The URL can be used to link to this page

Home My WebLink About01-0505 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION 21-01-505 Decea~d. ~OO - <;9- 75 s. Social Security No. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl jqS for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in CUfr~tr /:!#ViJ . Cou!)I,Y, Pennsylvania, wit)! h last family or principal residence at I 6;0 B(.()~Gid rST(!.4~n?M> / "GH (list street, number and municipality) Dece ent, then years f age, d. d -fh, ~2o~ / , at f" OS , Scv<~ .) Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ ~CJQ~o, $ $ $ Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence ~M///'# 'a4J/ THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. t ~(lIIIt~ e KUs I/KlJ ~bA,;f<~ ~If:o .C;;~ P. 1J~ ~33 ~ ~ ~ 6/ J S 0 I'LTIt 't / S'.:3d / c.=: ~..= 3~ v'- 50 ~ t:: 00 en /b-~c:L--9 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } ss (,> 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 above decedent petitioner(s) will well and _ truly administer the estate according to law. , ~;{. t-~c:iJ Sworn to or affirmed and subscribed f ~- - -~- - before me this 21 s t day of ~ ~y B2001 B - __-'~yfl~"U'''f'ilhi4C~u~ ~ :; R~~~r {_ ~ No. 21-01-505 Estate of CHRISTOPHER KEITH RUSILKO , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW MAY 24 ~200 1 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that RICHARD CRUS ILKO is/ are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to RICHARD C RUSILKO CHRISTOPHER KEITH RUSILKO in the estate of >7"7 (2~m~ ~ .Rbt)~.I') Regis of Wills ~ FEES Letters of Administration $ 235.00 Short Certificates( ).......... $ 30.00 Renunciation ................ $ 5 . 00 JCP $ 5.00 TOTAL _ $ 275.00 Filed ..... MY. .2.~ . . . . . . .. A.D. 32001 ATTORNEY (Sup. Ct. LD. No.) ADDRESS PHONE u~"::::;.C'n< '=',r.'\' ('I'C'r:, This is to. certifY that t~e. inform~tion he~e given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The ongmal certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7252936 No. 1D r' ~df::R~ MAY 18 2001 Date HIOS.143Rev.2117 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH STOll>" "'*HJl Cumberland County 1~:'-"'-=-':::aI camp Hill Bora ~:~~r;.~._s..._' , .li....Il.Hi,,\DClAE~~....CIY/Tc>Mo.. PPCodeI OX .U, tmswonn. Y^. 153il LOCAnON. c~ sw.. z;peo. npEIf'_T IN "_NT IILAC:l( _ ~ale -.A( Df,CEDEN1;cf... ~"~ ilk I. Lhnstopher Ke1m KUS 0 UNOeR 1 YEAR - ! o.v. IllnM'LACi lClY- CIev:J:J: ()h: CcIuowYl Jl .... j1- o III ;;) , ::; c om; I'ROHOUHCEO DIAD\MClfII\. o.v. _I MA'f H.. 00 I ... U._I: E_IIle_.injuriM...~__.._ Do...._IIle_aldying._....-.. L. ....,__... __. DAlE OF DEATH ~ Oo,l,:"'''1!!I .. May, 10, i:uul ~IO SUA\/IVNllll'OUSE 1--._-- - ~ Beallsville, P A 15313 LICENSE NUMllEA DATE SllINED .Doy. .....1 MS CASE AEFEIlAEDTO MEDCAL ElCAMINE .....0 No~ acory ........ Ihoc;;k Of hMft tailuf. I~ . ................. l--- , : I'AIlT II: 0lIler....-_--.e1O_.bu1 _.-lng in...-.,;ng_.....in!WIT I. f1 ~ '0 ::::S ..EW;NB i- S"'#c..O/Y'lA DUE 10 COR AS A CONSEQUENCE Of): /lI~~ L- II) '-ClN !Lit- JlV I : d. WERE AUla'SY FINDINGS --.El'NDfl1O ~IYCAUlilE GeRm DUE 10 COR AS A CONSEQUENCE OF}: DUE 10 COR AS A CONSEQUENCE Of): _R IY DEATH 0AT1; IY INJURY ........ Day. _, b -1: (1- ~ 0; t_ c~ __ II -.. 0 __ 0 ec..w_....._ l'endong~ _0 NoD __ __ :N. QIIJ..-AcOlecl< onI\r anal 'Q!IlT'-""YllQAllcPl\_~~fiI___,,,,_....._p<~lle""'''''''c~_231 ro__..""_.......____....._.,....._..._..................................... . z :!: w ~ Q ~ ~ c z ."IIONOUNCAHQ AND CERTifYING ....VSlCIAN (Phy5lC1aIl I:KMl ptonOUIICtIlC)~.tItI oMw;I C8f"'vInQ to cause 01 CMaIh\ To........ of lIlY knowledea. duW. occur,'" at......, ..... and pfac.. .ncI......... cauHte. and .a",,-,.. ...Ied., . . . . . 'MEDICAl. EXAMINERlCOROHlEA On _ __ of ...",Inatlon and/or inwel'l9aIlon. in "'~ opinion. d..th OCCUI'ad ..the ,...... d.... and p1.ce. and due Co 'he Cau"(I' and ......,..,.. atalH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _. . . . . . . . . . 3'.. REGlSTRAR'S SIGNATURE AND NUYIIER .~ I ~3. TIMElY INJURY INJURY R _, DESCRIIIE HOW INJURY DC:C\IRRED. ..... 0 HoD --A ,-.-- ~OOI RENUNCIATION ... In ReEstateof C~ f7s--/zJjJZ(!t fe/fit lur;;/Lo C!LfllDfJ/mvf ~/!i1zJ County, Pennsylvania. t lprla/L{Z ( Sa 1-( tr (7)/J~tJ3 J the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters ~J/{fufi;th~ lbd7a/Zd (} Lm(iI!!--li deceased. To the Register of Wills of The undersigned of be issued to WITNESS hand this 9P day of jJ{o d .~C) I tl{lJ1~tvV- YtU:J / (Signature) N1i6bt/c11:! 51 (kJupl//jl/!rf- (Address) (Signature) (Address) (Signature) (Address) €. Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) (!/f,nS+-oy;f)'er- K. I3.rstJKo ~- / ~ - ~ (}{) / Name of Decedent: Will No. Admin. No. o:;:)/-CJ/-~~~ 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 S-- -t5l '" : Name Address XIOM~ SAE./\/ r I'~() (!AM {J SNAEL.() HILL fJA {f-_ 170/1 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: J- ~3 -~'() I ~~ ~~O Signature Name ~ 1J,#I9.ed ~ ,4SI/!,k.o Address g tJ X. s-~ :r eUSJltJtJ~1I /lA 103/ Telephone {J;f ~? - .3 7,2 7 Capacity: V-::sonal Representative _Counsel for personal representative , ~. HURLEY STATE BANK Staples Credit Card Plan PO Box 7004 Sioux Falls, SD 57117 July 30, 2001 1-800-767-3460 Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013-3387 Proof of Claim State of South Dakota IN CIRCUIT COURT SSN: 200-48-7588 File Number: 21-2001-505 County of Cumberland Judicial Court IN THE MATTER OF THE ESTATE OF Christopher Rusilko, Deceased STATE OF South Dakota COUNTY OF Minnehaha Wanda Handevidt, being duly sworn, deposes and says that the amount of the annexed claim against the estate of Christopher Rusilko, deceased, is justly due and owing to said claimant, Staples, whose post office address is PO Box 7004, Sioux Falls, SD 57117 that no payments have been made thereon which are not credited upon said claim, and that there are no offsets or counterclaims against the same to knowledge of claimant or affiant. Acct# 7972130101921942 "IA ~. Balance: ,$790.98 * See attached sheet )/V{) YI/'h titl/J'?d.t J/}();f Subscribed and sworn to before me this ~ I {)- day of (11.,1 Ij 2C1J) ~ My commission Expires: 11/3/05 (Name 0 Office) The within claim was presented to me for allowance , 20_, allowed by me for of the Estate of dollars. 20 and Deceased. Allowed and approved by me 20 _, at the sum of Dollars. Judge of the Circuit Court HURLEY STATE BANK Staples Credit Card Plan PO Box 7004 Sioux Falls, SD 57117 July 30, 2001 1-800-767-3460 Richard C Rusilko POB 533 Ellsworth, P A 15331 Proof of Claim State of South Dakota IN CIRCUIT COURT SSN: 200-48-7588 File Number: 21-2001-505 County of Cumberland Judicial Court IN THE MATTER OF THE ESTATE OF Christopher Rusilko, Deceased STATE OF South Dakota COUNTY OF Minnehaha Wanda Handevidt, being duly sworn, deposes and says that the amount of the annexed claim against the estate of Christopher Rusilko, deceased, is justly due and owing to said claimant, Staples, whose post office address is PO Box 7004, Sioux Falls, SD 57117 that no payments have been made thereon which are not credited upon said claim, and that there are no offsets or counterclaims against the same to knowledge of claimant or affiant. ~~~~ :::ct~~Os~e~21942 Jif~~e:m~Jt?J /leu- Subscribed and sworn to before me this BIll day of (Tr .J:j 2m I ~ My commission Expires: 11/3/ !J5 (Name of Office) The within claim was presented to me for allowance , 20_, allowed by me for of the Estate of dollars. 20 and Deceased. Allowed and approved by me 20_, at the sum of Dollars. Judge of the Circuit Court . Account Statement Payment Due Date JUNE 17 2001 New Balance $790.98 Your Account Number 7972 1301 0192 1942 Minimum Payment Due Amount Enclosed $50. 00 $ 5OS2O 5OS2O I 1 22 B SL Make checks payable to; STAPLES PERSONAL CREDIT CARD 7972130101921942007909800025000005000 CHRISTOPHER RUSILKO 1950 ENFIELD ST CAMP HILL PA 17011-3721 111.111...11111....11.1111..11.1...1111.1...11.1.1.11..11.1.11 50529 B AVSL STAPLES PERSONAL CREDIT CARD PO BOX 9029 DES MOINES IA 50368-9029 1.1.1.11.....11..11..1..1.1.1..11.....1.11.1,,"1.11.1..111'II Print addre.. change. above. .. Plea.e detach here. Send Notice of Billing Errors to: STAPLES PERSONAL CREDIT CARD PO BOX 8181, GRAY TN 37615 Customer Service: 1-800-733-2713 THIS N;COUNT ISSUED BY ASSOCIATES CIPIT IV.. B,iWK Account: 7972 1301 0192 1942 Credit Available $0.00 Closin Date MAY 22, 2001 Previous Balance $748.35 CURRENT ACTIVITY Transaction Oat. 11000064340522000066630 OS/22 11000064340522000066640 OS/22 New Balance $790.98 Transactions LATE CHARGE ASSESSMENT *BILLED FINANCE CHARGES* Amount $ 29.00 $ 13.63 Our records show that we have not received the minimum amount necessary to keep your account current. If you have not mailed your payment, please do so today. We appreciate your business and look forward to serving you further. REVOLVING CREDIT PLAN Previous Balance $748.35 Billed FINANCE CHARGES $13.63 Payments & Credits Plan Balance $790.98 Minimum Monthly Payment $50.00 Accrued FINANCE CHARGES Ex. piration Date CREDIT PLAN SUMMARY RNANCE CHARGE SUMMARY Average Daily Balance DAILY Periodic Rate Corresponding ANNUAL PERCENTAGE RATE Days In Billing Period ANNUAL" PERCENTAGE RATE FINANCE CHARGES Miscellaneous Fees Current B.lllng per.od REVOLVING CREDIT PLAN $755.70 0.06016% 21 . 96"V 30 21.96"V $13.63 Previoua Billing Period REVOLVING CREDIT PLAN 0.06071" 22.16%V 31 *Includes periodic finance charge and transaction charges. ACSNC 1 V;: RATE MAY VARY PAGE 1 OF llO3016 ....<r - ~ ::::::-~ == - -- ==- ~ ~ -~ - f ~ . I =--- a:= - - ===--- ~ - "" ~ ~ .~ .. ~ 'J'j ~ 1.:: ~ ~ - ~ - ~ ~ - = \ \ : 'C1 -c:O ru ...=t .=r ..D ru tr' tr' o 'C1 'C1 === == == - CJ ["- ..n ...=t CJ o Cl ["- \r) '~ '<1'\ -- ,~ ~ ~ IX i M ; -c r',1 '" :~ ~ Ir, >C'""t- rl -...... ~"....... -... J:.. -~ :-- ~ ~' \ i ~.~:..- ~, .? -- <:>~ .~ ('arrlServu'(;!; October 09,2001 Clerk, Probate Court Cumberland County, Pennsylvania Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 "" /, ') ..., ; LU~ I /),J . ~-) ;2 / ,", L- Re: Estate of Christopher K Rusilko Case No: 21-01-505-16-232 It would be appreciated if you would refer to the item(s) marked below: Pursuant to our telephone conversations, find the enclosure(s) marked below. The enclosed is for your information and files. If the enclosed meets with your approval, please sign and return to our office. _X_Please file the enclosed on our behalf and return a time-stamped copy to our office. X Our check is enclosed in the amount of$5.00 Please forward us a receipt. A self-addressed, stamped envelope is enclosed for your convenience. _X_An Affidavit of mailing. Thank you for your assistance with this matter. Very truly yours, O""-'1'V- r&~4..-J Anne L. Booghier 1-888-676-2722 Ext. 48535 Enclosure (Business Reply Envelope). Estate of Christopher K Rusilko Deceased 16-232 Case No: 21-01-505- AFFIDAVIT IN PROOF OF CLAIM STATE OF OHIO ) ) MONTGOMERYCOUNTY) The undersigned, Carol Hammond being first duly cautioned and sworn, states that I am the authorized representative for GE Capital Consumer Card Co., a national banking association organized and doing business under the banking laws of the State of America: that GE Capital Consumer Card Co. is the owner of a claim against Christopher K Rusilko on a Best Buy Account No. 6019170018140688, a copy of which is attached hereto and made a part hereof: that there is now due and owing on said claim the sum of Two Thousand One Hundred Fifteen and 81/100 dollars ($2115.81) with interest thereon at the rate of Twenty Two and 90/100 and percent (22.9%) per annum from and after the 16th day of May 2001; that there are no payments on said claim in the way of discounts or otherwise; and that there no setoffs nor counterclaims against the same. The above- referenced account was transferred from Bank One, NA to GE Capital Consumer Card Co. ~u.-Z~. . _~j( Carol Hammond Representative for Claimant GE Card Services c/o: OH3-4233 PO Box 8726 Dayton, OH 45482-0278 1-888-676-2722 ext. 48536 Sworn to before me and subscribed in my prese ce on the date of October 09, 20 1. ANNE L. BOOGHIER, Notary Public I n and for the State of 2h~ My Commission Expires U.:5 -a 1--()2- D Address change? Check here and complete the reverse side Mail Payment To GE CAPITAL CONS CARDCO PO BOX 9001557 LOUISVILLE KY 40290-1557 !4029015577! MMMM CHRISTOPHER K RUSILKO 1950 ENFIELD ST CAMP HILL PA 17011-3721 o00ooo ! 170113721502! Enclose This Coupon With Your Paymenl Make Check In U.S. Dollars Payable to: GE CAPITAL CONS CARDCO 601917001814068800002100002115813 Detach Here BEST BUY/GE CAPITAL CON CC GE CAPITAL CONS CARDCO ...-.-......................... .......................'....... ...-.-.,....................... .......,..................... ...............-.......................................'.-...-.....-..................... .....-.,...............................,.-.....-...............................'...'..... .......................,........................................u.......'............... ...-....-.. .................-....-.....................-.-....-. Payment Due Date Credit Umit Credit AvaDable $37.43 $50.00 Post Date Tran Date Reference Number Descri tion 04/05 04/04 85348122ZEMWZ3V AG BEST BUY 588 PITTSBURGH PA $37.43 SAME AS CASH 04/24 04/24 F9071003JOOOBP114 PAYMENT - THANK YOU $50.00 CR 04/25 04/25 .FINANCE CHARGE. $46.00 No Finance Charges will be incurred on the amount of a Deferred Interest or Same as Cash promotional purchase if you pay the promotional purchase amount in full by the indicated Due Date and (as applicable) you pay at least any Minimum Payment Due on your Account each month when due. "a promotional purchase amount is not paid in full by the indicated Due Date, Finance Charges will (or if any Minimum Payment Due is not paid when due, may) be assessed on this amount from the transaction date (or. at creditor's option. from the posting date). Purchase Date Purchase Amount Deferred Current Balance Due Date FINANCE CHARGE 12/1812000 $275.58 No Pay Deferred Interest WAIVED $0.00 PAID OFF 12/1812000 $244.83 No Pay Deferred Interest BILLED $15.74 $261.61 EXPIRED 12/20'2000 $37.09 No Pay Deferred Interest BILLED $2.33 $40.19 EXPIRED 12/20'2000 $158.98 No Pay Deferred Interest BILLED $9.99 $172.29 EXPIRED 11/2412000 $568.02 No Pay Deferred Interest $57.67 $568.02 0012412001 12/20'2000 $582.58 No Pay Deferred Interest $48.78 $582.58 07/2412001 0410412001 $37.43 Same As Cash $0.50 $37.43 07/2412001 "NOTICE: See reverse side and additional pages (if any) for important information concerning your Account. " This Statement is a Facsimile - Not an Original 5302 0000 KED 2 7 25 010425 Page 1 of 2 9071 0000 BBPR 01AG5302 00000000 1700 Grant Building Pittsburgh, PA 15219-2399 Telephone: 412-261-0310 Facsimile: 412-261-5066 Of Counsel: Jonathan G. Babyak. jgb@camlev.com Campbell & Levine, LLC Attorneys at Law April 25, 2002 Register of Wills of Cumberland County Courthouse, 1 st floor 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Christopher Keith Rusilko Dear Madam/Sir: Enclosed for filing with your office is an original and two copies of the Inheritance Tax Return, together with an original and one copy of the Inventory. Kindly return to me a time- stamped copy of both the Inheritance Tax Return and Inventory in the enclosed self-addressed, stamped envelope I have provided. Also, I have enclosed a check in the amount of $34 to cover the filing fee. If you should have any questions regarding the above, please give me a call. Thank you for your assistance in this matter. JGB/cms Enclosure .........."..., ... .~ " .," ,..... , :..;: r d f',.J cc: Rick Rusilko I --... I~^: Pittsburgh, Pennsylvania. Wilmington, Delaware G INVENTORY of all real and personal estate of Christopher Keith Rusilko, deceased, late of Camp Hill, Cumberland County, Pennsylvania 17011 who died May 16, 2001. $ 1,909 1,875 974 200 8,350 100 $13-408.00 Salomon Smith Barney Account #724-01120-16035 PFS Investments Account # 106045468 Waypoint Bank Checking Account #2300010019 Allfirst Bank Checking Account #00333-9870-4 2000 Dodge Intrepid 1982 Toyota Truck TOTAL ....-t..... ~~ d f'.J ~"_.~. =< I ---> Lv REAL ESTATE SCHEDULE REAL ESTATE IN PENNSYLVANIA (Description must be adequate to identify the property. Mortgages, judgments and other encumbrances on real estate should be noted.) $ 77,500.00 Lot #1, Final Subdivision Plan, East Pennsboro Township, Cumberland County, Tax Map #01-20-1854-178. Waypoint Bank - First Mortgage $70,605.00 Bank One - Second Mortgage $11,421.00 $ 77..500.00 TOTAL AFFIDAVIT OF EXECUTOR OR ADMINISTRATOR ~oI~~ ~oI~U IlL( ) ) SS. ) Personally before me, the undersigned authority, a notary public in and for said County and State, appeared Richard C. Rusilko, who, being duly sworn according to law, deposes and says that she is the executrix or administrator of the estate of Christopher K. Rusilko, deceased, that the foregoing schedules constitute a complete inventory and appraisement of the real and personal estate of Christopher K. Rusilko, deceased, that the figures opposite each item of real and personal estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said' ms as of the date of the dece nt's death. Sworn and subscri ~ Day of , 2002 ~ Ric rd C. Rusilko Executor-Administrator <- Notarial Seal Juditt\ M. Boyle. Notary PubHc Plttsbul'Qh, Allegheny_County My CommiSSIOn Explres Mar. 14. 20(1) Member, Pennsylvania As$OCiatiOt1 of Notaltn ADDITIONAL INSTRUCTIONS 1. The inventory shall be filed no later than the date the account is filed or the due date, including any extension, for the filing of the Inheritance Tax Return (9 months from the date of death) whichever comes fIrst. 2. A supplement inventory must be fIled within thirty days of discovery of additional assets. 3. An original and one copy must be filed. 4. Additional sheets may be attached as to personalty or realty. 5. See Section 3301 et seq. of the Probate Estates and Fiduciaries Code of 1972, as amended. 6. The inventory must be typed. a \ ~ (j) ~ ~ 0 ~ ~ 0 ~ ~ ~ ~ ~ p... ~ ~ ~ t; 0 ~ % 7- \ ~ ih f./l ~ e 0 () ~ .-d 0 "d CJ ~ <t. 0 0 ~ ~ ~ ~ ';7 .", .", . ~c ....~ ~, ((~ ;l.~ d N ;:g: ~ , ~ -~... ..~.~~" .k-~.' u 'j ~ "" ~ "'"\ on<";l -- ~O'Io a ~:gN~ · ~ ,...J ":; ~ q do) ~ ~ ~ ., tIl~<M ~ ~ e p..~ ~ - 'r)j e C) ~:;;. ~ 00 ""'~ ~ ~g~ ~ -~ ,J:J p: e ~ u ~ (Y7 "-' () (i:' o t-' ~1!l8EX(a.oGI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 . REV-1500 INHERITANCE TAX.RETURN RESIDENT DECEDENT c OFFICIAL USE ONLY It - ~ 3J- q FILE NUMBER .2. L - iL.L .1L..s.. .1L -5.. _ COUNTY COO€ YEAR NUt.l8ER f- Z W Cl W U W Cl DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Rusilko Christo her Keith DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-OD.YEAR) 5-16-01 11-1-66 (IF AFPLlCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) '" ... '3::$cn ,,"'>: ","-" J:;o-o ,,"'.... "-" "- <( o ,. Original Retum o 4. Limited estate o 6. Decedent Died re~tate (AltacI\ copy ofWilll o 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 2. Supplemental Return o 4a. FultJre Interest Compromise (4aIe of <llIlIul1l1' 12-1:Z~21 o 7. Decedent Maintained a Uving Trust(AlllldlccpycfTltl$l1 o 10. Spousal Poverty Credit (a'aleofdnlll CeIWetn tZ.31.~f V\d t.t.sS} o 3. Remainder Return {dale cf dull'l priot 10 12.1J.i!21 o 5. Federal Estate Tax ReltJm Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 911.3{A} (Altac:JSdtO} ..THISSECTlONc MUS't.BE.:COMPLETED.ALCCORRESP,ONDENCEAND C6NFIDEN-TlAL TAX INFORMATION SHOULD BE DIRECTED TO: i NAME COMPLETE MAILING ADDRESS Jonathan G. Babyak; Esquire . .noo Grant Building FIRM NAME 1"_1 ... z '" o z o "- '" '" '" '" o " z o ~ ..J ::;) !:: 0- <l: U w c:: z o i= ~ ::;) 0- ::2; o u >< ~ TELEPHONE NUMBER (412) 261-0310 1. Real Estale (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Flraprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Flersonal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellane<lus Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1~7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Sd1edule !) Pittsburgh, PA 15219 (1) (2) (3) (4) (5) OFFICIAL USE ONLY 77.500.00 .---.... :;.~.! .~ ~ R 1'.1 l',4(1R (10 I ~ (6) ,~~. (7) (8) $90,908.00 (9) (10) 7,055.00 108.796.00 11. Total Deductions (lotal Lines 9 & 10) 12. Net Value of Estate (line 8 minus Une 11) 13. Charitable and Govemmenta/Sequests/Sec 9113 Trusts for which all election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) (11) 511 'i.R'i1.00 (12) -$24,943.00 (13) SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES (14) 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate t 8. Amount of Una 14 taxable at collateral rate 19. Tax Que 200 . . x.o_ (IS) ,a_ (16) x .12 (17) x .15 (16) (19) ", " Decedent's Complete Address: STi<g5~O~Aeld Street CIIYCaJID JfilJ,.._ I STATE PA I ZIP 17()11 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Creeits ( A . B . C ) (2) 3. InteresVPenally if applicable D. Interest E. Penally TotallnteresVPenally ( 0 . E ) (3) 4. If Une 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 Une1 . Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. {SA) B. Enter the totai of Une 5 . SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, A GENT :~":':::;~~"::'~t;....:::~~?~;;;.:.r::~1,.,~.,'7~T.""1::,~;:;~:;;::-'<~~-,..:k""<;,,:~':;:,,.2"';:~~.!!'-;:;!:.7.:o:~,.;of:~.;t:."',r..~<:'lJ~~;:'~..:.;..'~}',~~,,;,:;:;~,:;, ,::/;g-~(~:r-~'";:j,;~,- _-"~,?'~'C~~f~"..;':J'",~~ff.""':Z:";;s'":,,,,,~:?::.4<;;.:,~ .....~~;~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes 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; DT.......................................................................................................................... 0 d. receive the promise for I~e of either payments, benefits or care? ...................................................................... 0 2. If death occurree after December 12. 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or securily at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other nan-probate property which contains a beneficiary designation? ........................................................................................................................ 0 No I8J I8J rn ~ ~ o ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. n9 senedules and statements, and to the best af my knowledge and belief, it is true. carted: and complete. fwhichprep rhas any knowledge. ADDRESS P.o. lJ,nv t;i;i SIGNATLRE OF P . / :ff- .-3 ~ () C;V ADORES 1700--Gr'ant Buildinq, PittshlInjOh. PII lS:11Q .~ . ".",L" ::~;~'.:.e-.:."~~/ .,"-"~~ . ..',....~ ~~:~,-;.._~,:..~'-::;:.~~....;-i?.7'~;:r~.:_~~~ ~--:.-.;.:'"1i.:.~.~~' ':,-.'~-~;.';.-.[:.'./'o-!~:;,.,.;:~::r.i>~,.!.-<>...~~i::..:;.i;.:.':;.,;;.; .~~;;;L~ /'~:"',:J: For dates of death on or after July 1, 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (al (1.1) (ill. For dates of death on or after January 1. 1995, the tax rate imposed on the net value of transfers 10 or for Ihe use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (H)I. The statute does nol exemot a transfer to a surviving spouse from tax, and the statutory requirements for disc!csure of assets and filing a tax return are still applicable ellen if the surviving spouse is the only beneficiary. For dates of death on or after Juiy 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent oflhe child is 0% [72 P.S. 99116(a)(1.2)). The lax rate imposed on the net vaiue of transfers 10 or for Ihe use of the decedent's lineal benefic:aries is 4.5'/,. except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on Ihe nel value of Iransfers 10 or for the use of Ihe decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling IS defined, under Section 9102, as an individual who has at lea.::l one parent in common with the decedent. whether by blood or adoption. REV-lmex.(l-g7} '* SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT DESCRIPTION VALUE AT DATE OF DEATH Residence 1950 Enfield Street Camp Hill, PA 17011 77,500.00 TOTAL (Also enter on line 1, Recapilulation) l 77 500.00 ~.lsoeEX~(l'971 '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Christopher K. Rusilko FILE NUMBER 21-01-0505 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned wtth the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Sa1orron SmithB;U:ney Account #724-8112::J-16035 :-f~ VALUE AT DATE OF DEATH 1,909.00 2. PFS Investrrents Account #106045468 1,875.00 4. Waypoint Bank Checking Account #2300010019 Allfirst Bank Checking Account #00333-9870-4 974.00 3. 200.00 5. 2000 Dodge Intrepid 8,350.00 6. 1982 TOyota Truck 100.00 TOTAL (Also enter on line 5, Recapitulation) $ 13,408.00 . ._~ --~...:"___I ~l.,~~I_ __ .l.,,, ~~~" ~;..,o\ 1'l€\l_lSnEX + (1-97) -. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF rhr;~r~n~r K ~l~ilkn FilE NUMBER 21-01,..0505 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral: Thonpson Marodi Funeral Harre 6,780.00 - B. AOMINISTRA TIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I E\N Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: .. 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 275.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 7. - TOTAL (Also enteron line 9, Recapitulation) $ 7,055.00 (If more space is needed, insert additional sheets of the same size) i=lEV.ISl1 ex. (M11 . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA \NHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ChrifJtDpRor l< F1Uii 1 k" Include unreimbursed medical expenses. ITEM NUMBER 1. FILE NUMBER .21-01-0505 DESCRIPTION AMOUNT .385.00 2000 ,School District Taxes 2. COll'Cast 62.00 3. GE capital consurrer Card 2,116.00 4. Discover ,1,096.00 5. Staples 791. 00 6. Walrnart 1,528.00 7. Lowes 470.00 8. Easy Spirit 590.00 9. Hone Depot, 139.00 10. Boscov 's 1,123.00 11. Bank One- second IlDrtgage 11,421. 00 12. Finova Capital Corp. 4,718.00 13. Waypoint Bank- first IlDrtgage 70,605.00 14. Verizon 480.00 15. Chrysler Financial 13,272.00 TOTAL (Also enter on line 10, Recapitulation) $r08, 796.00 (If more space IS needed, Insert additional sheets of the same size) \, / Ib-~~,:)- 9 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX '0:2 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-01-2002 RUSILKO 05-16-2001 21 01-0505 CUMBERLAND 101 JUL -9 JONATHAN G BABYAK ESQ CAMPBELL & LEVINE 1,.. 1700 GRANT BLDG Ctl PGH PA 15219 * REY-1547 EX AFP CUl-O!> CHRISTOPH K Allount Rellitted 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-Y-=is'4-j-ix--AFP--(cff=ozl--Noy-ici--oF-'rNHiifiTAifCE-TAX-APPR'jrisii'-ENT~--ALi-owAircE-ifR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RUSILKO CHRISTOPH K FILE NO. 21 01-0505 ACN 101 DATE 07-01-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) 77.500.00 .00 .00 .00 13.408.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subiect to Tax (9) UO) 7,055.00 108.796.00 Ul) (2) (3) (4) (5) .00 X 00 = (6) .00 X 045 = (7) .00 X 12 = (8) .00 X 15 = (9)= NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 90,908.00 115.81;1 00 24,943.00- .00 24,943.00- TAX CREDITS: . ~. .....,. IU::'\.I:.I.r'" I (+J AHOUNT PAID DATE NUHBER 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 $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~ .t.~_ -:---..., '. '\ ':; ~ ....i .., . . . . .~ \.() ~ \..t) \ -- <.) \ ~ .... ..J 4- :a (/) ~ ..J o ~ CC - u.. A. ~ ~ ~ .... ~ ~ ~o...O ~ %~~~ .t-l ...;l'S ';0. ~ ~<@~~~ ~ ~ % ~~~ Q6 \ '8 ~~ ~<r-~ ~ -'~ ~ ~ e C$ u \ ~ o 'ca ~ . o ~ S ~i2 fJ).gt};r./)~ ~U~~~ ~ ~ ~ g ~... Oc:s~.e~ ~g~fJ). """ ~.-...!.... ~ ~~~O'ca .~ e g Uu l:)I)i;)U~ ~O .. .~ t; ~\t0 f ~\'\, \ ~:\ . \~~\ 1\\\ '. ti .\C .\ \\ ..... ,- - , CI~ ~:~ 6 '~. Vi} ~)') IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA INRE: ORPHANS COURT DIVISION ESTATE OF CHRISTOPHER K. RUSILKO, No. 2001-0505 Deceased. Type of Pleading: STATUS REPORT UNDER RULE 6.12 Filed on behalf of: Richard C. Rusilko, Executor/Administrator Counsel of Record for this Party: Jonathan G. Babyak, Esquire P A J.D. No. 38234 1700 Grant Building Pittsburgh, P A 15219 (412) 261-0301 ~ ~ ~t/ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA INRE: ORPHANS COURT DIVISION ESTATE CHRISTOPHERK. RUSILKO, No. 2001-0505 Deceased. STATUS REPORT UNDER RULE 6.12 Name of Decedent: CHRISTOPHER K. RUSILKO Date of Death: May 16, 2001 Estate No.: 2001-0505 Pursuant to Rule 6.12 of the Supreme Court Orphan's Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State whether the administration of the estate is complete: Yes x No 2. If the answer is no, state when the personal representative reasonably believes that the administration will be complete. 3. If the answer to No. 1 is yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphan's Court No. (if any) for personal representatives account is: N/A. c. Did the personal representative state an account informally to the parties in interest? Yes x No .. . d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans Court and may be attached to this report. Respectfully submitted, Campbell & Levine, LLC Dated: Cf-Il --- 07--- on an G. Babyak, Esquire LD. No. 38234 1700 Grant Building Pittsburgh, P A 15219 (412) 261-0310 Counsel for Personal Representative