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HomeMy WebLinkAbout02-0471 PETITION FO~ttOBATE and GRANT OF LETTERS Estate of K/JThAtf(flV{- ~CA5 No. 2.'-02.- LI', also known as - ~ To: ~ i ,#)f!;J~ h j~:jt: ~eceased. ~~~~~~r ~:~~l~~~~~~~j in the Social Security No. /91.f - 'f.J'- '1;,t q "7 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut in the last will of the above decedent, dated and codicil(s) dated '><' '" named , 19-1l- (state relevant circumstances, e.g. renunciation, death of executor, etc.) (list street, number and muncipality) Decendent, then 9 I at 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 pr bate; was not th ictim of a killing and was never adjudicated " ,,"' L incompetent: , "" years of age, died ~ 6~ tI .4-k> 1./ .5l.s1h ~ ~ t'Jt') 2, / 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: / & 'r S I,t; I{ ,d; r- C /fri1,tJ if,' i I b (). /' 7~.t' / , " r ,dg,So<<J/ '/ ::;; WHEREFORE, petitioner(s) respectfully request(s) gthe probate of the last will and codicil(s) presented herewith and the grant of letters ."<=/1 e /l~{LJ1. ; tV.9r,{ 111;' /IN ~ tv " '-'- (testamentary; administration c.La.; administration d.b.n.c.t.a.) theron. ~ ';;" u j~ I1jtl{-/~ ~:}%f~jl/ l~ 0/f-J"11 j) I.J. iLl ,) If'1}, /70/ I 3d: ,,~ ;; 0 '" '" 00 Vl 1l-~ f 11 Xjfl4 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss ~() (; -3 ~-O /4-(P COUNTY OF -C,L/fI h tE,(? L;t}Nd 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 ~ding to law. Sworn to or affirmed and subscribed -1ll ry f, -1lltZJ ~ before me this 1 3th day of ~ 'M2 ~ I: ~ ~ I, - (03- 10 No. 21-02.- LlJI Estate of KATHARINE FUCHS , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY 1 5, 2002 ~v , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, lT IS DECREED that the instrument(s) dated 09-29- 1995 described therein be admitted to probate and filed of record as the last will of KATHARINI\\FUCHS A.k. A 'l<c..::h'IA..r\nl' \-,;,('1'15 0- .k. c:. ~"'ri.....-l r:;:,chs and Letters TESTAMENTARY are hereby granted to MARY E MAZURIKV \~:?/~?:f!:'//~ ~/J~n//2(7 ) /:J~Ajj Y C ISRegi r of Wills '--Y '1 / FEES Probate, Letters, Etc. ......... $ 200.00 S 12.00 hort Certificates( ).......... $ ~ .E:)S:t1="i'l. .pQ.ggEl.. $ 6.00 jcp $ 5.00 TOTAL _ $ 235.00 Filed ~{i~q~o. exec' on .5:...(5.:02...... ATTORNEY (Sup. Ct. l.D. No.) ADDRESS PHONE ~ ;..! .....~ - d ;-.... ::< -' VJ -0 L:l c J ~ ,'J ~. ~ ..... ::1 => :z., <t; ~ 2; ..... ~ A :r: '-< ~ ~ L.'\~lT {-.tILL 01" J{!l,THEF<~.!NA rnlCHS 2\-02- ~'\ I KATHE1.:INA FUCHS. .;)t" lUF, c;OUtl"l lc.th Stl^0Qi;. c.f Uv.:! Bor'0Uf:~tl of C~rnp HIll (~tlmberlar)d County. Penrl~vlvar!la. decl~l'e ttli.~~' '::1,.."' t.c- In'.' L='tst l}'ill dnd l't2v(:-kc .3n~/ l;.Jill. t'r(~\flc'u~l'/ ffldde bv me:. Item 1: ----- U()on m'/ dea.th, I bedueath to 0Rah of mv her01odftc!' n~m0d great-~rdl)dcl1ilctren the sum of 011e Thousand Dotl,:J.l'!.! ($'1,000.00) in. memc.~r'.j' of Hl'-.>>' son. JOHN FUCH~'), JR.. \\1ho l~ the Grarldfathc!' of tl1e t10~eifkdftc!' named beneficlar~es: 1.f1;.) Ashl'2v Hannlton of 1,03 FIrst Avenue. T10l^1'i:l VCL'de. F lorl.dd 33'71 5 .~dal~ Hanu 1 tQn cot' 1,03 Fl rs t Avenue T lQrl'a V':2'rd,~ F 101' ida 3 "2'/ 1 ~\ Zachar 10 Gu 1 a of 308 East l{"j l'2r' St r~.2et M(~/..:::han.~_c's~ur~~. Penn~3'/lvanltt 1?O~15; EIDll.V .~mber Gula. of 308 E.::l.!3t K/211el'" Str'2et. M<(.:chanl(.~sbul"'f.}" P'?nn~~Vlvanla 1'10'.:)5. Rll(!}!'l J.:Jhn Gula of 308 East Kel lei' Strc~2t . .Me0h-~n~csbul'g. P0r!r'1~1'.ilvanld 1~!O~5. Shelb~ Pae Fl!ctlU 0f 591-15 Gene\18 Ur'lve. Me0h~!1i~sburg. Pe!111~l!lvanid 1?O~S: and Mark ~lthorlV ~u011s, Jr. 0f ~41-1~ Geneva Orlve. Mechanlcsbura, Penr~evlvan~a 1'/055. fB) l't<.:lll mv dQath. I d~v'!'~)Q ,:tod J.)t~'~lueath tr'i'2 rQsidue of fU\1 E'.Jtate el!. e"h:?t'v l"!atu.!'e and wherec'.:\ever sItuate, tO~~12ther '..nth Hlsu!',,,-rl'2'? thereon. to rnv dau~,~lter, MARY E. MAZUPIK, of 290Q-OU2 ~-1(_It.:i,.=:t.'/ Hlll Dr'ivt;:'. CaHlL.\ Hill. Cumberla.nd Counti..f. .PQrln~p.ll1}5'.nl.=.. f:>r t'f.) the lssue of the same MARY E. MAZURIK. 1 '_~lU " .- I fiNe Bank. :1!)I.YJln1: Camo HIll. Cumb",rland COljntv. !:-,i-.2nnsvl'-/ania. f:~1-l~.rdl,=tn of dnV(..lI'(.JDCl''tv \)JhJ.ch oass-es ~nde!' thlS WJll or oth21'wise to a ID1Dor and witl) rCSD8ct which 1 dfC authorizQd to .:lr~"'t:\I::'\lnt ~ua:t.~dians and have not other\tJise SC1~L}i f 10..:i.l1 v dr.:)l"!i2 so. ~\t\l_n./ldf.=d Lhd L thie aIY()C\l.ntlllent (.If a guardiari shall not suoersede the right of any f~duciarv ~n its discretion to distl\lbute the s!)ar'e w!~e!'e Dc~sible to th~ lli2Dor J <l ::n i :r: Cl =1 ~r <1: ~ ;;:, io--4 Ct. ~ W :r: ~ :",1 ~: ~.~ ()t Lo d~-'Jc~th{21' f(.'l the: Wl~iC',~i I::; benef.!. t. SuC'h ,:;udrdJ.an shall b.::tl: t !"l L' ;:' <:..,'\": c: 1" t.:, ~:.::c ~u(..:!b. t'::-l'.1.n.'...:.l.!_'dl ~...le 11 ::'l.!.c;orn.'~ 1.' l' c..,fU ..... ......- as t J.!Jl'2 .. .t p l' ~~d 2. '1"i t!,~ . ; t.. ~ S \J" .. '. ,:,\,.=tl'e, tc' l J.1'''", 31..lr';"'L,lor t drid ';::-dW':'6 t lc,n (iriwl~~in2 ~011~~e ~du~ati0n, !)0t!~ grddu~te d!ld U11d01Q~aduat~) w~th0ut r'~;:~ard tG l~~s Qi' her' Care!ltsl s..billL. "::. '_' L I" L"} 2.....J '__' ,1-. nl'';':'''::~~C::l.!. '':':'';::,: ':..:', c..;'I.2j~ll)':':"'l t :..:.td '.-:'JUr'::,,~-; I ,':.'!.!.. ';)1' tc' :i;.;:~k'2 :....:.~'/1ll',;::: f..:, c 1. tll.::...,_t t r'.lr'~h_ L l"~'.:.: l)()l!~: i bi:.. ~ t. 'i,; '-,:....' t"l", ~M-' -,,t' t.' ,:.:..- '_ .:..! ::';' ~lL!. '_h6:' '. .=~ .t - '_: ''::'1' " "':>.J '~. .t ',,. ",::~!'C ' d_~ 1 \i " 1 r;,C' .1. _ ':."ll ~ fie" t-I, '1'; i",r',':' -.- '-'.-- It..:::u 'l.. I j~!',~:-:,~ t!; ::-~ _. '! l debt~ a!')~ '2)tP~J'lses 1 U~: f~ L':,' W.'./ ;:':i~'J. clC' ~,~'on as L\:t'd....:.,'~i!...,3.J. 3.ft:12r' :1:."/ d...:.-a1....h. Item. I!. I dir/2c't tl.!.dt W\I b<...'(!'/ bE' l.)ul'J.ed ~t the P'..)lli;"~~ ,-=-,.:",,', M':.::rl.;-:')!..~ ia.l Hi 11 GB.r'd-::f1S 1811 Carlicd", RQad, (~':-:l,';llD C~!llb~r'la!1d CO~J)tv. PQnnSVlvdrll~. l'ie)~t __ 11~ Ld~Q 1~US!)~11d, J0t;[1 !~'--.:.,~"Lz . Item !:l: 1 ''':::It'';.!'..:t tl'i::.t ~ll ta~'1o~~s ~..bdi.. m~\' !.)/..! dSS(z-ss(.;!d ~f; c'':'n.Sl2Guence e'f IuV' ,j':".3.tYl. :-\t ~tlhd.t8\?(:"1' nal~u.!"-'i...' :r.n,.J bv '.lih.a.te'vE:l"' ;i ~l' 1 ~ d .1':'" t ~ '':'ri .::. mtl!.::.'~'ed. :}l.:.~ 11 ')'2 t'-:'t i d f l:C'!l! JU..... f'C S J.. r-jua l"/ f.:?S t d L-e as; a ":ilL of th'2 '~Xl.".2ns~ .;."f the a.J!IrJ...C!.Lst.cdtl<_'fl C,ll' fr1'.- f2~:tE~te. I t ",2<m. 6; 1 :i :~i r:' () 1 n t d3.ut~ht(,;l . M}I,:R? <.- J.:.,. MP,.:!URIK, w:" ExecGlt'l~ 0f tIllS ffiV Last t~ill_ Item? . I .J i r'2'_' t t ba t m'vc,,? 1" S c.'no 1 l'et.\!"~':j '2L t ~ t i, "'}Q, or their ~,LL..'!.)essors ~~b,:iill ;;(_It bf~ re'Ju~.ced to t-ll.\'<",;': tU:'{ld !",) 1'. the f=~ithful D(~L'fol"m-::~!~(}f2 ':.,f tb,.:;.!.l" '.J.Utl'2'~ ') ;--, ::.r~v 112rlsd:.(....:"Ll.'..:..tll. "'- .:.n '.n TNE~;S (!HEf'EOF 1. k:t"''-' h'21"'2untu set lllV hi::u,.j tlu s d!i.-~ da.,. t.':' ''Set.)AU '-~ 19f."1I~\ . l(fJl~MM'" ~...~ KJ;THEF: INA f(UCHS T!-t,,:? I)rt:=(:!(~d.inQ ins-trUUlQnt. 00nB~~tln,~ '_;1' Lb.....:;.. .:.ud '':';,1/.-.;'" ,." ot!'l'~r t'l!:"';";'\llritten t:'-:l,ges, each ldentll'.!.ed bv Lh~ ;;;.,.il.;;.!,11c;LLul.~ f...:<1..' thE 'L:;c:1..dtl'l.X. KATHERINA FUCHS. WdS on the '-10.'/ ""nd c.l",t'2 thc.:l'C:'_:.'!:.~ S 1.s::nC:2-:1. t)'...lbllshed ar~d dec~la!"ed tv' KA'fHERINA FUCHS, THE T,~~::.t=.tl~i),~ i:h'2rein named. as and fc.~J:" h~f' Ld~:t f..lJill, 11'1 tlH: L'!'csenC'2 (:'1' each other. hd\},C' S'ub9Cr.lbed OLl! nallJ.e~. .:is \oil tnessc.:s h,:' I"':: t '::' B''1 ~r"':"{J 6dULL-A 6~~ :<1.. &'4'J", ;1/1 / 7()/3- , / ~ (7 w, L(') j,v i'7( ~, l"281dlng at ~ t .1M >,:<;;":/ ~rs- C('MJ-!ON\r~'~A.LTH ('F PENNSVLVli.NlA COlJl'trY ('IF CI_1MEIEELP-J.!U ss: ('!..:. ~:A.THEIUNA F"-,CHS _CMvy{ ~, stLt-~~__..._ O1n.1 ~~fl~ ~';A-fl-./ I t_! i';;:: .~. ~::..'~;'; t :'_ 1~ l' i. :..: ::', !'j ,~~ t l:t ~-~ 1,': l {: f: ',?:: ~2 t:-~' 1" ':::- s t) e ,_~,t. 1 ,) t? .t \.' ~,ilh~'~} '':~ (lam,,:: ~~~ll.~':: '31. 8:11 (.2 d t '_' t h(:: .::t -I: 1: -=:t'.:.iI-!€2'_~ f::'L '_'_'l"~:[,;'_'~ll~~ In:.::,' t l-I...!f.!'2n t ~tt:...1J~f,' fit-st. ...11..11'1 t:'\"\..'!'D ,_~(:, ~-.("!,/.2b'.l c!<>::.' 13. '~:'(= t c:- ':.1"':".: 1...J,!'J..je t' S l ~_:):nf:d :1 ',J t.: 11._, t" i '~ ".' L! 1 '::i t ~~ h'~ 'l'es 't ~ t r 1. x '~l ~',~ n,....: ,:t c;,:"td '2X''::'~~'L:I~,.~:",":.! t!'I.E: .If:~;t'!:'1l;1!'211t ':t~' h'.:~t" Lc..~-t vJ1.11 arId !.:lldt S11r;?, had sl_~~~nt2d \'Jill111t:.'l'/, -:tJ"1d thilL ,;;.t!~ .~)-:"=(Jut:f2.j It dS h...~.t' rl'f2~2 ,~J.-l(-t, \>,:)lunt :ii".' d(.' L 1"_'1' the c."urDose th(!rei.l'1 ex!:'reL:~t!d and that each (}:t: thc~ ~.',I.i L!'!(:::SBI::~ ' .1.11. t!t.;: '!_):r'~':.!~it(_'t::.' :1nd !!L'.:ii'l.f'.!.r1, '_\.l. t.I-Je 'l'(~Btt!..!-~l'l~V.. sl.!2.ne.jl,:l"l''? \1,li11 -5lS, \'lltrJ.'~'::.~:" to.fr(j t!l=.t. t(} ti'1e be::;'t '_'1' his 01' ht.:?f' kn':),-vl~dt.:.';e. thE:- T~stat!'~x vias at tb,:: t..:.:.~1J.>2 t:lt_"~."htct:'i"l f, :!. e ~, l,"f~~ ':'1.' ':..: c: f :i -::-',':: I:...... !.' 01 dj~ 1 0f sour.d ml!-ld ~nd urlc!er !)o co()str'&lr-tt or '~ndue lDrlueI)0~. 1~.aI.Jl~lK ~~ KF.THERINA FUCHS ~JA;i' -P sI~u~~ ~ .-tne'~ ~-7 ' Subscrib~d. 9WG1'{) ar\d ackl~Owledged before lae __~ry ~ ~ VA l!.- / L'v l:.F.THJ::F lNA FUCHS. th2 .!'~statl'lX, and subscribed dIld sworn to bafore me b1! /!JJt:rljl;f 5,0-/L,p .lo~ and '.h..:: ";.;.U','2SSE.:S. lhlS ~Yd--d:lV t/.Sz:L $.L;Jv c,t' 5f J.1.IL-i(J~ &j/Le.- 1 '::/5. t~"J-' r';J (SEAL) Q ...., "J P ~mAqlAL SEAL HENRY F. COYNE, NOTARY PUBLtC HAMPDEN TW. CUMBERL'ND CO. MY COMMISSION EXPIRES JUNE 17,1996 J- oe- Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) K~~ F~' d. ....:25"-0 '2.. ;?/ -O:z. -0 '17/ Admin. No. Date of Death: Will No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Notice has now been given to all persons entItle t ereto un er except l:W~f/k ir tJ1~,-lfJ ~ w.;d Date: '}j -~ -(!) '2-. Signature I~~ f fJ!~ Name IJ/~-ty ~ /!ItJ.Z~ ~,' t:::. Address tR/tfl-/~? ~,e ~ (3~ 1!--dI If}. ~ II Telephone'07 r 7~ -V f??.5 ,>\ capacity~erSOnal Representative _Counsel for personal representative 'l!:.....I~U~ ,~ ~; l"-';. l,' ;' ~~~,,:'-I\; '~("J~":" >:~, . /'7-6.8- /CJ COMMONWEALTH OF PENNSYlVANIA 0EPlIIRTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-ll601 v' :'V'FiC:,I.L ,i.C::_' :. t. REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 1lE~_MST. ~T.NJI1!!1lOLE INIIW.I !E " I?'U (v\ S -It. ~.J 1-\ f".-k \fJt"\ w Q UI U W Q _ . 2~~ -S::t::l-{J L FILE NUMBER ..2 L - .Q~_ _ _~.:).L COJHlY COOE 'fENl M.JMfIER SOCIAl SECURITY NUMBER - qU;q 11IS RE11IRN IlUST Be FII.ED IN IlIJI'UCATE WI1lf THE REGISTER OF WlUS SOCIAl SECURITY NUMBER t-Ji~ :- DATE OF DEATH (I6I.OO.YEAR) DATE OF 81RTH (fllM.OO.l'EAR) 02-2<;'. KJOJ.. :2- 20 j910 (IF API'lICABlE) SlJMVING SPOUSE'S _ (lAST, RRST. AHO lIIIJIJlE 1NfTW.) Nf,..,. !I! ~ 1 0<9n8l R_ o 4. LmIed Etla1e 06,~0i0d___~... 09,lltigoIIon_R_ o 2 StJpflIemenIal - o 4a. Future m1erest Compromise {daIII ddNfl__ 12.1Z..u1 o 7.___aLMngTrusI__~.",", o 10. Spousal Pov&fty Cntdil: ("*01'........... 12-3I..tl"'I-I.961 o 3.RemaioderRekJml_d''''~1012.1J.82) o 5. Fedaraf Estate Tax _ Required 8. TolalNumber aI Safe llepoojt Boxes o 11. EIecIionlO taxunde! Set. 9113l.^>t"-tlSdlO! z o ~ ~ I- 0: .( u UI ~ z: 2 ( , ~ ) ) IWlE (2' I; _1WlE.._ MI\'Lui2.\ Ie.. ',_E_~A) 2 _"'_~B) 3. C1000Iy _ ~ PaItws/Iip OJ SOIe-fupoioll>>hip 4.~&__(_D) 5. CasII.llanklleposils&___1'l-'Y I_e) 6. ~Ownedl'l-'Y(_F) o SelJDtMrv~ 16._alIi1e14_........... 11. _01 Uno 14_"-*'9"" 16. _alLileI4_at_.... 19. Tu Duo 200 COMl'IflE llAlllNG AOlJRE55 2\09- 10\0 Cf29A.R.. C~f \-\ ILL Pt\ , \'70\\ -7'+S?' K.l,_)~) -,,, . .'~ \)!'L\ c'" 7,lnlor,VMl5T_&___1'l-'Y (Sl:I1o<*JIoGOJl) 6. TaIII__(mlaIU>osI-7) 9.F_"-&_CosI!I(_H) IQ, llollIsal--'~l.iobiIitloo,&t.ea(_'1 11. TaIII...... "-_~1ilo59&IQ) 12. NelV_ar_(Line8_Li'lel1) 13. ~... Gun..._....1loquoolsISec 9113 T..... for _ an _.. _Ills... been -(-J) 14, NelV_SuIljo<:ItDruILi'le 12_Li'le131 SEE IIIS7Il\JCTIDIlllll REVERSE SIDE FOR APPUCA8LE RATES 15. _alUno 14_atlllespousallllX _. "'_ _See 9116 (aXl.21 (I) (2) (31 (4) (51 1\3 ~CJ() a> cr (j' )J." 190. Q rp OFFICIAL USE ONLY' (6) (1) 18) \ '~H(, ere . 19) l~-Ol 20, l~'f [101 (1'1 (12) (131 21 <..;'1\ (14) 1\20Q9 II 2,09<1 '0_ 1'5) , 0 '$S.. (16) SC'N '1 x12 (11) x .15 (t8) (19) C;o '+'1- CHE2K hfRF IF YOU ARE REQUEST\N\~.'.I. HEF'L ND OF AN OVERPAYMENT ".y''';c)'~:;.., ~ SIr<t:t:of ~SS 'lmv I STAlE Tax Payments and Credits: 1. Tax Due (Page lUne 19) 2. CI8dits/Paymenl A. Spousal Poverty Cmcil 8. Plilr ~ C.lliscOlI1I (1) Tolal Credits ( A + B + C) (2) ~ . . T 3. IntelestlPenalty l applicable O.lnterest E. Penalty \qO .. TolallnlOrosllPenalty { 0 + E } 4. " Line 2 is greater Ihan line 1 + Line 3. enter tile dIlIorenco. ThIs is Iho OVERPAYMENT. Choct< box on Pogo 1lino 20 10 rwquost . IlIfund 5. U line 1 + line 3 is gtll81er Ihan line 2. enter IIle dIIIt.."co. This is Ihe TAX DUE. (3) (4) (5) (SA) I ZIP -nv" ':;.'-"" 1 '-( . 'Or\ - ill...... A Ent'" !he interest on Iho tax due. B. EnIOr Ihe klIaI oIlitlo 5 + SA. This is !he IlALANCE DUE. (58) S 2-'<, 'i . Make Check Payable to: REGISTER OF WILLS, AGENT -.."" . . - --'-I'Uiili'~'-'1!ii', PLEASE ANSWER THE FOlLOWING QUESTIONS BY PLACING AN .X" IN THE APPROPRIATE BLOCKS 1. Did doc:edont mat<o olransler and: .. roloin tile use or i1c:omo 01 tile properly 1nIns/erred;........ ............................ b. retain tile right to designaIo who shall use Iho property InIns/erred or its inalme: .... .......... ......... c. reIain. reWllS/Onary ~ or............. ................ ....................................... d. I1ICOive Iho promise tlrlle 01 eit1er paymen1s, benolils or C8IO? .......................... .................. 2 U deB'" 0CCUIT0d after DocomlJor 12. 1982. did doc:edonllnlnslor properly within one year 01 doa'" wiIhouI!9C8iYI1g adequaIe cOllsidollllion? ......... .. ................... ............................. . 3. Did docedonl own an "in Irusl for" or ~ upon _ _ occount or security at his or he< doaIh? ......... 4. Did docedonlawn an IndMdualRetiremeflI Aa;oont, annuity. or _ non-pmlleIe properly _ contains a beneIiciaIy d6sigo ..oo.,? ....... ....................... ........ ..... .............. ..................... .................... ........ .......... Yes ........0 .....0 .....0 o o ...0 o 181 IF THE ANSWER TO AMY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FIlE IT AS PART OF THE RETURN. No ~ ~ ~ ~ ~ \hIor_1~.I_...I__...._inc>ld01g_.......'9_1Od_.1Od.....""'"""lnaooIodgo..._.'....._..._. 0Ir:tIAIirxI aI~ oIler......))IQOOIII ..........,w... iso.edCl'tllliJlol'mlli:lnd..tlich PRIf*8l"...., ~ SlGNAlIlRE Of PERSON RESPONSlIllE FOR FLING RETURN DATE AOORESS ~~. Of~OTHEll~.SENTATJVE '...? - . ('~ - ... - > MlIlRESS . 0r -. "'..... ..'.A....". \J"" :,lO\'7..','~'?' .~ \ "-.,. .t'r\ y...\ v _""'^ v-.><.. . l Q il\!. C 'f'v....a... ,.~. ' ::> _ :> . DAlE ( I <11\ (J~ For.... 01 doaIh on or aile< JAtj I, 1994 and IleIofa Jin8y 1, 1995. Iho .. ... ~ on Iho net vaIuo 0I1n111111ors 10 or tlr Iho IlSO 0I1ho suMWlg spouse is 3'JI. (72 P.S. Pl116 (a) (1.1) (IJ~ For .... ol_ on or _ Jin8y I, 1995. Ihe .. ... iIlflOSOd on Iho 1181 vaIuo 01 kansfeIs 10 or lor tile IlSO olllle SUrvMng spouse is 0% (12 P.S. Pll16 (a) (1.1) ('1 The __ does 1lIll_ a _ 10 . SUrvMng spouse fIllm I8ll, and Iho staIutory I8qUiraments lor <isdosIn II _ and 1ilOIg . .. relIIn 811! sliI ~ ovan lie SUl'INilg spouse is Iho only befJeIciary. For.... 01 doaIh on or aile< JAtj I, 2000: The .. rata impcsed on Iho nol valua oIlrana1ars from a _ _ lwM\y-ooll years ol age or )'OlV1!l8I' ., doaIh 10 or lor Ihe use 01 a nalural paRlf1l, an adopliW! __ ora.........~ 01... diId is 0% (72 PS. !9116(aX12)~ The...... ~ 00'" 1181_ 0I1rans1o!s to or tlr Iho use 0I1ho _rs lneaI bo...lUooios is 45%. ..l>lpl as noIod in n PS. 59116(1.2) (72 P.S. ~116(aXl)J. The .. raIa ~ on !he 1181 vaIuo 01....,.,. to or for !he use 01110 ..........s siblings is 12% (72 P.S. Pl116(a)l1.3)~ A -.g is defined. under SacIion 9102, as ., ndiolibII_ h8s ._ 0118....... in """""'" ... Iho -... _ b\' blood or adoption. -..-:"~ '*' SCHEDULE A REAL ESTATE OOIoUJHWEI\llli Of PENNSYlVANIA _RlTAHCE TAX RETURN DENT ESTATE OF FIl.E NUII8ER \-\ - i<. \ IN:"" ,CCGC'r\ " 2002 ~'Ci-+ 11 AI,.,......, toW, or.. tI:nMI:... c;ORftOII ftIUIt" rtpOtted It '* matbt "'...... fair martet..,aIue is defined as tile price at whICh propeny would be e_ctl,;Jnged- _a-.g """"llIld a ~_, _I>eingCOl1'4lOi1edlObuyorsell, "'"" hoYiog _~oI1he _, fadS __rty....ich iojoinlly.owned with "g't 0 . be on SttIoduIt F, ITEI.! NUMBER , DESCRIPTION S \\,-,G,<"", F~,,-,,\l. '1 \::~ S IN,::,'-KS" VAlt.:Eb.T 0:.. TC OF DEA ~h ~ ~_ ", ~" ~-1_>~~: : r" l.> Cr-,\..fr \-'1. \ ,,-. I Y-- !t;iH \\YlE=0 ('p\I'.,,\,? ", f:\\\i'<...\,..,.,C ~-- \.\. \. l. C..- pF\ \--JOl\ _~~s,,-)r :;.,\~"-",~ ~\ TOTAl (Alsoen\ef on hne 1. Recapllulatlonl $ ! \ :) SCx.::' . (If more space.s needed, Insert add,lIonal sheets of the same SIze) -;..."."",... ~TH OFPENNSVlVNM NERlTNa TA)( REMN RESIlfNT 0B:EllEHT ESTATE OF SCHEDULE E CASH. BANK DEPOSITS. & MISC. PERSONAL PROPERTY ';0 C\-\ S ~~"\ 'r\."Q \1--.1'" FIlE NUMIIER 20::' 2 cO,-\ , \ -1lo_oIlig11ionondllo_theplOCOllds --by"'_. AJlproportyjoinll\ ..,..._tbo rlghl oI_hip must ""_Iohd on Soh..... F. ITEM VAlUE AT DATE NUMBER DESCRIPTION Of DEATH 1. \\'-i C 1:t~~'0\c.. t'. C. \~C X C.?,(2)U \<:: 2c;~ So 1.-)CJ V\ <:'\,-;.G~>aU.l, I PI,)>. .'~' lc....., \(l( TOTAL (Also entor 00 line 5, Recapilulaliool $ Zc..... \ 'Ie' (If more space IS needed, mse!t _ sheels oIlhe same SIZe} ~t::\i'~5\1 E)\,- 129Y\ ~ ) COMMONWEALTH OF PENNSYLVANIA INHE.R\"TANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FilE NUMBER 2C:C-j Z- .-<r~ Y l ESTATE OF ~~"""(M~ \( ~,\ ~"\I';"',,2....\ l...._),;::...~ Debts of decederlt mU.$t be reported on Schedule l. nEM NUMBER ~ DESCRIPTION __ ----- ---t--- I U' _.__AMOUN~_ FUNERAL EXPENSES \:_", \-\'C"? s:,. I. ',,~ 12. )'_r'C'~ , t..1' U S ,r\. \ ~lJL \c..';~.~ j\.',....tC'"'"l'.>-.,:.... '->-)'(2 i~~\ I-.'v~ ~ '.~- ~ ~ ~^' "I'? , ' '.-\ \ L(~ i-=',,\ 1 ' B ADMINISTRATIVE COSTS '.,-,'I~. '._-.2_0 Personal Reptesenta1lVe s Comml.sSlOn~ Name of Personal Rep(~Sefl\alp;els:1 SOCial SecUtlty Numberls}iEtN Number (11 Personal RepreS6nlallVe(SL_ St{~el Address CIty SIi:lM~ z,p Year\sl CommIsSIon PaId 2 At10mey Fees :> Family Exempllon iiI de-eadem s adares:.. \;; nol the ;:.ame if:; CId!/nan!::., a\liKh ell.jJlitlldIIOJ1) ClaImant StreBrA.ddr.ess G'~ STOlTe lop Retahcnsnip or Ctalmanl to Decedent " Probate Fees .;:.. 2. --S .~} 1-( -j i.-- ---,. '-' , Accounl8n!"s Fees ,- ~ G Tax Aelum Prepare{s Fees , I ____1- I I ~==-==~~_=~~===_~___ ~O~A~(AISO enl:' ~n-,:n.-;_;~~lllla!iO~11 s~~'i(~~== (II more space IS needed. msert addlll(mal sheets ot Ihe sarne slze\ ESTATE OF IF'-I C. " S I I I SCHEDULE I I I DEBTS OF DECEDENT I MORTGAGE LIABILITIES, & i.IEN~ J ~ ~ \" r\ "-1<- \f-...j"" FilE NUMBER _ ___' lCX)2- -~ 'i -. I .--'.".'. >:'(}MMONItfAlTHQf PENNSYl \,lAM!; I~HtRll..o\HCE T AA RE TURN RfSJO€NT DECfOCNT Include unreimbursed medic.1 "p<!nses, ITEM NUMBER U'\'\L\"~f,. SE \\~ ~\~ ~\~~~~\PlI0~ r*)~~ ~ i-~--=-=+~~~<6~;~"'=' liS <<;; \J\?I~ '1 \\ ~\- \' 1--\ (~?Jc I c> f~ 10" - I y,q, - ~g:; - ~q1 - i..- ~. ~ - '::> I i i i I r I '> fv\tl'\\~~CX' on-\~ ~~ ~)(..f'ev...)~~\ \Z~"''"\. f'€'S ~c;. 'II mo _ . ____n_____n TOTAliAlso elller on 'm, 10, Recapr(ulal,ani I re space IS needed. Ins-en addl\lonaf sheets of the same Silel SLO, LR\:L,,_ I AlE NUMBER ). CC>l - (tx:b '-t7 I J'AElATlONSHIP TO DECEDENT AMOUNT OR SHARE' NAME AND ADDRESS Of PERSONtS) RECEIVING PROPERTY . __Do_Not UstT~_ _ _..~_E~.r.~_ TAXABlE DISTRIBUTIONS [include outright spousal distributKlos and 'nlf'\s.\e~ under See 911610)11 2)] 1 I t-...<;.\\L'C'-\ 1-\""",~L\aN t:>)..) 'C. , '~L\&"'T~\I2'Il- BLI.! ~ \~l<; ~'2"o~ ~~\' W~l.S-f,J.Jl2.G, ~Oll.d>'" ,.. p..b~/'-'\ \-\~\L'\t"'" I . -"'1)O;L~'-S.. Sf'\M~ "s p\<"f-\l~'\ IZA.U.,.......\(O GUL~ I .~?, 2.. ~ CR.JCA.l <;. ~\"'" C~(' \\\LL., Pl\ 17C 1\ b\Z.~ (j..vw;,U\1 b I I I I i '1"oon, "-:"" , ~ I i i ! ~ ~, I I I ~ I <; \-\EL0'i. F\.)C ~ <, <4.\ ~ ILSt(~ v L \ q '3> rC-'X GL~J cl 8 E' MNl-~ p....J UH Jv;l... ~"'" ~Pfl.~!'.\ ,,'> \-Jf\.&I . ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE. ON REV. 1500 COVER SHEET .. SCHEDUU j BfNEfICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~UC\1 \C.P\\t\ 1\(1... \t0~. __ . NUMBER I 1... <, '-1 E IV\ \\.... 'i C::> \...> L~ SI\M~ ",,,~t;..\ p.,(, R\\.. E '\ G\..JL"_ <;;"""'''' p.,Q\) il......l,<; >\<, zAc\illiH.:' ZI>.C 'r\'A.:L\ e <;'. l 7 .., I (:l..'(:1 ., (U'D I ( '<'1' fC'(~C' c< to( C ". ..., ICXiO fel'n ,. v ( C'C'C" 11 NON.TNCABLE DISTRIBUTIONS: A SPOUSAl DiSTRIBUTIONS UNGER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING ",ADE tvO~E , , I I I I B CHARiTABLE AND GOVERN>!ENTAl DISTRIBUTIONS i NO~ ; I i ! ___........L___ TOTAL OF PART 11- ENTER TOTAL NON.TNCABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ ~ --~") - (If more space is needed. inser1 additional sheets of tMe same size) \.- /'7-63- /(') BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRIS8URG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE DF DEDUCTIONS AND ASSESS"ENT OF TAX MARY E MAZURIK 2109-106 CEDAR CAMP HILL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-17-2003 FUCHS 02-25-2002 21 02-0471 CUMBERLAND 101 RUN DR PA 17011 *' REV...15li7 Ell AFP Ul1-U5) KATHARINE Allount Rellitted 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 ~ iffv=is4,-iX--AFP--foY=03rNcjficE--oF-YNHEifiTANcrTAsnfpPRjfisEifENT~--ALrOWANCE-cfR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FUCHS KATHARINE FILE NO. 21 02-0471 ACN 101 DATE 11-17-2003 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/Pertnership Interest (Schedule C) 4. "ortgagas/Notes Receivable (Schedule D) S. Cash/Bank Deposits/"isc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 113,500.00 .00 .00 .00 26,190.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H) 10. Debts/"ortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Velue of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 7,407.00 20.184.00 (11) (12) (13) (14) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 139,690.00 27.591 no 112,099.00 .00 112,099.00 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. NOTE: If an assess.ent was issued previously, lines reflect figures that include the total of abb ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (IS) 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 I S: .OOX 00 = 112,099.00 X 045 = .00 X 12 = .00 X 15 = (19)= ANOUNT PAID 5,234.00 DATE 09-12-2003 NU"BER CD003004 INTEREST/PEN PAID (-) 190.00- BALANCE OF UNPAID INTEREST/PENALTY AS OF 09-13-2003 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 5,044.00 .00 .00 5,044.00 5,044.00 .00 15.99 15.99 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE A REFUND. SEe REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) 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 MAZURIK MARY E 2109 106 CEDAR RUN CAMP HILL, PA 17011 -------- fold ESTATE INFORMATION: SSN: , 84-48-9497 FILE NUMBER: 2102-0471 DECEDENT NAME: FUCHS KA THARINA DATE OF PAYMENT: 09/12/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/25/2002 NO. CD 003004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,234.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: MARY E MAZUREK CHECK# 1833 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $5,234.00 DONNA M. OTTO DEPUTY REGISTER OF WILLS ..... "'\ oJ ..... O:J + t~ 1.1.\ (I ..... - ::- - g() ! ~~~nr .2>.( :;~~n Qc ~~:::H ~ ,"'" ;;:;;: ~ ..., ~"b'tr "'('~ if I:;j t::J ~ t B"1i~(^ I '- ~ /! '-r,~ J: " B::! nr "" ~I ~ ::; ~ ,.. V I: '- .. ","be".2>. :;z c::>() ... ,,~ ... '-!i!:2c::> .:z: l b:i 1\), & ~ ... ~tJ~r %! ~ ; ;;:/~~ ~ ~ ~~I\) I:;j ." !!"> L.... :.....V --------- t~~ *~~ -,l ~ ~f (lNJ ~~~ ~~ pgl ~(l'" :i~ aa' ~= ~ (, ) :~ : (,1 ',L-) \ -"' ~-"..- " (~ -'~ .'~ j " 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 MAZURIK MARY E 2109 106 CEDAR RUN CAMP Hill, PA 17011 -------- fold ESTATE INFORMATION: SSN: 184-48-9497 FILE NUMBER: 2102-0471 DECEDENT NAME: FUCHS KATHARINA DATE OF PAYMENT: 11/20/2003 POSTMARK DATE: 11/18/2003 COUNTY: CUMBERLAND DATE OF DEATH: 02/25/2002 NO. CD 003251 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $15.99 I I I I I I I I TOTAL AMOUNT PAID: $15.99 REMARKS: MARY E MAZURIK CHECK# 1864 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WillS '\.,/?-b9- /CJ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-1607ElCAFPCln-05) MARY E MAZURIK 2109-106 CEDAR CAMP HILL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-15-2003 FUCHS 02-25-2002 21 02-0471 CUMBERLAND 101 KATHARINE RUN DR PA 17011 Allount Relli Ued MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=i(;o-j-ix--AFP-foFoir-----...--iNifERITANCE-TAx-si'7ffEiiE-NT-cfF'-Acrcoui.ff--...--------------------- ESTATE OF FUCHS KATHARINE FILE NO.21 02-0471 ACN 101 DATE 12-15-2003 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-17-2003 PRINCIPAL TAX DUE: 5,044.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-12-2003 CD003004 190.00- 5,234.00 11-18-2003 CD003251 15.99- 15.99 TOTAL TAX CREDIT 5,044.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) C~ ovL STATUS REPORT UNDER RULE 6.12 Name of Decedent: /1~~A :;?.A-Vh Date of Death: 7~ ~s: ;lc':?r;,f ./ </ Will No.: ~/-t::1r>Z -c:JCf7/ Admin. No.: o:YtJcZ - tJtJ '/1/ 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 a 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 _ Noj8' b. The separate Ozphans' Court No. (if any) for the personal representative's account is: \0 N c. ~i~ the personal ~resentative state an account informally to the parties mmterest?Yes~ No 0 ' c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk ofthe Orphans' Court and may be attached to this report. . ~tu:J f ~:p4 Signature r7-/~9-//1b Iik/~JJJ/ Name t:: g: .5 a.: Date:c1 .19' - 0 t/ E ~,/JaI; AI/7/// Address ;/ J 970-- tJ ~9~- Telephone No. l'l N co W LL i) J.J ,', i= c) ::':7 , - .:~Ci ?3 Capacity: 111 Personal Representative o Counsel for personal representative