HomeMy WebLinkAbout95-0226~I-g5~naac~
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 200T ? ~ •
Date Fran eropoli, ' act
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
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COMMONWEAL7M OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VtTAI RECORDS _
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y REV-1500 EX+ (7-94) ~
COMMDEPARTMENT OFFPREVENUEANIA
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE~N,TIAL)
S~ der, Grdr [....
DATE OF DEATH
SOCIAL SECURITY NUMBER y I! b I~5
i~7 - ~F~• 96 20 ..7
FIRST AND MIDDLE INITIAL)
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50~24~~..1t~-,
INHERITAENTEDECEDENT RN
RESID
(TO H REGISTER OPPW~ LS)
WIT _
~r/rb/65
DATES OF DEATH AFTER 1 Zf31191 CHECK HERE
°A sPOUSAL
_ s*.r ~ot?DIT Is CLAIMED ^
FILE NU tMBER ~ ~ ~ ~ ~(~
` YEAR NUMBER
'EDENT'S COMPLETE nuunw..
223 iN. /Ylaryte pA ~~aSS
m~~ria~t~.~bu~y,
.._.., Cum be r ~c+. n ~_..__,,..,~,
IIF AFFLICABIEI SURVIVING SPOUSE'S NAME ILAST, ~~
N ~ ~ 2. Supplemental Return
1. Original Return
~] 4a. future Interest Compromise
4. Limited Estate (for dates of death after 12-12-82)
7. Decedent Mainf Tned)a Living Trust
/v
3. Remainder Return
(for dates of death prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
6. Decedent Died Testate (Attach copy o ru ~' > > ~~ ; -
(Attach copy of WIII) - -'
.,_ ~ '~ ~ C MPLETE MAILiN DDR-~S~ Y 6 1G ~~'
IJAME -~ ~ . ~n , P~A i ~DSs
J~'~.' der t+j9 g~~ ari acs b ~ ~~
,, 7.,,1._~~~ , 27 ~ S
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(8) ~2~6 ~
(12,s3~r•aa
(13) ~
G x. _ _
15. Spousal Transfers (forppdates of death aher 6-30-94)
S'Ide.n(Include valuesAfrolm SclheduleeKto9 S hedule M) (15) O x .06 =
(le-
16. Amount of Line 14 taxable at 6% rate 0 x 15
(Include values from Schedule K or Schedule M.) (17)
15% ate
1. Reol Estate (Schedule A)
(2 )
(1) `~/
2. Stocks and Bonds (Schedule B)
klPartnership Interest (Schedule C)
S d
i ~ j 6
toc
3. Closely Held
4. Mortgages and Notes Receivable (Schedule D)
t f'd $5
(5)
y
posits B Miscellaneous Personal Proper
5
C
E
.
~
(Schedule D
(6)
6. Jointly Owned Property (Schedule F) (71
7. Transfers (Schedule G) (Schedule L) .
8. Total Gross Assets (total Lines 1-7)
Miscellaneous
Costs
i ( ) ~ "J gQ
9
,
ve
9. Funeral Expenses, Administrat
(Schedule H) b '~
Expenses
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 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)
17. Amount of Line 14 taxable at r
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.) Discount Interest
19. Credits Spousal Poverty Credit Prior Payments
20 If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
21 If L~ine~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 21A.
B. Enter the total of Line 21 and 21A on line 218. This is the BALANCE DUE.
Agent
Make Check Payable to: Register of Wills,
~M
Under penalties of perjury, Y declare chat I have examined t
it is true, correct and complete. I declare that all real estate
based on all information of which p~eP°r DFn RN ny kn DID
return, mawln .. ~-••
s been reports at true
2 2 3 UI. /yJarSle ~'¢
~alst iCS~hu
(18)
O
6
D
(19) v
(20) O
(21) P1
(21 A) O
(21 B) O
statements, and to the best of my knowledge an•_
ion of preparer other than the personal represen'
/fir DATE /~
~` ' ~ ydSS~ DATE ~~ `7
Act #48 of 1994 provides for the reduction of the tax rotes i
the use of the spouse. The rates as prescribed by the statut
mposed on the net value of transfers to or for
• 3°~ (•03) will be a e will be:
pplieable for estates of decedents dying on or after 7/1/94
and before 1/1/96
• Z°~ (.02) will be applicable for estates of decedents dyin on
g or after 1/1/96 and before 1/1/97
• 1°y0 (•01) will be applicable for estates of decedents dyin on or
g 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 ~,~ j IN THE APPROpR
IATE BLOCKS.
1. Did decedent make a transfer and:
a. retain the use or income of the ro ert transferred
p P Y
b. retain the right to designate who shall use the property transferred or its i
c. retain ncome, ,,,,,,,,,,,,,,
d. recei a reversionary interest; or ..................................................................................,
ve the promise for life of either
payments, benefits or care$ ................
2. If death occurred on or before December 12 1982, did decedent within t
death transfer property without receiving adequate conaiderotion$ If dea
December 12, 1982, did decedent transfer property within one ear WO Years preceding
adequate conaideration$ ............... th occurred after
............................... Y of death without receiving
.................................
3. Did decedent own an 'in trust for'. bank account at his or her death$...........
...........................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIO
YOU MUST COMPLETE SCHEDULE G AND FILE IT A NS IS YES,
S PART OF THE RETURN.
`~ ~ ~
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,Y REV•1503 EX+ 4 86
1 • )
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS AND BONDS
C°rARy ~~ ~,uyDE~'
FILE
(All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.)
I~r more space ~s neeaetl, msen atltlihonal sheets of same size.)
REV. i30B Ek+ t2~B71
~,~ SCHEDULE E
' CASH, BANK DEPOSITS AND
COMMONWEALTH OF VENNSYLVANIA MISCELLANEOUS
1N RESIDENTEDECEDENiRN PERSONAL PROPERTY
ESTATE OF Please Print or Type
Gg~Y ~, ~ FILE NUMBER
~'~ D ~ ~.
(All property jointly owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
/. Cry 5 ~i
1 o~ / r
~. GGi~Gd2in~ ~Ccov~T ~~~~
~^, ~~sc . ~Je/SO~a.:~ ~ ro/Jer~y C~ID~i/Ic~ ~ ~vo~ls P~c~ ZOD
TOTAL (Also enter on line 5, Recapitulotion) $ /d ~~
(Attach odditional 8h" x 11" theets it more space is needed.)
r REV-1511 EX+ (7-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~~RY ~. ~iuYb~le.
Please Print or T
ITEM
NUMBER DESCRIPTION
A• Funeral Expenses:
I' /~emainS i'emaiJal, a/sma>t~o,,~ vvn /accff Htey~ovy book cards
Food ~i'' /undo ~//ew~n9 !h'emov.a/ ~er/~ce
Flow c,rs
(YrQ./e rnar~r
~ea {~i certi ~i•cwTe,f
B• Administrative Costs:
~• Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2• Attorney Fees
3• Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City
state zip code
4• Probate Fees
C• Miscellaneous Expenses:
1
2.
3.
4.
5.
6.
7.
8.
(If more apace is needed, insert additional sheets of same size.)
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
AMOUNT
I / ~~" ~'
r~~°
z~
~2C~"
/0"
TOTAL (Also enter on line 9, Recapifulation) $ /
y~0