HomeMy WebLinkAbout03-17-08
COMMONWEALTH OF PENNSYLVANIA
- - DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CAROL FAHNESTOCK, CTFA
FULTON FINANCIAL ADVISORS
ONE PENN SQUARE
LANCASTER, PA 17602
-------- fold
ESTATE INFORMATION: SSN: 204-26-9792
FILE NUMBER: 2108-0295
.
DECEDENT NAME: RILEY JANE F
DATE OF PAYMENT: 03/17/2008
POSTMARK DATE: 03/14/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 12/18/2007
NO. CD 009418
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $36,964.50
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TOTAL AMOUNT PAID:
$36,964.50
REMARKS: FULTON FINANCIAL ADVISORS
CHECK# 1097536
SEAL
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
.
FULTON FINANCIAL ADVISORS"
Making Success Personal."
Writer's Direct Dial Number
(717) 291-2719
March 14, 2008
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Register of Wills of Cumberland County
Cumberland County Courthouse
1 Courthouse Square
Carlisle,PA 17013
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Re: Estate of Jane F. Riley, Deceased
Dear Sir or Madam:
Fulton Financial Advisors, N.A. is Trustee under the Deed of Trust of Jane F. Riley dated
September 20, 1984. Jane F. Riley died December 18,2007. I am enclosing a copy of her death
certificate, for informational purposes only, for your records.
Enclosed is a check, in the amount of $36,964.50, representing the P A Inheritance Tax
prepayment in the Jane F. Riley Trust/Estate. There were no probate assets and the estate was
not probated. Please assign a number to this Trust and mail the P A Inheritance Tax receipt to me
at the following address:
Carol R. Fahnestock, CTF A, Vice President
c/o Fulton Financial Advisors, N.A.
P.O. Box 7989
Lancaster, P A 17604
If you should have any questions, or need any additional information, please let me
know.
Sincerely yours,
c;.~~ E. ?a-A,~~/C'cCL-
Carol R. Fahnestock, CTF A
Vice President
CRF:clo
Enclosures
One Penn Square, Lancaster, PA 17602 · www.fultonfinancialadvisors.com
Investments. Wealth Management. Corporate and Retirement Services · Private Banking · Insurance
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
'ee for this certificate, $6.00
P 13990860
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
/? jyJ ~ DEe z Z Z007
CMm-/<~./ /
Local Registrar Date Issued
REV 1112006
PAINT IN
AANENT
CKlNK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
204 - 26
ea. Place of Deal" (Check only onel
Hospital: Other:
lnpallent 0 ER I Oul,patient 0 DOA 0 Nursing Home 0 Residence OOther. Specify
9. Was Decedent 01 Hispanic Origin? KJ No 0 Yes 10. Race:.American Indian, Black. WMe, aie.
(If yes, specify CUban, (SpecilyJ
Mexican, Puerto Rican, elc.) whi t e
14. Marital status.: Married, Never Married.
Widowed, Di,orted (Spoc;M
Never Married
1. Name of Decedent IFlfSt, middJa, la$l, suffix)
5. Age (last Birthday)
May
6. Date 01 Bmh (Monlh, day, year)
75
v's.
Cumberland
Pennsboro Twp.
11. Oe<:edenfs UsualOc lior, (Kind of WOf'k done du( ~ 01 life, Do nol stale retired
Klnc:f of WoriI. Kind of Busmess' Industry
Admin. Assistant Federal Government
. 16. ~nt's Mailing Address {Street, city /town, state, zip code}
5225 Wilson Lane
Mechani,csburg, PA 17055
18. Falher's Name (First, middle, last, suffix)
Carlton Thomas Riley
o V.s ~No
Dee......,
Actual Residence 17a. Slate
Pennsylvania
Cumberland
lib. Coonly
l7c. gg Yes, Decedent livtd in
lTd. 0 No, Oecedet1t Lived within
ActuaJLimitsol
Twp
Lower Allen
City/Bore
19. Mother's Name (First, middle, maiden sumame)
Margaret Pollock
2Gb. lnIotmanfs Mailing Addre5$ (Street. cUy ( rown, slate, Zip COde)
1028 Keith Avenue, Berkeley, CA 94708
2lc. Place 01 Disposition (Name of cemetery, crematory or olherplaoe)
21d. location (City J town, Slale, Zip cOOe)
Upper Allen Twp.,PA 17055
FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
231>, lic8nse _ 23<, Oat. Signed (Month, day, yea~
24, TIme of Death 25. Dal. Pronounced Ilea<l(~, day, year)
3: l.JS M, i:2. i is \Z0(11
CAUSE OF DEATH (See InstruClfons and a..mplea)
Item 27. Part I: Enler ltle ~ - diseases, injunes, or complications that diredfy caused Ihs death. DO NOT enter lem>>nal....en1s SUCh as cardiac arrest,
mpiratory arrest, or ventriclnar fibrjffation without showing !he etiology. list onJy one cause on each line.
=~~dr~dise~ a. ::"\9P,f-il"CN ?N[V\"'~Ol'-J\A
I Approximate Interval:
: Onset to Death
I
: I dc<<-\
,
,
I
,
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,
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Due to (or as a consequence of):
~1ist_,Hany,
to cause bted on line a.
Enlor UNDERlYING CAlISE
~~~n:.~trsr
b,
Due to (or as a consequence of):
c,
Due 10 (or as a consequence 0I):
308, Was an Aotopory
Perlo!med'1
d,
3l~, Ware Aotopory Findngs
AWiI.bIa Priot to Co~
of Cause of Oeatf1?
31. MaM81 of Dea~
jl!N.turaI D-
0- 0 Pencing Inl'llSlfgation
o Suicide 0 Cou~ No! be De1ellTllned
M,
32(, ff T_1Ion Injury (SpocHy)
OO"'erlOperalor OP_ OPedest"'"
Othet " SpeoYy:
33b, S1gne\Ule and Tolle of Cattifier
~ J'\t""'-"-G"-H,' /-Iv
OVes I)Q.No
OVes ONo
32d. TIITI8 01 Injury
33e.Cattifier(<:heckonly.18)
ConI1yIng p/lysl:lln (Physiclan cen;ty;ng cause of daa~ whan anolher p/1y1idan has pIOI1O</llClld <lea~ and compete<lllem 23)
To the boot of my knowledge, _occurred due '0 tI1ecaw<(')and_Ualated.. _ u__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
~=~:=ge~:.!:=::~and~""~~~C;::'~~~~ m_aa alated.. _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ 59
~:=~~ and I or investigation, In my opinion, dtath occurred at the tlme. date, and place, and due to the cauu(s} and manner as stated.. 0
26. Was Case Referred to Medical Examiner I Coroner lor a Reason Other than Cremation Of Qona"on?
OVes tsNo
Part II: Enter other simIfir.ant conditinns contribullno to death,
but not resulting In the unclef1ying cause given in Part/.
28, 0i0 Tobacco Use Conlribute to Dea~?
o Yes OPTObllbIy
fgJ No 0 Unknown
29, " Female:
lil Not pregnant within past year
D Pregnant at time of death
o Notptagnanl,butpragnantwithin42<1ays
otdaath
o Not pregnant, but pregnant 43 days IQ 1 year
betOl8daath
o Unknown ff p~ within the past year
321:. PIece of tnjuIy: Home, Farm, SlJoet, FaclOly,
Dtllca Bulkling, ell:, (Specify)
H)' 1'01 H'I(2.01 01 <;,-...,
rM~K ll~ <; Of'!" C, 0 'ScA'>t
329. LocatIon of Injury (Slraet, city I town, stale)
rnO
33c. LIcense Number
mo 42\ q'(jO
33d. Date Signed (Month, cSay, year)
j 2. I S I 2C" 'J
, .9-, / 1:Al II I, 1:2..
Disposition PermH No. CX'A ~ '1 t) \
34. Name andAddreuof Person Who Conl>feled Cause of Death (lIero 21) Type I Print
N"u. on yV\ t<-. 170. kt'.f'"V\.il'-e
3",,>(., l''''''ndlt ~r'"l.
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