HomeMy WebLinkAbout12-09-14 J1505610101
REV-1500 EX`°l l°' ���
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individua(Taxes �NHERITANCE TAX RETURN
PO BOX 280601 RESIDENT DECEDENT 21 14 0946 ,
Harrisburg,PA 1'7128-o6oi
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
318- 09/28/2014 10/30/1929
DecedenYs Last Name Suffix Decedent's First Name M�
_._. ._ _
_ _ _
__ _
' LEPPIN ' MATTHEW H
(If Applicabie)Enter Surviving Spouse's Information Below
Spouse's Last Name Su�x Spouse's First Name MI
_ _ _ _ __ _ _ _ _ _
Spouse's Sociai Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum O 2.Supplemental Retum O 3. Remainder Retum(date of death
prior to 12-13-82)
p 4.limited Estate O 4a. Future Interest Compromise jdate of O 5. Federal Estate Tax Return Required
death after 12-12-82}
('� 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will} (Attach Copy of Trust)
Q 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(dale of death O 17. Election to tax under Sec.9113(A)
betweenl2-31-91 and 1-1-95) (Attach Sch.O}
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INfARMATION SHOULD BE�IRECTED 70:
Name Daytime Telephone Number
rv
THOMAS E. FLOWER (717) 243-5513� � � �
� �
REGISTER OF �L�I1SE ONl� G? p
t�l � Cj � � �
�7 �;a,. ('_` �
�^i
tn`t M
First line of address 7�-„ � � � �"�7 �
FLOWER LAW, LLC _ _ _ � c� .,;: � � �
_ __ __ « -�
,-;-} �� �,�y .J
Second line of address . .� c!, � �
10 W. HIGH STREET ` "� � � �
--i r—
City or Post Office State ZIP Code DATE�ILED � fJ� �
CARLISLE PA 117013
Correspondent's e-mai�address: TOM@FLOWER-LAW.COM _
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,
i[is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI RE OF PERSON RES��LE FO NG RETURM DATE
12/09/14
ADDRESS
DONNA M. LEPPIN, 15 CENTER DRIVE, CAMP HILL, PA 17011
SIGNAT � F PREPAJ3E��M1 REPRESENTATIVE DATE
� �_ 12/09/14
ADDRESS
THOMAS E. FLOWER; FLOWER LAW, LLC; 10 W. HIGH STREET; CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 7,505610101 1505610107, �
. �
� 15056101�5
REV-1500 EX DecedenYs Social Security Number
318-22-6824
DecedenYs Name:
RECAPITULATION _ _
1. Reai Estate(Schedule A). ..... .. ............ .............. ..... .. . . . . 1.
180,129.00
314,240.63
2. Stocks and Bonds(Schedule B) ...... ........ ....... ..... .. ....... ... . 2. _ _
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. . . . 3.
0.00
4. Mortgages and Notes Receivable(5chedule D) ...... ... ............ .. .. . .
4 0.00 .
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . ... . 5.
28,404.10
6. Jointly Owned Property(5chedule F) O Separate Billing Requested .. .._. . 6.
0.00
7. Inter-�vos Transfers&Miscellaneous Non-Probate Property 112,610.56
(Schedule G) O Separate Biliing Requested.. . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7)... . .. ..... .....
..:. s. 635,384.29
9. Funeral Expenses and Administrative Costs(Schedule H)...... 31,484.63
... . ... ... .. . 9.
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) .. .. . . . .. . . . . . 10.
730.06
11. Totaf Deductions(total Lines 9 and 10). . 11. 32,214.69
12. Net Va�ue of Estate(Line 8.minus Line 11) .. . . .. .. . .. . . ... .. .. . . . .. . .. . . 12. 603;169.60
13. Charitable and Governmental Bequests/Sec 9113 Trusts for wtiich 0.00
an election to tax has not been made(Schedule J) ... .. .. .... . .. ... ..:. . . . 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) . .. .:. . .... .. .. . . 14. 603,169.60
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
�a)t1.2)X A- 15. _
16. Amount of�ine 14 taxab(e 603,169.60 �g. 27,142.63
at iineal rate X.0 45 _ _ _
17. Amount of Line 14 taxable
at sibling rate X.12 17. _
18. Amount of Line 14 taxable
at collateral rate X.15 ' 18� _ _
_ 27,142.63
19. TAX DUE . .. .. .. . . . ... .. . . . . . . .. . . . . .. .... .. ... ..... . . . .. .... .. . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� ],505610105 15056],0105 J
REV-1500 EX Page 3 File Number 21-14-0946
Decedent's Complete Address:
DECEDENT'S NAME
MATTHEW H. LEPPW _ _
__ _ __
STREETADDRESS
15 CENTER DRIVE __ ____._-_.__ ___—_----- --
__ STATE _ ZIP _
_ __ _
_ _. _ _
c�CAMP HILL PA 17011
Tax Payments and Credits: 2�,142.63
1. Tax Due(Page 2,Line 19) �>>
2. CreditslPayments 25,000.00
A.Prior Payments
B.Discount 1,315.75 26,315.75
Total Credits(A+B) (2)
3. Interest �g�
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (4)
Fiil in oval on Page 2,Line 26 to request a refund.
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. �51
826.88
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN `'X" IN THE APPROPRIATE BLQCKS
1. Did decedent make a transfer and: Yes No
. �
a. retain the use or mcome of the property transferred:.................................-..-..........,....,.-. ....- -- �
b. retain the nght to designate who shall use the property transferred or its income:.........:...............::....::......:.... ❑ �
❑ �
c. retain a reversionary interest;or..................................:.:.....................:...................................................:......... x
d. receive the promise for life of either payments,benefits or care?...........................................:............:...,......... ❑ ❑
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration7............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payab�e-upon-death bank account or security at his or her death?.............. ❑ 0
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 GOMPLETE 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 usejof 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 return are stiil applicable even if the surviving spouse is the oniy 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(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 decetlent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under
Section 9102,as an indivitlual who has at least one parent in common with the decedent,whether by blood or adoption.
REv-rsoz ex+(��.-aa)
� � 4 pennsylvania SCHEDULE A
f
__ DEPARTMENT OF REVENUE REAL ESTATE
INHER[TANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
MATTHEW M. LEPPIN 21-14-0946
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 property
would be exchanged between a wiliing buyer and a willing seller,neither being compe{led to buy or sell,both having reasonable knowledge of the relevant facts.
Reai property that is jointiy-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold. VALUE AT DATE
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. OF DEATH
NUMBER DESCRIPTION
1� HOUSE&LOT, 15 CENTER DRIVE,TAX PARCEL 13-24-0805-056,LOWER ALLEN TWP.,
CUMBERLAND COUNTY,ASSESSED VALUE 185,700 X C.L.R.0.97= 180,129.00
TOTAL(Also enter on Line 1, Recapitulation.) $ 180,129.00
If more space is needed,insert additionai sheets of the same size.
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�� �����le P�ice�$:
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�� Year Built: 1.955
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Primary Exter�or. Aluminum .
�;Baseti�enfi P�ercentag���e . 1,{�� � �
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REV-iSo3 EX+(7-11)
��. _
� � pennsylvania SCHEDULE B
' ;- DEPAFTMENT qF REVENUE STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
MATTHEW H. LEPPIN 21-14-0946
Ali property jointiy owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
NUMEBER DESCRIPTION OF DEATH
1' ASSETS HELD WITHIN STIFEL,NICOLAUS INVESTMENT ACCOUNT#C1414:
41 SHARES AGL RESOURCES INC.@ 51.04 2,092.64
90 SHARES CITIGROUN INC NEW @ 52215 4,699.35
46 SHARES EXELON CORP @ 33.6825 1,549.40
692 SHARES FIRST MIDWEST BANCORP DE @ 16.3625 11,322.85
51 SHARES TRAVELERS COMPANIES INC @ 93.8775 4,787.75
5,745.736 SHARES AMERICAN BALANCED FUND CLASS A@ 25.53 146,688.64
4,111.948 SHARES GOLMAN SACHS RISING DIV GRWTH FUND CL A@ 21'.035 86,494.83
1,943.897 SHARES JP MORGAN VALUE ADVANTAGE FUND CL A@ 29.105 56,577.12
CASH 28.05
TOTAL(Aiso enter on Line 2, Recapitulation) $ 314,240.63
If more space is needed, insert additional sheets of the same size
10/3/2014 9:55 AM
G David Bias
Stifel Nicolaus Co., Inc.
Matthew H Leppin - Date of Death
September 28, 2014
Holdinqs: Approx. Value
1.) Ohio National -Oncore Premier- Non-Qualified Contract
$ 46,133.12
Contract Number: E1238058
Contract Issue Date: 07/09/1998
Total Purchase Payment: $43,660.69
Total Withdrawals: -0-
Annual Step Up Death Benefit Rider: $62,446.81
2_) 41.0000 Shs. AGL Resources Inc.
51.35 $ 2,105.35
3,) 5,745.7360 Shs. American Balanced Fund CI A
25.52 $ 146,631.18
4.� 90.0000 Shs. CitiGroup Inc. New
52.05 $ 4,684.50
5.)
46.0000 Shs. Exelon Corp. 34.11 $ 1,569.06
g,) 692.0000 Shs. First Midwest Bancorp De
16.32 $ 11,293.44
7.) 4,119.3070 Shs. Goldman Sachs Rising Dividend Growth 21.01 $ 86,546.64
Class A
g.) 1,943.8970 Shs. JPMorgan Value Advantage CI A
29_08 $ 56,528.52
g.� 51.0000 Shs. Travelers Companies Inc.
93.77 $ 4,782.27
Dividend/ Interest $ 28.05
10.) Approx. Total $ 360,302.14
Matthew H Leppin, IRA - Date of Death : '
September 2&, 2014
Approx. Value
Holdin_qs: $ 44,514.78
�.) Ohio National -Oncore Xtra- IRA
Contract Number. E1420544
Contract issue Date: 08/22/2001; Total Purchase Payment$83,101.38
Total Withdrawals: $49,885.92 (Taken RMD on 6/20/14 $3,177.02)
Annual Step Up Death Benefit Rider: $51,900.22
Gain Enhancement Benefit Plus-40%-Additional Rider DB$2,094.71
2.) The Hartford -The Director Plus Variable Annuity-Series 1 - IRA $ 21,962.66
Contract Number: 711163933
Purchase Date: 04/11/2002
Total Purchase Payment: $48,308.59
Totai Withdrawals: $22,740.45 (Taken RMD in June 2014$2,067.20)
Approximate Death Benefit Value: $45,839.72 qpprox. Total $ 66,477.44
"This performance summary is designed to provide information to help you evaluate your investments.
The information and statistical data contained herein have been obtained from sources we believe to be
reliable, but no independent verification has been made, and Stifel Nicolaus does not guarantee its
accuracy and completeness. Consequently, you must rely on your monthly Stifel Nicolaus.
statements and trade confirmations as your official record of transactions with us."
1
REV-15D8 EX+(11-10)
��� pennsylvania SCNEDULE E
�" � � CASH, BANK DEPOSITS &MISC.
- DEPARTMENT OFREVENUE
�� � INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
FILE NUMBER:
ESTATE OF: 21-14-0946
MATTHEW H. LEPPIN
Inciude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
�, METLIFE TOTAL CONTROL ACCOUNT#4057496196
8,995.58
2.
CITIZENS BANK CHECKING ACCOUNT#"*'""'5379-9 2,092.44 ,
3.
PNC BANK CHECKING ACCOUNT#51-1354-7523 17,316.08
TOTAL(A�so enter on Line 5, Recapitulation} $
28,404.10
If more space is needed,use additional sheets of paper of the same size.
Performance Checking Statement �PNCBANK
PN C Bank
Primary account num6er:51-1354-7523
Page 1 of 4
For the period 09/76/2074 to 10/15/2074 Number of enclosures:0
000669 p For 24-hour banking,and transaction or
�'��' MATTHEW LEPPI N DECD �interest rate information,sign on to
��t 15 CENTER AR PNC Bank Online Banking at pnc.com.
CAMP HILL PA 17011-7605 Q Forcustomerserviceca111-888-PNC-BANK
Monday-Friday:7 AN]-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espanol, 1-866-HOlA-PNC
Moving3 Please contact us at 1-888-PNC-BANK .
� W rite to:Customer Service
PO Box 609
' 1 Ilijl�Uil��i H iJLJL-J.'�JV
�Visit us at PNC.com
� TDD terminal: 1-800-531-1648
For hearing impaired clients only
Matthew Leppin Decd
Performance Checldng
Interest Checldng Account Summary
Account number: 51-1354-7523
Overdraft Protection has not been established for this account. :
Please contact us if you would like to set up this service.
�verdraft Coverage-Your account is currentlyOpted��ut.
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraksalutions:
Call 1-877-5883605,visit any branch,or Sign on to PNC Online Banking,and setect the"OverrJraft
Solutions"link underthe Account Services section to manage both your Overdraft Coverage and Overdreft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
17,794.3� 3,530.14 14,619.60 6,704.86
Avera9e monthly Charges
balance and fees
12,895.30 .00
rransaction Summary
Checks paid/ Check Card POS Check Card/Bankcard
withdrawals signed transactions POS PIN transactions
7 p o
Total ATM PNG Bank Other Bank
transactions ATM transactions ATM transactions
p p 0
As of 10/15,a tota I of$1.13 in interest was
Interest Summary paid this year.
Annual Percentage i N�et Rst peaod balance for'APYE InthreSPen°d
Yield Earned(APYE)
0.01% 30 12,895.30 .11
�
�,.�.,..�T,,, �„�.,..,,,,,- �.,. ,.�.�.�.�.,.�...... ...........
Performance Checking Statement
For the period 09/16/2014 to 10/75/2074
MATTHEW LEPPIN DECD
n For 24-hour information,sign on to PNC Bank Online Banking Primary account number:51-1354-7523
��on pnc.com. Page 2 of 4
Account number:51-1354-7523-continued
pctivity Qetail
There were 5 Deposits and Other Additions
Deposits and Other Additions totaling 53,530.14.
Date Amount Description
09j?6 155.75 Sign Unauthorized Retui�Ck OOOOOOOU0001�38
Effective 09-�5-14
09/26 55�.00 Sign Unauthorized Retuin Ck 000000000001�40
Effective 09-�5-1�
10/Ol 1,'��5 9H Duect Deposit-Retuemznt
Liberty Mutua10166G70
10 j 03 1,417.00 Direct Deposit-lxsoc Sec
SSA Treas S10?�?'�.1.1.1682`4A
10/15 11 Interest Payment
Cheeks and Substitute Cheeks check Date Reference
Check Date Reference number Amount paid number
number Amount paid number
q 15.0� Oy�99 086833�l�k3 1�'�� 532.00 09/25 08553�k1i5?
13_8 1341 329.66 09/26 o�sooai5
1337'* 40.54 09j 29 Os5o�53a � 109.Q1 10/O1 Os5?795Jo
155.75 09/?5 o�5siioi�+' 1'`�-
1�3�s :, . . � lj,�� 151.70 10/0� 077451521
1339 . 58.65 09/25 o753oiso3. '�`
There were 8 checks listed totaling
* Gap in check sequence $7,39229.
There were 3 Online or[lectronic Banking
Online and Electronic Banking Deductions Deductionstotaling$3,227.3t.
Date �� Amount Description ' � , , �� � � � .
09,/�5 34.41 Payrnent,E-Ct�eck Payrnents Vei-iion Financia 1�SG
10,.%0? 1,775.90 Paprnent,E-Gheck Payments Discover t�RG 13,4�
10/10 1,�17.00 Duect Paf�n�ent-Reversal
SSA Treas 3101.1.�.1X682�1-1
There was 1 Other Deduction totaling
Other Deductions $70,000_uo.
Date Amount _Description
10/0� 10,000.00 Withdrawal Reference No. 04606�6�44
Daily Balanee Detail Date Balance Date Balance
Date ea�ance Date ealance � 6,856.45 10/15 6,704.86
� 09 25 16,957.99 10/0.,
U9/16 17,794.3, � 5,1�1.75
99 17,779.3� 09/�6 17,316.08 10/0�
09/__ � 10 lU 6,704.75
pg��� 17,73�.7£3 10/O1 18,63.,.35 /
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��� '�„� �������� ���� i-888-910-4100 Checking Account
P.O.BOx 7000 � Catl Citizens'PhoneBank anytime for Statement
ROP450 account information,current rates and
PfOvldence,RI 02940 answers to your questions. Q
OF 1
Beginning September 25, 2014
through October 24, 2014
AV 01 057334 00739B184 D4#5DGT
I���'��I�I�I��1�"��II���I��I��1111��1���11�1�1��1���11���111'�II
MATTHEW LEPPIN
15 CENTER DR
CAMP HILL PA 17011-7605
d
r
US102 �
Checking `
MATTHEW LEPPIN
SUMMARY
Green Checking
Balance Calculation XXXXXXX537-9
Previous Balance 2,�9z•4�*
Checks .Q0 -
Withdrawals & Debits- .OQ - _
pepasitr& Credifis '.00 + _
Current Balance 2,Q42•44 -
You can waive the monthly maintenance fee of$9.99 by maintaining an average daily balance in -
your account of$1,500 or by making 5 qualifying transactions that post to your account during _
the statement period. _
Your average daily balance used to qualify this statement period is: $2�090 —
Your number of qualifying transactions this statement period is: _
A Senior waiver is active on your ac�ount so monthly maintenance fees -
are not currentLy being assessed. _
Your next statement period will end on November 26, 2014_ Previous Balance =
2,092.44
TRANSACTION DETAILS
No activity this statement period Current Balance
2,092_44
MEMO
--We re making changes.
Please read the enclosed insert for important information that will help make it easier to
manage your account and learn about changes to our Funds Avaitabitity Policy, effective
December 8, 2014.
NEWS FROM CITIZENS
--Do you, a fiend or family member have student Loan debt? You could reduce your monthly
payments and save money by refinancing your student loans today. Catl a loan specialist at
1-888-333-0128 or visi t www.c i t i z e n s b a n k.c o m/educationrefinanceloan to find out if our new
Education Refinance Loan is right for you.
-We all have savings goais.Whether iCs a new home, a child's education, redrement or
preparing for unexpected expenses, Citizens Bank makes it easy and rewarding for you to `
start saving_We have a range of solutions from savings accounts, money markets, CDs and
IRAs,to fit your needs. For more information on which accounts and programs are right for
you or to open a new account, call us at 1-888-821-3900, visit citizensbank.com, or stop by
your local branch_
Mem6er FOIC Q Equal Housing lender
REV 1510 EX+(08-09)
�� 9���. SCHEDULE G
:. � .�� pennsylvania
: DEPARTMENT OF REVENUE INTER—VIVOS TRANSFERS AND
m � iNHearraNceraxRETURru MISC. NON—PROBATE PROPERTY
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF 21-14-0946
MATTHEW H. LEPPIN
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 QF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
ITEM IN0.WE THE NA�ff OF THE TRANSFEREE,1HEIR RELATIONSHIP TO DKEQENT AfdD VALUE OF ASSET INTEREST �tF arPucaa� VALUE
NUMBER IFIE DATE OF iRANSFER. AiTACIi A C.OPY OF iHE�EED WK REAL ESTATE.
1. OHIO NATIONAL LIFE INS.C0.QUALIFIED ANNUITY CONTRACT 44,518.38 100 44,514.78
#E1420544,PAYABLE TO DONNA M.LEPPIN
2 OHIO NATIONAL LIFE INS.C0.VARIABLE ANNUITY CONTRACT 46,133.12 100 46,133.12
#E1238058,PAYABLE TO DONNA M.LEPPW
3 HARTFORD LIFE&ANNUITY VARIABLE ANNUITY CONTRACT 21,g62.66 100 21,962.66
#711163933,PAYABLE TO DONNA M.LEPPIN
TOTAL(Also enter on Line 7, Recapitulation) $ 112,610.56
If more space is needed,use additional sheets of paper of the same size.
REv-1511 EX+(10-09j
��, SCHEDULE H
� � �� pennsylvania
DEPARTMENT OF REVENUE FU N ERAL EXPE N SES AN D
INHERCfANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MATTHEW H. LEPPIN 21-14-0946
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' MYERS BUHRIG FUNERAL HOME,PROFESSIONAL SERVICES 5,840.00
2. FACILITIES,STAFF AND EQUIPMENT 1,250.00
3. VEHICLES 984.00
a. MERCHANDISE 3,895.00
5. CASH ADVANCES 2,568.10
g, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City _ State ZIP
Year(s)Commission Paid: _ _
12,500.00
2. Attorney Fees
3,500.00
3. Family Exemption: (If decedenYs address is not the same as daimant's,attach explanation.j
Claimant DONNA M. LEPPIN _ __ __
Street Address 15 CENTER DRIVE _
Gty CAMP HILL _ __ ___ _ _ State PA ZIP 17011 __ _
_ . _ _
Relationship of Claimant to Decedent DAUGHTER _ __ __
_
4, Probate Fees:
5. Accountant Fees: 570.50
6. Tax Return Preparer Fees:
7. PUBUCATION OF ESTATE NOTICES 265.54
a. RECORDER OF DEEDS,FILING FEE 80.00
s. USPS,REGISTERED MAIL RETURN RECEIPT FOR SAFE DEPOSIT BOX NOTICE 6.49
�a BANK FEE 25.00
TOTAL(Also enter on Line 9, Recapitulation) $ 31,484.63
If more space is needed,use additional sheets of paper of the same size.
� •
i�i�� e�s : �j u�C�ri
y
Funerul Homf .., Crematory �a.
Customer ,.. .. _. �.' � :� : �- . . .' . . . � ��� ���
Donna Leppin
15 Center Drive
Camp Hill, PA 17011 Invoice Number: 11345
Invoice Date: Sep 30,2014
Page: 1 '
�� uace uiueaEi�' �rayineni ie.rms � runerai uirector �`
"„�vame;ot i,�ceas�a ��'= . _ . _ ,
Matthew Leppin September 28, 2014 � Net 30 Days William L. Christopher
Item Number ' Quant�ty '. Description Unit Price ; :°Amount ,
_.` ,.. .. . �° ; . . �.�
pS Professional Services $ 5,840.00
FSE
Facilities, Staff and Equipment $ 1,250.00
V
Vehicles $ 984.00
Merchandise $ 3,895.00
M $ 2,660.00
CA . Cash Advances
$ 91.90)
CA Cash Advances Adjustment- Newspaper'Obituary �
Save $808.00 by paying this invoice by October 30, 201.4. _ - --
Please pay$13,729.10. _
ank ou for allowin us to serve ou and our famil .
Subtotal $ 14,537.10
Shipping $ 0.00
We gladiy accept the following forms of payment: Sales Tax $ 0.00
Cash, Check, Vsa, MasterCard, Discover,American Express 14,537.10
Total Invoice Amount $
Kind�y make your,check payable to: 0 00
Myers-Buhrig Funeral Home and Crematory PaymenUCred�t Appl�ed � �
� � � � p � TOTat�DUE ,-�'�.:" . . . � �� " ^$ 1.4��3710;;
Past due accounfs are subject ta interest charges of 1.5/o per month.
WalkinJ with Those in Grief
Robert"Bob"L.Buhrig,,TI".,FD.Supervisor•William"Bill"L.Christopher,FD
Pllone: (�i�)766.3421 • Fax: (�i�)79�J291 • 37 East Nlain Street • Niechanicsburg,PA 17055 • w�vw.Niyers-Buhrig.com • Directors@N(yers-Buhna.corn
REV-1512 EX+(12-08j
� � pennsylvania
SCHEDULE I
� OEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHER[TANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MATTHEW H. LEPPIN 21-14-0946
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION
1� HOLY SPIRIT HOSPiTAL 198.06
2. H.B.McCLURE PLUMBING&HEATING 532.00
TOTAL(Also enter on line 10, Recapitulation) $ 730.06
If more space is needed,insert additional sheets of the same size.
��.�� �iI.1 �.�t� �����mr��.
OF
MATTHEW H. LEPPIN
I, MATTHEW H. LEPPIN, of 15 Center Drive, Camp Hill,
� Cumberland County, Pennsylvania, do make , publish and declare this _
� to be my Last Will and Testament, hereby revoking all prior Wills
and Codicils by me at any time made.
� l. I direct that all estate and inheritance taxes, and
� interest and penalties thereon, which may be due and: pagable by
I
' reason of my death with respect to any property incl�ded in my ;
gross estate for �ax purposes, shall be paid by my Executi�ix as
an ex�ense and cost af ar.lmini_stration of_ rnl estateo My Executri.x
sr:a]_1 h�ve no duty ar obligation. to o�tairs reimbursemen.t for any
a such tax so paid, even thou�h on proceeds of insurance or other
f property not passing under this Will. In the absolute discretion
�
� of my Executrix, she shall pay such taxes immediately or. may
� postpone the payment of taxes on . future or remainder interests
until the time possession thereof accrues to the beneficiaries.
2 . I direct my Executrix to pay. the expenses of my last
illness and funeral expenses from the property passing under
e� ►-� � �
this Will as an expense and cost of administration � �y es�at� o �
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3. I give , devise and bequeath all the rest, residue and
remainder of my estate unto my wife, BARBARA LOUISE LEPPIN ,
regardless of the survival of any of my children, born before or
after execution of this Will, provided she survives me by Thirty
(30) days.
4 . Should my wife, BARBARA LOUISE LEPPIN, fail to survive
me by Thirty (30) days, I give my entire estate to my daughter,
DONNA MARIE LEPPIN.
5. The interests of the beneficiaries of this Will, until
actually distributed, shall not be subject to anticipation or
to vol.untary or involuntary alienation.
� 6 . I appoint my wife, BARBARA LOUISE LEPPIN, to be the
�
Executrix of this my. Last Wil.l anc+ Testament�e If , for any .reason, �
she is unable to complete her duties as Ex�cutrixP I a_ppoin� my' {
S
dat�g�ite r , �70NNA MAP.IE LEPP IN� as Executrix e �
� IN WITNESS WI�EREOF, I ha�e to this my Will .set my hand and
� y
seal this ��� daY of ��;-t:-.,..1-:=z� . 1982.
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�Matthew H. Leppin .
- 2 -
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_________-
---__ _ _
_ _
signed, sealed, published and declared by the above-
named Testator, MATTHEW H. LEPPIN, as and for his Will , in
the presence of us , who, at his request, in his presence,
and in the presence of each other, have hereunto subscribed
�.eur names as witnesses in attestation thereof.
''.\ � � .-__ r
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�, .�;:r�'��✓ � .��'z.�..s� Address 7G: �-s r'�;.'`f i ����-,����
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,�-.��� c�='� �' Ad dr e s s ��'�- ,��,,,...-�'� :�'� � _ � _ /
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ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
. SS. .
COUNTY OF CUMBERLAND )
We, MATTHEW H. LEPPIN, Testator and the undersigned
witnesses, respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority-. that the Testator signed' . _
; and executed the instrument as his Last Will and that MATTHEW H'.
s LEPPIN signed willingly, and that he executed it as his free
and voluntary act for the purposes therein expressed, and F
that each of the witnesses, in the preser�ce and hearing oi k
the Testator signed the Wii1 as witness' and tha.t to the E
best nf his knowledg.e the Testa�or_ was at that time eic�hteen �
years of age or old2ro of sound mind and under no cor�str_aint �
or uzidue inf_luence a
_ .'
' s:'!� '�-r� ...,, i�� .,,�,%��`;.:-,.�..- �SEAL)
� _ ! _
� _Matthew H. Leppin, Testator
..�
I �'� �
`,,_.�_� •�`,/d ;,�' W� �r�_ (SEAL)
i �,. '` itness
f, f' ; �� � ;!
.._ �Y� ,
""; �:����`r� (sEAr.,)
-�/--' Witness
Subscribed, sworn to and acknowiedged before me by MATTHEW H.
LEPPIN, the Testator, and subscribed and sworn to before me
b y �. ►=SL,a.�,..k--� ��- - an d �.«.�.:�Q, �. K �--
witne�, this �.� �^'�- day of ;�.�. , 19 g2 -
�. �� _,. _ ��-�.�
Notary lic`�j�
NpTARY PUBLIC
My Commission Expires Dec. 21, 1885
Lemoyne. Pa. Cumbedand Cquntx
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