HomeMy WebLinkAbout02-0670
Estate of iC/ E L. Y N :: ,(3:: ek
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
;;J.J-o~"G, 70
No.
To:
Register of Wills for the
. Deceased. County of (' d /)"} AC/Z L" "-"D in the
Social Security No. '""'(>~ - (> 3 - ., '/ d S 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 tZ. I x
in the last will of the above decedent, dated A fA. c;, U S r 'i
and codicil(s) dated
named
, 1922--
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (' 11 m e- r- t2 L "'.1j 0 County, Pennsylvania, with
he e hl~t f~,?,",ijy or principal residence at I q ~ tJ L L A /'Z...- /+ vE /?p T ~c ~
7",1-~r:JLJ~/l/SAK.t':..."" ;(3,,'LG" <;illr)fJ'-:J1I.s/~f.t/2(.. P/i /7...2~<./
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(list street, number and muncipality)
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at -; ,c L.5 /: (, IZ- C<:;r/- ~ /'':"',e' J a t..-( ,IC" YJ
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: ../'Vf (')
Decendent, then
!J-C'
years of age, died
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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:
$ ~ y' d;S,. :'3
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters rFsr.4 ..IJ/IE'/v T/7L.Y
(testamentar)'; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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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.
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Sworn to or affirPl'~ and
befo~eillfihis~ LD '
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MARY C.
,
17-1;-9
N 21-2002-670
o.
Estate of
EVELYN E. BECK
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JULY 25TH. x1$2illl.2.... 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 August 5th, 1999
described therein be admitted to probate and filed of record as the last will of
EVELYN E. BECK
and Letters TESTAMENTARY
are hereby granted to
Corinne KORtokov; r.h. nkrt r()rr;n~ l(na:Tllk"n\T; .....},
.
'..~
C.LEWIS fJ
MARY
FEES
Probate. Letters. Etc. .........
Short Certificates(3 ) . . . . . . . . . .
Renunciation ................
x-Pages (4)
JCP
S 115.00
S 9.00
S
S
TOTAL _ $
. . .JuLy. .25th,2Q02. . . . .141.00 . . .
ATTORNEY (Sup. Ct. I.D. No.)
12.00
5.00
ADDRESS
Filed
PHONE
LEJTERS AND ORDER WILL BE PICKED UP BY EXECUTRIX
ON JULY 25TH, 2002
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JRZ - 5.1 beck.2 July 23, 1999
21-2002-670
LAST WILL AND TESTAMENT
I, Evelyn E. Beck, of Greene Township, Franklin County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby declare this to be my will, hereby
revoking any and all former wills and codicils thereto by me
heretofore made.
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, sha.ll be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
II.
I g:Lve, de~'.'-ise and bequ2ath the resid:.i8 cf i.T(l 2.5tCltC of 2..,l(2ry
nature and wherever situate to my niece, Corrine Kostokovich,
providing she shall survive me by thirty days.
III.
Should my niece predecease me or die on or before the
thirtieth day following my death I give, devise and bequeath the
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residue of my estate of every nature and wherever situate to the
issue, per stirpes, of my niece, Corrine Kostokovich.
IV.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal,
without
regard
principle
of
to
any
diversification of risk.
B. To invest in all forms of property including st.ock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
C.
To sell at public or private sale, to exchange or to
le3.se for .::.ny period cf time 2.r:y real or F:3YScn2tl
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
Page 2
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F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
V.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VI.
I appoint my niece, Corrine Kostokovich, as executrix of this
my will.
VII.
No bond shall be required of any fiduciony !1ereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
Page 3
purpose of identification
4:t,~ ,l9/~~
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this
.,r.;-
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day
of
f: W)'<y"- E. ~ft (SEAL)
Signed, sealed, published and declared by the above-named
testatrix as and for her last will and testament in our presence,
who in her presence, at her request and in the presence of each
other have hereunto set our hands as attesting witnesses.
~
/~~/ &J~ ~, 04utu'ct-, /i
,,9. Y N. !icuJ: /ru.j,5t, Ci1(U/}1/xr:5 /Jury fA
('1 IWe~ Evelyn E.
\fife .-1.. Gro.}Imu
Beck, ~ I r< - Z-v-/ 1~'f1C- and
the testatrix and the witnesses
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testatrix signed and executed the
instrument as her last will and testament and that she exe'.cuted 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
said testatrix, signed the will as witnesses and to the best of
their knowledge, said signer was at that time eighteen years of age
Page 4
or older, of sound mind and under no constraint or undue influence.
&~. _ z: (Jade-
Testatrl
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
above-name witnesses this /;---day of
1:: <'$i?..-fr- , 19 /e/~/.
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Notary/Public
No....l.. ....
Cerln L ...... Nowy Public
Ch........... BolO, Franklin County
lIy Conltn181lol1 explr.a May 13,2001
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
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[K] 1. Original Return
o 4. Limited Estate
5ZJ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
REV-1500
OFFICIAL USE ONLY (!...,
/1- 01:!l______
F~ IUM~Ell ~ 11 {l k La
COUNTY CODE YEAR NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
SOCIAL SECURITY NUMBER
:2.01.../- 03
:7'10
DATE OF BIRTH (MM-DD-YEAR)
:z-
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL S,ErURITY NUMB, ER . I I' r::.
D 2. Supplemental Return
o 4a. Future Interest Compromise (date of death atter 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and t-1-95)
o 3. Remainder Return (dateoldeath prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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TELEPHONE NUMBER
/7-6 ?
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
COMP~~A~GADDRee~~ 0.-.
He-claM US bl.A,r I ~ 17tJ 53>-
(1)
(2)
(3)
(4)
(5)
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'OFFICIAl USE ONLY -,
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6~9 J {, :3?
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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9 Funeral Expenses & Administrative Costs (Schedule H)
10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductio 0)
12 Net Value of Estate (Line 8 minus Line 11)
q / / 01, , 0 .?
(6)
(7)
:J. J !? ), D . 3D
(8)
(9)
(10)
bpQ?,/()
IJ 9 ~ I AI>
gOCj:(.3t
~t)q f? 8,3, 17
(11)
(12)
(13)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
?- q f 1.1 , ? 7
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable al sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
j-~,p '3].17
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18) J? ;0Z;--!/)
(19) f A;(/;-; Id
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
CITY
t^7::..
ZIP
/72.;7
Tax Payments ana Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
J ':<'d.~-:! ()
ill. ~L
Total Credits (A+ B + C) (2)
fJ/..2!'
3. InteresUPenalty if applicable
D. Interest
E. Penalfy
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)
7P I 1. ot}
.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
7fl] ~tJ
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 lKl
b. retain the right to designate who shall use the property transferred or its income; ................. ... D 1KJ
C. retain a reversionary interest; or ... ................. ................ ................. ..... D fMl
d. receive the promise for life of either payments, benefits or care? .. . ........... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........... 0 [KJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?. ........... &l 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . .............. 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN.
Urlder perlalties of perjury, I declare that I have examined this retum, irlcludirlg accompanying schedules and statemerlts, and to the best of my knowledge and belief, it is true, correct
arld complete
Declaration of preparer other tharl the personal representative is based on all informatiorlofwhich preparerhas any knowledge
SIGN URE OF PERSON RESPONSIBLE FOR FILING RETURN
. /.J. ~W
ADDRESS '15 (, /3e PI'
DATE
f-//-o~
/7d
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)!.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(I.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 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.
,REV''''''''I:."W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF f? / J
!LeG ~, Evc~V\) F
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.
FILE NUMBER
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. F...rl ~","h. n'{r"rb",') If"! $Q,VJ"'.J J 23 :<13, C)J\.
,
;Z F.J.-M B"'....h ~1.-,a'J~e.vt"D /~ df'c(.~ >9'/'1 & /
/
J. &... h~) th /Je~ 4"vJ-a0'\-C~l1.<b~o b"'} t. 1 88 7. 5~
So.)c "f /le r.J 0 ""I f r'Ol"..Jc!) 0<"(1 t.aV'
TOTAL (Also enter on line 5, Recapitulation) $ '1/ I q (, I 0 B_
(If more space IS needed, insert additional sheets of the same size)
TRUST
CHAMBERSBURG
BOILING SPRINGS
MARION
MONT ALTO
NEWVILLE
SHIPPENSBURG
WAYNESBORO
CARLISLE
0022 0007
2254
Y
STATEMENT OF ACCOUNTS
33-65743
STATEMENT PERXOO
FROM THROUGH
7-17-02 8-18-02 0
PAGE 1 OF 1
EVELYN E BECK
%CORXNNE H KASTUKOVXCH EXEC
456 BETHANY DR
MECHANXCSBURG PA 17055
1 ENCLOSURES
5
1",111,,,111,,,,1,1,,1,1,,,1,11
REGULAR PERSONAL CHECKXNG
PREVXOUS DEPOSXTS/
STATEMENT 8ALANCE CREDXTS
5,944.61
CHECKS/
o DEBXTS 1
.00 5,944.61
ACCOUNT: 33-65743
SERVXCE
FEES
.00
ENDXNG
BALANCE
.00
* XNDXCATES SKXP XN CHECK NUMBERS
DEPOSXTS/ CHECKS/
DATE ACTXVXTY DESCRXPTXON REFERENCE CREDXTS DEBXTS
07-17 BEGXNNXNG BALANCE
07-25 CHECK
08-18 ENDXNG BALANCE
00800903752
5,944.61
BALANCE
5,944.61
.00
.00
DATE
07-17
07-25
08-18
F&M TRUST'S FREEDOM CARD MAKES SHOPPXNG EASXER.
THE FREEDOM CARD CAN BE USED XNSTEAD OF WRXTXNG
A CHECK ANYWHERE MASTERCARD XS ACCEPTED. YOUR
PURCHASES ARE DEDUCTED FROM YOUR CHECKXNG ACCOUNT
AS YOU MAKE THEM. THERE'S NO CHECKS TO WRXTE AND
NO WAXTXNG FOR CHECK APPROVAL. F&M TRUST'S FREEDOM
CARD GXVES YOU MORE FREEDOM
DXRECT FARMERS & MERCHANTS TRUST CO
XNQUXRXES TO: NORLAND OFFXCE 2405 PHXLADELPHXA AVE
CHAMBERSBURG PA 17201-8921
TELEPHONE: 717-264-5122
CHEC
,L\C~~OUNT STATEMENT RECONCILIATION
HOW TO EAL;\NCE ')'C}I..J(i ()-H:-Cf<I1\L~_l STATEf\/lENT
OUTSTANDING CHECKS OF( W!THDriM'i4LS
NOT YET CHARGED TO y,)lJR ACCO,)IH
1. Add to_your (;1 ;_eck ri:-:9Ls_icr dl"'\- I'l~(~r(~,,:,' P:J"k:fJ ~)Il()wn on this
s(ate,'"1E;lll
CHECK NUMBER
Af\t10UI'~T
2 S.!JbJmct lro!11Y(:i IT c): X:k.:T;I,;;j,.'f" e,l. ' ~_,H'vice 1;'lt:h~Je~~ ~;: ,-,\tVn l)!'
this stato:::m;:; ~t ;h~,t VO,i "-1:1,'1' !-, -)t r~;ie, ldy i Rcor,-Jed
3 Enter endir;~j bai;)ll!;
from front of stalenlGn:
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4 Enter- c!epo::'it~- ;): UHK:! (
recorded in YOt" n'~:w,tc'
shown un ihs -;t"i('nler~t
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I 6. Enter the t(")fn! (~!=h .'eke-, wi,ild(iIVvals.
servICe charoe~'- (I] ,inv). ami iluto-
I malic paJ'mC'~nlS nr;iC';;:'d in YOlll
~ check register but not <;iiOWI; on th!~.i
or previous statemf)nts.
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7. Subtr"act itf~rn 3 from t") abC)\ip
This shoulci be; the 1:),-danciC' ~,}~')wr: ,S
L_. ,_H2...~~'~,r, chec:kbof::~_~~qlsti:;i __1___
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5. Add the tot
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IF YOUR
ACCOUNT
DOES NOT
BALANCE
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1)''1:~\'k'__ ""'" witil 11','-' b,-'-'I:"'ICt.' II' vn,;r checkbook I'ogistel
'1,...ld~' ':"1",,, :J' '-""1,1,; iecordpc! IUl chc,:i("arlrj Gll'oerpilvnl<'nls,1r[-COIH'c1
. !--.-'lJ..., :,,-.- [i',e; "Its I,---'cc,'.--i,-,d 'or depq,;d~; ,ire curwct
.1.,.\.,,_, 'ei i'<h",:' deducleu ,,:i r.:-wr;~:'-. hom your lnl;mce
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PLEASE EXAMINE STATEMENT AT ONCE,
IF NO ERRORS ARE REPORTED WITHIN 10 DAYS.
THE ACCOUNT WILL BE CONSIDERED CORRECT.
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PROCEDURES FOl'l CORRECTiNG ERRORS
IN CASE DF ERRORS OR OUESTIONS ABOUT
YOUR ELECTflDNIC TRMJSFER Ofl YOUR LINE OF CREDIT ACCOllNT
Notify us promptly if I/')!I ttlink your statement or receipt is wrong or If you need more
information about a transfer listed on the statement or receipt. You must notify us no later
than 60 days after th8 first s18.temen~ on Wilich the pl'Oblem or error appeared.
1 Tell U~; your l1a:r,s w,d acccllmllllJlTibf,r
2 Describe ttle error m ~!w tl-a.nsfm-'Qu are unsure about. and explain as clearly as
you can V'Jrl\' you l)ellev~~ !! IS an BITar or why you need more information.
3. r ell us the do!lar amount ::.;f the suspc~Cled error.
If you tell us orall\l, \VP may lequlIP that you send us your complaint or question in writinq
within 10 business dav~:;
We will tell you the resIJIL; o! OLli' '!lvestigatlon withm 10 business days after we hear from
you, and we will correct any error promptly. If \ve need more time, however, we may take up
to 45 days to invGstinatc your complainl or qlJ8stlons_ If this action is deemed necessary, we
wiH recredit your accuunt within 10 bw;incss days for the amount you think is in error. so that
you wil! have the use (;f 1h8 rnonev rluril-:g the' time it takes us to complete our investigation
Jf we ask you to put your co'npJ::ljnt or r]lk'cc.tion irl wnling and we do not receive it within 10
business days, we r11C'iy not recr2c!i\ your account.
If we decide that trlere was no error,wn \1\<';1) send you a Written explanation within 3 business
days after ','F;:-' llnls~-~ nUt inv8sliqaticfi YO'J '!I;,'V ,'l.cjk for copies of the documents that we used
in our investlgatiCl'l
DIRECT INQUIRIES 10
F&M TRUST 20 Somh iilL";jil StreE~, Ch3(t':bersburg" PA 17201.. 717-264~6116
liNE OF CREDIT ACCOUNT
INFORMATION ABOUT YOUR
ACCOUNT CHARGES
We compute the FINANCE CHARGE on
your account by applying the periodic rate to
the "average daily balance" 01 your account
(including current transactions). To gl-)t the
"average daily balance," we take the t)8gill-
ning balance of your account each day, add
any new loans, and subtract any payments.
credits, unpaid finance charges, and unrx1icJ
Insurance premiums_ ThiS gives us the cindy
balance. Then, we add up aU the daily
balances for the billing cycle and divide the
total by the number of days in the bjJJin9
cycle. This gives us the "average daily
balance_"
It a "finance charge adjustment" is sh(lwn on
this statement, we computed this portion of
the FINANCE CHARGE by multiplymg the
principal a..mount to which the. ad!usttllent
applies by the periodic rate which "'ip~)iled .n
the b:iling cycle for which tIle adjustment
was made and oy the numher 0.' day:; fo:
which the adjustment was made
TRUST
CHAMBERSBURG
BOILING SPRINGS
MARION
MONT ALTO
NEWVILLE
SHIPPENSBURG
WAYNESBORO
CARLISLE
0022 0007
2267 Y
STATEMENT OF ACCOUNTS
33-65743
STATEMENT PERIOD
FROM THROUGH
6-17-02 7-16-02 0
PAGE 2 OF 2
EVELYN E BECK
19 HOLLAR AVE APT 203
SHIPPENSBURG PA 17257-2177
11 ENCLOSURES
5
ACCOUNT NO: 08-06766
FROM 6-17-02 THROUGH 7-16-02
INTEREST PAID THIS YEAR
ACCOUNT/INTEREST INFORMATION
64.72
OATE
06-17
06-28
07-16
ACTIVITY DESCRIPTION REFERENCE
BEGINNING BALANCE
INTEREST CREDIT
ENDING BALANCE
DEPOSITS/ WITHDRAWALS/
CREDITS DEBITS
63.18
BALANCE
33,210.74
33,273.92
33,273.92
***
ANNUAL PERCENTAGE YIELD EARNED DISCLOSURE FROM
ANNUAL PERCENTAGE YIELD EARNED
AVERAGE DAILY COLLECTED BALANCE
INTEREST EARNED
6-17-02 THROUGH
1. 1:ull
33,244.44
30.05
7-16-02 ***
SERVICE FEE BALANCE INFORMATION FROM 6-01-02 THROUGH 6-30-02
AVERAGE LEDGER BALANCE 33,210.74 AVERAGE COLLECTED BALANCE
MINIMUM LEDGER BALANCE 33,210.74 MINIMUM COLLECTED BALANCE
33,210.74
33,210.74
DIRECT FARMERS & MERCHANTS TRUST CO
INQUIRIES TO: NORLAND OFFICE 2405 PHILADELPHIA AVE
CHAMBERSBURG PA 17201-8921
TELEPHONE: 717-264-5122
f:';
"
,"',
'I'.'NT HECONCIUATION
:r
OUTSTANDING CHECKS OR WITHDRAWALS
I\'OT YET CHMiGFD TO YOUR ACCOUNT
l
I ~
li,!-
CHECI< f':UMgr~n
""'f.r: /;,L
AMOUNT
------!
~
I
~- ~
I
I
-~
:
-1
i
I
1
~~_ . ...J
PLEASE EXAMINE STATEMENT AT ONCE.
f,I.O [RnO:i;:~ Ah;:: Rt:J-:'~ORTED WITHIN 10 DAYS,
THE I.CCOUNT WILL BE CONSIDERED CORRECT.
,,,,"-~-,,,,,~,,,,,,,,,-=~-,,,,,,,,,~,,,,,,,,,,,-",,,,~~,",
;' -,t
, ., , ..~,
-r !\C:COUf\I"1
'ii I' !'.' IIp.(~d rnorc
:' rn ;;', [,':)t:T'J liS 'lU ntw
-lpp~.; loj
'q-,! "d ;)S clec~d\i as
ill()tlnation
(jliestion in wntinq
'K-;(j'1:,:)(1)
ii; \,';,'\1,"\ 'NI~ nE\)! uke tip
"i !' if',_ r,,:~d necessary, oNe
, 1;-'i:Y, is ijl error so H18t
':'1"[ lipt" our invr-;stigatlc,n
" ~t (cr(~iv:," it \VitliiniO
.,;ijtll' 1 -_~ I)!!'-;i!'e';~:',
;'di.'_,-, tl ,')t 'tii_ ,,," ri
.;--(,~--Si di
LINE OF CREDIT ACCOUNT
INFORMATION ABOUT YOUR
ACCOUNT CHARGES
We compute the FINANCE CHARGE on
your account by applying the penodic rate to
ihi:: "averi:l;je dally tJalarlce" of your account
(includiny current transactions). To get the
a\j(~raqe d"-lily balance," we take the begin-
!llllq baiil;lce of you" account each day. add
any m,II'.' 10an~-). and subtract any payments,
c'cdits. unpaid finance charges, and unpaid
Insurance premiums, This gives us the daily
t),-tlance_ fhen. we add up all the daily
ba:,'Hlces :or the bi!llng cycle and divide the
lCl1c:li by the number of days in the billing
,~ycle_ T!l:S qlves us tlle "average daily
bal8,nce '
If a .'findI1CC cl'large adjustment" is shown on
n,IS stcll(~rnent, we computed this portion of
lhe r-fN/\f-.JCE: CHARGE by multiplying the
pr:r',ciDC:\1 amount to which the adiustment
;jpp!if':<, \_;y !hf; periodic rate whrch applied in
iilfO b,il!:I~l cyc;p for whiCh the adjustment
/\;'iJ::O In8.(j;~ ;-'jnd by \118 number of days lor
1\"III(',!1 1he <:u1!LJstnwnl was made
---
John F. Kohler, Jr. - Auctioneer
Final Settlement
Date A\lttl'l ~"( I ~J 'U ~?
Owner 6~-e ~ €~lEL--I1\{ ~~K.. ~\\c.flt.WALw ~t"I\.'Dil(t'l\lL.W
Address C;~'!i: ~Ml\U w~ - 1'11" ~~M ill b6\ . - '\:.lli..&.
, )
Date of Sale ~ - \'"7.... n'L Sale Location ~"'Ce\JA>I ~"4.-~
Auctioneer ,\( l'\~l ~
Other
Clerk
, Cashier
PROCEEDS OF SALE:
Cash................... $-L ggy. ~
,
Checks. . . . . . . .. .. . . . . . .
Other.... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..'.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
Miscellaneous (see attached list) . . . . . . . . . . . . . . . fj 'j"{j
Total Proceeds of Sale................................................. $-Itrk- . -
LESS SELLER'S SALE EXPENSE: "
Auctioneer's Fee....... :~~."?Y...L ~..::).... $
Other SeDer's expenses advanced by auctioneer:
---1 ()~ e.At.l"'l\Mt\~Lur\ t ~OO ~)
\l"L~INC.
AJr~ .~-rAu..l"'l1.
3~\k
Q {\ l\~
q.1. 119-.-
'w
"1'5. -
Miscellaneous (see attached list) .... . . . . . . . . . . .
Deduct Total Seller's Sale Expense ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total Net proce",s to Seller .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
~
$~
$ 42j((}.
I. (or we>. the seller of goods, merchandise. and/or properly sold al public auction on above date and location, acknowledge and aceepl
tbia NUlemenl of proceeds 0( sale. I (or we' agree to accepl all responsibility for providing merchantable title to all goods. merdlandise.
and/or properly sold. and for delivery of titie to the purchaser.
(Seller's Sipature)
(Seller's Signature)
R8I-\51GEX~\Vm
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
COMMONWEAl1H OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
f? e c.J J:~J"I. F
/ (7/
ThlS schedule must be completed and filed if tl\e answer to any of questions 1 through 4 on the reverse side of the REV.1500 COVER SHEET is yes.
FILE NUMBER
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OFTHE TRANSF~REE, THEIR RELATIONSf-IlP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH A COPV OF THE DEED FOR REAL ESTATE
NUMBER VALUE OF ASSET INTEREST IIFAPPLICAB~\-
1. EdwarJ JOI'\~J 4-rC;D"''''+
h~Jj f"':J; ~ f~~et'J If"; 2l/ t ~J'D 7Ut 3d (M.dO ? )~..<fJ j
Lon""hC- dJ.J:r.Jw.V' [nt'Ic.&J
TOTAL (Also enter on line 7, Recapitulation) $ J..ll>>.;',
tJ
tJ
(If more space is needed, insert additional sheets of the same size)
Edward Jones
4829 East Trindle Road
Mechanicsburg, PA 17050
(717) 763-7669
Mark R. Snyder
Investment Representative
EdwardJones
July 29, 2002
Mr. & Mrs Richard J. Kostukovich
535 Knoll Way
Millsboro, Delaware 19966
Re: Evelyn Beck - Edward Jones account number 270-10033
Dear Dick & Corinne:
Per your request, I am writing to provide valuation for the following
security belonging to the person listed above, now deceased.
As of July 6, 2002, the security held in this account was worth $24,820.30.
The joint account for Evelyn Beck and Corinne H. Kostukovich was opened
April 20, 2002. The security, Countrywide Home Loans Inc Medium Term Note
Series K, was purchased on May 10, 2002 for $25,000.
If you have any questions, please call me at 717-763-7669.
S~~~~~'f:_~
Mark R. Snyder
Investment Representative
REV,''''''',''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERlTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF f ).
13 ~~ ~ I:Tved", /
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
E
Debts of decedent must be reported on Scheduie i.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES: FtA,,~rl / j)-fl>'h~ St.lfr~s L......'J
t gr, c...1z~r II?.. 6)'90,/0
/
R ADMINISTRATIVE COSTS:
1. Persona! Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I E1N Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2 Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationsh'lp of Claimant to Decedent
4, Probate Fees Y""J-I 'J.fr.....- d~ W", Ii.; ,tll.tlO
5, Accountant's Fees
6, Tax Return Preparer's Fees / ,G H-)-- es ,J",/-r ~~,..; e. 3JJ. 1t-A.,dO
+-~ Se
7, pro/"' ......r J ....,
TOTAL (Also enter on line 9, Recapitulation) $ b ~c;3 ,tD
(If more space Is needed, insert additional sheets of the same size)
0 0 0 0
0 ~
I
U1 U1 0 0 0
... ... '" I '"
'" '" U1 U1
-
"ii U1 '" '"
<f> <f} <f> <f>
'M U1
" U1
0 0
~ r- ~ ;c ;.> 3 "0 ~
~ 0 0 0 0 0 0 0 0 ';;J :e
+' 0 0 0 0 ] 0 0 0 '" " F 0.. "
m ~ ~ " "
0 <ll .<: 0 U1 00 F 0 0 '" C) ~ co
><: " p, U1 '" 00 '" 0 ~ ... 2 g
'M U1 C) "'~ C) ~ c.e
-ti '" >< g<
N A 0' C)
0 <ll <ll >< <f> <f} <f}<f> <f> <f> <f> <f> W
0 CO <=: ~~
N <=:
'M <<l m 1
til >< -" u '"
~ 0 +' oM ?; 0
~ <=: U <ll " 3 0
~ CO <<l 'M m N
~ .... -" ii % .M <ll
'" m '" u 'E >< oM
" " ~ U1 '" '8 ,~ ~ ~ >< <ll <<l 0, ~
..., til ... JE: " 0' " >< 0 ~
"0.- il- '" %. " <<l 0 u
J ~ '~ <ll >< " +'
"'''' ~W ! t9 0 'CJ III
~~ e"g +' '" <ll "
~ ~: -" " 0' 'M III 0'
0 "
-;.;.~ :E '< <ll " ~""' >< ~
" - ~ 0 - ~ 3 .M 0' 'M <ll
~ ~ ~ e ~E e ~E " >< +' "
" ~ g~ 0,):-::: 0
,; g g ~ " - " " <ll <ll >< 0 0
" F n :2 ,,'< 0 o,ri '" ri 0
" z ,.. 0..0.. ,..,," -< u- % OU U ~ "
1;( ~
0
-0 ~
;a ~
'" "0
{i ~ u
\;l > ~ ~
e .2 " "%
~ '"
co '" co
"
-0 -0 .e 'A
"
0 g ~ ~
u ,g 8
.e " ~ Ii -;;
'" ~ .B 'e "
" < .g
0 "
E {i; 1l > '0
" " g "0
'" U u u <:
;a ~
<: e >
"0 ~
" '"
~
u.
REV-1512 EX~{1-S7)
Q..~,,".>.
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF O~ ~ J
~ '=a, Ev-.!!; ~ }
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
f
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
J.
t-t,
S'.
'No~ Sh<lr-t 1:.I1.J.
COrn.-A,....+ fr!7"'"feV-J
S f""..,-t r:c/. bJ,
8 );<,./Y-
~-kw-<<;
(]..pI k 0'<./
/J...."'hV'... - ct 5<'// {f':1"'....,/
fJ ~r0
L/J'/J,7,/
30 . 'i tJ
'I{J. 31
LJI. /:(
jplJ{ ~~
1.
2.
TOTAL (Also enter on line 10, Recapitulation) $ ) J 9 Cj, /l6
(If more space \s needed, insert additional sheets at the same size)
CHAMBERSbURG ALS - WEST SHORE EMS
503 N 21st. St.
CAMP HILL, PA 17011
PHONE (8001367-0512 TAX ID 23-2463002
INVOICE
*
PATIENT NAME:
BECK, EVELYN E
PATIENT NUMBER:
CALL NUMBER:
204035405A pATE OF CALL:
QBS20403540tlME OF CALL:
CALLER:
FROM:
TO:
95342
C0116225
07/01/02
MDIP MDIP
INSURANCE:
l1EDICARE B
CAPITAL BLUE CR
Police/Fire/911
RENDVZ AT RT 11 & HOLLAR
CHAMBERSBURG HOSPITAL
EVELYN E BECK
19 HOLLAR AVE
SHIPPENSBURG,
PA 17257
REASON(S)
FOR
TRANSPORT
HEART FAILURE
SHORTNESS OF BREATH
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
PARMlEDIC INTERCEPT 1.0 429.78 429.78
5CC/10CC SYRINGE 1.0 3.92 3.92
ANGIOCATH i14-24) 1.0 4.75 4.75
IV EXT TUBING 1.0 7.92 7.92
l1ASTERFLO IV SET 1.0 23.73 23.73
OF SITE 1.0 4.47 4.47
LASIX 100lIG 1.0 1. 81 1.81
PROVENTIL 1.0 1. 52 1. 52
NORMAL SALINE 500CC 1.0 2.84 2.84
----------
TOTAL CHARGES THIS CALL $ 480.74
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
TOTAL PAYMENTS THIS CALL 0.00
PLEASE PAY THIS AMOUNT _ $ 480.74
PATIENT NAME:
PATIENT NUMBER:
BECK
95342
DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE
AMOUNT $
ENCLOSED
480.74
CALL NUMBER
BILliNG DATE:
C0116225
0'7109/02
THESE SERVICES ARE NOT COVERED BY MEDICARE
AND ARE YOUR RESPONSIBILITY.
503 N 21st Jt.
CHAI1BERSBURG ALS
CF..HP HILL,
- WEST SHORE EMS
FA 17011 (800;367-0512
1~1S4 ~] VISA ile.a,jl
_ and ,._~J
MASTER CARD
ACCEPTED
Comfort
KggpQr!:~
3374 Lincoln Wa':j East
Fa':jetteville. PA 17222
(717)3S2-2133
Bill To
bvelyn Beck
2961 Adams Drive
Chambersburg. PA 17201
Description
Hours Worked
In-Hoime Care Services Provided w/ending
6-30-0:2
__J
-
GOD BLESS AMERICA-WE'RE PROUD AND WE'RE STRONG.
Invoice
Date
Invoice #
~/24/200:z 2661
Week Ending June 30, 2002
Terms
Due on receipt
Rate
I
Amount I
3D.4Ol
I
I
I
I
i
I
I
,
I
I
I
I
$30.40 I
-I
--~
2
15.20
"[otal
t'lease retLJrn tnlS porn on wltn payment.
Sprint"
Customer service
1-800-829-8009
Internet address
sprint.com/local
Customer number
717 -532-5089-038
Date due:
July 30, 2002
o Check here if information is requested on back.
Total amount due: $40.38
$40.68 jf received after August 4.
Amount enclosed: I '-to ,Jf
Wllte yow 13---digit customer number on check.
Make checks payable to:
1",111,.,1.,1,1,1,1,1,.,1"1,1."111.,,11,,,1,1,1,,,11",11,1
AUTOCR"C-004
~
-
~
CLYDE V BECK
19 HOLLAR AVE
APT 203
SHIPPENSBURG PA 17257-2177
Sprint
PO Box 740463
Cincinnati OH 45274-0463
1,1"1,1,1",1,11",1,1,.111",,1,,1,11,,,,11.,1,1,1
-
~
~
!!!!!!!!!!!
12 71753250890384 00000000004038 000040389 0224707
*r'r"rsiY <';C!'4"";;;""'"'-'<1::i'4'""'-t~' < "(r<~""'-'"'("';""'-'-"'liliiiill~Jr""'-"""'~W<:i'" ""loll";'" ,,' ~':i "--""';'''111
STATEMENT
J}.Ldv!K
A Subsidiary of Blair Corporation
0** ALL FOR AADC 170
0031 0001
1..,111",1"1,1,1.1.1,..1"1,1,,.111,.1,,,1,1,1.1.,,11,1.,,11
MRS EVELYN E BECK
19 HOLLAR AVE APT 203
SHIPPENSBURG PA 17257-2182
SUMMERTIME IS HERE!
BLAIR CREVIT SERVICES
WISHES YOU A SAFE ANV
HAPPY SUMMER!
PI
7447723602 2002226004112 744772362
ACCOUNT NUMBER NEW BALANCE PAYMENT DUE BY PA~~~~.y~UE AMOUNT ENCLOSED
1744772362 1 1 41.121 108/04/021 22.26 I
PLEASE DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE. DO NOT SEND CASH.
ACCOUNT NUMBER CREDIT LIMIT
1 744772362' I 800.00 1
DATE REFERENCE
DAYS IN
AVAILABLE CREDIT BILLING CYCLE NEXT BILLING DATE
758.88 Qg] 08/12/02
TRANSACTION DESCRIPTION
PAYMENT DUE
1 22.26 I
AMOUNT
PRIOR SALES 450.59
PRIOR CREDITS 450.59
OS/21 30Z30762& BLAIR TOP 1 15955 16.99
PLAID PANTS 1 15956 16.99
SHIPPING & HANDLING 6.24
OS/24 63M390Bl& BLAIR KNIT PANTS 1 0920B 14.99
SHIPPING & HANDLING 2.75
END OF PRIOR BILLING FOR 744772362
06/24 . PAYMENT-THANK YOU 17.74-
PREVIOUS
BALANCE
Btai~ C4edit Se~vi~e~ ~epo~~ all payment hi~o~y to
~~edit ~epo~ng agen~ie~ a~ a matte~ 06 ~o~~e.
* We have Medited the payment U~d on thi~ ~ment
to yo~ a~~ount.
FINANCE
CHARGE
PURCHASES
PAYMENTS
57.96
1+ I
.00
1+ I
.90
I-I
17.74
I-I
CREDIT AND
ADJUSTMENTS
.00
NEW BALANCE
1=1 41.12 I
YOU CAN AVOID ADDITIONAL FINANCE CHARGE ON PURCHASES BY PAYING IN FULL BEFORE
FINANCE CHARGE, IF NOT THE MINIMUM OF .50, IS COMPUTED ON,
gQ~
MAKECHECKSPAYABLEToBLAIR CREDIT SERVICES AND MAIL PAYMENT OR INQUIRIES TO
08/04/02
NOTICE:
SEE REVERSE
SIDE FOR
IMPORTANT
INFORMATION
744772362
n. .... ...........,.."'.........".......'" ..n..., .............V<>T .........."., .... ..,,,'."'''' ....no
.--
John F. Kohler, Jr. - Auctioneer
Final Settlement
Date ~\I&11"''( 1 ~ I 'L1I ~ '?
Owner 6s:r1tt'fi ~ e'lEL~/IL ~6t.1L ~\\(',r.t.INIJ.,~ ~tl~..U:.KO\lLU/
Address C\'\~ \(~l\U ~A>t - t-(IIII:~~I\ 1)6\..- ~
Date of Sale ~ - l'7 .... O'L Sale Location ~~ p,.I ~At.-~
Auctioneer '\l::. 1'\\:4.1 vA Clerk Cashier
Other
PROCEEDS OF SALE: Cash................... $--if ~g1~ ~.9.
Checks .................
Other..... .. ............ . .., . ..... .. ...............
Miscellaneous (see attached list) ............... , Cill). '51!
Total Proceeds of Sale........ . . . .... . ...... . ... . . . .............. ... ... $~
LESS SELLER'S SALE EXPENSE: "-
Auctioneer's Fee....... .'?>.5'.'?Y.. L ~f7...:-:-).... $
Other Seller's expenses advanced by auctioneer:
----1Jl~ r'AM-n)Ml\~ll..s-) t ~OO f';Q)
\'l"L~IN.(.
A\)t:Q .~'"TA1L.1 A.M.
3~\k
Q() ~~
q.lA. ~-
.~
"1~ -
Miscellaneous (see attached list) ...............
Deduct Total Seller's Sale Expense .., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total Net Proceeds to Seller ...........................................
''t.
Lnk. -
$~
$ 4 2.~().
I. (or wel. \be seller of goods. merchandise, and/or property sold at public aucUon on above dale and locaUon. acknowled.e and accept
ibis MWemen! of proceeds of sale. I (or we J agree to accept all responsibility for providing merchantable Utle to all goods. merchandise,
aneIIor property "old, and fordeJivery of Ulle totbe purchaser.
(Seller'" Signature)
(Seller's Signaturel
Civ'
STATUS REPORT UNDER RULE 6.12
Date of Death:
(;:10:2 F Gec-k
Name of Decedent:
W ill No. ~OtJ A - () () h 7 0
Admin. No.
..:\ 1 -tJ :z -6670
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.
account with the
Did the personal representative
Court? Yes No .<
file a final
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
Cerk of the Orphans' Court and may be attached to this report.
Date: 7-//- rJ.J...
~/> , d./ J./. 7)",--, -t"./-"oCL "LJ
Sl.gnat-ure
{1 ,-IYI YH': ~"j.J,-^luW,'e- L
Name (Please type or print)
'-is"b f3e~Ot>\.:J. O.
1'1... ,1"",,,,,, 11>'"'-.-./ /u '705"J-
Address v'
t7171 (/17- t 7:1. r
Te 1. No.
Capacity:
X Personal Representative
Counsel for personal
representative
(MAH: rmf/AM3)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1 162 EX(1 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KOSTOKOVICH CORRINE AKA
456 BETHANY DRIVE
MECHANICSCURG, PA 17055
___n_n fold
ESTATE INFORMATION: SSN: 204~O3~5405
FILE NUMBER: 2102-0670
DECEDENT NAME: BECK EVELYN E
DATE OF PAYMENT: 09/11/2002
POSTMARK DATE: 0010010000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/06/2002
NO. CD 001607
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $7,813.84
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: CORINN KOSTUKOVICH
CHECK# 2162
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$7,813.84
MARY C. lEWIS
REGISTER OF WillS
/-;J-;J?- ?'
'v
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COI,INTY
ACN
10-22-2002
BECK
07-06-2002
21 02-0670
CUMBERLAND
101
CORINNE KOSTUKOVICH
456 BETHANY OR
MECHANICSBURG PA 17055
*'
REV-IH7EKM'P (01-021
EVELYN
E
AMount Remitted
I CHANGED
[ll
(21
(31
141
(51
161
17l
.00
.00
.00
.00
41, 106.03
.00
21.820.30
(BI
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 ~
RE\'::iSi;j-EX-A:,,"p--foFiii!Y-NOT"icE--OF-YNHER-ii'iNCE-TAX-A"ppRA"isEMEN:r;-A:LlowiNCE-OR"-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BECK EVELYN E FILE NO. 21 02-0670 ACN 101 DATE 10-22-2002
TAX RETURN WAS: (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule FJ
7. Transfers (Schedule Gl
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H)
10. Debts/Hortga~e Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitab1e/Gover~enta1 Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
191
1101
6,893.10
1.199.26
NOTE: To insure proper
credit to your account~
submit the upper portion
of this form with your
tax paYllent.
62,926.33
1111
1121
1131
1141
8.097 36
54,833.97
.00
54,833.97
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE:
.00
.00
.00
54,833.97
x 00 = .00
X 045 = .00
X 12 = .00
X 15 = 8,225.10
1191= 8,225.10
TAY CRI1DITS:
rAm"", 1+1 AHDUNT PAID
DATE NUHBER INTEREST/PEN PAID (-I
09-11-2002 CDOO1607 411 .25 7,813.84
TOTAL TAX CREDIT 8,225.09
BALANCE OF TAX DUE .01
INTEREST AND PEN. .00
TOTAL DUE .01
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
1 IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU /'lAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
v
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
E /IE LV /II
13, l3t.=ek-
Date of Death:
'TJ,LL'I
r.
.:l 0 O-:::L-
Will No.
.:)/- '-70
Admin. No.
~ /- (/, 70
To the Register:
I certify that notice of (beneficial interest) estate administration required hy Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
Co R Inn € k'oS-I-tA.J:-u V I U.J
'I :;- Go .ti IE r /I /1/1/ '/
OIL
/J1€(!J.lA/l/'~S
/Su....ec; ~/f
,
/'10 s-r
Notice has now heen given to all persons entitled thereto under Rule 5.6(a) except
Date:~~ I~ "::?<.JQ==>---
Signature
Address
Name ~ 7(~~-1J
</ S-c. /&u ~ A..4 .
~('--1. ~--<2-~ P...1-
/ ,/0 ,fJ'
Telephone ( ) 7 17 ~ G::,17 - /7::) ~
Capacity: _ Personal Representative
_Counsel for personal representative