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HomeMy WebLinkAbout97-00707 l'ETlTlON FOlll'HOBATE llllt.l CHANT OF LE'HEHS CJ./-J]7 - "/07 EJlau of GEOHGE ,1. KONECNl also ~"OWII os .--- No. To: Register of Wills for the ~ Dtctased. CoulllY of . CUMIJ EIU,IIND III Ihe Social Strur/ry No. 1 43 - 0 1 - 4 ] ~) 2 Commollweallh of Pellnsylvanla Thc petillo II of lhe ulldersl~lIed respectfully rcpresellts that: Your petllluller(s). who Is/arc 18 yenrs of age or older all the e~ecul.2J:..'i- llllhe lut will of Ihe above decedenl, daled _ IIpr U-lQ , alld codlcll(s) dated named _,19.--!!L --_...-- (~IMC: 1c1c:v:ull ChUIIlUlnIlC~S. (". ICllllIlCll\tlOll, tJcnlh or CAcculOl, tIc,) Deeedenl \l'lIS dOl1\lciled nl dcnlh In C:llmbeLLi.n.cL-- County, Pennsylvania, wllh IL is last family or principal residellce at 308 Manchester Road Lowe.Llll1en 1'own"hip llist ~lrcel, Humber, '1'\\'(1- or Uoro,l l)ecedenl.lhCll 88 )'ears of a~e. died IIlIg\lst g, ,19 g7 at Manor Care Health...,aervices . Except as follows, decedellt did not marry, was not divorced and did not h.avc a child born or adopted after execution of lhe will oUered for probale; was nollhc vlclilll of a killing and was never adjudicated IlIcompetent: Decedent at dcalh owned properly with eSlimated I'alues as follows: (If domlclled ill Po.) All personal pruperly S 36.800.00 (If not domiciled in Pa.) Personal properly in l'ennsl'lvania S (If not domiciled in Pa,) Personal property in County' S Value oCreal eslatc In Pennsl'\I'ania S None situated as follows: . WHEREFORE, pelilloller(s) respectfully presented herewllh and the Ilrallt of lelters thcron. request(,) lhe probale of the last will and codlcll(s) TestamentAry. (l~llmentlry; Idmlnislratlon c,t.I.; Idmlnisllllhm d.b,n,c.t...) 1 lO;;- II 'Me!! r Ii; ~f~~~"o Mp~h;:ani~Rhl1rg. PA. 170SC; OATH OF PEHSONAL HEPRESENTATlYE COMl\lONWEAL1'H OF l'ENNSYLVAN.IA } ss COUNTY OF' r:t1I~BERLAND The petltloner(s) Above.named swenr(s) or arfirlll(s) Ihatthe slatcmclIII in the foregoing petition are \Iuc and corrccllo lhe besl of Ih. knowl.Jge nnd belief of PCllllollcr(s) olld Ihnt es l.ersonftl reprcsen- Intivell) of t.he oboye deeedellt pelltioncr(s) \"111 well al d \Iuly administer lhe eslate according 10 law. ,'1 I) Sworn to or amUlled. alld subscribed { i. ,.:L.:jr,tr' ~ before me Ihis 21st. day of J 'C II. Scott: ':; ":r~\lst 19.-U- !l. ('1)0"0 c. ; '~" ~--' ~ f) ,)" ,/".1:,/ /(rglJICr - ~ -/97 ._ ~....t V. ,.... Tlli, i, '" ,,'nit'\' ,h", d", ilt'""",IlI"" h"I< I',I'T" " ",,,,.,,11 '''1'''.1 I,,,,,, .111 ",,\,111.,1 ..."'\1' .Il' "I .Iv.,d, .1,,1, lilnl wid, ,,," "'. r"",1 1("I~I'\"Il.' Thv 11I1[',111..1 "",ili. .11" will In- i,,'''.'''\''.1 ,,, ill' ",II' \'11,1 11.," ""I" ( ill" " I", 1"""1."1""' liI'''I',. WARNING: IIlu IlIogullo ~bpl?C~ill71~79 copy by phnlo!;IHI or photograph. hot' 101 Ihh 1.l'llilh;lIt', ~/,(]ll /lilJi""'''''",-- .;,.i't'~\'" Of pi.'~"',~" ""...,';":X ('f.~,.,f. .!If\........ <,...~\.~)t \1 f'i,i ~ .:b I \ ',' " i. "1 \ ~---'_~;:~I . }'I.!1fN1 ~\ ~~"",' 'tt~H1lJ!l!l!1lJU-- !2MV h~:t;;.a'~lf- Illl_d'r{q,,1~1I,11 ~ AUG 12 1997 4495836 Ilil\(' Ntl, " 1TI?M , ~ ~ SIDILD READ AS FOLLOWS, f/9/1?97 /) f..,A- {,,(5n-n,' /{J~br;'\"?"/flfL- . COMMONWEALTN OF PENNIYLVANIA' DEPAATMENT OF HEALTN' VITAL AECOADI . CERTIFICATE OF DEATH DATE Of OINH ,1oklAIl Pt,_ ;;;;----- 1997 "' ~~- J . l<onecn i -, ' ...... ~ ~..... IlfiittnACllCtt ..... SlIM'" 'OO"9'CQl.\lI~1 =".[J .... " IMoo,..~-_1 January 1 /IQl~g-...",n'UlIl:*I lUll ""nor , c- o t"" I c:- o- j - "'6 <;;' t . .... ~ . ~ . , " I ~ a . ,.., '" o m ~ 00 ~__~w; ,,'-,.- '<'-1 ,,-;-, d , :rj' , ~niR: {J-j C~j t~<j .., ~ ~, ['--~ D:l ~ II ~ ~ ~q ::l ~ 2: ~U I o III Ul z Z ~ t g ~ i <, . , " ; . .' '. - . . j"ii- son-In-law, ROBlm-r W. SC01'!', Executor. )~'SS WHEREOF, I hereunto set o.r(T' --- ,1988. . , my hand and seal this c"10 day of (1:~~/f''; (SEAL) J <onecIII Signed, sealed, pUblished and declared by the above-named Testator, as and for his Last WI11 and Testament, In the presence of us, who, at his request, In his presence and In the presence of each other have hereunto subscribed our nllmes as witnesses. -- ACKNOWIJEDOMllJil'r COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SSl 1, GEORGE J. I{ONECNI, 'restator, whose name Is signed to the foregoing Instrument, having been duly qualified according to law, do hereby acknowledge that 1 signed and executed the Instrument as my Last Will and Testament; that 1 signed It willingly; lInd that I signed It as my free and voluntary act for the purposes therein expressed. --t:./ ' , ":'- /C~_.A!<r-t/ ONECNI Sworn (lr affirmed to and acknowledged before me, by GEORGE J. l{ONECNI, the Testator, this :\~,)\ day of c.y,,"''I.... 1986. ("'r ,.' -..'> ,-""" " . ,~- ._~....~.~..--...~---..... Notary Public) t; DIANNE LENIG, NOTARY PUBLIC My COITlmlss\OIl (xpW$ lll"Cl'mbef 21. 1989 lemOYIIQ, PA CumllerlilnJ CQunW " CERTIFICATION~E-NOTLCE UNDER RULE 5,6(a) Name of Decedent: GgOROg ,1. KONECNl --- Date of Death: August 9, 1997 Will No. 0707 Admin. No. To the Register: 1 certify that notice of beneficial inter.est required by Rule 5.6(a) of the orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 8/22/97 I Joyce A. Scott Addr~ 467 Woodcrest Drive Name - MechanicAburg, PII 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Date: 10/1/97 ('-j I Name ace A. Johnson Johnson, Duffie, Stewart & Weidner Address 301 Market St.. P. O. BoX 109 Iemoyne, PA 17043-0109 "elephone (117) 761-4540 ~f~ _::;..J ULl Capacity: Personal Representative x Counsel for personal representative " , ...__ "'f ~..', ,,_ . '.., __o, \ , TO , Register of Wills Office CUmberland County Courthouse 1 Courthouse Square FROM JOHNSON, DUFFIE, STEWART I WEIDNER Attorneys at Law P.O. Box 109 LEMOYNE, PA 17043 . SlIBJECT: FOLO + Carlisle, PA 17013-3387 - Estate of George J. Konecni 21-97-0707 Date of Death: August 9, 1997 DATE: 11/5/97 Enclosed is a check in the amount of $1,500.00 as a payment on account of Inheritance Tax for the above-captioned Estate, being made within the 90 days to allow for the 5% discount. PLEASE REPLY TO -- SIGNED Horace A. Johnson REPLY DATE: SIGNED Roordor 110m I1F270 orllYlllC, p,o_ Bo~ 2944, ~tallford, (;1 {)(,10<l2944 "EO!. "". Priolo""" "" l'HIS COPY FOR P~f1S0N ADDRESSED ',r- ,\~- \ csh "'J ~'1 I. " -~ W- ~. ~T-"'- '\_.'. 'j i ...... I", ('S' \( ~,,\ ' . nO" .;' ;r" -., \..., ,"- ~>..-".,' l' ,j' \111\, \\1'; I" 'll: ~h\: 1'\;.<'1',,',,1 " ,,". '<,.v' ~_'f ,,\ ,'t'PJ:""'- -,.,'l '; ..-," ;;'.\~ 1- :.", 14l '':':''"",_1\,;;; l}'L:"_ ," I) --- ':~ l ~~~, I II;. .~. '<' _ '" "--"''-'''",,'': ~ p o el,:l H~ .... ~LJ 00 (L,O '" OUIil'" p:jl U')l>1 Ai'" ..:I ... t::> .-1 ..:1",010 Ht::>lIlt- ~o .-l ulil ... lilt'!: O~5P< ~ :0 [3.1 Iil [-<..:I ... ~ 0:: Ul. 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I- LL 0:: III Z CI Iii : ~ ~ ~ E ~ <( ..q: g ~ ~~Ui~~ lii ~ ~ g ~ lIi~~ciffi Ii: 0 I 0: D: .... ~ _ Id ::I 0( ~ Z o ~ i ~ o III Z :t o ., ~ .. .".,,,,,..,,.. . . " ~ Ul 8 tJ~ H c.: I'" (I., P co (1.,0 '" ~~~~. 0-'1 r< p..-l 0-'1 Z 010 H::> Ull- ~ 0 ..-l U~ (I., Ul Fl: 0(:1 P P< zo ~~~~ r<c.:~Ul Ul~pH H ~oo-'l r.9::;:U~ ~::> Fl: ""U..-lU . I \ I '... ~ .6.. ,_ _,,__,on. '.' " T 1 I "V1"'''':Jii''~ , ~ I 'l~ ..3 . . , H P NNSYLVI.NI~ DePARTMENT OF R~VENUE OEPT.l1Oe01 REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT r: :",y, di'd;"':'i!")o > BE SURE TO ANSWER ALL QUESTIONS,ON REVERSE:SIDE AND RECHECK MATH .< <. UndoI~ofl*fury, lde<lnlhall ",,"e_ned~1I "~m, 1r</vd1"l_~"I "hedur..IIld._~, ond 10"" besl 01 my I<nc>oIedge ond bellel, IllIirue, "",ecl ond ~te. Decltrlllonofprepil1l""" r LE FOR F~ RETURN, /APi<4~ T~T1VE . II! ~ ~ ~I ;itt(,lll\I't'Orj!r . '..u NUMliER::i"::~:",,7S,,;u;'-'7:i:;7"'" ':~'I ,,21 9,7 07,07 I i lil ~ T,'IAT,~U100l_, , 1" ,lAllllM'Writlb:.k~,ltP.I.~~' ,G '. F. 0 R G; F. ... DAtE Of' DEATH ..K O. NEe N I ,J IAlIECURITY Nl,fAIlER .' DATE Of (lIAnl 5.2 018 /09 /1 9 i 9 70' do 9/1 '9: O!g!; TNII RETURN MUifiiFUD IN DUPLI(:ATE WITN TNE REGISTER OF WILLS 1.43-01-41 (IF .YPlICABU!) SURVMOO SPOUSE'81-W.1E (lAST, FIRST, AAQMIODlE tMTlAI.) socw. SECURITY tM4BER [l9 1. ~Inel Ratum 0 2. Supplemental Rel1Jm 0 3. Remainder Rel1Jm'dIlI~.""".':"HlI o 4, Limited Estale 0 4a. Fulurelnler03tComprom~. (d"~."""l.ll-I~ 0 5. Fedaral ~~""e Tex Rel1Jm Raq'ilred IXI 6. Decedenl Died Testale,,,,," "'" ~ "") 0 7. ~!OOd.nl Maintained a L,'ng Tru,'lAllo:'''''' ofTNlQ _ 8. To",' Number 01 Sefe Deposit Bom o 9. L1tlgetlon Proceeds Roce.ed 0 10 Spousal Poverty Credit". ~... be""', U.II.111Ild Hll) 0 11. EleetIon to tax under Sec. 9113(A) ,"",'!<II 0) THIS SECTION MUST BE COMPLETEO. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: tw.U! COMf>lElEMAJlINQADORESS Horace A. Johnson, Esq. Stewart & Weidner 301 Market Street P. O. Box 109 I.emoyne, PA 17043-0109 1. Real E.""e (Schedule A) (1) 2. StockIend Bonds (Schedule B) (2) 3. Closely Held Corpo"Uon,P.rtn.~hlp or Sole-Proprt.'o~hlp (3) 4. MortgllgOS & Nolos Roce.able (Sch.dule D) (4) 1 S. ClSh, Bank Depos~ & MIsalIl.nOOllS Personal Property ..." Z (ScI1edule E) (5) 3 7 1 5, 1 0., ., .9 0 6. JoInlly (>,vneel Property (Sdledule F) (6) f, i j. ~ 7. Inler.VJyoa Transr.~ & Miscellaneous Non-Probal. Property .,<-'(; t..,,; -_~.';;:K>-;',"'.; (7) 41'5, 01 0',,0 0 E (Sdledule G or L) 8. Tolal Oroll Alletl (Iotal L1n031-n (8) ,',' ~ 9. Funeral E,pans03 & Admlnlslrallve Cosls (Schedule 11) (9) 13 ,; 5 i 2 i 7', 5 9' i -I _ _. .__ ~ 10. Debls of Decedenl, Mortge9. L1abIllU03, & Liens (Schedul.'1 (10) 1 9 4, 6,,7 8 11. Tolal Dtductlonl(total Lln03 9 & 10) (11) I' l)~-iil~'IA[-ulif.' Ofll'f i 42../0 i 1 i O. 7 9 14 474.37 12. Net Velu..' Ellate (Line B minus Line 11) 13. Cher1table and Govemmental Baqu.,lsISeo 9113 Tru," for which en eloclJon to lax ha, nol boen mede (Sdladule J) 14. Net V.lue Subjectt. To (Line 12 mlnu, Llnell) IS. Amountofine14taxeble , atlhtlpouaal tax rale 'I ." S..lnslnrotJon, on reve,.e sid. for epplleable pereanlag. 16. Amount 01 line 14 taxeble el6%raie 2 7 1 5 17. Amount 01 line 14 taxable etlS% rale (12) (13) I" 2 7, 5.36,..4 2 " , - 'n '- (14) .2 7 I ,i'". , 5 3,6 . 4 2 :f .,l X ..0 ( (IS) , , (; -: iJ f:l ~'~,- " i .I, , , ~;l -;"i:!"C;tl;, ;.f' 16. Tax Due 19. 3 6. 4 2 X .08 (16) 1 I 6 5 2 . 19 ',,;;,~', fe'..," ,.-1 " ,,.--" X .15 (17) , - 0 - (16) ,_"" 1 '. 6 5 2 " 1 9 ADDRESS 467 Woodcrest Dr.ive Mechanicsburg, PA 17055 O. Market St., P. O. Box Lemoyne, PA 17043-0109 109 DATE /,;-/1;1'7 DATE /2/1"/f7 ADDRESS ~ec'edent" Complete Addreu: TREf.T~~ ----.. Manor: Car.e Health Serv.l.oos ___*_' -.--_.-.-0 308 ManchoBt:er Road --- r CITY "nIT{' llill rlx Payments and Credits: 1. TIIX Due (Page 1 L1na18) 2. Credlta/Paymentl A, Spoueai Poverty Credit B. PrtOf Payments C. Discount r8T~TE n~-----rzw- L----,-=- ..L-. 17011 (1) 1,652.19 -0- =-1,500.00 78.95 Total Credits ( A + B + C ) (2) 1,578.95 3, IntereetlPenally If applicable D. Interest E. Penally TolallnteresVPenally ( 0 + E) (3) 4, II line 21s grealerthan line 1 + line 3, enter Ihedlfference. This Is the OVERPAYMENT. Check box on Plgl1 L1nlle to requelll relund (4) 5. II line 1 + line 31s grealer then line 2, enler the difference. This Is the TAX DUE. (5) A. Enler the Interest on the tax due. (5A) 8. Enler lhe tolal 01 Line 5 + eA, This Is the BALANCE DUE. (58) Maka Ch~k pa~ble to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Old decedent meke a Iranaler end: Yes e. retsln Ihe use or Incoma olthe property translerred; ............................................................. 0 b. relaln the rlghlto deslgnale who shall use Ihe property translerred pr Its Income; ......,......... 0 c, retain s reverslonsry Inlerest; or...............,.......................................,.......,............................. 0 d. receive Ihs promise lor 1I1e 01 either paymenls, ben~fits or care? .........................................0 2. II death occurred on or belore December 12, 1982, did decedent within two years preceding death transler property without receiving adequale consideration? II death occurred alter December 12, 1982. did decedenltranaler property within one year 01 death without receiving adequate consideration? ....... ........... ................,....... ......... ....., ,..,.. ...... ........... ...... ........ ~ 3. Old decedent own an 'In trusl lor' or payable upon death bank account or security st his or her dealh? ......................,.............,.......................,.........................................................0 4. Old decedent own an Indlvldusl retirement account. annuity, or other non-probate property? ....0 -0- 73.24 -0- 73.24 No [J!l ~ o ~ 72 P.S.li9116 (a) (1.1) (I) provided lor Ihe reduction of the lax rate Imposed on the nel value oltranslers 10 or lor Ihe use ollhe surviving spouse Irom 6% to 3% lor detes 01 death on or alter July 1, 1994 and belore January 1, 1995. 72 P.S.li9116 (a) (1.1) (II) provided lor Ihe reduction ofthe rata Imposed on the nel value ollranalers to orlor Ihe use 01 the surviving spouse Irom 3% 10 0% lor dales 01 death on or alter January 1. 1995. The statute ~oes not exemDI a Iranslerlo a aurvlvlng spouse Irom lax. and Ihe statulory requirements lor disclosure 01 assets and flllng II lex return are stili eppllcable even IIlhe surviving spoule Is Ihe only beneflclary. FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995. Plesse answer the loll owing question by placing an 'x'ln the appropriate space. Old Ihe decedent creale a truII or 11m liar arrangement which Is solely for Ihe IUNlvlng epoule" benent lor hll or her enllre Illetlme? Yel 0 No Q II you answered yes to the above question, the tax on the trust or similar arrangement Is postponed until the death 01 the second spouse, at which lime It will be lully taxeble at the rate(l) applicable to the remainder beneflclary(les). Enter the value 01 the trust on Schedule J, Part II, In order to remove It Irom the calculation 01 the tax due In this estate. You may wish to lIIe Schedule 0 In order to make the election available under Section 9113. IIlhe election Is made. Ihe trust or similar errangement Is taxed In the estate 01 the flrsl decedent spouse, the portion 01 the trust or similar errangement which benefits the surviving spouse Is taxed al the zero tax rate, and Ihe remainder Is taxed at the rate(s) applicable to the remainder beneflclary(les). II you choose to make the election, you must a"ach Schedule 0 to a tlmely.flled tax reMn, slong with Schedule(s) K andlor M In order to show the apportionment 01 the trust or elmller arrangement between the surviving Ipouse and the remelnder beneflclary(les). ... .....-.~'- ---,~,---<.....~...".._.",_.,-,,- oon.ln-Iaw, ROBER'r W. SCOTTI Executor. ~ .~~~~SS WHEREOF, I hereunto set 'rUA I 1986. my hand and seal this 8!) day of (SEAL) Signed, sealed, published and declared by the above.named Testator, as and for his Last Will and Testament, In the presence of us, who, at his request, In his presence and In the presence of each other have hereunto subscribed our names as witnesses. .......".,I.~. COMMOIN/EAl.TH OF PfNNSYlVANIII INHEIUTAHCE TIoX RETURN E8TATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-97-0707 KONECNI, GEORGE J. Indudell1t proceedl 01 IlIIgellon end the dll.o the proceedl were re<lNed bV the 0$1.01.0. All property jolnttvoOwned wtth the right ollul'llvol1lhlp mUll be dllololld on Schedule F. ITEM - VALUE AT DATE NUMBER DESCRIPTION OF DEATH -- I. 2. 3. Household C~s - date of death value 500.00 PNC Bank, N.A. - Savl.ngs Account No. 5130180962 - Date of death balance, plus accrued interest 34,785.56 Har~l.s Savl.ngs Bank - Checkl.ng Account No. 05-00009422 Date of death balance 2;225.23 '\ !hi;,>)""",_",'" TOTAl. (Also enter on line 5, RecapltulaUonl. 37,510.79 llf m!1(~,"M('~ I", f'I~rIf1f"t4 IM~rt ~rM\I1(w:I,,,h~tQ,..,t I.hl'l C!~rolt~ht\\,,_;..-.; ""["'i'\-;~'''''/<-~ . !t;~\...~t:l ., '* C(lMM(lIfflW.TH Of PEHNSYLVANIA INHEIUTANCE TAX RETURN I E.TAlEOF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER KONECNI, GEORGE J. Deble ot decedent mUAI be "ported on Schedule I. ITEM . NUMBER A. \, 2. 3. 4. 5. 6. 7. B. \. 2. 3. 7. 8. 9. 10. OESCRIPtlON FUNERAL EXPENSES: parthel1Pre Funeral Hare - funeral expenses parthel1Pre ~lneral Hare - additional death certificates Rolling Green Cemetery COITq;:>any - Interment Fees pealer's Flower Shop - funeral flowers Monsignor Lawrence - funeral service lrKoste Villa _ catering meal after viewing for out of town guests & relatives. Mercy Services ~ lunch after funeral ADMINISTRATIVE COSTS: Personal ptpteHllIIll'le'e COl\1I1lIS$IonS Ne"" 01 PellCnal Rep<esenllll'le (I) Socltl StcUlIty Numbe~l) I EIN Number of PellOOll Represenllll'le(l) - Streel ~ddlllS . ~ - Y"~I)CommlslIonPeld: _ MomeyF... _ Johnson, Duffie, Stewart & Weidner Feml~ EKempllon: (II decedenll e(\dress II nol "" ,,"".. clalmenll. etlach explanellon) Cltlment Street ~(\dr... SIIIe Zip CIIY Rellllonlhlp of Cltlment 10 Decedent 4. p~IIFees - Register of Wills - cumberland County 5. AcllOUntanfe Fees 6. Tex Retum P"p'"fl Fees cumberland laW Journal - advertise letters The patriot-NeWS - advertise letters Register of wills _ file Inventory & Inheritanoe Tax Return Reserve for close-out costs 21-97-0707 l AMOUNT..:..- 9,830.00 16.00 720.00 298.34 150.00 191.. 04 150.00 1,675.00 '\' 93.00 60',00 69.21 25.00 50.00 TOTAL (Also entnr on line 9, Recapllulatlon) $ 13,527.59 (It more apecels needed. Insert additional sheets of the same alze) OIY,"'lIX""n '* COMMONWEAlTH Of PENNSYLVANIA INHERITANCE TAX RETURN I SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21-97-0707 KONECNI, GEORGE J. Include unrelmburnd medlcelexpena". ITEM NUMBER 1. 2, 3. DESCRIPTION Manor Health Services - balance due - decedent's account not covered by insuranoe. Susquehanna Surgeons - balance due - deoedent's account not covered by insuranoe. Cornerstone Adminisystems - balance due - ambulance service - not covered by insurance. ,. TOTAL (A1ao enter on line 10, ~p1tulaUoni . $ (If l110Ie apace la needed, Insert eddlUonalaheets af the aame size) ..... AMOUNT 893.92 19.82 33.04 " 946.78 "I' OIY.''''''.I..n. COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE J BENEFICIARIES KONECNI, GEORGE J. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (Include OUlrlghlspousal dlstrlbulions) 1. Joyce A. Scott 467 Woodcrest Drive Mechanicsburg, PA 17055 FILE NUMBER 21-97-0707 RELAtiONSHIP TO DECEDENT AMOUNT OR SHARE Do Nol Usl True'..(a) OF ESTATE Daughter Tangible Property/ Residue ENtER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON.TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECtiON 9113 FOR WHICH AN ELECTION TO TAX IS NOrBEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART U. ENtER TOTAL NON.TAXABLE DISTRIButiONS ON LINE 13 OF REV 1500 COVER SHEet $ (" more aP8Clla needed, Insert addltJonalaheels of lh18am181ze)' ..... ! -1 --I MAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RUAIN LOWER PORTION FOR YOUR RECORDS ~ illv: is',f-iif"Ajop- io'9=i7Y -Ni'i'f f ci--o..-ItiiiiiiifAiicE-YA'irA-ppiliii iiMENT ~- -Ai.i"owiliicE -iili' -- -- - _m_ - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX GEORGE J FILE NO. 21 97-0707 ACN 101 APPROVED DEDUCTIONS AND EXEMPTIONS I '0 Funeral Exp.n.../AdM. Co.t.l"llc. E~p.n... (Schedule H) C,) 10. Debh/Nort.o.o LlobllltlOl/Uonl ISohodulo II (10) 146.78 11. Totol Doduotlonl (111 12. Not Voluo of To. Roturn (12) 15. Chorltoblo/Oovornoontol Boquolt.) Non-olectod '115 Tru.t. (Schodulo J) 1151 14. Not Volue of E.toto Subjoct to To. (141 NOTEI If.n ......m.nt w.. i..u.d pr.viou.1Y, lin.. 14. 15 .nd/or 16, 17 .nd 18 will r.fl.ct figur.. th.t includ. the tot.l af abb r.turn. .......d to d.t., ASSESSMENT OF TAXI IS. Aoount of LI~o 14 ot Spoulol roto (15) 16. A_t of Uno 14 to.oblo ot L In.oI/Clo.. A roto (16) 17. Aoount of Llno 14 to.oblo ot Collotorol/Clo.. B roto (17) lB. Prlnclpol To. Duo TAX CREDITS I P~YNENT DATE 11-05-97 12-17-97 ;5. ;qq- :3 BUREAU OF INDIVZDUAL TAMES IHHEIUUHCE 'AX DIVISION OfPT, 1.10601 HARRI..URQ, PA "1Z'~O'Ol COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INItERITANCE TAX APPRAISENENT, ALLOWA,;cE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAM HORACE A JOHNSON ESQ 301 MARKET ST PO SOX 109 LEMOYNE DATI! ESTATE OF DATI! OF DEATH FILE NUMBER COUNTY ACN 03-23-98 kONECNI 08-09-97 21 97-0707 CUMBERLAND 101 PA 17043 t Aoounl R.oltt... ESTATE OF kONECNI TAM RETURN WAS, I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. Rool E.toto ISchodulo A) 2. Stooke end Bond. ISchodulo B) S. Clo.oly Hold SIock/Portnor.hlp Intoro.t (Schodulo CI 4. Norl.ogo./Noto. Rocolvoblo ISchodulo D) 5. Co.h/.onk D.po.lt./NI.c. Por.onol Proporty (Schodulo E) 6. Jointly Owned Proporty (Schodulo FI 7. Tron.for. (Schodulo 01 B. Totol A..ot. I CliANOED III (2)_ IS) (41 ISI (6) (7) .00 .00 .00 .00 37.510.79 .....M. 4,500,00 lal 13,527.59 .00 27.536.42 .00 X . DO. M.06. X .15. IlB) RECEIPT NUNBER AA242438 AA242574 DISCOlllT (+) INTEREST/PEN PAID (-I 78.95 .00 1,500.00 73.24 ANOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ..~* .IY.I'~' II ", llt.~lI GEORGE DATI! 03-23-98 J . IF PAID AFTER DATE INDZCATED, SEE REVERSE FDR CALCUL~TION OF ADDITIONAL ZNTEREST. IF TOTAL DUE IS LESS TitAN .1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI. YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTZONS.1 NOTE: To tn.ura proper credit to your account, ,ub.it the upper portion of thl1 for. with ~our tax pay..nt. 42,010.79 14.474 37 27,536.42 .00 27,536.42 .00 1,652.19 ,00 1,652.19 1,652.19 .00 .00 .00 Ir': ~ ~ 'oil f'j 0(; RESEAVATION, E.tet.. of de~"'nt. dYlnt on or before ~~r 12, 19.2 ~~ If any future Inter..t In the I.t.t. I. trtn.f.rr~ In po.....lon or ,"j~v..nt to CI... B (~oll.t.r.l) b,",fl~llrl.. of the dec.dent Ift.r the .wpl,.tlqn of '"~ ....t. for Ilf. or for v..r., thl C~GnN'llth her.by .~pr..'IY r...r~.' thl right to .,prll.. end ...... tren.f.r Inh.rltene. T'M" .t thllawful e.... . (oolltt.rIU rlt. on MY 'uch future ,Intlrllt. PURPClS€ Of NOTICE, To fulfUl the rlqulr.,.ntt of S.etlctn 2UO of thl Inhlrlttne. IM'ld Eltetl TIM Act, Act 21 of 1995. (72 P.'. Stotlon ..4.). PAVMENT: Dltlch thl top portion of thlt NoUo. and .ubIllt with your ply..nt to thl n..ltter of Will. prlntld on thl rev.,... .Ide. ~~".kI chl~k or OMV ord.r p.ylbl. tOI REGISTER OF MILLS, AGENT REFUND (CAli. r.fund of I tlIC. ~rldlt, .mlch Nil not r.qutl.t.d on thl lex R.turn, IIY b. rlque.t.d by c!MPIIUI1l In "."lIcltlon for R.fund of Plnn.ylvenll Inherltlnol and E.tltl TAlC" (AEV~.)13). Applloltlon. .r. '''llllbl. .t thl OffiCI of thl R..ht"r of Nllll, eny of thl n Rlvenue DlItrlct OfficI., or by c.lllng thl .peclll 24~hour an....rlnt ,.rvlol ~r. for for.' orderlngl In Plnn.ylvanll 1-.00-S62-20S~, out.lde Plnn.vlvenla and within loell H.rrl.bur, Ir.1 (717) 787-10'4, TOOt (117) 711~22SZ (Helrlnt lapllrld Only). OBJECTIONS: Any plrty In Int_r..t not ..tl.flld with the appr,I..-.nt. .llowaRcl or dl..IION.ncl of d.ductlon., or ......-.nt of tlM (Including dl.count o~ Intlre.t) I' .hown on thl, Notlcl lU.t obJ.et Nlthln .IM~y (60) d.y. of r,cllpt of thlt Notlc. by: -~..rltt.n protl.t to thl PA D.,lrt.-nt of Revenu., lo.rd of App..l., Dept, 11'021, H.rrl.bur., PA 17'ZI-l011, OR ~-'I.ctlon to hIve the ..tter det.reined at IUdlt of thl account of thl par.on.1 repr..ant.tlve, OR ~.IPPIII to thl Orphtn., Court. alWlIN ISTRUII/E CORRECTIONSI Fectual error. dl.cov.r.d on thl. ....,.tant .hould b. eddr...1d In ..rltlng t01 PA Depart..nt of R.venut, Burlau of Indlvldull TI~'C, ATTNI Po,t A.....eent RIV..N Un!t, Otpt. 110601, Hlrrl.bur" PA 17128-0.01 Phone (717) 187.'SOS. SII pe.e S of thl bo~let ~In'tructlon. for Inhlrltenc. T.IC Return for. R..Jdlnt Dle.dlnt" (REY-ISOl) for Mn Ixpltnltlon of 168lnl,tr.tivlly corr.otlbll .rror.. , DISCOUNT I If ~y t'M due I. plld within thr.. (5) e.land.r ~th' .ft~r thl decedent'. dtlth, . flv. parcant (IX) dl.count of thl t'M 'lid I. 111owed. PENAL TV, ThI lS~ tlM .-nt.ty non-p.rtlclp.tlon panllty I. coaputtd on thl tot.1 of thl t.x end Int.r..t ......ad, and no~ plld before JanulrY 1', 1''', thl flr.tdIY .ft" thl .ud of thl tl~ MM,ty p.rlod. Thlt non~p'rt1clp.Uon pantlty It appa.llbl. in thl .... ,ann.r INKI In thl thl ,... U.. p.rlod .. you would app..1 thl tl. end Int"..t that hi. bien ......Id I' Indlcat.d on thl. notlc.. INTERUT I Int.r..' I. chlrlld bI,lnnlng with flr.t dlY of delinquency, or nlna (,) aonth. and one (1) d.y fr~ thl d.tl of de.th, to the dat. of P.ve,"t. TIMe. which btc... delinquent b.fore Janu.ry I, 1.6Z b..r Intlr..t .t thl r.t. of 11M .'X) p.rclnt par tnnUI calcullted .t . dlllV r.tl of .000164, All tlMa' which b.e... dlllnquent on and Ift,r Januarv I, 1.., ..Ill b..r Intare.t .t I r.tl which will v.ry frOt c.l.ndlr y.ar to ell,ndlr y..r with thlt r.t. ~td by the PA Dlplrt..nt of Rlv~N. ThI appllelbll Int.r..t r.ta. for 1962 throuth 19.e Iral U!! Int.rllt ..t. D.IIY Interl,t Flctor :!!!! Int""t Rllte DIllv Inter..t Factor 1.12 ZOX ."oslte 19., .l .OD02ft7 1915 III .00001 1'11-1991 III .00l1Dl I'" IU .000301 1992 'l ,0002.,.7 1911 15iC .000156 "91-1994 n .000192 If" IOl .000274 1991j-1996 .l ,0002lt7 ulntl,..t I, a.loul.tad .. follGNI! INTEREIT . IALANCE OF 1AX UNPAZD X NUHIER OF DAYI DELINqUENT X DAILY INTEREIT FACTOR .~Anv Motlce I.sued ,ft.r thl tllC baCOll' delinquent will reflact In Int.r..t c.lculltlon to flft"" (IS) dlVI beyond thl dltl of thl .....Hlnt. If Ply,,"t It ,aft efter thl lnterllt CoaputlUon dlt. lhown on thl ttotlaa, Iddltlontl Inter..t "".t be ollcu..ted.