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Home My WebLink About04-0546 S. BERNE SMITH Attorney-at-Law 107 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 07 J - 04 - 5LJ.lP June 10, 2004 Inre: Estate of Guy J. Pugliese, died May 23, 2004 SS# 172-01-1598 PA File: File: 194002 ,--. ..- Ms. Glenda Farner Strasbaugh ;..;...1"... c:5 Register of Wills .-.. _t:.'::o. Courthouse L ~ 1 Courthouse Square ~:. --' Carlisle, PA 17013-3387 c:: Dear Ms. Strasbaugh: ,...., . w Accompanying this letter is a Petition for Probate and Grant of Letters Testamentary in the Estate of Guy J. Pugliese, who died testate May 27,2004. Attached to the petition are the following: 1. The original and one copy of the Will of Guy J. Pugliese. 2. The Estate Information Sheet for the P A Department of Revenue. 3. Death Certificate for Guy J. Pugliese, aka Guy Pugliese. 4. The Will is a self-proving Will. We believe that this covers everything that is required. We ask that we be provided with twelve (12) short certificates. Please send them and the actual letters testamentary to the undersigned when they are prepared. Because we will be hand delivering all of the above materials to you, we will be prepared to pay the fees by check at that time. Thank you for your attention to this matter. If anything further is required, please advise. Sincerely yours, 4/J~~ S. Berne Smith Enclosures: cc: Raymond A. Pugliese, Executor Ms. Mary Lou DeCarlo Ms. JoAnn White PETITION FOR PROBATE and GRANT OF LETTERS Estate of Guy J. Pugliese, aka No..'2t-o,",-dlo Guy Pugliese Social Security No. 172-01-1598 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania. The Petition of the undersigned respectfully represents that: Your Petitioner is 18 years of age or older and is the Executor named in Article Five of the last Will of the above decedent, dated February 20,2003. Decedent was domiciled at death in Dauphin County, Pennsylvania, with his last address at Villa Teresa Nursing Home where he had lived since May 10, 2004. However, prior thereto for many decades decedent resided in New Cumberland, Cumberland County, P A and, more recently, at Country Meadows, 4902 E. Trindle Road, Mechanicsburg, Cumberland County, P A. Petitioner respectfully submits that Cumberland County was decedent's place of residence and that the Will should be probated in Cumberland County. Decedent, then 88 years of age, died May 27,2004, at Villa Teresa Nursing Home, 1051 Avila Rd., Harrisburg, PA 17109, Lower Paxton Township, Dauphin County. 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. Decedent at death owned property with estimated values as follows: 1. All personal property $ 99,000.00 2. Value of real estate in Pennsylvania None WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith and the grant of letters testamentary thereon. I~ I,t ~ Raymond A. Pugliese ;:! ; d .. 31 Chestnut Street -'='" Steelton, PAl 7113 ? ~.::.- --' o r....'-~ w OATH OF PERSONAL REPRESENTATIVE .:ll - O*-5*~ COMMONWEAL TH OF PENNSYLVANIA: : SS COUNTY OF CUMBERLAND : Petitioner, Raymond A. Pugliese, swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of Guy J. Pugliese, deceased, petitioner will well and truly administer the estate according to law. ~ ~ !~ Sworn to or affirmed before me, Raymond A. Pugliese this ID-t~ day of June, 2004 ~oJUk~~ '~ Registe~r~ iluzt- ..~- ,... ~ ,_ ..1' 0 - ..::0. L ~- ~.- --' 0 \",-' VJ 2. No. .2 , -OA4 -5~lD Estate of Guy Pugliese, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~NL 10 ,2004, in consideration of the petition set forth on the two preceding pages, satisfactory proof having been presented before me, IT IS DECREED that the instrument dated February 20,2003, described therein be admitted to probate and filed of record as the last will of Guy J. Pugliese, deceased, and Letters Testamentary are hereby granted to Raymond A. Pugliese, Executor. ~ ~lUlO/\ ~ Register of Wills ~\- <ri . ~ FEES /$~~ Probate, Letters, Etc. $ 2Do-cO Attorney: S. Berne Smith Short Certificates (12) Sup. Ct. LD. No: 07254 $~.OD ~--Q~ ~ 107 N. 24th Street $ it; ()t) Camp Hill, PA 17011-3602 Other $ la.OD Phone: 717-737-6789 TOTAL $~lol. 00 "..-.. .~- ,', c:5 ''- ~,-,. Filed: L ~ --' ,- ~- , '. - , "., w 3. ?':\ Thi' i~ to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Loc.!1 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 photograplf: Fee for this certificate. $2.00 4::~,~ .' P 10361099 No. Z\-C~- 5410 ~--.... ,r!'"'" ... .-.' , c:5 4~ C c.' ..:::.. -.. Cl H 1u5 143 Re." 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH .- TYPE/PRINT sTAre FILE NVM8ER " IN SEX SOCIAL SECURITY NUMBER PERMANENT BLACK INK j'1a1e 3.1 72 -01 - AGE (laslBarthday) BIRTHPlACE (Clly and P F ATH n . I 88 State 0( Foreign COuntry) HOSPITAL . Vrs rdsburg, PA ........0 ::OIV,O .. ... COUNTY OF DEATH FACILITY NAME (If not inStitutIOn, give street and number) RACE - Amencan Indian, Black, lMlfle. el . iSpeoIy) White MARITAL 51 A TUS . Mamed. SURVIVING SPOUSE Never Mamed, 'Mdowe<l. (It......, lP"I. I'n&ld.nn.mc) o._IS_Iy) ,.,Widowed . p", xtnn "p 17b. COlXrt i7d. 0 ~~~=~i=or CltyJbol"o fil <n :> <n < :; < ... : Approximate Other SIgnificant condIlJonS conlnbulll"IQ10 dMU'I. bul .mterval not reSUlting In !he undef'tylng cauH Qlva'l an PART I : onset and deatl"l a. $equwni8lly IISI conditions F if any, ~ to immedia cauH. Enter UNDERLYING CAUSE (DiMaSe a ~ury ( AS' . Nt iniu..d events reltiting on death ) LAST d. WAS AN AUTOPSY \'\ERE AUTOPSY FINDINGS MANNER OF DEATH 0'" TE OF INJURY TIME OF INJURY INJURY AT V\()RK? OESCRIBE HQWINJURY OCCURRED PERFORMED? AVAILABLE PRIOR TO (Monti, c." v,." COMPLETION OF CAUSE - Ii] - 0 OF DEATH? 0 0 Ve. 0 No 0 No [!( -, Pending Invelbgetion Va. 0 No l;I Ve.O $uacide 0 o 3Oa. 3Ob. M. 30<. Col.Jd not be determined PLACE OF INJURY. A1 home, fann, slleel. factory, olfice 2". bulclng,tIIC(Spec.fy) 2... 21, 3Oe. >-- 'CERTIFIER (Check only one) Z w ~l:~F~tGJ'~~\'~V:Jf;J.~:th~~~J:tr:: g:~.:=:r=r ~:~.r:~.~~,~~~~.t,l~.~~~ ,.....,.. ....Iil 0 w u w .PRONOUNCING AND CERTlFYlNG PHYSICIAN (PhysK:ian boCtl ptOt'lOU'ldng deMh ...:I certifying to cause of dUth) 0 l5 To the best of my knowted~, de.th occurred.t the time, date, and pIIlce, .nd due to the c..aee(a) and m.nn.r.. auted... .. ... . . ..... ... w -MEDICAL EXAMlNERlCORONER ;l; On the b.... of ...mlnaUon andlor Invntlgatlon. In my oplnton, dHth occurred at the Ume, date, and platee, and due to the cau.n(a) ~d 0( z manner a. a'Med ...." .................. ".."....."............."'..,..,.. 3'L REGI$TRAR'S ~GNATURE AND NUMBER . . . " LAST WILL AND TEST AMENT OF GUY J. PUGLIESE .. ,-- ) . . I, GUY J. PUGLIESE, of New Cumberland, Cumberland County, {, l,J... Pennsylvania, being of sound mind and disposing memory, though I realize the uncertainty of this life, I have full confidence and trust in my Lord and Savior, Jesus Christ, in His death on the cross for my sins and in His shed blood as an atonement for my soul; and I know by faith that because of His sacrifice on the cross for me I have eternal life, do hereby make this Will, hereby revoking all my former Wills and Codicils: Article One: Specific Bequests: S1.1 If I should predecease my friend, Josephine Ogden, currently of Mechanicsburg, P A, I give and bequeath to her the following items located in my home: A. Organ in the living room with all the music books; B. Nick Ruggieri painting over the fireplace depicting a rural scene in Pennsylvania; C. Nick Ruggieri painting over sofa in living room depicting a still life of flowers; and D. Metropolitan Opera scene over Hi Fi system in living room. Article Two: Other Tangible Personal Property: S2.1 I bequeath all the rest of my tangible personal property in accordance with the terms of a personal property memorandum I may prepare. If no such memorandum is located or received by the Executor within 60 days after being appointed as such, after conducting a reasonable search for such memorandum, the Executor shall be held harmless for distributing such property as hereinafter provided. S2.2 I bequeath such property not disposed of by such memorandum, or all of such property if no such memorandum is located or received, to my daughters, Mary Lou DeCarlo and 1 JoAnn White, both currently of Lehigh Acres, FL, per stirpes, to be divided between them in as nearly equal shares as they agree. In the event of irreconcilable disagreement between my children, they shall take alternate turns selecting individual items with the oldest child making the first selection. Any items not so selected shall be sold and the proceeds shall pass as a part of my residuary estate. 92.3 To the extent practicable in the Executor's sole discretion, I bequeath any policies of insurance on such property to the beneficiary entitled to such property. 92.4 I direct that the expenses of storing, packing, shipping, insuring and delivering any such property to the beneficiary entitled thereto shall be paid by the Executor as an administrative expense of my estate. Article Three: Residue: 93.1 I devise and bequeath all the residue of my estate of whatever nature and where ever situated to be divided and distributed to my daughters, Mary Lou and JoAnn, per stirpes. Article Four: Provision for Debts and Expenses: 94.1 I direct that any of my legally enforceable debts, any expenses of my last illness, funeral and burial, and any of the administrative expenses of my estate shall be paid from the principal of that portion of my estate disposed of by Article Three of this Will. Article Five: Appointment of Fiduciaries: 95.1 I appoint my brother, Raymond A. Pugliese, currently of Steelton, PA, as Executor of this Will. If Raymond A. Pugliese is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint my daughters, Mary Lou DeCarlo and JoAnn White, as first, contingent Co-Executrices. If either of them is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint the other as sole, contingent Executrix. All references herein to the "Executor" shall mean my originally appointed Executor or my successor Executrix, as the case may be. 2 Article Six: Powers of Fiduciaries: ~6.l No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. ~6.2 Any such fiduciary shall have the following powers, in addition to those given by law: ~6.2.1 To invest in, accept and retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; ~6.2.2 To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; ~6.2.3 To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; ~6.2.4 To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; ~6.2.5 To engage in litigation and compromise, arbitrate or abandon claims; ~6.2.6 To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributes on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; ~6.2.7 To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; ~6.2.8 To allocate, in the Executor's sole and absolute discretion, any portion of my exemption under Section 2631(a) of the Internal Revenue Code to any property as to which I am the transferor, including any property transferred by me during my lifetime as to which I did not make an allocation prior to my death; and ~6.2.9 To disclaim any interest I may have in any estate if the Executor deems such disclaimer to be in the best interests of my estate and the beneficiaries thereof. 3 . Article Seven: Provision for Taxes: 97.1 All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to any such tax ("Death Taxes"), and any penalties thereon, shall be paid by the Executor out of the principal of that portion of my estate disposed of by Article Three of this Will, and all interest with respect to any such taxes shall be paid by the Executor out of the income or principal or partly out of the income and partly out of the principal of such portion of my estate, in the absolute discretion of the Executor, without reimbursement from or apportionment among the beneficiaries, recipients or owners of such property for any such taxes, penalties or interest. Article Eight: Miscellaneous Provisions: 98.1 As used in this Will, the term "Internal Revenue Code" shall mean the Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of subsequent law. 98.2 Any amounts or assets which are payable or distributable to a minor or incompetent hereunder may, at the discretion of my fiduciaries, be paid or distributed to the parent or guardian of such minor or incompetent, to the person with whom such minor or incompetent resides, or directly to such minor or incompetent, or may be applied for the use or benefit of such minor or incompetent. 98.3 No interest of any beneficiary hereunder shall be subject to anticipation, pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his or her interest, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciaries for any liability of such beneficiary, whether such liability arises from his or her debts, contracts, torts, or other engagements of any type. 98.4 If any beneficiary hereunder should die within thirty (30) days after me or within thirty (30) days after any other person the survival of whom determines his or her rights hereunder, then such beneficiary shall be deemed to have predeceased me or such other person for all purposes hereunder. IN WITNESS WHEREOF, I, GUY J. PUGLIESE, have hereunto set my hand and seal to 4 this, my last Will, typewritten on six (6) sheets of paper, including the self-proving attestation clause 11. and signatures of witnesses, this 2.. c) /- day of February, 2003. J:LAi:l/ i~ (SEAL) GUY J. GLI~S Signed, sealed, published and declared by the above named GUY J. PUGLIESE as and for his last Will, in the presence of us and each of us, who, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. ~ f: ~.ReSidingat 2./04 (;3' - (oV'~rJT(l.,7 LI'1Nt: r- f'/J '7U2. .r ~~ C/I./C'LI1 . Residing at g Jo c::: AA ,../7)/ An AOr.:1l> J L/lSJ /? EL ll/'~rJl c:.J"~'-", ~iJ- I')~- )7 0 s-$"'- , I Residing at /V ? #" 2..6/~ ..J;-, C I:9n, /II '--.... /..-9_ /?t) II. I COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF CUMBERLAND We, GUY J. PUGLIESE, the testator, and ;J)I) ~ v FN'y /-? E ~ tAl . ;J , Jd.... /-f I-( /1 5.... n )QAlI F Ci..- r:> , and .r'> g (;~ AAI <€ ..JH /r# , the witnesses, whose names are signed to the attached 5 ,. . or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the Will as a witness and that to the best of his or her knowledge the testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ~ !-:Jr~ ~I!~. GUY J. PUG ESE Wltne s I:!~~ A 6'~AS) Witness Subscribed, sworn to and acknowledged before me by GUY J. PUGLIESE, the testator, and subscribed and sworn to before me by VOA, If '1-N,;? p, ,.-, ~JorHL1~ ~- /7/1-/\/1 Fo L.-I) L-/r.,v.JJrJ , and r ,Bc~/V.: Jh I -;- II' , the witnesses, this 2-07') day of February, 2003. ~[/~ Notary Public My Commission expires: SEAL Notarial Seal Laure E. Kane, Notary Public Hampden Twp., Cumberland County My Commission Expires Nov. 15, 2003 .. Member, Pennsylvania A.,>sociation ot Notaries 6 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Guy J. Pugliese Date of Death: May 27,2004 File No. 2004-00546 PA File No.21-04-0546 To the Register of Wills of Cumberland County, PA: I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 15, 2004: Name Address Ms. Mary Lou DeCarlo 1624 Pine Valley Dr. #302 Ft. Myers, FL 33907 Ms. JoAnn White 125 East Lake Drive Lehigh Acres, FL 33936-6907 Ms. Josephine C. Ogden 6203 Stanford Court Mechanicsburg, P A 17050 Notice has now been given to all persons entitled under Rule 5.6 (a) except: None. Date: June 15, 2004. /1 /J~~~) Signature:L / . Name: S. Berne Smith Address: 107 N. 24th Street Camp Hill, PA 17011-3602 Telephone: 717-737-6789 Capacity: Personal Representative X Counsel for Personal Representative , r ,~ .-- :::5 J -c.:J' !? ~..r' .;.....-... \J S. BERNE SMITH Attorney-at-Law 107 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 July 30, 2004 In re: Estate of Guy J. Pugliese, DOD May 27, 2004; SS# 172-01-1598 P A File: 21-04-0546; File No. 2004-00546 My File: 194002 Ms. Glenda Famer Strasbaugh Register of Wills Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Dear Ms. Strasbaugh: Enclosed is check no 998 from the Estate of Guy J. Pugliese in the amount of $13,000.00 payable to the Register of Wills, Agent, as a preliminary payment on account of the Pennsylvania Inheritance Tax. Thank you for your attention to this matter. If anything further is required, please advise. /2 Sincerely yours, &~ ,~~ S. Berne Smith Enclosures: cc: Raymond A. Pugliese, Executor Ms. Mary Lou DeCarlo Ms. JoAnn White 9r:- :=: ((, g :IJ ::1 :'I~ 'D 0-: () ct::1 () ~, :b , fjj" a;j ."', :') {.') ~ 31 j! N i;:;. 0 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX{11-96} DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004222 SMITH S BERNE ESQ 107 N 24TH ST CAMP Hill, PA 17011-3602 ACN ASSESSMENT AMOUNT CONTROL NUMBER nnnn fold n_n_nn n_n_n 101 I $13,000.00 ESTATE INFORMATION: SSN: 172-01-1598 I FILE NUMBER: 2104-0546 I DECEDENT NAME: PUGLIESE GUY J I DATE OF PAYMENT: 08/02/2004 I POSTMARK DATE: 07/31/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: OS/27/2004 I I TOTAL AMOUNT PAID: $13,000.00 REMARKS: CHECK# 998 INITIALS: JA 13EAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS ! n-CIl : o' s-->to >d ~ 3 ::r::l'--l'" o;::.:..p..V1 "..... s- S "::I ~. >~F" -8m -->....'" Ri;! ::ice6f ~ilts 0-. 13 '04 AUG -2 P2:.4 C1c. C -. CliIni. and Co .... ~I (.> ". :,.\ l.) .f' l.) (,1 ,\) l.) 0 n-n~~ '\) e; n 0 (JQ . o S. ~. 0 ~ ~ ~- ~ 5~g '''::Ig~g,g- > '" ~'Tj - '" ~. 8 - -Jr./) := 0..0 en (1l - ~ ... '-"e; CIl ~'" ~ '-" 00 --> ~ qg.. -- - -' , " Iii) \ 1 ( " \ ~. \ \ ' \ \ \ \ \ \ .1 '\ \ I i I i I : fill ! l,' " - , I " , " I .. i I I , , , I I . , I . , ; i, I " I I j' , ;r ~ I f , - I . ~~, '~ , V . COMMONWEALTH OF PENNSYLVANIA REV-1162 EX( 11-96) DEPARtMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT_ 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004922 SMITH S BERNE ESQ 107 N 24TH ST CAMP Hill, PA 17011-3602 ACN ASSESSMENT AMOUNT CONTROL NUMBER ____n__ fold -----~---- -~------ 101 I $2,729.58 ESTATE INFORMATION: SSN: 172-01-' 598 I FILE NUMBER: 2104-0546 I DECEDENT NAME: PUGLIESE GUY J I DATE OF PAYMENT: 02/07/2005 I POSTMARK DATE: 02/04/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: OS/27/2004 I I TOTAL AMOUNT PAID: $2,729.58 REMARKS: S. BERNE SMITH ESQ CHECK#1004 INITIALS: RSK SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS S. BERNE SMITH Attorney-at-Law 107 N. 24" Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 February 4, 2005 In re: Estate of Guy J. Pugliese, DOD May 27,2004; SS# 172-01-1598 P A File: 21-04-0546; File No. 2004-00546; EIN: 20-6224209 My File: 194002 Ms. Glenda Farner Strasbaugh Register of Wills Courthouse I Courthouse Square Carlisle, P A 17013-3387 Dear Ms. Strasbaugh: Being filed herewith are the original and one copy of the Pennsylvania Inheritance Tax return for the Estate of Guy J. Pugliese. Also, enclosed is a check from the Estate of Guy J. Pugliese in the amount of $2,729.58 payable to the Register of Wills, Agent, as the final payment of the Pennsylvania Inheritance Tax owed by the Estate. Please acknowledge receipt of the payment. Thank you for your attention to this matter. If anything further is required, please advise. r have appreciated the fine assistance of your staff. They are excellent. Sincerely yours, ~ 8~.LQ S. Berne Smith Enclosures: cc: Raymond A. Pugliese, Executor Ms. Mary Lou DeCarlo Ms. JoAnn White . . . . . . 0 . ~ < ~ b ~ " 0- " iii , ~ ,..., 9 (J-'(JiXl~ e;(J0~?, (J -' 'f1 [. ~ 9. CA' 0 -J ...... ::T(it- ~ S ee CI (tl 0"'1 CD '--00&108- >-Q z t"J CI ~ ;>> '" Cl> ..., Ol ::r::O~~ w -' ~ ~ "!j ..... i'd-; w ~a -JC.IJ ~3 b...,~t"J "" o~ -' "" __ e tf.l ('tI " ::r::", Vl CI ~~ we;.... --oN""~ ~(D r.t: :> -l>- ' CI ...,>.... ~':IQ w .... 0-' ::r1 -;l >-l CI 00 !.i CI ...m -> r::r 3(/)>=: lI'" ~ -' ~ ~~ t;~ 9.-.::, ~ ';-' t"J nJ :; - w tl1 Vl -.l """" \ ~..., to lI'" ~ U'l 0'> . -(::, "" \ -" Q--\ U'l .ll --t: ~ ...........- I 8~1J ~::;. '" "~ '" "~ '" h ~ '" J;lJ:: :::i '" w n ~ ~ co gi;;R- ~ID ~ i.n OC""1 o::Jr~' tit c:..tl>o........" .-. z~ -",oa ~c:::J -l';--~ VI tt.A.J U1" ~ '" " '" en rn - - . . ,_",.MO~.. _ ~ - ~~\)'l ~~,'i,\~, "" "\:;0, "~nll "t) '1. _,t', ~\:) S ('>-1,\ \\y~ - l~\, ........................................... CO\1MONWEAL TH OF REV - 1500 OFFICIAL USE ONLY PENNSYL VANIA ........................................ ............. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT 280601 21 04 0546 HARRISBURG. PA 17128-0601 RESIDENT DECEDENT COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z PUGLJESE, GUY J. 172-01-1598 LJJ DATE OF DEATH DATE OF BIRTH THIS RETURN MUST BE FILED IN DUPLICATE WITH THE a w May 27, 2004 July31,1915 REGISTER OF WILLS U w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER a None . X 1 Original Return 2, Supplemental Return 3, Remainder Return (date or death pfiorto 12- ~~v: 13-82) UL~ 4 limited Estate 4a. Future Interest Comprise (date of death afte' 12.12-82) 5, Federal Estate Tax Return Required . QU .coo o o.1!i 7. Decedent Maintained a living Trust (Attach a ropy 01 Trust) 0. X 6 Decedent Died Testate (Attach copy of Will) 0 8. Total Number of Safe Deposit Boxes ~ 9 litigation Proceeds Received 10, Spousal Poverty Credit\date oldealn between 12-31-g1 and 1.1-95) 011. Election to tax under Sec, 9113(A) (Attach Scn 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCe AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: C NAME COMPLETE MAILING ADDRESS <D = S. BERNE SMITH, ESQ 107 N, 24TH STREET c = = FIRM NAME (If Applicable) CAMP HILL, PA 17011-3602 ~ ~ = '-.:> TELEPHONE NUMBER 717-737-6789 1 Real Estate (Schedule A) (1) $0.00 OFFICIAL USE ONLY 2 Stocks and Bonds (Schedule B) (2) $000 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00 Z 4 Mortgages & Notes Receivable (Schedule D) (4) $0,00 0 ~ 5. Cash, Bank Deposits & Misc Personal Property (Schedule E) (5) $103,707.56 <( --1 6 Jointly Owned Property (Schedule F) (6) $0.00 ::J D Separate Billing Requested ~ Q c. <( 7 Inter-Vivos Transfers & Mise, Non-Probate Property (7) $274,949.07 0 (Schedule G or L) UJ cr 8 Total Gross Assets (total lines 1-7) (8) $378,656.63 9. Funeral Expenses & Administrative Costs (Schedule H) (9) $12,419.34 10 Debts of Decedent, Mortgage liabilities & Liens (Schedule I) (10) $1,486.41 11. Total Deductions (total Lines 9 & 10) (11) $13 905 75 12, Net Value of Estate (line 8 minus line 11) (12) $364,750,88 13, Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $000 made (Schedule J) 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) $364,750.88 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)(12) X 0.00 (15) $0.00 Z - 0 $364,750.88 f' 16, Amount of line 14 taxable at lineal rate x 4.5% (16) $16,413.79 X~ - ~f- 17, Amount of line 14 taxable at sibling rate x 12 (17) 5000 f-~ ~ ~ 18. Amount of line 14 taxable at collateral rate x 15 (18) 1000 0 0 19, Tax Due (19) 516.413,79 20.D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Copyright lO()O David Jam<:s 1'110lPC. {"lI Decedent's Complete Address: STREET ADDRESS Country Meadows, 4902 E. Trindle Road CITY I~TATE IZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1 Tax Due (Page 1 line 19) 11) $16.413.79 2 Credits/Payments A. Spousal Poverty Credit B Prior Payments $13,000.00 C. Discount $684.21 Total Credits (A + B + C) 12) $13.684.21 3 InteresUPenalty if applicable D Interest E Penalty TotallnterestlPenalty (0 + E) (3) $000 4 If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund (4) 5 If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. 15) $2,729.58 A. Enter the interest on the tax due 15A) B Enter the total of line 5 + SA This is the BALANCE DUE. (58) $2.729,58 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS 1 Did decedent mak.e a transfer and Yes No a. retain the use or income of the property transferred; ~ ~ b retain the right to designate wllo shall use the property transferred or its income: c. retam a revisionary interest; or d receive the promise for life of either payments, benefits or care? 2 If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? 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? 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 pequry, I declare that I have examined this relurn, 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 alllhe information of which preparer has any knowledge ~y ItC../-').-- DATE Raymond A. Pugliese, Executor February if ,2005 ADDRESS 31 Chestnut Street, Steelton, PA 17113 SIGNATURE OF PREPARER OTHER T. DATE S. BERNE SMITH, ESQ February '1 ,2005 ADDRESS 107 N. 24TH STREET, CAMP Hill, PA 17011.3602 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 PS &9116 la) 11.1) (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 139116 (a) (1.1) (ii)]. The statute does no 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. s9116(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. 39116(1.2) (72 PS. &9116(a) 11)]. 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. 39116(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 2()(JO DaVid James Thorpe. Esq COMMONWEALTH OF PENNSYLVANIA SCHEDULE E INHERITANCE TAX RETURN CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF GUY J. PUGLIESE FILE NUMBER 21-04-0546 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 DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Cash at date of death $1.51 2. Clothing - all clothing was donated to Goodwill Industries 0.00 3. Personal effects and furniture. At time of death, decedent was in a nursing home and had no such property or furniture, except for a time x watch with estimated value of $20.00 20.00 4. Quaint Oak Savings Bank, 607 Lakeside Drive, P.O. Box 216, Southampton, PA 18966-0216. CD # 71087. Date of Death Principal Balance: $75,000.00 75,000.00 5 Accumulated Interest on CD # 71087 to date of death: $24.94 24.94 (See letter of July 12, 2004, from Quaint Oak Savings Bank, Attachment B hereto) 6 Wachovia Bank, NA, P.O. Box 40028, Roanoke, VA 24022-7313. Checking Account # 1000613277892, opened January 2, 1950 and closed June 10, 2004. Date of death balance $23,478.71. 23,478.71 There was no accrued interest. (See letter of July 9,2004, from Wachovia Bank, Attachment C hereto) 7. Wachovia Bank, NA, refund of safe deposit box fee 32.50 8. Refund of portion of Home Owner's Insurance premium. 756.02 9. Refund of portion of fee from Country Meadows Nursing Home 2,311.51 10. Net amount of pension annuity from PA Treasury Department which was automatically deposited into checking account May 28, 2005. Gross amount deposited was $2,032.90. The Estate had to refund $203.29, leaving net annuity of $1 ,829.61 1,829.61 11. Refund of portion of Patriot News subscription costs 139.55 12. Refund from Keystone Oil Company 113.21 TOTAL (Also enter on line 5, Recapitulation) $103.707.56 (If more space is needed, insert additional sheets of the same size) Copyright 2000 David James Tho/fX., E<;q COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON.PROBATE PROPERTY ESTATE OF GUY J. PUGLIESE FILE NUMBER 21-04-0546 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 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSiON TAXABLE NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE 1. Merrill Lynch Account # 872~28845 opened April 1 , 1981. This was a transfer on death account. The TOO beneficiaries are the decedent's two daughters, Mary Lou Decarlo and JoAnn White, each 50% beneficiaries. The specific funds are as follows: a. 4000 units MFS Inter Income Trust Cusip # 55273C107 $25,800000 100% 0.00 $25,80000 b. 500 units Fin! Sec. Assurn. HJdgs Ltd Cuisp # 31769P605 11,100.00 100% 0.00 11,100.00 c. 5611.451 units ML Global Allocation Fund Cuisp # 589939206 83.161.70 100% 0.00 83,161.70 d. 21296.398 units ML Bond Fund High Inc. PI1 Cuisp # 590907101 109,463.49 100% 0.00 109,463.49 e. 48.464 units ML Bond Fund Core BD PFT CI1 Cuisp # 590907200 571,88 100% 000 571.88 f. 16001 units Corporate Income Fund 14,114.00 100% 0.00 14,11400 g 10 units Defined Assets Fund PA Ins Series 3 Cusip # 24476X268 7,44420 100% 0.00 7,444.20 h. 25984 units Govt Securities Inc. Fund Cuisp # 383743523 285.82 100% 0.00 28582 I. Merrill Lynch Banking 9,007.98 100% 0.00 9,007.98 (See Summary of Account provided by Merrill Lynch with letter of July 21,2004, Attachment 0 hereto) 2 Intervivos gift made May 19, 2004, to Mary Lou DeCarlo from Wachovia Bank, NA 10,00000 100% $3,000.00 7,000.00 3 Intervivos gift made May 19, 2004, to JoAnn White from Wachovia Bank 10,00000 100% 3,000.00 7,000.00 4. Intervivos gift made prior to decedent's death to Josephine C. Ogden. Ms. Ogden was bequeathed in ~1.1 B. C. And 0 of decedent's will several specific items of tangible personal property. However, she declined to accept the organ and music, which was disposed of before decedent's death. She did accept the two Nick Ruggieri paintings and the Metropolitan Opera print. (See Acknowledgment of Satisfaction of Testamentary Bequest and Release of Estate executed July 22m 2004 by Ms. Ogden, Attachment F hereto). The Metropolitan Opera scene is of nominal value, while the Nick Ruggieri paintings are estimated to have a value of between $500.00 and $700.00 each. (See Letter of June 8, 2004, from Mary Lou DeCarlo with respect to the Ruggieri paintings, Attachment F hereto) 1,40000 100% 1,400.00 0.00 TOTAL (Also enter on line 7, Recapitulation, $274,94907 (If more space is needed, insert additional sheets of the same size) Copyright 1000 David James Thorpe. I--:sq COMMONWEALTH OF PENNSYLVANIA SCHEDULE H INHERITANCE TAX RETURN FUNERAL EXPENSES & RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF GUY J PUGLIESE FILE NUMBER 21-04-0546 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: 1. The funeral was prepaid except for $725.64, primarily publication of obituary and other final expenses $725.64 2 Luncheon after the funeral - advanced by Mary Lou DeCarlo and reimbursed by S. Berne Smith on behalf of the Estate $100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Raymond A. Pugliese, Executor 2,00000 Social Security Number(s) (ErN Number of Persona! Representative(s) 204-01-9754 Street Address 31 Chestnut Street City Steelton State PA Zip 17113 Year(s) Commission Paid: 2005 2. Attorney Fees: S. Berne Smith, Esq. 9,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees 261.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Estate Notice - The Sentinel 95.27 8. Estate Notice - The Cumberland Law Journal 75.00 9. Estate Checks 27.00 10. Postage and certified mailings 74.14 11. Executor's expenses advanced 46.49 12 Automobile expenses 14.80 TOTAL (Also enter on line 9, Recapitulation) 512,419.34 (If more space is needed, insert additional sheets of the same size) Copyright 2000 Da\.id James Thorpe. Esq COMMONWEALTH OF PENNSYLVANIA SCHEDULE I INHERITANCE TAX RETURN DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF GUY J. PUGLIESE FILE NUMBER 21-04-0546 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1. West Shore EMS. ALS ($504.00 less refund of $323.60: $180.40) $180.40 2. Reimbursement for expenses incurred in cleaning house and preparing it for sale which occurred prior to death of Guy Pugliese in May 2994, paid to Mary Lou DeCarlo who had advanced the expenses. 551.07 3. Villa Teresa Nursing Home 740.00 4. Verizon Telephone 2.77 5. AT&T bill 12.17 TOTAL (Also enter on line 10, Recapitulation) $1.48641 (If more space is needed, insert additional sheets of the same size) Copyrighl 2000 David James Thorpe. I-sq COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF GUY J. PUGLIESE FILE NUMBER 21-04-0546 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Mary Lou DeCarlo, 1624 Pine Valley Drive, # 302, Ft. Myers, FL. 33907 Daughter 50% of resid ue of the estate 2 JoAnn White, 125 East Lake Drive, Lehigh Acres, FL 33936.6907 Daughter 50% of residue of the estate 3 Josephine C. Ogden, 6203 Stanford Court, Mechanicsburg, PA 17050 Friend Specific bequests of personalty which were satisfied prior to decedent's death ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-T , DIS-, K'~U "UN": A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $000 (If more space is needed, insert additional sheets of the same size) Copyright :2000 David Jamcs Thorpe, Esq LAST WILL AND TEST AMENT OF GUY J. PUGLIESE 1, GVY J. PUGLIESE. of New Cumberland, Cumberland County, PelUlsylvama, being of sound mind and disposing memory, though I realize the uncertall1ty of this Ide, 1 have full confidence and trust in my Lord and Savior, Jesus Christ, in His death On the cross lar my Sins and inl lis shed blood as an atonement far my soul; and I know by faith that because of IllS sacntice on the cross for me I have eternal life, do herebv make thIS W1I1. hereby rcv()kln~ "II , " my tarmer Wills and Codic1ls ;.nicle One: Specific Bequests: ~11 If I should predesease my friend, Josephine Ogden. CLlITCI1l!\ ell Mechanlcsburg. P A. [ gIve and bequeath to her the fallowing items Ic)eated in my home A Organ In the living room wllh all the music books; B. Nick Ruggieri painting over the fireplace depicting a rural scene In Pennsyl\al1la, C Niek Ruggieri painting over sofa in living room depicting a still life of nowers. and D Metropolitan Opera scene over Hi Fi system in living room, Article Two: Other Tangible Personal Property: ~21 [bequeath all the rest of my timgible personal property in accof'dance With Ihe terms of a personal property memorandum I may prepare. lfno such memorandum is located or received by the ExeclItor within 60 days after being appointed as such, after conducting a reasonable search for such memorandum, the Executor shall bc held harmless for distributing such property as herelnatier provided, 92.2 I bequeath such propeliy not disposed of by such memorandum, Of' all of slIch pf'operty i I' no slIch memorandum is located or f'cceived, (0 my daughters, Mary LOll DeCof'l" anJ I A TT4c/fH E'f'J' ,4 JoAnn White, both currently of Lehigh Acres, FL, per stirpes, to be divided between them in as nearly equal shares as they agree. In the event of irreconcilable disagreement between my children, they shall take alternate turns selecting individual items with the oldest child making the first selection. Any items not so selected shall be sold and the proceeds shall pass as a part 01' my residuary estate. 92.3 To the extent practicable in the Executor's sole discretion, I bequeath any policies of insurance on such property to the beneficiary entitled to such property 92.4 I dircct that the expenses of storing, packing, shipping, insuring and delivering any such property to the beneficiary entitled thereto shall be paid by the Executor as an admimstrative expense of my estate. Article Three: Residue: 93.11 devise and bequeath all the residue of my estate of whatever nature and where ever situated to be divided and distributed to my daughters, Mary Lou and JoAnn, per stirpes Article Four: Provision for Debts and Expenses: 94.1 I direct that any of my legally enforceable debts, any expenses of my last illness. funeral and burial, and any of the administrative expenses of my estate shall be paid hom the prIncipal of that portion of my estate disposed of by Ar1icle Three of this Will Article Five: Appointment of Fiduciaries: 9S1 I appoint my brother, Raymond A Pugliese, currently of Steelton, PA, as Executor of this Will. If Raymond A. Pugliese is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint my daughters, Mary Lou DeCarlo and JoAnn White, as first. contingent Co-Executrices. If either of them is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint the other as sole, contingent Executrix. All references herein to the "Executor" shall mean my originally appointed Executor or my successor Executrix, as the case may be. 2 Article Six: Powers of Fiduciaries: 96.1 No fiduciary under this Will shall be required to give bond or othcr security for the faithful performance of the fiduciary's duties 96.2 Any such fiduciary shall have the following powers, in addition to those gi yen by law 96.2.] To invest in, accept and retain any rcal or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; 96.2.2 To sell. exchange, pal1ition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; 9623 To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; 96.2.4 To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; 96.25 To engage in litigation and compromise, arbitrate or abandon claims; 962.6 To make distributions in cash, or in kind at current values, or partly .n each, allocating specific assets to particular distributes on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; 9627 To make elections, decisions, concessions and settlements In connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thercby; 96.2.8 To allocate, in the Executor's sole and absolute discretion, any portion of my exemption under Section 2631 (a) ofthe Internal Revenue Code to any propcny as to which I am the transferor, including any property transferred by me during my lifetime as to which I did not make an allocation prior to my death; and 9629 To disclaim any interest I may have in any estate if the Executor deems such disclaimer to be in the best interests of my estate and the beneficiaries thereof 3 Article Seven: Provision for Taxes: 97.1 All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to any such tax ("Death Taxes"), and any penalties thereon. shall be paid by the Executor out of the principal of that portion of my estate disposed of by Article Three of this Will, and all interest with respect to any such taxes shall be paid by the Executor out of the income or principal or partly out of the income and partly Ollt of the principal of sllch portion of my estate, in the absolute discretion of the Executor, without reimbursement from or apportionment among the bendiciaries, recipients or owners of such property for any such taxes, pcnalties or interest Article Eight: Miscellaneous Provisions: 08.1 As used in this Will, the term "Internal Revenue Code" shall mean the Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of slIbsequent law. 982 Any amounts or assets which are payable or distributable to a minor or incompetent hereunder may, at the discretion of my fiduciaries, be paid or distributed to the parent or guardian of sllch minor or incompetent, to the person with whom such minor or incompetent resides, or directly to such minor or incompetent, or may be applied for the use or benetit of such minor or incompetent. 083 No interest of any beneficiary hereunder shall be subject to antiCipation, pledge. assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his or her interest, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciaries for any liability of such beneficiary, whether such liability arises from hiS or her debts, contracts. torts, or other engagements of any type 084 If any beneficiary hereunder should die within thirty (30) days after me or within thirty (30) days after any other person the surVival of whom determines his or her rights hereunder, then such beneficiary shall be deemed to have predeceased me or such other person for all purposes hereunder. rN WITNESS WHEREOF, I, GUY J. PUGLIESE, have hereunto set my hand and seal to 4 this, my last Will, typewritten on six (6) sheets of paper, including the self-proving attestation clause ., and signatures of witnesses, this 2 c' J_ day of February, 2003. JLAJ1~f{1L-:e~ (SEAL) GUY J. GLlES Signed, sealed, published and declared by the above named GUY J. PUGLIESE as and for hiS last Will, in the presence of us and each of us, who, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. ~( t? ~L4-v-Residing at 2. 101....1 C Co v' '-'f'J<((, ("to.'", :' ~ ;P~~ C A/C',- '1 IF!' j 7L) -L J - -_.- Residing at g JD t::->~A r.J J JI At-,. /\e"" ---- (l r:.; C 11' /,~ rJi c: r.-:ILl ~c- f) d )7 c , ,~ I / . ,1 L/J~7 Residing at / ()7 IV LI4~ J-r, c nn/, /I'L~ //l_ /') () II J ~ ,---. COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, GUY J. PUGLIESE, the testator, and Pi' /( ,. ,'//,. ~ ;t:' fi LA..> , ,-J , {':;:;..-114/'~ 5' n .YJ/V/r~ 'I...- I;> and .--- r g c''p-'/V'~ J}-, / r# , the witnesses, whose names arc signed to the attached -,---- S or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the Will as a witness and that to the best of his or her knowledge the testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. r3U~ !-fk<L~ ~;jJ1~ - GUY J. PUG lESE . Wltne s ttdt/,I( -- d iJ~/lS) Witness Subscribed, sworn to and acknowledged before me by GUY .J. PUGLIESE, the testator. and subscribed and sworn to before me by , Ii ,- j 17 /7-,A.// Fo LV and ~~/" ~ '-"7 .l- /t., v..) J,..."/ L' ev- /1 '-1/:;; .n r bel''''" J~/;tI , the witnesses, this 2- (,' :J_ day of February. 2003. ~ [ /Cv~LL___ Notary Public My Commission expires: SEAL ---...--,--.--.-. :"<. " , I' i:1 ~ ~,,'O::11 Laurp. E. Kilne, Notary Public Hampden Twp, Cumberland County My Com~is:;i:'n ['(pires f\:ov. 15, 2003 --..--.. -- Member, \Jl.:OfI'IS'y'\,,':'BJ.', '</,',;,!:ono: Notaries 6 e cQuaint Oak S mJin/l,J Bank .- - LJkcJide Ofl;..r: PurK (j(j7 LJk.:eJide f)n!I/, P() Hf)~\. ;..)!{} l'uN/hump/()!!, E.l ! S%(,.(}2! {j h/~~ Jcrv or' ,(L~ ~/Y)'1- ~H;~--:7& ",",p a.~ ~"I7.v,';7 ~,." /-L-<.--LA::.._z::;{ ~c""-~ ~'r~^-k;~ .~'- ~>C~ ~~ ~ C<--c-<k . <7J' .~ /, .-;?' 'T.~C--<.J''''---''~ I) C.O # 7/0[7 J--) jf)o){; Y-~-'<--<j-~ ~. '75; I'-V /21 3. ~.....L- ~<',....-t;. ~1'Z-/,Iu V .:l-- <;/ '1 1" ,-/-) ~J 75- u.:;..,.-.9V J 5') ~~ ~~J <J 7r.o-:5 ..L",-,,~ w) ~...c ~-"_"" _,L S/J..(J/t- y J2 ;/ "T<j ~, >>-7/" ~~~ ~' ~~.t. / ?~~.u7) c7Jtt:~ q~A) ~~ Pho!le: 2/5.36-1--I-05(} F,r,: 215.}(,..f-/.6S0 Member FDIC e.n/ail qU{jilll(JiJkJt.J/)[n,~J"(i_L_JI)I.(()m ~ ATrNCf/hCf'-'T h ''''..--- LEHlER III ~~~ WACHOVIA Reference 10: 951924 Wachovia Bank N.A. Balance Confirmation Services POBox 40028 Roanoke. V A 24022-7313 July 9, 2004 S BERNE SMITH ATTORNEY AT LAW 107 N 24TH ST CAMP HILL, PA 17011 SUBJECT: Verification I Confirmation of Account and Balance Information provided for: Customer: GUY j PUGLiESE (SSN# 172-01-1598) Date of Death: May 27, 2004 Deposit Account Information Account Account Date of Death Average Date Maturity Interest Accrued YTD Date Type Number Balance Balance- Opened Date Rate Interest Interest Paid Closed CHECKING 1000613277892 $23.478.71 1/2/1950 NIA 6/10/2004 LEGAL TITLE GUY J PUGLIESE rOA RAYMOND A PUGLIESE rOA MARY LOU DECARLO . Due to system limitations, we can only provide n twelve month average balllnce on depository accounts, No Safe Deposit Box tound for customer . Date of death balance does not include accrued intt':rest. . If date of death occurrs on a weekend or a holiday, date of death balance does nol include any transactions that were made during that time period. ~r:~ (F) Scrvicenter Assocmte Phone: (540)563-7323 abs; al !? T ,AC(r'I(E""r C ';,8\.1(,1.0:. Alfred G. Farina, Jr. The Farina Group First Vice President PIA Portfolio Manager 2] 4 Senate A venue; SUite SO I P.O. Box 810 Kim Lee Kenawell-Hoffecker. CFM Camp Hlll, PA 17011 ASslstant Vice PresIdent ~ Merrill Lynch Senior Financial Advisor 800-937-0735 - Toll Free PIA Portfolio Manager 717-975-4602 - Dlreet 717-975-4663 - Fax www.fa.ml.comlFARINAGROUP July 21, 2004 Raymond Pugliese 31 Chestnut Street Steelton, PA 17113 Dear Mr. Pugliese: Enclosed is a breakdown of the Date of Death values for Guy's account. We have received a request from S. Berne Smith to provide this information to their office. We are not able to directly forward this information to an outside source without your written consent. Please either send us a letter instructing us to provide this information to Mr. Smith's office or, if you would prefer, you can forward a copy of the enclosed information directly to Mr. Smith's office. If you have any questions or need additional information, please do not hesitate to contact me directly at (717) 975-4604 or toll free at (800) 937-0735. I can be reached Monday through Friday between 8:30 am and 4:30 pm. -... c- Tr~sni1' L. aston Global Private Client Group Client Associate for The Farina Group enclosures AT -r Ac.lf 17..: N ,- 1) Date of Death Values ~ ---- ---,---------- I --- 872-28845 I _-+ __-=-:~=-- _, _ Gtly ;ji~~::;e.seT1--=~=-':L +- --- -~---- ------- --- --j-------- -~ -.- - ----t--!- - - -- i i I . -- --- - - --- ------ . - - -- - ~- --- -- ----'--f --- Quantity+- Security , Cusio Number , Price Per Share Total Value 40000~F~lnter IflcQmeTrlJst---':'-_~ _c ----.:_~5273C107T --___ ~6.45J j ~_25.8booo_ 500.000 Finl Sec Assurn Hldgs LId j 31769P605 $22.20 $ 11,10000 561 f451ML GlolJalAlIocation Fund- -- - _n - 5899392061 - $14.82 ' 11 83,16170 21296398MLElond Fund Highlnc PtI_ -:-1 --=--:-_ 590.9071011..+ $5,14~-. $_ 109,463.49 48.464 ML Bond Fund Core BD PTF CII 590907200 ,$ 11.801 : $ 571.88 16b~~~gWg~;fn~f~:~z~mF~~~~dA Ins s:ries 3-: --- =--244;~X268~--l $7:~:~~ i - 11 1~:~~::~~- "_ ____._ --.--..----.--.-.--.~--___r___.----'-~-.-.---: .----..--- -i------'----, - 25984000!G()vtSecurit~es Inc Fund___ __' ____3837,43523,jLQ.01.!..1 'I' $ 285,82 ~errill LynchBanking __ --1-- _.__._ ____ ~_' _ '+$ 9,00798. -- -- . !.--- -- --- -- . --- - n _ _ - - +---...:.._ _____! 1-=- _ L----:-==_=---:-__-==:_T:aIYa/Ue_a:Of5/27r~L i$ __ ~60,94907 --rrype of account: gel~are Investment Accou.flt _ __1...._ i _n'! __ TODBenefic[aries as of DOD:~Lou Decarlo 50%; JoAn" \^{hite 500/0 I , ____ Date account 0 ened: 4/1/81 ii' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF ORPHANS' COURT DIVISION Guy J. Pugliese, DECEASED No. 21-04-0546 ACKNOWLEDGMENT OF SATISFACTION OF TESTAMENTARY BEQUEST AND RELEASE OF ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: Ms. Josephine C. Ogden, Beneficiary, 6210 Stanford Court, Mechanicsburg, PA 17050, being potentially, beneficially interested in the above titled Estate, hereby acknowledges that she has received all of the beneficial interest left to her in Article One of the last Will of Guy J. Pugliese, deceased, dated February 20, 2003, and requests Your Honorable Court to charge the same to her in any Decree of Distribution to be entered in said Estate. Specifically, Ms. Ogden states that she received as gifts from Guy J. Pugliese, during his life time, the two Nick Ruggieri paintings and the Metropolitan Opera scene mentioned in S 1.1 B. c., and D of said Will, and that she declined to accept the Organ and music books mentioned in S 1.1 A of said Will. In consideration thereof, Ms. Ogden hereby releases the Estate of Guy J. Pugliese from any obligation to her. She further agrees that this Acknowledgment of Satisfaction of Testamentary Bequest and Release of Estate shall be made part of the final, informal or formal settlement or account of the estate proceedings and indexed and recorded as such, and it shall be binding upon her respective heirs, successors, administrators, and assigns, and governed by the laws of the Commonwealth of Pennsylvania. Signed, sealed and dated this ::.:J.. day of ~ .J .1 ' 2004. (} WITNESS BENEFICIARY P ~' , . II " . r .L,j N1 .... E. c ;rw~ J viJt.I,,~J'_ ~. (j Lv dE,,?) (Seal) J Josephine C. Ogden I E ;:1, T FtC-I< 17 EN T JUI~-~O-~~ ~~:ll AM M. L. DECARLO 941 369 4145 P.01 Mary lou DeCarlo 'e2~ Pine Valley Dr 11/302 FI Myers, FL 33907 FAX 239-454 .4336 Phone 239-~54-4336 E-m.il mld1ehigh@aoLcom June 8, 2004 S. Berne Smith 107 N. 24th St. Camp IIi ll, P A 170 t 1-3602 FAX: 717-737-6783 Dear Bern, It was a pleasure meeting with you last week on the disbursement of my Father's estate. RE: Niek Ruggieri Paintings that were "gifted" by my Father to Josie Ogden. I spoke to Rosemary Baer, daughter of Nick Ruggieri, to detennine the value oflhese paintings_ Rosemary explained that her father "undervalued" his work, Selling his paintings for a only a few hundred dollars_ Although he has now passed away (about 8 or 10 years ago T believe), the value of his paintings has not had a substantial increase in value. Based on these facts, she would set the value of these paintings at between $500 and $700 each. if YOll nced any additional infon11ation, please call her @774-0430. Sinccrely, \<\~~ A TT He Ifl'7e NT F . >:,/,." ":", . ' " 'f ' ,t\-4{ , S. BERNE SMITH Attorney-aI-Law 107 N. 24" Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 February 7, 2005 In re: Estate of Guy J. Pugliese, DOD May 27,2004; SS# 172-01-1598 PA File: 21-04-0546; File No. 2004-00546: ErN: 20-6224209 My File: 194002 Ms. Glenda Farner Strasbaugh Register of Wills Courthouse 1 Courthouse Square Carlisle, PA ]7013-3387 Attention: Roger Dear Ms. Strasbaugh: Enclosed is my check # 611 in the amount of$15_00 payable to the Register of Wills to pay the filing fee with respect to the Pennsylvania Inheritance Tax return for the Estate of Guy J. Pugliese which was sent to you last week_ 1 apologize for my oversight in failing to send the filing fee at that time. Thank you for bringing this to my attention. If anything further is required, please advise me. Sincerely yours, r ,) '/\ ~ B--R-~~ ./..L'V>'-<--! S. Berne Smith Enclosure: ,"<. Marjorie A. Wevodau Glenda Farner Strasbaugh First Deputy Register of Wills and Clerk of Orphans' Court Kirk S. Sohonage. Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 I INVOICE I Bill To: InvoiceNo: 206 Invoice Date: 2/9/2005 S. BERNE SMIlli Estate of: GUY PUGLIESE 107 N. 24m ST. Estate No: 21-04-546 RSK CAMP HILL, PA 170113602 Qty Fee Description Fee Total 1 Additional Probate 35_00 $35.00 Total: $35_00 o,ecks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. -^ COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE IIlITICE OF INHERITANCE TAX BUREAU OF INDIVIOU~[~[n (',::::1('[ (W:APPRAISEllENT, ALLOWANCE OR OISALLlIIIANCE INlERITANCE TAX DI\"ISI"U.../\.A ,,_<.,j \./! i !\jL t~jJ OF DEDUCTIONS AND ASSESSltENT OF TAX PO BOX 280601 HARRISBURG PA 11128-0601 REV-15'7 'EX AFP (03-05) DATE 04-25-2005 ~:9 t),! I'). 02 ESTATE OF PUGLIESE GUY J f ~! l~' .1 DATE OF DEATH 05-27-2004 CLET>~ FILE NUIIBER Zl 04-0546 S BERNE ~~114 'ESQ COUNTY CUMBERLAND ACN 101 107 N 2"1"11 51 I _t RMiHlId I CAMP HILL PA 17011 MAKE CHECK PAYABLE AND REMIT PA~ENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS 411 1t1!V-".tlr4"Yf.m.m~'.'1M'Im.!ftP.DMfllmll!!'.m.lwtlmM!lfr:.'X't'I:IIU'.II!!'.DYl'...........". ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PUGLIESE GUY J FILE NO. 21 04-0546 ACN 101 DATE 04-25-2005 1 TAX RETURN WAS: (X) ACCEPTED AS FILED I I CHANllED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE I ! APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. _1 Est.t. I_I. A) II) .00 NOTE; T., insur. prop.ir 2. stack. _ _. I_la B) (2) .00 er"'ed:lt t:.:pur IIOCOW'tt, _it -.- portion 3. Closa.ly /laId StockJ'...rt...r....ip Int.r..t (_1. CI (31 .00 of th~OI'IJ .1 th your 4. IIort_.lNot.. _1_1. I_I. DI ('II .00 tax p t. 5. C....I8_ Ilaposlt_iso. P...._l Pr_rty ISchedul. EI 151 103.707.56 6. Jointly _ P,,-rty (Sc:hadul. F) 161 .00 7. T~.f.rs (Schedule 8) 171 27',949.07 B. Tot.l A...ts IBI 378,656.63 APPROVED DEDUCTIONS AND EXEMPTIONS: 12,419.3' 9. F.......l Expsn..s/_. Co.tsIHiso. Ex......... ISchlldul. HI (91 11. DsbtslMort_ Liabiliti.S/Li... (Sohsdul. I) Ill) 1.486.41 11. Tot.l Deduction. Ill) r3.90r; 7r; 12. /lat V.lue of Tax Return (121 64,750.88 13. Charltabla/80v.rnasnt.l Baqus.t.; Non-.lect.d 9113 Tru.t. (Schlldul. J) (13) .00 14. Net Value of Est.t. Subject to T.x (14) 564,750.88 NOTE: I~ en ........nt was i..ued previously. lines 14. 15 and'or 16. 17. 18,and 19 will r8'flBCt ~igur.. that: inclUde the tatal or !!.b. rat:urns a.....ad to dat:e, ASSESSMENT OF TAX: .00 K 00 i 15. Amount of Line l' .t Spou..l r.t. (15) = .00 16. "-aunt of Line 14 taxabl. .t Llnsal/Cl... A rat. (16) 364,750.88 K 0'5 = 116,'13.79 17. "-aunt of U... l' .t Slbll"lll r.t. Iln .00 K 12 = I .00 lB. "-aunt of Line 14 taxabl. .t Coll.t.rsl/Cl... B rst. (18) .00 K IS , .00 = I 19. Prinel""l Tax 0- (19)= ' 16,lt13.79 . INTEREST/PEN PAID (-J AIlOUNT PAID 684.21 13,000.00 .00 2,729.58 TOTAL TAX CREDIT 16,413.79 ~ BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE IlEVERSE I IF TDTAL DUE IS LESS THAN n, IIlI PAYIIENT IS RElllIIRED. FOR CALCULATIIlIl DF ADDITIDNAL INTEREST. IF TDTAL DUE IS REFLECTED AS A "CREDIT'" (CIIJ, YDl/ IIAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORtI FOR INSTRUCTJ:IlIlS.) ; ..::' ..r: OJJ ::l '" lIt._ -5; ("- ~. ~ 00 .;:: ("""i If; ~ f: - ;...... ~ r'"\ V r./l :J_ '" _ 0<0 ~ :-..:: C/) r- "-- :::: " .'- ru '+- ('J ~ < ""d 0 rF.l 00... N '" ::l ~ ., V ..,.. 0 -;: ~ 1.... c~~5/i 0 ....... t 0'- t) u1 OJ) ;:I r \ h . _ ~J 0 >,....I C':j .i' ~ V _ U tJI (P I ., o (q (q + (q .rl ('j I" .,. ''l .~ -0 "-'1 , - . - ...,., dj 0 ;-<::;f'-. ,... '" .- ~-!;:' ...,.. ri"> ~ 2 J~. ("'-..1 . ~; t ~ ~" ---- :-;-; i c.- eo ~ E - '" (/2 ::.. .'--.J i'~" '!'- .;~, " . '~. , i ~ ~ '" '{ ~ ~ , \\ i, 'f> ;,: ~ I! '1) '" r ~ { '~ .~ ,> ,.; '" '" !j, '" II \',' ;.: ~ I., \(, ~ I~'~ fI, " " '" {, ,'::; '~ : ~ :;;:: :?1 "t/%. ~;'\. l'~, :.'~:, :;"., .. ","-.; '0;;' 4': :?", ~. (-" l i. " 1;\:I~. "(, ~:;'. ,/ ~~. 't': , " " S. BERNE SMITH Attorney-at-Law 107 N. 24'" Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 June I, 2005 In re: Estate of Guy J. Pugliese, DOD May 27, 2004; SS# 172-01-1598 P A File: 21-04-0546; File No. 2004-00546; EIN: 20-6224209 My File: 194002 Ms. Glenda Farner Strasbaugh Register of Wills ,-"'"; ~'".,.- Courthouse I" I Courthouse Square "-' Carlisle, PA 17013-3387 Dear Ms. Strasbaugh: ~._.. c'.::' Being filed herewith are the original and one copy of a Supplemental Pennsylvania Inheritance Tax return for the Estate of Guy J. Pugliese. The assets involved were obtained after the filing of the final Pennsylvania Inheritance Tax return and are the state and federal income tax refunds. Also, enclosed is a check in the amount 01'$252.41 payable to the Register of Wills, Agent, as the additional payment of the Pennsylvania Inheritance Tax owed by the Estate. Please acknowledge receipt of the payment. Finally, my check no. 644 in the amount 01'$15.00, payable to the Register of Wills is enclosed to pay the filing fee for the Pennsylvania Inheritance Tax return. Thank you for your attention to this matter. If anything further is required, please advise. I have appreciated the fine assistance of your staff They are excellent. Sincerely yours, ~ IJ~A~L S. Berne Smith Enclosures: cc: Raymond A. Pugliese, Executor 31 Chestnut Street Steelton, PA 17113 . ................,..................... ....... COMMONWEALTH OF REV 1500 OFFICIAL USE ONLY PENNSYLVANIA - ........ ........,.................. ...... DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FilE NUMBER DEPT 280601 21 0546 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT COUNTY CODE NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE JNITIAl) SOCIAL SECURITY NUMBER f- Z PUGLIESE, GUY J 172-01-1598 W DATE OF DEATH DATE OF BIRTH THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 0 W May 27, 2004 JUly 31, 1915 REGISTER OF WILLS U w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 None 1 Original Return X 2. Supplemental Return 3. Remainder Return (dale (If deall1 pflorto 12- 2 1:>-82) ~.<.'.ll/J u"~ 4 Limited Estate 4a. Future Interest Comprise (dale 01 death after 12-12-82) 5. Federal Estate Tax Return Required o au -Leg u am 0. 6 Decedent Died Testate (Allach copy 01 Will) 7. Decedent Maintained a Living Trust (AttaCh a copy of Trust) 0 8 Total Number of Safe Deposit Boxes ~ 9 litigation Proceeds Received 10. Spousal Poverty Credit (date of dealh ~etween 12-31.91 and 1-1.95) D~~t~~I;c~t~n to tax under See 9113(A) THIS SECTION MUST BE COMPLETED. ALL CQRRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: C NAME COMPLETE MAILING ADDRESS = = S. BERNE SMITH, ESQ 107 N, 24TH STREET = 0 = FIRM NAME (If AppliCable) CAMP Hill, PA 17011-3602 ~ 2> <5 '--> TELEPHONE NUMBER 717-n7--6789 Real Estate (Schedule A) (1) $0,00 OFFICIAL USE ONLY ., 2 StocKs and Bonds (Schedule B) (2) $0,00 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00 C,. 2 .....- 4 Mortgages & Notes Receivable (Schedule 0) (4) $0,00 0 \') f- 5 Cash, Bank Deposits & Mise Personal Property (Schedule E) (5) $5,624.00 <:( -".... -l 6 JOintly Owned Property (Schedule F) (6) $0.00 ::l D Separate Billing Requested ''''_'.1 f- a... - <:( 7 InterNivos Transfers & Misc Non-Probate Property (7) $0,00 G,:,; U (Schedule G or L) UJ 0:: 8 Total Gross Assets (total lines 1-7) (8) $5,62400 9 Funeral Expenses & Administrative Costs (Schedule H) (9) $15.00 10 Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $0,00 11 Total Deductions (total Lines 9 & 10) (11) 51500 12 Net Value of Estate (Line 8 minus Line 11) (12) $5,60900 13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $000 made (Schedule J) 14 Net Value Subject to Tax (line 12 minus line 13) (14) $5,609.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of line 14 taxable at the spousal tax Z rate, or transfers under See 9116 (a)(1.2) , 0.00 (15) $0,00 0 - ~ 16. Amount of line 14 taxable at lineal rate $5,609.00 , 4.5% (16) $252.41 X~ - ~~ 17, Amount of line 14 taxable at sibling rate , 12 (17) $000 ~~ ~ ~ 18, Amount of line 14 taxable at collateral rate , 15 (18) $000 0 U 19 Tax Due (19) $252.41 200 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Copyrig:llt 2000 David James Thorpe, l-:"t1 Decedent's Complete Address: STREET ADDRESS Country Meadows, 4902 E. Trindle Road CITY I~TATE !ZIP Mechan'lcsburg PA 17055 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) (1) $25241 2 Credits/Payments A Spousal Poverty Credit B Prior Payments C Discount Total Credits (A + B -+ C) (2) $0.00 3 Interest/Penalty if applicable D. Interest E Penalty TotallnterestlPenally (0 -+ E) (3) $0,00 4 If line 2 is greater than line i + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5 If line i -+ line?> \s greater than line 2, enter the difference This is the TAX DUE. (5) $252.41 A Enter the interest on the tax due (SA) B Enter the total of line 5 + SA. This is the BALANCE DUE. (58) $252.41 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS Did decedent make a transfer and Yes No a retain the use or income of the property transferred; ~ ; b retain the right to designate who shall use the property transferred or its income: c. retain a revisionary interest; or d. receive the promise for life of either payments, benefits or care? 2 If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? 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, Of other non~probate property? 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 basad on all the information of which raparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FI ~ DATE Raymond A. Pugliese, Executor 0> .,-ftv' June f ,2005 ADDRESS 31 Chestnut Street, Steelton, PA 17113 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ./ r9l ~ DATE S BERNE SMITH. ESQ . P'. ~ June I ,2005 ADDRESS 107 N. 24TH STREET, CAMP HILL, PA 17011.3602 For dates 01 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 PS S9116 (a) (1.1) (i)J. 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. 59116 (a) (1.1) (ii)J. The statute does no exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and 1iling 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 (s 4.5%), eXCE nA PI) P.S. s9116(a) (1)] The tax rate imposed on the net value oftrans1ers to orfor the use 01 the decedent's siblings is 12% [72 P.S 59116(c: Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or ad optic :T- Av..a- Copyri . COMMONWEALTH OF PENNSYLVANIA SCHEDULE E lNHERI1ANCE TAX RETURN CASH, BANK DEPOSITS. & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF GUY J. PUGLIESE FILE NUMBER 21-04-0546 Induce 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 DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Refund of Federal Income Tax for tax year 2004, received May 31,2005. $5,438.00 2. Refund of Pennsylvania State Income Tax for tax year 2004, received April 5, 2005. 186.00 TOTAL (Also enter on line 5, Recapitulation) $5,624.00 (If more space IS needed, Insert additIonal sheets of the same size) Copyrighl2000 David James 'lllOrpe, Esq . . COMMONWEALTH OF PENNSYLVANIA SCHEDULE H INHERITANCE TAX RETURN FUNERAL EXPENSES & RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF GUY J. PUGLIESE FILE NUMBER 21-04-0546 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. 1 2. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2005 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. Filing fee for f\l\ng Supplemental Pennsylvania Inheritance Tax return. $15.00 TOTAL (Also enter on line 9, Recapitulation) $1500 (If more space is needed, insert additional sheets of the same size) Copyrigl1t 2(}00 David James Thurpe, Esq COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG. PA 17128.0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005384 SMITH S BERNE ESQ 107 N 24TH ST CAMP Hill, PA 17011-3602 ACN ASSESSMENT AMOUNT CONTROL NUMBER __n____ fold __uuuu nn_n_ 101 I $252.41 ESTATE INFORMATION: SSN: 172-01-1598 I FILE NUMBER: 2104-0546 I DECEDENT NAME: PUGLIESE GUY J I DATE OF PAYMENT: 06/02/2005 I POSTMARK DATE: 06/01/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: OS/27/2004 I I TOTAL AMOUNT PAID: $252.41 REMARKS: CHECK# 1007 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA *' cA n ~~~~~T OF REVENUE Rt\'oHDE ~ I'JINHERITANCE TAX BUREAU OF INDIVIDUAL TAXES ~!\I'I'~pl!OQIIT,>::ll\LtOllANCE OR DISALLOIIAHCE INHERITANCE TAX DIVISION "OF i1tDllCTIONS- JlHD ASSESSI1ENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 REV-1547 EX AFP (06-05) 20n, f! If: -5 ;" I" C4 ;Jl) .'",...... Poi \ ,I. J DATE 08-08-2005 ESTATE OF PUGLIESE GUY J DATE OF DEATH 05-27-2004 FILE NUMBER 21 04-0546 C\, COUNTY CUMBERLAND S BERNE SMITH ESQ ACN 101 107 N 24TH ST APPEAL DATE: 10-07-2005 CAMP HILL PA 17011 ( See reverse side under Objections) A.ount Re.ittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS - REV:is4;-Ei-AFP-103:0si-NOTicE-OF-iNHERiTANCE-TAi-APPRAisEMENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PUGLIESE GUY J FILE NO. 21 04-0546 ACN 101 DATE 08-08-2005 TAX RETURN HAS: I X) ACCEPTED AS FILED I ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01 1. R..l Estate (Schedule A) III .00 NOTE: To insure prope,.. 2. Stocks end Bonds (Schedule B) (2) .00 cradi t to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) 131 .00 s~it the upper portion of this forB with your 4. Mortgages/Notes Receivable (Schedule D) I'll .00 tax payllent. S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 151 5.624.00 6. Jointly Owned Property (Schedule f) (6) .00 7. Transfers (Schedule &) (7) .00 8. Total Assets (8) 5,624.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 15.00 9. Funeral Expenses/A~. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 110) 00 11. Tot.l Deductions I1ll 11; nn 12. Net V.lue of Tax Return 112) 5,609.00 13. Charitable/Governaent.l Bequests; Non-elected 9113 Trusts (Schedule J) 1131 .00 14. Net Value of Estate Subject to Tax 1141 370,359.88 NOTE: I~ an asses..ent was issued previously, lines 14, 1S and/or 16, 17, 18 and 19 will reflect ~igures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: IS. A.ount of Line 14 at Spousal rate 115) .00 X DO - .00 16. Aaount of Line 14 taxable at Lineal/Class A rate 116) 370,359.88 X 045 _ 16,666.20 17. A.ount of Line 14 at Sibling rat. 117) .00 X 12 - .00 18. ~ount of Line 14 taxable at Collateral/Class B r.t. 118) .00 X 15 - .00 19. Principal Tax Due 119)- 16,666.20 X C : + AHOUNT PAID DATE NUI1BER INTEREST/PEN PAID 1-) 07-31-2004 CD004222 684.21 13,000.00 02-04-2005 CD004922 .00 2,729.58 06-01-2005 CD005384 .00 252.41 BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-02-2005 TOTAL TAX CREDIT 16,666.20 BALANCE OF TAX DUE .00 INTEREST AND PEN. 3.25 TOTAL DUE 3.25 ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE I IF TOTAL DUE IS LESS THAN 01, NO PAY"ENT IS REQUIRED. tV FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLEC~ED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) , "." .... a<C" s. BElUU, SMl111. ,. I' \OHlorth 24" Street I camP Hill, PA 17011,3602 \' .. " .'. \;.-',. r'f~ 'v; . ,.,.)/1 ~>....:,-~ r~) ~~ ~3;. , ;-'-i\ M'. Glenda famer Str,sbaugh ,0 q Reg\,"" of Will' co, ;.'~ CourWnuse ;;; , .a 1 Courthoo,", Squore ~ q corli,\e, PA 11013,3381 - ?'" . ~ <J \T~l - ., 3;; en -l . __ .'_ ,.'" _ . I \'\ '\\ ,,1\ 1\ \'\ II III \ \ \ II \ , !V,.,.-.,.,'j' I'"~ ''',' """"", '" "d" ''','' .", "" " IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL V ANlA IN RE: ESTATE OF ORPHANS' COURT DIVISION GUY J. PUGLIESE, DECEASED No. 21-04-0546 FAMILY AGREEMENT filed on behalf of RAYMOND A. PUGLIESE, EXECUTOR LL. to \.......' -~" c.) L..:. 0;. , - c) "- Fi- . . - c: C:_ ~. '----..' c-' :'--.-", ~ ,'~ j , [ c- t.......J L-_ c: ~~-'; C c - L . (!I- 1.,-.", C , L.;-. r .: ('~-: ~. Counsel of Record for this Party: S. Berne Smith, Esquire PA I.D. #07254 107 N. 24th Street Camp Hill, PA 17011-3602 (717) 737-6789 I FAMILY AGREEMENT This is an AGREEMENT by and between RAYMOND A. PUGLIESE, as Executor of the Estate of Guy J_ Pugliese, Deceased, and MARY LOU DECARLO, individually, and JOANN WHITE, individually, who together covenant and agree as follows: WI1NESSETH WHEREAS, Guy J. Pugliese, died May 27, 2004, having left his Last Will and Testament dated February 20,2003, which was duly admitted to probate by the Register of Wills of Cumberland County at the above number and term June 10,2004; and WHEREAS, Raymond A. Pugliese has been duly appointed as Executor of the Estate of Guy J. Pugliese, Deceased; and WHEREAS, the parties in interest under the Last Will and Testament of Guy J. Pugliese, Deceased, are: Name Address Relationship Share Mary Lou DeCarlo 1624 Pine Valley Dr. #302 Daughter Y:. of Residue Ft. Myers, FL 33907 Joanne White 125 East Lake Drive Daughter Y2 of Residue Lehigh Acres, FL 33936-6907 Josephine C. Ogden 6203 Stanford Court Friend Specific Bequests Mechanicsburg, P A 17050 WHEREAS, Guy J. Pugliese, Deceased, was not survived by a spouse; and WHEREAS, there were no unfulfilled specific bequests as is evidenced by the statement of Josephine C. Ogden attached hereto; and WHEREAS, each of the residuary beneficiary parties to this Agreement having been kept apprised of the estate's probate and non-probate assets, receipts and disbursements, they have determined that no formal Accounting is necessary; and WHEREAS, it is the desire of the parties to this Agreement that final distribution of the estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting; and 2 WHEREAS, the parties to this Agreement each acknowledge to have received their appropriate distributions of the residue of the estate; NOW, THEREFORE, WITNESSETH, in consideration of the mutual promises, covenants and agreements recited herein the parties do agree as follows: I. Each of the parties to this Agreement does hereby release and forever discharge Raymond A. Pugliese, Executor, from any and all liability which may from time to time arise in connection with his service as Executor of the Estate of Guy J. Pugliese, Deceased. The parties do further agree to indemnify and hold harmless Guy 1. Pugliese, Executor, from any and all liability which may arise against the estate from creditors or other claimants. 2. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators, and assigns. 3. This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. Dated as of August If ,2005. WITNESS: A 13.9~ ~>( l- f~ . Raymond A. Pugliese, as Executor of the Estate of Guy J. Pugliese WITNESS: ~ V3~ ,/LsVl \\\~Uv.,~~\o Mary Lou De 0, mdlVldually WITNESS: ~l ~ //-:/fi./Zv White, individually 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF ORPHANS' COURT DIVISION Guy J. Pugliese, DECEASED No. 21-04-0546 ACKNOWLEDGMENT OF SATISFACTION OF TESTAMENTARY BEQUEST AND RELEASE OF ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: Ms. Josephine C. Ogden, Beneticiary, 6210 Stanford Court, Mechanicsburg, P A 17050, being potentially, beneficially interested in the above titled Estate, hereby acknowledges that she has received all of the beneficial interest left to her in Article One of the last Will of Guy J. Pugliese, deceased, dated February 20, 2003, and requests Your Honorable Court to charge the same to her in any Decree of Distribution to be entered in said Estate. Specifically, Ms_ Ogden states that she received as gifts from Guy J. Pugliese, during his life time, the two Nick Ruggieri paintings and the Metropolitan Opera scene mentioned in S l.l B. C., and D of said Will, and that she declined to accept the Organ and music books mentioned in S 1.1 A of said Will. In consideration thereof, Ms. Ogden hereby releases the Estate of Guy J. Pugliese from any obligation to her. She further agrees that this Acknowledgment of Satisfaction of Testamentary Bequest and Release of Estate shall be made part of the final, informal or formal settlement or account of the estate proceedings and indexed and recorded as such, and it shall be binding upon her respective heirs, successors, administrators, and assigns, and governed by the laws of the Commonwealth of Pennsylvania. Signed, sealed and dated this ~ ~ day of (1./ .f/t-/ , 2004. . :J r , WITNESS: BENEFICIARY .~ ~' . I//" .' '~-"_d /Vl/ e. ~Ow J~--<'fz.-L- \..:', C~~ (Seal) I (j Jose ine C. Ogden S. BERNE SMITH Attorney-at-Law t 07 N. 24th Street Camp Hill, PA 17011-3602 PHONE: (717) 737-6789 FAX: (717) 737-6783 August 24, 2005 In re: Estate of Guy J. Pugliese, DOD May 27, 2004; SS# 172-01-1598 PA File: 21-04-0546; File No. 2004-00546; EIN: 20-6224209 My File: 194002 Ms. Glenda Farner Strasbaugh Register of Wills Courthouse I Courthouse Square Carlisle, PA 17013-3387 Dear Ms. Strasbaugh: Enclosed is a final Status Report Under Rule 6.12, reflecting that the Estate of Guy J. Pugliese, Deceased, is now closed. The Family Agreement is being submitted herewith. Also enclosed is my check nwnber 667 on behalf of the Estate in the amount of $20.00, payable to the Register of Wills for filing the Family Agreement in the above estate as part of the status report. If anything further is required, please advise. Thank you for your attention to this matter. I have appreciated the fine help of your staff in settling the Estate. They do an excellent job. Sincerely yours, s:;} /Il S. Berne Smith Enclosure: cc: Raymond A. Pugliese, Executor 31 Chestnut Street Steelton, PA 17113 STATUS REPORT UNDER RULE 6.12 Name of Decedent: GUY J. PUGLIESE Date of Death: May 27, 2004 File No. 2004-00546 Admin. No. -:U-84 gs4~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion ofthe 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: Not applicable. 3. If the answer to No. I is Yes, state the following: A. Did the personal representative file a final account with the Court? Yes No X - -- B. The separate Orphans' Court No. (if any) for the personal representative's account is: Not applicable. C. Did the personal representative state an account informally to the parties in interest? Yes No _X_ 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 attacked to this report_ Note: A Family Agreement is being filed herewith. Date: August 24, 2005 df3~~ Signature S. Berne Smith. Esq. Name (Please type or print) Address: 107 N. 24th Street \,I, Camp Hill, P A 17011-3602 (~) Ll.' . . - Telephone No. 717-737-6789 t',,; C) '. L!_'. L (..,~. ,-', .......J Capacity: Personal Representative c\ '. \_'::) Le-.! C.j L c. cr: '. L" ( _X_Counsel for personal representative c")( . - C_J ~__ . L L,.le.,_ ~ ,<-", C 0:' c... (_.~ C.-_) 1;'-. \1t COMMONWEALTH OF PENNSYLVANIA '*' DEPARTMENT OF REVENUE .,---.....-..-. -......,..,,'....-- r, INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT PO BOX 280601 HARRISBURG PA 17128-0601 REV-1607 EX AFP (03-051 [ -7 DATE 09-06-2005 .: i ESTATE OF PUGLIESE GUY J DATE OF DEATH 05-27-2004 FILE NUMBER 21 04-0546 COUNTY CUMBERLAND S BERNE SeITH ESQ ACN 101 107 N 24TH ST I Amount Remitted CAMP HILL PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT --- ESTATE OF PUGLIESE GUY J FILE NO.21 04-0546 ACN 101 DATE 09-06-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-08-2005 PRINCIPAL TAX DUE: 16,666.20 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-31-2004 CD004222 684.21 13,000.00 02-04-2005 CD004922 .00 2,729.58 06-01-2005 CD005384 .00 252.41 08-17-2005 CD005706 3.25- 3.25 TOTAL TAX CREDIT 16,666.20 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 " IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TDTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICR), pJ( YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS. )