HomeMy WebLinkAbout95-0362
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 2007
Date
H1o3.1e7 Rev. =137
TVPE/PNWT
w
BLACK
O
i
z
~ ? .
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS n ~ C '7 -7 C
CERTIFICATE OF DEATH iJ V ! / V
T ~i'E~~~T~••L Mbes•LrU SEX SOCIALSECURRVNWBER DATEOF DERN(MOM. Day. M•r)
C '• izabeth C. Bri =. Female =.167 - 50 - 9231 ..April 22, 1995
AGEIL•p BeeldlN UNDER,YEM UNDEi11 DAY DATE OFBERN BWTIIPLACE(C]y antl PLACE OF (Cnaoh anyorn-ar eletruclatr an alMrsitla)
Marts = D•y Noun I Mtr•ra p,Orn•D•N Merl Slob«F«aipn Gauntry) G7NER:
pp11
a. 103 Y"~ NOV 11, 91 T Dunbar Pa trwrb~a ^ ERptlMrlara ^ DDA ^ II It11 Rsaasnr ^ (SP. ~Y) ^
COUNTY OP DERV CRY, BOta,TWPOF DEATH FACILITY NAME Shat MWu9on, prv•prer and numer) NMS
p
ED~EN
~
OP NISPAl11C t7RKiS77 RACE-Amwk•n NtAarI,BMA,WNa, re.
/ ~
ry
r
I
N• L'I N. IJ 3,w,.gdly CuGVI. ~P°~')
N. Cumberland k- East Pennsborv .,- Blue Rid a Haven West "1tlCn'P""'°Rb'"•~ „
White
.
DECEDENT'B UBUALOCCUPRgN KINDOF BU91NE381MDUSfRY VNB OECEDEM EVER qi DECEDEM'S EDUCRION NaearMrrb4 WMOan0.
((7rvaHradratr tlal•wtlI~rrna1vpmop U.S.ARMED PORLf87
IN a06
7.e~i0)
d
aM
M
O
a
f
,
a
tE
•;
DIle
rera
Ebm•t•aty/Sacatttlary COMEa DlrolcM lSP•eg1
~atl.) Yr^ No®
CO-Owner ,,.Bri Drive-In (~,~ n•«s+) , Widowed
1a ,L ,_. 10.
DECEDENTS MASSpl ADDf1E3315treel. Cey/7awn,9bb, TpCOtla) DECEDENT'S
ACRML 77•. 91ra_ Pa Ditl /Ta^ 1M
tlratlwa Aratl in
.
3400 Walnut Street RESEIENLE ar.tlNa baP
Camp Hill, Pa 17011 ~'" "b•rlb'll,? No,tlr.tlHEare
+a anaQiBOS) „b. CI=-Iberland
na® •wblaa•rrtrd Camp Hill
FRifER'8 NAME (Err, Mitl4a, LrQ MOAER'S NAME IF•a MitlEr. MaA1r Surrwna)
Pa ick O'Hara , Srid t Fl
MFORMANTS NAMERw•Pralq ~ 8 MAEYXi ADOrEBBlsw.t. C1Afown. sw, Zp Cope)
Patricia Rutter
METNOOOF DRE OP DISP081T 900 Leeward Court York, Pa 17403
gN PLACE OF DISPOBITIDN-NrrdCamarty,Cwar«y LOCATION-CNy/fown, St•b, aD COtls
el.,rQ{cremrbn^ RamwalhanSWe^ .D•v.Mr) ~ «OIMrPro.
P/>aNL try re
D°wbn ril 25 1995 Resurrection Cemet West Hanover Ttap
IIb-
31e.
.
GP RAbip RPERSONAC,INOASSUCH
LXX:l/SErAnABEn
NAME AND ADDRESSGFPACERY a ee
„b, 011654-L ~ ~• p~_j-jarnpx ~~-~ Fine In Hill Pa 1701
I
rma •b bar d my bawbtlpa, dwb aecurrM r IM enr, hb •ntl Dlae• r.btl. LICENSE NUMBER Da0'E SXiNED
bnq watLrarrrde..rb aaMTpb)
(Mats. ~. ~)
o•rlly callaa a tlaatll.
_ _ =1a
xx.
Praon aA,o0ttrtlouler 0iab by TIME OF DEA3N ~~T D,QE PRONOUNCED DEAD PAOM, DeY.Mr) VMS CASE REFERREDro MEDICAL E%AMMERKXIRONER?
^
A
'
'Y
'
wa
~/I ~ ~.t ~ / 9 ~.!
Na6~
Z..
M. m.
n.-MTh. ErrlM dberK HrbO«rnnplpUOr wllktr eresOlM drM. DO ral rltrttr moMdOyfrp,rrAreraue«npero7 ravel. pack«MrtlMlr•. ~Mpwbrb PMTE: OUw
LW any «.arra•dl arb.
~
~
m ~
~
IYMrvr br•rn mt rw
ieny
r re na.rlyrp ,.,,
PART
BNIIIDIATE CAUSE (Finn I onrl rM b•b ,
6rra «mrdtipl I
I
rrultirlp bOeeln)'-- 0.
DUEro (OR AS A (XNJSEOUENCE OF):
SaRtwAiYy by ca«atl«n b ~
~ ~ (
DDE ro (GR As a coNSEOUENCE GP,:
~
o
I
..
M hiiretl evrb
DIAEro (OR AS A CONSEQUENCE CFX I
1aatAanO h tlrN) LAST
a
WAS AN AURJPSY WERE AU,OPSY FBVDIN('$ MANNER GF DERH DALE OF BUURY 7SAE OFINJURV IWURVRVgRK? DESCRIBE /10WINJURV OCCURRED
PERFORMEDT AWI PRIORro
.
(IA«itlL Day, Yrr)
uDMVLETIDNOPCAUSE e-„
OF DEATH? Natural j2<1 NOmIOae ^
Aaitled ^ Pana,nq Invapiprbn ^ Yr ^ NO ^
VM ^ N•~ YN ^ No ^ Subitla ^ C«Iltl ntrl be MtarmrW ^ 0. M. :~
PLACE OF INJURY -At borne
fenll
atrM
hcb
o31n LOCAT
N
,
,
,
ry,
g
(seer. CM ~ Sine)
MrMp, ate. (SVecaY1
~'~~~~~)
SIGNRURE AND TITLE OF CERTIFlER
•CERTfYE16 PMYSICIAN IPnyrarn cenYyirq terns d tleslb a1Hn aralhr pliyacien hr pr«arxKap Eaepr ra cOmpletetl Item 23) ~~/
T•IM bardlnyba•Aw.EE•.prln oeeum0«rbtlr ennalal•M rrawrrrW ..................................................... ^ /~'
7/b.
! DRE SKiNED(MOM,Dey. lbar)
'PIM)NOINN,'•q AND CERTIFYEq PHYSICIAN(Wryxian ealn ponwncinp tl•aM antl aenryin0bcaueadtlaaUQ LICENSE NUMBER
~
TO tlrbW dmy bwMbtlpa,tlrlb oceunatlr•r,Awe,dw,era plaeq aM drbtM•••••lal rtl mYmrratalW .......................... ~ 71e. QG ~Q ~( j~ G 71 tl. rI-~IZ ~ ~~ /-.
HALE AND ADDRESS OF PERSON WNO COMPLETED CAUSE OF DER
N
,
A
'MEDN:AL E)(AWI/ER/CORONER (Item 27)Typ•«Prin, ~/{Np~~ ~ ~vrw•tFr ASV
O
p
b
/C
n
w
rb M •a•ntln•,lon rtr/or Inverk•Ban. In my oplnwn. e.am 0«pmd •t nb wn•. er., rw Pres. r,a ew b u» a
ttbnnwratat•e
~
f a !7d G
~
e
~ ~~
,
.................................................................
~
^ oZD 7 ~
9=.
REGI R'S SKiNRl1RE AND NUMBER
DRE FlLED(Maeh, Day, Mar)
~
'
77. PERMANEN
°N
~.
~~ i r1 ~ ,r
v
U ~
v
s - 3 ~ - ~ 2 ~02~9916
REV-tsoo Ex+' (7-9a) t' FOR DATES OF DEATH AFTER 12/31191 CHECK HERE
INHERITANCE TAX RETURN POVERTY CREDIT IS CLAIMED ^
~. RESIDENT DECEDENT FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE 21 95 0362
DEPARTMENT OF REVENUE
DEPT. 280601 WITH REGISTER OF WILLS)
HARRISBURG, PA 17128.0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
BRI S Elizabeth C. 3400 Walnut Street
z SOCIAL SECURI NUMBER DATE OF DEATH DATE OF BIRTH ('~mr, Hlll PA 17011
167-50-9231 4 22 95 11 11 1891 co~~t C
p (IF APPLICA6lEl SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAl1 ~ SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
NA
~++ ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
Yarn (for dates of death prior to 12.13-82)
W ~rYS ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
~ ~ ° (for dates of death after 12-12-82)
a m ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
All:~`COkftESPONDENCE'AND CONFIDENTIAL"'TAX INFCfRMd ~ ; ' ,,, OULD~EaD1i~EC1rED~TO :;'~, N
y' Z NAME - COMPLETE MAILING ADDRESS
Leo E
Gribbin 138 E
Market St
t
. .
ree
v~ TELEPHONE NUMBER
PO Box 2588, York EA 17405-2588
717 854-9506 ~~=3
1. Real Estate (Schedule A)
(1) SRATR7 ~ _ 3.,5 _-- -
2. Stocks and Bonds (Schedule B) (2) 3, 860.20 ~ _'
3. Closely Held 5tocklPartnership Interest (Schedule C) (3) - 0 - I
4. Mortgages and Notes Receivable (Schedule D) (4) - (7 - =
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) - 0 - --
z (Schedule E) ,;
g b. Jointly Owned Property (Schedule F) (b) 12
6~-. ~~
~
7. Transfers (Schedule G) (Schedule L) ~
(7 ) -
c 8. Total Gross Assets (total lines 1-7) (8) 1 nFi~ ~Fi3 _ h$
ur',
°Q 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 1 n _ 743 _ f,G.
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) - ~ -
1 1. Total Deductions (total lines 9 ~ 10) (11) 10 , 743.64
12. Net Value of Estate (Line 8 minus line 11) (12) 95,620.04
13. Charitable and Governmental Bequests (Schedule J) (13) - Q -
14. Net Value Subjsa to Tax (Line 12 minus Line 13) (14) 95, 620.04
z
0
~-
i
0
c
15. Spousal Transfers (for dates of death ahsr b-30.94)
Sse Instructions for Appplicable Percentage on Reverse (15) x._= - 0 -
Side
(Includ
v
l
f
h
d
l
K
h
l
M
S
S
d
.
e
a
ues
rom
c
e
u
e
or
e
.)
c
u
e
16. Amount of Line 14 taxable at b% rate (16)
x .Ob =
- ~ -
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rate (17) 95,620.04 x .ls =
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from lines 15, 16 and 17.) (18) 14,343.01
19. Credits Spousal Poverty Credit Pr'or P ments Discount Interest
'
+ 1S
,6~~.00 + 825.00 _ 0 (t91 16,500.00
20. If Line 19 ' greater than Lins 18, enter the difference on line 20. Thi: is the OVERPAYMENT. (20) 2,156.99
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21)
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. (216)
Make Check Payable to: Re~isfer of Wills, Agent
unasr penaiTles or penury, t declare that I have examined this return, including accompanying schedules and statements, and to the best of my
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 pe
based on all information of which areoarer has env knowledas.
900 Leeward Court, York, PA 17403
f
is
DATE
/a o ~ PS'
DATE
ld' ~ 3 lF~~
REV•1502 EX+ (12.85(
`~ SCHEDUTL/E~TA
COMMONWEALTH OF PENNSYLVANIA REAL ES I /1 I E
EST
BRIGGS, Elizabeth C. ~5-q5-03Fi2
(Properly jointly-oweed with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
whkh is defined os the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled
(If more sauce is needed, insert additional sheep of same size.)
' REV-1503 ~X+ ~4.86~
A
r
., ~
N
BRIGGS, Elizabeth C. 21-95-0362
(All property jointly-owned with Riaht of Survivor:6fe .nu:f 6. die~Ine~.~ ww C.1.~.1..1~ e ~
SCHEDULE B
STOCKS AND BONDS
~•• •••-•~ ..,.....a •, nOpVOY, ~„ae,r Yvamona~ sneers of same srze.l
~ REV-1509 EX+ (7.83)
~ COMMONWEALTH OF PENN
INHERITANCE TAX RE7URNANIA SCHEDULE "F"
RESIDENT DECEDENT JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
BRIGGS Elizabeth C. 25-95-0362
Joint tenant(s):
NAME ADDRESS _ RELATIONSHIP TO DECEDENT
A. C. Patricia Rutter
B.
c.
ITEM
NUMBE LETTER
FOR
JOINT
TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
TOTAL VALUE
OF ASSET
DECD'S
9~6 INT.
DOLLAR VALUE OF
DECEDENT'S INTEREST
~' A /23/71 Checking, Mellon Bank 25,360.25 50 12,680.13
(#112-106-1764)
900 Leeward Court
York PA 17403
Niece
Jointly-owned property: -
TOTAL (Also enter on line 6, Recapitulation) I S 12,680.13
(If more space is needed insert additional sheep of same size)
REK1511 E7(+ (7.88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ITEM DESCRIPTION
NUMBER
A. Funeral Expenses:
~. Myers-Harper
B. Administrative Costs:
1. 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
4. Probate Fees
C. Miscellaneous Expenses:
~. Charlene Myers, Funeral dinner
2. Msgr. Thomas Smith, funeral services; notary
3. Pealer's, ''funeral flowers
4. Utilities, misc. expenses
5. Cropf Bros, plumbing balance
6• Patriot News, Cumberlan L.J., advertising
7. UGI, et al - furnance, garage door, trash
8• Register of Wills, debts & deductions
AMOUNT
$6,188.00
2,500.00
271.00
412.02
104.75
37.10
377.02
245.45
128.60
469.70
10.00
TOTAL (Also enter on line 9, Recapitulation) I $ 10, 743.64
Zip Code
Please Print or
LE NUMBER
21-95-0362
(If more space is needed, insert additional sheets of some size.)
REV•1513 E%+ X2.87)
~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DlCEDENT
ESTATE OF
BRIGGS, Elizabeth C.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
1. I ~
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $
(If more space is needed, insert additional sheets of same size)
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
REV-1547 EX AFP (12-95)
COMNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX
HARRISBURG, PA Inge-oeol DATE 02-05-96
lt.TAT! A!
cv.n~c yr oR1VVJ CL1LNbt11'7 ~ FILE N0.
DATE OF DEATH 04-22-95 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 TO:
LEO E GRIBBIN
138 E MARKET ST
PO BOX 2588
YORK PA 17405
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Amount Rewitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (12-951 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BRIGGS ELIZABETH C FILE N0. 21 95-0362 ACN 101 DATE 02-05-96
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
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 Z)
11. Total Deductions
12. Net Value Hof Tax Return
13. Charitable/Governmental Bequests (SeMduls J)
14. Net Value of Estate Subject to Tax
(1) 89.823.35
(2) 3.860.20
(3) .00
(4) .00
(5) .00
(6) 12.680.12
(7) .00
(s1 106, 363.68
(9) 10,743.64
(lo) .00
(12) 95, 620.04
(13) .00
ti4) 95, 620.04
NOTE: If an assessment was issued previously, lines
reflect figures that include th
t
t
l 14, 15 andior 16, 17 and 18 will
e
o
a
of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rata (151 . 00 X . 00_ . 00
16. Amount of Line 14 taxable at Lineal/Class A rats (16) .00 X .06. .00
17. Amount of Lina 14 taxable at Collateral/Class B rate (17) 95,620.04 X .15. 14,343.01
18. Principal Tax Due (181 14,343.01
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
07-07-95 AA047979 717.15 15,675.00
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT 16,392.15
BALANCE OF TAX DUE 2,049.14CR
INTEREST .00
TOTAL DUE 2,049.14CR
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A '•CREDIT^ (CR). YOU MAY BE DUE