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This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
AUG 16 2001
Date
H70&.1~3 Rev. 1197
TYPEIWDNT
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PERMANENT
BLACKINK
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS j ~ (~ vj ;~
CERTIFICATE OF DEATH
~ -
NAME OF DECEDENT (Fr9, Midrib, LEeg SEX SOCIAL SECURITY NUMBER DATE DEATH (M«qh, Yeer) n
+• zMale ~• 173- 36 - 7864 ••~ E ~~%
AOE(laet Biredey) UNDERtYEAR UNOER1Dp
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COUNTY OF DEATH CTN,BOR0,7WPOF DEAR FM: (h noL GvemreM and number
~ / NNSrr~D~ppECEDENT OF HISPANIC OfY61NT
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E RACE-Mrsdwn 4idn. Bbtlr, WhMe. Mc
(SPedly)
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yM, epscey Cuban,
M..Inn.P~m,PoRl~.n.«~. ,o. White
DECEDENT'S USUAL OCCUPATION qND OF BUSINESSANOUSTRV WAS DECEDENT EVER IN DECEDENT'S EDIiGOION MARfDLL SDPUS-Mardad~ ~ SULMVXXi SPWSE
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„- ,~, Married „• Charlotte L. Huf
DECEDENT'S MAXJNBAWgE3S(SbM.CAylfown, slme. Lp Cede) iECEDENT'S Penns lvanla
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506 Terrace Drive .
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RESIDENCE a.oed.d
New Cimberland
PA 17070 [7; ~~
Cumberland """°"'pT
New Cumberland '
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FATHER'S NAME (Fetl, Midge. Lang MOTHEWS NAME (Fret, Midge, Meidsn S«rurrw)
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XiFORMANT'S NAME(Type~Prea) INFORNAHT'S MAIUNO SS ISeeel, Cily/f ,Sme, Zip code)
20a taw 7
METHOD OF OI.SPOSRION DATE OF DISP091TION PLACEOF 019POSfT1ON-Named CSmmmx Crmrml«y LOCATION-CXyR ,Sbb, Zlp Coda
Crametion ^ Rarrwval hom SUb^ (MmXi, Day. yeerl «OIMr Pbu
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2,a. 2,b December 16,1994 etc Indiantown Gap Nat' 1 ~~'lanover Township, Pennsyly
FU sERVX,`EL E ACTXNiASSUCH LICENSE NUMBER - NAME ANDADORESSOFFACILfTY re a nc.
22b- 22a
Xerns 27ec ody Mlen urlXYirtg To Xm bMld ,daaXl ocaer ", daNeMpba sblW. LICE NUMBER DATE SGNED
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(MOnn.Dar.ysar)
das.m 7
27i A-LVU.y 2w. ~ 5 ~(~ yl[2 _ ~- zx.
~ceIA.L ~ 1~ 199
Xenr 242&rmulMCampNtW b'y TIME OF DEATH VNS CASE REFEiWED TO MEDICAL EXAMINERICORONER7
parson Ma Pmraurase deem.
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Za. G^ M. 20. te.
t7. PARTI: EmmtM dbweea.Xtj«ise«mmplieati«u wNdl wraW ale demh. DO nol enlariM eadsddyep, as cerdlacarsepkal«y arrsel. ebock«Marl bYUre. rApproalmeu PMNT 11: gMrslpniflcam wnNtiwro oodrDulingPodNtlr. bul
IJm ody erie puss an each Nns. ~ bterval balwaan rat rMUearg br IM underlyrty7 cwr gI+•n Nr PART I.
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MIEOMTE CAUSE (Foal
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_ (gip ~ r f e vl s ~~c v~
DUE TO ASA COIISEOUENCE OF): `
SaQuenaab lbt crorrgaom b. Lr ~G~L - Q
Xarry, begrp b imrrwgate DUE 70 (OR AS CONSEQUENCE O
crma. Enbr UNDERLYING
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ertl eiliebd everRS DUE TO IOR ASA CONSEWENCE Off:
resueng n Deem) LAST 1
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VaOS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF pEAOi DATE OFINJURV TIME OF INJURY INJURY AT WORKT pESCRIBE IIOW INJURY OCCURREp.
PERFORMED? AMVLABLE PRIORN (MOnm, Day. Year)
T CAUSE
F DE
T ~y
NeturY L'l lbmicid
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O e Ysa ^ No ^
Amfdard ^ Pending lnvemlgauon ^
Yas ^ No
Yea ^ No ^
Sukide ^ CouM nd M d.termbsa ^ 30a 7gb. M. 30e. 700.
PLACE OFINJURY - At Mme, farm. creel. bdory, duce LOCATION (Street, Cily/TOwn, State)
buagng, e,e. (SpecJyl
21b. 29. 30a. 301.
CERTIFIER (Cliete oMy one)
' SK3NATURE OF CERTIFIE
CERTIFYIINi PNYSN7AN (Physwn cenilyirg cause d dmn Mien andhp pnyscbn has ponounced death arq campbletl Item 231
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31b. V
LICENSE
NUMBER
GATE SIGNED(M«M,
Da
Y, Yaar)
'PRONOUNCING AND CFATIFYING PHYSICIAN(Physiuan boN prora«rcing death and cedeying brauseddeam)
To tlN beN O, my knowbdgs, dsam•CCluasd NUU tAna.daM, and pleas, arM dw t•1M eauas(s)erW manrwwslabd .......................... ''// ~~((,,,, ~`'/
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31C. VS ~'~fRS ~~ - L" 7,d. /Hi~r ~`h / 1T ! Y
NAME ANO ADpRESS OF PERSON WHO COMPLETEp CAUSE OF DEATH
'MEDICAL E%AMNiEWCORONER (Item 27) Type «Pdnt
-.i D/C.
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On Ula baala o/ e:ambuHOn sndfw inwetlga,bn, in my opinbn, GaM occurasd N tlIa time, da,a, and pbcs, aM due Lo tlr dace(s) aM ^
manrur as MsIM ~
Ha f ,-eS b «r 5 ~ ~-("'1
.......................... ........................................ . .
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REGIST 'SSKiNATI/REANDNUMBE ,IFy^ ~) / DATEFlLEDMOnm.Day,Year~
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~~~'I~'~®IV ~' ®I~ G~I11~' 101' ~~' ~'~']E~~ ®F' ,~~1MINISTItA"T~®1~1
William J. Eisenhauer No. ~~ ~S `'~~
Estate of _
also knobvn as To:
,~ Register of Wills for the
;. Deceased. County of Cumberland in the
Socsal Security No. 17 3 - 3 6 - 7 8 6 4 Commonwealth of Pennsylvania
The pe!ition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appLles for letters of administration
en the estate of
(d.b.n.; pendente lire; durant° absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Cumberland County, Pennsylvannta, with
his last family or principal residence at 5 Terrace Drive, Borough of
- New Cumberland, Pennsylvania pint street, number and municipality)
Decendent, then 49 years of age, died 14 December , 19 94 ,
at Harrisburg Hospital, Dauphin County, Pennsylvania ,
Decendent at death owned property with estimated values as folllows: $15 , 000 .00
{lf domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County gNone
Value of real estate in Pennsylvania
situated as follows:
Peti±ioner_ after a proper search has _ ascertained that decedent left no will and was survived by
,c,n Fnllnwino cr,n„se !if anvl and heirs:
Name Relationship xestaence
Cha~•lotte L. Eisenhaue s ouse 506 Terrace Drive
ew Cumberland, PA
Michael Eisenhauer son 340 Dorwart Circle
Etters, PA 17319
Kristie Eisenhauer dau hter 340 Dorwart Circle
lEtters, PA 17319
070
Ti-IEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
~~ J HA LOTTE L. EISENHAUER
ao 506 Terrace Drive
ti~ NeF~ Cumberland, PA 17070
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'1'h;: ~~titir'z7C'r(>; <.,avc-named svrear(s) or affirms} that the
St~tCrTiC.^+C5 IY2 ?i~c iu,ugoing petition are true and correct to the best
of tine !:Hoe: ieclv,e end belief of petitioner(s) and that as personal
representative(s) cf the above decedent petitioner(s) will well and
truly adn:inisier the estate according to law.
Sv~orn to ar affirnZed ay-~d subscribed H
., ~ a otte L. Eisen aue- ~
before :re this~_ ~~?~_,~.~ daY of
I~1~,
21 - 9 5 - 6 6
., ?~?TL,LIAA'I J. EISEI~HAUER ~t~~~~3~~
'rg, `~ ti H
JAfJUARY 25, 19 95 in consideration of the petition on
At~.P> ~ICrr: _
the reverse side Hereof, satisfactory pproof Having been presented before me,
I'~ 'S ~?Ef:R°Ei3 that Charlotte L. Eisenhauer
is~~,rP Qnr,rtRd to Lc;ters of ~dminisiration, and in accord ~.vith: such finding, Letters of l~dministraticn
a;ehurebygr^;~±.~cste~ Charlotte L. Eisenhauer __
-- ^, i tam isen ,aF uer-`
in the estate of
~'~.c:S
Letters of Facir^iristr~tion ..... ~ 50.00
Short ~eTt1T1C~.teS~) .......... $~~Q
2enttr-ciatio ................ ~
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I,~~i:ter flt i>?, l1
Mr~R'd C. (.Er,IS
George A. ~laughr., III (25i75Q )
---ATTORiNEY (,Sup. Ct. I.D. tVo.)
5?5 N. 12th Street, Lemoyne, FA 17043
AYlDRESS
(717) 761-5351 ,~
PHO*IF
f^"..ailed ~~tta~°s z^d order to attorney on 1-26-95.
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___.-- (-t?n~.~ j------._...
r,;,,,; Tf; ~,~rtt @.~ Charlotte L. Eisenhauer ___ -.__ _,.__.._. •
~ d'r.i~~tvtase ~~ i;~.0',i'~r:~si~1.:i R. ~ v~ ...~~ic~lrr6~ ia~ c 1a~2• t'.:catrta~!':l ~
:~ i. X06 Terrace Dr. , Flew Cumberland, PA_ 1_7__0.70-0361
nta February _~4 1995 -_
t; fa $ n:vrai-~
Evelyn. L, 0 iz, Collec n Superv:Csor
>a'~ ,.. P.O. 1~ox 590, Uniondale, riY 11553-.9404
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1. Real Estate (Schedule A) (1) SL/A
2. Stocks and Bonds (Schedule B) (2) N / A
3. Closely Held Stock/Partnership Interest (schedule C) (3) N / A
4. Mortgages and Notes Receivable (Schedule D) (4) N / A
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (5) 2 1 7 5 . 7 0
z (Schedule E)
6. Jointly Owned Property (Schedule F) (6) N / A
a
~
7. Transfers (Schedule G) (Schedule L)
(7) -
N / A
8. Total Gross Assets (total Lines 1-7) (8) 21 7 5 . 7 0
9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 9 9 21.16
Expenses (Schedule H)
10. +ebts, Mortgage Liabilities, Liens (Schedule I) (10) N / A
11. Total Deductions (total Lines 9 8 10) (11) 9921 , 16
12. Net Value of Estate (Line 8 minus Line 11) (12) 01
13. Charitable and Governmental Bequests (Schedule J) t~ ^""
,
" (13) QJ _
14. Net Value Subject to Tax (Line 12 minus Line 13) ~ ~~~
7
~ (14) Ol
15. Spousal Transfers (for dates of death after 6-30-94)
I
$
~
ee
nstructions for Applicable Percentage on Reverse (15) x =
Side. (Include values from Schedule K or Schedule M
) . -
-
.
16 Amount f L' 14 bl -
REV-I~l;" tA+ (/-Y41 k' ` res'
T' ~:
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INHERITANCE TAX RETURN
FOR DATES OF DEATH AFTER 121 191 CHECK
IFASPOUSAL
D
"
RESIDENT DECEDENT ^
POVERTY CREDIT IS CLA
"
COMMONWEALTH Of PENNSYLVANIA
DEPARTMENT Of REVENUE
(TO BE FILED IN DUPLICATE FIL
NUMBER
z ~ ~
DEPT. 260601
HARRISBURG, PA 17126-0601 WITH REGISTER OF WILLS) "
~~~
COUNTY CODE YEAR
' NL
DECEDENT
S NAME (LAST, fIRST, AND MIDDLE fNITIAI) DECEDENT'S COMPLETE ADDRESS
P.O. Box 361
w r SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH N e W Cumber 1 a nd , PA . 17 0 7 0
W 173-36-7864 1 2/14/95 11/04/46
W count
p (If APPLICABLE( SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED ($EE INSTRUCTIONSI
Eisenhauer, Charlotte L. 232-82-8889 bankrupt estate
~ ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
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^ 4. Limited Estate (for dates of death prior to 12-1
^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Re u
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a (for dates of death after 12-12-82)
o_
a ^ 6. Decedent Died Testate
Attach co of Will
( PY ) ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit B
(Attach copy of Trust)
~ AL~~COk)tESPbNDE
. ~1t+~Fbf2MATION SHO`~~._ BE. 1REGT~ .~, ~-~~•~'
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wW NAME CCiM~LETE MAILING ADDRESS ~-- -
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~ o Carl E S
TELEPHONE NUMBER 201 York Rd.
a_ 717 774-2500 New Cumberland, PA. 17070
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0
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x
a
o Ine faxa eat 6% rate (16) f~ x .06 =
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rote (17) ~ x .15 =
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
19: Credits Spousal Poverty Credit Prior Payments Discount Interest
# t
?0. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
!1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the balance due on Line 21 A.
B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE.
Make Cheek Payable to: Register of Wills, Agent
Under penalties of perjury, I declare that I have examined I
it is true, correct and complete. I declare that all real estate
based on all information of which preparer has anv knowle
(18) _~
(19) _~
(20) --~
(21) _~
(21 A)
(21 B) _~
~~ • ~S;`C1N REVERSE SIQE>ANDTO RECffECK~M1~ `;~~~~~ ~ ~ ~-
return, including accompanying schedules and statements, and to the best of my knowledge and E
s been reported at true market value- Declaration of preparer other than the personal representat
!.
DATE
~ 1 D~ ~~~ic. ~~ ~r~n t~ton 6~1~' ~-~~{~
' DATE
~~ (1Pu~~'ym~y~~~~~ ~/~ 170"7 ~ I ~ Z
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Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
• 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02j will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1°~ (.O1) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
BY PLACING AS CHECK MARK (~Oj IN TH APPROPR ONS
ATE BLOCKS.
l . Did decedent make a transfer and:
a. retain the use or income of the ro
p Pe~Y transferred, .................................
. .......................
b. retain the right to designate who shall use the- property transferred or its income, ...............
• c. retain a reversionary interest; or .............
................................:...............
d. receive the promise for life of either payments, benefits or care$ ..................
. .....................
2. If death occurred on or before December 12, 1982, did decedent within two .years preceding
death transfer property without receiving adequate consideration$ If death occurred after
December 12, 1982,. did decedent transfer property within one year of death without receiving
adequate consideration$ ....................................................................
--
3. Did decedent own an ''
m trust for'. bank account at his or her death$...........
...........................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE.. SCHEDULE G AND FILE IT AS PART OF THE RETURN.
r
REV-1511 CXa 17-88J
' SCHEDULE H
*~,_
>K - .~.
~~ ~ ~ ~` FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN MISCELLANEOUS EXPENSES
RESIDENT DECEDENT
ESTATE OF
William J. Eisenhauer
ITEM
NUMBER DESCRIPTION
~-• Funeral Expenses:
Parthmore Funeral Home, Inc.
~' 1303 Bridge St.
New Cumberland, PA. 17070
C.
City State Zip Code
B• Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative: _
Year Commissions paid
2. Attorney Fees George A. Vaughn III
525 N. 12th St.
3. Family Exemption Lemoyne, PA. 17043
Claimant Relationship
Address of Claimant at decedent's death
Street Address
4. Probate Fees
Miscellaneous Expenses:
1. Government overpayment
1403,80
s
6
7
8
TOTAL (Also enter on line 9, Recapitulation) I $ 9921 16
(If more apace is needed, insert additional sheets of same size.)
Please Print or
AMOUNT
6826.80
1690,56
f
r
+ REV-1508 FyX+ (2-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ES
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
William J. Eisenhauer
Please Print or
FILE NUMBER
(All property jointly-owned with the Right of Survivorship musT be disclosed on Schedule F)
(Attach additional 8'/a" x 11" sheets if more space is needed.)
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REV•1500 EX+ (7-94) t' / U C! +'+~ `~ ~J " ~.-~ FOR DATES OF DEATH AFTER 1 Z131191~`HECK HEF
INHERITANCE TAX RETURN iF A SPOUSAL
^
POVERTY CREDIT IS CLAIMED
RESIDENT DECEDENT FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE ' ~l ~ ~~`-, ~~
~~~X
~~
B
ERG WITH REGISTER OF WILLS) r
HARRIS
, PA
12B•0601
U COUNTY CODE YEAR NUMBI
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIALI.
' DECEDENT'S COMPLETE ADDRESS
i P.O. Box 361
z SOCIAL SECURITY NUMBER DATE OF DEATH i DATE OF BIRTH /IV e W Cumberland , P A . 1 7 0 7 0
173-36-7864 ~ 12/14/95 11/04%46
c°Dt1~
p (IF APPIICABIE) SURVIVING SPOUSE'S yAME (LAST, FIRST AND MIDDLE INITIAE)
/ SOCIAI SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
Eisenhauer,
Charl
- otte L. 232-82-8889 bankrupt estate
~ Original Return
1. ^ 2. Supplemenfol Return ^ 3. Remainder Return
Yaw (for dates of death prior to 12.13-8
,;; a ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
_ ~ °
U (for dates of death after 12-12-82)
a m ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxe
(Attach copy of Will) (Attach copy of Trust)
ALL CORRESPONDENCE;'AND q~FIQEN1f~At`,T, . ~ ,p~ T ION S O (.D, BE DIti;EGTED TO:
y Z NAME COMPLETE MAILING ADDRESS
C rl E S ~
, 2'01 York Rd.
~O~ TELEPHONE NUMBER ~ rF ~~
` jQeTp] Cumberland, PA, 17070
717 774-2500 ,~°
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1. Real Estate (Schedule A) /
2. Stocks and Bonds (Schedule B) }r1
3. Closely Held Stock/Partnership If~. e~
4. Mortgages and Notes Receiva~
5. Cash, Bank Deposits B~Miscell neous
(Schedule E) ~
b. Jointly Owned Property (Sc dfule F)
7. Transfers (Schedule G) (Sch Jule L)
8. Total Gross Assets (total LI ~s -7)
9. Funeral Expenses, Adminis a 've+~Co3
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (~~k•
11. Total Deductions (total lines 9n~~
12. Net Value of Estate (Line 8 minu Lin
,~--~,
13. Charit a and Governmental Beq
14. N Volue Subject to Tox (Line 1 i
chedule J)
' e 13) r~7`f(s • OC? )
(8) 2175.70
1111 9921.16
(12) _ {~
(13) ~
1141 _ A
15. S ousal Transfers (for dates o de h aher 6= -94)
e Instructions for Applicable ntage on arse (15) ~ x._=
S de. (Include values from Sche ~e K or Schedule M.)
16. A ount of Line 14 taxable at b%~ate (16) ~ x .Ob =
(Inc de values from Schedule K o Schedule M.)
17. Amoun' f Line 14 taxable at 15% .ate j17) ~ _x .15 =
(Include va s from Schedule K or chedule M.)
18. Principal to ue (Add tax from Lin s 15, 16 and 17.) (18)
19. Credits Spo~'~1"Poverty Cre Prior Payments Discount Interest
+ + - 19 ~
(1) N [~1
_
121' N/A .
e ule C) (3) N / A
I D) l4) N/A
sonal Property (5) 2 1 7 5. 7 0
lb) N/A
(7) N/`~
Miscellaneous (9) 9 9 21.16
N/A
~Fle I) (10)
20. If Line 19 is greater than 'ne 18, enter the difference on Line 20. This is the OVERPAYMENT
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the balance due on Line 21A.
B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE.
Make Check Payable to: Register of Wills, Agent
( ) --
(20) _ j71
(21)
(21 A)
(21 B)
~ y FiE SURE TO ANSWER ALL.Cl~ES~TfONS ON REVPRSE SIDE=AND 70 RECHECK MATH ~ t
Under penalties of perjury, I declare that I have examined this return, including occompanying schedules and statements, and to the best of my knowledge and bell
it is true, correct and complete. I declare that all real estate has bean reported at true market value. Declaration of preparer other than the personal representative
DATE
.' ~
DATE!
~ ~ ~~~~
~'
. ~.,
REV-1511 EXr I7-R8J
~;.;~
~
SCHEDULE H
~~~!~,~,:` FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISCELLANEOUS EXPENSES
PI@a5@ Print or Type
ESTATE OF FILE NUMBER
William J. Eisenhauer
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funeral Expenses:
Parthmore Funeral Home, Inc.
~• 1303 Bridge St.
New Cumberland, PA. 17070 6826.80
B. Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees George A. Vaughn III
525 N. 12th St. 1690.56
3. Family Exemption Lemoyne, PA. 17043
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees
C. Miscellaneous Expenses:
~• Government overpayment
1403.80
2.
3.
4.
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) $ 9 9 2 , 16
(If more space is needed, insert additional sheets of same size.)
ld
M1
. sMa~
r REV-1508 EX+ 12871
,.
.~ ,~
.~. ~,,.
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
IAiE pF
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
William J. Eisenhauer
(All property jointly-owned with the Riaht of Sorvlon..6c......... ~_ ~:__~___~ __ .. ~ _.
Please Print or
FILE NUMBER
pennsyLvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAINHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE.VEel� fq'D TFICE OF
PO BOX 2806 STATEMENT OF ACCOUNT
HARRISBURG PARDF8LMj-0l--
,:._
"1 1 , F
,,,B 17 13 DATE 02-09-2015
L ESTATE OF EISENHAUER WILLIAM i
DATE OF DEATH 12-14-1994
G L F.R OF FILE NUMBER 21 95-0066
') C,c,1,'".T COUNTY CUMBERLAND
SNYDEVS �r CARL % E
ACN 101
2010V67ks RD' Amount Remitted
NEW CUMBERLAND PA 17070
MAKE CHECK PAYABLE AND REMIT PAYMENT TO;
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure 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 --- -- --------- — --
—
- O� i6C70;Af
REV-16Q7 Cx- -AFP (I2-14)7 ---- -ii�"i i f-FA7N E i TAX STATEMENT
ESTATE OF:EISENHAUER WILLIAM J FILE NO. : 21 95-0066 ACN: 101 DATE: 02-09-2015
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. 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: 04-21-1997
PRINCIPAL TAX DUE: .00.
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (—)
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.