HomeMy WebLinkAbout01-12-07 (2)
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Decedent's Last Name Suffix
Date of Birth
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
C)
2. Supplemental Return
C)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C)
C) 4a. Future Interest Compromise (date of
death after 12-12-82)
C) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
C) 10. Spousal Poverty Credit (date of death C) 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT _ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Number
C)
C)
4. Limited Estate
8. Total Number of Safe Deposit Boxes
C)
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
City or Post Office
State
ZIP Code
",
First line of address
r,)
I
)
~....~
Second line of address
DJ
Under penalties of perjury, I declare that I ve examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
Correspondent's e-mail address:
.e..S,SI a
e d..u.-
DATE
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
y:..
-l-.
'3:> ~ L'- -::. t:! ....,.. t..-G-
REPRESEN.Tj\TIVE
Vx;;;(L~o-)-.\
P f\ ( cD ~ 1
f\ DATE I
6'^. N\. ~ It.~ \..;.s.. ":Sl2- _ c f -t"t ' oQ "$ t/:; ""
ADDRESS
("7-
'1) (L (~(, ~(.. ~ r:Jv-~<r f ~
PLEASE USE ORIGINAL FORM ONLY
~( 0\
Side 1
L
15056051047
15056051047
.-J
cs
.-J
15056052048
REV-1500 EX
.................... .
1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . .
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . .
6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . . . . . . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested.. .
9. Funeral Expenses & Administrative Costs (Schedule
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10).... .
. . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) .
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
TAX
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .O.Qg
16. Amount of Line 14 taxable
at lineal rate X.O<<
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
18.
'.3 ~ '1 (..?
J~ I
l
15.
16.
17.
19. TAX DUE. . . .. . .
.................................. .
. . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c:::>
Side 2
L
15056052048
15056052048
~
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME t:?
D ~E.~ ~\h ~ A
?--l
o~
004l.o<
STREET ADDRESS
s ~ '"'-' w-._W-_\~_~~~
CITY
-:s:::> \ L,..I".S a........ ~ ~
STATE;O~
ZIP.
{'70~1
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
7;J-<r." ~7
(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.
Fill in avalon Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
/;;2- '1.1.0,
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.
( 7- 7.1.07
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 ~
b. retain the right to designate who shall use the property transferred or its income; ....................".....".............. 0 g
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 1&
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.
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 three (3) percent [72 P.S. 99116 (a) (11) (i)].
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 zero (0) percent
[72 P.S. 99116 (a) (1.1) (Ii)]. The statute does not exempt 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 zero (0) percent [72 PS. ~9116(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 four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 PS. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(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-l5D8 EX + (1-97)
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I:::)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
,
+"
FILE NUMBER
:,:21- 0(;" 0'+
~
i~? ~
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.
::L
-3,
~
--' '
F'v-- t..."' <;) is. (1 ~d~ f<,
'P \~~s (j, .J' n.G....
I
( ~ 1\ I\..!
l"'. ~ +-: ,.,-
c.]:) tJ:$ 0 I
r< ,
1""'- ,_.\ (\." .,,> r.' f'<..
C'.., s:;:.
\J
o(
DESCRIPTION
C~.G'.f.;..f:'q:... f\ 1,- t;::::: S b 1'1- ~ ~ (, ~ (
p~ \10\ 9
VALUE AT DATE
OF DEATH
'6~7. ;t..{
(? ~ +--i r:--
Q:. '2 ,"" "
-'Y:).;;;~ I
(1'" R..'vJ \ '-~
l'~ "gj
. r-
j-;;,
!
1:::J~'
-f
1':3
r:r Pi ~-l i... -c ..;:
f'^"
V:Er~!+..J\'-io;;..,
"'-10
('f'" I
;..:, . (
Q I "1. <''''"
I ..,., ..... -' ;
:
""""'t
",-~'1 f
.5\
p U~ ,,J \ I;.. 1<:"') .p ~
I /
'"T.
f="....)>. (l.. \ ,-. v. t-t lJ\' \. .......)
;;'I"Ai.-
c.: ,,^.f
~/..;. ::::'Q
f f( t f' 0:'::;;;'+--1'- _.. ~I(", ~"''- C~ 'i.{"'.; .s.
'J.' ~...,
""'J ......, ';.. j .... v
r" f '''' ""'''1__
TOTAL (Also enter on line 5, Recapitulation) $ 3 ~ :J-Lr"J.
(If more space is needed, insert additional sheets of the same size)
REv' ',509 EX 1- ~1-97;
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSl LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~, _
r~~; <<:.R.., cV\'~'f-.
FILE NUMBER
;L \ 0 (,0- '0 '-f
, ,r
:0>::.
If an asset was made joint within one year of the decedent's date ,I)f death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. p"" \;'-1..- I ...\ fE, s" E V \ C.I<
$;" :;; vI" MM ',r-' ~ {1..
'"3.)\I..-\.-$e~ri..C- P.n' (70('7
~ i>,J'. C. \~' -". \,. I~
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DE; TH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT SINTER",:"
~I// F i.A. '- -.;;:. ,~ ,.:\ g\~, o <a'-f -0 ((GOI a -;La 4~ 9.5'1 5051.. /0 J I"';. ~
1. A. ... ';, /:J').. }---i.~.
!
TOTAL(Also enter on line 6, Recapitulation} $ /OJ;2. /4.80
o
(If more space is needed, insert additional sheets of the same size)
REV-15tO EX + (1-97)
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
P s" Ir... ('..... r;: V \t', fc
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
.;:11- ~,:)t;)(",,-O')I;'
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
1.
~j r,:'-\
~~
'. :)
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OFTRANSFER
ATTACH A COPY OFTHE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
-".'.....1. ....,
r.
"'"
~ J 1~~;,..
'-PI ':'>0.;)
C :5 v.- ;y> M '.r'":" 0';'
!
r
i, -I:;' l '9
\ I.-.t-' S G -I... (2. (,..,
/)
~\
;
.' " ~
G-'l~~l:J
\1 I" - I "..' -,
f~, I c. \-', Ir'
-.::: s v-. vv-. 'f'<'
\ ......... S C.}-.
{:c\ vJ
p.... S'~(,/I.C-~
(t., <0 () ~
-':~..,
.'" "y r,-
(2(,.... {J'~
- ..J
\ta \C(
%OF
DECO'S
INTEREST
- ,-:)-
__'.:Y--~
EXCLUSION
......1
:5 <~':),) J
'3-<:l~::l
TAXABLE VALUE
-:).:;).;;1
~3 ;:, '0 0
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
G:, \:)v O. Co
I
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
fG~ ~K
---
t::v I J...l ,A
FILE NUMBER I . L! ,.<,
;71--\ - () '"'" - D T ~ ..)
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. M EJ-'- ~ f'- 'h"",,; (: IZ t'''- f.. :)v"'i'-:;: S'60{,OO
I "'7 '? ~\((.;;;, :;;-<
v:;; .. ...
(:;j" c:. ~ f' ~ c.. f;.::... p~ I ~ (.. :s.)'
I
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN 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 sarne as claimant's, attach explanation)
Claimant
Street Address
City State _Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees SOO. ao
7. p.(S VE-/'(.~ i <; I .....' c.- 17~, \0
TOTAL (Also enter on line 9, Recapitulation) $ '-f J. -rl, (,0-1
'-\
(If more space is needed, insert additional sheets of the same size)
~U.JI vuu....
.LV.L'U .L
Fulton Bank
LISTENING.
STATEMENT OF ACCOUNTS
3619-68681
STATEMENT PERIOD
FROM THROUGH
x
12-05-05
1-03-06 0
1...111...111......111.1,,1.1...1.1.1..1.1.1..11....1.1..11..1
PETER EVINA
5 SUMMIT DR
DILLSBURG PA 17019-9589
PAGE 1 OF 2
6 ENCLOSURES
o
TRUE BLUE BANKING
PREVIOUS DEPOSITS/
STATEMENT BALANCE CREDITS 3
8,978.78 1,634.73
CHECKS/
DEBITS 6
9,726.26
ACCOUNT: 3619-68681
SERVICE
FEES
.00
ENDING
BALANCE
887.25
INTEREST PAID THIS YEAR
ACCOUNT/INTEREST INFORMATION
3.13
DATE ACTIVITY DESCRIPTION REFERENCE
12-05 BEGINNING BALANCE
12-28 CHECK 1477
12-28 CHECK 1474
12-29 CHECK 1476
12-30 CHECK 1473
01-03 US TREASURY 303
SOC SEC 010306
I XXXXX5539A SSA
01-03 PRU ANNTY PYMT
JAN 06
17193CXXXXX5539
01-03 MISCELLANEOUS DEBIT 03463405560
01-03 CHECK 1475 00131702600
01-03 INTEREST CREDIT
01-03 ENDING BALANCE
DEPOSITS/ CHECKS/
CREDITS DEBITS
03149000030
00735001210
00834903640
01334802480
00077900000
2,000.00
5,961.58
60.00
92.60
BALANCE
8,978.78
1,017.20
957.20
864.60
1,579.001'"
\
00077900000
52.60 }
/
-4
1,579.00
33.08
3.13
~87.25
(_8~~
CHECK NO
1473
1474
1475
TOTAL NUMBER OF CHECKS
CHECK
* INDICATES SKIP
AMOUNT
92.60
5,961.58
33.08
5
SUMMARY
IN CHECK NUMBERS
CHECK NO
1476
1477
AMOUNT
60.00
2,000.00
8,147.26
TOTAL AMOUNT OF CHECKS
***
ANNUAL PERCENTAGE YIELD EARNED DISCLOSURE FROM 12-05-05 THROUGH
ANNUAL PERCENTAGE YIELD EARNED .54%
AVERAGE DAILY COLLECTED BALANCE 7,094.30
INTEREST EARNED 3.13
1-03-06
............
............
DIRECT FULTON BANK DIRECT BANKING CENTER
INQUIRIES TO: PO BOX 504
k"AC;:'I' Pk"'I'k"kll;:ll.Tr!;lr.. PA 17<;;')(\-(\<;;(\.6.
Member FD.l.C.
~f' N' I
, BANiifBEllWICK
~~119530
60-71
313
~~ount of Caf:>h in deceaHoo en 01 96359 .!.1 3!' tlin 1 ?-2aJl5
DATE
7 214 Of.
PAY
'I
$ 15,163..52
CASH\ER'S CHECK
::~:::;;:::~:::..}~ '~::~:/~~: '.'.
.':. '::;>_{:':O:
<";'){<<:}h:'::~::;~);' ::;-::{" :;:;;
. ~ . . . .".". -. '. '....
TO THE
::JRDER OF
I
Pet€?t"" I1vina Estate
COPY-NOT NEGOTIABLE
Jr",p4;P~~. ~-::; c:r- it,.:);~ 7' I" {" ':?
~r 0.LJ-t: ~'- ~ C.L-,~ S' j J J 0 &.
Authorized-Signature
=
----~--_......_--"~~._.~----"~---~-~---_._--~--_..,.._,.._~_.._.-_. ..... ..- ..
~ N'j
, BANiifBEllWlCK
,:~ 49 531
60-71~
313~
~~~ount of Cash in dsceagad cn01 0,6'59 11 ';'1 '\'Yln 1 ?-2~
DATE 7 2'4 0&
...'.... ,>...'.'..............
...-...-....."....' .
,,-"
.'. ....::.}.::'.;.i( >"?~:}. ::}f~;~\f<?~~>. ::::::"::".?:: $ 20,032 .. 28
I CASHIER'S CHECK
PAY
TO THE
ORDER OF
I
COPY-NOT NEGOTIABLE
Peter E'llina Estate
Authorized Signatu~
J;J:;J;: /jc>~~C~ D 5"/ ,/0 c,
--~.~~-~--'_. --,--_.._-----_._~~_._._.._-'_.._---_.._-_._.._- .. .. --
!TCeIIu~ f?7lUle/~t !TC0fllb
/.;. 33 Third Street
NESCOPECK, PA 18635
March 25, 2004
Prearranged funeral services for Dorothy & Peter Evina:
Removal from anywhere in Penna., preperation of remains, hairdressor,
all professional services, use of funeral home, church setup, hearse and
lead car tQ cemetery, register book, memorial folders, thank you cards,
Thacker auburn 20 gauge metal sealer casket, mirrored sides, ivory crepe
interior as selected Complete $1,788.00
Cash Advances:
Elan Memorial Park
Casket Spray
Newspaper notices
Six certifieds
Minister
$700.00
132.50
100.00
12.00
50.00
TOTAL
994.50
$2, 782.50
e70k f7C&'te&z - {f)w-/le;<-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 67
06112789
03-21-2006
REY-1543 EX AFP (09-001
EST. OF PETER EVINA
S.S. NO. 166-05-5539
DATE OF DEATH 12-28-2005
COUNTY YORK
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
00 CERTIF.
PAULINE E STEVICK
5 SUMMIT DR
DILLSBURG PA 17019
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
YORK CO COURT HOUSE
YORK, PA 17401
FUL TON BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 064-0170070 Date 12-02-2004
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
20,429.59
50.000
10,214.80
.045
459.67
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return
to be filed by the decedent.s representative.
[] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
x
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. HOME ( )
WORK ( )
TAYPAVI=P "T~IIIATIIPI= TI= I I=PI.1n1ll1= IIII1MRI=P nAT~
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
estate of PETER EVINA
I,
SHORT CERTIFICATE
GLENDA FARNER STRASBAUGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 30th day of May, Two Thousand and Six,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
, la te of CARLISLE BOROUGH
(First, Middle, last;
in said county, deceased, to PAULIN E STERICK
(First, Middle. Last)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 30th day of May
Two Thousand and Six.
File No. 2006-00465
PA File No. 21-06-0465
Date of Death 12/28/2005
S. S. # 166-05-5539
~-Rk,-
-t>~ ~.
SfCM..~ od:.L'MbJI~
~+
Deputv
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
rhi:.; i-.: tt'l i..:;.::-rtit} th~l{ li";c' lnf,-lr:ltaUOn here given i;-;. l..'orrecily cnpied fro111 an original ccrtificak ~)f (k-at!: dUI\ fik'\..l",'ttli
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COMMONWEALTH OF PENNSYLVANIA' OEPARTMENTOF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
STATE FIlENV",eER
,. 92
COUNTY Of DEATH
SEX SOCIAL SECURITY NUMBER
2. Male 166 - 05
BIRTHPLACE {Cily.nd E F
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METHOD OF DISPOSITION
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REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2006-00465
Es ta te Of: PETER EVINA
PA No. 21-06-0465
IFirst. Middle, Lastl
Late Of:
CARLISLE BOROUGH
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 166-05-5539
WHEREAS, on the 30th day of May 2006 an instrument dated
December 14th 1999 was admitted to probate as the last will of
PETER EVINA
IFirst, Middle, Last!
la te of CARLISLE BOROUGH, CUMBERLAND County,
who died on the 28th day of December 2005 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, 1;, GLENDA FARNER STRASBAUGH Register of Wills ~n and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
PAULIN E STERICK
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 30th day of May 2006.
C :0/l
>>
/2 .
l..(~~
Deputy
......1\TI"lrr>D** 71TT 1\T7IMJ;>c! ZI'RnVR ZJ.PPRZJ."R (PTR.c:r. MTDDLE. LAST)
LAST WILL AND TESTAMENT
OF
PETER EVINA
I,
Peter
Evina,
of
Monaghan Township,
York County,
Pennsylvania, being of sound and disposing mind and memory, do
make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils by me at any time made.
ITEM I:
I direct that all inheritance and estate
taxes
becoming due by reason of my death, whether such taxes may be
payable by my Estate or by any recipient of any property, shall be
paid by my Executor out of the property passing under this Will,
which is not specifically devised or bequeathed, as an expense and
cost of administration of my Estate.
My Executor shall have no
duty or obligation to obtain reimbursement for any such tax paid by
my Executor even though on proceeds of insurance or other property
not passing under this Will.
ITEM II:
I hereby exercise all powers of appointment that I
may have at the time of my death in favor of my residuary estate,
and all property subject to all such powers shall be included in my
Estate.
ITEM III: I give and bequeath all my household furniture and
furnishings, automobiles, books, pictures, jewelry, china, linen,
silverware, wearing apparel and all other like articles of
household or personal use and adornment to my wife, Dorothy E.
Evina, if she survives me, or if my wife does not survive me, to my
daughter, Pauline E. Stevick, of Monaghan Township, per stirpes.
ITEM IV: I give, devise and bequeath all of the rest, residue
and remainder of my property, real, personal and mixed, to my wife,
Dorothy E. Evina, if she survives me, or, if she does not survive
me, to my daughter, Pauline E. Stevick, per stirpes.
ITEM V:
e,)
In the settlement of my Estate, my Executo,x shall
-~
possess, among others, the following powers to be executed for the
; ,-)
best interest of the beneficiaries:
1---1
Page 1 of 5
~,-'\
W
(a)
To sell either at public or private sale and upon
such terms and conditions as my Executor may deem
advantageous to my Estate, any or all real or
personal estate or interest therein, whether owned
by me severally or in conjunction with other
persons or acquired after my death by my Executor,
and to consummate said sale or sales by sufficient
deeds or other instruments to the purchaser or
purchasers, conveying a fee simple title, free and
clear of all trust and without obligation or
liability of the purchaser or purchasers to see to
the application of the purchase money or to make
inquiry into the validity of said sale or sales;
also, to make, execute, acknowledge and deliver any
and all deeds, assignments, options or other
writings which may be necessary or desirable in
carrying out any of the powers conferred upon my
Executor in this Paragraph V(a) or elsewhere in my
Will.
(b)
To pay all costs, taxes, expenses and charges in
connection with the administration of my Estate.
My Executor shall pay expenses of my last illness
and funeral expenses.
(c)
To distribute my Estate in kind or in money. If
any assets are distributed in kind, they shall be
distributed at their respective value(s) on the
date(s) of their distribution.
(d)
To retain any investments I may have at my death so
long as my Executor may deem it advisable to my
Estate so to do.
(e)
To vary investments, when deemed desirable by my
Executor and to invest in such bonds, stocks,
notes, money markets, real estate mortgages or
other securities or in such other property, real or
personal, as he shall deem wise, without being
restricted to so-called "legal investments."
(f)
To mortgage real estate and to make leases of real
estate.
(g)
To borrow money from any party to pay indebtedness
of mine or of my Estate, expenses of administration
or inheritance, legacy, estate and other taxes.
(h)
To vote any shares of stock which form a part of
the Estate and to otherwise exercise all the powers
incident to the ownership of such stock.
(i) C
In the discretion of my Executor, to unite with
other owners of similar property in carrying out
any plans for the reorganization of any corporation
or company whose securities form a part of the
Estate.
To distribute my personal property directly to the
Guardian of the person of any minor beneficiaries
hereunder.
(j)
(k)
To elect such settlement options as deemed most
appropriate by my Executor with r,espect to ax:y
pension, profit sharing or other ret1rement plan 1n
which I am a participant.
Page 2 of 5
(1)
To do all other
necessary or
advantageous
distribution of
acts in the judgment of my Executor
desirable for the proper and
management, investment and
my Estate.
ITEM VI: Any person other than my wife, Dorothy E. Evina,
who shall have died at the same time as me, or in a common disaster
with me, or under such circumstances that it is difficult or
impossible to determine who died first, or who shall fail to
survive me by ninety (90) days, shall be deemed to have predeceased
me. If my wife, Dorothy E. Evina, shall have died at the same time
as me, or in a common disaster with me, or under such circumstances
that it is difficult or impossible to determine who died first,
this Will shall be construed and I shall have been deemed to
predecease my wife.
If at any time any minor child or legally
incompetent person shall be entitled to receive any assets
ITEM VII:
hereunder, I hereby nominate, constitute and appoint my Executor to
act as Guardian of the assets payable to such person.
Said
Guardian may receive and administer all assets authorized by law
and shall have full authority to use such assets, both principal
and income, in any manner said Guardian shall deem advisable for
the best interest of such person, including college, university,
post-graduate or other education, without securing court order.
Said Guardian shall have all the rights and privileges as to the
Guardianship and the assets thereof as are herein granted to my
Executor as to my Estate and the assets therein.
ITEM VIII:
I nominate, constitute and appoint my wife,
Dorothy E. Evina, to be my Executrix (herein referred to as
"Executor") .
In the event of the death, resignation, refusal or
inability of Dorothy E. Evina to serve as my Executor, I nominate,
constitute and appoint my daughter, Pauline E. Stevick, to serve as
Executor in her place.
In the event of the death, resignation,
refusal, or inability of Pauline E. Stevick to serve as my
Executor, I nominate, constitute and appoint my grandson, David W.
Stevick, to serve as Executor in her place.
My Executor and
Guardian are specifically relieved from the duty or obligation of
filing any bond or bonds.
Page 3 of 5
IN WITNESS WHEREOF, I have set my hand and seal to this my
Last Will and Testament, consisting of this, the next, and the
preceding three pages this 14~" day of~, 1999.
<3~~.-.r :.
Peter Evina .'t-q.;
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named
Testator, Peter Evina, as and for his Will, in the presence of us,
who, at his request, in his presence and in the presence of each
other, have hereunto subscribed our names as witnesses in
attestation thereof.
~-~.J2,~
~15
5to (11'" ~ ;LeI'? D'J5c
Address ..~[eIi"_~I"'-"&-rJ 1.4 JV)cS.s-
Address ~~-efl:b~~ 'l~'
Address~iBtAlfj;~: iii 17D5'O
\-C.!dml{JO-)j)& f~
./
,,'!i-"'!"':Yf'8l'~ji#_'t';.~~,~~:,,~~~~....~~~~~~;il!t~~~r.:"'!~!~-~~"'''~~~i?"~'Ijf~l1fI"",""""''''''''''~~~'''i'~~'~X''~,,,'c'-';''''''~'''''' '.
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~yv~'~
55.
I, Peter Evina, the Testator whose name is signed to the
attach~d or foregoing instrument, having been duly qualified
accordlng to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; and that I signed it willingly and
as my free and voluntary act for the purposes therein expressed.
Evina,
Sworn to or
the Testator,
affirje1land aCknowle.dged before me by
this I.) day of Dec-~ , 1999.
'(j~ ~t~
pe)fr Efina, Testator
(~,eJ-rr )J - fdr ~
Notary I'ublic
My Commission Expires:
(SEAL)
Peter
Notarial Seal
Carolyn H. Sider, Notary Public
Upper Allen Twp" Cumberland County
My Commission Expires Oct, 22, 2001
Member, Pennsylvama Associallon of Notaries
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF rU1M--krl~
We, 1::::n"';\L1 R, Q.eCz..., L'I Vi-jC<J P; nEJs. , and
, the witnesses whose names are signed to
the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw
the Testator sign and execute the instrument as his Last Will; that
the Testator signed willingly and executed it as his free and
voluntary act for the purposes therein expressed; that each
subscribing witness, in the hearing and sight of the Testator,
signed the Will as a witness i and that to the best of our
knowledge, the Testator was at that time 18 or more years of age,
of sound mind and under no constraint or undue influence.
SS.
Sworn to
..\ P~\-12
~:~b4 )lc,T-
1999.
or affirmed and subscribed to before me by
, L j Yl-ck... PincA. ~?- I
, witnesses, this ~ day of ~,
Jj' 1? o.
w~;; ~fi7
Wltness
, (.2!7Lll(l )d'f)U~
Wltness ..
C~;~ AJ ~~~.
NotaryVPublic
My Commission Expires:
(SEAL)
Notarial Seal
Carolyn H. Sider, Notary PubUc
Upper AIIe,n -r:wp., Cumberland County
My CommissIon Expires Oct. 22, 2001
Member, Pennsylvania Association 01 Notaries
Page 5 of 5
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