HomeMy WebLinkAbout07-19-05
21- 05- OloL/2...
Cumberland Co Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
^ TTN: Register of Wills (agent)
Rc:Estate of Mary L Ritter (mother)
July 16,2005
Enclosed is the PA Inheritance Tax Return in duplicate for the estate of my mother Mary l Ritter
completed in full with additional documentation where applicable.
A Iso enclosed is a "Death Certificate" for additional information that maybe required.
Attached is the "tax due" for the amount 01'$2,598.04 (checkIl5237) as per required calculations.
I hope this return will be inclusive but ifthere are any questions or concerns please contact me as
required.
Cordially;
(J/J~ /I- 0:f:t
Charles H Ritter (son)
21 Neponsir Lane
Camp Hill, PA 17011
(717) 731-1344 (phone and FAX)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RITTER CHARLES H
21 NEPONSIT lANE
CAMP Hill, PA 17011
lold
ESTATE INFORMATION: SSN: 208-14-9183
FILE NUMBER: 2105-0642
DECEDENT NAME: RITTER MARY l
DA TE OF PAYMENT: 07/19/2005
POSTMARK DATE: 07/18/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/13/2004
NO. CD 005592
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,598.04
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TOTAL AMOUNT PAID:
$2,598.04
REMARKS:
CHECK# 5237
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
"ili", I, 10 certify that the infnnnation here gi\cll i, correctly LOj>led irom an ()riginal ccrtificatc of death duly filed with me as
L()ul Registrar. T..he orib"inal certificate will he 1'01 warded to till' Slale Vilal Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Fcc lor this certificalc. S2.00
Local Registrar
DEe 20 2004
No.
Dale
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H105143Rev 2/87
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECOROS
CERTIFICATE OF DEATH
STATE FILE NUMBER
<T
1.
AGE (last Birthday)
SEX
2. Female
SOCIAL SECURITY NUMBER
3. 208 14
9183
NT
IK
..
COUNTY OF DEATH
79
y"
BIRTHPLACE (City and
Slale at Foreign Coontry)
7. Williamsport,P
Resid.nee 0 . g~;~ify) 0
RA.CE. American Ir'ldian, Black. lNhite. et
(Specify)
2./
Sb.
Cumberland
Be. Camp Hill
KIND OF BUSINESS / INDUSTRY
10.
White
DECEDENT'S USUAL OCCUPATION
(~~~~:~~~~~eir~)lt
11.. Housewife 110. Home
DECEDENT'S MAILING ADDRESS (Street. CityfTown, State, Zip Code) DECEDENT'S
21 Neponsit Lane ~~~~t~NCE
16. Camp Hill PA 17011 ~e:::~t~~ns
MARITAL STATUS. Married. SURVIVING SPOUSE
Never Married, 'JIAdowed. (I/wite, yi.e makJen nAme)
Divorced (Specify)
14. Widowed ".
Hc. 129 Yes, decedent lived in Lower Allen
owp
17b. Countv
Cumberland
Did
decedent
bveina
tcmnship?
11d.O ~ijhi~e:t~li~i~:of
cllylboro
DATE OF DISPOSITION
(MonIll,Olly. Year)
Dec. 17, 2004
LICENSE ay'17'8 2 - L
22b.
MOTHER'S NAME (First, Middle, Maiden Surname)
19. Theresa Tavantski
INFORMANl..'::l MAl.Lj.NG ADDRE~~ (Slreet, CltyfTown;$tate. Zip C~tU PA 17011
200. Zl NepOnSIt Lane, camp Hill,
PLACE OF DISPOSITION. Name of Cemetery, Crematory LOCATION - CityfTown, State. lip Code
or Other Place
".. Twin Hills Memorial Park
NAMIi-f'.ND ApDRESS 9f FACILITY
220. :sanders Mortuary,
LICENSE NUMBER
26.
: Approximate
. interval between
: onset and death
Olher significant cc:ndihons contributing to dA"Iln. but
not resllltrng in me underlying cause given in PART I
Duran
Ritter
To the best of my knowledge, death occurred al the time, date and plai;:e stated
(Signature and Title)
23,1.
TIME OF DEATH
24. p:Sn
OAT RONOUNCEq DEAD (Month. Day, Year)
f>M 25. . (7('emte,€;" dO,)'!
27. PART I: Erller the diseases, Injuries or compllc,rtlons which UloSed the d....... 00 not _er Ihe mode of d~il>ll, luch es ~..hac Or respiratory arr~sl, sho<:k or hurt lallure.
llslonl~...,e c:...s.on each line.
~u~,~~~..~c~~t,,~:o~1
cL~
Sequentially IIs1 conditions
if any. leading to immediale
. cause Enter UNDERLYING
CAUSE (Disease or Injury
that inlhaled events
resulting on death) LAST
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
E
DUE: TO (OR AS A CONSE~UENCE OF)
OUI!: TO (OR AS A CONSEOUENC OF)
MANNER OF DEATH
DATE OF INJURY
lMonlh,Day,Year)
TIME OF INJURY
INJURY AT \MJRK? DESCRIBE ~IOW iNJURY OCCURRED
Natural
.In
o
o
H0miclde
o
DO )Ga. :lOb. M 30c
PLACE OF INJURY. At home. farm, street, lactory. omce
burldinll. etc:. (Spec:lly)
30e.
YesD NoD
ACCident
Penning Investigation
17'1 /iJ191&1
30d.
LOCATION (Strllet, CityfTown, Stale)
YesD NO~ YesD
28a, 28b.
CERTIFIER (Chack only one)
.~~~J~F:~~tGJ~~~;~e:efJ;;,s~~:rhcg~~~m~UJ: I~ ~e;~B:~~(=r~:r:~~X~~ra~s h~ire~~~,~,~.~~~~. ~~ .~.~~~~~.d_i~e_~?3.}
NoD
Suiude
Could nol be determined
29.
'PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and certifying 10 cause of death)
To the best of my knowledge, death occurred at the time, dlte, and place, Bnd due to the CIUsel5(B) Bnd manner.. slaled.
'MEDICAL EXAMINER/CORONER
~~~~:rb::I:t::e~~~.~I.~~t.I.~~. .~~.~~~,~ ,l~~~~~~~,~~~~.~: ...~. ~~. .~~I.~~~.~: _d~~_I.~ .~.~~.~~~~. ~.t. ~~. ~~~~.'. ~a~~.'. ~.~~ .~~~.~~'. ~~ ,~~~, ~~ ,t,~~ ~~~~,~~,(,~~ ,~~,~,. 0
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REGISTRAR'S SIGNATURE AND NU
17011
34.
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