The URL can be used to link to this page

Home My WebLink About01-0415 It Estate of Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS David A. DeGaetano No.~-O'-Dqj5 also known as , Deceased Social Security No. 191 - 46 - 2948 Paula K. DeGaetano Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) D A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut the Decedent, dated and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted atter execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [Xl B. Grant of Letters of Administration '.Q,... 5 .1'1. S . "t . a. (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) ~~~s Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I Paula K. DeGaetano spouse 621 Whiskey Springs Road (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 621 Whiskey Springs Road, Boiling Springs (list street number, and municipality) Decedent, then ~years of age, died 04/02/2001 at Harr isburg Hosp i tal, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled ir. PA) Personal property in County Value of real estate in Pennsylvania 10,000.00 $ $ $ $ situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a ro riate form to the undersi ned: Si nature T ed or rinted name and residence Paula K. DeGaetano 621 Whiske S rin s Road, Boilin s, PA 17007 Ju; Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. ",- .',. r J\ /..4: -"'V Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumber land 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(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. I~Cc )(Lv~~ Paula K. DeGaetano Sworn to or affirmed and subscribed It rif before me this ~ day of 7 '~r :u2'~ , l ~..' / . \ t) For t:-Re~i~~rl' (y{ 'i\aJ2. d1{ ..~ No. ~1-DI-D'f15 Estate of David A. DeGaetano Deceased Social Security No: 191-46-2948 Date of Death: 04/02/2001 AND NOW, A1)(~1 L ::A {~" , I}, 0 lj L in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters D Testamentary ~ Of Administration d B fl. c. ti a. 11(0 (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Paula K. DeGaetano in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. Letters. . . . . . . $ tc f Cj() Ib.[{"_! FEES Short Certificate(s). $ Renunciation. $ Attorney: Michael L. Bangs Affidavits ( $ I.D. No: 41263 Extra Pages ( ) . $ Address: 302 South 18th Street Codicil. . $ Camp Hill, PA 17011 h ....'\ Q ,C~lj Telephone: 717/730-7310 JCP Fee. $ Inventory. $ '\ nl! A:7LL]) LL-rrE:J~~ -Ie "T1iL /trrCFzr~~t~l . Other . . $ 1,,0 C:(-; TOTAL. . . . . . . .. $ u.' . " j P}fc Prepared by the Pennsylvania Bar Associ!lti.!. 8~"".1:11,. \~J ,,,,t> .:lrm software only CPSystems, Inc. Form RW-1 (1991) \:h~~' IS to certify that the information here given is correctly copi~d frOI,l.l an original certiflc~He of death dul~ filed with me as Local Registrar.' The origin~ll certifIcate will be fOlwarded to the State \; Ital Records Office for permanent fllmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~Hi;;~~ ii""" ,\\ OF p """'~ l~ \. ~\ ------l4'4'--~\ l~/ . ";'<f'..J:::~ i$~/ .1IliJi..~. \~.~\, I~~," ~ ',?"" l~!, ~, \~~ ~\~\~-~....~,/ ~J \*~ '~l ~~-~ -"'--. . ~/ -.... 7/1i~~ ""-- /\ 't.~ 111\ "",,/"EN1 \\ 1111,,1 ~"/~N/IJ/l1111 ~/?(~ Local Registrar fee for this certificate, S2.00 P 7295923 APR 0 5 2001 Date ,4 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA e DEPARTMENT OF HEALTH e VITAL RECORDS CERTIFICATE OF DEATH (Coroner) AGE (Last Birthday) UNDER 1 YEAR Monlhs Days UNDER 1 DAY Hours Minutes SEX 2. Male STIa"E FilE NUMBER SOCIAL SECURITY NUMBER ~ 191 - 46 - 2948 2001 NAME OF DECEDENT (First, Middle, last) 1. David A. DeGaetano BIRTHPLACE (Cily and PLACE OF DEATH (Chack only one see instructions on other side) Stala or Foreign Country) HOSPITAL: H i b PA Inpalient 0 EAlOutpalienl IQc DOA D 7, arr s urg, ... FACILITY NAME (II nOllnshtul,on, give streel and number) ~~iIY)O DECEDENT'S USUAL OCCUIWION (~~r;t~~~u':::'Jlr:fr . l1a. Correction Officer llJ.)tate DECEDENT'S MAILING ADDRESS (S/teet, CltylTown, Stale, Zip Code) 621 Whiskey Springs Road Boiling Springs, PA 17007 Harrisburg Ie. lei. KIND OF BUSINESs/INDUSTRY RACE. American Indian, Black, White, etc. (Spacily) White 10. Ins. Correction DECEDENT'S ACTUAL RESIDENCE (See instructions on other side) WAS DECEDENT EVER IN U.S. ARMED FORCES? Yes D No j;KI MARITAL STATUS. Married Never Married, Widowed, Divorced (Specify) 14. Married SURVIVING SPOUSE (II wile, give maiden name) 17a. State VA Did decadenl live in a lownship? 17c.D V.,deeadenlNvedin 1iaula Miller South Middleton Iwp, 12. 17b. Cou Cumberland cilylboro Removllfrom Slale 0 4-6-2001 LICENSE NUMBER _ __ 24-26 m... be completad by -=penonwho~death, -- 238. TIME OF DEATH DATE PRONOUNCED DEAD ~Monlh, Day, Year) 23b. 23c. WAS CASE REFERRED TO MEDICAL EXAMINEAlCORONER? V.. Kl f1) NoD 24.10:57 p.m. M. 5, April 2,2001 27. MAT I: Ellie< lhe diMaIa, injuries or compllcallons which cauoed the dealh. Do not enler lhe mode of dylng, auch.. cardiac or resplralory arr..l, ahock or heart lallure. - .~ Liat only one ca.... on eachllne, b. Cardiac arrh thmia DUE TO (OR AS A CONSEWENCE OF):. Acute M ocardial Infarction DUE TO (OR AS A CONSEOUENCE OF): H, I Approxlmala IlnlelVal ~n i onsel and death i PART II: Other algnlllcant condItlonl contrtbutlng to death, but nol resunlng In the underlying causa given In PART I. IMMEDIATE CAUSe (FioaI ..... or condition ~ reaulling in death)_ ;:::; Seque/llIaIIy IiIl oonditlons '-"11 any.1McIng to ImmadIate ....._. Enler UNDERLYING "- CAUSE (Disease or injury -Ihat iniIiated events _.r8lUting in dealh) LAST d. __ W\S AN AUlOPSY WERE AUlOPSY FINDINGS -= PERFOftMED? -.LABLE PRIOR TO ~ COMPLETION OF CAUSE - OF DEATH? Cardiac valve replacement H ertension DUE TO (OR AS A CONSEOUENCE OF): MANNER OF DEATH DATE OF INJURY (Month, Day, Year) TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Nalural 19C D D Homicide o D Ob. M. D :U~~~~=~tt home, farm, street, factory, Office 311e. YeaD NoD D , PA 17111 Yea D No 5a Yas D Nor:J AcckIanl Pending "'-igalion Could not be determlnad He. 21b. CERTW'lER (Check only one) OCERTlFYlNQ PHYSICIAH (PhySICian certilying cause 01 death when another phySICian has ptonounced death and completed Item 23) To the beet of IllY 1mowIedge, dMlIl occurNdduetothecauee(a) and man_..etated. .............,....., ,...., ............... ........... Suicide H. .PRONOUNCING AND CERTIFYING PHYSICIAN (Phyoiclan both ptonouncing dealh and certifying to cause 01 dealh) To the beat of IllY 1cMwladge, dMlIl occurNd at the time. date. and pIKe, and due to the cauee(l) and __ ..alated.. . . . . . , . . . . . . , . , . . , . , , , . . o == OMEDICAL EXAIIINERlCORONER On the bMleof UMllnIItIon MdJor Inv..aJgatIon, In my opinion, death occurrlld at the time, date, and place, and c1ua to the CMlM(a) and -..........................................................................................,..........,.... . 31L ' AEGIS ~I/~I// I ) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DAVID A. DeGAETANO Date of Death: April 2, 2001 Will No.: Admin. No: 21-01-0415 To the Register: I certify that notice of beneficial interest (estate administration) required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 3, 2001: NAME ADDRESS PAULA K. DeGAETANO 621 Whiskey Springs Road, Boiling Springs, P A 17007 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none. Date: ~)~3-{)1 ,: ./: " /~/ I /} '; (1.// .) Signaturet t/t.~)r'.. ~./ ~ .,,/ Michael L. Bangs, Atto -at-Law 302 South 18th Street ~ Camp Hill, P A 17011 (717) 730-7310 Capacity: Counsel for Personal Representative ESTATE OF DAVID A. DeGAETANO, Deceased ) IN THE COURT OF COMMON PLEAS OF ) CUMBERLAND COUNTY, ) PENNSYLVANIA ) ) ORPHANS' COURT DIVISION ) ) NO. 21-01-0415 INRE: RECEIPT AND RELEASE I, PAULA K. DeGAETANO, thl;; undersigned, do hereby: 1. State and acknowledge that I am an adult individual; 2. Waive the filing of an Account or Schedule of Distribution by the personal representative of the Estate; 3. Acknowledge that I have received all sums of money and personal property to which I may be entitled as an heir of the Estate of DAVID A. DeGAETANO who died intestate on April 2, 2001; 4. To the extent of said distribution, release PAULA K. DeGAETANO, Administratrix, of the Estate of DAVID A. DeGAETANO, and her heirs and personal representatives, from all liabilities, whether due to her negligence or otherwise, which she may have by reason of her administration of the Estate; 5. Agree to refund to the Estate and to the said PAULA K. DeGAETANO, Administratrix, any portion of the distribution to which I am not properly entitled, and, to the extent of said distribution, to indemnify her and the Estate for claims made against her and to reimburse her and the Estate all expenses and costs incurred in connection with any such claim; and Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of David A. DeGaetano No. 21- 01- 0415 also known as Date of Death 04/02/2001 ,Deceased Social Security No. 191-46 - 2948 Paula K. DeGaetano, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I /We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Name of Michael L. Bangs Attorney: I.D. No.: 41263 Address: 302 South 18th Street Camp Hill, PA 17011 Telephone: 717/730-7310 Signature: \../)" i' '/',. 1/ ;"" L/, '.!-ce- {::{,tvtlLL f...... j .rI-Ju~ (...l,L~ aula K. DeGaetano Signature: Address: 621 Whiskey Springs Road Boiling Springs, PA 17007 Telephone: 717/243 - 5426 Dated: 7-.31- 01 Description Value (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 10,313.33 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) '\ /6 -~02 6 -~-- 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 09-17-2001 DEGAETANO 04-02-2001 21 01-0415 CUMBERLAND 101 MICHAEL L BANGS ESQ 302 S 18TH ST CAMP HILL PA 17011 * REV-1547 EX AFP (12-00> DAVID A Amount Remitted CHANGED n) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 10.313.33 .00 .00 (8) 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 ~ RE-V: iS4j-EX--AFP--fi'2=oc.-r-NO,.-icE--OF-YtiHEifiiAirCE-,.-ix-A"PPRA-iSEMENY-,--AL"LOWAifcE-ifi----------- ---- -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DEGAETANO DAVID A FILE NO. 21 01-0415 ACN 101 DATE 09-17-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED 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 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 NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: (9) nO) 1,725.59 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 10,313.33 nlJ (2) (3) (4) 11.918 04 1,604.71- .00 1,604.71- 10.192.45 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = (9)= .00 .00 .00 .00 .00 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.) REGISTER OF WILLS OF CUMBERLAND COUNTY REPORT OF STATUS OF ADMINISTRATION (For Resident Decedents Dying after July 1, 1984) ESTATE NO. 21- 01- 0415 Name of Decedent: Social Security No.: DAVID A. DeGAETANO 191-46-2948 Date of Death: April 2, 2001 Name of Personal Representative: Paula K. DeGaetano 621 Whiskey Springs Road Boiling Springs, P A 17007 Capacity ( check one) Executor Administrator Administrator c.t.a. X Administrator d.b.n. Is the administration of the estate complete? Yes_X_ No If "Yes", how was the administration ended? (check one) By court accounting By account stated to parties in interest X Did the parties release the personal representative? Yes Other (explain) Total amount paid to date to creditors and for funeral and $1,887.59 administrative expenses Total value of distributions to date to beneficiaries $8,434.19 If administration is not complete, estimated value of assets $ still in administration NOTE: This status report is due no later than the due date for filing of the Pennsylvania inheritance tax return or, if no inheritance tax return is required, nine (9) months after the date of death; if the administration of the estate has not been concluded, a summary report shall be filed annually thereafter until the administration is complete. I certify under penalty of perjury that the foregoing information is correct to the best of my knowledge, information and belief. Date: 10 ./23 -Of IliA ~ /) ~~ i/t . t , MICHAEL L. BAN Attorney for Estate II:, -<X~~- 5 REV-150Q EX + (6~CO) CAPB HpRL EplO CRAC KOTK ES REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPA~TMENTOFREVENUE OEPT.2a060' HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DeGaetano David A. . DATE OF DEATH (I\lH..t.OQ-YEAA) FILE NUMBER .. C- OFFICIAL USE ONL '( 21-01-0415 CDUNTYCODE YEAR SOCIAL SECURITY NUMBEF\ 191-46-2948 THIS RETURN MUST BE FILED IN OUPUCATEWlTH THE NUMBER REGISTER OF WillS SOCIAL SECU 11'1 NU'MBE o o 3 date of death . RemaInder Return prior 10 12-13-82) 5. Federal Estate Tax Returl'I RequIred 8. Total Number of Safe Deposit Boxes C P o 0 R N R 0 E E S N T DATE OF BIRTH (MM-DD-YEAR) 10 18 1955 NAM LA ,FIRS, AND Ml DL INITIAL DeGaetano, Paula K. X 1. OrigInal Return 4. Limited Estate 6. Decedent !:lIed Testate (Attach copy of WII1) D 9. Litigation Proceeds Received 2. 4.. 7. supplemental Return Future Interest compromise (date of death after 12-12-82) Decedent Maintained a Living Trust (Attach copy of Trust) Spousal Poverty Credit (date of d&ll.th between 12:-31-91 and 1~ 1-95) ll.. None .None None None 10,313.33 None None 1,725.59 10,192.45 x X X X .0 0 o 45 .12 .15 Michael L. Ban s, Es uire FlAM NAME (It Applicable) 302 S. 18th Street Gamp Hill, PA 17011 3 - 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inler-Vivos fransfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estat. (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sub'.ct to Tax (Line 12 minus Line 13) Copyright (e) 2000 form software only The Lackner Group, Inc.. OFFICIAL USE ONL '( (8) 10,313.33 (11) 1l.918.04 (12) (1,604.71) (13) (14) (1,604.71) (15) (16) (17) (18) (19) 0.00 0.00 0.00 0.00 0.00 010. TELEPHONE NUMBER (1) (2) (3) R E C A P I T U L A T I o N (4) (5) (6) C o M P T U A T X A T I o N SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. (1,604.71) Form REV-1500 EX (Rev. 6-00) " Decedent's Complete Address: STREET ADDRESS 621 Whiskev Springs Road CITY I STATE I ZIP Boiling Springs PA 17007 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credos ( A . B . C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D . E) (3) 4. 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 (4) 5. If Line 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 to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 0.00 jii/!!,;,,'>':i" "'''<i')i;:nH::iWii' !H:iH/i!'" ' , " " " " ""''''':''','",:'''''''''.',;''''''''",:'"""....,:,..,,,,,-,,,,,,,,,,,,,,,,,,.,:,:...,,,,,,,,.,,,.,,,,.,,,,,.,,,_,,,,._""","""_",",,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, HHW F'I..EASEANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X'; 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? 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. . ",;,;;;"";;;;,;";,;;;",;;;;;";";;;;;,;";;;;;";;,;.":.,,,,,,.,, ..,:"",."......,....,.,.-,--..,................. - - ..-.. IN THE APPROPRIATE BLOCKS Yes No ~~ o o o ~ ~ ~ Under penalties of perjury, I declare that I have examIned this return, IncludIng accompill"l'jlng schedules and s\atements, and to the best of my Imowledge and belief. It is true. correct and complete. Declaration of preparer other than the personal representatlve Is based on alllr'lformatlon of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN 1 Paula K. DeGaetano _ _ _~~~_ _\o!J:1~ _s_~"y_ _~e,,_i_,y;;~ _ _R.'?~<:l_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Boilin S rin s, PA 17007 Michael L. Bangs, Esquire 302 S. 18th DATE " ) /1//o! DATE . For dates of death after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P. S. 9116 (a) (1.1) (il]. For dates 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% [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 retum are still applicable even ii 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. 9116(aXlI]. 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)j. 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) " REV-1508 EX + (1-97) COMMONWEA.LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER David A. DeGaetano SS# 191-46-2948 04/02/2001 21-01-0415 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Commonwealth of PA/Payroll Operations - Salary/overtime/shift and clothing allowance VALUE AT DATE OF DEATH 2,302.79 2 Commonwealth of PA/Payroll Operations - Leave payment 8,010.54 TOTAL (Also enter on line 5, Recaoitulation) S 10 I 313.33 (\f more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) " . COMMONWEALTH OF PENNSYLVANIA OFFICE OF THE BUDGET COMPTROLLER OPERATIONS June 22, 2001 Paula K. Degaetano 621 Whiskey Springs Road Boiling Springs. PA 17007 BUREAU OF COMMONWEALTH PAYROLL OPERATIONS PO. BOX 8006 HARRISBURG. PA 17105-8006 FAX: (717) 772-3104 Re: David A. Degaetano, Deceased Dear Ms. Degaetano: The enclosed check represents a leave payment for David A. Degaetano payable to the estate. Accordingly, the payee may negotiate this check. This office, The Bureau of Commonwealth Payroll Operations (BCPO), is working closely with the Personnel Office staff to ensure a timely resolution to all payroll related matters. Due to the time it takes to assemble and process the information, you may receive additional payments or material from BCPO during the course of the next several weeks. After the completion of all payroll transactions. BCPO will send you a letter for your file detailing the payments, deductions, and any adjustments that were made. At any time should you have any questions pertaining to the material that you receive from BCPO, please contact Mr. Edmund Brenner at 717-772-5368. Sincerely, b!" Chief Special Payments Section OJ c: :D m > I c: 0 Ln - r: :g "T1 D ~D ," -< (') ,- >-' ,-j- --i co 0 -i> )JJ 0 >- a: n t::: CO d- --i J: ~ a: )> )> CJ J:Li f) r,J :r :0 :0 0 m :n ~ ::0 .;: ,.0 i;; Z ::-":1 > ~. 0 0 '" " '" ~ --. G. eti ... JJ c b >- 0 :n << 0 '" '" m > 1:::' m 0 ~ r- .r n', JJ j; x >- --i ..D 0 oo 0 li! 8 " J: .... .,. :l) ~ ~ ~ ~ z ..D G 0 " '" c"- 8 "' -< n.J Ii' i: :D --. g "' z 0 --I 0 CO r- - r- .. 0 0 .r -0 m "'-' :D 0 > 0 :;j 0 0 :z 0 (J) ..D [T) .. " 0 z " 0 --.J '" 0 >- z .... .9 ,,-'< "'-' C'" :;jz ..D "- 0'" ",> ",::I 0 \, fi) 0.0 cO :''>.>-' r,) ~ ~~ :n~ ..D '1 -. !i'~ ,.,.-..\ f"(! m n.J ;~ a;, 8 --. ~;, g e_' ;; . '~... g ::'i z , '.~.:;:.:,. Q -, z 0 0 > :!J - m " "- :g J; -< CO -' <:;'!- 0 J: D ('J ~) >; 0 a ISI )> IS A '" _c- & --I IJ'J CD ,.' f-" ~.1 1.1) CD r(; I' N " '*' COMMONWEALTH OF PENNSYLVANIA OFFICE OF THE BUDGET COMPTROLLER OPERATIONS June 15, 2001 Paula K. Degaetano 621 Whiskey Springs Road Boiling Springs, PA 17007 BUREAU OF COMMONWEALTH PAYROLL OPERATIONS P.O. BOX B006 HARRISBURG. PA 17105-B006 FAX: (717) 772-3104 Re: David A Degaetano. Deceased Dear Ms. Degaetano: The enclosed check represents a salary, overtime, shift and clothing allowance payment for David A. Degaetano payable to the estate. Accordingly, the payee may negotiate this check. This office, The Bureau of Commonwealth Payroll Operations (BCPO), is working closely with the Personnel Office staff to ensure a timely resolution to all payroll related matters. Due to the time it takes to assemble and process the information, you may receive additional payments or material from BCPO during the course of the next several weeks. After the completion of all payroll transactions, BCPO will send you a letter for your file detailing the payments, deductions, and any adjustments that were made. At any time should you have any questions pertaining to the material that you receive from BCPO, please contact Mr. Edmund Brenner at 717-772-5368. Sincerely, ;1; tJ / ~'v1< ~ Margaret Reidlinger, Chief Special Payments Section \fl ;g , "io o r- IP .P ...,J o "io C1 r" ::;0 '->> ..-(1"\ ,D '" ,... ". l-.l)J r"1 l\1 ("'t (;j i\\ ro ,,: U) 0 ~~. ,;:' 0.. OJ --:: '" ro '" tv (',; " fjJ oj o - .. o r- ""' o o o o .P !r' - .. 1-0 ~ -\ o -\ ~ % ~ ~ o o o ... .., .P C?, ~-.:<^, ~ \":.:.') .. ,,;:~ <.~';~' (.;::-. "'f":~ ~~-.:::'~ ..(....).:..) ".::,.."-::-~ , - ,. ~ w. ~ ~ n ..~ ~; -; ~ 0 "l! ~~ ~"'"J~~ C"O ~ en ?>~\!l~ ~~~~ ~~~-o ~\ 'i~ ~O ..<;: ~ ~ ~ o ~ ." Z ('> '" ~ ..,1- 3~ ()~ ~;. 0- :o'i ~~ ~r- .~\ \ .J e ()' ~. .-- 0 en ~ ~. '" II) $ e ,... "'- % \ '8 o ~ .. ',,':"'- '\ s ~ ... It G 0 N "c\ G po. > 7- .' l') ~ ..' cP f".;( -' (p to \'" ',0 -l . --l .--1 1St 0 ,0 " REV-1511 EX ~ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF David A. DeGaetano SSfI 191-46-2948 04/02/2001 FILE NUMBER 21-01-0415 Debts ot decedent must be reported on Sehedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES, B. ADMINISTRATIVE COSTS' 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number{s) I EIN Number ot Personal Representative{s) Street Address City State Zip Year{s) Commiss'lon Paid: 2. 3. Attorney's Fees Michael L. Bangs I Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 1,500.00 4. Probate Fees Register of Wills 60.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Expense Cumberland Law Journal - Advertising 75.00 2 Expense The Sentinel - Advertising 90.59 TOTAL (Also enter on line 9, Recapitulation) S 1,725.59 (If more space \s needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) " REY~ 1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF David A. DeGaetano SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSfl 191-46-2948 04/02/2001 FILE NUMBER 21-01-0415 Include unreimbursed medical expenses. ITEM NUMBER 1 Expense DESCRIPTION Amoco (credit card) AMOUNT 467.50 2 Expense Texaco (credit card) 473.48 3 Expense 0.00 4 Expense 0.00 5 Expense - VISA 9,251.47 TOTAL (Also enter on line 10, Recapitulation) $ 10,192.45 (If more space \s needed, insert additional sheets of the same size) CopyrIght (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (1-97) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF David A. DeGaetano NUMBER /. 1 SCHEDULE J BENEFICIARIES SSfI 191-46-2948 04/02/2001 ;, FILE NUMBER 21-01-0415 AMOUNT OR SHARE OF ESTATE Entire ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 17, 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 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions): Paula K DeGaetano 621 Whiskey Springs Road Boiling Springs, FA 17007 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 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 (c) 1996 form software only CPSystems, Inc. Spouse I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 Form REV-1513 EX (Rsv. 1-97)