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HomeMy WebLinkAbout12-12-05 (2)FitV~1500 EX + (g-eej COMMONWEALTH OF • REV-1500 OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE ~NHER'1/1N~+E TAX RETURN MA R „ FILE NUMBER DEPT. 280601 ` 1 V I[ 1, vv` d HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ? I S - ~~ ~ ~ - NTM DE YEAR N R DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER H tZ Davis Lester E. 1 7 0- 2 1- 2 2 6 3 ~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE V 01 /01 /2005 05/24/1921 REGISTER OF WILLS W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER w a X^ 1.Original Retum 2. Su lemental Retum ^ PP ^ 3. Remainder Retum (date of death prior to 12-13-82) to woo ^ 4. Limited Estate ^ 4a. Future Interest Compromise (sate ofdeatn after tz-tz-az) ^ 5. Federal Estate Tax Retum Required c=i a m ^ 6. Decedent Died Testate (Mach copy or wlq ^ 7. Decedent Maintained a Living Trust (Attach copy of trust) 8. Total Number of Safe Deposit Boxes - a a ^ 9. Litigation Proceeds Received ^ 10. Spousal PoveRy Credit (dam ordeath between tz-3l-st and t-~-ssj ~ 11. Election to tax under Sec. 91 t3(A) (Aaacn son o) F T1-IIrS SECTION MUST 13E CGNtPLETEDF. ALL CORRESF'ONDE.NCE AN D:£ONFIDENTIALTRX INFORMATION SHQULb BE DIRECTED TO: w NAME COMPLETE MAILING ADDRESS z° H. Anthon Adams 49 W, Orange Street to FIRM NAME (If Applicable) Suite 3 p TELEPHONE NUMBER 717-532-3270 Shi ensbur PA 17257 1. Real Estate (Schedule A) (1) _ _ _-, OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) -, ? :a ~ _ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) . ~ i ' 4. Mortgages & Notes Receivable (Schedule D) (4) - ` ' _~ I -- ; ; i , _~ ~ -`t ~ I._l 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) - - ~~~ (Schedule E) ~ r Z ~ 6. Jointly Owned Property (Schedule F) (6) _ __ 82, 074.25 Q ^ Separate Billing, Requested ~ , ., ,- ~ _: J H a Q U W 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ~ j (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 82,074.25 9. Funeral Expenses & Administrative Costs (Schedule H) (9) _ 6,443.95 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) __ 6,443.95 12. Net Value of Estate (Line 8 minus Line 11) (12) 75,630.30 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Taz (Line 12 minus Line 13) (14) 75,630.30 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 rate, or transfers under Sec. 9116 (a)(1.2) X (15) F- ~ 16. Amount of Line 14 taxable at lineal rate 75,630.30 X .045 (16) 3,403.36 d 17. Amount of Line 14 taxable at sibling rate X .12 (17) V 18. Amount of Line 14 taxable at collateral rate X .15 (18) 19. Tax Due (1g) 3,403.36 H 20. ~ • ~• • ~ 1 • ~ • •~ > > °~E SURE TO ANSWER ALL QUESTIONS ON R~FtSE SIDE: AN©'RECHECK MATH < < 7ecedent's Complete Address: STREET ADDRESS 129 Walnut Bottom Road Room 113 STATE ZIP clTV Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 3,403.36 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 2.800.00 C. Discount 140.00 Total Credits (A + B + C) (2} 2, 940.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E } (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 463.36 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B} 463.36 Make Check Payable fo: 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 : ............................................................... ............ ^ X^ b. retain the right to designate who shall use the property transferred or its income : ............................ ............ ^ ^X c. retain a reversionary interest; or .......................................................................................... ............ ^ 0 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? ................................................................................... ............ ^ 0 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ..... ............ ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................... ............ ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, f declare that 1 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. SIGNATURE OF PARSON RESPONSIBLE FOR FILING RETURN DAT C ~ _ ~ awe-c..~s~ ~~~/Ig'~US ADD11S~1~ ~~f~- ~ ''VJN IJRAW~'OWJti.J, ~'Q~ 1'1aN~-I SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE y~ 1J.; ~xc~ ~ ~~ ~e~~ . `~.~~~- _ ~ ~\,.; cx~;-.~`r ..~ ~. Ica . ~ 7~ S 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 3°!° (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 0% (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 childtwenty-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 0% (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%, 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°l° [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) t COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Davis Lester E. If an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Carol E. Nollenberger 13 C JOINTLY-OWNED PROPERTY: 11473 Hickory Run Road Orrstown, PA 17244 child ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 1988 Mifflinburg Bank & Trust 10,000.00 50. 5,000.00 CD# 402602360 2. A 1988 Mifflinburg Bank & Trust 10,000.00 50. 5,000.00 CD# 4020601560 3. A 1996 Mifflinburg Bank & Trust 10,000.00 50. 5,000.00 CD# 402605260 4. A 1991 Mifflinburg Bank & Trust 20,000.00 50. 10,000.00 CD# 4017448860 5. A 1991 Mifflinburg Bank & Trust 10,000.00 50. 5,000.00 CD# 21617160 6. A 1988 Juniata Valley Bank 10,000.00 50. 5,000.00 CD# 44-451611-8 7. A 1988 Juniata Valley Bank 10,000.00 50. 5,000.00 CD# 44-45161-0 8. A 1995 Juniata Valley Bank 20,000.00 50. 10,000.00 CD# 43-454433-4 9. A 1988 Juniata Valley Bank 10,000.00 50. 5,000.00 43-454466-4 10. A 1988 Juniata Valley Bank 10,000.00 50. 5,000.00 CD# 43-426643-6 TOTAL (A1so enter on line 6, Recapitulation) I 3 82,074.25 (If more space is needed, insert additional sheets of the same size) - ~ ~, Continuation of REV-1500 Inheritance Tax Return Resident Decedent Davis Lester E. Decedent's Name Page 1 File Number Schedule F-2 -Jointly-Owned Property ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 11. A 2001 Orrstown Bank 44,148.50 50. 22,074.25 Checking Account # 103003129 SUBTOTAL SCHEDULE F-2 ~ 22,074.25 GRAND TOTAL SCHEDULE F-2 S 82, 074.25 REV-1511 EXv- (12-99) ' SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8s INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Davis Lester E. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fogelsanger- Bricker Funeral Home 2. Meal after Funeral Service B. 1 2. 3. 4. 5. 6. 7. 8 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) _ Street Address City State _ Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimanrs, attach explanation) Claimant Street Address City State _ Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees C&A Memorials Choice Critical Care Zip 5,875.78 81.15 225.00 Zip 15.00 35.00 85.00 127.02 TOTAL (Also enter on line 9, Recapitulation) I $ 6,44.95 (If more space is needed, insert additional sheets of the same size)