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REV-1500 EX + (6-00)
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OFFICiAL USE ONLY
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
0174
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Orner, William F.S. Jr.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
12-03-2005 I 04-18-1933
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
Orner, Elaine M.
w I~ 1. Original Return D 2. Supplemental Return
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lIl:: ~ UJ [] 4. limited Estate D 4a. Future Interest Compromise (date of death after
~ If ~ 12-12-82)
5 ~ 9 I xJ" 6. Decedent Died Testate (Attach D 7. Decedent Maintained a Living Trust (Attach
8:: m -- copy of Will) copy of Trust)
."___~_ _ ".I~J_ 9. Litigation Proceeds Received D 1 O. rf-g~~~1 ~~v1:~~redit (date of death between [J 11. Election to tax u~~~sec. 9113(~~t~~~"":~hO) .
THISc.SECTION....NlUST,aE<C.OMRUE;rE[);AU.~.c.~Q8Bi$~;~Ni~~ijNQifJNJt\~t;NmJeffBrJ.NJ;biMA'TJ~.N...'&.H(;)QJ.;f.)e.~c.Q'RECm.ep..."F(;)$
NAME COMPLETE MAILING ADDRESS
Michael L. Bangs
FIRM NAME (If applicable)
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TELEPHONE NUMBER
717/730-7310
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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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) D Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
208-24-0058
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
164-30-3122
[J 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
429 South 18th Street
Camp Hill, PA 17011
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(1 )
(2)
(3)
(4)
(5)
(6)
(7)
Ol~FICIAc-OSE ON~~
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(9)
None
86,650.20
None
None
None
None
None
(8)
8,588.99
3,112.41
86,650.20
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(11 )
11,701.40
74,948.80
0.00
(12)
(13)
13. Charitable and Governmental Bequests/See 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)
(14)
74,948.80
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20. D
0.00
0.00
0.00
0.00
0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
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Copyright 2002 form software only The Lackner Group, Inc.
15. Amount of Line 14 taxable at the spousal tax rate, 74,948.80 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
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i= 16.Amount of Line 14 taxable at lineal rate 0.00 x .045
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0.. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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u 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
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(19)
Form REV-1500 EX (Rev. 6-00;
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Decedent's Complete Address:
STREET ADDRESS
704 North Front Street
ISTATE PA
IZIP 17043
CITY Wormleysburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
0.00
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 thEOVERPA YMENT.
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.
8. Enter the total of Line S + SA. This is theBALANCE DUE
(3)
(4)
(5) 0.00
(5A)
(58) 0.00
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;............................................................................. [~] [!J
b. retain the right to designate who shall use the property transferred or its income;................................ [J [!J
c. retain a reversionary interest; or............................ ...-............................................................................ [~] [!J
d. receive the promise for life of either payments, benefits or care?.......................................................... [J C!1
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?... .... .... ...................... .............................. ...... ..... ........ ..... ........... .............. D L~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... [J l~
4. Did dece.gent own an Individual Retirement Account, annuity, or other non-probate property which~_
contains a beneficiary designation? .... ....... ..... .............--............ ...... ............ ...... ..... .......... ............ ............. .... L_J 1iI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEPULE 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 RESPONSIB R FILING RETURN ADDRESS
E Orner
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704 North Front Street
Wormleysburg, PA 17043
ADDRESS
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Michael L. Ban
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ADDRESS
DATE
429 South 18th Street
Camp Hill, PA 17011
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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% [72 P .5. 99116 (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 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statutedoes 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 adoptive parent. or a stepparent of the child is 0% [72 P.S. 99116 (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.
99116 1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use ofthe decedent's siblings is 12% [72 P.S. ~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.
Rev-1503 EX+ (6-98)
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Orner, William F.S. Jr.
FILE NUMBER
21-06-0174
ESTATE OF
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 1,820 shares of Aetna Inc. Stock 47.61 86.650.20
.
TOTAL (Also enter on Line 2, Recapitulation) 86.650.20
(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 B (Rev. 6-98)
Frank R. Baker
146 Springhouse Lane
Spring Grove, P A 17362
Phone: 717/225-5450
Fax: 717/225-0494
e-mail: frankr.baker@suscom.net
April, 24, 2006
The follo\ving is the value of Aetna, Inc. on December 2, 2005:
EQ uities
Hi2h
Low
Avera2e
Shares
Value
Aetna Inc.
AET
47.83
47.38
47.61
1820
$ 86,650.20
Since Mr. Onler died on Saturday, December 3, the prices for Aetna are from Friday, December 2.
If you have any questions, please call me.
Sincerely,
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Frank R. Baker
REV-1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Orner, William F.S. Jr.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-0174
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
2,896.00
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 !ees
Michael L. Bangs
5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
260.00
5.
Accountant's Fees
250.00
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
182.99
TOTAL (Also enter on line 9, Recapitulation)
8,588.99
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
Orner, William F .5. Jr.
FILE NUMBER
21-06-0174
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Kristin Rogers - Funeral luncheon and funeral deposit
750.00
2
Parthemore Funeral Home & Cremation Services, Inc.
2.146.00
Subtotal
2.896.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Orner, William F .S. Jr.
FILE NUMBER
21-06-0174
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland Law Journal
75.00
2
The Sentinel
107.99
Subtotal
182.99
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Orner, William F .5. Jr.
FILE NUMBER
21-06-0174
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Cumberland County Tax Claim Bureau - 2005 Real Estate Taxes
VALUE AT DATE
OF DEATH
1.871.46
2 Dorothy L. Mott, Esquire
1,209.00
3 Harrisburg Gastroenterology, Ltd.
10.05
4 Hospital Telephone & Telcom Services, Ltd.
16.00
5 Quantum Imaging & Therapeutic
5.90
TOTAL (Also enter on Line 10, Recapitulation)
3,112.41
(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 I (Rev. 6-98)
REV-1513 EX+ (9-00)
.
SCHEDULE ~
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Orner, William F .5. Jr.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)1
RELATIONSHIP TO
DECEDENT
Do Not list Trustee(s)
FILE NUMBER
21-06-0174
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
I.
1
Elaine M Orner
704 North Front Street
Lemoyne, PA 17043
Spouse
Entire
T olal
Enter dollar amounts for distributions shown above on lines 15 through 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART IJ- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleJ (Rev. 6-98)
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rJ I, WILLIAM F.S. ORNER, JR., of the Borough ofWormleysburg, Cunlberland
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~ County, Pennsylvania, declare this to be my last will and revoke any will previously made by
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me.
ITEM I. I direct that all my just debts and funeral expenses, including nlY gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all
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other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, to my wife, ELAINE M. ORNER, provided she survives
my death by thirty (30) days. Should n1Y said wife predecease Ine or be deceased on the thirty-
first day after my death, I give and bequeath all such items and insurance thereon in equal shares
to those of nlY issue, per stirpes, as survive my death by thirty (30) days.
ITEM III. I give, devise, and bequeath all the rest, residue, and reInainder of Iny
possessions and estate of every nature and wherever situate to my wife, ELAINE M. ORNER,
provided she survives 111Y death by thirty (30) days. Should nlY said wife predecease lne or be
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deceased on the thirty-first day after my death, I give, devise, and bequeath all the rest, residue,
and reInainder of Iny possessions and estate of every nature and wherever situate in equal shares
to those of nlY issue, per stirpes, as survive my death by thirty (30) days.
ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachInent.
ITEM V. I appoint my wife, ELAINE M. ORNER executrix of this my last will. Should
nlY said wife predecease me or otherwise fail to qualify or cease to serve as executrix of this my
last will, I appoint nlY son-in-law, BRIAN S. ROGERS, executor of this nlY last will.
ITEM VI. In addition to the other powers and authorities granted to nlY personal
representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to 111Y personal representatives the following powers and authorities effective without couli
approval and until actual distribution of all property: to compromise any claim or controversy;
to nlake dist:ibution in cash or in kind, or partly in cash and partly in kind, and in such manner as
nlY personal representatives may determine and at valuations finally to be fixed by then1; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as nlY
personal representatives deenl proper, without regard to any principle of risk or diversification;
to retain any or all assets of Iny estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of tilne,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
2
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deelTI proper in their sole discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
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day of
, 2002.
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WILLIAM F.S. ORNER, JR. 0
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The preceding instrument, consisting of this and THREE other typewritten pages, each
identified by the signature of the testator was on the date thereof signed, published, and declared
by WILLIAM F.S. ORNER, JR., the testator therein named, as and for his last will, in the
presence of us, who at his request, in his presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
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COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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( SS:
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The undersigned, being the testator whose nalne is signed to the attached or foregoing instnnnent,
having been duly qualified according to law, does hereby ackilowledge that I signed and executed the
foregoing instnnnent as iny last will, that I signed it willingly; and that I signed it as illY free and
voluntary act for the purposes therein expressed.
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WILLIAM F.S. ORNER, JR.
COMMONWEALTH OF PENNSYLVANIA
)
( 88:
COUNTY OF CUMBERLAND )
WE, /'1. J..-.J L &I'v;) -s and q kl\\ L , the witnesses whose
nalnes are signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testator sign and execute the instrument as his last will;
that he signed it wi II ingly and that he executed it as his free and voluntary act for the purposes therein
expressed~ thm each of us in the hearing and sight of the testator signed the wi II as witnesses; and that to
the best of Ollr knowledge, the testator was at that time 18 or lTIOre years of age, of sound l11ind, and under
no constraint or undue influence.
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