HomeMy WebLinkAbout04-0817PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of DE OLIVEIRA, CARLOS A., Deceased
Social Security No. 078-60-4059
County of Cumberland in the
Commonwealth of Pennsylvania
The Petition of the undersigned respectfully represents that:
Your Petitioner(s), who is/are 18 years of age or older, applies for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family
or principal residence at 708 Hanover Manor, Apt. D 108, Carlisle, Pennsylvania 17013.
(list street, number and municipality)
Decedent, then 44 years of age, died June 13, 2004, at M.S. Hershey Medical Center,
Dauphin County, Pennsylvania.
Decedent at death owned property with estimated valued as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
10,000.00
Petitioner after a proper search has ascertained that Decedent left fi:6 will an~ was survived
by the following spouse (if any) and heirs: ~:
Name Relationship Residence Cfi
Isabel De Oliveira
Mother
11 Schenck Avenue
Great Neck, NY 11021
THEREFORE, Petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the unL~i, gned.
Isabel De Oliveira
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY Or C_,~ ~,~ r I~ d ss
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law. //~
Sworn to or affirmexl and subscribed ~-y ~
bx~e nie this :'~1 LA, day of / w
Estate of
(-~.'l o s A. . "P.e
~'~' , De/~ased~
GRANT OF LETTERS OF ADMINISTRATION
AND NOW. '-,..-~Vx'~',_, ~'~ c,~C~ lg/ , in consideration of the petition on
the reverse sMe hereof, satisfactory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ~'.~t~ Z:ze Oi,~t't'~ ~ tO.'H,k~.. ,~.
in the estate of C.s~'lt~s, ~e. Ollq'~_ft'q
FEES
Letters of Administration ..... $ t~
Short Certificates( ) .......... $ ~ ~ .(2ND
Renunciation ................ $
-3C'C) $
TOTAL
Fil~ ~.x~:.&o~6. ..... A.D. 19
Reg/ster of Wilh ~-.Q'/~ ~
ATTORNEY (Sup. Ct. 1.D. No.)~
ADDRESS
(m*) z~-r375
PHONE
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of.
also known as
Deceased.
,No.
No.
To:
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
The
Your
the undersigned respectfully represents that:
who is/are 18 years of age or older, appl
lite; durante absentia; durante minoritate)
for letters of administration
on the estate of
h
Decendent,
at
death in
~, or principal residence at
__ years of age, died
County, Pennsylvania, with
(list street, number and municipality)
,19
Decendent at
(If domiciled in Pa.)
(If not domiciled in Pa.)
(If not domiciled in Pa.)
Value of real estate in Penns
situated as follows:
with estimated values as folllows:
All personal property $
Personal property in Pennsylvania $
property in County $
$
Petitioner after a proper search
the following spouse (if any) and heirs:
Name
__ ascertained that decedent left no will and was survived by
Relationship
Residence
THEREFORE, petitioner(s) respectfully request(s)
appropriate form to the undersigned.
of letters of administration in the
his is to certify that the inlbrmation here given is correctly copied from an original certificate of death dnly l'ilcd with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee fbr this certificate, $2.00
No.
Local Registrar
Date
Carlos A. DeOliveira
OI Oq ?17
COMMONWEALTH OF PENNSYLVANfA · DEPARll~ENT OF HEALTH · VITAL REC(~D$
CERTIFICATE OF DEATH
M 078-- 60 -- 4059
708 Hanover Manor; ,TL sm.
,~Carlisle, PA 17013Apt. D108
(Not Ascertainable)
~ Isbel
6/13/2004
/17/2004
Center , ~ ~te
(klaberland ~' ~'
Nassau Knolls
L
11021
Washington, NY
7033
ATTORNEYS AT LAW
323 W. Lakeside Avenue, Suite 200
Cleveland., Ohio 44113-1099
216.685.1000
www.weltman.eom
BURLINGTON, NJ
609.914.0437
CHICAGO,IL
847.940.9812
CINCINNATI,OH
513. 723 .2200
COLUMBUS,OH
614.228.7272
DETROIT, MI
248.362.6100
PHILADELPHIA, PA
215.599.1500
PITTSBURGH, P A
412.434.7955
WELTMAN, WEINBERG & REIS CO., L.P.A.
March 8, 2005
Cumberland, Register Of Wills
One Courthouse Square
Carlisle, PA 017013
Re:
Estate of Carlos A Deolivira
Case No. 21-04-817
Our Client: Bank of America, N.A.
Account No. 4427100035528780
Balance Due: $2,849.75
Our File No. 3878624
~ ,~I
f',,)
Dear Clerk of Courts:
This law firm represents Bank of America, N.A. in connection with its claim which we wish to file ou'6ur client's -behalf i~fo' . ':
Ihe estate of Carlos A Deolivira, deceased. Enclosed is our check in the amount of$IO.OO which we understand i~lhe filing
fee for this claim.
Our client's claim is based upon its account number 4427100035528780 in the amount of $2,849.75. As of the date of this
letter, this is the amount due. Included with this letter is the claim form which we wish to present to this court and which we
are forwarding to the attorney and/or fiduciary of this estate.
It would be appreciated if all correspondence and disbursements with respect to this matter be forwarded to our office and to
the attention of the undersigned. Additionally, it would be appreciated if any notices of any hearings also be forwarded to the
undersigned. Thank you for your cooperation in this matter.
VLF:iar
Sincerely Yours,
[/jJi;_*[;I:;:~.
Veda Flowers
Legal Assistant
(216) 685-1171
Enclosures
cc: Isabel De Oliveira
Sean M Shulty
if
WELTMAN, WEINBERG & REIS CO., L.P.A.
ATTORNEYS AT LAW
323 W. Lakeside Avenue, Suite 200
Cleveland, Ohio 44113.1099
216.685.1000
www.weltman.com
March 8, 2005
CERTIFIED MAIL
Isabel De Oliveira
11 Schenck Avenue
Great Neck NY II 02 I
Re:
Estate of Carlos A Deolivira
Case No. 21-04-817
Our Client: Bank of America, N.A.
Account No. 4427100035528780
Balance Due: $2,849.75
Our File No. 3878624
Dear Sir or Madam:
BURLINGTON, NJ
609.914.0437
CmCAGO,IL
847.940.9812
CINCINNATI,OH
513.723.2200
COLUMBUS,OH
614.228.7272
DETROIT, MI
248.362.6100
PHILADELPHIA, PA
215.599.1500
PITTSBURGH, P A
4]2.434.7955
f')
N
U)
Tbis law fIrm represents Bank of America, N.A. with respect to the claim wbich we wish to fIle in the estate of Carlos A
Deolivira. It is our understanding that you are the Attorney of the estate.
We are asking that you please accept our client's claim which is based upon its account number 4427100035528780 in the
amount of$2,849.75. As of the date of this letter, this is the amount due.
Please direct all correspondence and disbursements with respect to this estate directly to our office. It would also be
appreciated if you contact us to advise us when you anticipate making disbursements in this matter so that we may mark our
fIle for follow-up at that time.
Thanking yon in advance for your cooperation in this matter.
This law fIrm is attempting to collect this debt for our client and any information obtained will be used for that purpose.
Lastly, do not hesitate to contact us to further discuss this matter.
Sincerely Yours,
t/~(dt ~/{OUS.tL
Veda Flowers
Legal Assistant
(216) 685-1171
VLF:iar
Enclosures
cc: Isabel De Oliveira
Sean M ShuIty- regular mail
WWR#3878624
FORM 93-0.C. DIVISION
IN THE COURT OF COMMON PLEAS
of
CUMBERLAND, REGISTER OF WILLS, PENNSYL VANIA
ORPHANS' COURT DIVISION
IN RE: ESTATE
OF
No. 21-04-817
Carlos A Deolivira
Deceased
For a credit card with Bank of America, N.A.,
Account No. 4427100035528780
CLAIM
To the Clerk of Orphans' Court Division:
Index and make proper entry in your official records of the claim of Bank of America. N.A.
c/o Weltman. Weinberg & Reis Co.. L.P.A.. 323 West Lakeside Avenue. Suite #200. Cleveland. Ohio 44113-1099
(Claimant)
in the amount of $2.849.75
against the estate of the above named decedent.
This claim is filed under Section 3532 (b) (2) ofthe Probate, Estates and Fiduciaries Code.
The said decedent, who resided at 708 Hanover Mnr # 0108 Carlisle PA 17013
(Address)
Written notice of this claim was given to Isabel De Oliveira & Sean M Shultv
(Personal representative, if any, or counsel)
, died on 06/13/04
on
II Schenck A venue Great Neck. NY II 021 & 19 Brookwood Ave. Suite 106 Carlisle P A 17013
Address or Personal Representative, if any, or counsel
, i'tld~tf::~-
Veda Flowers, Agent for the Claimant
c/o Weltman, Weinberg, & Reis Co., L.P.A.
323 W. Lakeside Ave., Suite200
Cleveland. Ohio 44113
(Claimant's Address)
'_U'~l *' REV -1500=#= OF:":Ci.:"L USE O,L,
COMMONWEALTH Of' PENNSYlV"NI" INHERITANCE TAX RETURN i FILE NUMBER
OEP"RnAENT OF REVENUE RESIDENT DECEDENT i 21 04 00817
OEPT.280601
HARRISBURG. P" 1112&.0&01 COUNTY CODE YEAR NUMBER
DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
De Oliveira, Carlos A. 078-60-4059
...
z DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-OQ..YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
w
0
w 06/13/2004 05/09/1960 REGISTER OF WILLS
u
w
0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~ ,. Original Retum 0 2. Supplemental Return 0 3. Remainder Retum (dale of death prior to 12-13-62)
w
... 0 Limited Estate 0 4.. Future Interest Compromise (date of death after 5. Federal Estate Tax Retum Required
c~ 4.
12-12-62)
o 7. Decedent Maintained a Living Trust (Attach
copy of Trust)
o 10. Spousal Poverty Credit (date of death between
12-31-91 and 1.1-951
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
rAME COMPLETE MAILING ADDRESS
. ... Sean M. Shultz, Esquire
~z
Ww
a:: Q FIRM NAME (If applicable)
Zz I
g Ii' I Knight & Associates, P.C.
rELEPHONE NUMBER
----I 717/249-5373
~ 1. Real Estate (Schedule A)
I 2. Stocks and Bonds (Schedule B)
I
,
Due.. .5DOO
'Yd L\O,U\)
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:sg
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~
06.
09.
Decedent Died Testate (Attach copy
cfWill)
Litigation Proceeds Received
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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l!:
1l
w
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus line 11)
A.?b.IO.d)
I
o
1 8. Total Number of Safe Deposit Boxes
o 11.Eleclion to tax under Sec. 9113(A) (Attach Sch 0)
11 Roadway Drive, Suite B
Carlisle, PA 17013
(1)
C!"F:CIALuse
None
(2)
2,774.06
(3)
None
(4)
None
(5) 12,770.23
(6) 412.55
(7) None ()';'
(8) 15,956.84
(9) 14,513.16
(10) 7,730.10
(11)
22,243.26
(12)
insolvent
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
z
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~
~
~
~
o
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~
I
i 16.Amount of Line 14 taxable at lineal rate
I 17.Amount of Line 14 taxable at sibling rate
118. Amount of Line 14 taxable at collateral rate
11g. Tax Due
! 20. 0
x .00
(15)
x .045
(16)
x .12
(17)
x .15
(18)
(19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
of~:~,'1:
~pyright 2000 form software only The Lackner Group, Inc.
>> BE SURE TO ANSWER ALL QUESTIONS ON 'REVERS'esiDE AND RECHECK MATH <<
Form REV-1500 EX (Rev. 6-00)
v
708 Hanover Manor, Apt. D1 08
I
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Decedent's Complete Address:
STREET ADDRESS
CITY
Carlisle
I STATE PA
IZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C) (2)
0.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
(3) 0.00
(4)
(5) 0.00
(SA)
(5B) 0.00
TolallnteresUPenalty (0 + E)
4. If Line 2 is greater than line 1 + Line 3. enter the difference. This is theOVERPA YMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is theBALANCE DUE
Make Check
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;............................................................................. ~ I
~: ~:~::~ ~h~e~~~;j~~~~s:~~e~~s~~~.~~~~~.~.~.~.~~~.~~~~~~..~~.~.~~~~.~~.~..~~.i~~. i.~.~~:~~..................................:::::::::::~~.....
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? ....... .......... ...... ..... ........ ... .... .... .............................. .............n. .................... 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..............................n................................................................................ D ~
IF THE ANSWER TO ANY OF THE A60VE 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 relum, inCluding accompanying schedules and statements, and to the best of my knowledge and belief, it is lrue. correct
and complete. Declaration
preparer other than the personal representative is based on all inf lion of which pre parer has any knowled e.
SIGNATURE OF PERSON:t:ES NSIBLE FOR FlUNG RET AODRESS DATE ~
Isabel De Oliveira . I /I ./~ ;I 11 Schenck A venue .-
.3Q.tll.I::.,ox C-r.. Great Neck, NY 11021 -:; -I \ 'f) J
SIGNATURE OF PERSON RESPONSlB 0 FlUNG ~TURN. ADDRESS DATE
William A. Addams
27 West High Street 3 ? co 0'
Carlisle, P/\ 17013 -or /- ~
HAN REPRESENTATIVE ADDRESS DATE
II Roadway Drive4 Suite B
Carlisle, PA 1701>
>, 2-7/0";)
!/~1
.'}(Z~
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 <a) (1.1) (i)],
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)l. The statutedoes not exemotatransfer 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 Ihe child is 0% [72 P.S. ~9116 <a) (1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries Is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. ~9116 (a) (1)],
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
,
l'
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX REruRN
RESIDENT OECEDENT
I FILE NUMBER
21-04-00817
"STATE OF .
De OliveIra, Carlos A.
0\.11 property jolntly.-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
I 8,159 shares of Applied Digital Solutions, Inc. stock .340. 2,774.06
I
TOTAL (Also enter on line 2, Recapitulation) 2,774.06
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
I.
I
I
I
I
I
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
I FILE NUMBER
21 - 04 - 00817
:STATE OF ..
De Ohverra, Carlos A.
,c1ude the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of
;urvivorshtp must be disclosed on schedule F.
ITEM
NUMBER
I
DESCRIPTION
VALUE AT DATE OF
DEATH
50.00
Waypoint Bank Checking Account No. 100767946
2
Personal Property Found in Safe Deposit Box (see attached appraisal)
1,515.00
3
Commerce Bank Checking Account No. 536225774
345.47
4
Commerce Bank Savings No. 10724219
1,301.44
5
Financial Network Investment Corporation Account No. 4N2-884472
1,996.75
6
Unisys Savings Plan Account No. ENV#MG003048
56.57
7
1987 190E Mercedes - sale proceeds
5,000.00
8
1995 Ford Taurus
1,600.00
9
Refund from Hanover Manor
480.00
10
Refund of Security Deposit for apartment
425.00
TOTAL (Also enter on Line 5, Recapitulation)
12,770.23
APPRAISAL SUMMARY
It is in my opinion, that as of d.o.d. June 13,2004, the Fair Market Value of the personal
property of Carlos A. De Oliveira, deceased:
(One Thousand Five Hundred Fifteen Dollars and Zero Cents)
($1,515.00)
IBIS APPRAISAL
SERVICES
The reTJort must be read in its entiretv. The ATJTJraisal Summarv ONLY is
not the aTJTJraisal reTJort.
4
Personal Property Listing
1
Chann. Gold plated chann. "in emergency break glass".
Corresponding Digital Photograph File: r030I066Jpg
Rim!. 18k yellow gold emerald and diamond ring. Emerald: one oval
cut emerald, approximately .15 carat Diamonds: 26 round cut
diamonds, at approximately .01 carat each. Size: 6 %.
Corresponding Digital Photograph File: r030I058Jpg
2
Ring. l8k yellow gold diamond solitaire ring. Diamond: one
brilliant cut diamond, approximately 3/8 carat Size: 5 %.
Corresponding Digital Photograph File: r030I062Jpg
3
Ring. l8k yellow gold sapphire and diamond ring. Sapphire: one
oval cut sapphire, approximately .30 carat Diamonds: 18 round cut
diamonds at approximately .02-.05 carats each. Size: 7 v..
Corresponding Digital Photograph File: r030I063.hpg
4
Ring. Lady's platinum and diamond cluster ring. Nine round
brilliant cut diamonds prong set in a cluster plate. The center
diamond measures 4mm in diameter and weighs approximately .23
carats. The surrounding eight diamonds each measure 2.5mm in
diameter and weigh approximately .06 carats each. The clarity of the
diamonds is YSl, color is G-H
Corresponding Digital Photograph File: r030I067Jpg
5
Rinl!. l4kp gold plumbed man's wedding band. Decorative roped
edges. Size: 10.
Corresponding Digital Photograph File: r030I064Jpg
6
Ring. 10k yellow gold man's class ring. Great Neck South, Great
Neck, New York. 1978. Greenstone. Size: 9 v..
Corresponding Digital Photograph File: r030I065Jpg
7
$300.00
$400.00
$325.00
$375.00
$40.00
$70.00
$5.00
Total 51,515.00
6
*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
I
I
I
,
COMMON'NEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
"STATE OF
De Oliveira, Carlos A.
I FILE NUMBER
21-04-00817
1 an asset was made joint within one year 01 the decedent's date 01 death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A Michelle K. Dangiuro
ADDRESS
RELATIONSHIP TO DECEDENT
1124 Redwood Drive
Carlisle, PA 17013
companion
JOINTLY OWNED PROPERTY:
LETTER .I .I~ DESCRIPTION OF PROPERTY rl, %OF
ITEM DATE Include name of financial institution and bank account number DATE OF DEATH
NUMBER FOR JOINTI ~61~~'-' lor similar identifying number. Attach deed for jointly-held real DATE OF DEATH DECD'S VALUE OF
TENANT estate. VALUE OF ASSET :INTERES' DECEOENrSINTEREST
1 A 09/23/2003 Commerce Bank Checking Account No. 536225477 825.10: 50% 412.55
I
I
I
,
,
TOTAL (Also enter on line 6, Recapitulation)
412.55
*'
SCHEDULEH
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
I
,.
STATE OF
COMMONWEALTH OF PENNS'l1.VANIA
INHERITANCE TAX RETURN
RESICENT OeCEDENT
De Oliveira, Carlos A.
I FILE NUMBER
21- 04 -00817
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
~UMBER
... FUNERAL EXPENSES:
I Ewing Brothers Funeral Home - Funeral in Pennsylvania 5,604.00
2 Sunset Chapel- Funeral in New York 3,751.00
3 Funeral Luncheon - New York 525.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State - Zip
Year(s) Commission paid
2. Attorney's Fees to Knight & Associates 1,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address .
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees to Register of Wills 80.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
I The Sentinel- advertising letters 163.67
2 Cumberland Law Journal - adveristing letters 75.00
Total of Continuation Schedule(s) 3,314.49
TOTAL (Also enter on line 9, Recapitulation) 14,513.16
*'
Schedule H
Funeral Expenses &
Mninistratiw Cos1s continued
COMMQN\rVEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
,STATE OF
De Oliveira, Carlos A.
I FILE NUMBER
21 - 04 - 00817
3
IBIS Appraisal Services - appraisal of property in safe deposit box
105.00
4
Commonwealth of Pennsylvania - car title
22.50
5
UPS - overnight mail
7.99
6
Exxon Mobil - Car Repairs to the Mercedes in order to make marketable
1,750.00
7
Exxon Mobil - Car Battery for the Mercedes in order to make marketable
150.00
8
Priceless Storage - Garage for Mercedes
509.00
9
NY Times - Advertisement of sale for Mercedes
170.00
10
Car Trader - Advertisement of sale for Mercedes
IOO.OO
II
Train Tickets for Executor from New York to Pennsylvania
250.00
12
La Mont Mason - transport Mercedes from Pennsylvania to New York
250.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEAlTH OF PeNNSYlVANIA
INHERIT!.NCE TAXRE11.JRN
RESIOENT Oe.CE.Ce.NT
I FILE NUMBER
21-04-00817
ESTATE OF .,
De OllveITa, Carlos A.
Include un reimbursed medical expenses.
ITEM
NUMBER
I Carlisle Regional Medical Center
2
3
4
5
6
7
8
9
10
II
12
13
14
15
DESCRIPTION
AMOUNT
100.00
Philip D. Carey, MD
27.94
Bank of America Account No. 4427 10003552 8780
2,802.72
West Shore EMS - Carlisle
1,047.70
Central Penn Medical Group Emergency
49.99
Pharma Care
24.41
PPL Electric Utilities
51.93
Expert Tire Account No. 555694423
81.30
Unisys
44.23
Sprint
436.88
American Express Account No. 3712-821497-31007
472.00
Hershey Medical Center
100.00
State Farm Insurance
581.00
Rent for Decedent's apartment
1,060.00
Carns & Maniello - attorney fees for litigation matter
850.00
TOTAL (Also enter on Line 10, Recapitulation)
7,730.10
'1513EX+(I.oo)
SCHEDULE J
COMMONWEAL.TH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIOE-NT DECEOENT
: STATE OF De Oliveira, Carlos A. FILE NUMBER
21-04-00817
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
\ Isabel De Oliveira mother \ 00% residue
II Schenck Avenue
OreatNeck, NY 1102\
2 Michellel K. Dangiuro companion Commerce Checking
\ \24 Redwood Drive Account in Schedule F
Carlisle, P A 17013
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate. on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DiSTRiBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
*'
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
KirkS. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
SEAN M. SHlJL 12, ESQUIRE
11 ROADWAY DRIVE SUITE B
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
280
3/29/2005
CARLOS A DE OUVEIRA
21-2004-0817
JA
CARLISLE, PA 17013
Qty
1
Fee Description
Additional Probate
Fee Total
10.00 $10.00
Total:
$10.00
Cltecks should be made payable to the Register of Wills, Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
Glenda Farner Strasbaugh
Register of Wiils
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717}240-7797
INVOICE
SEANM. SHULTI, ESQUIRE
11 ROADWAY DRIVE SUITE B
InvoiceNo:
Invoice Date:
Estate of:
Estate No:
280
3/29/2005
CARLOS A DE OUVElRA
21-2004-0817
Bill To:
JA
CARUSLE, P A 17013
Qty
1
Fee Description
Additional Probate
Fee Total
10,00 $10.00
Total:
$10.00
Checks should be made payable to the Register of Wills. TelTI1S: Net 30.
Please return one copy of this invoice with your payment. Thank you.
v-
06-20-2005
DEOLIVEIRA
06-13-2004
21 04-0817
CUMBERLAND
101
APPEAL DATE: 08-19-2005
( See reverse side under Objections)
Amount Re.i tted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE _ RETAIN LOt/ER PORTION FOR YOUR RECORDS _
REv:is4;-Ei-AFP-co3:osi-NOTICE-OF-INHERITANCE-TAi-APPRAISEMENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
CARLOS A FILE NO. 21 04-0817 ACN 101
BUREAU OF INDIVIOUAL.TAXES
INHERITANCE TAX DIVISION -
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONt/EALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLONANCE
OF DEOUCTIONS AND ASSESSMENT OF TAX
z;
17
~ ".... 1
j: 0/'}
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
r-i:
O~~. ,.,,,..
Hrlrk\i'i :...-,
SEAN M~~l't't .ESQ
KNIGHT & ASSOCS
11 ROADWAY DR STE B
CARLISLE PA
17013
ESTATE OF
DEOLIVEIRA
*'
REV-1547 EX AFP (06-05)
CARLOS
A
TAX RETURN NAS: (X I ACCEPTED AS FILED
I CHANGED
DATE 06-20-2005
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Est.t. (Schedule A)
2. Stocks and Bonds (Schedule BI
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 8J
8. Total Assets
(11
(21
(31
('II
(51
(61
(7)
.00
2.774.06
.00
.00
12.770.23
412.55
.00
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. ExPenses (Schedule Hl
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern..ntal Bequests; Non-elected 9113 T~usts (Schedule J)
14. Net Value of Estate Subject to Tax
(91
1101
14,513.16
7.730.10
(Ill
1121
1131
1141
NOTE: I~ an assessment was issued previously, lines
reflect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. A.ount of Line 14 .t Spousal ~at8 (15)
16. A.ount of Line 14 taxable at Lineal/Class A rat. (16)
17. Amount of Line 14 at Sibling rat. (17)
18. Anount of Line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
NOTE: To insure proper
credit to your account~
s~it the upper portion
of this for. wlth your
t.x payment.
15,956.84
")"}_,,)4~ ")6
6,286.42-
.00
6,286.42-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
(19J=
.00
.00
.00
.00
.00
TAY CR IT":
-PA' 1+1 AHOUNT PAID
OATE IIUI1BER INTEREST/PEN PAID (-I
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
~
. IF PAID AFTER OATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $I, NO PA YHENT IS REl/UIRED.
IF TOTAL OUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE OUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.I
ORPHANS' COURT DIVISION OF THE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Carlos A. De Oliveira
Date of Death: June 13, 2004
Admin. No. 21-04-0817
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes -L No
2. Ifthe answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court? Yes _ No ---X
b. The separate Orphans' Court No. (if any) for the personal representative's account
IS:
c. Did the personal representative state an account informally to the parties in interest?
Yes -L No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts
may be filed with the Clerk of the Orphans' Court and may be attached to this report.
Date: November ll-, 2005 Respectfully submitted,
C71
C:.l
KNIGHT & ASSOCIATES, P.C.
~~u~~
Attorney ill No. 90946
11 Roadway Drive, Suite B
Carlisle, Pennsylvania 17013
(717) 249-5373
Counsel for personal representative
I .-
,
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