HomeMy WebLinkAbout95-0178~I ~5 ~I~~
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 1 ~ 200T
Date
~~ H105.143 Rev. 2/87
TYPEIPRIMT
N
PERMANENT
BLACK MK
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYWANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~ ~ ~ 7
CERTIFICATE OF DEATH
NAMEOF DECEDEHT(FLaL Mp/As. LaeB 9E7c 80CIAL SECURTIY NUAIEQi._.._- DATE OF DEATN (MOM,DSY. Wer)
~• U =MaEe =205 - 09 - 0029 ..Oct. 2, 1994
AOEBar BiFWey) UNDER,YEAR UNDERt OAY DATE OF BMRH B8iT/1PlACE IC3yarid PLACEOF OERH1Chak apy ar-fr:nbuc3aron aurfib)
Moats ~ Dayf Han t Mpabe (MOM•Daµ Wfr) 9raFaepn Caetr,q MOBMD~L:
OTHEA:
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INHERITANCE TAX RETURN FOR DATES OF DEATH AF7 EK B CIS s 17F ~ s,nesst ns:BCe
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EDIT IS CLAIMED
O
F ., RESIDENT DECEDENT FILE NUMBER z (~ ~ _ o i `7
COMMONWEALTH JF PENNSYLVANIA ~ ! (TO BE FILED IN t)UPLICATE
DEPARTMENT OF REVENUE
DEPT. 280601
WITH REGISTER OF WILLS).
COUNTY CODE YEAR NUMBER
HARRISBURG, PA 17128A601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDE NT'S COMPLETE ADDRESS
W SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH ~~ n , - n p P~~
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pFAPPLIC:ABLE) SURVIVING SPOUSE'S NAME ILAST, FIRST AND MIDDLE iNtilAll SOCIAL SECURITY NUMBER - AMOUNT RECEIVED ISEE INSTRUCTIONS)
~++
a .Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
(for dates of death prior to 12-13-82)
m
w
~d~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise
(for dates of death after 12.12-82) ^ 5. Federal-Estate Tax Return Required
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a°0 ^ 6. Decedent Died Testate ^ 7. Decadent Maintained o Living Trust ~8. Total Number of Safe Deposit Boxes
(Attach mpy of Will) (Attach copy of Trust)
/i~6r ~ G~ENTiAt T~ ~I~1~~~~~.a~ TF3r :.
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o NAME \ COMPLETE MAILING ADDRESS
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TELEPHONE NUMBER .
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(~ (~, 1 ~,~, lid 3
(71~L2-~3 i~ 5 0
1. Real Estate (Schedule A) (1 )
2. Stocks and Bonds (Schedule B) (2) i ~ Io8- S U
3. Closely Held StocklPartnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4 )
5. Cash Bank Deposits $ Miscellaneous Personal Property (5 )
z
0
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r
d
a
W
s
zo
i
P-
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0
v
r
it is true,
based on
(Schedule E)
6. Jointly Owned Property (Schedule F) (6 )
7. Transfers (Schedule G) (Schedule L) (7 )
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous (9 )
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line T 1)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 1.3)
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse
Side.' (Include values from Schedule K or Schedule M.) (15)
16. Amount of Line 14 taxable at 6% rate (16)
(Include values from Schedule K or Schedule M.)
17. Amount of line 14 taxable at 15% rate (17)
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments
+ +.
x.-=
x.06= U
x.15= U
(18)~
Discount Interest
_ (19)
20. If Line 19 is greater than Lins 1 B, enter the difference on Lme 20. This is the OVERPAYMENT. (20)
®^
21. If Line 18 is greater than Lins 19, enter the difference on Lins 21. This is the TAX DUE.
A. Enter the interest on the baloncs due on Lins 21A.
B. Enter the total of Line 21 and 21A on. Line 218. This is the BALANCE DUE.
Make-Cheek Payable to: ReRisfer of Wills, Agent
I have examined this return,
that all real estate has been
'sr has anv knowled®e.
(B) (3~fJ?.5o
2loz~.n~
~--~1 f _vo
(13)
1211 d
(21 A)
(21 B)
I aeeompanymg schedules and statements, and to the besf of my kncwledgs and belief,
at true market value. Declaration of prEiparec other. than the personal rspresentotive is
f DATE
r5 ~ S%. L ~r-f~~ lz ~~4- r?a! ~ 3 ~
Tl7Tf'7R~ DATE
P (} R(1X ~F1
CARLISLE, PA 17013
t REV-1503 EX+ (4.86)
r . COMMONWEALTH OF-PEN
SCHEDULE B
STOCKS AND BONDS
ESTATE OF FILE NUMBER -
fAll nrooertv ieintly-ovrn~d with Right of Survivorship must be disclosed on S~hedub F.)
(ff more space is needed, inserk additional sheets of same size.)
rttEV-1511 EX+ (7.83)
GOMMONWEALTti OF PENNSYLVANIA SCHEDULE "H"
r FUNERAL EXPENSES,
.INHERITANCE TAX RETURN ADMINISTRATIVE COSTS AND
RESIDENT DECEDENT MISCELLANEOUS EXPENSES
ESTATE OF C
L ~ ~ 15 ~j It rl +v E. ~
FILE NUMBER
~-t ~.5 --Ut73
ITEM DESCRIPTION
NUMBER AMOUNT
A• Funeral Expenses:
t. ~ ,?.~~`7.UG
~~ ~ r'14f1111:lSCi-ti!iVt: CUStS:
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
4. Probate Fees 3 ~I ~
C• Miscellaneous Expenses:
1.
TOTAL (Also enter on line 9 Recapitulation) I $ ~ ~ ~, ~ D p
(If mgrs space is needed insert additional sheets of same size)
r ~i cy ~ (2-AT
.~
COMMONWEALTHOF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DKEDENt
SCHEDULE J
BENEf~CIARIES
~ain~c yr
~- rl l 5 (z , ~p+
FILE NUMBER
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A, /Taxable Bequests:
~ `1.3 Hl -->~? t' I n ~ F~:~t , ~-o-~f ~' ~ (~' t"~- j 5 ~ r1 ~ ~~
f_ 1
3 . ~k ~ < < "" e~o~~ . l/
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
N ~ s~~
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recopitulation) g
(If mon spree is n~~did, lnsart addilionol sheets of some size)
~~
i~
5
AMOUNT OR
SHARE OF ESTATE
pennsyLvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO BOX 280
HARRISBURG601 11 171R54URDED OFFICE OF
I
REGO!STTER - WILLS DATE 02-09-2015
UNER
7015 IFEB, 17 Fn 1 14 DATEESTATE OFOF DEATH 10-G06-1994 ELLIS 0
FILE NUMBER 21 95-0178
C LE 7 - C COUNTY CUMBERLAND
E 101
,,�RgEORGE-- F
DOUGLAS CWH ACN
27 WAmount
CARLIRemitted
Tp— 1701t
K:A!-k
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 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 4-- -- -- - ----- - ---
- -gfi
-eX-il7l;* -012:174) INHERITANCE TAX 7E;&!f OF ACCOUNT
ESTATE OF:UNGER ELLIS OFILE NO. : 21 95-0178 ACN: 101 DATE: 02-09-2015
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED AGN 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: 07-07-1997
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.