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Home My WebLink About05-12-08J 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 ` 21 08 0188 Harrisburg, PA 17128-0601 °~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 170-12-4717 02/09/2008 10/02/1919 Decedent's Last Name Suffix Decedent's First Narne MI Potochney Michael (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW • 1 Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) • 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Heather D. Royer, Esq. (717) 234-2401 Firm Name (If Applicable) ~ - r~~ - REGISTER OPV~I~ USE ONtab Smigel,Anderson & Sacks -' ~ First line of address ~ =-tT ~C --, =;~ 4431 N Front St „ .-._ ~ r'' - . . \ Second line of address ~ ~' ~ ~ ~ , ~ -~ .. 3rd Floor TJ ~,--t ~v ' ~-' ~'> ...- .. ~; .. r `r^~ City or Post Office State ZIP Code DATE FILED --- C7 ~: '~• :--, Harrisburg PA 17110 Correspondent's a-mail address: hroyeft~SaSIIp.COm 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,9F PERSQN RESP~tS18~E FOR FILING RETURN 819 Linwood S_tre_e~t, N~e~w~_Cumberland, PA 17070_ iIGNATII~R.E OF PREeARtK Pt.LER THAN REPRESENTATIVE S/~ >/~ Smigel, Anderson & Sacks LCP, 4431 N. Front St. 3rd Floor, Harrisburg, PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 DATE °~4 ~ 15056052059 REV-1500 EX Michael Potochney ' Decedent s Name: RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. 7. Inter-Vivos "transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............. .. 10. 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers underSec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate~'X .045 75,305.02 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Social Security Number 170-12-4717 4, 809.26 31,235.00 ' 66,034.96 102,079.22 24,604.20 2,170.00 26,774.20 75,305.02 75,305.02 3, 388.73 3,388.73 ~: 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 08 o18s DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Michael Potochney _ __ ___ __ _____17.0_-_1_2_-4717 STREET ADDRESS 819 Linwood Street CITY ~ STATE i ZIP New Cumberland ~ PA ', 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 3,388.73 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 3,500.00 C. Discount 184.21 Total Credits (A+ B + C) (2) 3,684.21 3. InteresUPenalty if applicable D. Interest ___ E. Penalty Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Linf; 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 295.48 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) B. Enter the total of Line 5 -~ 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT 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 :................................................................................... ....... ^ Q b. retain the right to designate who shall use the property transferred or its income :..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent (72 P.S. §9116 (a) (1.1) (i)J. 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 zero (0) percent [72 P.S. §9116 (a) (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 return 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 zero (0) percent [72 P.S. §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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102. as an individual '~+ho has at least one parent in common with the decedent, whether by blood or adoption. REV-1505 E X+ (6-98 i ~:~~ ';:~~ SCHEDULE B C0~4fv10NWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Potochney Mirhael 21-08-0188 All property jointlyowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98j ~:5 COP~9MONU1'EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEM DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Potochney Michael 21-08-0188 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. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (e-981 ~,~ r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Potochney Michael 21-OS-0188 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. Lorraine S. Potochney B. C JOINTLY-OWNED PROPERTY: 819 Linwood Street, New Cumberland, PA 1707G ~ Daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. HT7ACH DEED FOR JOINTLY•HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET / OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST t. A. 07!19!9'9 Sovereign Bank Checking Account-#2331043469 12,654.32 50% 6,327.16 2 A 04/07/01 Sovereign Bank CD-#1055284325 1,786.20 50% 893.10 3 A 07119/99 Sovereign Bank CD-#2335251399 30,036.44 50% 15,018.22 4 A 12/30/98 PA Central Federal Credit Union Share Account-#82659-018 81.02 50% 40.51 5 A 12/30/98 PA Central Federal Credit Union CD-#82659-OB8 5,429.29 50% 2,714.65 6 A 12130198 PA Central Federal Credit Union CD-#82659-OAS 82,082.63 50% 41,041.32 TOTAL (Also enter on line 6, Recapitulation) l $ 66,034.96 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) ~ ~~~, SCHEDULE H FUNERAL EXPENSES & COMMONWEALT1i OF PENNSYLVANIA INHERITANCE TAX F7ETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Potochney Michael 21-08-0188 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' Parthemore Funeral 10,703.27 2 St. Theresa Church Caterers 100.00 3 Harpist 100.00 a Heller-Noenstine Funeral Home 3,346.70 5 Funeral Dinner 2,232.00 s Lodging of personal representative 305.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) _ Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 claimant Lorraine S. Potochney-Kobold Street Address 819 Linwood Street ciry'New Cumberland State PA zip 17070 Relationship of Claimant to Decedent Daughter 4. Probate Fees 260.00 5. Accountant's Fees 200.00 6. Tax Return Preparer's Fees ~. PA Department of Revenue 2007 Personal Income Taxes 206.00 s Advertising-The Sentinel 174.58 s Advertising-The Cumberland Law Journel 75.00 ~ o Gas, mileage, long distance telephone charges, and meals of personal representative 371.65 t t. Filing fee-Inventory and PA Inheritance Tax Return 30.00 TOTAL (Also enter on line 9, Recapitulation) $ 24,604.20 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALThi OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT' DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Potochney, Michael 21-08-0188 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical exoenses_ tlr more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-DO) "~~'`.~ SCHEDULE J ~;~~, .. COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Potochney, MichaE~l 21-08-0188 NUMBER f~lAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT I AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Daughter I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Lorraine S. Potocheny-Kobold 819 Linwood Street, New Cumberland, PA 17070 75,463.62 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET li NON-TAXABt.E DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS N07 BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) %~J,B-I-~~,L'~IVfII)I:~.'rm9h061i -1~.-AAI LAST WILL AND TESTAMENT -- OF MICHAELPOTOCHNEY I, MICHAEL POTOCHNEY, presently of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all Wills and Codicils previously made by me. MARITAL STATUS I declare that I am a widower. CHILDREN I have one (1) child, now living, whose name and date of birth are as follows: ~~ LORRAINE S. POTOCHNEY-KOBOLD born August: 11, 1956 All references in this Will to my child include only the child named above. PERSONAL PROPERTY ARTICLE I I give all of my household furnishings and tangible personal property to my daughter, LORRAINE S. POTOCHNEY-KOBOLD, presently of New Cumberland, Pennsylvania, provided she survives me by thirty (30) days. If my daughter, LORRAINE S. POTOCHNEY- KOBOLD, fails to survive me by thirty (30) days, then I direct that all of my household furnishings and tangible personal property be sold and the proceeds added to my residuary estate. RESIDUE ARTICLE II I give the rest, residue and remainder of my estate to my daughter, LORRAINE S. PUTOCHNEY-KOBOLD, provided she survives me by thirty (30) days. Should my daughter, LORRAINE S. POTaCHNEY-KOBOLD, fail to survive me by thirty 1;30) days, then the rest, residue and remainder of my estate shall be divided and distributed as follows: A. Fifty (50%) percent of my residuary estate to my daughter's husband, KIRKK E. KOBOLD, presently of Pickering, Ontario, Canada, provided he survives me by thirty (30) days. Should my daughter's husband, KIRRK E. KOBOLD, fail to survive me by thirty (30) days, then I direct that his fifty (50%) percent share of my residuary estate be divided and distributed equally between COLLEEN T. ALBRIGHT, presently of Sunbury, Pennsylvania, per stirpes, and IVIICHAEL ~V. POTOCHNEY, presently of Newark, Delaware, per stirpes. Should both COLLEEN T. ALBRIGHT and ItIICHAEL '~V. POTOCHNEY predecease me and leave no surviving issue, then I give this fifty (~0%) percent share of my residuary estate to the SACRED HEART R0~1~IAN CATHOLIC CHURCH of Lewistown, Pennsylvania. B. Twenty-five (25%) percent of m}~ residuary estate to COLLEEN T. ALBRIGHT, per stirpes, such that any issue shall represent anti take their deceased Page 2 of 9 Pages parent's share. Should COLLEEN T. ALBRIGHT predecease me and leave no surviving issue, then I give this twenty-five (25%) percent sham of my residuary estate to MICHAEL ~`'. POTOCHNEY, per stirpes, such that any issue shall represent and take their deceased parent's share. Should MICHAEL `~'. POTOCHNEY predecease me and leave no surviving issue, then I give this twenty-five (2S%) percent share of my residuary estate to the SACRED HEART ROMAN CATHOLIC CHURCH. C. Twenty-five (25%) percent of my residuary estate to k'HCHAEL W. POTOCHNEY, per stirpes, such that any issue shall represent and take their deceased parent's share. Should MICHAEL ~`'. PO'I'OCHNEY predecease me and leave no surviving issue, then I give this twenty-five (2~%) percent share of my residuary estate to COLLEEN T. ALBRIGHT, per stirpes, such that any issue shall represent and take their deceased parent's share. Should COLLEEN T. ALBRIGHT predecease me and leave no surviving issue, then I give this twenty-five (25%) percent share of my residuary estate to the SACRED HEART ROMAN CATHOLIC CHURCH. EXECUTRIX ARTICLE III A. Appointment. I appoint my daughter, LORRAINE S. POTOCHNEY- KOBOLD, as the Executrix of this Will. In the event of her death, resignation, renunciation or inability to act in that capacity, then I appoint m}~ daughter's husband, KIRRK E. KOBOLD, as the Executor of this 1~'ill in her place and stead. If my Page 3 of 9 Pages daughter's husband, hIRRIi E. KOBOLD, is unable or unwilling to serve in that capacity, then I appoint 1~IICH AEL W'. POTOCHNEY as the Executor of this Will. B. Bond. No bond or other security shall be required of any Executrix or Executor appointed in this Will. C. Compensation. The Executrix or Executor shall receive reasonable compensation for her or his services performed as determined by the Court in which this Will is admitted to probate. EXECUTRIX POWERS ARTICLE IV I give my Executrix in addition to and not in limitation of the powers given by law or by other provisions of this Will, the following powers with respect to settlement of my estate, to be exercised from time to tithe in the discretion of my Executrix without further order or license of the Register of Wills or of any Court: A. Investments. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries, to compromise claims, and to sell any property at public or private sale; B. Securities. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; Page 4 of 9 Pages C. Litigation. To engage in litigation and compromise, arbitrate or abandon claims; D. Distributions. To make distributions in cash or in kind at current values, or partly in each, allocating specific assets to particular distributes;s on a non-pro rata basis, and for such purl.~oses to make reasonable determinations of current values; E. Tax Return. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax. returns and the payment of such taxes, without obligation to adjust the distributive share of income or princ:ipai of any person affected thereby; F. Loans. To pay off any loans I may have taken against life insurance policies o~med by me that remain unpaid at the time of my death:; G. Borrowing and Encumbering. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; H. Property Management. To manage, control, repair and improve all personal and real property; I. Insurance. To procure and carry at the expense of the estate, insurance of the kinds, forms and amounts deemed advisable by the Executrix to protect the estate and the Executrix against any hazard; J. Employment of Attorneys, Advisors and Other Agents. To employ any attorney, investment adviser, accountant, broker, tax specialist or any other agent deemed Page S of 9 Pages necessary in the discretion of the Executrix; and to pay from the estate reasonable compensation for all services performed by any of them; K. Business Operation. To conduct alone or with others any business in which I am engaged or in which I have an interest at my death, with all the powers of any owner with respect thereto, including the power to delegate discretionary duties to others, to invest other property held hereunder in such business and to organize a partnership or corporation to carry on such business; L. General. To do all the acts, to take all the proceedings, and to exercise all the rights, powers and privileges which an absolute owner of the property would have, subject always to the discharge of her fiduciary obligations. The enumeration of certain powe:rs in this Will shall not limit the general or implied powers of the Executrix. The Executrix shall have all additional powers that may now or hereafter be conferred on the Executrix by law or that may be necessary to enable the Executrix to administer the provisions of this Will, subject to any limitations specified in this Wi11. NO ALIENATION ARTICLE V No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. Page 6 of 9 Pages NO CONTEST ARTICLE VI If any beneficiary or remainderman under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any share or interest in my estate given to tha: contesting beneficiary or remainderman under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary or remainderman had predeceased me without issue. LEGALITY OF ARTICLES ARTICLE VII If any provision of this Will or of any codicil thereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining provisions thereof shall continue to be fully operative and effective so far as it is possible and reasonable. TAPES ARTICLE VIII All estate, inheritance and succession taxes, together with any interest and penalties thereon, payable as a result of my death and imposed with respect to any property, whether or not disposed of by this tiVill, shall be paid out of the residue of my estate. Page 7 of 9 Pages IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last ~~'ill and Testament, consisting of nine (9) typewritten pages, including this attestation clause, to be executed, declared and published this ' ' day of J~y.,T; , 2006, at River Chase Office Center, 4431 I~'orth Front Street, Harrisburg, Pennsylvania. _ ..~'~<.~.~~.~ y~~z~.,,,,~~r (SEAL) IvIICHaEL POTOCHNEY ' Signed, sealed, published and declared by the above named 1~IICHAEL POTOCHNEY, Testator, as and for his Last Will, in the presence of us and each of us, who, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. W-~.~ ~~~- ' ~- i ~" - ,~ -,,.' .s_,.~._ ~.;____ Residing at ' ~ ~ ~ ~'~~~~ ~-~~~.: ~ .l /- ~?: ;` rr Residing at ~_` ~~t_ ;` 1 •. ~ ~.~- ~.~. ~_u,_,rnt . 2.: Residing at r - -r ~~~ Fe;~ i-1cttGw 1~. Page 8 of 9 Pages C0~1~10iv~VEALTH OF PEIvTISY"LVANIA SS. COUNTY OF DAUPHIN We, ItilICH AEL PO"I'OCHNEY, the Testator, ar>d l ; ~•_; ,.~~~--- "i``- ~ = --° /~~~ /~ 'i. ~ . \; , ;-+ ~,~ ,~~ ±t~~~~~_ and r~ick~ele E.~."urnt~r-, the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness and that to the best of his or her knowledge the Testator was at that time eighteen (1 ~) years of~ age or older, of sound mind and under n_o constraint or undue influence. 1viICHAEL POTOCHNEY Witness ~ - •~\ Witness {' Witn ss Subscribed, sworn to and acknowledged before me by MICHAEL I'OTOCHNEY, the ~ ,~'`~. Testator, and subscribed and sworn to before me b ! ,~'"~, , ~ ~_~ i s = }.~ ~• -° .''''~-; l: ~:`~ r s i ~ C_ { l~- (;; i . • ~ and ~ heie ~..~ >,m~-mac' , ~~'itnesses, this ~~ day of ~ , 2006. C~• Notary Public (SEAL ~--°~-~ NClafial S Page 9 of 9 Pages vicl:y L. Fitz, Notary Public Susci~.;ciianna "Iwp., dauphin Cuunty ht}' (onunissien Expires Jan. 6. 2007 - ~~.-. - -%-- ~sscaa!~onotiVotan~ Estate `~ialuation Date cf Death: 02/09/2008 Estate of: Michael Potochney Valuation Dater 02/09/2008 ~ Account: 6716-3511 Processing Date: 03/13/2008 Report Type: Date of Death Number of Securities: S File ID: Michael Potochney DOD08092008 Shares Security or Par Description 1) 134 CAPITAL WOR CL B SHS Mutual Fund 02/08/2008 Mean &/or Div & Int Security High/Ask Low/Bid Adj'ments ,Accruals Value LD GROWTH ~ INCOME (190593208; CWGBX) (as quoted by NASDAQ) 39.83000 Mkt 39.830000 5,337.22 2) 230.646 LORD ABBETT MID CAP VALUE FD (593919203; LMCBX) CL B Mutual Fund (as quoted by NASDAQ) 02/08/2008 15.32000 Mkt 15.320000 3,533.50 3) 396.36 LORD ABBETT AFFILIATED FD INC (544001209; LAEBX) CL B Mutual Fund (as quoted by NASDAQ) 02/08/2008 12.82000 Mkt 12.820000 5,081.34 4) 671.972 FRANKLIN TAX FREE TR (354723322; FBPTX) PA TF INC CL B Mutual Fund (as quoted by NASDAQ) 02/08/2008 10.92000 Mkt 10.420000 7,001.95 5) 570.849 INCOME FD AMER INC (953320202; IFABX) CL B SHS Mutual Fund (as quoted by NASDAQ) 02/08/2008 18.01000 Mkt 18.010000 10,280.99 Total Value: Total Accrual: Total: $31,235.00 $31,235.00 $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional a3nd attorney to discuss estate settlement and any legal matters. Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF D1!:ATH: Michael Potochney 170-12-4717 February 9, 2008 Account #: 2331043469 Type: Checking Open date: 7/19/1999 In the name of: Michael Potochney or Lorraine S. Potochney Date of Death Balance: $12,654.19 Int.(YTD) from 1/1/2008 to 2/6/2008 $2.49 Accrued interest to date of death: $0.13 Other Info; Account #: _ l 055284325 Type: CD Open date: 4!712001 In the name of: Michael Potochney or Lorraine S. Potochney Date of Death Balance: $1,783.83 Int.(YTD) from 1/1/2008 to 1/31/2008 $6.67 Accrued interest to date of death: $2.37 Other info: Account #: _ 2335251399 Type: CD Open date: 7/19/1999 In the name of: Michael Potochney or Lorraine S. Potochney Date of Death Balance: $30,000.00 Int.(YTD) from 1/1/2008 to 1/31/2008 . _ $102.83 Accrued interest to date of death: $36.44 Otherlnfo: Page 1 of 1 i.j l' 1.. ~,. _~ PA Central ~, ~~~~,~ ,.3.,,~~ ~~, ~ ~ r tiltircnian~,C~r,~t;. i'_A 17U I I FEDERAL C R E D I T U N I O N Apri19, 2.008 Smigel, Anderson & Sacks LLP Attorneys At Law 4431 North Front Street Harrisburg, PA 17110-1709 RE: Michael Potochney, Deceased Social Security Number: * * *-* *-4717 Date of Death: 02/09/08 Dear Ms. Bradley: 5137 f unestou~n K~r<ld Harrisburg, PA 171 1 2 1220 East Main Srreec Palmyra, PA 17078 www.pacentralfcu.ccnn 800-356-3875 FAX 717-564-1503 On February 21, 1946, Michael Potochney opened a share account, #82659-018, with Ethel L. Potochney as joint owner. On December 30, 1998, Ethel was removed from the account and Lorraine S. Potochney was added as joint owner. The balance at the time of death was $81.02. No accrued dividends. A certificate of deposit, account #82659-OB8 was made joint with Lorraine S. Potochney on December 30, 1998. The balance at the time of death was $5,429.29. No accrued dividends. A certificate of deposit, account #82659-OA8 was made joint with Lorraine S. Potochney on December 30, 1998. The balance at the time of death was $82,082,63. No accrued dividends. AiI accounts mentioned above were held jointly with Lorraine ~. Potochney with survivorship rights. If you need any further information or have any questions, please do not hesitate to contact me at 1-800-356-3875, extension 123. Sincerely, ~~ ~ 2 ~f~ ` ~ r Robin Haehnlen Member Products Representative _c=..n~~. =rai C~aE7 E"^~uE auae:.~ of ~r~D~~,noua~ TaxEs DEPT. 28C60t H ARniSBURG. PA 1 71 28-0601 tECEIVED FROM: _. ~ ~.! cX111-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT POTOCHNEY-KOBOLD LORRAINE S 819 LINWOOD STREET NEW CUMBERLAND, PA 17070 ACN ASSESSMEN7~ AMOUNT CONTROL NUMBER ------- told ESTATE INFORMATION: SsN: X70-iz-4717 FILE NUMBER: 2108-0188 DECEDENT NAME: POTOCHNEY MICHAEL DATE OF PAYMENT: O4/ 14/2008 POSTMARK DATE: 04i 1 112008 COUNTY: CUMBERLAND DATE OF DEATH: 02/09/2008 101 ~ $3,500.00 TOTAL AMOUNT PAID: [___~~~08 ~- -~G "7 ~- 2-5 S 3, 500.00 REMARKS: RECEIPT TO ATTORNEY SEAL CHECK# 1 1 71 INITIALS: AJW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS N0. CD 009547 TAXPAYER SMIGEL, ANDERSON & SACKS LLP ATTORNEYS AT LAW May 9, 2008 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA. 17013-3387 Re: Estate of Michael Potochney No. 2008-00188 Dear Register: c> -=~ ~ _- _-t ~~ PP 1 _-. T .. _ _ JET ~. N _., i _., ~, --~ - ~ :`, " - - - cn ao Please find enclosed for filing an original and three (3) copies of the Pennsylvania Inheritance Tax Return and an original and two (2) copies of the Inventory for the above Estate. I am also enclosing the required filing fee of $30.00. Upon receipt, please time stamp the additional copies of the Return and Inventory and return them to me in the self-addressed stamped envelope. Thank you for your cooperation and assistance in this matter. Sincerely yours, ~~~ Joanne A. Bradley, Paralegal :jab Enclosures cc: Lorraine S. Potochney-Kobold, Executrix (wo/encl.) JOANNE A. BRADLEY, PARALEGAL PHONE: (717) 234-2401 TOLL FREE: 1-800-822-9757 FACSIMILE (717) 234-3611 EMAIL: jbradley@sasllp.com www.sasllp.com File No. 7078-2-SA River Chase Office Center, 3~d Floor 4431 North Front Street, Harrisburg, Pennsylvania :L7110 A PENNSYLVANIA LIMITED LIABILITY PARTNERSHIP Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Michael Potochnev No. 21-08-0188 also known as Date of Death 02/09/2008 Deceased Social Security No. 170-12-4717 -_-, -- •- f1.i ~-> '__ 1_ .;_ -~ - L . ,__ ~: t. -- t_`~ ._ Lorraine S Potochnev-Kobold Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IIWe verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. M Personal Representative: ref ~ ~ ~ (V t~ fX' ~'/L't/ ~ c> ~ `''~'~ - Address: 819 Linwood Street N ~.t,~ - r- i1.~ ~ - ' c-'' ~ ? New Cumberland. Pennsylvania 17070 ~c - ~~_; Telephone: X717) 774-4620 N Dated: 5 ~G,O ~ Description PERSONAL PROPERTY 1. 67 SHARES of PRUDENTIAL STOCK x $71.78 ................................. (DOD) High: $72.50 Low: $71.06 Mean: $71.78 2. JANNEY MONTGOMERY SCOTT BROKERAGE ACCOUNT-#6716-3511 Value ••~••••••• ~ $4,809.26 " ~ $31,235.00 TOTAL: $36,044.26 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. ~~'"1 ~f ., ~r.-: :~ >'~ O_ r' N Y ~~ ~ N ~ ~ ~~~ ~ r ~ o4~Z4 ~.~~~,~ ~ Z I Wa. ~ ~ v u°~i w 0 ~ J ~ m N ~~ ~ m d' ~ ~ ~ ~~~~ g ?r N ~O