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02-1138 Register of Wills
Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Frances L. Grimes also known as Deceased Jeffrey L. Hileman and Richard L. Grimes Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) No. 21-02- ~ ~ 3p Social Security No. A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut ors the Decedent, dated 02/09/1995 and codicil(s) dated None Decedent's spouse, Daniel J. Grimes died Sept. 17, 2000 State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: none B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente life; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: or principal residence at 105 Spring Garden Estates, South Middleton Township, Carlisle, PA 17013 (list street, number, and municipality) Decedent, then 67 years of age, died 12/04/2002 at Carlisle Regional Medical Center, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All 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: 70,000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: or printed name and residence /~ (~~ Jeffrey L. Hileman l~~/ 29 Northview Drive, Carlisle, PA 17013 Richard L. Grimes - iii Q~~ ~ 43 Mountain Road, Carlisle, PA 17013 1~, ~~a~- Prepared by the Pennsylvania Ba opyright (c; 1996 form software only CPSystems. Inc. named in the last Will of Form RW-1 (1ss1, (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family 21-02-1138 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed /~~~ Jeffre Hileman before me this /u{ day of _ ~~~~n ~ , ~~~~~ ichard L. Grimes For e Register No. 21- 02 - 1138 Estate of Frances L. Grimes Deceased Social Security No: Date of Death: 12/04/2002 AND NOW, DECEMBER 13, 2002 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters OX Testamentary ~ Of Administration (c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate) are hereby granted to Jeffrey L. Hileman and Richard L. Grimes in the above estate and that the instrument(s) dated 02/09/1995 described in the Petition be admitted to probate and filed of record as the last Will of Decedent FEES ~~ ' Letters . $ 115.00 ,~~i72 e{- ~ _ ~\ egister of Wills Short Certificate(s). .5 $ 15.00 J' /' s ,,c ~~!/`~'G'1/ ,~~ ~~/~~G/!/L Renunciation. $ Attorney: s Robert C. Saidi Affidavits ( ) $ I.D. No: 21458 Saidis, Shuff, Flower & Lindsay Extra Pages ( 4 ) . $ t ~ _ nn Address: 2109 Market Street Codicil . .. $ Camp Hi 11, PA 17011 JCPFee. $ 10.00 Telephone: 717/737-3405 inventory. $ Other $ TOTAL......... $ 152.00 MAILED TO ATTORNEY 12-13-2002 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. Form RW-1 (1991) ~i ~: LAST WILL AND TESTAMENT 21-02-1138 OF FRANCES L. GRIMES I, FRANCES L. GRIMES, of North Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. It is my desire that my remains be cremated and disposed of as my personal representative shall deem appropriate. SECOND I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved Husband, DANIEL J. GRIMES, absolutely and in fee simple if he survives me by thirty (30) days. THIRD SAIDIS, GUIDO, SHUFF & MASLAND 26 W. High Street Carlisle, PA Iii the event that my husband, DANIEL J. GRIMES, fails to survive me by t.h.irty (30} days, then I give, devise and bequeath all the rest, residue and remainder of my estate in equal snares unto my children ar~d step-chi.l d, RICHARD L. GRIMES, D. MICHAEL HILEM~N, KIMBERLY L. ENOS, JEFFREY L. HILEMAN and KAREN S. GRIMES, per stirpes. FOURTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the r~rincipal of my residuary estate. FIFTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in his/her absolute discretion: (a) To retain in the form received, or to sell either at public or private sale any real or personal "s ~a SAIDIS, GUIDO, SHUFF & MASLAND 26 W. High Street Cazlisle, PA property; (b) To exercise any options to subscribe for stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosuz-e of any corporation in which my estate or any trust may hold stocks, b~.~nds or other securities; (d) To sell, transfer, convey, mortgage, pledge, lease or exchange ar~y property, real or personal, which at. any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or dist.r-i_buticn, for such prices and upon sucr. terms as my Lersonal representat=~.~e, in his/her sole c~i.acretion, m~z~' deem w:is°, and to execute and deliver deeds cif cc;r~veyance c-~ t.rans er. t~iereof; {ej To make settlements and compromises on st.lch terms as zny perscral representative in his/her sole discretion may deem wise without the necessity of obtaining any court approval thereof; (f) To make distribution hereunder either in cash or kind, as my personal representative in his/her discretion may deem wise. SIXTH I do hereby nominate, constitute and appoint my husband, DANIEL J. GRIMES, to act as Executor, of this my Last Will and Testament. Provided, however, that if he is unwilling or unable to act as Executor, I direct the duties of Co-Executor, be performed by RICHARD L. GRIMES and JEFFREY L. HILEMAN. SEVENTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, FRANCES L. GRIMES, have hereunto set SAIDIS, GUIDO, SHUFF & MASLAND 26 W. High Street Carlisle, PA my hand and seal to this my Last Wi11 and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for identification, this `~~ = day o~ ~' ,;~ . 1995. FRANCES L. GRIMES Signed, sealed, published and declared by the above-named Testatrix, FRANCES L. GRIMES, as and for-her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, In the presence of said Testatrix and of each other. _ADDRE S S ~,~~' ~. ~.: ~~Y ,' ~'' '" ~ ~ ~ / ~ ~~, ~ ~ N ~~--' cam- ~ _ .tiG-~~ ADDRESS _,7 ~; r--;,~~ :''~~-wC„~~.~~~ ~~~ , T _ ,/r ,, // mac:' SAIDIS, GUIDO, SHUFF & MASLAND 26 W. High Street Cazlisle, PA COMMONWEALTH OF PENNSYLVANIA: SS COUNTY OF CUMBERLAND WE, FRANCES L. GRIMES, ROBERT C. SAIDIS, and Joan E. Smith the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last will and Testament and that she signed willingly and that she executed as her free and voluntary act fog the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witness and that to the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. FRAN L. GRIMES ~~ ~~ Robe C. Saidis, Witness ~~. -'Joan E. Smith , Witness Subscribed, sworn to and ar.knowledged before me by FRANCES SAIDIS, GUIDO, SHUFF & MASLAND 26 W. High Street Carlisle, PA L. GRIMES, the Testatrix, and subscribed to and sworn or affirmed to before me by ROBERT C. SAIDIS, witnesses, this ~, day of ~~, `i` / `" and Joan E. Smith 1995. otary Public vim.. ..e st ~. .- ... ... . _~..x n A~9Y LC...,..:. _ . _, .._,. . _ _ (. ~~ >.' ~ s 1 13. 1997 v`~ REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Frances L. Grimes Date of Death: December 4, 2002 Will No. 1-02~0~"1 Admin. No. To the Register: I certify that notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiary of the above- captioned estate on January , 2003. Name Jeffrey L. Hileman Richard L. Grimes D. Michael Hileman Karen S. Trego (formerly Karen S. Grimes) Kimberly L. Strizzi (formerly Kimbery L. Enos) Address 29 Northview Drive, Carlisle, PA 17013 43 Mountain Road, Carlisle, PA 17013 842 Hillside Dr., Palm Harbor, FL 34683 3450 Peters Mountain Rd., Halifax, PA 17032 200 Mountain Road, Mt. Holly Springs, PA 17065 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none _- i Date: ~ ~~ ~, ~ Ro ert C: Saidis, squire 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: Personal Representative X Counsel for Personal Representative i .~.~',. , ~' __ ~~ . d s~ ~"- w 0 ~ ~ ~ ~ N ~ ~ } > ~ ~ ~ N ~~~ ~ c 32z~m J~.~~a ~ c~ o ~ r- 2 Q N ~ (II U w O ~- O ~- H Cn z J ~ r ~ O Q ~ ~ J ~ W (n ~ m J W ~ ~ ~UU ~o ~ \ `~ V ~y~' it) ~'~;r ~~ ~ ~:~ ...., ~~ t~• •M LAW OFFICES SAIDIS, SNUFF, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 JOHN E. SLIKE TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407 ROBERT C. SAIDIS EMAIL: attorney@ssfl-law.com GEOFFREY S. SNUFF www.ssfl-law.com JAMES D. FLOWER, JR. CAROL J. LINDSAY KIRK S. SOHONAGE THOMAS E. FLOWER LINDSAY GINGRICH MACLAY JACLYN M. SMITH February 28, 2003 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: The Estate of Frances L. Grimes File No. 21-02-1138 Dear Ladies: CARLISLE OFFICE: 26 W. HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL Enclosed is a check in the amount of $4,500.00 representing payment on account of the inheritance taxes in the above estate. Please issue a receipt for payment at your earliest convenience. Very truly yours, SAIDIS, SNUFF, FLOWER & LINDSAY `~ , ,~ ~/' -~'~ Ro~iert C. Saidis ? RCS/sly Enclosure COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002246 SAIDIS ROBERT C ESQUIRE 2109 MARKET STREET CAMP HILL, PA 1701 1 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold __________ -~ ESTATE INFORMATION: SSty: 185-26-1268 FILE NUMBER: 2102-1 138 DECEDENT NAME: GRIMES FRANCES L DATE OF PAYMENT: 03/04/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/04/2002 101 ~ 54, 500.00 TOTAL AMOUNT PAID: 54,500.00 REMARKS: ROBERT C SAIDIS ESQUIRE CHECK#104 INITIALS: AC SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS a> a w ~ o ~~ vo ~ ~0~5 ~,~ ~ A '~ A ` ~ a U ~wzw ~wao . ~= ~z ~, ~ M _ -U~ ~ ~ ~ o ~a u>~~i ~ ~ ~ _ _ c •~ C •L ~UU O LAW OFFICES SAIDIS, SNUFF, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 JOHN E. SLIKE TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407 ROBERT C. SAIDIS EMAIL: attorneyQssfl-law.com GEOFFREY S. SNUFF www.ssfl-law.com CARLISLE OFFICE: JAMES D. FLOWER, JR. 26 W. HIGH STREET CAROL J. LINDSAY CARLISLE, PA 17013 MATTHEW J. ESHELMANt TELEPHONE: (717)243-6222 KIRK S. SOHONAGE FACSIMILE: (717)243-6486 THOMAS E. FLOWER LINDSAY GINGRICH MACL AY JACLYN SMITH REPLY TO CAMP HILL September 4, 2003 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: The Estate of Frances L. Grimes File No. 21-02-1138 Dear Ladies: Enclosed please find an original and two copies of an inheritance tax return in the above estate. Also enclosed is a check for the balance of tax due and the filing fee. Please return atime-stamped copy of the return to our office in the envelope provided. Very truly yours, SAIII~S, SNUFF, FLOWER & LINDSAY ~he11~y~: Yingling, Estate Paralegal /sly ~ J Enclosures t Board Certified by the American Board of Certification in Creditors' Rights Representation ., . OFFICIAL USE ONLY ~ tEV-1500 EX + (6.017) REV-1500 INHERITANCE TAX RETU RN FILE NUMBER COM MONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE RESIDENT DECEDENT 21-021138 DEPT. 280601 HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER E Grimes Frances L. C E DATE OF DEATH (DAM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FRED N DUPLIG D E 12EfNJ~#+ X02 10/22/1935 REGISTER OF WILLS N (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER T X 1. Original l~etum 2. Supplemental Retum 3. Remainder Retum (~ P P B 4. Limited Estate 4a. ~W~drt ~tgQ) Compromise (date of death after 12-12- 2) 5. Federal Estate Tax Retum i P R P I 0 X 6. Decedent Died Testate 7. Begettedt Maintained a Living Trust 0 8. Total Number of Safe Dep (O T K (Attach copy of Will) $fit~ofoe®opy of Trust) E S ~ 9. Litigation Proceeds Received 10. Spousal Poverty Credit ~ 11. Election to tax under Sec. Qd~~PQt death between 12-31-91 and 1-1 -95) (Attach Sch O) THl& SECTION MUST 8E CgMPLE7ED. ALL!. CORRESPONDENC ~~ E & CONFIDENTIAL TAX 1NFCtRMATICIN SHpt1LD BE DIRECi'ED To: P NAME COMPLETE idAILING ADDnESS O N Robert C. Saidis R E R FIRM NAME (If Applicable) 2109 Market St . E N $ Saidis, Shuff, Flower & Lindsa Camp Hill, PA 17011 T TELEPHONE NUMBER 1 3 -3405 1Aeal Estate (Schedule A) (1) None OFFICIAL USE ONLY 2Stocks and Bonds (Schedule B) (2) None 3Closely Held Corporation, Partnership or (3) None Sole-Proprietorship 4Mortgages & Notes Receivable (Schedule D) (4) None R 5Cash, Bank Deposits & Miscellaneous Personal Property (5) 93 , 393.98 - C (Schedule E) A 6Jointly Owned Property (Schedule F) (6) None P ~eparate Billing Requested ~. ~ 7lnter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 25 , 443.62 ~ (Schedule G or L) A T BTotal Gross Assets (total Lines 1-7) (8) 118 , 837.60 ~ 9Funeral Expenses & Administrative Costs (Schedule H) (9) 6 , 3 38.76 N lmebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 4 , 826.29 1TTotal Deductions (total Lines 9 & 10) (11) 11 ,165.05 1~let Value of Estate (Line 8 minus Line 11) (12} 107 , 672.55 13rharitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13} made (Schedules J) 1411et Value Subyect to Tax (Line 12 minus Line 13) (14) 107 , 672.55 C O SEE IMSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M A ~ 15Amount of Line 14 taxable at the spousal tax X A rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (15) 0.00 T 16Amount of Line 14 taxable at lineal rate 107 , 672.55 X .0 45 (16) 4 , 845.26 I O 17Amount of Line 14 taxable at sibling rate X .12 (17) 0 .00 N 18Amount of Line 14 taxable at collateral rate X .15 (18) 0 .00 19rax Due (19) 4 , 845.26 20. 1111x:~C~~h~~i~~I~YC~1AI3~t~U>w~'~`t." . , . p ...'. ,° ~.......,,, .:~......~ ...: . ......... .... ........................ ......................... _ .k~fa. A ..~ ~lkk Q... iL.Q. ~~i AYM1' ; > > B~ SURE Tp ANSWER ALL CtUESTI0N5 ON.~EVERSE SIDE AND TO'R~CHECK MATH < < Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. s-oo) a r 3 Decedent's Complete Address: STREET ADDRESS 105 S rin Garden Estates CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1Tax Due (Page 1 Line 19) 2Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 4,500.00 236.84 (1) 4,845.26 3Jnterest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 4,736.84 zit death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ... .. ...... .. .. ^ 3Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. .... .. .... ^ 4Did 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. 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 o1' preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE P SONRSI EFORFILINGRETURN Jeffrey L. Hileman and Richard L. Grimes $4Z9-o D 29 Northview Dr. n ---------------------------------------------------- 'J/y//~ Carlisle, PA 17013 T SIGNATURE OFPREPARER E`er 1. REPRESENTATIVE Saidis, Shuff, Flower & Lindsay 6 2109 Market St. c~ /~~ A ------------------------------------- l ~~,~~ ~ Cam~Hi11, PA 17011PA 17011 ________________ G T >. F r . _ _ .... ..... _ _ ......... .......... ................................ o dates of death on r o after Jul 1 1994 and befor y e January 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. 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. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% (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 4.5%, 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 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 21x10 forth software only The Lackner Group, Inc. Forrn REV-1500 EX (Rev. 6-00) • REV-1508 EX + (1.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Frances L. Grimes date the pproceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M&T Bank, acct. ~~415715 checking acct. 200.06 2 Waypoint Bank, checking acct. 1903000122 5,258.12 accrued Interest 0.40 3 Waypoint Bank, CD 1953264387 4,369.18 accrued interest 2.09 4 Waypoint Bank, CD 1953264405 2,787.36 accrued interest 0.64 5 Waypoint Bank, CD 1953264406 2,787.36 accrued interest 0.64 6 Waypoint Bank, CD 1953264407 2,787.36 accrued interest 0.64 7 Waypoint Bank, CD 1953264408 2,787.36 accrued interest 0.64 8 Waypoint Bank, CD 1953264409 2,787.36 accrued interest 0.64 9 Waypoint Bank, CD 1956233253 3,127.91 accrued interest 0.70 10 Waypoint Bank, savings acct. 1960002129 6,262.47 accrued interest 1.54 11 Waypoint Bank, CD 1960257196 1,482.57 accrued interest 0.34 12 Waypoint Bank, CD 7100033294 4,002.53 accrued interest 0.51 13 Mobile :Home 42,500.00 ** (estimated value) 14 2001 Ford Taurus 8,500.00 (sale price) 15 Household furnishings 800.00 16 Erie Insurance, refund of unearned premium 55.00 17 U.S. Treasury, thrift savings plan, reed after death 278.39 18 The Sentinel, subscription refund 52.44 19 Sprint, refund 1.04 20 Comcast, refund 58.69 21 Down money for purchase of mobile home - forfeited 2,500.00 ** Note: Mobile home listed for sale, but not yet sold. Executor plans to submit an agreement of sale to support a final value upon execution of the same. TOTAL (Also enter on line 5, (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. 93,393.98 Form REV-1508 EX (Rev. t-s7> REV-J510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS $ MISC. NON-PROBATE PROPERTY FILE NUMBER Frances L. Grimes 12/04/2002 21-021138 This schedule must bra completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE THEIR RELA gnACH A OCUPY OF THE DEED FOR RTEAOL ESTATE FER. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 U.S. Treasury, Federal Retire- 25,413.55 100.00Y 25,413.55 ment, Thrift Savings (kids are beneficiaries - value as of 1/8/03) 2 pension, final payment 30.07 100.00Y 30.07 TOTAL (Also enter on line 7 Recapitl~ation) I 25 , 443 62 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1570 EX (Rev. 1-97) REV-1511 EX+(1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Frances L. Grimes 12/04/2002 21-021138 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. UNERAL EXPENSES: Ewing Bros. Funeral Home 1,428.00 B. 1. DMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) waived Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney's Fees Saidis , Shuff , Flower & Lindsay 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Clairant 4,494.00 Street Address City State Zip _ Relationship of Claimant to Decedent 4. ~ Probate Fees Register of Wills ~ 152.00 5. Accountant's Fees 6. Tax Return I'reparer's Fees 7. ~ Other Administrative Costs Cumberland Law Journal, estate notice 75.00 The Sentinel, estate notice 147.16 Register of Wills, filing fee for return 15.00 PNC Bank, check fee 27.60 TOTAL (Also enter on line 9 Recapitulation) ~S 6 , 338.76 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Forth REV-1511 EX (Rev. 1-s7) r REV-1512 EX + (1-97) SCHEDULEI lA DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Frances L. Grimes 12/04/2002 21-021138 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Spring Garden Estates monthly lot rent ($333 er mo ) 2 664 00 p (Jan. - Aug.) 2 PPL Utilities 253.74 3 Agway Energy, heating oil 120.00 4 Costs to repair car 129.52 5 Waste Management, trash removal 36.02 6 Judy Campbell, tax collector, Spring taxes 106.47 7 Saidis, Shuff, Flower & Lindsay, attorney fees - services prior to death 86.00 8 The Sentinel, advertisement 23.49 9 Dept. of Transportation, vehicle registration 36.00 10 CCS - West Shore Emergency Medical 486.10 11 Car inspection 27.56 12 Lawn mowing 162.50 13 Erie Insurance, premium 145.00 14 Judy Campbell, school taxes 549.89 TOTAL (Also enter on line 10 Recapitulation) ~; 4 , 826 29 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 forth software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-s7) REV-1513 EX + (9-00) COMMONWEALTH SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Frances i,- Grimes i ~ inc~i~nn~ 7l _n~i 1 2st RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. AXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Jeffrey L. Hileman son 1/5 of residue 29 Northview Dr. Carlisle, PA 17013 2 Richard L. Grimes step-son 1/5 of residue 43 Mountain Road Carlisle, PA 17013 3 D. Michael Hileman son 1/5 of residue 842 Hillside Dr. Palm Harbor, FL 34683 4 Karen S. Trego daughter 1/5 of residue 3450 Peters Mountain Rd. Halifax, PA 17032 5 Kimberly L. Strizzi daughter 1/5 of residue 200 Mountain Rd. Mt. Holly Springs, PA 17065 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18 AS APPROPRIATE ON REV 1500 COVER SHEET II. ON-TAXABLE. DISTRIBUTIONS: . SPOUSAL DISTRIBUTIONS UNDER SEC. 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 S 0.00 (It more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Forrn REV-1513 EX (Rev. 9-00) ~• , ~. ~ OFFICIAL C~jHECK No.~$'~ 63 35 - - Marlu(acturers and'rraders Trust Company BUFFALO, N.Y. 14240 G~x+r~rs ~~~ DATE As~~Nribt>~ 91. 20tl~k REMITTER PAY TO THE ORDER OF ~ ~~p ~~~,~,~ $~ . ~~~ , .-, tr.:: per r,,'Y.; ,~ `,: ,r, ~°sa. :~ ~~~~w CUSTOMER REC~kPT RETAIN FORt'YQUR~B~CORDS COpYI - NOS NEGOTI/j-BLE ** THRIFT EAVINOS PLAN March 10, 2003 Robert C. Saidis Attorney a.t Law 2109 Market Street Camp Hill, PA 17011 Thrift Savings Plan National Finance Center P.O. Box 61500, New Orleans, LA 70161-1500 Re: TSP account of Frances L. Grimes, Deceased Dear Mr. Saidis: This answers your letter to our office dated March 3, 2003, requesting information about the Thrift Savings Plan (TSP) account of Frances L. Grimes. The TSP is one part of the retirement system created for Federal employees in the Federal Employees' Retirement Savings Act of 1986. (See 5 U.S.C. §§ 8351, 8401-79.) The TSP is a tax-deferred retirement savings plan similar to those authorized under section 401(k) of the Internal Revenue Code for private sector employees. The TSP began accepting contributions from Federal employees in April 1987 and from members of the Uniformed Services in January 2002. As of the date of death, Ms. Grimes' TSP account balance was $25,413.55 and there were no outstanding loans We hope th_Ls information has been helpful. Sincerely, /~REGINALD G. HARGETT, Chief ""Thrift Savings Plan Operations Branch Wa oint yP BANK LOOK FOR US. WE'll GET YOU THERE. 12/30/2002 SAIDIS SNUFF FLOWER & LINDSAY 2109 MARKETS T C~'IP HILL PA 17011 The information which you requested on the account(s) of FRANCES (Social Security Number 185-26-1268) is/are as follows: GRIMES Account Number 1903000122 1953264387 Class of Account CHECKING CERTIFICATE Date Opened 07/l3/87 03/20/95 Principal Balance 5258.12 4369 18 Accrued Interest 40 . Balance at Date of . 5258 52 2.09 Death . 4371.27 Account Ownership JTO Name of Joint DANLEL SOLE Owner, if an Y GRIIV~S-DECD Date Ownership Was Established. 1953264405 1953264406 CERTIFICATE CERTIFICATE' 03/27/95 03/27/95 2787.36 2787.36 .64 .64 2788.00 2788.00 1953264407 .CERTIFICATE 03/27/95 2787.36 .64 2788.00 1953264408 CERTIFICATE 03/27/95 2787.36 .64 2788.00 SOLE SOLE SOLE SOLE Account Number 1953264409 1956233253 1960002129 Class of Account CERT[FICATE CERTIFICATE SAVINGS Date Opened 03/27/95 09/13/93 12/27/94 Principal Balance 2787.36 3127.91 6262 47 Accrued Interest .64 •70 . 1.54 Balance at Date of D 2788'00 3128.61 6264.01 eath Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established ,dditional iformation equested 1960257196 7100033294 CERTIFICATE CERTIFICATE 12/19/94 11/15/02 1482.57 4002.53 .34 .51 1482.91 4003.04 SOLE JTO SOLE DANIEL, GRIMES-DECD SOLE Sincerely, KA~~h~ OUN SENIOR SERVICES REP. P.O. BOX 1711, HARRISBURG. PENNSYLVANIA 17105-1711 Toll Free 1-866-WAYPOINT (I-866-929-7646) • IN YORK AREA 717/815-4500 • www.waypointbank.com ERIE BRIE INSURANCE EXCHANGE '~ INSURANCE P.O. BOX 1699 ERIE, PA 16530 NAMED INSURED COPY A~ EXCHANG~~. ' D ~ MPmber • Erie Insurance Group CANCELLATION NOTICE ~f ~i~t ~ ~ ~y~ i~iL t~ ~~iJ.. ®• MAIL DATE GS/:?7/ 3 CANCELLATION EFFECTIVE BAL: $55.00 CR POLICY NUMBER Q07 0903676 H 05/22/03 12.01 AM POLICY EFFECTIVE DATE 07/09/02 - PIONEER FAMILY AUTO POLICY STANDARD TIME NAMED INSURED ~n~~~~n~l~lrnu~~~nl~i~n~~~ ESTATE OF FF;ANCES L GRIMES C/0 JEFFREY L HILEMAN AA7638 29 NORTHVIEhf DRIVE CARLISLE PA .17013 WE ARE NOTIFYING YOU THAT THE ABOVE .POLICY IS CANCELLED AS OF THE CANCELLATION EFFECTIVE HOUR AND DATE SHOWN ABOVE. IF WE HAVE BEEN ASKED TO PROTECT OTHER INTERESTS, WE ARE. REQUIRED TO ADVISE THEM OF THIS CANCELLATION. THE REASON FOR THIS ACTION ASSURED DECEASED '~'~~FORMERLY - GRIMES, FRANCES L PREVIOUS BALANCE $.00 UNUSED PREN[IUM $55.00 CR PRESENT BALANCE S55,00 CR REFUND CHECK ENCLOSED 00087 AA7638 GARR GREGORY A G,~RRITY 992EXC 6; OU lll (-11-~~V~l~J~' 1N~ 1~ ~- ~ i~.. L~f-~k C.Uf~F' . ~ 1 X ~~ l Lal'1H 21-02-1138 LAS`i' Y~tILL AtJLs I'ESI'~~1IPNT Or FRANCES L.. GR.IN'f~:S r I, FRANCES L. GRIME'S, OF TaUrt:~1 ,~'ic3dlet:a:~ o~r~;ns?::i~~,. Cumberland County, Pennsylvania, being of sc?u .ci anc: d_.~i~~~~s:i_nc; mind, :memory and understanding, do hereby make a~ublis~h c~;u. declare this as and for my Lac;t Wi.I._l and Tes~ar ~;nt, hf~r-e~~~~ revoking all other Wills and COdic.i.lrs heretofo e made ~y ;re. FIRST I direct the paymeni= of my just debts and e.{penses c~i' my last illness and funeral. from my est~3te as sc3o after my ,~E>.at~~l .;;:; conveniently may be dune. It i:~ my desire tha my r:eni,~~ir:.c be cremated and disposed of as my persor3al repres nt_ative sr~r'_]. dc:e~ appropz-:iate . SEC:(:rli) I give, devise and raequeath a:I1_ *.he resi., resic:3ue <~r.~:E z:emainder of my estate to my he;l.c~ved :tusband, ~ 1~YaI~~].. ::~. G•:;'.]~NG~<:S, absol~itely and in fee si.n~ple if he ~i~.rvi_ves s«e b1~ th_r`:~= 0; C;~17$ THIRll ~~5, GiJIJaO, Fi'[]F~' & F~.'iI..AI~D /. High Strec~ F~-tialc, PA !~ Tci the event that my husband, DZ~NI.EL J. G IMES, fa._i.1 1_:~~~ {I survive me by t.h.irty (30; dayrs, than I give, d v:ise anc,l 1._•;:c{~.e~Zti~. I~ ~! all r_he rest, .residue anf-i remazr;der c~f_ my est =a F > in eq~.7.~:~.1 SI"~d7''::3 I~ i~ unto my f child.rer. and st:el:~- child, R?Ci]AR17 :~_ c ::rt• MI~S, D, M'''~:'H.P,~:i, HI1EA~Au,, KIMBERLY L_ ElVO~>, ,JEF'k'cZEY" I~.. HI7,ENl:l~iv q~[ l(1 K~ RE:~f "~. ~ C~RxME~, per st~rpes . FOC F~ ''H it ~! Ln_i_. ltr_v_ielG .1 ~7~10 LCHR I~UfCf = 7!/~ 711.)~'IH '~.'. L~I,.j I d.izect that any ~:r2c3 all '_nll~r.itt~nr e, ~~st=:atc~, arise transfer taxes imposed upon my est.at.e passing under t}..:. Wi a. ~:); otherwise shall be paid out o:f the pl.-incipa' a= my re.>.i{ai_:=, x_.-,r% estate_ ~i~~Tx In addition to the powers conferred by I I autho;::i.~.c~ ~3n perso;aal representative acting under: this inst ument, in hi_:~/hrar absolute discretion: (a) To retain in the form r.ecei.ved, ar to seal either at public o:r private sal. F: any z-eal c,r per. sonr:.l a "a ~S.~f, ~u~©. ~~UFk' & ~t1 SLAND w. !~ga s,~~~ c~~t>t~, pA p>~opprty; (b) To exer. r. i se any opr_ions t.o sixt~r. -x ibr'~ for stocks, bonds, or other i>:lve:~tn!F~nfit, . (~=) To join i.n any p).an of" I•ease, n ~r.tga:}e, consolidatiorl, exchange, reorg~,rrization c .- orec:3.os,;r_~~ of arll corporation i:l which my €~st-ate or ny trusi: ra~Y- ilol,d stocks, binds or other securities; (d) `ho sell, transfer, convey, mor_t a.ge, p1r~c~c;e, l~pase or. exchange any property, rc,a1 oa:- rsonal., which ait any time may fox'in part of my estate, 1. r.- thA ~r~-~yr~;:e_•,t. of debts oT~ taxes, or for amj ~».lrpose r~~ c.lninisrr•at~Yon o': di st.r.l_b~.ltzcn, ft)r sur}~ pz-icF~r;, and t:ipor ~.=ucYl t~er.i~is nS IP.~r n~~"bOnY_1 reprPSenti~.`~i.JE'', n tl].fi/t";.;:~I ~:f?.i,F.` (.]1:.C.>•,r`',:'_t);!, nti.!p cieen? w_i s t>, anct to exf~r. ; t ~, ,-, -;c1 clai. i_ti~~~r ~ c s~f.c:~~ :, f ::GrLveyan-:~, o_- trarlsYe;: t'.1rr~^c)f r ~ (e) Tc) make ~~ et-tI e[n~i,t~: L.:~d c; c7i:!cir on~~_~ ri~f, ~ ~;. !:i. r.: h term: as my perscral r_eprt.~:er:t~.~.<i~~e `r~~ :rri(~:/~rE:~r r;=,Fle.. ut_,- t~ -~~N~~~~ 1~~~ l~ ~t.HK u~Kr. ~tx ~~iuri~-a ~i,. discretion may deem wise w:ithot.ts- the r~.ei:e~ ~~;:i.ty of: oi:ttai ni_ng any court appr- c~~r~~ l t.hd:~ ,~eo `; (f } To make d_~.,strzbution l~+ereundea _it:her i t ec;;1-i o;r kind, as my persc>na>_ represer_tative in h:i.s/her d.:i s, c:~:-~~t,i.a~~ may deem wise. SIXTH I do hereby nominate, const.itutc~ and appo.' £IANIEL J. GRIMES, to act= as Executor,, of this Testament. Provided, horuever, that _+.f he is u~ to act as Executor, I d.i_x-ect the dut~~es of Ca-- pe.z~formed by RICHARD L. CRIMES and JE:FF'REY L. SEVF;NTH t my hu.sYr.and, Last I~i..I i anal wIl i ng or un-ab1.~a Pcut:or, b~: I1.~EMA1~ _ 1 direct that no p~°i-sotlal r. e~tre.~ent~~ti_ve, c~uarcii.an.,. ~:ru'=t:~-~~ ;, or other fiduciary appointed ur.der_ t:ttis instru ent Cha.1 .'. l ~c~ required to give band for the fa:i.thf:~t:.l performs nre c+f 1~i~e i r ~~ f ~~ f a i, dut:~.es .zn any jurisdiction. ~ ,~I IN WITNESS WHEREOk', I, FR1:IVCES L. GRIMES, have her.eczt^:to ~;r:t= ;~ ;I my hand and seal to this my Last. Wil_1_ and Tec;t: tent, ccr~.s i st:i.r~~~ i i ,~ o~ threc~ (3) typewritten pages, the 1 ~.rst two (2 ~ of wh.i c'1- tJ+~-z,-- I my s.i_gnature in the marg~.n for i_dent.; f-_i cation, this `~~- ~~ day c-w f ~ { 199. [S, GUIDO, ~L1FF ~ -SLANI? - I~ig6 Sorccc urliaiIt., PA FR.~LrTf"E S L .~ -,y,,~c.__.. --_J__ . ___.__ __ _ _ __. -.- . E. ~jS ____ _ i _ ___ t . LS, G~1IDU, TIFF ~ -SLAND . High Street Signed, sealed, pub.Iishec~ ~;~nd df>e~ared by the ~~bo~~~,- x~=a.rri~c:( ~I'e3't".atr' ix, FRANCES L. ~ c+ Gk CN~:S ~~_, and for her T ~s t: W i_:l i <~n~3 '['est:amerit in the pres ence of us, who have here nto subsc~z irfe~d c_,ti names at her request as witnesses thereto, In he px~esenc~, o£ said Testatrix and of each other. `, } .. ;! i /. .~`/ ~ _ - -~ ~, - .. r '7 ~._..._ ~ - ~ ~. ` .. - ~ j _ - _........- --_ ~~-L ._~ ADDF~' I; S S _ _~~ t,~, i =;J _ r. '~' r>.. ~ ' S, GUIDO, ~J~' & SLANb high Sweet ~slc, PA --~-~ -- ~~-~~- +-~ i~ LL.f"11\ l.Vl\I J11~ JLUI h 'COMMONGVEAL'rH QF PENNSYLV~iNIA: SS C:nUNTY OF CUMBERLAND WE', FRANCES L,. GRIMES, ROBERT C. SAIDIS, I-' . d ~1f- nd J<~an F; . Sm:i. t Bx ~~ , the Testatrix and witnesses, respe tivel whc~ y ~er nal,lE.. ar_ e signed to the foregoing or attached instru ent, bF:incj ~_r si::. duly F;worn, do hereby der_Iare tea the undersign d authc:~r.,-]..t~:~ ~:hat~ t:he Testatr_i.x signed and executNd th~~ i.nstrume t as he_r Ll:l:at: Wi..l and Testament and that she rigne~d willingly anc that s? -.e .,~xf:cut:E~~~i as her free and voluntary act for thcz purposes therein e:~~.,re~ ~c;,-;,d I and that each of the witnesses, in the presence and hear,irclc~f the Te:;tatr_ ix signed the Will, as w.i.tness and t t t.o th e l::est, c~ their knowledge the Testatrix was att:he time or more 5,~~'a,-;; ,,~~f I age, of sound mind and under no constraint or u caue i_nflu'enr_e I i i _ ~j FR:~N ' L . G :LMES r ; ~~ Robert C . Sa di s , W 1_trl<: -~ f. _..._ __._.. ~_ Y, .. _ _...._ ___ . ._ Joan F.. Srni . /~ . .. _ I h , W-Lt:n;.yas Subscribed, sworn tc and acF;nowlr~d ed b f g e o e me by E~ F?.~l~,re.]?,~, L • U&IME'~, the Testatrix, and surssr_ribed to t and sNOrn ~.,r.- ~:~ "_E zzme~~ci i tc betore me by ROBERT C'. SAIDI~~, and Joan E S mith _ witnesses, this " ,~~~dal o f _~ ~ ~ ~ ~ -u.~~,~c 9 ~3 5 . : - l/ ~~ ' , , ~ ~ fry _ - ---- -- /.y~__.___. I of ary Pub w.i /T ~ . ^Z -. ..._ ~~"1 E k _ .._ a 1' ~~ r•1V C41 n i -' ~ ~= ~~7 E ~ i ~ ~ I • ~7~~ COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 2 8-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002979 SAIDIS ROBERT C 26 W HIGH STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ---------- ESTATE INFORMATION: ssN: FILE NUMBER: 2102-1 138 DECEDENT NAME: GRIMES FRANCES L DATE OF PAYMENT: 09/05/2003 POSTMARK DATE: 09/04/2003 couNTY: CUMBERLAND DATE OF DEATH: 1 2/04/2002 101 ~ $108.42 TOTAL AMOUNT PAID: REMARKS: ROBERT C SAIDIS ESQUIRE SEAL CHECK#102 INITIALS: AC RECEIVED BY: DONNA M. OTTO S 108.42 DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EK RFP (O1-PS) DATE 10-21-2003 ESTATE OF GRIMES FRANCES L DATE OF DEATH 12-04-2002 FILE NUMBER 21 02-1138 COUNTY CUMBERLAND ROBERT C SAIDIS ~ ACN 101 SAIDIS ETAL Amount Remitted 2109 MARKET ST CAMP HILL PA 17'011 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GRIMES FRANCES L FILE N0. 21 02-1138 ACN 101 DATE 10-21-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) .00 (2) .00 (3) .00 (4) .00 (5) 93,393.98 (6) .00 (7) 25,443.62 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 118,837.60 APPROVED DEDUCTIONS AND EXEMPTIONS: 6,338.76 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 4,826.29 11. Total Deductions (11) 11.165 _ D5 12. Net Value of Tax Return (12) 107,672.55 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) [13) .00 14. Net Value of Estate Subject to Tax (14) 107,672.55 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 107,672.55 X 045 = 4,845.26 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 4,845.26 TAY f_RFf17TS~ DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 03-04-2003 CD002246 236.84 4,500.00 09-04-2003 CD002979 .00 108.42 TOTAL TAX CREDIT 4,845.26 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B [collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check ar money order payable to: REGISTER OF WILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax^ (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, ar by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 CTT 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 shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dapt. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return far a Resident Decedent^ (REV-1501) for an explanation of administratively correctable errors. DISCDUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is 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 period. 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 an this notice. INTEREST: Interest is charged beginning with first day of delinquency, ar nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Oaily Interest Daily Interest Daily Veer Rate Factor Year Rate Factor Year Rate Factor 1982 2D% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUliBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15l days beyond the data of the assessment. If payment is made after the interest computation date shown an the Notice, additional interest must be calculated. ,. - REV-1500 EX + (6.00) REV-1500 INHERITANCE TAX RETURN FILE NUMBER COMMONWEALTH OF PENNSYLVANIA RESIDENT DECEDENT DEPARTMENT OF REVENUE D E C E D E N T OFFICIAL USE ONLY 21-02-1138 DEPT. 280601 COUNTY CODE YEAR NUMBER HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Grimes Frances L. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 12 ~+ p02 10/22/1935 nc eooi~ni Fi Ci iRVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE IN ~. Original Return X 2• C A P B 4. Limited Estate 4a. H P R L X t 7• T EPIO 6. esta e Decedent Died K O T K E S ~ 9. (Attach copy of Will) Litigation Proceeds Received^ 10. Supplemental Return "' ~p~~r~~g[gQi) Compromise (date of death after 12-12- 2~ 5• Begededt Maintained a Living Trust 1 8• (tptlBoioes~py of Trust) Spousal Poverty Credit ~ ~' QA~pINt death between 12-31-91 and 1-1-95) 3RESPgI~i~ENCE & CQttIF`1DENTfAL'C' INFtJRMATIO COMPLETE MAILING ADDRESS P NAME p N Robert C. Saidis R p FIRM NAME (I1 Applicable) 2109 Market St . R s N Saidis, Shuff, Flower & Lindsa Camp Hill, PA 17011 T TELEPHONE NUMBER 1 3 -3405 1Real Estate (Schedule A) ( 1) None 2Stocks and Bonds (Schedule B) (2) None Partnership or oration Held Cor l 3Cl (3) None , p y ose Sole-Proprietorship (4) None 4Mortgages & Notes Receivable (Schedule D) R 5Cash, Bank Deposits & Miscellaneous Personal Property (5) 38 , 500.00 E C (Schedule E) (6) None A 6Jointly Owned Property (Schedule F) P I ~eparate Billing Requested T 7Jnter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None U L Remainder Return (da pri Federal Estate Tax Return Total Number of Sate Depo Election to tax under Sec. 9 (Attach Sch O) DfRECTED TO: OFFICIAL USE ONLY (Schedule G or L) A (J3) 38 , 500.00 BTotal Gross Assets (total Lines 1-7) - O 9Funeral Expenses & Administrative Costs (Schedule H) (9) !;~ ~ ~~. 5~ N 10Jebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1 , 058 . 11Total Deductions (total Lines 9 & 10) (11) 3 r~_,_.~'_ 1~let Value of Estate (Line 8 minus Line 11) (12) 13~haritable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 1~let Value Subject to Tax (Line 12 minus Line 13) (14) C SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES O M T ~ 15Amount of Line 14 taxable at the spousal tax A T rate, or transfers under Sec. 9116(a)(1.2) X .0 0 X A 16Amount of Line 14 taxable at lineal rate X .0 45 T I 17Amount of Line 14 taxable at sibling rate X .12 ~ X .15 N 1J3Amount of Line 14 taxable at collateral rate 19~ax Due 20. X ~"r~'llr~~ ~1~jlµ ~f'fi~ll?A~~ ~~iQ?l,l~l~~'INf~ )4.I~~~~:5?P AEI i^JIVEI~{PAY~~~T > B~'SIJRE TO ANSWER AL1, gUESTI0N5 ON R£VEJ~SE S{DE AND T! TM~ RE1>.~ Musr lae Fnfn ua our~~cn REGISTER OF WILLS (15) .00 0 _ (17) 0.00 (18) 0.00 (19} 1 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) .~ Decedent's Complete Address: STREET ADDRESS 105 S rin Garden Estates CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1Tax Due (Page 1 Line 19) 2Credits/Payments A. Spousal Poverty Credit (1) B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3lnteresUPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4Jf Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. ~ ~' .~ 3 Check box on Page 1 Line 20 to request a refund (4) ~ • v - - 5Jf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 00 0 A. Enter the interest on the tax due. (5A) (5B) . B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT , PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1Did decedent make a transfer and: Yes No X a. retain the use or income of the property transferred; .. .... .. .. X b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest; or ..... X X d. receive the promise for life of either payments, benefits or care? ... .. 2lf death occurred after December 12, 1982, did decedent transfer property within one year of death ^ . without receiving adequate consideration? .. ... 3Did decedent own an "in trust for" or payable upon death bank account or security at his ^ or her death? 4Did 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, Yntll 1-AtiST cAMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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, ...............a ,.....,,.sere nor~aratinn of nraoarer other than the personal representative is based on all information of which preparer has any knowledge. S~O~PERS N,~iESPONSIBLEFORFILINGRETURN Jeffrey L. Hileman and Kichard L. Urimes ti'~u't^-- 29_Northview Dr. - ~,.:,.~-~ Car:[.isle, PA 17013 SIGN EpE,PREPAREROTHERTHANREPRESENTATIVE Saidis, Shuff, Flower & Lindsay i J _ _ 2109 _Market St . ---------- --------------------------- ~'~ ~ .'-- ~ Camo Hill , PA 17011 D r v~//s~~`, A T e G T E For tes 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 3% [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 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [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 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. s-oo) REY-1508 EX + (1-97) SCHEDULE E ~~ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c M~S<r. INHERITANCE TAX RETURN PERSONAL PROPERTY FFCIr1FNT f1Ft?Ff)FNT ESTATE OF FILE NUMBER Frances L. Grimes SS~~ 12/04/2002 21-02-1138 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule p. Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. f -s7) (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8 INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Frances L. Grimes SS~~ 185-26-1268 12/04/2002 21-02-1138 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. UNERAL EXPENSES: B. 1 Zip Year(s) Commission Paid: 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. DMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Street Address City State Zip _ Relationship of Claimant to Decedent Probate Fees Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs Costs involved in sale of mobile home (see settlement sheet) Jeff Hileman, reimbursement for grass mowing PNC Bank, check fee Power wash trailer 85.00 2,151.96 150.00 27.60 70.00 TOTAL (Also enter on line 9 Recapitulation) ~S 2 , 484.56 (If more space is needed, insert additional sheets of the same size) Copyright (c)1996 form software only CPSystems, Inc. Form REV-f 51 ~ EX (Rev. 1-97) RE `1512 EX+(1-97) SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Frances L. Grimes SS~~ 12/04/2002 21-02-1138 Include unreimbursed medical expenses. Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1.97) (If more space is needed, insert additional sheets of the same size) SEI~TLEMENT STATEMENT __ r~ ~ /r~, ~~Dr ~ DATE Sellers: ~'~~.C~~ List # ,1~~`~L' ~/) / ~ J ~ , ~, Job # 0~ ~=~ Buyers: / ~i~~L SELLERS TRANSACTION SALE PRICE ~/$ ~3~_'~~~ . ~r~ LESS Commission: -~lv ~.`~ - UU LESS Payoff: _U LESS Other: LESS Other: _ ~~- .~ LESS Other: ~-~ $ ~^~~ ~ ' L PLUS Proration of Lot Rent: ~~~i ~.'? ~ PLUS Proration of Taxes: .j~7~ `~~ PLUS Other: PLUS Other: PLUS Other: ~ $ DUE TO /FROM SELLERS ~~'• ~ ~y^ ~ ******************************************************** BUYERS TRANSACTION SALE PRICE: Sales Tax: Title Fees: Insurance Closing Fees: Proration of Lot Rent: Proration of Taxes: School .~~/•,~l/ Other Other SUBTOTAL LESS Deposit Received: LESS Amount Financed: TOTAL CREDITS DUE TO /FROM BUYERS _j ~ ~l>ll . ~!U -~ - _ ~~ .yG_ ~ ~L ~iU.~~ ~~~_~ b ~J%7 '~~ $ ~~ ,~ ~ ~'lJ~' ~~ __ $ ~-- ******************************************************** DISBURSEMENTS ~ - SELL "~ - - ~ '4' - SELLE Years County lv ~~ ~` , 1 ~~ / ~ ~/ - f3"(J R ~~~ ~ ~C ~,~rr' n ~~ B YE v COMMONWEALTH OF PENNSYLVANIA Q~EAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INheiFITANCE TAX DIVISION ~ ~ DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX RFP (O1-PS) DATE 01-27-2004 ESTATE OF GRIMES FRANCES L DATE OF DEATH 12-04-2002 FILE NUMBER 21 02-1138 COUNTY CUMBERLAND ROBERT C SAIDIS ACN 101 SAIDIS ETAL Amount Remitted 2109 MARKET ST CAMP HILL PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ ------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03] NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GRIMES FRANCES L FILE N0. 21 02-1138 ACN 101 --------------------- OR DATE 01-27-2004 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( Xl CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule Dl (4) .00 of this fore with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 tax payment. 6. Jointly Owned Property (Schedule F) (6) •00 7. Transfers (Schedule Gl (7) .00 8. Total Assets (g) .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 2,484 .56 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1,058.23 11. Total Deductions (11) 3.542.79 12. Net Value of Tax Return (12) 3,542.79- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 104, 129.76 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate [15) •00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16l 104,129.76 X 045. 4,685.83 17. Amount of Line 14 at Sibling rate (17) • 00 X 12 . 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 - .00 19. Principal Tax Due t19 )= 4, 685.83 TOY f_RFf1TTC• . DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 03-04-2003 CD002246 234.29 4,500.00 09-04-2003 CD002979 .00 108.42 TOTAL TAX CREDIT 4,842.71 BALANCE OF TAX DUE 156.88CR INTEREST AND PEN. .00 7 TOTAL DUE 156.88CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. ++'' 2 , FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" tCR), YOU MAY BE DUEU/~ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) vv RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or Honey order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / ar speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, ar assessment of tax (including discount or interest) as shown on this Notice must object within sixty (607 days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing tc: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (7177 787-6505. 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: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: Tha 15% tax amnesty man-participation penalty is 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 period. 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, 1982 hear interest at the rate of six (6%) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent an and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rata announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .OD0247 1985 13% .000356 1993-1994 7% .000192 2002 6% .OD0164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must 6e calculated. ~~' :.~t +~.:,., REV-?470 Ex ~'i88) . ~ INHERITANCE TAX ~~~~ EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Frances L. Grimes 2102-1138 REVIEWED BY ACN John Kuchinski 101 ITEM SCHEDULE Np, EXPLANATION OF CHANGES E H,I 1 I Forwarded to Post Assessment Review Unit in reference to the reduction to value of the mobile home reported on the original return. Accepted additional deductions. Row Page 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION ! DEPT?~280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX REV-1593 E% pFP (O1-OS) RECORD ADJUSTMENT ROBERT C SAIDIS SAIDIS ETAL 2109 MARKET ST CAMP HILL PA 17011 DATE 01-26-2004 ESTATE OF GRIMES FRANCES L DATE OF DEATH 12-04-2002 FILE NUMBER 21 02-1138 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1593 EX AFP (01-031 ~~ INHERITANCE TAX RECORD ADJUSTMENT ~(~ ESTATE OF GRIMES FRANCES L FILE N0. 21 02-1138 ACN 101 DATE 01-26-2004 ADJUSTMENT BASED oN: ADMINISTRATIVE CORRECTION VALUE OF ESTATE: 1. Real Estate (Schedule Al (1) .00 2. Stocks and Bonds (Schedule B) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule Cl (3) .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 86,893.98 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 25,443.62 8. Total Assets [8) 112,337.60 DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Administrative Costs/ Miscellaneous Expenses (Schedule H) I9) 8,823.32 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 5,884.52 11. Total Deductions [11) 14, 707.84 12. Net Value of Tax Return (12) 97, 629.76 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 97, 629.76 TAX: 15. Amount of Line 14 at Spousal rate (15) . 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 97,629.76 X 045= 4, 393.33 17. Amount of Line 14 at Sibling rate (17) . 00 X 12 = . 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18] .00 X 15 = .0 0 19. Principal Tax Due (19) 4 393 33 TAY CRFT1TTCe , . DATE NUMBER INTEREST/PEN PAID [-) AMOUNT PAID 03-04-2003 09-04-2003 CD002246 CD002979 219.67 .00 4,500.00 108.42 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE • ,. TOTAL TAX CREDIT 4,828.09 BALANCE OF TAX DUE 434.76CR INTEREST AND PEN. .00 TOTAL DUE 434.76CR [ IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~. ;/ PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an ^Application for Refund of Pennsylvania Inheritance and Estate Tax^ (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service far forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY , T0: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is 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 period. INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one C1) day from the date of death to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six C6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1 , 1982 will bear interest at a rate which will vary from calendar yea r to calend ar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ?EV-1470 EX (6-88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 INHERITANCE TAX EXPLANATION OF CHANGES DECEDENT'S NAME FILE NUMBER FRANCES L GRIMES 2102-1138 REVIEWED BY SCOTT ELLISON A N 101 ITEM SCHEDULE Np, EXPLANATION OF CHANGES SCHEDULE ITEM #13 HAS BEEN ADJUSTED TO $38,500.00. Row Pape 1 ~~ . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ~~j~C STATUS REPORT UNDER RULE 6.12 Name of Decedent: Frances L. Grimes Date of Death: December 4, 2002 Will No. 21-02-1138 Admin. No. 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 X b. The separate Orphans' Court No. 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. / / f Date : ~7~-"-' t~ „l1, S~gnatur Name: Robert C. Saidis, Esquire I.D. No. 21458 SAIDIS, SHUFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: Personal Representative (if any) for X Counsel for Personal Representative �-.� COURT OF COMMON PLEAS CUMBERLAND COUNTY, R�ENNSYL�N�� ORPHANS' COURT DIVISION � ° � � o tz� -�, -� !n %� rn � � �� �:� � ,> r- r�� ;.� r�7 r- ;� �7 � �..3 � IN RE: MARIAN E. DEIBERT ,AN INCAPACIT��'���ERSONo ��� i-:7 t-, r, "� -Y� °"� FILLE NO: 21-02-1138 •� �? ' ~3 ..: C'7 ;�.:1 C.J r _ i M1"i „ r_.. _.� � ANNUAL REPORT OF THE GUARDIAN OF THE F�TATE � � 1. INTRODUCTION Pennsylvania Guardianship Association / Brian D. Brooks was appointed the Limited, X Plenary Guardian of the Estate by Decree of Or�han"s Court , Jud�e Dated: 1/13/03 X (A) This is the Annual Report for the period from 1/13/13 to 1/13/14 _ (B) This the Final Report for the period from to and is filed for the following reason: 1. The death of the incapacitated person, Date of Death 2. The guardianship was terminated by the Court by Decree of , Judge, Dated 2. SUMMARY A. State the value of the estate reported on the inventory $ 317,420.27 B. State the value(s) of principle assets at the beginning of the Report Period. (Same as the inventory if this is the first report, otherwise, balance from last report) $ 384.75 C. What is the total amount of income earned during the report period? $ 11,322.57 D. What is the total amount of income and principle spent for all purposes during the report period. $ 10,568.10 E. What are the balances remaining at the end of the report period? 1. Principle $ 2. Income $ 3. Total principle and income $ 1,139.22 � THE ESTATE OF: MARIAN E. DEIBERT 3. ADDITIONAL INFORMATION (If more space is needed, please attach additional pages.) A. Principle 1. How is the principle balance listed above currently invested? (Specify) PAGA CUSTODIAL ACCOUNT 2. Have there been any expenditures from principle during this report period? Yes X No If yes: a. Have al all expenditures from principle been for the sole benefit of the Incapacitated Person? Yes No b. List the purpose and amount of expenditures: SEE ATTACHED ALL TRANSACTION REPORT. c. Was approval received prior to expending principle? Yes X No 3. Were additional principle assets received during this report period that were not included in the inventory or any prior report filed far the estate? Yes X No If yes: a. Was court approval requested prior to receiving additional principle? Yes No b. State the sources and amounts of additional principle received: B. Income 1. State sources of income received during the report period: 1. SOCIAL SECURITY 2. PENSION Total income received during report period: $ 11,322.57 2. How is the income currently invested? (Specify) PAGA CUSTODIAL ACCOUNT THE ESTATE OF: MARIAN E. DEIBERT C. Expenses for Care and Maintenance: (Specify what expenditures were made from the principle and income for the care and maintenance of the incapacitated person) SEE ATTACHED ALL TRANSACTION REPORT D. Other expenditures (Specify any other expenditures not previously reported) E. Guardians Commissions (List the amounts of compensation paid as guardian's commission and state how amount was determined:) Amount Method of Determination Court Approval Obtained $ 1,200 00 12 (a� 100 00 (Yes) No F. Counsel Fee (List amounts paid as counsel fee, and indicate whether Court approval was obtained.) I verify that the foregoing information is true and correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A. S/S 4904. � Date: ��/� rian D. 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Q' Q' �' W W W W W W W ZZZZZZZ W W W W W W W UUUUUU(.� QQ ¢QQQQ C�C�c�C�C�C�C� QQQQQQQ � d � d �a � W � I : : : : : : : Z fA 3 � oic�iu�iao � ui� Z Z N N N N N N N � d Z M � W M � M +��+ �M M M M � �� � W W 0 QC��00�\OCOO\�D�ON � �2 LN � COf� 00 � e- m � � � 0 Z Z � N � W Q Q Q U Z m � _ � O O O N � O N Q � Q d ,, ;,� n � �s rr� + .CQ �:_ � � COURT OF COMMON PLEAS CUMBERLAND COUNTl'`�.,P�NNSY�VA�I� ORPHANS' COURT DIVISION � a � � ,�i � r -� �Ti f.,, ��,, a:� ' �° '� � r,'7 IN RE: MARIAN E. DEIBERT AN INCAPACITATE��I�ON.r �, � c-' �� -�-� � �, _, _... e__ :"�: �� FILLE NO: 21-02-1138 ° � c..� ;,, ��a `� � �.� cn c� ANNUAL REPORT OF THE GUARDIAN OF TH�PERSON� �� 1. 1NTRODUCTION Pennsylvania Guardianship Association / Brian D. Brooks was appointed the Limited, X Plenary Guardian of the person by Decree of Orphan's Court . Jud�e Dated: 1/13/03 X (A) This is the Annual Report for the period from 1/13/13 to U13/14 _ (B) This the Final Report for the period from to and is filed for the following reason: 1. The death of the incapacitated person, Date of Death 2. The guardianship was terminated by the Court by Decree of , Jud�e, Dated For Final Report, omit sections II through IV. 2. PERSONAL DATA Age of the incapacitated person 80 Date of Birth 1/27/33 3. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: MANORCARE, 940 WALNUT BOTTOM RD. CARLISLE, PA 17015 B. The Incapacitated Person's residence is: _`'Vard's own home/apartment X Nursing Home _ Boarding Home /Personal Care Home _ Guardians Home/Apartment _ Hospital or Medical Facility _ Relative's Home (name, relationship and address) C. The Incapacitated Person has lived here since: 6/16/06 If the Incapacitated Person has moved since the last report, state the prior address and reason for move: n . ' Estate of: MARIAN E. DEIBERT D. Name and address of the Incapacitated Person's primary care giver: MANORCARE HEALTH SERVICES 4. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are: SEVERE DEMENTIA, HISTORY OF BREAST CANCER, HYPERTENSION B. Specify what if any, social, medical, psychological and supportive services the Incapacitated Person is receiving: ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY 5. GUARDIAN'S OPINION A. It is the opinion of the guardian that the guardianship should: X Continue Be modified Be terminated The reason for the foregoing opinion is: The need for the guardian continues B. During the past year the Guardian of the Person has visited the Incapacitated Person 4 With an average visit time lasting 15 - 20 minutes . The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Person for the period covered by this Report may be attached to supplement this Report. I verify that the foregoing information is true and correct to the best of my knowledge, information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A. S/S 4904. Date: /(��� rian D. Brooks Pennsylvania Guardianship Association PO Box 7295 Lancaster, PA 17604 717-299-4568