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09-17-09 (2)
J 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 9 0 0 4 4 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 2 2 8 7 1 9 3 1 2 2 3 2 0 0 8 0 2 2 3 1 9 3 8 Decedent's Last Name Suffix Decedent's Firs t Name MI W I L B U R S H I R L E Y J (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 a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number R I C H A R D P M I S L I T S K Y 7 1 7 2 4 1 6 3 6 3 Firm Name (If Applicable) First line of address 1 W E S T H I G H S T S U I T E 2 0 8 Second line of address P 0- B O X 1 2 9 0 City or Post Office C A R L I S L E Correspondent's a-mail address State ZIP Code ev REGISTER[Ox~LLS USE~ObILY _T~ c7 r ~ ~ _ ~;~ - - 1 _.e. -1 -.J -:-, -n - .- ~~ ., DATE FILED '~ l ;'+'r ~....~ `.,J ;_a r_} ~? _~ _~ f c`~ P A 1 7 0 1 3 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and tc 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 f~UR, EAF PERZ~N RE, SPQNSIBLE R FILING RETURN ~/~~ pqT~ AD l ~ ~ I/ ~Q l~/ [~/~l `~ ~ ~" 1. /~ ~~ . G ~aJ v PJ SIGNATURE F EP ER OTHER T N ItNTA~V /' _ DATE FORM ONLY Side 1 1505607121 1505607121 1505607221, REV-1500 EX Decedent's Social Security Number decedent's Name: S H I R L E Y J W I L B U R 2 0 2 2 8 7 1 9 3 RECAPITULATION 1 0. 0 0 1. Real estate (Schedule A) 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. J, 0 0 0 0 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 1 4 6 3 9 . 1 8 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 6 4 9 3 8 5 4 (Schedule G) ~ Separate Billing Requested .... ... 7. . 8. Total Gross Assets (total Lines 1-7) g. 8 9 5 7 7 7 2 9. Funeral Expenses ~ Administrative Costs (Schedule H) .......... ... 9. Ir ]r I 1 3 3 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. 7 8 L 0 0 11. Total Deductions (total Lines 9& 10) ...................... ... 11. 1 1 8 9 4 3 5 12. Net Value of Estate (Line 8 minus Line 11) 12. 7 7 6 8 3 • 3 7 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. 7 7 6 8 3 . 3 7 TAX COMPUTATION -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 _ 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 7 7 6 8 3. 3 7 16. 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18 19. Tax Due 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O. o 0 3 4 9 5. 7 5 0. 0 0 0. 0 0 3 4 9 5. 7 5 a Side 2 1505607221, 1505607221 REV-~ 500 EX Page 3 Decedent's Complete Address: File Number 21 09 0044 DECEDENT'S NAME SHIRLEY J. WILBUR STREET ADDRESS 404 West Keller Street CITY STATE I ZIP PA Mechanicsburg 17055 Tax Payments and Credits: ~. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty 5, 000.00 174.79 0.00 0.00 (4) 1,679.04 (5) 0.00 (5A) (58) 0.00 (1) 3,495.75 Total Credits (A + B + C) (2) 5,174.79 Total InteresUPenalty (D + E) (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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable fo: 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; ... . . ...... . . ..... ^ 0 c. retain a reversionary interest; or ............................................................ ::: ::::: : :: :: ^ d. receive the promise for life of either payments, benefts or care? .................................................. ..... ^ ^X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ 0 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. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (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 twenty-one years of age or younger at death to or for the use of a natural parent, an adaptive parent, or a stepparent of the child is zero (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 four and one-half (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 decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 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 willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real orooerty which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH None 0.00 TOTAL (Also enter on line 1, Recapitulation) ~ $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH None TOTAL (Also enter on line 2, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1504 EX + (6-98) ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Not Applicable TOTAL (Also enter on line (If more space is needed, insert additional sheets of the same size) REV-1507 EX + (6-98) , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 All properky jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) ' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2003 Ford Escape 10,000.00 TOTAL (Also enter on line 5, Recapitulation) I $ 10 000.00 (If more space is needed, insert additional sheets of the same size) 2003 Ford Escape -Private ]'arty Pricing Report -Kelley Blue Book '~ "" ~~@~~8~1 ~~8~ BtlC~( THE TRUSTED RESOURCF Page I of 3 ~~ ~w~„~Ae ~.~,~~.~,~ _... SEARCH s t Home New Cars Used Cars Research & Explore News 8e Reviews Dealers & Lsventory Classifieds Laans & Insurance K88`'P Green Used Car Prices ~ Search Used Car Listing: ~ CertiFied Pre-Owned I Compare 'Jeh!cles I Perrect Car Finder ~ Hest Researches veLides I CAF.FAX vei:ide r•listory Welcome to K88 !Sian [n ~ Create Acco=int I My K,RB - ' Latest Car News j ~ CZ~tal~Ity tFtat Honda and Tovota can't bed#. j . Hanle > Used_',..drs > $. tlV~ > FGrd €stape > 24.4.]. > xLT Sport Utility 4D R-: - Save Vehicle Print 4_J Email .~ BOOKMRRK j r [~._. 2003 Ford Escape XLT Sport Utility 4D Trade-In Value Private Party value 6lUE BO©X" PRIVATE PARTY VALUE '" Suggested Retail Value ~~ Finance & Insurance r i I i~ Photo Gallery (': COf7dltlOn ~ r-; Value Compare Vehicles SEW' ~ Get a Plew Car Loan from Exteilent $10,410 5.4944. APR Blue Book Review Get aPre-Ow reA Loan rrom Consumer Ratings Good $9,835 5.544b APR Find Your Next Car ~~,,, , Fair $9,085 Get Your Credit Score Now Specifications More Photos Get a Free insurance Quote ~~ Shopping Tools ~ ~ ~~ ~~~ ~: gEARCH LOCAL LISTINGS __a eiu mom: tt --- rp~,^ Free CAPFAX P<ecord Check ['. .~~ Au[o Loan °rcm 5.44°.'c APR ~~~ 1 ,. lS Get your Credit Score Now Get a Free Insurance Quote Free CARFAX Record Che ck Powered by ~ ..............~... ' ) l "~~~ - ~ ' Payment Calculator VIN: ~ - : i - ! Ezter:ded Warranty Qwte No `JIN'+ No Problem! - '~ . r~r. ! r ,r~ ~ - 6 Print For SaE Si n _ ~ _ g 8UC d USED CAR Average Consumer Ratin g (630 Reviews) Read Reviews I /'1 j On Blue Book ClassiRedsTM QUaI1tJ/ tf'l~C Handal and Ford ~ <.:?"~3~1~.:?'~:' a.s out or s Revie:v this vehicle _ TQ~QtC~ Escape ~ ', Similar New Vehicles ea('yl~ ~'3eat, 50 Miles 203o Ford Escape 2010 Mercury Mariner 21P Code r-- Photos .,.~ Pk!.p4ps ~ ~ To View Ads, Click Re~seyy sit REVi~N, PcicittL'. Fr!LIt1.4 More Results E1ND THE RIGHT {dR _........ Compare Used vs. New 65,000 to gt0,000 -. Vehicle Highlights Both New and Used Mileage: 35,207 Crossover Engine: V6 3.0 Liter Transmission: AU[dmdtiC Drivetrain: 4WD - To View List, Click 41EW ANOTHER VEHICLE Select Year... Selected Equipment Change Equipment Standard Air Conditioning Cruise Control Power Seat Cr Search by Category vv^r Change 2ID Code http://www. kbb. com/KBB/UsedCars/PricingReport.aspx? WebCategoryId=42&Yearld=200... 9/9/2009 2003 Ford Escape -Private Party Pricing Report -Kelley Blue Book Page 2 of 3 Power Steering AM/FM Stereo Roof Rack Power Windows Multi Compact Disc Privacy Glass Power Door Locks Dual Front Air Bags Alloy Wheels Tilt Wheel ABS (4-Wheel) Blue Book Private Party Value Private Party ')aloe is what a buyer can expect to pay when buy!ng a useC car from a private party. The Private Party Value assumes the vehicle is sold "AS Is" and carries no warranty !other than the continuing factory :varranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Vehicle Condition Ratings Check Vehicle Title History fxcelient : $ioraio • Loo.:.= rew, Is :.n exC:;ilent mechanical condition and need.^, no reccnditicnir~g. • Nave: f!ad any pant o body .r:rk and !s free of nsf. • Clrar: title h!sicry and :will ;;ass a smog an:; safety :nsp°-ct:en. • Engine campy rtmant !s ::eon, :vdh no i'loi:; leaks and is free of any ,near or visible dafacts. • Compete and ver4iabl=_ service r=_cords. Less than 5": cf all used vehices tall mto this catrgnry. (i00d $4,835 • free of any mai:;r defrrts. • fb~ae tiGe histc!y, the paints, Cody, and nterior have or:Py minor (if any; :lemishes, .ar.d there are np :najdr mechanica problems. • L;tde ar no rust on this veh:cle. • Tires rratcn and cave substantial Cread wear !e'[. • A "good` vrh:rae wil naed some rea;nda:onuig to be sold at ret<n. Must consumer o:vn .vehicles fall :.nto this catec:ory. Fair iix:.C.~ #9,0$5 • Some mechanical or cosmetic defects and needs servicing but is - still in reasonable running condition. • Clean title history, the paint, body and/or interior need work performed by a professional. • Tires may need to be replaced. '. • There may be some repairable rust damage. Poor ~_, N J A • Severe mecnar.ical anG/or c^5 rnet!c defects and is in pom' r~.!r.ning coodition. • P?ay have croblerrs that ca rnot be readily fixed iurh as a damag?o flame rr a rusted-thraigh body. • Branded title (salvage, food, etc. i or unsubstantiated mileage. Kelley Blue Eock dues nut attempt to repc!t a value on a "pcor" venide be..a use the value of tie<e vehicles varies greatly. A veFde ir: pcor l'pndE!p^ may fPgpire a0 :ndep2pdera a~?praisal tp determine Its value. 'California 9i 9i?009 Accurate Condition Appraisal Change Condition Accurately appraising the condition of a vehicle is an important aspect in tletermining its Blue Book value. Taking our i6 question condition quiz will ensure you know the correct condition rating. ~~~~ ~~~• SEARCNLOCALLISTINGS http://www.kbb. com/KBB/UsedCars/PricingReport. aspx? WebCategoryId=42&Yearld=200... 9/9/2009 2003 Ford Escape -Private Party Pricing Report -Kelley Blue Book Page 3 of 3 ZB49 rie;!ey blue i3ocx c;o., ]nc. RI! nghls reserved. 9/4; 2009-~itQ~1009 fd;con. i he ~pecAic i;:7orrnation required fo deferrnine the ~'a/ue, fer lhis pdrtitular vehrcie ~nas Supplied by the person generating Phis repUrt. VehiCie valuatipns are opirripn5 dird rray L'aN f(Gm VehlCle b Veh!Cle. ACCL'd! vd/1:dtiOnS Wlll vdfy !)d52d 1/pOn market COndit;On.S, speClflCatiJnS, VehlC.e C'prldifiplr Of pihef pdffiCt:ldr iifCJmSCdnC'CS pt'rtlnt'n! LO LhlS VartlCUlar v?hide or Ch? t!'ansacfien or the cdrties tp the Vansacdun. ibis repprf is intended for the individual use of fhe;.erson .7enera0ng thci report only and shall ncf be s'nld ur trans Drifted to another par!y. XeNey Blur 3ppk assumes no responsibility ror efrors or mnissrons. ; v.J9C9.1 On KBB.<om 11 ~. -r.: .v Cas J, -. _ar fe:ea.ch,r '-rplnre Pour; S~7'.iews Gealus i:nva llcry Ctas,ifid; ~ars~insman_ vh3''Gr rn NFk, r'..F1 . Dt.?tuc. ~_I_s Featuring (he ir;rs•:ed Nafkeipleie.`~ bas P",ileage Champs Fint .4 ::ar Dearer Bast Car Duals 5 Gres. G,r Deals Car Eevie.Ws iars Fur Saia Cash For Clunkers About KBB i~.bnur. Its Con[ac! hs Cdr'?P,rS FAC, tAedia Advertisnc; Linking ?rivary Sitd :'^.dp CnpYri ,h! i4 Tradzmdrki Terms of Senicz ~C.' M1~ p 1995-2009 Kelley Blue Book Co., Inc. i/~~~ / ` http: //www.kbb. com/KB B/UsedCars/PricingReport. aspx? WebCategoryId=42&Yearld=200... 9/9/2009 REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 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 132 Glendale Drive, Mechanicsburg, PA 17050 RELATIONSHIP TO DECEDENT ADDRESS A. Jeffrey A. Wilbur B Robert E. Wilbur, Jr. c JOINTLY-OWNED PROPERTY: 404 Keller Street, Mechanicsburg, PA 17050 Son Son ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 050804 PNC Bank N.A. Savings Account #5030063355 15,514.28 50. 7,757.14 2 A 050804 PNC Bank N.A. Checking Account #5070089058 4,420.43 50. 2,210.22 3 A 091304 PNC Bank N.A. Certificate #31200246773 7,216.74 50. 3,608.37 4 B 040405 PNC Bank, N.A,. Savings Account#5004641908 2,126.90 50. 1,063.45 TOTAL (Also enter on line 6, Recapitulation) I $ 14 639 18 (If more space is needed, insert additional sheets of the same size) r~'o.1'~, 1UU'y ~~;~-irlvl rl'dC ~HIVK 411'lU'~-1141 PI~J~ ~oi~cxHew~Y February 25, 2009 Richard P Mislitsky Attorney At Law One West High Street PO Box 1290 Carlisle PA 17013 RE: S Joanne Wilbur SSN: 208-28-7193 DOD: 12.23,2008 Dear Mr. Mislitsky: rJo. ~y14 N. ~ In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Certificate of Deposit Account # 31200246773 S JOANNE WILBUR JEFFREY A WILBUR Established: 09-13 -2004 DOD balance: $7,202.71 + 14.03 accrued interest Checluing Account Account # 5070089058 . S JOANNE WILBUR . JEFFREY A WILBU'R DOD balance: $ 4,420.43 + 0.00 accrued interest Savings Account Account # 5004641908 S JOANNE WILBUR ROBERT E WILBUR JR DOD bal~ce: $ 2,126.10 + 0.81 accrued interest Account # 5030063355 S JOANNE WILBUR JEFFREY A WILBUR DOD balance: $15,511.25 + 3.03 accrued interest Established: 05-28-2004 Established: 04-04-2005 Established: OS-28-2004 Page 1 of 2 rt'~.1~. 1!JUN 1,41riVl r'IUG r;Hi~K 411-(U~-114( IVo, ~~/4 N. 1 Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial traasactlons or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Naiional Financial Services Center PNC Bank, N.A. Member FDIC Page 2 of 2 REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE,THEiIRRELATIONSHIPTODECEDENTAND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1. John Hancock -Venture Vantage 64,938.54 100. 64,938.54 Account#2669641 See Annual Statement Attached TOTAL (Also enter on line 7 Recapitulation) I $ 64 938 54 (If more space is needed, insert additional sheets of the same size) ;;,~( Venture Vantage Annual Statement future is yours Issued by John Hancock Life Insurance Company {U.S.A.) For the period of January 01 -December 31, 2008 Prepared For: 63751 SH NAS2P027 S JOANNE WILBUR 404 W KELLER ST MECHANICSBURG PA 17055 Your Account Value as of February 11, 2008 $0.00 Total Premiums $70,584.19 Total Payment Enhancements $4,235.05 Total Withdrawals $6,000.00 Change in Value -$19,243.81 Value as of December 31; 2008 549,575..43 Death Benefit Value as of December 31, 2008: YOUr Your Financial Representative: Steven M Zeigler John Hancock Financial Network 4909 Louise Drive Suite 104 Mechanicsburg PA 17055 John Hancock Contact Information: 1-800-344-1029 www.jhannuities.com Your Account Information ~~~cGpiion gccount Number: 2669641 Owner: S Joanne Wilbur $70,584.19 Annuitant: S Joanne Wilbur $4,235.05 Plan Type: IRA $6,000.00 Inception Date: 02/11/2008 Optional Riders Selected $64,938.54 • Income Plus for Life Future Number Unit Value as Market Value Allocation* of Units of 12/31/08 as of 12/31/08 MFC Global Investment Management 140 American Fundamental Holdings 100.0% ~ Total Account Value as of December 31,2008 1p0 0~l0 Your future allocation rndicates where subsequent payments will be invested. You must no! direcfed to ofherinvesfinent options such as a DCA source fund. Information 5,806.3286 8.538171 $49,575.43 $49,575.431 / us rn wnbng or by phone rf you would like your payments Please carefully review this statement to ensure that all instructions were acted on properly. It is important that any errors or omissions relating to personal information, transactions, holdings, riders or special programs be communicated to John Hancock and your broker dealer within 60 days of the requested transaction effective date. Oral communications should be re-confirmed in writing to protect your rights, including rights under the Securities Investor Protection Act (SIPA), if applicable. John Hancock Annuities Service Center P.O. Box 9505, Portsmouth, NH 03802-9505 z N . U xg 0 8 y o >~~CCC o z ro a N V °m W 0 A Produced on: 12/31/2008 Account # 2669641 Page 1 of 3 REV-1511 Ex + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Daybreak Church -catering funeral meal 670.49 2 Royer's Flowers 109.16 3 Malpezzi Funeral Home 6,024.40 B. 2. 3. 4 5 6 7. 8 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City State _ Year(s) Commission Paiii: Attorney Fees Richard P. Mislitsky, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Relationship of Claimant to Decedent Zip Probate Fees Cumberland County Register of Wills Accountant's Fees Tax Return Preparer's Fees Advertising Fee to Cumberland Law Journal Advertising Fee to The Sentinel Zip 3,750.00 318.00 75.00 166.30 TOTAL (Also enter on line 9, Recapitulation) I $ 11 113 35 (If more space is needed, insert additional sheets of the same size) ti~~~. ?*T ~a}5 to ~;~ r a rea C H U R C H tea( neople. Real Clod. Zeal Ghan~e. --- ~oP~ y~ a~.d Yw-• ~~ I,! (ar(, CoYi-~-~/~c/,i~,y ~ lGar~ o~ Go c~ a~ d ~~ oi~~- ~s Yov CcK find c -~o ~r~~o/~c. l f - !~/as a d/~8a~o9 b s ~~SSrn ~ ~ O ~ INIt, o-~i ~~ ~ SLY /G ~UU A.l ~ //j S4>'Y-~ S/ha~,!/ ~/~Y / ~^ t ~a-+~ Q~ f hC `~1~CrN1, Pl1,G~$y It'T ~l K-1~0~ l~ ! ~~tYC.s ~~~L~1'J ,~~ 0,~ -I-~,~ ~jP.~b~~~.~c ~~~ ~~, c~~ ~ c~~ ~.la,~ S,~d~ yon. Gov W i ~ I ~irt cl 'f 'etc I'e c~, fis ~' ~nG~o$~a P ~' r'Opd ~o/-'~ ~t i-c//I~ro"' I'NeU~I. ~ ~ Yov~ Conv~r~icnct ~Iepsc. S~bm~~- ~ ~,1~«Ic ~'~ ~` 57c~. y9~ P~yablc fo ~Jrt~ . P) ~ ~5~ (>na ~ ~ Or ~ ro~ p~~~ ~,.{- C,1'`~c k- p ~ I n d l~tu~ ~jo-~ br~.k ,. --~ ~ A.-}-~ ~ 5'~0~/ ~h , ~ ~ ~tp J ~~t G~ ~(U ~ s '~`/d Y~,s P ~l. G-Sc. c ~ Grog ~I~SS YoU /~ ~J ~I ~.'~- 321 Gettysburg Pike, Mechanicsburg, PA 17055 r^H 717:791.1200 '-;~ 717J91.1180~ ~~ ~ .~. _::: , ,~ ..~~.a, ,, _,~.: ,- ~,;^: m a~pezzi -FUNERAL HOME Michael J. Malpezzi, Owner • Jeremy J. Shartzer, Funeral Director 8 Market Plaza Way • Mechanicsburg, PA 17055 Phone: (717) 697-4696 February 23, 2009 Mr. Jeffrey Wilbur 132 Glendale Drive Mechanicsburg, PA 17050 The Funeral Service for Shirley Joanne Wilbur We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. TIC FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES., AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services, Facilities and Cremation $4275.00 FUNERAL HOME SERVICE CHARGES $4275.00 SELECTED MERCHANDISE: Oak Rental Casket $975.OG Jesus Reflection Register Package $68.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $5318.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. T1-IE FULLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Certified Death Certificates $120.00 Newspaper Notices -Patriot 2 days $376.40 Flowers $7.10,00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $706.40 SUB-TOTAL $6024.40 INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE $6024.40 ~, ~ .yam www.malpezzi funeralhome.com ~~08 Form 1040-V Department of the Treasury Internal Revenue Service What Is Form 1040-V and Do You Have To Use It? It is a statement you send with your check or money order for any balance due on the "Amount you owe" line of your 2008 Form 1040. Using Form 1040-V allows us to process your payment more accurately and efficiently. We strongly encourage you to use Form 1040-V, but there is no penalty if you do not. How To Fill In Form 1040-V Line 1. Enter your social security number (SSN). If you are filing a joint return, enter the SSN shown first on your return. Line 2. If you are filing a joint return, enter the SSN shown second on your return. Line 3. Enter the amount you are paying by check or money order. Line 4. Enter your name(s) and address exactly as shown on yourreturn. Please print clearly. How To Prepare Your Payment • Make your check or money order payable to the "United Stafies~Treasury." Do not send cash. • Make sure your name and address appear on your check or money order. • Enter "2008 Form 1040,":your daytime phone number, and your SSN on your check or money order. If you are filing a joint return, enter the SSN shown first on .your return. • To help process.your payment, enter.the amount on the right side of your check like this: $.XXX:XX. Do not use dashes or lines (for example,, do not enter "$ XXX-" or "$ XXX X100"). How To Send In Your 2008 Tax Return, Payment, and Form 1040-V • Detach Form 1040-V along the dotted line. • Do not staple or otherwise attach your payment or Form 1040-V to your return or to each other. Instead, just put them loose in the envelope. • Mail your 2008 tax return, payment, and Form 1040-V in the envelope that came with your 2008 Form 1040 instruction booklet. Note. If you do not have that envelope or you moved or used a paid preparer, mail your return, payment, and Form 1040-V to the address shown in the instructions that applies to you. Paperwork Reduction Act Notice. We ask for the information on Form 1040-V to help us carry out the Internal Revenue laws of the United States. If you use Form 1040-V, you must provide the requested. information. Your cooperation will help us ensure that we are collecting the right amount of tax. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Internal Revenue Code section.6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances. For the estimated'averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return. Form 1040-V (zoos) ~ Detach Hen: and Mail With Your Payment and Return ~ 7273 1040-V Payment Voucher oMSNo.,sas_oo,a Department of the Treasury rC~j o o Internal Revenue Service issi - Do not staple or attach this voucher to your payment or return. (-S 1 Your social security number (SSN) 2 ff a joint return, SSN shown second 3 Amount you Dollars Cents on your return are paying by check or 208-28-7193 mone order 591. a 4 Your first name and initial Last name ~' SHIRLEY J WILBUR G If a joint return, spouse's first name and Initial Last name w c a Home address (number and sVeet) Apt. no. ~ JEFF WILBUR 132 GLENDALE DRIVE City, town or post office, state, and ZIP code (If a foreign address, enter city, province or state, postal code, and country.) Mechanicsbur PA 17050 VSA FD195 Billing Date Account'No: 12/31 /08 153492 JOANNE WILBUR 404 W KELLER STREET MECHANICSBURG, PA 17055 Please detach here and retnm tep p2rtirn with remittance. 'Date invoice No. - - ~g~ct~Pt)o~ 12/16 5121380 Holi -flowers by wire 12/16 5121381 Holi -fruit bsk arrg $109.16 AMOUNT ENCLOSED PLEASE REMIT TO: P.O. BOX 330 LEBANON, PA 17042 MECHANICSBURG 717-697-7777 xecialent:, ~ - Amount , . UUF2A[IU $5y.35 GAYMAN $49.81 ~ .S~ 3 ~/~ ~ Please use the RETURN ENVELOPE provided for your convenience YOUR EASY ORDER ACCOUNT NUMBER IS 153492 Due upon receipt ~) - -- ~ } ~~ .-.._ ,., _ OUTSTANDIt\'G BA[„AIVCE_ - • • 12/31/08 I $109.16 I $0.001 $0 00 $0 00 $109 16 f BALANCES UNPAID BY THE 30TH OF NEXT MONTH WILL BE SUBJECT TO A RE-BILLING CHARGE OF 1 1/4°k (ANNUAL RATE 75Y) OR~~: Minimum rebilling charge is $2~ . . _ < ~ . :. `~ / ` ,~ OYER'S 153492 flowers £~ gifts Receive your Bill by Email? We now offer this new service for your convenience. Yes, I would like to receive my statement by Emaif k Check here if you would like to receive special offers by email My Email address is: Liberty Tax Service 67 West Main Street L~eERrr Tiuc Mechanicsburg,PA 17055 SERVICE phone (717) 591-9933 Fax (717) 591-7008 INVOICE Customer: HIRLEY J WILBUR /o JEFF WILBUR 132 GLENDALE DRIVE echanicsburg, PA 17050 Customer ID: * * * - * * - 7193 ayment Terms: Due Upon Receipt Invoice Number 1228 Date 4!312009 Type of Return Efile Type of Payment None Qty Bill Description Amount Tax Preparation Fees 168.00 Other Tax Preparation Fees Electronic Filing (Transmit Only) 1 1040A or E uivalent Base Retum Charge 1 Total IRA Distributions With No Form 8606 1 Total Pensions and Annuities 1 Taxable Social Securi or Railroad Retirement 1 1040-V - Pa went Voucher 2 1099R -Pensions and Annuities 1 PA Base Rate Tax Preparation 168.00 Thank You for your Business Promotions/Discounts Sales Tax Subtotal 16 8 . 0 0 Payments 0 Amount Due 16 s . 0 0 VSA FD1141 11/08/2007 208-28-7193 WI 0800917116 PAYMENT AMOUNT WILBUR SHIRLEY J 717-648.-3089 $ 12.00 132 GLENDALE DRIVE M E C H A N I C S B U R G Make check or money order PA DEPARTMENT USE ONLY Payable to the Pennsylvania 17 0 5 0 ~ Department of Revenue - - CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3186 Fax: (717) 249-2663 March 13, 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Richard P. Mislitsky, Esquire RE: Shirley J. Wilbur Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance.. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: February 27, March 6, and March 13, 2009 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director RETAIN THIS PORTION FOR YOUR RECORDS THE SENTINEL - LEGAL RICHARD MISLITSKY P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS SALESPERSON BILLING DATE LINES 364990 10 PUBLIC NOTICES heckb 03/11/09 30 * 2 AD DESCRIPTION START DATE STOP DATE EXECUTOR'S NOTICE LETTERS TESTAMEN 02/25/09 03/11/09 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 159.30 TOTAL AD CHARGE 159.30 3 PROOF OF PUBLICATION O1PRF 7.00 DAYS RU SE ORDER PAY THIS AMOUNT estate of shirley 166.30 ~ 199.56* MESSAGE: ~~t~~3~~~ Thank you for advertising with The Sentinel . MA(~ 1 `~ 209 Deadlines for in-column legal advertisements: Monday is Thursday at 5 p.m; Tuesday is Friday at 5 p.m.; Wednesday is Monday at 5 p.m; Thursday is Tuesday at 5 p.m; Friday is Wednesday at 5 p.m Saturday is Wednesday at 12 Noon; Sunday is Wednesday at 5 p.m. If you have any questions regarding your Legal bill please call Classified Manager at 717-240-7176 Fax your legals to 717-243-3754 attention Classified Manager You can also EMAIL your legal to Classified ads: classified@cumberlink.com Please send a cover letter including your name and address as an attachment ~sa~ Y~~ ~v .... _.« f /1 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 1/14/2009 Cumberland County - :Register Of Wills Receipt Time: 13:05:03 One Courthouse Sgware Receipt No.: 1055374 Carlisle, PA 17613 WILBUR SHIRLEY J Estate File No.: 2009-00044 Paid By Remarks: JEFFREY A WILBUR wa ------------------- ------ Receipt Distribution ----- -------- ------- -___ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 260.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15.00 28.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN JCP FEE AUTOMATION FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 ---- CUMBERLAND COUNTY GENERAL FUN Check# 8502 ------------ $318.00 Total Received..... .... $318.00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF~REVENUE BUREAU CF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX~11-96) N0. CD 010766 WILBUR JEFFREY A 132 GLENDALE DRIVE MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: Ss-v: 208-38-7~s3 FILE NUMBER: 2109-0044 DECEDENT NAME: WILBUR SHIRLEY J DATE OF PAYMENT: 01 / 1 4/2009 POSTMARK DATE: 01 /1 4/2009 COUNTY: CUMBERLAND DATE OF DEATH: 12/23/2008 REMARKS: RECEIPT TO ATTY SEAL CHECK# 8501 101 ~ 55,000.00 TOTAL AMOUNT PAID: INITIALS: WZ RECEIVED BY: 55,000.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bank transfer charge 10.00 2 Liberty Tax Service charge for 2008 Income Tax preparation 168.00 3 2008 Federal Income Tax due 591.00 4 2008 PA Income tax due 12.00 TOTAL (Also enter on line 10, Recapitulation) I $ 781 00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX •r (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHIRLEY J. WILBUR ~~ na nnnn 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 autnghtspousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Jeffrey A. Wilbur Lineal 25,894.46 132 Glendale Drive Mechanicsburg, PA 17050 2 Steven Wilbur Lineal 25,894.46 20 Sinclair Road Mechanicsburg, PA 17055 3 Robert E. Wilbur, Jr. Lineal 25,894.45 404 West Keller Street Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ t~~ more space Is neeaea, Insert aaaiUOnal sheets of the same size) REV-15'14 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN heck Box 4 on Rev-1500 Cover Sh ESTATE OF FILE NUMBER SHIRLEY J. WILBUR _ 21 09 0044 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH • NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Term of Years 1 Value of fund from which life estate is payable .. . .. . . . . . ............................ $ 2. Actuarial factor per appropriate table . . . . ... . . . . . . ............ . ...... Interest table rate - ^3 1/2% ^ 6%~ ^ 10% ^Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . .................. $ NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Term of Years 1. Value of fund from which annuity is payable ....... . . . . .. . .................... $ 2. Check appropriate block below and enter corresponding (number) . . . . .................... . Frequency of payout - ^ Weekly (52;) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ... . . . . . . . . . ........ . .......... $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^Variable Rate 6. Adjustment Factor (see instructions) . . . . ... . . . ................ . 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ...........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 .... . . . . . .. . . ....................... . ............ $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) KtV-1644 tX + (3-04) INHERITANCE TAX SCHEDULE L COM NOHERTANCEDTAXRETURNANIA REMAINDER PREPAYMENT RESIDENT DECEDENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER 21 09 0044 I. ESTATE OF WILBUR, SHIRLEY J. (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. $ 2. Stocks and Bonds .........................$ 3. Closely Held StocklPartnership ............... $ 4. Mortgages and Notes ....................... $ 5. Cash/Misc. Personal Property ................ $ 6. Total from Schedule L-1 ....................................................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................... $ 2. Unpaid Bequests ..........................$ 3. Value of Unincludable Assets ................ $ 4. Total from Schedule L-2 ....................................................$ E. Total Value of trust assets (Line C-6 minus Line D-4) ................................. $ F. Remainder factor (see Table I or Table II in Instruction Booklet) ................... . G. Taxable Remainder value (Line E x Line F) ........................................ $ (Also enter on Line 7, Recapitulation) II. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed ........................................................... $ D. Remainder factor (see Table I ar Table II in Instruction Booklet) ....................... . E. Taxable value of corpus consumed (Line C x Line D) ................................ $ (Also enter on Line 7, Recapitulation) REV-1647 EX + (g_00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE Box 4a on Rev1500 Cover FILE NUMBER SHIRLEY J. WILBUR _ 21 09 0044 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY I RELATIONSHIP I DATE OF BIRTH I NEAREST BIRTHDAY III. Explanation of Compromise Offer: 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal IV. Summary of Compromise Offer: 1. Amount of Future Interest .................................................. $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ...... $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% ................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ...................... $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ...... $ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ...... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ..................... $ (It more space is needed, insert additional sheets of the same size) REV-isaa EX iii-ss~ ~l) SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION (AVAILABLE FOR DATES OF DEATH 01/01/92 to 12/31/94) ESTATE OF FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1. Taxable Assets total from line 8 (cover sheet) ...................................................................................... 2. Insurance Proceeds on Life of Decedent .............................................................................................. 3. Retirement Benefits ............................................................................................................................. 4. Joint Assets with Spouse ...................................................................................................................... 5. PA Lottery Winnings ............................................................................................................................. 6a. Other Nontaxable Assets: List (Attach schedule if necessary) .. 6 a. 6 b. 6 c. 6 d. 6. SUBTOTAL (Lines 6a, b, c, d) 7. Total Gross Assets (Add lines 1 thru 6) ............................................................................................... 8. Total Actual Liabilities .......................................................................................................................... 9. Net Value of Estate (Subtract line 8 from line 7) ................................................................................... If line 9 is greater than $200, 000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part II. Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 a. Spouse ............................. 1 a. 2a. b. Decedent ......................... 1 b. 2b. c. Joint ................................. 1c. 2c. d. Tax Exempt Income ......... 1d 2d. e. Other Income not listed above ..................... 1e. 2e. f. Total ................................. 1 f. 2f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: 89, 577.72 1 577.72 89,577.72 TAX YEAR: 1 3b. 3c. 3d. (1~ + (2f) + (3f) _ (-3) 4b. Average Joint Exemption Income ............................................................................................................... _ If line 4(bJ is greater then $40, 000 -STOP. The estate is not eligible to claim the credit. If not, continue to Parf /II. 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ..............................._ _ ~ 1 2. Multiply by credit percentage (see instructions) .................................................................................... 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet .............................................................. 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ........................................................................................................................ 4. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet .......... 5 REV-1649 EsY + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) FILE NUMBER SHIRLEY J. WILBUR 21 09 0044 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance 8 Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital residual A B By-pass Unified Credit etc ) If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or sim- ilarproperty treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. Description Value Part A Total $ Part B: Enter the descri tion and value of all interests included in Part A for which the Section 91 13 A election to tax is bein made. Description Value Part B Total $ (If more space is needed, insert additional sheets of the same size) •i LAST WILL AND TESTAMENT OF S. JOANNE WILBUR I, S. JOANNE WILBUR, of the Borough of Mechanicsburg, Cumberland Cou7ity, Pemnsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and codicils by me at any time made. ITEM 1. I direct my Executor to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. I also direct that all expenses becoming due by reason of my death, other than inheritance and estate taxes, shall be paid by my Executor out of my residuary estate as an expense and cost of administration of my estate. ITEM 2. I give and bequeath unto my son, STEVEN B. WILBUR, of Mechanicsburg, Pennsylvania, my race car and parts and my 2003 Ford Escape, if he survives me. In the event that my son, STEVEN B. WILBUR, predeceases me, then I make said gift and bequest to his chiiciren, if any, in equal shares, uY' if r~o~~e, to any sc,,, Ji;T~FP;I;~'' .^ . ~x%Ir RT TR of Mechanicsburg, Pennsylvania. ITEM 3. I direct that my funeral expenses be paid from my Members 1't Federal Credit Union savings account, and I give and bequeath. the balance of said savings account to my son, STEVEN B. WILBUR, if he survives me. In the event that my son, STEVEN B. WILBUR, .f r" 4 - predeceases me, then I make said gift and bequest to his children, if any, in equal shares, or if none, to my son, JEFFERY A. WILBUR. ITEM 4. I give and bequeath my PNC Banlc savings account to my son, JEFFERY A. WILBUR, if he survives me. In the event that my son, JEFFERY A. WILBUR, predeceases me, then I make said gift and bequest to his children, if any, in equal shares, or if none, to my son, STEVEN B. WILBUR. ITEM 5. I give, devise and bequeath all the rest, residue and remainder of my estate of any kind whatsoever, real, personal and mixed, and wheresoever situate, and including my Total Control savings account to my son, JEFFERY A. WILBUR, if he survives me. In the event that my son, JEFFERY A. WILBUR, predeceases me, then I make said gift and bequest to his children, if any, in equal shares, or if none, to my son, STEVEN B. WILBUR. ITEM 6. In addition to the powers conferred by law, my Executor shall have the following powers: (a) 'To retain in his absolute discretion and for such period as to him shall seem advisabe, any and all assets constituting my estate, without liability for any loss incurred by reason of the retention of such assets. (b) `To change investments and properties, and to invest and reinvest all or any part of the corpus of my estate, in such securities, investments, or other property as to him seem advisable and proper, irrespective of whether the same are authorized for the investment of estate funds by the laws of the Commonwealth of Pennsylvania. ~~ F .173`''', LV /_ (c) To sell all or part of the property which at any time may constitute a part of my estate, at such time, upon such terms, for cash or on credit, with or without security, in such manner and at such prices, either at public or private sale, as to him shall seem advisable and proper, and to execute good and sufficient deeds and bills of sale therefor. (d) To lease any property held by him and for the duration of the term, irrespective of the provisions of any statute or of the termination of my estate; and to mortgage, pledge, collect, convert, redeem, exchange, or otherwise dispose of any securities or other property at any time held by him. (e) To borrow money, whether to pay taxes, exercise subscriptions, rights, and options, pay assessments or to accomplish any other purpose of any nature incide~ltal to the administration of my estate, and to pledge any securities or other property held by him as security therefor. (f) To enforce any bonds, mortgage, or other obligations or liens held hereunder; to enter upon such contracts and agreements and to make such compromises or settlements ofdebts, claims, or controversies as he may deem necessary yr ad~risable; to submi± to arbitratie;n any matter or difference; to vote personally or by proxy any shares of stock which may at any time be held by him hereunder. (g) 'to consent to the reorganization, consolidation, merger, liquidation, readjustment of or other change in any corporation, company or association, or to the sale or ,f; -3- .. lease of the property thereof or any part thereof, any of the securities or other property of which may at the time be held by him thereunder, and to do any act or exercise any power with reference thereto that may be legally exercised by any person owning similar property in his own right, including the exercise of conversion, subscription, purchase or other options, the deposit or exchange of securities, the entrance into voting trusts, and the making of agreements or subscriptions which he may deem necessary or advisable in connection therewith, all without applying to any court for permission to do so, and to hold, redeem, sell i~r otherwise dispose of any securities or other property which he may so acquire, irrespective of whether the same be authorized for the investment of estate funds by the laws of the Commonwealth of Pennsylvania. (h) To cause to be registered in his name as Executor hereunder, or in the name of his nominees without qualification or description, any securities at any time held in my estate. (i) To determine the manner in which the expenses incidental to or connected with the administration of my estate hereby established shall be apportioned as between income and principal. (j) To carry out agreements made by me during my lifetime, including the consummation of any agreements relating to the capital stock of corporations owned by me at the time of my death, and including the continuation of any partnership of which I may be a member at the time of my death whenever the terms of the partnership agreement obligate my estate or personal representative to continue my interest therein, and to enter into agreements for the r 4 rearrangement or alteration of my interests or rights or obligations under any such agreements in effect at the time of my death. (k) To apportion extraordinary and stock dividends received by him between income and principal in such manner as he may see fit; provided, however, that all rights to subscribe to new or additional stock or securities, and all liquidating dividends shall be deemed to be principal. My Executor may freely act under all or any of the powers of this Agreement given to him in all matters concerning my estate hereby established, after forming his judgment based upon all the circumstances of any particular situation as to the wisest and best course to pursue, without the necessity of obtaining the consent or approval of any court, and notwithstanding that he may also be acting as an individual, or as an agent for other persons as an individual, or as an agent for other persons or corporations interested in the same matters, or may be interested in connection with the same matters as stockholders, directors or otherwise. The powers herein granted to my Executor may be exercised in whole or in part, from time to time, and shall be deemed to be supplementary to and not exclusive of the general powers of executors pursuant to law, and shall include all powers necessary to carry the same into effect. The enumeration of specific powers herein shall not be construed in any way to limit or affect the general powers herein granted. ITEM 7. I hereby nominate, constitute and appoint my son, JEFFREY A. WILBUR, as Executor of my estate. ., [['' t' l My Executor is specifically relieved from the duty or obligation of filing any bond or bonds. ITEM 8. For the convenience of my Executors, I note that this Will has been prepared by Ronald D. Butler, Esquire and the Butler Law Firm. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, this --.. " day of ~. ~,; ~' ''~~:~ ~~ • ::. ~ .,, , 2004. ,- e „, ,~ .. x ~' % ~ ~~ ; ~ ~ ' . ~' ~~. ~~ ., (SEAL) d' ... S. Joanne Wilbur WITNESS: t' - ..._ ~. i..Y ~ ~ ~. ~ - ~~''`~~~~ ,. ~~( , . residing at ~ ,! ,~ ~ ~i_~_ ; L t ,/ ~}-_ ~~ ~ ~~~~L residing at ~ ~~~~ ~~ ~A. ~7~ia -6- COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF DAUPHIN ~ We S. JOANNE WILBUR ~i c-~-~5 ,~ ~.. t~ ~ , r, _ ~~ ~.;a~t_. ~ /~' ,and r-~ ~~= ~,~ ~ °s1~1_T~i2. ,the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned. authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her) and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge, the Testatrix was at that time eighteen years of age and older, of sound mind and under no constraint or undue influence. ~; S. Joanne Wilbur ~7i^ e ~' Witness ,~ ~~~ Witness Subscribed, sworn to and acknowledged before me by S. JOANNE WILBUR, the Testatrix, and subscribed and sworn to before me by _ ~~~,n„y ,d} ~i~ _~ ~ ,~~-t- t,~~ and ~~~>~t„~ ~_ ..tea-~-~ ~-~-~ ~ ,the witnesses, this ~~`f-~ day of ..S ~t'-~ `~..r~ Ci ~,~. , ?004. otary Public My Commission Expires: <.r r tE.:.r` a~v ~.'~ r ' ~apy_-~°3•~'4 N*~'4?i °n t~y"r,aa Ci~~~~"~~ e'.., ~ds~t~~.~~~, 4~~~Tgr Pu~1t~ Addition to My Last Will: Item: 2: THIS APPLIES TO ALL OF STEVE'S SHARE OF MY WILL" If Steve predeceases me, then I want Gloria to still get the Ford Escape and $10,000.00 in money from the investments and savings. I also want Tyler Robert Wilbur to get $5,000.00 in money, to be given to his Father, Rob, to determine how he wants to give it to Ty. The balance can go to Jeff. ~~ ~~ ~~~ Date S. oanne Wilbur