HomeMy WebLinkAbout95-0269a~Gs-OZ~q
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.
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Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLWNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH ~ ~ 5 7 ~
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REGIST 'SSKTNATUREAND ~• ~ ff+ i ~ ~ d~
DATE MED IMell.l. D.Y. Nyr)
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5~1fl848
REV-1500 EX+(11-91) ~"'"~ FOR DATES OF DEATH AFTER 12/31/81 1
INHERITA7~S( RETURN CHECK HERE IF A SPOUSAL
RESIDENT DECEDENT POVERTY CREDIT IS CLAIMED
COMMONWEALTH OF PENNSYLVANIA FILE NUMBER
DEPARTMENTOFREVENUE (TO BE FILED IN DUPLICATE
HARRISBURG,PA87128-0801 WITH REGISTER OF WILLS °~ ~ Da
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENTS COMPLETE ADDRESS
Ctumberland County Nursing Hone
DECEDENT Ar ast Wa a A. 375 Clareitant Drive
SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH Carlisle, PA 17013
200-24-1000 02/ /94 09/08/1930 County Cumberland
1. Original Return 2. Supplemental Return 3. Remainder Return
CHECK (for dates of death prior to 12-13-82)
APPRO- ~ 4. Limited Estate a 4a. Future Interest Compromise ~ 5. Federal Estate Tax
PRIATE (for dates of death after 12-12-82) Return Required
BLOCKS @ g Decedent Died Testate
a 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
CORRES-
PONDENT
RECAPIT-
ULATION
TAX
COMPUTA-
TION
/POA~
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( 8) 14, 651.83
(11> 1, 801.27
(12) 12, 850.56
(13)
or c e ule M.) .~ -
18. Amount of line 14 taxable at 15% rate (1 s) 10, 515.00 x .15 _ -
(Include values from Schedule K or Schedule M.)
NUMBER
COMPLETE MAILING ADDRESS
!/ 7 ~ ~/~u~rlitt G
~//~~e ,r71.1
~ -3 Z6
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 (5L„~^ '"
" 4,136.33
Property (Schedule E) ''"~"`
..~
8. Jointly Owned Property (Schedule F) (g)
7. Transfers (Schedule G) (Schedule L) (7) 10, 515.50
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses, AdminisVative Costs,
Miscellaneous Expenses (Schedule H) (9) l_
-' J 1, 742.47
~.,
~
10. Debts, Mortgage Liabilities, Liens Schedule I
( ) (io) ,s-..~-
~ 58.80
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (line 12 minus line 13)
15. Amount of line 14 taxable at 8% rate (15) 2
335
56 x
(Include values from Schedule K S h d ,
.
(18)
(19)
17. Principal tax due (Add tax from line 15 and from line 16.) (17) 1, 717.38
I8. Credits Spousal Poverty Credit Prior Payments Discount Interest
o_nn~
19. If line 18 is rester than line 17, enter the difference on line 18. This fa the OVERPAYMENT.
ii r~ i" ~ . f
:,....
jll
20. If line 17 is greater than fine 18, enter the difference on Tine 20. This is the TAX DUE.
A. Enter the Interest on the balance due on line 20A.
B. Enter the total of line 20 and 20A on line 20B. This is the BALANCE DUE.
Make Check Payable to: Register of Wills. Anent
0.00
(20) 1, 717.38
(2oA) 0.00
(2oB) 1, 717.38
12,850.56
140.13
1,577.25
g ~ e~lnt >R,
complete~ladeclarePhat all~real estate bass been reported t true market value Dec la atplonyof preparerlothertha tthe personal repheaentatlve Is
has any knowledge.
91GNATURE OF PER
SIGNA~dRE OF PREP/~RFtA~LHER THAN
1'Y~1W1/7 NTF 1208 ~--=
Copyright Forms Software Only, 1983 Nelco, Inc. N93PA001
Rf ADDRESS
See Schedule attached
/E ADDRESS
2913 Wirtdmill Road
Sirilci-ng Spring, PA 1!
edge and belief, it is true, correct and
on all information of which preparer
DATE
DATE
~li4/ gs
Estate of: Wayne A. Arbegast
SI]M~,RY OF ALIACATIONS Ta BE1~F'ICTAI7TF!G
Class A
Douglas K. Arbegast
Scott K. Arbegast
Class B
Terry L. Arbegast
1,167.78
1,167.78
2,335.56
10,515.00
-1994-
Estate of: Wayne A. Arbegast
The following persons are signing the return as representatives of the estate:
Terry L. Arbegast
1178 Newville Road
Carlisle, PA 17013
-1994-
e ` y
~ PA REV-1500(11-91)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~) INPTHE
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 properly without
receiving adequate consideration? 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? ........................................... .
YOU MUST COMPLE1TE SCHEDULE G AND FILOE T AS PARTNOF THESRETURN.
YES NO
~~
x
PA15002 NTF 2881
Copyright Forms Software Only, 1993 Nelco, Inc. N93PA002
• REV-1508 EX+(2-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
ESTATE OF FILE NUMBER
Wayne A. Arbec~ast -1994-
(Ali roperty Jointly owned wHh the Right of Survivorshl must be dlaclosed on Schedule F)
ITEM
DESCRIPTION VALUE AT
NO.
DATE OF DEATH
1 Guest Rind balance of Wayne Arbegast at Ctunberland County 1 862.78
Nursing Herne ~
2 Refund from Hoffman Roth Funeral. Hone of PA Funeral Trust 2,273.55
TOTAL (Also enter on line
(Attach additional 8 1/2" x 11" sheets if more space is needed.)
PA15081 NTF1215
Copyright Forms Software Only, 1993 Nelco, inc. N93PA081
' REV-1510 EX + (2-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~-~-:
SCHEDULE G
TRANSFERS
PLEASE PRINT OR TYPE
W_ ayne A. Arbegast 1994
THIS SCH. MUST BE COMPLETED & FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF COVER SHEET IS YES.
DESCRIPTION OF PROPERTY DECD. DOLLAR VALUE
ITEM Include name of the transferee, their EXCLUSION TOTAL VALUE % OF DECEDENT'S
NO. relationship to decedent, date of transfer. OF ASSET INT. INTEREST
1 AMP Incorp. Pension Plan, Ltmlp Sum 10,515.50
Distribution to Beneficiary, Re
of Ett>playee's Contributions and
Interest Earned
TOTAL (Also enter on line 7 Recapitulation) $ 10, 515
(if more space is needed, insert additional sheets of same size.)
PA15101 NTF 1217A
Copyright Forms Software Oniy, f 983 Nelco, Inc. N93PA101
REV-1511 EX+(7-68)
r
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Prlnt or Type
ESTATE OF FILE NUMBER
Wa a A. Ar ast -1994-
ITEM
NO. DESCRIPTION
A. Funeral Expenses:
1 Hoffman Roth Funeral Hone -Cremation and Casket
2 Hoffman Roth Funeral Home - Flaaers
3 2/17/94 Days Inn, Carlisle, PA -Rocca for Douglas Arbegast to
attend funeral
4 Funeral Repast
B. Administratlve Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees
3. Family Exemption
Claimant
Address of Claimant at decedent's death
Street Address
City
4. ~ Probate Fees
Relationship
State Zip Code
350.00
0.00
0.00
C. Miscellaneous Expenses:
1 Miscellaneous Administrative Expenses to Close Estate
TOTAL (Also enter on line 9 Recapitulatior
(If more space Is needed, Insert additional sheets of same size.)
PA15111 NTF 1218
Copyright Forms Software Only, 1993 Nelco, Inc. N93PA111
AMOUNT
1,148.00
27.07
42.40
125.00
0.00
50.00
REV-1512 EX+(1/93)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENTDECEDENT MORTGAGE LIABILITIES AND LIENS
Please Prlnt or T e
ESTATE OF
FILE NUMBER
Wayne A. Ar ast
-1994-
' FIEV-1513 EX+(2-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE')
BENEFICIARIES
ESTATE OF
FILE NUMBER
Wa a A. ast
ITEM -1994-
NO. NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
A. Taxable Bequests:
SHARE OF ESTATE
1 ~~~ L. ~~~
1178 Newville Road ~0~~ 10,515.00
Carlisle, PA 17013
2 Douglas K. Arbegast Son
44 Iroquois Street 1,167.78
gnnaus, PA 18049
3 Scott K. Arbegast Son
204 Richlarxl Road 1,167.78
Carlisle, PA 17013
ITEM
NO. NAME AND ADDRESS. OF BENEFICIARY
B. Charitable and Governmental Bequests:
None
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS Also enter on line 13, Reca itulation
(If more space Is needed, Insert addRlonal sheets of same size)
PA15131 NTF 1220A
Copyright Forms Software Only, 1993 Nelco, Ina N93PA131
AMOUNT OR
SHARE OF ESTATE
LAST WILL
I, WAYNE A. ARHEGAST, of Carlisle, Cumberland County,
Pennsylvania, declare this to be my Last Will and revoke any wills'
previously made by me.
I. I devise and bequeath all of the residue of my estate of
whatever nature and wherever situate to my two sons in equal shares.
II. I appoint my brother, Terry L. Arbegast to be guardian of
the estate of my two sons during their minority.
III. I appoint my brother Terry L. Arbegast to be executor
o! this my Last Will.
IV. ~ direct that my guardian and executor not be required
to file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I have heCreunto set my hand and seal to
this my Last Will this ~2..~~ y oiG~ 19?5.
l ~ ~~ ~ ~-~-Q ~! I G-~-v~~ C~~~ ( SEAL
s~q~a~~~.
The preceding instrument was on the date thereof signed,
published and declared by Wayne A. Arbegast, as and for hie Last
Will in the presence of us, who at his request, in his presence
and in the presence of each other have subscribed our named as
witnesses hereto.