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HomeMy WebLinkAbout97-00002 21-97-2 " i i" , . ii ~ :0:0 ,\~~ 0" ,,, CD c::> " (~ ,-" -, - (~I n r,) n , , -, If: ~.;:. , J (', ~~ -.:; , , " , " ;-;,:1 (,ll t: -' in ~ ~". U1 )>;:1 ,/::0 ,:; 1:1:I.< -;< .... eal Po> :z ~ ~ o f! ...1. ~i:2" ,f!.1> , Pol-l A ----~- " o ..~ o '" (,' P:. 0 l:lQtJ O.li!: ';:-:--04 .. . ..It/l MII;\Z lI::i'l'l: E-< := , _.-- ,&l4 t ~. 11;\0 0 ~ I>l is ... '" II< IX: 0 III .... II., 0 .. I>l ~ ~ ~ ... t/l .... r.l ... H ~ Cl H II< II., 0<1; Recor\:if":" R("f!';:':-' < "'tl-""I "1"-' of d;; 'lA;j Willa FEB 24 P 1 :09 .~ ~ " ~ '*l' ::1 ~ . ~.: ~".'~ 5 ~ _ ~ :l \it ~~' .~.~ H "l ~ ~ - d\',ISOOOt (1,'IJ) ", 1ti~ V l)' J. I' JiJ e I:, FOR OATES OF DIATH AnF.R 12/31191 CHECK HF.RE IF A SPOUSAL POVERTY CREDIT IS CLAIMED I I FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FilED IN DUPLICATE WITH REGISTER OF WillS) COMMONWEA[Tti or PENN5YlVAN!A DEPARTMENT OF REVENUE Dfflr 1110601 Ji.~R RI ~~U.~~~X~__!_~~ 2a.O~O I DEt:EDHH'5 NAM( llA~T. FIRST. ^N(l~';ii)fjiT"INij"I-M-1 F'A'J.'CHBNKO, IGOR V. 206 (.:. I.ocusl Strocl 1"(''/'9.';'.~'6 Mechanicsburg, 1'1\ ] '1055 ''''''''f Cumberland Count:y 1',u~'/~!l"",!l """"" AM!)~/~CElV!" I'" "","U(II:"'I_ _ -: ____ I I 2 Suppltlmon!cll Rnlurn ! I 3, Romaindor Rolurn (for datos of doolh prior 10 lZ.13.82j [ I 40 Fuluro Inlerost Compromiso [---J 5. Fodoral E'laln lox RelVrn Requlrod (lor e1ulos of doath aher 17.12-82) r] 6, Decodent Died TOIIOI(l L I 7. Docodont Maintainod a li....ing TrUll .Q._ 8. Total Number 0/ Safo DOpOlil Boxos 1 (Allach copy ('If Will) (AHClch copy of Truul . . -ALL CORRESPONDENCE AND CONFIDENTIAL. TAX INFORMATION SHOULP BE DIRECTED TOt_ NA.ME COMP(fTE MAILING ADDRr~s HOWARD D. KRUG, ESQUIRE 1719 North Front Street fEiTp';ONTNUMBE""--- Hi.ll:d,f3burg, PA 17102 . "~Lc,","~~'="o=".=-=,,~,~~,,.=~, 0- as " w U w " "' 0- ","'v> uii1:': wOoU ",,,,, uCl:..J &;'" '" ",0- ~u ffi "''' a:z "'0 UOo I 2, 3. 4. 5, z 0 , 6. 5 :> /' 7, 0- 0: 8. '" U 9, w '" 10, II. 12. 13, 14. / 15. 16, 17. z " ~ I B, 19, Oo :E " U >< 20. '" 0- 21. SOClAl~~~i~~U4~~575 II>A7/;/~'6 11;~J~lil ,>u-ivl-';,;ic,',,;nu'>f.~ Ij~M! IIA~' l'Q',i AII{J "'i'iid IlIdlAl1 I ~ I, Original Roturn L.J 4. Umiled Eslolo =,J,~dJJJ ___?,H_=-~LI,~,_,~""" Rool Estate (Schodulo A) Stocks and Bonds (Schedule B) Clolely Held Slock/Parlnership Interest (Schedulo q Morlgages and Nolos Rocol'/ablo (Schedule Dj Cosh, Bonk Deposih & Miscellaneous Personal Properly (Schedule E) JOintly Owned Property (Schedulo F) Trans!"" (Sch.dule G}{Schedulo L) Totol Gross Assets (Iota I lines 1.7) Funeral Expenses, AdministratIve COIU, Miscellaneous Expon,e. (Schedule HI Deb", MOrlgage Liabililles, liens (Schedule II Totol Deducllons (totoll.ines 9 & 10) Net Volue of Estoll:l (Lino 0 minus line 11) Chorittlble and Governmental Boquesls (Schedule J) NOI Value Sublect to Tax (lIno 12 minuI L1no 1?L-_._ Spousal Transfers (for dOl01 of dealh aher b.30.94) See InstructIons for Applicable Porcentage on Re....erse Side. Ilnclude ....aluel from Schedule K or Schedule M.J Amount of Line 14 laxable at 6% rala (Indude values from Schedule K or Schedule M,l Amount of lino 14 laxable at 15% rate jlndude voluel from Schodule K or Schedule M.l Prlnclpal tax due (Add IOK from Linos 15, 16 Clnd 17.) Credits Spousol PQ~orly (rod it Prior Paymonls + ,:A) . (-/ '!- ()OO_>Z COUNIYCODI' YEAR .-_. i)j-(:'I.ilTiil~(jMrifU^()flR7.~:<'----- ~-~- NUMBER ~. .. {I} ( 21 _ (3) {4 I 151 .- ~-..~-:2 ~:? \~:. -.-.1 ,11 .. .."i>dl}.l- ,------ I .t", (61 (7) ____ "'\) ,.) u,073 -ttr----- (8 ) ( 9 I _______..1_,_1!.Q2.__._); , (I 0)_______2L,..9..4.6.--____~_ -, 25,851 (II) _________________ (12) ___J 19..Jl!tL-____ (131 ___________ (l4),__.--JL_______ (151 ________________,_.X,__= (16) ._,______________,_________ X ,06 = (171 __________,... ______,______X ,15 = (18) Di:;counl lnlerest + -,. (19) (20) 1/ Line 19 Is grooter than Lino 18, entar lhe difforenco on tine 20. Thi5 is the OVERPAYMeNT, Ii1!i:J Chock hero If you arc requosfin (I rcfu"d of your overpayn1ent. , II line 18 is greolor than Lino IQ, Mlor Iho diflornnco on Line 21. This is tho TAX DUE. A. Enter tho inlerost on lho bnlanco duo on lino 21A B. Enter lho 1011".1\ of lino 2\ and 21A on lino 21B. This is lho BALANCE DUE, _____~~~_~_~~~k.~':lt~~I. to: R.~I.t._,_~, Wills, A~~__nt_ (21) {21AI (2IB) ~T-C;~-:-- ------~ ~ BE SURE-YO 'ANSWER ALL-QU~!fIONS-ONiiEVERSESiDE AND TO RECHECK MATH' ,<..\ili(i~\W!WfI.;,:"., Under penaltio! of perjury, I dod<.tro Ihot I have mwminoel this r01Ufll, inc:iuding occompanying "hodulos and 11olomonh, and 10 Ihe bOil of my knowledge and belief, il is lrue, cor rod and complolo. I declNo thaI oil roo I 0\1010 hm hoon rnportoc! 01 !ruo morkot ....aluo, Doclmation of proparer olher Ihon the penonal repr~'onlolive is ba,~~~-.2.n .~.I!_0!.l)_~_112.~1.i.?~: ~!__~~Ich p.r(}'p~~6r_hOl nny k_nowllldgfl __ ___ ..__ . ______ .__._~_..z:!.L'Z___,. ___ SloNATU~l Of PfRWN RESPm-l~lfI~l fOR f~WH. RfTllRN r.(I[lRI ~~ I 2 Sou t: h.,' i 1 be r t H t reel OAH ~ l-\/~rl:;,('t,._ j f 1<,l -f (' (I ( /r ),' C McchanicHburq PA 170' r. SlGN^lU'-~)f fAI f'ARI R 01HlR HI^,~ At flRt ~ftH'\ liYI ^(jfl/iJ ~', . -. r :I.) [lATi '_ -I' " 119N. (.'nml litre"t '(.~/..(jl -,-' "_ ..~::'-":,,-'."'i lJarl.'J.sbl1rg, PA 1'1102 . /.' 1 ..':.IIOII,I(+\1.t11 ~, ,-" , " ~"""~ I.'" . iN. SCHEDULE E CASH, BANI< Dl,pOSITS AND MISCW.ANEOUS Pr:RSONAl PIWPr:llTYuu "_ 'u_ _1:I"o.",I~ri!l'orlYfl.~. - , -----"'ci'iTI.' ITIJM Ii I'IT"-'-"-'~~~"-~==~-= 21-97-0002 (nMMONW~I\lTlI Of P(:NNSYlV^NIA H~IH:RI'I'M4CE fAX: RUURN ___~___.._u.___. __.~r:~~~~~!~!,!~!..._.."_______. 'f.~ r^Yf:(51-----.---~- (rEM NUMIIEH -_.-.._-- -- ----------------.--. ----_.-,. ._" ._-----. 1"'~I,!..~~~o',.( 1~1!'I_I!:_~'::':'_':.~,~~~I,~~.!~~ ~l_~_ht III Sill "i""lllli" rill/II II" diHlulod Ol\ Sd\lI(IIlI~-rf- IGOR V. FATCHENKO L 2. 3. 4. 5. 6. ...,.~'" IlESCfUPTlON VALU~ AT Il^H or IlEArH 1993 Toyota Pas eo (Damaged vehicle w/"R" title. 1995 Mitsubishi GT 300 (Wrecked w/30,000 miles) 1989 Acura Integra (133,000 miles) 1988 Mercury Sable Spa (166,000 miles) 19,000 lTIi~es) $ 1,250 2,900 1,200 625 28 70 Teamsters Looa1 #929 Supplemental Inoome F~nd FarmerI;' Trust (checking aoct #12"'06060) " , -'- ----D;O'-r:r---- ___._._..----ISlJAl (0!~~tlor on lioe 5. Rocopllulalionl S ' - ..~~_u~ - _______.____~_-------+---_______'_____O___~_ (AHatll oddiliotl(J1 0'11" I< II" Ihllotl if rnMI) '[wen iIMl',dod.! , R(Y 1\11 "1 I' ~':I ESTAIt OF ITEM NUM8ER 1'10'''0 PrI,,1 0' TVI'" I FIIF NuMhER *1~97~0002 \.;j, .y '~}.')~:i;:~.~ ((.II.,I,HlfJV" ,1,1111 or /'f11l1~nY"lll^ ltl!lUlllldfU 'A): RrHlfHf !H '>10111111[( f(1[t11 SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCEllANEOUS EXPENSeS IGOR V. FATCHENKO DESCRIPTION A. funoral EXflO'UO!il 8. I. 2, MUBselman Funeral Home, Inc. Adml"I,',uflvo Co.ls: PorWl1ul Ropl O!iOf\ltJliVG 'Colllmisslons SOCkll ~ocvrHy r~umboror Porsonol Hoprosonlullvoi Yoar COn1rnISSIOllS pnid Allornoy Fo.. PUrcell, Krug ~ Haller 3. Fomily,Exomplion Ck,imonl 4, C. 1. 2. :1. ,I 5, 6, 7, 0, ~elolion,ltlp Add,oss of Claimonl 01 d'ocodonl" d.olh S"eol Addl.ss .-.----<--~._~- '~-..,.-- ".. ..-. "------ City "........51010 __.~__ "".llp COqO_ Prouot. Fo., MI.e.llo"eou. Ex".n.oSl Penn DOT - Transfer fee for 1989 Acura Integra Musselman Funeral Horne (death certificates) P~vel Fatchenko (labor & materials for (painting/repairing Decedent's vehicle) Dauphin County Treasurer (medical records copied) Graham s. Hetrick (Coroner's Report) AMOUNT 2,660 500 45 19 9 400 172 100 . ~---_...~.-...__.----~-~"_..". --,i,;;""o 'I'oeo h "eodod, In.o,' "ddlllonol .hooll of '011\0 .1,.0.) TOTAL (Also onlor on lino 9, Rottlpltu'<tlionl ,J_$____~.ltO~____ __~~~~~nn _ .__"__~__~~.~U___~__~~n UYI"IH., I' UI ~ ~. Q I~",:'t;o'" :\tN(.i,~1 0' ",<<,,'1' 1 ~!!III'r rll!!llll''-',!UA II'HI' II~, to I IA. 'l.IU~ II '1 ~ltl'tI! (\I(f(IPIr SCltwUI.[ I DWTS 01' D[CI:DI:NT, MORIGAGI: l.lAllllms AND LIENS 1_1_11'~IS_IIYfi_!I_'__1) ~ __lY.I',IJ_ I'II' NllMlIl'I1 --", 21-97-0002 '''All 0' rGOR V. FATCHENKO IHM NllMIIU, ""UIIPIION AMOlll~1 West Shore EMS (Aoct #6752) 2. Tristan Assooiates (Aoot #29987963) 3. Harrisburg Hospital (Aoct #33396112) - $ 705 221 2,674 90 777 5,679 5,800 6,000 4. Moffitt, Pease & Lim ASBO., Ino. (Aoot #FACTIG-OO) 5. A.Z. Ritzman AssD., Inc. (Aoct #HH00730159) 6. S & T Bank (vehicle loan) 7. Pavel Fatohenko (reimbursement for payment of debt to oreditor, paid by Deoedent's brother) 8. Nikolai Kostivohenko (reimbursement for payment of debt to oreditor, paid by Deoedent's unole ' and other monies borrowed) " ) > ~~"~'-'~--------+--";''''''''-'L_---n~'K".____,_o.,---'~_-'-',~_~~-;-----<--'-'''__K~--,--,_~_._'~_____~,.__ _--,'_ TOTAtlAIHT of\lor elfl 11M 10, l~nC:(1piluloli()f\1 s 21J946 ..... --,-" ,._ '_no h+_,_.-_.___.._.__.-.,~_____. (If moftl Iflllt;o i\ "'Jollod, imlHl tTddilio/!{llllt(lOls of lUliw ti7fl.) [~:~::=-~~~~~t _R-"Mi=~~C- _=J MAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... ifE" V'- i!;iij- Ei{ - AF po (Oi-:97T - NOY iCE - -OF - i"NHEiii;: ANc E - "fAx - 'A"PPR'A- i SE j.fEN'r-, - -A L. row ANc E" OR - - - - -- - - - -" - 0 - - - , DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTAn OF FATCHENKO IGOR V FILE NO. 21 97-0002 ACN 101 DATE 06-30-97 I', ! '.I' COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INIIUUTANC[ 'AX IJlVlSJOH DEPT. 700601 tllloIfHIS811HO, PA I71Z8-0601 NOTICE OF INtll:RIrANCE TAX APPRAISEHnrE, ALI,OWANCI ON DISAl.lOWANCE Of DEDUCTIONS AND ASSESSHF.NT Of TAX HOWARD 1719 N HBG B KRUG ESQ FRONT ST DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 17102 TAX RETURN WAS I (X) ACCEPTED AS FILED RESERVATION CO~CERNINQ FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. Med Est.te ISch.dulft Al (ll 2, Stocks and Bonda I Schedule B) (2) 3. ClalMly Held stock/Partnership Int.rasl (Schadula CJ (3) 4. Hortgaga./Not.. Raca!yubla (Schedule OJ (4) S. Cash/Bank DtlposHs/H1sc. Parlonal Propedy (Schedul. E) (5) 6. Jointly Owned Property (Schedule Fl (6) 7. Transfar. (Schedule GJ (1) 8. Total Auat. APPROVED DEDUCTIONS AND EXEMPrIONS I ~. fun....l EXPGn.../AdIlL COlts/Misc. Expense" (Schedule H) (If) ~O. nebts/MQrtglga liabiliti../Liens (Sch.dule Il (10) 11. Tot.l nadueUonl 12, N.t Value of Tax Return 13. Ch.rit.bl./Gov.rn~.nt.l Bequ..ts (Schedule J) 14. Nat V.lu. of Est.tM Subject to Tlx If an assessment was iusued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 1&. "..aunt 01 Lina 14 16. AIIQunt of L,t". 14 17, Allount of Lina 14 18. PrincipII Tlx Due 06-50-97 FATCHENKO 07-05-96 21 97-0002 ClJMBERLAND 101 CHANGED .00 ,00 .....QJL .00 6,073.00 .00 ,0lL 181 3,905.00 21.946,00 (11) (12) (13) 1141 JJ:~ ,triJf/i8 U~'l~H II If' IOI.tll IGOR V NOTEI To insure prope.. credit to your account, lub~it the upper portion 01 thil for~ with your tax PIYl1l11nt. 6,073,00 2~ .A~I 00 19,778,00- ,00 19,778,00- Non I 14. 15 and/or 16, 17 and 18 will returns assessed to date. .t Spou.at t .xable .t taxable .t r.t. Lin..l/CI... A rat. CollataraI/CII" B ..at. I1S) (16) (17) TAX CREDITS I ----- PAVHENT DATE RECEIPT NUHBER DISCOUNT (t) INTEREST/PEN PAID (-) ,o~ X ,00: ,00X,06: .OOx.15: (18) AHDUNT PAID TOTAL TAX CREDIT BALAHCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, .00 .00 .00 ,00 '; ,00 ,00 ,00 .~----_._-- ,00 -----..~~ IF TOTAL DUE IS LESS THAN $1, NO PAVHENT IS REQUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND, SEE REVERSE SInE OF THIS FDRH FOR INSTRUCTIONS,) I,., \,j I 0' , ,,;:1, u. ~ l_} 'J ; '\ l'~ ..,IV RESERVATION I E.tate. of dec.dent, dyIng on or before O.caab.r 12, 1982 -- 1f any future lntar.,t In the ..tate 1. tran.farrad In po.....lon al' anjOYlll8nt ta CIa" 8 (oollatara1) benaflohri". of the dae.dant \!Ift.r th. lI<plrat1on of anY ..tate for life or for year., the C~..onwealth herlb~ expre..ly ta.ervI' the rIght to appral.. and fi..a.' tran,far Inherltanoe Ta~e. ~t tha lawful Cia.. B (oollataral) rata on any such futura Int.r..t. f'URPOSE Of HOTICEI IJI\VHEHTI REFUND C CR): OBJECTIOHSl ADI1IH IS:TRATIVE CORRECTIONSI DISCOUNT I PENAL n': INTEREST I To fulfill the raquJruanh of SectIon 2140 of the Inheritanoe and E.tate TalC I\ot, Act 21 of 1995, 02 P.S. Sect10n 9140), Detach the top portion of thl. Hotlc' and lub.lt wIth your paYlant to tha Ragl.ter of Will. prlntad on th. revarl, .Ide. uHaka ehe~k or loney ordar payabla tOI REGISTER OF HILLS, AGENT A rafund af " h~ oredit, whlch was not raqulltad on tha Tal( Raturn, Ilay ba raqua.tad by coaplatlng "n "Applloat1on for R.fund of P.nn.ylvanla Inharltanea and E.tata Tax" (Rf.V.1313). Application. ara awallabl. at tha Offlc. of the Regltter of Willi, any of the 23 Rav.nu. 01.trlot Offloo., or by calling the .paoial 24~hour an.w.rlng ..rwlo. nueb.r. for for.. orderIngl In Penn'vlvanla 1-800-362-20S0, out. ide P.nn.Ylwanla and within local HarrIsburg ara. (717) 787-8094, TOOl (717) 77Z-2?52 (Hearlng I~palrad Only). Any party in Inter..t not .atl.fied wIth tha oppralla.ent, allowance or di.allQwenc. of d.dyotlon', or e.......nt of ta~ (Including dlloount or Intar..t) a. Ih~wn on thl. Notic. IUlt obj.ct within sixty (60) day. of r.o.lpt of thh NeUe. bYl -~wrJtttn protut to the PA O'lpartllont of RIIYanua, Board of APPlllh, O.pt. 2111021, Harrhburg, PA -..lectlnn to havI the .att.r datarlin.d at audit of the account of the p'r.onal r.pra.antatlv., --app.al to the Orphan.' Court. DR 171211.1021, DR Factu~1 .rror. dl.oovlred on this a......ent .hould bQ addra...d In writing tOI PA n.pert.ant of R.w.nua, Bureau of Indlwldual Tax.., ATTHI po.t A.....II.nt Ravlaw UnJt, Oapt. 280601, Harrhburg, PA 111211~0601 Phon. (717) 7117-6S0S, S.. paga 5 of the booklet "Inttruotlon. for Inheritonoe lox RllIturn for a Ruld.nt Oac.nant" (REY-1501) fnr an elCplanatlon of adllnl.trativ.ly corr.ctabl. arror.. If any tax due I. paid within thr.. (3) oalindar lonth. aft.r thi deced.nt'. death, ~ flvl percent (5%) di.count of tha ta~ paid i. allow.d. Tn. 15% tlX I~a.ty non.partiolpatlon penalty I. ~o.puted on th~ total of the tax and Inter..t a......d, and not paid b.fora January Ill, 1996, the flr.t dey after th. end of the tax a.nuty Plrlod. Thh non-partiolpation p.nalty I. app.al&bll In the .0.. .ann.r und In the the .a.. tl.. plriod .. you would app.al the taM and Intlr..t that hat b..n a......d a. Indloatld on thll notlo., Int.r..t 1. charg.d b.ginnlng with flrlt day of d.linqu.noy, or nln. (9} lonth. and one (1) day frOI the date of death, to the data of paYlant. T~lCII which b.o..a dllinqu.nt bofor. January 1, 19&2 b.ar int.r..t It the rite of ~llC (6%) percent p.r annul calculatld at a dally ratl of .000164. All taxe. which bee... d.linqu.nt on and Ifter January 1, 1982 will b.ar Intlr..t at a ratl which will vary fr~. oal.ndar Ylar to cal.ndar y.ar with th.t rlt. ar\nounoMl by the PA O.partM.nt of Raw.nu.. 'hi appl1cabl. Inter..t rat.. for 19e2 through 1997 arel '!!!r Inter..t Rata Dally Intar..t Factar :!!!r Inter..t Rato Olllly Intlr..t Factor 1982 20% ,000548 1987 iii:'. .000241 1985 16% .000438 19118-1991 11% .000501 1984 111: .000101 1992 'X .000247 1985 In ,000156 1995-1994 1% .000192 1986 10:C .000274 1995-1997 'X .000247 --Intar..t 11 calculat.d e. follow'l INTEREBT . BALANCE OF TAK UNPAID K NU"BER OF DAYB DELINqUENT K DAILY INTEREST FACTOR ..Any Hotlo. l..u.d aft.r the tax baeo.e. d.llnquent will r.fl.rot an Int.r..t aaloul_tlon to flft..n (15) dlYI baYQnd thl data of thl a.......nt. If paY.lnt 1. .ldl aft.r the Intar..t ooaputatlon data .hown on thl Notlol, additional int.re.t .u.t b. oaloulated. ?I~1'J~ii _H ~.rO~1'__lJN!J.~~_...B u g_&.,-E Name of Decedent: IGOH v. I'WJ'ClmNKO ~~--,~--- - Date of Death: .July 5, 1996 ~._----------~.- Will No. 21-97-0ll02 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-captione~ estate: 1. State whether administration of the estate is complete: Yes No X 2. If the answer j s No, state when the personal representative reasonably believes that the administration will be complete: 'I'wo Years - Case is in li ligation. 3. If the answer to No. 1 is Yes, state the following: d. Did the personal representative file a final account with the Court? Yes No b, The separ'ilte Orphilns' CUllrt No. (if any) for the personal representative's ilccount is: c. Did the personal representative state an ar.count informally to the pilrUes in interest? Yes____ No d. Copies of rece~' p , t leases, joinders and approvals of formal or informal ac ounls ay be 'i~~~ith the Cerk of the Orphans' Court and ma be att c ,t'o/this report. ~, '/ / L 1// ,/ Date: 61ft> 51? . -./ __' , / /' , I ~ H ward 8. Krug, Esquire Name (Please tr.pe or print) 1719 North front Street Harrisburg, fA 11102 AddresS--- ~7 I 234-4178 Tel. No, Capacity: Personal Representative (MAH :rmf/AM3) J( Counsel for persona 1 representative jI;' .-' - \:.1 ~ H :> p QI ili I:-< tIl 0 ili ii\ Iii t.? '", 0 -l:l ~ ~' H p:, . 0 ii1 . . .~ 0 t)l 6 1'<<0 0 ili !~~ f P O~ 0 ~ 0 tIl ii ~~ I p ]1 ~ r-- E-< ~ <CU 'a-, .0: I!l Oil:-< a-, I:-< .. II/ <C M tIl .~ ii1 0.11'<< e:t: ~ :t :z: 0 0 H :z: Il;\ -"-- . , . ~ . , - -, ' ' -,""1#..' ',",,14't....tILI ....-111'. ','ClN~'OO4W'1l1WN'1t1J.'fWTW ,-CH,\I,"lf,""'j!\,lli(.II'lllfj';'I\,Miii\ lJli'J\I\jl,lU/lulllh'UIUI 1Ii.IJIj;\t.II)1 lilliIVI[HI'\1 1'\-(1 UU'1 :'lhu)(;l Ili\HflhIJUlIc;,I'A IJlilllJhl1 RECEIVED FROM: KRUG HOWARDB 1719 NORTH FRONT STREET HARRISBURG, PA 17102 ...'....lnl'l PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT EST A TE INFORMATION: SSN: 166-74.5575 FILE NUMBER: 21-1997- 0002 DECEDENT NAME: FATCHENKO IGOR V DATE OF PAYMENT: 01/02/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/05/1996 REMARKS: HOWARD B KRUG ESQUIRE CHECK# 43736 SEAL ACN ASSESSMENT CONTROL NUMBER TOTAL. AMOUNT PAID: INITIALS: AC RECEIVED BY: 1<I:X;1R'I'I':1< OF wn,r,s '101 !lL'/ 110/ I:Xlll'!fH NO, CD 000712 MARY C. LEWIS REGISTER OF WILLS AMOUNT $23,000,00 $23,000,00 . ) .-, ,.. '" bDe~edef.1.t~~ComPlete_~ddress..: ______~______ __ _ _______ ,_ _ __u_ __ ]!11111.[{'fH " 206 East LoclIst Stl eel . ____..__._. ._..__.., _. .~_'~'U'_ _ _. ____ ,.,_..__.u_....__..___.~_._..~____._.___ ~~-~~e~~irl-,:SI?lIlg, ____-==~===~___ _________ ____L "~' _~~___,,_=r51~5;-__:=~=~ Tax Payments and Credits: I T ii' Due (Page 1 line 19) 2 CreclilslPaYlllents ^ Spousal Poverty Credll R Prior Pnyments C Discount (1) 21,639,92 23.000,00 Total Crndllf> (A + B + C ) (2) 23,000,00 3 InleresVrenal~/11 applicable D Inlerest E Penally 0,00 0.00 4 TolallnloresVPenally (0 + E) (3) II Line 2 IS grealer Ihan line t + Line 3, enler lite dlllerence. Tltis IS lite OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) II Line I + line 3 IS grealer IMn Line 2, enler 1118 dlllerence TItIS IS Ihe T AX DUE. (5) A, Enl'" Ihe Interesl onlhe lax due (5A) t, fnler Ihe Iota I 01 Line 5 + 5A ThIS IS Ihe BALANCE DUE. (5B) Make Check Payable to, REGISTER OF WILLS, AGENT 1,360.08 000 0.00 0.00 5 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Old decedenl make a transfer and CI rfJlam lhe use or Income of the property transferred: b retain lhe right to designate who shall use the property tr;:msferrecJ or Its income;, c relam (-I reversionary interest: or cI receive Ihe promise for life of cllher paymenls. benefits or care? 2 If dealh occurred alier December 12.1982, did decedenllransler properly WI lit in one year 01 dealh Wllhout receIVing adequate consideralion? :3 Old decedent own an "in trust lor" or payable upon doath bank accounl or secullly al hIS or her dealh? 4 Old decedenl own an Indtvldual Retirement Account, annully, or olher non-probate property whICh conlall1s a benellctary deslgnallon? 'yes 110 0 [8:1 0 [8J 0 [8J 0 [8J 0 [8J 0 IX! 0 l8J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPI.ETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, ,hdflt r~nJ\If<<; 01 pllqUry I (11.'Cll(rl nil! I !lEl','O o~mlllf1CO Ihls returt' 11Ir,l1(j,IHJ ilCwmponymq 'iGt.<HJuh'~ md ';IJtQlllp.nts <lnd 10 llio l)f)sl of IllV ~ncw~dqfl ,1I,d h,ln[ II 151nl'l WIW{:,j and L'lmplJ!.) llo:';~lr.jlIOl' (11 plr'fHlIl1( olll.]f llinn Hill piwi)nalreplflsenlflil'/I) IS b:I',lld Oil a'llllr(JlllldllEJI1 of Wllidl pr.-,p,lr,'r h:I'; any ~no'li\;>dql' ~;IGI'lf\ 1\ JHe \JF f'Er\[iOI'1 m~~';1'01ISIBI.E FOR r:Il.HIG HETlIRt) /.ilit I), I / I-I -;, /1' i 1",'- M'III'i',', 12 Soutn Filbert Street Mect1anicsbllrg, ')ll;II'\ itit-;H,IF f'l{lT!\RCF; (\fl-lf_H THAtI f\!:f-'Rf.SEII(,'i rlVf" 'II I.i. I , It. "(, MAiiil:," 1719 North Front Street Harrisbur(J. ,[).tI.H: i 1/,;/,' PA 17055 )i'~I: / ,. '1/1 PA 17102 F or datE'S of dr.ath on or Hr!l'r July 1, 1994 and before .lallllC1ry 1, 1995, lhe tax rate Imposed on the net value of trfH1sfms to or for lhe use of the sllrvivlll~J spouse IS 3% [71 i' S ~9116(alllllll)1 For dr:lles of dmlth 011 or allm Januwy 1, 1995, the tax rate Imposed on flip. nel vallie 01 transfms 10 cr for the lIse of lhr surviving spollse IS 0% [72 PS 39116 (a) (1 1) (II)] The st<11ute dO(~8)Q~llilllL\ fl transfer to fI surviving spollse from l(lx, anclthe Sli-llutory reqlllrerli!!f1ls lor disclosure of assets and filing a lax relurn are slill applicable even If lhe slIrvlvlnn spouse IS the only beneflcimy For d31(!:; of death 01\ or (Iller .!llly 1,2000 The tnx ratt! Impo~;r.d on llw nel value of transfers from a deceasec! child lwenty.olle years of i1ge or younger ilt detilh to 01 for lhe lIse of El mlluml parenl an <ldopllvr pmelll or a sl'pp,,,ent 01 lit" rhtlcl" 0% [72 r s 99116(01(1 2)1 Tile tilX rElte IfllPOSP(j on ltw rwt valtw of tmns/err, to or for the lJSf! of the decedent's Irneal benefiCiaries IS 'I 5U/CI, exrepl <tS noted in 72 P ~:; 5911G(1 2) [72 P S ~gj 16(il}(1)] Tlw lHX f"lo Ill1posnd Oil Uw rwt villuD of transfers 10 or for the uso of the rlecedenl's slblmgs IS 12% [72 P S 99116((11(1 3)) A slblmg IS clefmcd, under SectIOn 91\)2, as (If) mellvlduClI who has atlNls! anp. pmf'nt III cornmon With the decodent, whelher by blood or adoption COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES !NIIUU 'flNef. TAX OIVISION ntPl. l80601 tIMIRISIIl!Rr., fl^ lllZlH60t NOTICE OF INtlERITANCE TAX APPRAISEMENT, Al.lOllAtlCE OR 0lSAI.1.0WANCF OF DEDUCTIONS AND ASSESSFtI'NT OF TAX 06-30-97 FATCHENKO 07-05-96 21 97-0002 CUMBERLAND 101 [-:_=-:~~~~~~:R~ili~-~~~----~l MAKE CH~CI( PAYABLE AND REMIT PAYMEN'T Tal REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ 1t~V ~ i ~ "('"i - j: y -~i: ii - f 1i="-: Ii; Y -Nor T F. i:" "oF - YN~i R-f f A torr. i - TAX - Xli PR X f S EM-If '1 'f: "A i row ~ii'c E. "oii -.,." -. - - -" - - - - --" DISALLOWANCE OF D~DU~TIONS AND ASS~SSMENT OF TAX IOOR V FILE NO. 21 97-0002 ACN 101 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN HOWARD 0 KRUG ESQ 1719 N FRONT ST HOG PA 17102 ESTATE OF FATCHENKO _N~_'_'___"_'___' I CWANOED TAX RETURN WAS I I X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE R~VERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~ate (Schedule A) 2, stocks and Bonds (Schedulo B) 3. Clogo1~ Hold stock/Portnnrship Intore9t (Schodulo C) 4, Mortgages/Notes RaooivRble (Schodula OJ 5. CAsh/Bank Doposits/Hisc, Personal Proporty (Schodule E) ft. Jointly Owned Proper'ty (Schedule F I 7. Tranaforn (Schedulo 01 8. Total Asset9 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. funeral Expensos/Adm, Costs/Misc. E~ponscs (Schudulo H) 10. Dobtu/Mortgage Liabilities/Liens (Schedula I) 11. Total Deductions 12. Net Value of Tax Roturn 13. Charitablo/Govornlrlental Boquoijh (Schodulo J) 14. Net Value of Estato SUbjoct to Tax 11' an aSS8!JSment was bllU..'; pt'El~ J.".....~~, :dt,,,.. rBflect figure I thBt include the total Df ALL ASSESSMENT OF TAXI IS. Amount of Line 14 at Spousal rote 16. Amount of 1.1no 14 taxabln at Uneol/Cless A rata 11. Amount of line 14 bxab1e at Colla-tural/ClooSl B rnh 18. Principal To~ Duo NDltol TAX CREDITSI PAYHENT DATE RECEIPT NUMBER DISCOUNT C'l INTERESTfPEN PAID C") ------~-~.-.._-_.- --.---..---- lll_ I~l_. 131 14'_ 151 16) 171_ 191_ llOI ,00 .00 .......Jl..Q... .00 6,073.00 .00 .00 CBl 3,905.00 21.946.00. 1111 (12) 1131 114) ~'" 'Ij.all II IfP Ill-III IGOR V .00 X,OO. . Oil. K .06.___ . DC!. X .15. 1181 AHOUNT PAID DATE 06-30-97 NOTE I To lns~lro proper credit to your aCCClllnt I submit tt,o uppor portiot, of this form with YOllr tax payment. 6,073.00 ?~.BSl 00 19,77B.00- .00 19,77B.00- 14, Hi cuiu,uj". 1(" 17 and 18 wil::' re~urn9 Bssessed to date. llSI 116)_ 1171 .00 .00 .00 .00 ..- --" '~ TOTAL TAX CREDIT .00 . ._~~-- --.--..------. BALANCE OF TAX DUE .00 -.---------- --... ---- INTEREST ANU PEN. .00 --~-.._-_._-_.-._..- ----_.--~ TOTAL DUE .00 ..._----~.- ..-..-- .-.-------- ----_.-_.~.--~-_.._---~-- INDICATED. SEE REVERSE AOPITIDNAl INTEREST. IF TOTAL DUE IS lESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFI.ECTED AS A "CREDIT" ICRl. YOU HAY BE DUE ...... ....".......r "u,r I'lr: T"'T~ enDH en" nJ'I:,TllllrTTON5. l PURPOSE OF NOTICE I To fulfill ~h" rllqulrelll"nh of Seotlon 2140 (bl' of thu Inhel'lhnce and E,tah TaM Aot, Aot 2! of' ZOOO, (72 P,S. SeoUon 9140), PAVHENTI Detaoh the top portion of, thh HoUoe ftnd lubllllt with !fOllr paYlIlunt to the Register of Willi printed on the reverse side, u Hake ohlok or .0n1lY order payable tal REGISTER OF HILLS, AGENT, REFUND (CRII A rofund of B taM crudlt ny be requutod by oOlllpleting sn "Application for Rofund of Penntlylvanht Inheritllnou l!Ind Estate Tax" (REV.B13l. Appllolltions are 8vai1ab!e 8t the Offlce of the Reghter of Willa, any of the 23 Revenue Distrlet Offiou or frolll the Deparhlent't1 24"hour answering liervlt.le for (or.. orderlngl 1"800-362'2050; !il8rvlces for t8Mpayers wIth sjlu,~lal hot'lting @Inri I or speakIng neeelsl 1-800'447-3020 (TT onlyl, OBJECTIONS I Any party In Interest not lIathfhd with th8 assesslIllmt of taM l'ltI shown on this noUee lay object within 51Mb (60) days of receipt of thls Notice bYI --written protest to the PA n"p8rtlllent of Revenue} Board of Appeals, Dep1:. 281011} Harrisburg, PA 171211"1021} OR ~-elooting to have the .atter deterlllIned at audit of the personal representatIve} OR --ilppul to the Orphans' Court. AOHIH~ ISTRATIYE CORRECTIONS I Feotual errors discovered on this eSS8SIIIl,ant should be addrossed In wrHing tOI PA DOpllrtlllont of Revenue} Buroell of Individual TollOS, ATTNl Post ASllUfilllont RevloN Unit, Oept. 280601, Harrisburg, PA 17128-0601, Phone 17171 787-6505, See page ~ of the booklot "Instructions for Inherltllnco Tax Return for B Rnidont Decedent" (REY"15011 for an oxplllnation of Kdrlinistratively oorreotable errors, PENALTY I The 1~% tax alllnesty non"partIoipatlon penalty is cONputed on the total of the taM and Intoro~t assessed, and not paid before January IB} 1996} th8 first day After tho end of the tax arllnesty puiod. Thllt non~perticipatlon penalty is oppealeble in the S6111e Manner snd in the the sau tile perIod B!i yoU would appeal tho talC snd Interest that hss been 6ssessed as Indicated on this notice. INTEREST I For date, of death on Dr after 10~3~91, PonnsylvenIo Estate TalC based on the Fodoral E~tAte TaM return beoolllllS delinquent at the e)(plr8tlon of nine (09) llIonths frolll the date of doath. For dllltes of death prIor to 10-3-91, Pennsylvania (state laM bllsod on the Federal Estate lax return beeollles delinquent at tho expiration of eighteen (18) llIonths frolll the dBte of dUBth. TSM8. whioh beca.e delinquent before JanlJfll'Y 1, 1982 bur Jnhorllst at the rate of aix 16%1 percent per annuli Claloulatwd at B dally rate of .000164. All taMIIS which booalllll dsllnquent on or after Janusry I} 1982 will bnr internt Itt a rete whloh will vary fro. ollhndnr yeer to oslendar ynr with that l"atH llnnounoQt! by the PA Depart.ent of Revenue. The appllcRblu Intorost t8tes for 1962 through 2002 erel Vear Inbrut Rahi Dally Interost Filotor Venr Interest Rate Dally Inter"ust FAotor 1982 20% .000548 1992 9% ,000247 198~ 16% .000438 1993~1994 7% .00019Z 1984 11% .000301 1995-1998 9Y. .000247 1985 13% .000356 1999 7% ,000192 1986 10% .000274 2000 8% ,000219 1987 9X .000247 2001 9% ,000247 1988.1991 11% .000301 200? flY. ,000164 ~-Inhrut Is oalou1l!lted .. follows I INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notloe issued after the tax b800~es delinquent will rofleot IIn interest esloullltien to flfte.n (IS) day, beyond the data of the US8Bslllant. If paYlll8nt is lIIP1de after the 1,,1:8rOlt ao.putatlon data shown on th. Notlel, additional lntutest .ust bo oRlculftted~ / [)..;_s/- ~ JI)REA~ OF INDIVIDUAl. TAXES INHUHTANCE 1M( lllVISItlN IJEPl'. 2110601 HARRISIlURu, fl" HIllI-0601 COMMONWEALTH OF PENHSVLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. AllOWANCE OR DISAll.OWANCE Of DEDUCTIONS AND ASSESSHENT OF TAX '[)l DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03~04-2002 FATCHENKO 07-05-1996 21 97-001l2 CUMBERLAND 101 JILL M WINEKA ESQ PURCELL ETAL 1719 N FRONT ST HBG \- [' ' PA 1 ~H~ I, Amount ROlllHtBd - .-. -:3- - - - - - -~-------- - - -- - ----- --- --~ - ~ - - --~-- MAKE CHECK PAVABLE AND REMIT PAVMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ... R 'EV: i5r.-i - E'iC A F p" (ii F Ii 2 Y' NOY i tE - '01' - YNHEff i;: ANe E - YA X - A-P PRA- is EMENT ~ ~ -iI i::L~ow A N-C f.' (iR' -....... - -. -.. - - -. DISALLOWANCE OF DEDUCl'IONS AND ASSESSMENT OF TAX IGOR V FILE NO. 21 97~0002 ACN 101 14, I5 and/ol' 16, 17, 18 and 19 will l'etul'ns assessed to date. ,00 X 00 .00 - 360,665.30 X 06 = 21, 639.92 .00 X 00 = .00 ,00 X 15 = .00 (19)= 21,639.92 ESTATE OF FATCHENKO TAX RETURN WAS: { ( X) CHANGED ) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real EiSltat8 (Schedule ^ I (1) ~ 2. Stocks find Bonds (Sc..hedulo 8) (2) 3. Closely Held stock/Paf'tnorship Intol'ost (Schedule C) (3) 4. Mortgagos/Notes Roceivable (Schadu18 DI (4) 5, CQsh/Dank Deposits/Mise, Personal PI'vpel'ty (Schedule E) (.5) b, Jointly Own"d Property (Schedule FJ (6) 7. 1r8nsf81'5 I Schedule G J <<7) B. Total Assets NO. 01 .00 .00 .00 .00 364 , 0'2L.ll. .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad,", tosts/H.\sc. ExpensBs (Schedule flJ 10. Debts/Mortgage liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Returl) 13. ChlAritable/Govef'''llIental Bequests; Non-elected 9113 Tr'Jsts (Schedule JJ 14. Net Value of Estate Subject to Tax (9) 1101 3,655.86 .00 (11 ) (121 ll3) (141 If a~ assessment was issued pl'eviouslY, lines I'eflect figul'es that include the total of ALL ASSESSMENT OF TAX: 15. A~ount of Line 14 16, Alllount of l.ine 1', 17. Anount of Line 14 18. Anount of Line 14 19. Principal Tax Due TAX~I.SJ DATE 01-02-2002 01-02-2002 NOTE: at Spousal rate taxable s.t lineal/Class A rate at Sibling rate taxable at CollaterBl/ClQss 8 (15) llb) 1171 1181 rata , --1lEcrII'I-'--'-'--' NUtlBER cliliOii71Y-- WRITEOFF -----~-UISt:Ot.JlIT-(lr'--- INTEREST/PEN PAID (-) 1,360.00- .00 AHDUNT PAID 23,000.00 8,603.20 C/ *' RFV.j~~1 r,~ UP (H.Ot! IGOR V SEE DA'rE 03-04-2002 ^TTACHED NOTICE NOTE: To insUf'e proper credit to your account, submit th8 upper portlon of this form with your tax paYlllent. 364,099.16 3.6~~,66 380..443.30 .00 360,665.30 TOTAL TAX CREDIT 22,999.99 ~,.."",,,-~--,~_.,.- ......._..".~"",..".__.... BALANCE OF TAX DUE 1.360.07CR ......,." - ......... .--,..-.............. .......--------- INTEREST AND PEN. .00 .. ....- .- -------------_..- TOTAL DUE 1,360.07CR . IF PAID AfTER DATE INDICATED, SEE REVERSE fOR CALCULATION Of ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENI IS REQUIRED. IF TOTAL DUE 15 REflECTED AS A "CREDIT" (CR I, YOU HAY DE DUE A REFUND. SEE REVERSE SlOE OF THIS FORH fOR INSTRUCrIDNS.) RESERVATION I EllbtaD of decedatlU dying en or bufofe D8oe",ber l~, 19112 H if any future! Intftf8lt In the utnte Is tr'ansfarred 1n poslesllon or .njoY~ent to ClaRI e (coll.terall beneflolar18s of the decedent after the e~plratlon of any eltate for life or fOfyeDfl, the Co~~onwe81th hereby expr8111y reserVeD tho right to apprallD and assels transfer Inheritance Taxes at the lawful ClasI8 (collaterall rate on any luch future IntoreMt. PURPOSE OF NOTICE I Tu fulfill the requirements of Sect Ian ?140 nf the InherJtancR Dnd Estate Tax Act, Act 23 of ZOOO. (ll P.S. Sootlon 914D l. PAYMENT I Detach the top portion of this Notice end sub",1t wHI1 your paYlll8nt tn tho RII~lst8r of I<Hlls printed on thu rllvllrse side. uHako oheck or 1II0nDY order payablll tal REGISTER OF HII,LS, AGENT REFUND (CR'J I A refund of . tax credit, whluh was not reqllDstod on tho Tax Roturn, ",p,y bo raquulEld by complotlng an "A?plicatlon for Refund of PunnlylVllnla Inherltanoe and Estab Tax"' IREV~1313). AppllcntJoO!~ ore ovallablo at the Offloe of the Reglster of Wills, flny of the 23 Revenuo [ll5trlct Offlcos, or by oolllng tho special 24-hour enlwDrlng servioe for foru ordllrll11.l1 }-800 3u~0!0~OJ sorviao:: for !axpul/ors I<Ilth o;pflCdBl hllarlnR nnd I or speaking needS! 1.8DO~447-3020 (TT only). OBJECTIONSl Any Nlrty In lnter.ut not satisfied with the appralselllent, allowance, or dlullowanca of deduotlons, or nlSus.ent (If tax (Inoludlng d!llcou"t or IntnrOllt) I!l9 shown on thh Notloe must ob.1ect wi thin sixty 160l day. of reoeipt of this Notice bYl --wrlUe!l protest to thll PA Oepl1rtllllmt of Revenue, Board of Appellls, Dert. 1.61021, Itarrlsburg, PA 17128.'1021, OR ueleotlon to have the lIIatter deter.lned lit audit of tho nccount of the personal representative, OR ~~apPDltl to thll Orphans' COUft. ADMIN- ISTRATIVE CORRECTIONSl Factual errorl discovered on this !lIS8SsllDnt should be addroued In IoIrHlng tnl PA Deparblllmt of Revlilnue, BurDau of Individual Toxu, ATTNl Post AlllleUMtint RIIVhl10l lInlt, Dup\. 280M1, HArrisburg, PA 17128.0601 Phone (717J 787~650!i, See page 5 of th8 book lot "Instruotions for tnherltonos TfI)< Return for a ROllldfll1t Oecedent" (REV-IS0l1 for an e)(planation of f1dlllJnistretlvDlY corl"HotnblD errors. DISCOUHTI If any tax due Is raid within thrllD (3) calendflf 1II0nthll afhr thll deoedflnt'lI doath, a five percent (5%l dllcount of the tax paid II Illowed, PI::NAlTYl The l!ir. tal< ..ne.ly non~partlclpatlon penfllty is cOMputed on the total of the tftX and Jnterelt aueued, and not paid before Janullry 18, 1996, thll first day after thll end of tho tfll< f1l11nllSty poriOd. This non-partlolpaUun penelty I. BPP8"lable In the .nllle lIIanner nnd In the the 'SIllII tl1118 purlad as you Would appeal the taK and tnterest thBt ha, baon allenlld at Indlauted on thls natito. INTERESTI Inhr8st II Clharged beginning with fiflt day of tlollnqulInoy, IIr nino (9) Gonths and one {II day frolll the dati of dutil, to the data of paYllIent. "'xus which ht/tlllll8 dollnquent before Jnnuar:,o I, 1982 hear Intorut at thE! rate of .he {6r.l p"rcent per annulII Qaloulatod fit fI dally rL'lte of .000164. All tOKU whloh beoalll9 d"lInquent on and IIfhr Janunry I, 1982 will bear interut lit II rnte ..hloh will VllfY frolll cll1endflr year to oalendar year with that rate announcod by the PA lIeport~ent of Revanun, Tho appllc.bhl Irlterut ratos for 196? thrc.ullh ?002 arel Vur Interut Rnt. DfI!ly Intere.t Faotor Vellr Intorost Rute (hilly Intorest Factor 198? ZOX .000548 1992 9X .000247 1983 161: ,000438 1993-1994 'Ii:: .000192 1984 11% .000301 1995-1998 <1% .000247 1985 H% .000356 1999 1r. .~DOI9Z 1986 10% .00(1274 ZOOD OX .000219 1987 9X .000247 zoo 1 9;( .000247 196&-1991 11% .0110301 ZOO? 6% .000164 ~-Inter8llt is oaltlulBted .. followlI INTEREST c BALANCE OF TAX UNPAID X NU"B~R OF OAYS DELINQUENT X DAILY INTEREST FACTOR .-Any NotiCle luued after the tnK becouI d..Unquent will reflect an Jnbrut oalculation to fift.en (15) dfl)'1i beyond the date af the atUUlllent. If flay..nt 11 lIIade ftftflr the Anterut oOlllpuhltinn date shown on the Notioe, additjonlll Inhll,..t IIU.t hi onlculnted, PAVHENl, Detaoh the top portion of thJ. Hotio. and ;u~.it with your .p.y~ent .ade paY.ble to the n... ~nd addr..s print.d on the 'Rever.. side. If RESIDt::NT DECEDENT "ske oheck or Rloney order ptlyabh tOl REGISTER OF WILLS, AGENT. If HONRAESIOENT DECEDENT lIillle ohllok or "'oneY ordllrpayabl8 tOI COMHONWEAL TH OF PENNSVLVANIA. REFUND (CRl I It refund of a tal( oredl t, whlnh WllI not ruquutad on thQ hI< Retul'n, ",ay be raqu511lted by oOlllpleting 8n "AppUo.'lon for R&funrt of Panns,Ylvtlnl"" Inherihmce lImd Estate 181<" IREV-131!,). ApplJauttorll are flvalhble at the Offloll of the Register of With, Any of tho 23 RovonuiI Dl!Otr.lot OHioQS or froWl the Dlilparhlei'lt'R 24..hour answering .ervloe for forllls ord.ringl 1-800-362.20501 servloes for tSMp8yerS with spgolal hear'ng and I or .p8llklng nefldsl 1-800-447-3020 ITT only). NEPlY TOI Questions regarding orrors oontalned on this noUoe f1hould 013 oddrused tOI PA Departlll9nt of Revenue, Buruu of IndlYidu~1 Taxes. ATTHI Post Assessment Review Unit, Dept. 28D601, Harrisbur~, PA 17128-0601, phon. (717) 7t17-6CiO!i, DISCOUNT I If any taK due Is paid within three (~) oalendar Month~ after the deoedent's de~th, a five peroent (5~) disoount of th. tex paid is allowed. PENALTY I The lSY. taM Ii.nuty non-partiolpation pe/la1t.V Is oOrlputed on the total of th51 tal< IlInd interest auassed, - and not paid before Junu~I'Y 18, 1996, thu first day after the-ilnd of thlil tal< alllnesty period. INTEREST I Interest I. oharged b.~innlng with first day of dellnquenr.y, or nine (9) lonths and one (I) daY fro. the data of death, to the data of paYMent. TaMes whioh bloaMe dolinquent before January 1, 1982 beer Interest at the rate ,of six (6X) peroantpar annUM oaiculated at 8 daily rate of .000164. All ttlMeS whioh becaMe delinquent on and after January 1, 1982 will bear Interest at 8 I.ate which will vary frOM ardander year to calendar yeer with that rate announoed by the PA Depart.ant of Revenue. ThQ applloable interest rat,~ for 1982 thrcugh 2002 ar81 V..r Interut Rate Dally Interest Faotor Vllar Inhrut Rate Dally Interest Factor - 1982 ZOY. .000548 1992 9% .000241 19&:5 16% .000438 1993-1994 7% .000192 198' 11% .000301 19~5~1998 .~ ,000247 1955 13:< .OnO:5S6 1999 7% .000192 1986 10~ .000274 2000 .~ .000219 1fj/1!I7 9% .000247 2001 9% .000247 19ftS-l991 11% ,00D:501 2002 ,~ ,000164 --Int.rast 1. c~loulatRd as follows I INTBREST = BALANCE OF TAX UNPAID X NU"RER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ~~ltny Netic. issued nfter the taM 000011I118 delinquent will refleot an Int.rut odCUhtlcn to fUben (1S) daYII b.yond tho date of the a5seSSlllent, If paYM.nt is iliad. after the Int8r.~t oOMputation dlt~ $hown en th. NoUoe, additional Interest lIust bo oaltlUhtad. WHEREAS, on March 15, 2001, the Decedent's Father, Valery I. Fatchenko gave his Interest In the Decedent's intestute Estato to his surviving son, Paul Fatchenl<o, A copy of the Maroh 15, 2001 Gift Letter is attached heroto and marked Exhibit "E"; WHEREAS, Lyubov Fatchenko and Paul Fatohenko, who are the only benefloierles of the Estate and the only parties signing this Family Settlement Agreement and Final Release, previously aoknowledged In writing their Joint receipt of $50,000,00 paid on January 14, 2002 as a partial distribution of the residuary of Ihe Estate as set forth on tho Acknowledgment of Partial Distribution Which Is attached hereto and marked Exhibit "F"; WHEREAS, $1,000,00 of the Estate monies will be held In escrow In a non-Interest bearing account by Purcell, Krug & Haller for payment of Any outstanding Income taxes on behalf of the Estate, preparation of the necessery Income Tax Returns, and for any other liabilities of the Estate which may come due; WHEREAS, the balance of the Estate monies will be distributed in accordance with the Stetement of Distribution which Is attachod hAreto and marked Exhibit "G"; NOW, THEREFORE, we, Lyubov Fatchenko and Paul Fatchenko, being the only two beneficiaries of the assets of the Estate of Igor V, Fatchenko, do hereby acknowledge that we have received the liquidated pr:Jceeds of all assets due us, by virtue of the intestate laws, with the exception of the $1,000,00 held In escrow, as set forth on the Statemant of Distribution attached as Exhibit "G". AND, wa do hereby stipulate tltat In order to avoid the expense and time Involved in the filing of a formal account and proposed schedule of distribution, we agree that no account is necessary and we . ) consent to distribution being made without the formal filing of an aocount and schedule of distribution, the same to be with the same force and effect as If the documents had been flied and confirmed by the Orphans' Court Division of the COLlrt of Cumberland County. THEREFORE, we do hereby release and forever discharge Howard B. Krug, EsqLlire and Jill M. Wlneka, Esquire and the law firm of Purcell, Krug & Haller, the Attorneys for the Estate, their assigns, executors and administrators, from all actions, suits, payments, accounts, and claims whatsoever, . I touching L1pon the Estate of the Decedent. We also agree that should any liability come due to the Estate of the said Deoedent after the signing of this Agreement, and efter exheustlon of the $1,000,00 being held In the esorow aocount with Purcell, Krug & Haller, we covenant and agree that we will share eQLlallv the 2 IlIV'30U l.(1 (/'14) '" >-, ><:,~VJ (..tn:::~ w,,-W ",00 L1[a( "- 0< I', fll,}:,~:~" .I,t,~~~ " , INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) FOR DATES OF OEATli AmR 12/31191 CtHCK HERE IF A SPOUSAL ' POVE~TYCREDIT IS ClAIMEO [ I FilE NUMBER '9 - O:?), '7- OO~ Yb\r~ NUMAlR I ! ',I ~~HJf'pl'HllHtllnl ~f1I\,rn I ) 4u, fuluro 1IIIIlrOll (omplomiso (h-,t r!{lltJ\ 01 duolh ,,/lor 12.17,02) ( I (), DIH:udonl DiIIC! TOII,,!o r ) /, Dn<.udnnt"'\ointairwd a UvirlH lrl!~1 jAtiud\ (opy of Will) (^II11~h c_ol'Y (If lru\!) Ai:LcqilRF.SiiONDENCTAND 'CONFIDENTIAL' TAX INFOR-MATioN-sHoijlii;\le-DIRECTliii;.ToT:~-- -,--,;--:;:--",,, , ;,,; "M" II(;;^HD ;:-'KIlUG, 1':SQ~~;::-------------rOMPl\T7^l"90N~~\\_h ["ror;~ StroH IEIHlkH-HWJMBIR Harrisburg, P1\ L7102: 7,1) I _2}4 --4J. 76 _ _ _,===,== __ __==__=~=~~____ ,-- Z IU o W <,' W q ('..lMMUNWtALTIi OIl'tNtl~YlV/dllA [JE/'ARfMtI.l1 01 Rrvu~ur D[f'T. 211G/)OI H ./I,n~~5_~t}_~1!,__ P^_ I? !~O -0&0 1 iiir.f[}fNl-;m^MfT\^1'C,iirsc^mJMli~lll t--lii'II;';-(-, - " l<'^'j'ClI!<:NKO, 1 GOIl V. COUNtY (:CJlJl Illr i[llHn (iji-~i;i-I-II^Oli~(,~~. ;:.----.-. Rr.ol blOll1 (Sdwrtul'1 A) ') Sh)~b Qod Uonds (SdHldulo B) 3. (I'Holy Hold Stv(:k/PwtIlUl'ihip.lnluru,t (5dlOdulo q 4. Mortgagol and Noto~ Ror.oivoblo (S<hodulc OJ , 5. Cosh, Bonk Depo~ih & Mi\col1onoou_\ Pef\onol Propony (Sc;hodulo t) , 6, J<;>iotly Ownod PrOf)Nly (Schedule Fl " 7, Trl)ndorl (Schedule GllSdiodulo l} 8. T 01(11 GrM~ As~ots(lolqlline~ 1.7) 9. Funoral Exponso~, Administrolivo Cost~, Mi~(OIIQnooll~ EXpOllSOI (Schodule H) 1,0, Dobh, Morlgogo liabllitlol, liol\S (SchodtJlo \) 11. Tolal Daductions (latallinos 9 & 10) 12. Not YahHI of Esh:He (litHI 8 minus lino 1" I 13, ChO/i!ablo and Governmontal Ooquesls (Schadulo Jl ......__._. ~_.~__.__~~_~~_VCl,lu~_SubjQct t~_ T ox (li~~.3. ml~~~~~~L_. __ ..'"_._._~"_'_M""_'.~._.. ._.._.._._.__...~_._.____. / 15. Spousol TrMs/al's (for dales of dealh afler 6.30.QI1) SOD II)Wudlon~ for Applicablo Porcontago on Rovono SIde, (Includo valuas from Schodulo K or Schodull) M.l 16, Amounl of line 14 taxo:lblo 01 6% role (1[lcluno volu(J~ from SchodulD K or Schodl!lll M.l 17. Amount of Uno 14 taxablo 0115% rato (lncludo VahJ01 from Schodulo K or Schodulo M,) 18, Princlpol tnx dun (Add lox from lines 15, 16 Clnd 17.l 19. Crodit~ SpouHll Povorty Crodil Prior P(lymont; ',UC,IAI "IClJ~m ~i\J'<'\~I.~ 166-74-,I)~)7~i I\)'\!( (ll Of All( '/ /~)/'J{, l['(,'/,I~ ;'~'() I:d!~ 1>\( ',f'-\(~I\Y /lIJMlll~ n/a 206 I~. Ilocust Ht~rQ(~t M(~chanicBburg, P^ l70~)~) ("""'i Cumberland County I ^-'MJllI-H -R[r'IIV[ll-j~ff-I-i:~~i~-ii'(:lj6i!;;j- II/a . , "I ~1'p;. ~~tfl ,(Iifl'''''', -,~,,,I'.! ~ tl~MIII,\1 'I~~,' .It/I' ''''''0'1 ";''',1,1 n/a 1>4 I Otl(/innl !tuturn ! 10, [ 15. 06, Rnnlflindor Roturn (lor dollH 01 dOC11h priQf to 12.13.B'2) fedorul b!ClIO Tax Roturn Roquiroc-l Totol HtJlllhul uf SClfo Doposil (kl(IH ! I,t Umilod.I:II(Jtll III 111 13} (4.) ( 5) _6,073 ,'- '" '. WrlJ ~o ~'" '0>0 (.1n. z '" ~ '" >-- ii.: '" '-' w ~ z o ~ [; <>- IE o '-' >< .. >-- - -~- - ----.----- + 161 (7 ) G,073 (9 I JL~J)5_ (81 .._ (101 ... "__21.,_9A6..._______"",, (Ill _,,~u,,_}~.L~?J (12) ,_".__LL9--I1!!L _" 1131 """'____,, "_______,,,,__ -_ (141 ,,,.."'..,,,, ",,--- --,:;,,2,==_,_... (1$1 ' x. ._ :l ~~________~______.___... (161 _______.~ X ,06 ::I (17} __" _,x, 15,. (161 [)iW)l!nt li,torOlit + --, (19) (201 20, If Uno 19 Is graClter than line HI, enlor tho difioronco all \.ino 20. Ii1U lh;, ;. tho OVERPAYMENT. Checlc he'r~ if you (Ire requesting a r.fui1d of our over ayment. 21. If Uno 18 ii groalor lhonlino 19, on!Or !hn diHornnr.D on Lino 21, Thil iltho TAX DUf,. A, f:'ltor the il1t.HOSt on tho bolollco duo on Uno 21A. B. Enlor tho total of Uno 21 and 21A on linLl21U, Thi~ is thl' BALANCE DUE. Make Chock Payablo tal Register of WHit, Agont if~'lmitl\;',i;;,;~:,;,..,>:~!\(BE.S~RE1TO;:~NSWERIALL.Q-UfjSYI(lNS,ON :REV,ERSEisIDErAND>I.lOJREC~ECKIMATH~~:,(~-<i__~\,~'i~j: Undor penohlo:; of perjury, I declaro ,hot I havo exominttd this return, incl\Jdinq Clc<:ornpmlyirlg schedultls und ,tate monts, and to tho best 01 my knowledge and balio~, It is true, torrect and complote, I decloro Iflt1t 011 reClI aslale has boon roported 01 t,I)O markot voluo. Doclarotion of prf'pCJrllr othor thon the personal reprl:Hentotive IS ~I~Y~~O:\. ~lfl ~~~~~~.~~~~~)~i~T~:f~)r~~~~tRrEI~~~~~1J~~1?A~~R(~~'~~..- 1 2 [iOll t: h P i ].i;~~-l.~t_-. "'-S-'t'-'~'.~~l-----_.m..- ...... ---. 6:.\iTf>._~~crnL-....-- ,~J ;;~1??!ii;:!":J,,'A~f'. /O~'::;~)'C~~tb:::I'_ PAd .17055--- "'.';---;--9......Z----- z-:' :.~~-, ,~:::::"---.,~llarr..~sbur;:gAd-~ A -17102 ----- f". .... --- ,/' C:"---t'~-'>' i~llllll( l____. .' ;.--\. "....;......... (211 (2IA) (21 B) ~\VUlll' I P.UI mAltOf ITEM NUMBER ,~\lt~}~ .....!~w'}" COMMOUW(^lfll or I'EtII151IV^HI^ 1t~IH[RlIAfK{ '^'o:.Il(llllltt 1I(5lflftH (lIJ.ftJrt.II SCHEDULE H FUNERAL EXPENSES, ' ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES IGOR V. FATCHENKO DESCRIPTION A. funort11 EKpiJI1SCS: Muaselman'uneral Home, Ino. I. u. Aumllllslrutlvo Costs: 2, Po/r,ol1ljl RoptJ)~ot\lfllivo. C()IIHHissio"~ Sodol Soturily f"lJfllbor of Pono/lCll RopmsQnlt1Hvo; )'0(11' Comrnis,iolls paid Allornoy foos Puroell, Krug & Haller 3. Ftirlllly ExornpHon Cldim"nl ,__________.. Rololioii,ltip Add,o" 01 Clrtillltlf\1 ol'docodonl" ,doollt 4, C. I. 2 :1. ,I 5, 6. 7. B, Slrool.Addross .__0. . '.'_~_"Mo_..'n____~'~__'---'__"._'__-'-'---'-'__'.._._'_'_"'_~---~..., Cily ,_____.._ __"._,.__._.....n__.._Stol(J ~________._.. Zij) (ouo flrobulo, Foo~, Miscellaneous Expensosl Plo<1'oPrll1to,Tyl'o ~r~~9N7u~:~:: n_......~'..,_, AMOUNT 2,660 500 45' Penn DOT - ~ransfer fee for 1989 Aoura Integra Musselman Funeral Home (death oertifioates) 19i 9 Pavel patchenko (labor & materials for (painting/repair.ing Deoedent's. vehiole) Dauphin County Treasurer (medioal records copi&d) Graham S. Hetriok (Coroner's Report) 400 172 100 - ---_.~--_.... _._"T_ ~__~___~___~_______T_~__' ~_.. ~~-- TOTAL IAlso 01110' all Iille 9. Recapllvlollolll (If ",Of 0 .pnco Is Iloodod, 1"'0,1 nddlllollol shoets of soma sl"o,) s 3..L90..!L_....___._ .,VII'II" !','" 'A; {\41~~\ 5CHWULI: I Of:IlTS or Df:Cf:Df:NT, MOIUGAGr: L1AIlLlTIf:S AND LIENS "",U.,,'III'.1 ~ll't 01 fllttHTlVI,III^ II lilt (l"Utl I~. .( tulll H"tu(tllllf(!l,Pl( I:ST^1I: or .. __' ,. .,__I.Jl.I"!!.~~t!,,.I.I_f~~I"I..:I~I..~'yI)f' T'Ui~~~,~r;~~~~; ...... IGOR V. FATCHENKO IHM IHlMIII'11 Ilt!iCItII'IION West Shore EMS (Aoct #6752) 2. Tristan Assooiates (Acot #299B7963) 3. Harrisburg Hospital (Acot #33396ll2) 4. Moffitt, Peass & Lim Asso., Ino. (Acct #FACTIG-OO) ,5. A.Z. Ritzman Asso., Inc. (Aoot #HH00730159) 6. S & T Bank (vehicle loan) 7. Pavel Fatohenko (reimbursement Lor payment ofdcbt to creditor, paid by Decedent's brother) 8. Nikolai Kostivchenko (reimbur('lement for payment of debt to creditor, paid by Decedent's uncle and other monies borrowed) --------~-_..... TOTAL (^ho ontof on IIno 10, RiJ(Opltulollonl .__._. ._~.__~'____~~'_'_'___ u. __,_"_~ ..__ (If "'0((1 S(HHJI is f1oodod, it1wrl ucldiliol1a/ 11.0011 ", wnw Siff'.} ^MlJlINI - $ 705 221 2,674 90 777 5,679 5,800 6/000 \21 946 .1.._.. .--- - .~7;;t.:V , 1710 N. FliONT STH~.iET "'^!tHL'tltlIHO, f'^, 171();,!.;"]1)2 'fP.U!Plf(}Ne(717)~~_, 1/1\>': i717J2:n,114U ~rl ~.~-. LYUBOV V. FATCIIENKO, Individually dnd as Administ.ratrix of. the Estate of IGOR V. FATCHENKO, Plaintif.fA f N '1'111': ('()l1I(I' OF COMMON PLEAS DAUPII] N COUNTY, PENNf:YlNANIA NO. 2679 S 1997 va. HARRISBURG IIOSPITA1" PINNAC).,E HEALTH HOSPITAL,S, PINNACLE HEALTH SYSTEM, A.Z, RITZMAN ASSOCIATES, INC., alld DR. TIMOTHY [<'ARRELL, Defendants CIVIl, ACTION" LAW JURY TRIAL DuiMANDED ORDER ,'j AND NOW, this 'J'~-') day of May, 2001, after review of Petitioner's Motion, the Affidavits of Service with originally signed documents, the Cover Le~Ler of counsel (English and Ukranian versions) and the fully executed Consent of Father'and Gift Letter forwarded by Father to Petitioner's counsel, the following is hereby ORDERED: A. The Rule of April 25, 2001 is hereby made Absolute; B, The proposed settlement of the subject action in conslderation of the payment of $750,000 shall be and is approved; C. The PetItioner is authorized and directed to execute the Full and Final Release agreed upon by the part~ecl; D. The settlement proceeds shall be apportion~d as follows: 1. $96,200 to th~ Wrongful Death action (payable to [,yubov V. Fatchenko); and 2, $653,800 to the Survival action (payable to the Estate of Igor V. Fatchenko) E. Counsel fees of forty (40%) percent of the gross settlement, plus all out-of-pocket costs and expenees, payable to the law firm of Purcell, Krug & Haller are approved; ':I;he.Jmllrt doeuments--rroncernin~this ca(;!e anct---it8-_ ) rf?"C\l", .c settlement, 'including-.this r,lotio~nd__Qfder shall be -, /' ,I ( sealed, ) ,) , (\ i!J. "",1 If-\r ) 'I "1'101" -'I U I I '. t ---...,-... I h b ----, ere v I'crl'fy !lul IIi:! rO;-:;-:;--J ;;:: true '11"1 C "" 'I '" .'" - ". " II/e(~," " , O"U(, C,,/" I)[]( 1:;'.1 Ulii)iilUJ " ~ '01. ~ ~ (,1 I,' ",.;;-;' :.- I ,~.~.':::... .\,::~:...~._l.:..~~':"'~'". \) r(J;)tl~;;"'::l.lfJI '--...._~..,- BY THE COURT: ~-' (/~ ~ -. ,( , "\" (', i (, l (..- , fj.,. ' t100ve r, ,u 11_Vl EXHIBf1 .':i"/J"lij'\ '. ,,,,;,;;,,,,,,,,,, ,,,,,I!i'" . I': . ":)1 < 11\,.:11,:,; II, 1/1.':1 (:!I,',,\I I" ;'1 ,illi! ,1;.\1.'1 il;\, I ,lfh!,ill!1 U,I)jlll~ II!ill^11 f- 2 W Cl lU U W Cl FATCHENKO. IGOR \I 11.\1' 'I ["I^liW,li,I(I, 'f.. II) 07/0S/199B ',Ii '\i'i'il "\[-1 i-I 1\'IJ,\T/III'; f'i!II,.I:;IIMJI 11'\,1 lii!.i t,!II'/,liillilll:jI;II.lj 06/09/1 970 i'! <~~ U ~0 ~! 00 ulral " ~ lUl, [] f....] I," ",i'-'ll I :"'.1 j, 1,11,. :""-" ".;-".;1\'.'11 LJ 'I: L'II!,;),I-""1' i !:.-" ",.,J ." I' '-11 " 'k' i,!!III. ,I f , ,,,; REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT (Ii\ I 'ii i1fl'!il,J,I,',li'!I"_-1I1 [X'I:; ';IIJ,pl..,,,,,t;il:,,I'iI'l r--] II !'iil'J!('ln"k,I{:'!':I" Inl "iii' di!."It",h I; Ililll LJ i Ii._ t'I'i'I,III!d.rll,'lli"'I"!lflJ.lr:"'pl.'j'l"fr,,,11 L.J 10 :;)"I'i ,'1"'1<4, !:I,' 1;1 " ,,1,1,\II'h.l:., "II I' I! " \ I' I-'i' .r'JII!' rilE ffUMIlf'R 2 0700002 .;:-;.-:w:I ---:7-~~ - - ~"':tit<- -. 'J I' I ~ I " f 1:\ Jllll '( III ! ~ .Illi '!~ (,6-74-5575 ffW, F{EIURU MUST UE FfLHl IN DlJf'UCA'fE WITH THf REGISTER OF WILLS "",j.ol 'j, CI IHIf '1' il:JI,\[IFH r. .'] 'I (-(['illlllld,'1 1(''';:1' 11".,,-,1,1,," II I' 1"'J !j IF,ll'l,il L ,!ell.' i .1' I' ,,1'11', 1 ~'" I :",,' _ Blni'lll).illIl"',,,! ,t I'r', .I:' LJ !ll}"'!LiI:I.'!I,. 'If j,: 111!1!'!i'I:,)!, TH'iSSecnoN MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA nON SHOULD BE DIRECTED TO: i 1,\\1[ Li J~.1f '111"'_ I\IM It I' ~ I\II[ Ir:f ,Jill M, Wineka, Esquiro ~ w o 5 " ~ U> " ~ o u ; jl;~,! r ::'},!I: [",ifr-i.: ti)IJi Purcell. Krll( & Haller ffl i: Ii. ;111. ;;II~llllUI. (717) 234-4178 1'11'" ,,'h'.I'I'" ,'..! , I ' H ,.J Ii, I, l '-~ ii' -.-LI,! I 'I 1719 Nortlt Front Sired Hmrishltrq, 1'1 ('I : ~ '. .. i I,r;: ~ ',t. ""/,II,II>(:::I',>I'Jl','[1: .,' I,' I ;"1 ;-'-'1',,', f':,ll',,-,'.I 'n (,' -I, l'i':'I""I,-,,-,I,,: 1';, r,I, Hw'_ [, !,"~ ,II" ,J. i'ILrur,me:i1J', i ',,:, AI:I' :'r,lprJ/I/ Illi,l) z o F= :5 ;:) f- a: <t () W a:: ;"HoI,';' I i'!-'rlt: 1 r'1,,(;t'fl'l (,;;;I,t](fij!t' F-) [J ';!!!'-ILllnfhl;I1'I!{I]'_!IJ{1"le;! co! '['I I' ,'i~ \.'",. , 111"_, f~ll:' !, r.,Ir'jl;l'II'lflf"~"-r; II,)! t':,.lt;"JI~ I Irq':);'!I/ ~L"I'I!'} ,', u l.i Tuti'lIOro%A!lsets(!<Ji-IIIII,\:,.I/) I I ;1';,(:11 ['Jl(J:!.;w;". 1\':hn'H:lrallv\~ GI':li (Sdl~,dll~(' H) Iii (ld11; (,i 0('<;\, torll M(Jltq:Ji]t. L;cJ[uhlio;., /l.11~11l~, (;;Cliwj,IIC I) (1\1) !I Toti'll Oodllr.tiol1s (Ir'!:11 Lllli.'-'~! I{ 10) !, Not Vnlllo of Estate (1In,) H lriln\l~, L'I'[' 11) (I) 1'1 II' ':1,,;111.1111(' II:I,j \.1w,)r:lrnf'!lI;III.~H(I'l<nI5hlf;c (1\ 1\ TIll:>!;, fllr wllll;h ,'III ol'I,;t.lii j, 1.:1\ hd_, 11-1\ bo"n PIY!.:- (,~r,h('(LJlo,l) 1-\ Net Value Subloct to Till! (Llnil 1~1 ml!lll'J 1.111(1 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPlICABlF. RATES z o F= <t f- ;:) 0. ::;; o u >< <t f- 1 rJ /\11,/111111 of l.111{' 1 ~ liJdJlo (It tho :iPOIl'iil! h( I ik, ,,' !r'III: iN:, !lIdN [,I',:: III \6 (a)( I ?) Ji, ^mc,fjl,1 (1j [1:'0 \.\ latilf.lf(] all'(lf'.]1 fale 1/ f',lli'HIIII Ilf 1111f! 1.\ I::n,~hln ill ~1Ibhn'11J!i! Iii /o111'JIIIII 01 1.1:10 1 .lldl.':11110 :11 L~['IIi1If'(,ll r!lli' FI Tille Duo ":__I!I, 360,66S.3q '( ~ (Ii!) I:, 1i.1tima, " C PA 17102 -= ()fF!Cli\L ll'~>~ Cl!!. 384 :099.16,;u 1'1 384,099 16 3.655,86 19,778,00 11'\ "I 23.43386 (1.') .. 360,66530 (1'1] II.t: 360.l165.30 21,639.92 (I.I - \11, 21~ > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's C~mplete Address: '.,'-I.\I'i'i', 206 FilSI LoclIst ShtH!! Mcclt<llllcslHII (I, ,,- . -- -.-...... ..J' " - u__ ~--l--- - - ',ridl /1" PA 17055 __' ...___n .... n_ __~_ ___ _. ___.._~_.._+__,.._ Tax Payments and Credits: !:Ix nUl' (f\lflC' llllh~ H'l) / {~II\\jl!:'./f)i1I{IIIBrll:~ /1. ;\P()\I!;~jl f'nvorly Crmlll H f]rlO! fJi'l'lmtJr\l:i C I)is("(lunl (I) l.!G3902 23.000.00 Inial C,od,l;; (A I I; + r: j (2) 23.00000 hdl'l P~~T'i~IHlly If i1r1ph...dhlfJ [) Intern:;! f~ f';-~flal!!, 0.00 0.00 TololllIl",,,oIlPolI,,lIy (Ill I .j 1Il.If\o ',? I:_~ WUiller (llCIn LlIle 1 .. Lino J. onlor tho chlferr.I1Ci! This I~:; 111(' OVERPAYMENT. CllOCI( box on Page 1l.ine 20 ~o roquosl a rofund (:I) i; I! Ilw' 1 '. (lfl':',{ 1~; IJrf1illt~f lh,lll till!' ;~, f.nlpf lIlf' liilffll(H1U) Hw, I'; tllll TAX DUE (4) ('.) 12,60 OS 1\ f:rlh~1 the lI!turD:;! 011 ItIP [,I'. r!lH' ('iAl () no 000 o on H ['nl?f !I,(' loL11 of Illw ~j ~ ~i,f\ 1111.: IS lilt: BALANCE DUE. U;H) Make Check Payable to REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS [Jid ,b::i:dr.nl nldkt' ilIJiH1slt'r and '1'1': (II) II [X! [] lx' --, [-I [xl [J IXI [] r8J [J [x] [J I~I 1"I,ml tll'~ l!';'~ 01 ill',~dl':l(' of lilt, f:ll)pl~l!i tr:1I1dt'IrL'U II 11~ldlf1 tl1\J nqll! 10 (h!f,Ii)l1alc II/Ill) :,:Ildllll'.,:' !II'! plopl'll~r' lr'III"~!WI \!d (Ii Ib InUJIlW c rt!I,;IIf1 CI l€vor,;lOn;lry 1Il1f.!resl,or 1:1 1l)(:\~I'lt'~ lile prcmw:;Q for iiI,? 01 either p:lyrl1onh\ bt>/IP1Its or cone7 2 If cJt','1111 (Jccllrred tlflm Decernbm12. 1982, did deC(!clr.rllll(ln:,~rer prupmty \';Illlllrl (lll!' Yllar of clr.:.\ll1 Itll!lIOlll recelvrnfj adequate considerallon? J [)Id decf!clenl own all "Ill lrust fur" or payable upon deal!1 bank account or St)cWlly (II hrs or 'WI' d~alll7 4 DIU d8cedfml 0\'111 3nlndrvidual netiremenl ^CCOlJll!, cHlIlllll'l, or ollwr n(Jn.prClbal(~ propelly which conlarns (1 beneficiary deslgnfltlon? 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 ",,!~, p:n.lh;'~ 'l( pfJIi:II'1 I :ll~i 1.",,11')11 h1/;1 f1;;I'III,']d thl': rflt'I'f1 If'dlcJllill :r;("flIPlIIlfIIHl "fhe:ILlla; nlld ~1'il<.'!Ilent'i fill'! 1(, th" hl~IIJIIIiV kn(,'/Ihlq'illl'll'''~flf ill' , I', r., ..';1 l'I"I.-.;I,r ,.11.'" ltl )'111", r,,"'-;''-'' Ilre!;fw,'!r;ldtLI': I, L.I.ul I,T .It'I.I,:rll'JI ''!iol 1';I"'.t l't':j1 .,_,f hf.', Y.'t' kU''!Ii'..-i~n ',I'J),'.] liFl 'rI' iff,S;)11 fIC';f'(JihlfiIF HI!{ rtur;n I~Cll,IHf I tlllU !,o'Hw;llIIvj,')'r'I,Hd "'" /. i /1 r ( /, II,~II I ' II j':'t :', :",', " 12 SOUlll Filbel1 Street Mecllanicsblllg, ',1",11:': '.';:11,'1 ['f,f:I',''-f{IY r 11 HLf~ 1 I-IM'I r~EI';,:r Ri I I ,\ fr'-Ji , I '. ,II , I' ('. :.['111,1" i '1719 NOl1b Front Street Harrisbur(j, PA 17055 P^,1! I I I' PA 17102 For O;:lt!'!::; 01 dealh on or after ,Iuly 1, 1994 !lnd beforr Jmlurlry 1, 1995, the 1,;1" rale impo<;:,ed on the rwl vahlfl of trallsfcl:; III {lr for Ihf! liSP. of Ihn Sllrvlvlnq SpOllSf' I~; ]0,''1 Iii f' S \9116 (<till 11(1)1 F~( d,lk!3 01 de,llh on or allm JilllllillY 1, 1995, Il1e tllX rnle Imposed on III() net vulilfJ of tr<ln~fe!s 10 or IOllhe IISfJ of Iiw survlvrng SpOil so IS 0% [12 P S *91 tG (iI) (1.1) (1/\1 111(") ~;l;ltutl' (J('\e~;_QQ!.i)!.ml}I2.! rllrcms!t'r In () survlV!fl9 srouse from lax, <lnd tho ~,t<ltuloIY roqwlr.rnenls for ol~iclo~uro of iI;.sel.-; ,lncl filing rlbx rfdwn are stili ,lpplrc,lblc (!Vl-'illf lhe ~,lIrvrvlflD spouse IS thr only benefrwuy for dille:: 01 df!i1t11 011 01 aftr.r July 1,2000 Tllfl tm raIn imposec! on H1f1 !lot valuo of lransfers Irom 11 c!eGHrlsed chrld IW(Jl1ly.OIw Yll;lr~; of ago or younnm at doalh III or lor 1110 L1S0 of [J n:llufill pdrolll nn ,lIbpllw P:II::llf or, ",epp",.nl ollha child i, 0% 172 PS 99116(0)(1211 TIle tilx ratA rm[1osed on lfllJ !let value allransfers 10 01 lor tlw use of the drcmhlfll's Iimli!1 berl(llrclarios I~i 115%, tl;;ctlpl a" l10tnclln n P S 9911G(\ 2) ['/2 f) ;.\ sOI1tl(.I)(1}) TIle lax rale Irn[1osed on Ihl3 nol v,lll1e ollransfers 10 or fot lho llse 01 the decoct{!fll'~j srbllrl~I:1 IS 1(% [12 P S g9116(iI}( 1 J)) .^. sibling rf, defll\fld UllCh~r Sec\lon 91O(~, d~; ,Ill mdrv'dual who ha!'i lit leAst one parent rn common wllh lhe decedonl, wtlf!lhor by hlood or adoption COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUF BUREAU Of INDIVIDUAL TAl(ES I~HlRIfANU: 'All DIVISION llt.PI,280601 IIMRISaURO, PA 1!l211"OMI NOTICE OF INHERITANCE TAl APPRAISEI1fNT j ALUHlMKf Or! DISAllOWAtICr OF DEDUCTIONS AND ASS[SSMIJlf Of TAl DATE ESTATE OF DATE OF DEATH FILE NUMBER COIJNTV ACN 06"30-97 FATCHENI(O 07-05-96 21 97-0002 CUMBERLAND 101 HOWARD B KRUG ESQ 1719 N FRONT S1' HBG PA 17102 *' U. IHI (t liP 11l.tll lClOR v [.__-}~~~n~R.lilt~od ~~'_~_j MAI(E CHECI( PAVABLE AND REMH PAVMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... f(~V:: i ~(;7" ~ Y -.,;:ji ..( (1~-:ci'iY-NO "ff r.i:" "r5~" "y'N'Ai;1iif is j.,fr.F "TAX - i\PPR Xiii EM"ENT ",- -,iLUiw4 t.re F - i'iri"-".'" ".." ---"""""" DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FATCHENKO IGOR V FILE NO. 21 97-0002 ACN 101 DATE 06-30-97 __~__ .., ~_,~_u..._<r..__"__~~.'_."""'~_._________~__ TAX RETURN WAS, I X I ACCEPTED AS F[LED RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Raal Estnto (Schodule Al 2, stock. and 80ndB (Schedule OJ :5. Closely Hold stock/Pnrtnorsh ip Intor-ost (Schodulo C J 4. Hortgages/Not9u Rocoivabln (Schodu1o D) 5. Cash/Bank Doposits/Hi9c. florsonal Praptlrty (Schedule El 6. Jointly Owned Property (Schodu16 f) 7. Tron9fero (Schedule G) 8. Total Assots APPROVED DEDUCTIONS AND EXEMPTIONS I I). Funors1 Expensos/Adrn. Costs/Misc. Expllnso!l (S(Jhed~lln Hl 10. Dobts/Mortgage Liabilities/Liens (Schodule Il 11. Total Deductlolu 12. Net Value of Tax Return 13. CharHable/Dovernmentnl DoquBsts (Schodull) Jl 14. Net ValuQ of Eshto Sub.1oct to Tax 1 'I' an assessmont was 155'''''; "I.B~ i.tJLlbj,l, HIll'" reflect figures tha't include the total (If ill, ASSESSMENT OF TAXI 15. Amount of LiMO 14 at Spousal 16. Amount of Ltna 14 trmnble ,':It 17. Amount of Line 14 taxable at lB. Principal Tax DUD N(lT~1 1 CIIANOED II I_..__".__,.,,__,~ 121__,_ . 00 (31_ ' 0 0 141,,_ . 0 0 151__ 6 ,073,00 (61 .00 (7) _____--,,!LQ. 181 3,905.00 191__ 1101_,--'.1,946,00" (11) ( 121 (131 (141 NOTF.l To insuro propar crodi t to YOUI- account I submit tho UPPAr portion of this forll1 \1ith your tox pSYnlont. 6,073,00 2~ .B~l 00 _.__J1.) 77 8 , 00- .00 19,77""8.00- 14, l;, i:iiH.i,uf' It, 17 t;nd 18 w~11 returna asseased to data. roto Lineal/Clnnu ^ rAtn Collatoral/ClaQo B rnto IISI.__._~ n .00,,_ 1161__..____~ X .06,__ 117l .00n.IS, (16)_,,_- ,00 ,00 ,00 ,00 TAX CREDITS I PAYMENT DATE RECEIPT NUMBER DISCOUNT (.) INTEREST/PEN PAID 1'1 ----------- At1DUtlT PAID ._----------~-- TOTAL TAX CREDI'r ,00 ----~------ --~- BALANCE OF TAX DUE .00 --- . INTEREST AND PEN. .00 ---...----- --."" TOTAL DUE .00 ._______.___._._.__'~._._.__"n ___._________ ~-----_.--~~." . 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 "CREon" ICR I, YOU MY 8E DUE ....~ ".."..n,," ,.Tn" nc TU"c! f"nDM F'nD nl~TFI\Jr_TtnN~. l PURPOSE OF HOTlCE I To fulfill the re~uire..nta of seotion 2140 of the Inheritanoe and E.tate raM Aot, Act 23 of 2000. (7t P,S. Seotlon 9140), PAVMENTI Detaoh th~ top portion rever.a side. ~~ Hake oheck or .on8~ of this Notioo and submit with your paYMent to the p.ogister of Will. printed on the order payable to: REGISTER OF HI~~S, AGENT, REFUND (CR)1 A rlilf'Jnd of II tax credit IllIIY be requested by oOllpleUng IIn "Appl1oat1on for Refund of Pennsylvania Inhllritanoe arit.! E~tate Tax" (REV~13U). Applloations are available at the OHioC! (If the Reghter of Wills, any of the 23 RMvenue Distriot Offioel or fro~ thu nupartlllsnt's 24~hour an~w.ring Burvlce for for",s orderingl 1+800~362-2050J services for taxpayers with special huorlng and/or speaking needsl 1~800-447w3020 (IT only). OBJECTIONS I Any party In Interest not satisfiod with tho ossess~ent of tox al shown on this notioe May objeot within 8iMty (60) day' of reoeipt of this Notioe bYI ~~"r1tten probst to the PA Dapart/lIent of Revlmue, DOl'lrd of Appeals, Dlilpt. 281021. Harrisburg I PA 1712B-I021, OR ~~gleoting to havo the Matter detbr~ined at audit of the personal representotive, OR --appeal to the Orphans' Court ADMIN- ISTRATIVE CORRECTIONS I Factual el'rors dlsoovered on this \\ssnslllent should be addrossed In writing tal PA Departlllent cf Rovenue, Aurenu of Individual hMes, ATTNI Post AssaSSliumt Reviftw Unit, Dept. 280601, tlarrhburg, PA 17H840601, Phone (117) 181-65115. $eo page 5 of the booklet "Instruotions for Inheritanoe Ta)( Roturn for 8 Ruldent necedent" (REV~1501) for an explanation of ~d~inlstrl'ltlv81Y correotable errors. PEH1.L TV I The lS;I, 'hIM a.nalt!! non-participation pef18lty is cOlllputed on the total of the tal< Elnd interest 8&s8Sud, and not Pllld before January 18, 1996, the first day Elfter the IInd of the tax alllnesty period. this non~pDrtlolp8tion penalty is I:lppelll!lble In the 18me IUInner and 1n ttie the lalle time period al you would Elppeal the tax and lnternt that hn been aSI8Bluid as indicated on this noUoa. IHTERESTI Additional Pennsylvani8 Estate Tax assessed 85 B result "f a oh8ngo on the Federal Estate T~x olo~lng l.ttsr beooll1ltS delinquent at thl! sxpirfJt10n of ons (lJ Month fI"olll the date the flnal notioo of tho Inorease in Fldel'al EstQtll Tax Is receivlld, TI!IXQS whith baoalllll dellnquent befol'e January 1, 1982 bear interest !It the ratR of slM (6;1,) percent per annu. clJlcul!lted at fI cll'dly rlltll of .0011164. All taMIIS whioh beoallle delinquent on or I!Ifhr .hmuary 1, 1982 will l:Iiltar inte~est !It a rata whioh will vary fro~ calRndar year to oalendar ylar with that rata announoed by the PA Oepart*snt of Revonue, The applioable Interest ratss for 1982 through l002 arel '!!!!: Interlilllt ~~ Dally Interest Factor ~ Interfl9t Rata Daily Interest Faotor 1982 20X ,000548 1992: 9X .000247 1983 161. .000438 1993~1994 7X .000192 1984 11~ ,000301 1995~199B 9Y. ,000241 1985 13;1, .000356 1999 7X ,000192 1986 lOX ,000274 ZOOO Bl. ,000211J 1987 91. .000247 ~OOI 'X .0002:47 1"8e~199l 111. ,000301 2:002 6;1, .000164 --'Interest is calculated ., follows: INTEREST = BA~ANCE OF TAX UNPAID X NUKBER OF DAYS DE~INQUENT X DAI~Y INTEREST FACTOR --Any NoUo&! hsued "Her the hx beOOMeB d.Unqufmt will roflect an hlterllSt oalcullJUon to fHtaen (IS) day' b8yond the dllte of the flSI!I8UlIlent. If pl'lYlllent Is llIado after the 'lntllrest Clo'llputathm dstl shown on the ~at1oe, additional Inter'e'JIt .'Hit be caloul8tlld.