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Home My WebLink About01-0916 PETITION FOR PROBATE and GRANT OF LETTERS Estate of He lefL R, N em eo If No. 21-01-916 also known as To: Register of Wills for the , Deceased. County of Cu ~ be r I and in the Social Security No. () q, - 10 - ~ 5"'7 3 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner~, who isfftf:e 18 years of age or older an the executOr- named in the last will of the above decedent, dated 5~~ IS', 19~ and codicil~ dated F~ S-, I cr q 7 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C -.\ tl'\ b ~ \" I 0. .... cJ..... County, Pennsylvania, with he v lastfamily ofJ,rincipal residence at --r" orJtu...>Cl J ~ 61t1... 4. I. 1/ 1701"3,. Bc-r-c"'- at C'a.f1sl-L- (list street, number and muncipality) Decendent, then --1.i_ years of age, died at ~o'''r'\w(\'(c:l H-c~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Il~ Serde M b ~, .2.( ,~OCf Decendent at death own.ed property with estimated values as follows: (If domiciled in Pa.) . AIl 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: 3:1..0,000. . $ $ $ $ WHEREFORE, petitioner(~ respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters i-e s t-c. VYI ~ .... i-a r-~ (testamentary; administlatlOn c . . admmlstra110n d.b.n.c.l.a.) ~ '" '0' u c 0) ~3 ~ ~ J.f tV tf7J.11. over >t, -g.g ~rli5(e- ,~A 001] C'd'~ 3~ 0)<- 50 ;;; c 00 C/i theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND J The petitioner(s) above-named swear(s) or affirm(s) that the state nts in the foregoing petition are true and correct to the best of the knowledge and belief of petitione (s) that as personal represen- tative(s) of the above decedent petitioner(s) will well d tru dm' ter th estate according to law. ~ ()Q' :::s l:l ..... l::: ~ ~ /7-/~ -Cj/ No. 21-01-916 Estate of HELEN R NEMETH , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW OCTOBER 5 ~ 200 ~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 9-18-1990 and 6-5-1997 described therein be admitted to probate and filed of record as the last will of HELEN R NEMETH and Letters TESTAMENTARY are hereby granted to JOHN H BROUJOS 7"1t71!mi;4.Jft /4<<>"( Rister of Ills FEES JOhn 1-\. Br':';<.LjOSIES~v.rre~o<o2..<C&' ATTORNEY (Sup. Ct. l. . No.) Probate, Letters, Etc. ......... a<rffEtitificates(L./) . . . . . . . . . . ~~~~............... $ 3o~QO $ 11..,00 10.)0 $ ~OO $ .:J ,00 TOTAL _ $ 341.50 . . . . . .QCTOB.ER. 4.,. .2001 . . . . . . . . . . . t{ ;1) fta.I'\.O ver ST.. C'u-( is (eo PA 1'10 rS , I ADDRESS Filed ,If- :llf3-1{':>'1Lj- aa~ /"'>. ~/ , ,,-,-...) Jl ~ (" "j o \ '"\ ~ " J ~ \~ \t 21-01-916 W ILL Tt Helen R. Nemeth of 1162 Redwood Drive, Carlisle, Cumberland County, Pennsylvania declare this to be my last will and revoke any will previously made by me. ITEM ONE: I direct that all my debts and funeral expenses, including any gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. It is my desire that I be cremated. ITEM TWO: I give, devise and bequeath my entire estate to my husband Zoltan Nemeth, if he survives me by 60 days. In the event that he predeceases me or is not then living on the 61st day after my death, then I give, devise and bequeath my entire estate, both real and personal property, as follows: A. Ten Percent (10%) to St. Johns Church of Carlisle, Pennsylvania. B. The balance is to be divided equally among the following persons: 1. My brother, Robert Roy Brown, of Prescott, Arizona, per capita. 2. My husband's brother, Arpad Nemeth, of Levittown, Long Island, per capita. 3. My cousin, Lois Ann White, of Lancaster, Pennsylvania, per stirpes. 4. The daughter of my cousin, Ann Louise Sfeir, of Williamstown, New York, per stirpes. C. In the event that my brother Robert Roy Brown and/or my husband's brother Arpad Nemeth predecease me, then his or their share shall lapse, and the share of St. Johns Church shall be increased five percent (5%) for each of these persons predeceasing me; with the balance being distributed as set forth in the subparagraph above. ITEM THREE: I appoint my husband Zoltan Nemeth Executor of my last will. Should he fail to qualify or cease to act as Executor, I appoint John H. Broujos to act as Executor with same rights, powers and duties. this the ITEM FOUR: I appoint Gary Sfeir of Williamstown, New York, the husband of the daughter of my cousin Ann Louise Sfeir, guardian of any property which passes to any person under the age of 25 years and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. Said ~ guardian shall have the power to use income from time to time for the beneficiary's education, support and welfare without regard to his or her parent's ability to provide for such education, support or welfare, or to make payment for these purposes, without further responsibility, to the beneficiary or to the beneficiary's parents or to any person taking care of the beneficiary. Said guardian shall administer the separate and equal share of each beneficiary until he or she becomes 25 years of age, at which time the share of each beneficiary remaining in the guardianship account shall be paid to said beneficiary in full. In the event of the death of any beneficiary after my decease and prior to reaching the age of 25 years, his or her share shall be distributed equally to the surviving children or child to be administered in accordance with this guardianship provision. Should he fail to qualify or cease to act as guardian, then I appoint CCNB Bank to act as guardian, with the same rights, powers, and duties. . . , ITEM FIVE: All estate, inheritance, succession and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ITEM SIX: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SEVEN: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my personal representative during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. IN WITNESS WHEREOF, I have hereunto set my hand this )J1day of September, 1990. ~ I' /)/ d. >- . SIGNED ~~ ,J ,.t; ~~~/{ \ Helen R. N'emeth- The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her req est, in her~sence and in the presence of each other have subseri ed !.~,S~~ /, COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We "30 ( "\ fl. Bor-& vt~~4.5 and (kc..-L.{or'-~ tr C. f0v..1.~ witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last willi that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no con, ,1' int or--~due influence. , <' ~ Sworn and subscribed to before me this ~~~ day of ~"0~ 1990. ~, fl~ ~ry Publ" .~ NOTARIAL SEAL KAREN F. BYERS, NOTARY PUBLIC BORO OF CARLISLE, CUMBERLAND COUNTY MY COMMISSION EXPIRES MARCH 18. 1991 COMMONWEALTH OF PENNSYLVANIA 5S COUNTY OF CUMBERLAND I, Helen R. Nemeth, whose name is signed to the attached instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as my free and voluntary act for the purposes therein expressed. ~/ A/~ ~/' -ri 'J/~_b" e-~~,,~, e en R. N~meth '.,-\ Sworn an~ atfirmed to and of !?y~m~ ,1990. ~/~b~ if ;L-~ acknowledged before me this;/c day NOTARIAL SEAL KAREN F. BYERS. NOTARY PUBLIC OOR() OF CARLISLE. CUMBERLAND COUNTY MY COMMiSSION EXPIRES MARCH 18, 1991 .. " 21-01-916 ((obicil I, Helen R. Nemeth of 1162 Redwood Drive, Carlisle, Cumberland County, Pennsylvania, having made my last will and testament dated September 18, 1990, do hereby make, publish and declare this to be a Codicil to my said last will and testament. ITEM ONE: I amend my will to delete Item Two thereof and to substitute therefor the following: "ITEM TWO: I give and bequeath to Rebekah Sapphire, granddaughter of my cousin Lois Ann White, my Holiday Organ. I give devise and bequeath the rest, residue and remainder of my estate as follows: A. Ten Percent (10%) to St. John's Church of Carlisle, Pennsylvania. B. The balance is to be divided equally among the following persons: 1. My brother, Robert Roy Brown, of Prescott, Arizona, per capita. 2. My friend Jean Carleton of Forbes Road, Carlisle, per capita. 3. My cousin, Lois Ann White, of Lancaster, Pennsylvania, per stirpes. 4. The daughter of my cousin, Ann Louise Sfeir, of Williamstown, New York, per stirpes. C. In the event that my brother Robert Roy Brown predeceases me, then his share shail lapse, and the share of St. John's Church shall be increased ten percent (10%) for that person predeceasing me; with the balance being distributed as set forth in the subparagraph above. ITEM TWO: I amend my will to delete Item Three thereof and substitute therefor the following: ITEM THREE: I appoint John H. Broujos Executor of this my last will. Should he fail to qualify or cease to act as Executor, I appoint Hubert X. Gilroy to act as my Executor with the same rights, powers and duties. ITEM THREE: I amend my will to delete the last sentence of Item Four and substitute therefor the following: Should he fail to qualify or cease to act as guardian, then I appoint PNC Bank to act as guardian, with the same rights, powers and duties. ITEM FOUR: I hereby ratify and confirm my said last will and testament in all other respects excepting insofar as any part thereof is revoked or modified by this Codicil. IN WITNESS WHEREOF, I have hereunto set my hand this -9 ~day of June, 1997. ,./. ':)J rIb v~~~___ ~e /&~~<;> . , Helen R. Nemeth \ The preceding Codicil, consisting of two typewritten pages, was on the day and date thereof signed, published and declared by Helen R. Nemeth as a Codicil to her last will and testament, and we, in the presence of each other, have snbscribed 'ifr names as ~~esses hy:to. etA ~r-t~ ~I WCU0 /17aLLLa :D. ~:~ COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUlVIBERLM1l We hLi DC,ET fh.J,j GuUQ~ and (l/orc;a .D. Wa-t~E>r_<; witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as a codicil to her last will; that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the codicil as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn and subscribed to before me this ,s""<"'L day of June, 1997. ~l1'ZA..(' .A.a / l' .1--, "t^-dl;et~ a0c:J0A~ D. t.A)~ Notarial Seal SherrI L Murphy, Notary Public Carl/sIe Boro, Cumberland County My Commission Expires Jan. 4, 1999 COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUlVIBERLAND I Helen R. Nemeth whose name is signed to the attached instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. 'h ......./ / cO ,;J ;>,;{ ~;t-.i' ,c. ?"u:+o, , Helen R. Nemeth Sworn and affirmed to and acknowledged before me this 511- day of June, 1997. ~" d fLt.a(:J/'-'j Notary Public Notarial Seal c . Sherri L. Murphy, Notary PUiJ!lc Carlisle Boro, Cumberland County My Commission Expires Jan. 4, 1999 COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROUJOS JOHN ESQ 4 N HANOVER ST CARLISLE, PA 17013 u___n_ fold ESTATE INFORMATION: SSN: 097-10-8573 FILE NUMBER: 21-2001- 0916 DECEDENT NAME: NEMETH HELEN R DATE OF PAYMENT: 12/20/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/21/2001 NO. CD 000663 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $35,000.00 I I I I I I I I TOTAL AMOUNT PAID: $35,000.00 REMARKS: JOHN H BROUJOS ET AL CHECK# 2 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS S- CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Helen R. Nemeth Date of Death: September 21, 2001 Will No.: Admin. No.: 21-01-00916 To the Register: I certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 21, 2001: Name Address Robert Roy Brown Lois Ann White Ann Louise Sfeir Jean Carleton St. John's Episcopal Church 123 N. Rush Street, No. 18, Prescott, AZ 86301 361 Roseville Road, Lancaster, PA 17601 8850 Woodside Drive, Clarence, NY 14031-1123 2 E. Eppley Drive, Carlisle, P A 17013 P.O. Box 612, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none Date: December 21,2001 N If) John H. Broujos, Esquire #06268 4 North Hanover Street Carlisle, P A 17013 (717) 243-4574 .-- E~~ Capacity: OJ ("oJ u - c:::l _ Personal Representative ~ ~~ a: .-- p ~..) .0 _S:: ..:I) = ,"Oi ,-< ".J "-" ---.2L Counsel and Personal Representative ~ ----- CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Helen R. Nemeth Date of Death: September 21, 2001 Will No.: Admin. No.: 21-01-00916 To the Register: I certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 21, 2001: Name Address Robert Roy Brown Lois Ann White Ann Louise Sfeir Jean Carleton St. John's Episcopal Church 123 N. Rush Street, No. 18, Prescott, AZ 86301 361 Roseville Road, Lancaster, P A 17601 8850 Woodside Drive, Clarence, NY 14031-1123 2 E. Eppley Drive, Carlisle, P A 17013 P.O. Box 612, Carlisle, PA 17013 none Date: December 21, 2001 o C::t John H. Broujos, Esquire #06268 4 North Hanover Street Carlisle, P A 17013 (717) 243-4574 Capacity: I"l I _ Personal Representative .~ d: "J ", - ..J" ',..... () (\) wCl: 0: N P ,....' ~- ~g 'J.l :::: 56 l Counsel and Personal Representative RESERVATION: Estates Df decedents dying Dn Dr befDre December 12, 1982 -- if any future interest in the estate is transferred in pDssessiDn Dr enjDyment tD Class B (cDllateral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr life Dr fDr years, the CDmmDnwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes at the lawful Class B (cDllateral) rate Dn any such future interest. PURPOSE OF NOTICE: TD fulfill the requiraments Df SectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 Df 2000. (72 P.S. SectiDn 9140). PAYMENT: Detach the tDP pDrtiDn Df this NDtice and submit with YDUr payment tD the Register Df Wills printed Dn the reverse side. --Make chack Dr mDney Drder payable tD: REGISTER OF KILLS. AGENT REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cDmpleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office Df the Register Df Wills, any Df the 23 Revenue District Offices, Dr by calling the special 24-hDur answering service fDr fDrms Drdering: 1-800-362-2050; servicas fDr taxpayers with special hearing and I Dr spaaking needs: 1-800-447-3020 (TT Dnly). OBJECTIONS: Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallDwance Df deductiDns, Dr assessment Df tax (including discDunt Dr interest) as shDwn Dn this NDtice must Dbject within sixty (60) days Df receipt Df this NDtice by: --written prDtest tD the PA Department Df Revenue, BDard Df Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electiDn tD have the matter determined at audit Df the accDunt Df the persDnal representative, OR --appeal tD the Orphans' CDurt. ADMIN- ISTRATIVE CORRECTIONS: Factual errDrs discDvered Dn this assessment shDuld be addressed in writing tD: PA Department Df Revenue, Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 PhDne (717) 787-6505. See page 5 Df the bDDklet "InstructiDns fDr Inheritance Tax Return fDr a Resident Decedent" (REV-1501) fDr an explanatiDn Df administratively cDrrectable errDrs. DISCOUNT: If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5%) discDunt Df the tax paid is allDwed. PENALTY: The 15% tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. This nDn-participatiDn penalty is appealable in the same manner and in the the same time periDd as YDU wDuld appeal the tax and interest that has been assessed as indicated Dn this nDtice. INTEREST: Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day frDm the date Df death, tD the date Df payment. Taxes which became delinquent befDre January I, 1982 bear interest at the rate Df six (6%) percent per annum calculated at a daily rate Df .000164. All taxes which became delinquent Dn and after January I, 1982 will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate annDunced by the PA Department Df Revenue. The applicable interest rates fDr 1982 thrDugh 2002 are: Year Interest Rate Daily Interest FactDr Voar Interest Rate Daily Interest FactDr 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .0003Dl 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as fDIIDws: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the NDtice, additiDnal interest must be calculated. ~ /?-/r::;- / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-16D7 EX AFP IDI-DZl JOHN H BROUJOS ESQ BROUJOS & GILROY 4 N HANOVER ST CARLISLE PA cr7Q13 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-26-2002 NEMETH 09-21-2001 21 01-0916 CUMBERLAND 101 HELEN R Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i';o-j-E3f-AFP-foY=o2Y------...--ZNHERITANc'E--fAx--Si']rfEMENf-'(fF-ACCouiff--.-i.--------------------- ESTATE OF NEMETH HELEN R FILE NO.21 01-0916 ACN 101 DATE 08-26-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 P R I NC I PAL TAX DU E : .......................................................................................................................................................................................................................... 37,270.91 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2001 CDOO0663 1,842.11 35,000.00 07-15-2002 CDOO1404 1. 69- 520.91 TOTAL TAX CREDIT 37,361.33 BALANCE OF TAX DUE 90.42CR INTEREST AND PEN. .00 It IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 90.42CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT make check or money order payable to: C0l1110NWEAL TH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (570) discount of the tax paid is allowed. PENALTY: The 1570 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (670) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 2070 .000548 1992 970 .000247 1983 1670 .000438 1993-1994 n .000192 1984 1170 .000301 1995-1998 970 .000247 1985 1370 .000356 1999 n .000192 1986 1070 .000274 2000 870 .000219 1987 970 .000247 2001 970 .000247 1988-1991 1170 .000301 2002 670 .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROUJOS JOHN ESQ 4 N HANOVER ST CARLISLE, PA 17013 _uu_u fold ESTATE INFORMATION: SSN: 097-10-8573 FILE NUMBER: 2101-0916 DECEDENT NAME: NEMETH HELEN R DATE OF PAYMENT: 07/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/21/2001 NO. CD 001404 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $520.91 I I I I I I I I TOTAL AMOUNT PAID: $520.91 REMARKS: JOHN H BROUJOS ESQUIRE CHECK# 122 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS .~EV-1500 EX ~6-00) 1)~,v-" * COMMONWEALTH OF . PENNSYLVANIA , DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY C{,/ REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I?-(a-.J FILE NUMBER 2 1 -01 0 0 9 1 6 COuNTYCO'ii'E ---vEA~ - - NUMBER- - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) NEMETH HELEN R. DATE OF DEATH (MM-DD-Year) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) o 97- 1 0 - 8 5 7 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 09/21/2001 12/28/1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER w ~ li::$(/) uO::li:: w&u :I:o::g u D.lll D. < [R] 1. Original Return o 4. Limited Estate [R] 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12.12.82) o 7. Decedent Maintained a Living Trust (Attach copy olTrus!) o 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95) D 3. Remainder Retum (date of death prior to 12.13-82) D 5. Federal Estate Tax Return Required 01 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS JOHN H. BROUJOS ESQUIRE 4 NORTH HANOVER STREET FIRM NAME (If Applicable) BROUJOS & GILROY P.C. TELEPHONE NUMBER 717-243-4574 or 717-766-1690 CARLISLE PA 17013 ~ z w o z o D. (/) W 0:: 0:: o U z o t= <( ..J ::> .... ii: <( o W 0:: z o t= <( .... ::> a.. :IE o o )( <( .... 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) D Separate Billing Requested 7. Inter-Vivos 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 Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) 0.00 ~. - . - - _.. __ . .. ,n . _ OFFICIAL USE ONLY 313,626.53 (6) (7) ~ f...,. .... Z W C W o W C (8) 313,626.53 (9) (10) 18,845.90 4,169.23 (11) (12) (13) 23,015.13 290,611.40 29,061.14 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 261 ,550.26 15. Amount of Line 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 18. Amount of Line 14 taxable at collateral rate 19. Tax Due X _(15) X _(16) 65,387.57 X .12 (17) 7,846.51 196,162.69 X .15 (18) 29,424.40 (19) 37,270.91 20. [8] CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < ,~-",;", '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF NEMETH. HELEN R. FILE NUMBER 21 01 00916 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Checking Acct #406252, Orrstown Bank VALUE AT DATE OF DEATH 78,550.62 2. Investment Acct #106210800, Orrstown Bank 226,601.69 3. Certificate of Deposit #5060058945, Orrstown Bank 5,017.45 4. Household items (in nursing home) (appraisal attached) 715.00 5. Jewelry (appraisal attached) 1,684.50 6. Coins (appraisal attached) 324.30 7. Blue Cross Blue Shield reimbursement of ambulance expense 71.13 8. Cash on hand from safe deposit box and room at nursing home 539.30 9. State Farm - refund of homeowner's insurance premium 122.54 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 313626.53 t-\~ N~~ \;::/:;~._.__..hh. ~.~ -s~-\- 1. ._~-_. ---. -.-.--------..-- . B '-.:)~~ J '->-(~"";\f"\6~ .-.---~--- .-\S-~\\,.) ~... . .. - OCP -Z,.... J?~('~~ - '7.~ ..- tt:; J -r'-V'f:). ~~.. Sc C( ~~ ~.~ .9-~ 1 r Fl il ,(/ 105-- ~ (r.-..e) ~ ~ iI',!f"vs to 7 (~4--fr~~) ~ S--- cf ~ ~ ~~c; s ~D 1 -'(~ 1 D 10 ;2~~ ~ ~ s'-- Il, 15- \'- "~d~~ 6 ~ {3---m---..._......t..'-. ......-. --~-_._. ..~_.~ ;lS -.---_.__.. ..._.._----_._~$~--- <:~. :_"';:'-:":''';.'?f~1~''-~.,.: " . "111 ,,~ "~'1' [""--' , ~ i i ~'jr_~~';~C r-,";j .. .. /5 .~~ Lt~ t~ n, I~,_ /.fS-- '11"'_d~~._5Wd&S r- {;j I ~ ,..,f1~t.(t{,(,-~ C - .El ~.~"Ir Ie; L~ ~.()l4- S~lc - S~rp-/z- "T'7(/$- /1- ;20, f)t<qL hr;~ /0 J I /31 A..JC:>~L~;; ~7/ ;/-2.- Lo1 dtZe..fi(J ~/,Ut- 1't~A-f~ q !...-,f''t-I-1- 1/#L~ / 25'"'- 7/t)()O . lAJ\~ G. P-fi'jlf-- .-Sk., L~ -- _......j... -...-----, -. ._..~_.- ill .- .'<--.---.".-. -- . -.-_,. ______u__. _. _ ___ _. B__ ..__.____...._____~_._.______..__.___.__ . MARGARET B. BUSHEY ANTIQUE AND ESTATE JEWELRY September 27,2001 The foUowing items belonging to Helen R. Nemeth have been examined and identified for the purpose of estate distribution. No liability is assumed for any action taken with regard to this identification. DESCRIPTION One lady's 8aum and Mercier 14K wristwatch One Waltham Railroad pocket watch - Silver Metal One lady's gold fiUed Hamilton wristwatch One lady's engraved gold fiUed bangle One lady's 14K rope bracelet One lady's sterling Norseland link bracelet One lady's sterling wide Nordic link bracelet One ornate flower design sterling strainer One Wallace sterling nut spoon One set of six demitasse spoons in the grape pattern, Rogers plate One punch ladle in the grape pattern, Rogers plate One Sheffield silver plated sugar tongs One cake server with sterling handle One Rogers Bros. silver plated sauce ladle One Reed and Barton silver plated nut shovel RETAIL VALUE $400.00 $25.00 $10.00 $65.00 $45.00 $40.00 $50.00 $95.00 $30.00 $40.00 $60.00 $15.00 $45.00 $10.00 $10.00 .~ MARGARET B. BUSHEY ANTIQUE AND ESTATE JEWELRY One Reed and Barton silver plated fruit spoon $10.00 One Reed and Barton silver plated miniature sauce server $15.00 One Reed and Barton silver plated pickle fork $8.00 One Sterling Canada fork with enameling $10.00 One set of six Holmes and Edwards silver plated fruit spoons $30.00 One lady's sterling bangle bracelet, woven design $15.00 One lady's sterling bangle bracelet, soldered circles $15.00 One lady's sterling brooch in the Japanese style $20.00 One gent's 14K watch chain with two gold filled utensil charms and a gold filled Spalding ball charm $50.00 One gent's gold filled watch chain $15.00 O/Jo 9c.nl'~ / J.j 1<.. ;rjtA~nl'~ X.'n i # So. at> 0110 / J.j /<. (/.'t.lor.Q.{) ler,'oriJ c-,'r~/o brooe-A I~a.{' ~~'ft7 w/M jJu:^r"/ ~ '6 5. (J(j , tr ~2(q3.0D MARGARET B. BUSHEY ANTIQUE AND ESTATE JEWELRY February 11, 2002 The following items have been examined and identified for the purpose of estate distribution. No liability is assumed for any action taken with regard to this identification. DESCRIPTION APPROXIMATE VALUE One Gent's Hamilton 14K white gold wristwatch with $40.00 leather band, engraved - To Zoltan Xmas 1955 One pair of sterling silver earrings with clip backs, fashioned $5.00 in a vine and bud design with an oval cabochon cut green stone at the bottom of each earring One Gent's fifty years service pin, Grand Lodge F. and A.M. $1.00 of Pennsylvania, 10K gold filled One white metal cuff bracelet $.50 One lady's powder compact with mirror; Mary Lewis $25.00 distributor, New York, NY; "We Want WiIlkie" #3 One lady's 14K yellow gold cross pendant measuring $75.00 30mmx46mm, center set in a star pattern with one old European cut diamond, approximately .05 - .06 carat, and with one 14K yellow gold 2mm rope chain -length 19 112 inches One 20inch necklace of hand knotted cultured pearls with a $ 250.00 14K white gold clasp. Tbe strand is graduated with one 8mm center pearl, four 7mm pearls on each side of the center pearl, and graduates down from 6.5mm to 5.5mm pearls at the back attacbed to tbe clasp. There are 65 pearls knotted in the necklace. One sterling silver cover in an openwork lattice pattern $15.00 measuring 2 3/8 inches X 2 liS inches $10.00 One sterling silver cover in an openwork lattice pattern with a sterling top 2 % inches Xl 1I2inches - -# Lf:::z \. S-n . (~~,-4~ r ~l;j~ ~~ 13;1"'_ A. V _ :2-2..06 ! r ! ~ ., A) /;3. " ~., u~~ /P?f-7TP / f j>J-. G ~. 0<) F 7. of) A" if-au t'r - qcP " . /<fi3 /P1~ /7''1' -0 ~) ., /6 .or- ~ 0:.5-.~ .,. .... 1t:1'+2..-D - I..... /9 S I /. .i t> "' J <Ii (, I.( I. J (3) I C;t.,t. {, .... . t:I f-..v.. = ( , Ie; (, 7 ."'~ l'itf ,~ (/ c) ...." 7.5 Q7J.<J ~. IK-'" - '16. fr'I 10. (37'. 4.a-. (. Sd 1/--9 t <0 ; ~ ;"It. v'- ),V" Fd.+1 I 7'. cru -0 vt::- /ou- /7).,p....f vG-- ,IN /e::zoy Q, - 5:.00 /7U-.s vp - 7. 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I CJ rt -bt. ~ 1.1d "3" !'i I tj - ::rc.J.A t.! 1 ; t. g- O ,xl'A.. (l.. 1 ,4- ~ ..r ?q((' ...--- / .,~.<;\ V J.JttU ? J-a ,. ~ , .coq'...L..;- 7 . 7t,./, A-tJqJT 6-...0 C!.r 1 CoIf- ~ r I '9 C) cY ~f- ~.~ --- ;lP~ i -(f ., t,) ~ .Io~f.~ ; - t 7'f f .:if. ~Q - - 1J'7 - ~ I A.o'..J <!: fJ-y.C ]'2l1f'~. - ~7. I.. &".l 76 ~ j.W .-:::>- ;c f1 '.s:e- G, /-vJ' .~ ~ C; ov-> i ,~ (/) I$~ 1. r.... Di ~ Ct.-J. .: ..r: 6'/J 7b rtJ'l.. .A..rt 9- 'fI ... J P/i ,oG-n, f1~-'--j I '7 (V. N. ~ J.Jol1'~ - ~"'.t. G ~I. _ 7.':' Petit iM"j 0.ui L l3<.is-h..) G-.....o G. -'P - 7. (:h 0. .f. Va 1..1.. (Ju-r- J.. . Q>ti 'is I q- ).--1. f_ 17~ . "" 1. "'I '~S7: ~ [11~ S' p~v 0' " r: "'~ .~ s~ ~+~ :f~ p-., ~ )( P- ~~ ~. P-t...b~(i::..'-C&J J,) (. ~.J --- ., J'" 7'. . ,. ~l, .. ','" ...,. : &R-o tJ f' -=t!r- 'L-, " '. ~ H.,OV\ (~ ~u-. .. ---rAc:,/l..KlIJ~J/J f2~ - ho/)~ IS~ /~ / - .:-r-I-. l...t!~~~ d~~J 8,LL.s ~.P C /",1 A-tL~ S,P~IJ/1i/t ffonrij v_, A J ~~ U~ (~~~~ ~}J ~,~) ;~ .,'fhvO ,Woo~~;J ~(1)L fGL~ -k1L(J-f~ (~t.R_ f1L'~-~-'~-:~U~ JJY'r,;< J__~ H ., r-' ,( r JZ~' / -6 ~~., cJtJ~ ~ ~~ fJ. j7d ,_~ " 1 ( 7 - ;y...p!. -- Y- :b-? 3 ~~1;c /I'~ ~ . biV~/r m~~' U ..::Jdfl,.., /~ /YJ / elf /.J-C- s ,..c r . .p /1 . ~ ~.3 - ~.J- 7' 3 1.3)- ~ sF ~ (2. 17.:;//] I 1 . f':s'it'....,J;: '1 f/d...-,~ J r "",=-J.Y r./~ ~: C/A...I ~ u ,t.-L,O p~((J_ / Co (tU D.a ~ i-. ~ '...,.. / /h....- () ;$u 7 fJ ~("/-.JJ ~~ ~ C (,J Lv ~ . lJ~ G.-f\~~i'.4' ~ t '1snL 1 ~ '11 '>-( 10 I . REV.151,EX+"ll.97) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF NEMETH. HELEN R. 21 01 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. DESCRIPTION 1. 2. FUNERAL EXPENSES: Ewing Brothers Funeral Home, 630 S.Hanover St, Carlisle - cremation; funeral service Ashland Cemetery, 630 S. Hanover St, Carlisle - headstone and concrete foundation 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) John H. Broujos Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 78 E. RidQe Street City Carlisle State PA Zip 17013 Yea~s) Commission Paid: 2002 2. 3. Attorney Fees Broujos & Gilroy, P.C., EIN 23-2267691 Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills, Cumberland County 5. Accountant's Fees 6. Tax Retum Preparer's Fees Gerald L. Brenneman, CPA, Carlisle, PA 7. 8. 9. Register of Wills - Inventory Register of Wills - Inheritance Tax Return Register of Wills - Final Settlement Statement TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 00916 AMOUNT 3,052.40 610.00 0.00 14,500.00 0.00 341.50 300.00 10.00 15.00 17.00 18845.90 . ";;",":"., .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NEMETH. HELEN R. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21 01 00916 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT See Attachment Page(s) TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4 169.23 " " Continuation of REV-1500 Inheritance Tax Return Resident Decedent NEMETH, HELEN R. 21 01 00916 PaQe 1 Schedule I - Debts or Decedent, Mortgage Liabilities, & Liens ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. DESCRIPTION AMOUNT 1,717.24 Thornwald Home - nursing care 442 Walnut Bottom Road, Carlisle, PA 17013 PharMerica - medicines PO Box 6176, Carol Stream, IL 60197 246.34 West Shore EMS - ambulance service 503 N. 21st Street, Camp Hill, PA 17011 63.00 Carlisle Regional Medical Center - emergency room care 246 Parker St, Carlisle, PA 17013 73.36 IRS - 2000 tax due Philadelphia, PA 19255 234.14 Department of Revenue - 2000 PA income tax due Dept. 280432, Harrisburg, PA 17128-0432 131.95 Darlene Moyer - 2001-2002 personal tax 19 S. Hanover St, Carlisle, PA 17013 11.20 Oiler's Lawn Maintenance - lawn mowing before house was sold Tom Oiler, 39 Nelson Dr, Carlisle, PA 17013 106.00 PP&L - electricity 827 Hausman Rd, Allentown, PA 18104 12.67 Sprint - telephone PO Box 740463, Cincinnati, OH 45274 26.40 William G. Rowe - inventory appraisal 211 Old Stone House Rd, Carlisle, PA 17013 35.00 Margaret B. Bushey - jewelry appraisal 246 Conway St, Carlisle, PA 17013 100.00 St. John's Church - flowers PO Box 612, Carlisle, PA 17013 50.00 Broujos & Gilroy, P.C. - elder care legal services prior to death 4 N. Hanover St, Carlisle, PA 17013 796.50 John H. Broujos - reimbursement for payment for cleaning house prior to sale (100 to 4 N. Hanover St. Chun Cha Yun) and for packing and transfer of furniture, etc. Carlisle, PA 17013 from nursing home (100 to David Sheibley) 200.00 SUBTOTAL SCHEDULE I 3,803.80 , '. . . ;> .. Continuation of REV-1500 Inheritance Tax Return Resident Decedent NEMETH, HELEN R. 21 01 00916 Paqe 2 Schedule I - Debts or Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. Mailboxes, Etc. - packaging of framed picture 20.25 Walnut Bottom Rd, Carlisle, PA 17. UPS - shipping personal items to niece in Oregon 154.05 18. Orrstown Bank - rental of safe deposit box 20.00 Stonehedge Office, Walnut Bottom Road, Carlisle, PA 19. Cumberland-Goodwill Fire Rescue EMS - 3 ambulance transports 71.13 102 W. Ridge Street, Carlisle, PA 17013 20. IBIS Appraisal Service - appraisal of Hungarian book 25.00 P.O. Box 24, Carlisle, PA 17013 21. John T. Michalski - appraisal of coins 75.00 132 Chester Street, Carlisle, PA 17013 SUBTOTAL SCHEDULE I 365. GRAND TOTAL SCHEDULE I $ 4,169 . " . """,~"", '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NEMETI- HELEN R NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) FILE NUMBER 21 01 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) OOQ1n AMOUNT OR SHARE OF ESTATE 1. Robert Roy Brown 123 N. Rush Street, No. 18, Prescott, AZ 86301 brother 22.5% 2. Lois Ann White 361 Roseville Road, Lancaster, PA 17601 cousin 22.5% 3. Ann Louise Sfier 8850 Woodside Drive, Clarence, NY 14031-1123 cousin's daughter 22.5% 4. Jean Carleton 2 E. Eppley Drive, Carlisle, PA 17013 friend 22.5% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS St. John's Episcopal Church (10%) P.O. Box 612 Carlisle, PA 17013 29,061.14 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) 29061.14 /7-/~ - I ~ BUREAU OF INOIVlDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I:NHERI:TANCE TAX STATEMENT OF ACCOUNT *' 1IEl'-lU7 EXAFP UI-Ul JOHN H BROUJOS ESQ BROUJOS & GILROY 4 N HANOVER ST CARLISLE PA 17013','" DATE ESTATE OF DATE OF DEATH FILE NUMBER 'C4I!UNTY ACN 01-21-2003 NEMETH 09-21-2001 21 01-0916 CUMBERLAND 101 HELEN R i' Amount R...i tied MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account I submit the upper portion of this for. with your tax payment. CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... REY=i6oTEx-Af'p-foFii3Y------..il-INHERi'TANCr;:AX-STATEMEti;:-O-"-AcciiuiW-il..--------------------- ESTATE OF NEMETH HELEN R FILE NO.21 01-0916 ACN 101 DATE 01-21-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN TME NANED ESTATE. SHOWN BELOW IS A SUHHARY OF TME PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 PRINCIPAL TAX DUE: mm.....____...... 37,270.91 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2001 CDOO0663 1,842.11 35,000.00 07-15-2002 CDOO1404 1. 69- 520.91 01-06-2003 REFUND .00 90.42- TOTAL TAX CREDIT 37,270.91 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SlOE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I I?-/~- / '" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN JOHN H BROUJOS ESQ BROUJOS & GILROY 4 N HANOVER ST CARLISLE RA17013 08-12-2002 NEMETH 09-21-2001 21 01-0916 CUMBERLAND 101 *' REV-1547 EX AFP (Ul-D2J HELEN R Amount Remitted CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 313.626.53 .00 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is4-j-E3f-AFP--foY=02Y-NOYicE--OF-YNHEififANCE-YAX-A-PPRA-isEi"-ENT~--Ar.rOWAN-CE-(fR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NEMETH HELEN R FILE NO. 21 01-0916 ACN 101 DATE 08-12-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses [Schedule H) 10. Debts/Mortgage Liabilities/Liens [Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts [Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 18.845.90 4.169.23 NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment. 313.626.53 (11) (12) (13) (14) 23.015 13 290.611.40 29.061.14 261.550.26 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS. .00 X 00 = .00 .00 X 045 = .00 65.387.57 X 12 = 7.846.51 196.162.69 X 15 = 29.424.40 (19)= 37.270.91 . n .....n' T+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID [-) 12-20-2001 CDoo0663 1.842 . 11 35.000.00 INTEREST IS CHARGED THROUGH 08-27-2002 TOTAL TAX CREDIT 36.842.11 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 428.80 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.71 TOTAL DUE 433.51 · 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.) RESERVATION: Estates Df decedents dying Dn Dr befDre December 12, 1982 -- if any future interest in the estate is transferred in pDssessiDn Dr enjDyment tD Class B (cDllateral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr life Dr fDr years, the CDmmDnwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes at the lawful Class B (cDllateral) rate Dn any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: TD fulfill the requirements Df SectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 Df 2000. (72 P.S. SectiDn 9140). Detach the tDP pDrtiDn Df this NDtice and submit with YDur payment tD the Register Df Wills printed Dn the reverse side. --Make check Dr mDney Drder payable tD: REGISTER OF HILLS. AGENT A refund Df a tax credit, which was nDt requested Dn the Tax Return, may be requested by cDmpleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-1313). ApplicatiDns are available at the Office Df the Register Df Wills, any Df the 23 Revenue District Offices, Dr by calling the special 24-hDur answering service fDr fDrms Drdering: 1-800-362-2050; services fDr taxpayers with special hearing and I Dr speaking needs: 1-800-447-3020 (TT Dnly). Any party in interest nDt satisfied with the appraisement, allDwance, Dr disallDwance Df deductiDns, Dr assessment Df tax (including discDunt Dr interest) as shDwn Dn this NDtice must Dbject within sixty (60) days Df receipt Df this NDtice by: --written prDtest tD the PA Department Df Revenue, BDard Df Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electiDn tD have the matter determined at audit Df the accDunt Df the persDnal representative, OR --appeal tD the Orphans' CDurt. Factual errDrs discDvered Dn this assessment shDuld be addressed in writing tD: PA Department Df Revenue, Bureau Df Individual Taxes, ATTN: PDSt Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 PhDne (717) 787-6505. See page 5 Df the bDDklet "lnstructiDns fDr Inheritance Tax Return fDr a Resident Decedent" (REV-1501) fDr an explanatiDn Df administratively cDrrectable errDrs. If any tax due is paid within three (3) calendar mDnths after the decedent's death, a five percent (5%) discDunt Df the tax paid is allDwed. The 15% tax amnesty nDn-participatiDn penalty is cDmputed Dn the tDtal Df the tax and interest assessed, and nDt paid befDre January 18, 1996, the first day after the end Df the tax amnesty periDd. This nDn-participatiDn penalty is appealable in the same manner and in the the same time periDd as YDU WDuld appeal the tax and interest that has been assessed as indicated Dn this nDtice. Interest is charged beginning with first day Df delinquency, Dr nine (9) mDnths and Dne (1) day frDm the date Df death, tD the date Df payment. Taxes which became delinquent befDre January 1, 1982 bear interest at the rate Df six (6%) percent per annum calculated at a daily rate Df .000164. All taxes which became delinquent Dn and after January 1, 1982 will bear interest at a rate which will vary frDm calendar year tD calendar year with that rate annDunced by the PA Department Df Revenue. The applicable interest rates fDr 1982 thrDugh 2002 are: Year Interest Rate Daily Interest FactDr Year Interest Rate Daily Interest FactDr 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7Z .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7Z .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as fDllDws: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NDtice issued after the tax becDmes delinquent will reflect an interest calculatiDn tD fifteen (15) days beYDnd the date Df the assessment. If payment is made after the interest cDmputatiDn date shDwn Dn the NDtice, additiDnal interest must be calculated. ~ /?-/~-I BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-1607 EX AFP 101-02) JOHN H BROUJOS ESQ BROUJOS & GILROY 4 N HANOVER ST CARLISLE PA tt7013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-26-2002 NEMETH 09-21-2001 21 01-0916 CUMBERLAND 101 HElEN R Anount Renitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax paynent. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV = ic,'ifj-EX--AFP--[OY=02Y------...--iNirERiYA'Nc'E--YAX--STA-fEM'E-NY-cfF'-AccoUiff--.-..---------------- ----- ESTATE OF NEMETH HElEN R FILE NO. 21 01-0916 ACN 101 DATE 08-26-2002 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW IS A SU""ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 PRINCIPAL TAX DUE: ............................... 37,270.91 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2001 CDOO0663 1,842.11 35,000.00 07-15-2002 CDOO1404 1. 69- 520.91 TOTAL TAX CREDIT 37,361.33 BALANCE OF TAX DUE 90.42CR INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 90.42CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. J PAVMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT make check or money order payable to: COHHONWEAL TH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLV TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENAL TV: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. IMTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Vear Interest Rate DailY Interest Factor Vear Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. INVENTORY OF THE REAL AND PERSONAL ESTATE OF Helen R. Nemeth, deceased File No. 21-01-00916 Date of Death: September 21, 2001 1. 2. 3. 4. 5. 6. 7. 8. 9. Checking Acct. #406252, Orrstown Bank Investment Acct. # 1 0621 0800, Orrstown Bank Certificate of Deposit #5060058945, Orrstown Bank Household items (in nursing home), appraised value Jewelry, appraised value Coins, appraised value Blue Cross Blue Shield reimbursement of ambulance expense Cash on hand from safe deposit box and room at nursing home State Farm - refund of homeowner's insurance premium C> $ 78,550.62 226,601.69 5,017.45 715.00 1,684.50 324.30 71.13 539.30 122.54 $ 313,626.53 John H. Broujos, Executor of the Estate of Helen R. Nemeth, late of Carlisle, Cumberland County, Pennsylvania, has made an inventory of the entire estate of decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item o( th ven,torY-r sent its fair value as of the date of decedent's death. \ \ TOTAL ASSETS o,H. Broujos, Execu December 19, 2002 .. -~ c,~ EST ATE OF HELEN R. NEMETH, Deceased : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS COURT DIVISION IN RE: : FILE NO. 21-01-0916 NOTICE TO ATTORNEY GENERAL OF THE COMMONWEALTH OF PENNSYLVANIA IN ACCORDANCE WITH ORPHANS COURT RULE 5.5 John H. Broujos, attorney for the Estate of Helen R. Nemeth, gives notice in accordance with Pennsylvania and Cumberland County Orphans Court Rule 5.5 as follows: 1. The following testate proceedings have been brought in the Orphans Court of Cumberland County, Courthouse, Carlisle, Pennsylvania, containing a bequest to a charitable interest. 2. The Executor, John H. Broujos, who is also counsel for the estate, filed for and was appointed on October 5,2001 as Executor of the Estate of Helen R. Nemeth, decedent, in the above Court. 3. A copy of the will and codicil are attached hereto and made a part hereof and contain a bequest to St. John's Church, Carlisle, Pennsylvania, as a portion of the residue of the estate. 4. The charitable interest is a present interest, consisting of a cash distribution in the approximate amount of$25,100. 5. The bulk: of the remainder bequest has been distributed. Copy of receipts is attached, except for a small amount remaining to be distributed. 6. There are no unresolved claims or material question or future interest requiring adjudication. 7. CERTIFICA nON OF SERVICE. Executor hereby certifies that he has served a true and correct copy of the foregoing Notice to the Attorney General on the following person at the following address by U. S. Postal Service, Certified First Class Mail, on February 18, 2003 to: Mark A. Pacella, Esquire, Chief Deputy Attorney General Charitable Trusts and Organization Section 14th Floor, Strawberry Square Harrisburg, P A 17120 The Attorney General is requested to acknowledge receip of this Date: February 18, 2003 c: Register of Wills ,--- INRE: ESTATE OF HELEN R. NEMETH, Deceased FILE NO. 21-01-0916 RECEIPT. RELEASE. REFUNDING. AND INDEMNIFICATION AGREEMENT The undersigned S1. John's Church, Legatee under the Will of Helen R. Nemeth, deceased, does hereby: 1. Acknowledge receipt of the sum of $10,000.00 as an advance on final distribution of proceeds of the estate; 2. Release John H. Broujos, Executor of the Estate of decedent, and his heirs and personal representatives, from all liabilities, whether due to the Executor's negligence or otherwise, which he may have by reason of this advance distribution; 3. Acknowledge that the estate may have debts not known or anticipated at the time of this advance, and that such claims may be asserted against the estate for a period of approximately one year after death, and that in the event assets of the estate are insufficient to pay such claims, Executor has the right to obtain from beneficiaries receiving an advance distribution sufficient funds to pay the claims; and does agree to refund to the Estate any portion of the distribution required to pay claims which may be filed and any portion to which they are not properly entitled, and, to the extent of said distribution, to indemnifY the Executor for claims made against the Executor; and 4. Declare that this instrument shall be legally binding upon the beneficiary and the beneficiary's personal representatives, successors and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this/'~'-day of April, 2002. WITNESS ~~~ G.y-. " ~ LS Sf-' John's Church of Carlisle .0. Box 612 Carlisle, PA 17013 , IN RE: ESTATE OF HELEN R. NEMETH, Deceased FILE NO. 21-01-0916 RECEIPT. RELEASE. REFUNDING. AND INDEMNIFICATION AGREEMENT The undersigned St. 10hn's Church, Legatee under the Will of Helen R. Nemeth, deceased, does hereby: I. Acknowledge receipt of the sum of $9,300.00 as an advance on final distribution of proceeds of the estate; 2. Release 10hn H. Broujos, Executor of the Estate of decedent, and his heirs and personal representatives, from all liabilities, whether due to the Executor's negligence or otherwise, which he may have by reason of this advance distribution; 3. Acknowledge that the estate may have debts not known or anticipated at the time of this advance, and that such claims may be asserted against the estate for a period of approximately one year after death, and that in the event assets of the estate are insufficient to pay such claims, Executor has the right to obtain from beneficiaries receiving an advance distribution sufficient funds to pay the claims; and does agree to refund to the Estate any portion of the distribution required to pay claims which may be filed and any portion to which they are not properly entitled, and, to the extent of said distribution, to indemnify the Executor for claims made against the Executor; and 4. Declare that this instrument shall be legally binding upon the beneficiary and the beneticiary's personal representatives, successors and assigns. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 11-'-... day of August, 2002. WITNESS a ()ci h ~ Ii;! . / u-i;;t<f'{ J' . ""-- ~;/:vI(A~~ -I- /f::c TtC.. St. 10hn's Church of Carlisle P.O. Box 612 Carlisle, P A 17013 .. ... INRE: ESTATE OF HELEN R. NEMETH, Deceased FILE NO. 21-01-0916 RECEIPT. RELEASE. REFUNDING. AND INDEMNIFICATION AGREEMENT The undersigned St. John's Church, Legatee under the Will of Helen R. Nemeth, deceased, does hereby: 1. Acknowledge receipt of the sum of $5,800.00 as an advance on final distrihution of proceeds of the estate; 2. Release John H. Broujos, Executor of the Estate of decedent, and his heirs and personal representatives, from all liabilities, whether due to the Executor's negligence or otherwise, which he may have by reason of this advance distribution; 3. Acknowledge that the estate may have debts not known or anticipated at the time of this advance, and that such claims may be asserted against the estate for a period of approximately one year after death, and that in the event assets of the estate are insufficient to pay such claims, Executor has the right to obtain from beneficiaries receiving an advance distribution sufficient funds to pay the claims; and does agree to refund to the Estate any portion of the distribution required to pay claims which may be filed and any portion to which they are not properly entitled, and, to the extent of said distribution, to indemnifY the Executor for claims made against the Executor; and 4. Declare that this instrument shall be legally binding upon the beneficiary and the beneficiary's personal representatives, successors and assigns. fN WITNESS WHEREOF, I have hereunto set my hand and seal this ('6 day of J/~ , 2002. WITNESS ~ P-.\.. jurq~"PY) N~~ 44 St. John's Church of Carlisle P.O. Box 612 Carlisle, P A 17013 I?-/~ - / ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-16D7 EX AFP [Dl-m JOHN H BROUJOS ESQ BROUJOS 8 GILROY 4 N HANOVER ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2003 NEMETH 09-21-2001 21 01-0916 CUMBERLAND 101 HELEN R Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6'ifj-E3f-AFP--foY..-03Y------...--iNHERiYA'NC'E-fAX--SyjrfEME-Nf-ifF"-Aifcouiff--.-..------------------ --- ESTATE OF NEMETH HElEN R FILE NO. 21 01-0916 ACN 101 DATE 01-21-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 P R I NC I PAL TAX DUE: ..................................................................................................................................................................................................................... 37,270.91 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2001 CDoo0663 1,842.11 35,000.00 07-15-2002 CDoo1404 1. 69- 520.91 01-06-2003 REFUND .00 90.42- TOTAL TAX CREDIT 37,270.91 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 ll! SIDE 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. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. If NDN-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3J. Applications are available at the Dffice of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (7171 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 n .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 n .000192 2002 6% .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. * . Final Set.tlement Agreement Fjl~No. ..il-O(- 0'1\(". THIS is an Agreement entered into this J <3 ,.d day of D Q C e ~ b t' r , 2002, by and between John H. Broujos, Executor ofthe Estate of Helen R. Nemeth, ofBroujos & Gilroy, 4 North Hanover Street, Carlisle, P A 17013 (Executor), and the following Beneficiaries: St. John's Church of Carlisle, P.O. Box 612, Carlisle, PA 17013; Robert Roy Brown, 123 N. Rush Street, No. 18, Prescott, AZ 86301; Lois Ann White, 361 Roseville Road, Lancaster, PA 17601; Ann Louise Sfeir, 1519 Tanglewood Drive, West Chester, PA 19380; and Jean Carleton, 2 E. Eppley Drive, Carlisle, P A 17013; whose names are set forth as signatories at the end of this Agreement. WHEREAS: A. Helen R. Nemeth, of 442 Walnut Bottom Road, Carlisle, PA 17013, died on September 21,2001. B. On October 5, 2001, Letters Testamentary were granted to John H. Broujos at File No. 21-01-0916 in the Register of Wills Office for Cumberland County, Pennsylvania. C. Executor has administered the Estate of Helen R. Nemeth up until the present time and has paid all debts of the estate, including Inheritance Tax owed. D. Helen R. Nemeth died testate, thereby vesting all rights and interest in her personal property to St. John's Church of Carlisle, Robert Roy Brown, Lois Ann White, Ann Louise Sfeir, and Jean Carleton. E. Estate of Helen R. Nemeth has received assets as set forth in Exhibit A attached hereto and made a part hereof and has paid debts and expenses as set forth in Exhibit B attached hereto and made a part hereof. F. There remains to be distributed to beneficiaries the assets set forth in the Schedule of Distribution in Exhibit C attached hereto and made a part hereof. G. Executor and Beneficiaries desire to forego a formal accounting and schedule of distribution and desire to conclude the estate by virtue of the filing of this document. NOW, THEREFORE, Executor and Beneficiaries intending to be legally bound, state as follows: 1. The Executor and Beneficiaries agree that the Executor ofthe Estate of Helen R. Nemeth need not file a formal accounting or schedule of distribution through the courts. 2. Executor states that all costs of the estate are paid. 3. Beneficiaries agree that the final distribution of all estate assets remaining after payment of debts and expenses shall be made to the Beneficiaries, with the exception of$5,035.97 to be held for a period of up to 4 months or longer if necessary in escrow by Counsel for the Estate, John H. Broujos of Broujos & Gilroy, P.C., for final tax returns and other unforeseen expenses, with the balance to be distributed equally to Beneficiaries with an accounting which shall not be filed with the Register of Wills. 4. The parties acknowledge that any distribution made by Executor pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executor with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied ofrecord any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Final Settlement Agreement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Helen R. Nemeth, subject to the provisions hereof. IN WITNESS WHEREOF, Executor and Beneficiaries intending to be legally bound hereby set their hands and seals the day and year first above written. fc:r fr'lf, ~ ~ , ~'1 <'- . ~ ...:;:: I _ ,-----/ \--~ WITNESS: John~ B~oujos, Execu. r ~ 4//'~'L4- 4,(/, St. John's Church of Carlisle, Beneficiary Robert Roy Brown, Beneficiary Lois Ann White, Beneficiary Ann Louise Sfeir, Beneficiary Jean Carleton, Beneficiary held for a period of up to 4 months or longer if necessary in escrow by Counsel for the Estate, John H. Broujos of Broujos & Gilroy, P.C., for final tax returns and other unforeseen expenses, with the balance to be distributed equally to Beneficiaries with an accounting which shall not be filed with the Register of Wills. 4. The parties acknowledge that any distribution made by Executor pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executor with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Final Settlement Agreement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Helen R. Nemeth, subject to the provisions hereof. IN WITNESS WHEREOF, Executor and Beneficiaries intending to be legally bound hereby set their hands and seals the day and year first above written. } , \.~,!~ WITNESS: St. John's Church of Carlisle, Beneficiary J-~<t:/ .~~.uJ ".&-~~/~~~ Robert Roy own, Beneficiary Lois Ann White, Beneficiary Ann Louise Sfeir, Beneficiary Jean Carleton, Beneficiary held for a period of up to 4 months or longer if necessary in escrow by Counsel for the Estate, John H. Broujos of Broujos & Gilroy, P.c., for final tax returns and other unforeseen expenses, with the balance to be distributed equally to Beneficiaries with an accounting which shall not be filed with the Register of Wills. 4. The parties acknowledge that any distribution made by Executor pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executor with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Final Settlement Agreement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Helen R. Nemeth, subject to the provisions hereof. IN WITNESS WHEREOF, Executor and Beneficiaries intending to be legally bound hereby set their hands and seals the day and year first above written. ~~ WITNESS: St. John's Church of Carlisle, Beneficiary )~-f ~ ff;.?~~-,. Robert Roy Brown, Beneficiary ~~040~0~ Lois Ann White, Beneficiary Ann Louise Sfeir, Beneficiary Jean Carleton, Beneficiary '''' ..... ' . held for a period of up to 4 months or longer if necessary in escrow by Counsel for the Estate, John H. Broujos of Broujos & Gilroy, P.c., for final tax returns and other unforeseen expenses, with the balance to be distributed equally to Beneficiaries with an accounting which shall not be filed with the Register of Wills. 4. The parties acknowledge that any distribution made by Executor pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiaries hereby release Executor with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The pm1ies designate this statement as a "satisfaction of award" and hereby a~lthorize and direct the Clerk of Orphans' Court to make satisfied ofrecord any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Final Settlement Agreement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Helen R. Nemeth, subject to the provisions hereof. IN WITNESS WHEREOF, Executor and Beneficiaries intending to be legally bound hereby set e their hands and seals the day and year first above written. ~~,~/ \~ WITNESS: St. John's Church of Carlisle, Beneficiary Robert Roy Brown, Beneficiary 4~~ Lois Ann White, Beneficiary Q~~ ~q--\.{.~~,.. )(~~~) Ann Louise Sfeir, Beneficiary Jean Carleton, Beneficiary e held for a period of up to 4 months or longer if necessary in escrow by Counsel for the Estate, John H. Broujos of Broujos & Gilroy, P.C., for final tax returns and other unforeseen expenses, with the balance to be distributed equally to Beneficiaries with an accounting which shall not be filed with the Register of Wills. 4. The parties acknowledge that any distribution made by Executor pursuant to this Agreement is an "at risk" distribution pursuant to 20 P .S. 3532. Beneficiaries hereby release Executor with respect to acts or omissions in the administration and distribution of the estate and hereby agree to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of nward" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Final Settlement Agreement shall be filed with the Clerk of Orphans' Court in final settlement of the Estate of Helen R. Nemeth, subject to the provisions hereof. IN WITNESS WHEREOF, Executor and Beneficiaries intending to be legally bound hereby set their hands and seals the day and year first above written. ~7 ,bu-/f; :/ WITNESS: St. John's Church of Carlisle, Beneficiary Robert Roy Brown, Beneficiary Lois Ann White, Beneficiary ~~ Ann Louise Sfeir, Beneficiary ~(?~ Jgn Carleton, Beneficiary EXHIBIT A ASSETS and INCOME ASSETS 1. 2. 3. 4. 5. 6. 7. 8. 9. Checking Acct. #406252, Orrstown Bank Investment Acct. # 1 0621 0800, Orrstown Bank Certificate of Deposit #5060058945, Orrstown Bank Household items (in nursing home), appraised value Jewelry, appraised value Coins, appraised value Blue Cross Blue Shield reimbursement of ambulance expense Cash on hand from safe deposit box and room at nursing home State Farm - refund of homeowner's insurance premium $ 78,550.62 226,601.69 5,017.45 715.00 1,684.50 324.30 71.13 539.30 122.54 TOTAL ASSETS $ 313,626.53 INCOME Interest earned on CD Interest earned on estate checking account Interest on investments (Orrstown Bank) Dividends on investments (National Financial Services) Interest on 7.30.02 bond Interest on 8.15.02 bond 44.88 409.32 443.70 458.27 771.25 1,687.50 TOTAL INCOME $ 3,814.92 TOT AL ASSETS AND INCOME $ 317,441.45 EXHIBIT B EXPENSES Funeral Expenses Ewing Brothers Funeral Home - cremation; funeral service Ashland Cemetery - headstone and concrete foundation Administrative Costs Broujos & Gilroy, P.c. - attorney fees John H. Broujos - Executor fee Register of Wills - probate fees Register of Wills - Inventory filing fee Register of Wills - Inheritance Tax Return Register of Wills - Family Settlement Statement Gerald L. Brenneman, CPA - preparation of income tax returns Register of Wills - 3 short certificates Other Miscellaneous Debts Thornwald Home - nursing care PharMerica - medicines West Shore EMS - ambulance service Carlisle Regional Medical Center - emergency room care IRS - 2000 tax due Department of Revenue - 2000 P A income tax due Department of Revenue - 200 I P A income tax 7. Darlene Moyer - 2001-2002 personal tax 8. Oiler's Lawn Maintenance -lawn mowing 9. PP&L - electricity 10. Sprint - telephone II. William G. Rowe - inventory appraisal 12. Margaret B. Bushey - jewelry appraisal 13. St. John's Church - flowers 14. Broujos & Gilroy, P.c. - elder care legal services prior to death 15. John H. Broujos - reimbursement for payments for cleaning house prior to sale ($100 to Chun Cha Y un) and packing and transfer of furniture, etc. from nursing home ($100 to David Sheibley) 16. Mailboxes, Etc. - packaging of framed picture to send to niece in Oregon 17. UPS - shipping personal items to niece in Oregon 18. Orrstown Bank - rental of safe deposit box 19. Cumberland-Goodwill Fire Rescue EMS - 3 ambulance transports 20. IBIS Appraisal Service - appraisal of Hungarian book 21. John T. Michalski - appraisal of coins 22. Broujos & Gilroy, P.C. - reimbursement for shipping bid items Subtotal A. 1. 2. B. 1. 2. 3. 4. 5. 6. 7. 8. C. 1. 2. 3. 4. 5. 6. Inheritance Tax ($37,270.91 less $1,840.42 discount) TOT AL EXPENSES $ 3,052.40 610.00 10,000.00 4,500.00 341.50 10.00 15.00 17.00 300.00 9.00 1,717.24 246.34 63.00 73.36 234.14 131.95 256.00 11.20 106.00 12.67 26.40 35.00 100.00 50.00 796.50 200.00 20.25 154.05 20.00 71.13 25.00 75.00 25.46 23,305.59 35,430.49 $58,736.08 EXHIBIT C DISTRIBUTION Assets Income Expenditures Balance Advance Distributions: Robert Brown Lois Ann White Ann Louise Sfeir Jean Carleton St. John's Church 2-21-02 $ 22,500.00 22,500.00 22,500.00 22,500.00 10.000.00 $100,000.00 8-2-02 $ 20,925.00 20,925.00 20,925.00 20,925.00 9.300.00 $ 93,000.00 Balance for Distribution * * * * * ~ . 11-22-02 $ 13,050.00 13,050.00 13,050.00 13,050.00 5.800.00 $ 58,000.00 $ 313,626.53 3.814.92 317,441.45 - 58.736.08 $ 258,705.37 $-251,000.00 $ 7,705.37 Actual cash on 12.23.02 for final expenses and distribution 12,662.55 Expected Income: inheritance tax refund 90.42 + minimal final interest in estate checking account to be received Final Bills (after Settlement Agreement signed): Register of Wills - filing fee for Family Settlement Agreement Broujos & Gilroy, P.C. -legal fees balance John H. Broujos - Executor fee Escrow for 2002 income taxes and tax return preparation and miscellaneous expenses, which will result in a small final balance to beneficiaries, with accounting. Total $ 17.00 3,200.00 4,500.00 5.035.97 12,752.97 -12.752.97 - 0 - '" FINAL ACCOUNTING TO BENEFICIARIES Estate checkbook balance on Dec. 23, 2002 Income 1.12.03 interest earned on checking account 2.12.03 interest earned on checking account Deposit 2.4.03 for refund of Inheritance Tax Deposit 2.4.03 for 2001 PA income tax refund received 1.29.03 Sale of remaining jewelry items of estate (not actually received but deducted from Distribution below) Balance Less Expenses Paid Register of Wills - filing fee for Final Settlement Agreement Gerald L. Brenneman, CPA - preparation of federal fiduciary return 1041 & P A41 United States Treasury - fiduciary income tax for year ended 12.31.02 P A Department of Revenue - fiduciary income tax for year ended 12.31.02 Broujos & Gilroy, P.c. - final legal fees John H. Broujos, of Broujos & Gilroy, P.C. - Executor fee Balance for distribution Distribution to beneficiaries: Robert Brown $ 730.56 ($972.14 less $225 for final bid on estate items and $16.58 for shipping charge) Lois Ann White Ann Louise Sfeir Jean Carleton S1. John's Church Total 972.13 972.13 972.13 432.06 Back out $225 not actually deposited (above in Income) into estate account Reimbursement to Broujos & Gilroy, P.C. for UPS shipping charge Balance in estate checking account $12,662.55 12.71 5.91 90.42 13.00 225.00 13,009.59 17.00 350.00 471.00 151.00 3,200.00 4,500.00 4,320.59 - 4,079.01 - 225.00 - 16.58 $ -0- STATUS REPORT UNDER RULE 6.12 v ~ OK Name of Decedent: Helen R. Nemeth Date of Death: 9-21-01 Will No. Admin. No. 21-01-0916 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/statement with the Court? Yes X 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 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Co rt and may be attached to this report. H. roujos 4 N. Hanover St., Carlisle, P A 17013 717-243-4574 Date: 4-14-03 Capacity: X Personal Representative