The URL can be used to link to this page

Home My WebLink About04-28-091505607120 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA Department of Revenue c Bureau of Individual Taxes ounty code rear File Numt~er Po Box.2soso~ INHERITANCE TAX RETURN Harrisburg, PA »~2s-oso~ RESIDENT DECEDENT 21 0 8 0 9 6 8 ENTER DECEDENT INFORMATION BELOW 09 18 2008 03 19 1925 Decedent's Last Name Suffix Decedent's First Name MI CIRILLO JOSEPHINE M (If Applicable} Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW XL~ 1. Original Return 4. Limited Estate g Decedent Died Testate (Attach Copy of Will) MI THIS RETURN MUST BE FILED fN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) 4a. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (date of death after 12-122) ~, Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credd (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JENNIFER B. HIPP 717 737 8761 Firm Name (If Applicable) BOGAR AND HIPP LAW OFFICES First line of address 1 WEST MAIN STREET Second line of address City or Post Office State ZIP Code SHIREMANSTOWN PA 17011 c~ REGISTER (3FVii~..LS USE,-ONLY ~' -' '_~_ : =~ - - = r~r - -::a.} C:O - ~ ~~ .I _ - } C.=D - - --i .. _ ~ 1 DATE FILED _~ ~,+J ,3 .~ c--, -- _) .,_~ _,' ``i` ~ Correspondent's e-mail address: 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, R is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. JIUIWII V Vr CRJVIY RCJf VIYJIDIC rVR rIL11Y RGI VRIY VMIC ~,,~,~;~~ ~j.,~ ~~~,,~ _ Christina M. Chaback ~ 02l O T ADDRESS 205 Eas~(t/7!PW~a~l~n~ut Street, Shiremanstown, PA 17011 SIGNATU E,~r.1r~7' ~,THER THAN REPRESENTATIVE PATE ~., ' ~~ Jennifer B. Hipp ~,a ~_ d~ One West Main Street, Shiremanstown, PA 17011 Side 1 1505607120 1505607120 J REV-1500 EX oecedanPsName: Josephine M. Grillo RECAPITULATION 1505607220 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) ................................................. ......... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ ........ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ..... ........ 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ..... ........ 7, 8. Total Gross Assets (total Lines 1-7) ............................................................... ........ 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................................ ......... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I} ....................... ......... 10. 11. Total Deductions (total Lines 9 & 10) ............................................................. ......... 11. 12. Net Value of Estate (Line 8 minus Line 11) .................................................... ......... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................................ ......... 13. 14. Net Value Sub)ect to Tax (Line 12 minus Line 13) ................................................. 14. 35,930.00 167,168.68 29,453.80 92,153.52 324,706.00 24,172.47 2,767.00 26,939.47 297,766.53 297,766.53 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 9 7, 7 6 6. 5 3 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 13,399.49 0.00 0.00 13,399.49 Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-0968 DECEDENT'S NAME Josephine M. Grillo STREET ADDRESS 205 East Walnut Street CITY STATE ZIP Shiremanstown PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 11,371.94 598.52 Total Credits (A + B + C) (1) 13,399.49 Total interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (2) 11,970.46 (3) (4) (5) 1,429.03 (5A) (5B) 1,429.03 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 :.................................................................................. ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^x c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ x^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... 0 ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-7503 FJ(+ (6-88) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA WHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Grillo, Josephine M. 21-08-0968 All property joiMlyownad with right of wrvWorship mart be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 1,000 shares of PPL Stock 35.93 35,930.00 TOTAL (Also enter on Line 2, Recapitulation) 35,930.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Page 1 of 1 _ _ _ _ _. 2008 September 18 Update Price September 18, 2008 High $36.47 Low $35.02 Open $35.33 Close $35.93 Volume 3,105,367 /04~ Shares o~ PPC S~k X 35.9 3 ,$ 35~93o.oc~ http://www.shareholder.com/pplllookup.cfm 4/14/2009 JOSEPHINE M CIRILLO 205 E WALNUT ST SHIREMANSTOWN PA 17011-6768 PPL Corporation Two North Ninth Street Allentown, PA 18101-1179 Dividend Check Account Number: 3099007386 Dividend Record Date: 09/10/2008 Payment Date: OCTOBER 1,2008 Check Number. 02804973 Amount: $335.00 Print Number. 68957000123 Number of Dividend Dividend Class of Stock Shares - Rate Amount PPL CORP COMMON 1,000.000 .3350 335.00 You can have your dividends deposited directly into your bank account. To request a Direct Deposit Authorization form, or if you have any questions regarding your account, visit the Investor Center at www.pplweb.com or call toll free: 1-800-345-3085 ;;; PPL Corporation ~ 's~s.r Two North Ninth Street + ~ lentown, PA 18101-1179 ` .r ~~ *`THREE HUNDRED THIRTY FIVE AND 00/100" JOSEPHINE ~1 CIRILLO O 205 E WALNUT ST SHIREMANSTOWN PA 17011.6768 No. 02804973 DIVIDEND - to OCTOBER 1,2008 IECK as-~ / 31~ ills.. dA~ ~el~. oe . Q1~ 88957000123 .ci.~u u•f'lflrl 2Ar1L4? ~n~ r•n z L innnr_ o.• o...or o r nn,.. To access your account online, please visit wvmv.shareowneronline.com Please detach and retain this statement for your records. 01 Rev-1508 l:X+ (B-98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8r. MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Grillo, Josephine M. 21-08-0968 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly~owned with the right of suMvorshlp must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Stifel Nicolas -Investment Account No. 2080020 162,377.89 2 Converted Watch on Chain -per appraisal (diamond necklace watch, per Will) 350.00 3 Diamond Cluster Ring -per appraisal (diamond beehive ring, per Will) 600.00 4 Diamond Solitaire Ring -per appraisal 700.00 5 Lady's Wrist Watch -per appraisal (diamond wristwatch, per Will) 1.200.00 6 Man's Synthetic Sapphire Ring -per appraisal (Man's tourmaline ring, per Will) 75.00 7 Mid 20th Century Diamond Fashion Ring -per appraisal (diamond solitaire with 750.00 smaller diamonds, per Will) 8 Personal Property -Sold at private sale 50.00 9 Sapphire and Diamond Cluster Ring -per appraisal (blue sapphire and diamond 450.00 ring, per Will) 10 Three Row Diamond Band Ring -per appraisal (diamond wedding band, per Will) 93.00 11 Highmark -premium refund 377.76 12 PA Department of Revenue -Refund 84.71 13 PA Department of Revenue -Refund 60.32 TOTAL (Also enter on Line 5, Recapitulation) I 167,168.68 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) STIFEL NICOLAUS October 15, 2008 Jennifer B. Hipp /bbl One West Main Street Shiremanstown, Pa. 17011 Re: Josephine M. Grillo Acct # 2080-4020 Dear Ms. Hipp: Enclosed is the Date of Death Values for Josephine M. Grillo. The information on the single account is as follows: Acct # 2080-4020 /Josephine M. Grillo Value as of 10/15/08 - $146,720.27 Account was opened on June 26, 2008 I will open an estate account since I have received the Death Certificate and Short Certificate. If you have any questions please give me a call at 717-730-1106. SincQerely, Lydia "Sis" Schiavoni Client Service Associate for G. David Bias & Henry J. Pofi This valuation reflects securities owned by you as indicated on our records resulting from transactions processed through Stifel, Nicolaus & Company, Incorp or from supplemental information supplied by you. The prices indicated are obtained from sources we consider reliable but are not guaranteed. Please consult your statements and confirms as your primary information sources. STIFEL, NICOLAUS & COMPANY, INCORPORATED 214 SENATE AVENUE, SUITE 601 ~ CAMP HILL, PENNSYLVANIA 17011 (717) 730-1100 ~ (866) 692-8435 TOLL-FREE ~ (717) 763-0537 FAx ~ wwwsTIFEL.coM MEMBER SIPC AND NYSE G. David Bias/ Henry J. Pofi Stifel Nicolaus Co.. Estate of Josephine M. Grillo Date of Death Values - 09/18/2008 10/14/2008 1:28 PM Shs. Holdings Hiph Low Close 1.) 5,889.093 DWS Strat. Govt Secs Fd CIA NAV NAV 8.49 2.) 189.000 PPL Corp 36.47 35.02 35.93 3.) 479.000 Pioneer Nati"I Resource Co 51.60 47.91 50.07 4.) 9.337 Putnam Amer Govt Fd, CIA NAV NAV 9.01 5.) 1,942.000 WP Carey & Co. 25.87 23.44 25.78 6.) 20.000 Hutton/Indian 84 Energy 0 0 Worthless 7.) 8,486.290 IBP-Insured Bank Product (Money Market) 8.) 22,970.010 Cash Balance (Sold on 09/18/2008 - 2,549.391 Shs. Putnam Amer Govt Fd, CI A) Approx. Total Total 49,998.40 6, 790.77 23,983.53 84.13 50,064.76 Worthless- $8,486.29 $22,970.01 "This performance summary is designed to provide information to help you evaluate your investments. The information and statistical data contained herein have been obtained from sources we believe to be reliable, but no independent verification has been made, and Stifel Nicolaus & Co. does not guarantee its accuracy and completeness. Consequently, you must rely on your monthly Stifel Nicolaus & Co. statements and trade confirmations as your official record of transactions with us." 1 This estate jewelry appraisal was prepared by Henderson & Co. Jewelers, Inc, Windsor Park Shopping Center Mechanicsburg, PA 17050 (717) 766-7771 for: Estate of Josephine M. Grillo c/o ]ennifer B. Hipp, Esquire One West Main Street Shiremanstown, PA 17011 This appraisal was prepared October 9, 2008. The following metal prices are from the date of death, September 18, 2008. The price of gold was approximately $841.00, platinum was $1067.00, and silver was $14 per ounce. The following equipment was used in preparing this jewelry appraisal: Binocular Microscope Dial Gauge Table Gauge Electronic Scale Mechanical Diamond Balance Color Master Stones Refractometer Polariscope Touchstone & Acids The appraiser was David A. Henderson, Gemologist of the Gemologieal _~r.~titutE~~f.._..__ America,'no. 3561240. ~ ~ ~ ~,~ ~,_%~_'' G.I.A. grading terminology was used in preparing this jewelry pfaisal~~ ~ ~ ~~ This appraisal was prepared for estate purposes only. The values given represent a fair price that the items could be expected to bring in a reasonable time period if sale was necessary to settle the estate. This is based on prices obtained for similar items in our area at the time this appraisal was prepared, or recent auction prices for similar items. The condition of the gems and their mountings was factored in when arriving at these values. This jewelry appraisal does not represent an offer to buy nor does Henderson & Co. ]ewelers have a stake in these items. (1) SAPPHIRE AND DIAMOND CLUSTER RING This white gold cluster ring was assembled from cast components. Alternating sapphires and diamonds are arranged on 4 levels. All stones are held by 4 prong settings. The ring is stamped 14 Karat. The ring has a split shank. Total weight of ring mounting with gems is 5.2 dwt. Condition of ring at time of examination was good. SAPPHIRES: Thirteen Round Faceted Genuine Sapphires Diameters: 1- 3 mm 12-2mm Color: saturated pure blue Clarity: slight inclusions, some color banding DIAMONDS: Twelve Single Cut Round Diamonds Diameter: 1.5 mm Weight: .015 carat each, .18 ct. T.W. Clarity: SI1 to Il Color: G-H ESTATE VALUE ...................................................................$450.00 (2) DIAMOND SOLITAIRE RING This two-tone ring is stamped 14 Karat. The ring's yellow gold shank was cast in a twisted rope design. A tall 4 prong basket setting holds the single oval diamond. Condition of ring at time of examination was good. Total weight of mounting with diamond is 2 dwt. DIAMOND: One Oval Brilliant Cut Genuine Diamond Dimensions: 6.73 mm x 4.76 mm x 2.9 mm depth Weight: .59 carat by formula Clarity: SIl Color: H Comments: This diamond has a faceted medium to heavy girdle. ESTATE VALUE ...........................................................$700.00 (3) DIAMOND CLUSTER RING This is a mid 20"' Century style diamond cluster ring. The ring was cast in 14 Karat (stamped) white gold. A split shank with tall wire cage support the 27 stone cluster. The stones are set in 6 levels. The ring has a split shank. Condition of ring at time of examination was very goad. Total weight of mounting with diamonds is 3.5 dwt. DIAMONDS: Twenty Seven Round Brilliant Cut Genuine Diamonds Diameter: 2.5 mm Weight: .Ofi carat each, 1.62 ct. T.W. Clarity: I1 Color: G-H ESTATE VALUE .........................................................$600.00 (4) MID 20T" CENTURY DIAMOND FASHION RING This white gold ring (stamped 14K) consists of a six prong setting and wrap around cluster on a narrow shank. The ring is of cast and assembled construction. The center larger round diamond is surrounded by 20 small diamond melee. Condition of ring at time of examination was very good. Total weight of mounting with diamonds is 2 dwt. CENTER DIAMOND: One Round Brilliant Cut Genuine Diamond Diameter: 4.3 mm Weight: .32 carat by formula Charity: VS1 Color: I SIDE DIAMONDS: Twenty Single Cut Round Diamonds Diameter: 1.5 mm Weight: .015 carat each, .30 ct. T.W. Clarity: SI2/I1 Color: I Total diamond weight is .62 carat ESTATE VALUE ..............................................................$750.00 (5) THREE ROW DIAMOND BAND RING This ring of cast construction is white gold, (stamped 14 Karat). Three rows of round diamonds set close together form the top of this ring. Condition of ring at time of examination was poor. One diamond is missing, 6 are chipped from their edges touching. Many prongs are thin. Total weight of mounting with- diamonds is 2.2 dwt. DIAMONDS: Twenty-One (should be 22) Round Single Cuts* Diameter: 2.1 mm Weight: .035 carat each, approximately 3/a ct. Clarity: I1 Color: I-J ESTATE VALUE .....................................................$93.00 (scrap value) *chipped diamonds of this size are of no value -there are two. (6) MAN'S SYNTHETIC SAPPHIRE RING One 10 Karat (stamped) yellow gold gypsy set ring with large blue violet synthetic corundum. Condition of ring was good at time of examination. Total weight of mounting with stone - 4 dwt. ESTATE VALUE ..................................................$75.00 (7) LADY'S WRIST WATCH This Swiss watch was made by Dalbania Watch Company. The movement has 17 jewels. The watch case is platinum (stamped) and set with twenty round diamonds. The watch bracelet is white gold (stamped 14 Karat). There are 30 round diamonds in the bracelet. The watch does run. Condition of watch is very good (dial is corroded). Total weight of platinum case, white gold bracelet, movement and crystal is 11.5 dwt, approximately 3.2 dwt. is platinum, approximately 7 dwt. is white gold. . DIAMONDS: Fifty Genuine Diamonds 20 Round Brilliant (in case) 30 Single Cut Round (in bracelet) Round Brilliants Diameter: 2.4 mm Weight: .05 carat each, 1.00 ct. T.W. Clarity: VS2 Color: G-H Single Cuts Diameter: 2 mm Weight: .03 carat each, .90 ct. T.W. Clarity: SI1 Color: I ESTATE VALUE ..................:................................................$1,200.00 (8) CONVERTED WATCH ON CHAIN This was a man's diamond wristwatch that has had the tugs removed from one end and an adaptbr bail has been placed on the other end to be wom on a chain. The watch case tests as 14 Karat white gold. There are 35 single cut round diamonds set on the watch bezel. At time of examination, the watch was on a 20 inch long 2.73 mm wide chain. gain is stamped ster7 ; *~. DIAMONDS: Thirty-Fve Single Cut Round Diamonds Diameter: 1.3 mm Weight: .01 carat each, .35 ct. T.W. Clarity: SI1 Color: H to J ESTATE VALUE ..................................................................$350.00 Rev-1li09 EX+ (~) SCHEDULE F Cona.lONwEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Grillo, Josephine M. 21-08-0968 Han asset was rtisds joint within one year of the decedents date of death, ft must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Christina M. Chaback 205 East Walnut Street Daughter Shiremanstown, PA 17011 B, Alicia V. Ciriilo 111 Grove Road Daughter Harrisburg, PA 17111 C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 9/10/2001 Sovereign Bank -Checking Account No. 3.504.88 50.000% 1.752.44 0571115845; date of death balance $3,503.95; accrued interest $0.93 2 A 10/22/199 Sovereign Bank -Certificate of Deposit 12,617.94 50.000% 6,308.97 No. 1715219745; closed on October 24, 2007 for $12,617.94 3 B 6R/2005 Susquehanna Bank - CD # 348153112; 42.784.77 50.000% 21,392.39 date of death balance $42,749.73; accrued interest $35.04 TOTAL (Also enter on Line 6, Recapitulation) I 29.453.80 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) _,,;~ Sovereign Bank MA1 MB3 02-10 Court Ordered Processing P.O. Box 841005 Boston, MA 02284 October 16, 2008 James D. Bogar Attorney at Law One West Main St. Shiremanstown, PA 17011 Estate of: Josephine M. Grillo Date of Death: September 18, 2008 Dear Ms. Hipp: Per your request, enclosed please find the account information as of date of death for the above-named decedent. Please note the balances do not include accrued interest. If you should have any further questions, please do not hesitate to call. Very truly yours, ^ ~~~... Linda Spavento Team Leader Court Order Processing Phone (617) 533-1789 Fax (617) 533-1931 Sovereign Bank ESTATE OF Josephine M Grillo SOCIAL SECURITY #: 202-20-0192 DATE OF DEATH: September 18, 2008 Account #: 0571115845 Type: Checking Open date: 9/10/2001 In the name of: Josephine M Grillo or Christina M Chaback Date of Death Balance: $3,503.95 Int.(YTD) from 1/1/2008 to 8/26/2008 $0.93 Accrued interest to date of death: Other Info: $1.88 Account #: 0354000564 Type: Savings Open date: 9/10/2001 In the name of: Josephine M Grillo or Christina M Chaback Date of Death Balance: $0.00 Int.(YTD) from 1/1/2008 to Accrued interest to date of death: $0.00 $75.59 Other Info: closed 9/17/08 for $2,628.91 deposited into 0571115845 Account #: 1718183955 Type: IRA In the name of: Josephine M Grillo Date of Death Balance: $0.00 Int.(YTD) from 1/1/2008 to Accrued interest to date of death: 9/17/2008 $0.00 Open date: 4/27/1994 $651.24 ---- Other Info: closed 9/17/08 for $16,616.84 Account #: 1715219745 Type: CD Open date: 10/22/1994 In the name of: Josephine M Grillo or Christina M Chaback Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 10/24/07 for $12,617.94 Account #: 1715219737 Type: CD Open date: 7/14/1994 In the name of: Josephine M Grillo ITF Alicia V Grillo Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 4/2/07 for $11,794.60 Page 1 of 2 9/12/2008 Sovereign Bank ESTATE OF Josephine M Grillo SOCIAL SECURITY #: 202-20-0192 DATE OF DEATH: September 18, 2008 Account #: 1715219760 Type: CD Open date: 10/26/1995 In the name of: Josephine M Grillo ITF Christina M Chaback Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 5/1/07 for $9,101.68 Page 2 of 2 Susquehanna October 16, 2008 James D. Bogar Law Offices Jennifer B. Hipp, Esquire One West Main Street Shiremanstown, PA 17011 RE: Josephine M. Grillo Estate SS#:: 202-20-0192 DOD: September 18, 2008 To Whom It May Concern: Susquehanna Bank 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 In response to your letter of October 10, 2008, here is the above customer account information as of September 18, 2008. • Account Title: • Account Type/# Account #1 Josephine M Grillo Alicia V Grillo CD/348153112 • Date Opened /Maturity Date: 6/07/05 -10/07/09 • Interest Rate: 2.72% • Account Balance*: 42,749.73 • Accrued Interest: 35.04 • YTD Interest: 1,242.19 *Account balance does not include accrued interest. Account # 348153112 was made joint with Alicia V Grillo on 6/7/05. There is no safe deposit box in the name of this decedent. If I can be of further assistance, please feel free to call. Sincerely, anet M. Peters Support Services Supervisor 1-717-625-6295 JMP/KKLO Rev-~a~o eX+ (a-ea- SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONV,EALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Grillo, Josephine M. 21-08-0968 This schedule must be completed and filed 'If the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER I I N F PR P INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °,6 OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Transamerica -Annuity No. 02ARK001003; the 78,536.68 78,536.68 Decedent's daughters, Alicia V. Grillo and Christina M. Chaback, were equal named beneficiaries of this Annuity 2 Sovereign Bank -IRA No. 1718183955; closed 16,616.84 3,000.00 13,616.84 September 17, 2008 for $16,616.84. *(AN EXEMPTION IN THE AMOUNT OF $3,000.00 IS CLAIMED IN ACCORDANCE WITH THE PROVISIONS OF THE INHERITANCE AND ESTATE TAX ACT, BEING 72 P.S. SECTION 9108(c) AND 72 P.S. SECTION 9108(c)(3)) TOTAL (Also enter on Line 7, Recapitulation) ~ 92,153.52 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) TR.~vS~zuCA e LIFE INSURANCE COMPANY Transamerica Life Iasurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 October 6, 2008 Christina M Chaback c/o Mark Chaback 205 East Walnut St Shiremans Town PA 17011 RE: Annuity Number(s) 02ARR001003 Dear Christina M Chaback: We have received notification, Josephine Grillo, annuitant of the above listed non-qualified tax deferred annuity is deceased. Our office wishes to extend sincere condolences for your loss. The following is the current information on this annuity: Annuitant: Owner: Primary Beneficiary(ies): Annuity Policy Date: Full Value as of 10/06/2008: Taxable Portion: Full value as of 09/18/2008: Josephine M Grillo Josephine M Grillo Christina M Chaback 50~ October 31, 2002 $78,632.38 $10,701.13 $78,536.68 The attached document reflects the options available to the beneficiary. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. Operations performed on an automatic basis when applicable have been terminated, such as; Systematic Payouts or Automatic Billing. The attached document contains general tax information based on Transamerica Life Insurance Company's interpretation and should not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the `EGON. Group fff+ ~ y .. ~D ~ .V. i +.. ~ ~ ,vi ~aA 11:7:.1 7 S£i~4i ~~v~~D 29 st-'S:.c~ + ~ ~ a~' °,'S~P>>ce;A~x~c Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-553-5957. A Transamerica Life Insurance Company representative will gladly assist you with any questions you may have regarding this annuity and help you meet your financial goals. Sincerely; Megan Frank Claims Transamerica Life Insurance Company Enclosure(s): Annuity Claimants Statement Death Option Packet Postage Paid Return Envelope = , ; Sovereign Bank MAl MB3 02-10 Court Ordered Processing P.O. Box 841005 Boston, MA 02284 October 16, 2008 James D. Bagar Attorney at Law One West Main St. Shiremanstown, PA 17011 Estate of: Josephine M. Grillo Date of Death: September 18, 2008 Dear Ms. Hipp: Per your request, enclosed please find the account information as of date of death for the above-named decedent. Please note the balances do not include accrued interest. If you should have any further questions, please do not hesitate to call. Very truly yours, ~U~-.. Linda Spavento Team Leader Court Order Processing Phone (617) 533-1789 Fax (617) 533-1931 Sovereign Bank ESTATE OF Josephine M Grillo SOCIAL SECURITY #: 202-20-0192 DATE OF DEATH: September 18, 2008 Account #: 0571115845 Type: Checking Open date: 9/10/2001 In the name of: Josephine M Grillo or Christina M Chaback Date of Death Balance: $3,503.95 Int.(YTD) from 1/1/2008 to 8/26/2008 $0.93 Accrued interest to date of death: $1.88 Otherlnfo: Account #: 0354000564 Type: Savings Open date: 9/10/2001 In the name of: Josephine M Grillo or Christina M Chaback Date of Death Balance: $0.00 Int.(YTD) from 111/2008 to 9/12/2008 $75.59 Accrued interest to date of death: $0.00 Other info: closed 9/17/08 for $2,628.91 deposited into 0571115845 Account #: 1718183955 Type: IRA Open date: 4/27/1994 In the name of: Josephine M Grillo Date of Death Balance: $0.00 Int.(YTD) from 1/1/2008 to 9/17/2008 $651.24 Accrued interest to date of death: $0.00 Other Info: closed 9/17/08 for $16,616.84 Account #: 1715219745 Type: CD In the name of: Josephine M Grillo or Christina M Chaback Open date: 10/22/1994 Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 10/24/07 for $12,617.94 Account #: 1715219737 Type: CD Open date: 7/14/1994 In the name of: Josephine M Grillo ITF Alicia V Grillo Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 4/2/07 for $11,794.60 Page 1 of 2 Sovereign Bank ESTATE OF Josephine M Grillo SOCIAL SECURITY #: 202-20-0192 DATE OF DEATH: September 18, 2008 Account #: 1715219760 Type: CD Open date: 10/26/1995 In the name of: Josephine M Grillo ITF Christina M Chaback Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 5/1/07 for $9,101.68 Page 2 of 2 REV-1757 Ex+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ IN RESIDENTEDECEDENTRN ADMINISTRATIVE COSTS ESTATE OF ~ FILE NUMBER Grillo, Josephine M. 21-08-0968 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Christina M. Chaback Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 205 East Walnut Street city Shiremanstown state PA zip 17011 Year(s) Commission paid 4,295.00 9,387.47 2. Attorneys Fees Bogar and Hipp Law Offices 8,400.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 130.00 5. Accountant's Fees 300.00 See continuation schedule(s) attached 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,660.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 24,172.47 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Grillo, Josephine M. 21-08-0968 ITEM NUMBER 1 Funeral Expenses Neill Funeral Home -funeral bill DESCRIPTION AMOUNT 4,295.00 H-A subtotal 4,295.00 Accountant Fees 2 Caroline J. Kerr -fee for preparation of personal income tax returns 300.00 H-B5 subtotal 300.00 Other Administrative Costs 3 Henderson ~ Company Jewelers -Appraisal fee 160.00 4 RESERVES -Costs to conclude administration of Estate including filing PA 1,500.00 Inheritance Tax Return and Inventory, and Fiduciary Income Tax Returns H-67 subtotal 1,660.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 E7(+ (8-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Grillo, Josephine M. 21-08-0968 Include unreimbumed medical expenaee. Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) (If more space is needed, additional pages of the same size) REV-1513 EX+ (9-00- SCHEDULE J COMMNHER ANCETAXRETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF I FILE NUMBER Grillo, Josephine M. 21-08-09 68 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not LJst Tru s) I • TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] See attached schedule Total Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r sheet II• NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J The BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Josephine M. Grillo 09/18/2008 202-20-0192 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) Christina M. Chaback Daughter One-half of rest, 205 East Walnut Street residue and Shiremanstown, PA 17011 remainder + specific bequests of jewelry as follows: diamond beehive ring, solitaire diamond ring, diamond wedding band, diamond wristwatch Alicia V. Grillo Daughter One-half of rest, 1111 Grove Road residue and Harrisburg, PA 17111 remainder + specific bequests of jewelry as follows: blue sapphire and diamong ring, diamond solitaire with smaller diamonds, Man's tourmaline ring, diamond necklace watch, (pearl and diamond necklace and earrings -not in existence as of date of death) LAST WILL AND TESTAMENT of: Josephine M. Grillo I, Josephine M. Grillo, a resident of Dauphin County, Pennsylvania declare that this is my will. FIRST: I revoke all Wills and Codicils that I have previously made. SECOND: I am not currently married. I have 2 children now living: Christina M. Chaback and Alicia V. Grillo. I have no deceased children. All references in this will to "my child" or "my children" includes any and all children hereinafter born to or adopted by me. THIRD: I give all my jewelry, clothing, household furniture and furnishings, personal automobiles and other tangible articles of a personal nature, or my interest in any such property not otherwise disposed of by this will or in any other manner together with any insurance on the property, to my children who survive me for thirty (30) days, in equal shares as they shall agree, or as my Executor shall in my Executor's discretion determine if my children do not agree. FOURTH: I leave the following special gift: daughters, Christina M. Chaback and Alicia or she survive me by thirty (30) days. ;~1 ~' Jewelry to my V. Grillo„ should he FIFTH: I give the residue of my estate to my children who survive me by thirty (30) days, and if any of them does not, the share that would have been received by that child had he or she survived me by thirty (30) days shall be distributed to his or her issue by right of representation. If any of my children does not survive me for thirty (30) days, and dies withoutleaving issue, the share that would have been given to that child had he or she survived me for thirty (30) days shall be distributed pro rata with the gifts which are effectively distributed under this paragraph. SIXTH: I declare that it is my intention to have my body cremated and my ashes to be buried in my burial plot with my husband and my funeral arrangements are to be made with Neill Page 1 Will of Josephine M. Grillo: October 5, 1994 Funeral Home, 3501 Derry St., Harrisburg, PA.. I direct my Executor to take all steps necessary to carry out such arrangements. SEVENTH: I nominate Christina M. Chaback and Thomas P. Kerr, CPA as joint Executors of this Will, to serve without bond. If either of the above shall for any reason fail to qualify as Executor, then the other shall serve as sole Executor without bond. The term "my Executor" as used in this Will shall include any personal representative of my estate. I authorize my Executor to sell, with or without notice, at either public or private sale, and to lease any property belonging to my estate, subject only to such confirmation of court as may be required by law. I authorize my Executor to invest and reinvest any surplus money in the Executor's hands in every kind of property, real, personal, or mixed and every kind of investment, specifically including but not limited to interest bearing accounts, corporate obligations of every kind, preferred or common stocks, shares of investment trusts, investment companies, mutual funds, or common trust funds, including funds administered by the Executor, and mortgage participations, that men of prudence, discretion, and intelligence acquire for their own account. ~-y~ v EIGHTH: (/ I direct that all inheritance, estate, or other death taxes (excluding any additional tax imposed under Internal Revenue Code Section 2032A or any generation skipping transfer tax) that may by reason of my death be attributable to my probate estate or any portion of it, or to any property or transfers of property outside my probate estate, shall be paid by my Executor out of the residue of my estate disposed of by this Will, without adjustment among the residuary beneficiaries, and shall not be charged against or collected from any beneficiary of my probate estate, or from any transferee or beneficiary of any property outside my probate estate. NINTH: If any beneficiary under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any share or interest in my estate given to the contesting beneficiary under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary had predeceased me without issue. TENTH: As used in this Will, the term "issue" shall refer to lineal descendants of all degrees, and the terms "child," "children," and "issue" shall include adopted persons. Page 2 Will of Josephine M. Cirillo: October 5, 1994 I subscribe my name to this Will vn ~C~L~~~' .~ at Camp Hill, Pennsylvania. ~.~~ On the date written below, Josephine M. Grillo declared to us, the undersigned, that this instrument, consisting of these few pages including the page signed by us as witnesses, was his or her Will and requested us to act as witnesses to it. He or she thereupon signed this Will in our presence, all of us being present at the same time. We now, at his or her request, in his or her presence and in the presence of each other, subscribe our names as witnesses. Each states that the testator is not a minor and appears to be of sound mind and that we have no knowledge of any facts indicating that the foregoing instrument, or any part of it, was procured by duress, menace, fraud or undue influence. We, each for himself or herself, declare that each of us is over the age of majority, and that each of us is, and the others appear to be of sound mind. We, each for himself or herself, declare under penalty of perjury that the foregoing is true and correct and that this attestation and this declaration are executed on the day of , 19 at Camp Hill, Pennsylvania. -C~GL L residing at C~h9-ern ~ .~l residing at _~ _ 3~OY ~arr~~~-r ~z~ ~_ ~L ~~ j 7d n 3~ Q ~ ~ ~.c~~~.~t~~ <. ~ l ~I ~~,z~.~ ~. Page 3 Will of Josephine M. Grillo: October 5, 1994 ADDENDUM to LAST WILL AND TESTAMENT of: Fourth Paragraph - special gifts Christina P1. Chaback Diamond bee hive ring Solitaire diamond ring Diamond wedding band Diamond wristwal-ch Alicia V. Grillo Pearl and diamond necklace and earrings Blue sapphire and diamond ring Diamond soliL-aire with smaller diamonds run's tourmaline ring Diamond necklace watch Josephine M. Grillo ;~n~ STATE OF PENNSYLVANIA COUNTY OF CUAiBERLAND SS . I, ~ 7, Testator, whose name is signed to the to hed or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last ~+1i11; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by Josephine M. Grillo, the Testator,- this ~ of ~c~.~(~e~ , 1994. Notary Public Cerc.;ine J. Kerr; ,,.,,j~, ~ tt,r My Com t srsio~ii~ Ct~~ ~~31ia~d`Co~~;ty EYf;ir~ Jury 17, 1398 f4lember, F'ernisylvania~,^iation of IVofaries My Commission Expires: /] /99S U