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Home My WebLink About02-0384PETITION FOR PROBATE and GRANT OF LETTERS also known as Deceased. Social Security No. //6 '- ¢ ! ~ 3 2. ~ ~- 21-02-384 Register of Wills for the County of _~;~Lm Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut in the last will of the above decedent, dated and codicil(s) dated in the named ,19 q7 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in c'7,~-az:,A,~,.,o County, Pennsylvania, with ht.s' last family or principal residence at / g._cZz__.f';'-,'d,4~rF,~.,,z-,o .~.,o. (list street, number and muncipality) Decendent, then Except as fo{low¥ decedent did nc~t marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania ~' $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: / WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. request(s) the probate of the last will and codicil(s) '-- -n~ii n~t(a 7'~(t~t~meTa~y~a~i non c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 'i COUNTY OF CUMBERLAND The petitioner(s) above-named swear{s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of pelitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s} will well and t= my administer the estate according to law. Sworn [o or ....... affirmed and subscribed before me ~his llt~ .... day of NO. 21-02-384 Estate Of StANLeY J GORCZYCA JR , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW APRIL 15, 2002 ~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated September 15, 1997 described therein be admitted to probate and filed of record as the last will of STANLEY J GORCZYCA JR ; and Letters TESTAMENTARY are hereby granted to RICHARD J GORCZYCA /'~ f ~' ister of Wills'/ FEES Probate, Letters, Etc .......... $ 115.00 Short Certificates( ) .......... $ 9.00 ATTORNEY (Sup. Ct. I.D. No.) ~,-page. s. enuncmtlon ................ $ 6,00 $ 5.00 ADDRESS TOTAL ~ $ 135.00 Filed APRIL 11, 2002 ................................... PHONE CD 21-02-384 LAST WILL AND TESTAMENT I, STANLEY J. GORCZYCA, JR., of 1292 Strafford Road, Camp Hill, County of Cumberland, Pennsylvania, do hereby make, publish, and declare this to be my LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in manner following, that is to say, FIRST, that I direct that my Personal Representative shall pay all of my just debts and funeral expenses as soon as this shall be practicable. SECOND, that upon my death I give, devise, and bequeath all of my property, real, personal, and mixed, to my son, RICHARD J. GORCZYCA, to be disbursed as he deems fit in his sole judgment. THIRD, that I hereby appoint my son, RICHARD J. GORCZYCA, as the Executor of my estate. I direct that my Personal Representative shall not be required to post bond in this or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 15th day of September, 1997. - ? · WITNESS ACKNOWLEDGMENT COM~4ONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, STANLEY J. GORCZYCA, JR., testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed the instrument as my Last Will and Testament; that ! signed it willingly and that I signed it es my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by STANLEY J. GORCZYCA, JR., the testator, this 15th day of September, 1997. ST~iNLEY J. ~9YCA~J~.~--~--' ~T~B L fII AFFIDAVIT COMMONWEALTH OF PENNSYLVA/~IA COUNTY OF DAUPHIN WE, CHARLES E. PETRIE and RICHARD J. GORCZYCA, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testator sign and execute the instrument as his LAST WILL AND TEST~IENT; that STD_NLEY J. GORCZYCA, JR. signed willingly and that he executed it 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 witnesses; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by CHA/~LES E. PETRIE and RICHARD J. GORCZYCA, witnesses, this 15th day of September, 1997. Wi TNESSOZ /~ WITNESS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No. Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, ! report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes _~,~ No__ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No ~,- b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes L,~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may Date: 7-~-~ % be att ched to this report. S.i. gna_t~u t'gg~ 7"-- Name (Please type or print) Address ' ' Tel . No. Capacity: ~ Personal Representative (MAH:rmf/AM3) __Counsel for personal representative Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) / WillNo. ~oO-t.. - ~o 3q~ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the .Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~'/3 ]0 ~_ · Name Address / Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Address Telephone ('7~ 7) 7-glr-~o,,, Capacity: ~ Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001374 GORCZYCA RICHARD J 1965 RANDALL ROAD ENOLA, PA 17025 ........ fold ESTATE INFORMATION: SSN: 116-01-3235 FILE NUMBER: 2102-0384 DECEDENT NAME: GORCZYCA STANLEY J JR DATE OF PAYMENT: 07/03/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/05/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,484.89 REMARKS: RICHARD GORCZYCA TOTAL AMOUNT PAID: $4,484.89 SEAL CHECK# 123 INITIALS: VZ RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1 500 RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM/DD-YyR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I-,. Z UJ Z o o [~1. Original Return ~-~4. Limited Estate [--~ 6. Decedent Died Testate (Attach copy of Will) ---]9. Litigation Proceeds Received r---~ 2. Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) [---~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) []10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) L---j3. Remainder Return (date of death prior to 12-13-82) r--] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [-'-~ 11. Election to tax under Sec. 9113(A) (Attach Sch O) FIRM NAME (If Applicabre) COMPLETE MAILING ADDRESS 17o 1. Real Estate (Schedule A) (1) ?~ 2. Stocks and Bonds (Schedule B) (2) ..~,.,~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ---]Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) J'-'-'-~l 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) OFFICIAL USE ONLY (11) (13) (14) { o °r, off .q fl o SEE INSTRUCTIONS ON REVERSE SIDE 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 Line14 taxable at lineal rate iOU~'lqOq,"~' x .0 /..,L.~ (16) 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) q,l ,flfl' Decedent's Complete Address: STREET ADDRESS CITY Ct~/~P ~II.-L STATE F& ZI. 17011 Tax Payments and Credits: J. Tax Due (Page J Line Jg) (J) 2. Credits/Payments A. Spousal Pove~ Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) (5) (5A) (5B) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, Make Check Payable to: REGISTER OF WILLS, AGENT u41 o, 0 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; ............................................ [] [] 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 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? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under penalties 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. SIGNATURE OF.);~P,~ON RFiSPC~ISIBLE FOR FILING RETURN DATE ADDRESS /i~" "~'/~' J' ' "~[~"~ '"~ o Z. - o '7,.. ~..D . C'~,cR , fa-. l'~o SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 twenty-one 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% [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%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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. REV-1502EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATEOF~'7'"~ Iq~--~Y I~o~C_. ~_ ¥'C/~ ,~' ,..~,., FILENUMBER All real property owned solely or as a tenant in c,3~iiiiion must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH $ REV-1503 EX* (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER<~ All prope~ jointly-o~ ~h ~ght of su~ivo~hip must ~ disclosed on Sch~ule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) R~-1~08 ~ + (1~ ~ COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE 0~../..~ t,/J.- ~ Y FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION ~&Fu~ oF f~ ~'pt e.~ L 3n-v1 ~o-~ # ~>70o¥¢/5'7aoo~ VALUE AT DATE OF DEATH 1, 7o ~f.o ~ .~00, oo /77, qo TOTAL (Also enter on line 5, Recapitulation) $ 2, '7 '7 ~, ~O (If more space is needed, insert additional sheets of the same size) REV:1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant __ Zip Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees State__Zip TOTAL (Also enter on line 9, Recapitulation) AMOUNT i25'.oo 110,5;0 (if more space is needed, insert additional sheets of the same size) REV-1512 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE O~,~ 7"/~' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILmES, & LIENS FILE NUMBER Include unmlmbumed medical expenses. ~TEM NUMBER DESCRIPTION TOTAL (Also enler on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH ,00 , R,EV-1513 EX,j- (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES EST A TE o.~.~.. -r ~- ~ ~ ~,,~ .u..~ o ~ ~- o o ~ ~ ¢ RE~TIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE II. TAXABLE DISTRIBUTIONS (include outright spousal distributions) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) COMRONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 17128-0601 REV-1Sq3 EX AFP COg-O0) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE NO. 21 OZ-O$Bq ACN 02125577 DATE 05-29-2002 RICHARD J 60RCZYCA 1965 RANDALL RD ENOLA PA 17025-12q8 TYPE OF ACCOUNT EST. OF STANLEY J $ORCZYCA [] SAVINGS S.S. NO. 116-01-5255 [] CHECKING DATE OF DEATH Oi-05-ZOOZ [] TRUST COUNTY CUMBERLAND [] CERTTF. REHIT PAYMENT AND FeRNs TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 ALLFIRST BANK has provided the Deportment Nith the inforoation listed beloa ahich has been used in calculating tho potential tax duo. Their records indicate that at tho death of tho above decadent, you Hero a joint oHnar/bonaficiary of this account, if you feel this inforoation is incorrect, please obtain Hrittan correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance aith the Inheritance Tax LaHs of the ComoenHoalth of Pennsylvania. Questions oay be ansHarod by calling (717] ?87-8327. COMPLETE PART I BELOW # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun~ No. 0057917~$9 Oa~e 08-Z8-196~ Established Accoun~ Balance 3,~08.16 Percen~ Taxable X 50.000 Amoun~ SubSec~ ~o Tax 1,70q.08 Tax Ra~e X .0~5 Pohang/al Tax Due 76.68 To insure proper credit to your account, tho (2) copies of this notice must accompany your payoent to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: Zf tax payments are mode Hithin three (3) months of the dacedant's date of death, you amy deduct a 5Z discount of tho tax due. Any inheritance tax due mill become delinquent nine Eg) months after the date of death. PART TAXPAYER RESPONSE A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills Hith tho copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of ~ ONE ~ ~ Hills and an official assessment Hill bo issued by the pA Department of Revenue. BLOCK B. ha above asset has been or Hill be reported and tax paid Hith the Pennsylvania Inheritance Tax return ONLY -- to be filed by the decadent's representative. C. [] The above information is incorrect and/or debts end deductions Hare paid by you. You oust cooplete PART [] and/er PART [] belcH. If you indicate a differen~ ~ax ra~e, please s~a~e your rela~/onsh/p ~o decadan~: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Da~e Established I PART TAX LTNE 2. Accoun~ Balance 2 3. Percen~ Taxable $ X q. Amoun~ SubSac~ ~o Tax q 5. Debts and Deductions $ - 6. Amoun~ Taxable 6 7. Tax Ra~a 7 X 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L/ne $ of Tax Compumat/on) Under panal~/as of perjury, I declare ~ha~ ~ha fac~s z have reported above ara ~rua, correc~ and COl~p. llil~:e ~:ck ~ha bas~: of my knowledge and belief. HOME ( ~/~ ) 7 [~-2q ~/ TAXPAYER S~G~ATURE ~ ~K ( ~"7 ) ~? - Z/J~ 7- ~-~ , ~LEPHONE NUMBER DATE GENERAL INFORHATION 1. FAILURE TO RESPOND NILL RESULT IN AN OFFICIAL TAX ASSESSNENT elth applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the dacedent's date of death. $. A joint account is taxable even though the decedent's name Nas added as a matter of convenience. q. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death ere fully taxable as transfers. S. Accounts established jointly betaeen husband and wife aero than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others ere taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the inforaation and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them aith your check for the amount of tax to the Register of Nills of the county indicated. The PA Department of Revenue mill issue an official assessment (Form REV-lS48 EX) upon receipt of the return from the Register of Nills. Z. BLOCK B - [f the asset specified on this notice has bean or will be reported and tax paid aith the Pennsylvania inheritance Tax Return filed by the decadent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, nept ZOO601, Harrisburg, PA lTIZB-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit thai with your check for the amount of tax payable to the Register of Nills of the county indicated. The PA Department of Revenue wiZZ issue an official assessment (Fora REV-1S4B EX) upon receipt of the return from the Register of Rills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after II/II/B2: Accounts which the decedent put in joint names within one (l) year of death ara taxable fully as transfers. Hoeever, there is an exclusion not to exceed $$,000 par transferee regardless of the value of the account or the number of accounts held, If a double asterisk (Ex) appears before your first name in the address portion of this notice, the S3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the data of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DTVIDED BY TOTAL NUMBER OF X lO0 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY ~ (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X log = 16.7Z (TAXABLE FOR EACH SURVIVOR) B.Tho percent taxable for assets created within one year of the decadent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): i DIVINED BY TOTAL NUMBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE OHNERS OR TRUST BENEFTCZARIES Example: Joint account registered in the name of the decedent and tad other persons and established within Dna year of death by the decedent. 1 DTVIDED BY Z (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 5. 6. The amount taxable (line 63 is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined baloa. Da~e of Death Spouse Lineal Sibling Collateral 07/01/9q ~o 12/$1/9q SZ 6Z 15Z 15Z 01/01/96 ~o 06/30/00 OX 6X 15X 15X 07/01/00 ~o preson~ OX q.SZ~ 12X mThe tax rate imposed on tho net value of transfers from a deceased child twenty-one 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 OZ. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children ahethar or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes al1 children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" ara defined as individuals abe have at least one parent in coaaon aith the decedent, ahethar by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART $ - DE~TS AND DEDUCTIONS CLAIMED Allo~able debts and deductions are determined as follo~s: A. You legally are responsible ~or payment, or ~e es~te subSect to adein[strat[on by a personal representative is insu~;icient to pay the deductible items. B. You actually paid the debts a~tar death o~ the decedent and can ~rn[sh proof of payment. C. Debts being claimed must be itemized ~ul[y Jn Part 5. Z~ additional space Js needed, use plain paper 8 l/Z" x 11". Proof of payment may be requested by the PA Department o~ Revenue. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND being duly eccordlng to law, deposes and says that he of the Estate of late of ............... , Cumberland County, Pa., deceased and that the within is an inventory made by , the said of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. and subscribed before me, 19 Executor - Administrator Address Date of Death Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, FiduclaHes Act of 1949. , Inventory of the real and personal estate of deceased RE'/-! r,0o COMMONWEALTH OF PENNSYLVARIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER L-o & COUNTY CODE YEAR NUMBER l""- Z LLI UJ Z 0 O DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL) GORCZYCA, STANLEY J JR. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 04/05/02 01/1 0117 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 116-01-3235 THIS RETURN MUST BE FILED BI DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER --]1, Odginal Retum [~4. Limited Estate E~6. Decedent Died Testate {A~d~ c~yof [--'~ 9, Litigation Proceeds Received ['~2. Supplemental Re~um E~4a, Future interest Compromise (~e o~(~ea~ ,~r ~42-~ ~7, ~n~ ~i~ined a LMng Trust (~ c~py o~ T~s~ ~10, S~al Pove~ Credit (~ ~ ~e~ 12-3t.91 ~d 1-1-95) r--] 3. Remainder Return {dae ~ deam p~ m 1243-82) [~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes J--'~ 11, Election to tax under Sec. 9113(A) (~ s~ o} NAME RICHARD GORCZYCA FIRM NAME (,~^~aue) TELEPHOI~IE NUMBER (717) 728-8941 1. Real Estate (Schedule A) (1) 2, Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4, MoC~gages & Notes Receivable (Schedule D) (4) 5, Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [-'~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)(10) 11, Total Deductions (total Lines 9 & t0) 12. Net Value of Estate (Line 8 minus Line 11) 13, 14, COMPLETE MAILING ADDRESS 1965 RANDALL ROAD ENOLA, PA 17025 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 7,99g.00.. 7,999.00 (11) (12) (13) (14) 7,999.00 7,999.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE 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 Ltne 14 taxable at lineal rate ................................... 7~___9~.9_;.0.0... x .o 45 (16) 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) 20. I'-'-I --L_~ II I I I 360.00 360.00 Decedent's Complete Address: STREET ADDRESS ' 1292 STRAFFORD RD CITYcAMP HILL I sIArEpA I ZIP 1701 1 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 360.00 360.00 360.00 To~al Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E, Penalty Total Interest/Penalty ( D + E ) (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT, Check box oo Page I Une 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is (he TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS IF THE ANSWER Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain lhe right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] ff death occurred after December 12, 1982, did deoedent transfer property wilhin one year of death wilhout receiving adequate consideration? .............................................................................................................. [] [] Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] Did decedent own an Individual Retirement Account, annuity, or other non-pmbete property which contains a beneticiary designation? ........................................................................................................................ [] TO ANY OF THE ABOVE OUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Dedaralion of preparer o0~r ~han ~ pemonal representative is based on all iniormation of ~ preparer has any knowledge. SIGNATURE OF P[H;tSON RE,~.PONSIDLE F,'I)R FILING RETURN DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rote imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S, §9116 (al {1.1) (iii. For dates of death on or after January 1, 1995, (he tax rate imposed on the net value of transfers to or for the use of (he surviving spouse is 0% [72 P.S. §9t16 (al (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 lax return am slill 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 (he net value of transfers from a deceased child tweniy-one 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% [72 PS, §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%, except as noted in 72 P,S. §9116(12) [72 P.S. §9116(a)(1)]. The tax rote imposed on (he net value of transfers to or for (he use of the decedenrs siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at leasl one parent in common with the decedenl, whether by blood or adoption. l ;': F. L'- !~':, '_,;, H - [ I:)1~. {_~; .~ ,~:,~ ['t'!¢ ESTATEOF ' ' ' GORCZYCA, STANLEY J JR. FILE' NUMBER 2002-00384 All real prope~ owned solely or as a tenar~ in common must be reported at fair market value, Fair marke~ value is delined as lhe price al which prope.y would be exchanged between a willing buyer and a willing seller, neither being compelled lo buy or sell, bo~h having reasonable knowledge of the relevant facts. Real prope~y which is Jointly-owned with right of survivorship must be disclosed on Schedule F. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 96400 1292 STRAFFORD RD., CAMP HILL, PA 17011 LESS APPRISAL ON ORGINIAL RETURN LESS COST TO REPLACE FLOORS, DOORS, KITCHEN COUNTER AND SINK, BATHROOM FIXTURES, REPAIR ROOF, AND SUMP PUMP LESS HOME INSPECTION LESS REAL ESTATE COMMISSION REAL ESTATE FEES OTHER SETTLEMENT FEES REAL ESTATE TAXES HOME WARRANTY & LAWN GRADING PLUS PAYMENT OF TAXES, SEWER, TRASH -76000 -4657 -196 -5784 -175 -1001 -830 -626 868 TOTAL (Also enler o~: line 1, Recapitulation) $ 7,999.00 (if more space is needed, i~serl addilbnal sheels of the same size} U. S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT T.A. of Harrisburg, LLP 4775 Linglestown Road Harrisburg, Pennsylvania 17112 717-671-6715 fax: 717-671-6718 B. TYPE OF LOAN 6. File Number: 7. Loan Number: HAR125-1394 8. Mortgage In~. Case No.: C. NO--ts furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked (p.o.c.) were ffaid outside the closing. They are shown her D · ~,. v eforinormational ur o · Borrower. ~; ~¢~ G. Basila _~ pur_~ ses and are not included in the totals. E. Seller: ~ _a: Stanley J. Gorczyca, Jr., Estate ~' M~bers Ist Federal Credit Onion F. Lender: ~ 5000 Louise DriV ~ Mechanicsburg, Penn~lvania 17055 1292 Stratford Road Lower Allen Twp, Cumberland County, Pennsylvania Lower Alien Township Lot 20, Highland Park, Book 5, Page 37 Cumberland Coun__t~,, Pennsylvania TiA' ofH~Sburg, LLP -- Place of Settlement: 4775Linglestown Road, Harfisbur~Ivania 17112 Dauphin Count__ August 23, 2002 G. Property: H. Settlement Agent: I. Settlement Date: J' SummarY of Borrower's Transaction 100. Gross AmoUn~ DUe From Borrower: I01. Contract Sales Price 102. Personal Prot?~y_ 103. Settlement Charges to Borrower (line 1400) Adjustments for Items Paid bY Seller in Advance -i06. ci/y / TOw. Z : County / Parish Taxes Aug 23, 2002 thru Dec 31, 107. 2002 108. School Taxes Au_t23, 2002.thru Jun 30, 2003 109. Sewer/Trash Aug 23, 2002 thru Sep 30, 2002 120. Gross Amount I~ue from Borrower: 200. Amounts Paid by or In Behalf of Borrower: 201. D_D_eEosit / Earnest Money 202. Princ~ipal Amo-Unt of New Loan 203. Existin Lo~ 204. 205. Adjustments foF~Items Unpaid by seller: 210. City / Tow. T~es 211. County / Parish Taxes 212. School Taxes 220. Total Paid by / for Borrower: K. Summary of Seller's Transaction 400. Gross Amount Due To Seller: 96,400.00 401. Contract Sales Price 402. Personal Pr~ 2,146.2~ 403. Adjustments for Items Paid by Seller in Advance: ~ / Town Taxes 115.68 407. C°unty / Parish Taxes Aug 23, 2002 thru Dec 31, 2002 115.68 723.57 408. School Taxes A_~ 23, 2002 thm Jun 30, 2003 723.57 28.61 409. Sewer/TrashAu~_g_23, 2002 thru Seo~30, 2002 420. Gross Amount Due to Seller: 97,267.86 9~ 28.61 I500. Reductions in _Amount Due to Seller: 2,000.00 ~ 501. 16,000.00 ~ ~off of First Mortgage to ~ort~e to ~ey Mortgage t-0- -~.. :~A~ItemsUnpaidb), Seller: -t 511. Countz 96,400.00 18,000.00 300, Cash at Settlement from/to Borrower: 301. Gross Amount due fi.om Borrower (line 120) 302. Less Amount Paid b_y/for Borrower ~ 99,414.11 18,000.00- 303. Cash From Borrower: $81,414.11 512. School Taxes 520· Total Reductions in Amount Due - Seller: 10,416.23 600. Cash at Settlement to / from Seller: 601. Gross Amount due to Seller (line 4~ 97,267.86 , 602. Less Reductions Amount due Seller (lin~e~5_2_0_) 1_0,4_1_6.23 603. Cash To Seller: $86,851.63 .I have carefully review,.t ~,e HUD. 1 Settlement Statement and to the best of my knowledge and belief, it is a tree a~nd ac:c~rate statem disbursements made o~la~ount or_J:game.~s transaction. I further ceni~, a,o, ~ ~. .............. ent of all receipts and Rich~G. Ba~ila · Seller: ~-~ ~'~C ~4'7"d ~ The HUD-I Settlement Statement which I have.prepared is a true and accurate account &this transaction. I have caused or will cause the funds to be disbursed in accordance with this~.t_~ment. ~ / . Se lement A ent: n O_.o..' rate: August 23, 2002 be o h C. ;cian- File No.: HARI25-1394 WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon TA K225417 include a fine or imprisorraent. For details see: Title 18 U.S. Code Section 1001 and Section 1010. conviction can HUD-1 July 2001 August 23, 2002 8:56 AM OMB No. 2502-0265 RESPA handbook 4305.2 ;ent Date:August 23,2002 Settlement Charges ~/ 701. 5,784100 to RF_JMAX Realty Professionals 702. 703. Commission Paid at Settlement 704. Deed Preparation to RFatlVIAX Real__~ Professionals 705~on/Proces_sin_, Fee t0.RF, fM~..A??eal__ Professionals 801. Loan Origination Fee. to Members 1st F~_e~al Credit Union 802. Loan Discount to Members 1st F~__oval Credit Union 803. Appraisal Fee to Members 1st F~eval Credit Union 804. Credit R~12ort to Merabers 1st Federal Credit Union 805. Lender's In~eetion Fee 806. Mortgage Insurance Application Fee 807. Assumption Fee · 808. Tax Service Contract Fee 809. Flood Certification 810. Document Preparatiofi 900, Items Required l~Y Lend~ t°'*be Paid in Advanee: 901. interest fi'°n~ AUg 2~,i2002 tO Sep 1, 2002 ~ 0.0000 / day 902. Mortgage InsuranceiPrcnfium 903. I-l_~a~d Insurance ?i~iv, ium 904. Flood Insurance F~ 1000: Re%~es DePOrted ~ Lender: 1001. I-lazard Insurance 1002. Mortgage Insurance 1003. City Property Taxes 1004. County Property Tax es 1005. School Taxes I100~ :Title: Ch~,~es: :: ~ 1101. Settlement or C185ing Fee 1102. Absh-act or Title Search 1103. Title Examination. 1104. Title Insurance B;nder 1105. Document PrepaLation 1106. Notary Fees to Deborah K. Bocian 1107. Attorney Fees (includes above item numbers: 1108. Title Insurance to T.A. of Harrisburg, LLP (includes abc,~e item numbers: 1101-1104 I 109. Lenders Coverage 16,000.00 Risk Premium 0.00 1110. Owner's Covera~.e 96,400.00 Risk Premium 840.75 1111. Endo~f~ents: 1~0, 300, 8.1 to T.A. of Harrisburg, LLP 1112. Closing Service Letter 1113 Overnight - pkg~' o T A. Title Insurance Company ~nn rnment RecOral~and Transfer Charges: 1201. Recording Fees: Deed 28.50 Mortgage 57.50 Releases 0.00 1202. City/County tax'stamps: Deed 964.00 Mortgage 0.00 1203. State tax/stamp~:__ Deed 964.00 Mortgage 0.00 1204. 1205. 1300~: Addifion~iS~ttl~m~nt?~k .rges: i~ 1301. Surve~ ;" 1302. Pest Inspection! ~ 1303. 2002/03 School~Taxes to Bonnie K. Miller 1304. Inheritance Tax Escrow to T.A. of Harrisburg, LLP 1305. Escrow Fee to: T.A. of Harrisburg, LLP 1306. Home Warranty to AHS 1307. Lawn to Stephen Leibich 1400. T°tal Settlement charg~~nter 0n line 103' Section J and line 502, Section K) Borrower Initials:~hard G. Basila Seller Initials: t ~ 6- Stanley $. Gorczyca, Jr., ' ' Estate File Number: HAR125-1394 TA K22541 Paid from Borrower's Funds at Settlement 75.00 Paid from Seller'! Fund~ a Settlemen 5,784.0t 100.0~ 15.00 840.75 150.00 15.50 86.00 9~ 964.00t $2,146,25 $10,41~ HUD-1 July 2001 August 23, 2002 8:~6 AM OMB No. 250: RESPA handbook \ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CONHONHEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-15~7 EX AFP ¢01-02) R/CHARD GORCZYCA 1965 RANDALL RD ENOLA ~* PA 17025 DATE 08-19-2002 ESTATE OF $ORCZYCA JR DATE OF DEATH 04-05-2002 FILE NUHBER 21 02-0584 COUNTY CUHBERLAND ACN 101 Aaount ReaLtted STANLEY J HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF NTLLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LZNE ~-- RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF GORCZYCA JR STANLEY J FZLE NO. 21 02-0384 ACN 101 DATE 08-19-2002 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/PartnershLp Interest (Schedule C) ($) 4. Hortgeges/Notas Receivable (Schedule D) (4) 5. Cash/Bank Deposlts/Nisc. Personal Property (Schedule E) (5) 6. JoLntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Costs/Niso. Expanses (Schedule H) (9) 10. Debts/Nortgaga Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return 76/000.00 31/333.60 .00 .00 Zi779.Z0 .00 .00 (8) 5,994.91 208.10 (11) (12) 13. 14. NOTE: CharLtable/Governaental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Nat Value of Estate SubSact to Tax (14) Zf an assessment Has issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Aaount of Line 14 at Spousal rata 16. Aaount of Line 14 taxable at Lineal/Class A rata 17. Aaount of Line 14 at Sibling rata 18. Amount of Line 14 taxable at Collateral/Class B rata 19. PrLncipal Tax Due TAX CREDITS: PAYHENT ' RECEIPI DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) 07-03-Z002 CD001574 236.05 NOTE: To insure proper cred/t to your account, suba/t the upper portion of this for; wi~h your tax payment. 111,112.80 104,909.79 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. .00 104,909.79 18 and 19 (15) .00 X O0 = .00 (16) 104,909.79 X 045= 4,720 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= 4,720.94 ANOUNT PAID 4,484.89 TOTAL TAX CREDIT 4,720.94 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( 1F TOTAL DUE IS LESS THAN $1, NO PAYNENT 1S REQUIRED. ZF TOTAL DUE IS REFLECTED AS A 'CRED/T' {CR}, YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001 560 GORCZYCA RICHARD J 1965 RANDALL ROAD ENOLA, PA 17025 fold ESTATE INFORMATION: SSN: 116-01-3235 FILE NUMBER: 2102-0384 DECEDENT NAME: GORCZYCA STANLEY J JR DATE OF PAYMENT: 08/26/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/05/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $360.00 TOTAL AMOUNT PAID: 9360.00 REMARKS: RICHARD J GORCZYCA SEAL CHECK#0213 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDiViDUAL TAXES INHERITANCE TAX DIVISION DEPT, 280601 HARRISBURG, PA 17128-D601 RICHARD GORCZYCA 1965 RANDALL RD ENOLA COHHONNEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT~ ALLO#ANCE OR DZSALLO#ANCE OF DEDUCT/ONS AND ASSESSNENT OF TAX REV-16117 EX AFP (01-02) PA 17.025 DATE 09-23-2002 ESTATE OF GORCZYCA JR DATE OF DEATH 04-05-2002 FiLE NUHBER 21 02-0384 COUNTY CUMBERLAND ACN 101 I Amount Remitted STANLEY J HAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS L/NE ~ RETAIN LONER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF GORCZYCA JR STANLEY J FiLE NO. 21 02-0384 ACN 101 DATE 09-23-2002 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE iNTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A} (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership interest (Schedule C) ($) q. Nortgeges/Notes Receivable (Schedule D) (~) 5. Cash/Bank Deposits/Nisc. Personal Property (Schedule E} ($) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expensas/Adm. Cos~s/Nisc. Expanses (Schedule H) (9) 10. Deb~s/Nor~gage Liabilities/Liens (Schedule I) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn NO. 01 7,999.00 O0 O0 O0 O0 O0 O0 (8) .00 .00 (11) (12) 15. lq. NOTE: ASSESSMENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal re~e 16. Amount of Line lq ~axable a~ Lineal/Class A ra~e 17. Amount of Line 1~ a~ Sibling rate 16. Amount of Line Xq ~axabla a~ Colla~eraX/Class B ra~e 19. PrincipaX Tax Due TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) 07-05-2002 CD001374 236.05 08-26-Z002 CD001560 .00 Charitable/Governmental Bequests; Non-elected 911:3 Trusts (Schedule J) Nat Value of Estate Subjec~ ~o Tax ]:f an assessment ~as issued prev/ously, 1/nes 1~, 15 and/or reflect flgures that include the total of ALL returns assessed to date. IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~hls form w1~h your tax payment. 4,484.89 360.00 ANOUNT PAID (15) .00 x O0 = .00 (16) 112,908.79 x 045= 5,080.94 (17) .00 X 12 = .00 (].S) .00 X 15 = .00 (].9)= 5,080 TOTAL TAX CREDIT BALANCE OF TAX DUE iNTEREST AND PEN. TOTAL DUE 5,080.94 .00 .00 .00 ( ZF TOTAL DUE KS LESS THAN $1, NO PAYHENT KS REqUiRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SiDE OF THiS FORN FOR iNSTRUCTiONS.) 7,999.00 .00 7,999.00 (].:3) . O0 (lq) 112,908.79 16, 17, 18 and 19 will