Loading...
HomeMy WebLinkAbout95-0274This 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 Fran eropoli, ct Division of Vital Records P.O. Box 1528 New Castle, PA 16103 N105.149 Ray. asT TTPE/~IMT EI OEIMIANENT aueN wN ~l i 0 U W D Z COMMONWEALTH OF PENNSVLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH 025837 390E RLE NUYaBI _ NAME OF OECEDEMIFial. Middle, Lay 8EX SOGAT SECURRV NUMEER DATE OF DERNdAVdl. Daa'~r, _ '' rt S er s hale a- 196 - 07 - 8110 ..,4~ ~ S / S 9S AOE M1.+slm~a.» uNDOII TEAR uNDOI,Dw DaEOSe.m, wn.uce PCMa•d rlAC[os OFRNICnarMaNyan-ya•~rawaaonon. adN MWrr = Da,a Nwa ` Ma,ar IMa.an. DaK,\Mrl aaYwFargn CaarM rn< r 21 190 ,Harrisburg,P ~ ^ ~^ ,~ ^ ^ ^ eouNTraEDERN cm:eoao.Twras DERV NAME Eraa.Mrro•.wr.nw aRIDwT RACE-ArNlunlad.ti Mra.wMr..Ie. ~ SP:-;>~ ~S ;~"~ Mraraa.Pr.,aRlrr~i,al~yDWr~ ,~llhite uEIIAL IoraarwlEwESawousrRV wASDEDEDOrt EVERw DEDEDe~TrsEwcRIDN MAR191L STRiIE•MaMw wndr.oaam. ev u.aARMEDwRIiMS'r am.o•.w a.awarKaerl: n"P~.a~ ws^ No Dc °^.wa.m"e.'r roro. "~aw•~"~oao ++ / ffi er leis rdwre Sto , '613' 12 "'n6" ,harried , Viola Diehl s~~~~~`~~'~`'a°~"" ,T..sw. Pennsylvania DM ,Ta.® M..d.a.dNaM.Y._ UDDer Allen Twp. 757 Alleghanyr Apartoente ~. °n0in1 ~' Mba n heohanioabur PA 17055 °l"r7dj ,,.- '°^~~ „~^ ~~ /R1FR6NNIE IF•,L MNrr, lay NAME FK Midsa MddnaunanW Cha les S. S a er Aaaa Shoo wioMlAwr'aNAME4ioMh4 E MAEJYEADDREEERaarCaM>~a. SIa.DpCaey ,,,E,,,~a 6342 Ste en's Crosei heohanioeburg, PA 17055 erwC3 a.arw^ R«aora•Msr.^ °is~ :a °rrre. -N•l••ac.•NINrILti•a.arr -~+rAe.WalrAarc•r °oir'°^^ ~~ ^ hash 13, 1995 Rolling Green Ceoeterq Lower Allen Twp, PA ra osgINENALEEIIVICa ollrEnsoN AssucN NuMEER ANOADDREasosFACUn ppeeZZ er Me - 011667 L aas 8 Market Plaza llaq heohanioebur PA 17055 ~~~ , . g, rar^wwrar.r N ~~1is"4°c•.arn«a.nsrwam..dwaneownw.rs ucENSENUMEFn ovEaDNEn arayaauaardar0. D•1.1~aA ~r •nap~~•••a •eM Oi DERN PRONOUMCF.DpDEM IMa+n.DwI M•~1 wISOABE nEFEmE6W MFpOAI OfAARIEappgpHERi 7A. MRTE lnl~oana~iM>•iinanrw lM arn.D•nr rar ar nwe•tlR1Yp,NrArcra•eanryaray arnr.rcaar A•r1 aY4aa. ~MPaaaarr /AIIT E: Owar 'a M~~ EMIEDMT[CAIgE1Fnr ia~rq~ n•INNAYq filar u~dNyyq con6tla+ -7L-~ , NrYrpnd•+~I-~ +V l i DUE A (OR AS A CONSEOUENC£ OF}. ~ i Ean„Nadaq MiraalaN Filler lll~-EIE DUE 7OlCR ASALONSEOl1ENCE OFk I CAUEE~praallav}av nr idYYd•l•iO DUE IOIORA$ACONSEOUENCE OF): NaAinp:ndwnl WT I a MMSANAUR7PSY lvl/~A{,IdsY RNDw0.9 MANNER pF DERN 1 1'ERFORLIED'1 AvAa pNORp O ~OFDgIN~ TIME OFWJUM EiIURYR WOfwT DE3CPoBE lIOwN~AJ1IY OCCURRED. OFCAUSE . DEIQ111 Nagar NaWitiGa ^ AttidNa ^ r~«raaya•,.rla.llaa ^ 1M ^ N• ^ ~~~--,../// 1M ^ N•l~ ~M ^ No ^ &YeM• ^ CaW notMA•NnNnM ^ Y• (\ PIACE Of w,AIIIV • Nn•ma Nrr rr.r 4aI•r%aMCa , , , Ra•rt C.Mkn. Sway - ar. H, ~ q. re. ISpr1y~ OMRM7EIlIGrck ar,'arW ar• - r ' CBRVYNE w A nE1C1ANl~r•~~+.ocauraeri+M+arw Mr>o<in MSpawcw MO~ana~nml•bClbm 2a) ~ (1 •ry Mawll/ d d r Ea. l aacvndOwbOrpuw(qr~/wwwa••MMi .................................................... /A h \.~ •MIDNDIINCwO AND CEIITIFYEq PNYa1C1AN IPI~va~can pmwicnq a.an r.d crt/yvgncau>dosr.) ,[ ~~M"~. TeaNSraa•r,ane•adE•,arwaaaar.wrwara,ara.rrol.e.,.Dena.ledNerNyNrr•~r.r...rrw ............. ^ a, -~ T~-~ - ............. a, 3" /7 ~~ . MEDICAL EIUIMINEA/COpp11ER (E•r~13~A001ESS OF ~RED"~COMPIE'IED OF DERV ~,,/~ On Na Mab d aaaMMNbn rtl/OrMVaallyNian. N m,r aplMon, deaM aecwrad r EN tlma, dra. and YM r RIM ~' M f [' ~ ~ PU ti r.P V ~ ' Waea anddw blM eauaa(a)rW V~ j/ Mannar as OahO . ............. al RE019TRM'S SIGNRURE AND R ~' DREFnEDIMUia.. D•Y.'A•rl a~ ~. a.. ~ ~' c ry %/ / 9 93 c. _~„>, `REV 15UL`EX+ v ~~ (~-Y41 t' INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12!31191 CHECK HERE IF A SPOUSAL -~ RESIDENT DECEDENT POVERTY CREDIT IS CLAIMED ^ COMMONWEALTH OF PENNS`?LVANIA DEPARTMENT OF REVENUE DEPT 280601 (TO BE FILED IN DUPLICATE FILE NUMBER ~ I ~'~ ~ Z`7~ . HARRISBURG, PA 17128-0601 WITH REGISTER OF WILLS) COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIALI ~~ ~ DECEDENT'S COMPLETE ADDRESS C . ,Stu W SOCIAL SECURITY NUMB R DATE OF DEATH DATE OF BIRTH ~:~ 7 ~J)~'~J~ ~I"~ ~ ~(,,.,(„~~ C `" 195-0 - 3-9-4~" --2 - ~s counr ~~ ~ I p (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FI RST AND MIDDLE INITIAL( SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONSI ~P~ Lam', ® 19 - 40 -(vZS3 ~++ ay ~ I. priginal Return U 2. Supplemental Return ^ 3. Remainder Return ~ ee x W dc~ ~ ~ o ^ 4. Limited Estate ^ 4a. Future Interest Com romise P (for dates of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required am ~ b. Decedent Died Testate tt ( A ac h c f Will (for dates of death after 12-12-82) ^ 7. Decedent Maintained a Living Trust _8. Total Number of Safe Deposit Boxes opy o ) (Attach copy of Trust) ~ {i ~ ~ r ~ ~ ~ 4RiF-~wR'ggf ., NAME ~~yy :i7?i.J.- -:..'~ .. r'.. v -i ~ ~-~ - ., e .~Y'~: a `yr~ ~~ di:~ ~.. h S ~~ ' ~. ',~, ~ ~ COMPLE IL DDR S , oz ®1~ r 64N~rt-~12 I,,3~.L S~tA~'s C' Uzo ~S~e,•}C - ~~ TELEPHONE NUMBER -5 2 (off' r )UIEC.~p.9 i G S~3 UcJ2~r . ~,4. ~Z~ ~~' z 0 e J a v 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) t 4. Mortgages and Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) b. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) (Schedule L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line B minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 4. Net Value Subject to Tax (Line 12 minus Line 13) z 0 a ~- o. 0 x 5. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicoble Percentage on Reverse Side. (Include values from Schedule K or Schedule M.) b. Amount of Line 14 taxable at b% rate (Include values from Schedule K or Schedule M.) 7. Amount of Line 14 taxable at 15% rate (Include values from Schedule K or Schedule M.) 8. Principal tax due (Add tax from Lines 15, 16 and 17.) 9 C d't S (1) _ (2) 41a ~~ ~ a t7V (3) -. (4) ~- (5) _" (b) (7) (9)~8: 12:4.0 (10) ~" (B}~9.yoZ~a~ (12) ~Oo $ 9 t CoC~ (13) (la) ~-o l 8B9.~0 (15) ~-Zp . 8894 fdO x. Q~= -~r~9-/~ -~ e; -~ (17) x .15 = re I s pousal Poverty Credit Pnor Payments Discount Interest + + - 0. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. 1. If Line 18 is greater thou Line 19, enter the difference on Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A. B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. Make Cheek Payable to: Register of Wills, Agent 1181 ~~ ~ '- (20) -~ 3 (21) (21 A) __ (21 B) n er enalties of er ur , I declare that I have examined this return, includin accom an In schedules and statements, and to the best of my knowledge and belief, it Is true, correct and complete. declare that all real estate has been re orfe at true mar et value. Declaration of re arer other than the personal representative is b on all information of w ch preparer has any knowledge. SI A URE ESPONSIB FOR FILING RETURN ADDR SS ~ - . v ~~ ~~ ~~~ _ DATE /'~ ~ ~~~~~ ~ ~ ~4~a SI TURE OF PR R OTHER H R RESENTATIVE ADDRESS 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 rates 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 • 290 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 190 (.O1 j will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1198 • 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 c. retain a reversionary interest; or ................................................................................... d. receive the promise for life of either payments, benefits or care$ ....................................... v 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$ ................................................................................................... 3. Did decedent ~-n an 'in trust for'. bank account at his or her death$ ...................................... ~,.. -- _ I:F THE AN$11~IIER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST ~MPI.~TE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~-- ~; _ ~ ~ ~ ~ µ ~- C..) U %fV-1503 EX+ (4-66) r` a CAMMANWFAITU nc ee~~ SCHEDULE B STOCKS AND BONDS "ZS'7 IM ~ ~S i i~1N1 V i L I..IA lr'E w~~c.~-i~ie~t~~~r, ~.• ~~.~~s (All property iomtly-ownod with R ght of Survivorship must be diselos~d on Seh~dul~ F.) ITEM NUMBER DESCRIPTION 1. ire Z ~-~'s ~~~~`.a-~N ~~~tT r~ ~~,,~. iM V> 2~•i~- 9 , 1 ~ 4 S PRl C >= Z 43f~. TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 2~-~az s 29 ,; 50Z, REV.I511 EX+ 1788) 1 r1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or ITEM NUMBER DESCRIPTION AMOUNT A• Funeral Expenses: ~. M ~~.Pe z z t fiu Nc-vzw~L l~w~-~ 4-, ~ ~Z i ~ ~+0 t4N~R~taKEa~E;w~~9Atw~iN~,..i-r~N~~e,r~rrq.-nog ~e~sKE1~~ ~.ow cu1Sl C ~.~ ~,~,, ~ L~j I Vr~-v~''~'i W1.V~gLY-~cL ~ OP~+sc-.9 tom. ~e~ ; ~ 1°zb •e-o B• Administrative Costs: 1. Pik©tJe 0t~~ s ~ 3000 f-nii..U~trE Zo Nesr, '~'iow bz-ro2w~~y ('~,~,~ ~9oustl L3i~~c's ~ 4 b t 40 ~N~~ Nou.~~ v~l,~w,~~~ ~t~o wzt,~s x. z y 2. Attorney Fees 1So,~-o 3. Family Exemption Claimant V i©LW ~~ ~f}/J i'~.~1P Relationship ~ l ~~ CrOO~Q Address of Claimant at decedent's death Street Address ~1L1~Si iA~la ~i~.l.•fQr~ City 1MEGL~A~ iC ~ 16 tr,~t~. State ~_ Zip Code ~°l d S~ 4. Probate Fees CV~3~~.~v4tJD ~f.~ , BZ~~ C• Miscellaneous Expenses: 1. 2. 3. 4. 5. 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) I $ SAh (~ do (If more space is needed, insert additional sheets of same size.) v ~~,., C: "4 i 4,; , .-_.,1' "`:a uuf"7 G'~ ., F ACN 101 DATE 09-04-95 ca i r~ i e ur arHnuL.trc L 5 FILE N0. 1 - 0 DATE OF DEATH 03-09-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: REV-15k7 EX AFP (12-94) `CONMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG, PA 17128-0601 DONALD C SPANGLER 6342 STEPHENS CROSSING MECHANICSBURG PA 17055 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LONER PORTION FOR YOUR RECORDS ~ -------------------------------------------------------------------------------------------- REV-1547 EX AFP (12-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SRANGLER C S FILE N0. 21 95-0274 ACN 101 DATE 09-04-95 TAX RETURN WAS: ( )ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedul• A) 2. Stocks and Bonds (Schedul• B) 3. Closely Held Stoek/Partnership Interest (Schedul• C) 4. Mortgages/Notes Recsivabl• (Schedul• D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedul• E) 6. Jointly Owned Property (Schedul• F) 7. Transfers (Schedul• G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedul• H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests (Schedul• J) 14. Net Value of Estat• Subject to Tax (1) .00 (2)-_. 29.502.00 (3) .00 (4) .00 (5) .00 (6) .00 (7) .00 (g) 29,502.00 (9) 8, 612.40 (lo) .00 (11) - A .61 40 (127 20,889.60 (13) . 00 (14) 20,889.60 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat' (15) 20,889.60 X .00_ .00 16. Amount of Lines 14 taxabl• at Lineal/Class A rat' (16) .00 X .06. .00 17. Amount of Line 14 taxabl• at Collateral/Class B ret• (I7) .00 X .15. .00 18. Principal Tax Due (lg) .00 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST (-) AMOUNT PAID 05-26-95 AA047811 .00 595.34 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT 595.34 BALANCE OF TAX DUE 595.34CR INTEREST .00 TOTAL DUE 595.34CR ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ''CREDIT" (CR), YOU MAY BE DUE _ __ _ fiiN/-1470 EX i6-9F! ~ ~~ INHERITANCE TAX COMMONWEAITh OF PENNSYLVANIA EXPLANATION BUREAU OF INDIOV!DUAL TAXES OF CHANGES DEPT. 28(601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER u • jtuart ,~;anfler 2I ~5-i327~ ACN IG1 SCHEDULE STEM NO. EXPLANATION OF CHANGES ~,ct ?_1 of I99~ reduced the tax rate or: transfers to a surviving spc,use 3ru„t 3 percent tc 0 percent fcr dates of death on or after January ~, ! 9'35. ~'he estate. record i7as been adjusted ir: accordance ~~ith the ct3anpes. TAX EX4MINER: i~euorai~ as:ii n~ton - PAGE