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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.
Date
AUG ~ 62001
? •
Fran eropoli, ct
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFlCATE OF DEATH
C14~4d,
" 70CIAL 9CCIIRITY Hl1MBEi1 DATE OFD&6HlMV1k.Cgt>Wl
~• Stanl F. Stone tda].e a. 334 - 18 - 5405 •
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wFanw~Hrs NAME (NP.IPrM ,,, Ella c~lburg
NJT•OHMANrTMAILWR ADDREeslsve.L C7pbwr, ]ur, avD•W
Melba ~~
220 Wood Street
Camp Hill, Pa 17011
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REV - 500 EX +(7-g4) FASPOIdSALF DEATH AFTER 12/31/91 CHECK HERE
INHERITANCE TAX RETURN
MMppNNyyyyEgqq~~~THH
M P v rY R DTISCLAIMED~
RESIDENT DECEDENT FILE NUMBER
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DEPARTpMEEpNT~O~Fp~PRpEVENYU NIA
H RRISBUR~
~ (TO BE FILED IN DUPLICATE ,Z, ~ - ~95-0175
,PA17
28-os0
' WITH REGISTER OF WILLS COUNTY CODE YEAR NUMBER
DE DENT
SfJAME(LAST,FIRST,ANDMIDDLEINITIAL) DECEDENT'S COMPLETE ADDRESS
D ONE, STANLEY F.
~ SOCI SECURITY NU 220 Wood Street '1 !'`
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MBER DATE ~
,
DEATH DATE OF BIRTH Camp Hill, PA 17011 (' ` } '
E 3 -18-5405 0 /23/95 10/15/08 `~.~~
N county Cumberland
T !IF APPLICABLE)SURVIVINGSP USE'S NAME(LAST,FIRS7ANDMIDDLEINITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEEINSTRUCTIONS)
~ A B 1. Original Return 2. Supplemental Return 3. Remainder Return
H P L
E A C 4. Limited Estate 4a. Future Interest Compromise
(for dates of death prior to 12-13-82;
~ F S
6. Decedent Died Testate (for dates of death after 12-12-82) ~ 5. Federal Estate Tax Return Required
~ 7
Decedent Maint
i
d
Li
i
(Attach
f Wi
) .
a
ne
a
v
ng Trust 0 8. Total Number of Safe Deposit Boxes
copy o
ll (Attach a cop of Trust)
C p
~ ~ ALL RRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
NA
Slike
E
i
°~ E
COMPLETE MAILING ADDRESS
E E .
,
s u
re Saidis
Guido
Shuff &M
l
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S N ,
" T , ELEPHONENUMBER ,
,
as
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2109 Market Stre
~
717 737-3405
~__ ,,. Cam Hill PA 17
~ ~i .,..,~7
2. Stocks and Bonds (Schedule B) 15 , 036.00 f
3. Closely Held Stock/Partnership Interest (Schedule C) (3) ~ ~'
4. Mortgages and Notes Receivable (Schedule D) (4) ,_,
~ 5. Cash, Bank Deposits $ Miscellaneous Personal Property (Sch. E) 158,439.58:'
C
A 6. Jointly Owned Property (Schedule F) 18 , 823.13
~.
p 7. Transfers (Schedule G) (Schedule L) (7)
~_ * ~
T
U ~
8. Total Gross Assets (total Lines 1-7) """ (8) c;
~,
192 ,'298
71
L 9. Funeral Expenses, Administrative Costs, Miscellaneous 17 , 711.08 .
A Expenses (Schedule H)
~ 10. Debts, Mortgage Liabilities, Liens (Schedule I)
(1 973
50
t)
N .
11. Total Deductions (total Lines 9 r3< 10) (11) 18
684
58
12. Net Value of Estate (Line 8 minus Line 11) (12) ,
.
173
614
13
13. Charitable and Governmental Bequests (Schedule J) (13) ,
.
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 173
614
13
15. Spousal Transfers (for dates of death after 6-30-94) ,
.
See Instructions for Applicable Percentage on page 2. (15) 0.00 X = 0
00
(Include values from Schedule K or Schedule M.) .
16. Amount of Line 14 taxable at 6% rate (16) 0.00 X .06 = 0
00
(Include values from Schedule K or Schedule M
) .
T
A
X .
17. Amount of Line 14 taxable at 15% rate
(17) 173 , 614.13 .15 =
26
042
12
(Include values from Schedule K or Schedule M.) ,
.
C 18. Principal tax due (Add tax from Line 15, i6 and 17.) (18)
P
19. Credits/Sp Povert
Pri
P 26 , 042.12
y
or
ayments Discount Interest
U
T + 1, 302.11 - (19)
20. If Line 19 is
reater than Li
18 1, 302.11
A g
ne
, enter the difference on Line 20. This is the OVERPAYMENT
(20)
.
~ ^ Chedk Ftere if yo
a 0.00
T n er
t uelstin a:refund of:youir ovs meir>x:
I
o 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
(21)
24
740
01
N A. Enter the interest on the balance due on Line 2fA. (21A) ,
.
B. Enter the total of Line 21
d 21A 0.00
an
on Line 21 B. This is the BALANCE DUE. (21 B) 24
740
01
Make Check Pa able to: R later of Wills, A ent ,
.
U
d - - BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~
n
~
er penalties of perjury, I declare that I have examined this return, nc uding aceomparrying sc ules and statements, and to the best o know)
correct and complete. I declare that all real estate has been reported at true market value. Deelaratlon of praparer other than the personal representative fs b
which preparer has any knowled
e
d l
f
g
. ase
on
all Information of
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Melba B. Wager
220 Wood Street
Cam Hill ~- PA --17011-------------------------- DATE
-- ~ /v ~/,~~
SIGNATURE OFPREPAREROTHERTHA RESENTATIVE Saidis, Guido, Shuff &Masland
J ~'j 2109 Mark
e
t
St
r
eet
'
-- DATE
_ .. _
_
_
_
_
GL~ c
----
_ Cam
, , ._ .. ..
Hill, PA 17011-----------------------
- ~~~ %
S
~ --- .
Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
•3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
•2% (.OZ) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1197
•1% (.01) will be applicable for estates of decedents dying on or after 111/97 and before 1/1/98
•Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A MARK ()C) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, . g
b. retain the right to designate who shall use the property transferred or its income, .. g
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . g
d. receive the promise for life of either payments, benefits or care?. .. g
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? .
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COIV~LETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
az'
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~___ "
LAST WILL AND TESTAMENT
err;-; OF ~~
~~r ~',~ ,
~Y f
~'~~ ~ ~t; ~ STANLNY F. STONE
~.
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' I STANLEY F. STONE, of the City of Chicago in the County
la
f' ,"° `~ of. Cook ,aricT~ Sate,, of ~ Illinois, ..being' of sound and disposing mind
,, ~ ~,
N{ , ,.~,~ rand ineinory~' and ~>~acting .u~id'er no .duress nor legal :disability, do
_.
hereby make, publish and declare this instrument to be my LAST
~~
Y ,
;. # ; ~; .
WI~LxAND~TESTAMENT, and~I~do hereby expresslq REVOKE any and all
prior Wi11s and Codicils by me made.
~~
'_ ARTICLE ~ ,
a
a t ,; 7 ' t
f .:r '~`+; I-~ he~et`~ ~dre~3t my° Executor hereinafter. named to pay all
of my ,just debts and funeral expenses as soon after my death as
may b;e,found convenient, and to pay from the principal of my
ARTICLE III
'~;
R
As of the date of this Instrument my cash assets consist
principally of moneys in a savings account and checking account
at The First National Bank of Chicago and in a savings account
at the North Side Federal Savings & Loan Association of Chicago,
Further, I own Four Hundred Sixty-Two (462) shares of the Common
Stock of First Chicago Corporation, and Government "E" Bond.
I do now hereby give, devise and bequeath unto my said
beloved sister, MELBA B. WAGER, any and all property of every
kind, nature and description which I may own at the time of my
death, including, but not restricted to, the assets describ ed
above, together with any automobile which I may then own, and
all personal articles wherever the same may be located.
Thou h it now seems unlikel that I shall be the owner
g y
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~~ W~SS WI~REOF I: have„ played m~r,.hgd°~n~ seal to this,
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~" , L~A1~D TESTAMENT, th~.s .'~~y~/~~'f~`~ay~`'ofL i;, . '
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REV - 1503 EX + (4-86)
COMM~NW~,,cl-~~NNgR~VANIA SCHEDULE B
IN R~~'"`"1'Fb F~]-n`1T tJ STOCKS AND BOl
STATE OF --
STANLEY F. STONE SS~p 334-18-5405 02/23/95
II property 'ointly-owned with Ri ht of Survivorship must be disclosed on Schedule
ITEM
NUMBER DESCRIPTION
1 1300 shares of First Chicago Trust Company
FILE N- U~MB R
1995-00175
TOTAL (Also enter on line 2, Recapitulation)
{If more space is needed, insert additional sheets of same size.)
Copyright (c) 1994 form software only CPSystems. Inc.
VALUE AT DATE
OF DEATH
50.12 15,036.00
_/~ 15, 36.00
c...„, 14f1f1 c..ti...~„i., n io..,. ~ oc~
REV - 1508 EX + (2-87)
COMtNRES~ENTDTECEDENT NANIA
ESTATE OF
STANLEY F. STONE
(All property 'ointly-owned
ITEM
NUMBER
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
SS~~ 334-18-5405 02/23/95
Right of Survivorship musf be disclosed on Schedule
DESCRIPTION
Dauphin Deposit Bank:
C . D . ~p8000157489
ice` C.D. ~~8000157896
C.D. ~~8000158078
C.D. ~~8000158124
C.D. ~~8000158132
C.D. 38000158353
Checking account ~~0082154538
First National Bank of Chicago:
Checking Account ~~12-20292
Passbook savings Account ~p1-942-550
Statement Savings Account ~~8-074-994
11 1978 Ford sedan, poor condition
Series "E" bonds per attached list
Print or Tvpe
FILE NUMBER
1995-00175
VALUE AT DATE
OF DEATH
10,002.30
8,002.33 ~
3,007.34 ~
4,013.02 ~
10,031.19 ~
7,008.05
205.47
26 , 322.59 '~"
54, 910.. 58 `~
32,821.47 ~
200.00
1,915.24
TOTAL (Also enter on line 5, Recapitulation) S 15 ,439.58
(Attach additional 8 1/2" x 11" sheets if more space is needed.)
Copyright (c) 1994 form software only CPSvstems. Inc.
- "___ Senn .._~ _~..,_ r ,.. ....-,
REV - 1509 EX + (12-88)
COM IN R~S~ENO~EN~N ANIA
STANLEY F. STONE SS~~ 334-18-5405 02 23 95 FILE NUMBER
1995-00175
Joint tenant(s):
NAME ADDRESS RELATIONSHIP TO DECEDENT
A• Melba B. Wager 220 Wood Street
Sister
Camp Hill, PA 17011
B.
C
Jointly-owned property:
ITEM LETTER DATE
NUMBER JOINT MADE
TENANT JOINT
1 A . `06/06/74
DESCRIPTION OF PROPERTY
phin Deposit Account
14103095
y~,~~~~~'co
/~P`~
TOTAL VALUE I DECD'S DOLLAR VALUE OF
OF ASSET % INT. ECEDENT INTEREST
37,646.2~r`~ 50.00 18,823.13
TOTAL (Also enter on line 6, Recapitulation) 18 , 3.13
(If more space is needed, insert additional sheets of same size.)
Copyright (cj 1994 form software only CPSystems, inc.
-- - - _ - _ Fnrm 15•'tn GV.ut v F lQm. 19 _AGl
SCHEDULE F
REV - 1511 EX + (7_gg~
COM MONEgW ETTAppL~~THEOF~PEpNENTS~YRLVANIA
IN RESIDEN~ DTECEDENT N
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
ESTATE OF -- --- -- ~ "~ "~°`~'
STANLEY F. STONE SS~~ 334-18-5405 02 23 95
ITEM
NUMBER DESCRIPTION
A• Funeral Expenses:
1 Rolling Green Cemetery - grave opening and marker
B• Administrative Costs:
1 • Personal Representative Commissions
Social Security Number of Personal Representative: 344-20-3618
Year Commissions paid 1995
Z• Attorney Fees Saidis, Guido, Shuff & Masland
3• Family Exemption
Claimant ~ Relationship
Address of Claimant at decedent's death ~-
Street Address
Clty State Zip Code
4• Probate Fees Register of Wills
C• Miscellaneous Expenses:
1 Cumberland Law Journal - legal ads
2 Patriot-News Co. - legal ads
3 Register of Wills - filing fees
4 Cook County Vital Statistics - death certificates
5 Reserved for future debts and expenses
Please Print or Type
FILE NUMBER
1995-00175
AMOUNT
771.00
7,538.00
8,656.00
258.00
40.00
59.08
25.00
14.00
350.00
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of same size.) S 17 , 1.08
Copyright (c) 1994 form software only CPSystems, Inc.
REV - 1512 EX+ (1-93)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE I
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES AND
ESTATE OF
STANLEY F. STONE SS~~ 334-18-5405 02/23/95
ITEM
NUMBER DESCRIPTION
1 Siegelbaum & Gunder Gastroenterology - balance due
2 West Shore Anesthesia Assocs.
3 Checks clearing after death
4 Susquehanna Surgeons
5 West Shore Advanced Life Support System
6 Internal Revenue Service - '94 tax due
7 H & R Block - tax preparation
8 A. Z. Ritzman Associates
9 Douglas Bream, M.D.
10 Physicians Rehab
11 Internists of Central PA
12 Health South
TOTAL {Also enter on line 10, Recapkulation) Z
{If more space is needed, insert additional sheets of same size.)
Copyright jc) 1994 form software only CPSystems, Inc.
- _ - - - - r....., 1 CM
1995-00175
AMOUNT
128.62
15.57
130.00
41.74
39.20
236.00
67.00
20.62
9.04
38.70
125.71
121.30
. ..
REV - 1513 EX + (2-87)
coM No~~ T~Q~~SX~,ANIA SCHEDULE J
ESTATE OF ~, rYf BENEFICIARIE
STANLEY F. STONE SS~~ 334-18-5405 02 23 95
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1 Melba Wager
220 Wood Street
Camp Hill, PA 17011
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
FILE NUMBER
1995-00175
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
Sister I100Y< of residue
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) Z
(It more space is needed, insert additional sheets of same size.) 0.00
C~nvrinht /d 1994 fnrm snfhniarn nnhi CPCvMomc ice,.
_ _ _. ^-.. Senn .._,. .., ~..,