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Home My WebLink About03-29-07 .1 , EV.1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 w ~ x:~(J) u~~ wQ.(J :r:oo (J~..J 0..a1 0.. <( d!tj(,!.,\L USE (iNl.'! INHERITANCE TAX RETURN FILENUM~EO '1 RESIDENT DECEDENT 4k y~ I- Z W o w o w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Davis, Harry F. DATE OF DEATH (MM-DD-YEAR) 2-5-2007 DATE OF BIRTH (MM-DD-YEAR) 8-26-1932 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Davis, Carol K. [!] 1. Original Return D 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12.12-82) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (date of death belween 12-31:91 and 1-1-95) ~ Z w Q Z o 0.. (J) W ~ ~ o (J 1HI8<: , NAME dO,! NUMBER SOCIAL SECURITY NUMBER 185 - 24 4382 THIS RETURN MUST BE FILED IN DUPLICATE WITH T: REGISTER OF WillS SOCIAL SECURITY NUMBER 195 - 26 - 1238 o 3. Remainder Return (date of death prior kl12.13.82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Auach Sch 0; Jerry A. Weigle, Esquire FIRM NAME (If Appli~~ WEIGLE & ASSOCIATES P.C. TELEPHONE NUMBER 717-532-7388 COMPLETE MAILING ADDRESS 126 East King Street Shippensburg, PA 17257 z o ~ :) l- n: <( o w 0:: (1 ) (2) (3) (4) (5) 0 (6) (7) (8) (9) 7~822.00 (10) 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) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 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) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::) Q. :E o o >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 _ (15) 16. Amount of Line 14 taxable at lineal rate x .0 _ (16) x .12 (17) x .15 (18) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT QI ~b . . fj ,:[2 1- :---...,) :;;; --./ -..... --v j,-:; ~: ~t! _.\..J -r f\-..j \.0 J! .r.:- ''''"'rOO''' o (11) (12) (13) 7,822.00 (7 ,822.0Q) (14) NONE - INSOLVENT (19) ">J>,..t'$U...",'TQANJWllm.tAQ,.I;r,1 Pf/~ Decedent's Complete Address: STREET ADDRESS 115 Hammond Road I STATE PA 17257 CITY Shippensburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount I ZIP Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 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 S + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; .......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................. 0 c. retain a reversionary interest; or....................... ...................................................... ....................................... ...... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........... .......................... .... .... ......................................................... ........ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................. .............. ......... ........ ................................ ......... ........... ................... 0 No ~ ~ ~ ~ ~ Kl [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury, I declare that I have examined this retum, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE pERSON RESPONSIBLE FOR FILING RETURN 'e J(( ADDRESS Carol K. Davis PA 17257 Jerry A. Weigle AD .C., 126 East Kin Street Shi DATE ') ~-:-. -2,--(./ ) DATE <""? - L-.-L- - 0 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)" The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as al individual who has at least one parent in common with the decedent, whether by blood or adoption. ' REV-1508 EX+ (2-87) *' SCHEDUL"E E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Type FILE NUMBER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Davis, Harry F. (All pr.operty jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH HOBE - ALL ASSETS JOINTLY OWNED WITH SPOUSE TOTAL (Also enter on line 5, Recapitulation) S (Attach additional 8V2" X 11" sheets if more space is needed.) REV-ISH EX+ (7-88) ESTATE OF ITEM NUMBER A. 1. B. 2. A. C. 1. 2. 3. A. 5. 6. 7. 8. . SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCEllANEOUS EXPENSES Please Print or Type FILE NUMBER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Davis, Harry F. DESCRIPTION AMOUNT Funeral Expenses: Fogelsanger-Bricker Funeral Home 7,722.00 Administrative Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid Attorney Fees Weigle & Associates, P.C. 75.00 3. Family Exemption Claimant Address of Claimant at decedent's death Street Address Relationship City State Zip Code Probate Fees Miscellaneous Expenses: Register of Wills, Cumberland County - filing Insolvent PA Inheritance Tax Return 25.00 TOTAL (Also enter on line 9, Recapitulation) s 7,822.00 (If more space is needed, insert additional sheets of same size.) REV-1513 EX+ (2-87) '* COMMONWEAlTH OF P!NNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Davis, Harry F. ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. Not relevant as estate is insolvent. : . . ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $ III ","PA !:I'UI~A ilt nAAdAd. insert additional sheets of same size'