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HomeMy WebLinkAbout01-0490 Register of Wills of Wayne County, Pennsylvania PETITION FOR GRANT OF LETTERS E~~e~ Beulah A. Calupca No. also known as R()()t~ A ri=lll1p~i=I / Sandra R .~.:,.rIrish P81IUoner(s), who Islar. 18 years of age or older, apply(les) for: (COMPLETE .A' OR 'B: BELOW:) ~ A. Probate and Grant of Letters Testamentary and aver that PeUtloner(s) lsIare the execut r ix ,Deceased Social Security No. 182-22-RQ70 named In the last Will of the Decedent, dated February 9, 1 995 and codlcll(a) dated Slale relevant circumstance., e.g., renunci.ion, dealh of execulor, elo. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate: was not the vlcUm of a killing and was never adjudicated Incompetent: o B. Grant of Letters of Administration (d.b.n.c."a.: pendente lite; durante ab.enlia: duran'.e minoritate) Petltloner(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 -1 .....--. .. - '.' .. (COMPLETE IN ALL CASe,s:) Attach additional sheets if necessary. Decadent W&S domlci/od at death In . . rnmhpr 1 i=I nn County, Pennsylvania, with hlslher !..... fq~!'.{ orprlncipalresldenc9at 24 Homewood Street, Dillsburg, Pennsylvania 17019 Decedent, then 77 (lilt Itreel, number and municipality) tI yearsofage,dled April 9 ,20..QLat Mechanicsburg, Pennsylvania (Location) Decedent at death owned property with estimated values as follows: (If domiciled In PAl All personal property (If not domiciled In PAl Personal property In Pennsylvania (If not domiciled In PAl Personal property in County Value of real estate in Pennsylvania $ $ A.().()()() nn $ $ situated as follows: Wherefore, Petitloner(s) respectfully request(s) the probate of the last Will and Codlci/(s) presented with this Petidon and the grant of letters In the appropriate form to the undersigned: SlgnattJre Typed or printed name and residence Sandra il. Irish HC-1 Box 525 18438 '.~.RW.1 /0 - ~3 J - 9 Oath of Personal Representative Commonwealth of Pennsylvania County of Wayne The Petltloner(s) above-named swear(s) or afflrm(s) that the statements In the foregoing Petition are true and correct to the best of the knowledge and belief of Petltloner(s) and that, as personal representatlve(s) of the Decedent, Pelltloner(s) will well and truly edmlnlster the estate aCCOrdlnsy~aw.. . Sworn to or affirmed and subscribed ~~ /~ ;t;' -P' \. iA' -/ ~ / . Sandra l(~rish 26th day of before me this APRIL 2001 ~ 4:i:;e!}tYlj REGISTER & RECORDER WAYNE COUNTY PA MY COMMISSION FXP'j:U:~' ~fO~T U0ll, l^~i 1001 No. 2 1 - 200 ] - 4 9 0 Estate of Beulah A. Calupca a/k/a Boots A. Caluoca Deceased Social Security No: 182-22-8970 Date of Death: Aoril 9, 2001 AND NOW, MA Y 18 TH 200 1 . _ , In consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, . -..._... ...... -........- .... - IT IS OECREED-that.tettefs-CiT-estamentary a Of Administration d.b.n.o.""; pend.nl.lil.; durante .b..mia; durante minoritat. are hereby granted to Kat: Sandra i8. Irish In the above estate and that the Instrument(s) dated February 9. 1_c) q:; described In the Petition be admitted to probate and flied of record as the last Will of 6ecedent. FEES Will ..................... ............. ~$ Letters ........... .................. $ 70.00 Inventory & Return .......... $ Advertising ...................... $ Death Certificate ............. $ Short Certificate ...(.5..l.... $ 15.00 Attorney: Anthony J. Magnott3, Esqutre 1.0. No: 37205 Oxford Place Route 590 Address: P.O. Box 408 Hawley, Pennsylvania 18428 Telephone: (570) 226-5700 Renunciation ................... $ x-Pages (3) ~.:.8g. JCP Fee .......................... $ Other ............................... $ TOTAL .................. $ 99 .00 Filed: May 17th,2001 MAILED LETTERS TO ATTORNEY A. J. MAGNOTTA 'h is to certify that the information here given is correnly (opied fi'orn an original certifIcate of death duly filed with me as ll)~ ~i1 R~gistrar. The original certificate will be forwarded to the Stale Vital Records Office for permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. /1I!1111"//;;;'~ jilf~\ltlOLff';'-~~ A'~~/ ~1'..rL-::'~ d~/ \r:-:. I~ ~/ \ii&.'. \lL~ ~ OO:::,:!!I>" \? ::. I~~! - .~~ "C:::. -.- I ~ \~ Co-' \ _ ,_-:~ ,/i; ~ ',*~.,j,; "J..~.~I*" -:. a~ . ~.~ !~~ \. ~, /~ "' ~ ~};-,- . .... ..' - /~",,:,\\y ...~-, 'l'IM;:N--l ~,~ ,I~ --~""""""//~/UIIlIlIJJ,'J ,I' / f~ Ref!;/? Ar1 Fee for this certificate, 52,00 P 7234656 tZrd- I ( J[)~J j I , Date No, 2 1- 20 0 1-4 9 0 HIOS. aJRo. 2/87 COMMONWEALTH Of PENNSYlVANIA 0 DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYPE/PRINT IN PERMANENT BLACK INK NAME OF DECEDENT IF"". ModaIe. Lag, SEX Female 3. STAlE FilE NUMBER SOCIAL SECURITY NUMBER 3. 182 _ 22_ DATE OF DEATH ,Mcntl1 Qa,. _I April 9, 2001 ~ ~ ~ a Ci ~ .. z t. COUNTY OF DEATH Cumberland AGE (LaSlllH1t>davl UHOER 1 YEAR Monlhl Dayo 77 Vra g:oIylO RACe . Amencan w.o.n. &lack, White. etc: ISpoc;yI White Mo. 10. DECEDEI'fl'S USUAl OCCUPArIOH lG<volund "'work done ""'~~ "'working hi.; mUfiaTr' I . 11.. uta.. DECEDENT'S MAIliNG ADORESS /SI,.... CoIylbon. ~. Z~ Codel 24 Homewood Street Dillsburg, Pennsylvania 17019 SURvIYING SPOUSE III ..... QOVO..- (\0lI101 1" FArNER'S NAME (F.... M"",",. Lasll 17b. Coun Did -- Iiw In. -.-p? 17d.O :....~.::::oI MOTHER'S NAME IF.... M",,*,. M_ Sumam., - ....,- I., INFORMANT'S NAME (TyplWPnntl 2Oe. METttOOOF DlSPOSIT~ . 0 IIuNI L1' C,......._ D ~ (Specolyl . 21.. Samuel J. Richard Weigle Mechanicsburg, Pennsylvania 01 34. ;1:4 ~ pm M 37.1't\RT I: EflI., rhe _..... "'lUllOSOI compIocOloona wIlichcaUUdlhe de.,h 00 nor.flI..rhe modo 01 yiog. such asca' llll only ana c..... on oacl\ line ~ tlUM1ttm; '" lO(OAAS ACONSEOUENCE OF): PART H: 0IMr signillcant_ fXlflInblJIing 10 de.th. Ilul "'" _ing in lIlO ~....._ in PART I I: DUElO(ORASACONSEOUENCE OF): I I I I ~ ------.., ~ DUE lOlOR AS A c6NsEoufNC~-------'--- ------.,- WERE AUlOPSY FINOtNGS MANNER OF DEATH AlAllABlE PRIOR TO COMPlETION OF CAUSE ~ 0 OF DEATH? Na"",,' Homocodo AccMienl 0 PendNlQ InvesuQal;on 0 Yes 0 No~ Suoclde 0 Could not be delermlned [J DATE OF INJURY (Man"'. Day. _) TIIolE OF INJURY INJURY R WORK? DESCRIBE HOW INJURY OCCURRED. _ [] NoD l~J! ,.71 {10"4 [] UVlI:/1( .:lJ ~ a... allb. CERTIFIER IC"*,,, only one, . CERTIfYING PHYSICIAN (PhyStCtan ce""Vlfll:j caU5e ~ <1eall\ wtlerl ,)ilOlne' pn.,.~.an has Pfonounceo I.lealh ana completed Item 231 To the be.t 0' "''t knowlredge. death OCCUlTed due 10 the cauee(s) and manner .. .'.Ied. . :29. PlACE OF INJURY - Al horM, filllm, str.... lactOf'(. offic;. bUilding, etc. ,Spec..,,) 300. . PRONOUNCING AND CERTIFYING PHYSK:IAN (PhySIC6&1n bolh ilfCOOUfiClflg tlealh ClOd Ceflllyang 10 cauS8 01 QeCllt,) To the bHI of m't knowledge, d..th occur""'.t IN ~, d.... .nd pl.c...Ad du.to the c.u..(a).nd manner.. a...ted.. .UEDICAl EXAMINER/CORONER On 'he b..il 0' e..minatlon and/or investigoation,ln my opinion, de.th ociCurred 8tthe lime, da'e, iIIod place, .nd due '0 Ihe cause(.) .nd manne, .. ttated.. . 31. LAST WILL AND TESTAMENT OF BEULAH A. CALUPCA ,. 21-2001-490 Beulah A. Calupca, also known as Boots. A. Calupca, presently residing at #8A Hemlock Glen, in the town of Tafton, County of pike and State of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my last will and testament. First: I hereby revoke all former Wills and Codicils heretofore made by me. Second: I direct that my Executor pay and discharge all of my just debts, including the expenses of my last illness, funeral and administration expenses as soon as shall be practicable. I further direct that any and all federal, state, foreign or other estate, transfer, inheritance, succession, legacy and similar taxes, including interest and penalties thereon, if any, imposed upon or with respect to any property required to be included in my gross estate under the provisions of any such tax law, and whether passing hereunder or by any Codicil hereto or otherwise, or upon or with respect to any person with respect to any such property, shall be paid out of my residuary estate as an expense of administration and shall not be equitably prorated or charged against the gifts provided herein. Third: I give, devise and bequeath all of the rest, residue and remainder of my property, real, personal and mixed, of whatsoever kind and nature and wheresoever situated, of which I shall die seized or possessed, and all property over or with respect to which I shall have any power of appointment, remaining after payment of my debts, funeral and administration expenses and any taxes which may be payable, absolutely and forever to my children in equal shares; Sandra Kae Irish, residing at #8A Hemlock Glen, Tafton, Pennsylvania; Richard L. Weigle, residing at 29 Homewood Dr., Dillsburg, Pennsylvania and Fredrick L. Weigel, residing at 3 Brandywine Dr., Mechanicsburg, Pennsylvania, should any of my children fail to survive me, I give, devise and bequeath all of my said property to my issue, in equal shares per stirpes. Fourth: In the event that any of the legatees under this Will shall die with me in a common accident or disaster, or under such circumstances as make it impossible or difficult to determine which of us died first or in the event that any such legatee shall die within sixty (60) days of my death, regardless of the circumstances, it shall be conclusively presumed that such legatee shall have predeceased me and deemed not to have survived me. Fifth: I nominate, constitute and appoint Sandra Kae Irish, presently residing at #8A Hemlock Glen, Tafton, Pennsylvania, as the Executor of this will. In the event of her death or resignation or failure or refusal to act in said capacity, I nominate , constitute and appoint Richard L. Weigel, presently residing at 29 Homewood Drive, Dillsburg, Pennsylvania as the successor Executor of this Will. Sixth: I direct that no bond, security or other undertaking shall be imposed upon or required at any time or in any jurisdiction of any individual named herein for the faithful performance of (his)(her) duties. IN WITNESS WHEREOF, I have set my hand and seal this ~~ day of ~/J~ \ 1995. _~~~ ~/ ec.~c~ BEULAH A. CALUPCA ,f3~ ~r ~ BOOTS A. CALUPCA The foregoing consisting of 3 pages inclusive of this page, the original of which was signed or initialled by the above testator prior to the execution thereof, was signed, published and declared by said testator as and for her Last will and Testament, in our presence and hearing and we thereupon, at her request, and in the presence of each other subscribed our names as witnesses this g-l-h day of F~Q/'O 1995. (1) ~~~ }.\rd:t~ \ residing at j2... ~ \ , 'f _,\\c,\ () 0, . l ~ \ ~'Bo residing at I-J.j J;;/~'(/o ,44 /i Lf?/;/t' (3) ~~.AeY'---' residing at tJij~,;U,?~kJ~~::3g ... (2) ,(d~~k-dl'<"!~ ACKNOWLEDGEMENT STATE OF PENNSYLVANIA Date: FEBRUARY 9, 1995 COUNTY OF WAYNE Before me, the undersigned Notary Public, personally appeared the above Signatory and Witnesses, respectively, known to me or satisfactorily proven to be the person whose names are subscribed to this instrument. These persons, being duly sworn, did hereby declare that Signatory signed and executed this instrument as Signatory's Last will and Testament and had signed willingly or directed another to sign and executed it as Signatory's free and voluntary act for the purposes therein expressed, and that each of the Witnesses, in the presence of Signatory, signed this Last Will and Testament as witnesses and that to the best of their knowledge, Signatory was at the time an adult, of sound mind and under no constraint or undue influence. This instrument was subscribed, sworn and acknowledged before me. ~~"~,.~crpJ Notary Publi My Commission Expires: Notarial Seal laurie J. Bishop, Notaty Public Honesdale Boro, Wayne Counly My Commission Expires Feb. 18, 1995 ~ G. ----- CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Beulah A. Calupca, a/k/a Boots A. CaluDca Date of Death: April 9, 2001 Will No.: 2001-490 Admin No.: 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 Sept pmhpr ? 4 r 2001 : Name Address Sandra Kae IriSh HC#1 Box 525, Lakeville, PA 18438 24 Homewood street, Dillsburg, PA 17019 Richard L. Weigel Fredrick L. Weiqel 3 Brandvwine Drive. Mp~'h~n;~c::hllrlJ. PA 17Q55 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N / A Date: 3.l2A/ 0 1 s~ej ~ Anthony J. Magnotta, Esquire Name Oxford Place Route 590 P.O. Box 408 Hawley, PA 18428 Address (570)-226-5700 Telephone Capacity: D Personal Representative kil Counsel for personal representative Anthony J. Magnotta, Esquire Oxford Place Route 590 P.O. Box 408 Hawley, Pennsylvania 18428 (570) 226-5700 I.D.#: 37205 IN THE COURT OF COMMON PLEAS NINTH JUDICIAL DISTRICT COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY IN THE MATTER OF THE ESTATE OF BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA ~ 1,- r";) I - lj.CfCJ ORPHANS' COURT DIVISION FILE #: 00490 ............................................................................................... . ............................................................................................... . ESTATE SETTLEMENT AGREEMENT ........... ..................................................................................... .... ......................................................... ~........... ................ THIS AGREEMENT, is made the ~ay orOdDw 2001, by and between SANDRA K. IRISH, EXECUTRIX OF THE ESTATE OF BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA, deceased, of HC# 1, Box 525, Lakeville, Pennsylvania 18438, hereinafter referred to as "Executrix", and Fredrick L. Weigel of 3 Brandywine Drive, Mechanicsburg, Pennsylvania 17055; and Richard L. Weigel of 24 Homewood Street, Dillsburg, Pennsylvania 1 7019, collectively the beneficiaries of the Estate of Beulah A. Calupca, also known as Boots A. Calupca, deceased. IN ACCORDANCE with their desire that the administration of the Estate of Beulah A. Calupca, also known as Boots A. Calupca, be terminated without the expense and delay of a court accounting, the parties hereto, in consideration of the mutual covenants herein expressed, and intending to be legally bound, hereby agree that: 1). The Estate of Beulah A. Calupca, also known as Boots A. Calupca, who died April 9, 2001, is now in the process of administration, Letters Testamentary having been duly granted to the Executrix by the Register of Wills of Cumberland County on May 18,2001. 2). That pursuant to the Decedent's Last Will and Testament, her residuary estate was given to the following beneficiaries in the fractional shares set forth opposite their names: (a) . Sandra Kae Irish - one-third (1/3) (b) . Fredrick L. Weigel - one-third (1 /3) (c). Richard L. Weigel- one-third (1/3) 3). The parties acknowledge that the Executrix received the assets and made the payments as set forth in the First and Final Account of the Estate of Beulah A. Calupca, also known as Boots A. Calupca, a copy of which is attached hereto as Exhibit "A", and made a part hereof, and the parties approve the said Account in its entirety. 4). The parties hereto agree that the remaining balance of the estate assets shall be distributed as set forth in the Schedule of Distribution, a copy of which is attached hereto as Exhibit "B", and made a part hereof, including distribution of all legatees and devises as set forth herein. Without intending to limit the rights or remedies of the Executrix, the parties further agree to indemnify the Executrix and save her harmless against al11iabi1ity, loss and expense including, but not limited to, costs and counsel fees which the Executrix may incur, whether due to the Executrix's negligence or otherwise, as a result of making the above described distribution without a court audit. 5). The beneficiaries authorize the Executrix to reserve from the above mentioned balance, the sum of One Thousand Dollars ($1,000.00), as reflected in the First and Final Account of the Estate of Beulah A. Calupca, also known as Boots A. Calupca, following their receipt of the Estate Tax Closing Letter and any estate deficiency that may be assessed, and any other proper expenses or liabilities of the estate of which the Executrix shall have received notice by that time, or which may otherwise be payable, the Executrix shall distribute to the beneficiaries in proportion of their interest as set forth in Paragraph 3 above, and without further accounting, the balance then remaining. Such distribution will also include any funds received by the executrix subsequent to the date to which the attached Account is stated. Should any proper liabilities of the estate, whether for taxes or otherwise, arise or come to the attention of the executrix or any of the other parties thereafter, the residual beneficiaries agree to be jointly and severally liable therefor. 6). The parties hereto forever fully release, compromise, settle and discharge any and all claims, demands, actions or causes of action, legal or equitable, absolute or contingent, vested or hereafter to accrue, which any of them may have against any other party hereto or against the Estate of Beulah A. Calupca, also known as Boots A. Calupca, deceased, or the Executrix thereof, by reason of any matter, cause or thing growing out of or relating to any act of the Executrix in her administration of said estate, even if attributable to her negligence or otherwise. 7). The parties agree to execute such additional releases as the Executrix may submit to them in order to confirm her discharge from any further liability to the parties in connection with the said estate. 8). This Agreement may be executed in multiple counterparts and, when so executed, shall be binding upon all the parties, and their respective heirs, personal representatives and assigns. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. _,J<Pd<~ )( \)...d SANDRA K. IRISH Executrix of Estate .d41~tJ- ~L ~ SANDRA KAE IRISH Indivi ally cI- ~< REDRICK L. WEI COMMONWEALTH OF PENNSYLVANIA : / ~ SS COUNTY OF W~ : ON THIS, the ~ OfU/~~OOl, before me, the undersigned officer, personally appeared SANDRA K. IRISH, EXECUTRIX OF THE ESTATE OF BEULAH A. CALUPCA, aJkJa Boots A. Calupca, and SANDRA KAE IRISH, INDIVIDUALLY, known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. NOT ARIAl SEAL SUE ANN lESTER, NOTARY PUBLIC OREGON TWP.. WAYNE COUNTY MY COMMISSION EXPIRES OCT. 11, 201M COMMONWEALTH OF PENNSYLVANIA COUNTY OF Jr \L ON THIS, the I b 1'9 day of act.\1b~r-< , 2001, before me, the undersigned officer, personally appeared FREDRICK L. WEIGEL, known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. SS IN WITNESS WHEREOF, notarial seal. P B I NOTARIAL SEAL J. RICHARDSON, JR., Notary Public DlfIsburg Boro. York County My Commisslln Expires Oct. 30, 2004 COMMONWEALTH OF PENNSYLVANIA: SS COUNTY OF t r \<-. ON THIS, the ~day of OL \..,bnr , 2001, before me, the undersigned officer, personally appeared RICHARD L. WEIGEL, known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. NOTARIAL SEAL JOHN J. RICHARDSON, JR., Notarj Public DUlsburg BolO. York County My Commission Expires Oct. 30. 2004 E X H I BIT "A" (First and Final Accounting) FIRST AND FINAL ACCOUNT ESTATE OF BEULAH A. CALUPCA'I also known as BOOTS A. CALUPCA ASSETS A.) MELLON BANK: Checking Account # 100-020-3230 $ 5,382.38 B.) MELLON BANK: Certificate of Deposit Account # 01120466 $ 33,457.50 C.) YEAGER'S PERSONAL CARE HOME: Reimbursement from Personal Care Home $ 667.15 D.) WESLEY AFFILIATE SERVICES, INC.: Death Benefit from Employment $ 2,000.00 E.) CUMBERLAND COUNTY NURSING HOME: Reimbursement from Nursing Home $ 4,316.30 F.) BLUE CROSS/BLUE SHIELD: Reimbursement from Insurance $ 166.80 TOTAL ASSETS $ 45,990.13 LIABILITIES A.) FUNERAL EXPENSES: 1). Myers Funeral Home $ 6,786.00 2). Gingrich Memorial $ 685.00 3). Luncheon (Funeral) $ 220.00 4). Flowers $ 280.00 5). Funeral Dress $ 125.00 B.) ADMINISTRATION COSTS: 1). Attorney's Fees $ 1,500.00 2). Register of Wills Cumberland County $ 99.00 3). The Sentinel $ 90.59 4). Cumberland County Law Journal $ 75.00 5). Register of Wills Cumberland County Inheritance Tax Return $ 1.625.83 TOTAL LIABILITIES PAID: $ 11,486.42 C.) FUNDS TO BE RETAINED PENDING COMPLETION OF ADMINISTRATION: $ 1,000.00 TOTAL LIABILITIES: $ 12,486.42 TOTAL ASSETS RECEIVED: $ 45,990.13 LESS TOTAL LIABILITIES: TOTAL FUNDS AVAILABLE FOR DISTRIBUTION: $ 12,486.42 $ 33,503.71 I, SANDRA K. IRISH, EXECUTRIX, do hereby state that the aforesaid First and Final Account is true and correct to the best of my knowledge, information and belief. /~k xJJ, ~ SANDRA K. IRISH, EXECUTRIX ESTATE BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA COMMONWEAL TH OF PENNSYLVANIA: 6~ SS COUNTY OF : ON THIS, the !]..E.- day Of()r~ ' 2001, before me, the undersigned officer, personally appeared SANDRA K. IRISH, EXECUTRIX OF THE ESTATE OF BEULAH A. CALUPCA, a/kla BOOTS A. CALUPCA, known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my seal. ~ NOTARIAL SEAL SUE ANN lESTER, NOTARY PUBlIC OREGON TWP., WAYNE COUNlY MY COMMISSION EXPIRES ocr. 11, 2tJ04 E X H I BIT "B" (Schedule of Distribution) Anthony J. Magnotta, Esquire Oxford Place Route 590 P.O. Box 408 Hawley, Pennsylvania 18428 (570) 226-5700 I.D.#: 37205 IN THE COURT OF COMMON PLEAS NINTH JUDICIAL DISTRICT COMMONWEALTH OF PENNSYLVANIA, CUMBERLAND COUNTY IN THE MATTER OF THE ESTATE OF BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA ORPHANS' COURT DIVISION FILE #: 2001-00490 ............................................................................................ .... ............................................................................................... . SCHEDULE OF DISTRIBUTION ................................................................. ................ ............... ............................................................. ..............................a.... I, Sandra K. Irish, Executrix of the Estate of Beulah A. Calupca, also known as Boots A. Calupca deceased, intend to make distribution as follows: (b). Richard L. Weigel $ 11,167.90 $ 11,167.90 (a). Sandra Kae Irish (c) . Fredrick L. Weigel $ 11,167.90 Each of the beneficiaries shall receive the aforesaid sums with a Receipt, Refunding, and Indemnification Agreement in substantially the form attached as Exhibit "C", attached hereto. /~j~ i Lt SANDRA K. IRISH, EXECUTRIX ESTATE BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA E X H I BIT "C" (Receipt, Refunding and Distribution Agreement) Anthony J. Magnotta, Esquire Oxford Place Route 590 P.O. Box 408 Hawley, Pennsylvania 18428 (570) 226-5700 I.D.#: 37205 IN THE COURT OF COMMON PLEAS NINTH JUDICIAL DISTRICT COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY IN THE MATTER OF THE ESTATE OF BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA ORPHANS' COURT DIVISION FILE #: 2001-00490 ....................... ..... .................................................................... .............. ... ... ... .... ........... .......................................................... RECEIPT, REFUNDING AND DISTRIBUTION AGREEMENT ............................................................................................... . ............................................................................................... . THE UNDERSIGNED, SANDRA KAE IRISH, under the Last Will and Testament of Beulah A. Calupca, also known as Boots A. Calupca, deceased, does hereby: 1). Acknowledge that she has examined and approved the First and Final Account and Schedule of Distribution. 2). Waives the filing of the Account and Schedule. 3). Acknowledges receipt of the sum of Eleven Thousand One Hundred Sixty-seven and 90/ 100ths ($11,167.90) 4). Releases Sandra K. Irish, Executrix of the Estate of Beulah A. Calupca, also known as Boots A. Calupca, her heirs, personal representatives and assigns from all liabilities, whether due to her negligence or otherwise, which she may have by reason of her administration of the estate. 5). Agrees to refund the Executrix, Sandra K. Irish, any portion of the distribution to which she is not entitled, and to the extent of said distribution, to indemnify the Executrix for claims made against her as Executrix and to reimburse to her all expenses and costs incurred in connection with any such claims. 6). Declares that the instrument shall be legally binding upon her personal representatives, successors and assIgns. ~~Ltjj ~~ Jr~ SANDRA KAE IRISH Individually COMMONWEALTH OF PENNSYLVANIA : U SS COUNTY OF ~ : ON THIS, the L day of OC)~ ' 2001, before me, the undersigned officer, personally appeared SANDRA KAE IRISH, Individually, known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. C Sl1I2-'f+'nnd~la( NOTARY PUBLIC NOTARIAL SEAL IU[ ANN lESTER, NOTARY PUBlIC OREGON TWP.. WAYNE COUNTY MY COMMISSION EXPIRES OCT. 11,2004 An thony J. Magnotta, Esquire Oxford Place Route 590 P.O. Box 408 Hawley, Pennsylvania 18428 (570) 226-5700 I.D.#: 37205 IN THE COURT OF COMMON PLEAS NINTH JUDICIAL DISTRICT COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY IN THE MATTER OF THE ESTATE OF BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA ORPHANS' COURT DIVISION FILE #: 2001-00490 ............................................................................................ .... ..................................................................................... .... ... .... RECEIPT. REFUNDING AND DISTRIBUTION AGREEMENT ...................................................... ....... ........................ ........... ...................................................... .... ............. ...... ..... .............. THE UNDERSIGNED, FREDRICK L. WEIGEL, under the Last Will and Testament of Beulah A. Calupca, also known as Boots A. Calupca, deceased, does hereby: 1). Acknowledge that he has examined and approved the First and Final Account and Schedule of Distribution. 2). Waives the filing of the Account and Schedule. 3). Acknowledges receipt of the sum of Eleven Thousand One Hundred Sixty-seven and 90/ 100ths ($11,167.90). 4). Releases Sandra K. Irish, Executrix of the Estate of Beulah A. Calupca, also known as Boots A. Calupca, her heirs, personal representatives and assigns from allliabilities, whether due to her negligence or otherwise, which she may have by reason of her administration of the estate. 5). Agrees to refund the Executrix, Sandra K. Irish, any portion of the distribution to which he is not entitled, and to the extent of said distribution, to indemnify the Executrix for claims made against her as Executrix and to reimburse to her all expenses and costs incurred in connection with any such claims. 6). Declares that the instrument shall be legally binding upon his personal representatives, successors and assIgns. COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~r'\<" ON THIS, the J ~t~; day of i.1 (\vhh'" , 2001, before me, the undersigned officer, personally appeared FREDRICK L. WEIGEL, known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. SS IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. 1W. '....1... i ..'!1tiI\llI'4f'~"""~lj, NOTARiAl SEAL ,:OHN J. RICHARDSON, JR, Notary Public DlIlsburg Boro. York County }! Commission Expires Oct 30, 2004 An thony J. Magnotta, Esquire Oxford Place Route 590 P.O. Box 408 Hawley, Pennsylvania 18428 (570) 226-5700 I.D.#: 37205 IN THE COURT OF COMMON PLEAS NINTH JUDICIAL DISTRICT COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY IN THE MATIER OF THE ESTATE OF BEULAH A. CALUPCA, also known as BOOTS A. CALUPCA ORPHANS' COURT DIVISION FILE #: 2001-00490 .................................................................... ...... ... ..... ... ........... ....................................................................... ......................... RECEIPT. REFUNDING AND DISTRIBUTION AGREEMENT ...................................................... .......................................... ............................................ ...... ........ ...................................... THE UNDERSIGNED, RICHARD L. WEIGEL, under the Last Will and Testament of Beulah A. Calupca, also known as Boots A. Calupca, deceased, does hereby: 1). Acknowledge that he has examined and approved the First and Final Account and Schedule of Distribution. 2). Waives the filing of the Account and Schedule. 3). Acknowledges receipt of the sum of Eleven Thousand One Hundred Sixty-seven and 90/ 100ths ($11,167.90). 4). Releases Sandra K. Irish, Executrix of the Estate of Beulah A. Calupca, also known as Boots A. Calupca, her heirs, personal representatives and assigns from all liabilities, whether due to her negligence or otherwise, which she may have by reason of her administration of the estate. 5). Agrees to refund the Executrix, Sandra K. Irish, any portion of the distribution to which he is not entitled, and to the extent of said distribution, to indemnify the Executrix for claims made against her as Executrix and to reimburse to her all expenses and costs incurred in connection with any such claims. 6). Declares that the instrument shall be legally binding upon his personal representatives, successors and assIgns. -C;;~!J~ RICHARD L. WEIGEL COMMONWEALTH OF PENNSYLVANIA COUNTY OF r;:rk SS ON THIS, the 1 b th day of <J c\l}b t~ , 2001, before me, the undersigned officer, personally appeared RICHARD L. WEIGEL, known to me, or satisfactorily proven, to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. ~, LIC NOTARIAL SEAL ~.M J. RICHARDSON, JR., Notary Public . DlIIsburg Bore. York County fJrJ Commisskm Expires Oct. 30. 2004 ~ Ib-~/-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 Recoroeci Registe" of vV ills DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-03-2001 CALUPCA 04-09-2001 21 01-0490 CUMBERLAND 101 .01 ole -7 All :34 ANTHONY J MAGNOTTA ESQ OXFORD PL RTE 590 ClerkC- ~~W~~~ 408 P~~lIRrz~ld C;~-~Cp~ * REV-1547 EX AFP 02-00l BEULAH A Amount Remitted ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 45,990.13 .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 ~ iffy =iS4-j-i'X--AFP-fi"2---ooi--Noi"-ici--OF-.rNHiifiiAifcE-i"Ax-jrpPRAisiHENT~--ALi-owAi'-cE-oR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CALUPCA BEULAH A FILE NO. 21 01-0490 ACN 101 DATE 12-03-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 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) (10) .00 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 45,990.13 9 860 -;9 36,129.54 .00 36,129.54 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 9.860.59 (11) (12) (13) (14) (15) .00 X 00 = .00 (16) 36,129.54 X 045 = 1,625.83 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 1,625.83 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-10-2001 CDOO0388 .00 1,625.83 TOTAL TAX CREDIT 1,625.83 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.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1 162 EX(1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MAGNOTTA ANTHONY J OXFORD PLACE ROUTE 590 POBOX 408 HAWLEY, PA 18428 -------- fold ESTATE INFORMATION: SSN: 182-22-8970 FILE NUMBER: 21-2001- 0490 DECEDENT NAME: CALUPCA BEULAH A DA TE OF PAYMENT: 10/15/2001 POSTMARK DATE: 10/10/2001 COUNTY: CUMBERLAND DATE OF DEATH: 04/09/2001 NO. CD 000388 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,625.83 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ANTHONY J MAGNOTTA ESQUIRE CHECK#108 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $1,625.83 MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUR~AU O~ INDIVIDUAL TAXES INHlRITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX COP'{ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-03-2001 CALUPCA 04-09-2001 21 01-0490 CUMBERLAND 101 ANTHONY J MAGNOTTA ESQ OXFORD PL RTE 590 PO BOX 408 HAWLEY PA 18428 * REY-1547 EX AFP (12-00> BEULAH A 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 ~ ffEV"=is4j-ix--AFP-fi'2=ool--No'T-icE--oF--rNHEifiTAifci-i"-AX-APPRAisEirENT~--ALi-oWAiiCE-(fR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CALUPCA BEULAH A FILE NO. 21 01-0490 ACN 101 DATE 12-03-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 11, 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 (IS) 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: .00 X 00 = .00 36,129.54 X 045 = 1,625.83 .00 X 12 = .00 .00 X 15 = .00 ll9)= 1,625.83 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 ll) (2) (3) (4) (S) (6) (7) .00 .00 .00 .00 45.990.13 .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 .00 (9) llO) 9.860.59 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 45,990.13 ll1> ll2) ll3) ll4) 9 860 1i9 36,129.54 .00 36,129.54 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-10-2001 CDOO0388 .00 1,625.83 TOTAL TAX CREDIT 1,625.83 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.) 'tJI .......... ~ Q: P y .1~1; \,~, !\/\,~ v /,\r+- h \J\ / "'~ I, ~ \ 'j , 'v STATUS REPORT UNDER RULE 6.12 Name of Decedent: BEULAH A. CALUPCA Date of Death: April 9,2001 Will No.: File #: 2001-00490 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: (1 LJ uf- V 1. State whether administration of the estate is complete: Yes B No 0 *SEE ATTACHED STATEMENT OF ACCOUNTING REFLECTING "0" BALANCt< 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 [] *ESTATE SETTLEMENT AGREEMENT WAS FILED WITH THE COURT ON NOVEMBER 5, 2001 b. The separate Orphans' Court No. (if any) for the personal representative's account is: 1l1L c. Did the personal representative state an account informally to the parties in interest? Yes @ No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date:May 22, 2003 J~~~. Signature i/ co ('Y' 0.1 Anthony J. Magnotta, Esquire Name Oxford Place Route 590 P.O. Box 408 Hawley, PA 18428 Address ..-.. ..- .......::.... f'..,. N :.:-. ~ , LI {.) s:;.- 03:; :;:(3 (570)-226-5700 Telephone No. Capacity: 0 Personal Representative XX] Counsel for personal representative REV.tSOO EX 1~>OOl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 OFfiCIAL USE ONLY w >- :.:::!lU) " ."" w"" :Coo ,,"'-' ..Ill ~ INHERITANCE TAX RETURN FILE NUMBER c:l.. / -.0 L RESIDENT DECEDENT CaUNlYeaDE YEAR - NUMBE~ <f.L2- I- Z w Q w (J W Q DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Calupc~, Beulah A. a/k/a Calu ca Boots A. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) April 9, 2001 October 21 1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 182 22 - 8970 G11. Original Return D 4. limited Estate [R] 6. Decedent Died Testate (Attadl oopY of Will) D 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale ofc1ealtl after 12-12.82) o 7. Decedent Maintained a Living Trust (Attach copy of Trusl) o 10. Spousal Poverty Credit (date of dealh 0elweef112-31-91 and 1-1-95) D 3. Remainder Return (date of death poor to \2-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attacn SchO) .... z w c z o .. ., w '" '" o " IS SEctrON MUST,BECOMPLETED. ALL CORRESPONDENCE AND, ONFIDEN TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS n FIRM NAME (If Applicable) Oxford Place Route 590 P.O.Box 408 Hawley, PA 18428 TELEPHONE NUMBER (570)-226-5700 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (S) OFFICIAL USE ONLY 3. Closely Held Corporation, Partnership or Sole-Proprietorship n - 0 - - 0 - o $45,990.13 - 0 - z o ~ :;:) l- ii: <C (J W D:: 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) o Separate Bilting Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (tolallines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (Line 8 minus Une 11) (II) 9,860.59 (12) $36,129.54 (13) 0 (14) $36,129.54 (6) (7) - 0 - (6) $45,990.13 (9) (10) - 0 - $ 9.860.59 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-' :;:) ll. :::e o (J >< ~ 15. Amount of Line 14 taxable at the spousal lax rate, or transfers under Sec. 9116 (a)(1.2) '.0_ (15) ,,04..5.... (16) $ 1 , 67.~ R1 $36.129.54 16. Amount of line 14 taxable at lineal rate 17. Amount of line 141axab!e at sibling rate , .12 (17) 18. Amount of line 14 taxable at collateral rale , .15 (18) 19. Tax Due (19) $1.625.83 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT , > >.BE SURE TO ANSWER ALL QUESTIONS OM REVERSE'SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 24 Homewood street CITY Dillsbura I STATE I ZIP PA 17019 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) $1,625.83 - 0 - - 0 - - 0 - Total Credits (A + 8 + C) (2) - 0 - 3. InterestlPenalty if applicable D. Interest E. Penalty $1,625.83 TotallnteresVPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Pagel 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. A. Enter the interest on the tax due. (5) (SA) 8. Enter the total of Line 5 + SA. This is the 8ALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT '.. ,~\~.~'~~~:"',,'.:.-;'ff;~:';';'~;i::;}~~~7;;~,~';~mt'd:4-n'f;i-~"P!--~~_7.z;;;r"?iF-.lj:;~~?.:.:..-::~~:;?.~~;N...2~A.~"Q~1~~fl1~~~~~ $1,625.83 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves a. retain the use or income of the property transferred;.......................................................................................... 0 b retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or ...................................................................................................................""..". 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an .in trust fo~ or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 No l&J ~ fi fi Q IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under penalties of pe~urf. I declare that I ha....e 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 personal representative is based on all informabon of which pre parer has any knowledge. PERSON RESPONSIBLE RFIU RETURN (Sandra K. Irish, Executrix) DATE ADDRESS HC#l, Box 525, Lakeville, Pennsylvania 18438 SIGNATURE OF PR.S7E~\RER OTHER T. HAN REPRESENTATIVE (Anthony J. Magnotta, Esquire) IFrrt{ ~} ~ ADDRESS v Oxford Place Route 590, P.O. Box 408, Hawley, PA 18428 tJ -'7-0/ DATE /0-10-01 l:,~,i~>A~,~_~G?:',~{~:i.~~J:/,:tR-t:.~~r.r~_1'~~J$j~~~~L. '~~31,:&;m~u:&tj;}-~,~ 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. ~9116 (a) (1.1) (i)]. 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. ~9118 (a) (1.1) (iill. 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 still applicable even jf 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)(1.211. 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 P.S. ~9116(a)(1)1. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(9.)(1.3)]. A sibling IS defined, under Section 9';J2, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ""'''''EXo[,m,* COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Calupca, Beulah SCHEDULE A REAL ESTATE A., a/k/a Calupca, Boots A. FILE NUMBER All real property owned solely Of 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 arid a willing seUe(, neither being compelled to buy or sen, both having reasonable Koowledge 01 the relevant facts. Real property which is jointty-owned with right of survivorshin must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) RfV_'~'''.'''"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Galupca, Beulah A., a/k/a Calupca, Boots A. FILE NUMBER All property jointly-owned with right of SUNlvol1hlp must be disclosed on Schedule F, ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. None TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV''''''.',.,,* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C 1 a upca, Beulah SCHEDULE C CLOSEL Y.HELD CORPORATION, PARTNERSHIP or SOLE.PROPRIETORSHIP A. a/k/a Calupca, Boots A. FILE NUMBER Schedule C-' or C-2 (Induding all supporting information) must be attached for each cIoseiy-l1eld corporation/partnelllhip interest of the decedent other than a sole-pl1lpnetolllhip. See instructions for the supporting information to be submitted for soJe-proprietorships. iTEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-l5C6E)(.(l-971 '*' SCHEDULE C.1 CLOSELY.HELD CORPORATE STOCK INFORMATION REPORT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Calu~ca, Beulah A., a/k/a Calupca, Boots A. FILE NUMBER 1. Name of Corporation Address City 2. Federal Employer 1.0. Number 3. Type of Business N/A State ~p Code State of Incorporation Date of InCOlpOration Total Number of Shareholders Business Reporting Year Product/Servioe 4. TYPE I TOTAL NUMBER OF NUMBER OF SHARES VALUE OFTHE STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDEN I DECEDENT'S STOCK Common $ Preferred $ Provide all nghts and restnctions pertaining to each class of stock. 5. Was the deoedent employed by the Corporation? if yes, Position DYes 0 No Annual Salary $ Time Devoted to Bus".: ss 6. Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the deoedent? 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy DYes o No 8. Did the deoedent sell or transfer stock of this company within one year pnorto death or within two years if the date of death was pnor to 12-31-82? DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. Consideration $ Date 9. Was there a wntten sharehoiders agreement in effect at the time of the deoedent's death? If yes, provide a copy of the agreement. DYes o No 10. Was the decedenfs stock sold? 0 Yes If yes, provide a copy of the agreement of sale, etc. o No 11. Was the corporation dissolved or iiquidated after the deoedent's death? 0 Yes 0 No If yes, provide a breakdown of distnbutions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. " A. B. C. Detaiied calculations used in the valuation of the deoedent's stock. Complete copies of financial statements or Federal Corporate Income Tax retums (Form 1120) for the year of death and 4 preoeding years. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market value/s. If real estate appraisals have been secured, attach copies. List of pnncipal stockholders at the date of death, number of shares held and their relationship to the deoedent. List of offioers, their salanes, bonuses and any other benefits received from the corporation. Statement of dividends paid each year. List those declared and unpaid. Any olher information relating to the valuation of the decedent's stock. D. E. F. G. REV-1507 EX+ (1-97) ~' . .9"J~,Q ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF Calupca, Beulah A., a/k/a Calupca, Boots A.FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. None TOTAL (Also enter on line 4. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) "":',","'.i"''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Calupca, Beulah A., a/k/a Calupca, Boots A. FILE NUMBER 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 VALUE AT DATE OF DEATH ::; 5,382.38 Mellon Bank Checking Account # 100-020-3230 2. Mellon Bank Certificate of Deposit # 01120466 $33,457.50 3. Yeagers Personal Care Home Reimbursement for pre-paid items 667.15 4. Wesley Affiliated Services, Inc. Death benefit from employment 2,000.00 5. Cumberland County Nursing Home Reimbursement 4,316.30 6. Blue Cross / Blue Shield Reimbursment 166.80 TOTAL (Also enter on line 5, Recapitulation) 545, 990. 1 3 (If more space IS needed, insert additional sheets of the same size) REV'&19""""* SCHEDULE F JOINTL Y.OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1 Ca upca, Beulah A., a/k/a Calupca, Boots A. If an ISlet was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. None 8. c. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %0' DATE Of DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Atta:h DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for joinUy-held real estate. VAlUE OF ASSET INTEREST DECEDENT~!NTEREST 1. A. ~ TOTAL (Also enteron line 6, Recapitulation) $ - (If more space is needed, insert additional sheets of the same size) e",,,,oex.,,,.,,,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Calupca, Beulah SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY A., a/k/a Calupca, Boots A. FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDETH~NAMEOFTHETRANSFEREE, THEIRRELATION$HIPTODECEDENTANDTHE DATE OF ,PANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COP'V OF THE DEED FORRE.o\L ESIATE. VALUE OF ASSET INTEREST (:FAPf'LlCA8lE\ NUMBER 1, None I I I I I i I I I , I I I I I , i TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) REV"""'''O''.~... .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRA TlVE COSTS ESTATE OF Calupca, Beulah A., a/k/a Calupca, Boots A. FILE NUMBER Debts of decedent must be reported on Schedule I ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. Myers Funeral $6,786.00 Home Gingrich Memorial $ 685.00 Funeral luncheon $ 220.00 Flowers $ 280.00 , Funeral dress $ 125.00 B. ADMINISTRATIVE COSTS Personal Representative's CommiSSions None Name of Personal Representative (5) Sandra K. Irish Social Security Number(s) f E1N Number of Persona! Representative(s) . Streel Address HC#1 Box 52') C;ly Lakeville State PA Z;p 1843R .. N/A Year(s) Commission Paid: Anthony Magnotta, Esquire (to be paid 2. Attorney Fees - J. calendar yr 2001 $1,500.00 3. Family Exemption: (If decedenrs address is nollhe same as claimant's, attach explanation) Claimant Street Address City State lip Relationship of Claimant to Decedent 4. Probate Fees - Register of Wills Cumberland County $ 99.00 - The Sentinel I 90.59 Accountant's Fees- Cumberland County Law Journal 75.00 5. None 6. Tax Return Preparer's Fees - None 7. TOTAL (Also enter on I;ne 9, Recapitulation) $ 9,860.59 (if more space is needed, insert additional sheets of the same size) "':""'.""". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Calupca, Beulah A., a/k/a Calupca, Boots A. FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER 1. None DESCRIPTION AMOUNT TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, Insen additional sheets of the same size) ;;~-15'3EX'I1.S/, ~ .~ '~' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESI~ENT D CEDENT SCHEDULE J BENEFICIARIES ESTATE OF Calupca, Beulah A., a/k/a Calupca, Boots A. FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do NotUstTrustee(s) OF ESTATE 1. Sandra K. Irish HCN1, Box 525 Lakeville, FA 18438 Daughter 1/3 of Estate 2. Fredrick L. Weigel 3 Brandywine Drive Mechanicsburg, FA 17055 Son 1/3 of Estate 3. Richard L. Weigel 24 Homewood Street Dillsburg, FA 17019 Son 1/3 of Estate ENTER DOLLAR AMOUNTS FOR DISTRiBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 None TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space IS neeaeo. rnsen additional sneets of the same Size) REV.1644 EX+ (3-84) INHERITANCE TAX -ti!- SCHEDULE "L" COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION INHERITANCE TAX RETURN RESIDENT DECEDENT OF TRUST PRINCIPAL FilE NUMBER I. Estate of Calupca, Beulah A., a/k/a Calupca, Boots A. - (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. Remainder Prepayment: A. Election to prepay filed with the Register of Wills on N/A (Dote) (attach copy of election) B. Name(s) of life Tenant(s) Date of Bi..th Age on date Term of years income or Annuitant(s) of election or annuity is payable e. Assets: Complete Schedule l.l 1. Real Estate S 2. Stocks and Bonds S 3. Closely Held Stock/Partnership S 4. Mortgages and Notes S 5. Cash/Misc. Personal Property S 6. Total from Schedule L- 1 S D. Credits: Complete Schedule L.2 1. Unpaid liabilities S 2. Unpaid Bequests S 3. Value of Unincludable Assets S 4. Total from Schedule L.2 S E. Total value of trust assets (line C-6 minus line 0.4) S F. Remainder factor (see Table I or Table II in Instruction Booklet) G. Taxable Remainder value (line E x line F) S (Also enter on line 7, Recapitulation) ." III. Invasion of Corpus: A. Invasion of corpus (Month, Day, Vear) B. Name(s) of Life Tenant(s) Date of Bi rth Age on date Term of years income or Annuitant(s) corpus consumed or annuity is payable C. Corpus consumed S D. Remainder factor (see Table I or Table II in Instruction Booklet) S E. Taxable value of corpus consumed (line C x line D) S (Also enter on Line 7, Recapitulation) REV.1646,EX+ (3-84) INHERITANCE TAX * SCHEDULE L-2 COMMONWEALTH OF PENNSYlVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER I. Estate of Cal upca, Beulah A., a/k/a Calupca, Boots A. - (Last Name) (First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilitie. Claimed again'I Original E.tale, and payable f,am asset. reported on Schedule L- 1 (plea.e li.I) N/A T atal unpaid liabililie. S (include on Seclian II, Line 0- 1 on Schedule L) B. Unpaid Beque'I' payable from assel. reporled on Schedule L-1 (plea.e Ii.I) T olal unpaid beque'I' S (include on Sedion II, Line 0-2 on Schedule L) C. Value of asset. reported on Schedule L-1 (olher Ihan unpaid beque.I.li.led under "B" above) that ore not included for tax purposes or that do not form 0 port of the Iru.t. Campulalion as follows: - Total unincludable assets S (include on Sedion II, Line 0-3 on Schedule Ll III. TOTAL (AI.o enler on Sedion II, Line 0-4 on Schedule Ll S (If more 'pace i. needed, altach additianal BY, x 11 sheet..) "".,,,,.,,,.,..,,,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEOENT SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev.1500 Cover Sheet ESTATE OF FILE NUMBER Calupca, Beulah A., a/k/a Calupca, Boots A. This schedule is appropriate only for estates of decedents dying after December 12,1982. This schedule is to be used for ail future interests where the rate of tax which wiil be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. o Will 0 Trust 0 Other I. Beneficiaries NAME OF AGE TO BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. o Unlimited right of withdrawal o Limited right of withdrawal III. Explanation of Compromise Offer: N/A ~ IV. Summary of Compromise Offer: 1. Amount of Future Interest $ 2. Value of Line 1 exempt from tax as amount passing to chanties, etc. (also include as part of total shown on Line 13 of Cover Sheet) $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One 06%, 03%, 00% (also include as part of total shown on Line 15 of Cover Sheet) $ 4. Value of Line 1 Taxable at 6% Rate (also include as part of total shown on Line 16 of Cover Sheet) $ 5. Value oWne 1 Taxable at 15% Rate (also include as part of total shown on Line 17 of Cover Sheet) $ 6. Total value of Future Interesl(sum of Lines 2 thru 5 must equal Line 1) $ (If more space is needed, insert additional sheets of the same size) REY-1648 EX (1_92) . . ~\~:~ ....:....~'....... COMMONWEALTH OF PENNSYLANIA INHERITANCE TAX DIVISION ESTATE OF Calupca, Beulah A., a/k/a Calupca, Boots A. SCHEDULE N SPOUSAL POVERTY CREDIT AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91) FILE NUMBER This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. PART I - CALCULATION OF GROSS ESTATE ......... .......... ....... ................. 1. ................... ...... ........ ... .... 2. ................. ............. ....... ..... 3. .............. ............. ........ ....... 4. ............. ..... ................ 5. 60. 6b. 6e. 6d. ................ ............................ 6. ............................................. 7. ............................................. 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............ 9. 'm the credit. If not, continue to Part II. PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income Tax Returns for decedent and spouse. ) Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 o. Spouse ..... .......... ..... 10. 20. 30. b. Decedent ............ ...... 1 b. 2b. 3b. c. Joint .......... ..... ........ Ie. 2e. 3e. d. Tax Exempt Income..... ld. 2d. 3d. e. Other Income not listed above ........... Ie. 2e. 3e. I. Total.... ..................... H. 21 31. 1. Taxable Assets total from line 8 (cover sheet) ................N./.A 2. Insurance Proceeds on Life of Decedent ...... 3. Retirement Benefits. 4. Joint Assets with Spouse .... 5. PA Lottery Winnings 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6. SUBTOT AL (Lines 60, b, e, d) ........ 7. Total Gross Assets (Add lines 1 thru 6). 8. Total Actual Liabilities ....................................................... 9. Net Value of Estate (Subtract line 8 from line 7) .................. If line 9 is greoter than $200,000. STOP. The estate is nof eligible to clOI 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (HI + (21) + (311 = (+ 3) 4b. Average Joint Exemption Income ........................... ................... ..................................... = If line 4(b) is greater than $40,000 . STOP. The estate is not eligible to claim the credit. If not, continue fo Part /fl. PART III - CALCULATION C1F SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES . 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less 1. 2. 3. Multiply by credit percentage (see instructionsl.......... ......................... ............................. 2. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of fatal credits on line 18 of the cover sheet. ..................... For Nonresidents, enter the ratio of the decedent's gross estate In PA to the value of the decedent's gross estate . . Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this fiaure in the calculation of total credits on line 18 of the cover sheet 4. 3. 5. ~-- , 5.! """~"'I,.n.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF Cal upca, Beulah SCHEDULE 0 ELECTION UNDER SEC. 9113(A) SPOUSAL DISTRIBUTIONS A., a/k/a Calupca, Boots A. FILE NUMBER Do not complete llils schedule unless the estate Is making the electlon to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, S, By-pass, Unified Credit, etc.). It a lrust or similar arrangement meets the recuirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is enlered in whole or in part as an asset on Schedule 0, then the transferors personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trusl or similar property treated as a taxable transfer in this eslate. If less than the entire value of the trusl or similar property is included as a taxable transfer on Schedule 0, Ihe personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is ecual to the amount of the trust or similar arrangement included as a taxable asset on Schede:) O. The denominator is ecual to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both tax~bie and non-taxable, regardless of location, which pass to the decedent's survivino soouse under a Section 9113 (A) trust or similar arranaement. DESCRIPTION VAlUE N/A Part A Total $ PART B: Enter the descriotion and value of all interests included in Part A for which the Section 9113 (AI election to tax is beino made. DESCRIPTION VAlUE Part B Total $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF BEULAH A. CALUPCA, ALSO KNOWN AS BOOTS A. CALUPCA LAST WILL AND TESTAMENT OF BEULAH A. CALUPCA lei) i/,!! /: - '0Lf ~ Beulah A. Calupca, also known as Boots. A. Calupca, presently residing at #8A Hemlock Glen, in the town of Tafton, County of Pike and State of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my last will and testament. First: I hereby revoke all former Wills and Codicils heretofore made by me. Second: I direct that my Executor pay and discharge all of my just debts, including the expenses of my last illness, funeral and administration expenses as soon as shall be practicable. I further direct that any and all federal, state, foreign or other estate, transfer, inheritance, succession, legacy and similar taxes, including interest and penalties thereon, if any, imposed upon or with respect to any property required to be included in my gross estate under the provisions of any such tax law, and whether passing hereunder or by any Codicil hp~eto or otherwise, or upon or with resp~ct to any person with respect to any such property, shall be paid out of my residuary estate as an expense of administration and shall not be equitably prorated or charged--'against. the gifts provided herein. Third: I give, devise and bequeath all of the rest, residue and remainder of my property, real, personal and mixed, of whatsoever kind and nature and wheresoever situated, of which I shall die seized or possessed, and all property over or with respect to which I shall have any power of appointment, remaining after payment of my debts, funeral and administration expenses and any taxes which may be payable, absolutely and forever to my children in equal shares; Sandra Kae Irish, residing at #8A Hemlock Glen, Tafton,. Pennsylvania; Richard L. Weigle, residing at 29 Homewood Dr., Dillsburg, Pennsylvania and Fredrick L. Weigel, residing at 3 Brandywine Dr., Mechanicsburg, Pennsylvania, should any of my children fail to survive me, I give, devise and bequeath all of my said property to my issue, in equal shares per stirpes. Fourth: In the event that any of the legatees under this will shall die with me in a common accident or disaster, or under such circumstances as make it impossible or difficult to determine which of us died first or in the event that any such legatee shall die within sixty (60) days of my death, regardless of the circumstances, it shall be conclusively presumed that such legatee shall have predeceased me and deemed not to have survived me. Fifth: I nominate, constitute and appoint Sandra Kae Irish, presently residing at #8A Hemlock Glen, Tafton, Pennsylvania, as the Executor of this Will. In the event of her death or resignation or failure or refusal to act in said capacity, I nominate, constitute and appoint Richard L. Weigel, presently residing at 29 Homewood Drive, Dillsburg, Pennsylvania as the successor Executor of this will. Sixth: I direct that no bond, security or other undertaking shall be imposed upon or required ~t any time or in any jurisdiction of any individual named herein for the faithful performance of (his)(her) duties. IN WITNESS WHEREOF, I have set my hand and seal this I'~ day of 1:/-:./ J- . 1995. ~~M~ 0<'/ &~~ BEULAH A. CALUPCA -I3J-P-U-- =-. ~~ BOOTS A. CALUPCA The foregoing consisting of 3 pages inclusive of this page, the original of which was signed or initialled by the above testator prior to the execution thereof, was signed, published and declared by said test...(tor as and for her Last Will and Testan.ant, in our presence and hearing and we thereupon, at her request, and in the presence of B3ch other subscribed our names as witnesses this g-ih day of F--'Ll/l_'-'-C~;"-J- 1995. (1) ft'-' "i- k--\ntt .~, \ residing at p., ~ \ 'i __\,'\1" C\ ) ,l ~I \ 2)'-G!o I \ '/ ----/ (d~L-a._.!.i.:-?:.-c'("/~'- residing at IJ'l i ,/1,;/,/"9d Ii- t.. r} ;P'/';'j/ j (2 ) ( 3 ) 7;~?<.A ~o/l Cr<-' residing at c1l1 ~'"U, 9 ~,L.~tJi cfr~ "g- , /g,.-.::> ACKNOWLEDGEMENT STATE OF PENNSYLVANIA COUNTY OF WAYNE Date: FEBRUARY 9, 1995 3efore me, the undersigned Notary Public, personally appeared the above Signatory and Witnesses, respectively, known to me or satisfactorily proven to be the person who:;e names are subscribed to this instrument. These persons, being duly sworn, did hereby declare that Signatory signed and executed this instrument as Signatory's Last Will and Testament and had signed willingly or directed another to sign and executed it as Signatory's free and voluntary act for the purposes therein expressed, and that each of the Witnesses, in the presence of Signatory, signed this Last Will and Testament as witnesses and that to the best of their knowledge, Signc.l..ory was at the time an adult, of sou,,,.! mind and under no constraint or undue influence. This instrument was subscribed, sworn and acknowledged before me. c::;f)CLu--'u.,; , ~,. ~c-pJ Notary publi My Commission Expires: NoIsriaI Seal UIJI1e J. BishoP. Notary Public HonesdaJe Bcro, Way,..., County My CorTll11lSSlOn Expires Feb. 18. 1995 ...' ~J