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HomeMy WebLinkAbout05-04-12_ _ _ _ _ ~ 5 ~~ '~ 1 DECEDENT'S ESTATE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Peter J. Chomyn DECEASED ~ ' o ~~ No. 21-10-1220 ~=~'n ~ ~ r~~.,,, ,.~--~ PETITION FOR ADJUDICATION J ~ ~~ ~, ;`-== STATEMENT OF PROPOSED DLSTRIBUTION ~ ~ ta, ` ~ ~, PURSUANT TO Pa. O.C. Rnle 6.9 ,.: r`' This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers required under items 8-19 inclusive; and any instrument pertinent to the adjudication. INCL UDE ATTACHMENTS AT THE BAC% OF THIS FORM. Name of Counsel: Robert W. King Supreme Court LD. No.: 25820 Name of Law Firm: King & Guiddy Address: 114 North Maple Avenue Telephone:724-836-1500 Fax: ~,4-R3(._ 1 t~FR Form OC-Ol rev. 10.13.06 Page 1 of 10 -T Estate of Peter J. Chomyn 1. Name(s) and address(es) of Petitioner(s): Name: Peter J. Chomyn, III Andress: 2536 Shellbume Drive Wexford, Pa 15090 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: None Deceased Is this the first accounting by this fiduciary? ..................... ®Yes ®No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on November 18, 2010 ® Letters Testamentary or ®Letters of Administration were granted to Petitioner(s) on December 13.2010 Date of Will (f applicable): November 3, 1997 Date(s) of Codicil(s) (f applicable): None Date of probate (zf different from date Letters granted): N/A Was a bond required? ®Ires ®No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ........ ®Yes ®No Dates of advertising of the grant of Letters: The Sentinel April 1, Apri18, and April 15, 2011; Law Journal Apri18, April 15 and April 22, 2011, See Exhibit "A" Form OC-01 rev. 10.13.06 Page 2 of 10 Estate of Peter 7. Chomyn Deceased 3. Was decedent survived by a spouse? ............................. ©Yes ^ No If yes, name of the surviving spouse: Bertha May Stuckey Chomyn 4. Has the surviving spouse filed to take an elective share? ............. Yes ©No (See Section 2201 et se . of the Probate, Estates and Fiduciaries Code) If yes, date of election: 5. In the. case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (f none, so state): N/A 6. Did decedent marry after execution of Will or Codicil(s)? ........... ^Yes ~/ No Were any children born to decedent after execution of Will or Codicil(s)? ........................................... ^Yes ©No If yes, give names and dates of birth: Name: Date of Birth: 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. § 1412, was a request for a statement of claim sent to the Department of Public Welfare? .............................. ©Yes ~ No A response from the Department of Public Welfare is attached as Exhibit "B". Form oc-o~ rev, 10.13.D6 Page 3 of 10 Estate of Peter J. Chomyn Deceased 8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. See Exhibit "C" . B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest is involved, Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice) must be submitted herewith. or at the Audit. 9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest(s): Peter J. Chomyn, III Trustee Trust 100% Peter J. Chomyn Family Trust 2536 Shellburne Drive Wexford, PA 15090 Form oc-o/ rev. /0.13.06 Page 4 of 10 Estate of peter J. Chomyn ,Deceased B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. N/A C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for this Audit (~ Pa. O.C. Rule 12.4). N/A D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. N/A Form OC-O1 rev. 10.13.06 Page 5 of 10 _ _ _ _~ Estate of Peter J. Chomyn Deceased 10. Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Address of Beach Claimant Amount oJClaim Claim Wil! Claim Admitted? Be Paid !n Full? N/A ^Yes ®Yes QNo ©No QYes ^Yes QNo ®No ©Yes ®Yes ®No ^ No ^Yes DYes [)Na ©No If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. § 3392 and the proposed payments. 11. Was family exemption claimed? ................................ ©Yes ®No Was family exemption allowed? ................................ DYes ~No Family exemption claimant's name and relationship: Name: Relationship: Farm oc-ol rev. /0.13.06 Page 6 of 10 Estate of Peter J. Chomyn Deceased 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows: Date Payment February 12, 2011 12,278.37 October 2, 2011 4,324.83 Interest 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond of a fiduciary? ................... ®Yes ®No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. Decedent was Trustee/Settlor of the Peter J. Chomyn Family Trust, dated November 13, 1997, of which your Petitioner is Successor Trustee and the sole beneficiary of this estate pursuant to the terms of the decedent's Last Will and Testament. Accounting for the Peter J. Chomyn Family Trust is separate from this probate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .................. ~ Yes ®No 15. If Petitioner(s) has/have knowledge that a share has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation. Form oc-n1 rev. 10.13.06 Page 7 of 10 Estate of Peter J. Chomyn Deceased 16. Had the decedent been adjudicated an incapacitated person? .......... [] Yes 0 No If yes, attach a copy of the Order if available; otherwise state the Court, term, number, date, and name of Hearing Judge. 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. N/A B. Has notice of the additional receipts and disbursements been given to the parties identified in Pazagraph 9 above? ............. DYes ^ No 18. If a reserve is requested, state amount and purpose. Amovnr. Purpose: N/A If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? ........................................ DYes ^No If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? .......................... ©Yes ^No As to real estate only? ........................................ Dyes D/ No Form OC-Ol rev. /0.13.:06 Page 8 of 10 Estate of Peter J. Chomyn Deceased Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled and suggest(s) that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Drstrtbutee(s) Amourv/Proportian Peter J. Chomyn Family Trust 100% B. Principal: Proposed Distrrbvtee(s) Peter J. Chomyn Family Trust Amoune/Proportion 100% Submitted By: (AU petitioners must sign. Add additional lines if necessary): ~~~~ ~ Name of titioner: Peter J. Chomyn, III Name of Petitioner: Form oc-oi rev. 10.13.p6 Page 9 of 10 Estate of Peter J. Chomyn Deceased Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * [that hers~e he is titre Executor of the above-named „tee vf~arpo~adan Peter J. Chomyn, deceased and) that the facts set forth in the foregoing Petition for Adjudication /Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relating to unsworn falsification to authorities). ~~ o~"'~ Signature o etit~one * Corporate petltioxers nwst corriptete bracketed informatJorL Certification of Counsel The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/ Statement of Proposed Distribution is a true and accurate reproduction of the fo Petition authorized by the Supreme Court, and that no changes to the Qrm have been ade and the responses herein. ~ '~ Signature of Counsel for Foy oc-oi rev. 10.13.06 Page 10 of 10 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tackie Cox, Retail Sales Manager of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Cazlisle, County and State aforesaid, was established December 13,1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regulaz editions and issues of THE SENTINEL on the following day(s): A ry it 1. Apri;18 and AprIl 15, 2011 COPY OF NOTICE OF PUBLICATION Affiant further deposes that he/she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as #o time, place and character of publication azehrue.• Swom t and subscribed ore me this Z~ ZD (,~,~. Notary Public My commission expires: NOTARIAL SEAL BAMBI ANN HECKENDORN Notary Public CARLISLE BOROUGH, CUMBERLAND CNTY ivly Commission Expires Jan 27, 2014 - _ _. PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: Anri18 April 15 and Apri122 2011 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. r ----~ L' a Marie Coyne, 'tor ~s•. >~ s., a~~a. 1~te of 9 Keswicyt Dt'ive M~}~_ Exic~burL ~Iver~rgp~~ o°~'A~P' 2536 3hellbume Drive, Wexford PA 15090. Attorneys: Robert W. King, Es- M ~' A~ u , 114 Naath 15601. ~~i. PA NOTARIAL SEAL DEBORAH A COLLINS Notary Public CARLISLE 80ROUGH, CUMBERLAND COUNTY My Commission Expires Apr 28, 2014 SWORN TO AND SUBSCRIBED before me this COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DNISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 April 13, 2011 KING & GUIDDY ROBERT W KING ESQUIRE 114 N MAPLE AVENUE GREENSBURG PA 15601 Re: Peter Chomyn SSN: ###-##-1714 Dear Attorney King: Pursuant to your letter dated March 07, 2011, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. If you have any questions, please feel free to contact me. Sincerely, -~- a Y ~. Vince A. Porter Reccvery :section Manager (717)772-6609 AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) )SS: COUNTY OF WESTMORELAND ) I, Robert W. King, Attorney for Peter J. Chomyn, III, Executrix of the Estate of Peter J. Chomyn, deceased, do hereby certify that an actual copy of the First and Final Account and Petition for Adjudication / Statement of Proposed Distribution and a written notice of the Audit was hand delivered to Peter J. Chomyn, III, Trustee of the Peter J. Chomyn Family Trust on the 17"' day of April, 2012, as evidenced by the attached Receipt KING & By: Robert W. King, Esqu~, Attorney for Peter J. Chomyn, III, Executor SWORN TO and subscribed bef e me this 17"' of April, 20 Notary Public My Commission Expires: y_ ~V/~UA ~anN seal pqM K M~~ GountY Oq adr.16 IO ~ Of IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION In Re: ) Estate of Peter J. Chomyn ) No. 21-10-1220 Deceased ) Late of Silver Spring Township ) RECEIPT I, Peter J. Chomyn, III, Trustee of the Peter J. Chomyn Family Trust dated November 13, 1997, the sole beneficiary of the above Estate, do depose and say that I have received and reviewed the First and Final Account and Petition for Adjudication /Statement of Proposed Distribution and a written notice of the Audit, and consent to and join in for approval of the First and Final Account and the Petition for Adjudication /Statement of Proposed Distribution, for myself, as Trustee of the Peter J. Chomyn Trust dated November 13, 1997, and my successors and assigns. IN WITNESS WHEREOF, I set my hand and seal this 17"' day of April, 2012, intending to be legally bound hereby. Peter J. Chomyn Family Trust dated November 13, 1997 BY~ ~~ ~ ...... gyp- (SEAL) Peter J. Ch nyn, III rustee WTTNRC.C KING &GUIDDY ATTORNEYS AT LAW 114 NORTH MAPLE AVENUE GREENSBURG, PENNSYLVANIA 15601 TELEPHONE (724) 836-1600 FAX (724) 836-1668 ROBERT W. KING JONES MILLS OFFICE MELISSA A. GUIDDY (na) s93-z~Do rking®kingguiddylaw. com BRADLEY A. KING" •ADMITrED IN PA AND NJ April 17, 2012 Peter J. Chomyn, III, Trustee Peter J. Chomyn Family Trust 2536 Shellburne Drive Wexford, PA 15090 RE: Estate of Peter J. Chomyn, deceased Cumberland County, Pennsylvania File Number: 21-10-01220 Dear Mr. Chomyn: This letter is to give you notice that the attached First and Final Account will be filed with the Register of Wills on or before May 18, 2012. The First and Final Account and Petition for Adjudication /Statement of Proposed Distribution will be presented for audit on June 19, 2012, before the Audit Judge of the Orphans' Court Division, Common Pleas Court of Cumberland County, Pennsylvania. If, after reviewing the Account and Petition, you have any questions, we will be pleased to answer them. You are not required to attend the audit if you have no objections to the contents of the Account, and as a course of conduct, razely does anyone appeaz at the time of audit other than the executor, when required. If you are planning on attending the audit, please let me know, as Cumberland County does not require a formal audit with the Attorney and Executor present. If you have objections to the First and Final Account or Petition for Adjudication / Statement of Proposed Distribution, you or your legal counsel must file with the Register of Wills of Cumberland County objections thereto in writing in conformity to Cumberland County Orphans' Court Division Rules, and submitted to the Court in writing, prior to the date and time set for audit. In absence of written objections the court will assume you have no objection to the account. -2- April 17, 2012 If you have any questions or concerns with regazd to this matter, please do not hesitate to contact my office. RWK:dm Enclosures First and Final Account (copy) Petition for Adjudication /Statement of Proposed Distribution (copy) ~~~x 3~~11 ~x~ ~~e~xttrrvext~ of PETER,J. ,CHONiYN I, PETER J. CHOMYN, of Lee County, Florida, being of sound and disposing mind anc! ^lemory, and fully aware of the uncertainties of this life, do hereby declare this instrument to be my Lest Will & Testament, and hereby revoke all prior wills and codicils. ARTICLE I. I direct that my legally enforceable debts, funeral expenses, and administration expenses be paid as soon as practicable after my death. ARTICLE II. I devise the rest, residue, and remainder of my estate, of every kind, nature, and description, which I now own, or hereafter acquire, or have the right to dispose of at the time of my death, to the then ac/tJi/n,.g_~Trustees of that inter vivos trust named the PETER J. CHOMYN TRUST, dated /~1I1oi~?! ~1Y-~ z~ ' .1997, that it is my wish that all of the above assets pour over into that Trust; by this devise and bequest I do not incorporate by reference the provisions of said Trust, but enlarge the living Trust created by said TRUST AGREEMENT (which living Trust has independent significances) so that the property so devised and bequeathed to the said Trustees shall immediately after being received by said Trustees be blended with and thereafter be administered and accounted for in all respects as an integral part of said living Trust as so enlarged and, accordingly, the receipt of said Trustees for the property passing to them by this Will shall ba a completo discharge of my Personal Representative: Last Will & Testament Of PETER J. CHOMYN H 5 w o, Page 1 AiiTICLE III. I appoint my son, PETER J. CHOMYN, JR., as the personal representative of my estate. If my son, PETER J. CHOMYN, JR. is unwilling or unable to act as my personal representative, then I appoint my grandson, PETER J. CHOMYN, III, as the personal representative of my +3state. I dire::t t1~at no bond be required of the personal representatives named herein. In additior, to, and without in any way limiting the powers conferred upon my personal representatives by law, I vest my personal representatives with full power and authority to sell, transfer, or convey any property, real or personal, which I own at the time of my death, at such time, and upon such terms (iggluding credit), es my personal representatives may determine, and to do every other act and thing necessary or appropriate for the complete administration of my estate. On ~, 1997, in the presence of the undersigned witnesses, sign this instrument er+d declare :t t..• hs r.:•J Last W!!I i?•.Testament. ~ETER J. OMYN On ~~~~l~L ~3 , 1997, in our presence, PETER J. CHOMYN signed this instrument and declared it to be his Last Will & Testament. In his presence and in the presence of each other, we hereunto sign our names as attesting witnesses, in Lee County, Florida. i .. ., ,V Y~i~nC $~ .. .. .. ~.J. ..... .. . ~ ~ ~.,X ~,LCU [.fit WltneSs Last Will & Testament Of PETER J. CHOMYN Page 2 ~li ~/ SELF PROOF OF WILL State Of Florida County Of Lee We, PETER J. CNOMYN, the testa±or, and the witnesses, whnse names are: ;,,q~itt 5.5 Lr;,a~. L, ~~~~t~y and whcaa names are signed to the attached or foregoing instrument, having been sworn, declared to the undersigned officer that PETER J. CHOMYN, in the presence of the witnesses, signed the instrument and declared it to be his Last Will & Testament, and that each of the witnesses, in the presence of PETER J. CHOMYN, and in the presence of each other, signed the will as witnesses. --~ ?E~ER OMYi3 ,~ . Witness C ~ T Witness ` LT~~he foregoing instrument was acknowledged before me this day of I,ICL~iC. , 1997, by PETER J. CHOMYN, the testator, who is personally known to me, ( )has produced as identification, and SRI S• SAAA1'~4 and W~~t-~he witnesses, vvho a//r~~e pe~,rsonallyy, known to me. Notary Public - ~ - _ ate: - ~~_ ,.~ . is O~PRV PUBS FALPH A NICXAFIOSON -: ~y~'.s'p~'~ ~~~' ~'''~ :~: k1e 9~ B9 ~'T~.:.~:r...... a~-v..ty,' Last Will & Testament Of PETER J. CHOMYN •~`~ • "~' ~ Page 3 xF ~o ~ a. o ~ z ~~ ~ H~ ~ 0 ~~Q~~ ~ ~ ~~~~~o `~ a ~"~~ fY. P.. ~ Q d N ~/~~~. ti C~~i ~ W ~a pd ~~~ ~V 9 o a ~ ~ ~ ~~ ~ ~ ~ ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: Estate of Peter J. Chomyn No. 21-10-1220 Deceased. DECREE AND NOW, to-wit: this day of , 2012, the account in this case having been filed and confirmed nisi and having been examined and audited by the Court, upon consideration thereof, it is decreed that the account be confirmed absolutely, and that the funds in the hands of the accountant, to-wit: $9,985.99, be paid in accordance with the schedule of distribution hereto attached and made part hereof and Peter J. Chomyn, III be discharged as personal representative, unless exceptions are filed within twenty (20) days. Presiding Judge Attest: Clerk SCHEDULE OF DISTRIBUTION Balance as shown by account $9,985.99 Additional Assets not shown by account: None p pp Total corrected balance $9,985.99 Additional disbursements not shown by account: None 0.000 Corrected net balance for distribution: $9,985.99 Personal Estate Fund - $9,985.99 Pursuant to Article II of the Last Will & Testament of Decedent: TO: Peter J. Chomyn Family Trust dated November 3, 1997 9 98 .99 Total Distributions: $9,985.99 3 3> ~00,~~1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: ESTATE OF Peter J. Chomyn Late of Silver Spring Township, No.: 21-10-01220 Deceased. r-~ ~ z+ FIR5T AND FINAL ACCOUNT OF ~~ ~ ~ ~' ~ PETER J. CHOMYN. III. EXECUTOR n p.rn ~ `- ' `-' {,,~ . ~ b ' ~ '- Date of Death: November 18, 2010 ~~ w _ ~~ ~~ ~ --f n 4T1 ~/~ Q Letters Granted: December 13, 2010 ~' First Complete Advertisement of Letters: Apri122, 2011 Accounting for the Period: Gross Estate: November 18, 2010 through April 16, 2012 $33,500.41 Peter J. Chomyn, III, Executor, offers this Account to acquaint interested parties with the transactions that have occurred during his administration. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Robert W. King, Esquire KING & GUIDDY 114 North Maple Avenue Greensburg, PA 15601 (724) 836-1500 SUNIl~IARY OF ACCOUNT Estate of Peter J. Chomvn Page Fiduciary Acquisition Value PRINCIPAL Receipts 2 $ 33,475.65 Net Gain (or Loss) on Sales or Other Dispositions 3 $ 0.00 Other Receipts 3 $ 0.00 $ 33,475.65 Less Disbursements: Administration Expenses 4 $ 1,142.11 Fees and Commissions 4-5 $ 2,400.00 Funeral Expenses 5 $ 2,915.47 Debts of Decedent 5 $ 453.64 Taxes 5 $ 16,603.20 $ 23,514.42 Balance before Distributions 5 $ 9,961.23 Distributions to Beneficiaries 5 $ 0.00 Principal Balance on Hand 6 $ 9,961.23 INCOME Receipts 7 $ 24.76 Less Disbursements 7 $ 0.00 Balance before Distributions $ 24.76 Distributions to Beneficiaries 7 $ 0.00 Income Balance on Hand 7 $ 24.76 COMBINED BALANCE ON HAND $ 9,985.99 -1- RECEIPTS OF PRINCIPAL ASSETS LISTED IN INVENTORY (Valued as of date of death) Fiduciary Acquisition Value CASH: 1. Wachovia Bank Checking Account Number 1010185375115 $ 25,539.72 2. Wachovia Bank Certificate of Deposit Account Number 247402053868356 $ 7,935.93 $ 33,475.65 TANGIBLE PERSONAL PROPERTY: None $ 0.00 $ 0.00 REALTY: None $ p.00 $ 0.00 TOTAL INVENTORY $ 33,475.65 -2- RECEIPTS SUBSEQUENT TO INVENTORY (Valued when received) Fiduciary Acquisition Value None $ 0.00 $ 0.00 TOTAL RECEIPTS OF PRINCIPAL $ 33,475.65 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS None $ 0.00 TOTAL GAINS AND LOSSES $ p.p~ -3- DISBURSEMENTS OF PRINCIPAL ADMINISTRATION EXPENSES -PRINCIPAL 1. Register of Wills, Probate (a) Letters Testamentary 12/11/2010 $ 20.00 (b) Law Journal -Advertisement 8/21/2011 $ 75.00 (c) JCS Fee 12/11/2010 $ 23.50 (d) Automation Fee 12/11/2010 $ 5.00 (e) Fee to File Will 12/11/2010 $ 15.00 (f) Short Certificates 12/11/2010 $ 32.00 (g) Inventory 8/21/2011 $ 15.00 (h) Fee to File Inheritance Tax Return 8/21/2011 $ 15.00 - (i) Balance on Letters 8/21/2011 $ 70.00 (j) Fee to File Account 4/17/2012 $ 50.00 (k) Advertisement of Account 4/17/2012 $ 80.00 (1) Fee to File Supplemental Inheritance Tax Return 11 /20/2011 $ 15.00 (m) Allegheny County Register of Wills - Fee for Swearing in Executor 12/6/2010 $ 25.00 2. The Sentinel -Estate Advertisement 4/27/2011 $ 166.30 3. Dollar Bank -Service Charge Monthly $ 27.00 4. King &Guiddy -Postage and Photo Copies 11 /20/2011 $ 33.31 5. Cumberland Law Journal -Advertise Estate 6• 3/3/2011 $ 75.00 6. King &Guiddy -Preparation of 2011 Fiduciary Tax Returns 4/16/2012 $ 400.00 TOTAL ADMINIS~'RATION EXPENSES $ 1,142.11 -4- FEES AND COMMISSIONS 1. King & Guiddy -Attorney Fee 8/21/2011 2• 11/20/2011 $ 2,000.00 3. Mason Financial Service -Preparation of 2010 Individual Tax Return 5/24/2011 $ 400.00 TOTAL FEES AND COMMISSIONS $ 2,400.00 FUNERAL EXPENSES 1. Malpezzi Funeral Home -Funeral Service 3/3/2011 $ 1,617.47 2. Christ United Methodist Church -Grave Site 3/15/2012 $ 1,298.00 TOTAL FUNERAL EXPENSES $ 2,915.47 DEBTS OF DECEDENT 1. PA Department of Revenue - 2010 PA 41 Tax Due 8/21/2011 $ 65.00 2. Outstanding checks in Wachovia Checking account 1010185375115 Various $ 388.64 TOTAL DEBTS OF DECEDENT $ 453.64 TAXES 1. Pennsylvania Inheritance Tax 8/21/2011 10/2/2011 $ 16,603.20 TOTAL TAXES ~$ 16,603.20 TOTAL DISBURSEMENTS OF PRINCIPAL $ 23,514.42 -5- _~ DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES None $ 0.00 $ 0.00 -6- PRINCIPAL BALANCE ON HAND 1. Dollar Bank Estate Checking Account -Cash $ 9,985.99 $ 9,985.99 Less Income Balance on hand $ 24.76 PRINCIPAL BALANCE ON HAND $ 9,961.23 -7- RECEIPTS OF INCOME INTEREST: 1.. Wachovia Bank Checking Account Number 1010185375115 $ 1.41 2. Wachovia Bank Certificate of Deposit Account Number 247402053868356 $ 23.35 TOTAL RECEIPTS OF INCOME $ 24.76 DISBURSEMENTS OF INCOME None $ 0.00 TOTAL DISBURSEMENTS OF INCOME $ 0.00 INCOME BALANCE ON HAND $ 24.76 -8- PROPOSED DISTRIBUTION TO BENEFICIARIES BALANCE FOR DISTRIBUTION $ 9,985.99 Cash withheld for payment of final expenses $ 0.00 Specific bequest $ 0.00 RESIDUARY BALANCE $ 9,985.99 DISTRIBUTIONS CASH WITHHELD $ 0.00 Pursuant to Article II. of the Last Will and Testament of Peter J. Chomyn TO: Peter J. Chomyn Family Trust -Cash $ 9,985.99 TOTAL DISTRIBUTIONS: $ 9,985.99 -9- AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF WESTMORELAND ) Before me, the undersigned authority in and for said Commonwealth and County, personally appeared Peter J. Chomyn, III, who, being duly sworn according to law, deposes and says that he is the Executor of the Estate of Peter J. Chomyn, deceased, late of the Township of Silver Spring, Cumberland County, Pennsylvania, that four months have elapsed from the date of the first complete Advertisement of Letters, that the disbursements shown in the account have been made to the parties entitled thereto and that the Account, as stated, is true and correct as he verily believes. Peter J. omyn, II, Executor SWORN TO and subscribed before me this 17~' day of April, 2012. ~ ~ NOTARY PUBLIC My Commission Expires: ~ ~ [liens K Menf~'-b IICf~Y ~y ~ d G~$ zoi5 REQUEST FOR DISTRIBUTION Accountant requests that the distribution be determined by the Court in accordance with the Petition for Adjudication /Statement of Proposed Distribution to be offered in evidence at the audit of this Account. Peter~omyn~ Executor