HomeMy WebLinkAbout95-0336r .~ „ !-,
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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 18 200 ? ~-
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
H705.1 t3 Rav. 4187
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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NAME OF OLCEOFMIFYi MidAa, Ltl) SEX SOCIAL SECURT' NUMBER DRE OFDERN IAtaMI, Dry,
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'Geraldine K. Manson 7• female 7201 - 18 - 4294
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• REV-1500 E + (7-94) ~, ~1 /~'CI b 1 ~' ~ ~ FOR DATES OF DEATH AFTER 12/31191 CHECK HERE
~~
~ INHERIT CE TAX RETURN
RESIDENT DECEDENT IF A SPOUSAL
DIT IS CLAIMED ^
L
-•
~ I
E NUMB
R
CO ONWEALTH OF PENNSYLVANI
DEPARTMENT OF REVENUE
PTO BE FILED IN DUPLICATE F
~
EPT.280601
HARRIS RG
PA 17128
0601
WITH REGISTER OF WILLS) ~?/ ~~
~3~
,
- COUNTY CODE YEAR NUMBER
DECE NT'S NAME (LAST, FIRST, AND MIDDIE INITIAL) DECEDENT'S COMPLETE ADDRESS
W CIAL S URITY NUMBER DATE DEATH DATE OF BIRTH ~~ ~Y1 OY /`(L ~ 1 ~ ~ / ~U
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(IF PPLIUBIE( SURVIVING SPOUSE'S NAME (LAST, FIRST A MIDDIE INITIAL( SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
~ 1. Original Return ^ 2. Supplemental Return
^ 3. Remainder Return
Wd~ 4. Limited Estate
^ (for dates of death prior to 12-13-82)
n 4a. Future Interest Compromise n S csa_._i c_,_._ r_.. o_.___ ..
(for dates of death after 12-12-82) '~°y""°"
°am 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)
j _...
,.
W W COMPLETE I IN
o= /~~}Re, K'• ~OLJL: /tea, ~Su,^!Rr•s~ v~~~.
v~ T EPHONE NUMBER ~,
1. Real Estate (Schedule A) (1) - C ~ _ •~'?
2. Stocks and Bonds (Schedule B) ( _~, C~ ~D ~ 0 D r
3. Closely Held Stock/Partnership Interest (Schedule C) 3) - 0 -
4. Mortgages and Notes Receivable (Schedule D) (4) Q - ---`
5. Cash, Bank Deposits & Miscellaneous Personal Property (5 ~ d , ~~ ., , ~ a --._
_ (Schedule E) ~ -
F°, b. Jointly Owned Property (Schedule F)
((y,~ /fo
car +-~, pi 6
S
° /~
;
7. Transfers (Schedule G) (Schedule L) °j 7~• '7, ~a ~, Q '] ~` ~
;..
.a
~
8. Total Gross Assets (total lines 1-7) (g) ~
~ U, 3~ `7 •' O
9. Funeral Expenses, Administrative Coats, Miscellaneous (9 ~ a?~(„„~G
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) ~_~, ~ ~ ~ • ~~ to
11. Total Deductions (total Lines 9 A 10) (11) ! ~2~j•a'• (~ 5
12. Net Value of Estate (Line 8 minus Line 1 1) (12) ~'/f (j (o ~ • L f t~
13. Charitable and Governmental Bequests (Schedule J) (13) `U -
14. Net Value Subject to Tax (line 12 minus Line 13) (14) G~/ USU. ~'
15. Spousal Transfers (for dates of death after b-30.94)
See Instructions for Applicable Percentage on Reverse (15) - 0 °
Side. (Include values from Schedule K or Schedule M.) x __ •- O -
1 b. Amount of Line 14 taxable of b% rate (16) ~, ~ In 0 . ~-/ ~
x Ob // /I
"I ~ta ~ • ~
(Include .values from Schedule K or Schedule M.) ,
17. Amount of Line 14 taxable at 15% rate (17) V. U - x 15 = - O ~-
°z (Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) ~t~ ~~ ~ (P
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
v
a
~ 20. If®e 1%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) '/
~~ (n ;~ D . `t S
-
A. Enter the interest on the balance due on Line 21 A. (21A) ' -V .-
B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE. (218) ~=~. (
~p, `~5
Make Check Payable to: Register of Wills, Agent T
°• r"••"•••°• °~ NO1IV17~ ~ aeciare rnaT I nave examined this return, including accom
it is true, correct and complete. I declare that all real estate has been reported at true
based on all information of which preparer has env knowledge.
ants, and to the
preparer other
Cc/t~x, :s~` • w-~ /o.~ ~C.vryr..~• ~~ `~ZeLU- u /'1y °7y
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ennocee ` C.s~-C~1/!~' ~
of my knowledge and belief,
the personal representative is
DATE
~- ~~- ys-
DATE
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°h (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02j will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1 °Y6 (.O1) 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 CHECK MARK (r~ IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and: j
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 C~UESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~ REV-1503 EX+ (4.66) ~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE B
STOCKS AND BONDS
ESTATE OF FILE NUMBER
(All property jointly-owned with Righf of Survivorship musf be disele:ed en 5~60d..1e F t
REV•1508 E%+ (2.87i
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
U~kA~I~/E ~~ I'~Ft1QT~,o ~J
(All property )omfly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM DESCRIPTION
NUMBER
/. ~t~f C_ ~ !-~ ec` l+' t N ~ 17CC. i . ~" ~! y o e~ ~f / ~ ~~3
'~; Cr;RT'F~c'-~~C v~ ~EP~sl~e ill `~~~% o~~c;a; / 8
a^: 1' oZ~ Ct~)
~~ ~~ R~c~ r~ A-~ PR 0 PCB( ~(
TOTAL (Also enter on line
(Attach additional 8Vs" x 11" sheets if more space is needed.)
Please Print or Type
ER ~ c 1~ - ~0~3~ ~
oZf t:~ - ~~331t
VALUE AT
DATE OF DEATH
~ 4 /~ ~~~
'•1 .~- ~ ~ ~ r~ 1
~, o r 7. l 8
S ~~
r
REV-1509 EX+ IlY-B8)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE iAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
OF
c ~.
Joint tenant(s):
N
NAME ADDRESS
A.~~-~~UI~i~ ~i~HR~ /'~l-~Rrtsd~ .38?I N~~c-~~nitC:S ui~~_G: rs.17
dpi ~~.Al^t-, ~Fs • l ~'QS~
B. (,ZRREN ~r4Y~= ~C~o~,~ 101 ~~~>Qls~ iy~F.
I~~i,~~ Lv M 8, t ~p,-~ ~'7 U `1 C3
C.
UMBER
~~ ` __ n ~ ~
RELATIONSHIP TO DECEDENT
~~ `~~
Jointly-owned property:
LE
ITEM TTER
FOR
DATE
UMBE JOINT
TENANT M
NT DESCRIPTION OF PROPERTY TOTAL VALUE
OF ASSET DECD'S DOLLAR VALUE OF
DECEDENT'S INTEREST
p
/~~/ L 1, ! 7~ ~ o ~7;• ~o ..~~"1 ~~
~ ~ `l (G ~ ~- ~~-~~:v~ ?~ S - ~,4vrr~1(a ~ ~rtJ G ~l-!. ELI _~Z~ o ~~ [t ~~. « l
Lk ~>
~/
e
C. i- ;
I ~ v~
l~9`1 c
TOTAL (Also enter on line 6, Recapitulation) I $ ~ ~
(If more space is needed insert additional sheets of same size)
f REV-1510 EX+ (2-87)
ESTA'
`~
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
TRANSFERS
PLEASE PRINT OR TYPE
-- -- FILE NUMBER
THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE enlcwFO rn euv ne rue n. ~~~*....~~ .... _.._ __..____ _-_ _ _ _
REV-1511 E7(+ (7-88)
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
.•+..~. c yr _
a _ +. FILE NU!
c72
ITEM
NUMBER DESCRIPTION
A• Funeral Expenses:
~ . ~ i ~ ~3 >/ ~ l ~ ~'!-~ ~ HL M 6 R C (~'~r~Cpt{¢l•CC_ cQ ~EfZ.V rC' e= s
G ~~r~~~r ~~ Pa R~-~~E ~zoR ~ - ~=bo7 ~~-Ri~~R
~~ U ~l ~l ~ T ~F/"1 CTfj-cQv ~~.5c~..
7C ~-~ ~T~c.~c.J CNuRcr+ r'~}- C~o~ - l=urt~;~A~. ~un~Cf~oN
~ ~r~l i^l ~~ :S ~ 2e +cr./ ,yam u .5 ~ - ~ Aso~~`7- ~P l~ 1-~ ~
B• Administrative Costa:
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 S+~+o Zip Code
4. Probate Fees
((,~7 ~ ozr
C• Miscellaneous Expenses:
~`l /~Pr ~,ti-~ ~
3.
4.
5.
6.
7.
8.
(If more space is needed, insert additional sl>teets of same size.)
TOTAL (Also enter on line 9, Recapitulation) I $
Please Print or T
3ER
ors- ~i6.~3~
AMOUNT
~!~`ltto6
~<<~ ~, ~
~Zd~ b~~
{oc ~o~
1~6=~0
' REK151Y EX+ (7.88)
r
SCHEDULE
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT
INHERITANCE TAX RETURN MORTGAGE.LIABLITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF
FILE N~
C~ ~ /~ R~ 1 r`l ~ ~~ ~l f}R7'~2J /`/
ITEM
NUMBER DESCRIPTION
~-(~'?~ ~rV~ILS'7`(r'l~lY7~' ~ ~}~ rC~~T -~vfZ l~'t~Yl
~F~ P~~ °`~l ~v
Pic ~ k
' _ R i~~ 1~~1 CN J ~ J !1i1 ~ ~ ~~
~~ P P ~~ ~
Io~ ~~-i~~. Af~~rvT~~.
1 ~~ C r/}P { l ~~ l~f~(._ ~<--~F-E o~-yc~-~M j L r•1~.7~ • ~P /
f a~ /~ . Z ~ ~ r -~`~ ~'~? Asp/ r
1 ~ ' ~ ~ , .~-~o~~ N ~'. ~ r~i ,2 ~`r~
Please Print or Type
IMBER ~c I.5
QG.~~~
~~ d 9 5 - i;_ .3 ~ ~._
AMOUNT
U~7a, ~~.
v~a~ ~ c d
;a.~
~~
~~,_ ~7
-.~• ~ ~/
~~~ ~ ~~
:~-8 ~ y I
l(~• ~8
c ~~~3
TOTAL (Also enter on line 10, Recapitulation) I $ ~ ~
(If more space is needed, insert additional sheep of same size.)
REV-1513 EX+ (2-87(
r"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY r~ ( v
RELATIONSHIP ~ :J -~ SU
AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
~ . ~.~ A-r~ r~~~, ~ - C~ ' ~ ~ ~ ~( t~ ~G~
Goo ~~-~sr-~~sF ~~.
C.~ ~ ie_R. i rat C, -7-z~ ~ 1 ~~ . 18 ~ .7 (~ .
~~ . ~~f~ Re ri ~ , ~t~- v w e._
~U~ ~ u~lr~Q(5~ A-~/c~ ~~uC;C-F~~~ D~1~ - (hr2~~
I~~,~~3 C, ~~~g, ~~~ r~ ~'?o
~~. ~~R~(~!~ ~~ (`1 RRT~~~i ~-c~r( Can(-~ - <1~Is~7
=~~s ~ ~ l'~1 e c i~ P rat ~c
~ iJ 1 ~.~~ ~ ~~~ .
7
W~~`fE' ~~ i r_ i-~R-~ l~G~~
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
V~G N
AMOUNT OR
SHARE OF .ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I $
(If more space is needed, insert additional sheets of same size)
r
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