HomeMy WebLinkAbout02-0864
PETITION F~~. PROBATE and GRANT OF LETTERS
Estate of' /'14. YI/ ~!1i [//.111' r No. 21-02-864
also known as I To:
Register of Wills for the /
Deceased. County of (/.",/'y/t71t1 in the
Social Security No. J cJ / - I r - '1;; 7~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(~, whon-;;}are 18 years of age or older an the%1e utY,.'X
in the last will of the abov~ecedent, dated / r. _1'r:C-
and codicil(s) dated
named
, 19-tL
(state relevant circumstances, e.g. renunciation. death of executor, etc.)
Decendent was domiciled at death in
he v last ~0~lfhr ~~Jfl:sidence at I p#
(list street, number and muncipality)
yea; o~ age, died , '9! ;2 t1tJ -:-
Except as foll ws, deceden did not marry, w s 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:
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:
/~. '(OO.t}{)
/
$
$
$
$
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
(testamenta ; administration c.La.; administration d.b.D.c.t.a.)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF {", If! if'Y rip} . J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ,.j/....AJ~j .1fI~.1 r;:;~ ~
before me this 24th day of _~ ~
SEPTEMBER 32002 ~
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No. 21-02-864
Estate of
MARY J SAVULlS
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW SEPTEMBER 24 ~2002 , 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 16, 1995
described therein be admitted to probate and filed of record as the last will of
MARY J SAVULIS
TESTAMENTARY
KATHLEEN MARIE GIERLAK
and Letters
are hereby granted to
~~I -'RY) ()b{:;:;; /.ar ~h A
Re~ster of Wills ~ A.U ~.~
FEES
JCP
$
$
$
$ 5.00
TOTAL _ $ 79.00
...... SEETEmlEIl.. 2ft.. .20.0.2.......
50.00
15.00
9.00
Probate, Letters, Etc. .........
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RenunCIatIOn ................
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
Filed
PHONE
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H105.805 HE\''j/(l6
This is to cenify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local R~gistrar. The original cerriticare will be forwarded to the State Vital Records Office for permanent llling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
7fALmAAd f-t~A) 71
Local Registrar
Fee for this certificate, $2.00
p
8606636
A i t;;..J,~ ~ ~ 4, OJ' OZ> >-
Date
21-02-864
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COMMOtfWEALTK OF PEHttSYLVAMlA . DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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Harry O. Trevenen
Patricia A. Betz
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LAST WILL AND TESTAMENT
OF
MARY JEAN SA VULIS
I, Mary Jean Savulis, of Camp Hill, Pennsylvania, revoke my former Wills and Codicils and declare this to be my Last
Will and Testament.
ARTICLE I
PAYMENT OF DEBTS AND EXPENSES
A. I direct that my just debts, funeral expenses and expenses of last illness be first paid from my estate.
ARTICLE n
DISPOsmON OF PROPERTY
A. Specific Bequests. I direct that the following specific bequests be made from my estate. However, such bequests
shall be made only if my spouse,
does not survive me,
I. living room mirror shall be distributed to Kathleen M. Gierlak. If this beneficiary does not survive me, this
bequest shall be added to my residuary estate.
2. living room mantle clock shall be distributed to Kathleen M. Gierlak. If this beneficiary does not survive
me, this bequest shall be added to my residuary estate.
3. sterling silver flatware shall be distributed to Patricia A. Betz. If this beneficiary does not survive me, this
bequest shall be distributed to Dustin D. Betz. If this beneficiary does not survive me, this bequest shall be
added to my residuary estate.
4. diamond engagement ring shall be distributed to Virginia L. Mastrine. If this beneficiary does not survive
me, this bequest shall be distributed to Ashley J. Mastrine. If this beneficiary does not survive me, this bequest
shall be added to my residuary estate.
B. Tangible Personal Property. Subject to the preceding provisions of this will, I direct that all of my jewelry,
clothing, personal items, furniture, household furnishings, automobile(s), and other items of tangible personal property
be distributed to my child(ren) in equal shares. If a child of mine does not survive me, such deceased child's share
shall be distributed in equal shares to the children of such deceased child who survive me, by right of representation.
If a child of mine does not survive me and has no children who survive me, such deceased child's share shall be
distributed in equal shares to my other child(ren), if any, or to their respective children by right of representation. If
no child of mine survives me, and if none of my deceased child(ren) are survived by child(ren), my tangible personal
property shall be distributed to the beneficiaries of my residuary estate.
C. Residuary. 1 direct that my residuary estate be distributed to my child(ren) in equal shares. If a child of mine
does not survive me, such deceased child's share shall be distributed in equal shares to the children of sucb deceased
child who survive me, by right of representation. If a child of mine does not survive me and has no children who
survive me, such deceased child's share shall be distributed in equal shares to my other child(ren), if any, or to their
respective children by right of representation. If no child of mine survives me, and if none of my deceased child(ren)
are survived by child(ren), my residuary estate shall be distributed to my heirs-at-law as determined under the laws of
the State of Pennsylvania.
ARTICLE m
NOMINATION OF EXECUTOR
A. I nominate Kathleen Marie Gierlak, of Hampton, Virginia, as the Executor, without bond. If such person or
entity does not serve for any reason, r nominate James Edmund Gierlak, of Hampton, Virginia, to be the Executor,
without bond.
ARTICLE IV
EXECUTOR POWERS
A. My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper
administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal
property that may be included in my estate, without order of court and without notice to anyone.
ARTICLE V
MISCELLANEOUS PROVISIONS
A. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes
only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this
Will in any gender shall extend to and include all genders and in numbers when the context or fltcts so require, and
any pronouns shall be taken to refer to the person or persons intended regardless of gender or number.
B. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will,
no person or organization shall be deemed to have survived me, unless such person or entity is also surviving on the
thirtieth day after the date of my death.
C. Children. The names of my children are:
Kathleen Marie Gierlak
Patricia Ann Betz
Virginia Louise Mastrine
All references in this Will to "my child" or "my children" include the above child (or children) and any other children
born to me or adopted by me after the signing of this Will.
D. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more
beneficiaries, the specific items of property comprising the respective shares shall be determined by the such
beneficiaries if they can agree, and if not, by my Executor.
-2 -
IN WITNESS WHEREOF, I have subscribed my name below, this / t, day of
aA'~nql"' .19$6-:-'
J41aML'- .-J~
Mary Jean S;;~ .
We, the undersigned, hereby certifY that the above instrument, which consists of 1./ pages, including
the page(s) which contain the witness signatures, was signed in our sight and presence by Mary Jean Savulis (the
"Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and
in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our names and
addresses as witnesses on the date shown above.
Witness Signature:
(l/f~ C7;~
Witness Name:
Adeline C. Trevenen
Witness Address:
390 North 19th Street
Camp Hill, Pennsylvania 170 II
Witness Signature:
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Witness Name:
Witness Address:
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Witness Signature:
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Witness Name:
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AFFIDAVIT
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5S:
Before me, the undersigned, on this day personally appeared Mary Jean Savulis, Adeline C. Trevenell, and
H/9/?"f!j J ff~VGNliN , known to me to be the
Testator and the witnesses, respectively, whose names are signed to the foregoing instrument All of these persons
were first duly sworn by me. Mary Jean Savulis, the Testator, declared to me and to the witnesses, in my presence,
that the foregoing instrument is the Testator's Wtll and that the Testator willingly signed and executed such instrument
(or expressly directed another person to sign the instrument for the Testator in the Testator's presence) in the presence
of the witnesses, as the Testator's free and voluntary act for the purposes expressed in the instrument Each of the
witnesses declared in the presence and hearing of the Testator that the foregoing instrument was executed and
acknowledged by the Testator as the Testator's Will in their presence and that they, in the Testator's presence, hearing
and sight and at the Testator's request, and in the presence of each other, did subscribe their names to the instrument
as attesting witnesses on the date of the instrument. The Testator, at the time of the execution of such instrument,
was of full age, of sound ntind, and the witnesses were sixteen years of age or older and otherwise competent to be
witnesses,
~~
Mary Jean . lis, Testator .
, 'e l--0-e~~
Adeline C. Trevenen, Witness
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, Witness
Subscribed, sworn to and acknowledged before me by Mary Jean Sawlis, the Testator; and subscribed and sworn
before me by Adeline C. Trevenen and / /
1IJ1/Ufj' ,r. rf?EVevev witnesses, this ~ day of
a'1,,-;t-. , 19~
~a~--=
"l'lOtary Public, 0 he' cer
authorized to take and certifY
acknowledgements and administer oaths
NOTARIAl SEAL
BONNI[ J. ROOT, NO!a(y Pu biic
Camp filii, C~nd County
My Commission Expires July 14. 1997
-4 -
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GIERLAK KATHLEEN MARIE
PO BOX 2262
GLOUCESTER, VA 23061-2262
___nn_ fold
ESTATE INFORMATION: SSN: 201-18-9676
FILE NUMBER: 2102-0864
DECEDENT NAME: SA VULlS MARY J
DATE OF PAYMENT: 12/16/2002
POSTMARK DATE: 12/12/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 09/20/2002
NO. CD 001953
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $6,833.25
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TOTAL AMOUNT PAID:
REMARKS: KATHLEEN M GIERLAK
CHECK#106
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$6,833.25
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
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CERTIFICATION OF NOTIC NDER R LE 5 6(al
Name of Decedent: S A V U L I S, Mary J.
September 20, 2002
Date of Death:
WiI1No. 2002-00864 PA No. 21-02-0864
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rulgs was
served on or mailed to the following beneficiaries of the above-captioned estate on D e c e m b e r 1 2, 2 0 0 L
ame Ad ress
Kathleen M. G•ierlak; PO Box 2262, Gloucester, VA 23061-2262
Patricia A. Betz; 8£19 Mandy lane, Camp hill, pA 17011
Virginia L. Mastrine; 217 K;ngs Highway, Marysville, PA 17053
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
/ ~ r
Date: December 12 , 2002 ~ ~//„~, ~ ,~~~~
Signature '~~ ~ ~
Name Kathleen M. Gierlak
Address PO Box 2262
Gloucester, VA 23061-2262
Telephone ( ) (g 0 4) 6 9 3 -1712
Capacity: X X X personal Representative
Counsel for personal representative
CERTIFICATION OF NOTI E UNDER R LE 5 6(a)
Name of Decedent: S A V U L I S, Mary J.
Date of Death: September 20, 2002
Wi11No. 2002-00864 PA No. 21=02-0864
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate admini trat~~~ required by Rule 5.6(a) of the Orphans' Court Rul s was
served on or mailed to the following beneficiaries of the above-captioned estate on 0 e C e m b e r 1 2, 2 0 0
...
Name ~ Ad r ss
Kathleen M. G~ierlak; PO Box 2262, Gloucester, VA 23061-2262
Patricia A. Betz; 8f19 Mandy-lane, Camp hill, pA 17011
Virginia L. Mastrine; 217 K;ngs Highway, Marysville, PA 17053
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: December 12 , 20.02
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Signature
Name Kathleen M. Gierlak
Address PO Box 2262
Gloucester, VA 23061-2262
Telephone ( ) (g 0 4) 6 9 3 -1712
Capacity: X X X personal Representative
Counsel for personal representative
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REV-1500
'\":' COMMONWEALTH OF
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. y '.~. ; DEPARTMENT OF REVENUE
, DEPT. 280601
..' HARRISBURG, PA 17128-0601
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FILE NUMBER
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COUNiYCODE. YE'AR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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NUMBER
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I SOCIAL SECURITY NUMBER
~01-18-9676
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
, REGISTER OF WILLS
SOCIAL SECuRITY NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SAVUlIS, Mary J.
D,1.TE OF DEATH (MM.DD.YEAR)
09/20/02
DATE OF BIRTH (MM.DD.YEARI
03/20/27
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
not applicable
~ 1. Original Return
o 4. Li:-nited Estate
o 6. Decedent Died Testate (A~.acr, r.:Jpy ~(WI::I
D 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (0310 of dl:,athilfte' ',2,12.82:1
D 7. Decedent Maintained a living Trust (Ma~h wp~ ~rTrus'l
D 10. SpoiJsal Poverty Credit (date of death b~rwtlCI112.31.91 and 1-1.951
D ~1. Remainder Return (date of ooath prior to 12.13-821
D 5. Federal Estate Tax Return Required
JL 8. Totai Number of Safe Deposit Bexes
o 11. Election 10 tax under Sec. 9113(A) {Mach Sch 0)
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COMPLETE MAILING ADDRESS
PO Box 2262
Gloucester, VA 23061-2262
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NAME
Kathleen M. Gierlak
FIRM NAME (~. Applicabltl)
TELEPHONE NUMBER'
(804) 693-1712
1. Rea! Estate (Sdledule A)
2. Stocks and Bonds (Schedule 8)
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25,097.09
none
(2)
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3. Closely Heid Corporation, Partnership or Sole-Proprietorship
4. ~\rlortgages & Notes Receivabie {Schedule Dj
5. Cash, Bank Deposits Po Miscellaneous Personal Property
(Schedu:e E)
(3)
(4)
none
24,291.18
(5)
122,657.08
(6)
6. JOintly Owned Property' (SchedUle F)
o Separate Bi!l!ng Requested
7, Inter.VfvOS Transiers & Miscellanem.ls Non-Probate Property
IScheduieGorL)
(7)
none
8. Total Gross Assets (total Lines 1-7)
(8i
12,120.93
82.34
(9)
9. Funeral Expenses & Administrative Costs (SchedUle H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule n
11 Total Deductions I.lolal Lines 9 & 10)
110i
1.11)
12. Net Value of Estate (lint": 8 minus line 11)
13. Chflritable and Governmental Bequests/See 9113 Trusts for which an elilction to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minUS Line 13)
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amolltlt of Line 14 taxable <lIthe spousal tax
rate, or tr<lnsters underSec, 9'116 (a)(1.2)
0.00
x 0 _
(15)
nunnuunnunnnunnnn1!j9)342,08u , .0 45
(16)
16 ,';mOllntof i...ine 14 taxabieat lineal rate
17 Amount of Line 14 taxabie at sibiing rate
0.00 x.12 (17}
0.00 x .15 (18)
(19)
18_ Amount of Line 14 taxable at coliateral rate
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
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172,045.35
12,203.27
159,842.08
nonp-
159,842.08
7,192.89
7,192.89
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Decede'lt's Complete Address'
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STREET ADDRESS
210 Todd Circle -
CITY Carlisle I STATE I ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousai Poverty Credit
B. Prior Payments
C. Discount
(1)
7,192.89
0.00
0.00
359.64
Total Credits (A + B + C ) (21
359.64
3.
Interest/Penalty if applicabie
D.lnterest
E. Penalty
(3)
0.00
0.00
0.00
4.
TolallnteresUPenalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enler the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
(SA)
(5B)
A. Enter the interest on the tax due.
6,833.25
0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
6,833.25
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
a. retain the use or incotlle of the propelty transferred; ..,.............. ............................. .................. D
b. retain the right to designate who shaH use the property transferred or its income; ................................... 0
c. retain a reversionary interest; or...... .............................. ....,."....,................ ................................ .................. 0
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? ...,..................... ................................... .............,.................. ..,....,....... D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individuai Retirement Accour.t, annuity, or other non~probate property which
contains a beneficiary designation? ..,.."...,.."................... ........,.......,................ ........,. ... ..... ...,......"...,.. 0
No
~
~
~
~
~
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under pef1alties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to lIle best 0( my knowledge and belief, it Is true, cooect
and complete.
OeclaratlOl1 of preparer other than the personal representative is based on all information of which preparer has any knowledge,
DATE
12/12/02
A. ESS
o Box 2262, Gloucester, VA 23061-2262
DATE
12/12/02
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 PS ~9116 (al (1.1) (i)l.
For dates of death on or after January 1, 1995, t~le lax rate imposed on the net Vil!Ue of transfers 10 or for Ihe use of the surviving spouse is 0% [72 P.S, ~9116 (i3) (1.1) (ii)].
1I1e statute does nol exenlOt a lransier 10 a surviving spouse from tax, and the statutory requirements for discfosure of assets and filing a tax return are still applicable even if
ihe surviving SiJO!Jse is the only beneficiary
For dates of death on or after Julv 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 natura! parent. an adoptive parent,
or a sleppilrent of the child is 0% [72 P,S, 99116(3)(':.2)].
The lax rate imposed on the net viliue 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)1
The tax rate imposed on the net vallie of transfers to or for the use of the decedenl's siblings is 12% [72 P.S ~9116(a)(1.3)J, A sibling is defined, under Section 9102. as an
individual who has atleasl one parent in common with the decedent, whether by blood or adoption.
"';"'~:""-::""" .
t:'.... ,.: I ~ ~~~;"
.;t' .,,'f-tee-.: ;'/ ~'.;.
.~. ~ ~.5;;;-~~-:~"x-.
J~.l ~ ~~)'~'tl':"
,\ ~ -
I;.JI" ,.
. )b ~
. ~', ,~ 'l
*.. ... ",'- ___"'. 7'l't.'J 't'"...
..... .. '!1'~~:>~t~~ .,..,.....
.. '/ -. t::",-~ ........
...... '- ~ " ~ ........"..
....... ___ __n' ..~
..~T;....
WHEREAS, on the 24th
dated Auqust 16th 1995
was admitted to probate as
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2002-00864
PA No. 21-02-0864
ESTATE OF SAVULIS MARY J
\LAbT, r .ll<.bl, lYJ.lLJLJL~j
Late of SOUTH MIDDLETON TOWNSHIP
CUM~~KLffi~U CUUN1Y,
Deceased
Social Security No. 201-18-'9676
day of September
2002 .an instrument
the last will of SAVULIS MARY J
(LAbl, r.ll<.bl, M.lLJLJL~j
late of SOUTH MIDDLETON TOWNSHIP CUMBERLAND County, who died on the
20th day of September 2002 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to GIERLAK KATHLEEN MARIE
who has duly qualified as Executor (rix)
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 24th day of September 2002.
~L7/~~6Z~) ~~.,y
e s er 0 1 s
~/I2U~
* *NOTE* * ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
,.,-_."".
LAST WILL AND TESTAMENT
OF
MARY JEAN SA VULlS
I, Mary Jean Savulis, of Ca.mp Hil~ PelUlsylvania, revoke my former Wills and Codicils.. and declare this to be my Last
Will and r esta.ment.
ARTICLE I
PAYMENT OF DEBTS AND EXPENSES
A. I direct that my just debts, funeral expenses and expenses of last illness be first paid from my estate.
ARTICLE n
DISPOSmON OF PROP.ERTY
A. Specific Bequests. I direct thst the following specific bequests be made from my estate. However, such bequests
shall be mlIde only if my spouse,
. does not survive me.
I. living room mirror shall be distributed to KJlthleen M. Gierlsk. If this beneficiary does not survive me, this
bequest shall be added to my residuary estate.
2. living room mantle .clock shall be distributed to KJltWeen M. Gierlsk. If this beneficiary does not survive
me, this bequest shall be added to my residuary estate.
3. sterling silver flatware shall be distributed to Patricia A. Betz. If this beneficiary does not survive me, this
bequest shall be distributed to Dustin D. Betz. If this beneficiary does not survive me, this bequest shall be
added to my residuary estate.
4. dia.mond engagement ring shall be distributed to Virginia L. Mastrine. If this beneficiary does not survive
me, this bequest shall be distributed to AshIey J. Mastrine. If this beneficiary does not survive me, this bequest
shall be added to my residuary estate.
B. Tangible Personal Property, Subject to the preceding provisions of this will, r direct thst all of my jewelry,
clothing, personal items, furniture, household furnishings, automobile(s), and other items of tangible personal property
be distributed to my child(ren) in equal shares. If a child of mine does not survive me, such deceased child's share
shall be distributed in equal shares to the children of such deceased child who survive me, by right of representation.
If a child of mine does not survive me and has no children who survive me, such deceased child's share shall be
distn"buted in equal shares to my other child(ren), if any, or to their respective children by right of representation. If
no child of mine survives me, and if none of my deceased child(ren) are survived by child(ren), my tangible personal
property shall be distributed to the beneficiarieS of my residuary estate.
C. Residuary. I direct thst my residuary estate be, distributed to my child(ren) in equal shares. If a child of mine
does not survive me, such deceased child's share shall be distributed in equal shares to the children of such" deceased
child who survive me, by right of representation. If a child of mine does not survive me and has no children who
survive me, such deceased child's share shall be distributed in equal shares to my other child(ren), if any, or to their
respective children by right of representation. If no child of mine survives me, and if none of my deceased child(ren)
are survived by child(ren), my residuary estate shall be distributed to my heirs-at-law as determined under the laws of
the State of Pennsylvania.
ARTICLE ill
NOMINATION OF EXECUTOR
A. I nominate KatWeen Marie Gierlak, of Hampton, Virginia, as the Executor, without" bond. If such person or
entity does not serve for any reason, I nominate James Edmund Gierlak, of Hampton, VIrginia, to be the Executor,
without bond.
ARTICLE IV
EXECUTOR POWERS
,
\
A. My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper
administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal
property that may be included in my estate, without order of court and without notice to anyone.
ARTICLE V
MISCELLANEOUS PROVISIONS
-
A. Paragraph 1liIes and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes
only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this
Will in any gender shall extend to and include all genders and in numbers when the context or facts so require, and
any pronouns shall be taken to refer to the person or persons intended regardless of gender or number.
B. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will,
no person or organization shall be deemed to have survived me, unless such person or entity is also surviving on the
thirtieth day after the date of my death.
C. Children. The names of my children are:
KatWeen Marie Gierlak
?tricia AnD Betz
Virginia Louise Mastrine
All references in this Will to "my child" or "my children" include the above child (or children) and any other children
born to me or adopted by me after the signing of this Will.
D. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more
beneficiaries, the specific items of property comprismg the respective shares shall be determined by the such
beneficiaries if they can agree, and if not, by my Executor.
- 2-
IN WITNESS WHEREOF, I have subscribed my name below, this I ~ day of
a~On.~ 19~-:--
~~~ --1~
Mary Jean ~
We, the undersigned, hereby certifY that the above instrument, which consists of 'if pages, including
the pagers) which contain the witness signatures, was signed in our sight and presence by Mary Jean Savulis (the
"Testator"), who declared'this instrument to be hislher Last Will and Testament and we, at the Testator's request and
in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our names and
addresses as witnesses on the date shown above.
Witness Signature:
(}J{'f,-<<~ CJ;~
Witness Name:
Adeline C. Trevenen
Witness Address:
390 North 19th Street
Camp Hill, Pennsyh.:ania 170 11
Witness Signature:
:% {~ ~:;;;;
Witness Name:
Witness Address:
7rs-
~A).fj9
)~ A ,y If) ){ R. r.) A .f?
Ii / LL, P,A, / '7d)/
/
'.
Witness Signature:
Witness Name:
"
"
Witness Address:
....,
"
'-"......."
""'~
"
.~.
....
- 3 -
AFFIDAVIT
~1~FOF~~~=19
, 5S:
Before me, the undersi&ned, on this day personally appeared Mary Jean Savulis, Adeline C. Trevenen, and
HJ'}.R~u v: 7J'G"I€NGN known to me to be the
Testator and thev'witnesses, respectively, whose names are signed to the foregoing instrument. All of these persons
were first duly sworn by me. Mary Jean Savulis, the Testator, declared to me and to t~e witne..es, in my presence,
that the foregoing instrument is the Testator's Will. and that the Testator willingly signed and executed such instrument
(or expressly directed another person to sign the instrument for the Testator in the Testator's presence) in the presence
of the witnesses, as the Testator's free and voluntary act for the purposes expressed in the instrument. Each. of the
witnesses declared in the presence and hearing of the Testator that the foregoing instrument was executed and
acknowledged by the Testator as the Testator's Will in their presence and that they, in the Testator's presence, hearing
and sight and at the Testator's request, and in the presence of each other, did subscribe their names to the instrument
as attesting witnesses on the date of the instrument. The Testator, at the time of the execution of such instrument,
was of full age, of sound mind, and the witnesses were sixteen years of age or older and otherwise competent to be
witnesses.
~~
'e~~~.
Adeline C. Trevenen, Witness
ry_l_ Z4~- ..~_
(7
Witness
Subscribed, sworn to and acknowledged before me by Mary Jean
before me by Adeline C. Trevenen and
fll'I/uey :r. -r/l?EVGNev
19~
Savulis, the Testator; and subscribed and sworn
_ witnesses, this _L~. day of
a'1"~~
...C-t$~~-
'NOtary Public, 0 he fficer
authorized to take and certifY
acknowledgements and administer oaths
N01 AlllAI sr N
IlONNlfJ. HOOT, N()I~IY Puhlic
Camp Hili, Cumoonand County
My Commission Expirns .)IJIy 14, 1997
-
.,
." ./.....
./ ....
-/
....
-,
'-
-'
-
--
'....
/-
".
,4 -
NOTES REGARDING DECEDENT'S WILL
Article II. A Specific Bequests. All items in paragraphs 1-4 were distributed to the beneficiaries prior to
1-1-2000. Therefore, they are not included as items of "Personal Property" on SchduIe E.
REV-.15~3 EX+ (6-98)
. 9.., /,i" '_~
~
CCMMONWEAl1H OF PENNSYLVANiA
INHERITANCE 'fAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
SAVUlIS, Mary J.
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
472,446 shares T. Rowe Price Equity Income Fund # 4009759697-2
343.881 shares T. Rowe Price Latin America Fund # 4009759701-0
VALUE AT DATE
OF DEATH
$8985.92
2321.20
2.
3.
734.501 shares T. Rowe Price Spectrum Growth Fund # 4009759709-4
7719.61
4.
Series EE U.S. Savings Bonds:
10 each, $500, issued 06/1994
4 each, $500, issued 02/1993
6 each, $100, issued 02/1992
1 each, $50, issued 02/1992
3712.00
1753.60
558.24
46.52
.
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert addj~onal sheets of the same size)
25,097.09
"April- June 2002
Statement Summary
If you have questions please call us at 1-800-225-5132 orvisit our
web site www.troweprice.com
I Mutual Fund Portfolio Value: $22,834.39
Rolling over your 401(k) is now as easy as signing your name.
just call our Rollover Specialists at 1-800-541-7865 to open
your account in one simple step or, if you prefer, visit
troweprjee.com/rolloveradvantage to get your rollover started.
Activity Summary
This Quarter
Year-to-Oate*
.~~~.i.~~.i.~~.Y~.I.~~. ..
Additions
Deductions
Income
Market Fluctuation
Ending Value
$25,532.70
0.00
0.00
........ ..............
37.66
.2,735.97
$22,834.39
Net Cha nge
-$2,698.31
Income Summary
$24.539_16
..........n.......,..
0.00
0.00
.....u...n.__
121.77
uunn-'u.un......_.
-1,826.54
$22.834.39
-$1,704.77
Taxable
This Quarter
$37.66
Year-to-Date*
$121.77
*Year-to-date income may include closed accounts n'o longer shown
en this statement.
--
'T.Roweftice.
Investor Number 879476
102943201 AT AUTO TOO 2050 17013-35961Q.1 M1
1..1111111111..,...11..11..111..1.1.1.1...111....1111....1.111
Mary J Savulis
210 Todd Cir
Carlisle PA 17013-3596
Asset Diversification
~
100.0% Stock funds
87.5% Domestic
. 12.5% Intemat'i/Global
$22.834.39
19,987.06
2,847.33
;;;;;;;;;;;;0
~
;;;;;;;;;;;;0
-
;;;;;;;;;;;;0
-
;;;;;;;;;;;;0
;;;;;;;;;;;;0
-
-
-
~
-
-
~
~
-
~
=--
!!!!!!!!!!!!!!!
Nonretirement
T. Rowe Price Mutual Funds
Equity Income
Latin America
Spectrum Growth
Total Market Value
3/31/02
Value
$11.561.45
.................N.....
3.497_27
10,473.98
$25,532.70
6/30/02
Value
Cllange
in Value
%of
Assets
$10.644.21
...............N
2,847.33
9,342.85
$22.834.39
-$917.24
-649.94
-1,131.13
.$2.698.31
46.6%
12.5
...>>.h.......... .
40.9
100.0%
Pagelof2
N
..
N
~
N
,.,
..
G>
N
o
April- June 2002
Mutual Fund Statement
1:Roweltlce.
Account Number 4009759697-2
Mary J Sav"lis
Tele*Access Code Date Activity This Quarter
37 4/1 Beginning Balance
Ticker Symbol 6/26 Div Reinvest 0.08
PRFDX 6/30 Ending Balance
Amount
Shares
Share Price
Average Cast Per Share: See back of page 1
$11,561.45 470.743 $24.56
37.66 +1.703 22.12
$10,644.21 472.446 $22.53
8 q R.s; 't L c..., -6 z-S' ~ " L
Year-la-Date Information
Taxable Divide'nds $75.04
Taxable Long.Term Gains $46.73
---
---
-
---
-
""'""""
---
-
-
-
==
-
Mary J Savulis
-
-
-
---
-
==
==
""'""""
-
Account Number 4009759701-0
Tele*Access Code
51
Ticker Symbol
PRLAX
Date
4/1
6/30
Activity This Quarter
Beginning Balance
Ending Balance
Amount Shares Share Price
$3.497.27 343.881 $10.17
$2,847.33 343.881 $8.28
2-.s U. 'Z.0 -.
Average Cost Per Share: See back of page 1
There was no activity this period.
Account Number 4009759709-4
Mary J Savulis
Tele*Access Code
43
Ticker Symbol
PRSGX
Dote
4/1
6/30
Activity This Quarter
Beginning Balance
Ending Balance
Amount Shares Share Pr;ce
$10.473.98 734.501 $14.26
$9,342.85 734.501 $12.72
7 7 /'11,(c I "
..,.
...
'"
~
n~L.
/90U,,75 ~
<I;
l'l
Z J-~()Z.
Average Cost Per Share: See back of page 1
There was no activity this period.
Page 2 of 2
U.S. Savings Bond Redemption Receipt
Redemption Date: 09/25/2002
MARY J SAVULIS 201-18-9676
210 TODD CIRCLE
CARLISLE, PA 17013
Transaction Number: 1777244
Issue Interest Redemption
Serial Number Series Denom Date Issue Price Earned Value
D-EE EE $500 06/1994, $250.00 $121.20 $371. 20
D-EE EE 500 06/1994 250.00 121. 20 371. 20
.
D-EE EE 500 06/1994 250.00 121. 20 371. 20
D-EE EE 500 06/1994' 250.00 121. 20 " 371.20
D-EE EE 500 06/1994 ' 250.00 121. 20 371. 20
D-EE EE 500 06/1994 250.00 121. 20 371. 20
D-EE EE 500 06/1994 250.00 121. 20 371.20
D-EE EE 500 06/1994 . 250.00 121. 20 371.20
D-EE EE 500 06/1994 250.00 121. 20 371. 20
D-EE EE 500 02/1993 250,00 188.40 438.40
D-EE EE 500 06/1994 250.00 121. 20 371. 20
D-EE EE 500 02/1993 250.00 188.40 438.40
D-EE EE 500 02/1993. 250.00 188.40 438.40
D-EE EE 500 02/1993 250.00 188.40 438.40
C-EE EE 100 02/1992 50.00 43.04 93.04
C-EE EE 100 02/1992 50.00 43.04 93.04
C-EE EE 100 02/1992 50.00 43.04 93.04
C-EE EE 100 02/1992 50.00 43.04 93.04
C-EE EE 100 02/1992 50.00 43,04 " 93.04
C-EE EE 100 02/1992 50.00 43.04 93.04
TEMP AGENT 1kjk1j
STREET ADDRESS LINE 1
STREET ADDRESS LINE 2
CITY, WV 11111
000-000-0000
Page 1 Of 2
I u.s. Savings Bond Redemption Receipt ~
Redemption Date: 09/25/2002
MARY J SAVULIS
201-18-9676
Transaction Number: 1777244
Issue Interest Redemption
Serial Number Series Denom Date Issue Price Earned Value
y
\\ Lp-EE
3D $.woj- 02/1992 I ~ '$:w:-mr IJJbJ-, 4.ke"'f14W.50l-~ I
EE
Total number of bonds redeemed: 21
Total Total Total
Price Interest Value
'::" .vO ,::'). )0.88 .$.e 116. 8'8
.8f~, 00
d~'I5.30
&070.3(P
Customer Signature
Customer ID: VA #T60-30-1743
TEMP AGENT lkjklj
STREET ADDRESS LINE 1
STREET ADDRESS LINE 2
CITY, WV 11111
000-000-0000
Page 2 Of 2
RIOV.H'" EX' (5.98) ~.
COMMONWEALTH OF PENNSYLVANiA
INHERITANCE Tt\X RtYURH
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
SAVULlS, Mary J.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with right of survlvorsllip must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. jewelry (value based on consultation with jeweler)
VALUE AT DATE
OF DEATH
$75.00
2. household goods and furnishings (value based on comparable items found in stores
specializing in second-hand merchandise)
3. 1998 Mercury Sable (value based on proceeds from sale of vehicle at auction)
750.00
4000.00
4. Members 1st Federal Credit Union, PO Box 40, Mechanicsburg, PA 17055-0040
savings account # 11975-00
life savings account # 11975-04
investment savings account # 11975-05
checking account # 11975-11
402.10
4000.00
8116.53
4319.76
5. coin collection (value based on appraisal by coin dealer)
862.50
6. cash on hand
439.00
7. security deposit refund, Todd Apartments, United Church of Christ Homes, Carlisle, PA
1172.94
8. insurance premium refund, State Farm Insurance, Camp Hill, PA
153.35
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
24.291.18
ZIEGLER AUCTION COMPANY, LTD.
1550 Sandhi 11 Rd.; HUllmelstown, PA 17036
717.533.4267 i<FAX 717.533.2114)
zieglerauc~ion.com
11/15/02
CONSIGNOR NUMBER : 7872
NJ'1ME
MARY J SAVULIS ESTATE
7920 CR0YDON LANE
GUREeTtR, 'IA n~f,l
-- CONSIGNOR STATEMENT - -
t(b)f1
804&931712
PROD ITM INV
CODE NO. ------ ITEM DESCRIPTION ------- NO. OTY
UNIT
PRICE
TOTAl
PRICE
PAGE I
IUTlON NUMBER : 021016
.
COMMISSION SELLER'S
AMOONT NET AMOUNT
SIDDER .
RI
--------------------------------------~--------~-----------------------------------------------------------------------------------
303
IS8 n'l8 MERWRY SABLE
4,00\l.00
1
4,000.00 0~
TOTAL GROSS SALE AMOUNT
ACTUAL SALES TOTAl
LESS COMMISSION
COM?lETED: YES NO
TOTAL tlET PROCEEDS.
TOTAL ITEMS: 1
TOTAL DUE TO SELLER
NOTE : THANK YOU FOR YOUR BUSINESS
.00 4,000.00
4,000.00
4,000.00
.00
4,000.00
4,000.00
MemberslST
FEDEKAL CREDIT UNION
P.O. Box 40 . Mechanicsburg, PA 17055-0040
(717)697-1161
TOLL FREE (800) 283-2328
www,mernbers1sLorg
~-v
CDP y/D
'Z,-S
STMT 11975-00S SAUULIS/MARY J
BEG DATE: 09/01/02 CLOSE DATE: 09/26/02
ENTRY DT PRCHS OT
09/03/02 09/03/02
09/03/02 09/03/02
09/03/02 09/03/02
09/03/02 09/03/02
09/25/02 09/25/02
09/25/02 0g/25/02
09/25/02 09/25/02
09/25/02 09/25/02
*END OF LIST*
r
j
....4, "j
TRAN DESC
US TREASURY 312
US TREASURY 312
US TREASURY 303
US TREASURY 303
(SHWI)
(SHOU)
(SHWI)
TFR TO SHARES
ViS4 (3/<..1...
22271&-05
SIGNATURE
v........ ftdo<.uf iNM.....,t..
NCUA
~."...,t:_I.'....~_.U.&_....,
09/26/02 04:08 PM BR:04
AMOUNT
1193.91
-1193.91
163.00
-163.00
-237. &7./
.4&V
-25. 00 .,/
-114.89/
BALANCE
159&.01
402.10
565. 10
402.10
164.43
164.89
139.89
25.00
MemberslST
FED EllA!. eRE,nrr t n",'!ON
P.O. Box 40 . Mechanicsburg, PA 17055-0040
(717) 697-1161
TOLL FREE (800) 283-2328
www,members1st.org
STMT 11975-04S SAUULIS/MARY J
BEG DATE: ,z'9/01/1Zi2 CLOSE D..HE: 09/2&/02
ENTRY OT PRCHS DT
09/25/02 09/25/02
09/25/02 09/25/02
*END OF LIST*
TRAN DESC
(SHDU)
TFR TO SHARES
222716-05
$lGNATURE
y""'.......rool<'IIlI,_.....lilOD.MO
NCUA
N......'''.......-_.U.&Goooo'o__.
09/26/02 04:08 PM BR:04
AMOUNT ./
4.58
-4004.58V
BALANCE
4004.58
.00
MemberslST
FEDERAl. eRE! >n' IlNION
PO. 80x 40 . Mer::hanicsburq, PA 17055-0040
(717) 097"1161
TOLL FREE (800) 283-2328
www,memberS1sf.org
STMT 11975-05S
BEG DATE: 09/01/02
ENTRY DT PRCHS DT
09/03/02 09/03/02
09/25/02 09/25/02
09/25/02 09/25/02
"END OF LIST"
SAVULIS/I~ARY J
CLOSE DATE: 09/26/02
TRAN DESC
US TREASURY 303
(SHDV)
TFR TO SHARES
MemberslST
1'F1)lmAI. CREDrr I.INION
P.O. Box 40 . Mechanicsburg, PA 17055-0040
(717) 697-1161
TOll FREE (800) 283-2328
www.members1sl.0rg
222716-05
SIGNATURE
09/26/02
Nc'ui
,,,,~.I ( <~J" ...... .."""',......... ol'.lo. "-"-~-'
04:08 PM
AMOUNT
163.00 --"
L> ~...."",
7.....,.:;
-8116. 53 0/"
BR:04
BALANCE
8107.00
8116.53
.00
STMT 11975-11S SAVULIS/MARY J
BEG DATE: 09/01/02 CLOSE DATE: 09/26/02
ENTRY DT PRCHS DT
09/03/02 09/03/02
09/05/02 09/04/02
09/10/02 09/09/02
09/10/02 09/09/02
09/11/02 09/10/02
09/13/02 09/12/02
09/18/02 09/17/02
09/19/02 09/18/02
09/25/02 09/25/02
09/25/02 09/25/02
09/25/02 09/25/02
"END OF LI ST"
TRAN DESC
US TREASURY 312
SHARE DRAFT ~
SH~lRE DRAFT ~
SHARE DRf'lFT ~
SHARE DRAFT l*
SHAHE DRAFT ~
SHAHE DRAFT l*
SHAflE DRAFT l*
(SHDV)
TFR TO SHARES
TFR TO SHARES
1263
1264
1262
1261
1265
1267
1266
222716-11
222716-05
SIGNATURE
V...,.....'_,iMIrMIOSIOO,OOO
NCUA
N,"n~"""'l,___.l'-',o.;.,__,
09/26/02 04:08 PM BR:04
AMOUNT
1193.91
-;:::0.00
--120.59
--H,8.24
-25.00
-25.00
-20.00
-25.00
2.87V
-2000.00 v""
-1069.86""""
BALANCE
4723.59
4703.59
4583.00
4414.76
4389.76
4364.76
4344.76
4319.76
4322.63
2322.63
1252.77
REV.l't09 EX.. (6.98)
'*'
COMMONWEALTH OF PENNSYLVANiA
INHERITANCE '[AX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
SAVULlS, Mary J.
FILE NUMBER
If an asset was made Joint within one year of the decedent's date of death, It must be reported on Schedule G.
A. Kathleen M. Gierlak
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
PO Box 2262, Gloucester, VA 23061-2262
daughter
B.
Patricia A. Bell
889 Mandy Lane, Camp Hill, PA 17011
daughter
c.
Virginia L. Mastrine
217 Kings Highway, Marysville, PA 17053
daughter
JOINTLY.OWNED PROPERTY:
LEiTER 0"':11::. DESCR\?T\ON OF PROPERTY ,. OF DATE OF DEATH
ITEM ~OR JOINT MADE INCLUDE NAME 0;: FINANC!.AlINSTlTUTION ANO BANK ACCOUNTNUMBER OR SIMV.fi DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINl ILlENTIFYING NUMBI:;R.AnACH DEED FOR JOIN'flY,HElD REAL ESTATE V!l,lUEOFASSET IN'rEREST QE,CEOEtn"S(NTER.Eln'
1. A. 12-15-00 Members 1 sl Federal Credit Union, PO Box 40, Mechanicsburg, 66,104.72 50 33,052.36
PA 17055-40; Account # 199702
2. B. 12-15-00 Members 1st Federal Credit Union, PO Box 40, Mechanicsburg, 66,104.72 50 33,052.36
PA 17055-40; Account # 199703
3. C. 12-15-00 Members 1st Federal Credit Union, PO Box 40, Mechanicsburg, 66,104.72 50 33,052.36
PA 17055-40; Account # 199704
4. A 8-29-00 M&T Bank, One M&T Plaza, Buffalo, NY 14240; account # 10,000.00 50 5,000.00
31003910995281
5. A. 8-11-00 WaypointBank, PO Box 1711, Harrisburg, PA 17105-1711; 12,000.00 50 6,000.00
account # 7100001418
6. B. 2-17-00 Waypoint Bank, PO 80x 1711, Harrisburg, PA 17105-1711; 13,000.00 50 6,500.00
account # 1700015365
7. C. 8-11-00 Waypoint Bank, PO Box 1711, Harrisburg, PA 17105-1711; 12,000.00 50 6,000.00
account # 7100001416
..
TOTAL (Also enter on line 6, Recapitulation) $ 122,657.08
(If more space is needed. insert additional sheets of the same size)
NOTES REGARDING JOINTLY-OWNED PROPERTY
Items 1-3. On the date of death, the decedent had three identical joint accounts with Members 1st Federal
Credit Union, one with each of the individual beneficiaries. These accounts were in the amount of
$66,104.72 each, and were broken out as follows:
Savings $ 104.72
3 Yr Certificate 21,000.00
3 Y r Certificate 2 L 000.00
18 Month Certificate 13,000.00
TOTAL $ 66,104.72
Item 4. M&T Bank, at some point in time, acquired Keystone Financial.
Items 5-7. Waypoint Bank, at some point in time, acqnired Harris Savings Bank.
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.members1st.org
Member's
Statement
of Account
Acoount Number From TO Page
.
199702 07-01-02 09-30-02 1 of 2
Membersl5T
FEDERAL CREDIT UNION
Main Switchboard:
Ca/l-24:
TOO:
TeleBranch:
(717) 697.1161 Of (8OO) 283-232B
(717) 697-4372 or (aOO) 283-4372
(717) 697-5312 or (800)283-2328 ex!. 5312
(717) 795.6049 or (800) 237.7288
1..1.1..11.11....11,,,,,11,,1,1,,1,1,11,,,,\,1,11,,,,1,11,,1,1 560"
MARY J SAVULIS
PO BOX 2262
GLOUCESTER
VA 23061
TRANS EFF.
DATE DATE
TRANSACTION DESCRIPTION
SUFFIX;OO SAVINGS
73102 DIVIDEND
83102 DIVIDEND
92502 CERT PAYOFF TRANSFER --~~
92502 CERT PAYOFF TRANSFER ~ISnlJl.
92502 CERT PAYOFF TRANSFER- ~
92502 ERROR CORRECTION
92502 CERT PAYOFF TRANSFER- 4~
92502 CERT PAYOFF TRANSFER - +0
92502 TFR TO SHARES 40139-40
92502 SHARE DIVIDEND
92502 SHARE WITHDRAWAL 7'0 <!-OlJ"i-ll
JOINT OWNERS: KATHLEEN M GIERLAK
Y-T-D DIVIDENDS:
ANNUAL
ANNUAL
TRUTH IN SAVINGS INFORMATION
PERCENTAGE YIELD
PERCENTAGE YIELD EARNED
1.75%
1.72%
j
JO I N US ON THURSDAY L OCTOBER '"
17TH. 20021 MEMBER:. 1 ST ".".
FEDERAL CREDIT UNION IS'
CELEBRATING INTERNATIONAL
CREDIT UNION DAY. SEE THE
ENCLOSED INSERT FOR MORE
INFORMATION.
.
AMOUNT
@
.15
.15
20051.68
11835.88
13027.35
-11835.88
12025.25
21093.76
-21000.00
.12
-45302.88
2.12
---------- ------------------------------------------------------ ------------
SUFFIX;40 3 YEAR CERTIFICATE
73102 DIVIDEND
73102 TFR TO SHARES 11975-11
83102 DIVIDEND
83102 TFR TO SHARES 11975-11
92502 CERTIFICATE DIVIDEND
92502 CERTIFICATE PAYOFF
JOINT OWNERS: KATHLEEN M GIERLAK
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
PERCENTAGE YIELD II 7.01%
PERCENTAGE YIELD EARNED 6.97%
ANNUAL
ANNUAL
121.10
-121.10
121.10
-121.10
93.76
-21093.76
1043.04 F RFEITURES:
CERT NO: 0 ISSUE DATE:12150D MATURITY DATE:1215 3 DIV RATE:
---------- ------------------------------------------------------ ------------
SUFFIX;42 3 YEAR CERTIFICATE
73102 DIVIDEND
73102 TFR TO SHARES 11975-05
83102 DIVIDEND
83102 TFR TO SHARES 11975-05
92502 CERTIFICATE DIVIDEND
92502 CERTIFICATE PAYOFF
66.76
-66.76
66.76
-66.76
51.68
-20051.68
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION.
BALANCE
104.42
104.57
104.72
20156.40
31992.28
45019.63
33183.75
45209.00
66302.76
45302.76
45302.88
.00
21000.00
21121.10
21000.00
21121.10
21000.00
21093.76
.00
.00
6.7900
20000.00
20066.76
20000.00
20066.76
20000.00
20051. 68
.00
56022
Account Number From
SEND ALL INQUIRES TO THE CREDIT UNION AT THE ADDRESS SHOWN ON PAGE # 1
Members 1ST
FEDERAL CREDIT UNION
TRANS EFF.
DATE DATE
199702 07-01-02
09- 30-02 2 of 2
BALANCE
.TRANSAGTlONOESCRIPTION
JOINT OWNERS: KATHLEEN M GIERLAK
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD I 4.00%
ANNUAL PERCENTAGE YIELD EARNED I 3.99%
AMOUNT
574.98 F RFEITURES:
CERT NO: 0 ISSUE DATE:110501 MATURITY DATE:l104 4 DIV RATE:
--- ------------------------------------------------------------- ------------
SUFFIX:43 18 KONTH CERTIFICATE
073102 DIVIDEND 32.61
073102 TFR TO SHARES 11975-11 -32.61
083102 DIVIDEND 32.61
083102 TFR TO SHARES 11975-11 -32.61
092502 CERTIFICATE DIVIDEND 25.25
092502 CERTIFICATE PAYOFF ~ -12025.25
JOINT OWNERS: KATHLEEN M GIERLAK
Y-T-D DIVIDENDS: 204.08 F RFEITURES:
TRUTH IN SAVINGS INFORMATION
PERCENTAGE YIELD II 3.25%
PERCENTAGE YIELD EARNED 3.24%
073102
073102
083102
083102
092502
092502
ANNUAL
ANNUAL
CERT NO: 0 ISSUE DATE:031502 MATURITY DATE:0913 3 DIV RATE:
------------------------------------------------------ ------------
SUFF I X: 44 18 KONTH CERTI F ICATE
DIVIDEND
TFR TO SHARES
DIVIDEND
TFR TO SHARES 11975-05
CERTIFICATE DIVIDEND
CERTIFICATE PAYOFF
JOINT OWNERS: KATHLEEN GIERLAK
Y-T-D DIVIDENDS:
11975-05
35.33
-35.33
35.33
- 35.33
(T'\\ 27.35
~ -13027.35
.00
3.9300
12000.00
12032.61
12000.00
12032.61
12000.00
12025.25
.00
.00
3.2000
13000.00
13035.33
13000.00
13035.33
13000.00
13027.35
.00
.00
--- ------ ------------------------------------------------------ ------------ ---
3.2000
151.58 F RFEITURES:
ANNUAL
ANNUAL
TRUTH IN SAVINGS INFORMATION
PERCENTAGE YIELD II 3.25%
PERCENTAGE YIELD EARNED 3.24%
CERT NO:
o ISSUE DATE:051502 MATURITY DATE:1113 3 DIV RATE:
FOR 2002
* OTHER YTD * TOTAL YTD * TOT L YTD
DIVIDENDS DIVIDENDS WITH DLDING
* TOT
FOR
*
IRA YTD
DIVIDENDS
.00
2165.27
.00
2165.27
L YTD *
EITURES
.00
Send Inquires to:
Member's
Statement
of Account
Account Number From TO Pag.
199703 07-01-02 09-30-02 1 of 2
,
JOIN US ON THURSDAY. OCTOBER.::
17TH. 20021 MEMBERS 1 ST .,'
FEDERAL CRED I T UN I ON IS ,'(,.
CELEBRATING I NTERNAT I ONALi'I."t':.;. '...,'....,...
CREDIT UNION DAY. SEETHE."....,
ENCLOSED I NSERT FOR MORE !. f}i<"-
I NFORMAT I ON ..~:;;;~i...,:
" d,~ ;'.
'1""""_
'.!(. ;C","~ ,
'".;~,Y'1" '
'J>, _ -i<:'_"
.~(',_:, .
Membersl"-
FEDERAL CREDIT UNION
5000 Louise Orive
PO 60)( 40
Mechanicsburg, PA 17055
www.memberslst.org
Main Switchboard:
Calt.24:
TOO:
Tele6ranch:
(717) 697-1161 or (800) 283-2328
{717} 697.4372 01 (BOO) 283-4372
(717) 697-5312 01 (BOO} 283.2328 ext. 5312
(717) 795-6049 or (SOO) 2:!7-72BB
1"1,1"11,11""11",,,11,,1,1,,\,1,11,,,,1,\,11,,,,),11,,1,1
MARY J SAVULIS
PO BOX 2262
GLOUCESTER
56019
VA 23061
TRANS EFF.-
CATE DA'TE
..
AMOUNT
TRANSACTION DESCRIPTION ..
SUFFIX:OO SAVINGS
~p102 DIVIDEND
~~3102 DIVIDEND
",93002 DIVIDEND
~gl~93002 TFR FROM SHARES 199703-40
93002 TFR FROM SHARES 199703-42
93002 TFR FROM SHARES 199703-43
93002 TFR FROM SHARES 199703-44
JOINT OWNERS: PATRICIA A BETZ
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD I 1.75%
ANNUAL PERCENTAGE YIELD EARNED I 1.72%
.15
.15
.15
117.20
64.60
31.56
34.19
2.15
---------- ------------------------------------------------------ ------------ ---
SUFFIX:40 3 YEAR CERTIFICATE
73102 DIVIDEND
73102 TFR TO SHARES 11975-11
83102 DIVIDEND
83102 TFR TO SHARES
~93002 DIVIDEND
p93002 TFR TO SHARES
JOINT OWNERS:
11975-11
121.10
-121.10
121. 10
-121.10
117.20
-117.20
199703-00
PATRICIA A BETZ
Y-T-D DIVIDENDS:
1066.48 F RFEITURES:
ANNUAL
ANNUAL
TRUTH IN SAVINGS INFORMATION
PERCENTAGE YIELD II 7.01%
PERCENTAGE YIELD EARNED 6.96%
CERT NO: 0 ISSUE DATE:121500 MATURITY DATE:121S
-----------------------------------------------------------------
SUFFIX:42 3 YEAR CERTIFICATE
73102 DIVIDEND
73102 TFR TO SHARES 11975-05
83102 DIVIDEND
83102 TFR TO SHARES 11975-05
93002 DIVIDEND
93002 TFR TO SHARES 199703-00
3 DIV RATE:
66.76
-66.76
66.76
-66.76
64.60
-64.60
NOTICE: SEE REVERSE.SIDEFOR IMPORTAIIT INFORMATION
BALANCE
104.42
104.57
104.72
104.87
222.07
286.67
318.23
352.42
21000.00
21121.10
21000.00
21121.10
21000.00
21117 .20
21000.00
.00
6.7900
20000.00
20066.76
20000.00
20066.76
20000.00
20064.60
20000.00
.
:56020
Account Number f_rom
To
SEND ALL INQUIRES TO THE CREDIT UNION AT THE ADDRESS SHOWN ON PAGE # 1
Members]'"
FEDERAL CREDIT UNION
TRANS EFF.
DATE DATE
073102
073102
083102
083102
093002
093002
073102
073102
083102
083102
093002
093002
199703 07-01-02
09- 30-02 2 of 2
.' ...... AMOUNT .. BALANCE'
TRANSACTION DESCRIPTION
JO I NT OWNERS: PATR I C I A A BETZ
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD / 4.00%
ANNUAL PERCENTAGE YIELD EARNED / 3.99%
587.90 F RFEITURES:
.00
3.9300
12000.00
12032.61
12000.00
12032.61
12000.00
12031.56
12000.00
.00
3.2000
13000.00
13035.33
13000.00
13035.33
13000.00
13034.19
13000.00
.00
CERT NO: 0 ISSUE DATE:051502 MATURITY DATE:1113 3 DIV RATE: 3.2000
----------------------------------------------------------------- ------------~---
FOR 2002
CERT NO: 0 ISSUE DATE:110501 MATURITY DATE:ll04 4 DIV RATE:
------------------------------------------------------------- ------------
SUFfIX:43 18 MONTH CERTifiCATE
DIVIDEND
TFR TO SHARES
DIVIDEND
TFR TO SHARES
DIVIDEND
TFR TO SHARES
JOINT OWNERS:
CERT NO: 0 ISSUE DATE:031502 MATURITY DATE:0913 3 DIV RATE:
------------------------------------------------------------- ------------
SUffIX:44 18 MONTH CERTifiCATE
DIVIDEND
TFR TO SHARES
DIVIDEND
TFR TO SHARES
DIVIDEND
TFR TO SHARES
JOINT OWNERS:
11975-11
32.61
-32.61
32.61
-32.61
31.56
-31.56
11975-11
199703-00
ANNUAL
ANNUAL
PATRICIA A BETZ
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
PERCENTAGE YIELD / 3.25%
PERCENTAGE YIELD EARNED / 3.24%
210.39 F RFEITURES:
11975-05
35.33
-35.3'3
35.33
- 35.33
34.19
-34.19
11975-05
199703-00
PATRICIA BETZ
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD / 3.25%
ANNUAL PERCENTAGE YIELD EARNED / 3.24%
158.42 F RFEITURES:
"
IRA YTD
DIVIDENDS
* OTHER YTD * TOTAL YTD
DIVIDENDS DIVIDENDS
" TOT L YTD
WITH OLDING
" TOT
FOR
.00
2214.81
2214.81
.00
L YTD *
EITURES
.00
S'lnd If\quues \Q:
Member's
Statement
of Account
Account Number From TO Page
199704 07-01-02 09-30-02 1 of 2
,,;:t~., ,_'
JOIN US ON THURSDAY, OCTOBER~;{".:-
17TH, 2002\ MEMBERS 1 ST 'J,mty
FEDERAL CREDIT UNION IS '1<"""'"
CELEBRATING INTERNATIONAL, ~),
CREDIT UNION DAY. SEE THE.:!' "<.:,.-
ENCLOSED,,! NSERT FOR MORE.;.. ~.:.;;~.'.i'-
I NFORMAT I DN. .. ~,"l,l'..
l<1'
!~~-; --
:::}1~' .
5000 Louise Prive
M' . b 1ST PO Box 40
em ers Mechanicsburg, PA \705S
FEDERAL CREDIT UNION www.members1st.org
Main Switchboard:
C..II~24:
TOO,
Tel.Sranch:
(717) 697.1161 or (800) 283-2328
(717) 697-4372 or (800) 283.4372
(717) 697.5312 Of (aoo) 283.2328 ext. 5312
(717) 795-6049 01 (BOO) 237.7288
1,.1.1,.11.11",.11.",,11,,1,1.,1,1,11.,.,1,1.11,..,1,11,,1,1
MARY J SAVULI S
PO BOX 2262
GLOUCESTER
56023
VA 23061
TRANS EFF., I'
DATE : CATE'
.'
, TRANSACTION DESCRIPTION
SUFFIX:OO SAVINGS
073102 DIVIDEND
083102 DIVIDEND
092602 CERT PAYOFF TRANSFER
092602 TFR TO SHARES 22274B-40
~92602 CERT PAYOFF TRANSFER
~92602 CERT PAYOFF TRANSFER
92602 CERT PAYOFF TRANSFER
92602 SHARE DIVIDEND
92602 SHARE WITHDRAWAL
92602 SHARE WITHDRAWAL
JOINT OWNERS: VIRGINIA L MASTERINE
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD / 1.75%
ANNUAL PERCENTAGE YIELD EARNED / 1.70%
2.12
AMOUNT
.15
.15
21097.66
-21000.00
20053.B4
12026.30
1302B.49
.12
-25.00
-452B6.13
",ti
,h'.~
:k~'~,
):~t
.'...,.'..,..,_....._-,..
. BA:LANOeI
104.42
104.57
104.72
21202.3B
202.3B
20256.22
322B2.52
45311.01
45311.13
452B6.13
.00
---------- ------------------------------------------------------ ------------ ---
SUFFIX:40 3 YEAR CERTIFICATE
73102 DIVIDEND
73102 TFR TO SHARES 11915-11
B3102 DIVIDEND
B3102 TFR TO SHARES 11975-11
092602 CERTIFICATE DIVIDEND
092&02 CERTIFICATE PAYOFF
JOINT OWNERS: VIRGINIA L MASTRINE
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD / 7.01%
ANNUAL PERCENTAGE YIELD EARNED / 6.97%
121.10
-121. 0
121. 10
-121.10
97.6&
-21097.66
104&.94 F RFEITURES:
CERT NO: 0 ISSUE DATE:121500 MATURITY OATE:1215
-----------------------------------------------------------------
SUFFIX:42 3 YEAR CERTIFICATE
73102 DIVIDEND
73102 TFR TO SHARES 11975-05
)83102 DIVIDEND
)83102 TFR TO SHARES 11975-05
~~2602 CERTIFICATE DIVIDEND
_92602 CERTIFICATE PAYOFF
NOTICE: SEE REVERSE SIOE'FDRIMPORTAfIITltJ"nQUAT'''"'
3 D I V RATE:
6&.76
-66.76
66.76
-66.76
53.B4
-20053.84
21000.00
21121.10
21000.00
21121.10
21000.00
21097.66
.00
.00
&.7900
20000.00
200&6.76
20000.00
20066.76
20000.00
20053.B4
.00
"
Membersl5T
FEDERAL CREDIT UNION
56024
SENt) ALL INQUIRES 1 () Iii!::: CREDIl UNION AT THE ADDRESS SHOWN ON PAGE # 1
Account Number From To . P.d~<'
199704 07-01-02 09-30-02 2 of 2
TRANS EFF,
DATE DATE
. AMOUNT BALANCE
TRANSACTION DESCRIPTION
JOINT OWNERS: VIRGINIA L MASTERINE
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD II 4.00%
ANNUAL PERCENTAGE YIELO EARNED 3.99%
577.14 F RFEITURES:
CERT NO: 0 ISSUE DATE:110501 MATURITY DATE:l104
-----------------------------------------------------------------
SUFFIX:43 18 MONTH CERTIFICATE
OIVIOEND
TFR TO SHARES
DIVIDEND
TFR TO SHARES 11975-11
CERTIFICATE DIVIDEND
CERTIFICATE PAYOFF
4 DIV RATE:
32.61
-32.61
32.61
-32.61
26.30
-12026.30
073102
073102
083102
083102
092602
092602
11975~ 11
.00
3.9300
12000.00
12032.61
12000.00
12032.61
12000.00
12026.30
.00
! JOINT OWNERS: VIRGINIA L MASTERINE
Y-T-D DIVIDENOS: 205.13 F RFEITURES: .00
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE Y I HD I 3.25%
ANNUAL PERCENTAGE YIELO EARNED I 3.24%
CERT NO: 0 ISSUE DATE:031502 MATURITY DATE:0913
-----------------------------------------------------------------
SUFFIX:44 18 MONTH CERTIFICATE
073102 DIVIDENO
073102 TFR TO SHARES 11975-05
083102 DIVIDEND
083102 TFR TO SHARES 11975-05
092602 CERTIFICATE DIVIDEND
092602 CERTIFICATE PAYOFF
JOINT OWNERS: VIRGINIA
3 DIV RATE:
35.33
- 35.33
35.33
-35.33
28.49
-13028.49 .
MASTER I NE
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD I 3.25%
ANNUAL PERCENTAGE YIELD EARNED I 3.24%
152.72 F RFEITURES:
3.2000
13000.00
13035.33
13000 .00
13035.33
13000.00
13028.49
.00
.00
CERT NO: 0 ISSUE DATE:051502 MATURITY DATE:1113 3 DIV RATE: 3.2000
--- ------------------------------------------------------------- ------------"---
FOR 2002
,'e
IRA YTD * OTHER YTD * TOTAL YTD * TOT
DIVIDENDS OIVIOENDS DIVIDENDS WITH
.00 2173.52 2173.52
L no "TOT~~ no *
OLDING FOR EITURES
.00 .00
/
, Keystone ~
, Financial ~
CERTIFJ~ATE OF DEPOSIT
NON-TRANSFERABLE
No. 3783106572
Member
FDIC
OFFICE# ISSUE DATE
814 08 29 00
FIRST INTEREST RATE
07.00 %
TERMS 1st MA TIJRITY
25 Months 09 29 02
FREQUENCY OF INTEREST PAYMENT
Monthly
Name and Address
MARY J SAVULIS OR
KATHLEEN M GIERLAK
210 TODD CIR
CARLISLE PA 17013 0000
25 MONTH PROMO
Relationship:
.. ---------_.- --..-------..--
TYPE OF CERTIFICATE
TYPE INTEREST PLAN
Auto. Renewable 060
METHOD OF INTEREST PAYMENT
Mail Check
840
CODE
Tax ID/SS#
201189676
000000000
AMOUNT DEPOSITED
$*****10 000.00
Authorized
Signature
Telephone #, H(7l7)249-5191 W(OOO) 000-0000
.: 5.88'" .0 1.01:
CERTIFICATE OF DEPOSIT
WITHDRAWAL AND FORFEITIJRE PROVISIONS
Funds deposited in a certificate of deposit cannot be withdrawn
in whole or in part prior to maturity except with the consent
of the bank at the time the request for withdrawal is made.
If the withdrawal is permitted, one of the following penalties
will be assessed:
A. Term of 7-89 days:
The depositor will forfeit at least seven (7) days interest.
If the funds have been on deposit for more than seven
(7) days, the depositor will forfeit any interest accrued
at the time of withdrawal.
8, Term of three months through one year:
The depositor will forfeit an amount equal to three
months' simple interest
C. Tenn of more than one year:
The depositor will foneit an amount equal
to six months' simple interest.
The assessment of forfeiture of interest may require
a reduction in the principal amount of the certificate.
Requests for withdrawal prior to maturity where the
owner or beneficial owner has either died or been
judicially dec1ared mentally incompetent will be made
without interest penalty.
Date Tax
Opened: 8/11/2000 Term: 36 MONTHS ID:
CERTIFICATE OF DEPOSIT COPY
AND
CERTIFICATE OF DEPOSIT SIGNATURE CARD
201-18-9676 Number:
Account Number:
7100001418
Amount of
Deposit: TWELVE THOUSAND AND 00/100
This Time Deposit is Issued to: Issuer:
$
CARLISLE BRANCHL HARRIS
17 W HIGH STREK!"
CARLISLE PA 17013
12,000.00
SAVINGS BlINK
MARY J SAVULIS
KATHLEEN M GIERLAK
210 TODD CIR
CARLISLE PA 17013-3596
Not Negotiable.. Not Transferable - Additional terms are below.
By l/;Xfj!J~tco+n/,lfi S".b ,. (Jrc...q
Additional-Terms and Disclosures
This form comains the terms for your time deposit. It is also the Minimum Balance Requirement: You must make a minimum deposit to
Truth-in-Savings disclosure for those depositors entitled to one. There
are. addi(io~l terms and disclosures on pa~e two of this form. some of open this account of $ 500 . 0 Q .
whlch explam or expand on those below. au should keep one copy of 0 . . . .. ,.
this form. You must mamtam. ~us m.InlffiUm balance on a dally baSIS to earn the
Maturity Date: This account matures 8/11/2003 annual percentage Yleid disclosed.
(See below for renewal information.) Withdrawals of Interest: Interest o accrued rnxcredited during a
Rate Information: The interest rate for this account is 6.88000 % term can be withdrawn:
with an annual percentage yield of 6.88 %. This rate will be AT ANY TIME WITHOUT PENALTY
,
paid until the maturity date specified above. Interest begins to accrue on Early Withdrawal Penalty: If we consent to a request for a withdrawai
the business day you deposit any noncash item (for example, a check). that is otherwise not permitted you may have to pay a penalty. The
Interest will be compounded NOT APPLICABLE penalty will be an amount equal tQ:
Interest will be credited MONTHLY LOSS OF 180 DAYS
BY CHECK interest on the amount withdrawn.
o The annual percentage yield assumes that interest remains on deposit Renewal Policy:
until maturity. A withdrawal of interest will reduce earnings. 0 Single Maturity: If checked. this account win not automatically
o If you close your account before interest is credited, you will not renew. Interest o will o win not accrue after maturity.
receive the accrued interest. ti! Automatic Renewal: If checked, this account will automatically
The NUMllER OF ENDORSEMENTS needed for withdrawal or any renew on the maturity date, (see page two for terms)
other purpose is: 1 Interest Olxvill o will not accrue after final maturity.
o Revocable Trust Designation as defined in this
agreement (Beneficiaries' names and addresses)
BACKUP WITHHOLDING
CERTII'ICATIONS
TIN: 201-18-9676
I&k Taxpayer LD. Number. The Taxpayer
Identification Number shown above (TIN) is
my correct taxpayer identification number,
I&k Backup Withholding. I am not subject
\0 backup withholding either because I have
not been notified that 1 am subject to backup
withholding as a result of a failure to report
all interest or dividends., or tl1.e Internal
Revenue Service has notified me that I am no
longer subject to backup withholding.
o Exempt Recipients - I am an exempt
recipient under the Internal Revenue Service
Regulations.
o Nonresident Aliens - I am not a United
States person, or if I am an individual, I am
neither a citizen nor a resident of the United
Statts.
SIGNATURE. I certify under penalties of
perjury the statements checked in this
seelio.n. ~ '
X"~YJ1 ~ ~
DATE aMf /1 a'1~ ~ ~ DO
ACCOUNT OWNERSlllP: You have requested
and intend the type of account marked below.
o Individual
lXkJoim Account ~ With Survivorship !~~~,~)lclnanl$
o Joint Account. No Survivorship (as lenanl); inC<lmm".,.l
o Trust: Separate Agreemem Dated
o
x
X
X
Cl1993 Bankers S'fstem$, \01;., St. C1oucl, MN n .800-397-2341) Form CD-AA-NPD 12l 2/21/96
READ PAGE TWO FOR ~li1JW\~R'!.'ll''I'llRMli'OO'I?~.. / ,/21
(g.HARRIS
iii SAVINGS BANK
235 N. Second St.
Han'isburg, PA 17101
TlIIS CERTIFIES THAT THE ACCOUNTHOLDER(S) LISTED BELOW HOLD A CERTIFICATE ()I' DEPOSIT ACCOUNT
WITH HARHlS SAVI"GS BANK FOR THE TERMS INDICATED BELOW:
Non.Transf~rablc
I
CERTIFICATE OF DEPOSIT
ACCOUNTHOLDER(S) :
1700015365
ACCOUNT NUMBER
02.17.00
DATE OF ISSUANCE
MARY J SA VUUS OR
PA TR TeI.A A BETZ
OWNERSHIP: no
OPEN1NG BALANCE MINIMUM BALANCE INITIAL RENEWAL TERM RATE OF COMPOlJND .. PENALTY
REQUIREMENT MATURITY DA IE EARNINGS PER FREQUENC'!'
ANNUM
$13,000.00 $500.00 02.17.04 48 MONTHS fi.,'\So~) NONI \80 IJc\ YS
--~- , '0.-'. __ --
EAR~I'iGS WILL
MO'iTHLY CHECK
Earning:-; Qlstribution dates beginning
**>1'** AND *"'***
Thcrcaft....r, wi\h \\1t' last distrihution Oll the final maturity date.
This certificate of deposit is subject to the rules of class, please refer to your Truth in Savings Disclosure for Your C~rtitlcate of Deposit and
your Rules of Deposit Accounts Brochure.
W."~'.~":'.'.~.
.'g,;
-,"""-
"i\:.(
;,\~
!.'2L
,.,'-"", ."",
,,> "'.' .li'.
ij;<",,',
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Mem~-rDlC/ 3);
,
By'
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. ~_~~.____.i_.;.:_.~~~_':.:...-b,-L__:..!..J' ...\ ~'7':_ :::'-~"f
Autnorized Slg:J1tltu/-e
C~l\V_11~ is/0"!)
Date
Opened:
8/11/2000 Term:
36 MONTHS
Tax
lD:
201-18-9676 Number:
Certificate of Deposit
Account Number:
7l00001U6/'
Amount of
Deposit: 'l'\OlELVE THOUSAND AND 00/100
This Time Deposit is Issued to:
Issuer:
$
CARLISLE BRANCHk HARRIS
17 W HIGH STREET
CARLISLE PA 17013
12,000.00
SAVINGS BANK
MARY oJ SAVULIS
VIRGINIA L MASTRINE
210 TODD CIR
CARLISLE PA 17013-3596
Not Negotiable - Not Transferable - Additional terms are below.
BY~ ...J}~N'4J<" 1--0~, (/>-r-tfdt
AdditionaLTerms and Disclosures
This fonn contains the terms for your time deposit. It is also the Minimum Balance Requirement: Yau must make a minimum deposit to
Truth.in.Savings disclosure for those depositors entitled to one. There
are additional terms and disclosures on pa~e two of this form, some of open this account of $ 500.00
which explain or expand on those below. ou should keep one copy of o You must maintain this minimum balance on a daily basis to earn the
this form.
Maturity Date: This account matures 8/11/2003 annual percentage yield disclosed.
(See below for renewal infonnation.) Withdrawals ofInterest: Interest o accrued ~redited during a
Rate Information: The interest rate for this account is 6.88000 % term can be withdrawn:
with an annual percentage yield of 6.88 %. This rate will be AT ANY TIME WITHOUT PENALTY
paid until the maturity date specified above. Interest begins to accrue on Early Withdrawal Penalty: If we consent to a request for a withdrawal
the business day you deposit any noncash item (for example, a check). that is otherwise not permitted you may have to pay a penalty. The
Interest will be compounded DOES NOT COMPOUND penalty will be an amount equal to:
Interest will be credited MONTHLY LOSS OF 180 DAYS
BY CHECK interest on the amount withdrawn.
o The annual percentage yield assumes that interest remains on deposit Renewal Policy:
until marurity. A withdrawal of interest will reduce earnings. 0 Single Maturity: If checked. this account wilt not automatically
o If you close your account before interest is credited. you will not renew. Interest o will o will not accrue after maturity.
receive the accrued interest. tl! Automatic Renewal: If checked, this account will automatically
The NUMBER OF ENDORSEMENTS needed for withdrawal or any renew on the maturity date. (see page two for terms)
other purpose is: 1 Interest CZl\vill o will not accrue after final maturity.
o Revocable Trust Designation as defined in this
agreement (Beneficiaries' names and addresses)
BACKUP WITHHOLDING
CERTIFICATIONS
TIN: 201-18-9676
IXk Taxpayer I.D. Number - The Taxpayer
Identification Number shown above (TIN) is
my cotrect taxpayer identification number.
IXk Backup Withholding - I am not subject
to backup withholding either because I have
not been notified that I am subject to backup
withholding as a result of a failure to report
all interest or dividends, or the internal
Revenue Service has notified me that I am no
longer subject to backup withholding.
o Exempt Recipients - I am an exempt
recipient under the Internal Revenue Service
Regulations.
o Nouresident Alieus - I am not a United
States person, or if I am an individual, I am
neither a citizen nor a resident of the United
States.
A provision for my signature, certifying
uuder peualty of perjury the statemeuts
checked in this section, is contained on the
first copy of this certificate.
ACCOUNT OWNERSHIP: You bave requested
and intend the type of account marked below.
o Individual
~Joint Account - With Survivorship \~~o~~~~;"'l\lll\L~
o Joint Account - No Survivorship (as teoant' in common)
o Trust: Separate Agreement Dated
o
ENDORSEMENTS - SIGN ONLY WHEN YOU REQUEST WITHDRAWAL
X
X
X
~ 1993 Bankers 5yslems, Inc_. St. Cloud. MN (1-800.3g7.234i) Form CD.AA.NPD III 2121/96
READ PAGE TWO FOR ~liliWt~~~OO'/9,i;g. 1 of 2!
RE:~"" EX+ t12~99:,*' . t..
' -, .
~
COMMONWEALTH of PENNSYLVANiA
INHERITANCE TtlX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATM COSTS
ESTATE OF
SAVULlS. Mary J
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers Funeral Home, 37 East Main St., Mechanicsburg, PA 17055
professional services (services of director and staff, embaiming, casketing, body preparation) $3080.00
use of facilities and services (wake, funerai ceremony, graveside service) 1470.00
use of automotive equipment (transfer of remains to funerai home, hearse, clergy car) 840.00
merchandise (casket, prayer book) 2195.00
miscellaneous (open grave, newspaper announcement, ciergy, death certs., flowers, organist, soioist) 1206.00
2. Food and refreshments (iuncheon following funeral, Knights of Columbus Hall, Camp Hill, PAl 241.18
3. Buriai lot, bronze memorial marker, vault (Resurrection Cemetary, Harrisburg, PAl 2675.00
B. ADMINISTRATIVE COSTS:
1 Personal Representative's Commissions 0.00
Name of Personal Represenlalive(s) Kathleen M. Gierlak
Social Security Number(s)/EIN Number of Personal Represenlalive(s)
Slreet Address PO Box 2262
City Gloucester S~te ~Zip 23061
Yearts} Commission Paid: not appiicabie
2. Attorney Fees 0.00
3. FamHy Exemption: (If decedent's address is nol the same as claimant's, attach explanation) 0.00
Claimant not applicable
StreelAddress
City Stale _Zip
Relationship of Claimanllo Decedent
4. Probate Fees 80.00
5. Accountant's Fees 0.00
6. Tax Return Preparer's Fees 0.00
7. Costs associated with moving expenses and storage pending final disposition of househoid goods and
furnishings:
storage facility 109.66
trailer rental 109.08
gas expenses 44.02
8. Miscellaneous costs (postage, paper, checks, certified letter/package maiiings, teiephone
charges, etc.) 70.99
TOTAL (Also enter on line 9, Recapitulation) $ 12,120.93
(If more space is needed, insert additional sheets of the same size)
REV.15~2 ~X+ (6.9BI
'*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
, .
COMMONWEALTH Or PENNSYLVANIA
INI-lERI1ANC~ TAl( RE.TURN
RESID~NT O::::CEOEr~T
ESTATE OF
SAVULlS, Mary J.
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
Sprint telephone biii, Oct. 13,2002
2.
Lower Allen Township Emergency Medical Service, Oct. 16, 2002
$37.91
44,43
TOTAL (Also enter on line 10, Recapitulation) $
llf more space 'IS needed, insert additional sheets of the same size)
B2.34
, '
Sprint@
Sprint FastConnect ~:'
DSL allows you \0 do
more wiih your Internet
(Gillie-cHon. To fmd out
more about Sprint
fastConnect and our
special offer go to
sprint.com/local or call
1-800-SPRINT DSL.
Not ,W i,i\:,\)l~ ." ~\1 ,If>:as
@ ~l\ease recycle
Monthly statement: October 13, 2002
Customer service
1-800-829-8009
Internet address
sprint.com/locsl
Fast Facts
, '1l<l!I:t~'-
:.::~~:,'~":7~
10f 6
Customer number
717-249-5191-607
Date Due: Nov 6, 2002
Total Due: $37.91
Customer summary
Previous charges
Payment September 30 Thank you!
Balance
Current month charges
Total amount due
Current month charges
Sprint local services: page 3
Sprint long distance: page 5
Totalcurrentrnonth charges
((frill
l/;
f~(
------------.------- -----------------
37,77
-37,77
,00
37.91
$31.91
16_22
21.69
$37.91
{ .
'\
/ ,
if J?i/t)f /IJ/
t Yi 7/
!1'Jr,J~JN',.I'Y (;
Lowc;r Allen Township
Emergency Medical Service
1993 Hummel Ave., Camp Hill, PA 17011
Phone (717) 975-7575
Tax# 23-6005253
Bill TO:
PATIENT:
MARY J SAVULIS
21121 TODD CIR
CARLISLE, PA 1712113
INVOICE
INVOICE #: (12121121489 )
DATE: ( 1121/16/2121~
MARY J SAVULIS
ACCOUNT #:
12121121489
1216(22/21211212
DATE OF= SERVICE:
TRIP#:
21211189676A
PATIENT PICKED UP:
PATIENT TAKEN TO:
HEALTH SOUTH (1712155)
Harrisburg Hospital
DESCRIPTION OF IllNESS/INJURY:
PATIENT TRANSPORTED FOR (78121.79) AND (298.9)
r
DESCRIPTION
UNIT COST
BLS BASE RATE EMERGENCY
BLS MILEAGE
OXYGEN
A12I42'
A12I38'
A12I42,
35121.121121
5.50
3121.121121
***BALANCE DUE AFTER MEDICARE PAYME T.***
QTY.
AMOUNT DUE
1.121
6.121
LiZ
35121.121121
33.121121
3121.121121
***FEDERAL BLUE CROSS HAS NOTIFIED'S THAT CHE(K 1/005183(037 IN THE
AMOUNT OF $44.43 WAS MAILED DIRJ CTLY TO YOt ON 09-09-02 FOR PAYMENT
OF THE REMAINING BALANCE OF THI TRANSPORT.***
Reasonable Collection Costs Will Be A ded To All Delinquent Injvoices.
COMMENTS:
BALANCE DUE ON OR
AN ADDITIONAL FEE
PAYMENT DUE BY 11-16-02
BEFORE 11-16-02 - $44.43
WILL BE ADDED AFTER 11-16-02
PLEASE RETURN SECOND COPY WITH YOUR PAYMENT
(Checks may be made payable to Lower Allen EMS)
Terms: Net 30
THANK YOU
'!),.,,,,,.,
SUBTOTAL
AMOUNT
PAID
413.121121
368.57
TOTAL
44.43
\ I~JIGl
fJl :Jl IO~
, ,c f 4~ 4J
.
,~E',1.-1Sr:j EX+ ('3-00)
'*
SCHEDULE I
BENEFICIARIES
COMMONWEALTH OF PENNSYL',/.I\NIA
\N\-IER\1ANCE W( RE'rURN
RESIDENT DECEDENT
EST ATE OF
SAVULlS, Mary J.
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not List 1'rustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (01 (1.211
1. Kathleen M. Gieriak, PO Box 2262, Gloucester, VA daughter one third
23061-2262
2. Patricia A. Betz, SSg Mandy Lane, Camp Hill, PA 17011 daughter one third
3. Virginia L. Mastrine, 217 Kings Highway, Marysville, PA daughter one third
17053
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IB, AS APPROPRIATE, ON REY.150n COYER SHEET
II NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
not applicable 0,00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
not applicable 0.00
TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REY.1S00 COYER SHEET $ 0,00
(If more space is needed, insert additional sheets of the same size)
.Form- V. S. No. 84
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PL~ OF B /i-H CO"MONW~ALT~ OF PENNSYLVANIA .~,t,~t
Countll Of!:-1-"1/1A~iAA..-.(" DE~~!~?,uM~~~A~~TA~~~~TH,j~L,,~'i'
TowmMp of _2.......-_._ CERTIFICATE OF BIRTII ~fu;:J;,)
or . ? .
Borou~: o~ -."""'-+- ~i:t~f:ta~~ _".........._. FU. No, ,...t / f' 1.< I":;
~:~ J3"j' '-Ji- ,/ k:~i.~:::twn Di8trict No/j::JEf/JR,,"to'Od No, J~,~:: '.~ :.;
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CHILD
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20. Number of ~ren of thl. mother. (talleA a. 01 \I~' 01 blrtb of ohUd her.ln cutln.d Inollldlng pt...nt birth.)
IIvln. _ . B. . Bora ..Un al\d: now d.ad - - c. Stlllbor.
CERTIFICATE OF ATTENDING PH
I bereby o,rtlfy that I att.nd.d lb. IIlrth or thl, ohlld. who w.a
OD the date above .tat.d. '!.
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01' midwife. then tbe fatber, hOUl.bolder" '
eto" abould m.k. w.u. return It. a\11lbnrP'
ohlld fa (lb' tb.t Deith,r b....thea not .
ahoWl other e..tdellflti 01 ure aher blrtb. ..1
Given na..e added Iro. .. aUPDIt.ental r.llOrt
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/'}- Yb-9
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE DF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
KATHLEEN M GIERLAK
PO BOX 2262
GLOUCESTER VA 23061
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-10-2003
SAVULIS
09-20-2002
21 02-0864
CUMBERLAND
101
AlIOUnt R_ltt.d
*'
REV-1S"41EXIoFPlOl_HJ
MARY
J
, .
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 ...
REV=is4j-EX-AFP-loFii3Y-riiifficnij:-YNHERiTANCn''AirAPpiA-isEiiErii;:~--Ai.i-ojjANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SAVULIS MARY J FILE NO. 21 02-0864 ACN 101 DATE 02-10-2003
TAX RETURN WAS: I X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previDusly, lines 14, IS and/Dr 16, 17, 18 and 19 will
re~lect ~igures that include the tDtal D~ ~ returns assessed tD date.
ASSESSMENT OF TAX:
15. ~ount of Line 14 at Spousal rate (15)
16. ~ount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of LiNt 14 at Sibling r.te (17)
18. Allount of LiNt 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
T X
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 D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. ~ointly Owned Property (Schedule F)
7. Transfers (Schedule 6)
8. Totel Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
25.097.09
.00
.00
24.291.18
122.657.08
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expanses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule ~)
14. Net V.lue of Estate Subject to Tax
(9)
(10)
12,120.93
82.34
Ill)
(12)
(13)
(14)
NOTE:
.00
159,842.08
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
+
AMOUNT PAID
6,833.25
DATE
12-12-2002
NUHBER
CD001953
INTEREST/PEN PAID (-)
359.64
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your account,
~it the upper portion
of this for. with your
tax paYlllent.
172,045.35
l' ?O?l ?7
159,842.08
.00
159,842.08
(19)=
.00
7,192.89
.00
.00
7,192.89
7,192.89
.00
.00
.00
I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
BUREAU DF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLONANCE OR DISALLONANCE
OF DEDUCTIDN"JND ASSESSIIENT DF TAX ON
JOINTLY ~LD OR TRUST ASSETS
RE'I-lSUEX AFP<Ol-l5J
VIRGINIA L MASTERINE
100 CAROLINE DR
MARYSVILLE PA 17053
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
'SSN/DC
ACN
03-31-2003
SAVULIS
09-20-2002
21 02-0864
CUMBERLAND
201-18-9676
03100937
A.oU"tt Rellitted
MARY
J
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-y=is48-Eif-AFi'-loi-=ii31------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 03-31-2003
ESTATE Of SAVULIS
MARY
J DATE Of DEATH 09-20-2002
COUNTY
CUMBERLAND
fILE NO. 21 02-0864
TAX RETURN WAS:
S.S/D.C. NO. 201-18-9676
(X) ACCEPTED AS fILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
03100937
fINANCIAL INSTITUTION: MEMBERS 1ST fCU
ACCOUNT NO.
199704-43
TYPE Of ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIfICATE
DATE ESTABLISHED 12-15-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
12,019.99
0.500
6,010.00
.00
6,010.00
.45
270.45
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION Of THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER Of WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER Of WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
PAYMENT MUST BE MADE BY 06-21-2003*. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 270.45
INTEREST AND PEN. .00
TOTAL DUE 270.45
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATIDN OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
17- 90 - C;
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Ul
HARRISBURG# PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISENENT. ALLOMANCE OR OISALLOMANCE
OF OEOUCTION"..ANO ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-l5liIEllAFPIOI_U)
VIRGINIA L MASTERINE
100 CAROLINE DR
MARYSVILLE
c
- I
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN,DC
ACN
03-31-2003
SAVULIS
09-20-2002
21 02-0864
CUMBERLAND
201-18-9676
03100936
Allount R...itied
MARY
J
PA 17053
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 ~
Rifv:i54-i-Eif-AFi'-foi-:031------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 03-31-2003
ESTATE OF SAVULIS
MARY
J DATE OF DEATH 09-20-2002
COUNTY
CUMBERLAND
FILE NO. 21 02-0864
TAX RETURN WAS:
S.S/D.C. NO. 201-18-9676
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
03100936
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
199704-44
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (Xl TIME CERTIFICATE
DATE ESTABLISHED 03-14-2001
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
13,021.65
0.500
6,510.83
.00
6,510.83
.45
292.99
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
PAYMENT MUST BE HADE BY 06-21-2003*. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 292.99
INTEREST AND PEN. .00
TOTAL DUE 292.99
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREOlr' ( CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. )
\. /?-90 - '?
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6DI
HARRISBURG1 PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
Recorc:edCd19~, of DATE
Rep;s,,", \",,1:8 ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
.03 MAY 16 A10 :48
VIRGINIA L MASTERINE
100 CAROLINE DR
MARYSVILLE
ME.1?-G53-0000
CI;mbs, " -,
"
-
RE'I-UMEX UP lOl-ln
05-12-2003
SAVULIS
09-20-2002
21 02-0864
CUMBERLAND
201-18-9676
03100936
Anount R_itt.d
MARY J
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 .....
----------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (01-03)
-- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 05-12-2003
ESTATE OF SAVULIS
MARY
CUMBERLAND
J DATE OF DEATH 09-20-2002
FILE NO. 21 02- 0864
ADJUSTMENT BASED DN:
COUNTY
S.S/D.C. NO. 201-18-9676
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACN
03100936
ACCOUNT NO. 199704-44
TYPE OF ACCOUNT: () SAVINGS () CHECKING ( ) TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 03-14-2001
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.45
.00
TAX CREDITS:
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE nn
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.l
VIRGINIA L MASTERINE
100 CAROLINE DR
MARYSVILLE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
Recorded('f'cs iMTE
Regisl:,~,JHISSTATE OF
DATE OF DEATH
FILE NUMBER
'03 MAY 16 Al~~~~
ACN
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
REV-15M EXAFP (81-ln
PA 17053-6118''',<
Curnber;L~_nd
05-12-2003
SAVULIS
09-20-2002
21 02-0864
CUMBERLAND
201-18-9676
03100937
AIIO...,t R...i tted
MARY J
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 ....
----------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (01-03)
-- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 05-12-2003
ESTATE OF SAVULIS
MARY
J DATE OF DEATH 09-20-2002
COUNTY
CUMBERLAND
FILE NO. 21 02-0864
ADJUSTMENT BASED ON:
S.S/D.C. NO. 201-18-9676
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
03100937
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO. 199704-43
TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 12-15-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.45
.00
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE nn
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDlr' ICR),
YOU HAY BE OUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
REV_1470EX (6-8B)
'*
INHERITANCE TAX
EXPLANATION
OF CH'WGES
( .~, ,~:, ~ ,<
eC,JrU'"'A
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
o
"ds
SAVULlS, MARY J
FILE NUMBER
REVIEWED BY
Bryan Rondon
'03 MAY 16 AlO:4
ACN
2102..()864
03100936/03100937
ITEM
SCHEDULE NO. EX{,~T10NOF cH....Nmill
Above-referenced ACN'S were zero ' Ift~ th Y e reported on the Inheritance Tax
Return.
ROW
PaQe 1
/
()~h
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Mar y J. Sa v u lis
Date of Death: 20 September 2002
Will No.
21-02-0864
Admin. No,
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 XXX No
--
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No XXX .
b. The separate Orphans' Court No, (if any) for
the personal representative's account is:
c. Did the personal representative sttff an
account informally to the parties in interest? Yes 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.
~ ~ rr'JdtAJ
5i nature
Kathleen M. Gierlak
Date:
17'!Qctober 2003
c,
N
Name (Please type or print)
PO Box 2262, Gloucester, VA 23061-2262
Address
1....1
~=:J
.-:C
(804) 693-1712
Tel. No.
Capacity: XXX Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)