881-4406 ommerce Plaza III, 5050 Tilghonan Street, 4th Floor, Allentown, PA 18014-9114 40,893.00 ,170 shares, NCV @$12.90/share TOTAL (Also enter on line 2, Recapitulation) I $ 128,677.68 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) ' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENTEDECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER Lela A. Grigonis 21 08 0152 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 • achovia Securities, LLC, Account No. 3881-4406 2,047.53 ommerce Plaza III, 5050 Tilghman Street, 4th Floor Ilentown, PA 18014-9114 2. achovia Bank, N. A., Checking Account No. XXXXXX7605 15,691.98 . O. Box 40028 oanoke, VA 24022-7313 3. achovia Bank, N. A., Savings Account No. 3083052204001 . O. Box 40028 116.16 oanoke, VA 24022-7313 4. achovia Bank, N. A., CD #247402043069214, POD/Antony M. Grigonis & Robyn J. Szoke 16,387.34 . O. Box 40028 oanoke, VA 24022-7313 5• achovia Bank, N. A., CD #247402303234930, POD/Antony M. Grigonis . O. Box 40028 80,647.78 oanoke, VA 24022-7313 6• achovia Bank, N. A., CD #247402303234934, POD/Robyn J. Szoke . O. Box 40028 80,647.78 oanoke, VA 24022-7313 7• ousehold Furnishings 2,000.00 8• lothing 400.00 9• 002 Volvo S60 8,935.00 10. 007 Pennsylvania Income Tax Refund 55.00 TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) ' ~ , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Lela A. Grigonis 21 08 0152 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Pearson Funeral Home, Bethlehem, Pennsylvania 9 852 72 2. Bethlehem Memorial Park (Mausoleum) 10,205.00 3. Funeral Luncheon 465.00 4. Pastor 200.00 5. Pastor's Assistant 100.00 6. Maintenance person for church 100.00 B. ADMINISTRATIVE COSTS: 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 R. Mark Thomas, Esquire 10,850.00 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation) 3,500.00 Claimant Robyn Szoke Street Address 6 Kitszell Drive City Carlisle State PA Zip 17013 Relationship of Claimant to Decedent 4• Probate Fees 440.00 5. I Accountants Fees 6. I Tax Return Preparers Fees 7 TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Lela A. Grigonis 21 08 0152 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. Penn National Car Insurance 2. ~inal car payment on 2002 Volvo S60 3. federal Income Tax for 2007 4. Milton S. Hershey Medical Center, Hershey, Pennsylvania 186.00 5, 988.77 305.00 60.53 TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lela A. Gri onis 21 08 0152 RELATIONSHIP TO DECEDENT AMOIJNT 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. Antony M. Grigonis SOLI 0.50 1636 Lowell Lane New Cumberland, PA 17070 2. Robyn J. Szoke 6 Kitszell Drive daughter 0.50 Carlisle, PA 17015 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) Wachovia Securities LLC Commerce Plaza II! 5050 Tilghman Street, 4th Floor Allentown. PA 18014-9114 Tel 610 398-5350 Fax 610 398-5389 800 345-0226 ~ACFi®FnE~ S.~CT~'~TEES Tony Grigonis 1636 Lowell Lane New Cumberland, PA 17070 04/17/2008 RE: Estate of Lela Grigonis Acct # 3881-4406 Date of Death 01/28/2008 To Whom It May Concern: As per your request the date of death on the above mentioned account is as follows: Quanity Symbol Price Value 1,000 CHC 5,.89 5 890 00 2,204.,970 TAHYX 10.01 , ,. 22 071.75 870 AVK 22..$9 , 19 914 30 2,124 CHI 15..77 , ,. 33 495 48 235 ERH 27,29 , ,. 6 49 3.,15 3,170 NCV 12.90 , 40,893,.00 Cash 2.047.53 Total Value 130,725,.21 If you should have any further goes#ions please feel to give me a call @ 610-398-5358„ Sincerely, ~ - Alexia Goodliff Senior Client Associate IdemCer M'SE/SIPC a Consolidated Statement 01 1000305837605 752 30 I 4~ACHOVIA 0 5 69,804 00019695 02 AT 0.459 02 3DG 61 ~ni~~~n~~~~~u~ni~~~nu~~~~u~~~n~~~~~~nn~~n~ ~n~~i~~~ '~~ LELA A GRIGONIS ~~ 1636 LOWELL LANE PB NEW CUMBERLAND PA 170702239 ~~ 1/11/2008 thru ~/ 812008 Summary of Accounts Checking & Savings ._ Account number Account Balance As of Interest Maturity rate date ~; 1.000305837605. CROWN. CLASSIC BKG 16,538.40 "2/08 '= ,3083052204001 UNI STMT SAV NONPKG 116.15 2/08 247402043069214 TIME DEPOSIT 7 MONTHS 1.:6,398.27 2/10 4 88 % 3103!2008 ~ 247402303234930 TIME DEPOSIT 24 MONTHS 80,564.34 _2/10 . 4.21 % 11!20-'2009 " 247402303234934 TLME DEPOSIT 24 MONTHS 80 564. 34 2/10 _ , . 4,21 °I° 1:1!20/2009 " ~ Total ., $1.94,181:50 x ... - . . _.. _ .. _. . N, .a o o' ~.. - m cc ~ o . . .... . ... . y O. o Cn. o '~ _o m N Z Z Z Z.. Z z Z ... Z Z-. .. Z O o o 0... WACNOVIA BANK, N.A. , SAUCON VALLEY p<~ge 1 of 5 Consolidated Statement ,02 1000305837605 752 - 30 WACHOVIA 0 5 69,805 1 /11 /2008 th ru 2/ 8/2008 Crown. Classic :Banking Account number: 1000305837605 Account owner(s): LELA A GRIGONIS Account Summary Opening balance i/L1_ , _, $i 7;880.03 ......Deposits and other credits 1;101.17 interest paid :0.65 + ':Checks. 1',887,00 - :Other withdrawals and service fees 556:45 .- :Closing=balance 2%08 _ $16,538.40 Deposits and Qther Credits .Date Amount Description 2/01 224.87 .,AUTOMATED CREDIT BETHLEHEM STEEL PN PMTS/BG CO. ID. 1046748526 080201 PPD 2/01 876.30 AUTOMATED CREDIT US TREASURY 303 SOC SEC CO. 1D'3031036030 080201 PPD 2/08 0.65 INTEREST FROM 01/11/2008 THROUGH 02/08/2008 Tote 1; 401.82 .Interest Number of days this statement period 29 Annual,percentage yield earned 0.05% -lnterestearnedthis statement period- $0.65 fnterest paid this.. statement period $0:65 Interest paid this year $1.36 .....Checks Number Amount Date Number Amount Date Number Amount Date 5471 50.00 1/29 5478 1,067:00. 1/11 Total 1,887:00. 5476* 100.00 2/01 5479 - 185:00 1/22 5477 105.00 2/01 5480 380.00 1/22 '~ Indicates a break in check number sequence WACHOVIA BANK, N.A. , SAUCpN VALLEY page 2 of 5 ~~ Consolidated .Statement ~~® •03 1000305837605 752' 30 0 5 69,806 WACHOVIA 1./11/2008 thru 2/ 8/2008... Crown Classic Banking Ofller Withdrawals and Service Fees .:pate Amount :Description 1/22 556.45 -AUTOMATED DEBIT ..VOLVO CAR FIN NA US VOLVO CO.'JD. 9696219020 080122 PPD ; '~ ......Total 556.45 ~. .~ Unistatement Savings .. Account number: 3083052204001 - _° Account'owner(s): LELA A GRIGONIS Account Summary Opening":balance 1111 $11'6 14 lrterest paid .0.01 + C')osing}~alance 2/08 $11.6.15 _z _ ` , : n c Deposits a><ld Other Credits Date Amount Description o 2/08 0.01 INTEREST FROM 01/t1/2008 THROUGH 02/08/2008 . otal 0.01 N Interest 2 _2 Z Number of days this statement period 29 Z Z Annual percentage yield earned 0,11'/, z Interest earned this statement period $0.:01 - Z -Interest paid this statement period $0.01 - z lriterest paid this year $0.02 z o 0 0 _o Important Message About Your Tax Return Information: a ~~ If you received a 2007.Form 1.099 statement from VUachovia, and have questions about the -form, please call us any time at S00-VVACHOVIA {800-922-4684) or visf your locale financial center. WACHOVIA BANK, N.A. , SAUCON VALLEY page 3 of 5 ~ GVACHOVIA Consolidated Statement 04 1000305837605 752 30 0 5 69,807 1 /11 /2008 th rta 2/ 8/2008 Got debt' - or want to do home improvements? VVe can provide smart choices to help you make your biggest asset work for you! Call Wachovia Mortgage today at 866-416-6076 to earn more about our products -and how to make-your mortgage work for you. Loans originated by Vachovia Mortgage Corporation or Vachovia Mortgage, fS8 are subject to credit approval, verification and collateral evaluation. Certain restrictions apply. .'Financing other debt with your home`s equity may increase the total amount you are required to repay. Ask for details. Equal Housing lender: Introducing Wachovia Blueprint(SM). Our Financial Specialists will create a customized report that will show you how you could simplify and maybe even reduce your monthly payments by consolidating your debt with a home loan. They'll even help you set some money aside for savings. Call f300-WACHOVIA for yourcustomized plan. Refinancing pre-existing - =- debtmay increase the total number ofmonfhly debt payments and the total amount-paid by a borrower over the term of the /oanAine, Equal Housing Lender. WACHOVIA BANK, N.A. , SAUCON VALLEY page 4 of 5 1 -~~ Consolidated.State ment ~~ 05 1000305837605 752 30 0 5 69,808 WACHOYIA _ 1/11/2008 thru 2/ 8/2008 - Customer Ser~~ice Information Phone number Address Checking & Savings Accounts, Check Card & ATM Card 800-WACHOVIA WACNOVIA BANK, NATIONAL ASSOCIATION , ... ...800-922-4684 NC8502_ TDp (For the Hearing Impaired) 800-835-7721 "P O"BOX 563466' - -° En espai7ol Para cuentas Corrientes y de ahorros -800-326-8977 CHARLOTTE NG28256-3966 Bank By Mail (Deposits Only) WACHOVIA BANK, NATIONAL ASSOCIATION ~- „ VA3289 P O-BOX 26090 ~~ RICHMOND VA-23260-6090 Consumer Loan Accounts 800-347-.1131 WACHOVIA BANK, NATIONAL ASSOCIATION VA0343 P O t30X 13327 ROANOKE VA 24040-0343 To `Balance Your Accou><it 1. Compare your account re ister to your account statement for Lis t Outstanding C hecks and Wit hdrawals unrecorded transactions such as ATM, Check Card, Interest earned, .....fees, etc) Your new account register totalshould match fhe `Ck. No. Amount Ck. No. Amount .adjusted balance in line 6 below. 2 . Write in the closing balance shown on the-front of account statement.. , 3. Write in any deposits you have made since' he date of this statement. 4. Add together amounts listed above in steps 2 and 3. I h o 5. n t e secti n to the right, fist and total altchecks and withdrawalsthat you have made that are not reported on your account statement. Write-in°the total-here: 6 S b h . u tract t e amount in line 5 from the amount in line 4. This is your,adjusted balance and should match the balance in Step 1 above: Tota( N 0 0 "o 0 _o ~~ W z z z Z z Z Z Z Z z _z Z z Z 0 0 W In Case of Errors or Questions AboutYour-Electronic Transfers; Telephone us at 800-WACHOVfA, 800-922-4684, or uvrite to us at WACHOVIA BANK, NATIONAL ASSOCIATION, NC8502, P O BOX 563966,,CHARLOTTE NC 28256-3966, as soon as you can, ;if you '' think your statement or receipt is wrong or if you need-more-information about a transfer on the statement or receipt. We must-hear from you no later than. 60 days after we sent you the FIRST statement on which the error or problem appeared. 1. Tell us your name and account number (if any). 2. Describe the error or the transfer you: are unsure about, and explain a5 clearly as you can why you believe there is an error or why you. -need more information. 3. Tell us the dollar amount of the suspected error. We will investigate your complaint and will correct any error promptly. If we take more than 10 business days to do this, we vvill credit your account for the amount you think is in error. You will have use of the money during the time it takes us to compete our irnrestigation. WACHOVIA BANK, N.A. AND WACHOVIA BANK OF DELAWARE, N.A. ARE MEMBERS FDIC WACHOVIA BANK, N.A. , SAUCON VALLEY page 5 of 5 ~~ Business Checkin g _ ~ 01 2000030116577 752 130 0 138 79,440 WACHOV7A_ 00027220 Ol AT _0.334 01 3DG 90 I~~~IIL~~IIL~~L~~III...,~I~LJ~L~II~LI~~~~II~~II~~Ii~„I - .ESTATE LELA A GRIGONIS ~_ 1636 1't)WELLIN CB - NEW CUMBERLAND PA 17070 ~~ BUS1neSS C~leCkln~ - 3/01/2008 thru 3/31/2008 .Account number. ~ 20000301:15577 ° ~ ." ` :Account ownerjs): ESTATE LEL.~~ 6~'~RIGONIS." Account Summar -Opening balance 3/01 , $1 i 694.15 - Deposits and other credits ~ ~ ~ 16 464.45 + Checks 21,167.49 - - ~Iosing~balancQ 3131 " ~ ~ $6,9,91.11 Deposits "and Other Credits Date " Amount Desgripton__ 3105 16,464.45 TRANSFER FROM 247402043069214 Total $16,464.45 . Checks" Date Date Number :Amount posted Number Amount posted Number Date Amount posted 0993 9,852.72'.. 3/10 0995 ....5,988.77 3/13 Total _ 21,167 49: f 0994 156,00 3/10 0996 5,].40.00: 3/07 `^_ a Daily Balanee Summary: Dates °. "°Amount Dares ~ Amount Date's Amount 3/05 28;158.60 3/1fl ~ ~.. ... 12,979.88 ~ ~ _ "3/07 ~ ~ ~ ~ 23,018.60 ; 3/13 ° 6,991.11 DEPOSIT CHECKS WHENEVER YOU WANT -FROM YOUR OFFICE. WACHOVIA ONLINE DEPOSITS ALLOWS WACHOVIA BUSINESS ONLINE CUSTOMERS TO ELECTRON/CALCY SCAN AND SECURELY DEPOSIT CHECKS RIGHT FROM THEIR BY CALLING 800-566-3862 MONDAY-FRIDAYB AMA s ~ ~© 9 PM ET ORV1S WACHO - IA.GOM/ONLINEDEPOSITS FOR MORE DETAILS. - WACHOVIA BANK, N.A. , CARLISLE page 1 of 2 Fax Transmittal 4/17/2008 12:38 PM PAGE 1/002 Fax Server ~'H Reference ID: 2418325 Wachovia Bank N,A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 April 17, 2008 R MARK THOMAS ATTORNEY AT LAW 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055-3851 SUBJECT: Verification /Confirmation of Account and Balance Informafion provided for: Customer: LELA A GItiGONIS (SSN# XXX-XX-7579) Date of Death: January 28, 2008 Deuosit Account Information Account Account Date ofDea[h Average Date Maturity Interest Accrued YTD Date Type Number Balance Balance* Opened Date Rate Interest Interest Paid Closed CERTIFICATE OF XXXXXXXXXXX4930 $80,564.34 11/20/2007 11/20/2009 $83.44 $287.05 DEPOSIT LEGAL TITLE: LELA A GRIGONIS POD ANTHONYM GRIGONIS CERTIFICATE OF XXXXXXXXXXX4934 $80,564.34 11/20/2007 11/20/2009 $83.44 $287 05 DEPOSIT . LEGAL TITLE: LELA A GRIGONIS POD ROBYN J SZOKE CERTIFICATE OF XXXXXXXXXXX9214 $16,330.63 8/3/2007 $56.71 $67 53 3/5/2008 DEPOSIT . LEGAL TITLE: LELA A GRIGONIS POD ANTHONY M GRIGONIS & ROBYN J SZOKE CHECKING XXXXXXXXX7605 $15,691.58 12/12/1975 $0.40 $0.71 LEGAL TITLE: LELA A GRIGONIS Fax Transmittal 4/17/2008 12:38 PM PAGE 2/002 Fax Server ~~ Reference ID: 2418325 SAVINGS XXXXXXXXX4001 $116.14 12/1/1975 $0.01 $0.01 2/14/2008 LEGAL TITLE: LELA A GRIGONIS CLOSING BALANCE: $116.15 Other Account Information Account Account Date of Balance Date Date Ledger Collected Type Number Opened Closed BROKERAGE XXXX4406 BRK -Your request has been forwarded to the broker fisted below and will follow sepazately. GARY MORGAN @ 800-345-0226 * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. ~~ J S7 Kim/ Jennifer Straub Servicenter Associate Phone: (540)563-7323 Js; Js r WACHOVIA TIME DEPOSIT Opening Date AUGUST 03, 2007 AUTOMATICALLY RENEWABLE PERSONAL CD 6 UP TO 9 MONTH Account Number Taxpayer ID Number 247402043069214 205127579 This Receipt Acknowledges That The Depositor Named Below Has Deposited With This Bank The Sum Of ~ *********16,000.00***** Depositor Name And LELA A GRIGONIS Address POD/ANTONY M GRIGONIS & ROBYN J SZOKE 1636 LOWELL LANE NEW CUMBERLAND PA 170702239 Term Maturity Date Interest Rate Per Annum Annual Percentage Yield Interest Payment Frequency/Period 07 MONTHS MARCH 03, 2008 04.88% 05.00% 1 MONTH[S] Interest Payment Disposition Account to Credit CAPITALIZE PROD-TYPE: 204 PROMO CD: CP00138 Issued by WACHOVIA BANK, N.A. NE CNTRL PA /CARLISLE PA X ` Q..- X ~ - 3 -~ -~ Authorized Si a ure Date Member FDIC NOT TRANSFERABLE 566591 (Rev 04 Page 1 of 3) CUSTOMER RECEIPT WACHOVIA Deposit Account Close Confirmation (Debit) WACHOVIA BANK, N.A. Date 02/14/2008 Customer Name(s) and Address LELA A GRIGONIS Taxpayer ID Number S205127579 1636 LOWELL LANE NEW CUMBERLAND PA 170702239 ACCOUNT NUMBER: 3083052204001 Available Balance $116.15 + Accrued Int : $0.00 -Fed W/Hd Due : $0.00 - Admin Fee : $0.00 -Outstanding Db : $0.00 -Closing Fee : $0.00 Paid To Customer : $116.15 CUSTOMER COPY i WACHOVIA TIME DEPOSIT Opening Date NOVEMBER 20, 2007 AUTOMATICALLY RENEWABLE PERSONAL CD 24 MONTH STEP RATE Account Number Taxpayer ID Number 247402303234930 205127579 This Receipt Acknowledges That The Depositor Named Below Has Deposited With This Bank The Sum Of $ *********g0,000.00***** Depositor Name And LELA A GRIGONIS Address POD }g~,cW-r-c, N Y dVrl , C,.,Q. i ~, o ~-, fS 1636 LOWELL LANE NEW CUMBERLAND PA 170702239 Term Maturity Date Interest Rate Per Annum Annual Percentage Yield Interest Payment FrequencylPeriod 24 MONTHS NOVEMBER 20, 2009 04.21 % 04.30% 1 MONTH[S] Interest Payment Disposition Account to Credit CAPITALIZE PROD-TYPE: 230 PROMO CD: Issued by WACHOVIA BANK, N.A. NE CNTRL PA /CARLISLE PA X ___ X 1 ~- ~ -U ~ Authorized ig ature Date Member FDIC NOT TRANSFERABLE 566591 (Rev 04 Page 1 of 3) CUSTOMER RECEIPT WACHOVIA TIME DEPOSIT Opening Date NOVEMBER 20, 2007 AUTOMATICALLY RENEWABLE PERSONAL CD 24 MONTH STEP RATE Account Number Taxpayer ID Number 247402303234934 205127579 ' This Receipt Acknowledges That The Depositor Named Below Has Deposited With This Bank The Sum Of $ *********$0,000.00***** Depositor Name And LELA A GRIGONIS Address POD ROBYN J SZOKE 1636 LOWELL LANE NEW CUMBERLAND PA 170702239 Term Maturity Date Interest Rate Per Annum Annual Percentage Yield Interest Payment Frequency/Period 24 MONTHS NOVEMBER 20, 2009 04.21 % 04.30% 1 MONTH[S] Interest Payment Disposition Account to Credit CAPITALIZE PROD-TYPE: 230 PROMO CD: Issued by WACHOVIA BANK, N.A. NE CNTRL PA /CARLISLE PA X ~~ X ~ t - -u _ U"? Authorized lure Date l Member FDIC NOT TRANSFERABLE J 566591 (Rev 04 Page 1 of 3) CUSTOMER RECEIPT PLEASE SEE IMPORTANT PRIVACY INFORMATION ON THE BACK OF THIS INVOICE WE APPRECIATE YOUR BUSINESS Account Number Vehicle Description VIN Statement Date Payoff Gaod Through 40000040114439 2002 VOLVO SSO YV1 RS61 R7221S9399 01!3012006 02/19/2006$18,8(18.,93 ~~LV~ For address changes or other communication, fee! free to contact us. Yoiro Car Fiaanu North America $~ Customer Service Center 1-800-770-8234 Mon-Thu team - 7pm CST Fri Sam - fipm CST Q Website Address ttitwww„volvocartinance..corn TRANSACTIONS SINCE LAST STATEMENT Date Description Amount Payments received after statement date are not reflected. AMOUNT(S) DUE Date Description Amount 02/19/2006 Payment Due $556 45 Payments received on weekends a holidays will be credited to your account on the next business day Payments received at a bcation other titan the remittance address shown below may delay crediting If you dispute information we report to a credit bureau or the amount needed to payoff your account, send all documents and disputed payoffs to: Vdvo Car Finance North America CIO Correspondence PO Box ssta77 Richardson, TX 75085-1077 Air other payments should be mailed to: your account unless otherwise provided by state law VWvo CaF Fii iEaiiCe N:>r th America PO Box 371395 Pittsburgh, PA 15256-7395 Looking for a convenient payment alternative? Arcange for your payments to be automatically transferred from your checking account Call ourtoll-free Customer Service Center number listed above to enroll in AUTO DEBIT today 1 Your Financial Services Partner Now and in the Future S ~8~ ~~ !vd~~a ~ ~ li~ /T,~c ~v~ ~7Po29~ l /~a,S~ ~'e~wr•~ewf~ ~~~ja.. WE MAY REPORT INFORMATION ABOUT YOUR ACCOUNT TO CREDIT BUREAUS LATE PAYMENTS MISSED PAYMENTS OR OTHER DEFAULTS ON YOUR ACCOUNT MAY BE REFLECTED IN YOUR CREDIT REPORT vozvo P O Box 680020 Volvo Car Fnancc North Amarlca Franklin, TN 37068-0020 1-800-770-8234 Account Number: 00000040114439 Vehicle: 2002 VOLVO S60 YViRS61R7221fi9399 Originating Dealer: BROWN-DAUB VOLVO PO BOX 265 NAZARETH, PA 18064 03/12/2008 043-S001 POGZZHOOA00013 ESTATE OE LELA A GRIGONlS 1636 LOWELL LN NEW CUMBERLAND PA 17070 Dear ESTATE OF LELA A GRIGONIS: Congratulations! Your account has been paid-in-full. Please note the following in reference to your contract and title: Contract Handling • if a copy of your contract is enclosed, please accept this letter as authentication that the copy is an unaltered optically imaged reproduction of the contract and security agreement. • If your original contract is not enclosed, please accept this letter as notice the contract is paid Credit Life and/or Disability Insurance and/or GAP Coverage • If you purchased credit life and/or disability insurance and/or GAP Coverage, you may be entitled to a refund of the unused Credit Life and/or Disability insurance and/or GAP Coverage premiums if your contract was paid-in-ful! prior to its original maturity date.. If a refund is due, your dealer will apply for the refund at your request. You may also contact the insurance company directly to apply for your refund. • State specific disclosures for AL, CO, IA, IN, KS, MA, MD, NH, NY, OK, UT, VT, WI and WY are providt;d on the back of this document. Title/t_ien Handling While processing the payoff on your account, we have also taken steps to release our lien and forward your title or lien statement to either you or the party who paid off the vehicle or to an alternate lien holder as you have directed. This process varies based on state specific regulations as follows: • If your state issues a physical or "paper" title and permits us to send the title directly to you, we have released our lien and have included your title or lien statement with this letter. If you .have received a paper title with our lien released upon it, you must submit the title to the state for them #o release our lien in their records. • If your title is not enclosed, it is due to one of the following: - Your state may require we forward the physical or "paper" title or lien statement to them in order to have our lien released. - Several states use an electronic titling system in which a physical or "paper" title is not issued. If your state uses an electronic titling system, we have released our lien electronically and requested }your title be forwarded to you, however, it is up to the state whether they issue a "paper" title or not. Please be aware the average time to receive your title is between three to six weeks (if applicable}. - You have transferred ownership to another party. ~ State specific disclosures for AZ, CA, FL, IA, ID, MA, MT, NE, NY, OH, PA, SD, VA, and WA are providE;d on the back of this document. Questions Please retain this information for your records If you have any questions regarding your account, please contact us at the number listed above.. We appreciate your business Thank you for allowing us to service your account! Sincerely, Volvo Car Finance North America YV 1 RS61 8722169399 P51 2 20080311 01 ~c~R~ a_~ F_n~ nnr ~~n _ i 74tB5CRR~ED nND SwoRN _ ~ ~ ~ If a-co-purchaser other than your spouse is:SS3ed ahd:you wan[ the tills to ~ ~~ • .,,,~_, - < ogr '~ ~ be 11,ted ;as toint,Teneh[s With. glrght of~.S.u rsh`Ip'. (fin deairtof p~Q "^"+-~ _ . ~ , '-~-._~1 ~W ~Elt~6/~JLS t:vS'UNIVtII~'DWr18,~'f'~iH~~.~~+„~.;,Qjf18RY198 '.;~I}8 titl~..•. -f ..T _ _ . i ~',~ KII {~~. !'6UB~ a5 ~Cf18r1t5 77 GAmR1D~ SQn;dggt}1~OI1B OWf18f, tl116faSI Ot ~ sar~nruaEOF e` ~ "; ~sa+~owlrosreR++co~«.~ .. , ou P~Sdatt+o rgoes to h15Jh e;S heas Prbet~t9) =' --,..-rte. - ..~. I -. ~ . , , , r -} STREET__-.r--~~,.r~ ~ ---a-~---~- ~ ~ ~ I ^r' i ~,.. CITY ti, t" ; ig7E ~ ~~. ~ ~ ~ : ' ~.-~ ;JF iH1S IS AN ELT, EHE~K .~ FWAI~s{~ ati ~ $ 2 ~. ~ ~ I NOTE: FW REQ. AED~ .. ~ INS717l~Tj~' N~ p Y. I ~ ~~ s~~ 2ND LIEN DATE --~ IF NO UEN HECK ~ ~~• s :-« d rac ro .ins .x.c. a,,vs,~y' - • J / _ .~ Wea - `.~. J.+..:. ri ia~h hem _ _ ` '`2ND i,IENHQEpEA "~ ~ •~ .'j :STREET - _. `sJ: ala~"`.~~r~ ~. r,~,n fzED &6NEii ~' -. ~ ~ ~.. SfA7E ZAP ', ~~ SIONA7UpE OF CO. .. ~ ~,; .. •_ . ,,, ArRInE aF,Al17{{pPoZFO &ONER ~ IF THIS kS AN ELT. CHECK HERE ^ FINANCIAL ~ ~ NOTE FIN REWI . , . . . RED ~ IM$TRUT10N N0 1 label (See instructions ) DECEASED Lela A Gsigonis 01/28/2008 Department of the Treasury - Internal Revenue Service U.S. Individual Income Tax Return ZQQ~ For the year tan 1 -Dec 31 2007 or other tax year beginnin ,2007, endir Your fast rmme MI Last Warne ~~ the H a joint return. spouse's first name IRS label. 0th A Grigc MI Last name Use Only - Do not wnZe or staple in this space. 20 oMa No. 1545-cola. Your social security number 205-12-7579 Spouse's soctaf security number p erwp e, lease rint or type.. Fbme address (number and streep . If you have a P..O. box, see instructions. 3.636 Lowell Lane partrnent no. - A You must enter your sticiai security city, tovm or post office. If you have a foreign address; see irrstructiorrs, ~ State zIP coos number(s) above. Presidential Election New Cumberland Checking a box below wilt not PA 17 0 7 O Compaign change your tiix or refund. , Check here if you, or your spouserf filing jointly, want $3 to go to this fundl(see instructions) ....... ... , ... - ~ You ~ Spouse Filmy $tatUS 1 Single 4 Head of household (with qualifying person). (See 2 Married filing jointly (even if only one had income) instructions.) If the qualifying person !s a child Check only 3 Married filing separately Enter spouse's SSN above & full but not your iependerrt, enter this child's name here one box. name here .. - ~~ 5 (~ . Ciualifying widow(er) with dependent child (see instructions) Exemptions fia Yourself. !f someone can claim you as a dependent, do n ~~ chedred ot cheek box lia b S use ~ ~ ~ an sa and 66 . ]„ No f l 7d . - ~ . • c Dependents: (~ Dependent's social recur' . o c u ren (3) Dependent's (4) _ rf °" ~ ~~ • numb rived r tatioraship qualfiyrinQ i er First name Last name lh you . to y0U mild for dull w tax credit • didnot (see instrs) rive with you due to divoru If more than - -- or ~sporation (soo rostra) . .-~" four dependents, - - t)epenaerds ~ an sc not see instructions. _ _ .nter.da~av. . - •~-- d Tofat number of exemptions claimed '- - Add numbers on tines .................... ........ above..... - ] Income ages, salaries, tips, etc,. Attach Form{s) W-2 7 8a Taxable interest.. Attach Schedule B if required . ..... ... ., bTax-exempt interest, iDo not include on line 8a ~ ~ • 8b 2 8a 8,576. - -- Attach Form(s) .. 1 59. 9a Ordinary dividends.. Attach Schedule 8 if required w-2 here. AISO attach Fomts ~ - b Qualified dividends (see instrs) ....... ~ 9 b 071 1 9a _ 10, 935 . W-ZG and ]099• R . _ 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) If tax was withheld. 71 Alimony received ' ' 10 _____ If you dkd not ,.. .., 12 Business income or ors ,Attach Sehoduie C or. C-Q ~ ) get a W-2, ... . . ~ .. . ...... .... 13 Capital gain or (toss). Alt Sch D if regd. If not read, dt here ... ... .... - ~ 12 ~-- see Instructions, .. 14 Other gains or (losses) Attach Form 4797 13 2 5 2 5 , . ... ,. 15a !RA distributions .. t5a bTaxable amount (see instrs) 16a Pensions and annuities 16a ~ 14 i5b ~ ' ~ .. .. :. bTaxable amount (see instrs) . 17 Rental real estate, royalties, partnerships, S corporations, trusts etc Attach Sched l E 166 2 902 , i ~ ~~~ Enclose but do , , u e .. i8 Farm income or (loss).. Attach Schedule F 7 ~ 5 - not attach, any p~r~ ~~ ..... nemployment compensation ......... , 18 -- . ~ please use Form 1440-Y., 0 a Social security benefits ............ ~ 20a ~ 11, 9 91 ~ b Taxable amount (see instrs) .. 2~ Other income O TH ER IN C O ME F i9 20 b ~ 3 , 613 . _ _ _ _ _ _ _ _ _RO_M_ _SCH_E_D_ULE_ _K-_1_ _ _ _ _ _ _ 22 Add tfle amounts in the far ri ht column for lines 7 thro h 2i '- - I8 .' Adjusted . This is our total income . - 23 Educator expenses (see instructions) . .. ~ 22 2 8 , 5 8 4 . .~ Gross 24 Corbin business -- g a~~' and fee-basis Pls r ~ Zfs 6 re2 o ~ Income govemmerit offrcia A ch Fon it t) o 1E 16 -EZ , .... ~ 25 Health savings account deduction.. Attach Form 8889 26 Moving expenses.. Attach Form 3903 ....... 26 - 27 One-half of self-employment tax. Attach Schedule SE ... 27 28 Self-employed SEP, SIMPLE, and qualified plans ............. 2g 29 Self-employed health insurance deduction (see instructions) 29 30 Penally on early withdrawal of savings 30 ...., 31 a Alimony paid b Recipient's SSN .... - 31 a 32 IRA deduction (see instructions) ..... , ~ 33 Student loan interest deduction (see instructions) . .... . 33 34 Tuition and fees deduction., Attach Form 8917........ . , 34 35 Domestic production activities deduction. Attach Form 8903 .. , . , .. ,. 35 36 Add fines 23 - 31a and 32 - 35 BAA For Disclosur ~ 37 Subtract tine 36 from Eine 22. This is your adJusted gross Income - 37 28 584 . e, Privacy Act and Paperwork R d t , e uc ion Act Notice, see Instructions. FD1A0172 ~2/06~0~ 7 W Form 1040 (2007) 7 Form 1040 Tax and Credits Standard Deduction for - •People who checked any box on tine 39a or 39b or who can be claimed as a Lela A Griaonis 205-I2-7579 38 Amount from line 37 (adjusted gross income) .... 39a Check ~ X^ You were born before January 2, 1943, ^ Blind.. Total boxes If' Spouse was born before January 2, 1943, Blind. checked > 39a 1 b Ef your spouse itemizes on a separate return, aryouwere adual-status alien, see irlstrs and ck here ~ 39b 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . ....... ..... 41 Subtract line 40 from line 38 42 If tine 38 is $117,300 or less, multiply $3,400 by the total number of exemptions claimed on Line 6d. If sine 38 is over $117,300, see the instructions ....:.. .... ..... Taxable Income. Subtract line 42 from line 4L if line 42 is mo than f 41 38 28, 584. 40 6, 650. 41 21, 934 42 _3,400. 1$,534. re the ,enter -4 .. ... ....... 43 dependent, see 44 Tax (see insfrs) Check if any tax is from: a ^ Form s 8814 b ^ Form 4972 instructions.. ( ) c Farm(s) 8889 , ....:.. 44 • All others: 45 Alternative minimum tax (see instructions).. Attach Form 6251 ........ 45 _ ...: Single or Married ~ Add Lines 44 and 45 :. :..... .. .... .. > 46 :.. _ .. _ f$t15in~s0eparately, 47 Credit far child and dependent care expenses. Attach Farm 244] . , , 47 ' 48 Credit for the elderly or the disabled Attach Schedule R 48 Married filing 49 Education credits:. Attach Form S$63 , . , , 49 jointl)r or 50 Residential energy credits Attach Form 5695 .. Quaitfytng 50 widower}, 57 Foreign tax credi#:. Attach Form 1116 if required ... 51 _ $10,700 52 Child tax credit (sae instructioru). Attach Farm 8901 if required .: ....... 52 Head of 53 Retirement savings contributions credit. Attach Form 8880 53 household, 54 Credits from: a ~ Form 8398 b ^ Form 8859 e ^ Form 8838 54 $7,851} 55 Other creditx a ^ ggoa b ^ 88ot c ~ Form _ ~ 5ti Add lines 47 through 55. These are your #otal credits ......... ... ~ :... > 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- ............ 57 ~~... Self-employment tax. Attach Schedule SE ... 58 :. .. Other 59 Unreported social security and Medicare tax from: a ~ Form 4137 b ^ Form 8919 S9 .... ............... . aX@S 80 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . 60 67 Advance earned income credit payments from Form(s) W-2, box 9 ... , . 61 Household employment taxes: Attach Schedule N ~ 63 Add lines 57-62 This is your tofal tax ~ Payments ~ Federal income tax withheld from Forms W-2 and 1099 ... .. 64 203 _ ,` If you have a ~ 2007 ~"~~ ~ Payments and amount applied from 2006 return .... ..... 65 1 520. -~ r gt~lifying - 66a Earned income credit (FJ~ ...................... ... 66a chrtd, attach ~ b Nontaxable combat pay election . - 66 b~ ~ - Schedute EIC. 67 Excess social security and tier 1 RRTA tax withheld (see instructions) . fi7 68 Additional child tax credit Attach Form 8812.. 68 69 Amount paid with request for oxter>,cion to file (see instructions gg 70 Payments from: a ~ Form 2439 b ^ Form 4136 c ~ Form 8885 70 _~__ 71 Refundable credit far prior year minimum tax from Form 8801, line 27 77 72 Add ~~ ~. ~, 66a, and 67 through 77 . These are your tohl paymerrts . ............................... y feat ~ 72 Refund 73 If line 72 is more than line 63, subtract Line 63 from line 72, This is the amount ou ove d ......... ..: 73 Direct deposit? 74a Amount of line 73 you want refunded to ou. If Form 8888 is attached, check here .. - ^ 74a See instructions - b Routing number XXXXXXXXX - c T e: Checking ^ Savings and fi!t in 74b, - d Account number XXXXXXXXXXXXXXXXX 74c, and 74d or Form 8888. 75 Amount of line 73 you want applied to your 2008 estimated tax ...... - 75 Amount 76 Amount you owe.. Subtract line 72 from line 63. For details on how to pay, see instructions :.... .. .. - 76 305 . You Owe 77 Estimated fax enal see irtsfructions ....................~ n ) -. '(~i~ pat.ty Do you want to allow another person to discuss this return with the IRS (see instructionsj? Yes. Complete the following . X No Designee name - Designee's Phone Personal identification no. number n'!M - Sigt1 ~ ~na~ t~Perlury, t declare that f have examined this return and accomparryirgt schedules and statements, arrd to the best of knowled a and Flere er _P1ete. Dectaratiorr of preps (other than taxpayer) is based on all information of which preparer~has ary knowledge. Joint return? Your signature ~ Date Your occu anon N ~t ~ ~ P Daytime phone number See instructions.. / ~ ~ ! 01 tioznemaker Keep a copy ~ Spouse's signature: If a ioint return, both must sign. Date Spouse's oaupation for your records. Paid rreparers ' ~~ Preparers Fam'sname $elf- Use Ont ~/ (°rynu'~'~ setfem to d ~ p ye ) address, and _ LP code Date Check if self-em t°yed d EIN --- Phorre no. FDwo~ t z t vo6rm Preparer's SSN or PT1N _ 2r 028. 0. 2,028. ._ 2,028. X123. Form 1040 (2007} Schedule'B (Form 1040) 2007_ oiua No. 7545-0074 Pa e 2 Name(s) shown on Form 1040. ~ -- ~ Your social security number Lela A Gz'1QOnis 205-12-'7519 Schedule B --- Interest and Ordinary Dividends seQ„~`"~ r";,o os part I 1 List name of payer. If any interest is from aseller-financed mortgage and the buyer used Amount Interest ~ Property as a personal residence, see the instructions and list this interest first.. Also show that buyer's social security number and address ..... ...... . ........ . _W_ac_hovia__Sec_ur_it_i_e_s _ g.38 See instructions Wachovia Bank _ or Form 7040, --_------_-_-_-_-_-_-_--_----_-_-_-_-_-__---.--- _ 7.6$7.97 line8a.) M and T Bank - ___---_-__ ______----- 613.23 CENTERLINE HOLDING COMT?ANY - - - - - - - -------------- ------------ 265.00 Not.. It you receivedaForm --------------------.------- 1099.INT, Form 7099-QID,or ----------------- substihde statement fromatxakerage ------------.------- firm, list the firm's - - - - nameasihs r ---_---------•-•----------- a~ enter the r Interest shown on -----------------_--- ----------------------- that form. - - 2 Add the amounts on line 1 - - - - - ' - - _ - - -' 3 Excludable interest on series EE and f U..S.. savings bonds issued after 7989.. Attach Form 8815 4 Subtracf line 3 from line 2 Enter th Part II Ordinary Dividends (See instructions for Form T 040, line 9a .) Nob. If received a Form 1099-0IV w sututituie statement from a.brakerage Trrm, list the fun's name a5 fhe payer and ernter the ordinary dividends. shown on that fomt. Part III Foreign Accounts e result here and on Form 1040, line 8a ........... e. if line 4 is over $1,500, you must complete Part ill. _ 5 List name of payer - --- Wachovia Securities -----"---- ----------------------------- CENTE~tLINE_HOLDING COMPANY _ --- I 8,575.58 '_8, 575.58 Amount 10,926.91 8.00 6 Add the amounts on Line 5. Enter the total here and on Form T040, line 9a .~_~~ Note. If line 6 is over $1,500, you must complete Part lil -- You must complete this part if you 4a]] had over $1,500 of taxable interest or ordinary dividends; or (b) had a foreign account; or (c) received a dtstribt>tion from, or were a grantor ot, or a transferor to, a foreign trust. No and 7a At any time during 2007, did you have an interest in or a signature or other authority over a financial account Trusts in a foreign country, such as a bank account, securities account, or other financial account? See instructions for exceptions and filing requirements for Form TD F 90-22..1 , ... X (See ..,.... .... instructions,) 'Y~.' enter the name of the foreign counfry . -_ _ _ _ _ _ _ 8 During 2007, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trusf? !f 'Yes,` ou ma have to file Form 3520. See instructions ........ X AA For Paperwork Reduction Act Notice, see Form 1040 instructions. FDIA0401 06~tiro7 Schedule B (Form 1040) 2007 0,934.91 ~SCHEC~ULE D ~Or'"' 10~> Capital Gains and Losses 2007 Department or ff>e Treasury 'Attach to Form 1040 or Form i090NR. -See Instructions for Schedule D (Form 1090). lntemal Revenue Service - Use Schedule D-1 to list additional transactions for Gnes 1 and 8. Attachment Name(s) shown on return Sequence No. ~2 Your social security Horn@ar Lela A Gziaonis _ 205-12-'75'79 __ Part I Short-Term Capital Gains and Losses -Assets Held One Year or~ Less -- (a) Description of {b) Date acquired (C}Data solo Sales pproperty (E7atmple: (~ Price (e} Cost or oilier basis Gain or oss i W shares XYZ Co) ~' day. ~ ~• ~y yr) (see instructions) (see instructions) S(btract (e) f om (d) 1 - 2 Enter your short•~term totals, if any, from Schedule D-1, line 2 .. , 2 _ 3 Total short-teen sales price amounts. Add lines 1 and 2 in column (d) ...... ... 3 .. 4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6787, and 8824 . . 5 Net short-term gain or (loss) from partnerships, S corporations, estates, and frosts from Schedule(s) K-1 .. 5 _ 6 Short-term capital loss carryover. Enter the amount, if any, from line 10 of your Capital Loss Carryover _____ Worksheet in the instructions .. ., ... ... ... ... .. ....... 6 ... .. 7 .Net short-term capita! gain or (loss Combine lines 1 throu h 6 in column Pert li _ Long-Term Capital Gains and Losses -Assets Heid More Than One Year - (a) Descxiption of {b} Date acquired (C}Date surd S --- property (Exampie: (Mo. day. yr) (Mo, da (~ aies pace (e) cost or other.~ass (f) Gatn or (loss) 100 shares XYZ Co) _ !' ]MJ (see instrudions) (see instrucions) Subtraact (e) from (d) 8 Dryden Global Total Return FD NC CL Z - -- ^ 01/23/02 06/01/07 9 338.00 9,590.00 -252.00 9 Enter your long-term totals, if any, from Schedule D-1, line 9 ..... g i0 Total Iong-term sales price amounts. Add lines 8 and 9 in column (d) ..... 10 9 338. __ 11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and song-term gain or (loss) from Forms 4684, 6781, and 8824. . 11 12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 ... , 12 13 Capital gain distributions. See irlstrs .. ... . .... ... ,. 13 2.777. ,. . 14 Long-term capital loss carryover. Enter the amount, if any, from line 15 of your Capital loss Carryover Worksheet in the instructions . _.. 14 .. ......... . 15 Net long-term capital gain or (loss), Combine lines 8 through i4 in column (t).. Then go to Part III on a e2 ........................ 15 BAA For Paperwork Reduction Act Notice, see Form i040 or Form 1040NR instructions. 2, 525 . Schedule D (Form 1040^) 2007 OMB No. 1545-0074 FDlA0612 11/07/07 Schedule D (Form 1040} 2007 Lela A Grigona.s ^ 205-12- 75 79 page 2 Part !f! ~ Summary 16 Combine lines 7 and 15 and enter the resulf 116 ~ 2 ff line 16 is: • Again, enter the amount from line 16 en Form 1040, line 13, or Form 1040NR, line I4 Then go to line I7 below. • A toss, skip lines 17 through 20 below. Then 9o to line 21. Also be sure to complete line 22.. • Zero, skip lines 17 through Zl below and enter -0- on Form 1040, line 13, or Form 1040NR, line 14, Then to go line 22.. 17 Are lines 15 and 16 both .gains? X~ Yes.. Go to line 18 Mo. Skip lines 18 through 21, and go to line 22.. 18 Erlter the amount, if any, from fine 7 of the 28°~ Rate Gain Worksheet in the instructions ... ...... .. ... > 18 19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the instructions , , , . , ~ 19 20 Are lines 18 and ]9 both zero or blank? © Yes. Complete Form I040 through line 43, or Form 1040NR through sine 40. Then complete the Qualified Dividends and Capital Gain lax Worksheet in the Instructions for Form 1040 {or in the Instructions for Forrn 1040NR). Do not complete lutes 21 and 22 below No. Complete Form 1040 throouuggh line 43, or Form 1040NR through tine 40. Then complete the Schedule D Tau Worksheet in the instructions.. Do not complete lines 21 and 22 below. 21 if line 76 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of: • The loss on line 16 or ~ ~ ..... .. ~ ($3,000), or if married filing separately, ($1,500) - Note. When figuring which amount is smaller, treat both amounts as positive numbers. - - 22 Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b? Yes. Complete Form 1040 through line 43, or Form 1040NR through line 40. Then complete the Qualitied Dividends and Capital Gain Tau Worksheet in the Instructions for Form 1040 (or in the Instructions for Form 1040NR). - - No, Complete the rest of Form 1040 or Form 1040NR, Schedule D (Form 1040) 2007 FDtA0612 11!07107 ~SCHEDUlE E (Foim 1040) Department of the Treasury Internal Revenue Service Supplemental Income and Loss (From rental read estate r Ri rtn rsh' OME! No. 1545 0074 , oya es, pa a rps, 207 S corporations, esta#es, trusts, REMICs, eic) ~ Attach to Form 1040 1040NR, or Form 1041. ~ See Instructions for Schedule E (Form 1040} se4 a ~;~. 13 Name(s) shown on return Your social secun~yr rnrmber Lela A Gri onis 205-12-75'79 Part i Incorne or Loss From Rental Real Estate and Royalties Note., If you are in the business of renting personal property, use Schedule C or C-EZ (see instructions). tf you are an individual, report farm rental income or loss from Farm 1833 an page 2, line 40. 1 list the a and location of each rental real estate ro 2 For each rental real estate Yes No A property listed on line 1 did ou _~ C ------------------------------------------- or your family use it during the - tax year for personal purposes A _ for more than the greater of: ----------------------------------- .14 days, or _ • 10°~ of the total days B ------------•------------•----------------- rented at fair rental value? - _ (See instructions.) c Income: Pro d185 Totals A ~ B C Add columns A, B, and CJ 3 Rents received 3 3 4 Royalties received .. " .... " ... " ... " .... 4 -"'-" ~..„e.,~e~. _~__. 15 . 4 15 . 5 Advertising .. 6 Auto and travel (see instructions) 7 Cleaning and maintenance ,., ... ,., 8 Commissions 9 Insurance. . 10 Legal and other professional fees .... , 11 Management fees 12 Mort+~age interest paid to banks, etc (see Instructions) ..... ..... .. .. . 13 Other interest . . 14 Repairs .. 15 Supplies . 16 Taxes . ............ 17 Utilities .... .. .. ... 18 Other gist) ~ 12 18 72 19 Add lines 5 through 1$ , ........ , . 19 19 20 Depreciation expense or depletion (see instructions) .. 20 21 --"-` 20 Total expenses, Add lines 19 and 20 .. Zi - 22 Income or (loss) from rental real estate or -- royaltyproperties. Subtract tine 21 from line 3 (rents) w line 4 (royalties If the result is a (lass), see instructions to find out if you must file Form 6198 ... .. , ... , 22 15 . 23 Deductible rerdal real estate loss. Caution. Your rental real estate loss on line 22 may be limited. See instructions th find out if you must file Fonn 8582 Real estate professionals must complete line 43 on page 2 ... .. , . 23 24 Income. Add positive amounts shown on line 22 . loo not include any losses 25 Losses Add ll l 24 15 . ____ . roya y osses from line 22 and rental real estate losses from line 23.. Enter total losses here . 2 25 _ S Total rental real estate and royally income or (loss}.. Combine lines 24 and 25 Enter the . result here.. If Parts It, IIl,1V, and line 40 on page 2 do not apply to you, also enter this amount on Form f040, lino 17, w form 1040NR, fine ]8.Otherwise include this amount , in the total online 41 on page 2 .....:... ........ .. 8AA For Paperwork Reduction Act Notice see instructions 26 15 , , . FD1T2301 uro7ro7 S chedu le E (Form 3040) 2007 File by Mait instructions foryour20O7 Pennsylvania Tax Return important: Your taxes are not finished until a1f required steps are completed. t l (If you prefer, you can stilt e-file.. Go to the end of these instructions for more information.,) Lela A Gxigonis 1636 Lowell Lane New Cumberland, PA 17070 _- I Balance } Youx Pennsylvania state tax return (Form PA-40) shows you axe due a Duel I refund of $55..00.. Re#und } What You Need to Mail Your tax return - The official return for mailing is included in this printout.. Remember to sign and date the return.. Be sure to mail all pages of your signed return along with any required attachments,. Mail your return and attachments to: Pennsylvania Department of Revenue Refund/Credit Requested 3 Revenue Place Harsisbuxg, PA 17129-0003 Deadline: Postmarked by April 15, 2008 Don't forget correct postage on the envelope., What You I Need to Beep these instructions and a co PY of your return for your records I Keep } If you did not paint one before closing Tu .. rboTax, go back to the program and select Print & File tab, then select the Print for 'Youx I Records category.. - -1 - __ 2007 I Taxable Income $ 2 Pennsylvania } Total Tax 2,302,.00 Tax I Total Payments/Credits $ $ 6s5.oo Return } Amount to be Refunded $ 740,.00 Summary I 55..00 I -- ----- -- __ - Special I Youx printed state tax forms may have special. formatting on them., FOrmatting } such as bar codes ox other s ymbals., This is to enable fast } processing., Don't worry, these fozms have been approved by your I taxing authority and are acceptable for printing and mailing.. - _l,- Changed } Xou can still file electronicall Just Your Mind Y• go back to fiuzboTax, select } the Print & File tab, then select the E-file category.. We'll waL:k About I you through the process,. Once you file, we will let e_fifin ~ you know if your 9• I return is accegted (or rejected) by the state taxing agency., Page 1 of 7 i J , D7DQ1131~72 Paso - 200 Pennsylvania income Tax Return ENTER ONE LETTER OR NUeRBER IN EACH BOX. Do Not Use Your Preprinted label 2051275'79 GRIGONIS L.ELA 1636 LOWEL.L LANE NEW CUMBERLAND A Occupation H O M F. M A K E R Occupation PA 17D7D 219QQ i a Gross Compensation, Do not include exempt income, such as combat zone pay and qualifying retirement benefits., See the instructions. i b Unreimbursed Employee Business Expenses, i c Net Compensation., Subtract Line lb from Line la 2 Interest income Complete PAScheduleA if required. 3 Dividend and Capital Gains Distributions Income Complete PA Schedule B if required 4 Net Income or Loss from the Operation of a Business, profession, or Farm. 5 Net Gain or Loss from the Sale, Exchange, or Disposition of Property, 6 Net Income or Loss from Rents, Royalties, Patents, or Copyrights 7 Estate or Trust Income.. Complete and submit PA Schedule .J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T, S Total PA Taxable income., Add only the positive income amounfs from Lines 1 c, 2, 3, 4, 5, 6, 7, and 8,. DO NOT ADD any Josses reported on Lines 4, 5, or 6, i0 Other Deductions, Enter the appropriate code for the type of deduction. N See the instructions for additional information.. 7 i Adjusted PA Taxable Income. Subtract Line 10 from Line 9.. PAIAo412 71/13/07 N Extension. N Amended Return. R Residency Status. PA ResiderrtlNonresident/Part-Year Resident from to S Single/Married, Filing Jointly/Married, Filing Separa#ely/Final Retum/Deceased pate of Death N Farmers. School District Name WEST S N O R E 1a p 1b D 1c Q 2 8575 3 23712 4 Q 5 -252 6 15 ~ D $ (] 9 223D2 1D Q 11 223Q2 EC Page 1 of 2 FC D 70D1131'72 ~ L__l.~~~ m ^ ~DD113172 J PA-40 - 20Q7 Social Security Number D7DD213186 2D51275'79 Name(s)Lela A Grigorlis 72 PA'Tax lrabiGty. Multiply Line 11 by 3,07 percent (0.0307), 12 6 8 5 13 Total PA Tax Withheld, See the instructions. Z 3 D 14 Credit from your 2006 PA Income'Tax return, 14 D 75 2007 Estimated Installment Payments.. 15 7 4 D 1& 2007 Extension Payment. 16 0 17 Nonresident Tax Withheld from your PA Schedule(s) NRK 1. (Nonresidents only) ], 7 D 18 Total Estimated Payments and Credits,. Add Lines 14, 15, 16, and 17. 18 7 4 0 Tax Forgiveness Credit, 19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased ], cJ 8 D 0 19 b Dependenfs, Part B, Line 2, PA Schedule SP ]r 9 b 0 D 20 Total Eligibility Income from Part C, line 11, PA Schedule SP. ~ 0 D 2i Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. ~ ] r D 22 Resident Credit. Submit your PA Schedule(s) G-Ft with your PA Schedule(s) G-S, GL and/or RK ~1. ~ ~ 23 Totat Other Credits.. Submit your PA Schedule OC. 2 3 0 24 TOTAL PAYMENTS and CREDTfS. Add Lines 13, 18, 21,22, and 23.. 2 4 D ~74 D 25 TAX DUE. If Line 72 is more than Line 24 enter the diff 26 , erence here Penalties and Interest See the instructions, Enter code: ~ 5 ~ ~ 0 If including form REV-1630, mark the box. IV D 27 'TOTAL PAYMENT. Add Lines 25 and 26. ~ '7 28 OVERPAYMENT. If Line 24 is more than the tots! of Line 12 and Line 26, enter ~ ~ 0 5 $ the difference here., The total of Lines 29 through 35 must equal Llne 28, 29 3 Refund -Amount of Line 28 you want as a check mailed to you.. Refund 2 9 ~ g 0 Credit -Amount of Line 28 you want as a credit to your 2008 estimated account.. 3 D , 0 31 Amount of Line 28 you want to donate to the YYild Resource Conservailon Fund, 3 ], D - 32 - Amount of lire 28 you want to donate to the Mllltary Family Relief Assistance Program:. 3 ~ 33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial 3 3 D D Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want #o donate to the .Juvenile (Type i) Diabetes Cure ~ > f D Research Fund. 35 Amount of Line 28 you want to donate to the Breast and Cervical Cancer 3 ~ Research Fund. aS~~grraLcro(s} Under perralties of perjury, I (~) declare itiat 1 (we) have examined this return, induding all Ying schedules and statements, and to the hest of fry (our) belief, they are true correct d , , an complete. Your Signature Spouse's Signature, if til' mg' joingy Preparer's Name and Telephone Number Self-Prepared Firm ElN Preparer's SSAUPTIN Pagge 2 of 2 PAIA0472 11/13/07 D70D213186 07DD2131$6 0'701310021 ~~ • PA SCHEDULE D Sale, Exchange, or Disposition of Property PA-40 D (09•Dn {I) 2007 __ OFFICIAL USE ONLY If ou need mores ace ou ma hatoco Name or Uie taxpayer filing this schedule Sacral Security Number (strown firsA Lela A Grigonis _ ~_ ~~_ _ 205-12-7579 Important Each spouse must file a se rate PA Schedule D fp report his or her sales. !f selling jointly owned property, spouse must submit a separate PA Schedule D far only that property.. A spouse may net offset his/her gains (lasses) against the other spouse's gairxs (losses). If filing separately but selling oirrtly owned propert}, each sparse reports his/her share of the gain (loss) from the PA Schedule D for the joint sale. Taxpayers must each submit g copy of the 'jolt PA Sdiedute !~. f2ead fhe instructions. Eater all sales, exchanges, or other disp~ons of real or personal tangible and Intangible properly, including inherited property. Amounts from Federal Schedule D may not be correct for PA income tax purposes. aN presidents should read carefuAy the instructions cortcemtng intangible prDperly If the result is a loss, check tha box next to the line 1 ~ (b) (c) td3 e (fl Describe properly: Date acquired: Date sold: Gross sales price Cost o<adjusted Gain or loss: 100 shares of XYZ stock, or Mo/day/year Mo/day/year less expenses basis of the (d) rninus (e) ~_10 acres in Dauphin Courtly - of sate property sold (if a lass, check the box) Dryden Global Tot 01/01/07 06/01/07 9 338. 9 590. ~~ - __ ~ 252. 2 Net gain (loss) from above sates ... ...... , L0~ ® 2 252 . 3 Gain from installment sales from PA Schedule D-1 _ 4 .. , ...... . ..:......................._. Taxably distributions from C i .,., 3 '- corporat ons .......Enter total distribution "- Minus adjusted basis . ~ = 4 5 Net gain Qoss) from the sale of 6-1-71 property from PA Schedule D-71 , .. .... ~^ ,. 5 6 Net PA S corporation and partnershi ain toss from our PA Schedules RK-1 or NRK-1 loss 8 .. ^~ ....... 7axaf>ae gain from seUing a rinci l id p pa res ence. Com late and submit PA Sch edule 19. Com late Columns (a) fhrou h e and enter our total in on tone 7 a Address of?esidence Date acquired: Date sold: Gross sates price ( Cost or adjusted ba i . G otr Mo/da ear Mo/da ear .less ex apses of sale s s of the Drooerty sold ain loss: rrn mini ~ roe 7 Taxable gain from the sale of your principal residence. If you realized a loss on the sale of your principal residence, enter a zero. If ou realised a gaiMoss an the sate of the nonresidential portion of your principa! residence enter the information on Line 1 t3 Taxable drstnbutlons from partnerships from Line 7c of REV-999 PT i g 9 Taxable dlstrrbubons from PA S corporations from Line & of REV-998 PT g .................. _ 0 Taxable am from exchan a of insurance contracts .... 10 - -"- 11 Total PA taxable gain (foss).. Add Lines 2 through 10. Enter on Line 5 of your PA-40, joss (If a nd loss, check the box) . 71 252 . 0'701310021 PA,A0507 trro6ro~ 0'701310021 D'7D7,4ZDD29 ~• PA SCHEDULE E Rents and Ro alty OFFICIAL USE ONLY _ _ _ If you need more soots, you may ohatocoov_ Noma of the taxpayer filing this schedule - Social Sectxity Number (shown firsfJ Lela A Griaoni.s _ _ i205-12-'75'79 See the instrucilons. Report the income and expenses for the use of your personal property by others. Also, report fhe income you received for the extraction of oil, gas, and other minerals from your property, and the use of your patents and copyrights. Note: ff you are in fhe business of renting your property, extracting minerals from your property, or producing products from your patents and copyrights -use PA Schedule C. Part A. Property Descnption: __~--'__ ~-- - Show the address and kind of each rental real estate props ,and/or each source of royal income. _ - Kind ofproperty For Profit Pro er ~ Address _ A YES N/A From Schedules K-1: Charts=Mac P10 B YES CENTERLINE HOLDING COMPANY -------------------------------------- Fxom Schedules K-1 Nn YES --"- C NO --_--___-._--_-------------------------- Part B. Identify the property from Part A and Indicate if the owner is the taxpayer {i =the name shown first on the PA 40) or the spouse (S) or if jointly awned (J) Important: Spouses may not offset income and losses. ~ Property A ~ Property B ~ Propertv C ~ 1 Rent received .. .. .. ........ .. 1 ~ - .2 Royalties received . 2 -- 1---5 -f--- - 3 4 Advertising ... ....... . . . . .. A t bil 3 -- 5 u omo e and travel ... .. Cleani d i a - --- - 6 ng an ma ntenance .. C i i ~ -- 7 omm ss ons ... , . , .. ,..... In g - 8 surance ..... Le al d f o 7 - 9 g an pro essi nal fees . M n t f g -- 10 a agemen ees _ , , , ,... ... M rt i 9 •- i1 o gage nterest ......... ......... ... Other i t t 10 - - 72 n eres ... R i 11 --- i3 epa rs ... .. ,. ....,. ... ..,, Su li 4 pp es .. ... ..... . . .... ..,. T b 13 _ ` 15 axes -not ased on net income .... . .... ... Utiliti 14 i8 es , . D i ti 15 _ - - eprec a on expense .... , . _ ... , Important: PA law does not permit arty federal bonus depreciation. PA laW limits the ER i6 C Secti on 179 expensing to $25 000. See the instructions 77 Other expenses (itemize):... .. .... , . 77 , . 18 Total Expenses -Add Lines 3 through 17 .......... ... 78 ___~ ~~"-~ Income or Loss _._ 19 Income -Subtract Line 18 from Line 1 or 2 i9 -~ ~ 15 . T_ 20 LOSS -subtract Line 1 or 2 from Line 18 (check box if a net loss) 20 - 0 ~ ~ . - ~ .~ 21 Net Income or Loss - --- 7otal Lines 19 and 20 .. (check fhe box if a net loss) ~ 21 ~__ 15 , 22 Rent or royalty income (loss)) from PA S corporation(s), and partnerships from your PA Schedule{s) RK-1 or tVRK-1 ..... ... , .. .. (check the box if a net loss) ~ 22 ~ -~ 23 Net Rent and Ro~alty Income (Loss}. Add Lines 21 and 22. if submittingg mare than one schedu e, total all amounts, and include on Line 6 of your PA-4(1 .. {check the box if a net loss) ~ 23 C 15 , D'?D141D029 Pwzosoi ionsio~ D7[l],41D029 l~ile.by Maif fnstruc#ions for your 2007 Federal Tax Return Important: Your taxes are not finished until all required steps are completed. . / / (If you prefier, you can still a-file. Go to the end of these instructions for more information.,) Lela A Gxigonis J.636 Lowell Lane New Cumberland, PA 17070 Balance ~ Youx federal tax xetuxn (Farm 1040} shows you owe a balance due of Duel { $305.00. Refund ) ~ You are paying by check., What You Need to Mail Youx tax xetuxn - The official return for mailing is included in this printout., Remember to sign and date the xetuxn.. Youx payment - Mail. a check or money order for $305.00, payablea to "United States Treasury". Write your Social Security number and "2007 Form 1040" on the check,. Mail the return and check together., Attach the first copy or Copy B of Form(s) 1099-R t.o the front of your Foxm 1.040., Mail your return, attachments and payment to: Department of the Treasury Internal Revenue Service Center Kansas City, MO 64999-0102 Deadline: Postmarked by Tuesday, April 15, 2008 Note: Your state xetuxn may be due on a different. date.. Please review Youx state filing instructions. Don't fozget correct postage on the envelope., What You ~ Keep these instructions and a copy of your return for your records Need to ,. j If you did not print one before closing TurboTax, go back to the: Keep ~ program and select Print & File tab, then select the Print foz•].'our -_ j Records category.. ~ 2007 j j Adjusted Gross Income $ 28,584.00 Federal j Taxable Income $ 18 534..00 Tax j Total Tax $ , 2,028..00 Return ~ Total Payments/Credits $ 1, 723..00 Summary j Payment Due $ 305..00 ~ Effective Tax Rate 7••09 Payments ~ Estimated Payments for 2008 - This printout includes your estimated You Need to j tax vouchers fox your federal estimated taxes (Foxm 1040-ES). Make I Page 1 of 2 J ~. ' k. F": F - SIAIEMENI OF FUNERAL GOODS AND SERVICES SELECIED Gharges are only for those items that you selected or that are required. if we are required by law or by a cemetery or crematory to use any items. we will explain the reasons In writing below. H you selected a funeral that may require erbalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial !f we charged for embalming, we will explain why below CASH ADVANCES Certified Copies of Death Certificate - t ~~ ~ $ i::s r':~ each __ $ (r~G1 ,!7C') Rr.,, Y No. Clergy l` r ~ _ , e DECEASED . -~: '. t'~ ~/ rrJr ~ ..:. ~e.-:.- . - ~ s DATE OF DEATH f - G'. ?' - i U Cr ~ ~ Musician y PLACE OF DEATH / .~"~ " i .{-'L,~~ ..q .f 1`~r i ' ~y ~ ~ ~.s ._._C pt~ ~ .~ ,~ DATE OF STATEMENT % - ~- ~ ~-N G 5 Paid News a er Noti r ~ _ ce - A. CHARGE FOR SERVICES SELECTED Cemetery ro ess~ona! Services: Basic Services of Funeral Director & Staff . _ Embalming _ Other preparation of body _ 2. Facffftfes; Equipment & Staff: Use of Facilities 8 Staff for Viewing /Visitation Use of Facilities & Staff for Funeral Ceremony . Use of Faalities & Staff for Memorial Service Use of Equipment & Staff for Graveside Service .. Use of Equipment & Staff for Church Service. :ra - ~ ! ft ~.~.1y-~` .1 3. Transportation: Lr,.;••~..~ }.-- Transfer of Remains to Funeral dome 1 Hearse ... Limousine Sedan Service /Utility Vehicle . 4. Other Services / Facfffffes / Equipmenf: t i . ~f ~y~ ~ ~~~ ~- ~~ 1 l; i i l~ I l i j I T- `I.i TOTAL OF SERVICES SELECTED . $ /~~- B. CHARGE FOR MERCHANDISE SELECTED f `. `J Casket (or other rece facts) ~ ~. ~; ~ NamelNa ~ / ` /J' Material t`.~fi pit=r-~->R...~ + Color Outer Burlat Container Name/No. Material Acknowledgement Cards ~~}. . Register Book i` /(~ Memory Folders / Rsayer~ards,~~ ly.:!- r: ol'S-; t i..at_ (.~__ Clothing . ,.. Cremation Um . . TOTAL OF MERCHANDISE SELECTED . $ Other TOTAL CASH ADVANCES $ We charge you for our services in obtaining: (specify cash advance item; SUMMARY Total Funeral Home Charges Local Sales Tax (if applicable) State Sales Tax (if applicable). Total Cash Advances . Less Credits and Payments GRANDTOTAL $ Total Credits ~--$---- BALANCE DUE -~ $ Billing To t-- DISCLOSURES - ;. Reason for embalmin ~-' s1_ _ ~ '_ "- _ Cud /_.7 `-'f~4- S_es'--C~ If any law, cemetery or crematory requirements have required the purchase of any items listed, the law or requirement. is explained below ACKNOWLEDGEMENT AND AGREEMENT I hereby acknowledge that f have the legal right to arrange the final services far the deceased, and t authorize this funeral establishment to perform services, furnish goods, and incur outside charges specified on this Statement. I acknowledge that I have rereived the General Price List and the Casket Price List and the Outer Burial Container Price List Terms of Payment: Full payment is duo no later than /~ --~- If any payment is not paid when dus an unanticipated`~ATE CHARGE of % per month (ANNUAL PERCENTAGE~RATE __ _ _ %1 Q m~ ro °m who ~° ' U W ~°m c mE~ y~'E,,, W 'o°rn o'~e-`o3' W ~m'3 EmC~Q v3 3 fi :° ~ t t-. ~ v v, ~ ~ ; Imo . m ~'naO3 ~ "' ~s ~ ~ tr ~~`3 ~ o G~ m Q w m ~>~b p~ ~ ~ tO i a f E ~ W ~ ~ ~ ~ C y~' m - E~~m_ y m ~~.. Q NaX. M-0 ~~~~~~ U ~ ~g , L~~ °i~m ~a~~o; 3°'~m•° t m Gro ~3Qm Oi N l ^ vi o mE ~oo~w.; a-... ° 'o Z... ° m ~y fn W i mym Z y~t~3 . G~ Q ~ ~ y ~ ~ ~ .~ I C3 U r ;,,~ ,,, y. .' ~, .~ •- 5.;. ~;..: `.. f.'; (\ t { •`y \ LY, ~' Cis ti'p'. s fn <. ~, ~; F~ ~ • -~~p h~ t ~~ Q ~ C ~? r ~'~ ,` t.: .t:: `' `•~ M ~~ z° w 1 ~ w a w ^ ~ (!l LL Q LL W WO W ~ F- CJ F w ¢ g o ^ a a ~~ III I '. 'III C ~ 1 a v .i ~ EA fH EA fR EH : J : : . 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GRIGONIS, of Bethlehem, Northampton County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my First Codicil to my Last Will and Testament dated September 20, 198. An_v and all references to I~IERIDI_-~N BANK, as set forth in Article IV. D. and Article V. A., are hereby revoked and shall be replaced with CHRISTINA A. SZOhE as the named successor Tnistee and successor Executrix, respectively. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my First Codicil to my Last Will and Testament, consisting of one page,,this .~~ day of ~t%_~~, 2002. LEL A A. GRIGONIS, Testa: Signed, sealed, published and declared by the above-named Testatrix, LELA :~. GRIGONIS, as and for the First Codicil to her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, ha,~~e hereunto subscribed our names as witnesses. i / Witness Address ~ ~ /',~ -._,~L~ `~ ._ ~ .~/l l Lc-l ~'I ~ l . ~' C~-L'I-~ Witness ~ ~ ~ / / ~ -~ Address -~` ~ ~'~ ~~ ~ ~'- ~ ~~~~~~ ,.~, ~, L1WPWin~WILLS\GrigonisL.Codicil.wpd August 13, 2002 COM1~IOl~t`WEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND I, LELA A. GRIGOVIS, THE TESTATRLY, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AIvD EXECUTED THE INSTRLTIVIENT AS THE FIRST CODICIL TO MY LAST WILL Ai~TD TESTAIvIENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIR~VIED TO AND ACKNO LEDGED BEFORE ME BY LELA A. GRIGOiVIS, THE TESTATRIX THIS ~!~ DAY OF CSC ~a~ ~,~'/ , 2002. N6TARIAL SEAL CASSANDRA T. ROSENBAUM, Notary Public Camp Hill Boro, Cumberland County My Commission Expires December 4, 2004 COMMONtiVEALTH OF PENNSYLVANL4 ) SS. COUNTY OF CUMBERLAND Notary Public ~~ ~ ~~ T Witness Witness ~~.f L"tom l~iF-~/ ~ ,.=~ K,_ G(_~f` ~- ( w ~ WE, _y~t Jr-~~. (-~ - ~-~~'..i' ~-.- AND / ! ~ ~ S: ~ ;'~, ~'%~l ; '1 THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BENG DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUIt~IENT AS THE FIRST CODICIL TO HER LAST WILL AND TEST~NIENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE ANTD VOLUNT.~RY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRLY SIGIv'ED THE CODICIL AS `WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (18) OR MORE YE<~RS OF AGE, OF SOUND MIND AND UNDER NO CONSTR_~INT OR UNDUE INFLUENCE. ~, SWORN OR AFFIFI`.IED TO AI~nJ SUBSCRIBED TO BEFORE. ~,IE, TIIIc ~~`;~ %iay OF C~-aLz,,~~_ , 200. N®TARIAL SEAL CASSANDRA T. ROSENBAUM, Notary Public Camp Hill Boro, Cumberland County My Commission Expires December 4, 2004 Notary Public CP/M C~dT8 32901.ww 329.01 Will 6/17/85 r ~., LAST WILL AND TESTAMENT `-lam _-_ -,~ OF ~ _., LELA A. GRIGONIS ~ ' - r.; - ,, I, LELA A. GRIGONIS, presently of the Township of Lower Saucon, County of Northampton and Commonwealth of Pennsylvania, declare this to be my Will, and I revoke all prior 6~7ills and Codicils that I have made. ARTICLE I. All estate, inheritance, and other deat'n taxes (including interest and penalties, if any, but excluding any generation-skipping tax), together with my just debts, funeral and all administration expenses, payable in any jurisdiction by reason of my death (including those taxes and expenses payable with respect to assets which do not pass under this Will} shalt be paid out of and charged generally against the principal of my residuary estate. I waive any right of reimbursement for or recovery of those death taxes and administration expenses, except reimbursement for or recovery of any federal or state estate tax attributable to property over which I have power of appointment. ARTICLE II. A. I give all my tangible personal property not otherwise effectively disposed of which I own at my death, including any household furniture and furnishings, automobiles, books, 1 CP/M CWTB 32901.ww ~ 329.01 Will 6/17/85 pictures, jewelry, art objects, hobby equipment and collections, wearing apparel and other articles o:f household or personal use or ornament, to my son, ANTONY Vii. GRIGODTIS and my daughter, ROBYN J. GRiGONIS SZOKE, in shares of substantially equal value, to be divided in such manner as t'ney shall agree, or, if they shall fail to agree within six (6) months after the date of my death, as my executor shall determine. In the event either of my children fails to survive me, his or her share shall be paid to his or her then-living issue, per stirpes, or in default of said issue, to my then-living issue, per stirpes. Provided, however, if a beneficiary hereunder has not reached legal age under the la;as of the jurisdiction in which that beneficiary is demociled at the time set for distribution under this paragraph, then the person having legal custody of that beneficiary (a) shall represent the beneficiary in any di~,~i_sion of such property, (b) may give a binding receipt for and hold the beneficiary's share for such beneficiary's benefit, (c) may sell any part or all of the share, and (d) shall deliver the share of sale proceeds to the beneficiary before or when such beneficiary reaches legal age as Bach person considers advisable. B. All costs of safeguarding, insuring, packing, and storing my tangible personal property prior to its distribution and of delivering each item to the place of residence of the beneficiary of that item shall be deemed to be expenses of 2 CP/M CWT8 32901.ww 329.01 Wi11 6/17/85 administration of my estate. ARTICLE III. I give my entire residuary estate, being all property, real and personal wherever situated, in which I may have any interest at my death not otherwise effectively disposed of, but: not including any property over which I have power of: appointment, to my son, ANTODIY M. GRIGONIS, and my daughter, ROBYN J. GRIGONIS SZOKE, in equal shares, share and share alike. In the event either c'nild is not then-living, his or her share shall be paid to his or her then-living issue, per stirpes, or in default of such issue, to my then-living issue, per stirpes. ARTICLE IV. In order to avoid court proceedings for the appointment: of guardians for beneficiaries during minority, I direct. that iE any minor becomes entitled to any income or principal under this Will, I give his or her share to my hereinafter named trustee for. the following uses and purposes: A. As much of such income as my trustee may from time to time think desirable for the health, maintenance, support or. education of such beneficiary or his or her dependents stall be applied for those purposes and any income not so applied shall be accumulated and from time to time added to the principal of the trust from which it was derived. 3 CP/M CWT$ 32901.ww 329,01 Will 6/17/85 B. In addition to paying the income, trustee is authorized to invade principal for the health, maintenance, support and education of said minor. C. All such accumulated principal shall be distributed to such beneficiary attaining the age of twenty-one (21) years or the removal of other disabilities. D, I appoint my son, ANTONY M. GRIGONIS, as Trustee of the trust created in this, my Will for the benefit of any minor children of my daughter, ROBIN J. GRIGONIS SZOKE. In the event my son, ANTONY M. GRIGONIS, does not survive, I appoint my daughter, ROBYN J. GRIGONIS SZOKE, as Successor Trustee. T_ appoint my daughter, ROBYN J. GRIGONIS SZOKE, as Trustee of the Trust created in this, my Will, for the benefit of any minor children of my son, ANTONY M. GRIGONIS. In the event my daughter, ROBYN J. GRIGONTS SZOKE, does not survive, I appoint my son, ANTONY M. GRIGONIS, as Successor Trustee. In the event both. my son, ANTONY M. GRIGONIS, and my daughter, ROBYN J. GRIGODIIS SZOKE, fail to qualify or cease to act, I appoint MERIDIAN BANK as Successor Trustee of this, my Will. ARTICLE V. A. I name my son, Ai`TTONY M. GRIGONIS and my daughter, ROBYN J. GRIGONIS SZOKE, or the survivor of them, as executors of this Will. In the event boti~ my son, ANTON`I M. GRIGONIS, and my 4 CP/M CWTB 32901.ww 329.Q1 Will 6/17/85 daug'nter, ROBYN J. GRIGONIS SZOKE, fail to qualify or cease to act, I appoint MERIDIAN BANK as successor Executor of this, my Will. No executor of this Will shall be required to furnish any bond or other security as executor. As used in this Will the term "executor" designates the court-appointed fiduciary of my estate from time to time qualified and acting. B. In addition to any powers granted by law, I give my executor power, exercisable in the discretion of my executor_ and without court order, to retain, sell (at public or private sale), exchange, lease for any term (even though commencing in the future or extending beyond the date of final distribution of. my estate), mortgage, pledge or otherwise deal for any purpose with the property, real or personal, from time to time comprising my estate, for such consideration and on such terms (with oz- without security) as my executor shall determine; to exercise any sLOCk options granted to me; to borrow money for any purpose, ai:: interest rates then prevailing, from any individual, bank or other source, irrespective of whether such lender is tizen acting as executor; to invest in any property whatsoever; to compromise or abandon any claims in favor of or against my estate, to hold. any property in the name of a nominee or in bearer form; to employ accountants, depositaries, attorneys, and agents (with or without discretionary powers); to execute contracts, notes, conveyances, and other instruments, including instruments 5 CP/M Cw~F8 32901.ww 329.01 will 6/I7/85 containing covenants and warranties binding upon and creating a charge against my estate, and containing provisions excluding personal liability; to make distributions wholly in cash or in kind, or partly in each; to allot different kinds or disproportionate shares of property or undivided interests in property among the beneficiaries; and to determine the value of any property distributed in kind. C. I direct my executor to ma'~e such elections under the tax laws as my executor deems advisable, wit'nout regard to t'ne relative interests of the beneficiaries, and my executor shall have no liability for, or obligation to make compensating adjustments between principal and income or in the interests of the beneficiaries by reason of, the effects of those elections. Any decision made by my executor with respect to compensating adjustments shall be binding and conclusive on all persons. D. ri~y trustees shall have all the powers and discretion with respect to the trusts created under this Mill during administration as are set forth or referred to above (including the power to sell real or personal property at public or private sales for any purpose and to hold title to property in the name of a nominee), to be exercised without court order. ARTICLE VI. No beneficiary shall be allowed to assign or anticipate his or her interest hereunder and no beneficiary's creditors shall be 6 • CP/M CwT8 32901.ww 329.01 wilt 6/17/85 allowed to attach or otherwise reach any such interests. I hereby sign this Will on the ,~;~` ~ day o:E T; ... ~, . :`~'~ ', 1985. " - LELA A. GRIGONIS ~'~% ,~~ SIGNED, SEALED, PUBLISHED AND DECLARED by the said Testatrix, LELA A. GRIGONIS, as and for her Last Will and Testament, in our presence, and in the presence of each of us, we all being present at the same time; and we, at her requst, in her. presence and in the presence of each other, have hereunto signed ou~ names as attesting witnesses. ~~ .~; ~,. ~ ~-'`+.~~~ ~~ residing a t '1~•.~; ~~.5' `{~-,... ~~ '~ ~ ~ 1 •~y ~~ ~' ~~a. f - residing at 7 f CP/M CW'P8 329O1.ww COMMONGVEALTH OF PENNSYLVANIA ) SS: COUNTY OF NORTHAMPTON ) 329.01 Will 6/17/85 I, LELA A. GRIGONIS, having been duly qualified according to law, acknowledge that I signed the foregoing instru- ment as my will, and that I signed it as my free and voluntary act for the purposes therein expressed. LELA A. GRIGONIS We, having been duly qualified according to law, depose and say that we were present and saw LELA A. GRIGONIS sign the foregoing instrument as her will; that she signed it as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing and. at her request signed the will as witnesses; and that to the best of our knowledge she was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~~ Witness ;t ~~_ Witness Subscribed, sworn to or affirmed, and acknowledged before me by the above-named testatrix and by t'ne witnesses whose names appear opposite ..c- ~.. ~' ~~ ~ , L. _""_ ~. Notary Public %"%