HomeMy WebLinkAbout95-0330r ~ T ~~- ~~
This is to certify that the certificate hereunto attached is a true and accurate copy o~i'the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, vrhose 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 1 g 200 ? _
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
N+os +u R.Y. +ro+
TYPEJ-laNT
PERMANENT
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COMMONWEALTH OF PENNSYLYMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS 0 3 6 r ? g
CERTIFICATE OF DEATH _ _ _
(Coroner)
NAME OF OECEDEM (f+%. MitlW,tap SEX SOCHL SECURRY NUMBER ~ DATE OF DE/PN lMOnn, Dq,1W)
,. Annie M Barner i Female , 2 ~ 76 ~ April 21, 1995
AGEILM BiBNq~ UNDER+YEAR UNDER+DAY DJVE OF GIRT/ BBTRIRACE(Gy•ntl RACE Of DEATN QCMCM «IyoM-auuiil.Uttlo~N UnoMlef rtl~
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REINiR'B NAME p-u,L MiAJ..lr) MoT11FA'S NAME(FiAI, M.itlN+sumray
,a Charles Marks » Alma lellan
NPDRM,vrra NAME RYV•'Ah0
Terry Barner
l~ounn~Lafori~s Plains NJ
OF DISPOSITIOII
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'PRONOINCNGAND CERTIFYNOPNYSKbW(PAysci•n bdhpM«uicirp tlMNe~W eernyinp nc•us•dd•elh) LICEN UMBER DAfE SKiNED(M«r, D•Y•'•••r)
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NAME AND ADDRESS of PERSON wNO COMPLETED GusE of DERH
.MEacA~ExA,w~EwcoRONER m..,znTyp.«P'""Michael L. Norris, Coroner
Ontnr brr of oarMMlon rWlar Nrvoutlputbn, in mY opinbn, Borth aacumd N Bw time, Bra, rld pro, Nltl aw to Nn c.u.o(r).ntl
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..x. Mechanicsburg
Pa. 17055
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REGISTRAR
S SIGNATURE AND Ld ,~,/, ~i pA{E FILEDIMmWt DeY. Yb«)
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REV-1500 EX+ (7-941 ~. v
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INHERITANCE TAX RETURN F A SPOUSALDEATNAFTER 12/31/91 CHECK HERE
POVERTY CREDIT IS CLAIMED ^
1 RESIDENT DECEDENT Flu NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE Z ~ ~r"" p'~~ a
DEPT. 280601
HARRISBUR
PA 1 WITH REGISTER OF WILLS
7128-0601
G, COUNTY ODE YEAR NUMBER
DECEDENT'S NAME (UST, FIRST, AND MIDDLE INITIAL)
'
~ DECEDENT'S COMPLETE ADDRESS
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LZ SOCIAL SECURITY NUMBE - DATE OF DEATH DATE OF BIRTH ,,,,,C {p^,py /~/~ t '~~
1~" l ~ 3
~/~ ~//~/_ •~ 4 1
p (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) ~ SCCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTR CTIONS)
F [~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
ae a Y
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^ 4. Limited Estate
^ 4a. Future Interest Compromise (for dates of death prior to 12-13-82)
^ 5. federal Estate Tax Rsturn`Requirod
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b
D
d
D
d T (for dates of death after 12-12-82)
7
a .
ece
ent
ie
estate
- (Attach copy of Will) ^
. Decedent Maintained a Living Trust
(Attach copy of Trust) _8. Total Number of Safe Deposit Boxes
f-
o Z
aNea.~~ I... ~'~
~t ~ 3$ VVlark~-4- s~~ ~•~'r-
vg TELEPHONE NUMBER
~~ hetA,~ ~ L ~~ I ~L7~~
1. Real Estate (Schedule A) (1) ~ tt-~
2. Stocks and Bonds (Schedule 8) (2) r 3 Z • (~
3. Closely Held Stock/Partnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4 )
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) l a~ 3~~ _ 3~
Z (Schedule E)
b. Jointly Owned Property (Schedule F) (b )
~ 7. Transfers (Schedule G) (Schedule L) (7 )
8. Total Gross Assets total Lines 1-7
( )
.Z-
~, ~7 • (~) 3g~. S'L 1.37
9. Funeral Expenses, Administrative Costs, Miscellaneous
E (9) -~_
xpenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
1 1. Total Deductions (total Lines 9 & 10) 7
1 1 ~l 1 , (~
12. Net Value of Estate (Line 8 minus Line 11) _
(12)
J~~ ~? 3.5~°3~
13. Charitable and Governmental Bequests (Schedule J) ~~30 .J ~ -
(13) ~,
14. Net Value Subject to Tax (Line 12 minus Line 13) (, 4) ~~r ,~ 1.? 3, ~`$
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse
Side. (Include values from Schedule K or Schedul
M
) (15) x,
/ _=
-
e
.
16. Amount of Line 14 taxable at b% rate ~
(16) » ~_Z~•~~x 7 ~, y~
.Ob = ~ Zl~ O ~~ • ~
(Include values from Schedule K or Schedule M.) --
17. Amount of Line 14 taxable at 15% rate (17) (, CTOV` ~ x .15 =
oz (Include values from Schedule K or Schedule M.) ~ ~~ Z
d ~ ~
F 18. Principal tax due (Add tax from Lines 15, 16 and 17.) ( )
(
1 g
1 Q , a ~
~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest _
+ + 14 O'~S - 119) ---~ O S g . d c~
F 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. (21J ZO
~~ Z... (1J
A. Enter the interest on the balance due on Line 21A. {
(21A)
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 g) __ _ZE? t L O Z, , Q'V
Make Cheek Payable fo: Register of Wills, Agent ~
Under penalties of perjury, 1 declare that I have examined this return, inducting accompanyLng schedules and statements, and to thi
it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other
based on all information of which preparer has env knowledge.
~ ~~
' 1 ~p5~~
It my knowledge and belief,
le personal representative is
DATE
DA/TE~ ' / Q
Act #48 of 1994 provides. for the reduction of the tax rates imposed on the net value of transhrs to or for
the use of the spouse. The rates as pnserib~d by the statute .will.. be•. - , .
• 3% (.03~ wiN be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02) will bs applicable for estates of decedents dying on or after 1/1/96 end before 1/1/97
• 1% (.01) will be applicabld for estates of decedents dying on or after 1/1/97 mnd before 1/1/98
• Spousal transfers occurring on or' oft~r 1 /1 /98 will be exempt from inheritagce 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:
-,
a. retain. the use or income of the ;property trcnsferred, .......................................................
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 considsration$ If death occurred after
Dsasmber 12,.1982, did decedent frcnsfer 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 4F TIE ABOVE QUESTI~IS I~~YES, ~.~
YOU MUST COMPLETE SCHEDULE. G AND FILE IT AS PA~i' ~OF 'FIE R~RN.
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REV-1502 EX+ (12-851
° ~ SCHEDULE A
COMMONWEALTH OP PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF - ------- ' - - -_ -- - - -
-_ -___-
,, n FILE NUMBER
(Property jointly-owned with Right of Survivorship 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 willins~ buyer and a willing :ell... neit6.. 6..s~., ~.,....,elled
1
REV•1503 EX+ (4.86)
SCHEDULE B
STOCKS AND BONDS
~rNe,r~ ~NN~~ ~
Z1~ S' - 033
(Ail property Jointly-owned with Right of Survivorship must be disclosed on Schedule F.J
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
,. g3z Sl~ases E~~~ ~2 ~q
x. , boo Secs ~~s~. ~~DS (~ S3~
3• `~~ sty is Q~ci~,~ c~ I a~~...~._.
~ ~ C~ ~~
,v~v St~.~cs PP~.L~~sa,,
TOTAL (Also enter on line 2, Recapitulation)
/It .....r. r.,r.r..r .....l.r! ...r.rs ...1.1:x.,.,,.1 .1...M ..t . ...~.. 1
~8~~3Z•t,J
3~,~~.~
7, ~~ • "`)
37, ~ ~ ~
s 13y y 3Z-
REV.150B Ix. is•87) SCHEDULE E
CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA pERSIONAL PROPERTY
INNERITANCE TAX RETURN
RESIDENT DECEDENT Please Print or
CJ II/11~C yr ,' A FILE NUMBER _
i~l~'A1'e~' ~ N N s ~. W5 ~ Z~°I~ -0330
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
3, ~ ~
`'~ ^'~' ~~a s i~ ~+~~ L',Q,~.`~ ~c,~c-s ~s.~ ~. Sol,v,~y s ~~ `t' (< <e l 2»
~0.rrhs~~r ~~ - ~ ~3ry3S.3g
`~"`~ 3 ~
(
TOTAL (Also enter on line 5, Recapitulation) I $ l g~i ~ ~ ~ l
(Attach odditiono) 8Y4" x 11" sheets if more space is needed.)
REV-1511 E%+ (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
ITEM DESCRIPTION
NUMBER AMOUNT
A. Funeral Expenses: ~ l~~.a
1. U~JSSt\ , ~.>we~ ~~ ~ ~
N Qs'!4r` ~~ay~a Q
B. Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
4. Probate Fees
C. Miscellaneous Expenses:
t. CDs` ~N~`a1~~0.~N~~'y \~
2. ~`F~QJIAS ~ ~'Cl ~M,W~I~S e.VUI w~ ~ ~'eC.~~y`L ~tv~
4.
5.
6.
7.
8.
t 5", z~.~ . of
•~~ ~ . sc~
z, ~~ . ~
~ct ! .
(If more space is needed, insert additional sheets of same size.)
TOTAL (Also enter on line 9, Recapitulation) $ ~t ~ ~ 7 ~~
REV-1513 EX+ (2-87) 1
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
~~ ~ . ~ u t ~ l(1(1 . 7 i~ r ,. r~c~~
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY ,-
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
~ ~ sae ~- ~~s ~> C 3sr~, ~ ~t~asL
Z. ~t~. C1~.,,1~s S~,~I-lam C~l~ss'b -~~11~.rLa ,I~,~
ITEM AMOUNT OR
NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE
B. Charitable and Governmental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I$ '] ~'!->r\
(If more space is needed, insert additional sheets of same size) F UU~~JJ
~ LAyV ~fFlc'ES
317 THIRD STREET
~IflW ~UMBLRLAND, PENNSYLVIWIA 17070
LAST WILL AND TESTAMENT
OF
ANNIE M. WARNER
I, ANNIE M, WARNER, of Lemoyne, Cumberland County, Pennsylvania,
ing of sound mind, memory and understanding, da hereby make, publish and
Clare this as and for ay Last Will and Testament hereby revoking and making
void any and all other wills by me at any time heretofore made.
I.
V
I direct that ay Executor hereinafter named shall pay all my dust
debts and funeral expenses as soon as canveniently may be done after ay decease
II.
I hereby give and bequeath the sum of one thousand (¢1,000.00)
my nephew, ALTON CHARLES SHULTZ, if he survives me.
III.
~.
I hereby give and bequeath the sum of five hundred (¢S~b:OO) dollars
ti.__.,,
unto GRACE UNITED METHODIST CHITRC~i in Lemoyne, Pennsylvania.
i
~~ a All the rest. residae and remainder of my estate, whether real,
r ~ '~
~`-~ personal or mixed, and wheresoever situate, I hereby give, devise and bequeath
unto my son, TERRY LEE WARNER, or if he does not survive me, then as follows:
A. One-half (}) unto my grandson, JEFFREY L. BARKER.
B. Dne-half (}) unto my granddaughter, BRYNLY L. NINTZEL.
I
,~ v.
~~ I hereby nominate, constitute and appoint my son, TERRY LEL' BARKER,
tww ornetn
.1oH F, LwFAVER ~ I
it7 TNw0 YTN![T ~~aa Executor of this, my Last Will and Testament. If the said Terry Lee garner
NliR CUY`fiRL11N0, rA ~ ~
i~should predecease me, fail to qualify or cease to act as such, then I nominate,i
i
•i
~~constitute and appoint my attorney, JON F. LaFAVER, as Executor.
I ~
~~ Page ane of two Pages
...~~...w.r. rr r..r......r. .w.. .......~.+v r.rr...w. •r.r....r..r.v... ..rvrr.r em.w,~r.~.w..ur. w.• r....r.w rn. ir.rneewiiW...e .ew ~. I~Rey..RNIf
VI.
pry acting under this Will shall be required to post bond
i or in any jurisdiction is which he may act.
3 WHERFAF, I, AIiNIE K. WARNER, the Testatrix, have unto this
3tament, set my hand and seal this. ~ ~1r 4~n day of August, A. D ,
~.~;,yz: ~~..~_. ~~ ~ r,~.~L~t.-F~-~,7~ (SEAL
~i ~
'~ SIGNED, SEALED, PUBLISHED and DECLARED by ANNIE M. WARNER, the above-~
:named Testatrix, as and for her LasC Will and Testament, in the presence of
~~
~us who have hereunto subscribed our names as witnesses at her request, in the
(presence of the said Testatrix and in the presence of each other.
~)
i '
I~ r
....~ ~
JON F. LwFAYER • '~~
sus rnma arnecr ' • /f 9
new wwaenLw„o, ~w ~ ~ i'
I~
i'
~~ Page two of two Pages
r
REV-1547 EX AFP (12-94)
COMNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX
HARRIS8URG, PA 17128-0601
ACN 101
DATE 10-30-95
ESTATE OF BARNEK ANNlt M FILE N0. cl y5-ussu
DATE OF DEATH 04-21-95 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:
RANDALL L HARTMAN ESQ REGISTER OF WILLS
438 MARKET ST CUMBERLAND CO COURT HOUSE
LEMOYNE PA 17043 CARLISLE, PA 17013
Amount Remitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (12-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BARNER ANNIE M FILE N0. 21 95-0330 ACN 101 DATE 10-30-95
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 Estat• (Schedule A) (1) 61 , 000.00
2. stocks and Bonds (Sehedul• B) (2) 1 34,43 2.00
3. Closely Held Stock/Partnership Interest (Schedul• Cl (3) .00
4. Mortgages/Notes Receivable (Schedule D) (4) .00
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 189,389.37
6. Jointly Owned Property (Schedul• F) (6) .0 0
7. Transfers (Sehedul• G) (7) .00
s. Total Assets (g) 384,821.37
APPROVED DEDUCTIONS AND EXEMPTIONS: 26,147.79
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Sehedul• Hl (9)
10. Debts/Mortgage Liabilities/Liens (Schedul• I) (10) .00
11. Total Deductions (11) ?6.147.79
12. Net Value of Tax Return (12) 358,673.58
13. Charitable/Governmental Bequests (Schedule J) (13) 500.00
14. Net Value of Estate Subject to Tax (14) 358, 173.58
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 Lin• 14 at Spousal rat' (15) . 00 X .00_ .00
16. Amount of Line 14 taxable at Lineal/Glass A rats (16l 357,173.58 X .06. 21,430.41
17. Amount of Lins 14 taxable at Collateral/Class B rate (17l 1,000.00 X .15. 150.00
18. Principal Tax Due (lg) 21,580.21
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
06-27-95 AA047935 1,058.00 20,102.00
TOTAL TAX CREDIT 21,160.00
BALANCE OF TAX DUE 420.21
INTEREST .00
TOTAL DUE 420.21
PAYMENT MUST BE MADE BY 01-22-96*.
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
Re'~~ 1470 E% (688)
.~ INHERITANCE TAX
COMMONWEALTH Of PENNSYLVANIA EXPLANATION
BUREAU OF IND VIDUAL TAXES OF CHANGES
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME FILE NUMBER
i['~7i. ~t";7F.'.Y ~t
yjn SI.
ACN
].; i
SCHEDULE ITEM EXPLANATION OF CHANGES
NO.
i I:PS'~ C I t ~ 1 ' ''.°['tlt&:: }:.nS ?`i='i?1'i : c:C~tlf ~-'<'~ r0 J~1:`~ .
i
TAX EXAMINER: -
PAGE