HomeMy WebLinkAbout03-0606 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as To:
Register of Wills for the
Deceased. County of Cumberland in the
Social Security No. 199-22-8489 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.
Decendent was domiciled at death in Cumberland , Co~anty, Pennsylvania, with
h is last family or principal residence at 1501 Williams Gvoveg,O~chanicsbuvg~ Horn'S. ~oura~ip.
(list street, number and municipality)
Decendent, then 74 years of age, died June 14, ,X~92003 ,
at 1501 Williams Grove Road, MechanicsbuvK, Pennsylvania 17055
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ 200,000.00
(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: nt-~,~
Petitioner after a proper search ha s ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Nellie h. Kavlovich Sister 18 Ma!~ Street, ~!_he__~ton, PA 17934
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
'~ 18 Main Street "
~ Gilbevton. Pennsylvania 17954
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF Schuylkill
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 affirmed and subscribed f fff)A~
before me this o) q gJ. day of
~)/~ . X~2003J ''
~ ¢. MC 'Register
No. ~.~ I- <D.~- ~o~
Estate of s*'~nsy P. K~v]ovlah , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW (~j~,~, ~ X~92003 , in consideration of the petition on
the reverse side hereof, sati-s~ctory proof having been presented before me,
IT IS DECREED that Nellie fi. Karlovich ~'r's
is/are entitled to Letters of Administration, and in accord with such finding,I~=.~ I~2 of
are hereby granted to Nellie fi. Kavlovich
in the estate of .q'rlnov P_ Kavloviah
FEES
Letters of Administration ..... $ heonard 6. 8eh,~o_k; v.~_ (n7ann)
ATTORNEY (Sup. Ct. I.D. No.)
Short Certificates( ) .......... $. 237 Nor~ch White S~=et, P.O. Box 135
Renunciation ................ $ Shenandoah, Pennsylvania 17976
$ ADDRESS
TOTAL __ $
Filed ..................... A.D. 19 (570) 462-0473
PHONE
This is to certify that the infbrmation here given is correctly copied from an original certificate of death duly filed with me as
Local Rggistrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~ling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee fbr this certificate, $2.00 ~ ,~/ff~ ~
~ a"t~:l octal -Registrar
No. ~ ff -bate
t'110$ 144 Rev $1Sl COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
~"~""'"~ CERTIFICATE OF DEATH
'" (Coroner)
P~.M~.E.~ Case #29-053
ACK INK NAME OF DECE~NT {F~M, M~, ~) S~E FILE ~R
Stiney p Karlovtch Male 99 - 22 - 8489 . June 14, 2003
74 Nov. 17,1928 ~
Cumberland Monroe 1501 Williams Grove Road ,~.~.
~ite
1501 Willi~ ~ R~d ~s,~ '~"a'"
~~, PA 17055 ~rl~
,,. ~t~ ~l~i~ ~ K~ntts~
PA 14939
~--O ~ ~ ~,~. J~ 20, 2003
1:00 P. June 17~ 2003
~ ~ ~ b.__
~ ~~~ ~ ~ ~n ~ ~ ~th and c~l~ It~ 23} ~U~ ~DT~
~"~,~a~,~,~,.~,=,o~..~.j~.~.~ .......................... ~ ;~;. ;~. Ju~e ]9, 2003
Mechanicsburg, Pa. 17050
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003010
SCHUMACK LEONARD G ESQUIRE
237 NORTH WHITE STREET
PO BOX 135
SHENANDOAH, PA 17976
ACH
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..........
101 $23,539,17
ESTATE INFORMATION: SSN: 199-22-8489
FILE NUMBER: 2103-0606
DECEDENT NAME: KARLOVICH STINEY P
DATE OF PAYMENT: 09/12/2003
POSTMARK DATE: 09/11/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 06/14/2003
TOTAL AMOUNT PAID: $23,539.17
REMARKS: NELLIE A KARLOVICH C/O
LEONARD G SCHUMACK ESQUIRE
CHECK# 101
INITIALS: AC
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
/ 200 -00606
REV-1500 EX (6-00) [ I
REV-1500
PENNSYLVANIA
DEPARTMENT OF REVENUE ~~
DEPT. 280601 INHERITANCE TAX RETURN I
HARRISBURG,PA17128-0601 RESIDENT DECEDENT i cou..co E
DECEDENTS NAME (LAST, F1RST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z Karlovich, Stiney P. 199 - 22 - 844489
I""1 DATE Of DEATH (MM-DD-YEAR) ] DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
UJ 06/1444/2003 I 11/17/1928 REGISTER OF WILLS
iii (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
"' E~] 1. Original Return E~ 2. Supplemental Return E~ 3. Remainder Return (date of death prior to 12-13-82)
· ~, "' ¥ [--] 4. Limited Estate [---] 4a. Future Interest Compromise (date of death after 12-12-82)
,,~ o. o E~ 5. Federal Estate Tax Return Required '
° ~. m [] 6. Decedent Died Testate (A~ach copy o~Wi,) [] 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes
< [---] 9. Litigation Proceeds Received [---] 10. Spousal Poverty Credit (dale el'death beNveen 12-31-91 and 1-1-95) r--] 11. Election to tax under Sec. 9113(A)(Attach Sch O)
Z
m NAME
,', COMPLETE MAILING ADDRESS
z Leonard G Schumack, Esq 237 North White Street'
0 °
"' FIRM NAME (If.Applicable)
~ P.O. Box 135
~ TELEPHONE NUMBER Shenandoah, Pennsylvania 17976
o
o (570) 44462-044473
1. Real Estate (Schedule A) (1) ;I.I.i-:, OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) 6 6,3 5 5.6 5
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1 6 3,8 6 9.7 1 I t
(Schedule E)
<~ 6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested . i.
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
~ (Schedule G or L) ~. ~
~ 8. Total Gross Assets (total Lines 1-7) (8) 2 3 0,2 2 5.3 6
I,LI 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1 7 ~ 5 ti. ti. o 5 2
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 6,1 9 6.9 3
11. TOtal DeductlbnS (total Lines 9 & 10) (11) 2 3 ~ ? 444 1. 444 5
12. Net Value of Estate (Line 8 minus Line 11) (12) 206,44483.91
13. Charitable and Governmental Bequests/Sec 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) 206,483.91
SEE INSTRUCTIONS ON REVERSE SlBE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
~_ rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15)
/. 16. Amount of Line 14 taxable at lineal rate x .0 (16)
O~ 17. Amount of Line 14 taxable at sibling rate 206,44483.91 x .12 (17) 2444,778.07
O 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due 2444 ??8 07
(19)
20. E~
Decedent's Complete Address:
STREET ADDRESS
1501 Williams Grove Road
CITY Mechanicsburg I S~AeTEnnsylvania Iz1~-7055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 24,778.07
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 1: 2 38.9 0
Total Credits ( A + B + C ) (2) 1,2 3 8.9 0
3. Interest/Penalty if applicable
D. Interest
E. Penalty Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2 3,5 3 9.17
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 23,539.17
Make Che~k Payai~le.to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..............................................................................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] ~']
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................
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 ether than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT_UR[~ OF PERSON RESPO~SIgIE F~R FILING PDETURN ,)(, ~DA~T~
ADBRESS
18 Main Street~ Gilber~on~ Pennsylvania '~ 17934
SIGNATURE OF PRE~P~AR~THER THAN~ESF~EN~.~/~/?/ / DATE
ADDRESS /''~, ..... ~-7¢'.~--:
'// 23? ~~ Stz"eet, P.O. Box 135, Shenandoah, Pennsylvania 17976
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 RS. {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 decedenrs 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 RS. §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.
No. 2003-00606
REV-1503 EX * (I-9;')
' ~ SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER Stiney P. Karlovich
All property jointly-owned with right of sundvorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. U.S. Treasury, Series BE Bonds (Cashed Value) ~1,290.~0
2. 759.093 shares Fidelity Growth & Income @ 33.02 25,065.25
3. 100 shares Cryo-Therm, Inc. No Value
TOTAL (Also enter on line 2, Recapitulation $ 6 6,3 5 5.6 5
(If more space is needed, insert additional sheets of the same size)
,~v*,~ Ex.(,.,7) NO. 2003-00606
~ SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Stine¥ ?. Kariovich
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorsh 3 must be disclosed on Schedule F.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. U.S. Treasury, bill and notes 150,000.00
2. Commerce Bank, statement savings 5,668.68
3. Providian National Bank, money market 8,20i~03
TOTAL (Also enter on line 5, Recapitulation) $ 16 3,8 6 9.71
(If more space is needed, insert additional sheets of the same size)
REV-~§~ 1EX * {1-97) ~ NO. 2003-00606
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stiney P. Karlovich
Debts of decedent must be reported on Schedule I.
iTEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funez'al Home 3,130.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. AUomeyFees Leona~'d G. Schumack, Esq. 13,813.52
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. PrebateFees Regis1:er' o£ Wills, p['obate and sho~'1: cerl:i£ical:es 281 .00
Cumbez'land Coun1:y [,aw Journal (estima1:e) ?0.00
5. AccountanrsFees Register o£ Wills, £iling account: (estimate) 250.00
6. Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation) $ 17,5 4 q.. 5 2
(If more space is needed, insert additional sheets of the same size)
No. 2063-00606
CO/~NW'ALTHOFPENNSYtVANIA DEBTS OF DECEDENT.
.~,~.~c~., MORTGAGE LIABLITIES AND LIENS
ESTATE OF Please Print or Type
FILE NUMBER
~ K~ov~ch
ITEM
NUMBER DESCRIPTION AMOUNT
1. Hembe~ ~s~ ~ede~Z C~ed~ Un,on, Zorn co-s~ne~ 5,5~g.52
2. fi~o~d D~v~s (Bd's Rent,Z), ~ent~Z ~o~ ~une 223.33
3. He~-Bd, e~ec~c ~ccount 70.58
~. T-Hobble, ce~ phone ~ccoun~ ~3.5Z
5. ATT, phone ~ccoun~ ~.g~
6. Ve~zon, phone ~ccoun~ ~Z.38
?. ~ U.S.A., c~ed~ c~d Z20.75
8. ~.~. Be~n, c~ed~ c~d g?.80
g. Comces~, c~b~e ch~e , ?5.Z0
TOTAL (Also enter on line 10, Recapitulation) $ 6,169.93
(If more space is.~ needed, insert additional sheets of some size.)
No. 2003-00606
,Ev,,,,Ex.,,-,,, ~ SCHEDULE J
COMMONWEALTHOF PENNSYLVANIA B E N E F IC IA RI E S
IN.ERITANCE TAX RETURN
RESIDE.T OECEDE.T
' 'ESTATE OF FILE NUMBER
St±ney P. Ka~'lovich
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Nell±e A. Karlovich Sister Entire
18 PJain Street
G±lberton, Pennsylvania 1793u~
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE~ 15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET
I [. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS WOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 1! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(if more space is needed, insert additional sheets of the same size)
!o
ica
~ ~
~
Commonwealth of Pennsylvania
Co~ty of Schuylkill
Nellie A. Ka~'lovich ·
Adminlsfr~ .....t. ri..x. ................................................................................. Execuf ....................................................................................................
of the Estate of Stine~. P. Ka~'~,~,V.i.c.h ...................................................................................
Cumbez~land
late of ..... ~e.~.c..~.~...n.~c.~s..~.u.~r.[~.~..~...n.~r"~.e.~.~...N...n.s...hi~. .............. in the County of ~huyl~kd6/does hereby verify
that the statements made in this Inventory are true and correct. I/~g understand that false statements
herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating fo unsworn falsification
fo authorities.
Regiiler Form 3~1
No. 2003-00606
IN THE MATTER OF THE ESTATE OF ...... S.t...i. ge.¥....~..,....Ea..~!.o..Y.~.ch .............. ,
late of Meehanics.bu~g,.. Mo. rx~.o.e /'.ownship, ,~:"~c~/]j~Z~ounty, Pennsylvania, deceased.
INVENTORY
PERSONAb PROPERTY
U.S. Treasury, bill and notes $150,000.00
U.S. Treasury, Series EE Bonds 41,290.40
759.093 shares Fidelity Growth & Income 25,065.25
Providian National Bank, money market 8,201.03
Commerce Bank, statement savings 5,668.68
100 shares Cryo-Therm, Inc. No Value
$230,225.36
x ~,,'~lfX ~e< AdminlstraJ~lLx
'-/~/- ~ CONMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHER/TANCE TAX DIV/SION
DEPT. 280601
HARR/SBURG, PA 17118-0601 NOT/CE OF ZNHER/TANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLOHANCE
OF DEDUCTIONS AND ASSESSNENT DF TAX
DATE 11-17-2003
ESTATE OF KARLOVICH STINEY P
DATE OF DEATH
FILE NUHBER 21 05-0606
LEONARD G SCHUMACK ESQ ~ -*~ :~ COUNTY CUMBERLAND
ACN 101
237 N WHITE ST Amount Remitted
PO BOX 155
SHENANDOAH PA 17976
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG TH/S L/NE ~ RETA/N LOWER PORT/ON FOR YOUR RECORDS
REV-1547 EX AFP [01-03) NOT/CE OF /NHER/TANCE TAX APPRA/SENENT, ALLOWANCE OR
D/SALLOWANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX
ESTATE OF KARLOVICH STINEY P F/LE NO. 21 03-0606 ACN 101 DATE 11-17-Z005
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVAT/ON CONCERNING FUTURE INTEREST - SEE REVERSE
APPRA/SED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 66;355.65 cred/t to your account,
$. Closely Held Stock/Partnersh/p Interest (Schedule C) ($) .00 subait the upper port/on
q. Nortgeges/Notes Rece/vable (Schedule D) (q) .00 of th/s fora w/th your
E. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (E) 163~869.71 tax payment.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Tote1 Assets (8) Z30,225.$6
APPROVED DEDUCTIONS AND EXEMPTIONS: 17,5qq.52
9. Funeral Expenses/Ada. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liab/1/ties/Liens (Schedule Z) (10) 6;196.93
11. Tote1 Deduct/ohs (11) ?~.7ql.q;
12. Net Value of Tax Return (12) ZO6,q83.91
15. Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00
lq. Net Value of Estate Subject to Tax (lq) Z06,~85.91
NOTE: Z~ an assessment ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of L/ne lq at Spousal rate (15) .00 X 00 = .00
16. Amount of Line lq taxable at Lineal~Class A rate (16) .00 X Oq5 = .00
17. Amount of Line lq at Sibling rata (17), 206,q83.91 x 12 = 2q,778.07
18. Amount of Line lq taxable at Collateral~Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 2q,778.07
TAX CREDITS:
PAYMENT RECEIPI DZSCOUNT
ANOUNT PAID
DATE NUNBER INTEREST/PEN PAID (-)
09-11-2003 CD003010 1,238.90 23,539.17
TOTAL TAX CRED/T 2q,778.07
BALANCE OF TAX DUEI . O0
INTEREST AND PEN. . O0
TOTAL DUE .00
[F PAID AFTER DATE ]:ND~CATED, SEE REVERSE ( IF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS RE~U]~RED.
FOR CALCULATION OF ADDITIONAL /NTEREST. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CA), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR TNSTRUCT]:ONS. )
RESERVATION: Estates of decedents dying on or before December lZj 1982 -- if any future interest in the estate is transferred
in possess[on or enjoyment to Class B (collateral) beneficiaries of the decedent after tho 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 Class B [collateral) rate on any such futura interest.
PURPOSE OF
NOTICE: To fulfil1 tho requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S.
Section 9lqO).
PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NILLS, AGENT
REFUND (CR): A refund of e tax craditj ahich ams not requested on the Tax Return~ may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office
of the Register of Hills) any of the Z3 Revenue District Offices, or by calling the special Z~-hour
answering service for forms ordering: 1-BOO-56Z-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-BOO-~7-3OZO (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance~ ar disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue~ Board of Appeals, Dept. ZelOZl~ Harrisburg, PA 17128-1021j OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appmal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes~ ATTN: Post Assessment Review Unit, Dept. 2BO601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
PENALTY: The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes ahich became delinquent before January 1~ 1982 bear interest at the rate of
six (6Z) percent par annum calculated at a daily rata of .O0016q. All taxes which became delinquent on and after
January l, 198Z will bear interest at a rate which will vary from calendar year to calendar year mith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO3 ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z ZOZ .0005q8 1987 9Z .O00gq7 1999 7Z .O0019Z
1985 16Z .000~38 1988-1991 llZ .000501 2000 eX .000219
198~ IIX .000501 199Z 9Z .O00Z~7 ZOOl 9Z .O00Z~7
1985 152 .000556 1995-1994 72 .000192 ZOOZ 62 .O0016q
1986 XOZ .O00Z7q 1995-1998 92 .O00Zq7 ZOO5 5Z .000157
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Not[ce, additional interest must be calculated.
1992
STATUS REPORT UNDER RULE 6.17
Name of Decedent: Stiney P. Karlovich
DaeofDeah: June 14, 2003
WilINo. Admin. No. 2oo3-00606
Pursuant to Rule'6.12 of the Supreme Court Orphans' Court Rules, I report the Iollowing with respect to
completion of the administralion of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes x 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:
a. Did the personal representative file a tinal account with the Court?
Yes No x
b. The separate Orphans' Court No. (if any) for the personal representative's account is:
¢. Did the personal representative state an account informally to the parties in interest?
Yes ~ No.
d. Copies of receipts, release, joinders and approvals el formal or iniormal accounts may be filed
with the Clerk of the Orphans' Court and may be attached to this report.
Date - 12 / 2 3 / 2 004 Signature J.~f~!~-~:~:.
Name Leona~"G r/Sc huma ¢ k, Esq.
Address 237 North White Street, PO Box 135
Shenandoah, Pennsylvania 17976
Telephone: ( 570 ) 462-0473
Capacity: Personal Representative 0
Counsel for Personal Repro