HomeMy WebLinkAbout01-0967
Estate of J oSc-' (Jh ~a<:oh S'; ,rY}OrJjG-
a/so known as
PETITION FOR PROBATE and GRANT OF LETTERS
~\~ D\-~u>'
No.
To:
Register of Wills for the
Deceased. County of C vrnheyid Yld in the
Social Security No. / cf'G. -- 0:3 -57 (, ,..;- Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that: / ~ I' " <.. (;J
CdY'C T Cor,." f j)
Your petitioner(s), who is/are 18 years of age or older an the execut S'U$ lJ.n , 7kon?.} r named
in the last will of the above decedent, dated ::< of-h d ~)' o-f- J b1,.lt~t':V , 19--22-
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C v "".be y 1.11'J J County, Pennsylvania, with
h IS last family or principal residence at "-/"-3 L~I4.J.~V' s+
(lJl]l')? it' /,4')/ /1/7 / ? 0 II
(list street, number and muncipality)
Decendent, then ~>f.:. years of age, died ,/~ A,tl of j'~j::JI-rI?JJ;cr , M ~()O I
at ltl J S If' p .; j rl ,7 Y1 C e - .
Except as follows, decedegt 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:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $-
situated as follows: Lot 111,,'. IPi ;'" j...o,-.uev.4IJ~ Tb~J?6bl'/J .
CuPi~~v ':;1::'::'~+;~,:::'>?~tl/fI({,:d(H''i~, l11 t'i1r~;,: f'A "'?f' J.h JI
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF-PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF CUMBERLAND -
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the' best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
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affirmed and
19th
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~o. 21-01-967
Estate of
:Jost:f'h J~co 6 "Si moni c
, Deceased
DECREE OF PROBATE A~D GRA~T OF LETTERS
AND NOW OCTOBER..22.1----xW.2illl.L, in consideration of '(he petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated ,,"o-+h dd.'/ of ~Ll""'t,lY'd.Y"Y /977
described therein be admitted to probate and filed of record as the last will of J ~s e:p h
Jato b ,<-C;\ vnD V'JJ' c..-
and Letters
are hereby granted to r"i\V'o' (4.. V''' /1 ,.~ YJd oS v,>, c)J/} T h Ihn(~.J'
~7(J~~~~)&(~
R ster of Ills
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
x-pages
KenUIlclation ................
JCP
$ 235.00
$ 6.00
$ 6.00
$ 5.00
TOTAL _ $ 252.00
. . .Q9:r~~~~. .1.9.,. . ?9.o.~ . . . . . . . . . . . . .
A TIORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE
.4. ~ Ie J
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,'.to"
5.805 REV 91R6 . . . . n is correcd copied from an original certificate of death dul~ filed with
This is to certify that t~e. mform~~on he~~l g~ve t d d t Y the State Vital Records Office for permanent filmg.
Local Registrar. The ongmal certlIlcate WI e orwar e 0
WARNING: It is illegal to duplicate this copy by photostat or photograph.
me as
No.
Fee for this certificate, $2.00
p
7733381
/'-/t9--c' /
Date
21-01-967
HIllS :4JfI.v 2187
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. IIITAL RECOROS
CERTIFICATE OF DEATH
Y PEiPRINT
IN
ERMANENT
lUCK INK
NAME Of DECEDENT (F".. "'oO<lI8 ....,
l.JOSEPH J. SIMONIC
SE~
2. Ma 1 e
~ rAti FilE ~U"'ER
SOCIA~ SECURlT't NUMBER
,.186 - 03
11, 2001
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DECEDENT'S USUAL occumlOH
,0__ 01 WOfk OO/le OuIonq.-
oI.....-..g 1lIe; CID noI use ,tIMed )
. II.. Steel Pourer ,,~teel Industry
DECEDENT"S MAILING AOOfIESS(S1'.... ColyITown. SlM. ZlpCooel DECEDENT'S
43 Center Drive ~~~~E
Camp Hill, PA 17011 ~~~
II.
FATHEJ"S NAME IF"Sl. ""'COle l.asl)
...Jacob Sirnonic
~Fc:;gfNSM: (TGr"of f
METHOD Of' OISPOSlTIOH
8uNI ~ Ct......._ 0
oa... ,Spoc....'
'oWlS DECEDENT EVER IN
U.S. ARMED FORCES?
__ 0 No lXllc
PlACE OF DEATH ICt>KlI (",.., l~ ....,. '''!lfUCIIlA!''f 1)fl'JIf"ef iKHM
HOSPITAL..
AGE \~351 !MMay)
UNDER 1 YEAR
__ Days
UNDER I QjW
Hoon l Minut.
SlATHPlAClIC.., _
State 01 fCley1 COUtlllyJ
Steelton,PA
,-.
EAlo..q,ac""" L.J
0lIlef ......
,~,u
86
Yro.
$.
COUNTY Of' 0EAft1
Cumberland
...
Lower Allen Twp. 43 Center Drive
Ie. ...
KINO OF BUSlHESS/INOUSTRY
RACE. Amencan lncNn. 8lectl. _. Me
ISP'lC4't1
White
10.
12.
17..se- PA
MAAlTAL STAl'US . M."'ad
N.... AoWr...,. w_.
i:)ww_ISpoc,M
14. Widowed
17c.e9 Yeo.__..
SUR\IIIIlNG SPOuSE
\u "t. "..~narnel
en
....
111>. CounIy CUMBERLAND
2001
11..0 ::"'-'::=01
MOTHfR'S NAME .FI5I. ,",,00Ie. twl_ Sur.....,
I'. Katherina Bekel ja
IHfQRMANrS MAIlING AOORESS 151,_. ColYr_. Slld. lop C.-)
.1 Chelten Circle Carn Hill PA 17011
PlACE OF DISI'OSlTION. N...,. 01 C_l.ry. C,amalDfy LOCATION . C,~Town. s..... rIll Cooa
Of 01.... PIac:.
21~te of Heaven Cemetery ~~chanicsburg, PA 17055
NAue.AHO AOORESS OF FACILITY
WcIEDEMAN FUNERAL HCX'1E, 357 S 2n:' st,S:ee!taltPAl7113
LICENSE NUIMlE!l ORE SlGNEO
(_. Clay._'
. 23c.
W'lS CASE REFERREO TO MEDICAL EXAMINEAlCOFIONER?
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PART II: 0lrIar ~ _......-.g 1lI_.W
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WERE AU1tlPSY FlNOINGS
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COMPlETlOH Of' CAUSE
Of' OEAJH?
MAHNlER OF DEATH
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ORE Of' INJURY
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TIMe 0# INJURY
INJURY /IZ WOAI<?
OESCRI8E HC1N INJURY OCCUAflEO.
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REG'STFlAR'S SIGNATURE ANO NUMBER
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.CEllTII'YING PHYSICIAN (Ph.~ cer1Ao;on9 cause 01_ .........- """'Coati N' or"""""""" de"'" ana c"""-",, ,,_lJI
To"" _ 01 my ......wleclQc. ........ee....... _ Ie"" ceuce(.) _ _ro. '''1''. . . . . . . . . . . . . . . . . . . . . .
21.
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'MEOICAL EXAMINER/CORONER
On lhe boo. of e._inallon .nd/a. invuliption. in m, ClIllr.ion. CS.e1tl occurred .llhe li..... d.I.. and place. allCl clue 10 'he causal.} ancl
".~an...... Sl.'ed.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . '.. . . C
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LAST WILL AND TESTAMENT
OF
JOSEPH JACOB SIMONIC
I, JOSEPH JACOB SIMONIC, of Dauphin County, Pennsylvania, declare this
to be my Last Will and Testament, hereby revoking and making void all Wills,
Codicils, or writings in the nature thereof by me at any time heretofore made.
FIRST: I direct that the expenses of my last illness and funeral shall be paid
from my Estate as an Administration expense.
SECOND: I give all of my property, real and personal, to my wife, ROSE
MARIE SIMONIC, provided that if she dies before the Thirtieth (30) day following
the day of my death, this gift shall lapse or be divested and I give such property
to my daughters, CAROL GROFF of Camp Hill, Cumberland County, Pennsylvania,
and SUSAN THOMAS of Carlisle, Cumberland County, Pennsylvania, per stirpes.
In the event any daughter is not surviving, and leaves no children, then her
share shall go to the surviving daughter. Particular items shall be allocated
among my issue as they agree, or, if they cannot agree, my Executrix or
Co-Executors shall decide.
THIRD: In the event my spouse predeceases me and there are minors as
beneficiaries under my Will, I appoint my Co-Executors as Guardian with
power (1) to hold for minors all property payable by law to a Guardian appointed
by my Will; (2) after considering the minor's wishes, to retain tangible personal
[j,/Lt /r {~~j
~~xLr~
~OSE - J OB SIMONIC
Page 1 of 3 Page s
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property or deliver it to the person standing in the place of a minor's parent,
without bond; (3) to invest the balance of the minor's property and all accumulated
income without restriction to investments authorized for fiduciaries; and (4) to
use income and principal for the minor's maintenance and education, either
directly or by payment to any person selected to disburse it whose receipt shall
be a complete acquittance therefor. All unexpended principal and income shall
be paid to the minor at majority.
My Guardian may, in discharge of all duty hereunder, pay any minor's share
deemed impractical of administration to the person standing in place of the minor's
parent or deposit it in an interest-bearing account in the minor's name.
FOUR TH: No interest of any beneficiary under this Will or any Codicil
hereto shall be subject to anticipation or voluntary or involuntary alienation.
FIFTH: In addition to powers given her by law, my Executrix and her
successors and any Guardian acting hereunder shall have the following powers,
applicable to all property held by them, effective without Court Order and until
actual distribution:
(A) To retain any property received by her (including the stock of any
corporate fiduciary acting hereunder);
(B) To sell real estate for any purpose, publicly or privately, for such
prices and on such terms as she deems proper, without liability on the
purchasers to see to application of the purchase moneys;
(C) To compromise controversies;
Wf?:~~ g:~~~t ,
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.~OS ACOB SIMONIC
Page 2 of 3 Pages
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(D) To distribute in cash or kind or both at such valuations as she may fix.
SIXTH: All taxes, interest, and penalties thereon payable by reason of my
death with respect to property comprising my gross taxable Estate, whether or not
passing under this Will, shall be paid from the principal of my residuary Estate.
SEVENTH: I appoint my wife, ROSE MARIE SIMONIC, Executrix of this Will.
If she does not act or continue to act, I appoint CAROL GROFF and SUSAN THOMAS,
Co-Executors in her place with the same powers and duties. No fiduciary acting
hereunder shall be required to post bond or enter security in any jurisdiction.
IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will
and Testament consisting of this and two other pages at the end of which I have also
set my hand and affixed my seal for greater security and better identification,
~'IB
this D( () day of
ry
#
, A.D., 1977.
~ ~A' ,
e:: ~ ., ~__yJ~Lf,
aOSE H COB SIMONIC
(..
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published and declared by the above-named Testator as and for his
Last Will and Testament, in the presence of us, who, at his request and in his
presence, and in the presence of each other, have hereunto set our hands and
seals the day and year above written, and we certify that at the time of execution
thereof, said Testator was of sound and disposing mind and memory.
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Page 3 of 3 Pages
21-01-967
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat_ in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19~
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
test at OIL
S'U&An ~omAs oncl ~l ~o~(:
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
~ J:\A.&'" familiar with the signature of Je~h J~c:.clo 5,mo"'I~
\..uJi\..ff.
will presented herewith and
codicil
believ~he signature on the will is in the handwriting of
of ('ORe of tAt Jdb;)~rlbmg wItness\;;) ~ the
---r-h t!- '1
,"-l~,~
to the best o~ l A..
that
j~~-L
S. n,o;" l c~
knowledge and belief.
Sworn to or affirmed and subscribed before
me this 19th _ day of
OCTOBER ~ 2001
'7f'7o/w~Jc,~;&i~'r
Register
/1 /~'
C_'~--L~ /gJL~I*-'
_ (Name)
I (i;; e /( ~t-' t!. / rc /c:-~
l /I I (Address)
/~~l \)ru~
j) !1 (Na'!!!)" 0
(~, 1\. f Dl) LJ Bj :~)I 0/ () I"A J 7()Dt~
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(Address)
c~, 111jO Af,/'/.~,f /7~~~
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death:
.J65r/J
9'-1/-02001
.J.
S/1J O/Jlc
Name of Decedent:
~\ -()\ -O~ ~7
Admin. No.
~)-6\-a9107
Will No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on "
Name Address
(!0'f""ol s: .Gruf-f / Ch e- / -f 81/) (!,',- t Cq Pvl JG Ii/II PA/70//
I
5u .5C??1 e, If, 0 Y)/1 C1 .s ~P! gD-X~33 13/ ct /1) Ph /700~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
1-07 9 - Oa-..
~Crd~
Sv5qn C.Thom4$
t?Rr ~[)~ ~ 33
I
B L A- I Uj fA I 7066
( 7/7) S :3 6 ~ .}( 4- \
Signature ~ ..d.~
Name Ccr ro/ $'"~ Grof--r
Address I C-he-/fe.,1 C!;, rei e
{!, a rJt1 p )d, 'II
,
;OA /70/ /
Telephone ( 1/17 137- q 7 S- 7
':":
Capacity: ~ersonal Representative
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_Counsel for personal representative
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'\, BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
NOTICE or INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSKENT or TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-15" EX AFP 101-02)
SUSAN C THOMAS
RR 1 BOX 36
BLAIN PA 17006
,T 11
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152747
Allount Rellitted
JOSEPH
J
'-;. .....;; ,
..:0
J
\ -- ~
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 ~
iifi=isiri-E)f-AFP--rol-:ozi------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152747
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
866504
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 07-08-1997
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
29,892.77
0.166
4,982.23
.00
4,982.23
.15
747.33
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 747.33
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 16.30
TOTAL DUE 763.63
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
{ IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
/?-/6= /0
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG1 PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~1 AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX iFP (01-021
SUSAN C THOMAS 'U:,. , I 'j 1
RR 1 BOX 36
BLAIN PA 17006
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152749
Allount Rellitted
JOSEPH
J
:."6
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE;;=is4-i-EX--AFP--foi-:02i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152749
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
2183679
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 05-08-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
51405.37
0.166
900.91
.00
900.91
.15
135.14
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT1 SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS1 AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 135.14
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.95
TOTAL DUE 138.09
· IF PAID AFTER THIS DATEI SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT" ( CRJ 1 YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J
\., /?-/6=/0
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEnENTL ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSnENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 Ell AFP U1-02)
SUSAN C THOMAS
RR 1 BOX 36
BLAIN
'()>~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
:J 6 SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152755
Allount Rellitted
JOSEPH
J
PA 17Q1J6
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 ~
iiEli:i5~i-Ex--AFi>>-(Oi-:02i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152755
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
0079220169
TYPE OF ACCOUNT: () SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 08-28-1964
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
3,727.40
0.166
621.25
.00
621.25
.15
93.19
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 93.19
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.03
TOTAL DUE 95.22
. IF PAID AFTER THIS DATE, 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" ( CRJ, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
/?-~ A:)
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1S48 EX AFP (01-02)
SUSAN C THOMAS
RR 1 BOX 36
BLAIN PA 17006'-
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
C,O,UNTY
SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152757
Allount Rellitted
JOSEPH
J
'j 'I
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 ~
RtE-Y=is4-i-ix--AFP--fo-l-:021------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152757
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
2183577
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 03-10-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
15,155.31
0.166
2,525.94
.00
2,525.94
.15
378.89
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 378.89
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 8.26
TOTAL DUE 387.15
· IF PAID AFTER THIS DATE, 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-- ( CRJ, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J
/?-~/O
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP 101-02)
SUSAN C THOMAS
RR 1 BOX 36
BLAIN
, 11
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSNI'DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152761
Allount Rellitted
JOSEPH
J
'O:Z
. :'f7
PA i\~7oo6
l ~,: i,
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=is41i-ix--AFP--foi-:02j------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152761
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
0098203959
TYPE OF ACCOUNT: () SAVINGS (X> CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-30-1999
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
9,116.88
0.166
1,519.51
.00
1,519.51
.15
227.93
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 227.93
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.97
TOTAL DUE 232.90
· IF PAID AFTER THIS DATE, SEE REVERSE 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.. ( CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
/?-AS=/D
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG1 PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1S48 EX iFP (01-D2)
SUSAN C THOMAS
RR 1 BOX 36
BLAIN PA 17U06
1 '!
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152759
Allount Rellitted
JOSEPH
J
:-'6
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-y=is4-i-Ex--AFit-foi-:021------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152759
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
2183183
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 03-30-1999
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
11,131.22
0.166
1,855.24
.00
1,855.24
.15
278.29
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 278.29
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.07
TOTAL DUE 284.36
· IF PAID AFTER THIS DATE, 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. )
1?-/6~/o
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG~ PA 171Z8-D6Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION~I AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP (01-02)
CAROL S GROFF
1 CHELTEN CIR
CAMP HILL PA.17011
(', .
... .. ,
"Lt.
'I "
., :':( '7
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152760
Allount Rellitted
JOSEPH
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-y=is4-i-ix--AFP--foi-:021------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152760
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
2183183
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 03-30-1999
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
111131.22
0.166
11855.24
.00
11855.24
.15
278.29
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT1 SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS1 AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 278.29
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.07
TOTAL DUE 284.36
· IF PAID AFTER THIS DATEI SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl1 YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
/,/-/6-- /0
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (01-02)
" 'I-j
I t
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
" :' 7 COUNTY
- SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152762
Allount Rellitted
JOSEPH
J
CAROL S GROFF
1 CHELTEN CIR
CAMP HILL PA 17~~1
't (...
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-v:is~i-Ex--AFP--fol-:02)------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152762
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
0098203959
TYPE OF ACCOUNT: () SAVINGS (>0 CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-30-1999
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
9,116.88
0.166
1,519.51
.00
1,519.51
.15
227.93
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 227.93
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.97
TOTAL DUE 232.90
· IF PAID AFTER THIS DATE, 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" ( CRl, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
/7-/6'-10
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG, PA 171Z8-D6Dl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOWANCE OR DISALLOWANCE
OF DEDUCTION~1 AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-iS.' EX AFP [01-02)
1 "'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152750
Allount Rellitted
JOSEPH
J
CAROL S GROFF
1 CHELTEN CIR
CAMP HILL PA 17011
" :':: 7
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE} PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-y=is4-i-Ex--AFit-col-:021------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152750
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
2183679
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (X> TIME CERTIFICATE
DATE ESTABLISHED 05-08-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
5}405.37
0.166
900.91
.00
900.91
.15
135.14
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT} SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS} AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 135.14
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.95
TOTAL DUE 138.09
· IF PAID AFTER THIS DATE} SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1} NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl} YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
/?-/$- /0
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION~} AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1S"8 EX AFP <01-02)
'U..:
II
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
.CQUNTY
'SSNI'DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152756
Allount Rellitted
JOSEPH
J
CAROL S GROFF
1 CHELTEN CIR
CAMP HILL PA 17011;':,
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE} PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-y=is4-i-Ex--AFP--coi-:oil------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152756
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
0079220169
TYPE OF ACCOUNT: () SAVINGS ()() CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 08-28-1964
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
3}727.40
0.166
621.25
.00
621.25
.15
93.19
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT} SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS} AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 93.19
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.03
TOTAL DUE 95.22
· IF PAID AFTER THIS DATE} SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1} NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ} YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J
r;:'-/S--/'O
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP UI-D21
'j 1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN:frtC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152758
Allount Rellitted
JOSEPH
J
CAROL S GROFF
1 CHELTEN CIR
CAMP HILL PA 17011
.-
r" ,
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-v=is~i-Ex--AFP--(Ol-:02i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152758
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
2183577
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (>0 TIME CERTIFICATE
DATE ESTABLISHED 03-10-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
15,155.31
0.166
2,525.94
.00
2,525.94
.15
378.89
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 378.89
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 8.26
TOTAL DUE 387.15
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT-- ( CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
/? -/~~/()
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOHANCE OR DISALLOHANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1541 EX AFP 181-82)
1 "'
:.-='6
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-14-2002
SIMONIC
09-11-2001
21 01-0967
CUMBERLAND
186-03-5765
01152748
Allount Rellitted
JOSEPH
J
CAROL S GROFF
1 CHELTEN CIR
CAMP HILL PA Iloll
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 ~
REli=is4-i-ix--AFP--fol-:021------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-14-2002
ESTATE OF SIMONIC
JOSEPH
J DATE OF DEATH 09-11-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0967
TAX RETURN WAS:
S.S/D.C. NO. 186-03-5765
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01152748
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
866504
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (>0 TIME CERTIFICATE
DATE ESTABLISHED 07-08-1997
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
29,892.77
0.166
4,982.23
.00
4,982.23
.15
747.33
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 10-22-2002 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 747.33
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 16.30
TOTAL DUE 763.63
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GROFF CAROL S
1 CHEL TON CIRCLE
CAMP HILL, PA 17011
-------- fold
ESTATE INFORMATION: SSN: 186-03-5765
FILE NUMBER: 2101-0967
DECEDENT NAME: SIMONIC JOSEPH JACOB
DA TE OF PAYMENT: 11/22/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 09/11/2001
NO. CD 001875
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $14,153.66
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: CAROL S GROFF
CHECK#1080
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$14, 153.66
MARY C. LEWIS
REGISTER OF WILLS
.0"" C..,.: "'0" . . . . n is correctl co ied from an original certificate of death dul~ filed with
This is to cernfy that t~e. mform~finon he~~l g~ve b d d t~ th: State Vital Records Office for permanent filmg,
Local Registrar. The ongmal cernicate Wi e orwar e
WARNING: It is illegal to duplicate this copy by photostat or photograph.
p'
Fee for this certificate, $2.00
p
7733381
No.
21-01-967
me as
/--/t9~c' I
Date
H 105 : 43 Ae. 2187
COMMONWEALTH OF PENNSYLVANIA 0 OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
V PE/PRINT
IN
ERMANENT
IUCK.NK
STATE FI.e "'-'MIlER
SOC,.... SECUflIN NU1lI8ER
J.186 - 03
NAME Of OECEDENT CF"SI MoOllIe. ""'1
1. JOSEPH J. S IMONIC
SEX
2. Male
H, 2001
P\..ACE OF OEATW .Ct--...cM 0''''' l~.. ..- 'll!lruchlA'" c)(l'JifP't!f ....
..
ERI~'''''' W
~ICJ
Oocl
--
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_noI\Ip1 17<1.0 :...~=oI
MOTHER'S N"'ue .FIS" M"". Ma.,.., Surname)
fl. Katherina Bekelja
1HF000MANT'S MAILING ...OOfIESS ,Sltll" Cl!yr_n. Slate. Zoo COOIJ
2Gb.l Chelten Circle Carn
PUoCE Of DISPOSITION. H..... 01 C_ory. c,....alCOY
11101... ~.
2t~te of Heaven Cemetery 17055
N"'ME AND AOORESS OF FACIUl'V
WJ:EDEMAN FUNERAL HClotE,:fJ7 S 2rC St,Steeltcn,PAl7113
LICENSE NUMllER DArE SIGNED
(J,lcnth.OIv._'
J.. 2:1eo.
'*5 CASE REFERRED TO MEDICAL EXAMlNERlCOfIONER1
v.. Kl HoD
AGE ILa.. flonr>aavl
UNDER I YEAR
__ O.va
UNDER 10M
-1--
8lRTHPI.AC( :C.... 4I1d
Stale 01 fClOolj/l CO"....,
teelton,PA
HOSPllA&..
86
YII
5.
COUHTY OF PERH
Cumberland
Lower Allen Twp. 43 Center Drive
k. M
KINO OF BUSIHES5IINDUSTRY
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DECEDENT'S USU"'L OCCUPRIOtI
'~~ :~a;:''::::L:'f
. lla, Steel Pourer l1~teel Industry
DECEDENT'S MAILING ADORESS (Sr,... CdyilOwn ~. Z",C""'l DECEDENT'S
43 Center Dcive ~~~~E
Camp Hill, PA 17011 ~~~
I'.
F.CrHEA'S NAME IF,,SI. MOC<lIe Lall)
...Jacob Simonic
INFC:;;df NS~ <T<rr"bff
METttOO OF DISPOSITION
lIuNI 29 C._I"'" 0
OonI'OOII 0 01,.., lSl>ec"'v'
21L
S1GN"TURE OF. HEAAL SERVICE
,*SDECEOEHTEYERIN
US. AAMEOFOflCE51
_0 HolibC
12.
17..~ PA
,7b. CounIy CUMBERLAND
2001
2..
27. NUn I: E...I<'III__o.......... 111 _a'....._
LIII 0lIl'/ one ca.-... lad> lone.
DATE PAQHOUNCEDllEAO,M"""'. Oay'.a',
September 11, 2001
M u.
the dHCh. 00 notltnter me mode 01 c:ft'nt. suehaa c:.tOtaCOI 'HIJN'~.ory a".... snoc. Of' "-&r1 fa"'r.
E
r
WEAE AUlOPSY FINOINGS
~PRIORlO
COMPlETION OF CAUSE
OF 0EAI'H1
~AOFDEATH
DArE OF INJURV
,_. Dav. "atl
-- )1
.-- 0
Suicide 0
~ 0
Pending~ 0
CoulcIIlOl be__ 0
:;.
...0
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)
... D.
C8n'IFIEft lChlC" en, 0flII .
'CUlTII'YIiIG PHYIlClAN IPh_oance<WyonqcauSlol_ __ "".""..." _ ptOt1OW'C""dealh ana c_"" ,,_ 231
To _ _ of..., --Iecl\tI. de.1Il OCC_ _ eo.... cauoe(ol- .........'.a ."IId. . . . . . . . . . . . . . . . . . . .
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'I"fIONOUHCING AND CEJlTIFYIHG PHYSlClAH lPh."".." bolt> ;'''''''''''''''''9 _ ..od c....oIylnq 10 C...... 01 ae~1
10.... _ 01..., _........ dealll occurred al .. _. cillo. end pIKa. _ due 10 lhI..y....I_ ......"., a. lta'ld.
'uu)ICAL EXAMIHEIIICORONER
On ,lie bMIa of ......in.llon ancllor inv."IiP'ion. in m, OSlir.ion, d..", occ:urred .I'M lime. d.'.. and placa, _ ,",.'0 'he ..u..(.)and
m....... aa .,a'ed.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " ..
3'..
REGISTRAR'S SIGNATURE AND NUIotflER
~I~~~
RACE.__._._. ""
l~l
White
10.
SURVIVING SPOUSE
lit .tI._ ~1l"LalCJM natn4l\
"'"
ClIY/bDOO
21.
. Appoa......
!=~==
I
:
PART": 0IIlIr~_~.._.0UI
"'" 1ftUIIing..!hI ~ -lI"'I"" PIlRT I.
TIME Of INJURV
INJURY Ar VoQAK7 OESCfIt8E HOW INJURY OCCURflEO.
... 0 HoD
~/
c
A..'
~
34.
REV-1500 EX (G-OD)
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11.
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SLMONIC, JOSEPH J.
DATE OF DEATH (MM-DD-YEAR)
09-11-2001
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH (MM-DD-YEAR)
02-02-1915
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[ill. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copyofTrust)
D 10. Spcusal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
/7 - /S-- I ()
FilE NUMBER
c2L-()L
COUNTY CODE YEAR
G
__!lbZ
NUMBER
SOCIAL SECURITY NUMBER
186 - 03 - 5765
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
NAME CAROL S. GROFF
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717 737-9757
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)
z
o
~
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~
t::
D..
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0:::
COMPLETE MAILING ADDRESS
1 CHELTON CIRCLE
CAMP HILL PA 17011
(1)
(2)
(3)
(4)
(5)
116,500 00
122,288.00
78,728.90
(6)
(7)
(9)
(10)
11 ,229.00
OFFICIAL USE ONLY
(8)
317,516.90
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
~
::)
D..
:!:
o
u
g
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(l.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
20. D
x.O_ (15)
x .0 45 (16)
x .12 (17)
x .15 (18)
(19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(11)
(12)
(13)
1 1 , ?? q nn
.,
306.281.90
(14)
306,281.90
13,782.96
13.782.96
; ~w~~~fI~Jt~~":~~ _~~..~~.~:,~:;;- :.~ ;;.~ ~ .~.' _ _' 'I > .
Decedent's Complete Address:
STREET ADDRESS 43 CENTER ST
CITY r.AMP HTLT I STATE I ZIP
PA 17011
Tax Payments and Credits:
1. Tax Due (Page ~ Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 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 Line 20 to request a refund (4)
11 782 96
,
370.70
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
14,153.66
.
A. Enter the interest on the tax due.
(5A)
14,153.66
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
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
o
Ga'
!21
[;:j
0'
Qf
G2I
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and beliel, it is true, correct
and complete.
Declaration 01 preparer other than the personal representative is based on all information 01 which preparer has any knowledge.
SIGNATURE OF PE . ON RESPONS~4~R Fill
ADDRESS
1 CHELTON CIRCLE, CAMP HILL
SIGNATURE OF PREP~ 9JHER THAN REP.BESENTATIV~
,. /cr~~~,',~~
ADDRESS ~. -
DATE
//-.;7;;' - 0 2..
PA
17011
DATE
/~- "2 ?
264A S. PROGRESS AVE
HARRISBURG PA 17109
~UJ~t:j~~
~) '2.
. - ~ . . .. .. '., ~ <~~~~....
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return aFe still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. S9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116(1.2) (72 P.S. ~9116(a){1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. s9116(a)(1.3)J. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.15Q2EX.. (1.97)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
SIMONIC, JOSEPH J.
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
43 CENTER STREET, CAMP HILL PA 17011
CUMBERLAND COUNTY, LOWER ALLEN TWP 116,500.00
TOTAL (Also enter on line 1, Recapitulation) $ 11 6 , 500 . 00
(If more space is needed, insert additional sheets of the same size)
REV.1503 Ex. (1.97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
JOSEPH J. SIMONIC
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
SEE ATTACHED 122,288.00
TOTAL (Also enter on line 2, Recapitulation) $ 122.288.00
(If more space is needed, insert additional sheets of the same size)
ESTATE OF: JOSEPH J. SIMONIC
FILE NUMBER:
SCH B, STOCKS & BONDS
ITEM NO DESCRIPTION VALUE AT DATE OF DEATH
1 U.S SAVINGS BOND X2190491EE 8516.00
2 U.S SAVINGS BOND X2190492EE 8516.00
3 U.S.SAVINGS BOND X2190503EE 8516.00
4 U.S SAVINGS BOND X2190504EE 8516.00
5 U.S SAVINGS BOND X2190505EE 8516.00
6 U.S SAVINGS BOND X2190495EE 8516.00
7 U.S SAVINGS BOND X2190494EE 8516.00
8 U.S SAVINGS BOND X2190496EE 8516.00
9 U.S SAVINGS BOND X2190493EE 8516.00
10 U.S SAVINGS BOND X2190499EE 8516.00
11 U.S SAVINGS BOND X5236606EE 6188.00
12 U.S SAVINGS BOND X5236604EE 6188.00
13 U.S SAVINGS BOND X5236603EE 6188.00
14 U.S SAVINGS BOND X5236602EE 6188.00
15 U.S SAVINGS BOND X5236607EE 6188.00
16 U.S SAVINGS BOND X5236605EE 6188.00
TOTAL
122288.00
--~:''''' '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE-OF
FILE NUMBER
JOSEPH J. SIMONIC
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUNivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
SEE ATTACHED 78,728.95
TOTAL (Also enter on line 5. Recapitulation) $ 78, 728.95
(If more space is needed, insert additional sheets of the same size)
ESTATE OF: JOSEPH J. SIMONIC
FILE NUMBER:
SCH E CASH, BANK DEPOSITS & MISC
PERSONAL PROPERTY
ITEM NO.
DESCRIPTION
VALUE AT DATE OF DEATH
1
2
3
4
5
6
7
8
ALLFIRST FINCL CHECKING ACNT 0079220169
ALLFIRST FINCL CHECKING ACNT 0098203959
ALLFIRST FINCL CERTIFICATE 2183679
ALLFIRST FINCL CERTIFICATE 2183577
ALLFIRST FINCL CERTIFICATE 2183183
ALLFIRST FINCL CERTIFICATE 866504
FURNITURE, TOOLS, OTHER MISC PROPERTY
AUTOMOBILE, 1996 FORD Fi ~s+a
3727.40
9116.88
5405.37
15155.31
11131.22
29892.77
2500.00
1800.00
TOTAL
78728.95
REV-1511 EX+ (12-99) _
.9:.1t:
~U
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
SIMONIC, JOSEPH J.
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
FUNERAL EXPENSES:
DESCRIPTION
Wiedeman Funeral Home
357 S 2nd St
Steelton PA 17113
AMOUNT
7669.00
1.
Includes opening of grave, mortician services, transpor-
tation, caslet, flowers, fee of clergyman, rental of house
for services
Knights of Columbus
Food & refreshments
321.00
Misc food, flowers and beverages
200.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)IEIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees
314.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees
Stephen S. Simonic
2500.00
7.
House appraisal fee, Dick Gibney Real Estate
225.00
TOTAL (Also enter on line 9, Recapitulation) $ 11229.00
(If more space is needed, insert additional sheets of the same size)
. "':".,"':"., '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
SIMONIC, JOSEPH J.
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
1.
CAROL S. GROFF
1 CHELTEN CIRCLE
CAMP HILL PA 17011
DAUGHTER
50%
SUSAN C. THOMAS
RR1 BOX 433
BLAIN PA 17006
DAUGHTER
50%
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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n. 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)
~
r
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Ju5e iP I,
I
Date of Death: Cj - ) } - () I
Will No.: 0 l - 9 ~ l
J.
S.'/?7D/1,' L
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State w~her administration of the estate is complete:
Yes g" No 0
2. lfthe answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes _ No 0 :r /1Af!'i -y. ; feMe e Tax R~ -fvV'1'? R 13// i ..:rUG I, led
~Vl d a CUP..fe.cl 11,Y /;)/1 j)i'~ f 0 { l?er.
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 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: j- /I-o~ ~ 4. 4;u.jf
Signature
(]q to/
Name
S. Grc+ l'
I (!. /, e /Jev,
Address
(J/YC1e. ~/"f>N//1 pIJ
( 7c>11
r';',
,-,.....j
737 - 9?S7
Telephone No.
Capacity: 0 Personal Representative
o Counsel for personal representative