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Home My WebLink About02-0125 PETITION FOR PROBATE and GRANT OF LETTERS' ,a,e o/ 0. also known as To: . . .' Register of ~!lls fqr the ,' ,_ Deceased. County of ~..~Arl~E~&~bnh ~ in the Social Security No. :~ ~ ~ - I~ - ~ ~ I ~' Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age. or older an the execut fi ~ named in the last will of the ab6ve decedent, dated and Codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor; etC.) ' Pecendent was domiciled at death in O_~Arn g, ~,,~' Id. n t~, · - CoUnty, Penn~lv"ia, ~th ~ ~ s la?. family or_principal res~den~at ' . . ~ 0ist strut, numar and muncipality~ .. ~ecenOent,~ the~ ~0 Eears of age, di~ ~~ ~ ~ ' ~l , ~ ~00'l Except as follows, ~edent did not marry, was not ~vorc~d and did not have a child bom or adopted after execution of the will offered for probate; was not the victim of a killing and w~ never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) AI, I personal property $ (If not domiciled'iu Pa.) Personal property in Pennsylvania $ (If not domiciled in. Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: I;s~'lS', 0o0. ~ WHEREFORE~ petitioner(s) respectfully~requ~st(s) the probate of the last will and codicil(s) presented herewith and the grant of letters t~,a~-tt nn ~ .~. theron. (testamentary; administration c.t.a.; administration d.b.n.e.t.a.) OATH OF PERSONAL REPRESENTATIVE' COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~C~.t nn/-~ I ~- ~,a/ f The petitioner(s)above-named swear(s) or affirm(s) that the statements in the foregoing p~tiOn ~e true and co~e~ to the b~t of ~he knowledge ~d belief of petitioner(s) ~d ~at ~ person~ represen. tative(s) of the above 'd~edent peti~oner(s) ~11 Well and truly administer the ~tate a~cording to law. Sworn to or affir~e~ and subscribed be~o~e me this No. 21-2001-125 Estate of ~'~t~ ~-~ ~. ~v ~ ]<'te. ~o, c z---' , Deceased DECREE OF PROBATE AND GRANT OF LETTERS February 4th AND. NOW the reverse side hereof, satisfactory proof having bg:n pr.esented before me, IT IS DECREED that the instrument(s) dated ,~Jl,~ ]~.~ ~-0; ] ~. Q described therein be admitted to probate and filed of record as the last will 2002, in consideration ofthe petition on and Letters are hereby granted to '-~r # c_ ~_, ~/. rO~ ~'1~O Iq/~ I'O,,~'t C~'2.~. FEES Probate, Letters, Etc .......... $ 865.00 Short Certificates(8) .......... $ 24.00 Renunciation ................ $ 'x-Pages (8) $ 24..00 5.00 JCP TOTAL $. Filed . .~e..b..ru..a. ry..: ?.t..~.,~q9.%..~...9.x?..-9.o. Re, stet of Wills Mary Co LeWis ATI'ORNEY ~up. Ct. I.D. No.) ~D~SS PHONE CALL A~fORNEY TPICIA D NAYLOP his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 7913242 No. 2 2oo' Date COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH '. Hen C. Gronkiewicz ,. Male ,. 8 -- 12 -- 9215 , Dec 21~ iOO1 I m umrxano I-. Carlisle I..~rlxsle R~ional Medical Center ;'~ ~'"[='~"' J,t ~ite ( ~CE~NT'S i Longsdorf Way .e~ ' ~ ,,,.~.~ ~u~h Mi~leton e, Pa 17013 Gronkiewicz .cz E Unkno~ Dec. 26, 2001 Gate of Heaven Carlisle, Pa 17013 21-2002-125 LAST WILL AND TESTAMENT OF HENRY C. GRONKIEWICZ 21-2002-125 I, HENRY C. GRONKIEWICZ, of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, and hereby revoke all former Wills and Codicils made by me. FIRST: I direct that the expenses of my funeral and burial, including a suitable grave site, marker and perpetual care, be paid out of my estate, in such amount as my executor may deem proper. SECOND: I direct that all estate, inheritance, succession or transfer taxes shall be paid by my executor out of the principal of my residuary estate. THIRD: I give, devise and bequeath all of my tangible personal property, including, but not limited to clothing, pictures, books, furniture and automobiles, to my children who survive me in equal shares. ~f my children shall fail to agree on the division of said property, it shall be divided as my executor shall determine. FOURTH: I give an amount equal to 7.5% of my gross estate to construct a suitable addition or room to St. Patrick School in Carlisle, PA. My desire, but not my demand, is that this addition be made so that a suitable art room will exist for the students of St. Patrick School and for St. Patrick Parish. My son and primary executor, Bruce V. Gronkiewicz or his assiDnee shall oversee that this charitable purpose is accomplished. The room for which this money is used shall bear a permanent marker that states that this Dift is made by Henry C. Gronkiewicz in lovinD memory of my life's partner and best friend, VirDinia A. Gronkiewicz. The room shall be a permanent expression of her faith in God and her hope for the future throuDh children. If such addition is not needed or appropriate at the time of my death, I order my executor to use his discretion in determininD an appropriate expression of my wife's memory throuDh this Dift to St. Patrick School. FIFTH: I Dive, devise and bequeath all of the rest, residue and remainder of my property and estate, of whatever kind and wherever situated and to which I may be in any manner entitled at the time of my death, to my children who shall survive me, in equal shares, provided, however, that if Earl S. Gronkiewicz and/or Bruce V. Gronkiewicz shall fail to survive me, the share which would have been distributable to such deceased named child shall be distributed to his issue who shall survive me, per stirpes. Under no circumstances are the children of Dean H. Gronkiewicz to be beneficiaries under this will or under the intestate laws. If my son Dean H. Gronkiewicz is not livinD at the time of my death, any share which he would have received under this will or in any manner from my estate, will lapse and the amount he would have received shall Do to my survivinD sons, or to their issue per stirpes if either of my said sons does not survive me. Without placing any legal obligation on Earl S. Gronkiewicz and Bruce V. Gronkiewicz, it is my hope that they wlll use thls legacy to pay for the educational needs of each's children. SIXTH: In the event that any beneficiary has not reached the age of 30 at the date of my death, said beneficiary's interest shall be held and administered in trust to be used exclusively for their health, maintenance and education. The Trustee is hereby empowered to pay out such sums as he in his discretion sees fit to provide for the health, support, maintenance and education of the beneficiaries. The trustee shall have the authority to do the following: To hold, manage, invest and reinvest the principal so received, and accumulation of income thereon, and to use, pay and apply the income and the principal or so much thereof as in trustee's sole discretion may be necessary for the maintenance, support, health and education of the beneficiaries. Payments authorized by this trust may be made by the trustee directly to the beneficiary, or may be made directly to the person having custody and care of said beneficiary, or may be made to any institution entitled to such payment by reason of services rendered or to be rendered to said beneficiary. The amount to be paid for the benefit of the beneficiaries shall be determined from time to time by my trustee and the amounts and times of said payment shall be determined by such need. Ail payments of principal and income hereby given shall be free from anticipation, assignment, pledge or obligations of the beneficiary, and shall not be subject to any execution or attachment. Ail principal and accumulated income, not otherwise applied shall be distributed in equal shares to the beneficiaries and the trust terminated according to the following procedure: 1/3 of the trust estate at age 21; 1/2 of the remaining balance of the trust estate at age 25; the entire balance of the trust estate at age 30; 5. Any income or discretionary principal payment due to any beneficiary hereunder which the trustee determines the beneficiary is unable to properly administer shall be made in any one or more of the following ways: a) to the legal guardian or conservator of the beneficiary; b) to a relative or friend of the beneficiary, to be expended for the beneficiary; c) to a custodian for a minor beneficiary under any Uniforn Gifts to Minors Act; or d) by making direct expenditures for the beneficiary. 6. No interest under this will shall be assignable by any beneficiary or be subject to the claims of his or her creditors, including claims for alimony or separate maintenance. SEVENTH: No person hereinabove named or described in this will shall be deemed to have survived me unless said person is living on the thirtieth day after the day of my death. EIGHTH: 1. The trustee may resign by giving thirty days' written notice to the alternate trustee described in section tenth below. 2. If the trustee and alternate trustees cease to act, then Orrstown Bank shall be successor trustee. 3. If the trustee is merged with or transfers substantially all of its assets and business to another corporation, or is in any manner reorganized or reincorporated, then the resulting or transferee corporation shall be the trustee. 4. As often as the trustee deems such action to be advantageous to any trust or any beneficiary, it may, by written instrument, resign and appoint as substitute trustee any bank or trust company, wherever situated. The substitute trustee shall have all the powers and discretions of the trustee, but shall exercise the same under the supervision of the trustee. The trustee may remove the substitute trustee at any time and reappoint itself as trustee. 5. The trustee shall consolidate and hold as a single trust property held hereunder and property held under another trust if the beneficiaries and the terms of both trusts are the same. 6 The trustee shall have the same powers as the executor under section eleventh. NINTH: I appoint the following as Executor in the order named. If for any reason the first named fails to qualify or ceases to act, then the next named shall act and be considered as my Executor: 1. 2. 3. BRUCE V. GRONKIEWICZ, My Son EARL S. GRONKIEWICZ, My Son DEAN H. GRONKIEWICZ, My Son TENTH: I appoint JOHN C. OSZUSTOWICZ, trustee of the trusts created by this will. If for any reason he fails to qualify or ceases to act as trustee, I appoint BRUCE V. GRONKIEWICZ as trustee. ELEVENTH: 1. I direct the executor to pay out of my estate passing hereunder, after satisfaction of the gifts made in sections Third and Fourth, all expenses of administering my estate and all estate, inheritance, transfer, and succession taxes other than a tax on a generation-skipping transfer which is not a liability of my estate (including interest or penalties, if any) which become due by reason of my death. I waive on behalf of my estate any right to recover from any person, including any beneficiary of insurance upon my life, any part of such taxes. 2. I give the executor the following powers and discretions, in each case to be exercised without court order; A. To sell at public or private sale, to retain, to lease, to borrow money and for that purpose to mortgage or to pledge, all or part of the real or personal property of my estate; B. To settle claims in favor of or against my estate; C. To exercise or not to exercise any election or option granted to executors by the Internal Revenue Code in force at my death, even though such exercise or non-exercise increases or decreases estate principal or income, without adjustment to principal or income; D. To distribute the residue of my estate in cash or in kind or partly in each, and for this purpose the determination of the executor as to the value of any property distributed in kind shall be conclusive; and, E. To execute and deliver any deeds, contracts, mortgages, bills of sale or other instruments necessary or desirable for the exercise of his powers and discretions as executor. F. To invest in any securities in which a prudent person would invest, but not being restricted to "legal investments" TWELFTH: If all of my children predecease me without leaving descendants, or if the trust is to be distributed by this section, I give the residue as follows: According to the intestate laws of Pennsylvania. THIRTEENTH: I direct that no surety be required on the official bond of my executor, guardian or trustee. IN WITNESS WHEREOF, I have hereunto signed my name and my seal, this ~DT~ day of~/~ , 1999 at affixed Carlisle, Pennsylvania. HENRY C. GRONKIEWICZ The foregoing instrument, consisting of ~ pages, this page included, was signed, sealed, published and declared by HENRY C. GRONKIEWICZ, the testator above named, as and for his last will and testament, in our presence and in the presence of each of us, and we, at the same time at his request, in his presence, and in the presence of each other, have hereunto signed our names as witnesses thereto, believing the said HENRY C. GRONKIEWICZ to be of sound mind and memory and under no duress, undue influence, or coercion at the time of so signing, the day and year first above written. residing at ~7~ ~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND: SS: Subscribed, sworn to and acknowledged before me by HENRY C. GRONKIEWICZ the testator, and subscribed and sworn to before as witnesses. ~.i~ ~ day of ~/~ . ~.~. Notary Public My Commission Expires: Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Henry C. Gronkiewicz Date of Death: December 21 , 2001 Will No. 2002-001 25 Admin. No. 21 -02-01 25 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Omhans' Court Rules was 2/21/02 served on or mailed to the following beneficiaries of the above-captioned estate on ' Name Address Bruce V. Gronkiewicz 1209 Stratford Dr.t Carlisle, PA 17013 Dean H. Gronkiewicz 16207 Breckinmore Ln.t Tampa, FL 33625 21108 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: March 12, 2002 Signature Name John C. Oszustowicz Address 104 S. Hanover St. Carlisle, PA 17013 ~lephone(71U 243-7437 Capacity: __ 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 001634 NAYLOR TRICIA D 104 S HANOVER STREET CARLISLE, PA 17013 ........ fotd ESTATE INFORMATION: SSN: 388-12-9215 FILE NUMBER: 2102-01 25 DECEDENT NAME: GRONKIEWlCZ HENRY C DATE OF PAYMENT: 09/19/2002 POSTMARK DATE: 03/21/2002 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/21/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $70,000.00 REMARKS: TRICIA C NAYLOR TOTAL AMOUNT PAID: 970,000.00 SEAL CHECK# 107 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUFIEAU OF INDIVIDUAL TAXES DEPT.'280601 HAR-ISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REVal 162 EX(11-96) CD O0O985 SHADE WAYNE F 53 WEST POMFRET ST CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 174-20-3118 FILE NUMBER: 2101 -0125 DECEDENT NAME: RUPP LEONA F DATE OF PAYMENT: 03/21/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/23/2001 ACN ASSESSMENT CONTROL NUMBER 101 AMOUNT $70,000.00 TO' REMARKS: WAYNE SHADE ESQUy / CHECK//107 INITIALS: AMOUNT PAID: JA SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS $70,000.00 REGISTER OF WILLS Received of Address page No. Estate No. ~ Estate of ~.. Social Security No. ~ Died /----oD, ~ _ C:> I Paid postmark Date ROW770 Daily Inheritance Tax Receipt Register For 9/19/2002 Receipt Receipt File Decedent Receipt Date No No Name Distribution Amount 9/19/2002 985 V 2001-00125 RUPP LEONA F .00 , IN~ TAX DUE 70,000.00- 9/~9/2002 1634 D 2002-00125 GRONKI~ICZ ~ENRY C 70,000.00 INH TAX DUZ 70,000.00 Daily Totals: Deposit $.00 $70,000.00- Cesh ..... $.00 Direct Deposit Checks .... $7~,000.00 ~nterest . . . $.00 Bank Adjustment $.00 Voids .... $70,000.00- Total ..... $.00 Credits .... $.00 Void Amount 70,000.00- Cheek Number 107 Page 1 -- Transactions -- 912-0 INH TAX DUE .00 ** Distribution ** -- ~ayees -- ~02 BUREAU OF REOEIPTS & CNTR M.D. ROW770 Receipt Date 9/19/2002 9/19/2002 Receipt File No No 985 V 200~-00125 1634 D 2002-00125 Cash ..... $.00 Checks .... $70,000.00 Daily Inheritance Tax Receipt Register For Decedent Name RUPP LEO~A F .00 ZN'~ TAX DUE ?0,000.00~ ~RONKIEWICZ HENRY C INH TAX DU~ 9/19/2002 Daily Totals~ Distribution Amount 70,000,00 70,000,00 Deposit · . · $.00 Direct Deposit $70,000.00 Interest . . . $.00 Bank Adjustment $.00 Voids .... $70,000.00~ Total ..... Credits .... $.00 V~id Amount 70,000.00- $70,000.00- Cheek Number 107 Page I '- Transactions 912-0 INH TAX DUE .00 ** Distribution ** -- Payees -- ~02 BUREAU OF RE~RIPTS & CNTR M.D. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-I O0 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 _ 02 00125 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Gronkiewicz, Henry C. DATE OF DEATH (MM-OD-YEAR) ~ DATE OF BIRTH (MM-DD-YEAR) 12/21/01 j 1 1/18/15 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURFrY NUMBER 388-12-9215 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [] 1. Original Return [] 2. Supplemental Retum E] 3. Remainder Return (dab ~deahl0d(r ID 12-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (da~e (~ a~ah aM ,2-12~) [] ~. Federal Estate Tax Return Required J'~ 6. Decedent Died Testate (Aua~ copy o~ w~) [--1 7. DenedentMaintainedaLivingmrust{~c~c~wo~T~u=~) . O 8. Total Number of Safe Beposit Boxes [] 9. U6galion Proceeds Received ['-'] 10. SpousalPovedyCredit(daleofdoahbe(ween12.3~.9, md,4e5) O 11. Election totaxunder Sec. 9113(A)(Afl~chSchO) THI~ SEC'i-ION MUST BE COMPLI= I B::D. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE NAME Tricia D. Naylor FIRM NAME (rrAmtca~e) COMPLETE MAILING ADDRESS 104 S. Hanover St. Carlisle, PA 17013 Law Office of John C. Oszustowicz TELEPHONE NUMBER (717) 243-7437 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Join~ Owned Property (Schedule F) (6) L.~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Uens (Schedule I) (10) 11. Tetal Deductions {total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 0.00 298,339.971 0.00 0.00 1,154,111.59 1,860.46 66,434.36 (8) 1,520,746.38 131,204.54 8,999.49 (11) (12) 140~204.03 1,380,542.35 (13) 0.00 (14) 1,380,542.35 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxabie at the spousal tax rata, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Une 14 taxable at lineal rote 17. Amount of Une 14 taxable at sibling rote 18. Amount of Une 14 taxable at collateral rate 19. Tax Due ....... x .0 (15) ....... _1,~38_0.,542.35 x .o 4~55_ (16) x .12 (17) x .15 (18) 62,124.41 (19) 62,124.41 Decedent's Complete Address: S r ~b~-T ADDRESS 1209 Stratford Drive C~TYCaflisle IsTATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ....... 70~,000._0_0_ C. Discount --3,_106.~2 (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D * E ) . (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 62,124.41 73,106.22 10,981.81 (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......... [] [] d. receive the promise for life of either payments, benefits or care? ................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons demtion? ..................... [] [] 3. Did decedent own an "in ffust for" or payable upon death bank account or secudty at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ' [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under p~..-.c.T.~, of pet'S, I ~,~,c~e that I have ~,~,;,,ed Ibis return, ktcluding accu,~,~mying schedules taxi statements, and to the best of my knowfl~ge and belief, it is I~ue, correct and compS. Declaration of IX~l~ o~e~ Ihan the personal repmsentaO~e is besed on all i~foema~on of wh~ preparer has any knoMedge. OF PERSON RESP.C)NSI. BLE FOR_FILING RETURN /~:,..~ DATE ...... .................. ....... 12t~_StraUord Dr=.,_Car!isle, pA__ 17_01~ 104~$. HanoYer St., Carli$1~5'D~h.q'7013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survMng spouse is 3% [72 RS. 89116 (a) (1.1)(i)]. For dates of death on or after January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 89116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax tatum am 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 Eom 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 RS. §9116(a)(1.2)]. The tax rate imposed on the net value of tmnsfere to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. {9116(1.2).[72RS. {9116(a)(1)]. The tax rate imposed on the net value of transfers Io or for the use of the decedents siblings is 12% [72 RS. {9116{a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at leasl one parent in common with the decedent, whelher by blood or adoption. REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Henry C._ SCHEDULE B STOCKS & BONDS .&Il property Jolntly-ovmed ~ right of suwivorshlp must be disclosed on ~.~bedule F. ITEM NUMBER DESCRIPTION 1. See Attached Continuation Schedule FILE NUMBER 71 _~ ~_~'1~ 1 VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) $ 298,339.97 (if more space is needed, insmt additional sheets of the same si~e) Estate of: Henry C. Gronkiewicz Continuation Schedule for. File Number. 21-02-00125 Schedule B - Stocks and Bonds Item Number Description For securities, give CUSIP number Unit Price Value at date of death 1 20 shares of Agere CIA 2.06 81.62 (CUSIP 00845V100 ) Common Stock 2 Agere CL A Cash In Lieu Common Stock 3 513 shares of Agere CL B (CUSIP 00845V209 ) Common Stock 4 Agere CL B Cash In Lieu Common Stock 5 300 shares of AOL Time Warner (CUSIP 00184A105) Common Stock 6 435 shares of AT&T Corp (CUSIP 001957109) Common Stock 7 139 shares of AT&T Wireless (CUSIP 00209A106) Common Stock 8 300 shares of American Express (CUSIP 025816109) Common Stock 9 186 shares of General Electric (CUSIP 369604103) Common Stock 10 810 shares of International Business Machine (CUSIP 459200101) Common Stock 11 1940 shares of Lucent Technologies (CUSIP 549463107) Common Stock 12 150 shares of Merck & Co (CUSIP 589331107) Common Stock 13 Dividend on Merck & Co. Stockholder of Record 12/5/01 Payable 1/23/02 Common Stock 14 1143 shares of Motorola Inc. (CUSIP 620076109) Common Stock 15 Dividend on Motorola Inc. Stockholder of Record 12/12/01 Payable 1/15/02 Common Stock 2.77 1.99 2.85 15.55 9.585 37.165 29.225 69.59 2.41 50.475 14.75 3.72 2097.14 1.03 9676.50 7869.15 1845.92 10263.00 7657.62 99310.05 9776.72 8979.75 52.50 17356.46 45.72 16 200 shares of Philip Morris Cos. (CUSIP 718154107) Common Stock 17 Dividend on Philip Morris Cos. Stockholder of Record 12/20/01 Payable 1/10/02 Common Stock 18 176 shares of Qwest Communications (CUSIP 749121109) Common Stock 19 213 Verizon Communications (CUSIP 92343V104) Common Stock 20 580.121 shares of Fidelity Fund #2AW-522660 (CUSIP 316153105) Common Stock 21 758.786 shares of Fidelity Magellan fK2AW-522660 (CUSIP 316184100) Common Stock 22 Series HH U.S. Savings Bond M02242580 Issued July 1984 23 Accrued Interest on #22 24 Series HH U.S. Savings Bond M02242581 Issued July 1984 25 Accrued Interest on #24 26 Series HH U.S. Savings Bond M02242582 Issued July 1984 27 ^ccrued Interest on fY26 28 Sedes HH U.S. Savings Bond M02242583 Issued July 1984 29 Accrued Interest on #28 30 10 units of Balcor Realty Investors 84-11 31 Accrued Interest and Dividens on #30 53.625 4.62 40.30 25.05 88.52 28.14 Total 9252.00 116.00 2465.76 10218.68 16655.27 78777.16 1000.00 320.00 1000.00 320.00 1000.00 320.00 1000.00 320.00 281.40 276.80 298339.97 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Henry C. Gronkiewicz PERSONAL PROPERTY FILE NUMBER 21-02-00125 Inctude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH See Attached Continuation Schedule TOTAL (Also enter on line 5, Recapitulation) -' 1,154,11'~.59 (if more space is needed, insert additional sheets of the same size) Estate of: Hen~ C. Gronkiewicz Continuation Schedule for: File Number: 21-02-00125 Schedule E - Cash, Bank Deposits, & Misc. Personal Property Item Number Description For securities, give CUSIP number Value at date of death 1 15,000 Household Bk Certificate of Deposit 15025.35 (CUSIP 441800M89) Matured 1/28/02 6.85% 2 Accrued Interest on Item #1 3 30,000 Greenwood Tr Certificate of Deposit (CUSIP 39739CFC8) Matured 2/4/02 6.70% 4 Accured Interest on Item #3 5 30,000 MBNA Amer Bk Certificate of Deposit (CUSIP 55264DCS3) Matured 5~3/02 6.70% 6 Accrued Interest on Item #5 7 20,000 Conseco Bk Certificate of Deposit (CUSIP 20846XTH6) Maturity 7/5/02 4.10% 8 Accrued Interest on Item #7 9 24,000 Washington Bk Certificate of Deposit (CUSIP 940615AZ0) Matudty 12/6102 6.65% 10 Accrued Interest on Item #9 11 15,000 Providian Bk Certificate of Deposit (CUSIP 74407CLZ8) Maturity 1/27/03 6.95% 12 Accrued Interest on Item #11 13 30,000 MBNA Amer Bk Certificate of Deposit (CUSIP 55262W7L4) Matudty 2/3~03 6.95% 14 Accrued Interest on Item #13 15 15,000 First Business Bk Certificate of Deposit (CUSIP 31938QBG8) Maturity 3/7/03 5.25% 416.63 30057.90 776.47 30132.6 264.33 20073.40 379.67 24335.04 65.59 15249.30 422.71 30372.90 805.44 15149.55 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Accrued Interest on Item #15 45,000 Greenwood Tr Certificate of Deposit (CUSIP 39739CKM0) Maturity 6/2/02 7.25% Accrued Interest on Item #17 10,000 Alliance Bk Certificate of Deposit (CUSIP 018533AC3) Matudty 7/7/03 4.50% Accrued Interest on Item #19 9,000 Providian Bk Certificate of Deposit (CUSIP 74407MC J2) Maturity 12/8/03 6.55% Accrued Interest on Item #21 15,000 Providian Bk Certificate of Deposit (CUSIP 74407FL40) Maturity 1/26/04 7.00% Accrued Interest on Item #23 30,000 Providian Bk Certificate of Deposit (CUSIP 74407F3V0) Matudty 9/27/04 6.75% Accrued Interest on Item #25 30,000 Providian Bk Certificate of Deposit (CUSIP 74407F4M9) Matudty 10/4/04 6.70% Accrued Interest on Item #27 39,000 Amedcan Bk Certificate of Deposit (CUSIP 027789YY6) Maturity 12/6104 6.60% Accrued Interest on Item ~r29 15,000 First USA Bk Certificate of Deposit (CUSIP 337434D92) Matudty 1/26/05 7.10% Accrued Interest on Item #31 30,000 American Bk Certificate of Deposit 226.54 178.77 10069.30 208.36 92O4.48 24.23 1 5405.30 425.75 30830.10 471.58 30816.30 429.53 39794.82 105.78 15283.50 431.84 30224.10 (CUSIP 027789H90) Maturity 3/7/05 5.45% 34 Accrued Interest on Item #33 35 60,000 First USA Bk Certificate of Deposit (CUSIP 33744HBE3) Maturity 12/6/05 6.65% 36 Accrued Interest on Item #35 37 24,000 Discover Bk Certificate of Deposit (CUSIP 25467BEY0) Matudty 12/7/05 7.00% 38 Accrued Interest on Item #37 39 60,000 Key Bk Certificate of Deposit (CUSIP 493066BU7) Matudty 1/31/06 5.80% 40 Accrued Interest on Item #39 41 60,000 Fireside Thrift Certificate of Deposit (CUSIP 318233CN1) Maturity 3/7106 5.50% 42 Accrued Interest on Item ~41 43 Legg Mason Money Market 44 Accrued Interest on Item #z13 45 Bank of Amedca #1:)02030523096 Checking Acct. 46 Accrued Interest on Item #-45 47 Bank of America #003916867460 Checking Acct. 48 Accrued Interest on Item #47 49 Bank of America #003923626377 Money Market 50 Accrued Interest on Item ~19 51 Orrstown Bank Certificated of Deposit #5060066141 52 Auto insurance refund 53 Blue Shield refund 54 Northwestern Mutual Policy -insurance on the life of Dean Gronkie~ 335.96 60891.00 163.97 24804.48 64.44 60157.80 1363.40 60782.40 949.32 38897.05 35.78 40775.92 6.74 1232.34 0.03 65899.57 11.30 387555.07 3345.87 15.18 2364.34 55 56 57 58 #5531030 No~hwes~m Mutual Policy-insumnce onthelifeof Earl Gronkiewicz #5302165 Northwestern Mu~alPolicy-insumnce onthelifeof Bruce Gronkiewicz #5122403 Miscellaneous Personal Property 2001 Federal Individual Income Tax Refund Total (Also enter on line 5, Recapitulation) 6631.45 11024.02 5000.00 14147.00 1154111.59 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Henry C. Gronkiewic2 SCHEDULE F JOINTLY-OWNED PROPERTY I FILE NUMBER 21-02-00125 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 A. Mary F. Gronkiewicz ADDRESS 1209 Stratford Dr. Carlisle, PA 17013 RELATIONSHIP TO DECEDENT daughter-in-law JOINTLY-OWNED PROPERTY: LETTER OATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MAD~ INCLUDE NAM~ OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DGATH D~CD'S VALUE OF NUId~ERTENANT JOINT IDENTIFYING NUP''r ~ ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 4/14/9) Orrstown ~nk Checking Account 3719.62 50% 1859~83 2. A 4/14/9) Accrued Interest on #1 1.30 50% .65 TOTAL (Also enter on line 6, Recapitulation) $ I 8 6 0.4 6 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMON--TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Henry C. Gronkiewicz SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-02-00125 This schedule must be completed and filed if the answer to any of questions 1 through 4 o~ the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPER'P( ITEM INCLUDETHE NAMEOF1TtEIRANSFEREE, THEIR RELAllOfl.~TO DECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACHACOPYOt:THEDEEDFORREALESTATE. VALUE OFASSET INTEREST ~:,*~UC..~a.g~ VALUE 1. See Attached Continuation Schedule TOTAL (Also enter on line 7 Recapitulation) $ · 66,434.3 (If mom space is needed, insert additional sheets of the same size) Estate of: Henry C. Gmnkiewicz Continuation Schedule for: Schedule G - Inter-vivos Transfers & Misc. Non-Probate Property ~tem Description Number For securities, give CUSIP number Date of Death % of Decds Taxable Value of Asset Interest Exclusion value 1 367.468 shares Strong Growth Fund to Brian 6434.36 100% 3000.00 Gronkiewicz, grandson of decedent, transferred 1/23/01 (CUSIP 862916103) 2 $10,000 to Earl Gronkiewicz 10000 .100% 3000.00 son of decedent, transferred 1/23/01 3 $10,000 to Pat Gronkiewicz 10000 100% 3000.00 of decedent, transferred 1/23/01 4 $10,000 to Mary F. Gronkiewicz 10000 100% 3000.00 of decedent, transferred 1/23/01 5 $10,000 to Mary C. Gronkiewicz 10000 100% 3000.00 son of decedent, transferred 1/23/01 6 $10,000 to Dean Gmnkiewicz 10000 100% 3000.00 son of decedent, transferred 1/23/01 7 $10,000 to Laura Gronkiewicz 10000 100% 3000.00 of decedent, transferred 1/23/01 8 $10,000 to Julia Gronkiewicz 10000 100% 3000.00 of decedent, transferred 1/23/01 9 $10,000 to Bruce V. Gronkiewicz 10000 100% 3000.00 son of decedent, transferred 1/23/01 10 $10,000 to Mary R. Gmnkiewicz 10000 100% 3000.00 of decedent, transferred 1123/01 3434.36 7000.00 7000.00 7000.00 7000.00 7000.00 7000.00 7000.00 7000.00 7000.00 Total REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gronkiewicz, Henry C. 21 -02-00125 Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. FUNERAL~PENSES: Honorarium Fr. Fontanella Gate of Heaven Cemetery Hoffman-Roth Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Contmissions NameofPemonalRepresentatfve(s) Bruce V. Gronkiewicz Social Secudty Number(s)/EIN Number of Personal Representalive(s) # S~eetAddress 1209 Stratford Dr. c~y Carlisle SUe PA Zip 17013 Year(s) Commission Paid: 2 0 0 2 AttomeyFees John C. Oszustowicz, Esq. Family Exemption: (if decedenrs address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip Rela4io~ship of Claimant ~ Decedent ProbateF~s Pennsylvania District of Columbia A~untant's F~ Tax Return Preparer's Fees Legal Advertisement Pennsylvania District of Columbia TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 350.00 344.00 10020.15 76628.00 42145.00 989.00 178.00 149.39 401.00 -1 31 204.54 REV-1512 EX+ (6-98) C(~EALTH OF PENNSYLVANIA NtERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Henry C. Gronkiewicz SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILmES, & LIENS RLE NUMBER 21-02-00125 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Manulife Financial - reimbursement for overpayment Carlisle Regional Medical Center - medical expenses Law Office of John C. Oszustowicz - professional services Cumberland Crossing Retirement Community - housing Pennsylvania Department of Revenue - 2001 income tax Triangle Travel Stores ~ medical expense Alert Pharmacy - medical expense Appalacian Rehab - medical expense West Shore EMS - medical expense Mobile X-Ray Imaging - medical expense Carlisle Imaging Assoc. - medical expense Symphony Mobilex - medical expense 416.67 446.21 3006.25 3647.18 1140.02 68.05 10.17 20.00 46.65 90,26 3.83 104.20 TOTAL (Also enter on line 10, Recapitulation) $ ' 8,999.49 (if more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Henry C. ?,ronkiewicz SCHEDULE J BENEFICIARIES FILE NUMBER 21-02-00125 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE B TAXABLE DISTRIBUTIONS [include outfight spousal dis~butions, and bansfers under Sec. 9116 (a) (1.2)] Bruce V. Gronkiewicz 1209 Stratford Dr. Carlisle, PA 17013 Dean H. Gronkiewicz 16207 Breckinmore Ln. Tampa, FL 33625-1016 Earl S. Gronkiewicz 484 Old Orchard Circle Millersville, MD 21108-2009 son son son 460180.78 C 460180.78 460180.79 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $' _ .- '. ' 0.00' (if more space is needed, insert additional sheets of the same size) Estate of Henry C. Gronkiewicz #388-12-9215 Item FOURTH of the Last Will and Testament of Henry C. Gronkiewicz refers to a contingent bequest to St. Patrick's Church in Carlisle, Pennsylvania. Prior to Mr. Gronkiewicz's death, the addition to the school detailed in his will was completed and paid for by Mr. Gronkiewicz. The intention of the Testator was to make certain that such an addition was built with estate assets only if such construction had not been accomplished prior to his death. St. Patrick's Church / School has no expectation of any distribution from the estate of Henry C. Gronkiewicz as evidenced by the letter (attached) from Rev. Andrew Fontanella, Pastor of St. Patrick's Church. Saint Patrick's Church 140 East Pomfret Street Carlisle, Pennsylvania 17013 (717) 243-4411 April 3, 2002 Mr..lohn C. Oszustowicz, Esq. 104 South l-tanover Street Carlisle, PA 17013 l)car .Iohn. I appreciated your kind letter of March 12, 2002 in the matter of the estate of the late }lcnry Gronkiewicz. I am in complete agreement that no further contributions are due either at St. Patrick Church or St. Patrick School. t lenry's generous gift has added a unique dimension to the curriculum of our school. The art room he so generously funded will always stand as a witness to the fine arts education of young people, such a cherished part of his life. The room will always honor his holy memory and that of his devoted late wife, Virginia. A picture of Henry and Virginia as well as a memorial marker have been placed at the. art room. With every best wish for the Lord's Easter peace upon you and your family, I remain, Pastor REV-~ 5~0 EX j~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 _ 02 00125 COUNTY COOE YEAR NUMBER I- Z LU UJ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Gronkiewicz, Henry C. ~"E~EATH (MM;DD;YEAR) DATE OF BIRTH (MM.DD-YEAR) 12/21/O1 11/18/15 ' ill'APPLiCABLE) SuRvIViNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) r-~2. supplemental Return [~4a. Future Interest Compromise (date of death erie,' 12-12-82) r--] 7. Decedent Maintained a Living Trust IA,ach copy of --]10. Spousal Poverty Credit (da~e of de~th beh,,een 12-3f-91 and 1-1.95) D1. Original Return O4, Umited Estate r'-] $. Decedent Died Testate (Aach copy of W~) D g. litigation Proceeds Received SOCIAL SECURITY NUMBER 388-12-9215 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS sOC~-AL SECURi.~ ~UU~ r-"-~ 3. Remainder Retum (~te o~de~ pr~ to 12-13-82) r--~ 5. Federal Estate Tax Relum Required 8. Total Number of Safe Deposit Boxes r'--] 11. Election to tax under Sec. 9113(A) (,Wch Sm O) THI~ SECTION MUST BE COMPL/= m't:u. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS 104 S. Hanover St. Carlisle, PA 17013 NAME Tricia D. Naylor Law Office of John C. Oszustowicz ~[ELEPHONE NUMBER (717) 243-7437 (1) (2) (3) (4) (6) (7) (9) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Coq~oration. Partnership or Sole-Propnetorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedume E) 6. Joinl~y Owned Property (Schedule F) -"]Separate Billing Requested 7. Inte~-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8, Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 11. Total Deductions (total Lines 9 & 10t 0.00 0.00 0.00 45,996.75 0.00 0.00 (8) 0.00 (10) 0.00 12. Net Value of Estate (Line 8 minus Line 1!) 13. Charitable and Governmental Bequests/Sec 9113 Tn~sts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 45,996.75 (11) 0.00 ¢2) 45,996.75 (13) 0.00 (14) 45,996.75 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 16. Amount of Line14 taxable at lineal rate 45,996.75 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 (18) 19. Tax Due (19) ~":"'~':~':,'~:~:~;::~'~':~:,'~' :~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH 2,069.85 2,069.85 Decedent's Complete Address: '~S~'REET ADDRESS 209 Stratford Drive C~TYcadisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount (1) 2,069.85 10,981.81 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest 8,83 E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Total Interest/Penalty ( D + E ) (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 10,981.81 8.83 8,903.13 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 transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] 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 pef~p/, I declare that I have examined ~ retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is ~ue, correct and complete. Dedaralion of I:~eperm' other Ihan the personal representative is based on all information of which preparer has any knowledge. SIGNATJJRE OF PER~ON RESPONSIVE FOR FILING RETURN ADDRESS ' - 12~ Stratford Drive, Carlisle, PA 1 REPRESENTATIVE 104 S. Hanover St., Carlisle, PA 17013 DATE DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 exemot 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 surdving spouse is the only beneficiary. For dates of dealh on or after July 1, 2000: The tax rate imposed on the nat 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 RS. §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 RS. §911611.2) [72 RS. §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 RS. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Henry C. Gronkiewicz 21 -02-001 25 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 45,000 Greenwood Tr Certificate of Deposit (CUSIP 39739CKM0) Matudty 6~2~03 7.25% Listed as Item 17 of Schedule E on Original Return - valuation figure was inadvertently omitted. TOTAL (Also enter on line 5, Recapitulation $ VALUE AT DATE OF DEATH 45996.75 "· 45,996.75 (If more space is needed, insert additional sheets of the same size) · REV-1513 EX* (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Henry C. Gronkiewicz SCHEDULE J BENEFICIARIES FILE NUMBER 21-02-0012~' RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE C Il TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Bruce V. Gronkiewicz 1209 Stratford Drive Carlisle, PA 17013 Dean H. Gronkiewicz 16207 Breckinmore Ln. Tampa, FL 33625-1016 Earl S. Gronkiewicz 484 Old Orchard Circle Millersville, MD 21108-2009 15332.25 15332.25 15332.25 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ , '0.00 (If mere space is needed, insert additional sheets of the same size) ? BUREAU OF TNDZVZDUAL TAXES TNHERTTANCE TAX DZVZSTON DEPT. 280601 HARR/SBURG, PA 1?lID-ODD1 TRICIA D NAYLOR JC OSZUSTOWICZ LAW OFC lOq S HANOVER ST CARLISLE PA 17015 COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 11-11-2002 ESTATE OF GRONKIENICZ DATE OF DEATH 12-21-2001 FILE NUHBER 21 02-0125 COUNTY CUHBERLAND ACN 101 HENRY HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUHBERLAHD CO COURT HOUSE CARLISLE, PA I70I$ CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF GRONKIEWTCZ HENRY C FILE NO. 21 02-0125 ACN 101 DATE 11-11-2002 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds (Schadula B) (2) $. Closely Held Stock/Partnorship Interest (Schedule C) ($) 4. Hortgagas/Notas Receivable (Schadula D) (q) E. Cash/Bank Daposits/H/sc. Personal Property (Schadula E) ($) 6. Jo/ntly Owned Property (Schedule F) (6} 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expansas/Ade. Costs/M/sc. ExpBnses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) 11. Total Deductions 12. Net Value of Tax Return (9) (10) 15. lq. NO. 01 .00 Char/table/governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate Sub~ect to Tax .00 .00 .00 q5~996.75 .00 .00 (8) .00 .00 NOTE: To /nsura proper crad/t to your account, subm/t the upper port/on of this form with your tax payment. NOTE: q5,996.75 (11) . tiff (].2) ~5,996.75 ('ts) . O0 (14) 1,q26,559.10 Zf an assessaent was issued previously, lines 14, 15 and/or 16, 17, reflect f/gures that include the total of ALL returns assessed to date. 18 and 19 Nill (KS) .00 x O0 = .00 (].6) 1,q26,559.10 x Oq5= 6q,19q.Z6 (17) .00 x 12 = .00 o8) .00 x 15 : .00 (19)= 6q,19q.26 ASSESSMENT OF TAX: 15. Amount of L/ne lq et Spousal rate 16. Amount of Line lq taxable et Lineal/Class A rate 17. Amount of L/nB lq et S/bl/ng rate 18. Amount of L/ne lq taxable et Collateral/Class B rate 19. Princ/pal Tax Duo TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) O$-ZI-ZOOZ CD00165~ $,209.71 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID 70,000.00 TOTAL TAX CREDIT 7~,Z09.71 BALANCE OF TAX DUEI 9,015.~5CR INTEREST AND PEN. .00 TOTAL DUE 9,015.qSCR ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents 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 decadent 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 lawfut Class B [colIataraZ) rate on any such futura interest. To fulfill the requirements of Section 21fiO of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT 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 Nills, any of the 23 Revenue District Offices, or by calling the special 2~-hour answering service for forms ordering: 1-800-362-2080; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-3020 (TT only). 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. ZBIOZ1, Harrisburg, PA 17128-1021, --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. OR 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, Dept. 280601, Harrisburg, PA 17126-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-15013 for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (52) discount of the tax paid is allowed. The 152 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 and cf the tax amnesty period. This nan-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. 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 bear interest at the rata of six (62) percent per annum calculated at a daily rate of .00016~. 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 rata announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOZ ara: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 ZOZ .0005q8 1992 91 .0002~7 1983 161 . OO 0~38 1993-199~ 72 .000192 198~ 111 .000301 1995-1998 97. .0002~7 1985 131 .000356 1999 71 . O0019Z 1986 IOZ .00027~ 2000 8Z .000219 1987 97. .0002¢7 2001 97. . O002~.7 1988-1991 111 . OO03Ol 2001 61 .OOO16q --Interest is calculated as follows: ZNTERES? = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent wlll 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 bm calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17128-0601 COHHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-lSq7 EX qFP (01-02) TRICIA D NAYLOR JC OSZUSTOWICZ LAW OFC lOq S HANOVER ST CARLISLE PA 17015~(i.~ DATE 11-0q-2002 ESTATE OF GRONKIEWICZ DATE OF DEATH 12-21-2001 FILE NUHBER 21 02-0125 CGUNTY CUHBERLAND Ad~ 101 I Amoun~ Remi~ed HENRY C HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF GRONKTEWICZ HENRY C FILE NO. 21 02-0125 ACN 101 DATE 11-0~-2002 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) 2 S~ocks and Bonds (Schedule B) Closely Held S~ock/Par~nership In~eras~ (Schedule C) Hor~gages/No~as Receivable (Schedule D) $ Cash/Bank Daposi~s/Hisc. Personal Proper~y (Schedule E) 6 Jointly O~ned Proper~y (Schedule F) 7 Transfers (Schedule G) 8 To~el Asse~s APPROVED DEDUCTIONS AND EXEHPT~ONS: 9. Funeral Expenses/Adm. Cos~s/Nisc. Expanses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. To,al Deductions 12. Na~ Value of Tax Re~urn (1) Z98~$59.97 .00 (s) lz15qzlll.59 (6) lzB60.q6 (7) 66zqSq.56 (8) (9) 151,20q.5q (10) 8,999 .q9 (11) (12) 13. lq. NOTE: .00 NOTE: To insure proper cradi~ ~o your account, subei~ ~he upper portion .00 of ~his fora wi~h your ~ax payment. 1,520,7q6.58 1,580,5q2.55 Char/~able/governeen~al Bequests; Non-elec'Fed 9115 Trusts (Schedule J) (13) Ne~: Value of Es~a~a SubSac~ ~o Tax (lq) Zf an assessment was issued previously, lines 14, 15 and/er 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 1,380,5q2.35 ASSESSNENT OF TAX: 15. Aeoun~ of Line lq a~ Spousal ra~:e 16. Amoun~ of Line lq ~axable e~ Lineal/Class A ra~e 17. Amoun'~ of L'ina lq e~ S'ibl*ing ra~e 18. Amoun~ of Line lq ~axable a~ Collateral/Class B ra~a 19. Principal Tax Due TAX CREDITS: PAYMENT RECETpT DT$COUNT DATE NUHBER INTEREST/PEN PAID (- 05-21-2002 CDOO165q 5,106.22 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 ~ill (15) .00 X O0 = .00 (16) 1,$80,5qZ.55 x Oq5: 62,12q.ql (17) . O0 X 12 = . O0 (18) .00 x 15 = .00 (19)= 62,12q.ql AHOUNT PAID 70,000.00 TOTAL TAX CREDIT 75,106.22 BALANCE OF TAX DUEI 10,981.81CR INTEREST AND PEN. .00 TOTAL DUE 10,981.81CR ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE~UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December iZ, 19BE -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CommonNaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z~ of EOOO. (TZ P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Hills, any of the g$ Revenue District Offices, or by calling the special Z4-hour answering service for fores ordering: 1-800-562-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). 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. 2810Z1, Harrisburg, PA 17128-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment shoutd be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (7173 767-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-lSD13 for an explanation of administratively correctable errors. If any tax due is paid within three (33 calendar months after the decedent's death, a five percent [5Z3 discount of the tax paid is allowed. The 15Z 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 on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (13 day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 19BE bear interest at the rate of six (6Z) 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 wlth that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rata Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20Z .000548 1992 9Z .OOOZq7 1983 16Z .000q38 1995-1994 7Z .OO019Z 1984 llZ .000301 1995-1998 9X .O00Zq7 1985 132 .000356 1999 72 .00019Z 1986 lOZ .O00ZTq ZOO0 82 .O00Z19 1987 9Z .000Z47 ZOO1 92 .O00Zq7 1988-1991 llZ .000301 200Z 6Z .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent w111 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 calculatad. BUREAU OF 'rNDZVZDUAL TAXES ZNHERTTANCE TAX DZVZSTON DEPT. 280601 HARRISBURG, PA 17128-0601 TRICIA D NAYLOR JC OSZUSTOWICZ LAW OFC 10~ S HANOVER ST CARLISLE PA 17015 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERHZNATZON AND ASSESSHENT OF PENNSYLVANZA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN REV-~i83 EX &FP (01-OZ) DATE 11-19-2002 ESTATE OF GRONKIEWICZ DATE OF DEATH 12-21-2001 FILE NUHBER 21 02-0125 COUNTY CUHBERLAND ACN 201 I Amoun~ Remi~ed HENRY C HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUH]}ERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account:, submit ~he upper por~:ion of ~:his for. wi~h your ~ex payment. CUT ALONG THXS LXNE ~ RETAIN LONER PORTION FOR YOUR FXLES ~ REV-483 EX AFP (01-02) ## NOTZCE OF DETERHZNATZON AND ASSESSHENT OF PENNSYLVANZA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN xx ESTATE OF GRONKTENICZ HENRY C FILE NO.Z1 02-0125 ACN Z01 DATE 11-19-2002 ESTATE TAX DETERHZNATZON 1. Credit For State Death Taxes as Verified 601~6~.15 2. Pennsylvan/a Inher/tance Tax Assessed (Exclud/ng D/scount and/or Interest) Inher/tance Tax Assessed by Other States or Terr/tor/es of the Un/ted States (Exclud/ng D/scount and/or Interest) q. Total Inheritance Tax Assessed 5. Pennsylvan/a Estate Tax Due 60/98q.55 .0O TAX CREDZTS: PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID ¢-) 60/98q.55 .00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 ~ZF PAID AFTER THIS DATE~ SEE REVERSE SIDE (IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED FOR CALCULATZON OF ADDITIONAL ZNTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.) PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: To fulfill the requirements of Section Z140 (b) of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGZSTER OF NZLLS) AGENT. A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (RE¥-1313). Applications ara available at the Office of the Register of Nills, any of the 13 Revenue District Offices or from the Department's Z4-hour anseering service for forms ordering: 1-800-362-Z050) services far taxpayers mith special haarlng and / or speaking needs: 1-800-447-3010 (TT only). Any party in interest not satisfied with the assessment of tax as shown on this notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 181021, Harrisburg, PA 17128-1021, --electing to have the matter determined at audit of the personal representative, OR --appeal to the Orphans' Court. 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, Dept. 180601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. See PaRe 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501} for an explanation of administratively correctable errors. OR PENALTY: INTEREST: The 151 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 and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. For dates of death on or after 10-5-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death. For dates of death prior to 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of eighteen (18) months from the date of death. Taxes which became delinquent before January l, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on or after January 1, 1982 will bear interest at a rate ahich w111 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z00Z ara: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1981 ZOZ .000548 X991 91 .000247 1983 161 .000~38 1993-1994 71 .000192 1984 111 .000S01 1995-1998 9Z .000147 1985 13Z .000356 1999 71 .000192 1986 lOZ .000274 ZOO0 81 .000119 1987 92 .0002~7 2001 9Z .000247 1988-1991 Ill .000301 ZOOZ 62 .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELTNqUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent Hill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shomn on the Notice, additional interest must be calculated. ? BUREAU OF *rNDTVTDUAL TAXES /NHERTTANCE TAX DTVIS/ON DEPT. ;'8O601 HARR/SBURG, PA 171Z8-0601 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP C01-02) TRTCIA D NAYLOR JC OSZUSTONICZ LAN OFC 104 S HANOVER ST ~' CARLISLE PA '1~7015 DATE 11-25-2002 ESTATE OF GRONKIEWICZ DATE OF DEATH 12-21-2001 FILE NUNBER 21 02-0125 COUNTY CUMBERLAND ACN 101 Amoun~ Remi'l:'l:ed HENRY C HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To Ansure proper credL~ ~o your account, submi~ ~he upper por~:ion of ~:hLs form wi~h your ~ax payment. CUT ALONG TH'rS LZNE ~* RETA'rN LONER PORT'rON FOR YOUR RECORDS *~ REV-1607 EX AFP (01-02) ESTATE OF GRONKIENICZ ~# INHERITANCE TAX STATEHENT OF ACCOUNT HENRY C FILE N0.21 02-0125 ACH 101 DATE 11-25-2002 TH/S STATEHENT /S PROV/DED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACH ZN THE NANED ESTATE. SHO#N BELO# /S A SUHHARY OF THE PR/NC/PAL TAX DUE, APPLICAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPL/CABLE, A PROJECTED /NTEREST F/GURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 11-04-2002 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 64,194.26 PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 5,209.71 05-21-2002 11-06-2002 CD001654 REFUND .0O 70,000.00 9,015.45- ZF PA/D AFTER THIS DATE, SEE REVERSE S/DE FOR CALCULAT/ON OF ADD/T/ONAL /NTEREST. ( ZF TOTAL DUE /S LESS THAN $1, NO PAYHENT 1S REQUIRED. /F TOTAL DUE /S REFLECTED AS A "CRED/T" (CR)~ TOTAL TAX CREDZT 64,194.26 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORH 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. -- If RESIDENT DECEDENT make check or money order payable to: REGTSTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check ar money order payable to: COMMONNEALTH OF PENNSYLVAN/A. 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-1315). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-BO0-56Z-ZOSO; services for taxpayers with special hearing end / or speaking needs: 1-800-447-50Z0 [TT only}. REPLY TO: Questions regarding errors contained an this notice should be addressed to: PA Department of Revenue, Bureau of IndividuaI Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA lTIZB-060l, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The leg tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and nat paid before January I8, 1996, the first day after the and of the tax amnesty period. 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 l, 1982 bear interest at the rate of six ESI) percent per annum caIculatad at a daily rate of .000164. All taxes which became delinquent on and after January l, 198Z 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 19BI through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Baily Interest Factor 1982 ZOZ .0005~8 I99Z 9Z .000247 1985 X6Z .000438 1995-1994 72 .O00IgZ 1984 llZ .O0050l 1995-1998 9Z .000247 1985 ISZ .000556 1999 72 .O0019Z 1986 102 .000Z74 ZOO0 8Z .000219 1987 92 .000247 2001 92 .000247 1988-1991 llZ .000501 ZOOZ 6Z .000164 --Xnterest is calculated as follows: XNTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELZNGUENT X DAZEY ZNTEREST 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 caXculatad. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX D/VIS/ON DEPT. 280601 HARRISBURG, PA 17128-0601 TRICIA D NAYLOR JC OSZUSTONICZ LAN OFC 104 S HANOVER ST CARLISLE PA 17015 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERH/NATZON AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUHBER ! .., :COUNTY ACN 02-02-2004 GRONKIEWICZ 12-21-2001 21 02-0125 CUHBERLAND 202 Aaoun~: RemJ.~ed RE¥-756 EX AFP (01-OZ) HENRY C HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit ~o your account, submi~ the upper portion of ~his fora wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR FILES ~ REV-736 EX AFP (01-02) #~ NOTICE OF DETERHZNAT/ON AND ASSESSNENT OF PENNSYLVANTA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~ ESTATE OF GRONKIENTCZ HENRY C F/LE NO.Z1 02-0125 ACN 20Z DATE 02-02-2004 ESTATE TAX DETERHZNATZON 1. Credit For State Death Taxes as Verified 60,464.15 Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) Inheritance Tax Assessed by Other States or Territories of the Un/ted States (Excluding Discount and/or Interest) Total Inheritance Tax Assessed Pennsylvania Estate Tax Due 60,984.55 .00 60~984.55 .00 Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return 7. Additional Pennsylvania Estate Tax Due .00 .00 TAX CREDITS: PAYNENT DATE RECEIPT NUHBER ~ZF PAID AFTER THIS DATE~ SEE REVERSE SIDE FOR CALCULAT/ON OF ADD/T/ONAL /NTEREST. DISCOUNT (+) :NTEREST/PEN PAID (-) AHOUNT PAID TOTAL TAX CREDIT 3ALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE (IF TOTAL DUE TS LESS THAN $1, NO PAYNENT ZS REiiUZRED ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) .00 .00 .00 .00 PURPOSE OF NOTICE~ PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: PENALTY: INTEREST: To fulfill the requirements of Section Zl¢O of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S. Section 91¢0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF NZLLS~ AGENT. A refund of a tax credit may be requested by coapZeUng an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplJcaUons ara available at the Office of the Register of Nills, any of the 13 Revenue District Offices or frae the Department's Z¢-hour anseering service for forms ordering: 1-8gg-$6Z-ZO50; services for taxpayers #ith special hearing and/or speaking needs: 1-aO0-q¢7-3gZO (TT only). Any party in interest not satisfied with the assessment of tax as shoNn on this notice may object within sixty (60) days of receipt of this Nat[ce by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1011, --electing to have the matter determined at audit of the personal representative, OR --appeal to the Orphans' Court OR 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, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. See page S of the booklet "InstrucUons for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanaUon of administratively correctable errors. 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 period. This non-parUcipatJon penalty is appeaIabla in the same manner and in the the same time period as you would appaaZ the tax and interest that has been assessed as indicated on this notice. Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing Zetter becomes delinquent at the expiration of ane (1) month from the date the final not[ce of the increase in Federal Estate Tax is received. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate ehich ail1 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOOZ are: Year Interest Rats Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 ZOZ .0005¢8 199Z 91 .0001¢7 1983 161 .000¢38 1993-199¢ 71 .000191 198¢ llZ .000501 1995-1998 91 .OOOZ¢7 1985 131 .000336 1999 72 .000192 1986 101 .00027¢ 2000 8Z .000219 1987 9Z .000Z¢7 2001 9Z .000Z¢7 1988-1991 1II .000301 ZOOZ 6Z .000164 --Interest is calculated as folloNs: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAZLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent Nil1 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. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-0125 ESTATE OF HENRY C. GRONKIEWICZ, DECEASED Late of South Middleton Township, PA FAMILY SETTLEMENT AGREEMENT BRUCE V. GRONKIEWICZ, EXECUTOR Date of Death: December 21, 2001 Letters Granted: February 4, 2002 First Complete Advertisemem of Grant of Letters: March 1, 2002 Account stated to September 18, 2003 John C. Oszustowicz, Esq. 104 South Hanover Street Carlisle, PA 17013 (717) 243-7437 AGREEMENT TO INDEMNIFY, RECEIPT, AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that, WHEREAS, Henry C. Gronkiewicz, late of South Middleton Township, Cumberland County, Pennsylvania, deceased, died testate on December 21,2001, having made his last will and testament, which was duly executed on July 20, 1999, and is duly recorded in the office of the Register of Wills in and for Cumberland County, Pennsylvania; WHEREAS, the said Henry C. Gronkiewicz, by the aforesaid last will and testament, appointed Bruce V. Gronkiewicz as Executor; WHEREAS, letters testamentary on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to Bruce V. Gronkiewicz, hereinafter called the personal representative; WHEREAS, the said personal representative has gathered the assets of the estate of the said decedent including interest accrued thereon during the administration of the estate, with a total value of $1,440,867.09 as set forth in Exhibit A, which is a statement of account of the personal representatives, and which is attached hereto and made a part hereof; WHEREAS, the debts, expenses and deductions, including the payment of inheritance tax in the said estate, amount to $450,785.69, leaving a balance for distribution of $989,800.00, also as set forth in the account of the personal representative which is attached hereto and marked Exhibit A; WHEREAS, in item FIFTH of his will, decedent directed Executor to give devise and bequeath all of the rest, residue and remainder of his property and estate, of whatever kind and wherever situated and to which he may be in any manner entitled at the time of his death, to his children who shah survive him, in equal shares,; NOW, THEREFORE, KNOW YE, that we, Earl S. Gronkiewicz, Bruce V. Gronkiewicz, and Dean H. Gronkiewicz, being the persons who are to receive the residuary estate of the said decedent, do hereby acknowledge that we have this day had and received ~om the personal representative, in full satisfaction and payment of all sums due us, which sums we have received in cash and in kind on or before this day, and which is set forth in Exhibit A; AND, we do hereby stipulate that in order to avoid the expense and time in the filing of a formal account and schedule of distribution, we agree that we consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Cumberland County, Pennsylvania. THEREFORE, we do hereby remise, release, quitclaim and forever discharge the personal representative, his heirs, executors, administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for and by reason thereot~ or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent, and we do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, we hereby covenant and agree with the personal representative that we will contribute a monetary equivalent to the property that we received from the estate to satisfy any and all claims, demands, suits or causes of action which may he successfully prosecuted against the estate or the personal representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. . , IN WITNESS WHEREOF, we have hereunto set our hands and seals as of this ~4~day of ~6~-~~ ,2003. WITNESSES: Brace V. Gronkiewicz, Executoru Brace V. Oronkiewicz, Beneficiarv//r_~ E ~, i[W~c'~, B;nefici STATUS I~BPOKT UNDER RULE 6.12 Name of Decedent: ~ Date of Death: D~c_t'_pt~k'x!r' 21, Ti)C) '1 _ Will No.: _'~OO 2 - (Dr') } 2, ~ 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 [] No 2. lithe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lithe angwer to No. 1 is Yes, state the following: a. Did the personal representative f-tie 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 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court 1 Oor n O. Oszus-[ wic'z- .2? Capacity: Telephone No. [2] Personal Representative [~] Counsel for personal representative RECEIPT FOR PAYMENT Cumberland County - Orphans Court Hanover and Hiqh StreeZ Carlisle, PA ~7013 Receipt Date 11/1014:/5~?03 Receipt Time 16 Receipt No. 1023280 GRONKIEWICZ HENRY C File Number Remarks Transaction Description FAMILY SETTL AGREE 2002-00125 JOHN C OSZUSTOWICZ JA Distribution Of Receipt ........................ Payment Amount Payee Name 17.00 CUMBERLAND COUNTY GENEP~AL FUN Check~ 131 Total Received ......... 17.00 17 00