HomeMy WebLinkAbout95-0350This 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 ~ 6 200T ? .
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
N103.,11 R.v. 1/91
TrrElv,or
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF NEALTFI • VITAL RECORDS
CERTIFlCATE OF DEATH
(Coroner)
01459
swE rat NUMBER
NME DF DECEDEM (Ft1, Nibble. W9
BDCULBECURDYNUMBER aveoE DeaNn+mn. o.r. wrr)
,. Thomas W, Safranek ,, Male ,. 202-48-6686 ,. Feb. 13,1995
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35
Feb.
18
Yo. 1959 ,6ethlehem, PA ~"~."""^ ERNrpri«.~ °°'"^ Np~^ RWa.a.^ ,^
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rATi1Ex8 NAME (Fnt, Nibble. I.•a'j MDTIER'8 NAME (F.a MWaM, M.ia.n Srrwns)
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. Safranek ,Emma DiLonardo
91FOM1ANf'S NAME (i,ywaq MIrORMANt'9 MAIINq ADDRESSR"r. Crytbwn, s,w, apcoay
William J
Safranek
.
3318 Oakland Road, Bethlehem, PA 18017
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...................... „~
Coroner
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Yowuranlrwrow.aw.arneaeWnarrrul».ar..ImW.,•..nano.w,n.ewy.>w«wl«..wew .......................... p ucwsE eER DA,ESF b«oe.i4~ 1995
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•MEOICAL E%AAW/Ep7CORO,1Ep NAME AND ADDRESSOF PERSON wNOCOMPI.ereD CAUSE oFcevl,
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nl.9n.~...m.e ...................................................................................
................
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L. Norris, Coroner
405 Fairway Drive
.
REQISTRAR'S SIONANRE AND NUMBER ~. Mechanicsburg, Pa. 17055
,,, _ 9 t, S DATEFq.ED (Moan, O.y, M.r)
"- n / 9 9S
~ RE~~•IS00 EX+ (8.8J)
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~- ~NHE i ANCE TAX RETURN
TH of NNSYLVA IA RESIDENT DECEDENT
iP E)UMINATION
:NT REVENUE (TO BE FILED IN DUPLICATE
URG, PA 17105
sox eJS7 WITH REGISTER OF WILLS)
ranek, Thom s W.
-48-6686
Y~ Y 1. Original Return
V W V ^4. life Estate
ud~~
e. m
~ ^6. Decedent died testate
(Attach copy of Willl
r-
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ud
2.~ c
~~
FILE NUMBER o?/ ' 9J` _~_
6907 Salem Park Circle
OF DEATH !Mechanicsburg, PA 17055
/13/95 ~,,,,, Cumberland
^ 2. Suppl ntal Return
utura Interest Compromise
^ 7. Decedent maintained a living trust
_ (Attach copy of trust)
^ 3. Remainder Return
^ 5. Federal Estate Tax
Return Required
0 8. Total Number of safe deposit boxes
ald S . Robinson, Esquire ADDRESS
P.O. Box 5320
y,E)NU~g~2_8525 Harrisburg, PA
Z
O
3
d
V
W
2
O
Q
d
O
V
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Hsld Stock/Partnsrship Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) (4)
5. Cash Bank Deposits ~ Miscellaneous Personal Property( 5)
(Sc~sdule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (Schedule l.) ( ~
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellansous~ , 2 0 0 .0 0
Ex
enses(S
h
d
l
p
c
s
u
e H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (1 7 4 8 8 . 6 2
11. Total Deductions (total lines 9 d~ 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Nst Value subject to tax (line 12 minus line 13)
15.,, Amount of line 14 taxable at 646 rats (15)
17110
( 8)
(~ 12,688.62
~iTlo~~ U . O 0
(1~ .~iaoa ~~ ~i
(mdude values from Schedule K or Schedule M) x .O6
16. Amount of line 14 taxable at 1596 rote (16)
(include values from Schedule K or Schedule M) x .15
17. Principal tax due (add tax from line 15 plus tax from line 16)
18. Total Prior payments: Amount Paid Discount (1~
Interest
19. IF line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT.
A• ^Check hers if you are requesting a refund of your overpayment.
20. If line 17 is greater than line 18, enter the difference on line 20. This is the BALANCE DUE.
A. Enter the interest on the balance due on line 20A.
B. Enter the total of line 20 and 20A on line 20B.
Make Cheek Payable to: Re islet of Wllls, A ent
»~-BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH«~
Under penalties of perjury, 1 dedare that I have examined this return, inducting accompan7ing schedules and statemenh, and to the best of my knowledge and bel
it is true, corcect and complete. I d are that all real estate has been repo ed at trw market value. Dedarotion of preparsr other than the personal npnsentativ
based o I informal f hick ep rhos any nowledge.
SIGNATU R R ' R ING RETURN
ORE S
OA E
~. 1 Z
SIGNATURE OP PREPARER OTHER THAN REPRESENTATIVE
AOORESS
DATE
(18)
(19)
0.00
(20)
(20A)
(208)
r
e
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~j 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 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 QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
REV-ISII EX, p.ael
~~
COMMONWEAIiH Of PE
INHERITANCE TAX F
RESIDENT DECEC
C.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ITEM
NUMBER DESCRIPTION
A• Funeral Expense::
1.
Pearson's Funeral Home
(casket, embalming, and grave opening)
B• Administrotiv~ Costs:
~ • 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 State
Zip Cods
4• Probate Fees
Miscellaneous Expenses:
2.
3.
4.
5.
6.
7.
8.
AMOUNT
$5,200.00
TOTAL (Also enter on line 9, Recapitulation) $ $ 5 , 2 0. 0 0
(If more space is needed, insert additional sheets of same size.)
Pleases Print or
l
REVlil7 E%. ~7.8E~
~'
4• ~~
I/~
COMMON WEAUM Of PENNSYLVANIA
INMERITANC! TA% RETURN
RESIDENT DEClDENT
SCHEDULE I
MORTGAGE L ABLDITIES AND LIENS
Pl~aso Print or T~
IMBER
ITEM
NUMBER DESCRIPTION
AINOUNT
~' AT&T Universal Card Services Corp.
P•~• Box 9999 $6,455.60
Columbus, Georgia 31997-0001
2. Discover Card Financial Services
P.O. Box 6011 $1,033.02
Dover, DE 19903-6011
TOTAL (Also ~rThr on ling 10, R~capitulotion) S
(If mores tpac~ is nNdsd, insert addiliona! shR>•h of soma size.) 7 ~ 4 • 6 2
0.Y V.;ti 17 E%+ ~287~
~~ ,` }`
COMMONWEALTH OF iENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
~• Mary Safranek
1712 Stones Throw Road •
Bethlehem, PA 18015
2• William Safranek
Emma Safranek
3318 Oakland Road
Bethlehem, PA 18017
3• [n7illiam Safranek, Jr.
110 Empire Court
Bethlehem, PA 18017
RELATIONSHIP I AMOUNT OR
SHARE OF ESTATE
U I Widow
100$
Father
Mother
~I Brother
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
0$
0$
0$
SHARE OF ESOTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $
(If more spate is needed, insert additional sFleets of same aizs) 10 0 $