HomeMy WebLinkAbout95-0147~I Q5-DI~I7
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.
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PERMANENT
FLACK IIIK
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Date
AUG 16 200T
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYUMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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/MME OF DEOEDENTIF:a LiEO•.1s0 SEx BDC1Al sECl,roTV NUMBER DREOP DF VNIMtone4 orti'w1
,.Almeda M. Shupp a. Female a 184 - 38 - 0751 ..r~~..M..h.,,--7 ~99y
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
HARRISBURG, PA 6107128-0601
SHUPP, ALMEDA M.
184-38-0751
1. Original Return
^ 4. Limited Estate
® b. Decedent Died Testate
(Attach copy of Willl
Frey and Tiley
71? 1 243-5838
FILE NUMBER
21-95Q147 <'
COUNTY CODE YEAR NUMBER
801 N. Hanover Street
Carlisle, PA 17013
Cumberland
^ 3. Remainder Return
(for dates of death prior to 12-13.82)
^ 5. Federal Estate Tax
Return Required
1 8. Total Number of Safe Deposit Boxes
5 South Hanover Street
Carlisle, PA 17013
1. Real Estate (Schedule A) ( 1) ~ `.... ~~ ~
2. Stocks and Bonds (Schedule B) 2 = - ~-" ~~ {j
3. Closely Held StocklPartnership Interest (Schedule C) (3) '~ r~~
4. Mortgages and Notes Receivable (Schedule D)
(4) ~ rw
_2~_
5. Cash, Bank Deposits 8 Miscellaneous Personal Property( 5) _
(Schedule E)
1904 2~ ~ - ,, _,
b. Jointly Owned Property (Schedule F)
(b) ^~
-_ ~. _; +:
--
i
7. Transfers (Schedule G) (Schedule L)
(7)
~- :~~~ !~s-! ~ ~~
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8. Total Gross Assets (total lines 1-7) (8) 1904.25
9. Funeral Expenses, Administrative Costs, Miscellaneous (9)
.Expenses (Schedule H) 303.00
10. Debts, Mortgage liabilities, Liens (Schedule I) (10)
11. Total Deductions (total lines 9 & 10) (11) 303.00
12. Net Value of Estate (line 8 minus line 11) (12) 1601.25
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (line 12 minus line 13) (13) _
(14) ~ 601- 95
15. Amount of line 14 taxable at b% rate (15) 1601.25 x .Ob = 96 08
(Include values from Schedule K or Schedule M.) --
16. Amount of line 14 taxable at 15% rate (16) x .15
(Include values from Schedule K or Schedule M.)
17. Principal tax due (Add tax from line 15 and from line 1 b.) (17) 96 08
18. Credits Prior Payments Discount Interest
+ _ (18)
19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19)
~^ -
20. If line 17 is greater than line 18, enter the difference on line 20•This is the TAX DUE. (20) 96.0$
A. Enter the interest on the balance due on line 20A. (20A)
B. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE. (20B) 96.08
Make Check Payable fo: Register of Wills, Agent
lnderrvpenalties of perjury, I declare that I have examined this return,
is true, correct and complete. I declare that all real estate has been
ase on all information of which preparar has any knowledge
IGNATURE O ERSON RESPO~ISIBLE,~JJR-FILING RETURN ennoaec
511 W
50069100
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED iN DUPLICATE
WITH REGISTER OF WILLS)
Nov. 7, 1994 ~ Nov. 15, 1897 Ico.~,r
^ 2. Supplemental Return
^ 4a. Future Interest Compromise
(for dates of death after 12-12-82)
^ 7. Decedent Maintained a Living Trust
(Attach copy of Trustl
accompanying schedules and statements, and to the best of my knowledge and belief,
at true market value. Declaration of preparar other than the psrsonal representative is
DATE _
~n Ave., Mifflintown, PA 17059 March 7, 1995
v - ~--- DATE
~`~`"{ ~ a ~ 5 S. Hanover St., Carlisle, Pa. 17013 March 7, 1995
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.
F -.... ..,, ... ~ .. .,.. ~., - _,
REV-1508 EX+ 12-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEQULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
ALMEDA M. SHUPP
(All property joinflywwned with tha Righf of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER DESCRIPTION
1. I Balance in personal care account, Church of God Home
Please Print or Type
NUMBER
21-95-147
VALUE AT
DATE OF DEATH
1,904.25
TOTAL (Also enter on line 5 Recapitulation) I $
(Attach additional 8~/z" x 11" sheets ii more space is needed.)
1,904.25
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REV-1511 EX+ (7-BB)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ALMEDA M. SHUPP
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ITEM
NUMBER DESCRIPTION
A• Funeral Expenses:
1.
Please Print or Type
3ER
21-95-147
AMOUNT
0.00
B• Administrative Costs:
1• Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City - State Zip Code
4. Probate Fees
C• Miscellaneous Expenses:
1• Register of Wills, filing Inheritance Tax Return
2.
3.
4.
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space ~s needed, insert additional sl>teets of same size.)
0.00
250.00
0.00
38.00
15.00
303.00
REV.1513 EX+ (2-87~
COMMONWEALTH OF PENNSYWANiA SCHEDULE J
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
ALMEDA M. SHU PP
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
t. Genevieve Zimmerman
Box 128-103C
Quincy, PA 17247
2• Jonathan C. Terry, III
511 Washington Avenue
Mifflintown, PA 17059
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
t' NONE
FILE NUMBER
21-95-147
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
Daughter 1/2 residue of estate
Grandson I 1/2 residue of estate
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more space is needed, insert additional sheets of same size)
S
AMOUNT OR
SHARE OF ESTATE
LAST WILL AND TESTAMENT
OF
ALMEDA M. SHUPP
I, ALMEDA M. SHUPP, widow, of 131 East North Street in the Borough
of Carlisle, Cumberland County, Pennsylvania, being of sound and
disposing mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament, hereby revoking
and making void any and all Wills by me at any time heretofore made.
1. I direct my hereinafter named Executors to pay all of my
just debts and funeral expenses as soon .after my death as may be found
convenient to do so.
2. I give and bequeath all shares of stock which I may own at
the time of my death to my greatgrandchildren, to be divided equally
among them. At the present time I have only one greatgrandchild,
Rebekah Jane Terry, .who is the daughter of my grandson, Rev. Jonathan
C. Terry, III. I further direct that the parent or parents of such
greatgrandchildren shall be the guardians of the estate of each such
grandchild and custodian of the shares of stock to which each such
greatgrandchild is entitled.
3. All of the rest, residue and remainder of my Estate, real,
personal and mixed, and wheresoever the same may be situate, I give,
devise and bequeath as follows: One-half (1/2) to my daughter,
Genevieve Zimmerman, her heirs and assigns, provided she shall survive
me by a period of ninety (90) days, and the other one-half (1/2) to my
grandson, Rev. Jonathan C. Terry, III, his heirs and assigns, provided
he shall survive me by a period of ninety (90) days, but should he
fai'1 to so survive me then to such of his issue as shall survive me by
a period of ninety (90) days, per stirpes. My said grandson, Rev.
Jonathan C. Terry, III, is the son of my deceased daughter, Lucille
Terry.
4. I hereby nominate, constitute and appoint my said daughter,
Genevieve Zimmerman, and my said grandson, Rev. Jonathan C. Terry,
III,-as co-Executors of this my Last Will and Testament, and I Further
direst that neither of them shall be required to post any bond to
secure the faithful performance of his or her duties in the Common-
wealth of Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this
my Last Will and Testament, written on one (1) page, this 11th day of
July 1985.
r (SEAL)
Almeda M. Shupp
Signed, sealed, published and declared by ALMEDA M. SHUPP, the
Testatrix above named, 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.