HomeMy WebLinkAbout12-08-08COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF IfJDi VIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
WILEY JAN M
THE WILEY GROUP
130 V\/ CHURCH ST STE 100
DILLSI3URG, PA 17019
fold
ESTATE INFORMATION: ssN:
FILE NUMBER; 2108- 1 222
DECEDENT NAME: REBERT JOSEPHINE E
DATE OF PAYMENT: 12/08/200$
POSTMAI~K DATE: 1 2/05/2008
couNTY: CUMBERLAND
DATE OF DEATH: 09/06/2008
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~ 52,992.50
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTORNEY
CHECK#13000
SEAL
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
INITIALS: AJW
52,992.50
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 010610
REGISTER OF WILLS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for thi; certificate. 5(1.00
Certificar:on Number
This is to certify that the information here given is
col-~•ectly copied fi-om an original Certificate of Death
duly filed with me pis Local Registrar. The original
certificate will be forwarded to the State ti~°ital
Recur 5 Office for permanent filing.
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Local ReLT~. trar r,,, Date Issued
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?itv„2n~E COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
?PINT w '
.aA),EN- CERTIFICATE OF DEATH ~ ~ ~~ ~ ~ '~a
~cr ivx (See instructions and examples on reverse) STATE FILE NUMBER
Sex 3. Sppkl $ecurAy NanMr 4. Dale d Oeem (MOnm, day. ytap
2
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'~. Na-~r r: ; . heal IFn=_; mridle. tors, suenl
Jose ins E. Rebert female 166 - 12 - 5066 Se tember 6 2008
ndayl Under t year Under t day 6. Oa;e of Brr!n IlAOnm. tlay. year) 7. &rmptace (Crry end stork a torsi n country) Bor. place d Deem (Ctbde only one)
5 nee Mast P~r•
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92 "'°""° °'" "°"' '~" ov. 11, 1915 dams County, PA "°'p"°` Other:
Yrs M n ^ fnpalkrH ^ EA / Outpatient ^ DOA ®Nurainp Home [] Residence QOlher ~ Spsdly:
County of Deem &. Cdy. Born, TWD_ d Deem
• Bo 8tl. FacY% Wms (h nd el5tllNion, 9k'e attest and axllDer) 9. Wet Decedent d Hispanle IDripn? ®No [] Yes 10. Rea: Amedarl klCUl, Black. Wtxle, ek.
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Cumberland County Camp Hill Boro ' white
Golden Living West 1AuuunrbR n, ea)
77. Decedents Usual non KM d work done du' mat d IAe. Do M stets rear 12. Wes Deeded ever M Mle 13. Decedenta Eduealion (Spedfy orxy txghesl grads conpklaal 14. Madel'lelua: Married, Near Mertied, 15 Survmnp ~a+ee (M wee, lMe maiden name)
Divacsd ISOSa7y')
W'd0'~d
JunC o1 Wak I(irq of Bualpess, IMUStry .
U.S. Am~ed Fortasi Elementary 7 (0-12) Cdkge (1~4 or 5+)
6 widowed deceased
Supervisor Cafe ena ^Yea [~rw
16 Docedenl s Mdiling Address IStreel, city: Iw.T. state. ib mdel
. Dptedeni'a Da Decedent
Deauent Li+Mk Twp
Pennsylvania t7c
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40I Church Street ,
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Aduai gesda,oe ,7a $t~e
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Barnesville, PA 18214 e
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t 7d. No, Decs
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nocounn c~t~, t1~11__;_ly QAn~alumkd BarnpcvillP cAy,Bao
Formals Name IFIrsI mxl0le, WsL so(lo)
is t9. Motlkr's Name IFlrsl, nlidae, rllaiderl surname)
. Ros Baker
unlmown
' 20D. Inlormed's Measg Addreaa (Boast, dly 1 awn, stork, zip ada)
s Name (Type I poop
20a. Informam
Kenneth F. Rebert, son 401 Church Street Barnesville, PA 18214
21a. Mefnod d Drspostron ^ Crematrm ^ Donation
' 21 D. Dale d DkDPSllgn (kanm, day, year)
8 21 C. Mace d Disposilbn (Name d a!r!Bta'Y, txemaary a timer place)
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i 2/d. loaUm (City' (awn, arak, rip opx)
PA 17343
htstown
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~ Burv ^ PemnyallronSlale
•. Wm erelna,anorlMnslbnAuttsodxed Sept. 15, 200 e
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~] ans. - Sceu1y: '~~, M t4edkwl Examiner I Coroner? ^ res ^ No
• 22a Sgnalure n! Funeral Servce Licensee la cersor. aaing as auto) 220. License Number 22c. Name and Address d FacAay
L l Home 125 Carlisle Street Gett sour PA 17325
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ComNme Items 23at only w!wn ce n9 23a. To ttIe best o! my ktlowkdge, Beam occurred at die tare. dale and Dlea staled. ISignaene and lek) 23b. Lkense Number 23C. Doe Spkd (asonm, day, yeap
phyvoan rc nrJl dvaAabk d' lime OI deem 10
WddY w'use M deals
We ass RetertW to Merlicel Examiner f Cprorlsr ar s Reason OUNr man Cremation a ~ ?
28
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2<. Tuna or Oeam 25. Da10 Pralolln{I60 IMOrlth, y, r)
Hems 2426 must be cOmptelM oy person ~ Y% Q Ab
woo Dronrxlncas deem pM. Q ~
CAUSE OF DEATN (See Instructions en exampNS) , Approrimaie mlervaP. Pen 11: Emer doer 2s. Da ToDecro Use CantdMe to Deam7
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^ prat'
YO{~
a GDmplicalpns -mat directly Caused me Beam. DO NOT emer lemmnal events such as cardiac artest. poser to Oeam M nd resuldrg in me underlying eons Divan k PM I. ^
mrynes
vgnl5 -diseases
I!e^ 2' Pa^ ! E n!er I^e (np_~jp
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ay
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resC~~alcry arrest. or venMcular Ilpri!lauon wilhOOi snowing dte eliplpgy. Lis( only One Guae do each line. CJ '^' ^ UnFlgrv"
WMEDIATE CAUSE (Fine! rnsaase a ~ ~' d F
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prpgrlam w.mxl past year
CMdAan resulting m ('Rath 1 ~' a
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Due to for as a consequence Q pregrud M erne d Beam
~1y kst con6lrons, A anY. D. , Q Not prepmm, do pregnam wdtwl 42 tlays
m
kading
ro dw ease sstcd on tine a Due to f or as a Consep!ena dl: d Osam
Enle the UNOEgLYING CAUSE
(disease a ^Mlry Thai milialed Ihp C_ Q Nd pra'pam, p/1 aegnam 63 daY510 1 year
evenes rpwn~ng .n deem) LA57.
Due to (a as a consequence op: beige loam
^ lAlkrlo•w A preaNnl wrmm Ina past year
d.
30a Was an Auloosy 30b Were Autopsy Fr~nas 3t. Mannar beam 32a. D81e d !ngsY IMmm. day, year) 32b. Desuioe Mow Injury Occurred 32t. Place d kM1•Y, Home. Farm. Steel. Fapory.
Oaice Buiaxy, eft. (Specilyl
?edornwd~ AvaAade PnOr to Completion alurel ^ Homgde
o'. Cause d Dean? Q Acr~derlt ^ Pending Invesugatan 32d. Time d Injury J2e. Injury al Work? 32(, a Transpatatan Injury (S,pxYly) 329. Locefion d hljury ISreM, cM I town, s(ale)
Gl vas Nc ^ Yas
^ Ves ^ No ^ Dover I Operate ^ Paeaerger ^Pedastnen
Suicia ^ Could Nor be Detemuned N Omer ~ Speciry:
3 goatee aM TAk d ' kr
33a Cemner Ichec• cmq one)
Ledllying Pny srcian rpnysc.an cenAying cause cl aealn when another physw an Has Dronounced Beam and mngleted earn 23;
d , ~A
- - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -
Tc iM best of my knowkdgl. death otturred due to IM <auaNa) and manner as aUlt
Peorrounerno and cenitying physician lPhYS~^c'.n all, prenouncirg deals arb cenlMng :^ cause of deem)
Te me bas'. of rov knowbdge. Beam occurred at lM lime. dale, and place, and due to me causgs) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
37c L!cense Number
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33d. le $ignM Ik1o~, da~; r~,~
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se cauae(T) end manMr as stated_ ~
ue to
l'rne. dale. aM place. aM d
death occurred al the
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d 00atn (Item 27) Type ' Pr,n,
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arw Address d perarm Wm0 Completed Cau
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Jan M. Wiley
David J. Lenox
''~rtr,, <, ,-
THE WILEY GROUP F
Attorneys at Law [~n~~`~r'~ ~ `~~
Qfl(''~N~`' ` (~(1f ~ T
December 5, 2008 ~U~•~~- ~ ,.~ , ~R,
~~
Pegister of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
In Re: Josephine E. Rebert, Deceased
Dear Register:
Enclosed please find an estate information sheet and original death certificate for the above
captioned decedent. All assets were jointly owned with the decedent's son, Kenneth F. Rebert,
and therefore no probate is necessary.
However, we would like to take advantage of the 5% discount for prepayment of the inheritance
tax. I am enclosing a check in the amount of $2,992.50 representing the tax prepayment for the
above captioned decedent. Please note the ostmark date to ensure ro er credit.
Please return a receipt to my office in the envelope provided.
Thank you for your assistance.
Sincerely,
~~~ ,
S. Dawn Gladfelter/Legal Assistant
/'dg
f;ncl.
130 W. Church Street, Suite 101 Dillsburg, PA 17019 • Phone: (717) 432-9666 (800) 682-4250 Fax: (717) 432-0426
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