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Home My WebLink About04-0493 " Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estateof HENRY GROSS JR. No. also known as , Deceased Social Security No. 717 - 09- 2267 William Navel Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or named in the last Will of the Decedent, dated 03/07/2000 and codicil(s) dated None Death of Julia A. Gross on 4/16/2003 State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship . Resi~;~ce " I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ' 2 Decedent was domiciled at death in Cumberland County, Pennsylvania with hi.~er last family or principal residence at 162 S. Enola Drive, East Pennsboro Township, Enola, PA 17025 (list street, number, and municipality) Decedent, then 88 years of age, died 03/21/2004 at Willow Valley at the Glenn, Lanc. , PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property $ l0,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 75,000.00 situated as follows: 162 S. Enola Drive, Enola TOTAL 85,000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersi~lned: I Signature Typed or printed name and residence I _ _ 900 W. Main Street, Mt. Joy, PA 17552 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc, Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~.~f~//~ Wi'lliam NagelJ / before me this ~day of Estate of HENRY GROSS JR. Deceased Social Security No: 717-09-2267 Date of Death: 03/21/2004 AND NOW, ~r~t'~t *~'~[D ,o'~(~{~ ,in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary ~ Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to William Navel in the above estate and that the instrument(s) dated 03/07/2000 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. ........... Letters. $ c:~F--)O ~ - "J 'Register o~Wills Short Certificate(s) ..... $ q ·/,.~t:~ Renunciation ........ $ Attorney: Shelly J. Kunkel, Esquire Affidavits ( ) .... $ I.D. No: 64485 Skarlatos & Zonarich LLP Extra Pages ( ) .... $ Ic~ . ~-~ Address: 204 State Street Codicil ........... $ Iqarrisbur~, PA 17101 JCP Fee .......... $ [(~ · O ~ Telephone: 717/233-1000 Inventory .......... $ Other ........... $ TOTAL ......... $ c'~ ~:>~ . Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form Ri-1 (1991) This 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 dupli6ate this copy by photostat or photograph. ~ Local Registrar No. ~ Date 143 Rev. ~87 COMMONW~LTH OF PENNsyLVANIA · DEPARTMENT OF HEALTH · ~TAL RECORDS ;'3 CERTIFICATE OF DEATH NAME ~ ~CE~NT ~;~, M~. ~) ~X J~L SECUR~ NUMAR '. Henry Gross Jr. m'- Male 13' 717 -- 09 -- 2267 h ~E (~ ~i;~y) ~ UN~R 1~ UN~R I ~Y ~ D~ ~ BIRTH I BIRT~OE (~ ~_.., ~p~ ~ D~H ~,~ ~ ~-- ~ ~ ~ -~- . I ' m ~ t Min~esm (M~,~y,~r) ~ ~le~F~e~n~y) IH ....... ~) i ~1~ ~ Da. ; ....... OTHER: m c~. ~o. ~ OF ~H I~CIL~ N~E 0; ~ ~1~. ~ ~ ~--~) I~ ~EC~ ~ Hi~ ~GiN? . ''" I Lancast I ' m ,.. Lancaster .. er Twp ~zllow Valley at the Glenn M~n,P~o~.~c. , ~E-~e~nl~,~,~e, elc. ~ ~ ~.~ ~ ~r~ KIND ~ 8USINES~NDUSTRy ~CE~ ~ER IN ~CE~'S E~ ~'s ~LING ~E~ ~ C~. S~. ~ ~) I~EDE~.S · 162 S. Enola Dr ~m~ ~m ,,. Enola, Pa 17025 ~) ,m.~ Cumberland z~' ,7~.~ ~ER'S ~E (F~ M~. ~ ~ ..... ~THER'S ~E ~, M~le. M~ .._ Mary Ann Na,~l IINF~n'~LING~DRE~'~'S~./*~} ,~m~ =~ 'D~E ......... I,~'J~. ~eese Ave., Lancaster, Pa 17602 ~ ~r~ ~ 3 · ~.. ~[~~ ].~?.D.01~897-~ ].:~ulli~a~ B~, 5; ~. B~ola D; ;~o ,~a :~ ~ ~ ~. r - · ' , , ~7~, ~ ~y. M~ ~ ~tl [ ~E ~ (~ ~ A C~E~E ~: ~. E~ UND~YI~ i / ~ DUE ~ {~ ~ A CON~EN~ ~: ~)~T I ~ ~1~ ~ ~'~ .... *" U l I I~' n ~1 ..................................................... ~.,,,. ~d~ (~ .............................. 6,,. 22 -~% O~ ~ ~M OI lXlml~tlo~ I~Or Inve~lgltl~, In my ~ln~n dish ~u~ it t~ time date mhd ICl and dui to the emu LAST WILL AND TESTAMENT HENRY GROSS, JR. I, HENRY GROSS, Jla, of 162 South Enola Drive, Enola, Cumberland County, p.ermsylvania 17025, declare this to be my Last W'fll and revoke any Will previously made by me. ITEM I: I direc~ that all my just debts and funeral expenses, including the cost of a suitable grave marker and perpetual care for my burial plot, shall be paid from the assets of my estate as soon as practicable after my decease. ITEM II: I give, devise and bequeath all of my estate, real, personal and mixed wheresoever situated to my wife, JULIA A. GROSS, provided that she survives me by thirty (30) days. If my wife, Julia, does not so survive me, then I give, devise and bequeath all of my estate to my nephew, WILLIAM NAGEL, of 254 School Lane, Mount Joy, Pennsylvania 17552. If my nephew William does not so survive me, I give, devise and bequeath all of my estate to my wife's sister, KATHERINE NAGEL, of 131 Reese Avenue, Lancaster, Pennsylvania 17602. If my wife's sister, Katherine, does not so survive me, I give, devise and bequeath all of my estate to my niece, KATHERINE HUGHES, of 8 Meadow Lark Drive, Stevens, Pennsylvania 17578. ITEM Ill: No interest in income or principal shall be assignable by or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. ITEM IV: All federal, state, and other death taxes payable on the property forming my gross Page 1 of 5 C:\]. $&g DTT.\lgj. 1]_s, Trusts & Estate l?~.ann±ng\GROSH01 - G~ross Henry, /i~:. and /7u]_±a 3k\G~:os$ Henry, /Ir. - 000~.06 - estate for tax purposes, whether or not it passed under this W'fll, shall be paid out of the principal of my residuary estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. ITEM V: I authorize my Executor: (a) to retain and to invest in all forms of real and personal property, regardless of(i) any limitations imposed by law on investments by executors or trustees, (ii) any principle or law concerning delegation of investment responsibility by executors or trustees, or (iii) any principle of law concerning investment diversification; (b) to compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value; to borrow fi.om, and to sell property to others, and to pledge property as security for repayment of any l%nds borrowed; (c) to sell at public or private sale, to exchange orto lease for any period of time any real or personal property, and to give options for sales or leases; (d) to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; (e) to use administrative or other expenses of my estate as income tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and Page2 of 5 C:\l S&Z DTZ\Wills, Trusts & Estate Planning\GROSH01 - Gross Henry, Jr. and Julia A\Gross Henry, Jr. - 000106 - Will.doc (f) to distribute in kind and to allocate specific assets among the beneficiaries in such proportions as my Executor may think best, so long as the total market value of any beneficiary's share is not effected by such allocation. These authorities shall extend to all real and personal property at any time held by my Executor and shall continue in full force until the actual distribution of all such property. All powers, authorities, and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without leave of court. ITEM VI: I appoint my wife, JULIA A. GROSS, Executrix under this Will. Should my wife, Julia, fail to qualify or cease to act as Executrix, I appoint my nephew, Wll JIAM NAGEI J, Executor under this Will. I direct that any fiduciary acting hereunder shall not be required to enter bond or other security in any Court or jurisdiction in which said fiduciary may be called upon to act. IN WITNESS WI-tF. REOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of Five (5) typewritten pages, including this attestation clause and the following Acknowledgment and Affidavit, to be executed, declared and published this 7 ~-~ day of ~ ,2000, at ,~>/Z.~/__~ , Pennsylvania. /HENRY 6'CROSS, JR. Page3 of 5 C:\i S&Z DTZ\Wills, Trusts & Estate Planning\GROSH01 - Gross Henry, Jr. and Julia A\Gross Henry, Jr. - 000106 - Will.doc ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF DAUPHIN ) I, HENRY GROSS, JR., the Testator, whose name is signed to the attached or foregoing instmmem, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly and that I signed it as my flee and voluntary act for the purposes therein expressed. Sworn or aflfirmed to and acknowledged before me by HENRY GROSS, JR., the Testator this /~Notary Public ! - - -b' F- Page; 4 of 5 C:\l S&Z DTZ\Wills, Trusts & Estate Planning\GROSH01 - Gross Henry, Jr. and Julia A\Gross Henry, Jr. - 000106 - Will.doc COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY/~F~A. UPHIN ) -- - -"3 ~ , and I . ~_: the wimesses, whose name~ to the attached wgOing instrument, being duly qualified according to law, do depose and say that we were present HENRY GROSS, JR., sign and execute the instrument as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as ~s; and that to theb~ of o~1~ knowledge, the Testator was at the time twenty-one (21)or more ~ I ~/~e, of/~oun(~:~G~:.d/~n?er no constraint or undue influence.':'~' // :~ [//. ~Uu.-~-~ Residing at Ox7 .~ ~~-5 ~ ~Cz%,~-~o / ~ Residing at (~ ~ tNotary Public ;' ~;,Y;'~,:, ~ ,. ~ My Comrmss~on Exp~¢s. ............ ~:,., < Page 5 of s C:\i S&z DTZ\C/±lls, Trusts & lgs~:aLe ?lann±ncJ\GROSH01 - Gross Henry, Gr. and Gul±a 3,\Gross Henry, Gr. - 000106 - l~±ll.do¢ CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: HENRY GROSS, JR. Date of Death: MARCH 21, 2004 Will No. 21 - 04 - 0493 To the Register: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiary of the above-captioned Estate on June 14, 2004: Name Address WILLIAM NAGEL 900 W. Main Street Mt. Joy, PA 17552 Notice has been given to all persons entitled thereto under Rule 5.6(a). Dated: June 14, 2004 Signature ~~ Name: Shelly J. Kunkel, Esquire Skarlatos & Zonarich LLP Address: 204 State Street Harrisburg, P~A~' 17lQ1 Telephone: (717) 233-1000 Capacity: Counsel for Persona~ Representative '.~, SKAIRk4T &ZONAPdCH LLP ATTORNEYS AT LAW 204 StAtE STREET HARRISBURG, PENNSYLVaNIa 17101 JOHN R. ZONARICH* STEELTON OffiCE ANNA MARIE SOSSONG SUNBANK BUILDING, STE. 201 KATHY SPEAKER MACNETT (7 I 7) 233- ! 000 51 SOUTH FRONT STREET JOHN [5. CONSEVAGE TELEFAX (717) 233-6740 STEELTON PENNSYLVANIA 17113 JOHN B. ZONARiCH WWW.SKARLATOSZONARICH.COM (717) 939-9358 GREGORY S. CHELAP Shelly J. KUNKEL TODD F. TRUnTZ ? MIDDLETOWN OFFICE DARRYLJ. LIGUORI (717~ 944-5109 DAVID H. JUDY ANGELO SKAR LATOS (1966-- IS)B1) * BOARD CERTIFIED IN CIVIL TRIAL ADVOCACY WRITER'S EMAIL: ~f ALSO ADMI~-rED in NEW JERSEY sharon@$kariatoszonarich.~om June 18, 2004 Office of Register of Wills Cumberland County Court House 1 Courthouse Square ~ · Carlisle, PA 17013 r,,._.~ Rig: Estate of Henry Gross, Jr. No. 21-04-0493 Dear Sir or Madam: Enclosed please find a check in the amount of $40,000.00 representing a prepayment on the inheritance tax for the above-referenced estate. Thank you. Sincerely, Sharon K. Shaffer Estate Administrator Enclosure MEMBER OF LAwPACTTM - A NATIONAL ASSOCIATION OF INDEPENDENT BUSINESS law FIRMS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004071 KUNKEL SHELLY J 204 STATE STREET HARRISBURG, PA 17101 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 ~40,000.00 ESTATE INFORMATION: SSN: 717-09-2267 FILE NUMBER: 2104-0493 DECEDENT NAME: GROSS HENRY JR DATE OF PAYMENT: 06/21/2004 POSTMARK DATE: 06/18/2004 COUNTY: CUMBERLAND DATE OF DEATH: 03/21/2004 TOTAL AMOUNT PAID' $40,000.00 REMARKS: CHECK# 1110 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~ ~ce ~ea h pro~d~ for yo~ ~tem~ me ~d~ Sewice: : ~ce m~t be ~ked on ~bffi. STANDARD OVERNIGHT MON emp: 477898 18JUN04 Del iver By: ~ ,~ 21JUN04 '-' TRK~ 8400 9758 ~227 FORM e2~5 AA ~~~~s~. 4a ~PackageSewice .. ~ ~k~=l~ . Date~- ~ ~-0~ ~d~Trac.ng Number 8400~7580227 ~ Fed~ Pri.~ Ovemig. ~ed~ ~andard Overnight ~ Fod~ Rr~Ovemig. ;~fj).~ ~'~r-r ,::: ~ F~lOay~eig~ ~ Fed~2DayFreight Fed~3DayFreight ~ , ~ackaging "Oecl ......... '-- ,. ~ ~,.~ ~ at Fed~ Locafim ~ at Fed~ ~caaon ~pera=ched ~ Ship~FsOoclar.on ~ DwIce ~ ~ 7/ P~ Bill~' O~inRecip.~ ~ Sender ~ Recipient ~ ~ird Pa~ ~ Cred~Card ~ Cas~Ch~ck ~ Address ~ _ . C~ ~ ~ ~ D D ~ 7 S ~ fl ~ ~ 7 ~ur~iabi~is~im~d~$~un~essy~udec~areahigherva~u~see~eFed~Se~c~uidef~rd~ai~s~ By signi~ you a~onze us ~ del~er ~is shipme~ ~o~ o~inin9 a signa~re .REV4500 I-:X (~-00) OFFICIAL USE ONLY REV-1500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN F,'E.UM.ER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT Z_co - DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z HENRY GROSS, JR '717-09-2267 t'"l DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE WITH THE LU REGISTER OF VVlLLS O HARCH 21, 2004 LM (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INFriAL) SOCIAL SECURITY NUMBER ,,, [] 1. OriginatRetum [] 2. SupplemantalRetum [] 3. RemainderReturn(dateofdeam~orto12-13-~) ~ a: ~ [] 4. Limited Estate [] ~a. Future lnterest Compromise I~at~ o, ~at, a~r a~-~2-a~) [] 5. Federal Eslate Tax Return Required LiJ Q- ~ ~: _, [] 6. Decedent Di~ Testate ~ttaeh copy of ~ll) [] 7. DecedcmtMaintatnedaki¥ingTrustl~tta~¢o~ofTrmt) 8. lotalNumb~'ofSafeDepos~Bo×es < [] ~. UtigatienProcc~sReceiwed [] 10. SpousaIPovert¥Cr~it(~at, of~atht~t~nu-3~-~an~4-~s) [] 11. F. lectien to tax un~er sec. 9113(^)(~acnSchO) ~ THIS S£CTION MUSl BE COM~[EI~D. ALL CORR£SI~NDfiNCfi .~D CONFIDENTLY. T.~X INFORMATION SHOULD BE DIRECTED TO: ,. NAME COMPLETE MAILING ADDRESS z WIT,T,TAH S.NAGET, 900 W'RST HATN STRRET o o. FIRM NAME (If Applicable) MOUNT JOY PA 17552 (,9 LU n' ~' TELEPHONE NUMBER o o 717 653 8194 1. Real Estate (Schedule A) (1) 78, 000 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) NONE 3. Closely Held Corporation. Partnership or Sole-Propriatorship (3) N ON E 4. Modgages & Notes Receivable (Schedule D) (4) N ON E 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1 0, 9 5 3 6. Jointly Owned Propedy (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Nen-Probate Properly (7) 1 3 3, 0 0 0 (Schedule G or L) ~' 8. Total Gross Asse{s (total Lines 1- 7) (8) 2 21, 9.5 3 ~ 9. Funeral Expanses & Administrative Costs (Schedule H) (9) ]. 2, 564 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 12 12. Ne~Valueof Estate(Line 8 minus Line 11) (12) 209, 389 13. Charitable and Govemmantat Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Ne~ Value Subject to Tax(Line 12 minus Une 13) (14) 209, 389 SEE INSTRUCTIONS FOR APPUCABLE RATES ~ 15. Amount of Line 14 taxable at the spousal tax ~ rate, or transfers under Sec. 9116 (a)(1.2) X .0__ (15) ~-' 16. Amount of Line 14 taxable at lineal rate X .0 (16) tl 17. Amount of Line 14 taxable at sibling rate X .12 (17) O 18. Amount of Line14 taxable at collateral rate 209,389 x .15 (18) 31,408 35 O ' 19. TaxDue (19) 31,408.35 20. [] LCHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENTJ > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < STF PA42021F. 1 · Decedent's Complete Address: STREET ADDRESS 162 S ENOLA DRIVE ENOLA I, STATE Pa I,z'P 17025 CrTY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 31,408.35 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 40,000.00 C. Discount 1,570.26 Total Credits (A + B + C) (2) 41, 57 0.26 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 I Line 20 to request a refund (4) l 0, 1 6 1. 9 1 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE (5) 0.0 0 A. Enter the interest on the tax due. (EA) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (EB) 0.0 0 Make Check Payable to: REGISTER OF IMLLS, AGENT PLEASE ANSVVER 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 dght 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 alter 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 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 penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best d my knowledge and belief, it is true, ca'rect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS - 900 WEST MAIN ST MOUNT JOY PA 17552 /URE OF PREPARER OT,,,H~::~ THAN REPRESENTATIVE DATE ADB-RESS,..%. \ ' 27 PFAUTZ ~VE LITITIZ PA 17543 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 alter January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or alter July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. STF PA42021F.2 I~fPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In Re: ESTATE OF HENRY GROSS, JR. No. 21 - 04 - 0493 TO: WILLIAM NAGEL 900 W. Main Street Mt. Joy, PA 17552 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent, Henry Gross, Jr., died on the 21st day of March, 2004, a resident of 162 S. Enola Drive, Enola, Cumberland County, Pennsylvania. The Decedent died testate. The personal representative of the Decedent is William Nagel, 900 W. Main Street, Mt. Joy, Pennsylvania, 17552. The Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Court House, 1 Courthouse Square, Carlisle, PennsYlvania, 17013. A copy of the Will is enclosed for your file. Date' June 14, 2004 Signature' ~ Name: Shelly J. Kunkel, Esquire SKARLATOS & ZONARICH LLP 204 State Street Harrisburg, PA 17101 Telephone: (717)233-1000 Capacity: Counsel for Personal Representative REV-1502 EX + (1-97) (I) SCHEDULE A CO~O~LT" OF PEN NSYLVANIA REAL ESTATE RET .N RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 All real property owned solely or as a teoam in commo~ must be repod, ed at fair marke~ value. Fair market value is defined as the pdce at which properly would be exchanged be~veen a willing buyer arid a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. RESIDENCE REAL ESTATE DAUPHIN COUNTY PA 78,000 162 SOUTH ENOLA DRIVE, ENOLA PA TOTAL (Also enter on line 1, Recapitulation) $ 7 8,0 0 0.0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021F.3 08/16/2004 10:54 FAX 717 920 9149 EXIT REALTY Capital Area ~002/005 /L Se~rfmn~ ~tabefnent U.~. Delight of ~o~9 a~d U~an D~elop~n[ OMB No. B. T~e of L~.. ~. F~ 2. F~ 3. ~. untns 6_ Eite N~e[ 7. Loan 4. VA 5. ~nv_ I~. 77~04 Morale Insurance ~se Nu~e~ C. Note: ~s fo~ A ~Ahed m gna you a s~te~nt of a~uat se~flt ~. ~ou~ ~id t~ and by ~a segment ~em am sh~. E~ ~d '(p.a.c.T were paid outside ~e ~ng; ~ey sho~ ~m br in~on pu~ses and am n~ included i~the t~ls. D. Na~d~ of Be~er: -- ~OY H. ZIMMer, JR ~D JODY L. Z~MER~AN 7a=a E. ~P~CHI~ T~ HARR SB~RG, PA E. Naiades ESTATE OF H~RY GR--,JR, ~LLI~ ~ F, Natured[ess of Lende~ FIRST ~TION~ B~K OF ~YSVt~E 101 LINCO~ S~E~ ~RYSVt~E, PA 17053 G Pmpe~ Loca~ Se~meflt ~e~ ~ur M. Fold, Esqu~e 162 S~ ENO~NOLA 1309 Brld~ ~, N~ Cu~edand, PA 17070 ~ TIN: ~258276 Date ~f Se~le~ JULY 14, 2004 ~,. SUMM~Y OF BO~RO~R'S'TR~SACT ON SU~y ~ S~ I FR'S ~NSA~I~ 100. ~S AMOUNT DUE FROM BORRO~R 400. ~OSS ~U~ DUE TO 101_ ~ Sa!es p~ 78,~.00 ~1. Coh~ Sales Pri~ ld2'. Personal Pro~ ~2. Per~flal P~e~, ' ?3. Seffle~nt ~a~e to borro~c {Line 1400} 2~482.50 403.00 104.00 404.~ Adju~s for ~e~ paid b~ seller in advance Ad~us~n~ for ite~ paid b~ ~1~ ~ a~n~ 1~. C~/town ~e~, 406. CI~ ~xes 107 Cou~ T~es 7/1~-~1/~ 93.58 4~7. Cou~ ~es 7/14~1~1~ ' ' 108. S~o~ T~es 7/14~0~5 751.14 ~. Snh~ T~ 7/1~/3~5 I09. Re.se & S~r 7/14~0/04 81 12 4~. Re.se & ~r 7/1~/30~4 ~1.12 110. Wa~r 410. Water 111. ~'~'sr ' ' 411. Sewer 112.~ 412 f~. ~oss ~ou~ DUE FROM BORRQ~R 81,408.26 ~0. ~O~ ~OUNT DUE TO SF[~I ER 78,~5.76 ~. ~OU~S PAID BY OR ON BE~LF OF BORRO~R 500. REO~TI~S IN ~OU~ DUE Td SE~R ' .201. ~oslt ~ ~st money 1,~0.00 ~1. Ex~ D~it (see ln~ons) ' 202. PfinQpal a~nt of new loan{s) 77,~0,0~ 502. SeCant cha~ges ~o sell~ (line 6,917.60 C~O81NGASSIST~CE FROM SE~R 3,~.0~ 1400) CLOSING ASSIST~CE TO BUYER 3,O~0~ 203. ~n~ I~s) taken subJe.~ to 503. ExJs~n~ I~n{s) ~n subje~ 2~.~ 5~. Payoff of 1st Mo~a~ Loan 205,O0 595. Payoff of 2nd Mod~¢~ Lo~ 2~.00' 506.00 ,~q~.oo 507.00 ,~JUS~E~Te FOR ~US UNP~O BY SELLER ~J~S~S FOR IT,S U~AID BY S~l ~ ~R 2~0.C~o~ ~eS 510. CHylto~ ~es 21 t. ~unt~ t~es 511.. cou~,~es 212. ~p~[~e~[s 512. 213. s~ool T~es ~]3. School ~14. Refuse '~ 514. 215. ~ter 515. Water 216. S~r . ,. 516. Sewe~ 217.00 517.~ 218.00 ,,, " 518.~ 219.~ 519.00 I~. YOTAL PAID BY,OR B~R~R ' 81T~0.~ 520. TO?~ R~D~C?IONS 300. ~SH AT SE~LEME~ F~o BORRO~R ~a. CASH AT UE I I ~MENT TO~R~ ~1, Gr~s amount due from boffo~er I 8; 438,26 601. Gross ~unt due to sefleT ~l~e ~ 78 ~ 76 ~e 120 ..... [' ) " I 4~) , ~tine ~0) ] ~ ~elJer'{tn' e 520) 303. CASH ~.From T~ ) ~o~e~ ' ~ 408,~603~ CASH ()m~ TO (X)SELLER ' SUBST~ ~RM 10~ SEL~R STATE~E~: ~e info~en con~ herein is ~e~ant ~x i~fion e~ -- :Is ~ ~hed to ~e Int~ R~enue Se~ce. ff you am r~ulr~ ~ file a r~m, a n~a~ce ~her san~on ~ ~ l~osed on you ~th~ ffem is requff~ to be repoRed a~ ~e IRS dete~n~ ~t ~ has not been ~oded. The ~n~ ~les price desc~b~ on fine 401 above con--eS ~e Gross Pr~ee~s ~n. SE~ ~ ~R INS~UCTI~s: ff ~ mai ~te ~ y~r ~c~al res~ce, ~e F~ P~pal Ees~, for ~ny ~m, ~ your ln~ t~ rets; for o~ ~an~, ~Ete the apH~ble ~pa~ of Fo~ 4797, Fo~ ~2 and/or Sch~ D (Fo~ 10~} Y~ em required by I~ to ~[~e ~ur ~ F~d, Esquire ~h yo~ ~re~ t~er nu~. tf you ~ ~t pm~e your ~ffe~ t~payer ~n~ nu~r. y~ ~y be s~ ~ ~ or ~inal ~a~es Impas~ by ~, and Und~ ~1~ of peru.. I cermet ~e numar sho~ on ~ ~d~E~l ~nts s~gn~ at · REV-1503 EX + (1-97) (I) SCHEDULE B co~o.w~_AL~. O,,E..S~V^.~ STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF :ILE NUMBER HENRY GROSS, JR 21-04-0493 All property jointly, owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 2, Recapitulation) $ NON E (If more space is needed, insert additional sheets of the same size) STF PA42021F .4 REV-150.4 EX + (1-97) (I) SCHEDULE C COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATION, INHERITANCE TAX RETURN RESIDENT DECEDENT PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 Schedule C-I or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 3, Recapitulation) $ NON E (If more space is needed, insert additional sheets of the same size) STF PA42021F.5 REV-150.5 EX + (1-97) (I) SCHEDULE C-1 CO O.W LTH OF"E""S V^N CLOSELY-HELD CORPORATE INHEPJTANCE TAX RETURN EESIDENTDECEDENTSTOCK INFORMATION REPORT ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 1. Name of Corporation State of Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2~ Federal Employer I.D. Number Business Reporting Year 3. Type of Business Product/Sen/ice 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common Preferred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? [] Yes [] No If yes, Position Annual Salan/$ Time Devoted to Business 6. Was the Corporation indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-827 [] Yes [] No If yes, [] Transfer [] Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate shee~ for additional transfers and/or sales. !9. Was there a written shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. 1,0. Was the decedent's stock sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated alter the decedent's death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? [] Yes [] No If yes, report the necessan/information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMI'I-rED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. Ust those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. S'l]; PA42021F.6 REV-15,O6 EX + (1-97) (I) SCHEDULE C-2 COMMONWEALTH OF PENNSYLVANIA PARTNERS HI P INHERITANCE TAX RETURN RESIDENT [)ECEDENT INFORMATION REPORT ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 1. Name of Partnership Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Product/Service 4. Decedent was a [] General [] Limited partner. If decedent was a limited partner, provide initial investment $ 5. PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was pdor to 12-31-827 []Yes [] No If yes, []Transfer [] Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? []Yes [] No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated a~ter the decedent's death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? [] Yes [] No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of finandal statements or Federal Partnership Income Tax retums (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedenrs partnership interest. STF PA42021F,7 REV~15C,7 EX + (1-97) (I) SCHEDULE D co~o~_~LT. OF.E..S~V^.~ MORTGAGES & NOTES INHERITANCE TAX RETURN RESIDENT DECEDENT RECEIVABLE ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 4, Recapitulation)$ N ON E (If more space is needed, insert additional sheets of the same size) STF PA42021F.8 REV-1508 EX + (1-97) (I) SCHEDULE E I COMMONWEALTH OF PENNSYLV^NIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RES,.E.TDECEOE.~' PERSONAL PROPERTY ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 Include the proceed s of I~tig ~io~ and the d~te the proceeds were received by lhe estste. All prope~ jointl¥-c~med with the right of survivorship must be disclosed o, Sc,~d~!e F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CHECKING ACCOUNT-BANK OF LANCASTER COUNMTY 6,504 2 CHECKING ACCOUNT- PNC BANK 2,869 3 IRS REFUNDS 1,580 TOTAL (Also enter on line 5, Recapitulation) $ 1 0, 9 5 3.0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021F.9 PN CBA] Aug~m 31, 2004 Ttmuk you for ~ PNC Bank. l~.,low you will find I~ foUowing bfformatkm ~in~ ~e ~c of ~ lc~ ~ ~~ ~ ~e m~fi~ ~. ~ ofH~ ~ Ir. ~~) S~ 717~2267 ~D 03-21~ ~~ N~ ~ of~ ~ A~ ~ I ~ th~ opportuuity to be of ramti~. If you have any further quest{oas regardi~ this maller, ple~e ooutaci ms: directly at 1-877-762-8000, extcusion 30192_ Siaccr~y, Clicat Satisfaction S~ FNC Bsnk., National F~mci~l S~iccs ~ 7 '~ l~5~ 'o~J 7 ~ q INJ7F,'7 ~£d~7 '7 '~aq~' REV-1509 EX + (1-97) (I) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF :ILE NUMBER HENRY GROSS, JR 21-04-0493 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT C. JOINTLY-OWNED PROPERTY: LET'i'ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH Il'EM FOR JOINT MADE Include name of f~andal inslit~on and bark accomt nu'nber or simibr identifying number. DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attach deed forjointJy-hetci real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insed additional sheets of the same size) STF PA42021F. 10 REV-151~ EX + (1-97) (I) SCHEDULE G CO~O.WEA'TH OF PENNS~LV^"~ INTER-VIVOS TRANSFERS & ~,,ER~TA"CETAX RETU,, MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 This schedule must be completed and flied if the answer to any of questions 1 through 4 on the reverse side of the REV-I,500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM iNCLUDE 'i]-.E NAME OF TFE 'IRN, EEEREE, TFFJ R RELATIONSHIP TO DECEDENT AND ]HE DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER OF TRANSFER. ATFACH A COF'Y OF TI-E DEED FOR REAL ESTA~. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. WILLIAM NAGEL,NEPHREW-JANUARY 2004 16,500 100 3,000 13,500.00 2 CONSTANCE NAGEL,NEPHREWS WIFE 01/04 16,500 100 3,000 13,500.00 13 SEBASTIAN NAGEL,NEPHREW-JANUARY 2004 33,000 100 3,000 30,000.00 4 MARYANN NAGEL,NIECE WIFE-01/2004 22,000 100 3,000 19,000.00 15 KATHERINE NAGEL, NIECE-JANUARY 2004 22,000 100 3,000 19,000.00 6 KATHERINE HUGHES, NIECE-JAN&FEB 2004 22,000 100 3,000 19,000.00 7 D HUGHES,NIECES HUSBAND-JAN&FEB 2004 22,000 100 3,000 19,000.00 TOTAL (Also enter on line 7, Recapitulation) $ 1 3 3, 0 0 0.0 -- (If more space is needed, insert additional sheets of the same size) ST[:: PA42021 F. 11 REV-15,11 EX + (1-97) (I) SCHEDULE H COMMONV~_ALTH OF PENNSYLVANIA FUNERAL EXPENSES & ,NHE~T'..CE'r~ RE'rU.. ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 565 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Sodal Security Number(s) I EIN Number of Personal Representative(s) Stree~ Address City State Zip Year(s) Commission Paid: 2. A['tomey Fees 7,234 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address Ci~/ State Zip Relationship of Claimant to Decedent 4. Probate Fees 3 07 5. Accountant's Fees 2, 000 6. Tax Return Preparer's Fees 500 7. MEDICAL EXPENSES 1,958 TOTAL (Also enter on line 9, Recapitulation) $ 12 ~ 5 6 4.0 0 (If more space is needed, inset additional sheets of the same size) STF PA42021 F. 12 REV-15~2 EX + (1-97) (I) SCHEDULE I COMMONV~-ALTH OF PENNSYLVANIA DEBTS OF DECEDENT, [NH ERITANCE TAX RETURN ..Es,oE.T DECED~.T MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 Include unreimbumed medical expertses. ITEM NUMBER DESCRIPTION AMOUNT 1. TOTAL (Also enter on line 10, Recapitulation) $ (if more space is needed, insed additional sheets of the same size) STF PA42021 F. 13 RE'~-15,13 EX + (9-00) I SCHEDULE J COMMONV -ALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE i. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] WILLIA34 S NAGEL 1. 254 SCHOOL LA_NE MOUNT JOY PA 17552 NE PHREW RE S I DUE 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insed additional sheets of the same size) STF PA42021 F. 14 REV-~lSl~ EX + (1-97) (I) SCHEDULE K UFE ESTATE, ANNUITY co o.v T, o, & TERM CERTN N INHERITANCE TAX RETURN RESIDENT DECED~.T (Check Box 4 on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax'retum. r--~Will E~lntervivos Deed of Trust [--]Other MFE ESTATE INTEREST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE [] Life or [] Term of Years__ [] Life or [] Term of Years__ [] Ufe or [] Term of Years__ [] Ufe or [] Term of Years__ 1. Value of fund from which life estate is payable $ 2. Actuarial factor per appropriate table Interest table rate - []3 1/2% I--16% [] 10% I--IVariable Rate % 3. Value of life estate (Line '1 multiplied by Line 2) $ ANNUITY INTEREST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE [] Life or [] Term of Years__ [] Life or [] Term of Years__ [] Life or [] Term of Years__ [] Life or [] Term of Years__ 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout - [] Weekly (52) [] Bi-weekly (26) [] Monthly (12) []Quarterly(4) [] Semi-annually(2) []Annually(I) []Other( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate [] 3 1/2% [] 6% [] 10% [] Variable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and pedod payout is at end of period, calculation is: Line 4 x Une 5 × Line 6 $ If using variable rate and period payout is at beginning of period, calculation is: (Line4 x Line5 x Line 6) + Line3 $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (~f more space is needed, insert additional sheets of the same size) STF PA42021F.15 REV-IQ,A7 EX + (9-00) SCHEDULE IVI FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on Rev-'1500 Cover Sheet) ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 This schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. [] Will [] Trust [] Other 1. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. IL For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedenrs death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. [] Unlimited right of withdrawal [] Limited right of withdrawal 1]I. Explanation of Compromise Offer: 1~. Summary of Compromise Offer: 1. Amount of Future Interest .................................................................... $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ........... $ 3. Value of Line 1 passing to spouse at appropriate tax rate CheckOne [--~6%, (--13%, ['-)0% .......................... $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One []6%, i--]4.5% ................................. $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ........... $ 6. Value of Line 1 Taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ........... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ................................ $ (,if more space is needed, insert additional sheets of the same size) STF PA42021 F. 16 R'E¥,IF:~ 9 EX + (1-97) (I) SCHEDULE O co..o.v ,T. OFPE..S -V . ELECTION UNDER SEC. 9113(A) INHEPJIANCE TAX RETURN RESIDENT DECEDENT (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER HENRY GROSS, JR 21-04-0493 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Act. If the election applies to mom than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113 (A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. OESCRIP'flON VALLE Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALLE Part B Total $ (if more space is needed, insert additional sheets of the same size) STF PA42021 F. 17 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '*' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT I ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-15~7 EX AFP 112-"' ~ r' ~ .J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-14-2005 GROSS JR 03-21-2004 21 04-0493 CUMBERLAND 101 HENRY WILLIAM S NAGEL 900 W MAIN ST MOUNT JOY Allount Rellitted PA 17552 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ firV' :1!t;'f-Eit-A''P--CB1-:6J'--Noi'YcE--oF-i-NHER-ffANcl!-i'-AX-APliflA-isEiiENT~-Ar.toQiNCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GROSS JR HENRY FILE NO. 21 04-0493 ACN 101 DATE 03-14-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cesh/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Trensfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (5) (6) (7) 78.000.00 .00 .00 .00 10.953.00 .00 133.000.00 (8) NOTE: To insure proper credit to your account. submit the upper portion of this forll with your tax paYllent. 221.953.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GovernllBntal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 12.564.00 .00 llU (12) (13) (14) 12.564 00 209.389.00 .00 209.389.00 If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. AllDUnt of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due NOTE: .00 X .00 X .00 X 209.389.00 X 00 = 045 = 12 = 15 = (19)= .00 .00 .00 31.408.35 31.408.35 ~v TAX CREDITS: , ..n....". "......~. l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-18-2004 CD004071 1.570.42 40.000.00 TOTAL TAX CREDIT 41.570.42 BALANCE OF TAX DUE 10.162.07CR INTEREST AND PEN. .00 TOTAL DUE 1O.162.07CR . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) BUREAU OF INDIVIDuiECI~:D OFf iCE OF INHERITANCE TAX DIVISlott'Ci'-;"';;"'<_ -"'... (' PO BOX 280601 :-i:__'_J:- ... -',' ~ HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-16D7 EX AFP (03-05 ZOGS MAY 16 P; 2: 45 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-18-2005 GROSS JR 03-21-2004 21 04-0493 CUMBERLAND 101 A.ount H...1 tted HENRY CLER!< OF ORn. "'I'~ en 'RT - iii/'ll \j :j _ p~:;/j, WILLIAMC~MiAGf:L !I) 900 W MAIN ST MOUNT JOY PA 17552 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper creel t to your account, sub.it the upper portion of this for. with your t.x payment. CUT ALONG THIS LINE I~ RETAIN LOWER PORTION FOR YOUR RECORDS ... ..............................:................................................................................. REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT KKK ESTATE OF GROSS JR HENRY FILE NO. 21 04-0493 ACN 101 DATE 04-18-2005 THIS STATEHENT IS PROVIDED TO A VISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHDWN BELOW IS A SUHHARY DF THE PRINCIPAL T X DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-14-2005 PRINCIPAL TAX DUE: 31,408.35 PAYMENTS (TAX CREDITS): PAYMENT DATE 06-18-2004 04-01-2005 RECEIPT NUMBER CD004071 REFUND DISCOUNT (+) INTEREST/PEN PAID (-) 1,570.42 .00 AMOUNT PAID 40,000.00 10,162.07- TOTAL TAX CREDIT . IF PAID AFTER THIS DATE, S E REVERSE SIDE FOR CALCULATION OF AD ITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED S A "CREDIT" (eRll YOU HAY BE DUE A REFUND. S E REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) TOTAL DUE 31, 408.35 .00 .00 .00 ~ BALANCE OF TAX DUE INTEREST AND PEN. STATUS REPORT UNDER RULE 6.12 Name of Decedent: HENRY GROSS, JR. Date of Death: MARCH 21, 2004 Will No.: 0493-2004 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report that following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2 . representative be complete: If the answer is No, state when the personal reasonably believes that the administration will 3. following: If the answer to No. 1 is Yes, state the a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative account informally to the parties in interest? Yes X state an No d. Copies of receipts, releases, approvals of formal or informal accounts may be Clerk of the Orphans' Court and ma~t_a,Ched Date: Aug. 5, 2005 ~_ Signature joinders and filed with the this report. , , l__", ( , ,-' r- (') C'd f-- Gregor S. Chela Name (Please type or print) LU ~-'; - ~i - C~-:' L_ N N C') =_J WfC:C Skarlatos & Zonarich LLP 17 S. Second Street, 6th Floor Harrisburg, PA 17101 Address cr ' :::-; :,' C) Lr.:> C':.'Y = C'-': C:,__ o (717)233-1000 Tel. No. Capacity: Counsel for Personal Representative CGI