HomeMy WebLinkAbout95-0359~I ~15-035q
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
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TTVEnRINT
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Fran eropoli, ///' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
CONNIONWEALTM OF PEINrSYLVMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
036842
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Joan Crrniwell 34 Scarsdale Drive Hill, Pa 17011
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REV-t5o0 Ex+ (2.871
FI LE NUMBER
. ~,.~ INHERITANCE TAX RETURN
RESIDENT
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DE
EDENT 21 395 ~ 0359
COM:aJNWEALTH Of PENNSYLVANIA (TO Bf FILED IN DUPLICATE
TaipARTMENT OF REVENUE WITH REGISTER OF WILLS)
FOST OFfiCE BOX 8327
HARRISBURG. PA t71o5-8327 CO UNTY CODE YEAR _ NUMBER
~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIA
~ DECEDENT'S COMPLETE ADDRESS \
T~`
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c Hain, Dorothy H. F
,: 2916 ~,
Harward Avenue ~.`~
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V SOCIAL SECURITY NUMBER DATE OF BIRTH Camp H 111, PA 17 011 ~
° 207-07-9391 -4/16/95- 9/21/08 co~~,v
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CX 1. Original Return ^ 2. pplemental Return
^ 3. Remainder Return
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% (for dates of death prior to 12-13-82)
4. limited Estate
4a. Future Interest Compromise ^ 5. Federal Estate Tax
v~~ (for dates of death after 12-12-82) Return Required
b m L21; 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
Q ~ ?Attach copy of Will) (Attoclt copy of Trust)
I AIrL GU.RRESP!Qf!i A{+tQ~`0~3[tflBEltE'1'tAL Fl[J( [1~tPfl ` T~ii 5F1E71UE:DI 61~;QIC~£TE~TOz
w ~ NAME COMPLETE MAILING AODRESS
c Jan M. Wiley, Esquire ~ 2 Barlo Ci rcle
O a TELEPHONE NUMBER C' \
~ y ~ Dillsburg,
1 PA 17019
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1
717 432-9666
l . Real Estate (Schedule A) ( 1) 8_~Y;'Z 18.3 7
2. Stocks and Bonds{Schedule 8) ~)
~ 3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) ( 4)
5. Cash, Bank Deposits 8, Miscellaneous Personal Property ' 120 ' 24
Z (Schedule E)
O
a I 6. Jointly Owned Property (Schedule F) (6 5. 9 0 8. 4 2
j 7. Transfers (Schedule G) (Schedule L) (7)
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8. Total Gross Assets (total lines 1-7)
353
47 (8) 2 3 5, 2 4 7. 0 3
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9. Funeral Expenses, Administrative Costs, Miscellaneou 9)
o~ Expenses (Schedule H)
,
10. Debts, Mortgage Liabilities, Liens (Schedule I) f 101 8~7: 9 3
1 1. ~ oral Deductions (total lines 9 & 10) (1 1) 2 9 , 2 51.4 0
12. Ner Yalue of Estate (line 8 minos line: 11) (12) 205 , 995.63
13. Charitable and Governmental Bequests (Schedule J) 13
( )
14. Net Yalue Subject to Tax (line.l 2 minus line 13) (14) 2 0 5._, 9 9 5.6 3
' 15. Amount of line 14 taxable at 6% rate (15) 2 0 5 , 9 9 5.6 3 x
06 ~
/'J~ 12 , 3 5 9 .7 4
(Include values from Schedule K or Schedule M.) .
,
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16. Amount of line 14 taxable at 15% rate (16) ~
x 15 . 0 • 00
Z (Include values from Schedule K or Schedule M.)
O 17. Principal tax due (Add tax from line 15 and from line 16.) (17) 12 , 3 5 9.74
~ 18. Credits Prior Payments Discount Interest
8,550,00 + 427.50 _ (18) 8,977.50
O 19. If line 18 is greater than line 17, enter the difference an line 19. This is the OVERPAYMENT. (19)
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fa.. I 20. If line 17 is greater than line 18, enter the difference on line 20•This
is the TAX DUE. (20) 3 , 382 • 24
I A. Enter the interest on the balance due on line 20A. (20A) _ 0 _ 00
B. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE. (20g) 3 , 3 82.2 4
Make Check Payable to: Register of WiI1s,~Agent . `
~I- ~-~ St~t~'Tt3~ ItNSYIER ALL Q~3~5TtC3~5 ON 1tlE~ERS~ a7~E? T+G R~HEGt~ IY~tTF~~t~t
nder penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
is true, correct and complete. I declare that oll real esters has been reported at true market value. Declaration of prepcrer other than the personal representative is
used on II information of which reparer has any know) dge.
GNAT RE P RSO RE 51 F R F LIN T ADDRESS DATE
MWE Scarsdale Drive, Camp Hill, PA 17011 f ~/Lb~ g~
REPARER OTHER THAN EP TATIVE ADDRESS DATE
J L SQU E, 2 Barlo Circle, Dillsburg, PA 17019
~~ ~e~ Rs
° R".'aagx.~x-e>t SCHEDULE E
GASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS
INNRESIDRNT DK>EDd~ITRN PERSONAL PROPERTY Please Print or Type
ESTATE OF FILE NUMBER
Dorothy H. Hain 21-1995-0359
(All property jointly-owned with Ih~ Right of~Survivorship must ba disclosed on Seh~dule Fj
17EM DESCRIPTION VALUE AT
NUMBER i DATE OF DEATH
1, Wheat First Butcher Singer Account No. 3801-0550
Keystone American Strategic Income:
Commonwealth Income Growth Fund VII:
2. First Federal Cert. #0266147762:
j Interest to date of death:
3. ~ Proceeds of personal property sale from
Wayne Myers Auction:
4. ~ PEBTF (RX reimbursements):
5 . ' Sammons Communications ( refund)
6. ' Bell Atlantic (refund):
7. Allstate Insurance (homeowners refund):
TOTAL (Also enter on line 5,
(Attach additional 8'h "' x 11^ shNts iF more space is na~dsd.l
$18,506.24
40,000.00
63,620.46
128.41
302.10
395.42
17.31
4.30
146.00
S 12 3 , x,2'0 .2 4
i~ittst ~iU ~tt~ (ZeskFxmrrtt
OF
DOROTHY H. RAIN
BE ST REMEMBERED, that I, DOROTHY •H. RAIN, of 2916
Harvard Avenue, Camp Hill, Cumberland County,
Pennsylvania, being of sound mind, memory and
understanding, do make, publish and declare this as and
for my Last Will and Testament, hereby revoking and
making null and void any and all Wills and Testaments and
writings in the nature thereof by me at any time
heretofore made.
ITEM 1: I direct that all my just debts and funeral
expenses be paid as soon after my demise as may be
convenient.
ITEM 2: All the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate,
whether it be real, personal or mixed, including property
over which I have a power of appointment, I give, devise
and bequeath unto my daughter, JOAN B. CROMWELL,
absolutely, provided she survives me for a period of
thirty (30) days.
ITEM 3: Should my daughter, JOAN B. CROMIPELL, fail
to survive me for a period of thirty (30) days, or should
we die simultaneously, I then give, devise and bequeath
my entire residuary estate unto my granddaughter, KAREN
L. BRICRNER.
ITEM 4: I direct my hereinafter named Executrix to
.,L~t`.t7" /T' ~?~`~ (SEAT,)
DOH<7iHY H.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF YORK
88
We, DOROTHY H. HAZN, JAN M. WILEY, ESQUIRE and
PATRICIA A. OGG, the Testatrix and the witnesses
respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix
signed and executed the instrument as her Last Will and
Testament and that she had signed willingly (or willingly
directed another to sign for her), and that she executed
it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the
presence and hearing of the Testatrix, signed this Last
Will and Testament as witness and that to the best of
their knowledge the Testatrix was at the time eighteen
(18) years of age or older, of sound mind and under no
constraint or undue influence.
,~
Y,ViLt ~V~.
)THY H . HA
Sworn to and subscribed
before' m'e ,,tJhis /'~fll day of
G(~7-Z;4~/ 1992.
.1 E ~ t
NOTARY PUBLIC
MY COMMISSION EXPIRES:
No+arial Sw1
S. Dawn GladteMer, Notary Pth~o
,arrol Twp., York County
My C,anmission Expires May 17,1993
n+bor, Reny pyt~aran r ar w
~~ ~
REV-1502 EX+ (12.85)
I-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Dorothy H. Hain 21-1995-0359
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair ma-ket value
which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled
to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM `/ALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
2.
Sale of home & property situate at 2916 Harvard
Ave, Camp Hill, PA:
Tax Proration due estate from sale of real estate
$85,500.00
718.37
TOTAL (Also entwr nn lino 1 RornnihJntinnl C R H 7 R_~ 7
REV-1509 EX a (~-86~
COMMONWEALTH OF PENNSYLVANIA SCHEDULE F
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy H. Hain 21-1995-0359
Joint tenont(s):
NAME ADDRESS RELATIONSHIP TO DECEDENT
A.
Joan B. Cromwell 34 Scarsdale Drive daughter
Camp Hill, PA 17011
B.
C.
ITEM
NUMBE L FORR
JOINT
TENANT DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
TOTAL VALUE
OF ASSET
DECD'S
% INT.
DOLLAR VALUE OF
DECEDENT'S INTEREST
~' A 10/14/ 2 Dauphin Deposit Bank
& Trust Co. Checking $51,784.38 50~ 25,892.19 ~~j~l
Account #0010292063
2. A Interest on checking 32.45 50~ 16.23
account
,- y,~
Jointly-owned property:
TOTAL (Also enter on line 6, Recapitulation) 2 5 , 9 0 8 . 4 2
(If more space is needed insert additional sheep of same size)
REKI572 EX• (7.88) /~`~
a
COMMONWEAU'N Of PENNSYLVANIA
INXERITANCE TA% RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF .DECEDENT,
MORTGAGE LIABLITIES AND LIENS
Dorothy H. Hain
Pl~as~ Print or 1
!NUMBER
21-1995-0359
ITEM
NUMBER DESCRIPTION AMOUNT
~• Settlement charges from real estate sale: 6,411.40
2. PAWC: 67
76
3. UGI; .
232.09
4. PP&L; 138.26
5. Wes Morret Lawn: 305.00
6. Waste management: 69.33
7. Bell Atlantic: 70
86
8. Lawn Doctor: .
64
46
9. Sammons Communication: .
19
98
10. SOS Industries: .
27
62
11. Boro of Camp Hill: ~ .
50
00
12. ~ PA Dept. of Revenue: .
68
00
13. Internal Revenue Service: .
212
00
14. Daniel Grace, CPA: .
270
00
15. Zimmerman Plumbing: .
80
00
16. Ann Markley, Tax Collector; .
778
25
17. Zimmerman Plumbing: .
22
65
18. I PA Dept. of Revenue: ~ .
9.67
TOTAL (Also enter on line 10, Recapitulation)
TS ~i / U 2
(If more space is needed, insert additional sheets of same size.)
Rfltllll Ofa (7.tq
~~ SCHEDULE H
` FUNERAL EXPENSES,
COMMONWEALTFI OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE-TAX RETURN MISCELLANEQUS EXPENSES
RESIDENT DECEDENT Pleose Print or Typ•
ESTATE OF FILE NUMBER
Dorothy H. Hain 21-1995-0359
ITEM DESCRIPTION
NUMBER AMOUNT
A. Fungal Expenses:
1. Joan Cromwell (reimbursement, funeral flowers): 188.55
2. Myers-Harner Funeral: 7,429.00
3. R.J. Romgerger & Sons (tombstone): 695.00
B.
1.
2
3
4.
C.
2.
3.
4.
5.
6.
7.
8.
drninistrative Costs:
Personal Representative Commissions
Social Security Number of Penonol Representative:
Year Commissions paid
rorney Fees Jan M. Wiley
miiy Exemption
C;aimant Relationship _
Address of Claimant at decedent's death
Street Address
City State
Ibate Fees Register of Wills:
scellaneous Expenses:
Cumberland Law Journal (advertise):
Patriot News Company (advertise):
Notary Fee:
Filing Fee:
Zip Code
i
TOTAL (Also enter on line 9, Reccpitulation)
(If more spats is needed, insert additional si+eets of same size.)
I
ii
11,500.00
321.00
40.00
149.92
10.00
20.00
20,353.47
aev.isi~ [x. ~zan
"•` SCHEDULE J
COAwONWlAUIIO~~ENNSYtVAN1A BENEFICfARfES
INNRRRANCR TAX RRTURN
_ RRSIeRNr ORCI041T -
ESTATE OF : FILE NUMBER
Dorothy H. Hain 21-1995-0359
ITEM NAME AND ADDRESS OF BENEFiC1ARY RELATIONSHIP AMOUNT OR
NUMBER I SHARE OF ESTATE
A. Taxable Bequests:
~' Joan B. Cromwell Daughter 1000
34 Scarsdale Drive
Camp Hill, PA 17011 I
ITEM AMOUNT OR
NUMBER I NAME AND ADDRESS OF BENEFiC1ARY SHARE OF ESTATE
' 8. Charitcble and Governmental Bequests:
i
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- -- -•-----•-•-•~-- -~~.~.~..~.. ir,~,~ enrer vn nne io, Retopitu~anonl 5
(If more spoee is needed, insert additional sheets of same size) '
- _.
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Inventory of the real and personal estate of
DOROTHY H. RAIN
deceased
"SEE ATTACHED LISTING"
r
INVENTORY OF THE REAL AND PERSONAL ESTATE OF
DOROTHY H. HAIN
1. Wheat First Butcher Singer Acct. No. 3801-0550
Keystone American Strategic Income: $ 18,506.24
Commonwealth Income Growth Fund VII: $ 40,000.00
2. First Federal Cert. #0266147762: $ 63,620.46
Interest to date of death: $ 128.41
3. Proceeds of personal property sale from
Wayne Myers Auction: $ 302.10
4. PEBTF (RX reimbursements): $ 395.42
5. Sammons Communications (refund): $ 17.31
6. Bell Atlantic (refund): $ 4.30
7. Allstate Insurance (homeowners refund): $ 146.00
TOTAL: $123,120.24
REAL ESTATE:
1. Sale of home & property situate at 2916
Harvard Ave, Camp Hill, PA: $ 85,500.00
2. Tax Proration due estate from sale of
real estate: $ 718.37
TOTAL REAL ESTATE• $86,218.37
JOINTLY OWNED PROP RTY•
1. Dauphin Deposit Bank & Trust Company
Checking Acct. X0010292063 - Joint with
Joan B. Cromwell - 10/14/92
Total amount - $51,784.38, 1/2 taxable: $ 25,892.19
Interest amount - $32.45, 1/2 taxable: $ 16.23
TOTAL JOINTLY OWNED PROPERTY: $ 25,908.42
TOTAL GROSS ESTATE: $235.247.03
:r
~ COMMONWEALTH OF PENNSYLVANIA
COUNTY OF l u'
Joan B
being duly warn according to law, deposes and says that She ~S the axar•„+,-;
of the Estate of -_n~r.~4+~,~~~~~n
late of -__-__1:ia.S_t' Ppnnshor~ Tnwnchin ,Cumberland County, Pa.,
deceased and that the
within is an inventory made by Joan B rnmS~o i 1_ _ _, the said_ exec-»+r; x
of the entire estate of said decedent, consisting of all the personal proparty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death .
Sworn to
and subscribed before me,
- / / .~C~ 19 9 .,~
~~~~ ,~1. ~ / A e .,c. ,.
S. Dawr Gi„~,e,;.;;, ~Iv;s`ary Public
Genol! T~~~°- Yo~c County
'~';/ Gpm `t35ty", _;;~~ ti3 i~a~ 17,1997
tiiJBf, P2tlttSyh~~1'rigr~,;^x.,a~rr nt YAP-:;~
Date of Death 16
Day
~ ` ~~-~~
Executor -Administrator
34 Scarsdale Drive
Camp Hill, PA 17011
Address
4 95
Month Ysar
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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REV-1547 EX AFP (12-95)
COMMONHEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 1 O1
BUREAU OF INDIVIDUAL TAxES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601
HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 03-18-96
r~•rw~rr wr
c.a~n~~ yr „ni~~ LURUTAY n FILE N0.
DATE OF DEATH 04-16-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO °REGISTER OF WILLS, AGENT"
REMIT PAYMENT T0:
JAN M WILEY ESQ
2 BARLO CIR
DILLSBURG PA 17019
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Amount R~nittad
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
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""-'547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RAIN DOROTHY H FILE N0. 21 95-0359 ACN 101 DATE 03-18-96
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Raal Estat• (Sch~dul• A)
2. Stocks and Bonds (Sehadul• 8)
3. Closely Hald Stoek/Partnership Intarast (Sch~dula C)
4. Mortgages/Notes Raeaivabl• (Sch~dul• D)
5. Cash/Bank Deposits/Misc. Personal Property (Sch~dul• E)
6. Jointly OMnad Property (Schadul• F)
7. Transfers (Schadul• G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fungal Expenses/Adm. Costs/Misc. Expenses (Schedule H)
30. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Begwsts (Schedule J)
14. Net Valw of Estate Subject to Tax
(1) 86.218.37
(2) .00
(3) .00
(4) .00
(5) 1.23.120.24
(6) 25.908.42
(7) .00
(81 235,247.03
(9) 20,353.47
do) _ 8.897.93
(11) 79.TS1 40
(12) 205,995.63
(13) .00
(14) 205,995.63
NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15 ) . 0 0 X . 0 0_ . 0 0
16. Amount of Line 14 taxable at Lineal/Class A rate (167 205,995.63 X .06. 12,359.74
17. Amount of Line 14 taxable at Collateral/Class B rate (17) •0 0 X .1 5. .00
18. Principal Tax Due (lg) 12, 359.74
TAX CREDiTSe
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
07-13-95 AA047990 450.00 8
550
00
11-27-95 AA082349 .00 ,
.
3,382.24
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT 12,382.24
BALANCE OF TAX DUE 22.50CR
INTEREST .00
TOTAL DUE 22.50CR
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT^ (CR), YOU MAY BE DUE