HomeMy WebLinkAbout09-10-10
1505610101
"", REV- i ~00 Ex (oi-io) J !l OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes `~~ t .,, INHERITANCE TAX RETURN ~ ~ _ ~ /, _ s~ ~ C~r
PO BOX 28o6oi RESIDENT DECEDENT C1 0~
Harnsburg PA i'Jiz8 o6oi
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
148-22-0656 ' 01/12/2010 12/27/1929
Suffix Decedent's First Name MI
Decedent's Last Name
Davidson Patricia K
(If Applicable) Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
i~~~iS-~~~ C7~ "vVI~LS
FILL IN APPROPRIATE OVALS BELOW
O
2. Su lemental Return
pp
O 3. Remainder Return (date of death
m 1. Original Return prior to 12-13-82)
O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
O 4. Limited Estate death after 12-12-82)
6. Decedent Died Testate O
~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
d O
i (Attach Copy of Trust)
Spousal Poverty Credit (date of death
10
under Sec. 9113(A)
a
O 11. E
ve
O 9. Litigation Proceeds Rece .
between 12-31-91 and 1-1-95) O
Attach Sch
( )
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
Name e~.a
John C Oszustowicz (717) 243-743 0 ~,
REGISTER O~' E ON>~
First line of address
104 S Hanover St
Second line of address
City or Post Office
idfii$ie
State ZIP Code
Dn, 17n1?
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N
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DATE FILED
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Corcespondent's a-mail address: john0 CarliSlepalaW COm
Under penalties of perjury, I declare that I have examined this return, 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 which preparer has any knowledge.
PERSON F3F O) SIBLE FOR FILING RETURN
v
ADDRESS
33 Mist Lane, Ephrata, PA 17522
cir_nm iaF F PGFPARER OTHER THAN REPRESENTATIVE
ADDRESS
104 S H over St., Carlisle, PA 17013
h.
USE ORIGINAL
ONLY
Side 1
L 150561D1D1 15D5610101
1505610105
REV-1500 EX Decedent's Social Security Number
Decedent's Name: Davidson, PatriCla 148-22-0656
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.
9 9 ( ) .........................
Mort a es and Notes Receivable Schedule D 4.
..
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 299,844.03
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
7
98
329
09
(Schedule G) O Separate Billing Requested...... .
.. ,
.
8. Total Gross Assets (total Lines 1 through 7) ....... ................... .. 8. 398,173.12
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 21,648.37
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 187.48
11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 21,835.85
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 376,337.27
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. 376,337.27
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 15.
16. Amount of Line 14 taxable
at lineal rate x .0 45 376,337.27
16.
16,935.18
17. Amount of Line 14 taxable
at sibling rate 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 O
Side 2
1505610105 1505610105 J
REV-1500 EX Page 3 File Number
no.-o.tpnt~c rmm~lete Address:
DECEDENT'S NAME
Patricia Davidson
STREET ADDRESS
770 S Hanover St
STATE Z~F
clCarlisle '~ PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 16,935.18
2. CreditslPayments 16,000.00
A. Prior Payments
B. Discount 842.08 16,842.08
Total Credits (A + B) (2) _
3. Interest
(3)
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. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 93.10
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? ................................................................ ......
If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
2
.
without receiving adequate consideration? ........................................................................................................
h? ...... ^
^
0
........
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her deat ......
Did decedent own an individual retirement account, annuity or other non-probate property, which
4
.
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)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 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)J.
• 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)]. 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) SCNEDt~LE Ep
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF
Davidson, Patricia
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
JMBER
1 Morgan Stanley Smith Bamey Investment Account #73H-00073-15
2 Accrued Interest on item #1
3 M&T Bank Savings Account # 25004920098214
4 M&T Bank Checking Account # 15004218083654
5 Cash held by Michael Davidson
6 Cash held in Escrow Account of John C Oszustowicz
7 Refund from Chapel Pointe (Retirement Community)
g Refund from overpayment to Carlisle Petroleum
9 Refund from overpayment to Hershey Medical Center
10 Refund from overpayment to Philhaven Medical
11 Refund from Millennium Pharmacy
12 Refund from Genworth Long Term Care Insurance Policy
13 Misc. personal property
14 2009 Income Tax Refund
FILE NUMBER
21-10-0269
TOTAL (Also enter on line 5, Recapitulation) b
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
54,218.97
423.49
37,898.29
9,180.99
49,000.00
140,282.71
4,939.75
600.00
76.48
65.32
406.31
1,920.00
500.00
331.72
299,844.03
RSV-15117 E;C+ (03-:19}
pennsylvania
!~] DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
aFCinFNT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
FILE NUMBER
1t mule ~Na~c ~o ~~~~~ , ._ _----
ESTATE OF 21-10-0269
Davidson, Patricia ~ ____,,___ , ,,,,,,,,nh d „~ nana FhreP of the REV-1500 is yes.
Rv-ISl ~x+;to-o~}
SCHEDULE H
~ Pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Davidson, Patricia 21-10-0269
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
I' Ewing Brothers Funeral Home 6,862.80
2 Cumberland Valley Memorial Gardens 1,495.00
3 Burial clothing 65.87
a Sunnyside Restaurant -reception 455.00
B. ADMINISTRATIVE COSTS:
I. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
12,000.00
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
458.50
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees,
~~ Legal Advertising -Cumberland County Law Journal 75.00
a Legal Advertising -The Sentinel 113.20
9 Ibis Appraisal Services 120.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 21,648.37
If more space is needed, use additional sheets of paper of the same size.
R=`J-1S1?. FX+ X12-08)
~ Pennsylvania SCHEDULE I
?~' oECaarMENT of REVENUE DEBTS OF DECEDENT,
wr+ERITaNCE Tax RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Davidson. Patricia 21-10-0269
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+ (01-10)
~1 pennsylvania
~i DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
Davison, Patricia
SCHEDULE J
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Michael L Davidson 33 Misty Lane, Ephrata, PA 17522
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE,
II I 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.
FILE NUMBER:
21-10-0269
AMOUNT OR SHARE
OF ESTATE
100%
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, use additional sheets of paper of the same size.
o°
LAST WILL AND TESTAMENT
OF
PATRICIA K. DAVIDSON
I, PATRICIA K. DAVIDSON, a legal resident of the Borough of Carlisle,
Cum erland County, Pennsylvania, being of sound and disposing mind, memory, and
unde tanding, do hereby make, publish, and declare this as and for my Last Will and
Test ment, hereby revoking all other wills and codicils heretofore made by me.
FIRST: I direct that all my just debts and funeral expenses, including my grave
mar r, shall be paid from the assets of my estate as soon as practicable after my
SECOND: I direct that all taxes that may be assessed in consequence of my
Beat , of whatever nature and by whatever jurisdiction imposed, shall be paid from my
resi uary estate as a part of the expense of the administration of my estate.
THIRD: I devise and bequeath the residue of my estate, of every nature and
whe ever situate, to my son MICHAEL L. DAVIDSON, provided he shall survive me.
Sho Id my son Michael fail to survive me, his share shall be distributed to his then living
issu , in trust if such issue is less than 25 years of age, per stirpes. If my son fails to
surv ve me and leaves no issue, such share shall be distributed to my sister JOAN K.
FOURTH: I nominate, constitute and appoint my son, MICHAEL L. DAVIDSON,
Exe utor of this, my Last Will and Testament. In the event of the renunciation, death,
resi nation, or inability to act for any reason whatsoever of the said MICHAEL L.
DA IDSON, I nominate, constitute, and appoint my sister, JOAN K. SODE, Executrix of
this my Last Will and Testament. I hereby relieve my Executor or his successor from the
n ssity of posting security in connection with their duties as such in any jurisdiction in
whi h they may be called upon to act, insofar as I am able by law so to do.
i
IN VNITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of
2004.
PATRICIA K. DAVIDSON
Signed, sealed, published, acknowledged and declared by the above-
named Testatrix, PATRICIA K. DAVIDSON, as and for her Last Will and Testament, in
the presence of us, who, at her request, in her presence and in the presence of each
other, have hereunto subscribed our names as witnesses thereto.
~,.
of ~~~~; (..~. J~,~_~-l~ 1f' ~~/'f-~ f~
,~~~
2
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0
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
I, PATRICIA K. DAVIDSON, Testatrix, who signed the foregoing instrument,
having been duly qualified according to law, acknowledge that 1 signed and executed the
instrument as my free and voluntary act for the purposes therein contained.
~ - ~d~.
PATRICIA K. DA IDSON
Sworn to or affirmed and
Acknowledged before me by
PATRICIA K. DAVIDSON, the
Testatrix, this ~_ day
of Rpr- 1 , 2004. _ __, _
i~;s.? 3~.nlp:~. SF..AI.,
~.__~--.- ~ ,~1 ~ Kii~IBE~LY f~, i_~~C, ~u~~~ public
Notary Public C?r!isle Faro, Cumberlac~d County
Commission Expires Oct. 90, 2005
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
We, the undersigned witnesses who signed the foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw Testatrix sign
and execute the instrument as her Last Will and Testament; that she signed and
executed it willingly as her free and voluntary act for the purpose therein expressed; that
each of us in her sight and hearing signed the Will as witnesses; that Testatrix is known
to each of us; and that to the best of our knowledge and observation the Testatrix was at
the time of sound mind and under no constraint ptt undue influence.
Sworn to or affirmed and subscribed
to before me by Tr «~ cti D. N 0..i 1 or
and,lh~n C ~ s zus~bw ~ `z , witnesses,
this ~ day of ~~r - \ , 2004.
Notary Public
NOTARIAL SEAT. R~
KIMBERLY R. LEO,
Carlisle Boo,
My Cormrission Expkes Oct 1Q
3