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Home My WebLink About04-18-11 1505611180 -~ REV- 1500 EX (02-11) (FI) PA Department of Revenue OFFICIAL USE ONLY Pennsylvania DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 ~ t ~ I RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 161-34-4537 11272010 08161943 Decedent's Last Name Suffix Decedent's First Name MI LIPPERT LARRY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI LIPPERT AUDREY Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 201-32-8833 REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW Q 1. Original Return Q 2. Supplemental Return ~ 3. Remainder Return (Date of Death Prior to 12-13-82) 0 4. Limited Estate ~ 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (Date of Death 0 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephony-Ijlumber - --.- ~. ~,.._. AUDREY LIPPERT :~;~~ ~~..~ ~ ~_ First Line of Address 520 N BEDFORD STREET Second Line of Address City or Post Office CARLISLE Correspondent's a-mail address: State ZIP Code PA 17013 ,- RrbF~aal~ USE'O` LY ~;- ~-~; .-~cr~~ CJ .," 1,r-, _ -_ `n _._,~ ~~ _ _ r - - ~-; - -~ -- ia.,~, ~ - tm::~ DATE FILED r--~ ~:.7 :a .._; ,~ _. :`> ~-, 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 com lete. Declaration of re arer other than the ersonal re resentative is based on all information of which re arer has an knowled e. SIGN ~TURE PERS RESPON IBL OR F G RETURN BATE J, /-~ - I ~-- I ~ ADDRESS SIGNATURE OF PREP R OTHER TH EPRESENTATIVE DATE ADDRESS 3 G S- ~-{Afvuto~K ST- GHyL~-I~SLt- n,~ J7a~3 PLEASE USE ORIGINAL FORM ONLY L 1505611180 Side 1 150561118D J 1505611280 REV-1500 EX (FI) Decedent's Name: LARRY LIPPERT Decedent's Social Security Number 161-34-4537 RECAPITULATION 1. Real Estate (Schedule A) ......................................... 1. 5 5 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) .................................... 2. 10 515 . O 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ........................ 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. 2 5 0 0 0 . 0 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 4 4 4 O O . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ....... 7. N 0 N E 8. Total Gross Assets (total Lines 1 through 7) . 8. 13 4 915.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. 16 4 2 7 . 0 0 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ 10. 3 5 2 3 . 0 0 11. Total Deductions (total Lines 9 and 10) ............................. 11. 19 9 5 O . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... 12. 114 9 6 5 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14. 114 9 6 5 . 0 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at p v the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X . 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 0 0 19. TAX DUE .......................................................19. 0.00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505611280 1505611280 J REV-1500 EX (FI) Page 3 File Number 161-34-4537 Decedent's Complete Address: DECEDENT'S NAME LARRY LIPPERT STREET ADDRESS G w- it3E j=oke s T ' CITY CARLISLE STATE PA ZI P 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments (1) 0.00 0.00 0.00 0.00 B. Discount Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in 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) Make check payable to: REGISTER OF WILLS, AGENT .. .~.t,tt: .. •.Cw, r ,:s.. 4w4 .• t+,~?w. ,. „... :... .:,..,;.»;.a*........:.w}v:..r,r:~,~:,~.~.:~::.~::..,~ ...::...:...::»,...::..:::,...: .::.».::.: ..: :.::: ,: :.: .. .. ~Z. .,. 3h.. .. ...,.4..: :..gyn. n ..:::. .::. C ,. ,n. .,...,.. •.:. ..» ., ..: ...........: .:.::...... .: ..:..:.»,.:..:..:.::.:. ....: ........ . .. a ..... c. ~.. .... ., .. .Y .:, .., :.. .., .... .:. ...., .. .:. Y.. .. .... ...:,.. :}...:.. ......... x. ...., .,. ......... ........4....u.. .:., :........::::: .::....,.. . 1:, : v 0..... n.n.... .n.:..: vn;.. n.. n,..... ,. .. .v .. .. ..:. Yn\:,.2: .::: }. .: vv n:: :w.:.x.hv~. v.,: .~.. : .. .:... .4.,..:. .. .. M .. \ : ., .... ... yt . .< ...:::. , ttC3 o..Ot. .:..e..,...,:. ... ..t .. :. S \.f { , 4 tt,A.. ,.,?.... ..\.. 4 .. ,~ .~i. .:. k\ ,n.. \,.v. 4i ,,..... ... v~4..,.n. 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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 .................................... ...... [~ ~i c. retain a reversionary interest ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ....... ^ ~] 2. If death occurred after Dec. 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 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. ~ ::.:..... .. ...... .. .:...4,.:.}::?.\....w;:..:.,.:n..v:...;?;.O.v:,a:i?}}.:.},v.:..::.}'.,.}::.i.::v::•:v~..?.::n:..::.v.:v.v:: ^nv:::, v: :..:?'::: ... *:;9.:.v:.}}:.~}::::.:.:.v:; ~.:: }.x..A. ::vii}'•.vnvnv::;..?}'.:}:'.}}}}::o::?:ni}%i:.Tn:~}}}}}}:;.}}'ni6:;~.;...i,;.... 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':.:.... u:ti.A: n\::.... 4.,... }.... .:: n:..:,..,.}:.:n ......... x; )..w:::.v......,:w:nv:n.} ..........:.......................:. v:t::.isv}i}}::::::::.:..........::v..........:.:: n:.n.....,......:... i:: nv::i: ~:.::n}}}:~ For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 4.5 percent, except as noted in [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 percent [72 P.S. §9116(a)(1.3)]. 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-1502 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LARRY and AUDREY LIPPERT All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. If more space is needed, use additional sheets of paper of the same size. REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER LARRY and AUDREY LIPPERT All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PENN GAMING 225 SH 7,862 2. ARCEL ORM 65 SH 2,358 3. MISC 295 TOTAL (Also enter on line 2, Recapitulation)~$ 10,515 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. NHERRT NCE ~Ax RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LARRY and AUDREY LIPPERT Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ (01-10) Pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT JOINTLY-OWNED PROPERTY ESTATE OF: LARRY and AUDREY LIPPERT FILE NUMBER: If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) I ADDRESS I RELATIONSHIP TO DECEDENT C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE 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 VALUE OF ASSET % OF DECEDENT' INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST MEMBERS FIRST ~ A 16,200 50.00% 8,100 MT BANK 2 18,000 50.00% 9,000 MT BANK 3. 5,000 50.00% 2,500 ORRSTOW N 4• 3,500 50.00% 1,750 CITIZENS 5 • 2,100 50.00% 1,050 ALLIANCE 6 44,000 50.00% 22,000 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 6, Recapitulation) I ~ 44,400 00 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX + (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LARRY and AUDREY LIPPERT Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN ROTH FUNERAL HOME 13,176 2. CEMETARY MARKER 3,251 3. 4. B 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4 5 6 7 City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: ZIP TOTAL (Also enter on Line 9, Recapitulation) ~ $ 16,427 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8~ LIENS ESTATE OF FILE NUMBER LARRY and AUDREY LIPPERT Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size.