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HomeMy WebLinkAbout04-0797 WILLIAM C. O'BRIEN, GR. ATTORNEY AT LAW 6 K(NGS HIGHWAY EAST HADDONFtELD, NEW JERSEY 08033 (8S6} 429-1811 December 9, 2004 Register of Wills Cumberland Counly 1 Court House Square Carlisle, PA 17013 RE: Estate of Stanley W. Slowakiewicz Tax Return Dear Sir: With respect to the above captioned matter, I am enclosing an original and copy of a completed Inheritance Tax Return along with a check in the amount of $967.87 for payment of taxes. Please advise if there any questions. Ve truly yours, WILLIAM C. O'BRIEN WCO:tk Enc. S112.RW3 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004726 O'BRIEN JEAN S 417 GARFIELD AVENUE PALMYRA, NJ 08065 ACN ESTATE INFORMATION: SSN: 186-12-9099 FILE NUMBER: 2104-0797 DECEDENT NAME: SLOWAKIEWICZ STANLEY W )ATE OF PAYMENT: 12/13/2004 ::'OSTMARK DATE: 1 2/10/2004 COUNTY: CUMBERLAND DATE OF DEATH: 06/12/2004 ASSESSMENT CONTROL NUMBER 101 AMOUNT ¢967.87 TOTAL AMOUNT PAID: ¢967.87 REMARKS: SEAL CHECK#1005 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS DEPARTMENT OF REVENUE PETITION FOR PROBATE and GRANT OF LETTERS ~tale of.Stanley W. Slowmk~ ~w~ ~z sociol s~'ur#y No.._ltl 6 ' i 2 - 9 0 9 ~eeeasecl. TO: Register of Wilts for the County of ~ in the Commonwealth of Pennsylvania The pedti(2n of the undersigned respectfully represents that: Your petitioner(s), who is/ere 18 years of age or older an the execut tr±x__~ named in the last w~ll of tile above decedcnl, dated November 25, 1-9'7~ ,19 and codicil(s) dat~ D.ecendcnt was domiciled at death in Cumberland County. Pennsylvania. with hls last family or principal resldence at West Shor~ Health g R~h~h~lit~tion (Iii: street, number atld rnunelImilty3 De, cgndent, then 8 8 years of age, died . June 12 ,. 2004 , at.. west Sheath & Rehabilitation Center Excelat as follows, decedent did not marry, was not divorced and did not have ~d born or adopteJ after execution of the will offered for probate; was not the victim of a kilUng and was llevCr adjudicated incompetent: None, .: .~ D~eeodent at dr. ath owned property with estin~ted values as (If domiciled in Pa.) All personal property $19. 256.0 0 (If not domiciled in Pa.) Personal properly in Pennsylvania (I~ not domiciled in Pa.) Personal property in County $ value of real estate in Pennsylvania $ Q situated as follows: WHEILEFORE, petitioner(s) respectfully request(s) the probate el thc last will and codicil(s) present~cl h~:rewith and the grant of letters Te s tam~anta%-y STATE OF NEW JERSEXOATH OFPERSONAL REPRE,SENTATIV~ COUNTY OF CAPE MAY The petitioner(s) above-named swear(s) or affirm(s) that true ~d co~rect to the be~t of the knowledge and belief of peti~on~(~) and that ~ per~o~ represen- tative(s) of the above d~cdent ~tition~r(s) wffi well~ ~'~nd ~gly administer the ~tatc accordins to law. Sworn to or affirm,d ~d ,ub$crib~ bef~emethis~ __dayof [ Rq~ter L R, LYNNE GERMANIO SPECIAL DEPUTY SURROGA~ Estate °f ~cr~v~°'c~" kx3 %kc~u_x~w.~.cI~ceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW(X~ir~k2~ ~o . 20C)t~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 11-~[~3~(described therein be admitted to probatexand filed of record as the last will of and Letters'l~0~g'ae~re~°h%~by granted FEES Probate, Letters, Etc ....... Short Certificates( ) ....... $ Renunciation ........'f. ...... JCP ..........................$ Total~'~/. IJ~ $ Register of ~Vill~.O.~ ~.~ Attorney (Sup. Ct. I.D. No.) Filed~-e2(o- (5Dr A.D. 20__ Address Phone OATH OF SUBSCRIBING WITNESS Stanley S lowakiewicz No.t~ E~tate Al,sok~ownas Stanley W. Slowakiewicz __, D¢ce~a~d Cecelia Stewart Derstine Stephen J. Maximo, Jr. (each) a s~bscribing wi~nes.~ ~o the will/codicil presented berewit~)~ (¢~eh) being ddy quahfie~ according to law, d~se(s) and say(s) we wer~e~t and ~w Stanley W. S lowakiewicz , ~ ~estat~ si~ ~e s~e ~d ~ we si~messatth~requestof~e~ or inhis pres~ Cecelia Stewart Derstine 308 Overlook Drive, Gulph Mills, PA 19428 Sworn to or affirmed a'~ subserib~  ~a~) S[eph~ J. M~imo, ' 254 West Rive~ood Drive (~) New Hope, ~A 18938 : RENUNCIATION Stanley W. Slowakiewicz T~ thc R~st¢r of WU~e of Cumberland Thc undcr$ign*d Richard Slowakiewicz, SOIl County, Pennmylvania, of · ca~ved~¢l:l~t,h~e~ run°un¢~$)thcri~ttoadministcr~eestateandrcs~ctfully~k(s)thatLelters Testamentary ~i~su~to Jean Stella O'Brien, daughter of the above decedent. WITNESS my Sworn to and subscribed before me this ~%ay of July, 2004. Notary Pu~ c~~ thl~ 7}t~ f Jul 04 hand _.. y o _~Y]~__, ~l. _Yu'Ivy_ Court, a~daorne, PA 19047 ($18netur¢} RENUNCIATION 01-1.- '"lq'-i In Re F~tat~ of Stanley W. To the R¢~ist~r of Wills of Cumberland County, Pennsylvania. Thc undersigned ,Stanley Slowakiewicz, son -- Of the above decedent, hereb~ renounce(s) the right to administcr thc es~al~ and rrmp¢ctfully ask(.~) ~hat Le:ters Testamentary bcis~u~dto Jean Stella O'Brien~ daughter to the above decedent. WlTNE5$ my -- hand this ~ day of J..uly .,2o04 Sworn to and subsribed before me this/90~day of July, 2004. ~80 Con~l~lsville' PA 17365 (Address~ ERT. NO. WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH o 1- oq- 'l q'l T 5649672 June 14, 2004 Name of Decedent Stanle~ Walter Sex Kale __Social Security No. 186 12 9099 Date of Birth kay 8~, 1916 Birthplace _Shenandos~l~ Place of Death West Shore Health & Rehab Cumberland Race White Occupation Salesman~ Tire Co. Slowakiewicz Date of Death June 12:2004 Camp Hill Pennsylvania Armed Forces? (Yes or No) Decedent's Marital Status Widowed Mailing Address 770 Poplar Church Rd.; Informant _._ Stanley L. Slowakiewicz__Funeral Director ~al~tin B. Name and Address of Funeral Establishment Feiser_Funeral Home Inct; Eas~ Berlin; Camo Hill; Pa. 17011 Wh~ela~ __ Pa. 17516 Part h Immediate Cause (a) Cerebral Vascular Insufficiency (b) Interval Between Onset and Death (c) (d) Part I1: Other Significant Conditions Manner of Death Natural ~ Homicide [] Accident ~1 Pending Investigation [] Suicide ~ Could not be Determined [] Name and Title of Ce,flier Thomas P. Kunkle, D.0. Describe how injury ~oL~rred: ;:=. Address New Cumberland, Pa. !7070 (M.D., D.O., Coroner, M.E) This is to certify that the information here given is correctly copied from 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. o _oo ~. ~4, 2004 ._~ 316 , STANLEY WALTER SLOWAKIEWICZ, residing in the City and County of Philadelphia, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, hereby make, publis~ and declare this to be my Last Will and Testament, hereby revok- ing all Wills and Testaments and Codicils at any time heretofore made by me. i~? ~r~ ~ FIRST: I direct that all o4 my just debts, funeral expemsg~, ex- penses of my last illness and the costs of adm%nzstmr~ng ~y es- tare be paid as soon as practicable after my death. SECOND: I give, devise and bequeath to my Wife, STELLA SLOWAI<IE- WICZ, if she survives me, her heirs and assigns forever, all of my property and estate, rea~ personal and/or mixed, of whatsoeve~ nature and character and wheresoever situate, of which ~ may die seized or possessed, or to which I am in any way entitled at the time of my death, or over ~ich I may have any power of testamen- tary disposition. THIRD: In the event my Wife, STELLA SLOWAKIEWICZ, predeceases me I give, devise and bequeath,~all my estate of whatsoever nature and character, real, personal and/or mixed, and wheresoaver sit- uate at the time of my decease, in equal one-third shares, share and share alike, to my children JEAN STELLA O'BRIEN, STANLEY SLOWAKIEWICZ and RICHARD SLOWAKIEWICZ or all to the survivor pro- vided that if any of my children die before me leaving issue, her or them survivtng~ I give, devise and bequeath to the issue per stirpes, the shares of my residuary estate which my said child or children would have received if living. FOURTH: Ail estate, inheritance, transfer, legacy, succession o any other similar taxes and duties, and any interest and penalti thereon, payable on any property which is devised and bequeathed under the provisions of this my Will or on any property other than under this my Will which shall constitute a taxable part of my estate, shall be paid out of the principal of my residuary estate. FIFTH: This Will shall remain in full force and effect notwith- standing that a child or children may hereafter be born or adopt ed by me. SIXTH: I direct that my Executor(s) and their s~ccessors, shall have the following power in addition to and not in limitation of any authority vested in them by law and by other provisions of my Will, and effective until actual distribution of all property: a) For the payment of debts or for any purpose of ad- ministration or distribution, power to sell, mortgage, lease, alter, improve, partition and exchange all or any of my real es- tate at any time, to sell at public or private sale for such prices and upon such terms as to cash and credit as they may dee~ best, or upon the reservation~of ground rents, and the said ground rents in turn to extinguish or assign, and to grant and -2- convey good and sufficient title, and to execute deeds of con- veyance thereof, without liability on the part of the purchasers or other persons so dealing with the Exexcutor(s), to see to the application of the purchase or consideration moneys. This power shall not be construed to work a conversion of the real estate unless and until the power is actually exercised, nor shall this power be construed to extend the lien of debts. b) To purchase or otherwise acquire real estate and to exercise the same powers thereover as hereinbefore provided with respect to other real estate of the estate. c) To retain all stocks, bonds and other investments owned by me, to invest and reinvest all moneys, securities or other personal property coming into their hands without being confined to what are known as "legal investments", and to seal and transfer the same, either in person or by attorney, without liability on the part of the purchasers to see to the application of the purchase or consideration moneys. d) To purchase securities at a premium, to amortize the premium out of income, or to charge the same to principal or in- come, or partly to principal and partly to income, at such times and in such amounts as they may deem best. e) To borrow money and pledge any stocks, bonds or other personal property of the estate as security therfor, without lia- bility on the part of the lender to see to the application of said money. f) To exercise any option to subscribe for stocks, bond~ or other investments. g) To join in any plan of lease, mortgage, consolidatic -3- exchange, reorganization or foreclosure of any corporation in which the estate may hold stocks, bonds or other securities. h) To pay income tax on gains from the sale or other conversion of capital assets out of proceeds therefrom. SEVENTH: In the event that any beneficiary shall die simultane- ously with me or under circumstances where there is not a pre- ponderance of evidence to determine the order of deaths, it shal be deemed that my Wife, STELLA SLOWAKIEWICZ, survived me. EIGHTH: As used in this Will, one gender shall mean either of the other wherever necessary or appropriate and the singular shall include the plural and vice versa. NINTH: The bequests made to my Wife, STELLA SLOWAKIEWICZ, are to be accepted by her in lieu of her dower right in any real estate of which I may die seized. TENTH: I nominate, constitute and appoint my Wife, STELLA SLOW- AKIEWICZ, Executrix of this my Last Will and Testament. In the event that my Wife predeceases me, I nominate, constitute and ap~ poin~ my children, JEAN STELLA O'BRIEN, STANLEY SLOWAKIBWICZ and RICHARD SLOWAKIEWICZ, or the survivor of them, Executors of this my Last Will and ~estament. ELEVENTH: I direct that my Executrix and Executors shall not be required to enter any security in any jurisdigtton in which he, she or they may act. IN WITNESS WHEREOF, I have subscribed my name this ~.~ 7 day of Stanley,~'~. Slowakiewicz ~ This Will consisting of five pages including this page was sign- ed, sealed, published and declared by Stanley W. Slowakiewicz the above named Testator, as and for his Last Will and Testament in the joint presence of us, who, at his request and in his pres. ence and in the presence of eac~ other, have hereunto subscribed our names as witnesses this3z3 day of -~ , 197~.~i~/~ -5- Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 12/06/2004 O'BRIEN JEAN S 417 GARFIELD AVENUE PALMYRA, NJ 08065 RE: Estate of SLOWAKIEWICZ STANLEY W File Number: 2004-00797 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPFIANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will.become delinquent on 12/06/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge Sincerely, GLENDA FARNER~ Clerk of the Orphans' Court STATUS REPORT UNDER RULE 6.12 Name of Decedent: Stanley W. Slowakiewicz Date of Death: 06/12/04 Will. No.: 2004-00797 Admin. No.: 21-04-0797 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I repo~X the following with respect to completion of the adn~istration 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: 3. If the answer to No. 1 is Yes, state the following: Did the personal representative file a final account with the Coup? Yes _ No ~] b. The separate Orphans' Coral No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~'] No [--] Date: Copies of receipts, releases, j oinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Capacity' Jean S. O'Brien 417 Garfield Avenue Ad&'ess (856) 786-1559 Palmyra, Telephone No. ___~ Personal Representative [--] Counsel for personal representative NJ 08065 9 WILLIAM C. O'BRIEN, dR. ATTORNEY AT LAW December 28, 2004 6 KINGS HIGHWAY EAST HADDONFIELD, NEW JERSEY 08033 (856) 42:9-1811 FAX (856) 429-3575 Register of Wills Cumberland County 1 Court House Square Carlisle, PA 17013 Estate of Stanley W. Slowakiewicz Filing Fee Dear Sir: With respect to the above captioned matter, I am enclosing an Estate draft in the amount of $15.00 for filing fees for the recent Amended Inheritance Tax Return Please advise if there any questions. Very~truly yours, WILLIAM C. O'BRIEN WCO:tk Enc. S112.RW9 COMMONWEALTH OF PENNSYLVANIA HARRISBURG, PA 17128-0601 ,E v- 5oo INHERITANCE TAX RETURN I-- Z RESIDENT DECEDENT DECEDENT'SNAME(LAST, FIRST, ANDMIDDLEINITIAL) Slowakiewicz~ StanleI W. DATE OF DE~H (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 06-12-04 05-08-16 FILE NUMBER 21 -04 07 97 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 186 '- 12 - 9099 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A X~ 1. ~1 Return Amended []4. Limiled Estate E~6. Decedent Died Testate (Allach copy el Will) [~9. Litigalion Proceeds Received 1~2. Supplemental Return []4a. Future Inlerest Compromise (dale o[ death afler ~2-12-82) []7. Deceden[ Maintained a Living Trusl (Atlach copy o[ T,-us0 ] 10. Spousal Poverty Credit ((lale ofdealh belweon 12 31-91 and I-I-95) 3. Remainder Return (d;m~ ./death I).or to 12 131~2; [~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposil Boxes I1. Election te (ax uudcr Sec 9113(A) ~Agt ,, h :,, *, Ye THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: UJ NAME William C. O'Brien~ Esq. FIRM NAME ¢~Applicable) same TELEPHONE NUMBER (856) 429-1811 COMPLETE MAILING ADDRESS 6 Kingshighway East Haddonfield, NJ 08033 1. Real Eslate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Noles Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) E~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total 6ross 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) $23,551.36 7,932.25 773.71 $28,700.52 (11) 8,705.96 (12) $19,994.56 0 03) (14) $19,994.56 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable al the spousal tax N/A rate, or transfers under Sec. 9116 (a)(1.2) $19,994.56 16. Amount of Line 14 taxable al lineal rate x .o 45 x .12 x .15 17. Amount of Line 14 taxable at sibling rate ~/A 18. Amount of Line 14 taxable at collaleral rate N/A 19. Tax Due 20. E~ ' ~' I ' 'el '' ' ~'1 '~ ' ' I]1 · I ] If I ' , ' f 3 (15) (16) $899.75 (17) (18) 09) $899.75 · ~ .. > · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < De~edent's Complete Address: STREEi;ADDRESS' West Shore Health & , o 770 Poplar Terrace Rehabilitation -[ STATE PA Center CITY Tax Payments and Credits: I. Tax Due (Page I Line 19) 2. Credits/Payments Camp Hill A. Spousal Poverty Credit B. Prior Payments C. Discount Interesl/Penalty if applicable D. Interest E. Penalty (1) .......... $_899, !5 . Total Credils ( A + B + C ) (2) 0 Total Interest/Penalty ( D + E ) 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 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) 0 (4) (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. IF THE ANSWER Jnder penalties of perjury, I declare Ihat I have examined this return, including accompany ng sc ~edu es and statements, and lo Ihe best of my knowledge and belief, it is Irue, correct and complete, )edaralion ol preparer other than the personal represenlalive is based on all information of which preparer has any knowledge. $899.75 (5A) 0 (5B) $899.75 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; .......................................................................................... LJ b. retain the right to designate who shall use the property transferred or its income; ............................................ [] c. retain a reversionary interest; or ....................................... [] _:~_J d. receive the promise [or 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? ........................................................................................................................ [] TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 6 AND FILE IT AS PART OF THE RETURN, .~IGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~,DDRESS J 417 Garfield Avenue, DATE 12/22/04 Palmyra, NJ 08065 {~22/04 NJ 08033 :or dates ct death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% 72 P.S. §9116 (a) (1.1) (i)]. :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)J. 'he 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 he survivin§ spouse is the only beneficiary. :or dates of death on or after July 1, 2000: Fhe 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. ~r a sleppal¢ld of the child is 0% [72 P.S. §9116(a)(1.2)] 'he tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. 'he 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)J. A sibling is defined, under Seclion 9102, as an ~dividual who bas .at le.~st one parent in common with the decedent, whether by blood or adoption. REV-~502 EX+ (6-98) "' '"' - .COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Stanley W. Slowakiewicz FILE NUMBER All real property owned solely or as a tenant in common must be reported at lair market value. Fair markol value is defin~-d as th~p,~-~]'l~]~cl~-i~(~';e;l~wi)tii~-~ exchanged between a willing buyer and a willin9 seller, neither being compelled to buy or sell, both having reasonable knowledge of Ihe relevanl facls. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL (Also enter on line 1, Recapitulation) 0 $ 0 (If more space is needed, insorl additional sheels of the same size) HEV-1.502 EX+ (6-98) .CO, MMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Stanley W. Slowakiewicz FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair markel value is defined as Ihe price al which properly would be exchanged between a willing buyer and a willing seller, noilhor being compelled to buy or soil, bolh having reasonable knowledge el lbo relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION None TOTAL (Also enter on line 1, Recapitulation) $ VALUE AT DATE OF DEATH 0 (If more space is needed, insert additional sheets of the same size) tll~V 1!,04 I X~ (~ 9/) COMIVJONWEALTH OF PENNSYLVANIA ° INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF Stanley W. Slowakiewicz FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be altachod for each closely-held corporalion/parlnership interest el li~e decedent, edger than a sole-proprietorship. See instructions Ior lhe supporting information lo be submitled for sole-proprietorships. ITEM NUMBER NUMBEH DLSCHIF' I ION 1. None TOTAL (Also enter on line 3, Recapilulation) (Il more space is needed, insert additional sheets of the same size) VALUE Al DAI'E ol [.)LAI ti s 0 ,~1[. V- 1504 EX~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Stanley W. Slowakiewicz Schedule 6-1 or C-2 (including all supporling informalion) rnust bo allachod l(.)r each closely-held corporalion/parlnership into,est of Ihe ducodont, olher than a sole-proprietorship. See inslructions lot lbo supporting information Io be submitted Jot solo-proprietorsh )s. iTEM NUMBER VAI UE AT DATE NUMBER D~{SC~ ;'[ ON et I.)LA'IH 1. None TOTAL (Also enter on line 3, Recapilulation) S 0 · ,, (11 more space is needed, insert additional sheets of the same size) ', COMMONWEALTH OF PENNSYLVANIA INHERITANCE lAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Stanley W. Slowakiewicz Include the proceeds of litigation and the date the proceeds were received by the estate. All property joinll¥-owned with the right el= survivorshi ~ must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION M&T Bank, Dillsburg, PA Account No. 37405888052 Wachovia Bank, N.A. C.D. Certificate No. 247412161894312 Wachovia Bank, N.A. Checking Account No. 1000030019303 Wachovia Bank, N.A. Checking Acocunt NO. 1010059322896 TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH $1,750.38 1,273.73 1,430.97 694.08 $ 5,149.16 " (If more space is needed, insert additional sheets of the same size) ":~ ~COMMONWEALTH OF PENNSYLVANIA · "' IN'HERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Stanley W. Slowakiewicz If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOIN [ T LNAN I'($) NAME ADDRESS i,~ I A [ IONf;I II~' I 0 [ )[ C[ [ )1 N T ~.. None JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH EM FOR JOINT MADE Include name of financial institution and bank account number or similar idenlifying number. Allach DATE OF DEATH DECD'S VALUE OF ~IBER TENANT JOINT deed for joinlly-held real estale. VALUE OF ASSET INTEREST DECEDENT'S INTERES' None TOTAL (Also enter on line 6, Recapitulation) $ 0 (If more space is needed, insed additional sheets of the same size) · ,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Stanley W. Slowakiewicz 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 % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND TIlE DATE OF tRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACll A COPY OF 1HE DEED FOR REAL ESTATE. NUMBER VALUE OF ASSET INTEREST i,~ ^.~ ~,:^[~ ) 1. None TOTAL (Also enter on line 7, Recapitulation) $ 0 (If more space is needed, insert addilional sheets of the same size) RE~f-1511 EX+ (12-99) '"- ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OFstanley W. Slowakiewicz SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ITEM NUMBER 5. 6. 7. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT FUNERAL EXPENSES: Feiser Funeral Home, East Berlin, PA Preparation, viewing, casket, transporation, notices, death certifica ADMINISTRATIVE COSTS: Personal Represen~alive's Commissions Name of Personal Representative(s) Social Securily Number(s)/EIN Number ol Personal Representative(s) Streel Address City Slale .... Zip Year(s) Commission Paid: Allorney Fees Family Exemption: (Il decedent's address is not lhe same as claimant's, attach explanation) Claimant Street Address City __ State __ Zip Relationship of Claimant to Decedent Register of Wills Cumberland County Register of Wills Bucks County PA Department of Health Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) $ $7,773.25 tes 112.00 20.00 27.00 7,932.25 (If more space is needed, insed additional sheels ot the same size) COMMONW£ALTH OF PENNSYLVANIA INHERITANCE TAX RETUNN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS ESTATE OF Stanley W. Slowakiewicz Include unreimbursed medical expenses. FILE NUMBER ITEM NUMBER 2. 3. 4. 5. 6. DESCRIPTION McKesson Medical Kilmore Eye Associates West Shore Emergency Medical Holy Spirit Hospital PharMerica (drugs) Verizon (telephone) TOTAL (Also enter on line 10, Recapitulation) (if more space is needed, insert additional sheets of the same size) AMOUNT $28 80 54 36 95 44 20 26 553 42 21 43 $ 773.71 REV-15~3 EX+ (9-00) *, ,COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Stanley W. Slowakiewicz FILE NUMBER NUMBER I t. 11 1. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE ~XABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(12)] Jean S. O'Brien 417 Garfield Avenue Palmyra, NJ 08065 Stanley L. Slowakiewicz 80 Conewago Avenue Wellsville, PA 17365 Richard L. Slowakiewicz 5 Ivy Court Langhorne, PA 19147 Daughter Son Soil One-third One-third One-third 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 I. TOTAL OF PART i! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0 0 (1{ more space is needed, insert additional sheets el Ihe same size) REV~1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA ' ' INHERITANCE TAX RETURN I IF,';IF)F N I I )1 'C,I TH:N I' ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN ..... _(Check Box 4 o. REV-1500 Cover Sheet) FILE NUMBER Stanley W. Slowakiewicz This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. [] Will [] Intervivos Deed of Trust [] Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE None [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years 1. Value of fund from which life estate is payable .......................................... $ 2. Actuarial factor per appropriate table Interest table rate- [] 3 1/2% [] 6% [] 10% [] Variable Rate % 3. Value of life estate (Line I multiplied by Line 2) ...................................... $ NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE None [] Lile or [] -rem, el Yoals [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years 1. Value of fund from which annuity is payable ............................................ $ 2. Check appropriate block below and enter corresponding (number) .......................... Frequency of payout- [] Weekly (52) [] Bi-weekly (26) [] Monthly (12) [] Quarterly (4) [] Semi-annually (2) [] Annually (1) [] Other ( ) 3. Arnount of payout per period ........................................................ $ 4. Aggregate annual payment, Line 2 rnulliplied by Line 3 5. Annuity Factor (see instructions) Interest table rate- [] 3 1/2% [] 6% [] 10% [] Variable Rate % 6. Adjustment Factor (see instructions) .................................................. 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 .......................... $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 .................................................. $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting lile or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, inserl additional sheets of the same size) ~' ;..' · COMMONWEALTH OF PENNSYLVANIA " " ~ ' ,INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) Stanley W. Slowakiewicz FILE NUMBER Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be flied for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in pad as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the ulection to have such trust or similar properly treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to lhe amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION VALUE N/A 0 0 Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE N/A Part B Total (If more space is needed, insert additional sheets of the same size) $ 0 Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 Reference ID: 1084710 Account Type December 17, 2004 WILLIAM C OBRIEN JR ATTORNEY AT LAW 6 KINGS HIGHWAY EAST HADDONFIELD, NJ 08033 SUBJECT: Verification / Confirmation of Account and Balance Information provided for: Customer: STANLEY W SLOWAKIEWICZ (SSN# 186-12-9099) Date of Death: June 12, 2004 Deposit Account Information Account Date of Death Average Date Maturity Interest Accrued Number Balance Balance* Opened Date Rate Interest YTD Interest Paid Date Closed CERTIFICATE OF DEPOSIT 247412161894312 LEGAL TITLE: STANLEY SLOWAKIEWICZ CHECKING 1000030019303 LEGAL TITLE: STANLEY SLOWAKIEWICZ CHECKING 1010059322896 LEGAL TITLE: STANLEY SLOWAKIEWICZ $1,273.73 2/10/2003 2/10/2005 $0.14 $1,430.97 12/17/1980 $0.02 $694.08 10/30/2002 $0.02 $7.40 $4.17 $2.53 Account Type * Due to system limitations, we can only provide a twelve month average balance on depository accounts. Other Account Information Account Date of Balance Date Date Number Opened Closed Ledger Collected ANNUITY WNFCAFJ237719 LEGAL TITLE: STANLEY SLOWAKIEWICZ AMERICAN GENERAL - For information regarding annuities, please call 800-424-4990 12/18/2002 0000 000614 ~7~CHOV/2~ No Safe Deposit Box found for customer. l{cfercnce ID: 1084710 * Date of~sh balance does not include accrued interest. // If/date o/f/death ocgurrs/~ weekend or a holi/dsy, date of death balance docs not include any transactions that were Servic~fiter Associate Phone: (540)563-7323 ssp; ag 0000 000614 ' ~'.'N COMMONWEALTH OE ~),:.,_ ~'. ,,,9~ PENNSYLVANIA · . ' ~'~¢~, '~'~.'~'~"tl~ DEPARTMENT OF REVENUE · , ~ ~,~'~,,~ '~'R~ DEPT. 280601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER COUNTY CODE YEAR NUMBER DECBDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER l'-- z SZo~akiewicz, Stanley W. 186 12 9099 LU ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED tN DUPLICATE WITH THE LU 06-12-04 05-08-16 REGISTER OF WILLS I.LI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SE~URI FY NdMBU~ -" Original Return 2 Relum u) ~] 4 L,11iled Estate ~ 4a Fuuo noes Can pomse¢~,,:, ,t,,,.,~r,,,r,2 1~821 ~ .9 Foderal Eslato T.~x Return Neq,i,red O '~ [] 9. Litigation Proceeds Received [] 10 Spousal Poverty Credit Idale of deat, be,wee, ~2 31-9, ~nd ~-~-9s) [] 11 Election to lax under Sec 9113(A)(A,,.%h Sch O~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS Esq. NAME William C. O'Brien, FIRM NAME TELEPHONE NUMBER (856) 429-1811 0 6 Kingshighway East Haddonfield, NJ 08033 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (2) $ 2 3,5 51,3 6 3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 0 4. Mortgages & Notes Receivable (Schedule B) (4) 0 5. Cash. Sank Deposits & Miscellaneous Personal Property (5) 6 ~ 6 2 0 . 8 6 (Schedule E) 0 6. Jointly Owned Property (Schedule F) (6) ~] Separale Billing Requested o 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Prepedy (7) 0 (Schedule G or L) 8. fatal Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 7,890.25 10 Debts ol Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 7 7 3 . 7 ]. 11. Total Deductions (total Lines 9 & 12, Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election lo tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) $30~172.22 (11) 8,663.96 (12) $21,508.26 (13) 0 (14) $21,508.26 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable al the spousa~ tax rote. or Iransters unde~ Sec. 9116 (a)(1.2) 16. Amount ol Line 14 taxable at lineal rate 17. Amount o[ Line I4 taxable at sibling rate 18. Amount o1 Line 14 taxable at collateral rate 19. Tax Due $21,508.26 o_ (~5) 0 .o__45 (16) 967.87 ,12 (17) .15 (18) (19) 8967.87 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Dece(Jent's. Complete Address: STREET ADDRESS West Shore Health & Rehabilitation Center ... J ~.., , 770 Poplar Terrace C~TY Camp Hill I STATE PA Tax Payments and Credits: I. Tax Due (Page 1 Line 19) 2. Credits/Paymenls A. Spousal Povedy Credq B. Prior Paymenls C. Discount Total Credits (A+ B + C ) 3. Interest/Penally if applicable D. Interest E. Penally Total InterestJPenagy ( U + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difterence. This is [he OVERPAYMENT. Cheek box on Page 1 Line 20 to request a refund (1) $967.87 (2) 0 (9) 0 (4) If Line 1 + Line 3 is greathr Ihan Line 2, enter the difference. This is [he TAX DUE. (5) $ 967.87 A. Enter the iolerest on the tax due. (SA) 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (SB) $ 9 6 7,8 7 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 ~ncome o1 ~he property translerred; .......................................................................................... ~.] ~ b. re~ain the righ~ 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 paymenls, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of dealh without receiving adequate consideration? .............................................................................................................. [] ~ 3. Did decedem own an "in ~rus[ 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS 417 Garfield Avenue, Palmyra, SIGNATURE OF PREPARE~{ O. IHEI~THAN~EPRESENTJ~,,!IVE~ ~. ~ NJ 08065 DATE 12/09/04 12/09/04 6 Kingshighway East Haddonfield, NJ 08033 DATE For dates of death on or after Ju~y 1, 1994 and before January 1, 1995, the ~ax rate imposed on the net value of Iransfers to or for the use of the sur,/iving spouse is 3% [72 P.S. §9116 (a)(1,1) (i)]. For dates of death on or after January 1, 1995, the tax tale imposed on ~he net value of transfers to er for the use of [he surviving spouse is 0% [72 P.S, §9116 (a) (1.1) (ii)], The slatute does eel exemp~ a Iransfer to a surviwng spouse ftom lax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even it the surviving spouse is ~he only beneficiary. For dates of death on or after July 1, 2000: The lax rate imposed on Iho net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use et a nalural parent, an adoplive parent, or a stepparenl of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on Ihe net value of transfers to or for [he 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 tale imposed on the nel value of transfers Io or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A siblin§ is delined, under $eclion 9102, as an individual who has at least one parent in common with the decedent, whelher by blood or adoption, · " ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS& BONDS ESTATE OF FiLE NUMBER Estate of Stanley W. Slowakiewicz All property jointly-owned with right of sun/ivorship must be d[sctosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 784 Shares of Common stock in B.F. Goodrich Company, share numbers GU 62181, GX 83468 TOTAL (Also enter on line 2, Ro{;apilula~ion) (il more space i~ needed, inserl addilional sheets of/he same size) $23,551.36 23,551.36 · · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Estate of Stanley W. Slowakiewicz 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 off Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M & T Bank, Dillsburg, PA Account No. 37405888052 Wachov±a Bank, Holmesburg, Account No. 1000030019303 PA $1,750.38 4,870.48 TOTAL (Also enter on line 5, Recapitulation) $ 6,6 2 0.8 6 (If more space is needed, insert additional sheets of the same size) REV 1511 EX+ (12-99) · ' COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Estate of Stanley W. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Slowakiewicz FILE NUMBER ITEM NUMBER 5. 6. 7. Debts of decedent must be reported on Schedule L DESCRIPTION FUNERAL EXPENSES: Feiser Funeral Home, Preparation, viewing, casket, notices, death certificates. East Berlin, PA transporation, ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative{s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City _ Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees State __ Zip TOTAL (Also enter on line 9, Recapitulatior (If more space is needed, insert additional sheets ol the same size) AMOUNT $7,773.25 117.00 $7,890.25/ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF g S t ate FILE NUMBER SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES~& LIENS of Stanley W, Slowakiewicz Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 2. 3. 4. 5. McKesson Medical Kilmore Eye Associates West Shore Emergency Medical Holy Spirit Hospital PharMerica (drugs) Verizon $ 28.80 54.36 95.44 20.26 553.42 21.43 TOTAL (Also enter on line 10, Recapitulation) J $ 7 7 3. 7 1 (If more space is needed, inseri additional sheets of the same size) CERT1FCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Date o f Death: Stanley W. Slowakiewicz 6/12/04 Will No.: 2004-00797 Admin No.: 21-04-0797 To thc Rcgisler: , I c¢i'tify that notice of(beneficial in, terest)estate adnlinistration reqmrcd by Rule 5.6~a)~gth~rphans' Court Rules ~ as scrx cci on or nlailcd to the Ibllowing beneficiaries of tile above-captioned estate on / / : Name Address Stanley L. Slowakiewicz 80 Conewago Avenue, Wellsville, PA 17365 Richard Slowakiewicz 5 Ivy Court, Langhorne, PA 19047 Jean S..O'Brien 417 Garfield Avenue, Palmyra, NJ 08065 Notice has now bcen given to all persons entitled thereto tinder Rule 5.6(a) except none Date: 12/12/04 Signature Executrix Nanlc 417 Garfield Avenue, Address (856) 786-1559 Telephone Capacity: [] Personal Representative [] Counsel for personal representative Palmyra, NJ 0~065 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AF' 112-841 WILLIAM C OBRIEN ESQ 6 KINGSHIGHWAV EAST HAD~DNFIELD NJ 08033 '",,1 (,") DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-07-2005 SLOWAKIEWICZ 06-12-2004 21 04-0797 CUMBERLAND 101 STANLEV W Allount Relli tted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE " , CARLISLE. PA 17013 CUTALONG:YHIS:::l.;VtE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv.:'IJ?i"'"W.AFp.!lfa.?-oJ1..Noli:ci.oF.I'NliirtifANcE.TAx.i,ppRi,fsii..EN';..ALLOWANCE.Oy................. ";ce:; ~~:; DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE Of(:':;SLOWAKIEWICZ STANlEV W FILE NO. 21 04-0797 ACN 101 DATE 03-07-2005 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE ~~,.-') !...-.."' RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real 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/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 23.551.36 .00 .00 5.149.16 .00 .00 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this forI! with your tax paYllent. 28.700.52 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdII. 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 14. Net Value of Estate Subject to Tax (9) UO) 7.932.25 773.71 (11) (2) (13) (4) 8.705.96 19.994.56 .00 19.994.56 (Schedule J) I~ an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. AIIount of Line 14 at Spousal rate (15) 16. AIlount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. AlIOunt of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due NOTE: .00 19.994.56 .00 .00 X 00 = X 045 = X 12 = X 15 = TAX CREDITS: . _. .._n. ..~_~A. \'I'J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-10-2004 CD004726 .00 967.87 TOTAL TAX CREDIT 967.87 BALANCE OF TAX DUE 68.12CR INTEREST AND PEN. .00 TOTAL DUE 68.12CR (9)= .00 899.75 .00 .00 899.75 · IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A nCREDI~' (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 ,-x (6-88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME Stanley W Slowakiewicz REVIEWED BY Deborah Washington ITEM SCHEDULE NO. INHERITANCE TAX EXPLANATION OF CHANGES EXPLANATION OF CHANGES Combined returns filed to date ROW FILE NUMBER ACN 2104-0797 101 Page 1 \, f'.: -:;': 59 Il) c.... o ~ M ...:!3 ~ cr,...-.l _OIZlO ~U1il~ ......"O~-<e: ~~~C1. 2i)t::~~ .~~ S ~ Il) ~ u 1;3 ~u......u l\f (:) o U lJl (II I (\j lJl l'1 (f) + (f) ... p:: ":J () 1'- ... z >- ~ ~>U10 H ~ <( <Xl p::-,~~ 0::1>-<(") . <( ~ - o I Z . ~ t9 0' uzi-' a: W .."., 0 U1 i;: ~ >- t9 z -<e: >- ~ 0 H <( '" 0 H \0 0 H ~ H ;::: WILLIAM C. O'BRIEN, JR. ATTORNEY AT LAW 6 KINGS HIGHWAY EAST HADDONFIELD, NEW JERSEY 08033 (856) 429-1811 FAX (856)429-3575 July 7, 2005 Register of Wills Cumberland County 1 Court House Square Carlisle, PAl 70 13 RE: Estate of Stanley W. Slowakiewicz Supplemental Inheritance Tax Return Dear Sir: With respect to the above captioned matter, I am enclosing an original and copy of a Supplemental Inheritance Return, draft in the amount of $892.00 for additional taxes due, and a draft in the amount of$20.00 for filing fees. Kindly return a copy marked filed in the envelope provided. Thank you for your attention and cooperation. WIUlAMC. o'n~ WCO:tk Ene. SI12RW.13 C) "'-:(J , ::-~ J 'l'J P ,-rj '(J ,:>Z ; rJ ;;~ (- :~ ~"-...) r:.:':} ',..~,::> .;:...".... L.. C:..:: ...-- C;;) -0 C0 en \..0 , "["t'I'~~ COMMONWEALTH OF ~.._I" .". '. PENNSYLVANIA : .... (I.~ ,~ DEPARTMENT OF REVENUE , l\~i.). DEPl 280601 '....*'1""'~,,~J. HARRISBURG, PA 17128-0601 DECEDENT'S NAME (L.AST, FIRST, AND MIDDLE INITIAL) Slowakiewicz, Stanley W. DATE OF DEATH (MM. DO. YEAR) DATE OF BIRTH (MM.DD-YEAR) 06-12-2004 05-08-1916 I- Z UJ Cl UJ U UJ Cl REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER I '. ;< L - 1)':1 COUNTY CODE YEAR (17_9-7 NU1\.lRl:R SOCIAL SECURITY NUMBER 186 -12 - 9099 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (L.AST, FIRST, AND MIDDLE INITIAL) N/A w r ~~U} U"'''' wo.U :<:00 u"'-' 0.'" 0. <( o 1. Original Relurn o 4. limited Eslale D 6. Decedent Died Testate (Mach copy of Will) o 9. litigation Proceeds Received ~ 2. Supplemenlal Relurn o 4a. Fulure Interest Compromise iU(llc of dC,llh ;llIer 1~-12.32} o 7. Decedent Maintained iJ living Trust (Allachcupy01 TruSI) o 10. Spousal Poverty Credit (dale of death lletweeIl12.31-~ll ilnd i-'-95) o 3. Remi1indcr Return ((jilli1 (II rkallllJIIUI 1;; Ii 1 ,'\-;'V,i o 5, Federal EslClte Tox Return ReqlllrccI 8. Total Number of Safe DepoSlI Boxes D 11. Elcclionlo lax under Sec. 9113(A) IAtt;KhSi.!IOi r z w o z o 0. <f) W '" '" o u THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME W' 11 . COMPLETE MAILING ADDRESS ~ ~am C. O'Brien, Esq. FIRM NA~gMI~"'bI'l z o ~ ..J :J !:: c.. <( u UJ 0::: z o ~ I-' :J a.. :2 o () >< ~ TELEPHONE NUMBER (856) 429-1811 1. Real Estate (Schedule A) 6 Kingshighway East Haddonfield, NJ 08033 (1) 0 (2) $23,551.36 (3) 0 (4) 0 (5) ~26,485.14 (6) 0 (7) 0 2. Slacks and Bonds (Scheelule B) 3. Closely Held Corporalion, Partnership or Sole. Proprietorship r---:> C~~] (-':'::1 <L..:'"l r ;:::: ,-- __1 1 ..') ) " _.i \:_-j . .;.1 ~ ; ~:~~ .'!-::-J . c ) \1"1 . .--) 4. Mortgages & Notes Receivable (Schedule D) () '=0 :0 n '~~ J-f'l _:] 7-': 'J() ~" (~2 "1'1 .) 1...'~;5 ..~ "} ","" 0::> 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. JOInlly Owned Property (Schedule F) o Separale Billing Requested --0 ~l:- o (....> 7. Inter.Vivos Transfers & Miscellaneous Non-Probole Property (Schedule G or l) $50,036.50 (8) 8, Totat Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debls of Deceden\, Morlgage liabilities, & liens (Schedule I) 11. Total Deductions (Iotallines 9 & 10) 12. Net Value 01 Estate (Line 8 mmus line 11) 19)~7 ,932.25 (10) 773.71 (11) 112) (13) 8,705.96 $ 41 , 336 . '5c4~~~~~~"'~~' o 13. Charitable and Governmental BequeslslSec 9113 Trusts for which an election to lax has not been made (Schedule J) (14) SH,330..2L 14. Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES x .0_ (15)__ 1 S. Amounl of Line 14 taxable althe spousal lax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rale 17. Amounl of line 14 taxable al Sibling rale 18, Amount of Line 14 taxable al collaleral rale 19. Tax Due N/A $41,330.54 x .043- (16) Sl,859.87 x .12 (17) x .15 (18) (19) $1,RSgR7 20.0 ~ . ."~-'" ,..' I. ,Decedent's Complete Address: STREET ADDRESS . . ______---H.e.sL-Sho.r~ea~_L_ReJlab3_1 H~t)"QD 770 Poplar Terrace Camp Hill _C eIlt:e ~ CITY I STATE PA -PIP 17 0 11 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $1,859.87 $967.87 Total Credits ( A t B + C ) (2) 967.87 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E ) 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 0 (3) (4) (5) --- 892.00 (5A) (5B) 892.00 ---- 5. If Line 1 + Line 3 is grealer than Line 2, enter Ihe difference. ThiS IS the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS .....0 []I IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;......... .............................. ..... 0 b. retain the right 10 designate who shall use Ihe property transferred or its income;.. ............................ 0 c. retain a reversionary interest; or.. ...................................... .... 0 d. receive the promise lor Iile 01 either payments, benefits or care? ....................... . ..... ..................... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death wllhout receiVing adequate consideration? ...... ............................ 3. Did decedent own an "in trust for" or payable upon death bank account or secuflty at his or her death?.... 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? ................. .................................. .............................. No [iJ 5Q ~ (]jj ..... LJ o [jg []I Under penalties of perjury, I declare that I have examined this relurn, Includlflg accompanying schedulos and sliltCnlCnts, and to the best of my knowledge and belief, It is true, Gorrect ,:md cornple~e Oed<lration of preparer other than rne personal representalive 'IS based on all information of which pre parer has any knowledge, SIGNATURE OF PERSON RESPONSIBLE FOR.FILlNG RETURN V DAiE 7/08/05 ADDRESS 17 Garfield Avenue, Palmyra, NJ 08065 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 417 Garfield Avenue, Palmyra, NJ 08065 7/08/05 For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rate imposed on the nel value of transfers to or for the use 01 the survivin9 spouse is 3% {72 P.S. 39116 (a) (1.1) (i)J. For dales 01 death on or alter 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. 99116 (a) (1.1) (il)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure 01 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 paren\. or a stepparent of the child is 0% [72 PS. 3911G(a)(1.2)]. ihe 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. 39116(1.2) [72 P.S. 59116(a)(1 )]. The lax rate imposed on the Ilet value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 59116(a)(1.3)). A sibling is defined. under Section 9102. as an individual who ~s at least one parenl in common with the decedent. whether by blood or adoption. 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 NO. CD 005588 O'BRIEN JEAN S 417 GARFIELD AVENUE PALMYRA, NJ 08065 ACN ASSESSMENT CONTROL NUMBER AMOUNT n_nu_ fold ESTATE INFORMATION: SSN: 186-12-9099 FILE NUMBER: 2104-0797 DECEDENT NAME: SLOWAKIEWICZ STANLEY W DATE OF PAYMENT: 07/18/2005 POSTMARK DATE: 07/15/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/12/2004 101 I $892.00 I I I I I I I I TOTAL AMOUNT PAID: $892.00 REMARKS: CHECK#1010 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS l j j ".-. --- "'J \ ! , J , " r- c- ,...... 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Ul 0 Ul ..,,, cD ... '0' '""'.....~ " .. Ul ::r".., cD ... cD , , ....ID ., ""'UlcD .....'" " .. g lit ......, .. 0 ~ ' Ul ., WILLIAM C. O'BRIEN, JR, ATTORNEY AT LAW 6 KINGS HIGHWAY EAiST HADDON FIELD, NEW JERSEX 08033 (8S6) 429-ISI1 FAX (SS6) 429-3S7$ September 26, 2005 Register of Wills Cumberland County 1 Court House Square Carlisle, P A 17013 RE: Estate of Stanley W. Slowakiewicz Dear Sir: With respect to the above captioned matter, enclosed is a draft in the amount of $15.28 for late penalty and interest Thank you for your attention and cooperation. " Ct?~ WILL~ C. O'BRIEN WCO:tk Ene. S 112RW.14 ". G'l "', ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-11621~X(11-96) I I I I I I j I ! i RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 2104-0797 SLOWAKIEWICZ STANLEY W 10/03/2005 09/29/2005 CUMBERLAND 06/12/2004 O'BRIEN JEAN S 417 GARFIELD AVENUE PALMYRA, NJ 08065 -------- fold ESTATE INFORMATION: SSN: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: REMARKS: CHECK#1013 SEAL 186-12-9099 TOTAL AMOUNT P INITIALS: JA RECEIVED BY: REGISTER OF WILLS NO. CD 00 5858 ACN SSESSMENT AMOU~ T CONTROL NUMBER -------- 101 I $15.2 8 I I I I I I I I AID: $15. D8 GLENDA FARNER STRASBA UGH REGISTER OF WILLS A 09-26-2005 SLOWAKIEWICZ 06-12-2004 21 04-0797 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 ~Y!_~~9~~_!~!~_~!~~______~___~~!~!~_~9~~~_~g~!!g~_~g~_rg~~_~~~g~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SLOWAKIEWICZ STANLEY W FILE NO. 21 04-0797 ACN 101 DATE 09-26-2005 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE BUREAU OF INDIVIDUAL .,.,.x~- :--, "'--.~r INHERITANCE TAX DIVISION, _ _' . PD BDX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ~APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX J. I -1 i DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN WILLIAM COBRIEN ESQ 6 KINGSHIGHWAY EAST HADDONFIELD NJ 08033 REV-1547 EX AFP (06-05) STANLEY W I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ !bh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: rft ..~... IlEl:EIPT ,+} AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12 10 2004 CD004726 .00 967.87 07-15-2005 ........ CD005588 .00 892.00 BALANCE OF UNPAID INTEREST/PENALTY AS OF 07-16-2005 TOTAL TAX CREDIT 1,859.87 BALANCE OF TAX DUE .00 INTEREST AND PEN. 15.28 TOTAL DUE 15.28 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets NO. 01 .00 .00 .00 .00 21.335.98 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 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 .00 .00 (11) (12) (13) (14) NOTE: (15) (16) (17) (18) .00 41,330.54 .00 .00 X 00 = X 045 = X 12 = X 15 = (19)= · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 21,335.98 nn 21.335.98 .00 41,330.54 .00 1,859.87 .00 .00 1,859.87 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) pt. REV.1470 EX (6-88) . '*' INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Stanley Slowakiewicz 2104-0797 REVIEWED BY ACN Deborah Washington 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Accepted additional assets. ROW Page 1 BUREAU OF INDIVIDU"~ ,.:J;I\~(\ (V-r-:rr INHERITANCE TAX DIVISI!>>U )',1i'L./'_:; ldii-j'i,j:: PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) '1nn~ neT? Q P'li';',i 1: 22 [u../'-' ,_3.1: f_V ......- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-24-2005 SLOWAKIEWICZ 06-12-2004 21 04-0797 CUMBERLAND 101 STANLEY W WILLIAM ,p=O~RIEN ESQ 6 KINGSHIGHWAY EAST HADDONFIELD NJ 08033 Amount Remitted 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 FILE NO. ACN DATE THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-26-2005 PRINCIPAL TAX DUE: 1,859.87 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-10-2004 CD004726 .00 967.87 07-15-2005 CD005588 .00 892.00 09-29-2005 CD005858 15.28- 15.28 TOTAL TAX CREDIT 1,859.87 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 PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) (r WILLIAM C. O'BRIEN, JR. ;~r~~<~~~sq ATTORNEY AT LAW * * * ~L' ~~fi _ 6 KINGS HIGHWAY EAST _ a` ~~~ _ ~~ HADDONF{ELD~ N. J. 08033 = ~ t - _ - = MAdt.ED FROM ZIP CODE _ _ Register of Wills Cumberland County 1 C©urt House „. Carlisle, PA 17013 .. ~ `+~{;~. ~'r'~•::~:.~i~.~ _~.:~:y.s3 ~1/1~>!t?t~~~i~ae~r~i~~~il~~a~~~i-'~~~~'j~~~~~~~~~~~~~~~~i~~i~i~~t' 6U- `l~ ] WILLIAM C. O'BRIEN ATTORNEY AT LAW 6 KINGSHIGHWAY EAST HADDONFIELD, NEW JERSEY 08033 (856) 429-1811 FAX (856) 429-3575 Register of Wills Cumberland County 1 Court House Square Carlisle, PA 17013 RE: Estate of Slowakiewicz Supplemental Tax Return Dear Sir: October 23, 2008 Enclosed for filing is an original and copy of a Supplemental Tax Return for the above referenced Estate along with a draft in the amount of $152.59 for filing fees and taxes. Kindly return a copy marked "filed" in the envelope provided. If there are additional sums owed, please advise. Thank you for your attention and cooperation. WCOak Enc. S 112RW.14 Very truly yours, - - i ~ ~~ WILLIAM C. O'BRIEN ~O ~ry -, -~ ~~~ ~ ~~~-- HIS, -~1~~-~, ~~ ~- _, -.~:: ~e~.. ~ -~I "~`~- - ~ ~I.S~ Sys --, ,~, ~h.oClc s •• _: Clock..-~ ~.3~ ~' ca;~~ ~~ ~Sl~ Gt~~ ~~/ ~o~ COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES ~ ~ DEPT'. 280601 HARRISBURG, PA 1 7 1 2 8-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 010456 O'BRIEN JEAN S 417 GARFIELD AVENUE PALMYRA, NJ 08065 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: SSN: 186-12-sos9 FILE NUMBER: 2104-0797 DECEDENT NAME: SLOWAKIEWICZ STANLEY W DATE OF PAYMENT: 10/27/2008 POSTMARK DATE: 10/24/2008 couNTY: CUMBERLAND DATE OF DEATH: 06/ 1 2/2004 REMARKS: RECEIPT TO ATTY CHECK# 438 SEAL 101 ~ $152.59 TOTAL AMOUNT PAID: S 152.59 INITIALS: WZ RECEIVED BY: GLENDA F,4RNFR CTR~CRn1 ir_u REGISTER OF WILLS REGISTER OF WILLS Hevieoa Ex ~ rror COMMONWEALTH OF PENNSYLVANIA - ~ DEPARTMENT OF REVENUE DEPT. 280601 ,d,~ HARRISBURG, PA 17128-0601 COMPLETE MAILING ADDRESS DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Z Slowakiewicz, Stanley W, DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) v 06-12-2004 05-08-1916 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ N/A F ^ 1. Original Return ~ 2. Supplemental Return Q N w a ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date ordeama(ter~z-iz-az) ~ a m ^ 6. Decedent Died Testate (Anacn copy or wiu) ^ 7. Decedent Maintained a Living Trust (Anacn copy or rrusq a a ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date or death between tz-3t-st and ~-t-ss) z ,irtr~~tcrtvN:MUST'BE'COMPLETED.ALL::COR o NAME o William C. O'Brien, Es . w FIRM lygMaE._tir~plicable) ~ J ImI1 p TELEPHONE NUMBER (856) 429-1811 Z O a J H a U W Z O Q H a U X H 6 Kingshighway East Haddonfield, NJ 08033 1. Real Estate (Schedule A) (1) 0 i - ~~~' FFICIAL tfSE ONLY f -,.'~ ~.. ~ . 2. Stocks and Bonds (Schedule B) (2) $ 2 6 , 6 0 $ , 9 6 ~ --`? ~ ' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) - 0 j ~ `,', ~ ~, i 4. Mortgages & Notes Receivable (Schedule D) (4) 0 ___ -~~ ~~' 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) 2 6 4 8 5.14 ~" (Schedule E) ~ _~ :: __ 6. Jointly Owned Property (Schedule F) ^ S t Billi (g) 0 ~ c,~ ..:> epara e ng Requested i ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0 (Schedule G or L) l __-___ __... ___ ._ . 8. Total Gross Assets (total Lines 1-7) (8) $ 5 ~ n 9 4 i n 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ] , 9 3 2.2 5 , 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) (10) ] ] 3 . ] 1 11. Total Deductions (total Lines 9 & 10) (11) 8 ] 0 6 12. Net Value of Estate (Line 8 minus Line 11) (12) $ 4 4 , 3 $ $ .14 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) 0 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $ 4 4 , 3 $ 8 14 att m~ t ttuG I IONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax N/A 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 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT x.0_ (15) 544,3RR_lLr x.o /~ (16)_ 51,997_Cr6 x .12 (17) x .15 (1g) 19. Tax Due $1, 9 9 7.4 6 E~ ~ ~„- 'z "> >'Bg St~RE TO,ANSWE , .~ ear __ - _ FILE NUMBER COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 186 - 12 - 9099 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ^ 3. Remainder Return (dare ordeorn prior m rata-az) ^ 5. Federal Estate Tax Return Required - 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) tatraon sin o) KrINFORMATION SHOULD BE DIRECTED TO: ~~ Decedent's Complete Address: STREETADORESS West Shore Health & Rehabilitation Center ,~ . 770 Po tar Terrace CITY ('.amr~ ~7; l l STATE Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments $1, 8 5 9 8 7 C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty ZIP (1) 51,997 46 Total Credits (A + B + C) (2) 1, 8 5 9.8 7 Total Interest/Penalty (D + E) (3) $13 7.5 9 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) $13 7 . 5 9 A. Enter the interest on the tax due. (5A) ~ B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) $13 7 . 5 9 ake Ch ec Payable to REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTION ~ T"M s .~ S BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :................................................................................... Yes ....... ^ No 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. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~~~~. J DATE 10/23/08 AnnRF " 417 Garfield Avenue, Palmyra, NJ 08065 SIGNATURE OF PRE'PARE~OTHER THAN~EPRES~TATIVE' .-. ADDRESS 10/23~BT~ 6 Kingshighway-£~t, Haddonfield, NJ 08033 __ n ^ _ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax~rate imposed onvthe net value of trap ers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (I)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still ;applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV•f503 EX ~ p~97( _. ' SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stanley W. Slowakiewicz All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. FILE NUMBER 784 shares of Common stock in B.F. Goodrich Company, share number GU 62181, CX 83468 2• 156 shares of Common stock in Enpro Industries, Inc., control number 200807250007983 VALUE AT DATE C)F DEATH $23, `i51.36 3,057.60 _ TOTAL (Also enter on line 2 Recapitulation) + $ 2 6 , 6 0 8 . 9 6 (If more space Is needed, Insert addltlonal sheets of the same size) WILLIAM C. O'BRIEN ATTORNEY AT LAW 6 KINGSHIGHWAY EAST HADDONFIELD, NEW JERSEY 08033 `_,r (856) 429-1811 FAX (856) 429-3575 October 29, 2008 Register of Wills Cumberland County 1 Court House Square Carlisle, PA 17013 RE: Estate of Slowakiewicz Supplemental Tax Return Dear Sir: Enclosed for filing is thr original and copy of a Supplemental Tax Return for the above referenced Estate along with a draft in the amount of $15.00 for filing fees. Kindly return a copy marked "filed" in the envelope provided. If there are additional sums owed, please advise. Thank you for your attention and cooperation. Ve truly yours, ~.~L/ WILLIAM C. O'BRIEN WCO:tk Enc. Sl 12RW.15 F_... n ~T ~~ T ~~ _ -.~ l 3 -i - _ f°-_ __ _. ~ ~;~ ;,j ' ~- ~, ~[~ [~;t I il!' i~ us -~ _ `y i'~ ~ ~ ~ P~.I Af I ~ t.~ A !A:' I,,, II l.,li ~. u. 4~i~ ~: ~ ~ ~~ ,~ •~t i. F- M Z ~ W to O ~ 3 w °D ~ Q o J } M Q 7 W Q 3 Z O > _ w ~? o U Z = w ~ ~ ~ ~ o ~~Z ~ a ? o F--1 Y O I-~ ~ Q a = H L C ~M r to O C~ p U N r, o~~~ a? ~~ m ~~~~ .~ ~ ~ ~~ ~ ~ U ~ ~ U r- U ii! c :~ r~ : •i° ~ a .;..3 i "; .,•a COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE i ~ ~" :NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES `ApPRAYSE~IENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION !- yPF'DEDUCTIONS AND ASSESSMENT OF TAX P9 BOX 280601 ~ "' HARRISBURG PA 17128-0601 ~ r-~~ ~r n n ~ ~ ., r J..,, ~n,- '' , ~,~ WILLIAM C OBRIEN Q '~ 6 KINGSHIGHWAY EAST HADDONFIELD NJ 08033 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 DATE 01-27-2009 ESTATE OF SLOWAKIEWICZ STANLEY W DATE OF DEATH 06-12-2004 FILE NUMBER 21 04-0797 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 03-28-2009 (See reverse side under Objections) Amount Remitted~- MAKE CHECK PAYABLE AND REMIT PAYMENT T0: CUT ALONG THIS LINE _ --~ R_ETA_IN LOWER PORTION FOR YOUR RECORDS E- _ _______________ REV-1547 EX AFP C12-08) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SLOWAKIEWICZ STANLEY W FILE N0. 21 04-0797 ACN 101 DATE 01-27-2009 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. 02 (1) .00 NOTE: To insure proper 1. Real .Estate (Schedule A) 3.057.60 credit to your account, 2. Stocks and Bonds (Schedule B) (2) 00 submit the upper portion 3 Closely Held Stock/Partnership Interest (Schedule C) C3) . of this form with your . D) CG) .00 tax payment. 4 Mortgages/Notes Receivable (Schedule . (Schedule t E) C5) .00 5 y Cash/Bank Deposits/Misc. Personal Proper . C6) ,00 6. Jointly Owned Property (Schedule F) 00 ~~) . 7. Transfers (Schedule G) 8. Total Assets 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 (9) REV-1547 EX AFP (12-OB) ~$) 3, 057.60 .00 clo) .00 C11) .00 c12) 3,057.60 .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 4 4,388.14 (14) 14. Net Value of Estate Subject to Tax NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will flect figures that include the total of ALL returns assessed to date. re ASSESSMENT OF TAX: ,00 00 _ .DO (15) X 15. Amount of Line 14 at Spousal rate 388.14 44 045_ 1,997.46 16. Amount of Line 14 taxable at lineal/Class A rate C16) , 00 x _ 12 .00 X17) . X _ 17. Amount of Line 14 at Sibling rate 00 15 .00 l/Class B rate t C18) . x = 18. Amount of Line 14 taxable at era Colla 997.4 6 1 C19)= , 19. Principal Tax Due ~~~ PAYMENT RECEIPT DISCOUNT c+~ AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 87 967 12-10-2004 CD004726 f .00 00 . 892.00 07-15-2005 CD005588 CD005858/ . .00 15.28 09-29-2005 / 28- 30 152.59 10-24-2008 CD010456/ . EDIT 46 997 1 U NPAID INTEREST/PENALTY AS OF 10-25-2008 TOTAL TAX CR . , BALANCE OF BALANCE OF TAX DUE .00 INTEREST AND PEN. 15.68 TOTAL DUE 15.68 * IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE e vrcuNn- SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-7470 EX (6-88) _y COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG. PA 17128-0601 BY ITEM SCHEDULE NO. Stanley W. Slowakiewicz Charlotte R. Lamke Accepted additional assets. INHERITANCE TAX EXPLANATION OF CHANGES EXPLANATION OF CHANGES FILE NUMBER 21 04-0797 101 Row Page 1 . .~. ~~ , ' t ,; ^~ r .[' ~ ~. ~ ~- u a `I ~ (~ w~~ ; ~~ ~ L . ~;'~ _ ~ . ... ~ c F rs. i~;) ~1 `) O ! E1 ~ 1 . - i i Y L t~' , ~ x~: _ , ,, ~ ~~a;. ~~ (~;~ ~ ~ - ~, ca r O ~ ~ ti U te ~ r.. a~oa a? a~~ m ~~~~ ~U. a' ` a i ,.~ ~Ur-U j~~ ,, r~'~ :.:. :. ; .:.., .; ~~.. Z "' ~ ~, W ~o '"'~ 3 w co J O r Q Q ~ Z 0 > _ W _~ ~ Z 2 W ~ N ~ Z Z Q1 ~' - ~ F„~ Q Y O a ~Q a = H w Q U z 3 F 0 J~ QQ~ y W ~ H z Z> V A E z W z ~ ti pW,~ ~ ow L~ ~-+ w rn LSO wzQ ~ ~ 2 3 q z ~-+ o z H' ~ LL J Q J~ o Q N w Z 3a H i ~ p W c i ~ ~q z w q O ¢ Q U ~ LL a o a a N W k a J = 0 0 (] N 0 > > ~ "+ o a r, z < '" .rte ~Q LLw~oa oZ~~ ~ ~ N m w~o~ ~wm~ x ~zo~ ~ a 3 rv LL ~" O I"` a W W Z ~"` z ~ Q W ~ N o ~ a ~ °~ a N,O w ~ U N , Obi g O O~ H ~ ~ q °3°~z ~ '~~ MD W 2 ~ ° W o N N N o J O Chi ' ~ ~ A ~ .-~ ~ Y ~ ~ ~ N 3~ W Zt ~ Z fn O O ul Q J U ^ p M . i ~ O, F ",~ W y ~ W N O~ O N U o A Fq U Q .p W a = i ~ d s o c Q~ 'i W 5 .may a W J J LL q pWq a y Q B Y I- ~ N O W= ~ ~ W H~ J ~ O z} ` ++ U w 2 Q W Q W W z ~ ~ U U a W Q fA H O V A w A li v Q ~ Q Y Q F r-~ r G:.:"9 `_ ~l `1-J _'- c~ ~~ _. r--- fil i4? C7~ ,. _a ;. D ~ iKj1 ' i 0 O' ~~~ wcnz Q z w W N ~ ~ 3 O 2 q C7 .J U -r LLl 2 H LL. Qc~z z o J H q J Y Q a 3 ~0 2 N A OC O W O O z O -ti ~_ 0 a W_ 3- D. J• Z= a u e r 1 1 W, z~ J y x F- c~ 2 O J Q F- U i 1 1 1 m N m D --I O Z m ~ ~•m rt ~•~ rt z m o~* m o m m ~ ~ ~ r ~ E o ~ ~ M ~ V• ~ o a ~' ~G ~ n m n a o m r ~ ~ o. ~ ~ m ~ ~ ~ rt rt u. ~ w 7 0 ~ 3 (j C7 N r 3 rtiC Y 3 m E ° 7 ~ ~ ~ o rfi~ o- v S ~ ~ ~ ~ w 7 m o rt m ~ ~ ~ n ~ o c o O ~ ~ r n m 7 % rt 9 K 9 ~ c ~ ~ ~ yi N d '1 ~ ~, r n ~ "" N 7 ~ Q M m r c won °° N `+ N m ~ ~ ~ H. y ~0 d ~ ~ 7 rt V• y~ (p h N '~ ~ 7 N IG N N rt ~ ~ ~ w ~ rt M 7 7 C rt m ~+ G rt a ~ o m m n o a ~ a m ~* ~ ~ ~ y rt ~ N. m y. d N ~ rt rt h N ~ "' 7 > > ~' rt h y 7 7 N ~ '~ N K N ~ c rt N. d rt ~ rt ~ m m ~ rt. N• ~ o a M ~ m ~* ~ o ~ -~. w 7 y In 7 ~ M m ~C m ~ ~ ~ m ~ rt y m d ,+ a ~ d n ,+ m m ~ ~ X ~ m N WILLIAM C. O'BRIEN ATTORNEY AT LAW 6 KINGSHIGHWAY EAST HADDONFIELD, NEW JERSEY 08033 (856) 429-1811 FAX (856) 429-3575 January 26, 2009 Register of Wills Cumberland County 1 Court House Square Carlisle, PA 17013 RE: Estate of Slowakiewicz Dear Sir: Enclosed please find my draft in the amount of $15.68 pursuant to the Notice from Department of Revenue. Thank you for your attention and cooperation. Very truly yours, ~ j~ - -Z/'/t-~~~ L-~J ~ti WILLIAM C. O'BRIE WCOak Enc. S 112RW.17 -~ ~~ - o ~ ~.~ ~- ~_. U -r. c> ~~ ; -~ ~.. ,- {_~. ~ - N '_ f~ ~_'\ ~ _ ~ Cs 3 _l_1 ._ b„ ,,, ~.r. - `=~ _ f N G' tti 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 N0. CD 010824 O'BRIEN WILLIAM C JR 6 KINGS HWY E HADDONFIELD, NJ 08033 -------- fold ESTATE INFORMATION: SSN: X86-72-9099 FILE NUMBER: 2104-0797 DECEDENT NAME: SLOWAKIEWICZ STANLEY W DATE OF PAYMENT: O1 /28/2009 POSTMARK DATE: 01 /26/2009 COUNTY: CUMBERLAND DATE OF DEATH: 06/ 1 2/2004 REMARKS: CHECK# 4274 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 515.68 TOTAL AMOUNT PAID: INITIALS: JN REV-1162 EX(11-96) 515.68 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX INHERITANCE TAX DIVISION STATEMENT O F AC C O U N T PO BOX 280601 HARRISBURG PA 17128-0601 REV-1607 EX AFP (12-DB) DATE 03-02-2009 ESTATE OF SLOWAKIEWICZ STANLEY W DATE OF DEATH 06-12-2004 FILE NUMBER 21 04-0797 COUNTY CUMBERLAND WILLIAM C OBRIEN ESQ ACN 101 6 KINGSHIGHWAY EAST Amount Remitted HADDONFIELD NJ 08033 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ --------------------------------------------------------------------------- REV-1607 EX AFP (12-08) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF SLOWAKIEWICZ STANLEY W FILE N0. 21 04-0797 ACN 101 DATE 03-02-2009 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND. IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-20-2009 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 1,997.46 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID *** SUMMARY OF LL 005 PAYMENTS *** - 01-26-2009 45.96- 2,043.42,__` ~_ h ~~~~ ~.~ l 1 1. } ^ --v --1 TOTAL TAX CREDIT .7 a7 r"t rya a ~o r1 ~ m ': _` T. ~ ~,,, ~ -, _ c=: ~:~5 __; ,-, W r ~ ~~~, ''~t - .~ - ~-~i © ., ~.. ..J { 1,997.46 (BALANCE OF TAX DUES .00 INTEREST AND PEN. .00 * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE I .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 016142 O'BRIEN JEAN S 417 GARFIELD AVENUE PALMYRA, NJ 08065 fold ESTATE INFORMATION: Ssrv: 186-12-9099 FILE NUMBER: 2104-0797 DECEDENT NAME: SLOWAKIEWICZ STANLEY W DATE OF PAYMENT: 06/20/2012 POSTMARK DATE: 06/18/2012 COUNTY: CUMBERLAND DATE OF DEATH: 06/12/2004 REMARKS: RECEIPT TO ATTY CHECK# 67800670/7 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 580.26 TOTAL AMOUNT PAID: INITIALS: DMB REV-1162 EX111-961 580.26 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS WILLIAM C. O'BRIEN ATTORNEY AT LAW 6 KINGSHIGHWAY EAST HADDONFIELD, NEW JERSEY 08033 (856) 429-1811 FAX (856) 429-3575 June 18, 2012 Register of Wills Cumberland County 1 Court House Square Carlisle, PA 17013 RE: Estate of Stanley W. Slowakiewicz File No. 2004-00797 PA File No. 21-04-0797 Date of Death: 6/12/2004 Dear Madam: Enclosed please find a Supplemental Inheritance Tax Return in connection with the above referenced Estate and reflecting the receipt of unclaimed property from the Commonwealth. Also enclosed is a money order in the amount of $80.26 representing the additional tax due. Please advise if any additional information is required. Thank you for your attention and courtesies extended.. Very rul~ urn, ~ ~. v ~~ WILLIAM C. O'BRIEN WCOak Enc. S112RW.19 r o °' dF~~ ° ~ q ~, ~"~ ~ n ~_~,~ o z-~O ? D a ~ ~ { ~ Co ~ O ~ w w U ~~- ~:. c: ~ n ~ i .~ ~ n ~ ~ = ~ € ~'`' -. O U- ~ ~, C~ D N ~ .5 , . O . t y: ;. ~ ~ ~ Q tJ1 ..~ ~ ~_ ~ O(nG W ~ ~' ~ ~ CD ~.. ~. ., ~~ ~~ ~ 1505610105 REV-1500 °` `O2-~' `~' OFFICIAL USE ONLY PA Department of Revenue ~ County Cade Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN `-~ Po BDx 28o6oi RESIDENT DECEDENT ~~ ~~ ~ 1 ~~ Harrisburg, PA i~i28-o6oi ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 186-12-9099 06-12-2004 05-08-1916 Decedent's Last Name Suffix Decedent's First Name MI Slowakiewicz Stanley W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's Soaal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW O 1. Original Retum ~ 2. Supplemental Retum O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Sc~redule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number William C. O'Brien, Esg. (856) 429-1811 REGISTER. SILLS USE j~LY ~~JJ ~ First Line of Address ~ N 6 Kingshighway East ^, vt ~~~ J Second Line of Address Q~ ~ ~ F a - ~ N _ ~ FILED .C' City or Post Office State ZIP Code Haddonfield NJ 08033 Correspondent's e-mail address: WCOEsq@AOL. COM Under penalties or perjury, I declare that I have examined this retrim, including acx:ompanying schedules and statements, and to the best of my knowledge and belief, ft is true, correct and complete. Declaration of preparer oMer than the personal n;presentative is based on all infonnafion of which preparer has any knowledge. SIGNAT OF PERSON R SPONSI E FQR FILING RETURN ^T~ ~It~fv pnnRr=cc 417 arfield Avenue, Palmyra, NJ 08065 _ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE I~ATF ~,.~~pp __- ennaccc 6 King,shig way East, Haddonfield, NJ 08033 _ PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J J REV 1500 EX (FI) Decedent's Name: Decedent's Soaal Security Number 186-12-9099 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0 2. Stocks and Bonds (Schedule B) ....................................... 2. $ 2 6 ,_6 0 8.9 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 2 $ , 2 6 8 • ~ 4 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 5 4 , 8 ~ ~ . 7 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ] 9 3 2 2 5 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. ~ ~ 3 • ~ 1 11. Total Deductions (total Lines 9 and 10) ................................. 11. $ ~ ] 0 5 , 9 6 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 4 6 ~ l ~ 1 • ~ 4 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 CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers und~~ sec. 9116 0 (a)(1.2) X .0 N/A 15. 16. Amount of Line 14 +~~,able $ 4 6 1 ~ 1. ~ 4 1 2 0 ~ ~. ~ 3 , at lineal rate X .0 6. ~ 17. Amount of Line 14 taxable 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable at cellateral rate X .15 18. 0 19. TAX DUE ......................................................... 19. 2 , 0 7 7.7 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 1505610205 O REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Stanley W. Slowakiewicz STRFFTAf)f1RFSS West Shore Health & Rehabilitation Center - 770 Poplar Terrace r~r Camp Hill STATE NJ ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ $1 , 9 9 7.4 6 B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (1) Total Credits (A + B) (2) (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. $2,077.73 1,997.46 80.27 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE B LOCKS 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 ........................................... . d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after Dec. 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 benefiaary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 Jan. 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 decedents lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)j. • 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ' REV-15D8 EX+ (11-10) perutsylvarr~a DEPARTMENT Of REVENUE INHERITANCE TAX RETURN RESIDENT DEGT:DENr SiCNEptILE E CASH, BANK DEPOSITS 8c MISC. PERSONAL PROPERTY FILE NUMBER: ESTATE OF: Stanle W. Slowakiewicz Indude the proceeds of litigation and the date the proceeds were received by the estate. All property ia~h ormed rrifh of surviMOrship nwst be disclosed on Sd~eduile F. V ~ E ITEM NUMBER DESCRIPTION DEATH OF 1. M&T Bank, Dillsburg, PA 750.38 $1 Account No. 37405888052 , 2 Wachovia Bank, N.A. C.D. Certificate No. 247412161894312 1,273.73 3 Wachovia Bank, N.A. Checking Account No. 1000030019303 1,430.97 4 Wachovia Bank, N.A. Checking Account No. .1010059322896 694.08 5 BF Goodrich Corp. Dividend Check, Unclaimed property 215.60 ID 3709106 6 BF Goodrich Corp. Dividend Check, Unclaimed property 470.40 ID 9227039 7 BF Goodrich Corp. Dividend Check, Unclaimed property 627.20 ID 10331979 8 BF Goodrich Corp. Dividend Check, Unclaimed property 470.40 ID 10994912 TOTAL (Also enter on Line 5, Recapitulatwn) $ I 28 , 268.74 If more space is needed, u~ additional sheets of paper ~ the same size. INHERITANCE TAX EXPLANATION OF CHANGES Decedent: Stanley W. Slowakiewicz File No. 21 040797 Explanation of Changes: The Decedent, a long time employee of BF Goodrich Corporation, received dividend checks during his lifetime that were not cashed. BF Goodrich turned over the dividend proceeds to the Commonwealth as unclaimed property. A beneficiary of the Estate became awaze of the existence of the property and notified the Executrix who thereafter made application to the Commonwealth for the proceeds. A check was received by the Executrix in the amount of $1,783.60. Attached is a copy of the statement received. 5112.EC1 !F ~ ~ i ~i ~ ' ~ l l .~ _ ~OInInODW~B~~~l~O.f P+~nnsy~v~Ill`d 1 of ' l'~ ~~ ,?k i c~'~{ +\' ~ ~ i' 000652 57 ~16454d ,~ ; ~~ Remittance-Advice ~~ ~i 'F - 'Penns lvania Treasury ~ - Bureau of Unclaimed Property Payment ~~~ ' Y I ' CLAIM ~ 77436084 ji,~~~. ------------------ ~ I„ Property ID Holder Name Description Amount 3709106 GOODRICH, CORPORATION DIVIDENDS 215.60 ' 470.40 9227039 GOODRICH CORPORATION CO DIVIDENDS , !' i i. 10331979 GOODRICH CORPORATION CO DIVIDENDS. 627.20 I+I , 10994912 GOODRICH CORPORATION CO DIVIDENDS ~ 470.40 Iii Total : 1, 783 .60 , ~~ ', ,~ I. ' i, i '1 ' ~ ~ ~i ~~ ~', ` II i ~~ L ~! ' ,~ ~ i I~ ~ ~ ~!}~ ,, ~s ~~ , i , ~ ~`~ I ( 1 ~,~ i; 'i y ~; I , ~; .:~ ~i ~ i ~~ i ~ ~ t ! ~,~~ ~~ ~ ~ ~ ~~ r ~ i ~ ~ ~ ~ ~ ~~ ~~ ri ~~~~ ~~i i ~. `a ,~ ,, ~ '~ !1 ~ ~ ,~ ~ ~, ~, ~ C~ ~ ~ s~~„~~ ~ PAYSS INFORMATION: NOTE: Direct payment inquiries to: ia~tl~:~, (' ~ PA Unclaimed Property 1.800.222.204 ~~~~,, l ~~WAKIEWICZ STANLEY W ESTATE OF ~, I ?~ P.O'. BOX 1837 ~~~ !~~' C/O JEANS OBRIEN EXEC ~ SbuYg, PA 17105-1837 ,!. ~i is ..III; Harr •, - 417 GARFIELD AVENUE ~'~ I~ ' ~ ~ ~ (~ PA~MYRA NJ 08065 , ~ ~!~ ., i ~ FOLD ON PERFORA'i ION, THEN DETACH CAREFULLY ! }I~ ~ ~~ r __ _____ ~~ °~~~ ~ ! ` ~ i ~ ~. ~~~' 4 ~' !'4 ~ `~, ~ ~ i i'~ h! 1 ~ !.~ ; ~ , :,' ~ ' - i i i ~t i ~~: 't •. i_ ~ i ,~: I 1 . P~ ~ , ~~ ~S j-. li i'r: 'i. WILLIAM C. O'BRIEN ATTORNEY AT LAW 6 KINGSHIGHWAY EAST HADDONFIELD, NEW JERSEY 08033 (856) 429-1811 FAX (856) 429-3575 June 22, 2012 Register of Wills Cumberland County 1 Court House Square Cazlisle, PA 17013 RE: Estate of Stanley W. Slowakiewicz File No. 2004-00797 PA File No. 21-04-0797 Date of Death: 6/12/2004 Deaz Madam: ~-- -3 ~.. cr.~~'~, C~ i„~. ~~ ~~ ~ . ~ ~ . .' ~^ '? rv c-,- f~ ~ ~ =~ c c:'.°~ c'~:? = -tt -~- ~ --r ~ _ --~, rv „ `~ ~~ .~- ca Enclosed is an original and copy of a Supplemental Inheritance Tax Return along with my draft in the amount of $15.00 for filing fees. Thank you for your attention and cooperation. Very truly yours, ~ ,/f l lam/ WILLIAM C. O'BRIEN WCOak Enc. S112RW.19 t .~ ~.., G'k,f Pr's i ~, ,~... I'rY ,. r,_a ~.,., t"wJ cf] ~ :; ~ I.'ql C;';I i ~, ,~ ~~...~ [ 7;;I~„'k if k 9;p;F ~~"" G rt:l k •x; ~:q7 C:il iy, L.P1 Pry K ~ ~~ ..Ch ~aSil N O ~O ~~'y~- °a r °'a~~ti v~.c~~, ~Vr-U z ~ ~ ~ ~ (~ Q J Q W 3 O ~ ~ ~'~{~ ~ ~~ { ~. ~ y'~I +u . W ~ p W V ~ O Q N _ ~ , H a Y ~ oO Q _ r~ ~~1 ~ ' ~~, - .: - _ ~__ __ ;. ,,:. G BUREAU OF INDIVIDUAL TAXES ~~'~~~~~ ~~TANCE TAX INHERITANCE TAX DIVISION ~~~(~;~ ~~` Po eox 2BO6B1 v ~A~T~II,~IT OF ACCOUNT HARRISBURG PA 17128-0601 ?Dt2 JUL t 3 PH t2: !~Z WILLIAM C O BRIE N ~ 1LwV~ t~V., RA 6 KINGSHIGHWAY EAST HADDONFIELD NJ 08033 pennsyLvarna ~~ . DEPARTMENT OF REVENUE REV-1607 EX AFP (12-11) DATE 07-09-2012 ESTATE OF SLOWAKIEWICZ STANLEY W DATE OF DEATH 06-12-2004 FILE NUMBER 21 04-0797 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your taz payment. CUT ALONG THIS LINE - - - - ~_ RE_TAIN LOWER P_ORTI_ON FOR YOUR RECORDS _ ~ REV-1607 EX AFP C12-11) *~* INHERITANCE TAX STATEMENT OF ACCOUNT ~*~ ESTATE OF:SLOWAKIEWICZ STANLEY W FILE NO.: 21 04-0797 ACN: 101 DATE: 07-09-2012 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-20-2009 PRINCIPAL TAX DUE: 1,997.46 PAYMENTS (TAX CREDITS): P DATE T I NEUMBER (INTEREST/PENT PAID C-) AMOUNT PAID *** SUMMARY OF ALL 006 PAYMENTS *** 06-18-2012 45.96- TOTAL DUE * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 2,123.68 TOTAL TAX PAYMENT 2,p77,72 BALANCE OF TAX DUE 80.26CR INTEREST AND PEN. .00 80.26CR COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280fi01 rtARRlseuac, PA n,z6-osol PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT O'BRIEN JEAN S 417 GARFIELD AVENUE PALMYRA, NJ 08065 ACN ASSESSMENT CONTROL NUMBER ESTATE INFORMATION FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 156-12-9099 2104-0797 SLOWAKIEWICZ STANLEY W 12/13/2012 12/11/2012 CUMBERLAND 06/12/2004 TOTAL AMOUNT PAID: REMARKS: CHECK# 639 INITIALS: HEA RECEIVED BY: SEAL REV-1162 EX111-961 N0. CD 016917 AMOUNT 525.18 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS WILLIAM C. O'BRIEN ATTORNEY AT LAW 6 KINGSHIGHWAY EAST HADpONFIEID, NEW JERSEY 08033 (856) 429-1811 FAX (856) 429-3575 December 11, 2012 Register of Wills Cumberland County 1 Court House Square Carlisle, PA 17013 RE: Estate of Stanley W. Slowakiewicz File No. 2004-00797 PA File No. 21-04-0797 Date of Death: 6/12/2004 Dear Madam: Enclosed is a payment in the amount of $25.18 in connection with the above referenced matter. Thank you for your attention and cooperation. V,~ ~"X-, ly WCOak Enc. S 112RW.21 l:~ ~ WILLIAM C. O'BRIEN ~' ~m c~ ^' m n CO ;~ 4'>p C7 _ CJ Y U~ . Jc " "s1 -re 7 C' -~,~ ~~ c ~ ~ • ,_ r~n -~ rJ ~' 'h -~ CI C 1 s r O m ~ 1 O ~"~ x N , M ~n N i - r 1° M1 9 z m $ i A a ° ~ ; m ~ y b H O ~' O O r ~ f .^ p ~ c ° ~ o A n R zy oic m m A mX C A ° ~ O ~Omm T £ = n~DZ % H O ~ r ~-' r „ ~ o~ ~ ~ o O Z ~ y C Z ~ y m N 3 .- i~ m=om -~ O < ~ m m A '" ., m r.~ Z C'~ m ,"., rn crn's ~ ~ ~ ~ Gi o ~ d ~m-on ~ wr z rn w :~ ,D.~„~, N ; f ~ 7~ y c~-~ -yry '-71 ovc;n Z ~ +~ .. ~'~ ~ ~1 ~ k.7 -~ N -7t y. u~ O m C'! r A = m cDV C1 p O m „" G N A ~ A m =< o m xoz 'o ~ ~ o A r~ 'O N m 77 ~ > m rEi ~°. r A r O d C A i ~ D N A H ~~„ m ? o 1 r i T d b N R ~ m p m p i Z m v m m -i m ~ = o m m C m O ~ p T ~ A ~ 9 = D o 'r C'I Y P N r r ~ Fq ~ ~ G ~ ~ m " ~ t N Y ~ m Y Z m ~ F A 'o N ~-+ N r ~om° A , m Z v t~ N p m a N z H ~"~ 9 N < Z = m r Z m ~ ~ ~ L A ~. ~ mZ ~_ am AA O ~.. a "~ pi c.. ~ cm N -i ~ ;a mK Z -i O m 9 ~ 9 w3N o ^~^,, ~ A W ^ < N m ,. Z ~~ .- c m . :¢t~ g~ ~ z~ , "~ ~ ',~ ~ ~ ~' t i~ d x$i ~g a ;. ~. F.m M r ~i ~, i 1 i. Yn a : S( ~{ :. n N s :;Hf ~Q y 0 ~ O ~U ~^ v o'a o ~ = .any y~U~~ ~U•-U ~ bd . .. ~, .ca ` `' ne no '` ~ ~a~ `~ 3 Q ~ o , ; , ~ .W~n / l Z = J / ~• ~ g ~ ~ J` .e !~.~s ~~ .~a h-1 Q Y O ) I~ V ~ '~,l ~V~a a ~ Q a S ``i~--/ r> SY~ i7i ill iTt i*) i'7 i'') ,.., !;i r,. .,..~ t ~~~ ~~,?;i'r,~, i. jrr?'t ~ OFNOTICE OF INHERITANCE TAX ~ Pennsylvania BUREAU OF INDIVIDUAL T~{~,!:, ~ ~tP,R~~14,SEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION ' "`~'i~~, -~' ~~ bEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP C09-12) PO BOX 280601 HARRIS~7lURG PA 7128-0601 <~i ~' ~~ i 3 P~ l ~ 0`~ DATE 10-29-2012 ESTATE OF SLOWAKIEWICZ STANLEY W - T ' DATE OF DEATH 06-12-2004 y , ~~ " ~ ~ `~ ~'~~~~ r v ~J; l `' W~l~ C~" PA CU~+~~~il FILE NUMBER 21 04-0797 ~ COUNTY CUMBERLAND WILLIAM C OBRIEN ESQ ACN 1D1 6 KINGS HWY E APPEAL DATE: 12-28-2012 HADDONFIELD NJ 08033 (See reverse side under Objections) Awount Rewitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER ------------------------------------------- PORTION FOR YOUR RECORDS ~ - - ---------------------------------------------- REV-1547 EX AFP C12-11~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: SLOWAKIEWICZ STANLEY WFILE N0.:21 04-0797 ACN: 101 DATE: 10-29-2012 TAX RETURN WAS: C ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. 03 1. Real Estate tSchedule A) (1) •D D NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) ~2) 3,05 7.6 0 credit to your account, D D SUbmit the upper portion 3. Closely Held Stock/Partnership Interest (Sche . dule C) (3) of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 2 3,119.5 8 6. Jointly Owned Property (Schedule F) ~6) .0 0 7. Transfers (Schedule G) C7) .0 0 8. Total Assets cs) 26.177.18 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (S chedule H) ~q) .0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) alp) .00 11. Total Deductions C11) .0 0 12. Net Value of Tax Return C12) 26, 177.18 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) X13) .0 0 14. Net Value of Estate Subject to Tax (14) 70,565.32 NOTE: If an assesswent was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will reflect figures that include the total of all returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at spousal rate (15) .0 0 X 0 0 - .0 0 16. Amount of Line 14 taxable at lineal rate C16) 7n. ~A~-;~ X 045 = 3,175.43 17. Amount of Line 14 at sibling rate C17) .0 D X 12 = .0 0 18. Amount of Line 14 taxable at collateral rate (18) .0 0 X 15 = .0 0 19. Principal Tax Due C19)= 3, 175.43 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCDUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID *** SUMMARY O ALL 06 PAYMENTS *** 06-18-2012 .00 2,123.68 INTEREST IS CHARGED THROUGH 11-13-2012 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT 2,123.68 BALANCE OF TAX DUE 1,051.75 INTEREST AND PEN. 517.05 TOTAL DUE 1,568.80 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS. (~ APPRAISEMENT: Efforts to obtain an inheritance tax return have been exhausted for the estate referenced. Therefore, the filling requirements have been waived. The department, however, reserves the right to assess any assets that may be recovered at a future time. RESERVATION: Estates of decedents dying on or before Dec. 12, 1982 - if any future interest in the estate is transferred in possession or enjoyment to 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 lawful collateral rate on any such future interest. PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills indicated on the front of the notice. Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien or the issuance of an Orphan's Court citation. REFUND (CR): A refund of a tax credit not requested on the tax return may be requested by completing an Application for Refund of Pennsylvania Inheritance and Estate Tax (REV-1313). Applications are available from the department's web site at www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the department's 24-hour forms ordering service: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance or disalbwance of deductions, or assessment of tax (including discount or interest) as shown on this notice may object within 60 days of the date of receipt of this notice by: A) Filing an appeal online at www.boardofappeals.state.pa.us on or before the appeal date identified on the front of this notice. Or sending a written protest to: PA Department of Revenue, Board of Appeals, PO BOX 281021, Harrisburg PA 1 71 28-1 021; B) Having the matter determined at audit of the account of the personal representative; or C) Appealing to the Orphans' Court. ADMINISTRATIVE CORRECTIONS: Errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO BOX 280601, Harrisburg PA 17128-0601, Phone (717) 787-6505. See page 4 Instructions for Inheritance Tax Return for a Resident Decedent (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three calendar months after the decedent's death a five percent discount of the tax paid is allowed. INTEREST: Interest is charged beginning with first day of delinquency, or nine months and one day from date of death, to the date of payment. Annual interest rates are available on Form REV-1611, available at www.revenue.state.~a.us, or upon request by calling 1-888-728-2937. Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR Any Notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days beyond the date of the assessment. If payment is made after the interest calculation date shown on the Notice, additional interest must be calculated. REV-1470 Ex (01.10) ~ pennsylvania DEPARTMENT OF REVENUE Y BUREAU OF INDIVIDUAL TAXES PO Box 280601 DECEDENT'S NAME Stanley W.Slowakiewicz Destiny S.R. Brown FILE NUMBER 2104-0797 101 ITEM SCHEDULE NO, EXPLANATION OF CHANGES Accepted additional assets and debts. INHERITANCE TAX EXPLANATION OF CHANGES Row Page 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX INHERITANCE TAX DIVISION S TAT E M E N T O F AC C O U N T PO BOX 280601 HARRISBURG PA 17128-0601 RECORi~="~ '?~'iG~ ~~ IOI3 ~F~~ ? ~i~ :~ ~2 WILLIAM C OBRIEN ~~RK ~iF 6 KINGS HWY E ~A~~,~~g„~~ HADDONFIELD ~R~ 8D ~~ CU'MBERLANQ ~G.. ~' ~~~`~~~ Pennsylvania DEPARTMENT OF REVENUE REV-1607 EX AFP (12-12) DATE 12-24-2012 ESTATE OF SLOWAKIEWICZ STANLEY W DATE OF DEATH 06-12-2004 FILE NUMBER 21 04-0797 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure 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 C12-12) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF:SLOWAKIEWICZ STANLEY W FILE N0.:21 04-0797 ACN: 101 DATE: 12-24-2012 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE> AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-28-2012 PRINCIPAL TAX DUE: 2,077.72 PAYMENTS CTAX CREDITS): PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) *** SUMMARY OF ALL 007 PAYMENTS *** 12-11-2012 71.14- 2,148.86 TOTAL TAX PAYMENT 2,077.72 BALANCE OF TAX DUE .00 INTEREST AND PEN. ~ .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TDTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS. s ' INHERITANCE TAX pennsylvania'i RECORD ADJUSTMENT DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES REV-1593 Ex AFP (12-11) INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 RECORDED ci z o F REGIS i E Gi° " _ S DATE 11 -29-2012 RR ESTATE OF SLOWAKIEWICZ STANLEY W LDEC 7 07 DATE OF DEATH 06-12-2004 FILE NUMBER 21 04-0797 CLERK OF COUNTY CUMBERLAND ORPHANS' COURT ACN 101 Amount Remitted WILLIAM C OBRIUMBULAND GO., ,`A 6 KINGS HWY E HADDONFIELD NJ 08033-2000 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE --I RETAIN LOWER PORTION FOR YOUR RECORDS EX AFP (12-11) INHERITANCE TAX RECORD ADJUSTMENT ESTATE OF:SLOWAKIEWICZ STANLEY W FILE NO. :21 04-0797 ACN: 101 DATE: 11-29-2012 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION VALUE OF ESTATE: 1. Real Estate (Schedule A) (1) .00 2. Stocks and Bonds CSchedule B) (2) 26,608.96 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) C4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 28,268.74 6. Jointly Owned Property CSchedule F) C6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets C8) 54,877.70 DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Administrative Costs/ Miscellaneous Expenses CSchedule H) C9) 7,932.25 10. Debts/Mortgage Liabilities/Liens (Schedule I) CIO) 773.71 11. Total Deductions (11) 8,705.96 12. Net Value of Tax Return (12) 46,171.74 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00 14. Net Value of Estate Subject to Tax C14) 46,171 .74 TAX: 15. Amount of Line 14 at Spousal rate (15) 00 X.00 - 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 46, 171. 74 X. 045= 2,077.72 17. Amount of Line 14 at Sibling rate C17) 00 X.12 - 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 00 X.15 - 00 19. Principal Tax Due (19) TAX CREDITS: 2'077.72 PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID AMOUNT PAID SUMMARY OF ALL 06 PAYMENTS 06-18-2012 45.96- 2,123.68 BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-19-2012 TOTAL TAX PAYMENT 2,077.72 BALANCE OF TAX DUE .00 INTEREST AND PEN. 25.18 TOTAL DUE 25.1 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 Fx (V-10) pennsylvania INHERITANCE TAX DEPARTMENT OF REVENUE EXPLANATION BUREAU OF INDIVIDUAL TAXES OF CHANGES PO Box 280601 HARRISBURG, 17128-0601 DECEDENTS NAME FILE NUMBER Stanley W. Slowakiewicz 21 04-0797 REVIEWED BY ACN Steven James 101 ITEM SCHEDULE NO, EXPLANATION OF CHANGES E The supplemental return assessed October 29, 2012 has been adjusted to reflect just the new asset submitted on the return. When submitting supplemental information it is important not to duplicate assets and debts already reported as an erroneous duplication in assets may occur. ROW Page 1