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OATil 0.' IJI':HSONAL IUWlmSENTATIVE
COMMONWEALTH m' I'ENNSYLV ANIA
COUNTY 0.' cm\l3ERLAND
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The petitioner!s) above. named swear!s) or affirm(s) tlllll the
statemenls in the foregoing petition are lrue and correCllo the besl
of the knowledge and belief of pelitioner!s) and thlll as personal
representative!s) of the above decedent pelitioner!s) will wcll nnd
truly adminisler the estatc according 10 ~aw. n "
affirme~ nnd subscnbcd A t i 7 /iqlo
.\7 L day of
19 C 1/.:;' ~
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Estate of
ALBERT J. TEZAK
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW MAY 30 19~. in considcration of the petition on
the reverse side hereof. satisfactory prpof having becp presenled before me.
IT IS DECREED that PatrJ.cJ.a A. RreJ. tzer
islare entitled to Letters of Administration. and in accord with soch finding. Letters of Administration
are hereby granled to patricia A. Kreitzer
in the estate of Albert J. Tezak
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FEES
Lettcrs of Administration ..... S 80 .00
ShortCertificates(6) .......... S 18.00
Renunciation ................ S
JCP S 5.00
TOTAL _ S 103.00
Filed .....~~Y..~Q...l.~~!i.. A.D. 19_
Richard A. Cairo, 27733
3501
.,rrORNEY ISUp. Cl. I.D. No.)
Hawthorne Dr., Camp
ADDRESS
Hill, PA
17011
717-238-04231 717-737-2684
PHONE
Mailed letters and order to Administatrix on 5-31-96.
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COMMONWEALTH OF PENNSYLVANIA. OEPAAUIENT OF HEALTH. VITAL AECORDS
CERTIFICATE OF DEATH
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71 Old Pioneer Rd.. Hill, PA 1701l
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.Gate of Heaven Cemetery r Allen
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18 Walnut Lane
camp Hill, PA 17011
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Frank Tezak
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RECAPITULATION
Allpralaed value of Personal property ..................................................................... 11.tJ',3'1'Y';'Z3
Allpraleed value of leal ostalll ............................................................................... 16.o.,.QOO...o.O
Total appraised value .......................................................................................... '7{l.,.;l"':J':'c~
AFFIDAVIT OF PERSONAL REPRESENTATIVE
Cumb
County 01 !/lKIj>l\iR ..:
Patri~ia!\ Urp;j;?pr
............................................. ~...J:.I.ht. .1...."...........................................................................
Execut
Administrat rix of the Estate oc......Albcr.t...J.....:r.o.za.k..............................................................
dcswM!ln beinJl: duly........I?W.Q.r.n.............................................. according to law. de~se and say that the
items appearing in the Inventory include all of the pcrsonal assets wherever situate and aU 01 the
rcal estate in the Commonwealth of Pennsylvania of said decedent; that the valuation placed opposite
e3ch item of said Inventory represents its fair value as of the date of the decedent's death; and that
decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears
in a ~~or3ndom ::.>~e end of the Inventory. ;' ) . a~' . -
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e ~ me t IS.........{........ ..............., Y 0 Jl:XOC1IlDr . Adll11Jl11tralDr
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M (;orl'misSlOf1 E>\>'os Dc"" 28,19,,' TR CTI
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1. An I ~~~&'In three IIlOntha atlOI' appoIntment of penonal ..p....nla&l...
Z. A. ,npplementallnTlDlD1'7 mOlt be Gled w11h1n lh1rt7 doT" 01 dl,coTl1'7 01 addlUonal ....It.
3. AddlUonal oheeta 1I1l1 be etUChed U lD penonaltT or rea1l1.
.. See ArtIcle lV. nd.ctart.. Act 01 1M..
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IN\'EN'ffllW,Ef81'1iijw. AND PERSONAL ESTATE
In lIJr -.un- of lIJr &ta1t Df.......J).!.l?.9.rJ...~.....:m.'t.<;t.~....................,..................
. cumberland
late OIl,QWOIO..A.1.LQn..'Vownlih.i.P...................JD the County ol~~\'An, State 01 Penna., decQKd.
JaandarV 01 the real and perlOnal estate which were 01 the above-named
............................................................................................... deceased. Taken and appraised
the ...3'1.9\:....... day 01 ....J.\l.l.y.................19 96. (Date 01 death .~.l.1.~.I.~~............)
1. House _ 18 Waln4t Lane, Lower Allen TWp.,
cumberland county, PA
$60,0 0.0 atsa1e
2. PNC Checking Account #5140063866 DaD Value
$10,3 7.2
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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boing duly " (, , ___ according 10 law, dopo.o. and .ay. that .,ho
, i (i , !' iJ.,~i~~-.:..,~---~,--- of tho E.tato of ,:", I ! '; ,. ! II :'.
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la~o :f.-,- ..'" ,l,l, :L(.', /",. , ,p .,' ------:--T--:--: ;umborland County, Pa:, doc~..~od and th~! ,th~,
w,th,n" an ,nvonlory mado by i; L1 (" ' / c.'-'-'- .l.__. tho n,d ., , ,1\" (1'(';1
of Iho onlilo o"alo of .aid docodonl, con.isting of all tho po..onal prop.r1y and ,oal ..Ialo, o.copt roal ."al. ouhlde
Iho Commonwoallh of Ponn.ylvania, and that Iho Ciguro. oppo.ilo each itom of Iho Invontory ropr..onl It's fair value
as of tho dalo of docodenl'. dealh.
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and subscribod boforo me,
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C L~I,\ {)r;;rdln Notary PublIC
~mp ,UI Ooro. Cu" berland Co
;1 CommlS>lon E'pires July 20. ~~
~.Pllnn..~"""'lClalionolNnl_
Month
Addr."
Hay 19. 1996
O.Ie of Doath
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INSTRUCTIONS
I. An invontory mu.t bo filod within three monlhs afler appoinlmont of porsonal ropresentative.
2. A supplement invenlory mu.I be filod within Ihirty day. of discovery of additional a..ots.
3. Additional sheets may bo attachod a. to personalty or roally
4. Soe ArticlolV, Fiduciarios Act of 1949.
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Invontory 01 Iho lUal amI pomonal uslatu ut
Albert .1. Tezllk
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I. Real property located nt 18 Walnut I.ane enml' 11\11. I'A 17011
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CERTIFICATION OF NOTICE UNDER RULE 5.6(al
Name of Decedent:
Albert J. Tezak
Date of Death: MAY 1Q. 1QQ/;
Will No. :z::;.~,\-It:,-/f-- Admin. No. 199(j 0012(j
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the. Orphans , Court Rules was served on or mailed to
the following beneficiaries of the above-captioned estate on
.JUR9 5, 199B
:
Address
Name
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Patricia A. Kreitzer
71 Old pioneer Road Cam Hill PA 17011
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Date: June 5, 1996
Name Richard A. Cairo
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Address 3501 Hawthorne Drive
Camp Hill, pa 17011-2721
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Telephone(711 737-2684
W_238-0423 .
Capacity: personal ~epresentatJ.ve
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Counsel for personal
representative
FAMILY SETTLEMENT AGREEMENT ANI> FINAL RELEASE
OF HEms OF ALBEIH .J. TEZAK
ESTATE NO. 19%-1111426, CUMUERLANI> COUNTY, PENNSYLVANIA
KNOW Al.l. MEN BY TilESI' PRESENTS TIIAT WIIEREAS Albcr! J. Tczak. latc of
18 Walnut l.anc. Camp lIill. (l.owcr Allcn Township. Cumbcrland County). Pcnnsylvania.
dcccascd dicd intcstatc on May 19. 1996: and
WIIEREAS. on May 24. 1996. Icllcrs of adminislrution wcrc issucd 10 Patricia A.
Krcitzcr, thc dcccdcnt's daughtcr. by thc Rcgistcr of Wills of Cumbcrland County. Pcnnsylvania:
and
WHEREAS. thc dcccdcnt's wife Anna tvl. Tezak. predeecnscd the dcccdcnt on June 3.
1989. thereby leaving his only child Patricia A. Krcitzer as his sole hcir under thc intestate laws
of the Commonwealth of Pennsylvania: and
WHEREAS. the said Patricia A. Kreitzer. administrutrix. wishes 10 account lor and
distribute the remaining assets of the estate: and
WHEREAS, certain debts. funeral expenses and costs of administrution. including
Pennsylvania Inheritance Tax amounl to $21.356.93 leaving a balance lor distribution of
$49,425.80. as indicated in the allaehed accounting marked Exhibil A.
NOW THEREFORE KNOW YE TI IAT l.Patricia A. Kreitzer. the sole bcneticiary of the
said estate under the said intestate laws. do hereby acknowledge thaI I have this day received
from the aforesaid administralrix. in full satislaction and paymenl of all sum or sums of money.
legacies. bequests. and devises as arc due me as of the date of this inslrument under the said
intestate laws, which mnounl I have received and which is set opposile my name in (he table and
schedule of distribution in said statement allaehed hereto and marked Exhibit A.
AND I hereby stipulate thm in order to avoid thc expcnse and time involved in the tiling
of a formal account and schedule of distribution. I agrec and do consent to distribution being
made without the tiling of an account and schedule of distribution. thc samc to bc with the same
force and cflcct as if they had been Ii\ed and eontirmed by the Orphans' Courl Division of Ihe
Court of Common Pleas of Cumberland County. Pcnnsylvania:
TIIEREFORE. I do hereby remisc. release. quitclaim and lilrevcr discharge the said
Patricia A. Kreitzer. administratrix alilresaid. her heirs. executors. administrutors and assigns. of
and from the said estate and Irmn all actions. suits. paymcnts. accounts. reckonings. claims and
PRINCIPAl. CREDITS
Thc Accountanls claim crcditlilr thc lilllnwing:
I. Burial and Funcrnl. Wicdcman Funcrnlllomc
$6,236.75
2. A.II. Rilzman X-Rays
$64.15
3. Intcrnists ofCcntrnlPa. (4 visits)
$274.07
4. Harrisburg Gastrocnlcrology
$112.37
5. Scars Charge
$4.117.91
6. Death Cerlilieatcs
$15.00
7. Allorncy Fcc I'aid Rcagcr & Adlcr for Filing Firstlnh. Tx Rclurn
$210.00
8. Advcrtising Granl of Lcllcrs Tcstntncntary
$119.50
9. Probalc Fecs to Rcgistcr of Wills
$93.00
10. Filing oflnv..lnhcr. Tx. & Family Sclllcmcnl Agrccmcnt
$67.00
1I.I'Iousc Mainlcnancc Costs up unlil salc
A.I'I'&L
B. I'a-Am Watcr Co.
C. Bcll Atlanlie/ATT
D. UGI (makcup bill)
$22.07
$20.87
$26.43
$398.42
12. Expcnscs relatcd 10 Ihc salc of Rcal Estatc
A. Sclllcmcnl Fcc Mid-Stalc Abstract Co.
B. Rcalty Transfcr Tax
C. NOlary Fcc
D. Rcal Estatc Commission
$35.00
$600.00
$5.00
$2.400.00
13. Emcrgcney Mcdical Call (ambulenee)
$65.41
14. I' A State Ineomc Tax Balancc for 1996
15. I' A Stalc Inhcritanee Tax
$15.00 (cst)
$3.403.77
16. Associated Cardiologists
$34.11
17. I'NC Chargc Card
$3,005.10
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Ill. Mculs un Whcels
$16.00
TOTAL PRINCIPAL CREDITS
$21.356.93
SUMMARY
TOTAL DEBITS
TOTAL CREDITS
$70,7112.73
$21.356.93
BALANCE FOR DISTRIBUTION
$49,425.110
SCHEDULE OF DISTRIBUTION
I'alriciu A. KrciJzcr
$49,425.80
Ihus cxhausling Ihc funds uvailublc for dislribulion.
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\ \'OR DAtU 0' DIAtH AnlR 12131191 CHICK HUI
INHERITANCE TAX RETURN ~tv::~yU~:~DIfISCLA!M~D.Lt, -'
RESIDENT DECEDENT IILl NUM81R
COMMONW(A"H 01 P!NNSYlVAN,. (TO BE FILED IN DUPLICATE J, J I 'I'/~ tf 2. (..
OE...~~~W~.:,\vENUE WITH REGISTER OF WILLS) -
..H~"'S'U'G, PA-,,\lOOM. , , COUNIY COOl YEAR NUMBER
Olel O,H' S HAMlI">! ...>!, AHO M'OO" "",.." OlelO"" "0."'" ADO""
TEZAK. AI.lIERT J. 1 B \~AI.NUT I.ANE
'OC..""URO" HU.'" 0.-"-01"'."".' 1'"'' 0""'''.'' CAN\' Hll.l., \'A 17011
179-12-5970 5/19/% 1".L 1'/26J.2.2_,,,~."~I(CU~.1IlERl,~NIL,,,,--
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Supplemenlol Relurn [.1 3. Remainder Return
. (lor dal.. 01 death prior 10 12.13.82)
[J 5 Federal hlol. Tall Relurn Required
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[] 40. future lnleunl Compromi\.,
(for dalfl' 01 deolh alte, 12.' 2.82)
06, Decedent Died Te,tolt 0 7. Decedenl Maintained 0 living Trul'
(Alloch copy of Will) (Anoth copy 01 Tru\l)
AU CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
NA.M( (OM'Ul( MAIliNG "'OD~H!.I
Uline \9 is greater Ikon line lB, enler the difference on line 20. This is the OVERPAYMENT.
a 0 ,tI:r.n"iT,u..laTI.ll..U'. (<I.lll.1 tlhI~...(,J rtr.r.n..TI.llI....'j.'Utl.:l..ul.1I1
If line 18 is greater Ihon line 19, enter the difference on line 21. 1hi, is the TAX DUE.
A. Enler the interest on the balance due on line 21A.
9. Enler the loto1 of line 21 and '2' A on line 218. 1his is the BALANCE DUE.
Make Check Payable to: Regllter 0' Will" Agent
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Original Return
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~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~
Unde, penoltie. 01 pe'iury. I d.c1o,e ,ho' 1 ho,e e,omin.d ,hi. reTurn. including o(Componying "h.d,'.. and "o"m.nll, and 'a ,h. b.., 01 my Inowl.dg. and b.liel.
i, i. I,ue. c""ee' and campi.", I declo,e ,ho' oil real ..'o'e ho. been repo,.ed a' ,,,. mOlle' ,a,,, Dee'o,o.ion 01 p..po,,' o,he, ,hon ,he p.Ilonnl represen.o'i,. i.
based qn 011 information a' which preparer has any knowledge.
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1. Real E.'o'e ISchedule Al
2, S'och and Bond. ISchedule BI
3. Closely Held Stock/Partnership Inle"" (Schedule C)
4. Mortgog" and NOI'S Receivoble (Schedule 0)
5. Cosh, Bank DeposiU & Misc.llane':)uI Personal Properly
ISchedule EI
6. Joinlly Owned Property (Schedule f)
7, T ,on..e.. (Schedule G) (Sch.du'e II
8. Tolal Gran Au.11 (lalollio" ,.7)
9. Funeral Expenses, Administrative COS11, Mi".lIoneoul
bpen.., (Schedule HI
10. Debh, Mortgage liabilities, liens (Schedule I)
11. Total Oeduction. (Ialollio" 9 & 10)
12. Net Value of eslote (line 8 minus line 11)
13. Charitable C1nd Governmental B_quells (Schedule J)
\4. Net Value Subject to ToJt (line 12 minus line 131
Spousol Tron"en (for dole. of death ohe, 6.30.94)
See Instructions for Applicable Percenlag' on Reverse
Side. (Include values ham Sc:hedule K or Sc:hedule M.l
Amount of line 14 laltable al 6% role
(Indude values from Schedule K or Schedule M.l
Amounl 0' line 14 taltable ot 15% role
(Indude values hom Schedule K or Sthedule M.)
Printipaltalt due (Add talt from lines 15. 16 ond 17.)
Credils Spousal Poverty Credil Prior PoymenlS
+
15,
16,
17.
z
..
~ lB,
... lQ,
=
..
:E
..
u
>< 20,
..
...
21.
(i
.----A6oilE~--.- ..'
,l J] /
_8. Tolol Number 01 Sale Deposit80U1
71 01.0 I'lONI'ER ROAD
CAI'Il' IlILL, PA 17011
(II ,,$&OJ~OOOJ.oO---
(2)
(31
(41
( 51
(61
(7)
(S) .JJill.. 000 . 00
(Q I _.2J 000 .0_0
(10)
(11) .--3...000...ll0
(121
1131
(141 .-liL,,000. 00
(151 ,----,-~,-)(,-.=
(16) .,iI.,D.QQ ,,,OO,.__~,-,)( ,06 = _3,-"-2.0,.00
(17) ~_~__.__..,"'----,,)( ,15 =
-------.-
(I B)
. ------.---
+
Diltounl
17 I. 00
Inleresl
._J 71..!- QO"
-~-----
(lQ)
120)
- -------------.--- ------.----
(21)
(2IAI
(21B)
3.249.00 -,..- ,,,,,,-,.
3,249.00~
3 J 249 .00__.
(
)I! I;:
rAlr
/
'/ '. r.,
~_ . /t.I'
I .' .,i.J / _":' i .
j)~, .,"-':',ll/'ol ,(C" p",.l1 IN /1.'.'(
'!
",
COMMOUWIAUtt Of PUHWI'lVU.jIA
IUHUnAUCf lU IlUUIlU
_ __ IlnlD~N!...D(C(DINl
ESTATE OF
-.
1111"111'.1'''1
--,-. -..."""....
.
\ SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
, MISCELLANEOUS EXPENSES
L ..,... P,.' .. T",
FILE NUMBER
2-/- ,')V . o1/z0
A I hut 'J j~]Jd,
AMOUNT
DESCRIPTION
ITEM
NUMBER
A. Funeral Expenus:
I.
B.
1.
Administrative Costs:
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Atiorney Fees
City
4. Probate Fees
C. Miscellaneous Expenses:
1. REAL ESTATE COHl'IlSSI0N
2. REAL ESTATE TRANSFER TAX
3.
4.
5.
6.
7.
8.
3.
Family Exemption
Claimant
Address of Claimant at decedent's death
Street Address
Relationship
Stote Zip Code
$2,400.00
600.00
TOTAL (Also enler on line 9. Recapitulation)
(If mare space Is needed, lnse,t additional shee" of same size.)
S 3.000.00
t/'
~'l/
/-' ) _ //A. -,'j
REV-1547 EX AFP 112-951 ~ i
CO""ONW( AllIl or III HNS'f'1 VMHA ~ I ACN 101
CU)AA'MINT Of NPJIHUI ~ . L NOTICE OF INtlERITANCE TAK I
BUN(AU 01 INDivIDUAL IAXLS ;.... ~.. .'"1 APPRAISEHENT, ALLOWANCE OR DISALLOWANCE,
~~:~is~~:~:'", '''''-'10'' ,.. OF DEDUCTIONS AND ASSESSMENT OF fAX I DATE 08-05-96
ES'TAiEiiF-~YEiAC~c~-~~=--AC8tRt' -~=:r=~~==o- ,-=~~= =~~~=FILE~N-O:~----- 21=96':' 0426--
DATE OF DEATH 05-19-96 COUNTY CUMBERLAND
NOTE: TD INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORrlON OF THIS FORM WlrH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
PATRICIA KREITZER
71 OLD PIONEER RD
CAMP HILL PA 17011
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
Anount Re"itt.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
iifli: iS4TE;C-AF:jo- -iiF 9S"I -NoYicE - -OF niNti EiiiTAiicE-Y Ii X -APPRA is EHE'Nr-,--m.-OwA'N-CE-ijli-mnum - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TEZAK ALBERT J FILE NO. 21 96-0426 ACN 101 DATE 08-05-96
TAX RETURN WAS: I X I ACCEPTED AS FILEO
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.al Estat. (Schedule A) 11)
2. Stocks and Bonds CSchadule OJ C2J
3. Closely Held stock/Partnership Interest ISchedule CI (31
4. Hortg.ges/Notes Receivable (Schedule D) (4J
S. CashlBank Deposits/Hisc. Personal Property (Schedule E) (51
&. Jointly Owned Property (Schedule f) (&)
7. Transfers (Schedule GI (7'
8. Total Assets
60,000.00
.00
.00
.00
.00
.00
.00
IB)
60,000.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funerel Expenses/Ada. Costs/Hisc. Expenses (Schedule HI (9)
10. Debts/Hortgege Liabilities/Liens (Schedule II CI0)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governaental aequests (Schedul. J)
14. Net Velue of Estet. Subject to Tax
3,000.00
,00
IIlI
1121
1131
114)
3.000 00
57,000.00
.00
57,000.00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 and IB will
reflect figures that include the total of ill returns assessed to date.
ASSESSMENT OF TAX:
15. Aaount of Line 14 at Spousal rate liS) .00 X .00= .00
1&. Allount of Line 14 taxable at Lineal/Class A rate 11&1 57,000.00 X .06= 3,420.00
17. Allount of Line 14 taxable at Collateral/Cless a rate 1171 .00 X .15= .00
18. Principal Tax Due lIel 3,420.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT 1'1 AMOUNT PAID
DATE NUMBER INTEREST I-I
06-25-96 AA1I2973 171. 00 3,249.00
I TOTAL TAX CREDIT I
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
3,420.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIDNAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, ND PAYMENT IS REQUIREO.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU MAY eE DUE
A REFUNO. SEE REVERSE SIDE OF THIS FDRM FDR INSTRUCTIONS. I
RESERYATlOH:
PURPOSE OF
HOTICE:
PAV"EHh
REFUHD (CR J :
OBJECTIONS:
AD"IN
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENal TV:
INTEREST:
;........J
(,t
r,
!..(".
I
,=~
,
','L_
'2t:
.,'\
~'.
"I
0U
Estata. of dacadants dying on or bafore Oacaabar Il, 1981 -- if any future Intarast In tha a.tata I. transfarred
in possassion or anJoyaant to Cla.s B lcollnterall beneficiaries of the decedent after the expiration of any estate
life or for year., the Co..onwaalth hereby expressly reser~es tha right to appraise and as.ess trans far Inheritance
at the lawful Class B (collateral I rat. on any such future Intarast.
I.,
Taxes
To fulfill the require.ants of Sactlon ll40 of the Inharitance and Estate Tax Act, Act Zl of 1991. 7Z P.S.
Section ZI"'O.
Detach the top portion of thl. Hotlce and sub.it with your paYRMnt to the Register of Wills printad on the re~orse side.
--"ake check or ..onoy ordu. payabh to: REGISTER OF MILLS, AGENT
Ail pay..onts recel~ed shall first bo applied to Dny Intarest which ..ay be due with any re..alnder applied to the tax.
A r.fund of a tax credit, which was not requestod on the Tax Return, Ray be requosted by co.pletlng an "Application
for Rofund of Ponnsylvanla Inheritance and E.tate Tax" fREY-IlllJ. Applications are available at the Office
of the Regl.ter of Wills. any of the II Re~enu. District Offices. or by calling tha spacial Z4-hour
answering s.rvlce nu..bers for for.s ordering: In P.nnsylvanla 1-800-l6l-Z0S0. outside PennSYlvania and
within local HarriSburg area (1171 781-8094, TOOl (1111 17Z-lZSl (Hearing I.paired Only).
Any party in Interest not satisfied with the ftpprals....nt, allowance or disallowance of dOductions, or allo.s.ont
of tax (Including dllcount or Int.r.st) as shown on this Hotlce ..ust obJact within sixty (601 days of r.celpt of
this Hotlce by:
--written prote.t to the PA Depart..ent of Revenue, Board of App.als, O.pt. 1610ll, HarriSburg, PA 17IZ8-10ZI, OR
--alection to have the Ratter detar.ined at audit of the account of the personal representatl~e. OR
--appeal to the Orphans' Court.
factual errors dlsco~ered on this assess.ent should be addressed in writing to: PA Dopart.ent of Re~anue.
Bureau of Individual Taxas, ATTH: Post Assessaont Revilllw Unit, nopt. Z80601. Ilarrhburg, PA l1lZ8-0601
Phone (717) 181-6SDS. See pag. 5 of the booklet "Instructions for Inharltanca Tax Return for a Ralldont
Decedent" (REY-1S0I) for an explanation of ad.inlltratlvely correctable .rror..
If any tax due Is paid within thrae III calendar Ronths aftar tha dacedent', daath. a fiva parcent ISX) discount of
the tax paid I, allowad.
The ISX tax aanosty non-participation penalty I. co.putad on the total of the tax and Interest a.,essod, and not
paid before January 18, 1996. the first day aftar the end of the tax a..nesty periOd. This non' participation
penalty Is appealable In the ,a.a ..anner and in the tho sa..e tl.e parlOd as you would appaal the tax and Intara,t
that has bean assas,ed as Indicated on thl, notice.
Interest Is charged baglnnlng with first day of d.llnquancy. or nln. (9) Ronth, and one (1) day fro.. the date of
death. to the date of pav.ent. Ta.., which beca..e dellnquant before January I. 198Z bear Interest at the rate of
six 16XI percant par annu. calculated at n daily rate of .000164. All taxa' which beca.e delinquent on and after
January I, 1961 will bear Int.rest at a rate which will vary fro. calondar yaar to calendar year with that rate
announced by the PA Dopart..nt of Revenue. the applicnb~e Interest rates for 198Z through 1996 are:
'!!!! Intor.st Rate Dally tnterut fllctor ~ Int.rest Rnte Onlly Inlar..t rnctor
1981 lO:t. .00DS...6 1981 97. .000l...,
1985 16X .000458 1988-1991 llX .000501
1984 llX .000501 199Z .% . 000~47
1965 n:c ,DDDSS6 1995-1994 7:t. .000191
1986 lOX .000214 1995'1996 .% .DDOZ41
--Inlar..t I. calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlce issued after the tax becoftol dallnquont will reflect an Interest calculation to flftaen tl~) days
boyond the date of the ass.ss.ent. If pay.ent Is aade after the Intorest co..putatlon date shown on tho
Hotlce. additional Interest aust be calculatad.
.. .-
~'"' I
PAvt€NTr
OtitKh the top portion of thh Hatlc. and Malt ldth your pa.,..,t .... peymla to the n-. end addr...
prlnt.d on t~ ravar.. .I~.
If RESIDEHT DECEDEHT ... ch8c:k or .....y ar~r paym)a tal REGISTER OF WILLS, AGENT.
If HQH-RESIDOfT DECEDEHT .... chKk or 80My order p.yabl. tor Cottf10NWEALTH OF PEflrCSVLVAHIA.
All p.pant. ncelv.d lhell be 8PP1I.d flr.t to MY Int.rut whIch IlIIY be due with .,y r_lnder 1IPP11.d to the tax.
REFUID (CAh A rafW'd of a tax credit, which we. not reque.t.d on the Tax Rdurn, aay tMI reque.ted by cDllPI.tlng .,
-application for Refund of Penn.ylvanl. Inherltanc. and E.t.t. Tax- (R[V.1511). application. .r. ~IIBbla at
the Offlca of t~ Regl.ter of WIll., .,y of the Z] R.venue Ol.trlct Offlc.. or froe t~ o.pertlant's l'.hour
.,....rlna ..rvlca nuabar. far far.s orderlngl In Penn.ylvanl. 1.100.56Z.Z050, outsIde penn'ylvanla
and within local HarrIsburg ar.. (717) 717.1094, fDO. (717) 77Z.ZZSl IHearlng lap.lr.d only).
REPLY TOI Quutlon. regarding arror. contelned on this notice should tMI eddra..ad tal PA o.partNnt of Revenue, Bur.....
of Individual Te..., ATfNl Pa.t A....seent Ravl... unit, Dept. Z80601, Harrllburg, PA 171ZI.0601, phone
(717) 717.6505.
DISCOlMT I
If My to: due II paid within thr.. (]) calendar ..nth. aftar the dltcadanP. death, a flv. parc....t (5%) dl~t
of the to: paid II allowed.
PENALTYI
The 15% tax ...,..ty non-participation peNlty Is COllPUt.d on the tot.l of the tax and Intsr..t .....Md, and not
p.ld tMlfara January 18, 1996, the flr.t day aftar the and of the tax aana.ty period.
INTEREST:
Inter..t II charged beglmlng with flr.t day of dal1~y, or nine (9) ..nth. end ana (1) ay frCMI the dBta of
death, to the data of paY8lftt. Taxa. which bee... delinquent tMlfure January 1, 198Z bear Int.ra.t at the rata of
,Ix (6A:) pareent par IIIY1l.W calculat.d at a daUy rata of .000164. All texe. which bee... dall~t on and efter
January I, 1912 will baar Intera.t et a rat. which will vary froe calandar y.er to calendar year wIth that rat.
announc.d by the PA GapertNnt of Revenue. The appllcebl. Intare.t rata. far 191Z through 1996 ar'l
Veer Intar..t Ret. DailY Intara.t Fector
Vear
Interaat Rata
Dally Intera.t Fector
1912 lOX .000548 1987 'X .000l"
I... lOX .000"31 1961-1991 In .000501
19" IlX .000501 1992 'X .000l"
1915 lSX .000556 1995-1994 n .00019Z
\9" lOX .000l" 1995-1996 .~ .000Z"7
ulnter..t Is calculatact II follOM.r
INTEREST .. BALANCE OF TAX UNPAID X HUKBER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
..Any Hotlc. I.~ .'tar the tax ~. delinquent will r.,lect ~ Inter..t calculatIon to fl,teen (15) day.
tMyond tM dIIt. of tM ........"t. If pa.,..,t Is Ada aft.r tM Intar..t COIlPUt.tlon dBta Ihown on tM
Hotlce, additional Intare.t ...,It be calculated.
....
r~) l,;, 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHlRIIAHC[ lAIt DIVISION
D{PI. laOttOl
ItAAAISIURC. PI. 111l1'0601
(,/
NOTICE OF INNERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
PATRICIA A KREITZER
71 OLD PIONEER RD
CAMP HILL PA
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11011
06-03-97
TEZAK
05-19-96
21 96-0426
CUMBERLAND
101
A~ount R8nltt.d
*'
..,.IUI II a" 111,'"
ALBERT
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
iiE'v:i54'i-EiCAFP-ioJ':97Y-iiii'ficE""ein-NHEifii'ilNCE-''fAit'A-pjiRAisEHEii'i'-,--.\i.i.-owilNCE-iflium---m------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TEZAK ALBERT J FILE NO. 21 96-0426 ACN 101 DATE 06-03-97
TAX RETURN WAS: ( I ACCEPTED AS FILED ( Xl CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL
1. R..I est.t. (Schedule A)
2. Stockl and Bonds (Schedule 8)
3. Closely Held stock/Partnership Inter..t (Schedule C)
4. Hortg.ges/Note. Receivabl_ (Schedule DJ
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule EI
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule GJ
8. Total Assets
RETURN
III
(21
131
(4)
(51
1&1
(7)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adn. Costs/Hisc. Expense. (Schedule HI (91
10. Debts/Hortgag. Liabilitias/Liens (Schedula I) (10)
11. Totel Deductions
12. Nat Valua of Tax Return
13. Charitable/Governnental aequests ISchedule J)
14. Net Value of Estate Subject to Tax
NO. 01
.00
.00
.00
.00
10.782.73
,00
900.00
(81
9,850.62
8.102.54
1111
1121
1131
1141
NOTE: To insure proper
credit to your account,
subnit the upper portion
of this forn with your
tax paynent.
11.682.73
17.9~~ H
6,270.43-
.00
50,729.57
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of abh returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Lin. 14 .t Spousal rat. (15)
16. Anount of Line 14 taxable at Lin..l/Class A rate (16)
17. Anount of Line 14 taxable at Collat.ral/Class a rat. (17)
la. Principal Tax Due
NOTE:
TAX CREDITS:
PAYMENT
DATE
06-25-96
10-08-96
RECEIPT
NUMBER
AA1l2973
AA146831
DISCOUNT ('1
INTEREST/PEN PAID (-)
152.19
.00
.00 X .00=
50,729.57 x, 06=
.00 X .15=
I1BI
AMOUNT PAID
3,249.00
154.77
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
3,043.77
.00
3,043.77
3,555.96
512.19CR
.00
512.19CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFlECTED AS A "CREDIT" (CRI, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
RESERYATION: E.tsts. 0' d.e.d.nt. dying on or b,'or. O.e..b.r 12, 1982 .. If any 'utur. Int.r..t In the ..tat. Is ttansf.rt.d
In po.....lan or .nJovs.nt to Cis.. I (collet.tal) b.neflelsrl.s 0' the d.e.d.nt .,t.t the ..plratlon of any ..tat. 'at
II" at 'or y.er., the Co..anw..lth herebv a.pr..sly r...rve. the tight to appr.I.. and .....s tran.f.r Inh.rltanc. TI..'
.t the lew'ul Cle.. I leollat.rsl) rsta on anv .uch 'utur. Int.r..t.
PURPOSE OF
HOTlCE.
To 'ul'III the r.qulra..nt. of S.ctlon ZI~O 0' the Inh.rltance and E.tete T.. Act, Act 21 0' 1995. 172 P.S.
S.ctlon 91~01.
PAYrtEHT:
D.tsch the top portion of this Notlc. and .ubslt with your pev..nt to the R.gl.t.r 0' Will. prlnt.d on the r.v.r.. slda.
..Mek. ch.ck or lon.v ord.t pevebl. to: REGISTER OF MILLS, AGENT
REFLICD ICA):
A r.fund 0' a tax cr.dlt, which we. not raqu.st.d on the Te. R.turn, .ev ba raqua.t.d bv co.pl.tlng an "Appllcstlon
'or R.fund 0' pann.vlvanl. Inherltanca and [.tsta Te." IREY.13131. Applle.tlon. ar. .vell.bl. et the O'flc.
of the Regl.t.r of will., any 0' the 23 R'v,nue DI.trlct Offlc.', or bv c.lllng the .p.clel 2'.hour
an.w.rlng ..rvlc. nUBb.r. for 'or.. ord.rlng: In p.nn.vlv.nla 1.800.36Z.Z050, out. Ide P.nn.vlvanle end
within local Harrisburg .rea (1111 781"809~, 100. 17111 712-2252 Ul.erlng I.p.lnd OnIYI.
OBJECTIONS:
Anv p.rty In Int.r..t not ..tl.fl.d with the .ppr.I....nt, allowanca or dl.allowanc. of deduction., or a.......nt
of te. (Including dl.count or Int.r..tl .. .hown on this Notice .u.t obJ.ct within .Ixtv (60) d.v. of r.c.lpt of
thlt Notlc. by:
uwrltt.n prot"t to the PA DIP.rtllnt 0' R.v.nu., Bo.rd 0' App..Is, D.pt. 281021, t:arrlsburg, PA
...llctlon to h.v. the ..tter dltlr.ln.d .t .udlt of the .ccount of the p.r.on.1 r.pr...nt.tlve,
.-.pp..1 to thl Orphans' Court.
11128-1021,
DR
DR
ADHIN
ISTRATIYE
CORRECTIONS:
Factu.1 .rror. dl.cov.r.d on this ........nt .hould b. addrl...d In writing to: PA D.p.rt..nt 0' A.v.nu.,
Bur.au of Indlvldu.1 T...., A1TN: Po.t A.......nt R.vl.w Unit, O.pt. 280601, Harrl.burg, PA 11128.0601
Phon. (717) 781.6505. 5.. pag. 5 of the booklat "In.tructlon. for Inherltanc. Ts. R.turn for I A..ld.nt
O.c.d.nt" (REY.1501) for an ..plan.tlon of adslnlstratlvely corr.ctabl. .rrors.
DISCOUHT:
If env ta. due Is peld within thr.. (3) cal.nd.r .anth. .ft.r the dec.dant's deeth, . 'Iv. p.rcent (5~) discount 0'
the t.. p.ld I. ellow.d.
PENAL TV:
Th. 15~ t.. ean..ty non"p.rtlclpatlon p.naltv Is co.put.d on the total of the t.. and Int.r..t .......d, end not
paid b.for. January la, 1996, the flr.t dav aft.r the end of the t.. alnl.ty p.rlod. Thl. non.p.rtlclpatlon
penalty 1. app..labl. In the .... .ann.r end In the the .... tl.. p.rlod e. you would .pp.al the te. and Int.r..t
that h.. b.en e......d e. Indlcat.d on thl. notlc..
INTEREST:
Int.r..t I. ch.rg.d b.glnnlng with flr.t day of d.llnqu.ncy, or nln. (9)> .onth. and on. II) dav fro. the date 0'
d..th, to the d.t. of p.v.ent. T.... which b.ea.. d.llnquent b.for. Januarv I, 1982 bI.r Int.r..t at tho r.t. of
.1. (6~>> p.rcent per ennue calcul.t.d at . dally rat. of .0001~. All t.... which bec... delinquent on and efter
January I, 198Z will be.r Int.r..t at . rate which will v.ry fro. c.l.nd.r v..r to cel.ndar v.er with that rata
announced bv the PA O.part..nt of R.v.nue. fh. appllcabl. Intor..t rat.. for 19aZ through 1997 ar.:
!!!! Inter..t Aata Oalh Inter..t r"ctor !!!r Inter..t Alt. Oallv Inter..t fector
1982 lOX .Oaa5~a 1987 'X .0002U
19a3 16~ .000U8 1988.1991 11~ .000301
19ai\ 11~ .000301 1992 OX .Oao2U
nn U~ .Oaa356 1993.199' 7X .000192
1986 lOX .OaoZ7i\ 1995.1997 'X .OODlU
--Inter..t I. celculat.d .. folio....:
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
..Anv Notlc. I..ued eft.r the t.. beco... d.llnquent will t.fl.ct en Int.r..t calculetlon to flft.en (15) day.
bevond the date of the ........nt. If pav..nt I. .ade I't.r the Int.r..t cQlPutatlon dlt. .hown on the
Notlc., addltlon.1 Int.r..t au.t b. cllculattd.
" ...
1I'i'.WOII""1 9 l. ~
"i~.l"l\
a- ~~t1t:h
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
Dm,2B0601
HARRISBURG, PA 1712B,D601
DECEDENT'S NAME J
/-jJ,u f- J
.
INHERITANCE TAX
EXPLANATION
OF CHANGES
k.bLUL
filE NUMBER
j I '96 1J'l..,lt.
ACN
tli
SCHEDULE
ITEM
NO.
EXPLANATION OF CHANGES
d(!..t!'j-./L-C/ //{';t'~/I;L",t. i)cL/s V /IS.5f..15
TAX EXAMINER:U_D_._L...'L l '-,\,----JlG..'- ,,________ --' PAGE
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PAVOTr
D.tach the top portion of thl. Notlc. and .ub.lt with your paY..nt .ad. peyabl. 10 the na.. and addr...
prlnt.d on the rlv.r.. .Id..
If RESIDENT DECEDENT .ak. ch.ck or .on.y order pey8ble tOI REGISTER OF WILLS, AGENT.
If NON-RESIDEN' DECEDEH' .ake check or .only order payabl. tor COHHONWEALTH OF PENNSYLVANIA.
REFUND (CA)I A refund of a ta. credit, which we. not reque.ted on Ihe re. Relurn, .ay be requ..t.d by co~l.tlng an
-Application for R.fund of Penn,vlvanla Inh.rltanc. end Estet. Ta.- (REY-1313). ApplIcation. ar. avallabl. et
the OffICI of the R.gl.t.r of Will., any of the 23 R.v.nu. DI.trlct Dfflc.s or fro. the D.part..nt". 24-hour
answlrlng 'Irvlce nuab.r. for for.s ord.rlngl In P.nnsvlvanla 1-100-362-20~0, out.ld. P.nn,ylvanl.
end wlthJn loc.l Harrisburg ar.. (717) 717-1094, TOOl (717) 772-Z252 (Hearing lap.lred only).
REPLV ro: Qu.stlons r.glrdlng error. contained on thl. notice should b. .ddr....d tal PA D.part..nt of R.venu., Bureau
of Individual 'a.ls, A'TNr Po.t A....s.ant Review Unit, Dept. 210601, Harrl.burg, PA 171ZI-0601, phon.
(717) 7.7-6505.
DISCOUNT:
If any ta. due I. Plld within three (1) calendar .onth. .ft.r the dec.d.nt". d.ath, a flv. percent (5Z) dJscount
of the ta. paid I. allowed.
PEHALfY:
Th. IS~ ta. a~e.ty non-participation penalty I. coaputed on the total of the tax and Int.r..t .......d, and not
peld be for. Janulry 11, 1996, the flr.t day aft.r the .nd of the t.. aan..ty plrlOd.
INTEREST:
Int.re.t I. charg.d b.glnnlng with fJr.t day of delinquency, or nlnl (9) eonth. and on. (I) day fro. the data of
death, to the data of pay..nt. 'a.e. which b.ca.e dellnqu.nt b.for. January 1, 1'12 bear Int.re.t .t the rat. of
.1. (6Z) perc.nt p.r annul calculat.d at a dally rat. of .000164. All ta.e. whJch beca.. dellnqu.nt on and after
January I, 1'12 will b.ar Int.r..t at a rat. which will vary 'roe calendar Ylar to cal.ndar y.ar with that rat.
announc.d by the PA Depart..nt 0' Rlvanu.. rhe appllcabl. Inter..t rat.. for 1982 through 1997 ar.r
V.ar Inter..t Rat. Dally Int.r..t Factor
Vlltr
Inter... Rat.
Dally Int.r..t Factor
1912 2'~ .GOOS41 1917 .~ .000247
1983 lU .000438 1911-1991 lU .000301
1984 lU .000301 1992 .~ .000Z47
1915 t5X .000356 1993-1994 n .000192
1916 1'~ .000274 1995-11}97 .~ .000247
--Int.ra" I. calculat.d a. fOllow.r
INTEREST = BALANCE OF TAX UNPAIO X NUNBER OF DAYS DELINQUENT X DAILY I/ITEREST FACTOR
--Any Notlc. I"u.d a,t.r the ta. baco... d.llnquent will reflect an Intere.t calculation to fifteen (15) day.
b.yond the d.t. of the a.......nt. If pay..nt I. .ad. .ft.r the Int.re.t co.putatlon data .hown on the
Hotlc., additional Int.r..t au.t b. calculated.
AfV.!.SCQ (1:. {8,1I~1
...
~ ! Tezak, Albert J'j 18 Walnut Lane
~ :'OClAl\fCU"I"UMIfA iO'''O'OEAlH Camp Hill, PA 17011
S i 179-12-5970 5/19/96 lCo'""-Cumberland--'
~ 0 I, Original Relurn !(] 2. Supplemenlal Return 0 3.
~~'"
V~~ 10 0
",a.U 4. Limiled EUale 40. Future Inleresf Compromise
:00 , (for dOle. of dealh aker 12.12.821
V:U: I 0 6 0
Q. I . Decedent Died Teslale 7. Decedent Maintained 0 Living Trust
, ,--.<,...1 (Allach copy of WillI (Arrach copy of T,u.11
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
~! 1,;:::;,;~.Ci'A. K~:;t:ec~-~=l'~:~~:r;~::~~- ;;;;~ . - .----
V... I l ._,
-.----~.L7,lq.J.~76,1""7194 =C=.c__.c-.c... "".~==~'=_~~."'-==.=======~-==~ _-- ~ ~=,~~'.=
I 1. Real E.lale (Schedule A) ( 1) ~,$M..O 0 0 . 00
I 2, Slack. and Bond. (Schedule B) ( 2)
3. C1o.ely Held Slack/Partnership Inle,e" (Schedule CJ (3)
4. Mortgage. and NOle. Receivable (Schedule D) ( 41
5. Cash, Bank Deposits & Miscellaneous Personal Praperly( 5) $1 0, 782 .73
(Schedule E)
6, Joinlly Owned P,operty (Schedule FI
7. T,an.fers (Schedule G) (Schedule l)
8. TOlol Gron Assets (total lines 1.7)
9. Funerol expenses, Administrative Casu. Miscellaneous (9) $ 9. 8'5 Q ,:;;?
Expen.e. (Schedule HI
,
/10, Debl.. Mortgage liabilitie.. lien. (Schedule I)
11, TOlal Deduclion. (10101 line. 9 & 10)
,12. Nel Value of Estate (line 8 minus line 11)
I
/13. Charitable and Governmenlal Bequests (Schedule J)
I U. Nef Value Subject to Tax (line 12 minus line 131
)IS. Amount of line 141 taxable at 6% rate
I (Include value. f,am Schedule K 0' Schedule M,)
16. Amount of line 14 taxable 0' 15% rote
(Include values from Schedule K or Schedule M.J
I
/17. Principal lax due (Add fox from line 15 and from line 16.)
118. Credits Prior Payments Discount
1 $]" 24q nIL- +
I
i 19. If line 18 is groater Ihan line 17, enter the diHerence on line 19. This is Ihe OVERPAYMENT.
! A.DCheclc her. if you or. requesting a refund of your overpayment.
!20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE.
I A. Enler Ihe interesl on the balance due an line 20A.
~ ~
1,_,
.. () - ')
! FILE NUMBER
Cl~.,~
"....., .\(\
',,-.
COMMONW["UH 01 P[NralT....Nt..
DfP"IlIMfNI QlllfVUHJ(
POST 0"1(( lOr II)U
H..ilIlISIUIIG. PA '!10.s IIlU
DE (fOf N r 'S.t7XM" fi'f,,)i:-fllI~~ f.AN"O:"~IODlCINifiAtf
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
)/
(It,
1/"'/
I t..{ Y'
,
.O[CfOENr'S COMPlUf "DDllfSS
05,
Remainder Return
(for dale. of deo,h pria, 10 12.13.82)
Federal Estale Tax
Return Required
Total Number of Safe Depasi' Boxes
_8.
z
o
;:
<
...
:>
...
a:
<
V
...
~
16)
( 7) -$-3,.9Go.(}{)
I 8) $7 1 , 68~ . 73
(10)
$8.102.54
(11)
(12)
(131
(14)
$17 qq
.
$lili 7?q
.
11i
li7
$lili,7?q li7
$3.403.77
(IS) $56.729.57
)( .06 =
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II.
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...
(16)
)( ,15 =
(171
Interest
(181
(19)
$~ ?4Q.1l0
.
(20) $154.77
(20AI
B, En'e, ,he '0101 of line 20 and 20A on line 20B, Thi. i. Ihe BALANCE DUE. (20B) $1 54 . 77
, m_,~ok"-_C~.ck Poy~b!!.!~_~.9'.!'~r a! IYUI"_.II.9"-"'__ __H ",_ '-------'-_'_'n_____,_ ____ __ UH_
- - --..:. BE SURE TO' ANSWER ALL QUESTiONS-ONREVERSE SIDEAND rei RECHECK MATH-....- .. -_
Uade, pea~llie. 01 perjury. I declare Ihal 1 h~ve ..ami~~dlhi. relu,a, iacluding accompanying .~hed"le. and "alemenrs. and 'a 'he be" 01 my Ino..ledge ond beliel.
il i. Irue. correct and comple'e, I declare ,hal 011 real e.la'e ha. been reported 0' I'ue morle. value. Declo,alion 01 prepo'er o'her ,hon ,he pe"onol ,epre.enlolive i.
:;,r.,~~~~~t,;t:%:'~7:7" "''';;''~'l~Pio;;ec~~ ~-~~:;;;;; :P~;701',"'(ij /i/'1"
I.IGN.~ ~~, ...!9..;(OIHti'ro;.\h.,I.uNhiJl---,~oo"" ~ -J -w-t--h' -- --,- '0' - 'c-.----' .--.---1'1------- --, 0"'" --," -", _,
,.f,../ /., ,:';"-~ !L~'..J, .{,~;)UI <a orne r., amp HI , Pa17011 :~ "\"/5/"
7.-~-~'-h--- .,'----,-_I.J-,./:1..__ .- .. , _____on ___h_ -'-''',_..._...,____,_ "'_._ ___"";-..~\_ "_nl.-
,.' ." //
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (v') IN THE
APPROPRIATE BLOCKS.
,_'_~_ ._~__ a_'
,YES NO
I '
1. Did decedent make a transfer and:
,
I
I
a. relain the use or income of the property Iransferred, ....................................... "
,
b. retain the right to designate who shall use the property transferred or its income, \_-2'-
, '
, :
t. .' t t I '
c. re am a reversionary In eres or .................................................................... .__lei
, I '
d. receive the promise for liie of either payments, benefits or care~ ....................... L__?'-,
I
I
2. If death occurred on or before December 12, 1982, did decedent within Iwo years! I
preceding death transfer property without receiving adequate consideration~ If dealh \ x
occurred aher December 12, 1982, did decedent transfer properly within one year of I
death without receiving adequate considerotion~ ................................................. \,-----.
3. Did decedent own an 'in trust for' bank account al his or her death?..................... IL__X_
x'
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
I.V.UOI".171J1
SCHEDULE liE"
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
I Please Prinl or Type
FILE NUMBER
21-1996-426
~j.
COMMONWIAlfH O' PENNSYlVANIA
INHlllfANCI 'AX InUIH
lurDINf DICIDIN'
ESTATE OF
Albert J ezak
fAil P'OP'fl)' loinll)'.own.d with Ih. RighI of Su'~i~o,.hjp mUll b. djl(loltd on Sch.dul. "F")
ITEM I
NUMBER OESeR PTlON
VALUE AT
DATE OF DEATH
1. PNC Bank Checking Acct. #5140063866
$10,317.23
2. PA Property Tax Rebate
$465.50
TOTAL (Also enler an line 5, Reea i1ulalian) S 10 782.73
IAIIQch oddilionol 8""- )( 11- Ih"'1 jf mo,. IpOC' il n..d.d.)
'.
~IY.1510 IX+ 111-flJ
~
COMMonWEAltH OF PENNSYLVANIA
INHf.rrANCf fA. RrrURN
--.----~~!l!.~~D_f~[.Q~~.!__ ___.
ESTATi-OF'----.--------."._____ _ _____.
Albert J. Tezak
I
;
I
SCHEDULE G
TRANSFERS
.-J_ .... .......__
U --FI(Il'NUMIiEil--'---'-----__ _
21-96-0426
-'-'-- ---------..----..-------.-----.. -----.----....---
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 "'~""." ;;;-;;;;;;;- . -- -- ---. - -;K;;;.~"".'". "'." 8FJ\l"'~1l
"'"~r-;-,,, che~~:le:~:~i:----1 $~9::':O /,';:- ,,::'::.;:
I
I
I
I
I
-----,--- TOrAL~."'.,O./;..7.R"op;ruroliO.J S 3900.00
(II mOt, 'pace is n..d.rI. ;nl'''' oddl/ionollllutl o( 10m, si,..)
.
\
'-.-.
........-
_hulIfI.i...,
, SCHEDULE H L
~:iit~~ FUNERAL EXPENSES,
COMMONW"'~~ o;;fNNmYANIA I ADMINISTRATIVE COSTS AND
IN~W'\;'f~~IDi~:~:~~'N --1-, MISCELLANEOUS EXPENSES PloalO Print 0' Typo
ESTATE OF J FILE NUMBER
Albert J. Tezak 21-96-0426
ITEM
NUMBER
A.
B.
2.
3.
4.
C.
DESCRIPTION
AMOUNT
I.
Fun"al ExponlO"
Wiedeman Funeral Home
$6,236.75
Admlnistrativo Costs:
I.
Personal Representative Commissions
Social Securily Number 01 Personal Representative:
Year Commissions paid
Auorney Fees Reager & Adler for Prep. of 1st Inh. Tx
Filing
$210.00
Family Exemption
Claimant
Relationship
Address 01 Claimant at decedent's death
Slreel Address
City
State
Zip Code
PrDbale Fees Probate Fee, 2 Inventories, 2 Inh. Tax
Filings, Family Settlement Agr.
Mlscollaneous ExpenlO"
$160.00
I. Death certificates
2. House Maintenance till Sale (PP&L, PA-AM, Bell)
3. Sale of House Expenses
A. Real Estate Commission
B. Settlement Fee to Mid-State Abstract Co.
C. Realty Transfer Tax
D. Notary Fee
4. Advertising Grant of Letters
$15.00
$69.37
$2,400.00
$35.00
$600.00
$5.00
$119.50
TOTAL (AlIa enler on line 9, Recapilulationl IS 9850.62
(II mort spaco is nooded, InlOrt additional shilts 01 samo slzel
11,h is 10 (t'nif)' challhi\ j\ a Inlt' \'01')' of lilt' rl'wrt! whidl j" 1111 fill' ill.hl' I'l'I1I1,,}'h'.lIli,1 Di"hioll of ViLli Hl'lord" ill ,1(UlrtlillICC
Wilh ^cr (,(j. P.l.. .\(}1. "plum',,' II)' Iht ('t'ller.,1 ^""lIlbJ)'. ./lIl1t 2". I'lj \.
~
i
~
WARNING: Ills Illegal to dupllcale Ihls copy by photostat or pholograph.
3875860
(jLL /I~
Fee for lhl' (Cnilic"'t. $loa
CllJrb J ,"nltsltr
SlaltH,'!:im.,r
MAY 30 1996
No,
D"'t
~'
HlllUU..... ..,
.......QlCIlQDlJff,..__~
" ANNA M. TEZAK
-"'-
. .
CO....ONWEALTH OF PENNSYLVANIA. DEPART"ENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
055808
~
...,""""'~...
........'--'1'1
teelroti; PA
,.",_
1U IOCW,.CU'llY~ OoIII'.aDlA"~u..~
.Femole ,209 -12 8128. June 3, 1989
64 Y.
""""'0......
1'\.IlQ00tJUlMu...______..__
...
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a.1ft".1*.IAl.~00
.-=:.;:.'='~
clair
.....-nlMUlllollilUUl......W'-\......t.eIIot
18 IIblnut Lane
..Call> Hill. PI. 17011
~nc:nzo"ln~oZI.
-
Albert J. Tezak
"_0 ~ 0-0 "---__0
...-
.
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Omberl and
Hanpdcn n.p.
'-.....-....-..~
71 Old Pioneer' Rd.
-
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Se.food Processing
............ww.__
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Ahrrled
IbeN J. Tezok
---
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.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Albert J. Tezak
Date of Death: M~y lQ. lQQfi
Will No.
Admin. No. 1996-00426
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 y
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. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be ~~ched to tzhiS ~ort.
",/ ~y .
Date: Ql"}fi/% //-;:/'r:..-~-j/C-? --?_?-~_
./(Signat.ure'
Richard A. Cairo, Esq.
Name (Please type or print)
3501 Hawthorne Drive
~~a~e~tl1, PA 17811
(717) 737-2684
Te 1. No.
Capacity:
Personal Representative
L.
....,...oJ
Counsel for personal
representative
x
(MAH: rmf/ AM3)
,
\