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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 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
X14481
NAME aF DECEDENT (fiY. Miom•, Leeq SE% SOCIAL SECURTTV NUMBER ~ DATE OF OERH PAan1~. Doy.,by)..
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',~,, INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131!91 CHECK HERE
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, POVERTY CREDIT IS CLAIMED
5~ RESIDENT DECEDENT FILE NUMBER
CO MMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE
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DEPT. 280601
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-- WITH REGISTER OF WILLS
HARRISBURG, PA 17128.0601 ,.~' COUNTY CODE YEAR NUMBER
DECEDENT'S NAME !LAST, FIRST, AND DLE INITIAL) DECEDENT'S COMPLETE ADDRESS 1
z SOCIAL SECURITY NUMBER DATE Of DEATH DATE Of BIRTH (~ ~~
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~++ [~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
Yarn (for dates of death prior to 12-13-82)
W e°C,cYa '^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. federal Estate Tax Return Required
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;AFL' CORRESPONJDENCE AND CONFIDENTIAL TAX INFORMATIOM .SHOULD,BE, DIRECTED TO:.- -
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1. Real Estate (Schedule A) (1) ~~
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3) --
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4. Mortgages and Notes Receivable (Schedule D) .---------
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5. Cash, Bonk Deposits $ Miscellaneous Personal Property (5) ~-•'
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(Schedule E) _____~------`'
b. Jointly Owned Property (Schedule F) (b) ~--
7. Transfers (Schedule G) (Schedule L) (7) -=
8. Total Gross Assets (total Lines 1-7)
9
Funeral Expenses
Administrative Costs
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11. Total Deductions (totol lines 9 & 10) ..
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12. Net Value of Estate (Line 8 minus line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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16. Amount of Line 14 taxable at b% rate (16) l - ~ ~ C ~ ` x .Ob = ~' S~~
(Include values from S h d l K S h d l M
15. Spousal Transfers (for dates of death after b-30-94)
Sea Instructions for Applicable Percentage on Reverse (15)
ceue or ce ue .)
17. Amount of Line 14 taxable at 15% rate (17) ~`-'
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
19. Credits Spousal Poverty Credit Prfor Payments Discount Interest
+ ~"+ +
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
21. If Line 18 is greater than 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 218. This is the BALANCE DUE.
Make Check Payable to: Register of Wills, Agent
x .15 = ^--~
(19)
(20)
(21 A) '~"-'~
(21B)- ~-,~2, 2~
r''~' s~~ ~ ~ BE~URETOANS1fV~#t'Aiit~llEST10NS`~t~l:RE11lERSE-5j1AE ANQ~TCI RECHEtKMA~'f~~~':-~{ ~ .:
Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
hosed on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPO SIBIE FOR FILING RETURN ADDRESS DATE
~c~.~.ec.a.. Q . ~.+~s~~- ~oCo .~: ~~ t~.~ ~~,., _ 1 ~~`~(- S 3rI L t _$ -S - 4 ~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE
REK1soR EX~ (2.8~ SC H E D U LE E
CASHr BANK DEPOSITS AND
~~~ MISCELLANEOUS
COMMONWEALTH OF PENNSYLVANIA
INNERITANGETAXRETURN PERSONAL PROPERTY Please Print or
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
(Afl property jointly-owned with the Ripht of Survivorship must be diselo~~d on ScKedule F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
I G1na.~.~ ~ In ~ ccc~c~t.~-c' ~ 5 ~4 o t 7 2 $2 7 ~t , o ~-a .'71
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S~ off. Sd.'t"4- ~ ~1 C~ ~~ ac~ccv~'Fs ~NoaQ..Qv~.~ a.~i 't
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TOTAL (Also enter on line 5, Recapitulation) $ ~ ,2, ~ 7
(Attach additional 815" x 11" sheets if more space is needed.)
RfY.1S11 rx4 ,~.r4 _ SCHEDULE ~N
~~+ FUNERAL EXPENSES, -
COhtA~IONwEA1TFiO~PlNNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN MISCELLANEOUS EXPENSES
RESENT DECEDENT
Pleesse Print or
lJIAI! tJP' `` E1~! rVUIYf,bl.K
ITEM DESCRIPTION AMOUNT
NUMBER
A.
B.
1.
~.
3
4.
~.
,.
~.
3.
~.
5.
6.
~.
8.
fuflQf01 Expensea: `
CcarrMG..~ low ~oCl~.~ o~ ~n.uKs IVu.r11c~.
~ 11 ~
C c a uw G.-~ ~ o t.~ ~- cJ e.cj-...-t ~ ~ ~ h C ~+ro~
Administrative Costs: ~A"(R.IG1t~ ~ •~t~itsTA~T
Personal Representative Commissions ~ ~ d uG ~ ci.C ~WI 1 S SI [~1~1
Social Security Number of Personal Representative: ~~ ~ -~ 5 ~ 2 2
Year Commissions paid 1 q 9 5
Attorney Fees
~N~ts, ~la~ ~~ ~ i~a,~ s , A~-~m~~~.~ S
~~ haw - ~o~ ~.~d., ~~~ ~.as C~~Iva~ ~~~ ~
Fami y Exemption `~
Claimant Relationship 1
Address of Claimant at decedent's death
Sweet Address
City State Zip Code
Probate Fees '
C~~,~.a-~~, ~o~~~
Miscellaneous Expenses:
~P11 ` `~ ~.
~d.~V~o ~lQ.r - 1-. 6~3q ~S"Ca.Y~C~
~os~~o~ C
'T ~ D~ O ~ p L V~
P~ ~
TOTAL (Also enter on line 9, Recapitulation)
~1~7 , ~ 0
~~t~ ~~~
221.Oo
72. ~ o
~5,~~
~-~.aa
3c~.t5
17.35
(If moro space is needed, insert additional :beets of sant• size.}
REV~1317 EX+ (2-87i ,~
SCHEDULE J
COMMON WEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TA% RETURN
RESIDENT DECEDlNT
ESTATE OF FILE NUMBER
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
1. A. Taxoble Bequests:
~A
'
~
~
~
Z Q t C l ~
~
c~.
cLY1S ~ ~~ C-~-IT~_
~~ to ~ J~ v~l~ ~c ~ ~ ~ , ~.,-,
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ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I $
(If more space is needed, insert additional sheets of same size)
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Regqaster Of Wills
Hanover and Hiq~013reet
Carlisle, PA II
GORDON ELSIE PEARL
File Number 1995-00293
Remarks PATRICIA DRABENSTADT
Distribution Of Receipt
Receipt Date 4/19/1995
Receipt Time 15:09:13
Receipt No. 1004583
Transaction Description Payment Amount Payee Name
PETITION FOR PROBA 40.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 3.00 CUMBERLAND COUNTY GENERAL FUN
EXTRA PAGES 9.00 CUMBERLAND COUNTY GENERAL FUN
JCP FEE 5.00 BUREAU OF RECEIPTS & CNTR M.D
Check# 4876 $57.00
Total Received......... $57.00
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters Testamentary
No. 1995-00293 PA No. 2195-0293
ESTATE OF GORDON ELSIE PEARL
Late of CAMP HILL BOROUGH
Deceased
Social Security No. 191-26-7124
WHEREAS, on the 19th day of April
1995 an instrument
dated May 15th 1991 _
was admitted to probate as the last will of(GORDON ELSIE PEARL
late of CAMP HILL BOROUGH , CUMBERLAND Count
y, who died on the
17th day of February 1995 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to PATRICIA DRABENSTADT
who has duly qualified as Executor rix
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 19th day of April 1995.
**NOTE** ALL NAMES ABOVE APPEAR lr.ACm _ FT17em MTTTIT T.+.
l ./j i
LAST WILL AND TESTAMENT
OF
ELSIE PEARL GORDON
I, ELSIE PEARL GORDON of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament,
hereby revoking any other will previously made by me.
I - I direct the payment of all my just debts and funeral
expenses out of my estate as soon as may be practical after my
death.
II - I devise and bequeath all the rest, residue and
remainder of my estate, both real and personal, of whatsoever.
kind or character and wherever situate, to my beloved husband,
Herbert William Gordon, to be his absolutely and forever.
III - If my beloved husband does not survive me, I direct
that all the rest and remainder of my estate be divided into
two equal parts, and I give, devise and bequeath one of such
parts to each of the following two persons to be theirs
absolutely and forever.
Patricia Drabenstadt - daughter
Linda Hatfield - daughter
Page 1 of 3 Pages
The share of any person above named who shall
not have survived me shall be paid to such person's issue
in equal shares per stirpes.
IV - I hereby appoint my daughter Patricia Drabenstadt,
as Executrix of my Last Will and Testament. I direct that
no bond be required in this or any Jurisdiction.
IN WITNESS WHEREOF., I have hereunto set my hand and
seal on this , the ~``~-
I -5 -- day of \~~ ct•~-~ 1991.
ici~J` Ste. =-~ L • ~~- ``~-- `~t"` L~~c~. ~l il~
Elsie Pearl Gordon
Page 2 of 3 Pages
Signed, sealed, published and declared by ELSIE PEARL GORDON,
Testator therein named, on this and two (2) other sheets of
paper as and for her Last Will and Testament in our presence,
who, in her presence, at h~~ request and in the presence of
each other, have hereunto subscribed our names as attesting
witnesses.
~O ~ s < .G. 7P L.' a.
Name
f
Name
Addres
J-t.cil c 1"'c
Add ss
Page 3 of 3 Pages
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND) SS.
WE, the undersigned, the testator and the witnesses,
respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testator signed and executed the instrument
as her Last Will and that she had signed willingly (or willingly
directed another to sign for her), and that she executed it as
her free will and voluntary act for the purpose therein
expressed, and that each of the witnesses, in the presence and
hearing of the testator signed the will as witness and that to
the best of their knowledge the testator was at that time
eighteen years of age or older, of sound mind and under no
constraint or undue influence.
Testator
n
Yv E 1 Ii -y ~ ~ i
~C • L, :~ ,...c
Witness
Witness
Subscribed, sworn to and acknowledged before me by the testator,
and subscribed and sworn to before me by both witnesses, this
day of ~, 1991.
'v Notar .• Pub
NOTARIAL SEAL
ROSEMARIE J. RYDER, Notary PubAo
Camp Hil, Cuns~erfand County
1Ay Commisai~tl Expiros Jan. 11, 1993