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Home My WebLink About01-24-11 15056051058 REV-1500 EX (OS-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 28oso1 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 0748 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 711-07-7901 06/24/2010 04/08/1922 Decedent's Last Name Suffix Decedent's First Name MI Sgrignoli Fioriy C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW • 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of ~ : '; 5. Federal Estate Tax Return Required death after 12-12-82) •': s. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Lisa Marie Coyne, Esq (717) 737-0464 Firm Name (If Applicable) REGISTER OF~LS USE ONLaf_: ': Coyne & Coyne, P.C. 7 ~ ,.. ' '~;-, _'~ ~-;~ ,. First line of address _=~~~ ._ ! , ; - _ ,. - r..._ _ , ~ 3901 Market Street ?~ ~ Second line of address ~ ~ ~ ~ :~"~> -- -, _--- _. ,. . _. ; _i l - _.___ _ DA7 FI~D ~ ~ '~~ City or Post Office . ~.> State ZIP Code . _.__ U Camp Hill 4:M , ~`'7 PA 17011 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG - EE O~~N RESPONSIBLE FOR FILING RETURN - DATE /.Z a // ADDRESS Alan L. Bruner 29 N. Humer Street, Enola, PA 1__7__025_ _ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS -- - ----- ---- -- - -- -- PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Fioriy C Sgrignoli ' 711-07-7901 s Name: Decedent ' TULATION RECAPI 1. Real estate (Schedule A) . ............................................ 1. 144,900.00 2. ....................................... Stocks and Bonds (Schedule B) 2. 937.20 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. 9 9 ( ) ............................. Mort a es & Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 1,725.27 6. Jointly Owned Property (Schedule F) ..: Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 0.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. 147,562.47 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 44,104.46 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 32,727.07 11. Total Deductions (total Lines 9 & 10) ................................... 11. 76,831.53 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 70,730.94 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 70,730.94 TAX COMPUTATION - SEE_INSTRUCTIONS FOR APPLICABLE RA . .._.. ....... . TES . .....Y . . ~ . ,..... ,.....,.. . __ ..... _. ....... ....,... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 70,730.94 1 g. 3,182.89 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. 3,182.89 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Flle Number Decedent's Complete Address: 21 10 -0748 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Fioriy C Sgrignoli __ 711-07-7901 STREET ADDRESS 7 Sgrignoli Lane ------------------------- - - - -- - CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 3,182.89 2. Credits/Payments A. Spousal Poverty Credit _ _ B. Prior Payments __ _ __ C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest _ E. Penalty _ - Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fitl in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,182.89 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 3,182.89 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ [~ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (11-08} ~ pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Fioriy C. Sgrignoli 21-10-0748 All real property owned solely 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 willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. r il~i;c /,u;;ruva~ PJo. 25uZ-02 i3 > ~.; ~,F~~ i~; ~~i` ~ ~~ A. Settlement Statement (HUD-1) MUD ~1 • :' i ' ~p Page 1 of d. Type c?f Loan ]. ~~ FIfA 2. ~ RHS 3. ~ Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4.~ VP 5. a Conv. Ins. 401001259-CL 0279442214 446-0570526-703 . NOTE: ~ This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. items marked ";p.o.e.)" were paid outside the closing; they arc shown here for informational purposes and are not included in the _ ~ __ totals. D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender G! F 4JhJ W. CONRAU AND DEBRA M. CONRAD ALAN BRUNER A/K/A ALAN L. SRUNER, WELLS FARGO BANK, N.A. EXECUTOR OF ESTATE OF FIORIY C. 1 EAST 22ND STREET, SUITE 800 10'?S CLOUS[~.R HULLOW R.U. SGRIGNULI LOMBARD, IL 60148 Nf_.VJ liL00t~1i=iFLD, t'A 17068 PA G. Property Location H. Settlement Agent SECURED LAND TRANSFERS, LLC ,~ ~ ., ' ~ ~. 7 S(:;F',IGf10L! (ANl?, 485 ST. JOHNS CHURCH ROAD , '_ F AS f Pr-f!tJStiORO, PA 17075 SHIREMANSTOWN , PA 17011 ' ~ Phone (717) 901-8342 '' CO!1N'ty, r,UMBERI_AND Ar?caa i.>: r-'U-1`•>-1740-0°-`1 Place of Settlement I. Settlement Date 12/23/2010 TC1~'JtJSHih: f:AST PE rJPJSBORO TOWNSHIP 485 ST. JOHNS CHURCH ROAD , SII[REMAN5T01NN , PA 17011 Disbursement Date 12123/2010 - J. Summary of Borrower's Transaction K. Summa of Seller's Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller ' t! 1'Cr,,rirract Sales Pncr.. ~ ~ ^ $144 900.00 401. Contract Sales Price $144 900.00 t02, t>ersunat Pro Crt 402. Personal Pro ert l U ;. Settlr~mant rharr es to borrower line 1400 8 214.70 403. - 1C•1.- i. n ~ _----_-._. _~__~- Adjustment for i_t_ems paid by seller in advance ^+ 1(~f., ,,liV/I CYlII„Ti3 Y. (:S _ _ 107. County_7^3xcs 388`0'1.00/}'r 1.2JZ3J10 to O1JOlJ11 ^ $9.57 lttf;. h~.strs,mcnt5 00/ r 12/23/10 to 07/01/11 lr)~. School Taxes ]201.60 $625.49 _ 110. ~,ravcr/Refuse ] 1.5.00/yr fer 17/2317.010 to 1/1/7011 $2_.84 _ 11 1"- --- _-._ 120. Gross Amount Due from Borrower $153,752.60 7.00, Amounts Paid by or in Behalf of Borrower 101.. Crposit or carnest_money ,$500.00 )0), Prm•.rpal l.oun Amount from Wells Fargo Bank, N.A. 141,226.00 Lti3. l: <i>trrxl loan{S) taken sub ect to ).04. t`~~, is Refund from Homeb~wn Mort a e Resources $94.00 J.U",. i,UG. J l i j `- - --~---- -. ~._» ICI ..__---- ' ----~-----_..___~~ -- ~; ~3 Acljustmen_ts_for items unpaid b setter ;.I1. Courit faxes _, __..__.._______.-.Y_-~_=- _ 771. ~sscssmenls 7 ! ;. :;rLrr Credit c 1_p~and tax service ~ _ _.~_~~ $7 000.00 7 ] 4 - _ 21_+.~_____~~.~. - -- --1 ~~---- ------ i.. ~_..- - ---- _ __~ _ 220. Total Paid b /for Borrower 148 820.00 300. Cash at Settlement from/to Borrower ;n1.- Gress anxx,nt due from aorrowcr (line 120, 153 752,60 t ess amounts paid b_Y/for_barrowcr (line 220 r,2. $148,820.00 _ 303 Cerst, ~~ From ~ to Borrower $4,932.60 404. 405. Ad ustment for items aid b seller in advance 406. Cit Town Taxes 407. County Taxes 388.0200/yr 12/2.3/10to O1/O1/11 $9.57 4.08. Assessments 409. School Taxes 1201.6000/ r 12/13/10 to 07/01/11 $625:49 410. Sewer/Refuse 115.00lYr for 12/23/2010 to 1/1/2011 g2 84 411. ~ 412. _ 420. Gross Amount Due to Seller $145,537.90 500. Reductions In Amount Due to Seller 501. Excess De ossts 502. Settlement Char es to Seller $21,741.58 503. Existin loans taken sub'ect to X04 Payoff First Mortgage to PNC Bank Consumer Loan Center ,__ $26,227.15 505. 506. 50 7. 508. 509. Ad'ustments for items unpaid by seller 510. Cit /Town Taxes 511. Count Taxes 512. Assessments 513. Seller Credit cc and tax service $7,000.00 X14. 515. 516. 517.. _ 518. 519. 520. Total Reduction Amount Due Seller 54 968.73 G00. Cash at Settlement to/from Seller 601. Gross amount due to seller line 420 $145 537.90 602. Less reductions in amount due seller line 520 $54 968.73 603. Cash X To From Seller ;90,569.17 T~.~. I',iil t; 'Zr:porlin~ tJ~.vd~n ter this collection of information is estimated at 35 minutes per response for Collecting, reviewing, and reportinu tie data. This agency may not ceh•~ca t!xs r+rarrr+aGon, an+J you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this~_r„Igstye ,; rrand;.to•y Tors c5 designed to prnv,de the parties to a RESPA covered transaction w,th information during the settlement process. ~JJ`~']((~~ Initials /,;~ `~ r / _ uV-v k 001259-CL HUD-1 Page 2 of 3 ` Settlement Char es ______~ 0. Total Real Estate Broker Fees;8274.00 Paid From Paid From Division of Commission line 700 135 f0il0W5: Borrower's Funds setter's Funds 1. 3987.00 to Center 21 at the Helm At Settlement At Settlement 2. 4287.00 to ERA-NRT LLC __ __ 3. Commission aid at settlement $8,2/4.00 4. Broker Fee to C~ntur 21 at the Helm `¢200.00 0. Items Payable in Connection with Loan _ ____ Loan Origination Fee % to Hometown Mortgage Resources(Includes $4,431.85 (from GFE # 1 ) i' Ori ination Fee X349.57 ~__ ___~ 2. Your credit or char"e' oints for the s ecific interest rate chosen -'3 142.28 from GFE it2 3. Your adjusted origination cltarges from GFE A 1 289.57 __ 4..A ralsal Fee to RELS from GFE #3 $455.00 ____._ 05. Credit re ort to Credit Plus from GFE #3 $10.24 __ _^ 06. Tax Service from GFE #3 __ 07. Flood Cert. Fee from GFE #3 ___ __ _ 08. Final Ins ection to RELS 100.00 00. Items Required by lender to Be Paid in Advance ' 01, Daily interest charges from 12/23/10 to 01/01/11 @ 17.41/day Wells (from GFE #10) $156.ti9 Far o Bank N.A. __ ______ 02. Mort a e Lisuranc Premwm HUD from GFE #3 1 398.28 ___ 03, Homeowner's .nsurance Allstate Property and Casualty Insurance(54.61 (from GFE #11) POC b Bu er' $558.68 OOO.Reserves Deposited with Lender ___ __ 001. initial de osrt for our escrow account from GFE #9 $671.116 002. Hazard Ins. Reserve 3.0000 month(s) @ 51.11 /month(s) to Wells Fargo $153.33 Bank, N.A. 4 _ _ 003. County Property Taxes 11.0000 month(s) @ 32.34 /month(s) to Wells $355 74 Far o Bank, N.A. _ _____~ 004. School Taxes %.0000 month(s) @ 100.15 / month(sj to Wells Fargo Bank, $701.05 N,A. __ 005. A re ate Accountin Ad'ustment to Wells Far o bank N.A. - 538.26 006. _ 007. ' 100.Title Charges ~~ 11U1.Title services and lender's Utle insurance to Secured Land Transfers, LLC from GFE k4 470.00 _ 1102. Settlement or clown Fec to Secured Land Transfers LLC $225.00 ~ ] 103.Owner's title insurance to Secured land Transfers, LLC from GFE # 5 __ 975.38 _ _____~_ 1104. Lender's title insurance to Secured Land Transfers, LLC 150.00 _ _ ~ 1105. Lender's title policy limit 141 226.00 _ __ ~~ _ ~ _. 1106.Owner's title polite limit $144,900.00 _ _ ~ 1107. Agent's portion of flit total title Insurance premium to Secured Land $1,[112.84 I ransfers Ll_C _ ___~~ .1108. Underwriter's portion of the total title insurance remium to TRGC 112.54 _ 1109. Notar fee to Connie L. Wertz Notar Public 20.00. 1110. insured Closin Protection Letter to TRGC $75.00 _ `~ 1200.Government Recording and Transfer Charges 1201. Government rccardin char es from GFE # 7 . 13E>.00 ~ 1202. Deed 62.00 Mortga e 74.00 Releases _.__- _ ____ - 1203."transfer taxes from GFE #8 1 449.00 _ 1204. Cit /Count .tax stain is Deed 1449.00 Mort a e _ ~_ _ 1205. State tax/stains Deed $1449.00 Mort a e $ _ ~- _ `_¢11449.00 1206. 1300.Additional Settlement Charges s^ 1301. Rc uired services that you can shop for from GFE #b "~119.0U ____~__ 1302. Pest Ins ection to AA~a Home Inspection POC(8uycr) $50.00 1303. Tax SVC to WF Real Estate Tax Svcs $100.00 1304. Flood Cert to Wells Far o flood Svcs 19 A0 __~_: 1305. Notar Fee to Cennic L. Wertz, Notary Public __ _ _~lU.UU _ 1306. Tax Ccrt. Processin Fee to Secured land Transfers - Mechanics~ur g]0.00 1307.2010 Count /"f~v Taxes to Debbie Lu old Tax Collector __ ~ '426.81_ 1308. Sewer/Refuse 10/11 r12 to East Pennsboro Townshi _^ ~126,5U 1309. Home Ins ecUOn to At ha Home Ins ection POC Bu er 300.00 1310. Gara a Door Re air to ]ones Construction & Lawn Services _ $415.00 _ ___ ~ 1311. Sat/Release Fee to Secured Land Transfers - Mechanicsbur ____ _ ____ bU.SU 2312. -scrow for Inheritance Tax to Co ne & Co ne ¢8,011.00 1313.2010 School Taxes to Debbie Lu old Tax CoAector _ ¢1,321.76 1314. Pest Treament to Bowers Pest Control _ $742.00 1315. Electric Re airs to uicktricit Electric _`_¢1 100.00 1400.Total Settlement Charges (enter on lines 103, Section 7 and 502, Section K) ;8,214.7 ;21,741.58 tt you have any questions about the settlement charges and loan terms listed on this form, please o~ntact your tender. Settlement agent is not responsiole for cunt~rA of lender's assessments on HUD. The seller's and borrower's signatures hereon acknowledge their approval and signify their understanding that tax and insurance prorabons and reserves dre te.sed vn figures for the preceding year or supplied by others or estimated for the current year, and in the event of any change for the current year. all necessary adjuslrm~nls wdl he made between borrower and serer directly. Any deficit delinquent taxes or mongage payoffs will be promptly reimbursed to the settlement agent by the seller I nave carefully reviewed the IiUD-1 SattlemenLStatemenl and to l'ne best of my knowleage and belie(, it s true and accurate statement of ail receipts and diso;xscrnards made cn my account or oy n:e ,n this transaction. I further certify that t have received a copy of the HUD-1 Settlement Statement. BUYERS SELLERS - .. Esla f r' C Sgngnoli Glenn rad y ~ ~~~ ~ ~ 1a !.~ `__ _/e.~7 S2„yf~ -.- _ y; Alan Bruner alk/a Alan L. Bruner. Executor D- ra M Conrad Tne FEUD-1 Settlement Statement which t have prepared is a true and accurate account of this Transaction. I have caused or wdl cause the funds to be disuursuu .n accordance wdh this s ~:ment. Settlement Agent ~ ~ Date i ~ ~ ~/ ~ '~ ~l.! REV-1503 EX+ (6-98) ~ SCNEDI~LE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fioriy C. Sgrignoli 21-10-048 All property jointly-owned with right of survivorship must be disclosed on Schedule F. trr more space rs needed, insert additional sheets of the same size) MFC Historical Prices ~ Manulife Series Fund, Inc. Comm Stock -Yahoo! Finance Page 1 of 1 Manulife Financial Corporation (MFC) At 12:23PM EST: X6.89 ~ 0.01(o.os~i~} Are experts talking ~ III L ~ ~~~' about MFC? Find aut, ~ ~ «~~ ~ ~~ Historical Prices Get Historical Prices for: GO. Set Date Range ~" Daily Start Date: ~ Jun ~ 24 :2010 Eg. Jan 1, 2010 ~' Weekly End Date: Jun ~ 24 2010 ~" Monthly ~`" Dividends Only Ge# Prices. Prices Date Open High Low Close Jun 24, 2010 15.77 15.80 15.51 15.62 * Close price adjusted for dividends and splits. Download to Spreadsheet Currency in USD. Fiat ~ I~r~~rict~~~ ~ I~lext ~ I".ast Volume Adj Close* 1,890,700 15.33 First ~ ~'rvicu~ ~ I11e~t ~ I~.ast http://finance.yahoo.com/q/hp?s=MFC&a=05&b=24&c=2010&d=05&e=24&f=2010&g=d 12/17/2010 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Fioriy C. Sgrignoli 21-10-0748 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ' ..r ~ ' 3. is ~ ~ /~ .. .. ~ - r ... ~ ~ ~ ~ - .. ~ , ir,. , 1 v r ~ i ' - , ~ r .. - _ ~ ' .J ~ ~ ~ N S , • , 1 . ~ • ~ ~ ~ ~ .1 + ' y EPOSIT TICKET ~ . EST, OF ORIY C SGRICNOLI so. CEC , . ~~ ,ALAN BRUNER. EXTR ~ - 29 N HU ER CA; ~ ENOLA PA 17 C . ~ ~~ H C- ~ . ~ DAT ~ ~ ~ , 3 marts M"Y NDT "" rw~~+MTHOIUwAI CHECKS OR TOTAI - , ~~ FROM OTHER SIDE SI(iN.HEAE 1F CASH.RECE:IVEp FROM DEPOg1T TrtH S SUB TOT/U ~ PN °~ CBAI\IK -, ~ - ~ ~~ PNC Bach, N:A pqp LESS CASH ~~ Central PA • DD ND7~USE DEPOSIT T7CRET ROUTING A FAR DEPOSIT AUTDlgATlC PAYMEMT3. USE VOIDED CHECK ,~ t , _, -- --~:' ,:~:~~;_ - 50058 i i3 23n^ . •. ~ ~~rS°0`":-N ~ s~ sit. „~, Y~Y.F 1C~111.~k/4jw w~'. X1.1 ~..~Y.< ... ': ~.'j ~.. .. ! 1 \ . , ti . r_. .+... _ .:R :YL ..». ~_ ~ ~ J ~ 1 _ ~ _ _ . ~. .1 .., %1 v:: ;,4f ~~4. ~~ .. l+ ~, `~~ ~ ~r~ ~; i I } -~ ( ' ~ I ~~ i ' / s `~' REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Fioriy C. Sgrignoli 21-10-0748 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Richardson Funeral Home, Inc. 5,973.00 2~ Reception 573.00 s. Honorarium 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Alan L. Bruner Social Security Number(s)/EIN Number of Personal Representative(s) _ Street Address 29 N. Humer Street City Enola .State PA Zip 17025 5,000.00 Year(s) Commission Paid: 2011 2. Attorney Fees 7,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 194.50 5. Accountant's Fees 6. Tax Retum Preparer's Fees 800.00 ~. Patriot News -- Legal Advertisement 123.58 $. Cumberland Law Journal -- Legal Advertisement 75.00 9. Inheritance Tax Return filing fee 15.00 10. Settlement Fees from sale of Real Estate -- see attached settlement sheet 20,730.58 ~ 1. Postage 88.00 12. Total from Schedule H, Page 2 3,331.80 TOTAL (Also enter on line 9, Recapitulation) $ 44,104.46 (If more space is needed, insert additional sheets of the same size) SCHEDULE H: FUNERAL AND ADMINISTRATIVE COSTS. PAGE 2 Item No. Descriution Amount 13 Reserves $3,000.00 14 PNC Bank Fee $5.00 15 Estate Checks $25.00 16 Toll Calls for Executor $50.00 17 East Pennsboro Ambulance Service, Inc. $96.80 Associates in Kidney Disease, Hypertension, & 18 Intensive Care Medicine, LLC $155.00 TOTAL: $3,331.80 REV-1512 EX+ (12-08) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Fioriy C. Sgrignoli 21-10-0748 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) ~' Pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT -- ESTATE OF FILE NUMBER Fioriy C. Sgrignoli 21-10-0748 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec, 9116 (a) (1.2).] 1. Jane M. Rode daughter 1 /7 2. Tom Sgrignoli son 1 /7 3. Rita Stimeling daughter 1 /7 4. Sandy L. Weikel daughter 1 /7 5. Robert M. Sgrignoli son 1 /7 6. Karen S. Duncan daughter 1 /7 7. Brian Sgrignoli son 1 /7 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, insert additional sheets of the same size. No. Estate Of : FIORIY C SGRIGNOLI PA No . 2 ~ - ~ 0- 0748 (First, Middle, Last) Late Of : EAST PENNSBORO TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : 7 ~ ~-07-790 ~ WHEREAS, on the 26th day of July 2010 an instrument dated August 20th 2002 was admitted to probate as the last will of FIORIY C SGRIGNOLI (First, Middle, Lastl late of EAST PENNSBORO TOWNSH/P, CUMBERLAND County, who died on the 24th day of June 2 010 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County,' in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: ALAN L BRUNER who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office ~a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 26th day of July 20 ~0. ~,, ,~; eglster o Wi s Deputy • - ------ .. ~ r .~a.RTll'I TT1/1TTT T nn'I~T n /L~TT7C+T MTTITIT.1:' T.~.~'T) • try c.:3 _ ~ ~ LAST WILL AND TEST'A:MENT ~ ~ . OF ~ ~ rv s c-~ * w...~. V/ I r4, 1 FIORIY ~. SGRIGNOLI ~ ~ ~ _,;~ --~ ~~;.-..; ~ ~ ~= •'~ ~n I, FIORIY C. SGRIGNOLI, of the Township, of East Pennsboro, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will or codicil previously made by me. ITEM 1: _ I direct that my body be buried next to my,late wife,, Dorothy M. Sgrignoli, at Fort Indiantown .Gap National Cemetery. ITEM 2: I.direct that all my just debts and funeral expenses be paid as soon as practical . .after my death. ~ - ~i ITEM 3: I give, devise and bequeath all the rest,. residue and remainder of my estate of . w1~• every nature and wheresoever situate, together with insurance thereon, in equal shares to my children f living.on the date of my demise, namely: James G. Sgrignoli, Jane M. Rode, Thomas J. Sgrignoli, Sr., Rita. A. Stimeling, Sandra L. Weikel, Robert M. Sgrignoli, Karen S. Duncan, and Brian M. Sgrignoli. I direct that the distribution to my children be on a per capita basis and not a per stirpes basis. ITEM 4: Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. ITEM 5: I direct that all taxes and interest and penalties thereon that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from y residuary estate as a part of the expense of the administration of my Estate. ITEM 6: I appoint JAMES G. SGRIGNOLI of 514 South River Road, Halifax,. Pennsylvania and ALAN BRUNER, of 29 Horner Street, Enola, Pennsylvania, Co-Executors of this my Last Will. • ~ ~ I direct that m~ ~ ersonal;re resentatives, or their successors shall not be required ITEM 7-. y p p :o give bond for the fathful~performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament this. ~ d day of , 2002. • ~ ~ ~r ' FIORIY C. SG . GNOLI .. .. s.. Slgned,`seal~ed, published:~and declared'by the above-named Testator as and forhis Last Will and Testament in our presence, who, at his request, in his presence and in the presence of each other, Have .~ . hereunto: `subscnbed~our names as attesting witnesses: ~ ~ ~ ' •~ .. residing at 7° ~t • ~ ~~r~,.~ ~ residing at ~®~`l •~ .. 4.~_ - . __..~. ~_.. ._~_ - -~----~--~-____~ _ _ - - _ . - ----- - 4 - - -- - ~ - " ----- - T ~ . ...~~_ - _ ~: ~ :... -. .. • 1' ... ~ - ,.. . - ., - ~• ., ... .. ~ ,. F rti. , • • - ~ •~- ~ '' : COMIVIONWEAL,TH OF PENNSyLVAN1A ) COUNTY OF CUMBERLAND ) ss: ), We, FIORIY C. SGRIGNOLI, ~ tS,Q. ~ Co ~ C and ~~ ' ~' ~ir~a,,r ,the Testator and the witnesses res e p chvely, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereb y declare to the undersigned authority that the Testator signed and executed the instrument as his L ast Will and that he had signed willingly, and that he executed it as his free and voluntary act for th e purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, si ed the b'n will as witness and that to the best of his or her knowledge, the Testator was at the time ei ghteen (18) .years of older, of sound mind and~under no constraint or undue influence. ~ i ~ 1 FIORIY C. GRIGNOL W' ess Witness Subscribed; sworn and acknowledged before me . ~ by FIORIY C. ~GRIGNOLI, the Testator, and subscribed and sworn to b . efore me by ~t2 /~ rte. ;,,~ ~c and ~~.~ ~ ~ .. . the witnesses, this ~~ day of . , 2002. 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