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Home My WebLink About04-11-13 1505610143 REV-1500 Ex(°2.11> ib OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 21 12 0578 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 11 2012 07 09 1924 Decedent's Last Name Suffix Decedent's First Name MI KOPP HELEN D (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 �� 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate E] 4a.Future Interest Compromise F ' 5. Federal Estate Tax Return Required (date of death after 12-12-82) L.l i 6. Decedent Died Testate (� 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes X (Attach Copy of Will) L (Attach Copy of Trust) -- P 9. Litigation Proceeds Received �] 10.Spousal Poverty Credit(Date of Death 12-31-91 and 1-1-95) 11.Election to tax under Sec.9113(A) between =� (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Teleshone Numb Il GARY L JAMES ESQ 717 539 ,-. 2 8 0 '' M "? Ca REGISTER OFVI2S U�E,ONLy-' First Line of Address . , 134 SIPE AVENUE t Second Line of Address I rl G> City or Post Office State ZIP Code DATE FILED HUNMELSTOWN PA 17036 Correspondent's e-mail address: gll @1sdc.com Unde 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 i! tr e,correct and complete. eclaration of oreparer other than the personal representative is based on all information of which preparer has any knowledge. SIG A R SON SPO BLE FOR FILING RETURN DATE William M. Kopp ADDRESS P.O. Box 3706 Hick 28603-3706 SIGNATURE OF PREPARER QTHER T REPRESENTATIVE DATE Gary L. James Esq. ! - L_�j ADDR 134 Sipe n e, F ju�melstown, PA 17036 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Kopp, Helen D. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 5 , 132 . 31 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, 015 . 22 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 1 , 001 . 11 7. Inter-Vivos Transfers&Miscellaneous NtProbate Property (Schedule G) Separate Billing Requested............ 7, 1 , 057 , 158 . 67 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 1 , 069, 307 . 31 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 65 , 730 . 30 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)............................ 10. 3 , 923 . 45 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 69, 653 . 75 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 999 , 653 . 56 13. Charitable and Governmental Bequests/Sec 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. 999, 653 . 56 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 15. 0 . 00 (a)(1.2)X.00 16. Amount of Line 14 taxable 999 , 653 . 56 16. 44 , 984 . 41 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE.................. . ...................................... 19. 44 , 984 . 41 . ...................................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. FK Side 2 ❑ 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-12-0578 Decedent's Complete Address: DECEDENT'S NAME Kopp, Helen D. STREET ADDRESS 28 Westfields Drive CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 44,984.41 2. Credits/Payments A. Prior Payments 43,500.00 B. Discount 2,249.22 Total Credits(A +B) (2) 45,749.22 1 Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 764.81 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. (5) 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;............................................................................... F xI ❑ b. retain the right to designate who shall use the property transferred or its income;.................................. Lx] ❑ c. retain a reversionary interest;or............................................................................................ .................. x] ❑ d. receive the promise for life of either payments,benefits or care?........................................_.................. ,z 2. If death occurred after Dec. 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?....... 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 Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent, or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. 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 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECECENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 $5,000 General Electric Capital Corp Notes 6% maturity date 102.213 5,110.65 1/15/2038-held in the Edward Jones Brokerage account# 574-12142-1-6;valued per statement dated March 30,2012 Accrued interest on Item 1 through date of death 21.66 TOTAL(Also enter on Line 2, Recapitulation) 5,132.31 (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) Rev-1508 EX-(11-10) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2000 Buick Century-valued per Kelly blue book;fair condition 2,625.00 2 State Farm -refund of homeowners insurance 496.22 3 U.S. Treasury-2011 personal income tax refund 2.894.00 TOTAL(Also enter on Line 5. Recapitulation) 6,015.22 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 EX+(01-10) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Janet K. Culp 3608 Golfview Drive Daughter Mechanicsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUEOFASSET NTEREST DECEDENT'S INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 08/15/1991 PNC Bank Checking Account#5070070963 - 2,002.20 50.000% 1,001.10 valued per letter dated April 27,2012 A 08/15/1991 Accrued income on Item 1 through date of 0.01 50.000% 0.01 death TOTAL(Also enter on Line 6, Recapitulation) 1,001.11 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) Rev-1510 EX+(08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE NUMBER THE DATE OF TRANSFER.SATTACIi A CO Y OF THE RELATIONSHIP DECEDENT A ES AtTDE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Jackson National Life Annuity#1006223741 - 215,263.00 215,263.00 Beneficiary is the Helen D. Kopp Revocable Living Trust dated dated November 9, 1990;valued per letter dated April 5, 2012 2 John Hancock Venture Annuity#2113123- 97,248.00 97,248.00 Beneficiary is the Helen D. Kopp Revocable Living Trust dated dated November 9, 1990; valued per letter dated April 5, 2012 3 Scudder Gateway Plus Annuity#CB10018641 - 107,769.00 107,769.00 Beneficiary is the Helen D. Kopp Revocable Living Trust dated dated November 9, 1990;valued per letter dated April 5, 2012 4 American Balanced Fund A-held in the American 66,370.00 66,370.00 Funds account#57267478;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5,2012 and public listing 5 400 shares of Baxter International Inc -held in the HD 23,564.00 23,564.00 Vest account#2563-6479;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5,2012 and public listing 6 800 shares of Bristol-Myers Squibb Co-held in the 26,320.80 26,320.80 Edward Jones brokerage account#242-11169-1-; titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990;valued per statement dated March 30, 2012 and public listing 7 1,656.5 Cash-held in the Edward Jones brokerage 1,656.50 1,656.50 account#242-11169-1-0;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per statement dated March 30, 2012 Total of Continuation Schedules See attached pages TOTAL(Also enter on Line 7, Recapitulation) 1,057,158.67 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) Rev-1510 EX+(08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE NUMBER THE DATE OF TRANSFFER.SATTRACIiTA COPY oRELATIONSHIP THE DEED FFOREREAL ESTATDE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 8 1,200 shares of General Electric Company-held in the 22,908.00 22,908.00 HD Vest account#2563-6479;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5, 2012 and public listing 9 200 shares of Harley Davidson Inc-held in the 9,416.00 9,416.00 Edward Jones brokerage account#242-11169-1-0; titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990;valued per statement dated March 30,2012 and public listing 10 47,062 units of HDV Bank Deposit Sweep Account- 47.062.00 47,062.00 held in the HD Vest account#2563-6479;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5, 2012 11 622 units of HDV WF Money Market Fund -held in the 622.00 622.00 HD Vest account#2563-6479; titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5, 2012 12 Members 1st Federal Credit Union Checking Account 8,067.76 8,067.76 #169876-11 -titled in the Helen D. Kopp Living Trust dated 11109/1990; valued per letter dated April 19, 2012 Accrued interest on Item 12 through date of death 0.22 0.22 13 Members 1st Federal Credit Union Investment Savings 54,255.02 54,255.02 Account#169876-05-titled in the Helen D. Kopp Living Trust dated 11/0911990; valued per letter dated April 19, 2012 Accrued interest on Item 13 through date of death 6.69 6.69 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) Rev-1510 EX+(08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THINCLUDE ATE OF TRANSFER. ATTTACH THEIR COPY OF THHE RELATIONSHIP TO DECEDENT ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 14 Members 1st Federal Credit Union Savings Account# 1,137.09 1,137.09 169876-00-titled in the Helen D. Kopp Living Trust dated 11/09/1990; valued per letter dated April 19, 2012 Accrued interest on Item 14 through date of death 0.08 0.08 15 New Perspective Funds-held in the American Funds 23,730.00 23,730.00 account#57267478;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5, 2012 and public listing 16 100 shares of PepsiCo Inc-held in the Edward Jones 6,332.00 6,332.00 brokerage account#242-11169-1-0;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990;valued per statement dated March 30,2012 and public listing Accrued dividend on Item 16 through date of death 51.50 51.50 17 Personal Property 1,500.00 1,500.00 18 PNC Bank Savings Account#5030127881 -titled in 16,390.84 16,390.84 the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 27, 2012 Accrued interest on Item 18 through date of death 0.56 0.56 19 Real Estate located at 28 Westfields Drive 172,900.00 172,900.00 Mechanicsburg, Cumberland County, Pennsylvania - titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990;valued per selling price Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) Rev-1510 EX+(OS-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE NUMBER THE DATE OF T TRANSFER. ATTACH THEIR A CO Y OF THE DEIED DECEDENT ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 20 Tax Exempt Bond Fund of America-held in the 22,134.00 22,134.00 American Funds account#57267478;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5, 2012 and public listing 21 Washington Mutual Investors Fund A-held in the 87,618.00 87,618.00 American Funds account#57267478;titled in the Helen D. Kopp Revocable Living Trust dated November 9, 1990; valued per letter dated April 5, 2012 and public listing 22 Wells Fargo Savings Account#9518-title in the 44,832.29 44,832.29 Helen D. Kopp Revocable Living Trust dated November 9, 1990;valued per letter dated June 1, 2012 Accrued interest on Item 22 through date of death 3.32 3.32 TOTAL(Also enter on Line 7, Recapitulation) 1,057,158.67 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1151 EX+(10-09) SCHEDULE H COMMONWEALTH OF,,gqPENNSYLVANIA FUNERAL EXPENSES AND INHERITANCE IDECEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 14,573.27 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attorney's Fees James, Smith, Dietterick& Connelly, LLP 15,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant James E. Kopp Street Address 28 Westfields Drive City Mechanicsburg State PA Zio 17050 Relationship of Claimant to Decedent Son 4. Probate Fees 97.50 5. Accountant's Fees 425.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 32,134.53 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 65,730.30 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Malpezzi Funeral Home-funeral 13,198.27 2 Oliver Korb-headstone 875.00 3 St. Katherine Drexel -contribution for luncheon after funeral 250.00 4 Worker's of St.Joseph -contribution for luncheon after funeral 250.00 H-A 14,573.27 Other Administrative Costs 5 BJ's-paper towels,trash bags to clean out residence 32.84 6 Cumberland County Recorder of Deeds-transfer tax per HUD 1 settlement sheet 1,729.00 7 Cumberland Law Journal -trust and estate advertisement 237.00 8 Cumberland Law Journal -trust and estate advertisement 316.98 9 Debbi Kopp-work done at residence-cleaning, hauling 595.00 10 Debra Wiest-tax certification per HUD 1 settlement sheet 10.00 11 Dillsburg Glass -repairs to residence 135.00 12 Dillsburg Glass-repairs to residence 262.00 13 Drinks Painting -repairs to residence 1,100.00 14 Drinks Painting-repairs to residence 2,082.45 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 ITEM NUMBER DESCRIPTION AMOUNT 15 Duty's Lock Service 123.18 16 First American Home Buyers -home warranty per HUD 1 settlement sheet 320.00 17 Floor Max- repairs to residence 1,620.00 18 Floor Max-repairs to residence 1,311.37 19 Frank Weiser-lawn care 106.00 20 Frank Weiser-lawn care 84.80 21 Frank Weiser-lawn care 106.00 22 Frank Weiser-lawn care 21.20 23 Frank Weiser-lawn care 106.00 24 Frank Weiser-lawn care 84.80 25 Gary Muccio-overnight fee per HUD 1 settlement sheet 60.00 26 H.B. McClure-repairs to residence 109.00 27 Home Depot 37.30 28 Hooke, Hooke& Eckman-broker commission per HUD 1 settlement sheet 5,052.00 29 James Smith Dietterick&Connelly LLP-reserve for estate administration closing costs 500.00 30 Janet Culp-reimbursement for mileage 640.47 31 Joshua L. Gleim -seller assist per HUD 1 settlement sheet 3,598.90 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 ITEM NUMBER DESCRIPTION AMOUNT 32 Lowe's 38.25 33 Lowe's 37.69 34 Lowe's 35.37 35 Members 1st-Estate checks 14.00 36 No more Dirty Blinds -residence 193.72 37 PNC Bank-low balance fee 20.00 38 Postmaster-postage 112.45 39 Re/Max Realty -broker commission per HUD 1 settlement sheet 4,605.00 40 Re/Max Realty Association -deed prep per HUD 1 settlement sheet 150.00 41 Robert Kopp-work done at residence-cleaning, hauling 595.00 42 Robert Kopp-reimbursement for materials for work done at residence 186.37 43 Shepp's Shop -oil change 31.88 44 Silver Spring Township Authority-final water/sewer bill per HUD 1 settlement sheet 110.71 45 State Farm -car insurance 103.66 46 State Farm -car insurance 53.83 47 State Farm -car insurance 53.83 48 State Farm -homeowners insurance 618.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 ITEM NUMBER DESCRIPTION AMOUNT 49 USPS -postage 71.00 50 WalMart 35.22 51 William Kopp-reimbursement for meals, lodging, mileage,to travel to area to administer 4,687.26 estate H-137 32,134.53 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF F21-12--0578 NUMBER Kopp, Helen D. Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Country Meadows-nursing home 2,281.24 2 Debra Bashore-real estate taxes 474.72 3 Diamond Pharmacy-prescriptions 71.00 4 Diamond Pharmacy-prescriptions 544.49 5 PA Department of Revenue-2012 estimated tax payment 300.00 6 PA Department of Revenue-2011 personal income tax liability 252.00 TOTAL(Also enter on Line 10, Recapitulation) 3,923.45 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX+(01.10) SCHEDULE J COMINOHERTAN EDTFA ETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Kopp, Helen D. 21-12-0578 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)) 1 Janet K.Culp Daughter 25%of residue; 250,664.23 3608 Golfview Drive joint PNC Bank Mechanicsburg, PA 17050 account 2 James E. Kopp Son 25% of residue 249,663.11 28 Westfields Drive Mechanicsburg, PA 17050 3 Robert C. Kopp Son 25% of residue 249,663.11 3981 Normandy Road Duncan, BC Canada V9L 6G2 4 William M Kopp Son 25% of residue 249,663.11 P.O. Box 3706 Hickory, NC 28603-3706 Total 999,653.56 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) C7 � n TJ G7 CD (/1 C C Q 'T1 DC Oo (n - O U) � _ a C/) (n Cf) 3 c� W C QO n 2 cn fD U) m vo _ O co Doom – 0 -4 x x o � 90 Won O p rn oCD CD r r m