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HomeMy WebLinkAbout95-0347~ I -~5- 0317 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 16 2001 Date 1~1J H705.1~.1 R•v. ?/37 TrvEewalT N PERBIAIIENT euac rRc -I . 2 w W i Z ? • Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYUNINIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH 077~'Ge MAMEaFOECEDExrI~.xMm..lra sex sacuLBECURnvNUweER DATEOCOEATNIMar~.DSy.~wl +• Mar A. Hill ,. F. a.171 - O1 - 1530 .. 8-IS ~i~ AGEBaR BYtWay uNOEn, rEAR uNDel, ar DATEOCSmN B,Im,MACi (Ciy a•d r1,IC~as DEaNtc~ d. «Ira..-s.w•cw~sal am aoR Ma,rr 1 Dq• Nan I Mbrr IMaN. o.~,'M 5tr.«iwgn Caawyl MOSPILIL oTMER: 86 Yz /25/1908 Treskow, PA ~. ~+^ ERxxAr..a^ ~^ IIO® Rr~dwxa^ ~"ISpacy1^ Co1NTraeDEIBN crn,eora.TwvovDEATN FACRflYNAMEpoo,nreaioA.v~•wesanen.narl wAS OCCEDErrroaMlBpRrxcoRgNr RACE-AwalrnYtlMI, Black,Wllp.NC. ~/ N C Iq N• 10 W ^ Myr,+paoilyCuban, ~ ^ n ^~ b tswdvl ~~ Cumberland jliddlesex Twp. s:-• FM in •a auN ur,bercl~Aao •n• N • •• s. White u OECEOEIIT'S USUAL OCCUPRION xND OF BUSB1E56M/OUSTRY YwS DECEDEIR EMERN DECEDENT'S EDUCQM)N ~ MARIDLL STNUS-ManNa SURVNBMA SPOUSE moM U.9. ARMED FOIICE37' ~ N IM.N.Vrmrtln nnrl dwa,aYpllla; danrur s ~~I "`^ " ~ ~~ ~ "~ Seamstres „ Garment Indust „~. ° g I ,a. I I Widow - ,~. tB. DECEDENT'B MAAIIq ADg1Eas 1s•a cllr+ra-.. sul.. naCOau DECmENrs r•adaaNadb 1 eSex ,Ta ACTUAL n 6a Mr s 375 Claremont Drive . .. m DIa . b~ RESx>ENC;E dM;adaa Carlisle, PA 1 7013 Cumberland ,M ~I+P+ ^ ~ ~ ~~ ~~ ~T~ d ,n FRNER'S NAMEIFrd. Midda. LaR, MOTNER•S NAPE (~. Miada. MYfNnSurnrMl ,.. J Artim ,,. Anna - Makarova wTwReuNra !<rvpRo MAxNDADDREBB ISn.I.apTor~sr.. zrc•du Thomas J. Hill 163 "D" Street; Carlisle, PA 17013 1AETIIODOf DREOP DIBPOSR,OM RACE OF .NanNdCMINMy. Clwnray LOCRgN•CNylbr~S,ra, 2lp Ca,a eI.I.T® Cl.llrur^ Rrnaalnpa8lra^ •DaAM"'I aO"MP10iSt. Michael's °oi~°^^ a~rrsT=M ^ :,s.8/19/1994 „ zar>rine Catholic Cgn. :,aMc'Adoo. PA 18237 aBNRUaEGF SERVICE OR ACRNB ABSUCM LICENSE NUMTIER NAMEANDADDRESSaP fACL,TY FD 012633 L ~ Bwin Brothers Funeral Home; Carlisle, PA 17013 ai•orayrba aaYylrq Mw e.rnam.ndrtl~lall•.Oa"rrpa•a raMd. I.ICEN9E NUMBER DRE9gNED ~aNb ararrbl.rwrdawnb $ - 15- 9 ~i 'i : 35 A,+r. ~' CG wH TM D - 0~12c,4 ti -L. OaltMrl aaa. Y-- l3 - 9`f Ilrr 2apS aar OaaanpYrdM aP DEAiN DAEE PRONOIxICED DEADPA,rdt Oax MMr) MRSCASE REFFARED70 MEDICALOUwa/ERACORDNER+ Pr.rrrprb,acrarL x ~ ~ 3s A M. Mr ^ No$t $- ~- ~1`t- x a7. PANTk Enbrar rran•. inFnN•«c«npLCrla+•1irN~rrEtluOrp. DO na rnrlM lrotl~dN'r10.wNrnrA•c«mpirlaY+r<rL S1nr«IrM hiw•. 1 AP/IrL'Irr PART L• WlafagliealamlldYSlarnaSrlprdrr.lAa LYtaMoMfJUron MIdlA.la. ~Yr,Yalaal•rll aalaaArq YIBM IarNryYlBerNyrnYIRVKI. d d r l SSIEOUITECAIAtE (P•.M Ialrtar ' S !7 A"T ' °« i ~ ,. to ~ ouE ro,CRASA caNBEauENCE oFl: Bapb•rByYaagdaN b I Ean,I Na4graMnaOra DUE TO (CR ASA CONSEQUENCE OF): I Sp ~ CAMS! (Dirr 1 fr 41S'btl•+rln DUE 70IaT ASACDNSEOUENCE OF}. nraA'x,+I drlal) LAST ~ I MRS AN AUTOPSY WBE AUTOPSY RIIDNGS MAIaIER OF DEATH DATE OF NAIRV TIME OF IM.IU(W BiAIRY ATWORxt OESCiBBE MOW INANWOCCURRED. PERPORIIED'1 ARAASLE PRg1170 IMar. Day, MI>I OE~T OFCAUSE Nor ~ Nom.nOa ^ 1 w w ^ No ^ ^ ACCidNa P•n6Y •• ^ ~p55 M. Ha ^ 11•~ laa ^ N• V]I 9uidd, ^ Car nr Mdalannaled ^ MACE OF MR/RY-N nolrla. Nnn, abM.hA+a,e dllr LOCA710N (Stra"CAWkwn. SaW baasn9. a,e (Spatil,9 ' aaw x ae•. xr. sIGMAnxaFANDTmE ~ xr u •rnt~MrB w o 3l "lMly.ar.eanN+n~,..aw.e.w.s.sw,rcl.veor,neswaw~c.eau.va camp"ea n... zal T•drlNr«www.I.M•.awseea•.wr..re.~alw•1.~.a.rawrm,w ..................................................... ^ a,a LICENSE R OQESI[;11EDILIala4 Da%Mwl •~vR~ow~cdNRtANDtERnsrrannalelANlvnr.~.maaaw~wrvaan,~e~«uMgbra,..aw.m, ~ rq .6~12c.44 L 8-IS•~i') ary Im•wl•4B•. MaYI eaerrW •[ V.a,ao•. dar, L.d piaea, rld dr b Bb ~aa••(•1 and.na.•r r •,aba .......................... 71 16 NAME AND AOORESSOF M:RSON WI,000MPLETEO CAUSE OF OFAH •MEDUCAL~ mamznryP.«Pnd 145o G~.wa Ho pc. RT) On tlN Oaah daxaadnalfa,l andl« MwaaNSNM, In my apbtl«y Ga,b a:w"h r tlb Wm, dra, and Place, and dw to MN eau••(s) and ~k:L., 6~A 1 PA 1 -1 O i 5 ^ n,annar~rabd .................................................................................................. a. EVlr.1~XT w.. JOJt-F w,lU, aa. REGISTRM'S SIGNATURE AND NUMBER ORE RLED IMOnT. DaY. Rrl ~. a.. 1b 1`~q 1 U ~ ~ - w __ l~ 3J ~ J~ ~(~~~~~ REV-1500 EX+ (7-94) ~. /~/ 'I NCE TAX RETURN FORSATES OF DEATH AFTER 12131!91 CHECK HERE OUSAI / INHERITA p r OVER RESIDENT DECEDENT FILE NU ER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE (TO BE PILED IN DUPLICATE ~~ C~ Jc•, ~ ~~,. DEPT. 280601 WITH REGISTER OP WILLS HARRISBURG, PA 17128-0601 COUNTY E YEAR NUMBE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ DECEDENT'S COMPLETE ADDR -- - -- -~~~'",. ~v>h+$eRLA.ID Ccwrli~/ I~yr~sxaJG ~I~ W SOCIAL SECURITY N MBER ' `~ DATE OF DEATH ~ ATE OF BIRTH y- " ~ ~ 3•'t~~ C'I yLR~.p~I,T Dq ~. 77 1r~~11 ~urr ~, ! - o - 1$ ~ -1 ~~ - z • oa 4 C ~ou~t l~ 3 CK p (IF APPLICABLE) SURVIVING-SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) O L++ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return YQy (for dates of death prior to 12-13-82) ,"~, d v ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required ~ ~ ° (for dates of death aFter 12-12-82) a ~' ^ b. Decedent Died Testate ^ 7. Decedent Maintained o Living Trust _ B. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) ,.. - - y ~ Z NAME COMPIETE fnAILING ADDRESS 141ovv1 o L~ f !.3 "D " 5 ~ . v O TELEPHONE NUMBER J ~:-~" "~'"~~~`,~5 ~ ^.~' a . r ~" ' ~ t .~.y3 - , 7 z 0 5 d a v z 0 a a 0 v x a (8) ITT-"~'1~. ~~ (11) X01 (~ b ~ L'f' Z (12) 1 Q ~ 1 O ~ (13) .Ob = ~y~, 6~i~ 15 = (18) (19) (20) (21) (21 A) (21 B) 1. Real Estate (Schedule A) (1) _~~#~7t'it . i:~~ ~ 2. Stocks and Bonds (Schedule B) (2 ) 3. Closely Held StocklPartnership Interest (Schedule C) (3 ) 4. Mortgages and Notes Receivable (Schedule D) (4 ) 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (5 ) (Schedule E) b. Jointly Owned Property (Schedule F) (b ) 7. Transfers (Schedule G) (Schedule L) (7 ) 8. Total Gross Assets (total Lines 1-7) / 9. Funeral Expenses, Administrative Costs, Miscellaneous E h d l H (9) ~ `~ ~~ ~ 'K xpenses (Sc u e ) e 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject fo Tax (Line 12 minus Line 13) 15. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicable Percentage on Reverse Side. (Include values from Schedule K or Schedule M.) (15) 16. Amount of Line 14 taxable at b% rate (16) ~ Q ~ ~ (U' I C~ (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + + - 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. ^ 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A. B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. Make Check Payable to: Register of Wills, Agent Under penalties of perjury, I declare that I have examined this return, includin4 it is true, correct and complete. I declare that all real estate has been reported based on all information of which prepprer has any knowledge. SIGNAT E OF PERSON RESlON518LE FOR FI G RETURN ADDRESS ~ SIGNATURE OF PREPAjOTHER THAN RI accompanying schedules and statements, and to the at true market value. Declaration of preparer other If my knowledge and belief, le personal representative is DATE ~.p ~ ~ ~ {~ DATE Act 048` of 199 ~pro7tdes for the reduction of the tax rates imposed on t~+e net ydlue ~of transfera'to or for the use of the "spouse , ''fie rates as prescribed by the statute; will,, be: • 39/0 (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before~l/1/96 e 20y6 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1°yb (.O1) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98 • Spousal transfers, accu~ring do or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK ~~) IN THE APPROPRIATE BLOCKS. 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 considsration$ If death occurred after December 12, 1982, did decadent transfer property within one year of death without receiving :.adequate consideration$ ................................................................................................... YES NO r/" G'°' 3. Did decedent own an 'in trust for'. bank account at his or her death$ ...................................... ~~ d- - c~- t;: - r IF TIDE AI~'SWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOUR-MUST ;COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~~ c: ~- ;.~ ,;~ r. ' L REV-1502 EX+, (12-85) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER -~.,..~. (Property jointly- ned 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 willing buyer and a willing seller, neither being eomuollad (~r more space is needed, insert additional sheets of same size.) REV-1511 EX+ (7-88) SCHEDULE H FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA IN E RN ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or T e _ RESIDENT DECEDENT yp ESTATE OF ~~ FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: ~. ~ ~°~ 5^~ . ~ ~,. y"v s'~ . fix, ~ . ~RIR-tIE; ~i`v~ ~ ~g RqV I~fT ~G'~-• ~~y. o0 B. Administrative Costa: 1. Personal Representative Commissions ~ ~~ _ ~T _ ~~~~ T Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees ~~ ~ ®~ Ita[p O© 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees ~'~ ; O (~ ~ sr : a o C. Mi neo s ce ll a us E xpenses: [[ ~~ ~~(11 x ~j ~1g /y t y d ~ ~ I• ~~~~ wr ~ ~ ~ ~~ V ~ ~'~ ' • Y . • OD !3S 2 3. 4. 5. 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) $ /Q~1,~ ~ ~ (If more space is needed, insert additional sheets of same size.) B . REV-1508 EX+ (2-Bn COMMONWEALTH OF PEI INHERITANCE TAX E RESIDENT DECED SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or (All property jointly-owned with the Right of Survivorsltiiss muss 6. di^dne.d ..., c.t._a..t- m (Attach additional 8Yz" x 11" sheets if more space is needed.) REV-1513 ER+ (2-87~ F' SCHEDULE J COMMON W EALiH OF PENNSYLVANIA BENEFICIARIES INHERITANCE iAX RETURN RESIDENT DECEDENT EJIATE OF ~ ~~ ~ . ~?~ ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: 1. ~~~i;w~ ~.~~ R ~a,~7~E-"Z S i . ~. I H~w-~5 vo N1~ ~~~~ ~}RLTS'~Et ~~ ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation( I $ (If more space ~s needed, insert additional sheets of same size) FILE NUMBER RELATIONSHIP AMOUNT OR SHARE OF ESTATE ~~~ ~'~ ~v~. I ~~ AMOUNT OR SHARE OF ESTATE