HomeMy WebLinkAbout95-0146~~ ~~~~ v'YUJ
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.
Auc i s- zoos
Date
' ~j' N,O6.,C3 ROV. ?l87
T/VEIPItB1T
M
PERMANO(T NAME
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLWINIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
G14493
c 3EX 90CIAL SECURfIY NUMBER IMDE OF DERNIAtaYh, O•Y•WM)
,. Vera E. Henry
:Female a. 136 - 18 -4267 ..Feb 1
1995
ADE
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EDtcAL PxAaRNffA/COR011ER (nem zl, ryae«PeM Steven L. Hatleber
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Carlisle Pa
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INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12!31 f91 CHECK HERE
IF a sPOUSat.
POVERTY CRE
^
''
~~- ~. RESIDENT DECEDENT DIT IS Cu-IMID
COM~tQNWEALTH OF PENNSYWANIA
OEfARTMENT OF REVENUE
DEPT.~80601
(TO BE FILED IN DUPLICATE FILE NUMBER
-Z j _ ~ S-_ ~: y ~ j /'
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HARRISBURG, PA 17148-0601 WITH REGISTER OF WILLS) T
AM , A MI COUNTY CODE YEAR NUMBER
HENRY, Vera E. Myl A E
s U treet
V IA RI UMe R DA DEA H DATE O BIR H CarllSle, Pennsylvania 17013
c 136-18-4267 2/1/95 5/27/04 Ctunberland
W
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®l. Original Return
co~~
^ 2. Supplemental Return
^ 3. Remainder Return
W a°C.u
=
^ 4. Limited Estote
^ 4a. Future Interest Compromise (for dates of death prior to 12-13-82)
^ 5. Federal Estote Tax
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t
^ 6. Decedent Died Testate (for dates of death after 12-12-82)
^ 7. Decedent Maintained o Livin
Trust Return Required
8
T
~
(Attach copy of Will) g
(Attach copy of Trust) .
_
otal Number of Safe Deposit Boxes
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Roger M. Nbrgenthal, Fsquire
717 1 243-5513
TO:
11 East High Street
Carlisle, Pennsylvania 17013
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1. Real Estate (Schedule A) (1) --° -
2. Stock: and Bonds (Schedule B) (2) ---
3. Closely Held Stock/Portnership Inters:t (Schedule C) (3) -
4. Mortgages and Notes Receivable (Schedule D) (4) -
5. Cash, Bank Deposits & Miscellaneous Personal Property( 5) 12,113.86
(Schedule E)
b. Jointly Owned Property (Schedule F) (b) ---
7. Transfers (Schedule G) (Schedule L) (7) ---
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous (q) 1,123.00
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 1,258.01
11. Total Deductions (total 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)
~~~~
( e) 12,113.86
(11) 2,381.01
(12) ' •
(13) ---
(t4) 9,732.85
15. Amount of line 14 taxable at 696 rats (15) 9, 732.85 58
(Include values from Schedule K or Schedule M.) x .Ob =
16. Amount of (ins 14 taxable at 1596 rats (16) ---
(Include values from Schedule K or Schedule M.) x .15
17. Principal tax due (Add tax from line 15 and from line 16.) (1 ~ 583.97
18. Credits Spousal Poverty Credit Prlcb~oytpLent: Discount Interest
b Utl
+
+ _ .31.58 _ (18) 631.58
19. If line 18 is greater thou lino 17, enter the difference on line 19. Thia is the OVERPAYMENT
~^ .. .. . (19) 47.61
20. IF line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (20)
A. Enter the intersst.on the balance due on:lins 20A
.
6. Enter the total of line 20 and 20A on line 206. This is the BALANCE DUE. (20A)
(20B)
Make Check Payable to: Register of Wills, Agent
", " ~- ~E4E:SURE.:TO"ANSWER`ALL`G~UESTIQNS ON REVERSE.:SIDE'AND TO`RECNECK MATH ~^~
nder penalties of perjury, i declare that I have examined this return, inch
is true, totted and complete. I declare that all real estate has been repo
used on all information of which preparer has env knowledgw
3 accompanying schedules and statements, and to the best of my knowledge and belief,
at true market value. Declaration of preparer other than the personal representative is
DAT
8. Bedford St., Carlisle, PA 17013 ~ L! ~~~--
1 ss
DATE
l~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~) IN THE
APPROPRIATE BLOCKS.
1. i d dent make a transfer and:
......
,,~ ,
r ~se ° 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 core? .......................
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.
REy4S0! EKa !2-pi
' ' SCHEDUI:E' E
CASH, BANK DEPOSITS AND
COMMONWEAITfI OP PENNSYLVANIA MISCELLANEOUS
iN ~ T~eDe~RN PERSONAL.PROPERTY
ESTATE OF Please Print or T e
FILE NUMBER
Vim' E' FAY 21-95-0146
(All prop.ty ioi~NY-owned with the Right of Survivershtp nwst bo ditelosod ea Sehodulo FI
ITEM
NUMBER DESCRIPTION VAWE AT
DATE OF DEATH
1. Checking Account - Fatzners Trust Company $12,.113.86
TOTAL (Also enter on line 5,
(AMOCh additions! 8l~i" x il' shstets if moro span is nshdod.)
S 12, 113.aEi
s
REKYSII EX• p~881
~ SCHEDULE H
... ~ FUNERAL l:7CPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE- COSTS AND
INHERITANCE TAX RETURN MISCELLANEOUS.' EXPENSES
RESIDENT DECEDENT
ESTATE OF
VERZ-~ E . ~-~NFtY
ITEM
NUMBER DESCRIPTION
A. Funeral Expenses:
1. Carlisle Memorial (inscription)
Please Print or
21-95-0146
B• Administrative Corn:
1. Personal Representative Commissions
Social Security Number of Personal ReprossMatiw:
Ysar Commissions paid
2. Attorney Fees Flower, bx~rgenthal, Flower & Ia.nczsay, P . C ,
3. Family Exemption
Claimant Relationship
Addross of Claimant at decedent's death
Street Address
City State T.Lp Code
. 4. Probate Fees
Register o= dills--Ctunberland County
Miscellaneous Expenses:
2.
3.
4.
5.
6.
7.
8.
AMOUNT
65.00
1,000.00
58.00
TOTAL (Also enter on line 9, Recapitulation) I $ 1,123.00
(If more space is needed, insert additional sheets of some size.)
C.
4~
REkISit E%r (7~Ep
a ~
cauwNwEnlnl a reNNanwNu
INMERrlANCI TAII'RETURN
RESIDENT DLClDENT
SCHEDULE I
DEBTS OP DECEDENT,
MORTGAGE LIABLITIES AND LIENS
VERA E. EERY
Pl~as~ Print or
E NUMBER
21-95-0146
ITEM
NUMBER DESC`RIP'TION
AMOUNT
1• Sarah A. Z~odd, Memorial Home
261.05
2• Darlene Moyer, Tax Collector (personal tax) 9.90
3. Carlisle Imaging
11.55
4. Care Apothecary (prescriptions)
64.37
5. ~ Emergency Physicians
17.44
-- 6. Carlisle Caitmunity Ambulance
129.10
7. Carlisle ~-:.ospital
716.00
8. Belvedere Medical
48.60
TOTAL (Also enter on line 10 Recapitulation) $ 1, 258 Ol
(!f more spoee is needed, insert additional sheep of some sizR)
AEV.1513 EX+ X87)
a ~:L.,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CtTATC ~e
SCHEDULE J
BENEFICIARIES
HENRY, Vera E.
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
~~ Aiarie J. Sheaffer
518 S• Bedford Street
Carlisle, Pennsylvania 17013
2 • Lee Eugene H~:nry
1320 Allaire Avenue
Ocean City, New Jersey 07712
y 3• Jack Arthur Henry
471 Freehold Avenue
Oakhurst, New Jersey 07755
4• Agnes Lois Brough
1598 Pine Road
Carlisle, P.e}-nsylvania 17013
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
~ ~ N/A
FILE NUMBER
21-95-0146
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
daughter 1/4
son ~ 1/4
son ~ 1/4
daughter I 1/4
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $
(If more space is needed, insert additional sheets of same size)
REV-147 EX AFP (12-94)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101
BUREAU OF INDIVIDUAL rAxES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601
HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 12-04-95
~~~~^ r VtKA E FILE N0.
DATE OF DEATH 02-01-95 -
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 T0:
ROGER M MORGENTHAL ESQ
11 E HIGH ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Amount Remitted
CUT ALONG THIS LINE - RETA_IN LOWER POR_TION_ FOR YOUR RECORDS ~
------------------------------------
-------------------------------
REY-lsk7 EX AFP C12-94) NOTICE OF INN€RITANCE TAX A'~~^~IS~ME~T, ALLOWANCE OTC
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HENRY VERA E FILE N0. 21 95-0146 ACN 101
DATE 12-04-95
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
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 B) (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] 12.113.86
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets
(a) 12,113.86
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 1,123.00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (107 1.258 O1
11. Total Deductions
12. Net Valw of Tax Return (11) - ~-;81 O1
13. Charitable/Governmental Bequests (Schedule J) (12) 9,732.8 5
14. Net Value of Estate Subject to Tax (13) .00
(14) 9, 732.85
NOTE: If an assess(nent was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 taxable at Collateral/Class 8 rate
18. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT
DATE NUMBER
05-01-95 AA04770
DISCOUNT (+)
INTEREST (-)
(15) . 00 X . 00_ .00
(16) 9,732.85 X .06- 583.97
(in . 00 X . 15. . 00
(ls) 583.97
AMOUNT PAID
00.
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT 629.20
BALANCE OF TAX DUE 45.23CR
INTEREST .00
TOTAL DUE 45.23CR
( IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS REQUIRED.
IF-TOTAL DUE-IS-REFLECTED-AS-A-''CREDIT'' (CRl_ YOU MAY-BE DUE