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Home My WebLink About10-21-10T --~ REV-1500 Ex (°1-1°' .. 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 0 9 0 7 3 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 208 24 1136 07 22 2009 Decedent's Last Name Suffix DEGRANDI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Date of Birth 08 29 1918 Decedent's First Name MI ATENEO Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE MATH THE REGISTER OF WILLS ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-8c') ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate -fax Return Required (date of death after 12-12-82) ® 6 Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) - -- 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number PATRICIA C ZUCKER ESQ 717 724 9821 First line of address 1035 MUMMA RD STE 101 Second line of address City or Post Office State ZIP Code WORMLEYSBURG PA 17043 REGISTER WILLS US~DNLY ,_ _ _ ~ ~,l C. ,_7 _. • _ ~ ~,..~ -.:.i - ;-~ r , ~, 1 ~~ ~ _ DATE=FILED ~.- +v; Correspondent'se-mail address: pzucker@dzmmglaw.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Teresa D. Warlow l~ ADDRESS 350 Hunters Valley Road iverpool, PA 17045 SIC~tTt1Fi PARER OTHE E IVE ~- atricia C Zucker Esq 035 Mumma Rd., Ste. ~1; Wormleysburg, PA 17043 the best +?i ~: ~~• kno•~!vledge and belief, prep~~~er ;,~~ an~a 4nowledge. .I ~ ~ n .. I d~~~/~kS ! D ~ q ao DATE Side 1 L 1505610143 1505610143 1 1505610243 REV-1500 EX Decedent's Social Security Number Decedents Name: D E G R A N D I, A T E N E O 2 0 8 2 4 113 6 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 0 0 0 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 7, 3 7 2 7 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 1 2 , 1 8 3 6 1 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Pro ert (Schedule G) ^ Separate Billing Requested ............. 7. 1 4 9, 0 6 9. 0 3 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 1 6 8, 6 2 5. 4 0 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. .5 5 , 2 7 0 . 2 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. .1 0 , 8 5 4 9 3 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11 • ~6 6 , 12 5.18 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 1 ID 2 , 5 0 0 2 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................................. 14. 1 I~ 2 , 5 0 0 2 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 10 2 , 5 0 0 . 2 2 16. 4 , 612.51 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 4 , 612.51 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 t REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 0739 DeGrandi, Ateneo STREETADDRESS 428 North 21st Street CITY Camp Hill STATE ZIP PA ~ 17011 i Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 11, 5 0 0.0 0 B. Discount 2 3 0.6 2 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (1> 4,612.51 (2) 11,730.62 (3> 0.00 (4) 7,118.11 (5) Make Check Payable to: REGISTER OF WILLS, AGENT. <~, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. re amt a use or income of the property transferred :.................................................................................. ~ x I~ l .- b. retain the right to designate who shall use the property transferred or its income :.................................... _J i x 1 ~_ c. re am a reversionary interest; or .................................................................................................................. ! _J x I _~ _- d. receive the promise for life of either payments, benefits or care? ................... rx ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ~roithout -- receiving adequate consideration? ....................................................................................................................... J IL-X. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death%'......... [_ ' x l ~___. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _ contains a beneficiary designation? ...................................................................................................................... ' x 1 ~_~ -- ~~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. w ~,. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Januarryy 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) ii)]. The stafute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [72 P.S. §9116 (a) (1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §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, w ether by blood or adoption. } t j SCHEDUTLETA COMMONWEALTH OF PENNSYLVANIA ~ EAL ES 1 A 1 E INHERITANCE TAX RETURN RESIDENT DECEDENT E NUMBER ESTATE OF DeGrandi, Ateneo 21 - 09 - 07;39 All real property owned sole)y or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wilting 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. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. - - --- - --------- ---- ITEM ----___-_ _____ NUMBER DESCRIPTION 1 Real Estate located at 428 North 21st Street, Camp Hill, Cumberland County, Pennsylvania 17011 (the house has been listed for sale, but we are unable to value at this time. Please suspend payment of inheritance tax. Executrix will file a supplemental return.) VALUE AT DATE OF DEATH TOTAL (Also enter on Line 1, Recapitulation) r 1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS - -- -- - --- -- --- FILE NUMBER ESTATE OF DeGrandi, Ateneo 21 - 09 - 0739 - ---- 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 Manulife Financial Corporation, Common Stock, Investor ID 1249581 49841 ' 20.7100 7,372.76 ', ~ ', SCHEDULE E ~ !, CASH, BANK DEPOSITS, &~MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPER 1 i INHERITANCE TAX RETURN ~ l ~ 1 ~ 1 ~ RESIDENT DECEDENT I _- - ___ -i ---- - -__ ..- ---- - i FILE NUMBER ESTATE OF DeGrandi, Ateneo 21 - 09 - 0739 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 DESCRIPTION 1 PNC Bank Checking Account No. 5000649603 2 Accrued Interest on PNC Bank Checking Account No. 5000649603 3 PNC Bank Savings Account No. 5003732103 4 Household Goods and Furnishings 5 Property Tax Rebate 6 Roseville vases and pitcher 7 Refund from Urology of Pennsylvania 8 Refund from Verizon 9 Refund from Highmark VALUE AT DATE OF DEATH 5,362.80 0.15 349.13 5,034.25 750.00 520.00 114.72 3.68 48.88 TOTAL (Also enter on Line 5, Recapitulation) 12,183.61 . SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY -------------- ____ _- - ~ - -------------__ _L -- ESTATE OF DeGrandi, Ateneo FILE NUMBER 21 - 09 - 0739 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. -------- ---- DESCRIPTION OF PROPERTY ~ % OF i ITEM InGude the name of the transferee, their relationship to decedent DATE OF DEATH DECD'S ExausiaN TAXABLE VALUE NUMBER and the date of transfer. Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST ; (IF APPLICAI3LE) --- ----- --+---- ---- fi-__ ___ -_- __ -- _ ___ 1 i ING Annuity, Policy No. C022820-SI 149,069.03 I 100% ! 149,069.03 ~ i it i i ~ 1 ~ SCHEDULE H FUNERAL DCPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~(~~~MQe~/~ RESIDENT DECEDENT r~~~N~ ~~ ~ ~ v1, , ~ ESTATE OF DeGrandi, Ateneo Debts of decedent must be reported on Sch_e_d__ u_le I_. -- - -------------- ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION ---- --------- A. 1 Neill Funeral Home 2 ~ Funeral luncheon -Good Shepherd Catholic Church, Camp Hill, PA B. j ADMINISTRATIVE COSTS: 1. II Personal Representative's Commissions Name of Personal Representative(s) FILE NUMBER 21 - 09 - 0739 AMOUNT 12, 800.17 150.00 j Street Address ~~ City State Zip ~ Year(s) Commission paid 2. ! Attorney's Fees Daley Zucker Meilton Miner & Gingrich, LLC 3. I~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent i 4. Probate Fees Additional Short Certificate 5. '~ Accountant's Fees 6. ~ Tax Return Preparer's Fees Schreckengaust Associates (2009 returns) 7, I Other Administrative Costs ', 1 i Cumberland Law Journal, publish Estate Notice TOTAL (Also enter on line 9, Recapitulation) 7,615.00 ~~ '~ 298.00 4.00 190.00 75.00 55,270.25 ~ Schedule H . ~ Fuierel E~erises & COMMONWEALTH OF PENNSYLVANIA A~ ~,~,~,,~ INHERITANCE TAX RETURN /~~~ ~AI7 ~nu~ RESIDENT DECEDENT ~ - ----- ------ I _ __ _ -- ---- - - - - --- - - - l~ - -- -- -- ---- __ _- --- ---_ - ----- - --- -- - ---..------- - -- - - I - ------ __ ESTATE OF DeGrandi, Ateneo FILE NUMBER 21 - 09 - 0739 2 ;Paxton Herald, publish Estate Notice 1 3 ~I Camp Hill School Tax (2009) i i 4 Camp Hill School District Tax (2010) ~! 5 Camp Hill Real Estate Tax (2010) 6 I'~, George Ulsh-appraisal for real estate at 428 N. 21st St., Camp Hill, PA 7 ' Brickers Auction-Commission for auction of household goods and furnishings 8 !, Cordier Antiques & Fine Art-Commission for auction of Roseville vases and pitcher 9 UGI Utilities, Inc. ~~ (09/09 through 09/10) 10 ~ Bureau of Camp Hill-Sewer Department j (09/09-09/10) 11 Erie Insurance-Homeowner's Insurance for 428 N. 21st St. Camp Hill, PA real estate ' (09/09-11 /09) i 12 I~! PPL Electric '~~ I~ (09/09-09/10) ~~ I 13 Penn Waste, Inc. ~', ' (09/09-09/10) ' 14 !Pennsylvania American Water j (09/09 through 09/10) ~~ 15 ;Matt Zuvich- for lawn care/snow removal ~~ '~, (07/09-10/10) 16 Steve Snook Residential Construction- multiple repairs to estate residence in ~, preparation for sale 48.00 1,984.26 14.70 2,168.71 325.00 1,670.00 130.00 1,119.33 411.59 560.00 688.27 243.75 427.98 895.00 23,276.49 Page 2 of Schedule H Sd~edule M COMMONWEALTH OF PENNSYLVANIA ~ ~ j INHERITANCE TAX RETURN ~~~ bN1 1Yn~ ~ RESIDENT DECEDENT --- - - -- - i IF LE NUMBER ESTATE OF DeGrandi, Ateneo 21 _09 - 0739 17 ~ George D. Boyer & Sons, Inc.- investigation of wet basement of estate residence in ~ 100.00 preparation for sale I 18 ~ Bob and Mary Haring-Trash pickup 75.00 i i Page 3 of Schedule H 1 '~ SCHEDULEI DEBTS OF DECEDENT, MORTGAGE ~, COM NHERTANCETAXRNETURN~IA LIABILITIES, ~ LIENS ~I RESIDENT DECEDENT FILE NUMBER ESTATE OF DeGrandi, Ateneo 21 - 09 - 0739 _--- -- Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Home Instead Senior Care 2 FIA Card Services (credit card) 3 Verizon (final telephone bill) 4 Comcast (final cable bill) 5 Diocese of Harrisburg (lenton pledge) 6 Good Shepherd Catholic Church (Helping Hands) 7 Home Health Care Services AMOUNT 3,446.33 6,670.00 48.04 20.56 120.00 150.00 400.00 TOTAL (Also enter on Line 10, Recapitulation) 10 854.93 REV-1513 EX+ (11-08) i '~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA ~ BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DeGrandi, Ateneo NUMBER II NAME AND ADDRESS OF PERSON(S) ~ RECEIVING PROPERTY I !TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not Llst Trustee(s) - __ -- --- FILE NUMBER j 21 - 09 - 0739 SHARE OF ESTATE j AMOUNT OF ESTATE (Words) ' ($$$) 1 i; Teresa D. Warlow ~ Daughter i One-fourth I, j 350 Hunters Valley Road ~ ', 'Liverpool, PA 17045 ~ !, 2 j Elissa A. Snook Daughter ', One-fourth ~ 625 Beagle Road ~I Lewisburg, PA 17037 3 Gloria D. Hoffman Daughter ', One-fourth ~, ~~ 1602 E. Camino Cielo Tuscon, AZ 85718 ' ~iI Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II. 'NON-TAXABLE DISTRIBUTIONS: !A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN ', B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~~ I i ~~ TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 ~ 1 REV-1513 EX+ (g-00) COMMONWEALTH OF PENNSYLVANIA i INHERITANCE TAX RETURN i RESIDENT DECEDENT SCHEDULE J BENEFICIARIES continued ESTATE OF DeGrandi, Ateneo r ---- -- - _--- - i NUMBER NAME AND ADDRESS OF PERSON(S) _ _ ~ RECEIVING PROPERTY I ;TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 4 Kathy A. Heasley i 9635 N. Fire Ridge Trail Fountain Hills, AZ 85268 i Daughter '-- --- FILE NUMBER j 21 - 09 - 0739 SHARE OF ESTf\TE ~ AMOUNT OF ESTATE (Words) ($$$) ~_. -- One-fourth ', Page 2 of Schedule J RELATIONSHIP TO DECEDENT Do Not Llst Trustee(s) COMMONWEALTH OF PENNSYLVANIA ` DEPAr~TMENT OF REVENUE BUREAU OF INDIV' ~:..^.L TAXES DEPT.280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: WARLOW TERESA D 350 HUNTERS VALLEY RD LIVERPOOL, PA 17045 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. C;D 01 1878 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: 208-24-1136. FILE NUMBER: 2109-0739 DECEDENT NAME: DEGRANDI ATENEO DATE OF PAYMENT: 10/20/2009 POSTMARK DATE: 10/20/2009 COUNTY: CUMBERLAND DATE OF DEATH: 07/22/2009 REMARKS: RECEIPT TO ATTY SEAL CHECK# 1015 101 ~ ~-1 1,500.00 TOTAL AMOUNT PAID: $'11,500.00 INITIALS: CJ RECEIVED BY: GLENDA EARNER STR,4SBAUGH REGISTER OF WILLS TAXPAYER BNY Mellon Shareowner Services P.O. Box 358333 Pittsburgh, PA 15252-8333 September 23, 2010 PATRICIA CAREY ZUCKER 103 5 MUMMA ROAD SUITE 101 WORMLEYSBURG PA 17043 RE: ESTATE OF ATENEO DEGRANDI Dear Sir or Madam: ~~ sHn~t_~a~;; r:EE; ~~i~~~: i::_~ 'Company MANtJLIFE ;Name FINANCIAL j CORPORATION Account D GE RANDI-ATEN- Key ~ 0000 rControl 201009220001043 Number ~ T lee phone 800-249-7702 Number ~ Thank you for your inquiry requesting information for this account. Please be informed that the number of shares as on 07/22/09 were 356. Also, note that the closing price, as on 07/22/09 was $ 20.7100 per share. We hope you find this information helpful. If you have additional questions, you may choose to speak with one of our Customer Service Representatives who are available from 9 a.m. until 7 p.m. on Monday through Friday at the above number. Sincerely, BNY Mellon Shareowner Services Page 1 of 10 yep. 18. L~~~y '~,~~~FPv~ FNC BANK 412-7C5-2747 i~Jo. X383 P, 1/1 l..EA~I~1G YHEII~-~Y September 18, 2009 Patricia Carey Zucker Esq 1035 Musntna Rd Suite 101 Wormleysburg, PA 17043 RE: Name: Ateneo A .DeGrandi SSN: 208-24-1136 DOD: 07-22-2009 Dear Ms. Zucker: In response to your request for Date of Death (DOD) balances for the customer noted above, our recoxds show the follouring: Checking Account Account # 5000649603 ATENEO DEGR.ANDI DOD balance: $5,362.H0 + 0,15 accrued interest Interest paid 01-01-2009 thru 07-22-2009 $0.70 YTD Savings Acco~r-t Account # 5003732103 ATENEO A DEGR-ANDI DOD balanCC: $349.13 + 0.00 accrued interest Interest paid O 1-01-2009 thru 07-22-2009 $0.00 YTD Established: 04-02-1996 Established; 03-20-2001 Please note that this office provides date of death balances for deposit accounts (IRAs, CDs., Checking a;ad Savings). vVe do not process any financial transactions or provide statements. Yf you .need assistance with any of these items, please calf 1-888-PNC-BANS (1-SSS-762-2265) or stop by your local P:NC Bank branch office_ Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 1 ING September 16, 2009 Patricia CaI•ey Zucker 1035 Mumma Rd Ste 101 Wornleysburg, PA 17043 Policy Number: C022820-SI & 90009809 Policy Owner: Ateneo Degrandi Re: Date of Death Value Dear Ms. Zucker 6 aOG°P~'l Thank you for your inquiry regarding the date of death value on the above listed contract. The dollar amount listed is the account value as of the listed date of death. Ateno Degrandi Policy Number: 0002820-SI 90009809 owner. Date of Death: 07/22/2009 Date of Death Value $149,069.03 $84,317.01 -This contract was surrendered prior to death of the If you have questions or would like additional information, please call our Customer Contact Center, toll free at (800) 366-0066, Monday through Thursday, 8:30 am to 6:30 pm and Friday 8:30 am to 5:30 pm Eastern Time. Sincerely, Policy Owner Services lp Annuities are issued by ING USA Annuity and Life Insurance Company and distributed by Directed Services, LLC, member NASD. Both companies are members of the ING family of companies. 409 Locust Street nes Moines, IA 50309-299 G1~G 1'S.~{ .1~inrrrn cmd I_rfe lns~uraacc~ Conr~~un~ Seller: Neill Fu neral Home, Inc. Contract. # - 741101000115 3401 Market Street 3501 Derry Street Case. # -206003085 'Camp Hill, PA 170114428 Harrisbwg, PA 17111 (717)737-8726 717-564-2633 Kevin J. Shillabeer ,Supervisor Stephen J. Wilsbach, Supervisor Part One of Three Parts Statement of Funeral Goods and Services Selected/Purchase Agreement Date of Death 07/22/2009 Date of Service 07{27/2009 Name of Deceased Ateneo DeGrandi Date of Birth 08/29/1918 Deceased's Last Address 428 North 21st Street City Camp Hill State pA Zip Code 17011 Purchaser's Name Teresa WarlOw Phone Number (717) 444-9961 Purchaser's Home Address 350 Httntet's Valley Road City LivemOOl State pA Zip Code 17045 Co-Purchaser's Name Phone Number Co-Purchaser's Home Address City State Zip Code In this Agreement the words you and your refer to the Purchaser and the Co-Purchaser, if any, signing this Agreement. The words we, us and our refer to the Funeral Provider or Seller whose name and address appear above. For good and valuab le consideration, wh ich each party acknowledges receiving, you agree to buy the goods and services described below. You authorize us to prepare and care for the body of the decedent named in th is Agreement and to conduct the funeral and services and incur the charges listed in said Agreement. W e have the right to collect the total amounts due under this Agreement from any person who signs this Agreement as Purchaser or Co-Purchaser. (N/A indicates items ofservice and/or merchandise that are not provided) Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reasons in writing below. If you selected a funeral that may req uire embalming, su ch as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below. SECTION t -SERVICES AND MERCHANDISE MERCHANDISE FUNERAL DIRECTOR AND STAFF SERVICES Casket or Alternative Container: Basic Professional Service Fee _______________________________ $ Tncl Manufactwer/Supplier Batesville PACKAGE OFFERINGS Model Name/Nwnber Meridian Direct Cremation -------------------------------------------- $ n/a Material Immediate Burial ____________________________________________ $ °/a Species of Wood hazdwood Forwarding Remains _________________________________________ $ n/a Type of Metal Receiving Remains ___________________________---_-----.__-_ $ rila WeighUGauge Dignity Memorial Honor Funeral Service ________ ___ ___ $ ------------------------ - 9,660.00 Crepe Interior ---------------------------------------------------------------- $ n/a Exterior Color ------- $ Incl Outer Burial Container: CARE AND PREPARATION OF REMAINS Manufacturer/Supplier Evans Eagle Embalming_------------------------------------------------- $ Incl Model Name/Number Sentinel Other Preparation (specify) Material concrete _____ $ 1,395.00 Dressingand_CasketingofI)eceased_________--_______ $ Incl Urn: --------------------------------------- ---- --- - -------- $ n/a , Manufacturer/Supplier ----------------------------------------------- •-------- $ n/a Model Name/Number ------- ---------- 'a n/a Material - $ n/a -- --- ---------------------------------------------------------- - n/a __ -- ---- ------------------------___ ---------------- ---- ----------•- $ a USE OF FACILITIES AND RELATED SERVICES ________________ $ nfa ---- ------------------------------------------- Visitation ------------------------------------------------------ $ Incl --------------------------------------------------------------- $ n/a Funeral Ceremony _________________________ ._________ $ Incl $ 11,055.00 _ _ _ __ TOTAL SECTION I - - $ Memorial Service-----------------------------------.-------- $ n/a 'Ua ___ _________ _ __ _ _ _ _ _ _ - - - - - ------- - SECTION II -CHARGES TO BE INCURRED BY US ON Graveside Service ---_________________________________-___ YOUR BEHALF (Certain charges maybe estimated-"e" means Other (specify): $ estimated.) We charge you for our services in obtaining those items ------------- ---------------------- ---- ---- ---------- ~a marked with an „X., $ n/a ------------------------------------------------------------ $ n/a C_e_met~ty---------------------------------------------------- S 950.00 ------------------------------------------------------------- TRANSPORTATION Clergy % Religious Facility $ 125.00 ---- -------------- ---- ------- -------------- ---- --- --- -- Transferring Remains to Funeral Home_____________________ $ Incl - - - - -- - - - Musicians or Singers____________________________________$ 75.00 Funeral Vehicle/Hearse---------------------------------------- $ Incl Certified Copies ------------------_--_---------------_---- $ 60.00 Other (specify): Newspaper Notices-----------------------------------------$ ~a Limousine------------------------------------------------ $ Inci ewspaper_Notice ----------------____-- 270.17 N _------------- Service Vehicle $ Incl _ - - n/a $ n/a n/a $ n/a n/a -- ---- ---- -- ---- ---- --- --------- -------------- - ------------------------------------------------------------ $ n/a --------------------------------------- -------------------- $ n/a ---------- ------- -------- --------- --------- - --- --- $ n/a OTHER GOODS AND SERVIi-ES Memorial Booklet ----------------------------- -------------- $ n/a Service Folders--------------------------------------------- $ n/a Prayer Cazds------------------------------------------------- $ n/a AcknowledgementCazds----------------------------------_-. $ n/a Memorial Pac ~e------------------------------- ----------- $ ~a 24_HowCompassion_Helpline ______________________________ $ Incl DignityMEMAlbum ___ __ ________ _________ __ _ ____ $ Incl Everlasting Memorial_______________________________________ $ Incl ARercare Planner ------------------------------------------------------------------ $ Incl Flowers -------------------------------------------------------- $ Incl Dignity Honor Burial_MemorialPackage________________- $ Incl ----------------------------------------------------------------- $ n/a ------------------------------------------------------------------ $ n/a $ n/a -------------------------------------------------------- ---- $ n/a --------------------------------------------------- --- -- ------ $ n/a $ n/a $ n/a $ n/a ----------------------------------------------------------- Altar Servers 15.00 Tent Chairsset_upcemetery________________________________$ 150.00 _OlgazUSl---------------------------------------------------- $ 100.00 $ n/a ------------- ----------------------------------------------- $ nia ---------------------------------------------------------------- $ n(a ------------------- $ n/a --------------------------------------------- $ n/a ---------------------------------------------------------------- $ n/a --- ------------ - -------- ------- -------- - --------------- -- -------------------------------------- -- ------------------ $ n/a TOTAL SECTION II______________________________________ $ 1 745.17 TOTAL SECTION (CHARGES ----.--__________________ $ 11,055.00 TOTAL SECTION II CHARGES__________________________$ 1,745.17 TOTAL SECTION I AND SECTION II CHARGES____ $ 12 800.17 PURCHASER'S INITIALS AND DATE W17'N S' INITIALS AND D E 7/24/09 15:20:10 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 DEGRANDI ATENEO Estate File No.: 2009-00739 Paid By Remarks: TERESA D WARLOW JN ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 2255 Total Received......... Receipt Date°: 8/11/2009 Receipt Time: 09:42:04 Receipt No.: 1057809 Receipt Distribution ----- --------- ------- ---- Payment Amount Payee Name 260.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUN'7CY GENERAL FUN 8.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIF?TS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- 298.00 298.00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 MYERS DONALD G Estate File No.: 2010-00739 Paid By Remarks: TERESA WARLOW HMW ------------------------ Receipt Distribution Receipt Date: 9/09/2010 Receipt Time: 16:18:53 Receipt No.: 1062549 Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 4.00 CUMBERLAND COUNT' GENERAL FUN ---------------- Check# 1130 $4.00 Total Recei~red......... $4.00 L,c'J'/Y~Ic'tj .~~[lltjl~ rlc.'cotcitl~zitt~.r The Estate of Ateneo DeGrandi 428 North 21st Street Camp Hill, PA 17011-2201 Invoice DATE .INVOICE NO. 4/13/2010 16398 FOR SERVICES RENDERED HOURS RATE: AMOUNT In connection with the preparation of your 2009 Federal, State and 2 95.00 190.00 ocal returns WE ACCEPT VISA / MASTERCARD /DISCOVER PAYMENT DUE UPON RECEIPT INTEREST CHARGED AT 1-1/2% PER MONTH Total $190.00 4460 Linglescown Road Harrisburg, PA 171 12-9503 (717} 6S7-2827 Fax (717) 657-9576 ~ www.ca5cpa.net BOO Gpl`T CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717} 249-3166 Fax: (717) 249-2663 September 25, 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal , publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Patricia Carey Zucker, Esquire RE: Ateneo Degrandi Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: September 11 September 18, and September 25, 2009 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director RALD T TM Pardon Harald •4910 Earl Drive, Harrisburg PA 17112. 6d/l~640 Fax East Shore (717) 657-3523 Office & Plant - (PO Box fi310) 101 Lincoln Street (717) 545-9540 Harrisburg, PA 171 12 (717) 545-8762 PROOF OF PUBLICATION STATE OF PENNSYLVANIA COUNTY OF DAUPHIN Before me, the subscriber, a Notary Public in and for the said County, personally came Lisa M. Carnes who, being duly sworn, doth depose and say that she is LERK of THE PAXTON HERALD, a newspaper of general circulation published in Harrisburg, Pennsylvania; That THE PAXTON HERALD was established on the 28th day of June, 1960, and has been published continuously since that date; That the advertisement, of which a copy is attached hereto, was published in the advertising columns of T E PAXTON HERALD in r'7- all respects as ordered in the issue(s) of ~ ~ L~`~ Affiant further deposes that she is not interested in the subject matter of the aforesaid notice or advertisement, and that the allegations in the foregoing statement as to the time, place and character of publication are true. ~^~~ ~~~ (Si ature of the fiant) Sworn and subscribed before me this day of ~`~:~.- ~C~ A.D. Notary lic Vii(;-. A.`silr,~ `.~,7L CrarPrl;lE JL~fJ S~f"'~~r'r'' ;`~;GTA~Y F'I~SL!C i.~~'~`JFR P~;~l"U~'d i'JvP,, i:l;,`-~~~i'{-iliJ C~~U~~~ f Y RhY COi~r:~r~IS~l~~ia E<'t~t'l~E:~ L~P-I'. 7, 2u i 0 .~m.,a~- ESTATE NUTICE NOTICE IS HEREBY GIVEN that letters testamentary or of administration in have been _ granted in the following Es- tate. All persons indebted to the said Estate are required to make payment, and those hav- ing claims or demands to present the same without . delayao the administrators, ex- , ecutors, or their attorneys -named below i ESTATE OF Ateneo Degrandi, late of Camp Hill, '~ Cumberland County,, Pennsyyl- ; vania. Died: July 22, 2009. Ex- ecutrix: Teresa D. Warlow. Attorney: Patricia Carey Zucker, Esqquire DALEY ZUCKER MEILTON MINER & GINGRICH, LLC 1035 Mumma Road, Suite 101 Wormleysburg, Pennsylvania 17043 9-9, X16, 9-23 . - , • • ~ • ~ ~ ~ ~ ~ . w~~ . , . B~ ~ het! an d:ammission ~ camptate safe ~arrewtc~ . ~3 Texaco Rd., -~Vtechantcsb~arg, ~~. ~ TtD~~ 7~~~5?'~5 ~S o~rtatand~r a`at~ S~ie -~, .~`~~ ~--..~ . To~ Checks _ - - .~ ~ ~ . ._ ~~ ~ ~ ~ ~ - TO`ta~ cash ~t$~ /~ c~ L/ .,~11~5 • ~-~t~oarses & C~~s ~ `~~~ ~ Adv. cost _ . •~ , `~~ . , r. Gv Sole situp or 1Fta~ .~' / ~ ~ ~ U Tole! ~a~ !..~,> 1 ~~, .I ~ 1 . ~'V' ~, ~~ ~ ~.S ~~ ,~~ ~~ ~ .~ ~~~ . ~ r' ' Cordier Antiques & Fine Art 2151 Market Street Camp Hill, PA 17011 Phone: 717-731-8662 Fax: 717-731-9830 Consignor: 1134 The Estate of Ateneo DeGrandi c/o Terry Warlow 350 Hunters Valley Rd Liverpool, PA 17045 Phone:717-444-9961 Auction: Variety Auction 10/10/09-10/11/09 Lot# Description CO #: 830 Date: 10/11 /2009 Page: 1 Quantity Unit Price Ext.Price Comm/BuyBack Expenses 738 Roseville vase - --- 758 Roseville pitcher 760 art pottery vase 1.00 75.00 75.00 -18.75 0.00 Bid Card # 224 1.00 55.00 55.00 -13.75 0.00 Bid Card # 224 - - 1.00 390.00 390.00 -97.50 0.00 Bid Card # 195 Total Quantity: 3.00 Total Invoice Sale Price: 520.00 Total Commission: ( 130.00) Total Due to Consignor: 390.00 Total PaymE~nts: 0.00 Balance: $390.00 Positive Balance, Monies Owed to Consignor COMMISSION SETTINGS Calculate Commission By: Each Commission Structure Type: Fixed Consignor Settlement Any Amount 25% z ~ ~ • Steve Snook Residential Construction 625 Beagle Road Lewisburg, PA 17837 570-524-4349 HIC # PA016044 Bill To Estate of Ateneo DeGrandi c/o Teresa Warlow 350 Hunters Valley Road Liverpool PA 17045 Invoice Date fn~oice # 3/26/2010 259 TeRns Due Date 3/26/2010 Description Amount Lewisburg Builders Supply -materials 332.44 West Branch Rental -carpet cleaner 48.79 Sherwin-Williams 12.93 Dale P. Kline Electrical -prepare home for inspection; install grounded outlets through out home, install 1,7I $.1 G switches & outlets in two 2nd floor bedrooms Tice-Spinello Contractiing -painting walls, ceiling and trim in entire house 5,4$8.51 Disposal of debris 199.60 labor 12,440.00 Overhead 3,036.06 '~ ~ ~ ~~ ~ ~' ~ ~~ % ~ n .{, ~s~ ThAnk you for your business. TOta ~ $23.276.49 Payments/Credits ~a.aa Balance Due $23,276.49 ~ ~ i • GEORGE ~_ BOYER Service Order 8t SONS, INC_ - .- ~~ 639 Antoine Street Harrisburg, PA 17110-2700 InvOiCe (717) 236-7672 FAX (717) 236-2375 31602 B>tll><n Address i ~~~. --- g - ---- --- ------- - ~ ---- - -- - ---Service Address -- __ ---------1 I~~me _ __ Terry Warlow --------- - ---- -Contact:-------------- -- -- j Street. 428 N 21st Street Completion Date: 4/23/2010 jI ------ --- - __-_ - -- --- - ----- - - - - -- -------- ----- ---------1 F- --- ~ City: Camp Hill PA 17011- Street: 428 N 21st Street ~-_---- __ .- --- - - - _ 1- - -City. - _-Camp Hill, PA ---- --- _ _ _- Zip : _17011- _ _------ -I Home Phone. Work . - - -_ - - i Make: Model: Serial #: ' ~~ Site Description Date Promised: ~ CallFirst ~_ -~-AM ^ C ~ PM _ -__ -_ - Tech: Ken_- -- -_ - - -_ -_- -_. _- _- ~~ Problem: Wet area on basement wall located in area where outside faucet is located. Service Performed: *04-22-10 Checked area and found water damage was around window well. Fi~und no ~ problem with water pipes. Recommendations: i i Materials and Services Qty• Item Unit Price Amount Labor First Hour Residential $100.00 $ l 00.00 Total Labor $100.00 ' Please Pay This Amount $]100.00 j I ~~ A ~~ _ ~~~ r ~'~ i Terms Finance charge of 1 1/2°1° per month Limited Warranty (18% annual) to all items over 30 All materials, parts and equipment are warranted by the manufacturers' or suppliers' days past due. written warranty only. All labor performed by the above named company is warranted for 30 days or as otherwise indicated in writing. The above named company makes no other warranties, express or implied, and its agents or technicians are not authorized to make any such warranties on behalf of above named company. _. ~~ Thank You for Using George D. Boyer and Sons *~ ~. ; v -~.~ 4 ~ ~y j ,~ ~ ~~~ ~ , E~ i Page 1 of 1 ~ c ~ ~ ® o ~ o 5002 Zenker Street, Mechanicsburg, PA 17050 Bill To i Warlow, Terry Invoice Date Invoice # 7/ 15/2009 1118-0709-1 P.O. No. Terms Project Quantity Description Rate Amount 0 0 HISC Services Client Miles 2,310.11 2.32 2,310.11 2.32 Tota I $2,312.43 ~ i i a ~ ~~ ~~.~. ~~ 5042 Zenker Street, Mechanicsburg, PA 17450 ~ _' , Bill To ~, Warlow, Terry Invoice Date Invoice # ~ 7/31 /2009 1118-0709-2 P.O. No. Terms Project Quantity Description Rate Amount 0 HISC Services 1,133.90 1,133.90 Total $1,133.90