HomeMy WebLinkAbout01-1089
PETITION FOR PROBATE and GRANT OF LETTERS
Estate o/Paul D. Sl!ril!noli
Also known as
~J .. 01 .. ItJ i<f--
No.:
To:
Register of Wills for the
County of Cum berland in the
Commonwealth of Pennsylvania
. Deceased.
Social Security No. 191-18-3852
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the exectrix named in the last Will of the above
decedent, dated July 28,1983
and codicil(s) dated None.
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, pennSYlVani~, w'th h~ last family or principa "
residence at 3908 Church Street, Camp Hill, Pennsylvania 17011.' r
(list street, number and municipality) ~ c;
Decedent, then sevelfty-eiszht (78) years of age, died November 5, 2001, at Holy Spirit Hospital. 503
North 21st Street. Camp Hill, Pennsylvania 17011.
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 ofa killing and was never adjudicated
incompetent: _
Decedent 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: 3908 Church Street, Camp Hill, Pennsylvania 17011.
$ ~~ //~~
$-
$
$ 103,920.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last Will and codicil(s) presented
herewith and the grant of letters Testamentarv.
(testamentary; administration c.I.a.; administration d.b.n.c.l.a.)
thereon.
"0 '-
liio~
~ VI
~ VI ~
VI~'"
~...",
... 0 C
... C 0
~.g :g
C "V; 0
CIl...Cl.
Vier:::
rf(~ ~ ;)h-IJ
fJ.ji,.
Normaiean.. Koch
3905 Church Street
Camp Hill, PA 17011
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA
}
} ss
COUNTY OF CUMBERLAND
}
Sworn to or affirmed and subscribed before
me this 28th day of Nav.
2001. . ~
7nnMl i 'PB .~~
) 7 -~'-f -3
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true
and correct to the best ofthe knowledge and belief ofpetitioner(s) and that as personal representative(s) of
the above decedent petitioner(s) will well and truly administer the estate according to law.
( ff(~~~
{ Normajean". Koch
{
{
.
"
Register
No. 21-01-1089
Estate of Paul D. Se;rie;DOli, Deceased
DECREEE OF PROBATE AND GRANT OF LETTERS
AND NOW, NOV. 29 ,2001, in consideration of the petition on the reverse side
hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated July 28.1983.
Described therein be admitted to probate and tiled of record as the last Will of Paul D. S2ri2noli; and
Letters Testamentary are hereby granted to ~...NQrm ,T~an t{t"'C'h
FEES
Probate, Letters, Etc. ..........$ 270.00
Short Certificates (6) ..........$ 18.00
Renunciation ... .., ...... .... ...$
x-pages $ ~. 00
JCP TOTAL $ ~.OO
~.OO
Filed...... J:JQY~.. .2S I.~.QQ)...........
'n'Yli C-. ~ -"'. illf"r.
Register of Wills I \
\..._ . 1-,(1. t.-J'-
~Bach 18727
A TIORNEY (Sup. Ct. 1.0. No.)
352 S. Sporting Hill Road, Mechanicsburg, PA 17050
ADDRESS
717-737-2033
PHONE
co <j"
N r:.t.
..-
a..
~ "ce"-
E5
z
1,'",:
I(~l:~;)
QU>
mCI:
0::.
..-
p
1-,-.""
(Ll
.:.' .Q
.;::: s=
.1)=
.,_ ..,JI
0(,)
~1()",..~n" P"EV 0/8(,
This is to certify that the information here given is correctly copied fron: 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 fihng.
21-01-1089
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7898407
No.
//- 9 -/Y/
Date
"'105 '4JA.w 2117
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
YPElPAINT
IN
:AMANEN T
"ACK INK
NAME OF DECEDENT llo"SI' Middle ..uI,
S"
PlACE OFQEIJH,O'<<II 01......''''. ''"'''\lI\I;'''">1nn~ 'UlJet
=",,0
I.
AGE llau e.nr.o~YI
B&RTHI'lACE :C.1)o .....d
3CA.....t'c'~..:OUflllvl
..
UNDER 1 YEAR
MoN~ Days
"",""TAl
Enola, PA ,....,_0
7. ...
FACIlfT'V NAME jM noI ofl\I'l\AIOI1 '.'Ye '>IINI MlO r1UlT'lDef.
/J,,~p. I.... \
. I. 78 v..
. COUNTY OF DEATH
...
Ie. E. Pennsboro Twp.
Cumberland
DECEOENl'S USUAL OCCUP.QlOH
l~:a=: Iif-:':O 0:- J:::t::r
"L Car Ins "..
DECEDENT'S .......L1NG ADDRESS (511.... c...,no-n. sw.. ZIpCOdilI
Railroad
DECEDENT'S
ACTUAL
RESWENCE
tSee1l'lURlC1lOnS
on""""",,",
3908 Church St.
Camp Hill PA 17011
Male
'! 'AlE ~Il( ~UWIKR
SCCIAl.. SECuRIT"l" '.U\lBEA
,191 - 18
3852
RACE . Amencan 1ncMn. SIK_. WhIle Me
tSpc~1
White
SUAV1\lIHQ SPOUSE
11l.......~~NmeI
....
...
IHFORMANT.S NAME (ly,*PIIOII
Joseph Sgrignoli
Norma Jean Koch
Cumberland "..0 ::..,"":"~..
""'THER'S NAIAF ,.., ""'die ........ ,,",0""" Fortuna Magaro
...
'NFORIAANT.S......1NG AOOAESS,S._. C'"'/Towft. ""'.~;P\;plo'17011
..... 3905 Church St. Camp Hili, t'A
PLACE OF DesPOSlTaoN - Nan'III Of Cemettty. CternalOty LOCArION . ClttlTown. Sllle.lip Coo.
.."'-.....Resurrection Cemetery Harrisburg, PA 17112
...
'Al"HEA'S NAME i.F"SJ. UoOdIe, lastl
17b.Cor.mty
:il
~
:>
'"
.
:;
.
~"omSlal.O
Nov 9. 2001
21c.
zo. ? .. '".
27. NItT I: Efller lhe 4t.....,. In",n., Of c:Ql'hPk:.AlIOfta whicfl caused the dU'h 00 not enl., !he ~ 01 dyl"i. sucn as ClfOoilC 01 '.5P"atory I.II.~. ShoCk 01 n.~ Iildur.
l... 0I/1I't one cau.. on eKt\ w..
"
.
WEAE AUlOPSV FINDINGS MANNER Of OEATH
Al.M..A8&.E PRIOA 10
COWPt.ETION OF CAUSE ~ 0
OF OEA7H1 ......... Hem",...
-- 0 P.nc;tlnQ ln~Sb9&t~ 0
V.. 0 NoD s..c... 0 Could nor be detannlf'led 0
DATE OF INJURY
CMonlh Day. ItiII
-
2ld.
NAWE"""O AOORESSOF FACM.lTY
2J,. Gilbert L. Dailey Funeral Hoole. Inc. 650 S. 28th SI. Hbg.. PA 17103
l..ICENSE. ,",UMBER DATE SIGHED
lMonetl.o.-,. "UtI
2311. 2Jc.
WI.S CASE REFERRED TO "EOCAl EXAMINEAlCOAOHEA1
....0 ...~
>0.
I AppID...,.,..I.
'--
: ..... and 0MIh
,
:
PART N: OINt '9"I'c*" condIIior4I c:anwtbuling 10..... brA
1101 t.-uIllftg!fllM ~C8uM""'IftPAAT I
TiME OF INJURY
INJw:ty AT WORK? DESCRIBE MON INJURY OCCURRED.
v.. 0 NoD
P
I
i
JOb. .....
PlACE OF INJURY. AI home tarm. SII..... lac1or,. orhce
lN~. .le ISpec."'!
alb.;n. He.
allTIPIER iCI"eclr OI'loy ~I
-CE..TlI'YING PHVSICIAN IPhy'>OC-.r> C~hfyoog cause oA ~th ,.",..,. ,JI'lOftoer Dhv$IC.'~ t\4s P'Q(lovnc.o IJUlh 41"10 Cornt:llE'l~ 'l8'n 131
To.... Mat at "" know.O_, d..UI or:cuned due........ cau..(IJ And "'Ann., A. I"'H.
'PftONOUNCING AND CERTIFYING PHYSlCIAHIF'hys.l:1iiI't t.wJft" ;JI":"'....,oefIQ <Je,Jlh d1.d ,......"f'IlQ 'O'..)u~. at ,1edlt>1
To 'h. betlt 01 m., kl'lO....d';lft. dl>Ath occw'M allhe u.n.. cI.I.. .nd pl.c.. .nd due 10.: ~;.. c....Nt.,.nd" ann.,... lIal'"
.MEDICAl EXAMINER/CORONER
On lhe be.IS of e..m,n.rion .lnd/Ofln"'eslig<lhon. In m., opinion. de.lh occ...rted.1 the lime. dale. and place. .And due 10 the c.use(sl.nd
manner..lIl.led.
)1. "
REGISTRAR 5 SlGNArUAE "NO NuY8EA /'; ,/'
------~~~-?
?
,/
L
-c>-~f'
1.2 t2J.2 V i:2'j
~{>.;
l_;
DATE FILED.'"""", 001'( 'e.m
J'
~ C- /
I'
LAST WILL
OF
PAUL D. SGRIGNOLI
I, PAUL D. SGRIGNOLI, of the Township of Hampden, Cumber-
land County, Pennsylvania, declare this to be my Last Will and
revoke any will previously made by me.
ITEM 1: I direct that all my just debts and funeral
expenses shall be paid from the assets of my estate as soon
as practical after my decease.
ITEM 2: I devise and bequeath all of my estate of every
nature wheresoever situate, together with insurance thereon, to
NORMA JEAN KOCH, MATTHEW J. SGRIGNOLI, ANTHONY P. SGRIGNOLI, and
GINA SGRIGNOLI, share and share alike.
I respectfully suggest
that the beneficiaries of my Last Will consider the fact that it
is my desire to provide a home for MATTHEW J. SGRIGNOLI and
ANTHONY P. SGRIGNOLI.
ITEM 3: I direct that all taxes that may be assessed in
consequence of my death, of whatever nature and by whatever
jurisdiction ~posed, shall be paid from my residuary estate as
a part of the expense of the administration of my estate.
ITEM 4: I appoint NORMA JEAN KOCH and MATTHEW J. SGRIGNOLt,
co-executors of this my Last Will.
ITEM 5: I direct that my personal representative or their
successors shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
;1.5'
IN WITNESS WHEREOF,
day of h-
I have hereunto set my hand this
,1983.
~
cf~lf, .
PAUL D. SG N
!1
,
410:
The preceding instrument, consisting of this and one
other typewritten page, identified by the signature of the
Testator, PAUL D. SGRIGNOLI, was on the day and date thereof
signed, published and declared by PAUL D. SGRIGNOLI, the
Testator therein named, as and for his Last Will, in the
presence of us, who, at his request, at his presence, in the
presence of each other, have subscribed our names as witnesses
hereto.
1)8~~r-
~~~f.~
~ q (') 1 1'n.uIad:S77
~ /-liLt) fa 1'701C
~,
7 C:h M ltM>> uJ pQ-
(~(> t-\'\ 1I ,\'A-llol\
residing at
residing at
COMMONWEALTH OF PENNSYLVANIA)
) ss:
COUNTY OF CUMBERAND )
We, PAUL D. SGRIGNOLI,
~.;P Vz .I
. . ~ :ZcV!j;~/l-0 ,
~41/'1 i ~ . and
the Testator and the witnesses
respectively, whose names are signed to the attached or fore-
going instrument, being first duly sworn, do hereby declare
to the undersigned authority that the Testator signed and
executed the instrument as his Last Will and that he had signed
willingly, and that he executed it as his free and voluntary
act for the purpose therein expressed, and that each of the
witnesses, in the presence and hearing of the Testator, signed
the Will as witness and that to the best of his or her know-
ledge, the Testator was at the time eighteen (18) years or age
or older, of sound mind and under no constraint or undue
influence.
g..-J~. ~
~ Subscribed, sworn to and acknowledged before me,
Jatl/)) 1( ~/fUVfitavJ
., by PAUL D. SGRIGNOLI,
and subscribed and sworn to before me by <-j/g1tJlt:
,r OJ ~
and lrhA,ML( t ~/lL1-hi3t/)j,->:-, witnesses, thi~"
(; ~
....{/ , 1983.
.-f I
t, ,
the Testator,
; 1t:y of
,d!.~~
. '&U..J J\. /~J41/1lj:1;;u-I{ SEAL )
NOT PUBLIC
Dolores V. Brenneman, Notary Public
Mv Commi,sion Expires March 19. 1984
Hampden r ownship Cumber:and C,)Unty
21=01-1089
RENUNCIATION
In Re Estate of Paul D. Sgrignoli deceased.
To the Register of Wills of Cumberland County, Pennsylvania.
The undersigned Matthew J. Sgrignoli of the above decedent, hereby renounce(s) the
right to administer the estate and respectfully ask(s) that Letters Testamentary be issued
to Normaiean F. Koch.
WITNESS my hand this J -> day of
fu-v
, 2001.
~-jJ~
' (Signature)
EQ4745, RD#lO, Box 10, Greensburg, PA 15601
(Address)
X~~~r~~
( Ignat
(Address)
~70 g' ~ <;7
II ~ (~na7M \(q
~ (/ ::;-tJl!
(Address)
ex:> <!
"0 N ll_
.....
(;J:' 0-
co
N ;'.,)
(,:1 ::::- ,:'(1
0 ~ii
::z::
() .0
u ..- ~s::
C> P J.>=
a::. -. :"(
f...)U
, .
~
.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Paul D. Sgrignoli
Date of Death: November 5, 2001
Will No.: ~,- Ol- \091 Admin. No.:
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-
captioned estate on November 29, 2001:
Name
Address
Normajean F. Koch
3905 Church Street, Camp Hill, P A 17011
Anthony P. Sgrignoli
3908 Church Street, Camp Hill, P A 17011
Matthew J. Sgrignoli
EQ4745, RD #10, Box 10, Greensburg, P A 15601
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
(None).
'+-
o~
.~~:~"
rt
~~~
Si~ture .
Name: James M. Bach, Attorney-at-Law
Date: November 29,2001
o
-
0:; ~f,;
e .Ii:!
00')
go>
a:: a::
CL
o
I"')
:::::-
~
Address: 352 S. Sporting Hill Road
Mechanicsburg, P A 17050
'C~:,
c:
ro
"CG
~.Q
...s::
\1>=:
ou
Telephone: 717-737-2033
p
Capacity: 0 Personal Representative
I:8J Counsel for Personal Representative
~
JAMES M. BACH
Attorney At Law
~
352 S. Sporting Hill Rd., Mechanicsburg, PA 17050, Tel: (717) 737-2033
February 25,2002
Cumberland County - Register of Wills
Hanover & High Street
Carlisle, P A 17013
Re: Estate of Paul D. Sgrignoli
Dear Register of Wills:
Enclosed herewith please an original and one copy of a Pennsylvania Inheritance Tax Return.
I enclose a check in the amount of $15.00, which represents the filing fee, and a second check in the amount of
$7,177.69, which represents the Pennsylvania Inheritance Tax due.
Please process in your normal fashion and return to me a Commonwealth of Pennsylvania receipt.
Re,peotfully, ~
~.B~
Attornry-at-LAw
JMB/sjr
Enclosures:
Inheritance Tax Return
Check #123 ($7,177.69)
Check #122 ($15.00)
CC:
Normajean F. Koch (Copy of Letter Only)
o
i'..J
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 000892
BACH JAMES M
352 S SPORTING HILL ROAD
MECHANICSBURG, PA 17055
ACN
ASSESSM ENT
CONTROL
NUMBER
AMOUNT
-------. fold
101
$7,177.69
ESTATE INFORMATION: SSN: 191-18-3852
FILE NUMBER: 2101-1089
DECEDENT NAME: SGRIGNOLl PAUL 0
DATE OF PAYMENT: 02/26/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 11/05/2001
TOTAL AMOUNT PAID:
$7,177.69
REMARKS: NORMAJEAN KOCH
C/O JAMES M BACH ESQUIRE
CHECK# 123
SEAL
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
t
Q
C
o
~o
-110
-10
-"...
%~
C)C
:>!a.
--~ ..
C[~C)
%.JO~
Ot-a.::)
cccnm
ID>%O
.W~-
:EZ::)Z
cn~Oc
WOU)%
:E~NO
c[~IOW
.". C tI) :Ii
Q)
en
:::J
o
..c:
1:::
:::J
oen_
U=Q)
>-~. ~
->-('1)
C_U')T"""
5 o. ~r -= 0
,..... I"-
'-J Q).. T"""
-o}i)f<(
~ .~ ~ a.
Q5 ~. .~~ ai
..0". en
E' .-
:::J .a. J.~(S ~
U<(+:U
\
-., .
(':.'
.~ 83,j lO.
".~,r::....u
+~);;.;Oa
"JO::>Stj
. ."".,'"
"
/ '7-02 ")/., l:5'
'\, BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-lS47 EX AFP (01.02)
lib.
JAMES M BACH ATTY
352 S SPORTING HILL RD
MECHANICSBURG t:PA'c17050 - 0 158
("l' '
, emu
'02 APR 1 2 P 1 :53
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-08-2002
SGRIGNOLI
11-05-2001
21 01-1089
CUMBERLAND
101
PAUL
D
Amount Remitted
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 ~
R "E-';=iS4-j-E3t-AFP--CoY:oiY-NOYicE--OF-YtiHERTrAN-cE-YA'X-A-PPRA-isEirENT-:--ALi-oWAN-CE-O-i------------- ----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SGRIGNOLI PAUL D FILE NO. 21 01-1089 ACN 101 DATE 04-08-2002
T AX RETURN WAS: (X) ACCEPTED AS F I LED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (I)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8.
Total Assets
103,920.00
.00
.00
.00
85,018.00
.00
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
188,938.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
ClO)
29,433.61
.00
ell)
Cl2)
Cl3)
Cl4)
::>9.433 ,,]
159,504.39
.00
159,504.39
NOTE:
If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of !hh returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
02-26-2002
Cl5)
Cl6)
Cl7)
Cl8)
.00
159,504.39
.00
.00
X 00
X 045 =
X 12
X 15
Cl9)=
.00
7,177.69
.00
.00
7,177.69
RECEIPT
NUMBER
CD000892
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
7,177.69
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
7,177.69
.00
.00
.00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
>
REV-~\OG.tEX 16-0~1 )
'*' COMMONWEALTH OF
.' PENNSYLVANIA
~ ,~, DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
~, ,
I-
Z
W
C
W
o
W
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Sgrignoli, Paul D.
DATE OF DEATH (MM-DD-YEAR)
11/05/2001
REV-1500
C-
f}FqC!At USE ONL.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
;).<-/-3
FILE NUMBER
~L-O-L
COUNTY CODE YEAR
_LCLX9-
NUMBER
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-YEAR)
08/06/1923
191
18
- 3852
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
w
'"
::r.:::g;cn
u"''''
w"-U
xOo
u"'--'
"-,,,
"-
'"
1il1. Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Attac~ copy 01 Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date ofdealh after 12-12-82)
D 7. Decedent Maintained a Living Trust (AtlachcopyofTrust)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date ofdllath prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AtlachSch0)
>-
z
w
o
z
o
"-
.,
w
'"
'"
o
u
z
o
!ci
..J
::)
l-
ii:
<C
o
W
0::
z
o
!.;;:
I-'
::)
D.
::i:
o
o
X
i:!:
M. Bach
FIRM NAME (If Applicable)
ames M.
TELEPHONE NUMBER
717-737-2033
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)
14 Net Value Subject to Tax (Line 12 minus Line 13)
Mechanicsbur , PA
352 S. Sporting Hill Road
(1)
(2)
(3)
(4)
(5)
$
103.920.00
$
85,018.00
..-..--
~ .... ~
.- ('
17050
I OFFICIAL USE ONLY
,
I
l
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(6)
(7)
(B) $
(9)
(10)
$
29,433.61
(11) $
(12) $
(13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14) $
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19 Tax Due
$159.501.39
, .0 (15)
,045- (16) $
, 12 (17)
,15 (1B)
(19) $
d
N
--n
'"
cr..:
i'J
r:7"
I'-,"~)
r'J
188,938.00
29,433.61
159,504.39
159,504.39
7 177 ft,Q
7.177.69
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Decedent's Complete Address:
STREET ADDRESS 3908 Church Street
CITY Camp Hill I STATE I ZIP 17011
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + 8 + C ) (2)
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
(SA)
8. Enter the total of Line 5 + SA. This is the 8ALANCE DUE. (58)
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 No
a. retain the use or income of the property transferred; .. ........................ .................. ......................... 0 g
b. retain the right to designate who shall use the property transferred or its income; .......................... ... D ~
c. retain a reversionary interest; Of.................. ....................... .................................... ................................... D ~
d. receive the promise for life of either paY'1'ents, benefits or care? .............................. ........................ ... 0 ~
2. If death occurred after December 12, 1 982, 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? ............ D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .. . ................... ................ ..................... ..................................... 0 ~
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 belief, it is true, correct
and complete.
Dedaration of preparer other than the personal representaUve is based on all information of which preparerhas any knowledge.
DATE
'Z._ 25- ...-t.....
Mechanicsburg, PA 17050
DATE
'2 - -z..S- 0 L
Hill, PA 17011
.... [ilIllI
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 PS 99116 (a) (1.1) (i)].
For dates of death on or after January 1. 1995. the tax rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 0% [72 P.S. 99116 (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 are 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(a)(1.3)]. 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.l~2EX+(1-97)
'*
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.'
ESTATE OF
Sgrignoli, Paul D.
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
survivorshin must be disclosed on Schedule F.
ITEM
NUMBER
1
FILE NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
3908 Church Street, Camp Hill, PA 17011
$
103,920.00
/
TOTAL (Also enteron line 1, Recapitulation) $ 103,920.00
(If more space IS needed, insert additional sheets of the same size)
REV-l~EJ+(1.97)
'.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Sgrignoli, Paul D.
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
$ 9,647.00
$ 39,896.00
$ 35,475.00
PNC Checking Account (Total Value $19,295.00)
1/2 Interest - Co-Owner Normajean F. Koch
2.
Met Life Total Control Account (#403-1101045)
3.
John Hancock Annuity Account
TOTAL (Also enter on line 5, Recapitulation) $ 85,018.00
(If more space IS needec, Insert additional sheets of the same size)
REV-1S'11E1.(1.97)
'.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Sgrignoli, Paul D.
Debts of decedent must be reported on Schedule I.
ITEM AMOUNT
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1. Gilbert Dailey Funeral Home $ 5,352.00
2. Catholic Cemetaries $ 650.00
3. Our Lady of Lourdes (Funeral JJ;uncheon) $ 206.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Narne of Personal Representative (s) Normajean F. Koch $ 9,447.00
Social Securily Numbe~s) I EIN Number of Personal Representative(s)
Street Address 3905 Church St:rF!~t:
City Camp Hill State PA Zip 17011
Year(s) Commission Paid: 2003
2. Attorney Fees James M. Bach $ 11 ,336.00
3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountants Fees
6. Tax Return Preparer's Fees
7. Kathryn Fetrow (2002 R.E. Taxes) $ 1,200.00
Keystone Oil Company $ 150.00
Patriot News Legal Ad $ 17.20
Cumberland Law Journal Legal Ad $ 75.00
Care for People (In-home care) $ 36.00
West Shore EMS $ 214.00
UGI $ 101.00
Terminex $ 107.00
Verizon $ 55.50
PP&L $ 51.38
PA American Water Company $ 52.70
Register of Wills (Probate) $ 314.00
oaf- f"'~hl ~
T .
TOTAL (Also enter on line 9, Recapitulation) $ 29,433.61
(If more space is needed, insert additional sheets of the same Size)
.
REV.1S13 ex + (1.g7j
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Sgrignoli. PAul D.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Normajean F. Koch Daughter 1/3
3905 Church Street
Camp Hill. PA 17011
2. Anthony P. Sgrignoli Son 1/3
3908 Church Street
Camp Hill. PA 17011
3. Matthew J. Sgrignoli Son 1/3
3908 Church Street
Camp Hill. pa 17011
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 II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)