Loading...
HomeMy WebLinkAbout05-03-12.' .- 150561D143 ~ REV-1500 ~"° OFFICIAL USE ONLY '-'°' PA Department of Revenue pennsylvanla county code veer File Number Bureau of Individual Tazes us.uaasaroe asve1"` Po Box.zeosot INHERITANCE TAX RETURN 21 11 0601 Harrisburg, PA 17128-0607 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 21 2011 02 17 1943 Decedent's Last Name Suffix Decedent's First Name MI GRIMES DIANE M (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 ^ ^ Supplemental Return 3. Remainder Return (date of tleath 2 ^ 1. Ori Inal Return 9 . r prior to 12-13-e2) 4. Limited Estate ^ ^ qa. Future Interest Compmmisa ^ 5. Federal Estate Tax Re[u„. R«°~^'°^ • '- ar 12-72-82) ~ death af l (date of O g Decedent Died Testate '^ f WII a l p 7. ~pjja haGOpy o(Trusga Living Trust B. Total Number Of Safe t~~j • ~ ~~ ~ v ) (Atlach Copy o ^ 9. Liti anon Proceeds Received 9 ^ 10 s ousel P0v d retl~t{date of death ^ 11.Elec[ion to tax under ~~ep t~r~) r ' b~tween 12-~1 ~Ji an -1 -95) (AHach Sch. O) ~l ~ ~ CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOU 8E DIRECTED TO: Daytime Telephone Nu ber Name RONALD M KATZMAN 717 234 4161 REGI~iF~IOFSE O~L'j' ~ ~~ -t First line of address T' ' ?rii W , '~ 4250 CRUMS MILL ROAD ~ ~`~C7 ~ O ' ,i 7 ~ "~ '~ Second line of address - ~ '~ PO BOX 6991 ~° ~ " ~ ~"' C ~ ~ n,.~u r'` ~ g City or Post Office Stale ZIP Code n HARRISBURG PA 17112 Correspondent's a-mail address: ""^l~!:y"1A1O1a^°'""°•••~""• Under penalties of perjury, I declare that. I have examined this return, including accompanying schedules and statements, and fo the best of my knowledge and belief, it is true, ct and complete. Deciarahon of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNAT E O PE N RE SIBLE OR FILING RETURN DATE Jennifer Miller ~ Z. ADDRES 19 Johnson Rd. PI mouth Meetin PA 19462 SIGNATURE OF PREPARER OTNER THAI~RIEPRESENTATIVE DATE ' ~, _ .., o ..,,. /-G ~ _--~_ Ronald M. Katzman ~' l(o -(~ 4250 Crums Mill Road, Harrisburg, PA 17112 Side 1 1505610143 1505610143 J~ ~m J 1505610243 REV-1500 EX Decedent's Social Security Number DecetleM's Neme. Gf11TteSr Diane M. RECAPITULATION 1 158 , 137.28 1. Real Estate (Schedule A) ..................................................................................... .. . 2. Stocks and Bonds (Schedule B) ........................................................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)....... .. 3. 4. Mortgages 8 Notes Receivable (Schedule D) ...................................................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. .. 5. 18 , 453.00 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6. 30 , 059 • 57 7. Inter-Vivos Transfers & Miscellaneous t~nn; Probate Property (Schedule G) u Separate Billing Requested........... . 7, 346,445.04 g, Total Gross Assets (total Lines 1-7) .................................................................. ... 8. $$3 , 094.89 9. Funeral Expenses & Administrative Costs (Schedule H) ..................................... .. 9. 31 , 277.58 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .. 10. $ 3 , 523.12 11. Total Deductions (total Lines 9 & 10) ................................................................. .. 11. 114 , 800 • 70 12. Net Value of Estate (Line 8 minus Line 11) ........................................................ .. 12. 438 , 294.19 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. 438 , 294.19 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 438 , 2 94.19 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 . 0 0 17. at sibling rate X .12 18. Amount of Line 14 taxable 0 0 0 18 at collateral rate X .15 . . 19. Tax Due ................................................. ................................................................ . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 19,723.24 0.00 o.oo 19,723.24 Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21-11-0601 DECEDENT'S NAME Grimes, Diane M. STREETADDRESS 17 Kings Arms Circle CITY Mechanicsburg STATE PA ZIP 17060 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) ~ (1) 19,723.24 2. Credits/Payments A. Prior Payments 22,000.00 B. Discount 986.16 Total Credits (A + B) (2) 22,986.16 3. Interest (3) q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 3,262.92 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. (5) Make Check Pa able 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 :............................................................................... ^ x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ~x c. retain a reversionary interest; or ............................................................................................................... L~nJi Bx d. receive the promise for life of either payments, benefits or care? ............................................................ x 2. If death occurred after December 12, 1962, 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 death7....... ^ ^x 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 QUESTIONSIS 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 January 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 statute does not exempt a transfer to a surviving spouse from tax, and the skatutory 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 de~lth 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. LAST WILL AND TESTAMENT OF DIANE M. GRIMES I, DIANE M. GRIMES, now of Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null and void all prior Wills and Codicils made by me at any time heretofore. ITEM I. I direct that all my legally valid debts, funeral and administrative expenses, and debts incurred or payable because oftny death, shall bepaid by my Executor, hereinafter named, from my residuary estate as soon after my death as practicable. All death taxes, including federal, state, and other death taxes, with respect to the property forming my gross estate: for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of administration of my estate, without apportionment or right of reimbursement. Taxes on future interests may be prepaid. ITEM II. I give and bequeath certain items oftangible personal property that are solely owned by me at the time of my death and that are identified in any separate writing directing distribution thereof after my death which is dated and is signed by me at the end thereof, to those persons designated in such separate writing who survive me. If any item oftangible personal property is identified in more than one separate writing, I direct that, unless stated to the contrary, the separate writing bearing the last date shall govern the disposition of such item. ITEM III. I bequeath the household and personas effects, j ewehy, automobiles, and other tangible personalty of like nature that are solely owned by me at the time of my death, not otherwise disposed of above, equallyto my children, JENNIFER EILEEN GRiME:S, MICHAEL CLARK GRIMES, and DOUGLAS EATON GRIMES (my "Children"), if they survive me by thirty (30) days; Provided, however, that if such a child of mine does not so survive me, then such shares shall be equally distributed to my remaining Children. Such property shall be divided by my said beneficiaries as they shall agree. As to those items upon which they shall not agree, distribution shall be detennined by my Executor. ITEM IV. I give, devise and bequeath all of the residue of my estate, wherever situate, including any property subject to any power of appointment which I may now have or hereafter acquire, equally to my children, JENNIFER EILEEN GRIMES, MICHAEL CLARK GRIMES, and DOUGLAS EATON GRIMES (my "Children"), if they survive me by thirty (30) days; Provided, however, that if such a child of mine does not so survive me, then such shares shall be equally distributed to my remaining Children. ITEM V. The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM VI. I hereby appoint my Daughter, JENNIFER EILEEN GRIMES, to serve as Executrix (the "Executor"), of this, my Last Will and Testament. In.the event of her refusal or inability to so serve, I then appoint my Son, MICHAEL CLARK GRIMES, to serve as Executor (the "Executor"), of this, my Last Will and Testament. ITEM VII. I direct that my Executor shall not be required to give bond or post any other security for the faithful performance of duties in any jurisdiction. ITEM VI [[. My Executor shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal of income, exercisable without Court approval, and effective until distribution of all property: A. To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate so to do. B. To vary investments, when deemed desirable by myExecutor, and to invest in such bonds, common trust funds controlled by my Executor, stocks, notes, real estate mortgages, or other securities or in such other property, real or persona(, as my Executor deems wise, without being restricted. to so-called legal investments. 3 C. In order to effect a division ofthe principal of my Estate or for any other purpose, including any final distribution, my Executor is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. If such division or distribution is made in kind, said assets are require;d to be divided or distributed at their respective values on the date or dates of their division or distribution. D. To sell either at public or private sale and upon such teens and conditions as my Executor may deem advantageous to my Estate, any or all real or persona( estate or interests therein owned by my Estate severall}~ or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge, and deliver any and all deeds, assignments, options, or other writings which may be necessary or desirable, in carrying out any ofthe powers conferred upon my Executor in this paragraph or elsewhere in my Will. E. To mortgage real estate, and to make leases of real estate for any period of time as is deemed reasonable by them. 4 F. To borrow money from any party to pay indebtedness ofmine, or of my Estate, expenses of administration, or inheritance, legacy, estate or other taxes. G. To pay all costs, taxes, expenses, and charges in connection with the administration of my Estate. My Executor shall pay expenses of my last illness and funeral expenses. H. To vote any shares of stock which form a part of my Estate, and to otherwise exercise all the powers incident to the ownership of such stock. I. In the discretion of my Executor, to unite with other owners ofsimilar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate. J. To compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value. ITEM IX. Any person who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. 5 ITEM X. It is my specific and express intention by the tE;rms of this Wil] that my Husband, WILLIAM GRIMES, shall not receive any interest whatsoever in my Estate or hold any fiduciary position related to my Estate, so that effectively, he is disinherited from any interest hereunder. IN WI1`NESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of six (6) typewritten pages, this ~ day of September, 2003. ~ (/ `, DIANE M. G ES We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testatrix, DIANE M. GRIMES, as azid for her Last Will and Testament, in the presence of us, who at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. \. ~ ;1 , ~ . Z .. Z . ~1.f.~, -•-~,E`` residing at `, / ~~`~~ Vtiac:<~ `.~~. residing at i icry-~ ~~~ l~r r ~- 5 { ~l~ ~ 1 ! u ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN . SS.. We, DIANE M. GRIMES, the Testatrix, and--t=?f}1°I ~57~-~S~ita,*'+.`~ ,and ~~~~„~ ~. 12~.Clx_ ,the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will anti that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~ (/! ~ !" ~NE~ GRI ES Wttne ~~a_.._rti l,'.3n.~~Q Witn~s Subscribed, sworn to and acknowledged before +me by the Testatrix, DIANE M. GRIMES, and subs~cyribed and sworn to before me by -.~1~"~-f1Y 1 ~.2~-.c?~('7i(~`Z~-•y and ~t"'1G? ~t~-T~. ~;x'C'n~1r, witnesses, this ic33'~`day of September, 2003. Notary blic V"`~" (SEAL) 1UU153.1 ` Notarial Seal l t'heryl L Baker, Notary Public 'M ^4 Harrisburg, Dauphin County .n}. r';xrn~nssion Expires Jan. 13, 2007 1`v!t ~'nP1;,l. ?nnnS~lt~ r:i=~ A55nCiatipn Df Notaries Rav-1503 EXa(77-Oa) I SCHEDULE A REAL ESTATE COMMONWEALTH OFPENNSYLVANIA INHERITANCE TA%RENRN RESIDENT CJECEOENT ESTATE OF ILE NUMBER All real property owned solely or asatenant in common must bereported etf~ir market value. Fair Markel value is defined ea Ne price et which pr edy would be exchangetl between a willin~ buyer an0 a willing seller, neither being compelled to buy w sell, both havNg reasonable knowledge of the relevant teMS. Ree property which le jointly-owned with dght of aurvivorehip must be tllac osad on schedule F. Attach a copy of the cettlement shoat If the property has bean soltl Include a copy of the dead showing decetlanl's Interest if owned es tenant In common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17 Kings Arms, Mechanicsburg, PA 17050 -total net from sale -Note: $10,000 shown on lined 156,137.28 518 of HUD-1 was held in escrow for payment of inheritance taxes and then added back to net proceeds of $148,237.28, as shown on line 603, for a total of$158,137.28, as date of death value. See attached HUD-1 TOTAL (Also enter on Line 1, Recapitulation) I 158,137.28 (If more space is needed, addigonal pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. F=orm PA-1500 Schedule A (Rev. 11-08) ~ayt OMRAppraval NO.2502-0265 IIMA~r A. Settlement Statement (HUO-1) 8. Flla Numher. ]. Login Number. e. MadBsee Insurance Case Number. 2.Q RHg 2©Cenv. Unina LDNG.1] 020]823045 5.0 Corn.lne. s: Th(s brmm ieNMabdbpNeywaHabmentolacfus/sef6'emanf msb. AmounbpeW Mend Sy tla aeflbmentepenf ere shown. ttemsmeNetl 7p.o.e.)'wem peyoulaye tlm abslrp; tlxYme shown ham (orlnlmmalbnNpumosu eMen rrof IrmMdedM We totals. e eM Atltlrosa of BOmmer. E. Nameantl Atltlmea NSellen F. Nemeantl Adtlmsa of LeiWer. C. Lonp III antl WELLS FARGO BANK, NA J LonO JennHer Milbp Execmda 101 NORTH PHILLIPS AVENUE '.m'q ROatl NNe ESby NDiem M. Gtlmae SIOUX FALLS.3D 5]104 R T2142 rerty LOUBen: H. Saplemw[AOenb 23-2402910 I. Setllement Dale: a grme PURRY ABSTRACT COMPPNY lubum, PA 1J050 3329 MARKEr STREET December 1, 2011 Cumbedantl CO. m N4+ CAMP HILL PA 17011 Ph. p17)]3J-0358 , PIem NSetllemeM: Century 2l Reelry SeMUa ' 9915 MatlrN 54 Cem HIO. PA mmaryWBertoweYa tremaatlon K Summary of BalNr'a transaatlon xa AmwM DUe ham BOmmwr. 400. Groea Amount OUero Se0er. 1]2900 00 Mmtl tabs tlce 1]2800.00 401. CaMrad ealee du . nonal prcpal6 402. Penonel e IlbmeM Chamee to eonober (Line 1400 6690.01 403. 604. 403. ienb for8ams Ntlb ee0ar In advarme Atl eablallb forlbma altl 8NIar In etlnrma IUNTYrtOWNSHIP 12tl1/11 y OLOtfl2 4. 400.CWNT7lJOWNSHIP 12A1H1 to 01101112 41.80 fvTAx ro Tgx laroun m oJmvu :HOOI 1,Be6s ah]. clry TAx le a6e. scHOOLrAX lamvn m mrovu 1B66s] . O OTR gEWERIREF 150twmty O1N1H2 50.54 408. 3RD OTR SEWER6YEF 9156 t2/Ottlito OlN1/12 50.51 41 . 411. 412. we AmountDw Iran Rprleear 180,662.82 620. Grosa AmomM1DUa to Belts 1]4,0]2.91 MaP ybv In BaMRMeormwer 600. RatluNOnay AmouN DUa Selbr. pw6orumeN momv 9000A0 501. Elmae tle Dell see lnaWNlone I IemouMNrmw bane 132,800.00 302. BedbmeMChe esy3sllw ne 1400 12500.83 isdnO bw(N taken auh aplb 502 FXbib ba a taken wb eclfa 50/. P FON MO e9e scan o e 500. 501. tttlb0. ea atla SOB. ALER gSSIST 2BOD.00 509. SELLER ASSIST 2900.00 IleMafer Porlrm In Ytlh BNbr uNmeNaforlbma un 6Nbr ]UNTYRDWNSHIP to 510. CWNfY/fOWNBHIP to TYTAX la 511. CRYTPX b :HOOLTA% fo 512 SCHOOLTAX ro 513. Std. 519. 518. 61l. HOMEWMRANT]yAHB 455.00 61&ESCROW INHERITANCE TAXES to PURRYAegrRA 1 ,00.00 510. ¢W pay rBOrtmwr 136.000.00 320. TNel Raduotlon Amount OUa Selbr 25,833.65 uhat6NlNmaMtramM BOnovsr BOO. aah NaNWmw6tdhem Baeer roe amount aus hem BOROwer Im 120 180882.92 801. Groea emeunltlueto 9a0er IIns 420 174072.81 na amount .y rBOmmver IIns 22 ( 138,800.00 602 Leea mductlolm OUe SeMr Ina 520 ( 20,838. nh O Fmm ~ To Borrower 41,882.92 606. Wh %~ Te ~ From 9aliar 148,13]20 MeniBnetl hwehyadmc ed IplNammN tlwp ofMb shbmantAany atlachmenb mbrmdro hemin Borrower Seller h Mlller EOHSUMq ~~ / , c. LonpA I ~ ~ IY."_/nl 4~ylKl Rave .Loop ~amvaa~~Y6nbMOidm MebnMnb.MFWe1ei6„1.u. W iarmrabeaaOpe+MW.vq~gb. W4Td.YrN m.YM¢MgeYlnbnaM W P+.n Mipu4Hb NMauwwkeeelaaomi/rW glameeiuiA[NatYMVe.m'e nrvne MertbwRhln~GaW.iNYAlbxEb Pwr~.Mia~b.R6PAOmMMnuelmvMlYmmtllen IxMM{mY Pye1 N9 HU0.1 (LONG.9.PFDAONG.9H8) ilR+al EalaM1 Broker Fees $10,200.00 ve10 Fioin ee,mw~e vv14 Fivn1 sew. ision mmiss n na ) ea (W ws' ro to CoMll Banker HOmeateed Salad Probssionala 000.OO Fumva vunaea e: Dne ]O1 lndutleaA usbnanl of 300.00 For $°a""'"~ s'u""'+ 100.00 to CENNRV 2I REALIY SERVICES imixslon aitl et se%bmeM 10 ~'~ 3'L COMMISSION to CENTURY 2I REALTY SERVICES 265.00 v Pa ble In Connedbnw%Ir Lmn o Ination there S 825.99 from GFE#1 ruetl%Or cheroe(polMa)for the speGOC lnlereNrate chosen E -358.89 (from GFE #2) r atllusletlo gna on Ne ea from GFE #A 266.1] sisal be b RELS VALUATION Irom GFE POCB 5365 tli[Re oM1 b RELS CREDIT fiom GFE#3 POCB 322 22.00 service to ( m #3) wNfiwSOn to from #3) ( m rom ) om ) m #3 ne Re uirotl Lentlarm Be Paid In Atlvanee Inlerecl the es from 12N1/11 to 01N1/12 31 515.4]90001d (from GFE#10J q8.5] i a elnsuranw remlum for months to Irom GFE a3 neownefa insumnpe r 1.0 an to RXE P CE INS CE rom #11 P CB 5236 from GFE #11 (hwn GFE#11) tterveaM %etl viM Lantlm X181 tlepwlt foryourewrow amount (hom GFE #9) 1,342.18 amamme sineurenm mo s par mon od a e munnm mon a $ er onth S npetlytaxea S G NTY moot e ® E er month ITY moot a ® per mpnl LT moMha Dar moot S %Y oxn Tema months ~ $ r moo Saessmenb mo mr moot OUNIYROVJNSHIP TAXES 11.000 months ®S 40.19 pm monN E 44209 CHOOLTAXES ].000 months ~ E 151.64 per monN S 1,081.68 $ E -160.81 ItM Cho n llb caMms orb IaMeh tltls Imumnm 1,390.51 :ettlemant ar doein M S s e murenm N I tram GFE ENHIREISSUE 198.00 a etilb murrmb RI T 0. ,213.61 aMeh tltle Ilm% E 132900.OD Nmafa We of gn% S 1]2800.00 r eMa mofNe ldal tltla inaunnm remlum to PURITYABSTRACT COMPANY 1199.]6 ' lntlerxMafn loo orths robl tltb imuranm remlum WFIRSTAMERICAN TITLE IN9. CO. S 211.]3 !Wa Fee to Nola Ckxk 10.00 > DPR a ERN 126.0 ex Fee k R AN N FE to AR A ~'~ 3E H F b l ARM A 6 ~~ iovemmenl Recording mtl TmrrNr Charges imammenl remNln cha to RECORDER OF DEEDS hom GFE# ESTIMATE II 158.00 ' betl E 82.00 Mo age S 98.00 Rebasm E OMer $ boater taxes to RECORDER OF DEEDS from GFE #8 1,]29.00 ' :' ICOO Imhtam n S 1,89.99 E 1,]29.00 date tex/shm e 4 189.00 f Wtlmorl SatlNmanf Eh i aired aervlmethat umn ah for tram GFE 119.00 fAX SERVICE b WF REAL ESTATE TA%SERVICES E 100.00 7000 CERTIFICATION t9 WELLS FARGO FLOOD SERVICES $ 19.00 'LUMBINO REPAIRS W JOSEPH T. GILLIS HANDYMAN FOR H 195.75 RESALE CERT. FEE tD JIM WISE 10.88 r,.r.r Setx.mrleNervrfenM en llMS103.8ectlr Jand 602, 9actlonp 590.01 12580.83 s9s.a.rarns.m.t led to be a tme mpy. Pape 2 of 3 HUO-1 (LON0.1].PFDAANO.1]M8) Rev-iSDa Ex+I6-96( - SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEPLTH OFPENNSVLVANIA INNERRANOE TA%RETURN REbIOENT DECEDENT ESTATE OF FILE NUMBER Grimes Diane M 21-11-0601 Include the pproceeds of litigation end the date the pmcaede ware received by Ne estate. All property jointly-ownedwith iho right of survivorship must ba tliselosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2000 Honda -value as per Kelley Blue Book 6,950.00 2 Household furniture and furnishings -Majority of these items (beds, couches, dishes, etc. .3,000.00 given to Goodwill). 3 Miscellaneous antiques owned by decedent -value per appraisal 7,140.00 4 Prepaid funeral expenses in October 17, 2001 to Auer Cremation Service 1,363.00 TOTAL (Also enter on Line 5, Recapitulation) I 18,453.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) LINDEN HALL ANTIQUES 211 N. OLD STONE HOUSE ROAD CARLISLE, PA 17015 717-244-1978 To: William Grimes 5534 Moreland Ct. Mechanicsburg, PA 17055 From: William G. Rowe, Appraiser 211 N. Old Stone House Road Carlisle, PA 17015 Date: June 16, 2011 °~ . d-~ le ~ ~ ~ ~ ` ~~~ ~~ INVOICE Appraisal of antiques -- $55.00 ,ti /'/ i /F LINDEN HALL ANTIQUES 211 N. OLD STONE HOUSE ROAD CARLISLE, PA 17015 717-249-1978 To: William Grimes 5534 Moreland Ct. Mechanicsburg, PA 17055 From: William G. Rowe, Appraiser Linden Hall Antiques 211 N. Old Stone House Road Carlisle, PA 17015 Re: Appraisal of Antiques 17 Kings Arms Ct. Mechanicsburg, PA 17055 Date: June 16, 2011 1. Comer cupboard -pine -solid doors 2. Hutch table with 6 chairs 3. 4-drawer chest of drawers 4. 4-drawer chest of drawers 5. 3-drawer chest of drawers 6. Flour chest with original dough box 7. Small blanket chest 8. Butler tray on stand 9. Bucket /water bench 10. Small stand /washstand 11. Spice boxes (2) 12. Small lift-lid salt box 13. Dry sink 14. Coffeegrinder-wallmount 15. Plank chairs -set of 4 16. Cherrydrop-leaftable 17. Small table -cross stretcher 18. Lot of copper 19. Plank seat rocker 20. End table -open washstand -plain bar 21. Openwashstand -spool bar 22. Mahogany end table 23. Small end table 24. Tool carrier 25. Luggage stand 26. End table -open washstand 27. Blanket chest -large 28. Copper bed warmer 29. Small storage chest 30. Bellows table 31. Wash bowl /pitcher set 32. Fruit prints (2) 33. Mirrors (8) 34. Mortised bench 35. Copper wash boiler 36. Small wall cabinet $850.00 $950.00 $165.00 $125.00 $115.00 $425.00 $250.00 $175.00 $485.00 $100.00 $90.00 $50.00 $400.00 $110.00 $120.00 $175.00 $65.00 $85.00 $85.00 $150.00 $150.00 $135.00 $120.00 $45.00 $20.00 $150.00 $350.00 $125.00 $75.00 $215.00 $75.00 $65.00 $205.00 $115.00 $65.00 $25.00 Grimes Appraisal 1 06/16/2011 37. Clock case wall cabinet $60.00 38. Brass scales $75.00 $5.00 Garage 39. Grain cradle sy[he $65.00 40. Oak mirror for dresser $30.00 TOTAL $7,140.00 William G. Rowe ~`'~~~ Grimes Appraisal 2 06/16/2011 ,11 22:45 6102720531 EAST NORRITON MS PAGE 02 MERCHANDISE Register Book Memorial Cards Thank You Cards Remembrance Package Arrange/Deliver Ashes To National Cemetery X Solid Sheet Bronze Ur1'1, with Satin Finish 5125.00 Urn Burial Vault Veterans Flag Case Gravy/Memorial Marker TOTAL MERCHANDISE 5125.00 CASH ADVANCED ITEMS Grave opening Cemetery Equipment X Harrisburg Patriot 588.17 Newspaper Vault Service Charge Clergy Church/Organist/Sololet Flowers X Crematory Charge Included X County Coroner Cremation Approval Fee 525.00 X 15 Certified Copies of Death Certificate 590.00 TOTAL CASI-i ADVANCED ITEMS 5203.17 SUMMARY OF CHARGES Special Charges $x,990.00 Professional Services S85.00 Automotive Equipment $0.00 Merchandise S125.00 Cash Advanced Items $203.17 SUS TOTAI. CREDITS AMOUNT PREPAID Date TOTAL AMOUNT PAID Date BALANCE DUE Oct 17, 2001 May 3, 2011 $2,403.17 ^$867.00 -,51,363.00 $173.17 -$173.17 $0.00 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES Rav-1509 EX~(6-88) ' SCHEDULEF COMMONNEALTH OFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERRANCE TPX RETURN RE910ENT DECEDENT ESTATE OF FILE NUMBER Grimes Diane M. 21-11-0601 If en asset was metla joint within one yearof tha dacatlent's date Df death, It must ba reportetl on schedule G.. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jennifer Miller 1925 Johnson Road Daughter Plymouth Meeting, PA 19462 B. C. JrTINTI V ('fWNFfI PRt7PFRTV~ ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEEO FOR JOINRY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH DECE ENT'S WTEREST 1 A Certificate of Deposit -Metro Bank -Account 21,594.67 50.000% 10,797.34 No. 303073 . 2 A Checking Account- Metro Bank -Account 34,808..39 50.000% 17,404.20 No. 32050445 3 A Savings Account- Metro Bank -Account No. 3,716.05 50.000% 1,858.03 626106348 TOTAL (Also enter on Line 6, Recapitulation) ~ 30,059.57 (If more space is needed, atlditional pages of tha same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-96) ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE No BUREAU OF INDIV IDUAI TA;ES~ PO BOX 280661 pennSyLvania '4ND ACN ~iMRR1sBURG pp 3712 a-6661 pEPAgrNEM DF aEVENUE TAXPAYER RESPONSE DATE vsv-tsn Ez ur usan JENNIFER E MILLER 1925 JOHNSON RD PLYMOUTH MEETING PA 19462-2541 EST. OF DIANE M GRIMES SSN 161-~34-4105 DATE OF DEATH U4-21-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FGRMS TD: REGISTER OF WILLS 1 COURTHOUSE SpUARE CARLISLE PA 17013 C l] 21 11-0601 11170285 10-26-2011 TYPE OF ACCOUNT SAVINGS CHECKING TRUST X^ CERTIF. METRO HANK provided the department with the information below, which was used in calculating the inheritance tax tlue. Retards indicate that at the death of the above-named decedent, you were a ,joint owner/beneficiary of thts account. IP you are the Spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. if YYou bel lave the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form end return it to the above address. Please call 717-787-8327 with puestions. COMPLETE PAR~T-•-i BELOW ~ SEE REVERSE SIDE FOR FILING 'AND PAYMENT INSTRUCTIONS Account No. 303073 Date 07-10-2007 7o ensure proper credit to the account, two Established copies of this notice must aceovparo Account Balance 21 594.67 payment to the Register of Wills. Make cha ck $ + Day able to '•Ree istar of Wills. Agent". Percent Taxable X 50.000 Amount Subs eat to Tax $ 10,797.34 NOTE: If tax payvents are node within three' months of kha decedent's date of death, Tax Rate - ~( . 1 5 deduct a 5 portent discount on the tax due. Pof an ti a7, Tax: Due 1 1,619.60 Aro' inheritance tax tlue will become del ineuent $ nine nonths after the date of tlaath. A. ~ Tha above information and tax duo is correct. _ Remit pavmant to the Register of Wills with two copies of this notiea to obtain CHECK a discount or avoid interest, or return this notiea to the Register of Wills and an official assessn ant w411 be issued by the PA Department of Revenue. ONE BLOCK B. ~ Tha above asset has been or will be reported and tax paid with the Pennsylvania inhe ri4ance tax return ONL V filed by the estate representative. C. ~ The above info rma ion is 4neorrect and/or debts antl deductions were paid. Complete PART ~ and/or PART ~ below. PART If in tll toting a different tax rate, please state ~ ~i 1 ' 4, ~ as wi rv ';'"'7, relaticnshSp to decedent: ~ I j i' !~' !' iB I 2 ii ~ ~ TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS -~ ~~ ~ Y~ 'I ~ LINE 1. Date Estahlis hetl 1 ~ ~ ~~~ 2. Account Halance 2 $ 'a 3. Percent Taxable 3 X n 4. Amount Subject to Tax 4 $ ` ~ 5. Debts and D¢ductions 5 - ~~~u~~ pu W~! ~EVIF.R7alRml4 ~~~ 6. Amount Taxable 6 $ l y ~ 7. Tax Rate 7 X ae1ee ~ F7~jBVp 8. Tax Due 8 $ Under penalties of perjury. I declare that the facts I reported above are tru¢, correct antl complete to the best of my knowlatlge antl be lS ef. HOME ( ) W6RiC ( ) PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION iAMOUNT PAID BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBUfaG PA 17128-0601 pennsyLvania DEPARTMENT DF PEVENUE REV-156a F% AFP f05-ill PENNSYLVANIA INHERITANCE 'i INFORMATION NOTICE AND TAXPAYER RESPONSE C..k~ FILE N0. 21 11-0601 ACN 11170284 DATE 10-26-2011 JENNIFER E MILLER 1925 JOHNSON RD PLYMOUTH MEETING PA 19462-2541 EST. QF DIANE M GRIMES SSN 161-34-4105 DATE OF DEATH D4-21-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. METRD BANK provided the department with the information bel au, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a Joint owner/beneTicta ry oT this account. If you era the spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department oT your relati anshtp to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If yyou believe the information is incorrect, please obtain written correction from the financial 1nstl tution. attach a Copy to this form'and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 32050445 Date 02-11-1995 To ensure proper credit to the account, two Established copies of this notice oust accompany payment to the Resister of Wills. Make she ck Account Balance $ 34.808.39 parable to "Reaistar of wills, Asent". Percent Taxable X 50.000 Amount Subject to Tax ~ 17,404.20 NOTE, If tax pavmants are made within three months of the tleeetleni's tlate of death, Tax Rate X , 15 tleduet a 5 vercent discount on the tax due. Potential Tax Due $ 2, 610.63 ANr inheritance tax due will beeona delinRUant nine months after the date pf tlaath. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. Remit payment to the RaBister of W111s with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Reais tar of Wills and an off ie ial assessment will be issued by the PA Oepa rtmant of Rovanua. ONE BLOCK B. ~ The above asset has been or will be ravorted and tax paid with the Pennsylvania inheritance tax return ONLY filed by the estate representative. C. ~ The above inf~rna ion is incorrect and/or debts and deductions were paitl. Comvleta PART ~2 end/or PART ~ below. PART If indicating a different tax rata, pleases tats re lationshlp to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 +fi 3. Percent Taxable 3 X 4. Amount Subieet to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rata 7 X B. Tax Due a +t .wx Mr: s h.x PART DEBTS AND DEDUCTIONS CLAIME^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above era true, correct and complete to the best of my knowledge and bale ef. HOME C ) ~ PENNSYLVANIA INHERITANCE 'iAX euRFAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE No. 21 11-0601 PO BOX 266661 penn5ylvania AND ACN 11170283 HARRISBURG PA 17128-6661 pEPARTMENT6FREVENUE TAXPAYE R RE SP O NS E DATE 10-26-2011 REV-156E E% AFP U9-11) TYPE OF ACCOUNT EST. OF DIANE M GRIMES ® SAVINGS SSN 161-34-4105 ^ CHECKING DATE OF DEATH D4-21-2011 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FDRMS TD: JENNIFER E MILLER REGISTER OF WILLS 1925 JOHNSON RD 1 COURTHOUSE SgUARE PLYMOUTH MEETING PA 19462-2541 CARLISLE PA 17013 METRD BANK provided the department with Lhe information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a Jof nt owner/beneficiary of this a(:c6unt. If yoU are the spouse of the deceased and any amount other than zero 1s reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written Correction from the financtai ins ti tattoo„ attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS' Acccunt No. 626 1 0 634 8 Data 09-09-2002 To ensure proper credit to the account, two Established copies of this no tics Host aeeompanv Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Taz Due $ 3,716.05 X 50.000 $ 1,858.03 X .15 $ 278.70 payment to tt)e Ra gist ar of Wills. Make check payable tq "Regis tar <f Wills. A9ant". NOTEr If tax payments era na da within three months of the tlacedant's date of death, detluct a 5 portent tlisc punt on the tax due. Arty inheritanea tax due will become tlelinquent nine months after the date of death. C. ^ The above inf or a Eon is incorrect and/or debts and deductions were paid. ConDlete PART 2~ and/or PART ~ below. PART Zf intlicating a different tax rate. please state relatlenship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2- A<eount Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 +C 5. Debts and Deduckions 5 ' 6. Amount Taxable 6 $, 7. Tax Rate 7 X 8. Tax Due 8 +t PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID A. ^ Tha above information and tax due is correct. Reait payment to the Rapist er of Wills with two cop ias of this notice to obtain CHECK a discount or' avoid interest, or return this notice to the Register of Wills and ONE en official as sassmant will be issued by the PA Deoa rtment of Revenue. BLOCK B. ^ The above asset has been or will ba reported antl tax paid with the Pennsylvania inheritance tax return ONLY filetl by the estate represent at lva. Dnder penalties of perjury, I tleclare that the facts I reported above era true, correct and complete to the best of my knowledge antl bell ef. NfIMF f l Rav-0570 FJ(+ (698) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Grimes. Diane M. _21-11-0601 This schedule must be completetl end fletl if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OFMTRANSERSATTACIiTA COPY OF THE DEED FCOREREAL ESTATE. DATE OF DEATH VALUE OF ASSET 9: of oeco's INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Large Core Quant-A Mutual Fund (IRA) - 0000 OD20 7,041.25 100.000% 7,047.25 1394 0058 2 002 2 RiverSource Life Annuity (IRA) - 0000 0931 0777 7904 339,403.79 100.000% 339,403.79 5 004 TOTAL (Also enter on Line 7, Recapitulation) ~ 346.445.04 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) p5115/2911 p8: 92 7174414898 AMERIPRISE FINANCIAL PAGE 01/01 Page l n£ 1 t)niPne Service and Adv~154p~e~ Amettiprise 4i~ Ftrrancial Ip ID: 0975 37137 5 001 'ethered: Yes ..,_ Enrollment: Adtiever Circle Help Total value of accounts shown below. X346,445 04 The torel valve dlaaounts does not intlude al products and eceounla as snaam on the client Conselidatatl Statement. The total valdo la not Mtl„cetl 6y any Duta!endln Owrtlratl Pletactlon 6elantea. Oth®r products Long Term Care Policy pate Nursing Home Benefit Nome Care Benefit LtiNG-1`t;R,ly(,CARE PLUS II DIANE A16RIME8 oood os+o r>~ sees a ood 08/16!21701 $239.26 $239.23 Per tlaY Per paY Notes: • The cost basis may not be accurate if the fund's shares were transferred to the account as a gift or inheritance. Dirsciosures: Thls service is ilNended for informational purposes only and is not an official report of any accounts. Accuracy, completeness and timeliness cannot be guaranteed, View Gorporate,irntitles and_Important piscloqunss, Weq 3ife.Rules and,Regulati9ns, Privacy Statement and About,E-mail Fraud. Copyright ~ 20052009 Ameriprise Financial. All Rights Reserved. Users of this efts agree to be bound by the terms of the Amerlpdse Web Site Rules and Regulatrons, ~. . hitps:!/clientviecver.ex.is.atneript7se.com/O5T/secure/AccoturtListByAroduct'AccountList... 5/13/20 t 1 REV~1161 EX+(f0-061 COM ~N~~~~FO~.~ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS - _ --- ESTATE OF FILE NUMBER Grimes. Diane M. 21-11-0601 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q, FUNERAL EXPENSES: See continuation schedule(s) attached B, 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) 2,403.17 Street Address City State Zio Year(sl Commission paid Waived 2. Attorney's Fees 15,000.00 See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 585.50 5. Accountant's Fees 6. Tax Return Preparers Fees 7. Other Administrative Costs 13,288.91 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 31,277.58 Copyright (c) 2009 form software only The Lackner Group, Inc. form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Grimes, Diane M. 21-11-0601 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex eu nses 1 Funeral expense to Auer Cremation Service -This amount Includes the amount of $1,363.00 2,403.17 which was prepaid in 2001 and is reported as an asset on Schedule E. H-A 2,403.17 Attorney Fees 2 Goldberg Katzman -Attorney's Fees 15,000.00 H-B2 15,000.00 Other Administrative Costs 3 Cumberland Law Journal -publication of estate notice 75.00 4 Gia Miller -House Cleaning 750.00 5 Hampden Township -Sewer Bill 315.76 6 Hampden Township -Sewer Bill 15.76 7 Hampden Township -Sewer Bill 150.00 8 Hampden Township -Sewer Bill 150.00 9 Joseph Gillis -Repair Attic Fan 225.00 10 King Arms Homeowners Association -August Association Fee 200.00 11 King Arms Homeowners Association -June/July Association Fee 400.00 12 King Arms Homeowners Association -November Association Fee 200.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Grimes, Diane M. 21-11-0601 ITEM NUMBER DESCRIPTION AMOUNT 13 King Arms Homeowners Association -October Association Fee 200.00 14 King Arms Homeowners Association - Replacement of Door 560.00 15 King Arms Homeowners Association -September Association Fee 200.00 16 Linden Hall Antiques -Appraisal of Antiques 55.00 17 Managing Partners Insurance -homeowners insurance 206.00 18 Metro Bank -Lost Safe Deposit Box Key 25.00 19 Michael Langan -School Tax 1,819.62 20 Terry Gazette -Hauling of Trash 150.00 21 The Sentinel -publication of estate notice 200.16 22 W.S. Carey Electric -Electrical Repairs in House 45.00 23 Winding Hill Window -Window Cleaning 35.43 H-B7 5,977.73 Other Administrative Costs Preparation of House for Sale 24 Abbey Carpet and Floor -New Carpet and Linoleum 2,180.97 25 Aunt Lillas Pond -Cleaning of Courtyard and Gardens 667.80 26 Envirogroup -Cleaning of House 2,377.41 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE CUSTS continued ESTATE OF FILE NUMBER Grimes. Diane M. 21-11-0601 ITEM NUMBER DESCRIPTION AMOUNT 27 Hyp Renovations -install and paint door 28 Just Add Paint -Balance of Painting Invoice 29 Just Add Paint -Painting of House H-67 560.00 925.00 soo.oo 7,311.18 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EXi (tt-0el SCHEDULE J ~N pp G ~y °°M~INHER,V~D ,~e~,i1 ftN ANNA HES ~dENNT BENEFICIARIES ESTATE OF FILE NUMBER Grimes, Diane M. 21-11-0601 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY oo DECEDENTS s (V~lords) ($$$) I TAXABLE DISTRIBUTIONS dl s~ e t t ansfers stribution n d under Sec. 9116 a 1.2 Douglas E. Grimes Son One-Third 113,134.60 934 N. La Jolla Dr. Los Angeles, CA 90046 Michael C. Grimes Son One-Third 713,134.60 4986 Trailridge Way Atlanta, GA 30338 William R. Grimes Other ~ 7,041.25 5534 Moreland Court Jennifer Miller Daughter One-Third 143,194.16 1925 Johnson Rd. Plymouth Meeting, PA 19462 Total 376,504.61 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1600 Schedule J (Rev. 11-08) GoldbergKatzman A T T O R N E Y S u t L A W May 1, 2012 ~a U S. Certified Mail Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle PA 17013-3387 Re: Estate of Diane M. Grimes Date of Death: Apri121, 2011 Dear Sir or Madam: ~ ~ ~ ~ ~ 1•' -.C ~ D ~ 1 ~ ~ 7i r , r Z~~ W . ~ ~C~(t'''~) '~ Y ~~=f1 ~ _ _._ C~ ~1 y i•,.. Please find enclosed an original and one copy of the Form Rev 1500, Pennsylvania Inheritance Tax Return, together with our check in the amount of $15.00 for the filing fee. Please file the return, time stamp the copy, and return in the self-addressed, stamped envelope enclosed for your convenience. Very t lyiy~ours~ V Jay Bishop, Paralegal to Ronald M. Katzman, Esq. Arnold B. Kogan, Esq. /jjb Enclosure {00596990;v1} 4250 Crums Mill Road, Suite 301 P.O. Box 6991 Harrisburg, PA 17112 1717-234-4161 fax: 717-234-6808 www.goldbergkatzman.com Plus convenient ojj'ices in downtown Harrisburg, Lancaster and Carlisle. ~ a ~, a N ~~ O N O L N ~ d O ~ a .n x o v~ y~ ~; ~~_ - _ ~~ ._ u LL i G` 4:tZ Ci, r v om n N N ~ 0 y~~ !_ 1 Ir1 ~i .` r_ M I ..' .~ ~ '~•~ ~~ ^~ ~ 5 4 4 [7- -~ ~ L, (' '~ /A j v+ ~ UUC 'A ~4.7 cam, ~ ~ ~ ~ v T ^~ C~ 3 ~--~ a ~z x o H ~"'~ H ~.... N ^. a on p x a 0 m O a 0 M '3 'O a a a U 0 N C Gl N 0 ~. 7 ~ o ~ U R M C 7 M ~_ O N O V y ~ ^C N •--~ o ~ o ~ v y ~ ~ y A CO .~ ~b1J ~ U 0.~ V ~ V ~. t ~~~~~