HomeMy WebLinkAbout06-28-11 (2)
REV-~ 500
PA Department of Revenue
Bureau of Individual Taxes
PO 80X.280501
Harrisburg, PA 17128-0501
150561t]143
~x lo+-+o)~
Pennsylvania
oau~.wr. os.eveMUe
INHERR
RESIt
ENTER DECEDENT INFORMAT1t;m tstwsr
Social Security Number Date of Death
209 20 9463 02 16 2010
Decedent's Last Name Suffix
KOVALCIFC
(If Applicable) Enter Surviving Spouse's Inftxmatlon Below
Spouses last Name Suffix
OFF1CIAt USE ONLY
Canty Code Year FPM Nurt~DBr
TAX RETURN 21 10 0573
)ECEDENT
Date of Birth
Decedent's First Name MI
JO$EPH A
Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST t3E FILED IN DUPLICATE WITH THE
REGISTER 4F WIILS
FILL IN APPROPRIATE OVALS BELOW _
~, Original Return , X, 2 SuRplemental Return i g, Remainder Return (date of death
prior tot 2-t 3-82)
q Umiled Fatale 48 Futw~ Intereu Comprem~se 5 Federal EStatE Tax Return RequKed
(dsteordeathsher r2-t2-P,Y)
& p~cedent Orod Testae ~ I 7, l~ ~I~y rusts Gvmp T~uet _ _ g Total Number W Safe Deposit Boxes
X tAttscn~o~roiwalf
ur aUOn Proceeds Rererved t0 ~°"~ P~ri('~'t ``d~ d ~aa+ 1 t Eledan to tax under Sec 9t t3(A)
~, rg ~ twtrsn t t- end 7-1- S) (AttAGh $Ch O]
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIbENT1AL TAX INFORMATION SHOULD BE DNtECTEO TO:
Name Daytime Tetephbne Nta-nber
MICHAEL L BANGS 717 730 7310
first line of address
429 SOUTH 18TH STREET
Second Ilne of address
City or Post Otfiee State ZIP Code
CAMP HILL PA 17011
REGISTER ~ 1bfILL3 USEDNLY _. ,
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Correspondent's ama11 address:
UrWer penatlles d perjury, I declare that I have examined this return. Indudiny accomRatty^!+g schedules and Statements, and to the best of my knowledge and babel,
n to true. coned and oomplele. Dederauon d praparer other than the personal representative ~ based on all infortnaha+ o<which preperer has any knowledge
,,,,rte
~~~'~'~~,,~ ~~ ~ ~ ~ Mark A Kovaicik ~,-~ ~~ Y/fr
ADDRESS
ost Office Box 395 G - MD 20621
.TURF OF PRE AR~R OTHER T PRE NTATIVE - OAT ~~
„~~,~'~,,~~ Michael L. t3angs ~ ~ ` u
ADDRESS
429 South 18th Str Cam Hill, PA 17411
Side 1
150561[1143 150561Q143 J
(
J
15D561D243
REV-1500 EX
Decedent's Name: KOVaIC1IC, Joseph A.
___ _ -- -
RECAPITULATION
1. Real Estate (Schedule A) ..................................................................................... .. 1.
2. Stocks and Bonds (Schedule B) ........................................................................... .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)....... .. 3.
4. Mortgages & Notes Receivable (Schedule D) ...................................................... .. 4.
5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. .. 5.
6. Jointly Owned Property (Schedule F) 'L_j Separate Billing Requested........... . 6.
7. Inter-Vivos Transfers & Miscellaneous Noq-Probate Property
(Schedule G) I_ _!. Separate Billing Requested........... . 7.
g. Total Gross Assets (total Lines 1-7) ................................................................... .. g.
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10.
11. Total Deductions (total Lines 9 & 10) .................................................................. . 11.
12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .............................................. . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ..............................................
- - _ . 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16 Amount of Line 14 taxable 126 940
57 16
.
at lineal rate X .045 ~ .
17 Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18 Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19 Tax Due ................................................................................................................ 19.
20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Decedent's Social Security Number
209 20 9463
131,212.84
2,334.62
120.30
133,667.76
__ _ __ __
3,218.00
3,509.19
6,727.19
126,940.57
126,940.57
0.00
5,712.33
0.00
0.00
5,712.33
Side 2
15D561D243 15D561D243 J
REV-1500 EX Page 3 File Number 21-10-0573
Decedent's Complete Address:
DECEDENT'S NAME
Kovalcik, Joseph A.
STREET ADDRESS
407 Woodland Avenue
CITY -
New Cumberland
_. - _ -- -
__ _ __ -
STATE ZIP
PA ' 17070
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 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.
Make Check Payable to: REGISTER OF WILLS, AGENT.
(3) 113.06
(4)
(5) 5,825.39
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? ...................................................................................................
_....._
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[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 21 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 percent [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 percent, 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 percent [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.
(1) 5,712.33
Total Credits (A + B) (2)
Rev-1502 EX+ (11-08)
COMMON WEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~ SCHEDULE A
REAL ESTATE
ESTATE OF
Kovalci
A.
FILE NUMBER
21-10-0573
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on schedule F.
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08)
(If more space is needed, additional pages of the same size)
Rev-1505 EX+I6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kovalcik, Joseph A. 21-10-0573
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 67 shares of Metropolitan Life - 67 shares Metropolitan Life 34.845 2,334.62
Trust Interests (mean value as of date of death)
TOTAL (Also enter on Line 2, Recapitulation) 2,334.62
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMON WEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kovalcik, Joseph A.
FILE NUMBER
21-10-0573
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.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (10-06)
COMMNHERITANCE TAX RETURNANIA
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Kovalcik, Joseph A. 21-10-0573
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N MBER
A, FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Ziq
Year(sl Commission Daid
2. Attorney's Fees Michael L. Bangs 1,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. I Probate Fees
5. Accountant's Fees 290.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,928.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 3,218.00
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF (FILE NUMBER
Kovalcik, Joseph A. 21-10-0573
ITEM
NUMBER
DESCRIPTION
AMOUNT
1-800-GOT-Junk -removal of trash and items of personal property from residence 1,128.00
Pete Spizzini -Change of electric panel at real estate
800.00
H-B7 1,928.00
Copyright tc) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+(12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kovalcik, Joseph A. 21-10-0573
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Borough of New Cumberland -sewer/trash 97.55
2 Borough of New Cumberland -sewer/trash 97.55
3 IRS - 2010 income tax due 2,728.00
4 PA American Water Company 56.41
5 PA American Water 28.01
6 PA American Water 55.88
7 PP&L Electric 89.98
8 PP&L Electric 111.42
9 PP&L Electric 87.05
10 PP&L Electric 42.45
11 PP&L Electric 7.54
12 PP&L Electric 9.01
13 UGI 14.82
14 UGI
13.13
15 UGI
14.30
16 UGI 15.42
17 UGI 14.34
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 10, Recapitulation) 3,509.19
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
Rev-1512 EX+ (6-98)
SCHEDULE 1
•° DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN continued
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Kovalcik, Joseph A. 21-10-0573
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (t t-08)
SCHEDULE J
COMMNHERIETANCE~AXRETURNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
Kovalcik, Joseph A.
FILE NUMBER
71 _1 A_AG7R
NUMBER
NAME AND ADDRESS OF
RELATIONSHIP TO
DECEDENT i
SHARE OF ESTATE
AMOUNT OF ESTATE
PERSON(Sl RECEIVING PROPERTY (~/ords) ($$$)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
Mark A. Kovalcik Son
Post Office Box 396
Chaptico, MD 20621
Jill A. Weaver Daughter
1332 Sugar Maple Court
New Cumberland, PA 17070
Total
Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
A. Settlement Statement (HUD-1) oMBApproval No. 2502-0265
1 ~ FHA 2. Q RHS 3. Q Conv. Unins. Mumber:
t 1177
N
umber:
6 8. Mortgage Insurance Case Number:
4- ^ VA 5. QX Conv. Ins. 0321
1SL 70
O
8
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown
Items marked
"
"
.
(p.o.c)
were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name ~ Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
Ashley R. Pesaresi Estate of Joseph A. Kovalcik, Mark A. Kovalcik, Jill A Lafayette Ambassador Bank
949-D Innsbruck Drive, Hummelstown, PA 17036 Kovalcik-Weaver '695 State Street, Petersburg, PA 17520
407 Woodland Avenue, New Cumberland, PA 17070
G. Property Location: H. Settlement Agent: I. Settlement Date: 06/10/2011
407 Woodland Avenue
New Cumberland
PA 17070 Regal Abstract (EIN: 23-3029160) Disbursement Date 06/10/2011
, 1476 Lititz Pike, Suite 114, Lancaster, PA 17601
New Cumberland Borough
717-399-9600
Place of Settlement:
411 Hershey Road, Elizabethtown, PA TitleExpress
r tinted 06/09/2011 at 2:57 pm
:.y SLM
:.
.e ~
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller
101. Contract sales price 143,225.00 401. Contract sales price
102.
Personal ro ert
402.
Personal ro ert 143,225.00
103. Setllemenl charges to borrower (line 1400) 6,070.52 403.
104. 4D4.
105. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
106. City/town taxes 06!1012011 l0 12/31/2011 232.59 406. City/town taxes 0611/2011 to 12/3112011 232
59
107. County taxes 06/10/2011 to 12/31/2011 152.55 407. County taxes 06/10;2011 to 12/31/2011 .
152
55
108. School taxes 06110/2011 to 06/30/2011 68.94 408. School taxes 06110/2011 to 06/3012011 .
94
68
109. Library Tax 06/10/2011 to 1213112011 11.47 409. Library Tax 06/1' x!2011 to 12/31/2011 .
110.
Trash 0611012011 to 06130/2011
8.91
410.
Trash 0611J'2011to 06/30/2011 11.47
g 91
111. 411.
112. 412
120• Gross Amount Due from Borrower 149,769.98 420. Gross Amount Due to Seller 143
699.46
200. Amounts Paid b or in Behalf of Borrower 500. Reductions In Amount Due :o Seller ,
201. Deposit or earnest money 2,000.00 501. Excess deposit (see instructions)
202. Principal amount o(new loan(s) 136,000.00 502. Settlement charges to seller(,: ie 1400) 1
203.
Exislin loa s taken sub ec( l0
503.
Exislin loa s taken sub eN °° 2,44127
204. 504. Pa off of first mort a e loan
205. 505. Pa off of second mort a e 1, ~
206, 506.
207, Sewer 04/01(2011 to 06110/2011 45.35 507. Sewer 04/01I2011to 06/10/2011 45
35
208. 508. .
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b s
ll
210.
Cityltown taxes to
510. e
er
City/town taxes to
211. County taxes to 511. County taxes - to
212. School taxes l0 512. School taxes to
213.
513. -
214
514.
215.
515. -
216. 516.
217. 517,
218.
518.
219.
519. --
220. Total Paid b Ifor Borrower 138,045.35 520. Total Reduction Amount Dra Seller 12
486
62
300. Cash at Settlement fromfto Borrower 600. Cash at Settlement tolfrom fieller ,
.
301. Gross amount due from borrower (line 120) 149,769.98 801. Gross amount due to seller f ie 420) 14
302.
Less amounts paid bylfor borrower (line 220)
138,045.35
602.
Less reductions in amount a
teller (line 520) 3,699.46
303.
Cash 0 From ~ To Borrower
11,724.63
603 ,
Ca
h QX T
" 12,486.62
e u m
, ur en or rs co nc ,ono ,n orma .on s es .ma . s
o G .
-om Seller 131,212.84
mrs m,m. ,m e a m,o es cer
~e~ii ~piev: a coReow ~a~a ornn ~.om.~~ ~„mti, v,, ,,,..,...a..,..~....:. response or w ac nq, rememiq, a repo ,oQ e a a. s .aPncv n.a. oo ~o
.~ ,.,,, ::.,,, ......_ _.... __ __ __.
process.
_•~~~•.~i~. y ~,is,saespnea oprovtle the Den,esloa RESPq cove,p,l ~nnsact,on wilA ,nlartnalion Ounny,l,. sc~pemenl
Previous editions are obsolete Page 1 of 4
HUD-1
'. -l-t _
700 T
Dial Real Estate Broker Fees $ 10,025.75
Division of commission line 700 as follows: Paid From
Bor
' Paid From
'
701. $5,7220(7 tD Walker Realty ~ rower
s
F
d Seller
s
702. $4,296.75 to Really 1, Inc.
703. Commission paid at settlement -- un
s at
Settlement Funds at
Settlement
704. Broker Fee ..
to Walker Realty 10,025,75
705. Trans Fee
tp Really 1
195 00 195.00
800, hems Pa able in Connection with Loan
801. Our origination charge (Includes Origination Point 0.000% or $0.00) $695.00 (from GFE #ty,
802. Your credit or charge (points) for the specific interest rate chosen $
(from GFE #2)
803. Your adjusted origination charges
(from GFE FJ
804. Appraisal fee to A r
i
l S
l
ti
4 695.00
a
sa
o
u
ons $
50.00 B POC (from GFE #3)
805. Credit report t
Inf
ti
R _175 DD
o
orma
ve
esearch (from GFE #3;,
806. Tax service to 15.1
from GFE #3)
607. Flood certification
to First American Flood Services (from GFE #.)
808. to 11 50
900. hems Re wired b Lender to be Paid in Advance
901. Daily interest charges from from 06/10'2011 to 07/01/2011 @ $19.0959Iday (from GFE t," :0) 401 01
902. Mortgage Ins. Premium (or months to (from GFE #:i
903. Homeowner's insurance for 1 ears to Erie Ins Co (from GFE #11) 494 n0
904. months to from GFE #'.'i
1000. Reserves De osited with Lender -
1001. Initial deposit (or your escrow account (from GFE #~! 1
356
48
1002. Homeowner's insurance months $ O.OOlmonth $ ,
.
1D03. Mortgage Insurance
months $ 75.931month $
1004, City Propedy Tax 5
~ -
months $ 34.51/month $172.55
1005
County Properly Tax 5
.
months_@ $ 24.341monlh $121.70
1006. School taxes 13 months $ 99.861month $1,298.18
1007. Aggregate Adjustment $-235.45
1100. Title Char es
1101. Title services and lender's title insurance
from GFc '!}
1102. Settlement or closing fee
-" 1,358.'5
to $
1103. Owner's title insurance from GF"r_ i;5
1104. Lender's title insurance $1,263.75 147.Pn
1105. Lender's title policy limit $136,000.00 Lender',: Policy ~.,r
1106
Owner's title
olic
limit $143
225
00 O
'
P
l
.
p
y
,
.
wner
s
lcy
o
1107. Agent's portion of the total title insurance prerrlum $1,158.64
1108
Underwriter's portion of the total titl
i
.
e
nsurance premium $252,gg
1109. Tax cert to legal Abstract Recording A
1110. Notary to ~Jota $30.00 10.00
-
1100. Government Recordin and Transfer Champs
1201. Government recording charges $ (from GFE ~'~~)' 138
00
1202. Deed $52.00 Mort a e $86.00 Release $ .
1203. Transfer taxes $ (from GFE #3) 1
432
25
1204
CitylCounty laxlstam
s ,
.
.
p
Deed $1,432.25 Mort a e $
1205
State Tax/stamps
.
Deed $1,432.25 Mort a e $ 1
1206
Deed $ ,432.25
.
Mort a e $ Release $
1207. $
1300. Additional Settlement Char es ' -
1301. Required services (hat you can shop for ~ (from GFE k=.?
1302, Survey to $
1303, to --
1304
2011 County(fw
lLibra
Taxe
.
p
ry
s to Robin Gas eretti
1305. Ke s ._
Ih'
lk
y t
R 706.15
o
a
6r
ealt
t1 ~ ~ - ~ ~ ~ ~ ~ ~ ~ r r
- 72 12
~
6,070.52 12441.27
'Paid outside of closing by (B)orrower, (S)eller, (L,endar, (I)nvestor, 8ro(K)er. "Credit by lender shown on page 1
"' Credi ! ; teller sh
w
.
SUBSTITUTE FORM 1099 SELLER STATEMENT: The ~aformation contained herein is important tax information and is bei
requred to file a return
a negligence penalty or other sanc!ion will b
i o
n on page 1
ng lure ~.-.~ :,'.io the Internal Revenue Service. I! you are
,
e
mposed on you if this item is required to be reported a
Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction. nd the !r:;< determines That it has no! been reported. The
SELLER'S INSTRUCTIONS. if the real estate was your principal residence, (le Form 2119, Sale or Exchange or Principal R
other transactions, complete the applicable parts of Form 4797
Form 6252 and/or Sch
d
l
D
F esiden, _. !or any gain, with your Income tax return; for
,
e
u
e
(
orm 1040).
You are required by law to provide the Regal Abstract (EIt,'~ 23-3029160 717-
) 399-9600(Fed. Tax ID No:
do not prov,de your correct taxpayer identification number, you may be subject to civil or criminal penalties im
d
I
with ; ;ur correct taxpayer ident9calion number. If you
'
pgse
p¢
~w. rider ep:
ties or r wry, I certiry (hat Ltie number
wrt on Ihis~ teme~is.mylcOrrect la7cpayer ides ifi'ation number. V ~1/~jr, / ,~~ Y F..
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n 5 dp~ -
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,,ao~~/y SELLER(S) SIGNATURE(S). ~
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f ~fzrk - 429 6
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SELLER(S)NEW ILI G DDRESS-
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HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HU0.1 Settlement Statement and to the best of my knowledge and belief, it is a true c^ 1 accurate statement of all receipts and
disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-t Settlement Statement.
/ ^ i '~..
Ashley R. Pesar - ~`
Eslate of Joseph A. Kovalci Mark A. Ko 1k
Agent: Mark A. Kovalcik
Title: Executor
'~'.~ T
Jill A. K alci - eaver
4
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have c:^~ised or will cause the funds to be
disbursed in accordance with this statement
1
SETTLEMENT AGENT
~~'/~ //
DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS CR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 16: U.S. CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4
HUD-1
LAST WILL AND TESTAMENT
OF
JOSEPH A. KOVALCiK
I, Joseph A. Kovalcik, a resident of New Cumberland, P ~-isylvania declare this
to he my Last Will and revoke a.ll former Wills and Codicils. ~ ~=
ARTICLE I
Identification of Family
At the present time I am unmarried. In making this `, .'iil I have in mind my
children, Mark A Kovalcik, born 1957, and Jill K. Weaver, 1- ~~ rt 1961, bu( does not
include any children hereaft~^r born to or adopted by me. Any ~< Terence to ~~ "child of
mine" ar "my children" shall include the persons named or referr~~.r~`b in this Article.
ARTICLE II
Disposition of Remains
I direct that my ret7iai s be buried with my wife. I authoT~~ my Execuio~ to can-y
out these directions and wisl~cs, particularly those for the disposit, : of my remains.
ARTICLE III
Appointment of Fiduciaries
A. Appointment of Personal Representative. I r~, ~oint my sc.;~. Mark A
Kovalcik, as Executor of my estate.
B. Bond; Court: Supervision. My Executor shalt. gave the right to serve
without bond and to administer and settle my estate wit; : ?t the inters; ention or
supervision of any court, except to the extent required by la-- Nothing herein shall
prevent my Executor from seeking the assistance of the court i-• ,my situatio~j where my
Executor deems it appropriate.
ARTICLE IV
Specific Gifts
A. Gifts of Spr~cified Items of Property. I give . ~ t my interest in certain
items of tangible personal property to the beneficiaries desi ~ sated in this section cis
follows:
Will of Joseph A. Kovalcik Page 1 of 6 Initials: _ Date: ~ _
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1. Specific Gift One. I give my 1996 Oldsmobile to my son, Mark A
Kovalcik if he survives me. If Mark A Kovalcik does not survi~;e me no property shall
pass under this Article.
2. Specific Gift Two. I give my home 4Q7 Woodland Ave New
Cumberland Pa and all of its contents to be divided equally between to Mark A I{ovalcik
+ i f :.:u... ~ ~ Iii ~ u:~ ~, .,~.~ tb-is
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~'~ C~ gift-te Jill K. Weaver.
B. Insurance. I give to each recipient of an item of tangible personal
property my interest in any insurance covering the item. My purpose in making this gift
is to give each recipient the benefit of insurance coverage for wl-~~ich I have already paid.
It is not my intention to give any recipient the proceeds of an insurance claim that exists
but is unpaid at my death.
ARTICLE V
Dx_ ~sAOSition of Residue
A. Provision for Descendants. I give all of the rest ~~nd residue o f my estate,
wherever located (hereafter referred to in this Article as "residua), to my descendants if
they survive me per stirpes.
1. Provision for Clthers. If I am not s~~trvived by airy of my
descendants, I give the entire residue to my heirs.
ARTICLE VI
Alternative Methods of Distribution
A. Purpose of Article. Recognizing that under curtain circumstances the
terms of this Will may direct that property be distributed outright to a person who is
under age twenty-one (21) or under a legal disability; I make the following provisions to
facilitate the distribution of ^~roperty to such persons.
B. Alternative :Methods. Whenever the terms c~f this Will direct my
personal representative (referred to in this Article as the "E`,duciary") to distribute
property outright to a pers~~n who is then under age twenty-o=,c (21) or under a legal
disability, the fiduciary may retain pursuant to Paragraph C. of this Article or distribute
all. or any portion of that property in any one or more of the follo~~ring ways:
1. Delivery directly to the beneficiary;
2. Delivery to the parent or stepparent of the',eneficiary;
3. Delivery to the guardian of the beneficiai-y'~s person or property;
Will of Joseph A. Kovalcik Page 2 of 6 Initials:' . ~ Date: _ ~ ~~ b
4. Delivery to any Custodian for the beneficiary under the Uni forn~
Gifts to Minors Act;
5. Delivery to any then existing trust created fir the benefici,u•y;
6. Deposit in a financial institution in an acc;~unt established in the
name of the beneficiary alone pursuant to the laws of the State of
Pennsylvania;
7. Storage of any tangible personal property in safekeeping with the
costs of storage to be borne by the beneficiary; or
8. Sale of any tangible personal property and c'elivery of the proceeds
in any manner permitted by this Article.
Provided the fiduciary acts in good faith, upon delivery of any property in
accordance with the provisions of this Article, the fiduciary shad be discharged from alt
responsibilities in connection with the property.
C. ]Discretionary Trust. Any property not distributed as provided in
Paragraph B. of this Article shall be retrained by the fiduciary in E.~-ttst for the beneficiary
on the following terms and conditions; During any period in ~rnich the beneficiary is
under a legal disability or under twenty-one (21) years of age, the fiduciary shall pay to
or apply for the benefit of the beneficiary so much of the income a-~d principal of the tntst
as the fiduciary, in its sole and absahite discretion, determines is advisable for the
beneficiary's health, support, education and general welfare. At such time as the
beneficiary is neither under a. legal disability nor under age twenty-one (21), the fiduciary
shall. distribute any remaining trust assets to the beneficiary. '.f the beneficiary dies
before all of the trust assets have been distributed, the fiduri~~-y shall distribute anv
remaining mist assets to the beneficiary's estate. /
ARTICLE VII
Administrative Provisions
A. Powers and Duties of Personal Representative. My persona.(
representative shall have ail of the powers and duties grante~~l to or imposed upon
personal representatives serving with non-intervention powers pursuant to the laws of the
State of Pennsylvania.
B. Debts and Expenses. All expenses of adminatration chargeable to
principal, the expenses of the disposition of my remains, and all my legitimalc debts, i f
and when paid, shall be paicl from the principal of my residuary estate. No debt need be
paid prior to its maturity in due course and except as otherwise provided in this Will no
interest in any property passing under this Will need be exonerated:,
Will of Joseph. A. Kovalcik Page 3 of 6 InitiaJsn Date: _ ~~~ (~
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C. 'T'axes. All estate, inheritance or other similar d<=;=ah taxes, together with
any interest or penalties thereon, arisin}; by reason of my de;' :h with respect. to any
property includable in my taxable estate, and any adjusted taxab' ° gifts, whether passing
under or outside of this Will, shall be paid from the principa; ~f my residuary estate
without reimbursement from the recipients or beneficiaries of :such property, provided,
however, that in the event any proceeds of insurance upon my ~ or any property over
which I held a power of appointment are included in my .state for }-purposes of
determining the federal estate tax liability of my estate, then the rFaidue of my estate shall
be entitled to receive from the recipients of any such proceeds o; property the portion of
such federal estate tax liability attributable to such proceeds or property determined in
accordance with TRC §§ 2206 and 2207.
ARTICLE VIII
Miscellaneous
A. Number and Gender. [Jnless the context indicG;':es a contrary intent, the
plural and singular forms of words shall each include the other, and every noun and
pronoun shall Have a meaning that includes the masculine, femini.~e and neuter genders.
R. Survival. To "survive" me, as that term is used i;: this Will, a person must
continue to live for thirty (30) days after my death.
C. Descendants. The "descendants" of an individual include only the
fol]owing:
1. All such individual's biological descendat~ia, except any person not
born in lawful wedlock and his descendants, unless the biological
parent who would otherwise cause him rr her to be a descendant
has acknowledged paternity or maternity in legitimation
proceedings, or in an unambiguous signe<~ writing identifying such
person by name, or by raising such persc~; in the same household;
and
2. Persons adopted by such individual or one of his or her
descendants, and their descendants.
If the parent, who would cause a person to be a descendant as ~_ =fined above, is replaced
in an adoption proceeding, such person shall remain a desc~ .~dant unless such parent
voluntarily consents to the relinquishment of his or her status as :parent in connection with
such adoption proceedings.
D. Heirs. The term "heirs" shall mean those persor;s entitled to inherit under
the then-applicable laws of the State of Pennsylvania gov€:rning the descent of an
intestate's separate estate. They shall inherit in their statutory proportions.
Will of Joseph A. Kovalcik ]Page 4 of 6 Initials: :. ~ Date: ~ ` b
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E. Exclusion of it'retermitted Heirs. Other than as : -~t forth in this Will, I
make no provision for any ci~ild of mine or descendant of a de:: iced child. o~ mine. I
specifically make no provisi.m for any person (whether now h 4- ~g or herea[tcr born),
other than a child named or referred to in Article I or a descends-,:±~ of mine as defined in
this Will, who maybe entitled to claim an interest in my estate wt:' ~r the laws c~ f the Statc
of Pennsylvania.
F. Legal Disabiaity. A person is under a legal d~~ bility if my personal
representative determines, in good faith, that the person is inc; -,able of managing his
property or of caring for himself, or both, or is in need of protection or assistance by
reason. of physical injury or illness, mental illness, developmc,; tal disability, senility,
alcoholism, excessive use of drugs, or of;her physical or mental in=~.=pacity.
G. Title to Real Property. Upon my death, title to .a~:,y real property passing
under this Will shall vest in my personal representative in his fid-~:--sary capacity and shall
remain so vested until my personal representative distributes ~~ sells that property, at
which time title shall vest in the distrsbutee or purchaser.
H. Disclaimer. Except as may be otherwise spec. 4cally provided in this
Will, in the event that any b~.neficiary disclaims an interest arisi°- ;out of this V~ ill or any
trust created herein it is my intention ghat the interest dssclaim•1 shall be distributed in
the same maruier and at the same time as if the disclaims- ; beneficiary had died
immediately preceding the event pursuant to the laws of the Stat.: ^+f Pennsylvania.
L Governing Law. The provisions of this Will .shall be interpreted in
accordance with and in ligh~. of the laws of the State of Pennsylvania.
J. Corporate Successors. Whenever a corporatic~~ or other business entity
is referred to herein, the reference shall include any successor o:-,anization.
K. References ~o Statutes. In this Will, the abbrevEZtion "IRC" shall refer to
the Internal Revenue Code of 1986 as amended.
Will of Joseph A. Kovalcik
Page 5 of 6
~~.
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Initial:
Date ~ ]~ V ~
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I have initialed and dated for identification purposes all ~~~ages of this, any Last
Will, and have executed the entire instniment by signing this }::~~ge on the ~ day of
200 , at ,-~~~'~• , ~~
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seph`~~. Kovalcik
Attestation and Statement of Witnesses.
Each of us declares under penalty of perjury under the l~~:vs of Pennsylvania that.
Joseph A. Kovalcik, the Testator, signed this instrument as his L,z•s~ Will in our ~~rescnce,
all of us being present at the same time, and we now, at the ~_~estator's request, in the
Testator's presence, and in the presence of each other, sign ` elow as the v•ihlesses,
declaring that the Testator appears to be of sound mind and ur .icr no duress, fraud, or
undue influence.
[Witness Signature]
~Jl ~ a ~ ~ ~ 1~~ l~ yU
[Print Namc]
[With: ~ s Signature]
~~ ~
[Ps gat Name]
Residing at ~ ~ ~p~ ~ ~ ~'~~~ Residing at (,~~.?;- L~a~~ ~
Witl of Joseph A. Kovalcii: Page 6 of 6 Initi..
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