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HomeMy WebLinkAbout95-0101 H10ti.tu Rer.1R, ~rrERanrr M P61YAN[NT r.ncK aac a~ Z 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. Date AUG 10 2001 ? • Fran eropoli, ' ect , Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLWNU • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFlCATE OF DEATH (Coroner) X02-~~~5 NAME OF DECEDEM (FwL Mwtl•Lrq s°°i"i~°`>a'rr'lY'!°E"~ 5216 ,. Berdetter Rafacioli :Male ,. ..January 27,1995 M1E(W BMD•y) uNDER,rERt tRIDER,D,er DaECrew.N e1R nw~A CE x~rr,n xACEOFDE~aNcdren.-...:.r„cea,en dn.r.a.) g ~ ~ Harr DeYe Han MYeAw (MaM. 0.1'. Year) SIISII4-a » F 7 2 7 O7HER: Yn ~ wwrNd ^ 19 2 2 7. ERpulpera ^ Dd ^ Haman. ^ Rwlaena~ WPeeiyl ^ OP OERH CT: DEVII NAeeEnar earubm,pi..rrsr enerwr~eer) DENT OF HISPANIC ORgW7 RACE-AmriCrr wiaern Bhdc,Nhb, re. Cumberland Silver Spring 16 Locust Lane,Mechanicsburg ~ ~ ~^' 's0'°"' White ~ , „ ~. to IOND CF SUSINESSANDUSfRY VM$DECEDENTEVERM DECEDENT'S EDUCRpN MARIL1L BiRUS-Nettled SURVMIq SPOUSE Riiwreadrrnaar mae U.S. AIMED FORCE87 Never Merrha YMaerMd, QI eAe. piw rwrr nerwl I Di 61 ~ °~~ a dr Rai 1 Road ~,.^ Ne^ a,~ l Tel~~ v v PO (,~) ,. DECtDlvlrsMAUtxIADDRESSlSbeel.Ceylkwn.shh.lgceaq DECEDEHr's 16 Locust Lane South "`gYe aD1dr e.ra "°.^ "",°.^.a"""'°" Mechanicsburg, PA 17055 Cumberland ", ~„e` ~ "` I +~ „~ ~~d Amore HONI'"o~t~4-~'Yoli M ~ ,~ HAyEryryptr~p "F0~"Iar'"~al'a Harris ~ ertie y 30, 1995 g awwdon^ Rrwrrir•rsm.^ rasa ~eaark LO~iSfIA'h~"fNp. ^ ~~^ oiw +. ers eral Hone H9O1 ~" 'xQ1~6'T~'PR92-L "Aa4'"!~°D~R! . , ec an c rg, mw. ,~. r wAwe«tlrywq r• wra mrw~a.l•as•.arnaoa.~.areran..awrwPw.rr.e. e~~ rirdawtleb irM Ta.l h ~cENSENUNeER aaESIONeD ` aenMyeeu ie (Moan. oe% beN ~' SI.23mrMWarpwatry TIME DRE PRONOl1NCEp DEAD~Abreh, 0.Y•Nal enr• Pr•rranw• dMUe. ~. tr. NRS CASE REFEMEDro ME E%AMPJERACORONER7 ,,. 2:30 P. K ,~ January 27, 1995 : w. ta^ . lT. MRI F. Errtlrdrewe, queWarearipYOtlbrr whiclrarea lhlaMn.D•nd enter aw ngaedayFp, coca raer6r orrwpwrory erreel, fli•eA down hire. IAPp•rwnre RNIT tl: adwK aramne LY edyaee eerrren wdriN. e4~•rr earriubgeoaWn, teA rwieerrr wrween nalrweltlrp In tM underywrp cerregiyw HPARTI. arnl rraa W t~NT! CAtIS[ (Fuel l ee ;,, Occlusive Coronar Arter Disease IwE ro roR As A coNSEauENCE oFl i MceuaYida 0 ~ tlreA le•awgnwrrrerre DUEro(OR ASACONSEQIIENCE OFk ErwU1DlKYNO OM7tKIDirewanjry l r wiersA r.•rr DUE ro (qi ASA CONSEQUENCE OFy. in aeea+) LAST WISAN AUNPSY riE1FAUIOPSY FWdNO3 MANNER dF DERV DQE OFIILURY PERFORMED? +w11iAELEPit10gro Mlarn.oey.~ 71ME OF INJURY RWRY RY/ORI(7 DESCRIBE IIgYiNJURV OCCVRRED. COMP ~TIONOPCAUSE Nstunl / _ HOmkNe ^ ~ L `An ^ N• ^ Yb ^ No ~ 1M ^ N• ^ AL'dderr P•~V ^ ^ P C M IA E OFIIL4IRY-N low, hrr, reel. leapt', dnr LOCATION(Strer, City/W.m.Slele) Suldae ^ Caaa na W aelerrrikna ^ e•brq, et0. (SPedN Le. rib. b. - ~, CMTIPIEJI Fnen~O//YaW SK3 ' ®TIIFYNIDMR'SIQNI tPnyaa.~, are'yYq awe d deem when anaew Pnrem•n nr penamcea a.rn ane amprea eem 23) ~ rr~~•.I•ua•.arnw•,.e.ua.mm.a...I.l.Harr...wrww ..................................................... ^ „ ~ Coroner •PaoNDDIICEtD AND t~xrIFYIND PHYSICJAN (Pnyeiar, can wprarw~rq e.rr eneoeray~ roves a aeeml ,er»swdr,.w•owrao.,arnoeelr.arn.uw.a.o..,nawe..weau.ba.~r.y.).wrr.wrrr.e .......................... ^ LICENSE DRE sroNED (Mmn. Der. Yea ax. o,a. Jan. 30,995 NAME AND ADDRESSOF PERSON UIFq COMRETED CAUSE OF DFiQI/ rEDICAt. EXAIAaIEA/CORO,/FR (firer zn rypswPanl Michael L. Norris, Coroner oral. wrM d •r•lRwerlml rlal•r wwrUpeebn, r ry apwa•n, deeM aearrW r tlee two.. aeU, end pies, •nAaue a tM eeusep) and rrR»....tr.e ................................. . . ri Mec . .............................................................. a,. ' ~ hanicsburg Pa. 17055 RE TRAR 331GNRl1FiE AND NUMBER J DRE FlIED(MerN, 0.y. lber) ~' ~.. ~J~NU~aa ~ 3v. i99s COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION I N H E R I TAN C E TAX DEPT. 280601 STATEMENT OF ACCOUNT HARRISBURG, PA 17128-0601 REY-1Po7 EX lii (DS-f7) BARBARA J HARRIS 4087 BUCKTOOTH RUN RD LITTLE VALLEY NY 14755 DATE 08-04-97 ESTATE OF RAFACIOLI BERDETTER DATE OF DEATH 01-27-95 FILE NUMBER 21 95-0101 COUNTY CUMBERLAND ACN 101 Anount R~witt~d MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper er~dit to your account, subwit thw upper portion of this fore with your tax payw~nt. CUT ALONG THIS LINE _- RETAIN LOWER PORTION FOR YOUR RECORDS __~ _____ ----------------------------- --------------------------------- REV-1607 EX AFP (03-97) ~(~(~( INHERITANCE TAX STATEMENT OF ACCOUNT ~~* -------"--"'"'" ESTATE OF RAFACIOLI BERDETTER FILE N0. 21 95-0101 ACN 101 DATE 08-04-97 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN 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: 05-05-97 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): 437.77 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 08-07-96 AA146598 30.82- 2,118.89 07-16-97 REFUND .00 1,650.30- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ^ IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN !l, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ^CREDIT^ (CR), VMI M•V CC RIIC • Drrllun cec nr~ir err ntn~ nr +,.tw r..nu r..w ~....~.....,~-,..,,, 437.77 .00 .00 .00 __ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF IN%'TVIDUAL TAXES INHERITwNI'E TAX DIVISION NOTICE OF INHERITANCE TAX DEPT. 280601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EM AFV (pS-97) DATE 05-12-97 ESTATE OF RAFACIOLI BERDETTER DATE OF DEATH 01-27-95 FILE NUMBER 21 95-0101 COUNTY CUMBERLAND BARBARA J HARRIS ACN 101 4087 BUCKTOOTH RUN RD LITTLE VALLEY NY 14755 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-97) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RAFACIOLI BERDETTER FILE N0. 21 95-0101 ACN 101 DATE 05-12-97 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Sehedul• B) (2) .00 credit to your account, 3. Closely Hald Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 8,39 4.34 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (g) 8, 394.34 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests (Schedule J) 14. Nst Value of Estate Subject to Tax (9) 34, 098 .11 (lo) .00 (11) 34.098.11 (137 . 00 (14) 7, 296.23 NOTE: If an assessment 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: 15 . Amount of L ine 14 at Spousal rata (15 ) . 0 0 X . 0 0_ . 0 0 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 7,296.23 X.06= 437.77 17. Amount of Line 14 taxable at Collateral/Class B rat' (17) .00 X .15. .00 18. Principal Tax Due (lg) 437.77 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 08-07-96 AA146598 30.82- 2,118.89 TOTAL TAX CREDIT 2,088.07 BALANCE OF TAX DUE 1,650.30CR INTEREST AND PEN. .00 TOTAL DUE 1,650.30CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A DC Cllun CCC DC1lCDCC CT,\C AC TIJTC C/\DM CAD TAIL TDIIf`TTRAIC \ REV~1470 ~ _ ~. h•.,ti~;, ~,~ ~~ "~' ~` INHERITANCE TAX COMMON', FAITH OF PENNSYLVANIA EXPLANATION BUREAU OF INDIVIDUAL TAXES OF CHANGES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER ` ACNJ -- ~ =? SCHEDULE ITEM EXPLANATION OF CHANGES NO. TAX EXAMINER: ___~ .., ~ ~ ~~o_ ~,G~ _ l ~~<--n.._Y, PAGE __~ (_~ ~ 1 ~/{ en / t 500 Ex+e(7.9a) ~ r• ~ ~ + v ~ ~- ~ t DATES OF DEATH AFTER 12131191 CHECK HERE p . tl,-.~;~- •, ~ n~nGRS rr'esv~.G r r+~ RGI {./RIV POVERTY CREDIT IS CLAIMED ^ ~ - 4. RESIDENT DECEDENT FILE NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE (TO BE FILtD IN DUPLICATE ~ /j o~~ys ~/<!~~ DEPT. 280601 H WITH REGISTER OF WILLS) __ ARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER DECEDENT' NAM (LAST, FIRST, AND MIDDLE ITIAL) a~ ' ~ DECEDENT'S COMPLETE ADDRESS /~ .Coe~s~"~~e ~~ ~~~ W SOCIAL S CURITY NUMBER DAT OF DEATH DATE OF BIRTH /J~~ ~~.~ JC5L7ti. r ~Q ~ W ' O IIF APPLICABLE( SURVIVING SPOUSE'S NAMF (UST, FIR51 AND MIDDLE INITIAL) ---~~ SOCIAL SECURIT NUMBER ~~ AMOUNT R CEIV D (SEE INSTRUCTIONS) s ~ ^ 1. Original Return 2, Supplemental Return ^ 3. Remainder Return ae a Y =oo ^ 4. Limited Estate (for dotes of death prior to 12-13-82) ^ 4a. future Interest Compromise ^ 5. Federal Estate Tax Return Required U~m ^ 6. Decedent Died Testate (for dates of death after 12-12-82) ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: y Z WW NAME /~. /~ `j n- g.~~~}1 ~1'T J l~li,~~l~ COMPLETE MAILING ADDRESS p~ ^~ RI/t 1~L 1"~Y• ~OC~~1' (~Iy,~l.t~~0~.!~H Y 1 ' l ~ ~~ TELEPHONE NUMBER '~/ 1 j •~L j- ~1 l S 5 ~A {~L-~ 7 rl ~ y• j ti L- L- ~ ~ (6 ~ ~ L-i z z 0 F= 5 c U s z 0 d r o. 0 x a 1. Real. Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages and Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) (Schedule L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) 11. Total Deductions (tc•tal 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) (1) ~r~o ~.2L o r (2) (3) (4) (5)~- ' e .~---'~ (6) (7) .r----- (10) (8)~[ ~ / (11) (12) ~ J 15. Spousal Transfers (for dates of death after 6-30-94) ~--- See Instructions for Applicable Percentage on Reverse (15) x, _= Side. (Include values from Schedule K or Schedule M.) ~ ~~„ _ + /~ 16. Amount of Line 14 taxable at 6% rate (16) x .06 = ,/~/~ (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) (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 Pri P yments Discount Interest + ~ DD ~ u (lq) (20) t 1. If Lme 18 Is greater than Line 19, enter the difference on line 21. This is the TAX D~ ~jE..,,~ [ 1) A. Enter the interest on the balance due on Line 21A. `-p'i~V~,O.~,i"~:I~~1 ) ~~~~ B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE. (21B) Make Check Poyoble to: Register of Wills, Agent D LIO i-w...w,., r r ~ , x.15= 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. f~- ^ y- ~- BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO REC E K MATH ~( ~ Under penalties of perjury, I declare 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 anv knowledge. DATE %1 '~ DATE REV•1502 EX + (12.851 1 i COMMONWE INHERI' r • o ` LTH Of PENNSYLVANIA NCE TAX RETURN :NT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF i ~ FILE NUMBER y,. ~7L~' (Property jointly-owned with Righf of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled R REV-1508 EX+ (2-871 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY /~erl~~r'/~=, (Ail property iointly-owned with the R ITEM NUMBER ~~ ~ ~ J ,. L /`~zs' ~~~-I'~L7 1 must be disclosed on Schedule F) DESCRIPTION ~~ I~S~ ~ ~ ~~e~~~~5 mac, ~- ~~~ TF 3. ~~~~~ ~ ~ ~~ ~~~ e ~ h~~~ ~ ~', . ~Q~e cue ~s~ ~"' ~ ~ ~~G ILL 'J ~© ~~- ~~~ ~ ~~ L'~ TOTAL (Also enter on line 5, itulation) I $ Please Print or Type vIBER /y 1 9,q / ~' y3 , ~~ ~~ , VALUE AT DATE OF DEATH ~~5~~. ale ,~D~ ~l ao ~- ~~ ,~~4 ~ ~~ a?~3~ 9 ~ f3~ ao ~~, ~ ~o~- ~~ ~~p~ ~ .- ~ •-- .~~'/s~_ ~~J -- d~ (Attach additional 8'/x" x 11" sheets if more space is needed.) RFV I511'EN• pB81 , 1~• ~a CUMMUNWEAIfH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT Df.CEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or DESCRIPTION ESTATE OF ITEM NUMBER A. Funeral Expenses: ~---- ~~-~~, ~~ ~~ AMOUNT B. Administrative Costs: 1. Personal Representative Commissions _ _ Social Security Number of Personal Representative: ~O ~/ ~~ Year Commissions paid ~~~,,,,, 2. Attorney Fees <..~~ ~ 3. Family Exemption - / ' 9~0, Sv fs7i,1~.V tic c-~ l- ~ - . / Claimant Relationship / ~~DO` ~ Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate fees ~Q r~0 C. Miscellaneous Expenses: QQ ~~ 3~~~ y ~ i3~L ~ ~~ ~~ ~ 3. 4. '~ ~s 1r(a 4' ~J~^p ~ / 5. '/yam ~ ~ ~ u~~' (,C~>.c Q. i ~ ~ ~~ '' s. as3. mss- ~~ . ~~r~Y~~ ~~5~ J~ TOTAL (Also enter on line 9, Recapitulation) ~~ ~ // (If more space is needed, insert additional sheets of same size.) /~~"?/!~