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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.
AUG 16 2001 ? ~_
Date Fran eropoli, ' act
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLYNNIA • DEPARTMENT OF HEALTH • VRAL RECORDS
CERTIFICATE OF DEATH
X14749
NAME DF DECEOENf IF•at MNtb.Lrp SEII SOCUL SECURRV NIIMSER~~ DATE DF DERH pw,n. D•F•wl
I. Madeline E. Priar LFemal a. 182 - 22 -5547 ~Februar 23 1995
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REGISTRAR'S SMaNATURE AND NUMBER DRE FlIED (MaND. D,Y. ltibr)
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• ~ ~i ~ ®~ °~ ~ '" `~ FOR DATES OF DEATH AFTER 12!31 !91 CHECK HERE
~ REV•1500 EX+ (7-94) ~ IF A SPOUSAL
t ~ INHERITANCE T RETURN POVERTY CREDIT IS CLAIMED ^
RESIDENT DECEDENT FILE NUMBER
COM pOPARTMENTOFPREVENUEANIA TO BE FILED IN DUPLICATE ~ ---~' f ~~
DEPT. 280601 tWITH REGISTER OF WILLS) COUNTY CODE ~ YEAR C~.S NUMBER
HARRISBURG, PA 17128-0601
DEEE EDENT'S MPLETE DDR
DECEDENT'S NAME (LAST, FIRST, AN MIDDLE INITIAL) T i1~f~~~ ~~y~ ~t
2 S CIAL SECURITY NUMBER DATE OF DEATH TE OF BIRTH rpc. y'
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p (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND IDDLE IN TALI SOCIAL ECU Y NUMBER AMOUNT RECEIVED (SEE INSTRUCTION
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. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
(for dates of death prior to 12-13-82
^ 4. Limited Estate ^ 4a. Future Interest Compromise
(for dates of death after 12-12-62) . ^ 5. Federal Estate Tax Return Required
^ 6. Decedent Died Testate ^ 7. Decedent Maintained o Living Trust
(Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
(Attach copy of Will)
COMP E MAILItJ~ADDRE55~ ~ 1• _ /
JAMES _ .~. ~ -i ~ VV ~L//JJ__LL~i~~'' f G•..~d/
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ELEPHONE NUMBER w.yR~ ~-"~-C/ ~'~~F-~rj _
LI
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3 )
4. t~
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Mortgages and Notes Receivable (Schedule D) (4)
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Cash, Bank Deposits & Miscellaneous Personal Property (5) JJ ~
(Schedule E)
6. Jointly Owned Property (Schedule F) (6 )
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7. Transfers (Schedule G) (Schedule L) (7) U~~~~~l~
8. Total Gross Assets (total Lines 1-7) ~ ~ ~ ~ LYE UL ~ (8 )
9. Funeral Expenses, Administrative Costs, Miscellaneous (9 )
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Expenses (Schedule H) ,~
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6 ~
10. ~
Debts, Mortgage Liabilities, Liens (Schedule I) (10) ~ O' ' U ~ r~ 23C.~ U ~
11. Total Deductions (total Lines 9 & 10) (11) -T
~ ~ ~ ~ `~
12. Net Value of Estate (Line 8 minus Line 11) (12)
.
13. Charitable and Governmental Bequests (Schedule J) (13) ~ 1 .
~ ~23•(0~
14. Net Value Subject To Tax (Line 12 minus Line 13) (14)
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse (15)
(Include values from Schedule K or Schedule M.)
Sid ~Q
x•-=
16. e.
Amount of Line 14 taxable at 6% rate (16)
(Include values from Schedule K or Schedule M.) x .06 = ''~
17. Amount of Line 14 taxable at 15% rate (17) x .15 =
(Include values from Schedule K or Schedule M.)
" ~
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) `
19. Credits Spousal Poverty Credit Prior Payments Discount Interest ~ ~
+ + -
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the balance due on Line 21 A.
B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE.
Make Check Payable to: Register of Wfll~, Agent
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief
tt is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
based on all information of which preparer has any knowledge.
SIGNAT E OF PERSON RES ONSIBLE OR FILING RETURN ADDRESS DATE
~~~ .rar.~J /~y ~jnco~d GPc~ /~~~1~i~ro%i,~ ~,~ /~o~~ a a~' 9~
_ __ _ ___'_' __..__ .... _.._.,...~..~..~.,~ enneeee ~' DA
(19)
(20)
(21) ~~^
(21 A)
(21 B) ~L'L~
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% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 111/97
• 1% (.O1) will be applicable for estat•a of decedents dying on or after 1/1/97 and before 1/1/98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
BY PLACING ASC ECK MARK (,~~ IN E APPROPR ATE BLOCK
S.
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.
REV~1508 EX~i 12-87) i SCHEDULE E
,~ ~ CASH, BANK DEPOSITS AND
COMMONWEALTH Of PENNSYLVANIA MISCELLANEOUS
INH ESiDENTEDECEDENTRN PERSONAL PROPERTY Please Print or T pe
ESTATE OF FILE NUMBER
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule FJ
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
/ c~ c%rt~ ~tnc vr,~~~
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~i~ ~y
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TOTAL (Also enter on line 5, Recapitulation) I $ ~l ~ 3~
(Attach additional BVs" x 11" sheets if more space is needed.)
REV-1511 EX+il7-881 i
SCHEDULE H
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE iAX RETURN MISCELLANEOUS EXPENSES
RESIDENT DECEDENT Please Print or Type
ESTATE OF
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funer Expenses:
~ . p~~~ ~ S~anae .fie rv~'c~i~ ~ y Q o , o Q
,~,~MOh~cc ..e.~ru~Prjun~ ~rJV. i~v
c2s~e ~- 5~. v n
Pc ll/~ ~~e~; y~Q o °
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
4. Probate Fees
C. Miscellaneous Expenses:
Zip Code
1.
2.
3.
4.
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space is needed, insert additional sheets of same size.)
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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO Box 280601R�qsQgg E D C F F 10 E 0 F
HARRISBURG PA
REGIS T E zilLLS DATE 02-09-2015
HIS FEB 17 M 1 14 ESTATE OF PRIAR MADELINE E
DATE OF DEATH 02-23-1995
C L E F,:, G FILE NUMBER 21 95-0177
COUNTY CUMBERLAND
PRIARORPHANS" DWAYRIE E ACN 101
132eoeORD• -RD
U$1-1-4 1 1 AmounRemitted
MECHANICSWRG ' PAt17055 I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS
I
TAX_HAYE;i�f O� ACCOUNT_WP* (I2-14)-----* -INHERITANCE
OX
ESTATE OF:PRIAR MADELINE E FILE NO. : 21 95-0177 ACN: 101 DATE: 02-09-2015
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. 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: 01-12-1998
PRINCIPAL TAX DUE: .00
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.