HomeMy WebLinkAbout04-0321 Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Evel.yn M. Nokovich
also known as
Joseph R. Nokovich , Deceased
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
Social Security No. 174-14 ~ 0057
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or
the Decedent, dated 06/13/[990 and codicil(s)dated None
~named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, ~e~ ~:
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted afteF'~3(ecution e docu~
offered for probate; was not the victim of a killing and was never adjudicated incompetent: ~':~i~
[] B. Grant of Letters of Administration ~
(c.t.a.; d.b.n.c.t.a; pendente lite; dura/~e=absentia;'~urante mihodtate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name
_ Relationshi Residence !'A
Joseph R. Nokovich [~S_°.n__L_ [521 Haldeman Blvd. ,-------~ew Cumberland,
Hilda M. Brenneman lUaUgn=er 1532 Orrs Brid.qe Rd., C~,? Hill, PA
Charles R. Nokovich ~Son ~ Marlboro, MD
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family
or principal residence at 521 Haldeman Blvd., New Cumberland BorouEh, New Cumberland, PA 17070
(list street, number, and municipality)
Decedent, then 84 years of age, died 03/04/2004 at Penn Twp./Perry County, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
(Location)
$ 140,000.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the a~Dpropriate form to the undersigned:
Signature T e.~y.p..~3rinted name and residence
"' ~6~X 2./~~ Joseph R. Nokovich
~ i_ ? 521 Haldeman Blvd., New C~berland, PA 17070
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (lgg~)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this ) ~ day of
~ (~ .~- For the Register
~se~h R. Nok~vich
No.
Estate of Evelyn M. Nokovich Deceased
Social Security No: 174-14-0057 Date of Death: 03/04/2004
AND NOW, ~ ~ ~ , c~O~ ,in consideration
r
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary [~ Of Administration
(c.ta.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Joseph R. Nokovich
in the above estate and that the instrument(s) dated 06/13/1990
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
Short Certificate(s) ..... $
Register of Wills ~ -- ~ (~ ~
Renunciation ........ $
Attorney: Michael L. Ban~s
Affidavits ( ) .... $
Extra Pages ( ) .... $
Codicil ........... $
I.D. No: 41263
Bangs Law Office
Address: 429 South 18th Street
Camp Hill, PA 17011
JCP Fee ..........
Inventory ..........
Telephone: 717/730-7310
Other ........... $
TOTAL ......... $ c~. ~
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
EVELYN M. NOKOVICH
Name of Decedent:
Date of Death: March 4, 2004
Will No.:
To the Register:
Admin. No:
I certify that notice of beneficial interest (estate administration) required by Rule 5.6(a)
of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the
April 5,
2004.
ADDRESS
532 Orrs Bridge Road, Camp Hill, PA 17011
521 Haldeman Blvd., New Cumberland, PA 17070
5909 Lowery Lane, Upper Marlboro, MD 20772
above-captioned estate on
NAME
Hilda M. Brenneman
Joseph R. Nokovich
Charles R. Nokovich
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none.
'MICHAEL L. B~i,~GS, E.s/qUire
429 South 18th Street
Camp Hill, PA 17011
(717) 730-7310
Capacity: Counsel for Personal Representative
his is to certi~ that the information here 'given is cgrrectly copied from an original ~ertificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the S~ate Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9826159
No.
Local Registrar '/
COMMONWEALTH Of PENNSYLVANIA * DEPARTMENT Of HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
84 ,,. : ~ Apr 10, 1919 McDonald, PA
I~.
t~,~.W.~;~ I Own Home I ~ ~ I
Homemaker I .... [,.. I,,. . 12]
New Cumberland, Pa. 17070 ~ .... ,~.-~ Cumberland
Joseph R. Nokovich
Mar 8, 2004
FD*012662-L
Martha Campbell
17070
Meghanicsburg CemeteryI,,. Mechanicsburg, Pa. 17055
ers F.H. 37'E Main StaMBG. Pi. 17055
"" ........... , D*men}.i; - ~l'chcime*' +'/pc
LAST WILL ~ TESTA~IT OF l~vl~,bYl~l H. NOKOVICIt
I, EVELYN H. NOKOVICH, of the Township of Hampden, County of
Cumberland and State of Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this my
Last Will and Testament, hereby revoking and making void any
prior Wills by me at any time heretofore made.
and all
I direct the payment of all my just debts and 'fu~eralc~xpenses
as soon after my decease as the same can be conveniently done.
I give, de~ise and bequeath all the rest, residue and remainder
of my estate, real, personal and mixed, of whatsoever nature and whereso-
ever the same.may be situate, to my three (3) qhildren, to wit, my daugh-
ter, HILDA H. BRENNEMAN, my son, JOSEPH R. NOKOVIC~, and my son, CgAP. LES
R. NOKOVIClt, share and share alike, per stirpes.
LASTLY, I nominate, constitute and appoint my son, JOSEPlt R.
NOKOVICH, Executor of this, my Last Will and Testament, and in the event
my said son should predecease me, or should he be unable or unwilling to
serve in such capacity for any reason, then in such event, I nominate,
constitute and appoint my daughter, HILI)A N. BRENNEHAN, Executrix of
-1-
this, my Last Will and Testament, in his place and stead, and in
either event my said personal representative shall be excused from
posting bond or other security in this or any other jurisdiction.
IN WITNESS W~OF, I have hereunto set my hand and seal
this 13th day of June, A. D. 1990.
M.. Nokovich
(SEAL)
Signed, sealed, published and declared by the above-named
g¥~b~N M. NOKOVICM, as and for her Last Will and Testament, in the
presence of us, who, at her request and in her presence, and in the
presence of each other, have hereunto subscribed our names as wit-
nesses.
-2-
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
I, ~¥F~LYNM. NOKOVICM , the testatrix
whose name is signed to the attached or foregoing instrument, having
been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament;
that I signed it willingly; and that I signed it as my free and volun-
tary act and deed~ for the purposes therein contained.
day of
Sworn and affirmed to and acknowledged before me by
~v~LYN M. NOKOVICH , the testatrix , this 13th
Jun~ , A. D. 1990.
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
SS.
NOTARIAL SEAL
I'tARY S. ROBINSON, NOTARY PUBLIC
MECHANiCSBURG RORO. C~IERLANO CO.
H~ Cemmtsslon Expires Sept. 21, 1991
We, the undersigned, J. ROBERT STAUFFER
and JOH~I M. F~AICIN , the 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 the
testat rix , ~V~d~YN M. NOKOVICH , sign and exe-
cute the instrument as ~m/her Last Will and Testament; that the
said testatrix , MVF~LYN M. NOKO¥ICH , executed it as
~*~/her free and voluntary act for the purposes therein expressed;
that each of us, in the hearing and sight of the testatrix , signed
the Will as witnesses; and that to the best of our knowledge, the
testatrix was, at the time, eighteen (18) or more years of age,
of sound mind, and under no constraint, duress or undue influence.
me this 13th day of
June , 1990.
NOTARZAL SEAL
MARY S. ROBINSON, NOTARY I~'JIL,[C
~tECHAN[CSBURG BORO. CLI~BERLANO CO.
Cen~tsslon £xp~res Sept, 21, 1091
429 SOUTH 18TM STREET
CAMP HILL, PA 17011
PHONE: 717-730-7310
FAX: 717-730-7374
MICHAEL L. BANGS, Attorney-at-Law
WILLIAM E. MILLER, ~R.
WENDY S. CHESBRO, Paralegal
Of Counsel
November 19, 2004
Glenda Famer Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Evelyn ~ Nokovich
File No. 21-04~0321
Dear Mrs. Strasbaugh:
Enclosed for filing as a part of the above-referenced estate please find the following:
1. Two original Pennsylvania inheritance tax returns;
2. The original Inventory;
3. A check in the amount of $6,343.67 paying the tax shown to be due on the return;
and
4. A check in the amount of $31.00 to pay the filing f~e.
Please return a paid receipt to me in the enclosed, stamped, pre-addressed envelope.
If you have any questions or require anything further, please contact me.
Very truly yours,
Michael L. Bangs
wsc
Enclosures
cc: Mr. Joseph R. Nokovich
REV-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
REV-I$00
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2104-0321
COUNTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
174-14-0057
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Nokovich Evelyn M.
DATE OF OEATH (MM- OD-YEAR) DATE OF BIRTH (MM-DO-YEAR)
THIS RIEl'URN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY N UMBER
~4; ~ date of death
OrlginalReturn 2. SuppI~i~,~,[~;Return 3. Remainder Return priortolZ-13-82
C A 4. Limited Estate . Future Interest Compromise (date of death after 1Z- 12-82) 5. Federal Estete Tax Return Required
HpI -- 5. Decedent DledTestate
E P · Decedent Mainta[neda LivingTrust
C R ~ (Attach copy of Will) (Attach copy of Trust) -- 5. Total Number of Sate Deposit Boxes
KOI [] 9. LitigatlonProceedsReceived J~]10. SpousalPovertyCreda r~ 11.ElectiontotaXunderSec. 9113(A)
(date of death between 12-31-91 and 1-1-95) (Attach Sch O)
Co"
C
O
M
NAME
Michael L. BanBs
FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
429 South 18th Street
Camp Hill, PA 17011
R
E
C
A
P
I
T
U
L
A
T
I
O
N
TELEPHONE NUMBER
717/730-7310
1. Real ;~tmt. (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole~Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
] Separate Billing Requested
7. inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11)
149
None
4,438.80
None
N~ne
OFFICIAL USE ONLY
5. (8) 154,422.78
lO. 10,575.81
11. 2,876.50
(11) 13,452.31
12. (12) 140,970.47
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13).
made (Schedule J) .
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 140,970.47
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
T UP 15. Amount of Line 14 taxable at the spousal tax
A
X AT rate, or transfers under Sec. 9116(a)(12) X .0 0 (15) 0.00
T 16. Amount of Line14 taxabJe at lineal rate 140,970.47 x 0 45 (16) 6 3
OI I 17. Amount of Line14 taxab~e at sibling rate X ~ . . , 43.67
~ .]Z [17) 0.00
N J 18. Amount of Line 14 taxable at collateral rate ~ X ,15 (18)' 0.00
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Oecedent's Complete Address:
STREET ADDRESS
521 Haldeman Blvd.
CITV
New Cumberland
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
Z, Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments
C. Discount
3. Interest/PenaRy if applicable D. Interest
E. Penalty
STATE
(1)
Total Credits ( A + B + C ) (~')
Total Interest/Penalty ( D + E ) (3)
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)
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. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB)
zrP
17070
6,343.67
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;
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. Jf 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? .............................................. [] ~-~
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 GUESTIONS 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 a~ii,Ha, lying scheduJes and statements, and to the best of my knowledge and belief, it is true,
0.00
0.00
0,00
6,343.67
0.00
6,343.67
correct and complete. DecJaration of preparer other than the personal representative Is based on air information of which preparer has any knowledge.
SIGNATUREOFPERSONRESPONSIBLEFORFiLiNGRETURN Joseph R. Nokovich
./, --*/~ ~t~] -/ ~, J .521 Haldeman Blvd. E~TE/ /
...................
SI~TURE~PREPAREROTH~RTH~EPRESENTATIVE Michael L. Bangs ~
~ ~ ~ I ,? ) /~ 429 South 18th Street / /
.........................
For dates of death on or after July 1, 1994 and before Janua~ 1, 1995, the tax rate imposed on the net va~ue 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 Janua~ 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 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statuto~ require~nts for disclosure of assets
and filing a tax return are still appiicable even if the su~iving spouse is the only beneficial.
For dates of death on or a~er Ju~ 1. 2000:
The tax rate imposed on the net value of transfers from a deceased chird twen~-one years of age or younger at death to or for the use of a naturaJ
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net varue of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P,S. 9116(1.2)
[72 P.S. S~ lS(aXO].
The tax rate imposed on the net value of transfers to or for the use of the decedent's sibJings is 12% [72 P.S. 9116(aX 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.
Copyright (c) 2000 form software only T he Lackner Group, ~nc. Form REV- 15~ ~X (Rev. 6-~)
REV-1503 EX * (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
Evel.yn M. Nokovich SS# 174-14-0057 03/04/2004
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
2104-0321
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE
OF DEATH
1 1,000 shares Oppenheimer & Company - Rite Aid Corp. 5.66 5,660.00
Shares
2 190.067 shares Oppenheimer & Company - Mutual Funds 31.27 5,943.40
(American Capital World)
3 1,480.583 shares Oppenheimer & Company - Eaton Vance 20.44 30,263.12
Tax-Managed Mutual Fund
4 344.084 shares Oppenheimer & Company - Growth Fund 25.78 8,870.49
America Incorp
5 420.521 shares Oppenheimer & Company - Growth Fund of 25.14 10,571.90
America - CL B
6 853.974 shares Oppenheimer & Company - John Hancock 14.59 12,459.48
Large Cap Value FD CL B
7 1,754.386 shares Oppenheimer & Company - Putnam Equity 16.17 28,368.42
Income FD CL B
8 867.246 shares Oppenheimer & Company - Putnam Growth & 18.19 i5,775.20
Income FD CL B
9 810.922 shares Oppenheimer & Company - Scudder Dreman 39.55 32,071.97
Hi RTN FD B
TOTAL(Alsoenteronline2, Recap~ulation) 149,983.98
I, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, inc.
Form REV-1503 EX (Rev. 1-97)
REV- 1508 EX + (1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
FILE NUMBER
Evel.yn M. Nokovich SS# 174-14-0057 03/04/2004 2104-0321
Include the p[oceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1 4,438.8 shares Oppenheimer & Company - CTS Prime Cash Series
MOney Fund
VALUE AT DATE
OF DEATH
4,438.80
TOTAL (Also enter on line 5, Recapitulation) $ 4,43 8.80
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. ? -87)
Z
REV- 1 $11 EX + (1 -g7)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCETAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
Evel.yn M. Nokovich SS# 174-14-0057 03/04/2004
Debts of decedent must be reported on Schedule I.
FILE NUMBER
2104-0321
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
James R. Gingrich Memorials
1
2
Myers Funeral Home, INc. - Funeral Bill
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip.
Year(s) Commission Paid:
Attorney's Fees Michael L. Bangs
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal - Legal Advertisement
The Sentinel - Legal Advertising
State Zip
100.00
7,198.50
2,500.00
266.00
300.00
75.00
136.31
TOTAL (Also enter on line 9, Recapitulation) $ 10,575.81
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software onh/CPSystems, Inc. Form REV- 1511 EX (Rev. 1-97)
REV- 151Z EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
ESTATE OF
Evelyn M, Nokovich
Include unreimbursed medical expenses.
ITEM
NUMBER
2
SS~/ 174-14-0057 03/04/2004
FILE NUMBER
2104-0321
DESCRIPTION AMOUNT
PharMerica (Medications)
Kinkora Pythian Home Corporation - Final Nursing Home Charges
TOTAL (Also enter on line 10, Recapitulation)
400.00
2,476.50
2,876.50
(rf more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software onry CPSystems, lnc. Form REV- 151Z EX (Rev. 1-97)
REV- 1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIOENTDECEDENT
ESTATE OF
Evel.$w
NUMBER
I.
2
SCHEDULE J
BENEFICIARIES
M. Nokovich SS~/ 174-14-0057 03/04/2004
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
t~ns~rs under Sec. 911~)(1.2)]
Hilda M. Brenneman
532 Orrs Bridge Road
Camp Hill, PA 17011
Charles R. Nokovich
5909 Lowery Lane
Upper Marlboro, MD
20772
Joseph R. Nokovich
521 Haldeman Blvd.
New Cumberland, PA
17070
RELATiONSHiP TO DECEDENT
Do Not List Tru~t~(s)
Daughter
S on
S on
5NTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18,
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
FILE NUMBER
2104-0321
AMOUNT OR SHARE
OF ESTATE
One-Third/Rema
inder
One-Third/Rema
inder
One-Third/Rema
inder
AS APPROPRIATE, ON REV 1500 COVER SHEET
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0. O0
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software onry The Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00)
LAST ITILL AND TESTAMENT OF EV~¥N M. NOKOVICn
I, ~¥gl.~N M. NOKOVICH, of the Township of Hampden, County of
Cumberland and State of Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this my
Last Will and Testament, hereby revoking and making void any and all
prior Wills by me at any time heretofore made.
I direct the payment of ail my Just debts and funeral expenses
as soon after my decease as the same can be conveniently done.
I give, devise and bequeath all the rest, residue and remainder
of my estate, real, personal and mixed, of whatsoever nature and whereso-
ever the same may be situate, to my three (3) children, to wit, my daugh-
ter, HILDA M. BRENNEMAN, my son, JOSEPH R. NOKOVICH, and my son, CHARLES
R. NOKO¥ICH, share and share alike, per stirpes.
LASTLY, I nominate, constitute and appoint my son, JOSEPH R.
NOKOVICH, Executor of this, my Last Will and Testament, and in the event
my said son should predecease me, or should he be unable or unwilling to
serve in such capacity for any reason, then in such event, I nominate,
constitute and appoint my daughter, HILDA M. BP~, Executrix of
-1-
this, my Last Will and Testament, in his place and stead, and in
either event my said pereonal representative shall be excused from
posting bond or other security in this or any other Jurisdiction.
IN ~'I~SS W-K~F~OF, I have hereunto set my hand and seal
this 13th day of June, A. D. 1990.
Eve~n M. Nokovich
(SEAL)
Signed, sealed, published and declared by the above-named
~v~-'-I'N M. NOKO~ICH, as and for her Last Will and Testament, in the
presence of us, who, at her request and in her presence, and in the
presence of each other, have hereunto subscribed our names as wit-
-2-
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
I, EVELI~N M. NOKOVICM , the testatrix
whose name is ~'igned to the attached or foregoing instrument,-having
been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament;
that I signed it willingly; and that I signed it aa my free and volun-
tary act and deed; for the purposes therein contained.
Sworn and affirmed to and acknowledged before me by
EV~L~N M. NOKOVIC~ , the testat~ix , this 13th
'~ay of Jun9 , A. D. 1990.
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
SS.
NOTARIAL S£AL
MARY S. ROBINSON, NOTARY PUILIC
M£CHAN|CiBURG BORO. CO~IERLANO CO.
M~C~m~$tofl ~xN~res Sept. 21, 1~91
We, the undersigned, J. ROR~RT STAUFFE~
and JOl~l N. F~d~T~ , the 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 the
testat r_rix , EVELYN M~ NOKOVICM T , sign and exe-
cute the instrument aa k~m/her Last Will and estament; that the
said testatrix , ~vF-,LYNM. NOKOVICH , executed it as
~/her fre~' and voluntary act for the purposes therein expressed;
that each of us, in the hearing and sight of the testatrix
the Will as witnesses; and that to the best of our nowledge, the
k ' , signed
testatrix was, at the time, eighteen (18) or more years of age,
of sound mind, and under no constraint, duress or undue influence.
me this l~th day of
June , 1990.
NOTARIAL
MARY S. ROBINSON, NOTARy PUBLIC
MECHANICSBURG BORO. CUMB£RLAND CO.
Ce~tsston ExNtres 5epC, 21, 1991
Register of Wills of COMB[RL D County, Pennsylvania
INVENTORY
Estate of Evelyn M. Nokovich
a~so known as
No. 2104-0321
Date of Death 03/04/2004
, Deceased Social Security No. 174-14- 0057
Joseph R. Nokovich,
Personal Representative(s) of the above Estate, deceased, verify that the ifems 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 Oecedent owned
no real estate outs[de of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I BNe verify that the statements made in this Inventory are true and correct. I~Ve understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
I.D. No.:
Michael L. Banss
41263
Address: 429 South 18th Street
Camp Hill, PA 17011
Telephone: 717/730-7310
Personal Representative
Signature: ~~ ~~
~.~ ep~ R. l~oko~l~Ch
Signature:
Address: 521 Haldeman Blvd.
New Cumberland, PA 17070
Telephone: 717
Description
(See continuation page(s) attached)
Attach additional sheets if necessary)
~-*~'VaJue
Total: 154,422.78
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the ejection of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory,
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form ~RW-7 (1992)
Estate of:
Date of Death:
County:
INVENTORY
Evelyn M. Nokovich
03/04/2004
Cumberland
CASH:
shares Oppenheimer & Company -
CTS Prime Cash Series MOney
Fund
4,438.80
1,000.00
190.07
1,480.58
344.08
420.52
853.97
1,754.39
STOCKS/LISTED:
shares Oppenheimer & Company -
Rite Aid Corp. Shares
shares Oppenheimer & Company -
Mutual Funds (American
Capital World)
shares Oppenheimer & Company
Eaton Vance Tax-Managed
Mutual Fund
shares Oppenheimer & Company -
Growth Fund America Incorp
shares Oppenheimer & Company
Growth Fund of America - CL
B
shares Oppenheimer & Company
John Hancock Large Cap Value
FD CL B
shares Oppenheimer & Company -
Putnam Equity Income FD CL B
5,660.00
5,943.40
30,263.12
8,870.49
10,571.90
12,459.48
28,368.42
4,438.80
-1-
867.25 shares Oppenheimer & Company -
Putnam Growth & Income FD CL
B
810.92 shares Oppenheimer & Company
Scudder Dreman Hi RTN FD B
15,775.20
32,071.97
149,983.98
TOTAL RECEIPTS OF PRINCIPAL ...............
154,422.78
-2-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF iNDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004656
BANGS MICHAEL L
429 S. 18TH STREET
CAMP HILL, PA 17011
ESTATE INFORMATION: SSN: 174-14-0057
FILE NUMBER: 2104-0321
DECEDENT NAME: NOKOVICH EVELYN M
DATE OF PAYMENT: 11/22/2004
POSTMARK DATE: 1 1/19/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 03/04/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,343.67
REMARKS:
TOTAL AMOUNT PAID:
$6,343.67
SEAL
CHECK//- 6
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INOIV~;A'A~ifsOFF[CE OF
INHERITANCE TAX DIlU~~''''_'1 'I
PO BOX 280601 '_.,.!" : '
HARRISBURG PA 17128-060"1'-" ,
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
2G05 JM~ 2l; fill 8: 18
CLEF:I<
ORFH'N'S
MICHA~~J!JBANGS .
429 S 18TH ST
CAMP HILL PA 17011
01-25-2005
NOKOVICH
03-04-2004
21 04-0321
CUMBERLAND
101
*
REY.1541 EK iFP (12~04l
EVELYN
M
Allount Rellitted
I CHANGED
III
121
131
141
151
161
(7)
.00
149.983.98
.00
.00
4.438.80
.00
.00
(81
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE.V' :r~2;"f.EX..AFp..rli1":6!')".NiiT.fcE.iij!'.l'NII!RYfANc!.TAx-'ipPR'iiSEiiEN'~--A[liiIiAM:i!.D'If.................
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF NOKOVICH EVELYN M FILE NO. 21 04-0321 ACN 101 DATE 01-25-2005
TAX RETURN WAS: I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule OJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule GJ
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
191
1101
10,575.81
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
154,422.78
1~.4~? ~l
140,970.47
.00
140,970.47
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
lS. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Lin. 14 at Sibling rate (17)
18. Amount of line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
.00 X 00 = .00
140,970.47 X 045 = 6,343.67
.00 X 12 = .00
.00 X 15 = .00
1191= 6,343.67
2.876.50
(Ill
1121
1131
1141
fAX CREDITS:
. ........, ....., '" AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-I
11-19-2004 CD004656 .00 6,343.67
TOTAL TAX CREDIT 6,343.67
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I .'~
~-...,
REGISTER OF WILLS OF CUMBERLAND COUNTY
REPORT OF STATUS OF ADMINISTRATION
(For Resident Decedents Dying after July 1, 1984)
ESTATE NO. 21- 04 - 0321
Name of Decedent:
Social Security No.:
EVELYN M. NOKOVICH
174-14-0057
Date of Death:
March 4, 2004
Name of Personal Representative:
Joseph R. Nokovich
521 Haldeman Boulevard
New Cumberland, P A 17070
Capacity
(check one)
Executor
Administrator
x
Administrator c.t.a.
Administrator d.b.n.
Is the administration of the estate complete? Yes_X_ No
If "Yes", how was the administration ended? (check one)
By court accounting
By account stated to parties in interest
Did the parties release the
personal representative?
Other (explain)
x
--
YES
;::)
(>:!
-.0.."
(.n
I.D
Total amount paid to date to creditors and for funeral and $9,766.98
administrative expenses
Total value of distributions to date to beneficiaries $132,412.17
If administration is not complete, estimated value of assets $0.00
still in administration
NOTE: This status report is due no later than the due date for filing of the Pennsylvania
inheritance tax return or, if no iuheritance tax return is required, nine (9) months after the
date of death; if the administration of the estate has not been concluded, a summary report
shall be filed annually thereafter until the administration is complete.
1 certify under penalty of perjury that the foregoing information is correct to the best of my
knowledge, information and belief.
Date: ~)J )/ () ,-
~)~(1 II;)
Atto ey for Estate l/ /
v
INRE:
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-04-0321
ESTATE OF
EVELYN M. NOKOVICH
Deceased
RECEIPT AND RELEASE
:~)
',0
'~:1
"1,.,_,.., .
:.~ _.:,: ('") :,'
I, HILDA M. BRENNEMAN, the undersigned, being a beneficiary under the~.Sti,te oL~
~-ll C)
,.'-,
Evelyn M. Nokovich, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
\':.:1
w
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received all sums to which I am entitled as a beneficiary of
the Estate of Evelyn M. Nokovich;
4. To the extent of said distribution, release Joseph R. Nokovich, Executor, of the Estate
of Evelyn M. Nokovich, and his heirs and persona! representatives, from all liabilities, whether
due to his negligence or otherwise, which he may have by reason of his administration of the
Estate;
5. Agree to refund to the Estate and to the said Joseph R. Nokovich, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnifY him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
.J
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this It.(- day of
'-J k IVL-Lk
,2005.
<::.~fhcl.-I.71t~~(SEAL)
HILDA M. BRENNEMAN
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
On this, the I LjlIJ. day of ~1 ill {lit. , 2005, before me, the
undersigned officer, personally appeared HILDA M. BRENNEMAN, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that (s )he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have h reunto set my hand and official seal.
7}
./1 :.1 d( ..1 CIt e.1M 0
Notary Public
NOTARIAL SEAL
WENDY S. CHESBRO, Ho!aIy Pu'Jllc
l.clwer Allan Twp., Cumile!llllid r.oooly
My Commission ExpIres May 10, 2007
ESTATE OF
EVELYN M. NOKOVICH
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
)
)
)
ORPHANS' COURT DIVISION.
c::::+
INRE:
NO. 21-04-0321
-'1'_1
RECEIPT AND RELEASE
1-)
I, JOSEPH R, NOKOVICH, the undersigned, being a beneficiary under the- Estate o~
Evelyn M. Nokovich, deceased, do hereby:
I. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received all sums to which I am entitled as a beneficiary of
the Estate of Evelyn M. Nokovich;
4. To the extent of said distribution, release Joseph R. Nokovich, Executor, of the Estate
of Evelyn M. Nokovich, and his heirs and personal representatives, from all liabilities, whether
due to his negligence or otherwise, which he may have by reason of his administration of the
Estate;
5. Agree to refund to the Estate and to the said Joseph R. Nokovich, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
v
.
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this I if day of
UQ.I'(1
,2005.
~ /~. V\~ (SEAL)
JO P R. NOKOVICH
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUM~~ND I. )
On this, the day of JU. (1;1 en , 2005, before me, the
undersigned officer, personally appeare JOSEPH R. NOKOVICH, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that (s )he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I a e
{j
y Public
.....~-".~ .-t:"_.,.,.. .~.~
NOTAR\L SFJII..
WENDY S. CHESBRO, Nlll2/y Pub2c
Lower AIloo Twp.. ClIIl1bGIIllnd County
My CommlssloIi ExpinJs May 10. 200~
INRE:
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYL VANIA
)
)
)
)
ORPHANS' COURT DIVISIONC)
;;0-.
ESTATE OF
EVELYN M. NOKOVICH
Deceased
NO. 21-04-0321
c)
RECEIPT AND RELEASE
, iC>
'..> ~,) ~>;"
I, CHARLES R. NOKOVICH, the undersigned, being a beneficiary unde~the Est~ of
'::J~1 ..
).", c.n
Evelyn M. Nokovich, deceased, do hereby: 1.0
I. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received all sums to which I am entitled as a beneficiary of
the Estate of Evelyn M. Nokovich;
4. To the extent of said distribution, release Joseph R. Nokovich, Executor, of the Estate
of Evelyn M. Nokovich, and his heirs and personal representatives, from all liabilities, whether
due to his negligence or otherwise, which he may have by reason of his administration of the
Estate;
5. Agree to refund to the Estate and to the said Joseph R. Nokovich, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnifY him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
-J-
..
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this /:,c day of
\"'l ~.....-'--'-
,2005.
r --pz-~....4'-/?"~.....J<"-.
CHARLES R. NOKOVICH
(SEAL)
STATE OF MARYLAND
)
( SS:
)
COUNTY OF
On this, the f6--!4.. day of f1~'.h ,2005, before me, the
undersigned officer, personally appeared CHARLES R. NOKOVICH, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that (s )he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
---I;1~-7 ?Ld;.LJ
No Public
=- M. ~lti
_ Public. _ of MII.1d
..., ComnI'_J.'lll &rJha 01/16108