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HomeMy WebLinkAbout95-0279ai -g5-oa~q ~~~- H108.lq Rw. 1/87 TrPE»a1NT M PEIMIANENT MACK eet .v .~ 1~ ly r I!1 z W U W 0 Z 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. Date AUG 16 200 ? . Fran eropoli, ct Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH 037121 SDPE I~ NUlaeffl _ 'Aari _ ~~ "0 DATEOr oERNdlo.w D. ~ ~ ~" "` ' . y. ,. Female ~ ~ 7956 :. '~ - ~ PRtL -t ~ /995 AOE(laol s:.w.» UN0E31t rEM1 twDEntowl oREOSemN alRrtrlACe(rivw tvACEas DEaNeal. ~«+ra»-e......~a•.ol.ax. sdn MalY1a, 1 oe,a Haw ( lraaw .I(N'b^1y~•w ~•n 5tarafaepn Caa*N i~os~~o1~~, ~~~ rn. 1915 7 Cbarlbid County, PA YIp.YrO ~ ERp„pye,• ^ DDA ^ ,~ ^ RaaiOwMe ^ ~„ ^ cawnoFDE.vrt arr,eow.nwocDERN NAMEnna.wlYOn.oVasy..uandaeasl oPNiePANleonGwv RACE•Awwiwnbarl,ebdl,wMb.aa s a~ P a.>w..~.,G~., ~ Fl PH 1N 1-lA 22 t c.c.~aJ tL M 6A tc.a t_ Ce+u tc~ Matloar. AaObRkan. e1n WpeCQ4hite DECEDENrs occlYaeioa YwoarsuewESSnNOUSrRV rws /w 1(~~w•'•(~_~?!~ EvENw ot:cEOENr•sEDUCietoN MAR181L8D8Ue•MrrtW l~w(k_dar Mq mer u.a MZ•IEDra~ INw MmIM Mlldw•4 tl i d I a MW • I 118x' n w^ raCT ~ ~"M; W(~p (, I tt n t u ta. , oECEOENrsMAILNpADONE8815aeaCaN~b•n.9Yb.ZpCoeN DECEOEtei'e t7a.star DM t7a.^~M,deoedaatMein 512WalrtutStreet ~~~ ,~ M M L Hilly Spkgs, PA •„ ~ " t~ CUmbeft8(lti b~+'^+~~ ,xU-.wllna~irre~s.a ~' ~y s ~a s t 0 8 ~ ~ 'IU , S ~on~a tSBS3 ~~~~ ~ wwr ~ rt ~ M Et ~ ri~ tlo11111e nTOens011 4~s sr,z~ 19~Ha1FMMDrIw ~'~ PA 173'MG~•( METHOOac D.acos Drero:dnoH P1ADEOS OtsrosrrtDN-NaaaacwMlw7, clwrb,y ~ocRIDN-CM4•a. ealwmcade cn.~^ n.n~w.lnaaelr^ ~ ^ oan.Yw^ on«~wt M 110, 1995 MLHd :tw ~ ly SwM9e CM~y Mt Holly Swinge, PA 17065 OF FUIIFJIAL DR PEt18p1ACT8q AS elICN LY.~1i8E 110. ?td ~ANDADDReaeacrAClutr 1589-L 501 N. liellkllofe Ave., ML Holly'Swklps, PA 17065 xu . YllelawM0l~atime adWl ~~~T~ d7•~arh auvndr M0100.er sldpbCO•Ir•d. M~~q ~ aawadww D A~ 2ed8 aM~MaanpYMdty oc DEaN DRE -RONOUNCED DEAD iMaIN. Oay, la.,, rMe CASE REt~WEDlO MEDICAL F.XAM1lU]iICORpNEp7 tlMeOn •M pnaMlYlcw chew. ^ ~ rb ' ~ ' L 't q ~ '^ rw w l7.tM111 r. Enw we al•eeaea. +Nl.+waaaar+Yon. w+au~..ddraw n. DO ea«rrw aoe.a LYeea,abaar en •aGtM. paq, weilrul~saeslwpealorya0••L aaxaa MOn hMae. ~Mpa•eaae tNWTw OYw aiaY'+aaolWsmm~YMYpMdnY401t j IeelMgnllM wdonyYgaMwprYlia tMAf I. t1a1®Mli[CAWElF l01 ~ I ~ty ~ ~ alaeraeondem ; . wa~Npin d•owi-- Gli.t./~/v~( DUETDpR ASACgISEOUENCE OFl: 8quenwtp.Ii~eendYbM p ~ 8~~1tNOB{Yw0 011E W(ORASACONSEDUENCE OCk I CMMepiNOairij0y ~ ~ Nie1o0 Mas OlE W IDR ASA CONSEpJENCE OFk AalYlgin d•YnILAfT a i Mr1e aN ~"'w~EnocDE ~ ~~ 'ERporoeE m w~ 1nnon , avEOSruuRV nwEOFUUUm wYiRraNOrm7 DESCrveENOwlNxmoccuwED. 1Yh Plo.et DaY COMPLETM3NDiGISE OF 0ER7n ,,,/ NauMl L7 Nancid. ^ • / Aetlbnt ^ PMlirp Irneodeallon ^ Na ^ No ^ Imo qa ^ No OU rw ^ No ^ 9aoftlo ^ CdYd na b•dN•wird ^ M• PLACE DF YWB/RY-AI M•» N,N an.L t.aerlt enlw LACQION 1.a. w. , , (Strsol.CM~.sla.i aYlana.w.ISO.Wt celrYgwlna+.a.a+r o.w 1a.. ~- 'CERfYq'wO PIIYe1CW1(PnY+Oal^~OI1.5 uus adaaN avn aMNar MY1~' Iu~Paiarlcad dra anaca^ololed MSn 231 low.u.aaroYn•.I•+w.d.aneceun.as.t•Yreuwlu rain.nn..wao.d ..................................................... ^ SM'aNRUREAND aF ~lw '-NONOI1NCNp AND GEATIFYINO tM7rSICIAN iPCyYe„O CON wa~a^90eatl. arMcvvyngbw.ueawaN) Te YN tMaanry ltroa•dY• duwaawndalM tlnb dW b d LICENSE NU ' ORE SKiNEO . I/ - S oOf . . ,M aae.,an wablM eau•N•IrW•unnwra•Md .......................... ~ ]ta j O4 71 d. /r' •Iw~lcw ExAtrteEtvcowoNEn On 81e Eeeb of wamNalfan a dl i NAME AND ADORE830F WIq COMPLEiEDCAUSE OFDERH rw «Plan (Ilan 27)T ~J'c~ f~cy ~u o, n ar nveaLyaBOn, b my opinion. daaw occurted al Bb time. dab, and place, all dw to ill uusa(q and lanlnw a a.ad...... C' ~ ~ ~i.+e Ceh lU ~ Y ^ ..... ............................. . ,V GISTRAR'S SMiNRUR D NUMBER ~ /~ ~t` ~ \ ,(`~ I ORE flLED (L1OON. Oey, Ywrl 37. .C ] V ~-!~J ~J\ ~ . 3•. r ~ 60038311 -~.~=~~-~a REV-1500 EX+ (7-94) ~ INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 14/31/91 CHECK HERE IF /- SPOUSAL RESIDENT DECEDENT PoveRTy cRED1T Is cuIMED ^ COMMONWEALTH OF PENNSYWANIA DEPARTMENT OF REVENUE (TO BE FI4ED IN DUPLICATE FILE NUMBER HARRISBURG; veA04i°~ize.oao, WITH REGfSTER ©F WILLS) 21 95 0279 . DECEDENT'S NAME (LAST, FIRST, AND MIDDLE I ITIAI) Nelson Betty R COUNTY CODE YEAR NUMBER DECEDENT'S COMPLETE ADDRESS , . 512 North Walnut S;t. W o SOCIAL SECURITY NUMBER DATE OF DEATH '' DATE Of EIRTN Mt : , -. ~ HOl ly Spr 1ric~ S , PA 1706 5 " o , , ... - ..; - - 4-7 6-1 -15 ceu Cumberland :r' ~.~... pr ArnicAatFl suRwviNO s-ousE'S NAME,LAST, FIRST AND MI INmAy SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) ` 'j' -- ~ Y ®1. Original Return ^ 2. Supplemental Return ~ ^ 3. Remainder Return w u+ o_ w xo J ^ 4. limited Estate ^ 4a: Future Interest Compromise (for dates of death riot to 12-13-82 P ) ^ 5. Federal Estate Tax Return Re uir d w ~ m ^ b. Decedent Disd Testate (ior dates of death after 12-12-82) ^ 7 D d q e c (Attach copy of Will) . ece ent Maintained a living Trust (Attach wpy of Tru:t) _.8. Total Number of Sofe Deposit Boxes . f- c= W. S. Daniels, Esq e One. W. High St., Ste. 205 w~ TELEPHONE NUMBER Carlisle, PA 17013 717 243-3831 - 1. Real Eatote (Schedule A) 4, .900.00 2. Stocks and Bonds (Schedule B) (2) 3. Closely Hsld Stodc/Partnership Intscest (Schedule C) (3) 4. Mortgages and Notes Receivable (Schedule D) (4) • 5. Cash, Bank Deposits & Miscellaneous Personal F'ropsrty 5 _ 5 . 4 5 2 . $ 5 ( z _ . (Schedule E) 0 S 6. Jointly Owned Property (Schedule F) (b ) ~ f- 7. Transfers (Schedule G) (Schedule L) (7 ) w 8. Total Gross Assets (total lines 1-7) '"~? (8) 8 0 , 3.52.8 5 u .i °C 9. Funeral Expenses, Administrative Costs Miscellaneous ( 15 ~3~4 . 7 Expenses (Schedule H) 10. Debts, Mortgage liabilities, liens (Schedule i) p) 8 ~ 000 • 61 11. Total Deductions (total Lines 9 8~ 10) (11) 2 3.3 3 5.3 5 12. Net Value of Estate (Line 8 minus line 11) ~- (12) 57, O17 . 50 13. Charitable and Governmental Bequests (Schedule J) (13) 14. Net Value Subject to Tax (line 12 minus line 13) (14) 15. Spousal Transfers (for dates of death after 6-30-94) See Instructions for Applicable Percentage on Reverse (15) x __ Side. (Include values from-Schedule K or Schsduls'M ) - " . 16. Amount of line 14 taxable at 6% rate (16) 5 7 , 017 , 5 3 x = (Include values from Schedule K or Schedule M.) 3 , 4 21 .0 5 17. Amount of line 14 taxable at 15% rats (17) oz x .15 s: (Inducts values from Schedule K or Schedule' M.) ~ F- 18. Principal tax due (Add tax from Linea 15, 16 and 17.) (18) ~ ~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest w ~ + 3,250.00+.:171.05 _ (19) 3 421.05 , '~ 20. If line 19 is greater than Une 113, enter•the difhr'ence an Line 20: Thts`is the OVERPAYMENT. (2p) _(~. __ ~~ 21. If Line 18 is greater than line 19, enter the difference on line 21. This is the TAX DUE. (21) -0- A. Enter the interest on the balance due on Une 21A . (21A) B. Enter the total of line 21 and 21A on Line 21B. This is the BALANCE DUE. (Y1B) Make Cbeck Payable to: Register of Wills, A9~nt Under penalties o per(ury, 1 are t at I avs examine t is return, ir-duding aaompanying schsdble: and statements, and to the it is true, correct and complete. I dedore that ol1 real •:fate has been re t d t est of my knowledge and belief , por e a true market value. Declaration of preparer other than the personal representative is based on all information of which rs stet has knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILINO RET ADDRESS Annie SIGN RE O • DATE Be & Pa i McElw c/o One W. Hi h St. ,Carlisle PA REP ER AN REP IV ADDR • 17 013 ' DATE e s uire One W. Hi h St. Carlisle PA 17013 / 3~--j.~ Act X48 of 1994 provides for the reduction of the ax rate: imposed on-.the net value of #ransfers to or for the use of the spouse. The rate: 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 (.Q2)'will be applkable for estates of decedents dying. on or after 1/1/96 and before 1/1/97 • 196 (.O1) wlll be applieoble for estates of deeed~nts 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 CHECK MARK { r) IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: x a. retain the use or income of the property transferred, ....................................................... x 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 death transfer property without receiving adequate consideration$ If depth occurred after x December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration$ ................. x 3. Did decedent own an 'in trust for'. bcnk account at his or her death$ ...................................... x ...., .; ~f TH~;~AN~~11~ER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU IViU3T ~MPLLTE SCHEDULE G AND FILE IT AS P~-RT OF THE RETURN. ,., ~;~ ~.. _ , - REV-1502 EX + (12-85) .~ ~..:~. '~~~~` SCHEDULE A COMMONWEALTH OF PENNSYLVANIA - I REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER Nelson, Betty K. 2195-0279 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM - -- ----- _ NUMBER DESCRIPTION VALUE AT DATE ----- --- OF DEATH -- ---------- -- --- -- Single family residential dwelling, 54,900.00 512 N. Walnut St., Mt. Holly Springs, Cumberland. County, PA 17065, Deed Reference 20"x"526, Tax Parce No. 23-31-21£39-019, assessed value $5,060. Sold 11/22/95 (See Settlement Sheet attached). _______ TOTAL (Also enter on line 1, Recapitulation) $ 54 , 900 . QQ (If more space is needed, insert additional sheets of same size.) REV.ISOtI E%+ (Y•87) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE' OF Nelson, Betty R. Please Print or T FILE NUMBER 2195-0279 (All property jointlyowned with the Right of Survivorship must be disclosed on Schedule F) _ ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH 1. PNC Bank, S/A No. 513-031-7383 23,409.29 Acc. Int. 145.18 2. US Treasury, March 95 Annuity Check 545.95 3. US Treasury, March 95 SSA check 357.00 4. Tangible personal property (See appraisal attache . ) .430.00 5. PA Blue Shield refunds. 114.95 6. 1995 County Property Tax Refund. 28.35 7. 1995-96 School Property Tax Refund 400.33 8. Sprint refund. 8.40 9. TV Cable refund. 13.40 TOTAL (Also enter on line 5, Recapitu (Attach additional 815" x 11" sheets if more space is needed.) $ 25"; 452.85 S ~ REV-1511 E7(+ (7-881 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Nelson, Betty R. Please Print or Type E NUMBER 2195-0279 ITEM --- NUMBER DESCRIPTION AMOUNT A• Funeral Expenses: 1. Gibson-Hollinger Funeral Home 2.- Carlisle Memorial Service 6,684.00 93.00 B• Administrative Costs: Bonnie N. Benson 1ZG - Srr _ lc?,y _3 1. Personal Representative Commissions patty J. McElwee- ~~, ~ -yY-~rs~ 4, 000.00 Social Security Number of Personal Representative: Year Commissions paid 1996 2. Attorney Fees W.S. Daniels, Esquire 4,000.00 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees Register 120.00 C• Miscellaneous Expenses: t. Register (Shorts 1) 3.00 2• Cumberland Law Journal, Advg Ltrs Testamentary 40.00 3. The Sentinel, Advg Ltrs Testamentary 78.92 4. Spahr~s Antiques, Appraisal personal property 35.00 5. Geo. Ebener Assoc., Appraisal real property 175.00 b. Register, filing inventory & inheritance tax return 25.00 7. Reserve for closing estate 80.82 8. TOTAL (Also enter on line 9, Recapitulation) $15, 334.74 (If more space is needed, insert additional sheets of same size.) REV.I51~ EX• X10-86f COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE SIDENT DECEDENT ATE OF Nelson, Betty R. FILE NUMBER 2195-0279 ITEM NUMBER DESCRIPTION AMOUNT. t, DeV~nie Construction, real estate repairs 1,633.24 2• R.L. Simons/BH Agency, realtor~s commission 3,119.00 3. Recorder of Deeds, realty transfer tax 549.00 4. Gilberts Pest Control, services 55.00 5. Nationwide, fire insurance 152.00 6. Yellow Breeches EMS Inc., ambulance 108.48 7. TV Cable, services 127.35 8• Met Ed, electricity 467.21 ~• United of PA, telephone 297.31 10. Borough of Mt. Holly Springs, water-sewer-trash 553.93 11. Mabel Satteson, Tax Collector, property taxes: County: ?.75.10 School : 66?_ . 99 TOTAL (Also enter on line 10, Recapitulation) $8, 000.61 (If more space is needed inserF additional sheep of same size) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABLITIES AND LIENS RFV-1513 E%+ (2-87) Iry~ ' ~\ COMMONWEALTH OF PENNSYLVANIA INHERITANCE 7A% RETURN RESIDENT DECEDENT ESTATE OF Nelson, Betty R. ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: ~. Bonnie N. Benson 19 Halfmile Drive Gardners, PA 17324 2. Patty J. McElwee 24 Peach Orchard Rd. Newville, PA 17241 3. Tammy J. Park Box 66, Mapleton Depot PA 17052 4. Debra L. Losh 12 McCandless Dr. East Berlin, PA 17316 5• David G. Smith R.D. 1, Box 129-C McVeytown, PA 17051 SCHEDULE J BENEFICIARIES ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $ (If more space is needed, insert additional sheets of same size) FILE NUMBER 2195-0279 RELATIONSHIP ~ „AMOUNT OR__ daughter ~ 1/3 daughter ~ 1/3 randdaughter~ 1/9 randdaughter~ 1/9 randson ~ 1/9 AMOUNT OR SHARE OF ESTATE