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HlllO lli REV 808ll
(fU f'Of\'fHI!l
bE~TIFIC"Tl' '2(0)
WARNING: IT IS IlLEOAl TO ALTER THiS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMOI.;Wf,A,i Th or I'J:NNHYI VANIA
Ol:PAAtMI::NT (J!! H(AIW VITAl rncDtloh
lOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. 3396201
1-9-97
-tl.iiI;T1,.vtl~"'UU~1I0;1"'----"".
Name of Decedent. W il ~,~ e ~'_~~'~~__'_'L_"~,.;,!,..... ..._..._~'-_ H il ~..~!L;/.r.-,-._~---.~.
Sex Me Ie _.._Social Security No.......!~-1~.-J9.~L_...._._._~_Date of Death_.~_12.: 31-96
Date of Birth ....... 3 -1 ~ -1 ~~___. Birthplace__....1L~J:.rj,!lJ;lJ.LI::~_X1L_______._..._....._____._.....
Place of Death Residence
fMihlvN.m&
Cumberlend
l1uunly
Hampden T~"""""penQflYJ}'!!olJ!
CII'{,!\OloUIII'l 01 'l'Oi/t"fl\lfI
White ......Occupation Automo'l1i ve JllflJJHl.flL._.Armed Forces? (Yes or No) .."_XU..w.___...
Deceden'!,s
Marital Status ~1 DEE i e ~___ Mailing Address
Race
302 ~J!.!!1JLPJL~.!:"J,JL!UL._. C a UlP--1iilL..__.PAlZO 11
NumblU; .')tt1\1l1 Clly Clf llJYjI\ ;' S181/1
Informant .___.:?u zen n e
NamA and Address of
Funeral Establishment
C. Hilton
__. Funeral Director ._...,,~J.eme~LL.J~.iQ..k!l_L_..__,.__~,......~____~.~
Nickel Funeral
(b)
---......,..,..._-~.~._-.;..,
H.9..I!1!3.LJ..f,l YSY.U 1 eL.. P A, 17 0 4l-~_.___...____.m...
: Intervel Between
: Onset and Death
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6 Mo.
Part I: Immediate Cause
(a)_~J'8ncre8tic cerl:?inoma
(c)_
(d).._____
Part II: Other Significant Conditions
Manner of Death:
Natural [!<J Homicide 0
Accident 0 Pending Investigation 0
Suicide 0 Couid not be Determined 0
Describe how In/ury oQcurred:
Name and Title of Certifier _._.
M.D.
------- (M.D., D.6:Coroner.-M~Ej
41.5 N. 21st St., Camp Hill, PA 17011.____. .._____.
Mery A. Simmo~ds
Address
This Is to cerilly that the Information here given is correctly copied from an original certificate of
death duly flied with me liS Local Registrar. The original certificate will be' forwarded to the Stllte
Vital Records Office for permanent filing.
1-2.[37
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~TT(jn'l AeQlllrlfof Vlt,1Rec\)!'cI ttlflc1No
.._~g~__~.a..~~l?:t:.~_~ t:..L~.~_\:'!_J3.;t.Q$'J1lf;i, 0 ~ Q.<_.elLj] 0 6 8
ShM'IMtlrllll l,.;11~,aOtooOh, l)Wf\ttllp
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fOA DAII5 Of D''''HAnlA 1~131/91 CHICK HIAI
INHERITANCE TAX RETU~N ~O~mn::DIT 15 ClAIMID I I
RESIDENT DECEDENT flU. NUM'"
(OMMONWEAlIfI ". "fNN"'VANIA (TO BE FILED IN DUPLlCA TE II d tJ 7~- () 0 121
r)[f'''RTMENT of REVENIJl If 7
HARRllfJiUl."rJl" 0601 WITH REGISTER OF WILLS) COlJNTVCQDI YEAR NUMO[R
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IjCj~I'(.73p- . 117.3/ r(, j IS 2~ '000' cUM 13B.RL-.fjNP
_ "{;Z~:;'!;,""~'~j~A'l~r):g ~'~;'Z~ I\~ ~i:fr.'~ "n'1~' r ^MO""j WNW I'" ""IRUClIO"\1
l,..t ,. Original Relufn [ ) 2 SupplomnnlClI R~turn j I 3. Remainder Reluni
(for dQle. of death prior 10 12.1J.B2l
I ) 5, Federal Eslate To)( Retuln Required
_Le
.._.___~__ .l!~~el Value ~ubje'llo_!~J~lne._~~.!nu, U~_l_~L~________..~_.__~.--._._.~._..
15, Spousal Tronsfen (for do'" of death after 6.30.941
See Instrucllons for Appllcoble Percentage on Reverso (151 .__~.____
Side. (Indude values from Sr,hedulo K or Schodule M,I
16, Amounl of l.ine 14 IOl<oble at 6% role
(Include values from Schedule K or Scheciule M,l
17, Amounl of line 14 toltoble 01 15% rala
(Indude valuo, from Schedule K or Schedule M,l
18. Prlnc1poltL'l1< clue (Add lax from linln 15, 16 and 17.1
19, Credih Spauiol Poverty Crodit Prior Paymon"
~rV-l~OO 0'+ V"'4)
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J .4(1, Future Intere,1 Comproml\6
(for dole' of death ollor 1,).12.B2)
Decedent Died hstOlo 1 7 De{odflnt Molnlalnod CI living T rut'
(Alloch copy 01 Will) (Al1och copy of Trull)
ALL CORRISPONOINCEANDCONflOiNTIAL -TAlC INfORMATION SHOULD 81 OiilCrlD TOI .-.
NAMf . ~..-~-...._~~_.__...._~~,~ (()MI'I(ii'.M^-lli~~r;'ir;DRru~'----~~--'-~~----"--' -,
. HLCTP_Ki__$V Z,.ttll ,A/f, C,
HHP~ION~ NlIMBtR
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T 0101 Number of 5(1fe Deposit 801le~
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1, Rool E,IOI. (Schedule ,~I
2, Slocks and Rondl (Schedulo Bl
3. Clo~ely Held Stock/Parlnennlp lntennl (Schedule C)
4. Mortgagel aud Nolel Receivable ISchedule Dl
5. COlh, Bonk Dupaslh & MilCellanfloui Personal Properly
(Schedule EI
6. Jointly Owned Property (Schedule Fl
7. Transfen (Schedule OJ (&chedulC'l II
8. Tolol Gron Aneh (10101 Uno I 1-7)
9. Funeral fIlpenlel, Admlnhtrotivo COlh, Mllcelloneoul
Expenl81 (Schedule H)
10. Debh, Morlgoge liobllillel, liens (Schedule II
1 L T 0101 Deducllons Itolol Until Q 8. 10)
12. Nel Value of eslale (Line 8 minus Une 11)
13,
(111
(12)
(131
(14) --tJ,./'I}-Cl2.L'J.
_,_x.~.~____ _
(161
____ ..-,x ,06.
Charilable and GO\lernmenlol 88qu81h (Schedule J)
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20. II line 19 j, grealer Ihon l.ine lB, enter the differenCE! on line 20. This i, the OVERPAYMENT.
mil
C1lC(~ heftl If you ClIO requesting {1 Icfu"d of your ovptpnynHtnl
21. If line 1815 greater Ihun liM lQ, 8ntM tl1ft difforon(n on Lino 21. Thii i~ 1110 TAX DUE.
A, Enter :hl! Intero~t on tho bolonco duo on line 21 A
B. Enter Ihe total 01 Uno 21 (lnd 21A on line 218. Thi~ i~ tfw BALANCE DUE.
~_a_~4I,.c~_~(k~ayahl. tOl RIAI!!_.r of Will., Ag.nt_
(21)
(2IA)
(21 B)
~.- _n~-==~_~-i!iJ_liIiEf~-~'!~Yi_E.~A!TQlJESTipN.s O~)EVER"s:ESIPE~F~l~~~t:iEC!~_~!~. ..~. r___~------=
Under penalties of porj\lry, I declare that IllClye ellomined thi~ return, includinfj o((ompan}'ing ,(hodule1 ond statements, and 10 the bft1t of my knowlf'ldge ond belle',
'1 is true, corroct and complelo I d/!dorl!l thol oil real osloto hO!> bono roported ot !IUD !11urkot '~alue Duciorr1tion of prflpOrtH olher tnon Ihe porsonol reprosentotiye Is
oaled on 011 Informal ion of which pr&poror hm CIIlY knowledgo
illjNFlJiiEOfH'Ii~6-N~RT5-PON5-iiHr.rotFf~[' RfllJR-N- . - MiDRl5-S- --. ---. DAfr'/.--.- /
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SCHEDULE E
CASH, BANK DEPOSITS AND
COMMONWEALlH Of PENNSYLVANIA MISCELLANEOUS
INNIRITAlICI YAK RmURN PERSONAL PROPERTY
ESTAtE OF RIIII!.N!DICID NY . ..,..,_.- . n.~_"~,_~~_._~~c FilE NUM-ti:;a~!.!rl~~_arJle!_.m..- -'
_J,{llJ::f:dL~._Q; .IiLL~J7? {.J (0 .. ___)J~q..1-=-_~_ b .I 'Z. 1 __n
~~~_~,o..p!.''!y_I~I"tly~~'!..~_wll~._~h. R~~!"..!!..~~~.~~~~~~~~_~~!!_~! ~I~~~!_~!_~ o~S~h~'d';I~-Fj . ___._~__... ._~_.
,
~~tk
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
/. c4S# (/ fro.
;2,. IRA 3o!r li" ,
3. tR4 L/ (J 6 S-.
Cf. c.O ) " q ere .
s, IRA "."'( 'I
G. Nt D IJ€-Y M4<<.(<~T t./ 2.- '1, t 'f
7. Tf< (l I (;) I (,
1. C-t> CoOOCl
1. If /rf/,.Lf3- L( PMCO '5610/ M 6'ro~ <!.-<f c.L~_ (2.- C> 0" ,,') .
16. fD~'D f(G(.( u-p (p~ '
___.u~_. ____TOTAL J.~\II? .n'.r_:>~i~!_ 5, Rocapltulatlan $.5''' _L~U,~_,_
(Allmh odlltlclnal 8\11" )( 11" .heo'l If more Ipace II needftd.)
/s'.-' 16{J, 1/
eOMMONWEAlTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TANES
INtllHJAHH TAM DIVIS,DN
DE:PT, 1110'01
HARMISlURG. IlA I1lla-OUI
NOTICE OF INtlUITANCf rAN
APPRAISEHENT. ilLLOWANCE OR OISAtLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAN
12-22-97
HILTON
12-31-96
21 97-0127
CUMBERLAND
101
['--_ AooounIRo.ltW-i
L______ __J
MAKE CHECK PAYABLF. AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS lINE .. RETAIN lOWER PORTION FOR YOUR RECORDS ...
iiiV: i!47 - iii -APi; - r oi,: 97"i "iloT i c i - -O'F - YNHiiii;: ANCE - TAX - 'A-PPRA i sEiiEii'f; -A L i:6WANCii - iili"" on - -- ..." - -" --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
WILLIAM G FILE NO. 21 97-0127 ACN 101
OAT!
ESTAT! OF
DAT! OF DUTH
FILF. NUMBER
COUNTY
ACN
SUZANNE C HILTON
302 LAMP POST LN
CAMP HILL
PA 17011
ESTATE OF HILTON
TAN RETURN WASj I X I ACCEPTED AS fiLED
RifilEFlVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l E.t.t. (Sch.dula Al
2. stooks and Bonds (Schadul. 8)
5. Clo.:Ily Hald stoc.,/Par'tnarlh1p Inhr..t (Schedula C)
4. "ortg~g../Hot., Reoeiyable (Schedule DJ
S. C..h/Bank Daposits/Hilc. ~.r,on.l Proparty (Sohedula E)
,. Jointly O.nad Propa.'ty (Schedule f')
7. Transfars (Schedule OJ
8. Tntal A...t.
I CHANGED
III 75,000.00
121 12.000.00
151 .00
141_ .00
ISI_ 56 .131.00
(6) ~
(7) .O!!..
181
APPROVED DEDUCTIONS AND EXEMPTIONS,
9. Funa...al E~p.~I../Ad". Calta/Hi.c. Exp."... (Sohedul. H)
10. b.bt./~ortu.g. Liabilitioa/lian. (Schedule Xl
11. Tot.l D.duction.
12. Net Valu. of rlK Return
IS. Ch.rltable/GovlrnRent.l aequa.tll Non-allctad 9115 Tru.t. (Schedull J)
14. Hot V.luo of Eat.to Subjoct to To.
If .n ......nl.nt W.II :l8su.d pr.viously, Une. 1,4/ 15 .nd/or 16, 17 end 18
reflect figure. thet include the totel of !bk return. ......ed to date.
ASSESSMENT OF TAXI
15. AMount of Uno 14
16. A~unt of line 14
17. AMount of Uno 14
18. Principal TIX Due
TAX CREDITS I
PAYHENT
DATf
NOT!! ,
.t Spou..l
taxable .'t
taxable .t
r.h
L in..lICla" A r.t.
Collltaral/Cl... 8 rat.
RECEIPT
NUHnER
DISCOUNT 1'1
INTEREST/PEN PAID I-I
1,494.12
33.256.76
nil
112.
(15)
114)
19l
nOI
IIS1
(16)
1171
108.380.12 x .00:
.00 K' 06:
.00N.15.
(18)-
c' ,
*,
.' ~
.
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
tH'lh' tl 'If Ift.Ul
WILHAM
G
DATI!
12-22-97
NOTEI To inlura ~rop'r
oredit to yn~r Iccount,
lub.,U the upper port ion
of thi. forM with your
tax ply..nt.
14';.131.00
_],4.7"0 AA
108.380.12
.00
108.380.12
will
.00
.00
.00
.00
-~oo
.00
.00
,00
, IF PAID AFTER DATE INDICATED. SEF REVERSE
FOR CALCUlATI~. OF ADDITIONAL INTEREST.
If TOTAL DUE IS LESS THAN '1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" ICR>, YOU HAY 8E DllE
A REFUND. SEE REVERSE SIDE OF THIS FURH fOR INSTRUCTIONS.)
.,.J
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RESERVATION I E.t.t.. of d.oMlolnh dying on or befor. 'Oeolltb.r 12, 1982 ~- if .ny futur. Int.rut In th. e.tate It trllf"l.ferred
In P~"e..lon or enjoya.nt to CIa.. B (collatar.l) bln-flci.rla. of 'the dlcedlnt .fter the eMPlratlon of ,anY ..tat. for
11ft! or, for y..r., the Co..onw..lth har.by Il<pre"ty ruer,," the right to apprahlt Wld a....' tran.hr Inheritance Te)(..
.t the hliffl.ll Cia.. B (coll1ter.ll rflte on IIt'y lucn future Int"I't.
PlIlPOSE OF
NOTICE I
To fl.llflll lhe requlrl.~h of Section l140 of thl Inhlrihnaa and E.teht Tal( Act, flct 21 of 1995. (72 P.S.
SlctJon'140l.
PAYMENT,
Det.ch the top I)OrtIon of thh Nottc. and $ubait with your paYlIIlnt to thu RCluhtlr of w11l1 prlntad on the rl".r.. .lide.
--Maka chick or lIO"ey order payable tal REGISTER OF HILI.S, AGENT
REFUND (CR)1
A refund of a tal( credit, Which Will rIOt requllted on the TIt>: Roturn, ",ay bel "oqvuhd by co..lotl"g an "Application
far Rafl.lnd of rlnrlly1vllnla Inher1tancI IInd EtltatG Tn>:" (REV-Ul3), Appl1catio.n. are avaUabll at the OffiCI
of the Regllt,r of Willi, any of thl Z3 R.v.nue Oistrlot Offlcel, or by calling the .p.cl.l 24-hour
anltot.rinll ..rvleil nullb.rlt for fOI'.s ordering: In Plmltvll.'''nht 1~800-36Z.20S0, outsl.do Penns)!lv.nla and
totithin looal Hl'Irrhbu"8 arlll (717) 787-809(1, TOOt (717J nZ~ZZS7. Olnrlnlll IlIpulr.d Only).
OBJECTIONS I Any party In Interut not IIIthfled with th~ apprllI5IIlltont, al10wancll or dhal1oWftM. of deductlonl, Of' ....ult.nt
of tine (Including dhcount or Inhrut) 1\11 shown on thh NotIco IIIUlt obj'lct wIthin .l>:t)l (60) da)!1 of receipt of
thlo Notlu b~l
-~wrltt.n pratut tD the PA llaparbont of RevenuII, Board of Appltah, llopt. Z&l(JZl, H.rrhOOr", PA 171Z-'~102L OR
--Ilectlon to ha",. the .ethr deterllllnad ftt iludit of the nccount of the persanal rapr"lfltatlva, OR
~.flpp.al to thl Orph.nl' Court.
ADHIN
ISTRATIYE
CORRECTIONS I
factual .I'ror. d!neov.red 00 thh I\UII.ltent .hould bit addr....d In wf'ltinQ tOI PA Uepilrt.llnt of Ra"MuHI,
Burlltau of Indl...l~u.1 Ta>:lI, ATTN: Po.t h'..51t8nt Ravle", Unit, nlpt. 280601, Harrlllburg, PA 111Z8-0601
Phone (17) 787-6S0li. SII' page S of the booklet "Instruction'll for Inh.rltBnce Tax R.turn for a R..,ldent
Deeadant" (RE~-1501) for an GKplanatJNl of adltl"l.tr.tlvel)l correct.bla error..
DISCOUNT l
If A4'lV hiM dull it paid within thr.. (5) colandor .onthl aft.r the decedent'. d..th, I't fl.... p.r.::ent (S:O dh~ount of
the taM PIIAd It allowed.
PENAlTYl
Th. 15:< t.M HMlty non-participation p~e1ty III cO<<puted on the total of thft taM and tnter..t uu..ed, .00 not
paid before January lft, 1996, the first day aft.r tnlll end of the taM a.n..ty p.riod. Thh non'pllrt1cl~atlon
pe"alty 1. IIppealabl. In tn. .... _anntr 11IM In th. the SlIlIte tI.. Plrlod III )loY would appeal the t.x end IntlrCl.t
th.et h.. bA'Jn .......d I.. Indlcatlld on tnh notlca.
INTEREfH I
Int.rast II chllrged bltginnlnll with flrlt day of deHnqu.ncy, or nlnl (9) eanthl and Ontl (lJ day fro. the data of
t1'lIth, to tn. d"t. of Plly.ent. hMe. whJch bac&ll4l d.l1nqu.nt b.for. January 1, 19&2 baer Intor-ut lit th, rat. of
.JM (6%) pllrcent par antlUIl calouht.d at It dally rata of .000164. All tax.. which b.e... dallnquent on .nd after
January 1, 198Z ",111 b..r Int.r..t at . ratl which will vafY fr08 cal.ndar )l1.r to calendar YI.r wtth that r.tl
annovnoad by the PA nap.rt..nt of Ravanue. Tha appllcabl. Intnr..t r.te. for 198Z through 1998 are,
'!!!! Int.r..t Rat. Dall~ Intar..t F~ct2! ~ Interut Rat. !!!!.!l. lnt.rut F&ctor
1982 lOY. .000548 1937 9% .000Z47
1965 16% ,000411\ 1988*19'91 Ili: .001UOl
1984 B% .000101 1992 9% .000l47
19n 13% .OO03!i6 1'93-11)94 7% ,00019l
198f, 10% ,000Z74 111:95"1"98 'X .n00241
--interllt III c.lculated .. '(lllo\ol,:
INTEREST . BALANCE Of TAX UNPAID X NUN'ER Of DAYS DELINQUENT X DAILY INTEREST fACTOR
--Any Hotlc. I..uad aft.r ttwt taK bftcOllu dallnquent will refhct en Inhr..t calculation to flft.an (15) d.~.
beyond the dat* of the e.I.....,..t. If pay~.nt I. aade .ftlr th, Int.r..t coeputetJon data .hewn on the
NoUn, addltJonlll Inhr..t ""s' bll calcul.ted,
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STATUS _REPS~!3T UNJlER RULE: ,.L..H
Name of Decedent: 0Jll~ {'( H(C'i(~fJ ,Ut
. ( . ,
Date of Death: I :~ j ,",I 'i.t:..._
,
'Z-1-cr1- 1tl Admin.
Will No. .__.~- No.
Purouant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of t.hQ estate is complet.e:
Ye8~_ No__
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. I f the answer to No. 1 is Yes, state the following I
a. Did the per70nal representative file a f.inal
account with the Court'? Yes v No__.
b. The separate Orphans' COllL't No. (if any) for
the personal representative's account is:
c. Did the personal representative state an Ii A
account informally to the parties in interest? Yes No
d. Copies of receipts, relea~es, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:~' ! )/1('- .J~U1A-HdU C. 1f d t&V\
~- Signatur,$'
ell
\..1
:r"
Name. e
Address
Hr.. Suaanne C. Hilton
SOt Lamp Poot Ln.
Camp Hill. PA 17011-1460
1--'
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o c.;
(111 I '/(,,1 ''';''I!
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Capacity:
" Personal Representative
l~.~')
____Counsel for personal
representative
(MAH I rmf/ AM3)