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HomeMy WebLinkAbout01-0248 Social Security No. PETITION FOR PROBATE & GRANT OF LETTERS No. 21-01-.:L. 't ~ To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania Estate of MYCHAILO KOMESZ also known as , deceased. 176-26-0678 The Petition of the undersigned respectfully represents that: Your Petitioners, who are 18 years of age or older and the Executors named in the Last Will of the above decedent dated October 18 . 1994, and codicils dated none, 19----2. The Executor named Maria Komesz died November 24. 1999. Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at One Chestnut Street. Mt. Holly Sprinas Borouah Decedent, then ~ years of age, died January 24 ,2001, at Carlisle Hospital 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 i ncom petent: Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: One Chestnut Street. Mt. Holly Sprinos Borouoh, Cumberland County $138,000.00 $ $ $89,000.00 WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of letters testamentary thereon. ~ature(s) and Residence(s) of etitione~s): Om ro 1408 r Road ReadinQ. PA 19611 610-372-4806 /j1~7~~ ;O/~ 7<"~ Mvchael Komesz a/kJa Mvchael Komesz Jr. 3315 Biolerville Road Biolerville, PA 17307 OATH OF PERSONAL REPRESENT A TIVE COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND 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 representative of the above decedent, petitioner(s) will well and truly administer the estate according 0 law. Sworn to or affirmed !;['d subscribed ~ lJ"-. b.ef~re me thi~ ~ . day of Dm ro Ko e z t.n~ljdUJ . 2001. ~ <rt;Q;y~ JG<,';'" ctli... t?O.~,dUJ ~. . / Registef ~ r /(;, _ ~ I)": .L No. 21-01- 248 Estate of Mychailo Komesz , deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, March 6, , 2001, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 18, 1994 described therein be admitted to probate and filed of record as the Last Will of Mvchailo Komesz ; and Letters Testame~ are hereby granted to Dmvtro Komesz and Mvchael Komesz a/kJa Mvchael Komesz Jr. 'TY}O,;/': ,;(;nd. ~. ~a ~~'9 J4-J/4- Re ister of Wills IRWIN McKNIGHT & HUGHES FEES Probate, Letters, Etc. . . . . . . . $ 270.00 Short Certificates(-3- ) . . . . $ 9.00 Renunciation(s) ..... . . . . . . $ JCP . . . . . . . . . . . . . . . . . . . . $ 5.00 Other Will Paqes (-3-) .... $ 9.00 TOTAL: .... $ 293.00 Filed. .MAE-ClI. P". .2.QQ~............ James D. HUQhes, Esquire (58884) ATTORNEY (Sup. Ct. I.D. No.) 60 West Pomfret St., Carlisle. PA 17013 ADDRESS 717 -249-2353 PHONE CALLED ATTORNEY MARCH 7, 2001 'lw is to certify that the information here given is correctly copied from an original certitlcate of death duly filed with me as IX;I] Registrar.' The original certificate will betorwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~~:a~~~~ Fee f(H this certifIcate, $2.00 p 6948076 JAN 2 6 2001 Dale 05. ~ 4J R"" 2187 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH AGE ILa.. 8"""'.y) 88 UNDER 1 YEAR Montna Days SEX 2. Mate. STATE FILE NUMBER SOCIAL SECURITV NUMBER 3.176 -26 OAT E OF DEATH ,M"""'. D.~.""''' a. 1/24/2001 NAME OF DECEDENT jF<", M_o. C....I 1. Myc.n.a.<.to KomeJ.>z v". UNDER 1 DAY _ ! Minut... 81RTHPLACt IC..., and R Os;;,a."h~lf Ceu>hVI ::".,.,0 " ' -<.\ $. COUNTV OF OEJITH Cumbvrtand PlACE OF oe,qH fC~k oNy f)f"Ie ~- iee ,nstrUC;11()OS on ott"et ,..,.) HOSPITAL: Inpolienl ~ E~i.... 0 7. ... FACIUTV NAME 111 nol """,'''''''''. QMl..... and numb." Cakt.<.J.>te HOJ.>p.<.tat RACE - Amencan Indi.". 8lat;k, 'Nh~.. etc. 1Sl>ec*t' Wh..i.te lit. Ie. 10. DECEDENT'S USUAL OCCUPATION KIND Of' BUSINESS/lNDUSTRY ((;;j':",,~ Mf':!'~ ':: ::~:'f . IlL LabMVr 1111. Manu 6 ac.tuk..i.ng DECEDENT'S MAILING ADDRESS (SIrNl. CIlyIlOwn. _. Z'f) COde) DECEDENT'S 1 CheJ.>tnut St. ~~~~NCE Mt. Hotty Spk..i.ngJ.>, PA 17065 ~;~ WAS DECEDENT EVER IN U.S. ARMED FORCES? .....0 No~ 17b.Cou CumbC'Jrland [);d -- Mini -..ship? l1d.!]' :;"'~:'::o' MOTHER'S NAME (F"I. ModdIe. M_ Surn.tme, 11. MaIt.<.a Ha.<.d k. INFORMANT'S MAIlING ADDRESS ISh.... Cilyfl'own. Slala. Lop c.-, ~,1 CheJ.>nut St. Mt. Hotty Spk..i.n J.>, PA 17065 PlACE Of' DISPOSITION. Name Of C_ery, Cr.matooy lOCATION. CilyITown, Slat., Lip Cocle Of 01"., Place la. l1e.0 Vaa.__in MARITAL STATUS._ Ne_ Married. WicIowed. w.ldo~e.r SURvIVING SPOuSE (If ..... 9'Y8 ma.oen name) rwp Cllyll>om. RamonI_ StoIa 0 21e.St. FJraYlc..<.J.> Xav..i.ek 17325 -6 PA 1706 LICENSE NUMBER 2211.071589L ~Ol 24. , M. 27. PART I; Enter tNt diMases, infUrieS 01 comphUihons which caused lhe dealh. 00 not enter 1M mode of t1ying, sue" as cardiac 01 ,espn-alory .".st. shod&: or heal1 fa.....'. List onPf one cause on ..en fine PART II: 01"., signille.... _ con<riI>uling to doOlh, bul nol resu"in9 in Iha UfIdattying ...... given in PART I l ~t',-\~~ ~ i h.- DUE TO (OR AS A CONSEOUENCE OF): ~\\:)~l:.~ v...Jt ~~~~q \ : DUE TO (OR AS A CONSEOUENCE OF): DUE TO (OR AS A CONSEOUE NCE OF): WERE AUTOPSY FINDINGS MANNER OF DEATH -'l.AIIU PRIQA TO COMPlETION OF CAUSE ~ 0 OF OEnH? _urlll Homcide _nt POndlnq I"""Sliglllion 0 No '9:: v... 0 No 0 Suicida 0 Could not be dele""lned 0 DATE Of' INJURY (Month. Day. ~ar) TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Vaa 0 NoD 288. 211I. CERTIFIER IC"eck oniy onel -CERTIFYING PHVStClAN IF*I~aan CP.t1~ cause d dealh 'Nher" anotf'\er phVSIC.an has pronounce<' oealh ana completed Item 23\ To the t>>at O. my II:nGwledoe. death accurn<l due to 1Pl. cause(.) and manner a. st..ted. . . . . . . . . . . . . . .. ............... at. 308. 30ll. PLACE OF INJURY. AI home. larm, str.... 'actory, orne. buildln9. "c. lSpec.tv) 300. t:\. ~~~~ ~~I~\lal 03111. . PRONOUNCING AND CERTIFYING PHYSICIAN (PhVSCl.3n 00tt'. ~::>nOunc::,ng death and cerlllYlng 10 cause of deattl\ To the b+I1 ot my knowl.dOl'!, d.alh occurred at the ,tine, date, .and pl.ce, and due to the UUH(S) and manner u staled 'MEDICAl EXAMINER/CORONER On the basil of 1.lminlUon and/or investigation, in my opinion. death occurred at the lime, date, and place. and due to the CIUSe(l) and manne' .s stated.. . . . . . . _ . .. . _ . . . . . . . . . , . , . , . . . . . . , . , , . . , . . . . . , . , . . . . . . , . . . . . . . . . . . . . . . , . . . , . . . . . . . . . . . , . . . . . . . . , 310. REGISTRAR'S SIGNATURE AN o all ft 3.. ~~ aOO\ , 21-01-248 LAST WILL AND TESTAMENT I, MYCHAILO KOMESZ, of 1 Chestnut Street, Mt. Holly Springs, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this will, shall be paid by the Executor or Executrix of my estate. TWO. My Executor or Executrix may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and Ji. j{', empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. THREE. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, Maria Komesz. FOUR. If my spouse, Maria Komesz, does not survive me by a period of at least sixty (60) days, then my estate of whatever nature and wherever situate I give, devise and bequeath as follows: a) $15,000.00 to my granddaughter, Natalie Patricia Komesz; and b) All the rest, remainder and residue thereof to my two sons, Mychael Komesz, Jr. and Dmytro Komesz, share and share alike, and if either of them is deceased, their share shall go to my granddaughter, Natalie Patricia Komesz; and c) Notwithstanding the provisions of subparagraph 4(b) above, either Mychael Komesz or Dmytro Komesz, as they shall agree, shall have a right of first refusal upon my death to purchase the aforementioned residence at 1 Chestnut Street, Mount Holly Springs, Pennsylvania, for a purchase price which shall be calculated using the fair market value of the property at the time of my death or using such other amount as they shall both agree in writing. The fair market value shall be determined by a certified appraisal of the property as of the date of my death. In the event that neither of my sons are desirous of exercising this right of first refusal to so purchase, then the property shall be sold and the proceeds therefrom distributed in accordance with this my Last Will and Testament. FIVE. I nominate and appoint my spouse, Maria Komesz, to be the Executrix of this my Last Will and Testament. If my spouse has predeceased me, failed to qualify or is not able or 2 cJi. )C does not serve for whatever reason, then I appoint Mychael Komesz, Jr. and Dmytro Komesz to serve as Co-Executors of my estate having the same powers as the original Executrix hereunder. SIX. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. SEVEN. No Executrix or Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of October, 1994. 1YUj ~ !(fJ /j1'LI/l V(SEAL) MYCHAILO KOMESZ Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 0Ya4hcd'!~~ e~7~~ d~ 3 , , ACKNOWLEDGMENT AND AFFIDA VIT WE, MYCHAILO KOMESZ, SHARON L. SCHWALM and CHERYL L. CLELAND, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. 2i!t ~ j( O./J11M-z-.-- MYCHAILO KOMESZ I!M,U/)-L d'?y~ " SHARONL;SCHWALM e~~.1&6I COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by MYCHAILO KOMESZ, the testator herein, and subscribed and sworn to before me by SHARON L. SCHW ALM and CHERYL L. CLELAND, witnesses, this 18TH day of October, 1994. 13kf ~}(h~lJ Nota Public Notarial Seal Betzi A Mooison. Notary PurJic Carlisle Bore, Cumberland County My Commission Expires Dec. 15. 1596 Member, Pennsylvania Assooiation of Notaries E CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MYCHAILO KOMESZ Date of Death: JANAUARY 24, 2001 Estate No.: 21-01-0248 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on March 22, 2001 Name Address Dmytro Komesz Mychael Komesz Natalie P. Komesz 1408 F arr Road, Reading, P A 19611 3315 Biglerville Road, Biglerville, P A 17307 1212 Village Crossing Drive. Chapel Hill. NC 27514 Date: 03/22/01 Notice has now been given to all persons entitled thereto unde Carlisle. P A 17013 Telephone (717) 249-2353 Capacity: Personal Representative x Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l j 55: Mychael Komesz, Jr. and Dmytro Komesz according to law. deposes and says that they are the Co-Executors of the Estate of Mychailo Komesz late of _ Mt_~_J!~~!:Y_~J~_Fj-_n.~s__B_orou~!:_______ I Cumberland County, Pa., deceased and that the within is an inventory made by Mychael Komesz, Jr. & Dm~tro Komesz _, the said Co-Executors of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. being duly sworn Sworn and subscribed before me, Mychael Kanesz, Co-Executor 3315 Biglerville Road Biglerville, PA 17307 1408 Farr Road Reading, PA 19611 Address Notarial Seal Jacque.line L. Drawbaugh, Notary Public Carlisle .B~ro, Cumberland COunty My CommissIon Expires Aug. 14,2003 DeatlMemhpr Pennsyl',ania ^33ocial'o IN t " IIIV oanes Day 01 2001 Date of Month Year INSTRUCTIONS I. An inventory must be filed within 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. ...c: :3 0 H 0 j:C:l >- -0 OJ (/) (/) CP .... W N bO tit H ~ >- c::: .... (/) ,:: 10 'r-! ~ 00 w < Cll :3 0 ...q o! 0.. I-- ~ -r-! u ~ 0 ~ H Cll CP N 0 V') 0 p.. C 0\ ~ 0 w c::: w J: ~ (/) IU I t- o.. ~ 0 M I-- -I u.. 10 0 Z -I 00( 0 0 :>-. 0.. H u.. H .....-i I W 0 00( W H .....-i .;.. ~ M 11 > z c::: ~ 0 0 N .... H Z 0 ~ c C U :::s Z 0 V') Z H . 0 ~ c::: 00( ~ +J U ~ CJ z I w ~ Q. ~ -0 ~ c .. 10 (/) z II - "'i: 0 <ll H Cll !::l ~ ..Q Cll E -0 ~ Ctl - ..! 0 ....., H 10 :::s 0 ....I U u: CCl Inventory of the real and personal estate of MYCHAILO KOMESZ deceased 1. One Chestnut Street, Mt. Holly Springs Borough, Cumberland County, PA. . 110,000 00 2. Adams County National Bank - Savings Account . . . . 7,487 18 3. Adams County National Bank - Checking Account. . . . . 5,435 97 4. Adams County National Bank - Certificate . . . . 8,505 62 5. Adams County National Bank - Certificate . . . . . . . . il 9,948 24 Ii I, 6. Adams County National Bank - Certificate . . . . 20,868 88 7 . Adams County National Bank - Certificate 15,230 70 8. Adams County National Bank - Certificate . . . . . . . . 10,477 34 9. Adams County National Bank - Certificate . . 7,376 04 10. Adams County National Bank - Certificate . . . . . . 5,281 17 11. PNC Bank, N.A. - Certificate . . . 8,069 52 12. PNC Bank, N.A. - Certificate . . . . . . . . . 35,950 41 13. PNC Bank, N.A. - Checking. . . . . . . . . 566 33 14. Personal Property Sold . . . . . . . 17,686 00 TOTAL . . . . . . . . . . . . . . . . . 262,88J 40 \' / 6"-(~ /6--.:l 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 JAMES D HUGHES ESQ IRWIN ETAL 60 W POMFRET ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-27-2001 KOMESZ 01-24-2001 21 01-0248 CUMBERLAND 101 * REV-l!;47 EX AFP (12-00> MVCHAILO 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 ~ ifE-Y-=is4j-EX--AFP--ci'2=ol.-r-NO'TicE--OF-'rNHEifiTANCE-'TAX-APPRAisEMEN:r,--ALi-oWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KOMESZ MVCHAILO FILE NO. 21 01-0248 ACN 101 DATE 08-27-2001 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) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) 110.000.00 .00 .00 .00 152.883.40 .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) 19,313.59 3.294.50 Ul) (2) (3) (4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 262,883.40 ??608 09 240,275.31 .00 240,275.31 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (5) .00 X 00 = .00 (6) 240,275.31 X 045 = 10,812.39 un .00 X 12 = .00 (8) .00 X 15 = .00 (9)= 10,812.39 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-23-2001 AA478300 513.16 9,750.00 07-17-2001 CDOOO058 .00 549.23 TOTAL TAX CREDIT 10,812.39 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 THI~ FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE p' 'qEAU OF INDIVIDUAL TAXES ..... DEPT~ 280601 HARRISBURG, PA 17128-0601 REV-1162 EX! 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HUGHES JAMES D 60 WEST POMFRET STREET CARLISLE, PA 17013 ______u fold ESTATE INFORMATION: SSN: 176-26-0678 FILE NUMBER: 21-2001- 0248 DECEDENT NAME: KOMESZ MYCHAILO DATE OF PAYMENT: 07/17/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/24/2001 NO. CD 000058 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $549.23 I I I I I I I I TOTAL AMOUNT PAID: $ 549.23 REMARKS: JAMES D.HUGHES, ESQ. CHECK# 17656 SEAL INITIALS: VZ RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS ~ r (~,.-;V ~..c JAr Ii L' S , - , ,ft'7 \) \ ~1) CI r v 'V I r' 7 - /~E(e1 pr KWU)([S C DC D1;[;15 c STATUS REPORT UNDER RULE 6.12 Name of Decedent: MYCHAILO KOMESZ Date of Death: November 1. 2001 No. 21-01-0248 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 _ No 2. If the an,swer 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 -X-. 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? ---X...--. Yes No Date: d. Copies of receipts, releases, joinders and accounts may be filed with the rk of attached to this report. ,/ // / l 11/28/01 ~.'.'.." .~~:;c , I........ vals of formal or informal rphan's Court and may be ~;-. I'"" ...~",P o ';'f , McKNIGHT & HUGHES r '....,,,' 0- 0\ N :::::> o Z .;~ . :5 ;,...0 "~ s:: 4)= aU James D. Hughes. Esquire Name (please type or print) 60 West Pomfret Street Address Carlisle. P A 17013 City, State, lip (717) 249-2353 Telephone Number <~.'\ 't i > ,:~~" 5 &:. <.)t.1) <DO: ex: p Capacity: x Personal Representative Counsel for Personal Representative ~ ~ - ~., ,,--" ~ .......... --.--- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT '* No.AA 4 7 8 300 REV-1162 EX (11-96) RECEIVED FROM: I ACN ASSESSMENT CONTROL NUMBER AMOUNT '"U(:;ilE:; ) (-lIvrE::;; D 1 r,l 1 'b:';' t 7(')0 . 00 ()(i IdEE, T ('C'!"lF f::F T ;3 -f F'EC'; :~_' ~', ~-, ~_ I r:_~: l.~ J=.. r~-' i~ 1. ~}' (j .i, :J FOLD HERE FOLD HERE - ESTATE INFORMATION: FILE NUMBER ,~-) 1 ~. ~..IC:.I,} \ (~,,~) t.f. ~:-; .'?r'; NAME OF DECEDENT (LAST) ,,"', 'J: DATE OF PAYMENT (FIRST) (MI) ~ / "} .:_~/ ',( "; POSTMARK DATE ,_ I ... l -H, -~ "~"; '.-'j (" r) COUNTY TOTAL AMOUNT PAID ':tl ,750.00 DATE OF DEATH V7' ,- ~- ,.....l " :~j .,,). ,. REMARKS .J I fY\ D i"~UGHF:.; [~;CHJ r HE:" RECEIVED BY f"lAF~Y C. L.EW I El SEAL C, ;~,.r~ ;~ l ' ....'t ~CGrSrE? OF W:~LS REGISTER OF WillS -"'- C OFFICIAL USE ONLY REV-1500 EX +-{6-00) REV-1500 ilo ;l/5 -L - INHERITANCE TAX RETURN FILE NUMBER COMMONWEALTH OF PENNSYLVANIA 21-01-0248 DEPARTMENT OF REVENUe: RESIDENT DECEDENT DEPT. 280601 COUNTY CODE HARRIS8URG,PA 171l8-0601 YEAR HUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 0 Komesz Mvchailo 176-26-0678 E C DATE OF DEATH (MM-DD- YEAR) DATEOF BIRTH (MM~DD-YEA.R) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE E 0 01/24/2001 08/23/1912 REGISTER OF WILLS E N (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. HAST. AND MIDDLE INITlAl) SOCIAL SECURITY NUMBER T .is 1. Origin;;!l Return _ 2. S,pploment,' Re"," B 3. . 1 lEa~ 01 death Remamder Return prior to 12- 13-82) APB X 4. limited Estate _ 4a. Future Interest Compromise (date of death after 12~ 12-82.) 5. Federal Estate Tax Return Required HpRL Decedent Maintained. a Living Trust ~ EplO 6. Decedent Died Testate _ 7. 8. Total Number of Safe Deposit Boxes ...;.: CRAC (Attach copy of Will) (Attach copy of Trust) KOTK 0 9. 010. 0 11. Election to tax under Sec. 9113(A) ES Litigation Proceeds Received Spousal Poverty Credit (date of death between 12-31 ~91 and 1-1~95) (AttaCh Sch 0) THI$$ECT@(:M\.I$'l'!le:C:<>MI>tml'l;:Ajl.:C:QBBE;S/ION"!;NC$l!.~I'IPeNT'At'l'AX:!NI'QAM"'I'Il:i!,!$fI<)\!I.l)Ill;l)IBl;q(El):'l'(l; P NAME COMPLETE MAILING ADDRESS C 0 0 James D. Hughes Esq. 60 West Pomfret Street R N FlAM NAME (If Applicable) West Pomfret Professional Bldg. R 0 E E IRWIN McKNIGHT & HUGHES Carlisle, PA 17013 S N T TELEPHONE NUMBER 717I?NI-2353 1. Real Estate (Schedule A) (1) 110,000.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) Niine. 3. Closely Held Corporation, Partnership or (3) None Safe-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) None R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 152,883.40 ~.". E (Schedule E) C A 6. Jointly Owned Property (Schedule F) (6) None P I 0 Separate Billing Requested T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None U L (Schedule G or Ll .. A T 8. Total Gross Assets (total Lines 1-7) (8) 262,883.40 I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 19,313.59 0 N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 3,294.50 11. Tolal Deductions (total Lines 9 & 10) (11) 22.608.09 12. Net Value of Estate (Line 8 minus Line 11) (12) 240,275.31 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 240,275.31 C SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0 M T P 15. Amount of Line 14 taxable at the spousal tax U A T rate, or transfers under Sec. 9116(aX1.2) X .0 0 (15) 0.00 X A 16. Amount of Line 14 taxable at lineal rate 240,275.31 45 (16) 10,812.39 T X .0 I 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 0 N 18. Amount of Une 14 taxable at collateral rate X .15 (18) 0.00 19. Tax Due (19) 10,812.39 20. n hc::l'iI;c::K:HE;l!I;:II':YIi!IiIA!lI;::l!lEIliQl!$t'Nlil:AREl'\lil~~~nli!\ll;!!I!A't''''~Tnl > > BE SURE TO ANSWER All. QUESTIONS ON REVERS!; SIDE AND TO RECHECK MATH < < COPYfight (c) 2000 form software only The Lackner Group, Inc. FormREV-1500 EX (Rev. 6~OO) Decedent's Complete Address: STREET ADDRESS One Chestnut Street CITY I STATE I ZIP Mount Ho11v Springs PA 17065 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Paymenrs A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 10,812.39 0.00 9,750.00 513 .16 Total Cred"s ( A + B + C) (2) 10,263.16 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E) (3) 4. If line 2 is greater than Line 1 of line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 10 requesl a refund (4) 5. If Une 1 ... Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) . Make Check Payable 10: REGISTER OF WILLS, AGENT ..pLEASffANSWERTHEFOLLOWiNG(m~~~;:ONSBYPLACJNGAN "X,,~~iiif~~~~~~8~~il~fi~ii~t~~i~f~i. 1. 0.00 0.00 549.23 0.00 549.23 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? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an ~in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~~ o o o []J []J []J Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the petsonal representatlve is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN t!, 5 NTATIVE Dmytro Komesz 1408 Farr Road - - R~adin - -,- -PA- - - i 96-1i - - - - - - - - - - - - - - - - - - - - - - - - - - -- IRWIN McKNIGHT & HUGHES 60 West Pomfret Street -- Car'i'i~i"": - P/;- -i'i6h----- -- - - - -- - ---- - --- 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 spouse is 3% [72 P.S. 9116 (a)( 1. 1) W]. es of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% .S. 9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stiff applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0'% [72 P.S. 9116 (a) (1.2)]. 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. 9116(1.2) [72 Ps. 9116IaXll). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. Copyright (cl 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) ADDITIONAL Personal Representatives Estate of Mychailo Komesz SS# 176-26-0678 01/24/2001 **************************************************** Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature ~/("~ Name Address Line 1 Address Line 2 City, State, Zip Mychael Komesz 3315 Biglerville Rd Date Biglerville, PA 17307 4" . '2 ,., . 2.d d / REV-l502. Ej( to-97) COMMONWEALTH OF PENNSYLVANIA INHERIT ANeE T M RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mychailo Komesz SS# 176-26-0678 01/24/2001 21-01-0248 AU real property owned solely or as a tenant in common must be reported at fair market value. Fair market 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 iOintly-owned with riaht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH lOne Chestnut Street, Mt. Holly Springs Borough, Gumb. Co. - 110,000.00 settlement sheet attached SCHEDULE A REAL ESTATE TOTAL (Also ontor on lino 1, Rocap."I..;on) SlID, 000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-tS02 EX (Rev. 1~97) REV-1508EX + (1-971 COMMONWEALTH OF PENNSYLVANIA INHERIT ANCe. Tf(X RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Mychai10 Komesz SS# 176-26-0678 01/24/2001 21-01-0248 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Adams County National Bank, savings account 7,487.18 2 Adams County National Bank, checking account 5,435.97 3 Adams County National Bank, certificate 8,505.62 4 Adams County National Bank, certificate 9,948.24 5 Adams County National Bank, certificate 20,868.88 6 Adams County National Bank, certificate 15,230.70 7 Adams County National Bank, certificate 10,477.34 8 Adams County National Bank, certificate 7,376.04 9 Adams County National Bank, certificate 5,281.17 10 PNC Bank NA, certificate 8,069.52 11 PNC Bank NA, certificate 35,950.41 12 PNC Bank NA, checking 566.33 13 Personal property sold 17,686.00 TOTAL (Also enter on line 5. Recapitulation) S 152,883.40 (If more space is needed, insert additional sheets of the same size) Copyright (el 1996 form software only CPSystems,lne. Form REV-1508 EX (Rev. t-97) REV-'S'" E~ ~('4'97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mychailo Komesz SSiI 176-26-0678 01/24/2001 FILE NUMBER 21-01-0248 Debts of decedent must be reported on Schedule I- ITEM NUMBER A. FUNERAL EXPENSES, B. 1. 2. 3. DESCRIPTION AMOUNT ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Social Security Number{s) I EIN Number of Personal Representative(s) Street Address City State Zip Year{s) Commission Paid: Allorney's Fees IRWIN McKNIGHT & HUGHES Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City SIOle Zip Relationship oi Claimant to Decedent 12,500.00 4. Register of Wills 293.00 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal - estate notice publication 75.00 2 Dehart's Auction, commission 4,520.91 3 Patricia A. Rosendale CPA - 2000 income tax prep. 95.00 4 Register of Wills - filing fee 25.00 5 Scott Ramsey, lawn care 60.00 6 Settlement charges on sale of real estate 1,650.85 Total of Continuation Schedule(s) 93.83 TOTAL (Also enler on line 9. Recopoulotion) S 19,313 .59 (If more space is needed, insert additional sheets of the same size) Copyright (el 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Escace of: Mychailo Komesz Soc Sec #: 176-26-0678 Dace of Deach: 01/24/2001 Icem If Descripcion Concinuacion of Schedule H-B7 (Ocher Adminiscracive Coscs) Amounc 93.83 7 The Sencinel, Legal - estate notice publicacion 93.83 , RE'f-151'z'EX+(V37) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERIT.AlNCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mychailo Komesz FILE NUMBER 21-01-0248 SSII 176-26-0678 01/24/2001 Include unreimbursed medical expenses. ITEM NUMBER 1 Aero Oil Company DESCRIPTION AMOUNT 447. 11 2 79.33 Barrick's Plumbing & Heating 3 Belvedere Medical Corp. 24.42 4 Bronstein Jeffries PA 55.09 5 Carlisle Imaging Associates 14.67 6 193.72 GPU Energy 7 PA Department of Revenue, 2000 income tax 159.00 8 RWC Emergency Physicians 30.30 9 S&W Petroleum Service - tank removal 2,009.50 10 Sprint Telephone 135.99 11 United States Treasury, 2000 income tax due 129.00 12 Walnut Bottom Radiology 16.37 TOTAL (Also enter on line 10, Recapitulation) S 3,294.50 {Ii more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV -15 13 E~ + (9-00} COMMONWEALTH OF PENNSYl.VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Mvchailo Komesz SSj/ 176-26-0678 01/24/2001 FILE NUMBER 21-01-0248 RELATIONSHIP TO DECIil!ENT AMOUNT OR SHAHE Do Not List Trustee(s) OF EST ATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [Include outright spoLJSaI distributions, and transft!rs under Sec. 9116{a)(1.2)] 1 Dmytro Komesz 1408 Farr Road Reading, PA 19611 Son 1/2 remainder 2 Mychae1 Komesz 3315 Biglerville Biglerville, PA Son 1/2 remainder Road 17307 3 Natalie P. Komesz 1212 Village Crossing Drive Chapel Hill, NC 27514 Gr anddaughter 15,000.00 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S {If more space is needed, insert additional sheets of the same size} Copyright (e) ZOOO form software only The lacknerGroup, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) LAST WILL AND TESTAMENT I, MYCHAILO KOMESZ, of 1 Chestnut Street, Mt. Holly Springs, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this will, shall be paid by the Executor or Executrix of my estate. TWO. My Executor or Executrix may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and Ji. /( empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. THREE. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, Maria Komesz. FOUR. If my spouse, Maria Komesz, does not survive me by a period of at least sixty (60) days, then my estate of whatever nature and wherever situate I give, devise and bequeath as follows: a) $15,000.00 to my granddaughter, Natalie Patricia Komesz; and b) All the rest, remainder and residue thereof to my two sons, Mychael Komesz, Jr. and Dmytro Komesz, share and share alike, and if either of them is deceased, their share shall go to my granddaughter, Natalie Patricia Komesz; and c) Notwithstanding the provisions of subparagraph 4(b) above, either Mychae1 Komesz or Dmytro Komesz, as they shall agree, shall have a right of first refusal upon my death to purchase the aforementioned residence at 1 Chestnut Street, Mount Holly Springs, Pennsylvania, for a purchase price which shall be calculated using the fair market value of the property at the time of my death or using such other amount as they shall both agree in writing. The fair market value shall be determined by a certified appraisal of the property as of the date of my death. In the event that neither of my sons are desirous of exercising this right of first refusal to so purchase, then the property shall be sold and the proceeds therefrom distributed in accordance with this my Last Will and Testament. .E!Y.t. I nominate and appoint my spouse, Maria Komesz, to be the Executrix of this my Last Will and Testament. If my spouse has predeceased me, failed to qualifY or is not able or 2 vU. JC. does not serve for whatever reason, then I appoint Mychael Komesz, Jr. and Dmytro Komesz to serve as Co-Executors of my estate having the same powers as the original Executrix hereunder. SIX. .No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. SEVEN. No Executrix or Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .!.i'-.- day of October, 1994. 1fUJ~/{fJ~V(SEAL) MYCHAfi,O KOMESZ Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 0Ya4hL~vJ.I,./~~ ~ rC/7.f ;t' c?/-'~ 3 , , ACKNOWLEDGMENT AND AFFIDA VIT WE, MYCHAILO KOMESZ, SHARON L. SCHWALM and CHERYL L. CLELAND, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. Ji!tt ~ f{ () /J1-tM-z--- MYCHAILO KOMESZ 0YtU/)-L- Y;~ku I SHARONL.SCHWALM f'~f.(1f.61 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by MYCHAILO KOMESZ, the testator herein, and subscribed and sworn to before me by SHARON L. SCHWALM and CHERYL L. CLELAND, witnesses, this 18TH day of October, 1994. .&, ~11(J111 Nota Pubhc Notarial Seal I3e1zII>. Mooison. NotaJy Pubr" Carnsle Boro, Currl:>e<Iar<l County My ComrrUssioo Expires Dec. 15. 159G Member, Penos~tvactia.Assoc:ia\lon 01 NCl\afics A. OMB NO. 2502-0265 "r:: SETTLEMENT STATEMENT U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT B. TYPE OF LOAN: 3. ~CONV. UNINS. 4. OVA 17. LOAN NUMBER: 615021863 5.0CONV.INS. l.oFHA 2.oFmHA 6. FILE NUMBER: 2171.1 8. MORTGAGE INS CASE NUMBER: C. NOTE: This (ann is furnished to give you a statement of Bctual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked '1pOCr were paid outside the closing; they are shown here for informational purposes and are not includod ;n the totals. 1.0 3198 (2171,1DONlEVPFDf21711/1O) D. NAME AND ADDRESS OF BO~ROWER: Eric J. Donley P. O. Box 93 Ml. Holly Springs, PA 17065 G. PROPERTY LOCATION: 1 Chestnut Street Mt. HoUy Springs. PA 17065 Cumberland County, Pennsylvania Adiustments For Items Unnaid Bv Seller 210. CountvfTwn Taxes to 211. School Taxes to 212. Assessments to 213. 214. 215. 216. 217. 218. 219. E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: The Estate of Mychaito Komesz 1 Chestnut Street Ml. Holly Springs, PA 17065 ABN AMRO Mortgage Group, Inc. 2600 West Big Beaver Road Troy, MI 48084 H. SETTLEMENT AGENT: 25-1736654 Law Omce of Michael J. Hanft June 6, 2001 I. SETTLEMENT DATE: PLACE OF SETTLEMENT 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013-9142 110,000.00 K. SUMMARY OF SELLER'S TRANSACTION 400. GROSS AMOUNT DUE TO SELLER: 401. Contract Sales Price 402. Personal ProDertv 403. 404, 405. J. SUMMARY OF BORROWER'S TRANSACTION 100, GROSS AMOUNT DUE FROM BORROWER: 101. Contract Sales Price 102. Personal Prooerty 103. Settlement Charaes to Borrower (Une 1400l 104. 105. Adjustments For Items Paid By Seifer in advance 106. CountvlTwo Taxes 06106/01 to 12/31/01 107. School Taxes 06/06/01 10 06130101 108. Assessments to 109. 110. Ill. 112. 120. GROSS AMOUNT DUE FROM BORROWER 200, AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 201. Deposit or earnest monev 202. Princioal Amount of New Loan(s 203. Existina loanis) taken subiect to 204. 205. 206, 207. 208. 209. 6,320.30 256.50 86.81 Adiustments For Items Paid Bv Seifer in advance 406. CountvlTwD Taxes 06/06/01 to 12/31101 407, School Taxes 06106101 10 06130/01 408. Assessments 10 409. 410. 411. 412, 420. GROSS AMOUNT DUE TO SELLER 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 501. Excess Denosit-'See Instructions\. 502. Settlement Charries to SellerfLine 14001 503. Existino loants\ taken subiect to 504. Payoff of first Mortgage 505. Pavoff of second Mortaaoe 506. 507. (Qeoosit disb. as nroceedsl 508. 509. 116,663.61 22,000.00 88,000.00 Adjustments For Items Unnaid Bv Seifer 510. CountvlTwo Taxes to 511. School Taxes 10 512. Assessments 10 513. 514, 515, 516, 517. 518. 519. 220. TOTAL PAID BY/FOR BORROWER 110,000.00 520, TOTAL REDUCTION AMOUNT DUE SELLER 300, CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From BorrowerlUne 1201 116,663.61 601. Gross Amount Due To Sellerlline 420\ 302. Less Amount Paid By/For Borrower (Une 220) (110,000.00) 602. Less Reductions Due Seller (Line 520) 303. CASH ( X FROM) ( TO) BORROWER 6,663.61 603. CASH ( X TO)( FROM) SELLER The underSIgned hereby aCkno;:.recei~~a compleled copy of pages 1&2 01 Ihls Slale~e:::~ferr:~r:;. Borrower ~ _____ y.,:; Seller // ~ , P: Eric J, Donley / ~e of Mychallo Komesz / 110,000.00 256.50 86.81 110,343.31 1,650.85 1,650.85 110,343.31 1,650.85 108,692.46 -..- -..--..- -,.~,. -~-.-._. ~._..- L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ Ii1l % PAID FROM PAID FROM . Division of Commission (/ino 700) as Follows: BORROWER'S SEL.LER'S 701. ~ to FUNDS AT FUNDS AT 702.$ to SETTLEMENT SETTLEMENT 703, Commission Paid at Settlement 704. to BOO. ITEMS PAYABLE tN CONNECTION WITH LOAN 801. loan Oriaination Fee % to 802, loan Discount 1.5000 % to Cody Financial Mortgage Services, Inc. 1.320.00 803. Appraisal Fee to Cody Financial Mortgage Services, Inc. 275.00 804. Credit Report to Cody Financial Mortgage Services, Inc. 50.00 805. Processing Fee to Cody Financial Mortgage Services. Inc. 250.00 806. lender Administration Fee to ABN AMRO Mortna e Grourl, Inc. 375.00 807. Flood Cert Fee to Cody Financial Mortgage Services. Inc. 21.50 BOB. B09. Bl0. Bll. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 06/06/01 to 06/30/01 @ $ 15.890000/day ( 25 days %) 397.25 902. Mortaaae Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 vears to Nationwide $448.00 POC 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 4.000 months $ 37.34 ner month 149.33 1002. Mortgage Insurance months $ ner month 1003. CountvfTwn Taxes 6.000 months $ 36.59 ner month 219.54 1004. School Taxes 13.000 months $ 103.51 ner month 1.345.51 1005. Assessments months @ $ per month 1006. months (ij) $ ner month 1007. months (ij) ~ ner month 1008. Aaareaate Adiustment months /1l) $ oer month -294.83 1100. TITLE CHARGES 1101. Abstract or Title Search to 1102. Settlement or Closin Fee to 1103. Document Prenaration to Irwin McKniaht & Huahes POC 1104. Attomev's Fee to 1105. Notary Fee to Notarv Public 4.00 1106. DRS Lien Searches to Law Office of Michael J. Hanft 20.00 1107. Title Binder Fee to (includes above item numbers: ) 1108. Title Insurance to CT1C/Law Office of Michael J. Hanft B37.00 (includes above item numbers: 1109. lender's Coverage $ 88.000.00 1110. Owner's Coverage $ 110.000.00 1111. Endorsements 100/300/8.1 to CTICllaw Office of Michael J, Hanft 150.00 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 25.50; Mort9age $ 49.50; Releases $ 75.00 1202. City/County Tax/Stamos: Deed 1.100.00' Mort a e 1.100.00 1203. State Tax/Stamos: Revenue Stamos 1.100.00; Mortoaae 1.100.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. Ovemioht Mail Fee to law Office of Michael J. Hanft Pko 26.00 1304. 2001 Countv/Boro Taxes to Mable Sattison, Tax Collector 447.95 1305. Final Water/SewerfTrash to Mt. Holly Springs Borough Acct # 3054 102.90 1400. TOTAL SETTLEMENT CHARGES fEnter an Lines 103, Section J and 502, Section Kl 6.320.30 1 ,650.85 By Signing page 1 of this statement. the signatories acknowledge receipt of a completed copy of page 2 of this \'M) page statemen JA-j /I )1+19- ;j La~tn:~cl!'of MichaeilJ. Hanft 1/ I / Selt ment A ent 9 Certified to be a true copy. (2171.112111,1110) MAR-?7-~1 ng:1~ 0PNCBAN< _en. Reporting Firstside Center P7-PFSC-4-F SOO First A venue Pittsburgh,PA 15219-3128 March 21, 2001 James D. Hughes 60 West Pomfret Street Carti.lo, FA 17013-3222 RE: Estate ofMycbailo KomCllZ, D<c<ased SSN: 176.26-0678 DOD: 1/2412001 Dear M, H~ghes: Please: find the date of death balances you have requested listed belOw" CERTIFICATES OF DEPOSIT 1131800162242 MYCHAlLO KOMESZ DOD Ba1=: $8,056.82 + S 12. 70 accrued in'e=! lnt=st Paid 1/112001-1/24/2001 - 530.11 #31900204138 MYCHAlLO KOMESZ DMYTRO KOMESZ DOD Balance: $35,810.05 + S140.36 occtUed in....est Inl..est Paid 111/200-1/2412001- S193.70 Page 1 of2 A member of The PNC Financial SE,rvic::~ On')U' PNC Bank N,A" Pimol.l<'9h Ptl'll'l~~I..atl,.. 15~6S 03/22/01 07:38 p.m...\'\? ISCP Established 08/1111999 Established 1210112000 TX/RX NO.5402 P,001 . I'm-.7;:,-;:n;::U nq: 111 P.ro/~-:" ~PNCBAN< CHECKING ACCOUNT #SOl10515359 Established 0212711997 MYCHAILO KOMESZ DOD B_: S56633 + SO.OO """roed int=st Interest Paid 1/]/2001 -1/24i2001 - SO.OO For Brokerage information, please call 1-800..762-6111. /NV# 20740147 Our office only provides date of death bI.bulces tor IRA's, CD'" Chedda.g aDd Savmgs. Keounts. We do NQ. Fhwu::bl TnmPCtioIU or StatemeAt Orden. For Further Infor_tiOD pi.... caU 1-800-4-BANKER or your local PNC Br...ch ...d ask to speak with a Financlal Servka Representative.., g--~~~ RacheUe Sciullo 1-800-762-1775 Page 2 of2 A _to.". <1fT""" PNf; R~ow;:l,,1 St....oees G-. !'Nt: Bank N_A- P",tt~urgh ~nm.ylwnia 15265. TOTR P.02 03/22/01 07:38 TX/RX NO.5402 P.002 . .~ ADAMS COUNlY NATIONAL BANK ","; ,-:'," .---', ",# ,.,,-, ~;.; J " . i l"~ 1;; I ...... .;;; .~,J February 21, 2001 Irwin, McKnight & Hughes 60 West Pomfret Street Carlisle, P A 17013 Re: Estate ofMychailo Komesz Dear Mr Hughes: The following information is being provided as per your request: Acct. Type Acct. Acct. Acc. Int. Ownership Date Number Balance to 0.0.0. Joint On 0.0.0. Savings 96-0553-3 $7,449.84 $37.34 Individual N/A Checking 060-587-5 $5,429.94 $6.03 Individual N/A C.O. 147567 $8,339.63 $165.99 Individual N/A C.O. 131279 $9,916.68 $31.56 Individual N/A CD. 6-4-006668 $20,788.34 $80.54 Individual N/A C.O. 6-4-104585 $15,000.00 $230.70 Individual N/A C.O. 152377 $10,274.38 $202.96 Individual N/A C.D. 152356 $7.000.00 $376.Q4 Individual N/A C.D. 152321 $5,257.14 $24.03 Individual N/A Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. 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