HomeMy WebLinkAbout95-0169
y N,OB.,tlRsv. ?la7
TYIf/rRNT
PEIBIANBIT
BLACK BNC
~D
z
U
W
0
7
2
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 ~ +6 r0a1 ? •
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYL1i1N1A • DEPARTMENT OF HEALTH • VITAL RECORDS _ _ _
CERTIFlCATE OF DEATH
f1(1~~7~
nAMEaFDECEDOiTSFtiMtf]aLra sEx soclALaECURffYNUMBOI oaEGFDERN1MOr*.Dp,~Mq
-,
,- i i ~ ~ A
'~
AGE (laM Baa.atYl VMDEII, YEM UNDEII/DN DATEOF BINITI BIRT10lACi lCayatd PLAC[OF06QN,CM rAaN,ant-,ttvntlmrtnano trYl
Maur.. Dale MoW I MMrr lM«M.DM.~hrl SsM«F«agl Courryt „py,p,L
Y° ^
`~" ~ °BO"er""' G DaA ^ '"„~ ^ R..dNr. ^ ,
86
Nov 23 , 08 '
is Pa
wuNrvasDEaN crrY.eoRO.TYwGFDEaN r,~ca mwwBal.«..n~tl~.w.trrw«..o.n DBCaDFxraFIBaPUaconewT RacB•A~..I,tt.r...atecw....r
Ne OC ,.. ^ aY«.ap.wcle.n
~dU Ba. ~ aB. .
1 aNrol,.w.IelBrrt..r. ,w White
OECEDF.IIT'8 g1OCF YNB DECEDENT M DECEOEIIT'8 MARIBIL BBBU6-ManMO ffiMIYIVBIB SIOIq[
IMd•vadBrdIaaqmoat U.I ARYEDFp1CER Natw Mtnrq YAds•aa. PI •a•. pytnrrr,«ny
rralYYpalaibra,rtNrlM.) Iy ~Y DNraad~Sptta,q
w^ NtL`l
Housewife , ,:
,a. ~,~ „~«s+l ,a. W' ,
DECEOENra~uNDADOREasa..+.c.r,El.~l.sr..zbcmx a ,x s
Pa
s.+ Hartc~den
o
„-~ w.
ere
.E
3449 Walnut Street D
t
„4
.
.
y.
r.
sloENCE a.a.dn.
Capp Hill, Pa 17011 ,,,~,;,~
",
~ ~~
M ~~
~
«
RQHER'8 NAME lRr. Aaaa.. ura MQMER'S NAME (Fri Mid4t. MtirNlal•nrlrl
,., Fled Zeiber ,,, Harriet Mitchell
asDRMAaTrs NAMe (TYpvdly aMwaAODREaaarw.c~/rowsrN.roc.ex
'orie Kitchen _
3449 Walnut Street Hill, Pa 17011
aFDMFasrgN aF Dlapoa,rlDN FucEaFDgraanlDN-NtaraCtnltrry,CnnlaaerY LOCRION-Ca,Ylt•w1, 91a,t. Atcoa.
sa,Y^ cwalrtw® Rrattrb
tsaw^ Dtawtll «aarlPro
«
°a""°"O °tlrF"'~~"` ^ '
rw Feb 2 1995 .. East harr
Gnat a,.. Harrisbur P
AcTagAasucN NuMBUI ANDADDRESSarTACam a treat
,,.. 011654-L Hill Pa 17011
aNN:aNT.rN, rra.r rdrart.artanaplapalYW. LICENaENUMBER D+DESgrtED
Y arraMr Ylrrraarllr carry pb,r,, pt,l Mrl
arrtrdar,. O O -31. YL
_ •_
aaaaatww•o,larranY oFDEaH PI«r.,DtF'~1 rwacAaEREFERREDIOMEDIDALFJtAMINENCOROMER'/
•atprlnlalc«ar. w ^ Na~
Y S~
M.
A.aMRTk Erw ar d4ttwa, Myarir«mpacrblswNd,atrtdar OttN. Dt nr ran ar na,WddyYp, taW as rttp~aN.Y+nti tllach «ntr, Nilrt. ~
ApalatYllrt
FART a: Gtlr tIBYaCraataAYrlamnailaYlBrdtaN.ttR
Lir ar/aM Calrt«IMGBM.
i YM
r
VY MM
•
w nal,•nrllglntllt atdal//Ygtalrtyatnil RlRT1.
r
N
b
.
BBlDIOE t:A11BE IFrrl
_ 1
~
ItwlBrgnerlN ~- i I /'
~ i1TF C
A
o /S~ ;
~
tr
f L _-
sad w
^atY. ~N
CAUBBIDitsrt«iryry DUE ASACCNSEGIIENLE CfI.
A / ;
__
nrrY10 r•I IAt/I IAfT DUE TDICR ASACO~LSECUENLE GFk 1
M11a AN AUIDPBY
pERFO111aED7 AU1OMYfBIDMaGa
AYIIIARE MBp1A YANNER Of OEATN DATE OFIMN711Y TIME OF MUIIRY BAIURY .QWORKT DESCRIBE MOW DUlY1Y000IIRRED.
Of CAUSE IaI«w, Day. lYar)
OERNT Nttrr Htmieat ^
Accidtr ^ nwldi
tn..,i
abn ^ rr ^ Nt ^
g
p M
YM ^ Nt
`M ^ Na ^
Sukrt ^ CauM n«adrNmMrd ^ .
PIACE OF aa111RY-Attrmt
Itnn
mM
lt«tr
t tllM:t IOCRION {Sa
rt CA
S
«
IIaw
Z!. ,
,
.
l
a
YW
y
••.
Mirig. re. fSPacayl
Sat.
C6TTMIER1Chsca aNyaW
'ClRTNYMD PNYfICMN a'I,ya.n...ryry true «dtaa. wtitn ananar pf,Yac+n Ilu pronancad daaN ena tandMM aem 231 SgNATURE AND„TLE IER
T•Br Etttol.nY ltlttMtCBt.OtM exnr•a Awb WUUtt(q tnUmwwrrwlW ................ .. ^
................................... S /
I
•PIIONOIMICWDAND t~RTIEraa WIYSICIAM IP,rytiun0oa. pan0untap Ottai anectnYynB4caux «dxNl NSE NUMBER SgNED MoMR Dey1Npr1
~' 3 Y~
~
~
raarerrll„.tnwltaa.,a..aecc«..arardrt,ar..anaPlK•..neawMUr..wlytnam.nn..na,Na ..........................
S
a,
„
'
Y
'MEDICAL EI[AYINERICORONER NAME ANDAODRE98 DFPERSON WNG ~~ OF DEATN
QIMn 27) Typa «PdM
[..9•%~'/+t*~ ••WAp
Or tl,a bYM W earl,Nttlon anNa Mrvaryatbn. M my opMlon, MtM accuntd r tlw tNna, dra, and plat.. and dut to eM csutt(s) tIM ^
m.nl..a.rN•d ..................................................................................................
a,a. fiS~, 1 ~ -
u. f+b Q 171II
REGISTRAR'S SgNATURE AND NUMBER ~ / ~/ DRE FltEDPbNn. I
A.
2 ~.,
~.
rr
r
E. _ .
413 9 ~ Or4 r s - ~~ - ~'" ~,~,.~i~ ~ " ~` ~ ~ ~`~ -_
REV•1500 EX-t• X11-911
INHERITANCE TAX RETURN FOtX~A7E5 vF Dt:ATn Arsssc tzw r ry r cnt:cK Hero
^
~~~'~ bVERTY CREDIT IS CLAIMED
!fry;~ :!~ RESIDENT DECEDENT FILE NUMBER
ANIA
N
T
N
C~
F (TO BE FILED IN DUPLICATE ~` / X95-00169
FREVE
UE
TO
DEPAR
ME
DEPT. 280601 WITH REGISTER OF WILLS) couNTY CODE YEAR NUMBfI
HARRISBURG, PA 17128.0601
DE EDENT' NAM LAS ,FIRST, ANO MIDDLE INITIAL DECEDEN 'S COMPLETE ADDR S
'"
`~ 3449 Walnut Street
W Kitchen, Clara C PA
Hill
W SOCIAL SECURITY NUMBER DATE O EATH DATE OF BIRTH amp ,
u
0
178-26-9910
1/31/95
c,,,n,Y
Cumberland
`ss ®1. Original Return ^ 2. Supplemental Return
~ ^ 3. Remainder Return
Qy (for dates of death prior to 12-13-82
W o°C. V ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax
~0 (for dates of death after 12-12-82) Return Required
u
°-m ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxe
Q (Attach copy of Will) (Attach copy of Trust)
L CORRESPOt+3!DEPICE At~10'CO.NFI E-+ITIAtTAX INFORMA ON=`SNOUtD 8~, ) i~,~,;, ED, TO ~'>~°s Y. ~; ~'
I NAAhE COMPLETE MAILING ADDRESS
H Reager & Ad , PC
David W. Rea er, Es uire
Q Z TELEPHONE NUMBER 2331 Ma t Street
~ ~
°~
717 763-1383 Camp 11, PA 17011
2
O
3
t-
a
Q
W
oc
2
O
Q
t-
n.
O
v
a
t-
1. Real Estate (Schedule A) ~,/ (1)
2. Stocks and Bonds (Schedule B) (2) 1 , 053.75
3. Closely Held Stock/Partnership Interest (Schedule C) (3) nn
1:..
4. Mortgages and Notes Receivable (Schedule D) (4)
~•
n De osits & Miscellaneous Personal Pro ert 5
5. Cash, Ba k
P P y 200.00
(Schedule E) _
b. Jointly Owned Property (Schedule F) (6) 6,813.45 ""
7. Transfers (Schedule G) (Schedule L) (7)
8. Total Gross Assets (total lines 1.7) ~ ~ j ~, i S (8) 8s 067.20
9. Funeral Expenses, Administrative Costs, Miscellaneous (9) ~--~~
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) ~~ 5 • D D /1/ ~l 0 '~. /,~'
11. Total Deductions (total lines 9 8~ 10) (11)
.~-r-~B=
12. Net Value of Estate (line 8 minus line 11) (12) ~-~-
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Value Subject to Tax (line 12 minus line 13) (14) --..~-~.-~ --
15. Amount of line 14 taxable at b% rate (15) __~ x .Ob = •--7-"~ --
(Include values from Schedule K or Schedule M.) S ~ 6 y. 0 5 '? 0 9 • ~J `~
16. Amount of line 14 taxable at 15°x6 rata (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)
18. Credits Spousal Poverty Credit 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 1 B, enter the difference on line 20. This is the TAX DUE. (20) 270.17
A. Enter rho interest on the balance due on line 20A. (20A) 270.17
B. Enter the total of line 20 and 20A on line 20B. This is the BALANCE DUE. (208) 270.17
Make Check Payable to: Register of Wills, Agent
.- Y - . , ~ Itl~ u-`EiE,St1RE,'f.0 A.NS • ER ALL Qt
Under penalties of perjury, I declare that 1 have examined this return,
it is true, correct and complete. I declare that all real estate has been
based on all information of which preparer has any knowledge.
z~~ ~ /E~a ~~.~
accompanying schedules and statements, and to the best of my knowledge and belie
at true market value. Declorafion of preparer other thou the personal representative
DAT
q CUa.~~~ •il~~- ~ ~ t ~,s'
~ Off DAE
~~~~
REV•1503' Qt )a.86)
mMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.. SCHEDULE B .~~ I
STOCKS AND BONDS ,.
Clara Kitchen 1995-00169
~wu ....,~~a., ie~ie~lv_ewnwd wif6 Rre6f of Survivorship must be disclosed on Schedule F.y
(If more spoce is needed, insert odditional shees's of some size.)
REV 1509 E% ~ (12-88~ ~. .
~~ ' ~~ SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA ~O~NTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
l'.lara Kitchen 1995-00169
Joint tenant(s):
NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Ma,xjorie Kitchen 3449 Walnut Street Daughter
Camp Hill, PA 17011
B.
C.
Jointly-owned property:
ITEM
NUMBE LETTER
FOR
JOINT
TENANT DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
TOTAL VALUE
OF ASSET
DECD'S
k INT.
DOLLAR VALUE OF
DECEDENT 5 INTEREST
1• A 5/20/88 Dauphin Deposit Bank &
Trust Co.
Checking account ~~0038341204 12,182.26 507 6,091.13
2. A 1/03/75 Dauphin Deposit Bank &
Trust Co.
Savings account 44910703918 1,444.65 507 722.32
/,.
TOTAL (Also enter on line b, Recapitulation) I S" 6, 813.45
(If more space is needed insert additional sheets of same size)
eew,a„ ~+ n~~ss' ~ ~ SCHEDULE H
~~~ FUNERAL EXPENSES, .
COMMONWEAITIi OF PENNSYLYANIA ADMINISTRATIVE COSTS AND
IN RESIDENT DECEDENTRN MISCELLANEOUS EXPENSES Please Print or Type
ESTATE OF FILE NUMBER
Clara Kitchen 1995-0016
ITEM DESCRIPTION AMOUNT
NUMBER
A, Funeral Expenses:
~, Cremation Society of Harrisburg 900.00
B. Administrative Costs:
1. Personal Representative Commissions _ _
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees
Reager & Adler, PC 500.00
3. Family Exemption
Claimant Marjorie M. Kitchen Relationship Daughter `-~-,-~~=~=-
Address of Claimant at decedent's death / ~' S ~3. % .3
Street Address 3449 Walnut Street
City Camp Hill State PA Zip Code 17011
4. Probate Fees
Cumberland County Register of Wills 59.00
C. Miscellaneous Expenses:
~• Cumberland Law Journal 40.00
2. The Sentinel 55.40
3. Inventory & Appraisement 10.00
70TAL (Also enter on line 9, Recapitulation) I S 3, 564.40
(If mor• spot. is n••d•d, in:•rt additional sh••t: of sam• size)
f REV-1512 EX+ (7-83) _ ';
COMMONWEALTH OF PENNSYLVANIA SCHEDULE "I" -
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE .LIABILITIES, AND LIENS
ESTATE OF ri~~ IVUIV16C11
Clara Kitchen 1995-00169
ITEM
NUMBER DESCRIPTION AMOUNT
1. Teufuel Orthopaedic Associates 85.00
TOTAL (Also enter on line 10, Recapitulation) ~ $
~•.
REV•1508 E%+ 12•en ~ ~~ ~ '~ ~S C H E D U L E E
~~ r ~ CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT Please Print or Ty e
ESTATE OF FIlE NUMBER
Clara Kitchen 1995-00169
-___.. ___... _.. __ _._ -_ .. _..__._ .. ._. _._ _r___ ._ .._____.~
,^
NOTICE OF INHERITANCE TAX ACN 101
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
HARRISBURG, PA 17128 oboe OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 09-25-95
ESTATE OF KITCHEN GLAF(A L FILE N0. ci 79-U107
DATE OF DEATH 01-31-95 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:
DAVID W REAGER ESp REGISTER OF WILLS
REAGER 8 ADLER CUMBERLAND CO COURT HOUSE
2331 MARKET ST CARLISLE, PA 17013
CAMP HILL PA 17011
Aaount Rewitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (12-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KITCHEN CLARA L FILE N0. 21 95-0169 ACN 101 DATE 09-25-95
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( Xl CHANGED SEE ATTACHED NOT ICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN SASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly ONned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Nst Value of Tax Return
13. Charitable/Governaental Bequests (Schedule J)
14. Net Value of Estate Subject to Tax
REV-1547 EX AFP (12-94)
CONMDNNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601 -
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Aaount of Line 14 at Spousal rate (15) . 00 X . 00_ . 00
16. Aeount of Lina 14 taxable at Lineal/Class A rate (16) 5, 164.05 X . 06. 309 .84
17. Anount of Line 14 taxable at Collateral/Class B rats (17) •00 X .15. .0 0
18. Principal Tax Due (lg) 309.84
TAX CREDITS:
(1) .00
(2) 1, 053.75
(3) . 00
(4) .00
(5) 200.00
(6) 6,813.45
(7) .00
(B) 8, 067.20
(9) 2,818.15
(lo) 85.00
(11) 2 .903 _ 15
(1z) 5,164.05
(13l .00
(14) 5,164.05
NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will
PAYMENT RECEIPT DISCOUNT (+)
AMOUNT PAID
DATE NUMBER INTEREST (-7
06-20-95 AA047898 .00 270.17
PAYMENT MUST BE MADE BY 11-01-95*.
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT 270.17
8ALANCE OF TAX DUE 39.67
INTEREST .00
TOTAL DUE 39.67
( IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ••CREDIT^ (CR), YOU MAY BE DUE
,FE4.ia~a ex le-sal
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OP INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 2 8-060 1
DECEDENT'S NAME
~~t<iT< ~'~?: C.~li:il
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
G1.yJ-~/.~i7 `f
ACN
' :~ ~
SCHEDULE STEM EXPLANATION OF CHANGES
NO.
~; }j--s T'2CILICE'C~ CU y I v ry5.? . / `? . ~~''.21V C'XET:1~.1t l{7t1 C :i1 0.1~~% ~E' :'. ic? 1 A°G ~.~,~t 1IiS l
t,l"Obdte ~185Ett5. _
TAX EXAMINER: Lis.:: %.~<^r. t i:nc.'-L'tinrc
PAGE