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IIETITION I;OI{ IllUmATE Illld (;J{ANT OF LETTEI{S
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EX"OPIIlS follow" do~o"onl dl" nOIIlUlrr)', wu~ nol dil'ur~od nnd did nOI hllve II child born or IIdOplOd
!lflo' oso~nlion of I~l willollo,o" fur prohato; WIIS "'lIlh" vklhn of II killing IInd wus lIever IIdjudlcnled
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De"o",lcIIIIII dOlllh "'Ino" p'OpOrl)' with oSlimlllod vlllu", lIS follows:
(If domlcilo" in I'll,) ^II porson,,1 propo'l)'
(If uol domlcilod In I'll,) I'orsolllll prop"r1)' In P"ul1S)'I\'lluill
(I I' 1101 domlcikd in I'll,) 1'0r,01l1lIp,op"r1)' In Counl~
Vllluo of ,oal ",uuo III 1'0nn",11'1I11111
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OATIl OF PlmSONAJ. IU~IIRESENTATIVE
COI\lI\lONWEAI.T11 010' I'ENNSYI.VANIA }::IS
COUNTY OIo'__C.U.MI3EBI.lINO
Tho pOliliOIlOI(,)alll1\O-nall1o" 'WOIII(5) 0' uffi,m(,) Ihallho '111101110111' IlIlho fo,egolng pOlltloll nr"
lruo IIn" "Ill re"' wlho hO'loI Ih" knowkdp" ,,1111 holloI' of POlillollo,(,) ulld Ihlll us porsonnl rep,osen.
IUlil'c(,) Ill' Iho uhmo do"odcIIIPCliliol1o,(s) will Wd~" I r:~:"Oly/rJ' 0 e'lu~o uoeo,dlug 10 Inw,
Sworn 10 or aflirnll'u an. d ,"h~crilll:d { _ _ _ . _ I~ -I, ~ ~
hoh"o 1110 Ihi, _~___, __...20th_,_ d,,~ of ----- i'
-___. - Of TOllER --- -- 1'1...94- i!
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fIf ..5J.'/:A.{."
No. 21-94-896
Estate of
MICHAEL D. KATKOCIN
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW OC'l'OBER 24 19.2..i-, In consldc,alloll of Ihe petition on
the 'everse side he,eof, salisfllclory p,oof hllvlng been p,esenled befo,e lI1e,
IT IS DECREED thnlthe Inslrument(s) dnled Jan. 21.1992
described therein be IIdll1ll1ed 10 probnte und n1ed of ,ecord ns Ihe 11151 will of
MICHAEL D. KATKOCIN
nnd Lellers TESTAMENTARY
n,e hereby g,nnled 10 M. DAN I EL KOT KOC I N
'1rJalU.~ c.., ';f,... ,~, .1... 1? 11 ~ . -\-
o Rcalslcror WlIIl ~
FEES
Probnle, Lellers, Etc. .'",.", $
Sho,l Certlncnles( 7) . , , . , , , , ,. $
Renunciation ................ $
~;?e $
270.00
21,00
ATTORNIJV tSup, CI, I,D, No,)
~:88
TOTAL _ $ 299.00
Filed ."OCmOBER,2,4,.l9.!i4"".",..
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1.l1t:,lIlh'gisu.lr. TIlt' III i.~il1.11 lTrlifit.lll' will hI..' furw,ndl'd to Ihl' SloIll' Vil.d Hunr"" (Hlill' 111I Pl'I'lIl;ltll'lll (jJiI1~.
21-94-896
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COMMONWEALTtt Of PENNSYlVANIA. DEPARTMENT 0' tIEALTtt. VlTALRECORDS
CERTIFICATE OF OEATH
(Coroner)
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and in, Tea simple'. in Io'quill "h.lT''''''' tnllO my five chlldr'en,: to will
M. Oanio1 Killkocln
Ij"wn,u'd L. 1<,,1.1<'01:111
JOBeilt,.J. Katko~L~
K"lhluon M. Urain.rct
Mauruon F. Karlson
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di...,et that my E"l1cutor bu Cl/(cuspd from po!;tlnq bond to guar,1ntee the
fal t;hful p",rformance of his dull..",
IN WITNESS WIIEI11:0F, I hava har(;!u'nto set my hand and $a,,1 this
ef( rJ di.y Clf J.1llUilr~', 1998,
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Mlehaal D. Katkocin
Signed",5ealed, publlGhod and decl.lred by the above namad MICHAEL
D. KATKOCIN a5 and for' hi.. La'l.t 10.1\'11 .1nd To,,-t..mant, In the presence of
us who ha....e' 'lIUbflcr'ibed OUt' 'names ,hero to <'l,G wltne~..es, at his request,
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21-94-896
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
(each) a subsc,iblng witness to I
law, depose(s) and say(s) that
e,ewith, (each) being duly qualified according to
p,esent and saw
Ihe lestal , sign the same
request of teslal In
other subscribing witnes sll,
Ihal
presence IInd (In Ihe presen
signed as a witness at the
f each olhcr) (In the presence of the
d and subscribed befo,e
day of
19_
Reglsler
(Name)
IAdd,ess)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON.SUBSCRIBING WITNESS
~ FrFRNA Rl/ .L. ~-rKoC.IN
(each) a subscriber he,eto. (each) being duly qualified according 10 law, depose(s) and say(s) Ihat
we ar.e familiar with the slgnatu,c of Mlchae 1 D. Ka tkoc j n
~
will
M, VANJEI- k"A rk'oClN
that
we
of (one of the subscrlblllg witllesses (0) the
p,esented herewith and
oadIdl
believes the slgnlllu,e on Ihe will Is In the handw,itlng of
teslat or.
Mj~
10 the best of
OUT
knowledge and belief,
'~
,
Sworn to or affirmed and subsc,lbed before
me Ihis 20 I:h dllY of
October. 19~
'"h-\n,u 0 c..l!:, ~,'i,t~ARegISler
?d)
n A J-I (Name)
L".d'-1P ILL
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Uvt'll p 'tl/iie)
(Address)
CERTIFICATION OF NOTICE UNDER RULE 5.6!a)
Name of Decedent I M IC~Af'1- " KA f"KOc.l N
Date of Deathl OC1"o8~R O~ I 'f 'l!:f
Will No. A I '1 <.{ - Bct (p Admin. No.
To the Registerl
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Hules was served on or mailed to
the following beneficiaries of the above-captioned estate on
1'2.'07-"Irf I
,
Name
Address
.1ouph r,l<~1""f',\J
'i\' OJ.~ IJ)Oot> II IIUte: (l,(MP 1-1/1.1- r)..
I
gn.IMJ 1-, K~-(I<-OCI"" '50<; Sfe.u~\) 'DR,! wr.:sr r'AI-M 501-(, PI-
MAil EE'tJ p, JlRL ts.I vJL. c't" CCHA,}lfC:itrU;e" fA t1tJ.'i'J
t<.A-r"L~E"1sI t'I, I5/1!AIN,AI?P 3'-1/7 ~XPOi!p f?cJ).), WiI.L/A""$(itJlt."G VA
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) Qn~ l"~
,
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Signat:ure
Name M DA "II f.O I- I< t\'f'~Oc I N
Address '207 MApLE. Ave;
CDAt-1p HIt..L fA \'701 t
Telephone!11") '11, .'.i''e<rs
Capacity: >c Personal Representative
Counsel for personal
representative
Date: (1.. -09'. Cf'i
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Register of Wills of County, Pennsylvania
Cumberland
INVENTORY
ESlale of
Michael D. Katkocin
21 1994
0896
No,
also known as
nla
10/8/94
Date of Death
,Deceased Social Secu,lty No, 191-14 - 4 7 3 4
Parsonnl Reprosonlollve(sl of tho above ESIOID, dacensed, vorlly Ihol Iho Ilems eppoarlng III the following Inventory Include all
of tho pOlllonol asaels whOreYOl situote and all 01 Ihe rool ostoto in the Commonweallh of Pennsylvania 01 said Decedont. lhol
tho valuation placed opposile eoch ilem ot said Inventorv reprosonts iI. lair value 01 011110 dale 01 Ihe Decedent's deolh, and
Ihl11 Docodont owned no 1001 eslolo oulsldo of Iho Commonwoollh 01 Pennsylvania Olleept lhot which appear. in a memorandum
al tho and 0' thislnvl!Intory. I/We verify lhol the alalements mode In fhls Invontory ore Hue and corroct. Ime underslRnd Ihal
111100 allllomonla heroin oro modo suhloet 10 tho ponollios 01 18 Po, C,S. Seellon 4904 rolating 10 unsworn Inlallieation lu
mllllUflliutt,
Nome uf
A Hornov:
John R. Zonarich
19632
204 State Street
Harrisbu~q. Penns.~~iA 17101
Tolophono: (717) 233-1000
I,D, No"
Oalod
Noll 0'5 1115
Addross:
Doscrlptlon
Value
1. Real Estate
2. Stocks and Bonds
3. Cash, Bank Deposits and Personal Property
4. Jointly Held Assets
5. Transfers
$112,500.00
$151. 031. 38
$161,891. 70
$ 16,335.39
$ 18,568.50
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TOlnl, 460,326.97
(Attach Additional Sheets if necessary)
NOTL The McmoulIIdum DI leal cstala olllllefe the CDmmollwullh 01 renlllylvanla may. at the election DIllie pllflonlllleprlllenlallvlI,lnclufle
Iht! value of lIach lIem, but slIch linllfallllould nol bee_Ulllded inlo the lolel of Ihe Invel1lnrv.
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llNHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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COMMONWEALTH Of PENNSYlVANIA
DfPAUMENT Of RfVfNUf
DEPT 280601
HARRISBURG, PA 11171.0601
DfCfOfNt. NAME IIA t. ',Ut. AND MIOOU INITIAlj
KATKOCIN NICIIAEL D.
SOCIAl $feURltV NUM.fA 04n 0' DEAtH
+
(!.
'OA OATIS 0' OIATH AnlA 12/3119' CHICK Hili
" A SPOUSAL "
POVIATY CAlOIT II CLAIMIO,,' '._. .... '. __
fill NUMIIA
21
CO~t'nv COO!.,
1994
YfAR
011%
NUMI!R
... ~. '.._..n.__
207 NAPI.g AVI':NLJI';
CAMP 1111,1., I'llNNSYI.vANIA 17011
_~_~]AM~:~I!:=,[:j~~:'~~U~~biilj-=~~'''.
I ] 3 Remolnd.r R.luln
I'.' d.I.. .1 ,I.n.h f1.I.. I. 12.13,821
{]~. fed"ol ftlQI. TOil Relurn R.qulr.d
(211 __L 47'1. 9G
(2IA)
12181 _L 477.96
~ i.,
_~ 8 TUlell Numb., 0' SuI. O.podt Bo...
21. If line 18 i. gr.al.r than lIn. 19, .nl., th. diff.r.nc. on lIn. 21. Thl.l. lh. TAX DUI,
A. Enler the inl.r.'1 on Ih. balanc. due on lIn. 21 A.
B. Ent.r the Iota I of lIn. 21 and 21A on lIn. 218. Ihlt it th. BALANCI DUI.
Male. Ch.cle Payabl. tOI R.gllt.r 0' Will., Ag.nt _
f. ~~ BE SURE TO ANSWIR ALL QUIITIONS ON RIVIRSI IIDI AND TO RECHICK MATH ..c:..c:
Under penalti.. of perjury, J declare thai I have uamln.d thl. r.turn, Including accompan~lno sch.dul.t and .,ol.m.nh, and 10 the bill of my knowledge and b.li.f,
it is tru., correct and complete. I d.c1are thaI all real "tal. has b..n ,epofl.d 01 true ma,hl valu.. D.clmatlon of p"par.r other Ihon the p.nanol representalive is
based on IIlnformolion of which ,. a er has any knowl.dg..
"0 ""0' ""lUR~ AD."" 2'07(.f^'PLI~-7iVr.NUE'''''- DAlE
CI}.~IJ).lIJJ!J!,_r2.A_J?(JIL,,_. 9/26/95
ADOIIU 204 S'J'^'l'g s'rngg'l' OAIf
IIhHJU5UUHG....l'h...17.101__. q /26/9<;
fJ 1. Original Relurn
o 4. limited Estat. 0 40. fulur. Inte'''t Comproml..
(for dol.. a. d.oth olt., 12.1'.82)
o 6. D.cedent Di.d Teslate 0 7. D.c.dent Malnlaln.d a living lru"
(Attach copy of Will) (Alloch copy a. Trusl)
ALL CORRESPONDENCE AND CONfiDENTIAL TAX INPORMAnON SHOULD II DllllalD
191-14-4734
10/B/94
III A"II("'~IISU.YIYI~O SK)UU . NAI"Il""t, "I" AtlD ""DllIl 'tlll'A~j
N/A
OICl IN .
MI' A
OAIf 0' IIUH
o 2. Suppl.m.ntal R.lurn
1. R.ol Estate (Sch.dul. A)
2. Slack. and Sands (Schedule B)
3. Closely H.ld Slock/Partn.rshlp Inler.st (Sch.dul. C)
... Mortgage. and Not.. R.ceivabl. (Sch.dule D)
5. Co.h, Bank Deposils & Mlsc.llan.ou. P.rsonal Prop.,ty
ISth.dur. E)
6. Jointly Owned Property (Schedul. f)
7, Tron.f." (Schodul. G) (Sth.dur. LI
B. Total Grall Auels (10101 Lin.. 1.7)
9. Fun.ral Expen.e., AdminislrOliye CoUs, Mi.cellan.ous (9) _____?9.t 9,()2,.C)3
Expens.. (Schedule HJ
10. D.bls, Mortgage 1I0bIliU.., Li.ns (Schedule I)
11. Total D.ductlons (tolal Lines 9 & 101
12. Nel Value of eslate (line 8 minus Line 11)
13. Charitable and Go....rnm.nlal S.qU.sls (Sch.dul. JI
14. Net Value Subj.ct fo Tax (line 12 minus line 13)
15. Spou.al Transf.rs (for dal.s of d.alh after 6.30.94)
See Instructions for Af,plicabl. P.rcenlag. on Rey.rs. (15)
Sid.. (Includ. ...alues rom Sch.dul. K or Sch.dul. M.)
16. Amount of lIn. 14 101labl. at 6% ral.
(Includ. volu.s 'rom Schedule K or Sch.dul. M.I
17. Amounl of L1n. 14 IOllabl. at 15% ral.
(Include ...alu.s from Schedule K or Schedul. M,I
18. Prlncipoltax due (Add tall from lin.. IS, 16 and 11.)
19. Cr.djlS Spousal Pov.rly Cr.dil Prior Po.rm.nh
. + _~,J!.()Q_ +,
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JOHN R, ZONARICH ES UIRE
tfU'H(;NE NUMIER
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IIAllIlI HlllllHl, flJ-:NNIlYI.vAN IA 17101
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(1)...112.500.00
l21_J5.J,031.31l
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( ~ 1 ._~Q 1./ U 9 I . 70
(61.____1(j, 335.39
(71 ....JIl, 5GII.50
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(10) __..9.,U(j6..09
(t1,.P_'_~O, 76B.12
1"1 . ..4.2.~.L52!L..B 5
(131 '''''''_.' -0-
....__.--..1'-1. ..429.,558. B5
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(161
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....2.5_,.:? 7 3.53
(171
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(181
Dlununl
1,;!95.51
Inl."st
(19)
(20)
24.295.57
20. If line 191& gr.al.r thon lint 18. .nle, the diU".nc. on lIn_ 20. Ihh h the OVIA'AYMINT.
aD
Chec~ hele if you 0'0 fequo\linu n llI'u"d of your oVUlflflyfflunt
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Act '41 ef 1994 provIde. for the reduction of the tax rate. Impo.ed on the net value of trander. to or for
the u.. ef the .pou.e. The rate. a. pre.cr/bed by the .tatute will bel
· 3% (.N! will be applicable for e.tate. of decedent. dyIng on or after 7/1/94 anti before 1/1/96
e 2% (.112) wllf Ite .ppllcable for e.tate. of decedenll dyIng on or after 1/1/96 and before 1/1/97
I
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e 1% (.'1) will IN applicable for e.tate. of decedent. dyIng on or after 1/1/97 and before 1/1/98
e .'".., treneMr. occurrIng on or after 1/1/98 will b. exempt from InherItance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
IV PlACING A CHECK MARK (,,) IN THE APPROPRIATE BLOCKS.
i
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,
.:
YES NO
1. Olri tlecerient make 0 transf.r and:
,!
Q. retain the use or income of the property transferred, .......................................................
x
b. retain the right to d.slgnat. who .hall us. the prap.rty transf.rred or Its Incam., ..,............
C. r""" a reversionary Interest; or ...................................................................................
ri. receive the pramls. for IIf. of .lth.r paym.nts, b.neflts or cor.' ......,......,........................,
2, If de.th occurr.d on or b.fare O.cemb.r 12, 1982, did d.c.d.nt within two y.ars pr.cedlng
d.ath transfer prap.rty without r.c.lvlng ad.quat. consideration' If d.ath occurred aft.r
December 12, 1982, did dec.d.nttransf.r prap.rty within one y.ar of d.ath without rec.l-llng
adequate consideration...... ........... ..... ...... ........ ........ .......... ....t....,........ to...... ................ '''0
, ,
3. Old d.ced.nt own on 'In trust for' bonk account at his or h.r d.ath'..,.....,....,.......................,
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
'1
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Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters Testamentary
No. 1994-00896 PA No. 2194-0896
ESTATE OF KATKOCIN MICHAEL 0
I LI\~'l', J: J.K~'l', I'IJ.UUL"'j
Late of
HAMPDEN TOWNSHIP
~UM~~K~~~U ~UUN~I,
,
WHEREAS, on
dated Januarv
was admitted to
the 24th
21st 1992
probate as
Deceased
Social Security No. 191-14-4734
day of October
1994 an instrument
the last will of KATKOCIN MICHAEL D
(LI\~~, J:J.K~~, I'IJ.UUL"'j
late of HAMPDEN TOWNSHIP
8th day of October 1994 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to M. DANIEL KATKOCIN
who has duly qualified as. Executor(rixl
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 24th day of October
,
CUMBERLAND County, who died on the
1994.
~nQ~~ ~,~.~ ~~~B.~2~~'
U 'WgJ.s~ar or wrl:%~
-
LAST WILL AND TESTAMENT OF MICHAEL D, KATKOCIN
I. MICHAEL D. KATKOCIN. of Hampden Township, County of Cumberland
and State of Pennsylvania, being of sound and disposing mind, memory
and understanding. do hereby make. publish and declare this m~ Last
Will and Testament, hereby revoking and making void any and all former
Wills by me at any time heretofore made.
..
1.
I direct my Executor hereinafter named, to pay ail my just debt~
and funeral expenses as soon after my decease as the same can
conveniently be done.
2.
All the rest, residue and remainder of my estate. of whatsoever
nature and wheresoever situate. I give. devise and bequeath ~bsolutely
and in fee simple, in equal shares unto my five children, to wit:
M. Daniel Katkocin
Bernard L. Katkocin
Joseph J. Katkocin
Kathleen M, Brainard
Maureen F. Karlson
3.
Lastly, I nominate, constitute and appoint my son. M. DANIEL
KATKOCIN to be the Executor of this my Last Will and Testament. I
-1-
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direct that my Enecutor be encUsed from pos~ing bond to guarantee the
faithful performance of his duties.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
6(fJ day of January, 19ge.
\
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OM \ i".J~:f), \~~. --
~lil:hael D.~Katkocin
Si~ned, sealed, published and ceclared by the abov~ named MICHAEL
.
D. KATKCCIN as and for his Last Will and Testament, in the presence of
us who have subscribed our names hereto as witnesses, at his request,
in his presence and in the presence of
'1..' . ;'.. .. ..' :~ ,. ,'>-:
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Page I of yC,
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Ca.h, R.po,t tolol only,
(2) sto.~.. L1.t In d.'olI .v.'y .ommon 0' pr.f.rr.d ..,tifl.OI., worronl 0' olh., 'Ighll found In bOA, Slo.k. 0'.
to be designated by nome of company, certificate number, dote of cortificate, nome In which slock Is r.glllered.
and numb.r of .ho,.. and clolI of ,'ock,
(3) Obligation. of U, S. Gov.rnm.nll Numb.r of II.m.. dol. of IlIu., fa.. volu.. nom.I In whl.h r.glll.,.d
and Iyp. of own.rshlp, I,.,. lolnlly h.ld. poyobl. on d.olh, .,.,
(4) Bond.. O..lgnol. by nom., omounl, ..rlol numb.r. or olh.r d..lgnollon, (B.o,.r Bond.)
(51 Ban~ and Saving. and Loan Pa..boo~.. 5101. nom. of d.posilor, numb., of book. 10., dol. opp.oring In
book. nom. of bonk and branch. and balonc.,
(61 J.wolry, Coin., Stamp., Manu..rlpt., .t., LIII and d...rib. a. fully a. pOlllbl.,
(71 O..d., Morlgag.., Curr.nt In.uran.. Pollcl.. or oth.r .vld.n... of Ind.bt.dn.... L1.1 and d..c,ib. a.
lully a. pOlllbl.,
(8) All oth.r .ont.nla,
ITEM
NO,
ITEM DESCRIPTION
"? vr.,{,y
Dot. ~
/q/.J,~ 9t./
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NOTE. Attach addltlanalS'I2" X II" .heetl')If neceuary or u.e dupllcat.. af thl. page af form.
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-- -. --- -"_.
, .
Page
SAFE DEPOSIT BOX INVENTORY
'f of r(...
INSTRUCTIONS
(11 Cash. R.portlotal only,
(21 Slacks. LI.l In d.'ail .'.'y common 0' pr.f.rr.d c.rtificol., warronl 0' olhs, 'iShl' found in box, Slock. a,.
10 b. d..lsnal.d by nom. of company, c.rtlfical. numb.,. dol. of c.rtiflcal., nom. in which .,ock I. '.Shl.,.d.
and numb., 01 .ha,.. ond do.. of ,'ock,
(31 Obligations 01 U. S. Goy.rnm.nll Numb., of lI.m., dol. of inu.. fac. .olu.. nom.. in which '.Shl.,.d
and Iyp. o. own."hlp, I,.,. lolnlly h.ld. poyabl. an d.alh. .Ic,
(41 Bonds. O..isnal. by nom.. amounl, ..,ial numb.,. or olh.r d..lsnalion, (B<<a,.' Bond.)
(51 Bank and Sayings and Loan Passbooks. 5101. nom. of d.po.iIO'. numb., of book, 10., dol. app.a,ing in
book, nom. o. bank and b,anch. and balanc.,
(61 Jew.lry, Coins, SIamps, Manuscrlpls, .1.. Li., and d.",ib. a. fully a. po..lbl.,
(71 D..ds, Martllall", Curr.nl Insu,anc. Pallel.. or olh.r ovld.nc.. ollnd.bl.dn.... Li., and d."rlb. a.
fully a. panlbl.,
(B) All oth.r conl.nls.
ITIM ITEM DISCR'PTlON I - , ., . _.
NO, _ ' ' ' I r /) Cf
_ } G Ld ~,j-MAJo (J44-4-~7,"1iJ!E /()()0;~~,fL, '~~,~:.:'d7:I.~'~:"-"';::":';~LjA 7
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_ fJ I L,1 91.{ (1fW'E. ~ _ . <..'11 ). /nt4i2bI4/ti;-rt! f/ArI4~1'v
1';) ttn;Ifl/-q'i'1cE ?~ ;/-1'41
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t() if-rv?1(" -,l./-IJE ;2.(~ '(:/"
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~I ..rllly 'nJ!6r.p.nalty, 01 ~ 7:ir hJjo~. [.co,d Is corr.ct and co
and b rf" J"" II r, (7"~..1 / /// ,1).J
51gn 'r{C{IIU2J) 11-, LA. l- . /, IV (J// f
Print Name aneHm. /I- viP
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pl.'. to Ihe b.'Iit:~j~l~dli
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NOTE, Attach addlllanal8'hw )C 11 w sh..I!sllf ne....ary ar use dupllcal.s of Ihls pog. af farm.
'~ ),
:/ Page ') of ,-;-{
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
III Cash. R.port 10101 only,
121 Stock.. llllln d.lolI .v.'y common 0' p,.f.rr.d ..,tiflcol., worron. 0' olh., ,Ighl' found In box, 510ckl 0'.
to be designated by nome a. company, certifieat. number, date of certiflcat., name In which ItOell h reghlered,
and numb.r a. ,horll and don o' 'tDC~.
131 Obligations o' U. S. Gov.rnm.nll Numb., 01 iI.m.. dol. oll..u.. loc. volu.. nom.. In whleh r.gill.r.d
ond .yp. 01 own.rship. I..,. joinlly h.ld. poyobl. on d.olh, .Ie,
141 Bond.. O..lgnol. by nom.. amounl. ..,101 numb.,. or olh., d..ignollon, (B.a,., Bond.)
151 Bank and Savings and Loan Pa..book.. 5101. nom. 0' d<<po.IIO'. numb., 0' book. 1011 dol. opp.aring In
book, nom. 0' bonk and branch. and balanc.,
161 J.w.lry, Coins. Stamps. Manusc,lpll, .tc. lI.t and d.scrlb. a. fully a. po..ibl.,
171 D..ds, Mortgag.s. Curr.nt Insurance Pollcl.s or oth.r .vld.nc.. ollnd.bt.dn.... lI.. and d.scrib. a.
fully a. po..lbl.,
181 All oth.r cont.nts.
ITEM DESCRIPTION
1
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pl. . to tho b.st o. my knowl.~~ /
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NOTE. Attach additional By.,. xII. .heetl.llf nece..ary or u.. duplicate. of thl. page a' 'arm.
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Ca.h, Roport 10101 only,
(2) Slack.. L1,'ln dotoll o.ery common or proforrod ..rtilieolo. warrant 0' olhor 'Igh" found In box, Stock. oro
to bo dlllgnolod by nomo 01 company. cortlflcolo numbor. dol. 01 c.,tilleal.. nom. In which .tock I. r.gl.t.r.d.
and number of .ha,.. and clall of ,'ock,
(31 Obllgallano 01 U. S. Gavernmonll Numb.r of lI.m.. dol. 01 IIIu.. foco .olu., nom.. In which roglll.r.d
and Iypo 01 owno"hlp. I,.,. lolnlly hold. poyobl. on d.o,h. olc,
(4) Bond.. 0..19na'. by nomo, omounl. ..,101 number. or olh.r d.lIgnollon, IB.or., Bond.)
(5) Bank and Saving. and Loan POllbook.. 5101. namo 01 d.po.llor. numb.r 01 book. 10.' do'. appoarlng In
book. namo 01 bank and b,anch. and balanc.,
(6) Jowolry, Cain., Slamp., Manu.crlp'" olc, L111 and d..c,lb. a. fully a. pOlllbl.,
(71 Dlld., Martgagll, Curront In.uranco Pollelll or alher ovldonclI allndobtodnoll' U.l and d..crlb. a.
fully a. panlbl..
(8) All 01 her cantont.,
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of ~
.
111M DISC"~T10N
,
'(
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NOTE. A"ach additional 8'10. x ". shoot(s)It nocouary ar usa dupllcatos a. this pago ollorm.
~
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1
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I
I
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Ca.h. R.port 10101 only,
121 Slack.. llllln d.lall .very cammon a' pref.rr.d certllica'.. warrant a' alher ,Ighh found In box, Slack, are
10 b. dlllgnal.d by nom. of company. certlficol. number. dol. of cerllflcal., name In which 'lack Is regltter.d.
and number of tharll and clan of 'tack,
(31 Obllgallon. of U. S, Governm.nll Number of i'.m,. dol. allnu., face valu.. namll in which ,eglller.d
and Iyp. of awn.rship. I,.,. jointly h.ld. payabl. on d.alh. .tc,
141 Bond.. Olllgnal. by nom.. omaunl. ..,101 number. 0' alher dlllgnallan, (B.a,er BondI)
(5) Bank and Saving. and Loan POllbook.. SIal. nom. of d.potltor. number of book. 10'1 dol. app.o,ing in
book. nom. of bank and b,anch. and balance,
161 J.w.lrv. Coin., Slamp., Manu.crlpt., elCl lI,l and d.scrlb. a, fully a, panibl.,
(71 O..d., Mortgage., Curr.nlln.uranu Pallel.. or olher evld.nce. of Indeblednelll llsl and d.scrib. a'
fully a, ponlbl.,
(a) All olher conl.nl..
--
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,Wl1liL ,1/bJ174 IN)t
I'hll/UJ. '~(N'
NOTEI Allach addlllanal B'I2M x 11 M .heell') If neC.llary or u.. duplicate. af thl. page of farm.
1"".--,. ,
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Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
11) Ca.h. Report total only,
12) Stocks. L1.lln delail eyery cammon or p,ererred certificate. warrant or athe, ,Ioht. laund In box, Slacks a'e
10 be deslonated by name 01 company, c.rtUlcale numbe" dale 01 certUlcate, nom. In which .Iack Is ,eolllered,
and numb.r 01 .ha,e. and clan 01 .tack,
13) Obflgatlans of U. S. Govemm.nll Numbe, alllem.. dot. of Inue, lac. yalu.. namu In which ,eolllered
and Iype 01 ownership, I,.,. (alnlly h.ld, payable an death, .tc,
14) Bondsl O..lgnale by name, amount, .e,lal number. or ather dulgnallan, (Bea,er Band.)
(S) Bank and Savings and Loan Pa..boaksl Stat. name 01 depa.itar. number 01 book, la.t dale appearing In
book, name 01 bank and b,anch, and balance,
(6) J.w.lry, Coins, Stamps, Manu.crlpll, etcl L111 and duc,lbe a. lully a. panlble,
(71 D.ed., Mortgag.., Curr.nt Insuranc. Poflcl.. or oth.r .vldences of Ind.btedn.... Li.t and dl"rlbe a.
lully a. panlble,
18) All other cont.nll.
~
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,
if
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NOTEI A"ach additional 8'12 - x II- sh.et(.11f nece..ary or us. duplicate. of thl. page of form.
..i
I
!
,
Page + of??
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(II Co.h. Report 10101 only,
(21 Stock.. lI.lln deloil every common or p,eferred ..,tiflcole. worronl 0' olhe, ,jghu found In box, Slack. ore
10 be de.lgnoled by nome of company. ..rtiflcole numb.,. dol. of c.rtlflcol.. nom. In which .10ck i. ,egl.II,ed.
and numb., of .ho,e. and clan of .Iack,
131 Obligation. of U. S. Governmenll Numbe, of II.m.. dol. of Inu.. foc. volu.. nom.. In which ,.glll.,.d
and Iyp. of own."hjp. I.... lolntly h.ld. payable on d.olh. ele,
(4) Bond.. O.Ilgnol. by nom.. amount. ,"rlol numb.r. or olh., d..lgnolion, (B.ar., Bond.)
(SI Bank and Saving. and Loan Poubaok.. 5101. nom. of depo.llor. numb., of book. 10.1 dol. app.orlng in
book. nom. of bonk and b,anch. and bolonc.,
(6) Jewelry, Coin., Stamp., Monu.crlpla, etc, lI.t and de.c,ib. o. fully a. ponible,
(71 Deed., Mortgog.., Current In.uranee Pollcl.. or other evidence. of Indebtedneu, lIII and d.scrlbe o.
fully o. ponlble,
(81 All other content..
'tit
10 the be.t of m)' kno'll'led)le
( () , )-0- ~
Oat.
'I:
NOTE, Attach additional 8'12 N x 11 N .heotl')If nocouary or u.o duplicate. of thl. pogo of farm.
~ of 7~
Poge
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Ca.hl R.port tolol only,
(2) Stockl! Lilt In d.lolI .y.ry common or pr.f.rr.d ..,llIlcOI., warrant 0' oth., 'ighll found in box, Slockl 0'.
10 b. d.lignol.d by nom. a' company. c.rtlficol. numb.,. dol. a' c.,lillcol., nom. in which Ilock is flgill.,.d,
and numb.r of Iho'.1 and clOII of Itock,
131 Obligation. a' U. S. Gov.rnm.nll Numb., of It.ml. dol. of IlIu.. 'oc. yolu.. nom.. in which flgisl.,.d
and typo a' own.rship, I,.,. lolnlly h.ld. poyobl. on d.oth. .,c,
(41 Bondll O.Ilgnat. by nom.. amount. 1.,101 numb.r. or olh.r dlllgnolion, (S.o,.r SandI)
(51 Bank and Saving. and Loon POllbook II 5101. nom. of dlpolito,. numb.r a' book, 1011 dol. opp.o,lng In
book. nom. of bonk and b,onch, and bolonc.,
(61 J.w.lry, Coin., Stomp., Manu.crlpt., .tCI Lilt and d.lCfib. 01 'ully 01 pOlllbl.,
171 O..d., Mortgag.., Curr.nt In.uranc. Pollcl.. or oth.r .vld.nc.. of Ind.bt.dn.... Lilt and dllc,ib. 01
'ully 01 pOlllbl.,
(81 All oth.r cont.nll.
I~:f ITlM DlSCIIPlION
UIlJIt'jJ.U/' t::; Cd .j,j &~/f\ n (t;f.I. Ct4tt )- VVG:. J..~~
:.,,,, - l~l lu 71, fJ ~ ~? Lf "bJ'ZU
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I c.,tlly unci.. ~a~ty a' p.rIJlry~tll.7~. ~~ard'I' ~o!r.ct and campl.t.1a the b..~c:..' my knowl")lg.
andb.II.'.i":i .I.~/Jj AI Ilfrx '//" //.uh A lu-J..-t-fF
SI,.",".. (t~IC((I~f4) /I., LA- /oW2A/c;uJ /I- /JP Da,.
Prlnl Nam. ond Tltl.
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NOTE. Attach additional 8 'h - x 11- .heetl.llf nece..ary or u.e duplicate. of thl. page of farm.
-"'. 1
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Ca.hl R.port 10101 only,
(21 Slock.1 lI.t In d.lolI .very common or pref.rr.d ..rtlllcol" worranl or 01 her 'Ighl' lound In box, Slach ore
10 b. dlllgnol.d by nom. of company. c.rtlllcal. number. dole of ..,tlflcol.. nom. In which Ilack II reglller.d.
and number of .ha," and clOII of Ilack,
(31 Obllgallon. 01 U. 5, Governmenll Number of lI.m.. dol. of IlIu.. fa.. valu.. namll In which regl'ler.d
and Iyp. 01 own."hlp, I,.,. lalnlly h.ld. payabl. on d.alh. .Ic,
(4) Bond.. olllgnale by nom.. amaunl. ..,101 numb." or 01 her dllignatlan, (B.ore, Bondi)
(51 Bank and Saving. and Loan POllbook.. 5101. nome of d.pa.ila" number of book. 1011 dol. app.a,ing in
book. nom. of bonk and b,anch. and balance,
(61 J.w.lry, CoIn., Slomp., Monu.c,lpl., etcl L1.1 and d.",ib. a. fully a. pOllibl.,
171 O..d., Mortgage., Currenlln.u,ance Poflel.. or olher evldenc.. of Indebl.dn.... L111 and dl",ib. 01
fully o. pallibl.,
(81 All olher cont.nl..
9
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I
(I:J
Page I () of 'Y&
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Ca.h. Report lolal only,
121 Stocl... lI.t In delall every common 0' preferred certllicote, warrant a, alher ,Ighu found In box, Stock. are
10 be d..lgnaled by name of company, certlflcale number, date 01 certilicale. name In which ,'ack i. regl.tered,
and number of .ha,.. and clan of .tock,
131 Obligation. of U. S. Govemmenll Number of lI.m., dol. 01 inu., lac. valu., nom.. In which reglst.r.d
and typo of own.rship, I,.,. jolnlly held, payabl. on d.ath. etc,
(4) Bond.. O..lgnot. by nom., amounl, ..,101 numb.r, or olh.r d..ignatian, (Bea,.r Bond.)
(51 Bank and Saving. and Loan POllbook.. Slate nom. of d.po.itor, numb.r of book, la.t dol. appea,ing In
book, name 01 bank and b,anch, and balanc.,
(61 Jewelry, Coin., Stamp., Manu.crlplo, etc. lI.t and d..c,ib. a. fully a. posslbl.,
(7) Deed., Mortgage., Current In.urance Policies ar ather evidences of Indebtedne... 1I.1 and d..c,lb. a.
fully a. possible,
(BI All ather contenlo.
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NOTE. Attach addltlanal 8...." x II" sheetlsllf neceuary ar use dupllcat.s af this page af farm.
of??
{f
Poge
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
III Ca.h, R.port 10101 only,
121 Stock.. lI,'ln d.lolI .very common 0' prel.rr.d ..rtilltal.. worron' or olher ,Ighh found In bo., Sloth ore
10 b. dlllgnol.d by nom. of company. ..rtilltol. number. dol. 01 t.rtillcol'. nom. In whith ,'otk II regl"er.d.
and number of .ho,.. and clan of .Iotk,
(3) Obligations of U. S. Gav.mm.nll Number of It.m.. dol. oll"u.. fat. valu.. nom.. In whlth flgl,'er.d
and typo of awn.nhip, I,.,. lolnlly h.ld. payabl. on d.alh. .It,
(4) Bond.. Olllgnal. by nom., amounl. ..,101 number. or 01 her dllignallan, (B.a,er Bond.)
(5) Bonk and Saving. and Loan Pa..baok.. SIal. nom. of d.pa.lto,. number of book. 10.1 dol. app.arlng In
book. nom. of bonk and b,anth, and balant.,
(6) J.w.lry, Coin., Stomp., Manu.c,lpt., .tc, U.l and d.mib. a. fully a. panlbl.,
171 D..d., Martgag.., Curr.ntln.u,an.. Pollcl.. or ather .vld.nc.. of Ind.bt.dn..., lI11 and d..trib. a.
fully a. panlbl.,
(8) All ather cont.nt.,
ITIM 1
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I certifY' und p.nalty 1'f "'rlury t,;.r, th~bo:" record I. corr.ct and compl.t. to the b..t of my knowl.djl.'
anu 'l"l'.l" .~ " ~f /,/ .-Y 'lr-'7n/l J. UIU,JO //;~ 2--(--0/ ~
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NOTE. Attach additional 8'12 w x 11 W sheetls)If n.c.ssary ar us. dupllcat.s of this pog. of form.
":i
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Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
111 Ca.h. RepClrtlolol only,
(21 Stac~.. lI., In deloil eve,y common or p,eferred certlllco'e, worron' 0' olher 'IShII lound In box, Slac~. ore
10 be de.lsnaled by name of compony. certi/lcale number. dole olcertillco'e. nome In which Iloc~ I. resl'lered,
and numb.r of shore. and clan of ItoC~.
131 Obllgallan. of U.S. Gavemmenh Number ollleml, dole ollnue, lac. volu., namOl In which r.slslered
and 'ype of owne"hlp, I,.,. lolnlly h.ld. payable on deolh, e'c,
(4) Bondll Designate by name, amount, serial numb.r, or other designation. (Bear.r Bonds)
151 Ban~ and Savlnll' and Loan Pa..bao~.. SIal. name of depalllor, numbe, 01 boo~, 101' dol. app.arlng In
boo~. name af bon~ and bronch. and bolonc.,
(6) J.w.lry, Cain., Stamp., Manu.c,lph. .tc. lI.t and d.scrlb. a. lully a. ponlble,
171 D..d., Morlgall", Curr.nt In.uranc. Palld.. or other evld.nc.. of Ind.bt.dn.... LiI' and d.scrib. a.
fully a. posslbl.,
(8) All ath.r cant.nt..
I Y' of
-vi
ITIM DISC.IPTION
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NOTE: A"ach addltlanaI8..... X II. .h..t!.,lt n.c.llary or u.. dupllcat.. o' thl. pag_ of form.
:(9'
If
of :z?
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Ca,h. R.po" 10101 only,
(21 Sloch, Lilt In d,'oil .v..y common or prtl.rr.d .."iflcot., warrant or olh.. rlghll found In box, Slack< art
to b, de.lgnoted by name 0' company, certificD" numb.r, dal. 0' urtificat., name In which ,'ock Is 'Igillered,
and numb.. 01 .ho,.. and clan 01 IIock,
(3) Obligation, 01 U. S, Gov"nm.n" Numb.. of H.m.. dot. of IlIu.. 10.. valu., nom.. In which rtglll...d
and typo of awn...hlp. I.... 'alnlly h.ld. payabl. an d.ath. tic,
(4) Bondi. Ol.ignol. by naml, amount, ..rial numb.r, or other dellgna'ion. (Bear.r Bondi)
(5) Bank and Saving, and Loan POllbook.. Stal. nom. of d'pa.itar, numb.. 01 book, 10., dol. app.a,lng In
book, nom. of bank and branch. and balan..,
(61 J.w.lry, Coin" Slamp', Manu,..lpla, .Ic, L1., and d..c,lb. a. lully a. panibl.,
(7) D..d" MortgagOl, Curr.nlln,uranc. Pollcl., 0' olh" .vld.nc.. ollnd.bl.dn.,.. L1., and d....ib. a.
fully a. panlbl.,
(B) All o,h" conl.nl..
ITIM DISC'''T10N
1- ') 7(, ~ 52;~
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NOTE, A"ach addltlanal B..... xlI. .h..t(.,ll n.c...ary or u.. dupllcat.. althl. pall' 0' 'o,m.
/ Y- of ~
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Ca.h. R.port 10101 only,
(21 Slack.. lilt In d.loil ..ery common 0' proferrod ..rtificOI., worronl or olher 'Ighll found in box. Sloch 0"
10 b. d..ignol.d by nom. of company. ..rtlllcol' numb", dol. of ..rtllicol" nom. In which Iloc~ it roglller.d,
and number of .ho,.. and clolI of Itoc~,
(3) Obllgallon. of U. S, Gov.mm.nh Numb" of lI.ml, dol. of IlIu.. fa.. valu., nom" In which roglll".d
and typo of own."hip, I,.,. jolnlly h.ld, poyobl. on d.oth. .IC,
(41 Bond.. O"lgnol. by nom., amount. ..rial number, or olher d"lgnollon, (B.oro, BondI)
(5) Bank and Saving. and Loon POllbook.. Sial. nom. of d,polllor. number of boo~, 1011 dol. opp.oring in
boo~, nom. of bon~ and b,onch, and bolon..,
(6) J.w.lry, Coin., Slamp., Manu.crlpl., .Ic. Lilt and d"crib. 01 fully 01 pOllibl.,
(7) Olld., Mortgag... Curronl In.uran.. Pollel.. or 01 her .vld.nc.. of Ind.bl.dn'II' Lilt and d.mib. 01
fully 01 pOlllbl.,
(II All other conI. nil. I' ·
I
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and I{,jll~'/ //// 'AI f a 0<. .../1/7// j/'" // ~ t(r') r-ft 'f/
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P,ln' Nam. an" Title
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;
/
I.J
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of
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(I) Ca.h, R.part ta'al .,nly,
(2) Slacks, lIl1ln d.tall .v.ry cammon or prof.rr.d c.rtificat.. warran' or alher .Ighll found In baa. S'ach aro
10 b. d..lgnat.d by nom. of company, corti/lca'. number, dol. of cortiflca'.. nom. in which 'lack h rogh'or.d,
and number of ,ha,.. and clall of 'tack,
(3) Obflgallan. 01 U. S. Gov.mm.nll Number of it.m.. dol. 0/ IlIu.. fac. valu.. nom.. In which rogh,".d
and typo of awn."hip, /,." lalntly h.ld. payabl. an d.a,h. .,c,
(41 Bond.. O..lgna'. by nom., amoun', ..,101 number, or alher d..lgnalian, IB.aror Band.)
(5) Bank and Saving. and Loan Pa..book.. S'a'. nom. of d.pa.ita" number of book, 10" dot. app.a,lng In
book, nom. of bank and b,anch. and balanco,
(6) J.w.lry, Cain., Slamp., Manu.crlp'" ,'cl lI.t and d..c,lb. a. fully a. palllbl.,
(7) O..d., Martgag.., Curr.nlln.uranc. Pallel.. or olher .vlel.nc.. al/nd.bt.dn..., lI.t and d.",lb. a.
fully a. palllbl.,
(8) All ather conl.nl..
.'
. card I. carred and campl.,. 10 Ih. b.., 01 my knal"l.dg.
-' ' ;J f-C}e::.
Da,.
NOTEI A"ach additional B'Ia- xlI- sh..t(s) If nee.uary a. u.. dupllcat.. af this pag. of fa.m.
,
(
'f.
Page ~ of yf.
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Calhl R.port 10101 only,
(2) StoCkl1 Ullln d.lolI .very common or prof.rr.d nrtlllcol.. warrant 0' olh" 'Ighll lound In box, Slacks oro
to b. d"lgnol.d by nom. 01 company, c.rtlflcot. numb". dol. 01 c.rtlllcoI.. nom. In which Ilock h roglll".d.
and numb" 01 Ihorll and clOII olllock,
(3) Obligation I of U. S. Gov.mm.nh Number olll.ml. dol. ollllu,. 10Ct volu.. nom.. In which roglll.rod
and typo 01 own.rshlp, I,.,. lolnlly h.ld. payabl. on d.olh. .Ic,
141 Bondll O..lgnal. by nom.. amount, 1,,101 numb.., or olh.. d..lgnollon, IB.aro, Bondi)
(5) Bank and Saving I and Loan POllbook.. SIal. nom. 01 dlpolilor, numb" 01 book,loll dol. opp.o,lng In
book, nom. 01 bonk and b,onch, and bolonn,
(6) J.w.lry, Coin.. Stamp., Monulcrlptl. .Icl lilt and dllcrlb. 01 lully 01 pOlllbl.,
171 D..dl, Mortgag,", Curr.nt Inluranc. Pollel.. or olher ..Id.nc.. ollnd.bl.dnll" lIll and d..c,lb. 01
lully 01 palllble,
(B) All other conl.nll.
ITEM DISCI'PIION
.. record II corr.ct and campl.l. to Ih. bill of my knowl.dg.
'I..
-Oe V AI". , ---1
NOTE. Atlach addltlanallJ...... x II" sheet(s) If neceuary or use dupllcole. ofthl. page of farm.
@.
I
,
, i
I
i
Page () af ~
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Ca.h, R.por1lalal only,
(21 Stock" lI,'ln d.lall .v.ry common 0' pref.rr.d c.rtificol.. worronl or olh., 'Ighl' lound In box, Slacks or.
10 b. d..lgnol.d by nom. of company. certillcol. numb.r. dol. of ce,lillcol.. nom. In which .Iock II '.glll,,"d.
and numb., of .har.. and clolI of ,'ock,
(31 Obligation. of U. S. Gov.'nm.nl' Numb., of lI.m., dol. of IlIu.. lac. valu.. nom.. In which ,.gill.r.d
and type of own.rshlp. I..,. lolnlly h.ld. poyobl. on d.olh. .Ic,
(41 Bond.. O..lgnal' by naml. omounl. ..,101 number. or olhor d..lgnollon, (B.are, Bond.)
(51 Bonk and Savings and Loan Paubook.. 5101. nom. of dlpa.llo,. number of book. 10.' dol. app"o,jng In
book. naml 01 bank and b,anch. and balance,
(6) J,wllry, Coin., SIamps, ManulCrlpt., IIc, lI.t and dlscrlb. a. lully a. pOllibll,
(7) D..d., Morlgagll, Curr.nl In.urane. Pollcl.. or olh.r .vld.nus of Ind.bl.dn.u, lI., and dlmlb. a.
lully a. pOlllbl.,
(8) All olher eonl.nl..
ITEM DESCRIPTION
7
I . above record I. eorr.el and campl.I. to Ih. b..I of my knowlldg.
Oat.
Iq:N/9''i
r.
NOTE, Attach additional 8'/2" x II" .h..t('llf n.e...ary or u.. duplleat.. of thl. page of form.
d
t:
-I
I Y of 'b(
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(I) Calhl R.port 10tal only,
121 Stock.. lI111n d.toll .very common or pref.rr.d certificol.. worranl 0' other 'Ighl. found In boa, Stocks ore
to b. d..ignat.d by nom. of company. c.rtiflcot. number. dot. of ce'tificot.. nom. In which .tock I. regi.ter.d.
and number of .ho,.. and clan of .tock,
(3) Obllgatlonl of U. S. Gavernm.nlt Number of it.m., dol. of Inu.. lac. volu., nom.. In which regl.ter.d
and Iyp. of own.rshlp. I,.,. Jointly h.ld. poyobl. on d.oth, .IC,
(4) Band.. O..lgnol. by nom.. amount. ..rial number, a, ather d..lgnolion, (B.are, Bond.)
(5) Bank and SavIng I and Loan Pa..baak.. SIal. nom. of d.po.itor, number of book, 10.1 dot. opp.oring In
book. nom. of bonk and branch. and bolonc.,
(6) J.w.lry. Calnl, Stompl, Manulc,lptl, .tCI lI.t and d..crlb. o. fully o. pOllibl.,
(7) O..dl, Martgog.., Curr.nt Inluranc. Pallet.. or ather evld.nc.. of Ind.bt.dn'''1 lI.1 and d..c,lb. a.
fully o. pOlllbl.,
IB) All ather cant.n".
ITIM DlSClt'1I0H
J
Clf,
bon record II carr.ct and campl.t. to tho bOlt of my knawl.dg.
(t.
I049-}; 9L/
P,lnl ~-r'~ on
kl{ i t
NOTEI Attach additional B'12" x II" .hootl')If noco..ar)' or u.. dupllcat.. of this page of form.
.. -. ......... ........
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
III Ca.hl Rlpart tolal only,
(21 Stac~lIl1llln dltall .vory cammon a' prolorrod corti/ical., warrant or alhor 'ighll laund In box, Sloch a,e
to b. dlllgnolld by nom. of company, Clrtlficat. numb.r, dot. of certificat., nome In which stock is rlgister.d.
and numbor allha,.. and clall Olllock,
131 Obligation. of U. S. Gov.mm.n" Numbor 01 il.ml, dale 01 illue, lac. value, nom.. In which "gllle,ed
and Iyp. of awn."hlp, I.." lalnlly h.ld. payabl. on d.alh, lIe,
141 Bond.. O..lgnal. by nom', amount, ..,ial numbor. or o,h.r d..lgnallon, (B.ore, BondI)
(51 Ban~ and Saving. and Loan Pallboo~1I Sial. nom. 01 d,pollto,. numbor 01 book. 1011 dol. appea,lng In
book, nom. 01 bank and b,anch, and balanc.,
(61 J,wllry, Coin., Stamp., Manu.crlpt., .t.. 1I.. and d..c,lb. a. lully a. posslbl.,
(7) D..d., Mortgagl', Cu,ront In.uranco Pallel.. or other Ivld.nc.. of Indlbtldnl'" Li., and d..c,ib. a.
fully a. possible,
(81 All other contlnt..
/ 7 of -;(
.
ITIM DISCIIPTION
r
'17
7
- 'In
. :'/i
r Inalty 01 PlrjUry that thl abavI record I. carr.d and complltl to tho b..t of my knowlldgl
p,l Ha",) an t J
/la - "'L (V;:
NOTE, AHach additional 8'11. JC 11. .h..tl'llf n.c...ary or u.. dupllcat.. of thl. pall. of farm,
Page "'}..U of ??
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(I) Ca.h. R.part tala I only,
(2) Slack" L1111n d.lail .y.ry common 0' pref.rr.d c.rtiflcal.. warranl or alher 'ighll found In box, Slacks are
10 b. d..ignal.d by nom. 01 company, certifical. number. dol. 01 c.rtlllcal.. nom. in which .Iack I. reglster.d.
and number 01 .har.. and clau 01 .Iack,
(3) Obllgallan. of U. S. Gav.mm.nll Number alll.m., dol. of luu., fac. yalu.. nom.. In which reglller.d
and Iyp. of awn."hlp, I,.,. jointly h.ld, payabl. on d.alh, .tc,
(4) Bond" O..lgnal. by nom., amaunl. ..,101 number. or alher d..lgnallan, IB.a,er Bond.)
IS) Bank and Savings and Loan POllbook" 5101. nom. cf d.palilar. number of book, 10.1 dol. app.a,lng In
book, nom. of bank and b,anch. and balanc.,
(6) J.w.lry, Coin., S'amps, Manusc,lpl., .... L1.1 and d.",lb. a. lully a. paulbl.,
(7) O..ds, Martgag.s, Curr.n. In.uranc. Pallcl.. or a.her .vld.nc.s of Ind.b..dn.s" L1.1 and d.",lb. a.
lully a. paulbl.,
(8) All a.her can'.nll.
!TIM
NO,
ITIM DISC."TION
cord Is co mod and campi... '0 .h. b.s' 01 my knawl.dg.
[.1 I t.~
NOTE. A"ach additional 8.... - xlI- sh..tlsll' n.c...ary or us. duplicates a. this pall. a. 'orm.
Page () of U
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Cash, R.po'l 10101 only,
(21 Stock.. L1llln d.lolI .v.ry common 0' p,.f.rr.d c.rllflcol.. warrant a, ath.r ,lOhll found In box, Slockl a,.
10 b. d.llonat.d by nom. of company, urliflcal. numb.r, dot. of c.,tlllcat.. nom. In which Ilack Is r.olll.r.d.
and numb.r of Iha'.1 and clall of Ilack,
(3) Obligation. of U. S, Governm.n" Numb., of It.ml. dol. of IlIu.. fac. valu., nom.. In which '.Ol.t.,.d
and typo of awn."hlp. I,... lolntly h.ld. payabl. on d.ath. .tc,
(4) Bond., O.Ilonat. by nom., amaunl, IIrlal numb.r, or oth.r d.slonatlon, (B.a,.r Bondll
(5) Bank and Saving. and Loan Paubaok., 5101. nom. of d.po.ltar, numb.r of book, lalt dot. app.a,lno In
book. nom. of bank and b,anch, and balanc.,
(6) J.w.lrv, Coin.. Stamp.. Manu.crlp'" .tc, Lilt and d..crlbe 01 fully 01 palllble,
(7) O..d., Mortgag.., Curr.nt Inluranc. Pallcl.. or oth.r .vld.nc.. of Ind.bt.dn.u, L1n and de.crlbe 01
fully a. pOlllbre,
(0) All oth.r conl.nt..
ITEM DESCRIPTION
7
I . above r.cord I. corr.ct and compl.t. to tho b..t of mv knowl.dg.
r.
NOTE. Attach additional B'l:aW x 11 W sheet!s)I' neceuory or use duplicates a. this page a. 'orm.
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
III Cash. R.part lalal only,
121 Stack.. llllln d.lall .yery camman ar pref.rr.d c.rtlflcal.. warranl ar alher ,Ighll faund In baK, Slacks are
la b. dlllgnal.d by name af campa ny, ..rtlllcal. number, dal. af c.rtlllcal.. nam.ln which .Iack II reglller.d,
and number af shar.. and cia.. af "ack,
131 Obllgatlans of U. S. Gavernment. Number af lI.m., dale af I..ue, face yalu., nam.. In which regl.ter.d
and Iyp. af awn."hlp, I,... lalnlly h.ld. payabl. an d.alh. .Ie,
141 Band.. O..lgnal. by nam.. amaunl, ..,Ial number, ar alher d..lgnallan, (B.arer Band'l
151 Bank and Savings and laan Pallbaakll Sial. name af d.pa.llar, number af baak, la'l dal. app.a,lng In
baak. name af bank and b,aneh, and balance,
161 Jew.lry, Calns, Stamps, Manuscripts, .tc. U.t and d..crib. as fully a. pa..lbl.,
171 O..ds, Martgag.s, Curr.nt Insuranc. Pallcl.s ar ather evld.nc.s af Ind.btednesll u.t and d.scrlbe a.
fully a. pa..lble,
lBI All ather cant.nll.
I r of -b(
ITEM DESCRIPTION
'J
e,f,
f,
bavo record Is carr.ct and campl.t. to th. b.st of my knawl.dg.
',Int ~.,.,. an
kIt: t
NOTE. Attach additional Sin. x"" sheet'sllf necessary or us. duplicates of this page of farm.
/ '1 of ~
.
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
III Ca.hl Rlport 10101 only,
(21 Stack.. list In dlloll IVlry common 0' preflrrld certiflcoll, worranl or 01 her 'Ighll found In bo., Sloch are
10 bl dl.lgnalld by noml of company, certllicol. numbo" dol. of c.rtlllcOII, nomlln which \lock 10 ,.glllerld,
and number of Iho'.1 and cia.. of Ilock,
(31 Obllllatlonl 01 U, 5, Gav.mmonll Numb.r allloml, dol. ollllUI, lOCI voluo, nomll In which ,.ghl.,od
and Iypl of own In hip, I.... lolnlly hold, poyobl. on dlolh, .Ic,
(4) Bond'l O.llgnol. by nom., omounl, ..rial numbor, or oth.r d.llgnollon, IBlorer Bondll
(51 Bank and savlnll' and Loan Paubook.. Sial. nom. 01 d.polllor, numbor 01 book, 101' dol. applo,lng In
book, nom. 01 bank and b,anch, and bolonc.,
(61 Jlw.lry, Cain., Stamp., Manu.c,lpt., .tCI lilt and duc,lbl a. fully 01 pOlllbll,
(71 O..d., Martllall.', Currlnt In.u,anc. Pallel.. or oth.r .vld.nc.. al Ind.bt.dn.... lilt and duc,lb. a.
fully 01 pa..lbl.,
(BI All ath.r cantont.,
ITIM
NO,
ITIM Dlsc..nION
..
'I)
7
- 'If)
::'/1
rJ
/eJO, 00
r .nally 01 p.rfury that th. abav. record I. carr.ct and compl.t. to th. but 01 my knowl.dll.
"1. Na"'lGn 1't. L
lU' , (1/;,
NOTEI ""ach addltlanaIS.... - xlI- .h..tl.11f n.c...ary or u.. dupllcat.. 01 thl. page 01 farm,
(if)
.:./
CL't
fU
J-~
Page 'tv of '}?
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
111 Cash. Roport total only,
121 Stock.. L1.lln d.toll ov.ry common 0' p,oforr.d corti/icoto, worronl or olh.. ,ighlllound in boo, Stock. 0'0
10 b. d..lgnotod by nomo 01 company. cortillcolo numbo" dolO 01 corti/lcolo, nom. in which IIock I. ,ogl.t..od,
and numbor of .horo. and clan of Ilock,
131 Obligations of U, S, Govommonll Numb.. 01 it om', dot. of inu.. lac. volu.. nom.. In which roghto,od
and typo 01 own.rshlp. i,.,. joinlly hold, poyoblo on doolh. .Ic,
141 Bond.. O..ignolo by nomo, omounl. ,0,101 numb... 0' olho, dOllgnolion, (Soo'or Sand.)
151 Bank and Savings and Loan Paubaoks: Stolo nomo of dopo.ilor, numbo, of book, 10.1 doto opp.o,ing in
book, namo 01 bonk and b,onch, and bolanco,
161 Jowolry, Cain., Stamps, Manuscripts, otc, lI.1 and d..c,ibo a. fully a. ponlblo,
171 OOIds, Mortgagos, Curront Insuranco Pollclos or othor ovldoncos of Indobtodnou, L1.t and doscribo a.
lully a. ponibl.,
IBI All othor contonts.
!TIM
NO,
ITIM DISC.tHIOH
cord Is conoct and comploto to tho bo.t of my knowlodgo
{..-; Ll /] L' IJ. V,?
NOTE: Anach addltlonaIB'I.- x 11- sh..tl.11t n.c.nary or u.. dupllcat.. of thl. pag. of form.
Page ry ( of rlG
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
111 Calh. R.port 10101 only,
121 Stack.. lIll In d.lolI .very common 0' pref.rr.d certificol., worronl 0' olher righl' faund In box, Slacks ore
10 be d..lgnol.d by nom. 01 company. c.rtilicot. number. dol. of ..rtificol., nom. In which .Iock I. regi'lered,
and number of Iho,.. and dOli of .10ck,
(31 Obllgatlane al U, 5, Gav.mm.nll Number of lIem., date of IIIU', fac. valu.. nomOI In which regl.ler.d
and Iyp. of awn.rshlp, I,.,. lalnlly h.ld, payabl. an d.a.h, .Ic,
(41 Bond.. DOIIgnal. by nom., amaun.. ..,101 number. or alher dOllgnallan, (B.are, Bond.)
15) Bank and Saving. and Loan Pa..boak.. SIal. nom. of d.pa.ita" number of book, 10" dol. app.a,lng In
book. nom. of bank and branch. and balanc.,
161 J.w.lry. Coin.. Stamp., Manu.crlpll, .,c. L1.. and d..c,lb. a. fully o. pOllibl.,
17) D..d., Mortgag... Curr.nt In.uranc. Pollcl.. or oth.r .vld.nc.. 01 Ind.bt.dn'II' L1.1 and d..c,lb. a.
fully a. posslbl.,
18) All oth.r cant.nll.
ITIM DISCRIPTlON
Is c.~
CS/JI.J.3fS
1,
that t . abav. record I. carr.ct and compl.t. to tho b..t a' my knowl.dg.
,4 'Ow-.
NOTl. A<<ach additional 8y,,- xii- .h..tl.II' nee...ory or u.. dupllcat.. 0' thl. pall. 0' 'arm.
,,'.'
dY
Page )-},/ 01
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
II) Ca.h, R.port 10101 only,
(2) stocka. lI'lln d'loilovery common or Plll.rr.d "rtlllcol., worronl 0' olher 'Ighll lound In baR, Sloch all
10 b. d..lgnal.d by nom. 01 company, "rtillcal. number, dol. of "rtillcOI', nom. In which Ilock I. IIglller.d,
and number 01 .ho,.. and clOII of .Iock,
(3) Obllllatlon. of U, 5. Gav.mm.nt. Number olll.ml, dol. ollnu., 10" volu., nom.. in which IIgl.I...d
and Iyp. of own.rshlp, I,." lolntly h.ld, poyabl. on dlath, .IC,
1"1 Bond.. O..lgnal. by naml, amounl, ..,101 number, or olher d..lgnallon, (Slall' SandI)
IS) Ban~ and SavIni' and Loan Pa..boo~1I Slall nom. of dlpolllor, number of book, 1011 dol. appla,lng In
book, nom. of bank and branch, and balanco,
(61 J.wllry, Cain., Stamp., Manu.cr/pt., .tc, lI11 and d..crlb. allully 01 pOlllbl.,
(71 D..d., Martial'" Curr.nt In.uranc. Pollcl.. or other .vkltnc.. of Ind.bt.dn..., lIll and d.lCrib. 01
fully a. pOlllbl.,
18) All ather cont.nt.,
y.(
-
./
""
,...
,..
,...
,...
.....
.....
./
,/
"
t
NOTII ""ach additIonal a y,. x 11. ahlltla)If n.c.llary or ua. dupllcat.. of thl. pag. of farm.
,
,
,
i
J
Page ?-;. of -;K.
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Ca.h. R.par1 10101 only,
12) Sloch. lI'lln d.lall .v.ry cammon or prel.rr.d cor1lllcal., warranl or alhor 'IShl' found In box, Sloch 0'0
to b. de.lgnat.d by name a. company, certificate number, dal. of certificat., name In which ,'ock is rlgllt.r.d,
and numbo, of .har.. and clall of .Iock,
(31 ObI/gallon. of U. 5, Gov.mm.nll Number 01 ifom., dol. of IlIuo, lac. valuo, nomOI In which flgl"o,od
and Iyp. 01 owno"hip, I.." lolnlly hold, poyobl. on d.ath, .fc,
(41 Bond.. O..lsnal. by nom., amaunl, .11101 number, or of her do.lsnatlon, (8.are, Bond.)
(5) Bank and Saving. and Loan Pa..boo'n. Slafo nom. of d.po.ilor, number 01 book, 10.1 dol. appoa,lngln
book, nom. 01 bonk and b,anch, and bolanc..
16) J.w.lry, CoIn., Slomp., Manu.crlpl., .,.. lilt and d.lCflb. a. fully a. pOllibl.,
171 O..d., Mortgag.., Curr.nlln.uranc. Pol/e1.. or olh.r .vld.nc.. ollnd.bl.dn.... lI.t and d.lCflb. a.
fully a. pOlllblo,
(B) All olh.r conl.nl.,
.corell. CO"oet and compl.,. to the b..t 01 my knowl.dg.
/(
LeI -~. t.tr/hLO
NOTEI A"ach additional 8'1.- xII- .h..tl.llf n,c,"ary or u.. dupllcat.. of thl. pag' of larm.
~ ,
Poge ?-'f of >C
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
111 Ca.h. Rlpartlolal only,
121 Slack" L1llln dllall .very common 0' proflrrld certificall, warranl or other righll found in box, Slack I a'e
10 bl dllignalld by name of company, cortilicoll number, doll of cortificote, nome In which 1I0ck il rogillerld,
and number of ,ha," and cia.. of 1I0ck,
(3) Obligation. of U, S, Gov.mmlnll Number of i1lml, dolO of IIIUI, face valul, namllln which rogillerld
and 'YPI of ownlrship, I,." lolnlly hlld, poyobll on dlalh, lIe,
(4) Bond" OOllgnol1 by noml, omaunl, ..,101 number, or olher dOllgnollon, (Blaror BondI)
IS) Bank and Savlnll' and Loan Pallbooko. Slall name of dlpolllor, number of book, 10 It doll applorlng in
book, naml 01 bank and branch, and balanco,
(6) J,wllry, CoIn., Stamp.. Manulerlpll. It" L111 and dlm/bl a' fully 01 pOllible,
(7) DI.d., Martgog... Curr.nt In.uronc. Pollel.. or other .vlelenclI of Ind.bt.dn.... Lilt and dlmib. 01
fully 01 pOlllbll,
lal All other cont.nll,
.TIM
NO,
1'2
( v:JY
Page ?- r:f 2.-0
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Ca.ht R.port 10101 only,
(2) Stock., llll In d.lall .very common or prof.rr.d c.rtifical., warrant or olher rlghll found In boa, Stock! 0"
10 b. dOllgnal.d by nom. of company, certlficat. numbor, dolO of certiflcal., nom. In which Ilock II rogilter.d,
and number of Iharol and c1all of IIock,
(3) Obligation. of U, 5, Gov.mm.n" Numbor of iI.ml, dolO of IIIU', face valu., nom.. In which roglllOrod
and typo of awn."hlp, I.... lolntly h.ld, payabl. on d.ath, .Ie,
(4) Bond., OOllgnal. by nom., amaunl, lorlal numbor, a' other dOllgnalion, (Boaro, Bondi)
(5) Bank and Saving. and Loan Pa..baok., Stal. nom. of d,polilo" number of book, 10 It dol. app.a,ing In
book, nom. of bank and branch, and balance,
(6) J.w.lry, Coin., Stamp., Manu.crlp'" .tCI lilt and d.",lb. 01 fully 01 palllbl.,
(71 O..d., Morfgag.., Curr.nt In.uranc. Pollcl.. or other .vld.n... ollnd.bt.dn..., lIll and d.",lb. 01
fully 01 pOlllbl.,
(8) All other cont.nla,
"1M DISC'''T10N
.-
-
-
1 // u...S
NOli, Attach additional..... - x 11- .h..ttl) If n.c...ary or UI. dupllcat'" of thll POll' of form.
""'v
Page
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
III Ca.h, R.port tala I only,
(2) Stocklt lI.1 In d.lail .very common or pref.rr.d cortlfical.. warranl or olher 'IOhl' found In box, Slacks are
10 b. d..lonal.d by nom. of company. cortlllcal. number, dol. of cortillcol'. nom. In which .Iock /. reol.ler.d,
and number 01 .ha,.. and clan of .Iock,
(3) Obligation. a' U, 5, Gav.mm.nlt Number of il.m.. dol. of inu.. loco volu., nom.. In which reoill.red
and Iyp. of own.rship, I,.,. lo/nlly h.ld, payobl. on d.alh. .Ic,
(4) Bandit O..lonol. by nom., omounl, ..rial number, or 01 her d..lonollon, (B.orer Bond'l
(51 Bonk and Saving. and Loan Pallbooklt 5101. nom. of d.po.i1or, number of book. 10.1 dol. opp.o,inO in
book, nom. 01 bank and b,anch, and bolonco,
(6) J.w.lry, Coin., Stamp., Manu..,lpt., .tel L1.1 and d.",lb. a. lully a. pOllibl.,
171 O..d., Mortgagu, Curr.nt In.uranc. Pollclu or other .vld.nc.. a' Ind.bt.dn..., Li.t and d.",ib. a.
lully a. pOlllbr.,
(81 All other cant.nt.,
-;y( of
/,l,
ITIM
NO,
111M DISC.IPTION
I ..rtlly un er .nally a' perjury
and b.lI. ,
.cord I. corr.ct and compl.t. to ih. but a' my knowl.dg.
"'n'
Da.. t/
/i.) /.:J ,j I Cj
I I I
1/ J
NOTI. ""ach additional 8'1>. x 11. .h..t(,,1f n,c'lIary ar u.. dupllcat.. af thl. pall' af farm.
. . ":.". "\ "'" *' J SCHEDULE A
ESTATt:;~~~~i~K~~ftZr~~~~:==,__-.~~=~~~~~_ E~T"A ~~'"=-'=='--FjL{NUM8Er{-'-'" ...-.'",-"
KATKOCIN., MICHAEL D. __.___.._.____~1-19~~-0_~~~__._.________
(P,op.rty lolnlly-own.d with Right of Survl.ollhlp mUll b. dllclo..d on Sch.dul. PI All ..al..tal. Ihould b. ..port.d 01 fal, marhl.alu.
which I. d.fln.d a.th. prlco 01 whIch p,op.rty would b. ..chang.d b.tw..n a willing buy.. and a willing ..II.., n.lth.. b.lng comp.lI.d
to bu 0' 1111, both ha.lng "alonabl. knowl.~g. of tho "I..anl fact.. ..______ ----,.--, "----
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
I.
207 MAPLE AVENUE, CAMP HILL, HAMPDEN TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA (SEE APPRAISAL
ATTACHED)
112,500.00
~
~
i
f!-
1
<:
. .
t~
;
I
:
...............,.--~-..,._.._.<---,
TOTAL AI.. .n'.. on IIn. I, RICO Itulotlon)
(II more 'pace is nele/ed, in'lrt additional .It..,. 01 'ame sin.)
S 112,500.00
UNIFORM RESIDENTIAL APPRAISAL REPonT '", tI.
. . i!G, OUU Comlllent, all eo.l "'''lIO.tll l.u~h ... ,OUlU 01 eo'l ,,'<"'.1., .il.
valu., .qulll 1001 ulcul.llOn IIMI Iu, IlUO, VA and rmlt.\, u~
..1111I.100 "II1'~"''' .conomlC ~I. ullh'IIIOl'Or1rt: !.)!j
llJUIlCI, 01' OX1LUI W\J~IIIILL Vr\1J.J11;I'lOlI
OUlV!lW NlUlOCIIL 'UIllVICIOlllJ,
V,IUl'Uon 'flCllon
f UU....'IDIlI.VH.UI
a ..1......110 hl,.nooucllOll COli tllW tJl 1UI"\ohUo"W'
o ~ 1,363_____"''' II 4U.2!i 0'
f lJGJ_lml'_.-__ ... n .. U.tiO .
1 'Al'1'L,tlU'L,t'511.II'I'I'!C,LUI/~,llt '
i o..~ __5J5 '" '.1 .. 1'I,OU
t.........iHCcltlNI. ..
11M ...,... ,............ I........
Dtp.d.~ --15, 54~ _
o ~lNv.w.............
H ......y"-t....."""........
!' INDICAlID VAlUIl BY COlT APPROACH
.
t-: 111M IUl\Jtcr .c,:I!,,.~n~_!'9.L__ _ ..__~l!UrMWtt~!/t~'__~
~ -201 MlIl'lE IIviiiul~. II<\'; IN1II'1 GIll' IQ) JI/14 tlll-lIlIlUl' UJ'
~ ~'M._ClIMe..J 11... /' W",'" 1ill.l1lll11ClJl.1UI'L.... ,Ci\HI' lIUL
~ J'O~.~.~_ f{fjjga,;;;,:;,. )\?:,t-l}J~. .... ... ",}..I~, . '"J\4!II~J/" ..H._
'1 .!"'L~__.__,,_.. ,. ::M,:;!({r-.0:!, .,..,)9i!,32! 7ZfZ:?:(,%{:,' '1."J~l,i!)\( i:4W,:'(W;'I'-V//.A~J)jXW
';;' .~_~!!'~.~_ .L ._. 0/. I .,1.03 _~II t,'l~1'1$, '70."~ I> ;;fZ%m:~~' _ __ 77.26 ~_~~
.~ Do..... 1I1Sl'Wl'10l1 tllll/I\JUl.1C lun::ms MllJ/I'UIIl.IC IUlDI~;6 1\JlJL1C IUlDIW
I... ~:E~U"" ~ ~~~,,~,~~:.~~~,;:~;- J~i~~,~,.-.=b1!;~"-~ '~f~i~~~~~~,~~~~~
".......- ~ 09"15-94.~.___.._. .,11"10-,94__..,..".... U~"~5-94
j.. .-... .mUWJE ~IWUUOO..u____I~,5UU .mUWJE, fJU\:UUOII_::J,UOO.
!!!!!!!!!!!!!!!!lL_ ,FElL , tEE: mE. . .I'Dl, _____
. ]!o,4UIOlE ,4611CHE ,19 lIaUL, ,~,500, .J4,lIaUL.__.__
:l\ "'. ,IIVElVJl;E IIVUVJl;E_, IIV!lVlOE. mu IIVUWlE
: ~~.!L- JW1al IWIClI .,..___..___ IWIClI IWlClL _
t .........""'..... .IIVElW.JE IIV!lVJl;IL._..,_........ IIV!lVJl;E,., llVUVJl;E.,_...:____._
.1t! .;19_, JU. .,......__ '" .J6u ,__.__, 16,.___,_.--=4,UOO.
. ~ _AVnw;1.:: . _ 00:.0 ___.._ _.._~._~~,~uo_ .G;XV_______ _ ___=2,000_ .0:;00______ _--=:a,5UU.
C IbMD... -1~~~f. tin" '9'-' .fWo""._b.,..~.. j""_-4~"'f.._Jl""._ J...._~..rI~"!'~j1t'''-
o Ibnc..n _6_J. 2 5__ .3..1.5_ +1,000 _Ci_~_J_:._2..._ __7_.._.J_~2__
M oo.t.M-'lIM' -1,3031<4" 1,5JO.fq!I~_:_._~4,200 .1,J25!k1JL._..u~_"~50_ 1,592"Jl~_=5,_70Q_
~ ..-.- roIL fUlL I'UIL fUlL
R -.......... JlalE_. 1w:::,1()q<\_._---"~,000. .lIJIIE...__._______ .lIaIlL..~___..,__
&' -.,., JlVElWJE IIVEIWlE_".__... _IIVUWJE___.___..IIVElWJE~,_..._...
o l!!!!9-'_ JIW/IIaIE IIII/C'JI. .. __.__-,,~,5UU 11II1C'JI_., ...__=~,5UU JIII/C'JI....m__-"~,50lL
~ Ow",_ -, .B10m.UI1'IS BlOHM. Ull'llL____ ._ ... , .llltlltLUlU'I'S ______ 81tlIRUU'JS.___._.
i J!o~- .~.CJ\RGI\IVJl;E 1 C'JIIlfOIU'_, ..-15,000 .1.,CJ\RlQIU'.____._ is,OOO. .~ (;/\II GI\IVJl;E__._. .".
.....,....- SUllli/1lI1ZI'IJIY 800111I1 IlIl'flUOIl +J,UUU lI/1'ElUOll +J,UOO
~ n_"..., _1_l'lIlEI11\CE, 1 FlIIEI'lIIC1l_.___.. .1.l'lREI'UlCE.._ .. 1 1'1I1El'1II0L__,__...,__
: r_,f'uc1l,'Ii:l_ _flUiJID N!'!'JC. 10m _.__~--l2,500. .IQUL______-I2,500_ .IQUL .__---+_12,500.
~~=- . _Ajj 1 '!5gg:J.,_C=~:~~gD;;J~. J1:~gg~
'il" ...... ~-./rzrt. ~u;rtif~. 1Q,20 . .llJ,O!iQ m~;iL-1.u,.JQQ.
::Of c-w.DnIallt.~cnwno'. .....ft<tI'""*'r.torfINU!ttu..r>t\tWlIBOd, '.1' cnoWl\IV\ULES _nD'RESEl(r_u::ar_RECfU~
i: ,SII1.ES.IN,=r.WIIlKEI'lIlG IIIlEIU\lIO.tIUUClI'IILl'IY IIIIVlJl:J SHU1IIIIllES1Gtl.NIOIII'i'EI\L../IIL,r\1lE_...
( .suPElUOR.l/Lr:olDl'I'lotl11I10 OmRCHll1l1\L IIlllllMElll'IY,./IIL lIICKl'lJUGlIID,/\'1'1'1C,__crnJ'IIlWlLEl.l ~ IIIIU
~ - - -
:~ .J,~WI',OV!l1lllL,IIlIlLG1VUI.GR&'Il'ESI'-UE1G1rl',_____ '_'_ _____.._ __
'"
,:j
_;l
:!
~
~
~
:'f: ~el'....,-.....ll'..........el'..lI,C'I>loJn,lWh..'9.I..~I~...,""'_'r"'oI""..I......"IIIoijId~cuPP....t.If'....,llf..1...oI...IlI....."".1UL
'i, JI/J>. .__... __". ...___.__'_'.._____,_._,_,"._____
i'i
~
65,7"!j
11,5U6
14,G!jO
9.0t)~
!Ul,U'J6
8i'E II'I'J'II011:lJ f.;JU:;I\JllIllU,CIIlL\J1I\'1'!0IIS
",
__.1!j,!H9
U5,!W/
4,~00
Co' .
"
.1.
"
(;l.'Nr.""'ItI'tO,
.iiiiTwl;,iii ciitiii-u
"U,uIlllUC,'\JVlU.
....------~_.._-~-----_._~_...__.._-_.----------_._--
11'1,1
0.","""". D."
Iaulw...ftbl'.....
.......,01 .IM!
['
IUBJICI . COMP.lWl\eltO ,
II/II . IQIE 1II IWIl' "iEIIII
C(ll,lrAn~nll! 110 . COMPAIW\lI NO ,
IIaIE iiil'NiJ'.",FAil" ,lOiiE.ii,i'lI8l' vFJ.i{
---_._---~~----- _._----_.~---- ---.--.-
INDICATED VALUE BV SALES COMPAAlSDN APpnOACU 1___112,500
INDICATED VALue BV INCOME APpnOACIl._ "'~AA, hUI," U..I.ln... 1 """ . 000" n.'.........-. ..
~~ lHIlC'P'........X ..... ~.,...,.rl.......I~..~CIIa:n....""hlld,.u. u,.cttu~.......~~....~"""
~ co-......._ .'llIE.II1'JWIlSElIIISSU.!FS IIJWlKEl1\IlLE'J'1'ILE.IIlIlDIII\'r .~IIIUWll HElIl'I\!JroCII\'IUJJil'llI_
" .'11lEJW.'J1Ml1Elrrs./'JUUlt \IOlWJ1:l. OHOm.,_ .,.... H"'_ ..._... , nd. u.. _ .__...._____
U ""'-- .~lIEJoI/\RI(El'./Il'1'R::1I\aUSCXlllSIIl!lU:l) 'IlIEI'OSl'.llELIJ\lJUlI'OIl 'J1IE 'IYl'~I1VI'!lllY.J}ElI/(L_,
a .1I1'HlJ\ISf;l),,_:i1IEJlltU1EII1'1'lUllal III\S_JlCIl'. DWI ,II1'1'LlW 1IS:1Yl'lCIIL llE1QIOOIUOOU~VI'E1U"i_IO____,__..
ft -OOER:llCCW.UIUINlUIll1:J;1lJll1'E llDll1ILJ)II1l\.OOE:U/(ll'.OOSI',_.._.~ _. __ _.,.. ...... ._____,_u___.
o n. fIU'p:lM el' ..1fIp..... II b......".. ",,,,-, WW"'. "tI~ ...,. U Mfod 01'" "plrL"'... Dn....b0-4 _~...,..C*lIubl,_qonI......._.
I ...............,"',............"',... tl',"h,.,IlII;f"",rl~t.l"'_6)f',,,"'U., '_Iooafttn.., _.6/93__1
lL IIWI)I!STlMAlt!THE RKITVALUE.ASDErlNED,OFTltEnEALPnOPERTYTHATISTlIESUBJECTOF1I11SREPonr,ABoF _. .12-:05=9_4 _____
(WHICHISTHIDA FINSP T1Dt'ANDTlIEErnCllvEDATEoFTlIlsnEPORnTOOEI 112, !jOO
T APPnAlSERI BUPEnvlsDRvAPpnAISEn(ONLVIFnEQUIRED): _ __
o ~ ~""_~'.m___. __._,____~,,_.. U... []"",..
.. N_ ~ ,._ ,.RAl\.. 'J~_~_~__m_ ._...___~_~__ Nc............
~ D,"A1p:l11~J:rEMBER.8,_.19!)4_ ____.____ ~."':'''~'v._'..._~._~____~__ __.__._._.____
~ ""c..~bH R1.0002JB=L . _&II".PA... ~_II~C..~_'&I?_!__. &q,.1I
~I" 0. 11111 u...., II." Or '",.1........' "'"
"NilIotMPomfO..u ,.........'_100<1."
.,OIJ.L.."".iNI~...bp."_.hl '~Al"""(l(It
'''0('0f' .
I
I
,
1
I
-\
Illn I~'mlm!'r & """""latm'l Roaltor
_. ........11on UNIFORM RESIDENTIAL APPRA SAL REPORT .11. No, A_,"M
, ....,..,....~.__207,MIIP1E AVUlU& .. ". _. ,,;.,CIlMI'IWL '..,PA '1'-17011.
:s;::;;!'! 1D~:.i~7~4~1.PIJIII:::~~~52 '''';;'~~~:'"'';.'2'~~~':'~:~
....~,.. h....... ,IPUlJ ~I..IO"'''' ..0.... "'"
~_~~~"'!'!._ __~ _o..n___ ._____.. __ __ _m _. .. ".,!'t...-___.. ..____~ll~_l1J .-. -
~~_.___._..__ __ D."...... _o.~.......-...btfI.,.....___ID~,..t.r~U/^ ..-.--
,~: HICUIfL 0, waw:x:II~~ ::~:~'~,lYIIIM1l\OClII 20~J~.~VE:,.~~;~IIlL..PL
'-_ ~ UIMft ~ Iub\IItlM ~....... Pncfomlnanl Ilngl' '.mll, houllng PrMenlltnd u.. % _land UI. than.,.
... ..X,CMIU'IIo "'" ~\NIf"'" I_:~r ~f t:: 0.""'" _100_ lXJN04..... LJUrot\'
0-91.... _.... ~..... ___ ~<>--- ~_B5__""u15__ .......... ..____ OM,.....
__ _No... ~.- '-...... i-'- ",J15."" ~s/...,""'- .___ ..______m_._
~..., ~...... -A ~kIroI _ 0........... ~ ytwllllO'" Wh1"~min!~~~h: ~ ____ ..--.----------.----
it I......... .......,_ u_ 0..,_ VM_I'IIo -'CIR ]~.,
NoI.: Race and the _ill compotlllon of 1M neighborhood IN nol 'pprllN. 'aclMa.
_ __ ... _ SEE A'lTACIl!DIW'..f~Jl1nI.OE'CJ\RLISLE ,PlKE. .11OR111.0F.Eo'nUllDLE.RD.-_,
.WEm'.OF_N.J4'11LBrnEEl'..f1\8r,OF,SPClU'lNJ.lWL ro,_ __,._.____._,0__.__. .-.-,.-------..--'
,........!IN ,............ ...1"DJ*tM",.~....-. .....,..........,__..~~, ~..Ilo....wl..ll:'
.1<<l.ADVfIlSE. o:IlllrrlCllS .IKmD, _ 5UllJfrr UX'JITED.lII.SlIllURIlI\IIIIARIUSWOO. Allll IIDllDfNl'lA!.o. SUIlDIVlBlal
.oF_IWll'DUI~t\'IISIIP.J<llOlstUIS "0I\I\1<0Q0D .PARKo~.Il&G1IOORlIOCO ,HlJpmrUS /IRE. OF. SlMIIJIR QU1IL!.Ti .AlIl
1\PPEJ\Lo.5CJJOlB. _SIJI'PmJ.. AND RW1FJITlaw. F/lCILlTlfl5.11RE ,Wl'lIWl. 2.=._ fHP1.OYMEN!' cmrms_
OJ\RE.wrDWI..J.5,MIlIl11'E. CXMI\11'E.OF. ==. _ Bll'lD'iMUlr.lS Sl'J\l1LE. ,/IRFA .OFFmS ,AVUWlE,Al'PFlIL.W_
o .~. . -~___._____~~_______________~_________
.......--... t'lN....... ~........ "4'Pl"l" ,............- .....If,.. ttrod............... ..............." ....."''''-.............,. ....,,""
.................., ....M...~.~.,...........,......... .....~____.ll:1
.SUPPI.Y/OElWIILIlUlIIIAllCE. .1IJ/\lI, 01SCXlUlr.FEES, AVIJ1l1aIU~J'. W. RJlQUlSmo-lltn"IlCMILAND______.
. -'XlICfl5SICllaAruulaLrnE.VElAIrr.~O~lIUWlKEr.l'1ACE, - .."
II ProJtct Informlllon feM' PUDe .. """1"It... ......\1ubI., ~ of"....... D-nIt1I'.......... p40Aj' '-_J"" -ON.
u ~"""'"""*"ur'Mh"'"",,,,1II'CfKI _ Awo_"IDIIl~"W1IIIIor"""'''Itot;IdP'Ojlld
0...-.. _........ ...., __............
- .UO.X.150 - . '0 r.:1 .-..... -=
... _ ~8000_B.F..___ _n______ ..__ eo-ue ,.. lXJNo Ion .~AVf1JJt;E.__
___...___b'l....dI._~. m:sIDnn'lAL """"'_~
__ IXI.....r.;;:J--rI':"-.....;;;;--O- OJ;,.... "'- JIl'PE2IRS.J\DWl/ITE_
.......'bf............ ............. QIlef"MI._ ........A~
f UtlIlU.. r;; Ohf on,.lt.lmprovlmlnll ''''' ~ "'!!!.II ~ .AvaMGE
~ IIINt ~ ....0. _ ~,...-- _~
I ... ~ .....- NaIE _ _ -..- PUDLlC-
WI'" _ ....... lOre _ _ ,p,tAIoecMIP\lod.4."'M. D~ HI
1 I"""Y- _ "Mt~ NatE _ --1 n......z- .C "'apO... .02=15=78_
....._ ..... .n...n;;- n.............,. -~0360 A
, c:.-.I................ ..---...-I......d.~.... .-...____..... ............""'-----........,....11I1 JJ:>_ADVERSE
~ ,~.oUlCXll\QJMm1'S. OR.OllIER J\llVmSE.ClllllrrlalS.lK1l'ID. SlTE..J.S.AOOVE.AVEl1llGILIlLS.tZEJtllL
J ODtIMLOIIC"lPTlON '1OIAIOftOUCAI"1ON PO..fCl"'hClN ......PollNt INlUlAflDI'l
o MD.lflWll _1_........- o::tIC.DLC<_ 11M _ M.aq" _1363__ fIooI __~
. MD.1f1_. __Olr:m;;.;t~ ::-.:.: nlUQ{___ Ct...,,*- ___ ______ ,........ _0___ c...,. _
3 T""lDelJAIII &OIUV.,uu ASHl SltN3_..~ FULl.t___ CIfro9 _____ w... ___
t Dll9'1'YtI IWtCl 0lI""'&~ AWinn.t1__ -.-..~ YfS_ w... n:a --
,~,...... :=l:'XIsrDl ~t"" ODld21J__ D.......... NO_f.VlD___'" .CONCm:rE,..... __.
, ..."., _J9__ .-..... ~~__"- Il().~--- 0..-''''' I<<l_.__ -_ X
, I~L ",,,,I 13_'" UII'\II~Hou.. r~ r.IIltI_ rn F\'Tn
! ~ -.!!J'I'_ ~_ _D!!1_ __II.~...!'!.-. _...!l!"_ -1!"'..!J!'!"...;.. ._~'"_ _~! ~'_'~_. _~~_ _~_ _,.,..!'t.~__.
o ---,,-' ..-, .----- .---- ---. -..- .-.- u.___ ,_lJ6J
, ....., 1- _..1._ ,.-J._ _. __._ .___ _L. _2._ ._X_ ,SUlLHL 1J6J
f a..l' -'- .-- .- - - ". -
II
.. "*'-4 .... .......
ft
o
V
.
II
ft
T
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M
..._. Aocwoo" '1 ~'l; ., 1I"~II; 1 ''It.::''l.......fHIolaro.
.........1:0.-........ HlAtHO klTCHDlIQlJlll "me .......mnu C.....ItOftAGl!.
IW1I:WJOD/AVG_ 'no I1W_ _.~ I.... '- .._"" ,00;.... [J
PI..JI3J:flVAVE._ rwI OIL__ ~o..tI ,... ::x: ,.." JJRlQ{__ o.r.,. '''WI
=~AVG,_. ~ AVE___ =nr :::..- =:: iiiru,---'OOID ~_ ~:: ~:_~_~_-.~"
TILE JY:JlOO/AVE c.r... NCtlE_ '1"IHDll4 n.. ::X:'- ~_" --"'-101 .__u____. _
IDLI.CW-CX:lVAVE Ohl ~.. till," ::X:,..... CI'PO'l
~ w."*'~ "'*'" V t'Irto9.." "---
~j .........".....1..... -..,............. '101' _FEJ\1\mES.SUCC.F.I:REPlACE IlL LlVING.PSXJ1,_BlCLOSfD_Sl1N_ n:x:H.Wl'Ul
o .lAWIllY.J1ICL06ID.!lREf:molAY..FDllSlEDJaTlC./IIlll.SIORAGE.RXIi,._ ".., -. ---
!! eorw.:an"IN~___lIDfIbJf'orIaI,.~""''''''''''"",NIdM,.,....ol~~---''101 .HIYSlCAL_
ii ,Om=ClI_WAS.IK1l'ID,._'11lmIUSJIO.MFA5IJIWlLE,E.VlDU1CILOF_EUl=aw. .atEX1'mlll\L,___.,__.
ft .OBOO=,_'11IIS..IS .TYPlCAL FORIIlUSES_OF. ~IIIS.roE.1IND. <MIL1TY,. RfX:l:MolE1lllW.REPJlIRSLREUNE n
T ,SCALIlI:iJ'AINr..otUXrElUC!Ul1l11XR'1RIIUIND. REl'AINrI_REMJl/E.OElllUS.flO\.YARD....
. .......... ~ ~ I""'" ...bu' lilt hllId 10, hulld:lul....... ",,*.--.. I~I P'"I"'fl h IN..."........,. '" IN...... h IN......." ~ ol IN
i __, 11OlIE1<NC\il,
t
...
Nt.""'"
-.
W...
T.....
...-
""W..--l
....
'...".......f9IIIfOl-fl
,........... f9III 100. .n
"TOl......IFJ'....."....,..,...""""'.rc. t.toO-AlJ.,I,IOlII
,AQI t Ol'J
~,;~. :,,',~,,"-"-_.
. IUY.IS03 Ell.. (~.'61
~'J~'$'l\
_\oUIJA:.
COMMONWfA\tll 0' PfNNSY\YAHIA
INUUltANCf tAlC REtURN
REStDfNt DfCfDfNt
SCHEDULE B
STOCKS AND BONDS
KATKOCIN, MICHAEL D.
FILE NUMBER
21-1994-0896
ESTATE OF
(All proplrtv lolntlv.ownld with Right 0' Survivorship mu,l bl dl,clolld on Schldul. F,)
ITEM
NUMBER DESCRIPTION
l.
VALUE AT DATE
OF DEATH
SEE ATTACHED SCHEDULES
151,031. 38
TOTAL Also enler on line 2, Reca ltulollon
'If more 'poc. i. n..d.d, in.ert addiliono' .h..h al.ame sin.)
S 151,031.38
IUV.I.S03U+IA.161 ~.
, 0. "
. . '\1(\
COMMONW!ALTH 0' PlNNSnVAHIA
INHUlfANC! TAX .nUlN
.!5ID!HT ClerOENT
ESTATEOF MICIl4!:\.. t1,\<.A.'-\<"CCIN
SCHEDULE B
STOCKS AND BONDS
t' ~.'"\lt.It\J<Lfl~"'\.~)
FILE NUMBER
l
IAII proporty lolnlly-ownod wilh Right of Survlvorohlp mUll bo dlIClo..d on Schodulo F,J
ITEM
NUMBER DESCRIPTION
._,,~._, J .5", r'I~; E I U,S .5.IY;';j" B.,."d ~1"7"";7Inz. i! .$25'/1' 25''7
2 " I qI7/0'70:ZZ16L":'.$2:r""/~"'l
~ II I. Q,180'1ft'a913.3;;426-:''''lij!''l
if:, " "o.leOSI'71'161E.p~~~':';'I.l.I.:i'7
5" 'I "q/8/Z"fCfO'i5(,I!:P:Zs"''2/60
b I' II GlIf'.o(,,37<'f3'h't.:'-t15"'''.y6(}
7 ,,,." "q /822. 'i 90 O~E .f>.2fi.C:L> .i/(;O
8, " "q reS'f'i3'f2(i,.f;if".J>2s':'''o/to
'7 " II q 185-'l"'t92"IE4:J.~-Y" Icff(J~
10 " ,I q I e S?03"J-"J.i:~2..5'_'''' I/lft!
_II. ., " :: q le6 5~!J?.2'lfEfj,zp~"':lt/pt
_1,2..____, '_'_ '" I.~ ,,__ _ q l'U.5!;7/i.'((;[ ~..b~"'" "/'O
__L4.__. _._, __~_~_____".__... ., ~ /95"'1.1.7911:)':'':" .f ;l:rw e!t.2.
___1'1., n, on.. ,....,I~.. , .' q 2.,:o';cl7078'lId"jJ2.5:~'C' i:./{.'I.
Ib ,I "q:ZO(.,SjJ2.t('OE'.f]'5;~~' fll'!'
16 ...1 ,/ q2.0(,:;'OCJ9(;/{E ';:J.:r:'" t(r
/1 .. ".~:" ~'l.~6?M;137:!Eh:J-'IG8/6'Y
/8 ", .. 41 2.06 '1 t..'S"gip7Eh.:P'" tr.'t~
17" I' q Zc>8/~6/,?C8E.:.f~,-("6 ?/~r~
.21/ I' ,I c(.z.C7S".z'T7.1~/iEIJ.5:.'.,) ~f
. .21." "q20a2..J.G(j,7'3~!25"":/,yq
,2.:z " uoo...o .. 'f2.082..Z~8c''1,U: ;2::>,,1, It./f'i
.2)" "Cp..O'l11.77'1~OE hs~C Iljcr
.:z'l_" "~'''7/'107%!''E.h5:vall5'f
2~" "C'/I./t.f217S1S'E 4/00.GI<I8/'<(
:2t' ,I ,I (.Ll'1,"/2I7S'l6c $/D(),""8f(,'f
27 ... < ..... ,I C.1I1of'l2/'7::ii7i:- -4 jOO,nc 8/6'/
:2.8 .. ",. _ ,..,,____ II c"I"I.lf217S18t.= 1/0(')."0 8/6<1
,27 _ II 0"".' ".. C"l.2'1S"68N'lt1" J /00.,",0 '/"'1
Jc> ." II cJIZ'l5'r!8 1S"1t: :f Ice, oc (/c.tf'
~I .. .. __....... . .~' C."I:z.I75'6e.t'5I.~$ I~,"C ilt'l
..;3.'~_ ~~_________, ... ,". c.. '12"l~6815:..(E ~ 100,"'':) r/l'l
VALUE AT DATE
OF DEATH
.$ I ,2.?
I 'i /.f, 75'
11-1'+, 7~
/ i5~:"
I J/ /, J/.!l'
1tJ./,'15
1"1'3,07
/7'2, "9
1'-12.10
1't,ZI"
112, ~.()
/'10. 1.1..
1rS'~ ~1/
13"t.U
/3j'. c~
1'3'1 6::3
/81,91.
/,;/, 9 y
13:1.. (,'0
/32, ~:o
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13.2, "0
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"'......
I rt"lZO
50/11f)
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,5'41''j/).
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5'13.2.0
5"tf3.~c
5'13, ;1.0
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TOTAL (AIIO Inlor on line 2, Recopilulation)
", mnr.. '~~r.. j, "..rl,,~ ;,.,.rl ",MiII"""' ,It.." ", ",,,.,, ,j,." I
S
o
5CI-\e"plJLE. (covs.L~)
s-roc.'i.S ~ 13o>ly.., s/~...~Ie 1\1'
V""C.R,P{IO,,", 1!.^'('1!. ~ 17E'''(H
'33. F"'<!!:.t7o", SHARf: <5''''c/I>l~S ~eTE: ~ c.~'l.-SS111 ,1/00co I,~~J c' /70 t1f1'f gO
311. II II C. ~z.,~ oW . /CO~ " "4"~ 1/,'(, ..,,,
sS: JI e~lq I 'ic..q , IOO'w I' III'if 1371b
II
~Ip, " 'I C. ~/9/70J' I ()O'eo " lo/~? W1..1.Jf
;3'7. II I{)O~ " /)~/"1 If'I~, 2. t
" C ~/!?1541
3'~, II " CI'? /tl/ tN~, fL t.f
II C IJ.lfvzOI1l... 1&0 tJC
'3<f , " II O.'2.3~603 I&O~ " tJtf/10 If 71 8'0
'f(J, /I II C2./GI gc, I 100''0 I' 01/tfI 'ft{f. ,'1'{-
If/. /I C 2.161713 I~#() I', atj"7 'Nt., ~tf
"
if'2, " C t2-IGI 'f~'Z. IOO~" II ()S~'1 Jflftl,(YI
1/
13, II C t/6/ 56'! lOr) ro I' osjGr tNMJ 'f
"
1+, II 1/ C. 21M 9.10 IO/) ~ ,I &'/f1 0/ '1,/.5"
1fS, II II C '3t(2-0fp I .1 01f'1 5/~,M
100CtJ
1r". " .1 C-S?'2./'31 I()O~ " 01/61 $IG,()g
>17, II II C "'12 2:S-7 1&017'0 " 08/61 51(;,08
Jf~, " II C '3C?2. "34 'i ICO 60 " etl!b .., $lG,OS
11 " " t 3C?2. 5(,1 /00.40 /I If /v 1 50S: M
..- l()e~ .' /tjb1 5og,J.8
':'0, II II (.:312. ~'iSS
.51, " C '3C?'2...'fSO 1 co (>d " Of6g S()~,32.
"
52., c.r3S'OOSS ,~PO I' 08/(,,'(, :5'o~ .~2.
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5'3, CI'35'8/'6'3 lac- DO I' 011/6 '0 SD~, "5 z..
,I 1/
5'1. c.. 1'356 '3'2~ I ()() tIC ., 01(/B ~52,(,rs
" If
.55- C 1'558 J'~q I Wod " 0(;1(,'i5 1/60,~
/I II
5~, .1 jI C. 2'2.3 '0100 l()OiJ'O II OS!7() L{2'6,01
-(01'" A L ~ I/I~?/l oLf
- -,....,-" _.,,~ .'-'."_,,"'~'-' ,--"
" ~~1',I."fe,.,.{
., M \;k...Jl, 'd.',i<41'\(Cc:.,..J
':;-:;
t
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1~~;'
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S -roeK 5 J G' 0 \.l 9 5 ( C ,",,-L.......Jl)
~o ,
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1/ II _ R IJ.35'7Q '397 fE. uc~ '~5tJJ 07/85'" I"WO~'
II I'
- R 1:35'80'2.12-((' ~,OD I' 01(85'" 1~<t,OO
II II
- f?'l35'81O ~o f,: w~" 06{SS' ('N60
- R'1'3521l.fg~ fr ~de) I' (jS/S5 l'f'/:~
_ f?~~6(S1,;r ~ II o,&{<g)' ('HriV
_ R'2."'55f1/ q'f7F:~ 1j(()(Jf) " (''1~) Icr~,CO
_ RQ'352/~b7 fE' ~m6(l " ccr/g., I'NOO
_ T?'2.'3qI},5187~[" tJ.PoDC ,I /1l/8, /i/q,c-t
R~312.7030(f' 2t(Jt!8 " /I(8S- Iq~,se
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I'oSf'l.1'E! ~f S'CI-IF.:PU/-C C3
KI.C~A.~I..i',t<>.TkoCIIJ S-rOCl(S ,...J 6CND5 (CcM~'~)
U,S, So\sJlllC.~ 1301011'- Se""ES r - 0 1'67(''~OIo107'&~ - ~S"" ISs.cJ 04t.1 $ 189,~
II II 0 Iq~551,-g(,,3 E: . Z."N I' 01/6-2. I-fO,7t....
'I " Q NCt., 1/11.2. 77~ [ . 2,'J.t'O I' 00/62. /8'7,0/(/
" 1/ 9 /Q5o I 5870St: ,j.!i~ " 07/u:. 1,9,,0
" "Q 1%'11"306/7 E'. 1.~~ " ()e/':'2 I~f.p '.!i,/'
1/ "Q fC(5'113833tfJ:"' '25,<" ,I 151/62. In 51
., 1/ QI'1(,,,q'N220f-~'ol:) " (DIM, lJ7.il
II "Q 1'(7002'/251 t' 1.5..00 .' 1//62. (~7.SI
" "Q Iq-r003'O005f, ZS:~,' 12(c't /,8',cg
II " Q 1'l7"f7S'l'l57 r~'2S:{I() ,I 01165 In,OS
I
Q In~l'fI'lt.J~E"'2.S.80 "C~r..3 11~-'.i31u
o '<185%55<=1'+ (, 2S,eo " O~p /tfJ.5. B(p
OWI2.()O(.,L(2.0t.I).S:~" 08((,5 IJ'5,"fCf
Q /'l8S'/7tf~c.1~' 1.5.c() " 03/65 I,S?N
Q IQ'l(,,4'l'3S'z'IE. 2:;.cc ,. 0'i/';3 /'5S.'17
Q 1'1% SS1Si.'3 (- ZS:&fJ " 05f3 /15.'17
o I'r'l{, Sr.C.lf5'-s E,:ZS:~ " 05)3 /,5:'/1
Q ZOO'3 S-otf '1 ~q € 2$p" I' Co/b 3 / J7. 0 I
Q2JJO'3SS/f)t/'a E '25,60 .' O~f-g /3'1,&1
Q1.003;JoS0-2/!= R.s.~ .' ~-rj63 Inl)/
Q '2010 OOi 1nE' Z5:t!C "0&/63 1..9'1,8,9-
Q ~ cr'lq g3'3 E' 2.5.~ "0&/.:, /8'/,.sa
Q'l.CJ/7Cf03%2.f' tJ$.iXJ " /olc.'3 /"3'l.rf.,
Q '1022-5:3.s~'Sof!' '25.~ " /163 /Jt.1~
-ro-rAL. f 3q~q 90
"
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"
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f.f(Af~'~
M'CIIA!;rV. kAft<aciJo./
Sc..H~PlJ~c .. i3"
S"l'OCK' .....Jl. CcNC>S (c.c..,.LJ)
ql, LLS, S..\I1,tJa.S BON.D.S~f?le/F:'- CIf'80g511b7~-liJtJ.~llf,,.j)a7/"1 I../5f.,z.1
q~, II /' - t '1~3~G0722t:, h'O~ of (n/'-1
~3 J{5', Z. 'f
II I' - C Jf?t~(,/1t.Zj['. k'Ot'C " "1"1 tflJ4 ' ti./'
q4.
" " - Ctf8~'2~07(;7i. /Cd~o " 12/"1 I-/'fCl, 'It{
'l5',
" " - r}"O/5t11t!'5SE. 1Vt)~ " 05/&9 4/}/1' 8 ~
'l'l.,
1/ ., .. C50f./5'1()%(-/<<J~ " Os/ill #);'1, ~ %
en,
II II .. r;soz /~O 5'Sq ~ - 100 ~ e' OG!69 t/,c,./{!.
'!l3,
II II _ C 502'tSZ /90f .. /t~ .' 07/"'1 lI~~,N
'lcr,
II II C 5'03(;(,3018 f- 1~tX' " OS!6Q ttf.540
100, C 5'053<6175"0 Ii _/OOfld " /O(kff /f~5. '10
" " ..
10 I, C 5011 ,Z3C,L1 f - IOOdd " 11(111
" " i-/~S; I{O
102.-
'I II _ C5072.~1/8/ ~- 'DO~ " 11{6'1 WI.7. (; 'I
10$,
'1 ,I _ C 5072(,~g03 (-IOo."c " 0I{10 IfllR ,0'1
to+,
,I I' _ C-5o~1583,,"f- IOO~ " 0'2(10 tf/7.IZ
10S:
,I ., - C 50<6 %'2.0 II ~.. IOO.1i'd " 03/10 417,11-
lOG, ".,
I' ., C.511'3'if7~ql (. /OO~ " M{10
- 417,'2-
/ {)7.
" I, C. ~ 31 ttld I M (- /CObO II Ol/b~ f{~3 zo
108. -
II " C. Y'311.f~11.r.,1 f-/cocltl " Ol{"~ s'tJ3, '20
1(If, -
II II C ttY.~2.r1SIO t- )coll) " ,,/1.'1 53MD
110,
II " Illb~
,I l}1~'t2.17511 r., 00,60 530, ~O
-(0 fA I- f tl; ()3 t/ 7 t9.
v
e.s1',tn:: ...f!.
H!C~At:/.. f;I, iQ..1'KoC/tJ
SCHEVO!..E "13"
~foCk.S ........Q 5'CN oS (C.cJ"JI'~~)
III, U,S, SAIJIl-JQ,S 130NO. SE:RI~~' ("- R'f1.'501 O'6<"E . ~COoo I~SrlJ 0'1.1"10 1'8117(;
/I'Z. . .' ., f\'4~~ ~%t.j~ f ' UJo,O'J " Olh, 14g,I14
-
/1'3.
,\ ,I R lot 2J2. 502 r. 2.()()~ " IO(-N GWS~
IN.
" " r\IO~Z331Z'l (, 21A3~ " /2/11 62"i.8~
1/5:
" " 1i!1O'5S2.7071f. WOO " M!7S {/2J, 76
I Ie, , 1J1/15
1/ 'I F?I055~C';37~r;. '2oo~ " (,'2.5 1"
117- 'I " f?/0'5'277q~~' 1.JXJ~ ,I Of7:) c.,::!.J1G
II'! " " f?/055~~So~f. ue~ .' Oo/7S' 6~J 7(,
-
fI 'f. I' ,. 1l1VD Lf-~71q(,[' '2tt)~ .' 017S b'23,-n
1'2..0, II II 0415
_ R2~Ot.f87q>5'~ r;. ~~..e ,I (p II. #
/2.1.
II " 0(,/7'5' ~/'2.. ,g:1'
- R200 lf881/1 f . ~Cl:l~ .'
/2'2.
" I' 0711~
_ 1?ZOD tf8'f %1 f. aC<J,cd " (.,/~, '$ S'
123,
I. ,I yt'200<f 90'2/fr,E 1.tO~ fJ 8/75'
I' 0/'2, ~ 8
-
/2.'/.
., - R'2OD~ ?O'!75![ CR(?';
.' w~ " 6/'2.,8'6
/;2.5:
I' II
I'l-t.. , _ 1-,(/(595GS13 f JaJ ~ " IOf.wl.> 12/27.10
II " _ )... t:,CfC,(,7tf6" E I' /l11s.~
/1-7. I}O CIO 4rJ}d'if/p
,I 'I - U,'/7 8':285?Ll r 5'oL'e " 1/ (6(, /f!I!J ' tj~
/2.'6.
,I /1 f:lt)
" _ J...(,q~1..q~Lf7'lr :iJP() " 11.7, '7'S
/'2.1, /I ffO.~ .. 11./(;("
" _ L 6'1'831'3534 r 1.2.1. q"i
I '3tJ.
II II _ /-.G,'1'aQg7,63 f bO,66 II '2/6~ '22.7, rr '8
/3 (. II " 01/67
__ L. -;CO/lZ 'M{, C 50,40 " 1.1.'i),OD
13'2"
/I /I _ L700116537 f' 50~ ,I ~/(P7 ~ 1.. ~,IJ()
f'33. /I I' -- L. -; 0"2 q9~ '187 E 50'~ (J%7 IJ.Q1.&()
"
(. /1,633, (J 2
-(o-rA L ."f,
,
.....::;r---
.RIV.U03 t"l. {....6J *
SCHEDULE B
COMMONWULTH 0' 'INNSYlYANIA STOCKS AND BONDS
INHUlfAN(f rAX It(fUaN
ltlllDINr OI(IDINr
ESTATE Of ((ic,N TI lslll E"c;~) fiLE NUMBER
M1CH^1'=1- V, KA(K~I\oJ
IAII proporty lolnlly-ownod with RIghI 0' Survlvonhlp mUll bo dl"lolod on Schodulo f,)
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
''3~ t{ S, s.u i3 ~ EE:- R21 ~51Sg5ff 100 '0 IH /';!Ist '2.:J/,28
11:7' " 1? 20 2.0 5"03' Ef 1Co~ " Ills~ 40/.'11
1'](.
" fi':.'..O:ZOS"::l.~8EE' ~~60 ,. 11(&t ~ 0/ .rJ/P
131
II R 1,O'ZC'i5"83 H' a~"o " lojS'f ;.o~, 3&
1:1'$ /I R ?o~ C~HH E ~c"Cc:' " 16/ '3~ ::1o~,'3q
/3'1 II R 20::()~?'i'l Ef :l.trlc" " O'l/8~ :ZOg,gS
NO, I' R ~D'2 039'2.0 H :2ct> oe " 0,/ (g4 :'::C,S?Sg
Nt, 1/
R I(,c:j tf(,(,/)(, ~~ ~1!6 ./ ()'1!84 ~C'1 ,Sg
II
/'i'l.. R. I(.,i 4i.27'1 f:J: ~'" I' o~ (~4 ~o~, gS
/1/3 /1 Rlb'l '15'<:(5'0 E IE. Qoo c}D II o~ /gq ~,,~, gg
l/{If II R'~3qnQ.l(. t::f' ~tO.lCI " 61 {~" lena't
/'15" I' ~ 2.,'1 2G{' qG, E E" :?O()~ " 1/ 1~5' /91.#
fLlv II l< 5'0,/ ::2.89 5"7 ~E 75~ " Ol!g:: ~~
1'1-1 U.$, SAS/, 'B:, !.I 0., Sl!'?, E R t'tlf 3lftf l-fo E 1.00~ I' &/ /12-
Ilf'g II R Ylflj "3+5n E l.CC a:J " M.1.1~ (/15', '! 2-
/II 'f. II R lflfl.f 3'+7"'2. E' w~ " 0'/71- ("'158z.
15d II R Lf5~9f.,() 1'3 f 2~~ " O~/1'Z. 6q~q'Z.
ISI " R1-/5~qr..I~1.~ -zmtX) " ()~/1e.. toCfS,'12.
/52., 1/ R 1f5~q(,3Lf7f '2~~ " 05(''2. t",qs', If '2.
153 II R ,/-S",/ ,/1,53"1 f. 1J.trOtJ() /' ()(., 72 1091, S~llp
15'1 /1 R IOO'f'b9094 f '1M~ " L,.lS4.
ISS' 01 ('1.
,I R 100 'f~~278 f ~tlO I'
15'~ O'g 1~
II It 100 '+88 "Y3E' 1J.trOt\:l ,I /0/72
/fJ7
" R 1fG''t %q 0'1 E ~~ " 1'2 /12
15"~
\I 1("/5lfQ'&'i1'6IE 2co~ " 01113
15'''f
II R 2D1SlgS32r: ~DO I' 11./1'1
f
TOTAL (AI.o onto, on IIno 2, Rocapilulotlon)
~'V,ll.' ,x. 1"'61 .
SCHEDULE B
COMMONWfALTH 0' '(NNSYLVANIA STOCKS A~~,}~.o~DJ.p)
INHl!lttrANCI! TAX IItnUlltN
IrSIDI!NT DfC!DI!HT
ESTATE OF FILE NUMBER
M IcHAIr'- P "A1"I(CC I ~
:
(All proporty 'olnlly.ownod wllh RighI of Survivorship mUll bo dlsclolod on Schodulo F,I
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
11.0, U,:;, S...>I' "'Cs G'o~ l'. S41l E . c.l.f 1'l> lfl'a 8'll)'. ICOM IS'~ (J1b3 SYUt.f
" /, C '1 ~8 Lj-1~ '3'?'1 (COed 07/6'3 5'/'3,0'7
14~ c 't':..7 lf1../ qq:5 ICOM 0'3/6"3 5"1-/" '1"
W~, C L/~7 Lf1../ q77 IC()~ 0;{63 :)<-1'5, '1 ("
I~'t, c.! t.!1J.712.f 'lIb Ilt)~ (n /t."5 5"'11. %
It.. 5 e 4-:'S %17 I '1 I LIO 40 0111;3 '-" ..."
,?,?..,,-
1~Io, C't'1SS,il/5" /(:0 eo Ol/IS 55/2 32
c' /~1 C f).'!..5"s~Cf 7/0 lto~ 191/6'3 -5"5'2"Z
1~8 /! lf1.S 75'1 7 17 If>> If} 011(;3 .5:5!Z, '$ ~
1''1 C 4'1SS5'q 1/'d k"()~ .)//1,1 55'2,1'2.
110 C Lt'l.5'3S'77/'? ICO"" o/(,J 55-2.12
11/, C If'25S5'r720 /tMCO olp 55t. J'Z.
IlL C 41)535'77'2./ /eo~ ()~'J 5"5232
173 e. IfO~ {,dG'11<f /~~ 12~0 fi''f,S'Z
lIt.[, " C 'fC~(j)r"q1'2. I~'" lij60 5"~,5~
17' C 4Cr" (,OH1 I I f:8 .:e 1'2./ f.() 5'1, S'2.
111", /... 7102(.:2. 6'2:3 f. tr()~ 0,1"7 Z:l~ N
/71 I.... 7/0'21';/01 ~ SOM O~A7 ~zg,l'I
11~ I.. 7()'H,(,'f(,tf6E. So~ O~~1 ~br..
17'1 /... 70g S"ll '3'7 t{ soll:> , Oi/67 4~{P(P
1'00 f.... 708 203 "'10 t Soli! 0'1167 '2'2~, 60
iii Is 70 g '2.0'/ s"" It 5o~ O'l1t.7 Q'28, ~
/'f2. /.. 70' e.'l.'1 'Q~ f" 5otlr:> d S/r,7 '2..2. g, 00
1~3 I.. 7e:f. 6 20 (;"31 It .5JDtJ tJi/r,,1 Z'Z8, C10
/'11, L 102 ffgJ.j 1/8'1 E !bt1() Oi67 ~2Y.CtJ
. ..._~.L_'_..__~..T_.. -'''-1'+_,..,_.
TOTAL IAho ont.r on IIno 2, Rota 1lu'otlo.
C9
,".'.,.'.'
I!Y,1503 IX. ,A.161 _9>-~.~.
~
COMMONWEALtH C' PrNNSYlVANIA
INHl!ItnANCI 'AI _nul'"
IUlolNt DICIDINI
SCHEDULE B
STOCKS, AND BOND,S
1"'-i11"'~ foP 1
ESTATE OP
Mt~llAf=L tl.k'.~n("CI 0.1
(All p,oporty 'olntly,ownod with Right of Survivorship mUll bo dlsclolod on Schodulo F,J
ITEM
NUMBER DESCRIPTION
18S'
11'
1~1
Pi'!'
1'4~
\QO,
l'l/.
Iq~,
IQS
rt/1,
1~5'
1%
1~7
W~
Iqq
~o
10/
'Z6~
1.JJ3
to 'I,
2OS:
Z/)ft"
1)./J7,
~d'3 ,
\-\
US. SA.... OIJPS,Sfr?,€'
c.' 2 0'?(P3i5-;.56 f ''2500 IISlk\!J
C' ~ Cq I 670 t0f {:. 1.5CC
Q 1.07 S'ZSg '3':.'2, f 2,5CD
Q 2c(, C(;(., '10''1 E '25~
Q '105 =..57 'N." S' E f:5..:d
((1051773 '61.3f: ~.'"
Q-:.cS/7f.J'I g~'l E :s'.St}
r; :Zc51 151. ~'f'5 E :::;,~~
li ~0'11 '2/..0 'I Sf., E 15Cl:'
{(~t.J0310?g,SE :::::;~
t) N6G 3~O(S8 E -;s~
Q 1?~'1 '11L>1i.7 E' '25,,0
Q 1'l~.q21r,,7Q(. E t;SM
!) lING crl3 30<1 f '25cc
f) w~.(, 'I'Sf rs'?f ~c"
f? / % 8 '2u, 'S1H t2S#(J
Q / q 12 '21':3 5'81 ( IJ.1t'O
o Hen ''1~ I r"(,, f '2$<>0
rp l'ii'''! Q41.. 055 E. 25-"0.
o /550 1"1(., 1'/0 E %~
.Q / '31.3 109 '2.1, t. 151'0
Q IS7'3 2Nqg-{f: ZS'~
Q 1(,-17 q..,S''t1.S f 1).5""
Q IG7f., G58 qg~E '2Seo
"
TOTAL (Also onlo, on IIno 2. Roco Ilulollon)
", marl saptl ;sn..cI.cI. ;n..rtacJcJilional .h..ts o( .op.,. ,1z..' __ .
FILE NUMBER
,2. C. 't
111"<1
09t'f
0(,/1.>"
()4r..1
eLl 1r..'1
()<1IG'I
03'/&1
c.'Sh'1
0:.'4 'I
,,~.z
0-'1/6 ~
o-i/c,'Z,
c~kz
0~2
Oil, 1
II !t,1
09/~1
/0 I GO
O'i~bO
O~O
00/"
O;l'i
172/57
VALUE AT DATE
OF DEATH
rn 'f 5
132, ~(;
/8/, qr;
11'11."5
/ :?? 73
/ J1.73
I", 1'5
/ ;;r. 1 S'
/ J":J. 75'
/,g:j/I
I'n 5/
1;,,/30
/"S1, $tJ
1 '3q, :;e
/.3'/, ~,C
1'12, ;;8
1 'IOs '2..
/'-10,3"'5
1'12,10
/t!O,,yt
11/3,07
#9,s'lD
N1,2CJ
/'19 1"
.
..- . ...... -. .-..... .- _.
IfV.U03 rx. (4.861 .~kil.
' W
COMMONWeALTH 0' 'ENNSYlVANIA
INH!IUTANCf TAX UTURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS AND BONDS
,'~\N"":"\ \.J 'J E. r''''
FILE NUMBER
ESTATE Of
MICHAe:L'D.I<Al"K.oCI'-I
IAII property Jolntly.own.d with Right 01 Survluonhlp mu.l b. dhclo..d on Sch.dule F.l
ITEM
NUMBER
20'1.
DESCRIPTION
.~ .
I S.ri.:~~ U, ~''''..,,;~,. I!.Md.
c "i2.8 "-178 8 9~ If 4> IOO~o7/6'5
C "t:2.8 '"t 78 895.: 4Ioo!~ 71t'3
c: ~"I a 2.!!...8 0 ~e E 4/CXJ,!Jo:> 2ft:;
c ~'ta .2.8809,01 E' -i IO() ~ ..y~
C:f7'B288/N.E'I/OCJ. '''21.;--
C?'f'82&8/<J2E./;iJ(},<v.o 2/5'
C- 't''I8~8/()3EI/aJ. .'(7 21r
c 'Ir8286'/OtjE-!I(JtJ,~. ~s-
c. ':';~82&B/CJj"Ehoo," .2f.:r
C.'IS/2.70/37E.J JUO.~o 1,kr-
t:: i;-.>/2..7o/585 iJ()(), ,tl ~1~
C:7'5"/27013'7E..ho(),o.~ r;;~
t:. ~t 3 ~:5" 7.:58 r:t,::: .JI()~"~ 5" /t c
C '763 ~j7385E4100,~~ .5/c~
c. ~cr'7.f7383t:';/OO."'o.5j&(
. c. '71(;3 41:57 '382E J /00, "" 5fi t
5'0 CD
/.- ('752.Z008'3fI!~ 1b~..
S'C:dC'
L 675223?Z2.EJ-.;.!J '1'6
t.. 675970tf20~ 1'$0,00 2/'6
/.. ~7fr'l'jr/7'fE~5~,"" 3/'/
L 67( ("'0303'iE.f5o.~ 3/U
~IO
~II
'1.f2
1.1'3
'2,tlf
~/.5
-;..{(,
2,17
21'S
2./q
n,,^
ot..'"'-"
.,
'2.'2. ,
Q.'Z :L
~3
~
12.1..'+
125
11..:21"
'2:2.1
,g2.Cif
1-29
VALUE AT DATE
OF DEATH
5'-1B,O'f
Sf'8, JY
1175,3~
'175'. B$.-
'17J': o~
c;'l~ gr,
lf1S-' 81c
If '1 s-. 3(,
l./'7J~.3"
qn'W
~77. (; 'i'"
rt 77. '" {z.
yc;D,
l/'1),qZ.
L/SIl,q--z.-
~<tI ,'It-
23if. 5"2-
23lf,S'.2.
/- 3"~ :1'2-
227,7l:.
;z.2 7. 7'
I ?
I!V.U03 u. 1..161 .
~
COMMONWEALTH 0' 'ENNSYlVANIA
INHunANCI TAl InuIN
USIDINt DECrDIN'
SCHEDULE B
STOCKS AND BONDS
'I' ,-\..., ~,; '" t"')
ESTATE Of
tv\ Ie l-1 AF.: (... r', h:,\T Me, '-J
FILE NUMBER
(All prop.rty lolnlly.own.d wllh Righi 0' Survlvonhlp mU'1 b. dlulo..d on Sch.dul. f,)
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
,'210~.,_... .I ~~ri..:r.' E ' \.l,S.S...vlnj ~ Go."J LG, 7""0"8781:: .1'5"L'~' "'I"' .f> 2'27. 7"
-~;:, ....,'~,._.___..','.,,,L.~8()t{11~5'1.r45c),''''t{M. 2.2.7:~~ ,__
:,::., ..- .._, ",':.. " l.. 6f3lcfH],7E" .1;5C1,"".o/'(. 1';;0, ~....
___.._.,':33, ,__~' ._______..__~'....__ L 6BI032'37GEfSo,C.1#l ",J}5.tlr.
2~~__, .... ,\ II R lall.z.e."'11.z42C~,c"i//7. C.7s'.J.S'"
1-'$'5 . ,I " ~ IO.z.9!10o~-E'~2CO,m 9/7.J ,c;s:o~
___ .z~l,.._ '__'__~_'__.m._" ~ 102. 1"/7. 'io7tE" 42CC.'''' 12/3 6'16.2.'1
'2.1)1, " ,I K I033935G8E'f;;'aJ,~e 1/7'1 (,'1&,.2'-1
._,_1?~, " " "103<1177'lOi:';2CO."a.z.j7Y 6'1~2-'f
'?:~._..._.__...'~_,.. ,I {(I03'1I8'i5'"2EI>,200.""3/7'1 ~r6.2r
__..1ifu.... . .._._~~.._ _.,_,., , ~'" h '" If 103 '11'1 /15" ~ 4.2()(J.~ ~7'1 bC/6,:J. 'I
.....,,_1,:/.L,,'. ,_.,,_~', ~/D3'i21706EI.200,,,o'f/ly 6~~,2~-""
~H2. II "f<.IP3~~.30'l)>EI?:~,~s/?-y' ....td83~~tf.~~~,
__.1tf1,____I~__ .:~.._, .~)a3 '7:JI/2SEh~o/P t/?r t7'/...~'.._,
~'1'f, . . ,.,,1,'_,....__'--.__... _~... f{ 10'! 7t2 /93E .;~oo. c" 'P r. -63'/,.88
'2.'/5: I'~ _'~._. ""10'-1 23//32E -1;;'O~,"o.;j8f tJ</.,s8
-..... _....L~
--_.... _~__ ____.~._n___.._._~. '_~"___
_ __'''_4 4.._.._._______...~__._
....._._.._---.-_._~...- ....- ".
.- -----.-- -..... ..-
- .----..,-. .......-.--.....-.----.-..
\<.
TOTAL (Alia .nl.r on IIn. 2, R.copilulo,lon)
", 1"1"1'. ,"",.. I, ....,l.~ :..,." "..I,l:"I"l.....I ,J...f, ..., '""'II Ii.. 1
\ '
,:3&
s
, ,
RlV.1503 I)C. 1~.'61 _~~~_
W
COM~~~~F'~~~IO:4~f.~!~~~~ANJA
US1D(Nf Df.Cf.Dl!NT
ESTATE Of
MIC:I~Ae;(.. 1:', i<'A......KOClo..l
SCHEDULE B
STOCKS AND BONDS,
I ~I.j-, ~u~ ,)
FILE NUMBER
(All proporly lolnlly.ownod with RighI a' Survl.o..hlp mUI' bo dllclolod on Sch.dulo f,l
\,..
US S."'u"' j),,"1>'~':R. EI!. R:::!4.,5:SSU '21>>"" 1,;....oJI 0;/'1:J'
f;'~;'I~c-1~! lit: z.",'" IO!Sf
O,fi ~
".~'f'
()djff5'"
t'1.:tS-
(l;/~~
t!1fr5
~/f5
01'1.5'
05/'1S"
"/.r .>
lol'i~
101 ~ c.
ID/~t..
lol~"
lol~(,
lo{g(.,
101'6(,
10 I f>(.
1018(.,
WIg c.
c SI'Z.I'Z3~5'E 100M> OSjT()
C 512.21333'2- E I~'" ')~ 01.70
R '2.'3,? e7 ~OS rtE: 2fti' ,I ,i/85'
R I (.q 1./5 (pI 8 fc:. 'JiiOIO " 01/81
RIl..3q2.7'I~1 f:( ~.. II IZ/?5
ITEM
NUMBER
'1.'1 ("
1.'11
2'19.
'2-1'1,
II
e'
,I
DESCRIPTION
f\;!.I':!.SSJ5S' FI1' ~...
/I. 21:! ,<1/ '?'if ((!; Z<c'"
R,zIZ.5S'17,:,rl! ~'"
R::'Nq~"5'G!>'(( zc.cco
R12'f'!5N()f( ;?a:1 ~
R'Z~'f '1(.,'1~.fe 2~.:c
Rr..r.tf fVl.'2.3(( 2~1!-d
R233"''''!..(.7M 240~
f??2.'fq~~13fe 2"0 '""
C S555'17~'1fe 100 ~
C {I '6~8 1071t6' 1~.:tJ
C II ~g8101'1f{ICO~
c 1/ ~8S W7Sff ,~~
~ 11'6~S IOT[lf Ice'"
C 11888 IOI(.,tt fro co
C. I \ ~~8107 Sft 100 t16
C II S5"3107'fu IGOclc:l
C. \ ISiS 1013tt! 100=
C Iff>'b~I012# JOO~
C. /I ~gif log Of6 , 0060
TOTAL (Allo enler on line 2, Reea ilulatlon)
" more J ace;, ne.d.d, insert addilional sh..,. o( Jome size.
VALUE AT DATE
OF DEATH
'2tJ/. ~'3
"''f.~
~l:1g
~1/.29
';'CI.:2'il
!?t'/..z~
~/, ~g
~t'I, ,:zg.
t;.,tJl, :28
J(!1. 00
/9if 00
/CO,6<{
qO.l'2,
qO, I '2.
qO,lZ
'70, \2
,/,0,12
90, 12-
qo,t'2
'70,12
qO,I'2.
10, ,'2.
417.12-
!/17./{).
1'(.7,01
W8,~8
Ino'!
s 1/ (p 1/, Jl8
I},~a.
"
HI
~5''Z.,
'253
1.5"1-
/l..S5
1).5'<-
1/..57,
'2..:)~,
'2.5lj
,/
"
I'
,I
,I
"
II
,I
I'
2.~O,
II
?,fol.
U-2..,
1Z.(s3,
12.l..'i ,
%5'
~(A..,
1-ki,
'2.{"~,
2..~'1,
'2."10,
'2..11.
']..:1'Z.,
II
..
"
"
"
//
II
"
V,S, SA~,'BO>J" - S E I(. r;
I'
ItS S.l,V 'l3:>1J\)
s~~ tE
, . IUV.I,SO) ix + 14.161
~
COMMONWfALTH Of PENNSYLVANIA
INHUlrANCf TAX IUTURN
US/DINT DEC!DfNT
SCHEDULE B
STOCKS AND BONDS_
('('\..l..n N',,:,;: I,'
ESTATE OF
MICo.{A.~L- l/I(.\f'/<:C'C/N
FILE NUMBER
(All prop.rty 'o/ntly-own.d wllh RighI of Surv/.orshlp mUll b. dl"lol.d on Sch.dul. F,J
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
271, L( S 5'.",,,,-; O~"p, S"t/?, f"- .2 ~""f :'17 ~'i'1 f, .j:,,'C~~ l')~; Dif/.~ ..5:J'l, 9~
,
'2.101, " . ' ~ U4~ :.!/7 S~'7: Il.;c"''d "/d f1t -fo
'L 1 :>' "
C ".J..f 117 5C, ( Ice"'" ,1/"'1 ~-;c- If C
i7G. " I'
II ~ ""'I '217 5c'j E I~"" Id'A 5?st-,'1c'
'2..77 " cil.u. '1~
C".,v11'" ,;'t....~ 'Iso, .
" .;.) f~. :) C
~T3 II
~ "~3 "''57 ;~, t. ICt""" c,hl. '1:;0,'1:1-
1..1"1. '1 ,e
, :J~ ~ ..J -7 ~""q C ',-'C ~"t: /.\,~(., '/S1J .9~
" l.. , J '~l ., I ...
2,'3(1, " ",4/.1"
~ .J(, ~ " ~~5 .. leo" l,I.so ,'If).
'I .,~. },....
~iI. "
,; '16-'1<:'7-....7" ,ere':': . -~" ~v,qf).
.' L.. .),,, ), _ :..~! .
2.'12., " "~~(,
C i/6"345n7i..i' I~,~ '1,!)v."~
" II
2'33 t, lft/lo5C -?-:/2. [ IloC,JC , '1/'{., U:i"f4-
'2.z'f I, .'
C 'I6'10';Oo.1':.5! 1~,<l:J 1i/"6 :..J.,5:1r;,
'2..'~S, h I'
e. '1(,"1 ~,o q~'i t ,~JC i";/"~ tJS"f(,.
'1%. \I I'
C t!lR OSOof-:3 ~ I~"" 12./"(, 'i,5:r"
d "
~i7 C'17Cf7573(,(,!: /k;"'" ~';A7 'IS! 3:L
\, II
'2'il\!, " l&o~ ~';f.7
C 'i7Q '15'73(,,; IE 'I!;I ' ~;J
..
~S'l, I' IfO~ . air7 '/0/..3:J.
C '171 ~57 ')67 F
,I ,I '8J~O / 'l&/,a~
'290, C u7'NS7;1(' s e I. ~~,,,7
'2.q t. " II 1~6C, ~:f/:7 'I61..9:J.
C 47'1 if5T'3r.'I f
'2.'12, " " C 'f7Q'l57 "371 i 1M'" dfu1 1.;.1,1 ,3:J.
M
,~
, . II:I!V.1503 flC+ 1....61 .
SCHEDULE B
(OMMONWU,LTH 0' PfNNSYLVANIA STOCKS AND BONDS
INHflUTANCf TAX UTUlN .. D
IUI'JeNT DfceDINT
ESTATE OF FILE NUMBER
M \CHA~" p, K",,'-t<oCll-I
(All prop.rtv 'olntlv-own.d wllh Right 0' Survivorship mUll b. dlsclol.d on Sch.dul. F,)
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
2<13, U. ~. $.~"'Y ~. - 0 ISO~'35'/ 21/0 f, 'l$.00 " oll~O 1'f~,(J~
l.!l'f, Q IgOc,,~~"tfS1f 'J..)ID .' Ol/(,/) 11/1.05
"
12M, ,/ () IS'Z3/1't "l3E 9S.1tJ I' 01.~O 1'/~01
'1.qc" II I( I~ 5'0 gD17~OG: 7.500 " o<l{(;() 1'12,0'1
1M. /I Q /St.S"I/S'7';1E ~oo ., "1 f:O 1'{2,10
~'lg /, ~ 1'i~'325~")~f ~()() .. 1'2/(,0 /'I~"!'a
Q.q'l. h (;I 1 &{,'3 (,68 8'OSE' ZS,4C' " 'o/t:O /'f'l.,3S
'2Dll, 1/ 9 /'10r. 1/7'151(,f fJ5.<<J " oq/fl /'IOS'3
'501 /I Q /90(. l./'8e. "3?o [ 6000 .' ~/(,/ I'I()S~
~oz., " It) I q 112. 270 0'2 C, E 'l$.~ '~l'~ 't' /'Ia12.
"563. /I . t? 1'1'Z0 S'i5"5W t 1.S,60 II ,,/ /'If HZ
'30 'f. II ~ 1'1'11 'r5'f gaS f QS;6Il " 4", l'IO,7'L.
-gos, 1/ Q Iqlff.,q'llq'l..'J r '15.1D II 0&/<'2- /1'1.36
30', /I ~ I'iSO ISO 04-2. ~ 15.1>0 I' 01/(,'2, IJ1,7"
"
:2 0-', "1, Q 110) qlf3~nE' 'l.~1O " OIl'S 111.'1 :;-
:30~, I' 9 21 0' 15U>7H t]5.1e I' 01 'i 1"51, ,/,~
SOIl. 1/ q ~/OG,c'5'31N~ f2$HJ .' 04(,S' W6 ?J
310, ., 9'2.J1'2.15~1'1[.,E '1.5~. " 03/1.s' , (/CL~Z
311 '/ Q z.m (1./5'095 E fJ.5f.C " 0s/1.5' 11'1, 'f~
:m" Q 21/5'3 't~S"47J: 25M .' ~~/" /1'1, Lf I
/I
313, I' q Z.'15'535 m. E: 1.5.60 " 0'//~:5 Il~,cf I
314 /I ~ Qlt/ '19.2IfqO ( 2.f'(}() " 0s/G5 . . 1/'1,1./ (
:315" /' 9 '2./~'f'l'25q1{)E '25.10 " 0" {t..> 1/1.,.,2..
31(; " c( ~13~ '1"31 VI.. ( /25.<<> " 01 I Ie>' 1/r"C.Z
31-'1, 1/ 91../3'D9..:J5I/l t: I}.S".CO .' Oi/uS IfU'Z.
'SIll. <? (l13'g2'/~%(., IE I}$.tJO " or. 1(,5' / IS. tN
II
to!
,~-
RlY.I:'03 EX. IA.161
.
SCHEDULE B
STOCKS AND BONDS
\ 1\.\ D
COMMONWUL1H O' PENNSYLVANIA
INHERITANC! TAX anUIN
aUID!N' D!CfDEHT
ESTATE Of Mlc.lHA ~ l- 1), \<'A n':oCI N
fiLE NUMBER
(All proporly Jolntly.ownod with RighI of Survlvo..hlp mUlt bo dlsclolod on Schodulo F.)
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
'31'\, I (Go) (}: S So~i"',\S ~r-!.. Q '2. I Or.:, lD'\5 59'/ E 2 SOo ~.G.s. .6:. _.._,
._}~~. I C~J L.. c.,(o'&' 'jj2~S'3&e. 50.co /1-6,5 .'2.T2.,_~<-/".
'31.1. I C.IZ)" L (p(P8 823/&&G 50,00/1-(,.5 232 0,-/
_..3~2,~,.. I L~), II C Lj4~ 2.175'1'2& /CO.CO 8,(Pl{ ..!f41.''l~_,_
~23'. Ill::) I' C l.{4II'2I7S13t3 1t,()QJ g.(p,/ c5c!rl/~.
,_, ,SZ'f. I (r-) _""___~h__" t '1lflf Z17590G" /CO,{XJ 5-ts-'{ c5':f'1!=__,
_'g?~., h ,U~)] __~~ . c. ljl{t( '2175'9<fC /t,(}:..~,~..~~..~'!." . ..,s,o/.Z~__'_H
-'3.2"",, __ .J (~, _'_'H"':"~' ._~.~~::-.~- 4~'\,(3lj 252"[: 2CO,CO,2 -7/ 7/7.., Of>
_~,2..7.,.._.1 C~L,~_ " R t.('/"3l(0ir....~-....~:vco..i,:7in '7;d:'ttO--
-~'?..:_.JJ~)._ - ',;-' -.." ~ 4~""02 ",oO'~--' '2.CO,oo q- 7/ 7to, 'to
, . -~;.-- \ '~i~-'~~~~~~~-'.':--~"" ~4,?J~1. z:-,ii_..., ~Op..__cl. ~.7~ . .~.1.;9-:'~ __-=.'
-- .. --------.--.'----_.h..P:1 L{3lc.Ol.Oq~ E '2,c060 (P-7/ ..13/ ,?l{ _....:._.
331. .I.. (~) I' t\ 41/0~5$;~E. -~O(),~~'-7/'" I~cr, 84
-H2, I (~L" " R YljO~'l187e: 21:00;' 4,-7( - -;;~, 8'-1
--.-..-- ...-_....~-.._-_....-...-.------_._._.__._-_._. -...... -.-------.
_?}}, _."._____,~,~,_._.,.... .R<-itt17'6901~,~___., 2ei?:~O...3-?' 72q: 8'1.."
'33~. ",___. ,1'--__,. AY'256111iPt" 200'CO 12-70 _~19''?9_,.
__...~??II,........._.~~___.. ~~~o~~ 200,00 /1-70, _<gt'7. 7(0
_..... ..'I~~._ . __~' .... .' ___ ,--'3 4'Z~.ct~t;(o.L_,..?,qq: 09., lo-7~_ ,Y-/7:.71o_
%1 ,I II ~4"?5o'2L/IE 20,9,00 7-70 ,<;/-9,<;1
~.
'33ca ,FS \)5 SQ""""fS6l>1L C. 223'61~ 100,00 5-70 428,~_
. --'-rl!';"'~~""S'\o\""~ Co 13 5 ~loo IOO-CO 7-l<7'is 4iPG ea
~'3'l,
"QO ,I C. \40"2.1(,,( (00.00 7-Co~
7;1"/-1, ,I _~_!~o'2_?'1D \00,00 II-Co3
o 3,+2. ., C.''-j02y~'-J /00.00 1I-1D'6
4"''' "12
44G,,1Z
l)",.-l.ZC{
. s 1.-9, q.j'3. 7"01
'''V,150' I" 1'.'6' *'
COMMONWfALtH 0' rlNNSYLYANI4
INHUITANCl 'AX InUIN
USIDfNr DICEDEN'
SCHEDULE B
STOCKS AND BONDS
- . T)
FILE NUMBER
ESTATE OF
MICI-lAEI.. 17, KA-r~oCIN
(All prop.rty 'olnlly.own.d wllh RI;hl of Survluonhlp mull b. dllclo..d on Sch.dul. F,)
ITEM
NUMBER
DESCRIPTION
.3'1j,
I (~) VS,SA';i~Sg.,..,O C'/C(P/i;otoqltlF- Ito,CO /7'1.0
'S{'! ,
I LG)
c.."/ololDt-{"Q5ZE 100,00 12 -60
:H5,
Il~)
__,__~~~'....,_. J.S~l_..u
W7. Itn
-------.------
sqS. I C~~.
c'4C(P(.,c:(p960t: /C:O.()O 12-(.,0
C. '1d.?l<<:(PCCl/9E /00.00 12-6-0
c.l(o&f.Jo(PCf7'5~ /t'O.t)O 12 'GD
CI.{C(p~r(,'2~ It:V.Co 12.-60
-.-. .. . .....-. ..-........- ----
1(':) t!.,!u(P(powClY(;t'. IOO.CO /'2.(po
--.-..---.. --- - ...-------.--.-. ._.._ ~_ __._____.__.. n._.~_._._________._.....__._"
__0,_ ~!~'-_" _L~~!__.__.u__ u' _ C, L/t'if (PCjrt '1~?E (ti~:CO. /z.-t/;o
__u}51 . I (~') C 'lOr, ~6h r~q:' /CO,OO I'Z.-"()
--- . ..-.--.------.----. .._-.-.. . -.-----.-----.------.---.---.-.--
352 I c.e.") C LfC(P ~O&f'W /tJO,t)O /2.-6;0
___'H "'----.-. _H ". "',. .. ., SO,QO . .
,53 I (In ~.. L 5'8ogLf\'{2532E~~ 3-":-
... .~..... .....-.----.--.-.-.-.\----. .-. .~.. .......~._..._-_.... -~..... "-. ...-. ... --.
'55~. I cn L. G:.t'o I <3l/8 7'14 e s~.oo ~ -" 5
. . . .---,.-----.-.-. ..- -.-.. .. ._. . ..-.--------..-- ~- -...---.-----
...,,_.._'355.___. .UG}..H...___...._ L (Pfb5'iS75tt'{II~_ 50-00 Q-G.5
35" I C€i) L(p(.,S<670fl./(P1! 50.00 '1-&5
-.-------- ...-..-----.--.-.----.-.. .. . - ..- -.-. ---- ....____. ._ _.. ___nO
'357. \ <.~) LCd4852...t14/3f:. 50.OD IO-&:'S
'3 'iq,
VALUE AT DATE
OF DEATH
5bq .52-
5&>'1,5"(..
5'&9, 5'2-
569. $'2.
56/1-5"2.-
5& (1-52-
- ----.----.. ..
S~ 7''5 Z
.-.-..-. .--...-..
5&9.S 2-
... . .-.-
St.9,5Z-
5&9.52-
'Z 71. ~8'
,.#c.!~~~~ .
2. '3'2. ol{
Z ?,"Zoy
Z 02, at{
_.__~:':~:..-... J.~..:?_._,.. LrJ~85J.5~/f~ SOO? IO-.~S_,_ ~:3.~~~L..
~~~~u_. l ~,O o,__.Jhlf>J.~.-?.~.~l2(~_,,_40'CO__7-:~~_ "Z.~.7. 7b
3(,0, , c.l!) L lJ,8fp0322.51~ .50-00 O(o-~(j, "2'2.7.78
---..-------..- -..--. -----..----...-. -.-.... ---.---..-.----- ...--.---------
,_o~~_ I l.n L G,~wDz8373i 5000 or; -ro~
--. - .- ----------___.__..__._ .._.___~ __'_h_~ .______ __.
3'~z, I t.t) /...{,7/3tf7(PC(I{ 50.CO IZ.-~S
p
'Z'Z.7 78
'f~1'A'r€.,~ .
MICHAEl... Po' k'A11(OC I /oJ
'OV3.
'3(.1,
'3f>5
3'-c',
:2(, 7
'3(,<$
~foq.
'3"10,
'31/,
31~,
"313,
31'1
".
'37.:J ,
31c'.
317.
31'a
'31~,
'3'l10.
3'2> I,
Q
'VCH F,Ov /..c 13
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'$ 1'3'1. :n.
u.,S. 5As/\IoIC,~ 130N\) , SS;;Ii!I~S [, Q~O(50'3'i~o1 f',II!i.oo "~ 0'4(.'5
/I /I _ Q~178''l{OO$f' 2.5-60 " fR{"3
" II , c.. 'fOWlc..Lf5/ (. 100.60 " 12./60
10 "tLtO'O'"lc..'f4~ E: - loo~ " 12/C:IJ
" "Cl./OID foO(,'llf2~. I(>>~ I' '4~o
/I "C"'~ eRc, ~53 f' /co~ .' '4('0
/I I' _ C~OH'((, 4111 [, I",'" " 1:./(;0
" ,I _ C 108 61(" 150! - If}{JtYJ e' 1~60
S q() " o"fsLl 1.0<< g~
u... ,SA~ltslCS~"p.~!:,w:s ~(_ R/("q~~~~"EE'- 1.00 III '
" 'I 'R1~Cflf~1i'2 ~f 'J.oo,QO I' tif'J1 Z,Off,ITS'
I' II ff/"'l~q 't52 (E' l}(}()tO ,I O~( 8'1 ~U'ij'
" I' _ R/lo59'l7G.O a: w60 I' ar/s~ dJo'l,9'l
R /(pS99 q<f~ G:E: '2fdC " O.5(~i
RJ~5q'l 1'3'2. ~f z,ood " Ol//~'1
R/~5q~~2.~E~ tttJ~ " O'l/~1 '1.11.11-
RJG?$q'8lq3/f,€' Zb06D " 03!gJ.j ~/"I2..
R/6:>'f1J'1'f"/{t[ ~o(Tll I' (%Ig~ ;z./r./~
R/& 5t'f8505'tE ~~., o'/~1 U~,IZ.
e IQOtz..11..'L I{)O"~ ,I Oliff{ '111,5"
.:J (p ,r.it/O, C/t,
/"'St(R("
~(If,5t..
'5{,'l,S~
5(/(,5t
5(,?5Z
5~'l,5t.
5(,9,52.
1\ " II
\, -
" ,I
.-
" "
'I II
II II
II "
S~~INCS No(e- (flecPOt'I liUAeE -
408, ~Y
2/'3./2.
-(o1AL
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M ICHAEt.. 1/,I<A1Klx:IN
'3'a~,
'3~5,
3St{.,
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'3'&(;...
'&87,
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3'&'l,
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'3'11
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"3'13
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'3Cf5
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'3"1Cf ,
100
'101
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SCHEl/UJ..( B
s.,..oc~s ~ &>NDS (,,"" t~)
u..,g, SA...rIIJCo"" 13,IJP, S~l?II~S [. 9'1.1,~';<3' 33'2.f;.J?.~,co IlsuJ 01~'i' -11/1",('2
" rI Q?-I-2.~23l/7;t,t, '25.ltJ " O&fiS- /1(.,,(,2
/I /I Q-2.IOI9'O'67b6[-~1Ij " OlhS- 1;,,'15"
,. " Q t05zS'58266 €'- ,zi.~ "oil'! /;,).'73
" " 0'2C1(,~Z~g6/f' '2.5"."' " IZ~'1
" " Q2.0~()'goZlq'l('fS.IL'" 01.6'1
" /I Q Z()lf1251'J If! f- 1-5.~" Oil" 'I
., ,,91.03Izc,505tft; 2~...ta ., O/~6'I 115:80
.' /I (J 2/)-;I2...~';371E' '1{.~ ., O}'1 I~S:~O
/I " () ~o~t.~:2i67.s;. 25{)!3 "1#3 ,,5':'40
'. "02.026'03'-1S'21?:-25~ " 1z/6'3 {';s,gO
I' /I () 10Z25'/'fC,3ii 15fJO " 11/63 1'3'/;q(p
" /I 0 1-0111tZ6rotf, 'l5co "/0/63 I"3Lf,C(~
,I .. 0 WI50~<D1ro8{ 1$&0" (JI(63 /)1C(~
" " -" Qli5"qZ.07t.f2~E'ZS"'I' O1f'Z.. 131.51
II "0 (q~700t:5q5~ 2.5.00" 10(b'2. 1315t
'/ 1/ 0 tQf,70t I OD~ f. 25~() "/flb'Z. 137,51
" . /. () (Q1i15/'32.cct 25bO "1462-. t,'O.c)'3
" ., Q 117'8153371 ( 2S()() .' 0/1""3 1S'f3,03
/I " Q tQ'65'QgZ.701 f; 2500 "03~3 135.'19
II " Q /Qq20t<tqqZ( 1J..s.~ " ~'fj63 135'.i7
/, "Q 200~e.15'qSof ~5.00 "07/63 131,a/
--r C) -fA L. .:/ ~ 9'1/5': '1.3
/!J. '15'\
13~. ·
1,3,~ /I
. III:Ey.1$t\3 EX. '4.161
*
COMMONW!ALTH 0' '!NNSYLYANIA
INHUITANC! TAX UTUlN
USID!Nf DeceDeNf
ESTATE OP
MICI~AL:r.. p,I<Ar-"(OC/l..J
SCHEDULE B
STOCKS AND BONDS ')
tOIJ 1'1 \J \J E. \7
(All prop.rtv (olntlv.own.d wllh Right 01 Survlvonhlp mUlt b. dllClol.d on Sch.dul. p,J
ITEM
NUMBER DESCRIPTION
1f<It,
1t~5.
I{()("
1-/07,
"kJ'l
J/Oq,
4-10,
'1/1.
tfti,
1f13.
If/'I:
qt5
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'fn.
'1ICZ,
4/'1,
f{lJ.fJ,
1/1.1.
~'2,
'1 z.:5
,
Jf'))f,
tf25.
tf~,
uS 5~I!/II(,:' i5,)JJ>S' S~e (,
,I
"
"
/I
II
If
"
11
"
,.
"
"
"
"
"
"
"
I'
"
.,
.1
"
I'
"
PILE NUMBER
Rloy1.S/ ~o II f. '2A'-" IS
R'l.OOt1'lI712 ~~.. "
R:!~'/f(2.'17'!{ ~.Id "
R2DtJf'3c. Nt,.J! f<V"" "
F?W'l.'iS77UJE 2tJJHJ "
"~1. ,/385'1(,1: 1J.(()46 "
R'20'l.1J/()74gt: ~tQ>> .,
1('21)'2 'Nt5tIF 20tr II
f?'20S'I6SabgE ~ "
R'l.O'3'1G'38z.'1[ 2(;0,10 "
R'U>3 'Iv,! f.,t/)( I)/J(J.""'"
R~3't6~'575( 'ltc,"" ,I
'R. @'J'I(." 1'15 (~,~ "
(?'l.{), 11I.71'11f( 2~"" "
J..,C,7115lt.211( .5t;~ "
L. '7S'f(g(;,s'?~ (~o,~ II
l.. (''d'S85917f 50.<<' "
t. (, ~'8 '2.1 1 g5S~ 50,10 "
"ro'a'8Q"fC,q08f ,s'a,<<J "
L (.l{'31tf:; 16ffC 5/J,C() "
l-(l?3162.~57,( S'Me. '..
L.t.rnQSc,?2/)E 5'/J,Of) "
/.. C'1SQ"3c.58t./E 5o,~ ,I
0'111
475
475'
O;;7~
~lr6.
110/7("
;ft
(JI.,!1f..
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Oq /1 C.
10/1("
"/16.
,d/1/P ,
0'/--1"1
lo/?5'
021'c,
01'h'
O;jtc,
O"i/H
0'6/"
0"1/,(,'
~'116'
101(.(.
VALUE AT DATE
OF DEATH
~'Nli'S
6/'2..li'11
"'oo,g~
C()U1
,a'2, '2.'1
60~, ~'f.l
590~7'
~''?I, bO
5ilI, 5'(1..
~ql,51..
5',?I,52../
6'lCf,Yr
5'(U.~2
~/,5''2..
/}S'l-50
'2.1'1.S" "2-
'2'21,7t.
'2.1..7,7{,-
'2'47.1'(,.
1J.'27...,.r..
'2..2.7...,. (p
1}.'J.7:1(.
'2~7,'" (p
F-'51' A1 e: 0 f'
MtCl-IA.fL, 'P,I<'Af~ ts\
Jf27.
1f~..'8,
1f1C(,
If 30,
Lf'3 I,
4-31. ,
/.1""
-():J
1st/:
J.fJ.5.
436>,
'131,
108,
4-3'1,
iflfo,
fit.
J.ftf 2. ,
tf'{-3.
44'f,
t.[<[-S
/.f:qfp .
l'
S'CH e: 170... ~ 6
S'fOl!\~S .~ 50"l\?S 0"""~'~ ')
u, S, ~""'\J\IJCo; 13'ON'D' S~RI~S E. C. IG(, :)'+3700 t: . 1coo<llss"J1 ooff:)1 i~u,'1O
II 1\. CIl.:,(.,5''-f3"q~[, ~OO.,c" "{51 ~5'o,~O
II ,,_ C /(,054'3 (R?C /Ob'" I' (j{~1 6,O,<{0
I' "_ Q IOI0'3'2.'3~';3~' z.~tC " 01(52 /10,(;c:'
" 1/.- QIOI032.3~33';-' '2:;~"() .' 0I15t. 170{,("
II 11..- Q 1010 '3'2'3Qn t' 1).5-~ ;' ~1'1. 170."c,
" I' _ 0 /010:3 2'5 C(1t.: t:. 'li,tJO " 0452. 11t1,l.C,
1/ 0/ _ ~ /0I0'3~3q2,?~,Z"'Gd " ozjS'z. 11C.c..t..
,I ., ///~I 1,<:"1
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II _ Q 10 I:; 1/1,; ObO E . ~s.4f) " Oi/5t. /10, "G,
/' Q /01'31/(,,0&/ f. '2.5,60 .. oq!S2- mi,M.,
" _ Q /02.'1~~(Pg31E" 25.~ "O'f(52. i70,IIff
I' Q/OI'31/('O~'3~' 1S.00" 0'3152 /10(:("
,I Q 13002..102-,+5. (lS.6'O II M/"r., 11/,~9
" _ Q 1051 $'2.gq-Sq , 15.00 .' /0/52. 1776'1
II Q 1'30'512..+~q'O. I}.i.~ .' IZI5~ (C,q,?7
,1 Q (0j'1 S:Z8 ~?O - 15.(;0 .' fllJ:rZ. 115. WI'
/I Q 105/ 5~S ,{11 - r;.5,CO " 10/52. rniJ!/
" _ Q 'Z.53 3/tj6S<J' '2.s.t70 " 6/1510 1/1,'25'
" Q 12.831gSQQfJ - 'l.5.ftO .. 07/Sb 17/,6~
"1crfAL .f. ;!;V70,4I
/I
II
1/
"
"
"
II
"
1/
II
"
"'IltOt... f~'~
~~
COMMOHW\AIIH O' "HNIVlVANIA
IHHIII AHCI TAX U,U.N
.ISID!.!~' DICIDIN'
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Ploalo P,lnl 0' Typo
FilE NUMBER
21-1994-0896
KATKOCIN, MICHAEL D.
IAII p,op.rtv lolnlly.ownld wllh tho light of Survlvorthlp mu.t II. dl.do..d on Sch.dul. '1
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DESCRIPTION
VALUE AT
DATE OF DEATH
PNC DANK
A) CHECKING ACCT. # 5140033026
B) CHECKING ACCT. # 5140258604
MEMBER 1ST FEDERAL CREDIT UNION
A) SAVINGS ACCT. # 5927-00
B) CHECKING ACCT. # 5927-11
C) INVESTMENT SAVINGS ACCT. # 5927-05
D) ORA ACCT. . 5927-10
E) ORA CERTIFICATE . 5927-15
1985 CHRYSLER LABARON (SEE ATTACHED APPRAISAL)
1989 NISSON TRUCK (SEE ATTACHED APPRAISAL)
OVACHITA 16' CANOE
PERSONAL PROPERTY (SEE ATTACHED, AUCTION SHEET)
COAL CRAKERS INVESTMENT CLUB REFUND
REFUND IN CANCALLED VEHICLE PURCHASE
REFUND LIBERTY MUTUAL INSURANCE
US. GOVERNMENT ANNUITY BONDS
FUNDS FROM GARAGE SALE
13,083.24
19,946.87
6,611.07
2,132.36
88,267.96
12.15
20,461.56
900.00
700.00
100.00
2,695.10
490.83
2,442.00
32.00
891.06
3,125.50
TOTAL AlIa onlo' on lino 5, Roea Itulatlon S 161 , 89 1 . 70
(Allach addlllonal0Y," )( 11" .hoohlf mar. 'poc.l, nood.d,t
I
PNC Bank, N,A,
.1~H2 C.;III1~ll' I'il.t'
(:"1,,1' lIi11. 1',\ 171111
December 9, 1994
PNCJBANK
John R. Zonrich
Skarlatos & Zonarich
Attorneys At Law
204 State Street
Harrisburg, PA 17101
RE. IUchael D,
Date of Death.
Social Security
Katkocin
October 8, 1994
No. 191-14-7434
Dear Hr, Zonrich.
As per your request for information on accounts the above
referenced decedent held with us, the information is as follows.
-Checking Account No, 5140033026 opened 01/01178 in the name of
Michael D. Katkocin, Margaret Katkocin, Balance at date of death.
$13,079,66. Accrued interest. $3,58.
-Checking Account No. 5140258604 opened 03/01/81 in the name of
Michael D. Katkocin, Balance at date of death. $19,919.57.
Accrued intere~t. $27,30.
A Safe Deposit Box #127 is located at our Hampden Office.
If I can be of any further assistance, please do not hesitate to
contact me at (717) 730-2321,
Sincerely,
aCwL =re-lA'\..~
Edith Tancil
Miscellaneous Services Supervisor
Bank Operations
ETlmky
SIIARE SAVINGS ACCOUN1':
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner. if any
CIIECKING ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Intereat to Date of Death
Name of Joint Owner. if any
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Certificate Number
Date Purchased
Rollover Dates. if applicable
Value, including interest at Date
of Death
Name of Co-Owner, if any
Maturity Date
Interest Rat~
Accrued Interest to Date of Death
* Jessica Carlson also listed
as joint on both certificates
** Certificates purchased by
transfer of funds from
5927 -05.
Estate of mCIIAEL D. KATKOCIN
Date of Death 10-8-94
Social Security No. 191-14-7434
Membersl.
FEDERAL CREDIT UNION
1
2
5927 -00
7-13-62
$6.606,51
$1..56
None
N/A
"
5927 -11
11-26-86
$2.IJ1,1.3
$.93
None
N/A
,
"
5927 -05
6-30-92
$88,196.65
$71.31
None
sI . N/ A
5927 -67 5 yr CD
N/A
7-22-94
N/A
5927 -68 5 yr CD
N/A
7-22-94
N/A
o $5.069.04 **
Brien Katkocin *
7-21-99
6.35%
$7.05
$5,069.04 ** ?
Brien Katkocin *
7-21-99
6,35%
$7.05
1ST FEDERAL CREDIT UNION
I
--
ignature
12-7-94
Date
Insurance Administrator
Title
5275 East Trlndlc !toad. 1',0, Box 40 . Mcchanlcsburg. Pennsylvania 17055 · (717) 697-1161
SHARE SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
CHECKING ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to !late of nnath
Name of Joint Owner, if any
INVESTNENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Certificate Number
Date Purchaaed
Rollover Dates, if applicable
Value, including intereat at Date
of Death
Name of Co-Owner, if any
Naturity Date
Interest Rate
Accrued Interest to Date of Death
* Certificates purchased by
transfer of funds from
5927 -05.
Estate of HICIlAEL D. KATKOCIN
Date of Death 10-8-94
Social Security No. 191-14-7434
Members].
FED E I~ ^ L C H ED I TUN ION
1
2
N/A
N/A
NIA
N/A
NIA
N/A
5927 -69 5 vr CD 5927 -70 5 yr CD
N/A N/A
10-7-94 10-7-94
" N/A N/A b
$5,000.88 * $5,000.88 *
Joseph J. Katkocin Joseph J. Katkocin
10-6-99 10-6-99
6.40% 6.40%
$.88 $.88
NE~rRS 1 ST FEDERAL CREDIT UNION
;(U?ti& M~ ~,
, CU Authorized ~ture --
12-7-94
Date
Insurance Administrator
Title
5275 Easl Trlmllc !load · 1',0, Box 40 · McchanlcshurH, I'cnnsyh'anla 17055 . (717) 697-1161
SHARE SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
INDIVIDUAL RETIRF,NENT ACCOUNT:
Account Humber/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Beneficiary
INVESTHENT SAVINGS ACCOUNT:
Account Number/Suffix
Dllte Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
IRA CERTIFICATE:
Account Number/Suffix
Certificate Number
Date Purchased
Rollover Dates, if applicable
Value, including Interest at ~ate
of Death
Name of Beneficiary
Maturity Date
Interest Rate
Accrued Interest to Date of Death
Benlificiaries:
H. Daniel Katkocin 1/5
Kathleen H. Brainard 1/5
Haureen F. Karlson 1/5
Bernard L. Katkocin 1/5
Joseph J. Katkocin 1/5
Estate of mClIAEL D. KATKOCTN
Date of Death' 10-8-94
Social Security No, 191-14~7434
M~mbers'"
FEDERAL CREDIT UNION
I
N/A
5927 -10
10-25-82
12.14 V
$.01
H. Daniel Katkocin
Kathleen tl. Brainard
N/A
2
N/A
N/A
cont.
Maureen F. Karlson
Bernard L. Katkocin
Joseph J. Katkocin
1/5 each
5927 -15 5 yr IRA certificate
N/A
11-5-91
N/A 1/
$20,429,82
see below
11-3-%
7. lOr.
$11.74
nion Official
1 '-'_Q/J, Inll:ltlt"nn~p Arfmini Qf"rnt'nr
Date Prepared Title
5275 East Trlndlc !load · 1',0, Box 40 · Mcchanlcshurg, Pcnns)'lvanla 17055 . (717) 697.) )61
William H. Wessels
USED CARS
811 Route 15 N, DlIIsburg, PA 17019 . Phone 432-2918 Voice Beeper 233,9571
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USED CARS
811 Route 15 N, DlIIsburg, PA 17019 · Phone 432-2918 VoIce Beeper 233-9571
Notary Public · Temporary Tags
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Penonal Property of
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Sold At Public Sale
Outstanding
BRICKERS AUCTION
Buy & Sell on Commlaslon - Complete Sale Service
93 Texaco Rd., Mechanlcsburg, PA 17055 766-5785
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19 7'-s
Total Sale
Total Checks
Total Cash
Cash After Payout
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Expenses
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Adv, Cost
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Slandard Form 1047
Seplember 1873
I TFRM UOOO
1047-108
General Services Administration
6BCRG
1500 East Bannister Road
Kansas City, MO 64131
VOUCHEIVINVOICE NO, 0003940068
VENDOR NO,
PUBUC VOUCHER FOR REFUNDS
PREP
TERMS
DT
NIl
TO:
MICHAEL KATKOCIN
207 MAPLE AVE
CAMP HILL PA 17011
ATTENTION:
for
has been applied as hereIn stated and the balance IndIcated Is returned herewIth:
Amount of deposit $ 2442,00
Applied as explained In 'Remarks" below
Deposit receIved from the above-named deposItor on
.19_
Balance author/zed to be refunded
$ 2442.00
Rdud lArd to (oUow.
Remarks:
REFUND FOR SALE 0003940058, ITEM 44, DUE TO MISDESCRIPTION.
cc: 3FBPS
Contact: Mark Gunnels
FrS: 926-7908
CommercIal: (815) 926-7908
Autovon:
~~
f$;l''''''''',,*1 Michael L McQuilkin ''''''''I "P-",.". ~J'-
,,,.. Chief, Claims, Collection & Sales Unit
03940068
*
DOCUMENT '
!lUMBER
IlOCNUMBER
ACT NUMBER
03940068
. Multlp" FJ.fund.: U., vaMbJ. dill. to,~... neld.1n rem"', or pr.".,.. OSA Form 2935. GerHIraJ Purpo.. Coding Document.
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CHIC II AMOUNT ILOCII HUWlIA
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CHICM Nl.IWaIA
CHICIl DATI
12/05/94
81039481
Libert)' MutuAl
In.urlGeo ONUp/lWelon
POLICYHOLDER: MICHAEL D KATKOCIN
POLICY NUMBER A02-231-004835-004
STATEMENT AS OF 12/0~/94
EFFECTIVE DATE
12/05/94
12/06/94
TYPE OF TRANSACTION
REFUND CHECK
CANCELLATION
AMOUNT
32.00
32.00CR
FOR SERVICE CALL OR'WRITE YOUR LIBERTY MUTUAL OFFICE AT:
5021 LOUISE DR MEC~ANICSBURG 795-8703
CAlllfULl.Y DITACH CHICK UFOAB DIP08ITINCI . ABTAIN 8TATIDIINT FOR VOUR RlCO_
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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.'
33.
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I SCI'IEDULE I
DEBTS OF DECEDENT,
h ~~~.T~~~~,L!.~n.'_L!r.I.~S A~D LIENS
j ".ow eo_. .. ,~.
I FILE NUMDER
KATKOCIN, MICHAEL D.
"..-.- ~......- ..... ...-- .....--.--...--..-.
DESCRlrTION
AMOUNT
._-._~--._------_....
PHOTOCOPIES
POSTAGE
ADVERTISEMENT - SALE OF HOUSE AND AUTOS
APPRAISAL ~ BARNINGER & ASSOC.
PP&L '
HAMPTON TOWNSHIP - SEWER
HOMEOWNERS INSURANCE
KEYSTONE OIL
BELL ATLANTIC
CHANGE LOCKS
PENNDOT TRANSFER CAR TITLE
STORAGE BOXES
PA AMERICAN WATER
BROTHERS WORK AROUND HOUSE
A&M TEXACO - (TIRE DSIPOSAL)
HOLY SPIRIT HOSPITAL
WEST SHORE ADVANCE LIFE SUPPORT - AMBULANCE
A-1 LINCOLN RENT-ALL (PRESSURE WASHER FOR HOUSE)
R&J ELECTRONICS (APPLIANCE REPAIR)
ALPINE TREE SERVICE (TREE & STUMP REMOVAL)
JOHN HUNTER (HANG FRONT DOOR)
DARBY MILLER PAINTING
GREG KAPP PLUMBING (LABOR & EXPENSE)
BRICKERS AUCTION (SALE EXPENSE)
JAMES BARKER (RE: TILE & GROUT HEATH (SALE OF HOME)
REAL ESTATE TAXES (HAMPTON TOWNSHIP!CV SCHOOL)
ADDITIONAL DEATH CERITIFCATES (VITAL RECORDS)
JEFF p, MATERAZZI (EXTER. PAINTING OF HOME)
KERRY S. SANTZ, ELECTRIC (ELECTRIC REPAIRS)
RONALD BONNER (YARD MAINT. - HOUSE)
PAUL'S CLEANING (SERVICES & SUPPLIES)
GENERAL MAINT. (SUPPLIES (REAL ESTATE))
7.50
22.19
162.34
225.00
661. 00
401.62
236.92
438.88
497.45
100.00
14.00
25.00
148.95
2,190.00
50.00
139.20
61. 95
76.91
97.52
570.00
115.00
400.00
491. 29
491. 40
80.00
1,339,24
20.00
200.00
42.00
90.00
319.50
151. 23
--------.- -.-.. ... -...-... .--,. .-...-..----...--.
TOTAL (Aha on lor on lino 10, RncopllulallonJ
..-----..---.---.,.-..--.-.----
(If lIIure '11"(0 ;11Irtl.'d,'.I. illl"" mldi';on,,! slum" of 1011I0 I;ZO.)
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$ 9,866.09
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CUlberland County Recorder of Deeds
Klscellaneous Incole
Recelptl 31040
lnltrl 1994-999999 10/20/1994 12150135
Remksl COPY
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Cash
lotal Received.......
$7.50
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PLEASE PAY THIS AMOUNT
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HOLY SPJR
503 N 21S
CAHP HILL
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ACCOUNT NUMBER AND U"ME
SEND
rAYMEN!
TO
HOLY SPIRIT HOSPITAL
503 N 21ST STREET
CAMP HILL, PA 17011
630'3978
KATKOCIN ,MICHA~L
FOR INFORMATION ON ACCOUNT. PLEASE CALL
717-763-2138
. ADH DT: 10089-4
H DSH DT. -NONE-
USB: 21026
a 717-737-3895
I HR. HS~
11 KATKOCJN
e07 HAPLE AVE
CAHP HILL PA 17011-4123
6303978
I
Aceounl Numb", 6303978
Pllienltlaml,KATKOCIN .HJCHAEL
S.I'IIC1 Slln, 10/08/94 S.I'IIC1 End,
SIII.menl 011', OS/22/95 llll SIII.menl 0111; 0"/22/95
Pig, No.
)01
/7.!J 'e
QUESTIONS? Pi.... CIU:
717-76'J-e1'38
Cont.ct
ACCOUNT BAUoNCE
ESTIMATED INSURANCE DUE
TOTAL PATIENT CREDITS
196,00
56,80
TRANS DATE
DESCRIPTION
. AMOUNT
PREVIOUS BALANCE
10/08/94 ATROP 0.1H~ SYR
10/08/94 DOBUTREX 250HG JNJ
10/08/94 DOPAHINE "OOHG SY
10/08/9" EPI O.II1G AHP
10/08/94 ACTIVASE TRAY-ECU
10/08/94 ACTIVASE TRAY-ECU
10/08/94 ACTIVASE TRAY-ECU
10/0B/94 LIDOCAINE 1GH S
10/08/94 NALBUPHINE 10H~/H
10/08/94 SOD 8ICARS 8.4SYR
10/08/94 NACL 0.9 1000
10/08/94 LRS 1000
10/08/94 ANESTHESIA SET
10/08/94 CARDIAC ARREST FEE
10/08/94 CHEHISTRY PROFILE
10/08/94 ACETONEfPLASHA
10/08/94 BLOOD ~ASES
10/08/94 CARDIAC SCREEN
10/08/94 CSC U/5 PART DIFF
10/08/94 APTT
Ii; 0 0 HO SG ACCOUNT BALANCE
FINAL NOTICE, YOUR BALANCE JS OVERDUE, FAILURE
FULL HAY RESULT IN REFERRAL TO OUR ATTORNEY.
HID HEDICARE D/P 56.80 899 BLUE CROSS 36
PLEASE DISREGARD THIS STATEMENT IF YOU HAVE PAID,
.00
4.30
193.50
55.90
l. 00
3,863,00
3,863.00
3,863.00-
8.60
2.00
4,30
9.00
10.00
17,00
170.00
69.00
16.00
132.00
81,00
32,00
3",00
CONTINUED
TO PAY IN
.00
INVOICE
, WEST SHORE
ADVANCED LIFE SUPPORT SERVICES, INC,
503 N 215151'..' . Camp HIli, PA 17011.2204 . (717) 761.1036
"OI""L 10 _n.1411001
INVOICE #: C 9410206A-~
DATE: C 01/27/95)
DOB: 11/23/23 :'::iN: Il:Il-14-4734
PATIENT: KATKOLIN,MICHAEL
207 MAPLE AVE
CAMP HILL,PA 17011
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BILL TO:
KATKOLIN,MICHAEL
207 MAPLE AVE
CAMP HILL,PA 17011
POLICY NAME:
INS, #:
INS, #:
TRIP #: 9410206A
DATE OF SERVICE: 10/08/94
PATIENT PICKED UP:RESIDENCE
PATIENT TAKEN TO: 3408-HOLY SPIRIT HOSPITAL:CAMP HILL, PA 17011
DESCRIPTION OF ILLNESSIINJURY:
4109-MYOCARDIAL INFARCTION ACUTE
458-HYPOTENSION
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ADVANCED LIFE SUPPORT (A0223)
ALS MILEAGE CHARGE
CARDIAC MONITOR (Z0224)
OXYGEN (A0070)
458.09
5.00
60.00
40.00
01
004
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01
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COMMENTS: PLEASE PUT ACCOUNT # ON CHECK.
WEST SHORE ALS, INC. IS A SUPPLIER OF BOTH
BLS (AMBULANCE) AND ALS (PARAMEDIC) SERVICES.
PLEASE CHECK DESCRIPTION OF SERVICE.
SUBTOTAL
AMOUNT
PAID
TOTAL
THANK YOU
458.09
20.00
60.00
40.00
578.09
516.14
61.95
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...... 'All MO. AND DUUIPIIOH "K' """"'" j N R
I ~f] 36011 MAnKET SrnEET
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I CAMP HILL, PA, 17011 N!! 45
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, 761.7090 or 701.7900
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"",__11.....--...""-:'..-'4...,...,.......................-'....,.., 101 PUrpoIl oIl"l:f aM n.pectbn. An I.P'"' mKtwlk:'. lAX
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Jjj A & M TEXACO SERVICE CE TE
66
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AHOUHT OF LAST BILL
BILLIHO FERlOD
Au.-31 TO 00t-03 I 33 d...)
Dillin. d.t. 10-11-94
NaKt r..dina on/.bout Hov-04
You paid (Thank You)
Prior balanca
CURREHT WATER CHAROES
CI..., H..ldantl..
SERVICE CtlAROE
1500 ..1 X ,003711
HETER IHFORHATIOH
H.t.,. nUMber H.ta,. alza
000150195 5/8
HETER READIHO IHFORHATIOH
p~t.AatU.l 61S0a
L- I~ 59800
Oal10na u..d 1500
1500 .a1
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OTHER CHAROE8
st.t_ Ta. Surchara.
R.t. chanua adjuat..nt
III
OALLOHS USED DAILY
TOTAL CURREHT CtlAROES
Your prior balanca wa.
__.11
\It
TOTAL AHOUHT DUE
BILLIHO PERIOD
00t-03 TO Ho.-04 ( 32 d...)
Dillin. d.t. 11-11-94
Ha.t ra.ding on/about Dee-08
AHOUHT OF LA8T BILL
Prior balanca
HETER IHFORHATIOH
Hat.r nUMb.,. Hate,. .iz.
150195 5/8
HETER READIHO IHFORHATIOH
Pr...nt-Actual 67100
L..t 61300
CURRE~T WATER CHAROE8
Cl.... R..idantl..
SERVICE CtlAROE
5800 0.1 X .003711
5800 Oal
O.Uon. u..d
5800
OTHER CHAROI8
St.t. Ta. Surchara.
L.t. pay..nt chara.
OALLOHS USED DAILY
TDTAL CURREHT CHARDES
Your prior balanca wa.
III
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TOTAL AHOUHT DUE
BILLlHO PERIOD
Ho.-04 TO D.o-08 ( 34
Bl111n. d.t. 12-15-94
Na.t ra.dlng on/about
AHOUHT OF LA8T BILL
day.)
J.n-ID
Prior balanca
HETER IHFORHATIOH
Hater nUlnbar Metar .b.
150195 5/8
HETER READIHO IHFORHATIOH
Pr...nt-Actual 69800
L..t 61100
CURREHT WATER CHAROE8
CI.... A..idantl..
SERVICE CHAROE
27DO ..1 X .003711
2700 aal
O.Uon. u..d
u.
27DO
~ .', OTHER CHAROE8
, st.t. Tax Surch.rg.
Ii, ~~ I~ ~,<1.~ L.t. p....nt oh.r..
\<. ".1
OALLOHS USED DAILY I ->I TOTAL CURREHT CIlAROES
,~ Your prior b.l.nc.'w..
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TOTAL AHOUHT DUE
III
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'20,26
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120,26-
'.00
68,4D
65,57
613,97
',02-
',79
614,74
614,74
614,74
614,74
68,40
121.52
629,92
'.04-
',22
t30,ID
614,74
'44.84
'44,84
644,84
68,40
610,02
618,42
',03-
',67
'19,06
'44.84
,( 663,90
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pi PENNSYLVANIA - AMERICAN MATER COMPANY
852 WESLEY DRIVE
HECHANICSBURG, PA. 17055
Business Telephone: 717-795-9800
EIIergency Telephone: 717-774-2420
Service tOI KATKOCIN H D
Average water used for this 207 HAPLE AV
period was 7 gallons a day. Account numbar, 660-11177575-00
MESSAGES TO YO FROM P NNS A IA - ARC
HELP the less fortunate, Add exactly $1 to the amount of your bill far
the DOLLAR ENERGY FUND, Your contribution is tax deductible. Thank you,
Taka time now to save'a check and postage as well. If you would rsther
not pay your water bill by check, consider signing up for Pennsylvania -
American Water Compeny's "SAVE-A-CHECK" program.
. No checks to write
. No postage to pay.
. Nothing to mail.
Your water bill will be peid on time eech month DIRECTLY
checking or savings account, AUTOHATICALLY, You will not be
this service and a copy of your water bill will arrive well
payment is due, To sign up, call our local business office.
A penalty of l,50y' will be added to your unpaid balance 04/04/95.
BILLING PERIOD
Feb-08 TO Har-08 ( 28 days)
Billing date 03-15-95
Next reading on/ebout Apr-l0
AHOUNT OF LAST BILL
Prior balance
tl9.l6
tl9,16
$8.40
$,74
$9.14
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$,01-
$.29 ,
$9.42
$19.16 I
$28,58
HETER INFORHATION
Heter number Heter size
150195 5/8
HETER READING INFORHATION
Present-Actual 70600
Last 70400
CURRENT WATER CHARGES
Classl Residentisl
SERVICE CHARGE
200 gal X ,003711
200 gal
Gallons used
200
15.
~<l 6
m ,~'1!~'ei,t;.'~ 1-
GALLONS USED DAILY l' I')
OTHER CHARGES
State Tax Surcharge
Late payment charge
TOTAL CURRENT CHARGES
Your prior balance wss
zoo
TOTAL AHOUNT DUE
150
In
, " .
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r r
" J J A SOH D J' F " 9
. u u U . 0 0 . . . . 5
y n 1 g p t Yon b r
from your
charged far
before the
(i) ~..=.
GaUon. u.ed
3400
AHOUNT OP LAST BILL .34,97
Prior behnoe .34,97
CURRENT WATER CHAROES
Cl.... Re.identiel 1
SERVICE CI/ARDE .0,40
V 3400 gal X ,003711 t126
3400 gal .21. 02
I "l'i' I'~L 1
o ER CHAROes
Stata T.x Surcharge .,04-
Lat. payment cherge .,52
TOTAL CURRENT CHARGES 2 . 0
Your prior b.lence w.. t34,97
TOTAL AHOUNT DUE 5 ,
BlLLINO PERIOD
Hay-09'TO Jun-oO C 30 day.)
Billing date 06-14-95
Next reading an/about Jul-ll
HITER INFORMATION
Heter number Heter size
150195 5/0
HETER RIADINO INFORMATION
Pre.ent-Actual 70000
Le.t 75400
15.
GALLONS USED DAILY
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PENNSYLVANIA - AHERICAN WATIR COHPANY
052 WESLEY DRIVE
HECI/ANICSBURG, PA. 17055
Buatnaaa Talaphgna. 1-800-717-7292
a.arganay Talaphona. 717-774-2420
S.rvice to. KATKOCIN H D
207 HAPLE AV
Account number. 660-11177575-00
PENNSYLVANIA . AMERICAN
Averege wat.r
period waa
u.ed far this
113 g.llon. . dey,
MESSAGES TO YOU FROM
HELP th. Ie.. fortunate. Add axactly .1 to the emount of your bill for
the DOLLAR ENERGY FUND, Your contribution i. tax deductible, Th.nk yOU,
Far your convenience, a new toll-free phone number and extended hour. of
customer .arvice have been establiahed to better meet your need., You mey
now call 1-000-7l7-7292CPAWC). Our new hour. are 0.15 e,m, to 0,30 p.m.,
Honday - Friday and Saturday. from 9.15 a,m, to 5.30 p,m,
A panalty of 1.50~ will be added to your unpaid belance 07/05/95,
U17 12522
(i) Co::
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-
FROM:
DAII DARNIIIGER , ASSOCIATES, REALTOR
2007 HlIRKET STREE"r
CAMP IIILL, PA, 17011
,"
. . . INVOICE,' .,."",
Invoica numborl 4-1203
Data 112-08-94
TO:
MICHAEL 0, I<ATKOCItI ESTATE
C/O DAII I<ATKOCIII
207 MAPLE AVENUE
CAMP HILL PA 17011
For professional appraisal servicss rendered,
207 MAPLE AVENUE
CAMP IIILL, PA
LOTS 30 lIND 31, PLTI/l DOOK 3 PAGE 52
A servica charge of 2\ par month will be appliad
all accounts more than thirty days past due.
207 MAPLE AVENUE
00 miles @ $0.25 per mile
00 miles @ $0,25 par mile
Thank you vary much for your business.
IlM Barnirger , Associates., Realtor
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,.fUODIC ANNUAL
'INANCI! CHAAOI
II COMPUno ON
ntlS "MOUH'
FINANCE
CHARGE
"..!50 H:f..O'r
CURR!NT
)0 DAva
'-1 t'WI
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0:)/:::1" I';'~~ ,;,~~~.. 'I (. I ~'i:~.. ,) I
KEYSTONE Oil. 1',0, BOX 157 . CAMP Hill, PA 17011
AMOUN'
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I~'I" '11:)1'- ;I:i,1 :H'I ~,.~
FI.IC,- 'I 0 I I t nWII,:o
PERCENTAGE RAn..-
PI!RlODIQ ANNUAL
rlNAMCI eftAhOl
II COM'UTlQ QN
THIS AMOU,..,
"NANCE
CIlARGE
" .50 1.3 II ClI,1
1).00
STATEMENT DATE
(1,,1)1:1
CURRENT
30 nA yn
enOAn
01/31/95 97.30
IlE.YMC\t.iC-..nU.__D n a.ou......... _~......_.u..._
nEFERENCE
DATI . "'.
nucn,pflON
~
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AMOUNT
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(1.1)(1
'0 AYOID ADDmONAL
',NANOIOUARal
PAY IALANe. IUO...
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DO DAVS
17) m,J451
.' :.J,1._::" AMOUNT
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t'.:"
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PIItIODtQ ANNUAL
'INANel CHAM.
II COMPUTID ON
tll AMOUNT
FINANCE
CHARGE
1.51
18.1 I)
1),0(1
IlODAva
STATEMENT DATE.
~3,:
CU"RINT
JOOAYII
11/30/9
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TO AVOIDADOmDNAL
FlNANOE CHARal '
PAY IALANC.lf1OlIIl1
12/30/94
DO DA VB
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217 East Main Slreet 38029
SHIRE MANS TOWN, PENNSYLVANIA 17011
Phone 737.7967
DATII'f'OWIIID
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o REPLACE PART811STED 0 CLEAN CHAB8IS1CONTROLS
o ADJUST CONVERGENCE 0 CHECK ANTENNA CONNECTIONS
o ADJUST ALIGNMENT 0 PERFORM SAFETY CHECK
o ADJUST PURITY 0 ADJUST TECHNICAL CONTAOLS
o ADJUST ORAY SCALE TRACKINQ 0
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HELPERS 0 TOTAl
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complellon ollh, lI00vIIlUc:ub.d ""Ofll.
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DATE 10-21-19%
CERTIFICATE HOLDER:
FATHER I
MOTHER I
FILE '1
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CAPTURE R11697 >SALE TIMEI 10127129
MARGARET KATl<OEIN
KATl<OEIN
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CERTIFICATE
DATE:
COUNTY
, CITY:
SEND 5 COPYIS)
MD I<A TKOC I N
207 ~U\PLE AVE
I NFORMAT ION-
DEATH
SEX
VCN VITAL BIRTH RECDS
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TO-
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15.00 5.00 0.00 \ 20.00 ,
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PA 17011
TERMINAL 005 pa~e 22. 0
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THE ESTATE OF MICHAEL KATKOCIN
L-'~
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PA. DE P'I ~ R(yE}JLl ~ I $ IriS DO
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1995 REAL ESTATE TAX NOTlCv.' MM OOUN,'1' "'HI
IIAMPDENTOWNSIIIP ((.)),1, ,.\MARCIIOI. 1995 9,590 (,208
lUll! tItre.' PAYHIU 1n ~ ~ f,
KATIIRVN ~I FETROW TREASUR Roo APR 07 1 Il0F tCE MMCI.OSED MONDAYMM
5000 CREEKVIEloI RD\ " :.JIIR,.;71UE!i TIIROUGIl FRI 9AM TO 5PM
MECIlANICSDURG, PA 17055 OCT-FED 9AM TO IPM CLOSED HOLlOAVS
PIIONE 737-(,82 2 KB1HR~M Wl[m6WsrR~AS\ffiER-U21 MID 9/ 19-9/22
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ACCT NO 10-21-0277-274 207 MAPLE AVENUE
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KATKOCIN, MICIIAEL 1. MARGARET OAK~IOOD rARK
207 MAPLE AVENUE lOTS 30-31 PIl 3 PG 52
CMlr IIILL. PA 17011 1l0USE
ON 1/15/96 UIlPAID TAXES WILL DE TURIlE~
OVER TO CUMIl. CO. TAX CLAIM DUREAU. I
$1.00 FEE FOR ADD'l RECEIPTS REQUESTED i
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COMMONWEAltH 0' PENNSYLVANIA
IHHUIIANCI TAX R!!TURN
UllDfNT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
KATKOCIN MICHAEL D.
FILE NUMBER
21-1994-0896
ESTATE OF
Jolnllonanll')'
NAME
A. KATHLEEN M. B~AINARD
209-46-1332
B. JOSEPH J. KATKOCIN
183-58-6980
C MAUREEN F. KARLSON
196-48-3751
D. M. DANIEL KATKOCIN, JR.
166-46-3840
E. BRIEN L. KATKOCIN
A/K/A BERNARD L. KATKOCI
20~-50-9818
ADDRESS
3417 OXFORD RUN
WILLIAMSBURG, VA 23185
8 OAKWOOD COURT
CAMP HILL, PA 17011
709 OWL COURT
MECHANICSBURG, PA 17055
207 MAPLE AVENUE
CAMP HILL, PA 17011
505 SPENCER DRIVE
WEST PALM BEACH, FL 3340
RELATIONSHIP TO DECEDENT
DAUGHTER
SON
DAUGHTER
SON
SON
Jolnlly-ownod proporty,
ITEM LmER DATE
FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBEI JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1.
SEE ATTACHED SHEETS
.
TOTAL (Aha onlor on IIno 6, Recap!'.!allan) S 16 335 3q
~,........v"",-~........".,.-_.~~.",.....__-....,...",o,-
(If more space is n..cJ.d insert oc/cii'ionol sheets o( some sjze)
;..'
fi'
ESTATE OF MICHAEL D. KATKOCIN 21-1994-0896
., SCHEDULE F
, JOIN'fLY HELD PROPERTY
,
f
.
.'t
, ITEM II LTR DATE DESCRIPTION TOTAL VALUE UNT. VLAUE
,
. 1. E S/90 US BONF HH SOO.OO SO% 2S0.00
, D2422999HH
$
';
~' 2. B S/90 US BOND HH SOO.OO 50% 250.00
D2423000HH
3. B 12/93 PA STATE BANK 5,214.33 50% 2,607.17
CD 300-0383-4
112738
4. 0 12/93 PA STATE BANK S,214.33 50% 2,607.17
CD 300-0249-7
112740
5. E 12/93 PA STATE BANK 5,214.33 50% 2,607.17
CD 300-0384-2
112739
6. B 2/94 PA STATE BANK 5,127.58 50% 2,563.79
CD 300-0383-4
112779
7. E 2/94 PA STATE BANK S,127.58 50% 2,563.79
CD 300-0384-2
112750
8. B 1/63 US SAVINGS BOND 138.08 50% 69.04
Q196176390SE
9. B 1/63 US SAVINGS BOND 138.08 50% 69.04
Q1961763906E
10. B 12/68 US SAVINGS BOND 436.60 50% 218.30
C492S79635E
1l. B 12/68 US SAVINGS BOND 436.60 50% 218.30
C492579634E
12. B 5/64 US SAVINGS BOND S34.92 50% 267.46
C444217446E
"
C?':;)'';,0~.i'f!~~.';,~.:~:r~,~ii.:'1i,~+;r;'';;~~#i\rili'-~;''!'j:\t'0~ ~:ni:
13. a 5/64 us SAVINGS BOND 534.92 sot 267.46
C444217445E
14. a 5/64 US SAVINGS aONO 534.92 sot 267.46
C44421'/447E
15. B 5/64 US SAVINGS BOND 534.92 sot 267.46
C444217444E
16. B 5/64 US SAVINGS BOND 534.92 sot 267.46
C444217443E
17. B 12/71 US SAVINGS BOND 1,780.20 sot 890.10
D94515469E
17. 0 10/53 US SAVINGS BOND 168.43 sot 84.22
Qll02456143E
'"
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September 27, 199~
Starlatoe , Zonarich
Attnl John R. Zonarich
Attcrneys at Law
204 State streot
Harrisburg, PA 17101
2141 Marid Sin
EO. BOI 4$
t'wnp IIdl. PA /700/~8
7I7,7J/o12/
fAX: //7-7J/.7I/
Colonial Purl O/fi
600 CoIo.../ R..
HoniW.'I, PA /71/
7//,611
FAX: 7/7-64/.0$1
RBI Est.te or Kich.el D. Rattooin D.O.D. Ootober 8, 1994
Dear Mr. Zonarich:
Below is the informaticn that was requested on the above named deceased.
CERTIFICATE OF DBPOSIT AS OF 10-8-94
ACCOUNT I CDI OPENED BALANCE 10-8-94
ACCOUNT NAMES
Michael D. Katkocin -or- 300-1108-G 12736 12-8-93
Kathleem M. Brainard
Michael D. Katkocin -or- 300-0383-4 #2738 12-0-93
Joseph J. Katkocin
Michael D. Katkocin -or- 300-1189-4 12737 12-8-93
Maureen F. Karlson
Michael D. Katkocin -cr- 300-0249-7 #2740 12-8-93
Hichael O. Katkccin Jr.
Michael D. Katkocin -or- 300-0384-2 11I2739 12-8-93
Brian L. Katkocin
Michael D. Katkocin -or- 300-0383-4 #2779 2-28-94
Joseph J. Katkocin
Michael D. Katkocin -or- 300-0384-2 #2750 2-28-94
Brian L. Katkocin
$5,214.33
$5,214.33
$5,214.33
$5,214.33
$5,214.33
$5,127.58
$5,127.58
Regarding the above certificates original issue. The CD's that were taken out for
Joseph, Michael and Brian were rolled over from CD's that were originally issued
April and May of 1990. The CD's for Kathleen M. Brainard and Maureen F. carlsen
were issued on December 8, 1993 and were purchased with checks presented by the
deceased, Michael D. Katkocin.
If you need any additional information, please do not hesitate to give me a call.
Sincerely,
PENNS:L~ 8TATB BANR
~? .~
GiGi CUllen
Customer Service Rep.
THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES.
I. I i I DECO : DOllAR VALUE
IIEM DESCRIPlION Of PROPERTY EXCLUSION I lOTAI VALUE ... I Of DECEDENI'S
NUMBER 'oc',d. nom.ol,h. "0,,'..... 'h"""",o.,h,p'o d."d,,', do" 01...",/.. ' i Of ASSET I'll, I INTEREST
1. MEMBERS 1ST FEDERAL CREDIT UNION I I i
CD 5927-69 !
TRANSFER 10/7/94 TO SON, JOSEPH I
J. KATKOCIN 13,000 5,000.88 100~ 2,000.88
MEMBER 1ST FEDERAL CREDIT UNION
CD 5927-70
TRANSFER 10/7/94 TO SON, JOSPEH
J. KATKOCIN
ESTATE OF
3.
4.
5.
6.
Ir\t.!S\OU+ll.87)
.
SCHEDULE G
TRANSFERS
COMMONWUlHt OJ P(NN!lI'rlVAN1A
INHII"ANCI 'AX '(JUlN
IUIDINr DICIDIN'
KATKOCIN, MICHAEL D.
PLEASE PRINT OR TYPE
FILE NUMBER
21-1994-0896
2.
-0-
5,000.88 100% 5,000.88
MEMBERS 1ST FEDERAL CREDIT UNION
TRANSFER 7/22/94 TO SON, BERNARD
KATKOCIN 3,000
5,069.04 100% 2,069.04
MEMBERS 1ST FEDERAL CREDIT UNION
TRANSFER 7/22/94 TO SON, BERNARD
KATKOCIN -0- 5,069.04 100% 5,069.04
PENNSYLVANIA STATE BANK
TRANSFER 12/8/93 TO DAUGHTER,
KATHLEEN M. BRAINARD 3,000 5,214.33 100% 2,214.33
PENNSYLVANIA STATE BANK
TRANSFER 12/8/93 TO DAUGHTER,
MAUREEN F. KARLSON 3,000 5,214.33 100% 2,214.33
- -.--------. -_. '_.,-----....,
*___'T>._.__~__ ..,________..,. __,".. ~_"__.,"_._
T~TAL (Aha ~nlll' on line 7. Rec,,!pllulallanJ S 18 ,_~~!I._' 50
ilf more .pace ;. n..d.d, inuit' addilional ,h..,. a/,om. size.}
..
I
'}_:~'--'. -'-1"--,
"T-'~'..
".~'-'--"~"_L"'"
\,
-~._;--"~w
SHARE SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
CHECKING ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Certificate Number
Date Purchased
Rollover Dates, if applicable
Value, including interest at Date
of Death
Name of Co-Owner, if any
Maturity Date
Interest Rate
Accrued Interest to Date of Death
* Certificates purchased by
transfer of funds from
5927 -05.
Estate of MICHAEL D. KATKOCIN
Date of Death 10-8-94
Social Security No. 191-14-7434
Members1.
FEDEHAL CHEDIT UNION
1
2
N/A
N/A
N/A
N/A
N/A
N/A
5927 -69 5 yr CD 5927 -70 '''''J
N/A N/A
10-7-94 10-7-94
N/A N/A
$5,000.88 * $5,000.88 *
Joseph J. Katkocin Joseph J. Katkocin
10-6-99 10-6-99
6.40:1: 6.40:1:
$.88 $.88
~,
gnature
12-7-94
Date
Insurance Administrator
Title
. .
5275 East Trlndlc (toad · P.O. lIox ,j() · ,\Ieehanleshurg, Pennsyll'ania 17055 . (717) 697.1 J 6 J
SHARE SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
CHECKING ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Nsme of Joint Owner, if any
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Name of Joint Owner, if any
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Certificate Number
Date Purchased
Rollover Dates, if applicable
Value, including interest at Date
of Death
Name of Co-Owner, if any
Maturity Date
Interest Rat~
Accrued Interest to Date of Death
* Jessica Carlson also listed
as joint on both certificates
** Certificates purchased by
tranafer of fund a from
5927 -05.
Estate of MICHAEL D. KATKOCIN
Date of Death 10-8-94
Social Security No. 191-14-7434
Membersl.
FEDERAL CREDIT UNION
1
5927 -00
7-13-62
$6.606.51
$4.56
None
2
ilIA
"
5927 -11
11-26-86
$2.131./,3
$.93
None
N/A
'.
5927 -05
6-30-92
$88.196.65
$71.31
None
N/A
..;
5927 -67 5 yr CD
N/A
7-22-94
N/A
5927 -68 5 yr CD
N/A
7-22-94
N/A
$5.069.04 **
Brien Katkocin *
7-21-99
6.35%
$7.05
$5.069.04 **
Brien Katkocin *
7-21-99
6.357-
$7.05
1ST FEDERAL CREDIT UNION
"\
12-7-94
Date
Insurance Administrator
Title
5275 East Trindlc Hoad · P.O. Box 40 · Mcchanlcshurg. Pcnnsl'lv;lIlla 17055 . (7] 7) 697.1161
"
September 27, 1995
2/18 Morl<t SIm
PO,S.. 44
Cwnj' 1111'. fA 170010048
III-m.m
FAX.'1l7m.m
Colon"" Purl Om
600 C,I,nllJlI/..,
lIoni,b.r,. fA 171/1
717'611 OS(l(
FAX: 7176i1,OJ71
Skarlato8 , Zonarigh
Attn: John R. Zonarich
Attorneys at Law
204 state streot
Harrisburg, PA 17101
RBI Bstat. or Mioha.l D. Katkooin 0.0.0. october 8, 1994
Dear Mr. Zonarich:
Below is the information that was requested on the abcve named deceased.
CERTIFICATE OF DEPOSIT AS OF 10-8-94
ACCOUNT NAMES ACCOUNT II coli OPENED BALANCE 10-8-94
{ Michael D. Kntkooin -or- 300-1108-6 12736 12-8-93 $5,214.33
Kathleom M. Brainard
Michael D. Katkooin -or- 300-0383-4 12738 12-0-93 $5,214.33
Joseph J. Katkocin
[ Michael D, Katkocin -or- 300-1109-4 #2737 12-8-93 $5,214.33 1
Maureen F. Karlson
Michael D. Katkocin -or- 300-0249-7 12740 12-0-93 $5,214.33
MiChael D. Katkocin Jr.
Michael D. Katkoc1n -or- 300-0384-2 #2739 12-8-93 $5,214.33
Brian L. Katkocin
Michael D. KatJl;ocin -or- 300-0383-4 112779 2-28-94 $5,127.58
Joseph J. Katkocin
MiChael D. Ratkooin -or- 300-0384-2 #2750 2-20-94 $5,127.58
Brian L. Katkcoin
Regarding the above certifioates original iSBue. The CD's that were taken out for
Joseph, Michael and Brian wore rolled over from CD's that were originally issued
April and May of 1990. The CD's for Kathleen M. Brainard and Maureen F. Carlson
were issued on December 0, 1993 and wore purchased with ohecks presented by the
deoeased, Miohael D. Katkooin.
If you need any additional information, please do not hesitate to give me a call.
sincerely,
;::f!~~;2K
GiGi CUllen
Customer Sorvice Rep.
IIVUllr.. I'll'
.
l-
,,~I~'~1\
- ~rillP
COMMONWIAlTH 0' 'INI,WnV"'NIA
INtlUlfANCI ''''Il: RnUIN
'!~IDIt-!' D~~~!!IN'
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
j ".... "..., T ".
-FILE NUMBER
21-1994-0896
ITEM
NUMBER
KATKOCIN, MICHAEL D.
DESCRIPTION
AMOUNT
A. Funeral Expen'II'
I.
2.
3.
4.
5.
8r370.00
151. 05
175.75
169.98
50.00
NEILL FUNERAL HOME
STEPHENSON'S FLOWERS
FUNERAL MEAL
BURIAL CLOTHES
HELPING HAND - ASSITANCE AT FUNERAL
B. Admlnl.tratlve Co.II,
4.
C.
1.
2.
3,
4.
5.
6.
7.
8.
1.
Pellonol Repre.enlallye Com million. MICIIAEL D.
Social Seeurlly Number of Pellonal Repre.enlollye,
Vear Com million. paid 1995
KATKOCIN, JR.
166 - 46 - 3840
6,000.00
2.
Allorney Fee.
SKARLATOS & ZONARICH
Family Exempllon
Claimant Relollon.hlp
Addre.. of Claimant 01 decedent'. death
51 reel Addre..
5,500.00
3.
Clly
Slole
Zip Code
Probole Fee.
REGISTER OF WILLS, CUMBERLAND CO.
335.00
MI.eellaneoul Expen.e..
PATRIOT NEWS - AD
CUMBERLAND CO. LAW JOURNAL
35.25
40.00
25.00
50.00
INVENTORY - RETURN
FILE RECEIPT AND RELEASE
TOTAL (AI.o enler on line 9, Reeapllulallon)
(If more .paee I. needed, In.ert addltlonal.heell of .ame .Iu.),
S 20,902.03
'"
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f
1t;
~.
*'
~
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"
34{H MARKET STREET
CAMP HILL, PA 17011
(717) 737.8726
JAMES p, flCKES.I'D. SUl'ERVISol1
December 2, 1994
Services for: Michael D. Katkocin
Cemetery Grave equipment
Complete Traditional Service
Cemetery
Death Certificates
Honorarium
MusiciansIV ocalist
Copper-Y35
Vault
Jl/edI
FUNEHAL HOME INC.
"For lht "errccl Trihutc"
."
" ":
I~"',:,'
l.l '1"'1
~
Services Total:
Less Payments Received:
Balance Due on Account:
3501 DERRY STREET
HARIUSIlURO, PA 17111
(717) 564.2633
SCoTI' 0, SOWERS, I'D, SUPERVISOR
STEPIIEN J, WILSDACII. PRESIDENT
DENISE M, DECARLO, 1'0.
ADVANCE FUNERAL PlJ\NNINo
65.00
3,255,00
495,00
40.00
100,00
120.00
3,495.00
800.00
8,370.00
4,920.00
53.450.00
t{~\,;-"----
7___~C~~.~"".q.,~",-,,"'-_ .~_'::
{'
.. -->---'~"<"-'-"". :,t-:~;~;..:.!. :-"
- - .-'
1~
;,,~
~'
~
~,
STEPHENSON'S FLOWERS
145 S LOCUST ST
i'1i' 761 5990
"
,
f'......\..,I'.-,I. .'
Entry Mode: Online Resister Id: R2
Sales T\lPe: CC Del1vel"\l HC
l'rans No: 669517 10/11/94 02:28PM
SalesPet"sonr 0321-PATSY S.
t
,
~ ,
,
".
Qty llescri Ption Pl"ice
-----------
1 CASKET SPRAY 140.00
Sub Total: 140.00
Delivet"\l ehs: 2.50
Tax Amount: 8.55
Total: 151.05
CC TyPe: MC
Credit Card No: 5418 2951 0018 1776
Customer: MAUREEN F KARLSON
I
'Auth: T91382 Approved
THANK YOU FOR SHOPPING AT
. ,STEPHENSON'S FLOfIERS!
~-i';:':l";"h",;-,,,,
....... . Oc.... .....
. .t. ..~.
GIANT FOOD STORES, INC.
STORE 159, HECHANICSBURG, PA.
--CIGARETTES 15.76 T
PEPSI 1.19 &
GRAPEFRUIT JUICE 2.58 F
SEVEN UP .9S &
PREVIOUS 11EH IS &ONUS &UY PRICED
LIGHT HAYONNAISE 1,59 F
PEPSI 1.19 B
CANADA DRY SODA 1 ,09 &
PREVIOUS ITEH IS DOIIUS BUY PRICED
f'EPSI 1.198
PRODUCE 2.29 F
KETCUP 1.48 r
CANADA DRY SODA 1.09 B
PREVIOUS 11EH IS BONUS DUY PRICED
2 ~ 4/1,00
L1HES
2 ~ 5/1.00
LEHONS
SCHWEPPES T otll C
SCHWEPPES TONIC
CAULIFLOWER
0,66 LB e 2.99 ILB
WI SUGAR PEAS 1,97 F
FRENCHS HUSTARD .63 F
PREVIOUS ITEH IS &ONUS BUY PRICED
.--PURINA CAT FOOD .22 T
SCHWEPPES SODA .99 B
BROCCOLI 1.29 F
GIBPLEtS SNACK 1.70 F
BROCCOLI 1.29 F
WH PEELED CARROT 1.29 F
CELERY HEARTS 1.29 F
WH PF.ELED CARROT 1.29 F
UTZ CHIPS 3.32 F
DORITOS CHIPS 2.69 F
n.. TAX 2.17 BAL 115.45
-CAHPBELL SOUP .86 F
,CAHPBELL SOUP .86 F
(EXTRA LARGE EGGS W .81 F
nn TAX 2.17 &AL 117,98
..cAHPBELL SOUP .86 F
,ENGLISH HUFF illS 2.49 F
PREVIOU~ lTEH IS BONUS BUY PRICED
rEP FARH BREAD 2.06 F
2,96 LB 0 .25 ILB
WT BANANAS
0.60 LB 0 ,69 IL&
WT otllONS
1 0 3/1.00
CUCUHBER
HUSHROOHS
..nTAX 2.17 BAL
VF CREDIT CARD
rOT ll-tTER 1. 65 T
SPRINO WATER 1,95 F
OCEAN SPRAY 5.42 F
2% HILK W 2.57 F
FINAST JUICE 2,37 F
SHOKED TURKEY 5.08 F
HUENSTER CHEESE W 2.33 F
COPES WHITE CORN 1. 52 F
DUTCH POTATO 1.19 F
KING DIP 1.19 F
PREVIOUS ITEH IS BONUS BUY PRICED
GARDEN HEDLEY 1.1B F
PREVIOUS ITEH IS BONUS BUY PRICED
GREEN GIANT PEAS I .4B F
OAROEN HEDLEY 1.1B F
PREVIOUS ITEH IS BONUS BUY PRICED
HEFTY PLATES 1.65 T
PREVIOUS ITEH IS BONUS BUY PRICED
PLASTIC CUPS. .91 T
FOAH CUPS ,59 T
SPARKLE NAPKINS 1. 39 T
PREVIOUS ITEH IS BONUS BUY PRICED
, BAKED BEANS .47 F
PREVIOUS ITEH IS BONUS BUY PRICED
CAHPBELL BEANS ,47 F
PREVIOUS ITEH IS BONUS BUY PRICED
'1'tJRlNA CAT FOOD ,22 T
~NA CAT FOOD .22 1
DOHINO SUGAR ,99 F
PREVIOUS ITEH IS BONUS BUY PRICED
TURKEY FRANKS 1,18 F
~NA CAT FOOD .22 T
,rORINA CAT FOOD .22 T
)PURINA CAT FOOD .22 1
PLASTIC UTENSILS .55 T
~HPBELL SOUP ,B6 F
HALF ~ HALF 1. 09 F
.-lIUAKER OATS 2.64 F
PLASTIC FORKS .54 T
FlNAST SPOONS .55 T
FINAST RICE .56 F
~ST CEREAL 2.49 F
PREVIOUSITEH IS DONUS BUY PRICED
BLACK OLIVES 1.19 F
GRANOLA BARS 1. 34 F
GIANT ROLLS .63 F
ORAPEFRU IT JU I CE 1. 99 F
TOHATO JUICE 1.03 F
TOHATO JUICE 1. 03 F
COKE .79 B
PREVIOUS ITEH IS BONUS BUY PRICED
GRAPEFRUIT JUICE 1. 99 F
COKE .79 B
PREVIOUS ITEH IS BONUS BUY PRICED
FlNAST HONEY 1. 36 F
17055
PAYHENT
6011003328512544
.50 F
.40 F
.99 B
.99 B
l.B9 F
,74 F
,41 F
,34 F
1.59 F
126.47
126,47
......................................
GIANT FOOD STORES, INC. 159
6520 CARLISLE PIKE
HECHANICSBURG, PA,
CREDIT CARD
$126.47 9604
REF 1 012013
10/12/94 12:39 0059 06 0062 139
......................................
CHANGE
..;'.<.
.'
m.
GIANT FOOD .,
STORE t59, HECHANIC~
<:;;n TRA0 ~ 39~;-
.... TAX 2.40 9AL 42.38
CASH 60.00
CHANGE
t 7,62
10/12/94 18:40 0059 01 0394 102
'LOW PRICES, HONEST '
'PLEASE VISIT OUR PHARMACY I ,
d.. 11.
~~ 77/. dUN'_ (
~116 -- ~
E~/i..J& ",./J7l!~/.i.e-/ ,.tA-.J.loc/~
-:n.- 'f'~ ~
~O~:~III . __~L~.J._/1~
"""0 IN U......
riv~~
~~ac
r/W.
/.91.:L
.
.." ~;4'1(
/,/.1- ~ ;-"C htJ
~&
WIIIC t srIRm ~IIUrrE 2106
6520 CARLISLE PIKE .
IlECIlAIIlCS9URG, rA l1'm-5251
OUESrI011S, CUI/eERUS OR SUGGESTIO/IS
CALL 1-800-272-PLC9
210& 001 A 1045 0149
J 8EAH S TR PR91l
8,99
BLUSSOM HILL CIIARD
8,99
SIIlRIIOFF VOG Bopr
17 .J9
SUBTorAL
6.0,; SALES IA~.
4079
1 AT
~JJJ
1 AT
4"C
1 AT
0.99
~ (,'1.'
"""
17,JV
,~j.:! "
2.1,(
TOTAL
J7.50
RECElrT NUMBER 4J18
CREDIT/DEBIT CARD J7,50
TOTAL UUITS SOLD J
FOR !/IFURHATION UII
rLCB ALCOHUL EDUCATIUII f'RUGRAMS
CALL l-BOO-45J-PLCB
10/12/1'4 12:5J
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TO:
CUMBERLAND LAW JOURNAL
11 EAST HIGH STREET
CARLISLE, PA 17013
ADMINISTRAT
NOTICE
EXECUT oR
01 Administration
on the Estate 01 M I c: toll. I!. ~ 1>.
Letters
Testamentary
\<A1'KOCI'J
late olthe 'f"vJ P
01 I~AMPoet-l Cumberland County, Penna., deceased, have
been granted to the undersigned.
All persons knowing themselves to be Indebted to said Estate will
make payment Immediately, and those having claims will present them lor
settlement to
Execut 0 R.
Address 2,.01 M ^ Pl-~ A" ~ !oJ U ("
CA-MP H\\..1- 1"A 1"10~(
ROll"';'O( W. W"-t!.r.r;.rt €SQ
,
Attorney
Advlrt'llng COlt IIjO.CO payable In advance. Make checka payeble to:
Cumberland U1W Journal
--M,l7At-llln.. \(A1'\t.oe ".I
Adlnlnlstrat
I
.
,.- ----"'
Proof of Publication of Notite in The Patriot and The Evening News
and The Sunday Patriot-News
UDder .4.et No. Gaf. .\J1pro"ed "'ay .ft. 1~.
C/lm"'/l"wealth 01 Penllll/llvnnia, }
COlmtll 01 Dal/phin ~~:
..................................!1~.9.~.~.~.~...!:!~.~.;:~.~.....................befnR' duly sworn accordJng to law, deposes and says:
Asst. Controller
That he Is the ............................ot THE PATRIOT. NEWS CO., a corporation organized and existing
under the laws at the Commonwealth ot Penns)'lvanla, with Its principal office and place at bualness at
812 to 818 Market Street, In the City at Harrl_burg, County oC Dauphin. State oC Pennsylvania, owner
and publlsher at THE PATRIOT and THE EVENING NEWS and the SUNDAY PATRIOT-NEWS
newspapers at lI'eneral circulation, printed and published at 812 to 818 Market Street. In the City,
County and State atoresald; that THE PATRIOT and THE EVENING NEWS and the SUNDAY
PATRIOT. NEWS were estebllshed March 4th, 1864, and February 16th, 1917 and September 18th,
1949, respectively, and all have been continuously published ever since:
That the printed notice or publication which Is securely atteched hereto Is exactly na printed and
Metro West 27th day of December
publlehed In their re/l'llJaliedltlons and Jeeues which appeared on the ..........................................................
1994 and the 3rd and lOth days of January 1995.
........................................................................................................................................................................................
That neither he nor said Company Ie Interested In the subject matter at said printed notice or adver-
tlslnll'. and that all at the allell'atlons at this statement as to the time, place and character at publlcatlon
are true: and
That he has personal knowledge at the tscts atoresa and Is duly authorized and empowered to
verity this statement on behalt at The Patriot-News C . a(o esald by vi tue and pursuant to a resolu-
tion unanimously passed and adopted severally by t sto holders a .board at directors at the said
Company and SUbsequently duly re.:orded In the office or t ~'orilln' 1 D.e da In and tor said County
ot Dauphin In Mlocellaneoul Book "M". Volume 14. Page 17. / /.'
Copy at Notice or Publlcatlon II I ),
.......................... ......... .:".... .. ... .... .........i2.~h..........."..
Swo to and subscribed betore e th~.................day at
Januarv 1995.. _', ~
'........ No IJ- y '/ /-:-'.' C~
lads ..u . .,...-...;.... ..........................................
Teoy L. RUUIIIJ, NoIarypubl/c .F Notary Public
Hl1Il1sburg. Oauplin County
~lil!ID~~ll!l8.~..J.~St\.. ......,.......................
rtaiemenrorAC1Virtising Costs
.. Le","oiAdmlnlstranon ontM e.tcrt. of MI.
chcMl D.lCcrftocln. 1m. of the Town"'lo 01 Homp.
d.", CumM,'oncl Ceunty. P,nnnlvanlo. d,.
UGMd, havlM Men tII1Iftfwd tlIIlhe uncMnlenN.
OIINnCW'lllncMblldtD,*IttcrftCll'.'"""t~ 10
mah Im",~lat. 0CIY"*tt and thO,. havln'
cJoIm'w111 twltMftl"","", ","*,""t tOI
M. O"..llCetktdlt" btc:vtw
.,."......... -
c.".,. HIII.~. Irln
M.D. Ratkocin
........................................................................................
Camp Hill, PA. 17011
..................................................................................
To THE PATRIOT-NEWS CO., Dr.
For publishing the notice or publication atteched hereto on the
34.25
above stated dates _ $............................
., 1. 00
Probating same .............J:s..:.:!S'....
Total $............................
Publisher's Receipt for Advertising Costs
THE PATRIOT-NEWS CO., publisher at THE PATRroT and THE EVENmG NEWS and the
SUNDAY PATRroT-NEWS, newspapers at general circulation, hel'eby acknowledge recefpt ot the
atoresald notice and publication costa and certltles that the same have been duly paid.
THE PATRroT.NEWS CO.
" .
By
.....................................................................................
.
. Ilv.Un I.. lJ.l1)
".
ESTATE OF
ITEM
NUMBER
I.
2.
3 .
4 .
5.
ITEM
NUMBER
I.
.
COMMOHW'.U" 0' .fHHIYlVANIA
INM,.nANe. '......Iu.H
InID.NI D,eIDIH'
SCHEDULE J
BENEFICIARIES
KATKOCIN, MICHAEL D.
FILE NUMBER
21-1994-0B96
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Toxable SequI.hl
KATHLEEN M. BRAINARD
3417 OXFORD RUN, WILLIAMSBURG, VA
JOSEPH 'J. KATKOCIN
B OAKWOOD CT, CAMP HILL, PA
MAUREEN F. KARLSON
709 OWL COURT, MECHANICSBURG, PA
M. DANIEL KATKOCIN, JR.
207 MAPLE AVENUE, CAMP HILL, PA
BRIEN L. KATKOCIN A/K/A BERNARD L.
505 SPENCER DRIVE, W. PALM BEACH, FL
DAUGHTER
1/5
SON
1/5
DAUGHTER
1/5
SON
1/5
SON
1/5
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmenlal aequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aho ontor on IIno 13, Rocopllulotlon) S
(If mo,. .pac. II n,.d.d, In..rt addltlonal.h.... of lam. .111)
-. ... _.....' -. .....~,
,
'"
. , I,
'- ---------- -------- ---- -- -- ---- ------ - --- -- -- - - --
D;;'!,~,~L,~i?AA, ',",o,~, ;~i,2,\,;30, 4 .COMMONW, EA, LTH OF PENNSYLVANIA'
", "".." ' DEPARTMENT,OP REVENUE
;;;S:;1~;~'i;trX,:'OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.~
RECEIVED FROM.
i
ACN
ASSESSMENT r:t
CONTROL ~
NUMBER
AMOUNT
ZONARICH JOHN H
204 STATE STREET
lQl
.1,...",.,(6
HARRISBURG, PA 17101
- ,Oto HfI' '010 HUI .
ESTATE INFORMATION,
~ FilE NUMBER
511 21-1994-0S96
!:I NAME Of DECEDENT (LASTI
~ KATKOCIN MICHAEL D
II DATE Of PAYMENT
m POSTMAR E
COUNTY
SSN 191-14-4734
(fIRSTI (MI)
N
DATE Of DEATH
REMARKS
m TOTAL AMOUNT PAID
.1.477.96
CW
SEAL
M DANIEL KATKOCIN
C/O JOHN R ZONARICH
CHECK" I~B
ESQUIRE
I
'~----------------------------------------~-------~
REGISTER OF WILLS
RECEIVED BY 'lhvt" C. ;itu...", "~I,'
10 A R " .' .-
MARY C. LEWIS "/'/11/"''/';''/_
REGISTER OF WILLS
..,
.
t ,...
f,
..
.---'
-~
~-"
.
,",'
... --_.
--,_--:-;"'-~_4
I"
~' -'. .... -... ." _. ..~ .
,
"
.-~-------------------------------------------------
,
j ,
" " '. 'COMMONWEALTH OF PENNSYLVANIA
D~o.AA022615 DEPARTMENT Of REVENUE
:"~1l" ..I....' OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.~
RECEIVED fROM.
i
ACN
ASSESSMENT P:'I
CONTROL ~
NUMBER
ZONARICH JOHN H
204 STATE STREET
101
AMOUNT i
,
I
I
I
.es,ooo.OO I
I
:1
'otD HUt 1
HARRISBURG PA 17101
.. 'OlD HUt
ESTATE INfORMATION,
r:If fiLE NUMBER
~ 21-1994-0896
Il'I NAME Of DECEDENT ILASTI
~ KATKOCIN MICHAEL D
II DATE Of PAYMENT
m POSTMARK DATE
COUNTY
CUMBERLAND
DATE Of DEATH
SSN 191-14-4734
(fIRSTI
(Mil
\
REGISTER OF WillS
m TOTAL AMOUNT PAID e23, 000. 00
RECEIVED B~~/~' a _"
r/.L S AT II:
MARV C. LEWI
REGISTER OF ILLS
REMARKS
M. DANIEL KATKOCIN
SEAL
CHECK" 018
. '-I - - - - --- -- - -. - - - - - - - - - - - - - - - - - - - - - - - - ------ -,- ---r-'
~~ .'
",
. .
.
..__.& p-""""'-
--_--:~~---.....~..!l ~ _":("'\t, ..,..:~
: .
......
I,'
REV"1547 EX AFP (12.95_
COHHONWEAL III DF PEHHSVl VANIA
OEPAR'"EHT OF REVENUE
BUREAU OF INDIVIDUAL 'AXES .
DEPT. Z8D601
fIARRISIURO, PA 11ua-0601
$I'!-, /'/'),~' .
(. '-'
ACN 101
NOTICE OF INHERITANCE TAM
APPRAISEHENT. ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAM
DATE 08"19-96
FILE NO.
COU~TV CUMBERLAND
TO YOUR ACCOUNT. SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAM
OF WILLS. HAKE CIIECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
NOTE.
10-08-94
TO INSURE PROPER CREDIT
PAYHENT TO TilE REGISTER
JOHN R ZONARICH ESQ
204 STATE ST
HBG PA 17101
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
Allount R..ttted
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iIEV:i:scij-ixUAFij"nZ:9ST"iliiYiciUo';"INHiifii'A;(CE"1:iix"iippiiAiiii;.fiilT~uiii:rowili(cE-ijFi"_m"_m"__"m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MICHAEL D FILE NO. 21 94-0896 ACN 101
TAM RETURN WAS. ) ACCEPTED AS FILED I X) CIIANGEO SEE
ESTATE OF 'KATKOCIN
DATE
ATTACHED
08"19-96
NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Eat.t. (Schedul. Al (1)
2. stock. and Bondi (Schedule 8) (2)
3. Clos.ly Hald stock/Partnership Int.r..t (Schedul. C) (3)
~. Horta.gal/Not.. Receivable (Schedule OJ (4)
S. Ca.h/Oank Deposita/Hlle. Parlonal Property (Schedul. E) IS)
6. ~olntly Ownad Property (Schedule FJ (6)
7. Transfar. (Schadul. 0) (7)
8. Total A...t.
114.000.00
IS!. 031. 38
.00
,DO
161.891.70
19.637.47
18.568.50
(B)
465.129.05
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral Expan.../Ad.. Co.t./Hi.c. Expen... CSchadule H) C9)
10. Dabta/Hortg.ge Liabi1iti../Li.n. ISchadu1. I) C10J
11. Total Deduction.
12. N.t Value of Tax Raturn
15. Charit.bl./Gov.rn..ntal B.qu..t. CSchedu1a JJ
14. N.t Va1ua of Eatat. Subj.ot to Tax
30,398.81
9,866.09
(11)
(12)
(13)
(14)
40.:>64 QO
424,864.15
.00
424.864.15
NOTEI
If an assessment was issued praviouslY, lines
reflect figures that include the total of Abb
ASSESSMENT OF TAX:
1S. AMount of Lina 14 at Spou.al rata CIS)
16. AMount of Lina 14 taxabla at Lin..l/CI... A r.te (16)
17. AMount of Lina 14 taxabl. .t Co11.taral/C1... B rata C17J
18. Principal Tax Due
14, 15 and/or 16, 17 and'18 will
returns assessed to date.
.00 M .03.
424.864.15 M .06.
.00 K .15.
llB)
,DO
25.491.84
.00
25.491.84
TAX CREDITS:
PAYHENT
DATE
12-20-94
,11-13"95
RECEIPT
NUHSER
AA022615
AA082304
DISCOUNT (')
INTEREST (-)
1.210.53
40.51-
AHOUNT PAID
23,000.00
1,477.96
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
25,647.98
156.14CR
.00
156.14CR
I
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS TIIAN .1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SlOE OF TillS FORH FOR INSTRUCTIONS.)
RESERVATION. E.tata. of dac.dent. dvlng 0" or b.for. D.c.eb.r 12, 1982 .. If any future Int.r..t In the ..tat. I. tran.f.rr.d
In pa.....lon or ."jav..nt to CI... . (callat.ral) b.n.flclarl.. of the d.c.dant .ft.r the 'MPlratlan 0' any e.tat. far
Ilf. or far ya.r., thl Ca..on..aalth h.r.bv ..pr...ly r...rv.. thl rIght to appral.. and ...... tran.f.r Inh.rltanca T....
at the I,,,'ul Cia.. B (callat.ral) r.ta on any .ueh 'utur. Int.r..t.
PURPOSE OF
HOT ICE. To ful'lll the requlr...nt. of S.ctlan 2140 of the Inh.rltanc. and E.t.t. T'M Act, Act 22 a' 1991. 12 P.S.
Sletlon 2140.
D.tleh tha top portion 0' thl. Hotlel and .ub.lt with yaur Ply.ant to thl R.gl.t.r of Will. prlnt.d on the r.v.r.. .Id..
uHlka eh.ck or .on.y ordar pllv.ble tOI REGISTER. OF HILLB, AGENT
All payaent. r.c.lv.d .hall flr.t b. .ppllld to .ny Int.r..t which IllY ba due with any ra..lnder .ppllad to the tax.
REF.UNO (CA). A r.fund of a tax eradit, which w.. not r.qu..ted on the Tax Raturn, "V b. requ..t.d by ca.pletlng In "APplicatIon
'or R.fund of p.nn'Vlvanla Inharlt.nc. and E.tat. T.x" (REV-1SIS). ApplIcation. .rl Iv.ll.bl. at the o"lc.
of the Rlgl.tlr of Will., .nv of thl 2S R.v.nu. DI.trlct Offlc.., or bV c.lllng thl .p.cl.1 Z4.hour
.n.w.rlng ..rvlce nuab.r. for 'or.. orderlngl In p.nn.ylvanl. 1-800-362-2050, aut.ld. P.nn'Ylvanla and
within local Il.rrhburg ara. (111) 181-8094, TOD. (711) 172-Z2S2 (H.arlng IIp.lr.d Only).
PAVttEHTI
OBJECTIONS a Any party In Intar..t not ..tl.fl.d with tha .ppr.I....nt, allc...nc. or dl.allow.nc. of deductIon., or a.......nt
of tax (InclUding dl.count or Int.ra.t) .. .hown on thl. Hatlc. au.t obJ.ct within .Ixty (60) day. cf rlc.lpt of
thle Notlc. bya
"wrltt.n prot..t to thl PA D.p.rlalnt of Rev.nu., Board of App.als, D.pt. Z8lall, Harrisburg, PA 11128-1021, OR
".I.ctlan to have thl a.ttar d.taralnad at audit of tha account of the par.onal r.pr...ntatlv., OR
_..pp..1 to the Orphan.' Court.
ADHIN
ISTRATlYE
CORRECT IONS I
ractual .rror. dl.cav.r.d on thl. ........nt .hould b. .ddr....d.ln...rltlng tal PA Dlpart..nt of R.vlnu.,
Bur..u 0' Indlvldull T.xu, ATTHI Po.t A.......nt R.vla.. UnIt, D.pt. Z806DI, Harrisburg, PA 17128-0601
Phon. (711) 787-6505. s.. p.g. S of tha bookl.t "In.truetlon. for Inh.rltanc. T.x R.turn for a R..ld.nt
D.c.d.nt" (REY:ISOI) for an axpl.natlon of adalnl.tratlv.lY corraet.bl. .rror..
If any t.x due I. p.ld within thraa (S) c.l.nd.r aonth. .ft.r tha dlc.d.nt'. d..th, a flva p.rc.nt (5~) dl.count bf
the tax p.ld I. allo...d.
Th. 15X tax a~..ty non-p.rtlclpatlon p.n.lty I. co.put.d on the tot.1 of the tax and Int.r..t a......d, and not
paid bafar. January 18, 1996, the 'Ir.t day .ft.r tha and of the tllX ..n..ty p.rlod. fhl. non-participation
p.n.lty I. apP'lllabl. In tha .... "annar and In the the .... tl.. p.rlod a. you would .pp..1 the tax and Int.r..t
that ha. b.an .......d a. Indlr..t.d on thl. not Ie..
DIS~OUHTI
PENAL TV I
IHTEREST.
Intara.t I. ch.rgad b.glnnlng with flrlt day of d.llnqulncy, cr nln. (9) lonth. and on. (1) d.y frc. the data of
d.eth, to the d.t. of paY'lnt. 'ax..' which b.c... d.llnqu.nt b.for. Janu.rv 1, 1982 b..r Int.r..t at the ret. of
.IM (6~) parcant p.r annua calculat.d at a d.lly rat. of .000164. All ta~.. which b.ca.. d.llnqu.nt on and .'t.r
January 1, 198Z will b..r Int.r..t .t a r.t. ..h\ch will vary fro. c.lendar yaar to calend.r yaar with 'that rat.
announc.d by the PA Dapart..nt of Rav.nu., Th. .ppllc.ble Int.r..t rate. for 1982 through 1996 ar'l
'!!!! Tnter..t R,t. n.llv tntar..t Factor ~ Int.r.st Rat. Dallv Int.r..t Factor
.
1982 ZDX .000S...8 1987 'X .000247
1985 lOX .0004!8 1988-1991 IIX .0OOSOl
1984 IU .00OSOl 1992 'X .OOO2U
1985 UX .00OS56 I99S-199~ 7X .000192
1986 lOX .DOOU" 1995.1996 .X .000241
--Int.n.t I. calculat.d .. 'ollow'l
INTEREST a BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
..Anv Notlc. I..uad aftar the tllx b.co.a. d.llnqu.nt will raflect an Int.r..t calcul.tlon to flft..n ~IS) d.y.
b.yond the d.ta of the ........nt. If p.y..nt I. .ad. aftar the Intar..t co,putatlon d.t. .hown an tha
Hotlea, additional Int.r..t au.t b. calculat.d.
'f'~ "
11.4.lt/li'l
*
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU or INDIVIDUAL TAXIS
DEPT, 280601
HARRIS8URG, PA 17128,0601
DECEDENT'S NAME
SCHEDULE
A
F
1\
ITEM
NO.
1
1-2
C. 6
thru
7
c
IHchue! t:nLkocin
INHERITANCE TAX
EXPLANATION
OF CHANGES
FilE NUMIER
2194-0896
AeN
101
EXPLANATION OF CHANOES
The value of the real eSLate la increRaed CroLl ~1I2,500 tll $1I4,UOO as th"
'ruDult of auttliltlunl ahuet aut.llI!tt"d tll llUpllrtlllcut.
The taxable value of Buvings bonda \laB !ucrelllled tu IUD percent. Tho'-
decedcut \las thu Bole individual \11th aCCllYB to the bonds held In tbe
saCli' dUl'odt 'DIlK;
Included vlllull of Buttlement coStH in the 61:lounL of $9,496.78.
-~~-'-'-"~"---"--'~"-'.' ~~."'.~' ,-"""
~., _..,._,...-._-_._--,.._---~--_......-.....~.' ...-.,~.
_ _ ___~ ._~._~ ~_ _. ._. M'__'",__'~""_ .' ...~._ _.... ~.' .-, ."._... ....-. -. - .~.-. -'.-. ^
-_....-.,_.~~..' ..._,.,~_..~ ~----------_._--,_.........
__.___'... ~__ . ~_ ..... .'_.'_. __.._ _.___. ______ __.. _..~~__ .~._~_ ~.. "_e ~ ._~~_~__..~ ,,-_",'
_~ _______. _._ ___~__. ~ _L....,.~____""" __L____~.~_..,._ ..._.. L_~ ..~,. ..~...... _ __u _~_w_ ._~ ._ --~____- '- .-;-..".,-~",* ~~---~~.--------~.-
. ._. ~._~ .-------.--~..._..-~..,---... ._. ._.....__L.____~_--'.___...._.__..~ "~~ .._..".,.'..._.__L_.....___._..____.___._T __.. -_...._;.....____" _____..__w_._
. ..-.-. .- ...-.....-..-.... -..~.-_.--.~-.._..~..._. .~--.---~.~.~. -."7--' ..---.,~...-.. ~~~-'~--' ".:.-.^'-....-;~t~:..t::~-.---...---.-.-_..--... ~'''.,~'......~---._.._-. ..,..
.
~.___~....__.._.... ,L... .~.. _.__ __.____._-,. ...,'. ...._.... ,.._.~~.~ .'--"' ____...~.~__._,__'_.~.~.~_~~,_.,.. ....~.._.....~~. w._~.,_....__;_. ......-.;..., .....-<'",,-~.....__...
_..- ~ .-
_____.____. ..._._....__....._.__.~ ~_...._,,___. ..__.__...... "... " .~..~ w'.:'.._~ _...... ~.... ~__ _ _.. _. v.
TAX EXAMINER,
lIarda Silberman
PAGE
.
)'-
..--...........-
_..__--~.----.._. t.. J,~.,.~.",:.
, ..'
\.
1'1 - ,)l/"~ - 6-
BUREAU Of INDIVIDUAL TAXES
IHHlAITANC[ TAM DIVISION
OEPr. 1I06Gl
HAAAISlURO.. Pi HIlI-06DI
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
u
..
I...IU'" ", ....t61
'JOHN R ZONARICH
204 STATE ST
HOG
ESQ
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-09-96
KATKOCIN
10-08-94
21 94-0896
CUMBERLAND
101
Allount Re..ltt.d
MICHAEL
o
PA 17101
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
HOTEl T6 insure proper credit to ~Dur .ccount, lub.it the upper portion of thl. forn with your tax pay..ent.
"
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEV: il.'iW Ex-"j:ji-ifii:ijl.-i--n--iiii.-iNHERiTANC:Ci';.X-STA'i iliiENi'-OF-A'c-couiii--iiJiii-n--n-n-----------
ESTATE OF KATKOCIN .MICHAEL 0 FILE NO.21 94-0896 ACN 101 DATE 09-09-96
THIS,STATENENT IS PROVIDED TO ADVISE Df THE CURRENT STATUS Of THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
IS A SUNNARY Of THE PRINCIPAL TAX DUE, APPLICATION Of ALL PAYNENTS, THE CURRENT BALANCE, AND. If APPLICABLE,
A PROJECTED INTEREST fIGURE.
DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT, 08-12-96
PR I NCI PAL TAX DUE I .------.-.---------.------.--.-.---.--.----.-----
25,491.84
PAYMENTS (TAX CREDITS),
, PAYMENT
DATE
12-20-94
11-13-95
08-23-96
RECEIPT
NUMBER
AAD22615
AA082304
REFUND
DISCOUNT (+)
INTEREST (-)
1,210.53
40.51-
.00
AMOUNT PAID
23,000.00
1,477.96
156.14-
'0
't
:'-1
fl.1
"
(J:
:-...,
.. ~ ::: i
0(,)
TOTAL TAX CnEDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
25,491.84
.00
.00
.00
. If PAID AfTER THIS DATE, SEE REVERSE
SIDE fOR CALCULATION Of ADDITIONAL INTEREST.
I If TOTAL DUE IS LESS THAN tl,
NO PAYNE NT IS REQUIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" CCRI,
YOU NAY BE DUE A REfUND. SEE REVERSE SIDE Of THIS FORN fOR INSTRUCTIONS.
PAYHENTI ,
D.tach the top portion of thl. Notlc. and .ub.lt with .,our PI.,..nt .Id. PI.,lbll to t~. nl" and Iddr...
prlnt.d on the rav.r.. .Id..
_'". If RESIDENf DECEDENT ...... ch.ck or .on.., order plivabl. tal REGISTER OF WILLS, AGENT.
.... If HON"RESIDfNT DECEDENT ...... ch.ck or .on.., ordar PI.,lbll tal COHHONWEALTH OF PENNSVLVANIA.
All pev.~te rec.lved ah.ll ba appllad flret to ~., Int.r.at which .1" b. due with anv ra.alnder appllld to the t.x.
REFUND (CR), A rafund of a tax cr.dlt, Which we. not requa.t.d on the Tlx A.turn, ..., be r.que.ted b., coapletlng In
~Appllcatlan for R.fund a; Penn..,lvlnl. Inh.rltancl and E.tat. Tlx~ (REY'"IS1S). Appllc.tlon. Ir. .v.ll.bl. .t
the Dfflc. of the Regl.t.r of Will., anv of the 2) Rev~' DI.trlet Dfflca. or fro. the o.p.rt.ent.. Z~"haur
anlw.rlng ..rvlca nuaber. far for.. ordarlngl In Pann.vlvanla 1-100-S62'"2050, out.ld. Pann,vlvanla
and within 10e.1 H.rrl.burg .re. (117) 111'"109~, TOO' (717) 112'"2252 (He.rlng I.p.lred ani.,).
REPLY TDI
OU..tlan. r.g.rdlng .rror. cantalnad an thl. notice .hould b. .ddr....d tal PA oepart.lnt of A.v,nu., Bur.au
of IncUvldul1 Tin., ATTNI Pa.t Au.....nt A.vl.w Unit, Dlpt. ZI06D1, tt.rrhburg, PA 171ZI'"0601, phone
(717) 117'"6505,
.
. DISCOUNTI
If anv tax due I. paid wIthin three (S) cal.ndar .anth. aft.r thl decld.nt'. delth, I flv. percent C5~) dl.count '
of thl tax paid I. .llow.d.
PENALTY.
Th. 15X t.x aan..tv non'"partlelp.tlon p.nalt., Ie coaput.d on the total of the tax and Int.r..t .......d, and not
p.ld ba'ora Janu.rv II, 1996, the flr.t dav a,ter the .nd of the tax lan..tv p.rlod.
INTEREST I
Int.r..t I, charg.d b.glnnlng wIth flr.t da., of d.llnqu.ncv, or nine (9) lonth. and on. Cl) d.v frol thl d.tl of
d..th, to the d.t. of pav..nt. .fl'" which b.e... dlllnqu.nt b.fore Januarv 1, 1982 bill' Int.r..t at the ntl of
.Ix (6X) p.rclnt plr annul calcul.ted .t a dallv rat. of .00016~. All taxe. which blca.. delinquent on and aft.r
Janulrv I, 1912 will bear Int.rl.t at a rat. which will varv frol cal.ndar 'lIar to cal.ndlr vear with that rat.
announc.d bV the PA Deplrt.lnt of Revlnul. Th. appllcabl. Int.r..t rat.. for 1912 through 1996 .r'l
V.ar Int.r..t R.t. 0.11., Int.r..t F.ctor
Veal'
Int.r..t R.t.
0.11'1 Int.r..t factor
19aZ zU .000548 1987 .~ ",000241
19aJ 16X .000418 1988-1991 llX .000501
1984 1I~ ,000501 1992 .~ .00DZft7
1985 ax .000556 1995-I99~ 1~ .000192
1986 lOX ,OODZ7~ 1995'"1996 .~ ,OOD2~l
"'Int.r..t 11 cllcuht.d .. 'allow. I
INTEREST a BALAIICE or TAX UNPAID X NUnDER OF DAYB DELINQUENT X DAILY INTEREST FACTOR
--An., Hotlce I..u.d 1ft... the tax ber.o... delinquent will r.fl.ct an Int.re.t calcul.tlon to fifteen CIS) de.,.
be.,ond the d.te of the ........nt. If p.y..nt I. ..de .ft.r the Int.r..' Co.,utltlon dltl shown on the
Notlc., .ddltlon.1 Int.r..t .u.t b. cllculet.d.
"
c,..
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF MICHAEL D. KATKOCIN
Late of the Borough of Camp Hill
Cumberland County, Pennsylvania
Estate No. 21 1994 0896
RECEIPT, RELEASE AND REIMBURSEMENT AGREEMENT
WITH FIRST AND FINAL ACCOUNTING
of M. Daniel Katkocin, Executor
BENEFICIARY: M. Daniel Katkocin
Date of Death: October 8, 1994
Letters Granted: October 24, 1994
First Complete Advertisement of Grant of Letters: January 10, 1995
~~~~W.;:l;.~,',-;'~ .~j'-;1l.!
.,.
ESTATE OF
MICHAEL D. KATKOCIN
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE NO. 21 1994 OB96
RECEIPT, RELEASE AND
REIMBURSEMENT AGREEMENT
WHEREAS, MICHAEL D. KATKOCIN, late of the Borough of Camp
Hill, Cumberland County, pennsylvania, died testate on October B,
1994, havitlg first made his Last Will and Testament, duly executed
on January 21, 1992, which is recorded in the Office of the
Register of wills of Cumberland County, pennsylvania;
WHEREAS, by his aforesaid Last Will and Testament, the
said Michael D. Katkocin named M. Daniel Katkocin as Executor of
WHEREAS, Letters Testamentary on the Estate of the said
Michael D. Katkocin were duly issued by the Register of Wills of
Cumberland County, Pennsylvania, unto M. Daniel Katkocin on October
24, 1994;
his Last Will and Testament;
WHEREAS, M. Daniel Katkocin as Executor of the Estate of
Michael D. Katkocin has gathered the assets of the Estate, which
consists of personal property and real estate having a value as set
forth in Exhibit "A", which is a Statement of Account of the said
Executor and is attached hereto and made a part hereof;
WHEREAS, the debts and deductions, including payment of
the Pennsylvania Inheritance Tax on said Estate have been made by
"
the Executor, leaving a net balance as reflected on Exhibit "A",
for distribution to the beneficiaries.
WHEREAS, it is the desire of the undersigned that
distribution be made without the formality of an accounting, and
the said M. Daniel Katkocin is willing to make such distribution
upon the receipt of a proper release and indelnnification, which it
is the purpose of this Agreement to provide.
NOW, THEREFORE, KNOW YE that I, M. Daniel Katkocin, one of
.
the sole residuary beneficiaries named in the Last will and
Testament of Michael D. Katkocin do hereby acknowledge that I have
this day had and received from the aforesaid Executor in full and
final satisfaction and payment of all sum or sums of money,
legacies, bequests and devises as are given, devised or bequeathed
by the said Last will and Testament of Michael D. Katkocin, the
amount or distribution which is set forth opposite our names in the
Schedule of Distribution in the Statement attached hereto and
marked Exhibit "B";
AND I acknowledge that certain articles of household goods
and items of personal use and adornment of the said Michael D.
Katkocin which had been property of the Estate shall be divided in
kind amongst the beneficiaries of Michael D. Katkocin, in
accordance with a schedule retained by the Executor and shall be
made available upon request, and do hereby consent and agree to the
'.
aforesaid division of such articles and items without specific
accounting therefore;
AND I declare that I have examined the Account of the said
M. Daniel Katkocin attached hereto as Exhibit "A" and "B" and find
the same to be true and correct in all particulars and hereby
approve the same and request him to make final distribution without
the filing of said Account for audit and approval by the Orphans'
Court Division of the Court of Common Pleas of Cumberland County,
.
Pennsylvania. In consideration of the delivery to us of the
distribution as aforesaid, for myself, my heirs, executors,
administrators and assigns, I do remise, release, quitclaim and
forever discharge M. Daniel Katkocin individually and as Executor
of the Estate of Michael D. Katkocin, Deceased, John R. Zonarich,
Esquire, the law firm of Skarlatos & Zonarich, its successors and
assigns, of and from any and all actions, suits, payments,
accounts, claims and demands whatsoever or by reason of their
administration of the Estate of Michael D. Katkocin, Deceased,
hereby agreeing that the Orphans' Court Division of the Court of
Common Pleas, Cumberland County may, by its decree, confirm the
said account and discharge M. Daniel Katkocin. I further agree to
indemnify and hold harmless M. Daniel Katkocin and Skarlatos &
Zonarich from any and all claims, loss, liability and damage which
they may suffer or to which they may be subjected by reason of the
'.
settlement of this account and distribution of the assets of the
said Michael D. Katkocin without Court approval.
I do further declare it is my intention to be legally bound
by the execution of this instrument and do hereby covenant and
agree with the said M. Daniel Katkocin and with each other, that
should any liability come known against the Estate of Michael D.
Katkocin after the signing of this Agreement, I will contribute pro
rata with all other beneficiaries up to our share of the residuary
.
estate to satisfy any and all claims, demands, suits or causes of
action which may be successfully prosecuted against the Estate of
Michael D. Katkocin, Deceased, or the aforesaid Executor in his
capacity as such after the signing, sealing and delivery of this
Receipt, Release and Reimbursement Agreement.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
the
~. day of ~
, 1996.
~o,t1~
M~~J?.+b;""
1)1 ''''A ~ Ill~"n'"
Ifll'; ~!. ~~'.I!.ll.
NorAH { 1'1181.1(; . HI\n: I)F oHIO
My Gommi;sioll Giplru:; r:!;'.', 1'l, 1:)~il
~-rA"'E OF O\~\O
eOMMOmlBAL'l'II 9F PBtuU:n.\'AmA-)
COUNTY OF F"RA.N \<.1...1 ~
: SS:
)
On this, the
~
day of C'71 ~~ .
, 1996,
before me, a Notary PUblic, personally appeared M. Daniel Katkocin,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he/she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
.
DIANA S. ADDliN
NOTARY PUBLIC, STATE OF OHIO
My Commlsslun expires tluv. 17, 199B
" ~~
~liC
(SEAL)
My Commission Expires:
1'.~ <'c." ,.-',
. ,
~
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF MICHAEL D. KATKOCIN
Late of the Borough of Camp Hill
Cumberland County, pennsylvania
Estate No. 21 1994 0896
RECEIPT, RELEASE AND REIMBURSEMENT AGREEMENT
WITH FIRST AND FINAL ACCOUNTING
of M. Daniel Katkocin, Executor
BENEFICIARY: Brian L. Katkocin
Date of Death: October 8, 1994
Letters Granted: October 24, 1994
First Complete Advertisement of Grant of Letters: January 10, 1995
.
....-.......---..--- ..-~-
'..'-......::.,;"....
....- "'-it
. '
EXHIBIT "A"
1.
Total Deposits (including interest)
Total Payments (less Partial
Distribution)
$ 425,488.94
2.
($ 49,574.56)
NBT ASSETS OF BSTATE
$ 375,914.38
EXHIBIT "B"
NET ASSETS OF THE ESTATE
A. Partial Distribution
previously made to;
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 375,914.38
$20,000.00
$20,000.00
$20,000.00
$20,000.00
S20.000.00
TOTAL AMOUNT DIST. ($ 100,000.00)
B. Expenses to be paid
(Atty Fees, Misc. Estate Fees
Tax Returns, Filing Fees (Release) IS 3.471.631
NBT BALANCE FOR DISTRIBUTION $ 272,442.75
AMOUNT TO DISTRIBUTED TO BACH BENEFICIARY
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 54,488.55
$ 54,488.55
$ 54,488.55
$ 54,488.55
S 54.488.55
Total
$272,442.75
ESTATE OF
MICHAEL D. KATKOCIN
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE NO. 21 1994 0896
RECEIPT, RELEASE AND
REIMBURSEMENT AGREEMENT
WHEREAS, MICHAEL D. KATKOCIN, late of the Borough of Camp
Hill, Cumberland County, Pennsylvania, died testate on October 8,
1994, having first made his Last will and Testament, duly executed
on January 21, 1992, which is recorded in the Office of the
Register of wills of Cumberland County, Pennsylvania;
WHEREAS, by his aforesaid Last Will and Testament, the
said Michael D. Katkocin named M. Daniel Katkocin as Executor of
his Last Will and Testament;
WHEREAS, Letters Testamentary on the Estate of the said
Michael D. Katkocin were duly issued by the Register of Wills of
Cumberland County, pennsylvania, unto M. Daniel Katkocin on October
24, 1994;
WHEREAS, M. Daniel Katkocin as Executor of the Estate of
Michael D. Katkocin has gathered the assets of the Estate, which
consists of personal property and real estate having a value as set
forth in Exhibit "A", which is a Statement of Account of the said
Executor and is attached hereto and made a part hereof:
WHEREAS, the debts and deductions, including payment of
the pennsylvania Inheritance Tax on said Estate have been made by
the Executor, leaving a net balance as reflected on Exhibit "A",
for distribution to the beneficiaries.
WHEREAS, it is the desire of the undersigned that
distribution be made without the formality of an accounting, and
the said M. Daniel Katkocin is willing to make such distribution
upon the receipt of a proper release and indemnification, which it
is the purpose of this Agreement to provide.
NOW, THEREFORE, KNOW YE that I, Brian L. Katkocin, one of
the sole residuary beneficiaries named in the Last Will and
Testament of Michael D. Katkocin do hereby acknowledge that I have
this day had and received from the aforesaid Executor in full and
final satisfaction and payment of all sum or sums of money,
legacies, bequests and devises as are given, devised or bequeathed
by the said Last Will and Testament of Michael D. Katkocin, the
amount or distribution which is set forth opposite our names in the
Schedule of Distribution in the Statement attached hereto and
marked Exhibit "B";
AND I acknowledge that certain articles of household goods
and items of personal use and adornment of the said Michael D.
Katkocin which had been property of the Estate shall be divided in
kind amongst the beneficiaries of Michael D. Katkocin, in
acco=dance with a schedule retained by the Executor and shall be
made available upon request, and do hereby consent and agree to the
aforesaid division of such articles and items without specific
accounting therefore;
AND I declare that I have examined the Account of the said
M. Daniel Katkocin attached hereto as Exhibit "A" and "B" and find
the same to be true and correct in all particulars and hereby
approve the same and request him to make final distribution without
the filing of said Account for audit and approval by the Orphans'
Court Division of the Court of Common Pleas of Cumberland County,
Pennsylvania. In consideration of the delivery to us of the
distribution as aforesaid, for myself, my heirs, executors,
administrators and assigns, I do remise, release, quitclaim and
forever discharge M. Daniel Katkocin individually and as Executor
of the Estate of Michael D. Katkocin, Deceased, John R. Zonarich,
Esquire, the law firm of Skarlatos & Zonarich, its successors and
assigns, of and from any and all actions, suits, payments,
accounts, claims and demands whatsoever or by reason of their
administration of the Estate of Michael D. Katkocin, Deceased,
hereby agreeing that the Orphans' Court Division of the Court of
Common Pleas, Cumberland County may, by its decree, confirm the
said account and discharge M. Daniel Katkocin. I further agree to
indemnify and hold harmless M. Daniel Katkocin and Skarlatos &
Zonarich from any and all claims, loss, liability and damage which
they may suffer or to which they may be subjected by reason of the
. .
settlement of this account and distribution of the assets of the
said Michael D. Katkocin without Court approval.
I do further declare it is my intention to be legally bound
by the execution of this instrument and do hereby covenant and
agree with the said M. Daniel Katkocin and with each other, that
should any liability come known against the Estate of Michael D.
Katkocin after the signing of this Agreement, I will contribute pro
rata with all other beneficiaries up to our share of the residuary
estate to satisfy any and all claims, demands, suits or causes of
action which may be successfully prosecuted against the Estate of
Michael D. Katkocin, Deceased, or the aforesaid Executor in his
capacity as such after the signing, sealing and delivery of this
Receipt, Release and Reimbursement Agreement.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
the .:f'.:lJ.. day of
Q.~-t[LV
, 1996.
WITNESS:
.G.1/;; -'/ 7J t:c/"A,,{
,
r~ ~I (~
Brian L. Ka
NerAllY ~u:: ~ WIlLe"
MYCO~ISSION N~~,~R/DA
",MISSIoN"'" -.-.,./6
...P. MAR, 211997
""""",..- li__4=*_C....'.;c. 0+ -'--"==_~"'.~' __.'"..=-'''''''''''''
. .
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF Ct(II'BE'~J,,q,c,1,) )
ss:
On this, the .r-tl.... day of r.{Jdi:",~
, 1996,
before me, a Notary Public, personally appeared Brian L. Katkocin,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he/she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
NOrAllY JJF DWBLaj
COMMISS UCsrA1ll OF FLoRIDA
MYCOMMISS:g~ ~'?; e?62916
...r......R.211PlI7
.-d~~'JJ zr alJL'd
Notary Public
(SEAL)
My conunission Expires: 3/:1 1/tJ 7
-, "":'-~""-,-!t--;''''''';",,,,,'i, .,'..:i",:,>-"",,,,"
EXHIBIT "A"
1.
Total Deposits (including interest)
Total payments (less Partial
Distribution)
$ 425,488.94
2 .
($ 49,574.56)
NET ASSETS OF ESTATE
$ 375,914.38
EXHIBIT "B"
NET ASSETS OF THE ESTATE
A. Partial Distribution
previously made to;
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 375,914.38
$20,000.00
$20,000.00
$20,000.00
$20,000.00
S20.000.00
TOTAL AMOUNT DIST. ($ 100,000.00)
B. Expenses to be paid
(Atty Fees, Misc. Estate Fees
Tax Returns, Filing Fees (Release) (S 3.471.631
NET BALANCE FOR DISTRIBUTION $ 272,442.75
AMOUNT TO DISTRIBUTIID TO BACH BENEFICIARY
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 54,488.55
$ 54,488.55
$ 54,488.55
$ 54,488.55
S 54,488.55
Total
$272,442.75
0..-
"
.
.
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF MICHAEL D. KATKOCIN
Late of the Borough of Camp Hill
Cumberland County, Pennsylvania
Estate No. 21 1994 0896
RECEIPT, RELEASE AND REIMBURSEMENT AGREEMENT
WITH FIRST AND FINAL ACCOUNTING
of M. Daniel Katkocin, Executor
BENEFICIARY: Maureen F. Karlson
Date of Death: October 8, 1994
Letters Granted: October 24, 1994
First Complete Advertisement of Grant of Letters: January 10, 1995
'.
.
.
ESTATE OF
MICHAEL D. KATKOCIN
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE NO. 21 1994 0896
RECEIPT, RELEASE AND
REIMBURSEMENT AGREEMENT
WHEREAS, MICHAEL D. KATKOCIN, late of the Borough of Camp
Hill, Cumberland County, pennsylvania, died testate on October 8,
1994, having first made his Last Will and Testament, duly executed
on January 21, 1992, which is recorded in the Office of the
Register of wills of Cumberland County, Pennsylvania;
WHEREAS, by his aforesaid I,ast will and Testament, the
said Michael D. Katkocin named M. Daniel Katkocin as Executor of
his Last will and Testament;
WHEREAS, Letters Testamentary on the Estate of the said
Michael D. Katkocin were duly issued by the Register of wills of
Cumberland County, Pennsylvania, unto M. Daniel Katkocin on October
24, 1994;
WHEREAS, M. Daniel Katkocin as Executor of the Estate of
Michael D. Katkocin has gathered the assets of the Estate, which
consists of personal property and real estate having a value as set
forth in Exhibit "A", which is a Statement of Account of the said
Executor and is attached hereto and made a part hereof;
WHEREAS, the debts and deductions, including payment of
the Pennsylvania Inheritance Tax on said Estate have been made by
~
'f..'- .
..
the Executor, leaving a net balance as reflected on Exhibit "A",
for distribution to the beneficiaries.
WHEREAS, it is the desire of the undersigned that
distribution be made without the formality of an accounting, and
the said M. Daniel Katkocin is willing to make such distribution
upon the receipt of a proper release and indemnification, which it
is the purpose of this Agreement to provide.
NOW, THEREFORE, KNOW YE that I, Maureen F. Karlson, one of
the sole residuary beneficiaries named in the Last will and
Testament of Michael D. Katkocin do hereby acknowledge that I have
this day had and received from the aforesaid Executor in full and
final satisfaction and payment of all sum or sums of money,
legacies, bequests and devises as are given, devised or bequeathed
by the said Last Will and Testament of Michael D. Katkocin, the
amount or distribution which is set forth opposite our names in the
Schedule of Distribution in the Statement attached hereto and
marked Exhibit "B";
AND I acknowledge that certain articles of household goods
and items of personal use and adornment of the said Michael D.
Katkocin which had been property of the Estate shall be divided in
kind amongst the beneficiaries of Michael D. Katkocin, in
accordance with a schedule retained by the Executor and shall be
made available upon request, and do hereby consent and agree to the
aforesaid division of such articles and items without specific
accounting therefore;
AND I declare that I have examined the Account of the said
M. Daniel Katkocin attached hereto as Exhibit "A" and "B" and find
the same to be true and correct in all particulars and hereby
approve the same and request him to make final distribution without
the filing of said Account for audit and approval by the Orphans'
Court Division of the Court of Common Pleas of Cumberland County,
Pennsylvania. In consideration of the delivery to us of the
distribution as aforesaid, for myself, my heirs, executors,
administrators and assigns, I do remise, release, quitclaim and
forever discharge M. Daniel Katkocin individually and as Executor
of the Estate of Michael D. Katkocin, Deceased, John R. Zonarich,
Esquire, the law firm of Skarlatos & Zonarich, its successors and
assigns, of and from any and all actions, suits, payments,
accounts, claims and demands whatsoever or by reason of their
administration of the Estate of Michael D. Katkocin, Deceased,
hereby agreeing that the Orphans' Court Division of the Court of
Common Pleas, Cumberland County may, by its decree, confirm the
said account and discharge M. Daniel Katkocin. I further agree to
indemnify and hold harmless M. Daniel Katkocin and Skarlatos &
Zonarich from any and all claims, loss, liability and damage which
they may suffer or to which they may be subjected by reason of the
i
I
\,
...
'.
settlement of this account and distribution of the assets of the
said Michael D. Katkocin without Court approval.
I do further declare it is my intention to be legally bound
by the execution of this instrument and do hereby covenant and
agree with the said M. Daniel Katkocin and with each other, that
should any liability come known against the Estate of Michael D.
Katkocin after the signing of this Agreement, I will contribute pro
rata with all other beneficiaries up to our share of the residuary
estate to satisfy any and all claims, demands, suits or causes of
action which may be successfully prosecuted against the Estate of
Michael D. Katkocin, Deceased, or the aforesaid Executor in his
capacity as such after the signing, sealing and delivery of this
Receipt, Release and Reimbursement Agreement.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
the Isl day of
(}~.k",.^?
, 1996.
WITNESS:
Uev->- U~~)
Maureen F. Karlson, Individually
q;t~c--~
.
.........~'''',.
'.
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF ~/-...ltt.laul
SSI
On this, the
k/.
tfl.lzu5" .c
, 1996,
day of
before me, a Notary Public, personally appeared Maureen F. Karlson,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he/she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
Ok~~
Notary Public
(SEAL)
My Commissio
. .
BXHIBIT "A"
1.
Total Deposits (including interest)
Total payments (less Partial
Distribution)
$ 425,488.94
2.
($ 49,574.56)
NET ASSETS OF BSTATE
$ 375,914.38
EXHIBIT "B"
NET ASSETS OF THE ESTATE
A. Partial Distribution
previously made to;
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 375,914.38
$20,000.00
$20,000.00
$20,000.00
$20,000.00
S20.000.00
TOTAL AMOUNT DIST. ($ 100,000.00)
B. Expenses to be paid
(Atty Fees, Misc. Estate Fees
Tax Returns, Filing Fees (Release) IS 3.471.63)
NET BALANCB FOR DISTRIBUTION $ 272,442.75
AMOUNT TO DISTRIBUTBD TO EACH BENEFICIARY
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 54,488.55
$ 54,488.55
$ 54,488.55
$ 54,488.55
S 54.488.55
Total
$272,442.75
..........-..,~~""'..,..~_,.. 'H~_n"'..'h. __._'.,' ..,-
. .
.
.
.'
<'
C/
IN THB COURT OF COMMON PLEAS
OF CUMBBRLAND COUNTY, PBNNSYLVANIA
ORPHANS' COURT DIVISION
BSTATB OF MICHABL D. KATKOCIN
Late of the Borough of Camp Hill
CUmberland County, Pennsylvania
Bstate No. 21 1994 0896
RBCBIPT, RBLEASB AND RBIMBURSEMBNT AGRBBMBNT
WITH FIRST AND FINAL ACCOUNTING
of M. Daniel Katkocin, Bxecutor
BBNEFICIARY: Joseph Katkocin
Date of Death: October 8, 1994
Letters Granted: October 24, 1994
First Complete Advertisement of Grant of Letters: January 10, 1995
~
~ ..\;... ~
-..r.......
ESTATE OF
MICHAEL D. KATKOCIN
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE NO. 21 1994 0896
RECEIPT, RELEASE AND
REIMBURSEMENT AGREEMENT
WHEREAS, MICHAEL D. KATKOCIN, late of the Borough of Camp
Hill, Cumberland County, Pennsylvania, died testate on October 8,
1994, having first made his Last Will and Testament, duly executed
on January 21, 1992, which is recorded in the Office of the
Register of wills of Cumberland County, Pennsylvania;
WHEREAS, by his aforesaid Last Will and Testament, the
said Michael D. Katkocin named M. Daniel Katkocin as Executor of
his Last will and Testament;
WHEREAS, Letters Testamentary on the Estate of the said
Michael D. Katkocin were duly issued by the Register of Wills of
Cumberland County, Pennsylvania, unto M. Daniel Katkocin on October
24, 1994;
WHEREAS, M. Daniel Katkocin as Executor of the Estate of
Michael D. Katkocin has gathered the assets of the Estate, which
consists of personal property and real estate having a value as set
forth in Exhibit "A", which is a Statement of Account of the said
Executor and is attached hereto and made a part hereof;
WHEREAS, the debts and deductions, including payment of
the Pennsylvania Inheritance Tax on said Estate have been made by
t .... ".-:'-,,!":"" .-.,..... ,.::-: ".~~~ \"1-":,, '..,,~:.. ~ 1'''''''',""'1,1{<<
the Executor, leaving a net balance as reflected on Exhibit "A",
for distribution to the beneficiaries.
WHEREAS, it is the desire of the undersigned that
distribution be made without the formality of an accounting, and
the said M. Daniel Katkocin is willing to make such distribution
upon the receipt of a proper release and indemnification, which it
is the purpose of this Agreement to provide.
NOW, THEREFORE, KNOW YE that I, Joseph Katkocin, one of the
sole residuary beneficiaries named in the Last Will and Testament
of Michael D. Katkocin do hereby acknowledge that I have this day
had and received from the aforesaid Executor in full and final
satisfaction and payment of all sum or sums of money, legacies,
bequests and devises as are given, devised or bequeathed by the
said Last will and Testament of Michael D. Katkocin, the amount or
distribution which is set forth opposite our names in the Schedule
of Distribution in the Statement attached hereto and marked Exhibit
"B";
AND I acknowledge that certain articles of household goods
and items of personal use and adornment of the said Michael D.
Katkocin which had been property of the Estate shall be divided in
kind amongst the beneficiaries of Michael D. Katkocin, in
accordance with a schedule retained by the Executor and shall be
made available upon request, and do hereby consent and agree to the
aforesaid division of such articles and items without specific
accounting therefore;
AND I declare that I have examined the Account of the said
M. Daniel Katkocin attached hereto as Exhibit "A" and "B" and find
the same to be true and correct in all particulars and hereby
approve the same and request him to make final distribution without
the filing of said Account for audit and approval by the Orphans'
Court Division of the Court of Common Pleas of Cumberland County,
Pennsylvania. In consideration of the delivery to us of the
distribution as aforesaid, for myself, my heirs, executors,
administrators and assigns, I do remise, release, quitclaim and
forever discharge M. Daniel Katkocin individually and as Executor
of the Estate of Michael D. Katkocin, Deceased, John R. Zonarich,
Esquire, the law firm of Skarlatos & Zonarich, its successors and
assigns, of and from any and all actions, suits, payments,
accounts, claims and demands whatsoever or by reason of their
administration of the Estate of Michael D. Katkocin, Deceased,
hereby agreeing that the Orphans' Court Division of. the Court of
Common Pleas, Cumberland County may, by its decree, confirm the
said account and discharge M. Daniel Katkocin. I further agree to
indemnify and hold harmless M. Daniel Katkocin and Skarlatos &
Zonarich from any and all claims, loss, liability and damage which
they may suffer or to which they may be subjected by reason of the
,
.
settlement of this account and distribution of the assets of the
said Michael D. Katkocin without Court approval.
I do further declare it is my intention to be legally bound
by the execution of this instrument and do hereby covenant and
agree with the said M. Daniel Katkocin and with each other, that
should any liability come known against the Estate of Michael D.
Katkocin after the signing of this Agreement, I will contribute pro
rata with all other beneficiaries up to our share of the residuary
estate to satisfy any and all claims, demands, suits or causes of
action which may be successfully prosecuted against the Estate of
Michael D. Katkocin, Deceased, or the aforesaid Executor in his
capacity as such after the signing, sealing and delivery of this
Receipt, Release and Reimbursement Agreement.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
the z.~aay of OC!...t-ob~,.. , J.996.
.~
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COMMONWEA~~H(OF PENNSYLVANIA~ SS:
COUNTY OF(j.J?I.Af1{{,('~ j
On this, the~cr/.YC~day of [)C~~
, 1996,
before me, a Notary Public, personally appeared Joseph Katkocin ,
known to me (or satisfactorily proven) to be the person whose name
is subscribed to the within instrument and acknowledged that he/she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
Nolarlal Soal
Tracy L. Lockhart, Nolary Public
Harrisburg, Dauphin County
My Commlsslon Explros May 3, 1999
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(SEAL)
My Commission Expires:
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RXHIBIT "A"
1.
Total Deposits (including interest)
Total Payments (less Partial
Distribution)
$ 425,488.94
2.
($ 49,574.56)
NET ASSETS OF BSTATB
$ 375,914.38
BXHIBIT "B"
NBT ASSETS OF THE ESTATE
A. Partial Distribution
previously made to;
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 375,914.38
$20,000.00
$20,000.00
$20,000.00
$20,000.00
S20.000.00
TOTAL AMOUNT DIST. ($ 100,000.00)
B. Expenses to be paid
(Atty Fees, Misc. Estate Fees
Tax Returns, Filing Fees (Release) IS 3.471.631
NET BALANCB FOR DISTRIBUTION $ 272,442.75
AMOUNT TO DISTRIBUTBD TO BACH BBNBFICIARY
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 54,488.55
$ 54,488.55
$ 54,488.55
$ 54,488.55
S 54.488.55
Total
$272,442.75
I.
,
,
..
,
(Y
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF MICHAEL D. KATKOCIN
Late of the Borough of Camp Hill
CUmberland County, Pennsylvania
Estate No. 21 1994 0896
RECEIPT, RELEASE AND REIMBURSEMENT AGREEMENT
WITH FIRST AND FINAL ACCOUNTING
of M. Daniel Katkocin, Executor
BENEFICIARY: Kathleen M. Brainard
Date of Death: October 8, 1994
Letters Granted: October 24, 1994
First Complete Advertisement of Grant of Letters: January 10, 1995
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ESTATE OF
MICHAEL D. KATKOCIN
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE NO. 21 1994 0896
RECEIPT, RELEASE AND
REIMBURSEMENT AGREEMENT
WHEREAS, MICHAEL D. KATKOCIN, late of the Borough of Camp
Hill, Cumberland County, Pennsylvania, died testate on October 8,
1994, having first made his Last Will and Testament, duly executed
on January 21, 1992, which is recorded in the Office of the
Register of Wills of Cumberland County, Pennsylvania;
WHEREAS, by his aforesaid Last Will and Testament, the
said Michael D. Katkocin named M. Daniel Katkocin as Executor of
his Last Will and Testament;
WHEREAS, Letters Testamentary on the Estate of the said
Michael D. Katkocin were duly issued by the Register of Wills of
Cumberland County, Pennsylvania, unto M. Daniel Katkocin on October
24, 1994;
- -----..,,~....-...._,..-_..,
WHEREAS, M. Daniel Katkocin as Executor of the Estate of
Michael D. Katkocin has gathered the assets of the Estate, which
consists of personal property and real estate having a value as set
forth in Exhibit "A", which is a Statement of Account of the said
Executor and is attached hereto and made a part hereof;
WHEREAS, the debts and deductions, including payment of
the Pennsylvania Inheritance Tax on said Estate have been made by
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the Executor, leaving a net balance as reflected on Exhibit "A",
for distribution to the beneficiaries.
WHEREAS, it is the desire of the undersigned that
distribution be made without the formality of an accounting, and
the said M. Daniel Katkocin is willing to make such distribution
upon the receipt of a proper release and indemnification, which it
is the purpose of this Agreement to provide.
NOW, THEREFORE, KNOW YE that I, Kathleen M. Brainard, one
of the sole residuary beneficiaries named in the Last will and
Testament of Michael D. Katkocin do hereby acknowledge that I have
this day had and received from the aforesaid Executor in full and
final satisfaction and payment of all sum or sums of money,
legacies, bequests and devises as are given, devised or bequeathed
by the said Last Will and Testament of Michael D. Katkocin, the
amount or distribution which is set forth opposite our names in the
Schedule of Distribution in the Statement attached hereto and
marked Exhibit "B";
AND I aCknowledge that certain articles of household goods
and items of personal use and adornment of the said Michael D.
Katkocin which had been property of the Estate shall be divided in
kind amongst the beneficiaries of Michael D. Katkocin, in
accordance with a schedule retained by the Executor and shall be
made available upon request, and do hereby consent and agree to the
'.
aforesaid division of such articles and items without specific
accounting therefore;
AND I declare that I have examined the Account of the said
M. Daniel Katkocin attached hereto as Exhibit "A" and "B" and find
the same to be true and correct in all particulars and hereby
approve the same and request him to make final distribution without
the filing of said Account for audit and approval by the Orphans'
Court Division of the Court of Common Pleas of Cumberland County,
Pennsylvania. In consideration of the delivery to us of the
distribution as aforesaid, for myself, my heirs, executors,
administrators and assigns, I do remise, release, quitclaim and
forever discharge M. Daniel Katkocin individually and as Executor
of the Estate of Michael D. Katkocin, Deceased, John R. Zonarich,
Esquire, the law firm of Skarlatos << Zonarich, its successors and
assigns, of and from any and all actions, suits, payments,
accounts, claims and demands whatsoever or by reason of their
administration of the Estate of Michael D. Katkocin, Deceased,
hereby agreeing that the Orphans' Court Division of the Court of
Common Pleas, Cumberland County may, by its decree, confirm the
said account and discharge M. Daniel Katkocin. I further agree to
indemnify and hold harmless M. Daniel Katkocin and Skarlatos <<
Zonarich from any and all claims, loss, liability and damage which
they may suffer or to which they may be subjected by reason of the
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settlement of this account and distribution of the assets of the
said Michael D. Katkocin without Court approval.
I do further declare it is my intention to be legally bound
by the execution of thill instrument and do hereby covenant and
agree with the said M. Daniel Katkocin and with each other, that
should any liability come known against the Eetate of Michael D.
Katkocin after the signing of this Agreement, I will contribute pro
rata with all other beneficiaries up to our share of the residuary
estate to satisfy any and all claims, demands, suits or causes of
action which may be succesllfully prosecuted against the Estate of
Michael D. Katkocin, Deceased, or the aforesaid Executor in his
capacity as lIuch after the signing, sealing and delivery of this
Receipt, Release and Reimbursement Agreement.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
the IS r day of 0" 1 v'?/J/L_ ,1996.
WITNESS:
Q, _ '~_". .
T1 -Y' i. ;'" ,
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"L.A~iL.,... !/ l!'1AI.l___I-._O
Kathleen M. Brainard, Individually
Vir;g /l\Ji fL>
COMMONWEALTH OF rSt gYIN."LlIIA)
COUNTY OF ..:T"AIlIGJ' c.ikr
.
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ss:
On this, the IJJ'
day of Odo [,t r-
, 1996,
before me, a Notary Public, personally appeared Kathleen M.
Brainard, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within instrument and acknowledged
that he/she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto Bet my hand and official
seal.
Expires: &/3010l.00D
h.-'_, .. .'~ .-...;,.,.........,"'''''
"
RXIIIBIT "A"
1.
Total Deposits (including interest)
Total Payments (lesD Partial
Distribution)
$ 425,488.94
2 .
($ 49,574.56)
NBT MSRTS OF SSTATB
$ 375,914.38
RXIIIBIT "B"
NET ABBSTS OF TUB BSTATB
A. Partial Diotribution
previously mode tOI
a. Kathleen M. Brainard
b. Jooeph Katkocin
c. Maureen P. Karlson
d. Brian L, Katkocin
e. M. Daniel Katkocin
$ 375,914.38
$20,000.00
$20,000.00
$20,000.00
$20,000.00
S20.000.00
TOTAL AMOUNT DIST. ($ 100,000.00)
B. Bxpenses to be paid
(Atty FeeD. Misc. Estate Fees
Tax Returns. Filing Fees (Release) IS 3.471.631
NBT BALANCB FOR DISTRIBUTION $ 272,442.75
AMOUNT TO DISTRIBUTBD TO BACH BBNBPICIARY
a. Kathleen M. Brainard
b. Joseph Katkocin
c. Maureen F. Karlson
d. Brian L. Katkocin
e. M. Daniel Katkocin
$ 54,488.55
$ 54,488.55
$ 54,488.55
$ 54,488.55
S 54.488.55
Total
$272,442.75
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JOHN R, lONARICH
ANNA MARIE SOSSONO
OA VIO H. JUOY
.2 J.. qV~ f9 (0
SKARlATOS & WNARICH
ATTORNEYS AT LAW
204 STATE STREET
HARRISBURG. PENNSYLVANIA 17101
17171233.1000
FAX 11171233.6740
IfUL TON O"ICI
MECHANICS 8 a. L BUILDING
151IDU'" FRONT &TAUT
'TULTON, rENHIVLVAHIA 17113
(1' 71 ISI.tna
ALBERT 0, BTUART. P,C.
Of Caunltl
MIDDUTOWN OPPICI
273 NOftTH UNION STAUT
MIDDLETOWN, PENNIYLVANIA 17017
17171144.1'011
ANOELO BKARLATOB IIBBB.1BBII
November 8, 1995
Office of the Register of Wills
CUMBERLAND COUNTY COURTHOUSE
South Hanover Street
Carlisle, Pennsylvania 17013
RE: Estate of Michael D. Katkocin
Estate No. 21 1994 0896
Dear Register of wills:
Enclosed please find one (1) original and three (3) copies of
the Inheritance Tax Return as it applies to the above captioned
estate. I have also enclosed one (1) original and three (3) copies
of the Inventory. In addition, attached are two (2) estate checks
made payable to the Register of Wills, Agent. Check number 158 is
in the amount of One Thousand Four Hundred Seventy-Seven Dollars
and Ninety-Six Cents ($1,477.96) which represents the Inheritance
Tax due. Check number 167 is in the amount of Ninety-Five Dollars
($95.00) which represents the following costs due your office.
1. Filing Fee for Inheritance Tax Return
2. Filing Fee for Inventory
3. Addition Probate Fees
$15.00
$10.00
$70.00
Kindly file the same and return the time stamped copies.
Should you have any questions, please do not hesitate to contact my
office.
JRZ:tl
Enclosure
cc: M. Daniel Katkocin, Executor
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BUREAU OF INDIVIDUAL TAXBS
DBPARTMENT 280601
DARRISBURG, PA 17120-0601
July 17, 1995
MR M D KATKOCIN
207 MAPLE AVE
CAMP IIILL PA 17011
Dear Mr. Katkocinl
Rei Estate of Michsel D. Katkocin
File No.1 2194-0896
This is in response to your request for an extension to file
the Inheritance Tax Return for the above-referenced estate.
In accordance with Section 2136(d) of the Inheritsnce and
Estate Tax Act 255 of 1982, the time for filing the return is extended
for an additional period of six (6) months. This extension will avoid
the imposition of a penalty for failure to mske a timely return.
lIowever, it does not prevent interest from accruing on any tax remain-
ing unpaid after the delinquent date.
The return must be filed with the Register of Wills on or
before January 8, 1996. Because Section 2136(d) of the 1982 Act
allows for only one extra period of six (6) months, no additional
extension(s) will be granted that would exceed the maximum time
permitted.
..
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JOHN R. 7.0NARIOH
ANNA MAnlE SOSBONCI
THOMAS R, MillER
SKARlATOS & ZONARICH
ATTORNEYS AT LAW
204 STATE STREET
HARRISBURG. PENNBYLVANIA 17101
(717)233.1000
FAX (717)233.8740
STUlTON OFPIOE
MECHANICS S & L BUILDING
51 SOUTH PRONT STREn
snELTON. PENNSVlVANIA '71"
(717) B.B.8311
ANClElO SKARlATOS (1000'18'1)
December 20, 1994
Office of Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Michael D. Katkocln
No. 1994-00B96
PA No. 2194-0696
Date of Death: October B, 1994 .,
Social Security No. 191.144734
Dear Sir/Madam:
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Enclosed please flnd Estate check number 01 B In the amount of $23,000.00
representing an estimated payment toward the Inheritance taxes In the above-referenced
Estate. The formal Inheritance Tax Return and Inventory will be flied with the Register
of Wills at a later date. Please provide me with a receipt of payment In the self-
addressed, stamped envelope I have enclosed.
Thank you for your attention to this matter.
Sincerely,
O&'~_I #.11C/.II-c%e
~~n R. Zonarlch
JRZ/lad
Enclosure
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STATUS REPORT UNDER RULE 6.12
Name of Decedent:
MICHAEL D. KATKOCIN
Date of Death: 10/8/94
Will No.
1994-00896
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d.
approvals of formal or informal
Cerk of the Orphans' Court and
Date: 9/8/99
-' ~ :
204 State Street
Address
Harrisburg, PA 17101
( 717) 233-1000
Tel. No.
Capacity:
X
Personal Representative
Counsel for personal
representative
(KAH: rmf/AM3)