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HomeMy WebLinkAbout08-11-101505610101 REV-1500 Ex ~°1.1°' ' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania - - Bureau of Individual Taxes °EOAR.MENToFRE~EN~E County Code Year File Number PO Box Z8o6o1 INHERITANCE TAX RETURN Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ~ ~ 0 9 ~' a ~ 2 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 87`16 S8$S• od3'~~~,bog /o aFs ~9~2 Decedent's Last Name Suffix Decedent's First Name MI ~ ,~ /! S J' o s E p H I~t/ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ~l Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Depo:~it Boxes (Attach Copy of Will) (Attach Copy of Trust) (~ 9. Litigation Proceeds Received O 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 CH/.~.~LES ~ s/l /F~~s ~~/ 7/7 766 ~~o` ~-~_~ First line of address ~ CL~ u'S~'~2 ~o~ Second line of address /`!~ Q. City or Post Office ,II~`EC~f~NlCSBU~ State ~/¢ ZIP Code ,; ~;, t REGISTE¢TpF WILLS USE~iNLY - t- .. _ ~,t 1 ~~~ ' r....... , , _ , ~-_ ~~~~ , _ ..~ ~.~t ~~.J . ,. _ i DBE FILED - -- C"~ . ~ , /?os~g735' Correspondent's a-mail address: C e ~~ ~ ~~dS 3Q Corn CQS t• /~l° Under penalties of perjury, I declare that I have examined this return, including accompanying sched 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 se on all inform n of preparer has any knowledge. SIG RE OF PERSON PON~IBLE FOR FILING RETURN D TE ~~ x _ ~ • ADDRESS i/VNIT Jr• ~A-VIS ~ ~~NN~cS Dl4 __~_ _ erMQn 1 0?~• ~//~o~6u /~~ ~70~'~_ !~D had Land En.O~,~~4 ~7o~S_ SIGNAT~2FjOF P~PARE~OTHE TF~lj~REPR SEI~TATIVE DATE _•• v~L/Y ~,~~,~, ~C CjfQi/1 iCS~lKItil _ r/f / 70S•'S~ __~_._~~...~_.~_ PLEA USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J ._ ~~ J 1505610105 REV-1500 EX Decedent's Social Security Num b er Decedent's Name: ~0 S L~ ~"/Y ~AJ • ~~Vl1.S J7 ~ 7 ~ ' / , p to ~ ~ ~D ~' RECAPITULATION 1. Real Estate (Schedule A) ........................................ ..... 1. ,~ 2 0 O p. ~ O 2. Stocks and Bonds (Schedule B) .................................. ..... 2. ~ ~ O 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. „ Q O 4. Mortgages and Notes Receivable (Schedule D) ...................... ..... 4. . Q (~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. 5 ~ o` 7 (o • 7 / 6. Jointly Owned Property (Schedule F) p Separate Billing Requested .. ..... 6. s (~ O 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested... ..... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................ ..... 8. ~ o G a ~ 6 7~ ~ 9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. f ~, a b ,~ , 7 1 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... ..... 10. ~ j ~ ~ 7H / 11. Total Deductions (total Lines 9 and 10) ... ........................ ..... 11. / Y 3 g' ~ ~ tf ~ 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. ~ I $ -1 1 ~ a 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................... ..... 13. ., ~ D 14. Net Value Subject to Tax (Line 12 minus Line 13) ................... ..... 14. q ~ ~ ~ ~ ,, TAX CALCULATION -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~. . O C~ 16. Amount of Line 14 taxable at lineal rate X .0 ~ q ~ D ~' ~ a 9 17. Amount of Line 14 taxable at sibling rate X .12 „ Q C; 18. Amount of Line 14 taxable 15. * D O', 1 s. y~ 3 S• ~ ~ 17. pO at collateral rate X .15 ~ d O 1 g. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o,b 413-5.//. Side 2 1,505610105 150561,01,05 O J REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ I ` D~±~ ~ x ? DECEDENT'S NAME STREETADDRESS - _ ~ t oa _ n~'c,rt GK_ -~I-vd -_ _ _ --- -- CITY -_ ---- ----- - - __ _-- ---__ ------ -- -----__-__- _ ----- r STATE---- -- - .. - ~I ZIP / 7 c~ ~'o ~°.(.~lll~1 I C 5 r'r1 u r ~' Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) ~ ~ 2. Credits/Payments S'o 3 ~~7, A. Prior Payments ~- ____-__-_ __ _ __.__- B. Discount t a c ? ~ So 3. Interest 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. ~l. ~ 3SN / Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. ~ Q• ~~ ~~. ~ ~.s. ~ y ... ,.. ..r , 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 Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" ar 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 n 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 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 12 percent [72 P.S. §9116(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. COMMONWEALTH OF PENNSYLVANIA AEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT `~~ DAMS DONALD J ~'' . ~,~ ~' 2235 SHERMANS VALLEY RD I~ ELLIOTSBURG, PA 17024 foW ESTATE INFORMATION: SSN: 187-16-5885 FILE NUMBER: . 2109-0823 , DECEDENT NAME: DAMS JOSEPH WILSON DATE OF PAYMENT: 1 1 / 20/ 2009 POSTMARK DATE: 11 /20/2009 COUNTY: CUMBERLAND DATE OF DEATH: 08/ 27/ 2009 REV-1162 EX(11-96) N0. CD 012010 ACN ASSESSMENT AMOUNT CONTROL- NUMBER 101 ( $3,847.x0 TOTAL AMOUNT PAlD: REMARKS: Y3,847.a~ CHECK# 1 10 INITIALS: SAP sEat RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ,U his, .T ~S~d~~1 ~? FILE NUMBER 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 facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF C)EATH ~ . /~ // f~iaf ' CP.1`f4%~ r~ cf' ~~ ~a~Q~' s:~zcafe i ~ l~arx/~derJ ~w~,, L'tti,~r6erla,ld Coun ~~ ~ehi~Q. , bc~n~ n~or>e/ ~,larficw.l~.r y descrl~ed ~n -f~0ia,~ rer~'arn deed {+~•~ ~c~lna /n..Aa~,s~ Gt/~`c~occl, {y ~ ~~ kl. ~4vi S ~•ytc~ ~onoJyiy ~. ~a/iS~ `iiS w. jCt~ a~a~A~ .~'~i`!• ~ /1rs~, reCa r~~~ i„ ~t prCl~ D~ .~e ~~ CO rq~C/~ D/~ ~lC~t ir! Ct'~ r ,~r C is n~ ,bt~r~an q~ ~acc~,t ~ ,~11 T~/+ 5~t:~ Do~o~If, .~ vavs a~~,~oQr~~e~ ~.:r cQr~l ~/ /~ OJ7 .Trl/~. / ~~ 2D00 !v uQ/iP~tjD®h ~f~ C!~ ~S% ~i J~/c ~ ~tt S`tC4~~l/p/yliS~S ~/GS ~P.l/ ~r ~5~9~ Lv. lJctt~,,t ~a%d ~Oren,ises went sala/ ~j. ~~6/~~ ac~~~Soh do I~ TJ~ a~a.Y D~ /Yat~, a0 Q y' 1~ ~Ta c.d 6 grace tt cli2 r, .Ti' ~b r 1 ~~T'/ y - J~i~ID ~ O k S lcn cr ~uc~Q ~,v~t o v ~,~,Dl~~, °o af0//ors, ~s~~ doo, as TOTAL (Also enter on line 1, Recapitulation) ~ $ S'2~ GZ'90, ~° (If more space is needed, insert additional sheets of the same size) A. B. TY E F LOAN: U.S. DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT 1.QFHA 2.QFmHA 3. QCONV. UNINS. 4. ~VA 5. QCONV. INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent ane.shown. Items marked "(POCJ" werle paid outside the closing; they are shown hens fnr informatrona/ purposes and are not included in the btals. 1.0 3f98 (BUCHER -I.PFD/BUCHER IU4) D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: JACOB B. BUCHER, JR. ESTATE OF JOSEPH W. DAVIS JOYCE L. BUCHER 31 CHARTER DRIVE SHERMANS DALE, PA 17090 G. PROPERTY LOCATION: 6420 WERTZVILLE ROAD ENOLA, PA 17025 CUMBERLAND COUNTY, PENNSYLVANIA H. SETTLEMENT AGENT: 25-1697661 CHARLES E. PETRIE PLACE OF SETTLEMENT 6 CLOUSER ROAD MECHANICSBURG, PA 17055 101. Contrad Sales Price 102. Personal Property 103. Settlement Charges to Buyer (Line 1400) 104. 105. ~ustments r terns ar v _ e__er to a_ _ anc~ 106. City/Town Taxes 12/15/09 to 12131!09 107. County Taxes to 108. Assessments to 109. 2009-2010 SCHOOL TAXES 12/17/09 to 07/01/10 110. 111. 112. 120. GROSS AMOUNT DUE FROM BUYER 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 201. Deposit or earnest money 202. Principal Amount of New Loan(s) 203. Existing loan(s) taken subject to 204. 205. 206. 207. 208. 209. pus ments or terns near y e er 210. City/Town Taxes to 211. County Taxes to 212. Assessments to 213. 214. 215. 216. 217. 218. 219. 220. TOTAL PAID BY/FOR BUYER 300. CASH AT SETTLEMENT FROM/TO BUYER: 301. Gross Amount Due From Buyer (Line 120) 302. Less Amount Paid By/For Buyer (Line 220) 303. CASH (X FROM) ( TO) BUYER The undersigned hereby a owledge receipt f a con Buyer IC~'SJ OB CHER, JR. JOYCE L. UCH R I. SETTLEMENT DATE: December 15, 2009 52,000.00 401. Contrad Sales Price 402. Personal Pro 1,072.00 403. 404. 405. 5.00 406. Ci !Town Taxes 12/15/09 to 12/31/09 407. Coun Taxes to 408. Assessments to 187.05 409. 2009-2010 SCHOOL TAXES 12/17/09 to 07/01/10 410. 411. 412. 53,264.05 420. GROSS AMOUNT DUE TO SELLER 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 5,200.00 501. Excess De osit See InstrUdions 502. Settlement Cha es to Seller Line 1400 503. Existin loans taken sub'ed to 504. Payoff of first Mortgage 505. Pa off of second Mort a e 506. De osit retained b seller 507. 508. 509. us ens or ems n a! a er 510. Ci /Town Taxes to 511. Coun Taxes to 512. Assessments to 513. 514. 515. 516. 517. 518. 519. 5,200.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 600. CASH AT SETTLEMENT TO/FROM SELLER: 53,264.05 601. Gross Amount Due To Seller Line 420 i ( 5,200.00) 602. Less Reductions Due Seller Line 520) 48 064.05 603. CASH (X TO) ( FROM) SELLER i copy of pages 18 2 of this statement 8 an attachme is referO herein. Seller ~ _ ~ ~ ~ (.(~ y w /! 52,000.00 5.00 187.05 52,192.05 _ 520.00 5.200.00 5,720.00 52,192.05 5,720.00 46,472.05 ,!/~ HUD-t (3-86) RESPA, H64305.2 ....... ~ .. ~ .-sue vv...~._wv~wn~• ~.+vacsM v~ ~ r ~ ie.e Division of Commission line 700) as Follows: w - rHiv rrcvm BuYE:l2's rHiv rrcvm SELLER'S 7O1 ' $ t0 __ FUNDS AT FUNDS AT 702. $ t0 _ SETTLEMENT SETTLEMENT 703. Commission Paid at Settlern_ent 704. to 0 .I AY N N C T N 801. Loan Ori ination Fee 1.0000 % to 802. loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mort a e Ins. A .Fee to 807. Assumption Fee to 808. 809. 810. 811. Y T V 901. Interest From to ~ $ /day ( days %) 902. MIP Totlns. for LifeOfLoan for months to _ 903. Hazard Insurance Premium for 1.0 ars to 904. 905. 1 E I 1001. Hazard Insurance months $ r month 1002. Mort a e Insurance months $ er month 1003. Ci !Town Taxes months $ er month 1004. Coun Taxes months $ r month 1005. Assessments months ~ $ per month 1006. months $ r month 1007. months ~ $ per month 1008. months $ r month 1 1101. Settlement or Closin Fee to CHARLES E. PETRIE 250.00 1102. Abstract or Title Search to 1103. Title Examination to CHARLES E. PETRIE 250.00 1104. Title Insurance Binder to 1105. Document Pre aration to 1106. Nota Fees to 1107. Attorney's Fees to includes above item numbers: 1108. Title Insurance to includes above item numbers: 1109. Lender's Coverage $ 1110. Owner's Coverage $ 1111. 1112. 1113. 120. VERNMENT REC RDIN AND TRAN F R CHAR 1201. Recording Fees: Deed $ ;Mortgage $ Releases $ 52.00 1202. Ci /Coun Tax/Stam s: Deed - Mort a e 1203. State Tax/Stam s: Revenue Stam s 1,040.00; Mort a e 520.00 520.00 1204. 1205. 1301. Surve to 1302. Pest Ins ection to 1303. 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K 1,072.00 520.00 tsy s+grnng page z of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement. Certifled to be a true copy. CHARLES E. PETRIE Settlement Agent ( BUCHER II /BUCHER II / 5 ) REV-1508 EX + (t-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF .~ ~ V, S j J''f1S~/~ {~/~ r~~~ rrumo~R a !_ O g r Q o~•3 Include the proceeds of litigation and the date the proceeds were received by the estate. A{I property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM 'VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ . /trt ~ T $~fF-NK ~. ~4ec~ : f: ~ cl.o.~. a~ .Z~fi~l ~• . 2B savi/1 S /~CG~. /lro. /Soo 5ra0 60~ 3./3b ~ ~ y 3 0, ooo. 00 ~scc ya/wafio~ l~~Cr {~o~ /yI ~ ! ,fan/( a ff ~.ohc~l ~ere•{~ .,~, ~' ws~ Proceeds ~r~n on- S i fG t~fi oh ~6~ IVGV i? ~ h: arl. ~'a `in~.s~ek ~tc~'oh~er~s o7~ cS~trman6C~4le , P~' ~~/, 79G . So ~ ~ (,~~e Se ~e~nt ~tie~~ ~~~! i~~fo~teerf ~ fhz~l~~ .3, ~@ i ~ ~,rSeM tn~'s ~.l,~ Pro - ra,~"i o nS c~ sa.~~ o~ r~~ es ~~G ~.r' ~~I~m~uf' shut o~}u-~u.~t ~ . Li r~ c 40(0 ~ ~,x.t~( Turn ~~Kt-.S ~,$', c0 S . L; nL '-coq Sc~-ool Tiuceb ~/~ 7. ©S' ~f. R~ ~r~~td l4-I~,r~' Pharma.c~,, ~ ~ . !7 9 Soo• ~, Qe 11aSr ~nSLLV'. ~Oii~ Du)~S f o~• t~ ~a~s; v~ TOTAL (Also enter on line 5, Recapitulation) I $ s'~, a7(Q,7i (If more space is needed, insert additional sheets of the same size) Q M&TBank 499 Mitchell Road, Millsboro, DE 199b6 Mail Code DE-MB-12 Charles E. Shields, III Attorney at Law 6 Clouser Road Corner of Trindle and Clouser Roads Mechanicsburg, PA 17055 Re: Estate o : Joseph T~ Davis Social Security: 187-16-5885 Date Death: August 27, 2009 ~-- . Phone (888) 502-4349 Fax {302}934-2955 September 18, 2009 Dear Sir or Madam: Per your inquiry dated September 14, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 2754641 Ownership (Names o~ f} Joseph W Davis Opening Date .4/28/80 Balance on Date of Death $11,162.31 Accrued Interest $ 0.28 Total $11,162.59 2. Type of A ccount Savings A ccount Account Number 15004206012136 Ownership (Names o,~ Joseph W Davis Opening Date 6/28/83 Balance on Date of Death $ 30, 000.00 Accrued Interest $ 1.40 Total $ 30, 001.40 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Summerdale :Plaza Office # 717-255-2261. Sinc ely, c Tracie Hare Adjustment Services ~~,,~ ~ ~ ~- ~,~ ~~~, ~ ~~~.~ ~ SETTLEIViENT SELLER NAME ~ ~ ~ ~~~ 1 S I~.~'74-T1~ DATE OF '" ~ SALE ADDRESS ~~r~ ~ V y ~~~Z ~O) ~ 1 ~ ~~*~ PHON E ~ ^~ ~~ ~- zIP 1 ~o~ -~ LOCATION OF SALE ~ t~l~ ~-.~ ~~~0 ~~ AUCTIONEER ~ l ht`- ~~~5~~~4 PHONE ~-'t~-~ar~.~ - ~~g 'Y.. ~ y,r n~. ~~c't".3a* - ~ t _ .S r, rani ~ ..4 a r -- - `~ ~1 - ' PROFESSIONAL FEES / _ .- .. AUCTIONEER ~~~ $ ~ ~~ CASH $ too .-~ ~ t - CLERK 1~~2 $ ~~'~ ~~ CHE ~ ~J ~ ~~ CKS $ { k`~ CASHIER ~~~~$_ ! j ~' OTHER RECEIPTS - OTHER EXPENSES $ ., .: _- ::. ~ k !'~~ ~ a $ $ v1 $ J fl ~, ~~ t~~ r at ~'' ,~- ~, $ .. ~ ~ $ ~~ '/ ~ ~ :- ~ ~- ~ $ ~~ f.~ ~- $ ~ ~y- $ $ $ f, $ TOTAL RECEIPTS $ ~~ ~ ~ ~' $ LESS TOTAL EXPENSES $ ~~ ~. ~O ~ ~ ~ ~. r .. - ~_ ~. ~, ~ _ r~-.f _ _ TO 5 LASES ~` ~ ~. ~ ~ ~ - '- A ~~` """ ~Y ~- ./ ~~~ ~~- ~ _ I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction. of my goods and property sold on the above date. !accept ail res onsibility for providing merchantable title to all goods, and property sold, and for deli of title to t~e p aser. ,~ ' j ~ ---. ~ Date ~~ ~ ~ Auctione r or Cashier`s ~gnatvre ( s Sig tore) ~~~~ ~ ~ ~ Date - Date (SeNer's Signature) SELLER'S COPY REV-15ii EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ~ /~-V I s TOS~i~I ~• F{LE NUMBER ~~ ` Q 1- ~~ 3 i 7 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: // ~~ nn ¢ 1. ~ VGy$ ~'i.t.I'11.Y2~ ~'"[brnc O >r ,/y1 eel~am~ cs b u ~ a, tDQ,S', o0 B. 1 ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions { ~-t~, Name of Personal Representative(s) ~onu~q T ~q~1~ s ~ d~nrli s ~. ~y+ S. __ ~ ~ ~ U ~~ Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees ~ h~~--les ~. s h~ ~~~s ~j ~S`~ • '',~ ate, 00 3. Fami{y Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant No Oit/E ~Lt6~.l3LE' _ ND,N~' Street Address City State Zip _ Relationship of Claimant to Decedent 1. p! _ 4. Probate Fees ~d o ri ~f ~ n4.~ t s3ue o'f 5~r-.or~ Carl ~ t~~Cot-~S ~r ~ Q. 04 5. Accountant's Fees ~ 1~„ fi~~»h`''~ -, ,~,~AU~.a~n~• ~p~• P~ •,~ ply 40~ ( Ph 4r r k ~ ~o ~t 1 0 ~~ 5 6. , eT~ . ~s o , I ~ ~ oy m• Tax Return Preparer's Fees 0 ~ ~ . C u. +nn b eX-~ an c~ L a,v~ 30 tern a I ~ d vt rfis; h ~` t~e-n,bursemanl-~ fi 7s', 00 Carl-ale ~,nt'~nel A~dvertiz.i ~ Chacrkse.~b~rlc~~ ~ 1'f ~, o~ q. 'T'ri - C'dunty A'bskYtc>F- ~trriC~ - 7f~e /V~bsl'~cf t / ~ S-, o 0 ~a• A-dd~~'onal pOr»haf~ ~Fce ~aoo. o0 1 !. ~,lin FGG t ~~isft~ v~ 6v~%Is ~" IS', 00 la• ' ~ fi~ I tub MisSiohS ~u+.~ e'1r(~t-t~St.S' ~d /¢ttc~,cn c~rS ~ u~ oN ~t'S Co 1~ 3, y~S,oo t ~ TOTAL (Also enter on line 9, Recapitulation) $ / Z,b$,7/ ~, (If more space is needed, insert additional sheets of the same size) ~s7 or D.~r~iS, ~s~i~ tU. ~~-~o ai~o9- gz.3 " 7" I ~ ~tcros lr~ fi~u Za - ~~~,f, {~ ?r~cc~r ~~ so• 8'3 ~~. ~ X~SL.S ~r c~Jal"~LS U~l QdZ~ a,~ ~~4~ ~STU~ 45 lam" ~~u,~~ sht~ a,~c~ca~ ~~, pPc tj0. s~7 I ~ ~ei/h ~re~~Jcn?~ n , E~. , ~ ~,~~ 01~'~ ~-ri v%r~s ~z t-vs~uf 6roa~~ o~c v~~krcls~lstrs' .~'~ au;e,~ o~ 96 ~. 33 /g. G~i~,,6arse~ ~ ~~s. ~: ~,~Q.la/s ?%-', ~y;~'~, Gu~~d ~, ~TD~~I,D ¢7S'.D L~ REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~/911/~ s I ~C~s ~„ ~ ~ a ! ` ~ ILE NUMBER '~l ~! L~.Z ~3 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If mare space is needed, insert additions! sheets of the same size) REV-1513 EX+ (9-00) LE J SCHEDU COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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)] a~z 35 ~~errnans Vail (~d- ~/l~ off~bu~, p~ /70 ~ ~ a. ~~N~v~s ,r, v.~-~~s soh `~z 6D ~ w , shady La.~~ •Enola, ~~ ~ 70 2 S ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, 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 i. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF JOSEPH WILSON DAVIS I, JOSEPH WILSON DAVIS, currently of 6420 Wert.zvi.lle Road, Enola, Cumberland County, Pennsylvania, being of sound and disposing, mind, memory and .understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wi11s by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral. expenses as soon as conveniently may be after my decease. 2. It is my wish that I be cremated. 3. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise_~and bequeath to my wife, Dorothy Romaine Davis, to her own use and benefit absolutely. 4. In the event, however, that my said wife should predecease me, or should die at about the same time as I die, such as in a disaster Gammon to both of us, I give, devise and bequeath my said Estate to my sons Donald J. Davis, currently of Elliotsburg, Perry County and Dennis J. Davis, currently of Derry Street, Harrisburg, Dauphin County, in equal shares. 5. I nominate, constitute and appoint my sons, Donald J. Davis and Dennis J. Davis, to be the Co-Executors of this, my bast Will and Testament. I further direct that neither of them shall be required to file bond or other security in the Office of the Register of Wills far the purpose of administering my Estate.: 6. I authorize _and empower my personal representatives, in their sole and absolute discretion, to purchase or otherwise -1- .~ r: 5 ... acquire and retain any investments of which I die seized, or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of, or grant options in regard to any or all property of any kind forming a part. of my Estate for such terms and such prices as they may deem advisable; to borrow-money for any purposes connected with the protection and preservation of my Estate; to mortgage or pledge any real ar personal property forming a part of my Estate, or to join in ar secure the partition of same; to compromise any claims or demands of my Estate against others or of others against my Estate; to make distribution in kind and to cause any share to be composed of cash, property in undivided fractional shares in property different in kind from any other share; and to execute and deliver such instruments as may be necessary to carry out any of these powers. IN WITNEpSS WHEREOF, I have hereunto set my hand and seal this ~y~~'1 day of August, A.D. 1987. ~` 1 SEAL) Signed, sealed, published and declared by the above-named JOSEPH WILSON DAVIS, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~J ,C1 /~ 1l ~ ~ f / ( i( ~ 1 J oY `~~' ~~ -2- COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND I, JOSEPH WILSON DAVIS, Testator, whose name is signed to tY~e attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. ~ ~ / Sworn or affirmed to and acknowledged before me by the above Testator this ~ t~,tp, day of ~h~,~- A.D. 1987. d Notary Public NOTARY PiteUC Mechanicsbur, "~ Cai~Ssrand County My Ccmmission ~::;,ir~s 1un3 20, 1988 COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND . We , .,~~`~~ ~, ~~/~L1.~S and ~L/2H~iC3~~iy ~• C(.I~LE,,, the witnesses whose names are signed to the attached or f~aregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JOSEPH WILSOIQ DAVIS, Testator, sign aUd execute the instrument as his Last Will; that JOSEPH WILSON DAVIS executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of JOSEPH WILSON DAVIS, Testator, signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. i Sworn or affirmed to and subscribed before me this at/~,~ day of ~ ~ A.D. 1987. ~~~~~ Notary Public NOTARY PJBUC Mechanicsburg, PA Cusnb2r:and County My Comnsis~ioa Expiizs June 20, 1988 CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) August 9, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Joseph W. Davis No. 21-09-0823 Dear Register of Wills: TELEPHONE (7 7) 766-0209 FAx (7 7) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Joseph VV. Davis Estate as well as Check No. 112, in the amount of $15.00 for the filing fee, Check No. 113, in the amount of $200.00 for additional Probate and Check No. 114 in the amount of $85.84 for the Inheritance Tax due. Thank you for your kind attention to this matter. Very truly yours, S ~~ C~~ Charles E. 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