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Home My WebLink About11-30-10 (2)J 15O561D1O1 REV-1.500 °`~03-f°' ~' PA Department of Revenue p~anla OFFrCU1L UEE ON Bureau of Individual Taxes °°"""~" """""' Caulrty-Code Year PO BOx seo6o~ INHERITANCE TAX RETURN ~~//11 L Harrisburg, PA s7~z8-o6oi RE8IDENT DECEDENT I' t:NreR vt~ttwENT NiFORMATLON BELOW Social Security Number Date of Death MMDDYYYY Datd of Binh IYEiIDDYYYY ('-~$- 2Z - ~to5co OIIIZI 201o IZIZ7 ~ 1929. OecedenYs Last Name Suffix Decedents First Name DAV i dsdn Pcl~l-~-i ~~~ a. (If AppllcabM) ErNsr SurvhMtp Spouw's brfarmsAlon Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number T1N8 RETURN MUST BE FIL.~ N DUPLICATE WI'F REGISTER OF WILLS FILL IN APPROPIBA7'E OVALS BELOW O 1. Oriplnst Relum m 2. Supplernerfal Retum O 3. Rernalnder priori 12- O 4. l.Ynked Eafsbe O 4a. Future Mluest CampromlN (date of O 5. Federal Esl deelh afMr 12-12-82) O 8. Decedent Died Testate O 7. Deoedsrk Maintained a Uvinp Trust 8. Trial Numb (Attach Copy of WIC (Attach Copy of That) O 9. L.Idpetbn Proceeds Received O 10. Spousal Poverty Credlt (date d death O 11. Electlon b between 12-31-91 and 1-186) (/-(~h S~ CORRESPONDENT - TFSS SECTION MUST YE COAI/LETED. ALL OONRESYONDENCE AND GOIIFIDENTIAL TAIL NrFORMMTt01t i110 Name Daytirne Telepltoi John C Oszus-I~awicz ~1~_ Zy REOIiTER Fkst tine of address lob S Hanover St Second IMe of address City a Post Office Car lislc Corrsspondsrrt's s-maN address: ~'~ aorred af~ury, ~ oaaue eut I hairo uoemined thb n>sum, it • of pnparer ofhw than the 31(3NAT}~E OFpE LE FOR FILING RETURN iL/~/_. THAN 1505610101 Stets ZIP Code PA I'101 3 FNe Number - ~ 6o ZE~~ MI K MI ~ (da19 a death ~ Retum RequNed af! ate DeposR. Brnrea u Sec. ~3(A) I) o ~~~yr O ~.> .,~ . '~ ~,~ "sT ~ _ -t~ ~ - ~ . _ ~ ` N ' s'T'+ r•" ~ i ~ ~.7 d ., i .~ chradules end ataYments, and to the b~ ~t rn~ ktawAadae and belief, b based on all kdonnatlon of which prspah+r ~aa any knowledge. Z Slde 1 j I 15O561O1[11II III !,I ~I __~ J J 1505610105 REV 1500 EX Deoedsrk's Nems: Decedent's So~ial Security Number __... 148-22-066 RECAPITULATION 1. Real Fatale (Schedule A) ............................................. L 2. Stocks and Bands (Schedule B) ....................................... 2. _._ .............. ... . .... .. ~....., , ....µ .,.. ~µ....,.._ 3. Cbsely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ,..:...,.... ..,. ...1 ...,:. _,._...,., _:._._.... 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. , 3,870.41 .....___~__._.__~.._...____~~,,._. ~._.._M__._,,..,,._ ~________.._ 6. Jointy Owned Property (Sd~edule F) O Separate Billing Requested ....... 6. 7. Inter-Vhros Transfers 8 Miscellaneous Non-PrabaEs Property _ (Schedule G) O Separate Billing Requested........ 7. I! 8. Total Gress Assets (total Lines 1 through 7) ............................. 8. ' ', 3,870.41 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ', ~, 10. Debts of Decedent, Mortgage LiabNfUes, and Liens (Schedule q .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. '', 12. Nst Value of Estate (Line 8 minus Line 11) .............................. 12. ' 3,870.41 13. Charitable and Govemmerrtal Bequests/Sec 9113 Tnists for which -_..~,__,__.._,,.., .__.._.~ ,,.~._._. __.,..,._._....__.._..__ an elecfjon to tax has not been made (Schedule J) ........................ 13. ! i L ~.~ ~ , .~~, Tm.r..~~ _.~ ~ .~ .. ..P~~,, ,~_~. 14. Nst Valus Subject to Tax (Line 12 minus Line 13) ........................ 14. ! ! 3,870.41 __ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax n3te, or transfers under Sec. 9116 ... ,,. (8x1.2) X .0_ ' ' 15. 16. Amount of Line 14 taxable ' _....~_ _~____ . ~_ _,__ _ _ .._.~.,._..___... at lineal rate x .0 4~` 3,870.41 ' 16. 17. Anaunt of Line 14 taxable """"""""""'..._._M__.._.m .....__.... _,....... ........... ......: at sibling rate X .12 17. 18. Amount of Line 14 taxable at cdlateral rate X .15 _. 18. 19. TAX DUE ......................................................... 19. 20. F~L IN THE OVAL IF YOU ARE REQUE8TING A REFUND OF AN OVERPAYMENT Side 2 1505610105 O REV 1500 EX Page 3 Decedent's Complete Address: File Number Patricia Davidson STREETADDRESS 770 S Hanover St C Carlisle sTa1EPA ' ~P17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPaynlents A Prior Payments B. Discount 3. Interest 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FNt M oval on Page 2, Lana 20 to request a refund. 5. ff Line 1 + Line 3 is greabr than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. _._ _. __ ... ~~ PLEASE ANSWER THE FOLLOWING QUESTK)NS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decadent mice a transfer and: a. retain the use or income of the property transfemed :.......................................................................................... b. retain the right to desig<late who shall use the property trensfemed or its income : ............................................ G retain a reversionary interest: or .......................................................................................................................... d. receive the promise for life of either payments, benefits or care? ...................................................................... 2. N death ooaured after Dec. 12, 1982, did decadent transfer property within ora year of death without receiving adequate consideration? .............................................................................................................. 3. Did decedent own an 9n trust for" or payable-upon~eath bank account or security at his or her death? .............. 4. Did decedent own an individual retirement account, annuity or other non-probate property, whid~ contakls a benetiaary designation? ........................................................................................................................ No a a a a 0 X^ IF THE ANSYYER TO ANY ~ THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT ~' PART OF THE RETURN. .r. :, 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 foF th~use of the surviving spouse is 3 percent (72 P.S. §9116 (a) (1.1) (~]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers tp or fa the use of e'surviving spouse is 0 percent [T2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requir is for disclosure of assets and (ding a tax retain are still applicable even if the surviving spouse is the only benefiaary. For dates of death on or after Juty 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 i/pr 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 i on the net value of tansfers to or for the use of the decedents lineal benetiaaries is 4.5'~ percent, except as noted in 72 P.S. §9116(L2 [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent (72 P.S. §9116~a)(I,',r.3)J. 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. I i I' I RE1~1509 EX+ (6.99) SCMEpYLrErc E c~+ COMMONWEALTH OF PENNSYLVANIA bI"~SH~ BAcN^K DE~'S11 T~ St M~'T.' INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF r'FlLE Nt~BER Davidson, Patricia 21-10-0269 Include the proceeds of Nligation and the date the procxeda were roceived by the estate. All plopsrty Jollltly~owrled with right of survivorship must bs disdossd on Schedule F. REM i VALUE AT DATE NUMBER DESCRIPTION OF DEATH .. , _.., , 1 ' Refund from Commonwealth of PA _ ~ 5.00 i 2 , Hghm~k premium refund !, 1,262.90 3 '.Cordier Antiques proceeds from variety auction 9117110 ~ 42.25 ~ Premium refund from Genworth Long Term Care Insurance Policy 2,560.26 II I I I i ,', ~~ '~ I i ., ,,. , ~ !,, I' ,: J I„ .. .... ..,: il° ,. 3,870.41 TOTAL (Also enter on line 5, Recapitulation) s I' (If more space is needed, Insert additional sheets of the same size)