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Home My WebLink About03-17-10J 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year FiN Number PO eox 280601 INHERITANCE TAX RETURN 21 09 0845 Heniaburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 187-12-6552 05/25/2009 04!14/1921 Decedent's Last Name Davis Suffix Decedent's First Name Stella MI E (H Applicable) Entar Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Davis David q Spouse's Social Security Number 164-24-3622 THIS RETURN MUST BE FILED IN DUPLICATE VYITH THE REGISTER OF WILLS FILL IN APPROPRUITE OVALS BELOW ~' 1. Original Retum _. 2. Supplemental Retum "~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate C~ 4a. Future Interest Compromise (date of :. 5. Federal Estate Tax Retum Required death after 12-12-82) _. "'~ 6. Decedent Died Testate ~ ~ V, 7. Decedent Maintained a Living Trust B. Total Number of Safe Deposft Boxes (Attach Copy of will) (Attach Copy of Trusq --' 9. Litigation Proceeds Received ....-: 10. Spousal Poverty Credit (date of death 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 Name DIRECTED T0: Daytime Telephone Number William C. Kollas (717) 731-1600 . , Firm Name (If Applicable) , , ° T Kollas and Kennedy REGISTE LLS USE ~!LY ~ ~ ' -~ ~ ~ ; ; ~ ~,~ ~ ., p ! 7 ~ ~ ~ r~ i7 First line of address ~ ' 1104 Femwood Avenue cT~ x . Second line of address ~ ~_ __ `_ _~ >CJC ~ _ - i ;' Suite 104 _ ~ o = 'T' - Clry Of POSt Of6C@ ~~ Stat@ ZIP Code DATE FILED ~ Camp Hill PA 17011 Corcespondent's a-mail address: jamesQkollasandkennedy.com v„uer peneiaas or perjury, i cec~re mat I have examined this return, IrICluding accompanying schedules and statements, and to the Neat of my knowledge and Uelief, v k is lNa, correct and complete. Declaration of preparer other then the personal representatNe b based on all Information of whkh preperer has any knowledge. `~ ^ SIGNATURE O~RSON NSIBLE FO);FILIN~ RN ~/~~ C ~ ~ ~ DATE ADDRESS ~ ~ ,~! (/ ~ A - /Z~ /ri/y/~ L/~ d///~i~ LE/r•roy„~ s~,,ry~ /Tots SIGNATURE O~R O, TH€R THAN REPRESENTATIVE DATE -- ADDRESS ~ ~' ~~ ///~~ ~~ / ~// ~~Dy ~/~ ~ L. 15056051058 Side 1 15056051058 ~`~ J REV-1500 EX 15056052059 Decedent's Name: $teila E Davis Decedent's Social Security Number __ ._ _ __. 187-12-6552 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property "` (Schedule G) c~ Separete Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. .,._.__ ____. _. r___. 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 & 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 - -- 0 (a)(1.2) x .o_ 29,447.99 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16 17. Amount of Line 14 taxable at sibling rata X .12 ' 17 18. Amount of Line 14 taxable at collateral rate X .15 18 _. _. _ 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 0.00 0.00, 0.00 40,710.14 0.00'1 0.00 40,710.14 ; 11,262.15 0.00 11,262.15 ' 29,447.99 0.00 29,447.99 '. C~ 15056052059 Slde 2 ' 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: __ FIM„Ngmpgr.._......_._. _.....: 21 ~~ 09 10845 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Stella E Davis 187-12-6552 STREETADDRESS 127 N. Front Street CITY STATE ZIP Lemoyne PA 17043 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Roverty Credit B. Prior Payments C. Discount Total Crectits (A + B + C ) 3. InteresUPenalty if applicable D. Interest E. Penalty 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, Lins 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. (~) (2) (3) (4) (5) (5A) (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRU~TE 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 Ilse 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 decedect own an "in NusYfor" orpayable upon death bank~account or security at his ocher death? .....:.....:.. ^ [Lc] 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)J. 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)J. 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)J. 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEpULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Stella E. Davis 21-09-0845 InGude the proceeds of IRigation and the date the proceeds were receNed by the estate. All property Jointly-owned with right of aurvivonhip must be disclosed on Schedule F (It more space is needed, insert adddional sheets of the same size) REV-1511 EX+ (10-09) pennsytvania ~V DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENr DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Stella E. Davis 21-09-0845 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Headstone -Rolling Green Cemetery 2,336.00 2. Burial -Rolling Green Cemetery 1,570.00 s. Funeral Service - Musselmans Funeral Home 6,923.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s) of Personal Representative(s) Street Address City _ State ZIP Year(s) Commission Paid: ~• Attorney Fees: 0.00 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 0.00 Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 5. Accountant Fees: 6• Tax Retum Preparer Fees: ~. 433.15 0.00 0.00 TOTAL (Also enter on Line 9, Recapitulation) ~; 11,262.15 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (11-08) ~ Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERRANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT esintt vt= FILE NUMBER Stella E. Davis ,,, „~ ,,,,~ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).j 1. David A. Davis Husband 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. ; n more space is neeaeD, msett atlm[fonal sheets of the same size.