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REV-1500 EX + (6-00)
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
*
FILE NUMBER
I II 2005
I COUNTY CODE YEAR
I SOCIAL SECURITY NUMBER
287-30-5877
00324
NUMBER
DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
WILSON, WANDA F
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
02-05-2005 11-20-1936
APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
Jordan, David W
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1 1 3. Remainder Return (date of death prior to 12-13-82)
1 1 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
1 1 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
11. Original Return
I 1 4. Limited Estate
xl 6. Decedent Died Testate (Attach
copy of Will)
1 9. Litigation Proceeds Received
2. Supplemental Return
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4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal of death between
. 12-31-91
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COMPLETE MAILING ADDRESS
NAME
Edmund G. Myers
FIRM NAME (If applicable)
Johnson, Duffie, Stewart & Weidner
TELEPHONE NUMBER
717-761-4540
P.O. Box 109
P.O. Box 109
Lemoyne, PA 17043
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
OFFICIAL.USE ONLY
53,945.00
None
None
None
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) 1 i Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
2,450.00
None
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(8)
56,395.00
(9)
7,131.10
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
(11 )
7,131.10
49,263.90
0.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
, 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax(Line 12 minus Line 13)
(13)
(14)
49,263.90
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 47,263.90 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0
~ 16.Amount of Line 14 taxable at lineal rate 2,000.00 x .045 (16)
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Q. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
x x
~ 19. Tax Due
(19)
0.00
90.00
0.00
0.00
90.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
Decedent's Complete Address:
STREET ADDRESS
603 Brandt Avenue
CITY New Cumberland
I STATE PA
]ZIP 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
90.00
0.00
Total Credits (A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(3)
(4)
(5) 90.00
(5A)
(5B) 90.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;............................................................................. x
b. retain the right to designate who shall use the property transferred or its income;................................ ' x ,
c. retain a reversionary interest; 0[........................................................................................................... xi
d. receive the promise for life of either payments, benefits or careL........................................................ ! x !
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................................................. i x I
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?................................................................................................................ i x I
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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. 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.
SIGNATURE OF PERSON RESP. NSIBL FOR FILING RETURN ADDRESS
E'O W JO~ 603 Brandt Avenue
New Cumberland, PA 17070
N RE OF PERSO R ADDRESS
ix
DATE
6If6(L./VS-
DATE
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
Ed und G. Myers
JJ
ADDRESS
DATE
P.O. Box 109
Lemoyne, PA 17043
b({fo(UC-
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 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax .-<- .
[72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes notexen
of assets and filing a tax return are still applicable even
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from
natural parent, an adoptive parent, or a stepparent of th
The tax rate imposed on the net value of transfers to or
~9116 1.2)[72 P.S. ~9116 (a)(1)].
{\\\1=>))
s to or for the use of the surviving spouse is 0%
ax, and the statutory requirements for disclosure
ciary .
'e or younger at death to or for the use of a
iciaries is 4.5%, except as noted in 72 P.S.
The tax rate imposed on the net value of transfers to or
defined under Section 9102, as an individual who has at
-:S
2% [72 P.S. ~9116 (a) (1.3)]. A sibling is
:adent, whether by blood or adoption.
Rev.1502 EX+ (6.96)
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
WilSON, WANDA F
FilE NUMBER
21-2005-00324
ESTATE OF
All real property owned solely or as a tenant In common must be reported at fair market valuliair market value is defined as the price al which property would be
exchanged between a willing buyer and a willing seller, neilher being compelled to buy or sell. both having reasonable knowledge of the relevant facts.
Real property which Is jolntly-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Real Estate - located at 603 Brandt Avenue, New Cumberland, Cumberland County,
PA. Deed Book C, Volume 27, Page 310.
Tax Parcel No. (Part of) 25-24-0811-003. Valued using 2004 assessed value of
property multiplied by the Cumberland County Common level Ratio
VALUE AT DATE
OF DEATH
53.945.00
TOTAL (Also enter on Line 1, Recapitulation)
53.945.00
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
Rev.1508 EX+ (6-96)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT OECEDENT
ESTATE OF
WILSON, WANDA F
FILE NUMBER
21-2005-00324
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Coin Collection 2.000.00
2 Jewelry - 3 Rings owned by Decedent. Valued and Appraised by Jewelry at $150.00 450.00
for each.
3 Sea Shell Collection - For informational purposes only. No monetary value 0.00
TOTAL (Also enter on Line 5, Recapitulation)
2.450.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-96)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
WILSON, WANDA F
FILE NUMBER
21-2005-00324
ESTATE OF
This schedule must be completed and filed if the answer 10 any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Disability Retirement Annuity - Beneficiary: 0.00 0.00
David W. Jordan, Surviving Spouse.
Mr. Jordan, as surviving spouse is entited to
receive, for life, an amount of $600.00 per month.
This is a transfer from wife to husband and not
subject to tax. This is being provided for
informational purposes only
TOTAL (Also enter on Line 7, Recapitulation) 0.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV.1151 EX+ (12.99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WILSON, WANDA F
FILE NUMBER
21-2005-00324
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
2,200.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State Zip
2.
Attorney's Fees
Johnson, Duffie, Stewart & Weidner
1,000.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant David W Jordan
Street Address 603 Brandt Avenue
City New Cumberland
Relationship of Claimant to Decedent
3,500.00
State
Spouse
PA
Zip
17070
4.
See continuation schedule(s) attached
Probate Fees
150.00
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
281.10
TOTAL (Also enter on line 9, Recapitulation)
7,131.10
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WILSON, WANDA F
FILE NUMBER
21-2005-00324
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Stone & Murray Funeral Home - Cremation Service
2.200.00
Subtotal
2.200.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-96)
*'
SCHEDULE H.B4
PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WILSON, WANDA F
FILE NUMBER
21-2005-00324
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register Of Wills Office - Probate fees
150.00
Subtotal
150.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H.B4 (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WILSON, WANDA F
FILE NUMBER
21-2005-00324
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Recorder of Deeds Office - filing fees
43.50
2
Cumberland County Register Of Wills Office - Filing Fees - Inheritance tax return
($15.00) and Inventory (15.00)
30.00
3
Cumberland Law Journal - Notice of Estate Administration
75.00
4
The Patriot News - Notice of Estate Administration
132.60
Subtotal
281.10
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
LISTING OF EXHIBITS FOR
ESTATE OF WANDA F. WILSON
EXHIBIT A
Last Will and Testament of Wanda F. Wilson signed and
dated on January cjh, 1998.
EXHIBIT B
2004 Tax Assessment.
:25303/
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mast l1Iill aub Wtstamtnt
OF
WANDAF. WILSON
I, WANDA F. WILSON, of the Borough of New Cumberland, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as
and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any
time heretofore made by me.
ARTICLE I
I direct the payment of my legal debts and the expenses of my last illness and ftmernl from my
Estate as soon after my death as conveniently may be done.
ARTICLE II
I give and bequeath my coin collection which I inherited from my father and the small safe where I
have kept the coin collection unto my daughter, SANDRA G. GEISWITE, provided she survives me.
ARTICLE ill
I give and bequeath my seashell collection unto my daughter, WENDY M. MIDDLETON,
provided she survives me.
ARTICLE IV
I give and bequeath my motor vehicle(s), the remainder of my househOld and personal effects and
other tangible personalty of like nature (not including cash or securities), unto my husband, DAVID W.
JORDAN, provided he survives me by thirty (30) days. In the event that my husband, DAVID W.
JORDAN, is not living on the thirty-first (31st) day following my death, it is my wish that any
Memorandum I may leave addressed to my personal representative indicating my desires with respect to
disposal of these items, or any of them, shall be regarded.
ARTICLE V
I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature
and wheresoever situate unto my husband, DAVID W. JORDAN, provided he survives me by thirty (30)
days. If my husband, DAVID W. JORDAN, is not living on the thirty- frrst (31 st) day following my death,
I give, devise and bequeath all the rest, residue and remainder of my estate unto my daughter, MELINDA
R. WILSON.
ARTICLE VI
I
I name, constitute and appoint my husband, DAVID W. JORDAN, Executor of this my Last Will
and Testament. Should my husband, DAVID W. JORDAN, faU to qualify or cease to so act, I name,
constitute and appoint my daughter, MELINDA R. WILSON alternate Executrix to complete the
administration of my estate. I direct that no fiduciary appointed herein shall be required to post bond for the
faithful administration of the duties required in any jtrrisdiction.
2
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IN rSS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, this7~dJiYOh ,1998
~A1'9-~
W ANnA F. WILSON
(SEAL)
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and
Testament, in the presence of us, who at her request, in his presence and in the presence of each other, have
hereunto subscribed our names as witnesses.
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ACKNOWLEDGMENT
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COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, WANDA F. WILSON, ~mulV2) u: 111f/&1f3 S and
et{(dS~N L UJf11-(;f-I the Testatrix and the wi1nesses, respectively, whose
nanles 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 and that she executed it as his free and voluntary act for the purposes therein expressed, and
that each of the wi1nesses, in the presence and hearing of the Testatrix, signed the Will as wi1ness and that to
the best of hislher lmowledge the Testatrix was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
~.~ )~~
WANDA F. WILSON
~
Witness
~~_lA Wit
Witness
I
this
Subscribed, sworn to and aclmowledged before me by WANDA F. WILSON, Testatrix, and
g/'y'YJUA/lj 0" mV!Y2.!J. and /::if t2 olE#' L LJ ~S/-I , witnesses,
9t1dayof Q)~ ,1998.
~~~L)
N Public
My Commission Expires:
.. Nd~rA[-WC.
NINA JUNE DAVIS, Notary Public
'. "rnovne Bora. ClImberland County
'\Hilnission [;;;Jiles Oct. 31,1998
;;ii-~~ i'ennsylvani a Associalion 01 Notaries
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