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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.
Date
AUG 167001
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA• DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
014715
NNE a OH;ELB(r~Y,llaeaw 1+10 8FX 96Y1N11'r NUAB61 TE OF OFATN Oer4 ar. Yrt)
,. Thomas H. Lilley Yale 204 - O1 -2233 Fehruary 15, 1995
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~~" `"' I'-'"I Y FOR DATE8 OF DEATH AFTER l ?131191 CHECK HERE
INHERITANCE TAX RETURN P
~'
-• OVERTY CREDIT IS CLAIMED ^
RESIDENT DECEDENT
COMMOf•tWEALTH Of PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT
28d601 FILE NUMBER
(TO BE FILED IN DUPLICATE ~ ~ q~ ~ ~qa
.
HARRISBURG, PA t712e-0601 WITH REGISTER OF WILLS
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL( DECEOE~OM~ET C~~~$$
~
W
°~ SOCIAL SECURITY N MBER
oy -
~ DATE OF DEATH DATE OF BIRTH C q r~q H ~ ~~ ~.• ~1O` ` ~~ f ~11~tJTw~
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o} aa33 ~-~S qs i ~-1a~11~ Ccunl ~u~,~,~~~~la
IIF A-PIICAlIE
N ) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL(
A SOCIAI SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONSI
x a rn 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
=oo
^ 4. limited Estate (for. dates of death prior to 12-13-82)
^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
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^ 6. Decedent Died Testate
(Attach co
of Will) (for dates of death after 12-12-82)
^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe De osit Boxes
P
A
py (
ttach copy of Trust)
AhI~:,C :_ ~L~SP t, ,
y Z
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~ 2 NAME
~ a -
MPLE E M lLf DDRES '
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(}~~0. ~'
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v~ TELEPHONE NUMBER '
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•~' ~ • ~ tD~O-~ loo _ ~12,C~1 ~'~ o~~ _ ~ ~~
1. Real Estate (Schedule A) (1) _ ~
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held StocklPartnership Interest (Schedule C) (3) _
a
4. Mortgages and Notes Receivable (Schedule D) (4) s7~ ..~~ci~~ , J~ ~
+~ ~ t~.
,_„
5. Cash, Bank Deposits & Miscellaneous Personal Property Jar
(5) _~_
~ . 0~ f! . ~
~ „~~~, tv
.-
Z (Schedule E) _ G7
~ 6. Jointly Owned Property (Schedule F) (6 )
7. Transfers (Schedule G) (Schedule L) (7)
~
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8. Total Gross Assets (total Lines 1.7) $
(8) ~ ` ~ 5~ , L~/
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H) (9) ~ s ~1.1p~, ~%
10. Debts, Mortgage Liabilities, Liens (Schedule I) r <)~
(10) 1 ~O",~, ~
11. Total Deductions (total Lines 9 & 10) (~ (~ /, Ov
(11)
1 `y~ ~
12. Net Value of Estate (Line 8 minus Line 11) f
-~ ~-
13. Charitable and Governmental Bequests (Schedule J) (13) O
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 3a ~ (~ ( ~ a~
15. Spousal Transfers (for dates of death aher 6-30-94)
See Instructions for Applicable Percentage on Reverse
Side. (Include values from Schedule K o
S
h
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M (15) {~ x . _= (~
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.)
16. Amount of Line 14 taxable at 6% rate
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(16) ~7 f71 'y x 1 (~
06 = I
`ISLo . ~~
(
nc
ude values from Schedule K or Schedule M.) .
s
z 17. Amount of Line 14 taxable at 15% rate
(Include values from Schedule K or Schedule M
) (17) d x .15 = d
c
a .
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) S 1 -1~~ ~/
d 19. Credits Spousal Poverty Credit Prior Payments Discoun Interest ~ p
~ (19)
Q
~ 20. If Line 19 is greater than Line 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) ~ 1 ~ ~_ a%
A. Enter the interest on the balance due on Line 21A. (21A)
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (41 g) ~~ 5~ 22
Make Cheek Payable to: Register of Wllls, Agent
Under penalties of perjury, I declare that 1 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 re
orted at tru
k
t
l
D
l
based p
all information of which preparer has any knowledge. e mar
e
va
ue.
ec
aration of pre parer other than the personal representative is
SIG T E OF PERSON RES NSIBIE FOR FILING RE URN ADDRESS
DATE
SIGN
ATURE OF PREPARER OTH R THAN E ENTATIVE ADDRESS
~~~~, DATE
t
~..-.+.., ~,. ,,.ae~
,~~ ;
SCHEDULE D
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN MORT6AaES AND NOTES
RECEIVABLE
RESIDENT DECEOlNT FleoSe Prlnt Or T e
ESTATE OF FILE NUMBER
(All properly loimly-evened with the Rfyht of ivenhip must be dbelored on Schedule F.)
ITEM
NUMBER DESCRIPTION VAWE AT
DATE OF DEATH
d ~-~~~-~ c ~3s '~~a~ ~t. o~~c~ e~. ~.
~
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o~
S~S~U•
~~ 1~ ~.,~ Sa'~S Q e~e•e. cc~en~' -~v ~ ~rbecq- ~. ~c
.~ ~~' .
a,as o~ tvw , a , ~ yq~ a ~ c ~ Sa~1~e pc ~L~e
~ ~34,vod ~ . ~cZ.~nooas ~c~~ ~~1,~0 ~
,~ v~ -~~;,5 ~~ ~ ~e~~~ ~ -~-~me, ~c~e~2~~r
~ ~~-~~ ~ ~ m~`~,r~as
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, ~ o
~s scJ~ w~ v Ise, ~~ Id a-~' ~ -- a, ~v ~s.
~~
TOTAL (Also enter on line 4, Recapitulation) $ O~~j...l~~~
(If more space is needed, insert additional sheep of some size.)
E J REK1508 E%+ (2.87)
COMMONWEALTH OF PEI
INHERITANCE TAX F
RESIDENT DECED
E OF
_._,` .~c~T,aS ~ ., L it y
Please Print or
FILE NUMBER
a• - ~, s• i 9a
(RII property (ointly-owned with the Riyht of Su~rivorship must be disclosed on Schedule F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
- ~he~IC~~ A~~ ~- 1y~1~5y~tov~~lya, `~a,os ti .~~
"~ Ivc, ~q~k N0~ G,,~c,~ ~~.~, e~-.
~. C°_~~• ~ ~e~a~~~ ~ 11~av5 ~ 1 a, ovo ~=
~~ c. ~k N~ G.nb ~c~c~l,
y t~c~~s i ~uc N .
s 3~~
~ ~~, o?
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SCHEQULE E
CASH, BANK DEPOSITS AND
IA MISCELLANEOUS
PERSONAL PROPERTY
TOTAL (Also enter on line 5,
(Attach additional BIFi" x 11" sheets if more space is needed.)
S
I REV•ISII EX+ (7-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ill
Please Print or
NUMBER
1- qs-- 1q2
ITEM J
NUMBER DESCRIPTION AMOUNT
A• Funeral Expenses:
1. ~1-l~.lr~l~ ePtlt7i'2, ~~J2rnt, L ~~M.¢,, '~~ota~g, ~~.
1~11,~ C~ce~.~ Ge~ti~
~ ~
B• Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2.
3.
4.
c.
~.
~.
3.
4.
5.
6.
7.
8.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Attorney Fees
Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State
Probate Fees
Cvt,r,), ~ ~o~~ ~e~ ~ ~ W;l1s
Miscellaneous Expen es:
~c~c~c-~; ~, ~, N ec- 0.-s ~v~Ne~o, l
~~~~ec ~ vw-ers
~~~5
Cam, Cou~~~ ~; l;t~ ~
°~y,°%
~u~,`~
3a . ~'
~~.~
~~, UV
TOTAL (Also enter on line 9, Recapitulation) I $ ~ .3~or1
Zip Code
(If more space is needed, insert additional sheets of same size.)
~ REV•1512 EX+ (10.86)
SCHEDULEI
DEBTS OF DECEDENT,
COMMONWEALTH OF PENNSYLVANIA MORTGAGE LIABLITIES AND LIENS
INHERITANCE TAX RETURN
REStOENT DECEDENT
ESTATE OF
~romAs. N. L~-I ~ FILE NUMBER
~~-95_ ~9a
ITEM
NUMBER
DES
CRIPTION
AMOUNT
1. t
, ` ,(,~
~ t`c~Dni~'~S ~rr~7T @ ~i 1 J ~'~ Q~QC C(tiUcs-T~ ~f9 i}~~~. 1 ~
1
~
y' C~~cl>51~e ~C.
mac. L.eIJ SI~~QN -~eN' 1~
CAn,p 1;11 `~ 'C~CiC' cS. '~v v~ ~.~~ , 1 q°~ ~' q~p,
`~ ~ ~~Amm~xvs ~nnl ~ ~ ~k -~-.~.) g
9.Y
S . ~pt1 ~~ aJ~r; ~ L phase
~ s
~
a~,
(~. U .~ c ~ ~qs ~~.)
q~
toy,
~.
.r.
-+~~A ~ o.~, ~rJ c,urr.~, ~X ~ ~ al
,~
TOTAL (Also enter on line 10, Recapitulation) I $ 1 ~ U
(If more space is needed insert additional sheets of some size)
~ , , REV.1513 EK+ t~~
~~
CAMONWEALTH OF PENNSYLVANIA
INHERITANCE TA% RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
tSIATE vf= FILE NUMBER
~~,r~s~ N. L~11e,.~ ~ ~. a-c_ ~ o,
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
i4. Taxable Bequests:
a~~ c~-~w
Z ~ ~ ~~ L;11e,~
~ ~ cofi~~e C-f , Sv,+J S~ I~
t~.¢,~~., Pq. \~o~S
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more apace is needed, insert additional sheets of same size)
AMOUNT OR
SHARE OF ESTATE
S