HomeMy WebLinkAbout95-0325_ _. _ - ~ 1
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.
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AUG 1 ~ 200
Date
,tiRECTEDITEMS: #21b
H,05.,a3 Rev. ?/87
PER: FD DATE: 05-09-95 dlc
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Fran eropoli, ct
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
- saaE PAE NULISEIi
036841
NAME DECEDENT IFira MieOa. Lang ._ SEX SOCIAL SECURRY NUMBER DATE OF IMOreI. Day,'
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REGISTRAR'S SIGNRURE AN UMBER DRE FILED (Manor. Day. Pearl n ~-
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5Q2~.82-~5. 1 ~ :.30-_3
REV-1500 EX~ (12-88) FILE NUMBER
~~ INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280401
HARRI58URG, PA 17128.0401 (TO BE FILED iN DUPLICATE
WITH REGISTER OP 'WILLS 21-9 5 -0 3 2 5
(COUNTY CODE _ YEAR NUMEER
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° DECE' DENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Heaney, Thelma E. _
SOCIAL SECURITY tlUMIiER DATE OF DEATH DATE Of BIRTH
040-16-4207 4/16/95 11/4/1913 DECEDENT'S COMPLETE ADDRESS ~~
25 Chester St.
Car 1 i s le , PA 17 013
c°unl Cumberland _
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^ 2. Su lemental Return
~ 1. Original Return pp
3.
Remainder Return
y (for dates of death prior to 12-13-$2)
~~V ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estats Tax
V ~O (for dates of death after 12-12-82) Return Required
d°~ ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
Q (Attach copy of Will) (Attach copy of Trust)
t 1- NAME M L M ILI
p ;Frances, H. Del Duca 10 West High St.
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O TELEPHONE NUMBER Carlisle r PA 17013
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717 249-1323
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Close{y Held Stock/Partnership Interest (Schedule C) (3) ~ __
4. Mortgages and Notes Receivable (Schedule D) (4) _ _
S. Cash; Bank Deposits 8~ Miscellaneous Personal Property( 5) 15 . 61 ~ • 3 3
Z (Schedule E)
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b. Jointly Owned Property (Schedule F) (b)
~ 7. Transfers (Schedule G) (Schedule L) (7)
=
a.
8. total Gross Assets (total lines 1-7)
(8) 15,610.33
_ ______
W 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 3 , 5 7 9 . 2 6
~ Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
1 ] . Total Deductions (total lines 9 & 10) (11) 3 , 5 7 9 .2 6
12. Net Value of Estate (line 8 minus line 11) (12) _12 r 031 .07
13. Charitable and Governmental Bequests (Schedule J) (13) _- ~ • _
14. Net Value Subject to Tax (line 12 minus line 13) (14) _12 , 0 31.0 7
15. Amount of line 1d taxable of b°i6 rate (15) x .Ob = _._
(Include values from Schedule K or Schedule M.)
1 b. Amount of line 14 taxable of 15°ib rate (16) 12 c-~ 31.0 7 x .15 = 1 - 8 ~ 4 . 6 6
Z (Include values from Schedule K or Schedule M.)
O
r 17. Principal tax due (Add tax from line 15 and from line 16.) (17) _
-
~ 18. Credits Prior Payments Discount Interest
v 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19) _
x ~^
~ 20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (20) 1 r 8 0 4 . 6 6
A. Enter the interest on the balance due on line 20A. (20A) _
8. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE. (208) 1 ~ 8 0 4 . 6 6
Make Check Payable to: Register of Wills, Agent
Under penalties of perjury, I 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
base n all information of which sparer has any knowledge.
SIG T RE OF PERSON SPON O FI NG RETURN ADDRESS
e ~'
~ ~ e DATE
~~ ~ ~la
SIG A URE OF PR AR OTHER THAN REPRESEN ATIVE ADDRESS /~D~ D.4T
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~) 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,
c. retain a reversionary interest or ....................................................................
d. receive the promise for life of either payments, benefits 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? .................................................
3. Did decedent own an 'in trust for' bank account at his or her death? ......................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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REV•1508 EX+12.87) SCHEDULE E
'' CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS
IN RESIIDENTEDECEDENTRN PERSONAL PROPERTY Please Print or
Thelma Heaney 2195-0325
(All property jointly-ownod with the Right of Survivorship must bs disclosed on Schedule F)
(Attach additional 8Yx" x 11" sheets if more space is needed.)
s€Klsll ex+ p.eel SCHEDULE H
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISCELLANEOUS EXPENSES
Please Print or Type
ESTATE OF FILE NUMBER
Thelma Heaney 21-95-0325
ITEM
NUMBER DESCRIPTION
AMOUNT
A.
1. Funeral.Expenses:
Eby Granite Works 424.00
Funeral Lunch 260.42
B. Administrative Costs:
1. Personal Representative Commissions
_ _
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees Frances H. Del Duca 500.00
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees 5 4 . 0 0
C.
1 Miscellaneous Expenses:
.
ATS Medical Services, Inc.
272.50
2.
Leader Nursing Home 2053.34
3.
4 Filing 15.00
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) $ 3 , 5 7 9 .2 6
(It more space is needed, insert additional sheets of same size.)
REV-1513 E%+ )2-87)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Thelma Heaney 21-95-0325
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
1 A. Taxable Bequests:
.
Nancy A. Osborn
Niece
100$
25 Chester St. ,
Carlisle, PA 17013
ITEM AMOUNT OR
NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I$
(If more space is needed, insert addifionol sheets of same size)
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