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HomeMy WebLinkAbout12-20-12 (2)1505611185 -' REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Cotle Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 12 0786 Harrisburg, PA 17'128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYVVY Date 0( Birth MMDDYYYV 184-26-4526 Decedent's Last Name 07062012 05031926 Suffix Decedent's First Name MI KARABCIEVSCHY ANNELIESE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW MI ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death ^ 4 Limited Estate ^ 4 F ^ Prior to 12-13-82) . a. uture Interest Compromise (date of 5. Federal Estate Tax Return Required ® 6. Decedent Died Testate ^ death after 12-12-62) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes ^ (Attach Copy of Will) ^ (Attach Copy of Trust.) 9. Litigation Proceeds Receivetl 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schetlule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOHN R. ZONARICH First Line of Address SKARLATOSZONARICH LLC Second Line of Atldress 17 S 2ND ST FL 6 City or Post Office HARRISBURG 717-233-100 W ~ ~ ~ n ro r-, o r..nr- m N --io c., rrr x,, z o o c- State ZIP Code - "-t DATED ~ m n cn o P A 17101 F-' ~^ Correspondent'se-malladdre.s: JRZa$KARLATOSZONARICH.COM Under penalties of perjury, I declare that I have examined this !alum, including accompanying schedules and statements, and to the best or my knowledge and belie!, it is true, correct and complete. Declaration of prepare! other than the personal representative is based on all information of which prepare! has any knowledge. SIG E OF PERSON R SPONSIBLE F R FILING RETUR DATE HARRISBURG, PA 17112 /~"=`~ ~~ 1~ S 2pID ST FL 6~ / HARRISBURG, PA 17101 side ~ 1505611185 OM464~3.000 1505611185 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 184-26-4526 Decedents rveme: KARABCIEVSCHY ANNELIESE RECAPITULATION 1. Real Estate (Schedule A) 1 2. Stocks and Bands (Schedule B) . 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . g. 4. Mortgages and Notes Receivable (Schedule D) 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5, 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requestetl g. 7. Inter-Vivos Transfers & Miscellaneous Nan-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) 8 9. Funeral Expenses and Administrative Costs (Schedule H). g. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 11. Total Deductions (total Lines 9 antl 10), 11 12. Net Value of Estate (Line 8 minus Line 11) 12 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) , .... . 13. 14. Net Value Subject to lax (Line 12 minus Line 13) , t4, TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax fate, or transfers un~er Sec. 9116 16. Amount of Line 14 xable anineal rate x .0 4~ 18 9, 3 8 9 •0 0 1 s. 17. Amount of Line 14 taxable at sibling rateX .12 0 • 0 [] 17. 18. Amount of Line 14 taxable at collateral rate X .15 ~ . 0 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM484a 3.000 0.00 0.00 0.00 0.00 106,661.00 65,310.00 25,068.00 197,039.00 7,o3a•oo 620.00 7,650.00 189,389.00 0.00 0.00 8,523.00 0.00 0.0~ 8,523.00 ,REV-1500E%(FO Pa9e3 neredent's ComnleTe Address' File Number 21 12 ^7&6 DECEDENT'S NAME K V HY STREET ADDRESS M R A CITY M RANI SBUR STATE PA ZIP 7 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 8,523.00 2. Credits/Payments A. Prior Payments 8 , U ~ 0.0 0 B Discount 400 • 00 Total Cretlits(A+g) (z) 8,400 •DO 3. Interest (3> 0 . D 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) ~ • 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 123.00 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 ........... f d it i ^ ncome . . . . . . erre or b. retain the right to designate who shall use the property trans s 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 tleath ^ without receiving adequate consideration? ..... ............. ? " " ^ or payable-upon-death bank account or security at his or her death in trust for 3. Did decedent own an 4. Ditl 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. 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 [he only beneficiary. Far 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 chiltl is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposetl on the net value of transfers to or for the use of the tlecedent's 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 [o or for the use of the decetlent's siblings is 12 percent [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 tlecedenL whether by blootl or adoption. OM46]1 2000 Rev-t soe ex. fn-tol pennsylvania SCHEDULE E oePnA~r.~rnoF aeveNUe CASH, BANK DEPOSITS, 8 MISC. o N1TUn~v PERSONAL PROPERTY A IaES Oe uoEC r n e ESTATE OF: FILE NUMBER: ANNELIESE KARABCIEVSCHY 21 12 0786 Include the proceetls of litigation and the dale the proceetls were receiostl by the estate. All ro art 'oin[I ownetl with ri ht of survivorshi must be tlisclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. M&T Bank - Checking Account No. 33380376 2,920 2 Integrity Bank - Certificate of Deposit No. 4020413 15,573 Interest accrued to 7/6/2012 174 3 Centric Bank Certificate of Deposit No. 3031994 10,033 4 Centric Bank Certificate of Deposit No. 3040698 20,620 5 Centric Hank Certificate of Deposit No. 3041043 15,465 6 Centric Bank Certificate of Deposit No. 3050432 26,563 7 Centric Bank Certificate of Deposit No. 3053246 5,256 S Centric Bank Certificate of Deposit No. 3053253 10,050 9 Donegal Insurance - Homeowner's policy refund 7 106,661 Owa6AD 2.000 If more space is needed, use atldilional sheets W paper IX the same size. REV-1 S09 IX+(0140) pennsylvania OEPMTMENT OF REYENVE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: ANNELIESE KARABCIEVSCHY 21 12 0786 If an asset became JOlntty owned within one year of the decedenPS tlate of death, tt must be reported on Schedule G SURJNING JOIM TBIAM(S)N4h£(5) ADDRESS RELATIOt45HIP TO OLCmENT A IWrabcievschy, Vladimir 4130 Valley Road, Harrisburg, PA 17112 JOINTLY OWNED PROPERTY: Son R~ NIAvHER u:rTER FpiJgNT TENONT ~'~ NW DE JOIPIr DESCPoPTION OF Ri0PBt1V INLLVCE N/.I,E 6iI1N NCLLL IN3TIT VTIW ANV 9A NIL ACCWNi N110.8 ER W31M Ufl IOEMIM1ING HLMER. ATTACH OEEV FgiJpXTLY NELG REAL E3iNTE. ~TE DF ATM VALUE DF A96Er % OF DECFDBQI'6 INtET26T Q4TE OF DEATH VALUE OF OECEOBNI'6 WI6EEST 1 A 12/26/200 9 Susquehanna Bank - Money Market Account No. 1810014260 17,578 50.0000 8,789 Interest accrued to 7/6/2012 50 50.0000 25 2 A 4/4/2009 Fulton Bank Certificate of Deposit No. 018- 0268182 23,909 50.0000 11,955 Interest accrued to 7/6/2012 3 50.0002 2 3 A 7/24/2007 Fulton Bank Certificate of Deposit No. 018- 0266418 24,203 50.0000 12,102 Interest accrued to 7/6/2012 132 50.0000 66 4 A 7/12/2010 Fulton Bank Certificate of Deposit No. 018- 0293401 20,983 50.0000 10,491 Interest accrued to 7/6/2012 539 50.0000 269 To al £rom c ntinuation schedules 21,611 TOTAL (Also enter on Line 6, Recapitulation) E 65 , 310 9WdfiAE ].000 f more space is needed, use additional sheets of paper of the same size. Estate of: ANNELIESE KARABCIEVSCHY 21 12 0786 Schedule F Part 2 (Page 2) Item Joint DOD Value of Perc DOD Value of No. Cot. Date Description Asset Int. Interest 5 A 8/22/2009 Fulton Bank Certificate of Deposit No. 018- 0293531 26,283 50.0000 13,142 Interest accrued to 7/6/2012 653 50.0000 327 6 A 8/23/2010 Fulton Bank Certificate of Deposit No. 018- 0293584 15,925 50.0000 7,962 Interest accrued to 7/6/2012 361 50.0000 180 Total (Carry forward to main schedule) 21,611 REV-1510 EX+(0e-09) pennsylvania DEPARTMEM OF REVENUE INHERITANCE TAX RETURN RESIDEM DECEDEM SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ANNELIESE KARABCIEVSCHY 21 12 0786 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCRIPTION OF PROPERTY ircw~ar~rvanE OFr~mararaaEE.r~in aaunoruwF ro oecaoEm nro ~wn:or mwsFx.nnA~acavvoc rhfi oefio FOa Rau fisrnre. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION IF PPPLJCABLE TAXABLE VALUE 1~ Fulton Bank IRA No. 391 -0001792 (beneficiary Vladimir Karabcievschy) 20,413 100.0000 0 20,413 Interest accrued to 7/6/2012 9 100.0000 9 2 Fulton Bank IRA No. 391 -1932062 (beneficiary Vladimir Karabcievschy) 4,644 100.0000 0 4,644 Interest accrued to 7/6/2012 2 100.0000 2 TOTAL (Also enter on line 7, Recapitulation) 3 If more space is neetletl, use adtlilional sheets of paper of tha same size. 9W4fiAF 2.000 REV-1511EX~(10.09) SCHEDULE H pennsylvania ' oEPmm~+ENroF aEVENUE FUNERAL EXPENSES AND INHERIrANce rAx aETUaN ADMINISTRATIVE COSTS RESIDEM nECEDENT ESTATE OF FILE NUMBER LIE SE KARABCIEVSCHY 21 12 0786 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Hetrick-Bitner Funeral Home - Final Arrangements 499 B. 1 Total from continuation schedules ~ 809 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation.) (:laimanf 4. 5. 6. 7. 1 2 Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Register of Wills - Oath of Office Fee Cumberland Law Journal - Estate Advertising Total from continuation schedules . 5,000 336 20 75 291 swasnc z.ooo TOTAL (Also enter on Line 9, Recapil If more space is needed, use additional sheets of paper of the same size. 7 Estate of: ANNELIESE KARABCIEVSCHY Schedule H Part 1 (Page 2) 21 12 0786 Item No. Description Amount 2 Romberger Memorials - Memorial Inscription 809 Total (Carry forward to main schedule) 809 Estate of: ANNELIE SE KARABC IEVSCHY Schedule H Part 7 (Page 2) 3 The Sentinel - Estate Advertising 21 12 0786 291 Total (Carry forward to main schedule) 291 REV-1512 EX * (12-OB) pennsylvania EEPPRTMEM OF REVENUE INHERITANCE TAX RETURN SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER ANNELIESE KARABCIEVSCHY 21 12 0786 Report debts incurred by the decedent prior to death that remained unpaid at the tlate of death, including unreimbursed medical expenses. swasAH z.ooo If more space is needed, insert atltlitional sheets of the same size. REV-1513 EX+(Ot-10) pennsylvania CEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDEM DECEOEI~IT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: ANNELIESE KARABCIEVSCHY 21 12 0786 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 [InGutle outright spousal distributions and transfers antler Sec. 9116 (a) (1.2).] i. Vladimir Karabcievschy 4130 Valley Road Harrisburg, PA 17112 All o£ Residue: 189,389 Son 189,389 ENTER DOLLAR AMOUNTS FOR DISIRIBUf10NS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET. AS APPROPRIATE. II NONTAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBIfIIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN'. 1. B. CFWRITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II • ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF 9W46AI 2.000 If more space is needed, use additional sheets of paper AND TESTAMENT OF ANNELIESE KARABCIEVSCHY A/K/A ANNA KARABCIEVSCHY I, ANNELIESE KARABCIEVSCHY, a/k/a ANNA KARABCIEVSCHY, a resident of the City of Harrisburg, Dauphin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument to be my Last Will and Testament, hereby revoking any and all wills by me at any time heretofore made. ITEM I: I direct my hereinafter named Executor to pay all my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after my decease. ITEM II: I give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal or mixed, of whatever nature and wheresoever situate which I may own or have the right toydispose of at the time of my decease to my son, Vladimir Karabcievschy, sylvania 17109. If my simultaneously with me, rest, residue and remai son who shall be living of 3147 Brookw`e~lRoad, Harrisburg, Penn- said son should predecease me or die then I give, devise and bequeath all the zder of my estate to the issue of my said at the time of my death. ITEM III: If my said son should predecease me or die simultaneously with me leaving no issue to survive him, then I give, devise and bequeath all the rest, residue and remainder of my estate as follows: A. 50% td my daughter-in-law, Ruth Karabcievschy, of 3147 Brookwood Road, Harrisburg, Pa. 17109. ITEM IV: I hereby nomirate,~.constitute and appoint my on, Vladimir Karabcievschy, Executor of this my Last Will and Testament, with full power in his discretion to do any and all things necessary for the complete administration of my estate, with full power to sell at public or private sale and without order of court any real or personal property belonging to my estate, and to compound, compromise or otherwise settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could if living. A. If my said son should predecease me or die simultaneously with me, or fail to complete his duties as Executor, then I nominate, constitute and appoint my daughter-in-law, Ruth Karabcievschy, Executrix, with the same power and authority as given my said son. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this ~ 1~-day of ~~~-~^~ 1977• ~Of"'~17~t' o~~, y /f~L~Yf ~ ' Lam/ ~ SEAL ) Anneliese Kara/b/cievschyy' ~/J~- .u ,a.n' ~-/..Q~/r'I'GC~f ~ SEAL ) Anna Karabcievschy Signed, sealed, published and declared by the above-named Anneliese Karabcievschy, a/k/a Anna Karabcievschy as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, we believing her to be of sound and disposing mind, memory and understanding, have hereunto subscribed our names as witnesses this 7_ yiti day o£ ~~,~ne.'~;~ 1977• 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 886-502-4349 F ax (302) 934-2955 August 9, 2012 Skarlatos Zonarich, LLC 17 South Second Street, 6u' Floor Harrisburg, PA 17101-2039 Re: Estate of Anneliese Karabeievschy Social Security: 184-2-4526 Date of Death: July 6, 2012 Dear Sir or Madam: Per your inquiry on August 1, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type ofAccaunt Account Number Ownership (Names ofl Opening Date Balance on Date of Death Accrued Interest Toml Checking Account 33380376 Anneliese Karabcievschy Vladimir Kambcievschy (POA) 0328/1988 $2, 920.01 $ 00 ..$2.920.01 For any additional information on the above accounts, induding ownership and any changer, dosures and/or reimbursement of foods, please ®11 the Capital Harrisburg at 717-?33-6435. We were unable to locate any safe deposit boa for the above-mentioned decedent This letter does not indude any acrnunts in which the d may have been lislcd as Power of Attorney, Custodian of Uniform Transfers, Represenfalive Payee, or Trus[ee under a Written Agreement Sincerely, Valarie Mercer Adjustment Services 12/..7/2012 '.7:25 717-92@-3501 INTEGRITY BANK PAGE •• Dec. 1). 2D12 3:28PM S & Z No. 4235 P. 1 ~ SkarlatosZon arlich Inte~lrity August 3, 2012 s a. ~ ' K RE: Estate of gaaeliase Karabchievschy To Whom It May Concern: The following information is in y~ponse to a letter received on A°gurt 3' 20er only had to the Estate of Annelieae KarabohievsohY• At the dme of death, the custom one tiau deposit with the bank, which was closed on Iuly 31. 'The togt>ested information is ss follows. o Recount Number: o Owner: o Date opened: o Date account trade joint: o Autopeatic Deposits: o Balance se of 716!12: ear undl death o Interest ppld for calendar y ( )~ o Amount of interest accrued to death: o Outstanding loans: o Safe deposit box: 4020413. Anneliose Karabcievlchy pctobar 20, 2010 N!A N!A 515,747.20 $174.25 $612.76 No No I have also enclosed a statement for this aocouat. If you have any questions please do not hesitate to oontaet =ne at (717) 920-3200. Sincerely, l~~ TractSebasnan Senior L7tstomer Servtce Representative InteSrity Bank 301 Colonial Rd Harrisburg. PA 17109 02/02 ~S Makd S<rceR GMp ffi4 AA 17071 • AMr~ 717.920^l900.877d•HAl?.17' `Psr717-920490f ` iannuinrA~M+'~"'t^'u'°`'N1O CENTRIC BANK We Revolve Around YOU. August 3, 2012 Skarlatos Zonarich LLC John R Zonarich 17 South Second Street, 6`" Floor Harrisburg, PA 17101 To Whom It May Concern: Below is the information requested pertaining to all accounts with regards to Anneliese Karabcievshy. Account Number: 3031994 Owner: Anneliese Karabcievschy Date Opened:2/25/10 Date Redeemed: 7/31/12 Date of Death Value: $10,032.88 Interest paid to DOD: $93.90 Account Number: 3033321 Owner: Anneliese Karabcievschy Date Opened:4/2/10 Date Redeemed: 4/2/12 Date of Death Value: $0.00 Interest paid to DOD: $147.94 Account Number: 3040680 Owner: Anneliese Karabcievschy Date Opened: 11/20/10 Date Redeemed: 5/22/12 Date of Death Value: $0.00 Interest paid to DOD: $65.38 Account Number: 3040698 Owner: Anneliese Karabcievschy Date Opened:11/20/10 Date Redeemed: 7/31/12 Date of Death Value: $20,620.19 Interest paid to DOD: $198.41 Account Number: 3041035 Owner: Anneliese Karabcievschy 4320 Linglestown Road Harrisburg, PA 17112 T 717.657.7727 F 717.657.7748 www.cen[ricbank.com Date Opened: l2/04/10 Date Redeemed: 1/5/12 Date of Death Value: $0.00 Interest paid to DOD: $17.96 Account Number: 3041043 Owner: Anneliese Karabcievschy Date Opened: 12/4/10 Date Redeemed: 7/31/12 Date of Death Value: $15,465.13 Interest paid to DOD: $173.07 Account Number: 3050432 Owner: Anneliese Karabcievschy Date Opened:9/26/11 Date Redeemed: 7/31/12 Date of Death Value: $26,562.86 Interest paid to DOD: $217.09 Account Number: 3053246 Owner: Anneliese Karabcievschy Date Opened:l/5/12 Date Redeemed: 7/31/12 Date of Death Value: $5,256.27 Interest paid to DOD: $28.48 Account Number: 3053253 Owner: Anneliese Karabcievschy Date Opened: 1/5/12 Date Redeemed: 7/31/12 Date of Death Value: $10,049.96 Interest paid to DOD: $49.96 Total yTD Interest: $1068.82 Interest paid to DOD: $992.19 Interest paid after DOD: $76.63 No loans or Safe Deposit Boxes. Sincerely, ~ Florence M. Higgins Centric Bank Susquehanna Au ust 8, 2012 Susquehanna Bancshares, Inc. g 26 North Cedar Street P.O. Box 1000 Lititr, PA 17543-7000 Tel 1.800.311.3182 Fax 717.625.4478 SKARLATOS ZONARICH LLC 17 S 2t'1D STREET 6r" FLOOR HARRISBURG PA 17101-2039 RE: Anneliese Karabcievschy Estate DOD: 7/6/]2 SS#: XXX-XX-4526 Tracking # 285175 To Whom It May Concern: In response to your letter of August 1, 2012, here is the above customer account information as of July 6, 2012. • Account Title: • Account Type/# • Date Opened /Maturity • Interest Rate: • Account Balance*: • Accrued Interest: Anneliese Kazabcievschy Vladimir Kazabcievschy MMDA 1810014280 12/26/09 .15% $17,578.23 $.50 • YTD Interest: $11.34 *Account balance does not include accrued interest. ® There is no safe deposit box in the name of the decedent. If I can be of further assistance, please feel free to call. Sincerely, Dawn M Bernier Deposit Research -Reporting Department Lead ]-717-625-6546 DMB/aed ~1tonBank LISTENING IS JUST THE BEGINNING.' August 10, 2012 Skarlatos Zonazich LLC Attorneys at Law 17 South Second Street 6u' Floor Harrisburg, PA 17101 Deaz Mr. Zonazich, C~~iFI~E~TlAL fiis inforKtation is furrrished as a matter of business courtesy in answer to yoga h4uirY, a.xt is kx Your wntidentlaf use only. The bank f~amiat~ttg this inturmazym dices not retuesent or guarantree ;bye accuracy, cetn~lei+xt&ss or ;sliabipty of the informa8on ~. No raaponaibflity is assumed by the tank ar any of its otlicars, empbya~ ar agents. Arty opinion herein expr¢ssed is subject to change without notice 13E: Anneliese Kazabcievschy, deceased July 6, 2012 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: DATE OF DEATH ACC CDN BALANCE INT RATE OPEN ROLL OVER MATURITY 018-0268182 $23,908.90 $3.37 2.57% 4/4/09 7/4/10 7/6/13 * Joint with Vladimir Karabcievschy 018-0268418 $24,203.06 $131.53 2.71% 7/24/07 4/24/10 4/24/13 * Joint with Vladimu Karabcievschy 018-0293401 $20,982.95 $538.65 2.57% 7/12/10 7/12/13 * Joint with Vladimir Kazabcievschy 018-0293531 $26,283.46 $653.45 2.81% 8/22/09 8/22/12 * Joint with Vladimir Kazabcievschy 018-0293584 $15,924.82 $360.58 2.57% 8/23/10 8/23/13 * Joint with Vladimv Karabcievschy 391-0001792 $20,412.71 $9.43 2.81% 9/18/09 9/18/12 * IRA- Titled in her name alone with Vlad imir Kazabcievschy listed as the beneficiary 391-1932062 $4,643.51 $1.96 2.57% 6/IS/10 6/15/13 * IRA- Titled in her name alone with Vlad imir Kazabc ievschy listed as the beneficiary If you have any other questions, please feel free to contact me at (717) 327-2497. Sincerely, ~~~ Joshua A. Groff Credit Confirmation Processor 1.800.FULTON.4 fultonbank.com Futon Bank, N.A. Member FDIC. Member oRbe Fulton Financial Family