HomeMy WebLinkAbout95-0127.Z ~ -~~ 1 D~ 27
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 16....2001 ~ ?
f
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _ " ~ I v
CERTIFlCATE OF DEATH v Q 2 ~; v 9
(Coroner)
+. Donald S Kna
AOE(lar SY,gry) uNDER1vEAR tN~DEn,Da cDMA~7Enac eITTrH
67 vim. Mae. Dap Hpn MbuNS J111y~~~",
1927
cotlNTVaFDERl1 arr DEATH R,carr
~/ Cumberland East Pennsboro Ho
~+ IDNDDVeUSNESSdNDUS,IiY µ ~
' ~,alMro ro~ ~•~I
Railroa3 Railroa3
DEC;EOO~raMAILNDADDREas~aaal.ctv~Twa,.sw.,nPCOdy s
109 Miller St. ,~~,~ +n
Summer3ale, Pa 17093 ~,
ll 'B NAME(Finl, MiOda,lrq 170.
,., John S. Knaby
NPOtOAANT'S NAME RYDa'Prira)
Dona13 M. Knaby
ME7HOO oP asPOSITgN DaE oP asPo
C;
sruEFAENUMBER ~ -
by
:Male SDCNLSECURTTYNUMSER
>.201-18-4999 DALE OF DEATH IMpah, Day, Ver)
BIR7HRLACe IGYW
SlW afnagn Canby)
rLACeor OFAII (CMCk anlY •ns-b•imwdiarmaMrad•) ..January 30,1995
Enola, Pa
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v NAME ryI nal bmbdo~. p~'•aro•lend rw.nber)
ly Spirit Hospital W13 DECEDENTDF HI8PA,aC ORgIN7
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~"Qibin~ RACE-
ArtNrcan bidvi, Blacb, Wllk•,
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1115 DECEDENT EVENN
U.S. ARMED FORf:ES7 DECEDENT'SEgJC10'gN •
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SURVMND SPOUSE
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Cumberlan3 L^S
Y•n^ odr, CnmaO•n^ R•mwal roan str^ lMr+n•Dw.wM
"~""7 ^ ,Feb 3, 1995
SERVICE PFABDN AC7,Iq A93UCN LICENSE NUMBER
--~~~-- ns. F. D _ 0
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~. Mabel E. Shutt
a1c s•°~'da~:"",'i331etown, Pa 17057
+ACEDPOnPOSTTIDN-Nan'aC•^~«xC~.n.Irr LocaaH-
OIIrrPbq CMrown. sm, nP Code
,In3iantown Gap Nat'l Lebanon, pa
NAMEANDADDRESSOPSAaLrrr
-L „.Sullivan F.H. 51 N. Enola Dr..F'.no7a_Pa
30, 1995
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sr. CWdnat badMUmbwd ^ PLACE OF~NJURV-Al li•in.. brm, sbar
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nq b~••A•aP.d•aMa•eWrW OwbiMUaaala)andaWaw M•OIt•0 ..................................................... ^
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REG1 '3 SIGNIOURE AND NUMBER
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`C/ Coroner
DATE SN3NEDIMOnn, DeV.'kr) -_
i,d Jan. 31,1995
J YVNO COMPLETED CAUSE OF DEiV H
ael L. Norris,Coroner
Fairway Drive
anicsburq, Pa. 17055
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RE3 150 EX'
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INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131 f91 CHECK HERE
IF A sf-ousAL
~ ~ RESIDENT DECEDENT POVERTY cRED~r fs cLAIMEO ^
•
COMMONWEALTH-0F PENNSYLVANIA
DEPARTMENT OF REVENUE PTO BE FILED IN DUPLICATE FILE NUM9ER
~ / ~ ~ ~ ~ !
DEPT. 280b01
HARRi5t3URG, PA 17126-0601 WITH REGISTER OF WILLS)
COUNTY CODE
YEAR NUMBER
DECEDENT'S NAME (UST, FIRST, AND MIDDLE INITIALI
~
S DECEDENT'S COMPLETE ADDRESS
'
'
Q ~d/Uf} ~l . Jic~E
.Q Si
/09 /t
7093
W SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH ,S6r/~ /~'~ E.e Of}C~ / ~~ • ~
W a o i - /Y- Y9 9'y i 3 ~- 9 S 7- 30 -- z ~ C
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d IIF AR-IICMLE) SURVIVING S-OUSE'S NAME IlASi, fIRST AND MIDDLE INITIAL) SOCIALSECURITY NUMBER AMOUNT-RECEIVED (SEE INSTRUCTIONS)
a 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
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^ 4. limited Estate (for dates of death prior to 12-13-82)
^ 4a. future Interest Compromise ~ ^ 5. Federal Estate Tax Return RE:quired
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^ 6. Decedent Died. Testate (for dotes of death after 12-12.82)
^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe De
osit fo
es
(Attach copy of Will) p
x
(Attach copy of Trust)
AlL CORRESPONDENCE AND CQNFIDENTIAL 1~AX INFORMATION SHOULD BE; DIRECTED TO:
y' = NAMEnn -
UDC ~fl /~'~. ~N~
~.¢p~++r~ssr
~ COMPLETE MAILING ADDRESS
/'o zo ~E~S ~22n
.
v~ TELEPHONE NUMBER
~~ ~ 9~Y- 9YY7 ~~p0 L~ ~~~ / Q~• ~ 7OS7
1. Real Estate (Schedule A) (1) ~ ~; (";
2. Stocks and Bonds (Schedule B) (2) _ (p ~ ,~ Z 7 ~ ~ S ~ `~' -~ ~
3. Closely Held StocklPartnership Interest (Schedule C) (3) ~
4. Mortgages and Notes Receivable (Schedule D) (4) ~ --' _ ~
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (S) ~ i ~~ ! - Z. _: a
_
_ .(Schedule E) 1 Tys
..~_
b. Jointly Owned Property (Schedule F) (b)
~
~ 7. Transfers (Schedule GJ (Schedule L) (7)
~
8. Total Gross Assets (total Lines 1.7) ~O O ~O a Z y ~ (8)
9
F ~r Q. 4 ~ ~
~ .
uneral Expenses, Administrative.Costs, Miscellaneous (9) J
E
h -
xpenses (Sc
edule H) ~ Z Z '9 ~ G ~
1
~
0.. Debts, Mortgage liabilities, Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 ~ 10) (11) _ ~< j .~~ ~ • 8Y
12. Net Value of Estate {Line 8 minus Line 11) (12) ~/j S~Z - Q 3
13. Charitable and Governmental Bequests (Schedule J) (13) _ D
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) T ~/ -f~L ' 0.,3
15. Spousal Transfers (for dates of death after 6-30-94)
~
~
Ses Instructions for Applicable Percentage on Reverse (15) x._=
Side, (Include values from Schedule K or Schedule M.) -"-'
-
1 b. Amount of Line 14 taxable at b% rate (16) ~ ~~ s' L ~ ~'3 x
Ob = .S~l ~® ~ 7 2
.
(Include values from Schedule K or Schedule M.) -
17. Amount of Line 14 taxable at 15% rate (17) x
15 = -r
zc .
(Include values from Schedule K or Schedule M.)
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n _
S/ ~(~ • ~ Z
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-- 18. P
i
cipal tax due (Add tax from Lines 15, 16 and 17.) (18)
~
19. Credits Spousal Poverty Credit Prior Payments Discount Interest _
chi + + - (19) _
a
~ 20. If Line 19 is greater than Line 18, enter-the difference on Line 20. This is the OVERPAYMENT. (20)
~^ _
21: If Line 18 is greater than Line 19, enter the-difference on Line 21. This is the TAX DUE. (21) _ s 9 70 ' ~ Z
A. Enter the interest on the balance due'on Line 21A. (21A) _ -+-
B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21 g) _ .f9 7~ J 2
Make Check Payable to: Reylster of Wills,. Agent
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK 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. 1 declare that all real estate has been reported at true market value
Declaratio
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.
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preparer ot
based on all information of which preparer has any knowledge. er t
an the personal representative i
SIGNAT f PERSON RESPONSIB R fl LNG RETURN ADDRESS - ` _._~ __.-DATE , '
OZ a ~=rCie5 ,~--lJ /~7~!D< <row~/ P~ /7bt7 ~'- Z ~j -'s
SIGNA URE OF PREPARER OTHE THA RESENTATIVE -ADDRESS DATE
~ REV
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-I~W,tX+ (7_94) ty ~ 1 'In/ ( '.
FOR DATES OFDEATNAFTER12I31/91CHECKHERE
V/"
IF A SPOUSAL
I HERITANCE TAX RETURN
J ~"~ % RESIDENT DECEDENT POVERTY CREDIT IS CLAIMED ^
COMMONWEALTH OF PE SYLVANIA~
O BE FILED IN DUPLICATE FILE NUMBER
OEPARTMENTOFREV NUE
DEPT. 280601
WITH REGISTER OF WILLS)
HARRISBURG, PA 17128- 1
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRS , D MI ITIAL) DECEDENT'S COMPLETE ADDRESS
t-
W SOCIAL SECURITY NUMBER TE OF DEATH DATE OF BIRTH
0
W
V Count
O
(IF APPLICABLE( SURVIVING SPOUSE'S NAME (LAST, fIRST AND MIDDL INITIAL( SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
'++
ay ^ 1. Original Return 2. Supplemental Return ^ 3. Remainder Return
~ oe ~
W dr,
x o o (for dates of death prior to 12-13-82)
^ 4. Limited Estate ^ Future Interest Com romise
P ^ 5. Federal Estate Tax. Return Required
v ~ m
a (for dates of death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. ecedent Maintained a Living Trust _ 8. Total Number of Safe De osif Boxes
(AMach cop
of Will)
p
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ttac
copy o
Trust)
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W Ly NAME COMPLETE MAILING ADDRESS f
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tag TELEPHONE NUMBER
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 )
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5 )
_ (Schedule E)
S 6. Jointly Owned Property (Schedule F) (6 )
~ 7. Transfers (Schedule G) (Schedule L) (7 )
r
c
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses, Administrative Costs, Miscellaneous (9 )
Expenses (schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) _.
11. Total Deductions (total Lines 9 8~ 10)
~~ (11) _
~
12. Net Value of Estate (Line 8 minus Line 11) ~ (12)
13. Charitable and Governmental Bequests (Schedule J) ~~"~~ (13) _
~4. iffier vows ~uolect to lax (Line 12 minus Line 13) (/ fir(7-!G (14) _
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) .06 =
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rate (17) x
zo (Include values from Schedule K or Schedule M.)
F 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (1 )
~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest
v + + - (19)
a
~ 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is The OVERPAYMENT. (20)
~ ^
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 the balance due on Line 21A. (21A) _
B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21 B)
Make Check Payable to: Register of Wills, Agsnt
<:
_ .,..
Under penalties of penury •I declare that I have examined this return, including accompanying schedules and statements, and to the best of m knowledge,and belief,
it is true, correct and complete I declare that all real estate has been re
orted at true m
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aration of preparer other than the pe anal representative is
based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR Fuwr. oonion~ ...,~e«~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS -
REK1543 EX+ 1s-96)
r t /~~~~
SCHEDULE B
COMMONWEALTH OF PENNSYWANIA
INHERITANCE TAX RETURN STO. CKS AND BONDS
RESIDENT DECEDENT
ESTATE.OF
o~/i~ ~ ~. 0 ~•
/ , FILE NUMBER
l \~ ~TrO
(AII property iointly-owned with Right of Survivorship must ba diselos~d on Schadul~ F.)
ITEM
NUMBER
DESCRIPTION
VALUE. AT DATE
OF DEATH
~. PRupE,,~°rsq~. v~Fa.~r-E~i .y~1CoME' ~un~D g.
3 13 s~q~
(~ ~ S 1
~- ~
Y 022 .29 7 . S~
. s
.
~• Cow ~e.~T c. T'r~ c. ~ C'o.>1~n o ~ S~'oc,~ 3 7 2 S
C p p
l 23 '
~
s~
~s) 2
~ ~ ~
y,
.
3, SE2=ES E E SAU~~GS Bo~~ S ~2~ Ybb ~ S~
TOTAL (Also enter on line 2, Recapitulation) S / ~ 3,,Z, 7 ~ a5
,•
~ ~. REK`!5091 EX• (].971
SCHEDULE E
-CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS
1"NREbIDENTEDE~oE~R" PERSONAL PROPERTY
ESTATE OF Please Print or Ty e
~~ ~~ ~b ~~~ FILE NUMBER
(All property jointly owned wd6 the Rs~ht of Survivorship mysf be disclosed on Sehedub F.)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
l• ff,ECK.z~G- ~~r. J PivC /~K ~ /~0 03939 ~ ~ 1 to qs , 3
3
.2, ~Nc CO ~ /o83~6D~SY ~~3 j l~ i ~ 3 ,1 ~
ANC CD ~ ~op3i6Do9oo 3~. ~.2 ~ 6 7.81
~
~• l 9G ~ ~~ T'E2i~AT~v~q c. Sco v-T / , O D
5, ; ~ 8~ PLY~ouTr+ ~E~s~r ~ C o oc~ . 0 0
l q 9 Y ~,C.v c-~,e g ~ ~n~ca r- c TA-X ~ru,~ ~ a ~f `(. ~ ~
~" ~~Z C i2o q~ . ~TS,e.~'i-'-,~ N ?' Bo+~D LCt~nP ~ ~ 3 3 ' S ~
S ~ m D~~T~ ~~~E~zT .
111
~~'P~t-zS Ez S~
C~S~ ~o:S• °°
-TOTAL (Also enter on line 5, Reca
(Attach additional 8Ya° x 11' sheets if more space is needed.)
J
. ~ L
~ ~ REKIS~I E% +7.88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
_ RESIDENT DECEDENT
SCHEDULE H
. FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
~.r.r..c yr - .
ITElN
NUMBER DESCRIPTION
A-• Funeral Expenses:
~_ SoH~ C, SC4C.L.=uq~ F'u,v,~'R,a~. 1-for-~
S ( AJort-ret CNO~A ~Rsc9E
Fwc.A ~ PA. ~ ~oZS
Please Print or
AMOUNT
B• Administrative Costs:
1_ Personal Representative Commissions r/
Social Security Number of P/ersonal Representative: ~ ~ ~ - 7 ~ - 391 Z
Year Commissions paid - /
2_ Attorney Fees ~q,vE' /-'), iQ~,cPtC-+, /0'/ S. SEtv.+O ST ff~2~usg.c~c
P9. /viol
3_ Family Exemption
Claimant °T`'' Relationship _ lVyL~
Address of Claimant at decedent's death
Street Address N/~tl
City _ n/~A~ State ~ Zip Code
4. Probate Fees CU/''1 [3E2Lq,~Q GO u ,/ T'y C O u ~t.T
IQE'<osSTE2 OF" W~L~S H'vu-i£
C• Miscellaneous Expenses:
1. F•2CE' ~^)flE.ezTq./CE T/FX Q~l~lz,~
2. F='[.F ~9L 3 pE',QSo,vAt EST~r~' =',~cJE,.~rv~y
a. ~n1Co.,r.~' T/~~r P/LEPf1Qs}T.r~~ ~S~u.O~R TgX SF2.uscE'~
5- ~OIJkq-2 C. S7"OGK ~GDC-MPTivN Con~M~55~J~~ PNC &QpK~
~'}c-C e01QP. - sCorT ct}2~E2,
e. ~~ s Fc'~e ~r~ E~ NoTg2 y S=EES -- /`!~'b ~C Yrl~~cT,~
~. PE2s o~,4-c .~,vvE,~TV,Q y gpP
~}/PQgssE,~S~ ~I-~S,~{. FE.E'~,2, FNs,h,~,•~6~t
8. pugG.=SH LEG-/fL /vOTU~'S `- C4~/-3. C'ou
,rr-y Lq~ Tau,r./y C.
9 . ~NR c ~s ~ ~.~ ~ ivpr=~~ - e,g2 c rsc E SE,~ r~w.cc.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of tame size.,)
ss3o. ~y
Sa. o~
Q, OCR
13~~0~
/~.DO
/p, o0
°l , o` a
~p , o
23/.2
3y,oo
~o.v c7
~~.ov
s2 • o y
s /~, og~ . 2y
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REV-1512 EX+ (~-~
C~M~DNWEALTH OF PENNSYLVANIA
M HERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or
IMBER
(It more space is needed, insert additional sheep of same size-)
REV-IS~IJ EX i (]Tn
a ~ ,
• SCHEDULE J
4MMONWEALTHOFPENNSYLVANIA
INHlRRANCE TAx lETURN BENEFICIARIES
~i ~
-
- - -
RESIDENT DECEDENT
ESTATE ~OF
o
s
FILE NUMBER ~
-'
o~ ~ ~ ~ . ~~ ~e
Y
ITEM
NUME3EA
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
i. Jon19co /YI ~ KNgB y /02o P~c,~cs ~'p s ~ ti Sid ~o
~-1soo~~rv~ti j P.~ ~ ~o r ~
~ , ~EB~~, Ce /j'1.~~-rrG~ /l13-8 GROPE QAuG.r~,-EQ ~~ °~~
/f~hea~sByQG` P9 / 7/ll
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
~. /Up~F
AMOUNT OR
SHARE OF ESTATE
N~,~
TOTAL CHARITABLE AND GO.YERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $
(If more space is needed, insert additional sfieet; of samr size). N/~