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HomeMy WebLinkAbout95-021321-g5-D213 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 r? • Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 "'DS''~ ~"' ~ coMMONWEALTH of PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS U 1 ~? 4 5 :~ TrrERn,NT CERTIFICATE OF DEATH _ _ . w nEnEUNENr NAAEOFDECEDEMIFRMM~wlaO smEwENUMw~ '~"~~+" Marie A. Collins ~" ~~~(~.~.~., '' >R Female ,, 19~~ 14p _ 2175 . ~ z ~aEn...e`.am uNDEn,vEAn uwrDe„o~r DaEaFEtnn, .wD.ucs~ ru«aFDE,cN MpiEb . (CMc. aNorr-+..iu.ucbnsaroMr•.M caW ~oF~ ~ "o"~' Ewowr."G DD,^ n~ ^ n.e.a.^ °'"' an DEAT+, rso.dn ^ ~/ NAME plop mlupn. D~'•e.M.nG mYn0~) OFMQMtMC ORgW4 RAf.'E-AmMblYtlrL EYrk. W,i"..M Cumberland E. Pennsboro f/ L~ J ~- }~ ~/ ~"~•~~. a0'~ u.uK IaNOaFw>elNESSnNOUSrnr /-~G S r"~ i ~.o•.bw~..b. White qq~~yy~b YMS DECEDOff EVER W lI. dwslbEOgyl~bl u.~i.C~j U.S. ARIED FlCNCES7 DECEDEIR'S EDIICRgN MAR1G{, ST,DIR•MrM" SIEMV"q SPOUSE ~YDb4 WICONq, AI •/w W.ra~nname, Housewife '"•^ "^® ~ n+«,., °~^aaw, DaceoEaraMAEWDADDNEae~.accw~.smbzpcoe., "' ' U ,.. Widow ,~ 404 Wren Court ,7•.8,.b Pennsy van a ob ,n,^M..e.o.e.•awb Mechanicsburg, Pa 17055 ~` ~" ~~• ,,,_ Cumberland F"b.w~N.1 ~.....",.,, wcNEN•s NAME(Fi,I.Mm.,~ ,». •Mti.rar~elb P ; - Wilbert D. Bomgardner MO"'E'"E"""E"""`0°'~ ~"^'^" WPar.,ANrsw,M~EOw•'~a Helen F. Sweger Gloria J. Shaud "'"`"1O~. ~~~ .~D,DDaP 4v Altoona Ave. , Enola, Pa 17025 a."r1Z c~.trb.^ w..v.rb,.sbb^ DoEE ~o ~'a" ~~°Earoer"°"."'^"e...b/r.a.m+dr ~oc~.s(rwzoae. ~ ^ pb`~'" ^„~ Feb 23, 1995 ollin Green Mem par ~ wt~nDE .a~,,,~,~,,,,~,~, r~ g a Camp Hill, Pa C wu~Ewo.DOnESaaF,v~cE,rv F. D. 011897-Z „~ Sullivan F.H. ,51 N. Enola Dr.,Enola,pa ~ w~rr~r "i~ib alb fib "b ~~~••O~Maoon.ar"r Ninw O.brW Nb+wba. LICENSE MM,BER DRE91ipED arW,owbelA,y~ P,onln. D.tt>rr, i~mtrwer.,bbee, aPDE.vN •~.o~otbbw.a..w °iQE~~°r~.DncNO1 ~susEnECEnnEDroMEOICALE,fAMWEq~Ogp„Eq, z,. SSG w. ~E J ~ ~~ ~'^ N°~ 77. /MRfk EnM,MAwwt,MWb.ammpf~Mbr.liN Crr70rW."1. DO not.llbr"N nnO. WC,Y1y, L141r W witl'an.err.n..GM. a +n.r..InGta MMI bYU... ~A ~D P11N-In CUW Y~YIkrMmNYarmwlyUpb Ar"4 UYI lJl ~•vW+Cnambn~i---. ,j ian..~ure.."~ i°""~byinM"u~lrlyYwer..ol..•brMrtr(. ~Ia Ja r 1 p~ 1 DueropaASA auENCE /17~~Ya' 7P ~ ~.I..E.,., ~ DuEropnASA NcEarx ( /~ c~, c ry "~~0~ ~ ~ ~7J~u CALMEIaw~a.VY C~ ~~~~ ~ DUE7DIDRASACONSEOUENCEOFk ( MNEAN AUIOpgy PEnronMEm iMLLMlEP111p170 MANNEnDFDE.aN DATEOPwx,nv TIME OPW.tum coMPiET,DNascAUSE IMOMI MY.>W) wpwr RY1[)RI(9 oESCwsE IIOWINJ11RVaccUw,E0. ~~ aPDE.vNr NYVY 1~/ Nunkid. ^ ~. ^ No~ n. ^ No ^ s.wie. ^ Doda~ue.ax«m:~.a ^ PI ACE OFWIUAY• M' a~a..b rs~rN nom.. ~, ea..r. r.cN„ I onin LOGOICN ~se.r. ~+ww•.~. Smtp ~' ~cn.ao.~r..e, sa. ~T~~EMIOdPMyflpAN lPtq+c.+a"uMyMq c•w.dtlW~.fis.angnr - S"iNRIXiE ANDTIT~E (~p7~p •7 bb•b""•, a..lp o.ewnOAwbIM onv.a.nnr P~w.c.a wam aMCanpNNy nmr.231 Sv( F ' erM.fN •M bwr.r wbi ................ ~Q .................................... Z ~, '~ ~~ DATE SIGNED (Mm1.. D.y, `dbr, nw.srerwb+.b~NOa..ae^^o~w.aa"jP"be'~"..,e.°qAe..,.avr.a..wa:bw.~o.wybnC°°••aa..wtw... ucENSENUMao L~ ~ L AND ADDNESS OF PENSON W11pC /' ~ (Dem 271 TYW ar Prim /1~~~ Ow rn e.w ef.><rnYt.u•w.narw Inr.gq.,bD, in TY •WMon, d..u oeeume n ub Wn., an., .na pbo., .na tlu.,o Db e.u ! ~K30 f' ........................................................... ....... REOt '9 sicN.vunE AND NU~ ~ 73. N1 /~G/ 1 ^ _ ~~ D.QE FlLED (MmN. p9y, ~( ~ ~ J, REV-1500 EX• 17.9a) ~~ ~ ~ O '- ^ v ~ ©s. ~~ ~~N~ INHERITANCE TAX RETURN -REST ENT DECEDENT COMMONWEALTH OF PENNSYt ANIA CTQ FILED IN DUPLICATE DEPARTMENT Of REVENUE -~ MARRISBUERG, Pa iiize-oaot H REGISTER OF WILLS) CULLiNS MARIE A. o SOCIAL SECURITY NUMBER DATE Of DEATH 196-14-2175 2/21/95 W G OF •~RIC~~IEI SuRwwNG S/OUSE'S N~,aE IuST, rIRST •ND MIDDLE iNlTi~ll W Y ~ iC l~„a.w =oo yam a N ~ W = ~o oz w°a z 0 -- J ~- a U s z 0 a 0 x [~ 1. Original Return ^ 4. Limited Estate ® 6. Decedent Died Testate (Attach copy of Will) ALL CORRESPONDENCE AND CONFI NAME F~TEmd G. Myers, ^ 2. Supplemental Return ^ 40. Futu Interest Compromise r dotes of death aher 12-12.82) ^ Decedent Maintained a Living Trust (Attach copy of Trust) FOR DATES Of DEATH AFTER 12131 /ql CH K EF IF A SPOUSAL POVERTY CREDIT IS CLAIMED ^ FILE NUMBER 21 95 0213 :OUNTY CODE YEAR NUMBS 404 Wren Court MecYianicsbtsg, PA 17055 , Ii~JC INFORMATION SHOULD BE ^ 3. Remainder Return (for dares of death prior to 12-13.8 ^ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxe TO: Johnson; ~~i~>~ie, Stewart & Weidner 301 Market St., P. O. Box 109 717 761-4540 Lslloyne, PA 17043--nin4 , 1. Real Estate (Schedule A) (~ ) 2. Stocks and Bonds (Schedule B) (2 ) 3. Closely Held Stock/Partnership Interest (Schedule C) (3 ) 4. Mortgages and Notes Receivable (Schedule D) (4 ) 5. Cash, Bonk Deposits 81 Miscellaneous Personal Property (Schedule E) (5) ___ 43.669 _ 4$ b. Jointly Owned Property (Schedule F) (b ) 7. Transfers (Schedule G) (Schedule L) (7 ) 8. Toto- Gross Assets (total lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) (9) - 5, fl9f; 51 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 300.81 1 1. Total Deductions (total Lines 9 ~ 10) 12. Net Value of Eztate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) 15 S l T . pousa ransfers (for dotes of death after b-30.94) See Instructions for A plicoble Percents a on R Side. (Include values from Schedule K o9 Schedule Me) (15) x • -_ -Q- 16. Amount of line 14 taxable at 69b rate (16) (Include values from Schedule K or Schedule M.) x .Ob . -~- 17. Amount of Line 14 taxable at 15% rate (17) 38 _ _70 7 Fi (Include valves from Schedule K or S h d I x .15 = _ 5,740.52 1. If Line 18 is greater than Line 19, enter the difference on•Line 21. This is the TAX DUE A. Enter the interest on the balance due on Line 21 A. B. Entsr the total of Line 21 and 21A on line 21B. This is the BALANCE DUE. Make Check Payable to: Register of Wills, Agent ~ BE SURE T c e u e M.) 18. Principal tax dus (Add tax from tines 15, 16 and 17.) 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + _5.000_00 + 263_15 !0. If Line 19 is greater than line ] 8, enter the difference on Line 20. This is the OVERPAYMENT. O ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~ Under penalties of perjury; I declare that I hove examined this return, including occempanYing schedules and statements, and to the best of my knowledge and belie .t is true, corretl and conTplete: I declare that all real estate has been reported at true market value. Declaration of preporer other than the aersonel ~.~.....,,...;.,. Dosed on all information of which preporer has any knowledge. ""N~jyRE OF PER N RE~PQNSIBLE ppR FILyrG RETURN AODRE55 ~'t'"Ls.W ~ 40 Altoona Avenue R RE. ADDRESS 301 Market St. , P. O. Box 109 L~ PA 17043-0109 Edmund G. Myers, Esq. J., (B) 43,669.48 (t l) 5,399.32 (12) __ 38.270 16 (13) -0- (141 38, 270.16 (1 s) 5.740 52 (19) 5,263.15 (20) (2 t) 477.37 (21 A) _ -0- (21 B) __ 477 7 DATE ~/- %o ys' 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: e 3% (.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 e 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 i. Did decedent make a transfer and: a. retain the use or income of the property transferred, ....................................................... R b. retain the right to designate who shall use the property transferred or its income, ............... X c. retain a reversionary interest; or ................................................................................... X ....................................... d. receive the promise for life of either payments, benefits or care$ X 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 X adequate consideration$ ................................................................................................... 3. Did decedent own an 'in trust for'. bank account at his 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. ~• } •~¢ ~" LAST WILL AND TESTAMENT OF MARIE A. COLI,INS I, MARIE A. COLLINS, of the Township of Hampden, County of 'umberland, and State of Pennsylvania, being in good bodily health nd of sound and disposing mind and memory, and not acting under uress, menace, fraud, or undue influence of any person whomsoever, Merely calling to mind the frailty of human life, and being desirous f disposing of my worldly goods while I have the strength and apacity so to do, I do make, publish and declare this my LAST WILL ND TESTAMENT. I hereby revoke, cancel and annul all my former Will nd Testaments, including codicils thereto, by me at any time made, nd declare this alone to be my LAST WILL AND TESTAMENT. AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH IN HIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ: ITEM 1. I direct that my Executors hereinafter named pay and ischarge all of my just debts, funeral and testamentary expenses. ITEM 2. I order and direct that I be buried in a lot which I wn situate at the Rolling Green Cemetery, Camp Hill, Pennsylvania. lso order and direct that Sullivan Funeral Home of Enola, ennsylvania arrange my burial, as this service is pre-paid. ITEM 3. It is my intention to die naturally, without the ssistance of machines. D 3 w ~ C.~ '~ ~ o ~ ~ ITEM 4. All the rest, residue and remainder of my entire D m ~ o rn state, resoever situate an ever it may consist of, I give, ' `8~v' v i o ~ vise, and bequeath, absolutely and in f e to my dearly beloved m Z z x m ister, GLORIA J. SHAUD, per stirpes. F o y ~ / S ~ o i n f ~ ~ ~J RIE A. COLLINS 1 ITEM 5. I hereby nominate and appoint GLORIA J. SHAUD, as Executrix of this~my Last Will and should the Executrix named fail to qualify or cease to act as Executrix, then I appoint ROBERT SHAUD, as Executor in her stead. ITEM 6. I direct that my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 7. I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for tax purposes, whether or not such property passesunder this Last Will, shall be paid by my Executor out of my residuary estate. ITEM 8. I grant to my personal representatives herein named, in addition to, but not in limitation of those powers vested by law, to be exercised without prior application to or approval of any court, the power and authority to retain indefinitely any property, to invest and reinvest any assets or the proceeds derived from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, transfer and encumber any property, to pay, settle or compromise all claims, to make distribution or divisions in cash or in kind, and in general to exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his own right, and to execute and deliver any and all instruments and to do all acts which may be deemed necessary and proper. .. ~.~ s' ~ MARIE A. COLLINS ------------------------------- --END----------------- COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) ss I, Marie A. Collins `••,TESTATRIX, whose name is signed to the attached or foregoing instrument, having 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 purpose therein expressed. Sworn or affirmed to and acknowledged before me, by Marie A. Collins the TESTATRIX, this 12' ' day of December 19~, NOTARY ppg~ X•'tG~-1~ Mechanicsburg, PA My Commission Expires: The preceding•instrument consisting of this and two (2) other typewritten pages, identified by the signature of the TESTATRIX, was on the date thereof signed, published and declared by Marie A. Collins , the TESTATRIX therein named as and for er LA WIL AND TESTAMENT. j BARBARA A. GLLSSNEI2 Residing at 352 S. Sportin Hill Road Mechanicsbur PA 17055 Residing at 352 S. Sportin Bill Road Mechanicsbur PA 17055 A F F I D A V I T COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) ss We JAMES M. BACH and BARBARA A. GLESSNE~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw TESTATRIX sign and execute the instrument as her LAST WILL; that she signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the TESTATRIX signed the WILL as witnesses; and that to the best of our knowledge the TESTATRIX was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by JAMES M. BACH and BARBARA A. GLESSNER witnesses, this _j•Z ddy of-Dp~pmher 19~. N TARY P BL -' Mechanicsburg, pA My Commission Expires: JAMES M. BACH •, 3 r s aEKisa cx, iz.an SCHEDULE E CASH, BANK DEPOSITS AND ~i7M Of -ENNSnVANIA MISCELLANEOUS ENT DKED -~++r~' PERSONAL PROPERTY Please Print or FILE NUMBER COLLINS, MARIE A. 21-95-0213 (All prop~rfy jointly-owned wkh tlw Rip6t of Survivonhip must b. disclosed on Sch~dul~ F) ITEM NUMBER DESCRIPtION VALUE AT DATE OF DEATH 1. 1974 Mobile Home - DeRose Size: 24 x 44 - Serial No. C17160 Located in the Hampden Village Rental Park 404 Wren Court, Mechanicsburg, PA Appraised Value 2. Household Goods located in Mobile Home Appraised Value 3. 1989 Pontiac Sedan 6000 LE - appraised value 4. Mellon Bank - Checking Account No. 162-106-3377 Date of death balance 5. Mellon Bank - Certificate of Deposit No. 14-A29594C Date of death balance, plus accrued interest 6. Mellon Bank - Certificate of Deposit No. 14-A61605-C Date of death balance, plus accrued interest 7• I Mellon Bank - Certificate of Deposit No. 140-081886-C Date of death balance, plus accrued interest TOTAL (Also enter on line 5 IAteoeh additions! 8K' x 11' :~K if mon spoe~ is e«d~d.) 10,900.00 2,900.00 3,00 .00 903.07 6,447.32 14,447.32 5,071.77 S 43,669.48 of V~1511 EXr p-eel ~..,~ SCHEDULE H ` FUNERAL EXPENSES, COMMONWEALTH Of ENNSYtvANIA ADMINISTRATIVE COSTS AND INHERITANCE TAx RETURN MISCELLANEOUS EXPENSES RESIDENT DECEDENT ESTATE OF Please Print or Type COLLINS, MARIE A. FILE NUMBER 21-95-0213 ITEM - NUMBER DESCRIPTION AMOUNT A• Funeral Expenses: 1. B. 2 3 4. C 1. 2. 3. 4. 5. 6. 7. 8. Administrative Costs: Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid Attorney Fees -Johnson, Duffie, Stewart & Weidner Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code Probate Fees -Register of Wills - Ctanberland County Register of Wills - Short Certificate Miscellaneous Expense:: Cumberland Law Journal - advertise letters The Patriot-News Co. - advertise letters Chuck Bricker - Appraisal - contents of mobile home Barbara A. Martin - Mobile Hone Appraisal Register of Wills - file Inventory & Inheritance Tax Return A9~Y Energy Products - oil delivery State Farm - Mobile Home insurance Reserve for close-out costs Sub-Zbtal fran Additional Sheet TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of some size.) 1,800.00 64.00 3.00 40.00 59.08 60.00 125.00 25.00 119.59 71.50 25. 2,7 .34 ,098.51 SQ~DULE H MISCELL~p~~ USES ESTATE OF: QOI.LIlVS, MARIE A. 21-95-0213 C. Miscellaneous Expenses, Continued: 9. Pennsylvania Power & Light - electric service 10. K. Fetrow, tax collector - School district real 297.94 estate taxes - 11. RVG Management & Develo 248.40 p'nent - Lot Rent - Hampden Village Mobile Home Park 2,160.00 Sub-Total $ 2,706.34 RE v.1317 E%~ (1.0]I COMMONWEALtM M ~ENNSYlVAN14 INMERRAN[[ ;A% tFTURN RESIDENT DECEDENT CfTAT! A~ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COLLINS, MARIE A. Please Print or FItE NUMBER 21-AS_n~~~ ITEM NUMBER DESCRIPTION I AMOUNT ~• Snoke Family Practice - decedent's account balance - 2• EKG Associates -decedent's account balance 44.65 3• ~ A. Z. Ritzman Associates -decedent' 2.25 4 s account balance 31.96 • I West Shore Pathology -decedent's account balance 5. Inners-Davis Associates -decedent's account balance 22.00 119.25 6. Holy Spirit Hospital -decedent's account balance 28.19 ~• Sammons Communications -decedent's account -final cable charges . g, Bell Atlantic -decedent's account -final telephone service charges 8.12 44.39 TOTAL (Also enter on line 10, Recapitulotion) $ 30U 81 (If more spoee n needed, Enserf oddrhonof sheers of some size.) COMMONWE~.IiN OF GFNNSV~VANIA INNElnANCE iAx RETURN RESIDEM DECEDENT C~IAIt VF COLLINS, MARIE A. - --- ITEM NUMBER ~ NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: 1. Gloria J. Shaud 40 Altoona Avenue Enola, PA 17025 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Choritoble ~ond Governmental Bequests: 1. SCHEDULE J BENEFICIARIES FILE NUMBER 21-95-0213 RELATIONSHIP AMOUNT OR i SHARE OF ESTATE Sister Residue AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recopitulation) S (If more space is needed, insert additional sheets of some size)