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HomeMy WebLinkAbout95-02532-I -q5' X253 M,05.113 Rw.7fB7 TYrEApNT RI PEIMBANtl1T eLACx EIR a~~ 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 16 200T ? • Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH Of PENNSYLAMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFlCATE OF DEATH X14553 NAME DF DECEDEIlf If A. MiEa•, LAIq 9E% SOCIAL SECURRY NUMBER ORE 6OFiQlIW«MI.OW.'~«1 ,. BESSIE L. STAKE ,. FemaEe x 162 - 22 - 4858 ~ e.lb,raa~ o~~ ~S' 95~' AGEN+Bn.c.r1 uNOO„rEAR uNDOI,DIr DaEassBln, Bwr,RACEICM+•s vLACEGSOE.a,I,CINCw«+p«.-+wrrnwA•rr•nar•aq M«AM . D•w N«r I Mrr IMO.Mi. aw, wrI SW «F«pnc•ur» ,p~IBU.; ~ T ~. PA MPa`" ^ ERIOUbMMa G Da ^ N« A. ~d' Rre.na ^ l~ M ^ 9 6 ~~ 12 / 14 / 18 9 8 ,Fnanbei.n owNnasDERN cm:eola.rwovoERN R,CERYNAMEINnaiaiNWlpi.•!rl«q~•Anb«I DECEDENrocNlerw+ICOwBINV RACE-AnwNanYtlr,aWawMU.ae w o w ^ wr•.. ww,Dar. csa.~n M•.Ir•.nNMRIr•.an whi.#e CumbenC.and ., (V. Pennebano Tw SWo...,M Flect~.a-~L C,e~i-e;,~ a ,a OEt~EOEIIT'S O~CCURpQgN KNDOi Nl8BES8BNDU6111Y N1IB OECEOEI/f EVEIIN DE<iOENT'S EDUCRIDN MARRIILSWI/B•Mr,IW A1no' U.a AR11EOPORCEB. T d•oMY ~ n~af i q r• ,rr hone ewi a „a ,a 8 j°,r "'«"' ,,, widow DEeEDEMreMAENBnooREBept.n.cMro•n.sr..zbcoex B sa. PA ,~ ,x^ w areN.B,.s~. ~ 131 W. King S.til.ee~t . . e M.sr, Shi.ppenebung, PA 17257 ,a ~n ~,°' '"'"• w,a.ra.wM/ ,~ °`n"~4 ,TaCI awnr,rlMYra RE/,ERB NAMEIFrI Mim.. V•q J F k C sw,ME~ LMau..M.an a.n.ly . ran oone ,a C.~una A nee Duncan EfORMANT7NAME f+vP•~n '~"~ ~~ a MAB1N0 AOORESSISrrLClMbwn, 9rr, Lp 131 Weed Ki S.ticee~t Sh-i eneb PA 17257 MErNroacoeroatgN BuU1® Crrrlgn^ R«n•wlY«n 8r>.^ arDlsroanol, •OM. wd ~ vuccas019~OBIIION.NrrdCrrINKDR•MI•n «OBw PYq LOCRION•C~yMw,Slaw}1pC•r PA ^ DYnMi1^ ~~. 2/28/95 ~4nbeneon Ceme.teny ,~~tnne•tt 7wp., FnanltPin C~t., AB SUCH NuMEEII NAMEAIaAaoREBBaFR,cam 011776-L -BnichenF.H.Inc.,PU Box 336, PA 17257 Ti•sn1,•Iw •«Wliny bM0•aa•7'~W.Mr,•x•nAa Sr,bw.rr rNyYrarr. UCENBE NUMBER DWESId1Ep /,,•krrnaw•uerrBnwaernM "'° O . IU M«+~.D.xw.n rr.aarN. L , m I F~ ~ Al 1 ~ F - r ~~1 1>•'~ Ynnr.2B •.rWmmadNaM of oE,a„ PRDNOUNCEDDEAD~,aN. D.,. wq wLB CASE RERERREDM MEpCAl E7fAMBiEWCOROMEM / ao paowr.rrn. ~ ~ y E~l ~ w ^ ~ M N. S M. a br ~ ~) IQf l7. MIITF E~rrBrArrA.irywy«mriple+Yn+rlikllewNtlr OrN. OO na «nrtM noMd WY9. wra reaWC LM ••h«ruw•nr AYr. Anrl,•Mt*«MN hi«•. iApp•dnrb MYR M. OM«MOW~silan~W,~aYrMY7b4•E\OYI ~NWra EMw«, n«nlrMnBintlruMMNtiBarr Shw MRVR I. ^M®Y1TlCAIpE lr i•I t ara r04a1~ . c«dlbn /~1,, ,,~ ~n i e~~ ~11 ~ NwignArwl-- •. L.L4LV's"' 1L OlIE70IOR ASACCNSEOUE Bq,r•Mry 4rnOYar 0 ~ ,~ L `(, ~~ ~MM ~U~~ DUEWIOIASACONBEQIENCE OFk I ~ i ~«~/Y t ~ i tl DUEIOICR ASACONSEOUENCE Cfk I nNnllirgn Wa~I WT AMAUR]-SY AUIDVSY RNDMg3 MANNER Of DERH ORE OFINIURV TIME QF ElBJf1Y INJUIIYRYYDi1K7 OESCREIE NDW E{AIRYOCCU,WEp. rERIaDRMEm vlaaa ro D"`'a') colrLEraNOSCAUSE aF OF.IVI,7 NM«AI NaniW ^ AteMrA ^ P«idipYMrgYW1 ^ w ^ N• w ^ N• w ^ No ^ 9~ACla• ^ CaYA r, W M«mMe ^ M. RACE OF BiR1RV-A,lonr, bnn,nrl,Irbry. aAw LOCRION(StrrL C•y/WA..,SWI Yob. 2S. Wydn9. ae.lSp•[I,1 SB•. 1 CiITB9611CMcM M, ma • eBmrrEq nnapAN n . % s,GNiuURe TRIE aR ~ ry rncw. c«Ipbq nw.a e••n wn awllw o•vece.n nr aa~arwe orm ra eanpr.e ~ nl wl•w•,ww.a..,na,e•nwewrE,.ewuNN,nawr..rrawe ..................................................... 4°L a,w , 'fRONO,N,CEp ANDCFRTIFYIIq PHYSICIAN(PliYfti•n Odh M«iwmnO Met. Ar.Onegyngacrrdd•vl.l 701M MManryYro~NYp•,Ortllr«•nAalM lbn•,AW,•n0 piA4,•n/UrblM e••••,•)aM.nrxwrY•Ma ......................... ^ lCEN9E ,` SIDNED IM•r.,DM•wrl (' 1 /~, 1.1 Q ~- L' Sl6 ~ J 'MEDICAL ElUMB/EA/CORONER E NAME AND ADDRESS PERSON ~~ COMp. YG N«n 2~Typ•«Pria 11,J7-YD 4 ~O • ) ^ ~ Wa~-rninrbR •ndlq MvM .. ..' In wry opnbn, 0utl, xurrW a m.,im., dr•, «nl Pl+n. rM 0u•,o,M Caurb) •ntl ^ Ala ...................................................... ....... ... ~~ ~ ~t "p [(~ .. D -1 t~ O 'A'fMAA` REGIS RUBE AN ~ ~. ORE Oay. Y,. RSV-,500 Ek ~ 17.941 ' ~ FOR DATES OF DEATH AFTER 12131 /91 CHECK HERE ~ INHERITANCE TAX RETURN IF A SPOUSAL ^ POVERTY CREDIT IS CLAIMED RESIDENT DECEDENT ~, . FILE NuMeER COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE ~~ 9'j -- (~ 2,53 DEPARTMENT OF REVENUE DEPT. 280601 WITH REGISTER OF WILLS COUNTY CODE YEAR NUMBER HARRISBURG, PA 17128-0601 DECEDENT'S NAME i ST, FIRST, AND MIDDLE INITIAL) ' L... DECEDENT'S COMPLETE ADDRESS ) 3 t We. s+- K. i n g SA+ r~e` ~/~J / W SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH ~ C h i ~ ~{. S b ut.+Q , Q/'~' ' / p~• J Y c W V + ~ . C°Unf p (IF APPLICABLEI SURVIVING SPOUS 'S NAME (LAST, FIRST ANp Ml °lE IHI L1 SOCIAL S CURI NUMBER AMOUNT RECEIVED (SEE INSTR CTIONSI w ,~av, 1. Ori Inal Return g ^ 2. Supplemental Return ^ 3. Remainder Return (for dates of death prior to 12-13-82) oc ^ d. Limited Estate ^ da. Future Interest Compromise ^ 5. Federal Estate Tax Return Required = ~ ~a0° Decedent Died Testate ~ b (for dates of death after 12-12-82) ^ 7. Decedent Maintained a Living Trust ~8. Total Number of Safe Deposit Boxes , . (Attach copy of Will) (Attach copy of Trust} i Ate, ~[31l ','C't ' r NAM COMPLETE AIL NG ADD ESS ' ~ ~ TELEP ONE NUMBER f Nary (~s b u rg, ~ 1. Real Estate (Schedule A) (1) ~L°_ 2. Stocks and Bonds (Schedule B) ----- (2) ~ ~'~ `- ~ 3. Closely Held Stock/Partnership Interest (Schedule C} (3) N r~ n ~ e V '~'~ ~ ~~ : __w "' nd Notes Receivable (Schedule D) t 4 M n (4) _5 or gages a . 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ `.~ 5~ ~ ~6 - 0 K (Schedule E) b. Jointly Owned Property (Schedule F) (6) ~ ~ rJ f ~ ~ d . ~~ vy 5 ~ 7. Transfers (Schedule G) (Schedule L) n 7 ~~~ tJdU •Ud ( ) ~~ ~ Q ~ a 8. Total Gross Assets (total Lines 1-7) 8 -.~ ~ ) i~t d , I _ Miscellaneous Administrative Costs Funeral Ex enses 9 (9) _~~; _ , , , . p , Expenses (Schedule H) ~1 O Liens (Schedule I) e Liabilities Debts Mort a 10 (10) '" hm , g g , . 9 & 10 l (11) .~yy ~ ¢~~~' ~ `~ Lines ) 11. Total Deductions (tota 11 _ . (12) ~ '~ ) 12. Net Value of Estate (Line 8 minus Line .. uests (Schedule J} tal Be e me Ch it bl d G 13 (13) q e an ov rn n ar a . x (Line 12 minus Line 13) t V t t T 14 N l S b (14) d u jec o a . e a ue 15. Spousal Transfers (for dates of death after b-30-94} e on Reverse licable Percenta f I t ti A S (15) x = g or pp ns ruc ons ee (Indude values from Schedule K or Schedule M.} Side . _ . 7 2 ~ y ~ , • ~~ ~j ~ ~ 3 V 16. Amount of Line 14 taxable at 6% rata 0 t (16J / x .06 = l (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) X .15 = ~ _.-, c (Include values from Schedule K or Schedule M.) a 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) _ ~ tr- - - - _ ~ 19. Credits Spousal Poverty Credit Prior Payments + Discount Interest + ~3y. ~ G _ 119) ~ n ~ ~ J a ` - 0 ~ T This is the OVERPAYMENT. enter the difference on Line 20 reater than line 18 If Line 19 is 20 (20) . , . g r ~ ^ 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21J , A. Enter the interest on the balance due on Line 21A. (21 A) - B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21 B) Maks Cheek Poyoble to: Register of Wills, Agent Under penalties of perjury, I declare that i have examined this return, including accompanying schedules and statements, and to the best 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. SIG URE OF PERSON RESPONSIBLE F FILING RETURN ADDRESS DATE ~ ~ ~ 71 .S-~.Z- 9~ SIGNATURE OF PREPARER O ER THAN REP ESE TATIVE AQDDR ' . / DATE ~~ ~ 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 rotes 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% (.02j 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, ....................................................... '~ b. retain the right to designate who shall use the property transferred or its income, ............... v V c. retain a reversionary interest; or ................................................................................... d. receive the promise for life of either payments, benefits or care$ ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate considsration$ If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving / adequate consideration$ ................................................................................................... 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. i ~ REK1508 Ex+ (2.871 COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or ESTATE OF FILE NUMBER (All property jointly-owned with the Right of Survivorship must be disclosed on Sehedub FI ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH Y>7~rlGQV1 Express - M.u~ ua l ~uhds `~`~D,'~9~~5~ P 11,1 C j3 A n k S a v i v~ 9 s /-~ ~c ou n ~l0 . 'S0 X100 (~ X190 ~0 '~I , 5 3b ~'~D Chec.ki-~G ~ccoun~ ~. 5 ~ 5va t uy9~ ~3 ~ 1 . o ~ ~-e r ~'~ ~-ica~-e ~~' ~~~oscp~ X78111 ~o) q~~8 ~I I, 3 0~ ' ~ ~ tt '' 17832 b0 1$~36`I '~/~, 1J0D. 0 a TOTAL (Also enter on tine 5, Recapitulations ~ $ ' J f I `-/~}~ , (} ~ (Attach additional 8~/s" x 11" sheets if more space is needed.) REY-1504 EX+ (7.871 ~ COMMONWEALTH OF -ENNSYIVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE "F" JOINTLY-OWNED PROPERTY ~~ S S i-r L .S-;-Q k ~ ~/ QS--p~.S3 Joint tenant(s): NAME ADDRESS .RELATIONSHIP TO DECEDENT A. ffy~?~~tG S. /-~rnc~f 13 I west ~K~ n Sf ~~f ~au~ h-~~r Sh~i'I°tns bur~~ ~A , • 17~ 5'~ B. c. Jointly-owned property: ITEM NUMBE LFORR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S 46 INT. DOLLAR YALUE OF DECEDENT'S INTEREST ~: ~ ~ 393 Trm~ ~r~l ficafe o~'~r~bsl ~.50~ 000 ~6°1o a 5 000 NQ. ~ g~7~ i TOTAL (Also enter on line 6, Rscapitulction) 1 I $ ~ Q ff 0 (N more space is needed insert additional sheet: o/ some ,size) . REV•1510 EX+ (2.87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G TRANSFERS PLEASE PRINT OR TYPE ESTATE OF FILE NUMBER S~- ak ~e, ~csS~ ~ L... ~l~'S -G~2~53 THIS SCHEDULE MUST BE COMPLETED AND FILED iF THE ANSWER TO ANY OF THE QUESTION S ON THE REVERS E SIDE OF T HE COVER SHEET IS YES. ITEM NUMBER DESCRIPTION OF PROPERTY include name oithe transferee, their relationshi to decedent, date of transfer. P EXCLUSION TOTAL VALUE OF ASSET DECD. % INT. _ DOLLAR VALUE OF DECEDENT'S INTEREST dt Dauoh~~r 3,~DD t~ B i 1~J40U 9j~©D rn . a Ame1 I31 West King Street Shippensburg, P17257 1l1 ?~ 95~ Rowl es ~a. h~-er g~~000 cl ~Lra J ~ia~ooo ~9,D od . 8680 OaKdale Road Qrrstawn, PA 17244 ~ (!~(9~ ~3.odo ~~~,~ooo ~9>Ooo William G. StaKe SOh 395 MaY t Doan Road Elizabethtown, 17022 ~~~~/9~ ~ ~9 o o ~ o00 ~3 4~~ ono , , T~oL~.~9hi~.r Zelda H. Stewart 17484 Stewart Road Spring Run, PA 17262 11 ~?/9~ '~ pp p ~~.~ ODD '~qj ODd t_uetta J. WicKard ~et.ur~h~r ' 124 Bridge ROad T~leww i 1 1 e , PA 17241 t ~ ~'1~9'y N1.o,ry S-~a~5t/ pau9h~~r-~n-law 3~Od0 /a~UOI) ~ 9, o od I~So9 I`'lil) ~na~l s~r~ n9 ~.~n, ~A~~~ ~ ~ i~/7~qy TOTAL (Also enter on line 7, Recapitulation) I $ 5" Zt QD (~ (If more space is needed, insert additional sheets of same size-) y ~~ REV-15i1 E%+ ~7-881 SCHEDULE H FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF S-~ak~~ ~~ s s ~~~ I..... FILE NUMBER ~ Q~-aez.6 3 ITEM NUMBER DESCRIPTION AMOUNT A. i Funeral Expenses:~'o~t~Sq~1JCr-8rt~ cr s tPp~ns6Nrg, A ~ ScrvlceSJ PatC-Soha~j s{'at~ and Qra~{ssiortal f ' ~~~,c~J1p,00 ~ pm an F'~r-a rat h orn ~ fat. i ~~ f~ acs and Gqq~, u. ih-~-crrnanf r`ece.p~ac'7z~clt/rs~l Cas~r~t 1 ~~~. UD ~ G ~ /~,rjo. O 3d • ~ ~ ~~ora~ spray s / q0. 8d ~ rl5. 00 rsrade UPen~ ~ p,00 3 B. Administrative Costs: ~~'{' h ~ • 1 " ~ n 5 Ce.r~~lyd C°p~'t~S ~ ~ ' ~~ 7S, od 1. Personal Representative Commissions ~h 1~i'Q ~ tY19_ Social Security Number of Personal Representative: - Year Commissions paid 2. Attorney Fees Nan e 3. Family Exemption Claimant Relationship Address of Claimant at d ce ent s death Street Address City State Zip Code 4. Probate Fees ~~"f T~ (~~' C. Miscellaneous Expenses: C, ~ a 0.W ,l p C~.l' hOl ` - Neu1S ~ f'011tG~ lay ~7 ~' ~~ ~ ~s~a-~c No}-c is - µw. zr . ~1U~7-~ ~. r~~~p~~~~- 3~,~~ 3. ~ODt~" a. M-e t~ t C a ~ 1.s5. U D 5. ~,l It 0.gG X30 - a ~ 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) I $ Y~ sZ3~. L7 ..3 (If more space is needed, insert additional sheets of same size.) I REV-1513 EX+ }2-87} ~, i . SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE SAX RETIiRN ESTATE OF S~-a~~; 1~eS s~~e~ f ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER A. Taxable Bequests: Amelia B. Arndt Pauline G. Earner 131 West King Street 31 Judy Lane Shippensburg, P17257 Harrisburg, PA 17112 U~,Je,~.6~~~'~Y Clara J. Rawl es William G. StaKe Raad 8650 paKdal a Road 1?244 395 P'lalytc~un E1 izabethtown, 17022 Qr•r•stawn, PA b ~o~h~e r Kenneth E. StaKe East Guy F. StaKe 16809 Mill Road 4010 Lincoln Way Faye t te~u i 1 t e , P17222 Sp+' i n9 Run , PA 17262 .SOh I Zelda H. Stewart Luetta J. WicKard 124 Bridge Road 17484 Stewart Road Spring Run, PA 17262 Newuille, PA 17241 1~ a,~~ hoer FILE NUMBER RELATIONSHIP AMOUNT OR SHARE OF ESTATE Ot.tlC~~!)~t ~' Sin Sin a~lgh~'e.r Inc-~i~h+~ ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER B. Charitable and Governmental Bequests: 1 Nonce AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) IS (If more space is needed, insert additional sheets of soma size) '1 L~ <'} ,/ fi/\ r ~. ", -,\ ~.+