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Home My WebLink About04-0188 PETITION FOR PROBATE and GRANT OF LETTERS Estate of' ?tg~ae /" I._~,j'/,n/ ~. No. ~//_~,ep~'_/OOO~ also known as To: Register of Wills for the Deceased. County of in the Social Security No. ?/e~' - / ~'~ - ?.~ $ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or olde/r an the execut~4 named in the last wilt of the above decedent, dated ~n/, 2 0~ ,1'9-.~-~e:9 and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~"~-o~nJ D County, Pennsylvania, with h last family or principal residence at Afl.4- .2'~t~/a~,ea/~ z. ~gu ~-r' (list street, number and muncipality) Decendenl. then 7~' years of age.died .0-4 tV( ..~t9 e ,'t'9'2OOg/f, 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 $ ~5'D; Ct'W). (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 f°ll°ws:/,.~.5" _d~,,¢/~,~ ~.~ R. 7' , ~'~_/.~'~. WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. e_, /'/'ftC' W'. ,,c--/-. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF 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 and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ~ 77-/~ day of REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Paul Levine Date of Death: January 30, 2004 File No. 21-04-0188 Admin. No. 2004-00188 To the Register: I certify that notice of 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 February 4, 2004. Name Address Barbara Lynn Zaikowski 1444 East 70th Street, Brooklyn, NY 11234 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Thomas E. Flower, Esquire SAIDIS, SHUFF, FLOWER 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: __Personal Representative X Counsel for Personal Representative Decedent's Complete Address: STREET ADDRESS 135 IMPERIAL COURT ClTYcARLiSLE I STATEpA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 786.20 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 600.00 C. Discount 31.58 Total Credits ( A + B + C ) (2) 631.58 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 154.62 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SD) 154.62 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for'' or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 ~rue, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN^IURE~NS~N DATE o¥ ADDRESS ~J Barbara Zaikowski, 1444 East 70th St., Brooklyn, NY 11234 SIG~R~SENTATIVE DATE~'" ~(7.0 (./ 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 RS. §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-1508 EX+ (6-98) ,~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. ~N,ER,TANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER PAUL LE¥1NE 21-04-0188 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M&T BANK CHECKING ACCOUNT #3782486579 312.17 TOTAL (Aisc enter on line 5, Recapitulation) $ 312.17 (If more space is needed, insed additional sheets of the same size) REV-1509 EX+ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER PAUL LEVINE 21-04-0188 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. BARBARA ZAIKOWSKI 1444 E. 70th Street daughter Brooklyn, NY 11234 c. I JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOIN'[ MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S iNTEREST 1. A. lot and dwelling house known as '135 Imperial Ct., Cadislo, P^ '105,000.00 50% §2,§00.00 TOTAl. (^lso enter on line 6, Recapitulation) $ 52,500.00 {if more space is needed, insed additional sheets of the same size) REV-1512 EX+ (12-03) ,~ SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OFDECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER PaUL LEVINE 21-04-0188 Re 3ort debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Principal Residential Mortgage, Inc., Loan No. 2274375-1, loan balance: $55,662.82 X 1/2 = 27,831.41 (One-half of loan balance apportioned to joint tenant, one-half claimed as debt of decedent.) TOTAL (Also enter on line 10, Recapitulation) $ 27,831.41 (If more space is needed, insert additional sheets of the same size) REV- 5. E×+ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER PAUL LEVINE 21-04-0188 Debts of decedent must be reported on Schedule ]. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. NOCE FUNERAL HOME, INC, WEST BABYLON, NY 5,889.75 Transport remains ......................... $ 2,202.75 Embalming ............................................. 895 Professional Funeral Services ............... 995 Casket .................................................... 1.595 Dressing/Casketing ..................................... 190 Death Certificates ........................................ 12 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 1,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 120.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. TOTAL (Aisc enter on line 9, Recapitulation) $ 7,509.75 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER PAUL LEVINE 21-04-0188 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 transfers under Sec. 9116 (a) (1.2)] 1 BARBARA ZAIKOWSKI, 1444 E. 70th St., Brooklyn, NY 11234 DAUGHTER 100.(~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO T~X IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-IAX~BLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0,00 (If more space is needed, insed additional sheets of the same size) 7177~?~4W? SflIDIS SHUFF MflSLflND 817 PO~ APR 2g '04 11:~8 M&T Bank Records ManagemenVMa/l Code DE-MB-12 499 Mitchell Road Millsbom, DE 19966 Re: Estate of Paul Lcvine Date of Dcath: January l, 2004 Social Security No, 118-18-1335 Dear Sir/Madam: The £oilowin8 is a complete record of the above decedent's accounts as of December 12, 2003, deccdeni's date of death. If ~hc dcccdcm had a safe deposit box, indicate numbcr"-~')~t). Balance on Date of Death Account No. Type of Principal Accrued Namcs on Datc Account Interest Account (All Opened Signature of Official ~' I THIS DEED MADE this /~'~day of 7']'/~,'~ 2002, BETWEEN PAUL. LEVINE, single man, of North Mlddleton Township, Cumberland County, Pennsylvania, "GRANTOR", AND PAUL LEVINE, of North Middletow: Township, Cumberland County, Pennsylvania, and BARBARA ZAIKOWSKI, of Brooklyn, New York, as joint tenants with the right of survivorship, "GRANTEES", WlTNE$SETH, that in consideration of the sum of One ($I.00) Dollar, in hand paid, the receipt whereof is hereby acknowledged, the said GRANTOR does hereby grant and convey in fee simple to said GRANTEES, their heirs and assigns as joint tenants with the right of survivorship; ALL THAT CERTAIN lot or piece of uround situate in the Township of North Middleton, County of Cumberland and Commonwealth of Pennsylvania, more particularly bounded and described as follows, to w/t: BEGINNING at a point on the non-them right-of-way tine of Imperial Court (50 feet wide right-of-way), ,said point being the comrnon comer of Lot No~ 83 and Lot No. 82 on th(: Plan of Lots known as "North Ridge-- Phase One": thence .along said northern fight-of-way line South 77 degrees 52 minutes 13 seconds West, a distance of 17.00 fret to a point; thence still along said northern right-of-way line, on a curve to the left, having a radius of 50.00 feet, an arc distance of 13.22 feet to a point; said point being the common comer of Lot No. 82 and Lots No 83 on said plan; thence along the eastern line of said Lot No. 82 North 03 degrees 35 minutes 05 seconds West, a distance of 144.28 feet to a p~int on the southern line of Lot No. 52 on the Plan of Lots known as "North Ridge- Phase Three":: thence along said southern line North 69 degrees 54 minutes 11 seconds East, a distance of 29.20 feet to a point, said point being thc common corner of said Lot No. 84 and said Lot No. 83; thence along the western line of said Lot No. 84 South 03 degrees 35 minutes 0,5 seconds East, a distance of 155.49 feet tca point, the Pl~ce of BEGINNING. CONTAINING 4,272.87 Square Feet or 0.0981 acre of land. BEING Lot No. 83 on a Plan of Lots known as "North Ridge- Phase One" recorded in Cumberland County Plan Book 67, Page 120, The aforesaid plan erroneously set forth Incorrect footage on the side boundaries. A copy of the correct calls which conform to the above description t~ recorded herewith and incorporated herein by reference. BEING the same property which Sealover Homes, Inc., by deed dated September 9, 1998 and recorded in the Office of the Recorder of Deeds in and for Cumberland County in Deed Book 185, Page 140, granted and conveyed unto Paul t. evins grantor heroin. UNDER AND SUBJECT to the Declaration of Amended Building and Use Restrictions for the Plan of North Ridge, Phase I as recorded in Cumberland County Misc. Book 496, Page 438 and to Declaration of Further Building and Use Restrictions for Certain Lots m the Plan of North Ridge Phase ~ ~ec(}rded i~'; Cumberland County Plan Book 67, Page 120, to be recorded AND the sa~d GRANTOR hereby warrant speciali~ the property herein conveyed. This deed Is between parent and child and is therefore exempt from all malty transfer taxes. IN WITNESS WHEREOF, the said GRANTOR does homily set his hand and seal the day and year first above written. Witness: PAUL LEVINE Estate Of ~, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW C_~ - ~ '~ .~n consideration of the petitionon the reverse side hereof, satisfactory proof having,be~ presented before me, IT IS DECREED that the instrument(s) dated (~~, c~c~, ~<f~'~(2 described therein be admit~robate ~d filed~record as the last w~l of ~d Letters ~~J~~ ~ ~e hereby ~anted to ~~ ~ ~//./~~ " / .... ~ R~.gister o f WiL~.~,,,~ E..~.,,/~ FEES ~enunciation ................ $ TOTAL ~ $. /~ ~ Filed .~:.~.~ 7.~.~...: .............. PHONE COMMONWEALTH OF PENNSYLVANIA - :SS. COUNTY OF CUMBERLAND - ON this the"~/~ay of~J/f-~'.~_...... ~ 2002, before me, the undersigned officer, personally appeared Paul Levinl~nown to me (or satisfactorily proven) to be the person whose name is subscribed to the within Instrument, and acknowledged the foregoing deed to be his act and deed and described the same to be recorded as such. WITNESS my hand and official seal the y and ~r flr,qt above wdtten. I hereby certify that the precise residence and complete post office address ot the within named GRANTEES is:~/.,,?~.%_~.....~., ...... '~ bc recorded . ,,:~ t,~:xt County PA x...~ :, Rccorder of Deeds 251 (6-0O) ~COMMONWEALTH R E._, V' I 5 0 0 l' ~ PENNSYLVANIA ~~~ DEPARTMENT OF REVENUE ~~~ DEPT. 280601 INHERIT NCE TAX RETURN 21 _ O4 0188 ~HARRISBURG. PA 17128-0601 RESIDENT DECEDENT co~.~co~ ~EOE.T'~.*~ (~ST. ~.ST.*.O ~ ,.,T~) ~A~SECU.,~.U~E. LEV'NE. PAUL ~8-~8-~335 DATE OF DEATH (MM-DD-YEAR) ~ DATE OF BIRTH (MM-DD-YEAR THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 01/30/2004 ~ 07/04/1928 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI~ NUMBER ,,, [] 1. Odginal Retum [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) r--3 4. Limited Estate I I L__J 4a. Future Interest Compromise (dale of death after 12-12-82) [] 5. Federal Estate Tax Return Required ~oo '"' ~ [] 6. Decedent Died Testate (Aftach copy of Will) [] 7. Decedent Maintained a Living Trust (Altech copy of T~Jst) 8. Total Number of Safe Deposit Boxes < [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (^tach ach O) m NAME ,"' COMPLETE MAILING ADDRESS z THOMAS E. FLOWER o 2109 MARKET STREET " FIRM NAME (IfApplJcable) "' SA,DIS, SHUFF, FLOWER & LINDSAY CAMP HILL, PA 17011 "' TELEPHONE NUMBER 0 ~ (717) 737-3405 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) 312.17 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 52,500.00 i-]Separate Billing Requested :.~ ::::3 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) I-- (Schedule G or L) ,~ 8. Total Gross Assets (total Lines 1-7) (8) 52,812.17 LU 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 7,509.75 10. Debts of Decedent, Mortgage Liabilities, & Uens (Schedule I) (10) 27,831.41 11. Total Deductions (total Lines 9 & 10) (11) 35,341.16 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 17,471.01 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax ~ rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) ~ 16. Amount of Line 14 taxable at lineal rate 17,471.01 x .o 45 (16) 786.20 ~: 17. Amount of Line 14 taxable at sibling rate x .12 (17) O ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) r---I ^., -Settlement Statement u.s. Department of Housing and Urban Development B. Type of Loan OMB No. 2502-0265 REV. HUD-1 (3/86) FINAL i. E]FHA 2. RFmHA 3. [3Conv. Unins. 6. File Number [ 7. Loan Number 8, Mortgage In;urance Case Number 4, [~VA 5 I~Conv ns ST2004-126CJL I ~ s ot~ i$ Iu~7'~lSh~(I to give y~u a slaternen of ac ua se lament cos $ ,,~moun s pa e o anti Dy the semement agent ere enown C. Note: ems marked" p o c "were pa d outside he c os rig; hey are shown here for information purposes aqd ~re not inc..lude~, in the totals. TitleExpress Settlement System WARNING It is a c~ime to know ng y make false stalemenls Io the Unlled S ales on h s or any gibe sim ar form I~enaltlaS upon c~nvicfion can include a I~ne and imprisonment For delails see: Title 18 U S Code Section 1001 and Section t010 Printed 04/14/2004 at 10:39 KLL D. NAME OF BORROWER: Scott Hodgson ADDRESS: E. NAME OF SELLER: Barbara Zaikowski ADDRESS: F, NAME OF LENDER: America's Wholesale Lender ADDRESS: MSN.SV791Document Control Dept, P.O. Box 10266, Van Nuys, CA 91410-0266 G. PROPERTY ADDRESS: 135 Imperial Court, Carlisle, PA 17013 North Middleton H. SETTLEMENT AGENT: Saidis, Shuff, Flower & Lindsay, Telephone: 717-243-6222 Fax: 717.243-6486 PLACE OF SETTLEMENT: 26 West High Street~ Carlisle, PA 17013 I. SETTLEMENT DATE: 04/1412004 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: t00. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101, Contract sales price 105~000.00 401. Contract sales price 105t000,00 102. PersonaIProperty 402. PersonaIProperty ~' 103, Se ement charges to borrower (line 1400) 6~744.75 403. 104. 404. 105, 405, __ Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 107. County taxes 04114104to12131104 212.31 407. County taxes 04114/04to12/31104 212.31 108. School Taxes 04114104to06130104 213.09 408. School Taxes 04114104to06130104 213.09 109. Assoc Dues 04114104to04130104 16.76 409. Assoc Dues 04114104to04130104 16.76 110, 410, 111. 411. 112, 412, 120. GROSS AMOUNT DUE FROM BORROWER 112~186,91 420, GROSS AMOUNT DUE TO SELLER 105~442.16 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or eamestmoney 1,000.00 501. Excess Deposit (see inslruclions) 202, Principal amount of new loans 84~000,00 502. Sett ement charRes to seller (line 1400) 9,563,23 203. Existing loan(s) taken subject to 503, Existin,q loan(s) taken subject to 204. 504. Payoff of First Mort,qa,qe Loan 55~662,82 Principal Residential Mortgage 205, 505, 206. 505. Estate Escrow 5~000,00 Saidis, Shuff, Flower & Llndsa 207, 507. 208. 508, 209, 509. Adlustments for Items unpaid by seller Adjustments for items unpaid by seller 213. 513, 214~ 514. 215, 515. 216. 516, 217, 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 85,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 70,226.05 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120) t 12~t86.91 601. Gross amount due to seller (line 420) 105,442.16 302. Less amounls paid by/for borrower (line 220) 85~000.00 602. Less reduction amount due seller (line 520) 70,226.05 303. CASH FROM BORROWER 27,186.91 603. CASH TO SELLER 35,216.11 SUBSTITUTE FORM IO99 SELLER STATEMENT: The infctrnatlon ce~lt~ned ~erein is important lax ioformation and I? being f~rnished to the Internal Re~venu~e Se~v'.~e_..If yo_u.are ?equ![e~d,te file a return, a negtigence penalty o~ ether sanction will be imposed on you if th~s item m required Io be reported and the IRS deterrmnes that it has not been reported, i ne ~onlract ~a[e$ ~-,rlce oescrl aQ on line 401 above constitutes [he Gross Proceeds of this transaction SELLER INSTRUCTIONS: If this real estate '.vas yourprincipal residence, fi~e Fonm 2119, Sale er Exchange of Principal Residence, for er~y gain, with your tncome tax return; for other transactions, complete the applicable pads of Form 4797, Form §252and/or Schedule D (Form 1040). you ere required by law lo provide the settlement agen (Fed Tax D Ne: ) with your correct axpayer den iflcatien number, if you do net provide your coffent taxpayer ident~cation numbe~, you may be subject to civil ~3r c~imin~l pei3alt~es imposed by law Under panalties of perjury, I ce~l~ that the n~r~par shown e~ th s statement is ~y correct taxpayer Identli~cation number. TIN: I SELLER(S) SiGNATURE(S): I SELLER(S) NEW MAILING ADDRESS: .,, ~NT'OF HOUSING AND URBAN DEVELOPMENT File Number: ST2004-126 FINAL PAGE 2 __oEI"T~i~MENT ........................ STATEMENT REV. HUD-1 (3/86) TilleExpress Settlement System Printed 04/1412004 at 10:39 KLL [~'[., SETTLEMENT CHARGES Paid FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price $105,000.00 ~, 7.000 = 7,350.00 BORROWER'S SELLER'S Division of commission (line 700} as follows: FUNDS AT FUNDS AT 701. $ 3,650.00 Io C-21 Associates Coon & Co. SETTLEMENT SETTLEMENT 702. ~ 3,700.00 to ERA NRT= Inc. 703. Commission paid ai Settlement 7~350.00 704. Settlemen~ransaction Fee to C-21 AssoclERA NRT, Inc. 125.00 100.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori.qination Fee % Commonwealth Funding Group 1,680.00 802. Loan Discount % 803. Appraisal Fee to Commonwealth Funding Group 275.00 804. Credit Report to Commonwealth Funding Group 19.00 805. Flood Cert to Landsafe Flood LR 25.00 806. Tax Service Fee to Countrywide Tax Service LR 90.00 807. 'Commitment FEe to America's Wholesale Lender LR 550.00 808. Frocessin.q Fee to Commonwealth Funding Group 150.00 809. PA Broker Fee to Commonwealth Funding Group 19.00 810. 811. Pram Pd by Ldr to to Broker (Cmmlth Funding) POC $420.00 900, ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. interest From 0411412004 to 0510112004 ~$ 12,9500/day 17 Days LR 220.15 902. Mod.qa.qe insurance Premium for [o 903, Hazard insurance Premium for to 904, 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo, ~,, $ 23.08/mo LR 69.24 1002. Mod.qa.qe insurance mo. ~ $ /mo 1003. City Properly Tax mo. ~ $ /mo 1004. County Property Tax 3 mo. ~,, $ 24.65/mo LR 73.95 1005. School Taxes il mo~ ~ ~ 83.10/mo LR 9i4.i0 1009. A,qqre.qate Analysis Adiustment LR -190.94 i100. TITLE CHARGES 1101. Se tlemen or closing fee tt02. Down Loan Fee to Said/s, Shuff, Flower & Lindsav 50.00 1103. Title examination 1104. Title insurance binder 1105, Doc Prep (Sub ol Mt.q/Deed to SSFL./ERA NRT, Inc, 150.00 75.00 1106. Notary Fees to Saidis~ Shuff~ Flower & Lindsa~ ........ 14.0-0 - 4.00 1107, Attorney's i~ees (includes above items No: 1108, Title Insurance to ACCP~ Inc. 883.75 (includes above Items No: 1109. Lender's Policy 84=000.00 - 1110. Owner's Policy 105~000.00 - 883.75 1111. End 100, End 300, End 820, Endto ACCP~ Inc. 200.00 1112. 1113. Ciosin,qServiceLetter to ACCP, Inc. 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin.q Fees Deed $ 38.50 ; Modga.qe $ 80.50 ; Release ~; 119.00 1202. City/County tax~slamps Deed $1 ~050.00 ; Modga,qe $ 1 ~050.00 1203. State Tax/stamps Deed ~;1~050.00 ; Mort.qa.qe $ 1t050.00 1204. Deed Recordin,q to Recorder of Deeds 38.50 1205. Escrow Aqt to Sa/dis, Shuff, Flower & Lindsay 75.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Overnight Pk.q/Payoff to Sa/dis, Shuff, Flower & Lindsay 20.00 20.00 1302, Pest Inspection to Home Paramount Pest 55.00 1303, 2004 Cty,q'wp Tax to Robin Sollenberger 295.78 1304, initiation Fee to Imperial Court Home Owners Assn 100.00 1305, Warranty to A.O.N. 409.00 1306, Incoming Wire Fee to Saidis~ Shufft Flower & Lindsay 10.00 1307, Final Water/Sewer #12004368 to North Middleton Authority 154.45 1308, Apdl Assn, Dues to Imperial Court H/O Assn. 30.00 1400, TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K) 6~744.75 9~563.23 HUD CERTIFICATION OF BUYER AND SELLER IhevecarefullyreviewedtheHUD-1 Settlement Slateme~t and to the best of m k~owledge and belief, it is a lrue ei3d accurate statemef3t of all receipts ar~clcilsbul'~ement..imadeonmyaccauntorbyr~e In this transaction I ludher cerllfy that I have received a copy of the HUD-1 Sett~iement Sletement. TheHUD-I Settlement tatementwh' e~eparedisatrueandeccurateacc~3untofthisb-ensaction. UNITED STATES ON THiS OR ANY SIMILAR FORM. PENALTIEe UPON CONVICTION I have ca,~jd or will the fu sbursed in accordance h th[ tatement. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004006 ZAIKOWSKI BARBARA LYNN 1444 EAST 70TH STREET BROOKLYN, NY 11234 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $154,62 ESTATE INFORMATION: SSN: 118-18-1335 FILE NUMBER: 2104-01 @8 DECEDENT NAME: LEVINE PAUL DATE OF PAYMENT: 06/03/2004 POSTMARK DATE: 06/02/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/30/2004 TOTAL AMOUNT PAID: $154.62 REMARKS' BARBARA ZAIKOWSKI ~ CHECK# 989 INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS-AT-LAW 2109 Market Street Camp Hill, PA 17011 TO: Register of Wills CUMBERLAND COUNTY COURTHOUSE One Courthouse Square Carlisle, PA 17013 LAST WILL AND TESTAMENT OF PAUL LEVINE I, PAUL LEVINE, now of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null and void all prior Wills and Codicils made by me at any time heretofore. ITEM I. I direct that all my legally valid debts, funeral and administrative expenses, and debts incurred or payable because of my death, shall be paid by my Executor, hereinaiter named, from my residuary estate as soon after my death as practicable. All death taxes, including federal, state, and other death taxes, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of administration of my estate, without apportionment or right of reimbursement. Taxes on future interests may be prepaid. ITEM II. It is my desire to be buried with my wife in Calverton National Cemetery in Calverton, Long Island, New York. Additionally, it is my preference that no viewing be held. I have discussed these wishes with my Executor hereinatter named. ITEM III. I make specific requests of real property to the following people: A. The interest I have, at the time of my death, in the property located at 1444 East 70th Street, Brooklyn, New York, to my daughter BARBARA LYNN ZAIKOWSKI, if she should survive me by thirty (30) days; Provided, however, that if any such named person does not so survive me, but leaves descendants who so survive me, such descendants shall receive, per stirpes, the share such named person would have received had she so survived me; but if such named person, nor their descendants, should so survive me, then this share shall be distributed under ITEM V hereof. B. The interest I have, at the time of my death, in the property located at 16 Old Post Road, Tobihanna, Pennsylvania, to my son, ROBERT S. LEVINE and his wife, BARBARA LEVINE, if either should survive me by thirty (30) days; Provided, however, that if any such named person does not so survive me, but leaves descendants who so survive me, such descendants shall receive, per stirpes, the share such named person would have received had he or she so survived me; but if such named person, nor their descendants, should so survive me, then this share shall be distributed under ITEM V hereof. C. The interest I have, at the time of my death, in the property located at 135 Imperial Court, Carlisle, Pennsylvania, to my daughter, BARBARA LYNN ZAIKOWSKI, if she should survive me by thirty (30) days; Provided, however, that if any such named person does not so survive me, but leaves descendants who so survive me, such descendants shall receive, per stirpes, the share such named person would have received had she so survived me; but if such named person, nor their descendants, should so survive me, then this share shall be distributed under ITEM V hereof. ITEM IV. I bequeath the personal effects, jewelry, and other tangible personalty of like nature that are solely owned by me at the time of my death, not otherwise disposed of above, shares to my daughter, BARBARA LYNN ZAIKOWSKI, if she should survive me by thirty (30) days; Provided, however, that if any such named person does not so survive me, but leaves descendants who so survive me, such descendants shall receive, per stirpes, the share such named person would have received had he or she so survived me; but if such named person, nor their descendants, should so survive me, then this share shall be distributed under ITEM V hereof. Such property shall be divided by my said beneficiaries as they shall agree. As to those items upon which they shall not agree, distribution shall be determined by my Executor. ITEM V. I give, devise and bequeath all of the residue of my estate, whether real, personal, or mixed, and wherever situate, including any property subject to any power of appointment which I may now have or hereafter acquire, in equal shares to my daughter, BARBARA LYNN ZAIKOWSKI, if she survives me by thirty (30) days; Provided, however, that if any such named person does not so survive me, but leaves descendants who so survive me, such descendants shall receive, per stirpes, the share such named person would have received had he or she so survived me; but if such named person, nor their descendants, should so survive me, then this share shall be distributed pursuant to this ITEM V hereof. ITEM VI. The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM VII. I hereby appoint my daughter, BARBARA LYNN ZAIKOWSKI, as executor (the "Executor"), of this, my Last Will and Testament. In the event of the refusal or inability of such named person to so serve, I then grant to the person the right and power, exercisable in her exclusive discretion, to nominate and appoint, whether in advance while competent, or at the time of a renunciation or resignation, a person or persons to serve as such Executor, which nomination shall be honored as if I had made such an appointmem in this Will. 4 ITEM VIII. I direct that my Executor shall not be required to give bond or post any other security for the faithful performance of duties in any jurisdiction. ITEM IX. Any person who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. ITEM X. My Executor shall have the following powers in addition to those invested by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distribution of all property: A. To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate so to do. B. To vary investments, when deemed desirable by my Executor, and to invest in such bonds, common trust funds, stocks, notes, real estate mortgages, or other securities or in such other property, real or personal, as my Executor deems wise, without being restricted to so-called "legal investments". C. In order to effect a division of the principal of my Estate or for any other purpose, including any final distribution, my Executor is authorized to make 5 said divisions or distributions of the personalty and realty partly or wholly in kind. If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. D. To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or interests therein owned by my Estate severally or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of' the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge, and deliver any and all deeds, assignments, options, or other writings which may be necessary or desirable, in carrying out any of the powers conferred upon my Executor in this paragraph or elsewhere in my Will. E. To mortgage real estate, and to make leases of real estate for any period of time as my Executor may deem reasonable. 6 F. To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration, or inheritance, legacy, estate, or other taxes. G. To pay all costs, taxes, expenses, and charges in connection with the administration of my Estate. My Executor shall pay expenses of my last illness and funeral expenses. H. To vote any shares of stock which form a part of my Estate, and to otherwise exercise all the powers incident to the ownership of such stock. I. To compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of seven (7) typewritten pages, this ~- ~' day of ~~~; 2000. PAUL LEVINE 7 We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator, PAUL LEVINE, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. COMMONWEALTH OF PENNSYLVANIA : : SS.: COUNTY OF CUMBERLAND : We, PAUL LEVINE, the Testator, and ~ ~ ~ ~')e Lo c e ~ z o , and u~) ~ ~1 ~' e ~ ~ a ~. , the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. PAUL LE~ jr Witness ~ Subscribed, sworn to and acknowledged before me by the Testator, PAUL LEVINE, and subscribed andsworntobeforemeby ..3"'-~¼~, Oe Loc e,~ ?_. o and t. DC, ~l ,~ e /--~. _~ /~ ~ ,,/ e._ , witnesses, this ~ ¢'Z~ day of ~ ~ ~ c~ c y, ,2000. Notary Pul61ic (SEAL) i Notarial Seal Connie d. Tritt, Notary Public i Carlisle, Cumberland County ,.... Commission Expires Oct. 5, 2000 13854.3 9 Fh~s is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. ,,,,, ~ Local Registrar "~ P 9990860 ~~ JAN 80 2004 No. ~ Date COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH "'" ,.-"""""~' , ...,./,,t' - ~r,- - Cumberland Carlisle . Carlisle Regional Medical Center k. . . ,.. White Dealership Manager ,,,.Automobile I,,. 1,,. 12 I ,.. Widowed 135 Imperial Court .E~o~.c~c?u~ ,7..~m PA ~°" ,,~.~ Carlisle PA 17013 ~ ,~. c.~ Cumberland ~? ,,..~ Harry Levine ~.s.~.~ ~,_~-,~) ,.. Rachel Rabinowit z Barbara Zaikowski I~' 1444 /Uth St., Brooklyn NY 11234 --~ c,~.,,.,,S .-~m.,.~ Sl,,~ebruary 3, 2004 I,,C~.lverton National Cemeteryl~,i.Calverton NY Im,?. . Hanover St. ~ Carlisle PA 17013 ·, ' I., Il: ~p~.. I.. ¢ ' ¢~' ° f I~ ..o ~~.~~,~,~,~ ...... ~ ................. r.~.~~. ..................... ~ ~,~. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003858 ZAIKOWSKI BARBARA LYNN 1444 EAST 70TH STREET BROOKLYN, NY 11234 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 101 $6OO.OO ESTATE INFORMATION: SSN: 118-18-1335 FILE NUMBER: 2104-01 88 DECEDENT NAME: LEVINE PAUL DATE OF PAYMENT: 04/23/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/30/2004 TOTAL AMOUNT PAID' $600.00 REMARKS' CHECK# 985 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BURLINGTON, NJ WELTMAN, WEINBERG & REIS CO., L.P.A. 609.914.0437 ATTORNEYS AT LAW CINCINNATI, OH 323 W. Lakeside Avenue, Suite 200 513.723.2200 Cleveland, Ohio 44113-1099 COLUMBUS, OH 216.685.1000 614.228.7272 www.weltman.com DETROIT, MI 248.362.6100 PHILADELPHIA, PA 215.599.1500 PITTSBURGH, PA 412.434.7955 May 19, 2004 Cumberland, Register Of Wills One Courthouse Square Carlisle, PA 017013 Re: Estate of Paul Levine Case No. 21-04-188 Our Client: Bank of America, N.A. Account No. 4427100032677903 Balance Due: $301.92 Our File No. 3646349 Dear Clerk of Courts: This law fLrrn represents Bank of America, N.A. in connection with its claim which we wish to file on our client's behalf into the estate of Paul Levine, deceased. Enclosed is our check in the amount of $5.00 which we understand is the filing fee for this claim. Our client's claim is based upon its account number 4427100032677903 in the amount of $301.92. As of the date of this letter, this is the amount due. Ineluded with this letter is the claim form which we wish to present to this court and which we are forwarding to the attorney and/or fiduciary of this estate. It would be appreciated if all correspondence and disbursements with respect to this matter be forwarded to our office and to the attention of the undersigned. Additionally, it would be appreciated if any notices of any hearings also be forwarded to the undersigned. Thank you for your cooperation in this matter. ~.~cerely Yours, Veda Flowers Legal Assistant (216) 685-1171 VLF:iar Enclosures cc: Barbara Lynn Zaikowski i:.', BURLINGTON, NJ WELTMAN, WEINBERG & REIS CO. L.P.A. 609.914.0437 ATTORNEYS AT LAW CINCINNATI, OH 323 W. Lakeside Avenue, Suite 200 513.723.2200 Cleveland, Ohio 44113-1099 COLUMBUS, OH 216.685.1000 614.228.7272 www.weltman.com DETROIT, MI 248.362.6100 PHILADELPHIA, PA 215.599.1500 PITTSBURGH, PA 412.434.7955 May 19, 2004 CERTIFIED MAIL Barbara Lynn Zaikowski 1444 East 70th St Brooklyn, NY 11234 Re: Estate of Paul Levine Case No. 21-04-188 Our Client: Bank of America, N.A. Account No. 4427100032677903 Balance Due: $301.92 Our File No. 3646349 Dear Sir or Madam: This law finn represents Bank of America, N.A. with respect to the claim which we wish to file in the estate of Paul Levine. It is our understanding that you are the Fiduciary of the estate. We are asking that you please accept our client's claim which is based upon its account number 4427100032677903 in the amount of $301.92. As of the date of this letter, this is the amount due. Please direct all correspondence and disbursements with respect to this estate directly to our office. It would also be appreciated if you contact us to advise us when you anticipate making disbursements in this matter so that we may mark our file for follow-up at that time. Thanking you in advance for your cooperation in this matter. This law finn is attempting~'to collect this debt for our client and any information obtained will be used for that purpose. Lastly, do not hesitate to contact us to further discuss this matter. i~ ' ~: i Veda Flowers Legal Assistant (216) 685-1171 VLF:iar I' ' ' ]~ Iv~ ~0. Enclosures ~ cc: Barbara Lynn Zaikowsld- regular mail WWR#3646349 FORM 93-O.C. DIVISION IN THE COURT OF COMMON PLEAS of CUMBERLAND, REGISTER OF WILLS, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF No. 21-04-188 Paul Levine Deceased For a credit card with Bank of America, N.A., Account No. 4427100032677903 CLAIM To the Clerk of Orphans' Court Division: Index and make proper entry in your official records of the claim of Bank of America, N.A. c/o Weltman, Weinberg & Reis Co., L.P.A., 323 West Lakeside Avenue, Suite #200, Cleveland~ Ohio 44113-1099 (Claimant) in the amount of $301.92 against the estate of the above named decedent. This claim is filed under Section 3532 (b) (2) of the Probate, Estates and Fiduciaries Code. The said decedent, who resided at 135 Imperial Ct Carlisle PA 17013 (Address) Written notice of this claim was given to Barbara Lynn Zaikowski on (Personal representative, if any, or counsel) 1444 East 70th St Brooklyn, NY 11234 & Address or Personal Representative, if any, or counsel (Claimant) Veda Flowers, Agent for the Claimant '' ~/p Weltman, Weinberg, & Reis Co., L.P.A. 3'33 W. Lakeside Ave., Suite200 Cleveland, Ohio 44113 (Claimant's Address) WWR # 3646349 ~ STATEMENT OF ACCOUNTS FOR: Bank of America, N.A. DECEDENT'S NAME: Paul Levine ADDRESS: 135 Imperial Ct CSZ: Carlisle, PA 17013 SSN: 118-18-1335 DOD: 01/30/04 ACCOUNT #: 4427100032677903 BALANCE DUE: $301.92 EXHIBIT A JRD/June 30, 1992/17858 In Re: Estate of PAUL LEVINE : ORPHANS' COURT DIVISION Late of NORTH MIDDLETON TOWNSHIP : COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY Estate No.: 21-04-188 : PENNSYLVANIA : NO. 21-2004-188 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: BARBARA LYNN ZAIKOWSKI Counsel for Personal Representative: Date of Grant of Original Letters: 02-24-2004 Date of Delinquency Notice: 06-03-2004 The undersigned, Glenda Famer-Strasbaugh, Clerk of the Orphans' Court, 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 named 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 Clerk of the Orphans' Court on JUNE 3, 2004, 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. Gl~nda Famer Strasbaugh,~Bt- ~, ~ Clerk of the Orphans' Cour0 ' O ~ Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for at in Courtroom No. 3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. ~ - %~'~'~'- COMMONNEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z8060! HARRISBURG, PA 171Z8-0601 NOTICE OF /NHER/TANCE TAX APPRA/SEHENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-164?EXAFP(01-05} DATE 07-26-2004 ESTATE OF LEVINE PAUL DATE OF DEATH 01-$0-2004 FILE NUHBER 21 04-0188 COUNTY CUMBERLAND THOMAS E FLONER ACN 101 SAIDIS ETAL Amount Ra.i~ad 2109 MARKET ST CAMP HILL PA 17011 HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LEVINE PAUL FILE NO. 21 04-0188 ACN 101 DATE 07-26-2004 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~e~e (Schedule A) {1) .00 NOTE: To insure proper 2. S~ocks and Bonds {Schedule B} (2) .00 credi~ ~o your account, $. Closely Held S~ock/Par~nership In~eres~ (Schedule C} ($} .00 subei~ ~he upper portion i. Hor~gages/No~es Receivable {Schedule D) (1) .00 of ~his fore wi~h your 5. Cash/Dank Deposits/Hisc. Personal Property (Schedule E) (5) $12.17 tax pay.ant. 6. Jointly Owned Property (Schedule F) (6) 5Z~500.00 7. Transfers (Schedule G) (7) .00 B. To'al Assa*s (8) 52,812.17 APPROVED DEDUCTIONS AND EXEMPTIONS: 7,509.75 9. Funeral Expenses/Ad.. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Deb~s/Hor~gage Liabilities/Liens (Schedule Z) (10) ~7;8~1.41 11. Total Deductions ,~-)~ (11) 12. Ne~ Value of Tax Re~urn ~ <~' (la~ .~,_~,471.01 (13~ 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule lI. Na~ Value of Es~a~e Subjec~ ~o Tax ~!; (li~ i,;i?*~::, ,471.01 _c=_~, 18~..:~ will NOTE: If an assessment ~as issued previously, 11nee 1~, 15 and~ri16, reflect figures that lnclude the total of ALL returns as~sSed ASSESSMENT OF TAX: ~*~ l~. A.oun~ o+ Line II at Spo.s.1 rate (lS~ --~!~O*~X O~ : . O0 16. Amount of Line Ii taxable at Lineal/Class A rate (16) 17,471~iix O~ 786 17. Aeount of Line li a~ Sibling rate (17) ~O~i"X 1~ .00 lB. Aeount of Line ii taxable at Collateral/Class B rate (18), .00 X 15 = .00 19. Principal Tax Due (19)= 786.20 TAX CREDITS PAYMENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 04-IS-ZOO4 CD005858 $1.58 600.00 06-0Z-Z001 CD004006 .00 154.62 TOTAL TAX CREDIT I 786.20 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE · O0 ~ IF PAID AFTER DATE ZNDTCATED, SEE REVERSE ( 1F TOTAL DUE IS LESS THAN $1~ NO PAYHENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyaent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coemonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laeful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 91qO). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the reverse side. --Make check or money order payable to: REGISTER OF #ILLS, AGENT REFUND (CR): 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 and Estate Tax" (REV-1513). Applications ars available at the Office of the Register of #ills, any of the 23 Revenue District Offices, or by calling the special 2~-hour answering service for forms ordering= 1-800-56Z-Z050~ services for taxpayers with special hearing and / or speaking needs= 1-800-~47-30Z0 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disalloeanca 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. ZSlOZ1, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060l, Harrisburg, PA 17lZB-060l Phone (717) ?&7-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-150Z) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CSZ) discount of the tax paid is allowed. PENALTY: The 15Z 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 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 wouId appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes ehich became delinquent before January l, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 198Z will bear interest at a rate ehich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZO0~ ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .0005~6 ~"~)"~6-1991 11Z .000501 ~ 9X .O00Zq7 1983 16Z .000458 199Z 9Z .O00Zq7 ZOOZ 6Z .00016fi 1984 112 .000301 1993-199fi 72 .00019Z ZOO5 5Z .000137 1985 132 .000556 1995-1998 9Z .000247 ZOOq qZ .000110 1986 IOZ .O00Z7q 1999 7Z .00019Z 1987 IOZ .O00Z7fi ZOO0 7Z .00019Z --Interest is calculated as follows: /NTEREST = BALANCE OF TAX UNPAID X NUNBBR OF DAYS DeLiNQUENT X DAILY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest caXculation 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. STATUs REPORT UNDER RULE 6.12 Name of Decedent: Paul Levine Date of Death: January 30, 2004 File No. 21-04-0188 Admin. No. 2004-00188 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, 1 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: 3. If the answer to No. 1 is Yes, state the following: No __X a. Did the personal representative file a final account with the Court? Yes___; account is: b. The separate Orphans' Court No. (if any) for the personal representative,s c. Did the personal representative state an account informally to the parties in interest? Yes ~X; No d. Copies of receipts, re/eases, joinders and approvals of formal or informal accounts may be flied with the Clerk of the Orphans' Court and may be attached to this report. · : ~ '~; ~j Name: Thomas E. Flower, Esquire i~oio I.D. No. 83993 SAIDIS, SHUFF, FLOWER & LINDSAY c~,:.17- 3fJY 1;~. 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 ':'~ az?~JO"W :::2:i Capacity: ----___ Personal Representative ~ Counsel for Personal Representative Glenda Farrier Strasbaugh Deputy Register of Wills Clerk of Orphans'Court ~'~'. ~!i~ Kirk S. Sohonage,solicitor Esq Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: 172 Invoice Date: 1-14-05 WELTMAN, WEINBERG & REIS Estate of: PAUL LEVINE 323 WLAKESIDE AVE Estate No: 21-2004-0188 STE. 2O0 VZ CLEVELAND, OH 441139978 Qty Fee Description Fee Total 7 COPIES 0.50 $3.50 Total: $3.50 Checks should be made payable to the Register of W'fils. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. 2flcl , - X'(\VOI~ Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solidtor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 172 1/14/2005 PAUL LEVINE 21-2004-0188 WEL 1MAN WEINBERG & REIS 323 WLAKESIDE AVE STE 200 CLEVELAND,OH441139978 vz Qty 7 Fee Description COPIES Fee Total 0.50 $3.50 Total: $3.50 Checks should be made payable to the Registet of Wills. Tenns: Net 30. Please tetum one copy of this invoice with your payment. Thank you.