HomeMy WebLinkAbout95-0071~, ~ -q 5- ~~7 I
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 ~ ~6 200T ? ~
Date Fran eropoli, ' act
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
M 105 1 M Rev. t/St
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ Q ~ „' ~ ,
CERTIFICATE OF DEATH
(Coroner)
NAME OF DECEDENT (FSSI, Mid0le. Last) SE% SOCIAL SECURITY NUMBER __ ~ DRE OF DERH(MOran.OaY•Wer)
1995
Januar
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e 3.043 - 18 - 7239 ..
,. Josephine B McKay fema
AGE ILeffi BirIMaY) UNDERIVEAR UNDERIDAY DRE OF BNiTN tKRflWI.A(.'E ICLY and PLACE OF DEAfH(Cneckany ane-aeeirrrucaons an anar side)
Monroe Days Hoes MImMe (MMm, Yer) Sri ar Faray, COUltry) IIOSPIAIL: OTHER:
New Haven . CT ImM:I. ^ EtLOrepsliere ^ DOA ^ ",,,,""'"9. ^ Rnaenaa~ (~ mn ^
May
Yrs.
7 2
19 2 2
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GOUNTV OF DEATH C BDRO OF DEATH FAGLRY NAME(a nq vuUXrtlan. pve saeel Arid rasnbar) rWS DECEDENT OF HISPINIC ORIGIN? RACE•American h,dbn,BMek, Wnas, riG
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Cumberland New Cumberland 427 Bridge Street M.aldn. PUrm Rken, ric.
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DECEDENT'S USUALOCCUPA710N KIND OF BUSINESSIINDUSTRY WAS DECEDENT EVER IN pECEOENT'SEIXICATION MAMAL STNUS-MemNd SURVMNO SPOUSE
WWOweO. ("wib.Ok+maiden ruO,el
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DECEDENT'S MAN.BIG ADONESS ($Ir,al, Gy/fin, Sbb,Zp Cods) DECEDENTS
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427 Bridge Street
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New Cumberland, PA 17070 onanssae) ,,,. Cu~r~nd '°"'""'°' ne.® wana.aiwll~Iaa New Cumberland
axylboro
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FNIIER'8 NAME IRA Midda. LasO - 6
MOTHER'S NAME,r ~. Mitlde. Maiden Surnrnel
Bessie
,~ Guy Williams „
"IFORLNNTS NAME MPwreei OFORAIANT'S MAaJND ADORE38 (Strer. Cily/kwrr. SIeM. ZgCade)
PA 17011
Hill
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29
Barbara McKa Geisel ,
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362 N.
LLE'ntooDFD1SPOSITION DREOFDLSFOGtrIDN PLACEaFDISlrostraN-Nemeac.m.t.r,crwrr«y LOCRK7N-CayYbrm,slMe,ZIPDade
B,".'p cromMbn^ RMavalOanSIW~ ^ J~aI•ll~]ary 17, 1995 Arlington National C~tlete Arlington, VA
Dorrallon^ OtAer l`a+aM
310.
BKLN/PIIRE ENSEE OR PERSOII ACMlG A8 SUCH LICENSE NUMBER NAME AND ADDRESSOF FACNJfY Part re Ftmer nC.
,,,. FD 012 849 L zra.
omlPMrllerrN19F0 c.dKVVta Toth hart of myluawMdpe.eeeM,acnersOri M. anre,arie anOPMCe striW. LICENSE NUMBER DRE SIGNED
War)
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Ilenrs lV-20 maw e. mnnletwM OF DEAfH prx. DIoEPRONOUNCED OEAD(Amr,O,, Day. War) rvAS CASE REFERRED TO E%M1BlERICO
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Januar 6, 1995 ,.
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-ART 1: Erew lM dMeeses.Yl)raMS Or NrrlpAeetlorn rAecb OMreeOOredeem. DO ml reerOle nah ddyap.M¢besaidbCa reapaalary amB.aMCk or beer) tYbve. (Appmsenrie PART p: gMrN0llacant mndtlaM,av4WAYrpmderin,W
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LY Oayoro uuean sets bu. ,Iriervd belWan rralnMrYeraNtlro rertlerf,Yra earree given in PART I.
i WMM and deem
B~IEOIATFG/dISE (Final I
~° a Occlusive Coroner Arter Disease
DtIE m (IDA AS A G]NSEIXIENCE OF):
BeaueNUN wtcandlalm e.
aany.Ieadrrpm erarreAate WETO(OR AS ACONSEOIIENCE OF): ~
Oerree. Enmr UNDEIILY[ND
G111EE(04eesa u sY.sY
ad'riiexsdevsnh C DUE TOIG,ASACONSEOVENCEOF):
rwltlrp n death) tA3T I
d.
WA8 ANAUTOPSV WERE AUTOPSY FINDINGS MANNER OF DERH DATE OFINRIRV TIME OF INJURY INJUM AT IMDRI(T DESCRIBE HONINJURV OCCURRED.
PIdiFORMEOt AMULABLE PRIORro (Marts. Oay. War)
COMP<Enot+oFCAUSE ~
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Hpnitlds .
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AcaMM ^ Perdrlg brvasOgatlon ^ M. 300. 30e.
.~ ^ Na ~ yH ^ IJO ^ PLACE OF INIURV • At lame, larm. risL lacbry, aaCe LOCIg10N (Streal, CilylTOxn, Stale)
suiciae ^ coaa r,a w,fri«mil»d ^ brrYdUlg, rte. (sPecily)
2k aeb. as. Sae.
CERTIFIER (Cheek artll' anal
•CENTIFYIIq INiYSIGAN (Physician cerNying Cause a de.m.d,en aramer MYSrJan has prmour,ced deem and rdnGNted Item 23)
^ SIONRU
Co r o ne r
re Mewaanwmra.ledye,d..Me«en.da»rots.a.M.(e)amen,.nn.r.eemra ..................................................... 3
LICE R DATE SIGNED (MOnm, Day, War)
•vRDnouNaNC AND t~RTIFrwG PHrsKaAN (Pnyesien hen w«,wcirq deem and eartarna a oaa,e a deem)
ar,d drre m Ure eaa.yaJ era nMrwr d,d,pe0 .......................... ^
COUmW ri BN IarM
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a•, NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DERH
(hem 27)Typa or Print Michael L. Norris,Coroner
'MEDICAL EXAMNiER/CORONFA
on M• Dolt m eaaminatlon ardor Mveriy.non, In Im opinbn, aeaM oecurted at LM Lime, Date, and Olga. and due to,iM oauee(e) and
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m.nn«..eL.tw ..................................................................................................
31a 3:. Mechanicsbur r Pa. 17055
.
REGISTMR'S SIGNATVRE AND NUMSER _
DATE FILED(Mmm, Day. War)
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:~si/.1'!d' O~__'~.1~'a1~e~1~~?q~ i.Y:_ ~r 1'tl~!!"".7~ 1~0. ~1 '~' ~~ '° d I
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Register of `Hills for the
-------_---- - Dsc~ased. County of ~~~~Eq~-AN(J ir, the
- ~~ -_~ ~x~j ~____~*s,~~ Commonwealth of Pennsylvania
','~.e p<'iitcn of the undersigned respectfully represents tha.i:
r .. for letters of administration
!,~.a. retui,~ner(s;, ~vho is/are 1$ years of age or older, appl.l°~,'~._-- on the estate of
(d.b.n.; ;:r';~dcrte iite; durante zbsentia; durante minori[ate)
the u^l`~o~ie ~t`re~J t'nt.
I3ec:endeni ~r+as domiciled at death in County, Pennsylvania, with
~:. ~~° _ last fa;niIy or principal residence at ~~~-- b6~
• (list street, number and municipality)
` r;c , _„ t ~~ ears of a e, died ~~ `~ , 19~,
t: deft;., hen . ._ >' ~,
~ecendent at death owned property with 4stimated values as folllows: ~•Z d d , !~ o
(If domiciled in Pa.) All personal property $-
(If not domicile.; in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County ~
'~lalu~~ of reai estate in Pennsylvania ~~ ~
situated as follo~~~s:
Petitic;ner_- after a proper search ha_-ascertained that decedent left no will and was survived by
.1..o 5.,11 r,,.,;nn cnnncr (i'F anvl and heirs:
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?'~I;/F,1=p'Q;~~, petitioner(s) respectfully ,request(s) the grant of letters of administration in the
a.pprepriate form to the undersigned.
~\`
Y~~
.7 ~~ RecorciF,{a_~?fi>`w~ of
'95 ,~~"f 23 P 2 :2~
The p°titio;~cr(s; ;above-nsimed swear(s) or affirm(s).that the ~~~~y_r` .~ R ,:~:'; CQUrf
st~te[raca:cs in the foregoing petition are true and correct to the best fiUrl'l~?~t ie3;14~ 1~0., f
of the knowledge and belief of petitioner(s) and titai as personal
representaiie•e(s) of the above decedent petitioner(s) will weA and
irui~• ~admsnister the estate according to lav+. f~. ~
S: ffir?rew'i and. subscribed __ ~ A ~ ~°`" ^
warn tc ~,;: s ~+
t~;~fcre ter: t?~is --.t•`~ ~~ dta o ~
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21 - 95 - 71
~s~~~ ~~ JOSEPHINE BARBARA McKAY _, I~C~tk
ANT ®F' I,E'g"I'~I~S ®F ~~NI~IISTIB,A-~®N
qq~~TT}}~~ w`''//yy~Y JANUARY 27, lg 95 , in consideration of the ~setitiozt on
d1i13J I9~J'Y7 - .n~ p
tl~e revers` si~e izereof, satisfactoryBARBARA M b GEi~EL t~ More me,
I'Y' lS D~C~,ED that
is/are eatitl~ to Letters of Administration, and in acxord with sock finding, Letters of Admaiaigtratiott
are hereby gr•tnted to BARBARA M. GEISEL
i'~ t'he estate of JOSEPHINE BARBARA McKAY
`~~ 25.00
Letters of .r~aniinistradon ..... S 1
Snort ~ertificates(5) .......... $ 5.00--
F.enc~rci~tiot! ................ 5 OlZ.
JCF ~
~~,.l~.y .....:)n~~UAR:L .27.,... A.l~. l9_3.~
~.~1 s1n_~.R..~t.., ~~~
Reuter of Wills
'r1ARY C. LEWIS
A'I1'ORNEY (Sup. Ct. I.D. Aio.)
AUI?ItESS
r~IOrrE
;'aired letters and order to Administratrir. on 1-27-95.
- ,~-._. ,m~,rt~da r may,; kn~~•al Try- .--l.r r»^n~H ~r'~;•q - :~`' +~~{~~j
.. .... ~''ti ~ n;;,T ~~'` ~L~~'•'~'7'9' '" ~o+~'~t+.'"'~3~°':'dt,,~';~ ~ ~ ~ r,C.{,' ~ r ',~' Y~
,~r ,T r, ~~oi~:ire ~ar'•~ar~~ I~Ir~Ca~~_~.____~..__----_.__._.~._~.__._ _ _r"~~:,~°J. S
G.~ atatrl n~~• ____ _ Ceu.ix~y, i?cnnsyiv:~.11a.
'' ~'{ ~ ice..,, .., iS. _.._. ~uia ~ .- i•iG.'~3y EialL~~E:ZD3r'E'L:~C' ii, 17aP_IIf1.ly,~.h~_.i4Y.Ei3 ____._.._.__.._ S;?
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r p~cif~31 ask93y t?~~t ~.rCY¢rs
? ~,c~a~, ~~ ry; ...? ,° c~ia?tn~~;s) Ll?~° ~avht t~:~ ac~m..ristef the e.,i2_e a-~d ~ Y ~
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dpi
i.3th day of ,Janaar~ i~ ~'; ``
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INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131191 CHECK HERE
P
^
,, ~ OVERTY CREDIT IS CLAIMED
;,~`,~ (~~ -. RESIDENT DECEDENT FILE NUMBER
" MMONWEALTH OF PENNSYLV NI (TO BE FILED IN DUPLICATE ~
~
1
1!
DEPARTMENT OF REVENUE 7 f
a ( Q J'
~ ~
1
URG
PA 671 WITH REGISTER OF WILLS)
HARRIS
,
28-0601 COUNTY CODE YEAR NUMBER
DECEDE 'S NAME (LAST, FIRST, AND MIDDLE INITIALI
~ DECEDENT'S COMPLETE ADDRESS
S v~T/ ~Q [- (/
~~ ~~
~~
~
~
(
Z
W
W IAL URITY NUMBER
~ ~ B ATE OF TH
i'
~ 5 ~s DATE OF BIRTH
3 dq -'a a-
Count "~ v
`
µ'~
Z~
~
I
, ~V Wl"`^~""~+7'v~ p r aV
p APPLICABLEi SURVIVING SPOUSE'S NAME (LAST, FIRST AN
~i IDDIE INITIALI SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONSi
. ~~
~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
x a Y
wd~+
^ 4. Limited Estate
^ 4a. Future Interest Compromise (for dotes of death prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
~ a m (for dates of death after 12-12-82)
a ^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
ALL C ESPONDfNCEA~ia CONFIDENTIAL TAX INFORMA~gti;:5H $E:DtRlsC1RED TO: -
o
~~~~ dd -
COMPIETE MAILIN
A
DDRESS
~
r
va LEPHONE NUMBER
l 7Ro ~ / ~ ~ l.~A'Y~ ~~` ~~ /`_
J/1~J
1. Real Estate (Schedule A) (1 )
2. Stocks and Bonds (Schedule B) (2 )
3. Closely Held Stock/Partnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4 )
5. Cash, Bank Deposits & Miscellaneous Personal Property ( / ~ _
Z (Schedule E)
6. Jointly Owned Property (Schedule F) (6 )
4
~
7. Transfers (Schedule G) (Schedule L) (7 )
a 8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses
Administrative Costs
Miscellaneous (~ ~~ !~ O (g) ~ ~~~j
,
,
Expenses (Schedule H) / _ -""'
10. Debts, Mortgage Liobilities, Liens (Schedule I) (10) ~ ~~~ ~
11
T
l D
d
i
l
~~ .!~ ~~y/ {,,,c (~ '~
.
ota
e
uct
ons (tota
Lines 9 & 10) ,
,
12. Net Value of Estate (Line 8 minus Line 11) ~ /~
~ ~ ~ '
~ y (12) O , .f0
/~
t ~
13. Charitable and Governmental Bequests (Schedule J) T ~ ~ ?
14
N
V
l
`
(13) ~-_
~ : '
.
et
a
ue Subject to Tax (Line 12 minus Line 13)
•~ f (14)
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse (15r. /
-_=
x
Side. (Include values from Schedule K or Schedule M.) ~~
l ;
16. Amount of Line 14 taxable at 6% rate (16) \' "--`~ x ~b~.= '-~`
(Include values from Schedule K or Schedule M.) ~,
17. Amount of Line 14 taxable at 15% rate (17) x .15
z (Include values from Schedule K or Schedule M.)
c
a 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (lg)
a 19. Credits Spousal Poverty Credit Prior Payments Discount Interest
a 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20)
~ ~ ^
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21)
A. Enter the interest on the balance due on Line 21 A. (21 A)
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 B)
Make Check Payable to: Register of Wills, Agent
--- ~)' 8E Si1RE TO ANSWER ALL QUIaSTIC1MS OIII RElit `fe~3E SIDE R?+fD 70'REL~FK 1G~AT#f ~ ~
Under penalties of perjury, { declore that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
based on all information of which preparer has any knowledge.
3RETURN ADD E S DATE
JTATIVE ADDRESS DATE
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°k (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02) 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.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (r) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
a. retain the use or income of the property 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 'in 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.
~ REV-~~508 EX+ 12-87~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEQULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
E
Please Print or
(All property jointly-owned with fhe Rltrht of Survivers6io ~n..s~ 1.. ds..l...~a ..., e.~e~..~_ e~
;~..a
r
~ REV-1511 Ex+ (7-88(
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ITEM
NUMBER DESCRIPTION
A• Funeral Expenses:
1. ~'
B• Administrative Costs: / ~
1. Personal Representative Commissions S~ ~
Social Security Number of Personal Representative: /7~ -~~' - °~i ~ J
Year Commissions paid
2. Attorney Fees /~^
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees ~:'
C. Miscellaneous Expenses:
1
2
3
4
5.
6.
7.
8.
AMOUNT
TOTAL (Also enter on line 9, Recapitulation) $`~~,~7
(If more space is needed, insert additional sheets of same size.) ~/
Please .Print or Type