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REV-1500 EX + (8-00) ·
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, COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAl USE ONLY
FILE NUMBER
21 -05 079 8
""COuNTYCOOE -YEAR- - - NuMBER- -
DECEDENfS NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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STEVENSON ELSIE M.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
1 95- 1 6 - 4 007
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
07/13/2005 05/16/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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00 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Allach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Allach copy olTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Retum (date of death priOr to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Allach Sch 0)
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THIS .SEC'I'10".MlJST..SE..COMPLlTED...AI..L..CORRESPQl\IOENCS.. A...a ..CONFIDEN1'IA.I....TU...INFEJRMA.'tION.SH.IUl..D.SEDIRECT'SO.TO:
NAME COMPLETE MAILING ADDRESS
DAVID W. REAGER REAGER & ADLER, P.C.
FIRM NAME (If Applicable)
REAGER & ADLER P.C.
TELEPHONE NUMBER
717-763-1383
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate BiDing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
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2331 MARKET STREET
CAMP HILL
~ 17011
-70 OFFICI (' SE O~['f ~:;3
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(1 )
(2)
(3)
(4)
(5)
129.748.39
(6)
-
129.748.39
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
16.367.34
19.622.73
11. Total Deductions (total Lines 9 & 10)
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 (Schedule J)
(11)
(12)
(13)
35.990.07
93.758.32
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under See. 9116 (a)(1.2)
16. Amount of Une 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
(14)
93.758.32
0.00
99.758.32
0.00
x _ (15)
X .045 (16)
X .12 (17)
0.00
4,489.12
0.00
0.00
4,489.12
0.00 X .15 (18)
(19)
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>>SteSURE to A.N&WERAtLQUESTtONSON'REVERSe'SIDE.ANDRECHECKMATH < <
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ece en s ampl e e ress:
STREET ADDRESS 476 Enders Road
CITY I STATE I ZIP
Halifax PA 17032
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
4,489.12
3.700.00
194.73
Total Credits (A + B + C)
(2)
3.894.73
3. InterestJPenalty if applicable
D.lnterest
E. Penalty
TotallnterestlPenalty ( D + E ) (3)
4. If Une 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 (4)
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
594.39
594.39
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?....... ......................................................................... .............. 0 l&l
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................. ..................................................... 0 l&l
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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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 thF! ~lJrvivinn cmnllC:'" ic: ~Ol..
[72 P.S. ~9116 (a) (1.1) (i)l. -,of
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 surviv a (.t 0 p if I t/
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets r),." /I
he surviving spouse is the only beneficiary. .). le cJ P' V't:..-
or dates of death on or after July 1, 2000:
(he 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 NAP P
Jr a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
he 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 n01 C (f'\ (Q " 1 )].
he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibfing is defined, under Section 9102, as an
ldividual who has at least one parent in common with the decedent, whether by blood or adoption.
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ent,
REV-1508 EX +'(6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEVENSON. ELSIE M
FILE NUMBER
21 05
Include the proceeds at 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.
0798
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
89,728.88
John Hancock - Brokerage Account
Account No. 591-6482875
2.
PSECU Checking account
2,772.63
3.
PSECU Savings Account
133.90
4.
PSECU Money Market
35,512.98
5.
Sale of Wood Shredder
700.00
6.
Sale of miscellaneous personal property
100.00
7.
Cemetery plots - Blue Ridge Memorial Gardens
800.00
TOTAL (Also enter on line 5, Recapitulation) $
(It more space is needed. insert additional sheets of the same size)
129.748.39
REV-1511 EX-t'(12-99) .
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEVENSON ELSIE M
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 05
0798
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MALPEZZI FUNERAL HOME 9,648.35
2. MEMORIAL CONTRIBUTION TO CHURCH 325.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5) Wayne E. Stevenson 3,840.00
Social Security Number(s)/EIN Number of Personal Representative(s) 199-34-8143
Street Address 1 Stevenson Drive
City Newville State P A Zip 17241
Year(s) Commission Paid:
2. Attorney Fees REAGER & ADLER. P .C. 2,000.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS 339.00
5. Accountanfs Fees
6. Tax Return Prepare(s Fees
7. CUMBERLAND LAW JOURNAL 75.00
8. THE SENTINEL 107.99
9. ADVERTISING COSTS - PATRIOT NEWS - SALE OF CEMETERY PLOT 32.00
TOTAL (Also enter on line 9, Recapitulation) $ 16.367.34
(If more space is needed, insert additional sheets of the same size)
REV-1512 E~ + (6-98) .
.
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEVENSON. ELSIE M.
Include unreimbursed medical expenses.
FILE NUMBER
21 05
0798
ITEM
NUMBER DESCRIPTION
1. CHURCH OF GOD HOME - final bill
2. CONTINUING CARE PHARMACY
3. HOSPICE
4. SPRING ROAD FAMILY PRACTICE
5. WEST SHORE EMS
6. HOWARD BURKETT DPM
VALUE AT DATE
OF DEATH
6,347.03
9,535.10
3,600.00
13.45
97.15
30.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19.622.73
REV.IS13 EX "w
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
~TI=V FI~IFM 21 OR 0798
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 pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Wayne E. Stevenson Lineal 23,439.58
1 Stevenson Drive
Newville, P A 17241
2. Ronald G. Stevenson Lineal 23,439.58
1005 Cherry Court
Richmond, KY 40475
3. Shirley Stuppy Lineal 23,439.58
476 Enders Road
Halifax, PA 17037
4. Linda Kingsborough Lineal 23,439.58
928 Alexander Spring Road
Carlisle, PA 17013
5. Christian X. Stevenson Lineal 1,000.00
5012 Grapevine Drive
Charlotte, NC 28271
6. Heather Schuyler Lineal 1,000.00
2 Meadows Road
Newville, PA 17241
7. Johnathan E. Stevenson Lineal 1,000.00
1217 Sewickley Drive
Charlotte, NC 28209
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART IT - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
STEVENSON, ELSIE M.
Decedenfs Name
Page 1
21 05 0798
File Number
Schedule J - Beneficiaries - 1
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)
8. Jeremiah Stuppy Lineal 1,000.00
4116 North Harding Avenue
Chicago, IL 60618
9. Brianna Stuppy Lineal 1,000.00
Unit 3,43 Harvest Road
North Fremantle, WA 6159 AUSTRALIA
10. Todd Kingsborough Lineal 1,000.00
928 Alexander Spring Road
Carlisle, PA 17013
LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT
I, ELSIE M. STEVENSON, a resident of Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my LAST
WILL and TESTAMENT, hereby revoking any and all Wills and
Codicils previously made by me.
I
I declare that I am not married, my beloved husband having
predeceased me, and that I have four (4) children, WAYNE E.
STEVENSON, RONALD G. STEVENSON, SHIRLEY STUPPY and LINDA
KINGSBOROUGH.
II
I direct that all my just debts and funeral expenses shall be
paid from my residuary estate as soon as practicable after my
decease.
III
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.
IV
It is my desire that my personal possessions, furniture and
household goods be divided among my four children as. they may
agree among themselves.
V
I give and bequeath One Thousand Dollars ($1,000.00) to each
of my grandchildren.
VI
My son, WAYNE, is indebted to me in the approximate amount
of $33,000.00. My daughter, LINDA, is indebted to me in the
approximate amount of $1,900.00. If these loans are not repaid
in full at the time of my death, then the residuary share of
WAYNE and/or LINDA should be offset against the balance of such
debt.
VII
All the rest, residue and remainder of my property, whether
real or personal, wherever situate, including any property over
which I may have a power of appointment, I give, devise, and
bequeath to my children, WAYNE, RONALD, SHIRLEY and LINDA, in
equal shares, per stirpes.
VIII
I nominate,
constitute and appoint my son, WAYNE E.
STEVENSON, and my son, RONALD G. STEVENSON, as Co-Executors of
this LAST WILL, to serve without bond. If either WAYNE or RONALD
is unable or unwilling to act in that capacity, then I nominate,
constitute and appoint my daughter, SHIRLEY STUFPY, as Co-Executor
.of this LAST WILL, to serve without bond.
IN WITNESS WHEREOF, I, ELSIE M. STEVENSON, have set my hand
to this LAST WILL this /SIfL day of fr1~., 2000.
t~~ <7)1, Afr~.
ELSIE M. STEVENSON
signed, sealed, published and declared by the above-named
ELSIE M. STEVENSON, as and for her Last Will and Testament, in the
presence of us, who, at her request and in her prersen, e .. and in
t~e presence of each other, have ~ e e to? s.,u, ~s9ribed ,Q.', names as
w~tnesses. /'/~, I ~~ ,/ /
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ACKNOWLEDGEKENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, ELSIE M. STEVENSON, 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; that I signed it as my free and
voluntary act for the purposes therein expressed.
r!!~~J ~ Jt;;~.h/L.'
ELSIE M. STEVENSON
Sworn or affirmed to and
STEVENSON, Testatrix, this
as-knowledged before me by ELSIE M.
/5 I'f....day of /Ylcuy/, 2000.
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Notary Public
-
Notarial Seal
Diane M. Smith, Notary Public
Mechanicsburg Boro, Cumberland County
My Commission Expires JunQ 22, 2000
AFF:IDAV:IT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, /h.-t.1"f'e..j R. Wo-U..tfS, iF and N(JYlt fh~{~Jo.12..:k.r; ,
the witnesses whose names are signed to the attac~d or foregoing
instrument being duly qualif ied according to law, do depose and
say that we were present and saw Testatrix sign and execute the
instrument as her LAST WILL; that ELSIE M. STEVENSON signed
willingly and that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hear' g
and sight of the Testatrix signed the Will as witnesses; and at
to the best of our knowledge, the Testatrix was .at the t' e 18
years of age or more, of sound mind t~a . U(t,.d......e. .7'/,0. . p.. onst . 'wt or
undue influence. fM . .m/
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Sworn or
me this
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affirmed to and acknowledged before
15'11- day of /} ld-- , 2000.
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Notary Public
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Notarial Seal
Diane M. Smith, Notary Public
Mechanicsburg Boro, Cumberland County
My Commission Expires June 22, 2000
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