HomeMy WebLinkAbout01-0001
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ja~ J -;;L~/'d j,{. No. OL I - C I - C'lO I
( I, .-:-'L -
also known as "-.l /f-C~ /(0 e Vr_1 ~ To:
Register of ~lls for ;the J / .
. Deceased. County of (~/#1 MP!f./A:::ll5L- III the
Social Security No. /11-';:< P - 4-~ 7 Commonwealth or' Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the exycut 5~il' 4-
in the last will of the above decedent, dated I) tJ(J- u ~~ :3
and codicil(s) dated
--L .
I E...L.e uoeJ named
, 191-1-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C v fvl I €~)
h ; <) last family or principal residence at
,ft ~ /1'c),
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
ob
/L/G ;3.'--
$
$
$
$
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
~
en
'V'
g \; r ~/ '
~~ 1 0~A~E /ueQiuo
~,~ - ~/> II;tJ,/tJ-. /7tJ //
ce '';: 7-
~<!)
~o...
<!) '-
a 0
til
c
eo
(Ii
~j ~ 1l<; /;
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH Of P~NSYLVANIA l ss
COUNTY OF L (.J flJ $1ee /#rJd J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to 0, r affirmed an d.subscribed (- ~ ~ / C' ,g~ ~
before me this Q2L) z;~t day of J;i~.4 C:. /e-LpPc/o ~
,[J;,-{'-Vr:ni1fVt...J j!J)~ ~
YrXi ~ (~ X'O.l.u..o 'pA . {i. a &( L";CU_AJI? ~
, ~ Register ~
/ to . / 9 ~-- c;
No.
21-01-001
~
Estate of JOHN TELENCIO JR A/K/A JACK TELENCIO
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUARY 2nd ~2001 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
lT IS DECREED that the instrument(s) dated AUGUST 3, 1991
described therein be admitted to probate and filed of record as the last will of
JOHN TELENCIO JR. A/K/A JACK TELENCIO
and Letters TESTAMENTARY
are hereby granted to SARA E. TELENCIO
(7/fr:A_y/J. ,\(~ I -V'LJ.. tJlA (? /{ Jl/2ri--Jo1l-J\l --1'
, =cr;./DJ-LUj-.,.,
Register of Wills . '-iJ - I
FEES
Probate, Letters, Etc. .........
Short Certificates( 2) . . . . . . . . . .
~ EXTRA.PAGES.I+.
JCP
$ 25.00
$ 6.00
$ 12.00
$ 5.00
TOTAL _ $ 48.00
. .JANUaRX, .2nd.,. .200l.. . ...... .. .
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
Filed
PHONE
MAILED LETTERS AND ORDERS TO EXECUTRIX JANUARY 3, 2001.
21-01-001
RE STER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
,
the test at , sign the same and that' . signed as a witness at the
request of testat_ in h presence ~d (in the presence of each other) (in the presence of the
other subscribing witness( es)).
\\
,
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
"
'~
"..
(Address)
Register
(Name)
(Address)
REGISTltR OF WILLS OF !{pn~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
S/l-~ /I C/;;;J-, E A/drZ 0 A/fJ 0 /JJ /-J,.e y ;1-ttJaJ P //4/1
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
'+I. f'l art' familiar with the signature of J3hn T(: I en (2. i 0 :rt- .
codicil
testatcr of (one of the subscribing witnesses to) the will presented herewith and
codicil
that '1-1. e ,. believes the signature on the will is in the handwriting of
Tch() -tt: lene 1(") -:Jr.
to the best of -M e I r- _ knowledge and belief. ,.-;--
~/ ~ JL~~~
Sworn to or affirmed and subscribed before
me f-tlis ~(~ day of C' C;; _____ lJ:1ame)
~JL)yY) o2lfi(JO ~ / e ~u ~ 0
'-rnaA~ (1. (tu..(.~ pH. C.U. ..;/ jAddressY7;
Register /0 7P /fL-I0'-rh,;?-- C'lf
~~ &- //P/j
21-01-001
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar.' The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
.' II /1' II'N"",,, -''' ';;'.I...
\\11\111~~\.1\\ OF PEi;----."'-
l~~.. _'. .' :f"~"\
~~-".. . ~\.
l~ ~ - .c.'.-.- ~~
~Q ,",,-" -~
~ c,...), . -.f~-~ " /:b ~
>.*~._,.." "/*~
\~ -. - ~l
'\.~ - ~l
"':.~~~~ '/lI'MENT \\\ ~\:,IIII\\
""""""",##~,"111IJfll
~~~/--
Local Registrar
Fee for this certificate. $2.00
P 6764162
OCT 0 6 2000
Date
3 Ae~ 2181
COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT Of HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
AGE (last BlrthOay)
UNDER 1 YEAR
MOOlhs Daya
SEX
a. Male
STAlE FILE ~UMBEA
SOCIAL SECURITY NUMBER
4227
NAME OF DECeOENT \flfst MI(jdIe, LaSlo)
,.
John Telencio Jr
3. 171 - 28
UNOfR 1 DAY
tioufa Minul..
BIRTHPlACE (C,ry .u"4
Stale 01 fCl(n(}r'l Countf~l
PlACE OF DEATH ICreek Of'ly QNt u ->ee ,nslfucl.Ofl$ on Olhe, ':lIde)
HOSPITAL:
,_,_ 0 ERlOutpo..... rid" OOA 0
=".,10
63 Vra
COUNTY OF DEATH
Wilkes-Barre
DECEDENT'
S h,
E~lltary;Sec.oocMry
(0-12)
l tc:
EDUCATION
com led
CoIIogo
(1-401 5t-)
RACE . Amancan--..llla<k, _.....
15_)
.... CLlnberland
DECEOEKT'S USUAL OCCUPAlION
(Give kind '" work done auung roost
01 working lite; dO not use ".ed)
. 11.. Retired Major lib. U.S. Anny
DECEDENT'S .....lING ADDRESS ($11_. C"Vrro..n. SIaIe. :c",CO<le\ DECEDENT'S
ACTUAL
RESIDENCE
(See .nsrrucllOr'lS
on OCher Sldel
1..
White
SUAVlVlNG SPOUSE
~u W\ltI. g.vel"l\alden name)
,..
FRHER'S NAME (~irst. MlOdle. LaSl)
tl. John Telencio SR
INFORMANT'S NAME (T )'P8l'P'irlfl
l7b. Cou
No, ~h'ed
1111I. wiIhin K"lu.J1imd. of
MOTHER'S NAMe ifirsl. MIddt8. MalCUtOSurr'lamel
Elizabeth Graham
();d
*-
..in.
townahip1
14.
17c.O Yn,~nllivedirl
MARITAL STATUS._
Never Married. Widowed,
OMlocod lS_dy)
Married
13.
1678 High Street
Camp Hill, Pa 17011
17.. Slat.
Pi'!
lwp.
cily.b:lro
Re.noval from St.,. 0
2..~t Olivet Cemetery
NAME AHO AOORESS OF FACIUTY
011654-1.
2ac
a."New Olmber land, Pa
C903 ~lfet~~rr7011
UM
23b. 23c.
WAS CASE REFERRED TO MEDICAL EXAMINERlCQRONER?
.,..0
~
IMMEDIATE CAUSE (Final
dISease 01 condition
r8ll.AlnQ" 0eaJh) ~ ..
O/Y\
2e.
I APPfOllimal.
: in'.I'Y. betwNn
I 0...... and death
I
:
PART II:
Other signiflcen( cancMion& tlOC\Uibu\ing \0 death, but
not resuIIing in 1M undertying caI.U given in PAAT I.
Sequentially HI condition.
if any, tNding 10 immedial.
c;...." Enl.. UNDERl.YlNG
CAUSE(OtaeaseOfI~V c.
. INllOltiaIed evenJ$
18l!lJllaniQV\0MIh.l.A$T
W\S AN AUlOPSV
PERFORMEP?
O.
WERE AUTOPSV FlNOOIGS
AVAILABLE PRIOR 10
COMPLETION OF CAUSE
OF OEAIH?
MANNER OF DEA.TH
...."'..
S-
O
o
DATE OF INJURY
(Monlh. Day. 'fea,l
TIME OF INJURY
INJURV AT WORK?
DESCRIBE HOW INJURY OCCURRED.
Accldenl
penong Invesaiqation
o
o
o PLACE OF INJURY. AI home. larm, SI'Ht 'actlXY. office
building. -'c. ISpec11vl
300.
"'" 0 NoD
HomiQM
"",0
...iJ
V.. 0
NoD
Suicidtl
M. 3Oc.
o
34.
Could not btJ det.,mlned
2". 2.b.
corrWIER ICheck onIV ooel
.CEI\T'FVING 1ttt'f1iICIAN IPhYSlCl8n CetlltYlng caused death when anottlel' phvSIC.an has pi'onOlJnced dealh ana complele<) Ilem 231
To the bile' o. thy knowiedge. death occun.-d due to the uu..(.. and manne, .. .t.t.-d. . .
211.
.~~:=~~y~~;~:~~~':.':::~~~~~~.l=;. :~.~~~~~~~ =l~~nc;:~;~~~:t.)u.s::~~~:~,.. alilted.. 0
.MEDICAL EXAMINER/CORONER
~~~~::'::I:t::=.~~.i~~t.l~~ ...n.~~ ~~~~~'~~t.i~~: j.~ ,,!.Y. :~i.n.i~~: ~~~~~ ~~~~~e.~ ~~ ~~~ ~I~~, ~~t~: ~~~. ~I~~~: ~~~ .~~~ ~~ ~~~ ~~~~~~~).~~ 0
3,..
REGISTRAR'S SIGNATURE AND NUM8ER
~~~
_.~
1~/1;1y// I
33
21-01-001
WILL AND TESTAMENT
OF
JOHN TELENCIO, JR.
I, JOHN TELENCIO, JR., presently of 1678 High Street, Camp
Hill, III the County of Cumberla.nd and S-tate of Pennsylvania, being
of sound mind, memory and understanding, do make and publish this
my last will and testament, hereby revoking and making void all
former wills by me at any time heretofore made.
And first, I direct that my funeral be conducted in manner
corresponding with my estate and situation in life and that all my
just debts and funeral expenses be fully paid and satisfied as soon
as conveniently may be after my decease.
As to such estate as it hath pleased God to intrust me with,
I dispose of the same as follows, viz:
I. All estate, inheritance and other similar taxes assessed
because of my death, u~der State, Federal or Foreign Tax Law,
shall be paid from the residue of my Estate as an administration
expense.
II. I hereby grant and bequeath, all of my personal property,
both tangible and intangible, wheresoever situate, to my wife,
Sara E. Telencio.
Page 1
~
III.
I hereby grant and devise all of my real estate or any interest
that I may have in any real estate, wheresoever situate, to
my wife, Sara E. Telencio.
IV. In the event of the simultaneous deaths of my said wife and
myself, or in the event of common disaster,
or if my said
wife should predecease me, then in such event only, I make
the following provisions, to wit:
A. I expressly empower and authorize my Executor/Trustee
to liquidate all of my assets into cash, at either public or
private sale, whichever my said fiduciary shall deem to be
in the best interest of my estate, and after the payment
first of all taxes, costs, administration and indebtedness
of whatever nature, I hereby.direct
(1) I bequeath the sum of $2,500.00 to the Camp
Hill Presbyterian Church;
(2) I bequeath and direct that Great-Grandmother
Greisinger's blanket from my wife's family, shall remain
in the joint possession of my said children, John A. Telencio,
Sara E. Telencio and Mark E. Telencio;
(3) I direct that the sum of $300,000.00 shall be
first set aside and placed in trust for the benefit of my six
(6) grandchildren, to wit: John R. Telencio, Christopher A.
Page 2
----
~\
Telencio, Jon L. Telencio, Matthew S. Telencio, Marc E. Telencio
and Amanda B. Telencio; for the expressed purpose of assisting
them in obtaining a college education or the equivalent thereof.
I further-expressly appoint, authorize and direct my son, John
A. Telencio, presently of 388F DeLaura Drive, Newport News,
Virginia 23602, to serve as 'cheir.Trustee/Guardian, without
the necessity of posting bond and without the necessity of
prior court approval, and to invest the same in any prudent
investment, as long as it is in a Federally Insured Institution.
The said Trustee/Guardian is further directed
to set up six (6) accounts, setting aside the sum of $50,000.00
for each grandchild towards their college education. The
Trustee/Guardian is fully authorized and empowered to invade
the said trust, both principal and interest, to provide for
the health, welfare, maintenance and education of each
grandchild, until said funds may be exhausted, but expressly
conditioned upon their pursuing a college education or the
equivalent thereof, such as an accepted trade school or the
like.
The said Trustee/Guardian is further directed
and empowered to utilize the said funds for the benefit of
each grandchild, and as each grandchild attains 25 years of
Page 3
~
-_.
_._~-
-----",
age, whatever balance is then remaining,
shall be paid to
that grandchild and said trust ,shall terminate.
However, in the event that any of my said
grandchildren should not desire to pursue a college education
or the equivalent thereof, then the said Trustee/Guardian
is directed to withhold the payment of any monies until each
said grandchild attains 25 years of age, at which time, they
shall be entitled to receive their respective share and the
said trust shall terminate, at such time.
(4) I further direct, as to the residue of my estate,
real, personal or mixed, wheresoever situate, the balance is
bequeathed equally, share and share alike, to my three children,
John A.Telencio, Sara E. Telencio and Mark E. Telencio.
v. I further hereby nominate and appoint John J. Krafsig, Jr.,
.
'Esquire, to serve as the attorney for my estate.
And I hereby nominate! constitute and appoint my wife, SARA
E. TELENCIO, Executrix and if she predeceases me or is unable to serve,
I hereby nominate, constitute and appoint my son, JOHN A. TELENCIO,
Executor of my last will and testament, without the necessity of
posting bond.
Page 4
~
IN WITNESS WHEREOF, I, JOHN TELENCIO, JR., the Testator, have
to this my will, written on
seal, this
'g
"--
day of
-5- sheets of paper,
a9'~
( 1991~
set my hand and
A.D. One Thousand
Nine Hundred and Ninety-One
~(SEALI
Jr. ~
Signed, sealed, published and declared by the above named
Testator, as and for his last will and testament, in the presence
of us, who have hereunto subscribed our names at his request as witnesses
thereto, in the presence of the said Testator and of each other.
7Af~ ~{J79~
~c6a )1ljA~
Page 5
I
, ,.
t:
-
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Jo A J -;;LeJJ C /'0 JA.
I
vd-. 3,;Looe>
,
Date of Death:
Will No.
Admin. No. oPo ~ / - C)tJ CJC) /
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule S.6(a) of the Qrphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on at-. .s; ..:2<!'e'J J :
Name
Address
(SIt' tJ ~e) SMA-
t3:
.--:""" . ~
leLeJJc./i'
/6> 7 R lit 6- J' ~I-.
(O~ ft/~ J1J- . )70 ~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
4)~jl
I '
Signature
"".---
Name 1J1~ .4--. ~. d/~
Address /~ ltf 4~ tf)--
tLy#L/, h ./ /.0' .---/
Telephone elf 7) '7 ~ )- 9 Rf" C
Capacity: V- Personal Representative
_Counsel for personal representative
'\, / k- /9.;?-~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-26-2001
TELENCIO
10-03-2000
21 01-0001
CUMBERLAND
101
SARA TELENCIO
1678 HIGH ST
CAMP HILL
PA 1 011
REV-1547 EX AFP <12-DOl
JOHN
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=is4j-ix-AFP-fl"2=iioY-NC)fiCi-OF-YNHEiiiTANCE-TAX-jrp"PRAisEi'-ENT~--A[UiwANCE-OR----------- ------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TELENCIO JOHN FILE NO. 21 01-0001 ACN 101 DATE 03-26-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
el)
(2)
(3)
(4)
(S)
(6)
(7)
.00
1,421.00
.00
.00
.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
7,300.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
1,421.00
7.300.00
5,879.00-
.00
5,879.00-
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of Line 14 at Spousal rate US) .00 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= .00
.00
(11)
(2)
el3)
(14)
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1500EXi6.001
w
...,
~$(I')
0.""
w"O
rOO
0"'....
..'"
II.
..
REV-1500
OFFiCiAL USE ONLY
6
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
/0 - /9 f- _C___
FILE NUMBER
J. i - () L d () ~<L L
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
/7 -~-~~7
THIS RETURN MUST BE FILED IN DUPliCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER ~
o 3. Remainder Return {elate 01 deatl1 prirnto 12.-13.82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Eleclion 10 tax under Sec. 9113(A) (Attach Sch 0)
NAME
----;-1. e );Ook ; 0
OFFICIAL USE ONLY
(8)
/1-...2/ ,;-J
COMPLETE MAILING ADD~E9S - /J!
/ G 7f' ~ d"--/?
~ )/r'/l/ ;".f-
/ 70 //
(11) 7.3 ch1 . ,H)
(12) - ~1 6"7f.d'-V
(13) C)
(14) d
x.O_ (15) ?J
x.O_ (16) ?J
x .12 (17) g
x .15 (18) 0
(19) '='
I-
Z
W
C
W
(,)
W
C
~ NAME (LAST, FIRST, AND MIDDLE INITIAL)
eLevc/1:> tJ
D TE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
()CJ- j 02th30 /lJ. /93
(IF APPLICABLE) SU VING SPOUSE'S NAME (LAST, FIRST, ANO MI
~e.dC;o ~ Z;
~-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 of death afl:er 12-12-82)
o 7. Decedenl Maintained a Living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (date of death OOMeel\ 12-31..91 aml 1.1-'>/5)
...,
z
w
C
z
o
II.
'"
W
'"
'"
o
o
FIRM NAME (If Applicable)
TELEPHONE NUMBER 1 ( 7 - 73 7 - pge,
(1)
(2)
(3)
14)
(5)
6
/ if- d--I
o
o
o
Ii)
z
o
~
;:)
l-
ii:
<
(,)
W
c::
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schellul. E)
6. Jointfy 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)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
16}
(7)
o
(9)
73cH.~
C)
(10)
14. Net Value Subject to Tax (Line 12 minus Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
!;(
I-'
;:)
0..
:i
o
(,)
~
15. Amount of Une 14 taxable at the spousal lax
rate, or transfers under Sec. 9116 (a)(1.2)
8
o
(15'
(I)
16. Amount of Une 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14laxable at collateral rate
19. Tax Due
20.0
CHECK HERE iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREETADDRESS;,~
CI1Y
STATE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
rt)
o
(')
Total Credits ( A + B + C ) (2)
3.
interesUPenalty if applicabie
D. Interest
E. Penalty
b
{iJ
4.
TotallnleresUPenaity ( D + 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
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.
8. Enter the totai of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
(1)
(
ZIP
d
C)
(3)
(4)
(5)
(5A)
a
o
()
(l
o
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
~
~
Q-"
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; .... ..................... ...................
b. retain the right to designate who shall use the property transferred or its income; '" ...............................
c. retain a reversionary interest; or.. .......".................."... ................
d. receive the promise for life of either payments, benefits or care? ........."....m..m.....................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................... ........................ ......................
3. Dkl decedent own an Qin trust for" or payable upon death bank account or security at his or her death? .........
4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which
contains a beneficiary designation? ..... ............""n...... ................................ ......................
Yes
o
o
o
o
....0
o
o g--
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
jLr
Id-
ING RETURN
Ullder pellalties of pe~ury. I declare that I have examilled this retum, illcludillg accompanying schedules B11d slatemellts, 81ld 10 the best of my knowledge alld belief, it is true,
correct and complete
Declaration of preparer othertl1an t/'te personal represenlati\le is based on al\ illforrnation 01 which preparer has any kllowledge
DATE
ADDRESS
RSON RESPONSle
-Lv
/&7F
SIGNATURE OF PREPARER OTHE
/ ~ //
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1) 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the lax rate imposed on Ihe net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116(a) (1.1) (Ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to ortor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers \0 or for the use of the decedent's siblings Is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV"""';"097I-.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF) I ____ 0 .
,0/1;J /eLeJJc,v
SCHEDULE B
STOCKS & BONDS
JL
AH property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
j}--?ne,t?.i(>A-/) (.()~R-
rn~+- L, Pr.?J
LL~~k s
FilE NUMBER
;;2/ g)/M..PS
(0 7 sid Mcl
VALUE AT DATE
OF DEATH
+ff"3M
Cf J? ~
TOTAL (Also enteron line 2, Recapitulation) $
(If more space is needed, Insert additional sheets at the same size)
PI.). / II tJ
REV.':'''X:I'.''_.
COMMONWEALTH OF PENNSYLVANIA
INHERlTANCE TAX RETURN
RESIDENT CEDENT
ESTATE OF r IJ ~/ / -
....J'? 11 e L- e,.) C / <J
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
J;z.
FilE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES: ~/Je~ ~ 73d-(! . k)
1. ;r;retlf~€1C--
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Sodal Secunty Numbens) I EIN Number a! PelllOnal Represenlalive(s)
Street Address
City Slate Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 73H.;-d
(If more space is needed, insert additional sheets of the same size)
,..:.
....1
(:1
'HI.
';..1
..j..
,',1
.::,
1:.:1
.:..1
-.
::::-.:
'"
~
""''''
~~
,t f~
~.
UV .
~
~
~'
--
==~
_oh
_."
-..
-......
_..
"-"
-'.'
___ ;~-,4
-.,.
_... \,...
l~~
l
, i
_ c:::
(J>
~
e
,~~r
~,~~.r
~Q~"
, '
~
"-.
~
..........
\
'-....
11M" \\\
~. . .
! ,', ..r
,
...
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
~
Date: 9/04/2002
SARA E TELENCIO
1678 HIGH STREET
CAMP HILL, PA 17011
RE: Estate of TELENCIO JOHN JR
File Number: 2001-00001
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 10/03/2002
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~7tl t5t4-1,d~~
MARY C. LEWIS ~~.
REGISTER OF WILLS
cc: File
Counsel
Judge
.
Ui/
STATUS REPORT UNDER RULE 6.12
Will No.
Jt!fhAf k!EIIJc;a ~~ .
(!)zJ. 3" c:? 0 (!) 0 d.J.u .#=-
Admin. No. c:< O(J / .-{){f)(!)6 1
Name of Decedent:
Date of Death:
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 L/ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No ~ .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes \~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
r /c./o~
I
./L~.J c": Z)~L~~~)
Signature
~fi- G-, ;;Le~6/d
Name (Please type or print)
~7tf" 40:-,( d: {~~ #/[ d. / ?CJ/I'
Address /'
(7r 7) 7..3 7 - 9' rt'" ;:,
Tel. No.
Capacity:
~personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)