HomeMy WebLinkAbout01-0521
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
JOHN M. SALAPA
Estate of
also known as
No. -dJ- 0 (- 5 2-l
To:
Register of Wills for the
County of CUMBERLAND in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. 19 1-4U-~ (/1~T:)(lj
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl ; p~
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 CUMBERLAND County, Pennsylvania, with
h is last family or principal residence at 239 Wal ton Street, Borouqh of Leployne
(list street, number and municipality)
Decendent, then 43 years of age, died February 1,
at 239 Walton Street, Lemoyne, PA
2001
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:
$ 6,000.00
$
$
$ None
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Tobey Allen Richards Son P. O. Box 809
DOB: 12/18/88 Northbridae.MA 0153
4
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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David A. Salapa ~
3109 Hillside Street
Harrisburq, PA 17109
) LP - d. 33 -I I
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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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. ~ 10.-<& D- ~aQ :,;
r~DaVid A. Salapa ~ ~
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No. ~I-DI. 0521
Estate of
JOHN M. SALAPA
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ,J\.tl.I\J e 2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Davi n A Sa1apa
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
David A. Sa1apa
in the estate of
John M. Sa1a a
FEES .1 ~
Letters of Admini~tion ..... $ Jt{). C)C)
Short Certificates( Yl' . . . . . . . .. $
Renunciation ...... ~ :~
801 TOTAL_~
Filed ....:......9L....... A.D. 19_
Edmund G. Myers (20558)
Johnson, Duffie, Stewart & Weidner
ATTORNEY (Sup. Ct. J.D. NO'b
301 Market St., P. O. Box 1 9
Lemoyne, PA 17043-0109
ADDRESS
(717) 761-4540
PHONE
05.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7176132
No.
ITEM If 3
SHOULD READ AS fOLLO\rVS:
/91-ftJ-6r;5~
~L:1~7~
FES 0 6 2001
Date
~ ,/{? ~PENNSVlYANlA' OEPARTIIENT OF HEAlTH' VITALRECOROS
~MU~ALT" UI"' CERTIFICATE OF DEATH
(Coroner)
!4 Rev. 1/91
M
SALAPA
DATE OF BIRTH
(Month. Day, _)
SEX
2. Male
UNDER 1 DAY
Houra MlnUle&
BIRTHPlACE (City and
Slale Of FOf8tgll Counlry)
Cl
Ie.
Lemoyne
239 Walton Street
ICI.
KIND OF BUSlNES5IlNDUSTRY
~S DECEDENT EVER IN
U.S.ARMEOFORCES?
Vel D No IJD
Pennsylvania
Did
decedenl
.....In.
IoWnlhlp?
DECEDENT'S
ACTUAl
RESIDENCE
(See inslluclions
on olll", side)
17.. Slale
Cumberland
17b.Cou
Sala a
Removal from SlaIeD
23a.
TIME OF DE.lrrH Aprx . DATE PRONOUNCED DEAD (Month, Day. YlNIr)
24. 10:00 A. M. February'I,200I
27. PlUn I: e_1he ....... injuries Of compllcalionl which caUllld \he dealh. Do not ent8l' the mode of dying. IUCh .. cardiac or rnplralOty err..t.1hock Of heart failur.
u.a only one ca... on NCh line.
e.
Com lications of Chronic Alcohol Abuse
DUE TO (OR AS A CONSEQUENCE Of):
&equentieIIy liII candiIiana
I MY.leIdlng aD lmmediaIe
_. E_UHDEALYING
CAUl&! (Oieease or inturv
.... inili8Ied ...-
reeulling in d8af1) LAST
b.
DUE 10 (OR AS A CONSEQUENCE Of):
DUE TO (OR AS A CONSEQUENCE OF):
MSAN AUlOPSV
PERFORMED?
d.
WERE AUTOPSY FINDINGS
AWlA8U! PRIOR 10
COMPlETION OF CAUSE
OF DEATH?
Natural
Homic:icle
MANNER OF DE.lrrH
ONE OF INJURY
(Month. Day. Yeal)
'gt
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STATE FilE NUMBER
SOCIAL seCURITY NUMBER
197-40-6953
DAn: OF DEATH (Month, Day, 'IIla1)
~ February 1, 2001
~)o
White
College
(1'" Of 5+) 2
MARITAlSWUS' ~
N_ Married, WIdowed,
DIvorced (Specify)
1.,Never Married
SURVIVING SPOUSE
(11 wife. give meiden nerne)
17C.0 '1M. dKedenlllwd 1/1
l'Np.
Lemovne Borou~h
city/bOro.
PA 17043
UCENSE NUMBER
231). 230.
~CASE REFERRED TO ME~ EXAMINE ONER?
as. 'lMD'! by':: D. NoD
.Approxlmate PART II: OIlIer Ilgniflcant condltions con\flbullnlllo death. but
: 1nIarva1 belwHn not r..ultlng In the undetlying cauae given In PART I.
1- and de.th
I
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TIME OF INJURY
INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED.
Ves 0 NoD
Pending lnv8ltigalion
CooId not be delermined
'1M 01. NoD
Accident
'1M.
No 0
SuIcide
21.
ala. 211I.
CMTIFlIR (CheI:Il my one)
.csmPYlIIG JIHYIIQAN (PhyIiclan certifying cauee 01 de8th wilen another pIIy51Cl8n haa lJfonounced dealh and c:ompIeted Kem 23)
To""" oflllY 1uIDwledge. .... occunM _10 the OlIUM(a) UlCI man_ uMated. . . . . . . . . . . . . . .. . . .. . .. . . .. . .. . ... . . . .... . .. . .... ....
'1'AC)lIIOUNCING AND CERTIFYING PHYSIClAH (PhySICian bOlh IJfOOOUIlCtllQ dealh and certifying 10 cause 01 de8th)
10 1M .... of .....1uIDwledge..... occ;UII'8CI a\ Ula uma. date. and place. UlCI due to the ca.e(e) .nd _.. alat8d. . . . . . . . . . . . . . . . . . . . . . . . . .
.MEDICAL IXAMlHERICORONER
on IM....CIII eumlMIIon endIor Investlptlon.1n my opinion. deeth OClCUnwd..IM time. date. and place. and due to tile cauaa(a) and
-......................................................................................................... .
31..
REG
:sa.
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SIGfU(I'URE
o ~~ Coroner
LICENSE NUMBER DATE SIGNED (Month. Oey. Veer)
o ~~ ~~ February 2, 2001
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF oe.orrH
(llem27)TypeorPrintMichael L. Norris, Coroner
~ 6375 Basehore Road, Suite #1
~". Mechanicsburg, Pa. 17050
DATE FILED (Month. Day. Veer)
34.~ 3 eJ.oo-'
~
2-1-0)-0521
RENUNCIATION
In Re Estate of
JOHN 'M. SALA'PA
deceased.
To the Register of Wills of
CUMBERLAND
County, Pennsylvania.
, The undersigned Natural mother of Tobev Allen Richards, minor son of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
David A. Salaoa
WITNESS
my
/ "7::#"
hand this ./ g -day of ,.I(~ ,19' 200~ .
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(Signature)
Eva,Dorothia Richards'
P. O. Box 809
Northbridge, 'MA.01534
(A(ldress)
(Address)
Sworn to and Subscribed
before me this
~ur
~ -,
d?-y of Jf Ir7 ' 2001
~~~
{ No ary Publl.c
L~/l1?L ,4 t=7Z;C/S C) tJ
MY COM:J;iSSION EXPIRfS
, JUlY 26. 2002
RENUNCIATION
2-1-0)- 0521
In Re Estate of
JOHN M. SALAPA
deceased.
To the Register of Wills of
CUMBERLAND
County, Pennsylvania.
The undersigned Joyce Hershock, mother
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
David A. Salapa
WITNESS
my
hand this ~~ '"\)f\ day of ~~ 1921l.h.1.
Sworn to and Subscribed
(Signature)
Joyce Hershock
239 Walton Street
Lemoyne, PA 17043
(Address)
before me this ~ ~ "'\.n
~~
, 2001.
~~~~
Notary Pu 'c"
(Signature) .
NOTARIAL SEAL
DIANNE LENIG, Notary Public
Lemoyne Borough Cumberland Co.
My Commission Expires Dec. 21, 2001
(Address)
(Signature)
(Address)
'2\-D 1- [,52J
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3\ AI)AW 2.001
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: JOHN M. SALAPA
Date of Death: February 1, 2001
Will No.: 2001-00521
Admin. No.:
To the Register:
I certify that notice of beneficial interest 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
July J 7 ,2001.
Name
Tobey Allen Richards
C/O Eva Dorothia Richards
Address
P. O. Box 809
Northbridge, MA 01534
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None.
Date: 7//7/0 I
Si9~~
Name Edmund G. Myers, Esq.
Johnson, Duffie, Stewart & Weidner
Address 301 Market S1.
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone (717) 761-4540
Capacity: Personal Representative
X Counsel for personal representative
'COMMONWEA1.TH OF PENNSY1.VANIA
COUNTY O.F CUMBERLAND
}
ss:
David A. Salapa
being duly swom according to law, deposes and says that he Administrator
of the Estate of John M. Salapa
. late of Ianoyne Borough . I Cumberland County. Pa., deceased and that the
within is an inventory made by him .. - , the ~aid Administrator
of the e~tire estate oT said decedent, consisting of all the personal propl!rty and real estate, except real estate outside
~he Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death. .
~0.r~
t~m~ af ~'I
/
~~~~
and subscribed before me,
~ rP r< S>>~'^-
~. Aclministrato,Q Dav:id A. Salapa
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3109 Hillside Street
Date of Death
~---.._-
~~otarial Seal
Nina June Davis, Notary Public
Lernoym~ Bora. Cumberland County
My Cor~l(iilrsion Expires Oct. 31, 2002
Memby, ;;;:r"llsylvarJld Association at Notaries
Harrisburg PA
1 7109.
Addnu
Day
February
Month
2001
Year
INSTRUCTIONS
~-~--Anlnv entory m usrce-fjlicf-WfHiin--fn ree m 0 nHiS-anir a p p 0 infm enfOlperso narre p_re se-nf at i" e :.-.--.--------.------.--- ....
2. A supplement inventory must be filed within thirty days of disc;overy of addition4rassets. ..
3. Additional sheets may be. attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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Inventory of the real and personal estate of
John M. Salapa
deceased
1.
Miscellaneous personalty including tools, fumi ture and toys
$1,152 50
REV.1SOOEX (5-00j
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAl)
Salapa, John M.
DATE OF DEATH IMM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
02/01/2001 12/31/1957
(IF APPLICABLE) SURVIVING SPOUSE'S NAME {LAST, FIRST, AND MIDDLE INITIAl)
OFr-.!C!-i'L tlS€ O~.ii._Y
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~ 1. Onginal Return
o 4. limited Estate
o 6. Decedent Died Testate (A"achropy orWill}
o 9. litigation Proceeds Received
o 2, Supplemental Return
o 4a. Future Interest Compromis~ (dale 01 ~e2lh a~er 12-12-82)
o 7. Decedent Maintained a living Trust (Allach copy orTMt)
o 10, Spousal Poverty Credit (dale 01 deall\ between 12.31-91 and i-','9S)
_._/.0,;( .JJ::/L._..______.
FILE NUMBER
21_0105
2 1
-- -- -~---
COUNTY COOE YEAR NUMBER
SOCIAL SECURITY NUMBER
197 - 40 - 6956
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return {dateolllealh pIlorlo 12.13-82)
o 5. Federal Eslate Tax Return Required
8, Total Number of Safe Deposit Boxes
o 11. Election to tax under See, 9113{A} \A\la~Scl;O)
rrH!s!s)~c::t!I;)I'i;JIIlLJ~;l';j;!E;;QPMJ~i-\;TEQ)~LI;.QQ~RESP:qNP:El!l(:EAr-iPPcjN8P.El'lflAt.iTAl<!N~dgM~t'IOliISHQ\.it.itl:'J3E"iJlt{ECtEPTO(
NAME COMPLETE MAILING ADDRESS
Edmund G. M rs 301 Market Street
J~~~~~PrAp~~fie Stewart & Weidner Lemoyne. PA 17043
TELEPHONE NUMBER
4
(11) 47,123.00
(12) -0-
(13) -0-
(14) -0-
x.O_ (15) -0-
'.0_ (15) -O-
x .12 (17) -O-
x .15 (15) -0-
(19) -0-
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OFFICIAL USE ONLY
1,152.50
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
" ,,":::1'i.:~:'V",,~>? llESURE)O'ANS~ER,ACtiQI)E~iot:!l;iJiN" REViiRSE' SIJ!jE'AI\fo RECHECK MATH'i:'<.;' :;:;1,,',;"',. ,.... '"
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(2)
(3)
(4)
(5) 1,152.50
(5)
(7)
(8)
(9) 7,155.00
(10) 39.968.00
1. Real Estate (Scf1edule Al
2. Slecks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or SOle.Proprletorship
4. Mortgagos & Moles Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
5. Joiniy OWned Property (Schedule F)
o Separate Billing Requested
7. tnterNlVOs Transfers & Miscenaneous Non.Probate Property
(Schedule G or l)
8. Total Gross Assets (Iolalllnes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debls of Deceden', Mortgage liabilities, & Liens (Schedule I)
11. Total Deduction. (tolal Line. 9 & 10)
12. Net Value of Estate (Une 8 minus Una 11)
13, Charitable and Governmental BequeslslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. NelValue SUbject 10 Tax (Line 12 minus Line 13)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rale, or transle" under Sec. 9115 (a)(1.2)
16, Amount of Una 14 taxable at lineal rate
17. Amount ofUne 14laxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Cue
Decedent's Complete Address:
STREET ADDRESS 239 Walton street
CITY Lerroyne I STATE PA I ZIP 17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) -0-
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + 8 + C) (2) -0-
3. InteresYPenalty If applicable
D. Interest
E. Penelty
TotallnteresYPenalty ( 0 + E ) (3)
4. If Line 21s greater lhan Line 1 + Line 3, enter the dlfferenca. This is the OVERPAYMENT.
Check box on Page 1 Un. 20 to r.quest a r.fund (4)
5. If Lin.l + Line 31s great.r than Lin. 2, enl.rth. diff.r.nce. This is th. TAX DUE. (5)
A. Enter th.lnterest on the tax due..
(SA)
-0-
-0-
-0-
-0-
8. Enter the lotal of Lin. 5 + SA. This is the 8ALANCE DUE. (58) -0-
Make Check Payable to: REGISTER OF WILLS, AGENT
E~~~"""'~--~"-"\1"~!"r~~;~6#-~~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did deced.nt make . transfer and: V.s
a. retain the m. or income of the prop.rty transferr.d;.......................................................................................... 0
b. r.tain the right to designate who shall us. the prop.rty transferr.d or Its incom.; ............................................ 0
c. retain a reversionary inter.st; or.......................................................................................................................... 0
d. receive the promise for lif. of either paym.nts, ben.fits or care? .....................:....................,........................... 0
2. if d.ath occurred after December 12, 1982, did dec.d.nt transfer property within one y.ar of death .
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an 'in trust for' or payable upon death bank acoount or securily at his or her death? .............. 0
4. Did dacedent own an Individual RetirementAccount, annuity, or othar non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
No
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1'9
1'9
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Ui1der penaIVes of peJjury, \ declare lhat I have examined this /'Blum, Including accompanying schedules aod statements, siWlo the. best of my knOW{edge aod belief, it 1$ true, COll'act
Bnd complete.
Declaration of prepar&1 olher than \he personal representative Ii based on a" information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING . T
David A. Salapa
ADDRESS
3109 Hillside Street, Harrisburg, PA 17109
SIGNATURE OF PREPARER OTHER THAN REPRESENTA
Edmund G. M ers
ADDRESS
301 Market Street, Lemoyne, PA 17043
~,!~~~~.i.t~_m.~~,Jl~~!!"ll\ll___..-l ",r~L......~.!m~-~~
For dates of death on or after July 1, 1994 and before January 1, 1995, It\e tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. !i9116 (s) (1.1) (i)].
For dales 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. 99116 (a) (1.1) (ii)!.
The siatute does not exemot a transfer to a survivin9 spouse from tax, and the statutory requirements for disclosure of assets and fiilng a tax return ara still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers trom 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. !j9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decadent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !j9116(1.2) [72 P.S. 99116(6)(1)).
The iax rate imposed on the net vaiue of lransfers to or for the use of the decedent's siblings Is 12% [72 P.S. 99116(a)(1.3)]. A siblln9 is defined, under Section 9102, as an
individual who has at least one parent In common with the decedent, whether by biood or adoption.
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(d)t'1/~ ('
"",.,..",.".,n.
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RE IOEHr OECEOEHr
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
John M. Salapa ?001-0S71 ,I 71-01 OS?1
Indudethe proceedS o!flOgatic" and the date the proceeds were received by the eslate. An property jolntly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. . Miscellaneous personalty ccosisting of tools, furniture L 152 .50
and tools
TOTAL (Also enter on line 5, Recapitulation) $ L 152 .50
(If more space is needed, Insert additional sheets of the same size)
AEV.1511 EX... (12-99) f.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETLRN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
John M. Salapa
FILE NUMBER
2001-0521 ! 21-01-0521
ESTATE OF
ITEM
NUMBER OESCRIPTION AMOUNT
A. fUNERAL EXPENSES:
1. Musselman Funeral Hare, Inc. 2,373.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's ~ommlssions
Name of Personal Representative(s)
Social Security Numher(s)/EIN Number of Personal Representatlve(si
Street Address
City State _Zip
Year(s) Commisslon Paid:
2. Attorney Fees 750.00
3. Family Exemption: (It deceden1's address is not the same as claimant's, attach explanation)
Claimant Jovce L. Hershock 3,500.00
Straet Address :239 Walton Street
City Lemoyne State~Zip 17043
RelatIonship ot Claimant to Decedent Mother
4. Probate Fees Register of Wills 55.00
5. Accountant's Fees
6. Tax Return Preparer's Fees.
7. Advertising 166.38
8. Filing Fee - Inheritance Tax Retum 20.00
9. Auctioneer's carmission on sale of personal property 290.50
TOTAL (Also enter on line 9. Recapitulation) $ 7,155.00
Debts Qf decedent must be reported on Schedule I.
{If mOfe space is needed, insert additional sheets of the same siz.e)
'*
COMMONWEALTH Of PENNSYLVANIA
INHERlT ANCE TAX RETURN
RESIDENT DECEDENT
ll.E\I.\S\2EX-\\.tlj
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
John M. Salapa
FILE NUMBER
2001-0521 / 21-01-0521
Include unreirnbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
DESCRIPTION
AMOUNT
1.489.00
420.00
2.634.00
789.00
3.320.00
15.267.00
77.00
310.00
550.00
240.00
505.00
914.00
555.00
3.670.00
21.00
255.00
130.00
60.00
4,481.00
750.00
1. 215 .00
1. 201. 00
1.115.00
Ciesco. Inc.
Commonwealth of Pennsylvania Account #233940
Pennsylvania State Collection and Disbursement (PA SCDU)
Acct# 2235000021
Pathology Assoc. of Central PA
Riverside Anesthia Assoc.
Pinnacle Health Hospitals/Systems
Mirage Marketing
Wes t Shore EMS
Risk Management Alternatives, Inc. (Sears)
Heritage Diagnostic Center
Central PA Hematology and Medical Oncology Associates
Pinnacle Home Health Care
Andrews & Patel Assoc.. P.C.
MidPenn Urology. Inc.
Quest Diagnostics, Inc.
Holy Spirit Hospital
Internists of Centwl PA
Moffit Pease & Linn Asso.
Susquehanna Surgeons, Ltd.
Tristan Associates
Telecom Collections Bureau
Allfirst Bank
Cumberland County Adult Probation and Parole
TOTAL (Also enter on line 10, Recapitulation) $ 39. 968 . 00
(If more space IS needed, Insert additional sheets of the same sIze)
REA TIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 00 Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1, Tobey Allen Richards
cia Mrs. Eva Dorothia Richards son entire estate
P.O. Box 809 (insolvent)
Northridge, MA 01534
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 DISTRIBUTIDNS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARJTABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 DF REV 1500 COVER SHEET $
;;=V.\51~E.X~1'.Nl
-~
~
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESlOENT DECEDENT
ESTATE OF
John M. Salapa
(If more space is needed, insert additional. sheets of the same size)
FILE NUMBER
2001-0521 I 21-01-0521
"'v /6-02~3-/~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITA~ TAX DIVISION
DEoT. Z8D6Dl
HA~RISBURG, PA 171Z8-D6Dl
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
'.' .... of DA TE
ESTATE OF
DATE OF DEATH
FILE NUMBER
P12 :02 COUNTY
ACN
RecorCiC:C~
Regjs1C;~
.01 IJ I C 17
EDMUND G MYERS
JOHNSON ETAL
301 MARKET ST
LEMOYNE
Clerk~('
PA 17Q41nberlan j
12-10-2001
SALAPA
02-01-2001
21 01-0521
CUMBERLAND
101
*
REV-1547 EX AFP 112-00)
JOHN
M
Allount Rellitted
(lJ
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
1,152.50
.00
.00
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=is4j-iif-AFP--ri'2-:ooi--NOTici--OF-i-tiliiifiTAifcE-TAi-A-PPRjrisiMENT~--Aii-oWAifcE-iri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SALAPA JOHN M FILE NO. 21 01-0521 ACN 101 DATE 12-10-2001
TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
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)
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
4,807.50
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this for. with your
tax paYllent.
(8)
1,152.50
39.968.00
Ul)
(2)
(3)
(4)
US) .00 X 00 =
(16) .00 X 045 =
(7) .00 X 12 =
(8) .00 X 15 =
(9)=
44.775 50
43,623.00-
.00
43,623.00-
TAX CREDITS:
PAYHENT RECEIPT DISCOUNT (+) 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.)
REV-1470 EX (6-88)
.. INHERITANCE TAX
..
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME FILE NUMBER
John M. Salapa 2101-0521
REVIEWED BY ACN
John Kuchinski 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
H 83 Reduced to $1,152.50. Family exemption can only be claimed against assets subject to
will or intestacy.
ROW
Page
) .
Cu u JI-.
V'
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM
YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: JOHN M. SALAP A
Date of Death: February 1. 2001
Will No.:
Admin No.: 21-01-00521
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:.
3. If the answer to NO.1 is yes, state the following:
A. Did the personal representative file a final account with the Court?
Yes No ~
B. The separate Orphans' Court No. (if any) for the personal
representative's account is:.
C. Did the personal representative state an account informally to the
parties in interest? Yes No ~
The Estate was insolvent.
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.
~~
Signature
Date:
r; (l/03
Edmund G. Mvers, ESQ.
Johnson, Duffie, Stewart & Weidner
301 Market Street, P.O. Box 109
Lemovne, PA 17043-0109
Address
(717) 761-4540
Telephone No.
Capacity:
Personal Representative
~ Counsel for Personal Representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/06/2003
DAVID A SALAPA
3109 HILLSIDE STREET
HARRISBURG, PA 17109
RE: Estate of SALAPA JOHN M
File Number: 2001-00521
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 2/01/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc: j File
Counsel
Judge