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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 16 2001
Fran eropoli, ' act
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYUlAN1A • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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DATE FlLED
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5 141
REV -'1600 IX + (7pp-91) Ly
~~~ ~~MDEPAR A ~ppOppFppPEEgVEN lul/ANIA
H RRIS~~~G,PBA~1~128-060t1
DE DENTSNAME(LAST,FIRST,AND
E t'ic wine
C SOC LSECURITYNUMBER
E
D 9-12-6634
E
N
'~ (IF APPLICABLE)SURVIVING
C A
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E P
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24 /55 -~i - /o
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF-WILLS
F A SPOUSALF DEATH AFTER 12/3r~ CHECK MERE
FILE NUMBER
21-95-0346
COUNTYCODE YEAR NUMI
"IDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
Pauline E. 319 Walnut Street
DEATH DATEOFBIRTH Boiling Springs, PA 17007
(/1995 02/22/1924
cor,nty Cumberland
NAME(LAST,FIRSTANDMIDDLEINITIAL) SOCIAL SECURITY NUMBER
1. Original Return e 2. Supplemental Return
/. Limited Estate 4a. Future Interest Compromise
~ (for dates of death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust
(Attach copy of wll) (Attach a copy of Trust)
CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE t
er B. Irwin
HONE NUMBER
-249-2353
k` y t
~.~
AMOUNT RECEIVED (SEE INSTRUCTIONS)
0.00
U 3. Remainder Retum
(tor dates of death prior to 12-13-82)
5. Federal Estate Tax Retum Required
0 8. Total Number of Safe Deposit Boxes
TO:
LETE MAILING ADDRESS
IRWIN, McIINIGHT & HUGHES
60 West Pomfret Street_
rlilse PA 17013
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B) (2) ~ None
3. Closely Held Stock/Partnership Interest (Schedule C) (3) None
4. Mortgages and Notes Receivable (Schedule D) (4) None
E 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Sch. E) 2 500
50
C
A .
6. Jointy Owned Property (Schedule F) 12
757.20
p ,
7. Transfers (Schedule G) (Schedule L) (7) None
T
U 8. Total Gross Assets (total Lines 1-7) (8) 97 , 757.70
L 9. Funeral Expenses, Administrative Costs, Miscellaneous (.9~" 11, 926.48
T /
Expenses (Schedule H)
l 10. Debts, Mortgage Liabilities, Liens (Schedule I) 121
26
O
N .
11. Total Deductions (total Lines 9 & 10) (11) 12
047
74
12. Net Value of Estate (Line 8 minus Lirte 11) ,
.
(12) 85
709.96
13. Charitable and Governmental Bequest (Schedule J) ,
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13) None
(14) 85
15. Spousal Tra
f
(f , 709.96
ns
ers
or 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) 85 , 709.96 .06 5
142
60
(Include values from Schedule K or Schedule M.) ,
..
T
A
X 17. Amount of Line 14 taxable at 15% rate
(17) 0.00 x .15 = 0
00
(Include values from Schedule K or Schedule M.) .
C 18. Principal tax due (Add tax from Line 15, 16 and 17.) (18)
P
19. Credits/Sp Poverty Prior Payments Discount Interest 5 ,142.60
U
T 0.00 + 0.00 + 257.13 - 0.00
20. If Line 19 is greater than Line 18
enter the diff (19) 257.13
,
erence on Line 20. This is the OVERPAYMENT.
® ~ Check he
ff (20) 0.00
re
ou are ; uett a nfutido(: ourovs menL
O 21. If Line 18 is greater than Line 19, enter the dfference on Line 21. This is the TAX DUE. (21) 4
885
47
N 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. 0.00
(218) 4
885
47
Make Cheek Pa able to: R aster of Wills, A ent ,
.
nder pena - - BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~
lties of per)ury
I declare that I have
,
exam ned this rotum, Inc ing aeeompanylnp ac edubs and etatamsMs tot t of know
correct and complete. I declare that all real estate has been reported at true market valor. DselaraUon of preparsr other than the personal ro~essntat~Is based on all Information of
which preparer has arty knowledge.
SIGNA
~ E OF PERSON RESPONSIBLE FOR FILING RETURN
~ ~ ~ I, '~~ _ 295 F i DATE
SIGNATURE OF PREPARER OTHER THAN
°..,..,,me onry crsystems, Inc.
a rview Street
------------------------
Carlisle, PA 17013 ~-----~--~----------"-"-'--"-
IRWIN,- McKNIGHT & HUGHES __ _
------
60 West Pomfret Street Carlisle, PA 17013
f,(~ltir
DATE
~~~ y~
Form (pm,, 7=g,)
Act X48 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:
•396 (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 111/96
•296 (.02) will be applicable for estates of decedents dying on or crier 1/1196 and before 1/1/97
•196 (.Of) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98
•Spousal transfers occurring on or crier 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING f1UESTIONS
BY PLACING A MARK (X) IN THE APPROPRIATE BLOCKS.
YES fN0
1. Did decedent make a transfer and:
a. retain the use or income of the property Vansferrsd . ....... ...... ................. ... X
b. retain the right to designate who shall use the property transferred or its income . .... ............ ... X
e. retain a reversionary interest; or .. . .. .......... ... ........... ................ X
d. receive the promise for Iffe of either paymerns, benefits or care? ...... ................... .... X
2. H death occurred on or before December 12, 1982, did decedent within two years preceding death
transfer property without receiving adequate consideration? tf death occurred alter December 12,
1982, did decedent transfer property within one year of death without receiving 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.
Copyright (c)1991 Corm software ony CPSystems, Inc: Form 1500 (Rev. 7-e~)
r
REV - 1502 EX + (12-85)
COMM~EpLT}f ~Ip: pENNgy~yANIA
SCHEDULE A
Pauline E. Richwine SS~~ 209-12-6634 03/23/1995 FILE NUMBER
21 95 0346
(Property jomUy owned with Right of Surnvorship must be disclosed on Schedule F) All roal estate should be reported at fair market value
which is defined as the price at whkh property would be exchanged between a willing buyer and a willing seller, neither being compelled to
b or sell, both Navin reasonable know) a of the relevant facts.
ITEM
DESCRIPTION VALUE AT DATE
NUMBER
1 319 Walnut Street, Boiling OF DEATH
Springs, South Middleton 82,500.
Township, Cumberland County,
Pennsylvania, more
particularly described in
Deed Book "X", Vol. 26, Page
497, suggested list price
(appraisal attached)
TOTAL (Also enter on line t, Reca itulation) i 82 00.00
(If more space is needed, insert additional sheets of same size.)
Copyright (c) 199 form aoftwere only CPS7stams, Inc,
Form 1500 Sc ule A (Rev, 12-85)
REV - 1508IX t (2-87j
COMM~~`j}{ plp~gy~vANIA
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
or
Pauline E. Richwine SS~~ 209-12-b634 03/23/1995 21-95-0346
REV - 1b09 EX + (12-88j
CO""S'"N~Fdl4T~~~,S,~,yANIA SCHEDULE F
~~~b'~~`' ~a''ff`'^" JOINTLY-OWNED PROPERTY
ESTATE OF
Pauline E. Richwine SS~~ 209-12-6634 03 23 1995 FILE NUMBER
21-95-0346
Joint tenant(s):
NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Dolores K. Flagle 295 Fairview Street daughter
Carlisle, PA 17013
e.
C.
Jointly-owned property:
ITEM L FOR R DATE
NUMBER JOINT
TENANT JOINT
1 A 04 /A ~
2 ~ A ~ ~ 03/92
3 ~ A , 105/93
DESCRIPTION OF PROPERTY
PNC Bank, N.A., - checkin
account ~~5140190064 ~
(confirmation attached)
PNC Bank, N.A., - savings
account ~~5130378952 ~
(confirmation attached)
Van Kampen Merritt, U.S.
Government Fund, Acct.
~~40-8000515695-3
(confirmation attached)
TOTAL VALUE DECD'S__ LLAR VALUE OF
OF ASSET ~Il~ ECE NT INTEREST
3,706.72 50.OOr ,853.14
5 , 569.40 ~~ 50 .
16,238.72 ,50.00%
TOTAL (Also enter on line 6, Reca Rulation)
(If more space is needed, insert additional sheets of same size.)
Copyrlyht (e) 1994 form software only CPSystems, inc.
Form 1500
,784.70
8,119.36
12 7.20
lub F (Rw. 12-88)
REV - Y511 EX + (7_gg)
SCHEDULE H
FUNERAL D~ENSES,
~M~N~~4r~~~~ANIA ADMINISTRATIVE COSTS AND
~Ibb''~~ MISCELLANEOUS EXPENSES Please Print or
ESTATE OF
FILE NUMBER
Pauline E. Richwine SSA 209-12-6634 03 23 1995 21-95-0346
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funeral Expenses:
1 Gibson-Hollinger Funeral 7,132.00
Home
B• Administrative Costs:
1• Personal Representative Commissions
Social Security Number of Personal Representative: 164-34-1579
Year Corrvnissions paid waived
2. Attorney Fees IRf»TIN, IicilaiIGHT 6 HUGHES
3. Family Exemption
Claimant none Relationship
Address of Claimant at decedent's death
Street Address
Crty State Zip Code
4. Probate Fees
C• Miscellaneous Expenses:
1 Cumberland Law Journal -
estate notice publication
2 Roy D. Gottshall, Autioneer
- appraisal fee
3 Register of Wills, filing
fees
4 The Insurance Company of
Decatur, homeowners policy
~~UF0945285
5 Notary Public fees
(see continuation schedule attached)
Total of Continuation Schedule(s)
TOTAL (A)so enter en fins o o.,..._....._.:_ _ ~
Copyright (e)1g91 form software only CPSystsms, Inc.. •v r~~o w rrwveq, rnserz aoamOnal iNeett Of tame ties.)
~_
Form 1500;
0.00
4,100.00
0.00
255.00
40.00
30.00
25.00
150.00
24.00
170.48 7
------
11, 6.48
idils H (Rev. 7-BB)
Estate of: Pauline E. Richwine SS~~ 209-12-6634 03/23/1995
CONTINUATION SCHEDULE
Continuation of Schedule H-C
ITEM DESCRIPTION
~~ AMOUNT
6 Patricia A. Rosendale, CPA,
preparation
of decedent's 30.00
1994 income tax returns
7 Patricia A. Rosendale, CPA,
preparation
of 1995 75.00
fiduciary income tax returns
8 The Sentinel - estate notice 65
48
publication .
170.48
REV - 1512 EX • (1-93)
SCHEDULEI
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES AND
Please
Pauline E. Richwine SS~~ 209-12-6634 03/23/1995 21-95-0346
roan ~a1N yChedWe IIRW. 1-931
REV - X513 EX + (2_87)
coMiN~@Sib'~'N~~~i~Y'"~iA SCHEDULE J
___ _ __ _ _ _ BENEFICIARIE
Pauline E. Richwine SS~~ 209-12-6634 03 23 1995
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
1 Dolores K. Flagle
295 Fairview Street
Carlisle, PA 17013
RELATIONSHIP
daughter
21-95-0346
AMOUNT OR
SHARE OF ESTATE
loor.
• -•-A.. ~. Form 1500 Schedule d (Rsv.2-87)
LAST WILL AND TESTAMENT OF PAULINE E. RICHWINE
~,
';~ I, PAULINE E. RICHWINE, of South Middleton Township, Cumber- ,
island County, Pennsylvania, declare this instrument to be my Last
!.Will and Testament, in manner and fot~ following: ~
~~
~~ 1. I hereby expressly revoloe ail Wills and Codicils hereto- ~
ifore made by me.
2. I hereby direct my gxecntor to pay all my 3ust debts, I
.,funeral and administrative expenses out of my estate, as soon as
'practicable after my death.
3. Should my husband, Daniel C. Richwine, survive me for
a period of thirty days following my death, I devise and bequeath
!'the s~emainder of my estate to Daniel C. Richwine.
i
4. Should my husband, Daniel C. Richwine, predecease me or
',die on or before the thirtieth day following my death, I devise i
and bequeath the remainder of my estate to mq daughter, Dolores
K. Mille r, and to her issue, per stirpee, if she ie not then !
~Iliving.
' S. I nominate and appoint CCNB Bank, N.A., Mount Holly
Springs, Pennsylvania, Trustee of the share of any beneficiary
under the age of twenty-one years. The income and/or principal
of said trust may be accumulated or expended for the maintenance, '
education and support of such beneficiary as my Trustee in its
~~sole discretion may determine; and my Trustee, in the expenditure
Iof income and/or prindpal for such purposes, may, at its dis-
;cretion, apply the same directly without the irate mention of a
gpuardian or pay the same to any person having the care or control
i~of said beneficiary or with whom the beneficiary resides, without
duty on the part of the Trustee to supervise or inquire into the
:application of the funds by any person to whom any payment is ao ~
.I
j.made. The balance of such income and/or principal shall be paid ~
u
- 1 -
to such beneficiary upon reaching the age of twenty-one years or
to such beneficiary's estate in the event of death prior thereto.
6. I nominate and appoint my hush;nd~ Daniel C. Richwine,
as Executor of this my Last Will and Testament; and as substitute
!Executors I nominate and appoint in order of preference, first,
~~
''my daughter, Dolores K. Miller; and aecond~ CCNB Bank, N.A.,
Mount Holly Springs, Pennsylvania.
i. I
7. I direct that my personal representative and Trustee,
as well as their successors, shall not be required to file bond
or security in any jurisdiction.
IN WITNESS 41I~REOF, I have hereunto set my hand and seal
ii this ~J ~ day of ~" , 1978.
~' I
~~~` . ;: , ~G. v (SEAL)
,~
(I'WITNESS:
~I
,_ ,~~ ~ 1'
~~
COMMONWEALTH OF PENNSYLVANIA
SS.
!' COUNTY OF C[fl~ERLAND
I,Ehuline E. Richwine, Testatrix, whose name is signed to ~
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and exe-
~~ i
;cuted the instrument as my Last Will; that I signed it willingly;
and that I signed it as my free and voluntary act for the
~puxposes therein expressed. j
~~
I! I
~~ - 2
I
Sworn or affirmed to and acknowledged before me,
Pauline E. Richwine, Testatrix, this ~ .t^ ~ day of ~^ ~'~s„~
~, 1978. r ~
C
ii ~' i' `' /,' ~ ~ ' '
I~ ~ es a
~~ I
~: ~, ~~~
~.'.•:• :. ..,~._~,_.~ _ .~ „~ J_::u:.ry ~'/, 1979
~;
''
C~10NidF.ALTH OF PENNSYLVANIA :
~ SS.
~~ COUNTY OF CtJI~ERLAND
I~
We, Tom H. Bietsch and Roger M. Morgenthal, the witnesses ~
,' whose names are signed to the attached or foregoing instr~ent,
'.:being duly qualified according to law, do depose and saq that we
h
were present and saw Testatrix, Pauline E. Richwine, sign and ~
~' i
;execute the instrumient as her Last Will; that she signed willingly
island that she executed it as her free and voluntary act for the
~~purposes therein expressed; that both of us in the hearing and
;sight of the Testatrix signed the will as witnesses; and that to
'!the best of our knowledge the Testatrix was at that time 18 or
'more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affiz~ed to and subscribed to before me by Tom H.
Bietsch and Roger M. Morgenthal, witnesses, this /J~ ~ day
of f-~ , 1978.
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