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Home My WebLink About04-0533Register of Wills of Estate of Jane W. Gross also known as Francis M. Gross, Jr Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS 2 -04-533 , Deceased Social Security No. 165 - 38- 0077 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) r--] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated and codicil(s) dated named in the last Will of 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.ta; 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: Name Relationship Residence Francis M. Gross, Jr Son 105 Shrefflers Ln, Lewistown, PA (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 7636 Wertzville Road, Middlesex Township (list street, number, and municipality) Decedent, then 87 years of age, died 05/13 , 19 04, at Carlisle Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania (Location) $ $ $ $ 125,000.00 situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of etters in the appropriate form to the undersigned: _ ~,-;Si~;n, at~ure Typed or printed name and residence . 105 Shrefflers Lane , Lewistown, PA 17044 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 before me this. ___~ .dayof - Foil the/P~f~gister Estate of Jane W. Gross Deceased Social Security No: 165-38-0077 Date of Death: 05/13/04 , 19 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters r~ Testamentary ~ Of Administration (c.ta.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Francis M. Gross, Jr in the above estate and that the instrument(s) dated LettersdeScribed in the Petition be admitted to probate and filed of record a~lthe last Will of DecedentFEES $ ~ 35,00~. ~ ~1 , . t~. J~/~ J ~ /~,.~ g(.~.~_~ ~,~~ ~ ~'/~/~/'--~L...~~ / RegiSter of Wills - Short Certificate(s) ..... $ ~' 4 , 0-(.~ ' Renunciation ........ $ Attorney: Gary A. Delafield, Esquire Affidavits ( ). ..... Extra Pages ( ) .... Codicil ........... JCP Fee .......... Inventory .......... Other ........... TOTAL ......... Prepared by the Pennsylvania Bar Association i O, 0 0 Telephone: Copyright (c) 1996 form software only CPSystems, Inc. I.D. No: 16145 Address: 300 S. Allen Street Suite 300 State Collese, 814/237-6278 PA 16801-4841 Form RW-1 (1991) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. zI-0E-S 3 [~ Local Registrar ~' MAY 1,52.004 P :!.0328!07 No. ~ Date NAME OF DECEDENT (F,r~ MsdOle LaMI COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH - VITAL RECORDS CERTIFICATE OF DEATH ,. Jane W. Gross AGE (ta~l I Ml~tho i Da~ ,. 87 ~,. Cumberland ~CEDENT'S USUA£ OCCUF~]Of4 7636 Wertzville Road Pa ,4. Widowed Middlesex 1,L Carlisle,Pa 17013 I FATHER'S NAME (F~'$L Micldle, LaM) 1,,. George A. Albright _J~ ~ranczs Gross Jr. Cumberland Hay 17,2004 ,,. Bertha Nailor I~ 105 Shrefflers Lane Lewistown,Pa 17044 1,,, Rolling Green Cemetery [,,, Camp Hill~ Pa ~ m (OR/~S A C _C~O~ENCE OU~ 10 (OR AS AICONS~OUENCE C~: miulmg m oeem) LA,IT IIHJURY AT WORK? COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Jane W. Gross Date of Death: May 13, 2004 Estate No. 21-04-0533 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 beneficiaries of the above-captioned estate on 6/11/04 Name Address Francis M. Gross, Jr 105 Shreffler Lane Lewistow/~44 Notice has now been given to all persons entitl,e~:H'hereto ~der Rule 5.6(a) except A. De sq · D~Gee_, Jones_& Kauffman, P.C. 300 South Allen Street, Suite 300 State College, PA 16801-4841 (814) 237-6278 Capacity: __ Personal Representative ~__ Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 February 16, 2005 Telephone (717) 787-3930 FAX (717) 772-0412 Delafield, McGee, Jones & Kauffman, PC Attorneys at Law 300 South Allen Street, Suite 300 State College, PA 16801 C) Re: Estate of Jane W. Gross File Number 2104-0533 Dear Gary A. Delafield: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 08/13/05. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. sincerelY,CV . IJ A -1 ~~ ./t(j~~ (!LA~("/'- (1) Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division Q":.~ STATUS REPORT UNDER RULE 6.12 Name of Decedent Jane W. Gross Date of Death Mav 13. 2004 File No. 21~04-0533 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above~captioned estate: 1. State whether administration of the estate is complete: Yes '" No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No _'" _ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state and account informally to the parties in interest? Yes _'" _ No Date:_7/29/2005 d. co , .. ('-J Capacity: Personal Representative '" Counsel for Personal Representative .- ( " ~ DELAFIELD, McGEE, JONES & KAUFFMAN, P. c. ATIORNEYS AT LAW 300 smITH ALLEN STREET, SUITE 300 STATE COLLEGE, PA 16801-4841 GARY A. DELAFIELD DANIEL McGEE ALFRED JONES, JR. ROSADELE KAUFFMAN DENISE M. BIERLY DEBRA DREIBELBIS THURLEY www.dmjk1aw.com August 10, 2005 Glenda Farner Strasbaugh Register of Wills Office One Courthouse Square Carlisle, Pennsylvania 17013 Re: Estate of Jane W. Gross File No. 21-04-0533 Dear Ms. Strasbaughr: TELEPHONE (814) 237-6278 FACSIMILE (814) 237-3660 (814) 237-2094 Enclosed please find copies of the following documents to be filed in the above referenced estate: 1. Pennsylvania Inheritance Tax return in duplicate; 2. Inventory 3. Status Report; 4. Check No. 684 in the amount of $30.00 to cover filing fees, and check no.685 in the amount of $5,707.03 as the remaining balance due on the Inheritance Tax. Thank you for your attention to this matter. GAD/kmm Enclosures Q , ,(-:J .:0 .~~~~ ,-.> = C"..;.) ~:J"l ~ C:: GJ ~u I -r~l C-:J n ::1) !:=J no C) C;:2, ~ C) 10' N """ o , lj') C:> ---r't ~ ex:> ~ RIiV. 110G EX + (MQ1 ,.. Z IU Q IU U IU Q I!! ,..co> Uii!,. lU"g "'li!.... U.... ~ .,.. o>z lUlU ~~ ul( z o ~ j:! ~ IU .. . (TFiClf<L USE: ()NL'i REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GrOSS, Jane W. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 05/13/2004 12/23/1916 FILE NUMBER 21 04 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 0533 NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 1, Original Return 4, Limited Estate 2, Supplemental Return 165-38-0077 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death prior to 12-13-82) o o 6. Decedent Died Testate (Attach copy oIWII) g. Litigation Proceeds Received 4a. Future Interest Compromise (date of death after 12-12-ll2) 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) 10. Spousal Poverty Credit (date 01 death between 1 1- 1 nd 1-1- 8. Total Number of Safe Deposit Boxes 5. Federal Estate Tax Return Required o 11.Election to tax under Sec. 9113(A) (Attach Sch 0) 300 S. Allen Street, Suite 300 State College, PA 16801 (J (1) None (2) 26,680.07 (3) None (4) None (5) 30,365.86 (6) 2,144.70 (7) 1,081,679.33 (8) (9) 31,590.79 (10) ,..'" = = 6 i-'r. (--) C) C:o :::J 11--; C~J () -=ri " .~ (::5 r-n ME Gary A. Delafield IRM NAME (If applicable) Delafield, McGee, Jones & Kauffinan, P.C. ELEPHONE NUMBER 814/237-6278 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation. Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) w 1,140,869.96 (11) 31,590.79 1,109,279.17 (12) 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 1,109,279.17 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 1,109,279.17 .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x ~ 5 (17) .. 17. Amount of Line 14 taxable at sibling rate x .12 ~ u S 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 49,917.56 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 49,917.56 20. D .,li;11I _(III Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6.(JO) j) f! f to, ~ g 11 J. i. Decedent's Complete Address: STREET ADDRESS 7636 Wertzville Road CITY Carlisle ISTATE PA IZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 49,917.56 42,000.00 2,210.53 Total Credits (A + B + C) (2) 44,210.53 3. Interest/Penalty if applicable D. Interest E. Penalty B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 5,707.03 (SA) (5B) 5,707.03 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 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or.................................................................................................................. d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................................................................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.............................................. ........................................................................ Yes No ~ I o ~ o ~ ~ 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. SIGNATURE OF PERS DATE 105 Shreffiers Lane Lewistown, P A 17044 -- 7-2-7-zJS DATE ADORESS ADORESS DATE 300 S. Allen Street, Suite 300 State College, PA 16801 f5 ~ /0 S--- For dates of death on or Iy 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)J. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)l. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P .5. ~9116 1.2) [72 P.S. ~9116 (a) (1)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 .5. ~9116 (a) (1.3)1. 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. .. SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYlVN41A ....HERfTANCE TAX RETURN RESDENT DECEDENT ESTATE OF Gross, Jane W. I FILE NUMBER 21 - 04 - 0533 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH 1 44 Shares common,MetLife 34.175 1,503.70 High: 34.57 Low: 33.78 Average: 34.175 COpy OF VALUATION ATTACHED 2 Various Stock 25,176.37 Total Value: 25,176.37 CONTINUATION SCHEDULE B-1 ATTACHED TOTAL (Also enter on line 2, Recapitulation) 26,680.07 SCHEDULE B-1 ESTATE OF JANE W GROSS FILE NO. 21-04-0533 STOCK NAME SHARES PRICE VALUE Sprint Corporation 108 17.635 1,904.58 SBC Communications 385 24.63 9,482.55 Lucent Technologies 132 3.395 448.14 Penn. Power & Light 18 40.45 728.10 AT&T 30 16.73 501.90 VodaPhone 100 23.94 2394.00 Bell South 180 25.70 4,626.00 Bell Atlantic 140 36.365 5,091.10 Agway, Inc 1 Stock Frozen/Bankruptcy Consolidated Paper 25 Couldn't locate company Cumberland Valley 1 Couldn't locate company TOTAL VALUE 25,176.37 *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gross, Jane W. I FILE NUMBER 21 - 04 - 0533 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jOintly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 3,780.77 Citizens Bank Certificate of Deposit Acct No. 6140729025 BANK LETTER ATTACHED 2 Citizens Bank Certificate of Deposit Acct No. 6140729025 9.59 Interest Accrued 3 Personal Property 25,840.50 Sold at public auction on 4/28/2005 Auction report attached Appraisal Attached 4 Check, Cingular Wireless 735.00 Merger Considertation for AT&T Wireless Stock 49 shares @ $15.00 per share Required Buyout of Shares on Merger 5 Citizens Bank Certificate of Deposit Acct No. 6140889049 1,387.03 BANK LETTER ATTACHED TOTAL (Also enter on Line 5, Recapitulation) 31,752.89 *' SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gross, Jane W. I FILE NUMBER 21 - 04 - 0533 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Francis M. Gross Jr 105 Shrefflers Lane Lewistown, P A 17044 Son JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM LETTER DATE Include name of financial institution and bank account number DATE OF DEATH NUMBER FOR JOINT MADE or similar identifying number. Attach deed for joinUy-held real VALUE OF ASSET DECO'S VALUE OF TENANT JOINT estate. INTEREST DECEDENT'S INTEREST 1 A 12/06/2002 Citizens Bank 2,628.70 50% 1,314.35 Checking Acct No. 6200843507 BANK LETTER ATTACHED 2 A 01/01/1978 PNC Bank 1,660.69 50% 830.35 Checking Acct No. 51-4002-4939 BANK LETTER ATTACHED TOTAL (Also enter on line 6, Recapitulation) 2,144.70 *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF Gross, Jane W. FILE NUMBER 21 - 04 - 0533 This schedule must be completed and filed if the answer to anv of Questions 1 throuah 4 on paae 2 Is ves. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF Include the name of the transferee. their re1ationship to decedent and the date of transfer. DECD'S EXCLUSION TAXABLE VALUE NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET (IF APPLICABLE) INTEREST 1 The Jane Gross Trust 1,045,242.71 100% 1,045,242.71 COPY ATTACHED Strategic Income Food $31,559.62 US Government Food $71,640.21 Citizens Bank Trust Acct No. 6140869781 $17,015.16 Citizens Bank Trust Acct No.6140869587 $25,027.72 Real Estate located at 7636 Wertzville Rd, Carlisle,PA APPRAISAL ATTACHED DEED ATTACHED $900,000.00 Beneficiaries: David Scott Gross, Grandchild Diane Renee Gross, Grandchild Francis Gross, Jr, Son Date of Transfer: 5/13/2004 2 AmeriUs Annuity Policy No. 310150 35,049.59 100% 35,049.59 Beneficiary: Francis Gross, Son Date of Transfer: 5/13/2004 TOTAL (Also enter on line 7, Recapitulation) 1,080,292.30 *' SCHEDULJ:H FUNERAl.. EXPENSES & ADMNSTRATlVE COSTS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF G J W ross, ane . I FILE NUMBER 21-04-0533 Debts of decedent must be reported on Schedule I. ITEM NUMBER A DESCRIPTION AMOUNT 1 FUNERAL EXPENSES: Myers-Harner Funeral Home 6,898.00 2 Rolling Green Cemetery 3,017.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Represenlative(s): Street Address City Year(s) Commission paid Attorney's Fees Delafield,McGee,Jones & Kauffinan, PC-Gary A. Slate Zip 2. 15,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills-estimated filing fees & costs State Zip 4. 450.00 5. Accountant's Fees 6. Tax Return Preparer's Fees Groups Tax & Payroll Service 300.00 7. 1 Other Administrative Costs Cumberland County Legal Journal Advertisement 60.00 Total of Continuation Schedule(s) 5,865.79 31,590.79 TOTAL (Also enter on line 9, Recapitulation) *' ScheWIe H FlI18IiII ExpeIIS8S & AmWIil:ob dtive Co5ls c::aD1ued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gross, Jane W. I FILE NUMBER 21 - 04 - 0533 4 2 The Sentinel Advertisement 115.79 3 SW Barrett Real Estate & Appraisal Services Real Estate Appraisal Fee 500.00 Bill Rowe, Appraiser Personal Property Appraisal Fee 85.00 5 Personal Property Auction Expenses: Auctioneer Commission 2584.00 Advertising 1127.00 Labor 350.00 Port a Potty 79.00 Tent rental 25.00 4,165.00 6 Tracy Gleim Assisted in moving personal property for sale 1,000.00 Page 2 of Schedule H REV-1513 Ell+ (9-GO) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT OECEOENT ESTATE OF Gross, Jane W. I FILE NUMBER 21 - 04 - 0533 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE n" Nnll 1.1 Tn .to .t., I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 The Jane Gross Trust Son 109,279.17 fIb/o: Francis Gross, Jr 105 Shrefllers Lane Lewistown, P A 17044 2 The Jane Gross Trust Grandchild 500,000.00 fIb/o: David Scott Gross 24 Yorkshire Court Elizabethtown, P A 17022 3 The Jane Gross Trust Grandchild 500,000.00 fIb/o: Diane Renee Gross 6515 35th Ave, NE Apt 202 Seattle, WA 98115 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (C(Q)~)f' TRUST AGREEMENT ~ day of THIS TRUST AGREEMENT is entered into this Nor. . , 1992, by and between: JANE GROSS, of Carlisle, Cumberland County, Pennsylvania, - AND - FRANCIS M. GROSS, JR., of Spring Mills, Centre County, Pennsylvania. ARTICLE I 1.1 DESIGNATION This Trust shall be known and referred to as the JANE GROSS TRUST. 1.2 PURPOSE The purpose of this Trust is to provide for the health, support, maintenance and education of Settlor's children, and to provide for the management and orderly disposition of Settlor's assets. 1.3 DEFINITIONS As used in this Trust Agreement, the following terms will have the meanings herein ascribed to them, unless from the context thereof a different" meaning is clearly intended: A. Settlor shall refer to and ~ean JANE GROSS. B. Trustee shall refer to and mean FRANCIS M. GROSS, JR. -" " I, E ~ ti C. Child or children shall mean the lawful children of the body of the person referred to, and persons who have been adopted according to law by the person referr~d to. In particular, Settlor's now living child is FRANCIS M. GROSS, JR. D. Grandchild or grandchildren shall refer to and mean the children of Francis M. Gross, Jr.. In particular, Settlor's now living grandchildren are DAVID SCOTT GROSS and DIANE RENEE GROSS. 1.4 TRUST ESTATE Settlor, either during her lifetime or by Will upon her death, or any other person, shall have the right at any time to add property to the Trust upon consent of the Trustee. All property, when received and accepted by the Trustee, shall become part of the Trust Estate. 1.5 REVOCABILITY During the life of Settlor, this Trust, or any provision hereof, may be amended, altered, revoked, or terminated, in whole or in part, by an instrument in writing signed by Settlor and delivered to the Trustee. The Trust may not be amended to change the Obligations, duties, or rights of the Trustee without the written consent of the Trustee to such amendment. If the entire Trust is revoked by Settlor, the Trustee shall transfer to Settlor all" of the Trust Estate as then comprised, 2 I L,"',-"",,,,,,, ,.,.~'~" .~."~,,,.,.. .~n" .~. .r ~ and shall execute and deliver to Settlor all instruments which are necessary or appropriate to release all interests of the Trustee in the Trust. On the death of Settlor, the Trust created hereby shall become irrevocable and shall not be altered or amended. ARTICLE II 2.1 The provisions of this Article shall apply during the lifetime of Settlor only. 2.2 The Trustee shall have no duty or obligation to payor cause to be paid the premiums on any life insurance policies on the life of the Settlor made payable to this Trust, or otherwise to see that any such insurance is maintained in force. 2.3 All rights, privileges, benefits, values and options available under any policy that is payable to this Trust may be exercised by the owner thereof, without the consent of the Trustee. The owner may also exercise such rights as are available under the policy to sell, assign, hypothecate or convert any such policy, or to change the death beneficiary thereof, all without the consent of the Trustee. 2.4 The Trustee shall pay from the income, if any, of the Trust Estate all costs, charges and expenses of administering the 3 ~ 'C.. . ~~~",~""""~'~"Cc..,, "" ". .-. ., .~ ,....f"r-<,~... .......... , ..~ _..- r ..... - , , ~, trust, including all taxes levied against the Trust Estate or any part thereof, and after the payment thereof the Trustee shall pay the remaining net income, if any, to the Settlor in such installments as the Settlor may elect. 2.5 During any period in the Settlor's life in which Settlor is, in the opinion of the Trustee, incapacitated, the Trustee may in its discretion Use so much of the net income and any portion or all of the principal for the support, comfort and welfare of the said Settlor in her accustomed manner of living, or for any other purpose the Trustee believes to be in her best interest. Any income not so used shall be accumulated and added to the principal from time to time. ARTICLE III 3.1 The provisions of this Article shall apply only upon the death of Settlor. 3.2 Should Settlor be survived by her child, the Trustee shall: A. Divide the Trust Estate into two shares, one share being composed of the maximum amount which may pass without imposition of any extra Federal estate tax by reason of the generation-skipping provisions of the Internal Revenue Code, as amended, and one share composed of those amounts, if any, which 4 .' I -1 '.,' exceed such maximum amount. The Trustee shall pay the amounts, if any, which exceed the generation-skipping tax limit to Settlor's child. The share which is less tha~ or eq~al to the exemption limitation shall be held in Trust according to the provisions of this Agreement; and B. Pay the income of the then Trust Estate to or on , payments, for the life of such child. behalf of Settlor's child, in no less frequent than quarterly 3.3 Upon the death of Settlor's child, or upon Settlor's death if she is not survived by her child, the Trustee shall: Divide the Trust Estate into as many equal shares as there are grandchildren of Settlor then surviving and grandchildren of Settlor then deceased with issue surviving, and shall hold one such share in separate Trust, under the terms hereof, for each surviving grandchild, and shall distribute one such share, subject to the restrictions of Article 4.11 hereof, to the issue of each deceased grandchild, said issue to take per stirpes and not per capita. Upon distribution of this Trust to any grandchild of Settlor, the Trustee shall, upon reques~ bya grandchild, distribute one-fourth (1/4) of the Trust corpus upon the grandchild attaining age twenty-five (25); one-third (1/3) the then-remaining balance upon the grandchild attaining age thirty (30) i one-half (1/2) the then-remaining balance upon the 5 - _k'r:' .."", -'.... ""'P-"~"" .. ~~~.' ~~r, , , "~'.7".. ~.. I '" _c" . -"'.'~--. .. 1 , I grandchild attaining age thirty-five (35); and the final balance at age forty (40). Upon final distribution, the separate Trust for a grandchild shall then terminate. ARTICLE IV POWERS OF THE TRUSTEE 4.1 In addition to all other powers and discretion granted to or vested in the Trustee by law or by this instrument, the take all such proceedings, and exercise all such rights and Trustee shall have the power and discretion to do all such acts, privileges in the management of the Trust Estate as if it were the absolute owner thereof, including, without limiting the generality of the terms, the following: A. To grant, bargain, sell, convey, exchange, or convert any real or personal property. .. B. To lease for terms within or beyond the duration of this Trust. C. To enter into oil, gas, and other mineral leases, on such terms as it may deem proper, and to enter into any pooling, unitization, repressurization, and other types of agreements relating to the development, operation, and conservation of mineral properties. improve any properties. D. To assign, partition, divide, subdivide, and 6 -"UJ,..."..."..,-,";"~.", ,_.'" .~; .'.... -. " - .-' - : " '. .- ~ -P?' ,..... . "'" ~...,. ..~,-':' ~~.... ., .. '. I , E. To loan,' reloan, invest, and reinvest the Trust Estate or any part thereof. F. To vote stock,give proxies, pay calls for assessments, call or exercise-stock subscriptions or conversion rights. G. To join in any plan of lease, mortgage, consolidation, combination, reorganization, dissolution, foreclosu~e, change of capitalization, or other change of structure of any corporation, trust, or organization, or the property or assets thereof; to deposit bonds, stocks, or other securities held by it with any protective or similar committee, and to take and hold any securities issued in connection therewith and to pay any assessment thereunder. H. To hold securities of other property in its name as Trustee, or in its own name, or in the name of its nominee, or unregistered in such condition that title shall pass by delivery. I. To procure and carry at the expense of the Trust Estate insurance of such kind and in such form and amount as the Trustee deems advisable to protect the Trustee and the Trust Estate against any hazard. J. To borrow money for any trust purpose', hypothecate the Trust Estate or any part thereof, and replace, renew, and extend any encumbrance thereon, on such terms, conditions, and security as may be determined by the Trustee and to pay loans or 7 .,. ' , - .. ,co other obligations of the Trust Estate as the Trustee in its discretion deems advisable. - K. To employ and follow the advice of any attorney, investment advisor, accountant, broker, tax specialist, or any other agent deemed necessary in the discretion of the Trustee, and to determine and pay to their compensation, whether from principal or income, as the Trustee shall decide'. L. To obtain and retain assets for the Use or benefit of a beneficiary hereof in non-income-producing form, without liability for loss of income or from loss of market value of the same. 4.2 The Trustee is expressly authorized to hold and retain any securities, properties, or other investments including shares of the Trustee or any affiliated or related corporation, and to continue to hold, manage, and operate any property, business, or enterprise received or acquired at any time hereunder,'as long as in its discretion it elects to do so, the profits or losses therefrom, if any, to inure to or be chargeable against the Trust Estate and not the Trustee. 4.'3 In investing, reinvesting, purchasing, acquiring, exchanging, and selling property for the benefit of this Trust, the Trustee shall exercise the judgment and care, under the circumstances then prevailing, that men of prudence, discretion, 8 --.....". -,' ".....,.... .". .' ~" ~ . - ""."" -~. . "'.'-"',," ,.." and intelligence exercise in the management of their own affairs, not in regard to speculation, but in regard to the permanent disposition of their funds, considering the probable income as well as the probable safety of their capital. Within the limitations of the foregoing standard, the Trustee is authorized to acquire every kind of property, real, personal, or mixed, and every kind of investment, specifically including, but not by way 4.4 Unless otherwise specifically provided herein, the < t , 1 I I I f ~ ~ n ~ f of limitation, participation in any common trust funds administered by the Trustee, corporate obligations of every kind, and stocks, preferred or common, that men of prudence, discretion, and intelligence acquire for their own account. Trustee in its discretion may determine what is principal or income and what shall be charged or credited to either, and its ~ ~ I judgment shall bind everyone beneficially interested hereunder. The Trustee may rely on the statement of the paying corporation as to whether dividends are paid from profits or earnings or are. a return on capital or a distribution of assets, and as to any r ! other fact relevant hereunder concerning the source or character of dividends or distributions of corporate assets. 4.5 If at any time, or from time to ~ime, any beneficiary entitled to receive income or principal hereunder shall be under age twenty-five (25), 9r an incompetent, or a person whom the 9 ""-~,,-,"1' ~_ Trustee deems to be unable to wisely or properly handle funds if paid to him directly, the Trustee may make such payments in its discretion, in anyone or more of the following ways: A. Directly to such beneficiary. B. To the natural guardian, or the legally appointed guardian, conservator, or other fiduciary of the person or estate of such beneficiary. C. To any person or organization furnishing care, support, maintenance, education, or recreation of such beneficiary. The Trustee shall not be required to see to the application of any funds as paid or applied and the receipt of such payee shall be full acquittance to the Trustee. The decision of the Trustee as to direct payments or application of funds shall be conclusive and binding on all parties in interest. 4.6 The Trustee, at its option, at any time, in connection with its management of the Trust Estate or the collection of any moneys due or payable to it as Trustee hereunder, may compromise or abandon any claims existing in favor of or against the Trust Estate. 4.7 The Trustee may lend or advance its own funds for any trust purpose to this Trust, the loans or advances to bear interest at the then current rate from date of advancement until 10 _ru!L'1l:1~)(~ .. . JUJ .\ _. L .'__ ,...__.,__, .. . - .' . -.. '. '. .,. - "... ,.. .- '''''~'''-''''.'''. I .--t ! paid, and, together with interest, to constitute a first lien on the entire Trust Estate until paid. 4.8 On any division of the Trust Estate into separate shares or trusts and on any distribution, the Trustee may apportion and allocate the assets of the Trust Estate in cash or in kind, or partly in cash and partly in kind, or in undivided interests, in such manner as the Trustee rn its discretion deems advisable. The Trustee may sell such property as it deems necessary to make any such division or distribution. After any division of the Trust Estate, the Trustee may make joint investments with funds from some or all of the several shares or trusts. 4.9 The Trustee shall have full power to pay from the Trust Estate any taxes, charges, or assessments for which Trustee, the Trust Estate, or any interest therein becomes liable, and any such payments shall be made from and charged to either income or principal of the Trust Estate or any sha~e or separate trust thereof, as the Trustee in its discretion deems proper. The Trustee may make any such payments directly or to a personal representative or other fiduciary and the Trustee may rely on a written statement on such fiduciary as to the amount and propriety of such taxes, interest, penalties, and other 11 costs, and shall be under no duty to see to the application of any funds so paid. and absolute discretion of the Trustee. any provision of this instrument is to be exercised in the sole 4.10 All discretion granted to or vested in the Trustee by I I I ! 4.11 Upon distribution of this Trust to a recipient other than a grandchild of Settlor, if any, such recipient is under the age of twenty-five (25) years, the Trustee shall establish a recipient reaches age twenty-five (25) years. Until such separate Trust for the benefit of such recipient, until such recipient becomes twentY-five (25) years, the Trustee shall have health, support, maintenance or education. full discretion to use income or principal for the beneficiary's ARTICLE V MISCELLANEOUS PROVISIONS 5.1 The Trustee shall have the right to resign at any time. On such resignation, Settlor's grandchildren, DAVID SCOTT GROSS and DIANE RENEE GROSS, or the survivor of the two of them, shall able to serve, or to continue to serve, the ~hen Trustee shall serve as alternate Trustee. Should neither of them be willing or do so, any beneficiary shall have authority to secure appointment designate a successor Trustee. In the event the Trustee fails to 12 I j of a SUccessor Trustee by a court of competent jurisdiction. Any such successor Trustee, however, shall be a disinterested corporate fiduciary oniy. 5.2 The Trustee shall receive compensation for its services pursuant to this Agreement in accordance with such schedules of compensation as are then in effect. 5.3 No bond shall be required of the original or any successor Trustee hereunder, or if ,a bond is required by law, no surety shall be required on such bond. 5.4 Except as otherwise expressly provided by this Agreement, no beneficiary of any Trust provided for in this Agreement shall have any right, power, or authority to alienate, encumber, or hypothecate his or her interest in the principal or income of such Trust in any manner, nor shall such interest of any beneficiary be subject to claims of his or her creditors or liable to attachment, execution, or other process of law. 5.5 The Trust created by this Agreement shall be administered, and the validity, construction and all rights under this Agreement, shall be governed by the laws of the Commonwealth of Pennsylvania. 13 ,,"', . ,~_i.~-. ~ , _ _ ._v ~.- . - -- - day twenty-one (21) years after the death of the last to survive of Settlor and of all the beneficiaries herein named or described terminate. who are living at .the date of death of Settlor shall forthwith 5.7 If Trustee shall at any time change its name or combine with one or more corporations under one or more differ~nt names, or if its assets and business at any time shall be purchased and absorbed by another trust company or corporation authorized by law to accept these trusts, the new or successor corporation shall be considered as the said corporate trustee and shall continue said trusts and succeed to all the rights, privileges, duties and obligations herein conferred upon Trustee. 5.8 Should any provision of this Agreement be or become invalid or unenforceable, the remaining provisions of this Agreement shall be and continue to be fully effective. IN WITNESS WHEREOF, and intending to be legally bound hereby, Settlor and Trustee have executed this Agreement the date first above written. 14 ; ~, f, , r: tf ~~ f' ,; Ii I' ~-~~ CC(Q)~V AMENDMENT TO TRUST AGREmmNT Pursuant to the authority of Article-l.5 of my Agreement of Trust, dated November 8, 1992, and known as the JANE GROSS TRUST, I hereby amend the same to provide as follows: 1. Trustee shall refer to and mean JANE GROSS and FRANCIS M. GROSS, JR. Either shall be authorized to act for the Trust independent of the other, although each shall keep the other informed of actions taken on behalf of the Trust. 2. The effective date of this Amendment shall be November 8, 1992. 3. In all other respects, the provisions of the Agreement of Trust shall remain in full force and effect. /J/'/f/L IN WITNEsS WHEREOF, I set my hand and seal this / - day of , 1995. WITNESS: r'&~(f-J ~ 4../). __ BigCharts - Historical Quotes Page I of2 INo.Ai)DLRECT Save YOM Hooey ......w1'iO~ This Historical Quoles tool allows you to look up a security's exact closing price. Simply type in the symbol and a historical date to view a quote and mini chart for that security. Enter Symbol: MET Enter Date: 5/13/2004 . MetHfe Inc Thursday, May 13. 2004 ClosIng Price: 34.15 Opere 33.98 High: 34.57 Low: 33.78 Vellums: 1,742,700 Go To Charting .111.. ~ SPONSORED LINKS ill No Splits 2.Month Daily Chart of Metlite Inc Get listed here S&P 500 E-mlni Tradil1gj;.YJ!tem - Simple, guaranteed S&P 500 E-mlnl trading course by Todd Mitchell. Hundreds.. . TlminaCube: UD 900% Since 2000 - 4 Trades a Year - Join thousands of Trend Timers who have taken control of their fi... Stock Option Tradlna: UD 92% in 7 Months - Free report on 124% gain on Fannie Mae while stock dropped 8%1 Harvard 61... 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See our privacy policy. updated 413/03. http://bigcharts.marketwatch.comlhistorical/default.asp?detect= 1 &symbol=MET &close _ d... 7/26/2004 +: CITIZENS BANK 525 William Penn Place Suite 153-2510 Pittsburgh, P A 15219 July 6, 2004 DELAFIELD MCGEE JONES & KAUFFMAN PC ATTN GARY A DELAFIELD 300 SOUTH ALLEN STREET SUITE 300 STATE COLLEGE, PA 16801-4841 Estate of JANE W GROSS Date of Death: May 13,2004 SSN: 165-38-0077 Dear SirIMadam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884. Sincerely, ~uk ~\f# Robert Roos Operations Services .~ CITIZENS BANK Account Number 6200843507 Account Title JANE GROSS OR FRANCIS GROSS JR Date Opened 12/6/02 Account Type Checking Principal Balance as of DaD $2628.70 Interest from Last Posting to DaD Account Balance as of DaD $2628.70 YTD Interest to DaD $1.87 .:: CITIZENS BANK Account Number 6140729025 Account Title JANE GROSS Date Opened 6/15/98 Account Type Time Deposits Principal Balance as ofDOD $3780.77 Interest from Last Posting to DOD $9.59 Account Balance as of DOD $3790.36 YTD Interest to DOD $40.38 .:: CITIZENS BANK Account Number 6140869781 Account Title JANE GROSS TRUST Date Opened 8/17/93 Account Type Trust Principal Balance as ofDOD $17000.00 Interest from Last Posting to DOD $15.16 Account Balance as ofDOD $17015.16 YTD Interest to DOD $192.14 .:: CITIZENS BANK Account Number 6140869587 Account Title JANE GROSS TRUST Date Opened 7/3/93 Account Type Trust Principal Balance as of DaD $25000.00 Interest from Last Posting to DaD $27.72 Account Balance as of DaD $25027.72 YTD Interest to DOD $383.32 .~ CITIZENS BANK Account Number 6140889049 Account Title JANE GROSS Date Opened 3/22/89 Account Type Time Deposits (IRA) Principal Balance as of DOD $1384.44 Interest from Last Posting to DOD $2.59 Account Balance as ofDOD $1387.03 YTD Interest to DOD $14.39 ROWE'S AUCTION SERVICE (RH 79L) Bill Rowe (AU 1538L) Ben Rowe (AU 1092L) 2505 Ritner Highway · Carlisle, PA 249.2677 697.4794 249.1978 Bob Rowe (AU 2276L) Dave Rowe (AU 2295L: Auction Is Action Call "Rowe" For Satisfaction SELLERS NAME TIVz. >'5 ,1""A"""i C~ .~P,.AJ~ lAJ C,/!A.~~ DATE M.J.r.n.. '7--"'2..j 1-""";''''- ADDRESS OTHER "1'" 3 4> I..... AlA" -2, Vll( ~ /)Jl ~ A.J\.- '--' ~ V;. t-DoA- n'() l~ PHONE 111~.s'{~.-1,;,"''i''Y AUCTIONEER % I D CLERK % L..,4.&.fl.- ~ 12.s:::../1f t.. AUCTION DATE/LOCATION AyA-il '2-B ~"'2..."1 ~c:H- DESCRIPTION OF MERCHANDISE A11 V,.:.....T'~...,..)V 5,f.r"~ <;: i..t d JI!. A- "'- ..' Q;J....." ~i F; l....& '" F; A.. l( .v/'i '- (~tA 51l? " 11=:- L'1' F. ,Il. 1 I"l S-... fr bA. -r - A- ~ () ..rr'T:"7 ' <:\ _ L -+-{).,l>'y ~,Q . ~l> . @I>) , .,.rQ _1' ~ S-O 1"- N'I 2~ ..::..... I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of the merchandise. goods and or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of referred to in this agreement. ~~-\2..~ AUCTION SIGNATURE Total Sales (Clerking Tickets Attached) $ ;;l .s- .' Less Sale Expense: Ie) OTHER: :3- ~A~ .e...Itt.. % Commission ~uctioneer $ - et1lA 1J~'t( ~l.u;:.. I \ ~...., <i~ % numssion Clerks $ ~ c-'- L ." f.? vi\..- ~~-\.J -' ~...n.... '" ~,,""'T'1' lo, ---.0 -r.K,j) T ;:). s.- "''' TOTAL SALE EXPENSE DEDUCTED $ ~ ~ V _7~R8_NET' l.{ \ \.oS '" ~ ....7 .~_.~~ '"'\ \ I - S-lJ . /,- " ... / ~ _ \tll ~, . ~ '/! / ~~;/~# To: Francis Gross 105 Shrefflers Lane Lewistown, PA 17044 LINDEN HALL ANTIQUES 211 OLD STONE HOUSE ROAD CARLISLE, pA 17013 717-249-1978 From: William G. Rowe, Appraiser-Auctioneer 211 Old Stone House Rd. Carlisle, PA 17013 Re: Personal Property Appraisal Jane W. Gross Estate 7636 Wertzville Road Carlisle, PA 17013 Date: March 5, 2005 KITCHEN Set of dishes & miscellaneous items Household items - pots/pans - kitchenwares Country Kitchen Collectible - Collection Tobacco tin / matches Vinegar jugs - 2 glass /1 crockery Ironstone sugar bowl Adv. Items / spice tins Knick knacks Limb / twig settee HALL Mi rror Parlor stove Oak desk - Mission style Children's books Chalk Santa - 2 chalk black figures Collectibles on desk Political buttons Iron Bulldog door stop Sad irons (4) Sewing items Miscellaneous collectibles Wooden nickels - Lemoyne, PA Sewing machine Chest of drawers Sewing basket / contents BASEMENT Gig License plates (PA) Kitchen collectibles - glasses, etc. Side board - as is Bag cart Bread box Wheelbarrow Gross Appraisal $30.00 $20.00 $235.00 $20.00 $35.00 $15.00 $35.00 $30.00 $40.00 $15.00 $225.00 $175.00 $35.00 $145.00 $60.00 $35.00 . $85.00 $20.00 $15.00 $30.00 $25.00 $75.00 $300.00 $30.00 $25.00 $35.00 $30.00 $150.00 $20.00 $15.00 $30.00 1 03/05/21'05 Modem chest of drawers, painted Tube tester floor model - portable testers plus hundreds of bulbs in basement & garage Wood box Small 2-door cupboard File cabinet Radio Miscellaneous tools Oil cans Drill press - old Kitchen cabinet - as is (parts) Maytag washing machine - older model LIVING ROOM Dog prints Sea shells Tea set - silver plate Box of miscellaneous glassware Stands (2) Recliner Iron kettle Lamp stand Figurines Victorian upholstered chair Miniature grandfather clock - York, PA Lamp Records Living room set - older model (used) Coffee table Paper weights Bookcase Books Doughtray Toy cannon - missing firing pin DINING ROOM Radio Sideboard Salt & pepper tollection Large vase Knick knacks Child's plate - Harrisburg Fiesta ware - yellow & green Plates Store jar Satin lamp base Tea cart Holiday items Glass baskets Blue bowl Iris vase Miscellaneous silver spoons, etc. Lion compote Miscellaneous plates / glassware Candle sticks Sugar / creamer - Nippon Cake plate Lot of collectibles on window sill Gross Appraisal 2 $10.00 $200.00 $125.00 $80.00 $75.00 $15.00 $30.00 $20.00 $25.00 $100.00 $25.00 $70.00 $25.00 $35.00 $60.00 $15.00 $80.00 $25.00 $15.00 $30.00 $75.00 $115.00 $30.00 $15.00 $20.00 $15.00 $30.00 $30.00 $20.00 $100.00 $30.00 $20.00 $125.00 $110.00 $25.00 $20.00 $20.00 $40.00 $30.00 $15.00 $20.00 $85.00 $30.00 $60.00 $25.00 $20.00 $25.00 $55.00 $80.00 $55.00 $20.00 $35.00 $80.00 03/0512005 Celery dish - Red R S Prussia Celery dish I salts - 2 sets Hand-painted china - miscellaneous pieces Planters jar Milk bottles Easter eggs (2) Collection of cut glass: Libbey punch bowl w/8 cups Syrup Pitchers Water bottles I tumblers Nappies - all sizes Bowls - all sizes Small compotes Dishes - plates Trays $115.00 $85.00 $40.00 $45.00 $110.00 $60.00 $4,000.00 HALL CLOSET UPSTAIRS Collection of knick knacks Collectibles Hat boxes $100.00 $75.00 $45.00 BEDROOM Painted cradle Chair, worn Miniature lamp (on mantle) Knick knacks Ink well - Cupid Dresser items Hat pin holder I hat pins Lamp Record player $100.00 $15.00 $75.00 $15.00 $100.00 $30.00 $65.00 $15.00 $20.00 BEDROOM Selection of costume jewelry Bookcase Small storage chests (2) Planters (5) Selection of stuffed animals - condition?? Hats I cloth! ng I purses Rocker Bedroom set Contemporary dolls Dolls - as is condition - Bisque dolls: German 1900310 open mouth, stationary eyes German DGHH closed mouth, moveable eyes Germany DEP 5/0 open mouth, moveable eyes Saber - Germany Field Artillery 1890-1920 $115.00 $15.00 $15.00 $50.00 $125.00 $150.00 $100.00 $300.00 $30.00 $950.00 $150.00 ATTIC Gross - sign Glassware Grinder Child's riding toy - shovel Christmas items Bookcase Box miscellaneous papers, etc. $100.00 $30.00 $10.00 $50.00 $10.00 $50.00 $50.00 Gross Appraisal 3 03/05/2p05 Single bed Miscellaneous collectibles - bank Ship clock Quilts & hand-made rugs $20.00 $115.00 $80.00 $65.00 SUMMER KITCHEN Large brass cash register Prints German clock - as is Kitchen items $250.00 $20.00 $35.00 $10.00 GARAGE Bucket Lamps (3) Scales Magazines Skillets / kitchen items Glassware Post card album Bank Farm tools Granite roaster Evinrude motor 1953 Hat rack Collection of wood & tin toys - as is condition Baker's rack Chairs Frames / prints Saddles / bridles File cabinet Christmas tree - silver View Masters / slides Games / puzzles Chairs / rockers Table / chairs Military uniforms Selection of old farm implements: Straw cutter - pump - sheller Windmill, tooth harrow Wood frame cultivator - hay fork Wagon wheel - buck saw - tools Blanket chest - small, turned feet Baskets Knick knacks $20.00 $65.00 $40.00 $10.00 $40.00 $30.00 $300.00 $60.00 $115.00 $20.00 $100.00 $60.00 $495.00 $115.00 $20.00 $50.00 $175.00 $40.00 $15.00 $65.00 $70.00 $60.00 $10.00 $50.00 $200.00 $120.00 $60.00 $25.00 SHED 3-drawer spool cabinet Truck $100.00 $350.00 BARN Record players (3) $175.00 $15,630.00 TOTAL '-a ~ William G. Rowe Gross Appraisal 4 03/0512005 Please Note: Your Merger Consideration is Attached BROKER's Nama, Address, ZIP Code, 2004 Proceeds From Broker and Barter Exchange Transactions Federal klenlif"",lion Number and Form 1099-B Instructions for Recipient TelepItone Number: COpy B FOR RECIPIENT Brokers and barter exchanges must report proceeds from MeHon In_ Sanricas --'IMPORTANT TAX INFORMATION-- transactions to you and to the Internal Revenue Service. This 85 Challenger Road This Is lmpollanl tax Information and is form is. used to report tl1ese proceeds. Rldgefoeld Park, NJ 01660 being furnished to lhe I_a! Revenue ServIce. If~ are IIIqUlnKIto IiIe 8 relum, 1Th CUSlP Number ----. 22-3367522 a negligence penally or oIher sanclion 18. Dale 01 Sale or Elo;hBnge Toll Free Numbar. 1-877-300-2600 may be im~ OllljOU iflhis Income Is 1012612004 I . OO209A 10 6 taxable and the IRS delarmlnad lhet n has 2. SIDcJcs. bonds, _ I 4. FEOERAlINCOMETAX WlTHHB.O not been reporIad. $135.00 i $0.00 - - IDWHOMPAIO REPORTED tzI Gross Proceeds TO IRS 0 Gross Proceads less commissions and option pramlums 7. Descripllon ' ...-----..--.... JANE W GROSS MERGER CDNSlDERAnoN FOR YOUR AT&TWlRB.ESS STOCK 7636 WEITZVlLLE RO 1n_10 I Rsciplenfs ldenllfioation Number on File CARlISlE PA 17013-9046 125130440478 165-38-0077 3m: 1a . Shows the trade dale of the transaction. For aggreg&le repoltlng, no !n:ry v.;1U be prosGnt. :lox 1 b. . For broker lransaolions, may show Ihe CUSIP (Com",""", on Uniform 38CUT1ly Identification Proc8dUrB5) number of the item reported. 3m: 2. . Shows the aggregate proceeds from tranaacilons involving sIOGks, JORds, other debt obligations, commodities, or forward conllllcls. Losses on '"ward conlracls are shOlll.'Il in parentheses. This box does not Include proceeds 'rom regulalad lulures contracts. Report Ihis amount on Schedule D (Form 1040). Capital Gains and Losses. Box 4. . Shows baakup withholding. Ganarally, a payer must backup wilhhold al .. 28% !'Rle Ir you did ~nl furnish your taxpayer IdentlOcatlDn numbsr to Ihe ll8yer. See FOrm W-S, Request for Taxpayer Idenlificallon Numbsr and CerllncaliDn Information on baclcup wilhhDldlng. Include this amount on your Income tax retUrn as tax withhold. Box 7. . Shows a brief descrlplion of the nem Dr SBlVlce for which the proceads or bartering income is being rapoltad. For regulated futures contracts and IolWBrd contracts, "RFC" or a1her epproprlale description may be shown. ..----.---------------.-------------------------------------------------------------------------------------------------- A IMPORTANT TAX RETURN DOCUMENT ATTACHED A This check represents payment for your shares (the .Shares'1 of AT&T Wireless S8IVIces, Inc. rAWE") pursuant to the Agreement and Plan of Merger :tha "Merger Agreement"), dated as of February 17, 2004, by and among AWE, Cingular WIreless Corporallon, Clngular Wireless LLC C'Cingular") and he other parties thereto. By endorsing and pnIilentlng this check for payment, you represent and warrant that you are the owner of the Shares, in respect )f whlch this check was provided, on the Effective Date (as deftned In the Merger Agreement), and they are held free and clear of any liens, resbidlons, lllverse claims and encumbrances, except as may be shown on the I'IICOl'ds of the transfer agent for the Shares, and that you have not previously )Iedged or otherwise transferred conIroI of the Shares to any other person or entity. RetaIn this InformaUon for your records. g iiiii !!!!!! = == == - - l&IiII !!II - ..... - = g - . ~ - ;;; . . i Ii II) m SHAREHOLDER OF AT&T WIRElESS SERVICES INC. DESCRIPnON MERGER CONSIDERATION FOR YOUR AT&T WIRELESS STOCK CUSIP D0209A 10 6 CHECK NUMBER 48885979 ACCOUNT KEY GROSS--JANEWoooo CHECK DATE 1012612004 INVESTOR ID 125130440478 CHECK AMOUNT $135.00 NET PROCEEDS ($) $135.00 SHARES EXCHANGED 49.0000 EXCHANGE PRICE ($) $15.00 GROSS PROCEEDS ($) $735.00 TAX WITHHELD ($) $0.00 ~~: cingularo WI..L... PLEASE DETACH BELOW 1:1...=-.,t.::r'..I:.tleI",'afll:lf..:r'1...U.lfl..Iei:l"U:..='-1."':I_':J.:f.II..~~.)...:JJ:ai1'iYiUllf.ll:::ll~.."'liI.""lft:tr..lli1.'l:t'I&=t.1t..MI/:~icmlr..;:i:';;':;;.;...~.lr.t:~...;...._.r_ 60-160 433"-- CHECK DATE 10/2612004 CHeCK NUMBI:R 48685979 C/O MELLON INVESTOR SERVICES PO BOX 3434 SOUlH HACKENSACK. NJ 07l1Oll-11118 PAYABLE AT MELLON BANK N.A. PITTSBURGH, PA. IN U.S. DOLlARS 564538001 FPO.352"PRSRT TllOll5llll1701~ ,,~oo ~ PAY TO THE ORDER OF: JANE W GROSS 7636 WEITZVILLE RD CARLISLE PA 17013-9046 I PA Y'''*************$735.00 I ~~ AUT IZEDSIGNATURE 1I....8b8 5q 7"". ':0...::1::10 lobO lol:O lo"1II8 5... 711. SEP-02-2004 23:29 PNC8ANK 412 768 3458 P.01/01 ~ PNCBAN< September 3, 2004 Gary A. Delafield, Esquire 300 South Allen Street, Suite 300 State College, P A 16801-4841 RE: Estate of Jane W. Gross, deceased SSN: 165-38-0077 DOD: 5/13/2004 Dear Mr. Delafield: In response to your request for Date of Death balances for the customer noted above, out' records show the following: CheckiDg Account Account #5140024939 Established 01/01/1978 JANE W GROSS FRANCIS M GROSS JR DOD balance: $1,660.69 (non-interest bearing) Please note that this office only provideli date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any f"mancial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~~ Rachelle Wells 1-800-762-1775 P7-PFSC-04-F SOO fi~t Ave. Pittsburgh P A 15219 Member FDIC TOTAL P.01 Brytczuk Financial Services 1 : .., .....d. .~. _.......".. June 1, 2004 Gary Delafield, Esq. Delafield, McGee, Jones & Kauffman 300 S. Allen Street State College, P A 16801 RE: Estate of Jane Gross Dear Gary: The Jane Gross Trust was the owner of two accounts invested with Oppenheimer Funds. The value of these accounts as of the date of her death, May 13,2004, is as follows: Acct # 230 2301124882 Strrategic Income Fund = $31,559.62 Acct # 220 2200629651 US Government Fund = $71,640.21 Should you require any further information, please feel free to contact me. Brytczuk Financial Services is not a subsidiary of nor controlled by ING Financial Partners. Inc. P.O. Box 787 State College. PA 16804-0787 Tel: 814.237.1518 . 800.882.6767 Fax: 814.237.2030 gbrytczuk@yahoo.com Branch Office 175 Quincy Street Holbrook. MA 02343 Tel: 339.469.1044 Registered representative of and securities offered through ING.,Ai) FINANCIAL PARTNERS Member SIPC AmerUs Annuity Group Co. 555 South Kansas Ave Topeka, KS 66603 1-800-ANNUITY July 16, 2004 AMERUS Annuity Group Delafield, McGee, Jones & Kauffman, P.C. Attn: Gary A. Delafield 300 South Allen Street, Suite 300 State College, PA 16801-4841 RE: Contract #310150 - Jane Gross American Investors Life Dear Mr. Delafield: Thank you for your recent request for information regarding the contract referenced above. Our records indicate the contract is no longer in force. The death benefit was paid to Francis Gross in the amount of $35,049.59 on July 13, 2004. Francis Gross was the only beneficiary. Should you have any questions or need additional information, please contact our office at 1-888-266-8489. Sincerely, Danelle Schwartz Correspondence Specialist AmerUs Annuity Group AMERICAN INVESTORS LIFE A. AMEaUS'c....,...." AMERUS Ufe 1-888-252-5530 (CUSTOMER SERVICE) 1-888-ANNUlTY (CUSTOMER SERVICE) S. W. BARRETT REAL ESTATE & APPRAISAL SERVICES Fie No. 05-0308 APPRAISAL OF LOCATED AT: 7836 Wertzville Road Carlisle, PA 17013 FOR: Mr. William Rowe 211 Old Stonehouse Road Carlisle, PA 17013 BORROWER: GROSS, Francis (Trustee) AS OF: May 13, 2004 BY: Cassandra J. Crockett Certified Residential Appraiser 124-126 NORTH HANOVER STREET, CARLISLE, PA 17013 717-243-6646 AND FAX 717-243-8627 S. W. BARRETT REAL ESTATE & APPRAISAL SERVICES File No. 05-0308 06/16/2005 Mr. William Rowe 211 Old Stonehouse Road Carlisle, PA 17013 File Number: 05-0308 Mr. Rowe; In accordance with your request, I have personally inspected and appraised the real property at: 7636 Wertzvllle Road Carlisle, PA 17013 The purpose of this appraisal is to estimate the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the estimated market value of the property as of May 13,2004 is: $900,000 Nine Hundred Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final estimate of value, descriptive photographs, limiting conditions and appropriate certifications. Respectfully submitted, ~. (2JJ)- Certified Residential Appraiser 124-126 NORTH HANOVER STREET, CARLISLE, PA 17013 717-243-6646 AND FAX 717-243-8627 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Gross, Jane W. also known as , Deceased No. 21 - 04 - 0533 Date of Death 5/13/2004 Social Security No. 165-38-0077 Francis Gross, Jr The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unswom falsification to authorities. Attomey: Gary A. Delafield I.D. No.: 16145 Signature: Address: 300 S. Allen Street, Suite 300 State College, PA 16801 Address: 105 Shrefflers Lane Lewistown, P A 17044 Telephone: 814/237-6278 Telephone: 717-543-6099 Dated: - 7-27-0\ Personal Property J .f~'.... ~ = ~03.7Q; ~ ;0.. ~ i'l ("""") = C,y C> C) (/5 :-.0 ---10 '-Ti ,-on N :::l CJ C> ;:!"1lD' ~r1 --:.- _. _"-n 25&6.3~~ M ~ ,..-)~ co 44 Shares common,MetLife High: 34.57 Low: 33.78 Average: 34.175 COPY OF VALUATION ATTACHED n ro..... -[---:"'1 -- -'-) Various Stock Total Value: 25,176.37 CONTINUATION SCHEDULE B-1 ATTACHED Citizens Bank Certificate of Deposit Acct No. 6140729025 BANK LETTER ATTACHED 3,780.77 Citizens Bank Certificate of Deposit Acct No. 6140729025 Interest Accrued 9.59 (Attach additional sheets if necessary) Total Personal Property and Real Estate $58,432.96 " Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of Gross, Jane W. No. 21 - 04 - 0533 Date of Death 5/13/2004 Social Security No. 165-38-0077 also known as , Deceased 25,840.50 Personal Property Sold at public auction on 4/28/2005 Auction report attached Appraisal Attached Check, Cingular Wireless Merger Considertation for AT&T Wireless Stock 49 shares @ $15.00 per share Required Buyout of Shares on Merger Citizens Bank Certificate of Deposit Acct No. 6140889049 BANK LETTER ATTACHED 735.00 1,387.03 Total Personal Property $58,432.96 2 ,...., = c.;'.;j U en ,-\ I :l"":r,. -:J c: () G"",) ~:::J ,-J f,"l N CJ C:) :POI --n -n ...."" c=:> c.s r-"f""l ,.!:"'" C) .'"rl 0) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1 162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DELAFIELD GARY A 300 SOUTH ALLEN STREET SUITE 300 SATE COLLEGE, PA 16801-4841 _n_n__ fold ESTATE INFORMATION: SSN: 165-38-0077 FILE NUMBER: 2104-0533 DECEDENT NAME: GROSS JANE W DATE OF PAYMENT: 08/12/2005 POSTMARK DATE: 08/12/2005 COUNTY: CUMBERLAND DATE OF DEATH: 05/13/2004 NO. CD 005683 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,707.03 I I I I I I I I TOTAL AMOUNT PAID: $5,707.03 REMARKS: DELAFIELD MCGEE JONES & KAUFFMAN PC CHECK# 000685 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS l~~5 c,,~ LLJ .... C) , [:, c:) ~ L c.;~~ C C-,' ( :: i! I,. i...... co <::'! 11._,-_ (',1 (') :..~2 .... ~ U',:> ,-::'.."l l___ ~) <-.. I - c m ~ "T1 tv iii !:!?8 J; !!l.(/.) ,.,.. COo :.. (') o5.)>C) o ::T::l:m ~::!::QJTl 10 m:J c.. _co:J~o :1J(/.)lIlz ~<:<Illm -r.CDr-+(n O'l~r"" CO- III "'"" 0(/.):iE" ....r::: :J> J;:..;:+ c: COCO "T1 .f>.tv "T1 ....0 ~ o :J> _z :tJ r> no:;;o(;) III ::::l ltl ltl ::::!.. ltl ceo ::::l -. III a- lii n....1ll -Oltl ~ltl c:: .., ." "tl:::l.oe: ltl ::::l'"-::::l ::::l 0 :E ltl ::::l c:: _..., 11I11I=(1) '<ltllll.... <(I)Oiil Ill.c ::r: III ::::l c:: -. 0- -. (') III III e: ltl c:: ....ltl CQ ...., ::::l'" o .... w CJ \ C> ...l::... I ~ \J.I ~ 10-24-2005 GROSS 05-13-2004 21 04-0533 CUMBERLAND 101 APPEAL DATE: 12-23-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~Yr_~~9~9_r~~~_~~~~______~___~~!~!~_~g~~~_~g~!!9~_E9~_ygy~_~~~g~p~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JANE W FILE NO. 21 04-0533 ACN 101 BUREAU OF INDIVI~~"'1;~" rn-rr INHERITANCE TAX DIVI~~N~,.,~i~_L) \."T:\A':' PO BOX Z80601, ' HARRISBURG PA 171Z8-06IU ,., COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN ,..~ '-"} ,:'CJ ["", j Ii ? ?4 ..,.,... II-. (' GARY A ,..DELAFIElD DElAFIElD ETAL 300 S ALLEN ST STE 30 STATE COLLEGE PA 16801 ESTATE OF GROSS TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 26,680.07 .00 .00 30,365.86 2,144.70 1,081,679.33 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 31,590.79 .00 (11) (12) (13) (14) - REV-1547 EX AFP [06-05) JANE W DATE 10-24-2005 NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax paynent. 1,140,869.96 31.li9D 79 1,109,279.17 .00 1,109,279.17 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate (15) 16. Anount of Line 14 taxable at Lineal/Class A rate (16) 17. Anount of Line 14 at Sibling rate (17) 18. Anount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 1,109,279.17 X 045 = 49,917.56 .00 X 12 = .00 .00 X 15 = .00 (19)= 49,917.56 ..-. l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-09-2004 ..:: CD004248 2,210.53 42,000.00 08-12-2005 CD005683 .00 5,707.03 BALANCE OF UNPAID INTEREST/PENALTY AS OF 08-13-2005 TOTAL TAX CREDIT 49,917.56 BALANCE OF TAX DUE .00 INTEREST AND PEN. 140.74 TOTAL DUE 140.74 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. nJl IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUff'\/'. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) DELAFIELD. McGEE, JONES & KAUFFMAN, P.C. ATfORNEYS AT LAW 300 SOUTH ALLEN STREET, SUITE 300 STATE COLLEGE, PA 16801-4841 GARY A. DELAFlELD DANIEL McGEE ALFRED JONES, JR. ROSADELE KAUFFMAN DENISE M. BIERLY DEBRA DREIBELBIS THURLEY www.dmjklaw.com , i I nLEPHONE (ffi.4) 237-6278 CSIMILE (8 4) 237-3660 (8 4) 237-2094 gdelafield@~jklaw.com October 27, 2005 Glenda Farner Strasbaugh Register of Wills One Courthouse Square Carlisle, Pennsylvania 17013 Re: Estate of Jane W. Gross File No. 21-04-0533 Dear Ms. Farner Strasbaugh: Enclosed you will find check no. 809 in the amount of$140.74. According to the N tice from the Commonwealth, this is the remaining balance due on the P A Inheritance Tax for th above referenced estate. ::-) ~-..j -:::--.> c.~.::) G-, (~) (~) --l (.,) -0 GAD/kmm enclosure (check) .) 0"\ I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 1712B-0601 REV-1162 X(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005949 DELAFIELD GARY A 300 S. ALLEN STREET STE 300 STATE COLLEGE, PA 16801-4841 ACN ASSESSMENT CONTROL NUMBER AMOU~ T __nn__ fold 101 $1 40. 4 ESTATE INFORMATION: SSN: 165-38-0077 FILE NUMBER: 2104-0533 DECEDENT NAME: GROSS JANE W DATE OF PAYMENT: 10/31/2005 POSTMARK DATE: 10/27/2005 COUNTY: CUMBERLAND DATE OF DEATH: 05/13/2004 TOTAL AMOUNT PAID: $1 40. 74 REMARKS: CHECK# 000809 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS lfl ~. <1)0 00 ill,~ ~ ~; 111,; ci ~ ~ "".,. 'I~-..... ~~.:;;:;. ~ 0.-09: ~ .il N ~'. "~M:2: (j,,J lflo 1-.'<(' if... ... a: '" ,.~, ...u.. o ;-., Q. I, . cD D ~ \\'''''>t o..~lJ.j vI....J 0 =. ~ '~ N 0 <( U>II03.:J:'N~. .~ :: :2: .~ '. . ... ~ .....",.. . .... - ~ . . M ~ o s::. 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I- (!) cc ILl Z ILl -I ILl -I ILl ~ -I -I ~ -I -10 ILl CCU cc I-l u... VI U.I > cc I- ac: -I Cl cc CCILI Cl I- (!)~ I'? VI Ell: I 01 lLl I ZI 01 HI 1-1 Ell: I 01 a.. I I Ell: I WI 31 01 ...II I %1 HI <I 1-1 lLIl Ell: I I I T: I I I 1 1 I lLIl ZI HI ...II I Uh HI %1 1-1 I l:>>1 %1 01 ...II <I I 1-1 :JI U, BUREAU OF INDIVID;tI41='(T,~1 INHERITANCE TAX DIVISION";. ,_ PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) r"" - ~J F: I :::' : ! 4 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-28-2005 GROSS 05-13-2004 21 04-0533 CUMBERLAND 101 JANE W I GARY A .DEtAFIElD DElAFIElD ETAL 300 S ALLEN ST STE 30 STATE COLLEGE PA 16801 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: CUT ALONG THIS LINE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ...... RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF GROSS JANE W FILE NO.21 04-0533 ACN 101 DATE 11-28-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-24-2005 PRINCIPAL TAX DUE: 49,917.56 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-09-2004 CD004248 2,210.53 42,000.00 08-12-2005 CD005683 .00 5,707.03 10-27-2005 CD005949 140.74- 140.74 TOTAL TAX CREDIT 49,917.56 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II! IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) RK