HomeMy WebLinkAbout97-00462
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"OR DIVISION OF
VITAL ReCORDS
OI!ClOIN
PLACfI Of
DlAlH
UIUAL
AIIIDl!NCf
OF Dle~DI"'t
f il .fAlOHA'
'G DATA. OP
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FUN&RAL
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COMMONWEALTH OF VIRGINIA
CERTIFIED COPY OF DEATH RECORD
COMMONWEALTH OF VIRGINIA. CERTIFICATE OF DEATH
DEPARTMENT OF HEALTH. DIVISION OF VIlAL RECORDS. RICHMOND
Rf'OI!1'lIAiiON.---'~-- CflllIF!i;ill' _._m." .-----1 J-'lf.iJTTilf--
AAfANUI,l8En 106 NUMIlFFI =2:.~2~~...."''''n=n-''''- :-."",,,,-~"'~J.-r.==t""""~"-_""",,_, ,l4uMntll
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ARMI!U r(JI'ICfS' 0 RJ
Manor Care
'Ctlvon lOWN OFOF.^'ttl
Char les Elmer Slack
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1 fl'OOlt>I I dl.,., I 1'loll11 I m'/llJIII1
tilt ~
O~I Pll
fllMf~m 1I'llll'lfll
o ~ Arlington
lo.orn 1=:1 ADDt11!8S on 111 MO (J' Pl"Cf O~ Df!"Hi
-
, NAME 0 IKlIIl'ltAl on IIlBlHIJflON (lr Of...ltl id MIIf!1 1O It.111
ft C(lvNTY Of [j
Hi 1" 1"IlfPln~l CIIy, 1d~1 blln~l
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o
'M~C'IyC)l'I{Mnli''IlII,1
yn 110
o
550 S. Carlin S rin s Rd.
11, 8TATe (OR FOREION COUNTRYI Of nec,mf;t.H-S AHlloeNCE
12 COU'4TY OF oeCfOOfNT-S RUlllE'iCf. ('llflQlptndftll CIIV. IU~I blanil.)
\Ii rg 1 n i.1.I
u CITY OR TOWN Of' RESIOfNCE
Fairfax
'"-.dI CIty Of tOWII I,motl? ~Aii01iES9orfR'fN'Oi:if"'AF.810ENCf
... M
o
2231Q
111'COOf
Alexandr ia
Ie NMlE Of' OEctOENT'S fATHIlR
t}:
6316 Rose Hill Dr.
18 MAIOE" NA.ME OF OECEot!l(l'B MOTHER
I Bsac Slack
11. RACE ~6iNf"
Sad ie Foster
lIJEDUC,iJiON(9p<<ltyonlyhlQlltel~';~CQfllpllltd)
CaucaIJ ian
1I~"ijjCQFJ(1IN? II PI, ,,*Ity CubIn, MI~iWl.
puertoRIUII.f\C
RJ 110 0 rtl ElIfl\IlIllf'f18KoNl'fY(o-\1I 5 COl. 11.o(Ofe tj
21. BIRTHPl....CF, (It 1111 Of COlJnlfl/ U NEVER MARHleO 0 owonCf.O 0 23 :11 ~~~~~~~ ~~~IWfD, NAME Cll' SPOUSE
Pennsylvania .,"",,00 ,",,,,,,,,oCX Elma Slack
~5 UOUA~ OR L~ST OCCUPATION 2t!.l(INO OF BUSINESS OR INDUSTRY il l'ifOflM.A.NT. OR SOURCE OF INFORMATION
2ll C1TIZ~N m WHAT COUNTRY
USA
U SOCIAL aEounrTV NIJMIIER
190-10-3585
Ilelder
Steel Industry
'I\~ila Noble
(Daughter)
INTEflV.4l~
ONSET AND DEATH
28 PART I. f.nlllf lh. cllllHlft. In~m" Of comphCIlOflI lhll Cll/11d the de,lh [)Q IIllI '"lll lnl modi 01 dying. IUCIl II ClIO,.,; 0/ IC'p-If-'orv Innt. I/Iol:~, Of hlllt IIIMIII
llltOfllyon,CIIIIIOfIeUhllnn C. (. I +
l-Y( iO~A ,",01\4"" h,..C.'l
IMtil!OLAT! CAUIl [F1I1II dl.....ol --.. (_'I ..I \
COf\d!\Il)fl f"IIIIIIIO III clfIlhl DUE TO [OR AS A CONSE ["ICE OF) ~
'" M lIt (oJ y' f (4f 1(. v..', ft ,4....1< S/.d C.'''I
OUF: TO (OR "5 A CONSEQUl!NCe OF)
~~::,'~r~'~C:d~:~'~H~~A~:3
OAUII 10000aM Of Ifljurylll., l"llllttod
'vll'll'IlKu"I~lnd,,'hIL""T
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AUTHORIZED fly
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~ IN P~ST ,1 MONTHS?
..0 f\OD
i 281. TIME OF (NJURY (1'1\0)
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28<1 OESCRlBE tlOW INJURY RELATING TO OEAltl OCCURRI!D
28c IF EXTERNAl CAUBE. IT WAS
I'RlloloVllCJ OICOOIRI8l//IHGt]
un~nownO lOCA\jSl!Of NAltl
[dly) (YlIar) nT INJURY OCCURRIiO
2tlQ PI.....OEOF INJUnYll1om..., Ilrm,
laclorv.llr..l.olllclIbtOO.llc,)
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L 0. Wrv'1.(.C ...Jfe.,,...
:xl BUAI^l REMJVAl CflEMATlON 30 f'1.ACE
OF BURtAL
ReMOv"'~. nc
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XftO(lp m,) on "'. "'Ill 'fld plll;lI llId 110m the elul'ltl Plntltd
- - - - ~ - - - TOATESIONio- - - - - -,- - - - - - - - -.- - -. -
_____ .._____0_ ________ ____i____'.~l'_Oj_!~______uu_
IADORESBOr- AnENOI1lU PHYSIOIAN A. I
: IVOt, S,J'n}<l ~V,<<-f "'.....,0(..,,,'" Z'~l.t..
I"aml! 01 C.IMI..y 01 cf,m.loryl 'I . (mly 0/ CO!J~1y) (11.11")-
Prospect Hill Cemetery Harrisburg, PA
~~~,~~6UNEAALAdvent Funeral Services
AD,"'" 211 Lee H Falls C
OAIERECORO
FIC'O 10/15/96
VA
"
~
Thh h to oertify t.hat thh h a true
with the Arlington "eparl:Junt of lIU11l&l\
and correct reproduotion of the original
Sarvica.. Arlington. Virginia
.pt/~td..~
gi.trar or D.puty
racord filad
(SUL)
Date I.aued ~pBRR 15. 1996
ANY RIU'RODt1CTIOll or THIS DOCllJIBNT 19 PROllIBITID BY STATUTI. DO NOT ACCIPT UNLBSS IT BEARS Till
IIIPRBSSID SD.L or Till ARLINGlTON tllPARTIIBN1' or HtIIIAN SBRVICIB CLEARLY lUPnXID
Section 32-1-272. Code of Virginia. a. Amended
Commom~eal th of Penney! van11t
DElpartm0nt of ReVOnllEl
RlJr~llU of Ind:lv:tdlJol TaxI!!,!
nCllt. 280M(
~larr iso".rg, PA 17128-0601
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HS MARY C LEWtS
REOISTER OF WIL~S
OUMllll,RLAND cOUNTY COURTHOUSB
OAR~lS~B PI. 11013
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COMMONWeALI"!! Of. rIlHNt!VINM./IA
P"PAtHMGNT 01' i1E'VnN~{;
BUREAU OF INQIVIP~A\. TAweS
DEPT,260fJO I '
HAHllISmmG, PA lIliHH10b,
Pl!NNSVLVANIA
INHeRITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEiveD PROM:
I
AGN
AfiSl'SSMENT
C:ONTI10L
NUMI)ER
NO. /\1\227590
AMOUNT
d~
HLV-Ilhl 1)( (11-'1(;1
10'1
~""O'~._~''''~''''''''''''''''~ -..._~____
~--J{:l'}(~J/ ~
I'W [I. A Ii Nil nil
Mlj 6 IW9[ 1I1ll 11f<
I1I.FXfINlHH(~ l'fi )~. jln-
~~--_...
fOtDIHJH
n.r-_".-+__.....~~~~"'~~~_
ESTATE INFORMAT 0 :
FILE NUMBff\
_ . Ii" IJ:' "04R4
NAME 01 IlH;EP,NT IIARli---- .,,- -"Ii1a-TJ -~ ~---- '-~--I"ili~
"mOI_I'A~M:;'{~,:~.~.;--~~f.~:l.~llr~_p: ~:- - .-1'u,
I'ClSTMAlIK "AH t:;.--- - ---"'IT- -. -----'~.. --~~ ,-----------..
0;,' J yl{li. .;r .
COUNTY --6 - --_~"""";~~'"o;-..~,___~_ ~__""",'-'_~~~_'~'k~-'.'
lIAlI Of n~^1~1l}!>JI,:IJil,~___~L--_~_--~m.--.___--'-~ _ ~: TOTAL AMOUNT PAID
~____jli' iHh9~'. :,:
IlIiMAf1KS ;--, ,.: REQEIVED BY
',/ /,
VA
REAL
. .-
- 1-~11!\G!P'~+f \ , i,)j
------
,-
A .
,- r p
FOUlHHIF. -
~~tH;;'f, , ';1 ;;1
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..................IIJ7' _,~'~T ~.~
09-01-97
SLACK
10-08-96
99 97-04~4
NON-RESIDENT ~(,'
101
[ ~.ount R..it::_J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
PA DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
CUT ALONG THU LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV:5i"'f-EiCAf.p-Tiii.-97n~iifXCE-7jTiijlj~!R;;S-iii~N"f-iifHilR-xiiiNb-~-i'Xx-~i>.PRAYmtE-Nf:--mowiiNCE- iiii---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF lAX
ESTATE OF SLACK CHARLES E FILE NO. 99 97-0484 ACN 101
TAX CDHPUTATIDH HETOOD ELECTED: C ) FLAT RATE I XI PROPDRTIONATE
TAX RETURN WAS, I X) ACtEPTED AS FILED I) CHANGED
RESERVATION CONCERNING FUTUR{ INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN-
1. R..I E.t.t. (Schedule A)
2. Stocks and Bond. ISch.dul. Bl
:5. Clos.ly Held Stoek/P.rtnllrship In~.....t (Schedul. (;)
4. Hortgaa-./Noteu R8ceAv.bl. (Schedule DJ
S. C.,h/Ba.nk DapoIH./11hc. Per.onll Property (Schedule E)
6. JOIntly awn.d Property (Schedul. F)
7. Trlnsf....s (Schedul. G)
a. Total A...t.
APPROVED DEDUCTIONS AND EXEMPTIONS:
" Fun.,..l Expens../AdiJI. COlts/HIla. Expen... (Sch.dul. H) (9) 17.834.87
10. Debh.lHortgllaa Liabiliti../Uen. (Sched"le Xl UO)_ .00
11. To',.l D.ctuction. (11) 17,834.87
12. N.t V.lu. of To. R.turn (12) 86 , 18 7 . 6L
13. CharUabb/Gov.rnIl6lnt.l 8oqUlt.t. (Schedule J) (3)' 00
]A. Hat V.lu. of E.tot. Subj..,t to lox (4) 86.187.67.
NOTE: If an assessment was issued previously, line. 14, 15 and/or 16, 17 and 18 will
reflect figures t~lIt include the total of lli returns a.. III led to date.
ASSESSI1ENl' 0"' T A~;
15. Altount of Una 14 lit Spousl,l rat. (l!1)
16. AMount of Lin. 14 taxable at Lin..I/Cl... A r.t. (16)
17. Anount of line 14 taxable .t Collateral/Cl... 8 r.t. (17)
11. PrlncJ,pal Talt Du.
TAlC CREDITS:
PAYHENT
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVF.NUE
SURE AU Df INDIVIDUAL TAXES
INHERITANCE T"II DIVISION
DEPT, ZI0601
HARRISBURG, PA 171za~06Ql
NDTICE Of NONRESIDENT INIIERITANCE
TAX APPRAISEMENT. ALLOHANCE OR
DISALLDMANCE OF DEDUCTIONS.
AND ASSESSMENT DF ThX
DATE
ESTA1'I! OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
TWIlA .M NOBLE
6316 ROSE HILL
ALEXANDRIA
DR
VA 22310
(1)
(2)
(3)
(4)
IS)
(6)
17l
n .000.00
.00
,00
.00
.00
27.022.54
.00
cal
.00 X .0,.=
63.778.88 X .06=
,00x.1S=
RECEIPT
WUHDER
DISCOUNT C.)
INTEREST/PEN PAID 1,,1
AHOUWT PAID
06-19-97
AA227590
,00
3.826,73
TOTAL TAlC CREDIT
BALANCE OF TAlC DUE
INTEREST AND PEN.
TOTAL our,
. If PAID AFTER DATE INDICATED, SEE REVERSE
fOR CALCULATION OF ADDITIONAL INTERESl'.
*
..Y.1I1 IJ.H III.tll
CHARLES
E
DATE
09-01-97
NOYE I To In.ure IJroper
crldi t to your account,
lub.it the t~per portion
of this for. with your
hx pay.ent.
104,022.54
Ilal
.00
3.826.73
,00
3.826.73
-,
3 826.73
,00
.00
.00
If' TOTAL DUE IS LESS TItAN n, NO PAYHENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" CCIII. YOU HAY BE OUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,1
!J\
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i)C:
RESERVATIONI E.t&ta. of d.q.d~t. dying on or b.for. o.o.~r 12, 1982 -- If any future 1nt.rl.t 1n the ..tatR I,
transf.rr.d In ~o.....l~ or enjoy..nt to CIa., B (oulletaral) blnlflol.rll. of the dle_dant aftlr t~ GKplratlcn of any .~t8t.
for 11f. or far y..r., the Co..onwe.lth h.r.b~ .Kpr".ly r...rv.. thl right to appr.l.. and a..... tran,flr Inh.ritanc. TIHli
.t tn. l~ful Cia" 8 'ooll.t.r~\l r~t~ on ,~~ ~u~h fu~ur. Int.r..t,
_EO!'
HOTItE I
OBJECTIONS:
A,,"IN-
ISTRATIYE
CORRECTIONS :
DISCOUNT:
REFUND (CR)1
PENALTY:
INTERfST:
TO REMIT
PAYMENT:
To fulfill the r.qulr...nts of SIt1t1cm 214Ci of tM Inh.rltftOC. Ilnd Est.t. {(II( Aot, "at 21 of 1995. (72 P,S.
Sl(ltlon 9140).
Any party in inter..t not satisfied with the .pprl!l1....nt, allawanCQ or dhallowano. of deduction., or ....st..nt
of tal( (Intlludlng dhcount or Intlilrut) os sho~ an thh Notic. MU't, abj.ct within ,lxty (60) days of rlollpt of
thlt Notice.
~Obj.otlons lay b. aad. bYI
~.wrlttln prot.at tu the PA D~pRrtlent af Revenu4, Board o~ App.als, Dept. 281021, Harrisburg, PA 17128-1021, OR
n.l~tlng tn h....o the lIathr deterldned at audit of the personal rt'lpreuntot1vill, OR
-~8PP.fll to lhfl Orphan,,' Court of Dauphin Caunh', Court ftoUUl, flftrrhbury, PA 171111.
Factu.l .rrors dJ'cov~rQd on this as'~SI.ent should be addressed In wrIting to: PA Ollpert..nt of Revenu.,
Bur..u of IndlvidU81 lI'I>llIl, ATHI: POflt AlsuS.IoOt Rwvhw Unit, O.flt, 280601, .tarr hburG, PA 17128~0601
Phone (717) 787~65D5. Su paUll 3 of tho baoklrlt "Instructions for Inh.dtanclI Tal( R.turn for '- Nonr..h1ent
Oec.dent" (REV-\736) for an ~~planfttlon of 8d~lnistr8tlvQl~ correctable errors.
If &nl/ tax due 11 p.ld wlthln thr... (1) .oothl IlIfhlr thl d.CHant's death, a dhcount of flv. p.rcent (S:<l of
thl tax paid 1. allowod.
A r.fLlf'l~ of II talC Clredlt, which was not reque.ted on the Tax RetUf'n, lIa~ bo requelted bl/ co.pi.tlng an "Appl1aaUon
for Refund of P8nnsylvlmla IoherJtl'lnce and f.stah Tax" (REV.BBL Appl1cetions are availabl$ at the Offloe
of the Reghhr of WJ11s, 8n~ of the 23 Ra....mu.. Dlstr1ct Offloll, or fra. the DlIpanllent's 24.hour answodng Irlrvlcll
nuabllrll for for.. ordilJrlng: 1n PiRnns~lvanllt 1-800-J6l-2DSD, outside PQnns~lvftnia Rnd within local HllrrliJoorg area
e7l7) 787.8094, lOD. (717) i'72~22Sl (HoarJnt) I.-palrl.ld Only).
Th. 15:( hll< Mlll..t}t non~pel.tlclpatlon p.Mlt~ i. r.:oaputlld on the tot",l, of tho talC And Int.r..t e.....ltd, 8M !lOt
paid b.fora January 1ft, 1996, th8 flrllt day after 'HI. end of the tal( a.nutv p.riod. Tills nonMparttclpatlon
P~llty 1ft IJppeelGbh In the SU. RanMl' and In the the salll. U.. p.rlod e. ~Oll wauld app.al the tal( Md Inhr..t
that ha. b..n &".I'~ a. Indlceted on thl. notice.
tnterent It charll~d begInnlnll with first dl1l~1 of dGllnfl\l4nC)/ or nlM (9) lonths llnd one O} day fro. the data fJf
d..th to the data af pft~lIent. Ta)(IIIS whIch beca.. daIlnq1Jent before Jllnuar~ I, 1981! bfHlr Int.r..t et th~ rat. of
.IK (6%) porcent par "nnu. calculat.d llt ft dldh rl!lt~ ('If 0')0164. ,1,11 t!I)(as ..hi,.h IHICU'I~ deUnquel1t on and aft.r
J~nuar)/ I, 1962 wIll b.llr Interest 8t 8 rat. which will vary frOB calendar ~e8r ta calandftr ~ear with that rete
ennouncod by the P" O.partwent of Revenue. The appllceble inter..t rate. for l?nZ through 1997 are,
'!!!! Int.rnt "ate Delly Int.r..t Factar V..r Interest Rat. Dally Inttlrsst F&(ltor
1982 20X ,000544 1987 ?X .000247
1983 i6% .000(130 19M~1991 11% ,000501
J.'J84 11;( .000301 1992 'l'% .000247
19ftS 13:( ,01l0356 1993~1994 7% .1l1l019Z
1986 10% .000274 1995-1997 9" ,llUOZ47
,.
--Intllrs.t ls clllculat.a ft. folloWAl
INTEREST 0 SA LANCE OF TAX UNPAID X NUmBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlc. I..ued .ft.r the tax bleo.... d.lln~lt will reflect ~ Int.ra.t calculation to fIfteen (IS) daYI
b.yond the dllt. of thl.........nt. If pnl/..nt 111 lede aft.r thl intere.t cQllPUtltion dah 'Ilown on the
Notic., additional inhr..t IUllt b. culculatad.
DetlOh th~ top rortlon of thl. Notlc. and .~lt ~Jth your pay-.nt to PA OeplJrtwant af R.venue, at the addr...
.hown on th. r.v.r". ,ide.
~"ak. check or ItOn.y ordvr pIIl/ebll tal COl1nONMEALTH OF PENNSYLVANIA