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HomeMy WebLinkAbout95-01172~i-g5~t~ii~ 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 1 +~ 20p~ Date Hlos.lun«. ae~ TrrEwewr N PElIYANEIIT E1.11CIL EIK i O U O O Fran eropoli, ' act Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS fl O ~ ~~. /1 A CERTIFICATE OF DEATH :J ~-F ~i OF /FiK 1/mwlr) (~ 90c ` SOCUL 3ECUpTY NUYIEN~~.G' ~^ DivE OF OERN(M«+n. 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OnIMIWn~dtlanYn•Ifon rldl«Ywnylyq«~.MmY nM~rn.EalA •t1M WM.d•b.«W P4c•. andOw to lM eauyfy rW ~n.r.....ra ................. NAME ANDADg1E9$pF LV/q OF OFAM (Xam 27(7ypn « Q~ ~~~ . ~ ~ ................................................................................ ^ • ~ 7V(a /~1 (7iJ3 ~ ~ fYL3 yam. REClsiww s SNirlrElMrE Ara NUMBER GRE MxEDrrAa.+n.D•r. w.n a. 7/-C aa. / - / ~ _ / J l ,,. ~l)R1~~r~UJ ~s~rs-S Y+.1 REV-1500 EX+ (7-94) ~ INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 1 ~/31 tY l ~MEGK MERE PovERTOirrrcREDIT IS CLAIMED ^ RESIDENT DECEDENT FILE NUMBER • COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE ~ ~/~ DEPARTDEPT. 28060jVENUE WITH REGISTER OF WILLS ~•; LL' COUNTY CODE ~ YEAR ~v NUMBER HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ DECEDENT'S COMPLETE ADDRESS z~= ELM w ~~ ~ !9 /~ ~ S 3~- ~ , // ~ / W S CI L S C R NUMBER DATE O DEATH DATE OF BIRTH ~y ~G~~yt,// L- ~~' ~J C/JC.C9 r J /y" r,~~S~ ` O V ° ® /~ p (IF PPIICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) f++ -~, Original Return ^ 2. Supplemental Return ^ 3. Remainder Return ~aH (for dates of death prior to 12-13-82) =cc ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required ~ (for dates of death after 12-12-82) Q" ^ 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) fyL W NAM _ COMPLETE MAILING ADDRESS n ` v~ T LEPHONE NUMBER // ! ~~L ~-~~~e S ~J / ~/1 ~~ 7dS--~ II~~/' f-. ~~ ~P ~ S ~ J 1. Real Estate (Schedule A) (1) 1~,~ iti _._. ~ ~, .t'a ~ ~~- - ~a C~ 2. Stocks and Bonds (Schedule B) (2) ~; i %:- , 3. Closely Held StocklPartnership Interest (Schedule C) (3) ~?' m 4 '~~~ 4. Mortgages and Notes Receivable (Schedule D) (4) '~ ~`- ~' ~, W . j 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (5) ~~/ ~ c ~ ~ ' ` - ` Z (Schedule E) ~ - _~ _ ~ a ' °-~ 6. Jointly Owned Property (Schedule F) (b) ~, ~ .~ ~ O a ~ 7. Transfers (Schedule G) (Schedule L) (7) -fi ~'~' ~ ~ a 8. Total Gross Assets (total lines 1-7) _ ~/.S, ~ (8) _ w 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) Expenses (Schedule H) _ ~ ~S ~J 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) ~ 11. Total Deductions (total Lines 9 8 10) / (11) !~ ~•S ~ GZJ 11 12 N V l f E Li 8 i Li (12 ~~ , ©~ ~~ ne ) et a ue o state ( ne m nus . ) - 13. Charitable and Governmental Bequests (Schedule J) (13) "' ... 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 15. Spousal Transfers (for dates of death after b-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 bD/o rate (16) x .Ob = (Include values from Schedule K or Schedule M.) ~- 17. Amount of Line 14 taxable at 15% rate (17) x .15 z (Include values from Schedule K or Schedule M.) o a 18. Principal tax due (Add tax from Lines 15, 16 and 17.) ._.- (18) 19. Credits Spousal Poverty Credit Prior Payments Discount Interest -- c + + ~ - (19) v a 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) t- ~ ^ 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) _ .-- A. Enter the interest on fhe balance due on Line 21A. (21 A) _'~ B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (21B) Make Cheek Payoble to: Register of Wills, Agent -^,Y~" '' Under penalties of perjury, 1 declare that I hove examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, i i l d I d l h l l t s true, correct an comp ete, ec are t at all rea estate has been reported at tr ue market va ue. Declaration of preparer other than the personal representative is based on all i nformation of which preporer has any knowledge. SIGNATURE OF PERSON RESPONSIBL OR FILING RETURN ADDRESS _ DATE ~ SIGNATURE OF P REPARER OTHER THAN REPR NTATIVE ADDRESS f ~- DATE `; 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 % (.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 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 G AND FILE IT AS PART OF THE RETURN. REV-1508 E,(+ (19~ ' SCHEDULE E CASH, BANK DEPOSITS AND CaMONWEALTtt Of PENNSYLVANIA MISCELLANEOUS INNERITANCE TAX RETURN PERSONAL PROPERTY Please Print or RESIDENT DECEDENT _ ._. _. _. .. ... __~._ ~___. ~_ ~i__~___J _~ 4L..1..1. FI (Attach additional 8Ys" x 11" sheets if more space is needed.) Y {~ . '~ '..J --y'} .~• C„N W Cf~