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HomeMy WebLinkAbout01-0027 REt-151){'EX 16.00J, w ,.., ~~~ <.>..<.> Woo "'",-, <.>..", .. .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY G INHERITANCE TAX RETURN RESIDENT DECEDENT ~_ /)00______ ~_____ FILE NUMBER &L-CL 000;;1,'1- COUNTY CODE YEAR - NUMBER"':' - SOCIAL SECURITY NUMBER 116 34 I- Z W C W (,) W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) D'Angelo, Quirino DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) December 16, 2000 January 27, 1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A [] 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate ("\\am copy 01 Will) o 9. Litigation Proceeds Received 7463 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-62) o 7. Decedenl Maintained a living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (dateoldeatl1 between 12-31-91 and 1-1-95) o 3. Remainder Return (date 01 death prior to 12-13-(2) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax. under Sec. 9113(A} (Attach Sch 0) 1. Real Estate (Schedule A) (1) 87.000 2. Stocks and Bonds (Schedule B) (2) Nnn~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1,000 Z (Schedule E) 138,778 0 Jointly Owned Property (Schedule F) (6) ~ 6. o Separate Billing Requested None ::l 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) I- (Schedule G or L) 0:: Total Gross Assets (total Lines 1-7) <( B. (,) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,454 W ~ Debts of Decedent, Mortgage liabilities, & Liens (Schedule 1) (10) None 10. 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) ,.., z w o z o .. '" w '" '" o <.> NAME David W. Knauer, Esquire COMPLETE MAILING ADDRESS 411A East Main Mechanicsburg, street PA 17055 OFFICIAL USE ONLY ~~ . " ~ ~X' d ~" N --.. 5:':; ;'""::1 \Ji :~J ;:f1 --J (8) 226.778 (11) 14,454 (12) 212.324 (13) None (14) 212,324 13. Charitable and Governmental Bequests/See 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 212,324 x.O_ (15) 45 9,555 x.O_ (16) x .12 (17) x .15 (18) (19) 9,555 FIRM NAME (II Applicable) TELEPHONE NUMBER 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT z o ~ I-' ::l ll. == o (,) ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 20.0 Decedent's Complete Address: STREET ADDRESS 821 North Walnut Street Mechanicsburn. PA 17055 CITY I STATE I ZIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditsJPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 9,555 None Total Credits (A+ B+ C) (2) 3. InteresUPenalty ~ applicable D.lnterest E. Penalty 4.00 TotallnteresVPenalty ( D + E ) (3) 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 (4) 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. (5) (SA) 9,555 4 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 9,559 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......... ......................... .......................... 0 b. retain the right to designate who shall use the property transferred or its income;.. ................ .................... 0 c. retain a reversionary interest; or..w..... ............................. ... 0 d. receive the promise for life of either payments, benefits or care? ................ ..."...................... ................ 0 2. If death occurred after December 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? 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...... ...............". ...................'" ............................... No lQI: U lQI: lQI: U lQI: .... 0 lQI: 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 lhal J have €.llamined lhis return, including accompanying SChedules and statements, and to the best of my knowledge and belief. it is lme, correct and complete Declaration of preparer other Ihan the personal representative is bas €d on all information of which preparer has any knowledge. ADDRESS 411A East Main Street. Mechanicsburq. PA 17055 OJu 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 Dr for the use of the surviving spouse is 3% [72 P.S. 99116 la) (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. 991t8 (a) (1.1) (Ii)]. The statute does not exemDt 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 Juiy 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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(I)]. 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. 99116(a)(I.3)]. A sibling is defined, under Seclion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. C",''''''''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Quirino D'Angelo FILE NUMBER 2001;:'00027 All real property owned solely or as a tenant in common must bf, reported at fair market value. Fair marKet ....alue 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 survivorshiD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 821 North Walnut street, PA 17055 (Tax parcel No. Mechanicsburg 18-22-0519-339) $ 87,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 87, 000. 00 (If more space is needed, insert additional sheets of the same size) REV-1508EX.(1-97) '*' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Quirino D'Angelo FILE NUMBER 2001-00027 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 Sch9dule F, ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Home Furnishings $500 2 Jewelry $500 TOTAL (Also enter on line 5, Recapitulation) $1, 000 (If more space is needed, insert additional sheets of the same size) REV"""'''.''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Quirino D'Angelo SCHEDULE F JOINTL Y.OWNED PROPERTY FILE NUMBER 2001-00027 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELAT10NSH1P TO DECEDENT A. Santina Peterson 3503 Beech Run Lane, Mechanicsburg PA 17050 Daughter . B. c. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY . %0' DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for iointly-held real estate. VALUE OF ASSET lNTEREST DECEDENT'S INTEREST 1. A. 5/95 Mellon Bank Acct # 100020329 1'1,.38<l.:Z2 50 5,692.11 A Mellon Bank; SD Box# 014-0015413 30,012.00 50 15,006.00 A 4/00 Mellon Bank CD # 1036513 35,196.22 50 17,598.11 A 5/00 Mellon Bank CD # 14-A49013 70,000.00 50 35,000.00 A 10/99 Mellon CD # 00770009 10,629.92 50 5,314.96 A 8/92 PNC Bank CD # 31900164443 120,334.43 50 60,167.22 138,778.40 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) '''';5''''.''.'71'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DEe DENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Quirino D'Angelo FILE NUMBER 2001-00027 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers Funeral Home, Inc $7,135.00 B. ADMINISTRATIVE COSTS: 1. Persona! Represelltati'Je's Commissions Name of Personal Representative (5) Santina Peterson Social Security Number(s) I EIN Number of PelSona, Representative(s) Street Address 3503 Beech Run Lane City Mechanicsburq StatePA Zip 17050 Yea~s) Commission Paid: Murrel R. Walters, III, Esquire $180.00 2. Attorney Fees D . d W. Knauer, Esquire $6,670.00 av~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) N/A Claimant Street Address City Stale Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills $229.00 Inheritance tax filing fee $ 15.00 5. Accountant's Fees None 6. Tax Return Preparer's Fees Included in Attbrney Fees Advertising - Cumberland County Law Journal $75.00 7. The Sentinel $84.11 8. HAFN Reporting Service, Inc. Deposition $65.93 transcripts TOTAL (Also enter on line 9, Recapitulation) $14,454.04 (If more space is needed, insert additional sheets of the same size) """"'."0"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Quirino D'Angelo FILE NUMBER 2001-00027 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Sarah Peterson Grandchild $10,000.00 2 Clifford Peterson Grandchild $10,000.00 3. Santina Peterson Daughter Remainder of estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Knauer & Associates, LSC Attorneys-at-Law 411A. East Main Street, Mechanicsburg, PA 17055 Telephone: (717) 795-7790 Fax: (717) 795-7793 Email: knauer@earlv.com David W. Knauer March 14, 2002 Mrs. Santina Peterson 3503 Beech Run Lane Mechanicsburg, PA 17050 RE: Estate ofOuirino D' Angelo Dear Mrs. Peterson: As you are aware, this office has been retained by the Estate of Quirino D' Angelo to represent it in all matters arising during its probate. In that capacity, you are named as a beneficiary under Mr. D'Angelo's Last Will and Testament and, when probate is concluded, will receive your bequest of the rest, residue an remainder of his estate after payment of specific bequests to your son and daughter that are in the amount of$IO,OOO each, the payment of the Pennsylvania Inheritance Tax, and other costs of administration. This letter serves as an official notice of your being named as one of the Estate's beneficiaries. When probate is concluded, I will send another document, a Release, to you for your review and execution so that I can then send your bequest. If you have any questions as to this, please feel free to contact me. Very truly yours, D~~~~ DWK:bm \company\d' angelo\03-14-02\Peterson.ltr Knauer & Associates, LSC Attorneys-at-Law 411A. East Main Street, Mechanicsburg, PA 17055 Telephone: (717) 795-7790 Fax: (717) 795-7793 Email: knauer@earlv.com David W. Knauer March 14,2002 Clifford Peterson 3503 Beech Run Lane Mechanicsburg, P A 17050 RE: Estate ofOuirino D'Angelo Dear Mr. Peterson: As you are aware, this office has been retained by the Estate of Quirino D' Angelo to represent it in all matters arising during its probate. In that capacity, you are named as a beneficiary under Mr. D'Angelo's Last Will and Testament. In that Last Will & Testament, Mr. D'Angelo made a $10,000 bequest to you. Your mother, the Executrix of Mr. D'Angelo's estate, has informed me that she made a $2,000 payment to you on that bequest. Consequently, when probate is concluded, you will receive $8,000, the balance of the bequest. This letter serves as an official notice of your being named as one of the Estate's beneficiaries. When probate is concluded, I will send another document, a Release, for your review and execution so that I can then send your bequest. If you have any questions as to this, please feel free to contact me. ?r~YO~p . t2~auerfXJ'Ml/ DWK:bm \company\d' angelo\03-14-02\Clifford.ltr Knauer & Associates, LSC Attorneys-at-Law 411A. East Main Street, Mechanicsburg, PA 17055 Telephone: (717) 795.7790 Fax: (717) 795.7793 Emaii: knauer@earlv.com David W. Knauer March 14,2002 Miss Sarah Peterson 3503 Beech Run Lane Mechanicsburg, P A 17050 RE: Estate ofOuirino D'Angelo Dear Miss Peterson: As you are aware, this office has been retained by the Estate of Quirino D' Angelo to represent it in all matters arising during its probate. In that capacity, you are named as a beneficiary under Mr. D'Angelo's Last Will and Testament. In that Last Will & Testament, Mr. D'Angelo made a $10,000 bequest to you. Your mother, the Executrix of Mr. D'Angelo's estate, has informed me that she made a $2,000 payment to you on that bequest. Consequently, when probate is concluded, you will receive $8,000, the balance of the bequest. This letter serves as an official notice of your being named as one of the Estate's beneficiaries. When probate is concluded, I will send another document, a Release, for your review and execution so that I can then send your bequest. If you have any questions as to this, please feel free to contact me. Very truly yours, 2iw~~j~~ DWK:bm \company\d' angelo \03 -14-02\Sarah.l tr JRD/June30,1992117858 JAN 1 2 2005 d./ '1 In Re: Estate of Quirino D'Angelo Late of Mechanicsburg Borough ORPHANS' COURT DIVISION COURT OF CONUWONPLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-01-0027 NO. 21-01-0027 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Santina Peterson Counsel for Personal Representative: None Date of Decedent's Death: 12/16/2000 Date of Delinquency Notice: 01/10/2005 The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on November 10, 2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 01113/2005 ~ Glenda Famer Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Estate File %oJt&... 4-, 2405 q;ool\M A hearing is scheduled for at in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. cft\ G'd STATUS REPORTlJNDER RULE 6.12 Na.'l1e ofDecedent: Q fA 114 ; /Va [Y (J,/ilCJi../{J 'I) J r7 Date ofDeath: 7V;r ~ c 'i:: "-" bin. I ( lOuD '\~fto.ft hi ;}.J-i)/-(}d:!-7 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State &ther administration of the estate is complete: Yes ~ No 0 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. I is Yes, state the following: a. Did the personal ~esentative file a final account with the CoUrt? Yes _ No !Xl b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal~resentative s. tate an account informally to the parties in interest? Yes JA;! No 0 c. Copies or receipts, releases, joinders and approval of rormal or informal accounts may be filed '\'Vith the Clerk of the Orphans' Court and may be attached to thisft,rt.. V U tUvQ LJ, (xrtovWf Signature J)/1-lIl(~ {j KIifA fA. ~~ ,fk1, Nmne / ( . Date: I/t-f.las C,_ f\ ,/ AA )'. /v1 I I /) !.Ii /11 (:: f v ItA,; /'v,\t 't. <: ~)/; r ~ ";)&'./'>1 ('~ . Address j U J7u S'l (7 J7 ')7'1S- 77tf() Telephone No. ;""'-- Capacity: g Person21 Representative ~ Counsel for personal representative ~ SE1>O-GEl.-l.ll. ~ad E!'uJ~ues dEO:Gl SO SG u"r Estate of Quirino D' Anqelo also known as PETITION FOR PROBATE and GRANT OF LETTERS No. ,;}./ - 0 I - ~? To: Register of Wills for the Deceased. County of ~llmhprl ;:\nn in the Social Security No. 11 6 - 3 4 - 7 463 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 rix in the last will of the above decedent, dated March 9 and codicil(s) dated named , 198R- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiCiled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at 821 Walnut street, Meehan; c~hllrg PA 17055 .- (list street, number and muncipality) Decendent, then 78 years of age, died December 1 6 j2 00 0 at R?1 w;:\lnllt strppt. Mp("h;:\n;("c::hllr'J, PJ\ 17055 Except as follows, decedent did not 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 Pennsy]v::lni,\ situated as follows: Borough of $ 2,000 00 $ $ $ 85,000.00 MQ'Chanic5iburg, Pennsvl vania WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentarv' theron. (testamentary; administration C.La.; administration d.b.n.c.La.) '" or ~ ~ i~ J;~~~ o::~ -g.g <0:1'= ~" ~Q. " '- ;:; 0 <Ii c "" Vi r~~ 3503 Beech Run Lane Mechanicsb'lP], PA 17055 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF CUMBERLAND J 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 petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirm. ed and subscribed { .s<P~~ t:Y f~~ en before me this 5th day of ~. J~!AB.Y n2!lO..L :? , rn c. U-tA ~ /& -a~ ~~. . j) B.~egiSler :s: N 21-01- 27 o. Estate of QUIRINO D'ANGELO , Deceased DECREE OF PROBATE AND GRANT OF LETTERS 20011 AND NOW JANUARY 9 ~, 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 03-09-1988 described therein be admitted to probate and filed of record as the last will of QUIRION D'ANGELO and Letters TESTAMENTARY are hereby granted to SANTINA PETERSON ~~ C-. ~ nRj)fJ\}'f\ \ Register of vlills FEES Probate, Letters, Etc. ......... $ Short Certificates( l).......... $ Renunciation ................ $ x-pages $ JCP TOTAL _ $ 229~88 Filed......... ~1W~. .~,.~99.1............. 200.00 lS.00 A TIORNEY (Sup. Ct. J.D. No.) 9.00 ADDRESS PHONE lat the information here given is correctly copied from an original certificate of death d\}ly filed with me as ,Ie original certificate will be forwarded to the State Vital Records Office for permanent filing. 21-01-27 WARNING: It is illegal to duplicate this copy by photostat or photograph. ,r this certificate, $2.00 f""llf"""''''''", ",""I"~~\.\" OF PEl----_.,. /\$-~4'~"\ t~~~ ~\ ~-I ". I~~ ...--== - - - -~ ~t::) ~- -;::: ~ e,..) _11;_,_ -~~ ~ ' . .~ ~ _ l ~ >.*~.~....". 'J*~ - <:;:2'-.' /~ ~ "\,,- ~ '. 1SS 1/' -".1',?,. _,~\.\-,I" . ~.,.,~ 'MEN11.\~'\' ,......,. """""'##1111111",,'1 p 6987621 No. ~L/J~~ 1{~.I0A~./ULTI Local Registrar 0 r J.9!u J2~LA. / 'I, 01 () 00 f Date H1U5 04JHev 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TVPEJPRINT 'N PERWANfNT BLACK INK SlAn FilE :'illM8ER NA"E ofoTcEOENiI'""-,,,~'Wl---- -~~;~.~o - ~'~;~eIO---=~~--"-' ----, ~EX'-~ale'-r:A; ~~UR:NUM~~ _ --- 7 463 '--'~:c:~~~r1-6, -2~;---- AGE 'LaS! B....tlOay) UNDER 1 YEAR UNDER 1 01<< GATE OF BIRTH BIRTHPLACE ie,ly;v.d PlACE ~ DEATH lCt><<:1t Oflly <)(>e -- __ ,nSlfuclul"J oname_ ':I...., MontNi Dill.,. !-tow. MlOui;;" MOfllh nay "eall 31ale ()( fCU.'1tJI1 Counuvl HOSPITAL 0 - - 78 y" Jan 27 1922 Abruzzi, Italy, ,...,_,0 ='~IO $. . I 1 ... COUN!'Y OF DERH CITY, BORa. TWP OF DEATH FACilITY NAME (II no! ,n!.NuhOO. gIve slrHt and oumbell RACE. Am.nean IndiAn, B&ack, Whil.. etc;: IS~I .... Cumberland Mechanicsburg ~s DECEDENT EVER IN US NUllED FORCES? y.. 0 No 5l ... KIND Of BUSINESS/INOUSTRY DECEOENl'S USUAL OCCUPAlION '~t'::~~k;;';'~~~r~ .... Cook ".. DECEDENT'S MAILING ADDRESS lSt,eet C~f1Own, s.... ZlpCodel Restaurant DECEDENT'S ACTUAl RESIDENCE lSeelfl5ltUCllOOli OI'lOlflmSldeI '0. White MARITAL STATUS. Mar-ned He."..- M..-Ied, Ww:eow.d. DNorced (Specly) Widowed SURV1VlNG SPOUSE (II '.,., "... ~ OAme, 14. l7c.O _.dIIcedenllNedin 821 Walnut Street Mechanicsburg, Pa. 17055 17b. Coun ();d - llwiina Cumberland -' "..[1:....00::,,";:::'.. MOTHER'S NAME ,Fur:. ....,ddIe. ....Oildeo Suman...) "....- 17.. Slale ". fNHER'S NA....E iFIIU. M.adIe, last) Vincenzo D'Angelo Santina Peterson ,., INFORMANT'S NAME (l ypaiPrlfll) z w ;:: ~ o (; w > ~ z Dec 21,2000 2le. lICENSE NUMeER FD-014318.L 24. 11 :00 A.M. " 20 December 16, 2000 27. MItT I; En'.' 1M olseases, injuries 01 complM:ahon5 whic-h causedlhe dealh 00 not enle, lhe mode 01 dyrng, such as ca'cSIaco, ,espo,aIOfy a"8sl, shock or heart lallur. llSl only ON CilUWOfl eachlWle /) , .----I.LQL,t..t..4 .LV<-, L, -'jO( '.r"L,s..L____L k. ~ DUE IDtOR AS A CONSEOUENCE Of): ~ b l.f..-..--ll ~~~~",...i'!..,,_--.--.dL 4-~,,-< t DUE 10 lOA AS A CONSEQUENCE OfJ.' c.~__~_.~.~ ________. __.__.~ DUE TO(OO AS A CONSlOUENCE OF) d.. ,_ __ ._.0 _ __. _. . .. ._.. . ..._... _ ....._ .._ '" WEAE AUTOPSY FINDINGS - ....ANNEH Of OEATH AVAILABlE PRMJR TO COtolPLETION OF CAUSE OF OERH7 DATE OF INJURY (Uoolh,Oay.'fI8afl - Mechanicsburq Unknown SI. John's Cemetery NAME AND AOORESS OF fACILITY Camp Hill, Pennsylvania 17011 22c. ORE SIGHED (Morel. Day, 'lUll 23b. 23c:. ~S CASE REFERRED to MEOtCAl EXAMINERlCORONER? ....0 lICENSE NUMBER 20. I ApproJlIII\aI. linlI........~ : onMI and dHItl , : ...0: PART I: Other ~ c:oncMIona oonlrtbuling 10 ~.In, bull nlIll'MUIing in 1M ~ ca.- grwiWllf'l PART I ~-- TIME Of INJURY INJURY AT WOftK1 DESCAI8E HOW INJURY OCCURAE.O Accld801 Pending In'4sllgilllon o o o PLACE Of INJURY. AI hom..I..r~~;e...lilCtOfY, ottica buikIinQ.etc:,ISpeclIV\ 300. NallM'al LX o [] Couki not be detetmlned Homocide No L-::Ix y.. 0 -... ...q 2... 2Ib. 29. URTlfJEA ICt'ecll 001'1' Of\e) ,. . . .CERTIFYING PHYSICIAN (PhySICldfl u""ly.ng C.aU5e 01 "'edll'l .....nefl J"OIh~' ot'~!)>L"ull'ld:i PfOflOU1'ICt!O ue..lt1 aoac\-.npl(:ltKI Item23l To 1M be., 01 mr knowMOIjte, death occurred dull so the cau.e(ll.lnd mann.r... II.ted, . PRONOUNCING AND CERTifYING PHYSICIAN IPt'r!i.lCliirl llI!rt: ;)':)jluu,K;,ng <JoJdlt1 dlld <.:ert"I"nq 10 l,;3U:;<l! or aedrt,) To Ih. ~t ot my knowledge, deAlh occ""ed .'!he Urne, d.le,.nd piKe, And due 10 the c."....) and mantle'" ,I.ted ...EDICAL EXAMINER/CORONER On Ihe b..i. ot ..aminallon and/or inyestlgation, in my opinion, death occurred at the time, da.e, and place. i1nd due 10 the cause(s) and manner a. 'tilted.. ..,. ...",.....,...,...,..................... ... ,. ".............,..... ........ '" 1-:lli ~^II ~I .... 0 NoD o ".. .__ LICENSE NUM DATE SkJNEO tMo...... ea.... Veatl 0",. Me nQi,._.b..,__ ".. f1,hcJ.U~~___. NAME AND AOORESSfJF PERSON WHOCOMPlETEO....cAUSE Of DEATH jl1em271TVP8orPnnl ~ 7OrCJ,/~ o 2:;;? /loV./"e Av-C. J2 _ e<'i<!l-4 /Ii //, ,I'd /7~. DAlE t-llEO(MOtIIh Oav. 'Na', , ", ,;D-c' (' <?,,; j ~ .v /7;.,,{' <J 0 c> \, /b-~-.;y BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-16D7 EX AFP <01-05) DAVID W KNAUER ESQ KNAUER 8 ASSOCS 411A E MAIN ST MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2003 DANGELO 12-16-2000 21 01-0027 CUMBERLAND 101 QUIRINO Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6'ifj-EX--AFP--foY--03Y------...--iNHERiYANCE--TA)CSTAYEME-N'T-'(fF'-Accoui.ff--...---------------- - - --- ESTATE OF DANGELO QUIRINO FILE NO.21 01-0027 ACN 101 DATE 01-21-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-01-2002 P R I NC I PAL TAX DUE: .......................................................................................................................................................................................................................... 9,555.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-15-2002 CDOO0956 4.00- 9,559.00 11-22-2002 CDOO1881 362.13- 362.13 TOTAL TAX CREDIT 9,555.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) L, STATUS REPORT UNDER RULE 6.12 Name of Decedent:~ U(~;,v3 Date of Death: !J-/rc,(hJu, OJ (()~ Will No. Admin. No -(;2/ -0 I - :J-7 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether ~gministration of the estate is complete: Yes NO-X- 2. If the answer is No, state when the personal representative rea80nanlY ~lieves that the administration will be , c9mplete: ~ -/7-M. opfVJs.~ f:.'f'iM 'AIf 0# ('0.<ift%/ +, ()u of fR-.f - ,--x?..14 Si~( t- o..,;'CJ../,MS'/ c'9-c ~:-dVvt 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 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 m~ ~;;a~h)edJ:; this report. Date:~(P-7( D( ( bu ~_ ~ Mgnature I ~ ( '1/.,. vtU \0 0. {'-I!/t.. 4- l/l- ame (Please type or P7int), (? rW /I- f; Joe;.- Sf, I~ltlwv\ dJ0}-j . /- Address L/ ! rJJ7) .~q[;'- 7'710 Te 1. No. (MAH:rmf/AM3) Capacity: Personal Representative )< Counsel for personal representative July 9, 2001 Santina Peterson 3503 Beech Run Lane Mechanicsburg, PA 17055 IN RE: ESTATE OF QUIRINO D'ANGELO Failure to File Certification Dear Ms. Peterson: A hearing was set for July 6, 2001, at 9:30 a.m., in the Courthouse in Carlisle, at which you failed to appear. The certification must be filed in the office of Register of Wills. We must hear from you within twenty-four hours; please phone Donna in the Register of Wills office at 240-6409, if you have any questions. Sincerely, Sandra S. Gobrecht, Secretary Judge Hoffer's Chambers JRD/June 30, 1992/17858 In Re: Estate of Quirino D'Angelo Late of Mechanicsburg Borough ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-01-27 NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: Santina Peterson Counsel for Personal Representative: Date of Grant of Original Letters: January 8, 2001 Date of Delinquency Notice: April 18,2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on April 9,2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Distribution: Personal Representative Counsel for Personal Representative Estate File Date: May 25, 2001 A hearing is scheduled for~~ ~;j.O in Courtroom No.3. If the Certification of Notice is filed prior to the hearing d~e, {he hearing will automatically be c el d. ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NmneofDeeooent ~ ))I~ Date of Death: _( d-. - (b - d-(J7TO Will No. Admin. No. d-{ -0 (-d-'7 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 NC (J4~ ~)!JV ~~ f?~~AU)/ Address )5"43 ) 50 '3 &ic1)d~~~~)Q & ffef,-- !2wv~ 4r~IC'ilvJ) Notice has now been given to all persons entitled thereto under Rule 5.6(a) except MIllL- Da'ell~ 1/ Z-t4' Qwl /J ;;;:;~ Signature Name ~({ .bJ I ~ Address 3l' AS-. {Y)A1f\J 5T JnedM~-- ItA- 17 oSr TelephonQtl ~ _ 171 C/ Capacity: _ Personal Representative 4Counsel for personal representative , JRD/June 30, 1992/17858 In Re: Estate of Quirino D'Angelo Late of Mechanicsburg Borough ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-01-27 NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: Santina Peterson Counsel for Personal Representative: Date of Grant of Original Letters: January 8, 2001 Date of Delinquency Notice: April 18,2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on April 9,2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: May 25, 2001 ( Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for~~ ~;;o in Courtroom No.3. If the Certification of Notice is filed prior to the hearing dite,~he hearing will automatically be c el d. t\L {~..(LQ dL <6 - \ -C) I CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: QUIRINO D'ANGELO Date of Death: December 16.2000 Will No. 2001-00027 Admin. No. To the Register: I certify that notice of beneficial interest 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 March 14. 2002 Name Address Santina Peterson. 3503 Beech Run Lane. Mechanicsburg. PA 17050 Sarah Peterson. 3503 Beech Run Lane. Mechanicsburg. PA 17050 Clifford Peterson. 3503 Beech Run Lane. Mechanicsburg. PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except Date: March 14. 2002 !f~(L4r I~ Signature Name: David W. Knauer Address: 411A E. Main Street Mechanicsburg. PA 17055 Telephone: (717) 795-7790 Capacity: _ Personal Representative ~ Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128.0601 REV.1162 EX(11.961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DAVID W KNAUER ESQUIRE 411 A EAST MAIN STREET MECHANICSBURG, PA 17055 ----~--- fold ESTATE INFORMATION: SSN: 116-34.7463 FILE NUMBER: 2101-0027 DECEDENT NAME: D'ANGELO QUIRINO DATE OF PAYMENT: 03/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/16/2000 NO. CD 000956 ACN ASSESSMENT CONTROL NUMBER AMOUNT I 101 I $9,559.00 I I I I I I I I TOTAL AMOUNT PAID: $9,559.00 REMARKS: DAVID W KNAUER ESQUIRE CHECK# 147 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS Knauer & Associates, LSC Attorneys-at"Law 411A East Main Street, Mechanicsburg, P A 17055 Telephone: (717) 795-7790 Fax: (717) 795-7793 Email: knauer@earlv.com David W. Knauer November 21, 2002 Ms Anita McCully Inheritance Tax Division Dept of Revenue (280601) Harrisburg, PA 17128-0601 RE: Quirino D'angelo, deceased File Number 2101-0027 Dear Ms Anita McCully: Please find enclosed my client's check in the amount of $362.13 in final payment after your division's review of the Inheritance Tax Forms filed. If you have any further questions, please contact me directly. Very truly yours, i, i '. / / 1/ '1.~~~.J< / 'U /S(~J~C {&.' /(/ David W. Knader DWK:bm Cc: Santina Peterson, Executrix \company\D'Angelo\ 11-21-02McCully.ltr 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 KNAUER DAVID W ESQUIRE 411 A E MAIN STREET MECHANICSBURG, PA 17055 _u_____ fold ESTATE INFORMATION: SSN: 116-34-7463 FILE NUMBER: 2101-0027 DECEDENT NAME: D'ANGELO QUIRINO DA TE OF PAYMENT: 11/25/2002 POSTMARK DATE: 11/22/2002 COUNTY: CUMBERLAND DATE OF DEATH: 12/16/2000 REV-1162 EX(11-96) NO. CD 001881 ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: REMARKS: DAVID W KNAUER ESQUIRE CHECK#1023 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS AMOUNT $362.13 $362.13 LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, QUIRINO D'ANGELO, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married to ANGELINA D'ANGELO, and that I have one (1) child, SANTINA PETERSON. II I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executrix out of my residuary estate, but not from any assets, funds, death benefits or insurance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. III I direct that all estate, succession, l-egacy, inheri tanc e or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executrix out of my residuary estate, but not from any assets, funds, death benefits or insurance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. IV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my wife, ANGELINA D'ANGELO, provided that she survives me by thir.ty (30) days. V I give and bequeath Ten Thousand ($10,000.00) Dollars to my granddaughter, SARAH PETERSON. This money shall be maintained in a guardianship account by Commonwealth National Bank until SARAH reaches the age of 18 years. VI I give and bequeath Ten Thousand ($10,000.00) Dollars to my grandson, GIFFORD PETERSON. This money shall be maintained in a guardianship account by Commonwealth National Bank until GIFFORD reaches the age of 18 years. VII I give, devise and bequeath my house and the sum of Fifty Thousand ($50,000.00) Dollars to Commonwealth National Bank, in trust for my daughter, SANTINA PETERSON. a) This trust shall continue for a period of five (5) years from the date of my death. b) If my daughter desires to maintain the house, its ownership shall remain in trust until she desires to sell it or until the expiration of the trust in five (5) years, whichever shall occur last. c) If my daughter does not desire to maintain the house or if she desires to sell it prior to the termination of the trust, the net value received from the sale of the house shall be placed into the trust along with the remaining Fifty Thousand ($50,000.00) Dollars. d) All costs of maintenance for the house including insurance, taxes and any other costs relating to the house shall be paid for by my daughter during the time that the house is maintained in the trust. e) It is my desire that my daughter be paid the interest accumulated on the Fifty Thousand ($50,000.00) Dollars, plus the proceeds from the sale of the house, if any, on a regular basis, but no less frequently than quarterly. f) At the end of the five (5) year period, the entire principal shall be conveyed to my daughter. If the house is still maintained by the trust, title to it shall be conveyed to her. 2 VIII All of the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, I give, devise and bequeath to my daughter, SANTINA PETERSON, per stirpes. IX I nominate, constitute and appoint my daughter, SANTINA PETERSON, as Executrix of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, QUIRINO D'ANGELO, have set my hand to this LAST WILL this 9th day of March, 1988. . ~c ~ /? r .,,?-<:-o IRINa D'ANGELO 3 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA SSe COUNTY OF CUMBERLAND I, QUIRINO D' ANGELO, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowled ed D'ANGELO, Testator, this 9th day of Q ..~ ....,{~ "----, - ",\. l~i/-- "':... _~\ ..~' " . - '\ f./:.~' ~~ - ~J ;;~ ...... - -, '\.. / C\\:~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SSe COUNTY OF CUMBERLAND : we,(J/Ia- Feo/~7.5~/;e and ~~/~' tUC//~ , 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; that QUIRINO D'ANGELO 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 the time 18 years of age or more, of sound mind and under no constraint or undue influence. ( / '7...-? I / . ;A_f a.-7~:J:--:;A c)-~-;~:' ~-./::.-<..~ Sworn or this 9th ~~ :::i~:e~art~~~e Notary Public MURREL R. WALTERS, III, Notary Public Mech~nicsburg, Cumberland Co., Pa. '-.j,y Commission Expires November 21,1988 A~ , "~..~. ~--- .~~ _:~...~_ ;..-- --'p ".r~ _,~ r -,."...-.."- :1:e: p. ,,\- r\'t ./ -- ' ~I '~~--~~/ .: --- ,', .< ,........~' y 4 \ /6 -026D -..2/ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX "o.z DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN JIL -u -., , .(~ rj DAVID W KNAUER ESQ KNAUER & ASSOCS 411A E MAIN ST MECHANICSBURG L ('1, '. '. PA 'ln55 07-01-2002 DANGELO 12-16-2000 21 01-0027 CUMBERLAND 101 Allount Rellitted '* REV-1547 EX AFP <01-02) QUIRINO MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=iS'4j-EX-AFP-(Cff':02Y-NOYicE-OF-YNHEififANCE-YA'X-APpflA"isEifiNT-,--AiDiwANCE-ifi-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DANGELO QUIRINO FILE NO. 21 01-0027 ACN 101 DATE 07-01-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 87.000.00 .00 .00 .00 1.000.00 138.778.00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 14.454.00 .00 (11) (12) (13) (14) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 226.778.00 14.454 00 212.324.00 .00 212.324.00 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 212.324.00 X 045 = 9.555.00 .00 X 12 = .00 .00 X 15 = .00 (19)= 9.555.00 .. ....... . "..~.... . (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-15-2002 CDOO0956 4.00- 9.559.00 BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-16-2002 TOTAL TAX CREDIT 9.555.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. 362.13 TOTAL DUE 362.13 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE .. RI'I'IIND_ SI'F REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) f-- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Will No. Vi ~f?6iO, Q U 1 (::/NO . ) ~ lb. d-tJ7m , ~-;;too 1- (1)O~ Name of Decedent: Date of Death: 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 Name Address ~ UNA- CYe-(.eRSoN 3~o~ .~ ~UN ~J /Y}~~ (fly " i10tr Notice has now been given to all persons entjtled thereto under Rule 5.6(a) except Date: I d-Ol-ol ll;J( !,J, ~ Signature Name -->>Mll7 lJJ . ~A'U~ Address Ai I A 6-'. MAt N ~~ ..- <;( ..- Ci- -.::t D- r- I c...:l ':.' ~'''.I c::l '.....+' ,,0 ~'''~ () ..:>:. ..0 0 ~ m ..- '- p (l) ::: 0:: GC (1 u-U- Telephonq rp ~ r- - LJ 1 0 Capacity: _ Personal Representative X-counsel for personal representative ~ r} . 'jP't yu.,. 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