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Home My WebLink About06-29-11 (3)15056051058 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of individual Taxes County Code Year File Number ' PO BOX 280601 INHERITANCE TAX RETURN - - Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 11 ~r ~"'~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207-09-1892 04/19/2011 11 /29/1918 Decedent's Last Name Suffix Decedent's First Name MI Davidson Quentin (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number - FILL IN APPROPRIATE OVALS BELOW ~`• 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) := 6. Decedent Died Testate (Attach Copy of Will) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 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 B E COMPLETED. ALL CORRESPONDENCE AND CONFIDEN TIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Susan C Martz (717) 697-1755 Firm Name (If Applicable) ~~ ~ _ . _ ..... REGISTER OI'~I~S USE ONL`Y` ~7,-'7 First line of address ~ ~~- r_. ~ 124 Woods Drive, ,, ~ f~ ~ ~ ... _. , Second line of address _ ;._ } .. Lot 4A ~ ~ ~ ~ ~,~ _n ..~: _ . i- City or Post Office State ZIP Code DAB FILED f.---. ~: ~ ~ Mechanicsburg ' Pa 17050 ~ _ ~T Correspondent's a-mail address 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. SIGNf;,TURE OF PERSONESP~ONSI /LE~FO FILING RETURN DATE '~ ~,~'~ / ADD ESS _ _ _ _ ¢ _ _ ~ _ -~~~ _ ~~, _ 7_ _/-______ r l/ - _ _ _ - , IGNATURE OF PREPARER OTHER THAN REPRESENTATIVE _ - ----- DATE ADDRESS _- __ PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 J REV-1500 EX 15056052059 Decedent's Social Security Number Decedent's Name: QU@ntln Davidson 207-09-1892 RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. 0.00 '' 2. Stocks and Bonds (Schedule B) .................................... ... 2 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... .. , 5. '' 0.00 6. Jointly Owned Property (Schedule F) ;Separate Billing Requested .... ... 6. ' 28 465 00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property , . - - - (Schedule G) Separate Billing Requested..... ... 7. 0.00 8. Total Gross Assets (total Lines 1-7) ................. 8 2 ................ ... . 8,465.00 9. Funeral Expenses & Administrative Costs (Schedule H) ...... 9 ............ ... . 1,722.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10 ............. ... . 2,754.00 11. Total Deductions (total Lines 9 & 10) ..................... 11 ' 6 ........... ... . 4,47 .00 12. Net Value of Estate (Line 8 minus Line 11) ..... ..... ..... 12 _ _ __ 13. ............. Charitable and Governmental Bequests/Sec 9113 Trusts for which .. 23,989.00 - an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ....... 14 ........... . . . . . 23,989.00 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 45 23,989.00 15. 1 079 51 16. Amount of Line 14 taxable , . - - at lineal rate X .0 __ 16. 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. 1,079.51 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Quentin Davidson 207-09-1892___ - ------ - STREETADDRESS _ _ _ - _ - - - _ __ _ - - - - _ _ _ _ - - _ 124 Woods Drive Lot 4A ------------ -- CITY - _ _ - - -_ __ _ STATE j ZIP ---------- ----- Mechanicsburg pa 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 1,079.51 2. Credits/Payments A. Spousal Poverty Credit -___ .Prior Payments C. Discount __ - _- --- _ __ 53.98 - - - Total Credits (A + B + C) (2) 53.98 3. Interest/Penalty if applicable D. Interest E. Penalty _- Total Interest/Penalty (D + E) (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) 1,025.53 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 1,025.53 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? .............. ^ 'I~ 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 Jufy 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-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Quentin Davidson SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Susan C Martz 124 Woods Drive, Lot 4A Mechanicsburg, Pa 17050 daughter B C. JOINTLY-OWNED PROPERTY: ~•• •••~•~ .•rw..~- ~~ ~~ccucu, inacn auunwnal SneBTS OT TnE S81Tle SIZe) F:~1~'-151' EX+ ' i3-J9j i pennsyLvania DEf~ARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS c,~~~c Vr FILE NUMBER Quentin Davidson beCedPnt'c rlat~ta m~iet hn ~e...,..a...i _~ e~_~_~__~ -----, _..,........,~,~„~~ ~~~~~~~ ~~ NaNci vi one same size. F~=L'-1512 EX-r X12-1~} ~ pennsylvania DE[~A[3iME:Ni OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Quentin Davidson Report debts incurred by the decedent prior to death that rpma~„o~ ~~„~~;a ~..w., .,_~_ _~ ~__.,_ .. FILE NUMBER _____, ..,,,,., ~ ~,,,,,~,,,,~~~ ,~~~~~, „~ UIC Sdfile SIZe.