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Home My WebLink About01-1065 PETITION FOR PROBATE and GRANT OF LETTERS .:1J - 01 - J Ob 5 No. To: Estate of Anna Beleski also known as n,nn.ol F RRl RAk; Register of Wills for the , Deceased. County of rnmhp...l and in the Social Security No. 189-(13-~ IV Commonwealth of Pennsylvania The petition of the undersign~::tectfullY represents that: Your petitioner(s), who is/are 18 years of age or older an the execut rices in the last will of the above decedent, dated February 15 , and codicil(s) dated n I a named , ~ 2000 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h~fami~:r~(I;e~8Jwdt~~~.~ (list street, number and muncipality) 'f Decendent, then 88 years of age, died November 16 , ~ 2001 , at Carlisle Reqional Medical Center 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: no exc,~ptions 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: / / ~ dtltJ.C() ./ $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.I.a.; administration d.b.n.c.t.a.) theron. -- "' ~ u u .: u ~3 u.... ~~ -g.g ~.;:: 3~ u.... ;;0 ~ .: bO Vi 1::ii::: u/4 11'1R Hnr;~k n,VRnllR Bgiling Springs, PJI 17007 ~~~ 336 Pine Grove RbJd Gardners. PA 17324 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF Cumberland J The petitioner(s) above-namedswear(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. ~~:1:::~:~~ s~:~:~~ { ~~(ft: t I 7 -, CA;"). 'bT---, ~o. 21-01-1065 Estate of ANNA BEEESKI a/k/ a ANNA F. BELESKI , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW November 21 ---,_,____ ~ 200~ in consideration c" ','le petitiop '~)n the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 15, 2()()O described therein be admitted to probate and filed of record as the last will of a/k/a Anna F. Beleski and Letters Testamentarv are hereby granted to Anita Wolf and Brenda Briggs Anna Beleski Probate, Letters, Etc. """'" Short Certificates( ).......,.. Renunciation ................ x-pages JCP $ $ $ $ 6.00 5.00 TOTAL _ $ ?I:\I:\.OO .... NOV.. .21,20.0.1................ 235.00 9.00 ADDRESS Carlisle, PA 17013 (717) 243-0123 ''1i{nJ ~ , ") FEES Filed PHONE ))0 ::<D :;j ;: , 0"' " 92 !;" 9 :o~ (;)0 tC) 0 'i:?:~' j:n es <:: N - :;;. ::z:::, \0 . . -- 4'11".:::':0" REV r:;1:::':(.. This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filIng. WARNING: It is illegal to duplicate this copy by photostat or photograph. 21-01-1065 No. "","""""'.""", "","""~~\.1" OF PEl----___ l~~.. ...... ~~"';. f~ ..!J'". ~"\ I.~. -'- -"~'~ "- _- ~i l!:Qif' ,- - -.\ -, \~~.d..TI~..~......., ~ ,,~. 7... ~,\\ '\. '% . ... ~,.." ...~~~~'!IAfENl \\\ ~~IIII """""'""nll'JJlI"" :'~' J ,::''';'.''J }v J l I~/I/ I.. <_"'..<__. Fee for this certificate, $2.00 Local Registrar NOY :; D 2001 P 7889447 Date Hl05.143A..... 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYPfJPAINT IN PEAMANENT BLACK INK o w '" :> '" c ~ c ~ Of O€CEO€p,"iliV ft' AGE Ilall8orNay) UNDER t YEAR __ Do,. r ~~Q/.-( SWI flt.( NUWalA SOCIAL SECUAITV NUM~A S .. J 8 - D" - I PlACE 01 DEATH lCt>eck 0l'Iy""" n ....1fl1l'UCt.OI" on 0Itlel SlOeI HOSPiTAl: I~_~ Oa~,"'J :;.. co I . I. . COUNTY OF OERH ~8 v.. UNDER 1 OM Hours ! MinuI_ 8IRTHPlACE lCoI'1 and J. t'l~~";;~r:eYI 1. P f) FACl.l'TY NAME (H nol~. QllleSlfHl ancJ~1 ="YJO Currberland i \ IlL SUAIIMNG S/'OUSE Ill....... gr.-madW\ Nme) . tt.. .... .".,- /ot"" ~~ >I. I Appfollimale I inlwn.I btMwMn : ~anddMlh I i ~ PART I: Other IignlIIcMl condiIiana CONrIbuling 10..... buIi "'l'MUIlIngin"'~'*-QilW'eninPARTI .... ~ 1Il <Il ..... ~ ~ I : WERE AUTOPSY FINOtNGS A\MJlA8lE PRIOR 10 COWP1..ETION OF CAUSE OF DEATH? MANNEA OF DEATH ....w.. 18- o o OATE OF INJURY ,Monltt,Oay. Ytiarl TIME OF INJURY INJUAY AT 'NORK1 DESCRIBE HON INJURY OCCURRED. HomICide o o o PlACE OF INJURY. AI home. tarm~:"l.laclory. otfice M. ~. etc. cSpedvj _. ... 0 NoD .-..... Pending Invest~lion v.. 0 NoD SutcilH Could noI be delemlltled RE~ATURE A~O ~UMBER "......-;. <.' J] .._F~L-7 L n{c~ ILfiol~Is-,gl /'-It:> 2... 28b. CERTiFIER tCr-<<:k or'lIy ot'iel .CEATlFYING f1'HY$K:IAN lPh.,.soc,.n Cetlllyoog cause (II dlrath wt!er> 4nOltter ptIv:wc~ h~$ plonourceo de.lt! ana compieled nem 2J) To.... ~l of no, Ilnow'-dV-. ....lh occu.red"''' lhe cauM('I.nd manner .I. ....ted. _.... . _ _ . . . . . . . .. ........ ... .. ~ :ii f;l o ~ o ~ z 'PROHOUHC1HG AND CERTIFYING PHYSICIAN tPhySoCoan boIh ;)fOf'lOunc<og uedlh <lfld Cet'''vong 10 cause 01 aea\tll To th. be-et 01 my know'-dgft. de.th OCcurrN.t the u.n., d..I., and place...nd due 10 I.... cau..(.).nd mannar.. ....ted.. .UEDICAL EXAMINER/CORONER On the b..i. 01 examination andlor Inyestlg..tion. in my opinion, de.th oc:c:urred III the lime, da'e, ilnd place, ilnd due to Ihe causeCs)'nd manner.s st.Ied........., .. .. .......... . .... ...... ...... _. ... .... ..................................... ". o ////1/(1/ LAST WILL AND TEST AMENT OF ANNA BELESKI I, ANNA BELESKI, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my grandchildren, equally, namely, MICHELE L. BELESKI, ROBERT P. BELESKI, BRENDA BELESKI BRIGGS, and ANITA M. BELESKI WOLF, provided that the share of any grandchild who predeceases me shall be distributed to his or her issue, per stirpes, and in default of such then living issue, such share shall be added to the share or shares for my other grandchildren or their issue per stripes. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my granddaughters, BRENDA BRIGGS and ANITA WOLF, or the survivor ofthem, Executors of this my Last Will and Testament. FIFTH: I direct my Executors and their successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. '. AFFIDA VIT COMMONWEAL TH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) We, RONALD E. JOHNSON and --r;. '-' , Ci y" P A ~r~..s , the witnesses whose names are signed to the attached or ~ mstrument, bemg duly qualIfied accordmg to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as his Last Will and Testament; that ANNA BELESKI, signed willingly and that she executed it as her free and voluntary act for the purpose 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 that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by RONALD E. JOHNSON ~d~\., \or f Avy}.rt;w..5 , witnesses, this --1.2.- day of ~(\)"-~ ' 2000. ) (SEAL) NOTARIAL SEAL SHELLY SEXTON, NOTARY PUBLIC CARLISLE BORO, CUMBERLA'~O COUNTY MY COMMISSION EXPIRES AP1iL 26. 2003 Member, Pennsylvania AS50Ci"::G~,:.( ilolaries 1 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of one (1) ty ewritten pages, each identified by my signature, this /cS'" M.. day of R J/:. , 2000. ~12~ ANNA BELESKI (SEAL) Signed, sealed, published and declared by the above-named Testatrix, ANNA BELESKI, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~~ COMMONWEAL TH OF PENNSYL VANIA ) : SS. COUNTY OF CUMBERLAND ) I, ANNA BELESKI, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by ANNA BELESKI, the Testatrix, this \5 daYOf~~~ ,2000. AN~~g~ (SEAL) NOTARIAL SEAL SHELLY SEXTON, NOTARY PUBLIC CARLISLE BORO, CUMBERLAND COUNTY MY COMMISSION EXPIRES APRIL 26, 2003 Member, Pennsylv/lnia As~(\r:iatlon "' Notaries ""''''''~''''' ,--'., ~ ,.- .X:::> ~ \ CERTIFICATION OF NOTICE UNDER RULES 5.6(a) Name of Decedent: Anna Beleski Date of Death: November 16,2001 Will No: 21-01-1065 To the Register: 1 certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries ofthe above-captioned estate on November 28, 2001: Brenda Briggs 336 Pine Grove Road Gardners, PA 17324 Anita Wolfe 1358 Horick Avenue Boilings Springs, PA 17007 no ,... ..,-,.., =('tl =' :::". a":' Cll '-'i d - :0 a? roo ((] 0 .;', '""""I C'') ("'J :5t ~,:,:_~~~ Michele L. Beleski Matthews 15A Sylvan Drive Hollidaysburg, PA 16648 ~~~j I: ~ <: ~ , ~,>< :-t::i :::~ )> ,..~ ;a o h7. \0 Robert P. Beleski 1961 Poplar Ridge Lane Dauphin, PA 17018 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No exceptions. Date: November 28,2001 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 NO. CD 000829 JOHNSON RONALD E 78 WEST POMFRET STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER _n_____ fold ---------- -------- 101 I $3,800.00 ESTATE INFORMATION: SSN: 189-03-5919 I FILE NUMBER: 2101-1065 I DECEDENT NAME: BELESKI ANNA I DATE OF PAYMENT: 02/04/2002 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 11/16/2001 I I TOTAL AMOUNT PAID: $3,800.00 REMARKS: RONALD E JOHNSON ESQUIRE CHECK# 6 INITIALS: JA SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULES 5.6(a) Name of Decedent: Anna Beleski Date of Death: November 16,2001 Will No: 21-01-1065 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) ofthe Orphans' Court Rules was served on or mailed to the following beneficiaries ofthe above-captioned estate on November 28,2001: Brenda Briggs 336 Pine Grove Road Gardners, P A 17324 Anita Wolfe 1358 Horick Avenue Boilings Springs, P A 17007 ......, ,.., ~":-;; :;: (n ::5 ~" ~ 'l ,,1 CD 1'-) -.J Michele L. Beleski Matthews 15A Sylvan Drive Hollidaysburg, PA 16648 l~ c-r, Robert P. Beleski 1961 Poplar Ridge Lane Dauphin, P A 17018 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No exceptions. R nald E. Johnson, E 7 West Pomfret Str arlisle, P A 17013 Phone: 717-243-0123 Capacity: Counsel for personal representatives Date: February 26, 2002 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG, PA 1712B-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JOHNSON RONALD E 78 WEST POMFRET STREET CARLISLE, PA 17013 ~------- fold ESTATE INFORMATION: SSN: 189-03-5919 FILE NUMBER: 2101-1065 DECEDENT NAME: BELESKI ANNA DATE OF PAYMENT: 06/10/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEAtH: 11/16/2001 REMARKS: C/O BRENDA BRIGG CHECK#15 SEAL REV-1162 EX(11-96) NO. CD 001278 ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: VZ RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS AMOUNT $2,043.77 $2,043.77 /?-c:JeQ - ? 'y BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN 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 REY-15~7 EX AFP I Dl-DU CARLISLE ClP.A 17013 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 ...... REY=i54-j-E3f-AFP--foY:02Y-NO'TicE--OF-YNHERiTANCE-'TAX-A-PPRAisEMiNT~--AL1-oWANCE-cfR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BELESKI ANNA F FILE NO. 21 01-1065 ACN 101 DATE 07-22-2002 TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (S) 110,635.03 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 28,000.00 8. Total Assets (8) 138,635.03 APPROVED DEDUCTIONS AND EXEMPTIONS: 4,226.97 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) UO} 102.00 11. Total Deductions (1I) 4.328 97 12. Net Value of Tax Return U2} 134,306.06 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 134,306.06 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: lS. Amount of Line 14 at Spousal rate (1S) .00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate U6} 134,306.00 X 045 = 6,043.77 17. Amount of Line 14 at Sibling rate (7) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due U9}= 6,043.77 TAX CREDITS: , n........ l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-04-2002 CDOO0829 200.00 3,800.00 06-10-2002 CDOO1278 .00 2,043.77 TOTAL TAX CREDIT 6,043.77 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 !II IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~oz \.,iJL RONALD E JOHNSON ESQ ANDREWS & JOHNSON 78 W POMFRET S1.: :! 9 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-22-2002 BELESKI 11-16-2001 21 01-1065 CUMBERLAND 101 ANNA F Amount Remitted IN RE: ESTATE OF ANNA BELESKI DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-1065 FIRST AND FINAL ACCOUNT OF BRENDA BRIGGS and ANITA M. WOLF, EXECUTRICES OF THE ESTATE OF ANNA BELESKI a/kla ANNA F. BELESKI LATE OFCARLlSLE BOROUGH ,CUMBERLAND COUNTY, PENNSYLVANIA Date of death: Letters Granted: Advertisement of Letters: The Sentinal: Cumbo Law Journal: ACCOUNT STATED AS FINAL November 16, 2001 November 26, 2001 May 8, 15, 22, 2002 May 17,24,31,2002 PRINCIPAL Receipts Less Disbursements Balance Before Distributions Distributions to Beneficiaries Principal Balance Remaining SUMMARY & INDEX Page No 2 3 3 $109,468.66 $10,242.74 $99,225.92 $60,000.00 $39,225.92 INCOME Receipts Less Disbursements Balance Before Distributions Distributions to Beneficiaries Income Balance Remaining 4 $0.00 $0.00 $0.00 $0.00 4 4 $0.00 COMBINED BALANCE REMAINING $39,225.92 Page 1 8/21/02 Cash: 2 3 4 5 PRINCIPAL RECEIPTS (Value as of Date of Receipt unless otherwise indicated) Checking account no: 5080471306 - PNC Bank Money Market account no: 5080467104 - PNC Bank Blue Cross/Blue Shield - refund David L. Hartzell, MD - eye glass refund Sarah A. Todd Memorial Home - refund Total Receipts of Principal Page 2 Amount $2,881.55 $106,456.22 $106.15 $20.92 $3.82 $109,468.66 8/21/02 2001 12/4 12/4 12/28 12/28 2002 2/4 5/13 5/29 5/29 5/29 6/10 6/10 PRINCIPAL DISBURSEMENTS Brenda Briggs - reimb. For moving expenses and luncheon funeral Andrews & Johnson - reimb. For probate fee advanced Betra Inhome Care - home health aide Sarah A. Todd Memorial Home - final bill Register of Wills, Agent-payment on account of PA Inheritance tax Lehman Monument Co - memorial lettering The Sentinel - advertise letters Cumberland Law Journal -advertise letters Andrews & Johnson - partial attys fees Register of Wills, Agent-balance of PA Inheritance Tax Register of Wills - PA Inheritance Tax Return filing fee RESERVED: Andrews & Johnson - balance of attys fees Notary public fees Reserve for closing and accounting 2001 2/11 2/11 2/11 2/11 TOTAL DISBURSEMENTS OF PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES Brenda Briggs - partial distribution Anita Wolf - partial distribution Michelle L. Beleski Matthews - partial distribution Robert P. Beleski - partial distribution TOTAL DISTRIBUTION OF PRINCIPAL TO BENEFICIARIES Page 3 Amount $480.72 $255.00 $102.00 $75.46 $3,800.00 $269.00 $106.79 $75.00 $1,125.00 $2,043.77 $15.00 1,125.00 $20.00 $750.00 $10,242.74 $15,000.00 $15,000.00 $15,000.00 $15,000.00 $60,000.00 8/21/02 . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Brenda Briggs and Anita M. Wolf ,being duly sworn according to law, deposes and says that the Account as stated is true and correct, and that the Grant of Letters and the first complete advertisement thereof occurred more than four (4) months before the filing of the Account. Sworn and subscriped to before me this 11 day of Au~~'\ ,2002 ~tl(7~~~ NOTARIAL SEAL SHELLY SEXTON, NOTARY PUBLIC CARLISLE BORO, ClIMBERLAND COUNTY MY COMMISSION EXPIRES APRIL 26, 2003 Member, Pennsylvania Association of Notaries Page 5 8/21/02 ~ Cii!>'=' 9~~~~ ~2!....z<; N~d'~cn ~;!~~! tj~...-10 WS~V')[""4= W >z ....~cn ~ I hereby certlfy that written notlco of the filing of thl8 Aooount. and of the data, time and place when the same wII be pI.M)I d8d to the Court for COt 11Il1. J8IIon and d Ile I8It day to me written objections to said AoooOOt. h8I been given to eveIY unpaid c68Iment and to every other person known \0 the accountant to have or ctetm an intereSt in the estate 88 credftof, be09ficiafY, heir Of: next of Idn. 7#d'/~ INRE: ESTATE OF ANNA BELESKI DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-1065 SCHEDULE OF PROPOSED DISTRIBUTION . Combined Balance for Distribution Remaining as Per First and Final Account: Per Item II of Will TO: TO: TO: TO: $39,225.92 . ' Michelle L. Beleski Matthews cash distribution ~ $9,806.48 Robert P. Beleski cash distribution $9,806.48 Brenda Beleski Briggs cash distribution $9,806.48 Anita M. Beleski Wolf cash distribution $9.806.48 .; $0.00 STATEMENT OF REASONS FOR THE PROPOSED DISTRIBUTION The above distribution is proposed in accordance with the Last Will and Testament of Anna Beleski a/k1a Anna F. Beleski Page 1 8/21/02 LAST WILL AND TESTAMENT OF ANNA BELESKI I, ANNA BELESKI, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECO ND: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my grandchildren, equally, namely, MICHELE L. BELESKI, ROBERT P. BELESKI, BRENDA BEJ;..ESKI BRIGGS, and ANITA M. BELESKI WOLF, provided that the share of any grandchild who predeceases me shall be distributed to his or her issue, per stirpes, and in default of such then living issue, such share shall be added to the share or shares for my other grandchildren or their issue per stripes. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my granddaughters, BRENDA BRIGGS and ANITA WOLF, or the survivor of them, Executors ofthis my Last Will and Testament. FIFTH: I direct my Executors and their successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. - . '. IN WITNESS WHEREOF, I have hereunto set my hand aod seal to this, my Last Will and Testament, consisting of one (1)]JPewritten pages, each identified by my signature, this /S-~ dayof Fe.hYq,L1J/; ,2000. / ~111L-j,Jj ANNA BELESKI (SEAL) Signed, sealed, published and declared by the above-named Testatrix, ANNA BELESKI, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~ ~ C01.1M:ONWEALrnOFPENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) I, ANNA BELESKI, Testatrix, whose name is signed to the attached or foregoing instnunent, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and' voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by ANNA BELESKI, the Testatrix, this \5 daYOf~~ .2000. ANN~E{{gljJl~ (SEAL) NOTARIAl. SEAl SHEllY SEXTON, NOTARY PU8UC CARUSLE BORO. CUMBERlANo COUNTY MY COMMISSION EXPIRES APRIL 26, 2003 Member. PeMsylYj\lliz Asf<<:laUon 01 Notaries ...--......--- ....- ...... ", .. AFFJDA VJT COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) We, RONALD E.l0HNSON and --rc;v \ 0 Y P A~raN..s , the witnesses whose names are signed to the attached or ~ instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as his Last Will and Testament; that ANNA BELESKI, signed willingly and that she executed it as her free and voluntary act for the purpose 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 w:as at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by RONALD E. JOHNSON ~d~,-( \or f A~rcw-5 ,witnesses, this ~ day of -\-e.-brV"-::J ,2000. ) (SEAL) NOTARIAl SEAl SHEllY SEXTON. NOTARY PUBLIC CARLISLE BORO. CUMBERLKm COUNTY MY COMMISSION EXPIRES AP"ll26. 2003 Member. Pennsyl~la AssoCiZI:O;: ':~ lIotaries ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Brenda Briggs and Anita M. Wolf, being duly sworn according to law, depose and say that the facts set forth in the Statement of the Reasons for the Proposed Distribution are true and correct. NOTARIAL SEAL SHELLY SEXTON, NOTARY PUBLIC CARLISLE BORO, CUMBERLAND COUNTY MY COMMISSION EXPIRES APRIL 26, 2003 Member, Pennsylvania Association of Notaries Page 2 8/21/02 "5 c c _l?~!~S~C . J ~iQ.CI~ Q. ~ .~ !Ii ~ .Z !~~Sit~'i ~~~!!~~~ ~i\)J~I~ U!~nil n~"u ~ii .~ .Jg.. ii.s ....i ~.~ ~ ~~~.E~~S~~ i '.; ~ ~ .~ i ~ i i ._ iiI "i ~ 1$ ~ oX .~ .t: ~ cn~" Z < 8:l Cf') :t...:lC;;SCf') Of-o..t".N -.<eII........ ~~i~~ cn~~.iN ~llC111l~ ~~~~S O-"~ ~ -I ~ ...& ~,O" ;::::::fj.!!::~ ,!J; 'U\)\.O \)taU JO JtOll'~ '.~ . ~ 941 U\ ~ US Wl9P JO 9^8lI c: \1,g~ ~ ~ uMOUlt ~ J8l.&lO AseNJ ~ pull . .;.UfliIIO ~ /ueNJ ~ ~ ueeq 184 ~ peeodoJd 10 ~I J P'S piIIIiI8 ~ ~ U8WJ'" .~ 0\ _1118I aQ 10 pUIIJ 1JOIP'1'91OO .q lPY.> Q 'J\ ~tt1 aq 1l!II\'8UJ88 eM ~ ~ pue ewu ,':1'9P 8I.lt 10 pua 'UO\l~ ~ ~ ~ .>l'-I\ 1O OUW Olt\ ;0 ao,P.l U(jllVfl, WlIl "Jnl~ j.qE)J64 I '"i"O' e:1 .......c: ;;::uU ~CI_>>oo 0'0 · ~ -c:l~ 10-- _ 0-,' .... Q. B.." ::l o. .0"''''' I-;:Cl.~ ! \- I .~ -:; c: \-0'- O. ~-o ~ ~ C c: ~ 1\ l'li (,) - ,.., ,.... c: ~~ , :;...",ii _'0- ,~.v'-"O ,_ 0 Od= go--- \ C 01\ ~- ; ; If. :;) .c:---I..o .. 0 ~!OS.s~ ()- JOSEPH T. BAMBRICK, JR. ESQ. ATTORNEY AT LAW Admitted to Practice Pennsylvania and New York Tax J.D. 23241 4532 Date September 26, , 02 re: Estate of Madeline M. Bellini Case No. 21-01-1130 Check Enclosed: $16.00 Mary C. Lewis Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Ms. Lewis, Enclosed for filing please find one (1) original and four (4) copies of a Petition for Hearing in the above matter. Please date and timestamp the enclosed and return any copies to the office in the self-addressed stamped envelope also enclosed for your convenience. Also enclosed is a check in the amount of $16.00 for the original citation and three (3) certified copies. Your courtesy and cooperation are appreciated in this matter. If you have any questions, please let me know. Sincerely, o I'Y.lzph i~( {!Ju>mj'V~kcJsz ~~h T. Bambrick, Jr., Esquire JTB\sek Enclosure cc: Msgr. Nevin Klinger SUITE K, THIRD FLOOR 529 READING AVE. WEST READING, PA 19611 610-372-6400 FAX 610-372-9483 IN RE: ESTATE OF MADELINE M. BELLINI IN THE COURT OF COMMON PLEAS ORPHANS' COURT DIVISION CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-2001-1130 CITATION WE COMMAND, you that laying aside all business and excuses whatsoever, you be and appear in your proper person before the Honorable Judges of the Court of Common Pleas, Orphans' Court Division at a session of the said Court there to be held, for the County of Cumberland to show cause why THE PETITIONER IS NOT ENTITLED TO THE RELIEF REOUESTED; THE RESPONDENT SHALL FILE AN ANSWER TO THE PETITION WITHIN TWENTY DAYS OF SERVICE UPON THE RESPONDENT; THE PETITION SHALL BE DECIDED UNDER P A. R.C.P. NO 206.7: AN EVIDENTIARY HEARING ON DISPUTED ISSUES OF MATERIAL FACT SHALL BE HELD ON AS REOUESTED, ARGUMENT SHALL BE HELD WHEN REOUESTED: NOTICE OF THE ENTRY OF THIS ORDER SHALL BE PROVIDED TO ALL PARTIES BY THE PETITIONER. Witness my hand an official seal of office at Carlisle, Pennsylvania, this 7TH day of OCTOBER, 2002. Clerk, Orphans' C urt Division Cumberland County, Carlisle, P A My Commission Expires on the 151 Monday January, 2006 SEP 3 0 2002 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF MADELINE M. BELLINI NO. 21-01-1130 AND NOW, this v X- :a: Eo: t7ik 2002, upon consideration of the foregoing motion, it is hereby ORDERED that: (1) a rule is issued upon the respondent to show cause why the petitioner is not entitled to the relief requested; (2) the respondent shall file an answer to the petition within twenty days of service upon the respondent; (3) the petition shall be decided under Pa.R.C.P. No. 206.7; (4) an evidentiary hearing on ~rfu:ed issues of material fact shall be held on ~ ~:i' -921- J..:L "'JI/PI.I lu d'l= CLOO'" ~_" d!!!ll,d'rarrn __~ \Ii.-"~ (5) argument shall be held ~ ~~oo? ~r ...2\M IDM i ~ r'nurtr()nm ()f +-R!. C~[...liilflUil.:Ri g8I!1.R~:' r'nllrthnllClQ: "'~a, (6) notice of the entry of this order shall be provided to all parties by the petitioner. BY THE COURT: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF MADELINE M. BELLINI NO. 21-01-1130 CITATION AND NOW, this day of , 2002, a hearing pursuant to the Petitioners Motion to Show Cause as to why the Executors should not be removed in the above matter will be held on , 2002 at the Cumberland County Courthouse in Carlisle, Pennsylvania in Court Room at AM/PM. BY THE COURT, GEORGE E. HOFFER, P . J . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF MADELINE M. BELLINI NO. 21-01-1130 ATTORNEY ID NO 45112 PETITION FOR HEARING COMES NOW, the Petitioner, Immaculate Conception Catholic Church, who files this Petition for Hearing in the above matter, and in support thereof says: 1. The Petitioner is Immaculate Conception Catholic Church. 2. The Respondents are James M. Bucci, Esquire, and Daniel J. DiNardo, Co-Executors of the Estate of Madeline M. Bellini. 3. On or about July 27, 1998, Madeline M. Bellini executed a will. 4. A codicil was executed on or about June 5, 1999. 5. Ms. Bellini passed away on or about September 2, 2001. 6. On or about December 19, 2001, James M. Bucci, Esquire sent the Petitioner a notice that he represented the Estate of Madeline M. Bellini. 7. On or about March 7, 2002, the petitioner filed a Petition to Remove Executors in Accordance with 20 Pa.Cons. Stat. ~ 3182 for Failure to File Inventory. 8. On or about March 8, 2002, the Honorable George E. Hoffer issued an Order to the Executors "to show cause why he should not be removed from his office as executors, the letters testamentary vacated, and he be ordered to file an account" within 20 days. 9. On or about March 8, 2002, Mary C. Lewis issued a citation to the Executors to show why "he should not be removed from his office as executors, the letters testamentary vacated, and he be ordered to file an account" within 20 days. 10. On or about April 3, 2002, the Executors filed an answer to the Petition. 11. However, the Petitioner has not received any accounting for the Estate despite the Order of President Judge Hoffer. 12. On or about April 15, 2002, the petitioner filed an answer to the Executors' New Matter. 13. The petitioner believes and therefor avers that other than a payment of inheritance tax, no further action has occurred in this matter since April 15, 2002. 14. The Petitioner/beneficiary to date has not received an accounting in this matter. WHEREFORE, for all of the above reasons, the Petitioner respectfully prays this Honorable Court to: A. Conduct a hearing pursuant to the Petitioner's Motion to Remove the Executors; B. To require the Executors to provide an interim accounting for the Estate from the date of the death of Ms. Bellini to the present time; C. To grant such other relief that this Court may deem fitting and just. Respectfully Submitted By, Date: September 25, 2002 rick, Jr., Esquire At orney for Petitioner 9 Reading Avenue West Reading, PA 19611 (610) 372-6400 t :::r ru IT'" IT" ...=i ..D cO LI'l ..J] CJ CJ CJ Return (Endorsenlen! Restricted (Endorserrent CJ ...=i LI'l f"I--.---------::--. ru SentTo /' '." ,.;".. ?' __.___.....r;(.r:l;:t(~~I..__(~. ...., ...=i Street, Apt. No. "7 ,/ / /);; CJ orPOBoxNo ...l.J...f{<.'::'(' ~ 'c;ty:slate,'Z(P;4/1 i. . ., ., l. {< 'LA:..c.<ru I:I!::I' HUll Total Postage & Fees $ I) , I (Hill 3800 J;:muary ?OO 1 I Ii$brnplete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery Is desired. . . Print your name and address on the reverse SO tI:1at we can return the card to you. . ~ this card to the back of the mailpiece, or on the. front if space penn Its. 1. ArtIcle Addressed to:~ ~. n 1._. ../Jj) t!!? (j r./ Y/).. tt:Ar~0. It. (. - '1-- 7f~ fJ~ji~iLl ~I Pa: 170l,3 3. Se . e Type liJ Certified Mail o Registered o Insured Mail 4. Restricted DeIiV~~;; 02-/ ~ tJl.-ltll'5 2. ArtIcle Number ~m~~:::~01 7001 2510 0006 5861 9924 -.... 11 : . IfIUI .....1140 Domestic Return Receipt {i; JRD/June 30, 1992/1 7858 DEe 0 4 2003 V . . Estate No.: 21-2001-1065 ORPHANS ' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of Anna Beleski Late of Carliisle Borough NO. 21-2001-1065 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Counsel for Personal Representative: Ronald E. Johnson, Esquire Date of Decedent's Death: 11-16-2001 Date of Delinquency Notice: 10-10-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Register of Wills on 10-10-2003, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Distribution: Personal Representative Counsel for Personal Representative Estate File Date: 12-3-2003 ;1-(; -Ci 'I q,.'.3rJ 4< In , A hearing is scheduled for at in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancel ~ i\d-iflI04 oK ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: /lAnd 4e!PfK/' Date of Death: / /- / ~ - 2.t1d/ -- Will No.: .2/ - 2(JIJ/- /tJ~J 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 ofthe above-captioned estate: 1. State~ther administration of the estate is complete: Yes r\ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. Ifthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? yes)( No 0 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' (\,/ v~K 7r If(/. ~/Q1k<< -'I. Address C'c/,-//,t: 2/ /# / 7 ~/.5 '//f:s -()/ }!,:r Telephone No. \.~~ ~'\ '\ ~ Capacity: ruersonal Representative ~ounsel for personal representative OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1 500 FILE NUMBER DEPARTMENT OF REVENUE DEPT. INHERITANCE 280601 HARRISBURG, PA 17128-0601 TAX RETURN RESIDENT DECEDENT 21 01 1065 COUNTY COOE YEAR NUMBER I- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z Anna Beleski a/kJa Anna F. Beleski 189-03-5919 UJ DATE OF DEATH (MM-DD-YV) DATE OF BIRTH (MM-DD-YV) THIS MUST BE FILED IN DUPLICATE Cl UJ November 16,2001 July 15, 1913 WITH THE REGISTER OF WILLS U UJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME SOCIAL SECURITY NUMBER Cl I w XJ 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return <( ~ t: Cf) :=J 4. 0 oc ~ Limited Estate 0 4a. Future interest Compromise 0 5. Fed. Est. Tax Return Req'd w n. 0 I 0 0 K!6. 0 oc -' Decedent Died Testate 0 7. Decedent had Living Trust 0 8. Total number of SDB's n. co - - n. 19. n 10. Spousal Poverty Credit n 11. Election to tax wi Sec. 9113(A) <( Lit'g'tion Proceeds Rec'd I- ;m~$::~~9.T.~P~;f!~'::Re.&UiR~pi::piR~qttA@:qQ$.R$$.ijPNP~NeSMMWqQNfip~N.tM:WtAXJ&fPRM.A.Tlptitt&i::::::J':J ............ . z NAME: COMPLETE MAILING ADDRESS: w 0 z Ronald E. Johnson, Esquire 0 Ronald E. Johnson, Esq. n. FIRM NAME: Cf) w Andrews & Johnson Andrews & Johnson oc oc TELEPHONE NUMBER 78W. Pomfret St. 0 0 717 243-0123 Carlisle, PA 17013 '. 1. Real Estate (Schedule A) (1) $0.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) $0.00 , 3.Closely Held Corporation, Partnership or Sole-Prop. (3) 4. Mortgages & Notes Receivable (Schedule D) (4) $0.00 --" Z 5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E) $110,635.03 - (5) 0 $0.00 i= 6. Jointly Owned Property (Schedule F) (6) <C o Separate Billing Requested ....J ::> 7. Inter-Vivos Transfers & Misc. Non-Propate Prop. (7) $28,000.00 l- e.. 8. Total Gross Assets (total lines 1-7) (8) $138,635.03 <C 9. Funeral Expenses & Administration Costs (Sch H) (9) $4,226.97 U UJ 10. Debts of Decedent, Mortgage liabilities, & Liens (10) $102.00 a::: 11. Total Deductions (total lines 9&10) (11 ) $4,328.97 12. Net Value of Estate (Line 8 minus Line 11) (12) $134,306.06 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $134,306.06 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z 15. Amnt of Line 14 taxable at the spousal rate, 0 i= or transfers under Sec.9116(a)(1.2) x.O_ (15) $0.00 <( I- 16. Amount of Line 14 taxable at lineal rate $134,306 (16) $6,043.77 :;) x.045 a. ~ 17. Amount of line 14 taxable at sibling rate $0 x.12 (17) $0.00 0 $0 $0.00 u 18. Amount of line 14 taxable at collateral rate x.15 (18) >< <( 19. Tax Due (19) $6,043.77 I- 20 n CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ....... ......................... .....--... ......- .. ,'. . ... ..... ........ ... ... ....... ..... ...................... ........... . .... ....... . ..... . ........ .. .... .... -.. .. ... . ...... ................ ........... .................. .......................................... ......................... ...............,............................ .......................... ............,........ .. .... ....... ..... (~7- 22 -~ ~ ::,:::,,?:'?t,{{:,,?:::::?:t'/{},:ii,Iil1$:'$.:v.g=e.}tp::AtiHilWI:m::At:t.::gP.~$JI9(!,l$:'p.ti,m\{tw;~$~l:ml,(te'1.;NttRj;$ffl~$KMA1.:l#.iil:tI:'tI:::,tf't::"tt::l=':;:t:",{,,:;:tt,,: Oecedent's Complete Address: STREET ADDRESS 1358 Horick Avenue CITY STATE ZIP Boiling Springs PA 17007 Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts $3,800.00 $200.00 Total Credits (A+B+C) 3. Interest/Penalty if applicable D. Interest E. Penalty 4. TotallnteresUPentalty (D+E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (1 ) (2) (3) (4) (5) (SA) (5B) $6,043.77 $4,000.00 $0.00 $2,043.77 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT $2,043.77 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: yes no a. retain the use or income of the property transferred: b. retain the right to designate who shall use the property transerred or ~s income: c. retain a reversionary interest: or d. retain the promise for life of e~her payments or care? 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or secumy at his or her death? 4. Did decedent own an Individual Retirement Account, annu~, or other non-probate property which contains a beneficiary disignation? CJ CJ CJ CJ CJ o CJ ~ ~ ~ ~ ~ ~ ~ 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 perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Pomfret Street, Carlisle, PA 17013 DATE DATE :~::~~::fi:i:i:~~:I:mmi:Immm@:~f:~g~:~i:L:;:&If@@~@i:ml11~i:i:mjjmi:~mID~~l1ill@mmlli@i~iH@Mmj;!mmi:~~g;ttmm~@~i~i~mlMMMMn;ii@t~~@i4ittjl*~~g@f@*@Ml[wl~i Fo. dates of death on o. alter July 1, 1 994 and befo.e January 1, 1995, the tax rate imposed on the net value of transfers to o. for the use of the surviving spouse is 3% (72P.S. Sec. 9116(a)(1.1)(I)]. For dates of death on Of after January 1, 1995, the tax rate imposed on the net value of transfers to o. to. the use of the surviving spouse is 0% [72 P.S. Sec. 9116(a)(1.1 )0Il)' The staMe does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. Fo. dates of death on Of after July 1, 2000: The tax rate imposed on the net value of transfers from a deseased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, o. a stepparent of the child is 0% [72 P.S. Sec. 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to o. for the use of the decedenfs lineal beneficia.ies is 4.5%, except as noted in 72 P.S. See 9116(1.2) [72 P.S. Sec.9116(a)(1). The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P.S. Sec.9116(a)(1.3)). A sibling is defined, under Section 9102, as an indMdual who has at least one parent in common with the decedent, whether by blood or adoption. LAST WILL AND TEST AMENT OF ANNA BELESKI I, ANNA BELESKI, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my grandchildren, equally, namely, MICHELE L. BELESKI, ROBERT P. BELESKI, BRENDA BELESKI BRIGGS, and ANITA M. BELESKI WOLF, provided that the share of any grandchild who predeceases me shall be distributed to his or her issue, per stirpes, and in default of such then living issue, such share shall be added to the share or shares for my other grandchildren or their issue per stripes. TIDRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my granddaughters, BRENDA BRIGGS and ANITA WOLF, or the survivor of them, Executors of this my Last Will and Testament. FIFTH: I direct my Executors and their successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of one (1) .pewritten pages, each identified by my signature, this /S-M... day of Fe.br~J/; ,2000. / ~IJ~ ANNA BELESKI (SEAL) Signed, sealed, published and declared by the above-named Testatrix, ANNA BELESKI, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~ COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) I, ANNA BELESKI, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by ANNA BELESKI, the Testatrix, this \ 5 day of ~~ ,2000. AifM~jj~~ (SEAL) NOTARIAL SEAL SHEllY SEXTON, NOTARY PUBLIC CARLISLE BORO, CUMBERlAND COUNTY MY COMMISSION exPIRES APRIL 26, 2003 Member. Pennsylvania As~()cI3t1on 01 Notaries --- ".:-.-.., ~ ...-....-.. -. -. '-- '. '. AFFIDA VIT COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) We, RONALD E. JOHNSON and ~ y P A , the witnesses whose names are signed to the attached or foregoi g instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as his Last Will and Testament; that ANNA BELESKI, signed willingly and that she executed it as her free and voluntary act for the purpose 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 that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by RONALD E. JOHNSON ~d~'-I. \Cf" f A~rcw.s , witnesses, this --1.2- day of -\-eA?(V"-:J ' 2000. ) (SEAL) NOTARIAL SEAL SHELLY SEXTON. NOTARY PUBLIC CARLISLE BORO. CUMBERLA~~D COUNTY MY COMMISSION EXPIRES AP"ll 26. 2003 Member. PennsylVilnia AssOCjZi:~r. r;! llotaries SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Anna Beleski a1k/a Anna F. Beleski 21-01-1065 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH 2 3 4 5 6 Checking account no: 5080471306 - PNC Bank (See letter attached) Interest accured to date of death Savings account no: 5080467104-PNC Bank (See letter attached) Interest accured to date of death Blue Cross Blue Shield - refund Miscellaneous furniture and household items David L. Hartzell, M.D. - eyeglass refund Sara A. Todd Memorial Home - refund $3,119.13 $0.13 $106,234.78 $150.10 $106.15 $1,000.00 $20.92 $3.82 TOTAL (also on line 5, Recapitulation) $110,635.03 JAN-11-2002 10:26 PNCBANf< elF DEPffiTI'lHIT 412 705 0057 P.01/02 0. PNCBAN< January 9! 2002 ISCP Andrews & Johnson Attornc:ys At law 78 West Pomfrct Street Carlisle PA 17013 RE: Estate of Anna Be1eski, Deceased SSN: 189-03-5919 DOD: 11/16/2001 Dear Mr. Johnson: In response to your request for Date of Death balances for the customer noted above, our re\:ords show the following. CHECKING ACCOUNT #5080471306 Established OS/22/1995 ANNA BELESKI ANTIiONY BELESKI DOD Balance: $3,1] 9.13 + $0.13 accrued interest SAVINGS ACCOUNT #5080467104 Established 09/01/1995 ANNA BELESKI DOD Balance: $106,234.78 + $150.10 accrued interest Please note that this omee only provides date of death balances for deposit accounts (IRAs, CDs, Cheddng llnd Savings accounts). We do not process any f"mandal transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your loeal PNC branch office. Page 1 of2 A m~flber of TM PNt Financial Semees Group One f'NC PIa.-,. 249 Fifttl AvenI/I:: Pittsburgh ~nn5'llval1ia 15222 2107 JAN-11-2002 10=26 Pt~CBAI~K elF DEPARTMEI--IT 412 705 0057 P.02/02 o PNCBAl\K S incerel y , rfuuDvn \)~~ Marian Donnelly 1-800-762-177 5 P7-PFSC-04-F 500 First A venue Pittsburgh, PA 15219 Page 2 of2 A atembef ofThc: PNC F1nanl'lal ~~ Group One PNC Pl:lZ2 249 Fifth Avenue Pittsburgh !\:nnsyivanill 15222 27'J7 TOTl=L P. 02 SCHEDULE G T ANSFERS ESTATE OF FILE NUMBER Anna Beleski a/kaJ Anna F. Beleski 21-01-1065 l11is schedule to he completed and tiled ifthe answer of the question on the reverse ofthe cover is yes. ITEM DESCRIPTION EXCLUSION TOTAL VALUE DECD.% DOLLAR VALUE NUMBER OF ASSET 1NT OF DECD. 1NT I 7/8/0 I-Cash gift to granddaughter 3,000 $10,000 70.0% $7,000 2 7/8/0 I-Cash gift to granddaughter 3,000 $10,000 70.0% $7,000 3 7/8/0 I-Cash gift to granddaughter 3,000 $10,000 70.0% $7,000 4 7/8/0 I-Cash gift to grandson 3,000 $10,000 70.0% $7,000 TOTAL (also on line 7, Recapitulation) $28,000 ~ SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES EST ATE OF FILE NUMBER Anna Beleski a/k/a Anna F. Beleski (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) c. ITEM DESCRIPTION AMOUNT NUMBER Funeral Expenses: 1 Joseph W. Piszczek Funeral Home - prepaid 2 Old Country Buffet-funeral luncheon $55.72 3 Lehman Monument Co. $269.00 Administrative Costs: I Personal Representive Commissions Social Security Number of Personal Representative: 2 Attorney fees to Andrews & Johnson $2,250.00 3 Family Exemption Claimant Relationship: Address of Claimant at decedent's death: Street: City: State & Zip 4 Probate Fees to Register of Wills $255.00 Miscellaneous Expenses: I Cumberland Law Journal - advertise letters $75.00 2 The Sentinel - advertise letters $106.79 3 Paul A. Bahn, Jr. - moving expense $425.00 4 Sarah A. Todd Memorial Home-final bill $75.46 5 Register of Wills - P A Inheritance Tax filing fee $15.00 6 Reserve for closing and accounting fees $700.00 TOTAL (a]so on line 9, Recapitulation) $4,226.97 A. B. - SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Anna Beleski a/kla Anna F. Beleski 21-01-1065 ITEM NUMBER DESCRlPTION AMOUNT Betra in-home care - outstanding medical expense $102.00 TO TAL (also on line 10, Recapitulation) $102.00 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Anna Beleski a/k/a Anna F. Beleski 21-01-1065 ITEM NAME AND ADDRESS OF BENEFICIARY RELA TIONSHIP AMOUNT OR SHARE NUMBER OF ESTATE I Brenda Briggs 33() Pine Grove Road, Gardners, PA 17324 Granddaughter l/4th 2 Anita Wolfe 13 58 Horick A venue, Boiling Springs, P A 17007 Granddaughter 1/4th 3 Michele L Beleski Matthews 15A Sylvan Drive, HoIlidaysburg, PA 16648 Granddaughter l/4th 4 Robert P. Beleski 1% 1 Poplar Ridge Lane, Dauphin, P A 17018 Grandson l/4th ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0