HomeMy WebLinkAbout05-06-05
The Law Office of
MARIELLE F. HAzEN
1J -bS-041 G Attorney at Law
Certified Elder Law Attorney by the National Elder Law Foundation
2000 Linglestown Road
Suite 303
Harrisburg, PA 17110
TEL: (717) 540-4332
FAX: (717) 540-4313
www.hazenelderlaw.com
May 3, 2005
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Charlotte K. Lipsett
Inheritance Tax
Social Security No. 165-22-7376
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To: The Register of Wills:
Enclosed please find a Death Certificate and a check in the amount of Six
Thousand Dollars ($6,000.00) which represents early payment of the inheritance tax
regarding Charlotte K. Lipsett, Deceased. Please note that an estate will not be opened as
there are no probate assets. However, an inheritance tax return will be filed by
November 25,2005.
Please forward the receipt for this payment to my office in the enclosed envelope.
If you have any questions or need anything additional, please do not hesitate to contact
our office.
Enclosure
cc: Bob Lipsett
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
LIPSETT ROBERT J
2901 BUTLER STREET
HARRISBURG, PA 17103
n_nn_ fold
ESTATE INFORMATION: SSN: 165-22-7376
FILE NUMBER: 2105-0416
DECEDENT NAME: LIPSETT CHARLOTTE K
DATE OF PAYMENT: 05/06/2005
POSTMARK DATE: 05/04/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 02/25/2005
NO. CD 005296
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $6,000.00
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TOTAL AMOUNT PAID:
REMARKS: R J LIPSETT
CHECK# 1347
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$6,000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
H 105.805 REV 1/05
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. .
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~I?~'
Local Registrar
Fee for this certificate, $6.00
p
11334530
FEB 2 8 2005
Date
lb. Cumber land
DECEDENT'S USUAL OCCUPATION
(C:--==:~~~:r
110. Housewl.re l1b.
DECEDENT'S MAILING ADDRESS (SIreet, CilylTown, Slat., Zip~)
801 North Hanover Street
18. Carlisle,Pa 17013
FATHER'S NAME (FilS!, MiddI., last)
18. Robert Stuck
INFORttt~M'tE 'C~ t t
201.
METHOD OF DISPOSITION
OoneIIon D BurIeI DO Cremation ORemovol 110m Sial. D
21 0IheI (Specify)
. S NATUR N~
Ie.
Carlisle
Church of God Nursing Home
S DECEDENT EVER IN DECEDENT'S EDUCATION
U.S ARMED FORCES? ..
Ves 0 No lID 11~";.)
12.
17L Sial. Pa
Cumberland
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Hl05.143 R.v. 2187
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
'PRINT
N
ANENT
KINK
I. 87 Yrs.
COUNTY OF DEATH
SEX
2. Female
STATE FILE HUMBEft
SOCIAl SECURITY NUMBER
:1,165 - 22
7376
NAME OF DECEDENT (Fnt, Middle. Lest)
1. Charlotte K.Lipsett
AGE (lest Birthdey)
BIRTHPLACE (Cily and
Stata 01 Fonlign CounIIy)
7. Berlin Pa :;-.... (j
FACllITV NAME (If not institution, give slreel and numbel)
ERJOulpo....D
OOAD
R-D ~) D
RACE - American Indien, Black, Wlite, at
(Specify)
10. White
SURVIVING SPOUSE
(Ifwite, s;ve lMIdtn n_me)
~I
KIND OF BUSINESS IINDUSTRV
17b. County
Did
decedent
Nve in a Mi No, decedent lived
township? 17d. L.:.J wittin actual limits of
MOTHER'S NAME (First, MidcIe, Malden Surname)
11. Nellie Kinmel
:~rB~~E~g~:erITIfu;ri'~~) Pa 17103
PLACE OF DISPOSITION. N""", of CemeleIy, CremelOfy lOCATION - CilylTown, SI8I8, Zip ~
or Other Place
21c. Resurrection Cemetery
NAME AND ADORESS OF FACILITY
u.M ers-Harner Funeral Home Inc
LICENSE NUMBER DATE SIGNED
(~DeJ' Vew)
Ub ,J/' 3 S'7 L 2~~
WAS CASE REFERRED TO A MEDICAl EXAMINER JCQRONER?
28. Ves D No g./
....... -........ . Approximat PART II Other significant condilionl contributing 10 deeth, but
Woi ~ ,~t ~::':"and:u. : not relUting ill tile urdertyl11g couse given "' PART!
MARITAl STATUS - M_,
Ne~~ed,
14. Widowed
170. D Ves,_livedill
Iwp.
DECEDENT'S
ACTUAL
RESIDENCE
(See instruction.
on__)
Carlisle
cityJboro
21d. Harrisburg, Pa.
~Tm
a.
CUET (
~aHy is! conditions b.
Wany, leading to ilnmediate I c.
. . caus.. EnteI UNDERLYING
CAUSE (Di..... or irjury
. . that Initiated events
nesuIIing on deall1 ) LAST d.
WAS AN AUTOPSV \\ERE AUTOPSV FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
o (OR AS
ONSEQ
EOf):
oueTO( AS CONSEQ
OF)'
MANNER OF DEATH
NoD
Nalu101
Accident
Suictde
o
D
o
DATE OF INJURV
(Month, o.y, Yew)
TIME OF INJURV
INJURV AT 'I'oQRK? DESCRIBE HOW INJURV OCCURRED.
VesO
Homicide
Pending Investigation
Could not be detennined
o
o -DNoD
O 300. 3Gb. M. SOC.
PLACE OF INJURY - AI home, larin. street, factoty, olIk:e
bolding, etc. (Specify)
3Oe.
21.
p.o.
pa,)
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