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HomeMy WebLinkAbout11-28-06 -.J 1505605105~ REV-1500 EX (06-05) PA Department of Revenue *' Bureau of Individual Taxes PO BOX 280601 ~ Harrisburg, PA 17128-0001 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT ~\ 0 10 6l\t>l Date of Birth 186-24-5294 03/17/2006 03/15/1914 Decedent's Last Name Suffix Decedent's First Name MI Grenkevich Margaret H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI nla Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4. Limited Estate . 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes James A. Miller, Esq. Firm Name (If Applicable) Miller Lipsitt LLC (717) 737-6400 REGISTER OF,WJLLS USE ONLY' ,,-~ First line of address 2157 Market Street Second line of address :.." City or Post Office Camp Hill State ZIP Code DATE FILEp PA 17011 c.) Correspondent's e-mail address: ~ 1A..1- J~I.J' c DwVt Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG~_~~N~IBLEFOR :~~=-____ ____________ _LJ(~~E~~~6 2';0' DDRESS Vincent Grenkevich, Executor 556 N. Enola Dr., Enola, PA 17025 ----- --------~---- --- ~-- SIGNATURE OF PREPARE THER THAN REPRESENTATIVE -----=_=~ ;?~~~< ,;;.---C ~.to ~ 2157 Market St., Camp Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 --.J .-J 15056052059 REV-1500 EX Decedent's Name: Margaret H Grenkevich RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 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. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O _ 111,617.04 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 186-24-5294 Decedent's Social Security Number 114,900.00 0.00 0.00 0.00 1,500.00 1,007.50 27,250.76 144,658.26 23,801.81 9,239.41 33,041.22 111,617.04 0.00 111,617.04 5,022.77 5,022.77 15056052059 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME .__~~rgare_t.___~Grenkevich STREET ADDRESS 540 North Enola Drive File Number DECEDENT'S SOCIAL SECURITY NUMBER 186-24-5294 , STATE PA ZIP 17025 CITY Enola Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,022.77 Total Credits (A + B + C ) (2) 0.00 3. InterestJPenalty if applicable D. Interest E. Penalty . ------ TotallnterestJPenalty (0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 0.00 0.00 5,022.77 0.00 5,022.77 A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... [i] 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i] c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percen1 [72 P.S. ~9116 (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 zero (0) percent [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is twelve (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 I,:MARGARET H. GRENKEVICH, vlidow and surviving spouse of Adam L. Grenkevich, of 540 Enola Drive, Enola, Pennsylvania, being of sound mind and memory, do declare this to be my Last Hill, and do revoke all Wills and codicils previously made by me. ITEM ONE: T direct the payment of all my just debts to be made as soon as practical after my decease. ITEM TI~O: I give devise and bequeath all of the rest, residue and remainder of my estate, be it real, personal, or mixed property, to Hhich I have, or ever shall have, any right, title or interest to my three following named children, share and share alike: 1. Richard G. Grenkevich 2. Vincent Grenkevich 3. Patricia Harris In the event that any of my children shall predecease me, then that share shall pass to that child's issue per stirpes. ITEM THREE: I hereby nominate, constitute and appoint my son, Vicent Grenkevich, to be the Executor of this, my Last Will and Testament. In the event that he be unwilling or unable to,so serve, then I direct my son, Richard G. Grenkevich, and my daughter, Patricia Harris, to be the Co-Executors of this, my Last ~Jill and Testa- ment. ITEH FOUR: I hereby give to my Executor/Co-Executors full, complete and lawful power to sell, convey, mortgage or lease any part or all of my real or personal estate, either at public or private sale, at such terms and at such times as to him/them may seem best, and there- upon to execute, acknowledge and deliver all conveyances, mortgages, leases, indentures, bills of sale, or other legal documents necessary and requisite to carry out the purposes of this, my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this 12th day of January, 1982. '7'11UAt~ J-f <~/LQ~ Mtf'rgaret H. Grenkevich . The preceding instrument was, on the day and date thereof, signed, published and declared by Margaret H. Grenkevich, the Testatrix therein named, as and for her Last Will, in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ~~C?~ / ;- M:g~~ ~rd -2- - - ,.. - ~ w 0 ,~ e\ ~ 'Jl ,. tri ~ 0 nj 1.\ ':l: ':l: ';G ~ ~ ~ ~~ w 171 ~ ~ ~ H o 0 ';. c. ';G ~ ~ ~ 'Z. 'Z. "'1l 1. ~ ell. ~ l" )> H n\ ~ ~ z :! 0 ~ GJ ';Z. 0 "t\ 2'. ~ ~ ~ Z "t\ 0 r' )> - (j) 2'. <: i ('l )> III tt\ ~ ~ p~ 1. )> \ll _ Z ~\ }> '^ < .. III 0 ~ Cl c tri 0 '" o. r (f). >;:c'. .. 0 ,g :i (j\ r-\ ~ REV-1502 EX+ (6-9*, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Margaret H. Grenkevich 2006 - 00407 All real property owned solely or as a tenant in common must be reported at fair marilet value. Fair mar1<;et value is defined as the price at which property would be exchanged between a wilting buyer and a wil~ng seller, neither being compelled to buy or seD, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPllON 540 North Enola Drive, Enola PA 17025 (see attached HUD-1 Settlement Statement) VALUE AT DATE OF DEATH 114,900.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 114,900.00 ,A. Settlemont Statoment U.S. Dopartmont 01 Housing and Urban Developmont OMB Approval No. 250; B. Type 01 Loan 1. { J FHA 4, { jVA 2'.L1.FmHA 5. ( X ) Cony, Ins. 3. { J Conv. Unins. 6. File tlumber 400600653-SK 7. Loan Number: 8. Mortgage Insurance Case Number: 0001268279 c. NOTE: This form is fumished to give you a statement of actual selllement cosfs. Amounts paid to a')d by the lielllement agenl are shown. lie marked "(P.o.c.)" were paid outside of the closing: they are shown here for informational purposes a~"d llre not included In the totals. D. Name and Address of Borrower E. Name and Address of Sellor F. Namo and Addross of Lender LINDA L. PHILLIPS VINCENT GRENKEVICH, EXECUTOR OF AMERICAN HOME MORTGAGE ESTATE OF MARGARET H. GRENKEVICH 538 BROADHOLLOW ROAD, MELVILLE, NY 11747 ,PA ,PA . Property Location H. Sottlement Agont 1 540 NORTH ENOLA DRIVE, ~ pECURED LAND TRANSFERS. MECHANICSBURG ENOLA, PA 17025 Place of Settlement I. Settlement Date 05/1112006 COUNTY: CUMBERLAND 3915 MARKET STREET Disbursement Date 05/11/2006 PARCEL 10: 09-12-2992-Q52 CAMP HILL, PA TOWNSHIP: EAST PENNSBORO TOWNSHIP J. SUMMARY OF BORROWER'S TRANSACTIONS K. SUMMARY OF SELLER'S TRANSACTIONS 100. Gross Amount Due From Borrower 400. Gross Amount Duo To Sollor 101. Contract Sal<Js Price $114,900.00 401. Contract Sales Price $114,90' 102. Personal Property 402. Personal Property 103. Selllement Charges to Borrower 54.776.18 403. Adjustments For ItomsPald By Soller In Advance Adjustmonts For Items Paid By Seller In Advance 113. Cityrrown T~xes 413. Cityrrown Taxes 114. County Taxes 270.30/'Ir 5/11/2006 to 1/1/2007 $174,03 414. County Taxes 270.30/yr 5/11/2006 to 1/1/2007 $17' 115. School Taxc,; 1,005.401yr 5/11/2006 to 7/1/2006 S140.48 415. School Taxes 1,005.401yr 5/11/2006 10 7/1/2006 $14C 118. Assessment!: 418. Assessmenls 119. 419. 121. Sewor for MNCh, April. May 62.0Q/qtr (or 5/11/200G to $14.15 421. Sewer for March, Apnl, May 62.00/qlr for 5/1112006 to $14 6/112006 6/1/2006, ' .... 120. Gross Amount Duo From Borrower I $120,004.84 420. Gross Amount Due To Sollllr I $115.228. 200. Amounts P~ld By Or In Behall Of Borrower 500. Roductlons In Amount Duo To Seller 201. Deposit or Enmest Money $1,000.00 501. Excess Deposits 202. Principal Loan Amount from American Home $114,900.00 502. Settlement Chargn to Seller $7.960 Mortgage 503. Existing Loan(s) Taken Subjecllo 203. Existing Loar'(s) Taken Sub/eel 10 Adjustments For Itoms Unpaid By Seller Adjustments For Items Unpaid By Seller 510. 210. , 511. 211. 512. 212. 513. CilyfTown Taxes 213. Cityrrown Ta<es 514. County Taxes. 214. County Taxe!' 518. Assessmenls 218. Assessments 519. 219. ..' 220. Buyer's Tot~1 Credits 300. Cash At Settlement FromfTo Borrower 301. Gross Amount Due From Borrower (line 120) 302. Less Amounl5 Paid By/For Borrower (line 220) S115,900.00 520. Seller's Total Chargos I $7,960 I I 600. Cash At Settlement To/From Sellor $120,004.84 60l. Gross Amount Due To Seller (line 420) 5115,900.00 602. less Deductions In Amt. Due To Seller (line 520) I I $115,228 QT,960 ~ --- 303. Cash [ X ) Fmm [ ) To Borrower $4,104.84 603. Cash [X) To [ ) From Soller , $107,268 )06006~ 3 - SK . Settlorunt S\atcment 00. Tot: Page < tivision ( II Salo CommIssion 114900.00 @ 5.5 %.. 6319.50 ,f Commission (line 700) As Follows: Paid From Borrower's Paid From Seller's 17.50 to Tim. Straub :\ Associal~s .., Funds At Settlement Funds At Settlement !2.00 to EM - NRT, Inc. ,mission paid at settlement $6.319.50 saction Fee to Tim Straub & A:;sodates .. $295.00 .saction Fee to ERA. NRT, Inc. $125.00 01. $26! 02. $34: 03. Con 06. Trar 09. Trar 00. Items Payable In Connect/on WltIl Loan 01. Loan Origination Fee 02. Loan Discounl - 03. Appraisal Fee to American Home /-"ortgage 5350.00 04. Crec!it Report to American Home M'Jrtgage S6.25 35. Lencler Inspection Fee 12. Floo.j Cert. Fec to American Home Mortgage 519.00 13. Tax Service to American Home Mor1gage 574.00 15. Appl'cation Fee to American Home Mortgage 5350.00 10. Items RequIred By LenderTo Be PaId In Advance 11.lnle 12. Mor IJ. Haz l4 . Floc lOO. Re~;erves Deposited With Lender I lOl. Ha; l02. Mo 103. Cit} 104. COl 105. Sch qO. A91; 00. Till.. Ch;uges I est from 5/1112006 to 6/11200(, @22.3419/day 5469.18 gage Insurance Premium ,rd Ins. Premium d Ins. Premium ard Ins. Reserve 3.0000 rrio @ 36.42/ me to American Hone Mortgage 5115.26 rtgage Ins. Reserve Property Taxes nty Property Taxes 5.0000 me @ 22.92 / me to American Home Mortgage 5114.60 001 Taxes 12.0000 me @ 64.11/ me to American Home Mortgage 51,010.04 regate Accounting Adjustment from American Homo Mortg<,ge -5229.90 - 01. SetllcmenVClosing Fee 02. Abslract or Title Search ." 03. Title examinallon 04. Title Insur.1nce Binder 05. Document preparation Deed Prep 10 Tim Straub & Associates 5125.00 06. Not:1ry fee to Cash $10.00 07. AlIo-ney Fee 06. Tille Ins. Tota/to Secured Land Tr<,nsfers - Mechanicsburg 5933.75 09. Lender's Coverage $114900.00 ($) 10. Owr.er's Coverage $114900.00 ($933.75) 11. End'lrsements.1 00/300/900 ($150.'JO) to Secured Land Transfers. Mechanlcsburg 5150.00 16. Insured Closing Proteclion Leller te Censtar TiUe Insurance Company 535.00 00. Government RecordIng And Tr:ln sfer Charges 01. Ree- 02. Cityl 03. Sial. 00. Additional Settlement Charges 05. Sew~r for Mar, April, May to East Pennsboro Township 00. Total Settlement Charges 54.776.18 $ , 60. Ive care'ully reviewed lhe HUD-l Sett/(.ment Statement ana 10 the test of my knowledge and belief it is lrue and accurate statement of al/ receipts and disbursements de on mt account or by me In this lran!.action. I further certify that I tJave received a copy of the HUD-1 Settlement Statement. Jrding Fees for Deed 36.50: Recording Fees for Mortgage 64.50 S103.00 County Tax/Stamps 1149.00 51,149.00 I Deed Tax 1149.00 ..' $1,149.00 YERS ~~ ~ Q,"~~(-~ ja L. Phil/ips SELLERS 4 E~ By: Vincent Grenkevich. Executor ! HUD.1 Settlement Statement which Illave prepared Is a true and (lccurate account of this transaction. I have caused or will cause the funds \0 be disbursed In ordance with this slatement. t1oment. ~ Datil ~ - 05/11/2006 REV-15G8 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Margaret H. Grenkevich FILE NUMBER 2006 - 00407 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 VALUE AT DATE OF DEATH 1. Household property items from residence - 540 North Enola Drive, Enola, PA 17025 1,500.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,500.00 REV-1509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Margaret H. Grenkevich 2006 - 00407 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Vincent Grenkevich 556 North Enola Drive, Enola, PA 17025 B. c. JOINTLY.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEEO FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENrs INTEREST 1. A. 03/25/05 M & T Bank Checking Account - Acc!. No. 950271923 2.015.00 50% 1.007.50 TOTAL (Also enter on line 6. Recapitulation) $ 1,007.50 (If more space IS needed. Insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Margaret H. Grenkevich SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY 2006 - 00407 FILE NUMBER 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. DESCRIPTION OF PROPERTY ITEM INCLUOE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCABLE) VALUE 1. M & T Bank Market Advantage Account - Acct. No. 15004211804255, 30,250.76 100 3,000.00 27,250.76 transferred on March 25, 2005 to Vincent Grenkevich, son. TOTAL (Also enter on line 7 Recapitulation) $ 27,250.76 .. (If more space IS needed, Insert addlllonal sheets of the same size) REV.173Hl EX + (9-00) ~_ REVERSE ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Use Schedule H ONLY for proportionate method of tax computation. FILE NUMBER Margaret H. Grenkevich 2006 - 00407 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT ITEM NUMBER 1. FUNERAL EXPENSES: Sullivan Funeral Home, 51 N. Enola Drive, Enola, PA 17025 - funeral services Pealers Flowers - funeral services 8,429.00 93.23 A. 2. 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. Attomey Fees James A. Miller, Esq. Miller Lipsitt LLC 7,358.28 3. Probate Fees Register of Wills, Cumberland County, PA 310.00 4. Accountant's Fees 5. Tax Retum Pre parer's Fees 6. Miscellaneous Expenses Executor administration fees 7,358.28 Legal Advertising - Patriot News 187.02 Legal Advertising - Cumberland Law Journal 75.00 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 23,810.81 REV-1512 EX+ (12.m) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABIUTIES, & UENS ESTATE OF FILE NUMBER Margaret H. Grenkevich 2006 - 00407 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 7,960.50 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Closing Costs - pursuant to sale of real estate (See HUD-1 Settlement Statement attached) Verizon - telephone bill 22.24 PPL - electric bill 83.36 UGI - gas bill 149.42 Manor Care - medical care bill 54.00 East Pennsboro Township - sewer bill 115.00 Moffit Health & Vascular - medical bill 1.17 BJ's House Repair - repairs to real estate prior to sale. 43.50 Gelco - carpet cleaning - carpet cleaning of real estate prior to sale. 160.00 Crop Bros. - repairs to real estate prior to sale. 117.95 Cleaning System - cleaning of real estate prior to sale. 100.00 PA WC - water bill 46.61 Merrill B - trash bill 90.00 UGI- furnace inspection 121.90 Comcast - cable bill 55.76 Ackerman Builders - water heater repair. 118.00 9,239.41 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+(9-00) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Margaret H. Grenkevich 2006 - 00407 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Richard G. Grenkevich, 1029 Patrick Road, Natchitouches, LA 71457 Son One-third (1/3) 2. Vincent Grenkevich, 556 N. Enola Drive, Enola, PA 17025 Son One-third (1/3) 3. Patricia Harris, Briarwood Lane, Camp Hill, PA 17011 Daughter One-third (1/3) 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 TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) EXHIBiT "13" STATEMENT OF ACCOUNT ESTATE OF MARGARET H. GRENKEVICH DATE OF DEATH: LETTERS GRANTED: March 17, 2006 May 11,2006 I. ASSETS: A. Real Estate: 540 North Enola Drive, Enola, P A 17025 B. Personal Property: 1. Financial Accounts: a) M & T Market Advantage - Acct. No.I50042II804255 Date of Death b) M & T Checking - Acct. No. 950271293 TOTAL ASSETS: II. DEBTS/DISBURSEMENTS: Item 1. Register of Wills, Cumberland County - Probate Fees 2. Legal Advertising - Patriot News 3. Legal Advertising - Cumberland Law Journal 4. Miller Lipsitt - Attorney Fees (5% of gross assets) 5. Vincent Grenkevich - Executor Fee (5% of gross assets) 6. Verizon - telephone bill VALUE/AMOUNT $114,900.00 $30,250.76 2,015.00 $147,165.76 Amount 310.00 187.02 75.00 7,358.28 7,358.28 22.24 7. PPL - electric bill ~3.36 8. UGI- gas bill 149.42 9. Manor Care - medical care bill 54.00 10. Pealers Flowers - funeral flowers 93.23 11. East Pennsboro Township - sewer bill 115.00 12. Moffit Health & Vascular - medical bill 1.17 13. Purchases - house 47.66 14. B1's - house repair 43.50 15. Eat n' Park - beneficiary dinner/meeting 49.22 16. Ge1co - carpet cleanin 160.00 17. Crop Bros, Inc. - house work 117.95 18. Cleaning System - house work 100.00 19. Pa.WC - house water 46.61 20. Merrill B - trash bill 90.00 21. UGI - furnace inspection 121. 90 22. Comcast - cable bill 55.76 23. Adj - balance/reconcile adjustment 26.97 24. Ackerman Builders - water heater 118.00 25. Closing Costs - sale of 450 N. Enola Drive (HUD-l Settlement Statement attached) 7,960.50 TOTAL DEBTS/DISBURSEMENTS: 5,600.00 $30,345.07 26. Pennsylvania Department of Revenue - Inheritance Tax ? III. DISTRIBUTION: A. Combined M & T Current Account Balance: B. Payments: 1. Miller Lipsitt - Attorney Fees 2. Vincent Grenkevich - Executor Fee 3. PA Dept. of Revenue - Inheritance Tax 4. Legal Advertising Total Payments: C. Escrow pending approval ofPA Inheritance Tax Return and/or expense pending 9 month claim period against the Estate D. Net Proceeds to Beneficiaries: $139,735.65 - $20,578.56 - $1,000 = Richard G. Grenkevich One-third of$118,157.09 1029 Patrick Road Natchitouches, LA 71457 Vincent Grenkevich One-third of$118,157.09 556 N. Enola Dr. Enola, P A 17025 Patricia Harris One-third of$118,157.09 Briarwood Lane Camp HilL PA 17011 TOTAL: 1 $139,735.65 7358.28 7,358.28 5,600.00 262.00 $20,578.56 $1,000.00 $118,157.09 $39.385.69 $39385.69 $39385.69 $118,157.09 MILLER LIPSlll LLC 21S7 lvl.ukl't Sln:'l'l C.1mp I fill, PA liP'll i'J 7 -73 '7 - h-l(III F.r..~ iI7-7:'7-::;l,S::; \"'\\"i.\'.1'.1.lt I.HV.C' '111 November 27,2006 Cumberland County Register of Wills Register of Wills, Agent 1 Courthouse Square Carlisle, P A 17013 Attn: Angie RE: Inheritance Tax Filing Fee, Margaret Grenkevich Dear Angie, Enclosed please find my check number 7907, in the amount of$15.00, you requested to file the Inheritance Tax for Margaret Grenkevich. I I Sincerell I r ( J~es A. Miller ~AM/kls Enclosure C) '"C) .,'l " . (,--j ~~,,) c.') -Tl ~. ':)\ ~-.) o w Harrisburg: 717.236.5161; Facsimile 717.236.8747 PHILA OFFICE: 1620 Locust Street, Philadelphia P A 19103