HomeMy WebLinkAbout02-0791PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Michael F. Robinson
also known as Frank Robinson
Deceased.
Social Security No. 306-OS-984
No. ,2~-Q~ -Iq ~
To:
Register of Wills for the
County of Cumberland _ in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/ara 18 yeazs of age or older, appl ies for letters of administration
(d.b.n.; pendente liter durante absentia; durance minoritate)
the above decedent.
on the estate of
Decendent was domiciled at death in Cumberland
his last family or principal residence at 821 Mandv L_ aniCamo H~ 11~ Pennsylvania, with
(list street, number and municipality)
Decendent, then 82 years of age, died AuQUSt 16 2002
at
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ 500,000.00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania
situated as follows: 821 Mand Lane Cam Hill PA 17011 $ 150.000 00
Petitioner- after a proper seazch h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
.,--
PA 17011
PA 17011
v Michael Cherewka
y
;,~ 125 Pelham Road
C
`X"
90 Camp Hill PA 17011
-
q'.^.
N ".1
~a Son-in-law
~ °
to Pursuant to Renunciations
c
m
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF Cumberland
The petitioner(s) above-named sweaz(s) or affirm(s) ,that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affinrt?d 2nd subscribed
before me this _30~8j7~ day of
` Read gister l
d~
No. ~1-Q,?--741
Estate Of MTf HAFT F RflaT*~cn*T n ~ ~**N ,Deceased.
GRANT OF LETTERS OF ADMINISTRATION
m
m
~.:
AND NOW AUGUST 30 2002 _ 19 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT~IS DECREED that
is/aze entitled to Letters of Administration, and in accord with such finding, Letters of Administration
aze hereby granted to MT('HAFT rraFRFr nrn -
in the estate of
FEES
Letters of Administration ..... $ 410.00
Short Certificates( ) .......... $~g; gg--
Renunciation ................ $-
1~- ~ $ C .TOD-~
TOTAL _ $ "Q~^~
Filed .....8-3.0-200.2..... A.D. 19
tiled to atty 8-30-2002
Re!!istet of Wi!!s
ATTORNEY (Sup. Ct. LD. No.)
ADDRESS
PHONE
> er,
~~ ais is ro celu'r r4ol tic iniormaton aere given is correcdY copied from :m original certihcare of deadl duly tiled svil~h Ine as
I. real RegiAUal The uril~in,ll Yrn ihcuc will be lonvarded ro the Srlrc Vital RLrords Office for prrln,lnenl tilin,y.
1VARiVING: It is illegal to duplicate this copy by photostat or photograph.
I~e, frx th~r LeLri-iL.ue. $? 00
P 8606167
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gEG18i SBIGNi1TURE µpNWBEq
O/SELILEpIMONI. Day wN
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~-/-IG~ B~i 6 /l c-o L
Register of Wills of Cumberland County, Pennsylvania
Renunciation
In Re Estate of fY11CHAEl f, ROBINSoN
deceased.
The undersigned l!//LL/y/p L, FI08/AISoN SOn/
of
the above decedent, hereby renounce(s) the right to administer the estate and
respectfully ask(s) that Letters OF AuMVYiST,QµTioN
be issued to MICHgEL CHERfWka
WITNESS MY hand this Z(o* day of Ai/GU$T ~ 7~ 2[b2
(my, our)
~____ tJOTAR Sl=~A!
SUSAN J. MIL' R, Notary P 'c ' ' n
Camp bill Eoro, ou ~i`
M Commiar+le; ~ ~ 20 6
~~3o~oz
Date Fi ed
_ Ll/L.1~ ~
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(Signature)
t3 a / MAC 1' ,~,v.
~P ifi~c P.~l /70i/
•ess)
( ignature)
(Address)
(Signature)
(Address)
ignature)
(Address)
(Signature)
ress
,,,, __NOTE _ Please have signature(s) notorized_if signed outside Register of Wills office
Register of Wills of Cumberland County, Pennsylvania
Renunciation
~l-oa-191
In Re Estate of M/CNA~f,G F, iQ08/A/SOh/
deceased.
The undersigned rJEBECCA R/CC/ c~ MICHFlE 2 CpEREWKR pp~7~s of
the above decedent, hereby renounce(s) the right to administer the estate and
respectfully ask(s) that Letters ~' Af7MIN157R/~Tlo~/
be issued to _ M)CH9Et CNEai~1Kq
WITNESS OUR hand this o2(~ day of [~gj~ s f ig c~OGoZ
(my, our)
(Signature)
NOTARIAL SEAL _
Christie L. Underkoffler, Notary Public ~ d3J lr3dJCa,i pin ~~ tea,/ ~p /J ~ DoY
Camp Hill Boro, Cumberland County (Address)
My Commisafon Expires June 24, 2006
( ignature)
(Address)
(Signature)
(Address)
ignature)
(Address)
l~~gnature)
~~3U~07~
Date Filed (Address)
,,,, NOTE -Please have signature(s) notorized_i_f signed outside Register of Wilis office
Name of Decedent:
Date of Death:
No.
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5 h/a)
MICHAEL F. ROBINSON
August l6, 2002
21-02-791
r
1 certify that the Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court
Rules was served or mailed to the following beneficiaries of the above-captioned estate on November
I5, 2002.
NAMES ADDRESS
William F. Robinson 821 Mandy Lane
Camp Hill, PA 17011
Rebecca R. Ricci 6035 Boxer Drive
Bethel Park, PA 15102
Michele R. Cherewka 125 Pelham Road
Camp Hill, PA 17011
Date: %171 ~~c 7~ The Law Offices of Michael Cherewka
Michael Cherewka, Esquire
624 North Front Street
Wormleysburg, PA 17043
- (717)232-4701
Capacity:
X Personal Representative
X Counsel for personal
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 260601
HARRISBURG, PA 1 J128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 001853
CHEREWKA MICHAEL
624 NORTH FRONT STREET
HARRISBURG, PA 17043
role
ESTATE INFORMATION: ssN: 2os-o5-sea5
FILE NUMBER: 2102-0791
DECEDENT NAME: ROBINSON MICHAEL F
DATE OF PAYMENT: 11/18/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 08/16/2002
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 525,000.00
TOTAL AMOUNT PAID:
REMARKS: MICHAEL CHEREWKA ESQUIRE
CHECK# 99
INITIALS: AC
SEAL RECEIVED BY:
525,000.00
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
Jnlf;.(J()1
'*' COMMONWEALTH OF
, PENNSYLVANIA
. .. 'lllli .. DEPARTMENT OF REVENUE
, '. DEPT 280601
. ~. HARRISBURG, PA 17128-0601
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
IMBltfStJtJ mlCHAEL
DATE OF DEATH (MM-DD-YEAR)
OB-II.- 2002.
n-~t)- \)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2,1 -0'2.
o 0 1 q
-----
COUNTY CODE
YEAR
NUMBER
f.
SOCIAL SECURITY NUMBER
20ft, - 05
981/5
, DATE OF BIRTH (MM-DD-YEAR)
10-1(1- Iq lq
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDOlE INITIAL)
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12.12-82)
o 7. Decedent Maintained a living Trust IAllach copy of Trust)
o 10. Spousal Poverty Creditldateof daalh belwean 12-31-91 and 1-1-95}
o 3. Remainder Retum(date of death priofto 12-1H21
o 5. Federal Estate Tax Return Required
r,; 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Al\ach Sch 0)
~1. Original Return
o 4. limited Estate
D 6. Decedent Died Testate (AnadloopyofWdl)
o 9. litigation Proceeds Received
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THI$ $llcflON MUst BE COMPI..ETEI).,I\L\. CORRESPONt)I!IlcEANl)iCONFlOllNmTi\I(INFokUAt'"0lJt.O i~Cn:DTO;
NAME #/'CHA/JL Ch13f!e4lkA COMPLETE MAILING ADDRESS
b2'1 NcJll-TIl ~NT $TI'~Ef.T
\Ull(I.mL~'/SeUl:G I PA 110"13
FIRM NAME lIf Appticahlll)
TELEPHONE NUMBER
(7/7) 232-410/
1. Real Estate (Schedule A) (1) 1'61/200.00 OFFICIAL USE ONLY
Oe: ::0
2. Stocks and Bonds (Schedule B) (2) liI1,053. ~1 - -.. 8
- (I' ~
::J~
3. Closely Held COI"pOralion, Partnership or Sole-Proprietorship (3) 0' 7'-
ll' "" (:::,
4. Mortgages & Notes Receivable (Schedule DJ (4) "Y', ==< ,";'.,
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 15qj ~(l.1.50 '~" -
0\
Z (Sch,dul,E) C
0 (6) () -0
~ 6. Jointly Owned Property (Schedule F) W
o Separate Billing Requested ,).;,:' ~: \it
qZ 851.l.fb ...... 0\
::J 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (7)
I- (Schedule G or L) I
Q: X5SIQI2.b3
c( 8. Total Gross Assets (Iotal lines 1-7) (8)
U 9. Funeral Expenses & Administrative Costs (Schedule H) (9) il, ft,b 2:21,
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lit:: (10) .3,ISL.. '1~
10. Debts of Decedent, Mortgage Liabilities. & liens (Schedule 1)
11, Total Deductions (Iolal lines 9 & 10) (II) 1~llZq.Z5
12. Net Value of Estate (line 8 minus Line 11) (12) i~""1123.311
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (ScheduleJ)
14. HetValue Subject to Tax (Une 12 minus line 13) (14) gq'l,IZ3.3i
SEE INSTRUCIIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of Une 14 taxable at the spousal tax
0
!;i rale, or transfers under Sec. 9116 (a)(l.2) x .0 (15)
x .0 ~ljqBS.5S'
"'" 16. Amount of Line 14 taxable at lineal rate (16)
::J
D. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
::e
0 18. Amount of Line 14 taxable at collateral rate x.15 (18)
U
g 19. Tax Due (19) 31, '1SS"S!)
20.0
'11 ij~QK.1\lll "~'~ ,;.,,;-:".
,,; 'Hi"';
Decedent's Complete Address:
STREET ADDRESS
CITY
~'21 M~Ml'/ LAN';
tA1I\P 1-111.1.
I STATE ff\
I ZIP
1101\
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3'IQe5.56
25000.60
I
1,31S.1~
Tolal Credils ( A T B + C ) (2)
2b .3l'5.15
3 InteresUPenalty if applicable
D.lnterest
E. Penalty
TolallnteresUPenalty ( D + E ) (3)
4. If Une 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 ~ine 20 to request a refund (4)
B. Enter the total of Une 5 + 5A. This is the 8A~NCE DUE.
(5)
(5A)
(58)
Illlo~<j. gO
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
lI,bl.q.80
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: ............... ~Bes NGr~
a. retain the use or income of the property transferred; ...... l!e1 .
b. retain the right to designate who shall use the property transferred or its income;.
c. retain a reversionary Interest; or.. ....................... ........ ........... ........... 0 ~ /
d. receive the promise for life of either payments, benefits or care? ....... ... 0 l.ir"
2. If death occurred after December 12, 1982, did decedent transfer property wtlhin one year of death
without receiving adequate consideration? ..... ................................. ................... DO ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. l...Y'
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which _ /
contains a beneficiary designation? . ....... ~ .
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Urlder penalties of pe~ury. I declare that I have examined this fetum, kIcludio9 ocoompll"'fin9 schedules aml5\alements, and to the besl of my knowledge and belief. it is true, correct
and complete.
Declaralion of preparer olher than Ihe personal represenfativeis based on a!l inlormafionofwhich preparer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~ ~ DATE S//h/d 3
ADDRESS
(.,2'1 )../(){lTH FRd/1J1 571leET
W{)l!.mLEYstJu'126
M
I7tJ'-{3
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
For dales of death on or after July 1, 1994 and before Januar; 1, 1995, the tax rate imposed on t'ne net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)).
For dates 01 death on or after January 1, 1995, the tax rate imposed on Ihe net value of Iransfers to or for the use of the survivin9 spouse is 0% [72 P.S. 99116 (al (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 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 01 transfers worn 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. 99116(a)(1.2)J.
The lax 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. 99116(1.2) [72 P.S. 99116(a)(I)].
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. 99116(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.
,
REV-1502 EX+ (6-98)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
M/tllflEl. F. ,ftPt3WSOA/
FILE NUMBER
2/-02-007rl
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is Jointly-owned with right of survivorship must be disclosed on Schedule F
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
l(esloeAlCE
3'2./ M fiN j) Y L I;IIIE
O/htJt II/U/I'A I7tP/1
Hftmt'1JaV 7lXIttVSHlf'
IS~ 2()()
TOTAL (Aiso enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
In. ZIJ()
REV-1503 EX+ (6-98) .
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
/J'lICIMct. F. I? ()BIIII.sM
FILE NUMBER
2/- tJ2-tJo791
All property jointly-owned with right of survivorship must be disClosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
2.
.3
1,
5.
/Y!E;(I.t2..ILLt.YNCif A'lf#llf/(;f1) ACC-vllNr
ktlJlINT IF 872-43572..
ItJ~ S5'2",3
1}?~/Ll.--LYNCil hllWACEJJ ~CCPtJAlT
/fCCO/)(VT It 872- O'/T 35
17&/'/5. is'
,'1?C-teR!u -all/elf A?1hJ/f6/iP ItaMJI
I'1Cct>VN7 # nz- 0'1571
1'i{~/f. 7tj
f>RWC/J111tl.- S&CV/lJ7J€5, INC,
!lCCtJilA/T 1/= <1,9 A - 0:%>b'/3
5~()o'I. 87
iNVESCO
./JcCtJf)f{T It 031" 711
~ft 3~, 23
'{11, O~3." 7
TOTAL (Also entar on lina 2, Racopituiation) $
(If more space is needed, insert additional sheets of the same size)
.'
FC, BRENNER,ROBERT
KAI PRC
ACCT, 872-43572
MR MICHAEL F ROBINSON
821 MANDY LN
CAMP HILL PA 17011
PAY
CSH
SETB
SETD 10/07/02
FF, 10/11/99
PRV YR, 01/--/99
SEC # SEC SYMBOL
55B29 RPLUS
5 5B2 9 RPLUS
94SK9 C 94SK9
97261 C 97261
976T8 C MBPYX
.67
.67C
.67C
CUSTOMER ACCOUNT ASSETS
S5#, 206-05-9845 (717)761-5475
POS/PGS, 5/ 02
UNPRC 0
12/01 INT, .00
MCSH .00
INTC .00
FME 0
SMA .00
MCAL .00
TCAL .00
UPDATE, 10/11/99
141,855 152,231
---- DESCRIPTION ----
MLF RETIREMENT PLUS
MLF RETIREMENT PLUS
ML BANKING ADVANTAGE
CMA MONEY FUND
ML PENN MUNI BD FD C
<END>
165,506
- QUANTITY -
54895.12
34606.89
922
1,335
1,179.0900
15:47
ACCT
T-VAL
RAFND
5TFND
C-MNY
C-OTH
BCORT
I ANU
MFA
CURR PX
1.0000
1.0000
11'\4.;;piJO
10/09/02 PG 1
COB 10/08/02
FC: 8163
TYPE, CMA
105,295.63
.00
.00
1,335.00
922.00
89,502.01
.00
-- VALUE --
54,895.12
34,606.89
922
1,335
13,535
] I~I); V
'r-~
~.G
FC: BRENNER,ROBERT
KAI PRC
ACCT: 872-04T35
MICHAEL F ROBINSON
821 MANDY LN
CAMP HILL PA 17011
PAY 113.59
CSH 113. 59C
SETB 113.59C
SETD 9(16(02
FF: 10(11(99
PRV YR: 01/--/99
SEC # SEC SYMBOL
00123 C ABT
002BO CALL
004Bl C T
05071 C ADM
o 73NO C BNI
078E4 C BEC
09728 C BA
144X5 C CVX
145W7 C COP
19639 C CAG
~S489 C EDS
256G4 C EAS
257D4 C XOM
27478 C FPL
2832'8 C FBF
349GO C HIG
36229 C HPQ
37734 C HBAN
389P1 C IR
39050 C IBM
44609 C LTD
47138 C MI
47429 C MAT
48654 C MRK
60106 C JCP
666D3 C SBC
76323 C UNP
79B06 C VZ
8CBE5 C WM
82258 C WY
83859 C XRX
9D9UO C WE
9D900 C WYE
976L5 C CMAST
CUSTOMER ACCOUNT ASSETS
SS#: 206-05-9845 (717) 761-5475
POS(PGS: 34( 04
UNPRC 0
12/01 INT: .00
MCSH .00
INTC .00
FME 0
SMA .00
MCAL .00
TCAL .00
UPDATE: 10(11(99
187,165 210,835
---- DESCRIPTION ----
ABBOTT LABS
ALLSTATE CORP DEL
AT&T CORP
ARCHER DANIELS MIDLD
BURLNGTN N SNTA FE$O
BECKMAN COULTER INC
BOEING COMPANY
CHEVRONTEXACO CORP
CONOCOPHILLIPS
CONAGRA FOODS INC
ELECTR DATA SYS CORP
ENERGY EAST CORP
EXXON MOBIL CORP
FPL GROUP INC
FLEETBOSTON FINL COR
HARTFORD FINL SVCS G
HEWLETT PACKARD CO
HUNTNGTN BANCSHS INC
INGERSOLL RAND CO LT
INTL BUSINESS MACH
LIMITED BRANDS INC
MARSHALL & ILSLEY CO
MATTEL INC
MERCK&CO INC
J C PENNEY CO COM
SBC COMMUNICTNS INC
UNION PACIFIC CORP
VERIZON COMMUNICATNS
WASHINGTON MUTUAL IN
WEYERHAEUSER CO
XEROX CORP
WACHOVIA CORP NEW
WYETH
CMA PA MUNICIPAL MON
<END>
574,108
- QUANTITY -
97
185
220
385
200
126
165
68
69
240
80
300
140
105
230
95
370
340
85
47
345
192
300
99
205
90
105
140
152
65
540
200
85
8,620
09/17 (02 PG 1
COB 09/16(02
FC: 8163
TYPE: CMA
167,525,1[>
.00
.00
8,620:~0 1'7~,H~.I)
.00
.00
.00
16:41
ACCT
T-VAL
RAFND
STFND
C-MNY
C-OTH
BCORT
I(ANU
MFA
CURR PX
38.3100
37.1000
12.3200
12.1900
27.0500
40.4600
37.2300
74.0000
51. 8800
25.8900
39.5200
20.0000
34.4000
52.5500
23.6500
48.5000
13 .6500
19.3900
36.8400
72.3200
15.9500
30.1000
19.7300
48.8100
18.8100
24.5800
58.9700
31. 0100
33.4400
51. 6000
7.1200
35.6500
42.0000
1.0000
VALUE --
3,716
6,863
2,710
4,693
5,410
5,097
6,142
5,032
3,579
6,213
3,161
6,000
4,816
5,517
5,439
4,607
5,050
6,592
3,131
3,399
5,502
5,779
5,919
4,832
3,856
2,212
6,191
4,341
5,082
3,354
3,844
7,130
3,570
8,620
FC: BRENNER,ROBERT
KAI PRC
ACCT: 872-04S71
MR. MICHAEL F ROBINSON
821 MANDY LN
CAMP HILL PA 17011
PAY 222.00
CSH 264.31C
SETB 222.00C
SETD 9/19/02
FF: 10/11/99
PRY YR: 01/--/99
SEC # SEC SYMBOL
HMOK4 C HMOK4
HM2N6 C HM2N6
HWAM8 C HWAM8
HWAR3 C HWAR3
H2634 C H2634
01199 C AFL
02940 C AIG
04491 C AMGN
06656 C ADP
08470 C BAX
10: 11 C BBBY
127X5 C CAH
138L4 C C
17179 C CSCO
18320 C KO
18417 C CL
23128 C DELL
25489 C EDS
28115 C FNM
31607 C GE
36780 C HD
39050 C IBM
40853 C JNJ
46399 C KRB
47102 C MMC
48047 C MDT
49522 C MSFT
55625 C NOK
58010 C ORCL
60739 C PEP
61001 C PFE
62726 C PG
670C9 C STT
678B4 C SLM
73233 C SYY
738A8 C TAPB
73841 C TXN
74DG3 C TGT
74E02 C TAPA
74E15 C MMM
76BN1 CUPS
80012 C WMT
80026 C WAG
CUSTOMER ACCOUNT ASSETS
SS#: 206-05-9845 (717)761-5475
POS/PGS: 45/ 05
UNPRC 0
12/01 INT: 403.00
MCSH .00
INTC .00
FME 0
SMA .00
MCAL .00
TCAL .00
UPDATE: 10/11/99
92,681 112,257
---- DESCRIPTION ----
FEDERAL HOME LN MTG
FEDERAL NATL MTG ASS
FEDERAL HOME LN MTG
FED HOME LOAN MRTG C
U.S. TREASURY NOTE
AFLAC INC
AMER INTL GROUP INC
AMGEN INC COM PV $0.
AUTOMATIC DATA PROC
BAXTER INTERNTL INC
BED BATH & BEYOND IN
CARDINAL HEALTH INC
CITIGROUP INC
CISCO SYSTEMS INC
COCA COLA COM
COLGATE PALMOLIVE
DELL COMPUTER CORP
ELECTR DATA SYS CORP
FANNIE MAE (USA) COM
GENERAL ELECTRIC
HOME DEPOT INC
INTL BUSINESS MACH
JOHNSON AND JOHNSON
MBNA CORP
MARSH & MCLENNAN COS
MEDTRONIC INC
MICROSOFT CORP
NOKIA CORP
ORACLE CORP $0.01
PEPSICO INC
PFIZER INC DEL PV$O.
PROCTER GAMBLE
STATE STREET CORP
SLM CORP
SYSCO CORPORATION
TRAVELERS PPTY CAS C
TEXAS INSTRUMENTS
TARGET CORP C
TRAVELERS PPTY CAS C
3M COMPANY
UNITED PARCEL SVC CL
WAL MART STORES INC
WALGREEN CO
<MORE:>
277,072
- QUANTITY -
4,000
4,000
4,000
3,000
4,000
10
39
47
40
23
18
48
32
75
15
33
34
20
27
84
63
16
25
80
12
57
40
40
36
46
77
12
25
10
54
.0000
47
29
.0000
13
15
53
54
09/17/02 PG 1
COB 09/16/02
FC: 8163
TYPE: CMA
76,601.79'
.00.
.00
.00
2,914.00
.00
.00
.00
16:43
ACCT
T-VAL
RAFND
STFND
C-MNY
C-OTH
BCORT
I/ANU
MFA
CURR PX
118.0940
110.8130
105.0630
109.5000
101. 3440
30.3200
58.8000
45.2900
37.5800
33.4000
34.7800
66.6000
29.8800
12.9300
50.6800
56.0600
26.7500
39.5200
70.9800
27.9000
34.0200
72.3200
54.9000
20.5100
46.8000
42.6900
47.7800
13.4900
9.2800
40.9500
30.2000
93.0000
40.5200
96.7500
31. 0200
14.1400
18.2700
36.9000
13.9700
119.0600
62.1700
54.7500
35.1500
lq I~ 1 ~ J1
VALUE --
4,723
4,432
4,202
3,285
4,053
303
2,293
2,128
1,503
768
626
3,196 ,
956
969
760
1,849
909
790
1,916
2,343
2,143
1,157
1,372
1,640
561
2,433
1,911
539
334
1,883
2,325
1,116
1,013
967
1,675
858
1,070
1,547
932
2,901
1,898
Prudential ~ Financial
Rodger & Bowen Group
Your Team at Prudential Secur~ies
October 11, 2002
Prudential Securities Incorporated
135 North George Street, York PA 17401
Tel 717 699-0188 888639-2208 Fax 717849-1069
The lnfonnatlon contained hilrelntill!l
been obtained from sources believed
reliable but is not necessarily com-
plete and cannot be guaranteed. Any
opinions expressed are subject. to
change without notice. Neith8l' thEl
information presented nor any C)pir'lioO
expressed constitutes represE..118llon
by us or a solicitation of the pur-
chase or sale of any security.
Law Offices of
Michael Cherewka
624 North Front Street
VVornlleysburg,Pennsylvwrial7043
Dear Mr. Cherewka:
Enclosed are the August 2002 and September 2002 statements for Mr. Michael F.
Robinson deceased, who died on August 16, 2002. On his date of death there was an
account number 08A-036643 at Prudential Securities Inc., in the name of Mr. Michael F.
Robinson and the account had the following investment:
2,055 shares PP& L Capital Trust II 8.10% Trust originated Preferred Securities
(TOPRS) cusip # 693498206 with a date of death value of25.36
For a total value
Accrued Interest
For a Total Value
$52,114.80
$ 890.D7
$53,004.87
The preferred stock was called on 9/18/02 for an amount of
Plus Interest
9/24102 money fund interest
For a Total of
$51,375.00
$ 890.D7
$ 7.00
$52,232.90
The interest has been set up to go out automatically and so on 10101102 a check went to
the address of record in Camp Hill, Pa. in the amount of$890.07. As per your letter
dated September 24, 2002, we are mailing a check for the balance of the account in the
amount of$51,335.83 which includes the small amount of interest earned on the money
market funds.
If you have any questions, please don't hesitate to contact us.
.Sin;;elY, /z
/~~~JJI
Bonnie L. Myers
Registered Associate___ .
Donald L. Rodger
Senior Vice President-Investments
Robert A. Bowen
Vice President-Investments
Philip M. Shar
Registered Associate
Bonnie L Myers
Registered Associate
o JNVESCO,
fNVESCO Funds Group, Inc.
P.O. Box 173706
Denver, CO 80217-3706
Need more information?
bwestor Services: 1-800-525-8085
Personal Account Line: 1-800-424-8085
Intemet: invcscofunds.com
Page J of I for the [Xnad 07/0J/2002 - 09/30/2002 ~
Investment Summary
1",111",111"""11",11",11,1,1",11"11,,,,1,1,,,11,,1,11
MICHAEL F ROBINSON
82 I MANDY LN
CAMPHILL PA 17011-1536
~
ACCOUNT NUMBER
536741
0J.0193
~ For Your Information
Go paperless I Now you can receive your INVESCO statements, confinuations, financial reports
and prospectuses online, anytime, at your convenience. For details, visit OUf Web site at
invescofunds.com.
~ Account Summary
Fund Name (Fund Code)
Account Number
Gro\\1h Fund-Investor Class (10) Ticker:
536741
As of 612812002
Market
Value
Number
of Shares
As of 9/3012002
Share
Price
Market
Value
I Total
FLRFX
$3,534.32
$3,534.32
1,941. 936
$1. 46
1 Total
$2,835.23
$2,835.23
ACCOUNT ACTIVITY
Growth Fund-Investor Class (10) 536741
Confirm Trade Description
Date Date
0612812002 BEGINNING VALUE
NO TRANSACTIONS THIS PERIOD
09/3012002 ENDING VALUE
Number
of Shares
1,941. 936
Share
Price
$1. 82
Dollar
Amount
$3,534.32
1,941. 936
$1.461
$2,835231
Please carefully review this statement to ensure that your transactions were made properly.
You must notify us of any errors within 90 days of this statement's ending date.
1-800-525-8085
.
REV*150B EX+ (6-98) ~
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
lI1/t HiJEL F RI)(3/ tlfSOJli
FILE NUMBER
2/-02- 6674/
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
s:
6,
7.
&;
'1.
If).
II.
I. LI.5/l"A Sl/'ImGs !1-CC/l/tf'l ItfXtJJlKT :ifax;cflJ?Z5
2. II1bHuaS 1ST rcPGt?At- ('-RGO/T ()AfI{)/lI
ACClJwr #= j 11'157 - 00
S, 41GII?eGil.5 Isr rer)~IJL CRGOIT VN/of./
AccotJAJ7 # l7it/57-1!
? tt'l3. K'/
9k{'i'lo. d!)
1,153,31.--
if ,PA srf/rtf en1fJLDY/?E$ ('~GiJl, UNION (PSECU)
t1CCOIIAJ/ IF OZO{,.05'l21..JS- (51)
2/)lq2~3%
1,4 STAre en11'l/)'j/?eS ~f-OIT IJNiO,J('SECI/)
!tCUJUNf '" Olf}bO"'18'1~ (5'1)
IH'I mRP t3f.Cl>YI.T LX, If [;Ja)fl SCOIW ('I1tJ/)() MlliS)
AlI/OA ()fFICllli (jL~ USE[) c~ 61110E
PC/3TF !?GltHI?iJRSeME3M"T
IRS l~efVNf) (1'''')1. YtSll1l.. wI)
PI IJEfJ4ftrMEJJf OF }EVEiNIIE /l.&f'uNp (7/JY. YeM 20d I)
U>fIiI IA/)vlZflrVCE REPtlND CIHCK ( ()()dlJ'I39zs)
A1ewrWCEIC IS1AG'lZ/AlE .5i1lJ S"C{lln70N Kl'17.1Nl)
2S; l'itS,!
21360.0(J
3'11. 71/
r,3b~,OO
Si.J,6tJ
CoD. If"
/1/, '19
Io-~ 9"47 ..fv
TOTAL (Also enter on line 5, Recapitulation) $
(If more space IS needed, Insert addItional sheets of lhe same sIze)
~
USM"'
9800 Fredericksburg Road
San Antonio, Texas 78288
Visit us at usaacom
For Automated Information About
Your SSA, Call (800) 531-6095 and
press 1 On Your Touch-Tone
13 37633
E~T OF MICHAEL F ROBINSON
C 0 MICHAEL CHEREWKA
1 5 PELHAM RD
CAMP HILL PA 17011-1353
.,., THIS IS NOT A BILL OR A CHECK. THIS IS A STATEMENT OF YOUR ACCOUNT. .,.,
SUBSCRIBER'S SAVINGS ACCOUNT (SSA) ACTIVITY
PRIOR SSA BALANCE
LESS CASH DISTRIBUTION (12/09/02)
LESS ADJUSTING TRANSACTIONS AS OF 12/31/02
$
1,671.11
60.16
167.11
+
1,443.84
102.73
===
......
;;;;;
......
~
~
-
=
;;;;;
=
=
=
""""
"""""
~
=
......
=
;;;;;
......
~
;;;;;;
=
==
;;;;
~
=
-
-
NEW SSA BALANCE
PLUS NEW ALLOCATION AS OF 12/31/02
$
CURRENT SSA BALANCE
$
1,546.57
USAA is pleased to send your 2002 Subscriber's Savings Account (SSA) statement, which reflects this year's
allocation.
Each year, after reviewing year-end financial results, the board of directors determines if profits are sufficient
to place some portion in SSAs. This amounl varies depending on overall insurance losses paid, performance
of USAA's investment portfolio and the financial requirements of the association.
The board may also approve cash distributions from 1hese accounts when the toW dollar amounl in all of the
SSAs is more than USAA's anticipated capilal needs. Most recently, the board of directors approved a toW
SSA distribution of approximately $165 million. which was paid out in December 2002.
All insurers need to set aside money to pay for growth; for large, unexpected catastrophic losses; to meet
regulatory requirements; and to remain financially SOII1ld. At USAA, this money is placed in SSAs, which are
held by the association in the names of USAA members. Since SSA funds are an integral part of USAA's
capilal structure, they remain with the association and cannot be accessed until the member leaves the
association. unless the board of directors authorizes a distribution.
As a 4Q-year-plus member, we want to remind you that when financial results allow us to make future SSA
Senior Bonus payouts, we will automatically perform the option you have chosen: we will either send you a
check, credit your P&C premium account, or leave your SSA balance intact. We will no longer send you the
option-selection form each time there is a bonus payout unless you ask US to do so. If you have questions
about your Senior Bonus, please call US at the number above.
Important Tax Implication: Amounts that are allocated to )Our SSA account are not taxable to .wu unless .wu deduct Jour
insurance p-emiums as a business expm,s'e. Distributions from )Our SSA account are not taxable. Please consult Jour tax advisor
if )OU have questions.
DM13685
D4481
MemberslST
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
174957 -00
03/31/1998
$98,869.60
$70.45
$98,940.05
None
LIFE SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
174957 -11
03/31/1998
$1,153.32
$.00
$1,153.32
None
INSURANCE DEPARTMENT
5000 Louise Drive
P. O. Box 40
Mechanicsburg, PA 17055
1-800-283-2328 or (717) 697-1161
CREDIT UNION
Denise A. Anders
Insurance Products Supervisor
October 31, 2002
Estate of: MICHAEL F. ROBINSON
Date of Death: 08/16/2002
Social Security Number: 206-05-9845
PSEC.,
the financial link TM
October 9, 2002
Account # 0206059845
MICHAEL CHEREWKA
624 NORTH FRONT ST
WORMLEYSBURG, PAl 7043
Dear MR CHEREWKA:
The following is the status of MICHAEL F ROBINSON's account with PSECU as of the date of death.
Joint Owner's Name
Date Established
Date of Death
Date of Birth
MARGARET ROBINSON, JOINT TENANT WIROS-PREDECEASED
02.15.1978
08.16.2002
10.10.1919
Share( s)
Regular Shares (SI)
Checking Shares (S4)
Balance
$20,925.38
25,198.54
Accrued Dividend
$17.03
10.37
Loan( s)
Personal Service Loan (L1)
VISA (L9)
Balance
$ 0.00
0.00
Accrued Interest
$ 0.00
0.00
The dividend earned from January 1, 2002 through the date of death was $419.31. We do not have safe
deposit boxes for our members. A check for the proceeds will be sent under separate cover.
If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At
the menu prompt, enter 6 and then extension 2227.
~
Meade Fairfax
Member Service Representative
Finance Support Unit
PENNSYLVANIA STATE EMPLOYEES CREDIT UNION
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990. (717) 234-8484. (800) 237-7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 . (717) 777-2100 (TOD) . (BOO) 472-1967 (TDD)
Web Address: www.psecu.com
Savings federally insured up to $100,000 by the National Credit Union Administration.
~
~ ,,,;'
iIlIII!!!!!!!i' {;"s ,
~ \fEIU~XCATIDN .
b:iK>~QQ
l!!!!!!!!!!!!!!
~
=
--
~
,0 'HE ORDER Of
\"~ ^
MICHAEL F
ROBINSON
821 MANDY l.ANE
CAMP HILL
$
j
i
,
,
PA 17011
&~R:-OFP-
~\
II." 2 2 2BBB (II" ':0 3 ~ 3o~" 2 2':
~ 2 ~.,_S 3B.. 711.
_J
,.-
,
,
II" ~oB 3 2 5 ~H. l!.:o.. 3 30 H, 271:
~o ~o., 3 W 2 211.
REV-1S10 EX+ (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
A1/CI#le-L F: ,f 0 IJIIV-S mJ
FILE NUMBER
Z 1-(J2- o(J7'J J
This schedule must be ccmp\eted and filed Ii the answer \0 any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH % OFDECD'S
ITEM lNCl.UDE THE NAME Of tHE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACHACOPVOFTHEDEEDFORREALESTATE VALUE OF ASSET INTEREST nFAPPUCABLEl VALUE
,. f?/1 !;'T1I1f /?lI4(JLIJ'IEE$ RETlffM&Nr S%1C,U 5:3,/
5.3Y
ACCiJ/)/lr #- 2IJfr05-981>
1. ItA I A?t1ll(/tl.-- L'INtH 3)'1'/.1/ 1,3'/1, I
/1CCPvllr .It $72- 79/)i,;, 1
3, ANN!)} TI E:J I fl?HiZllL - L'lNUI K'1,S02.
AcCfJv;rT JI: 812- 4~51-Y 8"1,)01.0/
TOTAL (Also enter on line 7 Recapitulation) $ qz, f'n t.J~
I
cJ/
(If more space is needed, insert additional sheets of the same size)
~-
COMMONWEALTH OF PENNSYLVANIA
PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM
Mailing Address
PO Box 125
Harrisburg PA 17108-0125
Toll-Free - 1-888-773-7748
(1-888-PSERS4U)
Local- 717-787-8540
Web Address: www.psers.state.pa.us
Building Location
5 North 5th Street
Harrisburg P A
January 30, 2003
MICHAEL CHEREWKA
624 N FRONT ST
WORMLEYSBURG PA 17043
RE: Michael F Robinson
8.8.# 206-05-9845
Dear Mr. Cherewka:
Thank you for your correspondence.
A Death Certificate for the deceased member is required for our records before any
payments can be made. A photocopy of the document will be accepted. If a death
certificate has been sent, please disregard this request.
A prorated payment of $5.34 for the period of August 1, through August 16, 2002, was
due Michael F Robinson, and is now payable to Rebecca Rice (daughter), as the
designated beneficiary. .
Please provide the current address of Rebecca Rice.
~
Because payments are pr~ared well in advance, the payments dated August 30,
September 30 and December 31, 2002 for $10.02 each have been issued and must be
reimbursed this office. Total relmoursement due P8ERS is $30.06. Please make your
check or money order payable to P8ER8 and send to the mailing address shown.
Enclosed is PSER8 Health Options Program information sheet which applies to any
surviving spouse or dependent(s) of the deceased member.
A 1 099-R will be sent which will report the deceased member's income for the
year 2002. This form will be necessary for the preparation of the final income tax return.
1099-R's are generated and issued at the end of the calendar year.
There will be no further benefits payable from this account.
-
FC, BRENNER,ROBERT
KAI PRC
ACCT: 872-79067
MR MICHAEL F ROBINSON IRA
FBO MR MICHAEL F ROBINSON
821 MANDY LN
CAr-IP HILL PA 17011
.99
.99C
.99C
PAY
CSH
SETB
SETD 12/21/01
FF: 10/11/99
PRV YR: 01/--/99
SEC # SEC SYMBOL
977G3 IIAXX
97ES7 C MBFGX
CUSTOMER ACCOUNT ASSETS
SS#: 206-05-9845 (717)761-5475
POS/PGS: 2/ 02
UNPRC 0
12/01 INT: .00
C-YR: .00
P-YR: .00
TRF FROM:
TRF TO:
TRF OUT DATE:
CLOSE OUT DATE:
UPDATE: 10/11/99
3,954 5,179
---- DESCRIPTION ----
ML BANK USA RASP
ML FUNDAMENTAL GROm
<END>
6,344
- QUANTITY -
313.14
217
16:40
ACCT
T-VAL
RAFND
STFND
C-MNY
C-OTH
BCORT
I/ANU
MFA
09/17/02 PG 1
COB 09/16/02
FC: 8163
TYPE: AT
3,030.97
313 . 14
.00
.00
.00
.00
.00
.00
33~i/1 \
,
SWEEP: FDIC
CURR PX
ACCT
VALUE
313.14
2,716
1~200
!
~ {JjffJdLld.-
, .
FC, BRENNER,ROBERT
KAI PRC
ACCT, 872-43572
MR MICHAEL F ROBINSON
821 MANDY LN
CAMP HILL PA 17011
PAY
CSH
SETB
SETD 10/07/02
FF, 10/11/99
PRV YR, 01/--/99
SEC # SEC SYMBOL
55B29 RPLUS
55B29 RPLUS
94SK9 C 94SK9
97261 C 97261
976T8 C MBPYX
.67
.67C
.67C
CUSTOMER ACCOUNT ASSETS
SS#, 206-05-9845 (717) 761-5475
POS/PGS, 5/ 02
ONPRC 0
12/01 INT, .00
MCSH .00
lNTC .00
FME 0
SMA .00
MCAL .00
TCAL .00
UPDATE, 10/11/99
141,855 152,231
---- DESCRIPTION ----
MLF RETIREMENT PLUS
MLF RETIREMENT PLUS
ML BANKING ADVANTAGE
CMA MONEY FUND
ML PENN MUNI BD FD C
<END>
165,506
- QUANTITY -
54895.12
34606.89
922
1,335
1,179.0900
15:47
ACCT
T-VAL
RAFND
STFND
C-MNY
C-OTH
BCORT
I AND
MFA
CURR PX
1.0000
1.0000
11\~OO
10/09/02 PG 1
COB 10/08/02
FC: 8163
TYPE, CMA
105,295.63
.00
.00
1, >35.00
922.00
89,502.01
.00
- - VALUE --
54,895.12
34,606.89
922
1,335
13,535
;} 101,)))/
'r-~
SCJr. G
REV-1511 EX+ (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF IJ1IC11t1tt f. /?ilDltV;lJn!
FILE NUMBER
2/~~Z-M791
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. NelU- fl)N~ tltll"le, TNe. 7pn,>~
2. Of,\'T>l1lQ.'/ - I'm~ul;\ pes'\" 6(\W\~E. 2%bO
3, oR>ITU/ll2.~ - 1.(1et!N€ Ae.",fW PlIBl.I*INl: UJ. 31. '10
li. tall\. N~1lceS- CUIV\6€ll.1JWO I..Aw ;rl)/jUl\AL. 15.00
5. LEbAL l,Jolll:e>- ~ ~'fl€\.. 81.3~
I.. /'R'EbT, C>l~Rtll, ol fo~l.. 31.0,00
I. f'UIllEAAI.. Illa'l'TIOtJ IllS!>. ()O
tS. B;)RIflL. A.fC1E:PllolJ, FoIU" h1'IEtlS Of'f'/CEIlS ('L.v/J, /lRU/t(61DN 1/321.. 3(p
B. ADMINISTRATIVE COSTS:
1 Personal Representative's Commissions
Name of Personal Representative(s)
SOOal Security Numbef(s)/EIN Number of PeTsonal Representative{s)
street Address
City State _Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Mdress
City State _Zip
Relationship of Claimant to Decedent
4. Probate Fees o/8S, 00
5. Accounlant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9. Recapitulation) $ 1/, b~Z..Z"
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
" ,
REV-1512 EX+ (6.9B)
*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE.SlDENT OECEDENT
ESTATE OF AA
",JClMt-L F. ~f)81N>DAI
FILE NUMBER
2/-()Z.-OIJ79/
Include unrelmbufsed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 P/I 5'mrr mtflU'IEtS /?eTl/Z~f?tIl.,. 5VS7E'P1
2. WcST 5/IM.f en1.f,
5. LeT/ell'.; /frJ717 5C7ev'fC.c
(e/ltt. WitS NoT lJilVElh'!>/.i. AT Tlf1~()F /)eftTJI)
'I. II t 7t-I{ tMJl S MStJlllr77DtJ BE:f(Ef'IT Rf:CD vgjl.'j
5, fll S1tflE zirlpI!)YGe5 Re-7JreE,M~T .sYS~
3d, O~
<151. '17
JZ)"',7ff
<.J 3'1, DO
,. rJStM /lbf% It 1ft; 1f) IAfS/.JM1Vc&
7, UbI
~ eDMCAsr
1. IrT~T
If). flA I!IJ1{;i!(CIIN 4I~ C/)A((JAtI'Y (i'/1WC)
/I, flA AJveI< ~ L/61tr cmtIJ/11IY ( (If.l.l)
/z. jJ/lTRJIJT #&1Qs
i(,l.lfo
LlZ/, "10
82,65
3'1,8z"
2'1, /3
(,6, b 7
r'l,3f
2f.30
/3. i<ffTih'l'IN tv, Ff7'l&uf / TR.tIISIJItd!.
2tXl3 Rl?11L .E~1/f-r6 J1hic s
i Y. M f)tf~1iJ1tfI'T cr: 7XMI5f;tz.T,H10Al
'13D.93
fll, IJD
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheels of the same size)
~ Ifffp, 91
; "
lJ,jE~3T ~3HiJf~~E E.!"!-!:ii
!::IO:3 N. 21 S'T'
C?\I~P HILL, PI:)
'~;JOt)) '::u,;, 7'-(i~5 i;2
._, AL.S
ST
11.(1.1 i
TAX III
2':><~4!,"3(1(>2 A
WEST SHORE
EMERGENCY MEDlCAL SERVICES
I"HDNE
INVOICE
PATIENT NAME: RIJB I I~SUN, i"1I CH?EI_ 1-'
INSURANCE:
ME..DICAf~~E .13
""EBTF
20~.07i9;34e,i?\
~IBD206'::>'j"'84'5
:;~Ob()~Y~)84~i
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
9:3'.lr:5':~
9~20~54:20A
O~3 / ~Y:;! / O':~~
Sil./P
SUP 2
',,:21 1'1..\NDY L.N
HOL Y~JP!."': I T HU'.,P I T?iL
MlniAE.L. F f':OBINSDN
:;::21 "'!A'\ID~. LN
C!'~MP HILL, P!-. 17':'1 i
REASON(S)
FOR
TRANSPORT
Unr-'esponf:51 \t,e Pat i ent.
Respi ra'toY"''y~ Di str'ess
OESCRIPTlOI( OF CI:tAIlGE
P?~h'AMEDIC INTEf':CEPf
ANGIDCAfH 114-24)
EJ<!3 ELECTRDDf::S
! ~.JFECT I ON C(]~r< '~:(]L SUPPL IE
QUANTITY
1.0
1.0
1..0
1.0
UtlmPElICE, ,;,:,;~
.i;::J
442."10.
4...7'":5
4.02
:;3-.. (H).
44.2.70
4 ..7~:i
4..02
:3....00
TOT!~L CH!~ROES THIS CI'1LL
$ 4:'.4.'4-7
oesCIlIPTION OF PAYMENT
RECEIPT
PJ!.vMENftlATE
'AMQliNT:
TD'r(:'~L f:'?~YMEN'r~:3 THIS C!':~LL
0..-00
,
PLEASE PAY THIS AMOUNT _
~'
R013l:NSllN
'181 ~i(:'
CALL NUMBER
llILLIN(l'DATE:
920'.;;4;;lOA-
04-/ l.;LJ.O.~
DETACHALON(l.PERFORMATION ANti
'A'fII=I,IITNi\M.E:
'i\T1ENTI1IUMBER:
Th i ~3 i~o\ccoLlnt i. '$ pa:.t due \ \ ~ Ole
t'iiH!!Du.nt. i.-s- yr.:H..H~ Cop,a,'>//L:teduc.t 1. b 19.
\i\\..\st be made nr:)\~.
ba'\ ance
I? .ayrnf2P..-t:
arc
VISA
[..I
AND
MASTER CARD
, Ii;
~
,
~
AUTOMOTIVE SERVICE
609 Market Street
Lemoyne PA 17043
(717) 761':2339
CUSTOMER
q~HAEL R CHEREWKA
?5 PE,LHAM RD
A'M?\' H)LL, PA 17011
PART NO. UNIT-PRICE AMOUNT
. . . . . . . ,
.
0.00 L ABOR ABOR--INSTALL ELECTRIC MIRROR 75.00 0.00
0.00 0 CHARGE 0.00 0.00
REMARKS TOTAL SHOP MATERIAL 0.00
TOTAL PARTS 119.60
IRES R 4/32
TOTAL LABOR 0.00
SALES TAX 7.18
TOTAL DUE 126.78
'ust,NO: CHERMICH
tJpnes :
~ctiatl;:c: 07
1 00 FOCZ17682c
SIDE MIRROT
!\fWo
E ~e'?1\tT
\\\)~~
P'~lf)"
'" -@
90 Days
Same As Cash
1 99 !'yEAk
VEHICLE ID
MILEAGE 46262.0
P ftiTATE
1JlWP<~I4ll\Q)
S 0 I'fYPE
~~@9
6'\vp~~~
I
.
. .
1'A~ENO.
1 OF
1 OMS NO.: 1510-0043
Expiration Date: 4/30/2003
i...._>,.,;___'>,::.:'''' ,"- :':"_ ,;,->:,>,: _,'
11ill~mMj&'!~iafliRlm~~Wllalll"l.
j;j~,;::z 3'(j:OC.}'4.0~~5-
RECIPiENT AND/OR BENEFICIARY NAME
'M!CHAEL ROBINSON
FROM: DEPARTl'lENT 01' iI.ilO TREA5t,.llW
'":!Ni'tNtIAL MANAGeMENT 511RVrCE
RI?:",roNAL!'"!I\lANCIAL CENTeR
PI:lST ClFf'"lCf: 130)(1490::18
A,~JSnt'\! TX 1a714~<;!Q:1a
DATE:
CLAIM NUMBER
2664"188600
DATE OF DEATH
OSI16/:;/Q02
DATE OF
PAYMENT
AGENCY
AND/OR
TYPE OF
PAYMENT
VA
TRACE
NUMBER
TYPE OF
ACCOUNT
DEPOSITOR
ACCOUNT NUMBER
AMOUNT
08130/2002
III O~'3~OO,t.33001 0
s
1749:'1700n
439.00
-~.+- -,-"....,'~~-;,.;~-"""..,........_-- .,:.",,~. .. .~:. ,)'-
.~-^' ,.'.+0.:..,."." ''''''''....;
f\-CH On
439.00
: of this notice
r~erefore, the
. is :person is not
f~:: ':,: - _. '-';',,', ',',','
,0 not understand
.>::':.:.,'..,...:.::....:'.. ..
.W~~, m'~king payments.
,.,':.;,i';;-:':'-'-,--,/
Your financial institution has been asked to return the payments shown on this notice to, the Government because
they were issued in error. The Government has asked your financial institution to send this notice to you, the account
owner. Your financial institution must notify you if it has taken action to recover these funds from the account.
Contact your financial institution immediately if you do not understand its actions. If the Government is unable to
collect from the financial institution the full amount of the payments made after death, you may be contacted by the
agency which made the payments.
IF THE PERSON IS NOT DECEASED
If the person is not deceased, immediately contact both your financial institution ,and the agency that made the
payments to correct the error. The Government regret$ ~ny inconvenience this error may cause. Your financial institu-
tion can correct the collection action if it is given satisfactory proof that the person is alive. NOTE: YOU MUST
,CONTACT THE AGENCY THAT MADE THE PAYMENTS BECAUSE THIS ERROR HAS STOPPED FURTHER
AYMENTS. ONLY THE AGENCY CAN RESTART THE PAYMENTS.
NOTICE TO ACCOUNT OWNERS
, ,
COMMONWEALTH OF PENNSYLVANIA
STATE EMPLOYEES' RETIREMENT SYSTEM
HARRISBURG REGIONAL COUNSELING CENTER
30 NORTH THIRD STREET, ROOM 319
HARRISBURq PA 17101
717 783-9065
1-800-633-5461
FAX: 717-783-9599
www.sers.state.pa.us
October 18, 2002
Estate of Michael Robinson
C/O Michael Cherewka
125 Pelham Road
Camp Hill, PA 17011
Invoice #10365
RE:
SS#:
Michael Robinson
206-05-9845
Dear Mr. Cherewka:
We have recently been informed of the death of Michael Robinson, a retired member of this
System. We wish to extend our condolences to you at this time.
Since Mr. Robinson died 8/16/02 and the August & Sept. checks were not returned to our office,
this account has been overpaid in the amount of $861.90 for the period from 8/17/02 - 9/30/02.
It will therefore be necessary for our office to be reimbursed for $861.90 to liquidate this
overpayment. '-
The reimbursement should be made payable to The State Employes' Retirement System, and
mailed with the enclosed copy of this letter to the address shown above.
Upon receipt of the reimbursement, this account will be closed. There are no further benefits to
be paid from this System.
Should you have any questions concerning this matter, please do not hesitate to contact me at
the above address or by telephone at (717) 783-9065 or 1-800-633-5461.
Thank you for your cooperation.
Sincerely,
~O~
Linda Dolafi, Administrative Assistant
Harrisburg Regional Counseling Center
Enclosure
~
ek Ii ()p93
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~
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--= GAS SERVICE
lilllng Summary for Service to:
~ F ROBINSON
121 MANDY LA
:AMP HILL PA 17011
lale Classificalion:
lesidenlial Heating
liIling Period:
17119/2002 to 08/19/2002 (31 days)
:stimated Read
Past BiIIlnformalion - UGI
The account balance on your last bill was ................
Thank you for your payment of .....................................
Your balance as of 08/21/2002 ...................................
Currenl Bllllnformalion - UGI
Customer Charge ..............................................................
Commodity Charge ( 15 CCF at $0.65800) ..............
Oistribution Charges (First 15 CCF at $0.34933) ...
PA State Tax Surcharge ..................................................
Total Current Charges .....................................................
EMP Close Dul Amounl (due by 09/13/2002) ........
Total Charges Due - UGI ...............................................
Tolal Amounl Due ...........................................................
$ 91.00
-92.14
-1.14
If you have any questions,
please call us at
717-232-1811. or write to
POBX 13009. Reading. PA
19612-3009. Please
contact us by September
13.
8.55
9.87
5.24
-0.09
23.57
83.79
$ 83.79
$ 82.65
'our current UGI charges include
>tate taxes totaling $ 0.76.
CPT
2115106995201
;d./! flUS D1--( 8-2b-DZ <.0/'/ =1= L/~5
10.80
9.72
8.64
7.56
6.48
5.40
4.32
3.24
2.16
1.08
0.00
Average CCF Per Oay
. . . . ...
ASDNDJFMAMJJA
2001 Monlhs 2002
= Estimated Usage
werage
last
Year
This
Year
:CF/day 0.50
laily temperature 76"F
0.48
79"F
Meter Reading Information
Meter Number Previous Readin9
1150674 1553 (eslimated)
Presenl Reading
1568 (estimated)
CCF Used
15
Messages from UGI
'Your current price to compare is $ 0.65818/CCF.
. Your total annual usage is 1.281 CCF. Your average monthly usage is 106 CCF.
. Your annual budget year began with September 2001.
To date you have been billed $ 1.276.79
To date you have used $ 1.276.79
-It is very important for UGI to read our meter. Please arrange for us to read our meter on
the next scheduled reading date of September 18. 2002. Thank you.
. Help prevent pipeline damage, accidents and service disruptions. If you see someone
digging near your home please call UGI.
If you pay at a payment agent please take your entire bill. Make check payable to UGI.
Keep this part for your records. Important information is on the back of this bill.
~omcast@
Account
Nnmber
Date
Dne
Total
Amount
Due
$34.82
0502050348201
9/10/02
Ilow to reach os...
~ You c8nreach our Customer Service Department at:
(717) 540-8900
24 hours a day, seven days a week.
IE:I www._Cl:)JU.Cast.com
':!\,.;
K YOU FOR PA YlNG yOlJR,B .
convenience, we now accePt regu\ai.a,iidi'
;'iii'i
"",,:-;:,',;:,',";
.....,':,j,:;'<.'..
Y6~AT&T Statement
M~8-~t 7,2002
#BWNCJFM
#09151462979016# D 115723A T1 O.292B52BA60553**3DGT
1."111,.,111"".,11",11,.,11.1,1."11,,11,,,.1,1.,,11,,1,11
MR M F ROBINSON
821 MANDY LN
CAMP HILL PA 17011-1536
SUlllmary of dlargcs
Previous balance ................................................ ... ._.................7.09
Payment received Jun 6 - Thank you................................. -7.09
AT&T One Rate~ Calling Card Plan....................p 4 ............ 3.00
AT&T One Rale~ Seven Cents Plan calls ..........p 4 ..........13.05
AT&T Local Toll Service Plan calls....................._p 4 ........._.. 8.40
Other charges and credits .......................................p 5 ............1.63
Taxes and surcharges ...........................................p 5 ............ 3_05
Total amount due
Date due
$29.13
September 1, 2002
This statement includes charges from the last three months.
~AT8aT
Customer 10: 717 761-5475
Page 1 of 5
Customer Service: 1 800 222-0300
Text Phone (TTV): 1 800833-3232
Internet Address: www.att.com
4f-- Extra! Extra!
Imagine being able to...Make as
many calls as you want. Talk as
long as you want. Whenever you
want. With AT&T Unlimited you
canl Continued~
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AOR:rG~G~CpMPANY
..."...."""'-...........,................, .
Control No: 010-002932
Land
31.500
BERL N
.00204.600
64.45
. 0010300
. 3.24
POEN
.00020DOO
6f.:'30:
2003 Statement bf Real Estate Taxes
Improvement. Mineral
155,700 0
Bill Date:
Total
181,200
Face
3101/200
Ass~ased
Values
C NTV\) C
~a tea .
COUNTY R Jl:"
Ra tea
COlllm' II
MAP NO: 10-18-1310-024 T HI
821 ;MANDY LANE \ Ea
AORES .340 "pPi <Z., Cl.L
CHESrN,LJTHILLS ~I""\\J,
lic>:rm1 =Att-l ft o~\O .0:.";
F'l.$ld.ntr$llB~jlding V < 1\)\)'1
flEI3IDlENffI"'L , 0 '2> II )'l'V .
, ,... ~. [:>.?". ~~;'l\l-\. I:
liH'MJ8HAEt. F ~ --q.I. .. ..
"'BET S R031NSON "'-'t\~~.. Ac!t\)~"
821 tilytANE l...r> 1:~-
CAMP HILL PA 17011 ..
'AVABLE
TO;
J{ATHRYN W. FETROW, TREASURER
5'000 OREEKVIEW ROAD
MECHANICSBURG, PA 17050-2099
.0020460Q
3iB.56
.000103 0
16.04
ISCOURt
2\
375.35
2 \
18.89
'ESC:
'L
TAX
AYEA
R
8.
ifFICE
OURS:
HOURS: "CLOSED MONDAYS"
TI,I"'S.I'RI9~M'5PM,MAY.JLJN 9AM-1PM
ANO SePT 15 -'DEC 9AM-1 PM
PHONE (7i7) 737-4822
Panal
10 '
421.3:
101
21. 2~
383.01
19.2$
If:,l
4l.\J
$483.70
7/01:/200
Return Bill With Payment. For a Receipt, Enclose Self Addressed Stamped Envelope.
.,,//
"':-'';:'-.~f'~<;"'" -
,." .
"
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 7/08/2004
CHEREWKA MICHAEL
624 NORTH FRONT STREET
HARRISBURG, PA 17043
RE: Estate of ROBINSON MICHAEL F
File Number: 2002-00791
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 8/16/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
STATUS REPORT UNDER RULE 6.12
Name of Decedent: MICHAEL F. ROBINSON
Date of Death: August 16, 2002
Will No.: 2002-00791
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether the administration of the estate is complete:
_. X Yes No
2. If the answer is "No", state when the personal representative reasonably believes that
the administration will be complete:
If the Answer is "Yes" to No. 1, state the following:
a. Did the personal representative file a final account with the Court?
Yes ~ No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest?
Yes No ~ ~'~ c:3
d. Copies of receipts, releases, joinders and approvals ~ formal ~ info~!:'
accounts may be filed with the Clerk of the Orphans~Court an~ma ' ":
attached to this report.
Date: AUGUST 13, 2004
THE LAW OFFICES OF MICHAEL CHEREWKA
Michael Cherewka, Esquire
Capacity: ~ Personal Representative
X Counsel for Personal
Representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/08/2004
CHEREWKA MICHAEL
125 PELHAM ROAD
CAMP HILL, PA 17011
RE: Estate of ROBINSON MICHAEL F
File Number: 2002-00791
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 8/16/2004
Your prompt attention to this matter wmll be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
REV-1162 EX111 961
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DUPLICATE
CHEREWKA MICHAEL
624 NORTH FRONT STREET
HARRISBURG, PA 17043
ACN
ASSESSMENT
CONTROL
NUMBER
ESTATE INFORMATION: ssly: 206-o5-saaa
FILE NUMBER: 2102-0791
DECEDENT NAME: ROBINSON MICHAEL F
DATE OF PAYMENT: 05/16/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 08/16/2002
NO. CD 002572
AMOUNT
101 ~ 511,699.80
TOTAL AMOUNT PAID:
REMARKS: MICHAEL CHEREWKA
SEAL
CHECK#102
INITIALS: JA
RECEIVED BY:
511,699.80
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
-~L~ J ~ COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. zeobol NOTICE OF INHERITANCE TAX
HARRISBURG, PA 17128-0601 pppRAISEMENT, ALLONANCE OR DISALLOMANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
MICHAEL CHEREWKA
624 N FRONT ST
WORMLEYSBURG PA 17843
ALONG THIS LINE _-____RETAIN LOWER
REY-554] E% %FR 5R1-un
DATE 08-18-2003
ESTATE OF ROBINSON MICHAEL F
DATE OF DEATH 08-16-2002
FILE NUMBER 21 02-0791
COUNTY CUMBERLAND
ACN 101
Anoun4 Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FOR YOUR RECORDS __~
REV-1547 E)I wrr Iua-u~, nvR..... -
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT 0
ESTATE OF ROBINSON MICHAEL F FILE N0. 21 02-0791 ACN 101 DATE 08-18-2003
TAX RETURN WAS: [ X) ACCEPTED AS FILED ( )CHANGED
_ _ wn..l Al+!
1ISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Meld Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers [Schedule G)
8. Total Assets
(17 187, 200.00 NOTE: To insure proper
(2) 419 .053.67 credit to your account,
(3) .00 subni4 the upper portion
(47 .00 of this Porn with your
[5) 159 .807 .50 tsx payment.
[b) .00
(7) 92 ,851 .46
(a) 858,912.63
APPROVED DEDUCTIONS AND EXEMPTIONS: 11,602. 26
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) f9)
186
3
49
10. Debts/Mortgage Liabilities/Lions (Schedule I) ( .
30) . 25
789
14
11. Total Deductions (11) .
.
844,123.38
12. Net Value of Tax Return az) .00
13. Charitable/Governnantel Bequests) Non-elected 9113 Trusts (Schedule J] (13) 844,123.38
14. Ns4 Value of Estate Subject to Tax [14)
NOTE: If an assessment was issued previously, lines 14, 15 and/or
ssess 16, 17,
ed to da 18 and 19 will
te
reflect figures that include the total of ALL returns a .
ASSESSMENT OF TAX: .00 X 00 _ .00
15. Anount of Line 14 at Spousal rate (157
844,123.38
X 045=
37,985.55
16. Anount of Line 14 taxable at Lineal/Glass A rate [16) 00 12 .00
t l17) _
X
17. e
Amount of Line 14 at Sibling ra 00 15 = .00
l/Class B rate
t (18) . X
18. era
Amount of Lina 14 taxable at Colla 37,985.55
(19)=
19. Principal Tax Due
AX R IT : + AMOUNT PAID
GATE NUMBER INTEREST/PEN PAID (-7
00
25,000.00
11-18-2002 CD001853 .
DO 11,699.80
OS-16-2003 CD002572 .
INTEREST IS CHARGED THROUGH 09-02-2003 TOTAL TAX CREDIT 36,699.80
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1,285.75
REVERSE SIDE DF THIS FORM INTEREST AND PEN. 19.20
^ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL DUE 1,304.95
l IF TOTAL OUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CR), YOU HAY BE OUE
p REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~~~"~`~ ~3 COMMONWEALTH OF PENNSYLVANIA
BUREAU DF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TR% olvxsxoN INHERITANC E TAX
KEPT. 280601
HARR ISBIIRG~ PA 17128-0601 STATEMENT OF ACCOUNT
REY-160) E% RFP c01-OSI
DATE 11-03-2003
ESTATE OF ROBINSON MICHAEL F
DATE OF DEATH OS-16-2002
FILE NUMBER 21 02-0791
COUNTY CUMBERLAND
MICHAEL CHEREWKA pCN 101
624 N FRONT ST Amount Ranittad
WDRMLEYSBURG PA 17043
MAKE CHECK PAYADLE AND REMIT PAYMENT T0:
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
YOUR
***
ESTATE OF ROBINSON MICHAEL F FILE N0. 21 02-0791 ACN 101 DATE 11-03-2003
ISIA SUMMARYNOFITXERPRINCIPAL TAXIDUE,FAPPLICATIONTOFTALLSPAYMENTSSTTHEDCURRENT BALANCEEDANDTAIF APPLICABLE N
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-18-2003
PRINCIPAL TAX DUE:
onvrAr u7c [TAX CREDITS):
37,985.55
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-) AMOUNT PAID
11-16-2002 CD001853 1,315.79 25,000.00
05-16-2D03 CD002572 .00 11,699.80
nlwTT
RV)I,Y ~....
^ IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
38,015.59
30.04CR
.00
30.04CR
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS. )
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TA% DIV ISIDN
DEPT. 280601
HARR ISBDRG~ PA 17128-Ob01
MICHAEL CHEREWKA
624 N FRONT ST
WORMLEYSBURG
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
_ 'S.
'p4 FEB 13 P 3 :31
PA x,7043
GittYS~E,t 1,! o . vD. „~/~
REV-1 W) EM RfV ~Ol-On
DATE 01-26-2004
ESTATE OF R08INSON MICHAEL F
DATE OF DEATH OB-16-2002
FILE NUMBER 21 02-0791
COUNTY CUMBERLAND
ACN 101
Anount Rnnittad
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 Nith your tax paynant.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS __~______________________
-------------------------------
':~::'in.-nii ------a~iROr-i NNER ITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF ROBINSON MICHAEL F FILE N0. 21 02-0791 ACN 101 DATE 01-26-2004
ISIA SUNMARYNOFITHERPRINCIPAL TAXIDUE,FAPPLICATIONTOFTALLSPAYMENTSSTTHEDCURRENT BALANCEEDANDTAIF APPLICABLEON
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: OS-18-2003
PRINCIPAL TAX DUE :......................
PAYMENTS (TAX CREDITS)
37,985.55
PAYMENT RECEIPT DISCOUNT C+)
INTEREST/PEN PAID (-) AMOUNT PAID
DATE NUMBER
11-16-2002 CD001853 1,315.79 25,000.00
05-16-2003 CD002572 .00 11,699.80
04-
30
01-12-2004 REFUND .00 .
TOTAL TAX CREDIT 37,985.55
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
^ IF PAID AFTER THIS DATE, SEE REVERSE I
SIDE FOR CALCULATIDN OF ADDITIONAL INTEREST.
C IF TOTAL DUE IS LESS THAN 51,
NO PAYNENT IS REGUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF TNIS FORM FOR INSTRUCTIONS. 1