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HomeMy WebLinkAbout04-0768PETITION FOR PROBATE and GRANT OF LETTERS Estate of Arlene S. Lipper also ktlowll as Social Security No. Deceased. 178-16-6~50 No. To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(g}, who is/~l~ 18 years of age or older an the execut, rix in the last will of the above decedent, dated February 21, 2002 and codicil(s) dated none in the named (state relevant circumstances, e.g. renunciation, death of executor, Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 1336 Baltimore Road, Shippen~hnrg Southampton Township (list street, number and muncipality) Decendent, then 84 years of age, died July 28 ~ 2004 , at 1336 Baltimore Road, ShiDpensburg. PA. 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: none Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) AIl personal property $ 36,215 (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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. Denise L. Williamson 1336 Baltimore Road Shippensburg~ PA 17257 OATH OF PERSONAL REPRESENTATIVE } " COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND The petitioner(s) abovemamed swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will welF3.nd truly administer the estate according to law. Sworn to or alftrmed, and subscrtbed ~l'14.~/'~ ~t~g~'>~ c~ befpre me this__~___ day of~ Denise L. Williamson ~' No. ~ I - 0 q- i) t'l~ 0¢ Estate Of Arlene S. Lipper ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 21, 2002 described therein be admitted [o probate and filed of record as the last will of Arlene S. Llpper ; and Letters Testamentary are hereby granted to Denise L. Williamson Probate, Letters, Etc .......... Short Certificates( ~ ......... . ...... TOTAL__ $ q~ 1/~.~ Filed ................................... AI~FORNEY(Sup. Ct.I.D. No.) WEIGLE & ASSOCIATES, P.e. 126 East King Street ADDRESS Shippensburg, PA 17257 717-532-7388 PHONE eacher H~chool District Baltimore Rd. ~sE~'~sEINr~C~o~ COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Arlene S. Lipper =Female ~ 17S -- 16 -- Antrlm ~wp. I ~ L3-13-1920 I~ anklln Co David Statler ~ Clara Hawbaker Denise Williamson 2e~.PO Box 574 1336 ~altimore Rd. Shippensburgl PA 1725~ LAST WILL AND TESTAMENT I, ARLENE S. LIPPER, presently residing at 1336 Baltimore Road, Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. 1 give and bequeath a sum equal to ten percent (10%) of the "liquid assets" of my estate (~hecking accounts, savings accounts, money market accounts, certificates of deposit, stocks, and bonds) to the SHIPPENSBURG CHURCH OF THE NAZARENE, presently located at East Orange Street, Shippensburg, Cumberland County, Pennsylvania 17257, to be used in the best interest of the Church as determined by the Church's local governing body. THIRD. I give, devise and bequeath all the rest, residue, and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, DENISE L. WILLIAMSON, presently residing at 1336 Baltimore Road, Shippensburg, Cumberland County, Pennsylvania 17257. FOURTH. In the event that my daughter, Denise L. Williamson, should predecease me or is not living on the sixtieth (60th) day following my death, I then give, devise and bequeath said beneficiary's share to my grandchildren, JOEL D. WILLIAMSON and JOSHUA M. WlLLIAMSON, in equal shares on a per stirpes distribution basis. FIFTtt. In the event that any beneficiary of this my Last Will and Testament is under the age of eighteen (18) years, I then give and bequeath said beneficiary's share to and appoint as Guardian of any property which passes under this Will or otherwise, GARY B. WILLIAMSON, presently residing at 1336 Baltimore Road, Shippensburg, Pennsylvania 17257, AS GUARDIAN, NEVERTHELESS, to invest and re-invest the same until the said beneficiary reaches the age of 18 years, with the following powers in addition to those presently given by law: A. The power to expend fne income towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; B. The power to expend the principal, within the discretion of the said Guardian, if the income is insufficient, towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business / i: :~ ? [ ~r~tec~ical school education, of the said beneficiary; (SEAL) C. The power to sell any and all real estate, within the discretion of the said Guardian; D. The power and obligation to distribute the balance of principal and interest, if any remaining, when the said beneficiary reaches the age of 18 years, without the necessity of a formal adjudication of the Guardian's Account in the Court of Common Pleas of Cumberland County, upon the receipt of a good and valid release; E. The principal of the Trust and the income therefrom shall be free from the debts, liabilities, and engagements of those beneficially interested therein, and shall not be subject to assignment by him or her, nor to attachment or execution under any legal, equitable or other process for the enforcement of judgments or claims of any sort against them, either individually or collectively; and F. In the event the above-mentioned person is unable to accept the position of Guardian, I then name, constitute and appoint JOHN WILLIAMSON, presently residing at 1237 Main Street, Akron, Pennsylvania 17501, as Guardian, with the same powers hereinbefore stated. SIXTH. I nominate, constitute and appoint my daughter, DENISE L. WILLIAMSON, to be the Executrix of this my Last Will and Testament; if she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint GARY B. WILLIAMSON to be the Executor of this my Last Will and Testament. SEVENTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. EIGHTH. I hereby direct that all federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of administration of my estate and that such be paid out of the rest and residue of my estate. NINTH. I direct my Executor to retain the services of JERRY A. WEIGLE, ESQUIRE, with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. iN WITNESS WHEREOF, I, ARLENE S. LIPPER, have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, the first page signed for identification only, this ? / ·" day of ~37 ,'~t~,~-~-~ t ~.~- ,2002. This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA cOUNTY OF CUMBERLAND SS I, Arlene S. Lipper, the person whose name is signed to the 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. Sworn or affirmed to and acknowledged before me by ARLFg_.i'~E S. LIPP__,E~, the T,eqtatrix, this-tb.)~ dayof /~j~,~i~'--"~ ,2002. Je ~ A. Weigle, Nota~ Public COMMONWEALTH OF PENNSYLVANIA SS cOUNTY OF CUMBERLAND We ~'~,,?::-~,/t,.-~.. /-. .//:>/TZ~/'~/ and t~4 (,( ~ ~ [~ m ~. , · e w~tnes~eJ ~h~e n~es ~e s~gned to th~regomg ms~ent, bemg duly qualified according to law, do depose and say that we were present ~d saw ~lene S. Lipper, the Testatrix, sign and execute the ins~ent as her Last Will; that she signed willingly and that she executed it as her kee ~d volunt~ act for the p~oses therein expressed; that each of us in the hearing and sight of the Testatrix, signed the will as wimesses; ~d that to the best of our ~owledge the Testa~ix was at ~e time eighteen (18) or more ye~s of age ~d of sound mind ~d ~der no cons~aint or undue influence. Sworn or affirmed to and subs. c. ribe~before me oy /~.., ,., . ...?.. witnesses, this ,~dayof :~ ,2002. I ~TAR~AL SEAL I Jer~ A. Weigle, Nota~ Public ~ Shippensburg, PA Cumberland Coun~ ~My Commission Ex~iE~ ~c~ober 07~ 20021 WEIGLE & ASSOCIATES, P.C. · ATTORNEYSAT LAW 126 EAST KING STREET, SHIPPENSBURG, PA 1725%1397 * TELEPHONE: (717) 532-7388 FAX: (717) 532-5289 IN RE: ESTATE OF ARLENE S. LIPPER, late of the Township of Southampton, Cumberland County, Pennsylvania, deceased : IN 'FILE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY : PENNSYLVANIA : ORPHANS' COURT DIVISION : ESTATE NUMBER 21-04-11768 CERTIFICATION OF NOTICE UNDER RULE 5.6 {a) Name of Decedent: Arlene S. Lipper Date of Death: July 28, 2004 Will No. 21-04-0768 To the Register: i certify that notice of beneficial interest 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 August 24, 2004: Shippensburg Church of the Nazarene 415 East Orange Street Shippensburg, PA 17257 Denise L. Williamson 1336 Baltimore Road Shippensburg, PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE. August 24, 2004 Signature ~ /r \ '-~ / ';/L; Name: Jerry A. weigle, Esquire Address: Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 Telephone: (717) 532-7388 Capacity: Personal Representative X Counsel for Personal Representative ~/x 0 O0 WEIGLE & ASSOCIATES, RC. Attorneys et Law 125 East King Street Shippensburg, PA 17257 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES OEPT 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004531 WEIGLE JERRY A 126 E KING STREET SHIPPENSBURG, PA 17257 fold ESTATE INFORMATION: SSN: 178-16-6250 FILE NUMBER: 2104-0768 DECEDENT NAME: LIPPER ARLENE S DATE OF PAYMENT: 10/22/2004 POSTMARK DATE: 10/21/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/28/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,000.00 TOTAL AMOUNT PAID: $1,000.00 REMARKS: SEAL CHECK#100 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS WEIGLE & ASSOCIATES, P.C. Attorneys At Law 126 East King Street Shippensburg, PA 17257-1397 RecO~ Register of wills, Cumberland County Courthouse Carlisle, PA 17013 REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMaER 21 COUNTY CODE HARRISBURG, PA 17128-0a01 0~4 0768 YEAR NUMBER DECEDEN'FS NAME (LAST, FIRST, AND MIDDLE INFFIAL) SOCIAL SECURITY NUMBER ~- Lipper, Arlene S. 178-16-6250 Z LU DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) o 07-28-2004 03-13-1920 w REGISTER OF WILLS C3 F APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCl/U_ SECURITY NUMBER O Z Z [] 1. Origina~ Return [] 4. Limited Estate [] 6. Decedent Died Testate (Attach copy of W111) [] 9. Litigation Proceeds Received [] 2. Supplemental Retum ] 46. FuturelnlerestCornpremisetdateofdeathafter ] 7. Decedent Maintained a Living Trust (Attach [] 10. IS2~¥.~I~vle.lr?95~redit (date of death betv,~e, ] 3. Remainder Return (date of death prior to 12-13~2) {~ 5. Federal Estate Tax Return Requi;~:l I 8. Total Number of Safe Deposit Boxes ] 11. Election to tax under Sec. 9113(A) (Attach Sch O) Jerry A. Weigle, Esquire :IRM NAME (ff applicable) Weigle & Associates, P.C. 'ELEPHONE NUMBER 717-532-7388 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 1 23.92 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) N 0 n e 4. Mortgages & Notes Receivable (Schedule D) (4) N 0 n e 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 38,4 7 0.1 7 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) N 0 n e [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) N 0 n · (Schedule G or L) [] Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1 1,0 1 0.7 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,1 42.96 11. Total Deductions (total Lines 9 & 10) COMPLETE MAILING ADDRESS 126 East King Street Shippensburg, PA 17257 _. :, ~ ~j ~i:''~'': ~None OFF ~L USE ONLY 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (6) 38,594.09 (11) 12,153.71 (12) 26,440.38 (13) 2,610.04 (14) 23,830.34 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate !9. Tax Due 0.00 23,830.34 0.00 0.00 x .00 (15) x .045 (16) x .12 (17) x .16 (18) (19) 0.00 1,072.37 0.00 0.00 1,072.37 Copyright 2002 form software only The Lackner Group, Inc. Form REV-tS00 EX (Rev. 6-00', REV-15~OEX+(6-O0) COMMONWEALTH OF PENNSYLVAN~ DEPARTMENTOFREVENUE DEPT. 28060f REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY 0,4 0768 HARRISBURG, PA 17128-0601 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER r- Lipper, Arlene S. 178-16-6250 ILl DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) r-, THIS RETURN MUST BE FILED IN DUPLICATE WI~B THE UJ o 07-28-2004 03-13-1920 REGISTER OF WILLS UJ ¢:~ IF APPLICABLE) SURVIVING SPOUSE'S NAME { LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~oo Z []1. OriginaIRetum [] 2. SupplementaIReturn [~4. Limited Estate [] 4a. FuturelnterestCornprornise(dateofdeathaBer [] 6. Dscedent Died Testate (Aitach [] 7, Decedent Maintained a Living Trust [ABach [] 9. Litigation Proceeds Received [] 10 Spousal Poverty Credit date of death belweert Jerry A. Weigle, Esquire Weigle & Associates, P.C. 'ELEPHONE NUMBER 717-532-7388 1 s. Total Number of Safe Deposit Boxes COMPLETE MAILING ADDRESS 126 East King Street 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 123.92 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) N o n e 5. Cash, Bank Deposits & Miscellaneous Personal Prope~ (5) 38,470.17 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) N 0 n e [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) N o n · (Schedule G or L) [] Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 11,010.76 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,142.96 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) Shippensburg, PA iN0ne 17257 OFFICIAL USE ONLY (8) 38,594.09 (11) 12,153.71 (12) 26,440.38 (13) 2,610.04 (14) 23,830.34 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0.00 x .00 (15) 0.00 23,830.34 x .045 (16) 1,072.37 0.00 x .12 (17) 0.00 0.00 x .15 (18) 0.00 (19) 1,072.37 Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00'. IJSTATE PA IZIP 17257 Decedent's Complete Address: STREET AUL)I~;'- S$ 1336 Baltimore Road JCTY Sh ppensburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2, Credits/Payments A, Spousal Poverty Credit B. Prior Payments C. Discount 1,000.00 52.63 (1) Total Credits (A + B + C) (2) 1,072.37 1,052.63 19.74 19.74 3. Interest/Penalty if applicable D. 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 theOVERPAYMEN~ (4) Check box on Page 1 Line 20 to request a refund 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) Make ~eck Pay~b!e to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOVVlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yea No a. retain the use or income of the property transferred; ............................................................................. r~ [] b. retain the right to designate who shall use the property transferred or its income; ................................ ~ [] c. retain a reversionary interest or .................................. [] r~ d. receive the promise for life of either payments benefits or care? ..................... ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................. [] [] 3. Did decedent own an ~in trust for~ or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own aR Individual Retirement Account, annu~y, or other non.probate property which contains a benefic ary des gnat on? .............................................................................................. [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Denise L. Williamson '1336 Baltimore Road Shippensburg, PA 17257 { (l.~//_~ ~( Jerry A. Weigle Esquire 126 East King Street Shippensburg, PA 17257 For ~tes 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 surv~wng 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 Df 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 impose(~ 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. Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COM MONWE~LT~ OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Upper, Arlene S. 21-04-0768 All property Jointly-owned with dght of Sur~lvomhlp must be disclosed on tlchedule F, ITEM CUSIP VALUE AT DATE NUMBER NUMBEIq DESCRIPTION UNIT VALUE OF DEATH I U.S. Savings Bond EE - proceeds of liquidation 123.92 09129/2004 TOTAL (Also enter on Line 2, Recapitulation) 123.92 (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 B (Rev. 6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY CONIMONW~ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 Include the proceeds of litigation ar~ the date the proceeds were received by the estate All proper~j Jointly-oWned with the dght of suwlvorshlp must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2 3 4 5 6 7 8 9 10 11 t2 Allstate -automobile insurance premium refund Coins (cash) in safe deposit box Coins in safe deposit box at appraised value - 1822 penny and 1827 penny PSERS - final benefit check for July 1 - 28, 2004 Sprint - refund AIM Investment Account #3811079528 Orrstown Bank Checking Account #103-800069 Accrued income on Item 7 through date of death Ormtown Bank Checking Account #657204 Accrued income on Item 8 through date of death Orrstown Bank Savings Account #703003196 Accrued income on Item 9 through date of death PSECU Checking Account Accrued income on Item 10 through date of death PSECU Share Account Accrued income on Item 11 through date of death Varig uard Wellington Fund #0991640t 150 Total of Continuation Schedule(s) TOTAL (Aisc enter on Line 5, Recapitulation) 5.00 49.14 40.00 790.79 7.95 28,398.22 2,103.35 0.12 938.97 0.01 1,051.53 0.40 341.48 0.06 251.71 0.14 4,191.30 See attached page 38,470.t7 (if more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-IS00 Schedule E (Rev. 6-98) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued COMMOI~'W=ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 ITEM NUMBER 13 VALUE AT DATE DESCRIPTION OF DEATH 1990 Oldsmobile 98 Regency Brougham Sedan 300.00 TOTAL (Also enter on Line 5, Recapitulation) 38,470.17 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-t500 Schedule E (Rev. 6-98) REV-II51 EX+ (12-99) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Weigle & Associates, P.C. 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 See continuation schedule(s) attached Probate Fees See continuation schedule(s) attached Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 4,693.00 2,437.50 3,500.00 104.00 276.25 11,010.75 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-'IS00 Schedule H (Rev. 6-98) RSV-1502 EX+ (6-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONV~LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 ITEM NUMBER DESCRIPTION AMOUNT 1 Fogelsanger-Bricker Funeral Home 4,693.00 Subtotal 4,693.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H.A (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-B3 FAMILY EXEMPTION continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Upper, Arlene S. 21-04-0768 ITEM NUMBER DESCRIPTION AMOUNT I Denise L. Williamson, daughter - 1335 Baltimore Read 3,500.00 Shippensburg, PA 17257 Subtotal 3,500.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-I$00 Schedule H-B3 (Rev, 6-98) Rev-'i$02 EX+ (6-98) SCHEDULE H-B4 PROBATE FEES continued COMMON*~N~=ALTH OF PENNSYLVANIA INHERITANCE T~( RLrTURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 iTEM NUMBER DESCRIPTION Register of Wills, Cumberland County - Lettem Testamentary and Short Certificat; Register of Wills, Cumberland County - 2 Short Certificates Subtotal Copyright (c) 2002 form software only The Lackner Group, Inc. AMOUNT 98.00 6.00 104.00 Form PA-1500 Schedule H-B4 (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 6 Cumberland Law Journal - advertising Lettem Testamentary Linda K. Klein - notary fee News Chronicle - advertising Letters Testamentary Register of Wills, Cumberland County - filing PA Inheritance Tax Return Register of Wills, Cumberland County - filing Family Settlement Agreement Weigle & Associates, P.C. ~ reimbursement for postage, xerox copies, and long distance telephone calls Subtotal 75.00 8.00 84.50 15.00 75.00 18.75 276.25 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-IS12 EX+ (6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMO~'~c~,LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 Include unmlmbumed medical expenses, ITEM NUMBER 5 6 7 8 9 DESCRIPTION Adams Electric Company - final billing Care Advantage - nursing care Nazarene Compassionate Ministries - completio~ of pledge support Orrstown Bank Checking Account #657204 - checks drawn on account, clearing after date of death Quest Communications - long distance service Sprint - local service State Employees' Retirement System - refund of overpayment of pension benefit for August 2004 Vivian Coy, Tax Collector - personal tax Wycliffe Associates - final pledge payment VALUE AT DATE OF DEATH 112.50 140.00 340.00 274.37 19.91 41.86 84.62 10.00 120.00 TOTAL (Also enter on Line 10, Recapitulation) 1,142.96 (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 I (Rev. 6-98) ESTATE OF Upper, Arlene S. NUMBER 1 [[. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS include outright spousal distribut ons, and transfers under Sec. 9116(a)(1.2)] Denise L. Williamson 1336 Baltimore Road Shippensburg, PA 17257 SCHEDULE J BENEFICIARIES Enter dollar amounts f d or istrioutions shown above on nes 1 NON-TAXABLE DISTRIBUTIONS: RELATIONSHIP TO DECEDENT Daughter through 18, as appmpt FILE NUMBER 21-04-0768 SHARE Of ESTATE (Words) 100% of residue Total ate, on Rev 1500 cove A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR. WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(a) attached AMOUNT OF ESTATE ($$$) 23,830.34 23,830.34 sheet 2,610.04 TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 2,610.04 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J-lIB CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS continued ESTATE OF FILE NUMBER Lipper, Arlene S. 21-04-0768 ITEM NUMBER DESCRIPTION AMOUNT 1 2,610.04 ShippensburgChurch ofthe Nazarene Amy Varner, Treasurer 415 East Orange Street Shippensburg, PA 17257 23-7359073 Subtotal 2,610.04 Copyright (c) 2002 form software only The Lackner Group, tnc. Form PA-1500 Schedule J-liB (Rev. 6-98) LAST WILL AND TESTAMENT I, ARLENE S. LIPPER, presently residing at 1336 Baltimore Road, Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give and bequeath a sum equal to ten percent (10%) of the "liquid assets" of my estate (checking accounts, savings accounts, money market accounts, certificates of deposit, stocks, and bonds) to the SHIPPENSBURG CHURCH OF THE NAZARENE, presently located at East Orange Street, Shippensburg, Cumberland County, Pennsylvania 17257, to be used in the best interest of the Church as determined by the Church's local governing body. THIRD. I give, devise and bequeath all the rest, residue, and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, DENISE L. WILLIAMSON, presently residing at 1336 Baltimore Road, Shippensburg, Cumberland County, Pennsylvania 17257. FOURTH. In the event that my daughter, Denise L. Williamson, should predecease me or is not living on the sixtieth (60~) day following my death, I then give, devise and bequeath said beneficiary's share to my grandchildren, JOEL D. WILLIAMSON and JOSHUA M. WILLIAMSON, in equal shares on a per stirpes distribution basis. FIFTH. In the event that any beneficiary of this my Last Will and Testament is under the age of eighteen (18) years, I then give and bequeath said benefieiary's share to and appoint as Guardian of any property which passes under this Will or otherwise, GARY B. WILLIAMSON, presently residing at 1336 Baltimore Road, Shippensburg, Pennsylvania 17257, AS GUARDIAN, NEVERTHELESS, to invest and re-invest the same until the said beneficiary reaches the age of 18 years, with the following powers in addition to those presently given by law: A. The power to expend the income towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; B. The power to expend the principal, within the discretion of the said Guardian, if the income is insufficient, towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; The power to sell any and ail real estate, within the discretion of the said Guardian; Do The power and obligation to distribute the baiance of principai and interest, if any remaining, when the said beneficiary reaches the age of 18 years, without the necessity of a formal adjudication of the Guardian's Account in the Court of Common Pleas of Cumberland County, upon the receipt of a good and valid release; E. The principal of the Trust and the income therefrom shall be free from the debts, liabilities, and engagements of those beneficially interested therein, and shail not be subject to assignment by him or her, nor to attachment or execution under any legai, equitable or other process for the enforcement of judgments or claims of any sort against them, either individually or collectively; and F. In the event the above-mentioned person is unable to accept the position of Guardian, I then name, constitute and appoint JOHN W1LLIAMSON, presently residing at 1237 Main Street, Akron, Pennsylvania 17501, as Guardian, with the same powers hereinbefore stated. SIXTH. I nominate, constitute and appoint my daughter, DENISE L. WILLIAMSON, to be the Executrix of this my Last Will and Testament; if she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint GARY B. WILLIAMSON to be the Executor of this my Last Will and Testament. SEVENTH. I direct that my personai representatives shail not be required to give bond for the faithful performance of their duties in any jurisdiction. EIGHTH. I hereby direct that all federai, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such taxes, shail be considered a part of the expense of administration of my estate and that such be paid out of the rest and residue of my estate. NINTI-~.. I direct my Executor to retain the services of JERRY A, WEIGLE, ESQUIRE, with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. IN WITNESS WHEREOF, I, ARLENE S. LIPPER, have hereunto set my hand and seal to this my Last Will and Testamen,,ct,_ written on two (2) pages, the first page signed for identification only, this o~Ix*' day of 5-~_~,~xxax~z/c~/ ,2002. ~~ -~- ~-~2~ (SEAL) This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : SS I, Arlene S. Lipper, the person whose name is signed to the 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. Sworn or affirmed to and acknowledged before me by ARL~.~u.BIE S. LIPPERt, the T~ .tala-ix, this -[ /~ day of ~ ,2002. COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We, ,~,n~- ,Z,. /~r~ and ~c~ ~ L. {~.~ , the witnesses whose names are signed to thet57oregoing inslrument, being duly qualified hccording to law, do depose and say that we were present and saw Arlene S. Lipper, the Testatrix, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes 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 the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and su~Q_~b~,before me wimesses, this '],~fday of ~J.O~./], 2002. WEIGLE & ASSOCIATES, BE. -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG. PA 17257-1397 SAFE DEPOSIT BOX INVENTORY PI. ease Print or Type MUST SE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT SOX IS LO~ATED A/dD RETURNED TO ABOVE ADDRESS COUNTY CODE FILE HUMBER [] SOCIAL S~CURITY OR DEATH CERTIFICATE NUMBER ~4~r',~C I / 'Tp/~ - ~ a~o . DtCIDENT'S NAME ~AST.'FIRST, MI~)DLL~ ~-! DATE OF BLAIN L,'fff~ ~, ~ ~-/¢~ ~- S.~' 7. ~-o' ~AME AND ADDRESS OF PERSON RmUESTING THE OPENING OF THE SAFE DEPOS. BOX ' ~ HGI ~ ~HfIS OF Fl~al[ I~S.TUTION WHILE THI Sill DEPOSIT lOX IS ~E) ~ N~E OF PERSON ~KiflG ~ OATE OF CO~T~ T~ ~ ~ ~ NUMB~ OF BOX ~ roLE UNDER W,~H BOX ~S ~ N~E AND A~ii~S OF PERSONIS} HAVING ACC~ TO BOX b. ~E) . i (STATE) (ZIP COOEI ICIT~ ( ~ATE) IZIP CODE) ~ H,ME *HD roLE OF ~PLOYE T*~G THE ~HVEHTORY JW~SIWILLIHTHEIOXt BYIS [fitlY, a. D~t~olw~h Page of SAFE DEPOSIT BOX ,INVENTORY INSTRUCTIONS (I ) Caeh~ Report tolal only. · (2) Stocks: Usl in dst&il every common or prelerred certificate, warrant or other rights Iound.in box. Stocks are to be designated by name of company, certificate number, date of certili~:ate, name in which stock is reglslered, " and number of shares and class ~>f st'oclc. ' (3) ObligatlonR of U~ S. Governments Number o~ items, dale o~ issue, face value, names In which reglslered and ~pe of ownership, I.e., Jointly held, payable on dealh, sic. (4) ~nds~ Designale by name, amenS, serial number, or other des'gnahon. (Bearer Bonds) (5) ~nk and Savings and L~n Passbooks~ State name of depositor, number of b~k, last date app~rlng in book, name of bank and branch, and balance. (6) Jewels, Coins, Slamps, Manuscripts, etcz List and describe os fully as possible. (7) Deeds, Me.gages, Current In*atonce Policies or other evldencel of Indebtednells List and des.lbs ~lly as possible. (8) All other conlenll. NO. ITEM DESCRIPTION ~. I ~;~[~ under penal~ of pe~u~ that the above Heard Is c6rre~ and ~mplete Io th~ be~t ~f my knowledge and belief. sheet(s) If necessary or use duplicates of this page of form. Vision - Account Value by Date Page 1 of 1 ~ ~v Assets · Search Results > Account Details Account Value by Date  ' Account#: 3811079528 Tax %D/SSN: 178-16-6250 Registration: ARLENE SLIPPER PO BOX 574 i~v~,.~,~$ SHIPPENSBURG PA Statements 17257-0574 Phone #: Statement~ - Evening: (717) 530-0147 Maintenance Oetails Acct Overview Acct Value by Date Tran~ection Hbtorv Mai.te.ance fli~terv Back-End Sake Char I r Bank %nformati~n CoM~ Oasis 2003 Tax Summary 2004 Tax Summary Accumulation Mgmt Co: AIM INVESTMENTS Fund Name: AIM LIMITED MATURITY TREASURY FUND - CLASS A View Fund Details Fund Code: 1523 Ticker: SHTIX Total Share~: 2,776.4590 CUS%P: 00142C300 Account Value: $28,542.00 Enter a price date to retrieve an account value from a previous day. I~rlce Date: 107/28/2004 ~ 08/25/2004 $10.2800 2,776.4590 $28,542.00 Current Price Date: Current Net Asset Value: Current Total Shares: Current Value: Too of oaoe Price Date: 07/28/2004 Net Asset Value: $10.2400 Total Shares: 2,773.2640 Value: $28,398.22 Cont~t U. I Disclaimer Copyright © 2004 DST Systems, Inc. All Rights Reserved. https://www3 .financialtrans.com/t f/Vision 8/26/04 TO: Weigle & Associates, P.C. Attorneys-at-Law 126 East King Street Shippensburg, PA 17257 FROM: ORRSTOWN BANK P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Arlene S. Lipper DECEASED DATE OF DEATH: July 28, 2004 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNTS ACCOUNTNO. TITLE OF ACCOUNT DATE OPENED 657204 Arlene SLipper 10/26/91 103800069 Arlene SLipper 2/11/02 SAVINGSACCOUNT ACCOUNT NO. TITLE OF ACCOUNT 703003196 Arlene SLipper DATE OPENED 11/03/03 DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 938.97 .01 2103.35 .12 DATE OF DEATH PRINCIPLE & ACCRUEDINTEREST 1051.53 .40 (3) CERTIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED DATE OF DEATH PRINCIPLE & ACCRUEDINTEREST 8/26/04 By Timothea Customer Service Operator P.O. BOX 250 SHIPPENSBURG, PA 17257 TEL. (717) 532-6114 PSEC the financial link~M September 10, 2004 Account # 0178166250 JERRY A WEIGLE 126 EAST KING STI~EET SHIPPENSBURG, PA 17257-1397 Dear MR WEIGLE: The following is the status of ARLENE SLIPPER's account with PSECU as of the date of death. Joint Owner's Name NONE Date of Death 07.28.2004 Date of Birth 03.13.1920 Share Description Open date Balance Accrued Dividend S 01 Regular Shares 04.08.1992 $251.71 $0.14 S 04 Checking Shares 04.08.1992 341.48 0.06 The dividend earned from January 1, 2004 through the date of death was $1.56. The decedent had no loans with us. We do not have safe deposit boxes for our members. We need the executrix to sign and date the enclosed Authorization to Close Account form. Use the pre-addressed envelope to return this form to us. If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Member Service Representative Finance Support Unit PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 · (717) 234-8484 - (800) 237-7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 - (717) 777-2100 (TDD). (800) 472-1967 (TDD) Web Address: Www.psecu.com Savings federally insured up to $100,000 by the National Credit Union Administration. A~_~'-JO-ZO04 Oi:58pm From-LEGG ~$ON CARLISLE +717 258 4492 T-541 P.OO2/OOS ;-9~3 From ~IGLE & ASSOC~S, P.C. 1.36 EA~T KING STREET SHIPPENSBURG, PENNSYLVANIA 17257-1397 TELEPHONE (7'~'~) 532-7388 FAx (717) 532-6552 SIGNED ~~Chevrolet, Oldsmobile Pontiac & Cadillac 730 l~n ~_ King Street S~ PA 17257 (717) 532-2121 Fax (717) 532-3658 To: The Estate of Arlene S. Lipper Box 574 Shi~ Pa 17257 August 18, 2004 The value for o~e 1990 Oldsmobile 98 Regency Bro~glmm sedan VIN: 1G3CW54C91A316992, with 204,869 Guide. If you have any questions concerning this pric~ please call me toll fi~e at 888-532-2121. NAME ~ ~-~ ~ "~ _'~Z~, SALES TAX ID~ THE COLLECTOR'S DREAM 6150 Lincoln Way East Fayetteville, PA 17222 Ph. 717-352-4936 Tom McCausltn - p~oprletor STAT~ ] CASH ] CHECK# I M/C VISA AIl sales are final. CHECK ] No refunds or exchanges Sale item Description Price Total Layaway balance ] Layaway terms Subtotal Purchase price t (1) Minimum purchase $100.00 Tax , Jess m% de~os~ I (2) Deposit nonrefundable ~ (3) Balance due 30 days Total PRINTAWAY PRINTING · CHAMBERSBURG, PA · 263-1839 COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVlDUAL TAXES DEPT 28060~ HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 00467O WEIGLE JERRY A 126 E KING STREET SHIPPENSBURG, PA 17257 ....... fold ESTATE INFORMATION: SSN: 178-16-6250 FILE NUMBER: 2104-0768 DECEDENT NAME: LIPPER ARLENE S DATE OF PAYMENT: 11/29/2004 POSTMARK DATE: 11/29/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/28/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 919.74 TOTAL AMOUNT PAID: 919.74 REMARKS: SEAL CHECK# 2762 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOXVXOUALTAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLDWANCE OF DEDUCTIDNS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 22 JERRY A WEIGLE ESQ WEIGLE & ASSOCS 126 EKING ST SHIPPENSBURG PA 17257 02-14-2005 LIPPER 07-28-2004 21 04-0768 CUMBERLAND 101 *' Rn-15~7 EX AFP (12~O~l ARLENE S AMount Reid tted I CHANGED III (21 (31 [41 [51 [61 [71 .00 123.92 .00 .00 38.470.17 .00 .00 (81 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=rIWf-E!t-AFp.-CB1-.-6!').-NOy-ici.oF-iNHERYfltl"ci-TAx.A.PPRA.isEii"~':..Ar.L'ij'wANCE-c"if---..._.......... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LIPPER ARLENE S FILE NO. 21 04-0768 ACN 101 DATE 02-14-2005 TAX RETURN WAS, (X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Estate (Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule fJ 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H) 10. Debts/"ortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (91 IlOI 11,010.75 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 38,594.09 1:>.1';3 71 26,440.38 2,610.04 23,830.34 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 : .00 23,830.34 X 045 : 1,072.37 .00 X 12 : .00 .00 X 15 : .00 1191: 1,072.37 1.142.96 (11) 1121 1131 1141 TAX CREDIT". 'ATM'N '-J AHOUNT PAID DATE NUMBER INTEREST/PEN PAID [-I 10-21-2004 CD004531 52.63 1,000.00 11-29-2004 CD004670 .00 19.74 TOTAL TAX CREDIT 1,072.37 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ . IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ""CREDIT" (CR) ~ YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I ESTATE OF ARLENE S. LIPPER File No. 21-04-0768 FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT moo,!bh J'1bay of ~ ,2005, BETWEEN: AMY VARNER, Treasurer of the SHIPPENSBURG CHURCH OF THE NAZARENE, and DENISE L. WILLIAMSON, being the legatees under ~the Last Will and Testament of Arlene S. Lipper, late of the Township of Shippensburg, Cumberland County, Pennsylvania, AND DENISE L. WILLIAMSON, Executrix of the Estate of Arlene S. Lipper, deceased. WHEREAS, Arlene S. Lipper died July 28, 2004, testate; and WHEREAS, Letters Testamentary were granted to Denise L. Williamson on August 18, 2004, by the Register of Wills of Cumberland County, Pennsylvania; and WHEREAS, all assets of the late Arlene S. Lipper have been liquidated or distributed and all her debts paid in full, and further the period of four months having been terminated since the first advertisement of the issuance of Letters to the said Executrix, the said parties hereto desire to waive the duty of the Executrix to file a First and Final Account with Proposed Schedule of Distribution for purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTHER desire that a Family Settlement Agreement be executed, which Family Settlement Agreement will be duly recorded among the deed records in and for Cumberland County. \>. WEIGLE & ASSOCIATES, P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 NOW, THEREFORE, WITNESSETH, that the parties hereto, in consideration of the premises above stated, and of the Accounting and Proposed Schedule of Distribution attached hereto and made a part hereof, and the receipt of their distributive shares as therein shown, do mutually bind themselves to the said Distribution and Accounting as set forth and further mutually release each other and Denise L. Williamson, Executrix, from all claims and demands whatsoever arising out of settlement of the Estate of Arlene S. Lipper. The parties hereto do further agree that should any liability come due to the estate of the said decedent after the signing of this agreement, they do hereby covenant and agree with the aforesaid personal representative that they will contribute pro rata their share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. WITNESS: SHIPPENSBURG CHURCH OF THE NAZARENE ~:/-a' > /j -tc.C?~ . . c/ 'Ly~ By: Ll-nu~ q;evL!Yl2AJ Amy \(t, er, Treasurer WMJA-J ~ IkJeJ1;;~ Denise . Wllhamson (SEAL) (SEAL) WEIGLE & ASSOCIATES, P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND ~ On this the 2. ) day of ~ , 2005, before me, the undersigned officer, personally appeared AMY VARNER, who acknowledged herself to be the Treasurer of Shippensburg Church of the Nazarene, a corporation, and that she as Treasurer, being authorized to do so, executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by herself as Treasurer. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~ fl'~ Notary Public (SEAL) Nolana ea Linda K. Klein, Notary Public Shippensburg, PA Cumberland County M Commission Ex ires Au ust 15, 2008 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND On this the ( r ~ day of 0jLJ , 2005, before me, a Notary Public in and for said County and State, the undersigned officer, personally appeared DENISE L. WILLIAMSON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. No anal ea Linda K. Klein, Notary Public Shippensburg, PA Cumberland Coun M Commission Explr.~~.~.:.~ ust 15, 2008 Notary Public (SEAL) WEIGLE & ASSOCIATES, P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 SUMMARY OF ACCOUNT Estate of Arlene S. Lipper, Deceased For the period of Julv 28. 2004 throuQh April 7. 2005 Proposed Distributions to Beneficiaries Paae 11 PRINCIPAL Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions 1 - 2 3 Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses Federal and State Taxes Commissions Fees Family Exemption 4 4 4-5 5 5 5 Balance Before Distributions Transfer to (from) Principal Distributions to Beneficiaries 6 Principal Balance on Hand 7 For Information: Investments Made Changes in Investment Holdings 8 INCOME Receipts This Account 9 Net Gain (or Loss) on Sales or Other Dispositions Less Disbursements Balance Before Distributions Transfer to (from) Income Distributions to Beneficiaries Income Balance on Hand 10 For Information: Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND Current Value 2,610.04 2,412.19 4,693.00 383.25 1,019.74 0.00 2,437.50 3,500.00 Fiduciary Acquisition Value 2,610.04 r 55.55 45,792.32 14,445.68 31,346.64 0.00 28,738.22 2,608.42 0.00 1.62 0.00 1.62 0.00 0.00 1.62 2,610.04 SCHEDULE A RECEIPTS OF PRINCIPAL Fiduciary Acquisition Value Cash 07/28/2004 AIM Investment Account #3811079528 28.398.22 07/28/2004 Coins (cash) in safe deposit box 49.14 07/28/2004 Coins in safe deposit box at appraised value - 40.00 1822 penny and 1827 penny 07/28/2004 Orrstown Bank Checking Account #103-800069 2.103.35 07/28/2004 Accrued income on above item through date of 0.12 death 07/28/2004 Orrstown Bank Checking Account #657204 938.97 07/28/2004 Accrued income on above item through date of 0.01 death 07/28/2004 Orrstown Bank Savings Account #703003196 1.051.53 07/28/2004 Accrued income on above item through date of 0.40 death 07/28/2004 PSECU Checking Account 341.48 07/28/2004 Accrued income on above item through date of 0.06 death 07/28/2004 PSECU Share Account 251.71 07/28/2004 Accrued income on above item through date of 0.14 death 07/28/2004 Vanguard Wellington Fund #09916401150 4.191.30 09/25/2004 Various Receipts after date of death - Allstate 5.00 automobile insurance premium refund 10/13/2004 Various Receipts after date of death - PSERS 790.79 final benefit check for July 1 - 28, 2004 10/19/2004 Various Receipts after date of death - Sprint 7.95 refund 10/19/2004 Various Receipts after date of death - Orrstown 1.246.32 Bank Checking Account #657204 pension deposits direct deposited after date of death 04/06/2005 Various Receipts after date of death - Denise L. 5.896.36 Williamson contribution for payment of debts and bequests in order to take assets in kind 45.312.85 Personal Property 07/28/2004 1990 Oldsmobile 98 Regency Brougham Sedan 300.00 300.00 Bond 07/28/2004 U. S. Savings Bond EE - proceeds of liquidation 123.92 09/29/2004 1 SCHEDULE B GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL Gain Loss 08/30/2004 share Vanguard Wellington Fund #09916401150 Net Proceeds Fiduciary Acquisition Value 4.246.85 -4.191.30 55.55 TOTAL GAINS AND LOSSES/PRINCIPAL LESS LOSS NET GAIN OR LOSS 55.55 55.55 3 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Debts of Decedent 08/25/2004 Adams Electric Company - final billing 112.50 08/28/2004 Orrstown Bank Checking Account #657204 - 274.36 checks drawn on account, clearing after date of death 09/11/2004 Care Advantage - nursing care 140.00 09/11/2004 Sprint - local service 41.56 10/18/2004 Quest Communications - long distance service 19.91 10/18/2004 Wycliffe Associates - final pledge payment 120.00 10/18/2004 Vivian Coy, Tax Collector - personal tax 10.00 10/22/2004 PA Treasury Department - return of 08/31/04 1.269.24 annuity payment direct deposited 11/16/2004 State Employees' Retirement System - refund of 84.62 overpayment of pension benefit for August 2004 11/16/2004 Nazarene Compassionate Ministries - 340.00 completion of pledge support Total Debts of Decedent 2,412.19 Funeral Expenses 09/11/2004 Fogelsanger-Bricker Funeral Home 4.693.00 Total Funeral Expenses 4.693.00 Miscellaneous Administration Expenses 08/18/2004 Register of Wills, Cumberland County - Letters 98.00 Testamentary and Short Certificates 08/24/2004 Cumberland Law Journal - advertising Letters 75.00 Testamentary 08/30/2004 Register of Wills, Cumberland County - 2 Short 6.00 Certificates 10/19/2004 News Chronicle - advertising Letters 84.50 Testamentary 11/24/2004 Register of Wills, Cumberland County - filing PA 15.00 Inheritance Tax Return 4 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued 11/24/2004 Weigle & Associates, P.C. - reserve for filing 75.00 Family Settlement Agreement with Register of Wills, Cumberland County 11/24/2004 Weigle & Associates, P.C. - reimbursement for 18.75 postage, xerox copies, and long distance telephone calls 11/24/2004 Linda K. Klein - notary fee 8.00 11/24/2004 Weigle & Associates, P.C. - reimbursement for 3.00 Short Certificate Total Miscellaneous Administrative Expenses 383.25 Taxes 10/21/2004 Register of Wills, Cumberlan'd County - PA 1.000.00 Inheritance Tax at discount 11/29/2004 Register of Wills, Cumberland County - PA 19.74 Inheritance Tax balance due Total Taxes 1.019.74 Fees 11/24/2004 Weigle & Associates, P.C. - attorney fee 2,437.50 Total Fees 2,437.50 Family Exemption 03/23/2005 Denise L. Williamson, daughter -1336 Baltimore 3.500.00 Road Shippensburg, PA 17257 Total Familv Exemption 3.500.00 TOTAL DISBURSEMENTS OF PRINCIPAL 14.445.68 5 Denise L. Williamson 08/28/2004 08/28/2004 09/29/2004 SCHEDULE D DISTRIBUTIONS OF PRINCIPAL 1990 Oldsmobile 98 Regency Brougham Sedan AIM Investment Account #3811079528 Coins in safe deposit box at appraised value 300.00 28.398.22 40.00 TOTAL DISTRIBUTIONS TO BENEFICIARIES 6 28.738.22 28.738.22 # Units PRINCIPAL BALANCE ON HAND Description Cash Orrstown Bank Estate Checking Acc Total Cash 7 Current Value 04/07/2005 or as Noted 2.608.42 2.608.42 2.608.42 Fiduciary Acquisition Value 2.608.42 2.608.42 2.608.42 SCHEDULE F CHANGE IN INVESTMENT HOLDINGS - PRINCIPAL # Units 1990 Oldsmobile 98 Reaencv Brouaham Sedan 07/28/2004 Inventoried 08/28/2004 Distributed AIM Investment Account #3811079528 07/28/2004 08/28/2004 Inventoried Distributed Coins in safe deposit box at appraised value 07/28/2004 09/29/2004 Inventoried Distributed Vanauard Wellinaton Fund #09916401150 07/28/2004 Inventoried 08/30/2004 Sold Total 8 Cost 300.00 -300.00 0.00 28.398.22 -28.398.22 0.00 40.00 -40.00 0.00 4,191.30 -4.191.30 0.00 0.00 SCHEDULE G RECEIPTS OF INCOME Interest/Bank Orrstown Bank Checkina Account #103-800069 08/20/2004 Orrstown Bank Savinas Account #703003196 08/20/2004 PSECU Checkina Account 09/22/2004 PSECU Share Account 09/22/2004 TOTAL RECEIPTS OF INCOME 9 0.88 0.88 0.32 0.32 0.13 0.13 0.29 0.29 1.62 # Units INCOME BALANCE ON HAND Description Cash Orrstown Bank Estate Checking Acc Total Cash 10 Current Value 04/07/2005 or as Noted 1.62 1.62 1.62 Fiduciary Acquisition Value 1.62 1.62 1.62 PROPOSED DISTRIBUTIONS TO BENEFICIARIES Current Value Fiduciary 0410712005 Acquisition or as noted Value TO: Shippensbura Church of the Nazarene 10% of liquid assets 2.610.04 2.610.04 2.610.04 2.610.04 Total 2.610.04 2.610.04 11 DENISE 1. WILLIAMSON, Executrix of the Estate of Arlene S. Lipper, deceased, hereby declares under oath (penalties of perjury) that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to her knowledge, there are no claims now outstanding against the estate; and that all taxes presently due from the estate have been paid. (VvUU t Lv( ii~.1ItVJ0 Denise 1. Williamson, Executrix Subscribed and sworn to by DENISE 1. WILLIAMSON, before me this /IJ~ dayof ~ 2005. ~ J( j(~ . Notanal eal Unda K. Klein, Notary Public Shippensburg, PA Cumberland County M Commissio~. EJ~.e!~~~.~llY!~ 15, 2008 WEIGLE & ASSOCIATES, P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 In the Court of Common Pleas of Cumberland County, Pennsylvania INRE: ORPHANS' COURT DIVISION Estate of Arlene 5. LiDDer NO. 21-04-0768 Status Report Under Rule 6.12 Name of Decedent: Arlene S. Lipper Date of Death: 7/28/2004 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following witlJ 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 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: QroJ " lj/ l7/tI~ Shippensburg, PA 17257 Telephone: 717-532-7388 Capacity: Personal Representative X Counsel for Personal Representative ~ .-J 15056041147 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX.280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY . County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 4 0768 Date of Birth 178166250 07282004 03131920 LIPPER ARLENE MI S Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1 Original Return 4. Limited Estate ~i 4a. Future Interest Compromise (date of death after 12-12-82) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required ~x 2. Supplemental Return 6. Decedent Died Testate (Attach Copy of Will) 1-= 7 Decedent Maintained a Living Trust . (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10 Spousal Poverty Credit (date of death . between 12-31-91 and 1-1-95) 11. Election to tax under Sec. 9113(A) (Attach Sch 0) CORRESPONDENT _ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY A. WEIGLE ESQUIRE 7175327388 Firm Name (If Applicable) WEIGLE & ASSOCIATES P.C. REGISTER GF WILLS USE -ONLY , ) First line of address r".'\ 126 EAST KING STREET (=.J Second line of address DATE FILED SHIPPENSBURG State PA ZIP Code 17257 L.. City or Post Office Correspondent's e-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. . SJ@NATUREOF PERSON RESPO SIBLE F R FILING RETURN OATE r Denise L. Williamson .3 -/2. -() 1? By Dale Clugston, Power of Attorney f Jerry A. Weigle Esquire DATE 3 / 2 -0 ? 126 East King Street, Shippensburg, PA 17257 Side 1 L 15056041147 15056041147 .-J r\ iD --I lS0S6042148 REV-1500 EX Decedent's Name Arlene S. Li P per 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) r i Separate Billing Requested............. 7. 8. Total Gross Assets (total Lines 1-7)....................................................................... 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/See 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, of transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 269,565 00 17. Amount of Line 14tai<able at sibling rate X .12 0 00 18. Amount of Line 14 taxable at collateral rate X .15 0 00 19. Tax Due........... ......... ..................... ......................... ............... ........ ................ ............ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L lS0S6042148 Decedent's Social Security Number 178166250 269,580,00 8. 269,58000 15 00 15 00 269,565 00 269,565.00 15. o 00 16, 12,130 43 17. o 00 18. o 00 12,130 43 o lS0S6042148 --I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Arlene S. Lipper STREET ADDRESS 1336 Baltimore Road File Number 21-04-0768 Shippensburg I STATE. PA 'ZIP CITY 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 12,130.43 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 2,108.03 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 2,108.03 (4) (5) 14,238.46 (5A) (5B) 14,238.46 Total Interest/Penalty (0 + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 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;.................................... 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 year of death without receiving adequate consideration? ........ ................. ......................... ....................... ............................................. x ! 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?....................... ............... ........... ................. ................................ ....... ............. x 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. 99116 (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. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for tile use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116 (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.!i) percent, except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (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. 99116 (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.15D2 EX+ (6.98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 21-04-0768 Lipper, Arlene S. 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 propmty 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 Real property which Is jointly-owned with right of survivorship must be disclosed on schedule F, ITEM NUMBER DESCRIPTION 1 Real Estate at 1336 Baltimore Road, Shippensburg, Cumberland County, PA- conveyed to Denise L. Williamson with Life Estate Interest TOTAL (Also enter on Line 1, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. VALUE AT DATE OF DEATH 269.580.00 269.580.00 Form PA-1500 Schedule A (Rev. 6-98) REV-t151 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Lipper, Arlene S. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-04-0768 ESTATE OF ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions B. Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Weigle & Associates, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-l'5Jl2 EX+ (6-98) *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF IFILE NUMBER Lipper, Arlene S. 21-04-0768 ITEM NUMBER DESCRIPTION AMOUNT 1 Register of Wills, Cumberland County - filing Supplemental PA Inheritance Tax 15.00 Retu rn Subtotal 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) 3(P I 0 l.. Y- HOSKINSON & WENGER .4r7EAST W~GTON STREET GHAMBERSBURG, PAl 7201 PHONE: (717) 263.85315 FAX: (717) 263-602<3 NOTICE THE PURPOSE OF THIS POWER OF ATTORNEY 15 TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER-OF-A TTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER- OF-A TTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME I INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT 15 NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER-OF- ATTORNEY ARE EXPLAINED MORE FULLY IN 20 Pa. C.S. Ch. 56. IF THERE 15 ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE, AND I UNDERSTAND ITS CONTENTS. Date: :IJ I ell 0 C; c"""l ,'''\ '" ~~!; cw':f; ll;[&0J}v11~ Denise L. Williamson DURABLE POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, that I, DENISE L. WILLIAMSON, presently residing at 1336 Baltimore Road, Shippensburg, Cumberland County, Pennsylvania, 17257, have made, constituted and appointed, and by these presents do make, constitute and appoint my HOSKINSON & WENGER 47 EAST WASHrn"GTON STREET GHAM:BERSBURG, P A 17201 PHONE: (717) 263.853:') PAX: (717)263-6026 husband, Gary B. Williamson, my true and lawful attorney or agent, for me and in my name and on my behalf generally to do and perform all matters and things, transact all business, make, execute and acknowledge all contracts, orders, deeds, writings, assurances and instruments which may be requisite or proper to effectuate any matter or thing appertaining or belonging to me, with the same powers, and to all intents and purposes with the same validity as I could, if personally present; hereby ratifying and confirming whatsoever my said attorney or agent shall and may do, by virtue hereof. In addition to the powers conferred above, I grant the following powers to my agent or Attorney-in-Fact as set forth in Section 5601 of the P.E.F. Code of the Commonwealth of Pennsylvania: A. To create trusts for my benefit; B. To make additions to an existing trust for my benefit; C. To disclaim any interest in property; D. To renounce fiduciary positions; E. To withdraw and receive the income or corpus of a trust; F. To engage in real property transactions; G. To engage in tangible personal property transactions; H. To engage in stock, bond and other securities transactions; I. To engage in commodity and option transactions; J. To engage in banking and financial transactions; K. To borrow money on my behalf; 2 HOSKINSON & WENGER ,,47 EAST W..ASHINGTON STREET CHAMBERSBURG, P.A. 17201 PHONE: (717) 263-8:533 FAX.: (717) 263-6026 L. To enter safe deposit boxes; M. To engage in insurance and annuity transactions; N. To engage in retirement plan transactions; O. To handle interests in estates and trusts; P. To pursue claims and litigation; Q. To receive government benefits; R. To pursue tax matters; S. To claim an elective share of the estate of my deceased spouse; T. To authorize my admission to a medical, nursing, residential or similar facility and to enter into agreements for my care; U. To authorize medical and surgical procedures; V. To request, receive and review any information, verbal or written, regarding my physical or mental health, including, but not limited to, medical and hospital records, and to consent to the disclosure of this information. My agent shall have the status and rights of a Personal Representative as provided in the Health Insurance Portability and Accountability Act, and each health care provider or Covered Entity is hereby directed to release to my agent such medical information as may be requested by my agent in order for my agent to perform his or her duties and/or for my agent to make any decision authorized hereunder. My agent is also authorized to execute any and all releases and other documents necessary in order to obtain disclosure of my patient records and other medical information subject to and protected under the Health Insurance Portability and Accountability Act; and w. To make any other health care decisions on my behalf in the event I am unable to effectively communicate my desires. Additionally, my agent shall have the right to specifically deal with, purchase, sell, redeem, register and re-register U. S. Savings Bonds, treasury securities of all kinds, and corporate securities and bonds. 3 HOSKINSON & WENGER .47 EAST WA.SHI:N"GTON ,S'l:'REET CH.AM:EEHSBURG, P A 17201 PHONE: (717) 263~8535 FAX: (717) 26:]-6026 This Power of Attorney shall not be affected by my subsequent disability or incapacity. In the event my husband, Gary B. Williamson, is unable to act as my agent or Attorney-in-Fact for any reason, I appoint Dale E. Clugston, presently residing at 6072 Olde Scotland Road, Shippensburg, Pennsylvania, 17257, as Successor agent in his place and stead. Any action that the Successor agent shall take in acting under the within Power..of- Attorney shall be conclusive proof to those dealing with the Successor agent that he has the authority to so act, and I hereby ratify and confirm such action of Dale E. Clugston as Successor agent, furthermore agreein~l to indemnify, hold and save harmless those persons or corporations from any claims brought against them for having dealt with Dale E. Clugston as Successor agent, based upon the assertion that he had no authority to so act. .,-~WITN~SS WHEREOF, Ihave hereunto set my hand and seal this~y of Y4""a~005 ,^ WIT SS: ' ~- // (SEAL) 4 HOSKINSON & WENGER l47 EAST WASHINGTON STREET CHAMJ3ERSBURG, PA 17201 PHONE: (717) 263-8530 FAX: (717) 263.8028 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF FRANKLIN . foiL ( /I"A). i- On this -/..J- day of \../{'( , 2005, before me, a Notary Public, the undersigned officer, personally appeared DENISE L. WILLIAMSON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged the foregoing power-of-attorney to be her act and deed, and desired the same to be recorded as such. Witness my hand and official seal, the day and year aforesaid. b~ Dlil.. (~ a ~~~ ~/NOT Y PUBLIC COMMONWEALTH OF PENNSYLVANIA No!alrcll Seal Evelyn L Shreiner, Notary Public Chambersburg 80r0, Franklin County My Corrvnlssion Expires Feb. 11, 2009 Member, Pennsylvania Association of Notaries 5 HOSKINSON & WENGER l47 EAST W.ASHINGTON STREET GHAMBERSBURG. P A 17201 PHONE: (717) 263-85315 FAX: (717) 263.GO~~6 ACKNOWLEDGMENT OF AGENT I, GARY B. WILLIAMSON, have read the attached Power-of-Attorney and am the person identified as the agent for the principal. I hereby acknowledge that, in the absence of a specific provision to the contrary in the Power-of-Attorney or in 20 Pa. C.S., when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. "- . OI,II')-~ cv..- l~ \..V -Vv 1.~Q..l'""'- (S EA.L) 'a B. Williamson COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF FRANKLIN IAtk ~j- On this 1-[ day of 't1.JI- c/ , 2005, before me, a Notary Public, the undersigned officer, pe'rsonally appeared GARY B. WilLIAMSON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the above, and acknowledged the fore~loing to be his act and deed, and desired the same to be recorded as such. Witness my hand and official seal the day and year aforesaid. /6 /) J~ . "~\'C'k.:r.E=~{;u:c ~ COMMONWEALTH OF PENNSYLVANIA Notarial Se.a! Evelyn L. Shreiner, Notary Public Chambersburg Boro, Franklin County My Commission Expires Feb. 11, 2009 Member, Pennsylvania AssoGiation of Notaries . " .r..., ,""":' J ~." 6 " , ACKNOWLEDGMENT OF AGENT I, DALE E. CLUGSTON, have read the attached Power-of-Attorney and am the person identified as the successor agent for the principal. I hereby acknowledge that, in the absence of a specific provision to the contrary in the ! Power-of-Attorney or in 20 Pa. C.S., when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. ._ ~~~/~~(SEj\,L) Dale E. Clu~ COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF FRANKLIN On thist1 \' day of !Yl P1 ' 2005, before me, a Notary Public, the undersigned officer, personally appeared DALE E. CLUGSTON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the above, and acknowledged the foregoing to be his act and deed, and desired the same to be recorded as such. Witness my hand and official seal the day and year aforesaid. ~~ "~ I ) /7 ~~L/- NOTARY PUBLIC HOSKINSON & WENGER PHONE: (717) 263-8535 FAX: (717) 263.6026 Notarial Seal Dan O. Place. Notary PUblic Greene Twp., Franklin County ivt~ (:ommission Expires Feb 20..2007 MllmDar, PannSYlvapi~AssocialiQnotlll.OtlrieS ;...;,..:-...:...... 47 EAST WASHINGTON S':l".REET GHAMBERSBURG, PA J.7201 7 ROBERT'P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 Instrument Number - 200736102 Recorded On 9/17/2007 At 11:19:51 AM * Instrument Type - POWER OF ATTORNEY Invoice Number - 4627 User ill - RAK * Grantor - WILLIAMSON, DENISE L * Grantee - WILLIAMSON, GARY B * Customer - HOSKINSON ET AL * FEES STATE WRIT TAX RECORDING FEES - RECORDER OF DEEDS COUNTY ARCHIVES FEE ROD ARCHIVES FEE TOTAL PAID $0.50 $17.50 $2.00 $3.00 $23.00 * Total Pages - 8 Certification Page DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA /J(,Of cu, ~'t ~~~' ~::OC~ ~ 1750 ~~ * - Information denoted by an asterisk may change during the verification process and may not be reflected on this page. 0004R9 1111111111111111111111111 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT WILLIAMSON DENISE L 1336 BALTIMORE ROAD SHIPPENSBURG, PA 17257 _____n_ fold ESTATE INFORMATION: SSN: 178-16-6250 FILE NUMBER: 2104-0768 DECEDENT NAME: LIPPER ARLENE S DATE OF PAYMENT: 03/20/2008 POSTMARK DATE: 03/20/2008 COUNTY: CUMBERLAND DATE OF DEATH: 07/28/2004 REMARKS: RECEIPT TO A TTY CHECK# 3984 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: CJ RECEIVED BY: REGISTER OF WILLS T REV-1162 EX111-961 NO. CD 009438 AMOUNT -----+-- I $11,438.46 I I I I I I I I $1 '1,438.46 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA OEPARTMI,NT OF REVENUE BUREAU OF INOIVIDUAl TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 009439 HOSKINSON WENGER 147 E WASHINGTON STREET CHAMBERSBURG, PA 17201 ACN ASSESSM ENT CONTROL NUMBER AMOUNT ____un fold 101 $2,800.00 ESTATE INFORMATION: SSN: 178-16-6250 FILE NUMBER: 2104-0768 DECEDENT NAME: LIPPER ARLENE S DATE OF PAYMENT: 03/20/2008 POSTMARK DATE: 03/20/2008 COUNTY: CUMBERLAND DATE OF DEATH: 07/28/2004 TOTAL AMOUNT PAID: $2,800.00 REMARKS: RECEIPT TO A TTY CHECK# 13051 SEAL INITIALS: CJ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 28D601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA ;- _ ~ - ~~ ~^~ ' ;" DErPARTMENT OF REVENUE _, ,; , :;NOTICE OF INHERITANCE TAX _. A~'PRAESEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX c~u r. «,.-, _ rJ ~n 11U~~, y; JERRY A WEIGLE ESQ 126 EAST KING STREET SHIPPENSBURG PA 17257 REV-1547 EX AFP (D6-05) DATE 06-16-2008 ESTATE OF LIPPER ARLENE S DATE OF DEATH 07-28-2004 FILE NUMBER 21 04-0768 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 08-15-2008 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE -~ RETAIN LOWER PORTION FOR YOUR RECORDS ------------------------------------------------------------- - - f-- ------ ____________ _ --- -- -- - REV-1Ei47 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE _ OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE: OF LIPPER ARLENE S FILE N0. 21 04-0768 ACN 101 DATE 06-16-2008 TAX RETURN WAS: C X) ACCEPTED AS FLLED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) tl) 269,580.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) C3) • of this form with your 4. Mortgages/Notes Receivable (Schedule D) C4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 6. Jointly Owned Property (Schedule F) C6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets ts) 269,580.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return t9) 15.00 clo) .00 C11) lr,.(l0 t1z) 269,565.00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax t13) ' 00 t14) 293, 395.34 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) •0 0 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate t16) 293,395.34 X 045 = 13,202.80 17. Amount of Line 14 at Sibling rate (17) •0 0 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) •00 X 15 = .00 14. Principal Tax Due C19)= 13,202.80 T•wv ro~nr•rc. PAYMENT DATE RECEIPT NUMBER DISCOUNT t+) INTEREST/PEN PAID C-) AMOUNT PAID 10-21•-2004 CD004531 52.63 1,000.00 11-29•-2004 CD004670 .00 19.74 03-20•-2008 CD009438 .00 11,438.46 03-20•-2008 CD009439 2,108.03- 2,800.00 BALANCE: OF UNPAID INTEREST/PENALTY AS OF ~ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR G4LCULATION OF ADDITIONAL INTEREST. 03-21-2008 TOTAL TAX CREDIT 13,202.80 BALANCE OF TAX DUE .00 INTEREST AND PEN. 308.52 TOTAL DUE 308.52 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DU w RFGffNT cCC ocvrocr n~r.r ..r ~~~... ~---• --- ------ COMMOMNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 009947 WILLIAMSON DENISE L 1336 BALTIMORE ROAD SHIPPENSBURG, PA 17257 fold ESTATE INFORMATION: ssN: X78-16-6250 FILE NUMBER: 2104-0768 DECEDENT NAME: LIPPER ARLENE S DATE OF PAYMENT: 06/27/2008 POSTMARK DATE: 06/26/2008 COUNTY: CUMBERLAND DATE OF DEATH: 07/28/2004 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5308.52 TOTAL AMOUNT PAID: REMARKS: CHECK# 4008 SEAL INITIALS: AJW REV-1162 EX111-96) 5308.52 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX t A' •~ p BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE 3~IY 1 $ 2Q INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 REV-1547 EX AFP (06-05) DATE 06-16-2008 ESTATE OF LIPPER ARLENE S DATE OF DEATH 07-28-2004 FILE NUMBER 21 D4-0768 COUNTY CUMBERLAND JERRY A WEIGLE ESQ ACN 101 126 EAST KING STREET APPEAL DATE: 08-15-2008 SHIPPENSBURG PA 17257 (See reverse side under Objections) Amount Remitted ~} ~, SZ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --• RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT DF TAX ESTATE DF LIPPER ARLENE S FILE N0. 21 04-0768 ACN 101 DATE 06-16-2008 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) (1) 269,580.00 2. Stocks and Bonds (Schedule B) (2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) C3) .DO 4. Mortgages/Notes Receivable (Schedule D) C4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 6. Jointly Owned Property (Schedule F) C6) .00 7 Transfers (Schedule G) (7) .00 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 8 Total Assets Cg) 269,580.00 . APPROVED DEDUCTIONS AND EXEMPTIONS: 15.00 9.. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 30.. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .00 11,. Total Deductions (11) 15.0 12.. Net Value of Tax Return C12) 269,565.00 13, Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) C13) .00 4 f Estate Sub3ect to Tax e l N t V C14) 293,395.34 . 1 u o e a NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .00 X OD = .00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 293,395.34 X 045. 13,202.80 17. Amount of Line 14 at Sibling rate C17) •00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) •00 X 15 = .00 19. Principal ~., _ Tax Due C19)= 13,202.80 ~~`PAYMEN DATE RECEI T NUMBER IS OUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 10-21-2004 (0004531 52.63 1,000.00 11-29-2004 (0004670 .00 19.74 03-20-2008 (0004438 .00 11,438.46 03-20-2008 (0009439 2,108.03- 2,800.00 BALANCE OF UNPAID INTEREST/PENALTY AS OF * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 03-21-2008 TOTAL TAX CREDIT 13,202.80 BALANCE OF TAX DUE .00 INTEREST AND PEN. 308.52 TOTAL DUE 308.52 C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DIyE A REFUNII_ SFF RFVFRCC cTTC nc Turc cno.. gyn.. ....a...•-.---••- `~- W O m r. W O N m ~ N ~ ~~o~W ~oZa `G a Q~Q 1W _CY- ~' N /~ O ~~`` ~ a~ t~ r` fY \y O LL d N Q ~~~1tNti o o ~ ?~ 0 V b L+ N ~ ~ ~ ~ S-+ O N ,~ V O M V ~ w 0 t!1 ',~ h e-{ 3J .-i r-I(". K-I ,7 ~ U ~C 4-a P-i O TJ N c1i N N r-1 r-i +} ~ ~ fA N •ri .~ ~ ~ N ~ cC (1i V V !'i't 3Y~E l~~! {~'! ;it ,,.t ~...; ,r..+ V r M E"'i '~ y ~ H ~ +~i N V -a r~ ~ O Q ~ d ~ ~ ~ ~ •~ L" ~'' L ~ W .Q W ~ ~ C.. -~ C. ~ ~ W BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE _ ~ ( '-' `-INHERITANCE TAX „;.S.TATEMENT OF ACCOUNT GI_F~r; .~i' ORP~-i~',i','' ~ C':~,Jf~~ JERRY A WEIGLE ESQ., 126 EAST KING STREET SHIPPENSBURG PA 17257 DATE 07-28-2008 ESTATE OF LIPPER ARLENE S DATE OF DEATH 07-28-2004 FYL~~ NUMBER 21 04-0768 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF LIPPER ARLENE S FILE N0. 21 04-0768 ACN 101 DATE 07-28-2008 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-09-2008 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): 13,202.80 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID *** SUMMARY OF LL 005 PAYMENTS *** 06-26-2008 52.63 .00 06-26-2008 2,416.55- 15,566.72 ^ IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT 13,202.80 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 C LF TOTAL DUE IS LESS THAN B1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )