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Home My WebLink About09-21-09 (2)1 X0560 7 I C.)5f3 REV-~ goo Ex (~-D~! OFFICIAL USE ONLY PA Department of Reverse Bureau of Ind~vrdual Taxes ~" '' INHERITANCE TAX RETURN aunty Code `~sar Fide Number P4 BOX 28f~64t 21 08 a657 Harrisburg, PA t7t28-060t -• RESIDENT DECEDENT ENTER OECEOENT INFORMATION BELOW Social Security Number Date of Death Oate of Birth 183-09-1733 05/23!200$ 08!11 /1916 D£eedent 5 Last Name Suffix E7ecedenYs First Name MI Davis John W (If Applicable- Enter Surviving Spouse's Information Below Spouses last Name Suffix Spouse°s First Name MI Spc7use s Soria( Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t Original Return ~ 2 Supplemental Return 3. Remainder Retum {date of death prior to 12-13-82) -t Limited Estate as Future Interest Compromise {date of 5. Federal Estate Tax Return Required death after 12-t2-i32) t; DeLedent Died Testa;±r 7 Decedent futainta~ned a Living Trust 00 8 Total Number of Safe Deposit boxes I.4ttac^ Copy of WiEIb iAttach Copy of Trust) =:+ .~' ~a;on Proceeds Received 'r? S;aoc,sat Poverty Credit (date of death 11 Election to tax under Sec. 9tt3{A} between t2-3?-ot and t-t-y5~ (Attach Sch. 4! CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOE Name Daytime Tefepttone Number Wiliam L. Adler (717) 234-3289 Ferrn Name t.lf Applicable) O _; ~:.~ ADLER 8~ ADLER ~ ~' (~ a (`° t ~ ___ First ~It'e of aaaress ~ ~ ~'' ~ ~ ~..r } f~" -Q r%. N r' ,~ ~~ 125 Locust Street ~ ~ _} _ ;, . Sc~cc~nd line of address ~~~~ ~~ 4 ` C.~ ~ `n ~ ~ ; -~ CX3 ~~ :,- Gty ur Post Office Slate ZIP Code ' - ~. ~,~ ;~ .`7 _;.I Harrisburg PA 17101 Carrespandent 5 e-mail address under ;~erartles of perjury, 1 declare that f have examined this return, including accompanying schedules and statements, and to the best of my knowledge and t~itrt, ~t ~ true, correct and complete. Oeelaralion of preparer other than the personal rearesentative is basod on all information of which preparer has any knowledge. 51GNATU QF PERSON RESPQNSIBI.E F FILING RE ~ RN PATE ~ c-yIL. _.__ ~_ S_ ~ 9 AQ~ 83 ~ ~ _ ` , ~~i?33 9 51Cafi~^T PREP RU R ."PRESENTATIVE ~qT aon ~. s //r~~~~ i! L S L o t~~ ~ ~ l>r~ ~ ~~ LEASE USE ORIGINAL FORM ONLY Side 1 1:iD5f~(1S I U58 15C)iEa():i 105$ J 15456052059 REV 1500 EX Decedent's Social Security Number o.cd.nrs ~~: John W Davis 184-09-1733 RECAPITULATION 1. Real estate {Schedule A)..... ............................... . ........ 1. 2. Stocks and t3onds (Schedule e) ....................................... 2. 11,678.00 3. Closely Held Corporation. PaMership ar Sole-Pr~op~ietorship (Schedule C) ..... 3. 4. Mortgages b Notes Receivable (Schedu~ D) ....... . . . ................... 4. 5. Cash, Bank Deposits b Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) Separate B~iing Requested ....... ti. 7. Inter-V+vos Transfers b Miscepaneous Non•Probate Property (Se~ndule G) Separate Billing Requested........ T. 8. Total Gross Assets (total tines 1-7) .................................... $. 9. Funeral Expenses b Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent. Mortgage 4abiliiies. b Liens (Schedule I) .... . ... . ....... 10. 11. Total Deductions (total Lines 9 b 10) ................................... 11. 12. Net Valus of Estate (Line 8 minus Line 11) ............................. 12. 13. Charitable and Governmental t3equests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..... . .................. 14, TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 {ax1.2) x .o_. 1s. 15. Amount of Line 14 taxable at lineal rate X .045 11,678.00 16. 525.51 17. Amount of Line 14 taxable at sibling rate X .12 1 T, 18. Amount of Line 14 taxable at cdlaterat rate X .15 tt3_ 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ 15056052059 Side 2 15056052059 REW1500 EX Pape 3 Decedent's Complete Address: File Number 21 08 0657 CEOENT'S DECEDENTS SOCIAL SECINtITY NUMBER John W Davis 184-09-1733 STREET ADDRESS - -' - - -- - 5225 Wilson Lane CITY - - - - I STATE --- ~P - _ _ Mechanicsburg PA 17055 Tax Payments and Credits: t. Tax Due (Page 2 tine 19) (1) 525.51 2. Credits/Pannents A Spousal Poverty Credit _ __- S. Prior Payments C. Discount _. __ _ _ _ - - --- Total Credits (A + 6 + C } (2) 8.909.04 3. InterestlPenalty if appfirabk D. Interest E. Penally " Total MteresdPenalty (D + E) (3) 4. N Line 2 is greater than Line 1 + tine 3. enter the diiierence. Ttlis is the OVERPAYMENT. Fill in oval on Page 2, Une 20 to request a refund. (4) 8.383.53 5. H Line 1 + Line 3 is greater than Line 2, enter the dAference. This is the TAX OUE (5) 0. Enter the interest on the tax due. (~) B. Eller the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t. Did decedent make a bansfer and: Yes ~ a. retain the use or income of the property transferred :................__...................................................................... ^ b. retain the right to designate who shall use rte properly transferred or its inc~mme• .......................................... ^ c. retain a reversionary interest; or ......................................................................................................................... ^ d. receive the promise tar dfe of either payments, benefas or care? ...................................................................... ^ 2. tf death oaxxxred after December 22.1982, did decsdent transfer property witl>in one year of death wittwut receiving adequate oonsideration? .............................................................................................................. ^ 3. Did decedent own an 'rn bust for' a payable upon death bank account or secxxity at his or her death? .............. ^ Q 4. Did decedent own an k>dvidual Retbement Account, annuity, or other non~probate property which contains a beneficary designa6on? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent j72 P.S. §9116 (a) (1.1) (i)j. For dates of death on a after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (Oj percent [72 P.S. §9116 (a) (1.1) (il~j. The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for discbsure of assets and ftiing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after Jt~y 1, 2000: The tax rate imposed on the net value of transfers from a deceased child lwenty~one years of age or younger at death b or for the use of a natural parent, an adoptive parent. or a stepparent of the child is zero (t)) percent [72 P.S. §9116(a)(1.2)j. The tax rate imposed on ~e net value of transfers to or for the use of the dec~ertt's areal beneficiaries is fora and one-half (4.5) percent, except as rotted in 72 P.S. §9116(1.2) [72 P.S. §9116(a~1)). The tax rate imposed on the net value of transfers b ~ for the use of the decedents siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)j. Asibling isdefined, under Section 9102, as an individual who has at Least one parent in common witl~ the decedent, whether by blood or adoption. t SCHEDULE "B" STOCKS AND BONDS Estate of John W. Davis File Number 21-08-0657 ITEM NUMBER DESCRIPTION VALUE AT DEATH Ikon Office Solutions, Inc. 988 shares common stock CIK 21676 11.82/share $11,678.00 TOTAL STOCKS AND BONDS $11,678.00 --~~ .3 ~ o ..~ '~AP1~