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Home My WebLink About05-01-13 (2) F J 1505610105 REV-1500 a t°2-"'tF1' PA Department of Revenue PennsAvwlda County o USE ONLY Bureau of Individual Taxes °`""�— ""`"°` Year File Number INHERITANCE TAX RETURN '-�� //ff_ 017;2, PO BOX 280601 ` V ! ` Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 08/04/2012 10/21/1911 Decedent's last Name Suffix Decedents First Name MI Kosarowich Olga - H (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's Social Security Number IS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CM 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) OD 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number A. Mark Winter, Esq (717)5334868 RtOISM OF WILMSE OdL 3` Q m n First Line of Address M (j -c C/1 :i ____._. _..._...-. o 310 W. Chocolate Avenue Second Line of Address 7c .O a f'7 ;Z DATE FILED r- M City or Post Office State ZIP Code ` Hershey PA _..__. - - � to 0 y 17933 v -rt Correspondent's e-mail address:markahersheyset.com Under penalties of perjury,I declare that I have examined this return,including parryi I-and statements,and to the best of my knowledge and belief, It is t frets and ion of preparer other than the i based on ation of! preparer has any knowled IGN F PER ON FIL RETURN DATE ! AD SS 0 C ' et Ln, Camp Hil P 17011 PO Box 119, Dillsburg, PA 17019 NA OF PRE OTH T ESEN1'AT DATE • r —13 ADOT to . G ©c.,0 L 9j PA (7033, PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX(Fl) RECAPITULATION 1. Real Estate(Schedule A). ............................. ............... 1. 2. Stocks and Bonds(Schedule B) ........................ ............... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 4. Mortgages and Notes Receivable Schedule D 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 275,610.59 7. lta s Tr nsfers&Miscellaneous Non-Probate ll _- (Schedule O Separate Billing Requested.. ...., 7 15,906.32 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 291,516.91 .I 9. Funeral Expenses and Administrative Costs(Schedule H)........ ........... 9. 19,385.70 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).... ........... 10. j 36,034.93 11. Total Deductions total Lines 9 and 10 ........................... ...... 11. j ( ) 55,420.63 12. Net Value of Estate(Line 8 minus Line 11) ....... ............ ........... 12. 236,096.28 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ............. ........... 13. i 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 236,096.28 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.0- 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 236,096.28 16 _^ ^ ._ "Tmm10,624.33 ___...._ .._ 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18,!. 19. TAX DUE.......................... ..... .......................... 19.! 10,624.33 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1500 EX(F) Page 3 File Number Decedent's Complete Address: DECEDWS NAME Olga H Kosarowich STREETADDRESS 566 Allenview Drive CITY STATE zIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 10,624.33 2. Credits/Payments A.Prior Payments 8,000.00 B.Discount 400.00 3. Interest Total Credits(A+B) (2) 8,400.00 4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (3) Fill In oval on Page 2,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) 2,224.33 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 properly transferred.......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income............................................ ❑ E 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 death without receiving adequate consideration?.............................................................................................................. ❑ 0 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? ........................................................................................................................ ❑ E 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)(1)]. 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 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(ax1.2)]. • 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.§9116(x)(1)]. e The tax rate imposed on the net value of transfers to or for the use of the decedents 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 decedent,whether by blood or adoption. RE -IW9EX+(orw) pennsylvania SCHIDIV .E F DEPARTMENT OF REVENUE 30DMY-OWNED PROPERTY WHOU,AMGE TAX RETM RESIDE!!!DEC'EDEN, ESTATE OF, FILE NUMBER; OLGA H.KOSAROWICH 2012-00973 If an asret become jointly owned within one year of the decedent's dote of death,R murk be reported on SchedWe 0. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.MICHAEL ANDREW KOSAROWICH 140 CRICKET LN SON CAMP HILL,PA 17011 8'OLGA ELEANORE MARCHIONE P. O.BOX 119 DAUGHTER DILLSBURG,PA 17019 C.MATTHEW JAMES MARCHIONE 130 GRANT AVENUE GRANDSON MOORESTOWN,NJ 08054 )OVMY OWNED M)PEWrY: LETTER DATE DESOUPTION OF PROPERTY %OF DATE OF DEATH ITEM TOR MADE INCLUDE NAME OF fvw40Ai WSITFUnI tt AND SANK AOMkffr NUMBER OR SPOLM DM OF DEATH DECSDdirS VALUE OF NUMM TEKW IOW, IDE4m MG NUMBER.ATrAM DMD FOR JOPM HUD REM.ESTATE. VALUE OF ASSET INTEREST Deemelm IMrBi6', 1. A. 03123/87 PNCBANK,CHECKING ACCOUNT 51402£-9485 40,833.43 50 20,416.71 2. A. 12!01/03 PNCBANK,CHECKING ACCOUNT 51-4026-9485,DEPOSIT 12,000.00 50 6,000.00 3. 8. 09101192 PNCBANK,CHECKING ACCOUNT 514026-9485,DEPOSIT 7,000.00 50 3,500.00 4. AB 09/14197 MEMBERS FIRST CU,SAVINGS ACCOUNT 163120 133.59 33 44.53 5. A. 11130198 VANGUARD FUND ACCOUNT 0036/09924688648 21,792.24 50 10,896.12 6. C. 11130198 VANGUARD FUND ACCOUNT 0036/09924688651 21,792.24 50 10,896.12 SEE ATTACHED EXHIBIT A: 7, A. US SAVINGS BONDS-SEE EXHIBIT A,PAGE I OF 7 118,848.00 50 59,424.00 B. B. US SAVINGS BONDS-SEE EXHIBIT A,PAGE 2 OF 7 79,784.00 50 39,892.00 9, C. US SAVINGS BONDS-SEE EXHIBIT A,PAGE 3 OF 7 9,000.00 50 4,500.00 10 D. US SAVINGS BONDS-SEE EXHIBIT A,PAGE 4 OF 7 8,203.72 50 4,101.86 i 11 E. US SAVINGS BONDS-SEE EXHIBIT A,PAGE 5 OF 7 1,560.44 5O 780.22 12 F. US SAVINGS BONDS-SEE EXHIBIT A,PAGE 6 OF 7 69,315.40 50 34,657.70 13 G. US SAVINGS BONDS-SEE EXHIBIT A,PAGE 7 OF 7 51,136.00 50 25,568.00 SEE ATTACHED EXHIBIT B: 14 AB 0512$/87 PROPERTY AT 566 AUENVIEW DRIVE,MECHANICSBURG,PA 164,800.00 33 54,933.33 TOTAL(Also enter on Line b,Recapitulation) ¢ 275,610.59 If more space is needed,use additional sheets of paper of the same size. ESTATE OF OLGA H. KOSAROWICH FILE NUMBER: 2012-00973 EXHIBIT A: SCHEDULE F-JOINTLY-OWNED PROPERTY LETTER JOINT TENANT NAME ADDRESS RELATONSHIP A MICHAEL ANDREW KOSAROWICH 140 CRICKET LANE SON CAMP HILL,PA 17011 B OLGA ELEANORE MARCHIONE P.O.BOX 119 DAUGHTER DILLSBURG,PA 17019 C MATTHEW JAMES MARCHIONE 130 GRANT AVENUE MOORESTOWN, NJ 08054 GRANDSON D JILL MARLENE MARCHIONE 36 HIGHLAND DRIVE GRANDDAUGHTER CAMP HILL,PA 17011 E DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE GRANDSON BOLINGBROOK,IL60490 F AMANDA MICHELLE KOSAROWICH 140 CRICKET LANE GRANDDAUGHTER CAMP HILL,PA 17011 G ROBERT WILLIAM KOSAROWICH 140 CRICKET LANE CAMP HILL,PA 17011 GRANDSON DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE A 04/1986 10,000.00 SERIES EE US SAVINGS BOND X447590EE 19,684.00 50 9,842.00 A 10/1986 10,000.00 SERIES EE US SAVINGS BOND X894209EE 19,300.00 50 9,650.00 A 10/1986 1 10,000.00 SERIES EE US SAVINGS BOND X894210EE 19,300.00 50 9,650.00 A 12/1988 10,000.00 SERIES EE US SAVINGS BOND X1594866EE 16,032.00 50 8,016.00 A 12/1988 10,000.00 SERIES EE US SAVINGS BOND X1594867EE 16,032.00 50 8,016.00 A 08/2003 1,000.00 SERIES HH US SAVINGS BOND M9087838HH 1,000.00 50 500.00 A 08/2003 1,000.00 SERIES HH US SAVINGS BOND M9087839HH 1,000.00 50 500.00 A 08/2003 5,000.00 SERIES HH US SAVINGS BOND V1754413HH 5,000.00 50 2,500.00 A 09/2003 1,000.00 SERIES HH US SAVINGS BOND M9117491HH 1,000.00 50 500.00 A 09/2003 5,000.00 SERIES HH US SAVINGS BOND V1760070HH 5,000.00 50 2,S00.00 A 09/2003 5,000.W SERIES HH US SAVINGS BOND V1760071HH 5,000.00 50 2,500.00 A 12/2003 500.00 SERIES HH US SAVINGS BOND D6470390HH 500.00 50 250.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M9205852HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M9205853HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M920S854HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M92058SSHH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M9205856HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M9205857HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M9205858HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M9205859HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND M9205860HH 1,000.00 50 500.00 A 12/2003 1,000.00 SERIES HH US SAVINGS BOND I M9205861HH 1,000.00 50 500.00 TOTAL—MICHAEL ANDREW KOSAROWICH 118,848.00 59,424.00 Page 1 of 7 ESTATE OF OLGA H. KOSAROWICH FILE NUMBER: 2012-00973 EXHIBIT A: SCHEDULE F-JOINTLY-OWNED PROPERTY LETTER JOINT TENANT NAME ADDRESS RELATONSHIP A MICHAEL ANDREW KOSAROWICH 140 CRICKET LANE SON CAMP HILL,PA 17011 B OLGA ECEANORE MARCHIONE P.O.BOX 119 DILLSBURG,PA 17019 DAUGHTER C MATTHEW JAMES MARCHIONE 130 GRANT AVENUE MOORESTOWN,NJ 08054 GRANDSON D ALL MARLENE MARCHIONE 36 HIGHLAND DRIVE GRANDDAUGHTER CAMP HILL,PA 17011 E DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE GRANDSON BOLINGBROOK,IL60490 F AMANDA MICHELLE KOSAROWICH 140 CRICKET LANE GRANDDAUGHTER CAMP HILL,PA 17011 G ROBERT WILLIAM KOSAROWICH 140 CRICKET LANE CAMP HILL,PA 17011 GRANDSON DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE 8 04/1986 10,000.00 SERIES EE US SAVINGS BOND X447591EE 19,684.00 50 9,842.00 8 10/1986 10,000.00 SERIES EE US SAVINGS BOND X698280EE 19,300.00 50 9,650.00 B 10/1986 1 10,000.00 SERIES EE US SAVINGS BOND X698281EE 19,300.00 50 9,650.00 8 11/1998 500.00 SERIES HH US SAVINGS BOND D482780SHH 500.00 50 250.00 B 11/1998 1,000.00 SERIES HH US SAVINGS BOND M6877350HH 1,000.00 50 500.00 8 11/1998 1,0130.00 SERIES HH US SAVINGS BOND M6877351HH 1,000.00 50 500.00 8 11/1998 1,000.00 SERIES HH US SAVINGS BOND M6877352HH 1,000.00 50 500.00 8 11/1998 5,000.00 SERIES HH US SAVINGS BOND V1364258HH 5,000.00 50 2,S00.00 B 11/1998 5,000.00 SERIES HH US SAVINGS BOND V1364259HH 5,000.00 50 2,500.00 B 11/1998 5,000.00 SERIES HH US SAVINGS BOND V1364260HH 5,000.00 50 2,500.00 B 02/2000 1,000.00 SERIES HH US SAVINGS BOND M7406309HH 1,000.00 50 5{0.00 8 03/2000 1,000.00 SERIES HH US SAVINGS BOND M7415442HH I 1,000.00 50 500.00 8 03/2000 1,000.00 SERIES HH US SAVINGS BOND M7415443HH 1 2,000.00 50 500.00 TOTAL—OLGA ELEANORE MARCHIONE 1 79,784.001 1 39,892,00 Page 2 of 7 ESTATE OF OLGA H. KOSAROWICH FILE NUMBER: 2012-M73 EXHIBIT A: SCHEDULE F-JOINTLY-OWNED PROPERTY LETTER JOINT TENANT NAME ADDRESS RELATIONSHIP A MICHAEL ANDREW KOSAROWICH 140 CRICKET LANE SON CAMP HILL,PA 17011 B OLGA ELEANORE MARCHIONE P.O.BOX 119 DAUGHTER DILLSBURG,PA 17019 C MATTHEW JAMES MARCHIONE 130 GRANTAVENUE GRANDSON MOORESTOWN,NJ 08054 D JILL MARLENE MARCHIONE 36 HIGHLAND DRIVE GRANDDAUGHTER CAMP HILL,PA 17011 E DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE BOLINGBROOK,IL 60490 GRANDSON F AMANDA MICHELLE KOSAROWICH 140 CRICKET LANE GRANDDAUGHTER CAMP HILL, PA 17011 G ROBERT WILLIAM KOSAROWICH 140 CRICKET LANE GRANDSON CAMP HILL,PA 17011 DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE C 04/1996 5,000 SERIES HH US SAVINGS BOND M5824103HH 1,000.00 50 500.00 C 04/1996 1,000 SERIES HH US SAVINGS BOND M5824104HH 1,000.00 50 500.00 C 04/1996 1,000 SERIES HH US SAVINGS BOND M5824105HH 1,000.00 50 500.00 C 04/1996 1,000 SERIES HH US SAVINGS BOND M5824106HH 1,000.00 50 500.00 C 04/1996 5,000.00 SERIES HH US SAVINGS BOND V1167406HH 5,000.00 50 2,500.00 TOTAL-MATTHEW JAMES MARCHIONE 9,000.00 4,SOO.00 Page 3 of 7 ESTATE OF OLGA H. KOSAROWICH FILE NUMBER: 2012-00973 EXHIBIT A: SCHEDULE F—JOINTLY-OWNED PROPERTY LETTER JOINT TENANT NAME ADDRESS RELATONSHIP A MICHAEL ANDREW KOSAROWICH 140 CRICKET LANE SON CAMP HILL,PA 17011 8 OLGA ELEANORE MARCHIONE P.O.BOX 119 DAUGHTER DILLSBURG,PA 17019 C MATTHEW JAMES MARCHIONE 130 GRANT AVENUE GRANDSON MOORESTOWN, NJ 08054 D JILL MARLENE MARCHIONE 36 HIGHLAND DRIVE GRANDDAUGHTER CAMP HILL,PA 17011 E DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE GRANDSON BOLINGBROOK,IL 60490 F AMANDA MICHELLE KOSAROWICH 140 CRICKET LANE GRANDDAUGHTER CAMP HILL, PA 17011 G ROBERT WILLIAM KOSAROWICH 140 CRICKET LANE GRANDSON CAMP HILL,PA 17011 DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE D 04/1974 200.00 SERIES E US SAVINGS BOND R101369602E 1,027.84 50 513.92 D 06/1975 100.00 SERIES E US SAVINGS BOND C2001067053E 532.60 50 266.30 D 08/1975 100.00 SERIES E US SAVINGS BOND C1055640247E 532.60 50 266.30 D 08/1975 100.00 SERIES E US SAVINGS BOND C1055640249E 532.60 50 266.30 D 01/1976 200.00 SERIES E US SAVINGS BOND R104516708E 1,078.08 50 539.04 D 11/2002 500 SERIES HH US SAVINGS BOND D6118828HH 500.00 50 250.00 D 11/2002 1,000 SERIES HH US SAVINGS BOND M8720803HH 1,000.00 50 500.00 D 11/2002 1,000 SERIES HH US SAVINGS BOND M8720804HH 1,000.00 50 500.00 D 11/2002 1,000 SERIES HH US SAVINGS BOND M8720805HH 1,000.00 50 1 500.00 D 11/2002 5,000 1 SERIES HH US SAVINGS BOND M8720806HH 11000.00 50 1 500.00 TOTAL-JILL MARLENE MARCHIONE 8,203.72 1 4,101.86 Page 4of7 ESTATE OF OLGA H. KOSAROWICH FILE NUMBER: 2012-00973 EXHIBIT A: SCHEDULE F-JOINTLY-OWNED PROPERTY LETTER JOINT TENANT NAME ADDRESS RELATONSHIP A MICHAEL ANDREW KOSAROWICH 140 CRICKET LANE SON CAMP HILL,PA 17011 B OLGA ELEANORE MARCHIONE P.O.BOX 119 DAUGHTER DILLSBURG,PA 17019 C MATTHEW JAMES MARCHIONE 130 GRANT AVENUE GRANDSON MOORESTOWN,NJ 08054 D JILL MARLENE MARCHIONE 36 HIGHLAND DRIVE GRANDDAUGHTER CAMP HILL,PA 17011 E DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE GRANDSON BOLINGBROOK,IL 60490 F AMANDA MICHELLE KOSAROWICH 140 CRICKET LANE CAMP HILL,PA 17011 GRANDDAUGHTER G ROBERT WILLIAM KOSAROWICH 140 CRICKET LANE GRANDSON CAMP HILL,PA 17011 DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE E 04/1974 200.00 SERIES E US SAVINGS BOND R101369604E 1,027.84 50 513.92 E 06/1975 100.00 SERIES E US SAVINGS BOND C2001067051E 532.60 50 266.30 TOTAL-DAVID CHRISTOPHER MARCHIONE 1,560.44 780.22 Page 5of7 ESTATE OF OLGA H. KOSAROWICH FILE NUMBER:2012-M73 EXHIBIT A: SCHEDULE F--JOINTLY-OWNED PROPERTY LETTER JOINT TENANT NAME ADDRESS RELATONSHIP A MICHAEL ANDREW KOSAROWICH 140 CRICKET LANE SON CAMP HILL,PA 17011 B OLGA ELEANORE MARCHIONE P.O.BOX 119 DAUGHTER DILLSBURG,PA 17019 C MATTHEW JAMES MARCHIONE 130 GRANT AVENUE GRANDSON MOORESTOWN,NJ 08054 D JILL MARLENE MARCHIONE 36 HIGHLAND DRIVE CAMP HILL,PA 17011 GRANDDAUGHTER E DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE GRANDSON BOLINGBROOK,IL 60490 F AMANDA MICHELLE KOSAROWICH 140 CRICKET LANE GRANDDAUGHTER CAMP HILL,PA 17011 G ROBERT WILLIAM KOSAROWICH 140 CRICKET LANE GRANDSON CAMP HILL,PA 17011 DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE F 07/1986 500.00 SERIES EE US SAVINGS BOND D12293591EE 984.20 50 492.10 F 07/1986 500.00 SERIES EE US SAVINGS BOND D12293592EE 984.20 50 492.10 F 07/1986 500.00 SERIES EE US SAVINGS BOND D12293593EE 984.20 50 492.10 F 07/1986 500.00 SERIES EE US SAVINGS BOND D12293594EE 984.20 50 492.10 F 07/1986 500.00 1 SERIES EE US SAVINGS BOND D1229359SEE 984.20 50 492.10 F 07/1986 500.00 SERIES EE US SAVINGS BOND D12293596EE 984.20 50 492.10 F 07/1986 500.00 SERIES EE US SAVINGS BOND D12293597EE 984.20 50 492.10 F 07/1986 500.00 SERIES EE US SAVINGS BOND D1229359SEE 984.20 50 492.10 F 07/1986 500.00 SERIFS EE US SAVINGS BOND D12293599EE 984.20 50 492.10 F 07/1986 1,000.00 SERIES EE US SAVINGS BOND M16203708EE 1,968.40 50 984.20 F 07/1986 1,000.00 SERIES EE US SAVINGS BOND M16203709EE 1,968.40 50 984.20 F 07/1986 1,000.00 SERIES EE US SAVINGS BOND M16203710EE 1,968.40 50 984.20 F 07/1986 1,000.00 SERIES EE US SAVINGS BOND M16203711EE 1,968.40 SO 984.20 F 12/1988 10,000.00 SERIES EE US SAVINGS BOND X1594868EE 16,032.00 50 8,016.00 F 12/1988 10,000.00 SERIES EE US SAVINGS BOND X1594869EE 16,032.00 50 8,016.00 F 09/1992 5,000.00 SERIES EE US SAVINGS BOND V2358280EE 6,840.00 50 3,420.00 F 09/1992 10,000.00 SERIES EE US SAVINGS BOND X2193824EE 13,680.00 50 6,840.00 TOTAL-AMANDA MICHELLE KOSAROWICH 69,31S.401 34,657.70 Page 6 of 7 ESTATE OF OLGA H. KOSAROWICH FILE NUMBER: 2012-009373 EXHIBIT A: SCHEDULE F-JOINTLY-OWNED PROPERTY LETTER JOINT TENANT NAME ADDRESS RELATONSHIP A MICHAEL ANDREW KOSAROWICH 140 CRICKET LANE CAMP HILL,PA 17011 SON B OLGA ELEANORE MARCHIONE P.O.BOX 119 DAUGHTER DILLSBURG,PA 17019 C MATTHEW TAMES MARCHIONE 130 GRANT AVENUE MOORESTOWN,NJ 08054 GRANDSON D JILL MARLENE MARCHIONE 36 HIGHLAND DRIVE GRANDDAUGHTER CAMP HILL,PA 17011 E DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE GRANDSON BOLINGBROOK,IL 60490 F AMANDA MICHELLE KOSAROWICH 140 CRICKET LANE GRANDDAUGHTER CAMP HILL,PA 17011 G ROBERT WILLIAM KOSAROWICH CA CRICKET LANE GRANDSON CAMP HILL, PA 17011 DATE DATE OF %OF DECEDANTS LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE G 12/1990 10,000.00 SERIES EE US SAVINGS BOND X2081293EE 14,808.00 50 7,404.00 G 12/1990 10,000.00 SERIES EE US SAVINGS BOND X2081294EE 14,808.00 50 7,404.00 G 09/1992 5,000.00 SERIES EE US SAVINGS BOND V2358279EE 6,840.00 50 3,420.00 G 09/1992 10,000.00 SERIES EE US SAVINGS BOND X2193823EE 13,680.00 SO 6,840.00 G 10/1997 500.00 SERIES HH US SAVINGS BOND D4537569HH 500.00 50 250.00 G 10/1997 500.00 SERIES HH US SAVINGS BOND D4537570HH 500.00 50 250.00 TOTAL—ROBERT WILLIAM KOSAROWICH 51,136.00 25,568.00 Page 7 of 7 ESTATE OF OLGA H. KOSAROWICH--FILE NUMBER: 2012-W973—EXHIBIT B—SCHEDULE F Cumberland County Board of Assessment Appeals THIS IS NOT A TAX Old Courthouse, First Floor One Courthouse Square Carlisle, PA 17013 ' 42003161-2A-33774 hri`IIlrt�lllrurhlrrlt6r11rrudllrGdnlullrrrllarlh�l 27350 KOBAROWICK, OLGA 2 RT AL T77 P1 CIO OLGA ELEANOR MARCRIOM 566 ALLENV33M DRXVZ Deadline for Scheduling an Informal Review NECBANICSBMG, PA 17055-6198 Appointment' June 14, 2010 For details,please see the reverse side. NOTICE OF CHANGE ASSESSMENT The Cumberland County Board of Assessment Appeals is providing you with notice of the value on this property, determined as a result of the Cumberland County countywide reassessment completed this year. The countywide reassessment values each property at current Fair Market Value, as of January 1, 2010, equalizing and establishing a uniform tax base so that properties of like characteristics and the same actual Fair Market Value will be taxed the same. FORMAL.APPEAL DEADLINE: June 14 2010 KLXLXM DAYS: gray 3, 2010 Parcel Identifier. ltonic.t 42 - UPP= ALLAN TOWNSHIP 42-28-2423-410. School: 6 - MUCK&HICSIMM SD Location: 2010 Base Year Assessed Value Old Assessed Value 566 ALL3XVI3tr 1NXV3 Fair Market Value {2010 Market x 10096 (2004 Market) ALLINVIE Land 17,500 17,500 12,580 LOT 15-3 STA= III Sec a P3 4 Buildings 147,300 147,300 128,190 TOTAL 164,800 164,800 140,770 Taxable Property 2010 Clean and Green Values Unit/Lot ID: L-00163 Land NOT NOT I NOT Land size: .03 acres Buildings APPLICABLE APPLICABLE APPLICABLE Property Typal R TOTAL Residential(under io Acres) Clean and Green values apply to qualified fern and forest land and become effective Only upon application and approval. Clean and Green applications must be received so"atead Approved' by-the Assessment Office no later than 4:30 p.m;-on October 15:-2(10. Those ._. previously approved for Clean and Green do not need to re~appiy. The ESTIMATED impact statement printed below is our best estimate of change, based on 2010 COUNTY tax figures. THIS ESTIMATE DOES NOT INCLUDE ANY BOROUGH,TOWNSHIP,OR SCHOOL DISTRICT IMPACT. Current 2010 County mills - 2.579 Adjusted 2010 County mills = 2,074 $ 363 : 2010 COUNTY Tax BEFORE Reassessment. $ 342 : 2010 COUNTY Tax AFTER Reassessment. REV-1510 EX+(08-09) Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND RMEWMM UX REIR" NISC. NON-PROBATE PROPERTY RESIDENT OECEDM ESTATE OF FILE NUNBER OLGA H. KOSAROWICH 2012-00973 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 DESCRIPTION MEAME OF PROPERTY DATE OF DEATH %OF DECD S EXCLUSION TAXABLE mauoE n�xr�OF THE ,THEM R9A1f0115110'm aeaDn+r um NUMBER THE WE OFIRANS R. ATM A COPY OF1WDM FOR R&LESOTE VALUE OF ASSET INTEREST pF wLxqm VALUE I. OLGA ELEANORE MARCHIONE,DAUGHTER-2001 6,000.00 100 6,000.00 US SAVINGS BONDS-SEE ATTACHED EXHIBIT C 1 MATTHEW JAMES MARCHIONE,GRANDSON-1974&1975 6,25336 100 6,253.36 US SAVINGS BONDS-SEE ATTACHED EXHIBIT C 3 DAVID CHRISTOPHER MARCHIONE,GRANDSON-1974&1975 3,652.96 100 3,652.96 US SAVINGS BONDS-SEE ATTACHED EXHIBIT C TOTAL(Also enter on Une 7,Recapitulation) ; 15,906.32 If more space is needed,use additlonal sheets of paper of the same size, ESTATE OF OLGA H. KOSAROWICH FILE NUMBER: 2012-M73 EXHIBIT C: SCHEDULE G -PAYABLE ON DEATH-JOINTLY-OWNED PROPERTY ITEM NO. JOINT TENANT NAME ADDRESS RELATONSHIP 1 OLGA ELEANORE MARCHIONE P.O.BOX 119 DAUGHTER DILLSBURG,PA 17019 2 MATTHEW JAMES MARCHIONE 130 GRANT AVENUE MOOREST,OWN,NJ 08054 GRANDSON 3 DAVID CHRISTOPHER MARCHIONE 780 WHEATLAND LANE GRANDSON BOLINGBROOK,IL 60490 DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE 1 04/2001 500.00 SERIES HH US SAVINGS BOND D5494276HH 500.00 100 500.00 1 04/2001 500.00 SERIES HH US SAVINGS BOND D5494277HH 500.00 100 500.00 1 04/2001 1 500.00 SERIES HH US SAVINGS BOND D5494278HH 500.00 100 500.00 1 04/2001 500.00 SERIES HH US SAVINGS BOND D5494279HH 500.00 100 500.00 1 04/2001 500.00 SERIES HH US SAVINGS BOND D5494280HH 500.00 100 500.00 1 04/2001 500.00 SERIES HH US SAVINGS BOND D5494281HH 500.00 100 500.00 1 04/2001 500.00 SERIES HH US SAVINGS BOND D5494282HH 500.00 100 500.00 1 08/2001 500.00 SERIES HH US SAVINGS BOND D5659247HH 500.00 100 500.00 1 08/2001 500.00 SERIES HH US SAVINGS BOND D5659248HH 500.00 100 500.00 1 08/2001 500.00 SERIES HH US SAVINGS BOND D5659249HH 500.00 100 500.00 1 08/2001 500.00 1 SERIES HH US SAVINGS BOND D5659250HH 500.00 100 500.00 1 08/2001 500.00 1 SERIES HH US SAVINGS BOND D5659251HH 500.00 100 500.00 TOTAL-OLGA ELEANORE MARCHIONE 6,000,00 DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE 2 07/1974 1,000.00 SERIES E US SAVINGS BOND M103768756E 5,200.80 100 5,200.80 2 01/1975 200.00 SERIES E US SAVINGS BOND 11102166143E 1,052.56 100 1,052.56 TOTAL-MATTHEW JAMES MARCHIONE 6,253.36 DATE DATE OF %OF DECEDANT'S LETTER MADE DESCRIPTION OF PROPERTY DEATH DECED DOD JOINT VALUE INT VALUE 3 07/1974 500.00 SERIES E US SAVINGS BOND D1040326S6E 2,600.40 100 2,600.40 3 01/1975 200.00 SERIES E US SAVINGS BOND I R102166142E 1,052.56 100 1,052.56 TOTAL-DAVID CHRISTOPHER MARCHIONE 3,652.96 REV-1511 Ex+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL. EXPENSES AND MWUANCE TM RETM ADMINISTRATIVE COSTS RESIDW DECEDErrr ESTATE OF FILE NUMBER OLGA H. KOSAROVIACH 2012-00973 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' MALPEW FUNERAL HOME 10,709.32 2. HONORARIA FOR PRIESTS,ORGANIST,CANTOR,ETC. 795.00 3. FLOWERS 339.15 4. DINNER FOLLOWING BURIAL 653.11 5, SNACK AT CHURCH,INCLUDES DONATIONS,TRAVEL 370.76 6. MEALS FOR VISITORS BEFORE AND AFTER FUNERAL 176.48 7• MISCELLANEOUS:MEDAL,BOOKMARKS,CLOTHING,THANK-YOU'$ 358.56 B. ADMINISTRATIVE COSTS: 1. Personal Representathte Commissions: Name(s)of Personal Representative(s) Street Address _ City�T State__-_—ZIP Years)Commission Paid: __-- 2. Attorney fees: 5,000.00 3. Family Exemption:(If decedent's address is not the same as daimant s,attach explanation.) Claimant Street Address City_--. State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 394.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 300.00 ! 7. ESTATE ADVERTISING 168.96 8. EXPENSES ASSOCIATED WITH PROCESSING ESTATE ASSETS 119.86 i TOTAL(Also enter on Une 9,Recapitulation) ; 19,385.70 If mare space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES$LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER OLGA H. KOSAROWICH 2012-00973 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION Of DEATH 1. MESSIAH LIFEWAYS AT MESSIAH VILLAGE-JUNE 9,178.63 2. MESSIAH LIFEWAYS AT MESSIAH VILLAGE-JULY 10,237.15 3. MESSIAH LIFEWAYS AT MESSIAH VILLAGE-AUGUST 950.10 4. MESSIAH LIFEWAYS COMMUNITY SUPPORT SERVICES 72.61 5. ALERT PHARMACY SERVICES,INC.-JULY 37.30 6. ALERT PHARMACY SERVICES,INC.-AUGUST 2.38 7. ALERT PHARMACY SERVICES,INC.-FINAL 47.35 8. REAL ESTATE TAXES-DENNIS ZERBE,TREASURER(AUGUST 2012) 1,866.04 9. EXPENSES ASSOCIATED WITH MAINTAINING HOUSE -INCURRED BEFORE DEATH 424.23 10. INCOME TAX PREPARATION FEE 300.00 11. PA DEPARTMENT OF REVENUE-2012 INCOME TAX 738.00 12. IRS FORM 1041-ESTATE INCOME TAX 6,000.00 DECEDENTS SHARE OF HOUSE EXPENSES AFTER DEATH IS 33%. 13. REAL ESTATE TAXES-DENNIS ZERBE,TREASURER(APRIL 2013) 211,72 14. ALLENVIEW HOMEOWNERS ASSOCIATION-QUARTERLY ASSESSMENT(2 PAYMENTS) 200.00 15. UPPER ALLEN TOWNSHIP-SEWER-QUARTERLY BILL(3 PAYMENTS) 112.00 16. YORK WASTE DISPOSAL#611-QUARTERLY BILL(3 PAYMENTS) 38.97 17. PPL ELECTRIC UTILITIES-MONTHLY BILL(7 PAYMENTS) 312.00 18. UNITED WATER PENNSYLVANIA-MONTHLY BILL(7 PAYMENTS) 29,87 19. HOMEOWNERS INSURANCE 329.95 20. HEAT PUMP MAINTENANCE SERVICE CONTRACT 76.33 21. SUPPLIES FOR CLEANING&ORGANIZING 54,83 22. CLEAN OUT 566 ALLENVIEW DRIVE,PRIOR TO SALE (426 HRS Q$15.00 PER) 2,130.00 23. IMPROVEMENTS TO 566 ALLENVIEW DRIVE,PRIOR TO SALE(PAINTING,CARPET,ETC.) 2,000.00 24. REPLACE NON-WORKING APPLIANCES 685.47 TOTAL(Also enter on Line 10,Recapitulation) $ 36,034.93 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) `ffo� pennsylvania SCHEDULE 7 DEPARTMENT OF REVENUE INHET,NCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: OLGA H. KOSAROWICH 2012-00973 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustae(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include Outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. MICHAEL ANDREW KOSAROWICH SON 50% 140 CRICKET LANE,CAMP HILL,PA 17011 2. OLGA ELEANORE MARCHIONE DAUGHTER 50% PO BOX 119,DILLSBURG,PA 17019 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 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: L TOTAL OF PART U-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.