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Home My WebLink About03-14-13 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017325 WESLER MICHELLE 209 BRADY RD NEW BLOOMFIELD, PA 17068 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold 101 $692.27 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0309 DECEDENT NAME: WESLER ANNA F + DATE OF PAYMENT: 03/14/2013 POSTMARK DATE: 0311312013 COUNTY: CUMBERLAND DATE OF DEATH: 12/17/2012 1 TOTAL AMOUNT PAID: $692.27 REMARKS: RECEIPT TO ATTY CHECK# 149 INITIALS: HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ALLEN E. HENCH LAW OFFICE, P.C. 220 MARKET STREET NEWPORT, PENNSYLVANIA 1 7074 (717) 587-3139 FAX NUMBER(717)567-3130 Allen E.Hench,Esq. Timothy N.Atherton,Esq. Adam P.Britcher,Esq. March 13,2013 Glenda Fanner Strasbaugh Cumberland County Register of Wills 1 Courthouse Square rn Room 102 Carlisle,PA 17013 w -0 m = C ;o >. r- rn r Re: Anna F.Wesler Estate Date of Birth: January 27, 1932 ' -- Date of Death: December 17,2012 , Social Security Number: 189-24-5347 r- M �_. C..,n Dear Ms. Strasbaugh: M This office represents the Estate of Anna F.Wesler and the named Executrix Michelle Wesler. Probate has not been opened and is not intended to be opened;however,we will be filing an inheritance tax return. In order to claim the three month discount on tax due,I enclose a check in the amount of$692.27. I also enclose a copy of the death certificate for your verification purposes. Please forward the receipt for this payment to my office in the enclosed self addressed envelope. If you need anything further,please let me know. Thank you very much. k i rel _.__ am . i c er APB:wmc Enclosure cc:Michelle Wesler 3-11-13W H105.805 REV 9/1 h LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to dLWI e this copy by photostat or photograph. of 'S Fee for this certificate, $6.00 1EG1S1;:R' This is to certify that the information here given it 'roi Ail OF -ectly copied f n an original Certificate'ofDeatl L -7 con I duly filed with me as Local Registrar. The 01,11CV1110t $ certificate will be forwarded to the State V"tal Records Office for permanen t filing. DEC 8 20)2 P 19134476 Certification Number Local Registrar Date I'ssued Type/Print in COMMONWEALTH OF PENNSYLVANI�', DEPARTMENT OF HEALTH VITAL RECORDS Per ca ma nennk t CERTIFICATE aF DEATH State File Number: inlet 1.Decedent's Legal Name(First,Middle,Last,Suffix) 3.Social Security Number of Death(Mo/Day/Yr)(spell Mo) T 2.Sax I Daceufl>aw 17, 2012 So.Age-Lost Birthday(Yrs) Sb.Under 1 Year I Sc.Under 1 Da 6.Date of Birth(Mo/Day/year)(Spell Month) 7a.Birthplace(City and State or Foreign Country) Months I Days I Hours I P1-x:L3LadaXPh:La. PA 80 Minutes > January 27, 1932 17b.Birthplace(County) Be.Residence(State or Foreign Country) 8b.Residence(Street and Number-Include Apt No.) Wl.d Decedent Live In a Township? 110 Griartdc�rx Way - docadentlived in. Hampden twp. Sd.Residence(County) CiLi-inbevILarid Be.Residence(Zip Cade) 17050 1 C3 No.decadent lived within limits of city/boro. 9.Ever In US Armed Forces? 110.Marital Status at Time of Death [:3 Married Wt owed 12.Surviving Spouse's Name(if wife,give name prior to first marriage) E3 Yes WNa MUnknown _I E3 Divorced ED Never Married E3 unknown 12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Lost) 'L ]F�anC:LS McIrjr:La Yanxpe]LT Wexler 14m.Informant's Name 114b.Relationship to Decedent 14c.informant's Mailing Address(Street and Number,City,State,Zip Code) 0 M:Lchft3_3_e We r.IL e ir 209 Brad�4�d . . Now BILoomfle][A. PA 17068 1_ or. . ...... y Zl;ih Hospital: ....U.6w ........... a.-n--t........... IFB� Occurred SoW;where Other Than a .... .......... "off tf Death Occurred in a Hospital:is E3 Emergency Room/Outpatiant E3 Dead on Arriv I E3 Nursing Home/Long-Term Care Facility E3 Other(Specify) 15 b.Facility Nama,(If not Institution,give street and number; ISc.City or Town,State,and Zip Code ISd.County of Death Gvana Hospice Mecheia:Lc_-sb"vA, PA Cumbe=rland 16A.Method of Disposition Gr Burial C3 cremation 16b.Date of Disposition 16c.Place of Disposition(Name of cemetery,crematory,or other place) L_J_041-61 from State [3 Donation Other(Specify) 12/19/2012 I cIae-veXt: Memorial Park 16d.Location of Disposition(City or Town,State,and Zip) 17a.Si i=tf Funeral Sarvtc Licens Parson in Charge of Interment 27b.License Number Twllwva,a a-, PA B 17c.Name and Complete Address of Funeral Facility COLDSTMNW ROGENSwRIM-0 R^P*-IAlEL.9A CNKIII.INQ 310 SECOND 28.Decedent's Education-Chock the box that best describes the 29.Decadent of Hispanic Origin-Check the 20.Decedent's Race-Check ONE OR MORE races to Indicate what #0 highest degree or level of school completed at the time of death. box that best describes whether the decedent the decadent considered himself or herself to be. E3 Sth grade or less Is Spanish/Hispanic/Latino. Check the"No,, [SkWhIto E3 Korean E3 No diploma,9th-12th grade box If decedent Is not Sponish/HispanWI-atino. 1-j Black or African American C3 Vietnamese a&High school graduate or 4SED completed EErNo,not Spanish/Hisponic/Latino E3 American Indian or Alaska Native C3 Other Asian 3 rL3 Some college credit,but no degree E3 Yes,Mexican,Mexican American,Chicano E3 Asian Indian C3 Native Hawaiian E3 Associate degree(e.g.AA,AS) E3 Yes,Puerto Rican r_3 Chinese 1:3 Guamanian or Chumarro Bachelor's degree(e.g.BA,AS,SS) [3 Yes,Cuban E3 Filipino Samoan E3 Muster's degree(e.g.MA,MS,MEnIr,MEd,MSW,MBA) C3 Yes,other Spanish/Hispanic/Latino E3 Japanese E3 Other Pacific Islander E3 Doctorate(e.g.PhO,EdD)or Professional degree (Specify) E3 Other(Specify) (e.K.MD,DOS,DVM,LLB,JD) 21.Decedent's Single Race Self-Designation-Chock ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a.Decedent's Usual Occupation-Indicate type of work W White C3 Japanese E3 Samoan done during mast of working life. 00 NOT USE RETIRED. [3 Stock a African American E3 Korean E3 Other Pacific Islander E3 American Indian or Alaska Native C3 Vietnamese E3 Don't Know/Not Sure Bookka spar (3 Asian Indian E:3 Other Asian C3 Refused 22b.Kind of Business/Industry aJr M Chinese C3 Native Hawaiian E3 Other(Specify) E3 Filipino Q Guamanian or Chamarro 1F:Lr1ELX1C e ITEMS 23M-23d MU&V BE COMPLETED 31 to Pronounce Dead(Mo/pay/Yr) 23b.Signature of Person Pronouncing Death(Only when applicable) License Number 4a Do ERTIFIES DEATH 11IC-0-1-w-en , C)L_<=>I.;;L- 23d.Date Signed(Mo/Day/Yr) Time of Death BY PERSON WHO PRONOUNCES OR C 12S.Was Medical Examiner or Coroner Contacted? Q Yes No CAUSE OF DEATH Approximate 26.Part f.Enter the chain of events-diseases,Injuries,or complications-that directly caused the death. DO NOT enter terminal events such as cardiac arrest. Interval: respiratory arrest,or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on aline. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE -----------a a. z__ (Final disease or condition Due to(or as a consequence of): resulting An death) b. Sequentially list conditions, Due to(or as a consequence of): if any,leading to the"use Isted on line a. Enter the C. UNDERLYING CAUSE Due to(or as a consequence of): (disease or Injury that : n&tiatad the events resulting a. n death)LAST. Due to(or as a consequence of): 26.Part 11. Enter other significant conditions contributing to jeath but not resulting In the underlying cause given In Part 1 27.Was an autopsy performed? C3 Yes in NO 28.Were autopsy findings available to complete the cause of death? 0 Yes C3 No 29.If Female: 30.Did Tobacco Use Contribute to Death? 31.Manner of Death ta Not pregnant within past your E3 yes E3 Probably [a Natural E3 Homicide E3 Pregnant at time of death ER No E3 Unknown E3 Accident C3 Pending Investigation C3 Not pregnant,but pregnant within 42 days of death C3 Suicide C3 Could not be determined C3 Not pregnant,but pregnant 43 days to I year before death 32.Date of Injury(Mo/Day/Yr)(Spell Month) C3 Unknown If pregnant within the post year 33.,nmo of Injury 34.Place of Injury(e.g.home;construction site;farm;school) 3S.Location of Injury(Street and Number,City,State,Zip Code) 36.Injury at Work 7.If Transportation Injury,Specify; 38.Describe How injury Occurred: C3 Yes. 11�;Driver/Operator E3 Pedestrian C3 No C3 Passenger E3 Other(Specify). 39a.Certifier(Check only one): CS Certifying physician-To the best of my knowledge,death occurred due to the cause(s)and manner stated E3 Pronouncing&Certifying physician-To the best of r9V knowledge,death occurred at the time,date,and place,and due to the cause(s)and manner stated C3 Medical Examiner/Ca f Rry(Won,and/or Investigation,In my opinion d rred at the time,date,and place,and due to the couso(s)and manner stated Signature of cartlifier._ Title of certifier-. License Number: 39b Na Addres d ZI 'Code a C n Cause oil Death(item 26) 39c.Date Signe p __12prson plating Co _9(Mo/Day/Yr) z�_,_,,,"e/- Q-492 / - 40.Rogistrov'S Distric N m bar Signature 42. g stray a Data(Mo/Doy/Yr) 43.Amendments r�p_S7 H20S-143 Disposition Permit No. REV 07/2011 i �O CD CL r O ry L_ r 0 AM I rm - • r O a. N r G7 CY) Vf r' «-= o cz cz w i c� .�... v) a' o o cn n V N 4.j rq v o cz t` l� W V ww � _, � W o `d e.00 fl Y1838Wno �' =Y 4310 U o u U �T1:1 ELF; Z W _ a