HomeMy WebLinkAbout95-0184/018521-q5' C)1$'~
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.
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PElMISYLWiN1A • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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INHERITANCE TAX RETURN
RESIDENT
DECEDENT FOR DATES OF DEATH AiTER 14!31191 CHECK HEF
POVERTY CREDIT IS CLAIMED ^
. FILE NUM
I/'
COMMONWEALTH OF PENNSYLVANIA
DEPART
(TO BE FILED IN DUPLICATE BER
MENT OF REVENUE
DEPT. 280601
HAR SBURG
PA 1
WITH REGISTER OF WILLS)
21 95 x184
,
7128.0601 COUNTY CODE YEAR NUMBS
DE DENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
I G, Bessie V. 395 Opossum Lake Road
W SOLI SECURITY NUMBER DATE F DEATH DATE OF BIRTH .Car 11 S 1 e , PA 17 013
77-42-4492 /15/95 3/29/08 c°un Cumberland
O A-PLIC:ARLE) SURVIVING SPOUSE'S NAME (LAST, FIRST A MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
~~++„ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
~~a`e
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^ 4. Limited Estate
^ da. Future Interest Compromise (for dates of death prior to 12-13-8:
^ 5. Federal Estate Tox Return Required
m (for dates of death after 12-12-82)
a 6. Decedent Died Testate
(Attach copy of Will) ^ 7. Decedent Maintained a Living Trust
A
h ~ 8. Total Number of Safe Deposit Boxe:
(
ttac
copy of Trust)
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o V. Otto III, COMPLETE MAILING ADD
Esquire MARTSON, RESS
DEARDORFF, [nTILLIAMS & OTTO
v~ T EPHONE NUMBER Ten East High Street
717 243- 4 PA 17n1~
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1. Real Estots (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Hsld Stock/Portnsrship Interest (Schedule C)
4. Mortgages and Notes Receivable (Schedule D)
5. Cosh, Bank Deposits 8 Miscellaneous Personal Property
(Schedule E)
6. 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)
1 1. Total Deductions (total Lines 9 8~ 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)
(1) ~
(2)
(3) ~
(4) 0
( _ 21,904.11
(6)
(7)
(y~ 8 , 415 8 0
(1 5,641.65
(8) 1 ,904 11
(tl) 14, 057.45
(12) 7, 846.66
(13) n
(la) 7, 846.66
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse (15) x._=
Side. (Include values from Schedule K or Schedule M.)
16. Amount of Line 14 taxable at 6% rate (16) 7 , 8 4 6 .6 6 .oe 4 7 0 . 8 0
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at IS% rate (17) x .15 =
oz (Include values from Schedule K or Schedule M.)
a 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18)
f-
a 19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ + 23.54 _ (lq) 2 4
a 20. If Line 19 is greater than Lins 18, enter the difference on Line 20. This is the OVERPAYMENT. (20)
~ ~ ^
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 4 4 7 . 2 6
A. Enter the interest on the balance due on Line 21 A. (21A)
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 B) 4 4 7 . 2 6
Make Cheek Payable to: Register of Wills, Agent
~ ~- BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE-AND TO RECHFGK-MATH ~ ~
Under penalties of perjury, 1 declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belie
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
ba don ail i rma ' of wh' pre arer has any knowledge
O FILING RETURN ADDRESS 395 !l•''^SSL1I11 Lake Rd. , Carlisle, PA 17013 DATE
703 For e Road Carlisle PA 17 _ J``~// l~5
G TURE F'. R AN R TATIVE ADDRESS 10 E, ~ H1gh Street DATE /
'~ ~' \' ~` - Carl i cl a _ PA 1 7(11 '~ .S'~ S ~ji
- -
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:
• 39k (.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/l /96 and before 1 /1 /97
• 1 °i6 (.O1) will be applicable for estates 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.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (r) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, ....................................................... x
b. retain the right to designate who shall use the property transferred or its income, ............... x
x
c. retain a reversionary interest; or ...................................................................................
.......................................
d. receive the promise for life of either payments, benefits or care$ x
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate considerations If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
..............................................................
adequate consideration$ ..................................... x
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 COMPLETE SCHEDULE G AND. FILE IT AS PART OF THE RETURN.
REV-1508 EX+ )2-87)
~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
ESTATE OF
KINGr Bessie V.
(All proptrty jointly-owned with Thy Right of Survivorship must bs diselo:.d on Sch~dul~ F1
Please Print or Type
ER
21-95-184
Kev-un ex+ p-ael
SCHEDULE H
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN
_ RESIDENT DECEDENT MISCELLANEOUS EXPENSES Please Print or Type
ESTATE OF FILE NUMBER
KING, Bessie V. 21-95-184
ITEM
NUMBER DESCRIPTION
AMOUNT
A. Funeral Expenses:
~, Hoffman-Roth Funeral Home, Carlisle, PA 5,722.00
2. Plainfield Church, Plainfield, PA: Reception 100.00
3. Georges' Flowers, Carlisle, PA: Funeral flowers 84.80
4. Carlisle Memorial Service, Carlisle, PA: inscriptio 85.00
B. Administrative Costs:
1. Personal Representative Commissions 1, 0 9 5. 0 0 7
Social Security Number of Personal Representative: 19 2 - 3 4 - 6 6 9 3
Year Commissions paid 19 9 5
2. Attorney Fees :MARTSON, DEARDORFF, WILLIAMS & OTTO 1,000.00
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees 6 4. 0 0
C. Miscellaneous Expenses:
1. Register of Wills: Filing fee 15.00
2. Reserved for miscellaneous costs,' fees and expenses 250.00
3.
4.
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) $ 8 , 4 . 8 0
(It more space is needed, insert additional sheets of same size.) ~
REV.1512 EX+ (I.93)
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT/
INHE RITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
Please Print or Type
ESTATE OF FILE NUMBER
KING, Bessie V. 21-95-184
ITEM DESCRIPTION
NUMBER AMOUNT
t. Outstanding Checks in Account 11-52009 on date of
death:
Church of God Home 4,615.28
Carlisle Cardiopulmonary Associates 47.36
2. Patient Accounting Services: Account payable 185.72
3. CGWM: Account payable 100.00
4. Blue Mountain Anes. Asso.: Account payable 97.94
5. Pease Pharmacy: Account payable 62.63
6. Belvedere Medical Corporation: Account payable 403.44
7. Yellow Breeches Family Practice: Account payable 48.50
8. Carlisle Hospital: Account payable 80,78
[The above medicals were balances after Medicare•
there is no additional insurance cov ge~J
TOTAL (Also enter on line 10, Recapitulation} I $
(If more space is needed, insert additional sheets of same size.)
REV-1513 EX+ (2-87(
F
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
KING, Bessie V.
FILE NUMBER
21-95-184
ITEM
NUMBER NAME AND ADDRf55 OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
t. Esther E. Warner Daughter 1/4 estate
3956 Enola Road residue
Newville, PA 17241
2. Doris E. Sheriff Daughter 1/4 estate
395 Opossum Lake Road residue
Carlisle, PA 17013
3. Lee V. King Son 1/4 estate
703 Forge Road residue
Carlisle, PA `17013
4. Edward H. King Son 1/4 estate
521 Stone Church Road residue
Carlisle, PA 17013
ITEM AMOUNT OR
NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE
B. Charitable and Governmental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more space is needed, insert additional sheets of same size)
0 D
0
LAST WILL AND TESTAMENT
I, BESSIE V. KING, of Lower Frankford Township, Cumberland
County, Pennsylvania, being of sound and disposing mind and memory,
do hereby make, publish and declare this to be my Last Will and
Testament, hereby revoking any and all former Wills or Codicils by
me made.
1. I direct that all my just debts, funeral expenses,
testamentary expenses and all inheritance taxes (whether such taxes
may be payable by my estate or by any recipient of any property)
shall be paid from my residuary estate as soon as practicable after
my decease and as part of the administration of my estate. My
Executor shall have no duty or obligation to obtain reimbursement
for any such tax so paid, even though on proceeds of insurance or
other property not passing under this Will.
2. I give, devise and bequeath all of my estate, both real
and personal property, in equal shares, unto my children, ESTHER E.
WARNER, DORIS E. SHERIFF, LEE V. KING and EDWARD H. KING,
absolutely.
3. I nominate, constitute and appoint DORIS E. SHERIFF and
LEE V. KING as Executors of my estate.
4. I direct that my Executors shall not be required to file
a bond to secure the faithful performance of their duties in any
jurisdiction.
5. I authorize and empower my personal representatives, in
their sole and absolute discretion, to purchase or otherwise
~~
B.V.K.
Page 1 of 3 Pages
acquire and retain any investments of which I die seized or any
real or personal property of any nature; to sell, lease, pledge,
mortgage, transfer, exchange, dispose of or grant options in regard
to any or all property of any kind forming a part of my estate for
such terms and such prices as they may deem advisable; to borrow
money for any purposes connected with the protection and
preservation of my estate; to mortgage or pledge any real or
personal property forming a part of my estate or to join in or
secure the partition of same; to compromise any claims or demands
of my estate against others or of others against my estate; to make
distribution in kind and to cause any share to be composed of cash,
property or undivided fractional shares in property different in
kind from any other share; and to execute and deliver such
instruments as may be necessary to carry out any of these powers.
IN WITNESS WHEREOF I have hereunto set my hand and seal this
. ,~,. ~' = day of _-: ' ;_ _:..~ ~ 19 9 2 .
Bessie V. Ding
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
Testatrix, as and for her Last Will and Testament, in the presence
of us, who at her request, have hereunto subscribed our names as
witnesses thereto, in the presence of the said Testatrix and of
each other.
~,
Page 2 of 3 Pages
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, Bessie V. King, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes
therein expressed.
Bessie V. King
Sworn or affirmed to and acknowledged before me by Bessie V.
King, the Testatrix, this 'day of "~ 'L~,_..,_ 1992.
- -; ,~ 1 . ,
Notary Public _+
;~
COMMONWEALTH OF PENNSYLVANIA ) CarrineL Myers,N~oharypubic
S S . carl~~e ~~ Cumberland County
COUNTY OF CUMBERLAND ) MYCommissionExpiresMay22.t995
Member, PeruisyNaruaAssoaabon of Notaries
the witnesses whose names are signed tc the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw Bessie V. King, the Testatrix,
sign and execute the instrument as her Last Will; that the
Testatrix signed willingly and that the Testatrix executed it as
her free and voluntary act for the purposes therein expressed; that
each of us, in the hearing and sight of the Testatrix, signed the
Will as witnesses; and that to the best of our knowledge the
Testatrix was at that time 18 or more years of age, of sound mind
and under no constraint or undue f uen e
_~-~, ~ - -
-~ .ti - ri Li--- ..
Sworn or affirmed to and subscribed before me this , .;_~' `day of
-- -.,_ ~ ,_ 19 9 2 .
_- -,..
- - _ .,
Notary Public
Notanal Seal
Conine L Myers, Notary Pt,~
Carlisle 6oro. Cumberland Cotx>hr
My Ccmmissicn FYOiras May 22. t ggg
Page 3 o f 3 Pages Member, Peru>sylvarya,4ssogapon of Notaries
ORC651 Cumberland County - Orphans Court 8/17/2.006
ORPHANS COURT FILE PRINT
Case No ...................... 1995- 185
Case Name .................... KING BESSIE V
Aye. .......................
C~se T e 1 PROBATE ESTATES
9 26 1995
Attorney(s) .................. / 76 MARTSON WILLIAM F
**********************************************************************
Petitioner/Guardian Type / Attorney(s)
**********************************************************************
Date Incapacitated Filed.. ... .................... 0/00/0000
Date Incapacitated Disposition Filed ..................... 0/00/0000
Incapacitated Disposition Description ..................
**********************************************************************
ACCOUNTS
Filed Description Disposed
A.K.As
Name
**********************************************************************
DOCKET ENTRIES
Date Description
-------------------------------------------------------------------
3/02/1995 PETITION FOR PROBATE AND GRANT OF LETTERS TESTAMENTARY
--------------------------------------------------------------------
3/02/1995 OATH OF PERSONAL REPRESENTATIVE
-------------------------------------------------------------------
3/02/1995 OATH OF SUBSCRIBING WITNESSES
-------------------------------------------------------------------
3/02/1995 DEATH CERTIFICATE
-------------------------------------------------------------------
3/10/1995 DECREE OF PROBATE AND GRANT OF LETTERS TESTAMENTARY
-------------------------------------------------------------------
4/06/1995 CERTIFICATION OF NOTICE UNDER RULE 5.6 (A)
-------------------------------------------------------------------
5/17/1995 INHERITANCE TAX PYMT
PAID - 1,500.00 ACN - 101 RECEIPT - 47775
DAUPHIN DEPOSIT BANK & TRUST
-------------------------------------------------------------------
6/30/1995 INHERITANCE TAX RETURN TAX DOCKET 15 20 6
-------------------------------------------------------------------
6/30/1995 INVENTORY
-------------------------------------------------------------------
6/30/1995 INHERITANCE TAX PYMT
PAID - 314.05 ACN - 101 RECEIPT - 47952
DAUPHIN DEPOSIT BANK & TRUST
-------------------------------------------------------------------
9/26/1995 STATUS REPORT COMPLETE
10/04/1995 REV 1547 NOTICE INH TAX APPRAISEMENT
Docket: 15 Book: Page: 20.00
-------------------------------------------------------------------
11/08/1995 FIRST AND FINAL ACCOUNT AND DISTRIBUTION
-------------------------------------------------------------------
1/30/1996 ACCOUNT CONFIRMED ABSOLUTELY
------------- ----- ----------------------------------------
3/07/1996 STATUS REPOR 6.12 COMPLETE
COST/FEES
D to Description
9/261995 RELEASE
Amount
13.00
**********************************************************************
ORC651 Cumberland County - Orphans Court 8/17/2006
ORPHANS COURT FILE PRINT
Case No ...................... 1995- 185
Case Name .................... KING BESSIE V
****END OF PRINT****
**********************************************************************
ORC463 Cumberland County - Orphans Court
Orphans Court File Inquiry
Casa No 1995 - 00185
Case Name KING BESSIE V
Page 1 of 3
Date
DAUPHIN DEPOSIT BANK & TRUST
-------------------------------------------------------------------
6/30/95 INHERITANCE TAX RETURN TAX DOCKET 15 20 6
-------------------------------------------------------------------
6/30/95 INVENTORY
-------------------------------------------------------------------
6/30/95 INHERITANCE TAX PYMT
PAID - 314.05 ACN - 101 RECEIPT - 47952
DAUPHIN DEPOSIT BANK & TRUST
-------------------------------------------------------------------
9/26/95 STATUS REPORT COMPLETE
-------------------------------------------------------------------
10/04/95 REV 1547 NOTICE INH TAX APPRAISEMENT
Docket: 15 Book: Page: 20.00
F2=Done F12=Cancel F17=Top F18=Bottom