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HomeMy WebLinkAbout03-0217PETITION FOR PROBATE and GRANT OF LETTERS Estate of'Vll~l(~ ~ b0~c1¢¢t?~c~$~1 , No. also known as Vi'I~C¢I~-t ~otr] '~Wczicrlqot~,Stq To: · Deceased. Social Security No. Ig¢ ' ~f 4 ' ~c~ ~'..~ ..9. l- o -a. tl Register of Wills for the County of (."c~O'~erlat~c[ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executr, )( in the last will of the above decedent, dated .~q ~ c~v~[ ~ and codicil(s) dated in the named ,1,9 ,:.9 oo ~ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in 0v n~ Iverq c, ~ cl Count:~, Pennsylvania, with h last family or principal residence at 4t~ (list street, number and muncipality) Decendenb then 3z[ ~years of ag~, died Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent 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 situated as follows: $ -4dC',. oo OO(5 WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. request(s) the .probate of the last will and codicil(s) (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) Sworn to or aff{rme~ and subscribed before~m~ethis · )'7 _ ..... -~ ' / RegisterS. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA -I COUNTY OF (". ~t ~"~q ~o,e r Ici. ~d f ss 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 represen- tative(s) of the above decedent petitioner(s) will well ~nd truly administer the estate according to law. No. 21-03-217 VINCENT C. WOJCIECHOWSKI A/K/A Estate Of VINCENT CARL WOJCIECHOWSKI ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS MARCH 12, AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated JANUARY 16.. 200~ described therein be admitted to probate and filed of record as the last will of VINCENT C. WOJCIECHOWSKI A/K/A VINCENT CARL WOJCIECHOWSKI and Letters TESTAMENTARY 11~)X 20.0.,3in consideration of the petition on are hereby granted to CATHERINE N. WOJCIECHOWgWI FEES Probate, Letters, Etc .......... $ 70.00 Short Certificates(2 ) .......... $ =~ EXTRA .I~AGES... $ JCP $ 10. O0 TOTAL__ $ 95.00 Filed ...15b..R. qH...1.2.,..2.0.0.3. ................ '- .' Register ~f ~Vills ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE MAILED LETTERS TO EXECUTRIX MARCH 12, 2003 21-03-217 21-03-216 VINCENT C. WOJCIECHOWSKI I, Vincent Carl Wojciechowski, of Carlisle, Cumberland County, Pennsylvania, being of sound and deposing mind, memory and understanding, do make publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, taxes that may be assessed in consequence of my death, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. SECOND I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate to my beloved spouse, Catherine N. Wojciechowski, providing that she survives me by sixty (60) days. THIRD In the event that Catherine N. Wojciechowski, predeceases me or dies on or before the sixtieth (60th) day following my death, then I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate to my beloved parents, Vernon C. Wojciechowski, Sr. and Veronica C. Wojciechowski, and to my beloved brother Vernon C. Wojciechowski, II, who survive me by sixty (60) days. The estate shall be divided so that my beloved parents receive seventy-five percent (75%) of the entire estate and my beloved brother receives twenty-five percent (25%). FOURTH In the event that Catherine N. Wojciechowski, Vernon C. Wojciechowski, Sr. and Veronica C. Wojciechowski, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate to my beloved brother Vernon C. Wojciechowski, II, providing he survives me by sixty (60) days. FIFTH In the event that Catherine N. Wojciechowski, Vernon C. Wojciechowski, Sr., Veronica C. Wojciechowski and Vernon C. Wojciechowski, II, predecease me or die on or before the sixtieth (60th) day, I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate in shares of seventy-five percent (75%) to Mayo Clinic Jacksonville, Florida, to be used in connection with research and treatment of sarcoma and of twenty-five percent (25%) to Pinnacle Health Hospice. SIXTH My executor and trustee are authorized and empowered to exercise from time to time in his, her or its sole discretion and without prior authority from any Court, with respect to any property forming part of any trust hereby created or otherwise in its possession hereunder all powers conferred by law upon trustees or executors and the testator intends that such powers be construed in the broadest possible manner. SEVENTH I nominate, constitute and appoint my spouse, Catherine N. Wojciechowski, of Carlisle, Cumberland County, Pennsylvania, Executrix of this, my Last Will and Testament. In the event Catherine N. Wojciechowski is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint Carol L. Cingranelli, to serve instead. I direct that my personal representative shall not be required to give or post bond for the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament thisff~..ay of _.~-~7~ , 2003. Witness / Vincer~C. Wojciechowski Witness ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS I, Vincent C. Wojciechowski, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to the 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 voluntary act for the purposes therein expressed. Vincent C~. Wojciechowski Sworn or affirmed and acknowledged before me by Vincent C. Wojciechowski the Testator, this/6,'~ day of ./a/~aarc/ , 2003 Notary Public I ~OTA~ilA[ SEAl. [0/~*[!~ !'~.: ~'~,,~,.,i r~,~ i~/UPHIN COUNTY " .............. '~i.sgo~. 3, 2ooa AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND whose names are attac~ed to the S.S. and ~C[~.~ ~,). '~ n r~ ;c~, the witnesses foregoing document, being duly qualified according to the law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that he signed it willingly and that he 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 Last Will and Testament as witnesses and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed and subscribed before me ~t,._h,). ~r~r~i~ this/~ day of .Ja/?aorc[ 2003. Notary Public NOTARIAL sF-'N' ' £o~vhx P/~ITON 1~. ~UPltlI~ ~ MY COMMISSION EX~IRES NOV. 3, 2003 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF ZNDIV/DUAL TAXES DEPT. ZB0601 HARRISBURG, PA 171Z&-0601 REV-25~iS EX AFP (09-DO) VERONICA C WOJCIECHOWSKI 58q G ST CARLISLE PA 17015 ZNFORHATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. Z1 05-0217 ACN 05116962 DATE 0q-25-2005 TYPE OF ACCOUNT EST. OF VINCENT C NOJCIECHONSKI [] SAVINGS S.S. NO. 186-6q-5955 [] CHECKING DATE OF DEATH 05-02-2005 [] TRUST COUNTY CUMBERLAND [] CERTTF. REMIT PAYMENT AND FORMS TO: REGTSTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PPG & ASSOCS FCU has provided the Department mith the information listed below which has been used in calculating t~na potential tax due. Their records indicate that at the death of the above decedent, you Nero a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth cf Pennsylvania. Questions may be answered by calling [717) 787-B3ZT. COMPLETE PART I BELON # x x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 68ql Data 07-Z5-198q Established Account Balance 511.75 Percent Taxable X 50.000 Amount Subject to Tax Z55.87 Tax Rate X .Oq5 Potential Tax Due 11.51 To insure proper credit to your account, ted (Z) copies of this notice suet accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax payments ara made within three (3) months of the decadsnt's date of death, you may deduct a 5g discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE I. ~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills aith two copies of this notice to obtain a discount or avoid interest, or you say check box "A" and return this notice to the Register of  CHECK -~ Hills and an official assessment mill be issued by the PA Department of Revenue. ONE BLOCK J S. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the dscadent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must comp[eta PART [] and/or PART [] below. If you indicate a different tax ratej please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Date Established I PART TAX LINE 2. Account Balance 2 $. Percent Taxable $ X q. Amount Subject to Tax q $. Debts and Deductions S - 6. Amount Taxable 6 7. Tax Rate 7 X B. Tax Due 8 PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAZMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line S of Tax Computation) c m~p~Under penalties of parSuryj/['dacler9 that the ate, to the bes,,'imof my kn~edga and/~aliaf./ 'TAXPAYER 'SIGNATURE /~ ~ facts T have reported above are true, correct And NORK ( ) TELEPHONE NUMBER DATE GENERAL INFORHATION 1. FAILURE TO RESPOND #lLL RESULT 1N AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedsnt's name was added as a matter of convenience. q. Accounts (including those held between husband and mile) which the decedent put in joint names within one year prior to death ore fully taxable as transfers. 5. Accounts established jointly between husband and Hire more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign tea copies and submit them eith your check for the amount of tax to the Register of Nills of tho county indicated. The PA Department of Revenue ail1 issue an official assessment (Form REV-15q8 EX) upon receipt of the return from tho Register of NiLls. 2. BLOCK B - If the asset specified on this notice has been or mill bm reported and tax paid with the Pennsylvania Inheritance Tax Return filed by tho dscodent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept Z80601, Harrisburg, PA ITiZB-0601 in the envelope provided. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and $ according to tho instructions baloe. Sign tee copies and submit them mith your chock for tho amount of tax payable to the Register of Nills of the county indicated. The PA Department of Revenue ail1 issue an official assossosnt (Fora REV-15~8 EX) upon receipt of the return from the Register of ~/ills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For o decedent dying after 1Z/Il/aZ: Accounts which the decedent put in joint names aithin one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $$,000 per transferee regardless of the value of the account or tho number of accounts held. If a double asterisk (ax) appears before your first name in the address portion of this notice, the $$,000 exclusion already has been deducted free the account balance os reported by the financial institution. Z. Enter the total balance of tho account including interest accrued to the date of death. 5. The percent of tho account that is taxable for each survivor is determined as folloas: A. The percent taxable for joint assets established more than one year prior to the decedsnt's death: 1 DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUNBER OF X 100 PERCENT TAXABLE JOINT ONNERS SURVIVING JOINT OHNERS Example: A joint asset registered in the name of the decadent and tad other persons. 1 DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the docedent's death or accounts awned by the decedent but hold in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARTES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. I DZVIDEO BY Z (SURVIVORS) = .SO X lO0 = SOl (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (Iine ~) is determined by multiplying the account balance (line 2) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (Zinc 7) as determined balsa. Date of Death Spouse Lineal Sibling Collateral 07/01/9q to 12/$1/9q iX 6Z 15Z liX 01/01/95 to 06/30/00 OX 6Z 07/01/00 to present OZ q.SZa 12Z 15Z eThe tax rata imposed on tho net value of transfers from a deceased child twenty-one years of ego or younger at death to or for the usa of a natural parent, an adoptive parent, or a stepparent of the child ]s The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ahethar or not they have been adopted by others, adopted children and step children. '"Lineal descendents" includes all children of the natural parents and their descendents, ehether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals mhD have at least one parent in common with the decedent, ahather by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as folloas: A. You legaIly are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid tho debts after death of tho decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. 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. REV-1162 EX(11-96) CD 002506 WOJCIECHOWSKI VERONICA C 584 "G" STREET CARLISLE, PA 17013 fold 'ESTATE INFORMATION: SSN: 186-64-3953 FILE NUMBER: 2103-021 7 DECEDENT NAME: WOJCIECHOWSKI VINCENT C DATE OF PAYMENT: 04/28/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 03/02/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03116962 $10.54 TOTAL AMOUNT PAID: 910.54 REMARKS: VERONICA C WOJCIECHOWSKI SEAL CHECK# 2620 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 R'EV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFiCiAL USE ONLY FILE NUMBER COUNTY CODE YEAR NUMBER I-- Z LU C~ U.I LU C~ 0 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Wojciechowski, Vincent C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 03/02/03 12/31/68 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Wojciechowski, Catherine N. SOCIAL SECURITY NUMBER 1 86-64-3953 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~1. Original Return 4. Limited Estate ~-~6. Decedent Died Testate (Attad~ copy of Wifl) 9. Litigation Proceeds Received NAME Catherine N. Wojciechowski FIRM NAME (If Applicable) TELEPHONE NUMBER (717) 249-9083 2. Supplemental Return [] 3. Remainder Return (da~e of death prior to 12-13-82) [] 4a. Future Interest Compromise (da~e of death aria' 12-12-821[] 5, Federal Estate Tax Return Required [] 7. Decedent Maintained a Living Trust (^~ch copy of Trust) ._~ 8, Total Number of Safe Deposit Boxes O10. Spousal Poverty Credit (da~ of death be~w~ 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (A~ch Sch O) COMPLETE MAILING ADDRESS 462 Franklin Street Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 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) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. Charitable and Governmental Beques~Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 0.00 f:y, 255.86 "~ 0.00 (8) 25,755.86 8,270.00 54,287.74 (11) 62,557.74 (12) -36,801.88 (13) 0.00 (14) -36,801.88 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or kansfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0.00 x .0 0 (15) 0.00 0.00 x .0 45 (16) 0.00 x .12 (17) x .15 (18) (19) 0.00 20. [] Decedent's Complete Address: STREET ADDRESS 462 Franklin Street ClTYCarlisle J STATEpa I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.O0 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments O.00 C. Discount 0.00 Total Credits ( A * B * C ) (2) O.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 Total Interest/Penalty ( D + E ) (3) O.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) O.OO B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS IF THE ANSWER 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? ...................................................................... [] [] If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] 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. DATE SIGNATJJI~E OF PERSON RESPONSIBLE FOR FILING RETURN SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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 (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 0% [72 RS. §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 4.5%, except as noted in 72 P.S. §9116(1.2) [72 RS. §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 RS. {}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-1502 EX+ (6-98,~, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Vincent C. Wojciechowski All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None 0.00 TOTAL (Also enter on line 1, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vincent C. Wojciechowski SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None 0.00 TOTAL (Also enter on line 2, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (6-98~_~ '~' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vincent C. Wojciechowski SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None 0.00 TOTAL (Also enter on line 3, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vincent C. Wojciechowski SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER ~ ~- o'~ - oo~ i r'"1 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH None 0.00 TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT E,~¥ATE OF Vincent C. Wojciechowski SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1994 Toyota SR5 Pick-up Truck 1995 Toyota Camry 2000 Harley Davidson Motorcycle 6,500.00 3,000.00 16,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 25,500.00 (If more space is needed, insert additional sheets of the same size) REV-1S09 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Vincent C. Wojciechowski 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. Veronica C. Wojciechowski JOINTLY-OWNED PROPERTY: 584 G Street, Carlisle, PA 17013 Mother LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINTMADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATI'ACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 7-25-198~1 PPG Associates Federal Credit Union 511.73 50% 255.8t 101 Bailies Run Road Creighton, PA 15030 Account # 6841 TOTAL (Also enter on line 6, Recapitulation)$ 255.81 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vincent C. Wojciechowski SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 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, THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATFACHACOPYOF?HEDEEDFORREALESTATE. VALUE OFASSET INTEREST (IFAPPUCABLE) VALUE 1. 401 (k) Retirement Account - Team Rahal of Mechanicsburg- 13,192.00 100% C O.C (Not transfered prior to death - Decedent never received disbursements from account and Spouse is beneficiary) 2. Fidelity Advisory Roth IRA 5,129.28 100% C 0.0 (Not transfered prior to death - Decedent never received disbursements from account as he was only 34 years old at the date of death - Spouse is beneficiary) TOTAL (Also enter on line 7 Recapitulation) $ 0.0 {If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (12~99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vincent C. Wojciechowski SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ITEM NUMBER 5. 6. 7. Debts of decedent must be reported on Schedule 1. DESCRIPTION FUNERAL EXPENSES: Ewing Brothers Funeral Home Hanover Street Carlisle, PA 17013 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Catherine N. Wojciechowski Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address 462 Franklin Street City Carlisle State Pa Year(s) Commission Paid: n/a Attorney Fees Family Exemption: (If decedent's address is not the same as daimanrs, attach explanation) Claimant Zip 17013 Street Address city Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees State __ Zip AMOUNT $8,000.00 0.00 270.00 0.00 0.00 TOTAL (Also enter on line 9, Recapitulation $ 8,270.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vincent C. Wojciechowski SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Washington Mutual Home Loan - Mortagage on property located at 462 Franklin Street, Carlisle PA 17013 54287.74 TOTAL (Also enter on line 10, Recapitulation) $ 54,287.74 (If more space is needed, insert additional sheets of the same size) REV-I§13 EX+ (900) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vincent C. Wojciechowski SCHEDULE J BENEFICIARIES FILE NUMBER e I- RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [include outfight spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Catherine N. Wojciechowski 462 Franklin Street Carlisle, PA 17013 Spouse 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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) VINCENT C. WOJCIECHOWSKI I, Vincent Carl Wojciechowski, of Carlisle, Cumberland County, Pennsylvania, being of sound and deposing mind, memory and understanding, do make publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, taxes that may be assessed in consequence of my death, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. SECOND I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate to my beloved spouse, Catherine N. Wojeieehowsid, providing that she survives me by sixty (60) days. THIRD In the event that Catherine N. Wojciechowski, predeceases me or dies on or before the sixtieth (60th) day following my death, then I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate to my beloved parents, Vernon C. Wojciechowski, Sr. and Veronica C. Wojciechowski, and to my beloved brother Vernon C. Wojciechowski, II, who survive me by sixty (60) days. The estate shall be divided so that my beloved parents receive seventy-five percent (75%) of the entire estate and my beloved brother receives twenty-five percent (25%). FOURTH In the event that Catherine N. Wojciechowski, Vernon C. Wojciechowski, Sr. and Veronica C. Wojciechowski, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate to my beloved brother Vernon C. Wojciechowski, II, providing he survives me by sixty (60) days. FIFTH In the event that Catherine N. Wojciechowski, Vernon C. Wojciechowski, Sr., Veronica C. Wojciechowski and Vernon C. Wojciechowski, II, predecease me or die on or before the sixtieth (60th) day, I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wherever situate in shares of seventy-five percent (75%) to Mayo Clinic Jacksonville, Florida, to be used in connection with research and treatment of sarcoma and of twenty-five percent (25%) to Pinnacle Health Hospice. SIXTH My executor and trustee are authorized and empowered to exercise from time to time in his, her or its sole discretion and without prior authority from any Court, with respect to any property forming part of any trust hereby created or otherwise in its possession hereunder all powers conferred by law upon trustees or executors and the testator intends that such powers be construed in the broadest possible manner. SEVENTH I nominate, constitute and appoint my spouse, Catherine N. Wojciechowski, of Carlisle, Cumberland County, Pennsylvania, Executrix of this, my Last Will and Testament. In the event Catherine N. Wojciechowski is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint Carol L. Cingranelli, to serve instead. I direct that my personal representative shall not be required to give or post bond for the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this~_~..ay of ~~,¢~' , 2003. Witnes~ / ' Vincen(C. Wojciechowski Witness CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Vincent C. Wojciechowski a/k/a Vincent Carl Wojciechowski Date of Death:March 2, 2003 Will No. 2003-00217 Admin. No. 21-03-0217 To the Register: 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 above-captioned estate on June 30, 2003 : Name Ad&ess Catherine N. Wojciechowski. 462 Franklin Street, Carlisle, PA 17013 Veronica C. Wojciechowski, 584 G Street~ Carlisle, PA 17013 Vernon C. Wojciechowski, 584 G Street, Carlisle, PA 17013 Vernon C. Wojciechowski, II 38 Furnace Hollow Road, Shippensburg~ PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: July 1, POOR Signature Name Catherine N. Wojciechowski Address 462 Franklin Street C. mwl'~al~, PA 1 7f~1 3 Telephone(71~ 249-9083 Capacity: X __ Personal Representative Counsel for personal representative BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DIVTSTOH DEPT. 280601 HARRTSBUR~, PA 171Z&-060! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF ZNHERXTANCE TAX APPRAXSEHENT, ALLOWANCE OR DXSALLONANCE OF DEDUCTTONS, AND ASSESSHENT OF TAX ON R~.,.JO.~NTLZ .HELD O~ TRUST ASSETS ['~ :~' ~' DATE 07-07-2003 ESTATE OF NOJCZECHOWSKZ VINCENT C DATE OF DEATH 03-02-2003 '03~L!L ........ _-~ ~ FILE NUMBER 21 03-0217 *.OOUNTY CUMBERLAND SSN/DC 186-64-3953 ACN 03116962 Amoun~ Remi~{ed HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 VERONICA C WOJCIECHOWSKI 584 G ST ~.,' CARLISLE PA 1701~~ REV-1S48 EX AFP (01-05) CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS DATE 07-07-2003 ESTATE OF NOJCIECHOWSKI VINCENT C DATE OF DEATH 03-02-2003 COUNTY CUMBERLAND FILE NO. 21 03-0Z17 S.S/D.C. NO. 186-64-$955 ACN 0311696Z TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED dOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PPG & ASSOCS FCU ACCOUNT NO. 6841 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ¢ ) TRUST ¢ ) TIHE CERTIFICATE DATE ESTABLISHED 07-25-1984 Accoun~ Balance 511.73 Percen~ Taxable X 0.500 Amoun~ Sub~ec~ to Tax 255.87 Debts and Deductions - .00 Taxable Amoun~ 255.87 Tax Ra~e Tax Due 11.51 TAX CREDITS= NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 04-28-2003 CD002506 .55 10.54 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE TF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDI'TIOHAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT TS REQUIRED. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORM FOR INSTRUCTIONS. ) 11.09 .00 .4Z PURPOSE OF HOT,CE: To ~uifill the requirements of Section Z14O of the Inheritance and Estate Tax Act; Act Z$ of ZOO0. (71 P.S. Section 91qO). PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit eith your payment to the Ragistar of Mills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the tax return; may be requested by completing an "Application for Refund of Pennsylvania Inheritance end Estate Tax" (REV-1513). Applications ara available at the Office of the Register of Nills; any of the 13 Revenue District Offices or by calling the special Iq-hour answering service for fores ordering: 1-800-362-Z050; services for taxpayers with special hearing and or speaking needs: 1-BO0-qq7-30ZO (TT only). Any party in interest not satisfied aith the appraisement; allowance, or disalloaanca of deductions or assessment of tax (including discount or interest) as sheen on this Notice may abject within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals; Dept. 181011; Harrisburg; PA 17118-1011; OR --electing to have the matter determined at the audit of the account of the personal representative; OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes; ATTN: Post Assessment Raviea Unit, DEPT. 280601; Harrisburg; PA 17liB-060! Phone (717) 787-6505. See page 5 of the booktat "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death; a five percent (SI) discount of the tax paid is alloaed. The 151 tax amnesty non-participation penalty is computed on the tote1 of the tax and interest assessed; and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has bean assessed as indicated on this notice. Interest is charged beginning with first day of delinquency; or nine (93 months and one (1) day from the date of death; to the date of payment. Taxes which became detinquant before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .00016&. All taxes which beca~a delinquent on or after January I, 1961 will bear interest at a rate which will vary calendar year to calendar year with that rata announced by the PA Department of Revenue. The applicable interest rates for 1981 through 2003 ere: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .O00S&8 1987 9Z .O00Zq7 1999 71 .O00lgZ 1983 161 .OOOq38 1988-1991 11Z .000301 ZOO0 81 .000219 198q llZ .000301 1992 92 .0001~7 ZOO1 92 .0002~7 1985 132 .000556 1993-1996 72 .000191 2002 62 .00016~ 1986 102 .O00Z7q 1995-1998 9Z .000147 2003 52 .000137 --Interest is calculated as follows: 'rNTEREST = BALANCE OF TAX UNPA.rD X NUHBER OF DAYS DELTNQUENT X DA.fEY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fiftaan (15) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on tho Notice; additional interest must ba calculated. BUREAU OF ZNDIVTDUAL TAXES TNHERTTANCE TAX DZVTSZON DEPT; Z80601 HARRTSBURG., PA 17128-0601 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOT/CE OF INHER/TANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOgANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-1647 EX &FP JUL CATHERTNE N NOJCTECHONS'KT ~,6~ FRANKLTN ST CARLI'SLE PA All BATE 07-1q-2005 ESTATE OF NOJCIECHONSKI BATE OF BEATH 03-02-2005 FILE NUMBER 21 03-0217 COUNTY CUHBERLAND ACN 101 I Amoun~ Remi~ed VZNCENT C HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR BZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF NOdCIECHONSKI VINCENT C FZLE NO. 21 03-0217 ACN 101 BATE TAX RETURN gAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE ZNTEREST- SEE REVERSE APPRA/SED VALUE OF RETURN BASED ON: ORTGTNAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Tnterest (Schedule C) (3) ~. Mortgages/Notes Receivable (Schedule D) .6. Cash/Bank Deposits/M/sc. Personal Property (Schedule E) (S) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. TotmZ Assets APPROVED BEDUCTZONS AND EXEHPTTONS: 9. Funeral Expanses/Ada. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return Z5~500.00 .00 .00 NOTE: To insure proper .00 credit to your account, .00 subeit the upper portion .00 of this fore with your tax payment. .00 (8) 8,270.00 5R,287.7~ (11) (12) 25,500.00 62.5~7.7q 37,057.7~- 15. 1~. NOTE: Charitable/Governmental Bequests; Non-elected 911:3 Trusts (Schedule J) (13) Net Value of Estate Subject to Tax (1~) Zf an assessment .as issued previously, 11nas 1~, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. .00 ASSESSHENT OF TAX: 15. Amount of Line Zq at Spousal rata 16. Aeount of Line 1~ taxable at Lineal/Class A rata 17. Aeount of Line lq at Stbling rata 18. Aaount of Line lq taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYHENT RECEZP1 DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 37,057.7q- 18 and 19 will (1~) .00 x O0 = .00 (16), .00 X Oq5 = .00 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= . O0 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE ~NTEREST AND PEN. TOTAL DUE ,00 ,00 .00 .00 ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decadents dying on or before December 11, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class 8 (cottataral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CA): OBJECTIONS: ADNZN- ISTRATIVE CORRECTIOHS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Sac[ion Z1~0 of the Inheritance and Estate Tax Act, Act 15 of 2000. (71 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Rog[star of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF RILLS, AGENT A refund of a tax credit, ah[ch was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of Hills, any of the ZS Revenue District Offices, or by calling the special Z~-hour answering service for forms ordering: 1-800-562-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~q7-5010 iTT only). Any party in interest not satisfied with the appraisement, allowance, or disalloaanca of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 181021, Harrisburg, PA 17128-1011, OR --election to have the aa[tar determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Dapartd. ent of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Ray[ss Un[t, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decadent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedant's death, a five percent CSX) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and in[aras[ assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty par[od. This non-participation penalty is appealable tn the same manner and in the the same time period as you ~ould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through 2003 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1981 lOX .0005~8 1987 91 .0002&7 1999 7Z .000191 1985 161 .000~58 1988-1991 111 .000501 2000 81 .000119 198~ 111 .OOOSOl 1991 9Z .0002q7 ZOOX 91 .0002~7 1985 132 .000556 1995-199~ 72 .000192 2002 61 .00016~ 1986 lOX .00027q 1995-1998 92 .O00Zq7 ZOOS 51 .000157 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPA/D X NUMBER OF DAYS DEL/N~UENT X DA/LY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent ail1 reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. REV-1470 EX 15-88) ,~ INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT"S NAME FILE NUMBER VINCENT C WOJCIECHOWSKI 2103-0217 REVIEVVED BY ACN John Kealy 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the jointly held asset is being stricken from the assessment of this return since it was previously assessed on 717/03 under ACN 031116962. ROW Page 1 BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DZVZS/ON DEPT. Z80601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTXCE OF /NHERXTANCE TAX APPRA/SEHENT, ALLOHANCE OR DXSALLONANCE OF DEDUCTXONS, AND ASSESSHENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS RE¥-1548 EX AFP (01-05) VERONICA C WOJCI~"CHO#SI(?-" 58~ G ST CARLISLE ',PA 17015 DATE 07-07-2005 ESTATE OF WOJCIECHOWSKI VINCENT DATE OF DEATH 05-0Z-Z005 PILE NUMBER 21 05-0217 COUNTY CUHBERLAND SSN/DC 186-6q-$955 ACN 0511696Z Amoun~ Rem/~ed HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 C CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-07-2005 ESTATE OF WOJCIECHOWSKI VINCENT C DATE OF DEATH 05-02-Z005 COUNTY CUHBERLAND FILE NO. 21 05-0217 S.S/D.C. NO. 186-6q-$955 ACN 031Z6962 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET ZNFORHATZON FINANCIAL INSTITUTION: PPG & ASSOCS FCU ACCOUNT NO. 68~! TYPE OF ACCOUNT: (~ SAVINGS ¢ ) CHECKING ( ) TRUST ( ) TZHE CERTIFICATE DATE ESTABLISHED 07-Z5-198~ Account Balance 511.75 Percent Taxable X 0.500 Amount Subject to Tax 255.87 Debts and Deductions - .00 Taxable Amount 255.87 Tax Rate X .~5 Tax Due 11.51 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT."' PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID Oq-Z8-2005 CD002506 .55 lO.5q ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 11.09 .q2 .00 .q2 PURPOSE OF NOT[CE: To fulfill the requirements of Section ZXqO of the Xnheritanca end Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CR): OBJECTZONS: ADH/N- ZSTRAT/VE CORRECTZONS: DISCOUNT: PENALTY: ZNTEREST: A refund of a tax credit, which ems not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special Z4-hour ans~aring service for forms ordering: 1-800-56Z-Z050; services for taxpayers eith special hearing and or speaking needs: 1-800-447-50Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as sheen on this Notics may object within sixty (60) days of receipt of this Notice by: --aritten protest rathe PA Deportment of Revenue, Board of Appeals, Dept. ZD1021, Harrisburg, PA 17118-1011, OR --mlectlng to have the matter determined at the audit of the account of the personal representative, OR --appeal to tho Orphans' Court Factual errors discovered on this essesmaent should be addressmd in Hriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. ZB0601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Znharitance Tax Return for e Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid eithin three (3) calendar months after the decadent's death, a five percent (51) discount of the tax paid is alloesd. Thm 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the s~me manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eJth first day of delinquency, or nine (9) months and one (1) day from the date of death, to tho date of payment. Taxes which became delinquent before January l, 1981 bear interest at the rate of six (61) percent per annum calculated at m daily rata of .000164. All taxes which became delinquent on or after January 1, 198Z will bear interest et e rate ~hich ~il1 vary from calendar year to calendar year .ith that rate announced by the PA interest rates for 19aZ through Z005 are: Interest Daily Year Rate Factor 1981 ZOZ .000548 1983 161 .000438 1984 llZ .000301 1985 15Z .000356 1986 101 .000Z74 Department of Revenue. The applicable Interest Daily Interest Daily Year Rata Factor Year Rate Factor 1987 91 .000247 1999 71 .000191 1988-1991 llZ .000301 Z000 8X .000119 1992 91 .000147 Z001 91 .000147 1993-1994 72 .OOO19Z ZOOZ 61 .000164 1995-1998 9X .000247 2003 SZ .000157 --Znterest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DATLY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent ~ill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the Notice, additional interest must be calculated. Catherine N. Wojciechowski 2339 N. 2nd Street Harrisburg, PA 17110 (717) 385-0608 April 20, 2004 Glenda Famer Strasbaugh Register of Wills & Clerk of Orphans Court Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Status Report Estate of Vincent C. Wojciechowski Dear Ms. Strasbaugh: Enclosed for filing please find the Status Report Under 6.12 I p~ared with respect to the Estate of Vincent C. Wojciechowski, a.k.a. Vi_.~cent Carl Wojciechowski - Estate No: 21-03-217. Please be advised that the administration of the Estate is complete. Pursuant to the Last Will and Testament of Vincent, dated January 16, 2003, his entire Estate was devised and bequeathed to me, Catherine N. Wojciechowski, as his spouse. The Last Will and Testament provides for no further distribution. Accordingly, no further administration is required. In addition, please be advised that all known claims against the Estate have been paid in full; to my knowledge there are no claims now outstanding against the Estate; and all taxes due from the Estate have been paid in full. As a further matter, please note that my address has changed. Therefore, please direct any furore correspondence to the address listed above. Thank you for your time and attention. Please contact me if you have any questions or require additional information. Sijacerely, Catherine N. Wojciechowski STATUS REPORT UNDER 6.12 Name of Decedent: Vincent C. Wojciechowski, a.k.a. Vincent Carl Wojciechowski Date of Death: March 2, 2003 Will No. 2003-00217 PA No. 21-03-0217 Pursuant to Rule 6.12 of the Supreme Court Orphan's Court Rules, I report the following with respect to completion of the administration of the above- captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Not applicable o If the answer to No. 1 is Yes, state the following: a) Did the personal representative file a final account with the Court? Yes No X b) The separate Orphan's Court No. (if any) for the personal representative's account is: Not applicable c) Did the personal representative state an account informally to the parties in interest? Yes X No Date: April 20, 2004 Signature Catherine N. Wojc~echows~, c5 Executrix/Personal Repres 'e~thtive 2339 N. 2nd Street Harrisburg, PA 17110 (717) 385-0608 -'