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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE DEPT.
280601 HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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OFFICIAL USE ONLY
FILE NUMBER
21 05
COUNTY CODE
YEAR
0917
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Gresham, Donna M.
DATE OF DEATH (MM-DD-YV) DATE OF BIRTH (MM-DD-YV)
10/2/2005 11/16/1941
(IF APPLICABLE) SURVIVING SPOUSE'S NAME
SOCIAL SECURITY NUMBER
192-34-5628
THIS MUST BE FILED IN DUPLICATE
WITH THE REGISTER OF WILLS
SOCIAL SECURITY NUMBER
I
XJ 1. Original Return D 2. Supplemental Return D 3. Remainder Return
:=J 4. Limited Estate D 4a. Future interest Compromise D 5. Fed. Est. Tax Return Req'd
[8] 6. Decedent Died Testate D 7. Decedent had Living Trust 0_ 8. Total number of SOB's
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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NAME: COMPLETE MAILING ADDRESS:
Ronald E. Johnson, Esquire
FIRM NAME:
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Andrews & Johnson
TELEPHONE NUMBER
717 243-0123
Ronald E. Johnson, Esq.
Andrews & Johnson
78 W. Pomfre~-~t.
Carlisle, PA 17--01:3
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$16,725.77
$0.00
$2,446
(8) $19,171.68
$16,253.58
$0.00
$16,253.58
$2,918.10
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(12)
$2,918.10
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(18)
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$131.31
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3.Closely Held Corporation, Partnership or Sole-Prop.
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Propate Prop.
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administration Costs (Sch H)
10. Debts of Decedent, Mortgage liabilities, & Liens
11 . Total Deductions (total lines 9& 1 0)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amnt of Line 14 taxable at the spousal rate,
or transfers under Sec.9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
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
8. 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 + 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)
(58)
$131.31
$0.00
$0.00
$131.31
$131.31
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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:
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 ,0. F PERSON RESP9NSIBLE FOR F~L1~G RETURN
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ADDRESS
et, Carlisle, PA 17013
SENT A TIVE
AD
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% [72P.S. 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 decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) [72 PS Sec.9116(a)(1)
Individual who has at least one parent in common with the decedent, whether by blood or adoption.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P S Sec.9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
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LAST WILL AND TEST AMENT
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 that 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- L.
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 WHERE 0 F, 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 I 3
day of June 2005.
CL?!J ~~
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
wi tnesses.
CO!\1MONWEALTH 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 Testanient; 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, Cumberlan~ County
My Commission Expires April 26, 2007
(SEAL)
AFFIDA VIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, RONALD E. JOHNSON and W...s , 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 \Vill 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
and ~~ ~r ~ , witnesses, this I da f June 2005.
NOTARIAL SEAL
SHELLY SEXTON, Notary Public
Carlisle Bora, Cumberland County
My Commisston Expires April 26, 2007
(SEAL)
(SEAL)
Notary Public
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Donna M. Gresham
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
DESCRIPTION
21-05-0917
ITEM
NUMBER
VALUE AT DATE
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
· rI M&fBank
499 Mitchell Road, MiIIsboro, 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 Security: 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 oj)
Donna M Gresham *
Debbie Jean Kecle, POA *
Opening Date
03/07/91
Balance on Date of Death
$1,642.92
Accrued Interest
$" 0.07
Total
$1,642.99
Interest Paid YTD
$ 3.35 (Accrued interest is not included)
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 THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT ANI:
Nillv1BER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. OF ASSET INT (if applicable) VALUE
1 Union Bank of California, NA $2,445.91 100% $2,445.91
401 K Transferred upon death
to Debra J. Keck, daughter
This schedule to be completed and fded ifthe answer of the question on the reverse ofthe cover is yes.
TOTAL (also on line 7, Recapitulation)
$2,445.91
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
FILE NUMBER
ESTATE OF
Donna M. Gresham
21-05-0917
ITEM
NUMBER
A.
B.
1
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 NUMBER
Donna M. Gresham
21-05-0917
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
Nillv1BER Do Not List Trustee( s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116(a)(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 250;6
4 Chirs M. Anderson
127 Meadowview Drive, Dover, PAl 73 15 Son 250/0
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. Charitable and Govenunental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation)
$0