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HomeMy WebLinkAbout95-0306~) -g5-03010 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 2pp]' Date ?~ • Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 3 O N+os.+u Rai aeT COMMONWEALTH OF PEHHSYWMPpA • DEPARTMENT OF HEALTH • VITAL RECORDS J Tr.enw,T CERTIFICATE OF DEATH M pER~„B,1 NAME dF DECEDEM IFea. Mind. L+al SDPE RIENUME61 ELAf,TC 036807 "` 8E)< SOCIAL SECWEIY NUMBFA DATE OF DEA111 Ueaeh, D•Y.'Ari, '• Victor R. D~'awba h ADE(L,a Bie~yH uNae„rEAR UUDOI, pA. ~~„~„ t male x184 - 05 '- 0262 Mpea, D.n Houa _ liaew iM•M.D•Y.KaI X91 a1RWfwUC~ D~.Nta~na+rcn.-,.~.~.a.~c.~.,n., s Y1L Oct 18 0'7 ,.Lisburn Pa tnv.a.ir~ E""°"""""G °°`^ ,~ O Raeinane^ rsOOM cwRr87sDEa+ + ^ t ~ Yt arr.eono.rtwaFDE.vtr NAMEana~e••iam.e~+arwawiaaie.I xMaDEDEDOrroF~EarrvxcaRIBINT MCE•Amakae Indn Bhnl Menea ate , . . Osi-berlary3 East Pennsbom ~-~~ ~~~ ~'aen tbuAlaoeuowiw+ IDNDaFewwEasiwgpmy ,~ w a ,a laelel•oa dar~I,iII,maa u.a ~, sEDUCiVIDM ~~ ' anan+yw;mmur i n ~ re e ) ICUt1i1SblHdtnlstl "M' p•ea ywm finny w6Cl N•O eim'" Y t ~a ~. p..,,s.t +~ Widowed , DeeEDCrcrawara3ADDncssav..LCn+aun.ar..avcnw DscEDENra 1700 Market Street tTa.str Pa ola „ap,~~•~~ aESIDENCE ~• Camp Hill, Pa 17011 • ~ .,.,,, +a tTS °r"'rNp7 ~° °iai°" . ,TaO} RCttExs RAMEtw,L IAi•!, t„q wr, grrti , Geor Drawbau IADrttEn•a NAM[ ff+t iAi,d, w.a.ns.n.nw nepEeis wtroRrwrs+wlERyma,a,ie n. Rider Daniel Drawbau wwauNr'sew,woADDlwaeisr.r.cln~..,.st,,..aoc•w DlenowrlDR o v 2424 Yale Avenue Hi 11 pa 17011 ~ E ox QC caer••^ Ran•wlAanalre^ Dal.em~ w°i'"' ~ -Ne•i••f4nrlrxp•m+ay I.DCgwn.cswr•.~n.ar..zbcm. „ ~ ~ ><+ it 21 1995 ADTw Aa stN~1 NuneER ,. ra ~ waEANDADDReasoFSACartr m. 011654-L 1903 Market Street _ rlr.iarlr •r•alaYyitllm•elO,„I,p me~~~w°"•i°s•.ewnax~.r.erwm+,w..naarnww. uDEraar~tateEq ••+eMerwdneaR ONE D Daft YIrI rm•wasmlwwmrol,rany Oae•e atiowoilpea..nwll OF OF.QN DAfE NCEp OEADINpiIn. Oaµ Yeeri UILB CASE REEF.RIIEDWM~XEXAMNiEpR`,p~gHEiy A./Y1RTh E~rllrq••m••.y~I,Mam~rgYenp~I~wWe•a~wOhrWW.O•na wnrtlr imE•1ial wxf~rwas> 3L W^ N•~ 1.41 M•y Ona Ceiaaenarl~ole. •n•KM JIp IWn WII•~. A00~••~nr• IARf! ~ dIMfC•~Wnatlnb~MgbO~M.hlt EIII~taTE CAIgEIFrpI ~ I~W ~I•t~aPialllEti Yle lanwyegnelaegA„i1 PART I. a + wraor caidon h .2 v,~ ^ ~ wadarq nnean+-y y `~ i~ OUE TaroR ASA OUENCE OF} •"lf C~~ Ifi1rti ~~~. ~ /~~ a•vnu+ro+cawm. a DUE IOIDR ASACONSEDUENCE pFk + I thalYie~ ~4nY ~ l DUE 10 (OR ASACOtVSEOUENCE OF}. rwi9 ^ n•MQ WT I a IIRa ANAU7C7RSy VAEI1F AUtU/gYFwpEiUg MA+WER OF DFAM , FERPoPMED7 MMAQERRIDN 70 DATE aF WJURY nIAEGIILIUR`/ iNJURYRNpW(T DESCRIBE NDWiNJURY DCWRREO. (Monet O•ylaer) COMPLEIgR Of GUSE ~ OF OE.VR7 Want tlanYnne ^ Aaidae ^ P••~Kl bn••n0•tbn ^ YLe ^ N•^ ~yI 'h ^ i'i•Y Y'•a ^ N• ^ Sukge ^ Caen Aof W nNMmine, ^ M. RACE OF IKIURY-N nenr, IAnn, arM IY yiyy Mka , , , LOCATION lea. 2,. ~ q. we. (SD•~•vl lSbew. CIM+w~n. SrM ~~ ~ nM' a+M ]w. 'CEIRIrYWD R MYa1GAN(Pnyan•n waM9taue.WnrN wnen spew OnYacien ne. p<mwxen avan eia SIGNRUiIE ANO nnE OF CER IER Te IM O•M eln Mn•r l•I•n e s z9 rom ry em b l - C G E•. aeaw oa:wneewMlM ~•ii•N•1aM m•NwY•tebn ................ ........................ . lk /Y4i1 'IRONOUNptp ANO CERTIryap PllYLf:U1N (PnYa~ian Oeeipmownrg wean artl I LICENSE NUMBER sIDNEDn~w.n.o mtMU.wan,ra„o,.l•eE•.awaen.,wMBrltm.,asr eneWe. .naawaln a L a ~ ~ °~+`°37 ~ t , . .•n•et .l .~a m - ~.a..w.a .......................... ^ ,e. NAME AND ADDRESS av PER$ON WNO COMPLETEOCAUSE OE D6RN ~~~~ E%ANwER/CORONER (hem 27) Type ar PrMll }--t," ,,,. M a M A . p ~~ m Nlon andlar hwesMgetlpn, in my uWnbn. deaM+xeumC Y tM Ume. ANe. an0 Wace. antl dw to IM uu o t ............... ................................... REGIS 'S SIOIUTURE ANp ri CG.~ f~(~~ ~ja + ~ ~ i DATE FlLED iLwMn. D•Y. Yarl " ~•' ~ ~~ _ i 9 5 r' U ~ /~ - ~( f~EV - 1500 EX ~ (7-94) ,,,...- '' 0 E C E D E N T HH ~ S. COM~r10NAV~rEDDAE~PPNT2OgpF~,Pp IUyANIA '~ HARRISBURG, PA 17128-060t1 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INI1 DRAWBAUGH, VICTOR R. 1. SOCIAL SECURITY NUMBER DATE OF DEATH 184-05-0262 04/18/95 ~o~~a~©~ rOR DATES OF DEATH AFTER 12/31/91 CHECK HERE INHERIT E TAX RETURN POVER~YCR DIT IS CLAIMED RES NT DECEDENT FILE NUMBER TO FILED DUPLICATE 21-95-0306 H REGI ER OF WILLS COUNTY CODE YEAR NUMI L) DECEDENT'S COMPLETE ADDRESS 415 East Marble Street DAT OF BIRTH Mechanicsburg, PA 17055 0/18/07 ccunry Cumberland F APPLICABLE) SURVIVING SPOUSE'S NAME (LAST,FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) C A B X 1. Original Return 2. Supplemental Return 3. Remainder Return H P L 4. Limited Estate 4a. Future Interest Compromise ' E P 0 (for dates of death prior to 12-13-82) C (for dates of death after 12-12-82) ~ 5. Federal Estate Tax Return Required K P 3 ~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Att h ac copy of Will} (Attach a copy of Tr ust) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION OULD BE DIRECTED TO: O O NAME COMPLETE MAILING ADDRESS E E John E. Slike, Es uire Saidis, Guido, Shuff &Masland $ N TELEPHONE NUMBER P. O. BOX 737 T 717 737-3405 1 R I Cam ~ ill PA 17001 R E C A P I T U L A T I O N T A X C 0 M P U T A T I O N ,SIG ea Estate (Schedule A) 1 7 2. Stocks and Bonds (Schedule B} (2} 1 , 096.25 3. Closely Held Stock/Partnership Interest (Schedule C) (3) / 4. Mortgages and Notes Receivable (Schedule D) (4) / 5. Cash, Bank Deposhs $ Miscellaneous Personal Rroperty (Sch. E) (5) f 96 , 410.10 / 6. Jointly Owned Property (Schedule F) (6) 15 , 761. 94 7. Transfers (Schedule G) (Schedule L) (7) 8. 9. Total Gross Assets (total Lines 1-7) Funeral Expenses Administrative Costs Miscell ( ( / , , aneous 9) 15 , 473.71 Expenses (Schedule H) , 191,906.29 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 5 , 920.05 ~/ 11. Total Deductions (total Lines 9 & 10) (11) 21 393 76 12. Net Value of Estate (Line 8 minus Line 11) (12) , . 170 512 53 13. Charitable and Governmental Bequests (Schedule J) (13) , . 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 170 512 53 15. Spousal Transfers (for dates of death after 6-30-94) , . See Instructions for Applicable Percentage on page 2. (15) 0. 00 X 0 00 (Include values from Schedule K or Schedule M.) . 16. Amount of Line 14 taxable at 6% rate (16) 170 , 512.53 .06 = 10 230 75 (Include values from Schedule K or Schedule M.) , . 17. Amount of Line 14 taxable at 15% rate (17) 0.00 X .15 = 0 00 (Include values from Schedule K or Schedule M.) . 18. Principal tax due {Add tax from Line 15, 16 and 17.) (18) 1 19. Credits/Sp Poverty Prior Payments Discount Interest 0 , 230.75 l + 10,000.00 + 511.54 20. If Line 19 is greater than Line 18, enter the difference on Lin - (19) e 20. This is the OVERPAYMENT (20) 10,511.54 0 ® Chedlt here if you afe raquet;tin a refund of your overP went: . 280.79 21. If Line 18 is realer than Li 19 g ne ,enter the difference on Llne 21. This Is the TAX DUE. (21) 0.00 A. Enter the interest on the balance due on line 21A. (21A) 0 .00 B. Enter the total of Line 21 and 21A on Line 216. This is the BALANCE DUE. (21 B) 0.00 Make Check Pa able to: Re ister of Wills, A ent - - BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~ penalties of perjury, I dec are that I have examined this return, including aceompanyi sc edules a slat nts, and to the best o my knowledge and belief, it is true, t and complete. I declare that all real estate has laeen reported at true market valuq` ec a t n of r e of r than t personal r resentatfve Is bas onsl in rmati f preparer has au9'fihowledae. ~ 1 SIGNATURE OF PREPARER OTHER T N REPR~SE ~~ ~' ConYrlq t r1 1994 form software oniv CPSvstems. Inc. ®~i~° on o RN D . Drawbaugh & R . D w augh ~ /~ ~~ c/o 2424 Yale Avenue .~~~~%J ----------------------------------------------------- Camp Hill, PA 17011 ATIVE Saidis, Guido, Shuff &Masland DnrE P. 0. Box 7.37 __ ------------- Camp Hill, PA 17001---------------------------- j~ ~~,~~`~ `, r.,..., 1.~_oe~ 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: •3% (.03) will be applicable for estates of decedents dying on or alter 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% (.01) 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 MARK ()Q IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: a. retain the use or income of the property transferred, . ~{ b. retain the right to designate who shall use the property transferred or its income, g c. retain a reversionary interest; or . X d. receive the promise for life of either payments, benefit§ or care?. ~{ 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? ~{ IF THE ANSWER TO ANY OF THE ABOVE tiUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. CooVrlght (cl 1994 form software only CPSvstems. Inc. -. - -_ _ _ _ c.,..., 1Sflft roe„ ~_an~ LAST t,+IILL AND TEST'iP7ENT OF VICTCR P,. DRAI~fBAUGH i I, VICTCR R. DRA~rJBAUG_-I, of the Borough of P•iechanicsburg, County of C~.zmberland and State cf Pen.nss,lvania, being of sound and di.sposin~* mind, memory a.nd understand.i..n~;, do make, publish and i dec'_a.re Y.hi.s my Last l~Ji.]l a.nd Teste~mer.t. 1. I direct the payment of a17. my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I T rive, devise and. bequeath all the .rest, residue and remainder. of my estate, of ti~rhatsoever nature and ,•rheresoever situate, to my wife, Lov.i.se r. Drawbaugh, her heirs and assi.~ns, absolutely and uncondi.ti.onally. 3• In the event that m-y wife, Louise '~. Drawbaugh, should predecease me, or should she die at about the same time as I do, such as in an accident common to both of us, then in such event, I ~~,ive, devise and bequea my entire estate, real, personal and mixed a.nd wheresoever situ te, to my two sons, to wit, 7}aniel ;3. Drawbaugh and Robert J. Drawb ~h share an ike. ~ LASTLV, I nominate, constitute and appoint my wife, Louise F. I Dra~,rbaugh., Fxecutr.ir. of this ra)* Last ',till and Testament, a.nd in tare evert that mtr said iai.fe shoi;ld pred.eceasc: me, or should she be unable to serve in such capacity for any reason, then ?.n such event, I. r.omi.nate, constitute a.nd ap,;oi.nt my sons, Daniel B, Drawbaugh a.nd. ??obert J. Drawbaugh, 'xecutors of this my Last 'vJill a-d Testa.ment in her place and stead. -1- It? k~T1d~;SS r~~~";Dr, I have hereunto set m;r hand and seal this day of ~ oJ' ~Yl~r-~7 ` _ , A. D. 1971. - AL ) Victor R. Drawbau~h Signed, sealed, published and declared b y the above named, Victor R. Drawbaugh, as and for his Last Will and Testament, in the presence of us, who have subscr.i.bed our names hereto as witnesses, at the request of said testator, in his presence and i.n the presence of each other. ,~~, ~'~ 4~~wr~z~~,~1 ~ ~ ---.T` ~~ ~-2~_ l ~~cL,u -2- REV - 1502 EX + (12-85) COMMONWETApL~TCH 0 PENNSYLVANIA INI~~SIDENT DTECEDENT N SCHEDULE A __ REAL ESTATE ESTATE OF VICTOR R. DRAWBAUGH SS~~ 184-05-0262 04/18/95 FILE NUMBER 21 95 0306 (Property ~otntly owned with Right of Survtvorshlp 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. neithe. ha~~„ ~~r....vuea .,. ~n iivia af7a{;tl IS fle@O@O, Insert aaottlonal sheets of same size.) Copyright (c) 1994 form softwdre only CPSystems, Inc. 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