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HomeMy WebLinkAbout04-0774 Register ofVViUs of Cumberland County Name of Decedent: -'1' ?l)/~uce STATUS REPORT UNDER RULE 6.12 c.e;;:::;~U/ Date of Death: C)'47J/Y// ~"~Z5~/() )/ , , Estate No.: 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)i; cOJl1ple!r /1 ~ ~/eQ , Yes ~ No 0 /~ I7/:- /,:).:5/ o. ,,-t/ ~ ~ y'- ~~J ~/1#~- J:7U ~w:y 6/'LOo";; 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: .6J<:Y'y;l;{,~ 3'. If the answer to No. 1 is Yes, state the following: a. Did the personal representative :file a final account with the Court? Ye~ No 0 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 U No U c. Copies of receipts, releases, joinders and approval offonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be , attached to this report / ,/' / ~ / (?/<., /('J ( L / (C/ ~ .. - 'SeT Date: /,-' ./ /'// / ,,' -,...-~~,..~;;-:..,.- /'--' .--:;.-, . /,~.,,-- 1... , _..' ~/.~/ t:/' . Signature ~ __ /' ' /,/::?' /-', ,.( V t.~ -C~../5.r/ [C.:/:.........C.--'<..J;.. t::'-// 'Name / r:,?33 / ~jc//'<_u//iC /0 "J/,' . <,~'/~--7 /Cc<>{; - CU(,CY- Addre.ss / " 1A?d- T~lephon o. Capacity: Q1:Personal Representative o Counsel for personal representative I., .'--....;.,.:.-;..--. ,/: / \ / 'vJ'i i/'\_' '",/ --1 \\~v, Estate of ~ Msoknownas Register of Wills of cUMBERLAND County, Pennsylvania , ION FOR GRAN T OF LETLT_ERS . PETIT m-0 l- O01'lq FLOKE~NCE V_~.CEKOVICH No. '.,-, ~ - ~-- -- ..-, Deceased Social Security No. 187-16-6104 GARY N CEKOVICH (COMPLETE "A" OR "B" BELOW:)-- in the Last Will of the Probate and Grant of Letters and aver that petitioner(s) is/are the executor named __ [~ A. and codicil(s) dated -- Decedent, dated ~ -- -- Except as lblloxt s, Decedent &d , ' ' ol a killing and v, as ne~er adju&cated incompetent none [~l B. Grant of Letters of Administration left no Will and petitioner(s) a Name GARY N CHERYL ANN BAKER DAUGHTER and heirs: PA 17025 6403 SALEM PARK CIRCLE, MECHBG.. PA (CONtPLETE IN ALL CASES:) Attach additional sheetS if necessary. County, Pennsylvania, with his/her last family or principal residence at ' ' ' at death in cUMB~BERLAND - deo -- Decedent was domtc -~,,^-T=n,~ Ham, q ale tt 6403 SALEM PARK CIRCLE, MECHBO,. -,~ Decedent, then 8_.__2 . years of age, died JULY 25 2004 at HOLY SPIRIT HOSPITAL CAMP HILL PA Decedent at death o~med property with estimated values as follows: .......... $ -- 20~ A persona property .......................................... . ........ $-- (If domiciled in PA) personal propex~y in Pennsylvania ............................. ... $ -- (If not domiciled in PA) $ 0 · (If not dom c led in PA) persona property n County .......................................... . ......... Value of real estate in Pennsylvan a . ' ........ Total ......... ~le~Sf;~ 7~ildn~°i~711tfully request(s)the probate of the last Will and Codicil(s)presented with this Petition and the grant of letters n the appropriate form to he undersigned: . T ed or tinted name and residence Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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, according to law. ~/~' ~ Petitioner(s) will well and truly administer the estate ~. / ~. ~ Sworn to and affirmed and subscribed GARY N. CEKOVICH before me this day of ~ ~/~'?~'</2004 No. Estate of FLORENCE V. CEKOVICH Deceased Social Security No: 187-16-6104 Date of Death: JULY 25, 2004 AND NOW, ~ L( (:1 D(~- ~ CI ~ 200 4, in consideration of the Petition on the reverse side hereon, satisfactory proof having been pre'sented before me, IT IS DE'~CREED that Letters [] Testamentary yof Administration D.B.N.C.T.A.; pendente lite; durante absentia; durante minoritate are hereby granted to GARY N. CEKOVICH_ in the above estate and that the instrument(s) dated in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... $~ Register of Wills Short Certificate(s) .......... $ `~'~ ' ~ ~ Renunciation .................. $ Affidavit ( ) ................. $ Extra Pages ( ) ............ $ Codicil .......................... $ JCP Fee ........................ Inventory ....................... Other ............................ .5.00 TOTAL ................ described Attorney: Robert C. Spitzer, Esquire I.D. No: 06264 Address: 2401 North Front Street, P. O. Box 12087 Harrisburg, PA 17108-2087 Telephone: 717/231-7600 $~ OMMONWEALTH OF PENNSYLVANIA ° DEPARTMENT OF HEALTH * VITAL RECORDS 82 yr$ 3'19--22 Cumberland E. Pennsboro DECEDENTSUSUALOCCUPATI©N K~ND OF BUS[NESS / INDUSTRY Navy Depot y ~chanlcsburg 6403 Salem Park Circle RE$,©ENCE Mechanicsburg, Pa. CERTIFICATE OF DEATH .............. 2 female, 187--16 ~6104 ~ White ~.~ ~o~ ~,* o,~.~ ...... widowed Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of FLORENCE V. CEKOVICH No. ~7~ I _ ¢-~/~---~-~'z~ also known as , Deceased The undersigned, CHERYL ANN BAKER , DAUGHTER (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters of Administration_ be issued to GARY N. CEKOVlCH Witness MY hand this i C'~ day of E'tA-f~Z~ , 2004. (~Signature) ' 6403 SALEM PARK CIRCLE, MECHBG,. PA 17055 (Address) (Signature) Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this /'~/~'/~' day of ¢~ (L,'¢¢~-;¢- ¢- , 2004. Register of Renunciations executed outside the Office of Wills are required in some counties to be notarized. BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: FLORENCE V. CEKOVICH Date of Death: July 25, 2004 Will No.: Admin. No. 774 of 2004 TO THE REGISTER: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on g/~.~//~ q : Name . Address MR. GARY N. CEKOVICH MS. CHERYL ANN BAKER 6855 Wertzville Rd, Enola, PA 17025 6403 Salem Park Circle, Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule except-- none. Date: ~/~/~/; ~ Name: Robert C. Spitzer, Esq. 5.6(a) Address: 2401 N. Front Street, Box 12087, Harrisburg, Pa. 17108 Telephone: (717)231-7600 Capacity: __ Personal Representative X Counsel for Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WI!,L RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's Will. If the decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA In re: Estate of FLORENCE V. CEKOVICH, deceased No. 774 of 2004 TO: MR. GARY N. CEKOVICH 6855 Wertzville Rd, Enola, PA 17025 MS. CHERYL ANN BAKER 6403 Salem Park Circle, Mechanicsburg, PA 17050 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The decedent, FLORENCE V. CEKOVICH, died on the 25th Day of July, 2004, at Holy Spirit Hospital, Camp Hill, Cumberland County, Pennsylvania. The decedent died intestate without a Will. The personal representative of the decedent is: Name GARY N. CEKOVICH Address 6855 Wertzville Rd, Enola, PA 17025 Telephone: 717-766-0567. If decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County. N/A If decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, Court House, Carlisle PA 17013 717/697-0371. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date Signature Name _Robert C. Spitzer Address 2401 N. Front Street, Box 12087, Harrisburg, PA 17108 Telephone No.717-231-7600 Capacity: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEpARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CEKOVICH GARY N 6855 WERTZVILLE ROAD ENOLA, PA 17025 __uun fold ESTATE INFORMATION: SSN: 187-16-6104 FILE NUMBER: 2104-0774 DECEDENT NAME: CEKOVICH FLORENCE V DA TE OF PAYMENT: 04/21/2005 POSTMARK DATE: 04/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 07/25/2004 NO. CD 005236 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,676.06 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: FLORENCE CEKOVICH CHECK# 3553 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $1,676.06 GLENDA FARNER STRASBAUGH REGISTER OF WILLS ~~ ",l..- Register of Wills Cumberland County, Pennsylvania INVENTORY Estate of CEKOVICH, FLORENCE V. No. 21..Q4-Q774 also known as Date of Death 7/25/04 , Deceased Social Security No. 187-16-6104 GARY N. CEKOVICH, 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 end 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 th Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. IN/e verify that the statements made in this inventory are true and correct. IN/e understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. 1.0. No.: ROBERT C. SPITZER 06264 BOX 12087, 2401 N. FRONT STREET HARRISBURG, PA 17108 717-231-7600 ~~~ Attorney Address Dated ~'/~~ ___,2005 Telephone: Description Value Personal Property 1995 MERCURY SABLE SEDAN, VIN 1G3AJ1137JG31oo87, SOLD 10-4-Q4 FOK $2,200 CEMETERY, CAMP HILL, PA., FOR 4 GRAVES. NOTE: DEED TO DECEDENT'S PARENTS. INCLUDING USED FURNITURE, FURNISHINGS, CLOTHING, SEE VALUATION ATTACHED M & T BANK, CERTIF DEPOSIT #31003914665111. INTEREST THEREON M & T CHECKING # 22081968 M & T SAVINGS # 15004208558625 TOTAL PNC INVESTMENT ACCOUNT: FEDERAL INCOME TAX REFUND $2,200.00 $0.00 $1,900.00 $1,188.34 $7.56 $1,068.30 $53.21 $19,968.07 fT- ~ 3y;. ?,' :7. lId (" -- j~~ 17 v ;; "-"}~ Total from Continuation Page(s) (Attach additional sheets If necessary) Total: NOTE: The Memorandum of real estate outside the ~lth()tiP.~nla may, at the election of personal representative, Include the value of each Item, but such figures should not be extended Into the total of the Inventory. , IlIV'I"'UlI~ :JI.~rn u~.x Cll C. u ::e~ c.;~'" 0:- <( Rev-1500 COMMONWlALTH 0fI PlHHSYLVANIA OEPAImiENT 0fI RlVlHUI DIPT.UOt01 HARIUSIIURG, PA 17,...., INHERITANCE TAX RETURN RESIDENT DECEDENT .... DECEDENrs NAME (lAST, FIRST. AND MIDDLE INITIAL) m CEKOVICH, FLORENCE V. fa DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DO-YEAR) ~ 07.25-2004 05-19-1922 a (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) Xl. Original Return 2. Supplemental Retum '" ~,~ .\). OFFICIAL USE ONLY ALENUMBER.............................................................. 21 2004 on4 Number County Code Y.. SOCIAL SECURITY NUMBER 187-18-6104 THIS RETURN MUST BE FILED IN DUPLICAte WITH THE REGISTER OF WILLS SOCIALSECURnYNUMBER 3. Remainder Retum'_"__.'2.'''''' 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 4a. Future Interest Comprise (d'" of death after lZ.lZ.82) 5. Federal Estate Tax Retum Required 7. Decedent Maintained a Living Trust {A1laCll aCllpy 01 TNSl> 1 8. Total Number of Safe Deposit Boxes 10 Spousal Pove"" Credit (dOl' 01 de... _ lZ.31.tl arcI l.l.~> D 11. Election to tax under Sec. 9113(A) . '" 1_....'" 4. Limited Estate c: (1) "'C = 8- en ~ 8 ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS ROBERT C. SPITZER, ESQ. 2401 N. FRONT STREET POBOX 12087 . HARRISBURG. PA 17108 THIS SECTION MUST BE COMPLETED. NAME ROBERT C. SPITZER, ESQ. FIRM NAME (If Applicable) ROBERT C. SPITZER. P.C. TELEPHONE NUMBER 717.231-7600 1. Real Estate (Schedute A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (1) (2) (3) (4) (5) (6) z o t- <( .....J ::J I- a. <( <-> W ~ 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Sank Deposits & Mise. Personal Property (Schedule E) 6. JoinUy Owned P~ (Schedule F) o Separate BiDing Requested 7. Inter.Vivos Transfers & Misc. Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Oecedent, Mortgage lIabiIiIIea & Uena (Schedule I) 1,. Total Deductions (total Unes 9 & 10) (7) (9) (10) z o t= ~~ ~j Q, 8 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Beques!slSec 9113 Trusts for which an eteclIon to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under See. 9118 (8)(1.2) x 16. Amount of line 14 taxable at Rnealrate J I $. ~,Q.'83 x . 17, Amount of line 14 taxable et IIbIIng rate 18. Amount of line 14 taxable et coII8tera1rate 111. Tax Due 20, D CHECK HERE IF yOu ARE REQUESnNO A REFUND OF AN OVERPAYMENT $e.soo.oo x .15 x .12 $0.00 1 0FaC1AL USE ONLY ["'} i ~:"-,:~.~ i, $O~OO,h 1:...11 . j:'<~.} ~ $0.001, : . :. ~:. $0.00 i: I') ;,."") ~: 41 Q5,t':, -c, 'I',,'. j $22,285~48 i'.. '. '..1 r' , -- ,'~. i: :....'.1, 1 i $13.391.701 1 -................................................................ (8) $401ItO.I~. I $14,598.92 $3,444.43 (11) (12) (13) 1181)41 35 ~ !)/)"l~"1 8.1:1 10m (14) ~ ~2.. .0 - 'r3 .045 - (15) (18) (17) (18) (19) $0.00 $/DI" C)j $0.00 s07~ 00 "t..?{,p > > BE SURE TO ANSWER ALL QUESnoNS ON REVERSE IIDE AND RECHECK MATH C C Decedent's Complete Address: STREET ADDRESS 6403 SALEM PARK CIRCLE CITY I~TATE I~P MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 51,,,q~.O(.. Total Credits (A + B + C) (2) so 00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) (3) 4. 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) 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) SO.OO A. Enter the interest on the tax due. S1,f>7'.Q(, B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 51J6Y'..(lb, 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 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 revisionary 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 on year of death without receiving adequate consideration? CD 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? c=J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? c=J [TI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. No m 6j Declaration 01 preparer other than the personal representative is SIGNATURE OF PERSON RESPONSIBLE FOR s any kno'Medge. DATE ADDRESS 6855 WERT SIGNATUR DATE ADDRESS 2401 N. FRONT STREET, HARRISBURG, PA 17110 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. S9116 (a) (1.1) (I)]. For dates of death on or after January 1, 1995, the tax rate imposed o'n the net value of transfers to or for the use of the surviving spouse is 0% [72 P .5. S9116 (a) (1.1) (ii)]. The statute does not exemDt 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. S9116(a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted In 72 P.S. S9116(1.2) [72 P.S. S9116(a) (1)], The tax rate Imposed on the net value of transfers to or for the use of the decedenfs siblings Is 12% [72 P.S. S9116(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. FA 1. AGE (Lest BiI1I1dey) 82 I. COUNTY OF DEATH Cumberland Month, Dey, Holn DATE OF I'llRTH (Mor.1h, Dey, Veer) 5.J19-22 I. CITY, BORO, TV'IP OF DEATH E. Pennsboro Yrs. Cumberland Did decedent live ina township? 11. 17e. Kl Ves, decedentlivedinF"'mpnQJ:l MARITAL STATUS. Married, Never Married, WCJowed, Di_ (Specify) 14.widowed ::"~I 0 RACE - American Indian. Black, \I'\hl:e. at (Specify) 10. Whi te SURVIVING SPOUSE CHvme, give maiden name) . lb. ... DECEDENT'S USUAl OCCUPATION KINO OF BUStNESS IINDUSTRV (GintlindofWOftdone InOII Nav D t seC'm"a~"'y"''' od) y epo 1~ I~Chan1csburg DECEDENT'S MAILING AOORESS (Street, 'lyiTown, SleIa, Zip Code) DECEOENrs 6403 Salem Park Circle ~~~P:-NCE II~echanicsburg, Pa. ~ou:=n' FATHE~ NAME (first, M~e, lut) h II. l"ranK .t:S. Ku n INFORMANrs NAME (TypeIPfint) 201. M THOO F DI SITION Iluti8I Dr Cremation ~emovel from State 0 Other (Sl*ily) N~RAL SER bNp 17b. Countv 17d. 0 ~~~:~:ru~ of city/bow 23b. 230. WAS CASE REFERRED TO A MEDICAL EXAMINER /CORONER? 21. Ve, 0 No ISZI k or heart lailu,.., : Approximate PART It: Other signifteant conditions contnbuting to dealh, bul . interval betwee not resutting in the uncter1ytng cause given In PART I : onset and death a. Sequentialy IisI conditioo, b ij eny, Ieeding to immediela . cause. Enter UNDERl VlNG CAUSE (Disease Of ir1ury ! c . U'laI initialed events ",'ult'"ll 00 death) LAST d. WAS AN AUTOPSV v..f.RE AUTOPSV FINDI GS PERFORMED? AVAIlABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? V.. 0 No m- Yes 0 21., 2Ib. CERTIFIER (Check only one) 'l:~FJ'':'GJ::'~\I~~= ~'3'uS:fJll:~.===\.t'~~~.~i:.t~.dlleth.~n<l.a.""plete.dlt8fl1.2~)...... NOD Suicide IZI o o DATE OF INJURV (Moolh, Day, Yeac) TIME OF INJURV INJURV AT \\QRK? DESCRIBE HOW INJURV OCCURRED Nature! Accident Homicide Pending Investigation o o 301. 3Gb. M. o PLACE OF INJURY. At home, farm, street, factory, office buiklng. etc. (Specify) 30.. Ve, 0 No 0 30<. 'MEDlCAL EXAMINERlCORONER ::-erb:'::.:~~~~~~~~.I~~~~~~~~~:.I~.~~.~~.~~.~:.~~.~~.~~. ~.~~.~~.'.~~'. ~~~.~~~.~~'.~~~.~~~. ~~.~~~~.~~.~~~~ .~~.. 0 31.. REGtSTRAR'S k>J Ibl V.f I 3<4. Coutd not be detefTlllned 21. ...........0 '''fo<:~~:;':,G~N~;:':J:.~=J:~= l~~::,~~=~.~~hd~I~Z~u~~j~~ '::::~~.r.. ...t.d........... ......... 0 RE.;J-1507 EX + (1j97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF CEKOVICH, FLORENCE V. FILE NUMBER 21-04-0774 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION DECEDENT SOLD REAL ESTATE AT 6855 WERTZVILLE ROAD, ENOLA, PA, FOR $45,000.,9-2-98. DECEDENT TOOK UNRECORDED MORTGAGE, AND NOTE- NO INTEREST- FROM BUYER, [HER SON AND DAUGHTER IN LAW, GARY N. AND DAWNELL CEKOVICH] FOR $45,000. PURCHASE PRICE. SON AND DAUGHTER IN LAW MADE PAYMENTS THEREON, REDUCING THE BALANCE TO $19,000. IN DECEMBER, 2003. TAX PARCEL # 38-14-0846-001 IN DECEMBER. 2003, DECEDENT FORGAVE PRINCIPAL BALANCE OF $19,000., AND, AS EVIDENCE THEREOF, GAVE COpy OF NOTE TO SON AND DAUGHTER IN LAW. WITH THE CONSENT OF ALL PARTIES IN INTEREST TO THE ESTATE- I.E. DAUGHTER OF DECEDENT- THE ESTATE CONSIDERS THE NOTE TO HAVE BEEN FORGIVEN, IN FULL, IN DECEMBER, 2003. GIFT REPORTED ON SCHEDULE G, ITEMS 1 & 2 NOTWITHSTANDING THE FOREGOING, THE ORIGINAL NOTE AND MORTGAGE-UNRECORDED- FOR $45.000. WAS FOUND ON POST DEATH SEARCH OF SAFE DEPOSIT BOX, AND WAS SO INCLUDED ON INVENTORY OF SAFE DEPOSIT BOX, LINES 8 & 10. THE ESTATE CONSIDERS THIS NOTE TO HAVE BEEN VALUELESS AT DATE OF DEATH. BY VIRTUE OF THE FORGIVENESS DOCUMENTED ABOVE. VALUE AT DATE OF DEATH $0.00 TOTAL (Also enter on line 4, Recapitulation) (If more space is needed. insert additional sheets of the same size) $0.00 RE!J.1508 EX + (1,97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CEKOVICH, FLORENCE V. FILE NUMBER 21-04-0774 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 1. 2. 3. DESCRIPTION 1995 MERCURY SABLE SEDAN, VIN 1G3AJ1137JG310087, SOLD 10-4-04 FOR $2,200 CEMETERY DEED DATED 7-11-1941 SECTION 87, BLOCK V, AT ROLLING GREEN CEMETERY, CAMP HILL, PA., FOR 4 GRAVES. NOTE: DEED TO DECEDENT'S PARENTS. NOTE: ORIGINAL DEED FOUND IN POST DEATH SEARCH OF SAFETY DEPOSIT BOX, AND INVENTORIED ON LINE 14. VARIOUS ITEMS OF HOUSEHOLD GOODS AND TANGIBLE PERSONAL PROPERTY, INCLUDING USED FURNITURE, FURNISHINGS, CLOTHING, SEE VALUATION ATTACHED FEDERAL INCOME TAX REFUND FOR 2004 VALUE AT DATE OF DEATH $2,200.00 $0.00 4. $1,900.00 $~ 1""'"3,- TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) J. ~~'!~~. RE".V-1509 EX + (1,.97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CEKOVICH, FLORENCE V. FILE NUMBER 21-04-0774 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. GARY N. CEKOVICH 6855 WERTZVILLE ROAD, ENOLA, PA 17025 SON B. CHERYL A. BAKER 6403 SALEM PARK CIRCLE, MECHANICSBURG, PA 17050 DAUGHTER C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DECD'S VALUE OF NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 7-31-91 M & T BANK, CERTIF DEPOSIT #31003914665111 $2,376.67 50.0% $1,188.34 A INTEREST THEREON $15.12 50.0% $7.56 2 A&B 8-28-64 M & T CHECKING # 22081968 $3,237.97 33.0% $1,068.30 3. A&B 8-21-78 M & T SAVINGS # 15004208558625 $161.24 33.0% $53.21 4. A&B 11-14-97 PNC INVESTMENT ACCOUNT CONSISTING OF CASH $6274.43, and 3360.766 BLACKROCK GOVT INC A@ $10.96, OR $36,834., AND 1531.066 SHARES BLACKROCK GOVT INC. B @ 10.97, OR $16795.79 TOTAL ACCOUNT: $59,904.22 0.3% $19,968.07 TOTAL (Also enter on line 6, Recapitulation) $22,285.48 (If more space is needed, insert additional sheets of the same size) RE;V-1510 EX + (1;97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF CEKOVICH, FLORENCE V. FILE NUMBER 21-04-0774 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S TAXABLE ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. INTEREST EXCLUSION NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET VALUE (IF APPLICABLE) 1. GARY N. CEKOVICH, SON, NOTE FORGIVENESS- ONE HALF OF PRINCIPAL BALANCE OF $19,000 12-03. Original 9-2-98 balance, $45,000. $9,500.00 100.0% 3000 $6,500.00 2. DAWNELL C. CEKOVICH, DAUGHTER IN LAW, NOTE FORGIVENESS, ONE HALF OF PRINCIPAL BALANCE OF ABOVE NOTE 12-03 $9,500.00 100.0% 3000 $6,500.00 3. CHERYL A. BAKER, DAUGHTER, CASH, 7-24-03 to 12-31-03 $2,410.00 100.0% 2410 $0.00 4. CHERYL A. BAKER, DAUGHTER, CASH, VARIOUS, 1-1-04 to 7-25-04, $3,391.70 100.0% 3000 $391.70 TOTAL (Also enter on line 7, Recapitulation) $13,391.70 (If more space is needed, insert additional sheets of the same size) REV-'511 EX. (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CEKOVICH, FLORENCE V. FilE NUMBER 21-04-0774 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MUSSELMAN FUNERAL HOME, LEMOYNE, PA $4,928.34 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions waived Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees ROBERT C. SPITZER, P.C. $6,079.58 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant CHERYL A. BAKER $3,500.00 Street Address 6403 SALEM PARK CIRCLE, City MECHANICSBURG State PA 17050 - Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees REGISTER OF WILLS, CUMBERLAND COUNTY $89.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $14,596.92 (If more space is needed, insert additional sheets of the same size) Rf.V-1512 EX. (1,-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF CEKOVICH, FLORENCE V. FILE NUMBER 21-04-0774 Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION WAYPOINT BANK, # 8551024039, AUTOMOBILE LOAN- SEE ATTACHED AMOUNT $3,444.43 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $3,444.43 REV-1513 EX;- (9-00)) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF CEKOVICH, FLORENCE V. FILE NUMBER 21-04-0774 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. GARY N. CEKOVICH, 6855 WERTZVILLE ROAD, ENOLA, PA 17025 SON GIFTS, Y. BALANCE 2. DAWNELL C. CEKOVICH, SAME, DAUGHTER IN LAW GIFTS 3. CHERYL A. BAKER, 6403 SALEM PARK CIRCLE, MECHANICSBURG, PA 17050 DAUGHTER GIFTS, Y. BALANCE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00 (If more space is needed, insert additional sheets of the same size) REV.485 EX+ (1.921 ,. SAFE DEPOSIT BOX INVENTORY COMMONWEAlTl1 Of PENNSYlV"NI" DEP"RTMENT OF REVENUE IN"""ANCI TAX DIVISION DEPT. 280601 H"RRIS8URG. P" 17128-0601 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS a. . c h ~OqJ b. (RELATIONSHIP) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) c. (NAME) (REtA TIONSHIP) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) a. b. (NAME) Dec..eJ en.+- (STREET ADDRESS) (STREET ADDRESS) (CITY) (STATE) (ZIP CODEt (CITY) (STATE) (ZIP CODE) . NAME AND TITLE OF &MrLe'M TAKING THE INVENTORY R b b~ t e. ... ~+3er WAS A WILL IN THE BOX? DYES DNO If yes, a. Date of will: b. Nallle and addre.. of personal representative, If nallled In the wlll (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) c. Nallle and addre.. of attorney, If any IN~' ~~II I r ml~rr SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U. S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, pa~able on death, ~tc... . .' I, :. (4) Bonds: .Designate by name, amount, serial number, o~ other designatio'n. (Bearer Bonds) (5) Bank and Savings and Loan Passbooles: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry,' Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedne..: List and describe as fully as possible. (8) All other contents. Page / of I ITEM DESCRIPTION (),~ Ce~e I M'rb Ll 5 J ~ .t1Hr.'; l.w ~<<~ a..Jv'-~e- PRINT TITLE 0.Y' CHECK APPROPRIATE BOX: o Executor(trii<).1Xl Administrator(trix) ! ,\., j o Estate Representative 0 Joint owner of safe deposit box additional 81/2" x '1" sheet (s) If necessary or usedupllcates'of t~ls page of-for!", NOTE: Page SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U. S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., i~intly held, pa~able on death, ~tc... . . . " ..' (4) Bonds: .Designate by name, amount, serial number, o~ other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry,' Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of Indebtedness: List and describe as fully as possible. (8) All other contents. / of .1 ITEM DESCRIPTION (),~ CE?~ T't1 tie S I M'rb Ll 5 J ~ of 1)+ r.'; l. w ~<<~ fA.. J v ,-~e- PRINT NAME NOTE: 0. v- CHECK APPROPRIATE BOX: o Executor(trii<) IXlAdministrator(trix), '.' o Estote Repres~ntative' 0 Joint owner of'safe deposit box I additional 81/2" x , 1" sheet (s) If necessary or ~sedupllcates'of t~ls page offor!". PRINT TITLE TO WHOM IT MAY CONCERN: IN RE: ESTATE OF FLORENCE V. CEKOVICH ss# 187-16-6104 The undersigned, GARY CEKOVICH, Administrator of the estate, and son of the decedent, hereby certifies: 1. He was familiar with the nature and extent of her property, and has made a diligent search of the property of decedent, at the date of her death, and 2. The following is a description and valuation of all the items of tangible personal property of the decedent, at the date of her death: ITEM: VALUE: TV $400 USED CLOTHES $500 BED $350 CHRISTMAS DECORATIONS $200 COSTUME JEWELRY $300 ROCKING CHAIR $50. POTS, PANS, KITCHEN UTENSILS ~~~~ GARY CEKOVICH $100 Total Value: $1,900 .. ..... JB 01:48 FAX 111 915 3333 .,!~:;;."':. :":':.. ". J ::.::". :... . ".ro. o' ..'::.:.7~ ." ... .' ",' .. ...; I UCP CENTRAL PA '. . ~ooz ,. 1784559 .. . .i i' Date ., ~ 14 r ;'..+k. Name' ~e.s Address !', . ~. 0' f . ~ . j .1 , J .' 1 , ":' ':1 ..:i . '.-, . 'l ;.:.~ .-:" .~ .~ . .,: .~.- '\:~:-:.:. J ~ . . ms-,a . . .~: ::.. .<\:)~ :.~ ...'eraD.........~..(I>~::~:;:..~b~.~~...:..::.':::.~.. . ~ . "':.' . .~ 1 l" .' _ -,:.~~~~}(:~_ _:;'-'1' ,~h: .'5{.-~ . ....:c. " AUG 3 0 2004 m M&fBank 499 Mitchell Road, MiIIsboro, DE 19966 Mail Code 501-120 Phone (302) 934-2909 Fax (302) 934-2955 August 23, 2004 Law Offices of Robert C Spitzer, P.C. Attorneys At Law 2401 North Front Street PO Box 12087 Harrisburg, P A 17108-2087 Re: Estate of Florence V Cekovich Social Securitv: 187-16-6104 Date of Death: Julv 25,2004 Dear Sir or Madam: Per your inquiry dated August 17, 2004, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Certificate of Deposit Account Number 31003914665111 Ownership (Names of) Florence V Cekovich Gary N Cekovich Opening Date 07/31/91 Balance on Date of Death $2,376.67 $ 15.12 Accrued Interest Total $2,391.79 2. Type of Account Checking Account Account Number 22081968 Ownership (Names of) Florence V Cekovich Cheryl A Baker Gary N Cekovich Opening Date 08/28/64 Balance on Date of Death $3,237.97 Accrued Interest $ 0.00 Total $3,237.97 3. Type of Account Savings Account AUG 3 0 2004 Account Number 15004208558625 Ownership (Names oj) Florence V Cekovich Cheryl A Baker Gary N Cekovich Opening Date 08/21/78 Balance on Date of Death $161.24 Accrued Interest $ 0.00 T olal $161.24 For further account information, closures and/or reimbursement of funds please call the West Shore Plaza Office at #717-255-2271. We were unable to locate any safe deposit box for the above-mentioned decedent. 0. PNC1NVESTMENTS Member NASD and Sll'C September 2, 2004 Subject: Estate of Florence V. Cekovich Social Security Number 187-16-6104 Date of Death: 07/25/2004 Title of Account Florence V. Cekovich & Cheryl Ann Baker & Gary M. Cekovich JTWROS Date Established 11/14/1997 Date of Death Value 3,360.766 Shares 1,531.066 Shares Blackrock Govt Inc A Blackrock Govt Inc B CCGAX @ $10.96 per share PNGBX @ $10.97 per share In the Investment Account there was a Money Market Balance of $ 6,274.43. The account was fully liquidated on July 26, 2004, and a check in the amount of $59,808.72 was sent on July 29, 2004. A member ofThe PNC financial Services Group 2 East Main Street Mechanicsburg Pennsylvania 17055 www.pncinvestments.com Important Investor Information: Securities and brokerage services are provided by PNC Investm~nts LLC, member NASO and SIPC. Annuities and other insurartce products are offered by PNC Insurance ServICes, Inc. a licensed insurance agency. II'May Lose VdIue I I .No Bank Qmantee ',,~. ...~t . . ~.,;. "".... ..#1# .... ...... Musselman Funeral Home & Cremation Services, Inc. Established 1895 Brian C. Musselman, ED. Supervisor William G. Pegan, F.D. P.O. Box 137 324 Hummel Avenue Lemoyne, PA 17043-0137 (717) 763-7440 Fax: 717-730-9798 www.musselmanfuneral.com To Funeral Expenses of FLORENCE V. CEKOVICH Our Services Casket Gown and Sweater Set CASH ADVANCE ITEMS: Flowers plus tax Death Certificates (15) Harrisburg Obituary $3495.00 1025.00 175.00 $130.00 ' 30.00 73.34 8-11-04 $4695.00 $233.34 _ Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ . $4928.34 ~ \:' \:\ W~ I~~ 6~ FOR APPOINTMENT PHONE 717-763-7440 ~-l\-"Dlf Sep 09 04 04:12p Robert C. Spitzer, Esq. 717-231-7602 p. 2 '1- IS-if - REPORT FROM: WavtlOint I. On the date of death of Decedent, our records showed the following balancc(s) to the credit of lhc above-named decedent: NOTE: FOR ALL CERTIFICATES OF DEPOSIT OR SIMILAR TYPES OF ACCOUNTS. PLEASE PROVIDE LAST RENEWAL DATE, NEXT MATURITY DATE, CURRENT FACE VALUE, CURRENT INTEREST RATE, HOW INTEREST IS PAID. ACCOUNT NO. lYPE OF ACCOUNT REGISTERED OWNER(S) JULY 25, 2004 ACCRUED AND DATE ACCOUNT BALANCE INTEREST IT, ESTABLISHED TO JULY 25,2004 ~ ~j ~~ ~()~; 1~2~ J.!;cSJ ~~ ~ 1'37 ~:?~r t;~~ i"f' S :..~V ~:;nc?~~f'~~lct~~~ f) S - f' ~ ll' lii ,::""r~~'Ai7:i~f~C~ ~~'~I~ ...i~r~.,~';~ 'u ^~ i /:.~gf '::'71;i ~ ";;.";'f" (~) ~ iN e.~ V-e..h,'cJ< i~ b~.n. h-e...\c:\ 0..<:> CollCLf'ua.(, j 2, Decedent did/did not maintain at date of death ;\safe deposit box with OUT institution. The box number is AliA Co-owners are: A/I A 3. Decedent, at date of death, owed us the following amounts: ACCOUNT NO. TYPE OF ACCOUNT CO-OBLIGORS PRINCIPAL ACCRCED DEBT SECURITY Il'TEREST ~-e. Q hnv~ Please provide copies of alll"otcs, Loan Agreements, Guarantees. Secur.ty Agreements, and related documents. Waypoint Date: ()? -/(}-6lJ cj,),,~ Le.u.-h 1)0...00 J Loo.n S-e ( V r C (~ W~a 'Pc, t f"\ -\- < .8o.n L (,,.,) qo~ - a.loC SEP-09-200404:17PM FAX:717 231 7602 ID: WAYPOINT PAGE: 002 R=95% COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLDWANCE --, ',,' OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-26-2005 CEKOVICH 07-25-2004 21 04- 0774 CUMBERLAND 101 APPEAL DATE: 11-25-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 9~!_~~~~~_!~~~-~~~~------~___~~!~!~_k9~~~_~9~!!9~_~9~_Y9~~_~~99~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX FLORENCE V FILE NO. 21 04-0774 ACN 101 DATE 09-26-2005 TAX RETURN WAS: ) ACCEPTED AS FILED X) CHANGED SEE ATTACHED NOTICE APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax .BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PD BDX 2B0601 HARRISBURG PA 17128-0601 ROBERT 2401 N PO BOX HBG C SPITZER FRONrST 12087 ESQ PA 17108 ESTATE OF CEKOVICH RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 4.443.00 22,285.48 13,391.70 (8) REV-1547 EX AFP ID6-05) FLORENCE v (9) 1l0) 14,596.92 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 40,120.18 18.041 3'> 22,078.83 .00 22,078.83 NOTE: If an assessment was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate 115) .00 X 00 - .00 16. Amount of Line 14 taxable at Lineal/Class A rate 116) 22,078.33 X 045 = 993.52 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate 118) .00 X 15 = .00 19. Principal Tax Due 119)= 993.52 3.444.43 Ill) 112) 113) 114) TAX CREDITS: n.....~'" Kt.Lt....., l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04 21-2005 ""' CD005236 .00 1,676.06 TOTAL TAX CREDIT 1,676.06 BALANCE OF TAX DUE 682.54CR INTEREST AND PEN. .00 TOTAL DUE 682.54CR · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. f)J'. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS.) REV-1470 EX (6-88) . INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME Cekovich, Florence FILE NUMBER REVIEWED BY Cheryl Gordon ACN 2104-0774 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES J 2 Lineal heirs are taxable at the rate of 4.5% for dates of death on or after 07-01-2000. ROW Page 1 BUREAU OF INDIVIDUALCT~s:;--rn :"'rr=tr: INHERITANCE TAX DIVISION' . '..V .....J ".J I-.J~ PO BOX 28060 I' -- - "". HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) ZODS eCT 28 Pic~~ 3: 22 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-17-2005 CEKOVICH 07-25-2004 21 04-0774 CUMBERLAND 101 FLORENCE v ROBERT 2401 N PO BOX HBG C sP'nZER ESQ FRONT ST 12087 Amount Remitted PA 17108 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS ~ --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF CEKOVICH FLORENCE V FILE NO.21 04-0774 ACN 101 DATE 10-17-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-19-2005 PRINCIPAL TAX DUE: 993.52 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-21-2005 CD005236 .00 1,676.06 09-30-2005 REFUND .00 682.54- .. TOTAL TAX CREDIT 993.52 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) c~ PLEASE FILE THIS REPORT WITIDN TWO YEARS OF DATE OF DEATH, REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: FLORENCE V. CEKOVICH Date of Death: JULY 25,2004 Estate No. 2004- 0774 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 +- No 2. If the answer is No. state when the personal representative reasonably believes that the administration will be complete: (Date) 3. If the answer to No.1 is Yes, state the following: A. Did the personal representative file a final account with the Court? Yes_ No X- B. The separate Orphans' Court No. (if any) for the personal representative's account is: (not applicable in Cumberland County) Yes C. NoL Did the personal representative state an account informally to the parties in interest: 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. BY Signature ROBERT C. SPITZER, ESQ. 2401 North Front Street P. O. Box 12087 Harrisburg, PA 17108-2087 717/231-7600 Capacity: _ Personal Representative j ~ Counsel for Personal Representative Date: 7h'S./O ~ ! on ,) :.) ,. ,." June S, 2006C:IMY FILESlWP Oiolll A.ZICEKOVtcH, Fldrenc,< 0., rep GARYlaaALL DOCUM 03.wpd ::':u ':':.~.') "..1..,..,)..:.,1 ~ Cumberland County - Register Of Wills One Courthouse Square Carlislel PA 17013 Phone: (717) 240-6345 Date: 5/31/2006 SPITZER ROBERT C 2401 N FRONT STREET PO BOX 12087 HARRI SBURG I PA 17108 RE: Estate of CEKOVICH FLORENCE V File Number: 2004-00774 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO. 103 SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after July 11 19921 the personal representative or his counsell within two (2) years of the decedent's deathl shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 7/25/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report I please disregard this notice. SincerelYI b~~.~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) \...ULllJJ<::L.La.llU \...UUllL.Y - r".t:::':::j.Li::iL.t:::.L V.L W.LJ..Li::i One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 24 0 - 6345 Date: 5/31/2006 CEKOVICH GARY N 6855 WERTZVILLE ROAD ENOLA, PA 17025 RE: Estate of CEKOVICH FLORENCE V File Number: 2004-00774 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, 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 is due by: 7/25/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, b~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel