The URL can be used to link to this page

Home My WebLink About02-0807 Estate of Ve (VeL.- \I,' VI '<< "'- also known as PETITION FOR PROBATE and GRANT OF LETTERS No. 2." "02..~+ To: (\'\""",'<-L Register of Wills for the , Deceased. County of C"-"",~.Q .-1 a-..L- in the Social Security No. ol. 0 \..f - 2l? - '0 '2- \.f Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner~, who isf.ftre.18 years of age or older an the executr: r- in the last will of the above decedent, dated and ~Baieil(3) silted-- CD - r::.. 'L e c u."h>r Le f'2.c) ~ w. /k.,It \ t..-k.. ~.,.. ",.J-, I L.. -I CC - '1~ Tu 1"1 .p '1 named ,19KL (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C ~Ik , ~. f ~ f\. ~ ~nty, Pennsylvania, with he'). last..fami~ or principal residence at ~ r'l~;~o"; nq(( Load! '/,,.,....,c: Ph'-" ti e hn.... ""-w Jj. a,.. II 'A f 70 I ? , . (list street, number and muncipality) 4 I~ Decendent'lhen, ft years of age, died ,out u.s r ~, ~;20c i1 , at k~ a..bD~ . 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: J1 0'" 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: (q (6(9.00 I $ $ $ $ WHEREFORE, petitioner~ respectfully request(s) the probate of the last will aad ~gdkil(s)- presented herewith and the grant of letters -r e { fa lfI\ ~ n. +n r--1 (testamentary; admimstration c.I.a.; administration d.b.n.c.l.a.) theron. '" or u t: ., :9~ "'~ ., ... ~., t: .,,0 c.;:: cu '';: 3~ .,..... ;;0 ~ t: bO Vi ~:;1~~:!Ft1{~((~ m..ia0 Ca.,...fl~(L IA 17() (? , OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERlAND J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed { ~tl'~ 7Jfn/}~ P~.A, !f1/;''uL before me this 8'52 day of SEPI'EMBER:l ~__ ~~~~'A." ~. ^ ,. 'R(fgister V:l QQ' ::s l::l .... l:: ~ ~ . - ...... No. 21-02-807 Estate of VELVA VIVIAN MINICH , Deceased DECREE OF PROBATE AND GRANT OF LETTERS SEPTEMBER 9, 2002 AND NOW 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 6-9-1989 described therein be admitted to probate and filed of record as the last will of VET -:VA VIVIAN MINICH and Letters TF.STAMENI'ARY are hereby granted to FAY MARCEUA MINICH (TRROV W MTNTCH PASSED AWAY) FEES Probate, Letters, Etc. ......... $ 'i~ ~qm . Short Certificates(~ . . . . . . . . .. $ ~Z. 9Q, ~.~ .~'ft:{l. rr"1,~\'.\\ $ 6?e-Q0 ::Tc...P ~ $ 9;~ TOTAL _ $ 63.00 Filed ..... ~:-.9.-:?99.2. . . . . . . . . . . . . . . . . . . . . called atty 9-9-2002 Register of Wills JOh~~. /106268 ATIORNEY (Sup. Ct. I.D. No.) 4 N.Hanover St, Carlisle,PA 17013 ADDRESS 717-243-4574 PHONE \,-\ '...0 I HI05.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death. duly filed with me as Local Registrar. The original certificate will be. forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. Date ~~.~~~~ Local Registrar Fee for this certificate, $2.00 p 8607727 AUG 1 9 2002 H'OS.I<3.....2117 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH .... SEX !NT !!NT OK NAME OF oeCEDENT if.... Middle. L., t. Velva V. Minich AGE (lul_ UNDER' YEAR - Ooyo 88 ~o COUNTY OF DERH . ... Cl.mber land . !lEeEDENT'S USUAL OCCUPl<lIOH ~~-='c:'~:r ... Hanemaker .... Own Home OECEDENT.SIIAIUNO_sa(SO....~_ZiP~ OECE!lENT'S 41 Pleasant Hall Rd. ~~ Carlisle, PA 17013 ~~ ,.. _SNAME(F"..._,lOOOl t Russell Sn er ...-rs..-crJOO'!"W! Fay M. Minich METHOO OF OISPCllIITIOH _Dl ~O __.....0 0IIw!!tv "'\t White SUIMYING SI'OUSE 1;11...... grve mIIlWi '*"" d,\ 11.. sa. PA Old - ...... - , ,..1n ___.. - ,7b. ,1tIcn. ory arr.... II'IOCl or ....." ...... ... ,- '-- :_w..- I I I PART" ""*___..-..... ---DM.....___.."""'l t : DUE 10 lOA AS' CONSEQUENCE Of): -.. - 'IjG o o DATE OF INJURY (,,-,lloy,-I TIME Of INJURY 1NJUAY 1<1 WOAK'I DESCRIBE HOW INJUAY~D. WERE AUlOPS'Y FINOlNGS ~""""'10 COMP\.ETlON OF CAUSE OF DEATH? MANNER OF DEATH ...~ ....0 ...~ - Coukt not be cteternuned o o o PlACEOFINJURY-AlhorM.rann.......1acIOtY.offtct; ... -....- 300. .... 0 ...0 - __Ion "MEDICAl. EXA_EIlICOllONER Oft the HII. of 'J1aminetion andIOIlnv.ttlgatkMt. In my opinion_ death occuned at the time, date, and prace. and due to the cauNet) and ....ftner..ttet..................... .......... ................................"............... .............. .... ... 3t.. REGISTRAR"S SKlNRURE ANO HUM , t:\. ~eu..~~ ~d~l,ol ... ... CltlTIl'lEtl'OOO.... _ -c&ITWYING PHYSICIAN (PhYlC*'~eeuM~ dMII'l",,*,.InOlhIr ClhyIC.... ha pronauncId dIIa1h ~CCJmCMted tItm 23) . Te........otMY~.......oocun'II4....._~.).ndmanne'......tIlI.......... ....... ............ ............ ... ... ...... ft. ~AHOCEflTlnINQ ItHYSICIAN(Phrsic1en bolt't pronounctr'lOOHth"'C~IOCluMoI deathl To........ of"" k~. dutttoccurNlll at the _. ..... ....,.....nd due to the UUM(I).nd m.nner nstllted......................'... 4 , ~ ~ WILL 21-02-807 I, VELVA VIVIAN MINICH of 41 Pleasant Hall Road, Carlisle, North Middleton Township, 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 give, devise and bequeath my house, garage, and household effects, including antique dishes, therein, except as otherwise disposed of in this will, and approximately 1.5 acres of land on which the house is erected, to my daughter FAY MARCELLA MINICH, if she survives me. In the event that my daughter FAY MARCELLA MINICH does not survive me, then I give, devise and bequeath the property herein to my son LeROY W. MINICH, per stirpes. ITEM THREE: I give and bequeath all of my interest in my savings account at Pennsylvania State Employee's Credit Union at the time of my death to my daughter FAY MARCELLA MINICH, if she survives me. In the event that my daughter FAY MARCELLA MINICH does not survive me, then I give and bequeath my interest to the children of my son LeROY W. MINICH, equally, share and share alike, to be held in trust by trustee as set forth herein. ITEM FOUR: I give and bequeath to my son LeROY W. MINICH my 1964 Plymouth Fury, antique pump organ, tractors, mowers, machines, and paraphernalia located in the last or eastern bay of my garage. In the event that he predeceases me, then I give and bequeath this property to the children of my son LeROY W. MINICH, equally, share and share alike, per stirpes, to be held in trust by the trustee. ITEM FIVE: I give and bequeath to my children such personal items such as pictures and miscellaneous mementos of my husband BUTCH MINICH and me as the children shall agree upon or in the event of disagreement, as decided by the executor in the executor's absolute discretion. ITEM SIX: I give, devise and bequeath the rest, residue and remainder of my estate, whether personal or real, of whatever nature, to my children FAY MARCELLA MINICH and LeROY W. MINICH, equally, share and share alike, per stirpes. ITEM SEVEN: I appoint my children, FAY MARCELLA MINICH and LeROY W. MINICH Co-Executors or the survivor as Executor of this my last will. For purposes of resolving any disputes between the Executors, I direct that Farmers Trust Company be appointed Co-Executor, for the purpose of resolution of any dispute and with all of the rights, powers, and duties of an executor. I authorize the appointment of Farmers Trust Company of Carlisle as Co-Executor upon delivery to Farmers Trust Company of a letter from the Co-Executors setting forth the nature of any disagreement. ITEM EIGHT: I appoint Farmers Trust Company of Carlisle Trustee for the purpose of administering and disposing of any portion of my estate designated herein to be placed in trust and for any property passing to a person under the age of 25 years. PAGE ONE OF THREE PAGES A. Trustee shall hold manage, invest, and reinvest trust income and after paying all charges and costs of any kind, properly payable by the trust, shall apply and pay over the net income therefrom and so much of principal thereof as required for the maintenance, welfare, comfort, travel, benefit, and education, including post graduate and technical schools, of the beneficiaries. Trustee shall liberally construe this provision and shall have the right to pay such portion of principal as trustee deems advisable in Trustee's absolute discretion. Trustee shall make payments from income and as necessary from principal until each beneficiary shall attain the age of 25 years, at which time the balance of the principal and income in the separate account for such beneficiary shall be payable thereto and the trust for that beneficiary terminated. B. In the event of the decease of any beneficiary during the administration of any trust account established therefor, trustees shall transfer and convey the remaining principal and income thereof to a separate account for the issue of said beneficiary or in the event that there are no issue, then to the surviving beneficiary or beneficiaries, administering the trust in the same manner as set forth herein. C. Trustee shall make payments hereunder without further responsibility to the beneficiary or to the beneficiary's parents or to any persons taking care of the beneficiary. ITEM NINE: 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 TEN: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM ELEVEN: 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 and to my Trustee, 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 as 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. To sell at public or 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. E. To make distribution in kind. F. To compromise claims. IN WITNESS WHEREOF, I have hereunto set my hand this ~+~ day of q ~ 1989. SIGNED Vkkll.~~ VELVA VIVIAN MINICH PAGE TWO OF THREE PAGES 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 h bscribed our names. \ COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We J~ ~.J. Sl.~-e--->'C~S and !I"btol.,-XG('-~t witnesses '~ose names are\signed to the attached or foregoing instrument being duly qua1ified 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. Sworn and subscribed to before me this q+~ day Q~ ~~ of , 1989. n7(.~~ Notary Public NOTARIAL SEAL . CONSUElO M. ROSITO, Notary Public 80ro of Carlisle, Cumberland County, Pa. ' My Commission Expires October 5, _1~~1 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, VELVA VIVIAN MINICH, 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 willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. VfJJ~~V ~~v~~~u.~ ,1{/ VELVA VIVIAN MINICH Sworn and affirmed to and acknowledged before me this qiR day of /2~ , 1989. ~~ ~./(~ Notary Public NOTARIAl. ~EAI. CONSUELO M. ROSITO, Nctary Public Boro of Carli~:c. C:.,....; i~nd County, Pa. My Commis iO~1 E ';:-ires October 5, 1992 PAGE THREE OF THREE PAGES J CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Velva Vivian Minich Date of Death: August 16, 2002 Will No.: Admin. No.: 21-02-0807 To the Register: I certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on q~ 2- t(-o 1.- Name Address Fay Marcella Minich 41 Pleasant Hall Road, Carlisle, P A 17013 Jessica Ann Dalinsky 409 E. Pine Street, Mahanoy City, P A 17948 Curtis Lee Minich 1112 BemRoad, Wyomissing, PA 19610 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none Date~ ~'/. ~tIJ :< . :J j'~Jd~U~ Sign re Fay Marcella Minich 41 Pleasant Hall Road Carlisle, P A 17013 (717) 243-5798 Capacity: X Personal Representative Counsel for Personal Representative INVENTORY OF THE REAL AND PERSONAL ESTATE OF Velva Vivian Minich, deceased File No.: 21-02-0807 Date of Death: August 16, 2002 1. Refunds from Conseco Senior Health insurance Company for nursing care at Sarah A. Todd Memorial Home $ 6,761.42 2. Refund of Conseco insurance policy premium 600.96 3. P A income tax refund 20.00 $ 7,382.38 Total Jointly-owned property with daughter, Fay M. Minich % of De cd's DOD Value Interest DOD Value of De cd's Int. 1. Pennsylvania State Employees Credit Union acct/member # 8002982158 savings $28.58; checking $3,370.88 $ 3,399.46 50 $ 1,699.73 Fay Marcella Minich, deposes and says that she is the Executrix of the Estate of Vel va Vivian Minich, late of Carlisle, Cumberland County, Pennsylvania, and that the within is an inventory made by Fay Marcella Minich, the Executrix of the entire estate of decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent its fair value as of the date of decedent's death. ~~ JJ1CPi1dLvd'~Ld} Fay arcella MInIch, Executnx Date: May 8, 2003 .~ ~ //7- <7/ I ,~(~, .~EV-'500e:X,+.(6-00) '* -- /,~/~- REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 . OFFICiAl USE ONLY FILE NUMBER 21 -0 2 00807 COUNTY'C05f -----vEAR- - - ifuMBER-- I- Z W C W () W C DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) MINICH VELVA VIVIAN DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year} SOCIAL SECURITY NUMBER 204-28-1024 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ~:$U) 0."" W~(J :t:a::g 0"-10 "- " 08/16/2002 03/25/1914 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [Xl 1. Original Return o 4. Limited Estate [R] 6. Decedent Died Testate (Allach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise ((ja~ofUe;l.\lI af\e 12.12.B2) o 7. Decedent Maintained a Living Trust (AttaCh copy of Trust) o 10. Spousal Poverty Credit (dateofdeathbetween 12-31-91 and 1-1-95) o 3. Remainder Return (dClleofdeath prior to 12-13-82} o 5. Federal Estate Tax Return Required Q.. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED_ ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ACDRESS JOHN H. BROUJOS ESQUIRE 4 NORTH HANOVER STREET FIRM NAME (If Applicable) BROUJOS & GILROY P.C TELEPHONE NUMBER 717-243-4574 or 717-766-1690 CARLISLE PA 17013 I- Z W o z o "- Ul W '" '" o o z o i= <( ...I ~ l- n: <( () W II:: z o i= <( I- ~ 0. ~ o () >< j::!: 1. Real Eslate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule OJ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Joinly Owned Property (Schedule F) o 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 Uabmties, & Liens (Schedule I) 11. Total Deductions (tolal Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) 0('": ..- - _f: ::j~ ~ lei . V-> OFFICIA!:\llSE ONLY (1) " :',) ::;< ::< r' I~i. ~ I, IN 7,382.38 --u ~ ~,' I (.f1 1,li99.73 w (8) 9,082.11 (9) (10) 5,605.00 183.92 14. Net Value Subject to Tax (Line 12 minus Line 13) 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) 19, Tax Due X _(15) 3,293.19 X .045 (16) X .12 (17) X .15 (18) (19) (11) (12) (13) 5.788.92 3,293.19 16. Amount of Line 14 taxable at lineal rate (14) 3,293.19 17. Amount of Line 14 taxable at sibling rate 148.19 148.19 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 < < 18. Amount of Line 14 taxable at collateral rate Decedent's Complete Address: STREET ADDRESS 41 Pleasant Hall Road CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. TaxDue(Page1Line19) 2. Credits/Payments A. Spousal Poverty Credit B Prior Payments C. Discount (1) 148.19 Total Credits (A + B + C) (2) 3. InteresUPenatty if appiicabie D.lnterest E. Penalty TotallnteresUPenalty (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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 148.19 148.19 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 [Rj b. retain the right to designafe who shall use the property transferred Of its income; . . ................ ......... 0 [Rj c. retain a reversionary interest; or . .................. ...... 0 1KI d. receive the promise for life of either payments, benefits or care? ... ............... .................. ... 0 [Rj 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?... . .................. ....... 0 IKl 3. Did decedent own an 'in trust for or payabie upon death bank account or security at his or her death? . ... 0 [Rj 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.... .................................. . .... ............................................. 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is trUE', CDJTect and complete Declaration of pre parer other Ihan the personal representative is based on all information of which preparer has any knowledge. SiGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN, X ';t,,~ /r?.A'1/).l'PtJfAI:7lJl~-u<1....) ADDRESS 41 leasant Hall Road Car'sJe SIGNATURE OF PRE ERO H TH~\~NTATIVE0 ADDRESS 4 N. anover Street Carlisle DATE O!J-()'K'-o3 PA 17013 DATE 5'-j? 05 PA 17013 For dates of death on or after Juiy 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (li)]. The statute does not exempt a transfer to a surviving spouse from tax, and fhe statutory requirements for disclosure of assets and fiiing 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 vatue of transfers from a deceased chiid twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value oftransters to orforthe use olthe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 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. ."v.'~m"'.",I* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF MINICH VELVA VIVIAN FILE NUMBER 21 02 00807 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Refunds from Conseco Senior Health Insurance Company for nursing care at Sarah A Todd Memorial Home VALUE AT DATE OF DEATH 6,761.42 2. Refund of Conseco insurance policy premium 600.96 3. PA income tax refund 20.00 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 7 382.38 .""eoo"'I.'."* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY.OWNED PROPERTY ESTATE OF MINICH VELVA VIVIAN If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FilE NUMBER 21 02 00807 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Fay M. Minich 41 Pleasant Hall Road Carlisle, PA 17013 B c daughter JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %0' DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and tlank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deedforjointly-heldrealeslale VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1980 Pennsylvania State Employees Credit Union 3,399.46 50. 1,699.73 acct # I member # 8002982158 savings $28.58; checking $3,370.88 TOTAL (Also enter on line 6, Recapitulation) $ 1 699.73 (If more space is needed, insert additional sheets of the same size) 'eEV';'''X''''''* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF MINICH VELVA VIVIAN FILE NUMBER 21 02 00807 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. prepaid B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Fay Marcella Minich 1,000.00 Social Security Number{s) I EJN Number of Personal Representative{s) 175-34-8046 Street Address 41 Pleasant Hall Road City Carlisle State PA lip 17013 Year(s) Commission Paid: 2002 2. Attorney Fees Broujos & Giiroy, P.C.; ErN: 23-2267691 1,000.00 3 Family Exemption: (1f decedenfs address is no11he same as claimanfs, attach explanation) 3,500.00 Claimant Fay M. Minich Street Address 41 Pleasant Hall Road City Carlisle State PA lip 17013 Relationship of Claimant to Decedent dauQhter 4. Probate Fees Register of Wills 63.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. Inventory filing fee - Register of Wills 10.00 8. Inheritance Tax Return filing fee - Register of Wills 15.00 9. Famiiy Settlement Agreement filing fee - Register of Wills 17.00 TOTAL (Also enter on line 9, Recapitulation) $ 5 605.00 (If more space is needed, insert additional sheels 01 the same size) CLAIM FOR F AMIL Y EXEMPTION IN ACCORDANCE WITH 20 Pa.CS 31, 21 To the Executrix of the Estate of Vel va V. Minich: !, Fay Marcella Minich, claim the Family Exemption of $3,500 payable to me under 20 PaCS 31, 21 and ! request that this amount be paid to me in cash. ! am the daughter of decedent and I resided with her as a member of the same household at the time of her death. %;t JJi11/",J/t/ n ~ JV Fay arcella Minich May 8, 2003 ."v'"",,:,;"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF MINICH. VELVA VIVIAN FILE NUMBER 21 02 00807 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Moffitt Heart & Vascular Group (48.01 + approx. 9.61 for 2 visits) 1000 N. Front Street, Wormleysburg, PA 17043 57.62 2. Central Penn Medical Group - April 6 ER exam by Dr. Guarrac 11.48 3. Philhaven, Lancaster, PA - psychiatric consult 114.82 TOTAL (Also enteron line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 183.92 .R8I""""''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES EST ATE OF FilE NUMBER MINlrH 1F'1 VA VIVIAN ?1 O? 1\1\1'.1\7 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not list Trust..ls} OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Fay Marcella Minich daughter 1/2 41 Pleasant Hall Road, Carlisle, PA 17013 2. Jessica Ann Dalinsky granddaughter 1/4 409 E. Pine Street, Mahonoy City, PA 17948 (daughter ofLeRoy W. Minich, deceased 12-19-98) 3. Curtis Lee Minich grandson 1/4 433 Zeigler Road, Leesport, PA 19532 (son of LeRoy W. Minich, deceased 12-19-98) 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. 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART I1- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROUJOS JOHN ESQ 4 N HANOVER ST CARLISLE, PA 17013 -..------ fald ESTATE INFORMATION: SSN: 204-28-1024 FILE NUMBER: 2102-0807 DECEDENT NAME: MINICH VEL V A VIVIAN DATE OF PAYMENT: 05/12/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/16/2002 NO. CD 002554 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $ 1 48. 1 9 I I I I I I I I TOTAL AMOUNT PAID: $148.19 REMARKS: C/O JOHN H BROUJOS, ESQ. CHECK# 3322 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS I~-Pb - /<.::2/ \. BUREAU OF INDIVIDUAL TAXES ~ INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV~lS47 EX AFP (0)-03) Rec,-;: _r f-ifr, ,."; r I DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-16-2003 MINICH 08-16-2002 21 02-0807 CUMBERLAND 101 VELVA V '03 JUN 20 An :40 JOHN H BROUJOS 4 N HANOVER ST CARLISLE PA 1 ~~i3" Clanb(~ :a, Amount Remitted 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 ~ R 'EV=is4-j-Ex-i.Fp--coY:oiY-NoYicE--oF-YtiHEifiTANcE-Yix-'A-ppR'ATsEMENT-:--i.ii-oWAN-CE-(ji----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MINICH VEL VA V FILE NO. 21 02-0807 ACN 101 DATE 06-16-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Pa~tne~ship Inte~est (Schedule C) 4. Mo~tgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Pe~sonal P~ope~ty (Schedule E) 6. Jointly Owned P~ope~ty (Schedule F) 7. T~ansfe~s (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 7,382.38 1,699.73 .00 (8) NOTE: To insu~e p~ope~ c~edit to YOu~ account, submit the uppe~ po~tion of this fo~m with YOu~ tax payment. 9,082.11 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. 10. 11. 12. 13. 14. Fune~al Expenses/Adm. Costs/Misc. Expenses (Schedule H) Debts/Mo~tgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Retu~n (9) ClO) 5,605.00 183.92 (11) Cl2) Cl3) Cl4) 5.788 9~ 3,293.19 .00 3,293.19 Cha~itable/Gove~nmental Bequests; Non-elected 9113 T~usts (Schedule J) Net Value of Estate Subject to Tax NOTE: If an assess.ent was issued preViously, lines lti, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !ll. returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal ~ate Cl5) .00 X 00 .00 16. Amount of Line 14 taxable at Lineal/Class A ~ate Cl6) 3,293.19 X OtiS = lti8.19 17. Amount of Line 14 at Sibling ~ate Cl7) .00 X 12 = .00 18. Amount of Line 14 taxable at Collate~al/Class B ~ate Cl8) .00 X 15 = .00 19. P~incipal Tax Due Cl9)= 148.19 TAY ~REDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-12-2003 CD002554 .00 148.19 TOTAL TAX CREDIT 148.19 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A R~~lIwn ~~C' DI:'\I~Dr-r- ~.......- -- -..-- --- Family Settlement Agreement File No.: 21-02-0807 THIS is an agreement entered into this / ~ay of ~, 2003, by and between Fay Marcella Minich, Executrix and Beneficiary under the Estate of Velva Vivian Minich, of 41 Pleasant Hall Road, Carlisle, PA 17013 (Executrix), and Curtis Lee Minich, 433 Zeigler Road, Leesport, PA 19532, and Jessica Ann Dalinsky, 409 E. Pine Street, Mahonoy City, PA 17948, Beneficiaries, whose names are set forth as signatories at the end of this Agreement. WHEREAS: A. Velva Vivian Minich, of 41 Pleasant Hall Road, Carlisle, PA 17013, died on August 16, 2002. B. On September 9,2002, Letters Testamentary were granted to Fay Marcella Minich at File No. 21-02-0807 in the Register of Wills Office for Cumberland County, Pennsylvania. C. Executrix has administered the estate up until the present time and has paid all debts of the estate, including Inheritance Tax owed. D. Velva Vivian Minich died testate, thereby vesting all rights and interest in her personal and real property to her daughter, Fay Marcella Minich, and her son, LeRoy W. Minich who predeceased decedent, thereby vesting his share in his children, Curtis Lee Minich and Jessica Ann Dalinsky. E. The assets of the estate are set forth in Exhibit A attached hereto and made a part hereof. F. Executrix has paid the debts of the estate as set forth in Exhibit B attached hereto and made a part hereof. G. There remains to be distributed to the beneficiaries the assets set forth in the Schedule of Distribution in Exhibit C attached hereto and made a part hereof. H. Executrix and Beneficiaries desire to forego a formal accounting and schedule of distribution and desire to conclude the estate by virtue of the filing of this document. NOW, THEREFORE, Executrix and Beneficiaries intending to be legally bound, state as follows: 1. The Executrix and Beneficiaries agree that the Executrix of the Estate of Vel va Vivian Minich need not file a formal accounting or schedule of distribution. 2. Executrix states that all costs of the estate are paid. 3. Beneficiaries agree that the final distribution of all estate assets remaining after payment of debts and expenses shall be made to the Beneficiaries. 4. The parties acknowledge that any distribution made by Executrix pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executrix with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement ofthe Estate of Vel va Vivian Minich, subject to the provisions hereof. IN WITNESS WHEREOF, Executrix and Beneficiaries, intending to be legally bound, hereby set their hands and seals the day and year first above written. WITNESS: -%7 /~ ~ 7rJa/lN~ 7J1~";""-.., .l.i Fay arcella Minich, Executrix and Beneficiary Curtis Lee Minich, Beneficiary Jessica Ann Dalinsky, Beneficiary 3. Beneficiaries agree that the final distribution of all estate assets remaining after payment of debts and expenses shall be made to the Beneficiaries. 4. The parties acknowledge that any distribution made by Executrix pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executrix with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied ofrecord any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Vel va Vivian Minich, subject to the provisions hereof. IN WITNESS WHEREOF, Executrix and Beneficiaries, intending to be legally bound, hereby set their hands and seals the day and year first above written. WITNESS: h/~ J\~A. Y'\~R ~ 7rJMN2k, lYJ.. ~1A IJ..) Fac:;, 1tc:nd Beneficiary CurtiS Lee tftch, Beneficiary Jessica Ann Dalinsky, Beneficiary 3. Beneficiaries agree that the final distribution of all estate assets remaining after payment of debts and expenses shall be made to the Beneficiaries. 4. The parties acknowledge that any distribution made by Executrix pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executrix with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Vel va Vivian Minich, subject to the provisions hereof. IN WITNESS WHEREOF, Executrix and Beneficiaries, intending to be legally bound, hereby set their hands and seals the day and year first above written. WITNESS: n/~ ~7rJMNPk , 7J1-,-~J.I. IJ..) Fay arcella Minich, Executrix and Beneficiary Curtis Lee Minich, Beneficiary Je . a Ann Dalinsky, Beneficiary EXHIBIT A - ASSETS AND INCOME ITEM NUMBER DESCRIPTION 1. Refunds from Conseco Senior Health insurance Company for nursing care at Sarah A. Todd Memorial Home 2. Refund of Conseco health insurance policy premium 3. PA income tax refund SUBTOTAL Jointly-owned property with dauQhter, Fay M. Minich VALUE AT DATE OF DEATH $ 6,761.42 600.96 20.00 $ 7,382.38 % of Deed's 000 Value 000 Value Interest of Deed's Int. 1. Pennsylvania State Employees Credit Union acctlmember # 8002982158 savings $28.58; checking $3,370.88 $ 3,399.46 50 TOTAL ASSETS INCOME 1. Dividends earned in estate checking/savings account TOTAL ASSETS AND INCOME $ 1,699.73 $ 9,082.11 52.12 $ 9,134.23 EXHIBIT B - DEBTS AND DEDUCTIONS ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES - prepaid B. ADMINISTRATIVE COSTS 1. Personal Representative Commissions - Fay Marcella Minich 2. Attorney Fees - Broujos & Gilroy, P.C.; EIN 23-2267691 3. Family Exemption - Fay M. Minich 4. Register of Wills - Probate Fees C. MISCELLANEOUS EXPENSES 1. Register of Wills - Inventory 2. Register of Wills -Inheritance Tax Return 3. Register of Wills - Final Settlement Statement D. MISCELLANEOUS DEBTS 1. Moffitt Heart & Vascular Group 2. Central Penn Medical Group - April 6 ER exam by Dr. Guarrac 3. Philhaven, Lancaster, PA - psychiatric consult TOTAL Inheritance Tax TOTAL DEBTS AND DEDUCTIONS 1,000.00 1,000.00 3,500.00 63.00 10.00 15.00 17.00 57.62 11.48 114.82 5,788.92 148.19 $ 5,937.11 EXHIBIT C - DISTRIBUTION Assets and Income Expenditures Balance Joint checking account on Exhibit A became property of Fay Minich on date of death Balance for distribution * * * * * Checking account balance Final Bills: Register of Wills - filing fee for Family Settlement Agreement Fay Marcella Minich - Personal Representative Commission Fay Marcella Minich - Family Exemption for care of mother Cash balance for distribution Final Distribution Fay Marcella Minich Curtis Lee Minich Jessica Ann Dalinsky $ 17.00 1,000.00 3.500.00 $ 748.69 374.35 374.35 $ 9,134.23 - 5.937.11 $3,197.12 - 1.699.73 $ 1,497.39 6,014.39 4.517.00 $1,497.39 -0- Q); oV" STATUS REPORT UNDER RULE 6.12 Name of Decedent: Velva Vivian Minich Date of Death: 8-16-02 Will No. Admin. No. 21-02-0807 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 X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account/statement with the Court? Yes No X 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 X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. 0'. ~~ ~ J/JoI>~.JiLJJ?~~j,) Sign ure Date: 8-- b2, 0 3. N I (V'"''l P -- " r ~, ...~~ Fay Marcella Minich 41 Pleasant Hall Road Carlisle, P A 17013 (717) 243-5798 Capacity: Personal Representative