HomeMy WebLinkAbout95-0180This is to certify that the cart' '
ificate 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 ~ ~00~ ?
Date ~
Fran eropoli, ' act
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
H10S'"s RB1' ~°~ cor~Ma+w~-~rH of aE~sr~ •
,Y,~,,,,, ~r of HEALTF~ • vRU. HECORps
~, CERTIFICATE OF DEATH "' ~1 yy~ •~((
rEREUNEKr NAMEOF DECEDENr(Fir,,, Mid W, ? •~ Q U i.3 `!
. ~ sEx sooER,E NUNIER
•~»~ ,. p( .~,, 80QAL 8ECURfTY NUMBER .
AGEILr Belb.r) uNDEn/vEM IB,DEn,DAY DATEOF DFAN(Malb,Dry, ~)
Mrrm. DATEDFBIRTN euar,°,ACe t Male s•119 '- 26 - 0444 •.
Y~ are Nprs ~ Mmuy (Maw. Der. w» slra«FOrrpn~o,,,~ TM.ACEDFDEaN1~.n1«+r«r-w:sW000Ie,r«,auraioe)
80 ~ June 30,14 mpmar^
OOUNTY DF DEATN C,T~: BOra,TW°GF pEq„ ~• I.1eW York City ^ DoA^ ~ ~ onrr
~I - FAdLRYNAME(7naaeBr»a,, ~ ~R'°r""'^ lSVepq^
and o~. rr.el•ne m,mL.r, w,s DECEDENTaFI•sRVac oRgwT RACE Amripn
.s. Qmberl b Laser All ® ^ u~en B~•ar, wne- -~-
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(Gl,+eroaw«am,,.Aa.~•maJ ssnNOUSTRY MRSDECEDENTEVERM .
a~ow:aonapere6ea) u.s.Aw,EnFORCEB, DECEOENT'SEDUC,vgN 1' LuR<uISTATUB ,o. '
Professor ~~ US w ® N• ^ ~ern+s.a«re.r, cap. NsYSrMrryq ~•~d m~"r., d~» °„rle~~ Iw .)
Do+rsMAE,w3ADDgEBB ~-'~' War Coll ,~ '°'~Jr+ t+.as«) G,rerpa~a,y,q
~eeel.~,+we+r.smo.,zocedy ,R.s ,~.~. Pa ,.Married ,lhkirie Ledernk7nn
770 Vista Drive RESEIENCE DM „e^Y».a.pa.,ao`.em
,a ,sa.:.erKO,na
m afar ss,y M~K
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Cliffon3 W. Hall MOTMER•s "~'""""'tl1Y1"i4d
NAME lF r MWAe, Mrasn Surnrn•) a
•,FDRMANT's NAME (Typrpnnp ,o. Edna Swain
Marie Hall '"FO~A~+,.su,,,luNOAOOgESS~r,c~Yrto~a,.snu,z,c«,y
~'MODOfp~11ON 770 Vista Drive
=D,,,rl,,,^ o wL r~^ R.rrww,mmsMr^ ~oa°FO.~,,~ q" ~~DLSVaBrrIDN-N.m.olcmr•,Y•o Hill Pa 17011
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lK)EN3E NUMBEp
,Mnu&-2! Isar MrorrolaNe M DATE
°•rean sna perauron ae•,n. OF DEA7N FRDT,Dl11xED (MaMI, DaV. MSy)
~~ ~' ~ ~. ~) Y0.S CASE REFERRED TO MEDICAL EKAMINERACpgD,~q,
17. F'ART1: ErrtlM Aaerea, mltal•sa ie. /•~ M. ?D. ~L 2~
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~erar.Emw UND61LY616 DUE 70 (OR ASACONSEDUENCE ~
ewaarp utarm)LA67 OtIE TO (OR ASACIXJSECUENCE CF]: ~ V
°ERFORMEDi ~ AUTOPSY FIJDING3 MANNEq CF DEAIN I
PF,ICR TO DATE DFKAIURY '
~ OFCAUSE W,«r ~( (Maw. aY. ~) TIME aF WURY INJURVAT WORK7 DESCRIBE NOW INJURY
ILJ N~~ ^ DDDURREO.
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fl7~ed, aa, anal JM. • CeY/rc'A+i
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Pranmcod seam anacamWrea nem 23) SqN TITLE CE FIER
ee•..t.).nemw.re.mr.a .............. rl~Q,~' /c e t-.L
.......................................
~PRONDIMCND AND CER71FYlp PIIYSICIM,I~YSirisnbW 9,b.
TstlN ba,elm,bue•',eaBa.4rh ee•r•,W rtlM eLne, Oaas, ene p•p. rW b ~b eJrgamrmrasebYa......... LKX:NSEN~ygEq, DATE SKiNED
•MEwcA~4uwNEncoaoNER ,a. / Z 2/ ' ~7 S~
On DI•basW a•zlmbrry«r~y«M,~ (NAME ANDADORE9~pF °Fy~v.,~~ °LETED!C~AUSE OF DErt~JN' .--~~--/
mr,n.T«•,aMtl .................. low•n, M mY o°bran, w•m •e«nTw r w. nm., aN•, •na w.e., •na aw e• nr ew•elp.na J7'TJ7~.- ~ ~ n NT /->', r~ 1 C L.
REGISTRAR'S SIGNATURE AND NUMBER - • • - • • • ~ ~ ~~ - / f ~ I N D C ` R L
DATE FILED (Mmm, y, ypr)
,,. ~,~ /r/v//
REV-1347 EX AFP (12-95)
COMMON 11FkLTH OF PENNSYLVANIA
DEPART 1IENT OF REVENUE
BUREAU ~ .INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
DEPT. 1~6oi APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
-HARRIS7tRG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX
ACN 101
DATE 04-29-96
DATE ~1F DEATH 12-28-94 ~nHrcLta S FILE N0. 21 95-0180 ~
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OFCH IS T ORM WITH YOUR RAX ND
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT••
REMIT PAYMENT TO:
MARIE L HALL
770 VISTA DR
CAMP HILL PA 17011
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Amount Renittsd
CUT ALONG THIS LINE _
--------_____________ _ RETA_ IN LOWER POR_ TION FOR YOUR
REV-1547 EX AFP (12-95) NO
-
RECORDS
------------------
TICE OF INHERITANCE TAX APPRAISEMENT
-------~ ------ ----------
, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HALL
_____
CHARLES S FILE N0. 21 95-0180
ACN 101
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) DATE 04-29-96
RESERVATION CONCERNING FUTURE INTEREST - CHANGED SEE ATTA CHED NOTICE
SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:
ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B) (11 .0 0
3. Closely Held Stock/Partnership Interest (Schedule C) (2) 5 78.50
4. Mortgages/Notes Receivable (Schedule D) (3) .00
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
(5)
6. Jointly Owned Property (Schedule F) 23,6 7 3 O1
7. Transfers (Schedule G) (6) .0 0
8- Total Assets (71 .00
APPROVED DEDUCTIONS AND EXEMPTIONS: (8) 24,251.51
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q)
10. Debts/Mortgage Liabiliti 16,05 2.7 7
es/Liens (Schedule I)
11. Total Deductions (10)
--- 2~8
12 - Net Value of Tax Return (11) 1 6 0 76 6 ~
13. Charitable/Governmental Bequests (Schedule J) (121 8,17 4.86
14. Nst Value of Estate Subject to Tax (13) .00
NOTE: If an assessment was issued
reflect figures that incl
d
p
i
l~
3 (14)
a
T 8,174.86
u
e
the
tota
of
ALL returns
ASSESSMENT OF TAX: assessed~to
date. 18 will
15. Amount of Line 14 at Spousal rate
(151 8
16
174
86
,
.
X . 03=
. Amount of Line 14 taxable at Lineal/Class A rate 245.25
17. Amount of Line 14 taxable at Collateral/Clas
B •0 0 X .06= .00
s
rate (17)
18. Principal Tax Due ' 00 X ' 15= . 00
TAX CREDITS: (1B) 245.25
PAYMENT RECEIPT
DATE NUMBER DISCOUNT (~)
INTEREST (-) AMOUNT PAID
02-01-96 AA082574 ._
15.
INTEREST IS CHARGED FROM 02-02-96 TO 05-07-96
AT THE RATES APPLICABLE AS OUTLINED ON THE TOTAL TAX CREDIT
207.62
REVERSE SIDE OF THIS FORM BALANCE OF TAX DUE
37.63
INTEREST 89
TOTAL DUE 38.52
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAV BE DUE
~rV-Ie70 EX 16-SP)
COMMONWEAL TH ~; PENNSYLVANIA
DEPARTMiiNT O REVENUE
BUREAU OF INDiV DUAL TAXES
DE ''T 28( 501
HARRISBUFG,FA 17128-0601
DECEDENT'S NAME ~ _
SCHEDUI
INHERITANCE TAX
EXPLANATION
OF CHANGES
.E ITEM _-
NO. EXPLANATION OF CHANGES
',
TAX EXAM LINER: ~ ` ` `:.=:t- ;,° ..;
NUMBER ---"-
PAGE
~~~ ~... t. .~I
. ' 4 ~®~
~ /.
CCMMONWEAITH OF PENrys?rVAN1A' ~~
DEPARTMENT O;' "EYENUE
MARRISlURG, PAD171yR~01
DECEDENT'S NAME lusi. FIRST, ANO MIOp(E !N
~. Nall ~:Zarles S .
o socut sscuRlTr NuMSER
W 119-2G-0444
n rr...r........~-- -
®1. Original Retu
~-~
o ^ 4. limited Estat
m e
~
~ ^ b. Decedent Died Teoote
(Attach copy of Wiilj
ALL CORRESPOND>~ICE AI
W W NAME
o z° .
~~es D. Flower E.
w d TELElMONE NUMBER
717 1 243-5513
0
v
W
a:
Q
.'~.
c°a
x
INHERITANCP TAX RETURN
RESIDENT DECEDENT
~TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
21-95-0180
of DEA-"~-' DArc of eutnt 770 Vista Dr::ve
2/28 4~" ~ 06/30/14 ~~ Hill, PA 17011
""'""+ socu- sEaRITr NuM~eR {~berland County
AMOUNT RECEIVED ISEE INSTRUCTIONSI
^ Z. Supplemental Return
^ 3. Remainder Return
^ ~• Future lrMereo ~ntpromise {for dote: of death prior to 12.1
(for dates of death offer T2-12.82) ^ 5. Fsderol Estate Tax Rewrn Requi~
^ 7• Decedent MaiMOined o Living Trust
(Attod, copy of TruoJ _. 8. Total Number of Safe Deposit 8t
Enat re.....
1. Real Eoa» {Schedule A) --~
2. SMdc: and Bonds (Schedule 8J
3. Oosely Held Stock/Partnership Interco {Schedule 4
4• Mortgages and Notes Reccivabb (Schedule D)
5' ~' Bank Dspo:its b Misalfaneous Personal Properly
{Sehedub EJ
6. Jointly Owned Property (Sd+edute ~
7. Tratufcrf (Schedule GJ (Schedule lj
8. Iota) Gros: Asst: {Polo! Lines 1.~
9' Funerof ~eeM~fesr Adnrinistrotivc Com, Misccllonbous
6tpcnses{Schedule H)
10. DsMs, Mortgage Liabilities, liens {Schedule IJ
11. Tetal Deductions (total Lines 9 b TOJ
12. NM Value of Eoar. (lLte 8 nrirw: line 11 J
13. Chorhoble and Governmemol 8
14. Net Value Subject to Tax ~~ {Schedule !)
(Dne 1Z +nmus Line 13)
15. Spousal Transfers (for dote o f
~ instruction: for °~ b+40.94 J
FIB[` TE MAIUN~} ADDRESS ~ . - , ~-
11 >r`as t Hight ~~ & ~ SAY
n 17n i -~
(ZJ 578.50
(g J N/1'`
(4J ' ,
{ S J 23, 673.OI
fbJ
(7J See Schedule G
{9J 17 052.77 ~ {-~1 24 251.51
„,: -
(lOJ 23.88
,'~'.~'{11) .:-~.7~ 0~7~ 155,
(12J ~:'~;°`174.86 -
_._..,.-
~` {taj 7,174. 8~.=....
e. {lndude volua~sd~icdule K o9e on Rewnc (15J ~-r.~ /4.50~ _ ` ~~
16. Amount of Sdtcdule M.J ~t. -~ # M'°25`',_
(Indude valuese from Saxabb at t5l5 rote _ -
dutdule K or Schedule nn,J (16J
17. Amount of line 14 toxabb of 1596 rote x .O6 :
(Indude values from Sdtedule K or Schedule M,J (1~
18. Prins o! fox x
P due (Add fox from LTnes 13, 16 and 17.)
19. Gediz: Spousal Poverty Gedi!
Prior Payment: Discount Interest
t +
20. IF Line f 9 is greater than title 16 -
~^ . eater the dNfirenp on line 20. This is the C1-ERPAYMENT.
21. If Line i8 is greater than Line i9, enter tM
A. Emcr the i differenp on Tine yl, This is the TAX OUE.
Mena on the batons due on Line 21A.
B. Enter the total of Lltt. 21 and 21A on
~~ ~ line 218. This is the BALANCE DUE.
sek Payeile te: Rc~lster ~ Wills, ~cM
~ BE SURE TO ANSWpt A
rVXpA1W VrYi/-.nMr~iX ILIa1i7. LntL
!f !- si~ousa~
IS s
(1~
(ZOJ
{Z1) 215.25 .
(T1A)
{T1BJ
N.nomes of perjury, I dedan that I haw LL QUESTIONS ON REVERSE S1DE AND TO
'e. correct and complete, I dedan that all ~a+Mned this rehtrn induding aa:om a mg schedule: and statemRsn~n,~ t~~
on all information of which real eoote has been re o P
_~R~ OF PERSON tES~nuem^ ._ Pnporer has any knowledge. P rtedat true market value. O.eloreeion f
r
i.
.? f,
Pnponr other !
,y~ ~ ~
or my knowledge and
the personal rear.^....,
GATE
~ r i
DATE... ~' . ,; a~.
Act #48 of 1994 provides for the reduction of the tax rotes imposed on the net value of transfers to or for
the use of the spouse. The rotes as Prescribed by the statute will bes
• 3°/6 x.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2°/6 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
i 196 (.O1) wit/ be applicable for estates of dendents 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.
PLEASE ANSWER THE i:OLLOWING QUESTIONS
BY PLACING A CHECK MARK ~/) IN THE APPROPRIATE BLOCKS.
VES i NO
1. Did decedent make a transfer and: X
a. retain the use or income of the property transferred, ......•.•.••••-••••••••••••••••••••••••••••••••'••""'
X
b. retain the right to designate who shall uas the property transferred or its income . ...............
x
c. retain a reversionary interest; or ...........................................................................
X
d. receive the promise for life of either payments, benefits or care ....................................... ~
2. If death ocwrred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate considsration~ If death occurred offer
December 12, 1982, did decedent transfer property within one year of death without recsivin9 X
...........................................
adequate consideration$ ............. •••••••'•••'...............................
X
3. Did decedent own an 'in trust for'. book account at his or her deathf ......................................
IF THE ANSWER TO ANY OF THE ABOVE QUEST110 CF THE RETURN.
T COMPLETE SCHEDULE G ANfl FILE IT AS
YOU MUS
__
REV•1503 EX~ Id.861
~'"~'~`' SCH E
COMMONWEAITIi OF PENNSYLVANIA RULE B
IN RESID NT OECEDENTRN STOCKS AND BONDS
EsrarE of ~~r,ES s. xar.r
FILE NUMBER 21_95-0180
(all property jointly~w~ed with Rlght of Survivorship must be disclosed on Schedule F.)
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
I • 13 shares - is t Fideli OF DEATH
ty Bancorp. at $44,50 per share.
$ 578.50
TOTAL (Also enter on line 2, Recapitulation)
nt ......e ..,..__ .- ---~--~ ~ S 78.50
~~~ SC~"lEDULE E
COlNMONWEALTH Of PENNSYLVANIA CASH, BANK DEPQSlTS AND
~NNERITgNCE TAX RETURN MISCELLANEOUS
RLS~~EHTDECEDENT PERSONAL PRnoeo*.r
:STerF nt: .~.,,____
(All property jointlywwned with the Right of Survivorship must be disclosed on Schedule ~
ITEM
NUMBER DESCRIPTION
1- Farr.>ers Trust Savi.n
gs Account #3-033540
2• Firs Trust
c'~~Y ®#106904
3' ~'~ners Trust ~~any CD #76426 (IRA)
4.
~~n ~P~it Bank and Trust
Imo' Accr7unt #6167089485* ~~anY
(As per attached)
* Gene°iciary - Marie L. Hall, Wiie
Please Print or TyF
ER 21-95-0180
VALUE qT
DgTE OF DEATH
$ 9,979.63
10,229.54
2,115.77
1,348.07
I. TOTAL (Also enter on line S, Recapitulation ~~ ~~
- - ~ _-... .. _ - 1 , S 23'; 673.01
SCHEDULE G
'TRANSFERS
ESTATE OF CHARLES S. HALL
Item
Number
1. Certificate of De
at Dauphin DepositoBankNand8Tr0u0s94Coo
held in name of Charles S. Hall in trust
for Marie L. Hall, his Wife. Date of
Death Accrued Interest $272.89
The Executrix makes report of the above
asset but asserts that it should not be
taxed as a part of this estate for the
following reasons:
1) That CDs numbered 8100394342 and the
above CD were both created from the joint
assets of Husband and Wife,
and
2) The CDs were placed in the trust
of Husband and Wife u names
staff member when originally issued of a
purpose being to assure FDIC insurancehe
coverage of amounts over and above the
customary $100,000. FDIC limit at a
single bank, in accordance with FDIC
regulations, and without disclosing any
possible adverse inheritance tax conse-
quences,
and
3) That the Decedent and his surviving
Wife, the Executrix, regarded these CDs
as their joint assets.
(See foregoing statement of Dauphin
Deposit Bank and Trust Company.)
(See November 25, 1995 Letter of
Executrix to Mary C. Lewis, Register
of Wills, immediately following
Schedule G.)
File Number 21-95-0180
$86,270.84
272.99
RfKi511 EX• h.eq •
`Al7N OF PENNSYLVANIA
fANtrE TAX RETURN
~EN7 DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ITEM
NUMBER
---__
A.
B.
3
C.
4.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
3.
4.
5.
1.
Please Print or
!ER 2~ _n,
DESCRIPTION
Funeral Expenses:
~'~s-F~arner Funeral Home Inc.
Frank]. Hoyt Funeral. Connecticut
Pastor, Jane Middleton
Reception, Camp Hill
Ad inistroti~; Cots ~~cut Reception
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2• (Attorney Fees
Family Exemption
Claimant Mari' a ~ ~Qi ~
----~ Relationship W; fA
Address of Claimant at decedent's death
Street Address 77
Ciry ~~? I
State ~_ Zip Coded
Probate Fees -i-_
~ Miscellaneous Expenses:
Filing of Inheritance Tax Return
Moni~nP.nt casts ~ estimated by Executrix
Estimated Closing Cost,,
TOTAL (Also enter on line 9, Recapitulation)
AMOUNT
5.826.00
3,220.00
125.00
467.37
187.40
1,000.00
67.00
10.00
3,000.00
150.00
S 17,052.77
REV.131~ fX• p•Ee~
~. v
`.
COIMMONWEAD'H Of PENNSYLVANIA
INHERITANCE TAX pETURN
RESIDENT DECEDENT
l=tiANT~T;~C J. HAT.T
SCHEDULE 1
MORTGAGE L ABLDITIES AND LIEN
S
N MBER
1.
DESCRIPTION
Debt - ~'~edical, Wal-Mart
Please Print or
iMBER 2I-95•
AA10UNT
$ 23.88
TOTAL (Also enter on line 10, Recapitulation)
nr ....,.e ..,,.,.a .~ ......a..a ...
--- - --
$ 23.88
REV. ~_jI7 EXs 1287
COMMONWEALTH Of PFNNSy(ygNlq
~~'y SCHEDULE ,1
INHERITANCE TAX RETURN B E N E F I C IA R T E S
RESIDENT DECEDENT
ESTATE OF (=1'fARL,ES S . F~~,
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
I' Marie L. Hall
770 Vista Drive
Cairn Hill, PA 17011
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
FILE NUMBER 21_9
RELATIONSHIP I SHARE OF ESOTATE
>r7ife I Share entire
estate .
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more space is needed, insert additional sheets of some size)
S
SHARE OF ESTATE