HomeMy WebLinkAbout95-0272This 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.
AUG 16 200
Date
H7os.~yERS'tED {TEi~: #19
^" ~°"°" FAA: FD DRTE! 4-12-95rc
PERMANENT
BLACI(BIK
~)
Fran eropoli, ct
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS V y
CERTIFICATE OF DEATH ~ ~ 5
(Coroner)
NAMEaP DECEDENr(FnL Midao. Lap) SEX socML SEDLIRRr NUwMeEn ~• DgEOF DEATH IM«wh, Dex Y.•n
+. Daniel A McGeehan 2. Male ~. _ _ ..March 9, 1995
ABE Sap BvMaY) l2VDER,YEAA UNDER,DM DATE OF eBITN BNTTHPLACE I(alYand PLACE OF DEATH(CIpCA aayanO-aM inp1YC50iManalNl pdy
M«Oh DOy Han MInaN (Md~. DOM. 1Y•r) Srr«FO,pp~CaahY)
OT/IER
~J
Vnx ' ~ /`" ^ ERgaPOO«O ^ DdA ^ ~ ^ RaOidpc• ~ (Ep•rAy) ^
COUIfTY OP OEATYI CRY, DPAH FACMIT,'NAMEMnoI inYOfon, OA+pr•a1«M nanh«) DECEDEl/T OFiMSPAMC ORgIN7 RACE-Am«kr,Otlp,,BraL W14O
Or.
,
700 Front Street ~•~ ~•^RY••.•P•aMCWen. rsPK2,n
Cumberland East P
b
p
enns
oro ,,, ;'
°^•"~'•"'~~ ,,
White
.
DECEDENT'6 X2aaF
~ suRWVxx~srousE
(cA~•rroa•aLaa•. mop u.s.ARMEOPORCEST
a•«MAB2r: ao na w.~..e ~ m was. m••mpw~, mm.)
,..^ Ha%1 o.•rar~,YS««,a.,, C~O2• DI•oo.e(sp~ay)
/Operator llmbing & HVAC ,
~'~ 12 u~.«s+) red
.
, Sharon L nn Smith
D~rt~MAara IsY..LOi~rto•n.srr.aPCoaR DEDEDENr's Penn lvania
nt Street ,T•
s,w sY Dia ,T
East Pennsboro
~
.
,,,,~
•.
w..d.•.eaaaYwr
Enola
PA 17025 ~ °a:°r°
""
,
.
I--,
,a a°"'°') ,n. CLI[~lP_S'l.di1(1 10M1w°T ,T•L rAl11r Y~1UY0m~Ib
PR11ER'9 HAMS IFM Midas. Lap) MOTHER'S NAME (FYp. MiaaO. M•idwiS«nrnp
u JOhri E u
S HAMS t<vvdPmd
n MAa2NiAD0RE38(9Y•p, Ca,YWn 9rlO, z+POadN
McGeehan 700 Ftont St. Enola PA 17025
00Ef110D OF 016POSRgN OF ION PIACEOF •NOOOrd C«np«y. C,•nrpy LOCATION•CYylTO~w~,9W, Zlp COtlO
Cr«nOtlw^ R•n,wp hom SlOlO^ IM«+R D•Y•nOr) OtlwPYa
DenOtlen^ OYr(Spaciy
^ March 13, 1995 ~lling Green M~-nrial Park bower Allen 41ap., PA
ACRND AB SUCH LKb1SE NUMBER NAMEANDACCRE980F FACRJLY p~ ~h~,,Trr,,rr~~ F~,~ ~a11 Home
013 340-L P.O. Box 431, lv~w-CUr~berla-c3~d-,rPA 1~p9p~c•
0m M{Ww, •OayYq tlra«am, rnwl•dP.dOph occlarW M•r•m•.dwardPruarbp LICENSE NUMBER DATE SgNED
r•a.n2.err••.aa..p,b .roTw)
orrddW. (Manlh, DaY. Y•«)
22•. bR 270.
0M•M 242~1Mp1o••pnPlp•d Dy TMAE OF OERH DATE PRDNDIXICED DEAD QJOriO~. Day, Year) ri1BCASE RL3ERREDWMEDICAL EXAMINERICORONER7
•~•P~••alpla.ad.pA.
A rox 8:30 A,. zs. March 9 1995 ""~ ~^
27.PART 1: EnrrB»a...a..,O*.r.«mng0aalbprAOa,opr•d,M MOM. DO nOI«0«tllO moe.aa,2q, aualreOnf•c«
LMOrOY Onaap•aneaa,IM. r••phabyrtMt, •AOa[«MpI rIW. ~Appminrb MRT B: Otl•rOgnMCOa mpalblM ••rbOwWgbOetla, 0u1
O~gM MdO h '~•°°~~S rIM ~x~drlYln2 tpM 9iwnInPMTI.
II~Im1Af t CAIIBt IFnel .
~°~ ,. Cardiac Tam onade
DUE TO (OR AS A CON9EOUENCE OF}
i
BOpw•ry 0p omatlam 0
~
IE a•21RDOaYNO DUE IOIOR ASACONSEOUENCE OF}.
1
alw•
.
CMMIB(OrOOaa «'Oyry e. '
M idtlOtltl ewaa DUE TO IOR ASACONSEOUENCE OF):
in dOeOp IABT
MaBAN ALIIOPBV MERE AUTOPSY FMJpNOB MANNER OF DEVH D/QE OP MMAMY TMIE OF 2LIURV MUURYR WORK7 DESCRIBE HOW 2UURV OCCURRED.
PERFOWAED7 AIRAABLE PfIgRTO (M«IA, D•y, `bOr)
COMPLETION OF CAUSE ~~ ~ ~ ^ Vas ^ No ^
pp~~
YM 1N N• ^ 1Y• ® No ^ Af<idO10 ^ P•Mip rVOpippbn ^ ,•,,
PLACE OF2WRY•M M•I•. Mn, pr•sL raary. o,0c• LOCQgN(Sr•e1, COYiTOwn,Srle)
Sukloa ^ Caad rot W dp•rmkNd ^ Op0ao0, O4C. ISP•~ihA
200. 2M. b
. 200. 701.
C03TTIPfA ICMCk «aY ans)
SgNQ OF R
'C23RFY2p)-IIYBICIA
1e
MdAl,ip cwlaad«m when anaMrpliyidanAM P•onounc•OdMNend camdped liam 23)
To 0Nr bal a Dry luwwl•plq o•aB axunM pw b 0,•aOMN•)•M nO,r•rr Y MOrp .................... ^
................................. 2,a De ut Coroner
•MIONOIAICWB AND CERTIFYWq PHYSICIAN (Phyacw LwOi Ppqundn0 de•N and eerdlyin0locauea d tleah) NUMBER DATE SgNED IMOT, DOM. lbsfj
To2Ne.pa•r,r,••bat.,a..n•e•pnw.,p.B•r.ew,.mPr•...m aw b,M ewrylrM«wrrrsMM .......................... ^ o,a. 2,a.March 11 1995
NAME AND ADDRESS OF PERSON WHO COMPLETED CAVSE OF DEATH
QIem 27)Typ•«Prrt A. R
Clark
~~~O
•
~
~
.
BbrONp
l«
i
«Inr•gipOllon,Mmyopinbn,dONhoceurtWtltMUmgaMO.OnaplOep,,,,aa,,.e•B»~.p.~,).Ra ~ 405 Fairway Drive
m•rplOrr•fOld ............................................................................... ..............
iL.
~.
REO 'S SgNRURE AND
~ DATE FILED(Magh, DeY•Y
I
,
)
~
,(
U p
~' /I/
b. .d ~ T ! C
t r i '
fi~~~~~~ ~9~~ RL
e~/•t500 EX+ p.9q
INHERITANCE- TAX RETURN FOR DATES OF DEATH AFTER 15/31/91 CHECK HERE
i~r nVCAEDIT IS CLAIMED ^
_, RESIDENT DECEDENT flu NuMSEA
COMMONWEALTH OP PENNSYLVANIA
DEPARTMENT OP REVENUE ' (TO BE FILED IN DUPLICATE
219 5- 0 2 7 2
DEPT. 2eobol
HARRISBURG, PA 17128-0601 VIIITH REGISTER OF WILLS] couNTY CODE YEAR NUMBER
DECEDENT'S NAME ILAST, RST, ANO MIDDLE INITIAy DKEDENT'S COMPLETE ADDRESS
McGeehan Daniel A. 700 Front Street
o SOCIAL SECURITY NuMBlR DATE oP DEATH DATE OP 61RTH Eno1a, PA, ' 17 0 2 5
198-50-5551 3/9/95 3/30/59 coY
a pr A~ASLq wRVmrw srausrs wwe IIASt, nRSr •rw woaE u+Iiutl SOCIAL SECURITY NUM6ER AMOUNT RECEIVED (SEE INSTRUCTIONS)
Sharon L. McGeehan 15 744.72
~++ ®1. Original Return ^ 2. Suppbmental Return ^ 3. Remainder Return
x ~~ ~ (for dates of death prior to 12-13-82)
,` ~ s cYa ^ 4. Limited Estote ^ 4a. Fvturo Interost Compromise ^ 5. Federal Estate Tax Return Required
~~°
c m (for dates of death after 12-12-82)
^ b. Decedent Oied Testate ^ 7. Decedent Maintained a Living Trust
~ 8. Total Number of Safe Deposit Boxes
(Attodl copy of Wile (Attach copy of Trust)
~- ... _.. :~, : ._ . w _
NAME PLlTE MAILING ADDRESS
sZ Susan E. Lederer, Es uire 134 Sipe Avenue
~ ~ TELEPHONE NUMBER Humzne l s tOWn , P~ ~ } 17 O 3 6
533-3280
1. Reol Estate (Sdutduls A) (1)
2. Stodu and Bonds (Schedule e) (2 )
3. Closely Held Stock/Partnsrship Interest (Schedule Q (3) `I"
4. Mortgages and Notes Receivable (Schedule D) (4) -.
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 15 , 7 4 4. 7 2
_ (Schedule E) - .,
b. Jointly Owned Property (Schedule ~ (b) _
~ 7. Transfers {Schedule G) (Schedule L) (7) -
c 8. Tatal Grass Asset: (fatal Lines 1-~ (8) 15 , 7 4 4.7 2
9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 11 , 8 4 7 • 9 2
Expenses (Sd-edule H) 3, 6 5$. 2 0
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
15,506.12
11. Totol Deductions (total Lines 9 ~ 10) (11)
12. Net Value of Estate (Line 8 minus Lins 11) (12) 2 3 8 ' 6 0
13: Charitable and Governmental Bequests (Schedule J) (T3)
14. Net Valw Subject to Tax (Line 12 minus Line 13) (14) 2 3 8 ' 6 0
15. Spousal Transfers (for dates. ot~ death. ofh~ 6.30.94} 2 3 8 • 6 0 0
0 0
See Instructions for Applimble Percentage on. Revene {15)
Side. (Include values from Schedule K or Schedule M.) .
x:_=
16. Amount of lino 14 taxable at 696 rats- (16) x .O6 _ ~ n _ n n
(Inducts values from Schedule K or Schedule M.)
1T. Amount of line 14 taxable at 1596 rots (17) x .15 = 0 . 0 0
z (Inducts valves from Schedule K or Shceduls M)
o 18. Prindpal tax due (Add tax from lines 15, 16 and 17.) (18j 0 . 0 0
~ 19. Credits Spousal. Poverty Credit _. Prior Payments D'ISCOUnt Interest
o + + - (19)
20. If-line 19 is greater than L1Ile t8, enter the difFerena on Line-20. This is the OVERPAYMENT.. (20)
~ ~^
21. If Une 18 is greater than Line 19, enter the difference on Line 21. This is the. TAX DUE. (21)
A. Enter the interest on the balance due on Line 21A, (21A)
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 B)
Make Ch«k Payaitls to: Register of 11Yills. AgerM
Under penalties of psry'ury, I declare that I have examined this roturn, including aceompanying sct+eduies and stotemems, and to the
it is true, correct and complete. I dedaro shot all real estate hoe been reported at true market value. Dedarotion of prsparor other 1
based on all information of which orooarer has env knowledas.
and
it IYRC Vr •C i KWIV ,110 rVR rlYlrla RCIYRI'1 MVVRC~.1 Y/11c
700 Front Street Enola PA 17025
NA RE Of PREPARER ER THAN REPRESENTATIVE RE GATE
l~'~ ~`ipe Avenue,. '~Tummelstown, PA 17036
b
Act #48 of 1994. provides for the reduction of the tax rates imposed on the net value: of tronsfers~ to or for
the use- of the spouse. The rates as prescribed by the statute will be:
• 390 ~.03~ wilt' be applicable for estates of deudents-dying on or after 7/1/94 and before T/T/96
• 2°Xo (.02} witl _be applicable for estate: of decedents dying- on or after 1/1/96- and. before 1/1/97
• 1 °J~s (.Olj.:wilf ba appltcablr foc estates of decedents dying: on or after 1/1/97' and before-1/1/9&`
• Spousal transfers occurring on or after 1/1/98'. will be" exempt from inheritance taxi
PLEASE: ANSWER THE FOLLOWING QUESTIONS
BY PLACING ACHECK- AAARK { r j IN THE ~kPPROPRtATE. BLOCKS..
YES NO
1. Did decedent make a transfer and:
x
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 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:. ` ` '.:___X
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 considerationf ................................................................................................... ~ x
" ~ 3'". Did` decedent- own an 'in trust for': bank account at his or her deathf....:........ x
IF THB ANSWER TO ANY OF~ THE' ABOVE QUESTIONS 15=YES,
YOU .MUST COMPLETE SCHEDULE. G AND FILR IT" AS PART° Q~ THBRETURN.
w
REV.ISOB EX+ (2-871
~~
GOMMONWEAUH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or
FILE NUMBER
DANIEL A. McGEEHAN 2195-0272
(All property jointly-owned with the Right of Survivonhip must be disclosed on Schedule f)~
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
1. Dauphin Deposit Bank & Trust Company checking
account #0010649972. Balance on date of
death: 1,226.49
2. Dauphin Deposit Bank & Trust Company checking I
account #0023537140. Balance on date of
death- ~
~ 1,304.69
3. Accounts receivable of decedent's sole
proprietorship received subsequent to his
death: j 2,663.54
4. 1988 Chevrolet truck model K3500, vehicle
identification #26BGK39K6J1214791. '~
Value at date of death: j 10,550.00
TOTAL (Also enter on line 5, Recapitulation) I $ 15 , 7 4 4 . 7 2
(Attach additional 8S~" x 11" sheets if more space is needed.)
n~. ~~~~ ~~* ~~-~~~ SCHEDULE H
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISCELLANEOUS EXPENSES Please Print or Type
ESTATE OF FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funeral Expenses:
~• Parthemore Funeral Home 6,373.00
2. Rolling Green Cemetery - grave marker 1,061.36
B. Administrative Costs:
1. Personal Representative Commissions
_ _
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees James, Smith & Durkin
I
750.00
3. Family Exemption ! 3, 5 0 0. 0 0
Wife
Claimant Sharon T,. M .Gc~PharRelationship
Address of Claimant at decedent's death
Street Address 700 Front Street
City Enola State Pp' Zip Code 17 0 2 5
i
4. Probate Fees Register of Wills 48.00
C. Miscellaneous Expenses:
~• Cumberland Law Journal - advertise Letters of
Adrinistration 40
00
2. .
The Sentinel - advertise Letters of Administration 75.56
3.
4.
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) I S 11, 8 4 7 . 9 2
(If more space is needed, insert additional sheets of same size.)
REK1312 EXt (1-9~(
_ SCHEDULE
COAIMONWCAUX OP PENNSmANIA DEBTS OF DECEDENT/
INNERIiANCE 7Ax RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
Please Print or Type
ESTATE OF FILE NUMBER
DANIEL A. McGEEHAN 2195-0272
(If more space is needed, insert additional sheets of same size.)
REV-1513-E% + (2.87) ~
SGHED~ULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EJtAiE OF FILE NUMBER
DANIEL A. McGEEHAN 2195-0272
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
1. Sharon L. McGeehan
700 Front Street
Enola, PA 17025 Wife .1000
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
NONE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I$
(If more space is needed, insert additional sheets of same size)
REV-1649 EX+(g/95)
CO1.~,fONWPwLlti OP PFMISYLVAMA
IIJ149trrAPICB TAX REi V RTI
aESmffi~lr I)tiLFDPNr
SCHEDULE O
TRANSFERS TO SURVIVING SPOUSE
ESTATE OF FileNumber
DANIEL A. McGEEHAN 2195-0272
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, (net of deductions)
which pass to the decedent's surviving spouse by will, int~'Y, operation of law, or otherwise.
Descri tion of items Amour
1 Dauphin Deposit Bank & Trust Company
checking account #0010649972. Balance on
date of death: $1,226.49
2 Dauphin Deposit Bank & Trust Company
checking account #0023537140. Balance on
date of death: 1,304.69
3 Accounts receivable of decedent's sole
proprietorship received subsequent to
his death: 2,663.54
4 1988 Chevrolet truck model K3500, vehicle
identification #26BGK39K6J1214791. Value
at date of death: 10,550.00
TOTAL: $15,744.72
Part A Total: Enter the amount alwwn on the recapitulation sheet in the Decedent Information Section
Election To Subject Property To Taz Under Section 2113(A) As A Tazable Transfer By This Decedent.
If a tout or similar arrangetr-ent meets the nquirwnents of Section 2113(A), and:
a. The trust or similar arrangemnt is listed on Schedule O, sad
b. The value ofthe trust or similar atrarfgement is entered in whole or in part as as asset on Schedule O,
then the transferors personal representative may specifically identify the trust (a-1 or a fracxional portion or percerrtage) to be included is the election to have
such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the tout or similar property is included as a
taxable transfer on Schedule O, the personal tepresentative shall be considered to have made the election only as to a fraction of the tout or similar arrangement.
The numerator of this fraction is equal to the amount of the trust or siatilar arrangement included as a taxable asset on Schedule O. The denominator is equal
to the total value ofthe trust or similar arrangement
ELECTION: Do you elect tinder Sectlon 2113(A) to treat o a tan6k tramfer in this estate all or a portion of a trust or similar arran;ement
created for the sole rase of this decedent's sarrivin; spouse duria;the survivin; spouse's entire lifetime?
YES a NO a 5I;trature Date
Note: If the election appUes to more than one trust or similar arran;ement. then a separate form must be ai;ned and tlled.
Pali B: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, (net of deductionu)
which pass to the decedent's surviving spouse for which a Section 2113 (A) election is being made.
Description of items Amt
1
Part B Tote!