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Home My WebLink About03-0500Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Catherine D. Cywinski No. c~//~'(~(3~- ~'"~ also known as Robed J. Ulmer Petitioner(s), who is/are 18 years of age or older, apply(les) for: , Deceased Social Security No. 194-24-6473 (COMPLETE "A" OR "B" BELOW:) [] A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ~ Decedent, dated 5/31/2000 and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c. La., d.b.n.c.t.a.: pendente lite, durante absentia; durante minodtate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 591 Geneva Drive~ Apt. 21~ Mechanicsbur,g~ Pennsylvania 17055 (list street, number and municipality) Decedent, then 71 years of age, died June 3 ,2003 , at Holy Spirit Hospital (East Pennsboro Township) (Location) Decadent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ......................................... $ (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ Real Estate situated as follows: 100,000.00 55,000.00 155,000.00 591 Geneva Drive, Mechanicsburg, Pennsylvania 17055 (Upper Allen Township) Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: I Signature Typed or printed name and residence Robed J. Ulmer 660 Geneva Dr., Apt. #6 Mechanicsburq, PA 17055 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and afffirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this 19 t h day of DECREE OF REGISTER Estate of Catherine D. C_vwinski Deceased No. 21-03-500 also known as Social Security No: 194-24-6473 Date of Death: 6/3/2003 AND NOW, June 16th , 2003 , in consideration ofthe Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary I~ of Administration (c.t.a., d.b.n.c.t; pendente lite; durante absentia; durante minodtate) are hereby granted to Robed J. Ulmer in the above estate and that the instrument(s), if any, datedMa¥ 31, 2000 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... $ Shod Certificate(s) .._4. .......... $ Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages( 3 ) .............. $ Codicil ................................. $ JCP Fee ................................. $ Inventory & Tax Forms ............. $ Other ...................................... $ RW-7A TOTAL ............................. $ Mailed letters to on 6/19/03 235.00 12.00 9.00 10,00 . 266.00 Attorney Donna M. Otto,~;%°f~;~uty '~~ ~'/~ Attorney roes E. Reid, Jr. I.D. No: 18032 Address: 3425 Simpson Ferry Road Camp Hill PA 17011 Telephone: 717-763-1121 DATE FILED: 6/19/03 L L: ~ ~' d L NI"II"' 21-2003-500 £l:8~i 6l N~l? fO. 21-2003-500 LAST WILL AND TESTAMENT OF CATHERINE D. CYWINSKI I, CATHERINE D. CYWINSKI of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Will and hereby revoke all prior Wills and Codicils made by me. DISPOSITION OF REMAINS FIRST: I direct that all of my just debts and the expenses of my last illness and funeral be paid by my Executor from my estate as soon as practicable after my death and that my remains be cremated. PAYMENT OF DEATH TAXES SECOND: I direct that all estate, inheritance and succession taxes that may be assessed in consequence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration; and all property includible in my taxable estate whether or not passing under this Will, shall be free and clear thereof. PECUNIARY BEQUEST THIRD: I bequeath the sum ofTen Thousand Dollars ($10,000.00) to my companion, Robert J. Ulmer, of Mechanicsburg, Cumberland County, Pennsylvania. DISTRIBUTION OF RESIDUE OF ESTATE FOURTH: I give, devise and bequeath all of the rest, residue and remainder of my estate of whatsoever nature and wheresoever situate, in equal shares to my son, Paul A. Cywinski, and my daughter, Cheri L. Cywinski, provided that they survive me by 30 days. FIFTH: In the event that my son, Paul A. Cywinski, should predecease me or fail to survive me by thirty days, and in the event that my son should have any living children at the time of my death, and in the event that my daughter ~heri L. Cywinski should still be living a survive me fc~r a period of thirty days, I give, devise and bequeath seventy-five percent (75%) of the share of all the rest, residue and remainder of my estate to my daughter, Cheil L. Cvwinski and twenty-five percent (25%) of all the rest, residue and remainder of my estate to be divided equally by the children of my son, Paul A. Cywinski. - SIXTH: In the event that my daughter, Cheri L. Cywinski should predecease me or fail to survive me by thirty days, and in the event that my son, Paul A Cywinski, should still be living and survive me for a period of thirty days, I give, devise and bequeath all the rest, residue and remainder of my estate to my son, Paul A. Cywinski. SEVENTH: In the event that my son, Paul A. Cywinski, and my daughter, Cheri L. Cywinski, should both predecease me or fail to survive me by thirty days, I give, devise and bequeath all of the rest, residue and remainder of my estate to be divided equally by their children. POWERS OF EXECUTOR EIGHTH: My executor and his successor shall have, in addition to those given by law, all of the powers given to them in this Will, to be exercised by them in their absolute discretion, which powers shall be applicable to all property held by them, effective without the order of any court. APPOINTMENT OF EXECUTOR NINTH: I appoint Robert J.Ulmer ofMechanicsburg, Cumberland County, Pennsylvania, the Executor of this Will. If he is unable or unwilling to qualify as Executor or, having qualified, is unable or unwilling to act, I then appoint my son, Paul A. Cywinski, of Canovanas, Puerto Rico, as Executor hereof. I direct that my Executor or his successor shall not be required to furnish security in any jurisdiction. HEADINGS TENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. IN WITNESS WHEREOF, I CATHERINE D. CYWINSKI, have to this, my last Will and Testament, contained on this page and the foregoing one (1) page, set my hand and seal, this ~ day of~000. ACKNOWLEDGMENT AND AFFIDAVIT State of Pennsylvania County of Cumberland SS: I, Catherine D. Cywinski, the testatrix in and the undersigned witnesses to the Will, the foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed the instrument as my Will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her Will, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Testatrix Wimess Address Witness Address t' _ SUBSCRIBED, swom to and acknowledged before me by CATHERINE D. CYWINSKI, ne iestatrix, and subscribed and sworn to before me by /~J(~ 5 3c~ d [~'.~ .'~o ¢C] and ~"~'~,~,. [,O~-;~,..e,c~,this fl/Sp dayof //~ .~.~ · Notary Public fit_~~~ 1~7a ' ' ' :- ~ NOTARIAL SEAL 250-060c COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O03617 REID JAMES E JR ESQUIRE 3425 SIMPSON FERRY ROAD CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 194-24-6473 FILE NUMBER: 2103-0500 DECEDENT NAME: CYWINSKI CATHERINE D DATE OF PAYMENT: 03/01/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/03/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $17,594.99 i REMARKS: JAMES E REID, JR CHECK# 1156549 SEAL TOTAL AMOUNT PAID: ESQUIRE 917,594.99 INITIALS' AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00) I-- Z ~J Z o rtl o Z Z 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) Cywinski, Catherine, D. DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year) 06/03/2003 I 11/13/1931 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 5 0 COUNI"f CODE YEAR NUMBER SOCIALSECURITYNUMBER 1 9 4-2 4-6 4 7 3 THIS RETURN MUST BE FILED IN DUPLICATE WffH THE REGISTER OF WILLS SOCIALSECURITYNUMBER I'll. Original Retum r~4. Limited Estate E~6. Decedent Died Testate (Attach copy of Will) F--~9. Litigation Proceeds Received '-']2. Supplemental Retum ['"~ 4a. Future Interest Compromise (date of death after 12-12-82) O7. Decedent Maintained a Living Trust (Attach copy of Trust) F~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1.95) [~]3. Remainder Return (date of death prior to 12-13-82) r'-] 5. Federal Estate Tax Retum Required __ 8. Total Number of Safe Deposit Boxes r~l 1. Election to tax under Sec. 9113(A) (Attach Sch O) NAME I COMPLETE MAILING ADDRESS James E. Reid, Jr., Esquire J 3425 Simpson Ferry Road FIRM NAME (If Applicable) ] Shumaker Williams, P.C. ] TELEPHONE NUMBER I 717-763-1121 I Camp Hill PA 17011 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 Pemonal Property (5) (Schedule E) 6. Jointly Owned Properly (Schedule F) (6) E] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11, Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable 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) (8) (11) 55,000.00 OFFICIAL USE ONLY 326 4'84;32 :.:, 26,116.00 1,665.60 395,448.00 27,781.60 367,666.40 (12) (13) (14) 367,666.40 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) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 357,666.40 x .045 X .12 10,000.00 x .15 20. (15) (16) (17) (18) (19) 16,094.99 1 ~500.00 17,594.99 Decedent',s Complete Address: I STREET ADDRESS 591 Geneva Street Apartment #21 CITY Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty ISTATE PA ziP (1) 17055 Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 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 a. retain the use or income of the property transferred; ........................................................................... [] b. retain the dght 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? ....................................................................................................... [] 17,594.99 No 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 perjur~, I declare that I have examined th s return, nc uding accompanying schedules and statements and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of wh ch preparer has any knowledge. SIGNATURE QF'"~PERSON ~ESPONSI[~LE F~OR FILING RETURN 17,594.99 17,594.99 ADDRESS 660 Geneva Drive, Apt. #6 Mechanicsburg SIGNATUF~-'OF, PREPARER OTHER THA~/REPRESENTATIVE · / ADDRESS f 342~-Simpson Ferry Road ~ _C/"amp Hill PA 17055 DATE "z --Z<;, .- PA 17011 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 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 P.S. §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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEA REAL ESTATE FILE NUMBER C_vwinski, Catherine, D. 21 03 0500 All real properly owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real properly which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 591 Geneva Street, Apt. #21 Mechanicsburg, PA 17055 TOTAL (Also enter on line 1, Recapitulation) 55,000.00 $ 55,000.00 (If more space is needed, insert additional sheets of the same size) SUBSTITUTE FORM 1099-S COPY B lfvou have questions call KATHY SCHNEIDER {~ (717) 763-1121 [ ] CORRECTED (if checked) FILER'S nam'e, street address, city, state, ZIP code, a'nd 'telei~hone no. - I Date of closing OMB No. 1545-0997 SHUMAKER WILLIAMS,P.C. 3425 SIMPSON FERRY ROAD Proceeds From Real CAMP HILL, PA 17011 10/22/03 2003 Estate Transactions 2 Gross proceeds $55,000.00 Form 1099-S FILleR'S Fedexal identiticafion numl~r I TRANSFEROR'S identification number 3 Address or legal description Copy E 23 -2013661 [ 01-6229943 For Transfero~ TRANSFEROR'S name 591 Geneva Dr., Apt 21 Mechanicsburg, PA 17055 This is important ta~ information and Estate of Catherine D. Cywinski being furnished to th~ lnternal Revenu~ Service. If you ar~ Street address (including apt. no.) required to file ~ 660 Geneva Dr. return, a negligenc~ penalty or othe~ Apt 6 sanction may b~ City, state, and ZIP code 4 Transferor received or will receive property or services imposed on you ifthi.~ Mechanicsburg, PA 17055 as part of the consideration (if checked) ~> I I item is required to b~ reported and the IRS Account number (optional) 5 Buyer's part of real estate tax determines that it ha., 03749 CYWINSK] $0.00 not been reported Form 1099-S (Keep for your records.) Department of the Treasury -lnternal Revenue Service Instructions for Transferor For sales or exchanges of certain real estate, the person responsible for closing a real estate transaction must report the real estate proceeds to the Internal Revenue Service and must furnish this statement to you. To determine if you have to report the sale or exchange of your main home on your tax return, see the Schedule D (Form 1040) instructions. If the real estate was not your main home, report the transaction on Form 4797, Sales of Business Property, Form 6252, Installment Sale Income, and/or Schedule D (Form 1040), Capital Gains and Losses. Federal mortgage subsidy. You may have to recapture (pay back) all or part of a Federal mortgage subsidy if all the following apply: ® You received a loan provided from the proceeds ora qualified mortgage bond or you received a mortgage credit certificate, · Your original mortgage loan was provided after 1990, and · You sold or disposed of your home at a gain during the first 9 years after you received the Federal mortgage subsidy. This will increase your tax. See Form 8828, Recapture of Federal Mortgage Subsidy, and Pub. 523, Selling Your Home. Box 1. Shows the date of closing. Box 2. Shows the gross proceeds from a real estate transaction, generally the sales price. Gross proceeds include cash and notes payable to you, notes assumed by the transferee (buyer), and any notes paid off at settlement. Box 2 does not include the value of other property or services you received or are to receive. See Box 4. Box 3. Shows the address or a legal description of the property transferred. Box 4. If marked, shows that you received or will receive services or property (other than cash or notes) as part of the consideration for the property transferred. The value of any services or property (other than cash or notes) is not included in box 2. Box 5. Shows certain real estate tax on a residence charged to the buyer at settlement. If you have already paid the real estate tax for the period that includes the sale date, subtract the amount in box 5 from the amount already paid to determine your deductible real estate tax. But if you have already deducted the real estate tax in a prior year, generally report this amount as income on the "Other income" line of Form 1040. For more information, see Pub. 523, Pub. 525, and Pub. 530. YOU ARE REQUIRED BY LAW to provide your correct taxpayer name and identification number for the transaction described above to: SHUMAKER WILLIAMS, P.C. If you do not provide your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. UNDER THE PENALTIES OF PERJURY, I certify that the above information, including my taxpayer identification number, is correct, and that I have received a copy of this statement. Estate of Catherine D. Cywinski Ba'fil-~. Ulmer, Entecutor ~- J File It: 03749 CYWINSKI COPY Made this '/'~ ~A day of /i~.~_, the year of our Lord One Thousand Nine Hundred and Ninety-Eight (1998)? BETWEEN and CATHERINE D. ROSS, a single person, Grantor, party of the first part, CATHERINE D. CYWINSKI, a single person, grantee, party of the second part. WITNESSETH, that the said party of the first part, for .and in consideration of the sum of Fifty-Four Thousand Eight Hundred Fifty ($54,850.00) Dollars, lawful money of the United States unto her well and truly paid by the said party of the second part, the receipt whereof is hereby acknowledged, does hereby grant, bargain, sell, alien, enfeoff, release, convey and confirm unto the said party of the second part, her heirs and assigns' ~LL THAT CERTAIN Unit, being Unit No. 591-21 (the "Unit") of Sunguild III, A condominium, located in Upper Allen Township, Cumberland County, Pennsylvania, which Unit is designated in the Declaration of Sunguild III, A Condominium (the "Declaration of Condominium") and Declaration Plats and Plans as recorded in the Recorder's Office of Cumberland County in Misc. Book 357, Page 20, and in Right of Way Plan Book 9, Page 24; as amended in Misc. Book 362, Page 1111, and Plan Book 57, Page 132 and as further amended in Misc. Book 365, Page 993 and Plan Book 58, Page 81. TOGETHER with an undivided 1.0763% interest in Common Elements as more particularly set forth in the aforesaid Declaration of Condominium and Declaration of Condominium and Declaration Plats and Plans, as amended. TOGETHER with the right to use any limited common elements applicable to the Unit being conveyed herein, pursuant to the Declaration of Condominium and Declaration Plats and Plans, as amended. UNDER AND SUBJECT TO any and all covenants, conditions, restrictions, rights-of-way, easements and agreements of record in the aforesaid Office, the aforesaid First Amendment to Declaration. and matters which a physical inspection and survey of the Unit and Common Elements would disclose. THE GRANTEE, for and on behalf of the Grantee and the Grantee's heirs, personal representatives, successors and assigns, by the acceptance of this Deed, covenants and agrees to pay such charges for maintenance, repairs, replacements and other expenses in connection with the Common Elements, and any Limited Common Elements appurtenant to said Unit, as may be assessed against her, or said Unit, from time to time by the Executive Board of the Sunguild III Condominium Association in accordance with the Uniform Condominium Act of Pennsylvania, and further covenants and agrees t~hat the Unit conveyed by this Deed shall be subject to a lien for all amounts so assessed except insofar as Section 3407(c) of said Uniform Condominium Act may relieve a subsequent Unit Owner of Liability for prior unpaid assessments. This covenant shall run with and bind the land or Unit hereby conveyed and all subsequent owners thereof~_~ ,fi- . e premi.~es which A~ a apPurtenances hen *u- -- "~ ~ne above de ' u ....~sa~ artv o ~ ....... scribed premises with P ~ f t..~ ~cvna par~, ~.heirs and assi-ns fo the AND the said party of the first part will warran~ hereby conveyed, specially the property IN WITNESS WHEREOF, the said party of the first part has hereunto set her hand and seal the day and year first above written. Signed, Sealed and Delivered in the presence of COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : On this, the /~ day of C~ , 1998, before me, a Notal~' Public, the undersigned officer, personally appeared CATHERINE D. ROSS, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed same for tt~e purposes therein contained. ',.. IN WITNESS WHEREOF, I hereunto set my hand and official seal · ,?b.~L;(ll, ...... ....~ · ..- ~,~,.... ,'.~.:.~,,, Title o£ Officer . .,.~ ..... My Commission Expires: I HEREBY CERTIFY that the precise residence of the Grantee is: F~EV- 1508 E~X +, (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Cvwinski. Catherine, D. ITEM NUMBER 1. FILE NUMBER 21 03 0500 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. DESCRIPTION VALUE AT DATE PNC Bank OF DEATH 7,834.15 Account No.51-4001-4378 Tangible Personalty (per appraisal by Linden Hall Antiques) Rent Paid to the Estate by Paul Cywinski Re: 591 Geneva Street, #21 Mechanicsburg, PA 17055 AIM Investments Mutual Fund - AIM High Yield Fund (non-qualified) Account #3909080602 TOTAL (Also enter on line 5, Recapitulation) 1,715.00 226.85 4,187.68 13~963.68 (if more space is needed, insert additional sheets of the same size) To: From: Re: Bob Ulmer 660 Geneva Drive - Apt. 6 .Mechanicsburg, PA 17055 William G. Rowe, Appraiser 211 Old Stone House Rd. Carlisle, PA 17013 Personal Property Appraisal Estate of Cathdne D. Cywynski 591 Geneva Drive - Apt. 21 Mechanicsburg, PA 17055 Date: July 24, 2003 LINDEN HALL ANTIQUES 2'11 OLD STONE HOUSE ROAD CARLISLE, PA '17013 717-249-'1978 LIVING ROOM Sofa Upholstered chair Lamp Picture Planter Hummel collection (5) Wing chair Knick knacks Music cabinet / shelf TV / VCR - accessories KITCHEN Table / chairs Pots ! pans Misc. household Dishes Small appliances CLOSET Linens Christmas items Misc. household BEDROOM Bedroom set Costume jewelry Lamps Prints OUTSIDE Patio set $110.00 $50.00 $5.00 $15.00 $10.00 $250.00 $30.00 $15.00 $50.00 $225.00 $40.00 $15.00 $15.00 $5.00 $10.00 $40.00 $5.00 $10.00 ,$450.00 $15.00 $15.00 $10.00 $25.00 Cywynski Appraisal I 7/24/2003 AUTOMOBILE 1984 Volvo - poor to average condition All appliances to be sold with townhouse $300.00 $0.00 TOTAL $1,715.00 William G. Rowe Cywynski Appraisal 2 7/24/2003 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER C_vwinski. Catherine, D. 21 03 0500 This schedule must be completed and filed if the answer to an), of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is res. DESCRIPTION OF PROPERTY % OF ITEM ~.c~u~ THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEOENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER Arr^c. A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IFAPPLICABLE) 1. US Allianz 33,118.04 100. 33,118.0zl Valuemark III - Variable Deferred Annuity (non-qualified) Account #DA449827 2. American Skandia 246,670.30 100. 246,670.3C Xtra Credit - Variable Deferred Annuity (non-qualified) Account #ASXT-O00556290 3. AIM Investments 27,166.88 100. 27,166.88 Mutual Funds - AIM Blue Chip Fund & AIR High Yield Fund Account #5022187446 4. Life USA 19,529.10 100. 19,529.10 Policy #4118637 TOTAL (Also enter on line 7, Recapitulation) $ 326,484.37 pace is needed, insert additional sheets of the same size) PINNACLE FINANSIAL SERVICES 475 West Governor Road Hershey, PA 17033 Phone: (717) 312-1238 · Fax: (717) 312-0807 Qualified Retirement Plans - Estate/Investment Planning June 23, 2003 Mr. Robert Ulmer, Executor 660 Geneva Drive, Apt. #6 Mechanicsburg, PA ~, 05~ RE: Estate of Catherine Cywinski Valuation of Securities Products Dear, Mr. Ulmer: Please note that listed below are the security products serviced by my firm titled in the name, Catherine D. Cywinski. A brief description, account number, valuation at the date of death and their actual death benefits are noted: US Allianz, 300 Berwyn Park, Berwyn PA 19312-0031 Valuemark III - Variable Deferred Annuity (non-qualified) - Acct., #DA449827 Value 6/3/03:$30,125.60 Death Benefit: $33,118.04 Beneficiaries: Paul A. Cywinski and Cheri L. Cywinski, in equal shares American Skandia, P.O. Box 7040, Bridgeport, CT 06601-7040 Xtra Credit - Variable Deferred Annuity (non-qualified) Acct., #ASXT-000556290 Value 6/3/03:$233,328.76 Death Benefit: $246,670.30 Beneficiaries: Paul A. Cywinski and Cheri L. Cywinski, in equal shares AIM Investments, P.O. Box 4739, Houston, TX 77210-4739 Mutual Funds - AIM Blue Chip Fund & AIM High Yield Fund (traditional IRA) Acct., #5022187446 Value 6/3/03: 27,166.881 Beneficiaries: Paul A. Cywinski and Cheri L. Cywinski, in equal shares ~ Actual and/or final distribution value determined by the date requested for disbursement by the noted beneficiaries. Securities Offered Through Hackett Associates, Inc. EO. Box 6647 Wyomissing, PA 19610 (800) 336-2929 J 0 N Member NASD and SIPC Robert Ulmer RE: Cywinski June 23, 2003 Page 2 AIM Investments, P.O. Box 4739, Houston, TX 77210-4739 Mutual Fund - AIM High Yield Fund (non-qualified) Acct., #3909080602 Value 6/3/03:$4,187.68 Beneficiaries: None (transfer on death documents were never completed)2 Please call on me should you require any further assistance in regards to Mrs. Cywinski's accounts. Sincerely, AnthonyJ. BrongI ' _ ~ Registered Represl:ntative Cc: James Reid, Esq. 2 AIM Fund Services will require the following items for redemption: certified county short form referencing you as the legal representative of the estate, letter of instruction with signature guarantee and a certified death certificate. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Cvwinski, Catherine, D. Bebts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. 21 03 0500 DESCRIPTION FUNERAL EXPENSES: Cremation Society ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Pemonal Representative (s) Social Secudty Number(s) / FIN Number of Personal Representative(s} Street Address 660 Geneva Drive, Apt. #6 City Mechanicsburg Year(s) Commission Paid: 2004 AttomeyFees Shumaker Williams, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Robed J. Ulmer, Executor State PA Zip 17055 Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Accountant's Fees Tax Return Preparer's Fees Publication Fees - The Sentinel Cumberland County Law Journal Brown Shultz - (Tax Return Preparation) Zip TOTAL (Aisc enter on line 9, Recapitulation) $ AMOUNT 200.00 5,000.00 19,500.00 266.00 75.00 75.00 1,000.00 26,116.00 (Ifmorespaceisneeded, insedadditionalsheetsofthesamesize) RECEIPT FOR PAYMENT Cumberland County - Register Of Wills Hanover and Hiqh Streen Carlisle, PA I7013 Receipt Date Receipt Time Receipt No. 6/19/2003 09:00:40 1033185 CYWINSKI CATHERINE D File Number Remarks 2003-00500 ULMER ROBERT J SK Transaction Description PETITION FOR PROBA SHORT CERTIFICATE EXTRA PAGES JCP FEE Distribution Of Receipt ........................ Payment Amount Payee Name 235.00 CUMBERLAND COUNTY GENERAL FUN 12.00 CUMBERLAND COUNTY GENERAL FUN 9.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D Check# 4524 Total Received ......... 66.00 66 00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS FILE NUMBER Cvwinski. Catherine, D. Include unreimbursed medical expenses. 21 03 0500 ITEM NUMBER 1. o DESCRIPTION PP&L AT&T Verizon Comcast Sunguild III - Maintenance Fee Real Estate Expense - State Tax Stamps/Deed Linden Hall Antiques - Appraisal Fee for tangible property Property Taxes for 591Geneva Street, Apt. #21, Mechanicsburg, PA 17055 TOTAL (Also enter on line 10, Recapitulation) AMOUNT 85.87 14.17 22.59 163.79 123.00 550.00 45.00 661.18 $ 1,665.60 (Ifmorespaceisn~ded, insedadditionalsheetsofthesamesize) REV-1513 EX + (9-nm COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Cywinski Catherine, D. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a)(1.2)] Paul A. Cywinski 591 Geneva Drive, #21 Mechanicsburg, PA Cheri L. Cywinski 289 Seames Drive Manchester, NH 03103 Robed J. Ulmer 660 Geneva Drive, Apt. #6 Mechanicsburg, PA 17055 21 O3 0500 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Son 1/2 of Remainder of Estate Daughter 1/2 of Remainder of Estate Friend $10,000 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF CATHERINE D. CYWINSKI I, CATHERINE D. CYWlNSKI of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Will and hereby revoke all prior Wills and Codicils made by me. DISPOSITION OF REMAINS FIRST: I direct that all of my just debts and the expenses of my last illness and funeral be paid by my Executor from my estate as soon as practicable after my death and that my remains be cremated. PAYMENT OF DEATH TAXES SECOND: I direct that all estate, inheritance and succession taxes that may be assessed in consequence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration; and all property includible in my taxable estate whether or not passing under this Will, shall be free and clear thereof. PECUNIARY BEQUEST TH/RD: I bequeath the sum ofTen Thousand Dollars ($10,000.00) to my companion, Robert J. Ulmer, of Mechanicsburg, Cumberland County, Pennsylvania. DISTRIBUTION OF RESIDUE OF ESTATE FOURTH: I give, devise and bequeath all of the rest, residue and remainder of my estate of whatsoever nature and wheresoever situate, in equal shares to my son, Paul A. Cywinski, and my daughter, Cheri L. Cywinski, provided that they survive me by 30 days. FIFTH: In the'event that my son, Paul A. Cyvvinski, should predecease me or fail to survive me by thirty, days, and in the event that my son should have any living children at the time of my death, and in the event that my daughter Cheri L. Cywinski should still be living a survive me for a period of thirty days, I give, devise and bequeath seventy-five percent (75%) of the share of all the rest, residue and remainder of my estate to my daughter, Cheri L. Cywinski and twenty-five percent (25%) of all the rest, residue and remainder of my estate to be divided equally by the children of my son.. Paul A. CywinSki. SIXTH: In the event that my daughter, Cheri L. Cywinski should predecease me or fail to survive me by thirty days, and in the event that my son, Paul A Cywinski, should still be living and survive me for a period of thirty days, I give, devise and bequeath all the rest, residue and remainder of my estate to my son, Paul A. Cywinski. SEVENTH: In the event that my son, Paul A. Cywinski, and my daughter, Cheil L. Cywinski, should both predecease me or fail to survive me by thirty days, I give, devise and bequeath all of the rest, residue and remainder of my estate to be divided equally by their children. POWERS OF EXECUTOR EIGHTH: My executor and his successor shall have, in addition to those given by law, all of the powers given to them in this Will, to be exercised by them in their absolute discretion, which powers shall be applicable to all property, held by them, effective without the order of any court. APPOINTMENT OF EXECUTOR NINTH: I appoint Robert J.Ulmer of Mechanicsburg, Cumbefland County, Pennsylvania, the Executor of this Will. If he is unable or unwilling to qualify, as Executor or, having qualified, is unable or unwilling to act, I then appoint my son, Paul A. Cywinski, of Canovanas, Puerto Rico, as Executor hereof. I direct that my Executor or his successor shall not be required to furnish security. in any jurisdiction. TENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. IN WITNESS WlZI~REOF, I CATHERINE D. CYWINSKI, have to this, my last Will and Testament, contained on this page and the foregoing one (1) page, set my hand and seal, this ~/_,c~_., day of~/O00. ACKNOWLEDGMENT AND AFFIDAVIT State of Pennsylvania County of Cumberland SS: I, Catherine D. Cywinski, the testatrix in and the undersigned witnesses to the Will, the foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed the instrument as my Will, that I signed it willingly and as my free and voluntary act for the. purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her Will, that she signed it willingly and execmed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Testatrix cO Wimess Address Witness Address I 75~ 7 SUBSCRIBED, swom to and acknowledged before me by CATHERINE D. CYWlNSKI, the Testatrix, and subscribed and sworn to before me by (L/~ ~)..~L fi__ ['~'~-Fm Cr-i and ~"~'ve,~,. b0'e-';~'-'e'c-~,this ~]$./' dayof //~ ,2Y0~~~ Notary Public ,,7--~'-~~ b/v %. / NOTARIAL SEAL I 250-060c INVENTORY Estate of Catherine D. Cywinski also known as Catherine D. Cywinski , Deceased No. 21 03 0500 Date of Death 6~3~2003 Social Security No. 194246473 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 Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Attorney: James E. Reid, Jr., Esquire ~,~,-- . ~z/ I.D. No.: 18032 Robed J. Ulmer Address: 3425 Simpson Ferry Road Dated February ,2004 Camp Hill PA 17011 Telephone: (717) 763-1121 591 Geneva Street, Apt. #21 Mechanicsburg, PA 17055 PNC Bank Account No. 51-4001-4378 Tangible Personalty Description Rent Paid to the Estate by Paul Cywinski RE: 591 Geneva Street, #21 Mechanicsburg, PA 17055 AIM Investments Mutual Fund - AIM High Yield Fund (Non-qualified) Account#3909080602 US Allianz Valuemark III -Variable Deferred Annuity (non-qualified) Account #DA449827 (Attach Additional Sheets if necessary) Total Value 55,000.00 .,~j ~34.15 226.85 4,187.68 33,118.04 395,448.00 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory Catherine D. Cywinski Description of Inventory Page 1 21 03 0500 Description American Skandia Xtra Credit - Variable Deferred Annuity (non-qualified) Account #ASXT-000556290 AIM Investments Mutual Funds - AIM Blue Chip Fund & AIR High Yield Fund Account #5022187446 Life USA Policy #4118637 Subtotal $ Grand Total $ Value 246,670.30 27,166.88 19,529.10 293,366.2R 395,448.00 REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Estate of Catherine D. Cywinski Date of Death: June 3,2003 SSN: 194-24-6473 File No.: 2003-00500 To the Register of Wills of Cumberland County, Pennsylvania: 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 {.~'t~L.~ /--~ , 2003. Name Address Robert J. Ulmer 660 Geneva Drive, Apt. #6 Mechanicsburg, PA 17055 Paul D. Cywinski 591 Geneva Drive, Apt.#21 Mechanicsburg, PA 17055 Cheri L. Cywinski 6 College Road Manchester, NH 03102 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none. Date: 02gc~ ,2003 If~/~~~'ff~- //Jan~k~..~id, Jr.~e ( SHbhM~R WILLIAMS, P.C. ~. Box 88 Harrisburg, PA 17108 (717) 763-1121 :157339 UZ73 Capacity: X Personal Representative Counsel for Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Catherine D. Cywinski No. 2003-00500 TO: Paul A. Cywinski 591 Geneva Drive, Apt. #21 Mechanicsburg, PA 17055 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Catherine D. Cywinski, died on the 3rd day of June , 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: Robert J. Ulmer 660 Geneva Drive, Apt. #6 Mechanicsburg, PA 17055 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsy.lvania 17013; (717) 240-6100. A copy of the Will or Petition may be obtained by contacting James E. Reid, Jr., counsel for the estate at the below address. Date: 4~13~_ Lt(' ~.1~ ,2003 ~ifl, Jr., Esquire James E. SHUMAI 2ER WILLIAMS, P.C. POB xt8;O..Bh,~' Harrisbur ~, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative : 157341 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Catherine D. Cywinski No. 2003-00500 TO: Cheri L. Cywinski 6 College Road Manchester, NH 03102 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Catherine D. Cywinski, died on the 3rd day of June ., 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland Court _ty, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: Robert J. Ulmer 660 Geneva Drive, Apt. #6 Mechanicsburg, PA 17055 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. A copy of the Will or Petition may be obtained by contacting James E. Reid, Jr., counsel for the estate at the below address. Date: x~d,~Lc~ L~5 ,2003 James E. B~i~i, Jr.,r-E~quire SHUIV[A~ER WILLIAMS, P.C. P.O. B&x, J88 Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative :157341 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: EState of Catherine D. Cywinski No. 2003-00500 TO: Robert J. Ulmer 660 Geneva Drive, Apt. #6 Mechanicsburg, PA 17055 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Catherine D. Cywinski, died on the 3rd day of June , 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: Robert J. Ulmer 660 Geneva Drive, Apt. #6 Mechanicsburg, PA 17055 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. A copy of the Will or Petition may be obtained by contacting James E. Reid, Jr., counsel for the estate at the below address. Date: ~I~ t.¥ Z{3 ,2003 James/E./R~eid, Jr., Esquire W LLI^MS, P.C. P.O. Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative :157341 BUREAU OF TNDTV/DUAL TAXES TNHERTTANCE TAX DIVISION DEPT. HARRTSBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERZTANCE TAX APPRA/SEMENT, ALLOHANCE OR DZSALLO#ANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX REV-I$~I7 EX AFP (01-0S) JAMES E REID JR ESQ SHUMAKER WILLIAMS SqZ5 SIMPSON FERRY R~ CAMP HILL APR 26 PA ~l~ DATE Oq-26-ZOOq ESTATE OF CYWINSKI DATE OF DEATH 06-05-2005 FILE NUHBER 21 05-0500 COUNTY CUMBERLAND ACN 101 I Amoun~ Remitted CATHERINE D MAKE CHECK PAYABLE AND REMTT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:~ CUT ALONG THZS LINE ~ RETATN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX ESTATE OF CYWTNSKT CATHERINE D FILE NO. 21 03-0500 ACM 101 DATE Oq-Z6-Z00~ TAX RETURN NAS: (X) ACCEPTED AS FILED { ) CHANGED RESERVAT/ON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership /nterest (Schedule C) ($) q. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilitles/Liens (Schedule 1) (10) 11. Total Deductions 12. Net Value of Tax Return 55z000.00 O0 O0 O0 15,,965.68 O0 SZ6,,q8q. $2 (8) 26,116. O0 1,665.60 (11) (12) 15. NOTE: ASSESSMENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Amount of Line lq taxable at Lineal/Class A rate 17. Amount of Line lq at Sibling rata 18. Aeount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DZSCOUNT DATE NUHBER ~NTEREST/PEN PA~D (-) 0$-01-Z00q CD00~617 .00 Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (1~) Net Value of Estate Subject to Tax (lq) Zf an assessaent was issued prevAousl~, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. $95,q. q8.00 27.781 $67,666.q0 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADD/TIONAL INTEREST. .00 $67,666.q0 18 and 19 ~ill (15) .00 X O0 = .00 (16) $57,666.q0 x Oq5 = 16,09q.99 (17) .00 x 12 = . O0 (18) 10,000.00 x 15 = 1,500.00 (19)= 17,59q.99 AMOUNT PAID 17,59q.99 TOTAL TAX CREDIT I I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 17,59q.99 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11) 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years) the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the 1aclu1 Class B (collateral) rate on any such futura interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS) AGENT A refund of a tax credit) which was not requested on the Tax Return) may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Nills, any of the 15 Revenue District Offices) or by calling the special Z4-hour answering service for fores ordering: 1-BO0-561-ZOSO) services for taxpayers with special hearing and / or speaking needs: 1-800-447-5010 iTT only). Any party in interest not satisfied with the appraisement, allowance) or disallowance of deductions, or assessment of tax (including discount ar 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. 281021, 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. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue) Bureau of Individual Texas, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501} for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. The iSZ tax amnesty non-participation penalty is computed on the total of the tm< and interest assessed, and not paid before January lA, 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 tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency) or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 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) 19BI will bear interest at a rate which will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through 1004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ lOX .000548 1988-1991 117. .000'~01 ~ 97. .O00Zq7 1985 162 .000458 1991 91 .000247 200Z 62 .000164 1964 111 .000501 1993-1994 72 .000192 2005 52 .000157 1985 157. .000556 1995-1998 92 .000147 Z004 42 .000110 1986 107. .000174 1999 77. .000191 1987 107. .000274 2000 77. .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Catherine D. CYWinski Date of Death: 6/3/2003 Will No. 2003-00500 Admin. No. 21-03-00500 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 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: a. account with the Court? Did the personal representative file a final Yes No 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 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: 3/10/2005 w~- gnatu e James E. Reid. Jr. Name (Please type or print) 3425 Simpson Ferry Road Camo Hill PA 17011 Address G) C,!) (717) -763-112 Tel. No . Capacity : Personal Representative X Counsel for personal representative c/G{