HomeMy WebLinkAboutOC1971-0715 - ESTATE OF KULIKOWSKIFORM 67
REV. 1-50
REG. WILLS
1\ppliratiott fnt 1£rttrrs nf 1\(lmtntstratiott ott tbr
Estate of ......... MJ.~.~.@.~ .... ~ .. ~ ..... ;TS~~J.~Q.~§.~.! ................ h ............... on ................................................................................................ .
late ofR .. ~It,.l .. , ..... G.9 .. P.J .... G.~n .. t~.:r. .. , ..... P..~., ...... (.Q.~JJ.t.!?..!:..U-..!.~ ... J2g.,:r.,o IDeceased.
Before the Register of Wills of Washington County
personally appeared .......... :·!..~E.!} .... K!:!.~ .. ~.~-<2.~.!?.~.:!: .................................................................................................................................. ..
who, being duly sworn deposes and says that... .... M.t!;.E .. ~.~.! ..... L.., ..... KMJ . .!.Js.9.:W .. §~ •. L ................................................... ..
age ..... ~.!... .... , having .... ~.~ .. ~ .... last family or principal residence at... .......... Jf.~ ..... P..~ ..... L ................................................ ..
(Street and Number)
G.9..9:.~ .... G:.E!:.~.!.~E .. , ..... 9. .. ?.-.~ .. ~.!5?.E.~.~.§!-. ..J?..~E.?..~~.?.: ................. , Washington County, Pennsylvania, died intestate
(City, Borough, Township) __
at. .............. .b..:i..s .... b..QID.fi: .................................................... , on the ... J .. ~ .. day of ...... Q.Q.t.Q.Q.~.r. ................................................... ..
A. D., 1~ .... 7.Q ........ , at... .. ; ... .J. .. Q.::..Q .. Q ................... ! ...... P..A.M.;: possessed of personal estate to the estimated value
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.! • .-.. ' .; ' l------$ .. ~ . .1 •• ?..Q.~ .. , .. ~.~ ...... , and of real estate in the Commonwealth of Pepnsylvania to the estimated value of
$ None · · .·· · . .................................... , situate In ........................... ,.; ............................................ ~ .................................................................................................. ..
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The names and addresses of the decedent's surviving ·spouse (if any) and other heirs including
heirs by adoption) are as follows. /
,
REI,ATIONSHIP RESIDENCE
John Kulikowski ' : rother • D. l Coal Center Pa. 15423 ................................................................................................ , •••••.•••• _. ......................................................... , .............................................. 1 .......................... ..
. :J..~.~ .. «!:.P.h .... ~~.!J.~.9.~:?..K~ .... : .. : ............. : ...................... !..!?..:t..h.~.r. ........... E .. : ..... P. .. : .... J: .. , ..... G.9 .. ~1 .... G.~.Q:t..~..:r. .. , ..... P..~., ......... .:!:.f> 4 2 3
Paul_Kulikowski rot'her . D. l Coal Center Pa. 15423 ....................................................... .-............................................................................................................. !. ............................................. ! ........................... .
. W.~.u-.9~~., .. KY..li.~.Q.»:.~k!............................................ .J .. ~.t..~r. .......................... :P. ........ l .. , .... C..9 .. ~! ..... C..~.n.t.g.;r. .. , ..... P..9. ........... Hi 4 2 3
.................................................................................................................................................................................................................................................
.......................................................................................................................................... 1 ..................................................................................................... ..
That deponent is over 21 years of age, resides at... ... :R .. , .... P. .. , .... .1 . .1 .... ~.2 .. ~J. ... ~.~.D..1.~.E . .l ............................... .
Pennsylvania .................................................................................................................................................................................................................................................. , -. is a citizen of the United States and a resident of Pennsylvania; and respectfully app!ies for Letters of
Administration upon the Estate of said decedent,
¥
ubscribed before me this .. ~ ................... .
................... ; .................. , A. D., 19 .. ?..!... .... .
~~
REGISTER
COMMONWEALTH OF PENNSYLVANIA } SS:
WASHINGTO OUNTY, ~ ~
And now ............................ 4.:.. .......................... , 19 ..... 7..1., come s ............. J.o.h.n .... Ku.lik.o.w..s.k.i ..................... ~ ... :~·' ........ ..
who being d sworn doth depose and say that... ..... h.!i! ................ will well and truly administer the goods and
chattels, rights and credits of... ....... MJ.g.h.9..~.L .. L ........ KJ.JJ .. !.l5;.Q.:W.§~.i ................................................................ , deceased,
to the best of....b..i.s .... skill and judgment in strict compliance with the laws of this Commonwealth, mind-
ful of the laws relating to inheritance taxes.
//
Sworn an · ubscribed before me this~ ....................... .
dayof ................................................... ~.L .... .
REGISTER
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APPLICATION FOR
Letters of Administration
ESTATE OF 0
................ M..H~.B.M.!! .... J~.: ..... ~Y..~.!.~Q.W.§M;!.. ......... .
Deceased
Letters ... ,.......... R $ .............. .. ........................................ .. .......... ..
p $ ..... /...4)_,, t7 D .....................
Extra Alias . . . . .......... $ ............................. .
Certificates . I A e . . $ / 0 0 ............. ······························ I . ..,.-·=---~ Renunciatio~~ : . .., ....... _.~ .. $, ... : .. : .. :.!.. .... 4:. .. .9.
~-_..., ;;D . J> rn r-r:,_ ... .
........................... ::::··~· .. ;:;;;··········· .. ·~ $.: ........................... .
:::':: if.~ (:-, , ............................ t···~~-.. ;~~~ ....... fl:: ....... l;L ... ~., ....... ~I;!.,:/ .. : ...... ~.:·o .. .
T ,:::> --·. • otal .......................... ,............... . • ::::::.: ~l 9. • ••••• ::.;..·····:········~·········:···· .....
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ESTATE OF
..................... : ...................................... , ..... M.!~ff@.1 ... J-! .. , ..... ~.Y.J.KQ.W.$..~.l .................................................................................... DECEASED
TI1e undersignecl ............ ?..:r::.~.~~-~-~ .. ~ ..... ~~~ ..... ~ .. ~.~·~·~·~·······································································-·········································and heirs
of .................. ~~ .. <?.!.!:.~.~.~ .... I:.~.-.. ~.~.~.~.~~-:'f..~.~ .. ~ ............................. Jate of .... Q .. ~I.tf.g,.E.!}.i.9: .... B..9..£.9. ..•.. C8..,.D. .•. .l.,.C.Q.al .... C.erte r.)
deceased, hereby renounces .. ~.~-~--~·~······ right to administer on ..... _.hJ .. § ........................................................................ ~ ..... estate
d f II k h L f Ad · · · b · d John K u l i k ow s k i · an respect u y as ·s t at etters o mtntstratwn e 1ssue to ....................................................................... -················-··--···········
---............................................................................................................................................................................................................................................ _ ...................... .
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<trnmmnuwralt4 nf Jruusyluauia, l ss.
llus4tugtnu C!!nuuty, \
I, Russell Marino , Register for the Probate of Wills and Granting
Letters of Administration in and for the County of Washington, in :the Commonwealth of Pennsylvania,
to John Kulikowski
administr a tor of all and singular the goods and chattels, rights, and
credits, which were of Michael Kulikowski late of Washington County, deceased,
GREETING:
WHEREAS, the said Michae 1 Kulikowski late of
California Borough in the county aforesaid, lately died intestate
(as is affirmed), possessed of divers goods and chattels, rights and credits, within the said County,
L
Russell Marino
by r·eason whereof the power of granting administration thereof doth belong .to me; I therefore, confiding
in your fidelity, do by .these presents gmnt unto you these LETTERS OF ADMINISTRATION, here-
by committing unto you full power to administer the goods and chattels, rights and credits, which were
of said deceased within this Commonwealth, you having taken and subscribed the oath of office pre-
scribed by law; requiring you to well and truly administer the goods and chattels, rights and credits,
which were of said deceased, and .to exhibit a true and perfect inventory thereof into the Register's
office, at Washington, within ninety days, .and to render a just and true account of your administration
at •the expiration of six months from the date hereof, and to regard and comply with .the provisions of
the laws relating to inheritance taxes.
IN TESTIMONY WHEREOF, I have hereunto set my hand and
caused the seal of said Office to be affixed this 12th.
day of Ju1y_ in the year of our Lord one thousand ------·--~-
nine hundred and Seventy One
RUSSELL MARINO, Register.
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Estate of ... MlC.HAEL ... L ...... KULl.KOWSKI... .......... ..
} No ................ of IL .... .
late of C.al.:if.o.+..n:L.a Boxough. . . , Deceased
KNOW ALL MEN BY THESE PRESENTS,
That we, ...... J..() l:l.n ... R~ ~ .. ~. J<..().W.!'?.~.t ... 9:P..4 ... Q P. .~.<?. ... C. a..s.l1. c:L~. ~.Y. .. C.() Ill P c:Ll1Y.... . .. .. . . . .. . . . . .. . .. ... .. . . .. .......... .
................................ .................... ·····································.····· ··············································································· ···············
all of Washington County, Pennsylvania, are held and firmly bound unto the Commonwealth of Pennsyl-
vania, for the use of those interested in the estate, in the sum of .. ~JgP.~ ... ~PC?.~.S.~~~ ........... Dollars, to
be paid to the said Commonwealth, to which payment, well and truly to be·· made, we do bind ourselves,
jointly and severally, for and in the whole, our heirs, executors, administrators, successors and assigns, and-
each and every of them, firmly by these presents. Sealed with our seals and dated the day of
... J..\(!S ................................ A. D., one thousand nme hundred and .sra:vra.!l.~.Y-~.<>!1:.~ .................. .
Ti-IE CONDITION OF THIS OBLIGATION IS, That if the above bounden
.. J.9.P...P. ... K~JJ.~.9.Y'!..!?.~.~----.................................................................................................................................... .
Administrator or any of them, shall well and truly administer
otherwise, it shall remain in force.
Sealed and delivered in the presence of:
.............................................. , .. , .....
t;tatrmrut nf t;urttn
I, ---·--------------------------------------------------------------------------------.. ·------------------------------.. --. surety in the sum of $ .......... -.................... on the
administration bond in the estate of ... -.............................. ______ , ________ .. ___ .. ______ , ...................................... , say that I reside at
--=:=:::::::::::_::__-::---------------...... -------.......... , Washington County, Pennsylvania; that I am the owner of real estate, the
title to which is in my own name and duly recorded, situated in .................................................................................................... ,
Washington County, Pennsylvania, worth above all encumbrances $ .... _________________________________________ ; and that I am worth the
amount expressed in said bond, over and above my just debts and liabilities.
··------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------Street P.O.
&tatrmrut nf &urrtn
I, -----------------------------------------------·---------------------------------------------------------------------------· surety in the sum of $ .... ____________________________ on the
administration bond in the estate of -------------------------------------------------------------------------------------------------------------------· say that I reside at
-----------------------------------------------------------------------------------· Washington County, Pennsylvania; that I am the owner of real estate, the
title to which is in my own name and duly recorded, situated in ....................................................................................... , ............ ,
Washington County, Pennsylvania, worth above all encumbrances $ .... ____________________________________________ ; and that I am worth the
amount expressed in said bond, over and above my just debts and liabilities.
OOoooooooo.ooooooOOooooooOooOoOOOoOooooOOoOooo•ooooooooooooooooooooooOo00HoooOoo00000ooooooOoooooOOOooooooooooooooooooo.
·-------------------------------------------------:-----------------------------------
Street P.O.
COMMONWEALTH OF PENNSYLVANIA, }
SS· WASHINGTON COUNTY, .., .
And now ........................................ 19 ............ , comes ....................................................................................................................................... .
who being duly sworn, says that he is acquainted with the financial standing of the securities to the within bond; that
the said obligors have each executed the said bond and that the sureties thereto are the owners of real estate in their
own right of value more than the penal sum of said bond over and above all incumbrances and exemptions.
Sworn and subscribed before me this ------------------------------
day of ------------------------------------------------------------------------------------A.D. 19 .... ____ _ ------------------------------------------------------------------------------------------------
J
03-7/~?/~'
No •. 7..1_7_ ______________ _
l\~miulntrntinu 1Bnu~
IN THE ESTATE OF
And now _________ _Jul:J ... l2 ____________ , 19 .. 7.1 __ _
Bond approved and Letters issued to
~ ~ -.: '-·-· '•
John J"Kta,i-kowsld-_ ..
--------------------£.0--;~--f~-----------~-----;:·:.~-:-------------
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----who.--wa-S~--iiul.Y:--q.ualif.i.ed ___________ _
(:) . ; --..., ~ G ~~ ------------Ru~.e:~l[M~~1~-----:~-------------------• r-:;;: '--'--' Register -u ,-----~
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Bond Book __ 6_4---------------------Page 202
BADZIK PRINTING ~9 DONORA
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CERTIFIED COPY OF POWER OF ATTORNEY
THE OHIO CASUALTY INSURANCE COMPANY
HOME OFFICE, HAMILTON, OHIO Noo 10-211
1Kuntu All Jlrn by (!J~rst 1frrstnts: That THE OHIO CASUALTY INSURANCE COMPANY, in pursuance
of authority granted by Article VI, Section 7 of the By-Laws of said Company, does hereby nominate, constitute and appoint:
John P. Wege --- - - - - - - - ---- - ---- -of Washington, Pennsylvania - -
its true and lawful agent and attorney -in-fact, to make, execute, seal and deliver for and on its behalf as surety, and as
its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single inatance
ONE HUNDRED THOUSAND - - - - - - - - - - - - - - - - - - -($ 100,000.00 --) Dollars.
Excluding, however, any bond guaranteeing the payment of notes and interest thereon.
And the execution of such bonds. or undertakings in pursuance of these presents, shall be as binding upon said Company,
as fully and amply, to all intents and purposes, as if they had been duly •executed and acknowledged by the regularly
elected officen of the Company at its office in Hamilton, Ohio, in their own proper persons.
The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s)-in-fact.
STATE OF OHIO,
COUNTY OF BUTLER
In WITNESS WHEREOF, the undersigned, Vice-President of the said The Ohio Casualty
Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of the
. said The. Ohio Casualty Insurance Company this 11th day of . October 19 68 •
(Signed) J. Earl Rochester
Vice-President
} ss.
On this 11th day of October A. D. 19 . 68 before
the subscriber, a Notary Public of the State of Ohio, in and for the County of Butler, duly commissioned and qualified, came J. Ear 1 Rochester , Vice-President of THE OHIO CASUALTY INSURANCE COMPANY, to me
personally known to be the individual and officer described in, and who executed the preceding instrument, and he acknow-
ledged the execution of the saine, and being by me duly sworn deposeth and saith, that he is the officer of the Company
aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate
Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the
said Corporation.
STATE OF OHIO,
COUNTY OF BUTLER
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official
Seal at the City of Hamilton, State of Ohio, the day and year first above written.
r ss.
(Signed) Dorothy Bibee
Notary Public in and for County of Butler, State of Ohio
My Commission expires ... ~ ... P..~~~P.~~ ... 9.-' ... 19.J.~.~ ....
I, the undersigned, Assistant 3ecretary of THE OHIO CASUALTY INSURANCE COMPANY, do hereby
certify that I have compared the foregoing copy of the Power of Attorney with the original thereof, and that the same is
a correct and true copy of the whole of said original Power of Attorney, and I do hereby further certify that said Power of
Attorney is still in force and effect.
IN TESTIMONY WHEREOF, I have hereunto set my hand this 8th day of July , A. D., 1971
Form S-4300-T Assistant SecrettWy
t, 3~71-11~
P.ffi~auit ®f tExrrutnr ®r P.~miuistratnr
/oF/ !;tatr nf Jruuayluauia. t .as:
C!Lnuuty nf llaa4ittgtnu ~
Personally before me, the undersigned authority, a ....... .N.Q.tf.!. . .t'S .... l?..JJ.b.l.i.c .............................. in and for said
County and State, appeared ........... J.3~J.ll.1 .... l}.1\.l .. :b.K9.:l!.?..~.L ....................................................................... who, being duly
sworn according· to law, deposes and says that he is the executor or administrator of the estate of
.. .Mi.c.hiJ<:e.l .... J.. ........ ~.~J .. i.KQ.:??.I?.~.L ............................................... deceased, that the foregoing schedules constitute a
complete inventory and appraisement of the real and personal estate of...JlU.c.lla.e.l .... L. ....... Kl.ll.i.KQ.W.~.~.~
deceased, except real estate outside the Commonwealth of Pennsylvania; that the figures opposite each item
of real and personal estate in the foregoing schedules are determined and stated by the undersigned to
be the fair value of said items as of the date of the decedent's death, based upon a just appraisement of each
item made by the above named Executor Administrator.
Sworn and subs!iibed bef.ore me this ....... 7d.:.
day of.. · : ..................... ~~~... /
PHYLliS L. .. KQ .................... · ... ........ . .: .... £~ ................. .. :Sxee1lWr-Administrator John Kulikowski California, Washingto o., Pa. .
My commission ires ADDITIONAL I c-STRUCTIONS
. Januaxy 2~, 75 b f'l d . h' h h f . f l . l. .nn mventory must e 1 e w1t m t ree mont s a ter appomtment o persona representative.
2. ·A supplemental inventory must be filed within thirty days of discovery of additional assets.
3. l Original and 2 Copies and 2 RCRI-34, Under $10,000; 1 Original and 2 Copies and 2 RCRI-33,
Over $10,000, including Copy of Will; 1 Original and 3 Copies and 2 RCRI-33, Over $50,000, in-
-cluding Copy of Will and copy of Federal Estate Tax Return.
REFERENCE FOR ADDITIONAL COPY
Act of 1947 P. L. 513 Sec. 5.2, 72 P. S. 4844.2
.. <~
1Jnurntnry nub 1\pprai.s.rm.rut of the goods and chattels, rights and credits which
were· of .......... M.:l.c.h~.e.l. .... Tr. ....... .KJJ.l.:l.k.Q.W.~.ki ................ late of ..... g~ .. +. .. ~.X.Q.!:.P.:i~ ..... ~.!?.r..g,.~z.!?: .............................. ..
Washington County, Pa., taken and made in conformity with the above affidavit.
Savings Account # 1879, Western Pennsylvania National
Bank, California Office, California, Pennsylvania
None
DOLLARS CENTS
8,806 99
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STATE OF PENNSYLVANIA,
WASHINGTON COUNTY, ~ 55:
The within named Accountant being duly sworn according to law, deposes and say s that the above account
as stated is tr~e and correct as ........... n.?.. .........................• verily believe.
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Wa,shington County, ss:
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<11 l •rl ~ ) i E-< ~~~ 0. ,.., ric rn. ~ f \ c.: ~ P=l ~i ~ •n \V!t~l «)) ~ .-i . · .. .....,; .-i
r~-"M·~ 1''\ ·-U:l L.,.
UAA}. ____ ~~~-----------1-;~~-l;~; Kulikowski
I do certify that I have given legal notice to all persons
concerned of the filing of the within account in the manner
prescribed by Statu>te and Rule of Court, as evidenced by proofs
thereof filed to No ___ ~_3,-:: _ _')_Pl,_-:f_{_1__ _____ -p
Witness my hand and official <Seal this .. I _____________________ _
day of ____ gn___ _ -------- --------C\Jj;j __ _ 19.7~
_ __ _ ____ IlL~~------
--~egister of Wills
...... .... ;::l 0 0 o."!! +> 0 0 CD ,.<:1 "'" ....., 0
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lt -.;,_ = CD "' ~· ~ SEL!_ rr .t 111&1(! = .~ ,.t-,Kf I' J 0 ;::l 0 STER 0 r· <:.l j" WILLS <:.l ol
INGTON co ... PA. = : .... :a ill ~ ~ .....,
~ ~ ....., "' +i ·~ 'bii <!:! ~ 0 CD .q uj CD ~ ...... ,.<:1 Q 1-i r~ ~ .....,
·.-l •rl Ci 0 0 ~ ~ 1 l ~l = "d ti' +> c:i = .,.; Ill z <11 ,.., Po.
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The Court is respectfully requested to determine
proper distribution i
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THE FIRST AND FINAL ACCOUNT OF JOHN KULIKOWSKI,
ADMINISTRATOR OF THE ESTATE OF MICHAEL L. KULIKOW3KI, DECEASED,
LATE OF CALIFORNIA BOROUGH, WASHINGTON COUNTY, PENNSYLVANIA.
* * * * * * * * * * * * * * * * * * * * * * * * *' * * * * * * * *
To Amount of Inventory and Appraisement filed $ 8,806.99
Interest on Savings Account 406.78
9,2;13.77
' Credits claimed by Accountant ___ 1--1_8 4 9 • 0 0
Balance for Diatributi~n $ 7' 36·1:. 77
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Oct. 14, 197 0
Oct. 15t 1970
July 7, 197
July 7, 197~
Mar. s, 197~
Ma.r. 197
Mar. 197
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Br6wnsville Hospital
D 'A 1 tori o F u ne ra 1 Home
Register of Wills
Guy Rogers
John Wege, Agent
Washington County R~ports
Brownsville Telegtaph
Register of Wills
Patrono, Ce i sler, Edwards &
Pettit
Register of Wills
i. •,
Emergency room
treatment
Funeral expensas
Letters of
A dm i n i s t ra t i on
Obtaining application
for Letters of
Administration
Administrator t s
bond premium
Advertising letters
Advertising letters
Filing inventory and
Appraisement
Attorneys fees
Filing Account
' .
$ 5.00
1,270.00
17.00
15.00
50.00
1·4. 00
9.00
3.00
450.00
113.00
$ 1,849.00
I Washington County Reports~
Washington, Pennsylvania
(PUBLISHED BY WASHINGTON COUNTY BAR ASSOCIATION)
PROOF OF PUBLICATION
In compliance with the Newspaper Advertising Act of May 16, 1929,
P. L. 1784 Sec. 3, paragraphs ( 3) and ( 25).
CouNTY oF WASHINGToN} SS.
STATE OF PENNSYLVANIA
Personally appeared before me, a Notary Public in and for said County
and Commonwealth, CHARLES C. KELLER, who, being duly sworn, deposes
and says: that he is the Editor of the WASHINGTON COUNTY REPORTS,
the officia!l legal periodical for said Washington County, published weekly
hav,ing its place of business at Washington, Washington County, Pennsylvania,
and is acting as its agent in this behalf; that the said WASHINGTON
COUNTY REPORTS was established on March 31, 1920, and was designated
as the official legal publication for Washington County, Pennsylvania, by order
of the several courts of said County, dated November 11, 1920; that the printed
notice or advertisement attached hereto is a copy of a notice or advertisement,
exactly as printed or published, which appeared in the said legal periodical in
its regular issues on the following dates:
July 22, 29, 1971
........... ~.!:!.9.~.l?..t ... ~.l ..•... L~.Z.L ............................................ .
Estate Notices
The Register of Wins has granted
letters, testamentary or of administration,
in the following estates. Notice is hereby
given to all persons indebted thereto to
make payment without delay and to those
having claims or demands to present
them for settlement to the Executors or
Administrators or their Attorneys.
• • • • • • • • • • • • • • • • •
KULIKOWSKI, MICHAEL L., Dec'd.
~ate of California Borough, Wash-
mgton County, Penna. Administrator: John Kulikowski R. D. #1, Coal Center, Pennsylvania 15423
Attorneys: Patrono, Ceisler, Edwards
and· Pettit, P. 0. Box 636, California Pennsylvania 15419 '
that the affiant or the corporation in behalf of whioh he is acting is not
interested in the subject matter of said notice or advertising and that all of the
:)':o;:!~ oi thi, "'""'"it " to !h. Qt; ""d "'"""" @' p~ !z:__./ -----------~---····-····-~
Sworn to and subscribed before this -~
........ 5 .. t.b. ..... day of ................... A.Y.Q.I.I.S .. t ............. , 197...1..a ........ .
~-s.l~~
JOSEPHINE T. SCIAMANNA
Notary Public, \'lashingtan, Washington Co.
My Commission Expires July l, 1974
' .
Proof of Publication of Notice in Brownsville Telegraph
State of Pennsylvania,
County of Fayette
Under Act No. 587, Approved May .16, 1929.
Charles w. McKinley, Gen. Mgr.
·---------------------------------·------·-----------·----·-------------------------of the BROWNSVILLE PUBLISHING CORPORA TI 0 N,
of the County and State aforesaid, being duly sworn, deposes and says that the BROWNSVILLE TELE-
GRAPH, a newspaper of general circulation published at 16-18 Bridge Street, Brownsville, County and
State aforesaid, was established January 27, 1915 since which date the BROWNSVILLE TELEGRAPH
has been regularly issued in said County, and that the printed notice or publication attached hereto is ex-
actly the same as was printed and published in the regular editions and issues oi the said BROWNS-
VILLE TELEGRAPH on the following dates, viz:
July 16, 23, 30 . D ------------------·-----· --·----· --------· ----·----------------------.. ,.: .... ------.---------. -----... ------------.--·· -------------------------.-.... -----------------_. A. . 19 .... _____ . __
fllATRONO, C-...._~,__~r IED'WA'RDS &
jP.O. Box 636
!California, Pa. 15419
\-
Patrono Geisler Edwards, Attorneys at law .......................... , ........................ 1 ......................................... ..
. P. .•. O .. B.ox ... 6)6 ................................. ______________________ , _______ _
... C.a.J.i.f9.~_P.i.~_. ___ r.~rm~.YJ_y:_~~-~---~24.~.9 ......
TO BROWNSVILLE PUBLISHING
CORPORATION, DR.
For publishing the notice or publication at-
tached hereto on the above stated elates $ ......... 9. .•. 0JL.
Probating same .................................................... $ ....................... .
Total ................................................................ $ ......... 9..!_99 ___ _
Publisher's Receipt for Advertising Costs
THE BROWNSVILLE PUBLISHING CORPORATION, publisher of the BROWNSVILLE TELE-
GRAPH, a newspaper of general circulation, hereby acknowledges receipt of the aforesaid notice and
publication costs and certifies that the same have been duly paid.
BROWNSVILLE PUBLISHING CORPORATION, a Corporation
Publisher of Brownsville Telegraph, a Newspaper of
General Circulation ..................... ..
By-----------------...... ------------.... -----------------------.... ------
(Form where decedent died Intestate)
1Jtt t4r ®rp~ans' Olnurt nf llas~tngtitu Olnunty
ESTATE OF No. 715 Term, 19 71 , A. A.
In the audit of the First and Final
Accountof John Kulikowski
. .Ml.CHAE.L .... L .•.... Kll.L.I.KO.W.SKI .......................................... .
State ( 1) whether de-
cedent was married or
unmarried; (2) if mar-
ried, whether a husband
or wife survived and
his or her name; (3)
whether or not there
was any marriage settle-
ment; ( 4) whether or
not family relation was
maintained Until deced-
ent's death;. and (5)
whether the decedent
left children or issue of
deceased children.
1~ l)eceased
The petition of ......... J.o.hn ... K.ul.ika.w.ski ......................................................................................... .
(Name of Petitioner)
respectfully represents: ......... MJ.9..b..~-~-.! ..... ~ ..•..... K\l), __ :jJ~9..W..~.k.:L ...................................................... .
(a) The decedent died ... Q.9..t.9..P~.r. .... J .. ~ . ..i ..... J,.~ .. 7.0 ................................ , intestate and
(Date)
letters of administration on .... hi.s ......... estate were granted .... J..:u.l.Y-.... 12 .. , ..... ~9..7.1, ........ .
(Date)
as per record thereof appearing in Administration and Bond Book No ..................... .
at page ............................................................ .
l)ecedent was survived by heirs listed below.
Decedent was never married and he left no children or
issue of deceased children.
within , (b) At the time of death, the decedent's domicile was~t the Com-
monwealth of Pennsylvania, to-wit, at .. C.a..l.i.f.ar.n.i.a. .... B.Q.r . .Q.u.glL, ..... P..e.nns_y.l.va nia
(Town or Township, State and Nation)
and residence was a L .... R .•..... P. ..•... ..tl.. .. J-........ ~.9.9:J ..... G.~.-~t.-~ . .:r ..• .' .... ?..~-~n.~?..Y1.Y.9:.nJ.'?.: ........... ..
(Town or Township, State and Nation)
(c) The names of all persons having any interest as heirs or next of kin
with the names of their deceased parents, to show relationship if they take by
representation are as follows:
NAMES Relationship Interest
Of age, sui-
juris, or not,
(write yes or
no).
N arne of Guardian, Trustee or Committee, if
any, or beneficiary, manr...er and place of
record of appointment and is bound suffi-
cient to cover and protect share.
John Kulikowski
Joseph Kulikowski
Brother
Brother
1/5
1/5
Ye.s
Yes~
(now deceased). John
Kulikowski was appointed
Executor of his Estate.
Paul Kulikowski
wanda Klll il{OVI sk .i.
Anthony Kulikowski
Brother
Sister
Brother
1/5
1/5
1/5
Yes
Yes
Yes
State exceptions, if any,
giving names and dates
of death and the names
of their executors or
administrators, or the
names of their issue as
the same may be mater-
ial.
All of said parties m interest are living, except Joseph Kulikowski
Describe type of notice. (d) All parties having any interest have hadw.r..i:t.ts-J.-ilotice of the filing
of the account by mailing a copy of the Notice lHlreto :J.tb.ched
on Apr1l 26, 1972.
j
~
....
(e) Balance for distribution per Account
(f) Additional debits, not shown by Account
(Itemize)
None
(g) Additional credits, not shown by Account
(Itemize)
Register of Wills, one short certificate.
$1.00
Penna. ·nept. of Revenue, 1~71 Income
tax. $9.35
$ .. 7. ..... 3.B..~ .. , .. Z.'l
$ ..... .n~u:ua .......... .
$ 10 3~ ••••••••••••••••••no\•••••!-/.
$ .. 7 .. J •• ~.P..~ ..... ~.?.
Insert word "not" where I (h) Claim for exemption has been made, and has ... TI.Qt. ........... been paid.
necessary.
(i) The estate is .................. subject to the payment of inheritance tax to the
State of Pennsylvania.
If taxable state w~eth-1 (j) The estate is ... UQ.t .............. subj ect to the payment of the county 4 mills
er tax has been pa~d.
.....
·tax.
(k) The estate is ... P&:t. .............. subject to the payment of Federal inheritance
tax.
(I) All creditors (and other persons who have complied with Rule II,
Sec. 9), of whose claims the accountant ...... h~ . .s ......... : .... notice or knowledge, have
........................ received actual notice of this audit; the amounts of their claims and
if too many .for the I whether or not they are admitted to be correct are as follows: space, annex a hst there-· ·
of; if no such claims, '·l 0 ne insert the word "none." ..
If any creditor or other
claimant has not re-
ceived actual notice, that
fact must be stated.
Indicate such claims as
may be secured or en-
titled to a preference,
and give detailed infor-
mation concerning such
security or preference.
Here insert a reference
to all questions requir-
ing adjudication, and a
•tatement of any mater-
ial facts not already
given. If none insert the
word "none."
If any share has been assigned or attached
that fact should also be
stated here.
State kind, form and
character of property
composing the balance
lor distribution, and if
any part thereof is not
cash, whether or not
there has been any elec-
tion to take such part
in kind.
~
(m) None
(n) The balance for distribution consists of property in kind, form and
character, as follows: Cash.
Are there any advance-
ments by decedent to be
considered on distribu-
tion and has any distri-
bution on account been
made by accountant to
any distributtee?
(p) None
( q) Give brief location of any real estate sold.
If prior accounts have
heen iiled, list number
and term.
None
(r)' None
Wherefore your petitioner asks that distribution of principal and income
be awarded to· the persons thereunto entitled and suggests that the balance of
principal and income should be awarded respectively as follows (shares being
stated in proportions but not in amounts) :-
After payment of the Audit costs and the Pennsylvania
Inheritance tax, 1/5 shares ~;~hould be awarded to each heir.
County of Washington, ss.
The above named petitioner being duly
sy1orn doth depose and say that the
facts set forth in the foregoing petition are true
to the best of hi.s ...... , ......... knowledge and belief.
to and subscribed before me this
/-.!? ziday of... ...... M9c.Y. ............................. , 19 ...... 7.2 ....•
~2~£~-;Wa;~~~~i~, Washington Co. Pa. ·····-··········-·······-~¥.J~~~~%~-~~~·:;\llfJ·rll~ ................................................... .
And your petitioner will, etc.,
(Signature of Petitioner)
.John Kulikowski
I , ..
!!) FORM IN CASES OF INTESTACY
No ...... 7.ll?. ...... , ................................ Term, 19 .. 7.1, A. A.
IN THE
ORPHANS' COURT
WASHINGTON COUNTY, P A.
Estate of .. MJ.CU.AE.I~ .... .L.A .... K.UL.!.KQ.W:.SXL .....
Deceased.
Sur account of .J.QllN .... KULTKQW.SK.L .................. .
PETITION SUR AUDIT
In Conformity with Court Rule III,
Sec. 5 (B)
COUNSEL FOR THE ACCOUNTANT WILL
SUBMIT HEREWITH
1. The letters of administration.
2. A copy of the inventory and appraisement.
3. Proof of advertisement of the grant of letters,
if not filed with accountant.
4. An appearance for those represented.
5. Inheritance tax receipts, if any.
6. Certificate of liens in case any of the funds for
distribution are derived from the sale of real estate.
7. Copy of Federal Estate tax return, if estate is
subject thereto.
8. Signed elections to take in kind, if any.
r· ~ . r·· t"'l ( ... '
i.-"t t . ., t. .. .:''
f 7? jJIU r P''{ i/ i I ,_ .... 1. t. ~ ~f:'
R U c I~ ·~ I I i ~ :1. :-1 L I' ;\ 'i 'd v C~ ~ l ·' ' l, ;· ~ I I i \...
2 E G I S T t. fc. (I F \'J l L L. S
VI ASH it·l !·;: 0 N I~ 0 .. PA.
&3-7!-11~ .J
~n t4t <trnurt nf <trnmmnu Jlrus nf lla.a4iugtnu <trnuuty.
Jruusyluuuiu. ®rp4aus · <trnurt iiuisinn
ESTATE OF No.-~6+3""~'7~-.~l-=•...l.-<71.~..,;.5L--------
Michael L, Kulikowski, In the matter of the _ ___,~Fo:....i~.Jrus;z..JtO!.-,Saa...~n~d""-'lFo:....iun..u;aa..~l'-
deceased, Account of __ .......::::J~o:.!;.;h~n~K:.!:::u~l:.:::i~k~o~w~s~k:.:::i'---
Administrator
ADJUDICATION AND DECREE
And now June 5 , 19:12._, this matter came on for hearing,
audit and distribution atthis session and testimony taken; and thereupon, upon due consideration
thereof of the bc:ilance for distribution in the hands of the Accountant is determined to be
$ 7, 3.5'11, h2 and the account is accordingly confirmed; and it is ordered,
adjudged and decreed that the said balance be' paid out by the Accountant in accordance with the
schedule 'of disribution hereto attached and made part he exceptions hereto
sec. reg. or an appeal be taken herefrom sec. leg.
SCHEDULE OF DISTRIBUTION
Balance per account----'---------------
Additional credit asked at audit ~
Balance ____________________ _
Deduct Clerk's Costs & Receipts, ____________ _
Attorney __ ___._P~s~--~t ..... r,:..o,O.a+no\loo....,,,__..c.u:e;~-.~j....;:s..,.l....,e;:..,~.r.:.--J,E:.~.duw~~-~;;a'""r,:..o,dw:S>--U& ........... P....r:e~t ...... t ..... i ..... t..___
Russell Marino, Agent, transfer inheritance
tax, $1039,65
Interest from 1-13-72 to 6-13-72 25.99
John Kulikowski, Executor of estate of Joseph
Kulikowski brother, now deceased, 1/5 balance,
cash,
J ohn Kulikowski, brother, .. 1/5 balance, cash,
p aul Kulikowski, brother, 1/5 balance, cash,
V.l andR Kulikowski, sister, 1/5 balance, cash,
A nthony Kulikowski, brother, 1/5 balance, cash,
10.35
26,00
No balance
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IN THE COURT OF COMMON P~EAS OF WASHINGTON COUNTY, PENNA
" ~ORPJ{ANS' COURT DIVISION
'T2 JU:-1
INRE:
! 5.
(
) .
Estate of I'. :·· (
•·1 Jtj.v :> C' G 1 r'• ... ..
tL ... ·.;lr:.r •,r ·.·:ll;-) ' ' f.' \... No. 715 of 1971.
MICHAEL L~ KULIKO'-i-J..~;..r;,; h' · .. '( {I• •' r · n '( ·wur~ .... ~; .. · l •• • ~-·., f'r· ~ •.
Deceased.
).
( .•
' .
. HEARING ON AUDIT ..
BEFORE: The Honorable P. VINCENT MARINO~ Judge of the
said CourL ·
\
·'
APPEARANCES: . PATRONO, CEISLER, EDWARDS' & PETTIT, Esqs.
of Washington, Pa., -represenHng the Accountant.
TIME: Tuesday, May 16, 1972, at 10:00 A. M., EDST
THE COURT: Number 715 ·of 197 1', the estate of Michael L.
Kulikowski; ·?eceased. The Administr.ator is John Kulikowski and t~e
'. , ·attorneys are Patrono, Ceis ler, Edwards &. P.ettit. Mr. Edwards,
who was handling this matter, is in trial in Common ~leas Court
today. And he has file~ what he believes to be all relevant papers n
this estate. He reports that t'here a're no questions for adjudication by
the Cou1t and no outstanding cla_ims that have come to their attenti) n.
Is there anyone· else in Court interested in this decedent's estate?
( NO. nE SPONSE )
,f
' ~
e
:!: z <( > .J > Ul z z Ill ll.
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IIi a: ld 1-a:
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II. 0 ~\
e
THE COU.hT: .The audit of these accounts will be ordered c1os ed
by tf!e Court.
( AUDIT CLOSED ) :
t hereby eertU, that the proeeedtn95 and ~idenee are "
eontatued fully and aec~ty ln the note! ta.k.en by me on the heartng · · . . .
·of the abO\fe cau5e, and that thts copy ts·a -corr~t transcript of the satt3:e ·
The tore90lng reccir~ of the proceedtogs upon the
heartng of the above ~w t ts hereby appro'ied and directed to be filed.
B7 tbe Court,·
. '
J •
. '
2
''
v ,
Form RCC-33
·' T
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT COUNTY OF
IMPORTANT: This return must be completed in detail and filed in duplicate, with will attached, with the·
Register of Wills of the County where decedent resided; Return is due within one year after
date of death, unless an extension is granted by the Secretary of Revenue. (Section 703 of
the Inheritance and Estate Tax Act of 1961.)
lU.c.ha .. e :.~.::.:K:::::.:.:k7~ -~~~-~-: ... :.~ .................................. }::FFID'HA: OF
(State full name of decedent)
Late of ...... W~ ... $ll, .. :!, .. p.gton_ . .. ......................................... County ADMINISTRATOR
J
...... J .. o.h.n ..... K:u..l.i.k.o.w..s.k.i ................................. . . .................................................. Baeetor
Administrator of the estate of the above-named decedent being duly sworn, depose S and sayS
Decedent died ................ O.c.t .. ob.e r .. ..
(Month)
................ 13..... .. . , 19 .. 7.0 .. ·{' toe !rt~ -ie-sV"irtg-r nTt-w:i ti":"' "t:""JJr·ll'l'-m\tt:tr 't's-tre "'"tlrnn~ }
(llay) (Year) intestate
Name and address of attorney or}
other authorized representative to
whom all correspondence should be
mailed.
Jolu:I. W •... E.d.W~T.ds, Jr., .. J?. ...•. 0 ..... ~ .. 92L 9 .. ~.~, G~:L:i.:f9l:'P..tct.
.J>ell:P.SYl.Y<:LJt:i<'L ...... l54lJL
That as such .. Admi.ni.s.:t.r.a.t.or. deponent is familiar with the affairs of said estate and the property con-
< t•:x.,cu tor-Administrator)
stituting the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly
with, or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent
or deputy, with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
..
That the contents of said safe deposit box or boxes are itemized under Schedules of this ---return, with the exception of the following, for the reasons hereinafter set forth:
That Sc.hedu/e A attached hereto and made part hereof sets forth fully and in detail all the
real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It
also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, giving
the amount still due at death, name of mortgagee, date, rate of interest, and book and page of record
thereof. It also sets forth in the columns provided therefore the assessed valuation of each of said
parcels, the estimated market value thereof as of date of death of decedent.
That Schedule 8 attached hereto and made part hereof sets forth fully and in detail all personal
property wheresover situated owned by the decedent at the time of death; all moneys left by the decedent
at the time of death, whether in decedent's immediate possession, standing to decedent's credit in banks
of deposit, savings banks, trust companies, or other institutions, whether individually,.:;·(ii.'cin·tr~st for ~ .... ' ....... -~ '• .. any other person or persons giving also separately the accrued interest thereon, if any,' domr•to the last
interest day prior to decedent's death in the case of savings banks, and to the date of de~edent''s ·death
' ~ . " . -in all other cases; all bonds, postal savings, treasury certificates or notes and other ~vidence of in--~ ....... debtedness of the United States--to-· the decedent; all obligations, whether by statute· or:agreement they
are designated as tax free, of the United .States, or any state, or political subdiviliior(•thereof, or of
any foreign country, which are owned at the time of death; all wearing apparel, jewelry; siiverware,, pic-...... ~ ~.., .
ture~, books, works of art, household furniture, horses, carriages, automobiles, boats, and'any and all
other personal chattels of whatsoever kind or nature, left bydecedent, together with the fairly estimated
market value thereof; all bonds and mortga~es held by decedent and of all claims due and owing decedent
at the time of death, and all promissory notes or other instruments in writing for the payment of money
of which decedent died possessed, of whatsoever nature, with interest thereon, if any, giving the face
value and estimated fair market value thereof, and if such estimated fair market value be less than the
face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys payable
to the estate from life insurance polici'es carried by decedent; all annuity and endowment contracts the
proceeds of which were payable upon the death of the decedent; and all the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of dece-
dent's death and other investment securities owned by the decedent at the time of death, with the market
value thereof at such time.
I ' ''
' "
In the case of securities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also seC forth in itemized form, together with the fair ~arket value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers ofproperty, real or personal, within two year~ of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relati~nship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take_ effect in P<;!S_sess!on ~r enjoyment at or_ af~er _death, there is also attached to the schedule a COJlY
of the deed, trust agreement or other instrument creating the trust. Ther1~ is also set forth in said
schedule a list of all property, real and personal, with its value, which pa8ses at decedent's death by
virtue of the exercise by decedent, ejther indiyidually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, andthe relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
of the decedent and others, plus the date and place of record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fUlly and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including fUneral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and fudiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and tmpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B"_, "C", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ............ 7.-d.:..
'Y-~~L~L~IS~L~:Il/K:~~~ lD -~~
California, Washington ~o., Pa.
My commission Exp1res
January 29, 1975
··tl
....•...... P. ......... #..l ......... C..9.?J..l ...... C..e.n.t.e .. r..~ ...... P. .. e.n.n.s..Y.l"v.a n ia
(Street Number)
G.9~ . .l. ..... C.e .. n.t .. e..r. ........ P..e.n.n.s.y.l.:v.~ .. n.if! .......... l .. 5 .. 4.2 .. 3
(City or Town and State)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
RCC-341(1-64)
COMMONWEALTH OF PENNSYLVANIA
,. DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Where property held as joint tenant or tenancy by entireties, report on Schedule "E". Property held by
the decedent as tenant in common with another or others, should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
The real property located In the Commonwealth of Pe!,nsylvanla should be (1) (2) (3)
described by lot and block number, street and street number, together with DEPARTMENT a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; if a ~arm state number of a-FOR YEAR OF ESTIMATED CAUTION cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space) to be listed· on Schedule "F" and must not be dedvctsd from this schedule.
!fo.n-e
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
/
RCC-35
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
' I
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. u. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e, g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed
estate of or income from any property held ln trust under the will or agreement of another, even though
located outside of the State, at the time of' death, should be listed in this schedule.
Item
No.
ITEM
List and describe i\llly
UNIT
VALUE
ESTIMATED
MARKEl' VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
----~-------------------------------------------------~-----+------------~--------~-------
S:i. vi ngs Account # 1879, We stern Penns yl va nia
National BAnk, California Office, California,
Pennsylvania
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
X X /$ 8,806.99 ~ 0 ro ~ ·9'1
0;1( Q1. '/
._COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "C"
TR..\.NSF'ETI.S
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consi.deration therefor? (Answer yes or no) -~..,_~J_,.o'-----
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) ('[ 0
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of' transfer ------
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no) ''L.>
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to hts power of disposition? (Answer yes or no)_-,,"-:rr,..> __ _
(b) What was the transferee's age at time of decedent's death?
(5) Dtd decedent in his lifetime make any transfer without receiving a val_u_a_b_l_e-an-d-adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) -~N~o~----
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no)_~N~o~---
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others _________________ ___
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) ~~~r.~o ___ __
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) __ ~~"u•L------
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)'----~"1~,-~----
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM DESCRIPTION
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the iast page of this return.
MARKET VALUE
(Estimated) DEPT. VALUATION
(Dept. Only)
RCC-38
CCMMONWEI\LTH OF PENNSYLVANIA
THI\NSJ:-~R INHERITANCE TAX
RESIDENT DECEDENT
•'
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRl'CTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
with another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal ,property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name l
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Rea! Estate. !
None
Unit
Value
percentage
Share
Estate
Valuation
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of
Entire
Property
Value of
Decedent's
Interest
h
j .. ,_ "
,iRcc..:37. h2-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
BENEFICIARIES AND ADDRESSES
State full names and addresses of all who
ave an interest, vested, contingent or other
wise, in estate)
John Kulikowski
Joseph Kulikowski
-~ PC:tul Kulikowski
Wanda Kulikowski
Address of all of the &bove
R D #1 Coal Center Penn
~ .
.
' ~
'
•
-.
' ;
I . ' . ' .
SCHEDULE "D"
BENEFICIARIES
RELATIONSHIP SURVIVED (If step-children or
illegitima,te children DECEDENT
are involved, set STATE YES
·forth this fact.) OR NO
Brother Yes
Brother Yes
Brother Yes
Sister Yes
heirs is
lsvlvania 15 23
DATE INTEREST OF
OF BENEFICIARY
~ IN ESTATE BIRTH
one-fourth
one-fourth
one-fourth
one-fourth
Deponent fUrther says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
Will
Administration t No. Year ........... .
IS THE
~lA TIER OF THE APPRAISEMENT
OF THE
ESTATE OF
.. Mi.c.h~e.l. L .... .Kulikowsk;l. ..
Deceased
Late of .. C~lifo.r.n.::l!=!-.. B.o.rquglL
County of W~sh.ington ..
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
60
PATRONO,
RY~
S111M .:W H3!Sm3H ONI~VW 113SSflM
• Zl Hd .. 8 l:IVH lL6l
cO~E"J, I ;!WARDs AND PETTIT
(Executor-Administrator
must complete "As
Reported" column #1.)
0 ....., '"d :::0 .... .... Cl) Cl) 0 II:> .... e:... "' ::1 "' "' "' 0
CD' ::1 1-C ....., e:... ....
II:> ~ 0 ~ 1-0'0 II:> .... Cl) C"' 0 .... CD' '0 ~
t%:1 Cl) .... ..... "' '< -II:> z ..... Cl) :z ;o :o i :::; =&7 :m
=&7 :00 ..
:00 :00 .;. :a
:00 ~ :o ,.
'9'l :(0
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:(0
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en c:: ~ a: > ::z:,
~ en en ><
0 0 ?"' ?"'
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:oo .. > ~ :z 'oo :z"' .. :o =o =o ::z:, Co '::3 :m :::; Cl)-
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RCC-81 (6-71)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
('\
IN YOlJR REPLY PLEASE J REFER TO
J
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
JOHN KULIKOWSKI
(Executor or Administrator)
In Re: Estate of __ MI_C_H_AEL __ L_.~KULI __ K_aw __ T_SK __ \.I~----------
__ W~A~S~H.:!::JIN~G~T~ON!oJ!..._ __ County -File No. --¥63.c.-::..J7~1-=-7.Ll~o...5L------
Dear Mr. Kulikowski:
You are hereby notified that the __ --=:o::.::r.=i:.cg.::=.in==:al=------------
appraisement in the estate of MICHAEL L. KULIK01iJSKI
has been filed in the office of the Register of Wills of WASHINGTON
County on MARCH 10, , 19_1_2, Said appraisement reflects the following
valuations:
Real Estate _______ ---=-------
Persona I P roperty ___ --=.8z...., 8=-:0:..:6:....:.:.L9..£-9 ___ _
Transfers _____________ _
Jointly Owned ---------,------
Total _______ 8:::..:,~8~0~6.!:.<.9u9 ___ _
As to such tax that is paid within three months hom date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by an appraisement may appeal therefrom
as provided by law.
Date _....:MAR==C~H--J~0=--,~1~97.!..::2=-------Signed --~F'RAN=-=-=-'-'CE=S---"LE=-='0~-------
T. I CHIEF APPRAISER 11 rte _____________________ _
DATE OF DEATH: October 13, 1970
Note: This is not a bill.
RCC?39 (5-68i
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
Estate of KULIKOWSKI, MICHAEL L. DATE OF DEATH 10-13-70 FILE NO. 63-71-715
(Last Name) (First Name) (Initial)
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of WASHil\'GTON
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing ret urn at
the values set forth opposite each i tern in the last column to the right in Schedules "A", "B", "C", and "E".
Dated: MARCH 10, 1972 ERA.NCES ~ aW .ad INHERITA~·-fAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for WASHINGTON County, Pennsylvania, do r espect-
r or fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greate
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents th e sum
allowed as a deduction.
Dated: REGISTER OF WILLS
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED
Real Property (Schedule A) $ $
Personal Property (Schedule B) 8.8oe .99 8.806. 99
Transfers (Schedule C)
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS 8,80~ .99 8,806. 99
Less Debts and Deductions nom none
(SCHEDULE F)
CLEAR VALUE OF ESTATE 8,80~ • 99 8,806 .. 99
Valuation of life estates or
annuities ................... $
I I EST ATE TAX ASSESSMENTS $
FOR USE OF REGISTER ONLY COMPUTATION OF TAX
Tax on$ 2% $
Tax on$ 6% $
Tax on$ 5% $
Tax on$ 1 $
Tax on$ 15% $
Exemptions (*)
Total Estate
TOTAL TAX $
Less tax previously paid $
I
BALANCE $
Less 5% of tax if paid within
3 months after death $
BALANCE OF INHERITANCE TAX DUE $
Add interest at rate of 6% from
to I $
AMOUNT OF ESTATE TAX ASSESSED $
Estate tax paid $ I BALANCE DUE $
Add interest at rate of 6% from
0 $
TOTAL TAX BALANCE $
PAID $
FOR USE OF REGISTER ONLY ADJUSTMENTS
VALUE AS REAPPRAIS ED
$
' .
I
0
As evidenced by Charitabl e
ued Exemption Certificates iss
by the Secretary of Revenu e.
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper rea son,
same should be noted below, with short explanation.
of
Will
Administration ~ No.
IN THE
Year ........... .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
lllCHAEL L. KULIKOWSKI
Deceased
Late of . . CALIFORNIA ...
County of WASHINGTON
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
"
"
s
l<.,unn _qcc-2
' ~
DEPARTM~~T OF REVENUE
BUREAU'OF COUNTY COLLECTIONS
HARRISBURG, PENNA. 1712 7
. L~ ~' COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE .... ~9-~ .. }Q?. ...... ~.?..?.? .................... .
WASHINGTON COUNTY ........................................................................... ..
FILE NO. .. ... ?.?..:.7.~.::71.5. ............................... ..
Whereas, ........................................ J:~.JQH~1. ... ~.~ ..... ~.Y.~~~9.Y.d.~~~ .................................. late of ........... g~.~~g~~.~~ ............................................................... .
in the County of ............................. J~ASHIN.GTDN ...................................................................... Commonwealth of Pennsylvania, having died on
the ..................................................................... l3.t.h ............ day of ............. e.c..to.'b..e.r. ......................................... 19 .... '19.., seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Th f FRANCES LEO ere ore, I, ....................................................................................................................................... , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement Description of Anet Values Made for Inheritance Tax Purpoaes
•
REAL ESTATE $ 8 806 199 I
NONE I
PERSONAL
SEE "SCHEDULE B" OF APPRAISEMENT
"
'
ro
'
I
I
I
I
I
_____J
I
0
I
I
I
I
I
I
I
I
form~;·!fhb~: :.:th:sw<>l"ll ~CCO~~~~~· ~.~ .~~ .. ~~c-e;~~7:;:;=·~~?~
~Q;!!J~;g~~=~
I
n.. . . ....... liASHJ:NGTON County
,.,
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
MICHAEL L. KULIKOWSKI ················· ············•········••••·······•···
Deceased.
Late of
CALIFORNIA
Date of Death, ..... .OC.TOa.E.R .... l3., .... 19.70 ................... .
38-Appraiseme11t Docket Vol.,
Page, ..... 188.~9. ......................... No .......... 63.~.7l,.,7l5 ...... .
'\.'
Filed in Register's Office, .. ~:r..~J:1. .. ~9..1. ....... 19 .... 7.? l.
Amount of tax due, $ ................................................................... .
·DEPARTMENT OF REVENUE
Received,
Examined and. Approved,
Wrote abo.ut Appra-isement,
Appeal f1'om Appraisement,
.~.
Entered and charged,
k·
~· -· ·'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
RC C-81 (6-73) 17127 IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
-JOHN . . . ,:~ . --~: KULIKOWS
(Executor or Administrator)
NICHAEL L. KULIKOviSKI
In Re: Estate of ---------------------
__ W_A_S_HI_N_1G_TO_N ___ County _ File No. __ 6_3_-7l_-_7l_5 ___ _
Dear MR. KULIKOWS:
, SUPPW.fENTAL
. You ?re hereby notified that the r.ICHAEL L. KULIKOWSKI appratsement tn the estate of ___________ ---;"7-;:";";";~;;;-;;;-;::;u------
has been filed in the office of the Reg.!ster of Wi lis of \'IASHINGTON
County on JULY 26, , 19_Th, Said appraisement reflects the following
valuations:
Real Estate ____________ _
Personal PropertY---~------
T ransfers--------..,.-=~,...-----
Jointl-y Owned ____ l_O....::,_ooo_ • .:....OO ____ _
Total ______ _,l...,0~,--"'0=00,._,,~00=------
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) ·months
(fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
!~terest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act al 1961,72 P. S. 2485-1001, P. ~ · . -(
Date JULY 26, 1974 Signed~~~
Title~/
. .
,.
DATE OF DEATH: OCTOBER 13 1 1970
Note: This is not a bill.
j
I
' . . --.
.:..-j ' ; d,.! .
I
RCC·39 (5-68)
COMMONWEALTH OF PENNSYLVANIA ..
I TRANSFER INHERITANCE TAX SUMMARY
I RESIDENT DECEDENT
Estate of KULIKOWSKI, MICHAEL 1. DATE OF DEATH 10-13-70 FILE NO. 63-71-715
(Last Name) (First Name) (lni tial)
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of WASHINGTON
' Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at ·
the values set forth opposite each item in the last column to the right in Schedules "A", ·"8", "C", and "E". ·
Dated: g~ 76, 117f
#' ~ .~-
I INH~TAX~ r -r SUPPLEJ:iJENTAL
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for WASHINGTON County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
.
Dated:
REGISTER OF WILLS
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
Real Property (Schedule A) $ $ $
Personal Property (Schedule B)
Transfers (Schedule C)
Joint-Held Property (Schedule E) .Lu,ooo 00
TOTAL GROSS ASSETS 10.000 00
Less Debts and Deductions none
(SCHEDULE F)
CLEAR VALUE OF ESTATE 10,000. 00
.
Valuation of life estates or
annuities ................... $
I I I ESTATE TAX ASSESSMENTS $
FOR USE OF REGISTER ONLY COMPUTATION OF TAX
I Tax on$ 2% $
Tax on$ 6% $
I
Tax on$ 5% $
Tax on$ ~ $
I Tax on$ 10.000 00 $ 1~500. 00
Exemptions
0
(*) As evidenced by Charitable
Total Estate Exemption Certificates issued
TOTAL TAX $ by the Secretary of Revenue.
Less tax previously paid $
I
BALANCE $
Less 5% of tax if paid within
3 months after death $ -
-,... ..
BALANCE OF INHERITANCE TAX DUE $
I
Add interest at rate of 6% from
to $
AMOUNT OF ESTATE TAX ASSESSED $ I
Estate tax paid $ I BALANCE DUE $ -.... ~ . .._-....
Add interest at rate of 6% from
•o $
I TOTAL TAX BALANCE $
PAID $
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason,
same should be noted below, with short explanation.
' ~~
Will
Administration t No. ....... . ... Year ........... .
IN THE
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
Deceased
Late of ........ .
County of
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
.i •
Fonn RCC-2 -. ........ ~.~.! ..... ?.?.'. ....... !?..7.4. ........................ . COMMONWEALTH OF PENNSYLVANIA DATE . ................ --'DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX WASHINGTON
BUREAU OF COUNTY COLLECTIONS COUNTY ............................................. ,_ ...................................................
HARRISBURG. PENNA. 17127 APPRAISEMENT FILE NO. . ........... ?.~.:?..~.:?.~.?. ...................... -.......................
Whereas, ............................................ N.J.Q.RAEL. ... L.f ..... KUL;Us:QW.$K.:;!; ............................... late of ..................... C!.\Llf..ORNJ..A ......................................................
in the County of ................................. : ..... .J'f.ASHING.TON: ............................................................ Commonwealth of Pennsylvania, having died on
the ...................................................................... 13 .. OCTOBER ........... day of ............................................................................... 70 19 ............ , seized and possessed of an estate
subject to Inheritan~ Tax der the ~Comnionwealtb of Pennsylvania; . .
Therefore, I, ..................................... :~ ..... ~ .......................... ~ ........... , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for llfe or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement Description of A &Set Values Made for Inheritance
SUPPlElVIENTAL Tax Purpoaes
JOINTLY-OWNED $
SEE SCHEDULE II]; II of appraisement 10,000. 00
~·
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fonn~;viw':~ ~: ~:~i:~ ~C<!()J?(:~~: ~:; o~ ... ~~~~~~:~~~~:~~7~:
. . ........ ~f:t .............• < ....... ;-:(.~s;;;;;;································· .. ~~
· ............ ~~··i·P~~oiii~~~ ............................................ , Penna.
~
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..
WASHINGTON County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
.,
MICHAEL L •. KULIKOWSKI
Deceased.
Late of
CALIFORNIA
Date of Death, ........ O.G..'r.O.~~ ... JJ.., .. 1.97.9 ........ : ........ ..
Appat'semellt Docket Vol., .. ..3..$.:::: ...................................... ..
Page, ... J.$.~~9 ........................ No ...... ~?..:-::Tl.::::7~.5. .......... .
Filed in Register's Office, .. :~'f!!::.~ .... ~.~.~ .......... 19.?.~ .. ..
Amount of tax due, $ ................................................................... ..
DEPARTMENT OF REVENUE
Received,
Examined and Approved,
Wrote abo.ut Appra.isement,
Appeal j1'om Appraisement,
Entered and charged,
: I
_,
"
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·•
•
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Form RCC-33
~ 63:_ 7/-7/s-
coMAA~~f~~Ic,fWtftif?t.vANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT COUNTY OF .WASH.I.N.GT.ON. ............................................... .
IMPORTANT: This return must be completed in detail and filed in duplicate, with will attached, with the
Register of Wills of the County where decedent resided; Return is due within one year after
date of death, unless an extension is granted by the Secretary of Revenue. (Section 703 of
the Inheritance and Estate Tax Act of 1961.)
........................... l::::a:l~~: .~:.u7:.k:~:::.~~·········· ························}==OF (State full name of decedent)
ADMINlSTRATOR Late of ...... Washington.. .. . . . .......... .. . . .......................... County
::.:· .;p:::::::::~": :·-~--=~~ }"'
...... J.Q.HN ......... KP..~.J..KQ.W.S..K .. I ......... .
Administrator of the estate of the above-named decedent being duly sworn, deposeS and says
Decedent died ....... O.G.t.9.P~:J::"
(Month)
JJt. ... .. . , 19.70 ....... .,5 KXI:XN»~j{X~K~XQ;CX~~:&K:~~~*~ }
(!lay) (Yt11r) L intestate
Name and address of attorney or}
other authorized representative to
whom all correspondence should be
mailed.
.JqbnW. E.ciwa:J::"ds, .Jx .•. , ... P.0 •.... ~.9f.:1: .. 6J§, C<?::LJ:f:Q:J::"P.Ja~.
Pennsylvania, 15419
That as such ~dm.ini.s.tr..ator ..... deponent is familiar with the affairs of said estate and the property con-
< Executor-Administrator)
stituting the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly
with, or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent
or deputy, with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
N
0
n
...e.
That the contents of said safe deposit box or boxes are itemized under Schedules ____ __
return, with the exception of the following, for the reasons hereinafter set forth:
of this
That Schedule A attached hereto and made part hereof set~ forth fully and in detail all the
real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It
also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, giving
the amount still due at death, name of mortgagee, date, rate of interest, and book and page or record
thereof. It also sets forth in the columns provided therefore the assessed valuation of each of said
parcels, the estimated market value thereof as of date of death of decedent.
That Schedule 8 attached hereto and made part hereof sets forth fully and in detail all personal
property wheresover situated owned by the decedent at the time of death; all moneys left _by the decedent
.,...,!-~-~ at the time of death, whether in decedent's immediate possession, standing to deced.Ei'rit1 s __ credit in banks
of deposit, savings banks, trust companies, or other institutions, whether indi~1\~).'y,;;..~i~ ,trust for
any other person or persons giving also separately the accrued interest thereon,$'i:f~.ai;,, do.wn tJ\the last
interest day prior to decedent's death in the case of savings banks, and to thl'~{e""of~d~c~~e'ntas death
in all other cases; all bonds, postal savings, treasury certificates or notes~ndiother~videnc} of in-
debtedness of the United States to the decedent; all obligations, whether by ~t-a't~t€ or -agreement they ~ ~"" ~-,., •. , A are designated as tax free, of the United States, or any state, or political subd~l:V1\sion -ther~of, or of ' WE(~~ ~ any foreign country, which are owned at the time of death; all wearing apparel, je~e~r~,~l~~rware, pic-
tures, books, works of art, household furniture, horses, carriages, automobiles, boa1~;:and any and all
other personal chattels of whatsoever kind or nature, left bydecedent, together with the fairly estimated
market value thereof'; all bonds and mortga~tes held by decedent and of all claims due and owing decedent
at the time of death, and all promissory notes or other instruments in writing for the payment of money
of which decedent died possessed, of whatsoever nature, with interest thereon, if any, giving the face
value and estimated fair market value thereof, and if such estimated fair market value be less than the
face value, it sets forth briefly the reasons for such depreciation as to each i tern; all moneys payable
to the estate from life insurance polici-es carried by decedent; all annuity and endowment contracts the
proceeds of which were payable upon the death of the decedent; and all the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of dece-
dent's death and other investment securities owned by the decedent at the time of death, with the market
"' value thereof at such time.
""
In the case of securities of close or family corporations, the values reported. are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the-agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers ofproperty, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers, In the case of transfers intended to
take efrect in possession or enjoyment at or after death, there is also attached to the schedule a co~y
of the deed, trust agreement or other instrument creating the trust. TherH is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's de.ath by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, andthe relationship of such issue to the beneficiary.
That Schedule E attached her·eto and made a part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
of the decedent and others, plus the date and place of record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and fudiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and tmpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B",
have been carried forward and properly registered in the Summary.
"C", "E", and "F" as directed therein,
'13~ Subscribed and sworn to before me this ............................... .
-~':':'?.tf7C.t. ... ~-da~ o:}~~ l~~~-
PHYlliS L. KON'EK, Notary Pllblle
California, Washington Co., Pa. My Commission Expires
January 291 1975
OJ_ ..... ~ ........ J ..... ~ ....................... : ................................. : .................... ~ ......... ~ ... · if'':(.''(if:~cutor-AdminiStrator)
........................................................................................................................................
(Street Number)
(City or Town and State)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word. "None", and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to· Schedule "B" are attached. Also make
certain that column #1 '" the "Summary" has-been properly completed as above-directed,
RCC-3,4 (1;-64) ,
EOMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEpENT
SCHEDULE "A"
REAL PROPERTY
~ ~
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Where property held as joint tenant or tenancy by entireties, report on Schedule "E". Property held by
the decedent as tenant in common with another or others, should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
The real property located In the Commonwealth of Pennsylvania should be ( 1) (2) (3)
described by lot and block number, street and street number, together wl th DEPARTMENT a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm state number of a-FOR YEAR OF ESTIMATED CAUTION cres; olso statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this spoce) to be listed on Schedule "F" and must not be deducted from this schedule .
. ,
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
' H.CC-oi5
r COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly wi~h apother or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. u. S. Savipgs··BQnds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate,
Tangible personal property should be listed first (e. g. jewelry, wearing appar.el, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
. . ,
Intangible personal property, such as bonds, treasury certificates, cash on. :ha11d.. and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, ·insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in.any~distributed
estate of or income from any property held in trust under the will or agreement of anoth~r,' even though
located outside of the State, at the time of death, should be listed in this schedule.
----~--------------------------------------~----~--------~--------------
Item
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKEl' VALUE
DEPARTMENT VALUATION
(Do not write in
this space) ----4---------------------------------------+-----~--------~------~~----
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
X X
BCC,-36,
~
COMMONWEALTH O'J<' PENNSYLVANIA
TRANSFER INHERITANCE TAX
RES IDE~T DECEDENT
SCHEDULE "C"
TRANSFEilS
(1) Dirt decedent, within two years of neath, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) _____ __
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no)-----
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer ----------
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no) __________ _
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no)--------
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer without receiving a val_u_a_b_l_e_a-nd--adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) ------------
(b) The right to designate the persons Who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) __________ _
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others ________________________________________________________________________ ~-----------
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) _____ __
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reservert power to alter, amend, or revoke, or which could revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) ______ _
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) _________ __
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM DESCRIPTION
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this 'return.
MARKET VALUE
(Estimated) DEPT. VALUATION
(Dept. Only)
RC C-,38
·C~MM~NWEA{ TH. OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
with another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name Unit percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
REALTY:
An undivided one-fifth interest in all
those two certain adjoining tracts of
land situate in the Borough of Cali-
fo;rnia (formerly East Pike Run Townshitp},
Washington~county, Pennsylvania, as
described in the deed from Martha
Kulikowski, unmarried, to Joseph
Kulikowski, John Kulikowski, Paul
Kulikowski, Michael Kulikowski, and
Wanda Kulikowski, as joint tenants with
the right of survivorship, dated February
26, 1962 and recorded in Deed Book 1123~
at page 410. A copy of the said deed
is attached hereto. Upon said propert~
is erected a dwelling house. Value of
all interests, $50,000.00
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last ·page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of
Entire
Property
~/. 1-tl 1/ cJ, tJOd. -
Value of
Decedent's
Interest
.·
"' 1"1 -.J --::: ::u --...... --· :r~ rrr :::0 (I} 0 c: c_ ~-:r: en r;::::
: I
, __ (/) (/) ,-; z -1 nt ~·, '· ....._, ...... ) C:J -~ ~·':· ,_
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~..J r-:2: )..') ,.._
0 l:>-(/) 0
~
h
" .
RCC-31 {i2-,63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
BENEFICIARIES AND ADDRESSES
State full names and addresses of all who
ave an interest, vested, contingent or other-
wise, in estate)
SCHEDULE "D"
BENEFICIARIES
RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF
illegitimate children DECEDENT OF BENEFICIARY are involved, set STATE YES IN ESTATE
forth this fact.) OR NO BIRTH
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
Will
Administration ( No.
P.ol THE
Year ........... .
.\IA TTER OF THE APPRAISEMENT
OF THE
ESTATE OF
MICHAEL L. K'(J:[.J:l{()t:VS!(I_,
Deceased
Late of .. .California Borough .
County of . Washington
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
(Executor-Administrator
must complete "As
Reported" column #1.)
C1 a "' "' ~ >< r:» C"' Cb
!:%:! "' ..... r:» or
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RCC-43 (5-65)
NOTE: TO BE SUBMITTED IN TRIPLICATE
Pennsylvania Department of Revenue
Bureau of County Collections
26 S. 4th Street
Harrisburg, Pennsylvania
Dear Sir:
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961,
· we herewith submit the following report:
NAME OF REPORTING
FINANCIAL INSTITUTION -~H~.u.e_sUitte_m~oa.·L...&..lPeo.!£m~q!!-il: .... v~W.-· ...,a,oi,..,U;Nl\...:lt~i..uonU!A~.l~F)ru'""'n..wk..__ __ _
ADDRESS 1bird & Liberty, California, Pa.. 15419
ACCOUNT NO. OF JOINT,
.,
TRUST OR INVESTMENT DEPOSIT Mr. Michael Kulikowski Sav. Aceout #1879
NAMES ON ACCOUNT
OR INVESTMENT Mr. Michael Kulikowski
DECEASED JOINT DEPOSITOR,
TRUSTEEORINVESTOR---~~~~~·~Mi~ .. ~e~~~ae~l~Ku~l~ik~mw~$~1 _____ __
ADDRESS __________________ ~n~.D~.H~1~~~·~~C~e~m~·e~r~·~P~a~·~l~5~h2~,~-----
DATEOFDEATH _____________ O~c~w~· \~~~r-L13~1~197u· ·~o ______________ ___
SURVIViNG DEPOSITOR,
BENEFICIARY OR INVESTOR --~Nt='A!.------------
ADDRESS __________________________________________ __
RELATIONSHIP TO DECEDENT _________________ ~
DATE DEPOSIT OR INVESTMENT D ? ~~1'\ •
WAS ESTABLISHED eeember , 17\N
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $ ___ ___,;J$8=·z;;,8::.:06,;:;,;· .:J1:9-'-9-~---~~~---
1 I
Form RC C -10
OFFICE OF THE
REGISTER OF WILLS
OF Washington COUNTY
AND AGENT OF THE COMMONWEALTH
STATEMENT OF DEBTS
AND DEDUCTIONS
11~ ..... 1l·
ESTATE oF Michael L. Kulikowski LATE oF California Borough
DATE OF FILING APPRAISEMENT March 8 1 ]972 DATS:OFDEATH October 13, )970
DATE NO. OF NAME OF PAYEE REMARKS AMOUNT VOUCHE"
9/14/70 ~rownsvill~ Hospital Emergency room treatment 5
9/15/70 DJ'Altorio Funeral Home Funeral expenses 1,270
7/7/71 Register of Wills Letters of Administration 17
Obtaining application for
Guv Ro_g_ers Letters of Ad-minil'ltrati.on Hi
John Wege, Agent Administrator's bond premiu ~ 50
washington County Reports Advertising letters 14
Brownsville Telegraph " " 9
Filing inventory and
3/8/72 Register of Wills Annra i sement ~
3.L'Z2
3/72
?.172
3/72
Pettit
Patrono Ceisler._ Edwards & Attorneys fees 450
Ree:ister of Wills Filing Account 16
IRee:i ster of Wills Short Certificate 1
Pa. Dept. of Revenue I 1971 Income Tax (9
(ija ... ~~'f ~~d ~-
'
...
COMMONWEALTH OF PENNSYLVANIA
68:
COUNTY OF Wa sb j ngton }
I, ----------------------~--~----HEREBY CERTIFY, THAT. TO THE BE•T OF
lilY KNOWLEDGE AND BELIEF, THE FOREGOING IS A JUST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSU OF
ADMINISTRATION SUBMITTED TO THE ESTATE OF Michael 1, KulikOWSki DECEASED, AS DEDUCTION$ F"OR
-~9JJ; ~~ ~ ~ (L. S.l
SWORN AND SUBSCRIBED l!IEFORE ME THIS _____ ,DAY 01' .1:._11' .A • . I. -r. ~ =-~~~~~~~~~----_-_,e _ _7_2_____ '\ ~O'Q 1v~ L ./.(J {1 t(~ 1 N
INHERITANCE TAX PURPOSES.
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