Loading...
HomeMy WebLinkAbout95-0210d,~'95~~~~-l r 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 16 2001 Date Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 NIa.1 .l~lM. l~~ ~~~A ' ~~~~~ ~Gi ~~~~ .~ ~. p~ ,~-/~-Q 3o( CERTIFICA~ O FDEATH ~- ~ rU , C M ~ rrr ' ~ 'R F.. rae.. i.o rw[ nu w~r.aw ,. ~ John M Roveleski Male ""'~" a o+~c as ouN iw.o. o., w.. . ~ .+ » m ~ Match 20,1993. N... aworan~o..~q - .+ ..,n...u., i 92 ~ '.' •.r.. L1; ~4 on^ ~ ,y"'"0.. ^ ~. ^ a an ^ p m~w~ Orlw W Cumberland East Pennsboro Holy Spirit:Hospita~ • M.wia.. ws.i ~ro~ w.r. r ~ ~w ; r -~ , , ; ~ White w ' r~AY~~~K /..~ilwwitl~j U. Mrr .~ P.~. P~..+.~i 1. Archi c r.~7 N.^ .~~ . r..i ..., A+r+au.+n rrrw .». W+aw aocm, 1003 Charles St. ~ .ham- R'A w ,*.^.......,..,..~ y MechaMcsburg PA 17055 ~ ~ ... ,,, „ . rfrlrr ~, Loui se . Kovel k1 I w~ o.. r, ow.wn, ' wsr.0 a:.-r"-°r`D ~.u........0 Y ^ -- I Gate of e ter U r ~ wrw rrr~~ww '~ r w ~r uw wri ~~~ 2:26 A. March 20, 1993 ~ r.i~ ,,,^ .. ~ • ` W.~w.rrM~ ~r.MiAwr./M.r.-O.Mw~rYrr warrwarw+Y.rry..r. ~r ' IMIR4 OMr11~Y.o.. ~.m OYr~Mr ~~ ~r~w ~ ~~1~r~ ~r.r.Y~Ilr.w.wyArrJirrMllf~ _ ~w stive Heart Failure . ~ Y.:~r. M ra~rr . q pfA rY~py .. ~ ~~ hr~tAR ~ • p1NA pik OtRN /W01111'~ . Nrl.r ^ ~. ^ 11. ^ ~ : w~... [~ 4W~..rrlrrlr~ ^ raPMd/l rr., w.lYoh--.I~> Q`r4C~l6.n, 11~rony 7N. ' MI~~Y~.I~Ma.YrYiarrdC.~r~.d~dN~nh.PVWCtlC~M r/ ~ *MMaMw~rM~~Rrrwrw/t..rYrrgy r/.rr.rrYL ............... ~!OM!el~t~' ^ . •••••••••••••••••.•••• COhOner 7~MOC~I~~MrM~ON1IA'rar 0~ponswonydlrnMOOrYyYiyb4rdAiy, ;, w~r~.rw.wr.rwrrr.+r.w. rrNw .rwrr ORE ~gILDMvw.~M.MY1 . . .rryyrr~..rr.r.a :.........:.......:..:. ^ Ma C 22 1 93 ''~~~~ ~....wr...r .,.r.,~~,,,,,, ~ - w+w..~..w....~wr ` ..~..rw~..~,~.,~,~... •..~......~.a ...................... ~T*.~~ ~woNw~waar~t~ncuwcororwN Michael L. Nor is Coroner ~ . , .......,. .... ~ ..........:........................ ..... 405 Fa$rwayy Dr ve Mechan cabi~r Pa. 17055 ~ r., aa,ew•reee~.c~, ~tv I~LL~aiLr?~ { ... A~c ~ .?Q, /99.s q r~i~ a7R22 REV-1500 + (7-94) x . u. ~' ~'" ~ ~ INH ITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131191 CHECK HERE POVERTY CREDIT IS CLAIMED ^ ESIDENT DECEDENT Full: NuNiBER CO MONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE DEPARTMENT OF REVENUE ~ ~ 95 ~~~ D PA 601 WITH REGISTER OF WILLS ~ HARRIS RG, 28-0601 COUNTY CODE YEAR NUMBER DECE NT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ DECEDENT'S COMPLETE ADDRESS /D a3 ,E, GHAR/Es ST, _ ~ G O ~ ~~ Z SOCI L CURITY UMBER D EATH DATE OF BIRTH , g J ~ ~ C /", ~/~` I GS t v W v ~r y (~~2Z- ~ d 'Z O' c,. 3 /'~.~' Count ~ V p (IF APPIICABIEI SURVIVING SPOUSE'S NAME (LAST, RST iDDtE CIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) G a ~, ~Q- ~6-7y~ ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return Yav~ (for dates of depth prior to 12-13-82) ,'; dcY.~ ^ 4. limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required ~ ~ ° (for dates of death offer 12-12-82) cm ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) uy''W sZ ~ MPL M _.. - / /oa3 C ~R/E s 5~ v ~ LEPHONE NUMBER ~ E ~ h, ~~} ,J S ~y S lC,l ~ ab 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) ( ~n ._S(f" ~'~~ 3. Closely Held. Stock/Partnership Interest (Schedule C) (3) - 1 .~. 4. Mortgages and Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (5) - '' (Schedule E) '`' ~~ _ b. Jointly Owned Property (Schedule F) (b) ~ 7. Transfers (Schedule G) (Schedule L) (7 ) a 8. Total Gross Assets (total Lines 1-7) (8) ~~~~~ 9. Funeral Expenses, Administrative Costs, Miscellaneous ~3J~ /.~.~Jr Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) ~C~iB,~ 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests (Schedule J) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ~- 15. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicable Percentage on Reverse (15) Side. (Include values from Schedule K or Schedule M.) x. _= 16. Amount of Line 14 taxable at b% rate (16) x .Ob (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) x .15 z (Include values from Schedule K or Schedule M.) o a 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (1 g) ~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest f c 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) r- ~ ^ 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) A. Enter the interest on the balance due on Line 21A. (21A) B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (21g) Make Cheek Payable to: Register of Wills, Agent Under penalties of perjury, I decll it is true, correct and complete. I e based on all information of which re FILING lave examined This return, including accompanying schedules and statements, and to thel it all real estate has been reported at true market value. Declaration of preparer other tl has any knowledge. ~r my Knowledge and belief, le personal representative is DATE DATE 7-~ ti- ss 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% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 111/96 • 290 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 19k (.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 (/) IN THE APPROPRIATE BLOCKS. YES NO 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 considsration$ 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. REV•1503EX+ (4-86) COMMONWEALTH OF PEN INHERITANCE TAX R~ SCHEDULE B STOCKS AND BONDS (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.) ,. • REV-1511 E%+ (7-BB) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ITEM DESCRIPTION NUMBER A. Funeral Expenses: 1. ~ ~--,.-.-cP~ B. 2. 3. 4. C. 2. 3. 4. 5. 6. 7. 8. Administrative Costs: Personal Representative Commissions Social Security Number of Personal Representative: _ Year Commissions paid Attorney Fees Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Probate Fees Miscellaneous Expenses: ~~-~'i~-d--Q~ AMOUNT ~ S~~ ~s 0 ~ ~o ~ O'er /~•~ TOTAL (Also enter on line 9, Recapitulation) $ ~ M1 (If more space is needed, insert additional sheets of same size.) Zip Code Please Print or r r .. REV-1513 EX+ (Z-8~ I" COMMONWEALTH OF PENNSYLVANIA INNERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE N ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP A. Taxable Bequests: ,. ~~~ ~~~ ~ o©.~ ~° ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) (If more space is needed, insert additional sheets of same size) S AMOUNT OR SHARE OF ESTATE AMOUNT OR SHARE OF ESTATE