HomeMy WebLinkAbout10-27-0815056041147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 7 0 111
PO 60X.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
192 44 6302 12 16 2006 03 11 1948
Decedent's Last Name
RIPKA
Suffix Decedent's First Name
CAROL
MI
A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X 1. Original Return ~ ~ 2. Supplemental Return
4. Limited Estate 4a. Future Interest Compromise
- (date of death after 12-12-82)
X g Decedent Died Testate ~ Decedent Maintained a Living Trust
(Attach Copy of Will) ~ ~' (Attach Copy of Trust)
MI
;3. Remainder Return (date of death
prior to 12-13-82)
1 !i. Federal Estate Tax Return Required
r3. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
- between 12-31-91 and i-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
7:17 532 7388
Firm Name (If Applicable)
THOMAS L. BRIGHT, ESQUIRE
First line of address
126 EAST KING STREET
Second line of address
REGISTER OF`WIL~S USE ONtY
}
~.~
DATE:~IL~D "'
City or Post Office State ZIP Code
SHIPPENSBURG PA 17257
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct 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 nnTF
Robert Boone
O-Zo--~
2976 Little Marsh Creek Road, Howard, PA 16841
SIGNATURE OF PREPAREF~,QTHER THAN REPRESENTATIVE DATE
Thomas L. Bright, Esquire I y -~ Z3 -0 ~_
ADDRESS`~~
126 East King reet, Shippensburg, PA 17257
15056041147
15056041147 J~
~/
Side 1
15056042148
REV-1500 EX
Decedent's Social Security Number
~ecedenes rvame: Carol Ann R i p k a 1 9 2 4 4 6 3 0 2
RECAPITULATION
1. Real Estate (Schedule A) ............................................................._..................... ... 1.
2. Stocks and Bonds (Schedule B) ..............................__............................._........... .. 2.
3. Closely Held 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.
6. Jointly Owned Property (Schedule F) ~ ~ Separate Billing Requested ........... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G} ~ ~ Separate Billing Requested ........... .. 7,
8. Total Gross Assets (total Lines 1-7) ..............................................................._... .. g,
9. Funeral Expenses & Administrative Costs (Schedule H) .................................... .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .... 10.
11. Total Deductions (total Lines 9 & 10) ............................................................... .. 11.
12 Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12.
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 Line 13) ............................................
_- .. 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 0 0 0 15.
16. Amount of Line 14 taxable 0 0 0 16
at lineal rate X .045 .
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18.
19. Tax Due ............................................................................................................. .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
37,556.41
410.81
37,967.22
7,179.66
46,869.71
54,049.37
-16,082.15
-16,082.15
0.00
0.00
0.00
0.00
0.00
Side 2
15056042148 15056042148 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-07-0111
DECEDENT'S NAME
Carol Ann Ripka
_.
STREET ADDRESS -
48 Short Lane
--__
CITY - _- _----
STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
g. Prior Payments
C. Discount 0.00
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable - -- - -
p. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4.
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
(4) --- _ -
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 0.00
A. Enter the interest on the tax due.
(5A) _ _-- _ _._
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) Q . Q 0
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 :............................................................................. ', ' ', x !.
b. retain the right to designate who shall use the property transferred or its income :................................ j j x
c. retain a reversionary interest; or ........................................................................................._................. ~ x
d. receive the promise for life of either payments, benefits or care? ........................................................... ~ x
2. If death occurred after December 12, 1982, did decedent transfer property within one yesir of death without
receiving adequate consideration? ................................................................................................................ ~i x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... I x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................._............................._.................... ~ x - ~I
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 statutedoes not exemot 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)]. A
sibling 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-15011 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF - (FILE NUMBER
Ripka, Carol Ann 21-07-0111
Include the proceeds of litigation and the date the proceeds were received by the ea:tate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 F 8~ M Trust Checking Account #33-38789 1,695.70
2 F 8r M Trust Checking Account #33-38789 -credits after date of death, including 1,810.54
social security, pension, and miscellaneous credits
3 F 8~ M Trust Irrevocable Burial Account #2983405 6,130.06
Accrued interest on Item 3 through date of death 75.11
4 1993 Redman Mobile Home 20,900.00
5 2002 Ford Ranger Short Bed 6,945.00
TOTAL (Also enter on Line 5, Recapitulation) I 37,556.41
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-151t) EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF - (FILE NUMBER
Ripka, Carol Ann l 21-07-0111
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DES RI TI N F PR PERTY
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 F 8~ M Trust IRA Certificate of Deposit #0900099 - 409.84 100.000 0.00 409.84
Shannon Riedel, daughter, beneficiary
Accrued income on Item 1 through date of death 0.97 0.97
TOTAL (Also enter on Line 7, Recapitulation) ~ 410.81
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1191 EX+112-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Ripka, Carol Ann 21-07-0111
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
1,559.00
2. Attorney's Fees 1 790.00
See continuation schedule(s) attached
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
See continuation schedule(s) attached
4. Probate Fees Register of Wills, Cumberland County 98.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 232.66
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 7,179.66
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+i6-98)
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Ripka, Carol Ann 21-07-0111
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-150`1 EX+ ~6-98)
SCHEDULE H-B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ripka, Carol Ann 21-07-0111
Copyright (c) 2002 form software only The Lackner Group, Inc. 1=orm PA-1500 Schedule H-62 (Rev. 6-98)
Rev15Q2 EX+ (6-98)
SCHEDULE H-B3
FAMILY EXEMPTION
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Ripka, Carol Ann 21-07-0111
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-83 (Rev. 6-98)
Rev-150'1 EX+ (6-98)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN co nti n u e
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Ripka, Carol Ann 21-07-0111
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-87 (Rev. 6-98)
Rev-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF (FILE NUMBER
Ripka, Carol Ann 21-07-0111
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Amerigas 581.04
2 Central Credit Audit 155.20
3 Department of Public Welfare 36.595.18
4 Embarq 233.86
5 Ford Credit -repossession of 2002 Ford Ranger Short Bed 6,945.00
6 Internal Revenue Service -balance owed on 2006 federal income tax return 189.83
7 Lock Haven Hospital Extended Care Facility -balance owed at date of death 2,169.60
TOTAL (Also enter on Line 10, Recapitulation) I 46,869.71
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule f (Rev. 6-98)
REV-15'13 EX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Ripka, Carol Ann 21-07-01 11
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee s
I TAXABLE DISTRIBUTIONS (include outright spousal
. distributions, and transfers
under Sec. 9116(a)(1.2)]
Not relevant as estate is insolven
Total
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r 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-1:100 COVER SHEETI 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND TESTAMENT
OF
CAROL ANN RIPKA
I, CAROL ANN RIPKA, Social Security Number 192-44-63x2, of the Commonwealth
of Pennsylvania, declare that this is my LAST WILL AND TESTAM)_;NT and I revoke all other
wills and codicils previously made by me.
I. I appoint my brother, ROBERT BOONE as my Personal Representative concerning
this Will. If my brother, ROBERT BOONE is unable or fails to serve, I then appoint my son,
KEVIN PAUL STEM to serve as my Personal Representative.
A. I request that my Personal Representative be permitted to serve without bond or
surety thereon and without the intervention of any court, except as required by law. I direct that
my Personal Representative act in unsupervised administration so as to administer my estate with
a minimum of court supervision. If it becomes necessary to have ancillary administration of my
estate in any jurisdiction where my Personal Representative is unable ar does not desire to
qualify as ancillary legal representative, Iappoint as such ancillary legal representative such
individual or corporation as my Personal Representative shall designatf;, in writing.
B. I direct my Personal Representative to pay the expenses of my last illness, the
expenses of a funeral appropriate to my station in life and custom of living (including a suitable
monument or marker for my grave), and written charitable pledges which I have made. I grant
my Personal Representative the power to extend or renew any debt for such time as my Personal
Representative shall deem appropriate.
C. All estate, inheritance,- succession and other death taxes with respect to all property
passing under this my Will shall be paid from and borne by the principal of my residuary estate,
without regard to reimbursement, as if such taxes were administration e:xpenses. My Personal
Representative may pay such taxes at any time deemed advisable, whether or not then due and
payable.
D. My Personal Representative is requested to settle my estate as soon after my death as
may be practicable, and to pay or deliver every legacy or bequest to my beneficiaries without
waiting any time that may be believed to be customary in probate matte;rs.
Last Will and Testament of CAROL RIPKA
Page 1 ~~ ~~
E. I may leave a letter of intent with the executed copy of this Will for the purpose of
giving guidance to my Personal Representative concerning the distribution or sale of certain
items of my property. I request, but do not require, that my Personal Representative honor my
wishes therein expressed.
II. I give, devise and bequeath, absolutely and. forever, all of my e:state and property of
which I may be seized or possessed, or to which I may be entitled, at the time of my death,
wherever situated or of whatever nature, be it real, personal, or mixed, 'to my son, KEVIN PAUL
STEM as his sole and absolute property if he shall survive me.
III. In the event that the above named individual shall not survive me, I give, devise and
bequeath, absolutely and forever, all of my estate and property of which I may be seized or
possessed, or to which I may be entitled, at the time of my death, wherever situated or of
whatever nature, be it real, personal, or mixed, to my friend, RUBY JoANN iJRICH as her sole
and absolute property if she shall survive me.
IV. In the event that no previously named beneficiary shall survive me, I give, devise and
bequeath, absolutely and forever, all of my estate and property of which I may be seized or
possessed, or to which I may be entitled, at the time of my death, wherever situated or of
whatever nature, be it real, personal, or mixed, to my son, KENNETH I~EROY STEM, my
daughter, LISA LOUISE HEPNER, and my daughter, SHANNON LYNN REIDEL, in shares of
substantially equal value to be divided as they may agree.
A. If any of the persons named above in this paragraph shall not survive me, then the
share of that deceased person shall go to the descendants of that person„ who are to take per
stirpes and not per capita. If any of the persons named above in this paragraph shall not survive
me and shall not be survived by any descendants, then the share of that deceased person shall be
distributed to those persons named above in this paragraph who survive me and the descendants
of any of the persons named above in this paragraph who fail to survive. me, in the manner set
forth above.
B. If they are unable to agree, the division among the persons named above in this
paragraph and the descendants of any of those persons named above in this paragraph who fail to
survive me shall be made by my Personal Representative, in that person's sole and absolute
discretion. I empower my Personal Representative to sell any or all of such property, if such
property is not distributed in kind hereunder, and to distribute the proceeds among the
beneficiaries under this paragraph in substantially equal shares. Any determination of my
Personal Representative as to what should pass or be sold under this paragraph and to whom it
should pass or be delivered or at what price it should be sold shall be conclusive.
V. Except as otherwise provided in this Will, I have intentionally railed to provide for any
other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have
failed to provide in this Will for any of my issue now living or later born or adopted, such failure
is intentional and not occasioned by accident or mistake.
Last Will and Testament of CAROL RIPKA
Page 2 ~,1 ~r~ /
VI. Any beneficiary who fails to survive until One Hundred and Twenty (120) hours after
my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be
disposed of accordingly.
VII. Definitions: A. The term "per stirpes" as used in this Will means that whenever
a distribution is to be made to the descendants of any person, the property to be distributed shall
be divided into as many shares as there are (1) living children of the pearson, and (2) deceased
children, who left descendants who are then living, of the person. Each living child (if any) shall
take one share and the share of each deceased child shall be divided among his then living
descendants in the same manner.
B. The term "Personal Representative" as used in this Will shall have the same meaning
as Executor, Executrix, Independent Executor, or any other title of like import which is used to
describe such a fiduciary.
VIII. In addition to any powers granted by the laws of the jurisdiction in which this Will is
probated, I hereby authorize and empower the fiduciaries named in this Will, to the extent of the
discretion herein granted, to sell, exchange, convey, transfer, assign, mortgage, pledge, lease or
rent the whole or any part of my real or personal estate, to invest, reinvest, or retain investments
of my estate, to perform all acts and to execute all documents which my fiduciaries may deem
necessary or proper in regard to my property. If any of my fiduciaries elect to receive
compensation for services, such compensation will be that allowed by aaw.
IX. If any part of this Will shall be invalid, illegal, or inoperative for any reason, it is my
intention that the remaining parts, so far as possible and reasonable, shall be effective and fully
operative. My Personal Representative may seek and obtain court instructions for the purpose of
carrying out as nearly as may be possible the intention of this Will as shown by the terms hereof,
including any terms held invalid, illegal, or inoperative.
IN WITNESS WHEREOF, I have at CARL~seE, ~E,uNsrwn-.IrA ,
on 9 ~),w~/~RY ~ ,set my hand and seal to this my LAST WII.L
AND TESTAMENT, consisting of L typewritten pages, each page bearing my handwritten
signature.
CAROL ANN
The foregoing instrument was, at CAKc~st.~, ~~NNSyw,~u(,~ , on
Last Will and Testament of CAROL RIPKA
Page 3 ~ -1~G--
~~~
j ,~~AaY 2orU ,signed, sealed, published and declared by CAROL ANN RIPKA, the
testator, to be her LAST WII.L AND TESTAMENT in the presence of all of us at one time, and
at the same time we, at her request and in her presence and in the presence of each other, have
hereunto subscribed our names as attesting witnesses, and we do so verily believe that the said
testator is of sound and disposing mind and memory at the date hereof.
~~r<.y I --~y~ P~ ~1T.~n~~ ~• ~~ Cc~i`lE~ ~ d~'~J ~z ~C-
Soc`,.S~Iec.No. `~-"
of i~ ~ ~~
Soc.Sec.No. --' Soc.Sec.No
r--
of ~Ci of ~~~~~~OP
Last Will and Testament of CAROL RIPKA
Page 4
WITH THE ARMED FORCES OF THE UNITED STATES
IN Carlisle, Pennsylvania
ACKNOWLEDGMENT
I, CAROL ANN RIPKA, testator, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my
free and voluntary a or the purposes therein expressed.
(SEAL)
CAROL ANN RIPKA
AFFIDAVIT
We, ~~~~ ~ I ~.5~ ~_ , ~ v~c~ ~ ~. }~. C~ ,and
~~bc`J~ ~~rz~E ,the witnesses, sign our names to this instrument, being duly
q auau lified according to law, do depose and say that we were present anti saw the testator sign and
execute the instrument as her Last Will; that the testator signed willingly and executed it as her
free and voluntary act for the purposes therein expressed; that each subscribing witness in the
hearing and sight of the testator signed the will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
~~
' I S W SS WITNE S
Subscribed, sworn to and acknowledged before me by CAROL ANN RIPKA, the testator, who is known to me
to be eligible for Legal Assistance under the provisions of 10 USC section 1044a
or regulations of the Department of Defense, and subscribedd and sworn to bjef~o~re me by
r' t~ ,~Ck t, ~ p d~tg~~' ~ ~'~~~ and
/~ '~~~ L%~ T~~ ,the witnesses, on q ~ tau 2D~d .. This acknowledgment is executed in
my official capacity under the authority granted by Title 10, United States Code, Section 1044a, which also states
that no seal is required on this acknowledgment.
(Print) V!/~ C . (~Oa~E',~~2r~l~L
RANK/COMPONENT: L.TC I~SanK
OFFICIAL CAPACITY: ~SS1StA~~ TR7tQNEY
Last Will and Testament of CAROL RIPKA
Page 5
~~~ ~ ~~
www.fmtrustou~flu~.com
Date of Death Valuations
Customer Name: Carol A Ripka
Date of Death: 12/1s/os
~~1
Acct T e Account Number O en Date Close Date Balance Accrued Int Total Balance Account Owners
checkin 33-38789 11/14/1997 still o en $ 1,695.00 $ - $ 1,695.00 Carol A Ri ka, Individual!
CD 000-0900099 03!08/1999 still o en $ 409.84 $ 0.97 $ 410.81 Carol A Ri ka, IRA F&A4 Trust Custodian
CD 014-2983405 03/03/2006 02/05/2007 $ 6,130.06 $ 75.11 $ 6,205.17 Carol A Ripka, Irrevocable Burial Acct
717-264-6116 888-264-6116 P.O. Box 6010 Chambersburg, PA
FINANCIAL SOLUTIONS... FROM PEOPLE YOU KNOW
17201-6010
GEORGE L. E,BENER & ASSOCIATES
]ZEALTORS
MULTIPLE
LISTING
Resideni:ial, Commercial & Farms SERNCE
Appraisals Sales Rentals ~~~'
REALTOR®
430 East King Street, Shippensburg, PA 17257
(717) 532-13530 (717) 532-3430
September 14, 2007
Mr. Kevin Stem
48 Short Lane
Shippensburg, PA 17257
RE: Property Appraisals
Dear Kevin:
At your request by phone to our office, I met with you to evaluate the Market Value of the properties at 48
Short Lane and 25 Firehouse Road, Shippensburg, PA 17257.
Market Value is defined as "the most probable price which a property should bring in a competitive and
open market under all conditions requisite to a fair sale, the Buyer and Seller each acting prudently and
knowledgeably and assuming the price is not affected by undue stimulus".
The value shown has been arrived at after careful study of the location, type of improvements, their
physical condition and their present use. Therefore, I believe it to reflect a, true measure of the Market
Value as of September 14, 2007.
Value Reported:
48 Short Lane - Doublewide mobile on rented lot.
Range: $19,900.00 - $21,900.00
25 Firehouse Road - 2 story dwelling
Range: $124,900.00 -129,900.00
I hereby certify that I have no financial interest present or contemplated, in these properties and that
neither the employment to make the appraisal nor the compensation there from is contingent upon the
value reported.
These properties were appraised as a whole, subject to the Contingent and Limiting Conditions outlined
herein.
Submitted by,
J ~~~~~~~
Charles L. Wenger
Broker/Partner
Pa. Certification # BH-001849-L
Kelley Blue Book -Private Party Pricing Report -Ford, Ranger
.--_--•
Page 1 of 3
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ZIP Code 16841
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~~~~ ~~~~
Vehicle Details
Engine: 4-Cyl. 2.3 Liter
Transmission: Automatic
Drivetrain: 2WD
Mileage: 50,000
Selected Standard Equipment
Power Steering
AM/FM Stereo
Fair
__ __
Value
$7,495
$6,945
(Selected)
$6,240
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-------------w----•
Blue Book Private Party Value
Private Party Value is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumE=_s the vehicle is sold
"As Is" and caries no warranty (other than the continuing factory warranty).
The final sale price may vary depending oil the vehicle's actual condition and
local market conditions. This value may also be used to derive Fair Market
Value for insurance and vehicle donation purposes.
Vehicle Condition Ratings Check \/ehicle Title History
//www.kbb. com/kbb/Selection/Conditi
a
8/3/06
THE TR4°~TE[t ItfSpL1~CE.
a I5(~ill1~I ~ , ~ '~, _
~. --
x
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
July 30, 2007
MANCHESTER & ASSOCIATES
SUSANNAH J WERKHEISER PARALEGAL
124 WEST BISHOP STREET
BELLEFONTE PA 16823
Re: CAROL RIPKA
CIS #: 230175241
SSN: 192-44-6302
Date of Death: 12/16/2006
Dear Ms. Werkheiser:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $36,595.18 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible tc reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $12,175.57, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, alnd Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $24,419.61, is
to be entered as a priority Class ~ claim against the estate.
S~
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
Barbara I. Aschenbr~>nner
TPL Program Investigator
717-772-6617
717-772-6553 FAX
Enclosure
~~~ d`~~~
v-r cc. i-~.., v-.. ~~,., ., -_ _ __.
B017143 f 17257 IRS USE ONLY WI 0 0
` For assistance, call:
_ 1-800-829-0922
Depamnent of the Treasury
Internal Re~~enue Ser~~ice Your Caller ID: 747576
Andover, MA 05501-0025 Notice Number: CP49
®CT ~ ~ 2Q~S Date: October 6, 2008
Taxpayer Identification Number:
192-44-6302
084535.542947.0319.007 1 AB 0.351 690 Tax Form' 1040
~~~~~~~~~~~~~l~l'~'~'1"'~"'~l"l~"'~'1'~~~~~~~~I~'I~~~~~~~I Tax Year: December 31, 2006
CAROL A RIPKA DECD
ROBERT BOONE EXEC
126 E KING ST
SHIPPENSBURG PA 17257-1326268
084535
Overpaid Tax Applied to Other Taxes You Owe
We applied $120.42 of the overpaid tax on your 2006 tax return to the unpaid balance of other federal
taxes which our records show you owe.
You may still be due a refund if we applied only part of your overpayment to other taxes. You also may
be due a refund if you recently made a payment against the other taxes that we had not credited when we
applied your overpayment. In either case, you will receive a check for any refund due you as long as the
amount is greater than one dollar. You must request a refund of less than one dollar. If you have any
questions, please callus at the number listed above.
The figures below show our calculation:
How We Applied Your Overpayment
Amount of Overpaid Tax on Your Return
Amount of Interest You Earned on Overpayment
Total Amount Due You
Total Amount Applied
Amount You Will Receive as a Refund
(any interest due you will be added)
Where We Applied Your Overpayment
Form(s) Tax Period(s) Amount(s) Applied
1040 December 31, 2005 $120.42
$120.42
$.00
$120.42
$120.42
$.00
Balance Remaining
$189.83
The following information may pertain to you if you are currently married or were previously married.
Did we use your refund to pay for income taxes that you and a former (or current) spouse owe? If you file
a claim, you may be eligible to receive relief from having to pay your former (or current) spouse's income
tax debt. A successful claim for relief could change the tax you have to pay. You may not owe anything
at all. You could receive your refund or other payments back.
Page 1
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