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HomeMy WebLinkAbout06-06-07 (3) J~'\' soo EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 0 8 2 2 COUNTYCciiiE --vE~ - - NuMaER- - .... Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Warcholak Timko DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURIT'Y NUMBER 2 0 6 - 1 2 - 6 3 8 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w ~ lil:-1Il (J O::lil: wc.(J :coo " 0::... ... C.lD C. ct 9/6/2006 3/6/1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Jo ce Warcholak [R] 1. Original Return o 4. Limited Estate [R] 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copyofTrusl) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (dale of death prlorto 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113{A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS David H. Stone Es uire 414 Bridge Street FIRM NAME (If Applicable) Stone LaFaver & Shekletski TELEPHONE NUMBER 7177747435 New Cumberland PA 17070 I- Z W C Z o C. 1Il W 0:: 0:: o (J z o i= <C ...J ::l ~ D.. <C o w 0:: z o i= <C .... ::l D.. :E o o ~ .... (1) (2) (3) (4) (5) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) _ .. .~ _._ _ .___... _ 4._ _ ____ OFFICIAL USE ONLY 124,4 75.66 (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(1.2) 19 Tax Due 7,398.66 X ~ (15) 243,899.23 X .045 (16) 0.00 X .12 (17) 0.00 X15 (18) (19) 78,049.53 ! ,--'" 7,398.66 ;',) 92,454.88 (8) 302,378.73 16 Amount of Line 14 taxable at lineal rate 45,515.93 5,564.91 (11) (12) (13) 51,080.84 251,297.89 0.00 17. Amount of Line 14 taxable at sibling rate (14) 251 ,297.89 18 Amount of Line 14 taxable at collateral rate 0.00 10,975.47 0.00 0.00 10,975.47 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < D d I C I t Add ece ent s om pie e ress: STREET ADDRESS 311 EverQreen Street CITY I STATE I ZIP New Cumberland PA 17070- Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit 8, Prior Payments C, Discount (1) 10,975.47 9.000.00 473.68 Total Credits (A + 8 + C ) (2) 9,473.68 3. InteresUPenalty if applicable 0, Interest E. Penalty TotallnteresUPenalty ( 0 + E) (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due, (5A) 8, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 1,501.79 1,501.79 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c, retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................... 0 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..................................................................,.................................... 00 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete, Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETU N DATE fU-, d- W4A- y-...\ 311 Evergreen Street New Cumberland PA SIGNATURE OF ARER ADDRESS PA 17070 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P,S. ~9116 (a) (1.1) (i)], For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P,S, ~9116 {al (1, 1) (ii)), The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 PS, ~9116{a)(1.2)], The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 45%, except as noted in 72 P S, ~9116{ 1,2) [72 PS ~9116{a)( 1)), The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS, ~9116{a)(1 ,3)], A sibling is defined. under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption, REV-1503 EX + (6-98) '* SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Warcholak. Timko FILE NUMBER 21 06 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0822 ITEM NUMBER 1 DESCRIPTION 180 shares MetLife Inc stock @ $54.115 each 2 80645.72 shares Morgan Stanley-Active Assets Money Trust @ $1.00 each Acct. #410-033025 3 17937.02 shares Morgan Stanley-Liquid Asset Fund Accl. #410-019216 @ $1.00 each 4 721.848 shares Morgan Stanley-MS Spectrum Tech LP @ $22.330 each Acct. #410-019215 5 2.467 shares PNC Investments-Putnam Classic Equity Fd CI A @ $13.520 each VALUE AT DATE OF DEATH 9,740.70 80,645.72 17,937.02 16,118.87 33.35 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 124,475.66 REV-1508 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Warcholak. Timko FilE NUMBER 21 06 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0822 ITEM NUMBER 1. DESCRIPTION 2006 Nissan Altima 2.5 S Sedan 4D @ bluebook value VALUE AT DATE OF DEATH 16,300.00 3 47897.2 shares Morgan Stanley-Bank Deposit Sweep Program @ $1.000 each Acct. #410-019215 47,897.20 4 New Cumberland FCU-Savings Acct. #4069 Dorothy Warcholak predeceased decedent 10,827.99 5 PNC Investments-Blackrock Money Market Fund Acct. #89905534 489.94 6 United Health Care-refund 2,534.40 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 78.049,53 REV-1509 EX + (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Warcholak. Timko FILE NUMBER 21 06 0822 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Joyce Warcholak 311 Evergreen Street New Cumberland, PA 17070 surviving spouse 8 c JOINTl Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTSINTERES 1. A. 8/9/04 PNC Bank-Checking Acct. #5004639015 joint w/Joyce 14,797.31 50. 7,398.66 Warcholak Prine. $14,795.92, Int. $1.39 0.00 0.00 TOTAL (Also enter on line 6, Recapitulation) $ 7,398.66 T (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Warcholak Timko FILE NUMBER 21 06 0822 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO OECEDENT AND DATE OF DEATH % OF DE CD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A copy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABlE) VALUE 1. MetLife Invs USA Insurance Sfg Fixed Annuity 59,257.27 100. 59,257.27 beneficiaries are Sandra L. Fowler, Thomas P. Warcholak, and Joan Louise Andrews 2 PNC Bank-Cert of Deposit ITF Joan L. Andrews 14,065.87 100. 3,000.00 11,065.87 Acct. #31500296085 3 PNC Bank-Cert of Deposit ITF Sandra L. Fowler 14,065.87 100. 3,000.00 11,065.87 Acct#31100297570 4 PNC Bank-Cert of Deposit ITF Thomas P. Warcholak 14,065.87 100. 3,000.00 11,065.87 Acct. #31200296567 TOTAL (Also enter on line 7 Recapitulation) $ 92 454.88 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Warcholak. Timko ITEM NUMBER A. B. 1. 2. 3. 4. 5. 6. 7. 2 3 4 5 6 Debts of decedent must be reported on Schedule I. DESCRIPTION 1 FUNERAL EXPENSES: Romberger Memorials-services rendered Stone & Murray-funeral expenses Joyce Warcholak-Reimb. for funeral luncheon ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (5) JOyce Warcholak Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 311 Evergreen Street City New Cumberland Year(s) Commission Paid: 2007 Attorney Fees David H. Stone, Esquire Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant Joyce Warcholak Street Address 311 Evergreen Street City New Cumberland State PA State PA Relationship of Claimant to Decedent Wife Probate Fees and short cert. to Register of Wills, Cumberland Co. Accountant's Fees Tax Retum Preparer's Fees Kelly Financial Services PA Dept. of Revenue-2006 tax due for PA40 return Cumberland Law Journal-advertising grant of letters The Patriot News Co.-advertising grant of letters US Treasury-2006 tax due on 1040 return Register of Wills-filing Inheritance Tax Return and Inventory Reserve for closing expenses FILE NUMBER 21 06 0822 (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 9, Recapitulation) $ Zip 17070 Zip 17070 AMOUNT 90.00 4,863.00 301.43 15,159.00 15,159.00 3,500.00 388.00 388.50 1,229.00 75.00 100.00 4,033.00 30.00 200.00 45,515.93 ,REV-1512 EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Warcholak. Timko FILE NUMBER 21 06 0822 Include un reimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION Members 1st Credit Union-payoff of car loan VALUE AT DATE OF DEATH 5,564.91 TOTAL (Also enter on line 10, Recapitulation) $ 5.564.91 (If more space is needed, insert additional sheets of the same size) '"""""'.'- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FilE NUMBER W~r,.hnl ,... Timkn ?1 OR OR?? RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Joan Louise Andrews Lineal 33,857.60 38 Turkey Hill Road South Westport CT 06880- 2 Sandra Lou Fowler Lineal 81,299.74 459 M Street Harrisburg PA 17112- 3 Thomas Paul Warcholak Lineal 81,299.74 563 Funt Road Aspers PA 17304- 4 Jessica T Andrews Lineal 15,814.05 38 Turkey Hill Road South Westport CT 06880-5521 5 Catharine L Andrews Lineal 15,814.05 230 E. 30th Street Apt. 2A New York NY 10016-8238 6 Olivia S Andrews Lineal 15,814.05 226 E. 70th Street Apt. 3G New York NY 10021-5429 7 Joyce Warcholak Spousal 7,398.66 311 Evergreen Street New Cumberland ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: -c- A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) ~TONE. 1.AJ'AVER t'lc ~BEKJ",ETSKJ ATTORNEYS AT LAW 414 BRIDGE~' NEW CVMUJ<;JU..\.ND PA 17()70 .~-. { . LAST WILL AND TESTAMENT OF TIMKO WARCHOLAK I, TIMKO WARCHOLAK, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that rrl'\T "t;"vt=>~n+-riv "'.1 ~..~----_.. hereinafter na~ed shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I devise and bequeath all the rest, residue and remain- der of my estate, of every nature and wherever situate, in equal shares to my children, SANDRA LOU FOWLER, THOMAS PAUL WARCHOLAK, and JOAN LOUISE ANDREWS, as survive me. Should any of my children predecease me, I devise and bequeath the share of such child to his or her issue, per stirpes; and should any such child of mine leave no such issue living following my death, I devise and bequeath the share of such child to my issue, per stirpes. lTE::~.1 I:;: I: I appoint my spouse, JOYCE A. WARCHOLAK, Execu~rix r-F 'J,"- this my last will. Shou~d my spouse, JOYCE A. WARCHOLAK, fail to Qualify cr cease to act as Execctrix, = appoint my daughter, SANCRA T ,~...: L,-,I.,- ~OWLE?, Execu~rix of this rn,r '''.1 last . ." , 1 'o'V-L...L__ ?aJe ~ :~f .j ITE~1 IV: No fiduciary acting hereunder stall be req~i~ed to Dost bond O~ ente~ se2urity for the faithful perfcrmance Gf his or her dcties in any jurisdiction. IN WITNESS WHEREOF, I, TI~IKO WARCHOLAK, have hereunto set my hand and seal this ;.".... :; 1 I! day of I //.... ~;. r... ",-I :.:' )"' / / ' '~:lt" I I~\/~ ,/" t' ~ , 2006. / / . /. / /' {(/tC({('t ~-'-/~ TUIKO WAPCHOLAK ?'~:1g~ ") ~~ ~ \.j..L SIGNED, SEALED, PUBLISHED a :-;j DECLARED J:::~' ~ ~:.:?':= :':_=_F.::~=:=-..::,~:, t.:->" ~est3tGr above named, as and ~C~ his Last Wil~ an~ T~sta~ent, and in tne presence of us, ~nc at his req~est, In his prese~2e a~d i~ ~he r:~e;se~l,-=:e of each otter, -'>." I ! . .' "' \ I ....: "', \ /: I .4..--'- / "\ '~!r i \ I ( I ./~ ha?e subscribed our names as witnesses. I vJi t n e s s .l. ,~_' 414 Bridoe St. , New Cumberland, PA Address 414 Bridcr("~ St. , New C'..:mberl acid, pll L L Address ,-..., '~ '. \ '-. \:~, I \ " ......~ l < \\--:\ Witness COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND 1, TIMKO WARCHOLAK, the Testator whose name lS signed to the at- tached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposJP therein contained. / / / " ,-' ",/ / / / ,/ i(; ,:. / L . '(. k.' /c> , . ... t //. t, ./ tj', TIt1K'J W"L.?CHOLAK Sworn to or affirmed to and acknowledged before me by TIMKO ~:A?2~:J~~K, ~he Testator, this ~~' ~' r,r; r , ~ _ ~ 0 . '/(ji>1WEALTH OF PEt'-<NS'rlVN,Jil\ NOTARIAL SEAL ; M HARTMAN, Notary Public ~ :t.erland Bore.. Cumberland Co :,-'<;1011 Expires Jan. 21,2009 Notary ?'.1blic Pal;e ,--,,'..L ':=':= :.::.2=:~~:rJ::.:s.~~ 2 :='? F ~ t::; S ~{~ \,T ..:....:J =..;. C '2' . ............' . :J~?~~Y OF :CMBS?LAND Ke, \'\/--, '. ,',~ j,'\' ", '. and , , \ \.. \\. \\ 1.., . ' \ . \ 't I \,". ~he witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his last will; that Testator sig~ed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. / 'r f . .;,' " " \ \ \ , \""- ( ".... "..'~ \ Witness Sworn to or affirmed to and , ). '\ .1- \\ L . \"') . r \'h\( acknowledged before me by ( , \ ,~ '~. " \' "~ L: and \... _. \ ~\, L . '- . , \. ~\i '" \''''__ ;'1 i t n e sse s , t his \ day of ,'" \, , ?ll~. ,I.>- '. 'i. ~ / , "f '-- "' .. ~ ~ ":OMMONWEALTH OF PE~i~~SYLVANlt, .- NOTARIAL SEAl. i'~NIEL M. HARTMAN. Notarf Public , Cumberland Boro,. Cumberland Co. :~~jnrnisslon Expires Jan. 21,2009 Notary Public Page 4 of 4 t-;:" ,s: ' r- - _5 \A:::-,';'- :::~:, I .;'~';'.\ -.....11 :"r::':.:, >-: 1;,f->.3""~ te-,j.:. .:;-C:;:l _:T.~:- IN RE: ESTATE OF TIMY-O WARCHOLAK, LATE OF fJE'Vl CUr-mSRLANC BORG: CUMBERLAND COUNTY, ?ENNSYLVANIA, CECEASED IN THE COUPT OF COr1r10N PLEAS OF CUMBERLAND COUNTY, PENNSYL'!ANIA ORPHANS' COURT CIVISION NO. 2006-00822 DISCLAIMER UNDER 20 PA C.S.A. ~6201 ~, JOAN LOUISE ANDREWS, one of the heirs of Timko Warcho~ak, late of the Borough of New Cumberland, Cumberland County, Pennsylvania, hereby exercise the rights granted to me in Chapter 62 of the Probate, Estates and Fiduciaries Code, 20 PA C.S.A. 56201-6107, and I hereby disclaim and renounce any and all of my right, title and interest which I may have in the said estate as a beneficiary under the Last Will and Testament of Timko Warcholak. IN WITNESS WHEPEOF and intending to be legally bound hereby, and intending that this disclaimer and renunciation shall be filed of record in the Office of the Clerk of the Orphans' Court Division of the Court of Cemmon Pleas of Cumberland County, Pennsylvania, as proiided in 20 PA C.S.A. ~62C4(a), I have hereunto set ~j hand and ,ei ja.,:' ,,"":.+:. 1)1' /J sea~ ~his b : ~_ ~ , 2006. ~~~~ '~~ - .~ ( ~~.. ,-,~'=:'.;:'J ~C~;...~=S::: :-:"':;:;;,E~';..3 (__ ,-_; ! .~:-~ . J rv v c.) o N STATE/c:)rJlr'lC~H'lEALTH OF (,1" :::JCNTY OF fu( ~'t (d SS: Wesfpurl On this, the ~~ day of ~~ , 20C6, before me the undersigned officer, a Notary Public, personally appeared JOAN LOUISE ANDREWS, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowl- edged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and year first above written. 0V1~ -- - Notary Public .......) ...",_~("'. ,j ~~ ,.". " d 'Ily Ce,I.I..,,),,. . /I '.)1 2DJJ HUg. OJ , MetLife, Inc. - Stock chart, Index chart - MSN Money <)1:.,1\.:. Ch:llt N<'ws RI"~l'~H eM ~iii,d':,: f~(<;'.1rch \-,n{1 Stud..s Rr'i;jt.~t1 l_inkS ;.. ;'., ,>"v.'''~ 100 ~, ""-."~';:)'" ~",'-.:". '47' tIi.~" . tFREETRADES ' [*TIIII"[ $otCU'it;of' Page 1 of I ,i),;'.)',j C' ,,<,.". '," '~.l""l""':."~..'...".':''''.'' ~'''' ' .,.,\ ~i'/" , 1.# .. .,,) ;. ___",-1 - d._,_, MetLife, lnc. 69,10' 69,35 68.94 68.37 / 80 s1)s )< 5lf. /15 -~ It C(7t.fO I 70 http://moneycentraLmsn.com/investor/charts/chartdLaspx?PT=3&D5= I &D2=0&D3=0&C... 5/16/2007 Mdljfr~ 1m i)_ ~ "'_'U ) :. ,~'! i. I ;-1,(;;;1)( "'t -, ,~t 5.',_.>3 :Or~; C)C;, ~ t..- , )-,_,;-1'/" ~~..f . (; ~: i' ,', ,j,' . 5..;..j6QC :)),27U0 ~3_r'}2CG e.; J~()n ;,;}'-?,:-;!',i \ 5::::, ~ ':CO ::;'\, i~:2 C;tj >.,j~(1n ():;,<'d"t- ~Sl')I)O ~;,I,~:;UG c~.u]oc: ~~;;lti\ j:' ;widef'; Avv-<<s <- ~ 14 of. L )If-.9~ 53 :17 10 g , '13 l... 1 c.1 cI- "" ~ 5 1. I( 5; (kJ-- sA. Morgan Stanley 4)07 North Front Street Suite 201 Harrisburg, PA 17110 toll ftee ROO 676 0675 direct 71725) 6666 fax 717 2)S (,6)1 March 14, 2007 Stone, LaFaver & Shekletski David H. Stone 414 Bridge Street. P.O. Box E New Cumberland, P A 17070 Re: Account #410-033025 (Timko Warcholak) Account #410-019216 (Timko Warcholak) Account #410-019215 (Timko Warcholak) Dear David: Per your request, here is the date of death values for all accounts for Timko Warcholak. All three accounts were registered individually. Two of the above referenced accounts were solely invested in money market at the time of death. The third account was invested in money market and one security. If you have any questions, please feel free to contact me directly at 717-255-6677. Account #410-033025: Security Active Assets Money Trust Quantitv 80,645.720 Price Per Share $1.00 DOD Value $80,645.72 Account #410-019216: Security Liquid Asset Fund Quantity 17,937.020 Price Per Share $1.00 DOD Value $17,937.02 Account #410-019215: Security Quantity Price Per Share Bank Deposit Sweep Program 47,897.200 MS Spectrum Tech LP 721.848 $1.00 $22.33 DOD Value $47,897.20 $16,118.87 Sin~rely~ )! '-/)l~lt'.. . /11 L,---- .......-. , Emily Bid n Registered Client Service Associate Investments and services are offered through Morgan Stanley, DW. Inc., member slPe. Putnam Classic Equity A - Mutual fund chart - MSN Money Page I of 1 ;r~.c~ 11 E / TRADE FINANCIAL .t'.~:::~:.~"."~-, -}f:'t~; ~';'~~i I~rr~ ~ Putnam Classic Equity A 16.16 ;,~'_ ~:_/.k, :J.-+;"O') : ~ '7'.0 :.J 4i'(,r" ;;'C<' \ '. PUTNAM CLASSIC EQUITY A Guid(>(l R'-:,>eiHcl1 ::~f'f) ;.J,..t;;GU Li.';2('t' :::.-;]IJI":' ':;.i.:';(" J.,21_,I.;(. :3.S2'jL ~ -':>...J":l.'U :3.:JHiC ;::>~(1 Fi;n~fS - -' -;.}~ :'/Ci:J J. -;~:liC 'it- '; ',;jUO . ';;hifj . -. ." . i ~ ! ~ : " ,J:di"l""J ':L~i(\~.:d Lltlio(s A~ 0~ ti 'i L /.J.~~ {3.s:J, ~ 7.0Y ~ -- 13,~d.. ~~I ~". J. Lj ~ 7 )( I J S- J.... ~ :::. 33 ,3 S- http:!'moneycentral.msn.comlinvestor/charts/chartdl.aspx?PT=3&05= 1 &02=O&03=O&C... 5/16/2007 v..~ ~j) ~;,I!~!~~~,~e~(~ . 'Db (1)111 Close Window X .1. "'''' ~ld\jcn i,;r;'rr~t:;nt . -- --> -.- . <, <..~' ,-' _ L-_.. ~< :~. ~ - ~. "..";'~'" '" . . ~. ~ ~ 'r, , ~ ,ff~ 2006 Nissan Altima 2.5 S Sedan 40 8 LJ tHO 0 K I r~ ACt -I \~ '/ A LlJ t Condition ..I Excellent Value $16,300 (Selected) Good $15,340 Fair $13,670 a(1vert!sen'lent Vehicle Details The 2008 Nissan Altima Engine: Transmission: Drivetrain: Mileage: 4-Cyl. 2.5 Liter Automatic FWD 2,000 ;! _. -. --.. ==~ =---~~: Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Single Compact Disc Dual Front Air Bags ...1 - .t _ _ '.. _ _ 4 Selected Standard Equipment Blue Book Trade-In Value Trade.in Value is what consumers can expect to receive from a dealer for a trade- in vehicle assuming an accurate appraisal of condition, This value 'Nillllkely be less than the Private Party Value because the reselling dealer Incurs the cost of safety inspections, reconditioning and other costs of doing business. Vehicle Condition Ratings ..I Excellent (Selected) $16,300 "Excellent" condition means that the vehicle looks new, IS in excellent mechanical condition and needs no reconditioning. This vehicle has never had any paint or body work and IS free of rust, The vehicle has a clean title history and will pass a smog and safety Inspection. The engine compartment is clean, with no fluid leaks and is free of any 'Near or VISible defects. The vehicle also has complete and verifiable service records. Less than 5% of all used vehicles fall Into thiS category. Good L. 4j ~ : " ,I a a $15,340 ,; ,,- \' ii'i':: has a c1(:,<;n ti!'k~ il!st;)f"Yr the i-"J<)rr)1", ~)()d~" dnd dit~:>'i(;r have G[~1y rninr)( it ,,):~'r') bi('rn;sn,::~~, ~:ln(j there jr.~'" ;U) rndjc;r n>>:lVi!1iCd! p;"ut)lcrns. Tht-::re :)ht)Lji(l be littj(' ()i fiG rust un thlS \/C~lic:f::', Ti1e tjr"CS !i1..He!! dnd h,]\Jc Sl.Jt~<;td!!ti,-)l tn>:id ';';\:~dr left. 1\ \Jo(,d" "./chic!e \\ill !-iC..~(j;ornc n.:ccndll.;C,nlnq to h~~ :/)j,j at "t:Jaii !'--1osr. Co(::;urn,:f" (),:~T!ed \;C'r'lc!cH; rail into this r::dt.t"\]Cry. Fair $13,670 "Fair" COil(;!tlcn ';iCJns Uk!t the vehIcle hdS "orne rr:('chanlcaJ or cosnictic (!(~fect'; anc QC<:';(1S '.)erv:c.inq hut ~s sttJ! in r~;,"]S':;fktb>:: rUn/1J1g CC<ldit;0n. This Verii(!C ha5 ,J ch:'dn title h!st<.)ry, Hie paint, t:.:)ejy anC]/G( intt:1"i(!( ;'~f?e(j-,\{~}rk i.>~:(f~)r,...nccJ iJy a prufessJ(;nai. 'The tirt::s [nay t1\2;::d to l)(' r<~piaccd. There rnay oe S'~)i'ne (coairablc ri.ist "Cjaf'Yi(::i~]C. Poor N/A "Peor" concj!t!on rneens Lrlat the vchick: has SC'jCrc ni(-lcflrHl!Ca! ancl/or COSITI(:tJ( dcf(:cts and 15 !n poor f"llnning condition. The '\ieh1cle frdY have prcbierns ttldt cannc;t he f'e'~1ddy flXf;d such as d dar--raqed frarne or a f"Lbted- thr;~Jugh bo~jy. A vehic1e \:v:th a branded title (salvage, fioo(j, etc.) or un~;!.ih:;tantldtec1 rnd":::;lg~~ is consicjered llpCiur.H !>.. vt~l1jcle in poor condit on i!iay r~:~qUH"(: an indept~n(jent appraIS,:.1! to determine its value. Kelley B ue E:ook does not atternpt to report a value on a '!pDorl! vehicle because t e v,"Jue of cars ill thiS cateCJory vanes greatly, ,. Pennsylvania 9/14/2006 "'t' ""~~M""''''''''''';'f''~''''-'!'':''''~~' .;g, ~,..... , \ 11' . ",- ....,:; .,~. ....'" ~~>~,.;"d'I~~f:.~':i./l.,o'~,'$i.- \ NCFCU New Cumberland Federal Credit Union Your Community Credit Union P.o. Box 658, New Cumberland, PA 17070-0658 Phone: (717) 774-7706. 1-800-716-2328. Fax: (717) 774-7996. Web: www.ncfcuonline.org March 16, 2007 Stone, LaFaver & Shekletski 414 Bridge Street POBox E New Cwnberland, P A 17070 RE: Timko Warcholak Dear Mr. Stone: Pursuant to your letter dated February 28,2007, in regards to Estate of Timko Warcholak the information is as follows: Account Nwnber: Owner(s) on Account: 4069 Timko Warcholak Dorothy Warcholak January 12, 1972 SI (Savings) $10,827.99 Date acct opened: Date of Death Balances: If you need anything additional in regards to this information, please feel free to contact me directly. Sincerely, -) a.-.' .:f \' ,I ~, 1"-, " \1 ,:\ / , \ ;.,.'f 1 Barbra Wright Branch Manager lJi. - ,- I ""'tJ.~ roo ..J"-t.JO r.t:.IJ. $ PNCBAN< June 1,2007 David H. Stone 414 Bridge Street P.O. Box E New Cumberland, P A 17070 RE; Estate of Timko Warcholak, deceased SSN; 206-12.6383 DOD: 9/6/2006 Dear Mr. Stone: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificates of Deposit Account #31 100297570 Established 07/18/2006 TIMKO W ARCHOLAK ITF SANDRA L FOWLER DOD balance: $14,065.87 + $39.30 accroed interest Account #3 1200296567 Established 07/18/2006 TIMKO W ARCHOLAK ITF THOMAS P W ARCHOLAK DOD balance: $14,065.87 + $39.30 accrued interest Account #31500296085 Established 07/18/2006 TIMKO W ARCHOLAKITF JOAN L ANDREWS DOD balance: $14,065.87 + $39.30 accrued interest Cbecldng Account Account #5004639015 Established 08/09/2004 TIMKO W ARCHOLAK JOYCE W ARCHOLAK DOD balance: $14,795.92 + $1.39 accrued interest The decedent maintained Investment Account (INV #89905534). For further information, you may contact the Brokerage Department at 1-800-762-6111. Page lof2 Ilnl ~~ ~~~I ,~.~~ I l't\...unl'tr' ""t.L.~ roo -.-1""+",)0 r.t:Jc:. Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or providE statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~W~ Rachelle Wells 1-800-762-1775 P7-PFSC~-F 500 first Ave. Pittsburgh P A ) 5219 Page 2 of2 Member FDIC TOTAL P.02 ;:~ :;j ~ ~,., ::'s ..,- =: ~ S! ~ bi' -*'1 :...~ ::! l ~- ~ ~ ~ ~~ ~~ '" !=l:l ~;:: ~ ;::: c ~. ~.a. ~~ ~t-- ~~ ~ ~ .. .IIl r,. ;;- ~!"I f;; >- A $ a ~ ~ -1::0.. 3:e 6~ :Eo >::; ~~ I o r > ^ CD:. '.:J - <D ~ 0::: U1 ~ U1~ ~~ ~ ~ ..; q'ml ~~. ;--/' "" .., i ~ ~I . . . "5. z;s: I ~ " 10 Ilol I ~ - .... I ~! ~f-. ' Q. ~ ,...', I 3' ~ ~ i ~ ~~.; ~ ) ~~ ~!::I ~ a ~ r .: ~ I "" - I ~:: i ~ .~~ o ~... 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