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HomeMy WebLinkAbout95-0342~21-95-d,3y~ This is to certify that the certificate hereunto attached is a tine 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 2001' ? Date Fran eropoli, ct Division of Vital Records P.O. Box 1528 New Castle, PA 16103 ,,,os.,A4 R•v.,/B, COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS V 3 7 1 /~ (~ TyT CERTIFICATE OF DEATH PERK NENi (~~) ~ - ~ - - .u«,~ --- _. SOCIALSECURrrr NUMBER DREaF DEA'/11Maim.Dry.'ker) ,. ~'~- Ka Santamaria s Female ~ 180-46-3612 .. ril 18, 1995 AOE D•r 8i"Wg9 UNOERtYEAR UNDERIDAY D/DE OF BATM BEiTHPLACE ICiIyriC PLACEOF DEATH ICAera aNY Ora-si•YUtlio.a on r~er aas IAaM+' D•N Nar rMlr (~~h.DM. Yer) SIW UFapACowgy) ~,~ 1 OTHER ~ Y° x7uly 18, 54 Pittsburgh, PA '"~'"'" ^ ERAaA,.rr ® ~+ ^ ~ ^ Rrlaaio, ^ ^ COUNTY aFDEATH Cff1; BORO.TWP OF DERN FACLRY NAMErynp:rialbn, v~•r•elwiAn+eal wAS cegiceNT OF NISMNIC ORgW7 RACE- Amaic•n AWn, Brck Wlts, re Dauphin Derry 7~T~p. Hershey Medical Center "°fl "" ^ "~°•TM~~• 's0°d") AM.Wn, Puam Rinn, re. oECEDE>rr•a AHgOFBI>SINESSnNDUSmY wASDECEDENTEVERM DECEDENT'BEDUC/DgN ,• ,&Whlte (GiwrnadrakOdyyY~nwr U.S.ARMED FORCE87 MAIYTAL STATVS-MArrW SURVIVBIO SPOUSE darAYq Brbnalur ii•tl.) Nn'r Mr~NA. Wtlowr. EIrW.piw myrn rma) ' office er estate government ~ xr® N•^ ~~ I,~°~1 °N01E•a~P"n'1 Gino J. Santamaria DECEDENrswAB)NBADDRESBar..LCaWw.r.smr.rmc,e.~ DECEOEIa,.a married , . 819 Wentzville Road ,~E ,T•.srl. Pella DM „~W.,e.wenam..ar East Pennsboro ar.a.r I A ~ Enola, PA 17025 """`~" a•r• ama sasl ,sue ,Tw CLTTD}varlanA 101M'I0p' na^ wwr.~"cwrw wa If•a MNOA, LrD MOT,IER'S HAAIEIFiaL MiaAA, MeitlanSurnr~y) ,•- ter , Audr Rli enslnith B,FORMANT'S NAME yprFVYy- s MMLwBADDRESS W".•L ay+ro.n. srr. ZgCaa.l ~ ~ DATE OF gSPOSITgN OF DISPO&11DN•Nrrd Baw^ arrrA~Kw•bwAOn,srr^ ^~.D•r.wn o"wPr•. c«Ar"xa"'""")' a LOCRgN.CIry/TwJia, .nPCm. °airr"~ O1Ai~"' it 21, 1995 Con-O-Lite Vault Co. a~ Schaefferstown, PA a"tNATUREOF As SUCH LICENSE NUMBER AND A~DRESSOFFACaurY ~„~„~~ a~ 013245-L trick Fun. Home, Inc., 3125 Walnut St., .,PA rnrw.ra.rr..ar~.mr°io . e~TB•w""r'°~.e.rnoo~,.naru»Ir»•awraPrrr.re. ucENSENUMBER gaES"v+ED wr.aa..r. Maim. Dry. Ws) 17109 aa. as. b•ra4•n•AMlwaralraM TMIEoFDEArN aae, D+aE PRQNOUNQEO DEAD(IApN, Dry. rM,) '"'°p°°"'r•^•rR wA3QASE REFERREDm MEDICAL EXAMINERICORONEgT ~. 2:03 .m. M, „ nil 18, 1995 Yr® ,,,p n. MRTk E+.raaar•r•.rN•iraoarphaaa WACn auralM e..m. D•notarraw noOAd ~' Lrl r,I aMTJ1lM an raA 111,. O/IIIQ•r1E11 reralACarnyAra, r•M. elacM ar MatAWu,. IAFprYr,• RN1B: Oma MpYlkaA aAN,IaaodmWNprarN, pA BIII®IATECAUBE(FirW loro•1•na rA,A rio1rr11M119 rIM alar./11p411r BN•n In PARTI. 1.a,rnD ~ a ~ Gunshot wound to head DUE TOICR AS A CONSEQUENCE OF}. B•41rAWYYaralbr p ~ "A^V• ~~ DUE TO IOR ASA CONSEQUENCE OF): i OMMBIgrwai1j11y c i aaliOl111an•r"s DUE TO (OR AS A CONSEQUENCE OF): n1uYnD in x••111 LABT d WAS AN AUTOPSY WERE AUTOPSY RNDSIOS MANNER OF DEATH DATE OF MRIAt, TNAEOFINJURV PFJRFORMEDT AMIr SLURYRWORKt DESCRIBE MOWa1JURY OCCURRED. oFCroausE n"O"~".Ory.*°') approx. "•"'" ~ ~~•• ^ Apr. 18, 95 12:37 p,m. w ^ Nam self-inflicted gunshot Mr ^ Naf~ ~„ ^ N, ^ A"a°a ^ P•^~wMrr7.mn O M. „~ wound t0 head salale. ® caaM nmwar.lmAaa ^ PLAQEQFUUURY-wnaA.,,rm,.".r,ra«,. a1o. LocaaN R•.•,. crRa•.1.srr) aa` _'°' "- a~a ~rtzville Rd. Enola, PA (q~.aY ~YanN SMaNATURE AND 7e ~Y~µ ~Y'~ ~•bY*q cr»• d Artl. w~nen eiMir MY~9~ nr Pr«wunceE arm enG candreE Ilan 231 m, tnoal•4•, a..w aeewne Ar b ar car•fN A1r ~nwwr •wr ....................................... ~. '~aIND ANDCERTIFYBq PHYSICIAN R'ftY9icrn Dam prawuncirp arm ai0 caayvpbpurdarm) LICENSE NU DATE MarAA, O•N 1ber) ..rla~•aI•aB•.rrn•xrwar,n.rr..aw.repr..abarmm.a...p)ra.w..r,M.a .......................... ^ a,a a,a nil 20, 1995 'MEDICAL E%AIRNER/CDROrER NAME AND ADDRE~OF PERSON YYIq COMPLETED CAUSE OFOEATH a,Lr°n.I~. "!r.".".1i11o".'.".°.'.°'!^""!b!!b":m'"v°?'"w^:°.r"«~^•nrB»TU»,e.e.,.aa w~.,rwal»,om•.).,,, ® Graham S. Hetrick, Coroner ........................................................... REGISTRAR'S SID AND NU 2 aa~.205 S. 28th St., Harrisburg, PA 17111 ~3~,111.~J DATE FLED Mall, D•Y. Y.a) nn a~i a'~ ~~~-~~~~ ~ REV: i500 EX+(7-9a) ,. INHERITANCE TAX RETURN `~`~~~`~~~~~_~~~~`.;;i~'j~1N!~)~°t~.,.li.:~'~i iil~iAji~l~~l~il~1'yl~!li~~~?i~lii,l~iii~f'1[Ili;;i~;jiljl`(I,l': Il~iill~l~!llliil~ll~~'~j' ~~/~~~OMMONWEAL7HOFPENNSYLV NI RESIDENT DECEDENT p~1~d~d#'t?~~~r,~<"#t,...~R~;ir':IfCE+S!tr€~p 1I' „i ;, iff DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE F(LENUMBER DEPT. 280801 WITH REGISTER OF WILLS) 21 HARRISBURG, PA 17128-0801 DE DENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) D TAMARIA, KAREN K D E N T SOC LSECURITYNUMBER 0-46-3612 (IF APPLICABLE)SURVIVING P (LAST, FIRSTAND MIDDLE I ~AMARIA, G ff,,~~'' 1. Ori~-ginal Return ^ 4. Limited Estate ^ e. Decedent Died Testate (Attach copy of Will) F~.CF DEATH ~ DATE~F BIRTH A P P eo H R E P C R K I A T E C P O O R N E E S N - T R E C A P I T U L A T I O N COUNTY COD E DECEDENTS COMPLETE ADDRESS 19 WERTZVILLE ROAD IJOLA, PA 19025 '~Q95 0342 YEAR NUMBER -18-95 18-54 county CUMBERLAND NAME SOCIALSECURITVNUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) 182-44-8715 ^ 2. Supplemental Return ^ 3. Remainder Return ^ 4a. Future Interest Compromise ^ 5 (for dates of death prior to 12-13-82) F . (for dates of death after 12-12-62) ederal Estate Tax ^ 7. Decedent Maintained a Living Trust Return Required 8. (Attach a copy of Trust) Total Number of Safe Deposit Boxes =~rNO J. SANTAMARIA TELEPHONE X717) -732-4398 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages and Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) (Schedule L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) 10. Debts, Mortgage liabilities, Liens (Schedule I) 11. Total Deductions (total lines 9 & ?0) 12. Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) COMPLETE MAILING ADDRESS 19 WERTZVILLE ROAD NOLA, PA 17025 (1) (2) (3) (4) (5) 1, 103.., (7) / ~ ~+ 7 (10) ¢~yi 60 (11) 7 (1 6, (1~ 0 . See Instructions for Applicable Percentage on Pagej2. (15) (Include values from Schedul K S " x • - - ~ f ' o e or chedule M.) 16. Amount of line 14 taxable at 6% rate (16) //O„~,Qp (Include values from Sched l K - v/ ` // ` .OS~ l/~. lf' o/ T u e or Schedule M.) ~ T~ A 17. Amount of line 14 taxable at 15% rate ~ X (17) 0 . (Include values from Schedule K or Schedule M.) x .15 = 0 C 18. Principal tax due (Add tax from Lines 15, 16 and 17.) M p 19. Credits Spousal Poverty Credit Prior Payments Discount ~,, (18) ~Cj'~~~ 0 ~ Interest + 66. + T A T 20. If line 19 is greater than line 18, enter the difference on line 20. This is the OVERPAYMENT. ~ (is) 66. (20) 1 k ffltA..ft.llf atr~ars t>~Westliig:a;;retufpd ~Y3t`oulrla~t `'imehti: C 6 . 0 21. If line 18 is greater than line 19, enter the difference on line 21. This is the TAX DUE N . A. Enter the interest on the balance d (21) ue on line 21 A. B. Enter the total of line 21 and 21A on line 216. This is the BALANCE DUE ~ (21A) . Make Check Pa able to: Register of Wills, Agent (216) Undsr penalt ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ies of perjury, I declare that I ha <- F ve 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 r which pre a r has any knowledge. epr esentative is based on all information of SIGNA OF PERS SIBLE F ILING RETURN ADDRESS SI ~" 819 WERTZVILLE ROAD ENOLA PA 17025 DarE A TH -PH 07-31-96 op ht C A ~fPRESENTATIVE ADDpRESS ~„ ' ~ry ~/ ~/~--. fp II ~JOi~ EXECV 1'V `' ~~ DATE i ~ ~~ ~ g r eat ve Micros t s I c.• Washington. D.C.. 7995 ~ 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 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estates of decedents dying on or after 1/1/98 and before 1!1!97 • 1% (.01) 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 MARK (X) IN THE APPROPRIATE BL~CKc 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 ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE REl Copyright Creative Microsystems Inc., Washington, D. C., 7995 YES NO X X X X X X 'URN. ~ REV-•1509 EX+(ty_98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CJIAIt OF KAREN K. SANTAMARIA SCHEDULE F I JOINTLY-OWNED PROPERTY p,o,~e o,;.,. „~ T.._ _ Joint tenant(s): FILE NUMBER 2-1995-0342 copynght Creative Microsystems Inc., Wasbinpton, D. C., 1995 -- ~ ~~~ -~.~~.~ ~~ °°11Q a~ca.~ REV-1548 EX AFP (12-94) COMMONMEALTH OF PENNSyIyANIA APPRAISEMENTE ALLOMANECETORDISALLORANCE DEPARTMENT OF REVENUE OF DEDUCTION, AND ASSESSfIEN? of TAX ON BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPT. 280601 HARRISBURG, PA 17128-0601 ESTATE OF SANTAMARIA DATE 11-o6-qS FILE N0. 21 95-0342 KAREN K DATE OF DEATH 04-18-95 S.S/D.C. N0. 180-46-3612 GINA M SANTAMARIA 819 WERTZVILLE RD ENOLA PA 17025 COUNTY CUMBERLAND ACN 95143036 REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------- R E_V- 1548 EX AFP ---------------------------------------------------------- (12-94) ----------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-06-95 ESTATE OF SANTAMARIA KAREN K DATE OF DEATH 04-18-95 COUNTY CUMBERLAND FILE N0. 21 95-0342 S.S/D.C. N0. 180-46-3612 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED ACN 95143036 JOINT OR TRUST ASSET INFORMATION ___ FINANCIAL INSTITUTION: PSECU "-- ~ _.. ACCOUNT NO 02066673 6 TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING ( ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 10-04-88 Account Balance Percent Taxable .' Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 2,206.07 _.~~.~ °~ 1,103.04 - .00 1,103.04 X 06 66.18 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) _ 09-11-95 AA082124 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT.' AMOUNT PAID 66.18 I _ L TAX CREDIT 66.18 * IF PAID AFTER THIS DATE. SEE REVERSE EnR cAictn srrnu nc • CE OF TAX-DUE .00 INTEREST .00 DOTAL DUE .00 of rY~~ __. _. _.. ._ Y~~r AAh~ 8 --- p ~ - ~' f ,~~.; ... ~ : ,~ ~~, - r ~ . PENNSYLVANIA y -~ :~,-~, ~~ n :Y DEPARTMENT°F REVENUE ~ '~, ~ ~ ~`~';. ~i4i`~~~r ~REK1162 Ek (4A4J ~.;~.GFpIC~ALRECEIPT''~ `~~r ~~` R : ~< ;.~ __ ~,,~ , ;PENNSYLVANIA INHERITANCE AND ESTATE TAX _ RECEIVED FROM: ACN ,i ASSESSMENT CONTROL ~ AMOUNT NUMBER GINO J SANTAMARIA 819 WERTZV I LLE RD 6 ----~ SS :'I~ ENOLA, PA 17025 ' 'LD HERf - ESTATE INFORMATION: © FILE NUMBER 21-1995-0342 ® NAME OF DECEDENT SSN 180-46-3612 (LAST) (fIRST) SANTAMARIA KAREN kqy (MI) a DATE OF PAYMENT © POSTMARK DATE REMARKS - GING J SANTAMARIA SEAL CHECk# 3388 T~1XP,~yER FOfO HFRE TOTAL AMOUNT PAID `E66. 18 CW RECEIVED BY ~, ~~ SIGNA~ MARY C. LEWIS ~~~ REGISTER DF WILLS REV-•t511 EX+(7-ggi COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KAREN K. SANTAMARIA ITEM NO. A. Funeral Expenses: ETRICK FUNERAT, 1 SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES DESCRIPTION B. Administrative Costs: 1• Personal Representative Commissions Social Security Number of Personal Repress Year Commissions paid 2. Attorney Fees 3. Family Exemption Claimant GINO J. SANTAMARI Address of ~aimaflt-~at dece~IBn'['~' a fh >.•-StFeetAddress 819 WERTZVILLE CityENOLA 4• a ees C• Miscellaneous Expenses: . ETTERS OF ADMINISTRATION A Relationship SPOUSE ROAD State PA Zip Code 1702 AMOUNT ~_ 4 `~ 33. ~ TOTAL (Also enter on line 9 (If more space is needed, insert additional sheets of same size.) Copyripht8reative Microsystems Inc., Washington, D.C., t995 Please Print or FILE NUMBER 1-1995-0342 4~y~` ~u 7. 1. y ' HETKICK FUNERAL HQME, Inc. 3125 Walnut Street; Harrisburg, PA 17109 (717) 545-3774 Fax (717) 545- Graham S. Hetrick, licensed d' .Hetrick, supervisor ,. Funeral Expense Agreement This is an explanation of charges as well as a sales agreement presented in accordance with the regulations of the Pa. State Board of Funeral Directors. STATEMENT OF FUNERAL GOODS AND VI Charges are only for those items that you Selected or arc required. If we are required by law or by a cemetery or crematory to use any items, we toil[ explain the reasons in writing below. If you selected a funeral which may require embalming, such as a funeral. with a viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as direct cremation or immediate burial. If we charge jot embalming we will explain why below. Legal, cemetery, crematory or other requiremenu compelling the purchase of any items listed below: Reason for Embalming: _ y, iK , ;r il. Funeral Services Date of Death 9-t Sr - 9S Date of Service y -__/- T-~ GOODS AND SERVICES SELECTED TYPE OF SERVICE AUTHORIZED TO BE ~ tyFra4itional Fu11 Serv;ce ROVIDED ~ iewing day of Service Register Book .....: ..................... _ ~ ~ ,~f ~! ~ ^ Gyveide service only Q'C eemati O No Viewing Prayer Cards ........................... _ $ on ~~ 9'Public Viewing O Immediate Dis Position ~.. ^ Anatomical Gift Crucifix ........ . ...................... . Temporary Grave Marker $ ~ Private Family viewing ^ Evening Viewing ^ Metnotial Service ^ ................. Memorial Board Rental ......... . ....... $ $ ShiPPNg Service . . Casket Rental A. Package Arrangement ^ RlCelVmg ServICG ........................... Clothm g• ........................... $ $ .... Flag Case . - ~ .............................. Other $ $ Total of Merchandise Selected (C) $ B. Charge for Services Selected: ............ D. Special Charges $ 1. PROFESSIONAL SERVICES B ' Forwarding Remains to sere Servrces Fee ..................... $_,$O Embalming ........................... $ SSn Cremation ............ ................ $-.,3_00 Other Preparation of Body Transfer of Remains to Funeral Home .... $ i~ a Sub-Total of Professional Services (BI) ...... $ /650 2. ADDITIONAL SERVICES AND FACILITIES Visitation ............................. $ T~_ Funeral Service ........................ $~¢ Memorial Service ...................... $ Graveside Service ...................... $ ~d e Sub-Total of Additional Services and Facilities (B2) .......... . . . . $ 1;~'CO 3. AUTOMOTIVE EQUIPMENT Funeral Coach ......................... $ Lead/Clergy Car ....................... $ Flower Car ................... $ Family Car .................. .......:: $--~Z Other than local 25 mile Transportation... $ Sub-Total of Automotive Equipment (B3).... $ 7~_ Total of Professional Services, Additional Service And Facilities, and Automotive Equipment (B).... $ C. CHARGE FOR MERCHANDISE SELECTED Casket ~ /~ Description __ r...L_ !/ $ 7~~ Other Receptacle Dactiption $ Outer Burial Container Dexription $ URN Deuription iYl~~' ~ r, ~ ~, $ c Acknowledgement Car'ds ............ ..... $ .. emorial Folders ............. . Receiving of Remains from $ Immediate Burial ..... $ ................. Direct Cremation ........................ $ Total of Special Charges(D) ................. $ E. Cash Advances , Opening of Grave ........................ $ Cemetery Equipment ..................... $ Clergy/Mass Offerin $~_ Flowers Si,;~. t~~. .,~-!,t.......... $ %° ~ Certified Copies of Death Certificate ..4 .... $ , Newspaper Notice ....................... $ Cemetery Lot and Deed ,, , , , , , , , , , , , ,,,, $ Pallbearers .............................. $ ........... Airfare . ..................... $ Vault Service Chazge ..................... $ Honor Guard ........................:'.. $- amt _ Organist ................ Other ................ $ For your convenience, we wi-1 advance the cost of the foregoing items; however, any error made by any supplier oC services shall be the sole responsibility of that supplier and our funeral home is relieved of liability therefore by acting as your agent --~ Total of Cash Advances (E) ....... . ......... $ ~+ /owl A. PACKAGE ARRANGEMENTS ........... $ -`-°'~ B. ADDITIONAL SERVICES/FACILITIES .. $~[~` C. MERCHANDISE ....................... $~ D. SPECIAL CHARGES ............ ..... $ Total of Ftmeral Home Charges ........ , , q~l E. Cash Advances ............. ...... $~/y3 ....... Total of Funeral Home Charges and ~--_ ------ Cash Advances -` ......................... -'$y,~.~g CASH ADVANCES MUST BE REIMBURSED PRIOR TO SERVICE DAY ~ ~+ AGREEMENT: [agree that I have impacted the goods and services selected above std found them to be attunte and according to the arrangements I have aelectad. I acknowledge receipt of a copy of this Sutemenl o(Gtxds and Services Selected. It is understood tlut.)he total charges shown above may be estimated and reflect oral that a additional items of aervitt or merchandise ordered or required after the time of this arrangement shall be ronsidercd part of this which we provide. Y greed upon at the time of [his agreement. Any PERMS: Thb is • enh agreemem and the cost win be rctketed on your Final Sutement for utrttticl red late to°sxtton due in fun in 30 days, and in as evenu becomes M paYrnent effective on the 31st day. Past due std delinquent after the 30 days date. A penalty of 13Yv per annum (1.23X monthly) will be charged WARRANTIES; The ordy warranty of the merchandise sold in connation with thin agreement is the express writ[w wamnty (if any), Provided by the manuf~nuru. The !utters[ dimtor makes w wamnty (expre»ed or implied) wi[h respec[ to nay (uneni reerchsMise. AUTHORIZATION: I oc We authorize std ratify prior convent to the funeral director [o take Poaaeasion of the body, give cote to and ca I or We tePrcsent ourselves n the penoo(s) having the legal right to arrsnge for the final disposition of the above rrY out the a the services std merchandise a listed shove, I or We named decedent, and do hercb rrangements hereto specified and agreed to. the waeetion of the war of this services gmnntee the paym°°t °f thu conmm according to the above terms, and also agree to Y Brant au[hority to the funeral director to aupP1Y Oral Permiaion To Embalm: The abore ~eettterrt. r'/ MY any anormy fee or legal lodgement imposed upon - ~ decedent t~as granted ^ Waa rcfuxd by !-si.e '~ ry d ii ~, cJ -./ A~7 Name FINAL ACCEPTANCE: I or We a aeer~~ O° y/~ /1Sat approx. ~Fj (am) ( -~ b hone ^ in effective / / / , and n to G g B P C acrd approve the above ulecgpns and terms, and acknowled a that the eneral rice list effecttMVeJ Y P ~~n' (/ contatne Rriee list effective / / /!f were made available prior [o selection of service. 6 / ~ /~ casket price list 3~ , rv or rch.xr .lrrt~w7.Q _ y_ /s- s.~ Dare aignnure o<Co-PUrehner ~ m Statement To: Accepted By , .w1rr1/r.,Yl./ _ _ .. +t Lek .. Cumberland County,.- Re ister Of Wills Hanover and Higgh:Stree~ Carlisle, PA I'~~13 j' '+ SANTAMARIp, ~REfiT KAY - File Number 1995-00342 Remarks GINO J SANTAMARIA AYMENT ____ Receipt Date 5 0 Receipt Time 10447956 Receipt No. 1004699 Distribution Of Receipt ---------- -------------- Transaction Description Payment Amount Payee Name PETITION LTRS ADM 25.00 CUMBERLAND COUNTY GENE SHORT CERTIFICATE 3.00 CUMBERLAND COUNTY GENER L FUN JCP FEE 5.00 BUREAU OF RECEIPTS & CNTR M.D Check# 3208 --- -__ Total Received........33.00 • 33.00 ~v~ Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters of Administration No. 1995-00342 PA No. 2195-0342 ESTATE OF SANTAMARIA KAREN KAY Late of EAST PENNSBORO TOWNSHIP Deceased Social Security No. 180-46-3612 WHEREAS, SANTAMARIA KAREN KAY late of EAST PENNSBORO TOWNSHIP UMBERLAND COUNTY ' died on the 18th day of April nd 1995; WHEREAS, the grant of letters of administration s required for the administration of the estate. •w THEREFORE, I, MARY C. LEWIS n and for the County of CUMBERLAND ~ Register of Wills omn-onwealth of Pennsylvania, have this da . in the y granted Letters of Administration to GINO J SANTAMARIA ( ~ !~o has duly qualified as administrator(rix) f the above named decedent and has agreed to administer the estatefacce estate ~ law, all of which fully appears of record in my Office at CUMBERLAND crding BURT HOUSE, CARLISLE, PENNSYLVANIA OUNTY IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal E my Office on the 4th day of May 1995 j - - _ r 1 S , BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 GINO J SANTAMARIA 819 WERTZVILLE RD ENOLA PA 17025 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT DATE ESTATE OF DATE OF DEA FILE NUMBER COUNTY ACN REY-1{07 E% OFF (DS-97) 06-30-97 SANTAMARIA KAREN I( TH Q4-,18-95 21 95-0342 CUMBERLAND 101 Amount .Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE __- RETAIN LOWER P_ORTI_ON FOR YOUR RECORDS ~ ----------------------------- REV-1607 EX AFP ( 03-97) ---"~~* -"---"'""" --------------------------- INHERITANCE TAX STATEMENT OF ACCOUNT ~x~ ESTATE OF SANTAMARIA KAREN K FILE N0. 21 95-0342 ACN 101 DATE 06-30-97 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-02-97 PRINCIPAL TAX DUE:....... .................................... .......................................................................................................................................................................... 6 6.18 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 09-11-95 AA082124 .00 66.18 TOTAL TAX CREDIT 66.18 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) r' BUREAU A~ YNDIVIDUAL TAXES INHERITAl~~ TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 GINO J SANTAMARIA 819 WERTZVILLE RD ENOLA PA 17025 REV-15f7 Elf ~FV (OS-97) DATE 06-09-97 ESTATE OF SANTAMARIA KAREN K DATE OF DEATH 04-18-95 FILE NUMBER 21 95-0342 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE------ - RETAIN LOWER PORTION FOR YOUR RECORDS ~ _ ------------------- ---------------------------------------------- -- -- ------------ REV-1547 EX AFP (03-97) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SANTAMARIA KAREN K FILE N0. 21 95-0342 ACN 101 DATE 06-09-97 TAX RETURN WAS: ( l 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. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests (Schedule J) 14. Net Value of Estate Subject to Tax (1) .00 NOTE: To insure proper (2) .00 credit to your account, (3) .00 submit the. upper portion (4) .00 of this form with your (5) .00 tax payment. (6) 1 103.00 (7) .00 (g) 1,103.00 (9) 4,291.00 (10) . 00 (11l 4. 91 OD (13) . 00 (14) 3,188.00- NOTE: If an assessment was issued previously, lines reflect figures that includ th t 14, 15 andior 16, 17 and 18 will e e otal of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat• (15) . 00 X . 00_ . 00 16. Amount of Line 14 taxabl• at Lineal/Class A rate (16) 1,103.00 X .06. 66.18 17. Amount of Line 14 taxabl• at Collateral/Class 8 rat• (17) .00 X .1 5. .00 18. Principal Tax Due (lg) 66.1 8 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TNTFDCCT Tc f`uAnnrn r..n........ AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 66.18 INTEREST AND PEN. 8.55 TOTAL DUE 74.73 IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A '•CREDIT" (CR), YOU MAY BE DUE • pFFI1Nn CFF pFVFpCF CTflF nF TNTC Ffl pM FAA TNCTp11rTTflNC 1 REV.1g70 EX (6~BB1 `~`~tiy ~~ INHERITANCE TAX COMMONWEALTH Of PENNSYLVANIA EXPLANATION BUREAU OF IND VIDUAL TAXES OF CHANGES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER ACN iris SCHEDULE ITEM NO. EXPLANATION OF CHANGES H ~'~.~ ~k:'~~ic.~c-,bra TU ~% ' . /-'f~i~~ ~~ yJ ~ ~ti:'t.7-'-~Ticc1 c.~ yi~,c i .c,-c%~/ ,~ .,~I~:.~t-~T, ,,q~r...~'- ~',~I~,Sr~L ~ 7`v 7'~t ~S~c2~.`~~crz..~, . ,c% ,, I-,E~-c-ccr~c~.f_`; c'.~.c./ ~".~ c~:_'G~4i,.-rL~-2: .~96.~it/~T ...~~> i,c/7' ~11~`.i1~'"2T. f ~qY T r~.9..:% ~C/~ T T.,~i'.~=" /L.E~~.vc,'.r.J.~~~'~c_~ Tcl dF ~~~-~ J r..ci~~iit,1c~c.~ 7`a ~=~'~ TAX EXAMINER: PAGE