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Home My WebLink About95-0868 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX OIVISION PO BOX 2B0601 HARRISBURG PA 1712B-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX :~EC()RDED :jf:t~~~ENT OF ACCOUNT '* REV-1607 EX AFP (03-05) , , -- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-18-2007 KITZMILLER 12-11-1993 70 0203440 CUMBERLAND 94151080 RICHARD 2007 JUN 29 PM I: 05 CLERK OF MARTYN R KITZMIL_HAN'S COURT 1190 LETCHWORTH RDCU~'1PC' "jr' (\0, Pll, CAMP HILL PA 17011' J-I -q;- olJ2 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE --------------------------------------------------------------------------- -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF KITZMILLER RICHARD FILE NO. 70 0203440 ACN 94151080 DATE 06-18-2007 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-16-1995 PRINCIPAL TAX DUE: 10.31 PAYMENTS (TAX CREDITS): INT AT REV PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) EREST IS CHARGED THROUGH 07-03-2007 TOTAL TAX CREDIT .00 THE RATES APPLICABLE AS OUTLINED ON THE ERSE SIDE OF THIS FORM.. BALANCE OF TAX DUE 10.31 INTEREST AND PEN. 9.62 II IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE 19.93 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. { IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. } Ci BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 2B0601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ::r:C!jir)l:n n[:,C!i"F..;'.N"H' ERITANCE TAX I,~ _,.... ' j ....- ',~ '... \..t" ..... __.... J;S",ti4'tEMENT OF ACCOUNT *' 2007 JUN 29 PH I: 06 REV-1607 EX AFP (03-05) CLERK OF ORPHAN'S COURT ('U~ 'r"T" ! I. T'! ,''.'" D' GLENDA MAXTON'" i'/..' i: ,I,I',.:,! '1\ 1190 LETCHWORT RD CAMP HILL PA 17011 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-18-2007 KITZMILLER 12-11-1993 70 0203440 CUMBERLAND 94151081 RICHARD ?-IAiS' ~(P{ Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: NOTE: To insu~e p~ope~ c~edit to YOu~ account, submit the uppe~ po~tion of this fo~m with you~ tax payment. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF KITZMILLER RICHARD FILE NO. 70 0203440 ACN 94151081 DATE 06-18-2007 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-16-1995 PRINCIPAL TAX DUE: 10.31 PAYMENTS (TAX CREDITS): INT AT REV PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) EREST IS CHARGED THROUGH 07-03-2007 TOTAL TAX CREDIT .00 THE RATES APPLICABLE AS OUTLINED ON THE ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 10.31 INTEREST AND PEN. 9.62 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 19.93 l! SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) G6 his is w ~_ert(?; rh~n the Iftfu!~matiun here gi~"en is an-rectly r~pied from an original certificate of ..ie.Le}~ dl(1•~ tilcct" ~~:til I»c~ ..<. Local Re .~~~r." • '1'}'tc (i(-igi(~s( rtifirate wilt be furw,+rded u; the State Vital Records Office for pc•rm,ll~ert fili(wJ. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fr~~ 'tar this cer[ific.ac, ~?.O0 ____L-_~ ~_~.~-~-~---- ~~. V,.T :: ~.-.. L 1. ,. n' l Rev. 7/87 -1'S.L - - Locai " e~riscrar r?<tte COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH NAME OF OECEDENT(Flral, Midrpe. Laaq SE% SOCIAL SECURITY NUMBER V~ DATE OF DEATH lMOnlh. Oav. Year) +• RICHARD L. KITZMILLER :. Male a. 162 - 07 - 6796 ..December 11, 1993 AOE (Loo Blrmdey) UNDERI YEAR UNDERtDAV DAlE OF BIRTH BIRTNPI.ACE (CIIyflM PLACE OF DEATH (CMr.N Only one --sea inelruclione on rnher aids) Months ) Uaye Hours ~ Mlnelee (MUnlh, UnY, ttmrl ~;eaa r. LUrniyn L:u,uary) HOSPITAL: OTHER: -"' 77 Yr, 4/15/1916 Shippensburg, Pa. In„a,lnmlL] ERroawn.nt ^ OOA^ " °m;"q ^ ~ , b Rw,a„~.^ rti)^ `. a. 7 . CWNTY OF DEATH CCTV, BORO,TWP OF DEATH FACILITY NAME QI nd In&nunnn, qiw atreM end nurzdxrr) WAS D ECEDENT OF HISPgNIC Oi11GIN9 RACE-Amsrken lndien, 8leeh. Wnru stc y ~ , No A,y Ne^Ilyw,epeclly DuGn, ItiM!n'tY) Franklin • ChambersburgChambersburg Hospital ~ ~ Mealcan,PwnpRlcen,atd. White . , to. DECEDENr9 USUAL OCCUPATION KIND OF BUSINESSIINDUSTRV WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARFfAL STATUS-MerdM SURVIVING SPOUSE IGve Nmd olwwN Wale tlurirrpp I U.S. ARMED FORCES? it all h h I re om Nswr Mewled. Wltlowwd, Ill won. u~vrr ~naatnn narnel of warklnq lNe: do nd uee rafN~) O slot Na^ Elementary/Secondary CaNege ONarced lSPeaitYl IA) LI • ,,,, School Administrator „b, Education 1z 19 lu'r) n^~5~1 5+ ,~ Married ,, Alcesta Smith , DECEDENT'S MAKING ADDRESS (Street, CNyR n, Sleta, 2lp Code) DECEDENT'S Pd ACTUAL 17.. Stets DW i7a.^ YM, dscedaM Ihretl In 61 Glen St tvrP . RESIDENCE dewdanl (.`,nn in•nrucnuns Ilw In Chambersburg, PA. 17201 n m d n n ,„„ n) 1O"nsh1p7 na ,a. „E ~nn, Franklin dm Chambersburg ~wNOinm.n.ixl ~n , ~~ . „ n FAFHER'$ NAME F M ( ist, iddle, LeN) MOTHER'S NAME First, Mme. MaNlan Surnema) kli F L Kit ill ~ ,,. ran n . zm nna Bedford er f. Corr INFORMANT'S NAME (Ty,wlPnmI Kitzm111er Alcesta 5 INFORMANT'S MMLINO ADOREB9151ram, Clly/Tnwn, Slnlr. Jip Crxml . 61 Glen Street, Chambersburg, PA. 17201 METHOD OF DISPOSITION BwNI ~ C tb U R l I U • DATE Oi DISPOSITION IMnllm. UnY. YrwO PLACE OF DISPOS1710N-NSme of CamMSry,Cromntory or qMr Plea LOCATION-CIryR n, Slate. Zlp DAM reme n emwe rom 91He Donetwn^ aMrestaa,aYl ^ December 15, 1993 Parklawns Memorial Gardens Chambersburg PA. ]7201 . ate. ' ale. ata. , afa. SIGNATURE OF FUNERAL SERVICE LICENSEE ORP- ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY z"~-E' t FD-011583-L ae. xxTHOMAS L. GEISEL FUNERAL HOME INC., Chambersburg, PA. 17201 Complete Name 13st only when csnllylrp To Ihs East of m Frawbdge. deem oceurred at 1M Ilma, date and dace Hated. LICFf13E yMBEi v J ~ L DATE SIGNED pnyekWrMnolewesbN el lima of death la (Srgnalum nd t~Ilel C ~ ~ b ' andl' CeuN Of death. 6 (MOnm. o:rr. v«np ~ ~ f '~ ( ~ .t ,\ Ndw a~..U .w K.~IXJYS / /1 -(1.A~1L C. xa . ~ •~C~Q (o+c ~- vo /1 ~/ 9 3 . Nsarm 2A.7e mtm ES epmplMedW TIME OF DEATH GATE PRO NCED OFAD (Moony My. Yavl WAS CASE REFERRED TO MEDIC AL r%AMINERICORONER9 - .: ... whc pran;nrn~rx drain tt , Yes LI No ae. S' M. aE. (st L ~ S ~. 27. PAR71: En1eI IM dMeeees, Inlunes or complketbna which cauead me Oeeth. Do not enter tM mode of dying. auto es cardiac or rseplntary nrtael, shock a haen /eiluro. i Appro,lmsls PART 11: qMr signlfkenl condnbns conlrm,nlrp to deem ha li m , p o y oM cease on each Ilne. ~ Interval EsMeen rrot reeuNlnq In the uMerlyrnq cause given in PgRT I , pneet ena ee.m IMeEED1ATE CAUSE (Final 1 msaese a ronmlwn , .w mrrp.n aslml-~ ~2.c<-../CL c:!(!_-T ~ ~•, ~ ' • DUE TO (OR ASA DnN.ST OIII N('.f (K 1. - - 5•glNmWyGq epMKMSM b. `' //~ Nerry, Medlnq to lmmedMle DUE TO (OR ASACONSEOUENCF OF): - I _ eeuee Eider UNDERLYING ~ ~,~, ,( ~~ C.,r,~ I CAUSE IPSeaee a ~nWry • mnl nlnwled events c DUE TC7 (OR AS A GDNSEGUENCE OFJ' I esrMmq in danm) LAST d. NM$AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH GATE OFINJURY TIME OFINJURY INJURY AT WORKS DESCRIBE HOW INJVRY OCCURRED . PERFORMED? AM\IUBLE PRIOR TO (Month, Day, Ynnr) COMPLETION OF CAUSE rryy// OF DEATH? Newrel ILl` Homklde ^ Yee ^ No^ M.eldent ^ Pendlrq lrnaellgetbn ^ rr--,~(( M, a0a. Yp ^ No tYe ^ No P~ Sukltle ^ CouW rot be dalerminsd ^ PLACE OF INJURY - AI hpme. term, mast, rectory, oeme LOCATION (SVael. Crly/T n. Slalel bulMMq, etc. (Spacityl ~°. aee. ». aa. xf. CERTIFIl11(Chap' Only' ane) SIGNATURE ANO TITLE OF CERTIFIER 'CER71eYNM PHYSICIAN (PnyzCbn cerMyinq cease U deem when another pnyscien Ms pronounced tlealn and crmpaled Item 23) To Ule EaN of my knowNape, dpM ottumd dw b LEe a•uee(p and menrw u Meted ..................................................... .Rl $76. L/ 'C'C~~tn-..-sue'/ ~C <-..-~ ~J • LICENSE NUMBER OATS SIGNEDIMOmn, Day. Vearl PIgNDUNCIIIp AND CER7IA'ING PHYSICIAN Ph 7o Ne 0eM of ( wicren nom pranowrcinp deem and cerlilyinq to cause of deem) my ane.l•uw.a.nro«ur,ed elUH lMm,een, end pMa•, endewrosM eeluale)eham.nn«awMa .......................... ^ /7/J - G'`i ( z ~C <. 7 / ~+ a+e. a,a. 2. / Z / . ~ NAME ANDADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH ' •YEOICAL EXAYINER/CORONER ( ) Ype a Print ~,.7 f- Item 27T ~,/,~CC~ .Lc+>.">.</r, n~ OS tlN bSSN d MSmN1E+km ERA/fN ImrSSTlEP1 In mY eWRbn, dePlh oaeuffSA St fIN LKne, dS+•r And PIAq, And eve to MN aA11N(E) ERd J 7) 0 / c.erc,q,,,7 t+i .' c .; . x J 7 (' mSmeru tlAled ..................... .... ..... ................................................ ^ ................ ate dt //c _.A i9 . 7Lc, . , ~ aa. pE018T ATURE AND N BE DATE D ( pmh, Oay, year) ~~~ b. ~.