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OFFICIAL USE ONL Y
COMMONWEALTH OF PENNSYLVANIA REV-1500 FILE NUMBER
DEPARTMENT OF REVENUE DEPT. INHERITANCE TAX RETURN
280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 05 0917
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I- Gresham, Donna M. 192-34-5628
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w DATE OF DEATH (MM-DD-YV) DATE OF BIRTH (MM-DD-YY) THIS MUST BE FILED IN DUPLICATE
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W 1 0/2/2005 11/16/1941 WITH THE REGISTER OF WILLS
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W (IF APPLICABLE) SURVIVING SPOUSE'S NAME SOCIAL SECURITY NUMBER
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w ;xl 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return
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uo::~ P 4. Limited Estate 0 4a. Future interest Compromise 0 5. Fed. Est. Tax Return Req'd
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:::cOO I8J 6. Decedent Died Testate 0 0_
uO::...J 7. Decedent had Living Trust 8. Total number of SDB's
a.a3
a.
~ I 9. Lit'g'tion Proceeds Rec'd n 10. Spousal Poverty Credit n 11. Election to tax w/ Sec. 9113(A)
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z NAME: COMPLETE MAILING ADDRESS:
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z Ronald E. Johnson, Esquire
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a. FIRM NAME: Ronald E. Johnson, Esq.
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w Andrews & Johnson Andrews & Johnson
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0:: 78 w. Pomfre~t. r-)
TELEPHONE NUMBER C:)
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U 717 243-0123 Carlisle, PA tlD1:S Cf'>
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1. Real Estate (Schedule A) (1 ) $0.00 OF-FI:(ltJl.~,lJSE OOL Y
2. Stocks and Bonds (Schedule B) $0.00 '--, ~_1 0"\
(2) ::.f) ::,':~
3.Closely Held Corporation, Partnership or Sole-Prop. (3) } c~~ r) -n
j =~~ ~;.l -,.,.,..
$0.00 --'.
4. Mortgages & Notes Receivable (Schedule D) (4) :::U N
Z 5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E) (5) $16,725.77 ~,J --i
0 $0.00 .:.?' W
i= 6. Jointly Owned Property (Schedule F) (6) 0
5 D Separate Billing Requested
:J 7. Inter-Vivos Transfers & Misc. Non-Propate Prop. (7) $2,446
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ii: 8. Total Gross Assets (total lines 1-7) (8) $19,171.68
cr:: 9. Funeral Expenses & Administration Costs (Sch H) (9) $16,253.58
0
w 10. Debts of Decedent, Mortgage liabilities, & Liens (10) $0.00
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11. Total Deductions (total lines 9&10) (11 ) $16,253.58
12. Net Value of Estate (Line 8 minus Line 11) (12) $2,918.10
13. Charitable and Governmental Bequests/Sec 9113 Trusts
for which an election to tax has not been made (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $2,918.10
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z 15. Amnt of Line 14 taxable at the spousal rate,
0
i= or transfers under Sec.9116(a)(1.2) x.O_ (15) $0.00
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::J 16. Amount of Line 14 taxable at lineal rate $2,918 x.045 (16) $131.31
a.
:!: 17. Amount of Line 14 taxable at sibling rate $0 x.12 (17) $0.00
0
0 18. Amount of Line 14 taxable at collateral rate $0 x.15 (18) $0.00
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~ 19. Tax Due (19) $131.31
20 D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS
124 Big Spring Terrace
CITY STATE ZIP
Newville PA 17013
Tax Payments and Credits:
1 . Tax Due
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discounts
Total Credits (A+B+C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
TotallnterestlPentalty (D+E)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5.
If Line 1 of- Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(1 )
(2)
(3)
(4)
(5)
(5A)
(5B)
$131.31
$0.00
$0.00
$131.31
$131.31
B. Enter the total of Line 5 of- 5A. This is the BALANCE DUE.
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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:
b. retain the right to designate who shall use the property transerred or its income:
c. retain a reversionary interest: or
d. retain the promise for life of either payments or care?
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?
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 disignation?
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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.
SIGNATU OF PERSON RES~R F~ RETURN
ADDRESS
et, Carlisle, PA 17013
SENTATIVE
Pomfret Street. Carlisle, PA 17013
DATE
DATE
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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% [72PS. Sec. 9116(a)(1.1)(1)].
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 0% [72 P.S. Sec. 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 deseased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. Sec. 9116(a)(1.2)}.
The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.9116(a)(1).
The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P.S. Sec.9116(a)(1.3)} A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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LAST WILL AND TESTAMENT
OF
DONNA M. GRESHAM
I, DONNA M. GRESHAM, of West Penn Township, 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 all other wills and codicils heretofore
made by me.
FIRST: I direct t.l}at all my just debts and funeral expenses, including my grave
marker, shall be paid from the assets of my estate as soon as practicable after my decease.
SECOND: I direct my hereinafter named Executor to sell all of my property and I
give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my
children, equally,' living at the time of my. death, namely, DEBRA J. KECK,-JERRY h -
ANDERSON, DALE E. ANDERSON, and CHRIS M. ANDERSON.
THIRD: I direct that all taxes that may be assessed in consequence of my death,
of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a
part of the expense of the administration of my estate.
FOURTH: I nominate, constitute and appoint my daughter, DEBRA J. KECK,
Executrix of this my Last Will and Testament. Should DEBRA J. KECK, fail to qualify or cease to
act as Executrix, I appoint my son, JERRY L. ANDERSON, Executor of this my Last Will and
Testament.
FIFTH: I direct my Executrix and his successors shall not be required to give
bond for the faithful performance of their duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, consisting of one (1) typewritten pages, each identified by my signature, this J 3
day of June 2005.
0-0110 ?!1 "It-,-
Donna M. GresHam
(SEAL)
Signed, sealed, published and declared by the above-named Testatrix, Donna M. Gresham, as
and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and
presence, and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
CO:MMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
I, DONNA M. GRESHAM, Testatrix, whose name is signed to the attached or foregoing
.instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it
as my free and voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowledged before me by Donna M. Gresham, the Testatrix,
this / ~ day of June 2005.
-
NOTARIAL SEAL
SHELLY SEXTON, Notary Public
Carlisle Boro, Cumber\an~ County
My Commission Expires April 26, 2007
(SEAL)
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, RONALD E. JOHNSON and W. , the witnesses
whose names are signed to the attached or foregoin instrument, being duly qualified according to
law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her
Last Will and Testament; that Donna M. Gresham, signed willingly and that she executed it as her
free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of
the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at
that time 18 or more years of age, of sound mind and under no constraint or undue influence.
or aff~e to and subscribed to before me by RONALD E. JOHNSON
6'r ~ , witnesses, this I da f June 2005.
NOTARIAL SEAL
SHELLY SEXTON, Notary Public
Carlisle Bora, Cumberland County
My Commission Expires April 26, 2007
(SEAL)
(SEAL)
Notary Public
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Donna M. Gresham 21-05-0917
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 disclosed on Schedule F
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1
Checking account no: 23523433 - M&T Bank (see letter attached)
$1,642.99
2
1990 Redman Mobile home - proceeds from sale
$10,000.00
3
2000 Chevrolet Cavalier automobile - proceeds from sale
$4,500.00
4
Department of Treasury - income tax refund
$582.78
TOTAL (also on line 5, Recapitulation)
$16,725.77
rl:1 M&fBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
October 26, 2005
Andrews & Johnson
Attorneys At Law
78 West Pomfret Street
Carlisle, Pennsylvania 17013
Re: Estate of: Donna M Gresham
Social Securitv: 192-34-5628
Date of Death: October 02, 2005
Dear Sir or Madam:
Per your inquiry dated October 19, 2005, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
Account Number
23523433
Ownership (Names of)
Donna M Gresham *
Debbie Jean Keck, POA *
Opening Date
03/07/91
Balance on Date of Death
$1,642.92
Total
$ 0.07
--$T64299-....-----.--.-..---..--------..----.-----.----
Accrued Interest
Interest Paid YTD
--$---.--3.3f.(Ac;:;:,~dira_;.e;tiS.not.ind~dedj----..----
Please be advised, there was no safe deposit box found for the above decedent.
· For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call
the Spring Garden Office # 717-240-4525.
Sincerely,
~e~
Records Management
SCHEDULE G
TRANSFERS
ESTATE OF
FILE NUMBER
Donna M. Gresham
21-05-0917
ITEM DESCRIPTION OF PROPERTY TOTAL VALUE DECD.% EXCLUSION TAXABLE
INCLUDE TIlE NAME OF TIlE TRANSFEREE. THE.IR RELATJONSlDP TO DECEDENT ANI:
NUMBER THE DATE OF TRANSFER. A'IT ACH A COPY OF TIlE DEED FOR REAL ESTATE. OF ASSET !NT (if applicable) VALUE
1 Union Bank of California, NA $2,445.91 100% $2,445.91
401K Transferred upon death
to Debra J. Keck, daughter
This schedule to be completed and med if the answer of the question on the reverse of the cover is yes.
TOTAL (also on line 7, Recapitulation)
$2,445.91
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF
FILE NUMBER
Donna M. Gresham
21-05-0917
ITEM
NUMBER
A.
1
B.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
Funeral Expenses:
Hoffman-Roth Funeral Home
$10,458.00
Administrative Costs:
Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
City: State: Zip:
Year(s) commissions paid:
Attorney fees to Andrews & Johnson
Family Exemption
Claimant Debra J. Keck
Street: 124 Big Spring Terrace
City: Newville State & Zip P A 17241
Relationship of Claimant to Decedent: Daughter
Probate Fees to Register of Wills
Accountant Fees to Patricia Rosendale, CPA
Tax Return Preparer's Fees
Kuhn Cable - TV cable
Adams Electric - electric bill
Sprint - telephone bill
Chase credit card
Register of Wills - filing fee for Inheritance Tax Return
Reserve for closing
$1,500.00
$3,500.00
$102.00
$23.68
$84.34
$25.66
$94.90
$15.00
$450.00
TOTAL (also on line 9, Recapitulation)
$16,253.58
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE N1J1.1BER
Donna M. Gresham
21-05-0917
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
I TAXABLE DlSTRlBlJITONS [include aullig\'A spou..l distributions. and transfers under Sec. 9116(0)(1.2)]
1 Debra J. Keck
124 Big Spring Terrace, Newville, PA 17241 Daughter 25%
2 Jerry L. Anderson
32 Center Street, #30, Mt. Holly Springs, P A 17365 Son 25%
3 Dale E. Anderson
1716 Windsor Way, Tampa, FL 33619 Son 25%
4 Chirs M. Anderson
127 Meadowview Drive, Dover, PA 17315 Son 25%
II NON. TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
B. Charitable and Govenunental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation)
$0