HomeMy WebLinkAbout02-0821
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Deceased.
No. 2.\-02.-82\
To:
Register of Wills for the
County of Cumber 1 and in the
Commonwealth of Pennsylvania
Estate of GAIL A. CARCHIDI
also known as
Social Security No. 190-50-7437
The petition of the undersigned respectfully represents that:
Your petitioner~), who is/ltitl<l8 years of age or older, appl i es
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentIa; durante minoritate)
the above decedent.
Decendent was domiciled at death in Cumberl and _ County, Pennsylvania, with
her lastfamilyorprincipalresidenceat 2905 Glenwood Rd" Lower Allen TW)).
(list street, number and municipality)
Decendent, then 43 years of age, died
at 2905 Glenwood Rd., Camp Hill. PA
July 24
,lQ< 200:>
Decendent at death owned property with estimated values as folllows:
(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:
$-.3. 0 l:lO.
$
$
$
cu
<..--
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
f
r
r
Penns lvania
P nn lvania
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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\ 'i- -R+ - 10
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} 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 petltioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and. subscribed f x R~~ jj ~~
before me this 11 t~__ day of
SEPTEMBER 2uv2 ~
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No.
21-02-821
Estate of
GAIL A. CARCHIDI
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW SEPTEMBER 11. 2007 x~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
lT IS DECREED that Peter E. Goldstrom
is/ are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Peter E. Goldstrom
in the estate of Gail E. Carchidi
FEES
Letters of Administration ..... $
Short Certificates( ).......... $
Renunciation ................ $
jcp $
TOTAL _ $
Filed ....9.7.1.1:-.49.Q?.... A.D. 19_
mailed to atty 9-12-2002
25.00
18.00
15.00
~a ~8o
William L. Grubb, E~q.
ATTORNEY (Sup. Ct. J.D. No.)
3105 Old Gettysburg Rd.
ADDRESS
Camp Hill, PA 17011
72661
PHONE
(717) 763-5580
RENUNCIA nON
~, - O~ -'i?".~...I
Gail A. Carchidi
deceased.
In Re Estate of
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Anne R. Golastrom, mother
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Peter E. Goldstrom
WITNESS
r...'j
'j'\ S
hand this ~ day of ...yie...l~ , ~ 200?
~
~ I! j;; t>f;.~;t;;~
(Signature) "
Anne R. Goldstrom
(Address)
2905 Glenwood Rd.
Camp Hill, PA 17011
(Signature)
(Address)
(Signature)
(Address)
RENUNCIATION
:21-0~~ ?.;)..../
In ReEstate of Gail A. Carchidi
deceased.
To the Register of Wills of Cumbe r 1 and
County, Pennsylvania.
The undersigned Stephen R. Carchidi, guardian of Branden Carchidi, son of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Peter E. Goldstrom
WITNESS
my
hand this .~O-/!:J day of
(Signature)
Stephen R. Carchidi, as guardian
of the minor child Branden Carchidi
(Addr.ss)
(Signature)
(Address)
(Signature)
(Address}
RENUNCIATION
..21 - o~- <g--~l
In Re Estate of
Gail A. Carchidi
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Adam Carchidi, son
of
the above decedent, hereby renounce(s} the right to administer the estate and respectfully ask(s} that Letters
of Administration
be issued to
Peter E. Goldstrom
WITNESS
my
hand this Fllt.,1 day of7~~, 19< 2002
tJ~ C~~J~
(Signature)
Adam Carchidi
197 Cc:.:f6t"A#-Il De, llEkArV{ HIt, '-
(Addr.")Cfr 9'(5"2..s
(Signature)
(Address)
(Signature)
(Address)
JRDlJune 30, 1992/1 7858
In Re: Estate of GAIL A CARCHIDI
Late of LOWER ALLEN TOWNSHIP
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.: 21-02-821
NO. 21-02-821
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: PETER E GOLDSTROM
Counsel for Personal Representative: WILLIAM L GRUBB
Date of Grant of Original Letters: 09-11-2002
Date of Delinquency Notice: 12-21-2002
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above nanled counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on DECEMBER 21,2002, and that
the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule
5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court
conduct a hearing to determine whether sanctions should be imposed upon the delinquent
personal representative or counsel for the delinquent personal representative.
Date: 01-02-2003
~~\\b~~(PQ~~
.. . ~ T "i, Register 0 W' s
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for cJ-tV-63 at 9';304.P1.InCourtroomNo.3. Ifthe
Certification of Notice is filed prior to the hearing date, the hearin will automatically be
cancelled.
cR
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
GAIL A. CARCHIDI
Date of Death:
July 24, 2002
Will No.
Admin. No.
21-02-821
To the Register:
! certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' COUl1 Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 9/2/ /02 :
Name
Address
Adam D. Carchidf
197 Cleopatra Dr., Plea~ant Hill, CA 94523
Branden R. Carchidi
2818 Harris Dr., Antioch, CA 94509
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
February 3. 2003
LJ~~~ .~
Signature
Name Wi 11 i am l. Grubb, Esq.
Address 3105 Gettysburg Rd.
Camp Hill, PA 17011
Telephone (717) 763 - 5 580
Capacity: ~ Personal Representative
~Counsel for personal representative
IN RE: · IN THE COURT OF COMMON PLEAS OF
· CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
GAlL A. CARCHIDI - ORPHANS COURT DIVISION
DECEASED
No. 2002 - 00821
STATUS REPORT UNDER RULE 6.12
Name of Decedent: GAIL A. CARCHIDI
Date of Death: 7/24/2002
Will No. Admin, No. 21-02 - 00821
Pursuant to Rule 6.12 of the Supreme Court Orphans' 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 XX No __
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:
3. Ift" e answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court? Yes No XX
b. The separate Orphans' Court No. (if any) for the personal representative's account is:
c. Did the personal representative state an account informally to the parties in interest?
Yes XX No.
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this report.
Date[]P [/~ -~~ir -o~ '
2905 Glenwood Road
~"~ Camp Hill, PA 17011
~. (717) 761-1821
-.::-:~: Capacity:_ XX Personal Representative
.: '55 Counsel for personal representative
CONNONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE
ZNHER/TANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DISALLOWANCE
OF DEDUCT/ONS AND ASSESSHENT OF TAX REV-~S47EXAFP~O~-OS~
R~L,:~: DATE Oq-19-ZOOq
i-i~i. ESTATE OF CARCHIDI GAIL A
DATE OF DEATH 07-2q-2002
FILE NUNBER 21 02-0821
WILLIAM L GRUBB ESQ '04 APR 20 f!ll .?~COUNTY CUMBERLAND
'~ °ACN 101
$805 GETTYSBURG RD Amoun~ Remi~ed
CAMP HILL PA 17Q,~
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-15~7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF CARCHIDI GAIL A FILE NO. 21 02-0821 ACN 101 DATE Oq-19-200q
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Es~e~e (Schedule A) (1) O0 NOTE: To insure proper
2. S~ocks and Bonds (Schedule B) (2) O0 credi~ ~o your account,
$. Closely Held S~ock/Par~nership In~eres~ (Schedule C) ($) O0 subai~ ~he upper por*1on
~. Not,gages/No,es Receivable (Schedule D) (q) O0 of ~his fora wi*h your
5. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) (S) 9/0q$.51 ~ax payment.
6. Jointly O~med Proper~y (Schedule F) (6) ZI800.O0
7. Transfers (Schedule G) (7) O0
8. Tote1 Assets (8) 11,815.51
APPROVED DEDUCTIONS AND EXENPTIONS: $,626.96
9. Funeral Expensas/Adm. Costs/Nisc. Expanses (Schedule H) (9)
10, Debts/Hot,gage Liabilities/Liens (Schedule Z) (10) I;$60.09
11. Tote1 Deductions (11) 7.987.05
12. Nat Value of Tax Return (12) $,856.t6
15. Charitable/Governaentel Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00
1fi. Ne~ Value of Es*ate Subjec~ ~o Tax (1~) $,856.~6
NOTE: Z~ an assessment .as Assued prev$ously, lines 1~, 15 and/or 16, 17, 18 and 19
refZect fSgures that AncZude the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Aaoun~ of Line 1~ a~ Spousal ra~e (15). .00 X O0 = .00
16. Aaoun~ of Line 1~ ~axable a~ Lineal/Class A ra~e (16). $,856.q6 x 0~5: 175.5~
17. Aaoun~ of Line lq a~ Sibling ra~e (~7). .00 X 1Z = .00
18. Amount of Line 1~ iaxeble at Collateral/Class B rate (18). .00 X 15 = .00
19. Principal Tax Due (19)= 175.5~
TAX CREDZTS
PAYHENT RECEIPT DISCOUNT (+)
AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
O$-01-aOOi CD005618 7.15- 180.71
TOTAL TAX CREDIT I 173.58
BALANCE OF TAX DUE .O~CR
INTEREST AND PEN. . O0
TOTAL DUE . O~CR
IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE 1S LESS THAN $1, NO PAYHENT IS REgUIRED.
FOR CALCULATION OF ADDZTTONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DU~
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)/~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,2B0601
HARRISBURG, PA 1712B-0601
REV-, '62 EX(' '-96l
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GRUBB WilLIAM l
3105 OLD GETTYSBURG ROAD
CAMP Hill, PA 17011
__n_n_ fold
ESTATE INFORMATION: SSN: 190-50-7437
FILE NUMBER: 2102-0821
DECEDENT NAME: CARCHIDI GAil A
DATE OF PAYMENT: 03/01/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/24/2002
NO. CD 003618
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $180.71
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: PETER E GOlDSTROM,EXEC
WilLIAM l GRUBB, ESQ
CHECK# 16
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$180.71
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
IN RE: · IN THE COURT OF COMMON PLEAS OF
· CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
GAlL A. CARCHIDI · ORPHANS COURT DIVISION
DECEASED
No. 2002 - 00821
STATUS REPORT UNDER RULE 6.12
Name of Decedent: GAlL A. CARCHIDI
Date of Death: 7/24/2002
Will No. Admin. No. 2002 - 00821 9
Pursuit to Rule 6.12 of the Supreme Cou~ Ochans' Court Rules, I repo~
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: Yes~ No XX
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete: September, 2004
3. If the ~swer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the CouP? Yes No~
b. The separate Ochans' Cou~ No. (if any) for the personal representative's account is:
c. Did the personal representative state an account info,ally to the pa~ies in interest?
Yes No.
d. Copies of receipts, releases, j oinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to~ [ep~.
William L. Gmbb, Esquire
3803 Gettysburg Road
Camp Hill, PA 17011
(717) 763-5580
Capacity: Personal Representative
,~ Counsel for personal representative
IN RE: : IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF :
GAIL A. CARCHIDI ORPHANS COURT DIVISION
DECEASED
No. 21 - 2002- 00821
PETITION UNDER SECTION 3102 OF THE
PROBATE, ESTATES AND FIDUCIARIES CODE
FOR SETTLEMENT OF SMALL ESTATE
TO THE HONORABLE, THE JUDGE OF SAID COURT:
Your Petitioner, Peter E. Goldstrom, Executor, by and through his attorney,
William L. Grubb, Esquire, files this Petition for Settlement of a Small Estate under the
provisions of Section 3102 of the Probate, Estates and Fiduciaries Code and in support
avers that:
1. Your Petitioner, Peter E. Goldstrom, is an adult irl~igidual, sui JUr!s~
residing at 2095 Glenwood Road, Camp Hill, Pennsylvania, and is t~hefathel,,~f'~ abo~e'
named decedent. :: ~
2. Gail A. Carchidi, daughter of your Petitioner, died on July 24, 2002, at the
age of 44 years, and prior thereto lived and was domiciled at 2095 Glenwood Road,
Camp Hill, Pennsylvania.
3. At the time of her death, the decedent formed a part of the household of
your Petitioner, Peter E. Goldstrom.
4. The decedent died intestate and Letters Testamentary have been granted by
the Register of Wills of Cumberland County to your Petitioner, Peter E. Goldstrom.
5. The decedent had no spouse at the time of her death and under Pa.C.S
§2103 her heirs are her two sons, Adam D. Carchidi and Branden R. Carchidi.
6. The decedent had no probate estate when she died other than the
following:
PNC checking $1,493.18
Health insurance refund $ 691.20
Child support arrearages $ 6,164.34
Misc. personal property $ 686.35
interest $ 8.44
1/2 interest in 1996 car $ 2,800.00
total $11,843.51
7. The debts of the decedent were $ 4,360.09.
8. The Funeral Expenses and Administrative Costs are $ 3,626.96.
9. The net Estate available for distribution is $ 3,856.46.
10. The Pennsylvania Inheritance Tax Return has previously been filed, a copy
of which is attached to this Petition as Exhibit "A".
11. The Inheritance Tax liability has been paid, a shown on the Notice of
Inheritance Tax~ a copy of which is attached as Exhibit "B".
12. The Estate Notice of the granting of Letters Testamentary in the above
captioned estate has been published for three (3) consecutive weeks in two (2) different
publications of general distribution. The Proof of Publication of each publication is
attached as Exhibit "C" and Exhibit "D".
13. There are no unpaid debts of the Decedent. Unpaid Administrative
Expenses of $1,000.00 are due to William L. Grubb, Esquire, for attorneys fees and costs.
14. There are no other claims against this Decedent's Estate known to your
Petitioner.
WHEREFORE, your Petitioner prays that the Court enter an order pursuant to
Section 3102 of the Pennsylvania Probate, Estates and Fiduciaries Code, directing the
distribution of the net Estate Assets to the Decedent's heirs, Adam D. Carchidi in the sum
of $1,928.23, and Branden R. Carchidi in the sum of $1,928.23.
William L. Grubb, Esquire '
ID 72661
3803 Gettysburg Road
Camp Hill, PA 17011
(717) 763-5580
Attorney for the Petitioner
VERIFICATION
I, Peter E. Goldstrom, verify that the facts set forth within the foregoing Petition
are true and correct, to the best of my knowledge, information and belief. I understand
that false statements herein are subject to the penalties of 18 Pa.C.S. §4904, relating to
unsworn falsifications to authorities.
Date:
Peter E. Goldstrom, Executor
OOMMONW ALT. REV'1500
~ PENNSYLVANIA
,,~j~,~ DEPARTMENT OF REVENUE
DEP 280eo INHERITANCE TAX RETURN
HARRISBURG, PA17128-0601 RESIDENT DECEDENT
DECEDENT'S NAME ILAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I'-- ~archidi Gall A. 190-50-7437
Z
t't[J'l DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD*YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
LLI 07/24/2002 09/11/1958 REGISTER OF WILLS
[/.I (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
m [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (dale of ~ath ,r~le 1~-13-S2)
[] 5. Federal Estate Tax RchJm Required
~:~ [~] 4. Limited Estate [] 4a. Future Interest Compromise (da~e of dea~ a~,r ~42-0~1
3:0O
¢ ~ [] 6. Decedent Died Testate (Aa,~,copy olw~) [] 7. Decedent Maintained a Living Trust I^~ch copy of Trust) 8. Total Number of Safe Deposit Boxes
[] g. Liliga~ion Proceeds Received [] 10. Spousal Poverty Credit (dale o~ dea~ baleen ~-3~-9~ end ~-~45) [] 11. Election to tax under Sec. 9113(A)
m NAME COMPLETE MAILING ADDRESS
z William L. Grubb, Esquire 3803 Gettysburg Read
i FIRM NAME oi~ue) Camp Hill, PA 17011
o TELEPHONE NUMBER
~ (717) 763-5580
1, Real Estate (Schedule A) (1} 0.00
2. Stocks and Bonds (Schedule B) (2) 0~0I'~.:
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) O~
4. Mortgages & Notes Receivable (Schedule D) (4) 0~00
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 9,043.51
Z (Schedule E)
~0 6. Joinlly Owned Pmgerty (Schedule F) (6) 2,800.00 ~ ,
,~ ~ ~ Separate Billing Requested
~ 7. Inter-Vivos Tracefers & Miscellaneous Non-Probate Pmpe~ (7)
~ (Schedule G or l)
~ 8. Total Gross Assets (total Lines 1-7) (8) 11,843.51
ILl 9. Funeral Exppnses & Administrative Costs (Schedule H) (9) 3,626.96
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)(10) 4,360.09
11. Total Deductions (total Lines 9 & 10) (11) 7,987.0~
12. Net Value of Estate (Line 8 minus Line 11) (12) 3,856.46
13. Chadteble and Governmental Bequests/Sec 9113 Trusts Ior which an eleclion to tax has not been (13) 0.00
made (Schedule J)
14, Net Value Subject to Tax (Line 12 minus Line 13) (14) 3,856,46
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Li~e 14 taxable at lhe spousal tax
rate. or transfers under Sec. 9116 (a)(1.2) x .0 (15)
~ 16. Arceu~. 9f Une 14 taxable at lineal rate 3,856.46 x.045 (16) 173.54
~ 17. Amount of Line 14 taxable at sibling rate x .12 (17)
0 18. Amount of Line t 4 taxable at collaleral rate x .15 (18)
X 19. Tax Due (19) 173.54
F/"
Decedent's Complete Address:
ISTREETADDRESS 2905 Genwo~od R~oad.
· -- ISTATE PA I z'P17011
CITY Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 173.54
2. CreditsJPaymente
A. Spousal Poverty Credit
B. Prior Payments
C. Discount Total Credits (A + B + C) (2) 0.00
3. interest/Penalty if applicable 7.17
D. Interest
E. Penalty Total Interest/Penalty ( D + E ) (3) 7.17
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 I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 173.54
A. Enter the interest on the tax due. (5A) 7.17
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 180.71
Make Check Payab/e to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
t. 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 properly transferred or its income; ........................................... [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ......................................................................
2. ft death occurred after December 12, 1982, did decedent transfer properlY within °ne year °f death [] []
without receiving adeq,,u, ate 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 Acc°unt' annuity' °r °ther n°n'pr°bate pr°perry which [] []
contains a beneficiary designation? ........................................................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
2903 G enwood Road, Camp Hill PA 17011
.............. DATE
SiG NATU RE Q F pREpA R E R nTH E R TI~A~J"I~-~'~ EN TATIV~_~__~ ..... ~-/'7-'~/
ADDRESS
3803 Gettysburg Road Camp H PA 17Oll
For dates of death on or after July 1, 1994 and before January 1, 995, he ax rate ~mposed on the net value of transfers to or or the use of the surwvmg spouse s
[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 suwiving spouse is the only heneficiary.
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 stepparant of the child is 0% [72 P.S. §9116(a)(1,2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116(1.2) [72 P.S. {}9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 ES. {}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-~0, ~* 16-98~ .~ SCHEDULE E
' CASH, BANK DEPOSITS, & MISC.
ESTATE OF FILE NUMBER
Carchidi Gall A. 21-02-0082
include the proceeds of litigation and Ihe 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
1 )NC checking account 1493.18
2 -~ealth insurance refund 691.20
3 Child support arrearages 6164.34
4 Misc. Personal property 686.35
5 Interest 8.44
TOTAL (Also enter on li~e 5, Recapitulation) $ 9,043.51
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (6-98~
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERLY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Carchidi Gall A. 21-02-0821
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. Peter E. Goldstrom 2905 Glenwood Road, Camp Hill, PA 17011 father
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
I~FEM -"OR JOINT MADE INCLUDE NAME OF F~NANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR CATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOIN)' )DENTFYING NUMBER. A~TACH DEED FOR JOINTLY. HELD REAL ESTATE. VALUE OF ASSET ,NTEREST DECEOENT'S INTERES~F
t. A. 4/17/2002 1996 Buick sedan 5600.00 50°/, 2800.0
TOTAL (Also enter on line 6, Recapitulation) $ 2,800.0~
{If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)~
. SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Carchidi Gall A. 21~02-00821
Debts of decedelll must be reported on Schedule i.
ITEM AMOUNT
NUMBER DESCRIPTION
A FUNERAL EXPENSES:
~' Musselman Funeral Home 1,687.00
B. ADMINISTRATIVE COSTS:
1. Personal Represenlative's Commissions
Name of Personal Representalive(s) Peter E. Goldstrom
Social Security Number(s)/EIN Number of Person¢ Rep[esentative(s)
Street Address 2905 Glenwood Road
CRy Camp Hill State PA _ Zip 17011
Year{s) Commission Paid:
Barbara Ingram,~ Esq. (Calif.) 777.05
2, A~erneyFees William L. Grubb,., Esq. (PA) 1_000.00
3. Family Exemption: (ff decedenPs address is not the same as claimant's, altach explanation)
Claimant
S[ree~ Address
City __ S~ate Zip
.,- Relationship el Claimant to Decedenl
4. Probate Fees Legal Adverti s ing 162.91
5. Accountant's Fees
6. Tax Re~urn Preparer's Fees
TOTAL (Also enter on line 9. Recapitulation) 3,6;)6.96
(1[ more space is needed, inserl additional sheels of Ihe same size)
SCHEDULE I
DEBTS OF DECEDENT,
ESTATE OF FILE NUMBER
Carchidi Gall A. 21-02-00821
Include unre[mbursed medics[ expenses.
VALUE AT DATE
ITEM
NUMBER DESCRIPTION OF DEATH
t. Hershey Medical Center 277.02
2. Lower Allen EMS 438.00
3. Holy Spirit Hospital 227.70
4. Pinnacle Health 217.12
5. Rehab, Industrial & Spine 21.00
6. Susquehanna Pain 27.20
7. Quantum Imaging 33.20
8. MSHMC Physicians Group 49.60
9. PA GI Consultants 21.00
10. CBSJ Collections 822.77
11. Barbara Ingram, Esq. 2,075.48
12. Sanford & Roumm 150.00
TOTAL (Also enter on line 10, Recapitulation) $ 4: 360.09
(If more space is needed, insed additional sheels of the same size)
REV-1513 EX+ (9~)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Carchidi Gall A. 21-02~0821
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
! TAXABLE DISTRIBUTIONS [include outright spousal distributions, and Iransfers under
Sec. 9116 (a) (1.2)]
Adam D. Carchidi, 197 Cleopatra Dr., son 1,928.23
Pleasant Hill, CA 94523
.Branden R. Carchidi, 2818 Harris Dr., son 1,929.23
Antioch, CA 94509
ENTER OOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
I~ON-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 Il - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 3,856,46
(If more space is needed, insert additional sheets of the same size)
COMMON#EALTH OF PENNSYLVAN/A
BUREAU OF INDIVIDUAL, TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
~PT. 180601 NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLOHAHCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE 04-19-Z00q
ESTATE OF CARCHZD! GAZL A
DATE OF DEATH 07-Zq-Z00Z
FILE NUMBER 11 02-081!
COUNTY CUMBERLAND
WILLIAH L 6RUBB ESQ ACN 101
3805 GETTYSBURG RD Amount
CAHP HILL PA 17011
HAKE CHECK PAYABLE AND RENZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701)
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-15~7 EX AFP (01-03) NOTICE OF INHER/TANCE TAX APPRAZSENENT, ALLOWANCE OR
D~SALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CARCHID! GAIL AFZLE NO. 21 02-0821 ACN 101 DATE Oq-/g-2OOq
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN ~ASED ON: ORIGINAL RETURN
1. Re~l Est~tm (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Sch~clule R} (2) . O0 credit to your account,
5. CZosely Hmld Stock/Pmrtnmrshlp Znteres( (Schedule C) ($) .00 submit (he upper
q. HortD~ges/Not~s Receivable (Schedule D) (~) .00 of this form with your
$. C~sh/BankD~pos~ts/Hisc. Personal Property (Schedul~ E) (5) 910~.5I ~ax p~yment.
6. Jotntly O~ned Property (Schedule F} (6) 2;800.00
7. Transfers (Schedule S) (7)
8. Total Assets (S) 11,8~3.Sl
APPROVED DEDUCTIONS AND EXENPTZONS: 3,626.96
9. Funeral Expm~ses/Adm. Costs/Hisc, Expenses (S~hedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule Z) (10) ~.360.09
11. Total Deductions (11) 7.~87.~;
12. Net Value of Tax Return (12}
15. Chmriteble/Dovernmental Bequmsts; Non-elected 9115 Trusts (Schedule J) (15) .00
14. Net Value of Estate Subject to Tax (lq) 3,856.~6
NOTE: Z~ an assessment was issued previously, lines 1~, 15 and/er 16, 17, 18 and 19
reflect ~igures that include the total of AL__~Lreturns assessed to date.
ASSESSHENT OF TAX: .00 x O0 O0
16. Amoum~ of Line lq taxmble mt Lineal/Class A rate (16) 3~G56.~6 X 0~5 = 175.5q
~AX CREDITS:
0S-01-200~ CD003618 7.1S- 180.71
TOTAL TAX CREDZT[ 175.58 [
~'"X ~J1; ~ ~, ,'~'~- "~" TNTERESTToTALAND~uEPEN' . O~CR
ZF PAID AFTER DATE INDICATED, SEE REVERSE ( ZF TOTAL ~E ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
FOR CALCULATZOH OF ADDZTZOHAL INTEREST. ZF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR)~ Y~ HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
UnderAct No. 587, Approved May16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Joseph A. Dennison, being duly sworn according to law, deposes and says:
That he is the Asst. Controller of The Patriot News Co., a corporation organized and existing under the laws
of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in
the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of ~ and The
Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the
City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established Mamh 4th,
1854, and September 18th, 1949, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published in
their regular daily and/or Sunday/ Metro editions which appeared on the 9th, 16th and 23rd day(s) of September
2003. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and
that all of the allegations of this statement as to the time, place and character of publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and
adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in
the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book
Volume 14, Page 317.
P U BLICATION ............... ....~....~...~ .................
COPY Sworn to de~'ubscribed before ~t~is 29th day/~S~e~p~ber 2003 A.D.
Notadal Sea~·
Tern/L. Russ~l, Nota~ Public . /,/
Cii,/Of Ha~sburg, Daup~n County ~ NOTARY PUBLIC
MyComm~,,sionExpiresJune6,2006 ~ My commission expires June 6, 2006
WILLIAM LEWIS GRUBB
ATTORN EY-AT-LAW
3105 OLD G~- I ~ ?SBURG ROAD
:' ~ CAMP HILL, PA. 17011
;
Statement of Advertising Costs
To THE PATRIOT-NEWS CO., Dr.
For publishing the notice or publication attached
hereto on the above stated dates $ 86.1 6
Probating same Notary Fee(s) $ 1.75
Total $ 8 7.91
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News· newspapers of general
circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have
been duly paid.
By ....................................................................
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
STATE OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND :
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
SEPTEMBER 5, 12, 19, 2003
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are tree.
Coy+ Editor
Ca~hidt, E~til A., dec'd.
Late of Lower Allen Township, SW/~i~-N TO AND SUBSCRIBED before me this
~-naastrator: peter E. Geldstrom, 19 day of SEPTEMBEIL 2003
c/o Wlllimn L. Grubb, Esquire,
3105 Old Gettysburg Road, Carap
Hill, PA 17011.
Attorney: William L. Grubb, Es-
quire, 3105 Old Gettysburg 1~ad, .
Camp Hill, PA 17011.
I 1.018 E. $1q¥OEIt, ~la~/~lio[
1N RE: IN THE ('OURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF
GAlL A. CARCH[DI ORPHANS COURT DIVISION
DECEASED
No. 21 - 2002 - 00821
ORDER AND DECREE UNDER SECTION 3102 OF THE PROBATE,
ESTATES AN[) FIDUCIARIES CODE
AND NOW, this ~ day of ~-- , 2004, upon
consideration of the annexed Petition. IT IS HEREBY ORDERED AND DECREED
pursuant to Section 3102 of the Probate, Estates and Fiduciaries Code, that the Estate
Assets be distributed to the Decedent's heirs, Adam D. Carchidi in the sum of $1,928.23,
and Branden ti. Carcbidi in the sum of $1.928.23. and further that a certified copy of this
Order shall serve as authority to Peter E. Goldstrom, executor, to make the distribution
directed hereby.
BY THE COURT:
NOTICE
TO: William Grubb
FROM: Kirk Sohonage, Solicitor for the Register of Wills
DATE: January 14,2005
SUB: Additional Probate Fees
Decedent: Gail Carchidi
Estate No.: 21-02-821
In an annual review of all estates and accounts, it has come to our attention the above
listed estate owes additional probate fees in the amount of$ 15.00.
Our records indicate that you are the personal representative or counsel for the same in
the above listed estate. Probate fees are estimated at the time of petitioning for letters.
Final probate fee amounts are determined by the value of the estate as reported on the
inheritance tax return filed in our office for the Department of Revenue.
The additional probate fee should be made payable to "Register of Wills" and be
forwarded in the enclosed envelope within 15 days of this notice.
If you feel you have received this notice in error, kindly contact the Register of Wills
directly at (717) 240-5411 and she will be happy to review the matter.
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esquire
Solicitor
One Courthouse Square
Carlisle, Pa. 17013
Glenda Farner Strasbaugh
Register of Wills &
ClerK of the Orphans' Court
(717) 240-6345
FAX (717) 240-7797
OFFICES OF
l\rgls'trr of mills anb ((lrrk of tbr ~rpbans' ((aud
ilCountp of ilCumberlanll
NOTICE
TO: William Grubb
FROM:
Kirk Sohonage, Solicitor for the Register of Wills
SUB:
Additional Probate Fees
y~
~))?
\-\'-\
DATE:
January 14,2005
Decedent: Gail Carchidi
Estate No.: 21-02-821
In an annual review of all estates and accounts, it has come to our attention the above
listed estate owes additional probate fees in the amount of$ 15.00.
Our records indicate that you are the personal representative or counsel for the same in
the above listed estate. Probate fees are estimated at the time of petitioning for letters.
Final probate fee amounts are determined by the value of the estate as reported on the
inheritance tax return filed in our office for the Department of Revenue.
The additional probate tee should be made payable to "Register of Wills" and be
forwarded in the enclosed envelope within 15 days of this notice.
If you feel you have received this notice in error, kindly contact the Register of Wills
directly at (717) 240-5411 and she will be happy to review the matter.