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This is to certify that the certificate hereunto attached is a tt~ue 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 Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ O
CERTIFICATE OF DEATH v
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y NAME AND ADDRESSaF PER^W W/IO COMPIETEDCAUSE Oi DERN
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a,,. rd S . podczaski , M. b.
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REGISTRAR'S 51G AND NU R ~'._ ORE FILED 1MOnM.OaY. Yea!
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i~sgis~ep of Wills of Cumberland Counfy, PBnnsylvsnis
PET9T~ON ~®R GRANT OF LETTERS
Estataol Susan L. Kennedy No. a -- ~~`~~
aim known as _~.~ _ ~ _ 74y~
. Docoased Social Security Na. SOS 9 ~ t/
Karl F. Keefer
. tbrrer(t), who are t a yeah o age or o ,app (lea)
(Ct]MPt.ETE'A'tDA'13' BELt71Y:)
® A. Probate and Grant of letters Testamentary and aver that Peddoner(s) Is/are the execut Harried to the tact VVAI of
dta Decedent, da5sd and codid!(a~ dated
3WS r~Nvmt dmlrtnuraea...g., tinw,cWfon. dwn .:aan«. Me.
Except as foNarrs, Decedent did not many, was not divorced, and dd not have a Child bom or adopted after exeeutlon of the documents
offered for probate; was not the victlm of a kiiliny and was never adjudicated MxmpetenE:
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B. Grant of Letters of Administration
Pedtiorier(s) after s proper search hadhave ascertained that Decadent left no WNI and was survived by the faNowiny spouse (if arty) and
heirs: ~p~{/{p/~y
rlniellMltll}1 • ~~~~• •^
1{iY l 10
Karl F. Keefer
Nusband
315 W. Main Street
Mechanicsburg, PA 170
Sv s,4:~r L . h'~.vn.~ Y ~-~:~aC 'fie-,_J .~it..c/
55
(COfAf'LETF IN ALL CASES:) Atlaot aaaoan•r aneep s naceaaar r.
Decedent was domiciled at death in Cumber 1 a n d Cotmry, Pennsylvania, with hisRier last family
orprinciparoai3anoeat_ 315 W Main Street, Mechanicsburg, PA 17055
(list etreat, rnxnBsr and mvudpalrry)
Decedent,then 31 yearsotage,died January 29 ,,g95 u 315 W. Main St. , Mechanicsburg,
(Loation)
Decadent at death ovmed property with esdmated values ns foNows: s 10 , 0 0 0 . 0 0
(If domfaiod in PA) A! t~o^~ Prof~rtY
(N net domMled in PA) ~ Personal property In Pennsylvania S,_
(if not domicled in PA) Personal Property in County ;
Veluo of rea! estate in Pennsylvania
~irJated as fo!fows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last WIN end Cod(cN(s) presented witli this Petition and the grout of
tannra in it,p aneroariate tone to the undersigned:
--
Form aAWt Fago t of 2
praparod bS+ thr Pennaylvenia Bar Association 1991
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tbe>mrnonsr3~+atth of I~~nr~syiwanla
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The Petitioner(s) ;zbavs-named swear(s) or affirm(s) that the statements in the foregoing Petition are tnse
and conrQCt to the br<+st of the knowledge and belief of t~etitianer(s) and that, a3 personal representative(s) of
the Decent, Peti~oner(sj wilt wail and truly ad star the estate rding to law.
~rJOm to or aftin•ned and subscribed ~~
befor~s Rio this 1ST ~ day of
FEBRUARY tg 9~_ .
For the Ragfster
`! C. LEI~IS
_.-..-------- No. 21 - 95 - 80
Estato of SUSAN i.. KENNEDY Deceased
~ociai ae~irity No: 159-62-7941 Date of Death: JANUARY '29, 1995
AND tso~~, FEBRUARY 1, _ , 19 95 , in consideration
o! the Petition on the reverse side hereon, satisfactory proof having been presented before me,
R 1S DECREED that Letters ®Testamentary ~ CN Administration
era hereby granted to
KARL F. KEEPER
In the above estate and that the instnyment(sj dated
described isi the Petition be admsred to probate and filed of record as the last 1M,lI of Decedent.
~E~
40.00
Latter: ..................... ~_
S1~ort Cor2iBcs te(s} .... ~ 3.00
Renunciation ............ ~_
Af,rdavit~ ( j ............. ~
Extra Pages t j ......... ~
Dodicil ......................
5.00
,Jt~F' Fe~i ................... ~
' ~sesr of win:
Attorney: "~G
I.D. No: ~ ~7® 9
Addr®sa: . d . ~ d •~~
Iraveniorp° .................. ~_
Jther ....................... S
TQTAt_ ............. ~ 48 00
Frnm 4r1`M-. g~a 2 et 2
~v: ~:+r+1 i.; ;tu 'aarinsy:r:: ~l~ ucr'.;sacdat~n 9991
Carters and order picked up by attorney on 2-1-95.
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0~~:~~ZC~.'~~Co?~Y tPP New%C~ ~D~2 RLF~'~ 5.6 (e~~ ' ". ;
~p~.r.~e a~ ~cw7c~~~n~c:: Susan Lynn xarford-~'ennedy -k~eePer.~ i~AR 1 ~ X10 :QQ
i:x~~e a~ ^~~'sc$:~: January 25, 1~~5
r~~.ii Vic, File No. 1385-00080 ~IB~r;,t ~-,~.~ .%O~rt
---~ state Nc. 2?95-0080 ~mb~;;~;,~ ,;;;., PA ~.
To the Reg{ s~t~ir:
1 c?r~.ify that notice of beneficial interest required by
~eu3.~ 5.+~{f>i~ of tha Orphans' Court Rules was served on or mailed
i;.u, t~:~~ :~c~~.?.u~r=in~~,r bea~egicYaries of the above captioned estate on -~..
:~~?,~~ AL~ARES$
~:a:~l F„ 7,n.,~f~;-~ 1260 York Road
Mechanicsburg, PA 17055
C~~i~;sy Lee :~ernedy 1260 York Road
Mechanicsburg, PA 17055
z~CSti^,~ ham now been given to all persons entitled theretoexceet
5.6(a) p
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~ athy Morrow, ESq.
P.O. Sox 250 ` ~~-.
217 S. Carlisle Street
New Bloomfield, PA 1706F~ ~'-;_= ,
Telephone:. 717-582-'313
Cagacity: Personal Representative
X Caunsel for Personal Representative ';;~Y, ,;
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ACN 101
EX AFP (12-94) NOTICE OF INHERITANCE TAX 11_20-95
REV-1547 ~~YLVANIA ALLOWANCE OR DISAOFOTA~E DATE
~pNp~pN11EALTH OF APPRAISEMENT, AND ASSESSMENT -
~PARTMENT OF REVENUE OF DEDUCTIONS
BUREAU of INDIVIDUAL. TAXES FILE NO• CUMBERLAND
DEPT, 280601PA 17128-0601 COUNTY
HARRISBURG,
ESTATE OF SUBMIT THE UPPER PORTION OF THIS FORA~H YOUR TA
DATE OF DEATH 01-29'95 "REGISTER OF WILLS, T0:
MAKE CHECK PAYABLE TO REMIT PAYMENT
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT,
PAYMENT TO THE REGISTER OF WILLS. 1ST ER OF WILLS
KATHY A MORROW ESQ
217 S CARLISLE ST
PO BOX 250 PA 17068
` NEW BLOOMFIELD
REG
CUMBERLANDPAO 10oR3 HOUSE
CARLISLE,
Aaount Reaittad
YOUR RECORDS ~ ----------'-""--
~ RETAIN LOWER PORTION FOR
TAX APDRpgSESSMENTAOF TAX E OR
CUT ALONG_TH_IS_ LINE ----------------------' 101 DATE 11-20-95
V-1547 EX AFP (12'941 NOTICE OF INHERITANCE T
-- DISALLOWANCE OF DEDUCTI021 95_0080 ACN ICE
RE SUSAN L FILE NO SEE ATTACHED NO
ESTATE OF KENNEDY ( X) CHANGED
TAX RETURN WAS: ( ) ACCEPTED AS FILED
___~wwr~T _ sEE REVERSE
RESERVATION CONCERNING rv ~.+~~- --
ppPRAISED VALUE OF hedulie p)$ASED ON: ORIGINAL RETURN
1, Real Estate (Sc
2. Stocks and Bonds (Schedule 8) Interest (Schedule C)
3, Closely Hald Stock/Partnership
4, Mortgages/Motes Receivable (Schedule D) (Schedule E)
5, Cash/Bank Deposits/Misc. Personal Property
6, Jointly Owned Property (Schadula F)
7, Transfers (Schadula G]
g, Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral ExPenseLiabilities/Lians•(Schedule Igchedule H)
10. Debts/Mortgage
11. Total Deductions
12. Nat Value of Tax Return
i /Governaental Begwsts (Schadula J)
,00
(i) .00
t2) .00
(3) , 00
(4)
11 418.00
(5) 200.00
(6) '00
l7) 11,618.00
(8)
11,499.72
(9)
(io) .00
11 499.72
(11) ---------118.28
(12) , 00
(13) 118.28
(14)
13. Charitab •
14. Nat Value of Estate Subject to Tax lines 14 s 15 and~Or 16 ~ 17 and iS wsii
NOTE: If an assessment was issued previously, .00
t figures that include the total of ALL returns ass Ooed.00 da e.
ref lec X . 0 0
(15) . 00 X .06=
ASSESSMENT OF TAX: (16) 17.74
15. Aaount of Lina 14 at Spousal rata 118.28 X • 15= 17 .74
16. Amount of Lina 14 taxable at Lineal/Class A rata (18)
17. Amount of Lina 14 taxable at Collateral/Class B rata (17)
18. Principal Tax Duo
TAX CREDITS: + T PAID
PAYMENT RECEIPT IINT~ER~E57 (-) AMOUN 5 , 32
DATE NUMBER , 00
,,.,_,,,_o~ AA048139
5.3~
TOTAL TAX CREDIT 12.4
BALANCE OF TAX DUE ,0
INTEREST IS CHARGED AgLEMAS OUTLINEDOONITHE 9 INTEREST
AT THE RATES APPLIC 12.5
TOTAL DUE
REVERSE SIDE OF THIS FORM
S1, NO PAYMENT IS REQUIRED.
( IF TOTAL DUE IS LESS THAN
IF TOTAL DUE IS REFLECTED AS A "CREDIT" lCR), YOU MAC
x IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
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REV-170 EX (6-B8I
COMMpEPARTMENT°OfPREVENUEANIA
BUREAU UEPN 280b~ AL TAXES
HARRISBURG, PA 17128-0601
..«cnFNT'S NAME
INHERIT NAT~ONX
EXP~-
pF CHANGES
EXPIANA710N OP CHA~ ES
~- ITEM
SCHEDULE MO.
PAS
Lisa Garland-Funk
TAX EXAMINER:
` " . ~ ~ ~'
i5 ~~?.~1;~ 508
REV-1500 EX+ 7-94) ~ ~'
INHERITANCE TAX RETURN FOR DAT~Of DEATH AFTER 12131/91 CHECK HERE
IFAS USAL
PovERTY cRED1T Is CLAIMED ^
~e RESIDENT DECEDENT FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE p
a / g' ~ ~~Ja 1
DEPT. 280601
HARRISBURG
PA 1712
1 WITH REGISTER OF WILLS)
,
8.060 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
Kenned -Keefer S san_L. 315 W. Main Street
W SOCIAL SECURITY NUMBER DATE OF DEAT DATE OF BIRTH M c C h a n 1 C S b U T 9
P A 17 0 5 5
W 159-62-7941 1/2 /95 10/31/63 co~~ . ,
C.umberl
p IIF APPLIU6LEI SURVIVING SPOUSE's N (LAST, FIRST AND MIDDLE INRIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
Keefer, Karl F. 206-36-7145 $59.14
~ (xJ 1. Original Return ^ 2. Su lemental Return
pp
^ 3. Remainder Return
Yax
W d~
°
^ 4. Limited Estate
^ 4a. future Interest Compromise (for dates of death prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
~ a
e °
m (for dates of death after 12-12-82)
a ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
W Z E
Kathy A. Morrow, C MPL E
Esquire 217 S. R 5 ,..-'
~~rlisle Street
V a TELEPHONE NUMBER P, 0. r~/ x rZ 5 O
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1. -Real Estate (Schedule A) (1 )
2. Stocks and Bonds (Schedule B) (2 )
3. Closely Held $tocklPartnerahip Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4 )
5. Cash, Bank Deposits $ Miscellaneous Personal Property (5) 1 1
..41.8_
Q~
(Schedule E) ,
~
b. Jointly Owned Property (Schedule F) (b) ~ 2 0 0 . 0 0
7. Transfers (Schedule G) (Schedule L) (7 )
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous
E
h (9) 11, 4 9 9 .7 2
xpenses (Sc
edule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
11 Total D d t' I L'
(e) 11,618.00
11 499 72
e uc Ions (iota Ines 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) ,
118.2 8
118 , 2 $
15. Spousal Transfers (for dates of death after b-30-94)
Ses Instructions for Applicable Percentage on Reverse (15) -~
Side. (Include values from Schedule K or Schedule M.) x ~ 3 = -~4--~t-
16. Amount of Line 14 taxable at 696 rate (16) -
(Include values from Schedule K or Schedule M.) x .~ _ .~-J-~
l/
17. Amount of Line 14 taxable at 1596 rate (17) ~ ~ ~' • ~ ~
x
15 =
~~ 7. '7 Y
(Include values from Schedule K or Schedule M.) .
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18)
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ + - (19)
20. If Line 19 is greater than Line 18, sMer the difference on line 20. This is the OVERPAYMENT. (20)
fil0 U
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 5.32
A. Enter the interost on the balance due on Line 21A. (21 A)
B. Enter the total of Line 21 and 21 A on Lins 21 B. This is the BALANCE DUE. (21 B) 5 , 3 2
Make Check Payable to: Register of Wills, Agent
..~~..e, penames vT penury, I asuars that 1 have examined this return, including accompanying schedules and statements, and to the be
it is true, corcsct and complete. I declare that all real estate has been reported at true market value. Declarotion of prsparer other that
based on all information of which preparsr has any knowledge.
SIGNATURE Of PERSON RESPONSIBLE FOR IN RETURN ADDRESS
K
le personal representative is
DATE
~/s`%~`-
DAT~--~
t
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 rotes' 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 % (.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 PLAC NG AS CHECK MARK (-~~ IN TH PPROPR ATE BLOCKS.
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, .................
......................................
b. retain the tight 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 L AND FILE IT AS PART OF THE RETURN.
REV•1508 EX+ (2-8n
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or
ESTATE OF FILE NUMBER
Susan Lynn Kennedy-Keefer
(All property jointly-owned with the Right of Survivorship must h» disclosed on schedule F)
ITEM DESCRIPTION VALUE AT
NUMBER : DATE OF DEATH
1, ring - one wedding band, 6MM, beaded edge, 25.00
14KT gold
2, ring - one wedding band 4 1/2 - 5MM, 18K gold. 18.00
(See attached appraisal)
3. 1990 Honda Prelude SL 7,975.00
Serial #JHMBA4134LC028553
4. -1994 Kawasaki Jet #KAW224891394 3,400.00
See attached appraisals
TOTAL (Also enter on line 5, Recapitulation) I $ 11 , ~ 8 0 0
(Attach additional 8y4° x 11"' sheep if moro space is needed.)
t
REK1511 EX+ (7.88 -
~b/d/VIONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Susan Lynn Kennedy-Keefer
ITEM
NUMBER DESCRIPTION
A. + Funeral. Expenses:
1•. Boyer Funeral Home
New Bloomfield, PA 17068
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B• Administrative Costs:
1. Personal Representative Commissions _
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees Kathy A. Morrow, Esq.
3. Family Exemption ,
Claimant K a r l Keefer Relationship H u s b a n d
Address of Claimant at decedent's death
Street Address 315 W . Mai n
City _ Mechanicsbur State PA Zip Code 17055
AMOUNT
5,631.50
500.00
2,000.00
4. Probate Fees
48.00
C. Miscellaneous Expenses:
I• Mumma's Jewelry Store - jewelry app. 10.00
2. Connor-Apicella Orthodontic Assoc. - open account 1,400.00
3. First Card #4250-404-047-810 - open account 1 156.37
4. Smarsh Chiropractic - open account 510.00
5. P.P.&L. - open account 46.71
6. Bell Atlantic - open account 121.42
7. The Sentinel - Estate Notice 75.72
8.
TOTAL (Also enter on line 9, Recapitulation) S 11 9 9 . 7 2
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i - - -
REV-1513 E4+ )2-87)
, COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA'X RETURN
RESIDENT DECEDENT
SCHEDULE J-
BENEFICIARIES .
CJIATE pF
Susan Lynn Kennedy-Keefer
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
~• Karl Keefer
1260 York Road
Mechanicsburg, PA 17055
2. Crissy Kennedy
R.D.1
New Bloomfield, PA 17068
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Goveremental Bequests:
1.
FILE NUMBER
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
Husband One-half
Daughter ~ One-half
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $
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