HomeMy WebLinkAbout10-19-05
REV.l500 EX (6-00)
II
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
'* COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
. DEPT. 280601
HARRISBURG, PA 17128-0601
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FILE NUMBER
21 05
0309
COUNTY CODe YEAR
NU BER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITiAl)
~ Grant, JoAnn
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
W 03/04/2005 06/04/1934
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W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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SOCIAL SECURITY NUMBER
300-28-3777
THIS RETURN MUST BE FILED IN DU~UCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1il1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (AIfad1 copy of Will
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date old..th aft<< 12-12-82)
o 7. Decedent Maintained a Living Trust (AIfad1 copy of Trust)
D 10. Spousal Poverty Credit (date of death belNeen 12-31-91 alii 1.1-95)
o 3. Remainder Return (date of deaf1 pIIcr to 12-13-a2)
o 5. Federal Estate Tax Return Rllquired
8. Total Number of Safe ~it Boxes
o 11. Election to tax under Sec. 9113(A) (AIfad1 Sch 0)
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THIS SECTION MUST BE. COMPLETED. ALLCORREs~ONDENCEANDCoNFIDENnALTAX INFORMATION SHOULD BE IRECTED TO:
NAME COMPlETE MAILING ADDRESS
James Grant 6107 Wallingford Way
FIRM NAME (nAwlIcable) Mechanicsburg, PA 17050
TELEPHONE NUMBER
(717) 763-0526
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sale-Proprietorship (3)
4. Mortgages & Notes Reoeivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate BilUng Requested
7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage LiabUlties, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for.which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under See. 9116 (a)(1.2)
136,400.00
0.00
0.00
0.00
39,144.00
0.00
0.00
175,554.00
(8)
5,571.00
9,780.00
(11)
(12)
(13)
15,351.00
160,193.00
0.00
(14)
160,193.00
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18. Amount of Line 14 taxable at "neal rate
160.193.00 x.O ~ (16)
x .12 (17)
7,208.69
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
(19)
7.208.69
19. Tax Due
CHECK HERE IF YOU ARE REQUES.TIN.G A REFUN.D. OF AN. OVERI?A.YMEN..T
20.0
> >BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
,
Decedent's Complete Address:
STRE T ADDRES
CITY M h . b
ec amcs ur
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
0.00
0.00
Total Credits ( A + 8 + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
TotallnterestlPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
\ I
7,208.69
0.00
0.00
7,208.69
0.00
7,208.69
5. If Une 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X.. IN THE APPROPRIATE BLOCKS
No
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(i]
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary Interest; or .......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other noFl1Jlllbate property which
oontains a beneficiary designation? ........................................................................................................................ 0
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IF THE ANSWER TO ANY OF THE ABOVE QUESTlONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties 01 pe~ury, I declare that I have examined this retum, induding accompanying schedules and statements, and to the best of my knowledge and belief. it is true. COITea and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
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ADDRESS
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SIGNATURE OF PREPARER 0 ER THAN REPRESENTATIVE
DATE
\Dllf()S
\/ DS:./.}
DATE
ADDRESS
II
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 sPOUS!8 is 3%
[72 P.S. ~9116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to t
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements
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 ' (:\, _ .~--"\
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)J. 0
The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12
individual who has at least one parent in common with the decedent, whether by blood or adoption.
N l\\)~_
. ^ft' r..~ P.S. ~9116 (a) (1.1) (ii)).
are still applicable even if
parent, .11 adoptive parent,
,72 P.S. ~116(a}(1)J.
under S~ction 9102, as an
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REV-1502 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Grant, JoAnn
FILE NUMBER
21-05-0309
All real property owned solely or as a tenant in c;ommon must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a wining buyer and a willing sener, neither being compened to buy or sen, both having reasonable knowledge of the relevant filets.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
116 Hill Lane Mechanicsburg, PA 17050: Hampden Twp,: Cumberland County
VALUE AT DATE
OF DEATH
1 ~,400.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
I
13~,400.00
,
OMS NO. 2502-0265 .,-....
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.0 FHA 2.oFmHA 3. ~CONV. UNINS. 4. OVA 5. oCONV. INS.
6. 6~LE NUMBER: I 7. LOAN NUMBER:
SETTLEMENT STATEMENT -504 79
8. MORTGAGE INS CASE NUMBER:
C. 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 "(POC)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (HUNT. JUNE.PFDI05-504/15)
D. NAME AND ADDRESS OF BORROWER: E. ILlU~ LI"ID ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
June Hunt, a single person C ~state of Jo Ann G~ American Home Mortgage
506 E. Elmwood Ave, Apt. 1 Acceptance, Inc.
Mechanicsburg, PA 17055 538 Broadhollow Road
Melville, NY 11747
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-2332041 I. SETTLEMENT DATE:
116 Hill Lane Residential-Commercial Abstract, Inc.
Mechanicsburg, PA 17050 July 28, 2005
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
3621 North Front Street
Harrisburg, PA 17110
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACT ON
100. GROSS 400. (.Rf rn <::1: I :D.
101. Contract Sales Price 136,400.00 401. Contract Sales Price 136,400.00
102. Personal Property 402. Personal Properlv
103. Settlement Chan:Jes to Borrower (Line 1400) 4,383.72 403.
104. 404.
105. 405.
i I Rv.,-;p.llp.rin ri
106. CitylTown Taxes to 406. CitylTown Taxes to
107. Countv Taxes 07/29/05 to 01/01/06 117.54 407. County Taxes 07/29/05 to 01/01/06 117.54
108. School Tax 07/29/05 to 07/01106 1,025.35 408. School Tax 07/29/05 to 07101/06 1,025.35
109. Sewer 07/29/05 to 10/01/05 80.00 409. Sewer 07/29/05 to 10/01/05 80.00
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 142,006.61 420. GROSS AMOUNT DUE TO SELLER 137,622.89
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 1,000.00 501. Excess Deposit (See Instructions)
202. Principal Amount of New Loan(s) 109,120.00 502. Settlement Charges to Seller (Line 1400) 4,118.54
203. Existing loan(s} taken subiect to 503. Existing loan(s) taken subiect to
204. Principal Amt of New Loan(s) 27,280.00 504. Payoff oUirst Mortgage
205. 505. Payoff of second Mortgaoe
206. 506.
207. 507. (Deposit disb. as proceeds)
208. 508.
209. Seller Paid Closing Costs 1,000.00 509. Seller Paid Closing Costs 1,000.00
Adlustments For Items nDaid Bv ~eller Adjustments For Items UnDald Bv Seller
210. CitylTown Taxes to 510. CitylTown Taxes to
211. County Taxes to 511. County Taxes to
212. School Tax to 512. School Tax to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 138,400.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 5,118.54
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: ,
301. Gross Amount Due From Borrower (Line 120) 142,006.61 601. Gross Amount Due To Seller (Line 420) 137,622.89
302. Less Amount Paid By/For Borrower (Line 220) ( 138,400.00) 602. Less Reductions Due Seller (Line 520) ( 5,118.54
303. CASH ( X FROM) ( TO) BORROWER 3,606.61 603. CASH ( X TO) ( FROM) SELLER 132,504.35
The undersigned herebCO'wledge rett of a completed copy of pages 1&2 of this statement & any attachments referred to herein.
Borrower ---= ~ u..,UJf' Seller ~ Jo Art(! Grant B.~{.L,.A Or
June Hunt ........ _
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a Bryan Grant, Executor
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HUD-1 (3-86) RESPA, HB4305.2
11
paoe 2
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ 1 <lg LInn nn (a) 1 nnnn Ofn 1364.00 PAID FROM PAID FROM
Division of Commission (line 700) as Follows: BORROWER'S SELLER'S
701. $ 1,364.00 to For Sale By Owner Plus Realtors FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 1,364.00
704. to
SOO.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to
802. Loan Discount % to
803. Appraisal Fee to American Home Mortgage Acceptance, Inc. 350.00
804. Credit Report to American Home Mortgage Acceptance, Inc. 8.25
805. DU/LP Fee to American Home Mortgage Acceptance, Inc. 21.70
806. Funding / Review Fee to American Home MortClaCle Acceptance, Inc. 430.00
807. MERS Registration Fee to American Home Mortgage Acceptance, Inc. 3.95
808. Tax Service Fee to American Home Mortgage Acceptance, Inc. 74.00
809. Flood Hazard Fee to American Home Mortgage Acceptance, Inc. 15.00
810. American Home Mortgage Acceptance, Inc.
811. Application Fee I 2nd Mtg. to American Home Mortgage Acceptance, Inc. 175.00
900. ITEMS REDUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 07/28/05 to 08/01/05 @ $ /day ( 4 days %) 87.90
902. Mortoaoe Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to
904. Prepaid Interest 12nd Mto. 1.0 years to American Home Mortoage Acceptance, Inc. 32.58
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months ( $ 39.25 per month 117.75
1002. MortaaCle Insurance months ( $ per month
1003. CitylTown Taxes months ( $ per month
1004. County Taxes 6.000 months ( $ 21.61 per month 129,66
1005. School Tax 2.000 months @ $ 94.43 per month 188.86
1006. Prepaid Interest/2nd Mta. months ~ $ per month
1007. months il $ per month
1008. Aaareaate Adjustment months ~ $ per month -125.68
1100. TITLE CHARGES
1101. Settlement or Closina Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to Residential-Commercial Abstract, Inc. 25.00
1106. Notarv Fees to Residential-Commercial Abstract, Inc. 20.00 10.00
1107. Deed Prep to Residential-Commercial Abstract, Inc. 150.00
(includes above item numbers: J
1108. Title Insurance to Residential-Commercial Abstract Inc. Short Fonm Policv 1 168.75
(includes above item numbers.1102, 1103, 1104 & 1108 )
1109. Lender's Coverage $ 109,120.00
1110. Owner's Coverage $ 136,400.00 1,168.75
1111. Endorsements 8.1 to Residential-Commercial Abstract, Inc. 50.00
1112. Closing Protection Letter to Old Republic National Title Insurance Company 35.00
1113. Courier Fees to Caldwell & Kearns 15.50
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ 118.00 ; Releases $ 156.50
1202. City/Countv TaxlStamps: Deed 1,364.00' Mortgage 1,364.00
1203. State TaxlStamps: Revenue Stamps 1,364.00; Mortoaoe 1,364.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to Sudden Death Tenmite & Pest Control 40.00
1303. 2005-06 School Tax to Marie Huber, Treasurer 1,110.54
1304. Tax Certification to Marie Huber, Treasurer 5.00
1305. Sewer to Hampden Township 115.00
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 4,383.72 4,118.54
By signing page 1 of this statement, the signatories acknowledge receipt of a completed cop' of page 2 of this two page statement.
Certified to be a true copy.
! ({/
Resid ntial-Commercial Abstract, Inc.
Settlement Agent
( 05-504 J 05-504 /15 )
II
REV-1508 EX+ (6-98) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Grant, JoAnn
FILE NUMBER
21-05-0309
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.
ITEM
NUMBER DESCRIPTION
1. 1995 Dodge Sedan vehicle
2. Commerce Bank Checking Acet 0536307929
3. Commerce Bank Savings Ace!. 430003173
4. Prudential Money Market Acet. 3833-7223
5. 2-single craftmatic beds
6. Mise. jewelry
7. Mise Clothing
VALUE AT DATE
OF DEATH
,
2,000.00
,
8. Household goods-Sofa, loveseat,kitchen table/chairs, dressers, lamps, TV, computer, vcr
2,173.00
7,544.00
22,477.00
250.00
200.00
300.00
2.500.00
1,500.00
200.00
9. Mise. Woodworking tools: Lathe, planer, router, sander, vacuum system
10. Mise. handtools;
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
139,144.00
Date: '-\ I ~ / 0 $
II
~L"<. J v l~ . G..
The Estate of J 0 Ann Grant agrees to sell a
1995 Dodge Sedan VIN: IB3HD46T3SF663970 to Gerald Lauro
For the sum of $2,000.00 Two Thousand Dollars,
AS IS, NO WARRANTIES.
~~ ~ LJ ~ ---
J ames Grant, Executor
~p~
Gerald Lauro
COl1ll1lerce
.Bank
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Commerce BanklHarrisburg N.A.
100 Senate Avenue
Camp Hill, PA 17011
-888-937-0004
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STATEMi=NT DATE
JAMES B GRANT
6107 WALLINGFORD WAY
MECHANICSBURG PA 17050
03/31/05
0430li>03173
ACCOlilNT NO.
CYCLE-052
*** SAVINGS *** STATEMENT SAVINGS BEGINNING RATE
ACCOUNT NUMBER 0430003173
PREVIOUS STATEMENT BALANCE AS OF 02/28/05 ... .....................
PLUS 1 DEPOSITS AND OTHER CREDITS. ..................
LESS 2 WITHDRAWALS AND OTHER DEBITS .......... ......
CURRENT STATEMENT BALANCE AS OF 03/31/05 .... .....................
NUMBER OF DAYS IN THIS STATEMENT PERIOD 31
0,25000
7,544.11
1.12
3,040.00
4,505.23
*** SAVINGS ACCOUNT TRANSACTIONS ***
DATE DESCRIPTION
03/09 WTHDRL SAV 5376 03/09 13:24
4860 CARLISLE PIKE MECHANIC PA
03/09 XFR SAVDDA 5375 03/09 13:23
4860 CARLISLE PIKE MECHANIC PA
03/31 INTEREST PAYMENT
DEBITS
40.00
CREDITS
3,000.00
1.12
*** BALANCE BY DATE ***
02/28 7,544.11 03/09
4,504.11 03/31
4,505.23
23-2324730
4.08
PAYER FEDERAL ID NUMBER
INTEREST PAID YEAR TO DATE
*** INTEREST EARNED THIS STATEMENT PERIOD
DAY S IN PERIOD .........................
INTEREST EARNED...... ......... .........
ANNUAL PERCENTAGE YIELD EARNED (APY)....
***
31
1.12
0.25%
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(\.) dt -l {J <1 ,\.
NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
Member FDIC
COllJllJerce
"Bank
JOANN GRANT
JAMES B GRANT
116 HILL LN
MECHANICSBURG PA 17050
Commerce Bank/Harrisburg N.A
100 Senate Avenue
Camp Hill Pa 17011
888-937 -0004
II
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Page 1 of 3
STATEMENT DATE
ACCotilNT NO.
16
*** CHECKING *** 50 PLUS CLUB
ACCOUNT NUMBER 0536307929
PREVIOUS STATEMENT BALANCE AS OF 01/24/05 .............. .......... 302.54
PLUS 3 DEPOSITS AND OTHER CREDITS. .................. 1,618.26
LESS 21 CHECKS AND OTHER DEBITS..... ............ ..... 1~5.48 _
CURRENT STATEMENT BALANCE AS OF 02/22/05 .......................... 4. .3
NUMBER OF DAYS IN THIS STATEMENT PERIOD 29 -+ R,,\i....'^^<_-\ "':.II/M I . \ t
S, s. ~Mos .5~, co ~
---------------------------------------------------------~~~-~~~~~____~tJ~~
*** CHECK TRANSACTIONS ***
SERIAL DATE
2354 01/28
2355 02/02
2356 02/07
2357 02/09
2358 02/07
2359 02/07
2360 02/09
2361 02/08
AMOUNT
75.00
17.20
42.24
68.49
75.00
130.30
40.30
50.00
SERIAL
2362
2364*
2365
2366
2367
2368
2369
2370
DATE
02/07
02/08
02/10
02/11
02/09
02/14
02/17
02/22
CYCUE-011
AMOUNT
170.23
115.00
225.00
69.75
41. 43
19.18
75.00
55.90
-----------------------------------------------------------------------------------
*** CHECKING ACCOUNT TRANSACTIONS ***
DATE DESCRIPTION
02/01 AC-US TREASURY 312 -CIVIL SERV
02/02 CKCD DEBIT 02/02 TWX*AOL
SERVICE 01800-827-6364 VA
02/03 AC-US TREASURY 310 -SOC SEC
02/07 WTHDRL DDA 7852 02/04 17:26
4860 CARLISLE PIKE MECHANIC PA
02/07 AC-AT&T Consumer -CHECKPAYMT
CK-00002363
02/18 WTHDRL DDA 1030 02/18 14:49
4860 CARLISLE PIKE MECHANIC PA
02/22 INTEREST PAYMENT
02/22 POS DEBIT 02/18 KARNS
QUALITY FOOD MECHANICSBURG PA
DEBITS
23.90
CREDITS
1,138.16 :t
60.00
37.04
60.00
33.92
540.00 ~
.10
-----------------------------------------------------------------------------------
*** BALANCE BY DATE ***
01/24 302.54 01/28
02/03 1,864.60 02/07
.02/10 809.57 02/11
02/18 585.04 02/22
227.54
1,349.79
739.82
495.32
02/01
02/08
02/14
1,365.70
1,184.79
720.04
02/02
02/09
02/17
PAYER FEDERAL ID NUMBER
INTEREST PAID YEAR TO DATE
23-2324730
.19
----------------------------------------------------
*** INTEREST EARNED THIS STATEMENT PERIOD
DAYS IN PERIOD .........................
INTEREST EARNED ......... ..... ..........
ANNUAL PERCENTAGE YIELD EARNED (APY)....
***
29
.10
0.15%
----------------------------------------------------
1,324.60
1,034.57
6145.04
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REV-1511 EX+ (12-99>_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Grant JoAnn
FILE NUMBER
21-05-0309
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Myers Funeral Home-Mach. PA
St.Johns Luthern Church
Blooms by Vickory-Flowers
Rolling Green Cemetary
2,800.00
150.00
162.00
2,129.00
2.
3.
4.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative( s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
. State
Zip
Year(s) Commission Paid:
2. Attorney Fees
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
330.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5,571.00
REV-1512 EX+ (12-03)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Grant JoAnn
FILE NUMBER
21-05-0309
ITEM
NUMBER
1.
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including un reimbursed medical expense..
VALUE AT DATE
DESCRIPTION OF DEATH
,
Commerce Bank-Line of Credit Account 000900001660 1,419.00
2.
Mail Handlers Platinum Mastercard
8,361.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space Is needed, insert additional sheets of the same size)
9,780.00
Com':f1erce Bank
America's Most Convenient Sank
II
-S;<-~(~u\<.. ~
Statement Date:
Account Number:
JOANN GRANT
Line of Credit Account Summary
06/05/05
000900001660
Payment Information
Closing Date of
Billing Cycle
05/15/05
Credit
Limit
Available
Credit
Payment
Due Date
Total
Amount Due *
5,000.00
5,000.00
.00
Current Payment
Amount
Past Due
Amount
Late
Charge
Credit Life
Insurance Premium
Minimum Payment
Now Due
The amo~~r~1 ~~~~q~?e hc't~~~rsnit~~~es3~e~aer1f~~ C:n,q:~;fi~6rJ~~ui~ t~~Y~i~r~~~ g~~7n"e~f si~~n above.
Finance Charge Information
Average Daily Daily Periodic
Balance Rate
1,407.61
.00021917808
Annual Percentage
Rate(APR}
8.00000%
Days In Billing
Cycle
8
Finance
Charge
2.4681
8
.00
Interest Paid YTD
49.43
Finance Charge accrual method is Average Daily Balance. The Periodic Rate may vary.
Please refer to the above activity section for information about the number of days used to compute the Finance Charge on your account.
Important Information
* Activity and balance information is reflected as of the statement date. For your current payoff amount, please call 1-888-937-0004
For Information Call 1-888-937-0004
@
Equal Housing lender
Activity Summary
Date
05/04/05
05/05/05
05/13/05
Transaction Description
PREVIOUS BALANCE
INDEXED RATE CHANGE
OLD RATE
NEW RATE
LOAN PAYOFF
PRINCIPAL
INTEREST
GENERATED PAYOFF
Amount
Principal Balance
1,407.61
7.75000
8.00000
G1~
1,407.61
11.51
05/13/05
0.00
0.00
0.00
-
;;;;;;;;;;;;;;;
;;;;;;;;;;;;;;;
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MAIL HANDLERS PLATINUM MASTERCARD STATEMENT
BRYAN W GRANT - Valued Cardmember Since 1997
PAYMENT SUMMARY
MINIMUM PAYMENT' $189.00
I CURRENT PAYMENT DUE' $189.001
PAYMENT DUE DATE 03122105
.. See reverse side for an explanation of
these amounts.
ACCOUNT SUMMARY
ACCOUNT
NUMBER
TOTAL CREDIT LIMIT
TOTAL CREDIT LIMIT
AVAILABLE
5407-0700- 1349-7772
$15,000
$8,639
STATEMENT DATE
02125/05
PREVIOUS BALANCIE
PAYMENTS/CREDI1!S
PURCHASESIDEBrl1S
FINANCE CHARGE!
NEW BALANCE
II
.
Page 1 of 1
BALAN E SUMMARY
+
$8,444.22
$225.00
$40.00
101.63
TRANSACTION SUMMARY
$8,360.85
-
= TRAN POST TRANSACTION
- Q8Ig Q8Ig DESCRIPTION
02109 02109 PAYMENT - THANK YOU
01/26 01/27 CMK'CAREMARK RX 8Q().,841-5550 IL
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REFERENCE
~
20209050270092041263601
MT050270041000010045009
AMOUNT
CH"RGES CREDITS
$225.00
FINANCE CHARGE CALCULATION
This is a 9race account. Grace period information on back.
$40.00
Nomi:j ANNUAL
Average Daily Days FINANCE CHARGE Annu PERCENTAGE
Daily Periodic In Billin9 At Periodic Cash Advance Percentagei RATE
Balance Rate Cycle Rate Fees Rat~
PURCHASES $8,512.28 .04288% 31 $86.57 $0.00 15.65o/J 15.650%
CONVENIENCE CHECKS $480.84 .04288% 31 $6.39 $0.00 15.65% 15.650"10
BONUS CHECK $0.00 .04288% 31 $0.00 $0.00 15.650/. 15,650%
BONUS CHECK $1,113.14 .01342% 31 $4.63 $0.00 4.90% 4.900%
STATEMENT CHECK $303.73 .04288% 31 $4.04 $0.00 15.65o/~ 15.650"/.
CASH ADVANCES $0.00 .0??oo% 31 $0.00 $0.00 19.99% 19.990%
!
./ MAIL PAYMENTS TO:
HOUSEHOLD CREDIT SERVICES
PO BOX 88000
BALTIMORE MD 21288-0001
J2I M41L INQUIRIES TO:
HOUSEHOLD CREDIT SERVICES
PO BOXI80027
SALINAS CA 93912-0027
'5" QUESTIONS?
24-HOUR CUSTOMER SERVICE
1-800-622-2580
OUTSIDE USA, COLLECT: 1-702-243-1575
TOD HEARING IMPAIRED: 1-800-655-9392
Jil Manage your account online at:
www.unionpluscard.com
010853 25 OOOOOO3OOO G STMT12 D G ??oo7598
PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT: To Assure Proper Credit Please Write Your Accoum Number On Your Check
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