Loading...
HomeMy WebLinkAbout02-0629 REV-I500E;<(6.oo) /1- /)?L-II ,...-/ REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT '* COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF REVENUE DEPT. 280601 . . HARRISBURG, PA 17128-0601 FILE NUMBER 21_02 COUNTY CODE YEAR 00629 -NUMBER--- w ~~u:l u."" w..u ,,00 u"'''' ..., .. <( SOCIAL SECURITI NUMBER I- Z W C W U w C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Chasarik Pau DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 03/29/2001 06/02/1933 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Chasarik, Anna E. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITI NUMBER 2.Qc1. Original Return o 4. Limited Estate 1Xi6. Decedent Died Testate (Altach copy ofWijl) o 9. litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (d~te of dBalh after 12-12-82) o 7. Decedent Maintained a Living Trust (Al\<lCh copy of Trust) o 10. Spousal Poverty Credit (date of dBalhbatween 12-31-91 and 1-1-95) o 3. Remainder Return (date ofdealh prior to 12.13-521 D 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes o 11. Ejection to tax under Sec. 9113(A) (Attach Sd1 0) ... Z W " Z " .. U> W '" '" o u ]1l1l;,$"'C'Ffotol:M!l&lHfle'CQ~l!lJ;:tlro,:~I:lI1.i,c.oaaE$!l" "IlE"e!;'i~O:<WN!5!Il~it~!!!\I'~IIlS;O~lIOfo1,$KPpl\1)fle:IlI~_Illi:1"O: NAME COMPLETE MAILING ADDRESS K i-h O. nncman Es uire FIRM NAME (tfAppUcabte) Sne1baker TELEPHONE NUMBER (717) 697-8528 44 W. Main Street Mechanicsburg, PA P. C. Brenneman & S are 17055 (1) (2) (3) (4) (5) z o ~ ::::l l- n: <( u w It: 1. Real Estate (Schedule A) 2. Slacks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Retei\lable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sch.dul.E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & Uens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental BequestsJSec 9113 Trusts for which an election to lax has not been made (Schedule J) 8,770.16 (6) 56,017.36 (7) 64,787.52 (8) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) (11) -0- (12) 64,787.52 (13) (14) 64,787.52 z o ~ I-' ::::l a.. :;; o u :< ~ 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) ,.0-0.. (15) n r;4,7R7 "7 ,.0_(161 16. Amount of Line 14 taxable atlineat rate ,.12 (17) 11. Amounl of Une 14 taxable at sibling rate x .15 (18) 18. Amount of Line 14 taxabte at collateral rate -0- (19) 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 R MSlM!II!j1,tU12Il1!ltfl~'ON'REVl:IISEllJDEiJU'lD~l'flIlECl(,RMATI-I'.;o"" A' . ' '( ;::'~! <';Hjr~Ht!j~~ , Decedent's Complete Address: STREET ADDRESS 906 Greenbriar Drivp CITY Mechanicsburg I STATE PA -, ZIP17050-1986 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) -0- Total Credits (A + 8 + C ) (2) 3. InteresVPenalty if applicable D.lnterest E. Penalty TotallnteresVPenaity ( D + E ) (3) 4. \1 Line 2 is greater than Line 1 + Line 3. enterthe 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. (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT -0- 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.......................................................................................................................... 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 fo~ 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? .......................,............................................................... ...................... ........... n No B B y ~ lQl: ~ o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIGNATURE OF PERSON RESPONSIBLE FOR FILING R TURN 1 ~ . Under penalties of pe~ury, I declare that I have examined this return, induding accompanying schedules and statements, and to tne best of my knowledge and btmef. it is true. correct and complete. Dedaration of preparer olher than the personal representative is based on all infonnation of which preparer has any knowledge. ADDRESS 906 Greenbriar Drive, Mechanicsburg, PA 17050-1986 SIGNATURE OF :Ii~~NTATIVE_ ADDRESS 44 W. Main Street, Mechanicsburq, PA 17055 Jl~;]. ,It}.3 ~TE ~~/n For dales 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 ar 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)l. The statute does not eXP-mot 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 jf 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 al 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 lax rale imposed on the net value of Iransters to or for the use of the decedent's ilneal 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. s9116(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.1!:(lS EX. P-97! ESTATE OF '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Paul J. Chasarik FILE NUMBER 21-02-00629 Include the proceeds of litigation and the date the proceeds were received by the estate. AU property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Dreyfus Investment Account No. 762-0300421914 VALUE AT DATE OF DEATH 8,770.16 TOTAL (Also enter on line 5, Recapitulation) $ 8. 770.16 REV-1510 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Paul J. Chasarik 21-02-00629 This schedule must be completed and filed if the answer to any of questions 1 ~hrough 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY lNClUOE THE. w.ME OF THE TIWiSFEREE. lHEIR REI)iTlOHSHI? TO DECEDENT /\NO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANS~ER. ATTACHACO?Y OF THE OEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 'tFAP?UCAflLE\ VALUE " IDS Life Flexible Annuity, Account No. 93101963588-3-004 56,017. 6 100% 56,017. I TOTAL (Also enter on line 7 Recapitulation) $ 56,017.36 36 (It more space is needed, insert additional sheets of the same size) ,REV-1513.EX+ (9-00) li: tik COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J 8ENEFICIARIES ik FILE NUMBER 21-02-00629 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE ESTATE OF NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under See 9116 (a) (1.2)J Anna E. Chasarik I. 906 Greenbriar Drive Mechanicsburg, PA 17050-19&6 Spouse 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-15QO COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1$ (If more space is needed, insert additional sheets of the same size) ---..--. -----.-_. , i L , , I , i . -;>,,~ ; '1~ I:"~ I' ii i-" LAST WILL AND TESTAMENT ..2L PAUL J. CHASARlK 21-02-629 I, PAUL J. CHASARIK, a resident of the State of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. FlRST. I hereby revoke any and all wills and codicils by me heretofore made. SECOND. I direct that all my just debts and funeral expenses be paid as soon as conveniently can be done after my death. THIRD. I give, devise and bequeath all my estate and property, including all property of which I shall die seized and possessed, all property to which my estate shall be otherwise entitled at the time of my death, and aU property over which I shall have power of appointment, of whatsoever kind or nature and wheresoever situated, be it real, personal or mixed, absolutely and forever, to my wife, ANNA E. CHASARIK, if she survives me. FOURTH. In the event my Wife, ANNA E. CHASARlK, predeceases me, I give, devise and bequeath all my estate and property, in equal shares, absolutely and forever, to my children, BARBARA M. WAGNER, PETER A. CHASARlK, JULIA E. CHASARlK and PA UL J.CHASARlK, JR.; but if any of my children pre- decease me, then to the heirs of such child or children who are liVing at my death,_ such heirs to take per stirpes and not per capita; in the event any of my children predecease me and ar~'-~ot ""'survived by heirs, _ then the share of any such chiW-or-' children sha,lllapse and shall be divided among my surviving children and the heirs of any of my children who have not survived me, such heirs to take per stirpes and not per capita. FIITH. Wherever in this my LAST WILL AND TESTAMENT it is pro- vided that any person shall benefit hereunder if such pet'son shall survive me, such (P~ 1 of3 p~e~ / /~ i.'~-'; ~.n I rT : 1"-- I !i'~'; por.on .hall be doe"""e... ~.. ..~ ..........co ...........1....- ........ . (30) days after my death.. SIXTH. I nominate, constitute and appoint my wife, ANNA E. CHASARlK, as Executrix of this Will. In the event she shall predecease me. Or fail to qualify or complete the administration of my estate, then I appoint my son, PETER A. CHASARIK. to serve as Executor of this Will.. I request that the Executrix or Executor, as the case may be. be permitted to serve without bond and without furnishing any other security. I further direct that the Executrix or Executor be allowed to serve without the intervention of any court except as required by law. SEVENTH. I give my said Executrix or Executor, as the case may be, abso- lute discretion and the fullest authority in all matterS including, but not limited to, complete authority to sell at public or private sale, for cash or credit, with or without security, mortgage, Lease, and dispose of all property, real, personal or mixed, at such times and upon such terms and conditions as she Or he shall determine to be in the best interest of my estate.. I direct that the administration of my estate be as independent of probate proceedings as the laws in force at my death shaU permit.. If any of my estate passes to a minor, I hereby direct that my Executrix or Executor pay over said portion of my estate to the Legal guardian of said minor or minors. EIGHTH. In the event any of my children are minors at the time of my death, and my wife, ANNA E. CHASARIK, has predeceased me., then~ in that event, I hereby direct that ROBERT WHITE and BETTY WHITE, 1029 DeLavista Place, Colorado Springs~ CoLorado 80911~ or the survivor~ be named as guardians of the person and property of said children.. I further direct that said guardians be allowed to serve without furnishing bond or any other security ~or acting in such capacity and have all rights and duties provided for such fiduciaries under the laws of the State of Pennsyl- vania in force and effect as of the date bereof. (Page 2 of 3 Pages) /2Jj (~ P A U L eCHASARIK --~ .., , .. ,..... '. '1f f-- , >.-. ,""" '" .. ~."'w._"~"~,, 1. ";dday of ~X;~:;~~~:~t~:-y hand cumberl8Dd. pennSylvania, this __ __ and seal to this my LAST WILL AND TESTAMENT consisting of three (3) typewritten pages, this included, the preceding pages hereof bearing my signature. ~~J.~ (SEAL) Signed, sealed, published and declared by the above-named Testator, PAUL J. CHASARIK, as his LAST WILL AND TEST AMENT, in the presence of all of us at one time, and at the same time, we, at his request and in his presence and in the presence of each other, have subscribed herelDlto our names as attesting witnesses, and we do hereby attest to the sOWld and disposing mind and memory of said Testator at the date hereof, and to the performance of the aforesaid acts of execution at New Cumberland Army Depot, New Cumberland, Pennsylvania, this ttt day of -j(fUL 1979. ~t-Jh 4-~"~/ ~X~ residing at 6!-Z. &,; JU, ffidc;.,,~ a. '/7//3' 2~!~M ~ '7/ (l"'Il\oq- res iding at (Page 3 of 3 Pages) JRD/June30, 1992/17858 Date: February 03, 2005 ORPHANS' COURT DIVISION Anna Chasarik 906 Greenbriar Drive Mechanicsburg, P A 17050 COURT OF COMMON PLEAS OF RE: Estate of Paul J. Chasarik File Number: 21-02-0629 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 03/29/2005 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, ~A=~:siGH REGISTER OF WILLS cc: File Judge I c-' Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: PAUL J. CHASARIK Date of Death: March 29, 2001 Estate No.: 21-02-0629 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: I. State whether administration of the estate is complete: . Yes 9 No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration willbe complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No.!XX 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 B. No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ( /vwL--.. Dme: March 7, 2005 ("') o .' --".. Signature Keith O. Brenneman Name 44 W. Main Street Mechanicsburg. PA 17055 Address ;:-.-,;) 717-697-8528 Telephone No. r:'~ Capacity: 0 Personal Representative ~ Counsel for personal representative vl PETITION FOR PROBATE and GRANT OF LETTERS Estate of 'f'':;UL. J. CHASt"l RII-( No. 2\r02r lo2Q also known as To: Register of Wills for the County of in the Commonwealth of Pennsylvania Deceased. Social Security No. I q 4 - ~ t> - II" J q b The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execw ftNNA in the last will of the above decedent, dated .:Aut. ( ~ t :J 11 and codicil(s) dated E CJ.lASJ:lAU.fned , 19_ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C 1/ ,'1 R f R L A N.f) . County, Pennsylvania, with h~'> lastfamilyorprincipa]re~denceat CJOb &ReE~~~IAf.l :1'1. _eCI-IANI(,,,:RuRG lYl. 110.~-O S:___A. $i>--.JN(,& (list street, number and muncipaJity) Decendent, then , "" 7 . years !'If age, died . H A fl. ~ J.I €t C!j , .jo'J"~ () 0 J , at I-i,"'y SPIRIT Ho"j>,TAL Ci'I/'1? H".L . 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: N (J iii e 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: ~goo()a , $ $ $ $ WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. re$)1est(s) the probate of the last will and codicil(s) ,,;. "'IAI'1 13TAR V (testamentary; administr.ftion c.La.; administration d.b.fl.c.t.a.) " . U l,. a'llJ/l'WW t: (..A!v,~ '- "" "'" -g.g A N IV r:I I: r? J-/ ~ 0, ft Ie 1 1<' cU',= Oat.} (...A~F..fVRIJ{A~ 7J ';l~ . .".~ H~ G'f,R/\/J DS A,)/Q G ~ 0 f ;q I 7 0 !;,-() o '" Vi OATH OF PERSONAL REPRESENTATIVE COMMONWE~TH OF PENNSYLVANIA } S8 COUNTY OF (ml~o((a>'\d. . 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 oraffi.rmed and ."~ a.-", C.' v ~~ ,~,_ before .ffiL~i~ 9th ~ day of . '-1h~,~ ,fu. . . RegIster '" ~. '" - " ~ ~ \1-\1-\--\\ No. Estate of PAUL J CHASARIK , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JULY 11, 2002 19_, 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 8-7-1979 described therein be admitted to probate and filed of record as the last will of PAUL J CHASARTK and Letters are hereby granted to 'rES'l'AMENTARY ANNA E CHASARIK FEES Probate, Letters, Etc. ......... $ Short Certificates( ).......... $ ~n ~.:t:'LP9-g~$... $ jcp $ TOTAL _ $ Filed 7-11-02 40.00 1 nn 6.00 . 5.00 54.00 AITORNEY (Sup. Ct. I.D. No.) ADDRESS ................................... mailed to exec 7-11-02 PHONE ."..... ,'~ ",.c f~: L l...) the testat , sign the same and that request of testat_ in h other subscribing witness(es)). R OF WILLS OF COUNTY TH OF SUBSCRIBING WITNESS codici (each) a subscribing witness to the will pr law, depose(s) and say(s) that ch) being duly qualified according to present and saw signed as a witness at the sence of each other) (in the presence of the me this day of 19_ Register (Address) REGISTER OF WILLS OF CUAVlBBl\Ul-ND COUNTY , OATH OF NON-SUBSCRIBING WITNESS \ 21- 0'2. - u,2.q kNNA S. tl-l-A3\RiI<'" that L '-fA llL to the best of fY\ '-I (each) a subscriber hereto, (each) being duly qualified according tf'llaw, depose(sl and say(s) that I A1Y\ familiar with the signature of~lAL -T UHA~R.t..K..- testat~ of (sRe Bf tl>. <nh<cdhing mitllesss, t,,) the ~ presented herewith and casieil believej; the signature on the Cw~ in the handwriting of 0, H-A sA Ie.! J<- s. knowledge and belief. Sworn to or affirmed and subscribed before h. ( 9th d f me t IS ay 0 y. 2 2 (~, E. efvM~ Register ?A (Name) I 70i:,-O (Address) , 11n~__"n-; """l.:;';(, h . to certlOhr that the mformation here given is correctly copied from an original ce,rtific~te of death du)~ tiled with T is IS 1) al R d ()fr f ~I l'h . I C WIll be corwarded to the Stare Vit ecor s nee or permanent tl mg. Local Rc:glsrrar 0 e ongma certlIlCate l' me as WARNING: It is illegal to duplicate this copy by photostat or photograph. P 7234419 1",Slff"""""-""" l'IIJ~~\.1" OF PEi"'~,"'C;. i'#~~~"\ I~_"" ~, ,~. ."... \?> S~t-.A :e'i ~Cl: 1-;:: \~~_~ . .41-, ': ,I:-j >d~"" . 'l"1"" \.~~ A~l\"'-' ";._":Ifh __ ..-/~\.\~.., ___7'Tf~.-_- c...... ,,' -';;",'''ENi~' //1.11 "'''-,-,-,-"",,''1111 ~~'~~L /r!w},w '~ Local Registrar ( Fee for this certificate, $2000 1'h1.. ~ 121 ,J. Of) bate No. HlO~ ; 4:1 A.. 2f1l7 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH npE.rPRIHT '" PERM"''''EHT SlACltlHIt UNDER1YE-"A - - SEX-- S''''f~''-~~UMllffl SOCIAlSECl,IRITY'IlIMW:R NAIoIEOfOECEOENT\f'"I.M_,l"" . Male .. 194 - 26 - 8196 ..J..oo i AGE\la..8onMavf IlIRTHPV.CE(C'V:"d S1iII.",f~'''9'C'''''''"Yf 67Y" COUtlTY Of OEMH landsford, Pl..ACt:O*OE......H'C~_"""'''''''-. _'n.."""....."'__1 ,.,,"~ ."""'''n1~ :=""10 RACE-"_IIl_n,_.WIIII.,OlC """,,, 'vVhite Cumberland OECEOENlOS USUAl. OCClJP,Q1ON ~"fl.:.:!':"':..'".::~::r II.. SU I Mana er na.. OEceOEHT'SIol.....INOAOOAE$SlS&r...,~.SUIo.ZopCOdef M. East Pennsboro ... .. fRHER'SN-"IolE\Fnl. "'__laSl) 906 Greenbriar Drive Mechanicsburg, Pa. 17050 OECEOENl'S ,~- RESIDENCE -- ono"",,_1 11..5'... Pa. MAAllAlsr......\JS.M_ _Maniad.W_ o.-c:ecllS~ If. Married II. 17C.~.__... ilver SPring SURvIVINGSf'OUSE ........~-......... KltooO*ElUSINESSilNOUSTRY U.S. Government Anna E. Kuhn .. l1b,C"" ~ - ~". Cumberland -...1 11".0 :':"'-=:::'::01 ...OTtlER.SNAMEiF.ll._...._Sul'-\ - - '. _ORIUHf'S_(1~~ John Chasarik Anna E. Chasarik Julia Walko ... IM'OfU,lANT"S .......IHG AOORESaISlreal, CoIyfboon, SIaIa, ZiI:> CoaIoI . 906 Greenbriar Drive Mechanicsburg, Pa. 17050 Pl.oCEOI'OISPO$ITION._oICa.....wy.C.....so.y lOCRION.~.~.CopC- or(kh..-P,- o m , ~ , METHOOOf'OISPOSlTION =~~_....D __51...0 ACTINGASSUCH Apr 3, 2001 llCEIOSEIOUMIIER 21<'. ~ ~ o ~ ~ , 21C. Indiantown Gap National Annville, Pennsylvania 17003 NAIoIEANO '" Myers Funeral Home, Inc, 37 East Main Street Mechanicsburg. pa 1705 UCEHSE_W:R l)AJ/!.SIGNEO l_.Oa~._f ~ , Wt.SCASEflEFERREOTOMEOICAl.ElCAIllIHEIIICORONER? ~.D ...IiI. to1he_o'm~ '.Oll<lllla} ... .1h"~.,,..,e<jal""I""",<3aI.a/IIlpl~...Led FD-014318-L >H. 14. : M as. O\...A.. 001 27_PAATI: En'.' ,,............ "'iu,..or complI<al....._heause<j',..d..'" Donol.n1.<lIoo~oldy, ,'""h'5C.'''"O''.~ O"l."....."""~O(....'lIal,,'. l'Mon/yOMC.'-on.__ .r /l._~\r_'to'-", ~. c.:.,\.~___~_~___ D c:TO~~~EOlIENCO~l_~__"___,,.._..,______~_. ! : _..-::::,:;;::~;:::;,~ -~--~~-~ .. WEflfAUTOPSYFINOINGS MANNt:ROF OE......fi OATEOI'lNJURY T1Io1EOF ItlJUflY ............81EPfllORTO (M<>'''.Day,l'II..) COMPlETlONOI'CAUSE Of'OEATtI? 'Applwmal. '__n :.......--... . : P","II: OV"'-....IIc.........-conlr.....;ngIO...",,1HtI flOI..."'*"'IIin"""....~__infWITl ~~. X II o Hem",,,,,, o o rJ f>tAC"OFltlJURY-Al...."...lann...'....laclory.olllc. D""""",..",_,Sp"",IVI .~. ClESCRl8E HON INJURY OCCURREO AcOldeol P.nd"'llI......,OII<j.llon y..O ~D ~<... .. Co<>kl",,'l>ed""m'n~d ~'-~~~~- bL.(..k1WlJ ~ ::-."' '" ,j'~"~ llCE~Et4UftR g~ o.oTE SlONt:DIM......, Da,. '110.., CJl" (.)C:i n~ lid. ~- 2.>J-~1._ H-"ME ANO AOORESS 0* PERSON WHO CQMPlETEOC"US/!. 0* OEATfi (llem21lTYpe",P,,",,e.~,.l tA.-Q o 'i"l'~ ~ --t ~,....,..,." cltO n. ~~ ::T~~~30, AOO AA'SSKJNMURE.NONU""aER LAST WILL AND TESTAMENT OF PAUL J. CHASARIK 21-02-629 I, PAUL J. CHASARIK, a resident of the State of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. FIRST. I hereby revoke any and all wills and codicils by me heretofore made. SECOND. I direct that all my just debts and funeral expenses be paid as soon as conveniently can be done after my death. THIRD. I give, devise and bequeath all my estate and property, including all property of which I shall die seized and possessed, all property to which my estate shall be otherwise entitled at the time of my death, and all property over which I shall have power of appointment, of whatsoever kind Or nature and wheresoever situated, be it real, personal or mixed, absolutely and forever, to my wife, ANNA E. CHASARIK, if she survives me. FOURTH. In the event my wife, ANNA E. CHASARIK, predeceases me, I give, devise and bequeath all my estate and property, in equal shares, absolutely and forever, to my children, BARBARA M. WAGNER, PETER A. CHASARIK, JULIA E. CHASARIK and PA UL J. CHASARIK, JR.; but if any of my children pre- decease me, then to the heirs of such child Or children who are living at my death, such heirs to take per stirpes and not per capita; in the event any of my children predecease me and are not survived by heirs, then the share of any such child or children shall lapse and shall be divided among my surviving children and the heirs of any of my children who have not survived me, such heirs to take per stirpes and not per capita. FIFTH. Wherever in this my LAST WILL AND TESTAMENT it is pro- person shall be deemed not to have survived me if he or she shall die within thirty (30) days after my death. SIXTH. I nominate, constitute and appoint my wife, ANNA E. CHASARIK, as Executrix of this Will. In the event she shall predecease me, or fail to qualify or complete the administration of my estate, then I appoint my son, PETER A. CHASARIK, to serve as Executor of this Will. I request that the Executrix Or Executor, as the case may be, be permitted to serve without bond and without furnishing any other security. I further direct that the Executrix or Executor be allowed to serve without the intervention of any court except as required by law. SEVENTH. I give my said Executrix or Executor, as the case may be, abso- lute discretion and the fullest authority in all matters including, but not limited to, complete authority to sell at public Or private sale, for cash or credit, with or without security, mortgage, lease, and dispose of all property, real, personal or mixed, at such times and upon such terms and conditions as she Or he shall determine to be in the best interest of my estate. I direct that the administration of my estate be as independent of probate proceedings as the laws in force at my death shall permit. If any of my estate passes to a minor, I hereby direct that my Executrix or Executor pay over said portion of my estate to the legal guardian of said minor or minors. EIGHTH. In the event any of my children are minors at the time of my death, and my wife, ANNA E. CHASARIK, has predeceased me, then, in that event, I hereby direct that ROBERT WHITE and BETTY WHITE, 1029 DeLavista Place, Colorado Springs, Colorado 80911, or the survivor, be named as guardians of the person and property of said children. I further direct that said guardians be allowed to serve without furnishing bond or any other security for acting in such capacity and have all rights and duties provided for such fiduciaries under the laws of the State of Pennsyl- vania in force and effect as of the date hereof. IN WITNESS WHEREOF, I have at New Cumberland Army Depot, New Cumberland, Pennsylvania, this 7,tivday of ar~ 1979, set my hand and seal to this my LAST WILL AND TESTAMENT consisting of three (3) typewritten pages, this included, the preceding pages hereof bearing my signature. ~:!JJ.CL~~i (SEAL) Signed, sealed, published and declared by the above-named Testator, PAUL J. CHASARIK, as his LAST WILL AND TESTAMENT, in the presence of all of us at one time, and at the same time, we, at his request and in his presence and in the presence of each other, have subscribed hereunto our names as attesting witnesses, and we do hereby attest to the sound and disposing mind and memory of said Testator at the date hereof, and to the performance of the aforesaid acts of execution at New Cumberland Army Depot, New Cumberland, Pennsylvania, this (tit day of L~ 1979. (J/ ~~Jh q..~~/ ~~X~~ res iding at 61':< ~__~: P, ~-,u a. 1"7//3 2~t ~~~ ~J . ~ ~++j ~~7/ r? r,., II \ () '1- residing at . . o d- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: 'PAUl. J. , . C 1//.}SfJR I k Date of Death: 1'11-1 R C H "q Q,ClCJJ Will No. ~ 0 0 ~ -00 b ~ CJ Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orpbans' Court Rules was served on Of mailed to the following beneficiaries of the above-captioned estate on Name Address ANN(.J E CwASA RIJ< q 0 b G R t: t N B R /R R . OR tIE UII-) IV I C S R {} tY. (]. ?f) n () 5' 0 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: /0 J 17 / 0 ~ / I Signature Name ~w !. aM/~ Address 00 h G R 0::' IV B /'~ I ~) /Y. ))4V N[eIHJt.I!>,SFl()~G, ?ff, /7?'S-(} I Telephone (1/1) 7 ? (;;.- s- ~ 16 Capacity: V Personal Representative _Counsel for personal representative Ii C 00 STATUS REPORT UNDER RULE 6.12 Name of Decedent :'PA U L ~ - ~q Will No. :2. 1- ()~ - b 29 Date of Death: J CHASRflll< - ~ DOl 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 whether administration of the estate is complete: Yes ~I,::-) No NO I 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. I f the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes"f€"4 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 may be attached to this report. Da te: 3 ) '- I ) (J:3 / I r!bvvn/)(/ ? SignaLure (::t~,(}t'WJ6 (MAH:rmf/AM3) IJNNf:! E CHILe:, /:J ~ Ik Name (Please type or print) I QOl9 G~eENBR/A~ ..DR. Address HE ClII.JNJ C S BURG 'PP (7/7 I 76h-5~lh /70S0 Te 1. No. Capacity: ~personal Representative Counsel for personal representative ~~........,-............................... "-"VU..1J.L-l ..J...;'::;>l.. -'..!.. .....'.1- V~.L..L...:...'j Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/07/2003 CHASARIK ANNA E 906 GREENBRIAR DR MECHANICSBURG, PA 17050 RE: Estate of CHASARIK PAUL J File Number: 2002-00629 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 3/29/2003 Your prompt attention to this matter will be appreciated. Thank You. V;:::;~W,d1J1 DONNA M. OTTO )U 1r 7- DEPUTY REGISTER OF WILLS ~ cc: /File Counsel Judge STATUS REPORT UNDER RULE 6.12 I GOK Name of Decedent: Paul J. Chasarik Date of Death: March 29, 2001 Will No.: 21-02-0629 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: I. State whether administration of the estate is complete: Yes 0 No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete wi thin next 6 months 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~/')'JI03 ~ p eIt-~tWlYi Signature Anna E. Chasarik Name 906 Greenbriar Drive Mechanicsburg, PA 17050-1986 Address 717-766-5216 Telephone No. Capacity: B Personal Representative o Counsel for personal representative Inventory of the real and personal estate of Paul J. Chasarik deceased I. PERSONALTY A. Dreyfus investment account No. 762-0300421914: TOTAL PERSONALTY: II. REAL ESTATE NONE $8,770.16 TOTAL APPRAISED VALUE, ALL PROPERTY: $8,770.16 I I II -O- J 1$8,770 16 il , I COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l J 55: Anna E. Chasarik according to law, deposes and says that She is the Executrix of the Estate of Paul J. Chasarik late of -~.- u.. __st!,,~r Spring _']'()....Il~)1ip Cumberland County, Pa" deceased and that the within is an inventory made by Anna Eo Chasarik ., the said Executrix of the entire estate of said decedent, consisting of all the personal propl:!rty 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, being duly sworn Sworn to and subscribed before me, this,);). <lay of 4-f'tlIL ff 2003 ~/~~ -l.i~+~~1 29 I f' j , ~(b- P. ~6IU4'~ Exec:utq,r - Administrator Anna E. Chasarlk 906 Greenbriar Drive Mechanicsburg, PA 17050-1986 Addrau March 2001 Date of Death D.y 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, Fiduciaries Act of 1949, 0. ,., .:::[ I ~I ). I 0 .... -0 "" >- ~; tl'l ~ Q I- W ~ N "" I- .,-li Q '" <tl '"' >- w -< jj ,., ~ = 0 c::: 0.. I- .. u or 0 In ~ '" "'Q I 0 w '" w 0. e '" '"Q N ~ J: 0.. ,~ Q.. Ecu 0 I- ..J u.. '" I Z u.. ..J -< 0 U .. 0.. 1 ~.. ...., W 0 -< w Q): ,;.. , -<!Xl I N > Z "" 'I >- - i I . z 0 ,.., ....,' c I' e ,., ~ 1 0 In Z Ul ! 0 ~~ I! 0 "" -< ...." U - !I z w ::l II 0.. <tl ." C Po. '" II - ~ I~ Q) 0 ~ ' ~ .J:l -0 -" I I 2 E ~ 0 " 0 F)- /'7- /1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG~ PA 171ZB-a601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT DF TAX KEITH 0 BRENNEMAN ESQ SNELBAKER ETAL 44 W MAIN ST MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-09-2003 CHASARIK 03-29-2001 21 02-0629 CUMBERLAND 101 *' REV-1S41EXAFPIOl-05J PAUL J Allount RBllitied 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 -41 RE-,,=i54TEx-,iFP-ioFiil'n;Jej'rICE--oF-YriHEifii'ANcE-TAx-il-pPRil-isEMENT-,--,iLrciwANcE-oR"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CHASARIK PAUL J FILE NO. 21 02-0629 ACN 101 DATE 06-09-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ 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 Llhe 14 at Spousal rat. (15J 16. Allount of line 14 taxable at Lineal/Class A rat. (16) 17. Allount of Line 14 at Sibling rat. (17) 18. Allount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due A DITS. 64,787.52 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 .00 X 15 = .00 (19)= .00 AMDUNT PAID RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Re.l Estate (Schedule A) 2. Stocks ~d Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Sehedule DJ S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets III (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 8.770.16 .00 56.017 .36 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. ExPenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governm.ntal Bequests; Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax .00 .00 Ill) (12) 113) (14) . INTEREST/PEN PAID (-) DATE NUMBER TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FDR CALCULATION DF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, submit the upper portion of this for. with your tax paYllent. 64,787.52 no 64,787.52 .00 64,787.52 .00 .00 .00 .00 ( IF TDTAL DUE IS LESS THAN $1, ND PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before Dece.ber 12, 1982 -- If any future interest in the estate is transferred in possession or enjoy.ent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate far lifa or for years, the to..onwaalth hereby vxpressly raserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill tha requiralllents of Saction 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91(0). Detach the tap portion of this Notice and sub_it with your paYlllent to the Ragister of Wills printed on the reverse side. --Make chac.k or .aney ordar payable to: REGISTER OF MILLS I AGENT A refund of a tax credit, which was not requestad on the Tax Return, lIIay be requestad by co.pleting an "Application for Refund of PennsYlvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling tho special 24-hour answering service for for.s ordering: 1-800-362-2050; services for taxpayers with speoial hearing and I or speaking naads: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraise.ent, ellowance, or disallowance of deductions, or assess.ent of tax (including discount or interest) as shown on this Notice lIIust abject within sixty (60) days of receipt of this Notice by: --written protest to the PA Depart.ent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the llIatter deterllined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assasslllent Review Unit, Dept. 280601, Harrisburg7 PA 17128~0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritanca Tax Return for a Resident Decedant" (REV-1501) far an explanation of ad.inistratively correctable errors. If any tax dUe is paid within three (3) calendar .onths aftar the decedent's daath, a five percent (5%) discount of the tax paid is allowed. The 15% tax a~asty non-participation penalty is co.puted on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax a.nesty period. This non-participation penalty Is appealable in the sa.e .anner and in the the sa.e time period as you would appeal tha tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) Months and ona (I) day fro. the data of death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January I, 1982 will bear interest at a rate which will vary fro. calendar year to calendar year with that rata announced by the PA Dspartment of Revenue. The applicable interest rates for 1982 through 2003 are: Intersst Daily Interest Daily Interast ~~ !!!r ~~ Year ~ Vear Daily Factor 198Z 20% .000548 1987 9" .000247 1999 7" .000192 1983 16% .000438 1988-1991 11% .000301 2000 8" .000Z19 1984 111.. .000301 199Z 9" .000247 ZODl 9" .000247 1985 13% .000356 1993-1994 '" .000192 2002 6" .000164 1986 10% .000274 1995-1998 9" .000247 2003 5" .000137 --Interast is calculated as follows: INTEREST = BALANCE OF TAX UIIPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR -~Any Notice issued aftar the tax beCOMes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the aSS8ssaent. If pay.snt is .ads after the interest cOllputation date shown on the Notice, additional intsrest lIIust be calculated.