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06-07-10 (2)
~~ ' _~- 1505607121 06-05 REV-~ OO EX ( ) V PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 9 2 1 ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death Date of Birth 1 5 6 0 5 8 0 1 9 0 9 0 6 2 0 0 9 0 2 1 3 1 9 1 7 Decedent's Last Name Suffix Decedent's First Name MI N A V A G A T O A N G E L O p (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Q 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Retum Required QX 6. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Living Trust 3 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litlgation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - TNIS SECTION MUST BE COMPLETED. ALL CDRRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name DayOme Telephone Number R M A R K T H O M A S E S Q U I R E 7 1 7 7 9 6 2 1 0 0 Finn Name (If Applicable) REGISTER OF WILLS USE ONLY First Iine of address c~ 1 0 1 S O U T H M A R K E T S T R E E T -~ ,-' 2 ~ Second line of address '' I ,. ~ ~1 . ~ s ~' City or Post Office State ZIP Code M E C H A N I C S B U R G P A 1 7 0 5 5 ~ ~ n~ c^rt . Correspondent's e-mail address: rmarkthomasC~gmail.wm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statemenb, and to the best of my knowledge and belief, d is true, coned and complete. Dedaretlon of preparer other than the personal representative is based on a8 (nformatbn of which preparer has any knowledge. S~NA~IJRERF P ~N RE~S~ONSIBLE FOR flLING RETURN pA¢ ~ Side 1 1505607121 1505607121 1U1 SOUTH MARKET STREET MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY r ~ 15d56C'7221 REV-1500 EX Decedent's Social Security Number Decedem'sName: ANGELO P• NAVAGATO 1 5 6 0 5 8 0 1 9 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2.' Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 8. 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) [] Separate Billing Requested ....... 7. 8. Total Gross Asssts (total Lines 1-7) ........................... 8. 0, 0 0 1 0 8 7 6. 7 4 5 4 5 8 9. 2 5 6 5 4 6 5. 9 9 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 7 6 2 8 , 1 0 10. Debts of Decedent, Mort a e Liabilities, 8 Liens Schedule I 10. 9 9 ( ) ............ 4 0 9 6, 7 0 11. Total Deductions (total Lines 9 & 10) ........................... 11. 1 1 7 2 4 , 8 0 12. Net Value of Estate (Line 8 minus Line 11) .................. ....... 12. 5 3 7 4 1 , 1 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........... ....... 13. 2 2 0 . 9 4 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ....... 14. 5 3 5 2 0 , 2 5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 1 g. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17, 0. 0 0 18. Amount of Line 14 taxable at collateral rate x .15 5 3 5 2 0.2: 5 1 g, 8 0 2 8. 0 4 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 8 0 2 8. 0 4 Side 2 1505607221 1505607221 REV-1500 Ex Pape 3 Decedent's Complete Address: Flle Number 21 09 0921 DECEDENTS NAME , ANGELA P. NA GATO STREETADDRESS 1100 GRANDON WAY CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: t • Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Diswunt 3. InteresUPenalty if applicable D. Interest E. Penalty (1) s.oza.oa Total Credits (A + g + C) (2) 0.00 Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. Fiil in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8.028.Oa A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 8.028.Oa Make Check Payable to: REGISTER OF WILLS, AGENT °n+,f :. t~ ~a:.a x ,~;_h,*~~tio ~J. v. ,.. :$zr a$ ...k.~ ~ . +~%#~4~"mow ~A S!~A~.'hi +,'ai°.N'3., ~ a.. _>~„a" , .`~~Sv,a i~ ~. ,~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for Irfe 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 consideration7 ....................................................................................... ^ X^ 3. Did decedent own an 'in trust for• or payable upon death bank account or security at his or her death? ......... ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. © ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST CiOMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~' aRxv~us °.'. ~~ ,"~'a,, µ ~d~, ry3~i,~~3¢.i! s~`~'`~ i .~,.~~).~x ` ,~ .dF,~L'x,.~'44;rn::2`i ~~'~~-.s~i`.~i~.~,1„~"!fw. ~~.v6r, 3a ..i.>::' , 3~,.,r~'-, ~,~,'~sl?9.p' mow, ..3 ,~.a*~ `,- -' 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 three (3) percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 'rf 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 zero (O) percent [72 P.S. §9116(a)(1.2)j. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (/2 P.S. §9116(a)(1)j. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (g_gg) SCHEDULE E COMMO LTHOFPENNSYLVANIA CASH, BANK D~~i~SfT$, $~ MISC. INHERI ANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE. NUMBER ANGELO P. NAVAGATO 21 09 0921 All propeRy join ~oed~with rlgM of survivorshlpmust be dlscbsed on Seheduk F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ • ins from safe deposit box (see attached appraisal) 1,450.00 2. ~(nives from safe deposit box I 50.00 3. NC Bank, Checking Account No. 5140261096 5,479.38 00 Grant Street, 38th Floor ittsburgh, PA 15219 4• eritage Investment Services Fund, 7!~1009431 1,062.56 51 Westport Drive echanicsburg, PA 17055 5• oyalton of Creekview -Refund Check - 2,659.80 100 Crandon Way echanicsburg, PA 17050 6• ederal Income Tax Refund - 2009 175.00 TOTAL (Also enter on line 5 Recapitulation) I ; (If mote space. is deeded, insert additlonal sheeb of the same size) REV-1510 EX + (6-Ba) " SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & ~ INHERI7ANCETAxRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ANGELO P.NAVAGATO 21 09 0921 This schedule must f>e 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 ITEM INQUOE7NENMIEpF7HE7RN,7Hpggg~np~g~ypT00ECEDEMNIp DATE OF DEATH 960FDECD'S EXCLUSION TAXABLE NUMBER THE DATE OF iPAN~ER ATTAd1A COM aF TXE DEED FOR FFx ESTATE. VALUE OF ASSET INTEREST pFAPRJCA9~E) VALUE 1• eriprise Financial Services, Inc., #81975004 1 Triplett Court, Suite 101 27,117.50 00. 27,117.50 Illsburg, PA 17019 2• eriprise Financial Services, Inc.. #81983004 1 Triplett Court, Suite 101 27,471.75 00. 27,471.75 illsburg, PA 17019 TOTAL (Also enter On line 7 Recapitulation) ~ ; (If more space a n~ded, Insert additional sheets of the same size) REV-1511 EX + (10-06) C04AMONWEALTH OF PENNSriVANIA INHERI'TrANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ANGELO P. NAVAGATO 21 09 0921 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers-Hamer Funeral Home, Inc. 4,872.00 B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representatrve (s) Street Address City State Zip Year(s) Commisslon Paid: y, Attorney Fees R. Mark Thomas, Esquire 3. Family Exemption: (If decedents address is not the same as GaimanCs, attach explanation) Claimant 4. 5. 6. 7. 8. 9. Street Address City State Zip Reladonship of Claimant to Decedent Probate Fees Accountants Fees Tax Return Preparers Pees Cumberland County Law Journal The Patriot News PNC Bank -charge to drill into three safe depostt boxes 2,000.00 151.00 75.00 75.00 155.10 300.00 TOTAL (Also enter on line 9, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, includ ng unreimbuned medical expensea. ITEM NUMBER Revenue Service - 2008 Tax Retum 2• putstanding check #2918, Payee unknown 3• ~meritus Corporation DESCRIPTION VALUE AT DATE OF DEATH 713.00 60.00 3,323.70 TOTAL (Also enter on line 10 Recapitulation) I ; (If more space s needed insert adddanal sheets of the same size) REV-1513 EX * (9.00) SCHEDULE J COA~MMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ANGELO P. NAVAGATO ~~ nn noes 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 [indude o ht ssppoousal distributions, and transfers under Sec 911fi~(a~ (1 2) . . ] 1. Michael and Carole Bongiomo 'Heal 45.00 136 Briannrood Court Camp Hill, PA 17011 2. Frederick Navagato ineal 45.00 1905 Cooper Cirde Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. American Humane Association 104.86 63 Inverness Drive East Englewood, CO 80112 Assemblies of God Foundation 116.28 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ; 220 94 pt more space is needed, insert additional sheets of the same size) r ~t ~iY~ ~Zt~ ~CP~t~11YPItt of Angelo Navagato r. I, Angelo Navagato, of Cumberland County, State of Permsylvania, make, publish, and declaze this to be my Last Will and Testament. 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. PART ONE INTRODUCTORY CLAUSES ARTICLE 1-1: REVOCATION OF PRIOR WILLS I hereby revoke all Wills and Codicils that I have previously made. ARTICLE 1-2: DECLARATION OF FAMILY I am a single man. At the writing of this Will, I have no living children or issue. I have no deceased children. All references to my children are to any child hereafter legitimately born to or legally adopted by me. ARTICLE 1-3: PAYMENT OF DEBTS I authorize the payment of all my just debts and expenses as required by law. ARTICLE 1-4: PERSONAL PROPERTY „ For all purposes of this Will personal property includes both intangible personal property as well as tangible personal property. 1 LAST WILL AND TESTAMENT -Angelo Navagato ~' jnilials PART TWO DISPOSITION OF ESTATE ARTICLE 2-1: TANGIBLE PERSONAL PROPERTY 2-1.1: Gift of Prouerty. I give my jewelry, clothing, household furniture, appliances, furnishings, books, paintings, heirlooms, and other tangible personal property of a similar nature (other than money, evidences of indebtedness, documents of title, securities, motor vehicles, recreation vehicles, and property used in a trade or business), together with any insurance on such property, to those persons named in a written statement or list in my handwriting or signed by me, prepared either before or after the execution of this Will, and which describes the items and devisees with reasonable certainty. 2-1.2: Alternate Gift of Property. To the extent not disposed of by such written statement or list, I give said tangible personal property, or my interest in any such property, not otherwise specifically disposed of by this Will or in any other manner, together with any insurance on such property, pursuant to the following provisions of this will, as part of the residue of my estate. ARTICLE 2-2: DISTRIBUTIONS FOR BENEFIT OF MINISTRY 2-2.1 Charitable Gift. I give, devise, and bequeath ten percent (10%) of the rest, residue, and remainder of my estate to the Assemblies of God Foundation, Springfield; Missouri, or its successor in interest, to be distributed to the following charitable organization in the percentage designated: Valley Forge Christian College, Phoenixville, Pennsylvania 100% In the event this charitable organization has ceased to exist before distribution to said organization, I direct the Assemblies of God Foundation, or its successor in interest, to distribute to another charitable organization that has a purpose and mission similar to the organization that has ceased to exist. -The Assemblies of God Foundation, or its successor in interest, shall have the right to determine such charitable organization in its sole and absolute discretion. 2-2.2: Distribution of Remainder. I give, devise, and bequeath the remaining ninety _ percent (90%) of the rest, residue and remainder of my estate as then constituted as follows: Equal shares to Michael T. Bongiorno and Carole Bongiorno, 45% of Camp Hill, Pennsylvania, or the survivor of them, but if they are not then living, then in equal shares to Marisa N. DiSalvatore, of Wellsville, Pennsylvania, and Mia G. Bongiorno, of Camp Hill, Pennsylvania, in accordance with the laws of intestate succession 2 LAST WILL AND TESTAMENT - Ange]o Navagato ~A,r' `- ~nitia]s Frederick L. Navagato, of Camp Hill, Pennsylvania, if he is 45% then living, but if not, then in equal shazes to Maria A. Navagato, of Camp Hill, Pennsylvania, and Michael G. Navagato, of Camp Hill, Pennsylvania, if they are then living, but if not, then to Good Shepherd Roman Catholic Church, Camp Hill, Pennsylvania American Humane Association, Englewood, Colorado 10% ARTICLE 2-3: MISCELLANEOUS DISPOSITIVE PROVISIONS 2-3.1: No Contest. If any beneficiary under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, or institutes other proceedings relating to the estate without probable cause for such proceedings, any share or interest in my estate given to that contesting beneficiary under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary had predeceased me without descendants. 2-3.2: Non-Exercise of Power of Appointment. I refrain from exercising any power of appointment that I may have at the time of my death. 2-3.3: Separate Property. All property or income distributed pursuant to this Will shall be distributed as the sole and separate property of the person to whom it is given and the income, rents, issues and profits thereon shall remain the sole and sepazate property of said person. 2-3.4: Failure of Remainder. If at the time of my death, or at any later time before full distribution of the entire trust estate, all individual beneficiaries provided for under this will and their issue are deceased, any unvested portion of my estate or of any trust estate shall be distributed to the Assemblies of God Foundation, Springfield, Missouri, or its successor in interest, to be distributed to the charity described in Article 2=2 above. 3 LAST WII,L AND TESTAMENT -Angelo Navagato V~ ~ Initials PART TI3REE DESIGNATION AND SUCCESSION OF FIDUCIARIES ARTICLE 3-1: DESIGNATION OF PERSONAL REPRESENTATIVE I appoint Michael T. Bongiorno, of Camp Hill, Pennsylvania, as personal representative of my estate. If said personal representative shall for any reason fail to qualify or, after qualifying, shall cease to act as personal representative, Iappoint Frederick L. Navagato, of Camp Hill, Pennsylvania, as alternate personal representative of my estate. ARTICLE 3-2: ANCILLARY APPOINTMENTS If it shall be necessary for a representative of my estate to qualify as a personal representative in any jurisdiction other than my domicile, I appoint as ancillary personal representative in such jurisdiction such person or corporation (including my domiciliary personal representative) as may be designated, in writing, by my domiciliary personal representative. Such ancillary personal representative shall have in such other jurisdiction all the rights, powers, privileges, and immunities conferred upon my fiduciaries under this will and under the laws of such other jurisdiction. ARTICLE 3-3: BONDS WAIVED I direct that each personal representative, including successors, shall be permitted to qualify and act without the necessity of giving a bond or other undertaking in this or any other jurisdiction for the faithful performance of such fiduciary's duties, or if any bond shall be required by law or rule of court, without the necessity of sureties thereon. ARTICLE 3-0: COMPENSATION OF PERSONAL REPRESENTATIVES 3-4.1: Corporate Compensation. Any corporate personal representative shall be entitled to receive, for services as personal representative hereunder, compensation which is fair, reasonable and customary with respect to trusts and estates of similar size and character; provided, however, that all fiduciaries shall be entitled to receive reimbursement for any and all out-of-pocket expenses incurred in connection with the discharge of their duties. Should the same entity be acting in more than one capacity (as personal representative under this will and as trustee of a trust created hereunder), such entity shall be entitled to reasonable compensation in all capacities in which such entity is then acting, provided, however, that no such entity shall be _ entitled to compensation for the same service in more than one capacity. 3-4.2: Compensation of Individual Personal Representatives. Except as otherwise _ provided herein, individuals who serve as personal representative hereunder shall be entitled to reasonable compensation and to reimbursement for any and all out-of-pocket expenses incurred in connection with the discharge of the duties of said office. 4 LAST WII,L AND TESTAMENT -Angelo Navagato ~~reitials ARTICLE 3-5: PERSONAL REPRESENTATIVE LLABILITY 3-5.1: Personal Representative's Liability. No personal representative or co-personal representative hereunder shall be liable for any mistake or error in judgment, but shall be liable only in the case of bad faith or dishonesty. In the absence of bad faith or dishonesty, a personal representative or co-personal representative shall in no event be liable for any loss which may occur by reason of an operating loss or by reason of depreciation or decline in value of properties at any time belonging to (i) a trust created hereunder or (ii) my estate. 3-5.2: Self-Dealing. Any person .or entity which is serving as personal representative hereunder is specifically authorized to employ, retain or engage any person, firm, or organization to render services to any trust established hereunder and/or my estate without incurring any liability for self-dealing by reason of such employment, retention or engagement. 5 LAST WILL AND TESTAMENT -Angelo Navagato ~.(nitials PART FOUR GENERAL TRUST AND ESTATE PROVISIONS ARTICLE 4-1: DISCLAIMER Except as otherwise provided in this Will, any beneficiary under this Will may renounce and disclaim, in whole or in part, any gift, interest, .right or power hereunder. Except as otherwise provided .elsewhere in this Will, the property and interest renounced and any future interest which is to take effect in possession or enjoyment after the termination of the interest renounced shall be disposed of in the manner provided in this Will and, if it is not expressly stated in this Will how such disclaimed property and interest shall pass upon disclaimer, it shall pass hereunder as though the disclaimant had predeceased me. ARTICLE 4-2: ADMINISTRATIVE POWERS AND DUTIES 4-2.1: Non-Intervention. My personal representative shall have full power to manage and settle my estate without intervention of any court or courts, including, but not limited to, the power to sell, lease, mortgage, invest, reinvest, exchange, manage, control or in any way use and deal with any and all property of my estate. My estate shall not be subject to supervised administration. However, if my personal representative shall petition for supervised administration, it is my desire that such administration be ordered. If any other person interested in my estate shall petition for supervised administration, it is my desire that such administration, nevertheless, shall not be ordered, unless changed circumstances would require supervised administration to protect the interests of my estate and its beneficiaries. 4-2.2: Continuation of Unincorporated Businesses. I authorize my personal representative to continue any unincorporated business or venture in which I am engaged at the time of my death in the same business form throughout the period of administration of my estate if my personal representative, in his sole discretion, deems such continued operation of such business or venture to be in the best interest of my estate and its beneficiaries. 4-2.3: Administration of the Personal Representative. Except as otherwise provided in this Will, in addition to the powers enumerated in the provisions, statutes, regulations, and case rulings of applicable state law, my personal representative shall have power (except as otherwise provided herein), without prior appraisal, authorization or approval of any court, to do everything they shall consider advisable in the management of my estate even though it would not otherwise be authorized for fiduciaries under any statute or rule of law, including within this grant, without _ impairing its plenary nature, the following powers: (a) Tax Elections. To make all elections and to take all other appropriate actions with respect to taxation of every kind applying to me or my estate. Such power may be exercised regardless of the effect of such exercise upon the comparative values of the several gifts made by this Will, and my personal representative shall not be required to make any adjustment in the amount of any gift or in the income or principal of my estate in order to compensate .for the effect of such exercise. However, if my personal representative is also a 6 LAST WILL AND TESTAMENT -Angelo Navagato Initials beneficiary under this Will, such personal representative shall not participate in the exercise of such power so long as any person who is not a beneficiary is acting as co-personal representative. (b) Method of Payment. To pay or apply any money or other property payable to any person, including, but not limited to, persons under a legal disability, in such of the following ways as the personal representative shall in his sole discretion determine: (1) through payment directly to such person, even though he may be under a legal disability; (2) to any pazent, guardian, committee, conservator or other personal representative of such person, or to any suitable adult person with whom such person resides; (3) through direct expenditure for the beneficiary's benefit, as, for example, for the purchase of and payment of premiums on policies of insurance on the life of such person owned by such person or his conservator or custodian, or through payment to his doctors, nurses hospitals, schools or other persons or institutions supplying him with food, shelter, care or maintenance, or other goods, property or service of any kind, not limited to necessities; (4) to any custodian of the property of such person, including custodians acting pursuant to the applicable state Uniform Transfers to Minors Act or similar state statutory provisions; or (5) to the personal representative of any trust for the exclusive benefit of a minor or disabled person. The receipt of any such payee shall be a full discharge for all property so paid or applied. (c) Occupancy of Real Property. To permit any person having any interest in my estate to occupy any real property forming part of my estate or upon such terms as my personal representatives shall consider proper, whether rent free or in consideration of the payment of taxes, insurance, maintenance and ordinary repairs, or otherwise. (d) Distribution in Kind. To make distributions in cash or in specific property, real or personal, or in undivided interests therein, or partly in cash and partly in such property or interest therein, even if shares be composed differently. Except as to gifts of specific property, my personal representative shall have absolute discretion in the selection of property to be allocated in satisfaction of any gift without regard to the income tax basis of such property and shall not be required to adjust the amount of any gift in order to compensate for the income tax liability inherent in appreciated property distributed in kind in satisfaction of such gift. The personal representative is further authorized to distribute my estate subject to any indebtedness incurred by me or my personal representative. (e) Borrowine. To borrow money to enable the personal representative to do whatever the personal representative is hereby expressly, or impliedly, authorized to do; and to secure payment of such indebtedness in such manner as the personal representative shall deem proper. No lender shall be required to see to the propriety of the personal representative's action _ in borrowing or to the use of the money borrowed. (f) Employ Agents. To employ such agents, consultants, and advisers as the personal representative may deem appropriate, including, but not limited to, investment counsel, custodians of securities, accountants, and attorneys, remunerate them and pay their expenses. (g) Deleeation of the Personal Representative's Powers. To the extent permitted by law, to delegate to any personal representative the exercise of any or all powers, 7 LAST WILL AND TESTAMENT -Angelo NavagatoInitials discretionary or otherwise. The delegation of any such powers and the revocation of any such delegation shall be evidenced by a document in writing signed by each personal representative making such delegation and each delegatee, who shall sign such document to acknowledge his acceptance of the delegation. So long as any such delegation is in effect, any of the powers delegated maybe exercised and any action maybe taken by the personal representative to whom such powers shall be delegated with the same force and effect as if the personal representative delegating such powers shall have personally joined in the exercise of such powers and the taking of such action; however, the delegating personal representative shall not be liable for any action so taken. (h) Leases. To rent or lease real or personal property and to make leases or to grant to the lessee an option to renew the lease or extend the term thereof, or to grant to the lessee an option, exercisable during or at the termination of the lease or of any extension thereof, to purchase the leased property. (i) Wasting Assets. With respect to wasting assets and properly subject to depreciation or obsolescence, or depletion, to establish and maintain such reserves as the personal representative shall deem adequate. (j) Receipt of Property. To receive additional property from any source by bequest, devise, or otherwise, and to administer such property in accordance with the terms and conditions hereof. (k) Authority to Deal with Others. To deal with any person or entity, including the personal representative in such person's individual capacity, provided that such dealings shall be for fair and adequate consideration. Such dealings may include the lending of estate fends to any person or entity. (1) Insurance. To purchase insurance _ of any form, nature or amount; provided, however, that a corporate personal representative shall not use estate assets to purchase insurance to protect itself against personal representative liability. 4-2.4: Sales to Personal Representatives. Any personal representative hereunder is not prohibited from purchasing assets from my estate as long as such personal representative pays the fair mazket value for the assets purchased. Such -personal representative 'also shall pay a commercially acceptable interest rate on all installment purchases.' Nothing herein shall be construed as requiring my estate to sell any assets to any personal representative. 4-2.5: Release of Powers. Every administrative power created by this Will is releasable in whole or in part, temporarily or irrevocably. Any such release maybe accomplished by an instrument in writing filed in any court which has granted probate of this Will or by any other method allowed by law. 4-2.6: Funding of Discretion. Any fiduciary appointed under this Will shall have the power to make divisions or distributions in money or in kind, or partly in each, pro rata or non- pro rata, whenever required or permitted to divide or distribute all or part of my estate or any 8 LAST WII,L AND TESTAMENT -Angelo Navagato V~' ~l Trials trust created by this Will. In dividing or distributing any asset of my estate or any trust that is income in respect of a decedent, the fiduciary may take into account the income tax liability associated with the asset, both to minimise the income tax on my estate (or any trust) and the beneficiary and to consider the aRer-tax amount received by any beneficiary. In addition, in making any distributions hereunder that qualify as a charitable deduction under the Internal Revenue Code of 1986, as amended, any fiduciary shall specifically have the discretion to first use any property, the receipt of which by the fiduciary would constitute income in respect of a decedent for federal income tax purposes, in satisfying these charitable gifts. I direct that no death taxes of any description due because of my death (or any interest or penalties thereon) shall be payable from these charitable gifts. In making any such divisions or distributions, the judgment of the fiduciary in the selection and valuation of the assets to be divided or distributed shall be binding and conclusive. , ARTICLE 43: CONSTRUCTTONAL RULES 4-3.1: Article. Any reference herein to an Article is to an Article of this Will. Articles are major portions of this Will composed of sections. Each Article is titled and designated as such by two Arabic numerals separated by a dash. For example, this paragraph 4-3.4 is part of Article 4-3. 4-3.2: Child in Gestation. A child in gestation who is later born alive shall be considered as a living child throughout the period of gestation. 4-3.3: Children. Child or children shall mean descendants, as defined below, related, as above required or permitted, to the particular ancestor in the first degree. 4-3.4: Code. The Code shall mean the United States of America Internal Revenue Code of 1986, as amended, in effect at the time in question, and the corresponding provisions of any subsequent federal tax law. 4-3.5: Descendants. Descendants shall mean legitimately born persons in a direct line of descent from a particulaz individual named or referred to, whether such named or referenced individual be living or deceased, and lawfully related to such individual by consanguinity or adoption. Living descendants, descendants then living, and words of like import shall include a descendant who is conceived at the time, but only ifwsuch descendant shall be later born alive. The requirement of legitimacy shall not apply to adopted persons. An adopted person and such adopted person's descendants shall be considered in this Will as legitimately born descendants of the adoptive pazent or pazents and of anyone who is by blood or adoption an ancestor of the _ adoptive parent, or of either of the adoptive parents. Except as otherwise provided herein, an adopted person shall not be considered the descendant of his natural pazents or of the ancestors of his natural parents if he is adopted while he is under the age of three (3) yeazs, except where he is _ adopted by the spouse of one of his natural parents he shall be considered the descendant of such natural parent and the descendant of the ancestors of such natural parent, and his descendants shall be considered the descendants of such natural parent and of the ancestors of such natural parent. For all purposes of this Will, an illegitimate child of a male person shall not be considered the child or descendant of such male person unless such male person expressly 9 LAST WILL AND TESTAMENT -Angelo Navagato ~ Initials acknowledges such child as his child in writing prior to the date on which such child's interest in any gift or trust would vest in such child if such child were legitimate. For all purposes of this Will, the illegitimate child of a female person shall be considered the child of such female person unless the pazental rights of such female person to such child shall be legally terminated. A person who shall be related to a decedent through two (2) lines of relationship shall be entitled to only a single share based on the relationship, which would entitle him to the larger share. 4-3.6: Determination of Distributees. If under, any provision of this Will a distribution is to be made to the descendants of any person, the personal representative and the trustee shall make distributions to those persons whom they believe, after making such inquiry as they then think reasonable, to be the persons so described, or if after making such inquiry, they believe there is no such person, they may act upon such assumption. The personal representative and the trustee shall not be obliged to secure judicial ascertainment of the identity of such descendants or the lack thereof and shall be immune from all liability which they otherwise might incur by reason of making the distribution without the aid of judicial settlement or decree. 4-3.7: Dollazs. All dollar amounts refer to values expressed in lawful money of the United States of America. 4-3.8: Gender and Number. Wherever a word is used in plural form, but there is only one person or thing within the scope of its application, the word, though in plural form, shall have a singular meaning, and vice versa. Likewise, words of one gender shall include the other gender. 4-3.9: Governing Law. To the extent not in conflict with the provisions of this Will the laws of Pennsylvania shall govern all questions as to the validity and construction of this Will and of all trusts. 4-3.10: Income. Income, as used in provisions with respect to its distribution or accumulation, shall mean gross income, less proper income expenses and charges. 4-3.11: Invalid Provisions. If any provision of this Will shall be held illegal or invalid when applied to any property interest, such invalidity or illegality shall not affect the remaining provisions, or any other property interests, and each provision of this Will shall exist separately and independently, and shall be applied to property ,interests sepazately and independently, of every other provision, and this Will shall be construed as if such illegal or invalid provision had never existed. 4-3.12: Order of Deaths. If the order of my spouse's death and my death cannot be established by proof, my spouse and I shall be presumed conclusively to have died simultaneously for all purposes of this Will. 4-3.13: Other Principles of Construction. The word give also shall mean devise and bequeath but shall not mean appoint; the words pay and distribute also shall mean assign and convey; and the table of contents, headings and underlined paragraph titles are for guidance only and shall have no significance in the interpretation of this Will. 10 LAST WII,L AND TESTAMENT -Angelo Navagato ~ Fnitials 43.14: Pazasrayhs. References in this Will to paragraphs are to paragraphs of this Will, which are not sections hereof. 4-3.15: Personal Representative. Use of the teen personal representative in this Will is for purposes of clarity only and shall include any personal representative, executor, or executrix of my estate, regardless of the gender or number of my personal representatives. 4-3.16: Power to Interpret. If and when in good faith, the Personal Representative is in doubt as to the proper construction, interpretation or operation of this Will, or as to what property be comprehended within its terms, or as to any question which may arise during the administration of my estate or any trust created hereunder, or the application, interpretation or construction of the laws of the State of Pennsylvania, or as to any other or additional matter involving the administration of my estate or any trust or the rights of any beneficiary or any person otherwise interested under or affected by my estate or any trust, or the rights of any beneficiary under this Will, the trustee and personal representative are authorized to resolve such doubts in such manner as the trustee or personal representative, as the case may be, shall deem equitable and proper, it being my intention thus to avoid suits for construction, instructions, or direction to the fullest extent possible. All decisions and actions of the personal representative and the trustee in the exercise of the discretion and power vested in the personal representative and the trustee by the provisions of this paragraph shall be conclusive on all persons ever interested in my estate or any trust created hereunder. 4-3.17: Principal. Principal, as used in provisions with respect to distribution of property when an income beneficiary reaches a stated age, or dies, shall include any accumulated income and undistributed income then on hand. 4-3.18: Representation. Whenever a distribution to the descendants of a designated person is to be made by representation, the distributable assets shall be divided into as many shares as there aze, at the time such assets are distributable, living descendants in the nearest degree of kinship and then deceased descendants in the same degree who shall have left descendants who are then living, each then living descendant in the neazest degree receiving one share and the share of each then deceased descendant in the same degree being divided among his descendants in the same manner. 4-3.19: Sections. Any reference herein to a section (other than to a Section of the Code) is to a section of this Willa Sections comprise Articles. Each section is titled and designated by three Arabic numerals, the first two of which are separated by a dash and the second two of _ which are separated by a period. A section maybe composed of several pazagraphs. 4-3.20: SuUUOrt. Support shall mean support, maintenance, health and education. Distributions necessary for health shall include distributions to pay medical, dental, hospital, nursing and invalidism expenses.. 4-3.21: Taxes. Taxes shall include interest and penalties thereon. 11 LAST WILL AND TESTAMENT -Angelo Navagata _ftiaZr I execute this will consisting of twelve (12) pages, this .~ day of ~~b., yj plr 2004. ' Angel avagato, estator Signed, sealed, published and declared by the Testator, Angelo Navagato, as and for his last will and testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribe ur names as witnesses. i ess 12 LAST WILL AND TESTAMENT -Angelo Navagato Initials 1 ~ COMMONWEALTH OF PENNSYLVANIA ) ss COUNTY OF CUMBERLAND ) We, Angelo Navagato, JQ„r~ ~6~ Inert-,,,.s and SAmaa ~,,,~.,.~. ,the Testator and the witnesses, respectively, whose names are signed to the attached 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 and that he had signed willingly or directed another to sign for him, and that he executed it as his free and voluntary act for the purposes therein expressed; and that each of the witnesses, in the presence and hearing of the Testator, signed the will as witness and that to the best of his knowledge the Testator was at that time 1~8 or more years of age, of sound mind and under no constraint or undue influence. Ange Navagato, Tes for ss Subscribed, sworn to and acknowledged before me by Angelo Navagato, the Testator, and subscribed and sworn to before me by -~,„,,, ,,,, . ,~ _ J. '@,~ 1K000OW and 5..,.„aK~ua n ,~ .c witnesses, this ~+~ ,- day of ~ aiPM Ob` , 2004. My commission expires: ~/ Notary Public SEAL) COMMONWEALTH OF PENNSYLVANIA Ndariel Seel Thanes Roh, Jr., No1ery Public Lower Allen Twp.. Cumberland County My Canmiasian Expires Oct 30.2007 Member, Pennsylvania Association Of Notaries Gold Mine and Amurrycoin & Currency 57 West Main Street, Mechanicsburg, PA 17055 (717`) 805=9257 Cell (717) 766-1697 Land Date/~/~ Time_~:~AM PM BILL OF SALE That 1, ~ ~~ (~ ,~s'{ *g ]- Phone # I Driver's # ~ V ~ I Birth Date In consideration of S~U value received, 1 do hereby sell and assign all properties listed on this bill of sale to Gold Mine /Mobile Merchants, and warrant that I have lawful authority to dispose of same. 1 further warrant the ', rigYht that 1 shall defend my right and title to dispose of said property. A DUANTI DESCRIPTION PRICE AMOUNT U.S.90% ~ f.J U.S. 40% W.T. Sc % T ~' CANADA CURRENCY COINS FOREIGN COINS SCRAP 10K 14K i6K 18K DIAMONDS WATCHES STERLING (/ GOLD BULLION .999 Fine Total ~_ / /°~ 7 NAVAGATO ESTATE -COIN COLLECTION ~~.~-,,~ United States: Quarter Dollaz Seated Liberty 1877 ($35.00) ZS .~ Capped Bust Half Dollaz 1825 ($50.00) 7S. r' Capped Bust Half Dollaz 1829 ($50.00) ?©~ ' Liberty Half Dollar 1955 ($15.00) (o - ~ Seated Liberty Half Dollaz 1843 ($45.00) ~ S. ~ ~ Seated Liberty Half Dollar 1847 ($45.00) 3~ - ~ Seated Liberty Half Dollaz 1849 ($45.00) 3 S • '~ Seated Liberty Half Dollar 1868 ($45.00) 3d :~' Seated Liberty Haif Dollar 1872 ($45.00) ZS- ~' Indian Head Penny 1864 ($20.00) u v . CU ~ ~, Meaico• 8 R Zs 1863 V.L. 10 D 20 G ($15.00 each) 8 R Zs 1895 F.Z. 10 D 20 G 8 R Zs 1884 J.S. 10 D 20 G 8 R Zs 1892 F.Z. 10 D 20 G 8 R As 1891 M.L. 10 D 20 G 8RGo 1859 P.F. 10 D 20 G 8RGo 1885 R.R. 10 D 20 G 8RGo 1888 R.R. 10 D 20 G 8RGo 1879 S.M. 10 D 20 G 8RGo 1886 R.R. 10 D 20 G 8RGo 1896 R. S.lOD20G 8RGo 1889 R.R.lOD20G 8RGo 1893 R.S. 1OD20G 8RGo 1894 R.S. 1OD20G 8RGo 1881 S.B. 10 D 20 G 8RGo 1834 P.J. 10 D 20 G 8RGo 1897 RS. 10 D 20 G 8 R Cn 1896 A.M. l OD 20 G 8 R Pi 1888 M.R. 10 D 20 G 8 R Pi 1881 M.H. 10 D. 20 G 8 R Pi 1885 M.H. 10 D 20 G 8RPi 1887 M.R. 1OD20G 8 R Do 1893 N.D. 10 D 20 G 8 R Do 1894 N.D. 10 D 20 G 8 R Do 1887 M.C. 10 D 20 G 8 R Do 1894 N.D. 10 D 20 G 8 R Do 1891 J.P.10 D 20 G 8 R Ca 1885 M.M. 10 D 20 G C2~~ ~~ ~ ~ ~~K~ S~ Sl3 - ~8 R Ca 1886 M.M. 10 D 20 G ($15.00 each) 8 R Ca 1890 M.M. 10 D 20 G 8 R Mo 1879 M.H. 10 D 20 G 8 R Mo 1882 M.H. 10 D 20 G 8 R Mo 1888 M.H. 10 D 20 G 8 R Mo 1896 A.B. 10 D 20 G 8 R Mo 1885 M.H. 10 D 20 G 8 R Mo 1876 B.H. 10 D 20 G 8 R Mo 1891 A.M. 10 D 20 G 8RMo1887M.H.lOD20G 8 R Mo 1888 M.H. 10 D 20 G UN PESO Mo 1899 A.M. 902,7 ($15.00 each) UN PESO Zs 1898 F.Z. 902,7 UN PESO Cn 1901 J.O. 902,7 UN PESO Mo 1908 G.V. 902,7 UN PESO Mo 1908 A.M. 902,7 J5 ~J e~ (2) Dos Pesos 24 Gr Plata Pura 1921 ($21.00 each) (p ~ ~ '~`~ (2) Un Peso Caballito 1910 ($11.50 each) ~~'{l7 ~ ~~- Cinco Pesos Mo 1950 Railroad Commemorative ($45.00) ~ ~ r' 50 Centavos Zs Z 902,7 1887 ($45.00) ~p , Germanv/Prussia- RI' Germany Prussia Funf Mark 1907 ($30.00) ~~f-'' Germany Prussia Zwei Mark 1904 ($20.00) '7. '" Hamburg Germany Drei Mark 1910 ($25.00) ~ . ~ Germany Prussia 200 year old commemorative 2 mark 1901 ($125.0 (2) Germany Prussia Drei Mark 1911 ($25.00 each) ~ ~ - Prussia Silver Thaler-Wilhelm 1861 ($45.00) I,~ Prussia Silver Thaler-Wilhelm 1865 ($45.00) ,~. ^ Prussia Silver Thaler-Wilhelm 1866 ($45.OQ) ~. ~ Prussia Silver Drei Mark Wilhelm II XF 1910 ($100.00) q. ~ Prussia Silver Drei Mark Wilhehn II XF 1911 ($100.00) ~{-_ ~ Prussia Silver Drei mark Wilhelm II XF 1912 ($100.00) S~ L( •_ Italy: 1 0 Italy Eritrea 1918 Tallem ($100. ~ ,; 0~~_~ `Great Britain• Silver Coin Crown 1891 ($40.00) Silver Victoria Dei Gratia Half Crown Coin 1887 ($1 Victoria D.G. Britt Reg. F. D. Silver Coin 1887 ($30. Ceylon Victoria 50 Cent 1900 ($25A0) . "'''~- Great Britain Half Crown 1934 ($30.00) Great Britain Victoria Crown 1844 ($50.00) 1900 UK Great Britain Silver Crown ($125.00) l S . ~' Peru• Peru 8 Realer 1834 ($35.0( Peru 1889 Un Sol ($25.00) Miscellaneous• ~>7~ ~~ Z~ ,~„ l~ S ~ ~,-1 ~ / (2) Poland 10 Zlotych Silver Coin 1932 ($40.00 each} i3 - '(3v Latvia First Republic Coin 2 Lati 1925 ($10.00) 3 Canada Silver Dollar 1951 ($40.00) ~ . ~.~ French Indo-China (Vietnam) 1 Piastre 1931 ($85.00) l~ . ~ Persia 1933 ($10.00) ~O ~' Franklin Mint• 100 Greatest Masterpieces Collection, 24K gold plated sterling silver medal -Marcus ~~. Aurelius - ($40.00) ~ < <`~- ~'~7 100 Greatest Masterpieces Collection, 24K gold plated sterling silver medal -The Raft of / the Medusa - ($40.00) ~ ~ ' 100 Greatest Masterpieces Collection, 24K gold plated sterling silver medal -Poseidon ($40.00) (p~iA'~~ /~Sv /' (_,d-S Z ~-~ - -~ nl i1~ ~ ~~ c.;-,o 48500041046 REV-485 EX (1-07) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE UEE ORIGINAL FORM ONLY Social Secu ' or Death Certificate Number Date of Death Year Flle Number nh+ ,N Coun e r ~ ~ r. Decedent s Last Name Suffix First Name ~ ~t MI C p ~ $ Y ADDRESS OFDENT STREET: CITY: STATE: ^ ZIP CODE: r. NAME AND ADDRESS OF PER30 REGUESTING TF~ OPENING OF THE SAFE DEPOSIT BOX NAME: ~ ```~ ~..QC'~1..t~ __ STREETADOR SS~ CITY: STATE: ZIP CODE: ~ NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PE SON(S) PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: STREETADDRES CITY: STATE: ZIP CODE: b. NAM ~LATION HIP: ~ STREET ADDRESS: ~- \^_ ~, ,,_ CITY: `; ``Y \ ` STATE: ZIP CODE: ~~~~ ~~Dy~. L`C .. ~\~'C~ ~~LATI~HI \~ ~~Q c. NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: ``\\ ~\v~ __ STREET ADDRESS: _ ~ n .~, CITY: -~_ STATE:_ ZIP CODE: NAMEtQF PERSON MAKING,, LAST ENTRY DATE (ND TIME OF LAST ENTRY DATE~,ICO~TRAGT T~O`R~ENT BOX ~ aUN(@E ~ BO~ ~ TIT),E UNDER_WH~H XIS RAEGVSTCERE~D ~~ ~, NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. NA E: \ ~\ b. NAME: STREETADDR SS: ` STREET ADDRESS: -- _ --- CITY: STATE: ZIP CODE: CITY: STATE: ZIP CODE: ~~ NAME AND TIT E OF EMPLOYEE T G_T ~ VENT~RY \ WAS A WILL IN THE BOX? ^ YES NO H yes, a. Data of will: ~~ b. Name and address of personal nprosentative, if named in the will ~- NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: __. -- _ - c. Name antl addross of attorney, if any NAME: STREET ADDRESS: 48500041046 CITY: STATE: ZIP CODE: 48500041046 REV~85EX 4 SAFE DEPOSIT BOX INVENTORY Page of INSTRUCTIONS (1) Cash: Report total only. (2) Stooks: List in detail every common or preferred Certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., Jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (g) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 ITEM NO. ITEM DESCRIPTION ~~ 0 \ ! ~~~'~~'C _ ~L~I,~S ~~ WSJ-~S 5\ ~S ~\ _ \ 1 __ __ _. __... I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COM E BEST OF AND BELIEF. SAFE DEPOSIT X INVENTORY: NATURE SIG TURF YAMS \\ PRIN~(''eM D APP IATE B(~X BELOW: PRINT TITLE DATE CHECK AP OPRUITE BOX: ecutor(trixl ^ ACmirnstrator(trix) e ^ Estate Representative ^ Joint owner of safe Ceposi[ box NOTE: Attac additional 8'/:" x 11° sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identity the decedent ark personal representatives of the estate. The Comnanwi3alth may also use the iMormatlon in exchange of tax information agreements with Federal and bcal taxi authoribes. The state law prohibits the Commonwealth's rsonnel from disclosing confidential fax information except for official u ses. A 48500041046 - REV-485 EX (1-07) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Secunty or Death Certificate Number Date of Death County Code Year Flle Number .,. s-~:.: rk "ra°C~(7y~ur+c.aw,r. ,_~ i2s - u s~"~z'w..2 i r :~ ... Decedents Last Name Suffix First Name 1 MI cirY: © A`DDRE~S,S~.O~F D ED(~ENT STREW\T.~ \~ STgy~~E`:I~ ZIP CODE:C atarl~i ~~~'~~-'f1c~O~e1 1~~ `h ~~,4e~~~`[M~ \\\ ~1~.J NAME A`NDT NAME: \V STREET AD PERSC~NG THE OPENING OF THE SAFE DEPOSIT BOX ~. ~~~.~~ t~ nov„ v~wnm l`~~.S._~Q~.~ _ y`1~~,~'~ ~, ---- -- CITY:~7`Q< `~~~~'vZIPCODE: STREETADDRES ' b. NAMF. TIDN$HIP: STREET ADDRESS: ``~ ~~~`~ ~ ~~~ ~~~~~ CITY: ~~~~'STATE: ZIP CODE: c. NAME: RELATIONSHIP: ~. STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSR BOX IS LOCATED NAME: ~~ STREETADDRESFi: CITY: STATE: ZIP CODE: OF PE~tSON MAKING LAST ENTRY ~ ~ ~ pA~ DATE OF CbNTR~CT TO RENT BOX 0 NUMBER OF BOX 1 TILE UNDER WHICH NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. NAME: b. NAME: STREET ADDRESS: STREET ADDRESS: ITY: STATE: P CODE: CITY: ` ~~ NAME AND TITLE OF EMPLBYEE TsK TNF ruvaurnw r\ WAS~A WILL IN THE BOX7 ^ YES ',~NO l If ysa, a. Date of will: b. Name and address of psraonal reprasenhtfva, if named In the will NAME: STREET ADDRESS: e. Name and address of attomsy, if any NAME: - - STREET ADDRESS: ciTY: _ OF LAST ENTRY IS REGISTERED 1 i~v ~~~ 0.C Cs STATE: ZIP CODE: ~e~~ STATE: ZIP CODE: CITY: STATE: ZIP CODE: L 48500041046 48500041046 J REV-485 EX SAFE DEPOSIT.. B4X INVENTORY Page of tryJ 1 RfJI. 1 IVIV.7 ~ , (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of tympany, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (T) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (S) Return Completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DNISION PO 80X 280601 HARRISBURG, PA 1128-0801 ITEM NO. ITEM DESCRIPTION Q \\ \L l~ ~e ~~. ~o ~. ~`e'c.~ L~ -- t~.~~- iSS ~ _ __ ~ 3 _. _._ ........ _. _ ~~^2~"~~ .. - I CERTIF ORREC Y UNDER PENALTY of PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF T AND COMP E BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT OX INVENTORY SI : 31G AT E °'~D ~ ~ S~~V PRI T TITL ~~~~ KJ 1v~~iE BOX -'W: t W ~ a \1`_ 7 f CHECI(J~PROPRIATE BO ~ Executor(Wx) ^ Atlministrator(trix) ~ ^ Estate Representathre ^ Joint owner of safe deposit box OTE: Attach additional 8'l:" x 11" sheet(s) if necessary o use duplicates of this page of form. The Department is authored by law, 42 U.S.C. §405 (e)(2)(C)(i) to require disclosure of Sora l S it b , a ecur y num ers in connection with administering state tax laws. The Department uses the Social Seventy number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities. The state law orohihira rno rnmmrteweelfh~e ,~k.....,e, ...._ .:_~__:__ ___~.__.,_.. .. _ --_.._... _... _._..........y ,,.,,,,...~„wo, .o,. ~,nvn unomi except wr vmclal uryo5e5. A J REV-485 EX (1-07) SAFE DEPOSIT BOX INVENTORY PA Departrnent of Revenue c_ 48500041046 PLPA4C r~!! wmwu. ~. --- r ~~ uouu~ ~.arancate rvumber Date of Death -- "°m "^" ~,.~~..,K„,. ~~ County Code Year Flle Number ^~ ; ~ ~ t Decedents Las'~N re ~V~',«~~ e - ~~ a ~ ~ 1 Suffix '"'~' .an~~~-s+ .•_--:m~• ~..3.~,_~'..msF-'mnz ~ ~ -. --- First Name ~ ... © ADDRESS OF rvAMt: -' "^^•° •~•~ • nc aMre UCPOSIT BOX ` ~--ter STREET ADDRESS: - -~. ~J `~ C TY: STATE: ZIP CODE: NAME, AD RESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) P ENT A THE BOX OPENING a. NA \ _ STREET ADDRESS: ~~,1 ~ , b. NAME. ~ ~`~~ w "~'~ ~ /`~ ~.~,~I~-CI \~\ ~ STATE j~ p CODE: ~ 1 ` RE~NSHIP: ~ l\: STREET ADDRESS: ~t~.~~~-`~: ~/~• ~~C S ~~~t \..~~~ \'~ __. ~~~ C, ,~,~~CITY~ ~~ ` l~ ATE: ZIP CODE: c. NAME: ) '~"~~ \ RELATIONSHIP: STREET ADDRESS: - - clrY: uaiua nun snneves .. _ STATE: ZIP CODE: ---- -• • °•^•`~•^~ ~~~ ~ ~ ~ u ~ ivn wnerze THE SAFE DEPOSIT BOX IS LOCATED .~,,..~. _ ...._. 1 ~"~.~ STREET ADDRESS: STATE: ZIP CODE: ~~ d N OF PERSON MAKING LAST ENTRY ~ C DA E A TIME OF LAST ENTRY DATE OF CON ~~RENT BOX NUMB O,F 80X 1 LE UNDER WHICH BOX 13 REGISTERED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX , ~ " a. NAM e~~ \ t~ v ~ b. NAME: STREET ADDR SS: l~ ~~~ ~ - - - STREETADDRESS: CITM' STATE --ZIP CODE: CITY: -- _~ hr r \~Cq ~~ ~~l\Sr\ STATE: ZIP CODE: ~i nqa ND TITL OF EMPLOYE TAI THE Q WAS A WILL IN THE BOX? YES NO b. Name and address of personal ropnsentativ NAME: STREET ADDRESS: e. Name and addrnaa of attomay, Ii arty - NAME: STREET ADDRESS: L 48500041046 m~[~r CS `i'\\ M yes, a. Date of will: If nametl in tha will aTr: CITY: STATE: ZIP CODE: STATE: ZIP CODE: 48500041046 J ., REV-485 EX SAFE DEPOSIT BOX INVENTORY Page of INSTRUCTIONS .:_: • (1) r Cash: Report total only. (2) Stocks: list in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name In which stock Is registered, and number of shares and class of stock. (3) Obllgatlons of U.S. Govemmant: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: pesignate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (8) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 N0. I T EM DESCRIPTION ,, \\ ~ ,~,` ' A ,n~ CC ~~ 1 i ~~\u(~ ~ , L~~~' Q0.. ~~~_.. ~~Li T ~ 3~~.~ ~~~~p ~~ ~~t~ l ~ CA`..~.5 ~~ m ~.~ r ~ Lam' ~ ~c ~ ~~~ _ ~~.~ _ L0. 0 C~ ~~ ~ ~~~.a `Q~ - ~~~~ __ ~.o~~ ~ 1~ ~~5~~ ~~~~~•e~S~ ~~ ~ ~i`~~k ~~`~ . ----- _-- I CERTIFY UNDER PENALTY OF PERJURY THA7 THE ABOVE RECORD IS CORRECT AND CO~jE BEST OF MY KNOWLEDGE AND BELIEF. ~c `~ J Phl~1T NAM ANp C CK APB RIATE BpX BELOW: 1 ~ \I PRI T TI E ~ DATE ~' ~ ii ~~ ~ ~ ~J"L CHECK ROPRIATE 80 Executor(trix) ^ Administrator(tdx) Estate Representative ~ Joint owner of safe deposit box NOT ttach additional 8'!= x 11" shoe a) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disdosure of Social Security numbers in connection with administerin state tax laws. The Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax info~ation agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disdosin confidential fax Information except for official ourmoses 4651 Westport Dr Mechanicsburg PA 17055 (717)796-9764 Mr Angelo Navagato C/O Michael Bongiorno 136 Briarwood Ct Camp Hill PA 17011-8471 Account Primary Account Holder 1009431 Angelo Navagato Ra~Qt 3.25% ~~ HERITAGE INVESTMENT SERVICES FUND An im~estmenc that luorks Sep 06, 2009 Ma ur Balance N/A $1,062.56 TOTAL PERIOD INTEREST $11.50 TOTAL ON DEPOSIT (includes unposted interest) $1,062.56 11-16-'09 12:09 FROM-Loyalton of Creekvw November 16, 2009 R, Mark Thomas, Esq. Attorney at Larv 101 South Mazket Street Mechanicsburg, PA 17055-3851 Re: Estate of Angelo P. Navagato Dear Attorney Thomas: ~~ ~~77304036 T-904 P001/005 F-426 We aze in receipt of your correspondence dated November 10, 2009 regarding your representation of the Executor of the Estate of Angelo P. Navagato. Along with copies of your documents I am sending a copy of our check # 98376, dated October 1, 2009 in the amount of $2,575.00 which represents apro-rated refund of monies paid to us for the Rent and Level of Care billing for the month of September, 2009, Please contact me directly should you require additional information or if you have any additional questions. Kindest Regards, ~~~`~ David D Berger Business Office birector ~~ ~MERITus s~ ~~~. 11-16-'09 12;09 FBOCJ-Loyalton of Creekvw 7177384036 T-904 P002/005 F-426 Page .., ;.~' ..:r~-. "^.^W.M M? 1 .WM„ ~..avM~MNYN.MY tY• tnw~.M•' A ••• ••~•• -\ r y ~"~ ,M~ a' YYw..n ~`"'"(~~~_Y~±t~~~ M3` FX:^M~'b+.t+~ ~. g. t3 ~ tdl "~!' mow. +w_, r'^' .~_ ++.. ~~~`.~".+~,'"'- 2'~k~ww +`~s. ., EM!~RiTUS SENIOR LIVING wollsF~rgo9ank,Nn 9837'6 3131 F~z,crTAVENUe sutra soe 119 Hos Ital Dtrve 1011/2009 "'°""" SEATTLE, WA A01Z1 Van W1rr1PON ari83t PAY TWO THOUSAND F1VE HUNDR[D SEVENTY FIVE DOLLARS ONLY TO THE •• ORDFR OF '$2,575,00 VOID AFTER t80 ql,Y$ ANGELO NAVAGATO THE ES7ATE OF ANGELO NAVAGATO 136 BRIARWOOD CT ~'"' "w „~~~~a CAMP HILL, PA 17011 ~•..,._•= pp `~° A SECt[RITY FEATOele INCLYGeO. Gl7wILS ON eAC1C t!.! It'p4837611' I:04 i 2038241: 9E0012539811' t''dDD025"r50C.~' =~ . -Ir• t;. • :~. . .. , ~ r .t. ~. : • ~ ~' : ~ 913 ~ ;. ~ y :1 - t !S i; 1 Fi . Amount:8 2,575.00 ACraunt Neme:l?MBRITCORPO Check Number98S78 Account Number.98007Z5998 POetirg Dete:10/14/Z009 Rougtl9 Number.241259B2 Ae O1 D~te:10H4lZ009 Type Ctxle/DescripUon:478/CHECK PAID Item Sequence NUmber0081ti4348585 ~ CopyriQtlt 2002 •2009 Wells Faryo. All rights roeerved. The Personal Advisors of Ameriprise ' Financial November 23; 2009 R. Mark Thomas Attorney at Law 101 South Market Street Mechanicsburg, PA 17055-3851 Re: Estate of Angelo Navagato, Deceased Client ID: 1318 2756 011 Account numbers: 0930 0778 8197 5 044 and 0930 0778 8198 3 004 Dear Mr. Thomas: Ameriprise Fnancial Services, Inc. Suite 101 11 Triplett CT Dillsburg, PA 17019 Tel: 717.432.7722 Fax: 717.432.2424 Toll Free: 800.311.4067 d o ri s. e. b rytr@a m pf. co m ~wa~~ ~~r~s We are writing in response to your letter dated November 10, 2009. We have enclosed account information for Mr. Navagato's annuities and beneficiaries. These values are provided for estate lax purposes and are not the specific value w be paid to the client. Actual values used in preparation. for future tax returns will be provided after the first of the year. VJe will contact Mr. Navagato's beneficiaries as part of our death claim settlement procedure. We will handle all the necessary paperwork for this claim. Once our home office has all paperwork completed, Mr. Navagato's beneficiaries will be able to access capital to defray any inheritance or estate settlement taxes that may be due. Would you please provide us with a copy of the Pennsylvania inheritance tax forms once you have them completed? Also, if you have any questions on the enclosed information please feel free to call u~ at the above phone number. S' erely B DB/cw Enclosures Dorls E. Brytr Financial Advisor An Ameriprise Fnancial franchise. Ameriprise Flnanclal Services, Inc. offers financial advisory services, investments, insu2nce and annuity products. t,royr\ Riti?rSourceo products are offered by affiliates of Ameriprise Fnanclal Services, Inc., Member FlNRA and SIPC. p.~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone September 30, 2009 (717) 787-6201 jwatts@state.pa.us AMERIPRISE FINANCIAL 11 TRIPLETT COURT DILLSBURG PA 17019 Re: Estate of Angelo Navagato File Number N/A Social Security 156-05-8019 Dear Ms Brytz: The Department issues this waiver for the following security held in beneficiary format by the decedent. The security will be subject to Pennsylvania inheritance tax. The Department will issue an information notice to the transferee of the potential Pennsylvania inheritance tax due for this asset. A copy of this waiver is to be used by you to notify the transfer agent that the reporting requirements of Section 6411 of the Probate Estates and Fiduciaries Code (Title 20, Chapter 64, Pennsylvania Consolidated Statutes), have been satisfied. Name of Company: AMERIPRISE FINANCIAL Type of Account: ^ Capitol Stock ^ Registered Bond ^ A Security Asset ® ur ID Number: 8 75004 & 81983004 Account Balancer $27,.117.50 & $27,471.75 Sincerely, j ~ Judy Watts Tax Examiner II Inheritance Tax Division AdvisorCompass~ Onllf3e Service and Transactlans Client Beneficiaries Client Profile ~ Acccount Roles Client Information Name: ClientlD: Client Beneficiaries Plan Type: Non-Qualified RVS RAVA 4 ADVANT NO ANGELO NAVAGATO 0000 0930 0778 8197 5 004 Account RVS RATE BONUS 2 NO ANGELO NAVAGATO 0000 0930 0778 8198 3 004 Designation Request Speling_Corr_ec_tion PRIMARY BENEFICIARY FREDERICK L NAVAGATO NEPHEW 51.00% MICHAEL T BONGIORNO POA 49.00% OR THE SURVIVOR Designation Reauest Spelling Correction + PRIMARY BENEFICIARY FREDERICK L NAVAGATO NEPHEW 51.00% MICHAEL T BONGIRNO POA 49.00% OR THE SURVIVOR View Corpo..rate Enti#les and__Important Disclosures, Web Site_._Rules_a..nd Regul_abo.ns., Privacy Statement and About E_maii Frau.d.. Copyright ®2008-2009 Ameriprise Financial. All Rights Reserved. Users of this site agree to be bound by the terms of the Ameriprise Web Slte Rules and Regulations. Addresses ANGELO NAVAGATO Hem Close Window Beneficiaries 1318 2756 0 001 Plan Page 1 of 1 Ameriprise ,~ Financ7at https://www8.ex.is.ameriprise.com/Ost/Secure/ClientInfo/ClientBeneficiaries.asp?FBCID... 11 / 17/2009 ` roe t Mr. Michael Bongiorno 136 Briarwood Court Camp Hill PA 17011 MYERS-HgR~VER;FUN~gL HOME INC. i ' '^•'Dle'is';; .190t'MAAK!'T STREET CAIdP fIII'4 PENNSYLVANIA 17011 "" 717.777-lV61 LOCALLY OWNED MYD OPBRAI'EU September 23, 2009 Services for Angelo P. Navagato September 10, 2009 Charges for Services Selected Professional Services Use of Facilities Automotive Er~uipment Charges for Merchandise Selected Prayer Cards Cash Advanced Newspaper Notice/Local Certified Copies Flowers Honor Guard Total due wit}Ln thirty days, please: Received check for Veterans Benefits $ 4,545.00 $ 211.00 36.00 .. 90.00 50~QO ROBERT 1{, IIw RNF.R SUPER VISOR DUSTIN' R. Bwi:F.R FUNE11wL DIRECTOR $ 4,545.00 $ 40.00 $ 387.00 ~ 4~ Balance Due: ~ $ 4,8T£.~6 +~ Iq IGI a R ~~'~ l~l Is_.'f ; B l._„ MYERS-HARNER FUNERAL HOME INC. t900 MARKET STREET CAMP HH.L PENNSYLVANU 1701 I 717.7]7.9961 L.OC:\L.1.Y OWNED AND OPF,RA"I'F:D September 23, 2009 Mr. Michael Bongiorno 136 Briarwood Court Ca.^:p Hill PA 17011 Services for Angelo P. Navagato September 10, 2009 Charges For Services Selected - Professional Services Use of Facilities Automotive Equipment Charles for Merchandise Selected ?rarer Cards Cash Advanced Newspaper Notice/Local Certified Copies Flowers Honor Guard Total due within thirty days, please: $ 4,545.00 $ 211.00 36.00 .90.00 50.00 NONENT 11. Il•NSlN ' SI:I'EN eIYDR bUITU N. Nw 6F.N Fl'~'F:NAI. DIR F.CgF $ 4,545.00 $ 40.00 $ 387.00 $ 4, ^~ ~~~dQg3 J'. ~~~~. RECEIPT FOR PAYMENT ------------------- ------------------- f GLENDA FARMER STRASBAUGH Receipt Date: 10/01/2009 Cumberland County - Register Of Wills Receipt Time: 10:17:08 One Courthouse Sqquare Receipt No.: 1058450 Carlisle, PA 17Q13 NAVAGATO ANGELO P Estate File No.: 2009-00921 MARK THOMAS R Paid By Remarks: C ~ ------------------------ Receipt Distribution ----- -------- ------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 90.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 16.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 3027 $136.00 Total Received......... $136.00 a, ll ~Arot+ k ~~~ c~he ~latriot-1~ews Riow you know • n ADVERTISING INVOICE !STATEMENT # : $ 0.00 03/01!2010 - 03/31!2010 R. MARK THOMAS .. . $ 155.10 $ 0.00 Net 30 Days . ~ ~ .. - $ 155.10 $ 0.00 $ 0.00 1 03/31/2010 R. MARK THOMAS THE PATRIOT-NEWS ATTN JOETTE L. MCGOWEN 23794 NETWORK PL 101 SOUTH MARKET STREET CHICAGO IL 60673-1237 Mechanicsburg, PA 170553851 USA 35242 35242 ^ Address changes on back ^ Credit Card Payment on back Balance Forward 03/15 P600487 PAYMENT-THANK YOU 310.20 -155.10 Amount to Pay: $155.10 I I I I I STATEMENT OF ACCOUNT AGING of PAST Due AMOUNTS $ 0.00 $ 155.10 $ 0.00 $ 0.00 $ 0.00 $ 155.10 I ~r.~`J` ~"`Q`~~~WS All Billing Inquires (717) 255-8213 ~~TM Now you know Fed. ID # 23-1304402 ` UNAPPLIED AMOUNTS ARE INCLUDED IN TOTAL AMOUN'T' 1M ~ • CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tale: (71 T) 248-8188 Fax: (71 n 249-2883 December 4, 2009 Cumberland Law Joumal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: R. Mark Thomas, Esquire RE: Angelo P. Navagato Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: November 20, November 27, and December 4, 2009 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director Department of Treasury Internal Revenue Service 1973 N RULON WHITE BLVD OGDEN, UT 84201-0021 C e r.-•:r%~:~ ry'i6'~` 023155 023155.669595.0185.006 2 3P 0.610 1885 ANGELO NAVAGATO C/0 136 BRIARWOOD COURT CAMP HILL PA 17011-8471 AIJR Control: 50502-7719 Notice: CP2000 Notice Date: December 07, 2009 Social Security Number: 156-05-8019 Form: 1040 Tax Year: 2008 To call for assistance: 1-800-829-8310 TOLL FREE between 7:00 AM - 8:00 PM To FAX information: 1-877-477-9640 LOCAL FAX January 06, 2D1D 1 2 3 Why are you getting this notice? The income and payment information (e.g., wages, miscellaneous income, interest, income tax withheld, earned income credit, etc.) that we have on file does not match entries on your 2008 Form 1040. If this information is correct, you will owe 5713 . The proposed changes to your tax are listed below. Following these steps can help you understand this notice. 1. Review your 2DDS tax return. 2. Compare your return to the information in the Explanation Section -- page 5 . 3. Decide if the information in the Explanation Section is correct. 4. Check the answers to Frequently Asked Questions -- pa a 2. 5. Complete and return the espouse Form in the enclosed envelope -- age 3. 6. Complete and return the /nstallmentAgreement Request (enclosed) ifpyou need to set up a payment plan. ~• Review your rights in The Examination Process Booklet (enclosed). What happens if you don't respond by January ob, zolo? We will send you a final notice, followed by a bill. During this time, interest will increase and certain penalties may apply. {SP1A} CP2000 (Rev. 11/2004) What steps should you take? .~ oa3iss OGDEN IRS CENTER ~~.. 156-05-8019 50502-7719 NAVA A011 12/07/2009 ~ 1. Review the Explanation Section to decide whether you agree or do not agree with IRS's proposed changes. 2. Complete and return the Response Form by January O6, 2010 . 3. If you need additional time, call us at i-800-829-8310. a • • - - _ .. • • • - • • ~ - ~ C If you agree with the changes !RS is proposing, return this form with your payment or with the completed Inst ment Agreement Request. OPTION 1 ~ I Agree with All Changes I agree with the changes to my 2008 tax return. I understand that I owe 5713 in additional tax, penalties, and interest. I understand that the law requires IRS to charge interest on taxes that are not paid in full by April 15, 2009. In addition, I understand that the IRS will charge interest until I have paid the tax in full. Certain penalties may also apply. I understand that I can challenge these changes in the U.S. Tax Court only if IRS determines after the date I sign this form that I owe additional taxes for 2008 . I understand that I can file for a refund at a later date. Signature Date If you do not agree with the changes IRS is proposing, return this form. When you return this form, include a signed statement that explains what you do not agree with. Atso include copies of any documents, such as a corrected W-2, 1099, or missing forms, that support your statement. ^ OPTION 21 I Do Not Agree with Some of the Changes I've enclosed documentation to support the entries on my original return. ^ OPTION 31 I Do Not Agree with Any of the Changes I've enclosed documentation to support the entries on my original return. Tip! Pay as much as you can now to keep penalty and interest charges low. Make your check or money order payable to "United States Treasury. " Write "Tax Year 2 0 0 S CP2000, "this Social Security Number 15 6 - 0 5 - 8 019 and your phone number on your check or money order. ~ OPTION 1 ~ I'm paying the full amount of 5713 ^ OPT10{d 2 ~ I'm making a payment of $ because either: ^ I'm paying the amount I agree with or ^ I'm making a partial payment at this time ^ OPTION 3~ I'd like to request a payment plan to pay the tax I owe. Complete the Installment Agreement Request (Form 9465) and mail it along with this form. i~~~~u~~~~~i~u~i~u~~gi~ {RF02} Page 3 CP2000 CREV. 11/2004)