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Home My WebLink About95-0329~, n ~/ 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 200T Date H105 tk Rw. ,/9, TYPE/PRN1T n~ PERMANENT BLACIL EIK ~1 is i z ~ f Fran eropoli, ct Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYWANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (Coroner) u36894 NNAE OF DECEDENT (Far, MEfls, LaY) SEX SOCIAL 9ECUMVNUMBER DATE OF DEATN IM•M.Ory, Yssr) ,. Donald R Myera ~ Male. a 174 20 4141 .. April 18, 1995 NiE B.w BtradsY) UNDER,YENI UNDER,DM DATE OF BIR,N BEiT1ilACE pTYW PLACE OF DERN~Cks ck aay ar-wnme;brNmoawr ada) ManSr Drys Nan MInW PamP,Dry. Yaer) SNeea F«rpiCaurar,9 IIOSPfD1L: . Aug. 19, ppe~ Fra~kford aw.Ih•I ^ ERXAaprha ^ DDA ^ INbu 75 m ~ ^ R i 6Q ^ . nN ea OMice f3oec+T) .. 1919 T. wp , a ,,, COUMYOF OFRH OF DEAN TACRfTY NAkEIY nd trea~tlm, p.. rrr and nunEer) DECEDENT OFINSPANX:ORKiMl7 RACE •Amaken Mhn,Bhtlt, VAdh, slc. Ntr Nr^nyr,.p.c,IYCara, lBVwd ylk-ite P , Cumberland Carlisle 1100 Stratford Drive , ,,,,,, ,k,,,,~. ar:. K •. , DECEDENT'8 aND OF lUSn+E vnl8 EVERw OECEDEM'S EDUC.QION MARTpISVauB-MrrO SURVIVIND SPOUSE U.S.NYED FORCFBT ~ C~ Nw (M wM..gM mrtlrrrrnN) E ~ I~i~q N ~A m ~ u•s ra r. ) r O •Refinishin , Furniture ""^ "°® n}ta 5 I+-aas+) , Single DECEaarr'e MAalrx, ADDRESS (Se..I, cr,~n. Shh. zocm•) DECEDENT'S ,Te srre a da ,T a ti ^ w e e . 1100 Stratford Dr. . e. er Na . w RESIDHICE e.re.a Carlisle Pa 17013 ~n."~`~°eu ~` Cumberland ~^•~+~ Carlisle tE. ,Tt ,76^ WlMrearlired cNYlkaa ,~Theodo er R Myers ,Alice 1~se Myers~~ Robert Lp Myers 1100 S at~feo~rd~r~'~~C~arl~s~'e Pa 17013 METNDDOF DATE OF OF -NawdCeaehrK CNara, IOCRION •Cky/Taw4 SNh, ap •aK~) an.Pr•. CnmeLion^ RanwrnanSbh^ ^ Dar1i•a^ W ~ 4-21-1995 Upper Frankford Church Ce Upper Frnkford Twp, Pa ACTMq AB BUCI, LICE//8~ NAMEANDADORESBOFRLCILT' O man- O une a 2 L ~U jj ,,,,219 N. Hanover St. Carlisle Pa 17013 OrrohlellereEfasaay werdar ~d..a~, e.rn«an.ar Erlk... a.r.ro ak•rr.a ~ ucEHeENwBEn avE SgN® p.I.IeA^traaeearkrrrrdeern,tr rrTEN Moak.D.y,r,.p ewlyaawdOeM. rA.. aw fle. PRONOIN/CEDDEADManat.D.Y.MeA MNSCASEREPERREDTOMEDICAI.DLAMWERICDRDNER7 M oPDE/vN Apra ~ r . prerd ior arl 1995 "'~ "e^ 4:40 P Aril 18 ,,, . M. ,., , YT.PWITk ErertlrAeerr, Yyrhe«aaepMeWOr dadturellM Aeelk.D•nel wthr,M.wMdOytrq,saA raedraneptrray eneel ek•dt«keerl hBtre. ~AppaaYMe PMT N: Otlre prkra awtAllar aNa'616pb AeeS4 W LMaayaMawrmeacnnr. YMMrlkrwrn na rMdWgln tln urMatytrgaar pNan hPAT1T 1. M®IRt CMM[(FW ;ow1en00eaN ~ ° Probable M ocardial Infarction j , „, DL)E TO (c R As A coNSEOUENCE DFl: aawreylYtanilar e.,Ir.aeEatrr.seh DuETOIaaASACarsEQUENCEQ~: rtre. ErwIRgILYNMi i cMNIE (DMweatrywY c. til vatleh0ewb DUE 70(OR AS A CONSEQUENCE Q~l: ~ iaAeetri)LABT r N118 AM NliDP3T WElE AU70PSY FEIDN/D$ MANNER aF DEATH DRE Of PLIURY TNAE OF MUURV ELX1RVQWORK7 DESCRIBE FIOY/IWURV OCCURRm. rERPaLMEm AvAB/18lE PRIDR TO Mma,Dry. V,eq of of CAUSE Nwr ~ ~~ ^ w ^ N• ^ 1M ^ N•~ `Ax ^ No ^ AmICNa ^ ~9 ^ PLACE OFIWURV-N kaae,hn,etrael haary, dnc. M LOCA,ION (Street. Caylfown, SWCMe ^ C aAMrO Y ^ a ehmt alO bi6t0. re.ISOer/r1 Mh. 7kb. 11. be. CdRIP1EA(GwAaNy one) 91ONRURE ' C®TTIPYINOMIYEIG~W (Pkydcw aeurynpaama d 0rM anon aiaPter Pkyefcun hr paatuncae Cra entl canplete0 han 23) e ~ .rlao.ne.a..a.rn«a.rwa»wE»a..Nq.a.atin.rrer.a ..................................................... ^ ~,w -- Coroner LIC ORESIONED7MaM. Day, Neh ~TOPa.~~Y.AeND~+E.~P.'w"'.w ~ w~"'°r~..,a .,.a°`~`Prr,:~e b ~"N`&A°a.e"ww:,rrdw .......................... ^ ,o o,aA ril 19 1995 NAME MD ADDRESS OF PERSON VApCOMPLETEDCAUSE OF OEIPN ,~ cnemz~ryPe«PrMn Michael L. Norris, Coroner oDwe.ww•,.krn.BoR.tw•.mvaLq.BOD,.7myapmeR,e..mow,ewrB»an,.,au,aDePI.~...taat.l.m.aw.ge)..a r.M....dwa ..................... ..... ~ 405 Fairwa Drive u . ................................... .................................. m.. ,z. Mechanicsb rg, Pa. 17055 REOISTRM'S SIGNANRE MBER DQE FlLEDMorm, OaY• Near) REV-1500 EX+ (7.94) ~ ~ " `~ r`" " `'" "'`' ~ INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12!31191 CHECK HERE P ^ OVERTY CREDIT IS CLAIMED ( ~ RESIDENT DECEDENT FILE NUMBER COMMONWEALTH OF PENNSYLVANIA \ (TO BE FILED IN DUPLICATE DEPARTMENT OF REVENUE DEPT. 280601 WITH REGISTER OF WILLS) 21-95329 HARRISBURG, PA 17128.0601 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIALI DECEDENT'S COMPLETE ADDRESS M ers Donald R. 1100 Stratford Drive W SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH Carlisle PA 17013 174-20-4141 r. 18 1995 A .6 1919 , count Cumberland p (IF APPlICA6LE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL( SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) ~++ ®1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return Y e H (for dates of death prior to 12-13-82) Ws0°c~.+ ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required _~° m ~ (for dates of death after 12-12-82) a ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) y Z OMPL U ~ Z Fre and Tile 5 South Hanover Street B g TELEPHONE NUMBER Carlisle, P~ 1?7 013 _~, `' 17 - 1. Real Estate (Schedule A) (1) ~ ~ 2. Stocks and Bonds (Schedule B) (2) ~J-'~'" . ,. Fti " , „ f ,'~(~~~~ ~ 3. Closely Held Stock/Partnsrship Interest (Schedule C) (3) ; --~ V,, s "' l 4. Mortgages and Notes Receivable (Schedule D) (4) ,. ~ 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) 6~'11L..3R ~~~ ^ ~~. ~ l _.- ~ z (Schedule E) . '.` (,! fi~.~' b. Jointly Owned Property (Schedule F) (b) `~ ~ `' /';~ ~ 7. Transfers (Schedule G) (Schedule L) (7 ) 6 8. Total Gross Assets (total Lines 1-7) ~ (8) 60, 702.38 9. Funeral Expenses, Administrative Coats, Miscellaneous (9) "~'~':'6'g'g: Expenses (Schedule H) ~~/ ~ ~~ ~ ~„ 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) ~~~ [~?~~ ~~ 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) T7j~~3• rL (12) ~'~~ 13. Charitable and Governmental Bequests (Schedule J) (13) _ ~~i`~3' ~a 14. Nat Value Subject to Tax (Line 12 minus Line 13) (14) 15. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicable Percentage on Reverse (15) x = Sid (I l d l f h S d l K l M S h d . _ _ e. nc u e va ues rom c e u e or c e .) u e 16. Amount of Line 14 taxable at 696 rate (16) ~ x .Ob = (Include values from Schedule K or Schedule M.) A~ ~ ^~ , ~ ~ ~ 17. Amount of Line 14 taxable at 1596 rate (17) ~ x .15 = ~ z (Include values from Schedule K or Schedule M.) ~ o 18. Principal fax due (Add tax from Lines 15, 16 and 17.) (1B) 3,123.59 ~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + + 156.18 __ (19) _ 156.18 a 20. If Line 19 is greater than Line. 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) -- ~ ^ • 21. If Line 18 is greater than Line 19, enter the difference on Line 21 . This is the TAX DUE. (21) 2, 967.41 A. Enter the interest on the balance due on Line 21A. (21A) B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (218) 2, 967.41 Make Cheek Payable to: Register of Wills, Agent Jnder penalties of perjury, 1 declare shot I have ' is true, correct and complete. I declare that al used on all information of which preparer has IGNATL(RE,Of PERSON REJrPpNSIBLE fOR FILING RETURt return, including accompanying schedules and statements, and to tht s been reported at true market value. Declaration of preparer other s. 1100 Stratford Drive, Carlisle, PA 17013 .,,..,,. .,.......,...,, ^r' ,..,,.~ ~~R~~~ ~+~C~~-c,.,~ ~... 7` e..~... 5 S. Hanover St., Carlisle. PA 17013 st of my knowledge and belief, n the personal representative is DATE July 13, 1995 DATE July 13, 1995 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°k (.03) will be applicable for estates of decedents dying on or after 7/1 /94 and before 1 /1 /96 • 29/0 (.02) will be applicable for estates 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 beforo 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 CHECK MARK (,~~ IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: X a. retain the use or income of the property transferred, ....................................................... b.. retain the ri ht to desi Hate who shall use the roe transferred or its income X 9 9 P P rh' , ............... 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 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 X adequate consideration$ ................................................................................................... .{. . ..x , 3. Did decedent own an 'in trust for'. bank account at his or her death$ ...................................... 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. ,~ , REV-1508 EX+I&87) SCHEQULE E CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INHRESiIDENTEDECEDENTRN PERSONAL PROPERTY Please Print or Type ESTATE OF FILE NUMBER DONALD R. MYERS 21-95-329 - (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH 1. Balance Meridian Bank Certificate of Deposit #4001973090 30, 000.00 Accrued interest to April 18, 1995 393.28 2. Balance Meridian Bank Certificate of Deposit #4001973629 30, 000.00 Accrued interest to April 18, 1995 309.10 TOTAL (Also enter on line 5, Recapitulation) I $ 0, 702.38 (Attach additional 8~/~" x 11" sheets if more space is needed.) • 1 REK1511 EX+ (7.88) ~~ SCHEDULE H FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND INHERITANCE TAX RETURN MISCELLANEOUS EXPENSES RESIDENT DECEDENT Please Print or Type ESTATE OF FILE NUMBER DONALD R. MYERS 21-95-329 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral. Expenses: ~• Hoffman-Roth Funeral Home 6, 351.20 Clergy and organist 200.00 B. 2 3 4. C. 1. 2. 3. 4. 5. 6. 7. 8. Administrative Costs: Personal Representative Commissions _ _ Social Security Number of Personal Representative: Year Commissions paid Attorney Fees 3, 035.11 Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State - Zip Code Probate Fees 123.00 Miscellaneous Expenses: Register of Wills, 1 short certificate 3.00 Thompson Eye Assoc., account 105.42 Ronald M. Schlansky, M.D., account 50.73 Eby Granite Works, grave stone 1,195.00 Reimbursement to Robert L. Myers for room and board and personal care rendered to Donald R. Myers for three years P mediatel , . 28._._.-----___ preceeding his death on A ril 18 1995 y p , , @ $800.00 er month ,~_, 800.00 Register of Wills, filing Pa. Inheritance Tax Return ~ ,~ , ~ ~~~ c,~ ~'~ 15.00 .~ ~~ ~~~~;.~~~~~I ~~ 1~~ TOTAL (Also enter on line 9, Recapitulation) $ 3,~,-8~6 (If more space is needed, insert additional sheets of some size.) i~ RF V. 151'1 FYa Ij.87) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER DONALD R. MYERS 21.-95-329 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: 1 • Robert L. Myers Brother esidue of estate 1100 Stratford Drive Carlisle, PA 17013 ITEM AMOUNT OR NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE B. Charitable and Governmental Bequests: 1. NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I $ (If more space is needed, insert additional sheets of same size) f* REV-1547 EX AFP (12-951 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAxES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. zso6o~ OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG, ~A 17128-0601 ACN 101 DATE 03-18-96 ESTATC OF I•IYtKJ LUNALll K FILE NO. Ll YS-UJLY DATE OF DEATH 04-18-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT'' REMIT PAYMENT TO: FREY & TILEY REGISTER OF WILLS 5 S HANOVER ST CUMBERLAND CO COURT HOUSE CARLISLE PA 17013 CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (12-951 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MYERS DONALD R FILE N0. 21 95-0329 ACN 101 DATE 03-18-96 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Nat Value of Tax Return 13. Charitable/Governmental Bequests (Schedule J) 14. Nat Value of Estate Subject to Tax (1) .00 (2) .00 (3) .00 (4) .00 (5) 60 , 702.38 (6) .00 t7) .00 (B) 60,702.38 t9) 11,078.46 (10) .00 (11) 11.078.46 (12) 49,623.92 (13) .00 (14) 49,623.92 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) . 00 X . 00_ . 00 16. Amount of Line 14 taxable at Lineal/Class A rata (16) . 00 X . 06. .00 17. Amount of Lina 14 taxable at Collateral/Class B rats (17) 49, 623.92 X . 15. 7, 443.58 18. Principal Tax Dua (lg) 7,443.58 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) AMOUNT PAID 07-13-95 AA047993 156.18 2,967.41 1NItKt~l 15 GMAKtitll FKOM 01-19-96 To 03-26-96 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT 3,123.59 BALANCE OF TAX DUE 4,319.99 INTEREST 72.56 . TOTAL DUE 4,392.55 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE RN-1470 E% (6-881 r COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 2 8-060 1 DECEDENT'S NAME I INHERITANCE TAX EXPLANATION OF CHANGES E NUMBER N ' '`+ i SCHEDULE ITEM ~ EXPLANATION OF CHANGES NO. ,- ; ,- , _ - - ,. ,,. t l TAX EXAMINER: PAGE