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Home My WebLink About03-1034 Estate of also known as Social Security No. "~74-05-1332 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the executor in the last will of the above decedent, dated Jan. 3, 1974 and codicil(s) dated N/A PETITION FOR PROBATE and GRANT OF LETTERS Gayle M. Grissinger No 21-03-- To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania named (state relevenat circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal 'residence at Thomwald Home, 442 Walnut Bottom Rd., South Middleton Township, Cumberland County (list street, number and municipality) Decedent, then 85 years of age, died Nov. 18, 2003 at South Middleton Township, Cumberland County Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: No Exceptions Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) Ail personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ unestimated $ Total: unestimated WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) jmes M. Grissinger 30 Garland Court II Carlisle PA 17013 OATH L}F I"ER~ONAL REPRESENTATIVE COMMONWEATLH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ~13~c~ day of ember, 2003 ~ O ~ (J ~oflegister No. 21-03 Estate of Gayle M. Grissinger , Deceased DECREE OF PROBATE AND GRANT OF LETTERS ~'x AND NOW .~,,~_~_~.m~ ! ~o 20 ~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated~ Jan. 3, 1974 described therein be admitted to probate and filed of record as the last will of Gayle M. Grissinger and Letters Testamentary are hereby granted to James M. Grissinger FEES Probate, Letters, Etc. $ _,b~5. CO Short Certificates(1 ) $ ,~. r~o Renunciation $ ~¢P $ i0. Total__ $ t'Register of Wi~q Robert M. Frey #06274 ATTORNEY (Sup. Ct. I.D. No.) 5 South Hanover Street Carlisle, Pennsylvania 17013 ADDRESS (717) 243-5838 PHONE REGISTKR.~ OF WI~L~~~ CUMB~UNTY OA~q~0~F SUBS~G WITNESS (c)a subsc~~sente~~~cri~ t° law' d~~d say(s} th~.~ere~and saw ,~statrix, S~~me an~~Y si.g. net~tn~s) at t.he ~~f te~er presence an~.~.~presence"bf each o~~ce~ subscrib~~ . S wom~e ~""an d"s~c ribe d bet'or.e,. Register REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NONSUBSCRIBING WITNESS .... ~t_-___o_~__-__t_o_&_,l._ .......... rber, 2003 Robert M. Frey and Robert G. Frey (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Gayle M. Grissinger, (one of the subscribing witnesses to) the will presented herewith and that each believes the signature on the will is in the handwriting of Gayle M. Grissinger to the best of our knowledge and belief. Sworn to or affirmed and subscribed before /~"~~~2/'/7 "~ me this__ day of Robert M. Frey 5 S.Hanover St.,Carlisle PA 17013 Robert G. Frey 5 S. Hanover St. Carlisle PA I, Gayle M. Grissinger, of North Middleton Township, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will previously made by me. I. I direct that all my just debts, taxes and funeral expenses shall be paid from my residuary estate, as soon as practicab![e after my decease, as a part of the expense of the administration of my estate. II. All the residue of my property and estate, real, per- sonal, and mixed, of whatsoever kind and wheresoever situated, I give, devise and bequeath to my husband, James M. Grissinger, if he .survives me by thirty (30) days. III. If my husband does not survive me as aforesaid, I give, devise and bequeath all of the aforesaid residue to my son, James Michael Grissinger. IV. I appoint my husband, James M. Grissinger, to be Executor, of this, my Last Will. Should my husband, James M.Gris sing r, fail to qualify or cease to act as Executor, then I appoint my son, James M. Grissinger, Executor of this, my Last Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will, this 3 day of January 1974. Signed, sealed, published and declared by the above n~ed Testatrix as for her Last Will and Testament in our presence, who, in her presence, and at her request, and in the presence of each other, have hereunto set our hands as attesting witnesses. GAYLE M. GRISSINGER GEORGE E. HOFFER ATTORNEY-AT-LAW 9 IRVINI~ ROW CARLISLE, PENNSYLVANIA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003562 FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 174-05-1332 FILE NUMBER: 2103- 1034 DECEDENT NAME: GRISSINGER GAYLE M DATE OF PAYMENT: 02/17/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 11 / 18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13,234.00 iREMARKS' TOTAL AMOUNT PAID: $1 3, 234.00 SEAL CHECK//114 INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS ESTATE OF GAYLE M GRISSINGER 60-2954319 J MICHAEL GRISSINGER, EXEC. 313 ' 17200 WESTGROVE APT 823 ADDISON, TX 7S001 , &- //_'~-~ DATE ORDEROF ~t ~ REV-1500 EX (6-~30) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 I use INHERITANCE TAX RETURN F,'E.U..E. 21-03- 034 RESIDENT DECEDENT Icou. cooE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER zr- Grissinger, Gayle M. 174-05-1332 uJ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) ~ THIS RETURN MUST BE RI.ED IN DUPUCA'rE ~ THE [U ,,,O 11/18~2003 11130/1917 REGISTER OF WILLS ¢3 IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER q I- ,,i ¢3 Z O n ,. O Z O ~-]1. Original Ratum ~'~4. Limited Estate ~'-~ 6. Decedent Died Testate (Attach copy of Will) r-~9. Litigation Proceeds Received ~']2. Supplemental Ratum J----]4a. Future Interest Compromise (date of death after 12-12-82) ~]7. Decedent Maintained a Living Trust (Attach copy of Trust) []10. S~I P~*e/Cred~ (~a~ of ~a betwee. 12-31-91 and 1-1-95) ---']3. Remainde~ R~urn (data orr dealh Ixt~to 12-13-82) [---'-~ 5. Federal Estate Tax Ratum Required __ 8. Total Number of Safe Deposit Boxes ~--]11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Robert M. Fray FIRM NAME (If Applicable) Frey & Tiley TELEPHONE NUMBER I717)243-5838 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE 4. Mortgages & Notes Receivable (Schedule D) (4) NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) r~Separate Billing Requested 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property COMPLETE MAILING ADDRESS 5 South Hanover Street Carlisle, Pennsylvania 17013 ~),321 48,216 ,l, ,l ~) OFFII~I,a~DUSE ONLY I (Schedule G or L) (7) 8. TOTAL GROSS ASSETS (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ~10) 11. TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 12. NET VALUE OF ESTATE (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/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) 230,927 339,464 13,214 7,472 20,686 318,778 (14) 318,778 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate ,or t~ansfers under Seo.9116 (a)(1.2) x .0 (15) 16. Amount of Line 14 taxable at lineal rate 318,778 x .0 45 (16) 17. Amount of Line 14 taxable at sibling rate x . 12 (17) 18. Amount of Line 14 taxable at collateral rate X . 15 (16) 19. Tax Due 20.~X-~ (19) 0 14,345 0 0 14,345 z~ [ t=rlssinger, ~ay~e M. 174-05-1332 Decedent's Complete Address: ISTREET ADDRESS 30 Garland Court Two CITY o' Carlisle STATE PA JZIP 170131 Tax Payments and Credits: 1. Tax Due (Page 1 Line-19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 13,234 697 Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C ) (2) Total Interest/Penalty ( D + E )(3) If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page '1 Line 20 to request a refund (4) If line I + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 14,345 13,931 0 0 414 414 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................ ~'~ [] b. retain the right to designate who shall use the property transtermd or its income; ............. ~-] [] c. retain a reversionary intemst; or ................................ [] d. receive the promise for life of either payments, benefits or care? ................... 2. If death occurred after December 12,1982,did decedent tmnster property within one year of death without receiving adequate consideration? ............................. ['--'1 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...... ['---1 ~'! 4. Did decedent own an Individual Retirement Account, annuity or other non-probate properly which contains a beneficialy designation? ................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND RLE IT AS PART OF THE RETURN. U,-,G~ perlalties of perjury, I .~..d~.. ~ that I have ex..r,,inad this return, including &,.~..,~,~,-,yirig ~c~,~las and statements, and to the best of my knowledge and belief, it is hue, and complete. Declaration of preparer other than the personal representative is h= _,~d on all ;nfc~,~;,~,, of which F, ,=,,~m =,. has an), kno~.__~;_-. SIGNATURE OF PERSON RESPONSIRI ~ FOR FILING RETURN ADDRESS ~ 17200 West,qrove, Apt. 823, Addison, Texas 75001 SIGNATURE OF PREPAR~ER OTHER THAN REPRESENTATIVE ADDRESS 5 South Hanover Stree~lvania 17013 DATE DATE /..//~/~ For dates of death on or after July 1, 1994 and before Janua,-¥ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. Section 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 0% [72 P.S. Section 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 appticable even if the surviving spouse is the only beneticiery. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child tv~nty--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 0%[72 P.S. Section 9116{a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the deoedent~s lineal beneficiaries is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P.S. Section 9116(a)(1 )]. The tax rata imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. Section 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 blond or adoption. REV-1508 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF Gayle M. Gdssinger FILE NUMBER 21-03-1034 Include ~e proceeds of liflga6on and the date the peoceeds were received by the estate. ALL PROPERTY JOINTLY-OWNED WITH ~-IE RIGHT OF ,SURV~ORSHIP MUST BE DISCLOSED ON SCHEDULE F. ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. DESCRIPTION VALUE At DATE Of DEATH Members 1st Federal Credit Union, C/DrY200186-41 Refund, United Church of Christ Homes Refund, Blue Cross/Blue Shield of AL #XAA174051332 Refund, Capital Blue Cross, Medical Refund, GE Capital Assurance, Long Term Care Refund, GE Capital Assurance Premium Refund, Travelers Insurance, Homeowners Refund 2003 Prorated School Taxes 57,058 1,512 83 99 24O 741 293 295 TOTAL (Also enter on line 60,321 (If more space is needed, insert additional sheets of the same size) MEMBERS 1st FF_,DERAI, CREDIT UNION .REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 200186 -00 12/28/2000 $25.00 $.oo $25.O0 J. Michael Grissinger 1 2/28/2000 CERTIFICATE OF DEPOSIT- Account NumbedSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 200186 -41 1 2/28/2002* $56,946.53 $111.93 $57,058.46 J. Michael Gdssinger 12/28/2002 *Certificate purchased with funds from redeemed joint certificate #200186-40 originally purchased 12/28/2000 MI~BERS 1sT FEDERAL CREDIT UNION Denise A. Wolfe ·// Insurance Superv~or February 13, 2004 Estate of: GAYLE M. GRISSINGER Date of Death: 11/18/2003 Social Security Number: 174-05-1332 5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · wwve. memberslst.org 217 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Gayle M. Grissin,qer 21-03-1034 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. James Michael Grissinger Son 17200 Westgrove, Apt ~823 Addison, Texas 75001 JOINTLY-OWNED PROPERTY: LEI-FER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDENAMEO~FINANCIALIN~TITUTIONANDBANKACCOUNTNUMBERORSlM~AR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOI Nm ID~NTIF-YING NUMBER. ATTACH DEED FOR JOII~TLY4-1ELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1.18.00 Waypoint Bank, C/D #1700015308 45,519 50.00% 22,760 Accrued Interest to Date of Death 146. 50.00% 73 0 2. A 5.5.95 Waypoint Bank, CID #1766268487 50,577 50.00% 25,289 Accrued Interest to Date of Death 162 50.00% 81 0 3. A. 12.28.00 Members 1st, Savings Account ~r200186-00 25 50.00% 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ... TOTAL (Also enter on line 6, Recepitulation) $ 48,21~ (If more space ~s needed, insert additional sheets of the same size) 2/12/2004 LOOK FOR Uq. WE'LL GET YOU THERE. FREY & TILEY 5 S HANOVER ST CARLISLE PA 17013 The information which you requested on the account(s) of GAYLE M GRISSINGER (Social Security Number 1 ~ 74-05-13o2) is/are as follows: Account Number 1700015308 Class of Account CERTIFICATT Date Opened 011800 Principal Balance 45518.90 Accrued Interest 145.86 Balance at Date of 45664.76 Death Account Ownership JTO Name of Joint J MICHAEL Owner, if any GRISSINGER Date Ownership 011800 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established 1766268487 CERTIFICATE 050595 50576.55 162.06 50738.61 JTO J MICHAEL GRISSINGER 050595 Additional Information Requested SENIOR SERVICES REP. RO. Box 171 I. HARRISBUR6. PENNSYLVANIA 17105-1711 Toll Fr~ 1-866-WAYPOINT (I-866.9;~9_7646). IN YORK ARr=A 717/815-4S00 · www. wauoointbank, com st MEMBERS 1" FF. DERAL CREDIT UNION REGULAR SAVINGS ACCOUNT- Account NumbedSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 200186 -00 12/28/2000 $25.00 $.oo $25.00 J. Michael Grissinger 12/28/2000 CERTIFICATE OF DEPOSIT. Account NumbedSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 200186 -41 12/28/2002' $56,946.53 $111.93 $57,058.46 J. Michael Grissinger 12/28/2002 *Certificate purchased with funds from redeemed joint certificate #200186-40 originally purchased 12/28/2000 M~,BERS IsT FEDERAL Denise A. Wolfe ..// Insurance SupervC~or February 13, 2004' Estate of: GAYLE M. GRISSINGER Date of Death: 11/18/2003 Social Security Number: 174-05-1332 5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www. memberslst.org 217 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER Gayle M. Gdssinger 21-03-1034 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVEF DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE'rR.NflSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER 'r~NS~. ATTACH A COPY'OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (~*uc*,~ VALUE 1. Transamerica Life Insurance Co., Annuity 65,00(] 100.00% 65,000 0 2. Real Estate, 30 Garland Court Two, South Middleton Township 135,000 100.00% 135,000 Cumberland County, Pennsylvania 0 0 3. M&T, Checking Account No.38783282 , 33,927 100.00% 3,000 30,927 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ......... TOTAL (Also enter on line 7 Recapitulation) $ 230,927 (If more space ;s needed, insert additional sheets of the same size) November 25, 2003 4333 Ed~ewood Road PO Box 3183 Cedar Rapids, Zow~ $;,406-3153 Michael Grissinger 17200 Westgrove Apt 823 Addison TX 75001 R~: AnnuityN~m~m~(s) 02SP0753336 Dear Michael Grissinger: We have received notification, Gayle M. Grissinger, annuitant of the above listed non-qualified tax deferzed annuity is deceased. 'Our office wishes to extend sincere condolences for your loss. Our records indicate the following annuity information: Annuitant: Owner: Primary Beneficiary(les): Annuity Policy Date: Full Value as of.11-25-2003: Taxable Portion: Full Value as of 11-18-2003: Gayle M. Grissinger Gayle M. Grissinger J. Michael Griss£nger 09-09-2002 $68,447.99 $3,447.99 865,000.00 The attached document reflects the options available to the primary beneficiary(les) listed above. The full value as of the date of death is for tax purposes only and is not a Guaranteed death benefit amount. The attached document contains general tax information based on Transamerica Life Insurance Company's interpretation and should not be relied upon for .your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Id Wdc3£:90 ~'00E Ir 'qa~ : 'ON ){M~ : 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Gayle M. Grissinger FILE NUMBER 21-03-1034 NUMBER 5. 6. 7. 8. 9. 10. Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Ewing Brothers Funeral Home COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Zip Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address c~ty Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees ister of Wills, (5) Short Certificates Checks cleared after Date of Death Estate Checks Register of Wills, Filing Fee State Zip TOTAL (Also enter on line ~ (If more space is needed, insert additional sheets of the same size) AMOUNT 5,800 7,012 248 15 99 25 15 13,214 REV'-1512 EX'+ (6-98) AT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~' RESIDENT DECEDENT ESTATE OF Grissinger SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-03-1034 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Comcast, Cable PP&L, Electricity Spdnt, Telephone Hartzell Eye, M.D. South Middleton Township Municipal Authority, Water PharAmedca, Medical Stonehedge, Maintenance Fees United Church of Christ Homes, Medical Waste Management of Central PA, Trash Removal Judy A. Campbell, Tax Collector, Prorated 2004 County Taxes Refund State Employees' Retirement System from 11/19/03-11/30/03 TOTAL (Also enter on line 10~ Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 2O2 474 357 17 109 148 314 5,355 46 76 374 7,472 217 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Grissin( ;r NUMBER I. 1. II. 1. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] James Michael Grissinger 17200 Westgrove, Apt. 823 Addison, Texas 75001 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) ~on ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOVVN ABOVE ON LINES 15 THROUGH 18~ AS APPROPRIATE~ ON REV-1500 COVER SH~-~- ! AMOUNT OR SHARE OF ESTATE 100% residue of estate NON-TAXABLE DiS¥~iBUTIONS- ~,. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) I, Gayle M. Grissinger, of North Middleton Township, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will previously made by me. I. I direct that all my just debts, taxes and funeral expenses shall be paid from my residuary estate, as soon as practicab after my decease, as a part of the expense of the administration of my estate. II. All the residue of my property and estate, real, per- sonal, and mixed, of whatsoever kind and wheresoever situated, I give, devise and bequeath to my husband, James M. Grissinger, if he survives me by thirty (30) days. III. If my husband does not survive me as aforesaid, I give, devise and bequeath all of the aforesaid residue to my s~n, James ~ichael Grissinger. IV. I appoint my husband, James M. Grissinger, to be Executor, of this, my Last Will. Should my husband, James M.Grissing. fail to qualify or cease to act as ~:ecutor, then I appoint my son, James M'. Grissinger, Executor of this, my Last Will. IN WIT~;ESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will, this ~ day of January !974. Signed, sealed, published and declared the above named Testatrix as for her Last and Testament in our presence, who, in presence, and at her request, and in the presence each other, have hereunto set our hands as attesting witnesses. .e CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: GAYLE M. GRISSlNGER Date of Death: Will No. NOVEMBER 18, 2004 Admin. No. 21-03-1034 To the Register: I certify that notice of (beneficial Interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captiOned estate on: April 6, 2004 Name James Michael Grissinger Address 17200 Westgrove, Apt. 823, Addison, TX 75001 Notice has now been given to all persons entitled thereto under Rule 5.6)a) except NO EXCEPTIONS Date: April 6, 2004 Name: Address: Capacity: Signature Robert M. Frey 5 South Hanover Street Carlisle, Pennsylvania 17013 Personal Representative X Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003788 FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 174-05-1332 FILE NUMBER: 2103- 1034 DECEDENT NAME: GRISSINGER GAYLE M DATE OF PAYMENT: 04/08/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 11/18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $414.00 R'.EMARKS: CHECK# 123 SEAL TOTAL AMOUNT PAID: 9414.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COHNONgEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ROBERT H FREY FREY & TILEY 5 S HANOVER ST t.. CARLISLE PA 1701~' ,.. DATE 05-$1-2004 ESTATE OF GRISSINGER DATE OF DEATH 11-18-200:5 FILE NUNBER 21 0:5-10:54 :~,_~OUNTY CUHBERLAND ACN 101 I Amoun~ Rem~ad REV-15¢7 EX AFP CDi-OS) GAYLE H HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -,~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF GRISSINGER GAYLE HFILE NO. 21 0:5-10:54 ACN 101 DATE 05-:51-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERS.". ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) 2. S~ocks and Bonds (Schadulm B) $. Closely Held S~ock/Par~nmrshlp Zn~eres~ {Schedule C) ~. Not'gages/No,es Receivable (Schedule D) 5. Cash/Bank Deposi*s/Nisc. Personal Propar*y (SchaduZa E) 6. Joln~ly Owned Proper~y (Schedule F) 7. Transfers (Schedule G) 8. To~al Assa~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Cos*s/NAsc. Expenses (Schedule H) 10. Dab*s/Hor~gage Liabilities/Liens (Schedule I) 11. To~al Deductions 12. Na~ VaZue of Tax Ra~urn 15. 1~. NOTE: ASSESSHENT OF TAX: 15. Amoun* of Line 1~ a* Spousal ra~a 16. Amoun~ of L/ne lfi ~axable a~ Lineal/CZass A ra~e 17. Amoun* of L/ne 1~ a~ Sibling ra*a 18. Amoun~ of L/ne lfi *axabla a~ Collateral/Class B rm~e 19. Principal Tax Due TAX CREDITS: PAYHENT / RECEIPT DATE NUNBER 02-17-2004 CD00:5562 04-08-2004 CD00:5788 (1) (2) (3) (~) ($) (6) (7) .. 60t:521.00 48t216.00 2:50~927.00 .00 NOTE: To insure proper .00 crmdi~ *o your accoun*, .00 subm1~ *ha upper portion .00 of ~his form wi~h your ~ax payment. (9) 1:5,214.00 (10) 7~47Z.00 (11) . 339,464.00 318,778.00 696.5:5 .00 1:5,2:54.00 AHOUNT PAID DISCOUNT INTEREST/PEN PAID (-) TOTAL TAX CREDIT I 14,344.5:5 BALANCE OF TAX DUE INTEREST AND PEN. / .00 TOTAL DUE ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR)~ YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. (~5) .00 x O0 = .00 (15) :518,778.00 x 045 = 14,:545.00 (17) . O0 X 12 = . O0 (18) .00 x 15 = .00 (19); 14,:545.00 IF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (12) Charl~abla/Govarnaen~al Bequas~s; Non-elect:ed 911:5 Trusts (Schedule J) (15) . O0 Ne~ Value of Es~a~e Subjac~ ~:o Tax (1~) :518,778.00 Zf an assess;ant ~as issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that lnclude the total of .ALL returns assessed to date. RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class S (collatmral) beneficiaries of the decedent after the expiration of any estate for 1ifa or for years, the Commonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the le.ful Class D (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (TI P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed an the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an -Application for Refund of pennsylvania Inheritance and Estate Tax" (RE¥-1515). Applications ara available et the Office of the Register of Rills, any of the 2S Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050~ services for taxpayers ~ith special hearing and ! or speaking needs: 1-80B-447-3OZO (TT onlY). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as sho~n an this Notice must object ~ithin sixty (60) days of receipt of this Notice by; --written protmst to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z&-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADNIN- [STRATIVE CORRECT[ONS: Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Sureau of Individual Taxes, ATTN: Post Assessment Revia~ Unit, Dept. Z80601, Harrisburg, PA 17128-6601 Phone (717) 767-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: [f any tax due is paid ~ithin three (3) calendar months after the decedent's death, a five percent (SX) discount of the tax paid is alla~ed. PENALTY: The 15Z tax amnesty non-participation penalty [s computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty per[od. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (BX) percent par annum calculated et a daily rate of .000164. All taxes which became delinquent on and after January l, 198Z will bear interest at a rate ahich will vary free calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for 1962 through ZOO4 are: interest Da[ly Interest Daily Intmrast Daily Year Rate Factor Year Rate Factor Year Rate Factor.. ~ ZOX .000548 ~'~-1991 ~ T000301 ~ 9X .000Z47 1983 161 .000438 1991 91 .000247 ZOOZ 61 .000164 1984 llZ .000301 1993-1994 72 .O0019Z 2003 SR .O001S7 1985 132 .000356 1995-1998 91 .000147 2004 41 .O001~O 1986 102 .000274 1999 7Z .O00lez 1987 10~ .000~74 2000 7~ .00019~ --Xntarest is calculated as follows: XNTEREBT = BALANCE OF TAR UNPAID X NUXBER OF DAYS DELXN~UENT R DAXL¥ iNTEREST FACTOR --Any Notice issued after tho tax becomes daXinquent ~i1! refXect an interest calculation to fifteen (15) days beyond tho date of the assessment. If payment is made after the interest computation data sho~n on the Notice, additionaX interest must bo calculated. Name of Decedent: Date of Death: Will No. STATUS REPORT UNDER RULE 6.12 GAYLE M GRISSINGER November 18, 2003 Admin. No. 21-03-1034 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes (X) No ( ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Date: 3. If the answer to No. 1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes ( ) No (). (b) The separate Orphans' Court no. (if any) for the personal representative's account is: (c) Did the personal representative state an account informally to the parties in interest? Yes (X) No ( ) (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. June 7, 2004 Signature Robert M. Frey Name (Please type or print) 5 South Hanover Street Carlisle, Pa 17013 Address (717) 243-5838 Telephone No. cap~ity: ( ) Personal Representative ( X ) Counsel for personal representative STATUS REPORT UNDER RULE 6.12 Name of Decedent: GAYLE M. GRISSINGER Date of Death: November 18, 2003 Will No. Admin. No. 21-03-1034 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes (x) No ( ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes () No ( ). (b) The separate Orphans' Court no. (if any) for the personal representative's account is: (c) Did the personal representative state an account informally to the parties in interest? Yes (X) No ( ) (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: March 3, 2005 ~A. ~ Signature ~ Robert M. Frey Name (Please type or print) '".D (.....",) 5 South Hanover Street Carlisle. Pa 17013 Address (717) 243-5838 Telephone No. Capacity: ( ) Personal Representative ( X ) Counsel for personal representative ~