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This is to certify that the certificate hereunto attached is a tine and accurate copy of the original.
death record vn 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.
Date
Auc i s zooT
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
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REGISTRAR'S $IGNRURE AND NUMBER - I ORE FlLED (Main. U.y. `bbl)
REV-1607 EX AFP (12-94) ACN 101
COMMONMEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE + N H E k ITANC E TAX
BUREAU DF INDIVIDUAL TAXES DATE 07-31-95
DEPT. 280601 STATEMENT OF ACCOUNT
HARRISBURG, PA 17128-0601
~~~„~~ ~~ I3AYLUR GEORGE A FILE N0. 21 95-0171
DATE OF DEATH 01-14-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER .CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE ADDRESS SHOWN. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: ,
ROBERT BAYLOR
436 CUMBERLAND CT
HBG PA 17102
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Amount R~~nittsd
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR FILES -~
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (12-94) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~xx
ESTATE OF BAYLOR GEORGE A FILE N0. 21 95-0171 ACN 101 DATE 07-31-95
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED
ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS,
THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-26-95
PRINCIPAL TAX DUE:
PAYMENTS CTAX CREDITS):
259.19
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST C-) AMOUNT PAID
04-25-95 AA023079 .00 518.40
07-03-95 AA047961 .00 259.21
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* IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREIIIT 777.61
BALANCE OF TAX DUE 518.42CR
INTEREST .00
TOTAL DUE 518.42CR
( IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS RE@UIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT'' (CR),
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E"[U FOR DATES OF DEA7N AiTFR 12!31 !9 f CHECK HERE
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Dt:?ARTAAlAirO~RCVlNUC {TO BE I:itED iN D~PLfC~Ti; „
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Dltt.'IeoaDl 1~/i~ RI!t3iSTi=R QF W1t1„S
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t1,raRlsauRa ~w Irtzs.c>bot COUNN COOL YEAR NUM6tcR
Geo1: a A.
Baylor CAP llil 1lQa tlt C¢nter
, 46 ad
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soCl SECURtT!r ttuMBCR DAiE or arAn+ o~ or
o
200-10-0921 1IF4/95 11/24/14 Cam Hf.ll 1~A 17011
~ Nf .rruc.~trttl suRVnlHts srotnr~s HwC Rwsr. rsttr ~NO.poots netuy IAt blCIIRITY MUMelR R!ClNCD (bC! RVbTRUGTIGN>g
4
W ®1. t)ryfnal Return ~} Z. 5vppiomental Return n 3. Remainder ReNrn
~~s jior dales of death prior to t2-13-82)
ems (] 4. limited Estate ~ Q de. Fuwn lrger~t ~~~~~~ofeke ^ 5. Federal FaaM Tax Return R.quird
Z~ (for dates t~f dsath'aNer 12-12-82)
6. (e ~ ~Te ^ 7. 'A t~ ~y kyained) a Living Trust _ e. Told Number of Safes' DeposM Baxet
,....,..._.....,. ~.'~ of T
~,
Robert Sa or Raberl: Baylor
N I
~'~ TEl 436 Culo~erland Court
Q
5
(t t) $3251.62 ,.~
(i ~ .....
1. Real Estate (Sehedukt A) (i) ~_ l~1 ,~ ~
Z. Stocks and Bonds (Sd+edu4- B)
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4. MorigaAes and Noes ReceHoble (Schedvk D} (d j 1.5 ~ '~~
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5. Cash, Bonk Deposih 8 M'neellaneoas Personal Property (5 j s .-
..
, ~~`
•
(Schedule @) ..._ _~
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6. ldnlly Owned Praporty (SaMdule f) (b j t _
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7. TTanahrs (Schsdub Ci) (Sdtsdule L) (7) ~" ~ ~ i.
~
'11
891.57
8. Total Gran Assets (fatal RJaa i.7j (B) ,
9. funeral E pees, Adminilralivo Costs, Miseallaf-eeus (9 j $ 52$1.62
Expernas S~chedute H) .
10. Debts, Mort~jaBe LiabBNivs, Liens (Sdiadule 1) (10) '
11. Total i~educTions (total tines 9 & loj
{2. Ne! Vdw of Estate (iJne 8 miavt line 11)
13. Ciroritabie and GoverntnerdaS Begvebte (Sdoeduki J)
14. NN Value Subtext to Tax !flee 12 ttthtus ifrte 18)
ode. (1 wl~ues~Sd>fduls~K or~l~~id (15) - - --x-r..~
-6. Amount of tine IL ksxabfe dt tis16 -a1- (it1) x .O6 •
(incWde vahteb tram adtedefe K or Schedule M.)
1S. spousal transfers (for des., ~ deotit oher 6aav+t?
$518.40
17. Anrount oP LMs 14 rozabM at IS16 taro (17~ -- x , iS s
(hrditde vohfes feeR- 5d-edtAe K or Schedule M.) $518.40
18- Principal tax dw (Add tax 6roel tins 15, 1e and 17.) (18) -.
19. Gedb Spousal Pawrly Credf Prior Payntentb 061cafttt kM.+est
Z0. If Line 19 M than Line 18, sR1a tM oe LAss 10. Thib b the OYwlAYMaiT. (20j --
®^
t1. tf 1hNr i6 a grrteter than 11ew 14, enhsthe di!!'ereftee en Line 21. Thi: b the TAX 01ll. (xt) $51$_40
A. Etetsr dte ittNrest on the bolaMa dw on tine Z l A. ri 1 A) !-
B. Setter rtes tafd d thee 31 and 21A a• Litre 2 tB. TbBt is tM eAtANCE Dltl. (21 B) $ 518.40
Molts Qtwft ~atra[Vb to: >Reaistter eii 1MNtr Mew
~ L irve, cvr..cr afid eeR
based on all iafantailort
amosn
t al true
r. u~
P~ ~
stonAtwte cr t'.RSart etsorotsewte rote twRna RltURN
Ptst~r 8. Foster 1 1 South Streot, Harrisburg, PA 17101
~ 4/24!95
HUG-fib-3b h~tt 1 1.5 ~ 33 P. 43
Act 94$ of 1994 provides far the reduction of the tax r+~tes imposed on the net valve of transFers to ar for
the vse of the spouse. The rates as prescribed by the statute wiB be:
e 34~p (.03j vritE be apptiedbte fer estates of decedeeu+ts dying vn ar after 7/1/94 oad beFore 1/1!96
• X96 (.42j will be appiieable far estates df dewdents dyin8 on or attar 1/1/9b and before 1!1/97
• 19{i ~.01j will bs applicable for estates of decedents dying vn or after 1/1/97 ~ before 1/1!98
e Spousal transfers occurring on or after 1/1!98 will be exempt fra-m inheritance fax.
PREASE ANSWER 'CHE PC~LLOWING QUESTIQNS
8Y PLACING A CHECK MARK (vy !N THE APPROPRIATE BUCKS.
Y
x
1. Did decedent make a tranefar and:
a. retain the use ar income of the property transferred, ..................
b. retain the right to designate who shat) use the property transferred or its income, ............... X
c. retain a roversionory interest; or ................................................................................... x
d, reaiw the proatiss for life of e'dher payments, benefits or eare$ ............................... ~
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without reviving adequate coneiderativnft If death oca+rred after
December 12, 198, did decedent transf~sr property within one year of death without receiving
adequate oons+dsratlont ..................................................................................................
3. Did decedent own an 'in trust for'. bank account at his at her deathle ......................................
!!~ THE ANSWER TO ANY 4P THE A80VE QUESTit3NS #S YES,
YQU MUST COMPLETE SCHEDULE G AND PILE IT AS PART QF THE RETURN.
AUG-~b-B'~ h~K l l h : 33
REI,T3ASE
P, 04
KNaw ALL MLN BY 't'[~IESE PRESEN`L'S TH1~,'t', I, ROBERT BAXLOR,
AllMfNIS'1'RATQR Ol,~ THE ESTATE OF GCORGE A. BAYLOR, da hereby
acknowledge that I have this day received pf and from the
Pennsylvania National Bank and 't'rust Company, TRUSTEE, under
REVOCRBLE AGRFEMEN'r O.i' TRUST FOR GLORC;~; A . BAYLOR dated Februazy
],3, 1985 the f..ollowing:
Cash Payable 3-20-95 $9,065.99
Fi.nt~7_ Interest Payable 4-4-95 22.96
..... in full .satisfaction and payment of distributions of Trust.
ANI:J THEREFORE I, ROBERT BAYLOR, the said Admin.~.stratoz of the
Estate oL- Geo,rge A. Naylor dt~ by these presence remise, release,
quitclaim. and fo~'ever discharge the said TRUSTEE, their heirs and
assigns Uf a.rxd from the said payment to ME and of anc~ from all
acl.icns, suits, payments, accounts, reckonings, claims and demands
whatsoever, for ax- by reasons thereof, or of any other act, matter,
cause or 1:h3.nq whatsoever.
I1V wiTNESS wHEREbI?', I have Yeereunto set my hand and seal this
day c7f _ 19_,_,
Signed, Sealed and Delivered
in the presence of:
(NAME3}
.. -
B /
obert Baylor,
A6ministratar of the
Estate of
George A. Baylor
(NAMES)
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HUlr-~5-yb hk 1 1 ~ : 34 P, 05
eEe;soe tx+ 1:•en SCyEQULG E
_ c~tstl, ~aN~ oEpos~~s Aldo
' coMano~+w~,~,~~+ or ~¢NaraYtv~ni,+ MISCEI.LANECUS
IbII~I ttT ~ s~~et+ PERSONAL PROPERTY. Please Print or Type
George A. Bay].ar
All prvpvrty Ivinlly-awmd whh the Right of 3_orvtvarthtp mutt be ditdesed en Schedule Fti -
1TEM TM~ f3ES~RIPTIC?N VALUE AT
NUM88R DATE CF DEATH
1 Trust Account for Decedent at Pennsylvania Nations]. Bank, $111865.99
Nozkh Front and Ft~ir~Cetr $t~G~kSs Hi;'tx3.sbnxg, Pty 1745-2D53
2 Interest from Pennsylvania National Bank for Fennsylvania
Municipal Gash TXusk
25.58
TOTAL {Also eetgr oa tiaa 5, Retxtgitulationj. f S 11,891.57
(Atlacb vdditknal SYs" X 17" ~iaab if awro space is a~edsd~
HuG-~5-u5 rx.i 1h~3~ P. 06
' Rswisq Fr. 17~9E1
scHEUU~.~ H
FUNERAL EXPENSES,
tnM/N4~7WEA4TM OF PEhtNSVLVANtA ADMIN(SrttATNE COSTS ANA
INHERITANrrf~ SA% Rt2iU1tN MISCELLANEQUS EXPENSES
RE5IDENT Df~EDENi PiBtlSe Print Or TYPe
1:STATE qF !L NU ~
GIrORGL A. I3AYLOR
tTfM T DfSCRIPTIQN ry
NUMi3l:R AMOEINT
A. _ ° Funeral Expenses: ~~~ ~~
i~ Funeral expense at Winfield Funeral l~omsr $2I7d.00
,BUrial expense at tviti. >:iaward Day Cemetary $ 630.00
E. Administrative Costs:
1. Personol Representative Commissians _ _
Social Security Number of Personol Representative:
Year Commissions paid
2. Attorney Fees fur Reter B. 9ostGr, Esquire
3. Family Exemption +
Claimant ~_~..~_w,,,,,,,,,,,,,,_r Raldtionship
Address of Cloimont at decedent'x death
Street Address _. _............___..,..-_-•--,-_.._._
City ......_._ State Zip Cade ....
4. Probate Fees f i1iln~ Bee
C. Miscellaneous Expenses:
1. PA Nntiona]. Bank Gash ManaBetaant F'e¢
2, i?].owmrs. for funeral from Louise Graves Flower Shog
3.
4
5.
b.
7.
8.
~ zso.aa
$ SI.QO
$ 2.62
$ 148:00
TOTAL Also enter on line 9, liewpitutation) ~$ ~~~~•62
{If mon space is needed, insert additional siserts of same dze.)
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BENEFiClARIES
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ESTATE QF ~ . ~1LE NUMBER
George A. Baylor
NUI MBER NAME AND ADDRESS OF 6ENEPIGIARY REt.ATIpNSNIP SH RA E OF ES ATE
~ A. Taxable Bequests:
1 Robert Baylox brother and L00~
436 Cumberland Court saa_e heir
1€arrisbuxg, 1'A 17I02 •
i
ITEM NAME AND ADDRESS OP dENlPIGARY AMOy~ OiR
NLfMB1iR .SNARE OF !STATE
8. Charitebh and Governmental Bequssfs: ~ '
1.
TOTAL CHARITABLE ANQ GQVERNMENTAL BEQUESTS ~Aiso enter oe lies 13,, Rseapitulation) S
(If maim spars h aid, ;nsKt'f additional sbeots of s¢me slsa} _ _.,..,
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