HomeMy WebLinkAbout95-0285~, I ... 1 V J ~~ V. /
H105 144 Rw. 1/81
TYPE/PRNIT
POMIA ElTT
xAac rRc
i
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 2ppT
? •
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH ~a~--~~ ~J
Coroner a
SWERU[NUMSER
NAME OF DECEDENT(Fn0. A8E7e. Lary SIX SOCML SECURRY NUMBER DATE OF DEI(<N IM«ah. D.y, N,M
,. Kenneth M Sheaffer
Male
,,
a 179 09 9543 .. March 15, 1995
L
AT+E
I
.eIei'k~r1 uNDEnIVEAR uNDEa1 DAr DaEDPlwrH eDrDIPLACe1cIyM~e rucE OF OE~aH lawck «+r «b-»..~m,aon. «~on.,o,l
M«sIM Dare Hours MkNAaa (Noah, Dr,,Nr) SbM«foraipn C,wy7)
1 T"ER:
80 vr. Ap1914 ~ T•~rrisburg kwMlMa^ ERIaawll.a^ Dw^ ,~ ^ ~ ^
oPDEaH crrY, TWP DEaH R,CSfIMNAMESIndwMisRan,pvsgrsslsrynArorl MasDEDEDENroPHIBR1NICOr,IaIN, RACE-ArrwkankiOMA,/I.ck
vmka
dc
,
,
.
Ib ^XYw ^ SYM aPSOSY Cukrr, Is°°aM
Cumberland Upper Allen X614 Diehl Rd, Mechanicsburg ~ Abn,PwrbRbrr.slc.
White
+
9 IaNDOP eIA4lIElsAdDU/rRY MasoECEDENT EVERw DECEDENr•lEDUCATION ~BWtq~ SUiMVW6SPOU.4E
NAOMmam«kmA.aA~Aral u.a ARMED wac:ESZ
m•+Ia
a.«M,
IIlrmmua
v+srusl~r~rirrr
.
o
l
~ C•E•l• Diwrasd floac~Y)
Nr ~[ Ns ^
Steelworker Steel ~ mIs 12 c,+«s+~ + Never Married
'
DECEDOIT
l MMLS4D ADDRE//ISre.L glNkmn.sbb. LPCoOe) DECEDENT!
,Tasrab Pennavlvania
„Q® Ma,ac.e.aa..eM Uouer Allen TwD
+
, 1
614 Diehl Road ,,,,.,
~
,
,„ ,~~,~
,a Mechanicabur PA 17055 °'°""°N 1e, +0`^++PT ~~^ . .~~au:ik +ua
'
RQIIER
8NAME(iat wlesa.lsal
INAME~ACna.•MMen~A•MA.I
El
G
Sh
mer
.
eaffer
w
Grace M. Boyer
lIFORMAN'r'BNAMERyprPrYb lMAaInaADOREl6pYnI.CA,YbwaSbls.aoCOaN
Paul M. Sheaffer 2219 Lo an St. Cam Hill PA 17011
elalal CK Crsnrllan^ RanlsW w«nsw.^ uvE ~' OMwPba •N.a.ac.a.bracr.arror, •Ck,Vbrn, Slals,aPDma
DMrbaO olr,s•.a~n ^ March 20, 1995 Neatniaster Cemetery Carlisle, Pa 17013
'0N1Q+/m "~1°ON"~T"'DAB~" '+++~"
A"°"°°"ES°°FR`°u'vMgera Fhneral Home
012662-L 37 E. Maio St. Meohaaicsbur PA 17055
wIw~ME{•, mrhaxunMMIMMM, ado and Pbu aNba
411Md "'lad ~ llf~l/BE MMlER DQE BgRED
~
~~
aM
afAr~
. Dar. n.n
>s
a s
~~~ma~aM TIIAEaPDEIVH A rX. DEAD IMarn, D.x Mrq Maa DAlE REFERIEDID MEDICAL EXAMINERI
p
March 15, 1995 wpa ,,,^
M ;
~ ~
3T. -MRTk llama alysrra~w~r~oarrlPSratlplawllks CarraadtlM Aaslk. DOrrawa.aomaaykrl, suchruMae«tipYn«YMw.M iw MrtlW4. INp,«tlm~b MIRR OtlrrYpYkpti mnalk,r anYEakpbmMk. bR
rkrlanalkdsssn na raNrlurrpMma uMMl,YpearM8lVanb PART1.
kIS1~LW! CRAM[ lFM I«ral arW daW1
,°rwa„°~ Probable M ocardial Infarction
DUE 10(DR AS ACONSEDUENCE OFk
1
~
i
Mato bsArV bhhrtlaa
DUE TDICR ASA CONSEDUENCE CFI:
OWN. Eaar UIMe1LYk1/
fiYM[1ar«iy«y e.
ti ~~•~ DUE Ta (CR AS A CCNSECUENCE CFk
hEaelhlLadT
b ~
MaI AN AUTOPSY WEREAUIDPSY RNDIILLi3 MANNER OF DEA7H DIDEOPINJURY TIME OF SO.IURY INJURY AT NbRKt OEBCRIBE 11GhV 8UURY000URRED.
PERF'OR\ED7 AYIIAIIE PRga Ta Ikbreh. Dsy, wep
coMnEraNOFCAUSE ~ H«Nada ^
oP DErvHT Nanxal w ^ No ^
M.
Yn ^ No~ tae ^ No ^ Accldaa ^ ~p ^
Sukitls ^ CsuM nol M EatarrlliraE ^ kal6q, BUURY •AI hmM. Ianrr. ahM. aa«Y. o1Ste (SSasI ~ Slael
'Jra 2Sb. b. 90a.
CBRSI611CheeconNmy -
'CERTSTYNM hl7la7AN
Sq
l~Y/til•~ar«1iVeaussa e9aN xhananawphYSicisn has P«ia«CeU Oaetlr ana camPlaeO roerri
Totieaddrwy bgasslya, Osdk aeerarw awblM wrrNalsse arnl.ras alsra ........................... ~........ ^
.............. .
c Coroner
S,0.
'-RON011NClNi AND CFRTIFYlq PHYSICIAN lPhYSCian Ddh Pr«qunCip AaaM one
Tlre.ddu~YMO.raP..mdeo«vn.adm.u...me...~wpra...,,amabur'~pbCUedtls~>
wwu.ae~a..~....w.a .......................... ^ DATE SIGNED /Aaan, Day.'UN)
>Ib.
,a March 16,1995
NAME AND ADDRESS OF PERSON WiS)CDMPLETEDCAUSE CF OFAH
cn~znT',°'«P`k"
~b~•..N,,,,,,P,,,,,,,.,..,,,,a~,^,.~~,,,.,~.,,,~,,,~
Abm.rrd.ba.......... ....... wK...llam,,,urlacaua.ll,lw
a,. ....................................
................
~~••~•~~~~"'~ Michael L. Norris,Coroner
405 Fairway Drive
REOI~TiUR'9 SIGNATURE ANO NUM9E
~. Mechanicsbur Pa. 17055
1 DREPaED IMmtl~. DaY. Nam)
<EV-1500 EX+ p•9al ~
. ,
~, ~ ~, Iii M.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
tZU SOCIAL SECURITY NUMBER E
W 179-09-9543
O Qf •nuC~RtE7 SURVrv,NG SPOUSE'S N.VME (LwST, fIRST wND
F [~ 1. Original Return
Y t N
o c ^ 4. Limited Estate
J
~
`m ~ b. Decedent Died Testots
(Attach copy of Will)
~ W
a= °
o~
~a
3/1595 X4/19/14
FCfR'DATES Of DEATH AFTER 12/31 !91 CHECK MER
IF A SPOUSAL
POVERT7 CREDIT IS CLAIMED ^
FILE NUMBER
21 95 0285
NTY CODE YEAR r
RD 9, 614 Diehl. Rtx~d
r1E~11anicsbllrg, PA 17055
~.~ C[~LArID
AMOUNT RECEIVED (SEE INSTRUCTION51
^ 2. Supplemental Return
^ do. Fvturs interest Compromise
(for dotes of death after 12-13.82)
^ 7. Decedent Maintained a living Trust
(Attach copy of Trust)
^ 3. Remainder Return
(for dotes of death prior to 12.13-8i
^ 5. Federal Estate Tax Return Required
~- 8. Total Number of Sofe Deposit Boxes
H~s• a.vsctct:arvlvoENCE AND CONFIDENTIAL TAX INFORMATION- SHOULD BE DIRECTED TO: ° °'~
NAME COMPLETE MAILING ADDRESS . ,
Jerry. R. ~Duffie, Rs Jam, Duffie, Stewart & Weidner='
fEIEPMONE NUMlER 301 Market St. , P. O• BID]C 109
( 717 1 761 _4 ,40 T~ir,n bs i ~n~ ~_rvs no
1. Real Estate (Schedule A) (1 51.000.00
2. Stocks and Bonds (Schedule B) )
3. Closely Held Stock/Portnership Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) (4) ~ _
5. Cosh, Bank Deposits & Miscellaneous Personal Property ( 60,123.73
_ (Schedule E) ,,.~
b. Jointly Owned Property (Schedule F) (b )
~ 7. Transfers (Schedule G) (Schedule L) (7 )
c 8. Total Grosa Assets (total Lines 1-7) (g) 111,123.73
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H) ~ 20.896.12
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10 184.45
11. Total Deductions (total Lines 9 8 10) (1 t) 21,080.57
12. Net Value of Estate (Line 8 minus Line 11) (12) 90,043.16
13. Charitable and Governmental Bequests (Schedule J) (13) _Q_
14. Net Value Subject to Tox (Line 12 minus Lins 13) (ld) 90,0,¢3.16
15. Spousal Transfers (for dates of death after b-30-94)
See Instructions for Applicable Percentage on Reverse
Side. (Include values from Sched I K S h d l (15) x.-= -Q_
z
0
o.
0
a
u s or c e u e M.)
16. Amount of Line ld taxable at b°r6 rate (16)
(Include values from Schedule K or Schedule M.) x .Ob . _Q_
17. Amount of line ld taxable at ISeib rate (17) 90,043.16 x 15 13
506
47
(Include values from Schedule K or Schedule M.) ,
.
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) 13,506.47
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ 12,500.00 + 657.89 _ (19) 13,157.89
i'0. If Line 19 is greater than Line 18, enter the difference on line 20. This is the OVERPAYMENT. (20)
i'.1. If Line 18 is greater than line 19, enter the difference on Line 21. This is the TAX DUE. (41) 348.58
A. Enter the interest on the balance due on Line 21A. (21 A) -0-
B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (21B) 34$•5$
Make CMck Payable to: Register of ~Ils, Agent
'~" ~ ~°~-~ BE SURE TO ANSWER ALL QUESTIONS::ON REVERSE SIDE:'AND.TO.RECHEGK MATH-~:=
Under penalties of perjury, I declare that I have examined this return, including occomponYmg schedules and statements, and to the best of my knowledge and belief
,t Is true correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparsr other than the personal representative i.
eased' on all information of which preporer has any knowledge.
StGUaTURP ne Oioenu uoeenu r•. a •.._ ......_ ___.._-.
,7 . R_ tf
•7~*~ .~*.esorn~u+ne •~~• ADDRE
~4.( ~.~~
e? . R~r-r _
2219 Logan Street DAT~
Catnt~- H i 1 1 , PA 17 (11 1 ~' ~/J
301 Market St., P. O. Box 109 DAE
LetnovnP PA 17c1a~_mn9 J/~, ~~
MBE
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:
e 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1% (.O1) will be applicable for estates of decedents 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:
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, . .............. X
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 death- occurred after
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'. bank account at his or her death ...................................... X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
. ~.
1 J • . ...
OO~OOOJTS $ (uol;oln~ldo~ay '~ aull uo Je;us osl~y) 1br101
'(Pauo~~~p ~aauS ~uausT~~aS ~o ~do~)
00'000'TS S a~z.zd aTsS
( 6TOT a62d ~ OZ ~ToA ' ..3.. X~H PaaQ )
e-ru2nTdsuuad ~ ~uno~ pueT.zaqum~ ' uaTTK
.zaddn ~o dzgsuMOs ~ ~azQ ~,T9 ' o~ - a~e~s3 Teag , ~
Hlb'34 ~O NOlldl?1~S3o a39Wf1N
31`d0 ld 3fild~ W311
'f~D~;YDA•~•J •y; ~O •Bp•~MOY7~ •~gDYOfD•J BulADy y;Oq ~~~•f JO Anq Oj
P°II•dwoa Bu!•q J•y;!•u ~J•~~•f BYl~~IM D pYD J•~^q BYl~~lM D Y••M;•q p•BYDy~X• •q p~110M d;J•dOJd yalyM {D •a~Jd •y; sc p•u~}•p s~ yalyM
•n~ow;•yJOw J~of;o p•~od•J •q ploys •;o;s• lo•J Ilt/ Id •I^P°y~S uo p•so~aslp sq;snw d~ysJOnlnJ^g }o;yela y;~M psu~no-A~;u~oj ~(yJ•doJd)
5820-56-TZ 'W H.L3NN3?I '2I3,33Kr'IHS
b39Wf1N Slid d0 31V1S3
1N343~3U 1N34IS3a
31d1S3 lb~3t1 VINVAIASNN3~0 H11V3MNOWWOJ
d ~~na~H~s
Ise-zIl +xa zosl-naa
REV.150B EX. fi-6n
~
: ,~ SCHEDULE E
:
CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS -
~N RE6IDEMEDECEDENTRN PERSONAL PROPERTY
Please Print or Type
ESTATE OF - FILE NUMBER
SHEAFFER, KENNETH M. 21-95-0285
(All property jointlybwned with the Ripht of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
1• 1964 Pontiac Sedan - sold at auction - sale price $ 390.00
2. Household Goods - appraised value 1,545.00
3. Meridian - Savings Account No. 8338267100 - date of
death balance, plus accrued interest 41,852.24
4. PNC Bank - Checking Account No. 51-4005-6973 +
Date of death balance ( 2,521.83
5. PNC Bank - Savings Account No. 51-3007-3585 - date of
death balance, plus accrued interest 11,456.85
6. Cash in decedent's possession 541.00
7. I Social Security checks in decedent's possession not
negotiated prior to death. 1,803.00
8. Reader's Digest - subscription refund 11.23
9. AT&T - refund - telephone rental charges 2.58
TOTAL (Also enter on line 5 Recapitulation) I $ 60, ]~~ 73
(Attach additional 8)4" x 11" sheets if mom space is needed.)
aEY~1511 E%~ 1~~9~1
r"
COMMONWEAUH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
SHEAFFER, KENNETH M.
ITEM
NUMBER DESCRIPTION
A. Funeral Expenses:
1. Myers Funeral Home, Inc. -funeral expenses
2. Gingrich Memorials -marker inscription
Please Print or T~
21-95-0285
AMOUNT
5, 280.40
96.00
B• Administrative Costs:
1. Personal Representative Commissions Paul M. Sheaffer
Social Security Number of Personal Representative: 185 O1 3435
Year Commissions paid 1996 5, 500.00
2. Attorney Fees _ Johnson, lhiffie, Stewart & Weidner 5, 500.00
3. I Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees -Register of Wills -Cumberland County 257.00
C• Miscellaneous Expenses:
1. Cumberland Law Journal -advertise letters 40.00
2. The Patriot-News Co. -advertise letters 62.71
3. Chuck Bricker -household goods appraisal 60.00
4, Nationwide Mutual Fire Insurance Co. - h~neowner's policy 264.00
5, Joseph McGraw, Inc. -real estate appraisal 1,800.00
6, Bell Atlantic -telephone charges -March -August 61.29
7. M. Arrr-atrout - lawn maintenance -April -August 635.00
8. PP&L -electric service -March -August 29.30
Sub-Total from additional sYyeet 1,310.42
TOTAL (Also enter on line 9, Recapitulation) $ 2U
896
12
,
.
(If more space is needed, insert additional sheets of same size.)
SCl~DUI~ "H" ~INUEp
ESTATE OF: SFIEAFFER, I~'IH M.
21-95-0285
C. M~G cellaneous Expenses - Continued:
9. Keystone Tree Service - removal of damaged tree
on decedent's property 150
00
10. Paul M. Sheaffer - reimbursement for signs purchased .
for sale of real estate 5.30
11. AT&T - telephone rental charges 14.55
12. Marlin A. yohn, Sr., Tax Collector - County real estate
taxes - billed March 1, 1995 113.72
13. Waste Mangement of Central, PA - rental of dumpster for
trash removal & charge for disposing of trash 304.11
14. Dauphin Deposit Bank & Trust - charge for Estate checks 16.42
15. Recorder of Deeds - 1% transfer tax - sale of
614 Diehl Road 510.00
16. Notary fees - sale of 614 Diehl Road 4.00
17. Marlin A. Yoh, Sr., Tax Collector - real estate taxes -
school due from 7/1/95 to 9/13/95 92.32
18. Reserve for close-out costs 100.00
S~'To~- $ 1, 310.42
r
REV-1511 EX• ~t-93)
SCHEDULE 1
COMMONWEAUM Of VENNSYIVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
Please Print or Type
ESTATE OF FILE NUMBER
SHEAFFER, KENNETH M. 21-95-0285
(~t more space is needed, insert additional sheets of some size.)
~REV.1513 E%a (Z-B?~
0.
SCHEDULE J
COMMONWEAITM OF PfNNSVIVANIA BENEFICIARIES
INNERITANCE TAX RETURN
RESIDENT DECEDENT
eals~ie yr
SHEAFFER, KENNETH M.
ITEM NAME AND ADDRESS OF BENEFICIARY
NUMBER
A. Taxable Bequests:
1~ Catharine Allington
P. O. Box 27150
Highway YY
Lebanon, MO 65536
2. Paul M. Sheaffer
2219 Logan Street
Camp Hill, PA 17011
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
FILE NUMBER
21-95-0285
RELATIONSHIP I AMOUNT OR
SHARE OF ESTATE
Sister IOne-half
Residue
Brother One-half
Residue
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Alao enter on line 13, Recapitulation) I $
(If more space Ts needed, insert additional sheets of same size)