HomeMy WebLinkAbout95-0187ZI - q~'Dl8 7
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 I-lealth, 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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Date
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH of PENNSYLYMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ 14 4 3 5
CERTIFICATE OF DEATH
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REV•1500 Ex+ (7-94) ~,
INHERITANCE ?rA~C RETURN
-' RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE
DEPARTMENT Of REVENUE
DEPT. 280601 WITH REGISTER OF WILLS)
HARRISBURG, PA 17128-0601
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Under psnolties of perjury, I deci~
it is true, correct and complete. I
hosed on all information of which
Jan4es D.
Boone, Anna M.
191-42-9133 ~02/27/1995I01/30/1906
APPLICAlLE) SURVIVING Si0U5E S NA/.1E (UST, FINST AND MI°DLF INITIAL) SOCIAL SECURITY NUMBER
® 1. Original Return
^ 4. Limited Estate
b. Decedent Died Testate
(Attach copy of Will)
FOR DATES OF DEATH AFTER 12131/91 CHECK HERE
IF A SPOUSAL
POVlRTY CREDIT IS CLAIMED I~
21 X895 .00187
VTY CODE YFOR -~~,.,
210 Big Spring Road
Green Ridge Village
Nye~~~l>~1r~~T a~izi 17241
^ 2. Supplemental Return
^ 4a. Future Interest Compromise
(for dates of death after 12-12-82)
^ 7. Decedent Maintained a Living Trust
(Attach copy of Trust)
^ 3. Remainder Return
(for dotes of death prior to 12-13-82j
^ 5. Federal Estate Tax Return Required
- ~ -8. Total Number of Safe Deposit Boxes
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James D. Boger, Esquire One West Main St.
TELEPHONE NUMBER Shiremanstown, PA 17011
717 737-8761
1. Real Estate (Schedule A) (1 )
2. Stocks and Bonds (Schedule B) (2 )
3. Closely Held StocklPartnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4 )
• 5. Cash, Bonk Deposits 8~ Miscellaneous Personal Property
(S
h
d
l
E (5) 19 ~ 0 51 • 2 5
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)
b. Jointly Owned Property (Schedule F) (b )
7. Transfers (Schedule G) (Schedule L) (7 )
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous
Ex
S
h
d
l (9) 6 ~ 8 51 • 7 6
penses (
c
e
u
e H)
10. Debts, Mortgage Liabilities, Liens (Schedule 1) (10)
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)
is s
(B) _ 19,051.25
(tt) _ 6, 851.76
(t2) _ 12.199.49
(13) _
(t4) 12, 199.49
pousal Transfers (for dates of death after b-30-94)
See Instructions for Applicable Percenta
e on R
1
g
everse (
5)
Side. (Include values from Schedule K
S
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l
x'-= -
or
c
e
u
e M.)
1 b. Amount of Line 14 taxable at b% rate (16) 12 , 19 9 .4 9
(Include values from Schedule K or Schedule M.) x .ob =
- 7 31.9 7
17. Amount of Line 14 taxable at 15% rate (17)
(Include values from Schedule K or Schedule M.) x .15 = -
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments Discount Interest (18) _ 7 3 1 9 7
+ 695.37 + 36.60 _
(19) - 731.97
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20)
~^ _
t 1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
(2t)
-0-
A. Enter the interest on the balance due on Line 21A _
.
B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (21A) _.
(21 B)
- 0
Make Check Payable to: Register of Wills, Agent _
e suRE TO'AtNSHlER A~L`~Gt
that I have examined this return,
are that all real estate has been
sparer has env knewlwrlnw
sported at t ue marke9value~ Declarationtof preparerd othere~
7 Glendale Drive
- "'""""' One West Main St.
B ar, Esquire -
~~I
of my knowledge and belief,
the personal representative is
s1141~~
DATE
SIZ~(ce.j
DATE
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Act #48 of 1994 pcovides 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% (.~2j will be applicable for estates of decedents dying on or after 1/1/96 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
• Speusstl 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.
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.
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IAII property loinfly.owned wifh fhe Righf of
ITEM
NUMBER
must be disclosed on Schedule F)
DESCRIPTION
Please Print or
!NUMBER
-95-00187
1• PNC Bank, N.A. Checking Account No. 5070053899,
date of death balance $18,415.0.8, accrued
interest $0.00
2• Audiological Consultants Inc. - Hearing aid refund
3• Bethany Towers - Security deposit refund
4• AT&T - Refund
5• Bell Atlantic - Refund
VALUE AT
DATE OF DEATH
$ 18,415.08
558.00
54.64
13.10
10.43
TOTAL (Also enter on line 5, Recapitulation) $ 19 , 0 51.2 5
(Attach additional 8Yi" x 11" sheets if more space is needed.)
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
REV-1511 EX+ (788)
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.~~~
AONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEaUl.E H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Anna M. Boone
ITEM
NUMBER DESCRIPTION
p-• Funeral Expenses:
i• Myers Funeral Home - Funeral expense
B• Administrative Costs:
1• Personal Representative Commissions None claimed or paid
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees -• James D. Bogar, Esquire as per agreement
3. Family Exemption
None claimed
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees & Short Certificates - Cumberland Co.
Register of Wills
C• Miscellaneous Expenses:
~• AT&T - Telephone bill
2• Bell Atlantic - Telephone bill
3• Presbyterian Homes Inc.
- Services rendered
4.
5.
6• Reserves to conclude administration of Estate
including filing fee for PA Inheritance Tax
~• Return and Inventory and related
8.
AMOUNT
$ 5,851.40
625.00
67.00
1.45
14.91
92.00
200.00
TOTAL (Also enter on line 9, Recapitulation) I $ 6 , 8 51.7 6
Please Print or
21-95-00187
(If more space is needed, insert additional sheets of same size.]
REV-1513 E7(+ ~~-87)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE J
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
Anna M. Boone
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
~~ Donald N. Boone
31.7 Glendale Drive
Shiremanstown, PA 17011
NOTE: Personal effects and diamond
rings referred to in Item II
of Will given away prior to
date of death.
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
FILE NUMBER
21-95-00187
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
Son I Rest, residue
and remainder
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $
(If more space is needed, insert additional sF>Ieets of same size)
LAST WILL AND TESTAMENT
OF
ANNA M. BOONE
I, ANNA M. BOONE, of the Borough of Mechanicsburg, Cumberland
County, Pennsylvania, declare this to be my Last Will and revoke
any Will previously made by me.
ITEM I: I direct my hereinafter named Executor to pay all my
just debts and funeral expenses as soon after my decease as may be
found convenient.
ITEM II: I devise and bequeath my personal effects and diamond
rings to my daughter-in-law, CORINNE BOONE. If my said daughter-in-
law, CORINNE BOONE, predeceases me, then I bequeath my said personal
effects and diamond rings to my grandson, DAVID HOONE, to be held in
trust by First Bank and Trust Company of Mechanicsburg, Pennsylvania,
until he reaches the age of twenty-one (21) years.
ITEM III: All the rest, residue and remainder of my estate of
whatsoever nature and wheresoever situate, including, but not limited
to, my checking and/or savings accounts, I devise and bequeath unto
my son, DONALD N. BOONE. In the event that my son, DONALD N. BOONE,
should predecease me, I devise and bequeath my estate in equal shares
as follows;
(a) 1/2 to my daughter-in-law, CORINNE BOONE; and
(b) 1/2 to my grandson, DAVID BOONE, to be held in
trust by First Bank and Trust Company of
Mechanicsburg, Pennsylvania, until he reaches
the age of twenty-one (21) years;
ITEM IV: I direct that all inheritance, estate, transfer,
succession and death taxes, of any kind whatsoever (including any
interest and penalties thereon) which may be payable by reason of
my death, whether or not with respect to property passing under this
Will, shall be paid out of the principal of my residuary estate.
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I r
ITEM V: 2 appoint my son, DONALD N. BOONE, Executor of this
my Last Will.
IN WITNESS WHEREOF, I have hereunto set my hand this :.1 '.day
of January, 1981.
Anna M. Boone
The preceding instrument, consisting of this and one other typewritten
page, identified by the signature of the testatrix, was on the day and
date thereof signed, published and declared by Anna M. Boone, the
testatrix therein named, as and for her Last Will in the presence of
us, who, at her request, in her presence and in the presence of each
other have subscribed our names as witnesses hereto.
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN SS:
I, ANNA M. BOONE
+vtiose name is signed to the attached or forego ~ngxinstrumentrlhaving
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.
Sworn or affirmed to and acknowledged before me, by
ANNA M. BOONE ,XkKi{}L-[7GSRR/testatrix, this 22nd
Jan gar d•~y of
191,
Not ry pu 11c ~~~~'-`--
My Commission Expires:
Sheila R. Grbuq~, NtJT:7". PE;;t~
AFFIDAVIT Mr Commi,don Exyirc, a~•a,„i e, ,.;y;
COMMONWEALTH OF PENNSYLVANIA ~~ PA gawlue eoumr
COUNTY OF DAUPHIN SS:
i We, LINDA L BEIGH
JAMES L. DEBACLE
WILLIAM E. SMITH III , the witnesses, bein dul ,
according to law, do depose and say that we were present and sawlified
testator/testatrix sign and execute the instrument as his/her Last
Will; that he/she signed willingly and that he/she executed it as
his/her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the testator/testatrix
signed the Will as witnesses; and that to the best of our knowledge
the testator/testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn to and subscribed before me this 22nd day of January
19 81 , ---
~~~~ ~~~~
Notary ub7ic -_'"~/~~
My ~'~muninnl„n P:xlri r,^~: J
Sheila R. Cedrmh, NG7ANY PUSUC
Mr cama,;nb„ Eayhu, au-,~; o, Iq^a
banhMe. PA Cauphhi Counlr
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