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Home My WebLink About03-0598PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Orsolina Sovich also known as Orsolina O. Sovich Deceased. Social Security No. 057-18-0553 State No.: No ~-~_.~~- ""9 ~ To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioner is 18 years of age or older and the'Executrix named in the Last Will and Testament of the above decedent, dated February 20, 1996. Decedent was domiciled at death in Cumberland County, Pennsylvania with her last family or principal residence at HealthSouth, Mechanicsburg, Cumberland County, Pennsylvania. Decedent, then 79 years of age, died April 14, 2003, at HealthSouth, Mechanicsburg, Cumberland County, Pennsylvania. Decedent did not marry, was not divorced-and did not have a child bom or adopted after execution of the Will offered for probate; was not a victim of a killing and was never adjudicated incompetent. Decedent at death owned property with estimated values as follows: All personal property $2,000.00 WHEREFORE, Petitioner respectfully requests the probate of the Last Will and Testament presented herewith and the grant of Letters Testamentary thereon. Signature and Residence of Petitioner .JAn~a Keller ] 977 Frystown Road Fredericksburg, PA 17026 PROBATE DATE: OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF : The Petitioner above-named swears or affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that as personal representative of the above decedent Petitioner will well and truly administer the estate according to law. Sworn to or affirmed and subscribed : ..... D~puty~e~lst~ -~ ',~-,' -_, ,/ - Signature ' ESTATE OF ORSOLINA SOVICH A/K/A ORSOLINA O. SOVICH, DECEASED DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, to wit, this~/~ay of ~ ,2003, in consideration of the P '' ' -.//. g etltlon attached hereto, satisfactory proof having been presented before me, IT IS DECREED that the instrument, dated February 20, 1996, described therein be admitted to probate and flied of record as the last Will of Orsolina Sovich a/k/a Orsolina O. Sovich; and Letters Testamentary are hereby granted to Anna Keller. FEES Probate, Letters, etc. Praecipe $ Short Certificates ( ) $.__ ._.,~:~_~ D~eath Certificate $ C~lon $ TOTAL File~. ~ ~ ~ ,2003 / / Charles V. Henry, Iii, Esquire Supreme Court I.D. No. 06322 Henry & Beaver LLP 937 Willow Street P.O. Box 1140 Lebanon, PA 17042-1140 (717) 274-3644 ARNING: ITIS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMM'3NWEAL'I H OF F ENNSYLVANIA OliiPA~,-r~J,[!NT ()~ ~ EALTF VITAl, RECORDS i!,.<)C~,%l~. F EGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 538516 April 18, 2003 Date of Issue of This Certification Name of Decedent ~_ O. Sovich First Middle Last Sex FemaLe Social Security No. 057-18-0553 Date of Death April 14, 2003 Date of Birth _ Oct. 14, 1923 Birthplace N-Y' Place of Death Race. Nhite Marital Status ___ Heal_~thSouth Cumberland Mechanicsburg City Borough or Township Occupation Concession Stand Oper./Entert/Wmed Forces? (Yes or No) No Decedent's Widowed__ Mailing Address 4950 Wilson Lane Mechanicsburg Number Street City or Town Informant Am"ta Keller Funeral Director Douglas E. Redinger Name and Address of Funeral Establishment Pennsylvania PA State Christman Funeral Home, Inc, 226 Cumberland St, Lebanon, PA, ~7042 Padl: Immediate Cause (a) Respiratory Failure Interval Between Onset and Death (b) Thoracic Aortic Aneurysm (c) Part I1: (d) Other Significant Conditions Manner of Death Natural ~ Accident ~ Suicide []_ Homicide Pending Investigation CouM not be Determined Describe how injury occurred: Name and Title of Certfier WM. Rolle, MD Address HealthSouth, Mechanicsburg, PA (M.D., D.O., Coroner, M.E.) This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filin9. 38-355 Local Registlar ot Vital Records Bistdct No April 17, 2003 ]685 Mill Rd, Lebanot~, PA, ~7042 Dde R~cei~ed by Local ~'~glstra, Street Address City Borough. Township LAST WILL AND TESTAMR. NT OF ORSOLINA SOVICH I, ORSOLINA SOVICH, of the County of Dauphin and Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this to be my Last Will and Testament and revoke all former Wills and Codicils by me made. I. I appoint Anna Keller as Executrix of this my Last Will and Testament. If the said Anna Keller refuses to serve or is unable to serve for any reason, I appoint Christina Miller as Executrix. No bond or other security shall be required of any fiduciary appointed hereunder. II. I direct that all my funeral expenses, my debts, expenses of the administration of my estate, and all state and federal estate and inheritance taxes, by whatever name called, becoming payable because of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, and any interest thereon, shall be paid as soon as possible after my death out of my residuary estate. III. I give, devise and bequeath all the rest, residue and remainder of my estate to Anna Keller, if she survives me, and if she does not survive me to Christina Miller. IV. In addition to the powers given to it by law, I hereby grant to my Executor under this Will, with respect to any and all property held which shall constitute a part of my estate the following powers: A. To sell at public or private sale, to exchange, to lease and make contracts concerning real or personal property for such considerations and upon such terms as to credit or otherwise as it may determine, which leases and contracts may extend beyond the term of any trust; to give options therefore; to execute deeds, leases, transfers and other instruments of any kind. B. To retain indefinitely any investments and to invest and reinvest in any property, including, but not by way of limitation, bonds, notes, debentures, mortgages, certificates of deposit, common and preferred stocks and shares or interest in investment trusts, including shares of stock of any corporate fiduciary, without being limited to the class of securities in which fiduciaries are authorized by law or any rule of court to invest, including diversification principles. C. To make distribution in cash or in kind or partly in cash and partly in kind, based on the value of the assets at the time of distribution. -2- IN WITNESS WHEREOF, I, ORSOLINA SOVICH, have to this Will, written on three (3) sheets of paper, each separately signed by me, set my hand and seal this ~O day of ~~. , 1996. ORSOLINA SOVICH Signed by Orsolina Sovich and by her declared to be her Will, in our presence, who have hereunto subscribed our names as witnesses at her request and in her presence and in the presence of each other this ~0 day of ~~ , 1996. -3- COMMONWEALTH OF PENNSYLVANIA: : ss. COUNTY OF LEBANON : We, Orsolina Sovich, / ~~il~ [~c~~ , the ~e~statrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority, that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. WITNESS: i~ - .~ Tes~I~xSOVIOH Subscribed, sworn to and a~knowledge~. ~efore~m~ by Orsolina Sovich, the Testatrix, ~z~~ ~3.~/ ~~ ~~~~~~ , w~nesses, this ,, ~ day of , 1996. OF ORSOLINA SOVICH HENRY ~ BEAVER ATTORNEY'S AT LA's~6' 93? V, rILLO%~' STREET P. O. BOX 11~,0 LEBANON, PA IX042-11,10 PRAECIPE FOR ENTRY OF APPEARANCE In Re: Estate of Orsolina Sovich a/k/a Orsolina O. Sovich, Deceased. In the Office of the Register of Wills & Clerk of the Court of Common Pleas Orphans' Court Division, Cumberland County, Pennsylvania. No. To the Register of Wills and Clerk of Orphans' Court of Cumberland County, Pennsylvania. Sir, Please Enter the Appearance of Charles V. Henry, III, Esquire of the law firm of Henry & Beaver LLP, whose address is 937 Willow Street, P.O. Box 1140, Lebanon, Penn.sylvania 17042-1140 as Attorney for Anna Keller, Executrix of the Estate of Orsolina Sovich a/k/a Orsolina O. Sovich, Deceased, in the above matter. Dated: ~'/,Z c/r ,2003 CS~upreme Qourt I.D. No. 06~ff22 CERTIFICATE OF NOTICE UNDER RULE 5,6~a) ~ Name of Decedent: Orsolina Sovich a/k/a Orsolina O. Sovich Date of Death: April 14, 2003 ~5~i~ , Will No. 2003-00598; Bureau No. 21-03-0598 To the Register: :27 I certify that Notice of Beneficial Interest 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 July 30, 2003. Name Address Anna Keller 977 Frystown Road Fredericksburg, PA 17026 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: July 30, 2003 CharEs V. Henry, III, Esq~r~ 937 Willow Street P.O. Box 1140 Lebanon, PA 17042-1140 (717) 274-3644 Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA IDEPARTMENT 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 003422 KELLER ANNA 977 FRYSTOWN ROAD FREDERICKSBURG, PA 17026 ........ fold ESTATE INFORMATION: SSN: 057-18-0553 FILE NUMBER: 2103-0598 DECEDENT NAME: SOVICH ORSOLINA DATE OF PAYMENT: 01/08/2004 POSTMARK DATE: 01/07/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/1 4/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $271.65 REMARKS: TOTAL AMOUNT PAID' $271.65 SEAL CHECK# 214 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS I REV-1 500 PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 I INHERITANCE TAX RETURN HARRISBURG, PA 17128-0601 = DECEDENT OECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~~ OFFICIAL USE ONLY FILE NUMBER Z Sovich, Orsolina Ltl t'~ DATE OF DEA'FH (MM-DO-YEAR) 0ATE OF BIRTH (MM-OD-YEAR) LU 4/14/2003 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE (g REGISTER OF WILLS LLI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ SOCIAL SECURITY NUMBER o ~i. 1. Odginal Return E~4. Limited Estate [~6. Decedent Died Testate ~A,acm ~----'~ 9. Litigation Proceeds Received '--]2. Supplemental Return --] 4.a. Future Interest Compromise (~ate of dealh after t2-12-82) '--] ?. Decedent Maintained a LMng Trust (Aftac~ copy of T.Jst) E~]10. Spousal Poverty Credit {~ale of deem [:e~een ~2-31-9! and 1-1-95) 2 1 - 0 3 0 5 9 8 COUNTY COOE YEAR ~ NU~IB"""-'~ SOCIAL SECURITY NUME~=~ 057 -- 18 -- 0553 ~--~ 3. Remainder Return (dale of deem pmr to lZ-13-82) ~'--] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes -]11. E!ection ID tax under Sec. 9113(A) [A~tach Sc:' C NAME Charles V. Henry, III, Esquire FIRM NAME ilfAO~icaD~ef & Beaver LLP TELEPHONE NUMBER 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 Proper'b/ (5) (Scheduie E) 6. Jointly Owned Property (Schedule F) (6) ~, Separate Billing Requested 7". Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (ScheduJe O or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Uabiiities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Chantabte and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) ELD_,:., .ED TO: COMPLETE MAIUNG ADDRESS 937 Willow Street P.O. Box 1140 Lebanon, PA 17042-1140 OFFICIAL USE ONLY 1,226.20 8,662.14 2,365.00 5,712.33 (8) ' 9,888.34 (11) (12) (13) 8,077.33 1,811.01 (14) 1,811.0~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the s~usal tax rate, or transfers under Sec. 9116 (a,)(1.2) x .0 ~ (15) 16. Amount of Uno 14 taxable at lineal rate x .0 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate 1 ? 8 1 1.0 1 x .15 (18) 19. Tax Due (19) 271.65 20. E~ el iii ,i I~1 · '~ I! f :I · '-'-??:7 :' ~'::'' ,-::.:" ::":: ':' '-' '~ · > BE SURE, iTO ANSWER ALL:QUESTIONS'ON: REVERSE SiDE.~N~K~MATH:~:.~.[,,¢~.y~E4~4,,::~:i' )e~:edent's Complete Address: STREETADDRESS Health South Mechanicsburg STATE PA [ZIP 17055 'ax Payments and Credits: Tax Due (Page 1 Line 19) Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) 271.65 Total Credits ( A + B + C ) (2) O. O0 Total Interest/Penalty ( D + E ) 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 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) O. O0 (4) O. 00 (5) 27],, ~.5 (5A) O. O0 (5s) A. Enter the interest on the tax due. Enter the total of Line 5 + SA. This is the BALANCE DUE. 2 71.6 5 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the proper'by 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. 1952, did decedent transfer property within one year of death without receivinc~ 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. IF THE ANSWER *der penalties of perjury, { declare that I have examined [ms return, ~nc~ubtn§ accompanying schedules and statements, and to the best of my knowledge and belief t is true correct and combte[e. ~c!arat~on of preparer other ~han the oer~onal re2resentatWe is based on ail information of which preparer nas any knowledge. ;GNATURjF-~CPERSON RESPONSIBL~FOR FILiNG.RETURN . DATE "3DRESS .. ] iGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ,.DDRESS or 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% "2 P.S. §9116 (a)(1.1) (i)]. or 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)]. he statute does not exemot 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 ~e surviving spouse is the only beneficiary. 3r dates of death on or after July 1,200(~: 2e 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, · a stepparent of the child is 0% F2 P.S. §9116(a)(1.2)]. '~e tax rate imposed on th~ net value of transfers t:- 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)]. ~e tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an dividual who has at least one parent in common with the decedent, whether by blood or adoption. RE'V-I~03 EX * ('1-97) COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT E$¥ATE OF Sovich, Orsolina SCHEDULE B STQCKS & BONDS FILE NUMBER 21-03-0598 All propert7 jointly-owned with right of sun~ivorship must be disclosed on Schedule F. ITEM DESCRIPTION 1. 30 shares Penn National @ $24.34 2. 80 shares Rite Aid @ 6.20 NUMBER VALUEATDATE OFDEATH $ 730.20 496.00 $ 1,226.20 TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sovich~ Orsolina SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILENUMBER 21-03-0598 Inctude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on SChedule F. ITEM NUMBER DESCRIPTION Jonestown Bank & Trust Company, Checking Commerce Bank, certificate of deposit Accrued interest TOTAL (Also enter on line 5, Recapitulationi (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $ 5,354.96 3,300.00 7.18 $ 8,662.14 COMMON~:ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sovich, Orsolina SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-03-0598 Bebts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 5. 6. 7. 8. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Reprssentative (s) Anna Keller Social Security Number(s) / EIN Numl3er of Pemonal Representative(s) Street Address 977 Fry,~nwn RnmH City Fredericksbur~ State PA Year(s) Commission Paid: ? 004 A~orneyFeea - Henry & Beaver LLP Family Exemption: (If decedent~s address is not t~e same as claimant's, attacfl explanation) Claimant 17026 Street Address Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparers Fees Bureau of Vital Statistics, Reserve death certificates State Zip $ 900.00 900.00 53.00 12.00 500.00 TOTAL (Also enter on line 9, Recapitulation) $ 2,3 6 5. O0 (if more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sovich, 0rsolina SCHEDULEI DEBTS OF DECEDENT, MORTGAGELIABILITIESI&LIENS FILE NUMBER 21-03-0598 Include unreimbursed medical expenses. ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 15. Quantum Imaging EKG Associates Physical Rehab Associates HealthSouth Cardiology Assoc. Dr. Robert Kantor Dr. Azizkahn Kumbil Surgical Dr. C. Inner Moffit Heart Group Dr. Giesswein West Shore EMS, ambulance Holy Spirit Hospital Pulmonary Critical Care Anna Keller, POA services DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 142.07 10.44 660.13 15.00 490.21 104.43 77.76 366.80 104.23 58.62 8.47 442.50 2,300.00 31.67 900.00 5,712.33 REV-1513 EX <' 0-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sovich, Orsolina SCHEDULE J BENEFICIARIES NUMBER FILE NUMBER -- 21-38-0598 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (include outright spousal disMbutions) II. Anna Keller 977 Frystown Road Fredericksburg, PA 17026 No Relation Residuary estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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 $ (If more space is needed, insert additional sheets of the same size) Register of Wills of Cumb er 1 and INVENTORY Estate of Orsolina Sovich aL~o known as , Deceased County, Pennsylvania 21-03-0598 No. Date of DeMh 4/14/2003 Soc~lSecur~No. 057-18-0553 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedenrs death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct, lANe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Attorney: Charles V. Henry, III LD. No.: 06322 Address: 937 Willow St. ,P.O. Box 1140 Dated 12/31/09 Lebanon, PA 17042-1140 Telephone: (717) 274-3644 Description 1. 30 shares Penn National @ $24.34 2. 80 shares Rite Aid @ $6.20 3. Jonestown Bank & Trust Co., checking account 4. Commerce Bank, certificate of deposit Accrued interest (Attach additional sheets if necessary) Value $ 730.20 496.00 5,354.96 3,300.00 7.18 ~o~1: $ 9,888.34 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania ma)', at the election of the per~orud- representative, include the vaJue of each item, but such r~ures ~hould not be extended into the totaJ of lhe Irrventc~y. Prepe. r~:l by I~e Per'."~ytva~ia Ba,' Assoc~a.~o~ 1~91 BUREAU OF ZNDZVZDUAL TAXES ZNHERZTANCE TAX DIVZSTON DEPT. 280601 HARRXSBURG, PA 17128-0601 CHARLES V HENRY III ESQ HENRY & BEAVER PO BOX llqO LEBANON PA 170q2 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOT/CE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTZONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FTLE NUMBER ACH 05-29-200q SOVICH 0~-1R-2005 21 05-0598 CUMBERLAND 101 Amount Remitted REV-IS~7 EX /iFP (01-05) ORSOLINA MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LZNE ~"~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERTTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTTONS AND ASSESSMENT OF TAX ESTATE OF SOVICH ORSOLINA FZLE NO. 21 03-0598 ACN 101 DATE 03-29-200~ TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNTNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: 0RIGZNAL RETURN 1. Real Estata (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Zntarast (Schedule C) (3) q. Mortgages/Notes Receivable (Schedule D) (q) $. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expansas/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Net Value of Tax Return 1~226.20 .00 8~662.1fi .00 .00 NOTE: To insure proper credit to your account, submit the upper portion .00 of this fora with your tax payment. .00 (8) 2,365.00 13. NOTE: ASSESSMENT OF TAX: 15. Amount of Llne lq at Spousal rata 16. Amount of Line lq taxable a~ Lineal/Class A rata 17. Amount of Line lq at Sibling rata 18. Amount of Line lfi taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYHEN1 RECEZPT DZSCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 01-07-200q COOO3q22 .00 9,888.3q ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. (15) .00 x O0 = .00 (16) .00 x OqS= .00 (17) .00 x 12 = .00 (18) 1,811.01 x 15 = 271.65 (19)= 271.65 AMOUNT PAID 271.65 reflect flgures that include the total of ALL returns assessed to date. (13) . O0 (l~) 1,811. O1 ': 16, 17, 18 and 19 will TOTAL TAX CREDZT J BALANCE OF TAX DUEJ ZNTEREST AND PEN. TOTAL DUE 271.65 .00 .00 .00 ( TF TOTAL DUE 'rs LESS THAN $1, NO PAYMENT 'rS REQUTRED. TF TOTAL DUE 'rs REFLECTED AS A 'CRED.rT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S'rDE OF THIS FORN FOR .rNSTRUCT'rONS.) Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) Nat Value of Estate Sub,~act to Tax zf an assessment ~as issued previously, 11nas 14, 15 and/or 5,712.33 (11) 8.077.33 (lz) 1,811.01 REGISTER OF WILLS OF ~ COUNTY Estate No. STATUS REPORT UNDER RULE 6.12 Zoo~--00~-~/8 State FILE NO. Il-- 0%- 5~ Name of Decedent: d~om/;.oA 5ovIC /~ Date of Death: ~//~/d~ Social Security Number: O~-;~ 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 ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. 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 ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: Date: c. Did the personal representative state an account informally to the parties in interest? Yes ~ 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. Name (Please type or'print) Address Telephone No. Capacity: Personal Representative X Counsel for personal representative