The URL can be used to link to this page

Home My WebLink About01-24-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) .... Z W C W o W C PALOMBO ANTHONY DATE OF DEATH (MM-DD-Yea-) DATE OF BIRTH (MM-DD-Year) 10/22/2005 04/19/1924 (IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A W I- ~~U) (,) f~ woC,) :1:0::9 C,) 8: ID <C 00 1. Original Return D 4. Limited Estate 00 6. Decedent Died Testate (AlIach copy ofWlQ D 9. Litigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (daIIl ofdealh . 12-12-82) o 7. Decedent Maintained a Living Trust (AlIach copyofTrustj o 10. Spousal Poverty Credit (dale ofdealh between 12-31-91l1\d 1-1-9S) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 5 0 9 5 7 "'COOiilYCODE -YEAR- - - NUiiER- - SOCIAL SECURITY NUMBER 1 92- 1 2 - 9 3 8 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (dalllofdeathpriorIo12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AlIach Sch 0) NAME MARK A. MATEYA ESQUIRE FIRM NAME (If Applicable) I- Z W Q Z o lL U) W ~ o C,) COMPLETE MAILING ADDRESS P.O. BOX 127 TELEPHONE NUMBER 717 241-6500 BOILING SPRINGS z o ~ j ::) .... 0: <C o w a:: 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule 0) (4) 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate B~Hng 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 liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Beques1slSec 9113 Trusts for which an eleclion to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::) Q. ::E o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 181,395.50 0.00 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (8) x _ (15) X .045 (16) X .12 (17) 0.00 X .15 (18) (19) >> CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20. 0 .-.....-~ :,,,.'1 , n ~J :"'-;--1 .,oc) .=-- <- ~, , " :.. .::.~ J :-, 1'_1 ;'--1 - -~ "r':.) -PA 10 '1-- 129,317.40 co S:PFFIC~USE ONl: \::::~ II ____ .'_} :::. i-n . .", '. / .,~ 61,341.49 5,396.22 196,055.11 13.866.78 792.83 (11) (12) (13) 14.659.61 181,395.50 (14) 181,395.50 o d t' C It Add ~ eee en s amPle e ress: ; STREET ADDRESS 824 L1SBURN ROAD APT 320 CITY I STATE 1 ZIP CAMP HILL PA 17011 Tax Payments ~nd Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 8,162.80 7400.00 389 46 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 7,789.46 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 Une 20 to request a refund (4) 5. If Line 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 Une 5 + 5A. This is the BALANCE DUE. (58) Make Check to: REGISTER OF WILLS, AGENT 0.00 0.00 373.34 373.34 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 ofthe property transferred; ........................................................................... 0 . 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..... .......... ..... ......... ......... ..... .................... ....... ........................ 0 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .......... ..... ..... ..... ....... ....... ......... .................... ..... ...... ................. ....... I&J 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS PA For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% (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% [72 P.S. S9116 (a) (1.1) (Ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% (72 P.S. ~9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, 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 decedenfs siblings is 12% (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. .!""'-1503.Elc . <. SCHEDULE B STOCKS & BONDS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 05 All property jolntly-owned with right of sUlVlvorshlp must be disclosed on Schedule F. ESTATE OF PALOMBO ANTHONY ITEM NUMBER 1. 2. 3. 4. 5. 6. 0957 DESCRIPTION 15000 FEDERAL HOME LOAN BANKS 5.425% 09/24/08 CUSIP NUMBER 3133M5SM3 INCLUDING ACCRUED INTEREST OF 58.77 25000 FEDERAL HOME LOAN MORGAGE COR MEDIUM TERM NOTE 4.85% CUSIP NUMBER 3128X3KQ5 INCLUDING ACCRUED INTEREST OF 474.90 30000 FEDERAL NATIONAL MORTGAGE ASSO NOTE 5% 3/16/15 CUSIP NUMBER 3136F6E54 INCLUDING ACCRUED INTEREST OF 150.00 14000 FEDERAL NATIONAL MORTGAGE ASSO NOTE 5.625% 01/28/12 CUSIP NUMBER 31359MMF7 ACCRUED INTEREST - 115.94 12000 GENERAL MOTORS ACCEPTANCE CORP MEDIUM TERM NOTE 4.375% 12/10/07 - CUSIP NUMBER 37042WG96 ACCRUED INTEREST - 27.71 34000 FEDERAL FARM CREDIT BANKS DEBT 4.5% 02/09/11 CUSIP NUMBER 31331TSS1 ACCRUED INTEREST - 310.25 VALUE AT DATE OF DEATH 15,375.87 25,358.03 29,371.50 14,191.54 11,448.35 33,572.11 TOT At (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 129317.40 F\EV-1508,ex + (6-98) '. SCHEDULE E CASH, BANK DEPOSITS, & MISC, PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PALOMBO ANTHONY FILE NUMBER 21 05 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of survivorship must be disclosed on Schedule F. 0957 ITEM NUMBER 1. DESCRIPTION RAYMOND JAMES FINANCIAL SERVICES - CASH 2. THE WOODS AT CEDAR RUN/G.C.C.C. REFUND SECURITY DEPOSIT 3. CITIZENS BANK - CHECKING ACCOUNT ACCOUNT NO. 610248-483-9 4 MEMBERS FIRST FEDERAL CREDIT UNION CHECKING ACCOUNT ACCOUNT NO. 241726 MEMBERS FIRST FEDERAL CREDIT UNION SAVINGS ACCOUNT ACCOUNT NO. 241726 MASTRO FRANCESCO FUNERAL HOME ANTHONY PALOMBO IRREVOCABLE FUNERAL TRUST ACCOUNT NO. 104106108 HIGHMARK BLUE SHIELD INSURANCE REFUND OF HEAL THCARE INSURANCE PREMIUM PAID FOR PERIOD FROM 10/1/05 THROUGH 12/31/05 5 6 7. VALUE AT DATE OF DEATH 168.66 1,985.00 2,009.14 5,056.64 46,137.05 5,670.25 314.75 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 61 341.49 REV-151Q t:X + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PALOMBO ANTHONY SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 05 This schedule must be completed and filed If the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. 0957 DESCRIPTION OF PROPERTY ITEM INClUDE THE NAIlE OF THE TRANSFEREE. THEIR RElATIONSHIP TO OECEllENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSfER. AnACH A COPY OF THE DEED FOR REAl. ESTATE. VALUE OF ASSET INTEREST (IF APf'l1CABlE) VALUE 1. CITIZEN'S BANK 8,396.22 100. 3,000.00 5,396.22 CERTIFICATE OF DEPOSIT NO. 6144-637753 IN TRUST FOR JAMES AND ROBERT PALOMBO TOTAL (Also enter on line 7 Recapitulation) $ 5.396.22 (If more space is needed, insert additional sheets of the same size) REV-15U EX + (12-99) 'w COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PALOMBO ANTHONY SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 05 0957 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MASTRO FRANCESCO FUNERAL HOME 6,260.10 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. AttomeyFees MARK A. MATEYA, ESQUIRE 7,000.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 314.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 7. CUMBERLAND LAW JOURNAL - ADVERTISEMENT OF ESTATE 75.00 8. THE PATRIOT NEWS - ADVERTISEMENT OF ESTATE 217.68 TOTAL (Also enter on line 9, Recapitulation) $ 13866.78 (If more space Is needed, insert additional sheets of the same size) .. REV-1512 EX + (6-98) . SCHEDULE' DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PALOMBO. ANTHONY FILE NUMBER 21 05 Include unrelmbursed medical expenses. 0957 VALUE AT DATE OF DEATH ITEM NUMBER DESCRIPTION 1. WEST SHORE FAMILY PRACTICE MEDICAL SERVICES 2. PBGC INSURANCE OPERATIONS DEPARTMENT PBGC CASE NO. 19524000 REFUND OF OVERPAYMENT OF PENSION FUND 54.00 738.83 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 792.83 ..RBi"'''''''.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER PAl ....... .......... ANTHONY 21 n~ 0957 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude oU~ht s~sal distributions, and transfers under Sec. 9116 (a (1. )] 1. JAMES PALOMBO Lineal 90,697.75 30 COLD SPRINGS ROAD DILLSBURG, PA 17019 2. ROBERT PALOMBO Lineal 90,697.75 10666 JOHN AYERS DRIVE FAIRFAX VA 22032 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART IT. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) . , REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 7.400.00 Discount: 389.46 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 throuah 1991 - 1992 1993 throuah 1994 1995 through 1998 1999 2000 2001 2002 2003 ~-- TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17,1996: Penalty: LAST WILL AND TESTAMENT I, ANTHONY PALOMBO, a married man residing in Ali9Uippa, Beaver County, Pennsylvania, being of sound and dispos1ng mind, memory and understanding, do make, publish and declare this to be my Last will and Testament, hereby revoking all Wills and Codicils heretofore made by me. I. I direct that the expense of my last illness and funer- al (including the cost of a suitable monument at my grave), all my just debts and the costs of administration of my Estate be paid as soon as practicable after my death. II. I devise and bequeath the rest, residue and remainder of the property I may own at m~ death, real or personal, of whatever nature and wherever s1tuate, to my Wife, MARY PALOMBO, provided she survives me by thirty (30) days. III. Should my wife, MARY PALOMBO ~redecease me or fail to survive me by thirty (30) days, I dev1se and bequeath-the rest, residue and remainder of the property I may own at my death, real or personal, of whatever nature and wherever situate, to my Sons, JAMES PALOMBO, of Dillsburg, Pennsylvania and ROBERT PALOMBO, of Fairfax, Virginia, equally per stirpes and not per capita. IV. I nominate, constitute and appoint my Son, JAMES PALOM- BO, as Executor of this my Last Will and Testament. Should m~ said Son, JAMES PALOMBO predecease me or be unable or unwil11ng to so serve, I nominate, constitute and appoint my Son, ROBERT PALOMBO, as Executor of this my Last will and Testament. I dir- ect that none of my personal representatives shall be required to post bond for the faithful performance of their duties. V. The personal representatives of my Estate shall have the following powers in addition to those vested in them by law and by other provisions of this my Last will and Testament, ap- plicable to all property, exercisable without court approval, and effective until actual distribution of all property: A. To retain any or all of the assets of my Estate, real or personal; B. To sell at public or private sale, to exchange or to lease, for any period of time, or to partition, any real or personal property and to give options for sales and exchanges for such terms or conditions as they deem proper, and to exercise options therefore for cash or credit, with or without security; C. To invest in, accept or retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal in- vestments; D. To borrow money from any legal entity including any fi- duciary acting hereunder, and to mortgage or to pledge _ . ,':' ",' ".",",tj,., ,~~ 'i~:,i~;:~)~~~:~~~?:,~;;~:;:j~J-( <~;':,;<:.: '~" " ,',. ,> "'" , ~~ any real or personal property; E. To hold shares of stock or other securities in nominee re~istration form, including that of a clearing co~or- at10n or depository, or in book entry form or unreg1s- tered or in such other form as will pass by delivery; F. To retain uninvested cash, in such amounts and for such period of time as shall be deemed advisable for the proper administration of the Estate; G. To exercise any option, right or privilege granted in insurance policies, or other investments; H. To retain and pay agents, employees, accountants and counsel for advice and professional services; I. To compromise any claim or controversy, to engage in litigation and compromise, arbitrate or abandon claims; J. To make distributions of my Estate in cash, or in kind, or both to any beneficiary, at current values, alloca- ting specific assets to particular distributees on a non pro-rata basis, and for such 'purposes as to make reasonable determinations of current values; K. To make elections, decisions, concessions and settle- ments in connection with all income, estate, inheri- tance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distribu- tive share of income or principal of any person affec- ted thereby. IN WITNESS WHEREOF, I have hereunto set my hand and seal this aix~c~n~h 9ay of April, 2004. SCl/ljJTEeNrfj a")\..-~a.io~ Anthony 0 0 VERIFICATION WE, the witnesses whose signatures are affixed and signed be- low, verify that we were within the sight and hearing of ANTHONY PALOMBO, the Testator, when he signed the aforesaid document as his Last will and Testament and that we, in fact, saw him sign said document as his Last Will and Testament. I/~ lI!L . / d7// 330 Cravo Avenue residing at Beaver PA 15009 residing at )(r{4jrh~{I) @,J tiff (JIP/JI( I S-C::O DATE: Y-/7-o Y STATE: PE)\i',l~,{LVANIA COUNTY: BE}\V~::! BEFORE THE ',: '<~::::F{SIGNED NOTA ill/i;:nL'V A'ff'AED~ -fM'rnD (~ Nolanal Seal J05 Reich. No5ubliC ulppa. Beaver My Comm sslon Ex?if8S Sept. I 2004 mber, Pel'l~sylv<;r:c: . \,<;soctatlon ot Notaries ~'" ~ .. INVENTORY Estate of ANTHONY PALOMBO also known as ANTHONY PALOMBO ANTHONY PALOMBO JAMES PALOMBO. EXECUTOR , Deceased No. 21 05 0957 Date of Death 10/22/2005 Social Security No. 192-12-9386 Personal Representative(s) of the above Estate, deceased. verity that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents Its fair value as of the date of the Decedenfs death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verity that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Name of Attomey: MARK A. MATEY A 1.0. No.: 78931 Address: P.O. BOX 127 Personal Representative: > #J~ L /1J"/'~f$)D' I Dated BOILING SPRINGS PA 17007 Telephone: 717-241-6500 Description 15000 FEDERAL HOME LOAN BANKS 5.425% 09/24/08 CUSIP NUMBER 3133M5SM3 STOCK INCLUDING ACCRUED INTEREST OF 58.77 25000 FEDERAL HOME LOAN MORTGAGE COR MED TERM NOTE 4.85% CUSIP NUMBER 3128X3KQ5 INCLUDES ACCRUED INTEREST OF 474.90 30000 FEDERAL NATIONAL MORT ASSO NOTE 5% 3/16/15 CUSIP NUMBER 3136F6E54 INCLUDING ACCRUED INTEREST OF 150.00 14000 FEDERAL NATIONAL MORT ASSO NOTE 5.625% 01/28/12 CUSIP NUMBER 31359MMF7 INCLUDING ACCRUED INTEREST OF 115.94 12000 GENERAL MOTORS ACCEPTANCE .CORP MED TERM NOTE 4.375% 12/10/07 CUSIP NUMBER 37042WG96 INCLUDING ACCRUED INTEREST OF 27.71 34000 FEDERAL FARM CREDIT BANKS DEBT 4.5% 02/09/11 CUSIP NUMBER 31331TSS1 INCLUDING ACCRUED INTEREST OF 310.25 Value 15,375.87 25,358.03 29,371.50 14,191.54 11,448.35 Total 3~72.11 .., ~ '" \ \'...... .- ""J _, ",,: IA.....'\\ '.,\.,.,;,....\lJU '.: '>,-i-:\-yj /'l'--1 (Attach Additional Sheets if necessary) ~11~~ 11 .~~ ~G n~r . NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal represeo!at~e. include the value of each item, but such figures should not be extended into the total of the Inventory. ..... ' 'C\, ," ..~ -,'~~, \ r' .';,~, r-:::(.'r;[UJ(1 RW-4 ,", ~. 1\-':0 \..:.:.l-.J~'~ J,J -'v,..... " ...... 4 Continuation of Inventory ANTHONY PALOMBO 21 05 0957 Pace 1 Description of Inventory Description RAYMOND JAMES FINANCIAL SERVICES CASH Value 168.66 THE WOODS AT CEDAR RUN/G.C.C.C. REFUND OF SECURITY DEPOSIT 1,985.00 CITIZENS BANK CHECKING ACCOUNT NO. 610248-483-9 CITIZENS BANK CERTIFICATE OF DEPOSIT VALUED AT 8,396.22 LESS EXCLUSION ACCOUNT NO. 6144637753 MEMBERS FIRST FEDERAL CREDIT UNION CHECKING ACCOUNT ACCOUNT NO. 241726 MEMBERS FIRST FEDERAL CREDIT UNION SAVINGS ACCOUNT ACCOUNT NO. 241726 MASTROFRANCESCO FUNERAL HOME TRUST PRE-PAID FUNERAL EXPENSE ACCOUNT NO 104106108 MIGHMARK BLUE SHIELD REFUND OF HEAL THCARE PREMIUM 2,009.14 5,396.22 5,056.64 46,137.05 5,670.25 314.75 Subtotal $ 66,737.71 196,055.11 Grand Total $