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HomeMy WebLinkAbout02-1143PETITION FOR PROB and Estate of '~'~; r~,Ts A . Cs?~GV T C 1-t ~ No. also known as To: Deceased. Social Security No. 1 ~~-1 E;-i~.h?O GRANT OF LETTERS a~-~a-~~~+3 Register of Wills for the County of . Curnhez~l_and in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor named in the last will of the above decedent, dated 1' e'r~rua.r~r 10. 200 ,~ and codicil(s) dated - (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C; urnk~ e r hez' last family or principal residence at 7-6 ?'enns~rlvan~a. (~zalnx~~~en mo~~nsr~i County, Pennsylvania, with (list street, number and muncipality) ~~n Dec~pde~nt, t~}en ~' ~ ears o~ age,~died 1~e e @ Cllh cy r• 2 , , ~ %' 2 0 02, at o.-.' apt?°~, ros ?~.ta , ~,ar~~~ .~ii._ , -;~ 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: - Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ ~ 000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ _ (If not domiciled in Pa.) Personal property in County $ Value of real estate in ~ennsylva~ia $ °0 000.00 _ situated as follows: '"lr~rt'-e .V~~~'~_Z1.'.~~ ~ ~c1:C'TI ~lY'Ct ~1i~~:T'O<C1.~"'lit F __ Jc~Cr%S C.~' ~_c3.f:1Q, Sl_l;l~atvE; l_1'i iT l""j7~aFr? 1'C)Wr1Sr!.lp~ l~il1~'.17GY'ZP<1C't (iC11a.Tlu,`T~ WHEREFORE, petitioner(s) respectfully re uest~s) the pprobate of the last will and codicil(s) presented herewith and the grant of letters ~ e S i, aTrie r~ t ar~;~ "estamentary; administration c.t.a.; administration d.b.n.c.t.a.) thero~ ? v :J C v -p .-. N 4+ cL ~ -p O C '~ ~ '~. N0., N ~.. ~ ~ cC C bq OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ~~ COUNTY OF CU3~~~?:~Z~1T?D 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 titioner(s) and t as so represen- tative(s) of the above decedent petitioner(s) will well _ ruly ac~r~i~ster ~~sta ~c rding to law. Sworn to or affirmed and subscribed - v, before me this 16th day of ~~ ~~yyu~ /.O ~/ ,1,~ Donna M. Otto, 1st Depu y Register t~ s NO. 21-2002-1143 Estate of ~' ~ '' ~ ~- ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW i) e C crib e I° 17th ~ ~ ~~ ~`,~n consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated i'ebr'i~-aI':~r 10, 1~~~:' described therein be admitted to probate and filed of record as the last will of ..~i;. ci. ,;~a~.Jd. ..~ and Letters l e s ~; ame n t ar zr ,~;,,,~ RTC~i1~RD ~-i. ~.,,:9,~~.O~r-~~r~:I are hereby granted to FEES Probate, Letters, Etc. ......... $ 200.00 Short Certificates(3) .......... $ 9.00 ~~x • xrPages . (l•)• • $ 3.00 JCP $ 10.00 TOTAL $ 222.00 Filed l~.c.@tCtla~z:.~7th,~Q02,,,,,,,,,,,,, ~~~ %,.2~~l y Register of Wills ~/ Donna M. Otto, 1st Deputy `' ~" ~~~ L~ ATTORNEY (Su . Ct. LD. No.) ADDRESS PHONE MAILED LE"I*I'EIZS TO ATTORNEY ON DECE[~1BER 17TH, 2002. REGISTER OF WILLS OF clll~~~;RZ,1~I'~~~ COUNTY OATH OF SUBSCRIBING WITNESS J. Robert Stauffer .mod (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that he was present and saw Ruth ~~.. Cel.ovich , the testatx'~-X ,sign the same and that he signed as a witness at the request of testat ri=s in er presence and (in the nce of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this 16th day of (Name) cember ~ 2.00 Iar?~et Square r31d~.. 17ecYzanicsbur~;, to ,tj - tl (Address) Donna M. Otto, 1st Deputy Register (Name) (Address) REGISTER OF WILLS OF CuI~P, JiT~T;~ COUNTY OATH OF NON-SUBSCRIBING WITNESS l~ichard. II. Ce?Lovich (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he is familiar with the signature of Ruth 1'.. Cer~ovich ~~ testat ril of (one of the subscribing witnesses to) the will presented herewith and c~,d~i~ that `te believes the signature on the will is in the handwriting of R ~.zth n . Ce 21-2002-1143 P~~ 17OS~ to the best of hi.S knowledge and belief. Sworn to or affirmed and subscribed before me this 16th day of )ecernber ;ti~gc~_ 16~n T,~1-ii127~ S l 8.1~ lt:~~_di j'~ECt'nYll('.Gi~Ur ~ .~ (Address) 17050 P:~ / Donna M. Otto,lst Depu (Name) (Address) _ _ , h;r rs to certify that the tnformatu,^ nere given Is correctly copteLi [rum an a 'i~in_I; s I?a:+~,. 1/` ;i..ll~~~ c ( L,~.;~I Regisn-ar. The original certificate will he forwarded to the titat:. Vital i.c~_I;r.+• t ~rill~t: + 1 i~~.;r.l ,, ,_I 1y ,,-. WARNING: It is illegal to duplicate this cop~F ~y p~:~3to~tat ~:~~ :~~i~t, ~1 Fee for this certifcate, ";_'..(i0 87?6.22 tit>. ,ro; :ad Hey re7 "Y PErPRiHT PERMANENT BLACK INK i w ~~~ ~I d ~ -r- -I 1 ~_vF'"9 v~ ~ j;; 9rME ~t a~~°;~,' ` ~~,,,,,,,,,,.r~ ~?GfcaQ..-CLL'auio~y COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH STATE FIIE NUMBER ----- La9) SE% SOCIAL RITY NUMB DATE OF DEATH,MCnm. Day.ball Middle 4020 AME OF DECEDENT IFU51 Female 1~~" rl~ . . N _ _ 2 ac>c i ~ ~< Cekovich ~ Ruth A ] ] e~ .A~ . I. AGE n asl Bnntlayl UNDER 1 YFAR UNDER 1 DAY DATE OF BIRTH BIRiMPUCE IGry and PLACE OF DEATH ICnecM aay me -see ruc149 On uma wool . OTHER: ,Mwnn. DaY. 'revel iYelea Fwegn COUnnYI HOSPITAL. Mar1M r Oaya MOwa i MNWM ,...,)( 1914 Mechanicsburg, Pa. In al»m 5L ERIOwP.nam G DoA ^","'°"t9 ^ R.sWnu ^ ;sp.~cJyl ^ °n" Oct 19 p , 88 Yra 7 s. e. T. w. COUNTY OF DEATH CT'. BORO.TWPOF DEATH FACILRY NAMEIII nOl inw~NUOn. give street and mAnhwi NMS[I~eEDEM OF HISPANIC ORIGIN'/ RACE-American lnban, 8lact, NTaa. ale IspecJyl White a aa l] xyw..p.c y .n. No Yp -~ ~ .AKan.PwnoRiun.«~. Cumberland EastPennsboro ~ ~ ~ ~ It; ~ sel eb. eye. ea. 10. DECEDEM'S USUAL OCCUPRION KIND Of BU51NESSlINDUSTRY YMSO CEDENT EVER IN DECEDENT'S EDUCATION MMITAL STIBUB~ManwO SURVIVING SPoUSE 5 n, Oe can NavarMUrIM, WiOOwaa. JI wJe. Viva ma~Ow~namal _ Osuarunggnema U.S.ARMED FORCE$9 oLe (Grveaur0 of worek a l C«laga ry'BacanWry D"'0~~~'~d ~( EkmaM l l Food Service f ai ON r ^ ~R R y u l I D ng vrw o NO L Yea , , IVIGIIdI IVIGII `J~' 1! . nb. 1x. u. u. • 1L . DECEDENT'S MAILING ADDRESS IStra«. Coy/fon.SON.Zy Caael DECEDENT'S lyt Y~ yny,a yyb;n __-_rw 17a Slala A ____ . ACTU L 1625 Lamb's Gap Road RESIDENCE d't•d•a Pennsylvania 170 ~~^vr~ln^• Cumberland '"'m° No, ac.a.«ww laarlanip7 Mechanicsburg , c ,nao pn mw Waal na.~ rann.auMwr,aad -- ----- Ay 1a_ 1Tb.cwn --- FATIIER'SNAMEiFUSIMbaa.Lasli ,lames O~Hara MOTHER'S NAMEiFasI.MWON.MaManSwname) Edith Gill u. la. INFORMANT'S NAME (TypEiPring Richard Cekovich INFORMANT'5~~~"~~elg7'~>}t91~Nanicsburg, Pa. 17050 xob za. METHOD OF DISPOSIT~!~, DATE OF DISPOSITION . PLACE OF DISPOSITION'Name dCerl,ete7•Cramalay aaMIPUr ' LOCATKJN ~CirylTown, Sl«s, ZW CoW 17025 Pa Enola ,«L1` cr.maliay^ Rwrov«Iran5lal.^ B • (Monm.Oay.ybwl D 2002 6 s Lutheran Church ST. Paul . , ^ a ^ , ec z a anwtSlaecM Don«Kn ab xle. l . . xla. ' SMaNATU FUNE R OR PER" IA AS SVCH LICENSE NVMBER NAME ANO AODR~ESS OF CILITV FD-012662-L Myers uneral Home, Inc. 37 East Main Street Mechanicsburg, Pa 17 5 - xxb. nt. . xza CO •aam lac aW roan unlryirg IMM««my Fnowlsdge, Oesth occurred at the Uma, data and place MatBd. LICENSE NUMBER OQE SIGNED (MOnm. Ddy, Vearl pnyMCwl a nd aviiMDN al Ome of death to ISpnwW a dnd Tine) twl~ly cave a a«n. z]s. zx. x].. wma 212E mu«ba compl.laaW TINE OF DEATH GATE PRONOUNCED DEAOIMwnn. Day Yearl YMS CASE REfERREDTO MEDICAL E%AMINERICORONER7 Yae^ Ib . - pwsalrb gawwicea M«h. V G l c y.-p-t / Z ~ n 1- xE. r~ • S~ P- M xE . . 11. iryurMa a complicalKxR wnicn uuaad Ins d.aln. Do rot Amer Ina mode of dying. a h as car0iac or raspiramry arrasi, iMCa or Man Ia;Wra. I Appoaw«a PART II: aver aKyiilka« I:oridaiona conlrilnvq to d.atn DW ^°I nwpup n Ina urWrrying caw pvan n PMT I. r IM daaaa.a PART 1 Em , ; s 77. lot omy uM caws on war lino. 1 aYMI arW aeamAaaN I IMYEdATE CAUSE 1Final (/~/~ I waeae'wa <onailiOn \ (I `Q ~ ~ ~ I r ~ (\ _ _ _ _ -- ~ i E TC1 (OR A SEQUENCE OF)' \J . - - - mi«I^u«mnaieona D 5~-~- ---~- I -.. ENCE OFD S Q d I U E ~, Iwai g to anma«ala E TC110R A C ----__._ --____.__-_ Emw UNDERLYING `~~ ~ ~ c - CAUSE InisnaSea~nyuy _ _ _ __ DUETOIyyFI CONSEQUENCEOn'. ~ e l nl tt l - uluu a M nw s i,rwany in wwml LAST _ ~~' - _-____ a -- GATE OF INJURY TIME OF INJURY INJURY AT WORKi DESCRIBE HOW INJURY OCCURRED. VMS AN AUIDPSV WERE AUTOPSY fINDING3 MANNER OF DEATH IMOnm. Day. Yean PERFOPMED9 AVAILABLE PRIOR 70 OFOOEATHpNa CAUSE Na1W« ~ HwnKiaa ~, V ^ No^ ea rr,, LJ Accdem ^ Pending lnvasligalwn M _~ ! LOCATION (SDeel. CiryRown. Stale) ~'~ ~ ~ y a ~ I.IO ~ SuKga ^ Could na be determined l_J PUCE OF INJURY ~ Ai Lama, tarm,~Mrs«. IaaOry, oBlce yes hooding, arc ISpucavl ~_ __ ]ga . 2M. xeb. eV. SIGNATURE AND TIT OFC L Q CERTIFIER:GecY Onry mnl 'CERTIFYING PHYSICIAN (Pnyscian cerulY~ng cause W dean when anWner pnvsician nos Vrpnour,ced tlealn anu cwnpleleO llem 2JI M _.- To ma Oast of mY knorlWga, de«h octurrarl dw b Ina cauaNal arW manner as elated ................. ............................... ]lb. D ILA nm. 0 y. Yeail VMBER GATE SIGNE ~EI S LICEN 1 ` ^ V~ I ~~ ]la. 1 `•~. ~? ~ am antl ueruWing to cause of tleaml ~ ]IC 'PRONOUNCING AND CERTIFYING PHYSICIAN IPnysKan twin pronuuix:ing ue To IM Deal of my knowledge, death occurred a1 the Uma, data, and place, and duo to Ina cauee(e) erb manner ae noted .. .... ..... .. ......... .... NAME AND ADDRESS Of PERSON WHO CO PLET~OF 0 ATN (Item 27) Typ. a Print K"(YJ ~ e ~ r~~ - 'MEDICAL E%AMINER/CORONER .2Q~ \~ X V On the Oa«a of aaamin«lon anNOr lnvsallgation, in my opinion, Oeeth occurred al the lima,Data, and place, and due to lhecwae(al and ~ ~ manner of a1a100 ...................................................................... .. ... .................... ... ]x. ]ta __. Nt GISTHARS SIGNATURE ADD NUMBER ~ 1~`l~'l~1 DATE FILED(MOnm. Day Yeail December-- ~ boo n Q t~> ~ ].. -- a (dt~~- ~x~r~ ---- ~ U LAST WILL AND TESTAMENT OF RUTH A. CEKOVICH I;, RUTH A. CEKOVICH, of the Township of Hampden, County of Cumberland and State of Pennsylvania, being of sound and dispos'.Lng mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my son, Richard H. Cekovich, absolutely, unconditionally and in fee simple. LASTLY, I nominate, constitute and appoint my son, Richard H. Cekovich, Executor of this my Last Will and Testament. Ilv WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of February, A. D., 1981. ' (SEAL) Ruth A. Cekovich -l, Singed, seated, published and declared by the above named, Ruth A. Cekovich, as and for her Last Will and Testament, in the presence of us, who have subscribed our names hereto as witnesses, at the request of said testatrix, in her presence and ir.- the presence of each other. w2~. _ __ ,_ . t" ~ :~ ~ y x o z ~ o ~ r a~ t-+ ~ 4 ~ z 7d p y i ~ ~ ~ ~ d b O H (. D 6 ~ ~ C LTJ o H [A ~ ~ H r, _ _ - -- ~.T Name of Decedent: ('ERTIFICATION OF NOTICE UNDER RULE 5.b(a) ~Urni~ A, ~LK(7VT~~ Dale of Death: l~eeer3ber 2, 2002 . Will No. 2t'~'fl2-0111 Admin. No. To the Register: I certify that notice of (beneficial interest) ett~te 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 ~eCBmber 27, 2002 Name Address RTC~ART~ ~~r~0~T~~ _ i h~~ T arnh; s C_ s~-n F2_o~,.d.~ "sieehgn~i. ~sbz~r~, P~# l'jf~~0 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Date: December 28, X002 .r !~ ,,: o` S•l~gnature /, Name J ~ Robert Statzf'f eP Address Market Square I31c1~. F~echan~csbur~, PA 17055 Telephone ~~'~ 766-9673 Capacity: _ Personal Representative ~_Counsel for personal representative r : ~ 1'\..i . ~~~ CDMNDNWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOT I C E DEPTAU2806D1DIVIDUAL TAXES AND FILE N0. 21 02-1143 HARRISBURG, PA 17128-obol TAXPAYER RESPONSE ACN 03106251 DATE 03-04-2003 REV-1545 E% AFP (09-00) TYPE OF ACCOUNT EST. OF RUTH A CEKOVICH ^ SAVINGS S.S. N0. 195-16-4020 ^ CHECKING DATE OF DEATH 12-02-2002 ^ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: RICHARD H CEKOVICH REGISTER OF WILLS 1630 LAMBS GAP RD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 1705D CARLISLE, PA 17013 PNC BANK has provided the Department with the inforwation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return ;t to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Cowmonwealth of Pennsylvania. Questions nay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31500205180 Date 06-01-1999 To insure proper credit to your account, two Established (2l copies of this notice must accompany your Account Balance 4, 004.25 Paywent to the Register of Wills. Make check payable to: ^Register of Wills, Agent''. Percent Taxable X 5 0. 0 0 0 2 D 0 2.1 3 NOTE: If tax payments are made within three Amount Subject to Tax , (3) months of the decedent's date of death, Tax Rate X .045 You way deduct a 5% discount of the tax due. 9 0.1 0 Any inheritance tax due will became delinquent Potential Tax Dua nine (9] months after the date of death. PART TAXPAYER RESPONSE A. ® The above inforwation and tax due is correct. 1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, ar you may check box ^A^ and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Departwent of Revenue. BLOCK ~ 8. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY tc be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You wust complete PART Z^ and/or PART 3^ below. PART y andscate a dsfferent tax rate, please state your :::::::::.::.:.. ,:,.:,:::,;,:,:,:,:,;,: , ...:::.:.: ~:::: ..~:::. ....-.:.:.:::.:..:: ,:: relationshi to decedent: ..:::::::::::::::::::::::::::::::~::;:::;:;:::;:,:;:,:;:;:;:;:;:;:::::::::::::::::::::~:::::~:s:::::::::~::~;:::;:::::s:::::'::: 2^ p ..,., .,.,,,.~ .~....., ............... ........... ----- TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 9F TPY ON ~lOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust far" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X^ in block ^A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EXl upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one C1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (**) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established mare than one year prior to the decedent's death: 1 DIVIDED BV TOTAL NUMBER OF DIVIDED 8Y TDTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. Tha percent taxable far assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable Cline 6) is determined by subtracting the debts and deductions (line 57 from the amount subject to tax (line 4). 7. Enter the appropriate tax rate Cline 7l as determined below. ^The tax rate imposed an 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%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. ^Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral^ class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject tc administration by a personal representative is insufficient tc pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ~ ~~~' OEPAR7MENTTOFOREVENUEYLVANIA ~`^ BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE N0. 21 02-1143 DEPT. 280601 AND ACN 03106246 HARRISBURG, PA 171zs-o6o1 TAX PAYER R E S P O N S E DATE 03-04-2003 REtl-1543 EX AFP (09-00) TYPE OF ACCOUNT EST. OF RUTH A CEKOUICH ^ SAVINGS S.S. N0. 195-16-4020 ^ CHECKING DATE OF DEATH 12-02-2002 ^ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: RICHARD H CEKOVICH REGISTER OF WILLS 1630 LAMBS GAP RD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17050 CARLISLE, PA 17013 PNC BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decadent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial instituticn, attach a copy to this farm and return it to the abnvw address. This a^.co~!nt ;s taxahle in accordance with the inheritance Tax. Laws of the Commonwealth of Pennsylvania. Questions may be answered 6y calling C717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31000175241 Date 01-10-2000 To insure proper credit to your account, two Established (2) copies of this notice roust accompany your Account Balance 5, 011.85 Paywent to the Register of Nills. Make check payable to: ''Register of Wills, Agent^. Percent Taxable X 5 0. 0 0 0 2,505.93 NOTE: If tax payments are wade within three Amount Subject to Tax (3) wonths of the decedent's date of death, Tax Rate X .045 you nay deduct a 5% discount of the tax due. 1 1 2.7 7 Any inheritance tax due will become delinquent Potential Tax Dub nine C9) wonths after the date of death. PART TAXPAYER RESPONSE .~~ '~::::~A.~::::#~~::: .: its ............................................................................................... ..'E'1!1 ~~r:::::'.~. A. ® The above information and tax due is correct. 1. You nay choose to rewit paywent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you way check box ••A^ and return this notice to the Register of 0 N E Wills and an official assesswent will be issued by the PA Oepartwent of Revenue. [ B L 0 CK ~ B. ^ The above asset has been or will 6e reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above inforwation is incorrect and/or debts and deductions were paid by you. You roust complete PART ~ and/or PART ~ below. PART Ifi ou indicate a diff :::::::::::::::::::::::::::::-::-::::-::::~::~::::::~::~_::::::::::;::-::,.,.,::::;:::::::::~:......::::::::::::::::::::: Y Brent tax rate, Please state your ::::::~:::~:,:,::~::::::~::~::~ :::.........:::..:::: :~:::::: ._:. ~ :..::::::::::::~~:::::::: ::, ; :~ [~:~::: • - iiiii°i' iEi=zEiEiiif isi ' ; • [ i~ ~ i ° ~ = ~ relatsonshsp to decedent. _::: . . : : : ~ _ s i :.::: •~~:~~ ii=€i€i':i':iiiiiiiii':siz': • `i'i€i ~? ..#.~~!~~!!....##YY.'!~~.!!::::-~.s.....:~:.#.}r...;iii..~.!.f~~.1`.~.,,.i.CC ..::::::::.:::::::: :~~ ::~ ~ ::::::~ :::::;:~~ :~:::::L~f~17:f;`: ~[ LRi€ifsl4:lCG1?ALRCif[ Ei~iEsi ~i~ii TAX R - ETURN COMPUTATION OF ;€ :~;_:~€€~;;s€:i€i€€:€;~~;;iiii~;°ss°'si~€i?i=~~~i;€~=i"s~€€ TAX ON JOINTiTRUST ACCOUNTS .:..p,~~;:...... _ :~: :: :::: ::;: LINE 1. Date Established 1 :;: 2. Account Bala nce 2 €:;:~:~:~~€:~ :::::::::::::::::::::::::::::~::,;:;:;:-:::::::s:::i:;:;:::;:;~:,:::::;:;:;:;:::;:,~,;~:;:;:;:;::;:€:€::~:~:;::;::;: 3. Percent Taxable 3 X :; ;.;.; ;.;. ., ; :.:.: ........ 4. Amount Sub' sect to Tax 4 iEiEi'ifiEsiiii~~:::~i~ii~i~€~~_;iiiiisi€siii'i;€iiii`i`iii€iis~i;iiiis~~i':ii~iiiiiiii°€s`iiii;i~i~~€~;i~:i~: s::~::::~::::?~:~ :.....::::::::::..:.....:.........:.:::::::-::::.;.,.;.;.;.;.;.;.;.,.,.;.;...,.,.,.,.,.;.;.;:;:;:,:;:;:;:;:;:;:;:;:; 5 . Debts and De ductions 5 ......:.:.:.:... ~;.;.;.,.,.,.,.,. ~,.:::.,.,:,.;.;:.,:,:,.;:,.;.;:.:-::, :.:::::::,=:::. ~:.,.:.,.,.::-::,.:.:::::::, :::::::-:~ :: ~::: - ss:~s~sss:ai ~:€:~::€:~ :::::::::::::::::::::::~::~::~::::::::~~::~::~::~:::_::::::::~:::::::::::~::~:::::,:;:;:..,:;..:,:;.,:... ..:...:.....:............::.:::::::::.:..:.:...:.:.:.:.:.:.:.....:...:.:.:...:.....:.:.:...........:.:.:.:.:.:...:.:.:..,:,:,:,:,:,:;:,:::::::;:; 6. Amount Tax able 6 :::::::.:::::::::::::::~:~::::::::::::::::::::~:::::::,:,:.:::,=:,::::=:::~:::,::::::.-:,:::,:;:,:,:::,:,::~:::::: ....... ............................................. ;;;:::;:€::~:::~ :~::~::::s::::~:z::::;~::~::~::~:;::s:::::::;s ::::::::::.::::::::::::::~::~:::::::::::::::::::::::::::::::~::::::::::::::::::: '' ' ' 7. Tax Rate 7 isiiiiiiis=i':i ~':~€€ii€ €i`: =_ sis':€`:€isii€iis°ii';isisiiiiii='iz~i€i':iiiii ~i i=_'=i~ iiiiii=~ _€iisSL~iiiiiiis€~ iii iiiiii=s€~ ~?'s's;ii X ;:~::::::::~::::: ::::_;:~:::;::st< :::::::::::::::::::::::~s:::::::;:;:;:;:;:;~_:;:~;:::::::::::::::::::::::::::::::~:::::::::::::::::::::::::: s:~ :;::~ :~:~:s:~ :..:........................::::::::::::.:.:.:...:.........:.:.:.:...:.:.:.:.:.:.:.:.............:.:.: 8. Tax Due 8 :: :::: ,;;., ,.,., ..; ,.: ,::; PART DEBTS AND DEDUCTIONS CLAIMED DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under p ties o perjury, I dec a that the facts I have repor~tj,ed above ~~reJJ true, correct and complete t e bes of ny n~ed elief. HOME CLL7) !~~-~d~~2 WORK ( ) _~ TAXPAY S GNA URE TELEPHONE NUMBER AT GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an ^X^ in block "A^ of Part 1 of the ^Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been ar will he reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in black "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (~*) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVDR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decadent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER DF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS DR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax Cline 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. The tax rate imposed on the not 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%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adapted by others, adopted children and step children. "Lineal descendents^ includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. ^Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether by blood ar adoption. The "Collateral^ class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. Vcu legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. Date of Death Spouse Lineal Sibling I Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% ~~~~ CDMMDNWEALTH OF PENNSYLVANIA '` DEPARTMENT OF REVENUE INFORMATION N O T I C E BUREAU OF INDIVIDUAL TAXES DEPT. 280601 AN D HARRISBURG, PA 17129-obDl TAXPAYER R E S PO N S E REV-1545 E% AFP t09-00) FILE N0. 21 02-1143 ACN 03106247 DATE 03-04-2003 TYPE OF ACCOUNT EST. OF RUTH A CEKOVICH ^ savlNGs S.S. N0. 195-16-4020 ® CHECKING DATE OF DEATH 12-02-2002 ^ TRUSr COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: RICHARD H CEKOVICH REGISTER OF WILLS 1630 LAMBS GAP RD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17050 CARLISLE, PA 17013 PNC BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return. it to the above address. This account is taxable in accordance with the Inheritance 7as Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (7177 787-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5140009982 Date 02-01-1968 To insure proper credit tc your account, two Established (2) copies of this notice must accompany your ACCOUnt Balance 18, 105.78 Payment to the Register of Wills. Make check payable to: ^Register of Wills, Agent^. Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax 9, 052.89 (3) months of the decedent's date of death, Tax Rate x .045 You may deduct a 5% discount of the tax due. 4 0 7 .3 8 Any inheritance tax due will become delinquent Potential TeX Due nine (9l months after the date of death. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. 1. You say choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box ^A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK ~ B. ^ Tha above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If ou indicate a diffe :::::::::::::.::::::::::.::::::: ~:::::-::::::.:.:.:.:.:.:.:.:.:.:.:.:.,.,.,.,.,.,.,.,.,...:::::::-::-:::::::~:::::::::::.....::::::::::::::::::::: PART y rent tax rate, Please state Your ;iii€;d~=s;t~€€€€€€s~°€!€€': ~_:._;: ;~•n:.ic:a~:•:~ € ~~ ...:::::. ::: ~ ::::::::: -,:::::::::- : :: relationship to decedent: ~~~~~~~••.......^:~~#:.: T1kX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate B. Tax Due PART 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID DATE Under lties of erjury, I declar that the facts I have reported above are rue, correct and couplet he best 7n/y k ed a elief. HOME C~Z~S ~~~'~~'~~-Z i~SiG WORK ( ) GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another ar others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X^ in block ^A" of Part 1 of the ^Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X^ in block "B^ of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register o+ Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (*~) appears before your first name in the address portion of this notice, the 53,D00 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable far each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decadent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR] B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED 8Y TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2] by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4). 7. Enter the appropriate tax rate Cline 7) as determined below. xThe tax rate lsposed on the net value of transfers from a deceased child twenty one years of age or younger at death to or far the use of a natural parent, an adaptive parent, or a stepparent of the child is D%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children^ includes natural children whether or net they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. ^Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The ^Collateral'• class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additional space is Headed, use plain paper 8 1/2" x 11". Proof of oavment may be requested by the PA Department of Revenue. Date of Death Spouse Lineal Sibling Collateral ~ 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) N0. CD 002317 STAUFFER J ROBERT ESQUIRE MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: ~s5-~s-4o2o FILE NUMBER: 2102-1 143 DECEDENT NAME: CEKOVICH RUTH A DATE OF PAYMENT: 03/20/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 03106247 ~ $407.38 TOTAL AMOUNT PAID: REMARKS: RICHARD H CEKOVICH C/O J ROBERT STAUFFER ESQUIRE CHECK# 1771 SEAL INITIALS: VZ RECEIVED BY: DONNA M. (~TTC~ 5407.38 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 1 71 28-060 7 RECEIVED FROM: REV-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002318 STAUFFER J ROBERT ESQUIRE MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: 195-is-4o2o FILE NUMBER: 2102-1 143 DECEDENT NAME: CEKOVICH RUTH A DATE OF PAYMENT: 03/20/2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 1 2/02/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 03106251 ~ 590.10 TOTAL AMOUNT PAID: 590.10 REMARKS: RICHARD H CEKOVICH C/O J ROBERT STAUFFER ESQUIRE CHECK#1772 INITIALS: VZ SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002319 STAUFFER J ROBERT ESQUIRE MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: ssN: i 95-i s-4o2o FILE NUMBER: 2102-1 143 DECEDENT NAME: CEKOVICH RUTH A DATE OF PAYMENT: 03/20/2003 POSTMARK DATE: 00/OO/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX111-96) AMOUNT 03106246 ~ $1 12.77 TOTAL AMOUNT PAID: REMARKS: RICHARD H CEKOVICH C/O J ROBERT STAUFFER ESQUIRE CHECK#1770 SEAL INITIALS: VZ RECEIVED BY: DONNA M. OTTO S 1 12.77 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLYANIA ~ COUNTY OF CUMBERLAND ~ ss: __-__ Richard II. Cekov.ich bein duI sworn -- -~----------- 9 Y -- - --------- -__. ____ -__ _ according to law, deposes and says that he ____s the FXeCUtor ----- -------- - of the Estate of Ruth A. Cekovlch - - - _ __-------- -- y --- late of __. IIampden Township ----- - Cumberland Count Pa., deceased and that the within is an inventory made by IZ.1.CI"l fl'C'C~ I1. Ce~~OVJ_Ch LXeCUtOr - _ ....__, the said---- ~ ------------- of the entire estate of said decedent, consisting of all the personal proparfy and real estate, except real estate outside the Commonwealth of Pennsylvania, and Ihal ihP fiyures opposite each it of the Inventory represent it's fa' value as of the date of decedent's death. Sworn ~~ ~' _____ and subscribed before me, u~f -- _ - - ----- xecvlo ifr7f 1G30 Lambs Gap oa r~echanicsburg, PA 17050 Address Date of Death 2nd December 2002 _------- Day Month Yssr INSTRUCTIONS I. An inventory must be filed witlrirr three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , O Z O z W r r- w r-- w <( d rte. w 0 w N ~ J lL ? U ~ J O Z ~ Q In z LL Q a. F~ 1 t"~ t -~ ry v r~ C> C, ,r; H ~~ f-y i i ~; •r7 ,L rq 1v 3 0 C-- ~+ Q~ `t3 w c~~+ r~ `o a~ ~9 _1 -o m N 47 t.r d Q ~o O. C 7 O U -v •o m _o E 7 V r. s~ a~ CV 4 ~ ~-1 O ~I ~r m 0 O lL O0 T m C 0 Q Inventory of the real and personal estate of I~11`I'II A. C:LISOVT.CII deceased (l) Parcel of land situate ire Abbott `.I'ownsh~i_p, Potter County, Pennsylvania. (2) PNC Bank, Id. A., Savings Account No. 50x031.1.2053• (3) 1gg0 Pord "Ranger" `T'ruck. (L_i) P~ZutuaJ_ of Omaha, premium refu.tld (5) Erie Insurance Group, prem.i.um rei'und. (6) Noun©hold 1ur.ni.shi_n~rs ~i:? appraised by lI. James Mumma. ('7) One-l alf :inter. est i..n tr~~ct of l.r_~nd si t;uate in Hampden Totianship, Cumberland County, Penns~rlvarli_a, described in Deed o.f F~uth A. Cekovich, dated. F+'ebrr.~ary 18, ].qq3 and recorded in the Cumber]_and County }lec~~rder's O:f.'fi.ce in Deed Book "D", Volume 36, Page 657. (c3) On©-I-calf int©r©st in Cort~i.ficafie of Deposit No. 611.i0~36f3L}.16, with Citizens Banlc of Pennsylvania. (q) One-half interest i n Certi.f i_cfite of Deposit TIo. 61L}.o~6L3L}.0£~, frith Ci_ti.ze.ns Banlc of }'enns;~rlvani_a. (10) Beneficiary of Annl.ri_t~,~ (;ontrr~c.:i, I~.TO. A207011.70 Urith Piet Life Tnv©stors. `['atal.. ....................~ 5,Li76 00 q61 21 2,800 00 15 qo lOq 00 633 00 76,679 20 5,000 00 5,000 00 1q.852.35 X116,53: 66 REV-1500EX(6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 \"l-\U\-l REV-1500 ~ OFFICIAL USE ONLY w ,.., ~'g,cn u"'''' w"-u rOo u"'... "-'" "- " FILE NUMBER 21 -02 COUNTY CODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT ~lLU_ NUMBER ~ Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CEKOVICH, Ruth A. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) December 2, 2002 Oct. 19, 1914 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A SOCIAL SECURITY NUMBER 195 - 16 !~020 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [iJ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attacl1 copy 01 Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date oldealh after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrusl) o 10. Spousal POlJerty Credit (dale 01 death between 12-31-91 and H-95) 03. Remainder Return (datec((jea\l\ pOOr \0 12-'\3-82} o 5. Federal Estate Tax Return Required -.2.. 8. Total Number of Safe Deposit Boxes D 11. Election to lax under Sec. 9113(A) (Attach Sch 0) I- Z W C Z o "- w w '" '" o u NAME COMPLETE MAILING ADDRESS Market S~lare Bldg. 1 h'est I-lain St. Mechanicsburg, PA 17055 J. Robert Stauffer, Att . FIRM NAMS ~ -ml~ble) TELEPHONE NUMBER 717-766-9673 1. Real Estate (Schedule A) 2. Slocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (1) (2) (3) (4) (5) 5,476.00 0.00 0.00 0.00 4,524.11 OFFICIAL USE ONLY z o ~ ::l ~ ii: cs: o w It: 4. Mortgages & N<ltes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) 8. Total Gross Assets (total Lines 1-7) (8) 11,883.79 0.00 116,531.66 (6) 86,679.20 (7) 19,B52.35 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12_ Net Value of Estate (Line 8 minus line 11) (11) (12) (13) 11,883.79 104,647.87 0.00 13. Charitable and GOlJemmental 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) (14) 104,647.87 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-' ::l 0.. :iE o o g 15. Amount of Line 14 taxable at the spousal tax 0 rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) 16. Amount of Line 14 taxable at lineal rate 104,647,fJ7 xO lJ2 (16) 4,699.15 17. Amount of line 14 taxable at sibling rate 0 x .12 (17) 0.00 18. Amount of Line 14 taxable at collateral rate 0 x .15 (18) 0.00 19. Tax Due (19) 4,699.15 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 1625 Lamb's Gap Road CITY Hechanicsburg, I STATE FA I ZIP 17050 ~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,699.15 0.00 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. interesUPenaily if applicable D.lnterest E. Penaily 4. TotallnteresUPenally ( 0 + E ) if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 0,00 0.00 (3) (4) (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 4,699.15 0.00 4,699.15 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. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS ~ ~ .........0 GJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;........................ ....................... ......................................... D b. retain the right to designate who shall 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? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....".. .. ...... .................... ............................................ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..................... .................... ............................. ................................... No ~ ~ rxJ ~ Ullder pellalties of perjury, I declare that I have examil'led this return. illc/udil'l9 accompan ing schedules aOO slatements, and to the best of my knowledge alld belief, it is true, correct and complete Declaraliollofprepareroth Ilthe persollal repre ntative is based on all info a' fwhiCh preparerhas any knowledge. SiGNATURE OF P DATE) J >/ -<'~ t 83 ADDRESS PA 17050 d'.J Market Squa e Bldg., Mechanicsburg, FA 17055 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. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transters to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (Ii)]. The statute does not exemDt a transfer to a survlvjng 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 Juiy 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 chlid is 0% [72 P.S. 99116(a)(I.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiCiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(I.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '~'~""[''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER 21-02-11 ~3 nu'ri1 A. C"l~o'nc 2002-011L~3 All real property owned solely Of as a tenant in common must be reported at fair market value, Fair marnet value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is Jointly-owned with right c survivorshiD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH All that certain piece or parcel of land located on BIU1nadahl Hoad, 'l'mmship of Abbott, COlmty of Potter and State of Pennsylvani.a and as more particularl7i' descrLbed in Deed fron Ji'x'Hnk nashula and Alice S. jjnsh1l.1o., hLs '..d.fe, doted ['T'1'11 10, ]')"!1 and recorded Ln tile Potto1' Count:! Hecol"Jer of Deeds Office in Deed Baal, Volume ll',e" Page 1,llJ, to ,John Celcovich and TI11th II. Celcovich, his I-rife. The said John Cekovich died on January 21, 1981 .fuereupon sole title in said premises vested in his wLfo, tho said TIuth A. Cekovlch by right <l.r sux'vivorship, ,.rhoso estate is being reported herewith. The property is assessed at :r,2,360.00 for the yoar 2002. The Potter County Common Level Hatio Ii'actor is currently at 2.32. 2.32 muHiplied by :~2,360.00 gives it a current market Value of :1;S,11-76.00. $ 5,476.00 5,1-1-76.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) REV.t!\OlltJc 'It.~11 ESTATE OF I.~~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAL THor rFNNsYt VANIA JNIIFnIT ANCE TAX RE JURN RESJU tI UECEOEN' FILE NUMBER 21-02-1143 2002-0114_3 nUTIl A. C [i;J\OV I ell Include the pror.eed5 olliligflllon amI the d{l\e the proceml!l wele rer:r!vf!d hy the e5!nlp.. ^" ,,'opp.fly Jolnlly-owned wlth the right of survivorship must be disclosed on Schedule r ITEM NUMBER 1. 2. 3. 4. 5. llESCRlP IIUI, PNC Bank, N. A., Savings Account No. 50803!~2053. 1990 Ford "nanger" 'rruck. Household Furnishings as appraised by H. James Mumma. Mutual of Omaha, premium refund. Erie Insurance Group, premium refund. J' VALUE AT DATE OF DEATH r~ 961. 21 2,800.00 638.00 15.90 109.00 - ~-,,--_.- '-'~---;:;-'-----.'--7-'-~-.-;::-:i.'7.--:-:-:-:-; _.I.HlJ...,...l ..1,,,,,...I,.,.,r /I..... ......on.... ,,1.,.....\ TOTAL (Alsoenleron line 5, Recapllulalion) $ 4,524.11 flEV.1S'19EX+(t.97j '*' SCHEDULE F JOINTL Y.OWNED PROPERTY COMMONWEALTH OF PENNS~ L-VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RUTH A. CEKOVICH 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. RICHARD JI. CmWVICH 1(,30 Lamb's Gap Road Mechanicsburg, PA 17050 Son 8. c. JOINTLY-OWNED PROPERTY: LETTER ITEM FOR JOINT NUMBER TENANT DATE DESCRIPTION OF PROPERTY MADE Include name of financial instilulioo and bank accounl number or similar identifying number. Attach JOINT need fCl ioll'lt\y-he\d leal estate. DATE OF DEATH VALUE OF ASSET %OF DECO'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A 2/1GI ALL 'r'!A'l' Cl!;R'rAIN tract of land sit 1993 uate in Hampden 'rownsbip, Cumberla. d County, Pennsylvania and as more particularly described in Deed datEd February 18, 1993 and recorded in the Cumberland County Recorder of leeds Office in Deed Book hr;lI, Volume 36 page 657 from Ruth fl.. Cekovich to Ruth fl.. Cekovich and Richard J!. C~ovich, her son. Containing 9.00 acres am having thereon erecteo a frame dwe.1ing, bank barn and outbui1dinl;js. The property is assessed at $151,840.01 for tbe year 2002. 'rhe Cumberland County Common Level Hetio Factor if currently 1. 01. 1. 01 multiplied b: $151, 8t~0. 00 give sit a current market value of $153,358.40.~ $153,358.40 50% $ 76,679. 2. A.. 2/121 Certificate of Deposit No. 61L.086- 1993 8416 with Citizens Bank of Pennsyl- vania. 10,000.00 50% 5,000. 3. A.. 2/121 Certificate of Deposit No. 611,086- 1993 8408 witb CHiz8.ns Bank of Pennsyl . vania. 10,000.00 50% 5,000. ~E C4rf;:l"r;J ~.....A c.)<...L'41/f\:1--+l/J(j5~f~Y-~ c..li"'''''.:~T\.vc..sF'"yc._J",~ Cd<'tltl,d"\~o~ (.(JA.th. (111.0.."", ,s w.f. b;:') D>eJ, !m~ ?/J.>.!5-.r- F'G-. 7.'&14 II ~r<< J-rd. 1"- 8-!tf. for 2. - ,." " '-""-~. 1-, i/.//J (. e/~'J )( ,'t(.,..~~ '" J<~/IO' ..~S oJ. k, h"m tJ..< .j,,~ < {:. e"sc"";~cd "P~"("' ~I . TDTAL (Also enter on line 6, Recapitulation) $ (If more space Is needed, insert additional sheets of the same size) 86,679. """'".""''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY ESTATE OF FILE NUMBER 21-02-1143 2002-0111.t.1 l1\JTIl A. CEKOVIGH This schedule must be completed and filed if the answer to any of Questions 1 through 4 on the reverse side of the REV.1500 COVER SHEeT is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE HIE NAME OF THf 1 RANSFEREE. THEIRRELA1ION"IIIP IODEGEOE"T ANOiHE OATEOF TRANSFf.R D~;~ OF DEATH DECO'S EXCLUSION TAXABLE VALUe A!TilCl1Acopvrwr,IFflfEllfOllRFN EST^lE. VAL E OF ASSET INTEREST IF APPi.,CA!llEI NUMBER .. 1, Annuity Contract No. A2070},70 Hith Net Life Investors, throueh PNC Investments. $19,852.y;; 100j0 N/A 11> 19,852. TOTAL (Also enter on line 7, Recapitulation) $ 19,852. (if more space is needed, insert additional sheels of the same size) REV.1S11fX,p.971 "* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT RUTH A. GEKOVICll FilE NUMBER 21-02-1143 2002-01143 ESTATE OF Debts of decedent must be reported on Schedule I ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. J1yeJ's Funderal llome, 37 East Hain St., Hechanicsburg, PA 17055, i'uneral expenses. 1> 7,780.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Number(s) I EIN Number of Personal Fepresentative(s) Street Address City State Zip Year(s) Commission Paid; 2. Attorney Fees J. Robert Staui'fer, Attorney fee. 2,800.00 3. Family Exemption: (If decedent's address (s not the same as claimant's, attach explanation) Claimant N/A Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees Regis tel' of \'Iills of Cumberland County, pennsyl vani a, Letters 1'es tsmentary. 222.00 5. Accountant's Fees 6. Tax Return Preparer's Fees ~: Nephrology Associates of Contrel Pennsylvania. 62.00 Associated Cardiologists, medical cere. 10.48 Holy Spirit HospItal, belence for medicel charges. 18.92 10. Holy Spirit llospi tal, Tn-Patient care, balance due. 812.00 11. Quantum Imeging &: Therapeutic Assoc., balance due. 2.17 12. Associated Cardiologists, medical care. 8.70 13. Associated Cardiologists, medical cere. 52.46 ll~. Conner-R ioh Associates, medical services. 64.78 1'5. Cluantum Imaging &, 'I'herapeutic, medioal service. 44.01 16. Register of Hills, n.lin,'!; 1nventory and Pennsylvania Inheritance 'rax Heturn. 25.00 TOTAL (Also enter on line g, Recapitulation) $11,883.79 (If more space IS needed, Ins')rt addItIonal sheets of the same sIze) REV.1513 EX + (1.91) ESTATE OF NUMBER L '*' SCHEDULE J BENEFICIARIES FilE NUMBER 21-02-11Lf3 2002-01143 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Nolllst Trusl..(8' OF ESTATE Enitre Estate. Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R $\ NT DECEDENT nlJ'.rH A. CEKOVTCI! NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (Include outright spousal dislribullons) 1. RICHARD II. CEKOVTCH 1630 Lamb's Gap Road Mechanicsbur~. FA 17050 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTP,IBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space IS needed, Insert additional sheets of the same SIze) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280607 HARRISBURG, PA 77128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-96) N0. CD 002349 DUPLICATE STAUFFER J ROBERT ESQUIRE MARKET SQUARE= BUILDING MECHANICSBURG, PA 17055 --- fold ESTATE INFORMATION: ssrv: i 95-~ 6-4020 FILE NUMBER: 2102-1 143 DECEDENT NAME: CEKOVICH RUTH A DATE OF PAYMENT: 03/27/2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $4,699.15 TOTAL AMOUNT PAID: REMARKS: RICHARD H CEKOVICH C/O J ROBERT STAUFFER ESQ CHECK#1774 54,699.15 INITIALS: DO SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~, BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 RICHARD H CEKOVICH 1630 LAMBS GAP RD MECHANICSBURG PA 17050 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLOWANCE OR DISALLOWANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST A55ETS REV-1548 EX AFP (81-857 DATE 04-21-2003 ESTATE OF CEKOVICH RUTH A DATE OF DEATH 12-02-2002 FILE NUMBER 21 02-1143 COUNTY CUMBERLAND SSNiDC 195-16-4020 ACN 03106246 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-21-2003 ESTATE OF CEKOVICH FILE N0. 21 02-1:143 RUTH A DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND S.S/D.C. N0. 195-16-4020 ACN 03106246 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31000175241 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING ( ) TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 01-10-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 5,011.85 NOTE: X 0.500 2,505.93 .00 2,505.93 X .45 112.77 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 03-20-2003 CD002319 .00 112.77 TOTAL TAX CREDIT 112.77 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE 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. ) 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 money order payable to: REGISTER OF WILLS, 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 Office 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 for taxpayers with special hearing and ar speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest net satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including disccunt or interest) as shown an this Notice may object within sixty (607 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 --electing to have the matter determined at the 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: Past Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (7177 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident Decedent" (REV-15017 for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent CS%l 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 net 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 ycu would appeal the tax and interest that has been assessed as indicated an this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (97 months and one C1l 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 .OOD164. All taxes which became delinquent on or 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 ZD03 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% .OOD301 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 fellows: 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 (157 days beyond the date of the assessment. If payment is made after the interest computation data shown on the Notice, additional interest must ba calculated. BUREAU OF INDIVIDUAL TAXES ~, INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 RICHARD HI CEKOVICH 1630 LAMBS GAP RD MECHANICSBURG PA 17050 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEKENT ALLONANCE OR DISALLOWANCE OF DEDUCTION, AND AS5E5SMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 E% AFP X01-03) DATE 04-21-2003 ESTATE OF CEKOVICH RUTH A DATE OF DEATH 12-02-2002 FILE NUMBER 21 02-1143 COUNTY CUMBERLAND SSN/DC 195-16-4020 ACN 03106247 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-21-2003 ESTATE OF CEKOVICH RUTH A DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE N0. 21 02-1:143 S.S/D.C. N0. 195-16-4020 ACN 03106247 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 5140009982 TYPE OF ACCOUNT: ( ) SAVINGS CX) CHECKING ( ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 02-01-1968 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 18,105.78 NOTE: X 0.500 9,052.89 .00 9,052.89 X .45 407.38 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 03-20-2003 CD002317 .00 407.38 TOTAL TAX CREDIT 407.38 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE 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. ) 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 tc: REGISTER OF WILLS, AGENT. REFUND CCR): 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" CREV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service far forms ordering: 1-800-362-2050; services for 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 discount or interest) as shown on this Notice may object within sixty C60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Oept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the 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 (7177 787-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return for a Resident Decedent" CREV-15017 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 non-participation penalty is computed an 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) months and one (1) 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 or 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 Veer 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% .OD0356 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 C15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT ALLORANCE OR DISALLOWANCE OF DEDUCTION, AND A55ESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 E% ~FP [01-03) DATE 04-21-2003 ESTATE OF CEKOVICH RUTH A DATE OF DEATH 12-02-2002 FILE NUMBER 21 02-1143 COUNTY CUMBERLAND SSN/DC 195-16-4020 RICHARD H! CEKOVICH ACN 03106251 1630 LAMBS GAP RD Amount Remitted MECHANICSBURG PA 17050 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-21-2003 ESTATE OF CEKOVICH RUTH A DATE OF DEATH 12-02-2002 COUNTY CUMBERLAND FILE N0. 21 02-1143 S.S/D.C. N0. 195-16-4020 ACN 03106251 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT N0. 31500205180 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST C X1 TIME CERTIFICATE DATE ESTABLISHED 06-01-1999 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 4,004.25 NOTE X 0.500 2,002.13 _ .00 2,002.13 X .45 90.10 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 T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 03-20-2003 CD002318 .00 90.10 TOTAL TAX CREDIT 90.10 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE 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. ) 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 ar money order payable to: REGISTER OF WILLS, AGENT. REFUND CCR): 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-13137. Applications are available at the Office 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-SDO-362-2050; services for 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 discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Bcard of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the 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 (7171 787-6505. Sae page 5 of the booklet ^Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanaticn of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CS%l 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. 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 (9) months and one (1) 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 an ar after January 1, 1982 will hear interest at a rate which will vary from calendar year to calendar year with that rata announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Oaily 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 NUKBER 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 he calculated. COMMONWEALTH OF PENNSYLVP,NIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT STAUFFER J ROBERT ESQUIRE MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 REV-1162 EX(11-961 N0. CD 002568 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: SSN: t95-ts-4020 FILE NUMBER: 2102-1 143 DECEDENT NAME: CEKOVICH RUTH A DATE OF PAYMENT: 05/ 1 5/2003 POSTMARK DATE: 00/00/OOOO COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 101 ~ 510.00 TOTAL AMOUNT PAID: REMARKS: RICHAFiD H CEKOVICH C/O J ROBERT STAUFFER ESQUIRE SEAL CHECK#1777 INITIALS: SK RECEIVED BY: DONNA M. OTTO 510.00 DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX UIVISI~N DEPT. 280601 HARRISBURG, PA 17128-0601 J ROBERT STAUFFER ATTY MARKET SQUARE BLDG 1 W MAIN ST MECHANICSBURG PA 17055 DATE 05-05-2003 ESTATE OF CEKOVICH RUTH A DATE OF DEATH 12-02-2002 FILE NUMBER 21 02-1143 COUNTY CUMBERLAND ACN 101 Amount Remitted 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-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CEKOVICH RUTH A FILE N0. 21 02-1143 ACN 101 --------------------- OR DATE 05-05-2003 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) (1) 5,476.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 4,524.11 tax payment. 6. Jointly Owned Property (Schedule F) (6) 86,679.20 7. Transfers (Schedule G) (7) 19,852.35 8. Total Assets (g) 116,531.66 APPROVED DEDUCTIONS AND EXEMPTIONS: 11,883.79 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 11.883.79 12. Net Value of Tax Return (12) 104, 647.87 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts [Schedule J) (13) .00 14 Net Value of Estate Subject to Tax (14) 104,647.87 . NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate (15l •00 X 00 = .00 16. Anount of Line 14 taxable at Lineal/Class A rate (16) 104,647.87 X 045. 4,709.15 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Anount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 .00 Principal Tax Due 19 (1q)= 4,709.15 . Twv nnrnrT~. __ --_--- - - DATE NUMBER + INTEREST/PEN PAID (-l AMOUNT PAID 03-27-2003 CD002349 .00 4,699.15 PAYMENT MUST BE MADE BY 09-02-2003*. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP (01-037 TOTAL TAX CREDIT 4,699.15 BALANCE OF TAX DUE 10.00 INTEREST AND PEN. .00 TOTAL DUE 10.00 ~ 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.) ~ -~ c~ ~; 3 .... ~ ~. ?.a y~;; ~ _. RESERVATION: Estates of decedents dying on or before Decenber 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right tc 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 money 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 Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service far forms ordering: 1-800-362-2050; services for taxpayers with spacial 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 discount or interest) as shown on this Notice must object within sixty (60) 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' Ccurt. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (7171 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent^ (REV-1501) far an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) 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. 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 C97 months and one (1) 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 C6%7 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% .OD0164 1986 1D% .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 an the Notice, additional interest must be calculated. ~ j ~-~d 9- ~ COMMONWEALTH OF PENNSYLVANIA BUREAU DF 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) r~ a - ~ DATE 05-27-2003 =:: - ESTATE OF CEKOVICH RUTH A DATE OF DEATH 12-02-2002 FILE NUMBER 21 02-1143 '03 JU~d _6 ~lj •~$ COUNTY CUMBERLAND J ROBERT STAUFFER ATTY ACN 101 MARKET SQUARE BLD G Amount Remitted 1 W MAIN ST h•~=~~' MECHANICSBURG Pb~t~~~~5~ 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 fora with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP (01-03) *~* INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF CEKOVICH RUTH A FILE N0. 21 02-1143 ACN 101 DATE 05-27-2003 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: 05-05-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 4,709.15 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 03-27-2003 CD002349 .00 4,699.15 05-15-2003 CD002568 .00 10.00 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. ] 4,709.15 .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 an 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 far taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should ha 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 (3) 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 an 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 (1) 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% .D00247 2001 9% .000247 1985 13% .000356 1993-1994 7% .D00192 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 C157 days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. i~ ;,- ~ Name of Decedent: Date of Death: STATUS REPORT UNDER RULE 6.12 - • .l ~~ Dec~,~b--r 2, 2x02 Will No. 2'02--0~-1~;-3 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 x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete:_ 3. If the answer to No. 1 is Yes, state the following: a. 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 x No 1'erst~nal representat~i.ve is sole beneficiary of estate. d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of ttie Orphans' Court and may be ttached to this report. Date: I`~oy. 1'~, 2003 gnature J. Robert Stauffer Name (Please tyyppe or print) Itiarfzet Sr~uare F3Ic3?,. 3~lechanicsbur, PA 7.705 Address fi'r' 7 ) '~~~6-Q6.''3 Tel. No. Capacity: Personal Representative ~ Counsel for personal representative (MAH:rmf/AM3)