HomeMy WebLinkAbout08-07-15 � 1505610105
REV-1500 Ex�oz_��,«,�:��
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania
Bureau of Individual Taxes �""p,ME"' County Code Year File Number
PO BOX28o6o1 � INHERITANCE TAX RETURN
Harrisburg,PA 1'71z8-o6o1 RESIDENT DECEDENT �� �� �5 ��J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
06/02/2007 09/09/1918
DecedenYs Last Name Suffix DecedenYs First Name MI
_ . __ __
Wilson Ethel Y
_ _ _
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name Mf
_ _ _ _ _ _ . __ _ _ _
_ __ __ __. _ . _
Spouse's Social Security Number
- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return O 2.Supplemental Return . p 3. Remainder Return(Date of Death
Prior to 12-13-82)
Q 4.Limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT—THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
_ __. _ . _ . . _ __ __. __ _. _ ._ . __ __ _
William S. Daniels (717)243-3831
_ . _ _. ___ _ _ __ _ __ _ _ ___. _ _ _._ . _
REGISTER OF WILLS JlS�ONLY
c`�:+
f'7 � �
First Line of Address �= �? _� �
_.._ __ _. _ _ _ _
_ _�_ .,,,
. ., c::� _
One West High Street � ; �':'. �-, �� "� '
_ _ _ _ . _ _ . . ... i Y,�
Second Line of Address __ __ _ _ _. _ 1 _ y, .' � M.,l
. __ _ _ K
SU�t@ 2��'J � .. ' � . � .. r'7
"1� -�'1
_ dATE':F ED� w;r
City or Post Office State ZIP Code
__ .
Carlisle _ _ _ _ PA _ 17013 , _ � r- r-n
; P.._ CJ
_ _ __ _ .-_ CJ � -rt
r �
CorrespondenYs e-mau address:humeranddaniels@outlook.com
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is tr ,correct and compl e.Decl ation preparer other than the personal representative is based on all information of which preparer has any knowledge.
RE OF P O ES B OR FILIN�TU DATE /�
/ •
ADDRESS
Emory il n, Saundra . untzinger c/o Wilson, 648 Highland Ave, Mount Holly Springs, P 17065
SIGNATUR PREPARER HE H N REPRESE IVE DATE -�
C!J� �y� �—Z�a �c �ts� �
ADORESS
William S. Daniels, One West High St., Ste. 205, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 150561�105 J
� 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
�ecedent's Name: Ethel Y.WiISOn
RECAPITULATION
1. Real Estate(Schedule A). . ..... .. . .. ... . . . . ....... . .. . . .............. 1. 1,295.00
2. Stocks and Bonds(Schedule B) 2. 4,516.62
................................. . .....
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00
4. Mort a es and Notes Receivable Schedule D 4. 0.00
9 9 � ) . ... . ........... . ..... ... . .
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 35,915.81
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Biliing Requested... ..... 7. 177,522.14
8. Total Gross Assets total Lines 1 throu h 7 s. 219,249.57
� 9 ).. . ............ . . . . . . . . ......
9. Funeral Expenses and Administrative Costs(Schedule H). . . .... . . . . . ....... 9. 24,762.55
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). .............. 10. 9,886.70
11. Total Deductions(total Lines 9 and 10).................... ............. 11. 34,649.25
12. Net Value of Estate(Line 8 minus Line 11) .. .. .............. .. . . . . . . . . .. 12. 184,600.32
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ... . .... .. . .. ........ .. . 13. 0.00
14. Net Value Sub'ect to Tax Line 12 minus Line 13 �a. 184,600.32
1 � ) ...... ..................
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ 15. 0.00
16. Amount of Line 14 taxable
at Iineal rate X.0 45 184,600.32 �6. 8,307.01
17. Amount of Line 14 taxable
at sibling rate X.12 17. �.��
18. Amount of Line 14 taxable
at collateral rate X.15 �g, 0.0�
19. TAX DUE . . . ...... ......... .. .... . . . ........ . . ...... . . ......... . . . 19. 8,307.01
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 1505610205 1505610205 J
.REV-1502 EX+ (12-12)
� pennsylvania SCHEDULE A
DEPARTMENT OFREVENUE
INHERITANCE TAX REfURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Wilson, Ethel Y. 2107-0565
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 wiiling seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1� Cumberland Valley Memorial Gardens,One(1)space,"Last Supper"49A#4(see attached) 1,295.00
TOTAL(Also enter on Line 1, Recapitulation.) $ 1,295.00
If more space is needed,use additional sheets of paper of the same size.
.,...:y.r« ";'r"�
��ay:
� � "
��� �r� � i� �; � Y� � 'Y' ¢ � ..Y fi y_ � $
i�YnF�w����� , .� " Sv � .. ka��������������. �AV�'..�:�.
^\w.✓ A. � �. f�v. i � .i. �`ew,�.++ l. �.. � F 1. �.� l. 1R � �^4..../ � w i.. �r
Cum6erCand vaCCey�lemoriaCGardens 1921 1�'tner.�f'igFiway CarCisCe, �A 17013
�Fione: 717-243-3541 �F'ax•717-243-4495
To Whom It May Concern: ���0��$
The following person(s) own property and/or merchandise at our cemetery. T'he values listed
below are current with today's selling prices and apply to this cemetery only.
At the time of purchase, all of the items with our cemetery were and are irrevocable. If you have
any questions or concerns, please do not hesitate to contact me. Thank you.
Sin erely,
U
Ginny A. Weller
Administrator
� NAME(S) W E�D� � �Y�{E�. V��t_4>N –�C.
PROPERTY OWNED � SPP�E
L�si S�PPt� �19A '��
PROPERTY VALUE � 12q S .°o
� MERCH. OWNED —''
C��.R�►�i ��cc,��oR-5
o►Jc
�F �ST�i t, �I�E ��►�c'�S . ��A
MERCH. VALUE
DATE PAID IN FULL 7��3
Osiris Holdi�zg of Pennsylvania,Inc.
� Contract No. 1313
�umb�rland alle � errror�al ardens
�� � �
GARDEN OF THE LAST SUPPER
`�h�s �s to G�ert�,{�j, �nT................W.���.�L.�,..�.�...��.�.�o N..�..�.�.��;r���...
�
.�......_W I LSO N�_ h�s...w i f e a....�°f�.w..�R.�D.M.�.l.a._..Gar dn.e r s.:�....Pe nna.�.....�.�.�...._....�.,..�..�».�........�.»..._....,.�.�.....u�....�_..
IS OR ARE THE OWNER OR OWNERS OF SPACES..........1.-2.'.�.'�} .... LOT NO.....,.,,.,...,�-t9A_............................,.,.,......,
,,.................,..... ,
GARDEN OF THE LAST SUPPER.
C`r�mberlartd �alle� ��emor�al �'ande»s
CUMSERl.AND COUNTY, PaNNlYLVANIA
FOR INTERMENT PURPOSES ONLY, subjcct to the following condidons,reservations,resuictions and rules aad regulations
to wit:
(a) No transfer or aasigament of wy intereat or rights acquircd bq Grantce ahall be valid without the written eonsent of Grantor and being
the�eaftu raorded on its books.
(b) No monumcnt or othu memorial, tree, plan�, objats or embellishmenu of any kind shall be•placed upoa,altered or removed from the
above-dauibed proputy by the Grantee without the consent of Graator. All Yndiag, landacape_work and improvements of any kind, aad all care on
rhe above-described property, ahnll be done, and all trea and plants of any kind shall be planted, trimmed,er removed, and all intetments, disintcs-
menu and removals, includiny all openings and closing�of arava,thall be made only by Gzantor with ita equipmeaG All iaterments shall be made to
the use of the type of w outer coatainu as ahall be daignated by Grantor in id nila and reguladons.
,
(c) Grantor, at the expcase of Granue and u a charge against the abore-dnuibed propury, maq repair or remove aay monument or othu
memorial whish's improper or oHentive or which has baome daagerous or dilapidated;and may remore anq tree,flower or plant,or otha object or em-
beliuhment ihac becoma uncighdq or daag«ou:.
(d) Grantor shall not be liable for lou or damage causal by tn act of God, coMmon enemy, thieva, randals, auilcua, malicious mischief
malc�cs,unavoidable accidmts,riot or ordu of aay military or civil authority.
(e) Only bronu memorial: a� praaibcd by the rula and re�ulations :ituate flush wich the lawa will be permitOed.
(f) The enumuatioa heteia of ceruia conditions, raervations, ratrictions and rtila and reguladone thall aot be considued u the only limits-
aons, but the Giaator :hall alwaqs hdd sll his iaurut aad ri�hts litaited by and subject w the rulu aad regularions aad by-laws of Grantor now
uiaaa�or which may be by it hereafter adopted eithcr by amendment, altendon or the adoptioa of aew ones.Thae rula and reguIations ue on file
for inspatioa in Granwr's o6ce and ue s�o�fically refured to and herein inxrted u if ut forrh in full.
IN WITNF�S WFiEREOF, The said CUMBERLAND VALLEY MEMORIAL GARDENS has caused thesc presents to
be execuc�d, chis....�.........1.9�i........».»...day of..........».......»..........Ju�.�...»....._.........._...�.�......., 19 6..�...»...
. CU $ERLA VALLEY ORIAL GARDENS
,
REV-i5o3 EX+(8-u)
� pennsylvania SCHEDULE B
� DEPARTM�NT OFREVENUE
INHERITANCETAXREfURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wlson, Ethel Y 2107-0565
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' US Savings Bond,Series EE,June 1988 1,341.20
2 US Savings Bond,Series E, December 1972 256.66
3 Met Life Stock, 10 shares,#8063-7473-7602,@$68.29 682.90
4 Prudential Stock,22 shares,#C0003085309,@$101.63 2,235.86
TOTAL(Also enter on Line 2, Recapitulation) $ 4,516.62
If more space is needed, insert additional sheets of the same size
REV-1$o8 EX+(08-12)
� pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX REfURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Wilson, Ethel Y. 2107-0565
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disciosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. US Coins(see appraisal attached) 141.00
2. 2007 Income Tax Refund 161.00
3. 2008 Economic Stimulus Payment 300.00
4, Wachovia CD No.24741 204-1122869 13,948.39
5. Adams County NB CD No.640119396 803.86
g. Farmers Trust CD No.001-0095386 1,618.95
7. Social Security Payment 928.00
g. PNC C/A No.5140194022 7,002.70
g. PNC CD No.31600258432 7,331.30
10. PNC CD No.65001015991 3,263.94
11. Blue Cross/Blue Shield Refund 366.53
�2. Kimberly Clark Retirement Benefit Checks 100.28
TOTAL(Also enter on Line 5, Recapitulation) $ 35,915.81
If more space is needed, use additional sheets of paper of the same size.
O
� Coin Values as presented by Dallas Gold and Silver Exchange(Verbal appraisal)
Estate of Ethel Y. Wilson DOD 6-2-2007
Silver dollars(10} $12.00 $120.00
Ha1f dollars(4) $5.00 $20.00
Dime(1) $1.00 $1.00
_ Total Coin Va1ue _- $141.00 _ _ _ _
Wachovia Bank, N.A. �
Carlisle Financial Center
PA6825
604 East High Street
Carlisle, PA 17013
Tel 717 249-7478
�
i
�
I��
WACHOVIA
Emory J Wilson
648 Highland Ave �.
Mt Holly Springs Pa 17065
Mr Wilson; '
Please accept my condolences for the loss of your mother. The value of her certificate of
deposit as of June 2"d was $13,948.39.
Should you need any further assistance please feel free to contact me at 717-249-7478.
Sincerely,
�
Jill Manley .
Manager �
Carlisle
�
�
1 �
CO
NATIONAL BANI�
July 27, 2007 E�`�-�
�J~v>asr-soor/
Emory J Wilson � G��e�i6
648 Highland Ave.
� Mt. Holly Springs,PA 17065
Re: Estate of Ethel Y Wilson
Dear Mr. Wilson:
The following information is being provided as per your request:
Acct. Type Account No. Account Accrued Ownership Date Opened
Principal on Interest to
D.O.D. D.O.D.
C.D. 640119396 $801.40 $2.46 Individual 5/3/95
Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer
Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5116.
Sincerely, , �
�� �' ` �_"
Lois A Kime
Deposit Services
PO Box 3129,GETTYSBURG,PA 17325�PHONe 7173343161 �To��Fxee 1.888.334.ACNB(2262)�www.acnb.com
�/.�a
�j�h E� Colleen M � ' To Jennifer Luebbers/Consumer/SCP/PNC@PNC
� �V Crowder/Consumer/PGH/PN
C cc
06/22/2007 09:48 AM bcc
Subject Wilson, Ethel Y date of death balance
Ethel Y Wilson (Deceased)
SS#201-07-5085
DOD 06-02-2007
�.
. ACCOUNT NUMBER * DATE OF DEATH BALANCE + ACCRUED INTEREST f-
� c1� CDA 31600258432 � 7,283.77 + 47.53 �
� �� DDA 5140194022 7,000.74 + 1.96
� E-!� REA 65001015991 3,258.71 + 5.23
✓
If you selected the balances to be sent to the "Branch"they will only be sent to
the requestor by Lotus Notes.
Have a nice day. �
. `—�
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REV-1510 EX+ (08-09)
� pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER—VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON—PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wilson, Ethel Y. 2107-0565
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATfONSHIP TO DKEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER fHEDATE0F7RANSFQ2. ATfACHACOPYOfhIEDEEDFORREALESTATE. VALUEOFASSET INTEREST (IFAPPLICABLE) VALUE
1• Met Life No.4035260857 177,522.14 100 177,522.14
TOTAL(Also enter on Line 7, Recapitulation) $ 177,522.14
If more space is needed,use additional sheets of paper of the same size.
Aug/26I2014 9:35:37 AM MetLife 515-457-43D3 1/1
MetLife .
P.O.Hox 10342
Dee Moines IA 60308-0342
�lletLlf e
August 25, 201a
KATHI.EEN DANI��S
FAX:717�243-5916
RE: CONTRACT00084b641RB
OWNER ETHEL Y WILSON(Deceased)
Dear Ms. naniels:
This letter is in response to you�fnquiry on the above referenced contract.
Ms, Ethel Wilson had begun taking annuity payments from her MetLife annuity, wit1�the option of�.Ife oniy
with 10 ye�rs period certain. This means that within the first ten years of this supplemental annuity
contract(spanning 7i11/20fl6 to 7/10/2fl96),elther Ma.Wilson or a named beneflclary, wouid recetve the
monthly payment of$2,063.15. Upon Ms.WI(son's death, there were 8 years remaining of that 10 year
guarankee, Becauae Ms. Wiison's beneficiary was her estate, per MetLlfe rulss,when a benefrciary is an
estaEe, we muat commute the value of remaining payments,and pay the estate In a Iump sum.
On July 6, 2007, a payment of$177,522.14 was sent to a Tota1 Contro�Account for the benefit of the
Estate of�thel Y Wilson. This one time accommodation represented the full commuted death benefit
value�f Ms.Wilson's contract.
If you have any questlo , pieas contact your representative vr cali our Customer Service Center at
1-800-838-77321-800- 38-7732 Monday through Fridey between 9:00 a.m.and 6:00 p.m., ET9:00 a.m.
and 8:00 p.m., 1".
Slnc a ,
�
�. i
l�
Michael Foster , �,,
Annuity Consulta t ` .
MetLife Annuity Operations and SeNICes
Help us etay eonnected: Ptesse keep ua updated wlth reaped ta all who aro aaaociated with thla conhact,inciudirtg the owner,the
ennultent,and any beneflciaries. Mske euro that wo have ths tollowing Intortnatlon for all pereona or entitles: neme,addreaa,
phone number,date of birth,and sodal aecurity or tax Idenhficstion number. Cl�ange9 may be 6ubmitted to the addtes8 provided
above,by celiing our Customsr Service Center at ths phoos number prov�ded above,or by contactinp your Reprosentative.
Metropalltan Life fnsurance Company•MetLife Investors USA lnsurance Company.MetLife Investor�
Insurance Company•New Engiand Life Insurance Company.MetLi�e Insuranca Company of
Connecticut.First MetLife Investors Insurance Company
REV-1511 EX+ (08-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wilson, Ethel Y. 2107-0565
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Hollinger Funeral Home,Services 1,086.50
2. Hollinger Funeral Home,Additional Death Certificates 62.00
e. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 9,571.43
Name(s)of Personal Representative(s) Emory J. Wilson and Saundra W. Huntzinger
Street Address c/o Emory J. Wilson 648 Hiqhland Avenue
city �ount Holly Springs state PA ZIP 17065
Year(s)Commission Paid: 2010
10,012.00
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation.) 0.00
Claimant N/A
Street Address
City State ZIP
Relationship of Claimant to Decedent _
4. Probate Fees: 85.00
5. Accountant Fees: 1,900.00
6. Tax Return Preparer Fees: 0.00
�• Cumberland Law Journal,Ads 75.00
s. The Sentinel-Legal,Ads 158.62
9. PNC Bank,Service Charge 700.00
�o. Register of Wilis,Add'I Probate 70.00
��. Register of Wills,Filing 42.00
�2. Reserve for Settling Estate 1,000.00
TOTAL(Also enter on Line 9, Recapitulation) $ 24,762.55
If more space is needed,use additional sheets of paper of the same size.
RECEIPT FOR PAYMENT * DUPLICATE *
GLENDA FARNER STRASBAUGH Receipt Date : 6/08/2007
Cumberland County - Register Of Wills Receipt Time : 13 : 16 :20
One Courthouse S auare Receipt No. : 1048765
Carlisle, PA 17613
WILSON ETHEL Y
Estate File No. : 2007-00565
Paid By Remarks : SAUNDRA W HUNTZINGER �
JA
---------- -------------- Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 20 . 00 CUMBERLAND COUNTY GENERAL FU
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FU
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FU
CODICIL 15 . 00 CUMBERLAND COUNTY GENERAL FU
SHORT CERTIFICATE 20 . 00 '-" CUMBERLAND COUNTY GENERAL FU
JCP FEE 10 . 00 BUREAU OF RECEIPTS & CNTR M.
----------------
Check# 2130 $85 . 00 �
Total Received. . . . . . . . . $85 . 00 • �
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CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
July 6, 2007
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 far publication of legal notices.
TO: William S. Daniels, Esquire
Ethel Y. Wilson, Estate
RE:
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:
June 22, 29, and July 6, 2007
Advertising Cost 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 75.00 �
Total Amount Due $ 0.00
Becky H. Morgenthal, Executive Directar
—�.-----
----
DETACH AND RETURN THIS PORTION WITH,YO� PAYM
' THE SENTINEL - LEGAL obert Culley
P.O. BOX 130 CARUSLE PA 17013 START DATE STOP DATE _
AD NUMBER CLASSO , _�.�"
330734 PUBLIC NOTICES 06/16 7 `_`_Ob����7 GROSS AMOUNT OF
AD D SCRIPTION BILLING ATE TELEPHONE NUMBER 21 9.07
ADMINISTRATRIXES NOTICE LETTERS OF 0 /3 0/0 7 717-24 0-3 8 31 DUE AFTER 07/30/07
TOTAL AMOUNT DUE
182 . 56
HUMER & DANIELS � ENTER AMOUNT ENCIOSED
1 W�ST HIGH STREET � �z . .S�
SUITE 205
� CARLISLE, PA 17013
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DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT R
THE SENTINEL - LEGAL START D TE Eo pe� Y' Wilson �
P.O.BOX 130 CARLISLE PA 17013
AD NUMBER CLASSO ,
06/15� 7 06�29�47 GROSS AMOUNT OF
3 3 0 5 0 8 PUBLIC NOTICES g�LLING DATE �-�--TEL�' NUMBER 1 JO.34
ADDESCRIPTION 06/29/07 717-240-3831 DUEAFTER 07/29I07
gXgCUTOR' S NOTICE LETTERS TESTAMEN
TOTAL AMOUNT DUE
158 . 62
ENTER AMOUNT ENCLOSED
gUMER & DANI$LS �� ��
1 WEST HIGH STREFsT
SUITE3 205 17013 �
CARLISLE, PA
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� pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX REfURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OP FILE NUMBER
Wiison, Ethel Y. 2107-0565
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1� LancasterHMA 33.75
2. Kinetic Imaging,Inc. 12.44
3. Church of God Home 299.69
4. Continuing Care RX 575.59
5. Carlisle Regional Med.Center 33.65
6. Masland Associates,Inc. 8.04
7. LancasterHMA 18�85
8. Hartzell Eye MDS 100.00
9. Three Springs Family Practice 16.27
10. Contiuning Care RX 5�88
11. Kinetic Imaging,Inc. 4.92
12. Church of God Home 4,806.43
13. US Treasury,Taxes 161.00
14. PA Dept.of Revenue,Taxes 226.00
15. Carlisle Regional Medical Center 992.00
16. Lancaster HMA 92'�9
17. Humer and Daniels,Estate Planning 2,500.00
TOTAL(Also enter on Line 10, Recapitulation) $ 9,886.70
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REV-i513 EX+(01-10)
`� pennsylvania SCHEDULE �
DEPARTMENT OFREVENUE
INHERTfANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Wison, Ethel Y. 2107-0565
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1� Emory Jacob Wilson Son 1/3
648 Highland Ave,Mt.Holly Spgs.,PA 17065
2. Saundra W.Huntzinger Daughter 1/3
1409 Treeline Dr.,DeSoto,TX 75115
3. Jennifer Huntzinger Grandaughter 1/9
457 FDR Drive,Apartment A1602,NY,NY 10002
4. Marc Huntzinger Grandson 1/9
165 Hill Creek Boulevard,Chapel Hill,NC 27516
5. James Huntzinger Grandson 1/9
4924 Green Run Court,Richmond,VA 23228
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
i.
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.