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RCC.33~(4.731
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COMMONWEALTIl or PENNSYLVANIA
DEPARTMENT OF REVENUE
\lURE,\U OF COUNTY COLI.ECTIONS
*
COUNTY OF.
CUMBERLAND
RESIDENT DECEDENT
IMPORTANT,
.-- -- ~- -- -. -- .- . .--
This return must he cOlllp!ctcd illllclUilnml filet! ill duplieutc, with nil llllHched, with thc Ht'gistcr llf Wills of tile
County whcre t1ecctlelll resided; Itcturll is duc withitlllillC months afwr date of death, unless 1111 eXlcnsiol1 is grantcd
hy lhc Sccrctllry uf ItC\l.ClltlC. (Sectilln/03 of 1I1l~ IlIhcrillllle(~ nnd Estatc TlIX Act of If)lIl.)
Julianna Kole,k
(STATE FULL NAME OF DECEDENT)
} ,ll'l'mAVIT OF
EXECUTOR
AI'\IINISTlIATOII
IN TilE MATTER OF TilE EST,ITE OF
Lata arew Cumberland, Cumberland
County
County of
Penns)Chrania
Cumberland
~}s"
Helen Klimczak
Exccutor
Slate of
P.
o.
E, Reid,
Box 966
Jr, , Goldberg, Evans &
Harrisburg, PA 17108
Katzman
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Admil1istrllltlr
of the estate of the above.named decedent being duly sworn, dopose
and soy
Decedent die"September
(MONTHI
'Harne and address of attorney or }
other aulhorh.ed represantatlvll to whom
all callespondenca should ba mollod.
That as such Administrator dcponent is familiar with the affairs of said estatc und thc property constituting
(EXECUTOR.ADMlNISTRA TORI
the assets thereuf and their ruir IMulwt value.
27
, I~~{'~~~~K~~>>~~~KK~~~~~X)
(YEAR) inlo5lola
\DAY)
James
That atthc time of death there was no safe deposil box registered in dccedent's individual mllllC, or juintly with, or
as agent or dcputy of another, or in dccedent's il1llividualnamc, with right of acccss by ullttther as agent or deputy, with the
exception of thc following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A S.~FE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
none
That the contents of sa id safe deposi t hox or boxes arc itemized under Schedules
with the exception-of the following, for the reasons Iwreinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully ;:md in detail all the real property
in the Commonwealth of Pennsylvania of which decedcnt died having an intercst therein. It also sets forth the
mortgage encumbrances u)lon each parccl of real property at the date of death, giving the amount still due at
death, name of mortgagce, date, rate of interest, I.Indbook and llugc of record thereof. It also sets forth in lhc
columns provided thereforc the assessed valuation of cuch of said pllfccls, the estimated market value thereof
as of datc of death of decedcnt.
ThAt Schedule B attached hcreto and mnJc part hereof sets forth fully ami in detail all personal property
wheresover situated owncd by the dcccdl:llt at thc timc of death; ;:tll moneys left by lhc Jccedcnt at the time of
death, whether in deccJent's il1111\cJi;lte pussession, standing 10 dccctlent's credit in hanks of deposit, savings
bunks, trust cnmlmnics, or other institutions, whether individuully, or in trllSt for uny other person or persons
giving also separntely the uccrucd .intl:rcst thereon, if any, down to thc last interest day prior to decedent's
death in the case of savings banks. and to Ihe date of dccl~llt:nt's dcath in all othcr cases; all honds,llflswl
savings, treasury certificates or notes allJ olha evidence of indehtedness of the Unilcd Statcs to (he de-
cedcnt; all ohligatiuns, whether hy statute or agreemcnt lhcy arc dcsignatcd as tax free, of Ihe United SWtcs,
or any state, or I'~olitical suhdivision thereof, or of any foreign coulltry, which ;:arc owncd at thc time of dClllh;
all wearing apparcl, jcwelry, silverware, pictures, blinks, works of art, hnllst:hold furllihlrl'" horscs, carri;:lges,
automobiles, hoats, and any and nil othcr pcrsunal chattels of whatsoenr. kil1l1 or naturc, Icfl hy decedcnt.
together with thc fairly estimated m~lrkd valul' thereuf; all honds ami llwrlgages h...ld hy dcccdent and of all
claims due and owing decedent al tl~t~ tilll!.: uf d~alh, and all Ilromissory nnte~ or other instruments ill writing
for Ihe payment of money of which decedent died possessed, of whilbflC\'er nature. with interest thereon, if
nny" giving the face value nnd cstimatcd r;:dr IlHlrkct value thereof, and if such estimated fairmarke't v.due he
less than the: face value, it sets forth hriefly Ihe reasons for such t1cJlreciation as to each itcm;all mon.:ys
payable to the estate from life insurance Ilulicies c:lrricd by dcc;edel\t; all annuity ilnd endowl1lcnl Cf,.ntrllcts
the pro'.:ecds of which were Ilayable 'Ipon Iht~ death nf thc decedent; all ,lIHI the cOflluratc stocks ;:lIId dividends
due thereon nnd unpaid as of the date of dt~ath. honds nnd lIcclllcLl interest thereun to the dale of decedent's
death and other investment securities owned hy the decedent al. the ,tillll~ of tleath, with Ihc markct value then,.
of at such time.
/"17
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In the cl\se 01' s(~cllrlt1es of' close or I'nmtl,r corpol'lltlo11S, t.llt! viti tlllS I'f!rlllrl<~d IIr!! liS ('ur IlS
possilJle sllbslunt.lulerl h~' f'illHlIclnl Sllllt'l1llmls of' tho cnrpol'lltlollS, showing till! IlssllLs unci IlnlJlll Ues
thereof 115 of the dnte of' dl~lIl.1lo The schelinl/! 1l1so sets I'OI't.!1 tile Inl.('I"'sl. of' deCI!llent. Ill. till' Urnl! of
d(!l\lh In IUI~' co-pllrt.nershlp or 11Ilslness, nml III sllpport. of' thl! vlIIIW 01' slIcll Ifll.(!rl~st. t.Ill~I'l! is Itllw~x4~d to
sull! sch('lllltf~, 1'11Hmt~11l1 stnlenumls showlngthcnsscts IlwlllniJllll.tps nf's/lltl cn-pI1rl.llnrshlp 01' huslllllSS.
A copr of tlu' co_pnrtmlrshlp ngt'eemnnt, (I l' ornl, Il stfltf~l11nl1t sntUI1J!; f'ort.h tllp. ll/ll.IIl'O of' tlll~ 11~I'Ill!llIntlt)
togetlll.'r with l\ slllll!ml!l1t set.tllIJ!; ('orth t.he charllcter of' tho hllsll\l.'ss, Its lonut.loll, 111111 SUdl nlh!'I' f'lIets
11ert/lllling 1.0 tile hm:;iness liS I1lIIY hn IWt'tlllenl, t.o n f'nlt' IItHl .IIISt. npllrlllslIl Ill' 1.111.' (\l!f~..dlmt.ls Illl."I'I~St,
therntll mllsthesubmlttp.d. It SllOllld ulso set f'flrth In Itentlzp.d 1'01'JIl, l.Uj.!,1!1I1..r wltllUII' ('Hl1' Inftrlm!. vul\lf~
thereot', IlIIY other Jlroperl~' oWlll~d or heqtlcllUwll b~' Uw dccedl~llt fit t.I11~ t.lme of dnlllll.
The Schedule C nttncllcll hereto nnel mlule P'lI't herNll' sets f'ol't.1I 1\ t.1'IIP IlIlSwer to l!1lc:h 11l1lulry
contfllnerl t1li~rcln nl\llln the cnse ol't.ransfers nf'proJlert;~', ren1 nl' pCl'snlln1, wi thin two ~'(JflrS 01' deCf!(\cntl s
dcnlh, In contemplation of decedent's {tent.ll, or 11It.I~ncled to I.llkn efl'ect. In possession or en.!oyment ut or
lirt.er dCllth, said sc1wdlll e sets forth t1w 111ltllrn lIJl11 vnIuf! of sueh J1I'ollf~rty, 1.0 whom t.rllllsi'l'rred, the
relntiollshlp or the trnnsferees to the decedent, t.he pruportJonnte shllrl~ r(!ef~lvefl h~' nllch l."/lIlsf'flrce nnd
Illl other f'llCts or n pertinent nnture rej.!,llrCUn,l.!; SHiel trllllsfers. In t.he ellsn of' tl'lUlsl'ers Intended to
tnke of'f'oct in possession or (m.loymont Ilt or lifter rlonth, thure Is nlsn llt.tllehl'Hl to the schec1ule n eOJlY
of tho dced, trust agreement or other instrument crelltlnJ~ the trust. TIH~rl~ is u150 set 1'0 I' t.hIn sllld
schedule /I list of nll property, real /lnd persoflul, with its vlllue, whleh pll~;!ies nt decedent's llenth by
virtue or the exercisc by decedent, either illll!viduully, or Jointly w1t.ilnllotlrer, or nny )lower 01' appoint-
ment. vested indc(:erlent, eitllcr Illlllviduully or Jointly, hythc will, deer!, or ol,hl:l-r instrument. of' 1111ol.hf~I',
with n copy of' the instrument crelltJng such powel' IIttllched to the schedule.
Thllt Schl'du/l' 0 attached hereto nnd mucic pllrt ht~renf sets f'urtll the nflmes IlO(1 lulrlresses of nIl
llersons heneficially interested in this estnte nt, the Limu of' Ih~cp.clcI1L' s {lentil, thc rwtlll'e of thclr res-
pective interests, their relntionshlp, if nny, to the cleceflcllt., tnf:!;p.t1lf~r with the ages nt the time 01'
decedent.'s death of all minors, annuitnnts and heneflcinries for lU'1! muler llccedent's Will. It ulso
contains a statement showing which of the llenefic1nrics named ill tile IIp.cp.dent's w1l1, 1.1' lillY, cIied prior
to decedent, tho.c1ntes of their deflth, their Iss1le, IUHI the relnt.1.onslilp of' such issue to the llel1cl'lciury.
Thnt SC/1pdule E nttached hereto nnd ntntle fl IHlrt hereof' sets {'orth 1111 properl~'J I'enl IUlll per-
sonal, owned by the decedent Jointly with nnother or others, inclucltng lntfUlj:!;ilJte, stnmltng In the nnnte
01' the decedent And others, plus the date nnd plllce of' record of instruments erf't~ct1ng the vestiturc of'
renl estate ami the date of acquisition of pcrsonnlty, plus the nnnte, llfhlre5S nnl} rl!lntlollship, if nny,
or co-owners to the decedent.
Thllt Sc/1l'dule F attached hercto and mnde n part hereol' sets rorth f'ull)' lInd in detail u1l llchts
nnd deductions claimed for nntt on behalf or this decedent's estllte, Incl1lfllng f'tlncrlLl eXllCnses pnidj
fl1nril~' exemlllion, where np'llUcnlllcj costs of ndmJnistrution of this estute; (:ounsel fees nnd 1'1lfltc1nry's
conunissions paid or to be pldd; cost cX11ended for blll'1nl trusts, tomhstones or grnvemllrkers, nnd reli~
gious services, in consequence of the dentll or the deccllentj elehts lUlll cln1ms owtng n1uI unpll1cl Ilt time of
death; t.llxes nccrued chnrgcnble for perioel prIor to decedent's <Ienth (cxcnpt those nlloweelunflcr Section
651 of' the Inlj(~r1tllnce nnd Estate Tux Act); together with II statement. 01' collat.eral 1Jlerlp;ed ror ohliga-
tIons, if /lny. It 1s ngreerl thllt. th(~ firluclnry will present proof nf' suid clalmlHI nhltglttions upon re-
quest, that if the lunount llctunllj' pll1.d In sett.lemcnt or llny ren, l:omrnlss1.on or deht Is less thnll the
estinulterl nmollnt c111.iming und 1l11owcd, thnt. the same will he rnportcd to the Itcglster of' Wl11s, /lnd thnt
the amount of' lax llsscssect cun he rcnsscssntl III lICCOrdllllce t.herewl tho
Thltt the totllls of the llpproprtnte columns In Schellulcs "A", "H", "e", "E", Hnl! "F" us drrr~Ctell there!lI,
httvC been CftJ'rierl forwarfl (Iud llrollCrly rc~ist.erctl In the Sl1lnmflr~'.
Subscribed and sworn to before me this
'm../l.~. ...... day Of;!/~7
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:}QiI:,.lf(:?:;;.ft.s/:~.:............"'t...'.m..............."""
. (S,treet Number) !I
);~. -/ \,.":< /;1 li:f", Ii. E1 17 (17 (/
(City or Town and State)
SOTE: Ihd'nre sJI~lIlnp; Ilf'f'irln\'i t. mllke sllre III I hlank splices ill tJll~ nffIdlLvl t 111111 schcl}ulflS llnnexel! ltrc
f'1l1elt in with lIntlllls or t1lt~ WOl'lt "NOI1p.", /lncl III ClIse tll(! tls~et.s ilw11111e rure 1U1I1 \llllJstcll fiecllrities,
securJ t.1\!S of cl n<;f' or f'lintl] Y (~nrporll t.J nllS or 1111 lnt.eres t. I n Illl~' cn-pfll't.nersldp or hilS Iness, thll t lhe
dfltll HIIII st.Ilt,f'mf~lIt.s rel)ulrl!<t under tho J'HrHV;I'apl1 nllo\'l' re]lIt.tng; to Scheetllle ltn" ltl'.~ nttnchcll. .\1 so nmke
cf~rtlllll I.hut. column #1 in Uln "SlIn&1lllq'" has IInp.1I properly completed IlS Ilhove-'l1rect.ed.
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COMMONWEAL1'1l OF PENNSYINANIA
T1W1SrnR INIlERI'l'ANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PllOl'lo:Jl'l'Y
.
I NSTllUCTIONS: This Schedule must discloSQ all tangible Met lntulIglhle Jlersonal property owned individually
by the decedent, nt. the Ume of his deat.h. Property owned hy t.hc decedont ,101nUy with anot.her or others
must be listed under Schedule "E". Int/mglhlc personal property, it tied In l,he nRme or the rlocedcnt, but
payable ilL dCllih to Ilnot.her or others, includl.ng hut not limited to P.O.D. U. S. Savings Donds and tentn-
tivetrust nCcOImts, mU6t be listed, dCHIIU.e t.he fnet thllt they are not of the lulmlnistered astuto.
Tungible personnl property should he listed first (e.g. jewelry, wearing apparel, household
goods, nnd furnishings, hooks, pllintlngs, automobiles, boats, otc.)
Intllnglhlo personnl property, ullch as hands, trollsury cert1ficntcs, cash on hand and in bank,
stocks, mortgages, notes, together with 6ccrued interest or dividendS, snlaries or wages, insurance pay-
able to the estate or fiduciary in Btdrl capacity, partnership interests, interest In any undIstrIbuted
estate of or income from uny prolJOrty held in trust under the will or agreement of another, even though
located outside, of the State, at the time of death, should be listed in this schedule.
Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKEl' VALUE (Do no t wr ite in
this space)
NONE
,
.
. .
. . X X 0
Insert this total oppoal to "Personal Propert.y", Schedule "B" in
the "As Reported" column on the last page ot' this return. ,11V1\
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
11I~~mENT llECEIJENT
SCIIEDULE "n"
B1'NEFICIAI:II,S
. .. - -
BENEFICIARIES AND AIJlJRESSES RELATlONSlllP
(State fullnurnes llncl Ilddrcssesof nil who (If tltep-dlLldron ur SURVIVED HATE INTEREST OF
have an intert'st, vesled, COl1tinscnl or other- illcgitimllte children DECEDENT OF IIENEf'lCIAllY
wise, in c.lstatc) arc involved, Sl~1 STATE YES BIRTH IN EST ATE
forth this fact,) OR NO
Helen Klimczak Daull:hter Yes of all:e total
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Deponent further soys that 011 the above-nomed beneficiaries arc living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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Real Properly
Personal Property
TriJl1sft:[s
Jo~ntlY held savings acct.
Debts and Deductions
Gruss Tnxnblc Estate
(Sell. IIA")
(Sell. UB")
(Seh,"C")
Sch. "E"
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(t)
(As Reported)
$
$
$
$ 12,76S.Rl
;-42J%tni
(2)
(As Determined)
$
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$
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Estate No. .......................,........
BOND
KNOW ALL MEN BY THESE PRESENTS, That ~x....I....HELEN...KLIMCZAK."............,.............,..
. ......... .... ......... ..... .... ........ ............. ....., ........................... ......... " ... ..,;............... ........... ,...... ,..., ........,.. ........., ..'" principal........,
and .......~l.~~....~.~.1.'.~A....9.A~.1,J!\}er..':L.NW,...s.v.~WrY..GQMp.ANI.....................,......................................
.........................................................................."............................................................................................., ,suret..y.........,
arc held and firmly bound unto the Commonwealth of Pellll'ylmni;t, ;n the sum of ..!fwenty...Five......,...........
w..........Thousand...................................,.... Dollars (5",-2-5-;,000';'00)' to be paid to the said Commonwealth,
her certain attorney or assigns, to which payment, well and truly to be made, we do bind ourselves, jointly and
severally, and our and each of our heirs, executors, administrators, successors and assigns, firmly, by these 'presents,
for and in the whole of the said sum,
SEALED and dated the ..............Rineteen................da)' of ..........Eebr,uar.y.................... 19...80
" HELEN KLIMCZAK
WHEREAS, the abo\ e named ..... ............................. ........... ............... ...... ...............................................................
..................................................................................................................................................................................................
has or have made, or is or arc about to make, application to the Register of Wills of Cumberland County.
Pennsylvania, for the grant of letters .....of..Administr.a.t.ion.......................................................................
on the estate of ......~'1.~.~.[i.t1.11.a....l.{qlt=.15......,.......... "'............,.......'. late of ....Nf?Y!....G.1Jm\:?~.J;)!!,)JQ...........,
Cumberland County, Pennsylvania, deceased:
September 27, 1979
them shall well and truly administer the said estate accord ing to law, this obligation shall be void as to the personal
THE CONDITION OF THIS OBLIGATION is, that if the said personal representative ............ or any of
representative or representatives who shall so administer th e said estate; but otherwise, it shall remain in force.
;jALED and delivered in the presence ~f
. .,~~~~n.~.:~
_..._;~_~t~Ln-n
----~-~--------------------~---------_.
(SEAL)
(SEAL)
-------_.------------~------------~------_.
. _' _n._nn__ ____.00.. .___ _ _ _" _._._ --- (SEAL)
:r!.!~-:-:~7:~~:r7-~~:z~~AL)
__..~~~V2~.L_-- .___ (SEAL)
Attorney-in-Fact
------------------------------------------.
-------------------------~---------------_.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF dlliIDl~1}x*l) DAUPHINss:
Personally appeared before me, a...m...............................
..............,.......... in and for the county and
state, aforesaid ................ ...... ......... .... ....... ....... ..................... .... ..... ..... .................. .............. ............ ...... ....... ................ .......... ..........
of.............................,...........,...............:...................................and .................,.................,.........................................................,....,
...................................................................................................of..........................,........"'.......................,......................................,
surities on the above bond who being duly sworn (affirmed) according to law, depme and say that they each own Real
Estate worth the whole of the penal sum named in the above bond, over and above their debts and the debtor's exemption.
..~IA!,.(~!l.1{!,,~1.~.1Jik........................ (Seal)
..........,.....,..................,............................."..,.............. (Seal)
...........,.....,......"...,......................,..,............................. (Seal)
..... ...................,........"'......................,....... ..... ....... ....... (Seal)
Sworn and subscribed before me this
. ...................//~..............., day of d/~.L.
~;~..J/...42~.............
.
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THE A:TNA CASUALTY AND SURETY COMPANY
1lMllord. C:lllnectlcul 0611:)
POWER OF ATTORNEY AND CERTIFICATE OF AUTHOHlTY OF ATTOHNEY(S)-IN.FACT
"NOW AU MEN D'l' THESE PilESf.NTS. THAT TIlE A:rN~\ CA~lU^I.TY AND $lJlIFl~' C~/.Wt'N'f .1 crup,'I.lltOol Clllly C'fyWle,1 ul1llt." Iho IJoV!'o tit 1I~
Sl,lle of Connecltc.ul. .md tldllmg II!'. p'InclpJI OffICI) 1" \hl' e.ty 01 ttartl()td. r./hl/\IV 01 t1.~",Yd, flt;,II! of Ct,!ult!Chcul, tl.llh lIliHJe, Cunstltuted ;1lI{1 npp.JlnlOO. ;.nd
LhJIt' by Ih~StJ p'e'!ol!rH~.tnil\..e, COl\!'ollluhl and ofil.'JIJlnl S. A. Eckcrd - -
01 Camp Hill, Pennsylvania
Clecu:e and lH;k.nowlerl\je, at 011'" place wlthm Ihi!
. its !ruo ilnd l,w..h:I AlI')f('oys.!n.FilCl, wIth full power nnd ilult'C'fity ho~rooy (;OrIlerred '0 si!1'.
UntIL...1 Sl,llt:~i. or, It the lo110~1fl11 11M 00 flHed In, wit~'lIn the are.) thi:le dest{illated
. thu lollowmg 1nsltlln~(.n::~,1
by hIS sole ~Itflah,;tol and net. ..n'! ..nd "U hlrlds. Wr:IXJrlIl..mcc5. CQrltri'lcl~ (If 111Clcl11nlly. ;'11'1.1 oth.tf WfiMgs oblin,lfNi' in Ihe naloft of a t::ond. nx:ognizance. Cl' con.
uiltOOal uI,della~lng. nnd any and ,111 CCofISiml$ ;ncidr:nl therlllo not e>:.ceeding the sum. of i"IVZ HlII~DHED THOUSAND
($500 ,000.00) DOLIA.11S -
and to bind THE .€TNA CASUAL TV AND SURETY COMPANY. therebi al> fullV Jr.d to thit sarn8 odetlt as. if the szml'l ....efO sigled by thet dul'!' authotil;&d offic:tlfs
of THE A:TNA CASUALT\' AND SURETY COMPANY. ilnd alllhe ilc150 alsaid Atlomt!vs.~n.FJct. purSUJnl to thlt authori1y har~;n Ui'lKl. are heleby ratifled ilnd con.
firmed.
This appoinlm~t is made undar and by aU1horilV of lhe fOllowing Standing RtlsolutlOl"IS of $..'lid Compan'i which ResoluliCi\s are now in full forc~ and effect:
VOTEO: That each 01 lhe foJlo....r!l9 oflicars: Chairman. Vice Chairman. P"llsidenl, An,!, Exccuti...e VIce Prosidenl. Any Senior Vice President. Any Vice Pre\ident.
Anv ^sSlstallt Vice PresIdent. ton'f Secrt!lar'l, Any As;.;slanl Secretary, may from lime to time oppolOl Resident Vice PresidenU, Re::.idi!nt Assislant Secretaries,
AIIOrneys.lfl.facl. and Agel\~s I., act lor ..nd on ~h311 01 thff Company and may Qivc any such arpoint~e such authOlily as hi:; cerlLllcate 01 authority ma'!
prescribe 10 '5lgn with I~ Company's name and seal l'iith Ihe Company's seal bonds. recognizancp.s. contrads of indernnily. and clher wrillngs obligalory in the
natule 01 a bOnd. recognizance, or condItional underta1dng. and any of !laid officers or the OOMd 01 DireclorS may .3t ilny time femo"e anI' such appointee an~
rtl'lO~e thlt pOl'ief an~ aulho:itv given him.
VOTED' That :In,!, bond. recoyniz"nce. contracl 01 indemnity. or wriling obli(latory in the natura of a bond, recogni:ance, or cOfldltlonat und~13k.ing shan be valid
antJbindln%l Upo.l Ihe Company wl'en lal Slgnzd bl' the Chairman. the Vice Chairmi1n, thi! Prtlsident, an Ekecullve Vice President. a Senior VIce Ptesidtml. a VIce
PfeSldent. an Asslt.lanl V't:~ Pfe'ij{j~nl or by a Residel'lt Vice P,esldent, pur5t1i1nt to the power prescHb~d in the cerllflc3te of auH",ority 01 such ReSIdent ViCff
Pfl;!Sldenl, and duly alleiteJ ",\lj :~iI:ed \'flln the Company's se.'tl by a Sec~t!tary Of Assis!ant Secretary 01 by a ReSident Assistanl Secretary. pUfsuant to Ihe powel'
r.,e~crihed In the ('ellrt~clle (II i\utlXlftty 01 511ch Re$tdenl Assist"nt Secr.:::ary; or Ibl duly e~ecult!d (under seal. :t required) by one or more Allornefs.in.F"ct pur.
s(lwl to the p.,....er pre<irr,bed in h,s or their ccrtihcall't or certific..tes 01 Authorttv.
This Powt:-r of Atlorney Jr.d C~fllr'C'):d of Au~lv.ll'itf is signr:d and Sf HI I t'ld by f01CS;'Tliltl und.!t and b'I autt-..1rity of the following Sl;)flding Resolution voted by the
Uoilrc1 01 Olr(.'clors ot THE ,':TN,~ CASUAL TV AND SURETV COMPANY whic;t! ne:iohJtion is now in full force find effect:
Secrete-tJ'
Conni'Cl icul
~!> I\ilfllord
Cu,lnt... ol H.Vlford
On Itll(, 3rd
JIO\'c;rLer
, In 76
VINCENT A. WAlSH
Secretary
0:'1 (of
. b":l!,yt! mr. perr.Dflillll' C.lme
1.1 1l'1e ~.f'r.',..n ...h.J l..:lf'9 h)' me l!"ly ~.....C\ln, did r..:-s.'0s.:l ancl SJY lhJt he I'>
T!ir" {rNA C"~5UAI.TY ;d':il SURETY CO\VM";V the ('(Jif(lr,lIIOn de5(.r~:tI.'d In ':If~d \'.'1,(:t, rll!.-u!.)d :M ;:1~)(WI".! II~Slrurt"lel1l. ttlJ~ h-! b""v"~s Ihe se~l 01 !.3'C
p.:,rotlllln,'lhi\llh~ roe:!l illlllcO 10 'hc~ s<lld ;n!>lIu!rl~.'nt Il) such c.nrpvriltf! !.l'ill. [1110111,tl he C'N:llleO lho~ ~Jld mSHum~'n'. on t.:hall 0' the ~lrr/.'lr<.lltOfl h..' ,'luthNIIV 011
(llIlce ulltl.!r th~ SlclfltjlO{l R~SO~U:lonS Iht!fcwl
.'
...,~. ' . \~J;
(,',0'-'.'" ~ #~' _
<'~<~'",.'.:.~..~,~:) ../JJ.A1LL.-f.: ... ~~Xd.
"I, "'".,~"''' {/'i''''h 3\, " 8oT....~-i;,.", pi
. (,tHTI~ICA TE
I, !lle Ul1dC:I:>lfI"ed. A5hi~t:1nt So:cret.a.ry "f l!ir. tErtj." C.\$:Jf"l TV "''';0 SUil;:TY CO,,'?ANY,.l "oIlY:" C:Orp.:Y31,Qn (I! I~ !\l,'
CO.ln.",:u1. 00 ,If.n::9Y C(hTI'Y th,)l In,: l,:tu~o,ng ;>:'ld i1ltJ,;tu'Id P:)w(" (If ..:I.}lllrlw' olniJ Cr_":IIIC.~:~ Cll "ulhCl!ll~' ",~m",ns ml\J1I fc..r.e .1nd tus noll...~~n rc""
,1'hJ hJllht'fmQf.~, Ih.lt I~ !,.:"nd,na Ih:~nllJ:'(('l!. of Ihl' P":IJ.d 01 Dlf,'CIOfS ,l;.~,'" I.....P, In !h~' C/oI'l,l,el!/'! 01 ^ll~tl~III'V" ,lfe r>..~N In fColr"
S'V'i'i~ ;,,,.1 S~.l!t'1.t ~Il l~{' tk.ntl' Olf,.c.(' (jl
If, I~' j;C
,- ~()-/(..~/.- ''-'1 '
th!l COml'\lny In Ihl~ CIty (II Ibr:'l'rl1 ~\I\f! ('f r,"'lI'i'('~Il~ul O;l!.'(1 I'"S
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REV.484 EX. (3.aol
INHERITANCE TAX SUMMARY SHEET
(BUR.I~~Y"yS~.QN~~)
File Numbcr )1-8Q.".Q,iQL._.."..__.__n____._.________",.___
Estate Namc __.:!lI~.in-"nn Kol~I,.,,_
Datc 01 Dcath
9/27/79
Social Security Numbcr ,... Oc,
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraise, in and for the County of Cumberland
Pennsylvanial do rospDctfuJJy report that I have appraised tire real and personal property as reported in fhe foregoing
return at the values set forth opposite each item in the last column ta the right in Schedules IlA", liB", "C", and "E"
Dated:
April 24, 1980
,&iLUil'if(r:'/I,r./ )
INHERlTANCl: TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
ADJUSTMENTS
CODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Real Property (Schedule A)
Personal Property (Schedule B)
Jolnt.Held Property (Schedule E)
Transfers (Schedule C)
$
None
!lone
00+
92+
10+
TOTAL GROSS ASSETS
12,76 81 20+
Hone 30+
____--.1- 2, 7~ .ill.-I__
40-
93-
Leu D.bts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
annultl.-', , , . . , . . . . . . . .
RATE
FACTOR
PRINCIPLE
VALUE
CODE
~-
FOR USE OF REGISTER ONL V
Tax on $
COD.!'
COMPUTATION OF TAX
$
$
$
6%
T ax on $
15%
Tax on $
Tax on $
$
T ax on $
Exemptions
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
S
$
$
Less Credits
DATE OF PAVMENT AMOUNT PAID DISCOUNT INTEREST
S + S S =
+ =
BALANCE S
INTEREST FROM TO__>
BALANCE DUE \
TAX CREDIT
$
'" 'Cl ~
,... ~ ~ " <=
~ .... d '"
::l ....
'"' 'Cl
~ ~ ~ " <=
I ~ iJ <'J
~ l>I ....
::l '"'
CIl U OJ
;;:l .... 11
g .... :>
.s " " .... '"
. , ~ U .... .... ....
~ Z
I:.< 9
~ ~ I:.< g
~ I:.<
0
Iii 0 CIl ~ r- ei ei
I<l CIl
.. ~ I<l Z Z
..l ei i ei ~ l:j I<l l>I
..l Z z Iii Q ~ Z
~ ~ ~ 8 0 ::l
I<l Q Po
RECAPITULA TlON
^ ppraised value of Personal Property ........,.......,............."....,.."...................".......".."..,........ $.:!-.~.)..?!??.:.?.t
,\ ppr:dsecl value of real estnle ......................"......,................""....""."."...,....... ".."."""...."...... $..................,.........
TOlal appraisecl value .,.......".... ".....,...""....,.......,............",.....",,,,,,,,............... ',....".........,,,... $.~.?.'..7..~.~.:..?..~.
County of Dauphin ss: ~ ," ! ' ;-,' ".'.. _ .~~ I
................ ...... ........".........../:.:.~:.~(:!.f!...../i:.~.'".'. .41.,,:!.:~,.C:.?}.../t,./C/. ..... ..........4.. ....,..,...........,.............................
Exccut.. . L"/' v <.../.~; I
^dministratrl'~ of the ESlale 0r.,..;;,;zC:."".:,(d,1d.J.:!.L~.L:........... ...!:..t.k/...r;b;:......,...................
c1eceased, beiu!: c1uly ..................................... ' ............................... according- to law depose and say that the
items appearing iu the Inveutory include all of the personal assets where~er situate and all of the
reai eslate in the Commonwealth of Pennsylvauia of said dececleut; that the valuation placed opposite
each item of saicl Inventory represeuts its fair value as of the date of the decedent's death; and that
decedeut owned no real estate outside the COl11monwealth of Pennsylvania except that which appears
in a memorandl1m at the end of the Inventory.
.....:?0?/?..~-'!........T?!.... and sUbsCribed! -II , ivf. . J
I f tl' I/:Pt:: d f .......N<<.I..,IJ..,.. ";..t.1<(.U'~.....'-d..,...............................
Je ore me us......,........ ...................... ay 0 'xecutor. ~mlnlstrator ~
'''''5.;{Y!.:~M~.....IY....::.l..' 19 f.q, ( ,,}"'t.:..~t!.((t~,:J.~~!:.e.(~~.IiJ.::.~&~.;.:.L........,.L7. D "7 ()
~....fr.{.,..~... . .................., Addres,
AFFIDAVIT OF PERSONAL REPRESENTATIVE
INSTRUCTIONS
1. An Inventory must be fllad wIthin three months atter appointment or personal representative.
2. A supplemental Inventory must be tiled within thirty dayS or discovery or additional Bssets.
3. Additional sheets Inay be attached as to personalty or realty,
4. See Article IV, Fiduciaries Act ot 1919.
'1:1 ~
~ ~i .. ..
'" .. ..
M ~ f
oi i 2~ r:i s
- ~ .. :;:
- ti S~ ll:
0 ~ .,:
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>< 41 Q): H; 'ti >- <( u
.:; .-l: Q); <Ii " ll::Z iB~:
0: .0: .,.j " 00 o !
~ ... ::<:i si i:l ~ ~m
0 "
;:I: <1! u ,,',:
t <Ili "
ui ~ 'tl ~'~:
~ .. 1':: ';!,
.. J::; ~i .. ~Q
~ <tI: Q); III p., '", :
I: OM; ZI S >; -Z " :
~i 41 .-<' <( ~ !
.:; ;:Ii QJ"d -= ..l .s~1
~; P-< J::" ........
~ oS ' <tI 0 ~
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0 :.0 ~ ~ ". Ii, i'
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0 Ou U Pl .......
..._~... ' __~__-=:JL
l/!,~RCC 4 (11/78). . . .
II')"'""....; , ;.. COMMONWEALTH OF PENNSYLVANIA
t1j~.Oa4429 . . DEPARTMENT OF REVENUE
S~y.Y~~!~t{;;if1:!'i/:/;;j OFFiCiAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
1!,.,,'!li"':I/'!",~,~\',,:'rl""""""" "".,.',..,., . \'
I'~"~" ,,"', ."."'" .
$ RECEIVED -------------------0- ",JIllnRIrn
II
~ F',Od:."
=
III
II
-.
r.::a __ "'-"- _._ r-.....
v,.......,.,8>>~...
.
~
-.~
James E. Reid, Jr. Attys.
(Helen Klimczak)
P.O. Box 966
FO~~~'rE ~ 26/]OO---------------4~~M
repres.eoling Pennsylvania Inheritance or
Estate Tax due from the following estate:
29'1: To)( on
$
$
Harrisburq.
PIl.
17108
6(k. Tax on
$
$
I FiI. No.
Dole 01 Poymenl ------Harch 12. 1980
21_80_162 Dol. of D.olh,8-27-1979
15% Tax on S
s
$
I
1.4C;.~6 I
t
JULIANNA KOLEK
'7" Tax on S
Estate To)., Act of
Moy 7, 1927
$
Name of Decedenl
$
"PAID ON ACCOUNT"
TOTAL TAX CREDIT
Less five percenlum of lox if
paid within three months oller
dole of deoth
Plus interest 01 the rote of
_%from
10
$
County ('nmhlf'P"' .n"
Remarks:
$
'U'OO~~[L~@illlJrn SEA L
TOTAL AMOUNT PAID
$
145.26
NOTE: Thil Triplicate Receipt to be rotained for audit purpOles.
Received by
NOTE: In occepUng the hOMIer inheritance 10. on future e$toles, prior to the death of the lile
tenonl or lenonl lor years, os e...idenced by thb receipt, it i$ under5tood thol Ihe Commonweohh sholl
nol be precluded or pre...enled from hereafter oueuing addlllonol inheritance la. 01 the dllOth 01 the
hfe t.nonl or tenonl lor years whene....r II appears Ihot such oddlllonolta. may bll 1119011y due and
coll.ctlblelor any reason whalsoe...er.
,
I
II
1._____ ___.________
I
I
_.__. _w._ ._._._ .._._. _ .___ _.... __._'_' ...-_ _._ _ __ -- .-.-. -- -.-- _._- -- - -. --
._'-:=:'..,.. ...~__:I'......... :ex: r::Jt.. ...........,.,~..~=......
~IlCC4(11/7B) '.' COMMONWEALTH OF PENNSYLVANIA
UNo;J063216' DEPARTMENT OF REVENUE
t . . .... OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
II
"
= RECEIVED -----------------Q3E HUNDRED TWENTY
11
= From:
/II.
il ~, Iress
I ij Hard.burg, Pa.
I ~ File No.
l e Dote 01 Payment
l Name of Deceden!
-
-=:L'
-.... ",<<",,'!
~....
we
Helen KlilllCzak
c/o Jams. E. Reid,
319 Market street
DOLlJ\,RS----------------------..!.,jlors
representing Pennsylvania Inheritance or
Estate Tax due /rom the following estate:
Jr. Esq.
2'lc Tax on
s
s
17108
6% TOl( on
s
$
21-80-162 9-27-1979
Dote of Death.
15%' Tax on
s
s
Check dated July 14, 1980
Dept. of Revenue received on
July 1.6, 1980.
We recived check on July 24,1
$
~
II
120.00 I
I
July 24. 1980
9,. Tax on S
Estate To)(, Act of
May 7, 1927
s
JULIA1IlNA KOLEK
s
County
Cumberland
TOT AL T AX CREDIT
Less five percenlum of lox if
paid within three months after
dote of deoth
Plus interest at the role of
_%from
8Q,
$
Remarks:
s
I
~
'ITOO~[p~J@&'ITrn SEAL
TOTAL AMOUNT PAID
$
120.00
I
NOTE: This Triplicate Receipt to bo retained for Iludit purpolell.
Received by
NOTE: In aC(llpllng Ihe transfer inherilance to. an luture e~totes, prior to the death of thfl Iii.,
lenanl or lenanl for yeorl. a, evidenced by this receipl, il is undealood thaI thll Commollwflollh ~holl
not b~ precluded or prevented from he-feoher oUessing additional inheritance ta~ at lhe deolh of the
liIe lenont or lenont for years whenever It oppeers Ihot such oddilional to~ OIoy be tOil ally dul' and
collecliblelor any remonwhOlsoever,
........
*'
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
Post 0//1 ce Box '1970
Horrlsburg, Pennsylvonlo
17105
REV. "(1-771
September 1 0, 1980
IN YOUR REPL.Y PLEASE
REFER TO
Ms. Mary C. Lewis
Register of Wills
Cumberland County Court House
Carlisle, PA 17013
Dear Ms. Lewis:
Re: Estate of Julianna Kolek
File Number: 21-80-0162
County of Cumberland
Date of Death: 09/27/79
Enclosed you will find copy of a Protest and Decision of the
Board of Appeals, concerning the estate of the above named decedent.
The Board of Appeals has sustained the Petitioner's
objection. Accordingly, you are authorized to amend the record of
this estate to conform with the Order of the Board.
Very truly yours,
~~.~~
Daniel Tomaso, superv~~~
Special Processing
Investigation Division
Enclosure
/~ ,~D
~ ' J- q-, {
I \)p -11IV
CC: Mr. Knovel F. Lamberti
District Administrator
.....'
COMMONWEALTH OF PENNSYLVANIA
2 DEPARTMENT OF REVENUE ' +
BUREAU OF FI~LD OPERATIONS JlC) q/ R:J. -:;trv I
t- Post Off,ce Box 'ZI7O ) - - - ~-
-e; Harri.burg, Pennsylvania - ----rt- . {. A?/
17105 .~y~ra' ~v
July 10, 1980 Itl VO\II. nEPCV P.E". 0
REr-ER TO
Department of Revenue
Board of Appeals
P. O. Box 1874
Harrisburg, Pennsyl vani a
17105
DEPART. OF REVENUE
~~":~1:8~F' ~
Re: Estate of Jul ianna '~~;r1.E ;F L
File No. 21-HU-U I b~ mm -- APPEALS
County or-cumberland
Date of Death: 9-27-79
Gent'1 emen:
Pursuant to Section 1001 (1) of the Inheritance and Estate
Tax Act of 1961 (72 P.S. 92485-1001), a PROTEST is filed on behalf of
the Commonweal th of Pennsyl vani a agai nst the action of the Regi ster of
Wills of Cumberland County allowing the family exemption claimed on the
Statement of Debts and Deductions approved May 21, 1980 in the subject
estate.
Our record discloses that the decedent's estate, reported for
inheritance tax purposes, consisted solely of a bank account, titled in
the names of the decedent and her daughter, Helen Kl imczak, appraised at
a value of $12,765.81 for the decedent's one-half interest.
Petitioner contends that the Register of Wills erred in allowing
the family exemption against the jointly held asset. In Stevens' Estate,
434 Pa. 259 (1969), the Pennsylvania Supreme Court held that the family
exemption can only be claimed against real and personal assets since the
Probate, Estates, and Fiduciaries Code creates the exemption out of the
probate estate. Therefore, because our record reveal s that the decedent
owned no probate assets, the exemption does not exist.
For the reasons set forth, it is the Petitioner's position that
the family exemption should be stricken from the Statement of Debts and
Deductions approved May 21, 1980.
Very truly yours,
'T-)()~Q R ~C/Yl"'-" c
Daniel R. Tomaso
Supervi sor
Special Processing
DRT/DEA:ll /Ztf .](}/ Pd
cc: Helen Kliloczak, administratrix . . ~
James E. Reid, Jr.~ Esquire 7ltvr ~- I1.t /701D
Department of Just, ce
T/IA;1- 0
r:-O