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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.
Date
AUG 1 G 20pT
f
Fran eropoli, `' ct
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLMANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
C3E920
NAMEasoeceoorr~:.1.Mm.,L.p sEx soculcsccuRrtvwo~R DREOroEaNwar~.Dyc~Aar~ - -
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REGISTRAR
S SIGNRUIIE AND NUMBER / ~ ORE FLLED OAarML. O.x I..O
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~~ ~ / ~ r r FOR DATES OF DEATH AFTER 12/31!91 CHECK HERE 1
REV- OOEX+(7-94)
INHERITANCE TAX RETURN IF A SPOUSAL r
pOVERTYCREDITISCLAIMED I
RESIDENT DECEDENT FILE NUMBER
~o ~I~~IAV~~~jjA ~I~ F P ~~fI~.~ANIA
~1 (TO BE FILED IN DUPLICATE /~., ~ ~
~
H RRISBG, ~28-0601 WITH REGISTER OF WILLS COUNTY CODE ~ ( YEAR
`~ NUMBER
DE DENT'S NAME ( AST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
E ahle, Florence Fe le Bethany Village
C SOCI SECURITY NUMBER DATE DEATH DATE OF BIRTH Mechanicsburg, PA 17055
E 1 0-07-2872 0 /16/95 10/12/08
E county Cumberland
N
T
(IF APPLI ABLE) SURVIVING SP SE'S NAME (LAST,FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
AMOUNT RECEIVED (SEE INSTRUCTIONS)
1. Original Return 2. Supplemental Return 3. Remainder Return
A B
,~ P L 4. Limited Estate 4a. Future Interest Compromise (for dates of death prior to 12-13-82)
O (for dates of death after 12-12-82) ~ 5. Federal Estate Tax Return Required
R C
(P S 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
Attach co y of Will) (Attach a co of Trust)
C p ALL C RESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
R N NAM COMPLETE MAILING ADDRESS
R D G e or M. Kerwin Kerwin & Kerwin
S N LEPHONE NUMBER East Main Street
- T 717 362-3215 Elizabethville PA 17023-9765
1. Real Estate (Schedule A) lU
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) (4)
R
E 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sch. E) 9 , 054.3 9
A 6. Jointy Owned Property (Schedule F) (6)
p 7. Transfers (Schedule G) (Schedule L) (7)
I
T 8. Total Gross Assets (total Lines 1-7) (8) 9 , 054.3 9
L 9. Funeral Expenses, Administrative Costs, Miscellaneous 5 , 592. Ol
A Expenses (Schedule H)
T
I 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
N 11. Total Deductions (total Lines 9 8, 10) (11) 5, 592. O1
12. Net Value of Estate (Line 8 minus Line 11) (12) 3 , 462.38
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 3 , 462.38
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) 0.00 X .O6 = 0.00
(Include values from Schedule K or Schedule M.) //''~~
T
A 17. Amount of Line 14 taxable at 15% rate (17) 3 , 462.38 x .1511= 519.36
X
(Include values from Schedule K or Schedule M.) l.. //
C 18. Principal tax due (Add tax from Line 15, 16 and 17.) (18) 519.36
O
M 19. Credits/Sp Poverty Prior Payments Discount Interest
~ + + - (19) 0.00
T 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) 0.00
T ~ ~ CI10t:IFltOle:if: ..L1ZaTp:RO:. t701i~itl :ifOfYfiifilQ~ 4C1E OY?lffpiy111pAt:
C 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX D UE. (21) 519.36
N A. Enter the interest on the balance due on Line 21A. (21A) 0.00
8. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (21B) 519.36
Make Check Pavabl® to: Rtaaister of Wills. Anent
- - BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~
Under penalties o perjury, I declare that eve exam th a return, nc ng accompany ng ac edulea and statsmeMs, and to the best of my nowledge and Ilaf, 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 ropresentative Is based on all Information of
which preparer has any knowledge.
S GNATU E OF P SON RESPONSIBLE FOR FILING RETURN John Hostetter DATE
_ 2460 Auburn Road
et~., York PA 17402---------------------------------- ~ ..C73
SI- A UREO PREPAREROTHERTHA REPRESENTATIVE Kerwin & Kerwin DATE
East Main Street
-----------------------------------------------------
..~ Elizabethville, PA 17023-9765 .~~~...~;~
r~r,~ }I~hf (mil 1..91 f~ rn snft~a~~re ~nlv f'PS~~sfems, inc. Fr;rm 1 (R.v. 7-94)
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 after 7/1194 and before 1 f 1196
•2% (.02) will be applicable for estates of decedents dying on or after 1/1196 and before 111197
•1~ (.01) will be applicable for estates of decedents dying on or after 1/1197 and before 111/98
•Spousal transfers occurring on or after 111198 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A MARK ()() IN THE APPROPRIATE BLOCKS.
t. 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 Iffe 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? .
YES NO
X
X
X
X
X
X
IF THE ANSWER TO ANY OF THE ABOVE (iUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
-~~i-!,!/-1199Afnrmsnfhvarrrrtp!CPSrsfe:n'.SJgr.
Fr.-:n 1.rr!10 rR..., -r .941
REV - 1508 EX + (p-8~ SCHEDULE E
CASH, BANK DEPOSITS AND
COM
I~ANIA MISCELLANEOUS ---
M
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,
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~~~
N PERSONAL PROPERTY Please Print or T e
ESTATE OF FILE NUMBER
Florence Fegley Stahle SS~~ 180-07-2872 04/16/95
(All roe 'ointly-owned with Ri ht of Survivorshi must bs disclosed on Schedule F)
ITEM
DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Irrevocable Burial Account ~~200893-6 at Miners 4,401.98
Bank of Lykens, 550 Main Street, Lykens, PA
2 One ladies white gold diamond ring (value based on selling price 2,500.00
3 One ladies white gold Eastern Star ring (value based on 100.00
selling price)
4 One ladies white gold Eastern Star pin (value based on 100.00
selling price
5 Bethany Village Health Care Center, refund 1,487.70
6 Checking Account ~~100971-1 at Miners Bank of Lykens 464.71
550 Main Street, Lykens, PA 17048
TOTAL (Also enter on line 5, Reca itulation) S 9 , 0 4.3 9
(Attach additional 8 1/2" x 11" sheets 'rf more space is needed.)
i t +' ~ t9~; f:•~msr,(l~rrr~+^nl~,('pS,,•:fer~s bir Form 1~nn Srherlule E (Rev.?-137)
r
REV - 1511 EX a (7-88)
COM IN~~4Jj{•SI~yJj$_y~,yANIA
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND _..
MISCELLANEOUS EXPENSES Please Print or
Florence Fe le Stahle SS~~ 180-07-2872 04 16 95
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funeral Expenses:
1 Schultz Funeral Home, Lykens, PA - funeral 4,289.45
2 Hershey cemetery, grave opening 525.00
3 Hershey Pantry, funeral luncheon 84.56
4 Telephone bills relating to funeral 40.00
B. Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative;
Year Commissions paid
2. Attorney Fees Kerwin & Kerwin
3. Family Exemption
Claimant
Address of Claimant at decedent's death
Street Address
Cky
4. Probate Fees Register of Wills
453.00
Relationship
State Zip Code
C. Miscellaneous Expenses:
1 Register of Wills, filing Inheritance Tax Return
and inventory
2 Register of Wills, filing Releases
3 Reserved for closing costs
_ TOTAL (Also enter on line 9 Recapitulation)
(If more space is needed, insert additional sheets of same
I ! ~ ~~ !~~ 4 frnn sofft~~are nnl•~ f'PSv~,terms, In-
67.00
~s
Form 1500
25.00
8.00
100.00
5 5 .O1
ile H IRev 7-88)
REV - 1513 EX + (2-87)
COM INO, NyV~/1A~OF P~yHS~LVANIA
SCHEDULE)
ESTATE OF FILE NUMBER
Florence Feeley Stahl P SSdd 1 R(1_n7_~A7~ ni, ii ~ ios
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
1 Myron Fegley Brother One-half of
Apt. A 120, 211 Willow Valley Square estate
Lancaster, PA 17602
2 Glenn Fegley Brother One-half of
307 South Tarr Street estate
North Baltimore, OH 45872
v~ ~ ~ n„ v aNaa.e ~a nnnaea, lflsef[ aOOIIIOIIaI SneetS Ot Saltle 5128. )
r+.p'^.'i^Iit (~~1 199A form s~fty~are onhi CPSvztem^,. Inr
. Frnm 15110 4rh~.'ri~!!» ,1 (R<• ~ R?)
LAST WILL AND TESTAMENT
OF
FLORSNCB FBaLSY BTAHLE
I, FLORENCE FEGLEY STAHLE, of Mechanicsburg, Cumberland
County, Pennsylvania, being of sound mind, memory and
understanding, do make and publish this, my Last Will and
Testament, hereby revoking and making void all former Willa by me
at any time heretofore made.
FIRST: I direct my hereinafter named Executor to pay all my
~';~ legally enforceable debts f
uneral expenses, administration
~-~ expenses, and inheritance, estate, succession or excise taxes,
r:
C., which I owe or may become due on account of my death, as soon as
' may be convenient after my decease.
BECOND; I give, devise and bequeath all o
f my property, be
it real, personal and mixed, whatsoever and wheresoever the same
~~ may be situate at the time of my death in equal share
,I~, s, as follows:
A• One-fourth (1/4) of my estate to my brother GLENN
~, E. FEGLEY,
a`
r
B• One-fourth (1/4) of my estate to my sister, PAULINE
;, FEGLEY,
'i .'
'~~ C• One-fourth (1/4) of my estate to my aister,~ LEROY
FEGLEY, and
D• One-fourth (1/4) of my estate to my brother, MYRON
FEGLEY.
` In the event an of
Y my aforesaid brothers or eiatera
predecease me, I direct that their share of my estate shall be
divided equally among my brothers and eiatera who survive me.
,.
THIRD; I nominate, constitute and appoint JOHN
HO3TETTER, as Executor of this, my Last Will and Testament,
authorizing and empowering him to sell and convey any and all real
estate of which I may die seized and possessed.
I further direct that my Executor or personal representative
shall not be required to poet bond to act in said capacity.
IN WITNESS WHEREOF, I, FLORENCE FEGLEY STAHLE, have hereunto
set my hand and seal, to this my Last Will and Testament, this
~,~j,day of of-.t~~ 1993.
SIGNED, SEALED, PUBLISHED
and DECLARED by the above-
named Testatrix, FLORENCE
FEGLEY STAHLE, as and for her :
Last Will and Testament, in
I the presence of ue, who at
' ~ her request and in the
presence of each other, have
hereunto set our names ae
wft eases: '
~~ ~ ~-~
eai n at:~
FLORENCE FEGLEY 8 AHLE
.~-~ rn ~
n__1
RCdlQing at; '
Lk~.e~ ,V-'R
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