HomeMy WebLinkAbout95-0111.. ~,1 ~q~~l I I
This is to certify that the certificate hereunto attached is a ttve 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
~,
H1DS. lA3 Rev. 2lB7
TYPE/PMNT
IN
-ERMANENT
e~-aTBaL
v'
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
t^t ,-~ ./. ~ ,~ C
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NAME OF DECEDENT IF+K. MiE1ae, Laq SE% SOCML SECURT/Y NUMBER ee~ DRE OF DERH IManm. Doy. 1ler)
,
Helen F
Gordon
.
.
7. Female ~ 192 - 14 - 5961 ~• J ua 1 1 5
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OTNER:
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COUNTY OF DE.QH
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w. Curt~berland k. Lemoyne N. 126 Woodside Road '""'""~"""°"'""•"° 7
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Mabel E. Coulson
MiFORMANT'S NAME (TypYP~i,q
Michael Gordon .
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METHOD OF D19P091TgN DRE OFD~IT 4
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INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12/31/91 CHECK HERE
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RTYCR DIT IS CLAIME
RESIDENT DECEDENT FILE NUMBER
COMDMQPAREAL,THOFP Y ANIA
t T
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NT
OF R~'v~~t `u~
(TO BE FILED IN DUPLICATE
2195 - 0111
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HARRISBURG,PA°Gi~i128-osol ~ WITH REGISTER OF WILLS COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INI TIAL) DECEDENT'S COMPLETE ADDRESS
E GORDON, HELEN F. 126 Woodside Road
E SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH Lemoyne , PA 17043
D 192-14-5961 01/01/95 11/06/23
E
N County Cumberland
T (IF APPLICABLE)SURVIVINGSPOUSE'SNAME(LAST,FIRSTANDMIDDLEINITIAL) SOCIAL SECURITY NUMBER AMOUNTRECEIVED(SEEINSTRUCTIONS)
A B X 1. Original Return 2. Supplemental Retum 3. Remainder Return
P L
P O 4. Limited Estate 4a. Future Interest Compromise (for dates of death prior to 12-13-82
=
C R C
QX 6
D
d
Di
d T (for dates of death after 12-12-82) ~ 5. Federal Estate Tax Return Required
P 3 .
ece
ent
e
estate ^ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach cop of Will) (Attach a co of Trust)
C P
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION
SHOULD BE DIRECTED TO:
R N NAME COMPLETE MAILING ADDRESS
R
E D
E John E. Slike, Es uire Saidis, Guido, Shuff &Masland
S N TELEPHONE NUMBER 2109 Market Street
T 717 737-3405 Cam Hill PA 17011
r. Huai ~suice txneau~e v./ (11
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) (4}
E 5. Cash, Bank Deposits $ Miscellaneous Personal Property (Sch. E) (5) 41 , 056.45
C
A 6. Jointly Owned Property (Schedule F) (6) 76 , 853.26
P
I 7. Transfers (Schedule G) (Schedule L) (7)
T 8. Total Gross Assets (total Lines 1-7) (8) 117 , 909.71
U
L 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 12 , 942.08
A Expenses (Schedule H)
0 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 610.00
N 11. Total Deductions (total Lines 9 & 10} (11) 13 , 552.08
12. Net Value of Estate (Line 8 minus Line 11) (12) 104 , 357.63
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 104 , 357.63
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on page 2. (15) 0. 00 X = 0.00
(Include values from Schedule K or Schedule M.) _
16. Amount of Line 14 taxable at 6% rate (18) 27 , 504.37 x .06 = 1, 650.26
(Include values from Schedule K or Schedule M.)
A 17. Amount of Line 14 taxable at 15% rate (17) 76 , 853.26 X .15 = 11
527.99
X (Include values from Schedule K or Schedule M.) ,
C
O 18. Principal tax due (Add tax from Line 15, 16 and 17.) (18) 13 ,178.25
M 19. Credits/S Pove Prior Pa ments Discount
P ~ y Interest
U + 12 000.00 631.58
~ -
(19) 12 , 631.58
T 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) 0
00
A
T A. Check here if ou are re tiestin a refund of our over
^ ^ Y 4 Y Payment. .
0.00
I
O 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 546.67
N A. Enter the interest on the balance due on Line 21A. (21A) 0.00
B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21B) 546.67
Make Check Pa able to: Re ister of Wills, A ent
- - BE SURE TO ANSWEfi ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~
Under penalties of perjury, I declare t at I ave examl th s return, ncluding accompanying schedu es a statements, a tot a best of my knowl ge a e , It s true,
correct and complete. I declare that all real estate has been reported at true market value. Declaretlon of preparer other than the personal representative Is based on ell information of
which preparer has any knowledge.
SIGNAT U E OF SO ESPO LE FOR FILING RETURN Michael S . Gordon DATE
430-Pines_Road,_Box 95
-----------------------------
Etters, PA 17319
SIG TUREOFPREPAREROTHERTHANREPRES NTATIVE Saidis, Guido, Shuff &Masland
2109 Market Street
--------------------------------------------
Cam Hill, PA 17011 -----
Co ri c) 1994 form software only CPSystems, Inc.
7 ~~~'~
DATE
,~~/~s'
Form (Rev. 7-g4)
a
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 7/1194 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 1/1198
•Spousal transfers occurring on or after 1/1198 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A MARK ()C) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, . g
b. retain the right to designate who shall use the property transferred or its income, ~{
c. retain a reversionary interest; or . .. g
d. receive the promise for life of either payments, benefRs or care?. X
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? X
3. Did decedent own an 'in trust for' bank account at his or her death? X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST. COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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Copyright (c) 1994 form software ony CPSystems, Inc. F^'m'~ iao, 7_Od1
LAST WILL AND TESTAMENT
OF
HELEN F. GORDQN
I, HE~.EN F. GORDON of ;'the; Borough of. Lemoyne, ,Cumberland
County, Pennsylvania, declare this to be my Last Will and
Testament, hereby revolting any will previously made by me.
';-^` ~I, - I direct the ~p,ayment of ~.ll.~my justi~,:debts and
funeral expenses .out of my estate as soon as may be practical
after,~my death.
II - I devise and bequeath all of my estate of whatever
nature and wherever situate unto my son, Michael S. Gordon, if
living, and if not, to his issue per stirpes.
III - I appoint my son, Michael S. Gordon, Executor
of this, my Last. Will and Testament, to act as such without the
necessity of posting bond in this or any jurisdiction
IN GJITNESS WHEREOF, I have hereunto set my hand and seal
on this , the °~~'--
~ day of ~~_,,,~~,,,,`~,~.~ 1980.
c_~~ dZ ~' ~...~ (SEAL )
Helen F. Gordon
AaxOLD, SLIEE & HAY1
ATTOENEYE AT LAW
nw w.
Cww• ftiu.,rixM~r~ .wu nay
Page 1
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S.igr~e,d, .sealed, publ.ished~ and .declared by HELEN F. GORDON, Tes-
tatr'ix therein named, on this and one (1) other sheet of paper
as ,and for. her Last .Will and Testament in our presence, who, in
her presence, at her request and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
e CaA
A ress
~~-----
a e ~ A ress
.BNOLD. SLIHE. & BA.YLEY
ATTOIWHTS AT LAW
Cwr• H~u,Pewnar~mNU nou
Page 2
• 'i jj))
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d~
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY OF CUMBERLAND)
Z~IE, the undersigned, the testatrix and the witnesses,
respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument
as her Last Will and that he had signed willingly (or willingly
directed another to sign for her), and that he executed it as
her free will and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and
hearing of the testatrix signed the will as witness and that to
the best of their knowledge the testatrix was at that time
eighteen years of age or older, of sound mind and under no
constraint or undue influence.
c_;~ ~ ~~
~¢~ Testatrix
mess
Subscribed, sworn to and acknowledged before me by the
testatrix and subscribed and sworn to before me by both
witnesses, this ~ day of December 19_~Q_.
ABNOLD, SLrEE & B~YLEY II
~TtORN{YE AT LA~V
Grp M~u,Pt~w~w~nu nw~
otary ~u~lic
Kathleen Py1. f?avis, NO?ARY PUB1tt
My Cemmissfan Ezairs Qu~;uzt 6, 1934
Gnu F:i;l, PA Cusnberlsrd County
Rev - tsoa ex + (z-a7) SCHEDULE E
CASH, BANK DEPOSITS AND
COMMONW ALTHOFPENNSYLVANIA MISCELLANEOUS
iN~~s~~"~F~~t~N
ESTATE OF PERSONAL PROPERTY Please Print or T e
FILE NUMBER
HELEN F. GORDON SS~~ 192-14-5961 01/01/95 2195-0111
(All property 'oint -owned with Ri ht of Survivorshi must be disclosed on Schedule F)
ITEM
NUMBER DESCRIPTION VALUE AT DATE
HARRIS SAVINGS BANK OF DEATH
:
1 Z~-account No. 04-80-019224
2
`''account No. 4-81-520026 5,482.48
3
~~-I account No. 4-81-520049 ~ 5,335.54
4
193
54
4 CD ~p04-05-149841 ,
.
5
Furniture and personal effects 7,950.00
2
100
00
b 1985 Chevrolet Celebr-itY-~ ,
.
3
000
00
7 Dauphin Deposit Banl~-..~$pJacct. ~~0141266006 ,
.
3
278
76
8 Dauphin Dep, Ban1~ R~A acct. ~p0141266007 ,
.
1
808
94
9 Mellon Bank IRA acct. ~~260-051967-C ,
.
7,907.19
TOTAL (Also enter on line 5, Recapitulation) S 41 , 056.45
(Attach additional 8 1/2" x 11" sheets ff more space is needed.)
Copyright Ic) 1994 form software only CPSystems, Inc.
Form 1500 Schedule E (Rev. 2-87)
REV - 1509 EX + (12-88)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE F
INRES~DENTDECEDENT N
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
HELEN F. CORDON SS~~ 192-14-5961 01/01/95 2195 0111
Joint tenants}:
NAME ADDRESS RELATIONSHIP TO DECEDENT
A. M. Wilbur Corpman 126 Woodside Road Brother
Lemoyne, PA 17043
e.
C.
Jointly-owned property:
ITEM LETTER
FOR DATE
NUMBER JOINT MADE DESCRIPTION OF PROPERTY
TENANT JOINT
DAUPHIN DEPOSIT BANK
1 A 03/19/9 C.D. ~~8000136074
2 A 04/03/9 C.D. ~~8000136082
3 A 12/05/8 C.D. ~~8000137836
4 A 08/14/9 C.D. ~E8000139510
5 A 06/24/6 Ck/Acct. ~~24128732
/ /
6 A 12/11/7 Single family dwelling
/ / situate at 126
Woodside Road, Lemoyne
assessed value - $8250
x common level ratio of
13.33 totals above listed
value.
TOTAL (AISO enter on line
TOTAL VALUE
OF ASSET DECD'S
°~ INT. DOLLAR VALUE OF
ECEDENT INTEREST
6,636.35
2,209.34
10,059.55
13,399.91
11,428.85 50.OOr
50.007.
50.007°
50.OOy
50.007° 3,318.18
1,104.67
5,029.77
6,699.96
5,714.43
109,972.501 50.OOY1 54,986.25
tir more space Is needed, insert additional sheets of same size.)
Copyright (c) 1994 form software only CPSystems, Inc.
f: 76,853.26
Form 1$00 Schedule F (Rev. 12-881
REV - 1511 EX + (7-aa) SCHEDULE H
E~pp~~,TT FUNERAL EXPENSES,
COMINOINERfTANCE~gy~NANIA ADMINISTRATIVE COSTS AND
rRcESS DDEEENNNTT DD •NN(jtT~ MISCELLANEOUS EXPENSES
ESTATE OF
HELEN F. GORDON SS~~ 192-14-5961 O1 O1 95
ITEM
NUMBER DESCRIPTION
A• FunsralExpenses:
1 Myers-Harner Funeral Home
2 Dillsburg Cemetery - grave opening
3 Gingrich Memorials - grave marker
B• Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees Saidis, Guido, Shuff & Masland
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees Rani cro,- .,f tr; i i ..
4,881.00
60.00
~• Miscellaneous Expenses:
1 Cumberland Law Jounral - legal ads
2 Patriot-News Co. - legal ads
3 Register of Wills - filing fees
4 Reserved for future expenses and filing fees
TOTAL (Also enter on line 9. Recaeitulsf~
~~~ nrvre space IS rleea@O, insert additional sheets of same
Copyright (c) 1994 form software only CPSystems, Inc.
or ryps
ILEILE N~UMB~ER
2196-0111
AMOUNT
4,673.00
500.00
2,404.00
40.00
59.08
25.00
300.00
IS 12,942 08
Form 1500 Schedule H (Rev. 7-88)
REV - 1512 EX f (1-93)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HELEN F. GORDON
SCHEDULEI
DEBTS OF DECEDENT,
SAGE LIABILITIES AND
SS~~ 192-14-5961 01/01/95
Please Prim of Tvpe
FILE NUMBER
2195-0111
opyr g c 1994 form software only CPSystems, Inc.
Form 1~OSchedule 1(Rev. 1-93)
_• .
M
REV - 1S 13 B + (Z_g~~
COYMONW ALT~E~NT~VANIA SCHEDULE J
I"~~~~~"" D BENEFICIARIE
ESTATE Of
HELEN F. GORDON SS~~ 192-14-5961 O1 O1 95
ITE M
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1 Michael S. Gordon
430 Pines Road, Box 95
Etters, PA 17319
2195-0111
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
Son ~100Y of residue
• -- ~~-----• •••-..•. •... v.uv. ~v~ ai~avW VI JGfi1B SIZ@.J
Copyright (c 19gq form software only CPSystems, Inc.
Form x$00 Schedule .I (Rev. 2-67)