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This is to certify that the certificate hereunto attached is a tine 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 18 2pp7
? •
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLWINIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
L 251w2
~ NAME OF DECEDF71ilF~a Middle. Latyl SEX $OCU4 SECURITY NUMBER DATE OF DEATHia1uM,, O+y.'Aev)
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NAME AND ADDRESS OF PERSON V/NO COMPLETED CAUSE OFDEATH
•,~DICAL E7UYBIENCORpNEA (Item 271 TYW «priM
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TRAR'S SIGNRURE _ R ^ DATE FlLED y. lyerl
~ FOR DATES OF DEATH AFTER 12/3,!91 CHECK HERE
REV`-,sooEx.(7-ea) INHERITANCE TAX RETURN pOVERTYCREDITISCLAIMED
RESIDENT DECEDENT FILE NUMBER -
CrMMONW'ALTH OF PENNSYLVANIA _ 2'
. D.EPAR~MENTOF REVENUE (TO BE FILED IN DUPLICATE ; m ~ ~a ~~-••~ ~~~, r7~~..
D E PT. 28080,
HARRISBURG,PA,7128-0801 WITH REGISTER OF WILLS COUNTVGa E `~"---YE-ikR~--____ NUMBER
DECEDENTSNAME(LAST,FIRST,ANDMIDDLEINITIAL) DECEDENTS COMPLETE ADDRESS ~'"''-°-~_,
E ORDON PEARL E 00 W LOUTER STREET ~ \`~~,
E SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH PT 2 "1
D ARLISLE PA 17013-2215 ~\~
N 161-14-5979 3/ 4/ 6/18/20 county CUMBERLAND
T (IF APPLICABLE)SURVIVINGSP,OUSE'SNA (LAST,FIRSTANDMIDDLEINITIAL) SOCIALSECURITVNUMBER AMOUNTRECEIVED(SEEINSTRUCTIONS)
CAB X 1. Original Return 2. Supplemental Return 3. Remainder Return
H P L 4. Limited Estate 4a. Future Interest Compromise
E P O (for dates of death prior to 12-13-82)
CRC (for dates of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
K P S ^X 8. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 08. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach a copy of Trust)
C p ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
O O NAME COMPLETE MAILING ADDRESS
E E BER J GORDON 38 OL STONE HOUSE ROAD
S N TELEPHONE NUMBER O SPRINGS, PA 17007-9678
- T (717) 258-3295
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) 4 2 5 6 . 3 4
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 0
4. Mortgages and Notes Receivable (Schedule D) (4) 0 ~'
E 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sch. E) (5) 13 8 9 8 . 6
A 6. Jointly Owned Property (Schedule F) (6) 0
p 7. Transfers (Schedule G) (Schedule L) (7) 0
T 8. Total Gross Assets (total Lines 1-7) ~ '~"(e) 5 6 4 6 3. 9 9
U 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 8 215 „~~'
L
T Expenses (Schedule H)
I 10. Debts, Mortgage Liabilities, Liens (Schedule I) ~ (10) 5 3 6 5 . 7 6
N 11. Total Deductions (total Lines 9 & 10) ~! ~ (11) 13 5 81.4 3
12. Net Value of Estate (Line 8 minus Line 11) y' (12) 4 2 8 2 . 5 6
13. Charitable and Governmental Bequests (Schedule J) (13) 0
14. Net Value Subject to Tax (Line 12 minus Line 13) (1a) 4 2 8 8 2 .5 6
15. Spousal Transfers (for dates of death after 8-30-94)
See Instructions for Applicable Percentage on page 2. (15) X - 0
(Include values from Schedule K or Schedule M.)
0
18. Amount of Line 14 taxable at 6% rate (1 s) 4 2 8 8 2 . 5 6 X10 = 2 5 7 2 . 9 5
(Include values from Schedule K or Schedule M.)
T 17. Amount of Line 14 taxable at 15% rate ,f',
A (17) X .15 = 0
X (Include values from Schedule K or Schedule M.) -
C 18. Principal tax due (Add tax from Line 15, is and 17.) (18) 2 5 72.95
M 19. Credits Spousal Poverty Credit Prior Payments Discount Interest
p + +
~ (1s) 0
T 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (2p)
T ^ ^ Y q ... g. X rp Y.....
A A:: :Check.here- If' oa are: r~ uesfln a. refund ot: our ave. a rrtent;
I 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
~ (21) 2572.95
N A. Enter the interest on the balance due on Line 21 A. (21A) 0
B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21B) 2 5 72.95
Make Check Pa able to: Re Ister of Wills, A ent
- - BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ t
Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedutea and statements, and to the best of my knowledge and belief, it is true,
correct and complete. I declare thatallreal estate has been reported at true market value. Declaration of preparer otherthan the personal representative is based on all Information of
which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
DATE
OLD STONE HOUSE_ROAD _
BOILING SPRINGS, PA 17007-9678 12/12/95
S NATURE REPARER ~Yi'HER HAN REPRESENTATIVE ADDRESS
.a''~ DATE
r~ 202 S THIRD_STR_EET ___________
COOPERSBURG PA 18036 -~-------""
cs, 12/12/95
Form 1500 (Rev,7-9a)
~ 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°~ (.0:~) 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% (.01) 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 MARK (X) IN THE APPROPRIATE BLOCKS.
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, ,
c. retain a reversionary interest; or .
d. receive the promise for I'rfe 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 consideration? If death occurred after December 12,
1982, did decedent transfer property within one year of death without receiving adequate
consideration?
YES NO
X
X
X
X
3. Did decedent own an 'in trust for' bank account at his or her death? X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE ,RETURN.
~S,
Form 1500 (Rev. 7-94)
~ REV- 7503 EX + (4-BB)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE B
INHERITANCETAX RETURN
RESIDENT DECEDENT STOCKS AND BONDS
ESTATE OF
FILE NUMBER
CORDON PEARL E 2195-0257
(All property Jointly-owned with Right of Survivorship must be disclosed on Schedule F.)
ITEM
NUMBER DESCRIPTION
1 ORTLAND TRUST GENERAL MONEY MARKET FUND 740.76 SHS
1.00
2 UFF & PHELPS UTILITIES INCOME INC 1500 SHS C~ 8.50
3 JR HOLDINGS CORP DEP SH RP STG 1/1000 PREFERRED SER
300 SHARES C~? 23.75
4 REENWOOD TRUST CERTIFICATE OF DEPOSIT 6.65% DUE
/11/97
5 HG 33W MORTGAGE BACKED SECURITIES 8.00% DUE 5/25/2024
ACTOR .9623 (9500.00)
6 ENNA TAX-FREE INCOME TRUST 175.155 SHARES Q 16.03
VALUE AT DATE
OF DEATH
740.76
12750.00
7125.00
10000.00
9141.85
2807.73
TOTAL (Also enter on line 2, Recapitulation) $ 4 2 5 6 5 . 3 4
(If more space is needed, Insert additional sheets of same size.)
csi
Form 1500 Schedule B (Rev.4-881
~ REV- 1508 EX ~ (2-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~-~7 ~ Ii 1 C lJr
GORDON PEARL E
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY Please Print
FILE NUMBER
(All property Jointly-owned with Right of Survivorship must be disclosed on Schedule F) 219 5 - 0 2 5 7
ITEM
NUMBER DESCRIPTION
1 EMBERS 1ST FEDERAL CREDIT UNION A C # 118463
2 AUPHIN DEPOSIT BANK & TRUST COMPANY PRIME OF LIFE
F LIFE CHECKING A/C #37-92646-2
3 AUPHIN DEPOSIT BANK & TRUST COMPANY STATEMENT SAVINGS
/C #5-7000-2790-9
4 UTOMOBILE-1984 SUBURU STATION WAGON
5 14K YELLOW GOLD DIAMOND SOLITAIRE ENGAGEMENT RING
6 4K YELLOW GOLD ENGAGEMENT RING JACKET
7 4K YELLOW GOLD DIAMOND CLUSTER RING
8 ERSONAL HOUSEHOLD GOODS
9 DEPOSITED CHECK 3/15/95 VANKAMPEN MERRITT
VALUE AT DATE
OF DEATH
1383.49
2261.35
1069.50
2100.00
3400.00
895.00
890.00
1805.13
94.18
TOTAL (Also enter on line 5, Recapitulation)
(Attach additional 8 1/2" x 11" sheets'rf more space is needed.) $ 3 898 • 65
csi
Form 1500 Schedule E (Rev, 2-87)
i. a
REV-,5„ Ex + (7-g8) SCHEDULE H
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN
RESIOENTDECEDENT MISCELLANEOUS EXPENSES
ESTATE OF
GORDON PEARL E
ITEM
NUMBER DESCRIPTION
A• Funeral Expenses:
1 WING BROTHERS FUNERAL HOME
2 LOWERS
3 UNCHEON
4 LOTHING
5 HURCH RENTAL
6 ASTOR
B• Administrative Costs:
t• Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees
CCOUNTING FEES
3. Family Exemption
CI '
Please Print or
FILE NUMBER
2195-0257
AMOUNT
6559.00
266.06
405.19
210.42
160.00
200.00
275.00
almant Relationship
Address of Claimant at decedent's death
Street Address
City
4. Probate Fees
C.
1
Miscellaneous Expenses:
SHORT CERTIFICATES
State Zip Code
48.00
92.00
TOTAL (Also enter on line 9, Recapitulation) $ 8 215.6 7
(If more space Is needed, Insert additional sheets of same size.)
cs,
Form t$00 Schedule H(Rev, 7-88)
_. _
+ REV-1512 EX+(1-93)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GORDON PEARL E
SCHEDULE I
DEBTS OF DECEDENT,
SAGE LIABILITIES AND LIENS Please Print of
FILE NUMBER
2195-0257
ITEM
NUMBER DESCRIPTION AMOUNT
1 AUPHIN DEPOSIT BANK & TRUST COMPANY
2
EMBERS IST FEDERAL CREDIT UNION 3234.14
3
ENTINEL-HOME CARE ADVERTISING 1503.96
4
EMBERS 1ST FEDERAL CREDIT UNION VISA CHARGE 15.75
5
ONTGOMERY WARD CHARGE 9.46
6
V CABLE OF CARLISLE 63.84
7
P& L ELECTRIC 23.60
8 EEN MISSIONS 32.62
9 ITED OF PA TELELPHONE 25.00
10 ENTRAL MEDICAL EQUIPMENT 118.14
11 ERICAN HEART ASSN 30.25
12. INTERNAL REVENUE SERVICE-1994 INCOME IAX 25.00
13 A DEPT OF REVENUE-1994 INCOME TAX 200.00
14 ALE N KEMMERER 1994 TAX PREPARATION 20.00
64.00
TOTAL (Also enter on line 10, Recapitulation) $ 53 65.76
(If more space is needed, Insert additional sheets of same size.)
csi
Form 1500 Schedule i (Rev. 1-93)
~ RED/- 1513 EX + (2-87)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE J
INHERITANCE TAX RETURN
RESIDENT DECEDENT BENEFICIARIE:
CJIAIt Ut
GORDON PEARL E
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1 BER J GORDON
38 OLD STONE HOUSE ROAD
OILING SPRINGS, PA 17007
93-36-2936
2 ANICE K HENCH
0 E CHERRY ROAD
UAKERTOWN PA 18951
96-48-2800
FILE NUMBER
2195-0257
RELATIONSHIP
HTER
AMOUNT OR
SHARE OF ESTATE
1/2 RESIDUAL
VALUE
DIAMOND
RINGS PLUS
1/2 RESIDUAL
VALUE
jai - - - -----. _.._..,........~ ..~ mama s~[e)
Form 1500 Schedule J (Rev.2-87)
' ~I,..PEARI.:E..GORDON of Middlesex,Township, Cumberland
County,;:Pennsylvania,.-being. of sound and: disposing mind, and .:-
memory., do hereby :make,-publish and declare .this to be my;.Last
Wi1L.and Testament, hereby. revoking any and all former Wills or
Codicils.. by me ,made.
1.
_ -' I direct that all, my just debts „funeral expenses,
testamentary expenses 'and all inheritance taxes shall be paid
from my residuary estate as soon as practicable after, my decease;
and as part of the admi.nistxation of my estate.
2.
•In the event I should own a Mercedes at the time of my
1 death, I give the same unto mY son, EBER J. CORDON and I direct •
that my daughter,.JANICE K,-HENCH, shall receive in cash. 'an
amount 'equal to th.e>market val.ue'of said Mercedes.
3.
I give my diamond rings to my daughter, JANI:CE K,.HEN.CH,
4 .~
All the rest, resi.due~and remainder of my estate,. :both real
-and personal property I give,. dedise and b.equeath., in equal
shares unto my children, EBER J. .CORDON and JANICE K, HENCH,
~ absolutely.
5.
In the event either of my. children shall predecease me then:;
I give his or her share unto his or her children, per stirpes
and I direct' that the same shall beheld in trust by DAUPHIN
DEPOST TRUST COMPANY until such grandchildren of mine shall
have attained the age of twenty-one (21) years, at which time
uw o~ecs
w~www F. MwnnoN, r. c.
.Page One
Pearl E. Gordon
• _ -they shall receive one-third.(1/3) of the principal sh
remaining and the remainder of said share upon attainin rethe
of twenty=five` 25 ~ ~. age
C ) years, 'During the period of said
the income and trust<
principal may be used in the. sole discretion;,of
my Trustee for the support, well-being and .education of sai '
grandchildren.- d
6.
I appoint EBER J, GORDON as Executor of'm '
in the event he is unable or unwilling to serve n suc'.however,
I then appoint JANICE K, ~ h capacity:;
HENCH' as `Executrix of my estate
IN WITNESS WHEREOF I have h:er..eunto set my hand and seal this
/y*day of 1979.
~Z~ CsEAL)
Pearl E. Gordon
SIGNED, SEALED, PUBLISHED and DECLARED. by the above=named
Testatrix, PEARh E. GORDON
as and for her Last Will .and
Testament, in the presence of us,.who, at h.er request tiav
hereunto subscribed our names as witnesses thereto, in thee,
presence. of said Testatrix and of each other,
..~...
~a„~,:~p ~ ,~
uw olgncec
WILLLr,M F. MAIITSON. P. C.
.. I~
Page Two
COMMONWEALTH OF PENNSYLVANIA) •
COUNTY OF C~E~1ND SS.
• )
I' PEARL E. GORDON
is signed: to the attached or fore ~ Testatrix
been duly qualified accordin g°ing instrument' whose name.
that I signed and executed thetinstw~ dO hereb having
that I signed it willin 1 rument as my acknowledge
and voluntar g Y; and' hat 2 si y'LastmWill;
y act for the purposes therein expressed,Y free
~ ~ ~~
SW°rn or affirmed to and acknowledged befor
the above Testatrix,. this i~~ day of.
e me. by
,"~~?X~,,,-~ 197 9 .
COMMO otar u ~~ ~~„~`,~-
NWEALTH OF PENNSYLVANIA) nv+aY ~ „ ~-~ ;;, rd;r~ry P~~!!c
COUNTY OF CUMBERLAjJD SS . '~• Cum~cr.~r:d Co., PA
. ) ~9 ~mrssion ~*,aaires Feb. 27, 19~
the witnesses whose names are signed ~~~`~~ p6'
foregoing instrument to the
law,'do depose and sa' being dul attached or
y that We Y qualified"according to
theEi~'tE~ GORDON were present and saw
rument as her Last Wi11Testatrix, sign and execute
signed willingly and that- that PEARL, E,
executed it as„her :free ..and vol ntarGORDON GORDON .
therein expressed; that each'of" Y act..for the
°f :.PEARL E. GORDON us `ln-the_ hearin purposes
as witnesses; and ;that to the 'Testatrix g and sight
Testatrix was at that time lg oTSt of signed the WiT'I
mind and under no constraint or °ur knowledge, the
more years of age, of sound
undue influence.
-~--t.~ ,
Address ~
~~a%G. 1~, r'
~~,~~ tea..
~~ ~-. ~
Address ~ ~'' 1c ~
Sworn or, affirmed to -C'?- 0, SQ,~
day of and subscribed before me
. 19 79• this /~~
-.. uw.orrrccs ~ _ _ ~-~c~-- ~SE~"'vyUC.~
WILr,~N F. MARTSON. P.C. ~ - _ ° tart' 1 C -_ .
MAAY LEA SFich:K, nbtory Publk
~~. Currk.~zand Co.,'PA
M> ~~a+ ucpires Feb. 27, 19d!