HomeMy WebLinkAbout94-00453
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21 - 94 - 453
RENUNCIA lION
In Re Estale of
WANDA K.PRZANOWSKI
. deceased.
To the Reslsler of Wills of Cumber 1 and
---.:.. Counly, PennEylvanla,1
The underslsned Georqe P. Dimm, Nephew
of
,Ihe above decedenl, hereby renounce(s) the rlsht 10 administer the eSlale and respectfully ask(s) thai Lellers
. ,
of Administration
,be Issued to John D. Dimm
--'
WITNESS
niy
hand this 2 <1 day of S IE. P 'r
,19~,
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. ,~JsnalUr.)
George P. 'D mm
4305 Central Avneue
Harrisburg,PA, 17110
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20. If llno 19 II greoler Ihon lino 1B, onler Iho dlllorenco on lino 20. Thlllllho OVERPAYMENT,
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21. If llno IB I'greoler Ihon lIno 19, onler Iho dilferonco on lino 21. Thll II tho TAX DUE,
A. Enlo, the Inlere'" on the balance due on Une 21A.
B. Enter Ihololol 01 lino 21 and 21A on lino 21B. Thl. II Iho BALANCE DUE.
Mak. r.hoc~ Pavabl. 'Ot R.gl"" 0' Willi, Ag.nt
~. -.~ ~-- IE SURITOANSWER. ALL QUeSTIONi ON-RIVIRSI'SIDI AND TO .ICIlICk MATH - oo(--~ ----=
Under ponalll.. 01 perlury, I doclore thai I hovo "umined Ihll relurn, Includlno accompanying "hod"l.. and 1I010monll, and 10 Iho bOil 01 my knowlodgo and boll."
" Is Irut, carrocl and complol' I d.clore Ihol 011 1001 011010 hOt boon repOrlod 011"0 morkot value. Doclornllon 01 preporor olher Ihon Iho p."onol repr...nlollv. Is
ba~'A~ n a~ :",omollono~,,, hlth :;i~iil~~:;"ny_~.no,~~.~~ .. -".~-.---__________. ..________._____ D.,;ff-----.-----
. -..\.. ..__.~42 0.. G!l?~}e__"'r_c. k_~~_!li.o.__C IlmEH} ~1_LJ'_~n_17211.. .-.{L!.L~~~~.
.., 'OllIE' It..It WRfS!NlAlIVE AltO"" oAI!
. C:;c___~L:~ C. '::__ Sh, 32 07 No r th~~_o_n t_.!~r e~~'_n~~:::!.~~~~~!n!~_.l 711~\~-.(!.:....J.L_
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WII.LS)
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COMMONWEALTH 01 PENNSYl'v'ANIA
DEPARIMENI 0' REVENUE
DEPT. 280hOl
HARRIS8UR.Q,!.~ 1!_!_~~~~.__
OfC!DENf'S N..4Ml lIAST. '"151. AND MIOCll( INlrIAt)
lOCl}S~~'~!{i~~~KL..W!l,ncllllii~d(jit>'-'ii'-'.."__1 .I[o-,-;;OIi.-"-. 6=~p c~~g~wt~k ~7g~ 1
-~QQ~JB~JBp_ ... . .09~Jl~91IL_jl.J,:"lQ=J9_J 1 c~'~r.-n..c-\lm.b.er.l/,\nd~.O.o_u.n_ty----_..n_h___
III A"l~:lllul.mtl(l HClVl! ~ IlAI,lIIIA.\1. "HI (lW ""(JIll! "1'1'''11 SOCIA.1 SECURITy NUM8f1t AMOUNT RECEIVED ISH l~lS'RUC'ION51
---_____n._____ __n -__ - - __ --_lifL.___ _._____. _ n_". n --.._.NA_________ __________~________.___
~-II. Original Rolurn I ) 2. Suppl.monlal Rolurn [h) J. R.malndor R,'urn
-- - Ifor dolO! 01 doalh prior 10 12.1 J.821
o 4. limltod E,lal. I I 40. Futuro Inl....1 Compromls. [.-J 5. Fodoral E"alo Yax R,'urn Roqulred
lIar dOl.. 0' doolh ofter 12.12.821
['I 6. Dorodont Dlod TOIlolo [ I 7. Docod.nl Molnlolned 0 living Tru,'
-- IAlloch copy 0' Willi (Alloch copy of TrUll)
ALL CORRlSPONDINCI ANDCONflDENTlAL TAXiNFoRMATION SHOULD BIDIRECTID TOI
N AI! 'i6MPLllf MAIlI~IO ADORfSS
St ~_Y_~_.C_~__N i c.ho1 a~IE8.q tli!.El..__ __ 3207 North Front Street
"'''HON' NU,"", Harrisburg, J~., 17110
L ~U'k~~~6-93~1u_~~="o,_=~__ -------OO~-~~_-"-_ ' _ lid(
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~..- a. Tolol Number of Sofe Dopo,ll BOX81
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I. R.ol ElIolo ISch.dulo AI
2. Slack. and Bond. (Sch"lul. B)
J. ClolOly H.ld Slock/Po,lne"hlp Inloro" (Schodul. q
4. Morlgages ol'd NOles Recelvablo (Schedulo DI
S. Cash, Bank Deposlll & Mllcollnnooul Perlonal Properly
. (Sch.dulo E)
6. Jolnlly Owned Proporly ISchodulo F)
7. Trantl". ISchodulo GI ISchodulo lj
8. Tolol GrOll All.II Ilololllnol 1.7)
9. Funeral Expenses, Adminislralivo CaUl, Miscellaneous
Expo"o. (Schodulo HI
10. Dob", Morlgag. 1I0bllill... 1I0" ISchodul. I)
II. T 0101 D.duCllonl (Iololllno. 9 & '0)
12. N., Value 0' ElIol. (lIn. B minu. lIno II)
1J. Chorllobl. and Governmonlol BoquOll1 ISchodulo J)
~1~~_Subl'~~~,'!.!.2umlnUlllno 13)
15. Spou.ol Yrontlo" Ifor dOIOl 01 doolh alrer 6.30.94)
See Instrucllons for Ar,plicable Porcontage on ReverIe
Sldo. (Includu vo/".. rom Schodul. K or Schodulo M.I
16. Amount 0/ line 14 taxable 01 6% role
(Includ. valuOl 'rom Schodulo K or Schodulo M.)
17. Amount of line 14 taKoble 0115% falo
(Includ. volu.. 'rom Schodulo K or Sch.dulo M.)
18. Principal lox due (Add lox 'ram lInOl IS, 16 and 17.)
19. Credill Spousal Puverty Credit Prior Payments Discount Inleroll
_m______.__.__. + .5..00-0-.D_O+_25.o...o_o.._ _____.._
II BI .. .___..h.____..______._.
5.250.00
(19) _ _._._ _.__.._______ _____
117.22
1201 __._..._____.____._________.._.
II I _______________ "__._______
I 2 ) ------"~m-___.________..m. "__. .
I J) __________._____._____
14) ______.._..... ________.____
(51.1t.6_..99_4..7L_______
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161 ----..-~--~------~--- ../ ~-l,
171 --.------------------ . ( 8) _ '4'6, 994 . 71
(9 ) .-5-...9-32.....8.L.:.-....___
(10)-.iI.~_~id_L
---
(Ill.. '12.776.17 '__
(12) -cJ.lb..aHL5_L_..____
(lJ) .
(14) ...J.lL.2..1.IL.i.4.____----:o.
1151 --.--___K._._"
- - --------.-------
1161 --------------__K .06 ~
---------.----.--------
1171 3.l42.L8,5..4___.._K .15" ---5....132..7.8_______.__
(211
121A)
(21B)
- -_._-~..~-~----._-..
---"----___.___u___~_.__
"- .."_._-------"----~
.
",Villi... 1"11 ...a." SCHEDULE H
~ FUNERAL EXPENSES,
COMMONWEAl'" Of PENNIYlVANIA ADMINISTRATIVE COSTS AND
~N.~\l:~1~~V~'&UJ\R" __. _ MISCELL_~N_~(:)uS EXPENSES _ ___ Pllall Print or Ty'~
~::_~f __~~~S~L wanda_~~._____________________.L NUMBER
ITEM
NUMBER
-.--.----. .- ~--------~----_._----
A, Funlral bplnl..1
1.
DESCRIPTION
AMOUNT
PA Cremation Society - Furera1
728.00
B. Admlnlltratlvl COIIlI
2,
1.
Personal Representative Commissions John D. Dinm.
Social Securlly Number of Personal ReprllenlatlvlI 161.- 34 - 1759
Year Commissions paid 1995______
2,400;00
Allorney Fees
Nicholas & Fbreman
2,400.00
3. Family Exemption
Claimant __.....:..___. Relationship
Address of Claimant at decedent/s death
Slreet Address ____._..____
Clly ..____________..._____~_S'ate ___ Zip Code
4,
C.
1.
2.
3.
4,
5.
6,
7.
0,
Probate Fees
~gister of Wills
~6.00
MllClllanlOUI bplnll"
Evening 8entina1 - Advertising
CUmberland Law Journal - Advertising
68.84
40.00
15.00
150.00
Clerk of Orphans I Court - Inventory & Debts
Clerk of Orphans Court - Final Acoaunt
Nicholas & Foreman - postage, copies, notary
35.00
_..-"----_.- ---_..-_...~-_._--------~------_.---_..-.-._-~_......--.---.---..-.-.--.-.----.....--- ------
TOTAL (Also enter on line '1/ Recapllulatlonl S 5,932.84
(II morl IpaCI II nlldld, 'nllrt addltlonal.hllll ollaml 1111,)
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You have a right to be represented at the hearing by an attorney.,
You should take this paper to your lawyer at once. You have the right
. .
to request the appointment of a lawyer to represent you. If you cannot
afford to pay for a lawyer, one will be provided to you without cost.
The Court may appoint a lawyer to represent you if it deems it
necessary. If you do not have a lawyer or cannot afford one, go to or
telephone the office set forth below to find out where you can get legal
help.
Court Administrator
4th Floor, Cumberland County Courthouse
Carlisle, P A 17013
(717) 240-6200
Witness my hand and official seal of office at Carlisle,
Pennsylvania, this day of ~, 1994.
BY THE COURT:
"
In Orphans' Court Division
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ESTATE OF WANDA K. PRZANOWSKI
AN ALLEGED INCOMPETENT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 2.1-94-453
IN RE: GUARDIANSHIP
BEFORE SHEELY. P.J.
MEMORANDUM OPINION AND ORDER OF COUJIT
A hearing was held today on the petition of John D.
Dimm seeking to be appoint9d the plenary guardian of the estate
and of the person of Wanda K. Przanowski who is allegedly an
inoapacitated person.
The Court today heard the testimony of John D. Dimm,
and also in accordance with the present statute a deposition of
her treating physician, Thomas A. Young, M.D., was presented at
the hearing today.
The doctor testified that the alleged incapacitated
person was admitted to the hospital on May 2nd, 1994, and he was
her treating physician since that time and saw her approximately
five times throughout her hospitalization.
The doctor rendered an opinion that he believed the
proper diagnosis of the alleged incapacitated person would be
senile dementia and that in his opinion she is not able to live
alone, take care of her personal needs, and also he did indicate
that he believes that it would be in the best interest of Wanda
K. Przanowski to have a guardian appointed for her.
,
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'.
EST ATE OF WANDA K, PRZANOWSKI
AN ALLEGED INCOMPETENT
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYL VANIA
,
,
: NO, CJI'C?4' l1S.3
: ORPHANS' COURT DIVISION
CERTIFICATE OF SERVICE
I, Stcve C, Nicholas, Esquirc, of thc law firm Df Nicholas & Forcman, do hercby certify
thut on May 16, 1994, 1 scrvcd by Certified Mail. return rceeipt requcsted a copy of thc Citation,
Petltlon, and Preliminary Decree on George p, Dimm, at 4305 Central Avcnuc, Harrisburg,
Pcnnsylvania 17110 and John D. Dimm at 420 Candlewyck Rond. Camp Hill, Pennsylvania
17011. Attachcd to this Ccrtificate of Servicc is a copy of the notice mailed. along with the
Domcstic Rcturn Receipt Cards signcd by John D. Dimm on May 19, 1994 and GCDrge Dimm on
May 20, 1994.
NICHOLAS! FgRE~AN
./; (/S---L d
BY: / - \.---
STEVE C, NICHOLAS. ESQUIRE
3207 North l~ront Street
Harrisburg, Pennsylvania 17110
(717) 236-9391
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ESTATE OF WANDA K, PRZANOWSKI
AN ALLEGED INCOMPETENT
: IN Tim COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA
"
I,
: ORPHANS' COURT DIVISION
,
: NO,:J./.<:JII -'-153
CERTIFICATE OF SERVICE
I. STEVE C, NICHOLAS, ESQUIRE, of the law firm of NICHOLAS & FOREMAN, dD
hereby certify that on this 19th day of May, 1994, accompanied by Mary Erne,
Supervisor of Social Services, Holy Spirit Hospitlll, Cmnp Hill, Pennsylvania, I
personally served a copy of the Citation, Petitionllnd Preliminary Decree on Wanda K.
Prznnowskl, an alleged incompetent, by handing sllmc to hcr, and explaining the contents
to her, at 4:35 o'clock p. m"ln the Holy Spirit Hospital, Camp Hill. Pennsylvania
~.,
NICHOLAS & FOREMAN
/~..--v--...... (!Ij,' C'{/'--"-h_" .
I'Y' '. '.
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STEVE C, NICHOLAS, ESQUIRE
3207 North Front Street
. Harrisburg, P A 17 J 08
(717) 236-9391
Superior CDUlt 10# 06845 .
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IN THE
COURT OF COMMON PLEAS
OF DAUPHIN COUNTY, PENNSYLVANIA
ElJtate of Wanda K. PrzanowlJlti: OrphanlJ I Court Div,
An .Alleged Incompetent No. 21-94-0453
DI';~ (lSJ.'J:,toJf _Qf'.....lfPM 11.11 ..JtL__ XPJUfQ--,_ltP..
Verbatim tranlJoript of depoaition
tak en at Hed i a a] Rea 0 rda Conf e ren oe
Room, Holy Spirit HoapHnl, 21st
street., Cnmp Hill, PennlJylvania,
on Tu e ad a y ,
June 7, 1994
3:30 p.m.'
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APPEARANCES:
, r.:~
STEVE C, NICHOLAS, Eaquire
Nioholaa & Foreman
3207 North Front. Street
Harriaburg, Pennaylvania 17110
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CAPITAL CITY REPORTING SERVICE
8150 DERRY STREET, BUITE C
HARRIS8URO. PENNSYLVANIA ]7Jl]
Tolephonc: (717) 561-0503
PAX: (717) %]-0,157
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Q Okay, W01l1 d you pleane nt.ate y(ltlt;'full
nallle?
A ,q'homnn l\llon YOllng.
Q linn at what. addreon do you maint.ain an
of fice?
II 890 Popl/.Ir Churoh Road, Buite 508, Cnmp
Hi II ,Pennnylvania.
Q Okny. Are you associ ated wit'" a group
. of dootors at. that.. loeation?
l\ YOIl.
Q IInd does your group praoti a~ u,nder a
trade' name?
A .Slloqueha.nna Internal Medicine
Tls.o oc i ate s ,
Q Okay. Woul d yoU bri eUy reei te for the
record your. eduoat.ional oaClkground ann your omployment
prior to YOllr annoointiDn with Bunqllehanna Tnternal
Menloine l\/lsociaten?
II Haoholor'fl negre!:', Franklin nnd
Marshall, 1986; Doctor of Modioine, Hllhnnemann
Univeroi ty, .1990; RC!1id!:'noy in Int.ernal Medioine,
Robert. Paoker Hoop.ital, Sarah, Pennsylvania, oomplet.ed
1993.
Q Okay. Arn you Hoard Cert.:lfied to
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praotice YDur 'profeDDi6n in'8~Y field?
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Q In what tiolct wOllld Hat bo?
1\ Internal Modioino.
'0 Okay. I\nct YOIl do maintain II private
offioe fqr t,ho pllrpono of floeing paUont:o?
1\ Yon.
Q And do you hilvo IIny I.lfHIi ilti ann wi.th
any honpHaln'1
TI HoIYSpirit.Honpitalan,d Hardnburg
Hoopi tal.
Q Oka.Y,Yol!, aro Board Oort.if:lf,ld ,an an
IntQrnint. ?
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Q 1>0, YOll npoi;.j al i 7,0 in any oert.llin l1reno
in t.hat fiultn
1\ No,
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Q Okay', HIIVO YOIl t-roatod pationtp
diagnonod with nevero domontia dllring, t.he ,'ooll'roo of.
your p'rnot.ioo?
TI Yoo,
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Q TInct onn Y,ou ont:iml1t.o how many D,IlOh
pntiontn Yolt havo trontrJd?
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TI' 100.
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Q Okny, In your optn.ion, io nhe able to
ltvoalorto' and take oaro of her pernonal neodn?
"No,'
Q Tn your opin.ion, in nhe abloto, t.ond to
her daY-to-day buntnenn affairn, nuoh an writing
oheokfl, pnyi ng bi 111'1, nhopping ,for food, propnrtng
foodr and no on'l
" No,
Q In YOUr opinion, ifl nho vulnerablo to
/lnyono who might WiFlh to take advnnt.ago of hllr and who
might tntend to doplete her ~ernonnl annntn?
" Yon.
,Q In yonr opin.ion, do you boli.ove it.io tn
hor bont int.erent. that- thin r.onrt nppot,nt. a !Jullrdian
t.o overnoo her <.lffai ni'l
" Yoo,
Q Now, what, if nny, in hor prognon.in to
reoovor from her ourrent condit.ion?
" Rho a I no hnn boen d.i nlJnoood w1 th bro,ant
Clnnoor, whioh ohein motantaHc; 00" hero prognofl.to io
poor.
Q Okny, How old in Wandn 'Pr?anowok.i, .if
YOU oan,giVoun hor date of birth?
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OE;R'I,'JF'JOI\T~ ..of.'u_~9Tl\RV: .l.tE;PQR'I,'ER
r hereby oert_ify, Ill) the Notary Reporter,
that the foregoing prooeedings were taken
stenographi cnll y by me, and th('reafter reduced to
typewriting by me or undnr my di reation; thnt this
trannoript i~ n true and aocurate record to the best
of my ability; that the witne~n whon", t.estimony
appear~ in t.he foregoing page~ wan duly nworn by me;
t.hat I am nd.ther counnel for, relat.ed t.o, nor
employnd by any of the part.ien t.o th", action in which
this deponit.ion wan taken; and, further, t.hat I am not
a relative or employee of any attorney or counsel
employed by the part.J.en hereto, nor financially or
otherwine
i nterent.e~) th",
~1
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1i~uilU . ~~. 0
Notary Reporter
the aotion.
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BOND #8-1416)0
.
" ,Foln' 5.4010 1I.16.IM
:;-';11 -' ? 1/. CJO 1s .3
GUARDIAN'S BOND
County of ..,Qwn.tlln:lnnd........., Penn.ylvanla.
E.'ate of "..I......'JiR1A4A,~".~~Mt\'t("k1.,....",.,.,.,.t ."",,,,,,,,, II"""""""""'''''' '}
No.2,194..:4.~ 19,..94..
...... '" ......+.J:l,9.9.Ip.p.e~.~nt .,..,.., "".,.,..." to",.,. to"...."""'.".'",, "."", .........., to
, Minor Child I Mentally InCfl/llpctenl
John 0 Dimm of
KNOW ALL MEN BY THESE PRESENTS, That we .. . ".............................
..J20 ~an~lewyck. R9.f!.9.I...f~!l1P Hill,; PA 17011..............................,.. Prlnclp.l, .nd
THE OHIO CASUALTY INSURANCE COMPANY, . corpor.tion of the St.te of Ohio, and .uthor-
Ized to become sole surety In the Commonwe.lth of Pennsylv.nl., are held .nd firmly bound unto the
Commonwe.lth of Pennsylvanin. for the use of those interested In the est.te, in the sum of..a"~,,QQQ....
" ,F.1t:t ~ an.. Thounnnd., nM."Tr:...:.~.'7.'7,~,'7.-:":":,~.;,"';.-:','7.-;.7.;,;:7,'7,7.;,;.j::,;,;t":,<;.'7.":".1~ ~.~,:,.~~,:,".,:,:~:-:QQI ~QQ".. "" Dollars,
to b. p.ld to the s.ld Commonwe.lth, to which p.ym.nt, well .nd truly to b. m.d., w. do bind our-
s.lv.s, jointly .nd aever.lIy, for .nd In the whole, our heirs, executors, .dmlnistretors, succ.ssors .nd
nsslgns, .nd e.ch .lId .v.ry of th.m, firmly by these pres.nts, S..I.d with our s.nls .nd dated the
..".....".?3.J;.4............. day of ........,N-P..~"",..,."..,..,.. A.D., 199.4..,,,,....
THE CONDITION OF THIS OBlJGATION IS, Th.tli the .bove beund.n..................................
.........................""."X.<?,h~...!?~.,..D~TI'.~.....I:,,',.,.......'..........,."...,.....".......... A8 GUArdian of the Estate of
,. ..................... ..Wrm~I}..K^,. f.J;'R!m.QY.Qr,l...........,..............",.,.... ,..",......... ........,...... ,....,,, shall w.lI and
~I Menlllily Incompetent
truly admlnlst.r the estato according to l.w, this oblig.tion, .h.lI be void as to tho.. who sh.lI so
.,"'.,.. 'b. ....,., b" '"'~''' " .b.1I "".,. ,. ".,. ~ '
Sealed and d.liv.rod in the presence of: ...... ..~ "~""~''''''~!;Q,,1)
,......"JO~J.lIUI)"IP,,1
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I NA,r~1 I, GRANG\o1 MUTUAI, INSURANOE CO,
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By.".:...."..... '... ..., ~.."., ,......., Ai~1nI~~:i~:f~~;''''''''
....Q.ho.r D B, .a.LIl).~.It" .".'
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II
Stale of Pennsylvania
I 55,
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County of ...,........................
], '.........,..... .H.9.0T.\,. P. P... ,1rl~mw.... ".................... ..... .............,.,. ......... ........."" ............ .................. ........... '
......,.......................,.......,....,......,......,.......................................,.......,..",,........0.P...,"...'1......."....llo;...,,'
r. ",' j'
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do solemnly swear that. 8S the Guardian ...,............ .,.,...,..........,.;,..........,.........".,.....,.......,.......~...I.....'"
,
of the estate of ....~p,..I;l.s:1R-...J$.,...,l?r.*.~ng.~:.?,~~....... .......".....'"..'....'..,,',........,.......,~...,..t'.~_~-,'.........,..........,
....... OI.................. .T. r~ .9.':1!1'l-1~ .t.'H n.t:""........,....,. II..'..'..'....,......",..."".,.",,,.,,,.... ..'....,."......""....".',........ I
Minor Child / Menllllly Incompnlent
wll1 well nncl truly IIchlliui.I",. tl", ""1111.. of ""icl
., ...~,r~,~~.~r.~~~.~~", to"...,.., 'II:; I;....'....
MInor Chnt! I Ml'lItnlly Incolllflclent
.ccordlng to I.w,
,
, .
Sworn .nd aubscribed bofor. me ' _
thl. ................ day of ....,.......................................1 ~ '\ ~ ")
AD, 19.......... and lellere of Ilu.rdi~n.hip granled ....""..i'::..~D...."..,~hDf 'l...f."........,.,..~I..
unto . lmm
.............."..........""............,"'........01....,""',...,',."...,'j
, _ '~".,.".... "tI....",,,.,.. ",,,..,,... ...,........."11".. .." It I' ""111
.'..".........,........,......."......,.........."..,...........1...........,
,
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. REOlsnR ,
NATIONiJL RANGE MUTUAL INSUR:;C;ZN E, COM~ANY
, BY:~~l. If. '
-.. ",I I'L I' II"
00... ~\\ "\." "'I ~ 'I"
Thl. pow.r I. Iny.lld If r.d dl'lIon.llmpr1nt ..~tl/olllll GI.n~ "'lltlia' In.ur.ne. Comp.ny, KHn., N"~~"'~'~I:lt\
'. .hown In II. .nl/I'ly, . ," !~/;.(;:~~ R4";, ';..\
Stale 01 New Hampshire " ~ ~ 1 9 2 30 \; \
County of Cheshire 3: ~
On this 12th d'YOf June 1991 ,before th. subscriber. N01.ry Pu the Stale of N "I'" Ii
Hampshire In and lor the County 01 ChHhlr. duly ccmmlllloned and qualllled, c.m. W'II.ce H. Smith .tlo I Gr !Ii?
Mutual Insurance Company. \0 m, Ptrtonllly known to be th. offlc.r described herein, .nd who executed th. nIIn!/'
and he acknOwledged Ih,' IXICll110n of sam., and being by me fully sworn. deposed .nd said th.t h. II .n offlc ~pY
aforesaid: th.lthe seal ~lfIlied to th. prtr.tdlng Inttrum.nt II IhI corporat. Sill of laid Company, and the s.id corpo1WlW ~"I and
- I
hiS slgnalure as oHloe, wile duly .ffl~edlnd subscribed 10 tho ~aid Instrument by Ihe euthorlty and direction 01 the sard Companv
that Anlcle V, Seotlcn2 of th. By-Law. 01 said Company II now In lorce,
t, "
IN WITNESS WHeREOF, I hay. htlr.unlo SIt my hand .nd affixed by offielll SIal .1 KHn.. New Hamplhlre Ihll .J2.tll.
f ", ',I 'I 19 ( ,,0_ '....
day 0, " June 91 . I '-7}) , "/ '" lit. r r I...
I ./..Lt'<I~rl ill , .........., ~''''I \
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01 ~J (,\l(i Notary Public t":'" "'.";
" '\ \ My Commission Expires: Jun 2. ~ T A f! ~ \ )
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. " '. I, Lyn E. Landry. Assistanl Vice Prllld.nt of th. N.t/on.1 Gllng. Mutu'l Insuranc. Company, do h.r.by ~ th.t ml ibov,,, :
: ~ loregolng II a lru. and correot copy of . POWII 0' Mern.y executed by sard Company which I. sl/lIln II fO~" t.H'tOI/ !
: ~ IN WITNESS WHEREOF, I hay. her.unto set my hand and affixed the Sill 0' sald~ Copa t ~., ..~ Il'twt'i~l.
... ~ 21rd day of. Juno . 19.2lL., '-z.... ~ "':r' ;"
Cl Alllatan Vie. Prllld.nt
z ,/,' /~;/
Z :, 68-6i21 (6/16) ,/
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~ National Grange Mutual
~!nsurance Company
POWER OF ATTORNEY
^ "-"I,n ~;II('I!I /.1111'111;1 ((I'liill",
:'i
KNOW ALL MEN BY THESE PRESENTS: That the National Grange Mutual Insurance Company, a New Hampshl/e corporation ~av.
Ing liS prtnclpal otfic~ ,n Ihe Clly of Keene. Stale 01 New HampShire. pL.rsuanllO Anlcle V, Secllon 2 of Ihe By. Laws 01 said Com,
pany. to WIt:
"Secllon 2. The ooard 01 dlrectcrs, the preSldenl, any vice presldenl, secrelary, or Ihe Ireasurer shall have 1l1e power and aUlhOllty
10 apPoint attorneys'In,lacl and 10 aulhorlze them to exeeute on behall 01 the company and aHix Ihe seal 01 the company IherelO.
bonds, recognizances, contracts of Indemnity 0' wrttlngs obligatory In Ihe nalure 01 a bond, recoqnlzance or condllional uncer.
taking and to remove any SUCh attorneys.ln,lact at any lime and revoke Ihe power and authority given to them," does nereoy
make, constitute and appolnt------Charles B. Humes-------------------,ts true and lawlul Attorney"n"act.
to make. execute. seal and deliver lor and on lis Oehalt, and as ,ts aCI and deed. bonds, undenaklngs recognizances. conlracts
01 Indemnity, or other wrtlings oOllgalory In Ihe nalure 01 a oond suoJecl to the lollowlng limitation:
I, No on. bond to uClld FlY, Hundred Thoullnd DolI,'e (5500.000.00),
oj.
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and to bind the National Grange Mutual'nsurance Company thereby as lully and 10 Ihe same extent as 'f !~Ch' instruments
were SIgned by the duly aulhollzed oHicers 01 the Nattonal Grange MUluallnsurance Company, and alllhe lacll'oi sard Attorney
are hereby ratified and confirmed. . , .
This power 01 attorney IS Signed and sealed by lacslmlle under and Oy the authortly of the lollowlng r8l0lullonadoPted by Ihe Direc.
tors of The Nallonal Grange Mutual Insurance Company at a meeting duly called and held On (he, 2nd day of Oecemoer 1977
Voted: That the slgnllure 01 any oHlcer authorized by lhe By. Laws and the company S~.I m1ay be wHlxed by lacSlmlle 10 any
power 01 attorney or special power 01 attorney or cenlllcatton of either given lor,th. executton of any bond. undenaklng.
recognizance or olher written obligation In Ih. nature thereof: such signature and ?!Ial. when so uaed being hereoy adopled
by the eompany as Ihe original signature of such oHlce and th. o"ginol seal ollhe company. to be valid and olndlng upon
the company wtlh the same force and eHect as though manually affixed,
.' I
IN WITNESS WHEREOF, The National Grange Muluallnsurance Company has caused these pr"rntsllo be Signed by Its Vice P,eSl.
dent and lis corporale sea' to be hereto affixed thll 12th . day of June, 99 , This appolntmenl
shall cease and terminate automatically as of December 31st. 1995 unless sooner ,evoklld as provided.
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REV-1547 EX AFP 112-94*
COHMONWEAl HI OF PEHHSVLIJAHIA
DEPAHTHEH' OF REVEHUE
BUREAU OF IHD1V1DUAL TAXES
DEPT, 230601
ItARRISIURO, PA 17128-0601
!&mE OF PRZANOWSK'r'=mur
DATE OF DEATH 09-11-94
1~-';.3q.. G.
lJov--
NOTICE OF INHERITANCE TAW
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF OEOUCTIONS ANO ASSESSHENT OF TAW
ACN 101
-j,
FILE IlO.
CDUNTV
DATE 07-03-95
53
CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAW
PAYHENT TO THE REGISTER OF WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAVMENT TOI
STEVE C NICHOLAS ESQ
3207 N FRONT ST
HBG PA 17110
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ent RIMlt~ld -=l
CUT ALONG THIS LINE .. RETAIN LDWER PORTION FDR YOUR RECORDS ~
REv: is;.-j - iif - iI F ii -IIF 94 Y -filii'" i c i- -6 F - INHiii if ANC i- TAx- iiP' PRAY ii iHEfir; -iI Ll-6wANC E- ori----. -- - - - - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF PRZANOWSKI WANDA K FILE NO. 21 94-0453 ACN 101 DATE 07-03-95
TAW RETURN WAS I I X) ACCEPTED AS FILED
( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1, Rill Eltltl (Sahldull A) 11)
2, Stack I Ind Bondi ISahldull B) (2)
S. Cla,"l~ HIld Staak/Plrtnlrlhip Intlrllt ISchldull CI (51
4, Hartglgll/Nat.1 Rlcli.lbll ISohldull D) (4)
5, C,"h/B"nk OlpalHI/Hho, Plrlanll Praplrh ISahldull EllS)
6. Jointl~ Ownld Praplrt~ ISahldull F) 161
7, Trlnlflrl ISahldull G) (71
a, Tatll Alllt.
.00
.00
,00
_ .00
46,994.71
,00
,00
lal
46,994.71
~PPROVED DEDUCTIONS AND EXEMPTIONS I
9, Funlrll E.plnlll/AdM, COlh/Hha, E.pon... ISahldull H) (9)
10, Dlbh/Hartglgl LllbUiU../Llon. ISchldull Il (10) 6.8{.3,33
11, Tabl DlduaUanl (11)
12, Nit VIlul of TI' Rlturn 1121
15, Chlribbll/Oa.lrIlMlnbl Blqu..h ISahldulI JI USI
14, Nit VIlul,..f E.t~tl Subjlot .ta TI. U4) 34,218,54
NOTEI If an aSle.sment"~aB ilsued previoully, linel 14, 15 and/or 1&, 17 and 18 will
roflect figureB that include the total of Ahh returns aSBelBed to date.
ASSESSMENT DF TAXI
IS, AMount of Li~~ '14 It SpauIII rltl 1151
16. AMount of Linl,l4 tl.lbll It Linlll/Cll.1 A rltl 116)
17, AMount of L1n"':14 b.lblo It Call1tlrll/CII'' B rib U7)
la, Prinaipol TI' DUI
,.
5,932,84
1?776 17
34,218,54
,00
.00W.03_
,00 w,06_
34,218,54 w,15_
ua)
,00
,00
5,132,78
5,132.78
TAX CREDI
PAYMENT
DATE
11-03-94
1-
, "
~! :1
RECEIPT -
NUMBER
MM91~145
DISCOUNT (+ I
INTEREST (-)
256.64
AMOUNT PAID
5,000.00
TDTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
5,256,64
123,86CR
.00
123.86CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF AODITIONAL INTEREST,
If TDTAL DUE IS LESS THAN II, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTf.D AS A "CREDIT" (CRI, YOU MAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS,)
"
'"
RESEAVATIONI E_t.tl. of dlcldlnt. dvlng on or blforl D.cteblr 12, 1982 -- If .nv futurl Int.r..t In thl ..tet. I. tran.f.rrld
In po.....lon or .nJov..nt to CIII. B (oolhtlrall blnlf,tolarlu of thl dlnld.nt aftlr thl "lCplratlon of any ut.t. for
Ilfl or for Vlar.. thl Co..onwlllth herlby lleprl..ly rt.lrv.. thl II;ht to .ppral.. .nd ...... tran.1,r Inhtrltanc. T.lel.
at the llwful CII.' B (oollatlrll) rat. on any such futurl lntlrl.t.
PtJIlPOSE OF
NOTICE I To fulfill the rlqulrf.lnt. of Slotlon 2140 of thl InhtlrltlnCl alld Eltat. Till Aot, Act 22 of 1991. 72 P.S.
Sootlon 2140.
~AVKENT, Dlttch thl top portion of thlt Notlcl .nd .~It with your p.y.ent to thl Rlal.tlr of Will. printed on thl rIVlr.. .Idl.
..H.k. ch.ck or .on.. ardor p...blt to. REaIBTER OF NILLS I AaENT
All plY.lnt. recelvld .hall flr.t be appll.d to any Interl.t which .ay b. dul with *MY r"llnd.r eppll.d to thl tftK.
REFUND (CA)1 A r.fund of a talC cr.dlt. which w.. not r.que.ted on thl Tftx A.turn, .IY b. requI.tld by oo~lltlng .n "Applloltlon
fcr R.fund of Plnn.ylvJnla !nh.rltanoi and E.t.t. T.." (REV-1S13). Application. arl aVlllabl1 .t the OffiCI
of thl R.gl.tlr of Will., IMV of the 23 R.v.nuI Ol.trlct Offlo... or by oalllng the .p.otll 24-hour
an.werlng .ervlcl nu.b.r. fcr for.. ordlrlng, In Plnn.vlv.nl. 1-800-362-2C50, out.lde P.nn.vlvanl. and
wIthin 10011 H.rrl.burg .rla (111) 781-e094, TOO' (117) 772-2252 (HI.rlng I.p.lrtd Only).
OBJECTIONS' Any party In Int.r..t not .atl.flld with tht .ppr.I....nt, .llowanc. or dl..llowenet of dtduatlon., or ........nt
of tale (InolUdlng dl.count or Int.r..t) .. lhown on thl. Hot tal lU.t objlct within .llCtv (60J dlv' of r,cllpt of
thlt Hotlal bVI
"wrltt.n pro tilt to tht pA D.part..nt of R'v,nut. Board of ApPllll, D.pt. 281021, H.rrltburg, PA 17128-1021, OR
.-.l.atlon to have the ..tt.r dlt.r.ln.d at audit of thl account of thl Plrlon,1 r.pr...ntstlv., OR
.-app.al to the Orphan. I Court.
ADIUN
lSTRATlYE
C~RfCTIOHSI Faotu.l .rror. dl.cover.d on thl. ........nt thould b. .ddr....d In writing tal PA D.p.rt.ant of RIVtnUl,
SUrelU of Individual talC", ATTHI Po.t A.......nt R.vl.w Unit, D.pt. laUOl, Harrltburg, PA 17128"0601
Phon"(717) 787-6505. S.. paa. ] of thl book lit "Inltruotlon. for Inh.rltanc. T.~ R.turn for. R..ldant
Dlc.dlnt" (REV-1501) for .n 'Mpl.n.tlan of adtlol.tratlv.lY eorr.et~l. .rror..
DISCOUNT I
If ~V t.~ due I. paid within thr.. (3) a.llnd.r tonth. aft.r the deo.d.nt'. dtlth, . flv. p.rc.nt (5X) dl.oount of
the tllC paid It allowed.
INTER1!ST'
Int.r..t II charg.d b.glnrrlnll with flrtt day of dellnqu.ncv. or nlnt (9) IKInth. Ind Ont (1) d.v frOlt thl d.te of
d..th, to the date of plvllnt. TIM" which bee... delinquent b.for. Janu.ry 1, 19.2 b..r lntlr..t It the r.tt of
.IIC (6X) p.ro.nt p.r annUl c.leullt.d at . dally r.t. of .000164. All t.K" whlah biOI" d.llnqulnt on and Iftlr
Jlnuary I, 1982 will b.ar Int.r..t at a r.t. which will vary fro. oal.ndar y.ar to a.l.nder v..r with that rlt.
.nnouno.d by tht PA D.part..nt of Alv.nu.. The appllaabl. Int.r'lt rat.. for 1982 through 1995 .rl'
!!!t Interllt Rate n.l1v Int.r..t F.etar ~ lnt.rllt Aat, DillY Intlrllt Faator
1m 20l .0.0148 1917 9l ,000247
1911 16l .000431 1918'1991 III .000501
1914 III .OD05.1 1992 9l .000247
19S5 Ul .000516 1993'1994 Il ,00.192
1916 III .000274 1991 9l ,01)0247
ulnt"r..t I. cllculat.d .. follow.,
INTEREST. BALANCE OF TAX UNPAID X NUftBEA OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Anv Hotlel luutd Ift.r thl t.K t.tCOII. d.llnquent will r.fltet In Int.rllt CI1cul.tJon to flfteen CIS) dlV'
blVond thl dltl of the 1..I....nt. If plyltnt I, aide .ftlr tAt Intlr..t ooaputatlon date .hawn'on the
Hotlc., addltlon.1 Intlrllt lU.t bl o.lcullt...
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PROPOSED DISTRIBUTION
The assets for distribution are
amount of $43,605.26,' The said
DIMM, Execlutor of the Estate of
comprised entirely of
assets shall be paid
WANDA K, PRZANOWSKI,
cash in the
t,o JOHN D.
The sum of $50.00
income taxes and
DIMM, Executor of
shall be held
any balance shall be
the Estate of WANDA K.
in reserve to pay final ,fiduciary
distributed to JOHN' D.
PRZANOWSKI .'
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PAYIENT.
Dttach thl top portion of thlt NntlcI and lubllt with your pIY',nt aid, pay,blt to thl n... IInd addr...
printed on the rev.r.. .Ide.
If REUDENT DECEDENT "k. ch.ck or .0nIY crdor PIYobl. I., REGISTER OF WILLS, ADENT,
If HON'RfSIDENT DECEDENT .1IIe. check or 'on" order p.y.bl. 101 COHHONWEAL TH OF PENNSYLVANIA.
All ply""t, reellvld ,hill bt app!Jld flrtt to eny Intlr..t which Uy b, du. with .ny r...lnder applltd to thl hK.
REFUND (CRll A r.fund of a taM oradlt, which W'I not r.quI.tad on the TIM Ntturn, lay b, r.quI.tad by Clo.,lttlng an
"ApplJe.tlon for R'fund of penn.ylvant. lnhlrltanca Ind E.tat. TaM" (REV-Ill]), '~pllc.tlon. ar. IVlllabl, .t
thl OfficIo' the R_gI,t,r 0' Willi, any of thl 23 Ravenue OJ,triat,Offlc,. or frol thl OIPartlent', 24-hour
an.werlng ..rvlel nu~.r. for for.. orderlngl In PlnnlYlvanla 1-800-362-2050, ~uttld. Ptnn.vlvant.
end within 10011 Harrllburg ar8a (711) 787-8094, TOOl (717l 771-2252 (H..rtng t.paJr.d only).
REPLY TO.
Qu..tJonl r.gardIng .rror. contaln.d on thl. notlc. .hould b. addr....d tal PA D.p.rt".nt of R.vlnu., Bur.au
of Indlvldull flxu, ATTNI Po.t A.......M Rlvl.w Unit, Dlpt. 280601, Htrrhburg, PA 17121-0601, phone
(7111 7.T'6505.
DISCOUNT.
If .ny tlX due 1. paid wlthtn thr.. (l) cat.ndar lonth. aft.r thl dlcld.nt'. d..th, a flv. pgrclnt (5~) dI.count
of th. tlX pat~ t. ellowld.
PENAL TY I
The 15X tlX a~l.ty non.partlcipatlon p."alty 1. cu.put.d on th. totel of thl tlX and Intlr..t I....~.d, and not
Plld b.farl January 18, 1996, thl flr.t day aft.r thl .nd of th. tlM aln..ty p.rlod.
INTF.REST.
Int.r..t I. chargld b.glnnlng "11th flr.t day of dlllnqu.nay, or nln. (9) lonth. Ind on. (I) day frol th. dati of
d..th, to the date of pay..nt. TaM" whiah bla... dlllnqu."t before JamJllry I, 1912 b..r Intlr..t at UlI r.t, of
.IM (6X) p.ra,nt plr annul calculatld It a dailY rat. of .000164. Atl taM" which bloa.. dlllnqu,nt on end .ftlr
Janutry I, 19U 101111 b.... Intlrut at a rat. which wU1 vary frol callndar yur to ollendar yl.r "11th thlt rate
announald by thl PA OIPart.lnt of Alvlnu., Thl appllcabll Int.r..t rat.. for 1982 through 1996 .r"
V..r Int"..t Aat. Dilly Int.r..t Flctor Vtar Internt Alt. Dally Int"..t Fletor
198/ 20% ,000548 1987 9% ,000247
1m 16~ ,U00418 1900-1991 11~ ,OODS'l
1914 11% .0'DSOl 1992 9% ,000247
1915 15% .000356 1991-1~94 7% ,000192
1986 10% .000274 1995-1996 9% ,ODD247
ulnt"..t J. allcul,t.d .. fo11ow.1
INTEREST . BALANL~ OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTDA
..Any Notlc. 1..u.d aft.r th. tlM b4CO... d.llnqu.nt wli1 r.fl.ot an Int.r..t alloulltlon to flft.en (IS) dlY.
b.yond the dltl of th. ~""".nt, If PIYI."t'll .'d. aftlr the Int.r..t eoaputltlon d.t. .ho"," on the
Notla., addltlon.1 Int.r..t IUlt bl aaleulatld.