HomeMy WebLinkAbout95-0251.21_c~_p2~j
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 2pp1
Date
• N,Da.TEp ITEMS: #16
TT~Epgp,T ~' FD DAtE: 03/09/95c~o
B,
VERIIAMEN7
BLACK BIK
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYUAlN1A • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
014585
s,In AE NuwER
NAME OF OFLEDENf(FrsL Mfdd., Ue) SEA SOCULL SECURITY NUMBEA DATEOF DEiVNpldrl, De,.'AwI
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104 Walnut Drive Parkesbur Pa. 19365
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arr .aN,l Rd Pa
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NAME AND ADDREaS DFVERSON WNO COMPLEfEDCAU of
•MEDICAL E7(AM11/Ep/CCRDNEp cR•n+zn T,p.«Wiln
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REGISTRAR'S SIGNATURE AND NUMBEII~,,
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DATE FkED(M°xn. pe, yeyl
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~ FOR DA~S OF DEA~ /I~T~ f~'13~191 CHECK HERE
INHERITANCE TAX RETURN POVERTY CRED
^
-• RESIDENT DECEDENT IT IS CLAIMED
t
COMMONWEALTH OF PENNSYLVANIA
DEPARTME
(TO BE FILED IN DUPLICATE FILE NUMBER
NT OF REVENUE
HARRISB RG
PA 60128
0601
WITH REGISTER OF WILLS) 9 5 0 2 51
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TY CODE YEAR
NUMBER
DECED T
S NAME (LAST, FIRST, AND M IDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
ee s, Stanley
CIA ECURITY NUMBER O. ~;
46 Erford Road
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DAT OF DEATH DATE OF BIRTH Camp H 111
PA 17 011
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W 95-07-3060
/18/95 8/05/14 cDUnr ,
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Cumberland
D APPLICABIEI SURVIVING SPOUSE'S NAME (LAST, FIRST D MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
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Ycy 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
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Limited Estate
^ 4a. Future Interest Compromise (for dates of death prior to 12-13-82)
^ 5. Federal Estate Tax Return Re
uired
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m (for dates of death after 12-12-82) q
a 6. Decedent Died Testate
(Attach copy of Will) ^ 7. Decedent Maintained a Living Trust
(Attach copy of Trust) Q 8. Total Number of Safe Deposit Boxes
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ra K. Wallet
Esquire ~..h k,.'i.j~'. .r..
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oMPLE EM I"IJGAD ~ ~ `
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vg T EPHONENUMBER 24 N. 32nd Street
717 737-1300 Camp Hill, PA 17011
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 ( 17 , 6 6 2 . 6 2
z (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) (g) 17 , 6 6 2 . 6 2
9. Funeral Expenses, Administrative Costs, Miscellaneous ~ 4 6 7 5 . 0 0
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (1 1 , 9 3 3 .2 7
11. Total Deductions (total Lines 9 $ 10) (11) 6 6 0 8.2 7
12. Net Value of Estate (Line 8 minus Line 11) (12) 1l , 054 .35
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Value Subject to Tax (Line 12 minus line 13) (14) 11, 0 5 4 .3 5
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 __
1 b. Amount of line 14 taxable at 696 rate (16) __ 11 , 0 5 4 . 3 5
(Include values from Schedule K or Schedule M.) .Ob 6 6 3 . 2 7
z 17. Amount of line 14 taxable at 1596 rate (17)
(Include values from Schedule K or Schedule M
) x .15
o
e .
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) 6 6 3 . 2 7
~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ + 33.17 _
(t9) 33.17
;,~ 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) - 0 -
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 6 3 0.10
A. Enter the interest on the balance due on Line 21A. (21A) -0-
B. Enter the total of Lins 21 and 21A on Line 21 B. This is the BALANCE DUE. (41 B) 6 3 0.10
Make Cheek Payable to: Register of Wills, Agsnf
-••--• r-••-•••~- ~• r~~ rv~ r. ~ aocwre TnaT I nave examined this return, including accompanying schedules and statements, and to the bast of my knowledge and belief,
it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
based on all information of which preparer has any knowledge.
SIGN URE Of PERSO RESPONSIBLE fOR FILING TURN ADDRESS
- DATE
104 Walnut Drive, Parkesburg, PA 19365 ,~J/ ~~~-
51 ATURE OF PRE RER OTHER THAN REPRESENTATIVE ADDRESS
DATE
•un4.-K•iA1au,.r 24 N. 32nd Street, Camp Hill, PA 17011 ~~~
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 1/1/96
• 2% (.02) will be applicable for estates of decedents dying on or after 1 /1 /96 and before 1 /1 /97
• 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 (~) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
.......................................................
a. retain the use or income of the property transferred, x
x
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$ ...................................................................................................
x
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.
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RE~~SOeEx+is_B~ SCHEDU4E E
CASH, BANK DEPOSITS AND
COMMONWEALTH OP PENNSYLVANIA MISCELLANEOUS
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT PI@a5@ Prlnt Or Typ@
ESTATE OF FILE NUMBER
Beers, Stanley 0. 21-95-0251
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
1. Mellon Bank
C mmonwealth Region
Route 22 East
5999 Allentown Boulevard
Harrisburg, PA 17112-4000 $16,692.07
Account #242-108-8648
2. Interest on Mellon Bank Account # 242-108-8648 44.15
3. Retail Pharmacy Program -Prescription Refund 901.40
4. Misc. personal property, clothing (given to nursing'~home) 25.00
TOTAL (Also enter on line 5, Recapitulation) I $ 17, 6 .62
(Attach additional 8'/z" x 11" sheets if more space is needed.)
~' ' REV-1511 EXa (7-88(
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
C.
Beers, Stanley O.
ITEM
NUMBER DESCRIPTION
A• Funeral Expenses:
1• Jessi Geigle Funeral Home
Linglestown Road
Harrisburg, PA
y State Zip Code
B• Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees Debra K, Wallet, Esquire
24 N. 32nd Street
3. Family Exemptio~ramp Hill, PA 17011
Claimant Relationship
Address of Claimant at decedent's death
Street Address
Cit
4. Probate Fees
Register of Wills - Cumberland County
Miscellaneous Expenses:
1. Copies, postage, and notary fees
i
8
(If more space is needed, insert additional sheets of same size.)
AMOUNT
$3,500,00
$1,000.00
$ 150.00
$ 25,00
TOTAL (Also enter on line 9, Recapitulation) I $ 4 , 6 ~5 , 00
Please Print or
E NUMBER
21-95-0257
REWS.~ EXa (1•V3~
COMMONWEALTH OP PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or
ILE NUMBER
21-95-0257
iIAIC Vt --
Beers, Stanle 0.
ITEM
NUMBER DESCRIPTION
1' Pharmacy Corporation of America
P.D. Box 4853
Chicago, IL 60680-4853
2. ATS Medical services, Inc.
DBA Mediq Mobile
P.O. Box 7
Westwood, MA 02090-0005
3. Polyclinic Medical Center
2601 North Third Street
Harrisburg, PA 17110-2098
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheep of same size.)
AMOUNT
$1162.85
36.42
734.00
5193! 27
REV-1513 E%+ (2-87~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Beers, Staple 0.
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
~~ Karen J. Moraski
104 Walnut Drive
Parkesburg, PA 19365
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1. none
FILE NUMBER
21-95-0251
RELATIONSHIP
Daughter
AMOUNT OR
SHARE OF ESTATE
100%
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $ 0
(If more space is needed, insert additional sheets of same size)
..
LAST WILL AND TESTAP!~ENT
I, STANLEY 0. AEEI?S, of Enola, Cumberla nd CountT, Fennsylrania,
being of sound and disposing min¢, memory and understanding, make and
publish this writing to be my Last Will and Testament, hereby revoY,ing
and making void any and all former xills bT me at any time heretofore
made.
ITEM 1. I direct the payment out o.f my estate of all my dust
debts and funeral expenses as soon after rrty decease as convenient. I
desire to be buried beside my son in Rolling Green Cemetery located at
Camp Hill, Pennsylvania.
ITEM 2. I give,. devise and bequeath my entire estate, both
real and personal to , my wife, Dorothy R. Beers and to, my daughter,
KAREN JEANbiE BEERS to be divided equally between them to share and
share alike. In the event that either my wife or daughter s2iou_ld become
deceased the survivor shall than receive all of the estate.
In the event heat both my wife and daughter should become deceased then
the estate shall go to, Tracey T,. Richards, my grand dau~ter and Hoy E.
RicHard, my step Son, to share and share alike.
ITEM 3. I hereby nominate, constitute and appoint National Bank
eu Trust Company of Central 'ennsylvania, Harrisbeu-g, Pennsylvania, as
Executor of this my Last Will and Testament and as Trustee for any minor
wteo may inherit under this will. I hereby empower said Trustee, in its
sole discreatj.on, to use such portions of the principal as it may deem
fitting and necessary for the Irealth, welfare, maintenance and education
of said minor, considering all of the available support and income benefiting
said minor. I further empower said Trustee to collect receive, and receipt
for any funds payable to my said daughter on life insurance contracts as
a result of my death. Said funds shall be added to and become a pare of the
trust herein established.
.. ,
~ YRTNFSS WHERPJOF, T havo hereunto set
~~!/~ -41' hand and seal this
,~S"~iay of 7LtrY: , A.D. 19~,~
Signed, sealed, published and declared by STANLEY 0. BF.RRS,
the testator above named, as and for his Last l~lill and Testament in
the presence of us, xho, in his presence, at his regttest{ and in the
presence of each other, have hereunto set otu• names as xitnesses.
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