HomeMy WebLinkAbout08-20-14 +� (�/{ 1505610140
REV- 1 500 Ex (02-11)(FI)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN �! ��
Harrisburg PA 17128-0601 RESIDENT DECEDENT l
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 5 0 7 2 0 1 4 0 8 1 6 1 9 2 7
Decedent's Last Name Suffix Decedent's First Name
Mt
0 1 S h e f S k i Het en A
(It Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS
1. Original Return ❑ 2.Supplemental Return 3. Remainder Return(Date of Death
❑ Prior to 12-13.82)
4.Limited Estate ED 4a.Future Interest Compromise(date of 5. Federal Estate Tax Return Required
death after 12-12-82)
❑X 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust 8,Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
9.Litigation Proceeds Received 10. Spousal Poverty Credit(Date of Death 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1.96) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Wi I I i a m J P e t e r s E s g 7 1 7 2 3 8 7 5 5 5
v.�
REGISTER�YYILLS USE q J tY
First Line of Address rnapC. , ;
2 9 3 1 N o r t h F r o n t S t r e e t �r °
c
Second Line of Address
City or Post Office ro DA,Mt.
State Z„ Cade �_.._—
H a r r i s b u r g P A 1 7 1 1 0
Correspondent's e-mail address: �p(a)pWIegaI.COIT1
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,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI P RESPONS16LE FOR FILING RETURN DATE
ESS
I$ 1L1
ase h M. Olshefski 325 North Second Street Wormle sour PA 17043
SIGNATURE OFCRER OTHER THAN REPRESENTATIVE ,�DA'TEE^
ADDRESS
William J. Peters 2931 North Front Street Harrisburg PA 17110_
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
J 1505610240
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Helen A. OlShefSkl
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . 1. 1 2 5 4 4 2 , 6 9
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
4. Mortgages and Notes Receivable(Schedule D) 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 5 4 1 3 7 , 3 6
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 1 9 2 5 6 , 6 4
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) 8, 1 9 8 8 3 6 , 6 9
9. Funeral Expenses and Administrative Costs(Schedule H) . . . ... . . . . . . . . . . . . . 9. 2 0 3 0 9 . 6 7
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 2 7 6 0 , 0 2
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 3 0 6 9 . 6 9
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 7 5 7 6 7 . 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 1 7 5 7 6 7 0 0
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.0 _ 15.
16. Amount of Line 14 taxable
at lineal rate x 0.045 16. 7 9 0 9 . 5 2
17. Amount of Line 14 taxable
at sibling rate X.12 17 ,
18. Amount of Line 14 taxable
at collateral rate X .15 18
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 7 9 0 9 . 5 2
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505610240 1505610240 J
RIEV-1500'EX(F0 Page 3 File Number
Decedent's Complete Address: D a
DECEDENT'S NAME
Helen A. Olshefski
STREET ADDRESS
19 Pheasant Street
CITY STATE 21P
Mechanicsburg I PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 7,909.52
2. Credits7Payments
A.Prior Payments 7,595.28
S.Discount 339.74
Total credal(A+e) (2) 7,935.02
3. Interest
(3)
4. If tine 2 is greater than Line f+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 25.50
5. If Line i +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0,00
Make check payable to: REGISTER OF WILLS, AGENT
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 ..........................................._......................... D
b. retain the right to designate who shall use the property transferred or its income .............................. D DX
c. retain a reversionary interest ...................................................................................._............... D
d, receive the promise for life of either payments,benefits or care? ....................................................... D
2, it death occurred after December 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ I]
1 Did decedent own an'intrust for or payable-upon-death bank account or security at his or her death? ......... D
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE 0 AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent 172 P.S.§9116(a)(1.1)(i)).
For dates of death on or after Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
(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 21 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 percent)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 percent,except as noted in 172 Ps.§9116(a)(1)).
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent(72 P.S.§9116(a)(1.3)1.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.
9EV-1502 EX.(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE
OF
NUMBER:
Helen A. Olshef FILE ski 0 0
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 that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
-4 1. 19 Pheasant Street, Mechanicsburg, PA 17050 125,442.69
SETTLEMENT SHEET FOR SALE OF PROPERTY IS ATTACHED.
TOTAL(Also enter on Line 1,Recapitulation.) $ - 125 442.69
If more space is needed,use additional sheets of paper of the same size.
rflvey
OMB Approval No.2602-026S
A. Settlement Statement (HUD-9)
w'GVesae9
B. Type of Loan
l,g FHA 2.Q RHS 3.00am Unhs. 6. F/e Number. 7.Loan Number. 8. Morigagelmuranre Case Number:
4.❑VA 5.0 Conl us GABFAM,14.043
C. Note: This form is furnished in giro)oua statement ofactual seftemnd coos, Amountvpaidto and by me sedMment agent arc shown.
items mar) dTP,o.c)'were pailoussde the obshg;theyarosloven fault for.41,"ormathnaipurplses and am not lodudedin do hoists.
D. Name and Address or Borrower. E. Name and address of Seller: F, Name am Addass of Lender:
Carol A.Malava Estate or Helen A.Old,afxfa
272 Helmer Street HNenA,Obhefa sici
Debware,CH 43015 325 N.Second Street
Warmleysbutg,PA 17043
SSN:46.7504686
G. Property Lobster: H, SelLmen!Agem: I. Settbmem Oate:
19 Pheasant Street GUARANTEEOASSTRAGT SERVICES,INC.
Mobhonbst urg,PA 17050 3813 MARKET STREET July 18,2014
Cumberland County,PennsyNanla CAMP HILL PA 17011 Ph. (717)724.8758
Plea:of Settlement:
GUARANTEEDABSTRACT SERVICES,INC.
3813 MARKET ST,CAMP HILL PA 17011
J. Summary of Borrowers transaction K. Summary al Selfer'stransaction
100.t;sosstvnount DUa irom Borrimer, 400. Gross Mevni Due to Seder.
101, Carsnus sales rlce 136750.00 401.Contract sacs Price 136750.00
102. Personal property 402. Pefso_a_lpmpttty
103, SeBbment Charges to BOrcOWer line fa60 3333.50 403.
IN, 404.
105. 405.
AtIustm ants for Items paid b Seller In advance Adjustments for items Paid b Seller In advance
106. COU'rfYfiOWNSHiP 07718/14 to 01)131115 1 207.83 406.COINTY/TOWNSHIP 07/18114 to 011131115 20713
107. CITY TAX ro 407.CITY TAX to
108. SCHOOL TAX 071/Bf1d lq 01101f15 1.172.86 408.SCHOOL TAX 07111014 to 07/01/15 5172.66
109, 409.
110. 410.
411.
112. 412.
120. Gross Amount Duo from Borrower 141464.19 420.Gross Amount Due to Seller 138,130.69
200, Mounts paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller,
201. Depose of earnest money 1000.00 501. Exmss deposit isw 4 Iudkms
202. PAincbaf amount of now cans) 502. Settlement char es to Soler Line 1400 17 9.73
203. Extslin hens taken sunect to 503. ExisC bans taken au to
204. 504,Payoff Fast Mod a
205. 505, Semnd Mort e
206. 506.
207. 507. (Deparsit dab.as resents
208. 508.
209. 509.
Adjustments for Rams unpaid b Seller Adjustment,for items unpaid b Setter
210.COUNTYITOWNSHIP to 510.CO1NTYffOWNSHIP to
211. CITY TAX to 511. CITY TAX to
212. SCHOOL TAX to 512.SCHOOL TAX io
213. 513.
214, 514,
215, 515,
216, 516,
217. 517.
218. 518.
219. 519,
220, Total Paid b ffar Borrower 1.000A0 520. Total Reduction Amount Due Seller 17.649.73
300. Cash at Settlement fnI Borrower 600. Lash of Settlement toffram Setlor
301. Gross amount due from Borrower Iso120 14148418 601.Gross amount due to Sa&r "420 138.130.69
302. Less amoun!Pak byAor Borrower time 220 ( 1,000.00) 602. Less reductions due Sclef Irmo 520 1 17,649,73
303. Cash ❑% From 11 To Borrawor 140464.19 603.Cash O To From Seller 120,480,96
Rftl.ddu raw tvmvsfmi. a n.eanfli
The undersigned hereby acknaYCdgee/fesebti of a comp_lCed day,of this stMemen!8 airy anaMments referred'ttoo harsh
9oryowe. �'lll7tt�/f LLr7�A ?!'n`'l� Seller EaWla W�f Ole t
Gafgi A.Ma6501k t=' -- A
1kA>r arnnbo.em>s».anvrndrromw'uumemseuassmww.nw=.uw+ar,Rrw.N.y cermmas.merx+ee<rmwrumleanrfuvumwmwwreNnw�aumnodn
gamn,drnf aafaM ewiav7vaieava Md vnlp,Na aYACellslry I+Cwe%Ntl+Onve4 maWy lxf h4YlpnrtlpeArotaMpO.nFAAmer4YacRamv]+6YVmllmptbyteaYCtTpt
P s..
Page i of 3 HUD-1
(MAUSIAKPFDIMALISIAl012)
L.Settlement Charges
706.Tolaf Real Estate Broker Fees $8,205.00 Paid F. PafFrom
Division of camonecon fAns 700)a$frpYYOWS BamHahs Sales
701._$4,297.50 to ReMax Delta Grou Inc Furs a! Fwd at
Note:tine 7011 nctudes Adjustment of 195.00 For Broker Service Fee Settlement Setllemanl
702.S 4AD2.50 to Them son Wood Real Estate
703 Commission paid at settlement 6400,00
704,
705, Deed Preparation to Guaranteed Abstrad Services 125.00
706.Additionat Commission to Thum spn Woon Real Estate 300,00
800.Items Payable In Connection with Loan
801.Our on Inatlon char e $ from GFE#f
802 Your credi or char (points)far the spedfs interest rate chasm $ (from GFE#2)
803.Your adjusted origination Uar es (from GFE#A 0.00 .
It A sisal fee to - from GFE#3
$05.Credit Report to from GFE#3
806.Tax service to (from GFE*3)
807.Ftopd certi`esem to from GFE#3
808. from GFE#3 _
809.
810, - (from GFE#3
811. (from GFE#3)
900,Items Required by Lenderto Be Paid In Advance
901.Dail interest charges from to $Ma from GFE#10
902.Mortgage insurance premium for _months to -rpm GFE#3
903_H me wner's inswanee tor1.0 nears to 'from
904. [mm GPE#11
905. {tram GFE,#11
1000.Reserves Deposited with Lender
1001,Initial deposit for your escrow account (from GFE#9)
1002.}iomeuwne aMsurence V S per S J�
003.Mortpaae insurance (dl S oar $
1204.Fr faxes $ _,
COUNTY TAX S se,
CITY TAX l5! $ per
SCHOOL TAX $ nor I
1005._ $
COUNTYITOWNSHiP par
SCHOOLTAX � S ear
1006. $ per $
1007, $ .r S
1008. - S
1004.AGGREGATEADJUSTMENT $
1100.Title Charges
1101. Tate servces and tender's Me insurance (from GFE#4)
11 Q2. 4wmen ar tlosi fee $_
1103. Owner's The insurance to FIRST AMERICAN TITLE INS CO. from E#5 1085.00
1104. Lender's the insurance to FIRST AMERICAN TITLE INS.Go S
1105. Lender's the pcliw limit $ - -
1105. Owne"s the poi finnit $ 135,750 00
1107, ent's portion of the total We insurance maninlurn to GUARANTEED ABSTRACT SERVICES.t $ 922.25
1108. Underwriter's portion of the total title Insurance Premium to FIRST AM ERICAN TITLE INS.CO. $ 16175
1103 Npiar Fee es GUARANTEEDABSTRACT SERVICES INC$ 10.00 10,00
1110. Tax Gertficatlon Reimbursmem to GUARANTEED ABSTRACT SERVICES,INC$ 2056.
1111. W_re Fee-Proceeds to GUARANTEEDABSTRACT SERVICES,INC.$ 25.00
1112. $
1113. 8
1200.Government Roaording and Transfer Charges
1201.Governmentrecordln charges to RECORDER OF DEEDS GFE#7
{(fem } 6200
1202.bead 7.00 Mod a e 8 Releases $ Other $
1203.Transfer hine. to RECORDER OF DEEDS fe.G E#8 1,367,50
1204.C t/C unt tax/sfam `�1.367.50 $ 1,367,R)
12)5.Btate laxratam s $ 1,367.50 S
1206.
1207.
1300.Additional Settlement Charges
1301.Required services that you can shoo for from GFE#6
1302.2014115 Salient Tax to Debra Sasehoro Wiest,Tax Collector $ 1,230.16
1303.Home Waverly to Home Buyers Resale W.capfthr Car $ MAV-tE7788338C 504.00
1304. Sewer Feas 4/114-7/10014 to Silver Spring Township Authority $ #269-290 129.65
1305.:nharilance Tax Facrow - to Guaranteed Absteact Services,Inc $ 6,342.42
1400.love Settlement Charges tenter on lines 103,Section J and 502,Section K) 3,3 3.50 11,649.7
•P...ksd 0 alhn,.rpMll')app tsl.leMaa e'.rd p mn
ar a�Paawgsrawawienmx w:,marrew.aacxmaw�,ewxaavmc�a+wnaraasaanwae.sayoe �.
GUARANTEE !TACT SERVICES,INC.,Setuemenl Agent
Certified to he a true copy. -
Page 2 of 3 HUD-1
(MALISIAK.PFOIMALISIA W 12)
REV-1506 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN CASH, BANK DEPOSITS & MISC.
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF
Helen A. Olshefski FILE NUMBER:
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Members 1st Federal Credit Union 25,252.41
5000 Louise Drive, P.O. Box 40, Mechanicsburg, PA 17055
Account No. 247199-00
2. Citizens Bank 12,255.41
2 West Main Street, Mechanicsburg, PA 17055
IRA Account No. 5381
3. Citizens Bank 4,200.51
Checking Account No. 2237
4. Local 520 U.A. Federal Credit Union 429.03
7187 Jonestown Road, Harrisburg, PA 17112
Account No. 01727
5. 2007 Chrysler 300 sold for- 12,000.00
TOTAL(Also enter on Line 5,Recapitulation) $ 54 137.36
If more space is needed, use additional sheets of paper of the same size.
RE W 1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Helen A. Olshefski 0 0
If an asset was made jointly owned within one year of the decedent's date of death,it must he reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Joseph M. Olshefski 325 N. Second Street, Wormleysburg, PA 17043 Son
B.James Oishefski 605 Central Street, Mechanicsburg, PA 17055 Son
c.Joyce Chesney 10 Meadow Lane, Hanover, PA 17231 daughter
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FORJOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELDREALESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1, A.B.C. 4-16-13 Members 1st Federal Credit Union 4,292.86 25. 1,073.22
#247199-41
2. A.B.C. 9-7-12 Members 1st Federal Credit Union 48,05131 25. 12,012.83
#247199-44
3. A.B.C. 11-10-1 Members 1st Federal Credit Union 19,447.82 25. 4,861.96
#247199-49
4. A.B.C. 1-4-13 Members 1st Federal Credit Union 5,23452 25. 1,308.63
#247199-52
TOTAL(Also enter on Line 6,Recapitulation) $ 19,256.64
If more space is needed,use additional sheets of paper of the same size.
I
Arv.151 f EX+(M13)
pennsyfvania SCHEDULE H
DEaARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Helen A. Oishefski 0 0
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1. Malpezzi Funeral Home, 8 Market Plaza Way, Mechanicsburg, PA 17055 11,590.84
Post funeral luncheon for sixty-five persons 2,000.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representatives)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: William J. Peters, Esquire 6,010.41
1 Family Exemption:(If decederss address is not the same as claimant's,aitaoh explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4, Probate Fees:
453.50
S Accountant Fees:
& Tax Return Preparer Fees:
7, Estate Advertising- Cumberland County Law Journal 75.00
8. Estate Advertising- The Sentinel 179.92
TOTAL(Also enter on Line 9,Recapitulation) $ 20 309.67
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVEN UE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF
Helen A. Olshefski FILE NUMBER
- 0
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Sale of car-AAA title transfer fee-2007 Chrysler
86.00
2. Local 520 Visa
363.83
3. United Water
30.20
4. PPL
130.85
5. Landscaping 38.16
6. West Shore Emergency Services 1,009.58
7. Erie quarterly homeowner insurance 113.00
8. Landscaping 95.40
9. PPL
56.35
10. United Water
11.56
11. Community Life Ambulance 109.80
12. Silver Spring Ambulance 100.00
13. Local Plumbers and Pipefitters Local 520 Pension Refund 400.85
14. United Water
17.79
15. Landscaping 73.32
TOTAL(Also enter on Line 10,Recapitulation) $
1760.02
If more space is needed, insert additional sheets of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Helen A. Olshefski
Decedent's Name Page 1 File Number
Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. United Water 6.58
17. Landscaping 38.16
18. PPL 78.59
SUBTOTAL SCHEDULE 123.33
GRAND TOTAL SCHEDULE $ 2,760.02
REV-1513 EX,(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
Helen A. Olshefski FILE NUMBER:0 0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
N NAMRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DINS (Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).J
Joseph Mki -son Lineal
325 N. Seeet Renounced property
17043 rights of distributior
2. James Olshefski - son Lineal One—Half
605 Central Street
Mechanicsburg, PA 17055
3. Joyce Chesney Lineal One—Half
10 Meadow Lane
Hanover, PA 17231
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
IL NON-TAXABLE DISTRIBUTIONS:
1. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
HELEN A. OLSHEFSKI; AKA HELEN A OLSH
I, Helen A. Olshefski,AKA Helen A. Olsh, of Mechanicsburg, Cumberland
County, Pennsylvania, being of sound and disposing mind,memory and understanding,
do hereby make,publish and declare this to be my Last Will and Testament, hereby
revoking any and all Wills by me heretofore made.
ITEM 1: I hereby direct my hereinafter named Executor to pay all my just
debts, funeral expenses, estate and inheritance taxes as soon after my death as may be
found convenient.
ITEM 2: All the rest,residue and remainder of my estate, whether real,
personal or mixed, or whatsoever nature and kind,wheresoever situate and from
whatsoever source derived, I give, devise and bequeath to my issue,in equal shares,per
stirpes.
ITEM 3: I nominate, constitute and appoint my son, Joseph M. Olshefski,to
be the Executor of this my Last Will and Testament. In the event of the renunciation,
death, resignation or inability to act for any reason whatsoever of my son, I nominate,
constitute and appoint my son, James R. Olshefski, Executor of this,my Last Will and
Testament.
IN WITNE7=1 reunto set my hand and seal this
day of 2007
(SEAL)�HelenA. ski; ,
-CA Helen A. Olsh
Signed, sealed, published and declared by the said Testatrix,to be her Last Will
and Testament in our presence, who, at her request, in her presence and in the presence of
each other, we believing her to be of sound and disposing mind andmemory,have
hereunto subscribed our names as witnesses.
of
of �L e c� . c o G i7 0 .s Z5
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
We, Helen A. Olshefski; AKA Helen A. Olsh; Testatrix,
�l6 ern !J JO S7a-z) , and IYvAm RY - ,!2 il t S
witnesses,respectively,whose names are signed to the attached or foregoing instrument,
being first duly swom, do hereby declare to the undersigned authority that the Testatrix
signed and executed the instrument as her Last Will and Testament and that she had
signed willingly, and that she executed it as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence and hearing of the
Testatrix, signed the Will as witnesses and that to the best of their knowledge,the
Testatrix was at that time eighteen(18) years of age or older, of sound utind and under
no constraint or undue influence.
eten A. Olshefski• Helen A. Oish-- estatrix
Subscribed,sworn to and acknowledge before my by Helen A. Olshefski; AKA
Helen A. Olsh,, the Testatrix, and subscribed and sworn to before me by
witnesses, this �pv ' ' day of� pp'7,
7 f' Notary Public
COM}ONW—.€A- ' O;_ ENNSYLVANIA
bT IAL SSt L
SUZANN€ �1, ®L@L8E8, Nntary Public
carrio dill ale �utabarlan8 County,
my C*ff %610M Aug,20, 200.9
WILLIAM J. PETERS
ATTORNEY AT LAW
2931 NORTH FRONT STREET
HARRISBURG,PENNSYLVANIA 17110
(717)238-7555,Extension 101
FAX: (717)238-7750
E-MAIL: wjpGDowleeal corn
August 19, 2014
Lisa M. Grayson, Esquire
Register of Wills & Clerk of Orphans' Court
Cumberland County Courthouse
I Courthouse Square, Suite 102
Carlisle, PA 17013
Re: Estate of Helen A. Olshefski
File No. 2014-00467
Dear Ms. Grayson:
Enclosed are an original and two copies of the Inheritance Tax Return with respect to the
4 above-referenced Estate. Please time-stamp and return a copy of the return to me in the
enclosed envelope.
Thank you for your attention to this matter.
Very truly yours,
P
William J. Peters
w'JP @pwlegal.com �v�,;- 12
extension 101
WJP/rmt
c�
Enclosures
Cc: Joseph M. Olshefski, Executor
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