HomeMy WebLinkAbout03-12-13 J 1505610140
REV-150 EX (01-1°'
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN Caul Code Year File Number
PO BOX 280601 2 1 1 3 0 0 1 7
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
1 2 1 4 2 0 1 2 1 1 1 4 1 9 1 6
Decedent's Last Name Suffix Decedent's First Name MI
S M I T R Q V I C H A G N E S C
(If Applicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILES
FILL IN APPROPRIATE OVALS BELOW
® 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death
prior to 12-13-82)
0 4,Limited Estate ❑ 4s.Future Interest Compromise(date of ❑ 5.Federal Estate Tax Return Required
death after 12-12-82)
® 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 9.Litigation Prooseds Received ❑ 10.Spousal Poverty Credit(date of death ❑ 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1.1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
G E R A L D J S H E K L E T S K I E S Q 7 1 7 7 7 4 7 4 3 5
rte..
ISTER OF V4W5 USITPA
:0 G} d
First line of address rn CS C/)
4 1 4 8 R I D G E S T X* � N a
Second line of address
0 C-5 O 'T3 —n
P - 0 B 0 X E
'L? D# 4LED r- M
City or Post Office State 21P Cade ;Z3 ATE4
N E W C U M B E R L A N D P A 1 7 0 7 0 CD -n
correspondent's e-mail address: G S H E K L E T S K I a@ S T O N E L A W•N E T
Under panaities of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SIGNA RE F P SO E3 NS L OR FILING RETURN DATE
D E
ELI ETH P. GALSKI 2431 LOBACH DR- MECHANICSBURG PA 17055
SIGNAT REP R 0 N P E
ADDRESS
GERALD J. SHEKLETSKI, ESQ•414 BRIDGE ST. NEW CUMBERLAND PA 17070
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
e \Na��o-
�'� �� �
� �
���
1505610240
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A) _... . .. ....... ...... . .. ... ...... 1.
2. Stocks and Bonds(Schedule B) .. . ..... . ... ... .. ...._ 2, 0 . 0 0
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .... 3.
4. Mortgages and Notes Receivable(Schedule D) ...... ... .. .... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)..... . . 5, 1 9 1 5 2 2 . 6 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . 6, 9 5 6 6 1 . 8 9
7. Inter-Vivos Transfers&Miscellaneous NbProbate Property
(Schedule G) Separate Billing Requested . ...... 7,
8. Total Gross Assets(total Lines 1 through 7) . . . .. .. . . . . . . . .. ... . ... .. & 2 8 7 1 8 4 . 5 6
9. Funeral Expenses and Administrative Costs(Schedule H) .. . . . . .... . .. .. . . 9, 2 5 6 4 0 . 5 4
10. Debts of Decedent,Mortgage Liabilities,and Lions(Schedule 1) . .... 10.
11. Total Deductions(total Lines 9 and 10) . . . . . .. . . . . .. .. . . . . ... . . ... .. . . 11. 2 5 6 4 0 . 5 4
12. Not Value of Estaft(Line 8 minus Line 11) .... ..... ....... 12. 2 6 1 5 4 4 . 0 2
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ...... ... ........... 11
14. Not Value Subject to Tax(Line 12 minus Line 13) . .. .. . .. . . . . . . . .. .. . 14. 2 6 1 5 4 4 0 2
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.O _ 0 . 0 0 15, 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X 045_ 2 6 1 5 4 4 . 0 2 16. 1 1 7 6 9 . 4 8
17, Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17, 0 . a a
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 is, a . a 0
19. TAX DUE .... . . . . ... .. ...... __...... .... .. ...... 19. 1 1 7 6 9 . 4 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
t 1505610240 1505610240
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 13 0017
DECEDENTS NAME
AGNES C . SMITROVICH
STREET ADDRESS
2431 LOBACH DR-
CITY STATE ZIP
MECHANICSBURG IPA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 11,769-48
2. Credits/Payments
A.Prior Payments 111181- 03
B.Discount 588.47
Total Credits(A+B j (2) 111769-50
1 Interest
4, If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. (3)
FIN In oval on Page 2,Line 20 to request a rotund. (4) 0 . 02
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0. 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; ...................................................--............... ❑
b. retain the right to designate who shall use the property transferred or its income; ..............--............ 171
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 frank 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.
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 far the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)).The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)).
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
72 P-S.§.4'Lib(1,2)[72 P,.S.-WWa)1-1-)j- __-___..__---- ----- ---..___ -----------. _ __ --------
+ The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(13)j,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.
i
REV-1508 EX-It 1.10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, S MISC.
INHERITANCE
ESIDEN DECEDENTTUR" PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
AGNES C • SMITROVICH 21 13 0017
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ali perry Jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. M&T BANK SAVINGS ACCOUNT NUMBER 15004220439481 107,431.63
2- M&T BANK CERTIFICATE OF DEPOSIT ACCOUNT NUMBER 25,545.29
31003920202105
3• CITIZENS BANK CHECKING ACCOUNT NUMBER 6220528062 91690-01
4 • CITIZENS BANK CHECKING ACCOUNT NUMBER 6223650772 33,678.67
5- CITIZENS BANK TIME DEPOSIT ACCOUNT NUMBER 6244561436 15,177.07
6• CITIZENS BANK SAVINGS ACCOUNT NUMBER 6255465447 0.00
TOTAL{Also enter on Line 5,Recapitulation)] $ 191,522 -67
If more space is needed,insert additional sheets of paper of the same size
REV-1509 EXa(01-10)
Pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
AGNES C. SMITROVICH 21 13 0017
If an asset was made Jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. ELIZABETH GALSKI 2431 LOBACH DRIVE DAUGHTER
MECHANICSBURG, PA 17055
B. GLORIA MAROTTA 801 HYSON ROAD DAUGHTER
JACKSON, NJ 08527
c. CECELIA A. MCGEEHAN 1050 OAK RIDGE DRIVE DAUGHTER
BLUE BELL, PA 19422
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FDRJOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST
1. X.B.C. 11-90 PNC BANK CERTIFICATE OF DEPOSIT 201080.86 25- 51020. 22
ACCOUNT *21000823146
2. A. 05-10 PNC BANK CERTIFICATE OF DEPOSIT 741014 .63 50. 37,007.32
ACCOUNT *31500349190
3- C. 05-83 M&T BANK CHECKING ACCOUNT 41539.10 50- 21269. 55
NUMBER 3954801217
4 . ABCDE 1993 UNITED STATES SAVINGS BONDS 1021729 .60 50. 511364 .80
F COPIES ATTACHED
TOTAL.(Also enter on Lime 6,Recapitulation) S 95,661-89
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
AGNES C. SMITROVICH 21 13 0017
Decedent's Name Page t File Number
Schedule F-1 -Jointly Owned Property
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
D.KELLY ANN GALSKI 2431 LOBACH DRIVE GRANDCHILD
MECHANICSBURG, PA 17055
E. PATRICIA A GALSKI GREEN 401 SAGAMORE HILL GRANDCHILD
MT- JOY, PA
F. MATTHEW MAROTTA 801 HYSON ROAD GRANDCHILD
JACKSON, NJ 08527
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
AGNES C. SMITROVICH 21 13 0017
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HILARY J. BONIN FUNERAL HOME 81704.00
99 WEST GREEN STREET, WEST HAZLETON, PA 18202
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. AaomeyFees: STONE LAFAVER & SHEKLETSKI ]21500.00
3, Family Exemption:(If decedent's address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4, Probate Fees: LETTERS TESTAMENTARY 153.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. THE STANDARD SPEAKER — OBITUARY 132.50
8 - TOP OF THE 80'S RESTAURANT — FUNERAL LUNCHEON 11285.44
9 - HOLY NAME OF JESUS PARISH CEMETERY — BURIAL 11050.00
10 . DEATH CERTIFICATES 60 . 00
11- LEGAL ADVERTISING — THE SENTINEL 200.10
12- LEGAL ADVERTISING — CUMBERLAND LAW JOURNAL 75.00
13 - HAZLETON HEADSTONE COMPANY 11200.00
14. ADDITIONAL PROBATE FEE 250.00
15- FILING FEES — INHERITANCE TAX RETURN AND INVENTORY 30.00
TOTAL(Also enter on Line 9,Recapitulation) $ 25,640-54
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX-(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
AGNES C. SMITROVICH 21 13 0017
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 out' ht I distributions and transfers under
Sec.91i6(a (1.2).]
1. ELIZABETH P. GALSKI Lineal 1381058.05
2431 LOBACH DRIVE
MECHANICSBURG, PA 17055
2. GLORIA ANN MAROTTA Lineal 961791.02
801 HYSON ROAD
JACKSON, NJ 08527
3. CECELIA A. MCGEEHAN Lineal 171630.95
1050 OAK RIDGE DRIVE
BLUE BELL PA 19422
4 . KELLY ANN GALSKI Lineal 3,081-60
2431 LOBACH DRIVE
MECHANICSBURG, PA 17055
5• PATRICIA A. GALSKI GREEN Lineal 21961.60
401 SAGAMORE HILL
MOUNT JOY, PA
6. MATTHEW MARATTA Lineal 3,020.80
801 HYSON ROAD
JACKSON, NJ 08527
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REVA500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX0 1-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017186
GALSKI ELIZABETH P
2431 LOBACH DRIVE
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 $10,500.00
ESTATE INFORMATION:
FILE NUMBER: 2113-0017
DECEDENT NAME: SMITROVICH AGNES C
DATE OF PAYMENT: 02/19/2013
POSTMARK DATE: 02/14/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 12/14/2012
TOTAL AMOUNT PAID: $10,500.00
REMARKS: RECEIPT TO ATTY
CHECK#0994
INITIALS: DMB
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
---------- --- - ---
TAXPAYER
NEW CUMBERLAND PA 17070
LAST WILL AND TESTAMENT
OF
AGNES C. SMITROVICH
a/k/a
AGNIESZKA M. ZMYTROWICZ
I, AGNES C. SMITROVICH a/k/a AGNIESZKA M. ZMYTROWIC7, of Upper
Alley, Township, Cumberland County, Pennsylvania, declare this to be my
last will and revoke an will previously made b me. i
Y P Y Y
i
_ITEM I : I direct that my Executrix hereinafter named shall pay
all my Just debts and funeral_ expenses as soon as conveniently may be
done after my decease from the residue of my estate:
ITEM II : I devise and bequeath all. of my estate of every nature
ana wherever situate, in equal shares to my children, ELIZABETH P.
GALSKI and GLORIA ANN MAROTTA, if they survive me. Should either
ELIZABETH P. GALSKI or GLORIA ANN MAROTTA predecease me, I devise and
bequeath the share of such child to his or her issue, per stirpes; and
should any such child of mine leave no such issue living following my
death, I devise and bequeath the share of such child to my issue, per
L
'ITEM I j "I have made no provision in this my Last Will for my
. L�
daarglP terg C 1 A. McGEEHAN, as I do not wish her to receive any share
W
o e ate.0- m
V UJ p
W c� U
if
Page 1 of 4
ITEM IV: I appoint my daughter, ELIZABETH P. GALSKI, Executrix of
this m last will. Should m daughter, ELIZABETH P. GALSKI fail to
l� Y Y g r �
qualify or cease to act as Executrix, I appoint my daughter, GLORIA ANN
11 MAROTTA, Executrix of this my last will .
i
ITEM V: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his or her duties
in any jurisdiction.
,
IN WITNESS WHEREOF, I, AGNES C. SMITROVICH a/k/a AGNIESZKA M.
ZMYTROWICZ, have hereunto set my hand and seal thisl day of
l
2009.
AGN S C. SMITROVICH
i) a/k/a AGNIESZKA M. ZMYTROWICZ
I
SIGNED, SEALED, PUBLISHED and DECLARED by AGNES C. SMITROVICH a/k/a
i
AGNIESZKA M. ZMYTROWICZ, the Testatrix above named, as and for her Last
{� Will and Testament, and in the presence of us, who at her request, in
her presence and in the presence of each other, have subscribed our
ji
names as witnesses.
414 Bridge St. , New Cumberland, PA
{ Witness Address
414 Bridge St. . New Cumberland, PA
It ess Address
Page 2 of 4
II
i COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
liI, AGNES C. SMITROVICH a/k/a AGNIESZKA M. ZMYTROWICZ, the
Testatrix whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law do hereby acknowledge that
I signed and executed this instrument as my last will; that I signed it
willingly and that I signed it as my free and voluntary act for the
purposes therein contained.
i
AGN C. SMITROVICH
a/k/a AGNIESZKA M. ZMYTROWICZ
Sworn to or affirmed to and acknowledged before me by AGNES C.
SMITROVICH a/k/a AGNIESZKA M. ZMYTROWICZ, the Testatrix, this -g —
day of 2009.
it
I'
Notary Public
COMMONWEALTH OE PENNSYLVANIA
NOTARIAL SEAL
CAROL L.TROXELL, Notary Public
New Cumberland Boro.Cumberland Co.
My Commission Expires Dec.27,2009
.j
I
I
Page 3 of 4
I.
I
jCOMMONWEALTH OF PENNSYLVANIA
SS:
I. COUNTY OF CUMBERLAND
I
i
We, ✓ and
the witnesses whose names are signed to the attached or foregoing
I
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as her
last will; that Testatrix signed willingly and that she executed it as
her free and voluntary act for the purposes therein expressed; that each
j of us in the hearing and sight of the Testatrix signed the will as
i
witnesses; that to the best of our knowledge, the Testatrix was at that
time eighteen or more years of age, of sound mind and under no
constraint or undue influence.
Ij
Witnes
Ij
I�
I
n s
Sworn to or affirmed to and acknowledged before me by
and J✓6nl �Cr
11 <
witnesses, this day of Gtr 2009.
s
I �C
COMMONWEALTH OF PENNSYLVANIA Notary P blic
NOTARIAL SEAL
CAROL L.TROXELL, Notary Public
New Cumberland Soro.Cumberland Co.
My Commission Expires Dec.27,2009 Page 4 of 4
I
it
'I
O M&T Bank
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-5024349
F ax (302)934-2955
Stone LaFaver& Sbekletalci January 15,2013
Attorneys at Law
414 Bridge Street
P.O. Boa E
New Cumberland,PA 17070
Re: Estate of Agnes C. Smitrovich
Social Security: 171-01-1466
Date of Death:December 14,2012
Dear Sir or Madam:
Per your inquiry on January 9,2013,please be advised that at the time of death,the above-named decedent had
on deposit with this bank the following:
1.
Type ofAccount Checking Account
Account Number 3954801217
Ownership(Names oj) Elizabeth P. Galski(POA)
Cecelia McGeehan
Agnes Smitrovich
Opening Date 0510111983
Balance on Date of Death $4,539.09
Accrued Interest $ .01
Total
$4,539./0
2. Type ofAccount Savings Account
Account Number 15004220939481
Ownership(Names qn Elizabeth P. Galski(POA)
Agnes Smitrovich
Opening Date 0512612010
Balance on Date of Death $107,419.86
Accrued Interest $ 11.77
Total _..
$107,431.63
3. Type of Account Certificate of Deposit
Account Number 31003920202105
Ownership(Names ofj Elizabeth P.GaLski(POA)
Agnes Smitrovich
Opening Date 1211712009
Balance on Date of Death $25,457.50
Accrued Interest $ 87.79
Total $25,'545,29
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of fuuds,
please call die Laurd Mad at 370450-7838.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the dece ned may have been fisted as Power of Attorney,Custodian of Uniform Tran*m
Representative Payne,or Trustee under a Written Agreemen4
Sincerely,
Valarie Mercer
Adjushnent Services
A
lit C i "" i z e n s Bank One Citizens Drive
ROP 112
Riverside, RI 02915
January 18,2013
Stone LaFaver& Shekletski
414 Bridge Street
P.O. Box E
New Cumberland, PA 17070
Estate of Agnes Smitrovich
Date of Death: Dec 14, 2012
SSN: 171-01-1466
Dear Sir/Madam:
In accordance with your request,the enclosed information sheets have been provided in the above
decedent's name as of his/her date of death.
For Investment account information,please contact our Investment Services Department at 1-800-942-
8300. For all other inquiries, please call 1-877-579-2667,option 2.
Sincerely,
Q
Heather Medeiros -�
Decedent Account Processing
REF#: 577155
7ov Citizens Bank
Account Number 6220528062
Account Title Agnes Smitrovich
Date Opened 12/2/2008
Account Type Checking
-Principal Balance as of DOD $9,689.72
Interest from Last Posting to DOD $ ,29
Account Balance as of DOD $9,690.01
YTD Interest to DOD $9.67
Citizens Bank
Account Number 6223650772
Account Title
Agnes Smitrovich
Date Opened 3/20/2009
Account Type Checking
Principal Balance as of DOD $33,677.66
Interest from Last Posting to DOD $1.01
Account Balance as of DOD $33,678.67
YTD Interest to DOD $81.67
Citizens Bank
Account Number 6244561436
Account Title Agnes Smitrovich
Date Opened 4/13/2004
Account Type Time Deposits
Principal Balance as of DOD $15,176.98
Interest from Last Posting to DOD $ .09
Account Balance as of DOD $15,177.07
YTD Interest to DOD $7.60
CtzensBank
Account Number 6255465447
Account Title Agnes Smitrovich
Date Opened 12/1/2008
Account Type Savings
Principal Balance as of DOD $ .00
Interest from Last Posting to DOD $ .00
Account Balance as of DOD $ .00
YTD Interest to DOD $ .00
Jan. 17. 2013 2:51PM PNC Bank No. 5455 P. 1
U&MO 'WYE'
January 17, 2013
Gerald J Shekletski Esq.
Stone Lafaver& Shekletski
414 Bridge St
POBoxE
New Cumberland,PA 17070
RE: Agnes Smitrovich
SSN: 171-01-1466
DOD: 12-14-2012
Dear Mr. Shekletski: -
In response to your request for Date of Death(DOD)balances for the customer noted above, our
records show the following:
Ceri fieate of Deposit
Account#21000823146 Established: 11-13-1990
AGNES SMITROVICH
CECELIA.MCGEEHAN
ELIZABETH GALSKI
GLORIA MAROTTA
DOD balance: $20,000.00+0.65 accrued interest
Interest paid 01-01-2012 thru 12-14-2012 S 80.21 YTD
Account#31500349190 Established: 05-25-2010
AGNES SMITROVICH
ELIZABETH GALSKI
DOD balance: $ 73,860.61 +62.35 accrued interest
Interest paid 01-01-2012 thru 12-142012 $ 91.67 YTD
Please note that this office provides date of death balances for deposh accounts(IRAs,CDs,Checking and
Savings). We do not proem avy Amcial transactions or provide statements. If you need assistance with
any of these items,please call 1-886-PNC-BANK(1-888-762-2265)or slop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
Page 1 of 2
Jan, 17. 2013 2:51PM PNC Bank . No. 5455 P. 2
77us message 4 intended for the use of the individual or entity to which it is addressed and may
contain information that is privileged confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient,you are hereby notified that any dissemination,
distribution or copying of this communications is strictly prohibited t1you have received this
communication in error,please notify me immediately by reply or by telephone at 800-762-1'775 and
immediately destroy this faxed document.
Page 2 of 2
Calculated Value of Your Paper Savings Bond(s) Page I of 1
Calculated Value of Your Paper Savings Bonds)
Calculator Results for Redemption Date 02/2013
Total Price Total Value Total Interest YTD Interest
$12,000,00 $30,401.60 $18,401.60 $344.00
Bonds: 1-7 of 7
Serial# Series Denom Issue Next Final Issue Price Interest Interest Value Note
Date Accrual Maturity Rate
M41777538EE EE $1,000 12/1990 06/2013 12/2020 $500.00 $1,010.40 4.00% $1,510.40
M41777537EE EE $1,000 12/1990 06/2013 12/2020 $500.00 $1,010.40 4.00% $1,510.40
M41777540EE EE $1,000 12/1990 06/2013 12/2020 $500.00 $1,010.40 4.00% $1,510.40
X2246254EE EE $10,000 01/1993 07/2013 01/2023 $5,000.00 $8,956.00 4.00% $13,956.00
V5073375EE EE $5,000 08/1994 03/2013 08/2024 $2,500.00 $2,702.00 4.00% $5,202.00
M41777539EE EE $1,000 12/1990 06/2013 12/2020 $500.00 $1,010.40 4.00% $1,510.40
V5073376EE EE $5,000 08/1994 03/2013 08/2024 $2,500.00 $2,702.00 4.00% $5,202.00
Totals for 7 Bonds $12,000.00 $1$,401.60 $30,401.60
Notes
NI Not Issued
NE Not eligible for payment
PS Includes 3 month Interest penalty
MA Matured and not earning interest
http://www.treasurydirect.gov/BC/SBCPrice 2/20/2013
r
5 r
�2 441, 1 I
ON
t , I
i v
� I
w
V
� 1
i 1
f
/
a�
23 '
dii!
—14
1
j;
k� F
/ ryb
t iry
_ l
l lFi
!u /�
I
n r
r
' ➢ µwe, 1�
Fl-
LA"
r
�• /,��`��� � � � y� �^,�%'1`yam'
..
r ,
M pN A
� 3
r1,
T
w%
xr r
'•�`'' _ �� ,rh9�r�I/ /lir� ,�L �rh".t y��Z H r r''�h, d
f N/�, Ak"w` M� .� � ,✓� H x,.fv �/�"�.� .rvja�n w^N a h
�y.=b�v,� � � y������ ..r• Wr���r,' " �y..�' (96 f"Y' u..wy �... >x ,'.
%��;.. v,:/ ✓� !4 �"'W .�1µ "171A r��v'r :A'y ."�T� ' 4r< � r.r!
I
ATYI W'111M1YM11{II11111 ' - SIERIES E
177 42 6156 . ^fit' 11 1990.1
t MATTHEW MAROTTA
Ta RD 4 8OX 562 Fits- PHIS:
JACKSON NJ 0$327 FISG ACT ,;US,,
a
OR AGNES SP IcTa0
a37aaaz4a 01 --914#51, s4O A l-
a }° .w
{ .
_. �(
1111540EE
. - 1 0000009000 71:0 7 9004 L 7 ? 7 540e'
I AT1M{MTN{f�M{YYOR sERZES EE-
177 42 6156 ��y"" 11 1990 ,
Ta MATTHEW MAROTTA
1 ,,> RD 4 BOX 562 Fie PHrL,
JACKSON =- NJ 08527 FISC AST US%
DEC 11 1990
OR AG4ES SIiI'l'R`O H I I
M-;O ` 1-777-537—i:g
39O337O0Q24
s , _` �:, , } M41�11�153�1EE
1:0000 9000 71:0 7 600 4 L ?? 7 5 3?
SERIES EE
ITT 42 6156 It 1990
�#.t
�• Tu
MATTHEW MAROTTA -------
RD 4 BOX 562 FRB PH U
JACKSON- -- NJ---065 2 7 ___ .___...___ "SG-AST US -
? 1{{YIwO M{wT{
I
'. DEC 11 1990
{ATewa{TAUS
,
777777-71
,
OR AGNES SNITROYICHI i A
M-Oz041-777-538-EE
$90337000246 011 94415i
'4 J I tM41�111538EE
1:0000900071:07 7004 L? 7753a0
Calculated Value of Your Paper Savings Bond(s) Page 1 of I
Calculated Value of Your Paper Savings Bonds)
Calculator Results for Redemption Date 12/2012
Total Price Total Value Total Interest YTO Interest
$24,000.00 $66,806.40 $42,806.40 $2,580.80
Bonds. 1-14 of 14
Serial # Series Denom Issue Next Final Interest
Date Accrual Maturity Issue Price Interest Rate Value Note
V2548599EE EE $5,000 02/1993 02/2013 02/2023 $2,500.00 $4,340.00 4.00% $6,840.00
v2548598ee EE $5,000 02/1993 02/2013 02/2023 $2,500.00 $4,340.00 4.00% $6,840.00
M42950786EE EE $1,000 03/1991 03/2013 03/2021 $500.00 $980.80 4.00% $1,480.80
M42950789EE EE $1,000 03/1991 03/2013 03/2021 $500.00 $980.80 4.00% $1,480.80
M4295078SEE EE $1,000 03/1991 03/2013 03/2021 $500.00 $980.80 4.00% $1,480,80
M42950787EE EE $1,000 03/1991 03/2013 03/2021 $500.00 $980.80 4.00% $1,480.80
M41133525EE EE $1,000 05/1990,05/2013 05/2020 $500.00 $1,040.80 4.00% $1,540.80
M41133524EE EE $1,000 05/1990 05/2013 05/2020 $500.00 $1,040.80 4.00% $1,540.80
M41133526EE EE $1,000 05/1990 05/2013 05/2020 $500.00 $1,040.80 4.00% $1,540.80.
M41133527EE EE $1,000 05/1990 05/2013 05/2020 $500.00 $1,040.80 4.00% $1,540. 0
X2246253EE EE $10,000 01/1993 01/2013 01/2023 $5,000.00 $8,680.00 4.00% $13,680.00.8
V2548597EE EE $5,000 02/1993 02/2013 02/2023 $2,500.00 $4,340.00 4.00% $6,840.00
V2548596EE EE $5,000 02/1993 02/2013 02/2023 $2,500.00 $4,340.00 4.00% $6,840.00
X2246255EE EE $10,000 01/1993 01/2013 01/2023 $5,000.00 $8,680.00 4.00% $13,680.00
Totals for 14 Bonds $24.000.00 $42,806.40 $60,806.40
Notes M )Loa D,j
N Nat Issued S �
NE E Not eligible for payment f i
PS Includes 3 month interest penalty 8or,I
MA Matured and not earnina interest
I
http://www.treasurydirect.govBC/SBCPrice 2/13/2013
_ t.i,nr r•;r - all . .... - - - . .fir pq�► e
!In.1RaRrOI.FR.MI:�A'11R++..IR_.. I 'I I
.T TN[ ORt.IN1[L N.TURIT♦ N[R[OI WILL •AY
£ 170 BICENTENNIAL 790 � ISSUE ATE IV �� F ,
A nes Smitrovich 171—O1-3I�b6 Aril JAR 7R pw
MO
600 W. Green St. Nor ,Q
W. Hazleton, Pa. 18201 of Pt y.
lu�lre m[w�L
OR IV
Mrs. Elizabeth Galski 0 24
IDWECLARAT10F [.I[r..r,twuwN.wrwwnw [u .cr.w�.trr..W.rW.• { 44 i
��� R.g l„[nM•.u.CbMby[ur0 NWYO bYY,[W\'I IY• IriIL!' \1� ''�"�t"CP `�'
N�ESERIES E zw ,�; :[ N4M.MPNWNMp[Nn�WM.,.RrN. 3
�✓ M 202 821376 E ,
0
III SEMES :
it �1-
INT[R[.T
171 01 1466: Ol i 193
4 t> :OC i[C 1 NP IU Y,Y
,.�. DA rF
roo AGNES SHIT50VICW - � Phi'
600 W GREE ST r„ 1,
NEST HAZLETON PA 18201 FISC GT U5, y
� a^"�'-.'t7!T�L� G' '-,�,�._ - ;: t :.t o•rxW'[rArft
ytr
$ETTY dktk0 U. 4 41' At
!- Y-!042-5+43— +�h1 r '
� a 4.0!x _ �� � �'� s .
t 4859BEE
1 V25
1:0 000"4000? SC100 25ka598iM
i I I S
u„[war�e[xoeii to 4Yw�a
171.. 01,., 1466 : i 0i�
T° AGNES SMITRUYIC y uE t�r,TE
F4
600 M GREEN ST
¢
WEST HAZLETON °• PA 18201 FI,5CAGTHUS,,
x F53 187 1941 '
�i. "'4 r •TRts.T�y
^_ rig d tt
}° `[IR ETTY GAts' 'F14I I ! Ts
y-0
2-548—%1*
lI�3® 6t?
8 (1047744D11% 0
lot
OU00000 7 _..___.
1: 9
— 1:08_ 6[100 254a599110,
III — i gffA -b""M({� SERIES EE"l Fmr9m "��`um4m INTERE3Y C[A![!i0 VCAR*
FROM 15iV[.DAT*
171 01 1466 12 ! 1992 1
AGNL-5 oMITRCVICH ------
i 600 W "PRE -N ST FItB PHTI�
FIS
WEST ,iAZL TC l PA 18201 C AG;T US',, ,
_ •' I ufmw..oRRrs
I
JAN 20 1943
' fATIN4 fTANf
CR' �ECELIA MgJi
893011 ap X—c a 2z-246=255—
X224b255EE
1:0000900071: 9000�».. 2 2
pq 2 246 25 SHE
WAWA"( SERIES EE
�,•I@ WA"( »� INT[R[!T C[M[R iO r[AM
IROM IiiV!oAT[
i�
171 01 1466 ' al 4 1943
r Ti. AGNES SHITRCVICN r r-- P-
600 W GREEN ST
WEST NARETON PA 18201 FISC AGT US,
i..A Aaf wrf
e F&B 13 1991.
v.eT•
fulwa fTAw.
CECE L 11A I�LE �NO 1 r,
j�
V—'0 2 548— .k- '
89o1UL,
3: � . . : .. V254859bEE
a _ E
1:0000900071:08 300025485960
R•
Tm -tom SERIES EE
1Nr[R9XT CsA![r!O V[AR*
rase iuu[owrs
171 01 A 1466 01' 1993.
AGNES SNITROVICtfi iii PNi"I.
600 W GR-EN ST
-! WEST HAzEFroN PA 13201 F1 AGT US',,
U—A.-
,,,,.
R FECELIA9'tdEFk NA T J �.�
: V-0• 2-548—S�Z.;�. _ _ ----
69304A0ppj1p p 401 -4 aDg5l
�V
.254.85.9 SEE
1:00009000 71:08 4000 2 5 48 59 7iN
a. . ''' uv► rte. rt:� � i .; r�atr ia�►'rcrs,��r;� �E '
S�r.S�Y`�.}'�u ���-__ INTEREST CEASES 90 YFARB i
FROM Iss OF oAT6 1
i
r 'ti JVICH -------
7v ? r ,T FxcB PHIL
'.l'-:T.7V �r 11201 i-1S'C AGT US'
IIaUINO A...T'f
JA'N 20 1993]
o ATI...TAM.
X—G-002-245-253—EE
j�3U15?w�43U 0':4 91247> RA
X224625
1:00009000 71:09 7000 2 246 2 5 3no
SERIES EE
i M WT111ah'II{MYI NILL NY
(,i lid li �til(1!'1iT4YYt8S
115 58 "49 05 1990
I
x 7;, KELLY ANN CiALSKI
600 WEST GlErN STC?PFT RR8 PHI-
' WEST 1-447L='TON DA 14201 FISC AGT US,
IffUINO AOtNT't 3
MAY 22 1990 .
' OAtINO ITAMA
A
00: .ACHES 04041Y��f!
w-03 1-133-527—E4_ -----
K9( 1? SOAA�7t9 ' ROI 4ZOI* RA
M41133521EE
Ge,ro�/M i...wa
1:00009000 71:0 7 2004 & & 335 2 7N'
.T TM WTUIIIT W MMwILL I1Y
SERIES E
135 58 7549 05 1990
"2r 7ir K�LI Y ANN GALSK I -
, _ 601? -=ST ,PEEN STREET FRB PHIL
WEST `+A7LFT.1N PA 18201 FLS6 AGT US
uaulNe Aatgrf
MAY 22 1990
OATINO!TANK
004 AGNFS SMITROVlrH4 I
M-0-041-133-526-EE
R4013500t 57Q 001 4ZOO!o j RAF '
M41l3352bEE
1:00009000711:07 L004L & 33526no
♦r rww +R'�wwwr�r,+
s�SE
iku � .vii .11Y icIR4T tlItY OP"
\ !! r
`4 185 58 7549 ',
• 9(lf.lF.0 CMP IU N7 r� l F NirN 11 t '... � .tY;. .
KE Lr A1414 GALSKt r y
ago k s T � x it
-t wE T HALLETUR RA 18201
` F �
Q 1-133
y t � n t a� '� 1 e'•.
2140k"'
irk ;s
At`T
NMIT:k 4INC P RST O�OF
s 18S 5B
75 f9 "�, i 4f 1.9t5t1
r
,:'�� +� soe aiwedn io na` ! �.p.—•r� e � MoN. e
pp 4
6El LiIESTNGiiE N�
c `- . EY` Nt+12LET4 P, 18201 FIS'
OE
R
\ S
1 Y [nutM[YuF „y
Cl10Ggd0G?1»0'lj 04 L i 3 5 2 sue. t
mv
A' OATkICI4 :A GALSG, ':
J
604 WE IT GREEN ST
WEST H ZLETO1* ! PA 16241 FIi a
DIES so
OVJRC � t
NK ONI 2x950- r s'k � s
0 0 Q04Q007EZ07 7004245078 7N'
sim
.(MtR
'r x
[` �� f.•r,sic.wx.o uo. �. tw°' ,r r.�rt t .
� ► =`, PkTR,ICIA A GASK
t)&Ol WEST aREE4 S, fRs PRI
y
fjRES S�f 'It s �'ib S'0
q 110,11
: x,1 � k• � v%fu�n u.,. mss,�� _ � J4ir�Gi- �' .
����z t Y i � IM►� �1 ilk c ;�.
f
DA . 1.
? N' LCI R G LS IdI
if It
t
D A -
aa� �\ � w S; I "a"oc"aicicp}i oxb`. •� ar YAn o�rP ;
xt f PpATR (~ K` CPALSA iJ 1 t Y
TU!W
T Al NA L
Pic I$241.s t ;'
c t /4 .R .,fie.}�.._.�—�'� 'S ;{ �!. � ��i�y xi�j}'�1: ,r` � �'ty•+�� \
CM
0 R,
Vt
°f
«
1