HomeMy WebLinkAbout96-00509
PETITION Hm PHonATE ulld GHANT 01-' LETTEllS
? 1 - 96 - r,09
hlllll' III Onlck i'ervil
1/1.\0 A,w",,, fl\
No.
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Sot'1II1 Sl'l'IIril,l' ,vII. 386.-12-.8729_
I{~~hw 01 Wil" lor Ih~
('ollrlll' 01 . Curnber-land-- in Ihe
l'ollllllonw~i1l1h of I'enll'ylvania
Till' pl'lilioll of lhl.' lllldl',\i!!IH:d Il"!1c\.'lfully 1\.'1'11.'\1,.'111\ Ihal:
YlHII Pl'lililHIClt\). \\IHI h/KC< IN year, llf aJ.!.l'lJl (1Idl'( alllhe l'\l'ClIIX ix. ~ ___~____ IHIIllcd
in Ih~ la'l "ill ollh~ a"",., d~''''''~or, "a'~d~eltembe.r)..1.,,_____ . 19_~
ami cmlkil(,) dar~d _ ,Decembe_r_.1_9L.J9!j _____,,_ ____
__Will admitted __to_ [lJ:obatc,..in_ Mon tana'l--__cert if iCiltiQ_lUL.a t t ached.
Helen Forbes McCollum renounced Apr1 5, 1996.
~--=-i\nciliary-ici:i:r;;:s='lre=:regueste:a:"in:'P^-fQcsale of real estate.
1~lall' ,dl'\OIl11l'nnlm";lIh""\, ".j!, h'IllHh:i.lIillll. lkillh Illl'\l'(llltH.l'h.:.1
I>~~end~rll "a, dOllliciled al d~ilIh ill. ..Hl'!.LE!.!UI,.. M9_ILt!l!l.~. ___l'I~llij/<~HI~l!ilf. wilh
h_is___..., la'l falllily llf principal r~,id~n~~ al,,22.1Jl_L_imeL Kiln Road
_lieJ..ena._Mont ana__!;9. 6.0..L.._ ____._____
Ill" 'Ill"", flUlllh"1 ;llhllllllllrlp.llll~1
J)~~~nd~nl.lhell_70__,)'~ar'ola~e,di~d_...!.anu.EE_Y 28 .1996
:II _Helena ...Montana_________ ____
E\~~pl '" follm", deccd~1II did nOlmarr)'. wa, not divnr~~d and did 1101 have a child born or adopled
afl~r e\~~lIlion nr th~ "ill on~rcd fur prnh,"e; wa' nOllhe viclim of a killing and Wa\ never adjlldicaled
inCOml'l'l~nl; N.on.E!__ __________
D~c\.'mh:l1t ill ul'a1h (l\\'n~d prllpl'rly \\ith c!'Itilllaleu \'altll" it, fuI1O\\,:
(If dl1luidkd in I'a,) All per'onall'rop~n)' $
(If nol domiciled in I'a,) l'~r""tal prnp~n)' ill I'enn'ylvallia S
III not domkil~d ill I'a,) l'~r"",,,1 prnl'cny in COllnly $
Valul' l,f rcall,.'!'IlalC in Pl'IlI1\VI\'allia $
,illlalcd a, folh",,; ..l_LO__A..r:[1()_,I._d_Ro~d.LEnola ,__1'.[\____
77,900.00
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\\HEREI'()RE, p~lition~r") r~'pcclfnll)' rcqlle'I(') Ihe I'roh,"e of Ihe ""I will and codicil(s)
I're'ellr~d h~r~"ilh and Ihe grallll1f kller'__anc.illaz:y___to___those_iIL-Mon t "n"
, 11~"1;1l11~'1II;\r\; ,.Jl1l1nl'" ,l(HIll ~.l..t.: ..dmini\tralinn d,h.lI.c.l.a.)
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__ ,P_a,kLtc_t<LA....J3oone
__2.nLLJ!!te Kiln Road
___,J:lE!J,e[1a.___~On.lilna 596~
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COl":\T\'
sfl1\I'Jl U,~AN'kllSONAL ImPHESENTATIVE
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OF __I,ewis &, Clark J
Thl' pl'lilioller(lo) aho\'l'-II:lIl1l'd \\\l',ub) or affirml"') Ihallhl' 'latl'l11l'llh in lhe foregoing petilion arc
HUl' and ~urrl'clln Ihl' hl'" ,)1" lhl' "'IH1\\h:dgl' and hdid or pl'litinner(') amI that ,,\ pcnonal reprcscn.
lali\'l'('" uf thl' aho\\" dl'l.:l'dl'1I1 pl'liliol1l'r(\) \\ill \\l'lI and lruly adlllini\tl'r the e\late al.:cof(Jin~ (0 law.
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S\\nrn Il' or arfinlll'd alld 'Ilh'crihl'd I _ "~.",.':".._~.4''.._'_~.!'':'.~~_(:~ ,/ ",..~ ~~.L~/." ~(" .-fC. t." --'-..,.-~
hel?"i_n~~ ~I~, _HUc5?"-, _m , Il)~'t 01__________,_ ~.
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NCl. ___-LL - ~6 - ~09
Esllllc Clf
ONICK PEIlV^
, I>cccuscd
I>EClmE 01<' 1)lmnATE ANI> GnANT 01: LETTEnS
ANI> NOW ____ JUNE 27_,_,___._~_ 19_96__, ill cOII\idenlliollof the petitioll 011
the rc\'cn.c \idc hen'of, satisful.'lUry pruuf hu\'ing heen Inc\clllcd hdurc l11e,
IT IS DECREE!> th:u Ihe inslrurnelll(s) dateL,WILLDATED__9.~lA.=.95 COD IC IL QATED 12-19-95
described Ihercin he adrnilled 10 I'robale ..lid filcd or rccurd as the last will of
ONICK PERVA
..lid n~>>lI. ANClLLAR.LLEUERS
are herehy grallled to___~l\TR IJ;IA A a.Ql)~E
FEES
Probate, Letters, Etc. ......... S 200.00
Short Ccrtific:ucs( 2, ' . ' . . . . . .. L____6"Jl.Q
Rellllncialioo ,............... $_,____
Ancillary Letters 80.00
JCP --.--,- L----5~OO
TOTAL ____.. S--?9-1.00
Filed ...... .JUNE. ,27., ..1.996. . . . . . . . - . . , .
~ K. Wallet, 23989
ATtORNEY ISIIP. CI. 1.\1. No.)
24 N. 32nd Street, Camp Hill, PA
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(717) 737-1300
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MONTANA
CERTIFICATE OF DEAltt
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HOgler-nnderson Kortunry
650 North l~gan Street
" IIcleno Hontana 59601
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STATE OF MONTANA
County of Lewis and CI.lIk
I heroby ccrtlly thJt the Instrument lo
which this certiflcato Is aflb:cd is a Irue and
correct copy of tho ongin.:1I on rile In my
offleo.
Wlt~ my hon and....1 01 Low1a and
Cla:k J,~1l!y C'/
thl ~ .<;.{ daY 01 .191'",
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LAST WILL AND ~MENT Of
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LAST WILL AND TgS'J'AMEN'J'
OF
o N I C K I' E It V A
I, ONICK PERV A, of Enola, Cumberland Counly, Pennsylvania, being of sound and
disposing mind, memory, and understanding, do hereby make, publish, and declare this to be
my Last Will and Testament and hereby revoke all other Wills and Codicils, 1hat I have
made, including (he Last Will and Testament daled October 3, 1994.
FIRST: 1 give and bequealh lhe sum of One ($1.00) Dollar to my son, LARRY
SCOTT PERV A, so long as he survives me by lhirty (30) days,
SECOND: AlIlhe rest, residue and remainder of my Eslale, of whalever nature
and wherever siluate, I give, devise, and bequeath 10 the following so long as each shall
survive me by Utirty (30) days:
A. Seventy (70%) percent 10 my daughter, PATRICIA ANN BOONE, of
Helena, Montana;
B. Twenly (20%) percenl to my granddaughler, AMANDA LYNNE
BOONE, of Helena, Monlana; and
C. Ten (10%) percenl to my sisler-in-Iaw, HELEN FORBES
McCOLLUM,
THIRD: All interesls of any beneficiary in lhe income or principal of this
Eslate, while undistributed and inlhe possession of my Executrix, even lhough vested and
dislrihutahle, shall not he suhjectto allaclunenl, exectllion or sequestration ((II' any deht,
contract, ohligalion or Iiahility of any beneficiary amI, furlherlllore, shall nol he suhject to
pledge, assignlllenl, conveyance, or anticipation,
FOURTH: All inherilance, estate, and succession laxes (including illleresl and any
penalties thereon) payable by reason of lilY death shall he paid out of and be charged
generally againslthe principal of lilY rcsiduary cslate withoUl rcilllburscmcnl from any
pcrson,
FIFTH:
I nominatc, conslilutc, and appoint lilY sislcr-in-Iaw, HELEN FORBES
McCOLLUM, as Execulrix of lhis, my Lasl Will and Teslament In lhe event of the
renunciation, dea1h, resignation, or inabilily of HELEN FORBES McCOLLUM 10 act for
whatever reason in this capacily, then I nominate, conslilute, and appoint my daughter,
PATRICIA ANN BOONE, as Executrix of 1his, my Last Will and Testament
I direcl that no representative named above shall be required 10 pOSl security for lhe
fai1hful perfonnance of her duties in any jurisdiclion insofar as I am able by law to relieve
her of such obligation, Any of my represenlalives shall be entilled 10 reasonable
compensalion for the perfonnance of the duties set forti! here,
IN WITNESS WHEREOF, I have hereunto sel my hand and seal this ~.f^'day of
Sff"-"'bc..-
, 1995, on lhis, the second of lwo lypewriuen pages, I have also
signed the tefl-hand margin of lhe first page for purposes of identificalion only.
~~~~~~~
ONICK P'R A ~
. ~-_.. ,,_.....,.. .... --.
AFFIDAVIT
Commonwcalth of Pcnnsylvania
Counly of Cumbcrland
Wc, Debra K, WlIllel and t!uJ~uI< .s~
, thc wilncsscs whosc namcs are
signed to the auached inslrument, bcing duly qualified according to law, depose and say lhal
we were present and saw lhe Teslalor sign and execule lhe instrument as his L1St Will and
Testament; thaI ONICK PERV A executed it as his free and voluntary acl for lhe purposes
lherein expressed; lhat each of us in thc hearing and sighl of the Tcslalor signed the Will as
witnesses; and lha1, to lhe besl of our knowledge, lhe Teslalor was at thaI lime 18 years of
age or older. of sound mind, and under no conslraint or undue influencc.
\.OLlllr.. -Ie. wu.&...t-
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Sworn or affinned 10 and subscribed before mc by Debra K, Walle1 and
wilnesses, this ~ day of ~.. ,1995,
J . NOlarjill S~),11
C~m~T:'~8' O~1I0". t JtJl.~,y Puhlic
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1y Commi!lslo/l EXPlrO.."lo',' oCJounly
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embor, PennsyfV.Ulic1 As~OC:1I'''''1 01 ,,_.
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LAST WILL AND ~MENT OF
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CODICIL TO WILL OF
ONICK PERVA
I, ONICK PERVA rcsiding in IIl'1l~na, Monlalla lit-dan' lhal this is my
codicil to my Last Will and Tes(anwnl. My Lasl \\IlIl alld 'l'I'stanll'n( Is dated
Scptcmber 14, 1995. I want (0 malu' lIw Iwo dlalll~l's sl'l Ollt SI'PI'l'lIt('\y below,
1. My will now leaves 20% of my ('slal(', as dl'lllwd by my will. (0 my
gr~nddaughter, Amanda LYIIIW !J()()III' 11)( >II !I/H/T/I. I hl'rl'by amcnd my
exisling will by changing (he dlrl'l'I Ill'l(lI('sl III a 1ll'l(nl'sl by Irllst wilh said 20%
of my estate to be Invested or spent, as nl'l'd 1)(', IIndt'r (he control and
discrelion of the truslee apointed Iwllllv alld al'llll'~ pllrsllalll 10 the direclions
set out below.
As further cxplalned hen'ln, nlY primary pllrpose III er('aling this trust is
to provide a mcans for releasing funds to Amallda at the limes and in the
amounts specifled by (his will. My Irush'l' shall hold and manage all
propeltles. including any insurance pr()('l'eds whldt may bccome part of this
trust, on the followIng (erms:
(A) Vnlil Amanda has atlalnl'd :10 years of age, my trustee shall
distrIbute trustincomc tu or fur the Ill~lwlH of Amanda slleh amoun(s as m)'
trustee may in his dlst:J'ellon dl~cm 1II'('('ssar)' 10 provide for her health,
educalion and wclfare, My trusll'c shall mid 10 Ilw prlnl'lpal any IIl1tllstribuled
income of the trust.
(13) During the period thai Alnilt)(la Is It-ss Ihan :10 Yl'ars of agt:, If the
Income from Ihis Irusl and I hI' fllllds from an)' ollwr sotn'ITS which lIIay bc
available to Amanda an' IlIslIlHl'Il'll1 III pro\'ldt' for I hI' 111'0111 h, edllcatlon and
welfarc of Amanda. tll)' IrIlSII'(' IIlay pay III or apply for Ilw Iwnl'lll of Amanda so
milch of the prlnl'lpal of Ihh Irllsl as h(' ('ollsldl'l's 1Il'I'I'ssar)',
Ii,
DATED _ ,v C! c.
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ICI After Amanda has reached her 30lh birthday. ( (lireclmy trus(ee (0
terminate this trust and to distribute the remaining income and principal of
the trust to Amanda, or If she be deceased to her children or to her estate.
(D) The trustee shall have the power to apply income and prlneipal
payable to any benefieiary who Is under legal disab\1lty. In this regard. the
trustee may distribute Ineome and prlneipal dlreclly to the benefiCiary. to the
guardian of the beneficiary. to a bank account in trust, or to a custodianship
for the beneficiary, or to a person with whom the beneficiary resides. The
receipt of the beneficiary, guardian, or person with whom the beneficiary
resides shall discharge the trustGe from his responsibillly for the proper
expenditure of the income or principal.
(El No interest In the principal or income of this trust created under
this Instrument shall be antlcipa(ed, assigned. encumbcred. or subjected to
creditor's claims or legal process before actual receipt by Ule beneficiary.
(F) This trust shall (ennlnate upon dis(ributlon of all property of the
trust.
(G) I appoint Gerard Michael Boone, father of Amanda. as trustee of
trusts, with Pa(ricla Ann Boone. mother of Amanda as alternative trustee,
created herein to selve without bond,
In addition to any powers specified In prior provisions of this codicil. my
trustee shall have all powers granted to trustees under the Montana Trustees
Act as that act exists at the date of the execution of this Codicil.
I do not give any specific Instructions as to how or where the trust
amounts are to be invested or held but instead I leave those decisions (0 (he
judgment of Ule trustee I have appoln(ed,
2. As a second change to my will, 1 note (hat my will now leaves 70%
of my estate. as defined by my will. to my daughter. Pa(ricla Ann Boone, I
hereby change (hat bequest from being (0 Patricia Ann Boone to being jolnlly
DATED \iQ<. \'" t'l'i t' ,l (' . Jt ,<.;/:nu
Page 2 of 4
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to Patricia Boone and h('1' hWihand, (jnanl Mldlar'l 1I001ll', Shollld eHher
Patricia or Gerard pl'ed('('('aH(' III!' Ih('n 1IIl' HIII'\'I\'ol' Hhall 11I1ll'I'H Ihe enlll'e
portion of the eslate I alii It'a\'lnlt 101h('11I Jollllly.
I hereby reaffll'lII all dallH('H 01 lilY will 1101 1II11lllfled hy I his Codicil.
IN WITNESS WI IE HI,: IIF, I llNICI\ I'Jo:HVA, Ih(' Il'Htalol', Hlgnmy name 10
this Instrulllent I his __"1111. day 01 ~l <:J"" b. ,-=.. , I !l!Hi, and being fll's( duly
sworn, do hereby dedan' 10 1I11' 1Ill1ll'1"slg\l('d alllhol'lIy thall sign and execule
this Ins(runll'nl as nlY LaHt wm alld T('slall\('1I1 and Iha( I sign It willingly.
that I execule H as lilY free alltL I'ullllltal')' ad 1'01' the purposes therein
expressed, alld lhal I alii (~Ighlt'ell years of age or older, of sound mind, and
under 110 conslrallll or IIndll(, Inlhll'ncl~,
.jf:.f'il_~L7 /~~ ...-"!l-
ONICI\ I'lmVA, Tesla(or
The fOrl'golllg IlIslnllllenl. cOlIslsling of four (4) pages,
Including Ihls page, each page belllg (ypewl'lUen only on one side,
was al (he dal(' 1I11'l'eof by 1I11' said ONICI\ I'EHVA signed, scaled,
published alld declal'cd 10 be a codicil 10 his Lasl Will and
Testalllent III 11ll' pl'csence of liS, who a( his I'equesl. in his
pl'esellce alld III Ihe pl'eseJl('(~ of each other, have subscribed our
names as allesllng wllnesses Ihel'elo,
.---4/' / tl '/j/ fj? / / ~ /
~~--I-'- --LCl:a_______ residing al --.!isz/eJi4
_-J~L.I9...:r.dl__(;::!I( {~-L-_____ ___,__ residing al /.f.:LtilCl...--
TilE STATI~ OF MONTANA )
: ss,
COUNTY OF 1.I':W15 AND CI.Alm )
We', ONICI\ I'Jo:HVAj::;','i.G~Xzffiv ,and.J!~~~/ ~r,
leslalor alld WlIlll'sses, n'SIH'e1ll'l'Iv/.'tvllOse names arc signed 10 the aUached or
foregoing IlIsll'llnll'nl, Iwlng first dilly SWUI'I1, do hereby declare to the
IIIHIt~rslglll'd all II 101'11)' Ihalthe It'slalol' signed and execuled Ihe Instrument as
a codldl 10 his Last Will and Tesl;lIll1'lIl and that he had signed willingly or
dln.('ted anollll'r 10 sign iiII' hllll and Ihat he e)(eculed [( as his free and
VOhtnlal"),' a,d lor 1I11' pllrpos('s IjH'I;e1n c)(prcs.;td and (ha( each,\of Ihe
DATI':!) _~Q~, 1'1, "I" \___, ,t!...r,____, fl_ ,SOLV
Page 3 of 4
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BEFORE TilE REGISTER OF WILLS
COUNTY OF CUMBERLAND. I'ENNSYL VANIA
CERTIFICATION OF No'nel'; UNDER RULE 5.6(1\)
In re: Estate of Onick l'erva. deceased
No, 21-96-509
Dale of Death: January 28, 1996
To lhe Regisler:
I certify lhal nOlice of benelicial inlerest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to lhe following beneliciaries of lhe above-caplioned
estate on OClober 7. 1996
Name
Address
Palricia A, Boone
2210 Lime Kiln Road
Helena. Monlana 59601
Amanda Lynne Boone
c/o Palricia A, Boone
2210 Lime Kiln Road
Helena. Monlana 59601
Helen Forbes McCollum
6117 Blueslone Avenue
Harrisburg.PA 17112
Larry Scoll Perva
B,L, 9463
1',0. Box A
Bellefonte. PA 16823
NOlice has now been given 10 all persons enlilled thereto under Rule 5.6(a),
Dale: Oclober 7. 1996
\.QL\'Ie... '\!. W~
Debra K, Wallet. Esquire
24 N. 32nd Slree1
Camp Hill. PA 17011
(717) 737-1300
PA Counsel for personal
represenlalive
21. ULina 18 is greater than line 19, enler the difference on line 21. This is the TAX DUE.
A. Enter the inlerest on the bolance due on line 21 A.
e. En'e' the lotal of line 21 and 21 A on line 21 B. This is the BALANCE DUE.
Mak. Chtek Payable 10: Reglst.r a. Willi, Agent
>- BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ...c:
Under penalties of perjury, I dedare thor I have uomined this relurn. including accompanying schedules and stolemenh, and 10 the he,' of my knowledge and beli.f,
il Ii true, conect and complete. I dedor. lhal 011 real estate has been reported allruo mor.et 'Value. Declaration of prepare' other than th. personal repr.sentativ, is
based on 011 information of which prepare' hos any 1cnowledge,
!l1(iNArUU Of PUSCN RU'ONSI,U fOR flUNG llEIUIlN ADOIEU OAn
',l,t",.\( cJM"I' 24 N. 32nd St.. Camp lIill. PA 17011 'vI" he-
SIGNA1U1l Of ,uP,un OTH(I: IHAN ~("t:a(N"'Tlvt ACOIlUS DAn
II(V.I~OO d. \7.Q.l
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,OA DATU Of DIATH A"IA 12/31/91 CHICK HIAI
If A SPOUSAL
povlAn CAlDIT 15 CLAIMID
. .ILI NUMuiR--m-
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INHERITANCE TAX RETURN
RESIDENT :>eCEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
21
,~OIJN1.Y_~O.o[ .
IJf,
'fE.AR
509
!'IUMBER
COMMONWfAl!H Of PtNNSYlVANIA
DEPARTMENT Of U'YfNU(
O(Pf 280001
HARRISIURG,'''' 171)8.0601
Of{(OIPl'....C"'.\tH ...Ilottn
,OECIOEN1') NAME llAllt. 'll::.f "'NO ....loaU "..lIAII
I PERVA. ONICK ( nmn)
lSOCJ,'~ SiCU."T NUMtU O"If Cf OfAht
, 386-12-8729 1/28/96
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\'" ....'"" ,,""'NO '''''''' . 0'0' "'" ,." .00.'"'' """"
tOAn 0' t.II..
I 11/9/25
I!iO(IAl UCUlltl' PlUMUI
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2210 I.illlo Ki In Ilond
lIelenil. Monl.nnn 59601
Counh
I ,U...OUNI .((tWIO ISH .'.SI'UC1IQ'ISI
,
C 3.
Remolnder Rlturn
(for dol.. 01 death prior to 12.13.82)
Federal e,Iote Tall Return Required
'---' 2. Supple menial Return
[Z 1. Original Relurn
o ol. limited Eslote [J olo. Future Inlerlll Compromise
(for doles of death after 12.12.82}
(X b. Decedent Died T"tole r'"' 7. Decedent Maintained 0 living Trust
(Altoch copy of Will) (Anoth copy of Trusl)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
C 5,
Jl..o
T 0101 Number of Sof. Deposit Bous
NAME
Debra K. Wallet.
TfUPHONE NUMltll:
1717 I 737-1300
COMPUtt MAIliNG ...OCllfS$
Es uire
24 N. 32nd
Camp Hill.
II} ---1.2.,...132. 0(,
121
13}
141
(51
Street
PA 17011
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1. Real estole (Schedule A)
2. Stoth and Bonds (Schedule Bt
3, Closely Held Slock/Portnership Inlerest (Sthedule q
4. Morlgages and Notes Recei'Vobte (Schedule D)
5, Cash, Bonk Deposits & Miscellaneous Personal Property
(Schedule EI
6. Jointly Owned Property (Schedule F)
7. T.and... ISchedule 01 (Sch.dul. l)
B, Tolol Gran Aue" (Iotollines 1.71
q, Funeral Expenses, Administroli'Ve COI", Miscellaneous
Expenles lSchedule H)
10. Deb", Mortgage liabilities, liens (Schedule I}
11. Total Deductions (10101 line, q & \01
12. Net Value of Estole (line 8 minulline 11)
13, Charitable and Governmental Beques's (Schedule J)
14. Net Value Subject to Tox (line 12 minus line 13)
\5, Spousal Tran,fers (for dotes of deoth oher 6.30.CjI4)
See Instructions for Applicable Percentage on Reverse
Side. (Include 'Values From Schedule K or Schedule M.I
lb. Amount of line 14 toxoble at b% rote
(Include 'Value, from Schedule K or Schedule M.l
17. Amount of line 14 taxable 01 15% rote
(Indude 'Volues from Schedule K or Schedule M.)
18. Principal loll. due {Add loll. from lines 15, 16 and \7,1
lCj1. Credits Spoulol Poverty Credit Prior Payments
+
20. If line 19 il greater thon line lB, enler the difference on line 20. This is the OVERPAYMENT.
SO .III:r.r.:1!"1iI,'l..I..I.I...U...o.I.III.J.tllll......1t'l'T':'T':1r.'I&'I'III.'l'.l'U~'hll,ht
121}
121A}
(2101
4 690 I R
1 0 ) R] R'
171
101 __1.2,4'4 RR
Iql 2.838_.20
(101 --1.,..613 11
JIll --4...451.51
{121 (,7. q71 17
(131
(14) (,7.971 17
x,_=
(15)
(101 61.176.03
(171 6 , 7..92..3 4
Discount Inlerelt
+
x .00 = ,--1._670.57
x ,15 =
1.019.61
(101
4.r;QO 18
(1q)
120)
4.690.1R
Act #48 of , 994 provides for tho reduction of tho tax rates imposed on the not value of transfers to or for
the use of the spoule. The rates as prescribed by the statute will be:
. 3% (.03) will bo applicable lor estates of decedents dying on or after 7/1/94 and before 111/96
. 2% (.02) will be applicable lor estates of decedents dying on or after 111/96 and belare 111/97
. 1% (.01) will be applicable lor ostates of decedents dying on or after 111/97 and befare 111/98
. Spausal transfers occurring on or after 1/1/98 will be exempt from inheritanco tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK tv) IN THE APPROPRIATE BLOCKS.
, YES i NO
1, Did decedent make a transler and:
a. retein the use or :ncome of the property translerred, .......,......,..................,.........,...........
b, rete in the right to designate who shell use the property translerred or its income, .............., '
. " . I
c. retaIn a reversionary Interest; or ,.........,.....,....,......,.............,....,....,................,............,
d. receive the promise far liIe 01 either payments, benefits or care~ ....................................... I
2, II death occurred on or belore December 12, 1982, did decedent within two years preceding
death transler property without receiving adequate consideration~ II death occurred alter
December 12, 1982, did decedent transfer property within one year 01 death without receiving I
adequate consideration~.. ....', ....,....".."..,'" ,..""....",.."""....".."....,.......,"",.."....,.... ......'
3, Did decedent own an 'in trust for' bank account at his or her death?...,..........,....,..............,..
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
, .
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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SECURED L,AND
TRANSFERS, INC.
L1. T11' (jf I u^'~
J800 Markel Streel
Camp lilli, PA 17011
Phon": 761. n 44
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IN TOTAl 'AL'SIll~OKEn'!lI:OtA"lIIrIIOH :"..111 Ull lutn I --,=. )OCT 1J:~ ."i1- I f10nRoWloR'~ I ~EllfFl'~
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IlOlloDnOr.,,,,,,",,." 1,000... --~1iCi1t.", '.;n';:::. <'It ;1Ifll'!I'lC:i'-"~".IJf]
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lIeG MtlIIQ8U01n,urMc8ArJPlir.allOllf"l,to .-- ~ .
ftC1 AnumpllCin Fuo ___ __, . I
DO' Doc. Pt"e . I'~I.: Mt,;:r, Cor..;. <'It Am.. "1 caJ ;i ~~ ,00 I
filii TalC Serv, Tr<ln.....U\I!I.::.ca I 70: Dill
.,0.1' oed eRr!. Ptnl1acl" pf\tii-Set"'1icH 1 26.001
SI1 A '01. (.'ee PNC1C;\ : :>303, PU::) I I
oco ITU.B REQUIRED "1 LEUDER TO BE PAlO '" ADVANCE .. -
0'" rlaroM"o'l1 07 08 91l-',07/31/96"$ 12. 27:,lny
1l(Y.J Mcr'olt(]G Int.urMClJ Prom lorn lor m~l, :0
IiOl. Hazard InwrancJ Promium tar ,rr Ir.
904 'In 10
14". -,~~
1
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J
I
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l-
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-I
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I
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),9'1,511
-1
I
ICOO, RESeRveD DEPOSITED WITH LEuaER FUU
1001 Haz3rn If\&IUDflCO '1
1002. MortgeqA Inr;urMCO
003, C'tyifoWOII:1J\
004 County trlJ, 5
000. Ac.U"''TlDllts
OD6 Schcol tax 1
""7.
"}8 A rAdJust
,'''' TITLE CHARGto
10:. Soltlllmenl or dO(W1Y IOO~D
I 102. Ab~lrfttl or ti:le 'o:ur.h to
110.1,1.:10 (umrrun.:lon to
,0... TllIo mr.IlFWlce bl!1dGr Ie
lot> Document PlQPUl3lJOIl to
lOt. NoCDry 100& to
107. Al\orrw:,.t'~ '09" 10
(ine \.Idll; ,)tovo iloms No ;1
!tOO. TIlle 'nSUlonCD 10
(ncluoos CI~O"O Aarr~ No,,)
100. Lenjsf's coverago $
11D. O\:lnor', cO'IInrlJgti.$
11l1.l>J.sb. Fee
1'\0." 1 15,00 1<'10
mo.U$. ;r.'IO
mo.@~ 1m.
mO.O$ 11,43 Imo,
""'.O~ Imo,
""",,$ 50,90 Imo,
100 c.s !mo
mo o.s !ma,
Pebra K, Will Ct PCC 5)
Casll
5,00
Secured Land Transfers
Ends. 100,300/8,1
59.900
77 900
Securen I.mu.l Trar.aters
1'12.
l~ 13.
1200 aDVEANUEnT RECDRDINa ANDTRANSFEA CNARGEB
201 ROCO'dona''''. Do"uS 23,50 MnIlO.~o,~ 29,S!)
lI:2 CRy/cau"V1ax/OInmps: Daou S 779 ,00 MaflrJogo 5
1203 Slal.la,/.tomps: D.ort S TI!L OOllollGogo S
:20.. R:t Sw7 6 9 Eiwt Pennr:boro TownG.~
,205, In T:<F.l-Icr.;- Debra K. Wi! et
200. ADDITIONAL nETTLEMErn Cu'iiiOES
iJol Stnvov to
1302. Po" InspocllCn to
303, '96 School
3"
30S Home Ins BJ.echler&Tillev$22S,PCC-1:lI
40). TOTAl9E1TLEMtNJ CHARGES (enWI c"n IIll\1llD.lnn::S6ol~. !:.4.:licnll J,o,nd t<l
Vlt,e $
53.00
779,00
779.00
87.75
"1"'90.00
POC (13)
1Cl.O--tf:-- SLl1U~
634,25
2855.92
14149.75
",,,,.. _liKe 'Il" I... IIIbC1l1't 'I u...,m.a by 5e11!tr1rnl.\g.'l1 !MII... .......JAt't of 1l1..,..,,1OI .", ",'II'''U.s L, 1I1h........ JIlWooI ...1111' )1UU, I :;..fll1ln.,,161"lll'I ".1 l;an"nulI'" ^tTftl frI.,.t.t ..p.."'t
~"f'\o..11_1f"..fI' loU......1I4ny ,mounl' t.uluC11Jdlrr dJt..lUu ,...d," ~n ,nl,.'III" Itr."~'1 tC:OJ~I,. ,. r..<l-,"j.', MI,""'" I"",""'~ ...dl.J ..tplA .n, ItlfoKI.' 50 ,.'1,", lol4..l*ft.r.CDU~III"""l\l\'In&'
ronll""'.'..lIlrtn....tn..,.I"tht.II....d.on
ttUD CEttTlrlCATION 0'- ntJvERS AND SHLFAR
. __ _.0.- .....' '., ....
lIV.llO'lJ.lll,1I1
SCHEDULE F
JOINTLy.OWNED PROPERTY
~
COMMONWIA1.TH Of PlNN$YWANIA
INHUltA,.,.CI t.... utUIN
ItSIDUoIT DtCtDINt
\' FILE NUMBER
21-96-509
EstATE OF
PERVI\, ONICK
Join' 10nont(,I'
RELAtiONSHIP TO DECEDENt
Daughter
NAME
~ Patricia A. Boone
ADDRESS
2210 Lime Kiln Road
Helena, Montana 59601
B.
c.
ITEM LmER DAtE
FOR tOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBER JOINT MADE DESCRIPTtON OF PROPERTY OF ASSET %INt, DECEDENt'S INTERESt
TENANT JOINT
T. A more Dauphin Deposit Bank
than
yr be . Account #68-40212-0 169.62 50% 84.81
death
2. A " Pa. state Employees
credit Union
Account #0386128729 6.02 50% 3.01
TOTAL (Aha enter on line 6, Recapilulalion) S 87.82
Jolntly.ownod proporty.
(If more space is needed insert additional sheets of same size)
l,ovlmu.I'Ut
,,~l~:~1\
_.fJu.-
COMMOUW[,lUH Of PWt-l!inVANIA
INH[RItANC[ TA. UTURN
RfSIDINT DlC[O(NT
EStATE Of --. ---.. -
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
l P1'0" . ,,"00, T ".
I FILE NUMBER
2 1 - %-=.5Jl.9.
PF.RV .-DNICK.__
ITEM
NUMBER
A. Funeral Exp.n...,
1.
2.
B.
1.
2,
3.
4.
C.
1.
2,
3,
4,
5,
6,
7,
8,
9.
DESCRIPTION
AMOUNT
Hagler-Anderson Funeral Home
Newspaper Obituary
401.67
88.00
Admlnl.tratlv. Ca.h,
Personal Representative Commission. N 1 A
Social Security Number of Personal Representalive:
Year Commissions paid
Attorney Fees - Debra K. Wallet, Esq.
Jan Mortl, Esq.
F 'I E ,David Cogley, Esq.
am. y .emptlon
Claimant --N/..JI Relationship
Addre" 01 Claimant at decedent's death
Street Addre"
900.00
50.00
100.00
City
State
Zip Code
Probate Fees
316.00
MI.c.llaneou. Expen.."
Atty's Costs: teleph.,
night mail
Executrix's Costs:
copies,
postage, fax, over-
\
36.00
50.35
teleph., postage, etc.
Helen McCollum - Real Estate repairs, cleaning,
assistance with sale
Alicia D. Stine- 1996 Property Tax - County, Twp.
250.00
173.18
East pennsboro Twp. - sewer
108.91
64.76
220.01
30.00
49.32
PP & L - electric
UGI - gas
C. Frank & Sons - Plumbing
Pa. American Water
TOTAL (Also enter on line 9, Recapitulation) , S
(II more .pace I. n..d.d, In..r! additional .h..,. 01 .am. slz..)
2,838.20
"-
;1
ESTATE OF
PERVA, ONIcK
SCHEDULE I I
DEBTS OF DECEDENT, I
MORTGAGE LIABLITIES AND LIENS I PI PIT
~__ ea.. r nt or YP.
I FILE NUMBER
21-96-509
IlVlmU'I'UI@'
CI. ,"
fti ~C\
_'.' :u;
COMMOHWI.UH Of UNN'U.ANlA
,""llt'"N(' ,,,.ltfUIH
"'.DIN' OIClOINI
ITEM DESCRIPTION AMOUNT
NUMBER
1. Intercity Radiology 16.05
2. Gallatin Nat. Medical Center 116.91
3. Med-Trans 359.51
541. 00
4 . Dr. Mow 12.05
5. Dr. Book 24.79
6. St. Peter's 31.00
7. Yellowstone Medical Center 500.00
8, Bozeman Deaconess 12,00
TOTAL (Also enter on line 10, Recapilulation) S
(II more span is needed, insert additional sheets of some size.'
AFFlnAVIT
Commonwealth of Pennsylvania
County of Cumberland
We. Debra K, Wallet and tJu,~t.tl< .s-k(a
, the willlesses whose names are
signed 10 the allached inslrument. being duly qualified according to law, depose and say that
we were present and saw the Teslator sign and execute lhe instrument as his LaSl Will and
Testament: that ONICK PERV A executed it as his free and voluntary act for the purposes
therein expressed: that each of us in the hearing and sight of the Testator signed lhe Will as
willlesses: and that, to the best of our knowledge, the Testator was at that time 18 years of
age or older. of sound mind. and under no constraint or undue influence,
1.Ot.lJ\"-..I[,w..........r
~~~~, ~
Sworn or affirmed to and subscribed before me by Debra K. Wallet and
witnesses, this .f!:L day of Jl,nf.. , 1995,
:---
J'" Ncrarl;\15,.!-,',
C'mu~ .~. DUlle", t~m:!I'1 Public
My ~ cg~~'j':;~I~f~'E~~~~o;g~~~ 2~O~~~e
AlorrtlclF . .
.' I cr.ns;/v;1rJCJAs.'iCC"'""CINc
...~... IJnt~
"
CODICIL TO WILL OF
ONICK PERVA
I, ONICK PERVA residing In (-Ielena. Montana declare that this Is my
codicil to my Last Will and Tcstamcnt. My Last WIl1 and Testament Is dated
September 14, 1995, I want to malte the two changes set out seperately below,
I. My w1l1 now leavcs 20% of my estate, as dcflned by my will. to my
granddaughter, Amanda Lynnc Boone (DOB 9/8/77), I hereby amend my
existing will by changing thc direct bequest to a bequest by trust WiUl said 20%
of my estate to be Invested or spent, as need be. under the control and
discretion of the trustee apointed below and acting pursuant to the directions
set out below.
As further explained herein. my primary purpose in creating this trust Is
to provide a means for releasing funds to Amanda at the times and In the
amounts specified by this will. My trustee shall hold and manage all
properties, Including any insurance proceeds whIch may become part of this
trust. on the following terms:
[AI Until Amanda has attained 30 years of age. my trustee shall
distribute trust income to or for the benefit of Amanda such amounts as my
trustee may In his discretion deem necessary to provide for her health,
education and welfare. My trustee shall add to the principal any undistributed
income of the tnlst.
(B) During the period Ulat Amanda Is less than 30 years of age. If the
Income from this trust and the funds from any other sources which may be
available to Amanda are insufficient to provide for the health. edu~~~n and
welfare of Amanda. my trustee may pay to or apply for the benefit of Amanda so
much of the principal of this trust as he considers necessary,
DATED ~ ~c. ,,,"\ ,1'1'1 ~
- )
ll,
1(1'
. SDL~
Page 1 of 4
(e) After Amanda has reached her 30th birthday, I direct my trustee to
ternllnate this trust and 10 dlstrlbule lhe remaining Income and principal of
the trust to Amanda, or if slw be deceased 10 her children or lo her eslale,
(DJ The lruslee shall have the power 10 apply Income and principal
payable to any beneficiary who Is under legal disability, In this regard, the
trustee may distribute Income and principal directly to the beneficiary, to the
guardian of the beneficiary, to a bank account In trust. or to a custodianship
for the beneficiary, or to a person with whom the beneficiary resides, The
receipt of the beneficiary, guardian. or person with whom the beneficiary
resides shall discharge the trustGC from his responsibility for the proper
expenditure of the Income or principal.
(E) No Interest In the principal or Income of this trust created under
this Instrument shall be anticipated. assigned. encumbered. or subjected to
creditor's claims or legal process before actual receipt by the beneficiary,
(F) This trust shall terminate upon distribution of all property of the
trust.
(GJ I appoint Gerard Michael Boone, father of Amanda, as trustee of
trusts, with Patricia Ann Boone. mother of Amanda as alternative trustee.
created herein to serve without bond,
In addition to any powers specified in prior provisions of this codicil. my
trustee shall have all powers granted to trustees under the Montana Trustees
Act as that act exists at the date of tile execulion of tilis Codicil.
I do not give any specific instructions as to how or where the trust
amounts are to be Inves(ed or held but instead I leave those decisions to the
. :.-...
judgment of the trustee ( have appointed,
2. As a second change to my lviII, ( note that my will now leaves 70%
of my estate, as defined by my will. to my daughter. Patricia Ann Boone, I
hereby change tilat bequest from being to Patricia Ann Boone to being jointly
DATED ~J~<. 1'\ 1'1.41:" ,/ / . -2;0 ,'SOW
I .
Page 2 of 4
to Patricia Boone and her husband, Gcrard Michael Boonc. Should eithcr
Patrlcla 01' Gerard prcdecease me then the survivor shall Inherit the enllrc
porllon of the estate I am leavln!,( to them jointly.
I hercby reafnrlll all clauses of my wtll not modified by thts Codicil.
IN WITNESS WHEREOF, 1 ONICK PERVA. the testator, sign my name to
this Instrument this ,q.,i\ day of ~1'.J,.....b-:-, 1995. and being first duly
sworn. do hereby declare to the undersigned authority that I sign and execute
this Instrument as my Last Wlll and Testament and that I sign it willingly.
that I execute it as my free and. voluntary act for the purposes therein
expressed. and that I am eighteen years of age or older, of sound mind. and
under no constraint or undue InOuence.
. -I .~
~U~;:, ;:.(:--;-/::2'
ONICK PERVA. Testator
J
The foregoing instrument. consisting of four (4) pages,
including this page. each page being typewritten only on one side,
was at the date thereof by the said ONICK PERV A signed. scaled.
published and declared to be a codicil to his Last Wlll and
Testament in the presence of us. who at his request. in his
presence and in the presence of each other. have subscribed our
names as attesting witnesses thereto,
~,4if ::t 1?t
residing at
IkL,t
,
.JLL.\ Q )"1 [). 1.2/u:. eLf
residing at U.:.LUla-
THE STATE OF MONTANA )
: ss.
COUNTY OF LEWiS AND CLARK )
We, ONICK PERVAiL,:kJ{; ~., , and,i.u;f;&'/ ~'7-.
testator arid' witnesses , respectivel. ' whose names are signed to ,the attached or
foregoing instrument. being first duly sworn. do hereby declare to the
undersigned authority that the testator signed and executed the instrument as
a codicil to his Last Will and Testament and that he had signed willingly or
directed another to sign for him and that he executed It as his free and
voluntary act for the purposes tpe,reln express]/d and that each--.,of the
DATED &lQc.. lq. l'I'1 (' ty'f" 11f.. . .5Dc..J
Page 3 of 4
------.- ..-." -.
11'1>1162111....'
146877 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF RIVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.
D NO. AA
RECEIVED FROM:
11
ACN
ASSESSMENT r:t
CONTROL ...
NUMBER
AMOUNT
DEBORAH K WALLET ESQUIRE
101
.4,690.18
I
t
j
I
I
I
I
i- 'OCD H(1f
!
24 N 32ND STREET
CAMP HILL, PA 17011
ESTATE INFORMATION,
I:t FILE NUMBER
~ 21-1996-0509
E'I NAME OF DECEDENT (LAST)
~ PERVA DNICK
II DATE OF PAYMENT
m POSTMARK DATE
COUNTY
SSN 386-12-8729
IFIRST) (MI)
CUMBERLAND
DATE OF DEATH
m TOTAL AMOUNT PAID
$4,690.18
PB
REMARKS
DEBRA 1< WALLET ESQU I RE
SEAL
CHECKtI 2529
'i
RECEIVED BY /;
, ..
-
REGISTER OF WILLS
MARY C. LEW1S '"
REGISTER OF WILLS
. ,-' ,
SIGNATURE
.'
, ~,.:"
,
oll.__ .
- .- _. ---- -- -or. .;-.. ....- ---
;
-_. -- - - ~_. -- - --~-- -..
"
.
~...,.."".-
---_- ...~.A.~ _ T ...,:~
/!/-/II -}
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
8u.IEAU OF INDIVIDUAL TAXES
INlitAltANCE IAI( DIvISION
DEPt. llOttOI
IlARRlsauRC. PA lllla-Ot.Ol
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DEBRA K WALLET
24 N 32ND ST
CAMP HILL
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
ESQ
PA 17011
c.-
02-03-97
PERVA
01-28-96
21 96-0509
CUMBERLAND
101
Anount R....Uhd
;~~,
~JP
11"1101 u.u 111'''1
ONICK
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 ~
iIEy:is4i-EiC"i:ii-m-:9&Y"NoYicE--tii'-YNHEiiii'AN-CE-YAX-'AP'PR'AisEHENT-;-m:tiwAN-c"E"'iili-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF PERVA ONICK FILE NO. 21 96-0509 ACN 101 DATE 02-03-97
TAX RETURN WAS, I I ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.al Est.t. (Schedule A) (1)
2. Stocks and Bonds (Schedule OJ (2)
3. Closely Held stock/Partnership Int.rest (Schedule C) (3)
4. Harig.ges/Hot.. Receivable (Schedule DJ C4J
5. Cash/Bank Deposits/Hlse. Personal Property (Schedule EJ IS)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule GJ (7)
8. Tot.l Assets
If an assessment was issued previously, lines 14. 15 and/or 16, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Anount of Lina 14 at Spousal
16. AnDU"t of Line 14 taxable at
17. A.ount of Line 14 taxable at
18. Principal Tax Dua
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funara1 Expanses/Ada. Costs/Hisc. Expenses (Schedule HJ (9)
10. Dobts/Hortgogo Llobllltlo./Llons ISchodulo I) 110)
11. Total Deductions
12. Net Velue of Tax Return
13. Charitab1e/Government.l aequests (Schedule JJ
14. Net Value of Estate Subject to Tax
NOTE:
rat.
Lin.al/C1ass A rat.
Col1.teral/C1ass 8 r.t.
US)
UbI
U7l
TAX CREDITS:
PAVHENT
DATE
10-28-96
DISCOUNT 1+)
INTEREST 1-)
RECEIPT
NUHBER
AA146877
,DO
72,337,06
,DO
,00
,DO
, DO
87,82
.00
18)
2.838,20
1.613,31
Ill)
(2)
(3)
U41
,00
61.184.81
6.788.56
X .00=
X ,06=
X ,15=
(8)
AHDUNT PAID
4,690,18
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account,
sub. it the upper portion
of this forn with your
tax paynant.
72.424,88
4.41;1 1;1
67.973.37
,00
67.973,37
.00
3.671.09
1.018.28
4.689,37
4.690,18
.81CR
.00
,81CR
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN .1. NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR). VDU HAV BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS.)
RESERVA"ONr E.t.t.. of d.c.d.nt. dylng on or b.for. D.c..b.r Il, 198Z -- If .ny future Int.r..t In the ..tat. I. tran.f.rr.d
ln po.....lon or .nJoy..nt to CI... a (coll.t.rall b.n.'lclarl.. of the d.c.d.nt .ft.r the ..plratlon of .ny ..tata for
Ilf. or for ya.r., the Co..onw..lth h.raby ..pr...ly r...rv.. the right 10 appr.I.. and ...... Iran.f.r Inh.rllancl ,....
.t tha I.wful Cia.' B (collal.ral) r.la on .ny .uch future Int.r..I.
PURPOSE OF
NOnCEJ
To fulfill the raqulr...nts of S.ctlon ll"O of Ihl Inh.rit.nce and (.tall la. Acl. Act ZZ of 1991. 1l P.S.
S.cllon ZI"O.
PAV"ENh
O.tlch the lop portion of thl. Nolic. .nd .ubllt with your p.y..nl 10 thl Ragl.l.r of will. prlntad on tha rlv.r.. .Id..
u".k. chack or .on.y order payabl. lor REGISTER OF MILLS, AGENT
All pay..nll r.c.lv.d .h.11 flr.t b. appllad to any Int.r..t which .ay b. due with .ny r..alnd.r .ppll.d to the la..
REFUND (CRlr A r.fund of . ta. cr.dlt, which wa. not r.qu..I.d on tha Ta. R.turn, ..y b. r.qu..tad by co.pl.tlng an "Application
for R.fund 0' p.nn.ylvanla Inh.rll.nc. and [.t.t. T.." (REV-IlIl). Appllc.tlon. ar. av.llabl. at th.Offlc.
of Ih. R.gl.t.r of Will.. any of tho II R.v.nu. Ol.trlct Offlc.., or by calling the .p.cl.1 Z"-hour
an.warlng ..rvlcl nuab.r. for for.. ord.rlngr In P.nn,ylvanla I-S00-36Z-Z0S0, out.ld. Pann.ylvanla .nd
..lthln 10ClI Harrhburg ar.. (717) 781'S09". IDOl 17171 11Z-ZZSl ol..rlng I.palr.d Only),
OBJECTIONS I Any p.rty In Int.r..t not .atl.fl.d ..llh tha .ppr.I....nt, allo...ncl or dl.allowanc. of d.ductlonl, or ....s...nt
of t.. Ilncludlng dlscount or Int.r..t. a. shown on thl. Notlcl lust obJ.ct within .I.ty (60. days of r.c.lpt of
this Notice byr
aawrlttln protIst to thl PA Dep.rt.ant of Ravanu., Board of App.al., Dept. Z810ZI. Harrisburg. PA 171l8a10ZI, OR
u.llcUon to have the .athr d.hrlln.d at .udlt of the account of the p.r.onel rapr...ntallv., OR
.-.pp..1 to thl Orphan.' Court.
AI>>UN
ISTRATlYE
CORRECTIONS I
Factual .rrorl dl.cov.rad on thl. a.......nt .hould ba addr....d In writing tor PA D.part..nt of R.v.nu.,
Bur.au of Individual T..... ATTNI po.t AI......nt R.vl.w Unit. D.pt. l80601. Harrl.burg, PA 17128-0601
Phon. (717) 187-6505. S.. paga 5 of tha bookl.t "In.tructlon. for Inh.rltance Ta. R.turn for I R..ldant
D.c.d.nt" IREV-ISOI) for an ..planatlon of .dalnl.tr.tlv.ly corr.ctabl. .rror..
DISCOUNTr
If any ta. dUll. Plld within thr.. (J) cal.nd.r .onth. aftar the d.c.d.nt's d..th. . flv. p.rc.nt (5X) dl.count of
the ~IM paid I. .llow.d.
PENAl TV r
Th. ISX t.. aan..ty nonap.rtlclp.tlon p.n.lty II co.put.d on the total of the t.. .nd Int.r..t .......d, and not
p.ld h.fora Janu.ry 18, 1996, the flr.t day .ft.r the end of tha t.. .an.sty p.rlod. Thi. non-p.rtlclp.tlon
p.n.lty I. app..labl. In the .a.. .ann.r and In the tho .... tl.. p.rlod a. you would app.al the taM and Int.r..t
th.t h.. b..n a......d a. Indlcat.d on thl. notlc..
INTEREST I
Inl.r..t I. ch.rg.d b.vlnnlnv with flr.t day of d.llnquency, or nln. (9) .onlh. .nd on. (I) day froa the data of
d..th, to the data of pay..nt. ,.... which bac..e dallnqu.nt b.for. January I, 1981 ba.r Int.r..t at tha rat. of
.1. (6XI p.rcant p.r annul calculatad It a d.lly rat. of .00016". All t.... which baca.. dallnqu.nt on and aft.r
January 1, 19S2 will b.ar Int.r..t at . rat. which will vary fro. c.land.r y,ar to cal.ndar yaar ..Ith that rale
announced by the PA D.part.ent of Rav.nu.. 'h. appllcabl. lntar..t rat.. for 19S1 through 1997 ar.1
'!!!! Inter..t Rate Dally Inhr..1 Factor !!!! Int.ra.t Rat. nally Intere.t FActor
1982 20:< .000SfoS 19a7 .~ .000l'"
1983 16:( .000"!8 1988'1'91 IIi!: .000301
1984 11:( .000101 199Z .~ .000l"7
1985 13:( .0003S' 1'93-199" n .000192
1986 10:< .00027" 1995-1991 .. .000l41
ulntar..t It ulculat.d .. followlI
INTEREST = BALANCE OF TAX UNPAID X NunBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Any Notlc. I..u.d .ft.r the tl. b.Co", d,llnqu.nt will rafl.ct .n Int.r..t c.lculatlon to flft..n liS) day.
beyond thl d.t. of the a.......nt. If pay..nt I. ..d. aftlr the Int.r..t co.putatlon data .hown on the
Notlc., addltlon.l lnt.r..t au.t b, c.lculat.d.
'IV-WOUI'''j
.
INHERITANCE TAX
EXPLANATION
OF CHANGES
.COMMONWEALtH Of PENNSYlVANIA
DEPARTMENT Of REVENUE
BUREAU Of INDIVIDUAL TAXIS
DEPr. 28060 I
HARRIS8URG, PA 17128.0601
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DECEDENT'S NAME
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filE NUM8ER
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SCHEDULE
ITEM
NO.
EXPLANATION OF CHANGES
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TAX EXAMINER:__~_!:-'~,--,'
/ ,,' ." I ,,' '';'~_______.______ ___ PAGE
ST.;'!'US REPORT UNDER RULE 6.12
Name of Decedent: Onlck I'crva
Date of Death: January 28, 1996
Will No. 21-96-509 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 t~e above-captioned estate:
1. State whether administration of the estate is complete:
Yes No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: within 3 months
3. If the answer to No.1 is Yes, state the following:
a. Old the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representati~e's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes 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 attached to this report.
Date: 2/4/98
--1iJJAM. ..v. Wu.-r
Signature
I)ebra K. Wallet, Esq.
Name (Please type or print)
24 N. 32nd St., Cnmp "Ill, PA 17011
Address
( 717) 737-1300
Tel. No.
.., '
Capacity:
Personal Representative
(MAH: rmf/ AMJ)
X Counsel for personal
representative
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~UN 0 9 1998
IN TilE COURT OF COMMON PLEAS
CUMm~RLAND COUNTY I'ENNSYLVANIA
ORI'IIANS' COURT I>IVISION
IN RE: Estate of ONICK I'ERV A. Deceased
Estate No. 21-96-509
PETITION FOR DISCHARGE OF EXECUTRIX
AND EXCUSE FROM ACCOUNTING
TO THE HONORABLE. THE JUDGES OF SAID COURT:
The pe1ition of Patricia A. Boone respectfully represents that:
I. Onick Perva, a resident of Helena, Montana, died testate on the twenty-
eighth day of January, 1996, and letters testamentary were granted to Patricia A.
Boone, Executrix, by the Montana First Judicial District Court, Lewis & Clark County,
on the tenth day of April, 1996.
2. Onick Perva owned real property in Cumberland County, Pennsylvania
at the time of his death.
3. Letters testamentary, ancillary to those in Montana, were granted to
Patricia A. Boone by the Register of Wills of Cumberland County on the twenty-
seventh day of June, 1996 in order to dispose of the real property located in
Pennsylvania.
4. All of the decedent's expenses, debts and obligations have been fully
paid and satisfied and the Pennsylvania Inheritance Tax has been fully paid. A copy of
the official receipt is annexed hereto, marked Exhibit" A" .
5. A "Personal Representative's Sworn Statement to Close Estate" has been
filed as required in the Montana First Judicial District Court, Lewis & Clark County,
as required by the state of Montana. A copy is annexed hereto, marked Exhibit "B".
6. Your petitioner, being the Executrix of this estate, prays that she be
excused from the filing of a final account in the state of Pennsylvania and that she be
discharged from the duties of her appointment.
Respectfully submitted,
l() 1M G. .Ai. W 6AA.-4"
Debra K. Wallet, Attorney for Patricia A. Boone
24 N. 32nd Street
Camp Hill, PA 17011
1. D. #23989
(717) 737-1300
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_ e......... ~ _ ..... ~=~___., . . . . -'
ACN ..' ,
ASSESSMENT r:"
CONTROL ~
NUMBER
RECEIVED FROM,
i
AMOUNT
DEBORAH K WALLET ESQUIRE
$..,0'90. !B
101
24 N 32ND STREET
CAMP HILL, PA 17011
ESTATE INFORMATION,
~ filE NUMBER
~ 21-1996-0509
~ NAME OF DECEDENT (LAST)
~ PERVA ONICK
m DATE Of PAYMENT
m POSTMARK DATE
COUNTY
SSN 386-12-8729
(fiRST) (MI)
CUMBERLAND
DATE Of DEATH
01/28/96
REMARKS
ra TOTAL AMOUNT PAID
$4 , 690. 18
PB
DEBRA K WALLET ESQUIRE
SEAL CHECK II 2529
TAXPAYER
EXHIBIT "Ato
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THOMAS K. HARLEN
Harlen, Thompson & Parish, P. C.
800 Sixth Avenue
Helena, Montana 59601
(406) 443-0360
Attorneys for Personal Rcprcsentative
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MONTANA FIRST JUDICIAL DISTRICT COURT, LEWIS & CLARK COUNTY
INTHEMATfEROrTHEESTATE )
)
OF ONlCK PERV A, )
)
Dcccased. )
Probate No. DP 96-045
PERSONAL REPRESENTATIVE'S
SWORN STATEMENT
TO CLOSE ESTATE
Patricia A. Boonc, personal rcprescntative of the above-named estate,
states that:
1. She is the duly appointed, qualified and acting personal
representative of the above-named estate.
2. Shc has given notice to creditors as provided in MCA 72-3-801, and
the time limitation for presentation of creditors' claims has expired.
3. She has fully administered the estatc of the decedcnt by making
paymcnt, selllcment, or other disposition of all claims which were
presentcd, expenses of administration, and cstatc, inheritance, and othcr
death taxes, and she has rcserved $500 to be utilized for the preparation of
the estate tax return. Any funds remaining shall bc distributed pursuant to
the decedent's will.
Sworn Statement 10 Close ESlale . ]
EXIIIBIT "B"
..
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4. She has distributed the assets of lhe estate to the persons ,e,ntitled
...... '.
. "
to said assets in the amount and manner to which they are entitled, as set
forth in the Instrument of Distribution on file herein.
5. She has sent a copy of this statement 10 all distributees of the
estate and to all creditors or claimants of the estate of whom she is aware
whose claims are neither paid nor barred, and she has furnished a full
account in writing, attached hereto, of her administration to the distributees
whose interests are affected thereby.
6. There has been filcd with the Clerk of Court a certificate from the
Department of Revenuc stating the amount of tax due and a receipt from the
County Treasurer stating the inheritance tax due on the assets of the estate
have been paid.
7. This statement is filed for the purpose of closing this estate and
terminating thc appointmcnt of the undersigned pursuant to MCA 72-3-1004.
'J{-IJiL'C~(} ~., -?tf
Patricia A. Boone ,I
STATE OF MONTANA )
: ss.
County of Lewis & Clark )
Patricia A. noone, being first duly sworn, upon oath, deposes and says:
That she has read thc forcgoing and that the facts and matters
knowledge and belicf.
accurate and complete to the best of her
-tl:Ate{~d ~, -/~
Personal Represen tati ve
contained thcrein are true,
Subscribed and sworn to
beforc me this /0 day of March, 1997.
$/(>~_L
Notary Public for the State of MT
Residing at Helcna, MT
My Commission expires ,2~I/f...
(SEAL)
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~UN 0 91998
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~ 09 199B
IN THE COURT OF COl\-Il'ION PLEAS
CUl\-IDERLAND COUNTY PENNSYLVANIA
ORPHANS' COURT DMSION
IN RE: Estate of ONICK PERV A, Deeeased
Estate No. 21-96-509
ORDER OF COURT
AND NOW, this JJ1!::. day of
consideration of the petition for discharge
executrLX, it is hereby
, 1998, upon
nd excuse from accounting filed by the
ORDERED AND DECREED that the petitioner, Patricia A. Boone, is excused
from the filing of a final account in the above captioned eSl:lte and she is discharged
from the duties of her appoinnnent as executrLx.
BY THE COURT:
IS/ ~ ~. JJir'"
P. J.
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