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HomeMy WebLinkAbout02-0170 PETITION FOR PROBATE and GRANT OF LETTERS Eslate of -~7"~d/~t~ O-, ]~OkP141~O/~' ,J'-'~. No..2/- d),2-]--]O also ktlowll as ~ To: Register of Wills for the , Deceased. County of CUMBERLAND in the Social SecuriO, No. _ / 7 ~ ~ ~ / ] ~,~ 0 Commonwealth of Pennsylvania The peiition of the undcrsigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut~ t' ~ named in the last wilt of the above decedent, dated ~ ,;4 ~ ~ v ~Od t 19 and codicil(s) dated -~' ' ' ~ (sTate relevant circumstances, e.g. renunciation, death of executor, elc.) Decendent was domiciled at death in (' t/t,/0 b e'er/ri:., ,./ County, Pennsylvania, with h [.:~ last family or, principal re~dence ~ "01/) '~//~ (list street, number and muncipality) Decendent, then ,~ ~ years of age, died ,-~O :.~p~ a~ ~%~, d&¢&m did ~o~ ~.:~y, wa~ .o~ di~or~a [.: did .o~ ha~. ~hi~d ~or. o: .dop~¢d after execution of the will offered for probate; was no[ the victim of a killing and was never adjudicated incompetent: Decendem 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 $ situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Te~'Ta theron. (testamentary; administration c.t.a~ administration d.b.n.c.t.a.) ~e ~ ('~.m ~r iap OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF CUMBERLAND ; SS The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed r .o.Z~i Oqffa. o~e~e~3' c~ before me this ] 3th day of { ~ ~' ~ o . '2.1~ o :2_- )'70 Estate Of STANLEY J BOHENICK JR , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW FEBRUARY 13 2002 ~]~x ., in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated JANUARY 9, 2001 described therein be admitted to probate and filed of record as the last will of STANLEY J BOHENICK JR _; TESTAMENTARY and Letters are hereby granted to ALBERTA BOHENICK MAR~f FEES Probate, Letters, Ere .......... $~0 Sho~ Ce~ificates( ~~~x. ax~a..page~ 3.00 JCP $ 5.00 ADD,SS 45.00 TOTAL __ FEBRUARY 13, 2002 Filed ....................... ma~ed to exec o 'JL'~UO2 PHONE This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l,ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Local Registrar No. '~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH J. Bohen~ck, Jr. '. male ~.172 -- 28 ~ 1770 80 ; ; December 17 Shenandoah, PA ' 1921 Cumberland E. Pennsboro white ~ ~c~m.s 2 Married ,~Alberta M. Bacevicz ~u~ ,~,. m,,. Pennsylvania ,~.~ 717 Elkwood Drive "~ ~ ~ · · . , New Cumberland, PA 17070 Cumberland ~' ,v~~ New Cumberland Stanley J. Bohenick Julia ~rcavage Alberta M. Bohenick 717 Elkwood Drive. ew Cumbe 17070 12, 2002 tdianto~ Gap National Cem ~p., PA 17003 FS 012 849 L :more FH & CS, Inc. 21-02-170 OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS ' codicil (each) a subscribing witness to will presented herewith, (each) being duly q~lified according to law, depose(s) and say(s) / present and saw the testat ~, sign the same and ~' ~ signed as a witness at the request of testat~ in h I d (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of (Name) 19 (Address) (Name) REGISTER OF WILLS OF CUMBERLAND COUN' OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, deposes) and say(s)that (~ ~ familiar with the signature of ~' ~.~ testat~ of (one of the subscribing witnesses to) the will presented herewith and that ~ believes the signature on the will is in the handwriting of to the best of C~ ~ knowledg~and belief. Sworn to or affirmed and subscribed before .~ ~~ me this ~ 3~h day of ~ ~ ~/(~////~ Y~~~ (Address) - (Name) (Address) · Re,:r~ex¢-o0) OFFICIAL USE ONLY COMMONWEALTHOFpENNSYLVANiA REV-1500 .., DEPARTMENT OF REVENUE INHERITANCE TAX RETURN F,LE DEPT. 28O6O1 HARRISBURG, PA 17128-0601RESIDENT DECEDENT / -_ / COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z BOHENTCK, STANT,EY ,3' JR. 1'72-28-1'770 I:~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE O 01/09/2002 12/17/1921 REGISTER OF WILLS III (If APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER BOHENICK, ALBERTA M ., [] 1. OriginalRetum [] 2. SupplementalReturn [] 3. RemainderReturnl(",eof(",thpn~rtou43-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (dae of (.,,th eeer U-U-e2) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (A,ach ¢o¢y of wil) [] 7. Decedent Maintained a Living Trust (~,,h c~ of Tru.) 8. Total Number of Safe Deposit Boxes o. < [] 9. Litlgation Proceeds Received [] 10. SpousalPovertyCredit(dateofdeathbaweent2-3t-~landl.l.,5) [] 11. Election to tax under Sec 9113(A) (~ac, scho) "' NAME COMPLETE MAILING ADDRESS z TIMOTHY C. WEWER 2699 PRINCETON PIKE o ~. FIRM NAME (If Appicable) ~ LAWRENCEVILLE, NJ 08648 ~u WEWER & ASSOCIATES TELEPHONE NUMBER O o 609-406-OOll 1. Real Estate (Schedule A) (1) ~ . OFFIC:IA~.USE ONLY 2. Stocks and Bonds (Schedule B) (2) 5 ~ 4 O2~:i; 30 ~ ' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) O'. O O 4. Mortgages & Notes Receivable (Schedule D) (4) O. O O 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) O; O O _._,  (Schedule E) :..l. :  6. Jointly Owned Property (Schedule F) (6) O ~O O "~ [] Separate Billing Requested ::3 7. inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) O. O O I'"' (Schedule G or L) ~ 8. Total Gross Assets (total Lines 1-7) (8) 5 / 402 . 30 O 9. Funeral Expenses & Administrative Costs (Schedule H) U~ (9) 6,030.00 10. Debts of Decedent, Mo~lgage Liabilities, & Liens (Schedule I) (10) O. O O 11. Total Ded ucfions (total Lines 9 & 10) (11 ) 6 / O ~ O. O 0 12. Nat Value of Estate (Line 8 minus Line 11 ) (12) - 6 2 7.7 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) O. O 0 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) - 6 2 7. 70 SEE INSTRUCTIONS FOR APPLICABLE RATES ~ 15. Amount of Line 14 taxable at the spousal tax --'~_..: rate, or transfers under Sec. 9116(a)(1.2) O. OO X .0 O (15) O. OO ~ 16. Amount of Line14 taxable at lineal rate O. OO x .0 O (16) 0 OO ~;13" 17. Amount of Line 14 taxable atsibling rate O . OO x .12 (17) O . OO O 18. Amount of Line l~a4 taxable at collateral rate O OO O ' X .15 (18) O . OO ~ (19) O. O0 19, Tax Due STF PA42021F. 1 · De'cedent's Complete Address: IT~ NEW CUIViBE~D I STATEpA IzIP 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) O. OO 2, Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3, Interest/Penalty if applicable Total Credits (A + B + C) (2) D, Interest E. Penalty Total Interest/Penalty (D + E) (3) 4, If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) O. 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) O. O O A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5Bi O. O O Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................ [] [] b. retain the 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 Individua Ret relent Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is 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 DATE ADDRESS 717 ELKWOOD DRIVE, NEW CUMBERALND, PA 17070 SIGNATURE~ ---- ~,"OF PREPARER ~TI'J~ THAN REPRESENTATIVE DATE _ o2 / 8 / o2 2699 PRINCETON PIKE, LAWRENCEVILLE, NJ 08648 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) (iii. 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. §911§ (a) (1.1) (ii)]. The statute does not exempt a transfer t;3 a su~;iving 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 or' 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 45%, 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. §911§(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. STF PA42021F.2 RI~V-1502 EX + (1-97) (I) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REAL ESTATE ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 All real property owned solely or as a tenant in common must be reported at fair mat's(et value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, ne~er be ng compelled to buy or sell both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ' ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 0 N/A TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, inserl additional sheets of the same size) STF PA42021F.3 REV.1'503 EX + (1.97) (I) SCHEDULE B co. Mo.w~LT. oF ,N.E.,T~CET*XRETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBEE BOHENICK, STANLEY J, JR. 2002-00170 All property jointly-owned with t~e right of survivorship must be disclosed on Schedule K ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 178 SHARES MET LIFE INC. 5,402.30 TOTAL (Also enter on line 2, Recapitulation) $ 5,4 0 2.3 (3 (If more space is needed, insed additional sheets of the same size) STF PA42021F,4 REV.1504 EX + (1-97) (I) SCHEDULE C J COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATION, ,NHER~TANCE TAX RETURN ,, RES'DENT OECEDENT PARTNEESH~P or SOLE-PROPE~ETORSH~P ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 Schedule C-1 or C-2 (including all supporting information} must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship Se~ ins~ctions for the supporting information to be submitted for sole-proprietorships, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 0 N/A TOTAL (Also enter on line 3, Recapitulation) $ 0.0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021 F, 5 REV:1505 EX + (1.g7} (I) SCHEDULE C-1 J COMMONWEALTH OF PENNSYLVANIA CLOSELY'HELD CORPORATE INHER)TANCE TAX RETURN "ES'DENT DECEDENT STOCK INFORMATION REPORT ESTATE OF FILE NUMBER BOHElqTCK, S'['A.tqT.E¥ O', ,.TR. 2002-00].70 1. Name of Corporation State of Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year 3. Type of Business Product/Service 4 TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting/Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common ,I; Preferred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? [] Yes [] No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-827 []Yes r'-'] No If yes, r-]Transfer []Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated alter the decedent's death? []Yes []No N/~ /,~-a, if yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? []Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. I !~i~! iiii~ii!!!~! H!~iii~!~!!iiii!iii!!!~iiiii! H i :::::::::::::::::::::::: :::::::::::::::::::::::: :: ...................................... A. Detailed calculations used in the valuation of the decedenrs stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedenrs stock. STF PA42021F 6 REV.1506 EX + (1.97) (I) SCHEDULE C-2 co o.wE T, PARTN ERS HIP INHERITANCE TAX RETURN RESIDENT DECEDENT INFORMATION REPORT ; ESTATE OF FILE NUMBER :BOI-IENICI<, S'I'A_N'T.E¥ ,.T, QR, 2002-00170 1. Name of Partnership Date Business Commenced Address Business Reporting Year City State . Zip Code 2. Federal Employer I.D. Number 3. Typo of Business ProductJService 4. Decedent was a [] General [] Limited partner. If decedent was a limited partner, provide initial investment $ 5. PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $. Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year pdor to death or within two years if the date of death was prior to 12-31-827 [] Yes [] No If yes, [] Transfer [] Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated alter the decedent's death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? [] Yes [] No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Fo, tm 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. STF PA42021F.7 REV-{507 EX + (1-97) (I) SCHEDULE D J COMMOI~NEALT" OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE T~X RETURN RESIDENT DECEDENT RECEIVABLE ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 0.00 N/A TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) STF PA42021F.8 R~V-1508 EX + (1.97) (I} SCHEDULE E COMMONVVF-.ALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER BOHENICK, STANLEY Jr JR. 2002-00170 include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. O.OO N/A TOTAL (Also enter on line 5, Recapitulation) $ O. O O (If more space is needed, insert additional sheets of the same size) STF PA42021F,9 RI~V-1509 EX + (1.97) (0 SCHEDULE F COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RES DE.T DECE E,T ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 If an asset wes made joint within one year of the decedent's date of death, it must be reported on Schedule SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Indude name of financial instilulioa and bank account na~,ber a' similar identifying numbe~. DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attach deed fo~ joinlly-held real es~ale. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 0.00 0 O.OC TOTAL (Also enter on line 6, Recapitulation) $ 0.00 .r .... space is needed, insert additional sheets of the same size) STF PA42021 F, 10 RE~/.1510 EX + (1.97) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTEE-VIVOS TEANSFEES & iNHERITANCE TAX RETURN MISC. NON-PEOBATE PEOPEETY RESIDENT DECEDENT ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM ~NCLUDE 3HE NAME OF 3HE ~FEREE, 3HEIR RELATIONSHIP TO DECEDENT N~IO THE DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER OF TPJkNSFER. ATI'ACH A COPY OF 3HE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1, 0. O0 0 0. O( TOTAL (Also enter on line 7, Recapitulation) $ O, 00 (If more space is needed, insert additional sheets of the same size) STF P^42021F 11 REV-1511 EX + (1-97) (I) SCHEDULE H I COMMONWEALTH OF PENNSYIVANIA FUNERAL EXPENSES & .NHER,T~.CE TAX.ETURN ADMINISTRATIVE COSTS RES,DENT DECEOENT ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 Debts of decedent must b. raported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. BURIAL, SERVICES G RELATED EXPENSES 6,030.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL /AIv..So enter on line (l~,i~ nit: ~; ~,,eca~,,,u,a,,on/ $ 6 r 0 3 0.0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021F. 12 RE~/.1512 EX + (1.97) (0 SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 0.00 N/A TOTAL (Also enter on line 10, Recapitulation) $ 0.0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021 F. 13 REV-1~13 EX + (9-00) SCHEDULE J I CO.MO.W T. O .E..S VAN A BENEFICIARIES INHERITANCE TAX RETURN .ES,DE.T ECEDE.T ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ALBERTA BOHENICK 1. 717 ELKWOOD DRIVE NEW CUMBERLAND, PA 17070 SPOUSE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET ri. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. O.OO B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART ]-I - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021F. 14 R'EV-1514 EX + (1-97) (I) SCHEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN & TERM CERTAIN RESIDENT DECEDENT (Check Box 4 on Rev.1500 Cover Sheet) ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. I--']Will [~]lntervivos Deed of Trust J-]Other NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE [] Life or [] Term of Years __ [] Life or [] Term of Years __ [] Life or []Term of Years [] Life or [] Term of Years 1. Value of fund from which life estate is payable $ 2. Actuarial factor per appropriate table Interest table rate - [] 3 1/2% [] 6% [] 10% [] Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) $ NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout - [] Weekly (52) [] Bi-weekly (26) [] Monthly (12) [] Quarterly (4) [] Semi-annually (2) [] Annually (1) [] Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate [] 3 1/2% [] 6% [] 10% [] Variable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line4 × Line5 × Line6 $ If using variable rate and period payout is at beginning of period, calculation is: (Line4 × Line5 ×LineE) + Line3 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest('s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) STF PA42021F 15 R~V-1647 E.X + (9-00) SCHEDULE M FUTURE INTEREST COMPROMISE COMMONWEJ~.TH OF PENNSYLVANIA )NHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 This schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests Where the rate of tax which v/ill be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax retum. [] Will [] Trust [] Other I. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. $. 1], For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. [] Unlimited right of withdrawal [] Limited right of withdrawal I]]. Explanation of Compromise Offer: ~ Summary of Compromise Offer: 1. Amount of Future Interest .................................................................... 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ........... $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ~--~6%, [--~3%, J-'lO% .......................... (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One l-'-16%, r-]4.5% ................................. $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ........... $ 6. Value of Line 1 Taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ....... . ....$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ................................ STFPA420211::16 (If more space is needed, insert additional sheets of the same size) R~:V.1649 EX + (1-97) (I) SCHEDULE 0 COMMO LTH O ,E,,SVLVA,,A ELECTION UNDER SEC. 9113(A) RES'DENT DECEDENT (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER BOHENICK, STANLEY J, JR. 2002-00170 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113 (A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION VALUE Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE Part B Total $ (If more space is needed, insert additional sheets of the same s~ze) STF PA42021F 17 Register of Wills of CUMBERLAND County, PennsylvanJ Certificate of Grant of Letters No. 2002-00170 PA No. 21-02-0170 ESTATE OF BOHENICK STANLEY J JR Late of NEW CUMBERLAND BOROUGH ~UM~L~ ~U~'l'~, ' Deceased Social Security No. 172-28-1770 WHEREAS, on the 13th day of February 2002 an instrumen dated January 9th 2001 -- was admitted to probate as the last will of BOHENICK STANLEY J JR (La~'l', ~'l~'i', late of NEW CUMBERLAND BOROUGH , CUMBERLAND County, who died on the Rth day of January 2002 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to BOHENICK ALBERTA who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 13th day of February 2002. **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) RECEIPT FOR PAYMENT Cumberland_County - Register Of Wills Receipt Date 2/13/2002 Hanover and Hiqh Street Receipt Time 15:29:48 Carlisle, PA ~7013 Receipt No. 1028346 BOHENICK STANLEY J JR File Number 2002-00170 Remarks ALBERTA BOHENICK JA ......................... Distribution Of Receipt ........................ Transaction Description Payment Amount Payee Name PETITION FOR PROBA 25.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN EXTRA PAGES 3.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 5.00 BUREAU OF RECEIPTS & CNTR M.D Cash ~45.00 Total Received ......... 45 00 STATE OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND I, MARY C. LEWIS Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 13th day of February A.D., Two Thousand and Two, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of BOHENICK STANLEY J JR late of NEW CUMBERLAND BOROUGH (LAST, r'±~'l', ~±~) ' in said county, deceased, to BOHENICK ALBERTA and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 13th day of February A.D., Two Thousand and Two. File No. 2002-00170 PA File No. 21-02-0170 Date of Death 1/09/2002 ~c,z~~/~,~/~j/~/j/~'~j,~.~~.,/ _ _ Register S.S. # 172-28-1770 / ~/ J NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL PETITION FOR PROBATE and GRANT OF LETTERS Estate of S'fiANEE~ J. BOHENICK ,IR, No. 21 - 07 - 170 also known as To: Register of Wills for the Deceased. County of CUMBERLAND in the Social Security No. 172 - 2.8 - "1770 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are .18 years of age or older an the execut R I X named in the last wilt of the above decedent, dated dANUARY 9, 5001 , 19.__ and codicil(s) dated (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in CUMBERLAND County, Pennsylvania, with h IS last family or principal residence at 717 FI I<WOOD DR NEW £UMRFRI ANI3~ PA 17070 NEW C. UMBERLAND BORO (list street, number and muncipality) Decendent, then 80 years of age, died .]ANllARY q ,~1~9..002 , at HOLY SPIRIT HOSPITAL CAMP HILL, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ .~,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: WHEREFORE, petitioner(s) respectfully request(s)the probate of the last will and codicil(s) presented herewith and the grant of letters TESTAMENTARY (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. , -=~ ALBERTA ~. BOHENICK Al BERTA BOHENI~K ~ 7'17 ELKWOOD DRTVF '~- NEW CUMBErLaND PA i. 707Q OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~> ss COUNTY OF C. lJM~FRI AND ] The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ,~ ~ r'/~. ~ ~ before me this ~ 'l 3TH /~ day of [ c~td~./~---e~ .~ ~' ~p. FEBR~R~ /) ' fir . - kT'~I~,~( C LE~IS ' Re;ister L [J---~ ~ Estate 0f STANLEY ,1 BOHENICK JR~w_J~ DECREE OF PROBATE AND ( the reverse side hereof, satisfactory proof having been pre: IT IS DEC~ED that the inst~ment(s) dated JAN described therein be admitted to probate ~d filed of record STANLEY ~ BOHENICK OR ~d Letters TESTANENTARY ~e hereby granted to ALBERTA M BOHENICK A/K/A ALBERTA BOHENICK ' of WilLs Register MARY C LEWIS FEES Probate, Letters, Etc .......... $. ?~,.00 Short Certificates(4 ) .......... $ '] ._9.00 ATTORNEY (Sup. Ct. I.D. No.) Renunciation ................ $ EXTRA PAGE 3.00 $ ADDRESS JCP 5.00 TOTAL__ $ 4E,vvnn Filed FEBRUARY 13~ ?007 .................. '-' ' ' ;-' ........... PHONE COHHONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE ZNHERZTAHCE TAX D[V/S/ON DEIST. Z80601 HARRISBURG, PA 17128-0601 NOTICE OF /NHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-1;~? EX AFP (01-02) i::i~ DATE 04-22-2002 ESTATE OF BOHENICK STANLEY d DATE OF DEATH 01-09-2002 FILE NUNBER 21 02-0170 O~ i!?ii 29 ~ ? :;? lCOUNTY CUHBERLAND TIHOTHY C HEWER ACN 101 HEWER & ASSOCIATES 2699 PRINCETON PIKE ~ LAWRENCEVILLE NJ 086~ HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE., PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF BOHENICK STANLEY J FILE NO. 21 02-0170 ACN 101 DATE 04-22-2002 TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE ZNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a*e (SchedulB A) (1) .00 NOTE: To Ansure proper 2. S*ocks and Bonds (Schedule D) (2) 5~402.30 cred/~ ~o your account, :5. Closely Held S~ock/Par~nershAp Tn~eres~: (Schedule C) (:5) . O0 subm/~ ~:he upper por*Aon ~. Nor~gages/No*es ReceAvebZe (Schedule D) (fi) . O0 of ~:hls for. wA~:h your 5. Cash/Bank DeposA~:s/NAsc. Personal Proper~y (Schedule E) (5) . O0 ~ax payment. 6. JoAn~ly Owned Proper~y (Schedule F) (6) . O0 7. Transfers (Schedule G) (7) . O0 8. To*el Asse~:s (8) 5,40~. 30 APPROVED DEDUCTIONS AND EXENPTZONS: 9. FunBra/ Expenses/Adm. Cos~s/NAsc. Expanses (Schedule H) (9) 6,030. O0 10. Debts/Nortgege Liabilities/Liens (Schedule Z) (10) . O0 11. Total Deduciions (11) ~. 030. O0 12. Ne~ Value of Tax Re*urn (12) 627.70- 1:5. CharA~ebZe/Governeen~al Bequests; Non-elected 9115 Trus*s (Schedule J) (1:5) . O0 1~. Ne~ Value of Es~a~e Sub~ec~ ~o Tax (1~) 627.70- NOTE: Zf an assessment was lssued previously, lines 14, 15 and/er 16, 17, 18 and 19 ~ill re~lect ~igures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 1.6. Amount: of LAne 1~ e~: Spousal ra~:a (15) . O0 X O0 = . O0 16. Amoun~ of LAne lq ~axeble a~ LAneal/Class A ra~e (16) . O0 X 045 = . O0 17. Amoun~ of L/ne 1~ a~ SAblAng ra~e (17) .00 X 12 = .00 18. Amoun* of L/n~ 1~ ~axeble a* Colla:~eral/Cless B ra*e (18) . O0 X 15 = . O0 19. PrincApal Tax Due TAX CREDITS: (1;)= . O0 PAYHENT ~ RI~CI~TPT DISCOUNT (+J DATE / NUNBER ZNTEREST/PEN PA]:D (-) ANOUNT PA]:D TOTAL TAX CREDIT I .00 BALANCE OF TAX DUEI .00 INTEREST AND PEN. / .00 TOTAL DUE I . O0 ~ ZF PAID AFTER DATE ZNDZCATED~ SEE REVERSE ( ZF TOTAL DUE ZS LESS THAN $1., NO PAYNENT ZS REQUIRED. FOR CALCULATION OF ADDZTZONAL ZNTEREST. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR)., YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THZS FORH FOR ZNSTRUCTZONS.) RESERVATION: Estates of decadents dying on ar before December 12; 1982 -- if any futura interest in the estate is transferred in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration of any estate for life or far years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer [nheritance Taxes at tho laafu! Class B (collateral) rata on any such future interest. PURPOSE OF NOT[CE: To fulfill the requirements of Section 2140 of the Xnheritancs and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Nilis printed on tho reverse side. --Hake check or money order payable to: REGXSTER OF #lEES; AGENT REFUND (CR): A refund afa tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Xnheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special 24-hour answering service for farms ordering: 1-800-$62-Z0S0; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTXONS: 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. ZeIOZX, Harrisburg, PA X7128-1021; OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans* Court. ADHXN- XSTRATXVE CORRECT[ONS: Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue, Bureau of Xndividual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg; PA ~7128-0601 Phase (717) 787-6S05. Sea page S of the booklet "Instructions for Xnheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DXSCOUNT: Xf any tax due is paid within three (5) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appea! the tax and interest that has been assessed as indicated on this notice. XNTEREST: Xntmrast is charged beginning aith first day of delinquency, or nine (9) months and one (l) day from the date of death; to the date of payment. Taxes which became delinquent befora January l; 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate af .000164. All taxes which became delinquent on and after January l, 1982 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 1982 through 2002 are: Year Xnterast Rate Daily Xntarast Factor Year Xntmrest Rate Daily Xnterest Factor 198Z 202 .000548 1992 92 .000247 1983 162 .000438 1995-1994 ?Z .O00Xgz 1984 XZZ .00050! 1995-1998 91 .0001~7 1985 131 .000356 1999 7Z .000192 1986 IOZ .000274 2000 81 .O00ZZ9 1987 92 .000247 2001 92 .000247 1988-1991 IXZ .OOO$OX Z002 61 .000164 --Xntmrast is calculatad as folloes: XNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DEL/NQUENT X DAXLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent ail1 reflect an intersst calculation to fifteen (15) days beyond the date of tbs assessment. Xf payment is made after the interest computation date shown on the Notice, additional interest must be calculated. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: ,~T-~/f4 b/z~ /~y q ) e~)O O~ Will No. ~O0 _C}, "" G0 ! ~ 0 Admin. No. To the Register: I certify that notice of (beneficial interest) 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 .~'- r~/- O,~, : Name Address ~ Al[~,~rT-~ /'q. [~j~e,~,~£ 9/0 E! k'~oood br. Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: .~'- 0 ~ -- 09 ~ ~ Signature Capacity: ~ Personal Representative Counsel for personal representative Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 BOHENICK ALBERTA 717 ELKWOOD DR NEW CUMBERLAND, PA 17070 RE: Estate of BOHENICK STANLEY J JR File Number: 2002-00170 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 will become delinquent on: 1/09/2005 Your prompt attention to this matter will be appreciated. Thank You. ncere~y~ ~ ~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge Estate of BOHENICK STANLEY J JR Late of LOWER ALLEN TOWNSHIP ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-02-00170 Date: 2/11/2005 NO.: 21-02-00170 BOHENICK ALBERTA 71 7 ELKWOOD DR NEW CUMBERLAND PA 17070 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: BOHENICK ALBERTA Personal Representative Counsel: ** NO INFORMATION FOUND ** Date of Decedent's Death: 1/22/2002 Date of Delinquency Notice: 1/09/2005 The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans' Court, in accordance with rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor their counsel, have filed with the Register of Wills or Clerk of Orphans' Court, his/her Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule, and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orhans' Court Rules, was given by the Clerk of Orphans' Court on 2/10/2005 and that the ten (10) day notice to file the status report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or their counsel. cc: File Personal Representative Counsel ~~q~~~ Glenda Farner Strasbaugh Clerk of Orhans' Court A hearing is scheduled for April 01, 2005 at 9:30 AM in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. GBOR~ uue.