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Home My WebLink About95-0247 This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. AUG 16 200T ? . Date Fran eropoli, ' ect Division of Vital Records ~ REV-1500 EX+ (12-88) ~~ ~_ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRIS$URG, PA 17128-0601 H z W 0 W v W 0 W QN ~00 d Q t ~ W z ~ W ~ ° O Z V ~ d z O t- a a v W z O i= a r. d 2; O v x a LEMPESIS, MARY HELEN 160-16-9140 1. Original Rs'urn ^ 4. Limited Estate ~; 6. Decedent Died Testate (Attach copy of Will) AL1: CORRESPONDENCE-AN Thomas A. (11) 358.89 (14) 26 4.49 (131 -0- (14) 264.49 15. Amount of line 14 taxable at 646 rote (lg) 264.49 x ~ : 15, $6 FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE 21 95 WITH REGISTER OF WILLS) COUNTY CODE YEAR IIT1A~) DECEDENT'S COMPLETE A S Bethany Tors 335 'nlesley Drive 4TE OF DEATH DATE OF BIRTH ~~ani ab~,g~ PA 17055 12-24-90 7-21-13 c,,,,,,,, C'~miberland ^ 2. Supplemental Return ^ 40. Future Interest Compromise (for dates of death after 12-12-82) ^ 7. Decedent Maintained o Living Trutt (Attach copy of Truatl (717 ) 233-7691 1. Real Estate (Schedule A) (1) 12. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages and Notes Receivable (Schedule D) (d) 5. Cash, Bank Deposits 8 Miscellaneous Personal Property( 5) i (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (Schedule L) (7) 8. Total Gross Assets (total lines 1-7) 9, funeral Expenses, Administrative Costs, Miscellaneous (9) Expenses (Schedule H) 10. Debts, Mortgage Liabilities, liens (Schedule I) (10) 1 1. Total Deductions (total lines 9 ~ 10) 12. Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) (Include values from Schedule K or Schedule M.) 16. Amount of line 14 taxable at 1546 rate (16) (Include values from Schedule K or Schedule M.) 17. Principal tax due (Add tax from line 15 and from line 16.) 18. Credits Prior Payments Discount ^ 3. Remainder Return (for dates of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes Beckley & Madden 212 N. 3rd St., P.O. Box 11998 Harrisburg, PA 1710 8 -0- -0- -0- 623.33 -0- -0- 345.05 13.84 ~~~ ~~ x .15 (17) (18) -0- (19) (20) 15.86 (20A) (20B) Interest + _ 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT ~^ 20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. A. Enter the interest on the balance due on line 20A. B. Enter the total of line 20 and 20A on line 20B. This is the BALANCE DUE. Make Check Payable to: Register of Will:, Aoent rtl-.r~-~~3~I~E" ... 711~t~t~1 Under nalties of perjury, I declare that I have examined this return, it is tru correct and complete. 1 declare that all real estate has been based lkiafos+eetiojrafjsrhich preporer has any knowledge. ,.,,.' o ncludmg occomponymg scMdule: and statements, and to the best of my knowledge and belies, sported of true market value. Dacloration of preporer other than the personal representative is 212 N. 3rd St., P.O. BOX 11998 DATE Harrisburg, PA 17108 6-26-95 212 N. 3rd St. p O Box 11998 DA Harrisburg, PA' 1710 $ 6-26-95 0247 NUMBEF .i PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (rj IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: 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 x d. receive the promise for life of either payments, benefits or care? ....................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? 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' bank account at his or her death? ...................... 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. ,. .~ ` NEV-1508 E%~ 17-85) r SCHEDULE "E" '~~~` CASH, BANK DEPOSITS AND LTH OF PENNSYLVANIA MISCELLANEOUS EM DECeDEl~RURN PERSONAL PROPERTY Please Print or T ESTATE OF FILE NUMBER LENJPESIS, MARY HELEN 21-95-0247 (All property jointly-owned with the Right of Survivorship must bs disclosed on Schedule "F") ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH 1. PNC Bank Checking Account No. 51-4003-7529, solely held in the name of the decedent 2. Bethany Towers -Refund 3. Union Fidelity Life Insurance Cal~any -premium Refund 4. Haar's Auction, Dillsburg,.PA -Proceeds $ 409.42 72.89 21.17 119.90 TOTAL (Also enter on line 5, Recapitulation) ~ $ 623 38 (Attach odditionat 8l~e" x 11" sheets if more span is needed.) REV•IS 11 EX+ ~Y•B6) ~,.,;,,~ ~ SCHEDULE H 'u.tn; ~r FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND INHERITANCE TA% RETURN RESIDENT DECEDENT MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF FILE NUMBER LENIPESIS, MARY HELM 21-95-0247 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: 1. B. Administrative Costs: 1. Personal Representative Commissions _ _ Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees Beckley & rladden $ 100.00 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address ' City State Zip Code 4. Probate Fees 49.00 C. Miscellaneous Expenses: Teimbursement ~• John Lempesis, Jr. -Urn 135.00 2. Claudia I,etYpesis -Delivery Charge 35.00 Death Certificate 1A .00 3. Beckley & Madden - Advances for: Telephone Tolls 2.04 Photoaapying 13.00 Postage 1.01 196.05 TOTAL (Also enter on line 9, Recapitulation) S 345.05 ter more space is needed, insert additional sheets of same size) t REV.1512 EXa ~l•93) . COMMONWEALTH OF /ENNSYIVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Please Print or ea~~ale yr FILE NUMBER LEN~ESIS, MARY HELEN 21-95-0247 (tt more space is needed, insert odditionol sheets of tame size) r REV.Ifif Ex. IFRN ~ ~~' ' ~ SCNED!!LE J COMMONWEAITX of nNNSVlVAN1A BENEFICIARIES INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF LEMPESIS, MARY HEIR NUMBER NAME AND ADDRESS OF 6ENEFICIARY A. Taxably B~gw:tR: ~ • Claudia A. Ienpesis 3002 Market Street, Apt. 3 Cam Hill, PA 17011 2. John M. Les~ipesis, Jr. 15 Wadzusett Drive Lexi.ngt,~n, MA 02173 FILE NUMBER 21-95-0247 RELATIONSHIP daughter son AMOUNT OR SHARE OF ESTATE Item III and Item IV - 50$ Itiem III and Item IV - 50$ NUMBER NAME AND ADDRESS OF 6ENEFICIARY AMOUt1T OR SHARE O~ ESTATE 8. Charitabb and GovElrnEnEaMOI B~gw:<R: ---- 1. i TOTAL CMARITAbLE AND GOVERNMENTAL BEQUESTS (Also EaTt~r on'lin~ 13, RElcopitulation) ~$ (If EENE~ spee~ is nNd~d, iwa~Ef OEId1110E1OI ~IENb of ER7E11~ si>TEt) .~ r1"1 c__. t.~' nJ "~ ~.-~- W q