HomeMy WebLinkAbout03-0148 Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Roman Kuznaik Jr. NO. 21 --'0 5 "' ~,~"~'~
also known as
, Deceased Social Security No. 178 - 22 - 14,73
Sylvia Kuznaik
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE 'A'.or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r i:x named in the last Will of
the Decedent, dated 06/27/2000 and codicil(s) dated None
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
I Name Relationship Residence I
Sylvia C. Kuznaik I spouse 200 Runson Road, Camp Hill, PA
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family
or principal residence at 200 Runson Road, East Pennsboro, Camp Hill, PA 17011-2637
(list street, number, and municipality)
Decedent, then 73 years of age, died 08/08/2002 at Select Specialty Hospital, PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $
(if not domiciled in PA) Personal property in Pennsylvania $ 20,000.00
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 85,000.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersi~lned:
I ,/'7 ~ Signature Typed or printed name and residence I
~. 200 Runson Road, Camp Hill, Pa 17011-2637
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software onty CPSystems, Inc. Form RW- 1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s)will well and truly administer the es.~rding to law.Sworn to or affirmed and subscribed~~/'/~~ Kuzna ~ik ~~
before me this 20thday of /,- ~lvia~
brua_.Ty , 2003
'
'- - For the Regist;r~"-~k~'~~..,/w~/~-~
Donna M. Otto, let Deputy
No. 21-2003-148
Estate of Roman Kuznaik Jr. Deceased
Social Security No: 178-22-1473 Date of Death: 08/08/2002
AND NOW, February 2 let, 2003 , , in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters IXl Testamentary I I Of
Administration
(c.ta.; d.b.n.c.ta.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Sylvia C. Kuzn~ik
in the above estate and that the instrument(s) dated 06/27/2000
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
Letters ........... $ 235.00
....... Register of Will~ / -,~' /' .,~')~_~
Short Certificate(s) { .3 ) . . $ 9. O0 Donna M. Otto, let Deputy
Renunciation ........ $ Attorney: Robert J. Mulderi~
Affidavits ( ) .... $ I.D. No: 48619
Turo Law Offices
Extra Pages( 3 ) .... $ 9.00 Address: 28 South Pitt Street
Codicil ........... $ Carlisle, PA 17013
JCP Fee .......... $ 10.00 Telephone: 717/245- 9688
Inventory .......... $
Other ........... $
TOTAL ......... $ :263.00 Put Letters _in ~ro's file _in Prothonotaz~'s office on 2/21/03
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form Ri-1 (1991)
H105.805 RFV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed wkh me as
Local Registrar. The original certificate will be £orwarc[¢cl to thc State Vital Records O£fice £or permanent filing.
WARNING; It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00 ~ ./~ ..¢.., ,.rf:,.--~
[~ Local Registrar
P 8 3 8 6 2 4 4 Auu i 20o
No. ~ Date
~44 Rev. 1191 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
ST~'E FILE NUMBER
NAME OF DECEDENT iF.St, M~dle. Lasl) SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Monlh, Day, ~)
UN~R 1 DAY DATE ~ BIRTH 61RTHP~CE (Cdy ~nd ATH (
73 v,... ar. 4, 1929 ~. Pl~uth Pa ~o.,~,~., ~ ~
Cumberland East Pennsboro Select Specialty Hospital
p c~)
171. ~ate P~ D~ l 7c.~ Yes, ~ b~d
200 ~son ~ ~s,~ ~.,
C~ Hill, Pa 17011
, witch ac[~l ~ ol rd ,,,[ ~ ~ 1 1
~ Kuzna~ ,,. Ve~ni~ Kuzna~
I~. 200 ~son ~ ~]~ ~11. Pa 17011
DATE ~ O,~OSITION I
~ Orsmat~ ~ R~ fr~ ~als ~ [(M~lh. ~y. ~) orP~CE~h,.OFpmceDISPOSlT~N - Name o[ Oemetmy. Cre~o~ L~ATI~ -
~,~nQ ~(~, ~[,,.Au~st 12,2002 ~,~. ~l]~n9 ~ ~t~
ss~, IL~EN~NUUCrn INAMEANDAO~ESSOFFAClLI~Y 1903 ~ket St~t
,,.. 011654-L ,~e~s-I a~er ~e~al H~ In~,~ H~ ] ]. Pa 17011
~TE PRON~ED ~AD (M~h. ~y. ~a~) ~ CASE REFERRED ~
~.~ao~ah. 11:07 A. M [,s. August 8, 2002 Y~
~us~(~,~.~,.~,~ c. C-6 and C-7 Fracture
,~,,~,.~,~)~*ST . Motor Vehicle Crash
~S ~ A~PSY M~NER ~ ~H
,o, ~,.v.~,, [ Aprx. [ IOperator failed to sion
~ ~ATH? Natural ~ ~m<,~ ~ r
I ' [3an.14,2002 [ ~-~ ,o~ red ~:af~c stg,a[-
. n ~ n ~ I~ ~ P~'"'~'~" ~1~ 13~ 8:00 A M 3~ ~struck broadside
~. '-~ .... ,~. mi nw~ f . ~ ~ ~ory Lane, York, PA
~e t~ ~ el m~ k~' ~effi ~C"~ due ~ ~ ~) a~ mawr ~ stal~ ..................................................... Q ' Coroner
· "~"""~''~'~m~"~"~',"m,'~',.~"--'-~-.~.;~.,.m~ ............... ~ .~. ~ ~,.. August 9, 2002
· mamC~LaX~m~c~m (,e.,zz)T~orP,m~ Michael L. Norris, Coroner
Ont~mofex~na~lorlnvestlgmtlon. lnmy~n deam~u,edatthetl~ dM, ,ndCac, ,~d~tomecau,, ,~ 6375 Basehore Road, Suite
.... .m,. ................. ~ .......................................... ,.,..: ......................... ? .... ~,z Mechanicsburg, Pa. 17050
LAST WILL AND TESTAMENT
OF
ROMAN KUZNAIK, JR.
KNOW ALL MEN BY THESE PRESENTS, That I, ROMAN KUZNAIK, JR., of the
Borough of Camp Hill, County of Cumberland, and Commonwealth of Pennsylvania, do
make, publish, and declare this instrument to be my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
FIRST: I direct the Executrix hereof to pay all my just debts, funeral expenses and
costs of administration as soon as conveniently may be done after my death. I further
direct the Executrix hereof to pay all inheritance, estate, transfer and succession taxes
which may be levied or assessed upon any property which is included as part of my gross
estate for the purpose of any such tax.
SECOND:I give, devise and bequeath unto my wife, SYLVIA C. KUZNAIK, rest,
residue and remainder of my estate, realty and personalty, howsoever designated
wheresoever situate provided that she is living on the thirtieth (30th) day after the date of
my death.
THIRD: In the event that my wife, SYLVIA C. KUZNAIK, does not survive me or
does not survive by the said period of thirty (30) days, then in that event, I give, devise and
bequeath all the rest, residue and remainder of my estate in equal shares, share and share
alike, to my Children, SUZANNE J. LOGAN, per capita, and DIANE C. HORAN and
KAREN E. HERNDON, per stirpes.
-1 -
FOURTH: I appoint my wife, SYLVIA C. KUZNAIK, to be Executrix of this my Last
Will and Testament. I do hereby give to the Executrix hereof full power, discretion and
authority at any time or times to sell, at private or public sale, mortgage, lease, pledge,
exchange or otherwise deal with or dispose of the property comprising my estate as
deemed best, to settle and compound any and all claims in favor of or against my estate as
deemed best and, for any of the foregoing purposes, to make, execute and deliver any and
all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or
desirable therefor.
FIFTH: In the event my wife, SYLVIA C. KUZNAIK, fails or refuses for any
reason to serve as Executrix of this my Last Will and Testament, then in that event I appoint
SUZANNE J. LOGAN as Executrix of this my Last Will and Testament.
LASTLY: I direct that no fiduciary appointed by this, my Last Will and Testament,
shall be required to give bond and that if, notwithstanding this direction, any bond is
required by any law, statute or rule of court, no surety shall be required thereon.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and
Testament, consisting of two (3) typewritten pages on the margin of which (except this
page) I have affixed my initials this 27th day of June, A.D. 2000.
-2-
Signed, sealed, published and declared by, the above-named Testator, as and for
his Last Will and Testament, in the presence of us, and each of us, who at his request, and
in his presence, and in the presence of each other, have hereunto subscribed our names as
attesting witnesses.
Beth Myers /' Amy
-3-
County of Cumberland :
: SS.
Commonwealth of Pennsylvania :
ACKNOWLEDGMENT AND AFFIDAVIT
We, Roman Kuznaik, Jr., the testator, and the undersigned witnesses to the Will,
the attached or foregoing instrument, having been qualified according to law do depose and
say:
(a)that I, the testator, do hereby acknowledge that I signed the instrument as my
Will, that I signed it willingly and as my free and voluntary act for the
purposes therein expressed; and
(b)that we, the witnesses, were present and saw the testator sign the instrument as
his last Will, that he signed it willingly and as his free and voluntary act for
purposes therein expressed; that each of us in the hearing and sight of the
testator signed the Will as a witness and that to the best of our knowledge the
testator was at that time 18 or more years of age, of sound mind and under
no constraint or undue influence.
Sworn to or affirmed before me by Roman Kuznaik, Jr., testator, and Beth Myers
and Amy Knauer, witnesses, this 27th day of June, 2000.
By: David W. Knauer Amy
Attorney I.D. #21582
David W. Knauer. P.C.
Attorneys-at. Law
41 I-A East Main Street
Mechanicsbur~ PA 17055
(717) 795-7790
CERTIFICATION OF NOTICE
UNDER RULE 5.6(a)
Name of Decedent: Roman Kuznaik, Jr.
Date of death: August 8, 2002
Will No. 03-148
Admin. No. 21-03-148
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above captioned estate.
Name Address
Sylvia C. Kuznaik 200 Runson Road
Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
Respectfully Submitted
TURO LAW OFFICES
Date Robert J. M~lderig, Esquire
28 South Pitt Street
Carlisle, PA 17013
(717) 245-9688
r ' ' Capacity as Counsel for
Personal Representative
I INHERITANCE TAX RETURN
COMMONWEALTH OF PENNSYLVANIA I ~ILE NUMBER -
DEPARTMENT OF REVENUE
DE...2~o, RESIDENT DECEDENT i 21 o3 00148
HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Kuznaik Jr., Roman
~- 178-22-1473
,,z, ' DATE OF DEATH (MM-DD-YEAR} I DATE OF BIRTH~-~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
08/08/2002
i ] 03/04/1929 REGISTER OF WILLS
~(iF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Kuznaik, Sylvia C 172- 28- 3355
,,, Ba 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date o~rEea~hor~T2?l~
,,, ~ ~ [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death
o ~ after 12-12-82) [] 5. Federal Estate Tax Return Required
~ ~ [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
~. of Will) copy of Trust) --
< [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
12-31-91 and 1-1-95)
NAME
, ~. Robert J. Mulderig I COMPLETE MAILING ADDRESS
Turo Law Offices 28 S. Pitt St.
~[:LEPHONE NUMBER Carlisle, PA 17013
717/245-9688
1. Real Estate (Schedule A) (1) None ,~ "' C::5
2. Stocks and Bonds (Schedule B) (2) 5,013.70 ~'~':"
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None :' ~
5. Cash, Bank Deposits & Miscellaneous Personal Property '; .... "i~i: ,~
(Schedule E) (5) 12,292.00 :.~ ~. ~
z 6. Jointly Owned Property (Schedule F) (6) 85,000.00 ~ ~, ~,~
o [] Separate Billing Requested ........
.~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
= (Schedule G or L)
<E' 8. Total Gross Assets (total Lines 1-7) (8) 102,3 05.70
,,"' 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 15,84 2.03
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 402.13
11. Total Deductions (total Lines 9 & 10) (11) 16,244.1 6
12. Net Value of Estate (Line 8 minus Line 11 ) (12) 86,06 ]. 54
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not (13)
been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 86,061.54
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 86,061.54 x .00 (15) 0.00
or transfers under Sec. 9116(a)(1.2)
i 16. Amount of Line 14 taxable at lineal rate ........... x .045 (16)
~ 17. Amount of Line 14 taxable at sibling rate x .12 (17)
O
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19) 0.00
20. 1'1 ..... · ......
Copyright 2000 form software only The Lackfler Group, Inc. Form REV-1500 EX (Rev. 6-00)
)ecedent's Complete Address:
STREET ADDRESS
1
200 Runson Road /
CITY Camp Hill ISTATE PA zip 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A +B+C) (2) 0,00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page '1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0,00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ............................................................................. [] []
b. retain the right to designate who shall use the property transferred or its income; ................................ [] []
c. retain a reversionary interest; or ............................................................................................................ [] []
d. receive the promise for life of either payments, benefits or care? .......................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................................................................................................................ [] []
3. Did decedent own an "in trust foV or payable upon death bank account or security at his or her death? ...... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and~c°mpleiel
De?laration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA~T~URE OF PERSON RESPON,~IBLE ~FOR ~;ILING RETURN ADDRESS DATE
,//., 200 R son Road
~ (---° ~-../}"~;rl'~-~ CampHill, PA 17011
./~IG"NA~,~rI~I-~P..~RE ~)N RESPONSlI~LE~ FOR J~I~ING RETURN ADDRESS - DATE
- SI(~IqATURE OF PRI=:~ ~(~(ER OTHER THAN Rt=Pr~=SEI~TATIVE ADDRESS DATE
~~~~~ Carlisle, PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116
1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE B
STOCKS & BONDS
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Kuznaik Jr., Roman i FILE NUMBER
21 - 03- 00148
All property jointly-owned with right of sunti¥orship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION UNIT VALUE
OF DEATH
1 Verizon Communications 27.70 5,013.70
TOTAL (Also enter on line 2, Recapitulation) 5,0]3.70
SCHEDULE E
CASH, BANK DEPOSITS. & MISC.
CoMMo~LT. O~.E..SY~VA.,A PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kuznaik Jr., Roman 21 - 03 - 00148
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM -
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Belco Community Credit Union Acct #014830 S1 ~,630~?_5
403 N. 2nd St
Harrisburg, PA 17108
2 Belco Community Credit Union Acct #014830 S5 2,661.75
403 N. 2nd St
Hamsburg, PA 17108
TOTAL (Also enter on Line 5, Recapitulation)
'~ SCHEDULE F
COMMONWEALTHINHERITANCE OF TAX PENNSYLVANIA RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF Kuznaik Jr., Roman FILE NUMBER
21 - 03 - 00148
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A Sylvia C. Kuznaik 200 Runson Road Wife
Camp Hill PA 17011
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY
.... o
LETTER DATE Include name of financial institution and bank account number DATE OF DEATH i ~0~ DATE OF DEATH
ITEM !FOR JOINT MADE or mmdar ....... ~denbfy~ng number. Attach deed for lomtly-held real [VALUE OF ASSET !INTI=g~I=.C:TUr'~L~ ~ VALUE OF
NUMBER TENANT JOINT estate. / ........ i DECEDENT'S INTEREST
1 A I 200 Runson Road / 170,000.00 ~-0% ~o 851000100
Camp Hill, Pa 17011
TOTAL (Also enter on line 6, Recapitulation) I 85,000.00
SCHEDULE H
FUNERAL. EXPENSES &
COMMONINEALTH OF PENNSYLVANIA
RESIDENT DECEDENT
ESTATE OF K. uznaik .Ir., Roman FILE NUMBER
I 21 - 03 - 00148
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: ....
1 Myers-Hamer Funeral Home 7,425.00
1903 Market Street, Camp Hill, PA 17011
2 Rolling Green Cemetery 2,533.00
Camp Hill, PA
3 The Camp Hill Cafe 430.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Secudty Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Turo Law Offices 1,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant Sylvia C. Ku~naJk
Street Address 200 Runson Road
city Camp Hill State PA Zip 1701 l
Relationship of Claimant to Decedent Spouse
4. Probate Fees Register of Wills ' 273.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs
1 The Sentinel Estate Notice 105.53
PO Box 130, Carlisle, PA 17013
Total of Continuation Schedule(s) 75.00
TOTAL (Also enter on line 9, Recapitulation) , 15,842.03
SchedubH
COMMONW~LT. Or PE..SV.VA.,^ Fune~ Expenses &
INHERITANCE TAX RETURN ~ C~S~B ~
RESIDENT DECEDENT I
ESTATE OF Kaznaik Sr., Roman !FILE NUMBER ;
21 ~ 03- 00148
2 Cumberland Law Journal Estate Notice 75.00
2 Liberty Ave., Carlisle, PA 17013
Page 2 of SChedule H
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMO"WEA".OF.=NNSY.VA..A LIABILITIES. & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Kuznaik ,Ir., Roman i FILE NUMBER
21 - 03- 00148
Include unreimbumed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Division of Infectious Diseases -
~0~.
1001 S. George St., 4th Fk Mk, York, PA 17405
TOTAL (Also enter on Line 10, Recapitulation) 402.13
REV-1513 EX,+ (9-00) ~
SCHEDULE J
CO~ONWE*,T. OF PEN,S~,VANIA BENEFICIARIES
INHERITANCE T,~J( RETURN
RESIDENT DECEDENT
ESTATE OF Kuzna~ Sr., Roman FILE NUMBER
21 - 03 ~ 00148
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPER'fY DECEDENT OF ESTATE
- Do Not List Trustee[si
L TAY~.BLE DISTRIBUTIONS (include outright spousal distributions)
1 Sylvia C. Kuznaik Wife ~
I100%
200 Runson Road, Camp Hill, PA 17011
i Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee
II. I NON-TAXABLE DISTRIBUTIONS:
iA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
;BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I
TOTAL OF PART II - ENTER TOTAL NON-T.aO(ABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
21-2003-148
LAST WILL AND TESTAMENT
OF
ROMAN KUZNAIK, JR.
KNOW ALL MEN BY THESE PRESENTS, That I, ROMAN KUZNAIK, JR., of the
Borough of Camp Hill, County of Cumberland, and Commonwealth of Pennsylvania, do
make, publish, and declare this instrument to be my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
FIRST: I direct the Executrix hereof to pay all my just debts, funeral expenses and
costs of administration as soon as conveniently may be done after my death. I further
direct the Executrix hereof to pay all inheritance, estate, transfer and succession taxes
which may be levied or assessed upon any Property which is included 'as part of my gross
estate for the purpose of any such tax.
SECOND:I give, devise and bequeath unto my wife, SYLVIA C. KUZNAIK, rest,
residue and remainder of my estate, realty and personalty, howsoever designated
wheresoever situate provided that she is living on the thirtieth (30th) day after the date of
my death.
THIRD: In the event that my wife, SYLVIA C. KUZNAIK, does not survive me or
does not survive by the said period of thirty (30) days, then in that event, I give, devise and
bequeath all the rest, residue and remainder of my estate in equal shares,-share and share
alike, to my Children, SUZANNE J. LOGAN, per capita, and DIANE C. HORAN and
KAREN E. HERNDON, per stirpes.
FOURTH: I appoint my wife, SYLVIA C. KUZNAIK, to be Executrix of this my Last
Will and Testament. I do hereby give to the Executrix hereof full power, discretion and
authority at any time or times to sell, at private or public sale, mortgage, lease, pledge,
exchange or otherwise deal with or dispose of the property comprising my estate as
deemed best, to settle and compound any and all claims in favor of or against my estate as
deemed best and, for any of the foregoing purposes, to make, execute and deliver any and
all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or
desirable therefor.
FIFTH: In the event my wife, SYLVIA C. KUZNAIK, fails or refuses for any
reason to serve as Executrix of this my Last Will and Testament, then in that event I appoint
SUZANNE J. LOGAN as Executrix of this my Last Will and Testament.
LASTLY: I direct that no fiduciary appointed by this, my Last Will and Testament,
shall be required to give bond and that if, notwithstanding this direction, any bond is
required by any law, statute or rule of court, no surety shall be required thereon.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and
Testament, consisting of two (3) typewritten pages on the margin of which (except this
page) I have affixed my initials this 27th day of June, A.D. 2000.
-2-
Signed, sealed, published and declared by, the above-named Testator, as and for
his Last Will and Testament, in the presence of us, and each of us, who at his request, and
in his presence, and in the presence of each other, have hereunto subscribed our names as
attesting witnesses.
Beth Myers /"' Amy
-3-
County of Cumberland :
: SS.
Commonwealth of Pennsylvania :
ACKNOWLEDGMENT AND AFFIDAVIT
We, Roman Kuznaik, Jr., the testator, and the undersigned witnesses to the Will,
the attached or foregoing instrument, having been qualified according to law do depose and
say:
(a)that I, the testator, do hereby acknowledge that I signed the instrument as my
Will, that I signed it willingly and as mY free and voluntary act for the
purposes therein expressed; and
· (b)that we, the witnesses, were present and saw the testator sign the instrument as
his last Will, that he signed it willingly and as his free and voluntary act for
purposes therein expressed; that each of us in the hearing and sight of the
testator signed the Will as a witness and that to the best of our knowledge the
testator was at that time 18 or more years of age, of sound mind and under
no constraint or undue influence.
Swom to or affirmed before me by Roman Kuznaik, Jr., testator, and Beth Myers
and Amy Knauer, witnesses, this 27th day of June, 2000.
By: David W. Knauer Amy
Attorney I.D. #21582
-3-
/'~-/'~'- ~ COMMONHEALTH OF PENNSYLVANIA
BUREAU OF TNDZVIDUAL TAXES DEPARTNENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT.
HARRISBURG, PA 171~8-0~01 NOT~CE OF ~NHERZTANCE TAX
APPRA~SEHENT~ ALLONANCE OR D~SALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-16d7 EX AFP C01-03)
Reco~'c? .~;~::;;.. oi' DATE 06-0~-200~
~_~:~_ , .....~ ESTATE OF KUZNAIK JR ROHAN
DATE OF DEATH 08-08-2002
FILE NUHBER Z1 0~-01~8
ROBERT J HULDERIJ03 JUN -6 ~l :50 COUNTY CUMBERLAND
ACN 101
TURO LAW OFFICES Amoun( Rmmi((md
28 S PITT ST "'
CARLISLE ~Lfl~b~7~l ~: .',:
HAKE CHECK PAYABLE AND REH~T PAYHENT
RE6~STER OF N~LLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701S
CUT ALONG THZS LXNE ~ RETAXN LONER PORTZON FOR YOUR RECORDS
REV-15~7 EX AFP [01-03) NOTZCE OF XNHER/TANCE TAX APPRAZSEHENT~ ALLONANCE OR
~ZSALLONANCE OF DE~UCTXON5 AN~ ASSESSHENT OF TAX
ESTATE OF KUZNA~K ~R ROHAN FZLE NO. 21 05-01~8 ACN 101 ~ATE 06-0S-~00S
TAX RETURN NAS: ( X} ACCEPTED AS F~LED ( ) CHAN6ED
RESERVATXON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE
APPRAZSED VALUE OF RETURN ~ASED ON: OR~6~NAL RETURN
I Real Es*a~e (Schedule A) (1) .00 NOTE: To 1nsure proper
2 S~ocks and Bonds (Schedule B) (2) 5~015.70 credi~ ~o your accoun*]
~ Closely Held S*ock/Par~nership Zn~eres~ (Schedule C) (~) .00 submi~ ~he upper portion
~ Hor~gages/No~es Receivable (Schedule D) (~) .00 of ~hls form ~i~h your
5 Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) (5) 1~.00 ~ax payment.
6 Join*ly O~ned Proper~y (Schedule F) (6) 851000.00
7 Transfers (Schedule G) (7) .00
8 To~al Asse*s (~) 102,$05.70
APPROVED DEDUCTZONS AND EXEHPTZONS: 15,8~2.05
9. Funeral Expenses/Adm. Cos~s/Hisc. Expenses (Schedule H) (9)
10. Debts/Hot,gage Liabili~ies/Liens (Schedule Z) (10) ~0~.~
11. Total Deductions (11) 16.~qq-16
12. Ne~ Value of Tax Re~urn (12) 86,061.5~
1~. Charitable/Governmental Bequests; Non-elected 911~ Trusts (Schedule J) (15) .00
1~. Ne~ Value of Es~a~e Subjec~ ~o Tax (1~) 86,061.5~
NOTE: Z~ an assessment ~as lssued prev/ously, lines 1~, 15 and/er 16, 17, 18 and 19 ~111
re~lect ~/gures that /nclude the total o~ ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Amoun~ of L/ne 1~ a~ Spousal ra~e (15). 86,061.5~ X O0 : .00
16. Amoun~ of L/ne 1~ ~axable a~ Lineal/Class A ra*e (16). .00 X 0~ = .00
17. Amoun* of LAne 1~ a* S1bling ra~e (17). .00 X 12 = .00
18. Amoun~ of L/ne 1~ ~axable a~ Collateral/Class B ra~e (18). .00 X 15 = .00
19. Princlpal Tax Due (19)= .00
TAX CREDZTS:
PAYH~NT K~CEIPI DISCOUNT
AHOUNT PAZD
DATE NUHBER ZNTEREST/PEN PA~D (-)
TOTAL TAX CREDTT .00
BALANCE OF TAX DUEI .00
TNTEREST AND PEN. . 00
TOTAL DUE .00
TF PATD AFTER DATE ZNDTCATED*, SEE REVERSE ( IF TOTAL DUE TS LESS THAN $1., NO PAYHENT TS REQUTRED.
FOR CALCULATTON OF ADDTTTONAL TNTEREST. TF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR)*, YOU NAY BE DUE
A REFUND. SEE REVERSE S/DE OF THTS FORN FOR TNSTRUCTTONS.)
RESERVATION: Estates of decedents dying on or before December 12, 19BZ -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life er for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S.
Section 9140).
PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGXSTER OF #ILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z~-hour
answering service for forms ordering: 1-800-36Z-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-~7-30Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to tho PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 171lB-lOll, DR
--election to have the matter determined et audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADNIN-
ISTRATZVE
CORRECTZONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 171Z8-0601
Phone (7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the dacadent's death, a five percent (BI) discount of
the tax paid is allowad.
PENALTY= The 15Z tax amnasty non-participation penalty is computad on the total of the tax and intarast assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty pariod. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (BI) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after
January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 19aZ through 2003 ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Yea.~c Rate Factor
1982 20Z .00054B 1987 92 .0002q7 1999 7Z .000192
1983 16Z .000~38 1988-1991 IIZ .000301 2000 8Z .000219
198~ llZ .O0030X 1992 9Z .O00Z~7 ZOOl 9Z .000247
1985 132 .000356 1993-199~ 7Z .O0019Z ZOOZ 6Z .O0016q
1986 IOZ .O0027~ 1995-1998 9Z .0002~7 2003 5Z .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the data of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must ba calculated.
IN RE: ESTATE OF : IN THE COURT OF COMMON PLEAS OF
ROMAN KUZNAIK JR : CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHAN'S COURT DIVISION
: NO. 2003-148
FAMILY SETTLEMENT AND FINAL RELEASE
ESTATE OF ROMAN KUZNAIK JR.
KNOW ALL MEN BY THESE PRESENTS, that Roman Kuznaik Jr., late of 200
Runson Road, Camp Hill, Cumberland County, Pennsylvania, deceased, died testate
on August 8, 2002, having first made his Last Will and Testament, which was duly
executed on June 27, 2000 and probated in the Office of the Register of Wills of
Cumberland County, on February 21, 2003.
WHEREAS, the said Roman Kuznaik Jr., by the aforesaid Last Will and
Testament, named Sylvia C. Kuznaik as Executrix of said Last Will and Testament;
WHEREAS, Letters Testamentary on the Estate of the said decedent were duly
issued by the Register of Wills of Cumberland County, Pennsylvania, to the said
Executrix, hereinafter called personal representative;
WHEREAS, the personal representative has gathered the assets of the Estate of
the said decedent and the assets consist of personal and real property with the total
value of $102,305.70 as set forth in Exhibit "A", which is a copy of the Pennsylvania
Inheritance Tax Return filed and approved by said personal representative, and which is
attached hereto and made a part hereof, and marked Exhibit "A";
WHEREAS, the debts and deductions, including the payment of inheritance tax
in the said Estate, which have now been paid, leave a balance for distribution of
$86,061.54, also as set forth in the statement of said personal representative, which is
attached hereto and marked Exhibit "B";
WHEREAS, the balance for distribution as shown in the said statement marked
Exhibit "B" has been has been distributed as herein indicated in accordance with the
terms of the Last Will and Testament of the said Decedent;
NOW, THEREFORE, Sylvia C. Kuznaik being sole heir under the Last Will and
Testament of the said decedent, and being that person entitled to inherit under said Last
Will and Testament, does hereby acknowledge that I have this day had and received
from the aforesaid personal representative, in full satisfaction and payment of all sums
of money, legacies, bequests, and devises as are given, devised and bequeathed to me
respectively by the said Last Will and Testament, the amounts due me under said Last
Will and Testament, which amounts I have received this day or prior to this day; and, I
do hereby stipulate that in order to avoid the expense and time involved in the filing of a
formal account and schedule of distribution, I agree that no account is necessary and I
do hereby agree that I do consent to distribution being made without the filing of an
account and schedule of distribution, the same to be with the same force and effect as if
they had been filed and confirmed by the Orphan's Court Division of the Court of
Common Pleas of Cumberland County, Pennsylvania.
THEREFORE, I do hereby remise, release, quitclaim and forever discharge the
said personal representative, Sylvia C. Kuznaik, her heirs, executors, administrators
and assigned, of and from the said estate and from all actions, suits, payments,
accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for
any other use, matter, cause or thing whatsoever, touching upon the Estate of the said
decedent, and I do further hereby covenant and agree that should any liability come due
to the estate of the said decedent after the signing of this Agreement, I do hereby
covenant and agree with each other and the aforesaid personal representative, that I
will contribute pro-rata my share of the Estate to satisfy any and all claims, demands,
suits or causes of action which may be successfully prosecuted against the said Estate
or the aforesaid personal representative after the signing, sealing and delivery of this
Family Settlement Agreement and Final Release.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and
year noted below.
Date
COHMONNEALTH OF PENNSYLVANIA
BUREAU OF. INDIVIDUAL TAXES DEPARTMENT OF REVENUE
ZNHERZTANC~ TAX DIVISION
DEPT. ~80~0~
HARRZSBURG, PA XTXZ8-O~O! NOT~CE OF iNHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX REV-lS~TEXAFP(01-05)
DATE 06-05-2005
ESTATE OF KUZNAIK JR ROWAN
DATE OF DEATH 08-08-2002
FILE NUHBER 21 05-01q8
COUNTY CUMBERLAND
ROBERT J MULDERIG ACN 101
TURO LAN OFFICES Amount ReeAtted I
28 S PITT ST
I
CARLISLE PA 17015
HAKE CHECK PAYABLE AND REN/T PAYNENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~'- RETAIN LONER PORTION FOR YOUR RECORDS
REV-!547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KUZNAIK JR ROMAN FILE NO. 21 05-01q8 ACN 101 DATE 06-05-2005
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 51015.70 credit to your account,
$, Closely Held Stock/PartnershAp Interest (Schedule C) ($) .00 subeit the upper portion
q, Mortgages/Notes ReceAvable (Schedule D) (q) . O0 of th/s fore with your
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 12;292.00 tax payment.
6. JoAntly Owned Property (Schedule F) (6) 851000.00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 102,505.70
APPROVED DEDUCTIONS AND EXEMPTIONS: 15,8q2.05
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) q02.15
11. Total Deductions (11)
12. Net Value of Tax Return {12) 86,061.5q
13. Charitable/governeental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
lq. Net Value of Estate SubSect to Tax (1fi) 86,061.5q
NOTE: I~ an assessment Nas issued previously, lines 14, 15 and/or 16, 17, 18 and 19
reflect figures that lnclude the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Aeount of Line lq at Spousal rate (15) 86,061.5q x O0 = .00
16. Aeount of Line lfi taxable at Lineal/Class A rate (16) .00 X Oq5 = .00
17. Amount of LAne lfi at SiblAng rate (17) .00 x 12 = .00
18. Aeount of Line 14 taxable at Collateral/Class B rate (18) ,00 X 1~ = .00
19. Principal Tax Due (19)= .
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT J .00
DALANCE OF TAX DUEl .00
INTEREST AND PEN. . O0
TOTAL DUE . O0
ZF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. TF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF TH/S FORN FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before Oecmabmr 1Z, 19AZ -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate far
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Znheritancm Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To ~ulfi11 thm raqulrmmants of Smction ZI~O of the Xnhmritanca and Estate Tax Act, Act 25 of ~. (TI P.S.
Section 91~0).
PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may bm requested by completing an "Application
far Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of tho Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z~-hour
answering service for forms ordering: 1-BOO-36Z-Z050; services for taxpayers mith special hearing and / er
speaking needs: 1-800-447-3DZ0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice suet object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171ze-loz1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADNIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assess~ent should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. ZBO6D1, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IBC1) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedant's death, a fivm percent (BZ) discount of
the tax paid is allowed.
PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January lB, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner end in the the same time period as you would appeal the tax and interest
that has been assessed as indicated an this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, lgBz bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after
January 1, 19AZ will bear interest at a rate which will vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOO3 arm:
Interest Oaily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z ZDZ .OOOS~8 1987 9Z .000247 1999 7Z .O0019Z
1963 16Z .000438 1988-1991 11Z .000301 2000 8Z .000219
1984 llZ .DOD301 1992 9Z .000247 ZOO1 9Z .000Z47
1985 X3Z .000356 1993-1994 7Z .00019Z ZOOZ 6Z .000164
1986 IOZ .000Z74 1995-1998 9Z .O00Zi7 ZOO3 5Z .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINi~UENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must bm calculated.
....... REV-1500 .... ' I
I
~o. Mo.w~,L,,o~,...s~v,,~, INHERITANCE TAX RETURN Ft'E,UMBER
DEPARTMENT OF REVENUE
o,~..=~, RESIDENT DECEDENT 2l 03 00]48
HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER
J DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
J Kuznaik Jr., Roman 178- 22-1473
+~['rE OF DEATH (MM-OD-YEAR) gATE OF BIRTH (MM-OD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE WffH THE
"q :, 08/08/2002 j 03/04/].929 REGISTER OF WILLS
3 J(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Kuz~a~, Sylvia C ]. 72-28-3355
[] 1. Odginal Return [] 2. Supplemental Return [] 3. Remainder Return (date of death pflar to 12-13-82) --
. [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death
after 12-12-82) [] 5. Federal Estate Tax Return Required
=O o, [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
o ~. ,n of Will) copy of Trust) --
'~ [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
12-31-91 and 1-1-95)
~AME COMPLETE ~LING ADDRESS
~ z~ i Robert J. Mulderig
~ ~3 ~:IRM NAME (If applicable)
oo ~ Turo Law Offices 28 S. Pitt St.
tELEPHONE NUMBER Carlisle, PA 17013
717/245-9688
1. Real Estate (Schedule A) (1) None !
2. sto~s and Bonds (Schedule B) (2) 5,0~3~/~
3. Closely Held Corporation, Parthership or Sole-Proprietorship (3) ~ ~[~
4. Mortgages & Notes Receivable (Schedule D) (4) o~. '[
5. Gash, Bank Deposits & Miscellaneous Personal Property (5) 12,292.0~
(Schedule E) :
6. Jointly Owned Property (Schedule F) (6) ~
__. [] Separate Billing Requested ~ ,
_~'~ 7. (Schedulelnter-Viv°s GTransferSor L) & Miscellaneous Non-Probate Property (7) No~ '-: 05'"'
· . 8. Total Gross Assets (total Lines 1-7) (~ 102,305.70
~,~ 9. Funeral Expenses & Administrative Costa (Schedule H) (9) 15,842.03
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 402. ] 3
11. Total Deductions (total Lines 9 & 10) (11) 16,244.16
12. Net Value of Estate (Line 8 minus Line 11) (12) 86,06] ..54
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not (13)
been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 86,061.54
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate. 86,06 ] .54 x .00 (15) 0.00
or transfers under Sec. 9116(a)(1.2)
o 16. Amount of Line 14 taxable at lineal rate x .045 (16)
~- 17. Amount Df Line 14 taxable at sibling rate x .12 (17)
O
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19) 0.00
20. []
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
De,cedent'.s Complete Address:
I STREET ADDRESS 200 Runson Road
CITY Camp Hill STATE PA zip 17011
Tax Payments and Credits:
1. Tax Due (Page I Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit '
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page I Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ............................................................................. [] []
b. retain the right to designate who shall use the property transferred or its income; ................................ [] []
c. retain a reversionary interest; or ............................................................................................................ [] []
d. receive the promise for life of either payments, benefits or care? .......................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................................................................................................................ [] []
3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? ...... [] []
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 COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and stalemenls, and to/he best of ray knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representalive is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE [OR FILING RETURN ADDRESS DATE
Syl C. hal
Camp Hill, PA 17011 d <~
~ RE~~.I~UIRI~I. ADD RESS ' DATE
$1(~XIATURE OF PRI=y,~AhtER OTHER THAN R.'-['~-,SEI*iIIAIIVE ADDRESS DATE
~~~.~' 28 S. Pitt St.
Carlisle, PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116
1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT D~CEDENT
ESTATE OF Ku2maik Jr., Roman I FILE NUMBER
21 - 03 - 00148
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION UNIT VALUE
OFDEATH
1 Verizon Communications 27.70 5,013.70
TOTAL (Also enter on line 2, Recapitulation) 5,013.70
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
coM~o.w~L,. Or.~..S~v..~ PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Kuznaik Jr., Roman i FILE NUMBER
~ 21 - 03 - 00148
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
su~ivomh~p must be disclosed on schedule F. '
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Belco Community Credit Union Acct #014830 S 1 9,630.25
403 N. 2nd St
Harrisburg, PA 17108
2 Belco Community Credit Union Acct #014830 S5 2,661.75
403 N. 2nd St
Harrisburg, PA 17108
TOTAL (Also enter on Line 5, Recapitulation) 12,292.00
~ SCHEDULE F
COM,~ONW~L~. OF PEN.SYLVA.,A JOINTLY'OWN ED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Kuznaik Jr., Roman FILE NUMBER
21 - 03 - 00148
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A Sylvia C. Kuznaik 200 Runson Road Wife
Camp Hill PA 17011
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY
% OF DATE OF DEATH
LETTER DATE Include name of financial insfituUon and bank account number DATE OF DEATH DECD'S VALUE OF
ITEM FOR JOINT MADE
NUMBERTENANT JOINT ~state.3r similar identi~ing number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTERES'
1 A 200 Runson Road 170,000.00 50~ 85,000.0~
I Camp Hill, Pa 17011
TOTAl_ {Also entor on line 6, Recapitulation} 85,000.00
SCHEDULE H
FUNERAL EXPENSES &
COMMONW~4,LTH O~ P£NN~YLVANIA
INHERITANCE TAX RETURN ~N~~ COSTS
RESIDENT DECEDENT
ESTATE OF Kuznaik Jr., Roman FILE NUMBER ....
21 - 03 - 00148
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: '
1 Myers-Hamer Funeral Home 7,425.00
1903 Market Street, Camp Hill, PA 17011
2 Rolling Green Cemetery 2,533.00
Camp Hill, PA
3 The Camp Hill Cafe 430.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Secudty Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Turo Law Offices ],500.00
3. Family Exemption: (If decedent's address is not bhe same as claimant's, attach explanation) 3,500.00
Claimant Syh, ia C. Ku2~a~
Street Address 200 Rtmson Road
City Camp Hill State PA Zip 17011
Relationship of Claimant to Decedent Spouse
4. Probate Fees Register of Wills 273,00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 The Sentinel Estate Notice 105.53
PO Box 130, Carlisle, PA 17013
Total of Continuation Schedule(s) 75.00
TOTAL (Also enter on line 9, Recapitulation) 15,842.03
Sctmdule H
co~.o.~.~, o. 'E.NS~V^N.^ FuneraJ Exi:x~ses &
"~E.,~'^NOE T~ ~ETU,~N Adminislr~Jve Oosts contJn~
RESIDENT DECEDENT
ESTATE OF
Ku2ma~ Sr., Roman FILE NUMBER
21 - 03 - 00148
2 Cumberland Law Journal Estate Notice 75.00
2 Liberty Ave., Carlisle, PA 17013
Page 2 of Schedule H
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
~o~Ho.w~... o~.~..s~vAN,A LIABILITI ES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kuznaik Jr., Roman FILE NUMBER
21 - 03 - 00148
Include unreimbumed medical expenses.
ITEM ..............
NUMBER DESCRIPTION AMOUNT
1 Division of Infectious Diseases 402.13
1001 S. George St., 4th Fir Mk, York, PA 17405
TOTAL (Also enter on Line 10, Recapitulation) 402.]3
REV-1513 EX+ (9-00)
SCHEDULE J
coMMo.~L~, oF .ENNS~_VAN,^ BEN E FICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kuznaik Jr., Roman FILE NUMBER
21 - 03- 00148
RELATIONSHIP TO i AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Do Not List Trustee/si I OF ESTATE
I Sylvia C. Kuznaik Wife ~ 100%
200 Runson Road, Camp Hill, PA 17011
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
/
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECT ON 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEtT
EXHIBIT B
GROSS ESTATE $102,305.70
LIABILITIES
A. Attorney Fees - Turo Law Office $ 1,500.00
B. Family Exemption $ 3,500.00
C. Register of Wills $ 273.00
D. The Sentinel $ 105.53
E. Cumberland Law Journal $ 75.00
F. Division of Infectious Diseases $ 402.13
G. Myers-Harner Funeral Home $ 7,425.00
H. Rolling Green Cemetery $ 2,533.00
I. The Camp Hill Caf6 $ 430.50
AMOUNT REMAINING TO BE DISTRIBUTED $ 86,061.54
100% DISTRIBUTION TO SYLVIA C. KUZNAIK $ 86,061.54
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/08/2004
MULDERIG ROBERT J
28 S PITT STREET
CARLISLE, PA 17013
RE: Estate of KUZNAIK ROMAN JR
File Number: 2003-00148
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: 8/08/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/08/2004
KUZNAIK SYLVIA C
200 RUNSON ROAD
CAMP HILL, PA 17011-2637
RE: Estate of KUZNAIK ROMAN JR
File Number: 2003-00148
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: 8/08/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
STATUS REPORT UNDER RULE 6.'12
Name of Decedent: Roman Kuznaik, Jr.
Date of Death: August 8, 2002
Will No.: No. 2003-148 Admin. No.: 21-2003-148
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: Yes
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
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
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report. Family settlement agreement filed July 3, 2003.
Date:
Robert J.cv, u,uerig, Esquir
28 South Pitt Street
Carlisle, PA 17013
(717) 245-9688
-. Capacity:__ Personal Representative
X Counsel for personal
, ?; representative
JRD/June 30, 1992/17858
SEP G~ ~004~
In Re: Estate of Roman Kuznaik, Jr. · ORPHANS' COURT DIVISION
Late of Camp Hill Borough · COURT OF COMMON PLEAS OF
· CIZMBERLAND COUNTY
Estate No.: 2003-0148 · PENNSYLVANIA
NO. 21-2003-0148
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPItANS' COURT RULE
Personal Representative: Sylvia C. Kuznaik
Counsel for Personal Representative: Robert J. Mulderig
Date of Decedent's Death: 08/08/2002
Date of Delinquency Notice: 09/10/04
The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance
with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on April 30,
2004, and that the ten (10) day notice to file the Status Report has expired· Accordingly, in
accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned
requests that a Court conduct a hearing to determine whether sanctions should be imposed upon
the delinquent personal representative or counsel for the delinquent personal representative.
Date: 09/10/04
Glenda Famer Strasbaugh
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A heating is scheduled for at in Cou~room No. 3. If the Stares Repo~ is filed prior to
the he~ing date, the he~ng will automatically be cancelled·
George ~}~off~r, ~.