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Home My WebLink About95-0078~I R5~C0~ 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 20Q1 Date M105.,13 Rev. 2/B7 TYPeJpRINT w pERYAMEMT eue~ BBc O`' 2 ? • Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYWANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH X988^6 NAMEOP DEDEDEN,(FYM, MNW.L.ve) soausECURm NI111BER ~~ OREOF DERH pAmfi. D.y, raa,l +. Joanne M. Fagan :Female x1 98 - 22 - 7898 .. /V -. 9y ~ ADE 8er8MtlaY1 uNOeR1YEAR uNDE11, DM o/aEaPeB+rN elRrlstnce(cM«a PlA[ias DERM~CArcF «iN one-rNNnA:bera,olh«ai0ej MaMr = Days Ilan I MNrw (Mo,O~. aY.~ gab«FaNiCunbq 81 Yr. Aug.19,19 3 Harrisburg, ^ +^ DDJ1^ „"~°~ ^ ^ DouNnaPDERH an:BDRD,TwPOPceICII rACatrrIMMENno1NYEbm.Dr..,traelerran~ asNlaRnBCOngwa RACE-ArakrNAr,BbcA,Wnae,ae. Ne w.^Myr.epruy Da,r. RPac~9 • ~ Cumberland Middlesex Twp. Cu•t J R/ .-~ r White "'°'°"' """`a` , 70. . DEOEOfM'B UBIIK lDluaFel>awEeBIBIDUBTnr MNB DECEDGIIEVER BI DeceoeNraeoucJBioN ~ ~ rol...l.~ea.ake.. mcr u.s.ARMED Na Iap Wlm +n4 ma ) a.awYq~aana °ur"~a~wE ) ~~~ . , Homemaker , Own Home , "'^ "°~ ~ g ~+~ (1~> ,AWidowed , oECEOEHr'°`a`N°AOwIEa'rs..a'a"w,"`sra'a°°°°y °EKrs ,,. sue. Pennsylyania Middlesex „~ . DN wa,,r.a.,,,,,,,,N 375 Claremont Dr. ResIDENDE ,.r,,,,, eap. Carlisle, PA 17013 ~° /~ Cumberland Mr'~'"p' „a^, rea ~ R arlER~s RAME tr+x MiEEIa, wn John R. Buchinsky MorHErca NAME pant, Mow. MYtlen sarm.) , Justina Folvar uIFORMANT'S NAME RYWPiNq pPORW/I,'B MAILUq ADORE98 Berl CYy/forn, StW,11DCOEq Dianne L Fa a . n 506 Indiana Ave.,Lemo ne,PA 17043 McTHOD OP D/8E OF016POSITgN PlACEtJF -Nre.a4aaa«y, Ci«nawy ,ODAUtoN-cayrkwn. stab. LPCCEa •OtN•H«) «OIIrrPbaa Cweleuon^ RNnwY but St«a^ ^ Oonauon^ =,a Oct.10,1994 Rolling Green Cemeter `Camp Hi11,PA 17011 oPgnIERAL aR PeRBDN~cnNDASSUCa, uceNBe Nt1,ABeR ~ NAME ANDADDiFSB aF FACRITY ~~"L._--- FD-013163-L 9usselman Funeral Home Lemo ne PA pgaNw b~i«~alumaaMW~b burW~^~'l•t••+•~•~ « ,Eabaal Place ataaE. LICENSE NUMBER DUCE 910NED ar aWMaraaaeaan. , ~ `~ / ~~ pJOM.Dax ~har~l 2J tletr242B xwr b•••epbrEM OFDE/BN IMaAt. ~ vwB CASE REREAREDTDMeacu EXA~BNERMgppNE117 M. ~B G 9 ~^ ~~ n. PAR.i: Ea«maal•.aa...IAIteW« Lla orl'erfi~mww iyrAtP~~au•n•r,ucl~aaare ur Ewa. DO na wl«urer0aa0yYp, aucnraawc« anr, ah•ck «nwt Nun. iAgxoanae MRf B: Otlr NpYlkrlawrNbrmMWtlrgb daea~AR n01 nruMnBN tlr aaiaryYpuYryNanNPMTI. BBIkDW[CAUBE IF•W iaaat rte a cation I rwArC NEwml-+ Ol1E lD(OFi ASACONSE tom: ~ ~ P~ rtte, b~ ' Duero ~'~~~ (Oil ASACONSEOUENCE OF} I t:AWltDi«ra«:yry o. - i uW aiaraE •w^b Dl1El0(ORAS A CONSEWENCE qF} reiYq n Eaeml WT , E NMB ANAU7CIPSY AUIOPSV PINDM08 MANIER OP OERH DQE OFINIINIY TIME OF INJURY tNJURYRMARN? DESCRIBE /10tN INJUi1Y OCCURRED. PERFORAED? ANLABLE P,uORro pAaW, DaY. IY«) cOMntrgNDPDAUSE aF DER117 Naha HomkMa ^ ACCMrA ^ weaap Nveatlpagn ^ Yn ^ No ^ SYa ^ N•~' Yw ^ ND ^ 9ukpa ^ CaeE na Ee EalennbaE ^ M. PLACE OF INNIRY-N hang bnn etrM ixtaY oBlar LOCRIO , , , . N fSa••L CM/torn. Sfaro) 3w. M. ai6W' ae ISD•cay) ]ea. Sal. C791'PiFB1(CTratany one) SgNRDRE ANOTIRE IFlER ^ •CERTIFYtaB//R7MTAN(Wryacrn osnlyNa,r„saaaravEw~.roma,y,ya~aen tra Pano~awaE Eeaa snE axnplaeE aam zs T u /y{,'I^//(/, o laeaaaay brrre0a, eaaw ecpewurwbur anryp Mr«rr«r«Nw ...............................~..................... ^ ~ 0. y~E~ '+I~~rr.rEa•O.e..noaa.B'"`.r.a~i..°.;m `~`"~OE.ama~E~«mY:pN~.u,.aE.w,l ~ ~E"~V C~' ~y ~ DRESgNEOIMar.. .n«I PMr. rtl Er b Mearga) ane arrrr aa.e .......................... 71 . 1 o,E. NAME AND ADOFiESB OF PERSON W110 COMPLETED CAUSE OF OF QN 'MEDICAL OIAYBB!'AMORONER (lam 27) Type «PrIM On MIe brie alex«nYrlbn anAlor h^'••uYabn, b t^Y opinion, Matlt a:~vtnA M tlr tlme, wte, rM plau, «M dtr b tlt• cu+wla)«M ernnww«e1W ^ ...................................................... i,a. ............................... >z. EO 'S SgNQURE AND DRE FILED(MOnN. Day.'ner) /" I I I~F'I'I'~'IDN F®It GItAN'I' DF I,E~EItS ()F ~Dl~f[INIS~'ItATION Estate of ~~~~~.1~~~~ (C1 ~/~ also known as Decease . Socia! Security ~Vo. To: Register of Wills for the County of CUMBERLAND in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners}, who is/are ]S years of age or older, apples S for letters of administration on the estate of (d.h.n.; pendente life; durance absentia: durnnte minoritate) t'tle abo^^JC dcCt'dent. Decendent was domiciled at death in Sl~~y~ ~DI f R Cod n~: Pep nsylvaniay~with E~Q V I E p/9 ~ _ h~f last family or principal residence at ~.~ r r t '/ -J- gist street, number and mutrl'cipatity) ~ 7~7 Decendent, then ~_ years of age, died /~ t'' Td ~ ~R ~o , 19_Z.~, at_~~~~i_~I~f3/1i,7 ~'oU1.Y~'Y ,l~y,L S/N- ~ m~ Decendent at death owned property with estimated values as folllows: ~~ ~ ' T $7e (If domiciled in Pa.} All personal property o (If not domiciled in Pa.) Personal property in Pennsylvania $ {If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioners after a proper search ha~l.~ ascertained that decedent left no will and was survived by t'rc following spouse (if any) and heirs: %, ame ~ ~ U ~ ~Relationshi ~ esidence -,~-~'1~ f, 36. 1~~1 /7/102.. ~o ~,~~ P~ ~70~3 THEREhORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. a ~ _. ~.~ ~` ~ ~~ _ ~ v ~ -- .~~ -~ ice--- !~ - /~~ _. , . ,r U , ®AT~ OF PERSONAL REp'R~SEN1 A'g'IVE GO1~ON~VEALT~I OF PER,'NSI~L~ANIA ~ ss ~®~N~~: OF ~,llMR~.RLAND The petitioncr(s) above-named swear(s) or affirm(s) ,that the statements in the faregoing petition are true and correct to t~5e best of the lcnowIedgc and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~ Sworn to or affirmed and ss~bscribed before one this 25TH i ~y of C. L E W I 5 Register NO. 21 -95-78 ES$~ ®$ JOANNE M. FAGAN , TD@CCASC~11 GRANT OF LETTERS OF AD~IINI~'I'RATIUN h .~ AND NOW FEBRUARY 1 , 19 95 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED Wet DIANNE L. FAGAN and JUDITH A. TONKOVIC is/are entitled to Letters of Administration, and in accord with such finding, Letters of Adutinistraiion ca are hereby granted to DIANNE L. FAGAN and JUDITH A. TONKOVIC . in the estate of JOANNE M. FAGAN , .. Regiata of ilia MARY C. LEWIS `. FEES Letters of Administration ..... S 25.00 Short CertlflcateS(~ .......... $ 9.OC) ATTORNEY (Sup. Ct. [.D. NOJ Renunciation ................ S JCP S 5_nn TOTAL _ $ ~ q - ~~ ~D~ Filed .....,JANUARY . 25.,... A.D. 19_.95.- PHONE Mailed letters and order to Dianne Fagan on ?_-1-95. b7 j~.y~• ~~ f L S, h.. ~ . ~ r.,P~i a 7 st 9 n 'REV-1500 EX+ (7-94) ~ t~ ~ v +- v ~ v +~ v I ERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131191 CHECK HERE POVERTY CREDIT IS CLAIMED ^ I ~ RESIDENT DECEDENT FILE NUMBER / C IMONWEAITH OF PENNSYLVANIA TO BE FILED IN DUPLICATE DEPARTMENT OF REVENUE URG, PA 171 WITH REGISTER OF WILLS) _ 0078 ~ Hq,RRI 28-0601 COUNTY CODE YEAR NUMBER DEC ENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS ,~ J M. c/o Ct,Jmberland County Nursing Home IA ECURITY NUMBER DAT F DEATH DATE OF BIRTH 375 C1 8rt?[llOnt Drive W 98-22-7898 0/6/94- 8/19/13 . ~ lisle. PA 17013-8820. Ct><ltb_ Co. p F A-PIICARLE) SURVIVING SPOUSE'S NAME (UST, FIRST D MIDDLE INITIA<) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) N/A N/A F 1. Original Return Yati o c ^ 4. Limited Estate ~ c m ^ 6. Decadent Died Testate (Attach copy of Will) 1. Real Estate (Schedule A) 1200.00 2. Stocks and Bonds (Schedule B) (2) -0- 3. Closely Held Stock/Partnership Interest .(Schedule CJ (3) -0- 4. Mortgages and Notes Receivable (Schedule D) (4) _0- 5. Cash, Bank Deposits & Miscellaneous Personal Property (~ 1586.96 (Schedule E) / b. Jointly Owned Property (Schedule F) (b) -0- 7. Transfers (Schedule G) (Schedule L) (7) -0- 8. Total Gross Assets (total Lines 1-7) / 9. Funeral Expenses, Administrative Costs, Miscellaneous (~/ 4$01- 50 Expense: (Schedule H) / 10. Debts, Mortgage liabilities, Liens (Schedule I) (10) -n- ^ 2. Supplemental Return ^ 4a. Future Interest Compromise (for data: of death after 12-12-82) ^ 7. Decedent Maintained a Living Trust (Attach copy of Trust) W Z L ~ o L. FAiC,~1N 506 IDIDIANA AVENUE ~a T EPHONE NUMBER I,IIypyNE. PA 1704x) -; 717 737-3299 c : n __ ~ z 0 5 a a W a: z 0 a F- d 0 a it is true, Dosed on ~~ '~~ ` • 6 INDIANA AVE. LEMOYI~ PA 17043 ,,.~,,...,~F ^ 3. Remainder Return (for dotes of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes (B) 2786.96 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) (11) (12) (13) (14) 4801.50 ( 2014 - 54 ) ( 2014.54 ) 15. Spousal Transfers (for dates of death after b-30-94) _0_ S I i f 00 es nstruct ons or Applicable Peruntags on Reverse (15) Side. (Include values from Schedule K or Schedule M.) X,_= . 16. Amount of Lins 14 taxable at 696 rate (16) -0- x .Ob = _ ()0 (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 1596 rate (17) -o_ x .15 '= nn (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (lg) . 00 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + t - (lq) .00 20. If Line 19 is greater than Lins 18, enter the differsnu on Line 20. This is the OVERPAYMENT. (20) - 00 21. If Lins 18 is greater thou Lins 19, enter the difference on Line 21. This is the TAX DUE. (21) -00 A. Enter the interest on the balance due on Line 21A. (21A) • 00 8. Enter the total of Lins 21 and 21A on Lins 21 B. This is the BALANCE DUE. (Y1 g) - 00 Make Cheek Payable fo: Register of Wills, Agent -at I have examined this return, including accompanying schedule: and statements, and to the re that all real estate has been reported at true mor et value. Declaration of preparer other rarer has any knowledge. of my knowledge and belief, the personal representative is DATE 7/31/95 DATE ,M . r 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% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1 % (.01) 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 (/) 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$ ....................... J` 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate considsration$ 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-1502 EX+ (12-85) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANrC TAY uctncu ESTATE OF FILE NUMBER JQAhIlVE M_ . F1~PT 2195-0078 (Property (ointly-owned with Ripht of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value ~ REV-1508 E%+ (2~ , SCHEDULE E CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INNERITANCf TAX RETURN RESIOeNT uECiecENT PERSONAL PROPERTY Please Print or Type JQAI~IlVE M. FAGAN 2195-0078 (All property jointly-owned with the Ripht of Survivorship must M disclosed on Schodvlo F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Guest Fund Account @ C~liberland County Nursing Ha~rne ` ~ Carlisle. PA 1553,95 2 Refund -Health Insurance CatQany Preilli,.um 33.01 TOTAL Also enter on line 5, Recapitulation) $ 158 _ 96 (Attach additional 814"' x 11" assts if mars spats is needed.) /~ REV-1511 EX+ (7.88) COMMONWEALTH OP PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF J M. FAiC~T SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or NUMBER 2195-0078 ITEM NUMBER DESCRIPTION A-• Funeral Expenses: 1. Services, Casket. Vault, Dress. Etc. 2 Opening of grave & closing, re~naval of headstone and i,T>:printing B• Adminilttrative Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: 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: 2. 3. 4. 5. 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) I $ AMOUNT 3930.50 832.00 -0- -0- -0- 39.00 (If more space is needed, insert additional sheets of same size.) I REV-1513 EX+ (~-B~ + SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCL TAX RETURN B E N E F I C IAR 1 ES RESIDENT DLC'EDENT ESTATE OF JQ~,I~II~ M. FAGAN ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY ;4. Taxable Bequests: I • DIAIVNE L. FAGAN 506 II~IDIANA AVF3V[JE. LII ~fOYI~. PA 17043 2 - J[JDI3H A_ 3~CxIICWIC 7808 KIWAIJIS DRIVE. NA RRgSBURG. PA 17112 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. FILE NUMBER 2195-0078 RELATIONSHIP TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) (If mon space is needed, insert additional ,sheets of same size) AMOUNT OR SHARE OF ESTATE -0- -0- AMOUNT OR SHARE OF ESTATE $ ^^ p --^ f ti} r,