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� 1505610105
REV-1 s oo EX(o2-ii)(FI)�
OFFICIAI.USE ONLY
PA Department of Revenue pennsylvania
OE�ANfMENI 01 REVENUE County Code Year File Number
Bureau of Individual Taxes �NHERITANCE TAX RETURN �� � ��
PO BOX 28o6oi j� �����
Harrisbury,PA 1�128-o6oi RESIDENT DECEDENT � (,
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
__ _ _ _
! 09/16/2012 04/08/1922
__ __ _ _._ _ _ __ _ _ __
Decedent's Last Name Suffix DecedenYs First Name MI
_ .__ __ __ _ __ ___ __. _.. _ _ ___ __ _..___
LEHMAN CHARLOTi"E �
_ _ .. __ __ _ ___ _ _ __ _ __ _
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M)
_ _. _ _ _ _ _ _
_ __ _ __ __. _
, _ _..__ _ __ _ _ __ ___ _ _ .. _
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 O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Requi�ed
death after 12-12-82)
� 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
__ _ .. _
JEFFREY S COHICK EA (717)249-5321
,::�
RE�TE�R OF WILL9'J1SE OI�
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First Line of Address ry"� �� � �`� '"
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390 ALEXANDER SPRING RD �" .� rn � �;" °��
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Second Line of Address �'" ` � � '�
_
. . . . . .. . . . . _ . . . .... . . ... .._. . . ._ ... �..:_ �-•�. f,,.,�,� —'�1 ..�..Y .,�,�
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City or Post Office State ZIP Code •. ��ATE FIL�,;
CARUSLE PA 17015 � c`� �� °
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Correspondent's e-mail address:jCOhICk�COhICkaSSOC.COCY1
Under penalties of pe�jury,I declare that I have examined this�eturn,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.
SIG TURE OF PERSON RESPONSIBLE FOR FILING RETURN D TE
a� 3
ADDRESS
CON L YOUNG 4 IPP RD, NEWVILLE, PA 17241
NATUR PA E S AT DATE
��D
ADD
JE REY COHICK EA, 390 ALEXANDER SPRING RD, CARLISLE, PA 17015
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 150561D],05 1505610105 J
5 •
J 1505610205
REV-1500 EX(FI) DecedenYs Social Security Number
oecedent's Name: CHARLOTTE I LEHMAN
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 and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 6,569.50
__ _ _
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
-- _.. . _ _ __
7. Inter-Vivos Transfe�s&Miscellaneous Non-Probate Property
(Schedule G) O Separate Biliing Requested........ 7. 29,602.96
8. Total Gross Assets(totai Lines 1 through 7)............................. 8. 36,172.46
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 827.50
10. Debts of Decedent,Mo�tgage Liabilities and Liens(Schedule I)............... 10. 2,990.52
11. Total Deductions(total Lines 9 and 10)................................. 11. 3,818.02
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 32,354.44
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 l.ine 13) ........................ 14. 32,354.44
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ 15.
_
16. Amount of Line 14 taxable
at Iineal rate x.0 45 32,354.44 16. �,455.95
_ _. _ ... _.
, . _ _ _.
17. Amount of Line 14 taxable
at sibling rate X.12 17.
. __ _. _ _
_ __ _
18. Amount of Line 14 taxable
at collateral rate X.15 18.
_ _ _ _ . __ _
19. TAX DUE ......................................................... 19.
1,455.95
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
SIC�@ 2
� 1505610205 1505610205 �
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REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
CHARLOTTE I LEHMAN
STREET ADDRESS
91 DOUBLING GAP ROAD
APT 204
CITY"--------__.�.__-_____--- ------..__._.._._..._......--------------._...._...----------------...._..---....__..._.__.._..--------.._..._....._...._......__....._...._........_.........STATE............_...._...._..............__.._._......_._._........._......._..._...............ZIP.........._........_........_.........................._.......................
NEWVILLE PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,455.95
2. Credits/Payments
A.Prior Payments _----.�_____._...--.--...._._._._._...---......_.__.—..___.,_.._...._..__.
B.Discount
—__-------------...-----________
Total Credits(A+B) (2)
3. interest
�3)
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,455.95
Make check payable to: REGISTER OF WILLS, AGENT.
f`:r�y� s :�` � .; �`'��:..:➢ � _: � x r_ �4 MR...,� 3 ..
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�':..L_.,ret.r�!^�...�..�,.,F.:.F..,.,,.;%.,s&r'E. .:.,. ,!. .. {, . <::• .',. . , � , , . . . .. . , . ... .
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 transfeRed.......................................................................................... ❑ �
b. retain the right to designate who shall use the prope�ty transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occuRed after Dec.12,1982,did decedent transfer property within one year of death
without�eceiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
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`.kb`&; c.+,<..,"s�a'�r M;rs�:.`x��. s�.��52�.��',r.�.:. .,�,h€. �.::.� >,. . , ., "��� � .. ...,. ... � . . , .. . ... .. � .. . . ..
For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are still applicable even if the suroiving 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)J.
• 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-i5o8 EX+(08-12)
� pennsylvania SCHEDI�ILE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CHARLOTTE I LEHMAN 21-12-1056
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ali property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�. 2004 CHEVROLET IMPALA SEDAN 4DOOR 43,750 MILES-SOLD 5,500.00
2. PERSONAL PROPERTY PUBLIC AUCTION 1,069.50
TOTAL(Aiso enter on Line 5, Recapitulation) $ 6,569.50
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
� pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHARLOTTE I LEHMAN 21-12-1056
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,
DESCRIPTION OF PROPERTY
ITEM lNCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATfACH A COPY OF 1HE DEED FOft REAL ESTATE. VAI.UE OF ASSET INTEREST IF APPUCABLE VALUE
1. WESTERN-SOUTHERN UFE ASSURANCE ANNUITY A/C#W0020683312 14,717.05 100 14,717.05
TRANSFEREE CONNIE L YOUNG,DAUGHTER,CHK DATE 11-1-12
2 WESTERN-SOUTHERN UFE ASSURANCE ANNUITY AlC#W0020583022 14,885.91 100 14,885.91
TRANSFEREE CONNIE L YOUNG,DAUGHTER,CHK DATE 11-1-12
TOTAL(Also enter on Line 7,Recapitulation) ; 29,602.96
If more space is needed,use additional sheets of pape�of the same size.
REV-1511 EX+(10-09}
� pennsylvania SCHEDULE H -
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
_
1NHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHARLOTi'E I LEHMAN 21-12-1056
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 0.00
Name(s)of Personal Representative(s) CONNIE L YOUNG
Street Address 574 SHIPPENSBURG ROAD
City NEWVILLE State PA Zip 17241
Year(s)Commission Paid: NONE PAID
2. Attomey Fees:
3. Family Exemption:(If decedenYs add�ess is not the same as claimanYs,attach explanation.)
Claimant
Street Address
��ty State ZIP
Relationship of Claimant to Decedent __
4. Probate Fees: 77.50
5. Accountant Fees:
6. Tax Return Preparer Fees: 750.00
7.
TOTAL(Also enter on Line 9, Recapitulation) � 827•50
If more space is needed,use additional sheets of paper of the same size,
REV-151Z EX+(12-12)
� pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHARLOTTE I LEHMAN 21-12-1056
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� ZEIGLER'S STORAGE&TRANSFER 415.75
2. CLAREMONT NURSING&REHABITATION CENTER 2,012.59
3. PPL ELECTRIC BILL 9.28
4. ALERT PHARMACY SERVICES INC-PRESCRIPTION MEDICINE 58.28
5. CUMBERLAND GOODWILL FIRE&RESCUE EMS 90.33
6. HIPPENSTEEL'S AUTO RECONDITIONING 135.29
7. EBY GRANITE WORKS ENGRAVING 119.00
8. JONES&MARTIN AUCTIONEERS-COMMISSION ON SALE OF PERSONALTY 15% 150.43
0
TOTAL(Also enter on Line 10, Recapitulation) ; 2,990.95
If more space is needed,inse�t additional sheets of the same size,
REV-1513 EX+(01-10)
� pennsylvania SCHEDULE �
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CHARLOTTE I LEHMAN 21-12-1056
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1• PHYLLIS E BARD, 177 CREEK ROAD,NEWVILLE,PA 17241 DAUGHTER 50%
2. CONNIE L YOUNG, 574 SHIPPENSBURG RD,NEWVILLE,PA 17241 DAUGHTER 50%
ENTER DOLIAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II—ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. �
If more space is needed,use additional sheets of paper of the same size.
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�HARLO�'TE l. LEI�`.���N ���' � ���;
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!, CHARLOTTE !. LENMAN, of 91 Daubling Gap Road, Apartment 204, Newville,
Cumberland County, Pennsylvania, being of sound and disposing mind, mernory and
C,.Ii1C�-G''i•�fiar�t.i��ig� Ui� �IC�ICC� �G�1�i5i1 'c�iiu G��iaiC-: ii,i� aS� o'�t i� �v� ti ji �..a�'��i'iii c'��u �i��iaiil�c�ii�,
hereby revoking and making void any and all former Wills, Codicils, ar writings in the
na#ure thereof, by m� at any time heretafore made.
FIRST: ` I hereby order and direct my Executrix, F�ereinafter named, to pay all
my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate,
Transfer and Succession Taxes, as saon as may be conveniently done after my death,
aut of my residuary estate.
SECtJND. 1 give my entire estate, both real and personal, to my daughters,
: PHYLLiS E. BARD and CONNfE �. YOUNC, in equal s�ares, per stirpes.
THIRD: I have made, or may fram time to time make, a written memorandum
expressing my desire to give certain items o�personal proper�y�o sp�c;i���;p�r�s�r�s. � urg�
my Executar and beneficiaries to respect these wishes. Such a memorandum, if made,
shal! be stored in canjunction with this Wi(l.
�AST�Y: � nominatey constitu#e and appoint �y a�►u�nt��, �{}NNIE �.
YOUNG, ta be the Executrix of this my Last Will and Testament. In the event that the
said CONNIE �. Yt�UNG sha11 be unable ta serve as Execu#rix for any reason, 1 appoint
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my granddaughter, WENDY J. ARMOLD, as Executrix. No Executrix shall be required to
file bond in this or any other jurisdiction.
t1�la
IN WITNESS WHEREOF, I have hereunto set my hand and seal this �--� �day
of �-� , 2008.
� �,���."� (;y�-C�t�'f''•�t c�.�-c.J
Charlotte I. Lehman
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
� - �
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COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
I, CHARLOTTE i. LEHMAN, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
exp ressed.
Sworn or affirmed to �nd acknowledged before me, by CHARLOTTE I. LEHMAN,
the Testatrix, this �`� - day of , 2008.
�,
C��-�-�--�-° <���..�-zt��-�,
Charlotte I. Lehman, Testatrix
Nota Public � - �
.. ��AtENE J.�� ��lOTAR1�
CARUS�,t�lMBERLA �p�PU A.I.IC
MY COMMI�SION EXPiRES JUHE 8,2010
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COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
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We, �'S�b(�-c �. �o�,�G�� � ,� � C-�/-�i��%
,
the witnesses whose names are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
Charlotte I. Lehman, 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 that time 18 or
more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by��Fc�� � �oc,�CrL4S� and
� y� L.� � this 2-q �� day of��„ , 2008
� �
Witness
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W itness
� Not ry Public �- �
HorAR�A�s�►�
MERLENE J. MARHEVKA,NOTARY PUBIlC
CARLISLE,CUMBERLAND COUNTY,PA
MY COMMISSION EXPIRES JUNE 8,2010
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