HomeMy WebLinkAbout01-0341
Estate of ANNA
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
r2J-O/~i/.)
MICZO
No.
To:
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. 205-18-1150 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 executrixes
in the last will of the above decedent, dated October 27. 1999
and codicil(s) dated
named
,19_
(state relevant circumstances, e.g. renunciation, death or executor, etc.)
Erie County, Pennsylvania, with
91 Sunset Drive. Carlsile. PA 17013
(list street, number and muncipality)
Decendent, then 81 years of age, died
at Erie, Pennsylvania
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:
March 14, 2001
, 19
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: 91 Sunset Drive, Carlisle, PA
$
$
$
$
17013
250.000.00
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WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
(testamentary; administration c.La.; administration d.b.n.c.La.)
theron.
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Margare~ Allard
931 Montpelier Avenue.
Erie, PA 16505
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~~lly Ann Pinrhnck
5334 Noland Drive
Tecumseh, MI 49286
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA "1 S'"
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 affirmed and
before me this 30th
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No. 21-01-341
Estate of
Anna Miczo
, Deceased
DECREE OF PROBATE AND GRANT OF LETfERS
AND NOW Ma~~h 30 .xx2001"d . f h . .
, . ; ~~, In conSl eratlOn 0 t e petitlon on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated OCT. 27,1999
described therein be admitted to probate and filed of record as the last will of
ANNA MICZO
TESTAMENTARY
MARGARET ALLARD AND SALLY ANN PINCHOCK
and Letters
are hereby granted to
Register of Wills
FEES
~ c.. ~ ~P.Il\L~
ATIORNEY (su/ Ct. 1.0. No.)
Hubert X. Gilroy, Esquire 29943
Probate, Letters, Etc. .........
Short Certificates( )..........
Renunciation ................
$ 305.00
$ 30.00
$
$~
TOTAL _ $ 346.00
Filed .....~. .~q!?9.q~..............
~c?ges
ADDRESS
4 North Hanover Street
Carlisle, PA 17013
PHONE
717-243-4574
H105.905 REV.(09/00)
This is to certifY that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records In accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
~~5.~/'6r'
Robert S.cZinJnerman, Jr., MPH
Secretary of Health
WARNING: It is illegal to duplicate this copy by photostat or photograph.
21-01-341
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No.
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Charles Hardester
State Registrar
1387198
AfAR 1 9 lClDr
Date
H105.143 Rev. 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEAL THo VITAL RECORDS
CERTIFICATE OF DEATH
TYPElPRlNT
IN
PERMANENT
BLACK INK
DE NT Irst. MddIe, LaIt)
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2. Female .. 205 _ 18 _ 1150
PLACE Of DEA1l1Q1edl. ani)' one -... NIructIonI on oa.r tide)
"March 14 2001
I.
COUNTY OF DEATH
81 v...
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DECEOENT'S USUAL OCQJPATION
~1nclln.BIeck.~*
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'''White
SUMJING SPOUSE
(If.... give mlIIden nmMI)
None
6351 West Lake Road
'I. Erie, PA 16505
FATlER'S NAME (Fnt. MlckII,laIII)
,I. Frank Miczo
1NFORIoWIT'S...... (Typoo1'rlnl)
MLMar aret Allard
METHOD OF D1SPOSIl1ON
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DECEDENT'S
AC1UAl.
RESIDENCE
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t.t01l-ER'S NAt.E (Fnt. MIddle. Malden SUmernrI)
11. Eva Ledne
JNFORMANrS MAILING ADDRESS (Sb'eIt, ClylTuwn, Stale. ~ Code)
~931 Mont elier Avenue, Erie, PA 16505
~~SPOSmON."""of~ LOCAOON-CllyITown, State. ZiP.Code
Horne
2001
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lICENSE NUMBER
D4TE SIGNED
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WAS CASE REFERRED TO MEDICAl EXAMINERICOR
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PART I: Other slgQftcanl condIIIonI contfb.ang to deaUl, bLt
notresulllnglntheU'lClertytng C8UHgI\WI In PART I.
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WERE AUTOPSY FINDINGS
AVAIlABLE PRtOR TO
COfoFlETtON OF CAUSE
OF 1lEA?!f1
OlE TO (OR AS A CONSEQUENCE OF):
MANNER OF 0:: ~
N..... };!:F-
DATE OF INJURY
(MonIh. Day, Yar)
TIME OF INJURY
INJURY AT WORK?
DESCRIBE HOW INJIRn' OCCURRED.
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PlACE OF INJURY... _. __ _ -,.......
buildilll. etc. (SpecIfy)
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I, ANNA MICZO, of Cumberland County, Pennsylvania, declare this to be my last will and revoke
any will previously made by me.
ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be
paid from my residuary estate as soon as practicable after my decease as a part of the expense of the
administration of my estate.
ITEM TWO: I direct that my estate be distributed as follows:
A. Twenty (20%) percent to St. Patrick's Church, 140 E. Pomfret Street, Carlisle,
Pennsylvania 17013
B. Five (5%) percent to the American Heart Association.
C. Thirty-seven and five/tenths (37.5%) percent to be distributed between my brothers and
sisters, share and share alike, per stirpes. My brothers and sisters are, ALEXANDER
MICZO, GEORGE MICZO, HELEN MICZO, MARGARET ALLARD, MARTHA
LEON, PAULINE WILSON and ELIZABETH LETKIEWICZ.
D. Thirty-seven and five/tenths (37.5%) percent to be distributed in equal share to my nieces
and nephews, share and share alike, per stirpes. A list of my nieces and nephew is as
follows: THEODORE MICZO, WILLIAM METZO, VINCENT LEON, PAUL
LETKIEWICZ, SEAN LETKIEWICZ, ALAN MICZO, NATHAN MICZO, DONNA
HAWES, MARGARET GILBERT, ELIZABETH A. METZO, KATHERINE METZO,
CHRISTINE METZO, SALLY ANN PINCHOCK, SUSAN HOLBROOK, SANDRA
HUNT-ENG, LISA COX, THERESA ANDERSON, EVA SMITH, LORI GAMBINO,
ERICA SCHUSTER and EMILY SCHUSTER.
ITEM THREE: I appoint MARGARET ALLARD and SALLY ANN PINCHOCK, Co-Executors
of this my last will.
ITEM FOUR: All estate, inheritance, succession and other taxes, imposed or payable by reason of
my death, and interest and penalties thereon, with respect to all property comprising my gross estate
for tax purposes, whether or not such property passes under this will, shall be paid out of the
principal of my residuary estate, without apportionment or right of reimbursement.
ITEM FIVE: I direct that my person representative or guardian shall not be required to give bond
for the faithful performance of their duties in any jurisdiction.
~ .
Anna Miczo ~
PAGE ONE OF THREE PAGES
'.
.
ITEM SIX: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this
will, I give to my Executor during the full time necessary and for the administration of my estate
the following rights and powers to be exercised in his sole discretion.
A. To retain any real or personal property which may at any time form a part of my estate so long
as he or she deems it advisable.
B. To invest in any real or personal property without restrictions to legal investments.
C. To repair, alter, improve or lease for any period oftime any real or personal property and to
give options for leases.
D. Prior to sale of personal property my sisters Margaret Allard and Martha Leon and my niece
Sally Ann Pinchock to go through personal effects and/or persoanl property.
E. To sell at private sale, for cash or credit, with or without security, to exchange or to partition
real or personal property, and to give options for leases.
F. To make distribution in kind.
G. To compromise claims.
. "'f'~
IN WITNESS WHEREOF, I have hereunto set my hand this J"J day of
a~ ,1999.
SIGNED ~ ~
ANNA MICZO
The preceding instrument, consisting of this and two other typewritten pages each identified by the
signature of the Testatrix was on the day and date thereof signed, published and declared by the
Testatrix therein named as and for her last will, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed our names.
C)&fK7
PAGE TWO OF THREE PAGES
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COMMONWEALTH OF PENNSYL VANIA
ss
COUNTY OF CUMBERLAND
We /Iv ~tr?rt '/ G~I fItq y and
witnesses whose names are sigtfd to the attached or foregoing instrument being duly qualified
according to law, do depose and say that we were present and saw the Testatrix sign and execute
the instrument as her last will; that she signed willingly and executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed
the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue influence.
OJ
Sworn and subscribed to
before me thiS'J{ ~ay
ofDG~~1999.
Li!t:f c:tV,CtvC~lv-J
o Public
. Notarial Seal
Bndg~t Ann Corcoran, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires June 10, 2002
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, ANNA MICZO, whose name is signed to the attached 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 andbffirmed to and acknowledged before me this
o LJ"t> ~r ,1999
lL:ez.et c1J.A'
Notary P blic
tf~ .
ANNA MICZO ~
".
day of
Gd'CeJ ~
Notarial Seal
Bridget Ann Corcoran, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires June 10,2002
PAGE THREE OF THREE PAGES
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: AA,.A.,...-,4 ~ \." C, G,.. 6
Date of Death: J.-t tj -() I
Will No.: :; tJ(J 1- CJO~ Y I 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 fiZI 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.1 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 r~sentative state an account informally to the parties
in interest? Yes C1 - No 0
Date:2! l & (ti7
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. ~
' ' (//-
Signature
NaJ
Ad
HUBERT X. GILROY
ATTORNEY AT LAW
4 NORTH HANOVER STREET
CARLISLE, PA 17013
]
LAW OFFICE 717-243-4574
BROUJOS & GILROY, P.C. 717-766-1690
hgilroy@broujosgllroy.com FAX 717-243-8227
Tel www.broujosgilroy.com
<;:apacity: 0 Personal Representative
o Counsel for personal representative
Cumberland County - Register Of wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/07/2003
MARGARET ALLARD
931 MONTPELIER AVE
ERIE, PA 16505
RE: Estate of MICZO ANNA
File Number: 2001-00341
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: 3/14/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc: J File
Counsel
Judge
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
,
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
MICZO ANNA
DATE OF DEATH (MM-DD-Year)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
e.
FILE NUMBER
21-010341
"'CC:M&i'Cc)OE ---YEA~ - - iMiBER- -
SOCIAL SECURITY NUMBER
DATE OF BlRTH {MM-OQ..Year)
205-18-1150
HilS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
03/14/2001 09/15/1919
{IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INlTIAL)
SOCIAL SECURITY NUMBER
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00 ~ - Original Return
o 4. Limited Estate
06. Decedent Died Testate (Attach copy of Will)
o 9. LiHgation Proceeds Received
o 2. Supplemental Return
o 4a. Future InterestCompromlse (dateoldeatllaf\e{ \2-1H2j
o 7. Decedent Maintained a Living Trust (Attach copy ofTrusl}
o 10. Spousal Poverty Credit (dateofdealhbelween 12.31-91 and 1-1-95)
o 3. Remainder Retum {date of death priofto 12.1J-82)
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 Q)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULO BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
HUBERT X. GILROY 4 NORTH HANOVER STREET
FIRM NAME (If Applicable)
BROUJOS & GILROY P.C CARLISLE, PA 17013
TELEPHONE NUMBER
717-243-4574
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1. Real Estate (Schedule A)
2. Slocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole~Proprietorship
4. Mortgages & Noles Receivable (Schedule D)
5, Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate BlUing 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)
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
109,043.10
220,225.40
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104,763.41
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(6)
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(7)
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(8)
434,051.91
(9)
(10)
36,394.16
3,177.70
10. Debts of Decedent. Mortgage Liabilities, & liens (Schedule I)
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)
(11)
(12)
(13)
39,571.86
394,480.05
98,620.01
14_ Net Value Subject to Tax (line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
295,860.04
15. Amount of Line 14 taxable at the spousal lax
rate, or transfers under Sec. 9116 (a)(12)
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
19. Tax Due
x _(15)
X _(161
147,930.02 X .12 (17) 17,751.60
147,930.02 X .15 (18) 22,189.50
(191 39,941.10
20 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
"" BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address: .
STREET ADDRESS
91 SUNSET DRIVE
CITY I STATE I ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discounl
(1)
39,941.10
Total Credits (A + B + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. It 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. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE, (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
39,941.10
39,941.10
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
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 affer December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.. ................... ...............
3. Did decedent own an "in trust fo~ or payable upon death bank account or security at his or her death? ...
4. Did decedent own an Individual Retirement Acoount, annuity, or other non-probate property which
contains a beneficiary designation? .............................. ....................
Yes No
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0 !KJ
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...... 0 !KJ
0 !KJ
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0 !KJ
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 pe~ury, I declare that I have examined this return, includin~ accompanying schedules and statements, and to the best of my kooNledge and belief, it is true, correct
and complete
Declaration of preparer other than the personal representative is based on alllnformallon of which preparer has any knowledge.
)jIG~N WRE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
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SIGNATURE OF PREPARER OTHER THAN R PRESENTATIVE DATE
-r
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 PS ~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 slepparenl 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 lax rate Imposed on Ihe net value of transfers to or for Ihe 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.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R ID NT ENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
MICZO ANNA 21 01 0341
All real property owned solely or as a tenant in common 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
survivorshio must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Sale of real estate at 91 Sunset Drive, Carlisle, PA
(net proceeds - see Hud-1 attached)
VALUE AT DATE
OF DEATH
109,04310
TOTAL (Also enter on line 1, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
109,04310
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE IDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21 01
0341
ESTATE OF
MICZO ANNA
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
DESCRIPTION
VALUE AT DATE
OF DEATH
6,726.00
A TT - 300 shares
Anadarko Pete - 45 shares
2,912.85
Bell South - 400 shares
16,26000
Exxon-Mobil - 200 shares
16,528.00
General Electric - 600 shares
24,36000
Avaya - 33 shares
424.05
Lucent - 400 shares
4.408.00
Merck - 200 shares
14,386.00
Minnesota Mining - 200 shares
21,50200
Nuveen Insured - 2.476 shares
35,827.72
Nuveen Penn - 300 shares
4,56900
Raytheon Co CI - 200 shares
5,920.00
Union Pacific Corp - 100 shares
5,309.00
Verizon - 274 shares
14,497.34
Nuveen Tax Exempt Bond - Unit 214 - 95 shares
9,515.20
Nuveen Tax Exempt Bond - Unit 223(quarterly) - 57 shares
822.51
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
220 225.40
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MIClO, ANNA
21
01
0341
Paqe 1
Schedule B - Stocks & Bonds
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17 Nuveen Tax Exempt Bond - Unit 223(semi-annual) - 48 shares 692.64
18 Nuveen Tax Exempt Bond - Unit 224 - 50 shares 657.00
19 Nuveen Tax Exempt Bond - Unit 106 - 52 shares 2,969.72
20 Nuveen Tax Exempt Bond - Unit 118 - 79 shares 2,264.93
21 Nuveen Tax Exempt Bond - Unit 131 - 55 shares 1,127.50
22 Nuveen Tax Exempt Bond - Unit 144 - 109 shares 3,143.56
23 Nuveen Tax Exempt Bond - Unit 99 - 49 shares 555 09
24 Pennsylvania Insured Muns Income - Unit 172 - 5 shares 4,908.20
25 Pnme Cash Series/Money Market 19,93909
SUBTOTAL SCHEDULE B 36,257.73
GRAND TOTAL SCHEDULE B $ 220,225.40
",VI"W''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
MICZO ANNA
FilE NUMBER
21 01
0341
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF OEA TH
1. Members 1st Account 3,52521
Acel # 28905
2 Waypoint Bank Account 43,227.89
Acct # 1703014705
3 Way pont Bank Acount 27,284.45
Accl # 1700033344
4 First National Bank 28,21034
Acct # 4877023
5 GE Capital Assurance - rebate 492.89
6 Alliance Mortgage - refund 4.39
7 USAA auto insurance refund 11.68
8 TROA - medical supplemental refund 49756
9 Proceeds from sale of household items 1,01000
10 2000 Federal Tax Refund 219.00
11 Federal Tax Refund 300.00
TOTAL (Also enter on line 5, Recap'tulation) $
(If more space IS needed, insert additional sheets of the same size)
104783.41
""'''''".,,';'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
MICZO ANNA
FILE NUMBER
21
01
0341
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Burton Funeral Home 4,385.00
B. ADMINISTRATIVE COSTS
1. Personal Represen1a\ilJe's Commissions
Name of Personal Representative (s) Marqaret Allard ($7,500) Sally Pinchock ($7,500) 15,000.00
Social Security Number(s) I EIN Number of Personal Representative(s) /
Street Address C/O 4 North Hanover Street
City Carlisle State PA Zip 17013
Year(s) Commission Paid:
2. Attorney Fees Broujos & Gilroy, PC 15,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claiman1
Street Address
C,ty State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees Boyer & Ritter 2001 Tax Return / Final Return 350.00
6. Tax Return Preparer's Fees
7. Register of Wills - Filing 346.00
8 Short Certificates 30.00
9 Cumberland County Law Journal 75.00
10 The Sentinel - legal advertising 93.16
11 File Inheritance Tax Return 1500
12 File Accounting & Prepared Schedule of Distribution 175.00
13 Reserve to conclude estate 750.00
14 Mailing Expenses - Broujos & Gilroy 175.00
TOTAL (Also enter on line 9, Recapitulation) $ 36394.16
(If more space IS needed, insert additional sheets 01 the same size)
,~,,,,,,,,,,;,,.
COMMONWEALTH OF PENNSYLVANIA
lNHERlTANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
MICZO ANNA
FILE NUMBER
21
0341
01
Include unreimbursed medical expenses.
ITEM
NUMBER
2
3
4
5
6
7
8
9
10
11
12
OESCRIPTION
PP&L Electric
True Green
Master Charge
Carlisle Imaging
Cresscare Medical
Robin Sollenberger Taxes
UPS Mailing
2000 Tax Preparation/Maloney Reed Scarpitti & Co -paid by Margaret Allard and
reimbursed / see attached
PA Dept of Revenue 2000 Income Tax - paid by Margaret Allard and reimbursed
see attached
Reimbursement to Margaret Allard for expense in closing Anna Miczo home
see attached
Reimbursement to Sally Pinchock for expenses in closing Anna Miczo home
see attached
Reimbursement to Sally Pinchock for expense in closing Anna Miczo home
see attached
AMOUNT
685.23
42.39
269.73
9.57
93.17
11.00
20.43
195.00
180.00
10.78
1,63365
26.75
TOTAL (Also enter on line 10, Recapitulation) $
{If more space is needed. Insert additional sheets of the same size}
3177.70
--
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
MW70 ANNA ?1 n1 n~41
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 oulright spousal distributions)
1. Alexander Miczo Brother 5.35%
620 Alamo Court, Apt 4
Mountainview, CA 94043
2 George Miczo Brother 5.35%
638 Olin Avenue
Girard, PA 16417
3 Helen Miczo Sister 5.35%
4004 Pacific Avenue, Apt 208, c/o Salisbury Apts
Erie, PA 16506
4 Margaret Allard Sister 5.35%
931 Montpelier Avenue
Erie, PA 16505
5 Martha Leon Sister 535%
2371 Richland Avenue
San Jose, CA 95125-3644
6 Pauline Wilson Sister 535%
5381 Northway Road
Pleasanton, CA 94566-5454
7 Elizabeth Letkiewicz Sister 5.35%
921 W 7th Street, Apt 1
Erie, PA 16502-1102
ENTER DOLLAR AMOUNTS FOR DISTRI8UTIONS 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 EUECTlON TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. St. Patick Church 20%
140 E. Pomfret Street
Carlisle, PA 17013
2 American Heart Association 5%
98,620.01
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 98620.01
(If more space is needed, insert additional sheets of the same size)
,",U""""""OIl or tU::V-.IOUU mnernance I ax rteturll rte~i1uern ueceaent
fll.ICZO, ANNA
21
01
0341
Pace 2
Schedule J - Beneficiaries - 1
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)
8 Theodore Miczo Nephew 1.78
260 Landmark Court, # 5
Carrollton, KY 41008
9 William Metzo Nephew 1.78
739 Forest Lane
Taylor Mill, KY 41015
10 Vincent Leon Nephew 1.78
2371 Richland Avenue
San Jose, CA 95125-3644
11 Paul Letkiewicz Nephew 1.78
1830 West 35th Street
Erie, PA 16508-2112
12 Sean Letkiewicz Nephew 1.78
921 W 7th Street, Apt 2
Erie, PA 16502
13 Alan Miczo Nephew 178
5662 South Calann Drive
Salt Lake City, UT 84121
14 Nathan Miczo Nephew 1.78
1424 Westview Drive
Macomb,1I61465
15 Donna Hawes Niece 1.78
1049 SE Walnut Street, Apt 20
Hillsboro, OR 97123-4650
16 Margaret Gilbert Niece 1.78
1 Strout Lane
Durham, NH 03824
17 Elizabeth A. Nash Niece 1.78
2388 Ewing Drive, NE
Atlanta, GA 30319-3930
18 Katherine Metzo Niece 1.78
c/o Ruth Metzo, N168W20101 Main Street
Jackson, WI 53037-9602
19 Christine Metzo Niece 1.78
c/o Ruth Metzo, N168W20101 Main Street
Jackson, WI 53037-9602
20 Sally Ann Pinchock Niece 1.78
5334 Noland Drive
Tecumseh, MI 49286-9584
21 Susan Holbrook Niece 178
1101 West Avenue
Medina, NY 14103-1734
~~ V~"U" ,~, - '>I .rTY
2220 Buffalo Run
Las Vegas, NV 89123
-. -_.~...-._~._.. -....-. .--... .............-..~... ._~ ....~..._... ...--.--.... .....--...-..........
MICZ0~ANNA
21
01
0341
Paqe 3
Schedule J - Beneficiaries - 1
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)
23 Lisa Cox Niece 1.78
8220 Mountain View Drive, #E
Pleasanton, CA
24 Theresa Anderson Niece 1.78
2371 Richland Avenue
San Jose, CA 95125-3644
25 Eva Smith Niece 1.78
401 Baylor Drive
Woodland, CA 95695
26 Lori Gambino Niece 1.78
187 Seward St
Buchanan, NY 10611
27 Erica Schuster Niece 1.78
6636 Manchester Farms Road
Fairview, PA 16415
28 Emily Schuster Niece 1.78
6636 Manchester Farms Road
Fairview, PA 16415
.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/02/2005
GILROY HUBERT X
4 N HANOVER STREET
CARLISLE, PA 17013
RE: Estate of MICZO ANNA
File Number: 2001-00341
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: 3/14/2005
Your prompt attention to this matter will be appreciated.
Thank You.
~~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
oJ
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/02/2005
GILROY HUBERT X
4 N HANOVER STREET
CARLISLE, PA 17013
RE: Estate of MICZO ANNA
File Number: 2001-00341
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. I, for decedents dying on or after
July I, 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: 3/14/2005
Your prompt attention to this matter will be appreciated.
Thank You.
~r~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
uJ
JOHN H. BROUJOS
HUBERT X. GILROY
BROUJOS & GILROY, P.c.
ATrORNEYS AT LAw
4 NORTH HANOVER STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717) 243-4574
FACSIMILE: (717) 243-8227
jbroujos@broujosgilroy.com
hgilroy@broujosgilroy.com
NON-ToLL FOR HARRIsBURG AREA
717-766-1690
March 10, 2005
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
RE: Estate of Miczo Anna
File No. 2001-00341
Dear Glenda:
We received a letter from you dated February 2, 2005 suggesting that the filing is
delinquent in the above matter. I enclose a copy of the status report which we filed
with your office on February 21, 2003 along with my letter which should have
concluded this estate.
Do we have to file anything further? Please advise.
;JP
Hubert X. Gilroy
- .)
srb
J
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/02/2005
GILROY HUBERT X
4 N HANOVER STREET
CARLISLE, PA 17013
RE: Estate of MICZO ANNA
File Number: 2001-00341
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: 3/14/2005
Your prompt attention to this matter will be appreciated.
Thank You.
A:~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
JOHN H. BROUJOS
HUBERT X. GILROY
BROUJOS & GILROY, P. C.
ArrORNEYs AT LAW
4 NORlH HANOVER STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717) 243-4574
FACSIMILE: (717) 243-8227
jbroujos@broujosgilroy.com
hgilroy@broujosgilroy.com
NON-ToLL FOR HARRISBURG AREA
717-766-1690
February 19, 2003
Donna M. Otto, Deputy
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Anna Miczo / No. 2001 - 00341
Dear Donna:
Enclosed is the Status Report in the above referenced matter. This Estate has been
settled. We previously filed an Estate Settlement Agreement with your office.
Sincerely yours,
~.
Hubert X. Gilroy
dca
Enclosure
, ..--..
/. -
Name of Decedent:
STATUS REBORT UNDER RULE 6.12
AA,..A.,..-~ A (... c, -z. 6
Date of Death:
Will No.:
:l6(J 1- tJI)3 YI
Admin. No.:
Pursuant to Rule 6.12 ofthe 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 fiZ[ No 0
2. Ifthe answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. Ifthe 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 r~sentative state an account informally to the parties
in interest? Yes ri No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts maybe filed with the Clerk of the Orphans' Court
and may be attached to this repoa ~
Date:2! l & (fi) CLL_
Signature
..
N3.i
Adl
HUBERT X. GILROY
AlTORNEY AT LAW
4 NORTH HANOVER STREET
CARLISLE, PA 17013
I
LAW OFRCE 717-243-4574
BROUJOS &. GILROY, P.C. 717-766-1690
Tel, hgllroy@broujosgllroy.com FAX 717-243-8227
www.broujosgilroy.com
Capacity: 0 Personal Representative
o Counsel for personal representative
..
G.
---
JOHN H. BROUJOS
HUBERT X. GILROY
BROUJOS & GILROY, P.c.
ArrORNEYS AT LAW
4 NORTH HANOVER STREET
CARUSLE, PENNSYLVANIA 17013
TELEPHONE: (717) 243-4574
FACSIMILE: (717) 243-8227
INTERNET: brgilroypc@ao1.com
NON-ToLL FOR HARRISBURG AREA
717-766-1690
April 11, 2001
Mary C. Lewis
Register of Wills
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Anna Miczo/File No. 21-01-0341
Dear Mary:
Please accept this letter as Certification of Notice under Rule 5.6(a).
The Decedent is Anna Miczo. The date of Death is March 14, 2001. The Estate No. is 21-
01-0341
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 April 11, 2001:
Alexander Miczo
620 Alamo Court, Apt. 4
Mountainview, CA 94043
George Miczo
638 Olin Avenue
Girard, PA 16417
Helen Miczo
4004 Pacific Avenue, Apt. 208
Erie, PA 16506
Margaret Allard . .
931 Montpelier Avenue
Erie, PA 16505
Martha Leon
2371 Richland Avenue
San Jose, CA 95125
Pauline Wilson
5381 Northway Road
Pleasanton, CA 94566
Elizabeth Letkiewicz
921 W 7th Street, Apt. #1
Erie, P A 16502
William Metzo
739 Forest Lance
Taylor Mill, KY 41015
Mary C. Lewis
April 11, 2001
Page 2
Vincent Leon
2371 Richland Ave.
San Jose, CA 95125
Sean Letkiewicz
921 W 7th Street, Apt. 2
Erie, P A 16508
Nathan Miczo
620 Adams Ct., Apt. 4
Mountainview, CA 94043
Margaret Gilbert
1 Strout Lane
Durham, NH 03824
Katherine Metzo
c/o Ruth Metzo
N167W20101 Main St.
Jackson, VVI 53037
Sally Ann Pinchok
5334 Noland Drive
Tecumseh, MI 49286
Sandra Hunt-Eng
5500 Mountain Vista, #528
Las Vegas, NV 89120
Theresa Anderson
2371 Richland Ave.
San Jose, CA 95125
Lori Gambino
898 Larkspur Ct.
Louisville, CO 80027
Emily Schuster
6636 Manchester Farms Rd.
Fairview, PA 16415
Paul Letkiewicz
1830 W. 35th Street
Erie, P A 16508
Alan Miczo
5662 S. Calann Drive
Salt Lake City, UT 84121
Donna Hawes
1049 SE Walnut Street, #20
Hillsboro, OR 97123
Elizabeth Metzo Nash
2388 Ewing Drive, NE
Atlanta, GA 30319
Christine Metzo
c/o Ruth Metzo
Nl68W20101 Main St.
Jackson, VVI 53037
Susan Holbrook
1101 West Avenue
Medina, NY 14103
Lisa Cox
8020 Mountain View Drive, #E
Pleasantville, CA 94588
Eva Smith
401 Baylor Drive
Woodland, CA 95695
Erica Schuster
6636 Manchester Farms Rd.
Fairview, PA 16415
St. Patrick's Church
140 East Pomfret Street
Carlisle, PA 17013
Mary C. Lewis
April 11, 2001
Page 2
American Heart Association
P.O. Box 8835
Camp Hill, P A 17011
Charities
Charitable Trust & Organization Section
14th Floor
Strawberry Square
Harrisburg, P A 17120
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
If you have any questions, please feel free to contact me.
Sincerely yours,
LUroY
Attorney for Estate of Anna Miczo
dca
. .
~
JOHN H. BROUJOS
HUBERT X. GILROY
BROUJOS & GILROY, P.c.
AITORNEYS AT LAW
4 NORTH HANOVER STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717) 243-4574
FACSIMILE: (717) 243-8227
INTERNET: brgilroypc@ao1.com
NON-ToLL FOR HARRISBURG AREA
717-766-1690
April 19, 2001
Mary C. Lewis
Register of Wills
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Anna Miczo/File No. 21-01-0341
Dear Mary:
Please accept this letter as Certification of Notice under Rule 5.6(a).
The Decedent is Anna Miczo. The date of Death is March 14, 2001. The Estate No. is
21-01-0341.
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 April 19, 2001:
Alexander Miczo
620 Alamo Court, Apt. 4
Mountainview, CA 94043
George Miczo
638 Olin Avenue
Girard, PA 16417
Helen Miczo Margaret Allard
4004 Pacific Avenue, Apt. 208 931 Montpelier Avenue
Erie, P A 16506 Erie, P A 16505 ~..~
Martha Leon
2371 Richland Avenue
San Jose, CA 95125
Pauline Wilson
5381 Northway Road
Pleasanton, CA 94566
Elizabeth Letkiewicz
921 W 7th Street, Apt. #1
Erie, P A 16502
William Metzo
739 Forest Lance
Taylor Mill, KY 41015
JOHN H. BROUjOS
HUBERT X. GILROY
BROUJOS & GILROY, P.c.
A TIORNEYS AT LAW
4 NORTH HANOVER STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717) 243-4574
FACSIMILE: (717) 243-8227
INTERNET: brgilroypc@aol.com
NON-ToLL FOR HARRISBURG AREA
717-766-1690
April 19, 2001
Mary C. Lewis
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Anna Miczo/File No. 21-01-0341
Dear Mary:
Enclosed is an amended Certificate of Notice under Rule 5.6(a) in the above matter. This
amendment was required because we missed one heir in the original certification.
Thank you for your attention to this filing.
~
Hubert X. Gilroy
dca
Enclosure
cc: Margaret Allard
Sally Ann Pin chock
Mary C. Lewis
April 19, 2001
Page 2
Vincent Leon
2371 Richland Ave.
San Jose, CA 951 25
Sean Letkiewicz
921 W 7th Street, Apt. 2
Erie, P A 16508
Nathan Miczo
620 Adams Ct., Apt. 4
Mountainview, CA 94043
Margaret Gilbert
1 Strout Lane
Durham, NH 03824
Katherine Metzo
c/o Ruth Metzo
N 167W201 01 Main St.
Jackson, WI 53037
Sally Ann Pinchock
5334 Noland Drive
Tecumseh, MI 49286
Sandra Hunt-Eng
5500 Mountain Vista, #528
Las Vegas, NV 89120
Theresa Anderson
2371 Richland Ave.
San Jose, CA 95125
Lori Gambino
898 Larkspur Ct.
Louisville, CO 80027
Paul Letkiewicz
1830 W. 35th Street
Erie, P A 16508
Alan Miczo
5662 S. Calann Drive
Salt Lake City, UT 84121
Donna Hawes
1049 SE Walnut Street, #20
Hillsboro, OR 971 23
Elizabeth Metzo Nash
2388 Ewing Drive, NE
Atlanta, GA 3031 9
Christine Metzo
c/o Ruth Metzo
N 168W20 101 Main St.
Jackson, WI 53037
Susan Holbrook
1101 West Avenue
Medina, NY 141 03
Lisa Cox
8020 Mountain View Drive, #E
Pleasantville, CA 94588
Eva Smith
401 Baylor Drive
Woodland, CA 95695
Erica Schuster
6636 Manchester Farms Rd.
Fairview, PA 16415
Mary C. Lewis
April 19, 2001
Page 3
Emily Schuster
6636 Manchester Farms Rd.
Fairview, P A 16415
American Heart Association
P.O. Box 8835
Camp Hill, PA 17011
Theodore Miczo
260 Landmark Court, #5
Carrollton, KY 41008
St. Patrick's Church
1 40 East Pomfret Street
Carlisle, P A 17013
Charities
Charitable Trust & Organization Section
14th Floor
Strawberry Square
Harrisburg, PAl 71 20
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
If you have any questions, please feel free to contact me.
Sincerely yours,
dca
Hubert X. Gilroy
Attorney for Estate of Anna Miczo
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INOIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
GILROY HUBERT X
4 N HANOVER STREET
CARLISLE, PA 17013
_Uh___ fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN: 205-18-1150
FILE NUMBER: 21 - 200 1 - 0341
DECEDENT NAME: MICZO ANNA
DATE OF PAYMENT: 11/09/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/14/2001
ACN
ASSESSM ENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: HUBERT X GILROY ESQUIRE
CHECK#109
SEAL
INITIALS: DO
RECEIVED BY:
REV-1162 EX(11-96)
NO. CD 000505
AMOUNT
--------
I $39,941.10
I
I
I
I
I
I
I
I
$39,941.10
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
/~ ---;;l;;'/ .-.3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ReG':? ,
Rt;L;
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
'02 FEB 13 Gll0 :48
HUBERT X GILROY
BROUJOS & GILROY
4 N HANOVER ST
CARLISLE
G:t~f't\
PAC!l)\l!fs; .
02-04-2002
MIClO
03-14-2001
21 01-0341
CUMBERLAND
101
Allount Rellitted
'*
C/
REY-1547 EX AFP 112-00)
ANNA
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=isl;j-E3f-AFP--ci'2=oOY-NOTicE--OF-YNHEifiTANCE-TAX-A-PPRAisEMENT~--Ar.rOWAifCE-(rR-------------- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MIClO ANNA FILE NO. 21 01-0341 ACN 101 DATE 02-04-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
( ) CHANGED
U)
(2)
(3)
(4)
(5)
(6)
(7)
109.043.10
220.225.40
.00
.00
104.783.41
.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 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 and/or 1&, 17, 18 and 19 will
re~lect ~igures that include the total o~ 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:
PAYMENT
DATE
11-09-2001
NOTE:
RECEIPT
NUMBER
CD000505
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
· IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(9)
ClO)
36.394.16
00 =
045 =
12 =
15 =
Cl9)=
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
434.051. 91
39.1i71 86
394.480.05
98.620.01
295.860.04
.00
.00
17.751.60
22.189.50
39.941. 10
39.941.10
.00
.00
.00
( 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.)
3 .177 . 70
Ul)
(2)
(3)
(4)
.00 X
.00 X
147.930.02 X
147.930.02 X
AMOUNT PAID
39.941.10
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.
~
Estate of Anna Mi~o
;;21 - 0 1- 3c..j I
Estate Settlement Agreement
THIS AGREEMENT made this (J.. day of /lI 0 V , 2002 between Margaret
M. Allard and Sally Ann Pinchock, Executrixes of the Estate of Anna Miczo (collectively
referred to hereinafter as the "Executrixes")
AND
Alexander Miczo, George Miczo, Helen Miczo, Margaret Allard, Martha Leon, Pauline
Wilson, Elizabeth Letkiewicz, Theodore Miczo, William Metzo, Vincent Leon, Paul
Letkiewicz, Sean Letkiewicz, Alan Miczo, Nathan Miczo, Donna Hawes, Margaret
Gilbert, Elizabeth A. Nash formerly Metzo, Katherine Metzo, Christine Metzo, Sally Ann
Pinchock, Suzanne Holbrook, Sandra Hunt-Eng, Lisa Cox, Theresa Anderson, Eva
Smith, Lori Gambino, Erica Schuster, Emily Schuster, St. Patrick's Church and the
American Heart Association (collectively hereinafter referred to as the "Beneficiaries").
WITNESSETH
WHEREAS, Anna Miczo (Decedent) was born on September 15, 1919 and died on March
14, 2001 while domiciled in Cumberland County, Pennsylvania; and
WHEREAS, pursuant to the Last Will and Testament of the Decedent dated October 27,
1999 (Will), a copy of which is attached hereto and marked Exhibit "A", the Decedent
named Margaret Allard and Sally Ann Pinchock as Co-Executrixes under her Will; and
WHEREAS, pursuant to appropriate action of the Cumberland County Register of Wills
at Docket Number 21-01-0341, Sally Ann Pinchock and Margaret Allard were granted
Letters Testamentary in the Estate of Anna Miczo on March 30, 2001, a copy of which is
attached hereto and marked Exhibit "B"; and
WHEREAS, the named Beneficiaries have been listed as beneficiaries of the Decedent's
Estate pursuant to Item Two of the Will, with the distribution being as follows:
A. Twenty percent (20%) to St. Patrick's Church, Carlisle, Pennsylvania; and
B. Five percent (5%) to the American Heart Association; and
1
.
C. Thirty-seven and five tenths percent (37.5%) to be distributed equally
between Alexander Miczo, George Miczo, Helen Miczo, Margaret Allard,
Martha Leon, Pauline Wilson and Elizabeth Letkiewicz (resulting in each
brother and sister receiving 5.35% of the estate); and
D. Thirty-seven and five tenths percent (37.5%) to be distributed equally
between Theodore Miczo, William Metzo, Vincent Leon, Paul Letkiewicz,
Sean Letkiewicz, Alan Miczo, Nathan Miczo, Donna Hawes, Margaret
Gilbert, Elizabeth A. Nash formerly Metzo, Katherine Metzo, Christine
Metzo, Sally Ann Pinchock, Suzanne Holbrook, Sandra Hunt-Eng, Lisa
Cox, Theresa Anderson, Eva Smith, Lori Gambino, Erica Schuster and
Emily Schuster (resulting in each niece and nephew receiving 1.78% of the
Decedent's Estate); and
WHEREAS, the Executrixes have truly and appropriately administered the Estate of the
Decedent; and
WHEREAS, the Executrixes have filed a Pennsylvania Inheritance Tax Return with the
Pennsylvania Department of Revenue, said Return being attached hereto and marked
Exhibit "C"; and
WHEREAS, the Pennsylvania Department of Revenue has accepted the Inheritance Tax
Return and has issued a Notice of Appraisement for the Estate, a copy of which is
attached hereto and marked Exhibit "D"; and
WHEREAS, the Decedent owned real estate located at 91 Sunset Drive, Carlisle,
Cumberland County, Pennsylvania (Real Estate) at the time of her death, and the
Executrixes sold said Real Estate on May 22, 2001 at a sale price of $119,000.00 which,
after deducting costs of sale, netted proceeds to the Estate of $109,043.10 (See Schedule A
of the Inheritance Tax Return and HUD-l attached to Inheritance Tax Return); and
WHEREAS, the Decedent owned various securities and other investments as set forth on
Schedule B of the Inheritance Tax Return, and the Executrixes have sold those assets and
converted those assets into cash, with those funds deposited into a Fahnestock Money
Market Account showing a balance (also reflecting accrued interest) of $228,004.00 as of
July 31, 2002; and
WHEREAS, the Executrixes have set up a checking account for the Estate with
Commerce Bank (Commerce Account), with the proceeds from the sale of the Real Estate
of $109,043.10 deposited into the Commerce Account; and
2
..
WHEREAS, the Executrixes have received various other miscellaneous assets of the
Estate as set forth on Schedule E of the Inheritance Tax Return, including proceeds from
the sale of miscellaneous household items, which monies were also deposited into the
Commerce Account; and
WHEREAS, the Executrixes have made various payments on debts of the Estate out of
the Commerce Account, said payments being as follows:
Check Number
Date
101
102
103
104
105
106
107
108
7/1/01
7/1/01
7/1/01
7/1/01
7/1/01
7/1/01
7/3/01
7/10/01
109
11/9/01
110
3/21/02
111
112
6/16/02
6/16/02
113
6/16/02
Payee/Description
PP&L $
True Green - Yard Care $
Universal Card - Master Charge Card $
Carlisle Imaging - medical bill $
Crest Care - medical bill $
Burton Funeral Home $
Robin Sollenberger - Taxes $
Broujos & Gilroy, P.C. - reimbursement
on costs advanced for Estate
Administration - Items B7, B8, B9
B10 of Schedule H of Inheritance
Tax Return
Register of Wills - Pennsylvania
Inheritance Tax
Pennsylvania Department of Revenue -
Income Tax
IRS - Federal Income Tax
Pennsylvania Department of Revenue -
State Income Tax
Boyer & Ritter - accounting services
3
Amount
685.12
42.39
269.73
9.57
93.17
4,385.00
11.00
$
564.59
$39,941.10
$ 60.00
$ 1,112.00
$
$
166.00
450.00
WHEREAS, the following additional obligations of the Estate remain to be paid;
Item
Payee
Amount
Executrix Fee
Executrix Fee
Legal Fees
Miscellaneous Reimbursements
Items 8, 9, 10, 11 & 12 of
Schedule I of Inheritance Tax
Return
Margaret Allard
Sally Ann Pinchock
Broujos & Gilroy, P. C.
$ 7,500.00
$ 7,500.00
$15,000.00
Margaret Allard &
Sally Pin chock
$ 2,046.18
WHEREAS, the Executrixes desire to hold and reserve the sum of $10,000.00 for
purposes of paying the final Income Tax bill, if any, to conclude the Estate and any
additional accounting fees associated with that, and also to hold money in reserve for a
period of 9 months from the date of filing this Estate Settlement Agreement to cover any
contingent claims; and
WHEREAS, taking into consideration the $228,004.00 in the Fahnestock Accountl and
the current balance in the Commerce Account of $171,972.38, the total money held in the
Estate at this time is estimated at $399,976.38; and
WHEREAS, the Executrixes desire to proceed with paying the bills as outlined above and
withholding $10,000.00 for reserve as mentioned, leaving the approximate sum of
$357,000.00 available to distribute at this time; and
WHEREAS, the Executrixes have provided an opportunity for all Beneficiaries to
examine all records of the Decedent in the possession of the Executrixes and to examine
all records of the Estate in the possession of legal counsel for the Estate; and
WHEREAS, the Executrixes are prepared to achieve the final distribution of the
Decedent's Estate subject to the reserve as set forth herein; and
WHEREAS, the Executrixes and all Beneficiaries desire that the administration of the
Estate of Anna Miczo be terminated without the expense and delay of a court accounting
and the parties are willing to enter into this Estate Settlement Agreement in order to
expedite the conclusion of the Estate.
1 This account balance is based upon a July 31, 2002 statement, with additional interest having accrued.
4
NOW, THEREFORE, in consideration of the mutual covenants as set forth herein, the
parties agree as follows:
1
The above named beneficiaries hereby waive the filing of a formal accounting and
schedule of distribution in the Estate of Anna Miczo.
2
The parties agree that the Executrixes may proceed with paying the following additional
obligations at this time:
Item
Payee
Amount
Executrix Fee
Executrix Fee
Legal Fees
Miscellaneous Reimbursements
Items 8, 9, 10, 11 & 12 of
Schedule I of Inheritance Tax
Return
Margaret Allard
Sally Ann Pinchock
Broujos & Gilroy, P.C.
$ 7,500.00
$ 7,500.00
$15,000.00
Margaret Allard &
Sally Pinchock
$ 2,046.18
3
The beneficiaries also agree that the Executrixes may make the following Estate
distributions:
Name Percentage Amount
St. Patrick's Church 20% $71,400.00
Carlisle, Pennsylvania
American Heart Association 5% $17,850.00
Alexander Miczo 5.35% $19,100.00
George Miczo 5.35% $19,100.00
Helen Miczo 5.35% $19,100.00
Margart Allard 5.35% $19,100.00
Martha Leon 5.35% $19,100.00
Pauline Wilson 5.35% $19,100.00
Elizabeth Letkiewicz 5.35% $19,100.00
Theodore Miczo 1. 78% $ 6,355.00
William Metzo 1. 78% $ 6,355.00
Vincent Leon 1. 78% $ 6,355.00
5
.
Paul Letkiewicz 1. 78% $ 6,355.00
Sean Letkiewicz 1. 78% $ 6,355.00
Alan Miczo 1. 78% $ 6,355.00
Nathan Miczo 1. 78% $ 6,355.00
Donna Hawes 1.78% $ 6,355.00
Margaret Gilbert 1. 78% $ 6,355.00
Elizabeth A. Nash formerly Metzo 1. 78% $ 6,355.00
Katherine Metzo 1.78% $ 6,355.00
Christine Metzo 1. 78% $ 6,355.00
Sally Ann Pinchock 1.78% $ 6,355.00
Suzanne Holbrook 1.78% $ 6,355.00
Sandra Hunt-Eng 1. 78% $ 6,355.00
Lisa Cox 1.78% $ 6,355.00
Theresa Anderson 1. 78% $ 6,355.00
Eva Smith 1. 78% $ 6,355.00
Lori Gambino 1. 78% $ 6,355.00
Erica Schuster 1. 78% $ 6,355.00
Emily Schuster 1. 78% $ 6.355.00
Total $356,405.00
4
The parties agree that the Executrixes shall hold the sum of $10,000.00, plus any accrued
interest not specifically accounted for above, as reserve of the Estate for payment of any
income tax, accounting expenses or miscellaneous expenses that may accrue. Upon the
final payment of all income taxes owing and all accounting bills and upon the Executrixes
and legal counsel for the Estate being satisfied that all contingent bills are paid, the
parties agree that the Executrixes may distribute all monies kept in reserve to all of the
Beneficiaries listed in Paragraph 3 above in the same percentage set forth in Paragraph 3
above. The Executrixes will need no further written permission from the Beneficiaries or
from the court to distribute the reserve monies as long as said reserve monies are
distributed to the Beneficiaries within one year from the date of this Agreement with an
appropriate letter outlining any expenses paid and the method of calculation of the
distribution.
5
The parties acknowledge that they have been provided the opportunity to present this
Agreement to their own legal counsel for legal advice if such party desired such legal
advice.
6
6
The Beneficiaries collectively and individually hereby forever release, compromise, settle
and discharge any and all claims, demands, actions or causes of actions, legal or
equitable, absolute or contingent, which any of them may have against any other party
hereto or against the Estate of Anna Miczo or against the Estate Executrixes, Margaret
Allard and Sally Ann Pinchock, by reason of any matter, cause or thing growing out of or
relating to any property or assets of said Estate, or growing out of or relating to any act
of the Executrixes in the administration of the Estate. This release shall release the
Executrixes from all liabilities, whether due to their negligence or otherwise, which they
may have by reason of their administration of the Estate of Anna Miczo. However, this
release shall not release the Executrixes from any claims relating to fraud or claims
relating to any willful action on behalf of the Executrixes, either individually or together,
in failing to disclose or account for assets of the Estate which the Executrixes may have
received.
7
This Agreement shall not be binding until signed by all parties to the Agreement including
both Executrixes in their capacity as Executrixes and in their capacity as Beneficiaries,
and all named Beneficiaries. The parties agree that legal counsel for the Estate may
assign a date to this Agreement to be inserted on the first page to coincide with the date
legal counsel receives all signatures from the Beneficiaries.
8
The parties agree that this instrument shall be binding upon themselves, their successors,
assigns and personal representatives.
9
The parties agree that this Agreement may be filed with the Cumberland County Register
of Wills and shall constitute a receipt and acknowledgment of the distributions as set forth
herein and also constitute as a statement from all parties that the administration of the
Estate of Anna Miczo is concluded except for miscellaneous matters held in reserve as set
forth herein.
10
The parties acknowledge that because of the difficulty in getting signatures of multiple
parties on one page, this Agreement may include signature pages for each party that only
includes one party to each signature page.
7
11
The Executrixes agree to provide to each party to this Agreement with a fully signed copy
of the Agreement prior to this Agreement being recorded in the Cumberland County
Register of Wills Office.
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
ATTEST
ESTATE OF ANNA MICZO
M
"'~cz~ ~
'Sally n Pinchock, Executrix
WITNESS
BENEFICIARIES
~h,r-~.,I
argare Allard
/_#d~L/
~ Pinchock
~'
1rJA ~ rl-
George M. zo ?-"
Emily Schuster
Erica Schuster
8
. ,
11
The Executrixes agree to provide to each party to this Agreement with a fully signed copy
of the Agreement prior to this Agreement being recorded in the Cumberland County
Register of Wills Office.
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
ATIEST
ESTATE OF ANNA MICZO
Margaret Allard, Executrix
Sally Ann Pinchock, Executrix
WITNESS
BENEFICIARIES
Margaret Allard
Sally Ann Pinchock
George Miczo
Emily Schuster
x t./I1"'rl1 SC~~
Erica Schuster
8
- .
. ,
11
The Executrixes agree to provide to each party to this Agreement with a fully signed copy
of the Agreement prior to this Agreement being recorded in the Cumberland County
Register of Wills Office.
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
A TrEST
ESTATE OF ANNA MICZO
Margaret Allard, Executrix
Sally Ann Pinchock, Executrix
WITNESS
BENEFICIARIES
Margaret Allard
Sally Ann Pinchock
George Miczo
t' C3
~..5 ~~l~''-.-/''---
Emily chuster
Erica Schuster
8
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
t~ei~
ETt\iE W/C-"1-
~,~~
Paul Leitkiewicz
L.S'T1(16w"
Sean Leitkiewicz
,t.. EI KI ~ YV K.-:l..
j~~
Helen Miczo
9
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
~ 911
I ... ')
I QitQ.,? '. t!ZtuJ cfYJ
Teresa A.nderson
10
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
})Uvu'r97~
[,1
I'
ot:::~. ~~
Lori Gambino
11
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
Sworn to before me this 25th day of October, 2002, at Durham, New Hampshire.
WITNESS
BENEFICIARIES
~"'c." ~.
~~ 't2/Jfji-:ilik;d;
Marg t Gilbert
DONNA L. HAMEL, Notary Public
Justice of the Peace
My Commission Expires September 19, 2006
12
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
cr
iO~ ~uU~
Donna Hawes
OFFICIAL SEAL
_JUDY E. ARMSTRONG
NOTARY PUBUC-OREGON
. COMMISSION NO. 356605
M1 COMMISSION E)flReS APRIL 10, 2006
13
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNijSS
. . ;/ '/ _ ,//1/<//
I/~O{~:)
f
BENEFICIARIES
4~<>#lq/ p..../
./ SUZ e Holbrook
14
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
/ .......) / '"
\- .!a/~~.
s.liifo.....~ Hunt-Eng" / f _ ~.
t\...:w~.~ ~ Ci4]
/"'~-" ~'-'''''
/".-
15
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
A~ c7f'~
U?;n . .
~ ~~tZ-
Vm~ent Leon
~ax
Lisa ~
(;/~ ~
Pauline Wilson
16
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS BENEFICIARIES
~ ('{\. ~a P/l)l
~~
17
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
BENEFICIARIES
A~/~
WITNESS
18
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
~~
~;w~. .
Alexander Miczo Y
19
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
~~
Nathan Miczo
20
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
21
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
~
22
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
BENEFICIARIES
~~
~0~.
Eva Smith
23
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
ff' Jf &~O.l
24
IN WITNESS WHEREOF, the parties, intending to be legally bound, have hereunto set
their hands and seal the day and year first above written.
WITNESS
~fL
American eart Association
~U€/ ./
25
.r.
~
. '
1L~~ ~1L1L ~j}t1B ~(f~~~.ffl(fj}~ ~
~j}j}~ :f1IDJ((l<!&
I, ANNA MICZO, of Cumberland County, Pennsylvania, declare this to be my last will and revoke
any will previously made by me.
ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be
paid from my residuary estate as soon as practicable after my decease as a part of the expense of the
administration of my estate.
ITEM TWO: I direct that my estate be distributed as follows:
A. Twenty (20%) percent to St. Patrick's Church, 140 E. Pomfret Street, Carlisle,
Pennsylvania 17013
B. Five (5%) percent to the American Heart Association.
C. Thirty-seven and five/tenths (37.5%) percent to be distributed between my brothers and
sisters, share and share alike, per stirpes. My brothers and sisters are, ALEXANDER
MICZO, GEORGE MICZO, HELEN MICZO, MARGARET ALLARD, MARTHA
LEON, PAULINE WILSON and ELIZABETH LETKIEWICZ.
D. Thirty-seven and five/tenths (37.5%) percent to be distributed in equal share to my nieces
and nephews, share and share alike, per stirpes. A list of my nieces and nephew is as
follows: THEODORE MICZO, WILLIAM METZO, VINCENT LEON, PAUL
LETKIEWICZ, SEAN LETKIEWICZ, ALAN MICZO, NATHAN MICZO, DONNA
HA WES, MARGARET GILBERT, ELIZABETH A. METZO, KATHERINE METZO,
CHRISTINE METZO, SALLY ANN PINCHOCK, SUSAN HOLBROOK, SANDRA
HUNT-ENG, LISA COX, THERESA ANDERSON, EVA SMITH, LORI GAMBINO,
ERICA SCHUSTER and EMILY SCHUSTER.
ITEM THREE: I appoint MARGARET ALLARD and SALLY ANN PINCHOCK, Co-Executors
of this my last wilL
ITEM FOUR: All estate, inheritance, succession and other taxes, imposed or payable by reason of
my death, and interest and penalties thereon, with respect to all property comprising my gross estate
for tax purposes, whether or not such property passes under this will, shall be paid out of the
principal of my residuary estate, without apportionment or right of reimbursement.
ITEM FIVE: I direct that my person representative or guardian shall not be required to give bond
for the faithful performance of their duties in any jurisdiction.
tl~~ dJz.-~
Anna Miczo
PAGE ONE OF THREE PAGES
EXHIBIT
j A
-<
.\
, .
ITEM SIX: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this
will, I give to my Executor during the full time necessary and for the administration of my estate
the following rights and powers to be exercised in his sole discretion.
A. To retain any real or personal property which may at any time form a part of my estate so long
as he or she deems it advisable.
B. To invest in any real or personal property without restrictions to legal investments.
C. To repair, alter, improve or lease for any period of time any real or personal property and to
give options for leases.
D. Prior to sale of personal property my sisters Margaret Allard and Martha Leon and my niece
Sally Ann Pinchock to go through personal effects and/or persoanl property.
E. To sell at private sale, for cash or credit, with or without security, to exchange or to partition
real or personal property, and to give options for leases.
F. To make distribution in kind.
G. To compromise claims.
~
"t'"
IN WITNESS WHEREOF, I have hereunto set my hand this )fI) day of
() cr- ,1999.
SIGNED fL.z...-v<-<L- 7/'v?~]
ANNA MICZO l
The preceding instrument, consisting of this and two other typewritten pages each identified by the
signature of the Testatrix was on the day and date thereof signed, published and declared by the
Testatrix therein named as and for her last will, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed our names.
C)fsfK,
P AGE TWO OF THREE PAGES
oJ
.
.. .,
, .
COMMONWEALTH OF PENNSYL VANIA
ss
COUNTY OF CUMBERLAND
We !I~ (;tr/Tt '/ Crt tAo '/ and
witnesses whose names are sigr{ed to the attached or foregoing instrument being duly qualified
according to law, do depose and say that we were present and saw the Testatrix sign and execute
the instrument as her last will; that she signed willingly and executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed
the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more
years of age, of sound mind and under no OOnBtr~"}d~ce.
Sworn and subscribed to
before me thiSJ{ ~ay
ofDLh~1999.
L{l..el; cJtv aLCQ[t~
l'~o&try Public
Notarial Seal
Bridget Ann Corcoran, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires June 10,2002
COMMONWEALTH OF PENNSYL VANIA
ss
COUNTY OF CUMBERLAND
I, ANNA MICZO, whose name is signed to the attached instrument, having been duly qualified
according to law, do hereby acknowledge that T 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 and bffirmed to and acknowledged before me this J
o cl--D 0 (" , 1999
g,-,'~.et cilAA< G-JU'Jd
Notary P blic
PAGE THREE OF THREE PAGES
A~A~1CW '7Ju~~
tp
day of
Notarial Seal
Bridget Ann Corcoran, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires June 10,2002
r
',-
WHEREAS, on
dated October
was admitted to
. .
Register of Wills of CUMBERLAND County, pennsy'
Certificate of Grant of Letters
No. 2001-00341 PA No. 21-01-0341
ESTATE OF MICZO ANNA
(LA~~, r~K~~, M~UUL~)
Late of
NORTH MIDDLETON TOWNSHIP
~UM~~~U ~UUN~l,
,
Deceased
Social Security No. 205-18-1150
day of March
the 30th
27th 1999
probate as the last will of MICZO ANNA
(LA~~, r'~K~'l', M1UUL~)
late of NORTH MIDDLETON TOWNSHIP
14th day of March 2001 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and f r.
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certif}
that I have this day granted Letters TESTAMENTARY
to MARGARET ALLARD and SALLY ANN PINCHOCK
2001 an ins1
,
CUMBERLAND County, who died on t
..
who have duly qualified as Executor(rix)
and have agreed to administer the estate according to law, all of which full~
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 30th day of March 2001.
~n'4 ~.~ ~.p8~.:\--~
eg~st r of . ~ s
EXHIBIT
I g
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
, ,
*
CQMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
I
DEPT. 280601
HARRISBURG. PA 17128-0001
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21 -0 1 0 3 4 1
""CoUNTYCOOE -YEAR- - - NWiiER- -
DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
....
Z
W
C
W
o
W
C
MICZO ANNA
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
03/14/2001 09/15/1919
(IF APPLICABLE) SURVIVING SPOUSES NAME (LAST. FIRST. AND MIDDLE INITIAL)
2 0 5 - 1 8 - 1 150
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
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[K] 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date 01 death prior to 12-13-82}
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
to-
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
HUBERT X. GILROY 4 NORTH HANOVER STREET
FIRM NAME (II Applicable)
BROUJOS & GILROY P.C. CARLISLE, PA 17013
TELEPHONE NUMBER
717-243-4574
1. Real Estate (Schedule A)
OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
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3. Closely Held Corporation. Partnership or Sale-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly ONned 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)
(7)
i: :~
IJ
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.j:::.
109,043.10
220,~~0
= (6'
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9
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(6)
9 Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I)
11. T olal 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)
(9)
(10)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15 Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19 Tax Due
X _(15)
X _(16)
147,930.02 X .12 (17)
147,930.02 X .15 (18)
(19)
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
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
104,1.83.41
(...:~
';:.) I, .
(8)
434,051.91
36,394.16
3,177.70
(11)
(12)
(13)
39,571.86
394,480.05
98,620.01
(14)
295,860.04
EXHIBIT
17 751.60
22189.50
39 941.10
I
r/
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND
K MATH < <
Decedent's Complete Address:
. .
STREET ADDRESS
91 SUNSET DRIVE
CITY I STATE I ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
39,941.10
Total Credits (A + 8 + 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 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. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
39,941.10
39,941.10
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; .................... ...................................................... 0 [Z]
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [Z]
c. retain a reversionary interest; or .................................................................................................... 0 [Z]
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [Z]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.... ..... ...... .... ...................... ........ .... .... ................ .... ................. 0 [Z]
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 [Z]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 [Z]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
)<...
AD RESS
T~.h7.rf(9~
S~URE OF PREPARER ~RESENTATIVE
AOORES~ax.
~ Pc~ '~5 o~- /5:'lJ 0
DATE
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. 99116(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. 99116 (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. 99116(a)(1.2)1.
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 PS 99116(1.2) [72 P.S. 99116(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. 99116(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.
<."~.,,,,(; .-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R ID N D NT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
MICZO. ANNA 21 01 0341
All real property owned solely or as a tenant in common 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
1.
DESCRIPTION
Sale of real estate at 91 Sunset Drive, Carlisle, PA
(net proceeds - see Hud-1 attached)
VALUE AT DATE
OF DEATH
109,043.10
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
109,043.10
.,
A.
u.s. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
4.0VA
OMB NO. 2502-0265 -"="
SETTLEMENT STATEMENT
2.0FmHA
C NOTE: This form is furnished to give you a statement of actual settlement costs Amounts paid to and by the settlement <!gent are shown.
Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not Included In the totals
'.0 3198 (MlelO. ANNA ESTATE OF.PFDlMlClO. ANNA ESTATE 0/5)
D NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER F. NAME AND ADDRESS OF LENDER
John H. Billman
5 Mt. Rock Road
Newville. PA 17241
Estate of Anna Mielo
4. North Hanover Street
Carlisle, PA 17013
G PROPERTY LOCATION
91 Sunset Drive
Carlisle. PA 17013
Cumberland County. Pennsylvania
H. SETTLEMENT AGENT
Broujos & Gilroy, PC.
23-2267691
5 OCONV INS.
May 22,2001
I. SETTLEMENT DATE
PLACE OF SETTLEMENT
4 North Hanover Street
Carlisle, PA 17013
m
Seller
20688
15537
::J
10.13297
8
HUO.' (3.861 RESPA HB4]O; 2
..
Certified to be a true copy
L. SETTLEMENT CHARGES
119,000.00 @ 7.0000 % 8,330.00
Page 2
PAID FROM
BUYER'S
FUNDS AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS AT
SETTLEMENT
Iday
days
%)
per
per
per
per
per
per
per
per
$
Releases $
25.50
o gage
: Mortgage
( MIClO. ANNA EST ArE 0 I MIClO. ANNA EST ATE 0 15 I
."~".,,. '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
0341
VALUE AT DATE
OF DEATH
6,726.00
2,912.85
16,260.00
16,528.00
24,360.00
424.05
4,408.00
14,386.00
21,502.00
35,827.72
4,569.00
5,920.00
5,309.00
14,497.34
9,515.20
822.51
ESTATE OF
MIClO. ANNA
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
21
01
DESCRIPTION
ITEM
NUMBER
1.
A TT - 300 shares
2 Anadarko Pete - 45 shares
3 Bell South - 400 shares
4 Exxon-Mobil - 200 shares
5 General Electric - 600 shares
6 Avaya - 33 shares
7 Lucent - 400 shares
8 Merck - 200 shares
9 Minnesota Mining - 200 shares
10 Nuveen Insured - 2,4 76 shares
11 Nuveen Penn - 300 shares
12 Raytheon Co CI - 200 shares
13 Union Pacific Corp - 100 shares
14 Verizon - 274 shares
15 Nuveen Tax Exempt Bond - Unit 214 - 95 shares
16 Nuveen Tax Exempt Bond - Unit 223(quarterly) - 57 shares
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
220 225.40
,.
,
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MICZO, ANNA
21
01
0341
PaQe 1
Schedule B - Stocks & Bonds
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17 Nuveen Tax Exempt Bond - Unit 223(semi-annual) - 48 shares 692.64
18 Nuveen Tax Exempt Bond - Unit 224 - 50 shares 657.00
19 Nuveen Tax Exempt Bond - Unit 106 - 52 shares 2,969.72
20 Nuveen Tax Exempt Bond - Unit 118 - 79 shares 2,264.93
21 Nuveen Tax Exempt Bond - Unit 131 - 55 shares 1,127.50
22 Nuveen Tax Exempt Bond - Unit 144 - 109 shares 3,143.56
23 Nuveen Tax Exempt Bond - Unit 99 - 49 shares 555.09
24 Pennsylvania Insured Muns Income - Unit 172 - 5 shares 4,908.20
25 Prime Cash Series/Money Market 19,939.09
SUBTOTAL SCHEDULE B 36,257.73
GRAND TOTAL SCHEDULE B $ 220,225.40
,Wl508EX.i1,~'; ~~
,.~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
MICZO. ANNA
FILE NUMBER
21 01
0341
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Members 1 st Account 3,525.21
Acct # 28905
2 Way point Bank Account 43,227.89
Acct # 1703014705
3 Waypont Bank Acount 27,284.45
Acct # 1700033344
4 First National Bank 28,210.34
Acct # 4877023
5 GE Capital Assurance - rebate 492.89
6 Alliance Mortgage - refund 4.39
7 USAA auto insurance refund 11.68
8 TROA - medical supplemental refund 497.56
9 Proceeds from sale of household items 1,010.00
10 2000 Federal Tax Refund 219.00
11 Federal Tax Refund 300.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
104.783.41
,.,'.
KE".1511EX +(1-971
, .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MICZO. ANNA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
01
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8
9
10
11
12
13
14
DESCRIPTION
FUNERAL EXPENSES:
Burton Funeral Home
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Margaret Allard ($7 ,500) Sally Pinchock ($7 ,500)
Social Security Numbe~s) I EIN Number of Personal Representative(s) 158-18-8882 /184-34-6385
Street Address C/O 4 North Hanover Street
City Carlisle State PA Zip 17013
Yea~s) Commission Paid:
Attorney Fees Broujos & Gilroy, PC
Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
Probate Fees
Accountanfs Fees Boyer & Ritter 2001 Tax Return / Final Return
Tax Return Prepare~s Fees
Register of Wills - Filing
Short Certificates
Cumberland County Law Journal
The Sentinel - legal advertising
File Inheritance Tax Return
File Accounting & Prepared Schedule of Distribution
Reserve to conclude estate
Mailing Expenses - Broujos & Gilroy
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0341
AMOUNT
4,385.00
15,000.00
15,000.00
350.00
346.00
30.00
75.00
93.16
15.00
175.00
750.00
175.00
36394.16
"~
"""""'''0;' ..
ESTATE OF
MIClO. ANNA
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FilE NUMBER
21
01
0341
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
685.23
2
3
4
5
6
7
8
9
10
11
12
PP&L Electric
True Green
42.39
Master Charge
269.73
Carlisle Imaging
9.57
Cresscare Medical
93.17
Robin Sollenberger Taxes
11.00
UPS Mailing
20.43
2000 Tax Preparation/Maloney Reed Scarpitti & Co -paid by Margaret Allard and
reimbursed / see attached
195.00
PA Dept of Revenue 2000 Income Tax - paid by Margaret Allard and reimbursed
see attached
180.00
Reimbursement to Margaret Allard for expense in closing Anna Miczo home
see attached
10.78
Reimbursement to Sally Pinchock for expenses in closing Anna Miczo home
see attached
1,633.65
Reimbursement to Sally Pinchock for expense in closing Anna Miczo home
see attached
26.75
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3177.70
"
.
"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
MICZO ANNA 21 01 0341
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Alexander Miczo Brother 5.35%
620 Alamo Court, Apt 4
Mountainview, CA 94043
2 George Miczo Brother 5.35%
638 Olin Avenue
Girard, PA 16417
3 Helen Miczo Sister 5.35%
4004 Pacific Avenue, Apt 208, c/o Salisbury Apts
Erie, PA 16506
4 Margaret Allard Sister 5.35%
931 Montpelier Avenue
Erie, PA 16505
5 Martha Leon Sister 5.35%
2371 Richland Avenue
San Jose, CA 95125-3644
6 Pauline Wilson Sister 5.35%
5381 Northway Road
Pleasanton, CA 94566-5454
7 Elizabeth Letkiewicz Sister 5.35%
921 W 7th Street, Apt 1
Erie, PA 16502-1102
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. St. Patick Church 20%
140 E. Pomfret Street
Carlisle, PA 17013
2 American Heart Association 5%
98,620.01
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 98620.01
(If more space is needed, insert additional sheets of the same size)
ueceaent
M~CZO, i~NNA
21
01
0341
Paqe 2
Schedule J - Beneficiaries - 1
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)
8 Theodore Miczo Nephew 1.78
260 Landmark Court, # 5
Carrollton, KY 41008
9 William Metzo Nephew 1.78
739 Forest Lane
Taylor Mill, KY 41015
10 Vincent Leon Nephew 1.78
2371 Richland Avenue
San Jose, CA 95125-3644
11 Paul Letkiewicz Nephew 1.78
1830 West 35th Street
Erie, PA 16508-2112
12 Sean Letkiewicz Nephew 1.78
921 W 7th Street, Apt 2
Erie, PA 16502
13 Alan Miczo Nephew 1.78
5662 South Calann Drive
Salt Lake City, UT 84121
14 Nathan Miczo Nephew 1.78
1424 Westview Drive
Macomb, 1161465
15 Donna Hawes Niece 1.78
1049 SE Walnut Street, Apt 20
Hillsboro, OR 97123-4650
16 Margaret Gilbert Niece 1.78
1 Strout Lane
Durham, NH 03824
17 Elizabeth A. Nash Niece 1.78
2388 Ewing Drive, NE
Atlanta, GA 30319-3930
18 Katherine Metzo Niece 1.78
c/o Ruth Metzo, N168W20101 Main Street
Jackson, WI 53037-9602
19 Christine Metzo Niece 1.78
c/o Ruth Metzo, N168W20101 Main Street
Jackson, WI 53037-9602
20 Sally Ann Pinchock Niece 1.78
5334 Noland Drive
Tecumseh, MI 49286-9584
21 Susan Holbrook Niece 1.78
1101 West Avenue
Medina, NY 14103-1734
~ -
"-"- .....g. "..,g , ...., H-"""~ ,..,el"e I. u
2220 Buffolo Run
Las Vegas, NV 89123
- -...-....---.-.. -. 1.._. -___ .......... .110......"'.... ...." . ,v.... .. . ...__.__... -...."'v""....."
. .
r_~JCZO, ANNA
21
01
0341
PaQe 3
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OFEST ATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
23 Lisa Cox Niece 1.78
8220 Mountain View Drive, #E
Pleasanton, CA
24 Theresa Anderson Niece 1.78
2371 Richland Avenue
San Jose, CA 95125-3644
25 Eva Smith Niece 1.78
401 Baylor Drive
Woodland, CA 95695
26 Lori Gambino Niece 1.78
187 Seward St
Buchanan, NY 10611
27 Erica Schuster Niece 1.78
6636 Manchester Farms Road
Fairview, PA 16415
28 Emily Schuster Niece 1.78
6636 Manchester Farms Road
Fairview, PA 16415
..
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF ~NDIWIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8060l
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
HUBERT X GILROY
BROUJOS 8 GILROY
4 N HANOVER ST
CARLISLE
PA 17013
02-04-2002
MICZO
03-14-2001
21 01-0341
CUMBERLAND
101
Mount R_i tted
'*
IEY-1547 EX IF' (12-111
ANNA
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 ~
REY=is'4-f-EX--AFP--(i'2-=OOY-NOYicE--OF-YtiHERiTANCE-YASc-APPRA-isEiiENT~--Ai.LoNAifcE-cfR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MICZO ANNA FILE NO. 21 01-0341 ACN 101 DATE 02-04-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
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)
S. Cash/Bank DapositslMisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
( ) CHANGED
(1)
(2)
(3)
(4)
(S)
(6)
(7)
109,043.10
220,225.40
.00
.00
104,783.41
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. CostslMisc. Expenses (Schedule H)
10. DebtslMortgage Liabi1ities/Lians (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
lS. Amount of Line 14 at Spousal rate (lS)
16. A.ount of Line 14 taxable at Lineal/Class A rate (16)
17. A~t of Line 14 at Sibling rate (17)
18. A.ount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
11-09-2001
NOTE:
RECEIPT
NUMBER
CD000505
T (+)
INTEREST/PEN PAID (-)
.00
EXHIBIT
I~
36,394.16
3,177.70
(11)
(2)
(3)
(4)
(9)
UO)
.00 X
.00 X
147,930.02 X
147,930.02 X
AMOUNT PAID
39,941.10
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
00 =
045 =
12 =
15 =
(9)=
NOTE: To insure proper
credi t to your account,
sub.it the upper portion
of this fOnD with your
tax pay.ant.
434,051.91
39.571 86
394,480.05
98,620.01
295,860.04
.00
.00
17,751.60
22,189.50
39,941.10
39,941.10
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIr' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
.