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HomeMy WebLinkAbout95-0234~I -q5- b~3y H105.1~3 Rw. ?/87 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. Date AUG 1 ~ 200 ? ~_ Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ~258~1 Tr-EIPIaNr a 6'ENIIAMENT ~~ ~ SDBE RE NUMBER NAME OF DECEDENT IFirN. MiaM.lsap SE% 90004. SECURffV NUMBER DATE OF DEATN IMaiM. DOy. Mar) ,. Janet D. ~riiller ~E~ ~~ DAY ~~~ ,Female ~ 098 - 16 - 7147 ,.,March 16,1995 MdeBa Dry. Noun I MNUI.. (MaeA, OeY.Mr) Srr~or CwnrY) I ~~ DERNICIrG V'Nana-wimhuclamm aMrrOy B. _ 72 Ynt. ~ Augi 62227 , Scotland NWa«+DA EleDawn.n ^ DOA^ Nome. ^ R..idarlo.^ ,B~ ,~^ COUNTY DFDE,aN , CTrr,eoRO,TwT+CF DEATI/ FAGITTY NAME pIna N.lilulion. giveeV.Mand nunpar) NNB CEDENT aF NISPANIC ORIOwT RACE-Am.rLnn lydMl, MeaM,var.,.b. Cumberland N,~M„^„,w,,~,~ rsP.w» BB. ~. Carlisle K Carlisle riospital ; ~~°^'"~^aR~^•~~ 10. White DECEDENT'S UBIML OOCIJPRpN IGNOOF BUSINE931INDUSTRY VMS DECEDENT6VERM OECEDENT'BEOtIGAT10N MARTIAL SDfTUB-WnMO (C~NrMawnlB dorr rma U.S. ARMED FORCEST SURVIVBq SPOUSE a+alrrglB.•eonaNb ) M.^ No E'"""~'~'0p1m'r care. N.YwMrdW,VAtlpwd, lerib.e^'emME.nnemel „ Crystal -Voer ~~rystal Plant 1z ~ ~~ ,D,~12 ,,.arT;.> T~. ll`1~d ~~ _ DEC£DENT'S MABIND ADONEBB ISaeeL Ciryrtown, Slw,Zp CoM) DECEDENT'S 654 l~orth College Wit. , IiEBBJENCE "~~~ rennsvly nia ec".~.e.ra ,Te.^ M.. a.c.d.re 6,,.dN e•M1 ,~Carlisle,Penna.17013 ~,«~ " Cumberland bwrNpT Nee .eN+e..e Carlisle ~n• rn ~ wlBdnacAWTNWa . T:VNER'B NAMEIF.M, Midds. L.ae MOTNER'S NAMEIF >e. Midde. Maidb Sunwrr) ,. John Linnell . ,., Janet Ke r NIFORMANT'SNAME RYWPrNq BIFORYANI'9 MAILeq ADDIESS(SeaM, ~ IIp Janet L. Yates - 1, box 32B Fal~s~~'ree'~c,Pennsylvania 15840 METNOOOF g9PO8ff10N DATE OF dSP'OSITION PLACE OF DIBPOBTNOf1•Nem.aC.mM.ry, G.mebry LQCJPgN•CBy/bwar,Srl.. 77p Cod. ^ ~ R.movel ham SbN^ (ManN.O•Y.Vbr) arOtlrrPr> Darrlbn^ Otlr. `B°°`'" ^„garch 2261995 fast Harrisburg Cremat r~y.Harrisburg,Penna. ~ PERSQNACTWDABSUCN ~~0217-~./ ~wlnrcth rss~Sg1~~~~hP~~~vg~ ~~~g ~ aP 1 onywllM, oarWyNp IrMamy Mnowt.06.. tl..W OacunO altlw Wr,dMa MgprpaWaa. pyalaMlr We6aBb MlaMadbBlb ..nd Tda) LICENSE NUMBER DATE eg6EO w•I6Y adNel. IMarMn.Ory, Mar) eellr 8426 r•IrRWCan91M.dM OF DERH DATE PR0110UNCED IMarM. Y. veer) M118 CASE REFERRED IO MEDCAL E%AMINEW'CORDNEfi7 OM.on rin prc..oulw. MaB,. n I~ I-rt ]T. MBT I: EnbrerdWer., NluW armrnppc.lrrr wlYa awa.dlM daeM. DO na.n.rdr nrMdWNB. euoEa or r.N>k+b7amM,drea ornun/Me.. Awn*Nrr PART B: onw a4+M'++mnaBar Ca+WNBraewtea LM edF err uu..on.eM M. _ BMEp11TE CAIpE(Final ~aWIW4.ln MnraINp NlM rld•rlyYlp rreMplwrTN MRiI. 7 QWeb M'e . aoer on 1 1 - ra.uBnpNaerh)--+ Yll ro vt~e d str ~.~~;ye w~,~.en-tr e~t (~SC~LS ~ ! h ears • DUE 10 (OR AS A CONSEQUENCE OF): MarllcrMipb NrraM. a i DUE N ~ AS A CONSEQUENCE OF): T+Iw. EnM Il/b[KYI110 I CAllillDra.b or Njwy a ~ er NiYelW.yanr DUE IOIOR AS A CONSEQUENCE ~: r..u6Yp N de.eq LAST d I VMS AN AUTOPSY 1VERE AUTOPSY FlNDINDS MANNER OF DEIPH PATE QFINJURY TIME OF NIJURV WJURY AT VA7RIC7 DESCRIBE PION WJURYOCCURIBiD. PERFORMED? NIULABLE PRIOR 10 (ManN Oay Mar) . , . COaWLETION OF CAUSE ~ OF DEATN7 N.lunl Il.rracida ^ ^ P.ndig Ir.v.Mip.,bn ^ MS ^ NO ^ lM ^ No Yb ^ No Suiciaa ^ GMana Wd.larmNW ^ M' PUCE OFINJURY~At Ibm. /.rm .bM laaar oBiaa LOCRI , , , y, ONI9trad, CdY/ban,SWa) BY. „. ~rq. sb.lSPeaay) CEIRilR(CAaak aay ary %I• ~ CIPNYBICW ~~ AN Ta D TITL- -E OFiERT~ R ~ n^ /~ IIPhY9aienaer0lyugcana aaeaM wlwi&nBw PI~YSCir~ha Warwuric.d aeaN ana corridMaa ttan 23) ^ ~ °P brarrdM.d.Nllaoau.M dw btlr e.uaa(y eM rrwwr.M.d ..................................................... le. j__\JJ u/%-Y r „r LICENSE MBER (P~YK Odh paUUnti aeatlr entl /y / .M~r~ T•tlr a..I Mrlry blebee.d~MhoeNndM tlr lee.,dw,rW placi en04rbIM rgrocauaeaaeem) ~. .(~ ~J L ~-L-. 9/ DID ~f}~' Cerr.(y ella malYNlb.1•bd .......................... Ble. NAME ANDADORE$S OF Wlq qq~~p 'MEDICAL EI(AMINEp/CDgD/gp (Item 27)Typoa Prinl SCI Ll// ~~ /// y it / _ ~ ee • ~ A I7 On Ble bWe daaemrelbl, Mwla MwatleMroR N m o inion d M ~ ~ ~ ~. ~v`~ . y p , ee ottwred el UI. tbne, dab. and pleee, end due ro tM cw 9/ mM11M p elerd ............. a.(y elld ^ y ~U CGY c~ l ~iE813TRAR'SSgNANRE NUMBER ~~ ~ 0.~' ~~ S ~'. /¢ /~V~j ) 1 ~ O DATE FILED (MOreh, DaY. Marl / ~. \~~ . C - ~.. ~.z . \q Lg9S . ._._, .: ~.°°"o . _ ., . ` ' FILE PiUMBER ' ~' INHERITANCE TAX RETURN -~ ~ t~ES1DENT DECEDENT ,~ ,.~ n COMMONWEALTH OF PEt•INSYLVAi~IA DEPARTMENT OF REVENUE tTG t3E trILED tN DUPLICATE . ~ _ )~'2 1 9 5 0 2 3 4 DEPT. 180601 HARRISBURG, Pt. 17128-0601 WtT~t REGISTER Cif WILLS) ' - ~ _ COUNT f CODE YEAR NU/~18EF ~ , D ECEDENT'S NA1vEBAST, Fs?:~r, AN _ __ _ _ D MIDDLE INITIAL) DECEDEIJT'S CO- MPLE~E ADDRESS ~' '--' ~ c Miller Janet - _ D. 654 No. College St. w ° SOCIAL SECURITY tJUM9EP DAZE OF DEATH DATF. Of BIRTH -~- Carlisle, PA 17013 ~ 098=16-7147 ~ 3/16/95 8/27/22 coup Cumberland ~ ~Y ~I. Original Retu~~n __ ^ 2. Supplemental Return ^ 3. Remainder Return z ~ Wat:J ^ 4. Limited Estate (for dates of death priorte 12-13-82J ^ 4a. Future Interest Compromise ^ S Federal Estate T v4m . ax (for dates of death after 12-12-82) Return Required n, ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes Q (Attach copy of WiIIJ (Attach copy of Trust) F F ~- Z NAME MPL ~ MALI A R S ~'--- ~~""`~" " -' I ~'Z ~ Frances H:. Del Duca 10 West High St . ~ ~ TELEPHONENUMRER CarllSle r PA 17013 _ ~ (717-2~9-1323 1. Real Estate (Schedule A) (1) ~,. _~ - _ 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,-Bank Deposits & Miscellaneous Personal Property( 5) 2 r ~ ~ ~ • 0 0 _ ZO (Schedule E) Q b. Jointly Owned Property (Schedule F) (b) _ 2 91.5 6 7. Transfers (Schedule G) (Schedule L) (7) ,,V V 8. Total Gross Assets (total lines 1-7) (8J 2 r 2 91 .5 6 W 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 6 r 4 41.3 8 °L Expenses (Schedule H) 10. Debts,' Mortgage Liabilities, Liens (Schedule I) (10) __ 11. Total Deductions (total lines 9 & 10) (11) 6 , 441.38 12. Net Value of Estate (line 8 minus line 11) (12) _ (4 ,149. $2 ) 13. Charitable and Governmental Bequests (Schedule J) (13J _ 14. Net Value Subject to Tax (line 12 minus Line 13) _ (14) _ 0 _ _ 15. Amount of line 14' taxable at 69/o rate (15) x 06 = (Include values from Schedule K or Schedule M.) . 16. Amount cf'line 14 taxable at 15% rate (16) x 15 = Z (Include values from Schedule K or Schedule M.) . O 17. Principal tax due (Add tax from line 15 and from line 1 b.) (17) 18. Credits Prior Payments Discount Interest ~ + - (18) - u 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19) X ~^ Ia. 20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (20) _ A. Enter the interest on the balance due on line 20A. (20A) _ B. Enter the total of line 20 and 20A on line 206. This is the BALANCE DUE. (206) - Make Check Payable to: Register of Wills, Agent Under penalties of perjury, I declare that I have examined this return t is true, correct and complete. I declare that all real estate has been Dosed on all 'nformatio of which preparer has any knowledge. iIzGNATURE O O_N SPONS BLE FOR FILING RETURN ~~DRE55 \ ~ 1 1/~~ preparer orner than the personal representative i5 DATE /7 d'~~ I Y I, Si DATE v REV-ISOAFXr Izn~i ~ t~ ~ SCHEDULE C !~~~~~` CASN, BANK DEPOSITS AND cc,ln~n~.r-Iwenun or retu-sv-vnrnn MISCELLANE~JUS INttrR-tntJeE Tnx REIURIJ PERSON/~-L PROPERTY RESIDENT UECEUEtJT E51n1[ Uf __ _ ~l~u-eL ll. Miller (AII t~roporly ioinAy-owned wrlh tbo Right of Survivorship must bo disclosed on Schodulo F) f~EM N!..'MBEI2 19G1 '1'i Ll Fc~ r L:i.te Please Print or 1995-00234 r ..1509 EX~ 117801 ~C COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIUEIJT DECEDENT ESTATE OF -'-------_-__- JcTltc l U. M-i.].1ei: Joint fennnl(a); A. --- _.. Faye B. C. Jointly-o~ ____- LETTER -~------------ ITEM FOR DALE NUMBER JOIN! 'MADE DESCRIPTION OF PROPERTY IENAIJf JOINT -- -__ _ 1. ----- 8/4/80 Dauphin Deposit Banc ((0060549777 Check. Acct FILE NUMBER 1995-00234 TOTAL VALUE DECU'S DOLLAR VALUE OF OF ASSET % tNT. DECEDENT'S INTEREST 583.12 291.56 - -- I - - _ -__ _,-- ----- --- -_ -------- ------ I ~ --- TOTAL (Also enlor on line b, Recapitulation) $ 2 91 5~6 _ _ _ _ . _ _ .- .-.._ . _ _ _..- -- - --------------- r" (!f more space is needed insert vddilional sheets of same size) ~ JOINTLY-OWNED PROPERTY .v~rsn ex« f~.ee~ ,~ ~ ~ SCHEDULE H '"~~~~`~ FUNERAL EXPENSES, COMMntJWEn1T11 OF PfNNSY1VANrA ADMINISTRATIVE COSTS AND nuiennnrJCe Tnx n~rurrrJ __= _ RrsionJT orcronrr MISCELLANEOUS EXPENSES Esrn~€ or __- - Janc~l M.i...l.].e:r. ~t/Jc/a/ Janet 1). Miller - --- . - i ------"- ------ -- I I CIYI -- __~- NUMBER DESCRIPTION A• funeral Expenses: - ---__ 1. Lwing 1~ uneral Ilonte 3,212,00 B. 2 3. .( C. i :i, -1. .~. G. J. ~. Administrative Costs; Personal Representative Commissions Social Security Number of Personal Represerrlalive: _ -' Yoar Corrunissions paid _,_ __Please_ print or Type UAA[lER--" --- - 1995-00234 AMOUNT Attorn©y Foos Prances Il . Del Luca Family Exemption Claimant - -Relationship Address of Claimant at decedent's death Street Address City -__--- `-----Stale _,___ Zip Code Probate fees Miscellaneous Expenses; 11rt1-ur Weaver - lot rent (npril tttru December ) United oL P11 r.~P&.I, c~, . Dar]_ene Moyer - personal taxes Bank Une/1111I2I' Credit Ca rdiService I'A DePt • or 't'ransportation - cert . of title Keserve .Lot filing TOTAL (Also onler on lino 9, RocapifulationJ (If more space is needed, insert additional sheets of same size.) x00.00 29.00 1440.00 24.14 25.23 162.00 9.90 24.91 595.20 19.00 100.00 1.30 r ~rEV.lsl:f Ex ! i2 nri :fit :$y~ r r rnvn.rr twcnlnl or rE i nlsrlvnrlin iN116RIlANS:E T/Yx pf.1URN .___ _ .. RESIUEN! UFCEUEflT ESTATE OF ~ -- Jar-e L I_i. M_i_:Ller ITEM NUMBER tJ/+IME A. taxul~le [-eyucsis: 1. J~t~eL 1,. Yal Il , ll . ]., Box 1~'al:Ls Creek, --_-._ .. I _ _-_ __ rrrM NUtvIBER SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF BENEFICIARY - __ El. Cfiarilablo and Governmental Bequests: - - - -- _.__._. -- ._ t TOTAL CIIARITABLE ANU GUVERtJMENTAI BECIUESTS (Also enter on line 13, Reca itulalion _ _. _ p ) _--- - (If 1rTOre space is needed, insert addlrional slTeels of same size) S AMOUNT OR SHARE OF ESTATE 1995-00234