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HomeMy WebLinkAbout02-1023PETITION FOR PROBATE and GRANT OF LETTERS11 Estate of Irene Zazetski No. ~~~~ ~~Q~J also known as Irene P. Zazetski To: Social Security No. 198-01-6809 The petition of the undersigned respectfully represents that: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Your petitioner, who is 18 years of age or older and the executor named in the last will of the above decedent, dated March 25, 1983, as successor executor by virtue of the death of Leo Zazetski on the ~~ day of (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 412 Poplar Avenue. New Cumberland Borough Cumberland Countv Pennsvlvania 17070 (list street, number and municipality) Decedent, then 81 years of age, died October 26. 2002 at Holv Spirit Hospital East Pennsboro Township Cumberland Countv. Pennsvlvania. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: None Decedent 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: $_90,000.00 WHEREFORE, petitioner respectfully requests the probate of the last will and codicil presented herewith and the grant of letters testamentary thereon. (testamentary; administration c.t.a.: administration d.b.n.c.t.a.) Signature(s) and Residence(s) of Petitioner(s) eonard a ets ' /k/ 412 Poplar Avenue New Cumberland, PA 17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS 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 repres tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~F Swom to or affirmed and subscribed before me this 15 day of November , 20 02. - `~ ~ ~,/ ~; Register )6~~~~~ Signature(s) Z Donna M. Otto, lst Deputy / 7 /~~/- NO. 21-2002-1023 Estate of Irene Zazetski, aka Irene P. Za?etGk; ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW November 15th ~ 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 March 11th, 1990 described therein be admitted to probate and filed of record as the last will of Irene Zazetski, aka Irene P. Zazetski and Letters Testamentary _~_ are hereby granted to Leonard Zazetski FEES Probate, Letters, Etc.......... ~ 200.00 Short Certificates(lOj .......... ~ 30.00 • x-Pa es 3.00 ~~~~x ..... 9 ........ ~ 10.00 C ~ TOTAL $ 24, 3.00 Filed ..November, 15th, 2002, . , , , , .... , . Register of Wills ,,/~ !N , Donna M. Otto,lst Deputy i~Lz~ Robert P. Kline # 58798 ATTORNEY (Sup. Ct. I.D. No.) 714 Brid~P Strc~Pt ADDRESS New Cumberland, PA 17070 PHONE CALL ATTORNEY ON 11-15-2002 ARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. __ _ _ .- CC)h4hiC3~VJ~ALTH :~F P~~1d4~~.~Y!_Vv.Nldi C;EFN~iTltil~'w7 Cirri.:--^;'~~"~r± tf';15, FiE.~'.!~3~5 ~Ot.~A~, R'E~IaTRAR'S CI~~~aT4~°I~AT'€Gt~i O~ R~E~?,~i°` ,. '-, . ~4. ,. ~ .. ; , .-- '~ yam;,. ,,., , ~, 6 F~c ~t ~, l',~i ~r' -, __ _..~i/•~i ;.~ ,. ~ V l.;" t/y/~~1~/~1' } iw ,, t ~ _ ___ ~ Vv ~ ` ' .~ ~~ e~e~ t ~~~ f ... .- _ __ _ __-.. .. -_ _ a .~ Cl __ 1 -_ _.__ _ - - - - -- ~~Lc. /4 -~~~o~ -, __ ~~? _ j/ .. ~. , ; t / //,, ~~ ~. --- __ __ _ _._. ____ _ ____ --- -- --- _ / ~ V~i f_,, ' ~_ -- -=~--__-- - c i , ,,.~ _ ,~' i i'`l;'~1 ctt't~n .~ ,:: j' d('`' '~ ~ .~ i ('.jl ;t?C%Iul, f!"~`-(~~/l ~ ~~ ~ ~% '/ ~ ,/ - 't:S ','~~ ~ ~~ ~ CCc'~~ i-is-~~~-=t'~,I'. a ,f ~?~± t;2('~,I~ C~'t~ .i j / ...., ;~ ~ _ _ ___ -, F `--- _ ~~~~~~%%~ ~~ __~ -3D -~d~~ ~ ~ a~ T ~ IRENE ZAZETSKI, residing at 1010 South Market Street, Nanticoke, County of Luzerne, Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare the following as my Last Will and Testament, hereby revoking and making null and void any and all Wills and Codicils at any time heretofore made by me. FIRST: I direct that all my just debts and funeral expenses be paid as promptly as possible. SECOND: I give and bequeath to my husband, Leo Zazetski, all of my estate, real, personal, and mixed, of which I shall die seized and possessed, or to which I shall be entitled at my decease. THIRD: I nominate and appoint my husband, Leo Zazetski as Executor of my estate. In the event that my husband fails, or is unable to act, I appoint my son, Leonard Zazetski as his successor. I further direct that no fiduciary herein appointed shall be required to enter security in any jurisdiction in any capacity. FOURTH: In the event that my husband should predecease me, I give and bequeath to my son, Leonard Zazetski, all of my estate, real, personal, and mixed, of which I shall die seized and possessed, or to ,which I shall be entitled at my decease. IN WITNESS WHEREOF, I, IRENE ZAZETSKI, the Testatrix, have to this my Last Will and Testament, written on one (1) sheet of paper, set my hand and seal this 25th day of March, 1983. } ~~ IRENE ZAZE KL Signed, Sealed, Published and Declared by Irene Zazetski, the above named Testatrix, for her Last Will and Testament, in the presence of us, who at her request are here present, all being present at the same time, have hereto subscribed our names as witnesses. 1' f GU~~ esiding at > r) ,, ~" ~} ~~;'~,. ;~~- :;f'~~G~1~cL~zC` residing at ~~ J?rxL/1 r~-,,rt,~„~ _ ~-~ ~~1-r'~.~~.e~ ~ i-~o A C K N O W L E D G E M E N T COMMONWEALTH OF PENNSYLVANIA: COUNTY OF LUZERNE ss I, Irene Zazetski, Testatrix, 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 and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein stated. Sworn or affirmed to and acknowledged before me, by Irene Zazetski, the Testatrix, this 25th day of March, 1983 c . ./9 e' ~ 2..E ~':~... IRENE ZAZET~ I,~'~ (SEAL) COMMONWEALTH OF PENNSYLVANIA: COUNTY OF LUZERNE A F F I D A V I T ss . ~~ -~ ~~~~: Nanticone• L!i~eme ::runty, Pa. rdiy C:;;rmusion Expiras 9uty 25, 1~£~5 ~, WANDA SEMANCHIK and LOTTIE GLUCHOWSKI the witnesses whose names are signed to the attached foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein stated; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by WANDA SEMANCHIK and LOTTIE GLUCHOWSKI Witnesses, this 25th day of March, 1983. ~ ;, ~% '~ '~ fi . ~~ _~~~, 1. , ~ ICI/-{ ~ ~fi ,' _t {{ ~: (SEAL) NevOr. ~~u~~cY PlantcoF::;. Fuze.>n2 County. ?~.. ~~ y %amnission ~xpirErs )uly 2y, 19$~i' V CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Irene Zazetski, also known as Irene P. Zazetski Date of Death: October 26, 2002 Will No.: 2002-01023 Administration No.: 21-02-1023 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on the 17th day of December, 2002: Name Address Leonard Zazetski 412 Poplar Avenue, New Cumberland, PA 17070 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date:~~-'DC2~ ?s73Z ~~~ ROBERT P. KLINE, ESQUIRE Attorney ID# 58798 714 Bridge Street Post Office Box 461 New Cumberland, PA 17070-0461 (717) 770-2540 Counsel for Personal Representative REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Irene Zazetski a/k/a Irene P. Zazetski, INVENTORY No. 2002-01023 Deceased Date of Death: October 26, 2002 Social Security No. 198-01-6809 Leonard Zazetski, Personal Representative of the Estate of Irene Zazetski a/k/a Irene P. Zazetski, deceased, verifies that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I verify that the statements made in this Inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Attorney: ~ ~~~ ~'" Robert P. Kline, Esquire I.D. No.: 58798 Address: 714 Bridge Street Post Office Box 461 New Cumberland, PA 17070 Telephone: (717) 770-2540 /' Executor Dated: ~- ~ ~ - (~ Description Value Miscellaneous United States Savings Bonds, 26,629.40 Series EE Merrill Lynch Fundamental Growth Fund Class D 10,073.55 (754.573 shares x 13.35 per share) Merrill Lynch Basic Value Fund Class D 20,659.45 (901.3 72 shares x 22.92 per share) Merrill Lynch Basic Value Fund Class B 5,265.76 (234.242 shares x 22.48 per share) Alliance Technology Fund Class B 3 172.50 (90 shares x. 35.25 per share) AIM Constellation Fund 13,492.64 (784 shares x 17.21 per share) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the G''~ G,/\ STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~2E,v,L ~~.~E~kT Date of Death: Ck~ Z~, ZG©Z Will No. 2aa2 -col O23 Admin. No. 22 - oZ- loz~ 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 ~C 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 ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: ~)~ c. Did the personal representative state an account informally to the parties in interest? Yes ~ 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. Z~ 3Po~. Zs~~} Date: ~~ Signature ^-~ 1) ~~~~-T T t~-Liv~E ~S~ Name (Please type or print) ~c~ Z1 Col ~ c'tiJ ~~e7C.1,,4~,y~~ ~~} ~~°~ Address i ~1~-1 ~-~ -Z~ v Tel. No. Capacity: Personal Representative ~ Counsel for personal representative (MAH:rmf/AM3) /1- /Ol-C:V tiLE NUMBER 21 02 L GQ!JNrrJ~_(;)OL YEAR --- --- ----- SOCIAL SECURIlY NUMBER . R~..flllll~'."~r REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OEPT.280601 HARRISBURG, PA 17128-0001 01023 __.!iYMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Zazetski, Irene 198-01-6809 ~ z W Q W i;\ Q I L I I DATE OF DEATH (MM-OO-VEAR) DATE OF BIRTH (MM.OD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE .10/26/2002 11/24/1920 i (IF APPLICABLE> SURVIVING SPOUSE'S NAME ( LAST ~ FIRST ANDMIODL'E INITIAl) REGISTER OF WILLS SOCIAL SECURIlY NUMBER '-- IT 3. Remainder RetUm(date-Of c:le'itiipnar-to12=1i.:{,2) --- ~ 1. Original Return 0 2. Supplemental Return o 4. Limited Estate 0 1&1 6. Decedent Died Testate (Attach copy 0 ofWUI) o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 ii.Election to tax underSea. 9113(A) (Attadl SchO} .-. -_ni !!fl.. ME I COMPLETE MAILING ADDRESS . Robert P. Kline - ----- fiRM NAME (If applicable) 714 Bridge Street Kline Law Office P.O. Box 461 IrELEPHONENUMBER ! New Cumberland, PA 17070 w ~ "S0 u~" w~g %o~ ufG) ~ 4 4a. Future Interest Compromise (date of death ~ter t2-12-82) 7. Decedent Maintained a Living Trust (Attach cop-yofTrust) o 5. Federal Estate Tax Return Required 8. Total Number of Safe DepoSit Boxes ill 12 o u 717/770- 2540 (1) (2) (3) (4) (5) (6) (7) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. fnterNivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9, Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) None 79,852.10'- C ----------::: ii' No~~~; None c:i VJ L. c: .. N w 25,836.60 21,284.91 3,514.75 2?~ ..---' z o ~ ~ ~ " 4 U w ~ (8) 0:. 130,488.36 (9) (10) 7,542.01 951.48 (ll) 8,493.49 121,994.87 (12) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Line 12 minus Line 13) (13) (14) 121,994.87 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 121,986.12 .045 (16) 0 16. Amount of Une 14 taxable at lineal rate x ~ ~ ~ ~ 17.Amount of Une 14 taxable at sibling rate x .12 (17) ~ 0 u ~ 18. Amount of Line 14 taxable at collateral rate 8.75 x ,15 (18) 19. Tax Due (19) 5,489.38 1.31 5,490.69 CHECK HERE IF yOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 20. 0 . Form REV.15DD EX (Rev. 6-oD) Copyright 2000 form software only The Lackner Group, Inc. DeCedent's Complete Address: STREET ADDRESS 412 Poplar Avenue CITY New Cumberland ,__ n_ ,STATE PA I ZIP 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,490.69 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D Interest E. Penalty TotallnteresUPenalty (D + E) 4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0.00 (4) (5) 5,490.69 (5A) (5B) 5,490.69 Make Check Payable to: REGISTER OF WILLS, AGENT Did decedent make a transfer and: 8. retain the use or income of the property transferred;.... b. retain the right to designate who shall use the property transferred or its income;... c. retain a reversionary interest; or.... . d. receive the promise for life of either payments, benefits or care?... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS '~ I 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.. . o o 181 181 181 o 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 penalties or perjury, I declare that I have examJnetllhls feturn, including accompanying schedules and statements, and to the best of my knowledge and beUet, II Is true. correct and complete. Declaration of preparer other than~e perso_nal re enta!!v.!_ls b_~.!~ on _~!!J~llr"!!~~ of _~h_~_p~parer ha,s.~1!>' kn~~J~~ge.__ SIGNATURE OF P. N RESPON LE FOR FILING RETURN ADDRESS 'IY.{ 412 Poplar Avenue SIGNATURE OF PERSON RESPONS"R b "7-'r-Y ADDRESS New Cumberland, P A 17070 DATE L~1 "2 O=t-~B - 03 NATURE OF PRE ARERO~ ADDRESS 714 Bridge Street P.O. Box 461 New Cumberland, P A 17070 DATE lEC~~ ~) For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (ill. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or forthe use of the surviving spouse is 0% [72 PS. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)1. The tax rate imposed on the net value of transfers to or for the use of the decadent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [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% {72 P.S. 99116 (a) (1.3)1. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blOOd or adoption. ESTATE OF '* COMMONWEALTH OF PENNSYLVANIA INHERITANce TAX RETURN RESIDENT DECEDENT Zazetski, Irene SCHEDULE B STOCKS & BONDS FILE NUMBER 21-02-01023 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 2 3 4 5 6 7 Misc. US Savings Bonds, Series EE DESCRIPTION UNIT VALUE Merrill Lynch Fundamental Growth Fund Class D 13.351 Merrill Lynch Basic Value Fund Class D Merrill Lynch Basic Value Fund Class B Alliance Techoology Fund Class B AIM Constellation Fund Metropolitan Life Insurance Co. I VALUE AT DATE OF DEATH 26,629.40 10,073.55 20,659.45 5,265.76 3,172.50 13,492.64 558.80 79,852.10 22.92; ! 22.48 35.25 17.21 25.40 TOTAL (Also enter on line 2, Recapitulation) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETlJRN RESIDENT OECEOENT ESTATE OF Zazetski, Irene FILE NUMBER 21 - 02 - 01023 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 25,836.60 Merrill Lynch Bank Deposit Program - Money Market Fund TOTAL (Also enter on Line 5, Recapitulation) 25,836.60 *' SCHEDULE F JOINTLY-OWNED PROPERTY I [ FILE NUMBER 21 - 02 - 01023 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zazetski, Irene If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Leonard Zazetski 412 Poplar Avenue son B Linda Armstrong Npw rllTTlnprhmn PA 17(l7f) 412 Poplar Avenue New Cumberland, P A 17070 daughter-in-law JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY DATE OF DEATH i % OF DATE OF DEATH ITEM LETTER DATE i1nclude name of financial institution and bank account number NUMBER FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real I DECO'S VALUE OF TENANT JOINT estate. VALUE OF ASSET [INTEREST OECEDENT'S INTEREST A Misc. US Savings Bonds, Series E 22,232.72 50%, 11,116.36 2 B PSECU Regular Share Account #8303720293 17.501 50%1 8.75 I I 3 A Citizens Bank Checking #610115-660-9 3,040.501 50% 1,520.25 4 A Citizens Bank Statement Savings #6140-430410 17,279.10 50%, 8,639.55 TOTAL (Also enter on line 6, Recapitulation) 21,284.91 -. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Zazetski, Irene ,FILE NUMBER 21-02-01023 ESTATE OF ITEM NUMBER This schedule must be c:ompletedand filedi! the answe-,to any of questions 1 through 4 on paj(<! 2 is yes. DESCRIPTION OF PROPERTY .... ... T" ... '/:;F ., .- I Include the name of the transferee, their relaUonship to decedent and the date of transfer. I DATE OF DEATH I DECO'S ; EXCLUSION I TAXABLE VALUE Attach a copy of the deed for real estate VALUE OF ASSET INT I (IF APPLICABLE) I . EREST Citizens Bank IRA #6141-049494 2,324.31 1,190.441 I 2,324.31 2 Citizens bank IRA #6141-049508 1,190.44 TOTAL (Also enter on line 7, Recapitulation) 3,514.75 '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATlVE COSTS C~NWEALTH Of' PENNSYlVANIA INHERITANCE TAX RElURN RESloeNT DECEDENT ESTATE OF Zazetski, Irene FILE NUMBER 21 - 02 - 01023 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: The Grontkowski Funeral Home, P.C., Nanticoke, PA 2 Frank Grontkowski Monuments, Inc., Wilkes-Barre, PA B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Kline Law Office 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills Cumberland Law Journal The Sentinel 5. Accountant's Fees State Zip 4. 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Menill Lynch Bank Deposit Program - Money Market Fund TOTAL (Also enter on line 9, Recapitulation) 5,450.00 IOO.OO 1,500.00 332.00 75.00 85.01 25,836.60 7,542.01 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHEFIJTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zazetski, Irene FILE NUMBER 21 - 02 - 01023 Include unreimbursed medical expenses. ITEM NUMBER 1 East Pennsboro Ambulance Service DESCRIPTION AMOUNT 401.00 2 Susquehanna Internal Medicine 48.03 3 NeighborCare Pharmacy 454.66 4 The Pennsylvania State Employees Retirement System 47.79 TOTAL (Also enter on Line 10, Recapitulation) 951.48 Jr~f~tr au~ ~fa1Unf of IRENE ZAZETSKI ~ ~f IRENE ZAZETSKI. residing at 1010 South Market Street, Nanticoke. County of Luzerne, Commonwealth of Pennsylvania, being of sound mind, memo1:Y and understanding, do mak.e. publish and declare the. following as my Last Will and Testament. hereby revoking and making null and void any and all Wills and Codicils at any time heretofore made by me. FIRST: I direct that all my just debts and funeral expenses be paid as promptly as possible. SECOND: I give and bequeath to my husband, Leo Zazetski. all of my estate, real, personal, and mixed, of which I shall die seized and possessed, or to which I shall be entitled at my decease. THIRD: I nominate and appoint my husband, Leo Zazetski as EXecutor of my estate. In the event that my husband fails. or is unable to act~ I appoint my son. Leonard Zazetski as his successor. I further direct that no fiduciary herein appointed shall be required to enter security in any jurisdiction in any capacity. FOURTH: In the event that my husband should predecease me. I give and bequeath to my son. Leonard Zazetski. all of my estate. real. personal, and mixed, of which I shall die-::seized and:possessed, ':or to.'.which'"I. shal:l~be, ent;f[tled'at WJ decease. IN WITNESS WHEREOF ~ I. IRENE ZAZETSKI. the Testatrix ~ have to this my Last Will and Testament. written on one (1) sheet of paper~ set my hand and seal this 25th day of March. 1983. IitPtAf~ti(j,d . Signed. Sealed. Published and Declared by Irene Zazetski~ the above named Testatrix, for her Last Will and Testament. in the presence of us. who at her request are here present~ all being present at the same time, have hereto subscribed our names as witne.sses. /<~i i~J~esiding at '<" t'YYW f):J:;i ~~ f~/~Jl:~/it .J Pet-. reSiding at 1,(0/ ,'fHI(M;r),JfUJIr~ A C K NOW LED GEM E N T COMMONWEALTH OF PENNSYLVANIA: ss COUNTY OF LUZERNE I. Irene Zazetski. Testatrix. whose name is signed to the attached or foregoing instrument, having been duly qualified according to law. do hereby acknowledge that 1 signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein stated. Sworn or affirmed to and acknowledged before me, by Irene Zazetski, the Testatrix, this 25th day of March, 1983 ~"'/1' Jg~Rt;1 NE ZAZE (SEAL) '1A"''t1 'Sl. S.J....L \/ RorJ.'R\o<p!l..~ Nantlcoke, tuzem8 County, Pw.. My Cum mission ExplrB' July 2S, 19~ A F F I D A V I T COMMONWEALTH OF PENNSYLVANIA: ss COUNTY OF LUZERNE WE, WANDA SEMANCHTK and LOTTIE GLUCHOWSKI the witnesses whose names are signed to the attached foregoing instrument, being du11 qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it. as her free and voluntary act for the purposes therein stated; that each of us in the hearing and sight of the Testatrix signed the Will as witnesseSi and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and and LOTTIE GLUCHOWSKI subscribed to before me by WANDA SEMANCHIK , Witnesses, this 25th day of March, 1983. _~,~~k . 4c-lo&t ~~~1<'( (SEAL) ~rOli~u~.J....A~ NanUcolle. luzerlWl County, Fr. My Commission .Expires J~y 29, 198ia