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HomeMy WebLinkAbout10-03-14 t �y 1505610105 - 0Ex(o�-11)(FI)t1�]T REV-150 PA Department of Revenue •pennsylvania OFFICIAL USE ONLY ^ •�I County Code Year File Number Bureau of Individual Taxes �' PO BOX 28o6oi INHERITANCE TAX RETURN I I� Harrisburg,PA 1'7128-0601 RESIDENT DECEDENT l 109 ENTER DECEDENT INFORMATION BELOW Social IS Number Date.of Death MMDDYYYY Date of Birth MMDDYYYY ...............__._.._._......_.....__.._.._._........................_........._.................... ...................................................__..._........._.........._._. 02/18/2013 .................... 03/17/1937..........03/17/1937..............._.......................................... .... _........._........__.._........_..........._..._....._.._........_.._......__..._.....__.......................... ................................................................................ ............................: Decedent's Last Name Suffix Decedent's First Name MI BoyagodaUpali .�...._..__`....___._�_...___..._..___......___.......__...__ _ j __............._.....................__.........._............................................................................................................................................_......._, ............................................. i.._N....... (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ..........................................................................._........................._.........._........................................_..........__........................_.................... ; Boyagoda Terri L Spouse's Social Security Number C THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ' GD 1.Original Return p 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate (: .4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) m 6.Decedent Died Testate O '7.Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) - CORRESPONDENT– THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIR�qED TO: a Name Daytime Telly one Numbef j G=----•-----'----.•.•.�--_---_._.tom_, `Michael Cherewka _ (717)23;F-_47_0J1 REGISTER�FWLLS USE ONM TI iLIF I( –. U� ;0 +� z Y First Line of Address 'f624 North Front Stree_t ...................._....... ... ......_....... _..... .w .............. __..._............ .... rr r�Y Second Line of Addresst— i i N City or Post OfficeState ZIP Code DATE FILED .................._..........._............._........_...................................................................._..................................................................................................... Wormleysburg PA 1 1117043 Correspondent's e-mail address: mcherewka@cherewkalaw.com 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. GNATURE Qff PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 713 FI rence Circle, Mechanicsburg, PA 17050 SIG P P T R THAN REPRESENTATIVE DATE 9 zs A15DRffSS 624 North Front Street, Wormleysburg, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 f � 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Upali Boyagoda RECAPITULATION ..................... .......................................... 1. Real Estate(Schedule A). ............................................ 1. 0.00 2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ` 0.00 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 2,500.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 180,100.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0.00 . 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 182,600.00 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 3,431.67 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 120,259.02 11. Total Deductions(total Lines 9 and 10)................................. 11. 123,690.69 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 58,909.31 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. 58,909.31 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 ��...� ._ ___ ._�.•__m._......... (a)(1.2)X.0 0 58,909 31 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0_ 16. 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. 0.00 ............................................................._.................................................................. .__...,...... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Upali Boyagoda STREETADDRESS 713 Florence Circle CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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.......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ E c. retain a reversionary interest.............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ E 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ E 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. 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[72 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[72 P.S.§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)].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-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Upali Boyagoda 21-14-104 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Mortgage on 713 Florence Circle,Mechanicsburg,PA 17050;Face Value-$160,000 80,000.00 2. Mortgage on 767 Erford Road,Camp Hill,PA 17011;Face Value-$60,000 30,000.00 3. BNY Mellon Line of Credit Account#00040701803 00001 10,259.02 TOTAL(Also enter on Line 10, Recapitulation) $ 120,259.02 If more space is needed,insert additional sheets of the same size. REV-1510 EX+(08-04) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Upali Boyagoda 21-14-104 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH °/a OF DECD'S EXCLUSION TAXABLE INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE) VALUE 1. TOTAL(Also enter on Line 7, Recapitulation) $ 0.00 If more space is needed,use additional sheets of paper of the same size. REV-1542 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Upali Boyagoda 21-14-104 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 1. TOTAL(Also enter on Line 1, Recapitulation.) $ 0.00 If more space is needed,use additional sheets of paper of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Upali Boyagoda 21-14-104 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) I. Tem L Boyagoda 713 Florenc Circle,Mechanicsburg,PA 17050 Wife 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1 Tem Boyagoda,713 Florence Circle,Camp Hill PA 17011 100% B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II— 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. REV-iso9 EX+(oi-io) r pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Upali Boyagoda 21-14-104 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.Terri Boyagoda 713 Florence Circle Wife Mechanicsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER,ATrACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. Joint Bank Account 200.00 50 100.00 2. A. 04/25179 767 Efford Road,Camp Hill,PA 17011 132,500.00 50 66,250.00 3. A. 05/03/99 716 Florence Circle,Mechanicsubrg,PA 17050 227,500.00 50 113,750.00 TOTAL(Also enter on Line 6, Recapitulation) $ 180,100.00 If more space is needed,use additional sheets of paper of the same size. REV-1507 EX+(04-13) Uvpennsylvanla SCHEDULE D DEPARTMENT OF REVENUE MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Upali Boyagoda 21-14-104 All property jointly awned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1 1 i 1 l TOTAL(Also enter on Line 4,Recapitulation) $ 0.00 (it more space is needed,insert additional sheets of the same size.) REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Upali Boyagoda 21-14-104 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Funeral Home Expenses-Death Certificates/DVD IES, 60.00 �02. Funeral Expenses-Funeral � �� 3,021.61 _i► B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 33 }� f 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: (i 5. Accountant Fees: r mac_. -acs= 6. Tax Return Preparer Fees: I( 7. Advertising-Patriot News 350.00 ILIM+-+ .�-......-.. ,"►:tet-"'+�-..�.-.""` ,.. .1 El El TOTAL(Also enter on Line 9, Recapitulation) $1 3,431.67,1 If more space is needed,use additional sheets of paper of the same size. REV-i5o8 EX+(o8-i2) �j pennsylvania SCHEDULE E ' DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Upali Boyagoda 21-14-104 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2002 Audi Sdn Mileage 113,000 Fair Condition 2,500.00 TOTAL(Also enter on Line 5, Recapitulation) $ 2,500.00 If more space is needed,use additional sheets of paper of the same size. 7/15/2014 Kelley Blue Book N�tl Kelley Btue Book The Trusted Resource i Adverhsenvrrt Why ads? 2002 Audi A4 Sell To Private Party Pricing Report Goad Fair Condition Very Goat! Condition $2,940 Condition Style:Sedan 4D $2,501 $3,042 Mileage:113,000 Exceaent 49 w € � h xyc Vehicle Highlights Fuel Economy: Max Seating:5 City 18/Hwy 26/Comb 21 MPG Private Party Values valid for your area through Doors:4 Engine:4-Cyn,Turbo,1.8 Liter 7/17/2014 Drivetrain:FWD Transmission:Automatic EPA Class:Compact Cars Body Style:Sedan Country of Origin:Germany Country of Assembly:Germany .. . . ............ Your Configured Options Our pre-selected options,based on typical equpment for this car. ✓Options that you added while configuring this car. Engine Braiding and Traction Entertainment and Instrumentation ✓ 4-Cyl,Turbo,1.8 Liter ABS(4-Wheeo AM/FM Stereo Transmission Comfort and Convenience Cassette ✓ Automatic AP Conditioning CD(Single Disc) Drivetrain Power W hdows Safety and Security FWD Power Door Locks Dual Air Bags Cruise Control Side Air Bugs Steering Wheels and Tires Power Steering Alloy Wheels Tilt Wheel _. ...... ........ .. Glossary of Terms Kelley Blue Book@ Trade-in Violas-Thisis the amount you can expect to receive when you trade Tip: in your car to a dealer.This value is determined based on the style,condition,mileage and options it's crucial to know your car's indicated. true condition when you sell it, Trade-In Range-The Trade-in Range is Kelley Blue Book's estimate of what you can reasonably so that you can price it expect to receive this week based on the style, appropriately. Consider having P yle,condition,mileage and options of your vehicle when you trade R in to a dealer.However,every dealer is different and values are not guaranteed. your mechanic give you an objective report. Kelley Blue Book@ Private Party Value-This is the starting pont for negotiation of a used-car sale between a private buyer and seller.This is an"as its"value that does not include any warranties.The final price depends on the car's actual condition and local market factors. Private Party Range-The Private Party Range is Kelley Blue Book's estimate of what you can http:/Mmw.lbb.com'ati i/a4/2002-audi-a4/sedan 4d/?condition=good&%ehicleid=3398&irdent=trade-in-sell&mileage=113000&catego-rsedan&options=1310581t... 1/2 7/15/2014 Kelley Blue Book reasonably expect to receive this week for a vehicle with stated mileage in the selected condition and configured with your selected options,excluding taxes,title and fees when selling to a private party. Excellent Condition-3%of all cars we value.This car looks new and is in excellent mechanical condition.It has never had paint or bodywork and has an interior and body free of wear and visble defects.The car is rust-free and does not need reconditioning.Its clean engine compartment is free of fluid leaks.It also has a clean title history,has complete and verifiable service records and will pass safety and smog inspection. Very Good Condition-23%of all cars we value.This car has minor wear or visible defects on the body and interior buts in excellent mechanical condition,requiring only minimal reconditioning.It has little to no paint and bodywork and is free of rust.Its clean engine compartment is free of fluid leaks. The tires match and have 75%or more of tread.It also has a clean title history,with most service records available,and will pass safety and smog inspection. Good Condition-54%of all cars we value.This car is free of major mechanical problems but may need some reconditioning.Its paint and bodywork may require minor touch-ups,with repairable cosmetic defects,and its engine compartment may have minor leaks.There are minor body scratches or dings and minor interior blemishes,but no rust.The ties match and have 50%or more of tread.It also has a clean We history,with some service records available,and will pass safety and smog inspection. Fair Condition-18%of all cars we value.This car has some mechanical or cosmetic defects and needs servicing,but is still in safe running condition and has a clean title history.The paint,body and/or interior may need professional servicing.The ties may need replacing and there may be some repairable rust damage. ©1995-2014 Kelley Blue Book Co.®,Inc.AD rights reserved. ©2014 Kelley Blue Book Co.,Inc.All rights reserved.711112014-711712014 Edition for Pennsylvania 17011.The specific information required to determine the value for this particular vehicle was s upplied by the person generating this report.Vehicle valuations are opinions and may vary from vehicle to vehicle.Actual valuations will vary based upon market conditions,specifications,vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction.This report is intended for the individual use of the person generating this report only and shall not be sold or transmitted to another party.Kelley Blue Book assumes no responsibility for errors or omissions.(v.14072) http://wrow..lbb.corriaLidi/a4/2002-audi-a4/sedan-4d/?condition=good&%ehicleid=3398&intent=trade-in-sell&rrileage=113000&category=sedan&options=1310581t... 2/2 J PropertyMapper Cumberland County, PA l3 FLORENCE CIRCLE� :, ►--..Y. 00 Y: aiz Owner.SOYAG00A, aY= Land Use .: Property Type- Aaeage: r (leanSquare Feet: 1936 Taxable Status-T Land Assessed ► Bu4cfinq Assessed flit = Total Assessed Value$:227500 PERRY COUN Sale Price$. 125WO le Date:Mon May 3 1999 08:00:00 .9j M1 Pm 9� y r 1 , t 00 YORK COUNTY � " �` ` � ' i aria-♦ � - � ;�. > .„�' „• �. Copyright 2011 Esri..All rights reserved. Wed May 7 2014 04:0:4:38 PM. 713 FLORENCE CIRCLE PIN: 10-18-1312-180 Deedbook: .00198-00858 Owner: BOYAGODA, UPALI N &TERRI L Land Use Code:. 101. Property Type:R Acreage: 0.3 Square Feet: 1936 Taxable Status:T Clean&Green Status: Land Assessed Value $: 57500 Building Assessed Value $: 170000. Total Assessed Value$: 227500 Sale Price.$: 125000 Sale Date: Mon May 3 1999 08:.00:00 PM Year Built: 1977 Municipality: HAMPDEN TOWNSHIP Height.in Stories: 2 Type of Dwelling:, DETACH Primary Exterior: Aluminum Basement Percentage: 100 Air Conditioning: AC Total Rooms: 8 Bedrooms: 4 Full Bath: 2 Half Bath: 1 1 y Property Mapper Cumberland County, PA 767 ERFORD . . t 09-17-1044-008 - Deedhook.-00281-00747 Owner. :i ! • `s t -Code., 10 Property }" . Acreage.0.13 Square Taxable Status: Status- Land Assessed •it Suildiuv Assessed t_..t Total •Value t• Sale Prke$: itt IPE YO f�Ty Sale Date. Wed Apr 08:00:00 PM "v�.z ° h,a,.,,xr' 'w'c_ sk `'''( t g j ', ,>,. ! •S, .w�`„. a _ Fl i Mkt„�1 , } "mac {ki' � j 77 � It I ✓ ' bbj s-S mi 677 Copyright 2011 Esri.All rights reserved. Wed May 7 2014 04:02:44 PM. 767 ERFORD ROAD PIN: 09-17-1044-008 Dee dbook: 00283-00747 Owner: BO YAG ODA, UPALI N& TERR I L Land Use Code: 101. Property Type:R Acreage: 0.13 Square Feet: 1492 Taxable Status: T Clean&Green Status: Land Assessed Value $: 2.2600 Building Assessed Value $: 109900. Total Assessed Value$: 132500 BNY MELLON WEALTH MANAGEMENT HOME EQUITY LINE STATEMENT Statement Date Feb 17,2013 For personal assistance, call Payment Due Date Mar 11,2013 A Client Service Rep 800 830-0549 361 Account Number 00040701803 BNY Mellon, N.A. Note Number 00001 New Statement Balance $10,230.09 P.O. Box 371038 1Fees Charged/Unpaid $0.00 Pittsburgh, PA 15251-7038 Past Due Amount $0.00 Minimum Payment Due $112.07 000361 XMZ60S01 I I I I I I I I I I If 11 11 1 11 11 It I If I 111 1 It I I I I I I III fill Is 111 11 11 111 Please make check payable to BNY Mellon,N.A.andrem it your payment to: ; UPALI N BOYAGODA 425 B.O. MELLON,N.A. 713 FLORENCE CIR P.O.BOX 371038 - MECHANICSBURG PA 17050-2212 PITTSBURGH,PA 1 525 1-7038 Amount Enclosed YOUR CHECKING ACCOUNT WILL BE CHARGED FOR THIS PAYMENT ON 03111/13. RETAIN THIS STATEMENT FOR YOUR RECORDS. Account Number: 00040701603 00001 Page 1 of 3 Statement Date: 02/17/13 Payment Due Date: 03/11113 Available Fees Charged Current Past Due Minimum Credit Unpaid Amount Due Amount Payment Due $0.00 $0.00 $112.07 $0.00 $112.07 Transactions Trans Post Advances/Debits Payments/ Balance Subject Date Date Description Interest Charge Credits to Interest Rate 01/18 Principal Balance at the Beginning of the Cycle $10,259.02 02/08 02/08 Payment $112.84 $10,188.27 Principal Portion: $70.75 Interest Portion: $38,03 Insurance Portion: $4.06 ....................- ......................................... ........... ............ X. d-... .............. ................................ ------- ............ ............ w%= ............. ...................... ............. ............. ........... ...........- 02/15 02/15 Insurance $4.01 TOTAL FEES FOR THIS PERIOD $4.01 ..........- .................. .................................................... . ....................... ...............I_;;<?....... ....... .............. .......... ............ tff .................................. ............................... ..........-............ .......... ............. .......... .......... ------------ 02/17 02/17 Interest Charge $37.81 TOTAL INTEREST FOR THIS PERIOD $37.81 For customer service after business hours,call our BNY Mellon Phone Center at 800-830-0549 BNY Mellon,N.A. Member FDIC Equal Housing Lender 000361 XMZ60S01 000721 Upali Boyagoda Obituary; U� Boyagoda's Obituary by the Patriot-N ­s. Page.1. of 1 Upali N. Boyagoda Mechanicsburg, PA-Upali N. Boyagoda,75,entered into eternal rest on February 18,2013 at 11:53pm at his home surrounded by his loving family. Upali was born on March 17, 1937 in Sri Lanka to the late Henry and Tikiri Boyagoda. Upali was the only member of his family to leave Sri Lanka,coming to America with only a few hundred dollars to his name and putting himself through undergraduate and graduate school, eventually earning his Master's Degree in Social Work. He stayed true to his Alma Mater and was a devoted Pitt and Steelers fan. Upali first worked as a social worker for the mental health unit at the Harrisburg Hospital. Later he changed careers and became a Real Estate Agent working for Jack Gaughen and on to Remax Realty,where he retired after a career of 21 years. Upali was a dedicated family man who took great pride in the accomplishments of his children and grandchildren. He was a devoted husband,father and grandfather who taught his children humility and compassion. Upali lived by example and always put others first. He never missed an important event in his children's lives and braved all obstacles and weather to make it to all of his son's football games. Upali will be greatly missed by all those who knew him. Upali is preceded in death by his parents,2 brothers and a sister. Upali is survived by his loving wife of 35 years,Terri, his son Upali"Paul"Boyagoda, his 2 daughters Anitra Boyagoda and Nina Bickel&husband Christopher,2 grandchildren Christopher and Mia and a future granddaughter, Isla. Upali is also survived his brother Ananda Boyagoda of Sri Lanka and by several nieces and nephews. A memorial service will be held on Saturday February 23,2013 at the Jesse H.Geigle Funeral Home;2100 Linglestown Rd., Harrisburg, PA 17110.A visitation will be held from 10-11 am with a memorial service beginning at 11 am with The Reverend Michael Scalzi officiating. In lieu of flowers memorial contributions may be made in Upali's name to Hospice of Central PA, 1320 Linglestown Road, Harrisburg, PA 17110. Online condolences may be made at GeigleFuneralHome.com. GEIGLE FUN,TIRAL HON Published in Patriot-News on February 21,2013 http://obits.pennlive.com/obituaries/pennlive/obituary-print.aspx?n=upali-n-boyagoda&pid..'. 2/21/2013 ii LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS,that I, UPALI N. BOYAGODA currently residing in Mechanicsburg, Cumberland County;Commonwealth of Pennsylvania, being in good health and of sound and disposing memory do hereby make, declare and publish this as my Last Will and Testament,hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all of my debts not barred by the statute of limitations, expenses of my last illness, funeral expenses, costs of administration and claims allowed in the administration of my estate shall be paid by my Executor hereinafter named, from my-estate as soon after my decease as shall be found convenient. . SECOND: I bequeath my automobiles,household and personal effects and other tangible personalty of like nature (not including cash or securities),together with any existing insurance thereon,to my wife, TERRI L. BOYAGODA. In the event that TERRI L. BOYAGODA should predecease me, I give, devise and bequeath my tangible personalty to my children,NINA K. BOYAGODA, ANITRA N. BOYGODA and UPALI E BOYAGODA,to be divided among them by my Executor with due regard for their personal preferences in as nearly equal shares as practical. Should any of my children not survive me,then I devise and bequeath her share to her issue,per stirpes, who survive me. THIRD: I give, devise and bequeath the rest,residue and remainder of my estate, whether real, personal or mixed, and of any nature whatsoever and wherever situate,to my wife, TERRI L. BOYAGODA. In the event that TERRI L. BOYAGODA should predecease me,I give, devise and bequeath the rest,residue and remainder of my estate, whether real,personal or mixed and of any nature whatsoever and wherever situate, as follows: A. One-third-(1/3)to my daughter,NINA K. BOYAGODA. In the event that my daughter,NINA K. BOYAGODA does not survive me, I devise and bequeath her one-third(1/3) share to her issue,per stirpes,who survive me, and if my daughter does not survive me and does not have any issue who survive me, then her one-third(1/3) share shall be added to the shares for my daughter, ANITRA N. BOYAGODA and my son, UPALI E. BOYAGODA. B. One-third(1/3)to my daughter, ANITRA N. BOYAGODA. In the event that my daughter,ANITRA N. BOYAGODA does not survive me, I devise and bequeath her one-third (1/3) share to her issue,per stirpes, who survive me, and if my daughter does not survive me and does not have any issue who survive me,then her one-third(1/3) share shall be added to the shares for my daughter,NINA K. BOYAGODA and my son, UPALI E. BOYAGODA. C. One-third (1/3) to my son,UPALI E. BOYAGODA. In the event that my son, UPALI E. BOYAGODA does not survive me, I devise and bequeath his one-third (1/3) share to his issue,per.stirpes, who survive me, and if my son does not survive me and does not have any issue who survive me, then his one-third(1/3)share shall be added to the shares for my daughters,ANITRA N.BOYAGODA and NINA K. BOYAGODA. FOURTH: I hereby nominate, constitute, and appoint my wife, TERRI L. BOYAGODA, as Executor of this,my Last Will and Testament. In the event that TERRI L. BOYAGODA shall predecease me, or be unwilling or unable to act as my Executor, as aforesaid, then I nominate,constitute and appoint my daughter,NINA K. BOYAGODA without necessity for posting security regardless of state of residence, as Executor of this,my Last Will and Testament. All references to the Executor herein shall be applicable to said substitute Executor. FIFTH: My Executor shall have, in addition to the powers and authority conferred upon him by law, the following additional powers and authority: 1. To sell at public or private sale, exchange, transfer,partition, give options upon, lease, mortgage,pledge, or otherwise dispose of any property,real,or personal, at any time constituting a portion of my estate, and upon such terms and conditions as the Executor shall deem wise. L 2 i f 8. The Executor may make payments to or on behalf of any person who is the beneficiary hereunder but in no event;however, shall payments be made to any creditor or other such person because of anticipation of payment by the beneficiary;and any such claim made by way of anticipation by the beneficiary shall be of no validity or legal effect. 9. To borrow money from any person, firm or corporation, including any corporation acting as an Executor hereunder, for the purpose of protecting and preserving or improving my estate hereunder;to execute promissory notes or other obligations for amounts so borrowed. 10. To employ legal counsel, accountants, brokers, investment advisors, custodians,managers and other agents and employees and to pay reasonable compensation out of . my estate or any funds held hereunder to which said compensation is attributable. 11. To carry on any business owned or controlled by me at my death for whatever period of time my Executor shall think proper, and my Executor shall have the power to do any and all things my Executor deems necessary or appropriate, including the power to close out, liquidate or sell the business at such time and upon such terms as my Executor shall deem best. 12. To do all other acts in my Executor's judgment necessary or desirable for the proper and advantageous management, investment and distribution of my estate. SIXTH: I direct that all transfer and inheritance taxes;state or federal, assessed because of my death,whether the funds,property or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate; that my Executor pay, or provide for payment of all such taxes at such time, or times, and in such manner as my Executor deems best. 4 COMMONWEALTH OF PENNSYLVANIA: ss COUNTY OF CUMBERLAND I, UPALIN. BOYAGODA, Testator whose name is signed to the attached or foregoing instrument,having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will;that I signed it willingly; and that I signed it as my- free and voluntary act for the purposes therein expressed. ~t Y UPALI N, BOYAGODA Sworn or affirmed to'and acknowledged before me by UPALI N. BOYAGODA, Testator, the Le day of A-u " . -� , 2010. (SEAL) Notary Public COMMOi} AJEALTH OF PENNSYLVANIA Notarial Sea, Michael Cherewke,Notary Public Wormieysburg ROTO,Cumberland County My commission Expires April 27,2013 Member,Penn.,V�nnia Assa^.at'on of Notaries COMMONWEALTH OF PENNSYLVANIA.: ss COUNTY OF CUMBERLAND : Weand a_�poca_. . the witnesses whose names are.signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed;that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue inf 7,ce. t Sworn or affirmed to and subscribed to before me by A24;, Id and Oyhcm (n t4i4� witnesses,this__sz=�day of Q,Lia a,]- 2010'. (SEAL) �i1ur Cda� Notary Public COMMONWEALTH OF PENNSYLVANIA Sea! MiiM27,2013 ,Notary Public Wormlumbarland County My Cires Agri!27,2043 6 Mer?b=.rssacis2ion of Notaries Law Offices of Michael Cherewka 624 North Front Street Wormleysburg, Pennsylvania 17043 (717) 232-4701 Fax (717)2324774 September 26th, 2014 Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Upali N. Boyagoda Our File No. 2931.00 Enclosed please find one original and one copy of the inheritance tax return for Upali N. Boyagoda. Also enclosed is a copy of the first page of the return. Please time stamp this page and return it to our office in the enclosed self-addressed stamped envelope. Feel free to call our office if you have any questions or concerns. Thank you. Very T 1, Yours, Dominic Montagnes- sate Dm/mc Enclosure 3-- o c M C>ap .moo C'� — C) t- m M tj N M v The Law Offices of 66 L ,� Michael Cherewka 624 North Front �'`� � < Street Wormleysburg, PA 17043 RECORDED GFFiCE OF R GIS FF: `F WILLS 2Ql`[ ivCT 3 nil 12 33 CLEF,;', , - ORPIAM-i`' r; CUMPERLf" _ F County Register County Courthouse Square Carlisle, PA 17013 F Y r �t ' fIlll }1 �� I,II 1 , #=i,Jl'�