HomeMy WebLinkAbout95-0182~I~qS-DIgZ
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 162001
Date
H,Oa.,~3 RSV.7/a7
nrE~Rwr
7ERNANElIT
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16,103
COMMONWEALTH OF PENNSYLWiNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
X88684
NAME OF DECEDENfcF~nL MbW.LrO sEn socuLSECUprtv NUMBER oaEOroE~vNwar~.o ~.wn
,. ANNA i:. THOMAS L Female ~. 183 - 12 - 3581 •. 9 - -
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INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131 !91 CHECK HERI
IF A SPOUSAL
POVERTY CREDIT IS CLAIM
^
RESIDENT DECEDENT ED
FILE NU s
COMMONWEALTH OF PENNSYLVANIA
DEPA
T
(TO BE FILED IN DUPLICATE ER ~ 9 5 -Q'0 1 8 2
R
MENT OF REVENUE
DEPT. 280601
HARRISBURG
1 WITH REGISTER OF WILLS) R
~ , PA 17
26.0601 COUNTY CODE 2) YEAR 1 9 9 5 t~L~M$~
DECEDENT'S NAME (IAST, FIRST, AND MIDDIE INITIAL} DECEDENT'S COMPLETE ADDRESS
THOMAS ANNA E. 198 Fairview Road
w SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH S h i p p e n s b u r g, P A 1 7 2 5 7
W 183-]2-35f11 9/8/94 10/]4/23 c°~er Cumberland
O (IF APPLICABLE) SURVIVING SPOUSE'S NAI1E (IAST, FIRST AND MIDDIE INITIALI SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
'+' ®1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
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^ 4. Limited Estate (for dates of death prior to 12-13-82
^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Re wi
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(for dates of death offer 12-12-82) q
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a ^ b. Decedent Died Testate
(Attach co
of Will) ^ 7. Decedent Maintained a Livin Trust
g ~ 8. Total Number of Safe Deposit Boxes
A
h
py (
ttac
copy of Trust)
ALL~CORRESPONDENCE AND EONFIDENTIAI:TAX INFORM~-TIQt~,SHOULD~BE D~ftECT~f~TO:,;
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uy'J w NAME _
COMPLETE MAILING ADDRESS
~Z FOREST N. MYERS, Es wire 10000 Molly Pitcher Highwa
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TELEPHONE NUMBER
717 532-9046 y
S h l e n s b u r
PP g, PA 17257
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held StocklPartnership Interest (Schedule C)
4. Mortgages and Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
b. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G) (Schedule L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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15: Spousal Transfers (for dates of death aher b-30-94)
See Instructions for Applicable Percentage on Reverse
Side. (Include values from Schedule K or Schedule KA.)
1 b. Amount of Line 14 taxable at b% rate
(Include values from Schedule K or Schedule M.)
17. Amount of line 14 taxable at 15% rate
(Include values from Schedule K or Schedule M.)
18. Principal fax due (Add tax from Lines 15, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments
(1) -0- ~
121 - 0 - `~_.JY ~ ~~~1
(4) -0- ~~j7
(5) 500.00 VVV
(b) -0-
(7J -0-
(q) 5,600.50
(10) -0-
(11) 5,600.50
(12) (5, 100.50)
(13) -0-
(15)
(16)
(14) _(5, 100.50)
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x.06=
(17) ~i ~5 = ~'}
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r~ (18) sin? r,,
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Discount Interest -o
~ _
i'.0. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. {20) ~
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>1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. :(21) ~ to ~.
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A. Enter the interest on the balance due on Line 21 A. .~^' ~lA) d -..
B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21 B)
Make Check Payable to: Register of Wills, Agent
P ~#" F ~ ~ BE SURE TO ANSWER ALL QliESTlONS QN REVERSE SIDE AND TO RE HECK`MAT
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Under enalttes of eryury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief
it 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 i
based on all information of which preparer has anv knowledge_
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Si~«Ptsr,~Sb'.~2..C-,, e~~. ~7 2..57
DATE
4-tt--9s
DATE
a
Act #48 of 1994 provides for the red rescribed by the statutepwill ben the net value of transfers to or for
the use •f the spouse. The rates as p
• 3% (,®:$) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• Z% (,®~) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1% (.®1) will be applicable for estates of decedents-dying on or after 1/1/97 and before 1/1/98
• Sp•.nss! transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (/) IN THE APPROPRIATE BLOCKS.
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. retcsin a reversionary interest; or ................
.......................................
d. receive the promise for life of either payments, benefits or care
2. If death occurred on or b NfotheouDe Gebe~9 a~dequat d ons de ation?~tlfndea~hy occurpred eafter
death transfer property
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 QUESTIR ~F THE RETURN.
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PA
ti
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?EWSOB ~M~ (Y-87) SCHEDULE E
CASH, BANK DEPOSITS AND
COMMONWEALTH Of PENNSYLVANIA MISCELLANEOUS
IN RESIDENTEDE~EDENTRN PERSONAL PROPERTY Please Print or T
ESTATE OF FILE NUMBER
ANNA E. THOMAS 21-95-00182
(Attach additional 615° x 11" sheets if more space is needed.)
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REY•151^ R± (7.881
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OF
ANNA E. THOMAS
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or
NUMBER
21-95-00182
ITEM DESCRIPTION
NUMBER AMOUNT
A. Funeral. Expenses:
1. Fogelsanger-Bricker Funeral Home
$5', 334.50
B.
2.
3.
4.
C.
1.
2.
3.
4.
5.
b.
7.
8.
Administrative Costs:
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
Attorney Fees FOREST N. MYERS
Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State _
Probate Fees
Miscellaneous Expenses:
Inheritance Tax Return, Filing Fee
Zip Code
26.00
15.00
;`
l
TOTAL (Also enter on line 9, Recapitulation) $ 5 , 6 0 0 . 5 0
225.00
(If more space is needed, insert additional sheets of some size.)
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