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HomeMy WebLinkAbout04-0738 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 I'~ARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004559 KELLEY PAULETTE 245 EAST POMFRET STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $2,164.76 ESTATE INFORMATION: SSN: 174-05-1983 FILE NUMBER: 21 04-0738 DECEDENT NAME: LIPPERT GERTRUDE P DATE OF PAYMENT: 10/28/2004 POSTMARK DATE: 10/28/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/02/2004 TOTAL AMOUNT PAID: $2,164.76 REIVIARKS' CHECK//102 INITIALS: MW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 I oo~o..~_*j~#.rOoV~¢~..,,~ INHERITANCE TAX RETURN ~,~. ~o, RESIDENT DECEDENT 2~ 04 00738 HARRISBURG, PA 17128-0~1 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER LIPPERT, GERTRUDE ~ ~ ' D~Y~ 0~ 0E~-6D-VE~) . _ . 174- 05 - 1983 ~ 08/02/2004 01/29/1901 REGISTER OF WILLS a 0~ ~e~Uc~) su~v~w6G s~ous~'S ~u~ ( ~sT, ~ST ~D M~DD[E ~.m~ soc~ s~cu~v .UUBE~ ~ ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after ~ ~ ~ 12-12-82) ~ 5. Federal Estate Tax Return Required ~00 ~ ~ ~ ~ 6 of Decedentwill) Died Testate (Attach copy ~ 7. copyDecedentof Trust)Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes ~ ~ 9. Litigation Proceeds Received ~ 10. Spousal Povedy Credit (date of death between ~ 11.Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and 1-1-9~ NAm . ~co~,:~ MA,UN6 ~ ~ Edward L Sc~o~p, Esquire ~ ~ FIRM NAME (If applicable) .... o~ ~ Martso~ DeardorffWjitia~s ~ O~o :¢ Ten East ~ig~ S~eet ................. Carlisle, PA 17013 TELEPHONE NUMBER ? ] 7/243-334 ~ 1. Real Estate (Schedule A) (1) No~e 2. Stocks and Bonds (Schedule B) (2) None ::.~' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Modgages & Notes Receivable (Schedule D) (4) None 5.(ScheduleCaSh' BankE)Deposits & Miscellaneous Personal Property (5) .... 6 1,2 3 5.6 2 6. Jointly Owned Properly (Schedule F) (6) None ~ ~ Separate Billing Requested ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7) None (Schedule G or L) ~.. ~ 8. Total Gross Assets (total Lines 1-7) ~< (8) . 61,235.62 ~ 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10,285.95 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,478.54 11. lotal Deductions (total Lines 9 & ~0) 01) 11,764.49 12. Net Value of Estate (Line 8 minus Line 11) (12) 49,471.13 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. ~et Value Subject to lax (Line 12 minus Line 13) (14) 49,471.13 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLIGABLE ~TES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) ~ 16. Amount of Line 14 taxable at lineal rate 48,971.13 x .045 (16) 2,203.70 o= 17.Amount of Line 14 taxable at sibling rate x .12 (17) o ~ 18. Amunt of Line 14 taxable at collateral rate ~ 500.00 x .15 (18) 75.00 19. lax Due H9) 2,278.70 20. ~ Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: l STREET ADDRESS One West Penn CITY Carlisle , STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page I Line 19) (1) 2,278.70 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 113.94 Total Gredits (A + B + C) (2) 113.94 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund ' 5. If Line l + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 2,164.76 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) 2,164.76 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 secudty 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. Under penalties of perjury. I declare that I have examined this relur-n, including accompanying schedules and statements, and'to Ihe best of my knowledge and belief, it is true, correct and complete Declaration preparer other than the person~a!, r_epresegtative is based 9n all in_formation of which preparer.has e,_r~y knowle_dge. SIGNATURE ¢)F'-I~ERSON P-,E'SPONSIIBLE FOR FILING RETURN ADDRESS Paulette/S.,~elley / ] · ,/ t · .~' .,//] DATE u~~ Carlisle, PA 17013 SiGNA5P~~. ADDRESS sIGN,~,TuRE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS ..... DATE Edward L. Schorpp Ten East High Street /~7.) /...~7/y//"~ ~ Carlisle, PA 17013 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 survMn9 spouse is 3% [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 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes 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 0% [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 4.5%, 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 12% [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.  SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF'' : LIPPERT, GERTRUDE P FILE NUMBER __ 21 - 04 - 00738 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorsh,p must be disclosed on schedule F. ITFM ...... NUMBEF DESCRIPTION VALUE AT DATE OF :[ Wacho-via Ban~ ch~cing~c~ount~t 10'1~42~097013 .............. DEATH 1,848.87 5! Wachovia Bank CD #247412041308356 10,039.33 2; Waypoint Bank, checking account #100363902 5,165.75 4. Waypoint Bank, CD #1700009024 33,090.57 5 Waypoint Bank CD #1756223526 10,029.04 6 Capital Blue Cross, refund of premium 96.44 7 Comcast, refund 1.62 8 One West Penn, refund of security deposit 184.00 9 Household goods and personal property 200.00 10 Social Security, July benefits 580.00 TOTAL (Also enter on Line 5, Recapitulation) 61,235.62 FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF LIPPERT, GERTRUDE P FILE NUMBER 21 - 04- 00738 Debts of decedent must be reported on Schedule I. - - - ITEM NUMBER DESCRIPTION AMOUNT A. ~ FUNERAL ExpENsI=~i 1 Hoffman-Roth Funeral Home, Carlisle, PA 6,955.00 2 Carlisle Memorial Service, Inc. 150.00 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 2. Attorney's Fees Martson DeardorffWilliams & Otto (estimated) 3,000.00 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. Probate Fees Cumberland County Register of Wills 145.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs ;[ Register of Wills, Short Certificate 3.00 2 Register of Wills, filing fee, Inheritance Tax return 15.00 Total of Continuation Schedule(s) 17.95 TOTAL (Also enter on line 9, Recapitulation) 10,285.95 ~ Schedule H COMMONWEALTH OF PENNSYLVANIA Fune~ Exper~ses ~1~ INHERITANCE TAX RETURN RES,[~E.'r [~ECE[~ENT P4:t'nin~ Costs continued ESTATE OF L[PPERT, GERTRUDE P i FILE NUMBER :~ ~:: - -7 21 - 04 - 00738 3 PPL, final billing 14[.29 4 Sprint, final bill 3.66 Page 2 of Schedule H  SCHEDULE I DEBTS OF DECEDENT, MORTGAGE OOM~ONWE^LT, OF PENNSYLV^N,A LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT LIPPERT, GERTRUDE P FILE NUMBER - 21 - 04 - 00738 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Forest park Health Center, account payable 1,375.88 2 PPL, account payable 14.29 3 Sprint, account payable 39.23 4 Cumberland Goodwill Fire Rescue, account payable 42.90 5 Quantum Imaging & Therapeutic, account payable 6.24 TOTAL (Also enter on Line 10, Recapitulation) 1,478.54 REV-1513 EX.+ (9-00)~ SCHEDULE J COMMONWEALTHOF PENNSYLVANIA B E N E F IC IA RI E S INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~:~-- ~: :~ ~ : LIPPERT, GERTRUDE P FILE NUMBER _ 21 - 04 - 00738 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY i RELATIONSHIP TO AMOUNT OR SHARE DECEDENT ........ - ....... J~Not List llusJtee(s). _ _ OF ESTATE t TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Shirley Lippert Niece 500.00 12 Carlton Avenue Carlisle, PA 17013 2 John Ray Kelley and Paulette S. Kelley Grandson and his wife All of estate residue 245 East Pomfret Street Carlisle, PA 17013 i Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet ~I. I NON-TAXABLE DISTRIBUTIONS: I iA. 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 SHELl WACI-IOVIA Reference ID: 990.520 Wach0via Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 August 20, 2004 MARTSON DEARDORFF WILLIAMS & OTTO TEN EAST HIGH STREET CARLISLE, PA 17013 SUBJECT: Verification / Confimaation of Account and Balance Information provided for: Customer: GERTRUDE P LIPPERT (SSN# 174-05-1983) Date of Death: August 2, 2004 Deposit Account Information Account Account Date of Death Average Date Maturity Interest Accrued YTD Date Type Number Balance Balance* Opened Date Rate Interest Interest Paid Closed CERTIFICATE OF DEPOSIT 247412041308356 $10,000.00 8/18/2000 $39.33 $42.91 8/20/2004 LEGAL TITLE: GERTRUDE P LIPPERT CHECKING 1014228097013 $1,848.78 10/22/1998 $0.09 $1.17 LEGAL TITLE: GERTRUDE P LIPPERT * Due to system limitations, we can only provide a twelve month average balance on depository accounts. No Safe Deposit Box tbund for customer. * Date of death balance does not include accrued interest. * If date of death occun's on a weekend or a holiday, date of death balance does not include any transactions that were ,~---made during t-hat'tir~e'perfod.~ Audrey Troutt Servicenter Asso~e Phone: (540)563-7323 abs; at 0000 000634 8/17/2004 MDW&O 10 E HIGH ST CARLISLE PA 17013 The infbrmation which you requested on the account(S) of GERTRUDE P LIPPERT (Social Security Number 174-05-1983) is/are as follows: Account Number 100363902 1700009024 1756223526 Class of Account CHECKING CERTIFICATE CERTIFICATE Date Opened 062602 070698 062992 Principal Balance 5165.25 33089.50 ln~ ~ Accrued Interest .50 1.07 29.04 Balance at Date of 5165.75 33090.57 10029.04 Death Account Ownership SOLE SOLE SOLE Name of Joint Owner, if' any Date Ownership 062602 070698 062992 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Si~nc. erely~_, . Requested EKIN E WATTS ~'-' SENIOR SERVICES REP. P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17lOg-17li · >[~ FP~ [-~-WAYPOINT (i-gfif-DED-7646) · IN YORK AR~ 717/815-4500 · ~.wagpointbank. com LAST WilLL AND TESTAI?iIENT GEII~TI~UDIE l?o I, Ge~rude i¢o Lfil~pert, a legal resident of the Borough of Carlisle, Cumberland County, ?ermsylvania, being of sound and disposing mind, memory, and understanding, do hereby 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 direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whateverjurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. Tll-]I}lilCdl3: I give, devise and bequeath the sum of Five Hundred and no/100 ($500.00) Dollars to my niece, Shirley Lippert. Should she fail to survive me, this bequest shall lapse and become a part of the residue of my estate. FOUt~TH: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to John Ray Kelley and Paulette Kelley, husband and wife, as tenants by the entirety. Should both of said persons fail to survive me, I devise and bequeath the residue of my estate to John E. Kelley, Jr. and Craig M. Kelley, in equal shares, or to the survivor. IFt[IFT1$I: I nominate, constitute and appoint John Ray Kelley and Paulette Kelley, or the survivor, Co-Executors, of this, my Last 'Will and Testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of the said John Ray Kelley and Paulette Kelley, I nominate, constitute, and appoint John E. Kelley, Jr. and Craig M. Kelley, or the survivor, Co-Executors, of this, my Last Will and Testament. I hereby relieve my Co-Executors or their successor from the i~ecess~ty of posting securky in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as i am able by Iaw so to do. I~N WIlTNESS WIHIEIlCdg©IF~ I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of three typewritten pages, each of which bears my initials, dayof ~-r-~.~ef _, 1999. ' ~-~'~'~ /v ~-'-~,~':~Y (SEAL) Gertrude P. Lipperi, Testatrix Signed, sealed, published, and declared by the above-named Testatrix, Gertrude P. Lippert, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) I, Gertrude P. Lippert, Testatrix, 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 act for the purposes therein expressed. Swgxn or affi~ to and acknocgedged before me by Gertrude P. Lippert, the Testatrix, this ag} '4/fl:ir'day of ~, 1999. Testatrix, Gertrude P. Lippert AFFI[DAV]IT COMMONWEALTH OF PENNSYLVANIA ) · SS. COUNTY OF CUMBERLAND ) We, Edward L. Schorpp and ~.. s:'.i ;~, b!. ~',: '~:,'. , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that Gertrude P. Lippert signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed and subscribed to before me byrd '..~i ",?< A. '":!'..,..:c~.,.. , witnesses, this c~ '3,.~day or(' ~"~-----/l~-J--~t-x.~ ,1999. ~'.,~~(SEAL) Witness, Edward L. Schorpp ' ': ~' (SEAL) :,'~ 5-'-' '~,~-~ c,... &::i: ....-, Witness Notary Public ...... ~-.. Seal .G;3;-1~s}(5 b(.,<.,. C;urnberland CounN ,n ru os: ::~ ~s .>spL 4, 1999 PETITION FOR PROBATE and GRANT OF LETTERS Estate of GERTRUDE P. LIPPERT No. (~ ! -- (~) /-/ ~ O"7 B also known as To: Register of Wills for the Deceased. County of Cumberland in the Social Security No. 174-05-1983 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner is 18 years of age or older and the Executrix named in the last will of the above decedent, dated January 27, 1999, and codicil(s) dated [none]. John Ray Kelley has renounced his right to serve as co-Executor. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at One West Penn Street, Carlisle Borough. Decedent, then 103 years of age, died August 2, 2004, at Forest Park Health Center, 700 Walnut Bottom Road, Carlisle, PA 17013. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 60,000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: None WHEREFORE, petitioner respectfully requests the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. OATIt OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitione~d that as personal representative of the above decedent, petitioner will well and truly administer the/6st~e according to !aw. I , Sxvorn to or affirmed and subscribed ~~ be~re me this /6~' day of ~auiette Kelley- "] [, ,~' - ~,_ ~ ~),~o t*,egister Estate of Gertrude P. Lippert, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument dated January 27, 1999, described therein be admitted to probate and filed of record as the last will of Gertrude P. Lippert and Letters Testamentary are hereby granted to Paulette Kelley. Will Book # Page Register of Wi~t_ FEES Edward L. Schorpp, Esquire (17495) Probate, Letters, Etc. $ ]]b'-, OO ATrOP, NE¥ (Sup. Ct. I.D. No.) Short Certificates(J) $ ri, 0(.9 MARTSON DEARDORFF WILLIAMS & OTTO Renunciation $ 5' O0 10 East High Street ¢ (>~r3~ $ ~, t.~) Carlisle, PA 17013 TOTAL $ ~0. old (717) 243-3341 Filed ~-~--~ FAFILES~DATAFILE~ESTATES\11283-1.1ettemtcs RENUNCIATION In Re Estate of Gertrude P. Lippert, deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned John Ray Kelley, named as co-Executor in the Last Will and Testament of Gertrude P. Lippert, hereby renounces the right to administer the estate and respectfully asks that Letters Testamentary be issued to Paulette Kelley. WITNESS my hand this -/ day of August, 2004. John Ray ~ - 245 East Pomfret Street Carlisle, PA 17013 his is Io certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~ Date ~0~.tH A,v ~a? COMMONWEALTN OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORD~ C CERTIFICATE OF DEATH ~ ~ ~rl~d . ~rlisle ~ ~rest ~ark H~lth Center . .~-~'. ire ~ ~ ~ I ~ , ~ I~. ~ M. I~ I~, LAST WILL AND TESTAMENT OF GERTRUDE P. LIPPERT I, Gertrude P. Lippert, a legal resident of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby 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 direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. THIRD: I give, devise and bequeath the sum of Five Hundred and no/100 ($500.00) Dollars to my niece, Shirley Lippert. Should she fall to survive me, this bequest shall lapse and become a part of the residue of my estate. FOURTH: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to John Ray Kelley and Paulette Kelley, husband and wife, as tenants by the entirety. Should both of said persons fail to survive me, I devise and bequeath the residue of my estate to John E. Kelley, Jr. and Craig M. Kelley, in equal shares, or to the survivor. FIFTH: I nominate, constitute and appoint John Ray Kelley and Paulette Kelley, or the survivor, Co-Executors, of this, my Last Will and Testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of the said John Ray Kelley and Paulette Kelley, ! nominate, constitute, and appoint John E. Kelley, Jr. and Craig M. Kelley, or the survivor, Co-Executors, of this, my Last Will and Testament. I hereby relieve my Co-Executors or their successor from the necessity of posting security in ~0~)ection with their duties as such in any jurisdiction in which they may be called upon to a~, i'nsofag~ts i amc.; ~ ..... ~ . ~ :;, ~ able by law so to do. ::" ' . ~ :.:~ IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my J_ast Will and Testament, consisting of three typewritten pages, each of whmh bears my !mtmls,~hsc-x~,2~: dayof ~,7',~,,,~ ,1999. ;:2 ~,~ ~o~ (SEAL) Gertrude P. Lippert, Testatrix Signed, sealed, published, and declared by the above-named Testatrix, Gertrude P. Lippert, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) I, Gertrude P. Lippert, Testatrix, 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 act for the purposes therein expressed. Swgzn or aff~ to and ackno3~ledged before me by Gertrude P. Lippert, the Testatrix, this ~} ~l~day of ~ ,1999. Testatrix, Gertrude P. Lippert Notarial Seal Susan K. G,*yer. Notary Public Carlisle Boro. Cumberland County My Commissio,n Expires Sept 4, 1999 ~~'v~i'~7~; ~ o ~ iatl~ h' 'Of-Notaries AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) We, Edward L. Schorpp and i-~ ~ ~. '~ ~ , the wimesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that Gertrude P. Lippert signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed and subscribed to before me by~ L...S. ch.o~rp~p~d ~ ~ ~ ~,~ , witnesses, this C~Xday of'~ ~, 1999. Witness, Edward L. Schorpp ~.'~.~o,, ~. ~v'~?,y?~ (SEAL) Witness Notaria! Seal Susan K. Gu~er, Notary Public Carlisle Boro, Cumberland County My Commission Expires Sept. 4, 1999 F:\FILES\DATAFILE\ESTATES\i 1283-I.notice.cert CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Gertrude P. Lippert Date of Death: August 2, 2004 File No. 21-04-0~g3 ~c~ To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on or about August 16, 2004. Ms. Shirley Lippert Ms. Paulette S. Kelley 12 Carlton Avenue 245 Pomfret Street Carlisle, PA 17013 Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: August 16, 2004. Signatur~~_.~~ Name Edward L. Schorpp, Esquire -- MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ,~.,~ BUREAU OF INDIVIDUAL~\/"'~~ INHERITANCE lAX DIVISION qr.r:~'r:-;.~:\ PO BOX 280601 \ ,L-\_I .. ,- HARRISBURG PA 17128-0601 ",r"I"1:: UN: "I"'lXlJ1 '"d " 'I' NOTICE OF INHERITANCE TAX ,0APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF OEDUCTIONS AND ASSESSHENT OF TAX 2fiQSJMl \0 Mi, g: \;9 CLfJ\K Of It ORPI1!\N'S cr)\JPJ \ EDWARD L s~TJ"'i~iP :.'} PI HARTSON ETAL 10 E HIGH ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-10-2005 LIPPERT 08-02-2004 21 04-0738 CUMBERLAND 101 A..ount Remitted '*' REV-l~41 EX iFP (12-041 GERTRUDE P MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... REV :iS4'-Eif-AFP--roFo!Y-NOY-iCE--O,,-J;'NHErfifANCE-YAX-iiP'PRA-isEiiENt;--Ar.rOWAi.jCE-oii----------- - -- - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LIPPERT GERTRUDE P FILE NO. 21 04-0738 ACN 101 DATE 01-10-2005 TAX RETURN WAS: (X I ACCEPTED AS FILED I CHANGEO NOTE: I~ an assessment was issued previouslY, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Lins 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due .00 X 00 = .00 48,971.13 X 045 = 2,203.70 .00 X 12 = .00 500.00 X 15 = 75.00 1191= 2,278.70 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schadul. Bl 3. Closely Held stock/Partnership Interest {Schedule CJ 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (11 121 (31 (41 (SI (61 (71 .00 .00 .00 .00 61.235.62 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern..ntal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (91 I1PI 10,285.95 1.478.54 (111 1121 1131 (141 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax p&YlIsnt. 61,235.62 11 .764 49 49,471.13 .00 49,471.13 TAY CREDTTS: .. ,o, AHOUNT PAID DATE NUH8ER INTEREST/PEN PAID (-I 10-28-2004 CD004559 113.93 2,164.76 TOTAL TAX CREDIT 2,278.69 BALANCE OF TAX DUE .01 INTEREST AND PEN. .00 TOTAL DUE .01 07 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 1 IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. < IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE 5 . A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I Name of Decedent: Date of Death: File No.: Social Security No.: ~ kivu REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) GERTRUDE P. LIPPERT August 02, 2004 21-04-0738 174-05-1983 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No Copies of receipts, releases,joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. August 25,2005 Signature: A t ~n fl R I J n .~ ~ Name: ~Esquire Address: MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PAl 70 13 (717) 243-3341 Counsel for personal representative d. ~~--. ~. Date: N <=> N 1-- c::-:: LU (-) ~ ~- w:. ~- 7'-::: U.--' u- '-_ o ,::-::::.{!-. o tf) L::....:::....".- w.J N LU <,- (J.~). (...') G:~ ~l.;._; ::::J C-: i '----;-_.J ~ (L~ ~Ll ~:\FlL~TAFlLE\ES~12S3,Lsrep 0: g U c--J ~:c;