HomeMy WebLinkAbout07-26-13 J 150561�14�
REV-1500 �"�,-,�'
pA Department of Revenue 6FFtCUL aSE�ilY
Bureau of trxiividuai Taxes ((�j�.{EI21T'ANCE TAX RETIIRN Caunty Code Year File Number
Po aax zaoso� 2 1 1 2 1 1 8 4
Hartisbum�PA 17128•0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Sociai S�urity Numbef Dat9 O(Death MMDDYriY Date Of Birth MMDpYYYY
1 4 1 1 2 � 1 2 0 6 2 4 1 9 5 3
pecedenPs Last Name Suffix DecedenPS Firet Name MI
S L 0 V E N S K Y J 0 H N G
(It Applieable)Entar Survfvtng Spousa's information 8eiow
Sp�use's last Neme Suffix Spouse's Fitst Name MI
Spouse's Sacfal Secudry Number
THIS RE7URN MUSF BE Fit.ED IN DUPLICATE WIT}#THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Origir�i Rstum � 2.Supplementai Retum Q 3.Remalnder Retum(date ot desth
p8orto 12-73-82}
� 4.ttmitad Eshate � qa,pukure Inter�t Compromise(dake of Q 5.Federat Esfate Taz Retum Required �
death after 12-i2-82) �
� B.4ecsdent Died Testate � 7.4ecedent A4aintatnad a Livir�g Trust _ 8.Tota!Number ot Sgle Deposit Boxes
(Attach Copy of Will) (Attach Copy pf Trust)
� 9.Litigation Praceads Rec�vad � 10.Spousai Poverty Credit{4ate af deaM � t t.EleCian to tax under Sec.91 f 3{A)
between t2-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONOENT-THIS SECTpN FRISS SE COMPLETE6.AlL CIXiRESPQNDENCE ANO CONFlpEFfTiAI.TAIt NiFORMATKNt SHOtRQ 8E D%7ECTEp T0:
Name Dayfime Telephone Number
M U R R E L W A L T E R S I I I E 3 Q 7 1 7 ,� 9 7 �F..b 5 0
c - � �
REOIST .-. II.LS U�ONLY;-;7
b ` c-- �
.. !�; _��.. __
�ilSf�ItiB 4�"ddd(855 t" " ' �� ('�J _'
T,,,. ...: ' .. .r
5 4 E A S T M A I N S T R E E T � � c� "
-r, c, ;
Second line of adtlress . �
' -_. �---.,
City or Post OffiCB $t3t8 ZIP CAde ._,. --J DATE Fl n � ��t
fV `�
M E C H A N I t S B U R G P A 1 ? 0 5 5
conssPonda�rse-mauaddres«: murrelQwaltersaallowav �com
Under perwMes of perJury,l declaro Na[i have szamined ih�ratum,InUUdfrq acsomparryirp schedube and sfatamer�ts,antl to d»6eat oi my krawledqe arW 6elief,
it is Vue,correct and compbte.bedendnn of preperar other Man iha personal roprosentaUve is basstl on all Infamatlon W whlch prcparer hes arry knoxletlge.
SIG RE OF PERS RESPONSIBIE FOR F7LING RETURN 7E
."
ADDRESS
SUSAN DUNMZRE, 5 L�VIEW IANE KZTTANNING PA 16201
SIGNATUREOF AFi O 7 REPR65ENTATNE 7F
L
ADORESS
MURftf� R. ALTERS ZII, 54 E- (1AIN ST MEGHANICSBtlRG PA 17�55
PLEASE USE OR141NAL FORM ONI.Y
Side i
� 15056b�14� 1505610140 ��
J 150561�24�
REV-t 5tlQ EX DacedenYS Sociei Security Number
oeeedenesriame: JOHN G� SIOVEN$KY
r�caPrru�anaN
1. Reai Estate{Schedu4e Aj ........................................... 1. B 8 0 U 0 . 0 0
2. stodcs a�d eor�ds{schedwe B) ...................................... z. 9 2 0 9 2 . 0 1
3. Cbsely Held Corporation.Partn�stNp or Sofe�Proprietwship(SChedule G} ..... 3. •
A. Na�rtgag�and Nates fteceivabie(Sd�edule d} .......................... a. •
5. Cash,Sank Deposiis and Misc�lan�us Personal PropeRy(Sc�edule E}.,..... 5. 3 8 0 9 2 . 7 5
fi. JoinBy Ouaretl Property(St�reduie F) ❑ Separate BiiVirtg Requasted ....... 8. 1 7 6 7 . 6 3
7. Inter-Vivos Transfers&Miscellaneous NpqProbate Properly
{Sd,edule c} t� se�arate anrr,g aeq�tea ....... z. .
8. ToWI 6ross Assets(totai Li�res 4 through 7} ........................... 8. 2 1 9 9 5 2 . 3 9 .
9. Funerat Expenses aMt Rdminisfrative Costs(Sehedule H} ..... ......... . ... 9. 2 9 5 4 2 . 6 5
10. Debts of DecedeM,Mortgage Liabii(ties,ana uens�scneame�} ............. �o. 3 6 8 6 1 . 0 3
1 t. Totai Deductio�s tiotai lines 9 antl 16} ... . . ... .... .. .. . . ... . .... ..... t 1. 6 6 4 4 3 . 6 8
12. Net Vaiue of Estate(line 8 minus Line i t) . . .. . . .. . ... . .. .. . . . ........ 12. 1 S 3 5 4 8 . 7 1
13. Charitable and tiovertwn�rtai 8epuestslSec 9113 Trusts far which
8n eleCtlon to tax has not been made(SChedule J} . .. . ... . .. . . ... .. . .. . . 13. .
14. Net Value Subjact to Tax iLine 12 mtnus Lins 13) . ... . .. . . .. . .. . .. . . .. . 74. 1 S 3 5 4 8 . ? 1
TAX CALCULATfON-SEE IN87RUCTtONB FOR APPUCABLE RA7E5
15. Amount of I.ine 14 ta�ble
at ths spousai t�rata,or
Vansfers under$ec.9116
{a}(1.2}X.0_ � , � � 15. � . (] �
16. Amou�t of Line 14 tax8ble
at tineai rate X �0 • 16. 0 . 0 �
17. Rmaunt of Line 74 taxa6le
atsiblingrate x.az 0 . D 0 �7. 0 . � 0
18. Amount of Line 14 taxable
atconaterairate x.t5 7+ 5 3 5 4 8 . 7 1 tis. 2 3 � 3 2 . 3 1
18. TAX DUE . . . .. . . .. . . .. . ... . .. . .. . .. . .. . . .. . .. .. .. . . . . . ... .. ... . t9. 2 � 0 3 2 � � �
20. FIL�IN itiE OVAL IF YOU ARE REat3fS71NG A REFUND OF AtV OYERPAYMENT �
Side 2
� 15�561024fJ 1505610240 �
REV-1500 EX Page 3 Fi1e Numbar
DecedenY� Camplete Address: 21 12 1184
DECE�ENTSNAME
JQHN G- SLOVENSKY
STREETADDRE55 -- -�---�-'.i-'�i.'-��i—
7001 SALEFI PARK CIRCIE_� _.
CITYi__--�--------------'--- — S7ATE .�..—. ZIP �---
MECHANICSBURG PA 17050
Tax Payments and Credits:
t. Ta�c Due(Page 2,Line t9� (t} 23,032.31
2. GreditslPayments
A.Prior Payments 1�w�00•00
B.Qisco�nt
TwaiCreditsiA+g} i2} 10,0�0.00
3. interest
(3}
4. H line 2 is greater th�tine i+�rre 3��ter the dlft�ence.This is the OVERPAYMEM7.
FIII in ovel on Pape 2,Lina 20 b nquest a refund. (4) �•17 0
5. If Line 1+Line 3 is greater than Line 2,enter the difterence.This is the TAX W E. (5) 13,0 32•31 i
Make check payable to: REGISTER OF WII.LS, AGENT
; PLEASE ANSWER THE FOLLOWING QUESTIONS BY PI.ACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use a incume at the property transferted; ......_.............................................................. 0 �
b. retain the right to desigoate who ahall use the prqpedy transferred a its income: ...............................
a. retain a reversionary iMeresq or ................................................................................................
d, receive the pranise fw Nte of eittrer payments,ben�ts�c�e? ....................................................... �
2. If death axuRed after December 12,1982,did decedent transfer property within one year of death
wittrout receiairtt�adequate caisi�iar? ....................................................................................... � �
3. 4id d�edent axn an"in krust for'w payable-upon-death bank ac�unt w security at his a her death? .........
4. Did decedent own an indivlduai retirement account,annuiry or other rron-probate prqperry,which
contains a ben�'ici�y d�ian?.................................................................................................. � �
IF THE ANSWER T4 ANY OF THE AHQYE QUESTIONS IS YES,YOU MUST GCNN�.E'fE SCHEDULE G AN4 FILE IT AS PART OF THE RETURN.
For dates of death on or aRer Ju�y 1, 199d,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for tlre use of tlre surviving spouse is
3 percent{72 P.S.§9t 1$(a}{1.1){i}].
Fa dates W death on a aft�Jan.1, 1995,tl�e tau rate imposed on the net value of transfers to a for khe use of fhe surviving spouse ls 0 percent
[72 P.S.§9116(a)(1.1)(ii}j,The atetute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements fa disdasure of�sets and
fiNng a tax retum aze st�applicable even if Use surviving spouse is the only benefiaary.
for dates of death ar or after July t,2000;
• The ta�c rate imposed o�the net veiue of Bansters hom a deceased chi�21 years of age a your�ger at death ta oe for tlre use of a nat�r�parent,arr
adoptive parent or a stepparent of the child'+s 0 percent[72 P.S.§9116{a){t.2)j.
• 7he tax rate imposed on the net value of transfers ta or for fhe use of the decedenPs Iineal beneficiaries is 4,5 percent,except es noted in
72 P.S.§9118(1.2}[72 P.S.§9116(a}{1j�.
• The ta�t rate imposed on the neE v�ue nf transfers to or for the use of fhe decedenPs siblings is 12 peresnt(12 P.S.§9116(a)(1.3)].A sibling is defined,under
Sectian 9102,as an individuai who has at ieast ane parent in common with the decedent,whether by biood or adaption.
REV-i562 EX*{47-10}
pennsylvania SCHEDULE A
DEPARTMENTOFREVENUE
i2EAL ESTATE
INHERITANCE TpX RETURN
RESIDENT DECEDENT
ESTATE OF: FlLE l�IM�ER:
JOHN G• SLBVENSKY 21 12 1184
All real properly owned wkty or as a kanaM in common must be nporbd et hir mnlcet value.Fair ma�lcet value is defined as lhe prica at whioh propeRy
wouid be exchanged between a wiliirrg buyer and a wNiing seiler,neither b�ng cbmpalled to twy a sNi,t�Ur having reasan�le knawledge of it�ralevaz�t fads.
Real prapeAy that is JoMtlyormed wNh�igM of turvNanhip must bs discbsed on Scheduk F.
Attach a copy W the settlement sheet if the property has been sold.
ITEM indude a c�apy of the�d showing decedent's interest if owned as ten�t in commai. VALUE AT DATE
NUMBER OFDEATH
DESCRIPTION
1 • 7001 SALEM PARK CIRCLE 95,255.12
MEtHANICSBURb, PA Z?05�
6ROSS SALE PRICE
�
TOTAL(A1so enter on Ur�e 5,Recapitul�a,.) S 9 5,2 5 5•12
If mme��needed,use aGd�ehesb W peper of�e same�ze.
��� or��w�m.zso�oze�
A. Settlement Staternent {HUD-1)
1.Q FHA 2.Q RHS $.Q Conv.UNna B.F%e Fhtm6er. .loan Num4er. &MeAgepe inauranx Caaelhnnher.
13188
4.(�VA 6.[�COnv.trw.
G Nob: b rtn is lumirhed b pM You�ahbmaM M Wu�l aeMlameM cMb.AmwMS P� M• bY 1M�Nment W�Ma an�ham meiksd
"tp.a.c}"wa�e P��w�fe me UosinC:theYre anown llm faie�AVm�GOnN puryow and e�rat tnciud�d in W tcWa
D.Mame R Adtlresa of Bortowar. E.Neme 8 Addrosa oi Selkr. F.Neme&Atltlrps of Lmdx:
�ias G.'tianey dcM G.SbtenMry Estais FWCm B�dt�tiA
t0 9na Lene,Mechani�urg,PA 17055 7001 Selem Perk Grdq MxfimfaWrg,PA 17p60 One Pann Squa0.4ancaalm,Pa 178tl2
6.PropMy Cotatlon H.3ettiemaK Apatt 6 Settl�mmr6 Dpb:�'tAfmt3
7001SalanParkClyde 1nAdvaimpef�enleme�n5avhb.l�. Dlebunemerrt0e.ta:0&iM2013
Mechm�ecstrurg.PA 47056 6375 Meraxp DtMe,S�702,Aiechsnlabuip,PA T�OSQ
Hampden Town9hip
Ttleptqn¢7f 7�td765 Fa�c;777a41-7756
8�375�A1�9rha,Su�ib10'[,M�ceWrg,PAfl05Q PAIMeQ�013at 20�pm
byVNt
tU0. OroMAqaqRDurlanBCrtowlr rW. Gms{MiaeMOwbSNW
t . s es ,^_ 95, . . Cd�6aQ�iae ����.-.-- ��
702. Pmlawl 402. Pdem i
103. Semementchazp6s�Edrawer(MetiW} 3�fQ6.30 �s.
9W. _._._.__.__ - 404, �_.._.�_.
103. iO3.
forlM� rMIerNWvmw wN�aibbr4m � �e6ahWnina
146. Cipt6Tmffiou to d�6. CKyRawntax� b
1p7. CouMytezqe 08N4R0'13�071191I2013 157.10 407. Countytmroc OBM4�2013to11�l112018 15/.70
9t�8. SdscotTa�et flB1f4(2413kt�13 44.� iD4. SCwdTacet Ofl�i4tkt3ffi0&�30.+'tli3 4¢b4
100. ZndatrHpA 0&M4Z013M08(d012013 P3.35 40A, 2nApfHOA O6i14Yl073to0B/,!Nl013 23.35
i5�. �tl�SMnr![rept 96t54dXf13m07Afit�}13 79.� 414. 7ndptSexerRrash UBt14t2018bff7(Ot12073 29.68
N1. 411.
152 <12
120. GIW�Mnu�tOwhomBp�owN 9t,�H.62 �70. doMAnoWH�wOO$Wr 96,256.12
lAd. Npom+kFN9 Mi�8111MfM80mevlef fi00. Mtlu�aminAmcw�OwtoShc�r
t. aemrbetrt�' . e eee
2Q2. PllndPalanamtdr,wrlaa�a) SO�OOD.�P 5�2. SeltlemaMChaqn�eallerOb�e1400) 77,730.00
2Q3. s nkai M 503. Ed6X tl ieken ' W
20d. 50l. P cQArs[ ben
216. 965. PeYd�Maamltlmcetgag6bart
206 606,
i67. 307.
2Q@. 508.
509
brorMrmu w�n wiwihtwmuns w�Yr
0. tm�es to 5 . � te
211. C4uMylmes to 511. Coun taWn fa
272. Sdwo�TS� to 512. SchcdTm�es to
213. 513,
27d. 51<.
215. 579.
2tg. 5t6.
277. 517.
218_ 59$.
219, 519.
?2A Tah{Pdd 8eme��r 61,000.0@ Siq. TaWMduqkuiMOmROwB�Yr 77,130.00
800. QMht811tlempnthoMMBOmlwsr BGO. C�eh�te�rdMlGom8�Mr
3Qt. �tosssTwntA+eficm6ataxa Inei2l11 9$.7b1.62 691. GmweirmuMEUe4iBellerpine42� 95255.12
30z. teaanwme Mrtarbarox�er ne?2t� s1�000.00 802 taaared�ctlanamsnamtaueaeWw(Me irt�.On
$83, Gatf � fNm ❑ToBamwr 37,76f.83 gp9. G6h Q To Q fromBNK 7l,135.1i
bbmlxtlwY IvmtlywYCMWApmmWf..WmMllAtlYtY4wY�C;nMW'ywAY1M]Cry.TWY bpwlYtl� Y�MtlMUw1�'�9M NamYan MpM
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p�5,dp m . Settiement Setttement
7 AselYa�lenl 5� �
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800. ixns �COetrttialvd8at.an
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t neurar�m maHhaW (
904, m.aRhtto fromC�fEfti
1001. Initlai depopitfaryar eecrox exouM (fran 4FE tl9)
1002.MOmenwnm'9 inwra� monlhe O.OWmaM S
i(4xi.Mcrtgge Ineurmsc mOnp�e S D.�Otmd� #
iaaa.CityPraperyTmr mpN,t qdq/mm91 S
1W5.CaMyPmpMyiat monq�a E ,77lmaM f
1pO6.Schod7axes mand�g S 80.BOImmlh S
t W7.Ayprep�e ' S
itOp.Ti1M
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1102.Setlkmenlacion�pfee a E
if03.4wndaUNeMaurerrce GFE�S 192.3�
iib4.landetaEllBimurenw 3�S.Q0
11pS,laMers 11tle paGq umtt 580,000,00 lnnEa's Pdiq
11W.Ow�'slplepUYqIMR$&R,qpO.W Wmel9Falicy
ttO7.t�gazd'spwpm�Crelotd�elnaranoepiendum E889.12
110$.U�w�'Bpor�and6ie�tlmeiM1SUraaeP'� 1�.38
11�,
1110.Ndery ipVlckieWekx 10,00
11it.TmcCxtlfiC�lmFm totetAdr SatlmneMS 1p.00
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1201.Govemmentreoadtrpchagn S (M1umGFEiI� t52.6p
11p2.DeeE 582.(A1 M .00 Rekaee
1203.Tmffistazns 6 lfidnGhEAB) 950.00
t2Q4.G�f�Y�'+� De9dS950.06
1205. SaUT�Jelemps Deed 950.00 956.00
1206. DeeC E
1207. S
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urvey M
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#2EV-1503 EX+{6-95}
� SCMEDULE B
CQMMONWEALTNOFPENN3YLVANIA STOCKS 8�BONDS
�NtiERiTANCfi TAX RETURN
RESIDENT DECEDENT
ESTATE OF F�E!Alf�ER
JONN G� SLQUENSKY 21 12 1184
All property Jolnty�ovmad wllh dpM ot survMonhlp musl be dkebsM on&hedule F.
ITEM VALUE AT DATE
NUh9BER OESCRIPTI4N 4F DEATH
1• US SAVINGS BONDS 4,113 .3U
8 SERIES E -- 5 a �1C}0 VAIUE 8 3 a 550 VALUE
REDEMPTI4N VALUE
2� PP6 2?,714.?5
24D�037? SHARES o� �115•46
3• EXXON MOBLE 33,602.?8
36$•527898 SHARES a �91•17
4• YUM 6,061.74
86•683 SHARES a �b69•93
5• I9M 7,441 .94
35• 813 SHARE3 a #207•80
6 • COLA COLA 439.34
11•528221 SHARES � #38•1]�
7• PEPSICO 12,637•66
181•0�35 SHARES a #69.82
6• AXA gp.5p
5.395358 SHARES a #14 .92
iOTA�(Alsa�ter o�Iine 2,Rec�iNiatiar�} i 9 2,�92�Q 1
{If mae space is needed.insert addNbna!sheeffi W fha same sae)
REV-1508 EX+{tt•tOj
pennsyivania SCHEDULE E
DEPARTMENTOFREVENUE
CASH, BAN!( DEPOSITS, &MISC.
MHERITANCE TrV(RETURN
aesiaENruecEOeNT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
J4NN 6� SLOVENSKY 21 12 1184
Indude Ihe proceeds of INipatlon and Ma date Ihe proceedn xrere received by the estate.
AN oxaadw#h t�ofawvh�rsh �kbedbobsada�ScMduMP.
ITEM VALUE AT DATE
NUMBER DESCftIPT10N OF DEATH
1• MERRILL EDGE 32,760 .75
INVESTMENT ACCCBUNT
2• TRAVELERS CHECK3 240.00
12 �20 CHECKS
3• YARD SA�E 273.�0
PERSQNA� PRflPERTY
4 � CASH 71�55
CASH
5• INTERNAI REVENUE 3ERVICE 1,143.45
2012 R€FUND
6• JEEP 3,500.00
NET SALE PRZCE
7 HIGHMARK 104 .00
INSURANCE REFUND
TaTnL(Aiso ent�on u�5,Recapitul�} S 38,09 2�75
If mwe spece Is needed.ineert additlonal sheals aPaPerof ine sartre alze
iwnu �
REV-1509 EXt{Ot•1Q)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE �p��TLY-OWNEDPROPERTY
MHERITANCE TAX RETURN
RESIDENT DECE�ENT
ESTATE OF: FILf tfllt�ER:
JOHN G• SlBVENSKY 21 12 11$4
N an asset was mode Jointly owned wNthin one year of the decedeiK's date of death,k muxt be repoAed on Schedule G.
SURVIVING.&�NT TENANT(S}NAME{S} ADDRESS RELATIpP6SNiP TO QECEDENT
n. SUSAN DtlNMIftE 115 HILLVIEW LANE �4USIN
KITTANNING, PA 16201
s.
c.
JOHtfLY-0WNE4 PR�ERTY:
LETfER OATE CIESCWF'TIONpFPROPERN %OF DATEOFDEATH
REM FORJOINT hdADE INCktRJENA#tEOFFINAHCiA1.iNSiiMiONANDBANKACC0Uh4TN47MBERORSihBtAR OATE4FDEATH DECEQENT'S VAI.UEOF
NUMBER TENANT JOIM' IDENTIFYINGNUMBER, ATTACHDEEDFORJOINTLV�NELDREALESTATE. VALUEpFA59Ei INiEREST DECEDENT5INTEREST
1. A. ai�ioa MEMBERS 1ST FEDERAI tREDIT UNIBN 3,535.26 5�• 1,?67.63
CNEGKING
t4TAL(Aiso enker on Line 6,Recapitui�on) S 1,76?•63
It mwe sp2ce is neeAed,use addNknal aheeb oiPaPer of thb same sixe.
REV.1511 EX+(10-09}
pennsylvania SCHEDULE N
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INNEWTANCETAXRENRN ADMiNISTRA7IVE COSTS
RESIDENTDECEDEW�
ESTATE OF FILf NUMBER
JOHN 6• SLOVENSKY 21 12 11b4
oeceM�rH':�mua 6s reporaa on&Mdak I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAI.EXPENSES:
1• BAUER FUNERAL HOME, KITTANNING, PA S,q62.89
B. ADMINISTRATIVE COSTS;
t. Persanai RapreseMaUve Cammissiars;
r�re(,�ofPersanatR � ,) SUSAN DUNMIRE 1C1,GOD.O❑
saeecndarea, 115 HILLVIEW LANE
c�y KITTANNING stam pA zia 16201
veaqs�Commbaion PaM; 2013
2. A�romeyFees: MURREL R • WALTERS, III 6,60�.0❑
3. Family Ezemption:Qf tlecedenCs adtlress is not the seme as daimanYS,atqdY ezpleaaHon,}
G�ht�M
StreeE Addtess
City StatO ZIP
Relatiawhip of Claimanl lo Decedent
4 • probateFeea; CUMBERLAND COUNTY REGISTER OF WILLS 427. 50
5, Acmuntant Fees:
6� Taz Retum Preparer Fees:
7• CUMBERLpND CO LAW JBURNAL ESTATE NBTICE PUBLItATIBN 75•00
8. PATRZ4T FlEIdS ESTATE NOTZLE PUBIICATI9N 137.24
9 . MAILIN6 COSTS 110•02
Z0� REAL ESTATE — SETTLE(1ENT CHAR6ES SAIE OF Ht�USE 7,130.00
TO?AL{AlsoentaronLine9,Recapituladan) S 29,542�65
It mare space b neaded.uee addidaial sheeb of PaPer of ine seme alze.
REV�1512 EXr(12-087
pennsylvanta SCHEDULE 1
DEPARTMBNTOFREVENUE DE6TS OF DECEDENT,
iNHewraricerwcaeruarr MORTGAGE LIABIUTIES, &LtENS
RESIDENT pECEDENT
ESTATE OF FILE NUMBER
JOHN G • SLOVENSKY 21 12 1184
Report dabb Incurted by tlre decedent prbr W dasfh that remained unpaid at tlu date of daad�,incpMtng onreimbuned s�dipl expenaes.
1TEM VAIUE AT dATE
NUMBER DESCRIPTION OF DEATH
1 • HAZEN ELDER LAW 943• 00
ESTATE PIANNING FEE
2 � DI3COVER BANK 8,484.3i]
tREDIT tARD
3• BARCIAYS BANK DELAWARE 5,197.84
CREDIT CARD
4 . GftZSWAID HOMECARE 84 .00
MEDICAL
5• MEALS ON WHEELS 84 •�U
FflBD
6. VERIZON 210•21
TElEPH4NE
7. DISH TV 93.46
TELEVISION
8� PPL 405.05
ELECTRIt
9• AMERICAN WATER 255.85
WATER BILL
10• HERSHEY MEDItAL CENTER 27.16
MEDItAL
11. HAMPDEN TBWNTHIP 353.23,
SEWER
12• CUMBERLAND {OUNTY TAX tLAIM BUREAU 14 .1U
PERSONAL 2011 TAX
13 • ZIMMERMAN PLUMBTNG AND HEATING 8,658 .Od
FURNAtE tIEAN-UP, ZNSPECTIQN & NEW FURNACE
14 INSTABLE TECN 45.tI�
INSTALL DISHWASHER
1b� ESSIS & SONS 1,687.94
CARPET REPLACEMENT
TOTAL(Afso enter ar Lfne 1Q Recaptuladon) S 36,861�03
rc more space(s neeaea,Msert add�,a�sneab of ine sarta srze.
Gon#�nuation af REY-15001nheritanae Tax Retum Resldent Decedent
JOHN G. SLOVENSKY 21 12 1184
DeceUer�Ys Name Page 1 File Number
Scheidule I-Debts of Decedent, Mortgage I.iabilitles, &Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16 BEST 8UY 819.97
DISHWASHER
17- HflME DEP4T 629.�4
HOUSE STAIN 8 TOILET SEAT
18• L4WE'S 850.9B
DOOR KNOB, LANDStAPE TIMBERS & SHUTTERS
19• J4HN SONGSTER 753•QO
INTERIBR HBUSE PAINTIN6
2C1• VICTOR 3 • BAHN 1,822.0�
, EXTERZOR HQUSE R£PAIftS
21- FURNITURE WORID 463.?1
GARPET SUPPIIES
22- SAIEM PARK HOA 40Q.�0
H4ME4WNERS DUES
23• CASTLE �ARPET 137 .80
CLEAN tARPET
24 • DAVID CAPRISE 57.00
EIECTRItIAN
25• FOREMOST INSURANCE 582�00
H4ME4WER'S INSURAHCE
26• AILSTATE INTURANtE b2.D8
JEEP INSURANCE
27� t42tHAEl IANGkN, TsX LOLIECTOft 2$5.29
2013 COUNTY/TOWNSHIP TAXES
28. PA DEPARTMENT OF ftEVENUE 65.00
2012 TAXES
29 . INTERNAL REVENUE 3ERVICE 2,080.00
2012 TAXES
30. CUMBERLAND COUNTY TAX tOLLECfiBR 9•80
PERSQNAI TAX
SuBTOTtu.sCMEIXlIE 1 9,017.57
Cantinuation af REY-15401nheritance Tax f2eturn lResident Decedent
JOHN G. SLOVENSKY 21 12 1184
DecedenYS Name Page 2 � File Number
Schedule I-Debts of Decodent, Martgage Liabilities, 8 Liens
iTEM
NUMBER DESCRIPTION AMOUNT
31- WEST SHtlRE E11S 1,Od0•34
AMBULANCE
32� LEZZER LUMBER 300•��
BATHROOM VANITY
StI5T4TAL SGNE�t1LE 1 1,3��•3 4
GRAMDTOTJ4t.SCHEDU�E4 i 3g,gg�.pg
�v-�sas�*ta�-�o�
pennsylvania SCHEDULE J
DEPA0.TMENT OF REVENUE gENEFICIARIES
INHERITANCE TAX RETURN
RE&IDENT pECEDENT
ESTATE OF: fILE NUTABER:
JOHN G- Sl4VENSKY 21 12 1184
RELATIpNSHIP TO pECEpENT AMOUNT OR SHARE
NUMBER NAME ANa ADDRESS OF PERSON(S}RECEIVWG Pf2CtPERTY t3o Not l�t Ttu�{s} 4F ESTATE
I FAXABLE4ISTRIBUTION3 pnduda�1�spousaldishibutbnssndtransCersunder
Sec.91f6(a}(t2}.j
1� MICHEIE McGRAINOR taliateral 50.DD
3891 LAKE RUN BLVD.
S'fBW, QH 44224
2• SUSAN DUNMIRE Collateral 50 •CIO
115 HILLVIEW LANE
KITTANNING, PA A16201
EhTER pOLLAR AMQUNT5 P4R DISTRIBUTIONS SHOWN A80VE pN LlNES 15 THRpUGH 18 OF REV-1500 Cl?VER SHEET,AS APPROPRIATE.
A. NON-TAXABLE DISTRIBUTIONS:
A.SPOt1SAL DISTRIBUTiONS UNDER SECTlON$1 i3 FOR WHICN AN ELECTION TO TA?(IS N4T TAKEN:
1.
8.CHARITABLE AND GOVERNMENTAL DISTRIBUTIdNS:
1•
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTWBUTIONS pN LINE 13 OF REV-1500 COVER SHEET. S
If more space is needed,use addiGanai sheets of paper of ihe same size.
.
LAST WILL OF
JOHN G. SLOVENSKY
I, JOHN G. SLOVENSKY, of 7001 Salem Park Circle,
Mechanicsburg, Pennsylvania, being of sound mind, memory and
understanding do hereby make this my Last Will, hereby revoking
any and all Wills heretofore made by me.
FIRST: I give to Valarie Schock any of my videotapes or
DVDs that she desires.
SECOND: I give all the residue of my estate, both real and
personal wheresoever situate, to Michele McGrainor and Susan
Dunmire.
THIRD: I hereby appoint Michele McGrainor and Susan Dunmire
as Co-Executrices of this my Last Will, and I direct that my
personal representatives shall not be required to enter any bond
or security in any jurisdiction in which they may act.
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�'"" day of �l;[�utYL . ----_ _ _--- - -==° -- - -
the persons witnessing it a= —_ __ . e==.
������J"/'j�'�,a%��i
JOnN G. S�G.=S�?":
Signed, published and declared by the above named JOHN G.
SLOVENSKY, as and for his Last Will, in the presence of us, who
at his request, in his presence and in the presence of each
other, have hereunto subscribed our names as witnesses.
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I.7ohn G. Slo4 zn�k}.tz,7ac�K.W fiox nazx�si�:�t�a�e�r�asa�t ia�ae��
qualified according to laK.do hereb� acknowiea�r ilsm T ra.r si�msd cae�-essed t�e estor�as m�
Last Will;chat 1 siened it�cilGnel}:and that I�ian�i it�mt frzz a=d��,a.�t�n act:or tEr�a�pa�-s�a;
espressed. �
I� SEAL]
OHN G. SLOV 'SKY
Swom t before me
this�day of Q�-.�,2012.
COMMONWEALTH OF PENNSriV DIIA
. �����r� �I / �..� RuMennaKaib�.NOWYPubBe
� '(.�jYUj� o«ry7WP•.Dat�hMCouMY
NotaryPublic �^ .u,2o�s
Menbsr.PsnneYh'mla Aeeod�tlan W NdaAar
WITNESS AfFIDAVIT
COMMON WEALTH OF PENNSYLVANIA:
: ss
COUNTY OF ARMSTRONG .
We, Qu'f'�1 1.11rv�?�' andyct,�e?•r'i�� l.:�tec h���-v�v�-/ ,the
wimesses whose names are signed to the attached instrument,being duly qualified accordin o law,do
depose and say that we were present and saw the testator sign and execute 4he instrument as his free and
voluntary act for the purposes therein expressed;that each of us in the hearing and sight of the testator
signed the Will as wimesses;and that to the best of our knowledge the testator was at that time eighteen or
more years of age,of sound mind and under no constraint or undue influence.
t�.�-�-�1���
' ` ��.t..i��.�.�.�c.-h,. L�'�<�:� �RJ
��
Swom to before me
this�day of�,2012.
WYI�/iQ_
Notary Public
COMMONNIEALTH OF PENNSYlVAW1A
. "�f_��..�Counq�
2�.201]
' ?enneylvM4 NdeAas
LAST WILL OF
SOHN G. SLOVENSKY
I, JOHN G. SLOVENSKY, of 7001 Salem Fark Circle,
. Mechanicsburg, Pennsylvania, being af saund mind, memory ana
understanding do hereby make this my Last Will, hereby revokinq
any and all Wills heretofare made by me.
EIRST: I give to Valarie Schock any of my videotapes ar
� DVgs that she desires.
SECON�: F give all the residue af my estate, both real and
persanal wheresoever situate, to Michele McGrainar and Susan
Dunmire.
THIRD: I hereby eppoint Michele McGrainor and Susan Danmire
as Co-Executrices of this my Last Wzll, and Z direct that my
personal representatives shall not be required to enter any bond
or security in any jurisdiction in which they may act.
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� aay o� �[�.d,�lFj}� - - -• --� ---= - - -'=--_ - -
the persans witnessing it �= �_ _- .__s�.
1� ����y���
Signed, published and declared by the abave named JOHN G.
SI,OVENSKY, as and for his Last Will, in the presence of us, caho
at his request, in his presence and in the presence of each
crther, have hereunto snhscribed our names as witnesses.
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COt�+;i"F�'r ���'�'�'+'CJ
1.7oho G. Slo�:nsk�.cz��ac4u. uh.�na�:�sr��i•��r �:�c? a^�s-�c.�w��xes#�
qua{ified according co iau,do hereb� a:t.nou teaix:e�.�_"rso: ;_,-�-3�ra:�n+�ai�e �s��.
Last R'ill:that 1 si_nzd'et«illin�h:and that I s;gr,ru;�r.s.. :;e:�-�:'.tik:�a„�n a:.I�}r�r�+sa;a.-s.-s�
espreesed.
f ��SE�,L,
OHN G.SLQV 'SKY
Swom t before me
this�day af��{t� ,2012. C�M���G.f.H OF pEtdNSYLVAbIfA
�^'�,.�,,.y-J� ��� /I ,/ y R�KvMr+,N�ry PutrNe
�9� 67.�(IYt.�/��... C.anry�TiwpOn"GWMn Ga+�1013
NotaryPublic µ�,pau�rmia dHoMAa
WlTNESS AFFIDAVIT
COMMdNWEALTH OF PEIVNSYLVANIA:
: ss
COUNfiY OF ARMSTRONG .
We, �.u�1 l.11 wt p_,Y` and V it�(?�'���'. ��'l�'� h� '1 .the
wimesses whose names are signed to the attached instrument,being duly qualified acwtdin o law,do
depose and say that we were preaent and saw the testator sign and execute the instrument as his free and
voluntary act fpr the purposes therein expresstd;that each of us in the hearing and sight of the testator
signod the W ill as wifiesses;and that ro Ihe best of our knowledge the testator was at that time eighteen or
more years of age,of sound rnind and under no constraint or undue influence. .
1'C�-�l���
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Swarn to before me
this�day of �,p�Cf/�,,,,ZO I2.
-�Q.�S�d1tl�__��2t2,.
Notary Public
cor�onu�atn+o�ae�vivsn.vuuw
� RWhanne KoMrp�NpfyY Pudk
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� '�^nsylvanlaASaotlatlon �fea