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Home My WebLink About01-16-14 (2) � REV-1500 E"c°,-,o' 1505610143 � OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code vear File Number Bureau of Individual Taxes DEPARTMENTOFREVENUE Po Box.2soso� INHERITANCE TAX RETURN 2 1 13 0 6 2 6 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 04 18 2013 05 27 1923 DecedenYs Last Name Suffix DecedenYs First Name MI LIPPLRT MARY A (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 Retum ❑ 2. Supplemental Retum � 3.Remainder Return(date of death priorto 12-13-82) � 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required (date of death after 12-12-82) � g Decedent Died Testate � � Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) � 9. Litigation Proceeds Received ❑ ��•beiweeniz 31 si anditid;t�e5of death � ��.Election to tax under Sec.9113(A) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARTIN R WILSON 570 523 �.],62 � � REQ�$�2 OF WItLS USa�O�Y � rri � c� ''� ..�_� � First line of address � Ax � � � � 222 MARKET STREET � �n � � .•�.� r7 � �? -e-o -•"� Second line of address � C� � --3 µi."' --T � � �, _..::. ,-',> . � C"� �`.. 1�^i ""bATE FI E ' r,� City or Post Office State ZIP Code �„ LEWISBURG PA 17837 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is Vue,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN URE OF PERS ESPONSI LE FOR FILI URN DATE �, �Xe� JONATHAN D. LIPPERT „� !,y ZOf RESS 4413 SAYBROOK LANE, HARRISBURG, PA 17110 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE MARTIN R WILSON p � ,S Za> A DRESS 222 MARKET STREET, LEWISBURG, PA 17837 Side 1 L 1505610143 1505610143 J � 1505610243 REV-1500 EX DecedenYs Social Security Number Decedent�s Narne: L I P P E R T� M A R Y A L I C E 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 Personai Property(Schedule E)................ 5. 8 , 5 5 4 . 8 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 1 , 1 0 2 , 2 16 . 3 4 (Schedule G) ❑ Separate Billmg Requested............. 7. 8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 1 , 1 1 0 , 7 7 1 . 2 1 9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 1 2 , 16 6 . 1 1 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 1 , 7 5 0 . 6 9 11. Total Deductions total Lines 9 8�10..................................... 1 3 , 9 16 . 8 0 ( ) ................................. 11. 12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 1 , 0 9 6 , 8 5 4 . 4 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. 13. 2 6 6 , 4 4 5 . 2 7 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. �4. 8 3 O , 4 0 9 . 1 4 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal ta�c rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 16. Amount of Line 14 taxable at lineal rate X •045 16. 17. Amount of Line 14 taxable at sibling rate X .12 ��• 18. Amount of Line 14 taxable at collateral rate X .15 8 3 0 , 4 0 9 . 14 1 S. 12 4 , 5 6 1 . 3 7 19. Tax Due..................................................................................................................... 19. 1 2 4 , 5 6 1 . 3 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 � 1505610243 1505610243 � REV-1500 EX Page 3 File Number 21 - 13 - 0626 Decedent's Complete Address: D NT' NAM LIPPERT, MARY ALICE STREET ADDRESS 5225 WILSON LANE, SUITE 306 CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,�ine 19) (1) 124,561.37 2. Credits/Payments A. PriorPayments 114,000.00 B. Discount 6,000.00 Total Credits(A +B) (2) 120,000.00 3. I nterest (3) 0.0 0 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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) 4,5 61.3 7 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?.............................................................. ❑ Ox 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?...................................................................................................................... ❑ 0 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 Jul 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.§91�6(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 refurn are stilf 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)(9.2)]. •The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,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 decedenYs siblings is 12 percent[72 P.S.&9116(a)(1.311. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blooa or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTHOFPENNSYLVANIA PERSONAL PROPERTY INHERITANCETNCRETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF LIPPERT, MARY ALICE 21 - 13-0626 Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorsh�p must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 PSECU CHECKING ACCOUNT 1,675.94 2 PSERS, FINAL RETIREMENT PAYMENT 1,128.46 3 CARLISLE SENTINAL, REFUND 86.18 4 MILLER INSURANCE, RENTER'S INSURANCE REFUND 35.00 5 BETHANY VILLAGE, REFUND 1,993.00 6 COMCAST, REFUND 25•�2 7 CHARITABLE REMAINDER UNITRUST OF MARY ALICE LIPPERT, TRUST DISTRIBUTION 3,587.79 8 PINNACLE EMERGECY DEPARTMENT, REFUND 22•78 TOTAL(Also enter on Line 5, Recapitulationj 8,554.87 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS � INHERITANCE TAX RETURN RESIDENTDECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF LIPPERT, MARY ALICE FILE NUMBER 21 - 13-0626 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET INTEREST (IF APPLICABLE) and the date of trensfer. Attach a copy of the deed for real estate. 1 WADDELL& REED, ACCOUNT NO. 00035510619, 835,��.o� 835,771.07 TOD TO MARY J. LIPPERT-COLEMAN, WILLIAM J. LIPPERT, TIMOTHY A. LIPPERT, MARGARETTE C. LIPPERT-MORTON, LOIS E. LIPPERT, KAREN N. LIPPERT, JONATHAN D. LIPPERT, JOHN T. LIPPERT AND ESTATE OF MARY ALICE LIPPERT 2 WADDELL 8� REED, ACCOUNT NO. 00032435420, 266,445.27 266,445.27 TOD-84%TO UNITED METHODIST STEWARDSHIP FOUNDATION; 15%TO PFLAG; 1%TO SAMARA FOUNDATION OF VERMONT, INC. 3 TOTAL(Also enter on line 7, Recapitulation) 1,102,216.34 S(��ULE H FIA�RAL Dff�NSES& CONMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ��T�� RESIDENT DECEDENT FILE NUMBER ESTATE OF LIPPERT, MARY ALICE 21 - 13 -0626 Debts of decedent must be reported on Schedule I. ITEM AMOUNT NUMBER FUNERAL EXPENSES: DESCRIPTION A. 1 BETHANY VILLAGE, MEMORIAL SERVICE FEES 388.00 2 AUER CREMATION SERVICES 3,381.26 3 REV. MICHAEL MINNNIX, FUNERAL SERVICE 100.00 4 WESTMINSTER CEMETERY 1,575.00 B. ADMINISTRATIVE COSTS: �, Personal Representative's Commissions Name of Personal Representative(s) JONATHAN D. LIPPERT 2,000.00 StreetAddress 4413 SAYBROOK LANE City HARRISBURG State PA Zip 17110 Year(s)Commission paid 2. Attorney's Fees WILSON &WILSON 2,000.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 343.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 ISAAC'S DELI, MOVING CREW LUNCHEON 103.19 TOTAL(Also enter on line 9, Recapitulation) 12,166.11 Schedule H Fur�eral E�er�ses& COMMONWEALTH OF PENNSYLVANIA w�M�M A__L�n� INHERITANCE TAX RETURN i•xa�a��auauv�tAb'6 RESIDENT DECEDENT FILE NUMBER ESTATE OF LIPPERT, MARY ALICE 21 - 13-0626 2 THE SENTINEL, ADVERTISING GRANTING OF LETTERS TESTAMENTARY 200.16 3 CUMBERLAND LAW JOURNAL, ADVERTISING GRANTING OF LETTERS 75.00 TESTAMENTARY 4 LAIRD S. GEMBERLING, II, PROFESSIONAL SERVICES FOR 2007-2012 2,000.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTHOFPENNSYLVANIA LIABILITIES, 8� LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF LIPPERT, MARY ALICE 21 - 13-0626 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 OMNICARE, BALANCE DUE 663.92 2 PSECU,VISA PAYMENT 101.18 3 PSERS, REIMBURSEMENT OF OVERPAYMENT OF RETIREMENT BENEFITS 263.78 4 PINNACLE HEALTH, BALANCE DUE 42.91 5 AT&T, BALANCE DUE 35.90 6 PENNSYLVANIA DEPARTMENT OF REVENUE, 2012 INDIVIDUAL INCOME TAXES DUE 575.00 7 PENNSYLVANIA DEPARTMENT OF REVENUE, 2013 INDIVIDUAL INCOME TAXES DUE 68.00 TOTAL(Also enter on Line 10, Recapitulation) 1,750.69 REV-1513 EX+(11-08� SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIPPERT, MARY ALICE FILE NUMBER 21 - 13-0626 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee�s) I� TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 John T. Lippert Nephew 1/9 OF ESTATE 908 Main Street Akron, PA 17501 2 Jonathan D. Lippert Nephew 1/9 OF ESTATE 4413 Saybrook Lane Harrisburg, PA 17110 3 Karen N. Lippert Niece 2/9 OF ESTATE 50 Easfinrick Lane Carlisle, PA 17015 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 UNITED METHODIST STEWARDSHIP FOUNDATION, 303 MULBERRY DRIVE, 223,814.03 MECHANICSBURG, PA 17050 2 SAMARA FOUNDATION OF VERMONT, INC., BURLINGTON, VT 05402 2,664.45 3 PFLAG, PFLAG NATIONAL OFFICE, 1828 L STREET, NW, SUITE 660, WASHINGTON, 39,966.79 DE 20036 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 266,445.27 REV•1613 EX+(9-00) SCHEDULEJ COMMONWEALTHOFPENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIPPERT, MARY ALICE FILE NUMBER 21 - 13-0626 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not Llst Trustee(s) I� TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 4 Lois E. Lippert Niece 1/9 OF ESTATE 6481 Lyters Lane Harrisburg, PA 17111 5 Margarette C. Lippert-Morton Niece 1/9 OF ESTATE 3245 Tearose Lane Charlottesville, VA 22903 6 Timothy A. Lippert Nephew 1/9 OF ESTATE 76 Anderson Street Portland, ME 04101 7 William J. Lippert Nephew 1/9 OF ESTATE 2751 Baldwin Road Hinesburg, VT 05461 8 Mary J. Lippert-Coleman Niece 1/9 OF ESTATE 518 Lily Lane Mechancisburg, PA 17050 Page 2 of Schedule J