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HomeMy WebLinkAbout11-09-0915056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number POBOx28ol~vldualTaxes INHERITANCE TAX RETURN , Hanistwrg, PA 17128-0601 RESIDENT DECEDENT 21 09 00187 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 194-26-6236 ' 02/11/2009 Decedent's Last Name Suffix Davis ; (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Socal Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return Date of Birth 11/24/1931 Decedent's First Name MI Janet L Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ~.9 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of C~ 5. Federal Estate Tax Return Required death after 12-12-82) °~ ~' 6. Decedent Died Testate ~'"",....?" 7. Decedent Maintained a Living Trust ____. __ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) -~ 9. Litigation Proceeds Received t~ 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number James W. Kollas ' (717) 731-1600 Firm Name (If Applicable) _ _.____ .... _...._._ , REGISTER OF WILLS USE ONLY Kollas and Kennedy N ': c7 ca `: ; First line of address C ~ ~ ar ~ o ''"~ ; ~` 104 Fernwood Avenu ~.x_ C~ ~ ~ ~ 7 ,. o~, 1 C~,3 ~"~ f ~: Second line of address e ^ ~ I ~ y ~ ~ ~ ~; r': ; r?-t , Suite 104 i r~~C7~--~ -s t 7 C~ Tt ~}~ , ,;-; City or Post Office State ZIP Code ~ . ~ILED .,,.. -- .1~ .. 7 .- ~°! -*' --~- r.:.' ~ si Camp Hill '! PA 17011 -' ttt `~~' 1 ' ~ e, Correspondent's a-mail address: fames@kOllasandkennedy.com Under penalties of perjury, I declare that I have examined this return, including acxompanying schedules and statements, and to the bast of my knowledge and belief, R 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 OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGN OF~REPARER OTHER THAN REPRESENTATIVE DATE i ,~-t,~..-~' 11 /09/09 1104 Fernwood Avenue, Camp Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number __ Janet L Davis ' 194-26-6236 De~eaenc S Name: RECAPITULATION 1. Real estate (ScheduleA) ........................................... .. 1. 150,900.00 , 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. !! 0.00 4. Mortgages 8 Notes Receivable (Schedule D) ........................... .. 4. 0.00 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. ,; 42,926.64 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ..... .. 6. ' 582.89 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C~ Separate Billing Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................10. 11. Total Deductions (total Lines 9 8 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/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 - (a)(1.2) X .0_ 0.00 15. 16. _ _.....__._ . Amount of Line 14 taxable ... ... W_.. _.._._~ _ at lineal rate X .045 176,065.44 `,' 16, 17. Amount of Line 14 taxable Y A ~ ~ ~ " ._""~"" ~ "`"""`°"°"" . _.._ ..._.. _ at sibling rate X .12 0.00 i 17 18. Amount of Line 14 taxable at collateral rate X .15 0.00 18. 19. TAX DUE ..................................... ................ ....19.i 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 194,409.53 17,084.67 1,259.42 18,344.09 ''~! 176,065.44 0.00 176,065.44 0.00 I 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: .File Number ,,._ ,., ,. f 21 ~ 09 ~ 00187 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Janet L Davis 194-26-6236 STREET ADDRESS 25 Fieldcrest Drive CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments _ C. Discount 3. InterestlPenalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) 7,922.95 0.00 0.00 0.00 7,922.95 0.00 7,922.95 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 No 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? .................................................................................................................. ...... ^ 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 [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 zero (0) percent [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 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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (11-08) ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Janet L. Davis 00187 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads. Real property that Is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 • 25 Fieldcrest Drive, Mechanicsburg, PA 17050 150,900.00 TOTAL (Also enter on Line 1, Recapitulation.) ;' 150,900.00 If more space is needed, insert additional sheets of the same size. REV-1508 EX+ (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Janet L. Davis 00187 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with right of aurvivorahip moat be diacloaed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank Acxounts A. Personal Savings -Account #: 15004214960707 184.33 B. CD -Account #:31003917268657 1,100.85 C. CD -Account #: 31003917269316 10,387.73 2. Commerce Bank CD -Account #: ****2458 30,300.73 3. Cash on Hand 28.00 4. Members First Savings -Account #:138275 25.00 5. Household Goods and Furnishings 500.00 6. Clothes 200.00 7. Jewelry 200.00 TOTAL (Also enter on line 5, Recapitulation) 3 42,926.64 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Janet L. Davis 00187 If an asset waa made joint within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Debra D. Kirby 627 Allenview Drive, Mechanicsburg, PA 17055 Daughter B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 11/01/05 M&TBank-Account#:9834652308 1,165.77 50 582.89 TOTAL (Also enter on line 6, Recapitulation) I ; 582.89 (If more space is needed, insert addRional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Janet L. Davis 00187 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. Musselman's Funeral Home; Services rendered for funeral 6,912.52 2. Brookendort Memorials; Stone 295.00 3. Wood Lawn Memorial Gardens; Interment Fee 1,225.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representatlve(s) _ SVeet Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 8,000.00 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Claimant SUeet Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees 652.15 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation0 $ 17,084.67 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Janet L. Davis 00187 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-OS) ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Janet L. Davis 00187 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Debra D. Kirby Daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~I 0.00 If more space is needed, insert additional sheets of the same size.