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Home My WebLink About95-0089This 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 H,05,/t Rev. 1MJ, TvPEmawT w nr PERaaA,~ BLACK M1K ~\ i Z Fran eropoli, • ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS r. ~ r- CERTIFICATE OF DEATH ~' ~ ~ ~ ~ b (Coroner) - - - NAPE OF DECEDENT~n,, MieW.Ltl) SE% SOCNL SECURRV NUMBER DRE OF OERHDAaW, D•Y,~ 1995 January 15 L Jones 22 88 4 , a Female a. 5- 077 .. - ,, Tracy AOE M1.N B:me.vl ,wDER,vEAR UNDER,DM waEQF a,aTH e,RrHPLACe ICM+^d PIADE OFDE~aHICheckWyane-Nsinebucaawma7ar alas) «a.D•%'hh srorc«.onCav*rl NosPRU: Ma,r D•r• Nave MaxAr (M y 24 Yti ~197~ Bremerhaven a NipNl„e ^ ERIQAprWe D DQA D „~ ^ ,,,• ^ ~ T. COUNTY OF DF aN cm, Twv DE~cN r~aLm NAwEMm~ msaw~+.ror1 vwS DECEDENTOF wsw~ac oRioxn RACE•An»nc...~... ei.a~. wnt., NC. Ne w.^ B riNaa,.e .• , MP°`~ y . . v White Cumberland Middlesex KClaremont Rd., Carlisle ,Prao Rken, Ne w ,o. g IDNDOF BUSINE89ANWSTRY NAB DECEDENT EVERW DECEOENT'B EDIN;+QK)N MARRALSWUS-MeeMa SURVIVWO9POUBE u.9.ARMEDPORCE31 N ~ ~ m..a.ow•mwr~..e,a tcw.Nroa.o~.m.a.~mor • NwiKgB4cee•,1ur ~, Never U~larri d - YeiO Nei 2 nom" , Own Home work DECEDENrarAai+DADDaESSMr.e.a~WwY,.~.aw..nacoaet oECEOars ,T. R~.. re2lilay van a Da ,T. a.na.~eW.a ^ w 323 North Eaet Street . . . „~B~E„DE e.re,,. Carlisle,Penna.17013 a ~" Carlisle ~ ~ Cumberland M~* ,.. ~~ „ o, ,,, FQIIER'B NAME~FM.MMer.Lrp Allan L. Jones,Sr• POTHER's NAME~FYN.1}Qa.~~YidMS.~w ~inni ch ,~ ~~ ~.e ,Nrow,ANraNAMER '4At°lan L. JonesaSr. MAlLB1OADDREStR•r.G)Ikwn.aW zq 29 Darr AvenueaCarlis~'e,Pennsylvania 17013 ~ oP PLACE •NeAra GwnNUT LOC.RION•Cay/bir,9Nb,21PCOae 8,.,.,J~1 a.eMNe^ RwnovYaemabb^ °~'~^ °OMr"°Cumberland Valley West Penrisboro Twp. DAD «~ ^ anuary 19 a 1995 , • umberland Count Penria ~~~~ ""'"E""D"°°"~~~""' 630 youth Hanover S rest s i ~ ~~~ 'AeNllaceYlw/tbEeN.ON• - LK~ENULIBER ~~) Y Md ~ QOePMr ~ ~ N 4 iN Y,O ae..,n . n. aaw b.. uas1e,rweaeoN,•aey ~~ prX. PRONOIMICED DEAD IMO•~•O•Y•Yrr) CA9E REPERREDlO1EpCAL E]cANAIERICOROHF'm .Nea..r~e~e..e.r. "'~ "°^ ,.. 6.00 A. ,L January 15, 1995 ,~ p./IART! ENwtlr6rw•.Y}.Y•armnp.uUar M~kl,tuneebe aeW.D,r1e1MrIMee,bNO/Yq, aiMrrN,car n,pMel,ry e.n,L NxaarOr,Nauw. tAppee,Mb PMTM: Opw.IpiMCa.mdibrmibWY9beeW,bN W aeyar rreoe rrA ar. .IaaYN EN,wen n,lnsAeplnlM uMNY)YgcrM pkenb RYTT I. tarty YddeAi YI®YRE CAWEtFd ~ Crushin Chest In uries °r"; ~ , t daETO(ORASACONSEQUENCEOPI: ~ eeprW.y,rmnarwr e ^e,IK NeigbYMNAW DUE TD (OR AS ACONSEWENCE OF} ~ rW. EN,I IIIIOBRY~10 CAYBEtDYrwaiYvy a viiW ewe, DUE lO (OR AS A CONSEQUENCE OFt: ~ ntlW~tLABT MMBANAUTOPSY PERFORMED? AUTOPSY FaVDIN(iS ro MANNER OF OERH DJBE OFSWRY BAa,n,Dq'.Nwt TY,E OP BUURY A rx I/LRKiY RVpPoft DESCPaBE1gNSiKH1V OCCURRED. V hi l l Si ,o~oFC AUSE p . e e ng e c Operator, oFOERNa He^+,be ^ wwd D Jan.15,1995 6:00 A. "" ^ "°~ vs. Tree C T( Aa:ksR 1V V•r~rYb~.~ D M 1N ^ N•~ `he ^ No ^ 0 D ^ C 1° 1° °" ` PLACE OFINKIRY-Nlgn,e, him. ebrL hcOay, aar ° V11 " ~ ~' ^ LOCRK7N (SaeN, CiryRown, SteH) fa- an. 5i11tlr o no ' "'" " zo. Rural Road i ~ ` °' ' ar. a --Rd. Carlisle Pa. CrIT/'IWIICIMd~MY•~N •CaBITMY111B pNYfICW1,NyrcwicaETyvq ~+•darri Nisnra~er dge~ur n.saa•owa•aae,n eaaea llam 23) ^ SK~URE .. R ~. - (•,OTOner .~ ' Te tlr EeYNery bi•wbAO•.OeNh•aw,M Arbtlr•r•M•)eM memerr eMMe ..................................................... . _.y ~ LK7ENSE NUMBER DRE STONED F~,eer•. Dey, `hr) •PROMOLBK:NIO AND CERTSVaaB PNVSICWI(Phytic®n can praqucinptlW~eM ar,lYNDbourddra,) .................... O ..aawbw..+.We).r..~...rNNw ew e..w..~,.~NNm.u.. b N . .mw... r r s LN ..... , a,a• JSn• 16, 1995 . . . . . . » r rr v. ANDAODRESS dF PERSON VIYIOCOMPLETEDCAUSE OF DERH ~nen,x>)TYPeaPaM Michael L. Norris, Coroner onu,ebrfea~~BYatlon ~aMvMgtlon,Mmy oplnbn,MNh oeeumd NlM tlm•. d.q. aNl q.u,.~w e..w~n.ew..eq e.e ~ 405 Fairway Drive nw.»...N~a .................................................................................................. alw tt Mechanicsburg, Pa. 17055 REGISTRAR'S SgNRURE AND NUMBER ORE FlLED PAavn, D.Y. `bar) -= ~~ ~ ~~ ~ ~ (~ l,`'~ stc~ s ~!~ -,L---- _ _ Register of ~~Ills for the --------------- _1?~ecease~'. County of CUMB"kRLAND in the -~--"------- -~-~ ~,~ ~--_;-' l~r_ ~•; Commomvealth ar" Pennsylvania -}•„e petition ~` th~~ urdersign~d respectfully represents that: . ,a. , ~; Gam' ~; , "~~t7ut• 7;r,i.ti~~~r-e.rs), ~~,ha islare Ifi years of age ar older, appl.,re7~_~_ for letters of administration _ on the estate. of -- (d.b.r~ renv'.~c~=_ `i[e; d.erantc ubs:rttia; tiuraate minciritate) -- -- t?ze s$t~o'~., ,W..~._~_,,,.. ~ecer~e~ T,t a~:.::; domiciled at death in ~~~~~~- County, Pennsylvania, with r~~~ .- last family or principal residence at .~~-3' ,4.lozTr/ ~~sr Sr ~_~,E~: ist~ (list street, number and municipality) .~•-~ ~ ~c~.cr.?ent, t.~er, ~ Years of age, died ~.~1~.~1_y.Lrs ~' i' ~-' , 19~'.i , ,~ t __~r~ ,,? .~J.. tip:- ~; rx T~J.?~JS~ ~ P - %}E~,~.rzJ.era .~t ~'~~~~th a•R~ned property with estimated values as folllows: ylf cao-*~ici'ec? i-~ 1'a.) All personal property elf not di^•mi<,iled in Pa.) Personal property in Pennsylvania (lf not domiciled in Pa.) Personal property in County V~.lue af' r:;z:I estate in Pennsylvania ;1tll~tt; ~. ;3S fell; CiViS: $~~Z T'etitior~~r_ tfte~ a praper searc}1 ha 5 __ ascertained that decedent left ne wild and was su-vived by ,,.., c,.,:.-..,.;,,,- ;•t~~ fiF ^ryvl anr~ heirs' ;•;a„ne ~+~_?~-rtn sew%~~~~d. ~ Relationship~i~° -'/z ~ Residence a_ -~,~i'~-h~.~z./ ~,~~•r-fir ~ 1~c iSG~- - 1 t,~ S~e- -???p,~~~,~~;;,~;, netitio;rer(s) respectfu.lly request(s) the grant of lc:ters of administration in the ar-pro;•-i.~~:e frr~~z to the undersigned. T: c:. ---...----------- ~~r.~ ,.._~. 6 '~`~'t~s',. ~c ..., ~r.s."r:~be? s~zat:? s~:~sc;a'~~' <.,,. ,,;. 7~~i-i day of ~~~: t`: ~i 3 ~~ ~~ C} ~..; L L Vii` ~ ~+ ~ _ ~ ~^ -^ r.~ ~ ~ ~~ . rv .,_._ ~° a v 21 -a5-8c _;~~ a ~, W.,, ,~.~ TRACY LYNN JONES rte, ~~~.~r al ..._ p~~\'~~{g~[~pgry~ yp~'~py~~j~ Y.g~~T~ ~~ ~j3'~J W~ NYIA ~~19~A.fY 6PiV ~.: •'.'_' _;' .s'" " _..-_ F E 3 R U AR Y d , x 9 y 5 , in consnd~:ratian o. tiac ped~ition an • r ~ c'+.iS1P.~tr3i ' Y6l~ ~1?3N1IH 'r'ti`°:.i7 riliC~ ~°.:'f0?~ dt:~, r~ - , . ~~ ~+~x 3 1Fn $ '~ t TC T ~ ~ °Tlat W L~' `~ ~ • J011E SR . ~,.r ^r~~ r_..+.t,_i. to ~.,.t:~ura of r~,~'.~.ait7isuation, end in accord v~ritia such :ia7ding, a.;ctt~s o€ ~dc~i.~is°.ration <~-~ ~ar~:~.. U-;s:b~±_~ tai ALLAN ~. JONES SR. ,.. t'~e _ , :te 4yr ~ TRACY LYNN JONES ~~ i (/(( t~1ARY C. i.E1tiIS 6.':it'i: ":i 4'`. ;'r,r„~~Tia^:S$Ci;;LiUSIt ..... .A ..r.,.,. ~ a m (fib}" r ~i'Z'I'O~.NE'Y (snap. LX. 4.X7. 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Y~ vs bra; ' ~ . _ .. ,t f - ' y~-,rti rN,}iti'~' 'k ii ~ Y~~'~~~'~+~i.x'xir ~'ar ~.."~'-. -~ .,t.:° (3a g~-~C:}r~c:d-~-, , ~' e^ r ~ ~ 'rte e'i~ 5~„°: i 9~.C P x~~M1e L'~~T'.~ S,.i ~' d},a iii ~~{.1 f..~a.a~~J' _~i {.r.J_ ~:'= < .i:;~ `i::~.`: I2U~].Ct~ C}'F'p',,EI3EiJ.Cic`~3 SFZ°GG-'.~:GS'C x@C~9X5..~'EC 1?~ "Li~.'~ ~. ~ ~.._ ,;~~E v5:~'~;3tR13 ~.~.C?':.i~:i =t.'~~'.iE.:u iya3~ u8Z'3PEC~ Q1'1' OZ' ET'.E.'.f.'i~a"~. ~U ~,.. ~ ~S x.7`4 1'~_' '?'yn!~':.X.C.~.s°3x'1+'~ U~ ~.Tl@ cl'DOVFr-C8l'~'~30£1cC~ EaS±u'ti~+ U~1 a _ j qt: f~~..~'.__. ___.__w__~.~_ ,l~CJ,~~ ~'.=~ S ..---..._ ._..__ _.. _. ..._ ____ _..._r.. a~ k ~ ._._~_~~7_.~, ._.._ Viz? .._ ~, _. `:'xnr"t tit :_"4'x'.9'1 (..O a_A7. ~E~~C`-."~ 2Y1'G].~~.~(3:~. ~.~"kt'x'PC.i~ r3.S2dE:: /S/,,r 1~ ~ (1' ~__ ! is :'t:.= _ f ~~. ~ ~------®~ _ _ -''~`-'r.'.ld=,.' -- /wR r~ _._!__" ~:o9~c'~!,'S.S~_Ss.. :~./' ~°'E?S;':~~UTAc~.L~~it'3~;Z'~' sEY? t~..ia~i.l rr~a t,?=~tj~~"9f:~~?i 'Li3i 'iJG.i.~~V[x'.a..i. ~. .+ ~[~ "4E° iH"~ i ~:'+a1 ~ e '~ a r~,y ,~,. ".}~k~~"i,~{,.F ~~ ~.Y ~"`7~~'~d"S.%„".;~ -. r .. ,. .~4 ~_..+~ 1 .,. ,~+ ,.yj~..ri s'7~3arry^n..~~.y!~.~.,Q~g3+43 ~. i ~~ ~: ~~ k', F~ . n -. ~ , .,. d r e ~, iI ;+ M '. t ` ~ ~~; .. ~`. - 1 r a;~-`' ~ 1yr, r '.2 `.~'r~s tin ~++-4 .r~~ ~~ Y+~ n~,L`3mr.G'' ~- 50~24~.~3 C rr REV-15,00 EX+ ~A4) y FOR DATES OF DEATH AFTER 14/31191 CHECK HERE tr '' INHERITANCE TAX RETURN IF A SPOUSAL POVERTY CRlDIT IS CLAIME ^ • RESIDENT DECEDENT D -_ FILE NUMBE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE R ~ - ©~~ DEPT. 280601 HARRISBURG PA t7t WITH REGISTER OF WILLS) 5 9 aJ , 2B-060t COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) - - ~ DECEDENT'S COMPLETE ADDRESS 7 .J~s ~~r~.y L . 3~•j .U ~s~-.r-~: W p SOCIAL SECURITY NU BER DATE OF DEATH - DATE OF BIRTH C,~2~ ~ S~-~ ~j~ ~7d ~3 W ~_2s - ~~ ~o r1? /s'fcJ 95' ~/r~9 y ~~ ccDOr u~c-r ~3~=~ X77 p E~ APPLICABLE) SURVIVING SPOUSE'S NAME (UST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONSI 1eJ [~1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return Yar" Wdw = ° ~ (for dates of death prior to 12-13.82) ^ 4. Limited Estate ^ 4a. Future Interost Compromise ^ 5. Federal Estate Tax Return Re uired a e ~' m q (for dotes of death aher 12-12-82) Q ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Livlnq Trust ~ 8. Total Num6ar nF SnFn fle.:...1• n,...e. ~^••--•• ~~r~ ~' '•'r tr~rracn copy or irusrl ~~ y 2 ¢o oz wg z 0 d a w z 0 a t•- 0 U K 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) ~~fi~ 8 7 8 ~ - 11. Total Deductions (total Lines 9 & 10) (l t) 12. Net Value a~state li e~ minus Line 1 1) ~ S 3 y. 0(~) ~, _ a~ .g D'r1 13.E Cl~gritable a~t~1 Govera~r~ntal Bequests (Schedule J) (13) /t/~i~ 14 'l~l8h Value Sa`6ject to Tax;~,Line 12 minus Line 13) -- ~ •5 3y p~4) ~r - O ^ ,. n °"~ r- LL,Q~ ~ . ~G2tJ~.S .S/Q- - TELEPHONE NUMBER 02 -~ ~.~ ~ ...vmrLC l[ MAILIrVV AVVKtDJ ---------~~-" /~a9 ~~/2ie~~Cr6nr-' Gr~~ `~ ~-~' % ~`~ ~ --~~ i3 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) ~1~iA ' 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ /-2 rl5 7~ (Schedule E) 6. Jointly Owned Property (Schedule F) (b) ` _ /~/~~ 7. Transfers (Schedule G) (Schedule L) 8. Total Gross Assets (total Lines 1-7) (7) /(/ljQ B 7 ~' "? "] r ' ~~~s ~ 7 ~ s; (8) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) (9) 15- Spousal Tratts-tars (foh dates of death after b-30-94) `~5ee Instructlb"n for Applicable Percentage on Reverse (15) (si8,q. (Indud¢values ffrort- Schedule K or Schedule M.) 16 F~-A,ris~unt of l~ 14 taxabCesat b% rate (16) Irii:lt,de values from Schedule K or Schedule M.) 17.~~unt of'~,{~ 14 to L(Oq xxjb~at 15% rate (17) {Include values from ~c le 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 + + 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. ~^ i!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 21A. B. Enter the total of Line 21 and 21A on Line 216. This is the BALANCE DUE. Make Cbeck Payable to: Register of Wills, Agent x,_= x .Ob 15 (18) G (19) Q (20) -- (21) ~ (21A) ~ (21 B) /~ Under penalties of perjury, I dec are that I have examined t is return, including accompanying schedules and statements, and to the be it is true, correct and complete. I declare thot all real estate has been reported at true market value. Declaration of preparer other the based on oll information of which preparer has any knowledge. SI ATURE OF RSON RESPONSIB~LrlE FOR FILING RETURNf~ff ADDRESS -7~,~1 ~[ -7 I 7 Slf•lcie i~ nc oec /n ~ ~4•t_ /`~~ !1/P/~- ~pC/~ ~2t' l,f(-~ ~~ / /Gt1 I the personal representative is DATE ~~ /~.~- DATE '~- .~~ Act #48 of 1994 provide: for the reduction of the fax 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: • 39/0 (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 29'6 (:02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 196 (.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 (-~) IN THE APPROPRIATE BLOCKS. 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 conaideration$ 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. ~~, ncv-un to+I_aa) r -' SCHEDULE H . FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND INHERITANCE TAX RETURN MISCELLANEOUS EXPENSES RESIDENT DECEDENT Please Print or Type ESTATE CF FILE NUMBER ri~.~c y ~ ~,~,~ ~~ ,mss ~s - a~a ~ ITEM NUMEIER DESCRIPTION AMOUNT A. Funeral Expenses: $ Car.++,3.s~e. L,g.,uD /.~r-~-~'~ Mac eMo ~z i ~ 1. 1/llu~T- . g'TS. coo ' C, C~,a..a /,~ cSA-~'~g-~U S - /qa ~ ,e ~rnl~r:. ,C~ ct~w Ca p&N~NC -f~ cc.os',w6 C~rL~,. Sc.it PA i~o~ 3 ~ SU. vv . 7 op ~s'So 9 ~ /'YIFi~ro,e~.4-~ ~~f,cl~- ~.. . ~ d 33r7. va ~~,~ SS ~ ~.c1,1 ~- S:.cJ i c~--S ~ i~a~~ 1 ~'v-~ a~s ~~ grdsa ~ ~P,~-c~.~l-T .3 285 o t^~b PL.t 4. c,,.aacn c~.s,ca-v- l ' vC F - . a ,`8 a ~ 1 goo 6. c~ ~ ~ F~Ravple: ,e,S ~un1~A~. (~owtF 7~,w+a cs,~-r,~'~ca.-a--.r (,s~~ , co B. Io 30 .So ~ vn( f{q.tly /8-K .Ft Administrative Costs: - ~ 30 . ad c~,c,~,,, s ,,~ ~ ~,~ I ~®`3 1 . Personal Representative Commissions _ _ Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees 3: ~ Family Exemption Claimant ~a~T~ ~• .~ c~ Relationship T~*•t6t~T"~2 ~ ~S`. `~ Address of Claimant at decedent's death ~ Street Address =~.2 3 ~ E,4 S-T ST. City G-4.e ~~scE- State ~_ Zip Code ~?~ ! 3 4. Probate Fees ~ Gt.I~'! F,jeciGc.,~jC7~ ~.fnc..r N-TvJ ~~~ .o,.o C. 1. Miscellaneous Expenses: 2. 3. 4. ' 5. 6. 7. 8. ~`~~~.?? TOTAL (Also enter on line 9, Recapitulation) $ ~~r more apace is needed, insert additional sheets of same size.) l , ,,." REV-1511 EK + 1781 `~ ._..^ CC>rMONWEAIiH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Plsase Print or ESTATE OFD ~ y~ FILE NUMBER ITE M NUM BEI DESCRIPTION AMOUNT A. Funeral Expenses: ~ o' o ~ ` f' G~rsciSc-fir ~'iA ~7013 ' 0 ~ 7 , ~~w+oQ~ ~ ~ ~~~y~.e.- v. /x3r7. ~ c• '~iCo~c SS ~ dN.A ~- ,SE2J~ ~S~ ~.q2 ~G . •r i F;S fr ~Qu,'Pirt~/~ " ~t/iNG 1~~bTr~~2 f w ~ Z2 ~ ~a G. T o PcA ~. ~t.~-ba'D oASY-S`T vF.e~ cg,2~t~~.a~s ~.r> . ~ l~ X30 So~.rfd ~ B. Administrative Costs: ~-¢~~~f'~-+~; ~ /70~~ ~ 1_ Personal Representative Commissions _ Social Security Number of Personal Representative: Year Commissions paid 2 _ ~ Attorney Fees 3. ~ Family Exemption Claimant ~~,.~r.~~y ~Q. ,c~G~ Relationship ~8~~4-rz-z Address of Claimant at decedent's death '~~ooo o-o Street Address -~~.~ .v. E,~ -r r• City G~-~-~sc.~ State ~ Zip Code ~7~ ~~_ 4. Probate Fees GV.~-.T,~s~c..d'sv'~ Goti~t~y-y / '~~'7. o-c~ C. Miscellaneous Expenses: 1. 2 3. 4. 5. 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) I $ ~3?~ o-v (If more space is needed, insert additional sheets of some size.) c~ _~ 4 ~`' ..: ..`; ,3 y ~~ ~~ r'. REV-157 EX AFP (12-94) `GOMNONNEALTH OF PENNSYLVANIA ACN 1 0 1 DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 09-04-95 HARRISBURG, PA 17128-0601 ESTATE OF J L FILE N0. -0 8 DATE OF DEATH 01-15-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO ^REGISTER OF WILLS, AGENT'• REMIT PAYMENT TO: ALLAN L JONES SR 129 DARR AVE CARLISLE PA 17013 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (12-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF JONES TRACY L FILE N0. 21 95-0089 ACN 101 DATE 09-04-95 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHAFED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 2. Stocks and Bonds (Schedule 8) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1,255.77 6. Jointly Ov+ned Property (Schedule Fl (b) .00 7. Transfers (Schedule Gl [7) .00 8. Total Assets (g) 1,255.77 APPROVED DEDUCTIONS AND EXEMPTIONS: 8,789.77 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9l 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10l .00 11. Total Deductions (11) 8 •789 • ~~ 12. Net Value of Tax Return (12) 7,534.00- 13. Charitable/Governmental Begwsts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (l4) 7,534.00- NOTE: If an assess(nent was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: ( 5) . 00 X .00_ . 00 15. 1 Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate (16) • 00 X . 06. . 00 17. Amount of Line 14 taxable at Collateral/Class B rate (17) •00 X .1 5. .00 18. Principal Tax Due (lg) .00 TAY f`DCT1TTQe PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST (-) AMOUNT PAID 05-30-95 AA047814 .00 10.00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT 10.00 BALANCE OF TAX DUE 10.000R INTEREST .00 TOTAL DUE 10.000R ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT^ (CR), YOU MAY BE DUE REV-1470 EX 16-881 i • COMMONWEALTH OF PENNSYLVANIA DEPARTMENT Of REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 1 7 1 2 8-060 1 DECEDENT'S NAME Tracy L. .3or~as INHERITANCE TAX EXPLANATION OF CHANGES FILE NUMBER ACN zul SCHEDULE STEM EXPLANATION OF CHANGES NO. r? G'3 Ke~uced to .$1,255.77. T'az~~ily exe:~~~tion can. only he ciai.5~ec3 a~;ainsfi pro- ~Uci~E iiSSF:t5 TAX EXAMINER: i~euora.z~ d3astiinGtor, PAGE pennsyLvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14) INHERITANCE TAX DIVISION FTAT EMENT OF ACCOUNT W PO BOX 280601 FF 10 E O HARRISBURG PA 171284FODED 01 RMIST" F 'VILLS DATE 02-09-2015 ?01S FEB 17 p11 1 13 ESTATE OF JONES TRACY L DATE OF DEATH 01-15-1995 FILE NUMBER 21 95-0089 COUNTY CUMBERLAND JONES SR 0RPHAkLl- A'C--L ACN 101 129 DAR�uu Ft' I Amount Remitted CARLISL PA 17013 1 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 --- ------ - - --- --- I -&-H i i f TANCE TAX-STATEMENT OF OF iCC OUAf ESTATE OF:JONES TRACY L FILE NO. : 21 95-0089 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: 08-28-1995 PRINCIPAL TAX DUE: .00. PAYMENTS (TAX CREDITS) : PAYMENT RECEIPT DISCOUNT AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 05-30-1995 AA047814 .00 3.20 TOTAL TAX PAYMENT 3.20 BALANCE OF TAX DUE 3.20CR INTEREST AND PEN. .00 TOTAL DUE 3.20CR 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.