HomeMy WebLinkAbout95-0209~I-~5~~~
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 ~ 6 200T ?
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
H10ti.iq Rev.?/B7
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COMMONWEALTH OF PENNSVLININIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFlCATE OF DEATH
IiVL~.~V V
soNE FaE MaANNR
NAMEaFDEeEDOFrIFea GMOd•.Lr9
aECURITY NUIeeER DREaF OFATM OAaryl.Dp,'AMq
'• Mar aret I . Cover a. F a. 162 - 05 - 3926 .
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ADE(Lw BialOgq tINDERtrEA11 U/IDEIIIDA' OREt7 t1RN MIDRACE (Qyaee aicEC,FDE~cNpw~a+r,n.-,»:rwe~.eece~..w
MMlllle = D•le Ilolea ~ tabdr lManw, DeK. Yaw, a1r1a Fwwpl CdM„ ,
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DEC:®vTrswrnD ADDREESaa.a DNNb•n. ar.. Lipcodd
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3424 Bedford Drive 'had• Penna. ~
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a Camp Hili, Pa. 17011 ~" Cumberland "~7 Nwe.naaaa.w Cam Hill
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NFORIIA117'S NAME(Tyow.ea NWORMAM'aMA/11ND ADDINFE{,aeael, Cay6en, 91dA Zp Caey -
Cl de R. Cover, Jr. 4324 Bedford Dr., Camp Hill, Pa. 17011
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~a,~ 1/12/95 a; Middletown Cemetery
Middletown, Pa.
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ANAUIOVBY
AUTD~BY FNDMR'i.4 AIANIIER OF DEATH
eERF'O/MtEDt PR1011W dF ~ TWE OF WJURY NUURY AT NORIf7 bESCRIBE NOWIMMYODpJRRED.
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'RaDNOUNCINO AND CEATNn'a1D FItYSIC1A11 (Peyacyn EaN Mandnanp axle arN b_ LICENSE NUMBER DATE SNiNEDIMann. Day. lbarl
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NAME ANDAOOgEaBCF PERSON WIIO COMPLETEDCAUSEOF DERV
(„wn 27) T f /
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' ra•«rree ,,Ls 6. Gana..s~ry
On E1e Bede d e~
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enyor hvealfgalion. b my opMion. OeeN oceum0 H IM Nme. Oeb. and
lnanllr N dated........... Piece. and due IO tM Caufe(e) and
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REGIBTRM'SSIGWVURE AND NUMBER ~'+'•~ ~'`y)v Y.
~ OREFILEDIMaMA.Ds1t M1erl
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e...;=,.:~ II~J#~iERiTANCE TAX RETURN
'"' `~~-~~`%~' RESIDENT DECEDENT
COfdlNON'•NEALTH OF PENNSv;•VAVIA ~ (TO BE FILED IN DUPLICATE
OEPAR?~~1E~~- 0= °.EVEAiUE I
cEPT.2aodcl I WITH REGISTER OF WILLS
HARRI58URG, PA 17128.Od01 I
FOR DATES OF DEATH AFTER 12131/91 CHECK HERE
IF A SPOUSAL
POVERTY CREDIT IS CLAIMED ^
FILE NUMBER
r~ ~•-~ ~,~ oaf
cctttNTV r'nnF n(~ viceo~J
i- DECEDENT'S NAME (LAST, FIRST, AND fliDD! E INITIAL] DECEDENT'S COM t TE ADOR 5
Cover, Margaret I. 3424 Bedford Drive
(SOCIAL SECURITY NUMBER DATE OF DEATH PATE OF BIRTH Camp Hill, PA 17011
:~ 162-05-3926 01/09/95 01/08/05 ca~n~rCumberland
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1. Origincl Return
^ 2.
Supplemental Return ^ 3. Remainder Return
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^ 4. Limited Estate
^ 4a. (for dates of death prior to 12-13-82)
Future Interest Compromise ^ 5
Federal Estate Tax
v ~ m .
(for dates of death oher 12-12-82) Return Required
a ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
~ (Attach copy of Will) (Attach copy of Trust)
;ALL CURItESPCfP1bE, l'CE At+11} Ci)3~#f#bENTIAL TAX INPORMAT FON SHOULD ~BE DIRECTED TO:
I NAME COMPLETE MAILING ADDRESS
"' z
a I William C. Dissin er,
g Es
quire
28 North Thirty-Second Street
~ TELEPHONE NUr.~.9ER Camp Hlll, PA 17011
_ a ~. 717 975-284 ->~
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1. Real Estate (Schedule A) (1) nnnP
2. Stocks and Bonds (Schedule 6) (2) _~r000.00
3. Closely Held Stock/Partnership Interest (Schedule C) (3) none
4. Mortgages and 1`lotes Receivable (Schedule D) (4) nnnP
5. Cash, Bank Deposits & Miscellaneous Personal Property( S) - 6,520.79
(Schedule E)
b. Jointly Owned Property (Schedule F) (b) none
7. Transfers (Schedule G) (Schedule L) (7) 13,000.00
8. Total Gross Assets (total lines 1-7)
9. funeral Expenses, Administrative Costs, Miscellaneous (9) f3 , A -6. q4
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) none
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (line B minus line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (line 12 minus line 13)
i5. Amount of line 14 taxable at b% rate
(Include values from Schedule K or Schedule M.) ,
16. Amo~;nt of line 14 taxable at 15% rate
(Include values from Schadule K or Schedule M.)
17. Principal tax due (Add tax from line 15 and from line 16.)
r
(15) 16r1~~_ x .Ob = _ 1 r007_~iq
(16) _ 1,7A7.2 x .15 = 269.58
18. ~.raalts Spausol Pov=; ty Credit Prior Payments Discount Interest
~ + ~ + 0
19. If lire 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT,
2U. If line 17 is greater then line 18, enter the difference on line 20. This is the TAX DUE.
A. Enter ihs interest on the balance due on line 20A.
8. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE.
P>fal:e Cfi,k Puyabie ta: Register of Wills, Agent
(17) _ 1,277.11
(18)
(19)
-0-
(20) _ 1.277.11
(20A) -0-
(2DB) 1, 277.11
_ ~'- ~r 5E 3UftE TCJ A>'~15~'IER ALL QUE57lON5 ON REVERSE.SIDE AND:TO RECHECK MATklrl4r
Under pencltia: of cariury, I dac!ore that I have examined this return, including accompanying schedules and statements, and to the best of m knowled a and belieF,
it is 'rue, cor-ect anJ Complete. I declare that all real estate has been reported of true market value. Declaration of preparer other than the .personal representative is
hosed on all informetior, of which preparer has any knowledge.
SIGnIATURE Of PERSON R/E~P~Ot~v51,61E F FILING R'cTURN ADDRESS DATEO~
I. (,~' ,- 3424 Bedford Drive, Cam Hill, PA 17 O ~ ~
SIGN. URE~O~F/P1R~EPARER OTHEnR T. E ESE~ITATIVE ADDRESS DATE
~,~L.C/~7~'I (f t"~ 28 North 32nd Street, Camn H~ ~ i PA i 7ni i ~~~ ~~
( 8) ~7, 5~(Z 79
(11) f3,A26 34
(12) 18,594.45
(131 none
(14) 18 , 594.45
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~) 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
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 x
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 hi.s 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.
t5J7 e:X~ (q.atj
COM~YIONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
TATE OF
property jo
ITEM
NUMBER
1.
SCHEDULE "B"
STOCKS AND BONDS
DESCRIPTION
8 series HH. U.S. Savings Bonds
TOTAL (Also enter on line 2, Recapitulation)
(It more space is needed insert additional :heats of same size)
Margaret I. Cover
-owned with Right of Survivorship must be discloseo on Schedule "F
FILE NUMBER
21-95-209
VALUE AT DATE
OF DEATH
$8,000.00
,y 6
REv.150B Ex« (2871
_~
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COMMONWEALTH OF PENNSYLVANIa
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ATE OF
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
FIL
Pleose Print or T
ER
(Attach additional 8Yz" x 11" sheets iF more space is needed.)
R'EV,IS10 EX'+ ¢7.87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENTDECEDENT
A
SCHEDULE "G"
TRANSFERS
rs~~ rvUMtSER
Margaret I. Cover 21-95-209
THIS SCH EDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVFRSE SIDE OF THE CO
ITEM VER SHEET IS YES.
NUMBER DESCRIPTION OF PROPERTY
EXCLUSION TOTAL VALUE DECD.
9k DOLLAR VALUE
OF ASSET
INT. OF DECEDENT'S
INTEREST
1• Cash, gift made 12/27/95 to
Helen Vanidestine (daughter-in-law) 3,000.0 10,000.00 100% 7,000.00
2• Cash, gift made 12/27/95
to Cl
d
R 3,000.0 0 9,000.00 100• 6,000
00
y
e
. Cover, Jr. (son) .
TOTAL (Also enter on line 7, Recapitulations ~ $
(If more space is needed insert additional sheets of some size.)
E
_;~;? ~n
COMMONW'.ALiH OF PENN$YIVANIA
INHERITANCE 7AX RETURN
RE$tOENTDECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
_ Please Print or T
LE NUMBER
_ Margaret I COVer
ITEM
NUMBER ~ DESCRIPTION
A. Funeral Expenses:
~• Funeral -Frank Matinchek Funeral Home
2. Tombstone -Gingrich Memorials
AMOUNT
$ 3,925.00
60.00
B• Administrative Costs: '
1. Personal Representative Commissions Clyde R. Cover Jr
._
Social Security Number of Personal Representative:__ 1~4-12-30 ~
Year Commissions paid __ 1 A45 1,425.17
2. Attorney Fees Dissinger and Dissinger
1,425.17
3. Family Exemption
ClaimantClydP R Cnvar' ,JR Relationship Qnn
2,000.00
Address of Claimant at decedent's death
Street Address _3424 RPdfc~ d l~ri P
City Camp Hlll State PA Zip Code_17011
4. °robate Fees Register Of Wills
54.00
C. Miscellaneous Expenses:
~• Income Tax Preparation -Cooper Agency
37.00
TOTAL (Also enter on line 9, Recapitulotion) S $,926.34
(If more space is needed, insert additional sheets of same size)
tE-..13:1 °~. I:~e 7~ e
~`:~.~~
~•
COMMON'N a;~ TY O? P:,yN $wf,V .l Nli
IN MERIiANCE TAX RETURN
RESIDENT DECEDENT
CJIHI[ Vf
Margaret I. Cover
SCHEDULE J
BENEFICIARIES
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1• Clyde R. Cover, Jr., 3424 Bedford Drive
Camp Hill, PA 17011
2• Verna Cover, 1014 South Market Street,
Mechanicsburg, PA 17055
3• C. Robert Cover,l4(? Shenks Ferry Road,
Conestoga, PA 17516
4• Dianne Cover,I40. Shenks Ferry Road,
Conestoga, PA 17516
5• Brian Cover,140 Shenks Ferry Road,
Conestoga, PA .17516
6• Melissa Cover, 1014 South Market Street,
Mechanicsburg, PA 17055
7• Timothy Barnes, 1014 South Market Street
Mechanicsburg, PA 17055
8• Corey Barnes, 1014 S. Market Street,
Mechanicsburg, PA 17055
ITEM
NUMBER NA141E AND ADDRESS OF BENEFICIARY
B. Choritoble and Governmental Bequests:
FILE NUMBER
21-95-209
RELATION HS I 1~10UNT OR
SHARE OF ESTATE
Son 2,000.00
None 1/2 Resid.
Grandson I 1/12 Resid.
Grand-daughter 1/12 Resid.
in law ~
Great-grandson 1/12 Resid.
Granddaughter 1/12 Resid.
reat-grandson 1/12 Resid.
reat-grandson 1/12 Resid.
Ah10UNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVEP.NMENTAL BEQUESTS (Also enter on line 13, Recapitulotionj $
(If more space is needed, insert additional sheets of
same size)
+ u~
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WTZ.L
~I Margaret Cover, widow, of 1014 S. Market Street, Mechanicsburg
Pa. 17055.do~take this my last will and testament.
1. 'I give•and bequeath to my son Cede R. Cover Jr.
of ~073•~~arlisle Pike, Carlisle, Pa.. 17013 the sum-of $2,000.00. The
furniture that C. Robert Cover has of mine he keeps and
any remaining•indebtednesa from dim to me is forgiven.
I give":~to.~erna Cover all ~my ddothea and furniture
and my~ cair:
2.~.;~`~All the rest, residue and remainder o! my estate
is divided and given as follows..
a. One-half .to Verna Cover of 1014 S. Market Street,
Mechanicsburg.` .. .
b. One-fourth to~C. Rotrert Cover, Dianne Cover
his wife•..and their children, including their son Brian
Cover,''of.'RD1 "Boz 496A~ `Conestoga, Pa. 17516. I ~ appoint C; '
Robert Cover testamentary guardian (or trustee if need be) for
such child~or chi•ldx'en should I die before? he or they attain 18,
authorii~ig him to place any ghild's share in a savings account
from ~-hich income (and principal as needed for educational purposes)
may be;~applied by-him •f or the benefit of such child or children.
~• One-fourth to my grandaughter Melissa Cover ~ ~•
(divoroed) and her children Timothy Barhes abd
they being tr+ina, and I a Corey Barnes,
testameritar PPoint my son C1 de R. Crier Jr
y'guardian (or trustee~if need}. should I die before they
reaeh~l8,~~authoritiing him to place each twins share in a
savinga~account_so that he may apply the income for the benefit of
each, also,,princpal for the benefit of each.
3. •I .:nominate; constitute and appoint my son Clyde R. Cover Jr.
the executor `of~~mY~~~•~xill and estate.
and moat coinplete.powers, rights and privilegespthatiittis broadest.
the law.~of Penn ylvania for a testatrix to vest in her executoritoetheder
end that he ma~e°able to assemble, administer and distrib
my estate as economically, efficiently and expeditiousl as~e
In witness;;whereof I have hereunto affixed my handyand practicable.
seal this 7th day. of February, 1984.
• ' )y
.'.~ -
• Margaret Cover. (SEAL);
Signed, sealed, published and declared as and for her
last will~and testament by Margaret Gover, who is of
sound and disposing. mind, memory and understanding in the
presence of u$.xho at her request and in the presence of: her and
of sash other~'2i~~.e hereunto subscribed our names as witnesses.
both residing at 134 N.IInion St.
Middletown, Pa. 17057