The URL can be used to link to this page

Home My WebLink About03-0796THEODORE a. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE DEBRA DENISON CANTOR Writer's E-Mail Address: reagerpc@epix.net REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com October 2, 2003 THOMAS O. WILLIAMS SUSAN H. CONFAIR JOANNE HARRISON CLOUGH SUSAN J. SMITH + Certified Civil Trial Specialist Via Hand Delivery Cumberland County Register of Wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17019 Estate of Blanche MacF Gonglewski Our File No. 99-047.003 Dear Sir or Madam: Enclosed please find a check in the amount of $25,000.00 as advance payment on the inheritance tax account for the above-referenced estate. This estate is being administered through the terms and conditions of a living trust and therefore, no probate was necessary. Enclosed please find a completed Estate Information Sheet for your information. In the event you have any questions or require additional information, please feel free to contact me. Very truly yours, M6nica D. Zercher Legal Assistant 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 NO. REV-1162 EX(11-96) CD 003080 REAGER DAVID W ESQUIRE 2331 MARKET STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 150-20-1704 FILE NUMBER: 2103-0796 DECEDENT NAME: GONGLEWSKI BLANCHE MACF DATE OF PAYMENT: 10/02/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/04/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $25,000.00 TOTAL AMOUNT PAID: $25,000.00 REMARKS: MARGARET R GONGLEWSKI-C/O DAVID W REAGER-TAX PAMT 10/2 SEAL CHECK//1001 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Reager & Adler, P.C. 2331 Market Street Camp Hill, PA 17011 Via Hand Delivery_ Cumberland County Register of Wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17019 18/02/2883 14:84 7179894939 REAGER & ADLER PC PAGE 01 REAG£R & ADLER, PC Theodore A. Ad/er David W. Reager Charles £. Za/aski l inus £. Fen/cie Debra Den/son Cantor ATTORNEYS AND COUNSEL ORS A T LA W 2331 Market Street Camp Hi1/, PA 1701 ~-4642 Telephone: (7~ 7) 763- Telefex: (717) 730- 7366 Thomas O. Will/ems Susan H. Confair Joanna Harrison Clough Susan J. Smith DouglasP. Lehman Date: October 2, 2003 From; Monica D. Zercher Same to Follow by Mail: FACSIMILE CO. VER SHEET To: Sue Fax No.: 240-7797 Page(s) to Fo/Iow: II . I Message: Sue, attached is the death certificate for Blanche Gonglewsk/. Her date of birth is October 29, 1927. As left a message for Margaret Gonglewsk/. As soon as / hear from her, I will call you. Thanks for your assistance. Sorry for the oversiEhts. Please call Brooke Burl/son at (717) 763-1383 if there is any problem in transmission. The Information contained in this telefacsimiie is transmitted I~y en attorney. It is privileged end confidential, intended only for the use of the individual or ent~'ty named el)ova, if the reader of this message is not the intended recipient, you ere hereby notified that e~ly dissemirletion, distribution or col~ying of this ~ommunieetion is strictly prohibited, ff this communication has the above address vie the U,S. Postal Se~ice (we will re/minutes postege)o Thank you. 18/82/2883 14:84 7179894939 REAGER & ADLER PC PAGE 82 ~ha.i~m ~ni~ ~t thc i~~n ~m ~n is ~ctl~ ~picd from an arisln~ ~tdfi~e of' dmth dul~ fii~ ~ ~ u WAJINN~N); It Il IlleOII to dUpllMte thio oopy by photolMt or photooelph. Fee ret dd~ cefldFiute, $2.00 OP--qYIIrlI~ATI OiI DIATH 1510- ZO ~ 1704 ~A /7070 2003 ,14 -,.0 -.13 10/0712003 15:4G 7179094939 REAGER & ADLER PC PAGE 01 THEOOC~£ A. AD[.~R DAVID W. CI',IA~L~,~ E, ZALESKI I.INU$ ~;. k"~NICLE 13EBRA D~NISON C~NTOR REAGER & ADLER, PC ATTORNEYS AND COUN8ELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717.730-7366 October 7, 2003 THOMAS O. WILLIAMS SU~,AN H, CONFAIR JOANNE HARRISON CLOUGH SUS, A.N J. SMITH ~ Fax No. 240-7797 Registcr of Wills Cumberland County Courthouse I Courthouse Square Carlisle, PA 17013 Aim: Sue lug: lEst~te of Blanehe M#cFtyden Gonglewski Our File No. 99-047.003 Dem' Sue: Margaret Gonglewski provided me with he~ racial security number missing from the Bstate Infonna~ Sheet provided to you for the above-referenced cstate. That number is: 202-56-3851. Thank you for your assistance with this matter. Ve~ tnfly yours, Mo: fica D. Zorchcr Log d Assistant REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE DEBRA DENISON CANTOR Writer's E-Mail Address: reagerpc@epix.net October 6, 2003 Cumberland County Register of Wills Cumberland County Courthouse Attn: Sue Hanover and High Streets Carlisle, PA 17013 RE: Estate of Blanche MacF Gonglewski Our file number: 99-047.003 Dear Sue: THOMAS O. WILLIAMS SUSAN H. CONFAIR JOANNE HARRISON CLOUGH SUSAN J. SMITH + Certified Civil Trial Specialist &!-03-7 Enclosed please find the original Death Certificate for Blanche MacFayden Gonglewski. In the event you have any questions, please feel free to contact me. MDZ/bab Enclsure Very truly yours, Moil. ica D. Zercner Legal Assistant his is to certify that the information here given is correctly copied fi'om an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. /~ Local Registrar No. ~ Date NAME OF OECEDENT (F,rst M~d~te. La*aI COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH New Cumberland, PA 17070 ,,. Frank Hampson MacFadyen Bess S. gon~lewski - Blanche ~cFadyen Gonglewski [:. female I, 150 -- 20 -- 1704 g Jul '4-' 2' ~. '1 : , , ~. ~oo~ I Kearn~ NJ /~ ~,,,~ ~u i~ ~ ~ ~ m , ~ ~ . _ I~TU~ ,7. ~,. sylvania .,~ ,7 ~ ~- ~-- · Aouz ~rz~ge Street JeEm~ ' ~ c.~ ~ ,m.~ Cumberland ~ ,,,.~ ~~ New Cumberland ,,. Silvia Elsa I ~. 14 Williams Street~ Rockville, ~ 20850 "" =J,,.. July 8. 2003 J~,..Yorkto~e Cre=tory J,,. York, PA 17404 nemore ~'. a os, Inc. New Cumberland. PA 17070-0431 21-2003-796 REAGER & ADLER, PC 2331 MARKET STREET CAMP HILL, PA 17011 CUMBERLAND COUNTY REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE ATTN: SUE HANOVER AND HIGH STREETS CARLISLE, PA 17013 h,,llh,,llh,,,,,ll,,Ihl,,hl IVOi3+3301 REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE DEBRA DENISON CANTOR THOMAS O. WILLIAMS SUSAN J. SMITH Writer's E-Mail Address: MZercher@ReagerAdlerPC.com August 9, 2004 SUSAN H. CONFAIR JOANNE HARRISON CLOUGH THOMAS J. ROZMAN TIFFANY M. CARTWRIGHT PETER R. WILSON +Certified Civil Trial Specialist Via Hand Delivery Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Estate of Blanche MacF Gonglewski Our file number: 99-047.003 To Whom It May Concem: Enclosed please find the Inventory and Inheritance Tax Return for the above-referenced estate. Also enclosed is a check in the amount of $1,990.14 for the tax due on the Estate and a check in the amount of $28.00 for the filings fees. Please file the originals with your office and time-stamp all copies to be returned with our courier. Thank you for your assistance with this matter. In the event you have any questions, please feel free to contact me. MDZ/bab Enclosures Very truly yours, Legal Assistant ~EV-15OO EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESlBENT BECEBENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 7 9 6 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL GONGLEWSKI, BLANCHE MACF DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year) 07/04/2003 I 10/29/1927 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIALSECURITYNUMBER 1 5 0-2 0- 1 7 0 4 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIALSECURITYNUMBER [-~1. Original Retum r~4. Limited Estate r--~ 6. Decedent Died Testate {Attach copy of Will) O 9. Litigation Proceeds Received [] 2. Supplemental Return [~] 4a. Future Interest Compromise (date of death after 12.12o82) r-~7. Decedent Maintained a Living Trust (Attach copy of Trust) r-"l 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [~]3. Remainder Return (date of death prior to 12-13-82) [] 5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes {~] 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME DAVID W. REAGER, ESQUIRE FIRM NAME (If Applicable) REAGER & ADLER, P.C. TELEPHONE NUMBER 717-763-1383 COMPLETE MAILING ADDRESS 2331 MARKET STREET CAMP HILL PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property {5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 321,810.00 10~4~20 63,~.97.00 105,~:93.18 19,607.,91 114,885.48 OFFICIAL USE ONLY I (8) 635,440.77 7,882.02 (11) 7,882.02 627,558.75 (12) (13) (14) 627,558.75 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. x (15) 627,558.75 x .045 (16) x .12 (17) x .15 (18) (19) 28,24O. 14 28,240.14 )ecedent's Complete Address: STREET ADDRESS 1602 BRIDGE STREET CITY NEW CUMBERLAND STATE PA 17070 Fax Payments and Credits: Tax Due (Page 1 Line 19) Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount 25,000.00 1,250.00 Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (1) 28,24O. 14 26,250.00 (3) i.If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) i. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,990.1 4 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 1,990.14 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 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? ....................................................................................................... [] [] F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Jnder penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the b~st of my knowledge and belief, it is true, correct and complete. )eclaration of preparer other than the personal representative is based o~ all information of which preparer has any knowledge. [E OF PERSON RE~ DATE 31GNATURE OF ~DDRESS DATE :or 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% 172 P.S. {}9116 (a) (1.1) (i)]. :or 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)]. Yhe 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 ihe surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: ]'he 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, ar 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. {EV-1502 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER GONGLEWSKI. BLANCHE MACF 21 03 0796 All mai 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 propert7 which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. 1551 BRIDGE STREET, NEW CUMBERLAND, PENNSYLVANIA contract sales price 2 1600 BRIDGE STREET, NEW CUMBERLAND, PENNSYLVANIA 135,130 county assessed value x 1.0 = 135,130 3. 1602 BRIDGE STREET, NEW CUMBERLAND, PENNSYLVANIA 23,250 county assessed value x 1.0 = 23,250 4. 1316 BRANDT STREET, NEW CUMBERLAND, PENNSYLVANIA 75,930 county assessed value x 1.0 = 75,930 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 87,500.00 135,130.00 23,250.00 75,930.00 321,810.00 · 'EV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER GONGLEWSKI. BLANCHE MACF ;gl 03 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 07~6 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SEE ATTACHED SCHEDULE 10,247.20 TOTAL (Also enter on line 2, Recapitulation) $ 10,247.20 (If more space is needed, insert additional sheets of the same size) {EV-1507 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER $ONGLEWSKI. BLANCHE MACF 21 03 All propen'y jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MORTGAGE RECEIVABLE 63,697.00 TOTAL (Also enter on line 4, Recapitulation) 63,697,00 (If more space is needed, insert additional sheets of the same size) {EV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY -'STATE OF FILE NUMBER ,~ONGLEWSKI. BLANCHE MACF 21 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of sun/ivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. HOUSEHOLD GOODS AND PERSONAL ITEMS 1,000.00 VANGUARD ACCOUNT # 9965655232 104,193.18 TOTAL (Also enter on line 5, Recapitulation) $ 105,193.18 (if more space is needed, insert additional sheets of the same size) :~EV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER ~QN(~LEWSKI, BLANCHE MA(~F 21 Q~ If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 0796 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. MARGARET GONGLEWSKI B ELIZABETH CONGLEWSKI C JOHN GONGLEWSKI JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF ~IUMBERTENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERES I. A. 2003 MEMBER'S FIRST FCU SAVINGS ACCOUNT #230108 25.00 100. 25.0¢ _~. A&B 2003 MEMBERS FIRST FCU INVESTMENT SAVINGS 11,656.72 100. 11,656.72 #230108 ?,. A&B ~2003 MEMBERS FIRST FCU CHECKING ACCOUNT #230108 3,671.41 100. 3,671.41 ¢. A&C 1999 MEMBERS FIRST FCU SAVINGS ACCOUNT #117892 815.87 33.333 271.9~ 5. A&C 1999 MEMBERS FIRST FCU SUPPLEMENTAL SAVINGS 4,213.09 33.333 1,404.35 #117892 3. A&C 1999 MEMBERS FIRST FCU CHECKING 2,825.77 33.333 941.91 #117892 7. A&B 1998 MEMBERS FIRST FCU SAVINGS #100743 25.00 33.333 8.32 ~). A&B 1998 MEMBERS FIRST FCU INVESTMENT SAVINGS 6.72 33.333 2.2zl #100743 9. A&B 1998 MEMBERS FIRST FCU CHECKING 1,803.00 33.333 600.9~c #100743 10. A&C 2000 MEMBERS FIRST FCU CERTIFICATE OF DEPOSIT 3,075.05 33.333 1,025.01 #180263 TOTAL (Also enter on line 6, Recapitulation) $ 19,607.91 (If more space is needed, insert additional sheets of the same size) {EV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY -'STATE OF FILE NUMBER 3ONGLEWSKI, BLANCHE MACF ;~1 03 07~)6 This schedule must be completed and filed if the answer to any of questions 1 throu¢ h 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR REU~TIONSHIP TO DECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE lUMBER THE OATEOFTRANSFER. A'I'rACH ACOPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLIC,~BLE) VALUE 1. INDIVIDUAL RETIREMENT ACCOUNT 114,885.48 100. 114,885.48 VANGUARD ACCOUNT# 9870108777 TOTAL (Also enter on line 7 Recapitulation) $ 114,885.4( (If more space is needed, insert additional sheets of the same size) ~EV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF $ONGLEWSKI. BLANCHE MACF Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION FILE NUMBER 21 03 OT~g 8. 9. 10. 11. 12. FUNERAL EXPENSES: CREMATION SERVICES, INTERMENT AT COLUMBARIUM, PASTOR, ORGANIST FLOWERS, FOOD FOR WAKE, MISC EXPENSES ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudt'/Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees REAGER & ADLER, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees 1602 BRIDGE STREET- ELECTRIC PP&L 1602 BRIDGE STREET - GAS UGI 1602 BRIDGE STREET - WATER 1602 BRIDGE STREET- PHONE VERIZON 1602 BRIDGE STREET - LAWN MAINTENANCE 1602 BRIDGE STREET - SEWER AMOUNT 3,222.80 3,500.00 57.50 99.41 132.25 80.00 440.00 350.06 TOTAL (Also enter on line 9, Recapitulation $ 7,882.07 (if more space is needed, insert additional sheets of the same size) ~EV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS --STATE OF $ONPaLEWSKI. BLANCHE MACF FILE NUMBER · 21 Q:~ Q7~6 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) [EV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF $ONGLE:WSKI. BLANCHE MACF NUMBER I. 1. 2. 3. 4. 5. 6. II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] JOHN DAMIAN GONGLEWSKI 7345 YORKTOWN AVENUE, N.E. ALBURQUERQUE, NM 87109 ELIZABETH SIMMS GONGLEWSKI 14 WILLIAMS STREET ROCKVILLE, MD 20850 HUGH MACFADYEN GONGLEWSKI 13345 SW 84TH AVENUE PINECREST, FLORIDA 33156 JENNIE GRACE GONGLEWSKI 7011 CRESHEIM AVENUE PHILADELPHIA, PA 19119 MARGARET RUTH GONGLEWSKI 3440 N. 12TH ROAD ARLINGTON, VA 22201 ALICE ELEANOR GONGLEWSKI FILE NUMBER ;gl q~ RELATIONSHIP TO DECEDENT DO Not List Trustee(s) SON DAUGHTER SON DAUGHTER DAUGHTER DAUGHTER 0796 AMOUNT ORSHARE OF ESTATE 1~ OF RESIDUE OF ESTATE 1~ OF RESIDUE OF ESTATE 1/6 OF RESIDUE OF ESTATE 1/6 OF RESIDUE OF ESTATE 1/6 OF RESIDUE OF ESTATE 1/6 OF RESIDUE OF ESTATE 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 SECTION 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 SHEET $ (If more space is needed, insert additional sheets of the same size) Savings Bond Calculator Page 1 of 1 [07/2003 ....... Series Bon s Denomination # Bonds Total Price 13 $5,500.00 SerialNumber Issue Date Series Denom M43888762EE 02/1992 EE $1,000 M43888763EE 02/1992 EE 1,000 M43888764EE 02/1992 EE 1,000 M43888765EE 02/1992 EE 1,000 M43888766EE 02/1992 EE 1,000 M43888767EE 02/1992 EE 1,000 M43888768EE 02/1992 EE 1,000 M43888769EE 02/1992 EE 1,000 M43888760EE 02/1992 EE 1,000 D31294433EE 04/1993 EE 500 ,~t []~ Viewing Bonds 4-13 Serial Number Savin, Total Interest $4,747.20 Issue Price Interest Value $500.00 $458.40 $958.40 500.00 458.40 958.40 500.00 458.40 958.40 500.00 458.40 958.40 500.00 458.40 958.40 500.00 458.40 958.40 500.00 458.40 958.40 500.00 458.40 958.40 500.00 458.40 958.40 250.00 155.40 405.40 Total Value $10,247.20 Interest Rate 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 3.01% Issue Date YTD In $281 Next Final Accrual Maturit 08/2003 02/202 08/2003 02/202 08/2003 02/202 08/2003 02/202 08/2003 02/202 08/2003 02/202 08/2003 02/202 08/2003 02/202 08/2003 02/202 10/2003 04/202 Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty ME Matured (Exchangeable for HH) MN Matured (Not Exchangeable for HH) Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator C' C' C C' INVENTORY Estate of GONGLEWSKI, BLANCHE MACF also known as , Deceased No. 21 03 0796 Date of Death 7/4/03 Social Security No. 150201704 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory, laVe verify that the statements made in this inventory are true and correct, laVe understand that false statements herein made are subject to the penalties of 18 Pa. C.$. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Address: DAVID W. REAGER, ESQUIRE 2331 MARKET STREET CAMP HILL PA 17011 Personal Representative: Telephone: 717-763-1383 Stocks & Bonds Descdption SEE ATTACHED SCHEDULE Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable MORTGAGE RECEIVABLE Cash, Bank Deposits, & Misc. Personal Property (Attach Additional Sheets if necessary) Total Value ,--'::='t'0247.20 kid , 63,697.00 500,947.38 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory .~ONGLEWSKI, BLANCHE MACF )escription of Inventory Page 1 21 03 0796 Descdpfion ~OUSEHOLD GOODS AND PERSONAL ITEMS /ANGUARD ACCOUNT # 9965655232 ~eal Estate 1551 BRIDGE STREET, NEW CUMBERLAND, PENNSYLVANIA contract sales price 1600 BRIDGE STREET, NEW CUMBERLAND, PENNSYLVANIA,._ ~, 135,130 county assessed value x 1.0 = 135,130 ~"~ "' "" ,/ ~- 1602 BRIDGE STREET, NEW CUMBERLAND, PENNSYLVANIA~'~ 23,250 county assessed value x 1.0 = 23,250 1316 BRANDT STREET, NEW CUMBERLAND, PENNSYLVANIA 75,930 county assessed value x 1.0 = 75,930 Value 1,000.00 104,193.18 87,500.00 135,130.00 23,250.00 75,930.00 Subtotal $ 427,003.18 Grand Total $ 500,947.38 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 NO. REV-1162 EX(11-96) CD 004250 REAGER DAVID W ESQUIRE 2331 MARKET STREET CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 150-20-1704 FILE NUMBER: 2103-0796 DECEDENT NAME: GONGLEWSKI BLANCHE MACF DATE OF PAYMENT: 08/09/2004 POSTMARK DATE: 08/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/04/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,990.14 )YEN REMARKS: TOTAL AMOUNT PAID: GONGLEWSKI ELISABETH $1,990.14 SEAL CHECK# 279 INITIALS' SK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDTV/DUAL TAXES INHERITANCE TAX DIVISION DEPT. 28060i HARRISBURG, PA I7128-060! CONNONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DAVID N REAGER ESQ*04 REAGER & ADLER PC 255! HARKET ST CAHP HILL 13 .;i 8:05 DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN RE¥-ISd? EX AFP (01-05) 10-11-200q GONGLENSKZ BLANCHE H 07-Oq-ZO0$ 21 05-0796 CUHBERLAND 101 Amoun~ Remi~ad r HAKE CHECK PAYABLE AND REMIT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS -~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF GONGLENSKZ BLANCHE H FILE NO. 21 05-0796 ACN 101 DATE 10-11-200~ TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVAT/ON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bends (Schedule B) (2) $. Closely Held S~ock/Par~nership In~aras~ (Schedule C) (3) q. Mortgages/No,es Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Propar~y (Schedule E) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asso~s APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expensas/Adm. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Dab,s/Mortgage Liabili~ias/L/ens (Schedule 1) (10) 11. To,al Deduc~/ons 12. Ne~ Value of Tax Ra~urn 15. Charitable/Governmental Bequests; Non-alac~ad 9115 Trusts (Schedule J) Ne~ Value of Es~a~a Subjac~ ~o Tax $21z810.00 10z2~7.20 .00 65~697.00 105~195.18 19~607.91 11~z885.~8 (B) 7,882.02 NOTE: To /nsure proper crad/~ ~o your account, subai~ ~he upper pore/on of ~h/s form w/~h your ~ax payment. NOTE: 655,q~0.77 19. Principal Tax Due TAX CREDITS: PAYMENT R~CE~P1 DATE NUNBER 10-02-2005 CD005080 08-09-Z00~ CD00~250 lO-OR-Z00q REFUND DISCOUNT INTEREST/PEN PAID (-) 1,315.79 26.88- .00 IF PAID AFTER DATE /NDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. · O0 X O0 = . O0 627,558.75 X 0~5= 28,2~0.1~ . O0 X 12 = . O0 · 00 X 15 = .00 (~9)= Z8,2qO.lq AMOUNT PAID 25,000.00 1,990.1q 38.91- TOTAL TAX CREDIT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE ASSESSHENT OF TAX: 15. Amoun~ of L/ne lq a~: Spousal ra~e (15) 16. Amount: of Line lq ~axable a~: Lineal/Class A ra~e (16) 17. Amount: of L/ne lq a~ S/bl/ng ra~a (17) 18. Amoun~ of Line lq ~axabla a~ Collateral/Class B ra~a (18) 28,ZqO. lq .00 .00 .00 ( IF TOTAL DUE TS LESS THAN $1, NO PAYMENT IS REi)U/RED. ]:F TOTAL DUE IS REFLECTED ASA"CREDIT" (CR), YOU MAY BE )OUE.'~7~ ~ A REFUND· SEE REVERSE SI:DE OF THIS FORM FOR INSTRUCTIONS. Zf an assessment Nas issued previously, lines lq, 15 and/or 16, 17, 18 and 19 reflect figures that lnclude the tote! of ALL returns assessed to date. .00 (11) 7.882.02 (12) 627,558· 75 (13) . O0 (lq) 627,558· 75 RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December ZZ, 1981 -- if any future interest [n the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfut Class S (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may bo requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office of the Register of Ni11s, any of tho 13 Revenue District Offices, or by calling the special 24-hour answering service for fores ordering: 1-800-361-Z050~ services for taxpayers eith specie! hearing and ! or speaking needs: 1-800-447-302D (TT only). Any party in interest not satisfied with the appraisement, allowancm, or disallowance of deductions, or assessment of tax (includln9 discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-1021, OR --election to have the matter determined at audit of tho account of the personal representative, OR --appeal to the Orphans' Court. 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. 180601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a fivm percent (5Z) discount of tho tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of dolinquency~ or nine (9} months and Dna il) day from the date of death, to tho date of payment. Taxes which became delinquent before January 1, 19BI bear interest at tho rate of six (61) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January 1, 19DZ 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. Tho applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor ~ 20X .000548 ~-1991 111 .000301 1983 167. . 000438 1992 97. . 000147 1984 111 .000301 1993-1994 71 .000191 1985 132 .000356 1995-1998 92 .000247 1986 101 . 000274 1999 72 . 000192 1987 101 .000274 ZOO0 72 .000192 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPAID Daily Year Rate Factor ~ 9X .0002~7 2002 6X .000164 Z003 51 .000137 2004 ~Z .000110 X NUHBER OF DAYS DELINI;IUENT X DAILY INTEREST FACTOR --Any Notice issued after tho tax becomes delinquent will reflect an interest calculation to Tiftoen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVI'SI'ON DEPT. 280601 HARRISBURG,, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-I&07 EX AFP CB1-03) DAVID W REAGER ESQ REASER & ADLER PC 2551 MARKET ST CAMP HILL DATE 10-18-2004 ESTATE OF GONGLEWSKI DATE OF DEATH 07-04-2005 F/LE NUHBER 21 05-0796 COUNTY CUMBERLAND ACN 101 BLANCHE' M PA 17011 MAKE CHECK PAYA]~LE AND REi~ZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT H~SE CARLISLE, PA 17015 ..... NOTE: To insure proper credi~ ~o your accoun~c, submi~ ~he upper por~ion of ~his' form wz~our ~mx payment. CUT ALONG THIS L'rNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~N~ 'rNHER'rTANCE TAX STATEMENT OF ACCOUNT ~ ESTATE OF GONGLEWSKI BLANCHE M FILE NO. 21 05-0796 ACN 101 DATE 10-18-2004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAHED ESTATE. SHONN BELON ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS., THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FZOURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-11-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 28,240.14 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 1,515.79 10-02-2005 08-09-2004 10-04-2004 CD005080 CD004250 REFUND 26.88- .00 25,000.00 1,990.14 58.91- ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 28,240.14 ~ALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NTLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANTA. 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-IS15). Applications are available at the Office of the Register of Nills, any of the Z5 Revenue District Offices or from the Department's Zq-hour answering service for forms ordering: 1-800-56Z-gOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-q47-50ZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, Dept. ZB060I, Harrisburg, PA I71gB-060I, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (BZ) discount of the tax paid is allowed. PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, er nine (9) months and ane (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, I982 bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on and after January 1, 19BI 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 19BI through ZOO4 ars: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z lOX ,000548 1988-1991 llg .000501 ZOOl 9g .000Z47 1985 16Z .000458 1992 92 .000Z47 ZOOZ 62 .000164 1984 Ill .000~01 1995-1994 7X .000191 2005 5X .000157 1985 13X .000~56 1995-1998 92 .000247 2004 4X .000110 1986 101 .000174 1999 72 .000191 1987 91 .000Z47 ZOOO BZ .000Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELXNQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of tho assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.