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Home My WebLink About09-12-08 (2)COMMONWEALTH OF P N . YLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 RECEIVED FROM: PNC WEALTH MANAGEMENT PO BOX 308 CAMP HILL, PA 17011 ------- told PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EXI11-96) NO. CD 010262 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: FILE NUMBER: 2108-0919 DECEDENT NAME: POOL MARJORIE KISHPAUGH DATE OF PAYMENT: 09/ 1 2/2008 POSTMARK DATE: 09/12/2008 COUNTY: CUMBERLAND DATE OF DEATH: 06/14/2008 101 ~ 526,600.00 TOTAL AMOUNT PAID: REMARKS: PNC WEALTH MANAGEMENT CHECK#1250175 SEAL INITIALS: WZ 526,600.00 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS o-~ c~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Fee fur this certificate, $6.00 P i4541o1 Certification Number 3EV II/2006 PRIM IN ANENT ;K INK 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. Local Registrar ate Issue COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER C7 ~ 4 `= O w~- , ~ ^ " j~ _ ___~ t'- ~ ~ _J~ ~ r.. ~ ' "_ _. - t .~ ~-+ O 1. Name of Decedent (First. middle, last, suffix) 2. Sex 3. Social Secunry Number 4. Date of Death (Monty, day, year) Mar orie Rish au h Pool F 143 -18 =1672 June 14, 2008 5. Aga (Last BiMdayl Under 1 year Under 1 day 6. Date of BiM (Month, tlay, year) 7. DiMplace (C' antl seta or for ego country) Ba. Place of Death (Check only one) Abner Days Mwrs Minuiee Hosplial: Other. 88 vm. December 2, 1919 Pittsburgh, PA ®Inpaham ^ERlOutpalienf ^DOA ^Nursi Home rig ^ Residence ^Other ~ Spamty: Bb County of Death 8c. Clry. Boro, Twp. of Death Bd. Faalhy Name (II not inslhulbn, give street aM number) 9. Was Decedent of Hispanb Origin? $] No ^ Ves 1 D. Race: American IMian, Black. While, etc. Dauphin Harrisburg rrisburg Hospital Ql yea. specify Cuban, M i P R (SPepIN) White ex can, ueno ican, etc.) 11. Decedent's Usual Occ tbn K'xtd of work d one tl un most of world Ilfe. Do not stale reeked 12. Was Decedent ever in Ina 13. Decedent's Educatbn (Specify only highest grade comp leted) 14. Marital SIGNS: Monied, Never Marretl, 15. Surviving Spo use (II wife give maiden name) Kind of Work Ph i i Klnd of Busines I IMuslry S lf E ~ d U.S. Armed Fo7qrxc-e~s? Elementary /Secondary (0-12) Coll (t-4 or 5+) ~ Witlowad Divorced (Specify) , ys c an e - mp oye ^yea LINO + Widowed 18. Decetlenl's Mailing Address (Street. city /town, stale, zip wtle) Decedent's Did Decadent State Pennsylvania uye m a 1,p Lower Allen Actual Residence 17a ~ y tl' D d l ^ 5225 Wilson Lane/Bethany Village . ,~, . epe en w m Twp T°wnanlp? ,~d.^N°,Decadantwadwanin 17b c°°nt Mechanicsburg, Pennsylvania 17055 ~auphin Actual Limits of c /BOm ~y 18. Father's Name (First midtlle, last. sufllxl 19. MoNer's Name (First, middle, maitlen surname) flier it 20a. Inlonnant's Name (Type 1 PrrdJ 206. Informant's Meiling Adtlress (Street, city /town, slate, zip code) Mr. William C. Pool 207 North 38th, Harrisburg, Pennsylvania 17109 21 a MelrwO of Dispositbn Cremation ^ Donatbn 21 b. Dale of Oisposabn (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Location (City I town, state, zip cotle) ^ Burial ^ Removal from Stale I Wes Cremation or Donation Aulhodud ^ Other-Speciry~ i byMedicalExaminerlCaroner4 ®Yes^Np June 17 2008 Cremation Societ of PA arrisbur , PA 17109 2 I funeral Swytal(e a (or person a,adn 5 such) 22b. Cleanse Number // // ~ 22c. Name antl Adtlress of FacilityAver MemOrlal HOme 5 CrematlOn Services , IIIC . ~~I V~[[ ~ van a 1710 Complete hems 23at ooh/ when cenilying 23a. To Me best of my knowletlge, deaN oaunetl at Me lime, date and place salted. (Signature and title) 23b. License Number 23c. Dale Signed (Month, tlay, year) physician is nW avaaabk al time of death to ceniry cause of tlealh. Items 24-26 must ce completed by person 24. Time of Death 25. Date Prorounced DeeO (Mpnfh, tlay, year) 26. Wes Case Refened to Medical Examiner /Coroner for a Reeson Olhet than Cremation or Donation? wh° prprtouncea deem 4 : 5 5 a . M. June 14 , 20 0 8 ^ yes ®N° CAUSE OF DEATH (See Instructlons antl examples) r Approximate interval: Pan II: Enter other Sitlnificanl contlhions contnbutlno to death, 28. Oitl Tobago Use Contnbme to Death? rem 27. Pan I: Enter the chain of events -diseases, injures, or complications -that directly caused Ule tlealh. DO NOT enter terminal events such as cardiac arrest, r Onset to Death but not resulting in dte underlying cause given in Pan I. ^Yes ^ Pm6a6ry respiremry arrest, or ventrkular fibrilletbn wdhou! showing the atiola,7y. Ust onry one cause on each fine. r ~ a1ME01ATE CAUSE IFi l di n ]~ No ^ Unknown ne sease or ~ wnditlon resuhing in aM) r% l yP")l N (~ r E O ~ S Q ~ (~ '1~I ~1 '- G 1Cl - " ~ 29. If Female: -~ a , a G L y ~Y t„nu r + s 1s~SE Due to (or as a consequence ofJ: ~ ~ Not pregnant within past year Sequenliafiy list condaans, tt any, 6 ~ le9dinq to die cause fisted on line a Pregnant al lime of tlealh . Enter the UNDERLYING CAUSE Due to (or as a consequence oQ: i ^ hbl pregnant, but pregnant within 42 days (dsease or injury that inhiatetl me ° t events resulting in tlealh) LAST t of death Due to (or as a consequence off: ^ N°I pregnant, but pregnant 43 tlays l0 1 year d ~ before tlealh ^ Unknown if pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Findings 31 Manner of Death 32a. Date of Injury (Month, day, year) 326. Describe How Injury Occuned 32c. Place of Injury. Home Farm, Street. Factory, Perormetl? Available Prior to ComDleuon ~ Natural ^ Homkrde Odlce Buikkng, etc. (Specfy) of Cause of Daath? ^ Yes ~ No ^Yes ^ N° ^ Ac,ident ^ Pending Investigation 32tl. Tme of Injury 320. Injury al Work? 32f. if Transportation Injury (Seedy) 32g. Location of Injury (Street, city I town, stale) ^ Suicide ^ Could Nol be Determinetl ^Yes ^ No ^ Dover /Operator ^ Passenger ^Pedeslran M Other ~ Speciy 33a. Cenilier (check only one) 33b, SigmNre and file of Censer • Cenftying physician (Physioan certitying cause of death when another physxhan has pronourxred deaN and cemDletetl Item 23) To IM beat of my krowedge, death occurred due to the causs{s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , ~ ~`~2, , ~. M i~ • Promundng end cenifying phyaiNen (Phyaidan both prortorzcing death and cenifying t° cause W death) T° the best of m knowled death occ e r ed at the ti e tl t M l d tl t tM d t ^ 33c. License Numoer 33tl. Date Signed (Month, tlay, year) y g , u r m , e e, a p ace, an ue o cause(s) an manrtar u am etl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medlcel Exeminer I Coroner ,F / ~, i'I' /~ ~ ~ ~ -(~ J J L (i,) ~ C p Dn the beats of exeminetton end / or investlgatlon, In my opinion, tlealh occurred et the time, sate, aM place, and due to the cause(s) erM manner as steted_ ^ ~ ~ 34. Name antl Address of Person Who Metaled Cause of Death 1llem 27) Type /Prim ~ 35. Regis r' Signature and ~ 36 Date 'ed (Momh day, year) I~Gra,azAtzl1~ (J~U(~Y ^ l C ~. I ~~ I I `~'I ^ I I ~ I 'J /fn ~/ -3 ¢S~ 1 -Y1 IQ '`L"LYY G~tY1/ I~I \ pC; I~CiII Disposition Pennil No C/' .~Sz ~ r~ Ji Q ~ PNC WEALTH MANAGEMENT PO Box 308 Camp Hill PA 17011 Tel: 717 730-2265 c7 ~ , `~ -- ~ ~ ~ ! September 12, 2008 ' ~ i ~ _ ' ' -' ~ (_ "~ ~. t .' Register of Wills ~`'n ~' <-y Cumberland County ` '~' "" '' South Hanover Street 'A oa ~ f~=, Carlisle, PA 17013 ~ o vl Re: Marjorie K. Pool Date of Death 6/14/2008 Non-Probate Estate Dear Register of Wills: On behalf of the Corporate Trustee of the above-referenced Estate, I enclose a check in the amount of $26,600.00 for payment on account of Pennsylvania Inheritance Tax. This payment will yield a 5% discount in the amount of $1,400.00 for a total credit towards the Pennsylvania Inheritance Tax in the amount of $28,000.00. Please assign a file number and send us the usual customary receipt at your earliest convenience. Sincerely, ~~~~~ Linda J. Lundberg, CTFA Estate Administrator Vice President Enclosure: LJUjmh Member of The PNC Financial Services Group 4242 Carlisle Pike Camp Hill Pennsylvania 17011