HomeMy WebLinkAbout97-00748
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PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of- ';~~)1~~~~~
also known as \ 'IS
d. I - C{ 1- 7 I.{ R'
Deceased.
Social Security No. ;:::;'>l-, ,'<.;:c-. . () ::::::. Cl 'S'
No.
To:
Register of \'9l1s fqr the I
County of ~i.ll.~~ in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who islare 18 years of age or older, appl, ~,....~
for letters of administration
on the estate of
(d.b.n.: pendente lite; durante absentia: durante minoritatc)
the above decedent.
pecendent was domiciled at death in
h ,C; last family or principal residence at
(list street, number and
at D~~~f_~he~ ~ 3.~s ~~e, ~ie~~ ~c:-~ 1::'~(~
) f'
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
ennsylvania, wit~*-....
micipality)
,19C\1,
\3c.> .CO 'D,
,
$
$
$
$
Petitioner_ after a proper search haS- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
c
~~~~
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
L Q~ 'S:,,~~~
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ERI
ESTATE RECOVERIES, INC.
P,Q BOX 24~66
BALTIMORE, MARYlAND 11214
"o.n HAWOPD IIOAD
B^IIlMOPl' MAINlAND 21214
(410)4448en. lAX NO (4'O)421"llJ~)1
1 8m 129 84 /I
September 30, 1997
Register of wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
RE: Estate of John Butler
Davis, deceased.
Our File#: DAX-51606
Estate #: 21-97-748
Dear Sir/Madam:
Enclosed please find our claim regarding the above
captioned estate which is being filed on behalf of American
Express, a creditor.
A copy of this claim is being sent to Anne S. Davis,
Personal Representative for the estate.
If you have any questions concerning the attached claim,
please do not hesitate to contact this office.
Sincerely,
(}J}l f-'~
EN E. TITUS,
EXTq 7
,
KET:mic
i>- j'
Enclosure
STATE OF PENNSYLVANIA
IN THE MATTER OF
ESTATE OF:
JOHN BUTLER DAVIS
IN THE PROBATE COURT
OF CUMBERLAND COUNTY
ESTATE#: 21-97-748
STATEMENT OF CLAIM
1. The creditor, American Express, certifies that there
is due and owing by JOHN BUTLER DAVIS deceased, the sum of TWO
THOUSAND TWENTY FIVE DOLLARS AND EIGHTY FOUR CENTS ($2,025.84).
2. The nature of the claim is a PERSONAL account
372425698511002, established in February, 1971.
3. The name and address of the claimant is: American
Express, 200 Vesey Street, New York, New York 10285-3830.
4. The name and address of the claimant I s agent is:
KAREN E. TITUS, Estate Recoveries, Inc., P. O. Box 24566,
Baltimore, Maryland 21214.
5. This claim is not contingent and is not secured by
any liens or judgments. The last payment on said account was made
on July 3, 1997 in the amount of $724.99.
6. The balance represents an accumulation of charges as
posted to the account number described above.
On behalf of American Express, creditor, I do solemnly declare
and affirm under the penalties of perjury that the information in
the foregoing claim is true and co rect to )fe best of my
knowledge, information and belief., "~ '..!1~
Ka en E. Titus
Estate Recoveries, Inc.
P. O. Box 24566
Baltimore, Maryland 21214
(410) 444-8022
My
and Notarial 9€al this
/<'1 l //' ~,
// '.. /:.t, ..i~
Gerke, Notary Public
State
IN WI
30th
County of Baltimore:
I hereunto set m~ h~nd
er, 1997. ,0/
1/
Lisa M.
September 1, 2000
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
. . .
File No. 2b91:14S
Estate oLJOHN BI JTLER DAVIS
, Deceased
. . .
NOTICE OF CLAIM by ~S
Filed Pursuant to Section 3532 (b) (2) of the Probate, Estate,
and F i d u cia I' y Cod e ,20 P a. C. S . A . SS 3 5 3 2 (b) (2).
To the Clerk of the Orphans' Court' Division:
En tel' the c I aim 0 f KAREN E TITllS, AGENT for AMERICAN EXPRESS
(Claimant)
in the amount of $_2.025.84 ,against the above entitled
est ate. The Dee e den t, who I' e sid e d at ,RO NORTH 5TH STREET,
(Street Address)
LEMOYNF. ,PA 17041
, CIJMRERI AND
. County,
(City)
Pennsylvania, died on
06126/97
(Date)
. Written notice
o f s aid c I aim was g i v e n t 0 ANNE S DAVIS
Personal Representative,
or
.If known to c1aimaint, at
(his Counsel)
1RO NORTH 5TH STREET, T ,EMOYNE, PA J 704,
(Address)
,on Septern ber ,0, 1997
(Date)
, Claimant
KA N E. TITUS, AGENT
POST OFFICE BOX 24566, BALTIMORE, MD 21214
(Address)
Claimant's Counsel:
(Address)
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Personal Card Statement of Account
PllparldFOl
JOHN BUTLER DAVIS
CIOlIftllOll. A<<OIInrl:ltmb"
May 17, 1997 3724-256965-11002
p,fYiotl. Calli &\Inc" Cald PlymIIU/O,dill'
I 606,66/1 0.0011
Statement includes payments and charges received by May 17, 1997,
'IncflC8les posting dale,
Nt"Galde""g...
45.001
New CMd BAIMW>> S
Going on vacation? Pick
up a p'epa,d FirstClass
Phone,:ard (TM) baclled
by American Express,
Available at participating
US Post Otlices
nationwide or call
'.800.506.9815
651.66
Your account is past due. Pay by 06/06/97 10 avoid delinquency charge.
For fast balance and payment information, call our automated service line at
1.800.292-2639 using a touch tone phone. Please have your account number ready. If you
have a question about your account, call 1-800-528-4800 (24 hours(7 days).
Card Detail ....... $
Card Tranaacllons for JOHN BUTLER DAVIS
C.d372.f.zse~11002
April 28, 1997
MEMBERSHIP REWARDS PROGRAM NEW YORK NY
ANNUAL FEE
RtlIf.ntt: MMS97OS2a
Total for JOHN BUTLER DAVIS
New CUlOII 25 00 New Cl'tcl.. 0,00
Other Card Account Transactions
Please reler 10 page 2
for important informatIOn
regarding your Card
Account
25.00
25.00
20.00
May 17, 1997"
DELINQUENCY CHARGE ON 606,66
Total of Other Card Account Transactlona
Nt'f1 ChllQI' 20 00 Hft Cf.clrl 000
TOiiii of Card Activity
20.00
New Card Charg..
New Card PaymenlelCredKe
45.00
0.00
ContInued on reverse
. PIt... fold on 1M pertollllllln bilow, dllach ..nd Ilturn W1Chyc"Jr plyml" ,
Plcase pay
lmmedlately
PIe-ISo anter account
number on all Checks
and correspondence,
Payable in U,S, Collars
upon receipt w~h a
check drawn on a bank
in the U,S, or money
order I processable
through the U,S, banking
system,
Check here if address or
telephone number has
changed, Note changes
on reverse side,
ACcollrtNum~1
Payment Coupon
3724.256985.11002
Td" Amount Dw
$651.66
JOHN BUTLER DAVIS
311 S RIVER ST
HARRISBURG PA 17104-1657
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Mail Payment to:
AMERICAN EXPRESS TRS
P.O. BOX 1270
NEWARK NJ 07101.1270
o
111,,,1.,,1,,,11I1,.,,,,11,,,11.,1,11,,,111,,,1,1,,1,\,,,,11.I
2425698517 000651660000045008
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Page 2 of 2
.
Telephone
Numbers
Customer Service
1,800.528.4800
(24 hours, tollhoo)
e'ptess Cosh
1,800,CASH.NQW
Pay,ments, Your monthly slalement1s payable In lull upon ,ecijl(~ The mailing addresS lor payments 15 shown to
the nght. USing the enclosed envelope, mmllhe bottom por110n 01 the f.rst page of thiS slalement With your check
drawn on 8 bank located In the US or money order, jJ!ocessable through tno US banklOg system, payable In
U,S. Dollars 10 American Express, 00 not senCt cash. Payments received after 1200 noon or on weekends or
holidays may not be credIted unlrllhe ne><l business day. Please do nol send post,dated checks 10 our payment
processing centors. They will be deposited upon receipt, If payment IS made at any other location, thero may be
a delay in processing- Please include your account number on the lace 01 your payment
Lost or Stolen Card II the Card IS \osl or slolen In the UOIled Slates, conlact uS immedIately at 1.800.992.3404
Outside the U,S" contact the nearest Amencan Exptess Travel Service Off.ce or call uS collect at 9,0.333.321"
You are fully p:olected against any,fraudulent use at the Card when you notify American Ellpress belore .t IS
fraudulently used, Your maximum liatillty IS $50 should you lailto report ~s loss or the"
Charlie Card and Statement In!ormatlon The annual fee is $5500 lor Ihe Bas.c Card and $3000 for
each Aaditional Card. An adclihonal $515 Charged for billing addresses outside the U,S.AenewaJ Cards are ISSUed every
three years. If the Card you carry IS damaged, you may have It replaced sooner by calhng Customer Service, You may
discoritinue yqur Membership by calhng Customer SeIV100. Be SUfe to keep your copy or rhe charge slips for comparison
to your tilled charges,
The Statement Closing Date is, the last dale that charges and credIts are pmcessed to, appear on the st,atemen1.
Your account will be Past Due I' payment lor your prevIous month's statement was receIved atter the clOSing date,
To keep your acoount currenl, pay by Ihe date ptinted on the Paymenl Coupon portion of Ihe statement.
BIlling Rights Summary
In ce.. 01 Error. or Questlonll About Your Bill:
If you think your bill is wrong, or if you need more information about a lransactionwhich appears on your statement, write or
call the Customer Service department as noted to the right. We must hear Irom you no later than 60 days after we sent you
the first bill on which the error or problem appeared. Although you may telephone us, doing so will not preserve your rights.
What W. N.ld From You Whln You HaVI A Billing Inquiry:
. Your name and account number.
. Th6 dollar an'lounl olthe su5~&d error.
. Describe the error and explain, if you can, why you believe the~e is an error. If you need more information, describe
the item you are unsure about,
You do not have to pay any amount in question while we are investigating, but you are still obligated to pay the parts of your
bill thai are not in Question. While we Investigate your inquiry, we cannot report you as delinquent or fake any adlOn to
coiled the amount in Question, Please retain any receipts pertinent to your claim.
Sp'eclal Rules For Charge Card Purchases II you have a ptoblem wilh the quality 01 goods or services
that you purchased with the Care, and you have tried in gooO laith to correct the ptoblem w~h the merchant, you
may net have to pay the remainin.9_ amount due on the goods or services. You have this p:Dtection only when the
purChase price was more than $50 and tho purchase was made in your home state or within 100 miles of your
mailing address. (If we own or operate the merchant, or if we mailed you the advertisement for the property or
services, all purchases are covered regardless of amount or localion of purchase.)
Express Cash Information
In Ca.. of Errors or Questions About Your Electronic Trane'.ra:
If you think your Express Cash statement or receipt is wrong, or if you need more information ab::>ut a transfer on the
slatement or receipt, call1.800.CASH.NOW or write to the E'ptess Cash address noted to Ihe right. We musl hear Irom
you no later than 60 days afterwe sent you the FIRST statemenl on which the error or problem appeared,
When calling or writing pl..."
. Tell uS your name and account number.
. Provide the dollar amount o!the suspected error,
. Describe the error or the tr~nsler yqu are unsure of, and explain as clearly as you can why you believe there is an
error or why you need more Information.
We will investigafe your complaint and will correct. any error promptly. II we take more than 10 business days to do this, we
will credit your account for ttie amount you think is in error, so that you will have use of the money during the time it takes
us to comPlete our investigation,
Exp:9SS Cash participants who have changed their bank account must contact uS to obtain ploper updating forms. 00 not
use EXpt9SS Cash until the bank account change has been confirmed,
Credit Balance If a credij balance {designated 'CRj is shown on this statement, it rep'..enls money owed
to ~u. You may make charges against the credit balance or request a refund. Requests tor refunds should be
made in writing to the Refund UnIt at the Customer Service address noted to the right.
I
Lost or Stolen Card
1.800.992.3404
Inl'l collect:
910.333.3211
Hearing Impaired
TTY: ,.800.221.9950
Fax: 1.800.695.9090
Addresses
Customer Service
P,O, Box 297804
Ft, Lauderdale, FL
33329.7804
Exptess Cash
r unds Access Serviceti
P,Q, Box 53809
Phoenix, IV.
85072.3809
Payments
P,Q, BOX 1270
NeWARK NJ 07101.127
Change 01 Address
Kcol'I.donlrort
do not un
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DUPLICATE COPY
.. Cards
Personal Card Statement of Account
P1"PM.dFOI
JOHN BUTLER DAVIS
CIollng 0.. Auoulll....mblf
June 17,1997 3724.256985.11002
Prrmu. ClJd Ballnc.' Card F'lym'n1I1O.dU'
651.6611 ,606,0011
Statement include5 payments and charges received by June 17, '997,
. Indicates posting dal.,
Ntw Card Cl\afll" ,
679.331
Nrlw Cad B*naI t
724.99
Your account is 30 days past due. Payment must be received by 07/06/97 to avoid a
delinquency charge.
::
For fast balance and payment information, call our automated service line at
1-800.292.2639 using a touch tone phone. Please have your account number ready. If you
have a question about your account, call 1-800-528.4800 (24 hours/7 days).
Card Payments
Alnaunl S
June 2 1997"
PAYMENT RECEIVED - THANK YOU
Total of Card Payments
Card Transactions for JOHN BUTLER DAVIS
Cr.rd 3724.25eG8S-11002
June 9, 1997
TRAVEL PROFESSIONALS HARRIS8URG PA
US AIR
From:
HARRISBURG PA
-606.00
-606.00
Mean S
163.00
Class:
VE
VE
VE
VE
To: Carrier:
LAGUARDIA INTL PJP US
NANTUCKET MA US
BOSTON MA US
HARRISBURG PA US
TIcket Number: 03715309409556 Date of Departure: 07/24
Passenger Name: DAVISlJ
Document Type: PASSENGER TICKET
Total for JOHN BUTLER DAVIS
NhCMIget 16300 HMO.d.. 0.00
163.00
Continued on reverse
+ Alia.. lold on lhe perlO'liIion bIlow, dlllach and "turn WIIIh 10111 p'rm.1lI +
Payment Coupen
"'ccutCNumber
3724.256985.11002
Please Pay
Immediately
Tdal AmOLri [W
5724.88
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JOHN BUTLER DAVIS
380 N 5TH ST
LEMOYNE PA 17043-1613
1",III",III""I"I"II""II,II"illl"II,I"I,II,,"11,,1
Mail Payment to:
AMERICAN EXPRESS TRS
P.O. BOX 42010
PHILADELPHIA PA 19162.4201
1,"111,1,""11,11,",1,1,1"1"1,111,,,,,,111,1,,1,1,,,11,,1
2425698517 000724990000679339
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Page 1 of 4
Visrt American Express
on-line lodayl ReView
Card blling aetaols,
check rewards points, &
more. For access, go 10
keyword: Ame. on AOL
or on the Web at wnw.
amuricanexpl"8SS,COm
Please reler to page 4
for important information
regarding your Card
Account
Please enter acr.ount
number on all checks
and correspondence.
Payable in U,S, Dollars
upon receipt with a
check drawn on a bank
in the U,S, or money
order, processable
through the U,S, banking
system.
Check here it address or
lelephone number has
changed, Note cl1anges
on reverse side.
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June 12, 1997 178,00
THE TAL80TS CAMP Hill PA
CLOTHING
LINEN SHORTS
SHORT SLY TOP
ADDITIONAl. PURCHASES
Rtl..nce: 011&4111
June 12, 1997 69.12
....~. .'::::' REA & DERICK, INC, LEMOYNE PA
HEALTHIBEAUTY.AIDS
.'.,'.-,. Rtfll'nce: 0001&421 Roc ~mb.r- 00016ot2,
,....-.
June 13, 1997 4.95
REA & DERICK, INC, LEMOYNE PA
HEALTHIBEAUTY.AIDS
Rthw.nce: 00040t$0 Roc rwmbll' 00G401lSO
June 13, 1997 51.36
PENN ENCORE .El 08 MECHANICSBERG PA
BOOKSISUPPLIESlGIFTS
Refer.nce: 01662411e
DUPLICATE COpy
Pr.plI.dFOf
JOHN BUTLER DAVIS
Card Tranaactlona lor ANNE S DAVIS
Caul ~7~.256'" 1010
AcUilnltwmtllt P 2 14
3724-256985.11002 age 0
Am ourIl
June 11,1997
GUMPS BY MAIL 800.638-2424 PA
GIFT ITEMS
Rtflt.ntt P17$22070 Roc rwmb. 0072~1I~3
-----,--.------..---- -.---------.,.--,-
June 12, 1997
THE TAl.BOTS HINGHAM MA
CLOTHING
SHORT SLY TOP
LINEN SHORTS
POSTAGE
Rtl..ntl' 510811507
70.70
96,00
June 14, 1997
THE TALBOTS CAMP Hill PA
CLOTHING
PANTYHOSE
Rlllt.nCl~ 017llOB5
June 17, 1997
HECHT CO. HARRISBURG PA
MILllNERY
FIII..IICI: 0280,420e Roc ~mb.,: 2800140206
5,00
20.00
Continued on next page
Change of Addless
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DUPLICATE COpy
.. Cards
PrtptlldFct
JOHN BUTLER DAVIS
Tranaactlona Continued
Juna17, 1997
HECHT CO. HARRISBURG
CHANEL COSMETICS
AII..,IICe: 02106e1lO Roc "'mb.,: zao06Goaeo
Tollll for ANNE S DAVIS
NewChlr".. 51533 ....Cred.. 000
Tollll of Card Activity
PA
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3724.256985.11002 Page 3 01 4
OdlingOle.
June 17,1997
M1cucl
21.20
518.33
679.33
-606.00
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DUPLICATE COpy
A.plI.dFol
JOHN BUTLER DAVIS
-"'0"'" ""'mbfl P 4 f4
3724.256985.11002 age 0
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.
Telephone
Numbers
Customer Service
1,800.528,4800
(24 hours, toll free)
EXp'ess Cash
1.800.CASH.NOW
Payments Your monthly statement IS payablo 10 lull upon reoo,pI ThO ma,lIn~ address for payments IS shown to
the nght. Us,ng the anclosed envelope, mall tho boMm port,on 01 the flrsl page ollhlS slatemont wllh your check
drawn on a bank located ,n the US or monoy order, processable through the US banking system, payable ,n
U,S, Dollar. 10 Amencan EXp'ess Do not .end cash Payments rece,ved aller 1200 noon or on weekends or
holidays may not be credlled untIl the ne" buSIness day, Please do not send posl.dated checkS to our payment
proces.lng centers, They will be deposlled upon ,ecelpl II payment I. made III any olher location, Ihere may be
a delay in processing, Please include your account number on the lace 01 your payment
Lost or Stolen Card IIlhe Card is lost or stolen In the UMed States, contact uS Immediately at 1.800.992.3404,
Outside the US" contact thO nearest Amencan E,press Travel SeNloo 011100 or call uS collect at 910.333.321"
You are lully prolected againsl any fraudulent use of Ihe Card when you nOl'ly Aonencan Express before It is
fraudulently used, Your max,mum lIaDllty is $50 should you fail to report ItS losS or thell
Charlie Card snd Statement Informallon The annual lee" $55 00 lor the BaSIC Card and $30 00 lor
each A/!diIional Card An addItional $51s chargod for billing add'esses outs,de the U 5, Renewal Cards are ISSUed every
three Wars, II the Card you carry is damaged, you may have it replaced sooner by calling Cuslomer Service, You may
dIscontinue yllur Membership by calling Cuslomer Servloo Be sure 10 keep your copy oflho charge s"Ps 'or companson
to)'Ol!r billed char~es,
The Stalemenl Closing Date is Ihe last date that charges and credits are processed 10 appear on the stalement.
Your account will be Past Due if payment for your prevIous monlh's statement was received aller the clOSing date,
To keep your ecoount current, pay by tne dale prinled on the Paymenl Coupon portIon of the statement,
Billing Rights Summary
In ca.. of Errore or QUIIUonl About Your Bill:
II you think your bill is wrong, or If you need more inlormatlon about a Iransactlon which appears on your statemenl, wnte or
cwl Ihe Customer Service clepartment as noled to the nght, We musl hear Irom you no later than 60 days aller we senl you
Ihe firsl bill on which the error or p'oblem appeared Although you may 'eiephone us, dOing so will not preserve your rights'
Whol Wo Nlld From You Whon You Hovo A Billing Inquiry:
. Your name and account number.
. The dollar amount ofthe suspected error,
. Describe Ihe error and explain, if you can, why you believelhere is an error, II you need more inlormation, describe
the item you are unsure about.
You do not have topay any amount in question while we are investigating, but you are stili obl,gated to pay the parts of your
bill that are not in question, While we investigate your inquiry, we cannol report you as delinquent or take any action to
collect the amount in question. Please retain any receipts pertinent to your claim,
Special Rules For Charge Card purchases If you have a problem with Ihe quality 01 goods or services
thill yllu purchased wtth the Caro, and you have tried in good laith to correct Ihe problem wrth Ine merchant, you
may not have 10 pay the remaining~ amount due on the gobds or services, You have this p<otectlon only when the
purchase price was more than $50 and the purchase was made in your home stale or wilhin 100 miles of your
mailing address, (If we own or operate the merchant, or if we mailed you the advertisemenl for the property or
services. all purchases are covered regardleSS of amount or location 01 purchase,)
Express Cash Information
In el.. of Error. or Qu..tion. About Your Electronic Transfers:
If you think your Express Cash statement or receipt is wrong, or if you need more informalion about a transler on Ihe
stalemenl or receipl, call1.800.CASH.NOW or wrtte 10 the Express cash address noted to the nght, We must hear from
yllU no laterlhan 60 days after we sent you the FIRST statement on which the error or problem appeared,
Whon 08111n9 or writing ploss..
. Tell us your name and account number.
. ProvIde the dollar amount of Ihe suspected error,
. Describe the error or the tr~sfer yqu are unsure 01. and explain as clearly as you can why you believe there is an
error or why you need more information.
We will investigate yllur complaint and will correct any error promptly. If we lake more than 10 business days to do this, we
will credtt your account for Ihe amounl you think is in error, so thai you will have use ollhe money during the time tt takeS
us to comDlete our investigation.
Exp<ess Cash participants who have changed their bank account musl contact us to obtain p<oper updating forms, Do not
use Express Cash until the bank account change has been confirmed,
Credit Balance II a credit balance (designated oCR") is shown on this statemenl, il represents money owed
to you, You may make charges against lhe credrt baiance or request a refund, Requests lor relunds should be
maCa in wrrting to tne Refund UIIII aI tlie Customer Servioo address noted to the righi,
Lost or Stolen Card
1.800.992.3404
Int'l collect:
910.333.3211
I
Hearing Impaired
TTY: 1.800.221.9950
Fax: 1.800-695.9090
Addresses
Customer Service
PO, Box 297804
Ft. Lauderdale, FL
33329.7804
Express Cash
F un~ Access Services
P,O,80x53809
PhoeniX, p.:z
85072.3809
Payments
P,O, BOX 4201 0
PHILADELPHIA PA
19162-4201
...,
','
DUPLICATE COpy
."
, Cards
Personal Card Statement of Account
Pt'piI.dFO'
JOHN BUTLER DAVIS
CIolino 0.. Account "'INII
July 17, 1997 3724.256985-.11002
.,'
F'rIYlOUI Catll &laM':I Card P.ym.rlll/Q.dIl.,
r 724.991/ -892.4911
Statement includes payments and charges received by July 17,1997,
, Indicates posting date,
Nt. Card Challl"'" Hlw CIId B6lMl:a .
2,370,841
'........-
2,203.34
Your account is cancelled. Return all charge cards.
For fast balance and payment information, call our automated service line at
1-800-292-2639 using a touch tone phone, Please have your account number ready. If you,
have a question about your account, call 1-800-528-4600 (24 hours/7 days).
Card Payments
July 3, 1997*
PAYMENT RECEIVED. THANK YOU
Tolal of Card Payments
Card TransacUons for JOHN BUTLER DAVIS
CUd 3724.25e1lt!5-11002
., July 4; 1997* .
", MEMBERSHIP FEE CREDIT - CANCEUATlON
'July6,1997
MEMBERSHIP REWARDS PROGRAM NEW YORK NY
,,970528ANNUALFEEREFUND
Total for JOHN BUTLER DAVIS
HlwOW",. 0,00 Ntw O'.dll .55 00
Amounl S
-724.99
-724.99
Amcut S
-32.08
, -22.92
-55.00
+ PtII...lold on ItIt PIIIor.lon b.lo.It, dellth .nd relurn w.th your p.ym.l'lI +
Continued on reverse
Payment Coupon
AceounlHumblr
Plf:!ase Pay
Upon Receipt
3724.256985-11002
Ta" Amount Due
$2,203.34
o
~
8
~
N
i
o
JOHN BUTLER DAVIS
AMEXCO COLLECTIONS
2423 E LINCLN DR
PHOENIX AZ 85016-1299
11"1"1,1,1"",.,11,1,..,,,11,.',11,1,.1,1,,,.1,',,1',,1..11
i
Mail Payment to:
AMERICAN EXPRESS TRS
BOX 0001
LOS ANGELES CA 90096.0001
11,1"/1",11",1,1",11"11,..'1,,,'1,,.,,,"',1.,1,,,.1",II
2425698517 002203340002370840
.......".' .,0 ".u......... ~...
Page 1 of 5
Give someone close to
you an Additional Card,
FOl an annual lee 01 $30
share virtually aJI~he
benefitsol the American
EXJlIilSs Card, To apply
plo..e call
1.800.223.7583,
Ple..e re'er to page 5
for important information
regarding your Card
Account
PIG:J~e elller account
number on all checl<s
and correspondence.
Payable in U.S, Dollars
upon receipt wijh a
check drawn on a bank
in the U,S, or money
order, processable
through the U,S, banking
system,
Check here if address or
telophone number has
changed, Note changes
on reverse side.
[]
.......~___n..'_.,'. '.__"'''_'''.,,,.,,, '..., '...', ','~"'" '.'.--.., ,"
"
DUPLICATE COpy
......."....,.,~_......'....:...........
.'-
u
. Cards
Prepllld For
JOHN BUTLER DAVIS
.",.m ........ Page 3 of 5
3724.256985.11002
00111100..
July 17, 1997
~s
Tran88cllons Continued
-------'.'.
11.00
June 23, 1997
GETTY HYANNIS MA
Getty Pet
GASlMISC 000174010015
~~~~-
June 23, 1997
A & P '172 NANTUCKET MA
GROCERIES/SUNDRIES
Rll.IIlln: 017&l420,
110.36
June 25, 1997 26.75
SUMMER HOUSE POOL SIASCONSET MA
FOOD-BEV
FooD-BEV 22.75
TiP 4,00
Rel.,.",,:011I52S022
June 25, 1997 11.10
MURRAY'S BEVERAGE NANTUCKET MA
UaUORfflEVERAG8SNACKS
All".",,: 017625020 Rot "unbl': 17625020
June 25, 1997 182.00
VIS. A - VIS NANTUCKET MA
APPAREUACC
AI'"l1ne.: 017625031 Roc. follrnber: 17625031
June 25, 1997 31.45
E WILSON NEEDLEWORKSNANTUCKET MA
HAND MADE CRAFTS
Rll.llne.: 011625013 Rac: Numb,r: 17625013
389.00
To: Carrier:
BOSTON MA US
HARRISBURG PA US
Ticket Number: 03715666791 093 Date DI Departure: 06/26
. Passenger Name: DAVIS/A
i DocumenlType: PASSENGER TICKET
June 26, 1997
~ MARINE LUMBER CO NANTUCKET
~ LUMBER/ACCESSORIES
;I All",,,,,: 0001.0626
June 26, 1997
SWAINS TRAVEL INC
USAIR
From:
NANTUCKET MA
NANTUCKET MA
Class:
YB
YB
9.24
MA
.5.00
~ July 4, 1997.
; MEMBERSHIP FEE CREDIT. CANCELLATION
Continued on reverse
COMMONWEALTH OF PENNSYlVAWA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT 280601
HARRISOURG. PA 17128-0601
RECEIVED FROM:
I
LEFEVER RICHARD R ESQ
POBOX 1166
HARRISBURG, PA
17108
FOLD HERE
ESTATE INFORMATION:
FilE NUMBER
s 1-1997-07',e
NAME OF DECEDENT (LAST)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
*'
NO. AA 269888 AEV".2EXtlf,.6J
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
~
Vi5~:19_0Q
FOlD HERE .1
!ilS~1 sOb :301-0..95
(FIRST)
IMI,
DA"IS JOH~' S'llL EP
DATE OF PAYMENT
3/Pl-./l QQr:l
POSTMARK DATE
3/20; '1 Q9r:l
COUNTY
-C'IMSIiOR\ MIl)
OATE OF DEATH
REMARKS ANNE S. DAV I S
SEACHECK# 2536
~- ----..-.--- --- -- -- ,--- _._~-
.
TOTAL AMOUNT PAID
$5,719.00
REGiS I ::,; or 'NII_LS
.~'.~ , / VZ
1/----
RECEIVED BY -i /, /,,'~ . ,/. ( _,<,~'-,/ "'''_~'/.''i.JI:;/>:,.1
~~~~ S~ER L~ I ~ lL.L~':'1-;r;f:'l'~ '/7;t
......
-----I p-~'
-::- --;.--:--.--~'-.~;:,jri.
_ .,J--~. T
-oof.~~ ~ ,
'1
\
J '.
IN THE MATTER OF THE ESTATE OF
JOHN BUTLER DAVIS, DECEASED
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 748-1997
DISCLAIMER OF INTEREST
IN ACCORDANCE WITH 20 PA. C.S.A. ~6201
KNOW ALL MEN BY THESE PRESENTS, That:
1. John Butler Davis a/k/a John B. Davis ("Decedent") died
on June 26, 1997, a resident of Cumberland County, Pennsylvania,
and Letters of Administration were granted to his wife, Anne S.
Davis, on September 10, 1997, by the Register of wills of
Cumberland County, Pennsylvania, under Admin. No. 748-1997.
2. Decedent was survived by his wife, Anne S. Davis, and
his two children, Laura FitzGerald and Emilie Davis.
3. Decedent owned two Individual Retirement Accounts at
the time of his death: Smith Barney Inc. IRA Account No. 724-
60788-1-5-002, with a date of death balance of approximately
$121,000.00 (the "Smith Barney IRA"), and Harris Savings Bank IRA
Account No. 0140152124, with a date of death balance of
approximately $16,750.00 (the "Harris Savings IRA") (collectively
the "Retirement Accounts") .
4. The primary beneficiary of the Harris Savings IRA is
"Anne S. Davis and Richard R. Lefever as Trustees under an
agreement of trust established by John B. Davis dated January 19,
1973 as amended" (the "Revocable Trust").
5. The Revocable Trust is also the primary beneficiary of
the Smith Barney IRA.
!,C'''"?..ft,\j~~~;....-.;;:;;:i:lJ:':;;''~'";:",,,~,'''_:I,. l',J",\.'1"_' ~'"~",.,y~'_'."'r.',~..',,,., '" ,",.,', ".,;',-','
, .
6. The contingent beneficiary of the Smith Barney IRA is
Anne S. Davis, and the contingent beneficiary of the Harris
Savings IRA is Decedent's Estate.
7. During the lifetime of Decedent's wife, Anne S. Davis,
the income and principal of the Revocable Trust may be
distributed to Decedent's wife and children, as determined in the
discretion of the Trustees, for certain specified purposes,
taking into account the other resources available to them.
8. Upon the death of Decedent's wife, Anne S. Davis, the
trust assets are to be divided equally between the Decedent's
children and held in separate trusts for them until they reach
thirty years of age. If either of Decedent's children should die
before reaching age thirty, her share of the trust assets is to
be distributed per stirpes to her issue, or if none, per stirpes
to Decedent's issue.
9. Decedent's daughter, Laura FitzGerald, is over thirty
years of age and Decedent's daughter, Emilie Davis, will reach
thirty years of age on October 11, 1998.
10. Neither of Decedent's children have any children.
Therefore, the only parties interested in the Revocable Trust are
Decedent's wife, Anne S. Davis, and his children, Laura
FitzGerald and Emilie Davis (collectively, the "Trust
Beneficiaries") .
- 2 -
~~.H~,f~~;if.J'~~:;;~'9l',~"~~~::i;t,:~k~it,P~;;~'(f,;,:!,~,~,;.~:1^~"<.,,~",,,.M<-"""I"'''-c'''':~:~J., ~;~ \J'Dl.:r ~ ,;:iL;.;,:',;.::;~'.t,.
., ~~
11. Neither the Revocable Trust nor any of the Trust
Beneficiaries have heretofore accepted any interest in the
Retirement Accounts.
12. The Trust Beneficiaries hereby irrevocably and
unconditionally disclaim, and consent to the Trustees' disclaimer
of, all of their right, title and interest in and to the
Retirement Accounts.
13. Anne S. Davis and Richard R. Lefever, in their capar.ity
as Trustees of the Revocable Trust and pursuant to instructions
from the Trust Beneficiaries, hereby irrevocably and
unconditionally disclaim all of the Revocable Trust's right,
title and interest in and to the Retirement Accounts.
14. In addition, Decedent's children, Laura FitzGerald and
Emilie Davis, in their capacity as beneficiaries of Decedent's
Estate, hereby irrevocably and unconditionally disclaim all of
their right, title and interest in and to their respective
intestate shares of the Retirement Account proceeds to be
received by the Decedent's Estate as a result of the aforesaid
Disclaimer by the Revocable Trust, and they shall not be entitled
to substitute other Estate assets for the amount(s) so
disclaimed.
15. This Disclaimer is being made under the provisions of
Chapter 62 of the Probate, Estates and Fiduciaries Code of the
Commonwealth of Pennsylvania, 20 Pa. C.S.A. 996201 ~. ~., and
- 3 -
,~J~~:;~~i~;L;;~~~~;f,#iJ!i,~~'Ii!<!'i'!;"""\"V\r/IM;';r.W'ct"'.,,..., ..,.
i","<
. ".
is intended to be effective under Section 2518 of the Internal
Revenue Code.
16. In accordance with 20 Pa. C.S.A. ~6204(b.1), Anne S.
Davis, individually and as Administratrix of the Estate of John
Butler Davis, hereby acknowledges receipt of this Disclaimer as
the person entitled to the Retirement Accounts by reason of this
Disclaimer.
17. This Disclaimer may be executed in any number of
counterparts, each of which shall be an original, but all of
which taken together shall constitute the Disclaimer of Interest.
18. The undersigned shall deliver copies of this Disclaimer
to Smith Barney Inc. and Harris Savings Bank and shall file a
copy of this Disclaimer with the Clerk of the Orphans' Court
Division of the Court of Common pleas of Cumberland County,
Pennsylvania, in accordance with 20 Pa. C.S.A. ~6204.
IN WITNESS WHEREOF, and intending to be legally bound
hereby, the undersigned have executed this Disclaimer on the
dates set forth below.
Dated:
m~L "-~c;) ) l11 ~
~ 'S~))_\
Anne S. Davis, Ind idually,
as Trustee of the Revocable
Trust, as Beneficiary of the
Revocable Trust and as
Administratrix of the Estate
of John Butler Davis
[SIGNATURES CONTINUED ON NEXT PAGE]
- 4 -
it~.t:}$~~~~~~~ffli~~Z)Yi'\I~~\<:t\!:~!';C!;'~~';J,''4\~~'~:il!;~.~;,:~c:;iif:::;r.,t"ct!::\~I"~j,'~":;~',i,"~;"),;I,;',,.-"",.'..,..,.....,'.': ':_J'~,w~':" ,:~:i'~:\
. .
.
Dated:
Dated:
Dated:
Laura FitzGerald, as
Beneficiary of the Revocable
Trust and as Beneficiary of
the Estate of John Butler
Davis
V\ ())l
Emilie Davis, as Beneficiary
of the Revocable Trust and as
Beneficiary of the Estate of
J\~~t5\Da~~:I~
Richard R. Le ever, as Trustee
of the Revocable Trust
:')/ I qq (~.
~,-; U
..i
- 5 -
ssaJdX3 rBJapa~
@
....
Register of Wills of Cumberland County, Pennsylvania
...
INVENTORY
Estate of JOHN B. DAVIS
No. 21-97-0748
also known es
Date of Death 6/26/97
,Deceased Social Security No, 206-32-0295
Anne S. Davis
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent. that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death. and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. IfWe verify that the statements made in this Inventory are true and correct. I/We understand that
false statements herein are made subje\:t to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Name of
Attorney: Stephanie Kleinfelter
,~
{
1.0. No,:
80089
McNees, Wallace & Nurick
100 Pine Street, P.O. Box 1166
H.rri~h"rg, l'A 1710R-116fi
Telephone: (717) 232-8000
Dated
Address:
Oescription
Value
SEE ATTACHED
$346,413.74
or:, ::J
r: r ~' \.:) :J r!
(;.,j
~. ....j
n
~
~
,-
.> " ,.,
c
,'"
Total: $346,413.74
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of teal estate outside the Commonwealth of Pennsylvania may. at the election 01 the personal representative, include
the value of each item. but such figures should not be extended ;nlo the total of the Inventory,
fOllnRW.71Cum~.t.ndCounlv.R.v91921
Co
.
Inventory
Estate of John B. Davis
1
c:' I
..'...'..1
1;',\
:;,...'..."11
k-
','
,I
i
j
I:escription
Cash on liand
Smith Barney Cash Account
M::lney Market Accounts
Smith Barney M::lney Funds Portfolio
Caml::m Stocks
8 soo. AT&T Corporation
5 units Boston Celtics Limited Partnership
1 sh. C Tee Corporation
15 soo. C Tec Corp Class B Canron Stock
200 soo. Bell Atlantic
500 soo. Dauphin Deposit Bank
200 she. General Electric
210 soo. Harsco Corporation
150 she. Hewlitt Packard
150 soo. IntI Business Machines (IEM)
180 she. JI.G Industries Inc.
2 shs. Lucent Technolcgies
200 she. McDonalcls Corporation
200 soo. Microsoft Corporation
Closely Held Corporations
Jolm Butler Davis Associates Inc.; I:ecedent
held 90 of 100 shares (90%) of corporation at
his death; Valued per proceeds received in
oral buyout agreerrent
Miscellaneous Property
Equitable Life of Iowa Life Insurance Policy
No. U066176; Payable to I:ecedent's Estate
"'-..,. ..,....,,_.... ,.......' '.......... ' '\
Accrued Interest
17.80
21. 00
0.90
1
Value
291.25
127.50
33.88
506.72
14,650.00
22,343.75
12,993.75
8,308.13
8,144.44
13,739.06
2,425.27
143.87
9,700.00
25,868.75
Total
88.65
11,650.30
119,276.37
90,398.42
125,000.00
346,413.74
----------
---------
\ . (ltJ..u)
REV.HiOO EX + (1.97)
1. Real Estete (Schedule A)
2, Slocks end Bonds (Schedule B)
3, Closely Held Corporalion, Partnership
or Sole.Proprietorship
4, Mortgages & Notes Receivable (Schedule D)
5, Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E)
6. Jolnlly Owned Property (Schedule F)
7. Inler.Vivos Transfers & Miscellaneous
RECAPIT - Non.Probate Property (Schedule G or L)
ULATION
14. Net Value Sub ect to Tax Line 12 minus Line 13
15. Amount 0 line 14
taxable al the spousal 93 552 87 ""
tax rale 1 . X .UJ
Seelnstruclions on page 2 lor applicable parcentage
16, Amount of line 14
taxable at 6% rate
17, Amount ofllne 14
Iaxableat15%rate 0.00 x ,15 (17)
16, Tax Duo (16)
19,CHECKHERE IFVOUARE REQUESTlNG A REFUND ClFAN ClVERPA YMENT
"':"'''''''''''''''''''''.''.''''''''.{:.'''.'?','''::,li',BE,,SUREoTOYANSWER,.Att"'QUESTIONS"'ON."PAGE..'2"ANO'.'RECHECK.',MATH .'",,,,'
nder penallies 0 perjury, I declare thai I have examined this return including accompanying schedules end slalemenls, and 10 Ihe beSl of my knowledge
and bell, 1 it is true, correct and complete, Declaralion of preparer other than ll1e personal representative is based on alllnlormallon of which preparer has
an e.
DECEDENT
CHECK
APPRO-
PRIATE
BLOCKS
CORRES-
PONOENT
TAX
COMPUTA-
TION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT,260601
HARRISBURO, PA 17128,0601
I!:J -. d.. OJ.. -3
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NSl..h~,P
c.
OlTlcrAL USE ONLY
FILE NUMBER
COUN~tO"E '~Ah
DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
Davis John B.
SOCIAL SECURITY NUMBER DATE OF BIRTH
206-32-0295 7/22 1942
(IF APPLICABLE) SURV'V'NG SPOUSE'S NAME "AST, THIS RETURN MUST BE FILED IN DUPLICATE
~IAST, AND MIDDLE INITIAL)
Davis, Arme S. WITH THE REGISTER OF WILLS
1 Oi' IR I 2 S I IIR I 3 Aem.::llndorRelum
. r gIns e urn . upp emen a 0 urn . (date 0' death pilar 1012.13.821
4, Limited Estate 4a. ~U;~;~{~:~~~la?t~~f~~'.~~l 5, Fedeml Estate Tax Rtrn. Required
8, Ooc.,,", A'.. T"Io'. 7, p.':f:,~'~:~';1'~~:g' "vo., TM' 8, Total No, of Safe Deposit Boxes
IAlloch oopy,' W'") 10. Soo"" P"My C"d,' "a1""'a1h bal.... 11. Eloc',on '0 "".d.. Soc. '"'IA)
9. litigation Proceeds Received 12.31.91 nod 1.1.95 AUach Sch 0
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE 3. CONFIDENTIAL TAX INFORMATION SHOULD BE OIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Ste hanie Kleinfelter, E 100 Pine Street
FIRM NAME (If Applicable) P . O. Box 1166
McNees, Wallace & Nurick Harrisburg, PA 17108
TELEPHONE NUMBER
717-232-8000
(1)
(2)
None
130,926.69
OFFICIAL USE ONLY
(3)
(4)
90,398.42
None
(5)
(6)
88.65
None
(7)
0.00
8, Total Gross Assets (tolal LIRes 1.7)
9. Funeral Expenses & AdmInistrative Costs (Schedule H) (9)
10. Debls 01 Decedent, Mortg, L1abilllies, & Liens IS,", ') (10)
(8)
16,885.52
47,422.51
221,413.76
11. Total Deductions (tolai Lines 9 & 10)
12, Net Value 01 Estate (Line 8 minus Line 11)
13, Charilable and GovernmenlalBequestslSec 9113 Trusls
for which an election to lax hes not been made (Schedule J)
(11)
(12)
64,308.03
157,105.73
(13)
None
(14)
157,105.73
(15)
0.00
63,552.86 x
,06
(16)
3,813.17
0.00
3,813.17
ADDRESS
See Schedule attached
DATE~_GC,
ADDRESS
100 Pine Street, P.O. Box 1166
Harrisburg, PA 17108
DATE ,
'I 'J - "I'
-.,_.. " -v;
.",'....-.,..,..
"~,'".".'."<';,.,"''''',,.,
.',
\,
,L'. -".
Estate of: John B. Davis
21-97-0748
"
SlJI.Ml\Ry OF ALLCX:'ATICNS 'IO BENEFICIARIES
Class A
Laura FitzGerald
Einilie Davis
31,776.43
31,776.43
63,552.86
t:.:.".
~,;/!
~:"
~ ,~:
Estate of: John B. Davis
21-97-0748
'!he following person(s) are signing the return as representative(s) of the estate:
Anne S. Davis
553 Briclgeview Drive
Lerroyne, PA 17043
.'
PA REV'I500 EX (1.97)
Decedent's Com lete Address:
STREET ADDRESS
380 N. 5th Street
CITY
I STAlE
I'^
e
Tax Payments and Credits:
1, Tax Due (PagelLine 18)
2, Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments
C. Discount
111
5,719.00
Total CrodltR (A . 0 I C) (~)
3, InterestlPenalty if applicable
D. Interest
E, Penalty
TotallnlorflRVPflnnlly (0 I EI (31
4. II line 2 is greater than line 1 + line 3, enter the dilference, This Is tho OVERPAVMENT,
Check box on Page 1 Line 1910 requost a rofund (4)
5. If line 1 + line 3 is greater than line 2, enter the dillerence, This is Iho TAX DUE. (5)
A, Enter the interest on the tax due, (SA)
B, Enter the total of Line 5 + SA, This Is the BALANCE DUE, (5B)
Make Check to: REGISTER OF WILLS. AGENT
THE FOllOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; ,...""..."..,..".'""
b. retain the right to designate who shall use the property lransforrod or Its Incomo; .....'
c, retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . , . . . . . , , . , , , . . , . . . . , . , , ,
d. receive the promise for life of either payments, benefits or care? ..........""".,......,.....,
2, If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? II death occurred
aller December 12,1982, did decedent transfer property within one yeor of death without
receiving adequate consideration? .,..,.......,.......".."....",..,.".",..".,..
3. Old decedent own an Nin 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 othor nDn-prDbato property? ' . , . . . . , . . , .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST SCHEDULE G AND FilE IT AS PART OF THE RETURN
IIiI'
1'/0.)]
3,813.17
5,719.00
0.00
1,905.83
Yes No
~ I
D ~
@ ~
72 P,S. S9116 (a) (1.1) (i) provided for the reduction of the tax rate Imposed on Iho nel voluo 01 tronslers to or tor the use 01 the surviving spouse from 6% 10
3% for dates of death on or aller July 1, 1994 and before January 1, 1995,
72 P,S. S9116 (a) (1.1) (II) provided forthe reduclion 01 the rete imposed on Ihe net valuo of transfers to or for the use of the surviving spouse from 3% to 0%
for dates of death on or after January 1, 1995. The statute does not oxemot a translor 10 8 surviving spouso from tax, and tho statutory requirements for
disclosure of assets and filing a tax return are still applicable oven II the surviving spouso is tho only banollclary,
FOR DATES OF DEATH ON OR AFTER JANUARV 1. 1995 -- Ploeso enswer the tollowlng question by placing on 'x'ln the opproprlete spece,
Old the decedent create a trust or similar arrangement which Is solely for the 8urvlvlng spouse's benefit for his or her entire lifetime?
Ve. DNa:@:
spouse, at which time It will
to remove It from the
the election is made,
benefits the surviving
to make the election,
or similar
If you answered yes to the above question, the tax on tho trust or sImilar orrongolllontls postponed until tho dooth 01 tho second
be fully taxable at the rate(s) eppllcable to the remainder benetlciary(ies), Enter Ihe valuo ollhe Irust on Schedule J, Part II, in order
calculolion of the tax due In this estate. You may wish to file Schedule 0 in ardor to mako the election evailable under Section 9113, If
the trust or similar arrangement Is taxed in the estoto 01 tho Itrst docodont SPOUBO, tho portion of tho trust or similar arrangement which
spouse Is taxed at the 2ero tax rate, and tho remeinder is taxed otthe mte(o) appllcnblo 10 the ""'fllnder benellclary(ies), II you choose
you must attach Schedule 0 to a tlmely.filed tex return, elong wllh Schedulu(s) K nndlor M In urdur to show the apportionment of the trust
arrangement between the surviving spouse and tho romolndor bonollclory(los),
7 PA15002 NTF 10870
Copyright Forms Bollware Only, 1997 Nolco, Inc.
,
Page 2
.'
REV.1503 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John B. Davis
21-97-0748
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All proporty JolnUy-owned with right 01 survivorship must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
ITEM
NO, DESCRIPTION
1 8 shares AT&T Corporation
2 5 shares of B::lston Celtics Units of Limited partnership
291. 25
127.50
3 1 share of C-Tec Corporation camon stock
33.88
4 15 shares C Tec Corporation Class B Carrron Stock
506.72
ASSETS HELD IN SMI'lli BARNEY ACCOUNT NJ. 724-17630-1-5-002;
VALUED FRavI WALL STREE:I' JOURNAL
5 11632.50 shares of SB MOney Funds Cash Port Class A @ 1.00/share
11,632.50
Accrued Dividend
17.80
6 200 shares Bell Atlantic Corporation @ 73.25/share
7 500 shares Dauphin Deposit Bank @ 44.6875/share
14,650.00
22,343.75
8 200 ~~s General Electric @ 64.96875/share
12,993.75
9 210 shares Barsco Corp. @ 39.5625/share
10 150 shares Hewlitt Packard @ 54.15625/share
8,308.13
8,123.44
Accrued Dividend; Record Date: June 18, 1997; Payable Date July
9, 1997
21. 00
11 150 shares Intl Business Machines Corp. @ 91.59375/share
12 180 shares JIG Industries Inc. @ 13.46875/share
13,739.06
2,424.38
Accrued Dividend; Record Date: June 13, 1997; Payable Date: July
1, 1997
0.90
13 2 shares Lucent Technologies @ 71.9375/share
14 200 shares McIbnalds Corporation @ 48. 50/share
15 200 shares Microsoft Corp @ 129.34375/share
143.88
9,700.00
25,868.75
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
130,926.69
7 CPA31 NTF 1090S
Copyright Forms Soltware Only. 1997 Nelco, lnc,
,....-.....-.,..., ,~..',~~.,....'.~.., ",.~,_._--,. _.-"
, '
R(Vl!W"'IItT)
.
SCHEDULE C.1
CLOSELY .HELD CORPORATE
STOCK INFORMATION REPORT
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE IOENT OECEOENT
21-97-0748
ESTATE OF
John B. Davis
1. Name Df Corporation John Butler Davis Associates, Inc. State 01 Incorporation I'A
Address 31l South River Street Date 01 Incorporalion 12-31-79
City Harrisburg State I'A Zip Code 17104 Total Number 01 Shareholders 2
2, Federal Employer I.D, Number 23-2118835 Business Reporting Year 11/1 - 10/31
3, Type of Business Professional Service ProducUService Architec ts
4,
TYPE
Voting I Non.Voting
TOTAL NUMBER OF
SHARES OUTSTANDING
100
NUMBER OF SHARES
OWNED BY THE DECEDENT
90
VALUE OF THE
DECEDENT'S STOCK
$ 90,398.42
$
PAR VALUE
STOCK
Common
Preferred
Provide all rights and restrictions pertaining to each class 01 stock,
5, Was the decedent employed by the Corporation? KJl. Yes o No ( 1997)
If yes, Position Officer/Architect Annual Salary $ 43,750
6, Was the Corporation indebted to the decedent? 0 Yes l!J No
If yes, provide amount of indebtedness $
Time Devoted 10 Business 1 9
7, Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $ 100,000.00
Owner of the policy John Butler Davis Associates, Inc.
8, Did the decedent sell or transfer stock of this company within one year pnor tD death or within two years if the date of death was prior to 12.31-82?
DYes l!J No If yes, 0 Transfer 0 Sale Number of Shares
Consideration $
Date
Transferee or Purchaser
Attt\ch a separate sheet for additional transfers andfor sales.
DYes g No
9, Was there a written shareholders agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
10, Was the decedent's stock sold?
o Yes 0 No
If yes, provide a copy of the agreement of sale, etc,
Was the corporation dissolved or liquidated after the decedent's death? 0 'YeS< 0 No *Proceeds
If yes, provide a breakdown of distnbutions received by the estate, including dates and amounts received,
12, Did the corporation have an interest in other corporations or partnerships? 0 Yes g No
If yes, report Ihe necessary information on a separate sheet, including a Schedule C., or C.2 lor each interest.
_ $90,000.00 - 9/16/97
398.42 - 4/27/98
11.
THE FOLLOWING INFORMATlbN MUST BE SUBMITTED WITH.THIS SCHEDULE
A, Detailed calculations used in the valuation of the decedent's stock,
B, CDmplete copies of financial statements or Federal Corporale Income Tax returns (Form 1120) for the year of death and 4 preceding years,
C, If the corporation owned real estate, submit a list showing the complele address/es and estimated lair market value/s, If real estate appraisals have been
secured, attach copies,
0, List 01 principal stockholders at the date Df death, number of shares held and their relationship to the decedent.
E, List of officers, their salanes, bonuses and any other benefits received from the corporation,
F, Statement of dividends paid each year, List those declared and unpaid,
G, Any other inlormation relating to the valuation of the decedent's stock,
REV.1Sl0 EX + (1.97)
SCHEDULE G ;J
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John B. Davis
21-97-0748
This schedule must becomplated and filed if the answer to any of quesllons 1 through 4 on the raverse side of the REV.l500 COVER SHEET Is yes,
ITEM
NO.
DESCRIPTION OF PROPERTY
INCLUDE NAME OF THE TRANSFEREE, THEIR
RELATIONSHIP TO DECO & DATE OF TRANSFER.
ATTACH COPY OFTHE DEED FOR REAL ESTATE.
%OF
DECO'S
INTEREST
EXCLUSION
(IF
APPLICABLE)
TAXABLE VALUE
DATE OF DEATH
V ALU E OF ASSET
1 Decedent held t\\O individual
retirerrent accounts with the
followiIB date of death balances:
138,064.03
0,00
Smith Barney
Ha=is Savings
$ 121,310.07
16,753.96
Said retirerrent accounts are not
taxable as that the decedent was
under the age of 59
7 CPADl NTF 10910
Copyright Forms Sohwara Only, 1997 Nelco, Inc.
TOTAL (Also enter on line 7, Recapitulation) $
(If more space Is needed, Insert additional sheets of the same size)
0.00
REV.1511EX + (1.97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John B. Davis
FILE NUMBER
21-97-0748
Debls of decedent must be re orled on Schedule I.
ITEM
NO, DESCRIPTION
A, FUNERAL EXPENSES:
AMOUNT
None
B, ADMINISTRATIVE COSTS:
1. Personal Representative'S Commissions
Name at Personal Representative!s)
Social Security Number(s)/EIN No, of Personal Representative(s)
Street Address
City Slale
0.00
Zip
Year(s) Commission Paid: _
12,500.00
3,500.00
2,
3,
Attorney Fees Narre: McNees, Wallace & Nurick
Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant Anne S. Davis
Street Address 553 Ridqeview Drive
City r.errovne Slate PA Zip 17043
~elationship of Claimant to Decedent Spouse
S'Qouse: .Lived W1.tn dec~ aL. LIUlt::
or death. Spouse moved to a new residence in 9/98
Probate Fees
0.00
340.00
4,
5,
Accountant's Fees
0.00
6,
Tax Return Preparer's Fees
See Schedule attached
545.52
Total fran continuation page (s)
TOTAL (Also enler on line g. Recapitulation) $
(If more space is needed, insert additional sheets of the sarno size)
16,885.52
7 CPAll NT"0911
COpyright FOITTlS SOtlwlIr8 only, 1997 Nolco. Inc.
REV.1512 EX + (1.97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John B. Davis
100100. unr.lmbur.od modlc.1 .x n...,
ITEM
NO.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21-97-0748
DESCRIPTION AMOUNT
1 John Davis Butler Associates; Outstanding !.Dan due business; See
copy of correspondence fran Carpany attached
3,100.00
2 Arrerican Express; Credit Card Balance
2,025.84
3 Dennis Milke, MD.; Medical Expense
65.00
4 Mellon Bank Installrrent !.Dan No. 0275.177-4000155; !<brtgage on
property located at 380 N. 5th Street, l.erroyne, pennsylvania
held jointly with spouse; Principal balance as of 6/26/97 of
$84,463.34; Arrount reported is one-half of the outstanding
balance; See bank letter attached
42,231. 67
7 CPA12 NTF '091'
Copyright Forms Sollware Only, 1997 Nelco, lnc,
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, Insert additional sheets of the same size)
47,422.51
. .
REV.1513 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-97-0748
RELATIONSHIP TO DECEDENT AMOUNT OR
Do Not US, Trust..(s) SHARE OF ESTATE
John B. Davis
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (Include outrlghlspousel dislribulions)
surviving spouse 93/552.87
1 Anne S. Davis
553 Bridgeview Drive
I..aTOyl1E!/ PA 17043
31/776.43
2 Laura FitzGerald
3803 Rayrrond Street
Chevy Chase, MD 20815
Daughter
3 Emilie Davis
513C West San Francisco
Sante Fe, NM 87501
Daughter
31,776.43
ENTER DOLLAR AMTS, FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 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
None
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
None
TOTAL OF PART II.. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
7 CPA13 NTF 10913 (If more space is needed, insert additional sheets of the same size)
Copyright Forms Sollware only, 1997 NelcD,lnc.
0.00
McNEES. WALLACE & NURICK
ATTORNEYS AT LAW 'I ?
100 PIN~ STR~~T ,'1/. q1- I
p, O. BOX 11GB
HARRISBURG, PA 17108.1188
TtLtPHONtl?l71232.eOOO
FAX 17171237,5300
http://WWW.mwn.com
LINDA M. ESHELMAN
Estate Paralegal
DIRECT DIAL: (717) 237.5210
E-M^IL ADI>RESS: LESIIELMA@MWN.COM
Septcmbcr 28, 1998
VIA CERTIFIED MAIL
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
0(;
C:jj';'
~_:=
\l:i
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::0
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S~ (~~:
Re: Estate of John B. Davis
Cumberland County No.: 21-97-0748
MWN File No: 18248-000 I
c~
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Ladies and Gentlemen:
~
..1 ~.
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~~...
~'.,j
U1
Our firm is counsel to Anne S. Davis, the Administratrix of the Estate of John B. Davis.
Mr. Davis died on June 26, 1997.
Enclosed for filing in the Estate are the following documents:
1.
Pennsylvania Inheritance Tax Return (2 originals, I with exhibits for Department
of Revenue, and I without exhibits for Register's Office). A refund is due the
Estate of$I,905.83.
I
"
2.
Inventory (2 originals)
,
I:).
3, Copy of Estate's Federal Estate Tax Return (Form 706)
4. Check No. 78882 for $28.00, the fee for filing the inheritance tax return and
inventory .
Please date-stamp the extra copies enclosed and return to our office in the envelope
provided.
. COLUMBUS, OH
WASHINGTON, D.C, .
,-_._~"._-~,.,.."
"',0"" ....
,...., .'~~ '-..-..---..................---..
Register of Wills
Septcmbcr 28, 1998
Pagc 2
Tbank you.
LE/lme
Enclosures
ce: Anne S. Davis
Yburs truly.
, : ' I ~, I ,
, \ /. , _'"....' /1
Linda M, Eshelman
Estate Paralegal
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INRE:
ESTATE OF:
JOHN BUTLER DAVIS
ESTATE NO. 21-97-748
DECEASED.
SATISFACTION AND RELEASE OF CLAIM
The undersigned, Deborah Berlin, Agent for AMERICAN EXPRESS, has received a
payment of $2025.84 which satisfies the claim as filed for the date of death liability. This
Satisfaction and Release of Claim is executed to acknowledge discharge of the claim and to
release the estate and personal representative from all further liability with respect to the date of
death liability on account number 372425698511002.
Executed this December 4, 1998.
AMERICAN EXPRESS
Claimant
By:bb rJJv t'~A,L
DEBORAH BERLIN, Agent
Estate Recoveries, Inc.
P.O. Box 24566
Baltimore, MD 21214
410-444-8022 Ext. 765
/5~CJ.OJ - 3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~*
BUREAU Of INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 28D601
HARRISBURG, PA 17128.0601
~OTICE Of INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSHENT OF TAX
10.1147 II U, '"."1
STEPHANIE KLEINFELTER ESQ
MCNEES ETAL I~..
PO UOX 1166 :;LI
HBG PA 17108
DATE 02-01-1999
ESTATE OF DAVIS JOHN B
DATE OF DEATH 06-26-1997
'I FILE NUMBER 21 97-0748
COUNTY CUMBERLAND
ACN 101
A.ount Renitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE"Y=lS'4j-EX--AFP-[oij:,m--NiificniJ;-i-NHEifiTANCn'"Ain-pPRA-isEifiN:r,--AL'DiwANcE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DAVIS JOHN B FILE NO. 21 97-0748 ACN 101 DATE 02-01-1999
TAX RETURN WAS: I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.al Estat. ISchedul. A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Hortg.ges/Notes Receivable (Schedule DJ
5. Cash/Bank Deposlts/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule G)
8. Total Assets
) CHANGED
.00
130.926.69
90.398.42
.00
88.65
.00
.00
IS)
(1)
(2)
(3)
141
IS)
(6)
(7)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this for.. with your
tax paytlent.
221,413.76
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule X)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governm.ntal Bequests; Non-elected 9113 Trusts
14. Net Value of Est~te Subject to Tax
(9)
(10)
16,885.52
47.422.51
(11)
(12)
(13)
(14)
64.308 03
157,105.73
.00
157,105.73
(Schedule J)
If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of Abh returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 taxable at Collateral/Class B rate (17)
18. Principal Tax Due
TAX CREDITS:
NOTE:
93,552.87 X .00=
63,552.86 X .06=
.00 x.15=
I1S)
.00
3,813.17
.00
3,813.17
PAYHENT
DATE
03-25-1998
DISCOUNT 1.1
INTEREST/PEN PAID 1-)
.00
AHOUNT PAID
5,719.00
RECEIPT
NUKBER
AA269888
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
5,719.00
1,905.83CR
.00
1,905.83CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATIOM, E.tot.. of d...dont. dying on or b.for. D.c....r 12, 19BZ -- If .n, future Int.r..t In th. ..t.t. I. tr.n.f.rr.d
In p......lon or .n;o,..nt to CI... 8 (coU.t.r.ll bon.Hcl.rI.. .f tho d.c.d.nt .ft.r th. .xplrotlon .f .ny ..t.t. f.r
Ilf. or f.r y.or., th. c....n...lth hor.b, .xpr...lY r...rv.' tho right to .ppr.I.. .nd ...... tr...f.r Inh.rlt.ne. T.x.'
at the lawful Class a (collateral) rata on any such future interest.
PURPOSE OF
HDTICE: T. fuHII1 tho r.qulr...nts .f s.ctlon 2140 of th. Inh.rlt.nc. .nd E.t.t. T.x Act, Act ZI of 1995. (72 P.S.
SGlction 9141)).
PAYNEHT: D.t.ch tho top portion of thl. Hotlc. .nd .ub.lt .Ith your p.,..nt to th. R.gI.t.r of Will. prlnt.d on the r.v.r.. side.
-."ak8 check or .oney order payable to: REGISTER OF MILLS I AGENT
REF1JH1l (OR): A r.fund of . t.x cr.dlt, which ..s n.t r.qu.st.. .n the T.x Raturn, ..y b. r.qu.st.d by c..pl.tlng .n "AppUC.tlon
f.r R.fund of p.nnsylv.nl. Inh.rlt.nc. .nd Est.t. T.x" (REV-I'I". Appllc.tlons .r. .v.ll.bl. .t the Offlc.
of th. R.gI.t.r of Will" .ny of tho 2' R.v.nu. DistrlDt offlc.s, or by c.Ulng the .p.cl.1 24-hDur
.ns..rlng s.rvlc. nueb.rs for fDr.s Drd.rlng: In P.nnsylv.nl. I_BOO_362_2050, outsld. P.nn.,lv.nl. .nd
within local HarrIsbUrg are8 (717) 787.8094, TDDI (717) 772.2252 (Hearing I.paIred Only).
DBJECTIDHS: Any p.rty In Int.r.st not satlsfl.d .Ith tho .ppr.i....nt, .IID..nc. Dr dl.oIID.onc. of d.ductlons, Dr os...s..nt
of tax (including discount or Int.r..t' os .hD.n on this HDtlc. .ust Dbj.ct .Ithln sixty (60' daYS of r.c.lpt of
this Notice b::H
--.rltt.n protost to the PA D.part..nt of R.v.nu., BD.rd of APP.ols, D.pt. 2BI021, H.rrisburg, PA 1712B-IOZI, OR
__.I.ctiDn to h.v. the .att.r d.t.r.ln.d at audit of the .ccount of the p.rson.1 r.pr.s.nt.tlv., OR
-.sPPlial to the Orphans' Court.
Foctu.1 .rrDrs discov.r.d on this 'SSDss..nt should b. .ddr....d In .ritlng to' PA D.p.rt..nt of R.v.nu.,
Bur..U of Indlvldu.1 T.x.s, ATTH: Post Ass.s...nt R.vl.. Unit, D.pt. 2B0601, HarriSburg, PA 17128-0601
Phon. (717) 7B7-6505. 5.. p.g. 5 of th. bDDkl.t "Instruction. for Inhorlt.nc. T.x R.turn for. R.sld.nt
Decedent" (REV-ISOl' for ~n Qxplanation of ad.lnistrativelY correctable errors.
If ony t.x due Is p.ld .ithln thr.o (,) c.l.ndor .Dnths aft.r the d.cadont's ..ath, a flvo p.rc.nt (51.) discount of
the tax paid Is allowed.
Th. 151. tax BOn..ty non-partlclp.tIDn p.nalty Is cD.put.d on the tDt.I of the t.x .nd Intar..t .ss....d, .nd not
paid bofora Jonuary IB, 1996, tho first d.' aft.r the .nd of th. tax ..n.sty p.rIDd. This nDn-partlclp.tlon
p.n.lty Is .pp.al.bl. In tho s... ..nn.r and In th. the s... tl.a parlod .s you .ould .pp..l th. tax ond Int.r.st
that has been assessed 85 indicated on this notleD.
Int.r.st I. chargod b.glnnlng .Ith flr.t d.y of dallnqu.ncy, or nine (9) .onths .nd one (1) d.y fro. the d.t. of
d.ath, to the d.te of p.y..nt. Tax.s .hlch b.c... d.llnqu.nt b.for. January I, 19B2 b..r Int.rest et the rat. of
six (61.) p.rc.nt p.r .nnue c.lcul.t.d .t a dall, rata of .000164. All taxoS .hich b.c... d.llnqu.nt on ond .ft.r
J.nu." 1, 19B2 .111 boar Int.rost .t a r.t. .hlch .111 v.ry fro. c.londar y.or to c.lendar y.or .Ith that r.t.
.nnounc.d by the PA D.p.rt..nt of R.vonu.. Tha .ppllcabl. Intere.t r.tes for 19B2 through 1999 .r.'
~ IntClrest Rate Dally Interest Feetor ~ Interest Rato Daily Interost Factor
1982 20i: .000548 1988.1991 11Z .000301
1983 16i: .00043& 1992 9Z .000247
1984 Hi: .000301 1993-1994 7i: .000192
1985 13i: .000356 1995-1998 9i: .000247
1986 10i: .000274 1999 7i: .000192
1987 9i: .000241
-.Intorost 15 calculated as followS:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any HDtlc. I..u.d .ftor tho t.x bOCD..' d.llnquent .111 r.fl.ct .n Intor.st calcul.tlDn to flft..n (15) day.
boyond the d.te of the ..se....nt. If pa,..nt Is ..de .ft.r the Int.ro.t cD.put.tlon dat. .hoon on th.
Notico, additional interost .ust bo calculatod.
ADMIN
ISTRATIVE
CORRECTIONS:
DISCOUHT:
PENAlTV:
INTEREST:
j"
/S-,dtJ;J-3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
. COUNTY
ACN
<!.
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 211D601
HARRISBURC, PA 111211-D601
1"-4l1n ,,, 111.'"
'I
02-01-1999
DAVIS
06-26-1997
21 97-0748
CUMBERLAND
201
Allount RHitt.d
JOHN
STEPHANIE KLEINFELTER ESQ
MCNEES ETAL ~;:,
PO BOX 1166 CL:
HBG PA 17108
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax pa~nt.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES .....
iiEii:483--EX--AFP--f03~-9;)-----.-.-NiificE--OF--jETifRHIiiATIo-N-Aiij-ASlsEss-HENir----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF DAVIS
JOHN
B FILE NO.21 97-0748
ESTATE TAX DETERMINATION
ACN 201
DATE 02-01-1999
1. Credit For State Death Taxes as Verified
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount end/or Interest)
3.813.17
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
*IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
"""'.."..'.,..,^,.......,...,...,...'"..,,"..,
,--,'r',-",','''..''-,<
';:h":<,;" .,.".
B
.00
I
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PAVHEKT:
PlIRPOsE OF
NOTICE:
T. fulfill the '..,I'OIOnt. of Soctlon 2145 Cb' .f tho 'nhe.Jt.... and E.t.t. T.. Act. Act 21 cf 1995.
(7Z P.$. Section 9145).
Ilotoch the top po.tlon cf this Netic. and ,.qlt .lth YOU. P....nt tc tho ...loh. of Nllh p.Jntod on the
raWr.. aide.
-- Hek. Check or .",.y ordtr peY8bl. to: REGISTER OF MILLS I AGENT.
REFIlm (all, A "fund cf . t.. c'odlt ... bo ..qU..t.d by c_J.tI"" on "Appllc.tlon fc. ..f..... of P.....ylyonJ.
Inhe.JtGnco and E'ht. T.." (REV-1313). AppJJc.tJcn. ... .v.Jl.bJ. .t the OffJ.. cf tho R..J.t.. cf NJl1..
any .f the 23 ..YInUo 01.t.Jct OffJ... .. f... tho Dep..to..t'. 24-hou. "'''.J"" ...yJc. nuobo.. fc. f.... c....Jng,
In Penn.ylvanJ. 1-"'-362-2.5.. out.Jd. Penn'YlyonJ. end .JthJn '.00' Ha..Jsbu.. .... (717' 7.7-.....
lOB. (717) nZ-225Z CHilaring IlIP8ired Only).
OaJECTIONS, Any ...ty In Jnt....t not IOtJ.fJ.d .Jth tho ........nt cf t.. .. ..... on thJ. n.tJc. .'Y cbj.ct .JthJn
aixty (60) dayS of receipt of thb HotJce by:
--..Jtt.. p.ct..t tc tho PA DeP..t..nt cf ..v...... ....d cf Ap""" Dept. 231021. Harrlsbu... PA 17123-1021. OR
--ell1Cting to have tho .atter deter.inod at audJt of tho personal repre.enteth,e, OR
--Dppql to the Orphans' Court.
ADlfIN-
ISTRATIVE
CORRECTIONS:
_LTV:
IIITEREST:
Foe...,1 .rrc.. dlseev...d on thls ........nt sheuld .. .dd.....d In ..JtJn. t., PA bop......t cf ..y.....,
au.... .f IndJvJdu,' T..... ATTN, Pc.t A.......nt ..yJ.. Unit. Dept. 2....1. Ha..Jsbu... PA 17'2'-'..,.
Phono C7171 787-0S05. So. P'" 5 cf tho _,.t "In.t.uctI.n. fc. Inho.It.... T.. R.tu.n fc. . ..sld..t
Docedont- (REV-IS01) for an explanation of ftdwiniatrativelY correctable errors.
Tho 1~ ... .....ty non-p..tJcJp.tJ.n "n"ty Is c...ut.d .n tho tct" of tho ... and Int....t ..s....d. and not
..Jd bofo.. JOnua.y 18. 19", tho fJ..t d.y .ft.. tho .nd cf tho t.. "'.sty po.Jcd. This ncn-p..tlclp.tJon
.....,ty Is _"Ob,. In tho .... ..nn.. ond In tho tho .... tI.. p..led .. YOU .culd ,_., tho t.. and Jnt....t
~t has been assessed as indicated on this notice.
Fc. dot.. .f d..th on .. .ft.. 1.-3-91. P.".ylv.nl. Est.t. T.. b.... on tho F.d..., E.t.t. T..
return becoaos delinquent at tho expiration of nine (09) .onths fro. tile date of death.
F.. dat.. .f do.th p.J.. t. 1.-3-91. P.".ylvonl. E.t.t. T.x b".d on tho F.d...l E.t.t. T.. ..tU.n
becaus delinquent at tho expiratJon of eiDhteen (8) bonths frOll the date of death.
T.... ""Ich - dollnqu..t b.f... J.nu..y " 1932 b... Int....t .t tho rat. .f .Ix (6:/) p..e.nt ... .....
ooICUl.t.. .t . dolly rat. .f ....161,. AU t.... ""leh b..... dollnouont .n .. .fto. JOnua.y 1. 1932 N1U ....
Into...t .t . rato .hleh .Jll v"Y f.... c.lOnd.. Yo.. t. C"ondo. yo.. .Ith that rat. onno......, by tho PA
lktpertaont of Revenue. Tho apPUcable interest rates for 198Z through 1999 are:
Vear Interest Rate DaUy Interest Factor Vear Interest Rate Dally Interest Factor
1982 ZO;,: .000548 1988~1991 11% .000301
1933 16:/ .000438 1992 9Z .000247
1984 11% .000301 1993-1994 n .000192
1985 13:< .000356 1995-1998 9Z .000247
1986 10;': .000274 1999 n .000192
1987 9Z .000247
--Int.rest is calCUlated as fOllow.:
INTEREsT = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any N.tJco I..... .fto. tho t.. ......s dollnquont .Jll '.f10et .n Jnt....t c'lcul.t'on to flft..n (15) d.y.
boYond tho doto of tho .........t. If P'Y"nt Is ..do .ft.. tho lnto.o.t c...ut'U.n d.t. she"" on tho
HotJc., additIonal lnt.rest lUst be calculated.
-~"'-"""""JC'l~--::-_..."\..'1 """"If'~:':;'''''''''''''''''"'''''''~,'h'.
PA\1EKT:
Detedh the top portion of this Notice and .~it with your pa~nt aade payable to tho ~e and eddress
prlnt-.:J on the raverA .Jete.
If RESIDENT DECEDENT ..e check or .OMY order payable to: REGISTER OF WILLS, AGENT.
If NON~RESIDENT DECEDENT uka check or aoney order peyable to: COHHONWEAL TH OF PENNSYLVANIA.
REFtICD (CR): A rahnt of a tax credit, which was not requested on the Tax RClturn, ny bo reQUuted by cQIIPletlng an
"AppllClltion for Refund of Pamsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of tho Register of NUb, any of the Z3 Revenue Distr-ict Offlcas or fr~ tho Departaent.. 24-hour
enswerll1Q service ~rs for forws ol"der-ing: In PeMsylvania 1-800-362-2050" outside Pemsylvl!ll1ia
and within local Herrisburg area (117) 781-8094, TDDI (117) 772-2252 (HGaring I~aired only).
REPL V TO:
DISCOlIIT :
PENAL TV:
INTEREST:
Questions rcagarding errors contained on this notice should bel eddressed to: PA [lepartont of Revenue, Bureeu
of Individual Taxes, ATTH: Post Assessaent Review Unit, Dept. 280601, Harrisburg, PA 11128-0601, phone
(717) 787-6505.
If IIIlY tax dull is paid within three (3) calendar aonths sfbr the decedent's dClath, a fivCl percant (52) discount
of the tax paid is allowed.
TtMI 152 tax __sty non-partlcipat1on pelnel ty is cogputed on thCI totel of the tax end interest assessed, and not
peid before Janucry 18, 1996, thCl first day efter the end of the U1X aanesty periOd.
Interest is charged beginning with first day of delinquency, or nine (9) aonths and one (1) day fr~ the date of
death, to the date of pa~ent. Taxes which beceae delinquent b~forCl January 1, 1982 bear intercast at tho rate of
six (6:() percent per aMlIa calculated at 8 dally rate of .000164. All taxes which beca.. delinquent on and aftcar
January I, 1982 will bear interest at II rat. which will vary froe calendar year to calClndar ycaar with that rate
announced by the PA Depart.ent of Revenue. The applicable interest rat.s for 1982 through 1999 are:
Vear IntcarClst Rate Daily Interest Factor Veer Interest Rate DailY Inter.st Factor
1982 202 .000548 1988-1991 11Z .000301
'983 16Z .000438 1992 .. .000247
'9" 11% .000301 1993-191J4 n .000192
1985 '''' .000356 1995-1998 .. .000247
'986 102 .000214 '999 71. .000192
1987 9Z .000247
--Interest is calculated aB follows:
INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any HoticCl issued after the tax beC08as delinquent will reflect an interest calculation to fifteen (15) deys
bayond the dato of tile a5se5...nt. If plI~ent is eade after the interest coaputatlon datca shown on the
Hotico, additional interest au.t be calculated.
'~.
IS:--,;l~~ -..3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DfPT. z.a6Dl
HARRISBURC, PA 17128-06Dl
STEPHANIE KLEINFELTER ESQ
MCNEES ETAL
PO BOX 1166
HBG PA 17108
Vw
IIV-7I'U'''IU-'1)
07-05-1999
DAVIS
06-26-1997
21 97-0748
CUMBERLAND
202
A"ount R."itted
JDHN B
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
NDTE: To insure PNlPIlr credit to your .ccount, .ubIoit thll uppIlr portion of this fOI"ll with your t.x p_t.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES .....
Rifv:73ir-EX--AFP--io3~-9j)-----.-.-Niificif-OF--UETifR"iNiiiiiiN-Aiiu-ASisESSiMENir----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ..
ESTATE OF DAVIS
JOHN
B FILE NO.21 97-0748
ESTATE TAX DETERMINATION
ACN 202
DATE 07-05-1999
1. Credit For State Daath Taxes as Verified .00
2. Pennsylvania Inheritance Tax Assessed 3,813.17
(Excluding Discount and/or Interest)
3. Inheritance Tax Assessed by Other States .00
or Territories of the United States
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed 3.813.17
5. Pennsylvania Estate Tax Due .00
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return .00
7. Additional Pennsylvania Estate Tax Due .00
TAX CREDITS:
PAVMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED
.LCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS.)
PURPOSE OF
NOTICE:
To fulfill th8 requlr......t. of Section 2145 (b) of the Inhedtence BOd Estat. Tax Act# Act 21 of 1995. (72 P.S.
Section 9145).
PAYIlEHT:
Detach the top portion of this Notice end sua.lt with your PIIYHflt to the Register of WUls pdntad on the
r.va..M sldI.
__ Make chec:k or GMY ol"der payable to: REGISTER OF MILLS, AGENT.
REFUHD (CR): A reftnd of II tax cr~lt I18Y bA requested by capleUng en "Application for Refund of pennsylvenl.
Inheritance BAd Estate TII~" (REV-1313'. ApplIcations a..e available at the Office of the Register of WIlls,
en)' of the a Revenuo District Offices or frOll thG 08partJI8nt.s Z4-hoUr ens...dng se..vice OUIlbers for for.5 ordering:
In Pennsylvania 1-800-362-2050, outside Pennsylvania and within local Harrisburg ar.. (717) 787-6094,
TDDI (717) 772-2252 (Ii_ring 1IIPII1rad OnlY).
OBJECTIONS: Any party In interest not satisfied with the 8ssessaent of tax liS shoWn on this notice MY object within
slKty (60) days of receipt of this Hotlee by:
-....r1tt.. protest to the PA DaparbNnt of Revenue, BoaI'd of Appeals, Dept. 281021, Hal"l"isbul"g, PA 17128-10Zl, OR
--aIKting to heYe the uttel" detel"llined at audit of the pllII"sOIUII repl"esentati'ltl, OR
--appeal to the Or-phans. COUl"t
AIIIIN-
JSTRATIVE
CORRECTIONS: Factual errol"S discovered an this aSS4IS5Illilf1t should be addressod in writing to: PA O8FNIrtHnt of Rev"""
BuI"88U of Individual Taxes, ATTN: Post AsslIS,.nt Review Unit, Dept. 280601, Hardsburg, PA 17128-0601,
Phone (717) 187-6505. S88 pagG 5 of the booklet "Instructions for Inhedtance TIlX Return for e Resident
Decedent'" (REV-150l) for an explanation of edllin!strativalY corracteble errors.
PENAL TV:
The 15:( tu __sty non-perticipation penalty is co.puted on the total of the tax and inter.st assasud, and not
paid before JanuaI"Y 16, 1996, the first dell' eftel" the end of the tax 811n8sty period. This non-perticipetion
penalty is appllelable in the SMQ .enner and in the the selKl tl.e per iod as you would eppeel the tax and interest
thet has bHn assessed as indicated on this notice.
INTEREST:
Additional Pemaylvania Estate Tox assessed es 0 result of II chenge on the Federal Estate Tax closing
latter beCOlles delinquent et the expiration of one (1) .onth frOll the date the final notice of the incraeH
in Federal Estate Tax is received.
TaXG' which beC8118 delinquent before January 1, 1982 bear interest at the rate of six (6~) percent per IInr'IWI
calculated at a daily rabl of .000164. All taxes which baCaallO dolinquent on or after January 1, 1982 ,01111 bear
interest at a rate .,hich .,i11 vary frOll calendall" ynr to calendZll" ynr with that rate ~ by the PA
Oep8rblent of Re."lIIlU8. The applicabllil interest rates for 198Z thrOUllh 19'99 are:
Vaal' Interest Rate Dally Interest Factor
~
Interest Rate
Daily Interest Factor
1982 ZO% .000548
1983 16% .00043.8
1984 11~ .000301
1985 13X .000356
1986 10% .000214
1987 9% .000247
--Int. rest Is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
1988-1991 11%
1992 9Z
1993-1994 r~
1995-1998 9%
1999 n
.000301
.000247
.000192
.000247
.000192
X
NunBER OF DAYS DELINQUENT
X
DAILY INTEREST FACTOR
./ i
,~...j'
--Any Hotice issued after the tax baCo..s delinquent .,ill reflect an interest calculation to fiftean (15) days
beYond the dato of the assessaent. If payaent is .ado after the interest CotlPutBtion date shown on tM
Notice, lMIditionel interest aust be calculated.
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PLEASE f"lLI: TillS RI:I'OllT WITIIIN TWO HAltS OF HATE OF HI:,\TII ItEl;AIUlLI:SS OF TilE STATUS 01' TilE ESTATE.
IF r.STATt: IS ~()T CO;\II'U:TEU. FILt: A C1.121:(lItM yt:AIU.Y UNTIL COMI'U:TlO;'l.!,
STATUS OF ADMINISTRATION REI'ORT
Name of Decedent:
John Butler Davis a/k/a John B. Davis
Date of Death:
June 26, 1997
Will No.
Admin, No. 748-1997
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to
completion of the administration of the above-captioned estate:
I. State whether administration of the estate is complete: Yes ----L.. No_
2. If the answer is NO, state when the personal representative reasonably believes that the
administration will be complete:
3. If the answer to no, I is YES, state the following:
a. Did the personal representative file a final account with the Court?
Yes No-L.
b, The separate Orphans' Court No, (if any) for the personal representative's account
is:
c. Did the personal representative state an account infonnally to the parties in
interest? YeS---1L No_
d, Copies of the receipt, releases, joinders and approvals of fonnal or infonnal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report. 0 ~
Date:QJctC1 oL b )']/)00 'J nn 'Z ~ ~ LJ'- :\
Anne S. Davis
c/o McNees, Wallace & Nurick
100 Pine Street
P,O. Box 1166
Harrisburg, PAl 71 08-1166
"'"
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(717) 232-8000
-L Personal Representative
_ Counsel for Personal Representative
Capacity: