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Home My WebLink About07-12-07 (2) REV . 11~ EX'" CI.oa) w .... 15~l:! Wc..g :cli!.... Uc..m c.. ~ . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ; FILE NUMBER I 21 07 0056 _f'l~JMBER_.. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.060' OFFIC;AL. USE mjLY COLl.NIY_c;()[)1: .. YI:~B __________m____ _______m SOCIAL SECURITY NUMBER .... Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Davis, Thomas S. ~~: ~ ;~;~M;:Db-YEAR) ~~~~T ~;E/ ~F;;~T:-~~-DD-YEAR)_~~~-- (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) ... J~~1~-0322 I THIS RETURN MUST BE FILED IN DUPUCATE WITH THE ------J- REGISTER_ OE_WIl~.I.~___ SOCIAL SECURITY NUMBER '.... IIlz Ww O::c O::z 00 Uc.. . . ---D2~-Supplemental Return o o o 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between - 0 3, Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Soh 0) 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received IRM NAME (If applicable) Ahrens Law Firm, P.C. ELEPHONE NUMBER 717/697-1800 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o ;: :5 ::> .... ii: ~ U W 0:: 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) 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due I COMPLETE MAILING ADDRESS . --------- - ----------.. -----.-. (1 ) None -------------- (2) 3,530.92 (3) None -- -----._.-. (4) None (5) 42,169.06 (6) None (7) None (8) (9) 11,552.17 ------- ..-------- (10) i 52 Gettysburg Pike Mechanicsburg, PA 17055 x .12 x .15 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been I made (Schedule J) - --I' : 14. Ne~~~e SUbj~~:~N:;:~::I~N:i;= ~::~:SE SIDEFORAPPLlCAB~E RATES--- ------- 15. Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) --- - ~ 16. Amount of Line 14 taxable at lineal rate 34, 1 47. 81 x .045 S ::> c.. ::E o U g 20.0 Copyright 2000 form software only The Lackner Group, Inc. r--.> c:::, -----c--.-=--c--~ .-,~- :~, --; " .FICiAL US~ ONLY r- i= . '''-~--.-. :.:~ :_:-!~s : i~:~ : ,~::) N '-0 ::r: I') w 0' 45,699.98 (11 ) 11,552.17 34,147.81 (12) (13) (14) 34,147.81 (15) (16) 1,536.65 (17) (18) (19) 1,536.65 Form REV-1500 EX (Rev. 6-00) ~ Decedent's Complete Address: STREET ADDRESS 105 Cherry Lane CITY I STATE PA IZIP 17013 --- Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 1,536.65 Total Credits (A + B + C) (2) 0.00 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. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 0.00 1,536.65 1,536.65 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: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or.. .................................................................. .............................................. d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................................................................................................................. ..... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?... .......................................... ....................................... ................................. Yes No ~ I D ~ D ~ D ~ 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 hava examined this ratum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of whici1 pre parer has anx knowledg"c.._ _n____.. _.. .. ._ ___ ___ SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE sl:::s;f6~;~~O~ES~;~SI~~~~~NG RETURN---~--ADDRESS- ~~~~,~~~kaJ~()1~____. --5?-li6~,ff!2 ---~..._"---------~_.- -- ---- - SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Thomas J. Ahrens.,; -;::' ''il /--. ~ ADDRESS DATE 52 Gettysburg Pike Mechanicsburg, PA 17055 .....7-.ll-o 7 For dates of d ath 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, S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .5. 99116 1.2) [72 P.S. 99116 (a) (1)]. 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. 99116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ==.=.....=,==c,.===-----1,"="'==.,,==.==..-c=~=~=== ESTATE OF Davis, Thomas S. _.._.. L_n_ n__~_ -~! ALE-NuMBER- , 21 - 07 - 0056 ...._L All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER rVALUEAT-DATE OF UNIT VALUE I iu DEATH 86.12' 3,530.92 DESCRIPTION 1 Prudential Financial Stock TOTAL (Also enter on line 2, Recapitulation) 3,530.92 *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 - 07 - 0056 ESTATE OF Davis, Thomas S. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH --- ------ - -,-..------ 6,000.00 -'" .._._----" ----..-----.------....-- - ----- ...------ - --..,-..--- ------. ...---- 1 2003 Ford Taurus 2 PNC Checking account # 5140427965 4,038.04 3 PNC Savings account # 5130353595 9,829.55 4 PNC CD # 31700243342 10,551.47 5 1986 Schult House Trailer - 14' x 70' 11,000.00 6 Personal contents in house trailer, not sold with the home 750.00 TOTAL (Also enter on Line 5, Recapitulation) 42,169.06 . SCI-EDU.E H IUERAI... EXPENSES & ADNINSTRATIVE COS1S COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Davis, Thomas S. FILE NUMBER 21 - 07 - 0056 Debts of decedent must be reported on Schedule I. ITEMu T ___n - NUMBER i FUNERAL EXPENSES: p:--~I Baggus Fu~~ralH;me-n----- DESCRIPTION AMOUNT ~;,991.79 2 Flowers 170.61 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip 2. 3. Year(s) Commission paid Attorney's Fees Ahrens Law Firm, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 3,000.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees Cumberland County 170.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 PA Inheritance Tax filing fee 15.00 Total of Continuation Schedule(s) 204.77 TOTAL (Also enter on line 9, Recapitulation) 11,552.17 *' I COMMONWEALTH OF PENNSYLVAN~A INHERITANCE TAX RETURN RESIDENT DECEDENT ------------,--. ESTATE OF Davis, Thomas S. Schedule H FlI1eraI Expenses & AOninis1ralive Costs conIi1ued 2 Estate notice in Cumberland County Legal Journal 3 Estate notice in The Sentinel 75.00 129.77 ------TFILE- NUMBER ~1-07-0056 -- ---- I Page 2 of Schedule H REV.1513 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN , ____ .u~_ESIDENTDEC':llE~T..__~____ ESTATE OF FILE NUMBER 21 - 07 - 0056 RELATIONSHIP TO DECEDENT _... _ i.>~uNO.I, L!s.t,.rUst8l!{S) Davis, Thomas S. _.._----~------.-_._- ! NUMBER : NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY - ------+----.--------------.-- . ---..-----.. ....--.-----.--------.- I. ! TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 2 3 4 5 James T. Davis 96 Cherry Lane, Carlisle, PA 17013 ,Son AMOUNT OR SHARE OF ESTATE John R. Davis 160710 Court, Lafayette, CO 80026 I Ison 20% of residue 20% of residue 20% of residue 20% of residue 20% of residue Michael S. Davis 316 Allegany Street, Frostburg, MD 21532 Ison i Ison i iDaughter Todd P. Davis 41 Mary Coburn Road, Springfield, MA 01129 Terri A. Davis Box 216, Ft. Bredger, WV 82933 See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET