HomeMy WebLinkAbout95-0273Zl-~~S- v2-~3
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 2001
Date
G
8
H/06.743 Rav. 2/87
TrPEIPwMr
B,
~«
V!1
1
U
U
T
? •
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLWLNIA • DEPARTMENT OF HEALTH • VITAL RECORDS J ~ 4 ~ ~ 5
CERTIFICATE OF DEATH _ ..
,,
~ NAME OF DECEDENT (Fer, Midds, Led) --
H soc 1
~R 05
3282
` oaEOF OEATII(MOrM.Oey16er)
,.
elen -~. Carus >remale a I
_
7
. ..February 17.1995
woEt<arBipWSy) uNDEa1YEM LNIDER1DAr DATEOFewTN BwTHPLACE(Ci,ruq
SUarrl
SI
M
F
C PLACEaFDEAT,IE',tle[ kadyane-erinluca«rana,wrW)
Monar . Dave Haun j MMVr •~~1 a
«
Orrpn
a«Vryq
OTHER:
7 7
Y«.
• ~ ula 1 •
l + 1i arll s 1 e , aw.,r+ ~ ERIOVmrMnl ^ DoA ^ a I': ° ^ RrMwle. ^ (SDeoVY) ^
COWRY aF DF QH cRY. B0110~TWPOF D
ERH FAC0.RY HAKE mnolvMMlion. Brve led anO nndM
p
~CEDEMOF H18A1NIC ORIDIH7 MCE.AnrfkYr
1^deq BIrM. YYhM. ek.
I.
~
!b IO W ^ M may)
yr
.DealN Cdrn
~) ,
,
',.,Cumberland ,~ Carlisle ,~ Carlisle Hospital •~•~•••~
rlhite
1Q
DEC~Nr•streLMlLOCCIwAT10N aNDOFeus„EBBnNwarnv wLSDECEDOREVER,+ oEceDEnr•sEDUCaION MARIDII.STAUS-MenIW stNTVrvWOSPOUSE
(OM dwaM AOrr mar U.S.ARMED FORCES? Nrver ManM., WNOw.Q IS •#e, puemeitlen nrria)
d~wm^al•~) Ca
Ti
tl
li
l
re y„•^ ,~~ ,
r
s
e
rY cor,. PhTM~•atsP•dv)
Rece tionist ~~~ 2„~«a*)
Divorced
-
,~
,,,
DECEDENT'S MAILINOADaaESB RIre.1.OMbwn.Sws. LP CaE•) S V
Penns 7 van; a
sm
^
"~""IL n•
•
,7e.
.
SM~AenbMWtlin Iwp.
2 i~Ie•st Penn street
„_ Carlisle,Penna.17013 ~«~ Cumberland rMrw•iIPT Ne,aao.rxt,~aA Carlisle
». na.~.wrlad.alamrd le«w
RRHER'B NAMEIFiIII. Mittl., Leeq MOTIIEfMB NAMEIF.aL Mitld..M~~ra ' A
St
`"
Ch H . Cams .
oner
LS,Ll
INF'giMANP3 NAME RwrPr.q S MAaIND ADDRESS(91reL CMTarui. sar, ZgCOCS)
Joan C. Mattson 7 ~tra er Drive Carlisle Penns lvania 1 Ol
METTaooF DATEa,gsvosRgN PLACE DF OBIPOSRION.NrraCrnrry,Cnnrbry LOCATION-Cay/ban,SUM, 21P COd.
~
~~"~' «~~
'~"'"I°"^ R°""I'"`'°"I~"°^
DaMOa^ a,
. i
^
North Middleton Tw .
b
22 1
W
t
Q
i
t
ruar
• :>
.e
„~
es
m
ns
er Cemeter nn
SIOI/IYURE SERVICE I.ICEH6EE OR AC(,q AS 811CH LICENSE NUMBER NAMEAND ADDRESS DF FACRffy SS
n,, 008219-L wing Brothers j Olie~ehPe~~~ig~a4~ gg 13
•dT•~r~arSl,Vl,
N eearWrurd MMro Yw ,r,eWOC«erW dtlM IYM,WranOPlo.Mrd. LICENSE NUMBER
DRESM3NED
""" dare. 33Q 0`Y+ L ~'.D.x~f 7
vim/
42S mul 1. c«upl.reW TMeE DEATH DATE lMOrelL Oey, leer) WAS CASE REFERREDTO MEDK.AL EKMpNER/CORDNER?
,•r•ae.elo Pranalnl. eAeeW
ST. MITT 1: Enrrard.eree, inl«Ir rTidr ulrW ara.em. DO rl.nrrar eua.dOyMp..udrrcerdlee«mpMel«Yeeer.dak«MenNMe. ~MPrwMnw MMY: OMr
.rr err an.ecn Mr.
p
b ~~
inn
I~ tliaYl na rrlNaN reiOryllpy
-_
YI®IKiE CAWS
,err «corlEitlon ~ I V I r~ ~
i
no.e,r)~ a. \ . 1
DllE ~ I
Bpr.u.,Y,rc«ramee a ,AA.:. ~j i 1
DUE TO( ACONSEOUENCE OF} 1
~~lN1OdlY,lO
~
1
CAUS[Lgrw«irAey e I
rwrYlpn )aeeN LAST q1E 70 (IXi AS ACONSEDIIENCE Of]: I
e r
VNS AN AUTOPSY VIERS AUTOPSY FMgNDS MANNER OF DEATH DATE OF MLAIRY TIME OFINJURY INJURYR WORIL7 DESCREIE HOW,LIUILY OCCURRED.
PEFiOM1ED7 AMISABLE PRIOR TO ~~. ~,. N,y)
OF CAUSE I--I~-
OFOEAfT1t Ndural L~J ~ NwnMlW ^
AoaV.« ^ P.ndrghmglpdipn ^ Nr ^ No
~/ M.
VM ^ No Vr ^ No L1 Sddh ^ CoWe naM WlerrnnW ^ PLACE OF~,~y.-N ~y
y~
drNt
,.cyay
aMm LOCARON
S
lf
C'
.
.
.
~
(
traN,
ry
in.$gb)
LnieYp, re. (Spedly)
2M. A. a,e. a01
CERTIFIER (OhedroNy one) .
SID
•rn,n~ PNraoANlPnyr~.noermylnv~wedaeeur~.rbe,erpn,~a.nn.ewona,n~.aaeemrwa«nPleleen«nza) OFCERTIFI
~
•awr•r•lr,..e.rneeoaneaeu.wrr
e..Wqene.r«we.eMra .......................................... /
~ L-
........... a,e. L
•PnoNOUNCnaANDCEmisrrrBPHrsIaANIPnv,~.ncann«w~e~,oae.lnerwaw ~ Ioarda..ln
Totlr eMr elnryluwaMa,.. aeaM Oe«Irreartll. tl111.•w,e•ana pleee,eM alrbar
a•rl••1•Irra malerrrrr.e .......................... ^ ~~ ff D•r.Yrr1
1 _
- ,e. --- a,a. '
. .,~,CM~„~ NAME ANDAODRESS OF VRIO DCAUSE DEATH
IIIem 27)Type«PrNr
~ ~
_
Oa tM brie W ulnbrtlon lq/or 6waatipatbn, in my aMrllon, wale Daum, attlr tYm, wu, ana qra, and dw b 1M trrala) arW
mrNlrrsubA ............. ...................................................................................
aL. ^ ~
~
,
~
RH/i~15~\Q1iA~R'93gNANRE R ~
.
az. i
ti G~
DATE FBED(ManM. De `leer)
~„~,
»+
-~(~ Q
>..
~ i
REV-1500 EX + (I t •e I I FOR DATES OF OEATH AFTER 12131191 tH ECK H
~ ~ ~ o...:#~ .
"'
y~
~' INHERITANCE TAX RETURN IF A SPOUSAL
POVERTY CREDIT IS CLAIMED ^
`~
'
"' ~'- RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPA
T
(TO BE FILED IN DUPLICATE FILE NUMBER
R
MENT OF REVENUE
DEPT. 280601
HARRISBURG
PA 171 WITH REGISTER OF WILLS) 21 ~95-0273
,
28A601 COUNTY CODE YEAR NUMI
f- DECEDENT'S NAME (LAST, FIR ,AND MIDDLE INITIAL) D CEDENi' C MPLE ADDRES
Z
W Carns Helen W. 2 We st Penn Street
u SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH
Carl
isle, PA 17013
c 174-05-3282 2-17-95 3-16-17
cou~~y
Q ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
~ ia: u
un.u
y~~
^ 4. Limited Estate
^ 4a. Future Interest Compromise (for dates of death prior to 12-13-i
^ S. Federal Estate Tax
u o. o (for dates of death after 12-12-82
)
Return Required
~ b. Decedent Died Testate
(Attach co
of Will) ^ 7. Decedent Maintained a Living Trust
A
h _- 8. Total Number of Safe Deposit Bo>
py (
ttac
copy of Trust)
i
r
W Z
0: W
O z
u p
o.
ALL CQ,tt:ESPONDENCErrAND.CONFIDENTlACTAX
William A. Duncan
717 t 249-7780
SHOULD BE::DIRECTED TO:
1 Irvine Row
Carlisle, PA 17013
Z
O
d
Q
u
W
m
Z
O
Q
:-
a
O
u
:c
1. Renl Estate (Schedule A) ( 1) ~ P;~
2. Stocks and Bonds (Schedule B) (2) -
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. PAortgages and Notes Receivable (Schedule D) (4)
5. Cash, [lank Deposits & Miscellaneous Personal Property( 5) 11 , 945.36
(Schedule E)
b. Jointly Owned Property (Schedule F) (6) ~y ``
7. Transfers (Schedule G) (Schedule L) (7) '~ `-`
.:~,;
=.._3~
~:.- _ _
~_
I
~,
_,~ _
~~~- -
..
8. Total Gross Assets (total lines 1-7) (8) 12, 145.36
9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 3, 525.47
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
11. Total Dedudlons {total lines 9 8, 10) {11) 3, 525.47
12. Net Value of Estate (line 8 minus line 11) (12) 8, 619.89
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Nit ~/alue Subject to Tax (line 12 minus line 13) (14) _ R ~ h 1 9 _ R9
15. Amount of line 14 taxable at 6% rots (15) x
06
(Include values from Schedule K or Schedule M.) .
-
16. Amount of line 14 taxable at 15% rate (16) _ 8, 619.89
(Include v
l
f
S
h
d
l x .15 . 1, 292.98
a
ues
rom
c
e
u
e K or Schedule M.)
17. Princiaal tax due (Add tax from line 15 and from (ine 16.) (17) 1, 292.98
1 S. Crdirs Spousal Poverty Credit Prior Payments Discount Interest
+ + - (18) -
1^. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT . (19)
~^ -
20. If line i7 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (20) _ T
~g2 g$
,~. Enter the interest on the balance due on line 20A. (20A) ~
B. inter the total of line 20 and 20A on line 20B. This is the BALANCE DUE. (20B)
A1ake Cheek Payable to: Register of W#Ils, Agent
^- ~BE:SIIRE~TO'ANSWER'AL[~Q#
nder penalties of porjury, I declare that I have examined this return,
is true, correct and complete. I declare that all real estate has been
used on ail. information of which preparer has env knowledge.
acwmpanymg scnsautes and statements, and to the bes
of true market value. Declaration of preparer other than
~r my Knowleoge and beliet,
le personal representative is
DATE
DATE
REV-1508 EX± (2-871
~~~
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Carns, Helen W.
L Please Print or Type
FILE NUMBER
1995-00273
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule f)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
1. Farmers Trust Company Checking Account 4611-82498 $11,770.36
2. Security Deposit Refund from Housing Authority 175.00
3. Sale of 1983 Chevy Chevette 200.00
TOTAL (Also enter on line 5, Recapitulation) $ 12,145.36
(Attach additional 8%s" x 11" sheets if more space is needed.)
REV•1511 E%+ (7;88)
' SCHEDULE H
.~. ~ -`~ FUNERAL EXPENSES,
egMMONwEa~Ta of P~NNSywaNia ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN MISCELLANEOUS EXPENSES
RESIApNT AftRDENT
serero nc
Please Print or
ITEM DESCRIPTION
NUMBER AMOUNT
A. Funeral Expenses:
~• Ewing Brothers Funeral Home (Death Certificates/Hair) 49.00
2. Westminister Cemetery Grave Marker 599.00
B.
2.
3.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Administrative Costs:
Personal Representative Commissions _ _
Social Security Number of Personal Representative:
Year Commissions paid
Attorney Fees Duncan & Otto P. C.
Family Exemption
Claimant Relotionship
Address of Claimant at decedent's death
Street Address
City _ State Zip Code
Probate Fees Register of Wills.
Miscellaneous Expenses:
Cumberland Law Journal Legal Ad
Joan Martson reimburse car repairs
Carlisle Imaging Assoc. x-rays
PP & L. final bill
UTS final bill
Carlisle Hospital Medicare deductible
Belvedere Medical Corp.
Walnut Bottom Radiology x-rays
Darlene L. Moyer Personal Taxes
TOTAL (Also enter on line 9, Recapitulation) $
1000.00
400.00
40.00
46.00
54.65
9.11
37.15
696.00
146.69
21.12
9.90
(If more space is needed, insert additional sheets of same size.)
REVNSII EY+ P•Rq SCHEDULE H
~~
FUNERAL EXPENSES,
COMMONWEALTH 0/ PENNSYLVANIA ADMINISTRATIVE COSTS ANC
INHERITANCE TAX RITURN MISCELLANEOUS EXPENSES
RESIp~NT DItIDINT
ilA1C VP
Carns Helen W.
ITEM DESCRIPTION
NUMBER
Please Print or
M ER
-00273
AMOUNT
10. RWC Emergency Physicians ER
11. CP02 Oxygen Rental Equipment
12. Carlisle Ambulance
13. The Sentinel Legal Ad
TOTAL
17.44
280.50
56.79
62.12
3,525.47
I RlKISI~ E%+ (2~
i
~w<TM a rl~s
s+emrr~wos tex a
ssaoser owe
TATE OF
Carps Helen W,
NUM ER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1' Elwood Carns
137 Brookwood Drive
Carlisle, PA 17013
2. Mark E. Carns
2141 Main .Street R.D. 46 1
Corpus, NY 14036
3. Charles H. Carps
40 Heritage Road
Hilton Head Island
S. Carolina. 29928
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmsnrol Bequests:
1.
FILE NUMBER
21-1995-00273
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
Brother ~ 33 1/3
Brother ~ 33 1/3
Brother ~ 33 1/3
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Rsmpitvlationi
(If mop space is needed, insert additional sheets of same size)
SCHEDULE J
BENEFICIARIES
S
AMOUNT OR
SHARE OF ESTATE
v lla\ v-s Ja.a a a JV CIC Vf'1~YVf\~. 1'1l\ T V11V
1 L =
rf-+t.t si s
Rl~V-1547 ~X AFP C 1St-94]
tir[rrn of pBNSVtv~an
a~tic9er oF.:gaAOe~ No~rn:E OF LMEtR1TANCE TAX ACN 101
^1daE1W OF DR~ItdINL rA~S APPRAISBkIIf, ALLOYANCE OR QnAI.l.ORA1MrE
n@T. tde~oi OF DQ011t:TT01ds A[O A1EItt OR TAX
~, aA inxd-~su HATE 09-04-45
DAT& ~ IIEATH Q2-I7-95 - ~a~o :w. ~+ ~a-ucia
CQ[IN'[Y CUMBERLAND
NOTE: TO INSAlRE PROPER CRltD:T TO YOUR AOCOwtT, SEMQT TEE tR'PE! ldR7'tCM OF TNtS PORN MI7N Yq[IR TAX
PAYMENT TD THE RECISTE! OR illLt,S. HAKE tSEpC PAI-AEI.E TO "REii3'tER OF NILLS, AOENI"
REMET PAYMENT TO:
YILLIAM A BUNCAN
i IRVINE ROY
CARLISLE PA 17013
wr uoWa TI~YS ~_~
REBISi'ER OF WILLS
Ct8lBERLAND CO COURT HOUSE.
CARLISLE, PA 17Q13
Aso:a. Rss+ittad
~.._.
Fad YOUR ~ -r
a=~n~.to~en~ of ~aucTxoNS i~""'_r..,~.." .~..~:~..~.~ ~ - --- . _.-_...._ ..__ _.._
AEIfT OR TAX
T~iTATE 9E t;ARMS t1ELEN W It2LE NO. 21 95-0273 ACN IQl nATg 04-04-95
TAx RlTMM1 NAB: t X 1 ACCErT® AS FILM t ) ClIANiED
AwNeA=spa viu.~ o~ rttte~ ~AS® oH: a~seltrAL REruRN
1. Rlrl Ea1~ tSaF:aduir A) tl) .OD
s. Sfise~es and Sonda tsal,.dui~ s) [2y . p
3. Ciosaly Nrld Stoac/POr-t~rship LY6deasE [~d~duL C) t3) .00
4- ~taa IUdods~bla [Sd:.Ania D) t4) ~ .00
. 5. caeh/MNc Os'ositaJNLsa. Por~e:a<i lrooarty iSo1MMk:)a E) t3) 11.945.36
e..)os:~thr o:w,.d Prap.rty cSet[ad~is F: ta) . oe
~. T:-~:+.~s csa+.d~s s) c7J tto
i. Total Assns ta) 1l , 945.34
APPROVEII pEOtICTIONS AqD EXElIPTIONS:
!. F:a:aral ~naadA:Ar. Costa/N3ae. E~snsas (5olfad[:J,a H) t9) 3,525.47
10. D~b~ts/lbrtOar Lidsi2141aa/Lians [SrJ~:I~ S) [id) , QQ
21. Total Daduetlans till z_ ~7
l2. lldt Vsiua of Tact ~n [ix) 8:
419.$4
13_ t~r2 Eage:~sfs CSatrdula J) t13) .~ ,,,
fl~
14. Nat ltalua ark Esta~h S:biact to Taoc
_.~ ._
tl4) ,-----.-~
8,4!19.89
~
r~leOt ft~u~S that 3nexlNdt t'!1O 'pfd ;~'-
~L
1"i~Yr113 8~S*d~1~,de't
~.-~__.....
,
Asst aF rAx: !.
i5. A~Irotst ~ «:,. ~~ at spaedwi r.t. e~~ . na X . a3, . 00
ib. Aaaur! of Lte. 14 taawbia e{ Lsn.ailetaas A rst. [sa) .00 X . 0~ .00
i7. Aao:att Of tine i4 taucaul~a of f rvh [I7) 8,419.84 x .15, 1,262.98
iS. Prineip$ Tax Dua cis) 1,262.98
TAX tXtESITSx
PAYMENT
RATE R~IPT
1RD'BEd; D~OlR!! (t)
[-)
AlIDIRtT PAIg
6-Ob-9 AAi! 4 - 1,24 .
TOTAL. TAX CREaIT 1,242.98
sA~.AMCE OF rAx ~ so.oacR
~~T . 00
roru. ~ 3Q . oncR.
* IF MIB AFTER WITE Do1CATE0, SEE REYERiE [ IF TtK1'At C1iE IS LESS THAN sl, ND PAYNEKi if SIRED.
POR GtCYLATTpt OF AsDZTiOItA! ~tYlR'liCT. IF TOTAL DUE IS RIfLECiED As A ^Gdi~T" {GtJ, YOY IIAY DE DYE
a QFF7ito _ sPA' lRf1ERSF 3lDE tIF TNffi lORtl FOR INSTtRR;TIOIL4. ]