HomeMy WebLinkAbout03-20-09J 1505607120
REV-7 500
EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes county toes rear File Number
INHERITANCE TAX RETURN
Po eox.2eosol
Harrisburg, PA 17128-0601 21 0 8 10 3 0
RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
09 23 2008 03 16 1920
Decedent's Last Name Suffix Decedent's First Name MI
ROSSECOPF MAVIS A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRWTE OVALS BELOW
1. Original Retum
4. Limited Estate
g, Decetlera Died Testate
(Attach Copy of Wilg
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Retum
qa, Future Interest Compromise ^
(date of tlaeth after 12-12A2)
T Decedent Meintametl a Living Tmst D
(Attach Copy of Tiust)
1D. ~ ^P2overN C~k'date~af tleetn
Name
JENNIFER B. HIPP
Finn Name (If Applieable)
BOGAR AND AIPP LAW OFFICES
First line of address
1 WEST MAIN STREET
Second line of address
City or Post Office
SHIREMANSTOWN
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examin
it is true, correct and complete. Declaration of preparer
Central Boulevard, Camp Hill, PA 17011
State LP Code
PA 17011
Steven H.
Jennifer B. Hipp
1 West Main Street, Shiremanstown, PA 17011
Side 1
1505607120
3. Remainder Retum (oats o(tleath
priof to 12-13-82)
5. Federal Estate Tax Retum Required
6. Total Number of Safe Deposit Boxes
11.Election to taz under Sec. 9113(A)
(Adach SU. O)
Daytime TeteplmDte Number N
717 73'~~761
T ~~ ate;
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REGISTER t~.~~ USE 10DILY
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DATE FILED
le best of my knowledge and belief,
preparer has any knowledge.
DATE
.~~ 1~'D9
DATE
~-I ~-oy
1505607120 ~ ,~i
1505607220
REV-1500 EX
oecaeenr: Nama~ Mavis A. Rosskopf
RECAPITULATION
Decedent's Social Security Number
2010
1. Real Estate (Schedule A) ...................................................................................... .... 1.
2. Stocks and Bonds (Schedule B) ........................................................................... .... 2. 9, 9 8 9. 8 8
3. Closely Held Corporation, Partnership or Sole-Propdetorship (Schedule C)...... .... 3.
4. Mortgages 8 Notes Receivable (Schedule D) ....................................................... ... 4.
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............. ... 5. 2 , 3 5 3 . 0 3
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ........... .. 6. 4 6 , 3 0 4 . 5 9
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ........... .. 7, 2 1 8, 9 3 2. 9 2
8. Total Gross Assets (total Lines t-7) ..................................................................... .. 8. 2 7 7, 5 8 0. 4 2
9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... .. 9. 12 , 6 5 6 . 5 3
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. .. 10. $ 3 . S 7
11. Total Deductions (total Lines 9 8 10) .................................................................... .. 11. 12 , 7 1 0 . 1 0
12. Net Value of Estate (Line 6 minus Line 11) ........................................................... .. 12. 2 6 4 , 8 7 0 . 3 2
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................ . 13.
14. Net Value Subjeet to Tax (Line 12 minus Line 13) . .............................................. .. 14. 2 6 4 , $ 7 0 . 3 2
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.z> x .o0 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x .045 2 6 4, 8 7 0. 3 2 16. 11
919.16
17. Amount of Line 14 taxable ,
at sibling rate X .12 0. 0 0 17~ 0
0 0
18. Amount of Line 14 taxable .
at cellateral rate X .15 0. 0 0 16. 0. 0 0
19. Tax Due ....................................................................... .............................................. 19. 1 1 , 919.16
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
L aide 2
155607220
155607220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-7030
DECEDENT'S NAME
Mavis A. Rosskopf
STREET ADDRESS
824 Lisburn Road
CITY
Camp Hill STATE ZIP
PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments (1) 1 1 , 91 9.16
A. Spousal Poverty Credit
e. Prior Payments 11,014.6$
C. Discount 579.72
3. InteresUPenalryifapplicable Total Credits (A+g+C) (2) 11,594.37
p, Interest
E. Penalty
Total InteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT
.
Check box on Page 2 Line 20 to request a refund (4)
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE
. (5) 324.79
A. Enter the interest on the tax due.
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(56) 324.79
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 Vansfer and: Yes No
a. retain the use or income of the property Vansferred :..................................................
................................ x
b. retain the right to designate who shall use the property transferred or its inwme :....................................
x
c. retain a reversionary interest: or ..................................................................................................................
d. receive the promise for life of either a x
P yments, benefits or care? .............................................................. x
2. If death occurred after December 12, 1962, did decedent transfer property within one year of death without
receiving adequate consideration? ....................... ^ ^
...............................................................................................
3. Did decedent own an "in trust fof or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................... ~ ^
...........................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ror 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 tloes not ezemot a transfer to a surviving spouse from tax, and the statutory requirements
for disGosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
Far 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 defnetl under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rav159a E%~ (6-98)
SCHEDULE B
STOCKS & BONDS
COMFION/IEALTH OF pENNSYLVANN
ttJHERRPNCE TPX RETURN
RE61~ENr OECEOFM
ESTATE OF FILE NUMBER
Rosskopf, Mavis A. 21-08 1030
NI proparryjolntlyowneE vAM tl9ht ofsurWVOnhip nwst M tlieel96stl on Sehetlub F.
ITEM CUSIP
NUMBER NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE
OF DEATH
1 U.S. Savings Bonds - 43 Series E U.S. Savings Bonds - 9,989.88
Total Price - 31,812.50; Total Interest Earned -
38,377.38; Total Value - 59,989.88 -See Attached
Treasury Direct Savings Bond Calculator Results
TOTAL (Also enter on Line 2, Recapitulation) I 9 989 88
(If more space is needeq atltlitional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Farm PA-1500 Schedule 8 (Rev. 6-98)
Calculated Value of Your Paper Savings Bond(s)
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 09/2008
Page 1 of 2
Total Price Total Value Total Interest YTD Interest
1 612.50 9 989.88 8 377.38
179.24
Bonds: 1-43 of 43
http://www.treasurydirect.gov/BC/SBCPrice 3/10/2009
Calculated Value of Your Paper Savings Bond(s)
Page 2 of 2
Notes
NI :Not Issued
.NE dNot_eligible.forpayment _
PS Includes 3 month interest penalty _
MA :Matured and not earnin interest
http://www.treasurydirect.gov/BC/SBCPrice 3/10/2009
R.v-esoe Fx. ls-sa(
CONM]NWEALTH OF PENNSVLVAN W
AVHERRANCE TA%RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Rosskopf, Mavis A. 21-08-1030
All pmpery jotrMYOwnatl rAM lhs right olsuMVanhlp neat tq dlaoloeed on aehadule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1 Mid Penn Bank -Monthly interest payment
34.82
2 Personal Property -Sold at private sale
400.00
3 Comcast -Refund
5 82
4 Highmark -Premium Refund
192.59
5 The Woods at Cedar Run -Rent refund
1,720.00
TOTAL (Also enter on Line 5, Recapitulation) I 2 353 03
(It more space is neetle4 atlditional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rrv-1609 E%. (Bde)
SCHEDULE F
LOIAMONWFALTX OF PEIJNSTLVANW JOINTLY-OWNED PROPERTY
INNERRANCE TAX RENRN
RESIpENT DELEOENT
ESTATE OF
Mavis A.
Men rset vies
ywr nl Ola
ADDRESS
SURVIVING JOINT TENANT(S) NAME
A: Steven
B.
C.
JOINTLY OWNED PROPERTY:
25 Central Boulevart
Camp Hill, PA 17011
(FILE NUMBER
21-08-1030
II must bs mpoMd on eehadule G.
RELATIONSHIP TO DECEDENT
Son
ITEM
NUMBER LETTER
FOR JOIN
TENANT DATE
T MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
ALUE OF ASS e
~a OF
DECD'S
INTEREST
DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1 A 11/8/1999 Commerce Bank -Checking Account No. 3,305.68 50.000% 1
852
83
513144543; date of death balance ,
.
$3,305.68
2 A 7/23/2008 Mid Penn Bank -Certificate of Deposit 38,900.37 50.000% 19
450
19
No. 314000033 -date of death balance ,
.
$38836.29; accrued interest $264.08; total
date of death balance $38900.37. This
was arenewal/rollover from an existing
jointly owned certificate of deposit.
3 A 12/12/2003 PNC Bank -Certificate of Deposit No. 47,384.13 50.000% 23,692.07
11020093089; date of death balance
$46,703.97; accrued interest $680.16
4 A 1/5/2000 Vanguard -Money Market Fund Account 3,019.00 50.000% 1
509
50
No. 0030-09938529893; date of death ,
.
value $3,014.78; accrued interest $4.22
TOTAL (Also enter on Line 6, Recapitulation) I 46,304.59
(If more space is needed, adtlitional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn Pq-1500 Schedule F (Rev. 6-98)
October 17, 2008
James D. Bogar Attorney at Law
Attn: Jennifer B. Hipp
1 W. Main St.
Shiremanstown, PA 17011
RE: Estate of: Mavis A. Rosskopf
Tax Identification Number: 471-18-2010
Date of Death: September 23, 2008
To Whom It May Concern:
Commerce
Bank
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following:
Account Type: Checking
Account Number: 513144543
Date Opened: 11/06/1999
Primary Owner: Mavis A. Rosskopf
Secondary Owner: Steven H. Rosskopf -Right of Survivorship
Date of Death Balance: $3305.66
Please feel free to contact me at (717) 412-6127 if I may be of further assistance.
Sincere) ,
Gam'
Diana Reynolds
Commerce Bank
Research Associate/Deposit Services
Commerce Bank /Harrisburg, N.A.
PO Box 4999
3801 Paxton Street
Harrisburg, PA 17111-pggg
commercepc.com
December 19, 2008
* Revised
James D Bogaz
Attorney at Law
One West Main Street
Shirer.:aistown, PA 17011
Re: Estate of Mavis A Rosskopf
Date of Death: September 23, 2008
SSN: 470-18-2010
Deaz Ms. Hipp
In response to you letter requesting information on the accounts of Mavis A
Rosskopf, I have accumulated the necessary data below:
Account #: 1207259002 -IRA
Account Name: Mavis A Rosskopf
Date Opened: 03/14/08
Date Closed: 10/17/08
Balance DOD: $16140.37
Balance Accrued Interest DOD: $14.60
Total DOD Balance: $16154.97
Joint Ownership Name: NA
Date Joint Ownership Established: NA
Account #: 314000033 -Certificate of Deposit
Account Name: Mavis A Rosskopf
Date Opened: 7/23/08
Maturity Date: 9/23/09
Balance DOD: $38636.29
Balance Accrued Interest DOD: $264.08
Total DOD Balance: $38900.37
Joint Ownership Name: Steven H Roskopf
Date Joint Ownership Established: Always joint
Corporate Headquarters: 349 Union Street, Mi]IersburbePAD17061
g (717) 692-2133 • www.midpennbank.com
I apologize for any inconvenience the first letter may have caused. If you have any
further questions, please call me at 717-692-7161
S' cerely,~
~~'~
ennifer LaSalle
Deposit Processing Representative
~F~VC
LEADIN6TNHNtdY
December 24, 2008
Jennifer B FFipp
C/0 James D Boger Esq.
One West Main St
~ib'emanstowa, PA 1'7011
RE: Mavis A Rosskopf
SSN: 470-18-2010
DOD; 09-23-2008
Dcar Mz. Boger.
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
CerdGmte otDepos&
Account # 11020093089
Established: 12.12-2003
MAVIS A ROSSKOPP
DOD balance: $ 46,703,97 + 680.16 SSKOPF
Interest paid Ol-Ol-20D8 thru 09-23-2008 S 902.50 YTD
Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Cheoking end
Savings). We do not protean any Lnancia! tr'enaactions or provide statements. If you need assistance with
any of these items, please call 1-888 PNC-BANK (1-888-762-2265) or stop by Your ]ceel PNC Bank branch
office.
Sincerely,
National Financial Services Center ~
PNC Bank, N.A. ~ j
Member FDIC I
i
I
Page I of 1.
Vainguard®
October 29, 2008
JENNIFER B HIPP
JAMES D BOGAR ESQ
1 W MAIN ST
SHIREMANSTOWN PA 17011
Estate of Mavis A. Rosskopf
Dear Ms. Hipp:
P.O. BOx 2600
Valley Forge, PA 19482-2600
www.vanguard.com
We are responding to the letter we received notifying us of the death of Mavis A.
Rosskopf, and requesting a valuation of her Vanguard account on September 23,
2008. First, please convey our condolences to the family for their loss. The
information requested is included on the enclosed account value reports.
If you have any questions, please call us at 800-662-2739. You can reach us on
business days from 8 a.m. to 10 p.m. and on Saturdays from 9 a.m. to 4 p.m.,
Eastern time.
Sincerely,
~~ ~.~r
Andrea Walker
Registered Representative
Enclosure(s): **Mavis A. Rosskopf --ACCOUNT VALUE REPORT
51086294
Mavis A. Rosskopf &
Steven H. Rosskopf
Jt Ten W ROS
824 Lisburn Rd
Camp Hill, PA 17011-7102
PrimeMoney Mkt Fund
~ '~" Page > 1 of 1
Vd11 ,gi1d7C~~
:Repo oi'08/Z320tiS;~ pp,~ P4~''~.~,°*~a,~r -, r:-,
iuz.... ~ «.1ta,.,5> ++~Yax.£Yka. Cc,~a L.dwsx ..a,,.a$sr.',`gu ~+sF~rv'''r
Voyager Services: 800-284-7245
Total report value: $3,019.00
(Total report value includes any accrued dividentls.)
.;Number Opeperl 'Shares Sfiarec ,value' Accrued -:
0030 09938829693 07/05/2000 3 014 780 .° ~ dividends::
$1 00 $3,014.78 ~ $4.22
0296968238 10/24/2008 10:23:53
Rev-1610 E%t (e-9a)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
LOMNpNKEPLTI OF PENNS1tVhNN
INHERRANCE TAX RETURN
RESmENT DECEDENT
ESTATE OF
Rosskopf, Mavis A.
LE NUMBER
21-08-1030
Th6 schetlule must be compleletl antl filetl R Me ansvier to any M questions i tHOUgh 4 on Iha reverse sqa of tha REV-1500 COVER SHEET is yes.
NUMBER I INCLUDE NAME OF TRANSFEREE, TNEIR RELATIONSHIP TO DECEDENTAND DATE OF DEATH %OF DECD'S E%CLUSION TAXABLE
THE DATE OF TRANSFER. ATTACHACOPV OF THE DEED FOR REAL ESTATE. VALUE OFASSET INTEREST (IFAPPLICABLE) VALUE
Mid Penn Bank -IRA Account No. 1207259002
date of death balance $18,140.37; accrued
interest $74.50; total date of death balance
$16154.97.
Susquehanna Bank-IRA CD No. 4800672930;
date of death balance $196,343.17; accrued
interest $8,434.78
16,154.97 I I 15,154.97
202,777.951 1 ~ 202,777.95
TOTAL (Also enter on Line 7, Recapitulation)
218.932.92
(If more space is neede4 atlditlonal pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule G (Rev. 6-98)
+~+ x..,~
N" • ! i°
MID I~ENN BIANK
Making things happen for you.
December 19, 2008
* Revised
James D Bogaz
Attorney at Law
One West Main Street
Shizvn<a;,~own, PA 17011
Re: Estate of Mavis A Rosskopf
Date of Death: September 23, 2008
SSN: 470-18-2010
Deaz Ms. Hipp
In response to you letter requesting information on the accounts of Mavis A
Rosskopf, I have accumulated the necessary data below:
Account #: 1207259002 -IRA
Account Name: Mavis A Rosskopf
Date Opened: 03/14/08
Date Closed: 10/17/08
Balance DOD: $16140.37
Balance Accrued Ynterest DOD: $14.60
Total DOD Balance: $16154.97
Joint Ownership Name: NA
Date Joint Ownership Established: NA
Account #: 314000033 -Certificate of Deposit
Account Name: Mavis A Rosskopf
Date Opened: 7/23/08
Maturity Date: 9/23/09
Balance DOD: $38636.29
Balance Accrued Interest DOD: $264.08
Total DOD Balance: $38900.37
Joint Ownership Name: Steven H Roskopf
Date Joint Ownership Established: Always joint
Corporate Headquarters: 349 Union Street, MillersburbePAD17061
g (717) 692-2133 • www.midpennbank.com
I apologize for any inconvenience the first letter may have caused. If you have any
further questions, please call me at 717-692-7161
S' cerely„ ( ,7t~
C~~`~/~~
ennifer LaSalle
Deposit Processing Representative
Susquehanna
October 24, 2008
Jennifer B. Hipp, Esquire
One West Main Street
Shiremanstown, PA 17011
RE: Mavis A. Rosskopf Estate
SS#:: 470-18-2010
DOD: September 23, 2008
To Whom It May Concern:
Susquehanna Bank
26 North Cedar Street
P.O. Box 1000
Lititz, PA 17543-7000
Toll free 800.311.3182
In response to your letter of October 15, 2008, here is the above customer account information as
of September 23, 2008.
• Account Title:
• Account Type/#
Account #1
Mavis A. Rosskopf
IRA CD/4800672930
• Date Opened /Maturity Date: 9/23/03 / 9/23/09
• Interest Rate: 5.15%
• Account Balance*: 196,343.17
• Accrued Interest: .00
• YTD Interest: 6,434.78
*Account balance does not include accrued interest.
Beneficiary for the IRA is Steven H. Rosskopf, 100%.
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,
et M. Peters
~~ ~'
Support Services Supervisor
1-717-625-6295
JMP/Ijr
REV-7161 Ex+(12-88)
CDMMONN/EALTH OF PENNSYLVANIA
INHERITANCE TAx RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ESTATE OF FILE NUMBER
Rosskopf, Mavis A. 21 08 1030
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES. I
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
Ciry State
-_ Zlp.
Year(s) Commission paid
2. Attorney's Fees Bogar and Hipp Law Offices
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4,055.12
6,765.00
4. Probate Fees
322.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 1,514.41
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 12,656.53
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Rosskopf, Mavis A. 21-08-1030
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Musselman Funeral Home 3,280.00
2 St. Paul Pioneer Press -Obituary 523.60
3 The Patriot News -Obituary 271.52
H-A Subtotal 4,055.12
Other Administrative Costs
4 Register of Wilis -Short Certificates 8 00
5 RESERVES: -Costs to conclude Estate, including filing Pennsylvania Inheritance 1,500.00
Tax Retum and Inventory, Personal Income Tax Retums and Fiduciary Income Tax
Retums
8 U.S. Postal Service -Certified Mail to Treasury Retail Services re transfer of bonds 5.41
H-e7 Subtotal 1,514.41
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rsv-f612IX~ (8-88)
SCHEDULE i
DEBTS OF DECEDENT,
CDM4IDNN£ALTH OF RENNSYLVANN MORTGAGE LIABILITIES, & LIENS
INHERRPNDE TAX RENRN
RESIDEIfr DECEDENT
ESTATE OF FILE NUMBER
Rosskopf, Mavis A. 21-08-1030
lulutla unnNmbunW msdlnl sa0ansr.
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
REV-0573IX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSVIVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Rosskopf, Mavis A. 21-08-1030
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOU
]f
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
0o Noe u.e Truahs(s (Words)
under See. 9116(a)(1.2)]
Steven H. Rosskopf Son One Hundred
25 Central Boulevard percent of rest
Camp Hill, PA 17011 ,
residue and
remainder
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropria te, on Rev 1500 cover sheet
II~ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION T O TAX IS NO
BEING MADE T
CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
T OF ESTATE
($$$)
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0 OO
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND TESTAMENT
OF
NA\TIS A. ROSSICOPF
I, MAVIS A. ROSSKOPF, of Camp Hill, Cumberland County,
Pennsylvania, make, publish and declare this as and for my Last
Will and Testament, hereby revoking all other Wills and Codicils
heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, to my son, STEVEN
H. ROSSKOPF.
SECOND: Should my son, STEVEN H. ROSSKOPF, predecease
me, I devise and bequeath all the rest, residue and remainder of
my estate of whatever nature and wherever situate, including any
property over which I hold power of attorney and together with
any insurance policies thereon, to CHRIST PRESBYTERIAN CHURCH, of
421 Deerfield Road, Camp Hill, Pennsylvania 17011, to be used for
general purposes, as the governing body of said church deems
appropriate.
THIRD: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
tc pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
~ extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
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FOURTH: I direct that all inheritance, estate, trans-
fer, succession and death taxes, of any kind whatsoever, which
may be payable by reason of my death, whether or not with respect
to property passing under this Will, shall be paid out of the
principal of my residuary estate.
FIFTH: I nominate and appoint my son, STEVEN H.
ROSSKOPF, Executor of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any
reason whatsoever of the said STEVEN H. ROSSKOPF, I nominate and
appoint my friend, JOYCE A. BROWN, of 27 Central Boulevard, Camp
Hill, Pennsylvania 17011, Executrix of this, my Last Wi11 and
Testament. I direct that my Executor or Executrix, as the case
may be, and their successors, shall not be required to post
security or a bond for the performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set mrypp''hand and
seal to this, my Last Will and Testament, this ~`~ ==Clay of
~L(iY~! - 2 0 0 7 .
~ ~
U l" /./`sit ~.ceJ ~ ~ ~+-I ~~AL )
MAVIS A. ROSSKOPF
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Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
Address
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