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Home My WebLink About06-05-12 (2) J 1505610105 REV 1500 - OFFICIAL USE ONLY PA Department of Revenue Pennsylvania """""`~ Counry Code Year File Number Bureau of Individual Taxes Po BDX zso6ot I INHERITANCE TAX RETURN HarrtsburD PAt9t26-o6ot ~ I RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 03/07/2012 05/26/1928 Decedent's Last Name Suffix Decedent's First Nam[: MI CINGRANELLI ANNE E (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 IN APPROPRIATE OVALS BELOW 47 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death aker 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Sate Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-i-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ALECIA A BROGNANO (703) 754-7097 First Line of Address 4028 GYPSUM HILL ROAD Second Line of Address State ZIP Code PA 20169 KJ Y ~~ rv O City or Post Office HAYMARKET Correspondent's a-mail address: Under penalties of perjury. I declare that I have examined mis realm, inclutling acwmpanying schetlules antl statements, antl to the oast of my knowledge and Oeuef, it is true, correct and complete. Declaration of preperer other then the personal representative is based on all information of which preparer has any knowledge. SI ATURE~/O77F PERSON RESPONSIBLE FOR FILING RETURN DATE,/ ADDRESS 4028 GYPSUM HILL ROAD HAYMARKET VA 20169 SIGWATURE OF PREPARER OTHER T}IAN REPRESENTATI\(E, ~ DATE VVIEDEI01'AN ANb'DOUTY PC 282 LOWTHER STREET#201 LEMOYNE PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 NET N REGISTER O ~5 USE ONJ~Yn _. ~ C_ C' ~~ ~ C.'' ~T cn„ { cn P* _z: C`` _> OC-r1 ~ r - ^ ti .~ i DA~ FILED O 47 ii rrT J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number oecedent's Name: ANNE E CINGRANELLI RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 0.00 2. Stocks and Bonds (Schedule B) .................................... ... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 192,404.50 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property O S Billi R d L 206 520 76 (Schedule G) eparate ng equeste ..... ... , . 8. Total Gross Assets total Lines 1 throw h 7 ( 9 ) .......................... 8. ... 712,611.28 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 4,054.23 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 1,447.00 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 5,501.23 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 707,110.03 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. 707,110.03 TAX CALCULATION -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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate x.045 707,110.03 is. 31,819.95 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 1s. Tax DuE ....................................................... .. 1s. 31,819.95 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 E% (FI) Page 3 Flle Number Decedent's Complete Address: _ DECEDENT'S NAME ANNE E CINGRANELLI STREET ADDRESS BETHANY VILLAGE, MAPLEWOOD ASSISTED LIVING 5225 WILSON LANE CITY-~~-- STATE ~IP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 1,591.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line i + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) 1,591.00 31,819.95 (3) (4) (5) 30,228.95 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 dght to designate who shall use the property transferred or its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after Dec. 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 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 Jan. 1, 1995, the lax 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 statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements far 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 fol•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(a)(1)]. • The tax rate imposed on the net value of transfers fo or for the use of the decedent's siblings is 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-i5D8 EX+ (ir-ia) ~~i ' Pennsylvania SCHEDULE E ~~ oERARTnENTOr REVENUE CASHr BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FLLE NUMBER: ANNE E CINGRANELLI 2012-00396 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. If more space is needed, use additional sheets of paper of the same size, REV-1510 EX+ (Oa-09) ~- pennsylvania SCHEDULE G DEPARTMENT OE REVENUE INTER-VIVOS TRANSFERS AND mMERITANCE rAx RENRN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ANNE E CINGRANELLI 2012-00396 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV~1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INRUDE THE NAME OF THE TRANSFEREE, iHEN REUtI0N5HIP TD DECEDENT AND THE DATE OF TRANSFER. ATTACHA[DPY DF THE DEED FDR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °h~OF DECD'S INTEREST EXCLUSION tF APN(ANE) TAXABLE VALUE 1. TAX DEFERRED ANNUITY-INTEGRITY LIFE INS CO ACCT #2100097011-EQUAL SHARE AMONG 5 BENEFICIARIES 263,159.92 100 263,159.9: TAX DEFERRED ANNUIN-INTEGRITY LIFE INS CO 2 ACCT #2100097012-EQUAL SHARE AMONG 5 BENEFICIARIES 124,643.83 100 124,643.8: TAX DEFERRED ANNUITY-INTEGRITY LIFE INS CO 3 ACCT #2100113089-EQUAL SHARE AMONG 5 BENEFICIARIES 132,403.01 100 132,403.0' TOTAL (Also enter on Line 7, Recapitulation) $ 520,206.76 If more space is needed, use additional sheets of paper of the same size. Rev-ISn ex+ ito-o~i ~} i~ Pennsylvania ri~7 DEPARTMENT OF REVENUE INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ANNE CINGRANELLI 2012-00396 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' NELSEN FUNERAL HOME-412 SOUTH WASHINGTON HIGHWAY, ASHLAND VA 23005 1,337.45 ALECIA A BROGNANO -AFTER FUNERAL GATHERING 901.98 e. ADMINISTRATIVE COSTS: I. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City ._-_. ______..__._.-.....-_____ _ -._.._......._.._-_-_- State _... ZIP Year(s) Commission Paid: _. 2. 3. Attorney Fees: Family Exemption: ([f 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: 577.00 5. Accountant Fees: 480.00 6. Tax Retum Preparer Fees: ~ CUMBERLAND COUNTY BAR ASSOCIATION- PUBLICATION 75.00 ADMINISTRATIVE EXPENSES -SUPPLIES, MAILINGS FEES AND MILEAGE 882.80 TOTAL (Also enter on Line 9, Recapitulation) I ¢ 4,054.23 if more space is needed, use additional sheets of paper of the same size. REV-1512 E%+ (12-DP) G!]' pennsytvania C;7 DEPAFTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER ANNE E CINGRANELLI 2012-00396 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+ (O1-10) pennsylvania DEPARTMENT OF REVENUE INHERRANCE TA% RETURN RESIDENT DECEDENT SCHEDULE 7 ESTATE OF: FILE NUMBER: ANNE E CINGRANELLI 2012-00396 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISiRIBUTI0N5 [Include outright spousal distrihuti°ns and transfers under Sec. 9116 (a) (1.2).] 1. JOHN CINGRANELLI JR 119 DAYTONA AVENUE, ALBANY, NY 12203 SON 20% 2 ALECIA A BROGNANO 4028 GYPSUM HILL ROAD, HAYMARKET, VA 20169 DAUGHTER 20% 3 RICHARD L CINGRANELLI 11 HARVEY WAY, AVERILL PARK, NY 12018 SON 20% 4 CAROL L CINGRANELLI 5 1 203 SOUTH COURT STREET #72, HARRISBURG, PA 17104 DAUGHTER JUDITH DUDLEY 10509 WHITESTONE ROAD, RALEIGH, NC 27615 DAUGHTER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 20% 20% TraTAI AC PART iT - FNTFG Tf1TAl Nr1N-TAYARI F f1ICTRIRI ITI(1NC ON I INF 1 i OF RFV-t 500 COVFR SHFFT I3 If more space is needed, use additional sheets of paper of the same size. COMMONWEALTH OF PENNSYLVF""^ COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate o:E Wills and Granting Letters of Administration .in and for CUMBERLAND County, do hereby certify that on the 2nd day of April, Two 'Phousand and Twelve, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of ANNEEC/NGRANELL/ late of LOWER ALLEN 7UWNSH/r (First, Middle, Last! a/k/a ANNE BUCHANAN CINGRANELLI in said county, deceased, to ALECIA A BROGNANO !First, MiddM, Lestl and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 2nd day of April Two Thousand and Twelve. File No. PA File No. Date of Death s.s. # 2012-00396 21- 12- 0396 3/07/2012 229-28-3355 C u`Q2Ec7 E~j "ro *~aa5 -,zg- 3 3S$ .~ ~ i, ~ f l l f •~,~ 111 l€. k' C a t __ ~'-' epur~ NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL METRO BAN K 18418 7463067 001 092L40 ANNE BUCHANAN CINGRANELLI 4028 GYPSUM HILL RD HAVMARKET VA 20169 Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 1-888-937-0004 mymetmbank.com ~th~ ~ ~-~em~ We're here 7 days a week, 24 hours a day at 1.888.937.0004. Transactions By Date Interest Summary Fees Summary PERS PREMIER SAVINGS 0626649792 JS Cycle Page 1 of 4 NOTE :SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC For your convenience, a summary of overdraft and retumetl item fees appears on your monthly statement Please note that the overdraft fee summary includes non-sufficient funds fees, uncollectetl funds fees and unavailable funtls fees. The summary tloes not reflect refunded or waived Items credited to your account. APC112 - Infonnati Time Inquiry -Basic Account Data Account number 1701045 022 M~A^ Short name CINGRANELLI ANNE E Type CERTIF OF DEPOSIT Balance Data Current balance Hold amount Available Balance Interest due asic interest Data Interest rate Average rate Daily factor Int paid YTD Interest W/H YTD Interest method 3. .001 (DAILY COMP I -HCCOUnr. uaces Issue/Open date Last renewed Maturity date Automatically renewable Avail interest: S G (~ ~ Page 1 of 1 =Z-l-e m~ L Next Display Maturity/Reinve omer Data- ANNE E CINGRANELLI 5229 WILSON LN RM 109 MECHANICSBURG PA 17055 Home phone L 7037547097 t ~- Business phone r L Officer r1017 L TIN/Crt XX Payment Data- Next payment date Payment amount Disposition (CAP Last payment date Last payment amount C Last payment APY earned http://cbsgui:8091/Alliant?x=x&SessionId=138467739&ProcessId=49 5/14/2012 METRO BANK >09256 7436015 001 092140 ANNE BUCHANAN CINGRANELLI 4028 GYPSUM HILL RD HAYMARKET VA 20169 Metro Bank 3801 Patton Street HeMsburg PA 17111-1418 1-888-937-0004 mymetrobank.com We're bare 7 days a week, 24 hours a day at 1.888.937.0004. 50 PLUS CHECKING 0536971732 _~ illll~ a m Check Transactions Number Data Amount Number Date Amount Number Date Amount 1107 02/29 582.49 Items denomd with an'E' era electronic entries arM wgl not have a check image. Items denole0 vriyl an "' irsiicete pn>cessed checks oW of seGUBm~e. Interest Summary is cycle Paps 1 of 9 NOTF ~ RFF RFVFRRF SIrIF FOR IMPORTANT INFORMATION Memhwr FOIE: B21°O sou mrn Transactions By Date 03N3N2 EXCPTFORCEDR Orwti a+' ~ 574.18 :14,800.32 METRO BANK >02051 7489084 001 092140 ANNE BUCHANAN CINGRANELLI 4028 GYPSUM HILL RD HAYMARKET VA 20169 Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 1-888-937-0004 mymeVObank.com ~c. h ed~-~--' ~e Y~ ~~ We're here 7 days a week, 24 hours a day at 1-888.937-0004. Transactions By Date +~ Data Deseri lion Debit Credit Balance Interest Summary Fees Summary 15 Cycle Page10f2 ezino eou onn NOTE ~ RFF REVERSE SIDE FOR IMPORTANT INFORMATION Memher FDIC For your convenience, a summary of overdraft and returned item fees appears on your monthly statement. Please note that the overdraft fee summary includes non-sufficient funds tees, uncollected funds fees and unavailable funds fees. The summary does not reflect refunded a valved ttems credited to your account. ' ' .MAY. 30. 2012 L9: 02AN1et .~,.. . XFINITY Connect Contract Values From :Mme Rmta eafelda~nwtlk,0oma ~MJeee : oolmad: Values To : hro0nana@OOrtICasLneC Aleda, here are the numbers HOm 1nteAmY N0. 646~`P. 21 t Pont sits ~~h Cr iue, May z9, ao12 os:oi PM ppntradNaLask40'~ta Value ;124,643.83 Z +e rn ~2 7012 ;132,409.01 Tt c ~"` ~ 3 3089 6263x159.92 ~+e m~ : 7011 I was told by IrIte9Alyr then: b n0 p~ ee "Slmender VaWe" they base the diehtbutlglc 011 tl19 wrrent OaldtaCt wlale. let me plow If you rmed anytNrp el6e. 1}Ia11k you, Anna Ferris Sales MefataM NortheKlt RrIxlt4al Grout 200 SprinO Sheet Suite 120 NerrldOn, VA 20170 703-810.1072x107 boo-2~a1s6 x 107 tmc7IXD810.1079 ~omaohd!lc,mm Nor8lwtet pYlancial Group b a re¢ahned invaatmtimt odvaor and rcgletlyad /fir mamba F7NRA/3IVG Sanultlea Offered OOnb~ed I~rtllrreBt Rrwlclal Gro1p~1ef0r aaxurideaaleutanae dnaas ao L,PI. RrHtaaal. ~ I aOlYahs. LPL Rnandal has The llrvecurlelt Products sob ttunu9h LPL FrercW aro trot rowed WorOnVest Fedenll Celt Cation dapmpa and art not Nl1JA lrrurad. Thee prodlals n not Or NoAhaveat Federal pdrc Union and aro not aMoned,lecomnlendad, ar gwranteed tH Northwest FederN CedR Unpn ar a1ry partrtVnetd apancY. ~ value al' OM inwxa<11eM may flume, the tetum on the invaaUnellt p not guerardaad, en4 the loan of pAndpal ie passlbll. The N1fOrrr1a11011 OOntained p this mall meaeape p tlein9 tranetrYlhed t0 eaM a Ineended far the use of only tl1e IndlYxllnl~ «rc is addreNed. ff QIe leader of ihh mewOelblR'd. ff tr0u ra0dved thk rlleaaa0e in enotr W~feiahd~~ dde~te~r mpyilg OF Chia nllMaQ6 t5 ahfUlY P~ http://sz0028.wc.mail.comcast.net/zimbra/h/printmessage?id-27... 5/29/2012 ®Integrity Life ~ Insurance Company A member of Western & SouMem Financial Gmup Owner ANNE CINGRANELLI GO ALECIA BROGNANO 4028 GYPSUM HILL RD HAYMARKET, VA 20169-0000 M U a age n ua to me of unt 8/0 ~ ~ - 1 /2 Representative Information Phone: (703) 810-1072 RUSSEL A. CESARI Lt 200 SPRING ST 5Gh ~ ?/ sTE 12o y,~ ~m HERNDON, VA 20170 Account Change Beginning Account Value $118,134.89 $100,000.00 Contributions $0.00 $0.00 3.sz Withdrawals $0.00 $0.00 Chazges and Adjustments $0.00 $0.00 Interest Credited $3,544.33 $21,679.22 Total Change $3,544.33 $21,679.22 Benefit Value $121,679.22 lar YTD Contributions $0.00 If you have any questions concerning your annuity, refer to your convact, or consult with your financial representative. Please contact us immediately if you feel this statement is in error. If we aze not notified within 30 days of the date of [his statement, we will not be responsible for any errors. Our Customer Service Team can be contacted at 1.800.325.8583. Our mailing address is Integrity Life Insurance Company, P.O. Box 5720, Cincinnafl, OH 45201-5720. Express mail should be sent to integrity Life Insurance Company, 400 Broadway, Cincinnati, OH 45202. Faxes should be sent to 1.888.220.2672 Visit our website at www.integritycompanies.com or email us at service@integritycompanies.com Integrity Life Insurance Company ~ 400 Broadway •Cincinnafl, OH 45202 - - - Projected value assuming no withdrawals, loans or transfers, if permitted. Integrity Life ~ Insurance Company A member of Western & Southern Financial Gmup Owner ANNE CINGRANELLI C/O ALECIA BROGNANO 14089 CLATTERBUCK LOOP GAINESVB,LE, VA 20155-4485 Account Change M U a age n ua to me of tint 8,/1 10 - 5/2 1 Representative Information Phone.• (703)810-1072 RUSSEL A. CESARI SLh ~ 3 200 SPRING ST STE 120 ~,pe,~`' HERNDON, VA 20170 Beginning Account Value $121,722.03 $100,000.00 Contributions $0.00 $0.00 Withdrawals $0.00 $0.00 Chazges and Adjustments $0.00 $0.00 Interest Credited $5,903.52 $27,625.55 Total Change $5,903.52 $27,625.55 Death Benefit Value $127,625.55 Calendar YTD Contributions $0.00 If you have any questions concerning your annuity, refer to your contract, or consult with your financial representative. Please contact us immediately if you feel this statement is in error. If we aze not notified within 30 days of the date of this statement, we will not be responsible for any errors. Our Customer Service Team can be contacted at 1.800.325.8583. Our mailing address is Integrity Life Insurance Company, P.O. Box 5720, Cincinnati, OH 45201-5720. Express mail should be sent to Integrity Life Insurance Company, 400 Broadway, Cincinnati, OH 45202. Faxes should be sent [0 1.888.220.2677. Visit our website at www.integritycompanies.com or email us at service@integritycompanies.com Integrity Life Insurance Company •400 Broadway ~ Cincinnati, OH[ 45202 - - - Projected value assuming no withdrawals, loans or transfers, if permitted. ® Integrity Life Insurance Company A member o1 Weshm & Southern Financial Gmup Owner ANNE CINGRANELLI C/O ALECTA BROGNANO 4028 GYPSUM HILL RD HAYMARKET, VA 20169-0000 Account Change 01/01/2011 -08/01/2011 ntmtnmi _nan5i~ntt M U a age n ua to me of unt /(1 10 - 1 /2 1 Representative Information Phone: (703) 8/0-1072 RUSSEL A. CESARI 200 SPRING ST ~Lr ~~~ STE 120 HERNDON, VA 20170 ~j ~m Beginning Account Value aaa Contributions Withdrawals Chazges and Adjustments Interest Credited Total Change Death Benefit Value Calendaz YTD Conh $245,085.37 $200,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9,803.41 $54,888.78 $9,803.41 $54,888.78 $254,888.78 $0.00 If you have any questions concerning your annuity, refer to your contract, of consult with your financial representative. Please contactus immediately if you feel this statement is in error. If we aze not notified within 30 days of the date of [his statement, we will not be responsible for any errors. Our Customer Service Team can be contacted at 1.800.325.8583. Our mailing address is Integrity Life Insurance Company, P.O. Boz 5720, Cincinnati, OH 45201-5720. Express mail should be sent to Integrity Life Insurance Company, 400 Broadway, Cincinnati, OH 45202. Faxes should be sent to 1.888.220.2677. Visit our website at www.integritycompanies.com or email us at service@integitycompanies.com Integrity Life Insurance Company ~ 400 Broadway • Cincinnati, OH 45202 - - - Projected value assuming no withdrawals, loans or transfers, if permitted. ~ch Nelsen Funeral Home -Ashland = fG/Yl ~ . ~ 412 S. Washington Hwy Ashland,VA 23005 '(804)798-8369 Mrs. Alecia Brognano Funeral Expenses of, Mrs. Anne Buchanan Cingranelli 4028 Gypsum Hill Road Date of Death 3/7/2012 Gainesville,VA 20155 Date of StatemenC. 4/20/2012 Case Number A201200451 Professional Services Basic Services of Funeral Director and Staff 1695.00 Cosmetology Dressing & Casketing 165.00 Embalming of Normal Remains 545.00 Miscellaneous Service 300.00 Receiving Remains from other Funeral Home 0.00 2,705.00 Use of Faeilhles Facilities & Staff Chapel Service 460.00 460.00 Automotive Equipment Additional Mileage Charge 459.30 Use of Flower Vehicle 115.00 Use of Hearse 275.00 ',Ise of LeadlService Car 115.00 Transfer of Deceased Into Our Care 375.00 1,339.30 Merohandlse $200 Flower Arrangements 250.00 Gdd Cross Memorial Package 165.00 Woodhaven Pecan Casket - 205162 3545.00 3,960.00 Cash Advances Death Certificates 10 Q 6.00 = 60.00 Newspaper Notice -Out of State Paper 184.80 Newspaper Notice - Out of State Paper 308.57 Newspaper Notice - RTD 600.80 1,152.17 Tax Group Sales Tax 198.00 198.00 Total Charges 9,814.47 Adjustments Preneed Adjustment -1260.00 -1,260.00 Payments Amertcen Memorial ck#805308 3/30Y2012 -7217.02 -7,217.02 Total Payments x,477.02 Balance Due 1,337.45 Account Inq~liry --~ G ~ ~ -- Resldenb Cingranelli, Anne E. (73648VAL) Trans Oatn: thru 4012012 Entry paESS: thru 4/18/2012 Payne: Private Pay Plans: All Op0ora: Prior Period, Summarizatan Collection NoOes Biq Holds Account inquiry • Open kam ~y+~,n Period Payer Snvks Untb Charpss P ~~ Bahna Coins To Dabll 2/2012 8) Private Pay - Pnvate Pay ,AL Meal 2 1000 1000 0.00 Fab 2012 Tobb _ _10 _._ 10.00 _ 0.00 ~i'~~.~~~ ~ _. 4019 y ~ 5 11 I8/20 f ILPrivate Pay- PPM AL ~Asaiated Livi Room and Board(AMV AL L1) ~ 3 ~ fi35.50 535.50 0.00' ~ -___ I r w _ ~~ ~ 012' D11 Private Pay -PPM AL /heisted Livin Room and Ooard(L4) ~ 27 6,021.0 - 6,021.00 - 0.00 + _ w X8/2011 Private Pa -PPM AL Pa ent( n CrediQ I 0 0 ~ 0.00 0.00 2011 Touts: 0.558. 8.888.80 OAO 912011 Private Pa - PPM AL Asalsted Livi Room and Board(Ld} I 30 6,690.00 r 6,690.00 - -..~ _. 0.00, .~_BM/ Touts: B,MQAO• ~,Mda9i 0.001 1012011 Private Pa -PPM AL Assisted Livi Room and Board(40} 31 8,913.00 8,913.00 0.00 ! Oct 2011 Tr~b: 6,012 8,91A00 0.00'+ 11 /2011 Private Pa -PPM AL Beau /Barber(82100) 3 89.00 89.00 0.00 1 t /2011 Private Pay - PPM AL Assisted Livin Room and Board L4 30 8,890.00 6,690.00 0.00 Nov 2011 Tobb: 8,789.0 8,7.00 0.00 12/2011 Private Pay -PPM AL Beauty/Barber(82100) _ 2 36.00 36.00 0.00 __ 12/2011 Private Pa -PPM AL Assisted Livl Room end Board(L4) 31 8,913.00 8,913.00 0.00 Dec 2011 TotaN: 8,959.00 8,1i/9A0 0.00 1/2012 Private Pa -PPM AL BeautyBarber(82100) 2 37.00 37.00 0.00 __ Yxtw ': 1/2012 PrivaN Pay -PPM AL fisted Living Room and 8oard(L4 31 7,223.00 7,223.00 0.00 Jan 2012 Tobb: 7,250.00 7,280.00 0.00 '2/2012 Private Pey -PPM AL Bea Barber(82100) 2 34.00 34.00 0.00 w 2!2012 Private pay - PPM AL aisied Living Roan and Board(L4) 29 6,757.00 6,757.00 0.00 __ '212012 Private Pay -PPM AL Pa mem(Open Credk) 0 0.00 -24.00 24.00 Fsb2012Totab: 8,791A0 8,787.00 24.00 __ 312012 3 Private Pey -PPM AL NSF Fea(98251) 1 25.00 0.00 25.00 __ !2012 Private P - PPM AL Assisted Livin Room end Board(L4 Mar 2012 Tofak• 8 1,398.00 1 425.00 0.00 000 1,3!38.00 1,422J10 v i Y , ~' Psyn-Wan ~ . CMr0as I rem G aa3ma ~ 1~t~T Bethany Village ~ 3S Wesley Drive f^ Mechanicsburg, Pp 17055 ~(~r ` 1 k~'~ Alecia Brognano 4028 Gypsum Hill Road Haymarket, VA 2D169 ~~~gE SE T Page: Cingranelli, Anne E. PLEASE DETACH AND RETURN UPPER PORTION WITH YOUR REMITl'ANCE 05/07/2012 Cingranelli, Anne E. Assisted Living ~.. ... w ~, :~ . -~ • ~ N ~in 0 ~~~ LAST NZLL AND T1lSTA1[Sli'1' ~~ ~ ~-.::c ~, y ( .~ l1 ~~ r V~ ~ N r 1y.: C.7 ~ 71D11iE 8. CINGAAIIELLI ~$~ =~` ~ ~ ~'; r~ ~v -~ V' I, ANNE E. CINGRANELLS, of the County of HenricEP, Virginia, declare this to be my Last Will and Testament and hereby revoke any and all other Wills or codicils heretofore made by me. ARTI4L8 I ebts and_Ta I direct ray Executor to pay my just debts, funeral expenses (including the cost of a marker for my grave) and the expenses eonneeted,with the administration of my estate. My Executor shall pay from my residuary estate all estate, inheritance and like taxes upon or with respect to any property which ie required to bs included in my gross estate for such tax purposes, whether passing under this Will or otherwise without apportionment to or reimbursement from any recipient of any such property. ARTICLS II T.„Ra t.~ a i+ersonai PronertY I will leave a written list providing for those items of tangible personal property that T want to be distributed to particular recipients. The list may or may not specifically refer to this Will. The list will be in existence at the time of my death; the list may be prepared before or after the Vp 1 Z 'd Sl9'ON Wd0§~9 bIOZ'l 'N~f execution of this will. The list will be dated and signed by me. MY Executor shall follow such list. If I do not 1Bava a list, or the list is incomplete, then the remaining tangible personal property shall be distributed to my Husband, JOHN CINGRANELLI, SR., (hereinafter referred to as "my Husband"), if he su'r'vives me. If my Husband does not survive ma, then such property shall be divided by my Executor in equal shares as practicable and distributed to my descendants p~ stirpge who survive my Husband and me, unless specifically provided elsewhere in this Will. If any suoh descendant is a minor, my Sxacutor may deliver such beneficiary's share to any adult with whom suoh descendant then resides and the receipt of such adult shall be a full discharge of my Executor; provided that my Executor in his discretion may sell any of such property which h~ deems not appropriate to be distributed to any beneficiary and add the proceeds therefrom to my residuary estate. All insurance policies on suoh tangible personal property shall pass with such tangible personal property, including the rights thereunder. 1~tTICLE III Raaidaaae I devise to my Husband, if he survives ma, all my ,Q G ~ interest, whatever it may be, in real estate which my Husband ~+~_~ and i are using as our home at the time of my death. If such 1Jk~ 2 s a y~9 oN wdoy~9 a~oa ~~ ~N~r real estate at the time of my death is subject to a lien, mortgage or deed of trust, my 8xecutor shall not be required to exonerate it from such lien, mortgage or deed of trust, or any oontraat or note pertaining thereto, but if the adminiattatfon of my estate will thereby be unduly delayed, my Executor shall have authority to exonerate suah real estate Prom such lien, mortgage or deed of trust without obligation to seek contribution for any such payments from any person interested or jointly liable therein. IL my Auaband does not survive me, such real estate shall peas as part of my residuary estate as hereinafter provided. Anxx~L~ sv Residuary Hlatate All the rs:t, residue and remainder of my estate, oP every kihd, wherever located and however held, herein called my "residuary estate", I devise and bequeath to my Husband, if he survives me. If my Husband does not survive me, then I devise and give my residuary estate to our ohildrsn in five equal shares, and as of the data of this mill our children are: ALECIA A. S120GNANO currently residing at 14975 Alexandras Grove Drive, Asburn, Virginia 20147, JOHN CINGRANELLI, JR. currently residing at 119 Daytona Avenue, Albany, New York 12203, ,~,/~ RICHARD LEE CINGRANELLI currently residing at 38 Saybrook PAY Drive, Latham, Nsw York 12110, yz~: 3 ti .d 5~9 ~oN wvo5~9 a~oa ~~ ~N~r aF~ -~4~- _C6. JUDITH DUDLEY currently residing at 3 Hillcrest Driva, Tyngsboro, Massachusetts 01879, and CAROL L. CINGRANELLi currently residing at 236 Green bane Driva, Clamp Hill, Pennsylvania 17011. in the event that JOHN CINGRANELLi, JR. doss not survive my Husband and me, his share shall be divided among those of our children wha do survive us. In the event any other of our children do not survive my Husband and me, hie or her share shall be distributed to his or her children (our grandchildren), provided that if any of such grandchildren are under the age of 21, then that grandchild's share shall be held in a uniform for Transfer to Minors Act Aocount until such child reaches the age oP 21, and the custodian under such account shall be selected by my Executor at the time of such distribution. if such deceased child leaves no surviving children (our grandchildren), then his or her share shall be divided among the other oP our children who survive my Husband and me. Tn the event that 2 have made any loans to my children or grandchildren or gifts to my children or grandchildren prior to my death, my Executor shall not Consider sash loan as a debt and collect it, nor consider the loan or gift as an offset against that child's or grandchild's share oP the estate. The phrase "doss not survive" shall mean does not survive Por a period of three (3) months after the data of the death. 4 § 'd § l9 'oN wdos~9 a~oi ~~ 'Nor 1 I, ~scLS v A ~'C a ~ +...®eus Heath If my Husband and i die and®r airaumatanaes where there is no sufficient evidence that we have flied other than simultaneously, it shall be presumed, for the purposes of this will that i survived him. urrxcz~ v= nwvmra of ALt11OriSitiOII My Executor is authorized to exercise all powers granted fiduciaries under Section 64.1-57 of the Code of Virginia as in effect on the date this Wi11 is executed, which Section is hereby made a part of and incorporated in this Will by reference and also to exercise the power to make any elections allowed by law which may result in an overall tax savings for my estate, without adjustment to any income or principal interest with respect thereto. Any provision contained herein or in such Section shall not relieve my Executor from using prudence and reasonable diligence in the exercise of their authority. My Executor is authorized to transfer any shares of this estate Eor the benefit of a minor to a custodian under the Uniform Transfer to Minors Act of Virginia or of such state wherein such minor beneficiary resides with the beneficiaries to receive the principal at age 21. 5 9 'd 5l9 'ON wvt5~9 z~oz'~ 'Nor R3tTIGL6 Vii sYSautor I nominate my Husband JOHN CINGRANELLI, SR. as my 8xecutor, and request that no surety bs required on his bond. In the event that my Husband shall not serve or continue to nerve, then T nominate my daughter ALECI?, A. BROGNANO as my Executor, and request that no surety be required on her bond. In the event that she shall not serve or continue to serve, then I nominate my daughter CAROL L. CINGRIINELLI as Executor of mY estate and request that no surety bs required on her bond as suoh. MY daughters shall carve without fee, but shall be compensated Por any expenses including professional advice Prom attorneys, accountants or appraisers. My Executor shall b6 entitled t4 ohargs Par such expenses as travel, overnight lodging, postage and long distance telephone and facsimile costs oP my individual executors as proper expense charges against my estates any cost oP storage of, insurance on or transportation in distribution of my personal property incurred while my estate fs open shall be proper expense charges against my estate. I request that no appraisement be required oP my estate. IN WITNESS WHEREOF, I have hereunto set my hand and Baal EC ~, i to this Will consisting of seven (7) typewritten pages, in the 6 ~ 'd s ~ 9 ~oN wd~5~9 a~oa ~~ ~N~r margin of each but this page, I have written my initials, ail on this ~ day of May, 2000. (SEAL) ANNE E. CINf3RA! LLI We, the uridesigned, da hereby certify that ANNB E. CINGRAN$LLI has signed, sealed, acknowledged and declared the foregoing paper as and for her Last Will and Testament in the presence of us, two competent witnesses who, in her presenoe and at leer request, and in the presence of each other, all present together at the same time, have subsoribed our names below as attesting witnesses, all on this ~, day o! May, 2000. (Addresses) STATB OF VIRGINIA, '~i~3t/COl7NTX OF }{El1//Ld , to-Wit: Before me the undersigned authority, on this day personally appeared ANNE E. CINGRANELLI /~a~a.¢rf ~.. ~1, olb.4Q.Ne and !1lk.~tPid ~R. t~aan known to me to be the Testator and the witnesses, respectively, whose names era signed to the nttached or foregoing instrument, and all oP these persons being by me first duly sworn, ANNE E. ,the Testator, deolared to me and to the witnesses in my presence that said instrument is her Last Will and Testament and that she had willingly signed or directed another to sign the same Por her, and executed it in the 7 8 'd §l9 'ON Wdl§~9 dlOb'l 'N~f ~ ~ presence of such witnesses as her free and voluntary act !or the purpose therein expressed; that suah witnessaa stated before ms that the foregoing Will was executed and acknowledged by the Testator as her Last Will and Testament in the presence of such witnesses who, in her prassrice and at her rec,~uest, and in the presence of each other, did subscribe their mamas thereto as attesting witnesses on the day of the date of such will, and that the Testator, at the time of execution of such Will, was over the age of eighteen (1$) years and of sound and disposingnmind and(~me~mlory. /~a!yt~ G , uvn.Wi ANNE E.~CINGRANELL~~ wetness witne s Subiscribed, sworn and acknowledged before me by ANNE B. ~GRANBLLI the Testator, subsorib and awo n before me by f5a~r~~ %~el~/y~( . Arid (~,~t~`iC R ~`n the witnesses, this L(t.~! day of May, 2000. My commission expires: ed fl+,p~o~~ ,e, l~l. /r~aa./ N cry Public This Last will and Testament was prepared by Robert L. Dolbenre, P.C., Attorney at Lnw, ICoger Executive Center, 8002 Discovery Drive, Suite 101, Box It-3, Richmond, Virginia 23288. 8 6 'd S l 9 oN wv~y~9 z~oa ~ ~N~r