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Home My WebLink About01-0761 CUMBERLAND Register of Wills of ~ County I Pennsylvania PETITION FOR GRANT OF LETTERS Estata of "A' hl:::>rr ~ ~ 1 ("\'\7; rh No. 21-01-761 also known as , Deceased Social Security No. 204-03-6955 ,....'......'101. ....n """ ,. vu" 01 ... Of ~. ......"......... (COMPLETE" A" OR "B" BELOW:) Pa A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut~ named in the Last Will of the Decedent, dated March .11, 1997 . and codicil(s) dated N/A i,. .' . . . J" , ..,... '..."M. 01_......... .,. ~ioII. ....".. ....,.... ..~, Except .1 follows. Oecedont did not marry, wa. not divorced. and did not hava a child born or adopted after execution of the documents offered for probate; wa. not the victim of a killing and wa. never adjudicftted inoompetent: Q B. Grant of Letters of Administration le, .... ..~." 1.1.', ,.,....... -... .".... .........; "",.... """""" Petitioner(sl after a proper searchhas/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence Decedent was domICiled at death in Cumberland residence at One T ~ll!=;T Rn;:u1. r~n:1P Hi 11. PA .... tI..... ..-.., ... "-.....'v, Decedent, then 81 years of age, died AU<;lllst 6. , 2O....Ql at West Shore Health & Rehab lI._iOn, Oecedent at death owned property with estimated values as lollows: (If domiciled in PAl All personal property ...,.......................... $ (If not domiciled in PAl Personal property in Pennsylvlnil . . . . . . . . . . . . . . . . . . . . . . $ (If not domiciled in PAl Personal property in County . . . . . . . . . . . . . . . . . . . . . . . . . . $ V.lue of reel e.tate in Pennlylvania ................................................ T ot.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . . $ Roal Estlte .itulted a. follow.: OnP T ~ l!=;T Rn;::tn. r~TQp Hi 11. ppnn!=;y hr;:m i rl 8.100 ~g:~88 Wherefore. Petitioner(l) respectfully reque.t(s) the problte of the lilt Will Ind Codicil(l) pre.ented with this Petition Ind the grlnt of leners in the appropriate form to the undersigned: ed or printed name and re.idence 1121 Westminster Rd., Harrisbur , PA 17109 6207 Catherine St. Harrisburq, PA 17112 RW-7 II:,-~o- I~ Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. rL~#~~. day of ( J ._ 20-12..1 ~7.~1Z/c-J ~~Yo/~h~j/(O/ A2r~ Sworn to and affirmeti and ~ubscribed before me this 16th AUGUST - DECREE OF REGISTER No. Estate of ALBERT S BELOVICH 71-01-7h1 also known as _ Deceased Date of Death: 08-06-2001 Social Security No: 204-03-6955 AND NOW, AUGUST 17 , 20~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters U Testamentary 0 of Administration are hereby granted to 'f:. ". d ",' ~ I . ~,. .,.. ",".". a"""I'_, chlt""lv "."'ml"II', JOHN MAVRETIC AND HELEN MAURER in the above estate and that the instrument(s), if allY, dated MARr.H 11 r 1 QQ7 described in the Petition be admitted to probate and. filed of record as the last Will of Decedent. FEES Letters.... ....... ...... .... ...... $ Short Certificate(s)....~..... $ Renunciation... ........ ... .... $ $ $ $ $ $ $ Affidavit ( )................. Extra Pages ( )............ Codicil......................... . JCP Fee........................ Inventory & Tax Forms... Other........................... . TOTAL................ $ RW-71 115.00 '?~r (J ]i!::</~H~O~ R.gi't~ f ~"i", 24.00 12.00 5.00 Attorney: 'Ihomas F. . Gacki. 1.0. No: 44864 Address: 213 Market St., 8th Floor Harrisburq, FA 17101 Telephone: 717. 237.6093 DATE FILED: August 15, 2001 ~dJ ~~ . ~ //72,,~.;;~" ~ 156.00 1-11(\0:;.8(\0:; ~FV "'~t; T::~l j~:~i~~;\~~:tO~?;i~~O:::t.~~e ":~l te~::::;~c~~ t~e"~t~t~'Zr7t~n R~~~;~~ ~~tifi~ate of death dUfill~ filed with me as Ice ror permanent I mg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7732554 No. 21-01-761 ,?-, ;1-- c' ) Date "'OS ") A.. 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECOADS CERTIFICATE OF DEATH SrAfE "'l.f -.uMHA 7.- Of DECEDENT lf~~-~~ --~~.~~~--~. - ~~~Ch ----.--.-- -------, ~~~ Mal~.-.--II~~SECuR:..O~ER AGE (lall 800v>cay, UNOER 1 Ye..A UNQE~ I 0IfI OATE Of lllRTH 8IRTHPI.ACE :C........., PVCE Of DEATH ,<,:_,('1,.."",.. ._ .n'''''':!...... en._ _I Months Oa~ Hourw:, Winu... .Mom" ~...I j~lJlIr'c'.q'lt:Ol.Inlfvl -------- VIS Harrisburg, PA E~,onI o...J NT NT II( 81 S. COUNTY Of OEJIfH .. Cumberland Ie. E. Pennsboro Twp, OECEOENT'S USUAL OCCUPRIOH l<;-:"'~:::" ':: ':::zt::f . II.. Steel Worker m.. Steel Manuf. Ind. DECEDENT'S MAIlING ADOflfSS (SIr.... C~. ~. Z..COCIel _S DECEDENT EilER IN U S AAMED FOACES? .....~ NoD 12. 1 Locust Road ," Camp HUI Pa 17011 FAl'HER'S NAME ,f.... M..ue l"'l DECEDENT'S ACTUAl AESlOEHCE -- on 0I"i., Stde) Cumberland 17a. SI.. 00cI - M". --' IJ".c........, :="'10 RACE. A-.con _. _.. _... l~' White 10. ..AAlTAl STATUS. IoIamod ,....e< Men..... W-.". ~e...lSIlIcllVl Never Married $VAl/IVING SPOUSE I"""'. ;jNe...-_1 l1e.O ....___.. - 17d. =""-=-=01 Camp Hill ""- 1.. _ONolANT'S NAME (l ypowP'onI1 John A. Mavretic MOTHER'S NAME ,F... ~<lC" ~"oen Suo""",., It. Helen Bratusa 1Hf'00000T"S IoIAlUNG AOOAESS (S-Wl. C.cy/bwn. SIaM. ZiQ Codel 1121 Westminster Road Harrisburg. PA 17109 PLlCE OF OISPOS1TIOH . Name 01 c.........,. Cr_MOIV ~OCAJIOH. CitylTown. StM.. Z'. Code 01 01...,.,..,. Holy Cross Cemetery John Belovich -- METHOO Of OlSPOSlTIOH ....... f}:t c,_ 0 _ _ 51...0 ou..r(~l 21,. nc. 24. M 2'. 27. MIWT I; EnI... tl\e 4IMaMS. "'tU"1fl, 01 comphCatlOftS which caUUd lhe death 00 not enter the mode 01 Oylng, SUCn i$ clrdlaC or ,eSOI,,.tory .Iff"''' shoGtl Of Man '.th.,I. L'" onIf one "iON on 1adI.... JJ,..~ /;11- '> /) r. j~r:J; /.~t.5;?!~/7 I'Y'- DUElOtoAASAC~NCECf) / ~ D !t-/l'-C""l"V .J c./.../U' h: (./hz~{:/J" 17'_ ,j('t'/ Ie DUE IOtOfl AS A CONSf.O\JENCE Of) DUE 1010flAS ACONSf.O\JENCE Of) d WEAE AU1tlPSY FINDINGS IoAANNER OF DEATH ~BLE ~AlOR 10 COMPLETION OF CAUSE Of DEAlH? 21.. Harrisburg. PA 17111 I "wo..,.,.... :=-== I : PART .: ou..r~_CQnU""''''''IO_''''' 1Illl.-....,.."'" ~~~.. PIUIT I. _II LL. o o DArE Of INJURY (101""" Oay. .....1 nME Of INJURY INJURY A1 WOAlC? OESCAleE HC1N INJUIlY OCCURIlED - P~_lQAl"'" o o CJ ~CE (y IkJURY , "I homII farm. 11;"1, lactory, office M. b\ltIc;IIncJ. Me l~pec"V' _. Y.. 0 ....0 Hom'Cldl YIS 0 NoD Suocode Could not be o.t.,ml"4d a.... CERTIFIER :Ctoeck 01'\1)' one) -CERTIfYING PttYSICIANf~;\IC..an Ol~'tlyWV) Cc,!oe all d@alfl .-f'er" ,."CM'1I!f otl\l~ i&fl h4~ ~Of'lOWlCea ,Jt!..1h oU'IU Comt,.;Il:!eQ lIen' !Jl To Ihe beet .'",y knowledge. de.tt, occuned due.. thai caLl"(S) ~nd Iftanner ...l.t". . 29. -PfIIONOUNCJNG AND CERTIFViNG "'HYStCIAH If'tlw~1otO r..,u. ;"I~'(~~,lf.:"lt') tlP...att\ ....0 ";~ht'VtI'IQ IQ .;.Ju'A f;IIJedtf'll To 'h. bee' 01 Ifty kftOwled')lt. de..'" occurred at the lime. da.e. .,nc1 pllICe..nd due to lhe clus.ta).nd m.nn.,.. SlAted ,.,EDICAL EllAMINERiCOAONER On the be... 01 ...mlna.ion ~ndJO' Inv.s"9~'lOn. In my opln,on. death occu.ft.d ~I the time, date. and plAce. and due to the c.use(s) Jnd mann... .. ".led. _ .. .' . . . . . . . . " ... .. . . . . )'. REGISTRAR S SIGNATURt: AND NI.o"'BER _~)19~; ~.LL,;.A.2! -- ..., V' / 14 )-,,/-,:1. _______.__.*"'_ . u_..,___ WILL OJ' ALBERT 8. BELOVICB 21-01-761 I, &LBBRT 8. BELOVICB, of Camp Hill, County of Cumberland, Commonwealth of Pennsylvania, make this my Last will, hereby revoking any and all former wills or codicils made by me. ARTICLE OBE pavaent of Last BxDense. I direct my Executor to pay the expenses of my last illness and my funeral expenses as soon as may be convenient after my death. ARTICLB TWO SDecific Beauests I give the sum of Eight Hundred Dollars ($800.00) to ST. PATRICK CATBEDRAL, 212 state street, Harrisburg, pennsylvania, 17101. ARTICLE THREE Tanaible Personal PrODertv I give all my automobiles, household and personal effects, and other tangible personal property of like nature (not including cash or securities), together with any existing insurance thereon, in equal shares to my niece, BBLEN MAURBR, presently of Harrisburg, Pennsylvania, and my nephew, JOHN KAVRBTIC, presently of Harrisburg, Pennsylvania, as are living on the sixty-first (61st) day after my death in such shares or by such items as they may agree upon or, if they are unable to agree, then said property shall be sold and the proceeds shall be divided equally between them. ARTICLB POUR Residue I give all the residue of my estate, in equal shares to my niece, BBL" MAURBR, and my nephew, JOHN MAVRETIC, provided that the share of any beneficiary who predeceases me or dies on or before the sixtieth (60th) day following my death shall be distributed to his or her issue per stirpes living on the sixty- first (61st) day following my death and, in default of any such then living issue, such shares shall be added to the share for my other beneficiary. ARTICLB ~IVB Exeoutors section 1. Executors of Mv will. I appoint my niece, ..L" MADR", and my nephew, JOHH XAVRETIC, as Co-Executors (hereinafter defined as "Executor") of this will. If either of my Co-Executors predeceases me or is unable or unwilling to serve for any reason then I appoint the remaining executor as sole Executor. section 2. Waiver of Bond. No Executor hereunder shall be required to give bond for the faithful performance of duty in any jurisdiction. section 3. Power to Retain Assets. My Executor may retain as an investment without any duty of diversification, all property, real or personal, owned by me at my death. section 4. Power to Invest. My Executor may invest and reinvest the principal held in trust, together with any income accumulated thereon, in such stocks, bonds, mortgages, securities or other property, real or personal, as he deems advisable without being limited to the classes of securities or investments in which trust fiduciaries are authorized by law to invest trust funds. Section 5. Power to Sell Real Estate. My Executor may from time to time sell any and all real estate held hereunder, at public or private sale, for such prices and upon such terms as he deems advisable, and may make, execute and deliver any deed or deeds therefor, conveying title therein in fee simple absolute, or for any less estate, to any purchaser or purchasers, freed and discharged of any and all trusts hereunder. Section 6. Power to Deal with Assets. My Executor may from time to time sell, exchange, lease, encumber, option or otherwise dispose of all or any portion of the assets held in trust in such manner and upon such terms and conditions as he deems advisable, and may make, execute and deliver deeds, mortgages, leases, assignments and other documents necessary to carry out any of the powers granted the Executor, and which shall specifically include the authority to grant leases which extend beyond the period authorized by law. Section 7. Power to Distribute in Kind. My Executor may distribute in cash or in kind, or both, and may allot different kinds of property to different shares, as he deems advisable, without respect to the income tax basis of such property, and such designations or divisions, including the values placed on -2- such property for such purposes, shall be conclusive upon all parties. section 8. Tax Elections. My Executor in connection with the making and filing of all income tax, estate, inheritance and other death tax, gift tax and other tax returns and paying of any such taxes, whether or not the liability for such taxes arises before, at or after my death, and in connection with the adjudication or settlement of liability for any such taxes, may make such elections, decisions, concessions and settlements, including extensions of time for the payment of any Federal estate taxes or other taxes due as he or she, in his or her uncontrolled discretion, may determine to be proper, without liability to any person thereby affected and without the necessity of having to make compensating adjustments. ARTICLB SIX CUstodial Accounts for Kinors If any beneficiary entitled to receive a share of the principal of my estate is under the age of 21, my Executor shall deliver his or her share to such person selected by my Executor to receive such share for such minor child, including, but not limited to, a custodian under the Pennsylvania Uniform Transfers to Minors Act, or under any similar law of another state which may be appropriate. ARTICLB SEVEN SDendthrift No interest in income or principal shall be assignable by, or available to, anyone having a claim against a beneficiary, before actual payment to the beneficiary. ARTICLB BIGHT Source of pavaent of Taxes and BxDenses All estate taxes, inheritance taxes, transfer taxes, and other taxes of a similar nature, including any interest or penalties thereon, payable by reason of my death upon or with respect to any property subject to any such tax, whether or not such property passes under this Will, and all debts, costs of administration and other proper expenses shall be paid by my Executor out of the principal of that portion of my estate disposed of by Article Three, without reimbursement from or apportionment among the beneficiaries, recipients, or owners of such property. -3- ARTICLB IIIIIB InterDretation of will section 1. Sinaular and Plural: Use of Gender. Whenever used herein, the singular shall include the plural, the plural the singular and the use of any gender shall be applicable to all genders. section 2. C~Dtions. The captions of articles and sections of this will are for convenience of reference only and shall not affect the interpretation of this will. Section 3. Governina Law. I hereby declare that I am a domiciliary of the Commonwealth of Pennsylvania and that the succession laws and other applicable laws of the Commonwealth of Pennsylvania shall control the interpretation of this Will and the ownership of any other property passing at the time of my death other than under this Will, and that no succession laws of any other nation or state shall have any applicability to this Will or the ownership of any other property passing at the time of my death other than under this Will. Section 4. Definition of Child. Children. Grandchild. Grand Children or Issue. Whenever the term "child", "children", "grandchild", "grandchildren", or "issue" are used herein such terms shall be limited to persons related to me by blood and shall specifically exclude any adopted persons or step-children. IN WITNESS WHEREOF, I have hereunto set my hand and seal to the original of this will on this 1/"i"A day of March, 1997. ~.0~ (SEAL) ALB RT S. BELOVICH cYD<t- 03-(0 9..A~ Social Security Number Signed, sealed, published and declared by the above- named Testator, as and for his Last will in the presence of us and each of us, who, at his request, in his presence and in the of each other, have hereunto subscribed our names as ereto the day and year last above written. ~-/ cJ tX~",- witne -4- . . ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ) ss: COUNTY OF 0 Al.-\fH;r:,J ) We, ALBBRT 8. BBLOVICR, W(('J--1d--t.L. ..6v-cH-I,V\ , and ../ fV\(.t..(j ~rt'1 O. ehCt.t"/N{~ , the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last will and that he signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~dovC1!~ t{)0~wj~ "?11'lJ'~ O. c.1i':'.L- witne s SUBSCRIBED, sworn to and acknowledged before me by ALBERT 8. .BLOVICB, the Testator, and subscribed and sworn to before me by v...k~ 1-. 13 rra++ 0 " and m ur-J 4r--(+ ~ f At-/ /Y't{;'1 , witnesses, this ) J~ day of March, 1997. Nota~~~ (Notarial Seal) . Not:>i:,"; Seal ~ H Eli;:, f\Mary PubliIC CarfJ-1", .:;:. C M ;'"<,::~~=.;~0rc;_umber.and County , . -.IJ;' i, 1..SS;on Ex,01res Sept 22 -. . ,1997 107948.1 ~ ~ IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA INRE: ) ) ) ) No. 00761 of 2001 ORPHANS' COURT DIVISION ESTATE OF ALBERT S. BELOVICH, Deceased Date of Death: August 6, 2001 CERTIFICATION OF NOTICE UNDER RULE 5.6(~) To the Register, I certify that notice of [beneficial interest] estate admini~ation 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 September h . 2001 (attach additional sheets, ifnecessary) ~ Address John A. Mevretic 1121 Westminster Rd. HarrisbuIi PA 17109 Helen M. Maurer 6207 Catherine St. Harrisburi P A 17112 Cathedral Parish of St. Patrick a/kJa St. Patrick's Cathedral Attn: Rev. Monsi~nor William M. Richardson 212 State Street. Harrisburi. PA 17101 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: j/l;l..Ldt I (Signature) f) /.- r~ Name Thomas P. Gacki. ESQJIire Address 213 Market Street 8th Floor Harrisbur~ PA 17101 Telephone (717) 237-6093 Capacity: 0 Personal Representative 0' Counsel for Personal Representative {J0570812.1 } COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GACKI THOMAS P 111 NORTH FRONT ST POBOX 889 HARRISBURG, PA 17108-0889 __n_n_ fold ESTATE INFORMATION: SSN: 204-03-6955 FILE NUMBER: 21 - 2001 - 0761 DECEDENT NAME: BELOVICH ALBERT S DATE OF PAYMENT: 12/28/2001 POSTMARK DATE: 12/27/2001 COUNTY: CUMBERLAND DATE OF DEATH: 08/06/2001 NO. CD 000703 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,206.06 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: JOHN MA VRETIC C/O THOMAS GACKI ESQUIRE CHECK#1019 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS $5,206.06 MARY C. LEWIS REGISTER OF WILLS \'/b-~-O- IY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG~ PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Recc;.; Re' DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-18-2002 BELOVICH 08-06-2001 21 01-0761 CUMBERLAND 101 .02 FEB 25 Al1 :57 THOMAS P GACKI ECKERT ETAL PO BOX 1248 HBG c(~n\ PA ~td-;{_-,,-";" ~\l1(J IY~. t : "".~. FA *' REV-1547 EX AFP U2-DD> ALBERT S Allount Rellitted J CHANGED (lJ (2J (3J (4J (SJ (6J (7J 50~000.00 615.72 .00 .00 11~478.55 .00 .00 (8J MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-V:is4-j-ix--AFP-(i2':Ooi--NO'~ffci--OF-i-tiHiifffAiicE-T-A;rAPPRA-fsiirENT~--ALi-oWAifcE-ifR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BELoVICH ALBERT S FILE NO. 21 01-0761 ACN 101 DATE 02-18-2002 TAX RETURN WAS: (X J ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule BJ 3. Closely Held Stock/Partnership Interest (Schedule CJ 4. Mortgages/Notes Receivable (Schedule DJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule FJ 7. Transfers (Schedule GJ 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule HJ 10. Debts/Mortgage Liabilities/Liens (Schedule IJ 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax 12,224.65 327.48 U1J U2J U3J U4J (9J UOJ NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 62,094.27 12.1i1i? 13 49,542.14 800.00 48,742.14 NOTE: I~ an assessment was issued previously 1 lines 141 15 and/or 161 171 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. AlIOunt of Line 14 at Spousal rate 16. AlIOunt of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: USJ .00 X 00 = .00 U6J .00 X 045 = .00 U7J .00 X 12 = .00 U8J 48,,742.14 X 15 = 7,311.32 U9J= 7,311.32 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-02-2001 CDOO0488 105.26 2,,000.00 12-27-2001 CDOO0703 .00 5,,206.06 TOTAL TAX CREDIT 7,,311.32 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.J ~ V' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA INRE: ORPHANS COURT DIVISION Estate of Albert S. Belovich No. 2001- 00761 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Albert S. Belovich Date of Death: August 6, 2001 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 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 Orphans Court No. (if any) for the personal representatives account is: 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 :~: ~!5:r:Of Orphans Court and may be attached to ~/iS report. /::l\ 7 ~ / Date: ...JLO.LI_ ~ Signature L~ r ,~~ Name: Thomas P. Gacki Esquire Address: 213 Market Street. 8th Floor C::i ~. Harrisburg. PA 17101 Telephone: (717) 237-6093 ~ :"::S .i:..- Capacity: Personal Representative p ~':'_'Jd -f.: ..:> ~ ~Jc3 x Counsel for Personal Representative {J0607672.1 } .111IIO VI tHOI '* COMMONWEALTH OF PENNSYlVANIA . DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W o w C DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) DATE OF BIRTH (MM-OO-YEAR) 08-06-2001 11-26-1919 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) N/A UI ..., ~:!!illl uCI:~ UIILU x09 uflll ~ [Zl1. Original Return o 4. limited Estate [Xl 6. Decedent Died Testate (AItadlCXlpyalWil) o 9. Litigation Proceeds Received JJs:Jj'll i~O~SP.QlfDENCE~~~ COMPlm MAILING ADDRESS o 2. Supplemental Return o 4a. Future Interest Compromise (dateal_.fter12-12.a2) o 7. Decedent Maintained a Uving Trust (AItadl CXlpy '" Trust) o 10. Spousal Poverty Cre<it (_ "'_..._ 12-31.91111d 1.1-ll5) NAME FIRM NAME (" Appicablo) E k S amans Che in & Mello t TELEPHONE NUMBER (717) 237-6093 L OFFICIAL USE ONLY __ / & _~__ o?~~q__ - / r..; FILE NUMBER 2- ..l.. - $l...L .JL -0. L .6.... .L COUNTY COllE YEAR NUMIlER SOCIAL SECURITY NUMBER 204 - 03 6955 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURllY NUMBER o 3. Remainder Return (dale "'_ prior 10 12-1U2) o 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AlladI SdI 0) P.O. Box 1248 Harrisburg, PA 17108-1248 x.O_ (15) x.O_ (16) x .12 (17) x .15 (18) 7,311.32 (19) 7,311.32 z o ~ ::) l- ii: c( o w 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate BiRing Requested 7. Inter.VlVos Transfers & Miscellaneous 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 Uabilities, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus lile 11) 13. Charitable and Governmental Bequesls/Sec 9113 Trusts for which an election to tax has nol been made (Schedule J) (1) (2) (3) (4) (5) 50,000.00 615.72 11,478.55 (6) (7) (9) 12,224.65 327.48 (10) 14. Net Value Subject to Tax (line 12 minus line 13) z o ~ ~ ::) Q. ~ o o ~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPlICABLE RATES 15. Amount of line 14 taxable at the spousal lax 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 18. Amount of Line 14 taxable at coIateraI rate 48,742.14 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I'll. ,... -"',' = (f' -r;7 1'"'r' ..,J r't OFF I ciALTisE-o;liIT d :r:O -a. -1.'7"' ~ ," o C'"J N 0:> "0 I,~~j W (8) 62,094.27 (11) 12,552.13 (12) 49,542.14 (13) 800 . 00 (14) 48,742.14 Decedent's Complete Address: STREET Fl6~ust Road CITY STATE PA Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,000.00 105.26 Total Credits (A + B + C ) (2) 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) ZIP 17011 7,311.32 2,105.26 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 5,206.06 A. Enter the interest on the tax due. (5) (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 5 , 206 . 06 Make Check Payable to: REGISTER OF WILLS, AGENT - ~~n Illlmll ,! .....~J,~~~ ..,Jrt __J~f~llil.. 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; 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 for" 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 IKJ IKJ r&J IX] ~ ~ Ii] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND ALE IT AS PART OF THE RETURN. M. aurer, 6207 Catherine Street, Harrisburg, PA 17112 Jonn A. Mavretic, 1121 Westminster Road, Harrisbur , PA 17109 SIGNATURE OF PREPARE R RESENTATIVE rL ~RE~ Thomas P. Gacki, Eckert Seamans Cherin & Mellott P.O. Box 1248, Harrisburq, PA 17108-1248 1 ........,_J.Jlkt~_J~ I1HIl . _'__~''i~'aall ~_~. J L " 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 10 or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)). The slaMe does not exemDl a transfer to a surviving spouse from tax, and the staMory requirements for disclosure of assets and filing a tax retum are sliD applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate inposed on the net value of lransfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural paren~ an adoptive paren~ or a stepparent d the child is 0% [72 P.S. ~9116(8)(1.2)~ The lax 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)). The lax rate inposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an ilcfrvidual who has at least one parent in common with the decedent, whether by blood or adoption. --."... '*' COMMONWEAl. TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Albert S. Be10vich 21-01-00761 AD ruI property owned solely or . I tenant In common must be reported It fair lIIIIIlet value . Fair market value is defined as the price at which property would be exchanged between a ~ buyer and a willing seller, neither being compelled to buy or seI. both having reasonable knowledge of the relevant facts. Rell property which is jolntly-owned with right of lurvlvorshln must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VAlUE AT DATE OF DEATH 50,000.00 1 Locust Road Lower Allen Township, Cumberland County (Sale Price - Settlement Sheet Attached) TOTAL (Also enter on tine 1, Recapitulation) S 50,000.00 (If more space is needed, insert additional sheets of the same size) Settlement Statement A. U.S. Oepartment of HoualnQ OM 2 02-0265 B. Tvoe of Loan and Urban Develooment BNa. 5 1.0FHA 2. DFmHA 3. DConv. Unins. I 6. File Number I 7. Loan Number 1 8. Mortgage Insurance Case Number 4. OVA 5. nConv. Ins. 01-500 C. Note: 'nil rorm 'I rurllllnea la give you I' emen COSIS, AmountS palo 10 ana oy lne 1I1IIemen'lgem are snown. Items mlrkld '(p.o.c.)' were paid oulSldetha clOlln~; thay are shown here for Infonmatlon purposes and are nollneluded in the lolals. WARNING: It 's a crime, t,?"~nowlngIY make '111Il!:' 8!'!'~~ls ta ~~II~~~~ S~at~~~~ Ihls or any,ather similar 'orrci'1 ~~nalt'es upon D. NAME OF BORROWER: Hf"lT .....u IS FAMILY PARTN ADDRESS: E. NAME OF SELLER: ALBERT S. BELOVICH ADDRESS: F. NAME OF LENDER: ADDRESS: G. PROPERTY ADDRESS: 1 LOCUST ROAD, CAMP HILL, PA 17011 TOWNSHIP OF LOWER ALLEN H. SETTLEMENT AGENT: Central Penn Settlement Services, Inc., Telephone: 717-671-9876 Fax: 717-671-9676 PLACE OF SETTLEMENT: 4309 Linglestown Road, Harrisburg, PA 17112 J. SETTLEMENT DATE: 11/05/2001 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER: 101. Contract sales crlce 50,000.00 401. Contract sales crice 50,000.00 102. Personal Procertv 402. Personal Procerty 103. Settlement charges to borrower lline 1400\ 1,188.25 403. 104. 404. 105. 405. Adiustments for items oaid bv seller in advance Adjustments for items oaid bv seller in advance 106. City/town taxes 406. City/town taxes 107. County taxes 11/05/01to 12/31/01 42.77 407. County taxes 11/05/01to 12/31/01 42.77 108. School Taxes 11/05/01 to 06/30/02 469.35 408. School Taxes 11/05/01to 06/30/02 469.35 109. SewerlTrash 11/05/01 to 12/31/01 42.16 409. SewerlTrash 11/05/01to12/31/01 42.16 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 51,742.53 420. GROSS AMOUNT DUE TO SELLER: 50,554.28 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deoosit or earnest money 1,500.00 501. Excess Decoslt Isee instructions\ 202. Pnndpalamountofnewloanlsl 502. SeUlement charaes to seller (line 1400\ 4,232.00 203. Existino loanls\ taken subiectto 503. Existing loanls\ taken subiectto 204. 504. Payoff of First MortQaQe Loan I I 205. 505. Payoff of Second Mortoaoe Loan 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unoaid bv seller Adiustments for Items unoald bv seller 210. Citvltown taxes 510. CIIv/town taxes 211. County taxes 511. County taxes 212. School Taxes 512. School Taxes 213. 513. 214. 514. 215. 515, 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 1,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 4,232.00 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower IlIne 120\ 51,742.53 601. Gross amount due to seller !line 420\ 50,554.28 302. Less amounts oaid by/for borrower lline 220\ 1,500.00 602. Less reduction amount due seller IlIne 520\ 4,232.00 I 303. CASH FROM BORROWER 50,242.53 I 603. CASH TO SELLER 46,322.28 I U.S. EPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT File Number: 01-500 PAGE 2 L, SETT~EMENTCHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price $50,000.00 . 7.000 . 3,500.00 BORROWER'S SELLER'S Division of commission (line 7001 as follows: FUNDS AT FUNDS AT 701. S to SETTLEMENT SETTLEMENT 702. $ 3,500.00 to CB Homesale Services Group, Inc. . 703. Commission oald at Settlement 3,500.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Oriolnatlon Fee % 802. Loan Discount % 803. Aooraisal Fee 804. Credit Report 805. Lender's Insoection Fee 806. Mortoace Aoollcation Fee 807. Tax Service Fee 808. Document Preoaration 809. Flood Certification 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to ailS Idav 902. Mortoaoe Insurance Premium for to &03. Hlzerd Inlurlnel Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. HlZlrd In.urlne. mo. QIl S /mo 1002. M"rt"..".ln.u"n"" m".II!l!. 1m" 1003. Cltv Prooertv Taxes mo.l!!l $ Imo 1004. Countv Prooertv Taxes mo.l!!l$ 22.83 Imo 1005. School Taxes mo. (1il$ 59.99 Imo 1009. Aooreoate Analvsis Adiustment 1100. TITLE CHARGES 1101. Settlement or closlno fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Preparation to Thomas P. Gacki, Esq. 100.00 1106. Notarv Fees to Cash 7.00 7.00 1107. Attomev's fees lincludes above items No: \ 1108. Title Insurance to Central Penn Settlement Services, Inc. 528.75 (Includes above items No: 1101,1102,1103,1104 \ 11 09. Lender's Coveraoe $ 1110. Owner's Coverage $ 50,000.00 - 528.75 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordina Fees Deed $ 27. SO . Mortoace $ : Release $ 27.50 1202. City/County tax/stamos Deed $ 500.00 : Mortoaoe $ 500.00 1203. State Tax/stamos Deed $ 500.00 . Mortnace $ 500.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survev 1302. Pest Insoection to Waived 1303. Home InsolRadon Testino to Waived 1304. Transaction Fee to CB Homesale Services Group, Inc. . 125.00 125.00 1305. 1306. 1307. 1308. _..~. '* COMMONWEAlTH OF PENNSYlVAN'" NiERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Albert s. Belovich FILE NUMBE~1_01_00761 All property joIntly-owntd with right of IlIl'VIYorIhlp mUlt be dilcloled on Schedule F, ITEM NUMBER 1. DESCRIPTION 21 Shares Met Life Common (29.32jshare) VAlUE AT DATE OF DEATH 615.72 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 615.72 __n',,,,. . COMMONWEALTH Of PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Albert S. Belovich FILE NUMBER 21-01-00761 ESTATE OF Include the proceeds of Iitiga lion and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VAlUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Mellon Checking 152 1421915 1,845.93 2. Mellon Savings With Accrued Interest 00150 280373 8,923.85 3. County Taxes Refunded at Settlement 42.77 4. School Taxes Refunded at Settlement 469.35 5. Sewer/Trash Refunded at Settlement 42.16 6. Donegal Insurance - Refund of Homeowner's Insurance 110.50 7. Suburban Cable Refund 43.99 TOTAL (Also enter on line 5, Recapitulation) $ 11,478.55 (If more space is needed. insert additional sheets of the same size) @ P.O. Box 7899 Philadelphia, PA 19101-7899 Mellon Bank September 20, 2001 Eckert Seamans Cherin & Mellott LLC USX Tower 600 Grant Street 44th Floor Pittsburgh P A 15219 Attn: Geraldine Allison Estate Of Albert S Belovich Date of Death: 08/08/2001 SSN 204-03-6955 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedents name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-537-5591. For all other inquiries, please call (215) 553-1585. jt~~ Mellon Bank, N.A. Deposit Support Services 199-5355 Page 1 of 2 qj Mellon Bank Account Number Account Title 152-142-1915 Albert S Belovich 00150-280373 Albert S Belovich Thursday, September 20,2001 I Date Opened: 03 30/1981 Account Type: DO I I Principal Sal Int from Last Account Sal YTD Int to ( as of DOD Po ing to DOD as of DOD DOD $1,845.93 $0.00 $1,845.93 $0.00 \ Date Opened: o /30/1981 Account Type: SA Principal Sal I t from Last Account Sal YTD Int to as of DOD sting to DOD as of DOD DOD $8,923.42 $0.43 $8,923.85 $18.47 Page 2 of 2 -.,..-. . COMMONWEAlTH Of PENNSYlVANIA IMiERIT ANCE TAX RETlJRN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Albert S. Belovich FILE NUMBER 21-01-00761 Debts of decedent must be reported onSchedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAl EXPENSES: 1. Daley Funeral Home 4,755.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative s Convnissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative{s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 2,500.00 3. Family Exemption: (If decedent s address is not the same as claimant s. attach explanation) Claimant Street Address City !':tlltll Zip Relationship of ClaImant to Decedent 4. Probate Fees 156.00 5. Accountant s Fees 6. Tax Retum Preparer s Fees 7. Dan Barett - Contractor to remove appliances 105.00 8. Water Bill 21.24 9. PP&L Bill 16.78 10. Sewer Bill 67.50 II. Water Bill 9.96 12. UGI 36.00 13. PP&L 15.62 *CONTlNUED ( N ATI'ACHMENT TOTAL (Also enter on line 9. Recapitulation) $ 12,224.65 (If more Space is needed. insert additional sheets of the same size) SCHEDULE H - continued FUNERAL EXPENSES & ADMINISTRATIVE COSTS EST A TE OF ALBERT S. BELOVICH 14. Mower Repairs (Executor's mower damaged by rocks in Decedent's yard) 15. Water Bill 16. PP&L 17. UGI 18. Realtor Commission 19. Deed Preparation 20. Notary Fee 21. Transfer Tax 22. Transaction Fee 250.00 10 .46 4.82 43.77 3,500.00 100.00 7.00 500.00 125.00 -~..,.... '* COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Albert s. Be10vich FILE NUMBER 21-01-00761 Include unrelmbursed medical expenses. ITEM NUMBER 1. Homeowner's Insurance DESCRIPTION AMOUNT 156.50 73.12 95.92 1.94 2. 3. 4. PP&L UGI AT&T Phone Lease TOTAL (Also enter on line 10, Recapitulation) $ 327.48 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI-EI1.LE J BENEFICIARIES ESTATE OF FILE NUMBER Albert S. Belovich 21-01-00761 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(l) OF ESTATE I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Helen M. Maurer Niece 50% 6207 Catherine Street Harrisburg, PA 17112 2 John A. Mavretic Nephew 50% 1121 Westminster Road Harrisburg, PA 17109 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. St. Patrick's Cathedral $800.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 800.00 (If more space is needed, insert additional sheels d the same size)