HomeMy WebLinkAbout95-0198This 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 16_..2001 ?
Date Fran eropoli, • ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
NI05.113 Rw. ye7 COMMONWEALTH OF PENNSYLVMIIA • DEPARTMENT OF HEALTH • VRAL RECORDS
rr.E/rnllr CERTIFICATE OF DEATH
p NAME OFDECEDENfIR+L warae,LYQ BDpE FLE NDHBOI
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DERTIFIER
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OR tlN s••N of •aalni,a,yR ana/ar intr:Iyrion
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M NAME ANDADDRESS OF PERSON YAIOCOHPLE7E0 CAUSE OF DEATN
(Item 27(Type «PriM
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REGISTRAR'S SKiNRURE AND NUMBER
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1500 EX+ i7-94)
1•
,~`;~ ;~ INHERITANCE TAX RETURN
RESIDEN?" DECEDENT
COMMONWEALTH OF PENNSYLVANIA (TO BE FILeD IN DUPLICATE
DEPARTMENT OF REVENUE
DEPT. 280601 WITH REGISTER OF WILLS)
HARR45BURG, PA 17128-0t 01
DECEDENT'S NAME (LAST, FIFST, AND MIDDLE INITIALI
MILLER [BARREN E.
o SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTh
"' 199-07-8846 3/1/95 3/2/20
D IIF AVPLICABIE) SURVIVING SPOUSE S NAME ILASi, FIRST AND MIDDLE INITIALI SOCIAL SECURITY NV
N/A
NT
N/A ~ N
r-
"' ~] 1. Original Return ^ 2. Supplemental Return
Y ¢ y
=oo ^ 4. Limited Estate ^ 4a. Future Interest Compromise
" a m (for dates of death after 12-12-82)
a ~b. Decedent Died -'estate ^ 7. Decedent Maintained a Living Trust
a Attach co
_ ( py of Will) (Attach copy of Trust)
^ 3. Remainder Return
(for dates of death prior to 12-13-82)
^ 5. Federal Estote Tax Return Required
8. Total Number of Safe Deposit Boxes
••..~ ....nns:arvnus:rva.~ s-nu c.VNr1uENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
y Z NAME COMPLETE MAILING ADDRESS
~o KATHRYN E. ZIMMERMAN 2434 Berryhill Street
v ~ TELEPHONE NUMBER
17171 2;36-3267 Harrisburg, PA 17104
z
0
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a
a
W
z
1. Real Estate (Schedula A) (1) - 0 -
2. Stocks and Bonds (Schedule B) (2) _ - 0 -
3. Closely Held Stock/P~rtnership Interest (Schedule C) (3) -0-
4. Mortgages and Notes Receivable (Schedule D) (4) -0-
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) $ 2 , 6 5 5 . 6 3
(Schedule E)
b. Jointly Owned Property (Schedule F) b -0-
( )
7. Transfers (Schedule G) (Schedule L) (7) -0 -
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous
E
S
h (9) 7 8 5 . 0 6
xpenses (
c
edule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 2 , 13 2 . 4 9
11. 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)
15. Spousal Transfers (for dates of death after b-30-94)
See Instructions for Applicable Percentage on Reverse
Side. (Include values from Schedule K or Schedule M.)
1 b. Amount of Line 14 taxable at b% rate
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable of 15% rate
(Include values from Schedule K or Sch d I M
(15)
(16)
(17)
x._= -0-
x .Ob . -0-
-0-
X.15=
o e u e .)
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) -0-
a
~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest
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 online 21. This is the TAX DUE. (21) -~ -
A. Enter the interest on the balance due on Line 21A. (21 A) _ -(1-
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 B) _ - n
Make Check Payable to: Register of Wills, Agent
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~
Jnder penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
t 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 is
used on all information of which preparer has any knowledge.
iIGNATURE OF PERSON RESPONSIBLEFOR FILING RETURN
ADDRESS
DATE
Executrix, 2434 Berryhill St,, HBG. PA 17104 8/8/95
iIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS
DATE
(g) $2,655.63
$2,917.55
(12) ($261.92)
(13) -0-
(14) -0-
FOR DATES OF DEATH AFTER 14/31191 CHECK HERE
IF A SPOUSAL
POVERTY CREDIT IS CLAIMED ^
FILE NUMBER
21 95 0198
COUNTY CODE YEAR NUMBER
230 Four Seasons Lane
Summerdale, PA 17093
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:
• 3°k (.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 1/1/96 and before 1/1/97
• 1 % (.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, ...............
...................................
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? ...................................................................................................
~X
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.
REV-1502 EX + (12.85)
~`
COMMONWEALTH OP PENNSYLVANIA SCHEDUTLE*A
INHERITANCE TAX RETURN REAL ES 1'A 1 E
_ RESIDENT DECEDENT
ESTATE OF
~~¢Q /~~ ,t f ~ /~/j/) r `/~ FILE NUMBER
Pra err y./1/~-/C- /v ~~~ l~~' ~/ -15 -~ ~r~~!
( P y joint! owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled
to buy or sell, both !raving reasonable knowledge of the relevant facts.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
- I
~ ~ OF DEATH
N~/J~
--- _______ TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of same size.) S _r O `+
REV-1503 EX + (4-86)
ATE OF
~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
TOTAL (Also enter on line 2, Recapitulation)
(If more spoce is needed, insert additions! sheets of same sire.)
SCHEDULE B
STOCKS AND BONDS
VALUE AT DATE
OF DEATH
(All property join>?ly-owned with Right of Survivorship must be disclosed on Seh~duls F.)
ITEM
NUMBER DESCRIPTION
1.
/Z~~i~' ~
REV-150< EX+ (4-89)
?. ~
IA
ESTATE OF
t+~...av~e a,-~ or a.-z must be attached for each business interest of the decedent, other than a proprietorship.)
ITEM
NUMBER DESCRIPTION
,. ~ ~Vc~N ~..r
Please Print or Type
FILE NUMBER
~~ --~1S - o/y'~
VALUE AT
DATE OF DEATH
TOTAL (Also enter on line 3, Recapitulation) $ -'-' U
(If more space is needed, insert additional sheep of same size.)
SCHEDULE C
CLOSELY HELD STOCK,
PARTNERSHIP AND PROPRIETORSHIP
REV-1507 EX+ (7.88)
> .
CIS ~ ~\
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
t~TA7E OF
~-
reu ---- -
' - ~"."'. ~~'~°~r-ownea with fps Right of Survivorship must be disclosed on Schedule E)
ITEM
NUMBER DESCRIPTION
/`Vow ~
TOTAL (Also enter on line 4, Recapitul
(If more space is needed, insert additional sheep of same size.)
SCHEDULE D
MORTGAGES AND NOTES
RECEfVABLE
Please Print or
VALUE AT
DATE OF DEATH
$ -O -
REV~150B EX+ (2.871
SCHEDULE E
~~ CASH, BANK DEPOSITS AND
1LTH OF PENNSYLVANIA MISCELLANEOUS
1NCE TAX RETURN PERSONAL PROPERTY
SENT DECEDENT
FILE NUMBER
WARREN E. MILLER, DECEASED
(All property lointl d 21- 9 5 - 019 8
Y-owM with fhe Ripht of Survivorship must be diseloeed en Schedule F)
ITEM
NUMBER DESCRIPTION VALUE AT
1.
CHECKING ACCOUNT BALANCE DATE OF DEATH
DAUPHIN DEPOSIT BANK ACCOUNT ~~ 60-82562-6
$
5
2.
Gerber life insurance refund on premium
$ 40.10
5
3.
SPRINGDALE ARMS REFUND OF SECURITY AND RENT
$ 3.29
18
4.
General Accident insurance refund on premium
$ 5.00
5.
PRUDENTIAL INSURANCE REFUND ON PREMIUM 37.00
6.
Burial Allowance - Cumberland County Veterans Fund $
$ 94.18
7.
BURIAL AWARD - RAILROAD RETIREMENT BOARD 100.00
8.
AARP GROUP HEALTH INSURANCE PAYMENT FOR CARE $
$ 650.00
8
9.
PENNSYLVANIA RENT REBATE PAYMENT for 1994 95.00
$ 100.76
TOTAL (Also enter on line 5, Recapitulation) $ 2 , 6 5 5 . 6 3
(Attach additional 8'/s" x 11" sheets if more space is needed.)
Please Print or
REV-1509 EX ~t (IY-8B)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
- w• vw ~° .
~~~~~~ ~ 1 ~ /~ f /~~ FILE NUMBER
Joint tenant(s): ~~y C' -
• ----- •••-~• • ......nwnv+ sneers Or some size)
COMMONWEAL*H ~~F -ENNSYWANIA SCHEDULE G
IIINItITAA<;~ 7A7I ttTUtN TRANSFERS
_ __-- __---_R__awt-fT arc_EOtNr
ESTATE OF ~ ~ -- - - i PlEASE PRfNT OR TYPE
FItE NUMBER
-- ~(.~~_~_='~~ti~ ~'- /~ /~ /~ ~ ~- y' S -- ~/yam
TMK fCNEDIJLE MUST dE I::OMPLETED AND HIED IF THE ANSWER TO ANT OF THE QUESTIONS ON THE REVERSE SIDE OF THE DOVER SHEET IS YES.
- --- --
I
ITEM DESCRIPTION Of PROPERTY DECD. 1
NUMBER Inehrde norne of M,e honsferee, IMir nlofionshi to I EXCLUSION i TOTAL VALUE i 96 OF DECEDENT'S
_ ___ _ _ _ P wok dole ollronsfer. Of ASSET
N ` , ~ IN1. ~ INTEREST
O f LJ '~' i ~ _ __ - - -
~ - i I ~
I
i I I '
i
' i
i
~ ~
I i
I ~
I
~ I ~
I
~ I
i
I
I
i
1
1
TOTAL (Also enter on lino 7, Recopitularion) $ '- ~ -~
(If mon space is needed, insert oddifbnal sh«h of some size.)
REV-1512 EX+ (l-V3~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE i
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or Type
~ILE NUMBER
ITEM
NUMBER DESCRIPTION
1. 1/i5f~ ~ Ccov,~
~~~~~-- °~~~- ~ ~~s- 37yS
~x i~z ~5~
;Z . UrS~4 ACC°o~rU i
,~r2 S j U-~iq ~ r9-~ti/C
~. G . ~~X ~ ~ SG
GU/C_ /d7iiU~7CJ~fJ ~1~. ~ l~cr~~ " lJG(j /
AMOUNT
~,y ~ 7
~~i sy
~'~~/ ~ ~
~~~5, a6
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of some size.)
s 2~=
. i ;• -
LAST WILL AND TESTAMENT
I, ~'`~~EN E• MII.LER, of 230 Four Seasons Lane, Enola, Cumberland County,
Pennsylvania 17025, do hereby make, publish and declare this to be my last will and testament,
hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and administrative
expenses as soon as convenient after my decease.
2. I authorize and empower my personal representative to sell any realty and/or
personalty owned by me at my death and not specifically devised or bequeathed herein, at public
or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee
simple, as I could do if living. My representative is authorized and empowered to engage in any
business in which I may be engaged at my death, for such period of time after my death as seems
expedient to said representative.
3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to
Kathryn Zimmerman, of 2434 Berryhill Street, Harrisburg, PA 17104.
4. If Kathryn Zimmerman does not survive me by a period of at least
my estate I give, devise and bequeath to Goodwill Industries Ham ~Y (60) days, then
sburg, PA.
5. I nominate and appoint Kathryn Zimmerman to be personal representative of my estate,
to serve without bond. If she cannot or does not serve, then I appoint Harold S. Irwin, III to be
the substitute personal representatives, also without bond.
6 I suggest that my personal representative retain the services of Irwin, Irwin &
McKnight, Carlisle, Pennsylvania in the settlement of my estate.
W WITNESS WHEREOF, I have hereunto set my hand and seal. this_ ~ G ~ day of July,
1994.
~~ ~~~~7
WARREN E. MII.LER (SEAL)
Signed, sealed, published and declared by the above-named person as and for a last will
and testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
~~ S~
~ Sl C ~ ~
ACKNOWLEDGMENT A___ND AFFIDAVIT
~'~'E, WARREN E. MII.LER, SHARON L. SCHWALMt and CHERYL L.
CLELAND, the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator
signed and executed the instrument as his last will and that he had signed willingly, and that he
executed it as his free and voluntary act for the purpose herein expressed, and that each of the
witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the
best of their knowledge the testator was, at that time, eighteen years of age or older, of sound
mind and under no constraint or undue influence.
WARREN E. MII,I,ER
~'/ ~ls
SHARON L. SCHWALM
_ ~S C G~
CHERYL L. CLELAND
COMMONWE~,1-g OF PENNSYLVANIA ;
COUNTY OF CUMBERI,A1~ : SS:
Subscribed, sworn to and acknowledged before me b W
testator herein, and subscribed and sworn to before me b SHARAp EL S~ ~~R' ~e
CHERYL L. CLEI.AND, witnesses, this ~ Z may of Julyy 1994. CHWA~ and
is~ /~~ ~
Notary public