The URL can be used to link to this page

Home My WebLink About95-0230.. - ~ i -~~-0,30 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 182001 i ? . Date Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 N,os.,a Rw. ,ra, TYPE/MIn1T IN rEarANENT eT.Aac r„c ~~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (Coroner) 121,.89 r~~~y~ c •~n p~ smETxe NUImIER NAME OF DECEDENT TF•m. MIESe. Lem) 1aV1711J ~Wlfl•L CraAIC ~ 90dK SECURT'NUYBER DRE OF DFANIMon~. Daµ Mqr) '- ~-e ~. 207-46-6089 .. 12/16/94 ADE{LamB;Ed•„ uNDER,vEAR R,DM TaREQRT,wrN enT7NPLACe~t^w`y~am~ rLACEasoEaN Mrlr D•r• Noun M4Mee (MaM,aaµ,e.r) SlwaFa.gn`^'~^") K7:rA aayon•-wieb:a:eonfan an«stl•) NosPrTU: 33 vn. MAY 1,1961 GREENSBURG, PA ea.u.m ^ ERrowo.n.a ^ Da ^ ~ ^ R..idmK. ^ h(~ ~ ,L ~. Y`L cauNrraPDERTT cmooRO,rnPDFDERN FACILRVNAMEm:a:uenAw..pwmweronume•r) ~wBDECEDENTDFNTSR~wTCOwDB„ RACE-amrwnmar,.era~.wtir.. «c. a. F3-anlrl i n ~ ~ ~• - ~ u~ r~'w1~AkM awe, ISwoM WHITE __ ~ ,.. DECEDENT'S BUAL ryK~NI~D~OR.~B.~U~SI~IiESSTip,i~p~UB{Ry Wig pECEDEM EVERW DECEDENT'S EDIMXIDN WMDILSyQUg-Mrrra $Up~NMq 5pU9E (C+N•liitla ~ ) `++w+L11RT FiDI'1 U.S.ARMEDT ~st Nww wrra WlmwO. ~+rfc~f m•+.. P~acnui.CW.n~,name) ' ' N•^ 110 '~T (1-t~a5+) dwrwE~eol„ l,[IGRYL F~.77GR ciyrro•nser.zgcoa) DECEae+rs n.ar. PENNSYLVANIA ' , 34 HAMILTC)N ROAD w~REtcE ote „~Cw,,,,«,,,,,~,e,;, SO.MIDDLEIC)N - ~~ BOILING SPRINGS,PA 17007 ~••` m"""a.~" C-~.t+'+'~berl0.v~d "~,~7 Ne,e,e,~,~~ ,"D ,n. na.^ mnraaewTrm.•, PRIER'S NAME ~+m. Midse. LaeS Y07NEA5 NMIETFiaL T/id W. M•dsn surM:y , ,a MIFORMANTB NAME Rmw~V MIWFMANT'SAMRniO ADDRE93R4a•,L Ciylbwl, 9rr.7~Cwy CHERYL F. CERK FE MEn,oooRDlsPQeTTIDN PIACE DTSrosIrlDN-Nrwac.ar,, LocvIQN- S,r. apCade ~ ~ Ta.m.xen ^ Renpve,nm SM•^ 0•µm 01MrPrw ^ ourlon t ^ DECEhi6ER 19,1994 GREENSBURG CATHOLIC CEM. GREENSBURG, PA 15601 ~ ~ ~ ~~ ~~~~~~ NUYFER I'MMEANDADDRESS OF MCMY ~ , - ~. Mdr FaITrY HDIm, MTe. 518 S1rNOn St, 6-erubTrp, PA 15801 emll•,a.e•a, w era aq raeedp,~ A••W aonnw•1 a.,rl. a•randOMe•arlM , . rrwrerenm.aa.re,e a„d,n., UCENSENUMTER D,vEyaNED w•e.aOeelR (~. pay,.yS ,w. _ .o~~~v,T >as. ,ee. 'm1DQ1~d°~"ciiditli~ aDOilt 6:05 a. D~~A~Pn~.^.r.~`•n ,wBGSE ,QaEDICALEIfAMINERICORONERp w•~ No^ M. ~ 7n. M11-1: EtirlM i•a•••. Myur•olomnpEUtlon•WYCeuueA Db Awe. DO na aMrllw moMasjNq,mrl~Yadrea r•yNMOry •nr.NaeaM•n iMur•. T,eTOa, pM CYIM M•wlell•. ` ~ MATE OIIMImO1MCY110WIdrM b ~ ~ R b MMVm em pWey N•or PART 1 . M®MTECAIRE(RW ~awleM drN na npmkprlM n~dRµp er•oroondSOn- Illa.$S1VIe heaT:l 171~Ur1T?S in deals)-- DUE 1D QDR AS A CONSEQUENCE OFT Ym oanaMMr D i n~~UIOB~YNO DUE IO (ORASACONSEOUENCE OFT ~ ,:MNE(Drer•or inFaY e ~ iillal10MY DUE,O (OR AS ACONSEOUENCE OFT. rdsenp uSi i AN AUTOPSY WEIEAUIOPSY FlPbNiOS MANNER OF DERV ORE OF MiA1RY Tn1FL O~FITUURµ NUURVR WORN7 DESCMBE lIOW MIURVOCCURiED. POIFOMIED7 AYYLASlF P1110R1O Qaoaa, Daµ lbm) a OF GUSE lt a.JlJl OF OEiOH4 N•er•I ^ NonYeld• ^ auLJll ri• ^ No ~ ~l~ Car L11~y't WaS iLlt 12/16/94 X6:05 a -~ f,~T r~ , }~, a }~~ Y•• ^ No~ N• ^ ,r ^ AodMa LS Wn4q ^ „ SucM• ^ - Court na M tlmwmYrd ^ e ~ INAIRV -N 4•nw, rnn, mneU l•c,orµ oMu LOCRIOH (S•peL CiY/Uwn. Srr) Id m0°`~'' a Ile. "• ~•. ~9~Y ,997 1 mi.E.of Greenvillage ,:urwlu„cn.a:a„y,ny ',xRT.rrwT+,rsleMRm+~«n,r:w~m,•eaa.aE wbnemew Mre~lre nonovc•e demo s,d ~° ~ r t T ` P ~ d " e r rore~rTOwmT•+w.a.weave..wewbe»wrN•Irr.~r...rerra ................ .p~ . .~: .~. ,~..................... ^ » COrOIS2r •PRDNOUNeeS,o ANDCmnP,~NOT+NraTaANTPnr:r oon ravd•r,.ea rtrnr,:gaow.ad•.n ~~ lMO^~. D•r.wM tb nw e.e«nl'rwwra0•. deM~oeemMMth•IrM,bY.Mdry•e•.rWa•.bIM•••••f•1•ba.nr)rrwrd .......................... ^ ~, au 2/17/94 '~~~ D~2~ ADDRESS OFPERSON WNOCOMPLETED CAUSE OF DERN oRnl.e.ww.,.mM.uam.md~«x~waro.ebm.u.n,rapxr•n.erTr«o«.wen.m».am..ww.~..eaua.Tpn»uwy:/~Ra Kenneth L. .?ei~fer Jr. , Coroner ..M..,..aaa ............................................................................... a,. ~31 Peruia Ave C'ha¢rhersb P 1 , . . , urg, a. , 7201 REOISRRAR'S SIQNRURE AND NUMBER _ /~ _ ~ DRE FlLED (MOriIU. Deµ 1gx) - ~ 5L~ _ H. ~ ~ ~` ~'~ `i_ v PETITION FOR GRAtNT OF LET~"ERS QF AD11vIINISTRATION Estate of "- k also known as Deceased. Social Security No. ~"{ _ y 4- Co $ g No. - .5..... c~~.~ To: Register of Wills for the County of ~0.~d in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18~~years of age or older, appl i e_S for letters of ,administration (d.b.n.; pendente liter durante absentia; durante minoritate) On the estate Of the above decedent. Decendent was. domiciled at death in _ w^a k~ ~ ~ h Count ,Pennsylvania with ~_ last family or principal residence at ~ ~, r `~~ S ! (-~ i (list street, number and municipality) ptJ,-~ h m , dd 1 e ~a r Decendent, then -3 -3 years of age, died _ ~ ' ~ , 19_, T"J C` at Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property $ ~^~ (If not domiciled in Pa.) Personal property iit Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value_of real-estate in Pennsylvania $ ~ situated as follows: 1~1/ ~ - ~ ~ - - - Petitioner after a proper search ham ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: ~ l ~ ~~ ~v ~~.~ ~v .-. ~'i _ C ~ of ' H a _. ~~ o a THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to th.e .undersigned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ss Recor~{-~~=-~'~~~ ~ `~_ ~~ COUNTY OF CUMBERLAND J '95 h1AR 21 P 3 :02 The petitioner(s) above-named swear(s) or affirm(s) .that the statements in the foregoing petition are true and correct to the best Cl~~ r, --` ' ~ ~. - :-uft of the knowledge and belief of petitioner(s) and that as personal CUrrlber~~.r:i~ `~'~'' PA representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed a~d subscribed ~-'-~1~-5~ ~:.Q~~~ ... before me this al s day f ._„ (~.., MA C. L W S Register .~~:hW,,', ••si~'~,;r: -.,,- x_. ~., ~. .. ~~,,tg 4 `w''j..:~`i... ... ,~~~ ;,s ~.;.ri' ~ 3 199' NO. ILi - 95 - 230 s :,~. Estate 4f THOMAS E .{ CERK Ulri'}' '~ ~=i'fi ~ ~~` ~~~~`','=~^Ji1r'_ -~- ~..,~ ~ ~ ~ ~ ~ 9 ~i~iri~t C:fii~ce GRANT OF LETTERS OF ADMIN~STRA~ION AND NOW MARCH 2 2 , 19 9 5 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that CHERYL F CERK is/are entitled to Cotters of Administration, and in accord with such finding, Letters of Administration are hereby granted to _, CHERYL F CERK in the estate of THOMA~F CER r t / ReBitter of ills MARY C. LEWIS FEES Letters of Administration ..... $ 1~ Short Certaficates(~) .......... $ 3.00 ATTORNEY (Sup. Ct. LD. NoJ Renunciation ................ $~- JCP $ 5_nn TOTAL $ 26.00 ADARE$S Filed ......MARCH , 22.,..... A.D. 19 95 PHON$ Mailed letters and order to Administratrix on 3-22-95. -~ ~ _ REV-1500 ~ ~~r~ca=lu~EOr+l.v _. - ~--- COMMONWEALTH PENNSYLVANIA INHERITANCETAX RETURN Fpf11tlMBER~ - --~-~- DEPARTMENT OF REVENUE ~~ ~ P~°; RESIDENT DECEDENT ~ ~ ~ 5 ~~ ~ HARRS z DECEDENP$ NAME (LAST, FlRST, AND MI ..INmAI) usa a blank block b separate wards z W C e r k Teti a w.;a ~, ~ __ , 0 SOCULL SECURtiY NUMBER <" DATE OF DEATH DATE OF BIRTH ~ ,~o7-- Cv-Co. 8 ~ ~ a~ ~ ~~ ~ ~ ~ ~ o Slo ~ / ~ ~ ~ ~ W ~ pF APPLICABLE) SURVMNG SPOUSE'S (LAST, FlRST, AND MIDDLE aenAy SOGAL rrr NUMBER Ce1/"1~C CJ-'lE I ~ THIS RETURN MUST BE FILED IN DUPLICATE WrrH THE . . I l~ ~O -5;~- y l (~ p REGISTER OF WILLS ~ 1.OriginalRetum ^ 2. SupplementalRetum ^ 3. RemainderRetum(dreadeatl,prbrbt2-t3~82) m a ~ ^ 4. Limited Estate ^ 4a. Future Ingest Compromise (dace aeealh alax ~za2-a2) ^ 5. Federal Estate Tax Retum Required ~ d m ^ 6. Decedent Died Testate (Adach copy swag ^ 7. Decedent Maintained a LNing Trust (Attach copy arose) ~ _ 8. Total Number of Safe Deposit Boxes a ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (era aaam besveen t2Jt-Bt and ~-~-8~ ^ 1 t. Election t0 tax under Sec. 9113(A) (Adaeh 5ah of ~ THIS~SECTIOI+fMUSTBECOMPT_ETED; ALL CORRESPONDE;MCElkND CCNEiDEI~fTiACTAX IN~ORItiWTI!ON SHOULD $E DIRECTED T0: NPME COMPLETE MAILING ADDRESS ~ V ~ . H u, FIRM NAME (H ) ~~ (`~ `~ r ~~ ~ (~ ~ '1 ~,J w d' 0 TELEPHONE NUMBER ~ V ai.'r 1. Real Estate (Schedule A) (1) } ~ . . ' ` ~ . _ ` ' 2. Stocks and Bonds (Schedule B) (2) ~ ~ G. 3. Closely Held Corporation,Partnership orSole-Proprietorship (3) } ~ . _ - ~ 4. Mortgages & Notes Receivable (Schedule D) (4) ~ ~ d _ _. 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) S h d l E Q O ( c e u e ) , , ' 6. Jointly Owned Property (Schedule F) (6) ~ } ~ . 7. Inter-VNos Transfers & Miscellaneous Non-Probate Property (7) S h d l G L d ~ ( c e u e or ) , , d 8. Total Gross Assets (total Lines 1-7) (8) ' ' Q W _._ ^; 9. Funeral Expenses 8 Administrative Costs (Schedule H) (9) ~ ~ a ~ D ;; (~ Q ~ 10. Debts of Decedent, Mortgage liabilities, 8 Liens (Schedule I) (10) r ~ 11. Total Deductions (total Lines 9 810) (11) 3 ~ ~ ~ O 0. O 12. Net Value of Estate (Line 8 minus Line 11) (12) , t EO ~ Q ~ . 0 0 , 13. Charitable and Governmental BegLtest~lSec 9113 Trusts for whidt an election to tax has not tx~en (13) made (Schedule J) : , 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) _ t ~~0 © ~ ~© 15. Amount of line 14 taxable Z at the spou~ai tax rate r- t x 0 (15) , , O See instructior>,s on reverse side for applicable percentage ~ a 16. Amount of line 14 taxable F - at 6% rate , r X .O6 (16) , , H a 17. Amount of line 14 taxable C at 15% rate r a X .15 (17) ,,: ,, v 18. Tax Due _ (18) © . ., ~, s 19. > BE.SLIRE TQ'ANSYYER i4~i:..Q~IE$TION$"~1~F~'RE~StDE IkND RECHECK: MATH < < Under penalties of perjury, I declare that I have examined tltie rehm, indud'mg eccompenyinp schedules and statements, and b the beat of my knowledge and belief, it is true, Correct and corn Lhan the oersonr reoreseniafive is used on all inforrnrion of wMdt oreoarar has anv knowledge. plate. Dedarebon of preparer other SIGNATURE OF PERSON-RESPONSIBLE FOR FILING RETURN ADDRESS nerF OF a~ w, ADDRESS :.Ci ~ (~ ~. D6 (a DATE REK1S1tIX.(ti7) .SCHEDULE H Co~toNwEA~THOFaENNSnvANV, FUNERAL EXPENSES ~ _ INHERRANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NIiMBER 1 /1UYV~C+~ ~ '~ 1/ Debts of decedent must be reported on Schedule 1. . ITEM NUMBER DESCRIPTION AMOUNT A• ;~ FUNERAL EXPENSES: G~bc. ~ , P14 ~• B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Soaal Security Number(s) / EIN Number of Personal Represertlative(s) Street Address City State Z'ip Year(s) Commission Paid: 2, Attamey Fees 3. Family Facemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address . Cdy State Zip .. ~: Relationship of Claimant to Decedent 4, Probate Fees 5• Aarountant's Fees g• Tax Retum Preparers Fees 7 TOTAL (Also enter on line 9 Recapitulation) I S CP ~ • ~ CJ ~, lif more seaoe rs needr~l. maert arktitinnal chaatc of the same sizel IpennsyLvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14) INHERITANCE TAX �V�QN,D STATEMENT OF ACCOUNT Po Box 28mfi E L) `FFICE OF HARRISBURG PA R C-7 VOJILLS DATE 02-09-2015 HIS FEB 17 FM 1 14 ESTATE OF CERK THOMAS E DATE OF DEATH 12-16-1994 C L EF'.\' 0 FILE NUMBER 21 95-0230 C E R K 0 R PH A 1:�' CC'H'EiR'YCOUNTY CUMBERLANDL F ACN 101 42r,LwV1A4�;P X 'b&t Amount Remitted GROVE CITY PA 16127 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE —0, RETAIN LOWER PORTION FOR YOUR RECORDS 4-OF ACCOUNT iCC70bif EX AFP -CH:1745- - - --x;;-fWH i i ffA7N E TAX STATEMENT;i4f ESTATE OF:CERK THOMAS E FILE NO. : 21 95-0230 ACN: 101 DATE: 02-09-2015 THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-22-2001 PRINCIPAL TAX DUE: .00 PAYMENTS (TAX CREDITS) : PAYMENT RECEIPT DISCOUNT AMOUNT PAID DATE NUMBER INTEREST/PEN PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.