HomeMy WebLinkAbout02-1068a~
LAW OFFICE
TAMES, SMITH, DURKIN & CONNELLY LLP
P. O. BOX 650
HERSHEY, PENNSYLVANIA 17033-0650
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
AEV~ 1500 EX <l- (6-00)
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COMMONWEALTH OF PENNSYL..VANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Freistak Evel
DATE OF DEATH (MM-DD- YEAR)
X 1. Original Return
4. limited Estate
X 6. Decedent DIed Testate
,/
OFFICIAL USE ONLY
/?-/O~-0
FILE NUMBER
c2l 002- /Ohg
NUMBER
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
192-14-2898
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
sac AL SECUR TYNU BER
2.. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
X 7. Decedent Maintained a LIving Trust 1
(Attach copy of Trust)
3 daie of eath
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of WfH)
o 9. litigation Proceeds Received
o 10. Spousal Poverty CredIt 0 11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1-1-95) (Atta.ch Sch 0)
THIS SECTION MUST'BECOMPLEtEO. AU;COIlRESPONOENCE'& CONFIDENTIAt;TAX~NFORMATIO"tSHOULO BEiDIIlECTE01tO" .
NAME COMPLETE MAILING ADDRESS
Gar L. James Es .
FtRM NAME (If Applica.bie)
James, Smith, Durkin & Connell, LLP
TELEPHONE NUMBER
134 Sipe Avenue
Hummelstown, rA 17036
3-3 8
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 BlUing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule l) (10)
11. Total Deductions (total Lines 9 & 10)
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 Subject to Tax (Line 12 minus Line 13)
(1)
(2)
(3)
R
E
C
A
P
I
T
U
L
A
T
I
o
N
(4)
(S)
(6)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(t2)
16. Amount of Line 14 taxable at lineal rate 451,479.79
17. Amount oi Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
Copyright (c) 2000 iorm soi\ware only The LaCKner Group. Inc.
None
None
None
OFFICIAL USE ONLY
None
1,500.00
1,000.00
493,162.31
36,955.50
6,227.02
(S) 495,662.31
(11) 43.182.52
(12) 452,479.79
(13) 1.000.00
(14) 451,479.79
x
X
X
X
.0 0
.045
.12
.15
(lS)
(16)
(17)
(IS)
(19)
20,316.59
20,316.59
Form REV-1500 EX (Rev. 6_00)
Decedent's Complete Address:
STREET ADDRESS
500 Walton Street
CITY I STATE I ZIP
Lemoyne PA 17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
20,316.59
1,015.83
Total Credits ( A + B + C) (2)
1,015.83
3. Interest/Penalty if applicable
D. Interest
E. Penalty
19,300.76
19,300.76
...,',;;;;:"HiHijiiiji::!i!];:':i';,."'....
Under penaltIes of perjury, [ declare that I have examined this return, Including, accompanying schedules and statements. and to the best 01 my knowledge and bellet, It Is true,
correct and complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
Joseph D. Bellomo
.. .~~~. .~()\l!'.t:~~!'. .'!'!Y............. __................
Morris Plains, NJ 07950
JAMES, SMITH, DURKIN & CONNELLY, LLP
.. P"..~ ~P!'. .P.Y!'.'!':O'................................
Hummelstown PA 17036
DATE
11-11-~
DATE
(( - ('7 - '")..-'0(:.1.-
For dates of deat aft Jul , 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. 116 (a) (1.1) (i)].
For dates at death on or atter January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or tor the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal tJeneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(a)(11].
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. 9116(a)(1.3)]. A sibling is defined, under
Section 9102, a5 an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6~00)
REV~ 1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESlDENT DECEDENT
ESTATE OF
Evelyn T. Freistak
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
SSiI 192-14-2898
08/28/2002
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
1
DESCRIPTION
Miscellaneous household furnishings
VALUE AT DATE
OF DEATH
1,500.00
TOTAL (Also enter on line 5. Recapitulation) $ 1,500.00
Of more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems.lnc. Form REV-1508 EX (Rev. 1-97)
REV-15OSEX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TPJ< RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn T. Freistak
SCHEDULE F
JOINTL V-OWNED PROPERTY
FILE NUMBER
5511 192-14-2898
08/28/2002
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
A.
SURVIVING JOINT TENANT(S) NAME
Judy Chabonik
ADDRESS
500 Walton Street
Lemoyne, PA 17043
RELATIONSHIP TO DECEDENT
Daughter
B.
c.
JOINTLY-OWNED PROPERTY,
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial Institution and bank DATE OF DEATH DECD'S VALUE OF
account number or similar Identliylng number.
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
1 A 01/01/96 1996 Chevy Geo 4d Sedan 2,000.00 50.00% 1,000.00
with 54,000 miles - jointly
held with daughter, Judy
Chabonik
TOTAL (Also enter on line 6, Recapitulation) $ 1,000.00
T
llt more space is needed insert additional sheets of the same size)
Copyright (cl 1996 form software only CPSystems, Inc.
Form REV-1509 EX (Rev. 1-97)
REV-1510EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn T. Freistak
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
SSjl 192-14-2898
08/28/2002
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER
I
DESCRIPTION OF PROPERTY
RELA W&kM~I~ t~b~~5g~l~WJ~A~1fJT~E6F ~~~r~SFER.
ATTACH ACOPYOFTHE DEED FOR REAL ESTATE.
Emily Hollister - gift
dated 11/06/2001
DATE OF DEATH
VALUE OF ASSET
1,000.00
% OF
DECD'S
INTEREST
100.00%
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. Inc.
2
6 Agere Systems Inc., CUSI?
#00845V100 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
9.36
3
234.84
152 Agere Systems Inc.,
CUSI? #00845V209 - Held in
the name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
4
44,962.17
3,333 shares AIM Select
Real Estate Incom, CUSI?
#00888R107 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
5
6,566.957 shares American
High Income Trust, CUSI?
#026547208 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
64,356.18
6
1,000 shares Bristol Myers
Squibb Company, CUSI?
#110122108 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
24,955.00
7
400 Cisco Systems Inc,
CUSI? #17275R102 - Held in
the name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
5,540.00
8
650 shares Cohen & Steers
Prem Income R, CUSI?
#19247V104 - Held in the
name of the Evelyn T.
9,779.25
Total of Continuation Schedu1e(s)
EXCLUSION
(IF APPLlCABL.E)
1,000.00
FILE NUMBER
TAXABLE VALUE
9.36
234.84
44,962.17
64,356.18
24,955.00
5,540.00
9,779.25
343,325.51
493,162.31
Form REV-1510 EX (Rev. 1-97)
Estate of: Evelyn T. Freistak
Soc Sec #: 192-14-2898
Date of Death: 08/28/2002
Continuation of Schedule G
(Inter-Vivos Transfers & Misc. Non-Probate Property)
Item Description of Property
i/
Date of Death % Decd
Value of Asset Intrst
Taxable Value
Freistak Living Trust dated
OS/25/2000
9 1,000 shares Household
Capital Trust IV, CUSIP
#44l80S207 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
27,110.00
27,110.00
10 3,251 shares Invesco Ed FDS
Inc, CUSIP #46l28RlOO -
Held in the name of the
Evelyn T. Freistak Living
Trust dated OS/25/2000
16,287.51
16,287.51
11 576 shares Lucent
Technologies Inc, CUSIP
#549463107 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
1,005.12
1,005.12
12 Merrill Lynch - Money
Market Account #872-52850;
held in the name of the
Evelyn T. Freistak Living
Trust dated OS/25/2000;
account opened June 6, 2000
37,234.00
37,234.00
13 Mortgage held for Max and
Judy Chabonik, daughter and
son-in-law - Balance owing
at date of death
49,802.98
49,802.98
14 3,514.4405 shares
Muniassets Fund Inc, CUSIP
#626l8Ql06 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
41,312.25
41,312.25
15 25,000 shares NM Household
Financial Corp - Held in
25,000.00
25,000.00
Estate of: Evelyn T. Freistak
Sac See #: 192-14-2898
Date of Death: 08/28/2002
Continuation of Schedule G
(Inter-Vivos Transfers & Misc. Non-Probate Property)
Item Description of Property
if
Date of Death % Decd
Value of Asset Intrst
Taxable Value
the name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
16
1,200 shares Pfizer Inc,
CUSIP #717081103 - Held in
the name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
39,816.00
39,816.00
17
PNC Bank - checking account
#5140077344; held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000; Established
June 14, 2000
14,716.65
14,716.65
18
2,300 shares PPL Resources
Inc H1dg CO, CUSIP
#69352F204 - Held in the
name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
44,781. 00
44,781.00
19
46,260.00
46,260.00
3,000 shares Tri
Continental Corporation,
CUSIP #895436103 - Held in
the name of the Evelyn T.
Freistak Living Trust dated
OS/25/2000
343,325.51
REV-1511 EX~{1-97)
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Evelyn T. Freistak
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
FILE NUMBER
SSfl 192-14-2898
08/28/2002
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES,
Funeral Luncheon
441.40
2
Gravemarker engraving
250.00
3
Parthemore Funeral Home - bill
9,797.10
1.
ADMINISTRATIVE COSTS,
Personal Representative's Commissions
Name of Personal Representative{s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year{s) Commission Paid:
2.
3.
Attorney's Fees
Family Exemption:
Claimant
Street Address
James, Smith, Durkin & Connelly, LLP
(If decedent's address is not the same as claimant's, attach explanation)
7,500.00
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
S. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Recorder of Deeds - filing fee for Assignment of Mortgage never
recorded
17.00
2
Reserve for additional administration expenses
1,000.00
3
Tamdot - charge for removal of medical equipment
50.00
4
Joseph D. Bellomo, Trustee Commission
17,900.00
fOTAL (Also enter on line 9, Recapitulation) $ 36,955.50
(If more space is needed, insert additional sheets of the same size)
Copyright (e) 1996 form software only CPSystems, Inc:. Form REV-1511 EX (Rev. 1-97)
REV-1S12 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERIT ANCE T /IV{ RETURN
RESIDENT DECEDENT
ESTATE OF
Evelyn T. Freistak
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
FILE NUMBER
SSff 192-14-2898
08/28/2002
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
Country Meadows - final bill for care
AMOUNT
4,001. 90
2
Final charges for Home Health Care aides
395.00
3
Verizon - telephone charges for August
22.72
4
West Shore Fire Department - donation check written prior to
death but did not clear account until after death
40.00
5
Social Security Check received for September 2002 that
appeared in account at PNC as of date of death but was then
subsequently electronically withdrawn from account
1,767.40
TOTAL (Also enter on line 10, Recapitulation) $ 6,227.02
(Ii more space is needed, insert additional sheets of the same size)
Copyright (cJ 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
REV-1sn EX + (9-CC)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX. RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Evelvn T. Freistak
NUMBER
I.
SSf/ 192-14-2898
08/28/2002
FILE NUMBER
AMOUNT OR SHARE
OF ESTATE
20% of residue
20% of residue
401. of residue
20% of residue
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
RELATIONSHIP TO D"CEQ~NT
Do Not List Trustee(s)
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (Include outright spousal distrIbutions. and
transfers under Sec. 9116(a)(1.2)]
Joseph D. Bellomo
121 Mountain Way
Morris Plains, NJ 07950
Son
1,000.00
TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
{If more space is needed. insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
2
Judi th Chabanik
500 Walton Street
Lemoyne, PA 17043
Daughter
3
Dennis Freistak
1001 Foxcroft Drive
Camp Hill, PA 17011
Stepchild
4
Janice Hollister
3605 Edencroft Road
Huntingdon Valley, PA 19006
Daughter
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Specific Bequest - St. Theresa's Catholic Church, 1300 Bridge
Street, New Cumberland, PA 17070
Tax-Exempt f/75-20108-0
1,000.00
Form REV-1513 EX (Rev. 9-00)
RE'.'-485 EX+(g..OO)
'*'
SAFE DEPOSIT BOX
INVENTORY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DE?!. 280601
HARRISBURG, PA 17128-0601
Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANC\AlINSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE
FILE NUMBER
SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
192-14-2898
DECEDENT'S NAME ILAST. FIRST, MIDDLEi
Freistak, Evelyn T. Eo...llaro
DATE OF DEATH
l\u3tJst 2B, <m2
ADDRESS OF DECEDENT
5CO W3Jrn.rt: street
(STRE=r,
(CITY)
Laroyne
(STATE";
PA
(ZIP ,:OOE)
17043
I
Ii NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
i (NAME)
G3ry ::.. Jarres
(STREET NAME)
134 Si;E Ave1l.l:, l:'urIrelsto.n, P.^. 170::6
(CITY)
(STATE)
(ZIP CODE)
NAME. ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(Sl PRESENT AT THE BOX OPENING
a. (NAME) (RELATIONSHIP)
G3ry L. Janes .l\t"-..orney
(STREET NAME)
l34 Sipe Avern:e
(CITY)
Ht:rrrrelsto;,n
(STATE,
PA
iZIP CODE.
170..."'6
b. iNAME)
(RELATIONSHIP)
(STREET NAME'j
(CiTY)
(STATE)
(ZIP CODE,I
c. (NAME!
I"RELATIONSHIP)
IS7RE:::: NAME':
ICITY)
(STATE')
;'ZIP CODE)
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
i
i
I
I {STRE::T NAME:.
Ce:i3r Cliff M3ll, 1104 Carlisle Pike,
lID NAME OF PERSON MAKING LAST ENTRY
Unknown - C3cO missin
DATE OF CONTRACT TO RENT BOX
See 10
{NAME;
EN: B3nk
{CITY\
(S7ATEi
;ZIP CODE)
C3rp Hill, PA 17011
NUMBER OF BOX
301
m DATE AND TIME OF LAST ENTRY
'" 1
TITLE UNDER WHICH BOX IS REQUESTED
See 10
NAME AND ADDRESS OF PERSONfSl HAVING ACCESS TO BOX
a. (NAME)
See 10
(STREET ADDRESS)
'b. :'NAME;
(STRE:::7 ADDRESS)
(CiTYi
(STATE)
iZIP CODE)
r'CJTY)
(STATE)
'-ZJP C:'DEj
1m NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY
Ii WAS A WILL IN THE BOX?
I
i
I
I
,
i
I
L....; YES
i"11 NO
If yes,
a. Date of will:
b. Name and address of personal representative. If named in the will
(NAME)
ISTRE:::T NAME';
(CITY)
(STATE}
(ZIP CODE)
c. Name and address of attorney, if any
(NAME)
ISTREET NAMEi
(C:TY)
(STATE)
IZIP CODE:-
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
Page
1
of
1
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
ITEM!
NO.
Cash: Report total only.
Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by name of company, certificate number, date at certificate, name in which stock is registered, and
number of shares and class of stock.
Obligations of u.s. Government: Number of items. date of issue. face value, names in which registered and
type of ownership. i.e., jointly held. payable on death. etc.
Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
Bank and Savings and Loan Passbooks: State name of depositor. number of book. last date appearing in book,
name of bank and branch. and balance.
Jewelry, Coins, Stamps, Manuscripts, ete: List and describe as fully as possible.
Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
All other contents.
ITEM DESCRIPTION
None - hnx pm~ry
II CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS
I CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE. AND BELIEF.
j SlGNA RE
I
L-~
,
! PERSON RECEIVING COpy OF
. SAFE DEPOSIT BOX INVENTORY'
SlGN RE ,~
.u-
i PRINT NAME
,
i PRINT TIT..':
Attorney
, DATE j CHEC1-, APPROPRI _ ~x
, , '
! {(_ ~,.-~ =:]Exel;l.llOrtlPX; CJAom~trCllor(!riJO
! I ~SUlte RepresentativE' :""-i .101m owner of sate OeDOsl! pox
NOTE: Attach additional 811/' x 11" sheet(s) if neces$ary or use duplicates of this page of form.
O:T-15-2002 19:00
PN:BRNK
412 768 3458
F.01
e....
o PNCBAN<
October 16, 2002
James Smith Durkin & Connelly
Atm: Stephanie L Gaffey
POBox 860
Hershey, P A 17033
scp
RE: Estate of Evelyn T Bellomo Freistak (Deceased)
SSN: 192-14-2898
000: 08-28-2002
Dear Ms Gaffey:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Account
Accountll5140077344 Established 06-14-2000
EVELYN L FREISTAK LIV TRT
URTAD OS/2512000
EVELYN T FREIST AK ITEE
DOD balance: $14,716.65 Non interest bearing account
Safe deposit box
The decedent mamtained safe deposit box #301. It was in one name.
EVELYN L FREISTAK
It IS located at:
CEDAR CLIFF MALL
1104 CARLISLE
CAMP HILL P A 17011
717-761-3291
Page 1 of2
ULI-l~-~~~~ l~.~~
r-"1'jl.,tlHI'jK.
'-'.l.'::::' rDO ~'-':,)o
r.I::::'::;
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accoWlts). We do not process any financial
transactions or provide statements. If you need assistance with any of these ltems, please
call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office.
s~/~
Erica L Schlegel
PNC Decedent Reporting
Firstside Center
SOD First Ave, 4" FJ elF
Pittsburgh PA 15219.3128
1_800-762-1775
Member FDIC
Page 2 of2
TOTRL P. 02
~ .srrm Lynch
Private Client Group <=---
214 Senate Avenue
Posl Office Box 0810
Camp Hill, Pennsylvania 17001-0810
7179754600 Office
800 937 0735 Toll Free
FAX 717 975 4663
September 17, 2002
The Estate Security Formula
Attention: Stephanie Gaffey
P,O, Box 650
Hershey, PA 17033
RE: Estate of Evelyn T, Bellomo Freistak
Account #872-52850
Ms, Gaffey,
As per your request, I am sending you the date of death value of the above
referenced account as of August 28". The money market value was
$37,234,00, Attached are historical pricing sheets that show the value of all
other securities held in the account on that date, as well as the number of
shares. The interest earned between January 1" and the date of death was
$4,247.12 and the dividends received were $4,300.05, Mrs. Freistak
opened this account on June 6, 2000. The titling of account reads Evelyn T
Freistak Trustee, UIA DTD 0512512000, By Evelyn T Freistak.
Please contact me at 975-4638 if you have any questions or require any
further assistance in this matter.
J;~ -
Gwyn Wertz ~
Client Associate to
The ECB Group
Financial Advisors
The Information set forth herein was obtained from
sources which we believe reJiablt:, butwe do not
guarantee its accuracy. Ne.i\tler the inloHnalion
nor .me' opinion expressed. constitutes a solicitation
by us oj the purchmre orsaleof nnvsecLuities or
commodities PrimlE:'dinUSi'.
Historical Pricing Inquiry
01854 - AGERE SYS ilK Cusip: 00845Vl00
Date High Price Low Price Close Price Volume "
08/28/2002 1.600 1.520 1. 560 953400
020Dl - AGERE SYS INC Cusip: 00845V209
Date High Price Low Price Close Price Volume
08/28/2002 1.590 1.500 1.520 1821000 15'l.
11011 - BRISTOL MYERS SQUIBB CO Cusip: 110122108
Date High Price Low Price Close Price Volume ( O(J ()
08/28/2002 25.410 24.500 25.060 4400000
17179. CISCO SYS INC Cusip: 17275Rl02
Date High Price Low Price Close Price Volume Lf60
08/28/2002 14.040 13.660 13.720 53872000
31AR4. TRI CONTL CORP Cusip: 895436103
Date High Price Low Price Close Price Volume 3000
08/28/2002 15.500 15.340 15.360 61100
31BTS - MUNIASSETS FD INC Cusip: 62618Q106
Date High Price Low Price Close Price Volume 3S/Lf.l.J.'i-05
08/28/2002 11. 790 11. 720 11.720 20800
31 E30 - AIM SELECT REAL ESTATE INCOM Cusip: 00888R107
Date High Price Low Price Close Price Volume 3333
08/28/2002 13.620 13.360 13.620 110500
31 E45 - COHEN fi: STEERS PREM INCOME R Cusip: 19247V104 (., S-O
Date High Price Low Price Close Price Volume
08/28/2002 15.090 15.000 15.000 723500
433B3 - LUCENT TECHNOLOGIES INe Cusip: 549463107 57?
Date High Price Low Price Close Price Volume
08/28/2002 1.840 1.650 1.690 35509000
HJ468 --> Historical Pricing data not available for this symbol.
Iv'rV/ J-!ouS'cf/ot...P FIN GO/?? Jf.R5"CltJC. (:Jtj
I
ct:Foo 0
The information has been obtained from sources we believe to be reliable but we do not guarantee its accuracy. Past performance is not
indicative of future performance.
" Historical Pricing Inquiry
52F35 . HOUSEHOLD CAP TR V Cusip: 44180S207
" Date High Price Low Price Close Price Volume / tJtJ 0
OS/28/2002 27.240 26.9S0 27.090 10800
59FFl . PPl CAP FOG TR I Cusip: 69352F204 ~ 30c7'
Date High Price Low Price Close Price Volume
OS/28/2002 19.600 19.340 19.400 25900
61001 . PFIZER INC Cusip: 717081103 1';/"00
Date High Price Low Price Close Price Volume
OS/2S/2002 33.590 32.770 33.110 11717000
9EK89 . AMERICAN HIGH INCOME TR Cusip: 026547208 ~ Sc'f;. '1570
Date Bid Price Offer Price
OS/28/2002 9.S00 9.800
97MK8 - INVESCO BD FDS INC Cusip: 46128Rl00 3o?sI
Date Bid Price Offer Price
OS/2S/2002 5.010 5.010
The information has been obtained from sources we believe to be reliable but we do not guarantee its accuracy. Past performance is not
indicative of future performance.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 001890
JAMES GARY L ESQUIRE
134 SIPE AVENUE
HUMMELSTOWN, PA 17036
fold
ESTATE INFORMATION: sSN: 192-~4-zees
FILE NUMBER: 2102-1068
DECEDENT NAME: FREISTAK EVELYN F
DATE OF PAYMENT: 1 1 /26/2002
POSTMARK DATE: 1 1 /25/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 08/28/2002
AMOUNT
ACN
ASSESSMENT
CONTROL
NUMBER
101 ~ 519,300.76
TOTAL AMOUNT PAID:
REMARKS: GARY L JAMES ESQUIRE
CHECK#113
INITIALS: AC
SEAL RECEIVED BY: MARY C. LEWIS
REGISTER OF WILLS
519,300.76
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
GARY L JAMES ESQ
JAMES ETAL
134 SIPE AVE
HUMMELSTOWN
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1547 E% AFP (O1-OS)
DATE 01-20-2003
ESTATE OF FREISTAK EVELYN F
DATE OF DEATH 08-28-2002
FILE NUMBER 21 02-1068
~- .. COUNTY CUMBERLAND
ACN 101
Amount Remitted
PA 17036-9501
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETA_IN LOWER POR_TION_ FOR YOUR RECORDS -~
-----------------------------------------
------------------
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF FREISTAK EVELYN F FILE NO. 21 02-1068 ACN 101 DATE 01-20-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
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)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 36,955.50
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 6.227.02
11. Total Deductions
(11) 4.18
12. Net Value of Tax Return 452
479
79
13. Charitable/Governmental Bequests; Non-elected 9113 Trus (12)
ts (Schedule J) (13) ,
.
1,000.00
14. Net Value of Estate Subject to Tax 451
479
(14) ,
.79
NOTE: If an assessment was issued previously, lines
reflect figures that include th
t 14, 15 andior 16, 17, 18 and 19 will
e
otal of ALL
ASSESSMENT OF TAX: returns assessed to date.
15. Amount of Line 14 at Spousal rate (15) .00
00 _ 00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) X
451,479.79 X 045 . .
20,316.59
17. Amount of Line 14 at Sibling rate (17) .00 X 12 - 00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 _ .
00
19. Principal Tax Due
TAX CREDITS: (19)= .
20,316.59
DATE ~ NUMBER ~ INTEREST/PEN PAID (-) I AMOUNT PAID
PAYMENT MUST BE MADE BY 05-28-2003*. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 20,316.59
INTEREST AND PEN. .00
TOTAL DUE 20,316.59
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(1) .00 NOTE: To insure proper
(2) .00 credit to your account,
(3) .00 submit the upper portion
(4) .00 of this fora with your
(5) _ 1.500.00 tax payment.
[6) 1, 000.00
(7) 493 ,162.31
(8) 495,662.31
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side.
--Make check or Honey order payable to: REGISTER OF HILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an ^Application
for Refund of Pennsylvania Inheritance and Estate Tax^ (REV-1313). Applications are available at the Dffice
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services far taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including disccunt or interest) as shown on this Notice must abject within sixty (60l days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return for a Resident
Decedent^ (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If anY tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of
the tax paid is allowed.
PENALTY: The 15% tax amnesty man-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) eonths and one C1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additicnal interest must be calculated.
~ /~-iay ~
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 INHERITANCE TAX
HARRISBURG, PA 17128-0601
STATEMENT OF ACCOUNT
REY-1607 EX AFP (O1-OS)
DATE 01-21-2003
ESTATE OF FREISTAK EVELYN F
DATE OF DEATH 08-28-2002
FILE NUMBER 21 02-1068
COUNTY CUMBERLAND
GARY L JAMES ESQ ACN 101
JAMES ETAL Amount Remitted
134 SIPE AVE
HUMMELSTOWN PA 17036
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment.
CUT ALONG THIS LINE------- RETAIN LOWER PORTION FOR YOUR RECORDS ~
------------------------ -------------------------------------------------------------------------------
REV-1607 EX AFP (01-031 ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~*~
ESTATE OF FREISTAK EVELYN F FILE N0. 21 02-1068 ACN 101 DATE 01-21-2003
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-20-2003
PRINCIPAL TAX DUE:
PAYMENTS CTAX CREDITS):
20,316.59
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-) AMOUNT PAID
11-25-2002 CD001890 1,015.83 19,300.76
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ''CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
20,316.59
.00
.00
.00
PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax° (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / ar
speaking needs: 1-800-447-3020 CTT only).
REPLY TD: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (37 calendar months after the decedent's death, a five percent (5%) discount
of the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar Year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must ba calculated.