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HomeMy WebLinkAbout03-0563PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of RICK¥ E. LATSHA NO. ~:~1- /)3-,5[05 also known as RICK E. LATSHA To: Register of Wills for the .Deceased. County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 184- 4 $- 3700 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, applies for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 208 Sprinq Lane, East Pennsboro '2OWl~ship (list street, number and municipality) Decendent, then 48 years of age, died June 28 at 208 Sorinq Lane, East Pennsboro Township 2003 , Decen/:lent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ 50,000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioner afterapropersearchhas thefollowingspouse(ifany) and heirs: Name Lawrence B. Latsha ascertained that decedent left no will and was survived by Relationship Father Residence 7 Raspberry Drive Mechanicsburq, PA 17050 THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. 7 Raspberry Drive Mechanicsburg, PA 17050 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF C~,~.RL~ 3 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 representative(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 I ~ 4-~ day of ~~ X~9 2003 No. Estate of RICKY E. LATSHA also known as RICK E. LATSHA , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW ~,~t~ I1¥ ~ 2003, in consideration of the petition on the reverse side here~, sat~factory proof having been presented before me, IT IS DECREED that Lawrence B. Latsha is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Lawrence B. Latsha in the estate of Ricky E. Latsha, also known as Rick E Latsh~ c_ ~ Register of Wills ~ 01:. i FEES Letters of Administration ..... Short Certificates(I ~ ................ $ TOTAL Filed .~.'-.I.~.-.O..~ ........ A.D. 19 , Marlin R. McCaleb (#06353) _ ATTQ~NEY ~gp. Ct..I.D. No.) 219 ~as~axn ~ree~ Mechanicsburq, PA 17055 ADDRESS (717) 691-7770 PHONE LAW OFFICES MARLIN R. McCALEB CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Ricky E. Latsha, a/k/a Rick E. Latsha Date of Death: June 28, 2003 Will No. 21-03-0563 To the Register: I certify that notice of beneficial interest and estate administration required by Rule 5.6(a) of the Orphans' Court Rules was personally served on the following beneficiaries of the above-captioned estate on July 21, 2003. Name Address Lawrence B. Latsha 7 Raspberry Drive Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: July 21, 2003 Marlin R. McCaleb Attorney I.D. No. 06353 219 East Main Street P.O. Box 230 Mechanicsburg, PA 17055 (717) 691-7770 FAX: (717) 691-7772 Counsel for Personal Representative 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 O03O6O MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 184-48-3700 FILE NUMBER: 2103-0563 DECEDENT NAME: LATSHA RICKY E DATE OF PAYMENT: 09/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,800.00 TOTAL AMOUNT PAID: $1,800.00 REMARKS: RECEVIED LAWRENCE B LATSHA IN C/O MARLIN R MCCALEB, ESQ. SEAL CHECK# 18 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV~1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 E C E D E . N T REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Latsha Rick.y E. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 06~¢'~,,~ ~ 03 05/24/1955 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) cAPB 4. HpRL EpIO 6. CRAC ~-oTK " ES 9. C O R R E S R E C A P I T U L A T I O N OFFICIAL USE ONLY FILE NUMBER 21-03-0563 COUNTY CODE YEAR NUMBER C 0 M x[ T I 0 N SOCIAL SECURITY NUMBER 184-48-3700 THIS RETURN MUST E FIE-D IN DIJPLICA REGISTER OF WILLS SOCIAL SECURITY NUMBER Odginal Return ~ 2. Limited Estate 4a, Decedent Died Testate 7. (Attach copy of Will) Litigation Proceeds Received[-'--"] 10. Supplemental Retum I J 3. ~eP~l~r~z~,~r§~t) Compromise (date of death after 12-12-[] S. Beqei/e~t Maintained a Living Trust 0 8. l?,Al~he~opy of Trust) Spousal Pove.y Credit ¢:t~f death between 12-31-91 and 1-1-95) NAME Marlin R. McCaleb Esq. FIRM NAME (If Applicable) Law Offices-Marlin R. McCaleb TELEPHONE NUMBER 717/691 - 7770 1 Real Estate (Schedule A) (i) ZStocks and Bonds (Schedule B) (2) 3Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4Mortgages & Notes Receivable (Schedule D) (4) 5Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6Jointly Owned Property (Schedule F) (6) ~Beparate Billing Requested 7~nter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8.Total Gross Assets (total Lines 1-7) 9Funeral Expenses & Administrative Costs (Schedule H) (9) 10~ebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11Total Deductions (total Lines 9 & 10) 1;~Net Value of Estate (Line 8 minus Line 11) 13~haritable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) l~Jet Value Subject to Tax (Line 12 minus Line 13) Remainder Return (pdda Federal Estate Tax Return Total Number of Safe Depo ~Election to tax under Sec. 9 ~,'~ ~ (Attach Sch O) COMPLETE MAiL,N A ;DRES 219 East Main Stree~ P. O. Box 230 '::?~ : ~ Mechanicsburg, PA 17055 ": !:~' OFFICIAL USE ONLY None 3,174.85 None None: 63,484,42 None None 18,846.64 235.42 (8) ;.,;, · ! c~o6,659.27 (11) (12) (13) 19,082.06 47,577.21 (14) 47,577.21 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 150,mount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16~mount of Line 14 taxable at lineal rate 17Amount of Line 14 taxable at sibling rate 18~mount of Line 14 taxable at collateral rate X .0 0 (15) 47,577.21 x .o '45 (16) X .12 (17) X .15 (18) 0.00 2,140.97 0.00 0.00 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 208 Spring Lane CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1.Tax Due (Page 1 Line 19) 2Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1,800.00 94.74 (1) Total Credits ( A + B + C ) (2) 2,140.97 3Jnterest/Penalty if applicable D. Interest E. Penalty Totat Interest/Penalty ( D + E ) (3) 4Jf 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) 5Jf 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. (EB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1Did 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? ................... 2if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ E~ ~-] 3Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ ~ 4Did 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. 1,894.74 0.00 0.00 246.23 0.00 246.23 Under penalties of perjury, I declare that I have examined this retuml including accompanying schedules and statements, and to the beet of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Lawrence B. Latsha /~ -- ---. ~~/ 7 Raspberry Drive __ .. S'G"ATUREO~P~EPARE~HER~R~NTAT,VE Law Offices-Marlin R. McCaleb /~ ~,~//~~/ 219 East Main Street ~__~ ¢~ For dates of death on or affer July 1, 1994 and before Januaw 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) ¢)]. For dates of death on or affer Januaw 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the su~iving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a sullying spouse from tax, and the statutow requirements for disclosure of assets and filing a tax return are still applicable even if the su~iving s~use is the only beneficiary. For dates of death on or a~er July 1,2000: The tax rate imposed on the net value of transfers from a deceased child ~en~-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 iineai 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. Copyright (c) 2000 fo~ software only The Lackner Group, inc. Fo~ REV-1500 EX (Rev. 6-00) REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ricky E. Latsha SS# 184-48-3700 SCHEDULE B STOCKS & BONDS 06/28/2003 FILE NUMBER 21-03-0563 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 12 shares AT&T, CUSIP #001957505 - common (Equiserve 8.35 100.20 Acct. #529197818). 2 52 shares AT&T Wireless Services, Inc. common stock, 8.35 434.20 CUSIP 002094 10 6. 3 21.608 shares AT&T - common (Equiserve Acct. 8.35 180.43 #270610436). 4 53 shares Comcast Corporation - Class A, common 30.63525 1,623.67 5 Employee Stock Option - non-transferrable option to 0.00 purchase 30 shs. AT&T common @ $35.8085, issued 08/01/97, for 10 years. Market value of AT&T common on D.O.D.: $19.47. 6 Employee Stock Option - non-transferrable option to 0.00 purchase 48 shs. AT&T Wireless Services, Inc., common @ $18.6724, issued 08/01/97, for 10 years. Market value of AT&T Wireless Services, Inc., common on D.O.D.: $8.35. 7 Employee Stock Option - non-transferrable option to 0.00 purchase 101 shs. AT&T Wireless Services, Inc., common @ $29.1560, issued 04/27/00, for 10 years. Market value of AT&T Wireless Services, Inc., common on D.O.D.: $8.35. 8 205 shares GRIC Communications, Inc. - common, 205 shs. 4.07 834.35 9 t share Lucent Technologies, Inc. common stock, CUSIP 1.9975 2.00 549463 10 7. TOTAL(Alsoenteronline2, Recapitulation) 3,174.85 ...... (If more space ~s needed, insert additional sheets of the same size) AT & T CORP. (21C) RICK E. LATSHA 208 SPRING LANE - FRONT E~OLA, PA 17025 Optionee Detail Report as of 10/28/2003 Hire Date: 06/25/19,79 Term. Date: 06/28/2003 Death Date: 10/28/2003 Page: 1 Grant Date/ Grant Options Option ---Transaction--~ Ex%Dr. Date Plan Type Granted Price Date Am ...... ' - · . Shares ~tions Shares .............................................................. ~L_ =rte =~sa=t~on n.e Sold Out.tandi=g EL1. 08/01/1997 97ALNQ 30 $35.8085 ................................................................ 08/01/2007 AT&T LTIP 1997 Ail employee 30 30 Total Opcions Outstanding: 30 Total OpCions ~xercisable: 30 · he[em, but we cannot ~uerantee its accuracy_ co~eten~,t~~ a sol~citaQon ~or t~e pure AT&T WIRELESS RICK E. LATSHA 208 SPRING LA/NE - FRONT EI~OLA, PA 17025 Optionee Detail Report Date: 10/28/2003 as of 10/28/2003 Page: 1 Hire Date: 06/25/1979 Gra~t Date/ Grant Options Option ---Transaction--- __E~_~_~ . Shares Options Shares ate Plan TYlDe Granted Prlce Date Amount Price Transaction TylDe Sold Outstanding Exbl 08/01/1997 SPLT NQ 48 $18.6724 08/01/2007 SPLIT-OFF 48 48 04/27/2000 IPOA NQ 101 $29,1560 ............................................ 04/27/2010 AT&T ALL EMPLOYEE IPO GRA/~T 10! 10! Total Options Outstanding: 149 Total Options Exercisable: 149 ~on herein has been obtained from SOUrCeS ~o~eten~ ....... ~oli~i~tion ior the ~rchase or sam sec ~, REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ricky E. Latsha SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SS# 184-48-3700 06/28/2003 FILE NUMBER 21-03-0563 Include the proceeds of litigation and the date theproceeds were received by the estate. All property jointly-owned with the right of survivorsh,p must be disclosed on Schedule F. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 DESCRIPTION AT&T - paycheck for 06/27/2003. AT&T - paycheck for 07/03/2003. 18 19 Belco Community Credit Union principal balance as of DOD. S4 Checking Acct. #108730, Belco Community Credit Union - Si Savings Acct. #108370, principal balance as of DOD. Betco Community Credit Union - Si Savings Acct. #108370, dividend accrued to DOD. Cash and coins in Decedent's possession. Coins found in Decedent's apartment. 1995 Chevrolet Camaro automobile AT&T Long Term Savings and Security Plan - 401(k) Plan Belco Community Credit Union ~ Si Savings Acct. #108370, AT&T Pension Plan payment. Citibank/AT&T Universal Card - settlement of class action lawsuit. Fidelity Investments - Account No. X47-308498, cash balance. Household goods, contents, furniture and furnishings. Liberty Mutual Insurance Co. - refund of unused automobile insurance premium. Municipal & School Income Tax Office - refund of 2002 local income tax Peoples Benefit Services, Inc. - refund. Peoples Benefit Services, Inc. refund of medical prescription plan. Summerdale Apartments refund of security deposit. U. S. Treasury - refund of 2003 personal income tax. Total of Continuation Schedule(s) TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH 547.33 547.33 648.55 31,674.85 28.80 288.65 5.38 4,500.00 21,665.85 444.63 1.53 10.21 640.00 402.00 2.05 13.42 7.95 565.00 1,417.23 73.66 63,484.42 inc.(If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSysterns, F~rm REV-lS08 EX m~,, Estate of: Ricky E. Latsha Soc Sec #: 184-48-3700 Date of Death: 06/28/2003 Continuation of Schedule E (Cash, Bank Deposits & Miscellaneous Personal Property) Item Description Value at Date of Death 20 West Shore Tax Bureau - refund of 2003 local wage tax. 73.66 73.66 BELCO Community Credit Union 1. Name(s) in which the account was held: Getti~8 You T~ere DECEDENT ESTATE INFORMATION .... Account number: ~('~)._ '7 Balance as of date of death: Balance Accrued Dividends Christmas Club: $- $ Whatver Club: $ $ Checking: $ ,~.~ ~. ~ $ ..~ Money Market: $ $ Certificates: Balance Accrued Dividends For 4. Date the account was initiated: 5. Name(s) in which Safe Deposit Box was held: YTD Dividends $ $ YTD Dividends $ $ $ $ $ Certficate Number Date the box was initially rented: Branch address at which the box is located: Unsecured Loans: Loan Information: A. B. Secured Loans: C. Mortgage Loans: Balance Accrued Interest $ $ $ $ $. $ $ $ $ $ $ $ $ $ $ $' $ Per Diem Int $ BELCO COMMUNI~ CREDIT UNION MAIN OFFICE 403 N. 2nd Street · P.O. Box82 · Harrisburg, PA 17108 · (717) 23-BELCO Web Site: ~w. belco.org UT/ZUlU3 i~:UU ~'A~ ~ U~ Page 1 of 3 AT&T Long Term Savings & Security Plan RICK E LATSHA 208 SPRING LANE - FRONT ENOLA, PA 17025-2147 Your Account Summary Savings Plan Statement ~' Customer Service: (800) 610-7100 Rdelity Investments Institutional Services Co. 82 Devonshire Street Boston, MA 02109 Statement P~riod:'06/28/2003 to 06/28/2003 Beginning Balance Ending Balance Additional Information Vested BaJance $21,665.85 $21,665.85 $21,665.85 YOur personai.Rateof Returh '. ' ". . · .. ..... :. ', ... . ... , ~.' . : , . .~ .,~ ... .. _._ , " ,.. . Your Personal'Rate of RetUrn is calculated With a time-weighted.formula,- Widely used by financ!al analysts b~ calculate investment earnings.' tt reflects the ?esults of your'investment selections as' well as.any activity in the plan. account(s) shown. There are other Personal 'Rate of Return formulas used that may yield, different results. Remember that pas'~ performance is no guarantee of future results. " Your Asset AlloCation Statement Period: 06/2'8/2003 tb 06/28/2003 ~1 Bond Investments ($19,765.02), 91.22% II Stock investments ($1,900.83), 8.77% https://corporatebencfi ts 112.fidelity,corrYplansponsor/sponsor/online_statement_detail.do 3UL 29 2003 15: 1J 07/29/2003 P~GE. 12 REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ricky E. Latsha 184-48-3700 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 06/28/2003 FILE NUMBER 21-03-0563 Debts of decedent must be reported on Schedule I. ITEM NUMBER Bo DESCRIPTION =UNERALEXPENSES: Myers Funeral Home Latsha). funeral services (reimbursed to The Elizabethville Monument Co. gravemarker Lawrence ~DMINISTRATIVE COSTS: 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: Attomey's Fees Law Offices-MArlin R. McCaleb 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 Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Brickers Auction - expenses of public sale of household contents Cumberland Law Journal - advertising Letters (reimbursed to Marlin R. McCaleb, Esq). DoubleGold, Inc., d/b/a RestoreCore - bio-chemical cleaning of decedent's apartment and contents, and replacement of carpet, to remove odor and bodily fluids caused by decedent's decomposing body (decedent had been dead for several days before his decomposing body was discovered in his apartment). George's Cleaners - cleaning leather coats in preparation for Total of Continuation Schedule(s) TOTAL (Aisc enter on line 9, Recapitulation) (If more sPace is needed, insert additional sheets of the same size) Bo AMOUNT 1,419.00 450.00 5,500.00 120.00 211.00 75.00 8,646.17 79.90 2,345.57 18,846.64 Estate of: Ricky E. Latsha Soc Sec #: 184-48-3700 Date of Death: 06/28/2003 Item Description Continuation of Schedule H-B4 (Probate Fees) Amount Register of Wills - probate Estate (reimbursed to Marlin R. McCaleb, Esq.) 120.00 120.00 Estate of: Ricky E. Latsha Soc Sec #: 184-48-3700 Date of Death: 06/28/2003 Item Description Continuation of Schedule H-B7 (Other Administrative Costs) Amount 5 6 7 8 9 !0 11 12 13 sale. PP&L - electric service for cleaning out apartment. PP&L - electric service for cleaning out apartment. PP&L electric service for cleaning apartment. Reserve for Filing Account, releases, etc. Summerdale Apartments $ummerdate Apartments Summerdale Apartments The Neighborhood (MCI) The Patriot-News July rent. August rent. September rent. telephone service. advertising Letters. 81.11 95.74 52.43 250.00 565.00 565.00 565.00 65.56 105.73 2,345.57 REV-1512 EX + (I-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ricky E. Latsha SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS¢/ 184-48-3700 06/28/2003 FILE NUMBER 21-03-0563 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 AT&T Universal Card Acct. ¢~4784 8080 0019 9232 - credit card 58.51 balance. 4 5 AT&T Universal Card - Acct. ¢J4784 8080 0019 9232, account payable. Pennsylvania Department of Revenue account payable. 2003 personal income tax, PP&L - electric service, account payable. The Neighborhood (MCI) - telephone service, account payable. TOTAL (Also enter on line 10, Recapitulation) $ 48.00 6.00 57.89 65.02 235.42 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rick'~ E. Latsha SS¢/ 184-48-3700 NUMBER I. SCHEDULE J BENEFICIARIES 06/28/2003 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distdbuti0ns, and tmnsfem under Sec. 9116(8)(1.2)t Lawrence B. Latsha 7 Raspberry Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Father FILENUMBER 21-03-0563 AMOUNT OR SHARE OF ESTATE Entire Estate II. ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEb~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEbl $ 0.00 (If more space is needed, insert additional sheets of the same size) Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estateof Rick¥ E. Latsha No. 2003-00563 also known as Rick E. Latsha Date of Death 06/28/2003 , D~oei~bcurity No. 184-48- 3700 Lawrence B. Latsha, 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I ANe verify that the statements made in this Inventory are true and correct, lANe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Attorney: Marlin R. McCaleb Esq. Signature: . _ _ ~. ~ Lawrence B. Latsha- I.D. No.: Signature: Address: 219 East Main Street Address: 7 Raspberry Drive Mechanicsbur~, PA 17055 Mechanicsbur~, PA 17055 Telephone: 717/691-7770 Telepho,e: 717/697-1618 Dated: Description (See continuation page(s) attached) (Attach additional sheets if necessary) Value 0[ Total: 68,659.27 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. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) Estate of: Date of Death: County: Ricky E. Latsha 06/28/2003 Cumberland INVENTORY CASH: AT&T Paycheck for 06/27/2003. AT&T - paycheck for 07/03/2003. Belco Community Credit Union - S4 Checking Acct. #108730, principal balance as of DOD. Belco Community Credit Union - Si Savings Acct. #108370, principal balance as of DOD. Belco Community Credit Union - Si Savings Acct. #108370, dividend accrued to DOD. Cash and coins in Decedent's possession. Coins found in Decedent's apartment. 547.33 547.33 648.55 31,674.85 28.80 288.65 5.38 33,740.89 PERSONAL PROPERTY: 1995 Chevrolet Camaro automobile AT&T Long Term Savings and Security Plan - 401(k) Plan 4,500.00 21,665.85 ~1- Belco Community Credit Union Si Savings Acct. #108370, AT&T Pension Plan payment. Belco Community Credit Union - Si Savings Acct. #108730, CUNA Mutual Group life insurance on BELCO account. Citibank/AT&T Universal Card - settlement of class action lawsuit. Fidelity Investments No. X47-308498, cash balance. Account Household goods, contents, furniture and furnishings. Liberty Mutual Insurance Co. refund of unused automobile insurance premium. Municipal & School Income Tax Office - refund of 2002 local income tax Peoples Benefit Services, Inc. refund. Peoples Benefit Services, Inc. - refund of medical prescription plan. Summerdale Apartments - refund of security deposit. U. S. Treasury - refund of 2003 personal income tax. West Shore Tax Bureau - refund of 2003 local wage tax. 444.63 2,ooo.bo 1.53 10.21 640.00 402.00 2.05 13.42 7.95 565.00 1,417.23 73.66 31,743.53 -2- STOCKS/LISTED: 12.00 shares AT&T - common (Equiserve Acct. #529197818). 52.00 shares AT&T Wireless Services, Inc. - common stock, CUSIP 002094 10 6. 21.61 shares AT&T ~ common (Equiserve Acct. #270610436). 53.00 shares Comcast Corporation - Class A, common Employee Stock Option - non-transferrable option to purchase 30 shs. AT&T common @ $35.8085, issued 08/01/97, for 10 years. Market value of AT&T common on D.O.D.: $19.47. Employee Stock Option - non-transferrable option to purchase 48 shs. AT&T Wireless Services, Inc., common @ $18.6724, issued 08/01/97, for 10 years. Market value of AT&T Wireless Services, Inc., common on D.O.D.: $8.35. Employee Stock Option - non-transferrable option to purchase 101 shs. AT&T Wireless Services, Inc., common @ $29.1560, issued 04/27/00, for 10 years. Market value of AT&T Wireless Services, Inc., common on D.O.D.: $8.35. 100.20 434.20 180.43 1,623.67 -3- 205.00 shares GRIC Communications, Inc. common, 205 shs. 1.00 shares Lucent Technologies, Inc. - common stock, CUSIP 549463 10 7. 834.35 2.00 3,174.85 TOTAL RECEIPTS OF PRINCIPAL ............... 68,659.27 -4- COMMONWEALTH OF PENNSYLVANIA DEP/..~RTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806O1 HARRISBURG, PA 17128-0601 RECEIVED FROM: MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 17055 NO. REV-1162 EX(11-96) CD 003661 ........ fold ESTATE INFORMATION: SSN: 184-48-3700 FILE NUMBER: 2103-0563 DECEDENT NAME: LATSHA RICKY E DATE OF PAYMENT: 03/10/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 06/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $246.14 REMARKS: ! SEAL CHECK//126 TOTAL AMOUNT PAID: $246.14 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF TNDTVZDUAL TAXES INHERITANCE TAX BIVISION DEPT. 280601 HARRISBURg, PA 17128-0601 COHMONgEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-i$¢i7 EX AFP (01-05) MARLIN R MCCALEB ESQ M R HCCALEB LAW OFCS PO BOX 230 MECHANICSBURG '0~ AFR 26 PA 17 ~!~j~TiL ..... ~ DATE 0q-26-2004 ESTATE OF LATSHA DATE OF DEATH 06-28-2003 FZLE NUHBER 21 03-0563 ? 1 :$~ COUNTY CUMBERLAND ACN 101 I Amount Remitted RICK E HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF gILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOgER PORTION FOR YOUR RECORDS ~ REV-154? EX AFP [01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOgANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LATSHA RICK E FILE NO. 21 03-0565 ACN 101 DATE 04-26-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING 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) $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Hortgages/Notes Receivable (Schedule D) (~) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (S) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule 1) (10) 11. Total Deductions 12. Net Value of Tax Return 3~174.85 .00 63,,484.42 .00 .00 NOTE: To insure proper credit to your account, submit the upper portion .00 of this form with your tax payment. .00 (8) 18,846.64 15. lq. NOTE: ASSESSMENT OF TAX: 15. Amount of Line 1~ at Spouse1 rate 16. Amount of Line 1~ taxable at Lineal/Class A rate 17. Amount of Line 1~ at Sibling rate 18. Amount of Line 1~ taxable at Collateral/Class B rate 19. Principal Tax Duo TAX CREDITS: PAYNENT RECEZPT I D/SCOUNT (+) DATE NUHBER I ZNTEREST/PEN PAZD (-) 09-26-2005 CDO03060 94.74 03-10-2004 CD003661 . O0 66,659 .Z7 235.42 (11) ]Q.082.0¢ (12) 47,577.Z1 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (1~) Zf an assessment ~as issued previously, l:~.nes 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 47,577.21 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 will TOTAL TAX CREDIT I 2,140.88 BALANCE OF TAX DUEI .09 INTEREST AND PEN. I .00 TOTAL DUE I .09 ( 1F TOTAL DUE 1S LESS THAN $1, NO PAYHENT 1S REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) 1,800.00 246.1~ AHOUNT PAID (15). .00 x 00 = .00 (16) ~,7,577.21 x 045= 2,140.97 (17) .00 X 12 = .00 (18) .00 x 15 = .00 (~9)= 2,140.97 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life ar for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the 1aclu1 Class B (collateral) rate on any such future interest. To ~ulfill the requirements of Section gl40 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Ni118 printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which ems not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax [including discount or interest) as 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. Z810Z1, Harrisburg, PA 171lB-lOll, 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 Taxes, ATTN: Post Assessment Review Unit, Dept. leO601, Harrisburg, PA 171ZB-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three {33 calendar months after the decedent's death, a five percent (BI) discount of the tax paid is a11eeed. 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 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 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated et a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19BZ through 2004 are: Interest Daily Interest Dally Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 19BE 2OZ .0005q8 I~'~-1991 1XZ .O003fll ~ 9Z .OOOZq7 1983 162 .O00~3B 199Z 9Z .O00247 2002 6Z .00016~ 19Bq XZZ .000301 1993-199~ 72 .O0019Z 2003 52 .000137 1985 132 .000356 1995-1998 9Z .000247 ZOOq qZ .000110 1986 IOZ .000274 1999 72 .00019Z 1987 iOZ .000Z74 ZOOO 7Z .O00lgZ --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/18/2005 MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 RE: Estate of LATSHA RICKY E File Number: 2003-00563 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 6/28/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ REGISTER OF WILLS cc: File Personal Representative(s) Judge ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: RICKY E. LATSHA Date of Death: June 28, 2003 Estate No.: 21-03-0563 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 lXJ. No 0 2~ If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No lKl b. The separate Orphans' Com1:No. (ifany) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 8 No 0 Date: Hay 23, c. Copies of receipts, releases, joinders and approval offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be 20.:bed to iliisreport ~~i? d~ Signature ..__4 .,.. Marlin R. McCaleb Name 219 East Main Street Mechanicsburg, PA 17055 Address (717) 691-7770 Telephone No. Capacity: 0 Personal Representative .I2n Counsel for personal representative ud