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Home My WebLink About10-15-08 z 4. Limited Estate „_°:'= 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) `:!.'z 6. Decedent Died Testate (Attach Copy of Will) ~ :::: 7. Decedent Maintained a Livin Trust (Attach Copy of Trust) 9 8. Total Number of Safe Deposit Boxes .,~~.,, 9. Litigation Proceeds Received >,,,,,,,w 10. Spousal Poverty Credit (date of death ~ `;`~~; 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Susan M. Brown • (717) 763-9022 E . Firm Name (If Applicable) _ _ n `=' ~, cx7 REGISTER... S USE O~ _ . pouse s Social Secunty Number - -- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - - - REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ?a:°g 1. Original Return Cµ_ "~ 2. Supplemental Return 3. Remainder Retum (date of death prior to 12-13 82 J 15056051058 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox 28oso1 INHERITANCE TAX RETURN - - Harrisburg, PA 17128-osol RESIDENT DECEDENT ~ ~ 0 ~ Q ~ -7Jr- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death __. Date of Birth '.204-03-3105 01/16/2008 ' 03/11/1913 Decedent's Last Name Suffix Decedent's First Name MI Lipovsky Annette R, (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name ___ S _ __ Suffix Spouse's First Name MI First line of address 18 Campbell Place. Second line of address __ City or Post Office Camp Hill _ r 8 C'ta~w,,~h e 1 1 Plta,~ , •' a Nf 1 1 PA ~? o r I SIGNATURE OF PREPARER OTHER THAN REPRESENra ivF Correspondent's a-mail address: none Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, wrrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS ~/M1 I ~ 0 ~ ~~/o~ ~ p ADDRESS 1> DATE FILED i.1T State ZIP Code _ Q3 PA 17011 ': - , ~ . ~ -r-~ i~ -~.. n ~--,~ -^i . r- ~• _ t n _ ;~~ U, J ~-,,-, ' > -~ ; ~~ ~-- ' -- ._.. . -I N ,; .. ' DATE PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number _ Annette R Li y Decedent's Name POVSiC , .._._„_..,,,,,~.~_~,_..._. __ 204-03-3105 __ ~„_.,.~.µ,_.__,_.__ RECAPITULATION ---"-"--.. ..-",,,,,, ,,,,,,,_.., 1. Real estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. i 102,495.64 3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. ' ... ~~_ 375,577.52 6. Jointly Owned Property (Schedule F) -';M~= Separate Billing Requested ..... .. 6. 69,906.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property - - - (Schedule G) ~'"'"""" Separate Billing Requested...... .. 7. 8 Total Gross Assets (total Lines 1-7)....... . .......................... ,.,.H .. s. .m„~ -.~._ 547,979.16: ..m. __ _ 9. Funeral Expenses &Administrative Costs (Schedule H) ................... . 9. ,.... ~.,.. _ . 15,229.72" 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 581.65 11. Total Deductions (total Lines 9 8 10) ................................. .. 11. 15,811.37 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 532 167.79 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which , - " - an election to tax has not been made (Schedule J) ....................... . 13.! 14. _,.,,_ Net Value Subject to Tax (Line 12 minus Lrne 13) ...................... ._.__._,.,.__,~,.,,..,_,,,.... ~,_....__._..,_ _,,,~..,...,,,.._...___.~ ..,_w_,,,_ .µ__,,., .. . 14. 532,167.79 . ._._~,......,...~._.___.,,_ ..,.,~..,_ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES .~._.., _ ~.... ~ M~,__ ""°" 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ _ _ _ _ - __ (a)(1.2) X .0._ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 532,167.79 16. 23, 947.56 17. Amount of Line 14 taxable - -. at sibling rate X .12 17. 18. Amount of Line 14 taxable _ __. at collateral rate X .15 18 19. TAX DUE ........................................................ . 19. ' 23,947.56 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~ 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Annette R Lipovsky 204-03-3105 STREET ADDRESS 18 Campbell Place CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 23,947.56 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 25,000.00 C. Discount 1,197.38 Total Credits (A + e + C) (2) 26,197.38 3. Interest/Penalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 2,249.82 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No 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 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" or payable upon death bank account or security at his or her de th? ^ ^ a .............. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. n f~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 {a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)], The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)J. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE B STOCKS & BONDS CJIAIE OF Annette R. Lipovsky FILE NUMBER All property Jointly-owned with right of survlvershln muse tie ,~i.~i,..ea .,., e..~..~..~_ ~....._. _ _r,...,..,, ~ ~......a.., ~~ ~~~~ ~ a~~~~~~~.o. snaeis or me same s¢e) i ESTATE OF ANNETTE LIPOVSKY D.O.D. 01/16/2008 SCHEDULE B -STOCKS MEAN PRICE SHARES AT D.O.D. DESCRIPTION AMOUNT 252 $38.55 Bank of America -common stock $9 714 60 296 52.96 PPL Corporation -common stock , . 202 31.74 Vanguard Wellington Fund -mutual fund 15,676.16 283 17.58 Delaware Balanced Fund AClass -mutual fund 6,411.48 8403.87 7.82 Federated Fund for U.S. Government Securities -mutual fund 4,975.14 65,718.26 TOTAL $102,495.64 Bank of America ~ Investor Relations ~ Historical Price Lookup Banko#an~fica "'' Overview ~~„~ Historical Price Lookup Stock information Shock Chart Hisl~orica! Price Lookup Investment Calculator feinandal Relassss Services for Shareholders DfvMana History Mnual Reports SEC Flliryp Csll Reports Sacuritlzatlon Lwesbor Ract Book Webcasb Page 1 of 1 Home Locations • Contact Us • i Symbol BAC (Common Stock) Lookup Date January ~ 16 ~ 2008 •~~ Results Date Requested 01/16/08 Closing Pr1ce $38.69 Volume 46,459,400 Split Adjustment Factor 1:1 Open $37.68 Day's High $39.41 Day's Low $37.68 p~ NOTE: The Closing Prke, Day's High, Day's Low, and Day`s Volume have been acqusted to account splRs and/or dividends which may have occurred for this security since the date shown above The p~~.~y~ . not adjusEed for splits or dtvklends. The Spilt Adjustment Fscbor is a cumulative factor which encaF spNts since the date shown above. Earnings Estimates . The dosing prk:e above Is not necessarily indicatNe of future pHoe performance Fwfdamentab . Ownership Summary Copyright ®2007 MarketWatch~ Inc. All rights reserved, please see our Terms of Use. MarketWatch, the MsrketWatch k-go, and BigCharts are registered trademarks of Marketwatch In E=mai1 Alerts , c intraday data delayed 15 minutes for Nasdaq, and 20 minutes for other exchanges, All quotes are exchange time. Antl-Matey Vng Intraday data provided by , a dh-isbn of Interactive Data Corp. end sutrject to terms of u Newsroom Historkal, current end-~-day data, and sptKs data provkkd by Fi" Int?racttve Data. Home Privacy 8c Security . i Careers .Site Map . OMtart~ww~rT Bank of America, N.A. Member FDIC. Eoual Housing pnd r fl us,ae~ ® 2007 Bank of Amerka Corporation. All rights reserved. PPL Corporatbn TVMO MOllh Wlr~til .~ ANe11i0w11, PA 18101-1179 Date March 28, 2008 Re: PPL Stock Account Type of Stock: PPL Corporation Common Stock CUSIP: 69351T-10-6 Account Number: 3osoi635oo Social Security Number: 204-03-3105 Account Registration: Annette R. Lipovsky Date of Death: January 16, 2008 _ Number of Sharea Cunrintly Held: 14s In Certificate Form 14s In Direct Registration In Dividend Reinvestment Plan 296 TOTAL SHARES Number of Shares Hs/d as of Date of Dead>r: 148 In Certficate Form 14s In Direct Registra5on In Dividend Reinvestment Pian ~~ 296 TOTAL SHARES ,: ;s2.96 Closing market price of Common Stock on New York Stodk Exchange on date of death or last business day prior to date of death. Other Comments: PPL Corporation ~. ~ . Investor Servkes, ~..: ~,~: a V Cynthia A. Buchman ~ , ~ ~ ~ •sa -~~~ w.-- a~~, ~~ ~ ,~~ ~ to Investor Services toll Free Number 800-345.3085 I Page > 1 of 1 V+angu81K1" Annette R Lipovsky *; "''' ~., 18 Campbell PI Giant Services: 800-682-2739 Camp HiA, PA 17011-2530 ' Total report value: 58,411.48 (Total report value hxdudes any socrued dtvidends.j ~~,. Anne~4t. Lipovalry, "ii'rillvidu~t A,c~ouri ,,'~ ,~, '' ~ ,,t ,i~~ ~-' r _. _ , -. y ~. ~. ,,.at. _ .:- Fiarne ~ :Fund &Acxount ~ Date ~~{{~~.,~~ Prtce (:'er ._ ~ .. _~.._.` _~~^.~~ IMetingbn Fund h1v 0021-051561200f21 08122/1991 202000 =31.74.. :6.411.48 - - -, ~ ToQals • . ; S8„ A11:48 ~ Stl.Otl' ' DoeenY indude aocnied rfniderds. 004827343 05/13/200818:22:54 Delaware Investments° A member of Lincoln tinanaa/Group March 11, 2008 Susan Lipovsky-Brown 18 Campbell Place Camp Hill, PA 17011-2530 Re: Delaware Balanced Fund A Class #2-5020272760 Annette R. Lipovsky 00290402 250-MAINT Dear Ms. Lipovsky-Brown: zoos tNa~lcet ssa Philadelphia. PA 19103-709 We are writing as afollow-up to your recent conversation with one of our Service Center representatives outlining the procedures far transfer upon death for an individual account. We are happy to provide you with this information. In order to transfer or liquidate this account, we ask that you provide the following documentation: * • A certified copy of the court document evidencing the appointment of the Executor of the Estate. This document should ! be dated within 90 days of our receipt and be affixed with the raised court seal. • A letter from the Executor requesting the transferor liquidation containing tbefr signature accompanied by a Medallion STAMP' (Securities Transfer Agents Medallion Program) signature guarantee. Medallion 'STAMP' signature guarantees are used across the imesiment industry to protect shareholder accounts from any unauthorized activity. You can obtain a Medallion STAMP' signature guararaee from a ban~E or brokerage firm .where you maintain an account We are unable to accept a notarized signature in place of the signature guarantee, as notarization dues not provide the legal protection mired to conrplele this type of request • If the account is to be liquidated, the letter should indicate how the check should be made payable and the. mailing address. i , • The enclosed lYew Account Registration Form must be completed to tra~~sfer this account to a new(registration. We ~~ ~, have also enclosed a Business Reply envelope for your convenience. ~ . Additionally, we are happy to provide you with the Fund's Net Asset Value inform~ttion for January 16, 2008, as requ6sted. On that date, the Net Asset Value on the Delaware Balanced Fund A Class was $17.58. 1f you have any questions or require assistance please contact our Service Center at I-800-523-1918. Our.representati~es are available between 8:00 a.m. and 7:00 p.m. Eastern Time, Monday through Friday. Sincerely, Mike Greco Client Service Representative Enclosure(s): New Account Registration Form Business Reply Envelope ..........1..1-..«...-..,..-......-...e ....... Federated Shareholder Services Company Pittsburgh, ptnnsylvu~ia NrwYork. NrwYarl: Dublin. itrlancl Fedrruedlnvestorc.com March 18, 2008 ~;derated CG~oRtu-Cil-ss Ir~vgsrn~~rr Mnnncett Susan Lipovsky Brown 18 Campbell Place Camp I~Ill PA 17011-2530 Reference: 00209445 Federated Fund for U.S. Government Securities Annette R Lipovsky Dear Ms. Lipovsky Brown: Thank you for contacting Federated; it is a pleasure to provide the information you requested in your telephone call on March 7, 2008. The share price or Net Asset Value (NAV) of the Federated Fund for U.S. Government Securities, Fund number 337, is provided in the table below: F1and Number Net Asset Value A Dilate 337 57.82 U16PLOOS Please call us if you have questions. Client Service Representatives are available to help.you from 8:00 a.m. to 6:00 p.m., Eastern time. The number is 1-800-245-4770. sintxxely, .l rl~~~ ': . J~ovacs Communications Specialist <; • REV-1508 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY wiAle yr Annette R. Lipovsky FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with rioht of survivershie moat hs dlar~..a.d .,., e.~...a..~_ .__._ _,.__,, ,,,,,,,,,,, „~„ ,,,~~„~~„~ ,,,CCiy or cne same size) ESTATE OF ANNETTE LIPOVSKY D.O.D. 01/16/2008 SCHEDULE E -CASH IN BANKS 8~ MISCELLANEOUS PERSONAL PROPERTY CASH IN BANKS NAME DESCRIPTION AMOUNT Integrity Bank Certificate of Deposit - A/C # 4004690 $ 62,327.42 Certificate of Deposit - A/C # 4004885 31,693.88 Citizen's Bank of Pennsylvania Certificate of Deposit - A/C # 6251427192 51,585.36 Certificate ofDeposit - A/C # 6249835003 13,467.79 Susquehanna Bank PA Certificate of Deposit - A/C # 333188310 3,561.18 Certificate of Deposit - A/C # 403300004419 83,862.08 Graystone Bank Certificate of Deposit - A/C # 3000004929 33,061.68 Certificate of Deposit - A/C # 3000034763 54,264.96 Pennsylvania State Bank Certificate of Deposit - A/C # 9150013983 41,074.76 M & T Bank Checking Account 11.41 TOTAL $ 374,910.52 MISCELLANEOUS PERSONAL PROPERTY Federal income Tax Refund Form 1040 for the year 2007 $ 1,530.00 Less -Amount Paid with Extension (1,000.00) Net Refund 530.00 Pennsylvania Income Tax Refund Form PA-40 for the year 2007 137.00 TOTAL $ 667.00 TOTAL SCHEDULE E $ 375,577.52 Integrity B A N K Mazch 10, 2008 Annette R Lipovsky CD 4004690 and 4004885 As requested, the balances as of January '16, 2008 on the Certificates of Deposits listed above aze as follows: #4004690 $62,327.42 d f~, #4004885 $31,693.88 G ~'~ • Both CD's aze in Annette R Lipovsky name only. • Sincerely andy Po VPBranch Manager 717-920-3500 3445 Marlret.Strort. Came Nill.. PA 17011 • Phnne: 717-920-4900.877-I-HAVEIT • Fay 717-920-4904 • www. intevritvbunkonlinecom 1 • ~' ~ F1~ J/J/ ~ J t Citizens Bank° Account Number Account Title Date Opened Account Type Principal Balance as of DOD Interest from Last Posting to Account Balance as of DOD YTD Interest to DOD 6251427192 ANNETTE R LIPOVSKY 5/4/2007 Time Deposits $51479.18 _ _ _ - - - $i86:~ 8---- _ - $51585.36 O ~C $219.91 F Citizens Bank° Account Number 6249835003 Account Title Date ed ANNETTE R LII'OVSKY 6/2/2006 Account T Time sits Princi Balance as of DOD $13439 24 Interest from Last Po to DOD . $28.55 Account Balance as of DOD $13467.79 O YTD Interest to DOD $57.17 Susquehanna April 16, 2008 Susan M Lipovsky Brown 18 Campbell Place Camp Hill, PA 17011 Susquehanna Bank PA 28 North Ceder Street P.O. Box 1000 Lititz, PA 19543-7000 Toll free 800.311.3182 RE: Annette R. Lipovsky Estate ~~ SS#: 204-03-3105 DOD: January 16, 2008 To Whom It May Concern: In response to your letter of March 15, 2008, here is the above customer account information as of January 16, 2008. Account #1 Account #2 • Account Title: Annette R Lipovsky Annette R Lipovsky • Account Type/# Certificate of Deposit Certificate of Deposit /333188310 /403300004419 • Date Opened /Maturity Date: 8/ 1 /06 - 8/ 1 /08 11 / 1 /07 - 9/ 1 /09 • Interest Rate: 4.89% 5.08% -, ~, • Account Balance*: $3,554.05 ~ ~~ $83,687.85 ~ , r~~ • Accrued Interest: $7.13 =..~~~~ ~ ~ $174.23 rb~ L~ ~E • YTD Interest: $15.85 $362.88 *Account balance does not include accrued interest. There is no safe deposit box in the name of this decedent. ' If I can be of further assistance, please feel free to call. Sincerely, xe~ anet M. Peters Support Services Supervisor 1-717-625-6295 JMP/SFRA . Print Page 1 of 1 Certlflcate 3000004929 - ANNE7TE R LIPOVSKY Rel [Ol] ANNETI'E R LIPOVSKY p 18 CAMPBELL PL CAMP HILL PA 17011. Tax Name: [ij ANNETTE R LIPOVSKY Presentments No Presentments for Account Currant Cyc% Description Balance Forward: NEW ACCOUNT DEPOSIT Interest Interest Interest interest Interest Interest Interest Interest Interest Interest _ Interest Interest-' Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Interest Balance This Statement: ~AYSTONE - =- BANK- The Home of Crew RewardsrsM 112 Market Street SANA KHOURI Harrisburg, PA 17101 Branch Sales Ma er ~ Phone: 717-724-2284 Cell: 717-805-2456 skhouriC~graystonebank.com Fax;:717-236-0982 Debits Credits Date Balance ]an 12, 2006 $0.00 $30,000.00 Jan 12, 2006 $30,000.00 $118.48 Feb 11, 2006 $30,118.48 $107.44 Mar 11, 2006 _ $30,225.92 $119.37 April, 2006 $30,345.29 $115.98 May 11, 2006 $30,461.27 $120.30 Jun 11, 2006 $30,581.57 $116.88 Jul 11, 2006 $30,698.45 $121.24 Aug 11, 2006 $30,819.69 $121.72 Sep 11, 2006 $30,941.41 $118.26 Oct 11, 2006 $31,059.67 $122.66 Nov li, 2006 $31,182.33 $119.18 Dec 11, 2006 $31,301.51 $123.62 Jan li, 2007 $31,425.13 ' $124.11 Feb 11, 2007 $31,549.24 $124.11 Mar il, 2007 $31,673.35 $137.95 Apr li, 2007 $31,811.30 $134.08 May ii, 2007' $31,945.38 $139.13 Jun il, 2007 $32,084.51 $135.23 Jul 11, 2007 $32,219.74 $140.33 Aug 11, 2007 ~ $32,360.07 $140.94 Sep 11, 2007 $32,501.01 $136.99 Oct 11, 2007 $32,638.00 $142.15 Nov 11, 2047 $32,780.15 $138.16 Dec 11, 2007 $32,918.31 $143.37 Jan 11, 2008 $33,061.68 $143.99 Feb 11, 2008 $33,205.67 $135.29 Mar li, 2008 $33,340.96 $145.21 Apr 11, 2008 $33,486.17 $141.14 May li, 2008 $33,627.31 $146.46 Jun li, 2008 $33,773.77 $142.35 Jul 11, 2008 $33,916.12 $147.71. Aug 11, 2008 $34,063.83 Aug 24, 2008 $34,063.83 . Print Page 1 of 1 - Cert/f/cate 3000034763 - ANNETTE R LIPOVSKY Rei [Ol] ANNETTE R LIPOVSKY p 18 CAMPBELL PL ~AYSTONE CAMP HILL PA 17011 - BANK- The Home of Great Rewards!'" Additional Relationships Tax Name: [iJ ANNETTE R LIPOVSKY 112 Market Street SANA KHOURI Harrisburg, PA 17101 Presentments Branch Sales Manager Phone: 7 ] 7-724-2284 Cell: 717-805-2456 No Presentments for Account skhouri@graystonebank.com Fax:717-236-0982 Currant Cycle DescMption Debits Credits Date Balance Balance Forward: Feb 08, 2007 $0.00 NEW ACCOUNT DEPOSIT $51,782.58 Feb 08, 2007 $51,782.58 Interest $203.70 Mar 07, 2007 $51,986.28 Interest $226.42 Apr 07, 2007 "~ $52,212.70 Interest $220.07 May 07, 2007 $52,432.77 Interest $228.36 Jun 07, 2007 $52,661.13 Interest $221.96 lul 07, 2007 $52,883.09 Interest $230.32 Aug 07, 2007 $53,113.41 Interest $231.32 Sep 07, 2007 $53,344.73 Interest $224.84 Oct 07, 2007 $53,569.57 Interest $233.31 Nov 07, 2007 $53,802.88 Interest $226.77 Dec 07, 2007 $54,029.65 Interest $235.31 ]an 07, 20b8 $54,264.96 Interest $236.34 Feb 07, 2008 $54,501.30 Interest $222.05 Mar 07, 2008 $54,723.35 Interest $238.34 Apr 07, 2008 $54,961.69 Interest $231.65 May 07, 2008 $55,193.34 Interest $240.38 Jun 07, 2008 $55,433.72 Interest $233.64 ]ui 07, 2008 $55,667.36 Interest $242.45 Aug 07, 2408. ~ $55,909.81 Balance This Statement: Aug 24, 2008 $55,909.81 O 0 V _~ V _~ LL Z ~" ~~ ~~ ~3 ~~2 ~a`~ IL W m r V O > 1-Y ~ ~~a ~~ i m aaa r- ~s V E •. ~ ~ ~~ ~ ~~ W ~ V W 1~" D o ~ D O a~o 0 1 1 1 J ~ ~ ~ ~ C f ' Q ,~ ,~ E O ~ ~ D a ` ~ d pp~~ ~ ili r .a Q ~ ~ a ~ ? ~+ ~ Z ~' .t ~ C ~~ s ~ r~~ rD D L~L 7• i N O ~ W -~, ui w REV-1509 EX+ (rrg8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY wlAlt ur Annette R. Lipovsky If an asset was made Joint within one year of the decedent's date of death, It must be report SURVIVING JOINT TENANT(S) NAME ADDRESS A. Susan M. Brown 18 Campbell Place, Camp Hill, Wormleysburg, PA 17011 B. C. JOINTLY-OWNED PROPERTY: FILE NUMBER on Schedule G. RELATIONSHIP TO DECEDENT Daughter LETTER DATE DES R ITEM NUMBER FOR JOINT TENANT MADE JOINT C IPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH % OF DECD'S DATE OF DEATH ~ A IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST VALUE OF DECEDENTS INTEREST ~ . 03102!79 Personal Residence -18 Campbell Place, Camp Hill, Wormleysburg PA , t7ntt 0 139,812.00 50 69,906.00 (Wormleysburg assessed Value X 1.22) ($114,600 X 1.22 = $139,812) _ TOTAL (Also enter on line 6, Recapitulation) I S 69,906.00 (If more space Is needed, Insert additional sheets of the same size) 40: Sobel 2/22/79 ~ E01AAtiON1vEALThI OF PENNSYLVANIA = ' ' ~o DE PARTNENT OF REVFNUE = • _ RFvOR0F0.OFFICE Of THE e. REALTY RFOOflDER Rf DfEOd 45FER ~ 0 n^ 4 5 ~ . N '^X MARZ•'79 . CWIAEALAkO COUkTY PEXkSYLVAkM o P.4u162 .~ BAR 1 it zr AH'T9 ' DEED sr THIS INDENTURS made the I day of /yA2~k. ,• in the year of our Lord one thousand nine hundred seventy- ' nine (1979), Between LONG MEADOWS JOINT VENTURE, a partner- ship, as Grantor, and ANNETTE R. LIPOVSICY and SUSAN M. BROWN, ' as joint tenants with right of survivorahi p, and not as tenants in common, of Camp Nill, Pennsylvania, Grantees, WITNESSETA: ' That the said Grantor for and in consideration of the sum of Forty-five Thousand Dollars (545,000.00) lawful money of the Onited States of America, unto it well and truly paid by the ~ ; I said Grantees at and before the sealing and delivery of these presents, the receipt .whereof is hereby acknowledged, has granted, bargained, sold, aliened, enfeoffed, released and I ~ confirmed, and by these presents does grant, bargain, sell, ~ alien, enfeoff, release and confirm unto them and unto their '~ ~ i ~~ heirs and assigns forever. ~ ALL THAT CERTAIN Unit designated as Number 18, being 'a ~ Unit in Lonq Meadows Townehouses, a Condominium, located in the j Borough of Wormleysburg, Cumberland County,.Pennsylvania, under the Declaration of Condominium as recorded in the office of the Recorder of Deeds, in and for the County of Cumberland, in ~ Miscellaneous Baok 229, Page 142, and designated in the Decla- ~ ration Plans as recorded in the said office in Plan Book 30, '~ Page 85, • TOGETHER with all right, titlE: and interest, being a 5.555$ interest, of, in and to the Common Elements as more ~//1 Iowq- of !,~~~ _~~~~~„'-.'~- `•F'LA~ ~ • Cwnb. Co., •Pa. ~~ Seiwol Dist• Comb. Ce„ Pa. .JX Ro.l 6»b Yr,n.l.. T.. JLX R.d Est.'Y ire„slo, Tu xs ,.•, Aal st,~,.-~. ,. N ~i~-~._ [~~. ~ 6Q0~ 8 PAGE 78~, ' Cwnk Cs. Ditf. Col. Mt. d C"^!`. Ca oif. Col. AFL Iff'+ S ' ~ 10/15/2008 2:30:39 PM CUMBERLAND COUNTY Inst.# 197900726 -Page 1 of 5 • FacetWin Screen Print for pub1ic04, from "CAMA Login" 10/15/2008 2:11:15 PM CUMBERLAND COUNTY ASSESSMENT OFFICE 2004 BASEYEAR NEIGHBORHOOD: 4722 CONTROL # 47000596 DISTRICT: 47 - WORMLEYSBURG BORO SD: 9 PARCEL: 47-19-1590-064.-U--18 SPEC ID: 3000 LOT: 106A-U03.-018. Short Name LIPOVSKY, ANNETTE R ~ Tback: 47-19-1590-064. LAST NAME LIPOVSKY -~ FIRST NAME : ANNETTE R PROPERTY TYPE: R , ~ ~C/0 NAME & SUSAN M HROWN i 18 CAMPBELL PLACE ~ SALES IADDRESS2 ~ ~ DEED BK/PG.....0028H-00781 POST OFFICE: CAMP HILL ~ ~ DATE OF SALE...03/02/1979 ~3TATE & ZIP: PA 17011 i i SELLING PRICE: 45000 Situs: 18 CAMPBELL PLACE Pro Descri P p.: LONG MEADOWS TOFINEHOUSES Ij -CURRENT VALUES -~ CONDO Assess d LAND DESC: 5.555$ OF COMMON INTEREST e Fair Market I FMV - 114600 LAND USE TYPE: 107 L - 0 DEEDED ACRES: .00 C&G - B - 114600 ~ approved? -> T _ 114600 Screen 1 Enter Selection > Record: 57403 Number -Switch Screens X -Exit J , , -Jump Mode, F -Forma, I -Image Down Arrow -Next Entry, Up Arrow -Previous Entr ? y, -Screens, B -Browse , REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Annette R. Lipovsky SCNED~ILE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Myers Harner Funeral Home -funeral service 8,293.00 2 J. E. Gibbons Memorial Company, Williamsport, PA -headstone 1,200.00 3 West Shore Country Club -funeral luncheon 651.12 a Genetti Hotel, Williamsport, PA -lodging for executrix near burial site 69.60 5 Wildwood Cemetary, Williamsport, PS -grave opening 650.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) SUSan M. BrOWn Social Security Number(s)/EIN Number of Personal Representative(s) street Address 18 Campbell Place _ City Camp Hill .State PA 17011 Zip Year(s) Commission Paid: N/A -waived 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) claimant Susan M. Brown street Address 18 Campbell Place City Camp Hill state PA .Zip 17011 Relationship of Claimant to Decedent daughter 4. Probate Fees 5. Accrountant's Fees 6. Tax Return Preparer's Fees 7. County Filing Fee & Certificates t3 Stock Transfer Fees s Executrix Travel 0.00 0.00 3,500.00 418.00 0.00 0.00 35.00 25.00 388.00 _ TOTAL (Also enter on line 9 Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 15,229.72 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Annette R. Lipovsky Report debts incurted by the decedent prior to death which remained unpaid as of thn dap ~f ~o~rti :,,,.~~~a~..,..,.....~_~..__~ __~~__~ ____ __ ----- -~--_ ._ ........ ,,,`„ a.,~~~~~~a~ ai roew ui me same size) ~ No m~c~ie m X70 n ~ ~ ~ nW~ ~ ~ o:~ ~ 0 , f0 Xv~ O id 'O .~ C/1 N 'pwNN a rt acw'v 1D _ ' y ~ lv o c ~~~ o> c'> to ~ < °a ==i d _ ~ a ~ ~~o LO 7 ~ fH~ C O N ~N o ~ n (p 1 N ~' ~ A ~ W a ° c w o ~ c7 n C '~~ O G C7 t7 l7 ~~y~~~~~ r~ -• -• A ''-c~•n~ c c ~3 „3 /~ ~ -. 1 M % > > ~ ~ m v d~=ddd13~' n a~d~~`m~°~D3 ID N N ...~ ny~ ~ H~ N: "~ N ~C~ X y O~ 7 A ~' n: n- - ; ~ S~: '~1.T1 f7; C p _: SOT: ~ ~! f") p' : C') ,g ~„~ : " TTWi M. 0 .0•. ~ "C A fAN: fApy: pAW' ~' ; Wv'~: N n VA: N W~i N OI N O E v • W V N A O1JNO) W V VOI~O]CT A W W N N U C~ ~ o- S• dp wars .J ~ w w , `~ V" O O A A ~~am ama__ n In -e ~p~'yc)O ~ ~aD c~-+am 23-f0 i.I"' ~i N O n aOV.~ ~ ~ a~ ~Dm ~ y li' I' ~ o"i c ~' X~-• m co e7 x3 ° ~'''' ff ifli _ _ _ ~Wm ~ ~ ~ 3 W~ I' I f f a~A.~ CT vl "pWNM O A Mm r~mfA ~ cww Eo ' a~ ~ m~e v~cd ~ ~ 6' c D~~ ~ S` D~r3 ~ ~~ a N !Q d IV ~ ~ (~ ~ of ~ M ~ h ~ ~ a W ~~ O O ~ ~ <a' ~ e ~ W ai O ~ G ~ ~ A "' m ~ 10 ED ~ n c o n "' n a a s a o d ,v ~ •Y N O N tT 7=C 107 m ~ ~~N= ~ y' C d ~ N C C ~ ~ O ~ ~ M ~ ~ M ~ ~ (C(''~~l m O d°~a ~ s=x~~~m o~~ y`~ -3 m c7y~~~9 a ~ co N N 1D ~ M Q3 N 1D t0 .'~' ~. ~ 7 '•G O ~ D toil y'' d O O 7 fa N : ~ Cl ~ ~ ~~ O G! „Oj ~C~ CV71' ~ 0~.~7 ~ O~.y ~ i~71 ~~~ ~ C AMC ~ In = N M _' ~E ~ O°.~ g ~_~ • y • ~ W t?~ O • '.~ ~. A N ~: ~ N ~ w i9 A is {y lr W n f"\ O O W~ NN NN V ~ OV V-+ NA N O W W ~ W W W W 0 0 GTNN10 OWW ~~ ~ gyp. m~ s A° ~ ~ ~ ~ co: N b` r Q a A N~ ., ~ l!"' G W ~ (~ ~ ~\; Q W m W;~^ Q O O a V O REV-1513 EX+ (g-p0) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SC1~1EDt~LE J BENEFICIARIES ESTATE OF Annette R. Lipovsky NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY i TAXABLE DISTRIBUTIONS [nclude outright spousal distributions, and transfers Sec. 9116 (a) (1.2)] 1 Susan M. Brown, 18 Campbell Place, Camp Hill, PA 17011 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter FILE NUMBER AMOUNT OR SHARE OF ESTATE 532,167.79 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) + ~r hJ n ~,> L~0 m "r) "ti~Cl OF T~ `~ r ~. _J~ -. ~~' C!% j~ l:~ ANNETTE R. LIPOVSRY `~-:c~~_, -~, :.~ -~-, - {` ~ w I, ANNETTE R. LIPOVSRY, of 18 Campbell Place', Camp' Hill, Cumberland County, Pennsylvania, being of full age and of sound mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills by me heretofore made. FIRST: I direct that all my just debts and funeral expenses be paid out of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath all the property that I own, real, personal and mixed, to my daughter, Susan M. Brown, if she survives me. In the event that my daughter, Susan M. Brown, does not survive me, I give, devise and bequeath all the property, real, personal and mixed, that I own to my grandson, William Rhoads Brown. THIRD: In the event that both my daughter, Susan M. Brown, and my grandson, William Rhoads Brown, predecease me, I give and bequeath all the property, real, personal and mixed, that I own to the Trinity Lutheran Church of Camp Hill, Pennsylvania. FOURTH: I make, nominate and appoint my daughter, Susan M. Brown, to be the Executrix of this my Last Will and Testament, and direct that no bond shall be required of her. In the event she i, r can not serve, I make, nominate and appoint my grandson, William Rhoads Brown to be the Executor of this my Last Will and Testament, and direct that no bond shall be required of him. IN WITNESS WHEREOF, I, ANNETTE R. LIPOVSRY, the testatrix above named, have hereunto subscribed my name and affixed my seal this ~_ day of August, 1992. (SEAL) An ette R. Lip vs • r ,~ Signed, sealed, published and declared by the above named Annette R. Lipovsky as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto in the presence of the said testatrix and of each other. ~~~ i ') ~I (Nam { . ,. ,stn _._. ]c ~ ,r-~~,R( -1~,~ e1 ~4 (Address) ~ • Q~ ~-,~-~ler Roo. (Name) (Address) 7 ~ M 1 COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF FAYETTE We, Annette R. Lipovsky and, L.a.uc-~ ~.. U' ~o~.:~ r`1 and C-c~nn-e Fc~ IoW , the Testatrix and 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 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 the Will as witness and that to the best of their knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. e trix~ ~ ~~~ Wit s .~ - Witn s ,~-~ Subs gibed, sworn to and acknowledged before me by ~~"-~- ~ ~ th Testatrix, and subscribed and sworn to before me by _ Laur-e ~o~n and_ ~n__n-~ ~~roW witnesses, this ~_ day of August, 1992. ~~C"i~ 1'1 K e i d tit Notary Public ` `' Neta;;~i Seal East Tom. A~btary F'~rbNC ~ co~mas~«,~ , ~a~01~a ~~~