HomeMy WebLinkAbout95-0296~, ~ -c5- pa~i~
This is to certify that the certificate hereunto attached is a tine 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 200T
Date
S
H,03.1~,7 Rw.?1El
TrrE~r,wT
w
1ERMAMENT
BLACK BMC
a~~
0
f
0
V
W
D
0
w
2
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLrMN1A • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATHv
NAME DFDECEOENrIF:r.Mww.Lllb BEx SOCIAL SECURITY NIIMBfA. _ OREaF OEAHI~wrI. D<Y•'Anq
Martin 1Fema a 1204 - 30 - 7500 ~ r. -S
+• ha K
.
AOE M1rI BrBre•r, IBOER, rrAR uNDel, Dir DREarewTH aBmr,wcE pMlw rue[arDERN,CIUrA w+rarr-r<nwua.anm Ar adM
Mprw . e•,. Hqq MMr,< lM<M.D.~t'Y.r) SWUwI<pnCwr,q
~ `~"""^ ^ oD.^ `"~~ ~ "•"°"°^ `~~'^
a
11/22/1907 McConnellsbur
87 °1
COIINTVOrDERN CR\,BORO.TW-OF DEAN w1YEP~<IY®/on.W~'•<t an. m~'k<n MMB DECEDEIROFFIBPA/NCOIM6w4 RACE-Nwllu.Yid~n. EYtlc W1Y1<. MC.
or NurS; ~ome. ""I°""r"1Dfl1ni"r` ,1
Carlisle E,
Cumberland
,
..-
OECEDENT'BUBUKOCCUPRgN IWDOF BUSNE58MOUSTR1r YYLB OECEDEM EVEIIN SEDUGB,ON MARIDIL STRW-MIInM< 91BIVNB,D SIOUS!
u.IARMEOrpICESt N...,rA.,raweo..a aYr+..~.~<ra.rl.nw
I.led..ork<w»q~mrl
OIw<~IIISr<rIy)
d•aYYgM<; e.lrr u<•ritl.) `hs^ N<® Y
(,I
Housewife , , 2 ,.. W dow ,..
oECEDEKra.wLwADDREae~...LC<,rr~w~.sr.zacoeM oecEDENra
,nar. PenneX]yania DM ,Ta^ W<,ars<,rM.lti ter.
442 Walnut Bottom Rd. RESCENCE °'°'°'"'
M
Cumberland
""""'rT ,,,
t~ ~. ~;d Carlisle
~ ~
Carlisle
Pa
.
,,,•
,
.
11
iR/1FA'SNAME IF•,L Miltl<.1a,3 MOTNER'a MANE ff•t Miae.. M,i<,n Sull.nul
,.. Charles R. Steach Frances V.
'
wroRMANrSNAYE(TypoRiq BMAEINBAODNE33{4«<1.C<IIWwn,s,rw$c
.«.I
Warren B. Martin 3418 Brisbane St. Harrisbur Pa.
A,ETI,ooorderaalTl
DN DRE o ~OF~ 11DN-NwrdCo•MrY. CIwIYOry IACRgN•CPWTaM, 91Mw 24t<.•
`I
~
cl...Ila^ R<n1oYrAaw.91r<^ •n
D..IwI^ n
^ 3,w A rl 13 1995 3,.. m4
ruNERr1 oR AC,BgAbBI,uI NUMBEII NAMEANDABDIeasor
m.. n<• -
~ SIONED
<rl.wwnnrlBYYy MMrrlrl, omnwrwur d,<I.r rl•r~ LICENSE NUMBER )
i.Iwlw.rM<rlWrde,rnn,• rrTi) /) h ~7
O L n!'~
j
~ / ~
I
y
a,rda<Irl. QIQ.p/
B42ell.IfWtonOM•<M OFOERII DFADIM<IMk.OM.'Y••I) MMBCASEREfEWEOIOMEOICAL
a
m~
a
- , p ~ w.
N.
.Il.par•Ilc»a•ri,. q~rDK;,rr
G• ~
37.MRfk EnMrIM A•wMMMi••amn9BrAXe.+.NC. a,rW,M «rk. DOrg1 <rMM IM•1«<d avfl<• >r„rY,l<ry arr<r.IMxkailw,4iiAr. ~AgANnr. -ARf F. OIIw14pnBCtl <rlrWlrmrll<bBbC<,BIW ..
NRw,<I k,W«n m, n<Ir<gbtlr lwOrl/YiBa1r OY..MRYR I.
LM <rM•••e<IrmYdl b.
~Or.<Irr A~lll
_
1
«~'F"" PsN9 Iun.k.~
n~9~e.rkl-~ ~
OUE R)IDR ASACONSEOUENCE OFk
^ryye Ywnirr< k DUE IOIOR ASACONSEOUENCE OF): 1
Hruli6lLtNN
I
CMMBIOirr<ainMrr e
i1WYd MfY OUElO (GRAS ACONSEOUENCE OF}
r•JIYgnE,/IILAST
Q
WAS AN AUTOPSY WERE AUR78T FND11/(iS YANNEII Of DERV DREOF wA,RY TIME OFINJUM! wA1RYR WWYf? OESCi,IBE HOWINAMIY OCGIRRED.
m AYIIAw.E PRIOR W ,M•n<I. D•Y. WrI
caMPLETIDNOPUUSE
F
DIro N.knr ~ HInA 3« ^
a
OE~ M ^ No ^
A<CrN< ^ P•ndiq ~<dgrbn ^
M.
W. ^ Nv~ ve< ^ N< ^
3Bw SWCIA< ^ CW<nraer.rlnln.tl ^
r. vuceoFxwRr-arom..r....m.M.laaaxaBa
aaaw. re.lsOSilYI
m.. wcRaNls<.w.c+W~+...srq
3or.
eenwRa3rar IN, vr1
•C®ITIrYMB PMTSICIAN (PkY>•~ wMY~^9 uurd0<Yn dwn andnw MY.~ian h<s V.a.<wcW <wlnaM [unWl<C nen 23) IDIUPU CERTIFIER
~~~.
~"
r'~+
Th SI.O«I d n1Y Iln•w•.B•. Mrk <epI,IN Mb Ur<uw<Ip <nd Inr<wr r d<MU ..................................................... .
~.V
314 .
LICENSE NUMBER ORE Sg1/EDIMdISr, D•Y. Mrs
•-RDNDIR+DwaANOeEmisrwannslcl~wlrnYrw.cono,~w~,.gw.m..w~..uv.wro<r,rd<wnl
•nd.w<btlMr'+•WI lln<mwwrar<I,d ......................... ^
«•M<e«rtMrlM tlw<
.MM
rMpo
Totlr 4Mld•M ArwI•<S• 31C. Mo p11.1`!l6 „ PP41~ ~l ~4 ~j
,
,
,
. NAME AND AODI,ESS Of PERSON W/q COMPLETED CAUSE OFTiERM
'MEDICAL EXAMwER/CORONER pMm 2~ Typ. v Prins r,~
~oe~r'1~ P. ~t`t.-~Swvh
ooBl•elw.a.:.I.In.Iwo.rwalm,erq.xon.mmr<anion.e.dn««~.ennrBrn..aN..Mwvl+<..Mwe..IOm.<,...I<><na
.
.......... ^
o
.,.l...<r„b h9 CC-~-1~.. Pe
4c'cN-,
~ z
`
.
................................................•--..................................
l
31<. ,
i.rw.~
8
~
33.
REGISTRAR'S SgNRURE AND NUMBER ~,,~,,~,L , y~ ORE FlLED''//IMOMn. OaY. Mrs
T
K
>7. .
+
50i4:15~8
REV•-s00 Ex. ll•oq fOR OAt[S Of DEATH AfT1R 14f~ 1 f91 CHECK HERI
4• INHERITANCE TAX RETURN ~
vi
nUCRi
^
L° ~ fl
o
ofT IS CLAIMED
RESIDENT DECEDENT fllE NUMBER
COMMONW[AITN Of PENNS~IVANIA (TO BE FILED IN DUPLICATE
DEPARTMENT Of REVENUE
OF/T 7!0601
WITH REGISTER OF WILLS) 21 9 5 0 2 9 6
MARRISlURG, -A 1712e•0601 COUNTY CODE YEAR NUMEEF
DECEDENT'S NAME 1lASi, FIRST, AND MIDDLE INI11Al) DECEDEN 'S Oµ-IETE ADDRESS
MARTIN ORPHA K Thor
4 nwald Home ~0
°
SOCIAL SECURITY NUMBER GATE Of DEATH DATE Of IIRTN 4 2
Carl Walnut B O t t O m Road
E
isle, PA 17013
e+
v 204 30 7500 4/11/95 11/22/07 Count Cu la
o nr •mKU+p survrviNo srouse•s N.Me nu+, rMf+ swo r~oolr iHm•v SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUC110NS)
~++ ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
Y'~ tI) (for dotes of death prior to 12.13.82;
W gc'°s ^ 4. limited Estate ^ 40. Future Interest Compromise ^ S. federal Estate Tox Return Required
~ ~ m (for dates of death offer 12.12.82)
® 6. Decedent Died Testate ^ 7. Decedent Maintained o living Trust 1 8. ?oral Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
ALL CORRESPONDENCE AND CONFIDENTIAL tAX•INF~ORMq l0~1,~H0 ! D •.~y:..:,,ra. , -~•' '
~" NAME COM/l TE MAlll ADORE
s° James D. Cam bell Jr. Es uire Caldwell & Kearns
3631 N
F
ont St
t
u$ TEIEPNONENUMRER .
r
Harrisburg, ree
PA '~10-1533
717 232-7661 ~ ~r:
1. Real Estate (Schedule A) (1) • ~_~ _'_
T. Stocks and Bonds (Schedule 8) (2)
3. Closely Held Srock/Partnership Interest (Schedule C) (3) - iV
4. Mortgages and Notes Rscsivobb (Schedule D) (4) '-~'
S. Cash, Bank Deposits ~ Miscellaneous Personal Property (S) 9 8 , 1 8 0.21 -.,~ -
_ (Schedule E) ,~._,.
6. Jointly Owned Property (Schedule f) (6) ~,-° ~~ " . --^
~ 7. Transfers [Schedule G) (Schedule l) (7) '
6. Total Gross Assets (total Lines 1.7) (8) 9 8.18 0.21
9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 4 , 0 51.2 9
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, liens (Schedule I) (10) ~~ J-4 0 , 7 8 9 , 1 9 2 . 0 7
11. Total Deductions (total lines 9 ~ lOj [11)
12. Nst Value of Estate (line 8 minus line 11) (12) 8 8 , 9 8 8 . 1 4
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Value Subject to Tax (line 12 minus line 13) (11) 8 8 . 9 8 8 • 1 4
1S. Spousal Transfers (for dates of death offer 6.30-94)
Sse Instructions for AppGcoble Percentage on Reverse (15)
Bid
I
l
d
l x. __
s. (
nc
e va
u
ue: ffrom Schedule K or Schedule M.)
8 8, 9 8 8.14
16. Amount of line 14 taxable at 696 rote (16)
x .06 : 5, 3 3 9. 2 9
(Include values from Schedule K or ScMdule M.)
17. Amount of line 14 taxabb of 1596 tab (17) - ~ x .15 :
z (Include values from Sdssdule K or Schedule M.)
c
18. Principal tax due (Add tax from Ones 1S, 16 and 17.)
(18) 5 , 3 3 9 . 2 9
~ 19. Credits Spousal PoveAy Credit Prior Payments Discount Interest
+ + 266.96 _ 1191 266.96
~ 20. If line 19 is greater than lint 18, enter the di(hretsce on line 20. This u the OVERPAYMENT. (20)
21. If line 18 is greater than line 19, enter the diffsnna on line 21. This is the TAX DUE. (21) S , (1 7 7 _ ~ ~
A. Enter the interest on the balance due on line 21A. (21A)
B. Enter the total of line 21 and 21A on lino 216. This is the BALANCE DUE. (218)
Make Check Payable to: Register of Wills, Agent
BE SURE TO ANSWER ALL QUESTI REVER IDS • O REC = ~"' ~• •~- - '~ ' ~~
• . Fr6~:
Under penalties of perjury, I declare that i. have examined this return, includin occompan ing schedules and statements otsd to tM best of m knowled d bet' f
Y y ge on to ,
it is true, correct and complete. I dectore that all real estate has been reports of true market value. Declaration of preparer other thou the personal representative it
based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSteIE FOR fItING RETURN ADDRESS DATE
Q~,,;,,~ "'y)~_QJ1 -yh~,~ E~(~-C 3 01 Fourth S t., S u mm e r d a l e, P A 17 0 9 3 ~ 9~
ADDRESS DATE
3631 N. Front St. , Harrisburg, PA 17110 6~ic~q~
AN #48 of 1444 provides for the reduction of the tax rates Imposed on the net value of transfer to or for
the u:• of the spouse. Th• rates as prescribed by the statute. will be:
• 396 (.03) will be appltcabl• for •:fate: of decedents dying on or after 7/1!94 and before 1/1/96
• Z96 (.OZ) will be applicable for •:fate: of decedents dying on or after 1/1/96 and before 1/1/97
• 196 (.O1) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98
• Spousal Iran:fer: occurring on or after 1/1/48 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, ...............
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 decadent within two years preceding
death transfer property without receiving adequate considerationis If death occurred after
Dscsaabsr 12, 1982, did decedent transfer property within one year of death without receiving x
adequate considerctionis ...................................................................................................
3. Did decedent own an 'in trust for'. bank account at hie or her deathf ...................................... 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
REV.ISO~f[• I,.,n ~ `n SCHEDULE E
Q'~ CASH, BANK DEPOSITS AND
COM.µONWEAITH Of iENNSYIVANIA MISCELLANEOUS
tNN[auHC[ rAx R[TUaN PERSONAL PROPERTY
ttESID[NT DECEDENT Please Prinf Or TYPe
ESTATE OF FILE NUMBER
MARTIN ORPHA K 21 95 0291
(All property jointly-owned with fh• R19h1 0( Survlvorshlp must b• dlsclos•d on Sch•dul• f)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
1. Dauphin Deposit Bank & Trust Co.r CD #8000101998 23,266.81
2. Dauphin Deposit Bank & Trust Co., CD #8100618364 20,045.11
3. Dauphin Deposit Bank & Trust Co., Checking Account 11,373.63
4. 1st National Bank of McConnellsburg, CD #02609108 30,436.43
5. , 1st National Bank of McConnellsburg, CD #SV263411 12,860.00
6. Harrisburg Patriot-News Refund 12.30
7. Thornwald Home Refund 92.73
8. Blue Cross/Blue Shield 93.20
TOTAL (Also enter on line 5, Recapitulation) $ 9 8 , 18 0.21
%~
(Attach odditionol ftK" x il" sheets if more space is needed.) i
1
etv.sa ... I,.a
SCHEDULE H
„~ ~`~ ~~ FUNERAL EXPENSES,
~pMMONWEAl1H 01 Cf NNSYIVANIA ADMINISTRATIVE COSTS AND
INNER~TANCE fAK Rf fURN MISCELLANEOUS EXPENSES
RfSIDtNf DEC(DlN1 ----_- ._ _~---.__.----------__.. __
-- - - - -- - - -- ---- F
ESTATE OF
MARTIN ORPHA K
ITEM DESCRIPTION
NUMBER
A. Funeral Expenses:
i~ Kelso Cornelius Funeral Home
Cedar Grove Cemetery Association
Flowers
Funeral Reception/Refreshments
B.
2
3
4
C.
1.
2.
3.
4.
5.
6.
7.
8.
Administrative Cost::
Personal Representative Commissions Waive d
Social Security Number of Personal Representative:
Year Commissions paid
Attorney Fees Caldwell & Kearns
Family Exemption
Claimant Relationship _
Address of Claimcnt at decedent's death
Street Address
City State
Probate Fees
Miscellaneous Expenses:
Carlisle Sentinel, Legal Notice
Cumberland Law Journal, Legal Notice
Zip Code
257.00
68.84
40.00
TOTAL (Also enter on line 9, Recapitulations I S 4 , 0 51.2 9
(IF mor• space is needed, insert additional sheets of some size.)
i
~~
_ _Pleat• Prlnl or
E NUMBER
21 95 0296
AMOUNT
1,998.00
500.00
87.45
100.00
1,000.00
LAST WILL AND TESTAMENT OP ORPHA K. MARTIN
I, ORPHA K. MARTIN, of the City of Harrisburg,
Dauphin County, Pennsylvania, being of sound mind, memory
and understanding, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking
any and all Wills by me at any time heretofore made.
ITEM 1.'"I hereby direct my hereinafter named
Executor or Co-executors to pay all my just debts, funeral
expenses, inheritance and estate tax~fs as smAii a~tse~tfm•Y~
death as may be found convenient. f
ITEM 2. All the rest, residue and remainder of
my estate, whether real, personal or mixed, of whatsoever
nature and kind, wheresoever situate and from whatsoever
source derived, I give, devise and bequeath unto my husband,
PRANK J. MARTIN, if he survives me by thirty (30) days.
ITEM 3. In the event my husband has predeceased
me or fails to survive me by th irty (30) days, then I give,
~' • ~ ~
devise and bequeath all the rest, residue andtremaiiYd~r`~af
c~y._~estat~, real,, personal and mixed,.. of whatsoever,~~ature
• i f .- .
and kind, wheresoever situate and fpm whats®epe~ sou'r•"c~e
derived, in equal shares, unto my two children; WARREN E.
MARTIN and CALVIN NBILL MARTIN. If either of my children
fail to survive me, the share to which he would be entitled
shall be divided equally among his issue, per stirpes.
ITEM 4. I hereby nominate, constitute and appoint
uw ornccs
NISSLEY. CLECKHER
• ~-
uw ornccs
NIS SLEY. CLEC KN[R
• fEAREN
`• •;ti;`•cl.
.';.
•r
;~'ct
my husband, PRANK J. DiARTIN, to be the Executor of this, my •• ~`'?~_~~:
Last Will and Testament. In the event my husband, Prank J.
Martin, has predeceased me or is otherwise unable to
serve, then I nominate, constitute and appoint my sons,
WARREN E, MARTIN and CALVIN NEILL MARTIN, to be Co-executor"a ~'.~~;,'~'
of this, my Last Will and Testament. ~ ~~~~~
*.
. ~.,
• .~i
". t`.
IN WITNESS WHERBOP, I have hereunto set my hand
and seal this ~~day of June, 1965.
' ~ C SHAL)
Or a I . Mart n
Signed, published and declared by the said Testatrix,
ORPHA K. MARTIN, to be her Last Will and Testament, in our
presence, who at her request, in her presence, and in the
presence of each other, we believing her to be of sound and
disposing mind, memory and understanding, have hereunto sub-
scribed our names as witnesses.
/ ~ ~ of
:,LL
Page Two of Two