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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
~14i87
NAME OF DECEDENT (F•N. Miaae. Caen SE% SOCWI SECURITY NUMBER DRE OF DEATH (MOne.. DOY •A'er) - _
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REOISTRM'SSK3NA7URE AND NUMBER `. .. ,
DATE FlLED (MOMI1. DaY
Year)
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POR DATES Of DEATH AFTER 1 X131 f91 CHECK
4.. ~ . ~ I HERITANCE TAX RETURN ik A SPOUSAL
"'`'`'~" `~ ~ ~ RESIDENT DECEDENT ~ PovERTy cREDiT is cwMED ^
~~"`'~ k FILL NUM6ER
COMMONWEALTH OF PENNSYLVANIA ~ ~, ~TQ g FILED IN DUPLICATE
DEPARTMENT OF REVENUE 1 REGISTER OF WILLS 21 95 0299
DEPT. 280601
HARRISBURG, PA 17128 0601 COUNTY CODE YEAR NUMBER
DECEDEN ' NAM LA ,FIRST, D MI DLE I IAL N ' PL A R
F-
a SLIFKIN, ERNESTINE 105 May Drive
u SOCIAL SECURITY UMBER DATE OF DEATH DATE OF BIRTH Camp Hill, PA 17011
0 193 36 3018 2/10/95 11/04/07 County
~ ®1. Ori Inal Return
Q 9~ ^ 2. Supplemental Return ^ 3. Remainder Return
Y oc ~ (for dates of death prior to 12-13-82)
=C~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax
V ~ m (for dates of death after 12-12-82) Return Required
^ 6. Decedent Died Testate ^ 7. Dsc ant Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
Q (Attach copy of Will) ( ach copy of Trust)
:l1~.1. ~ ... AND CO ENTiAI
•~ , D#Ik TOa
I NAME OMPL E MAILING ADDR SS
,? Caldwell & Kearns
~ c James D. Campbell, Jr.
O Z TELEPHONE NUMBER 3631 N. Front Street
u d Harrisburg, PA 17110.
717 232-7661
1. Real Estate (Schedule A) ( 1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) (d)
5. Cash, Bank Deposits 8 Miscellaneous Personal Property( 5) 13 , 6 0 6. 3 2
ZO (Schedule E)
g 6. Jointly Owned Property (Schedule F) (b)
~ 7. Transfers (Schedule G) (Schedule L) (7)
d 8. Total Gross Assets (total lines 1-7) (8) 13, 606.32
W 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 4 , 714.3 4
~ Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 6, 938.70
11. Total Deductions (total lines 9 8.10) (11) 11, 653.04
12. Net Value of Estate (line 8 minus line 11) (12) 1, 953.28
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Nat Value Subject to Tax (line 12 minus line 13) (14) __ 1, 953 28
15. Amount of line 14 taxable at 6% rats (15) 1 ' 9 53 _ ~R x .06 = 1 1 7 0
(Include values from Schedule K or Schedule M.)
16. Amount of line 14 taxable at 15% rate (16) x .15
ZO (Include values from Schedule K or Schedule M.)
17. Principal tax due (Add tax from line 15 and from line 16.) (1 ~ 117.2 0
F' 18. Credits Spousal Poverty Credit Prior Payments Discount Interest
d
~ + + (18)
u 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19)
~^
a" 20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (20) 117.20
A. Enter the interest on the balance due on line 20A. (20A)
B. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE. (20B) 117.20
Make Cheek Payable to: Register of Wills, ABenf
~ ~Q .,
Under penoltlss of penury I declare that I have sxammed this return, mdudmg accompanying schedules and statements, and to the beat of my knowledge and belief,
it is true, correct omplete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is_.
based all information F which preparer has any knowledge.
SIG RE OF P RSON R NSIBLE FOR Flll ETURN ADDRESS
- 34 Devonshire Square DATE
l / ~~ Mechanicsbur PA 17055 ~'~~~SS
1 URE OF ARER OTHER HA REPRESENT E ADDRES
~ {! 3631 N. Front Street DATE
Harrisbur PA 17110 ~'~&/5S
,;,
REV•13a E%~(s•!7) SCHEDULE E
CASH, BANK DEPOSITS AND
COMMONWEALTH Of PENNSYLVANIA MISCELLANEOUS
iN RESI INTIDKIDINTRN PERSONAL PROPERTY Please Print or
CCTATG /1C ...... ...... ~~..
ERNESTINE E. SLIFKIN 21 95 0299
IAHach additional 8Ys" x 11° sheets if more space is needed.)
PNC Bank, N.A.
(::unl~ Ilill, I'A lilll I
May 22, 1995
James D. Campbell, Jr.
Caldwell & Kearns
Attorneys At Law
3631 North Front Street
Harrisburg, PA 17110-1533
RE: Ernestine E. Slifkin
Date of Death: February 10, 1995
Social Security No. 193-36-3018
Dear Mr. Campbell:
PNC I~~~1 IE~
As per your request for information on account __~.Y~e above
referenced decedent held with us, the informat' is as follows:
-Checking Account No. 5140172851 opened /06/89 in the name of
Ernestine E. Slifkin. Balance at date o death: $13,606.32.
If I can be of any further assistance, ease feel free tontact
me at (717) 730-2321.
Sincerely,
y «n~'
Edith Tancil
Miscellaneous Services Supervisor
Bank Operations
ET/mky
AEV.ISII E%f Q•Q)
~~
VEALTM OP PENNSYLVANIA
RITANCE TA% RETURN
SIDENT DECEDENT
ERNESTINE E. SLIFKIN
C.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Pleose Print or
21 95 0299
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funeral Expenses:
1. Neill Funeral Home 4,047.50
B. Administrative Costs:
1. Persona! Reprosentotive Commissions
Social Security Number of Personal Representative: _
Year Commissions paid
2. Attorney Fees Caldwell & Kearns
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State _
4. Probate Fee; inventory, tax return
Miscellaneous Expenses:
~ Carlisle Sentinel, Legal Notice
Z I Cumberland Law Journal, Legal Notice
t
7
8
Waived
450.00
Zip Code
108.00
68.84
40.00
TOTAL (Also enter on line 9, Recapitulation) I $ 4, 714.34
~ '
• REV.1311 EX+ (7.86( 1•
~:~~
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE 7AX gETURN
RESIDENT DlCEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABLITIES AND LIENS
Plsa:~ Print or
...~.~~~ yr I FILE NUMBER
ERNESTINE E. SLIFKIN 21 95 0299
(Lt more space is needed, insert odditional sheets of some size.)
uv 1,n11. u//i
np'; j; '~r
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(OMM(1NM1 ~IIN QI 11 NNS~I~~NIA
NIMI ~IIANCI tAR •IIYeN
•1110/NI O/CIOINt
~ -.__'
ESTATE OF
ERNESTINE E. SLIFKIN
SCHEDULE ~
BENEFICIARIES
FILE NUMBER
21 95 0299
ITEM
NUMBER NAME AND AOORESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. To+cobl• degvests;
1• Susan Peterson Zeigler Daughter 50$
34 Devonshire Square
Mechanicsburg, PA 17055
2. Judith S. Reed Daughter 50$
6201 Pine Street
Harrisburg, PA 17112
ITEM AMOUNT OR
NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE
B. Charitoble and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recopitulotion) IS
(If more epac• Is needed, inset odditionol sheets of som• si:e)