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OATH 0.' PERSONAL REPRESENTATIVE
COMMONWEALTH 0..' PENNSYLVANIA
COUNTY 0.' CLJMIlI';//I.MIl
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Thr prllllllnrr(l) above.namrd swrar(s) or affirm(s) that the
Ilalemenuln the foregoing prlllion are Irue and correct to Ihe best
of Ihe knowledge and belief of prtilioner(s) and Ihal B.l personal
rrprrlrntallve(l) of Ihe above decedent petitioner(s) will well and
trllly adminlsler the estale according to law. -4;,. ' '-_ /' . ;;
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Sworn III or affirmed and subscnbed I ,,.,, r r",,- ?',
before me Ihll_ 26th day of /" '
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No. JI-/qqlJJ -010'75
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,C ANDREW J. BOBONICK
Es~te o~a , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW DECEMBER 31 J9...2L. In consideration of the petlllon on
the rcvcrse sidc hercof, satisfactory proof having bccn prescnted beforc mc,
IT IS DECREED that
II/arc cnlltlcd to LCllers of Administration. and in accord with Such finding. LCllcrs of Administration
arc hercby granted to LOUTSE F. BOBONTCK
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In thc cSlalC of
ANDIlEW J. BOBONTCK
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MAllY C. LEWIS Resl"" of Will1
FEES
LCllers of Adminlstrallon ...., SIB. 00
Short CcrllfieatcsCl)......,... S J. 00
Rcnunelatlon .........,.,.,., S
JCP S 5.00
TOTAL _ S 26.00
Flied .,., .DEG..,J.l...,.,. A.D, 19-9-6-
A 170RNEY (Sup. Ct. 1.0. No.)
ADDRESS
PHONE
I.E'J"I'EIlS AND OHDER MAT LED TO ADMINISTRATOR
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This is ltlll'flil\" Ih.ll Ihe 1IJI1Irlll,IIioll ht'fl' .l:IH'IlI... ~IITllllh 1III'a,!III"" .11l1l11.1~1l1,d ll'lIillt.lll' III dt'.lth dilly filed with me .IS
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WARNING: It Is Illegal to duplicate this copy by photostat or photograph.
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3960320
No.
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I..Ital Hl',l;i"uJr
DEe, 1 7 1996
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"'M,&)1l...2;I1
COMMONWEALTH OF PENNSYlVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
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Andrew John Bobonick, Sr.
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ershc- town PA
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1833 Ritner IIlghv.y
Shlppensburg, PA 17257
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I Hichael Bobon1ck
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Louise Bobonick
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o 4, Llm,ted Estale 0 4a, Fulure InlerestCompromlSel"'~""'" ","'~ 0 5, Federal Estale Ta, Retum Required
o 6. Decedenl Ored Testate 1.l.l:M:I'l c~, of "".1 0 7. Oecedenl Maintained a living Trust (AllJeh tOCJ d fMt) _ 8 Total Number of Sale Oepos~ BOles
o 9, UtJ9aiJOn Proceeds Rece.ed 0 10, SpousaIPovertyCred'II""~"""_ ",",II ",,,,,,," 011, Election to taxunderSe<> 9113IA)IAucI>Sd>O,
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
kAME COOPlETEJ.WlINGAOORESS
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1.5 /51 - ,:<
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
J
CO\4VOtM'[AlHi r PElmS'I'lVAWA
Ol rAJUIJfPH or REV[tlU[
DEl'I i!l()j(Jl
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M)ClAI. 5lCURHY MAlIllR
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TELEPHONE NIA'BER
1, Real Estale {ScI1edule A)
2, Slocks and Bonds (Scheduk! B)
3 Close~ Held CorporaiJOn.Partnership or Sole,Propnelorship
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4, Mortgages & Noles Receivable (Schedule 0)
5, Cash. Bank Deposrts & M","'laneous Personal Property
ISchedule E)
6 Joinlly Owned Property ISchedule F)
7, Inler,Vivos Transfers & M,scellaneous Non,Probale Property
(Schedule G orl)
8 ToUI Gron Anets {Iotal Unes 1,7)
9 Funeral E'penses & Administrawe Costs (Schedule H)
10, Debts of Decedent Mortgage Liabilities. & Liens ISchedulel)
11, Total Deductions (Iotal Unes 9 & 10)
12, Net Value of E.UleIline 8 minus Line 11)
13. Chantable and Govemmental BequeslSlSec 91 13 Trusts for which an election 10 ta, has nel been
made (Schedu", J)
14, Net Value Subject 10 TaxlLine 12 minus Line 13)
15. Amount 01 line 14 taxable
allhe spousal tax rate , ,
See instructions on reverse side lor applicable percentage
16. Amount of line 14 taxable
aI 6% rate
17. Amounl of line 14 taxable
at 15%",le
x ,0
x ,06
x ,15
18 Tax Due
19,
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III HUMBER
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THIS RETURN MUST BE FilED IN DUPLICATE WITH TilE
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REGISTER OF WILLS
(11) ../ ? ry. E.,' {J
_?', 7-/-
. U
(12)
113)
(14) Z)
115)
116)
(17)
(18)
DATE I
/1 ';/'if
DATE
DocEldont's C~I!!P!~!<<l_~ddros..!:___
:. III L l' A.1l{)I; I ~,';
em'
I ~, , A I f
Ill"
Tax Paymonts and Crodlta:
1 T.1X Due (P.lge I Uno 16)
2 CredllS!PayrncnlS
A. Spousal Povorly Crod,l
8 Pnor Palmonls
C, D.sccunl
11)
J, InleresVPenally " applicable
D, Inloresl
E,Penally
Tolal Crod.ls ( A. 8. C) 121
TOlallnleresUPenalty (D. E) (3)
4, IIIine 2is grealellhan line 1 'line J, enlellhe difference, This is Ihe OVERPAYMENT.
Check box on Pagel Line 19 to requelta refund (4)
5, II line 1 . line J is grealer Ihan line 2, onler Ihe difference, This is Ihe TAX DUE. (5)
A, Enter Ihe interest on Ihe tax due, (SA)
8, Enler Ihe 101,11 of Une 5 . SA, This is Ihe BALANCE DUE, (58)
Make Check parable 10: REGISTER OF WILLS, AG~NT
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a, retain the use or income of the property transferred; ..........,....................,......................,...... 0 0
b. retain the right to designate who shall use the property Iransferred or its income: ................ 0 0
c, retain a reversionary interest; or..................,..............,................................,.......................... 0 0
d, receive the promise for life of either payments, benefits or care? ......................,..............,..,0 0
2, If death occurred on or before December 12, 1982, did decedent within two years
preceding death Iransfer property without receiving adequate consideration? If death occurred
after December 12. 1982, did decedent Iransfer property within one year of death without
receiving adequate consideration? ..,"',....,..,............",.............""""....,.."....",....,..,....",...."..,..,0 0
3, Did decedenl own an "in trusl for" or payable upon dealh bank account or security
,11 his or her death? ............,..............,..,................,....,......,........,............,........................,......,.... 0 0
4, Did decedent own an individual retirement account, annuity, or other non-probate property?.... 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
"'~iN~W"~~.-f!l2UI1 !&AHlftrI_~~.JIll'FJI"~dib~""I1.Wi~- ~
72 P.S, ~9116 (a) (1,1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995,
72 P.S, ~9116 (a) (1,1) (ii) provided for Ihe reduction oflhe rate imposed on the net value oflransfers 10 or for Ihe use of the surviving
spouse from 3% to 0% for dates of dealh on or after January 1, 1995, The slalule does not exemot a Iransfer to a surviving spouse
from tax, and Ihe statutory requiremenls for disclosure of assets and filing a tax relurn are slill applicable even if the surviving spouse
is the only beneficiary,
, ""~.>j:", i,J!i. ,";"
FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 - Please answer the following question by placing an "x' In the
appropriate space,
Old the decedent create a trust or similar arrangement which Is solely for the surviving spouse's benefit for his or her entire
lifetime? Yes 0 No 0
If you answered yes to the above question, the tax on the trust or similar arrangement is poslponed until the death of the second
spouse. at which lime it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies), Enter the value of the lrust on
Schedule J, Part II, in order to remove it from the calculation of the lax due In this estate, You may wish to file Schedule 0 in order to
make the election available under Section 9113, If the election is made, the trusl or similar arrangemenl is taxed in Ihe estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero lax rate,
and the remainder is laxed at the rate(s) applicable 10 the remainder beneficiary(ies), If you choose to make Ihe election, you must
attach Schec!ule 0 10 a timely-filed tax return. along with Schedule(s) K and/or M in order to show the apportionment of Ihe trust or
similar arrangement between the surviving spouse and Ihe remainder beneficiary(ies),
-.-.....- --.......--...
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COMMONWEAlTH Of PfNNSVLVANIA
INHERlTANCE TAX RETURN
R I NT NT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC,
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Include I/Ie pmceed. 011rtJg.1ion and Ihe date Ihe pmceed. were receiv<ld by Ihe estate, All property jolnUy..."",ad with thl right of IUrvlvOllhlp mUlt be dlaclolad on Schadult F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
(J~t~{(3 ~/
Y;J. 7, II
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert addilional sheets of the same size)
1lIV"'lll'I"'"
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
CQI,lt,l()fffl[Alltl Of PENNSYlVIJlIA
IN"ERlTANCE TAX RETURN
R I "T NT
FilE NUMBER
E5T.NE?1j ,
ft(\/LJ'f I t;;""r,./
~ r?~?;; G' IVr c..f.!..,
Debl1 01 decedent mUlt be reported on Schedule I.
ITEM
NUMBER
A,
AMOUNT
DESCRIPTION
1.
FUNERAL EXPENSES r-:J
H (.'.f rtf/itA! P)01 ~
fr,{,1f /1/ If'IT ;11
~2~/7 f ft?
B, ADMINISTRATIVE COSTS:
1- Pe"",,,,' Represenlali'll's CommisSIonS
NarM of Pe""",' R.prosenlali'll (s)
Social Security Numbe~s) I EIN Number of Pe"",,al RepresenlaliVe(s)
StreelAddress
City Slate Zip
Y..~s) CommisSion Paid:
2, Attomel Fees
3, Fami~ Exemption: (II decedents address Is nol the..rM as claimants, allach ",planation)
Clalmanl
Street Add....
City SIa\e Zip
Relationship 01 Clalmanl to Dece<I.nt
4, Proba\e Fees
5, Accounlants Fees
6, Tax Return Praparefs Fees
7,
TOTAl(AlSOenleronline9,Recapilulation) $ y-' ~ '7 ;>b
(lIl11Ole space is needed, insert additional sheets of the same size)
/. ~ /.s/ ~.;{
IUREAU OF INDIVIDUAL TAXES
....RITAHC( 'U DIVISION
DlPI. 180601
ItARAISllfi, PA 111U-otlll
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEMENT, AllOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
'''.1'''' II~' ltt.tlt
LOUISE BOBONICK
1033 RITNER HWY
SHIPPENSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUKBER
COUNTY
ACN
01-18-1999
BOBONICK
12-13-1996
21 96-1075
CUHBERLAND
101
A.ounl R..III.d
ANDREW
J
PA 17257-.U02
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEY:is4'rEX-AFji-iilij:m--ilil'ficniF"YNHEiiii'ANCn'-AX-iipiiiliiisEiiiil'r;-ALLOiiANCnii-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BOBONICK ANDREW J FILE NO. 21 96-1075 ACN 101 DATE 01-18-1999
TAX RETURN WAS, (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.t. (Schedul. A)
2. Stocks end IIonds (Schedul. I)
3. Clos.ly Held Stock/P.rtnership Int.r.st (Sch.dul. CI
4. Hortgag..lHot.. Receivable (Schedule OJ
5. CashlBank DepolltsIHllc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedul. F)
7. Transfers (Schedule G)
8. Tot.l As..ts
( I CHANGED
NOTE: To insure prope,.
oradl t to your account,
s...",1I the upper portion
of this fo.. Mith your
tax pa)'llent.
,00
.00
.00
.00
1.029.16
.00
.00
(8)
(1)
(2)
13)
(4)
(5)
(6)
(71
1,029.29
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral EXPen.../A~. Costs/Hilc. Expenses (Schedule H)
10. Debts/Mortgage liabiliti.s/li.ns (Sch.dul. II
11, Tot.l Deductions
12. Net Value of Tex R.turn
13. Charltabl./Goy.~.nt.l Bequests; Non-elected 9113 Trusts
14. N.t V.luo of Est.t. SUbj.ct to T.x
5,227.50
,00
(11)
(121
113)
(14)
(9)
(101
J;,??7 J;O
4,198.21-
.00
4,198.21-
(Schedul. J)
If an assessment was issued previously, lines 14, IS and/or 16, 17 and 18 will
reflect figures that incl~de the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Aeount of line 14 .t Spous.l r.l. 115)
16. Aeount of line 14 t.xebl. .t line.I/CI.ss A r.l. (161
17. Aeount of line 14 t.xobl. .t Coll.t.r.l/CI.ss I r.t. 117)
18. Principal Tax Due
NOTE:
.00 X .00:
.00 X' 06:
.00 X .15:
(181
.00
.00
.00
.00
TAX CREDITS:
PAYMENT
DATE
DISCDUNT (+1
INTEREST/PEN PAID (-I
RECEIPT
NUHIER
AHOUIfT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. 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 HAY BE DUE
A REFUND. SEE REVERSE SIDE DF THIS FORH FDR INSTRUCTIONS.)
RESERYATlOth
PURPOSE OF
NOTlCEz
PAYltENTz
REF\.ICD (CA):
DIJECTIONS:
ADHIN
ISTRATIVE
CORRECTIONS:
DISCCUfT:
PENAL TV:
INTEREST:
E.tat.. of decedent. dying on or bafor. o.c~r 12, 196Z -- If .ny future Int.r..t In t~ ..t.t. I. tr~.f.rred
In po.....lon or .nJo~t to Cl... I Icoll.t.ral) beneflcl.rla. of t~ decadent aft.r t~ .xplr.tlon of .ny ..tata for
11f. or for y.ar., the eo-onwulth ~raby .xpr.sslY r...rv.. the right to eppralse and ...... tr.n.f.r Inharlt.-.ce Tax..
.t the l.wful Cl... I (coll.t.r.l) r.t. on any such future Int.r..t.
To fulfill the requlreaant. of S.ctlon ZI~D of the I~rlt.nc. end E.t.t. Tax Act, Act 21 of 1995. 172 P.S.
s.ctlon 9140).
o.tllCh tha top portion of this Notlc. and .ubIIlt with your paV-Mlt to the Rqlst.r of "U" printed on the r.v.r.. .Ide.
utWc.. check or RMY order payabl. tOI REGISTER OF MILLS, AGENT
A refund of . tax credit, which wa. not requa.tad on t~ Tax R.turn, ..y ba r.que.ted by cOllPlaUng .n "Application
for R.fund of penn.vlv.nl. Inherltanc. and E.tata tax" IREY-1515). Appllc.tlon. .r. avallabl. at t~ OffIce
of the Reglatar of "Ill., any of the 2J R.venue DI.trlct Offlc.., or by callIng t~ specl.l Z~-hour
en....r-Ing service ......r. for fotll. ord.rlng: In JJ.m.vlvanl. 1-8aa-36Z-2050, outsld. PennsYlvania and
wIthin local Harrisburg ar.a (717) 787-8094, TOOl (717) 77Z-ZZS2 IH.arlng l~alrad Only).
Any p.rty In Int.r..t not ..tl.fled with the appr.I....nt, .llowanc. or dl..llowanc. of deductions, or .....~t
of t.x I Including dl.count or lnt.r..t) .. ahown on thl. Notlc. .u.t object within .Ixty (60) day. of recalpt of
this NoUca by:
--written prot..t to t~ PA Depart..nt or R.venue, Board of Appe.ls, Dept. 2810Z1, Harrisburg, PA
--alactlon to hava the ..tt.r det.ndMd .t audit of the account of the personal rapra.entBtlva,
--eppaal to the Orphan.' Court.
OR
17128-IOZ1,
OR
FKtual .rrora dbcov.red on this .......ent .hould ba .ddr..sed In wrlUng tOI PA Dep.rblent of R.venue,
Bur.au of Indlvldu81 T.x.., ATTNI Po.t A......ent R.vl... unit, o.pt. Z80601, Harrisburg, PA 171Z8-D601
Phone (717) 787-6505. Sea page 5 of the bookl.t ''In.tructlon. for Inheritance T.x R.turn for. R..ldant
Decadent" IREV-lS01) for en axplanatlon of .o.lnl.tr.tlv.ly corractabl. error..
If any t.x due Is paid within thr.. (]) calandar aonth. .ft.r the d.cadant'. d.ath, a flv. percant (~) discount of
the tax paid I. allowed.
The l~ t.x ......ty non-participation penalty Is c~tad on the tot.l of the tax and Int.r..t ......ed, and not
p.ld bafor. January 18, 1996, the flr.t day .ft.r the and of t~ t.x aana.ty parlod. thl. non-partlclp.tlon
J*\8lty I. appealabl. In the .... ...-nar and In the the .... tla. p.riod .. you would appeal the tax and Intaraat
that hat bun .....sad .. Indlcatad on this notlc..
Int.r..t 11 charged baalmh'tll with flr.t d.y of delinquency, or nine (9) aonth. and OM (1) day frOll the det. of
death, to the date of paYHnt. Taxa. which bac... delln.,.nt bafora January 1, 198Z baar Inter..t at thct rata of
.b 16%) parc..,t per IIMU8 calculated lit a d.lly rate of .OODIM. All tax.. which ~. de11nquent on and aftar
Jenuarv 1, 1982 will ba.r Int.r..t .t II rat. which will vary frOll c.lendar y.ar to cal.ndar year with that r.t.
announced by the PA Oapart-.nt of R.venue. The appllcabl. Inter..t rat.. for 198Z through 1999 .ra:
!!!! Int.r..t Rata DlIlly Int.r..t FM:tor :!!!r Inter..t Rllta D.Uy Int.r..t Factor
U8Z 20X .000S48 1988-1991 lIX .000501
1983 16% .00008 1992 'X .000Zft7
"84 llX .000501 1995-1994 7% .OOOUZ
1985 13% .000556 1995-1998 'X .000Z~7
,... lOX .000Z7~ 1999 7% .OOO19Z
1987 'X .OOOZO
--lntare.t 1a calculatad a. follow.:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlca I..ued aft.r the tax bacoee. dallnquent will r.flect en Intare.t calcullltlon to flft-.n 115) day.
bayonet the data of the .......ent. If paYMnt Is aada lifter the lnt.ra.t cDIIPUtaUon data shown on the
Notlc., eddlUonal Int.r..t .u.t ba calculatact.
STATUS REPORT UNDER RULE 6,12
Ihvir, !;' <- r: ~(' " j, 6) /1 r cj~
Nllme of Decedent: J /
,
Dllte of Death: / "2-/ ( s II ~ f "
Will No. ,;(/ - ~(~/-J67~~ Admin, No.
Pursuant to Rule 6,12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1.
State wtether administration of the estate is complete:
Yes V No
2, If the answer is No, state when the personal
representative reasonably beiieves that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal repr~sentative file a final
account with the Court? Yes No V.
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 ~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.
'-' ,/ / . I
- '..jU ., <J,/..../~7t-<.-t. ..::./
5i nature /
J-. (/- {(.: ., .Q. 8('..,1 (J/J I/{, .k.
Name (Please type or print)
/f-~C3 ;P1:N~-R/j", :'!.f ~1JX'<t'.? , <,,-,,,,,
Ad ress " '--' " ',/" ,c
('7/ /) _J,,?'J....-;,;:? 76'.;
Tel. No.
Do<e' I {il f {
c.: - .
,
.;,
-
.~ ~
,~~
Capacity:
Personal Representative
Counsel for personal
representative
(MAH: rmfl AM3)