HomeMy WebLinkAbout03-1017 COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1 500
t'i~i'£E'~'~'~,'~ ..............................................................
INHERITANCE TAXRETURNI~ I - 0 5 /_ O I '~
RESIDENT DECEDENT ~c-~-~-~E ~ ~ --
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DECED~.~'S .AMC (LAST. F.RST. ^ND M,DDL~ ,..T,^L)
DA*~ OF B~R*. (MM-OD*YEAR)
r'~l. Original Return
I[~4. Limited Estate
6. Decedent Died Testate ~ copy o~va)
D g. Litigation Proceeds Received
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
2. Supplemental Rstum
r--i 4a. Future Interest Compromise (da~ dck~h after 12.12-82}
r-'l 7. Decedent Maintained a Living Trust (Auach c=py ~'Tn~)
r--ilo. Spousal Poverty Credit (daa of dmth bet~,,em 12.31-91 and 1.1~5)
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FIt. ED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
/,~ -_~0 - ~.~/
3. Remainder Return (date of dash p~x to 12.13-82)
O5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
Dll. Election to tax under Sec. 9113(A) (Attach S~O)
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellenenus Personal Properly (5)
(Schedule E)
6. Jointly Owned Property (Schedule F)
r'-] Saparete Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
81 To*al Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (S~edule I)
11. To~al Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
(10)
Charitable and Govemrnental BequestsJSac 9113 Trusts for which an election to tax has not been
made (Schedule J)
(8)
(11)
(12)
(13)
14. Ne{Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate * x .0 __ (16)
17. Amount of Line 14 taxable at sibling rate x .12 07)
18. Amount of Line 14 taxable at collaterel rate x ,15 (18)
19. Tax Due (19)
Decedent's Complete Address:
CITY
Tax Payments and Credits:
1. Tax Oue (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pd~ Payments
C. Discounl
(1)
(3)
Total Credits (A + B + C ) (2)
3. Intarest/Penally if applicable
D. Interest
E. Penally
Total Interest/Penally ( D + E )
4. If Une 2 is greater than Line 1 + Une 3, enter the difference. This is Ihe OVERPAYMENT,
(4)
(5)
(5A)
(5S)
Check box on Page I Line 20 to request a refund
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the lax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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 reversiona~ 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? .............. [] ~
4. Bid 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.
Under penalties of page/, t d,~c~,,~e ~3t I have examined Ibis tatum, inducing accompanying schedules and statements, and to rte best of my knowledge and belief, it is true, correct and cempleto.
Dedaraion of preparer olher lhan 1he personal representalive is based on all informalion of which preparer has any knowledge.
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the nel value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1)(i)l.
For dates of death on or after January 1, 1995, the tax rate imposed on the nel 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 exem@~ 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 nel value of transfers from a deceased child Iwenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stapparent of the child is 0% [72 P.S. {9116(a)(1.2)].
The tax rata imposed on Ihe net value of transfers to or for the use of Ihe decedents 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 Ihe net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S. {9116(a)(1.3)1. A sibling is defined, under Section 9102, as an
individual who has at leasl one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX+ (6-98) 'h
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1. OF DEATH
TOTAL (Also enter on line 2, Recapitulation)
mom ~pa~e i~ n~d~, in~rt acl~itional sh~t$ ol the sam~ size)
REV-1509 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Ill
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
~_..?//-/.f 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 RELATIONSHIP TO DECEDENT
JOINTLY-OWNED PROPERTY:
ADDRESS
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL iNSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF OEATH DECD'S VALUE OF
NUMBER TENANT./ ~ .JOINT , iDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET
~t '?~ INTEREST DECEDENTS INTEREST
.]. ~,~o ,' 92/ d,~.4','i/~-- ~,/'/~ ' _~-~o~z~7 /~ ~-o.
TOTAL (Also enter on line 6, Recapitulation)
(If more space ~s needed, insert additional sheets of the same size)
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on t~e reverse side of the REV-1500 COVER SHEET is
DESCRIPTION OF PROPERTY
ITEM
NUMBEI~ ~a.u~e ~'E m~E Oe 'mE 'm.NeFE~EE. THE~ ~'n0~SHe TO oeca~ee-A~e DATE OF DEATH % OF DECD'S EXCLUSIOh TAXABLE
'mE~r~oF'm~NS~'ER. ~'r'r~c~Aco~vo~'n.~OEED;o~Rr~tes-rA-~. VALUE OFASSET INTEREST {~F,~.~C,~.L~ VALUE
TOTAL (Nso ~nter on line 7 R~i~ulatio~) $ ~
(If more space is needed, insert additional sheets of the same size)
EV-1511 EX*' (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule ~.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1.
5.
6.
7.
FUNERAL EXPENSES:
/
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
NameofPersonalRepresentative(s) '-~ /'/* /~7 :'
Social Security Number(s)/EIN Number of Personal Representative(s)
6ity
./
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees -- -
Accountant's Fees ~
Tax Return Preparer's Fees -~
/7/~/~./' '¢~ --q-~ 7- i~/~-~.~'~/~ ~ ,/~/
Zip
TOTAL (Also enter on line 9, Recapitulation)
more space is needed, insert additional sheets of the same size)
REV-1513 EX* (94)0)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Tm_-tee(s) OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRiBUTiONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(if more space is needed, insert additional sheets of the same size)
THIS DEED
MADE the .D~<~ day of ~%~- , nineteen hundred eighty eight
(1988), BETWEEN, M. BRiCKER PUSH and JANE A. PUGH, his wife, of R.D.
#5, Box 162, Shippensburg, Pennsylvania, hereinafter called Grantors,
and WILLIA~ D. DAVIS and SHIRLEY STURTZ DAVIS, his wife, of 1421 Curtin
Street, State College, Pennsylvania, hereinafter called Grantees,
WITNESSETH that in consideration of the sum of One Hundred Fifty
Thousand ($150,000.00) Dollars, in hand paid, the receipt whereof is
hereby acknowledged, the said Grantors do hereby grant and convey in
fee simple to said Grantees,
ALL that certain real estate, together with improvements thereon,
lying and being situate in Southampton Township, Cumberland County,
Pennsylvania, more fully bounded and described as follows:
BEGINNING at an existing railroad spike in the centerline of
Pennsylvania Route Number 533 at corner of lands now or formerly of
Grantors (said lands of Grantors being Lot No. 2A-B on the draft of
survey of Carl D. Bert dated June 30, 1988, being a land subdivision of
M. Bricker Pugh) thence by lands now or formerly of Grantors, South 83
degrees 8 minutes 8 seconds East, 464.98 feet to an existing iron pin
at line of lands now or formerly of J. Grover Henry; thence by line of
lands now or formerly of J. Grover Henry, South 36 degrees 43 minutes 9
seconds West, 296.99 feet to an iron pin at line of lands now or
formerly of Michael A. Harglerode, (said lands of Hargleroad being Lot
No. 4A on plan of lots of M. Bricker Pugh as per draft of survey of
Carl D. Bert dated August 20, 1984) thence by lands now or formerly of
Michael A. Hargleroad, North 45 degrees 52 minutes 30 seconds West,
499.03 feet to a railroad spike set in the centerline of Pennsylvania
Route Number 588; thence with the centerline of Pennsylvania Route
Number 533, North 44 degrees ? minutes 30 seconds East, 294.51 feet to
an existing railroad spike, the place of BEGINNING>
CONTAINING 3.6448 acres more or less being all of Lot No. 3 and
Lot No. 4B on the draft of land subdivision for M. Bricker Pugh, as
prepared by Carl D. Bert, R.S., dated August 20, 1984 and recorded in
the Office of the Recorder of Deeds in and for Cumberland County, in
Plan Book __ at Page
· Further Being all of Lot No. 2A-C on
draft of land subdivision f6r M. Bricker Pugh as prepared by Carl D.
Bert, R.S., dated June 30, 1988 and intended to be recorded in the
Office of the Recorder of Deeds in and for Cumberland County, prior to
the recording of this deed.
BEING part of that same real estate that was conveyed to Grantors
by deed recorded in the Office of the Recorder of Deeds in and for
Cumberland County, Pennsylvania in Deed Book "T" Volume 13 at Page
281. '
SUBJECT HOWEVER TO THE FOLLOWING RESTRICTIONS:
1. Subject to all set back-lines and restrictions as shown on the
H. ANTHONY ADAMS - ATTORNEY AT LAW - 432 EAST KING STREET - SHIPPENSBURG, PENNSYLVANIA 17257
SL~0~0
drafts of survey aforementioned.
2. No Mobile Homes may be placed or maintained on the propertY.
AND the said Grantors will warrant generally the property hereby
conveyed.
IN WITNESS WHEREOF, said Grantors have hereunto set their hand and
seal the day and year first above written.
Sealed and delivered in the
presence of :
CO~ONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND :
On this~______ day of 4.~,_~,CL.x~jL- , 1988, before me, a N~
and Jane A. Push, his ~ife, known to me (or sat~sfa~toril~ pro.n), to
be the persons whose names are subscribed to the lithin initru~t, and
acknowledged the foregoing deed to be their act and deed, and desired
the same to be re~orded as such.
Witness my hand and official seal, the day and y:ar af~esaid.
O~,~,x A's-,.,4~-.. t:~:>s:,x~., '".~ ~,.~,..; ~ Notary Pu~li~ ~ ~'
~?:x:,p:;.:;.::::... ..... ,'<.~'oug~ My Commission Expires:
C~mm~s~::~n ~xpi~ ~e~. 3, ! 992
H. ANTHONY ADAMS - ATTORNEY AT LAW - IB2 EAST KING STREET - S~PPENSBU~, PEN~YLVANIA 17257
{- ,~:ti:- of F~ennsylvanla ~ SS
C,o,~,;ty of Cumberland
?,~;corded in the office for t~e recording of Deeds
~tc.. in and for OumberlaEd ~unty, P~
,~ Book, ~ Vo~ Page
~ss my hand ~nd sea[ o~fice, at _
LAST WILL AND TESTAMENT
OF
WILLIAM DAVID DAVIS
I, William D. Davis, of Shippensburg, Cumberland County, Pennsylvania, being of
sound and disposing mind, memory, and understanding, do hereby declare this as and for my
last will and testament, hereby revoking all wills and codicils previously made by me.
FIRST
I direct the payment of my debts and expenses of my last illness and funeral from my
estate as soon after my death as conveniently may be done.
SECOND
If there is no cemetery lot available for my interment, owned by me at the time of my
death, I authorize my personal representative to purchase such cemetery lot with a contract for
perpetual care, using therefor funds from my estate, in such amount as my personal
representative shall consider necessary and desirable, and I authorize my personal
representative to cause title to or ownership of such lot so purchased to be vested in such
person as my personal representative shall designate.
Further, in this connection, I authorize my personal representative to expend funds
from my estate, in Such amount as my personal representative shall consider necessary and
desirable, for the purchase, erection and inscription of a suitable marker for my grave.
THIRD
I maintain a list of items in my lock box whieh i give, devise and bequeath to the
specific named individuals even if this list is prepared, signed and dated after the execution of
this will.
FOURTH
I give, devise, and bequeath all tangible personal property owned by me at the time of
my death, together with all insurance policies thereon, unto my wife, Shirley Sturtz-Davis if she
survives me by thirty (30) days. In the event she fails to survive my by thirty (30) days, I give
and bequeath said tangible personal property and all insurance policies thereon in as nearly
equal shares as is practicable unto such of my children and step children as shall survive me by
thirty (30) days.
I authorize my personal representative to deliver such articles to which a minor may be
entitled under this paragraph to the guardian of the minor or to the person having custody of
the minor, or to retain such property until an age at which my personal representative
considers it appropriate to deliver the property to him or to her, provided in no event shall
such property be retained by my personal representative beyond the time the minor attains his
or her majority. The receipt of such of the above enumerated persons as may be selected to
receive delivery of such property shall be a full and complete discharge to my personal
representative. In the event my personal representative at any time decides it is desirable to
sell any item or items of tangible personal property held hereunder for a minor, the proceeds of
such sale or sales shall be delivered to the guardian of the property of the minor appointed in
paragraph NINTH hereinafter to be held under the terms and conditions thereof.
FIFTH
days. I give my entire estate to my wife, Shirley Sturtz-Davis, if she survives me by thirty
SIXTH
Should my wife, Shirley Sturtz-Davis predecease me or die on or before the thirtieth
day following my death, I give my entire estate to my children and stepchildren and to their
issue per stirpes: Kimberly Beth Davis-Walker, Bryan Christopher Davis, Mark Edward Davis,
Kraig William Sturtz, and Steffany Rulyn Mc(~ueary.
SEVENTH
I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate
passing under my will shall be paid out of the principal of my residuary estate.
EIGHTH
In addition to the powers conferred by law, I authorize my personal representative, in
her absolute discretion:
Ao
To retain in the form received, and to sell either at public or private sale any real or
personal property.
To manage real estate.
To invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principle of diversification.
To exercise any option or rights arising from ownership investments.
To compromise claims without court approval, and without the consent of any
beneficiary.
To make distribution either in cash or in kind.
To borrow money and to pledge or mortgage with real or personal property as
security, and to make, execute, acknowledge, and deliver good and sufficient pledges,
mortgages, and other instruments to effectuate the same.
To join with my wife, Shirley Sturtz-Davis, or my personal representative in the filing of
any federal income tax return for any year for which I have not filed such return prior
to my death, and to consent to the treatment of any gifts made by my wife as being
made one.half by me for gift purposes notwithstanding the fact that such action may
result in additional liabilities for my estate. Any income or gift taxes due on such
returns and any deficiencies, interest, penalties, or refunds thereon, shall be allocated
between my estate and my said wife or her estate, or all to any of them, in such
manner as my personal representative and my said wife or her personal representative
may agree.
NINTH
I appoint Kraig William Sturtz and Kimberly Beth Davis-Walker guardians of any
property, including, but not limited to all proceeds of insurance on my life, which passes to a
minor and with respect to which I am authorized to appoint guardians and have not otherwise
specifically done so. In addition to the powers given by law, I authorize the guardians (a) to
use such amount of both income and principal as they in their sole discretion, deem proper for
the support, education and welfare of such minor without leave of any court, and (b) to invest
in any property without restriction to legal investments. The guardian shall not be required to
give bond or furnish sureties in any jurisdiction. I hereby direct that the guardians shall hold
the funds for any minor or any other beneficiary under the age of twenty-five years until such
minor or beneficiary attains the age of twenty-five years, and that all bequests to a minor, or
all funds passing to a minor under this last will and testament, or any beneficiary under
twenty.five, shall be held by the guardians until the said minor or beneficiary attains the age of
twenty-five (25) years.
I further appoint Kraig William Sturtz and Kimberly Beth Davis-Walker as successor
custodians of any accounts which I hold as custodian under the Pennsylvania Uniform Gift to
Minors Act.
TENTH
I nominate, constitute and appoint my wife, Shirley Sturtz-Davis as Executrix of this my
last will and testament. In the event of the renunciation, death, resignation, or inability to act
for any reason whatsoever of my said wife, I nominate, constitute and appoint Kraig William
Sturtz and Kimberly Beth Davis-Walker Executors of this my last will and testament. I hereby
relieve my personal representative from the necessity of posting security in connection with
their duties as such in any jurisdiction in which they may be called upon to act insofar as I am
able by law to do so.
WITNESS WHEREOF, I have hereunto set my hand and seal to this my
testament, this ,_~ last will and
/, .... --~? _(SEAL)
Signed, sealed, published and declared by the above named testator, as and for his last
will and testament in the presence of us, who at his request, in his sight and presence, and in
the sight and presence of each other have hereunto subscribed our names as witnesses.
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF FRANKLIN : SS
We, William David Davis, _,~e ~'h~ ~ ~ . '-i'
whose nam~ are s,~ned to th~ttached or ~ore bein~ duly sworn and
qualified accordln~ to law, do hereby declare to the undersigned authority that we were
present and saw the testator si~n and execute the instrument as his will, and that he had si~ned
willingly (or willingly directed another to si~n (or him), and that he executed it as his (tee and
voluntary act for the purposes therein expressed, and that each o( the witnes~s, in the
presence and hearin~ o~ the testator, signed the will as wimess and that to the b~t of their
knowledge the testator was at tha~ time eighteen years of a~e or older, of sound mind and
under no constraint or undue influence; and I, the said ~tator, do hereby acknowledge that I
signed and executed the instrument as my last wiU, that I signed it willingly, and that I si~ned it
as my free and volunta~ act for the purposes therein expressed.
Sworn and subscribed to before ~e
NotarY Public
J Notarial Seal
I Terassa Bard, Notary Public
J Chambersburg Bom, Franklin County
My Commission Expires Mar. 3, 2003
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIYTSION
DEPT. Z806Ol
HARRISBURG;, PA 17118-0601
SHIRLEY Z STURTZ DAVIS
265 NEWVILLE RD
SHIPPENSBURG PA 17157
COHHONWEALTH OF PENNSYLVANIA
BEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
BATE 02-02-200q
ESTATE OF DAVIS
BATE OF DEATH 05-15-2005
FILE NUHBER 21 03-1017
COUNTY CUHBERLAND
ACN 101
Amoun~ Rem/tied
REV-I~§7 EX AFP (01-05)
WILLIAM D
HAKE CHECK PAYABLE ANB REHZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THZS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP [01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR
BZSALLO#ANCE OF DEDUCTIONS ANB ASSESSHENT OF TAX
ESTATE OF DAVIS WILLIAH D FILE NO. 21 03-1017 ACN 101 BATE 02-02-200q
TAX RETURN WAS: (X) ACCEPTED AS FILED { ) CHANGED
RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held S~ock/Partnership Znteres* (Schedule C) ($)
4. Nortgeges/Notes Receivable (Schedule D) (4)
$. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED BEDUCTZONS AND EXEHPT~ONS:
9
10
11
12
13
Funeral Expenses/Adm. Costs/Nisc. Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Na~ Value of Tax Return
(9)
(10)
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Ne~ Value of Estate Subject to Tax
.00
1/599.00
.00
.00
.00
1551335.00
.00
(8)
1~,558.69
.00
NOTE: To insure proper
credit to your account,
submit ~he upper portion
of this form with your
tax payment.
NOTE:
156,93~.00
(11) 1~ .55B.6g
(12) 1~'+2,375' 31
(13) .00
(14) 1~2,375.
Xf an assessment was issued previously, 11nas 14, 15 and/er 16, 17,
reflect flgures that include the total of ALL returns assessed to date.
18 and 19 will
TOTAL TAX CREBZT I .00
BALANCE OF TAX DUEl .00
INTEREST ANB PEN. .00
TOTAL DUE .00
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS RE~U~REDo
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
ASSESSHENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amoun~ of Line 14 taxable at Lineal/Class A rate
17. Amount of L/nm 14 at Sibling ra~e
18. Amount of Line 14 ~axable at Collateral/Class B ra~a
19. Principal Tax Due
TAX CREDITS:
PAYFIENT R~C~.J.r' m D/SCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-)
AMOUNT PAID
(2;) lq2,375.31 x O0 : .00
(16) .00 x Oq3 = .00
(17) . O0 x 12 = . O0
(18) .00 X 15 = .00
(19)= . O0
RESERVATION:
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTIONS=
ADHIN-
ISTRATIVE
CORRECTIONS:
D~SCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such futura interest.
To fulfill the requirements cf Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Rills, any of the Z3 Revenue District Offices, or by calling the special Z4-haur
answering service for forms ordering: 1-800-36Z-ZDJO) services for taxpayers with special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disalloaance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171Z8-1021,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. LB0601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid aithin three (3) calendar months after the decmdent's death, a five percent (JZ) discount of
the tax paid is alloaed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax end interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at the rate of
six (6Z} percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary free calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO3 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20Z · 000548 1987 97* . 000247 1999 77. · 00019Z
1983 16Z .000438 1988-1991 X1Z . 000301 ZOO0 8Z .000219
1984 X1Z . 000301 199Z 9Z · 000247 2001 9Z · 00024?
1985 13Z .000356 1993-1994 7Z .O0019Z 200Z 6Z .000164
1986 lOZ .000Z74 1995-1998 92 .000247 2003 5Z .000137
--Interest is calculated as follows:
ZNTEREST= BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.
BUREAU OF ZNDZVTDUAL TAXES
:[NHERI'TANCE TAX DTVTSTON
DEPT. 280601
HARRISBURG, PA 17128-0601
CONMONWEALTH OF PENNSYLVANZA
BEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-15~i7 EX &FP (01-oS)
SHIRLEY Z STURTZ DAVIS
265 NEWVILLE RD
SHIPPENSBURG PA 17257
DATE 02-02-200q
ESTATE OF DAVIS
BATE OF BEATH 05-15-2003
FILE NUNBER 21 03-1017
COUNTY CUHBERLAND
ACH 101
Amouni Rami*ted
WILLIAM D
HAKE CHECK PAYABLE ANB RENZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ii- RETAIN LOWER PORTION FOR YOUR RECORBS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR BZSALLOWANCE OF BEDUCTZONS ANB ASSESSHENT OF TAX
ESTATE OF DAVIS WILLIAH D FILE NO. 21 03-1017 ACN 101 BATE 02-02-200q
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAZSEB VALUE OF RETURN BASEB ON: ORIGINAL RETURN
1. Ram1 Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) {2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
4. Hortgages/Notes Reca/vable (Schedule D) (4)
5. Cash/Bank Daposits/H/sc. Personal Property (Schedule E) (5)
6. Jo/ntly Owned Property (Schedule F) (6)
7. Transfers [Schedule G) (7)
8. Total Assets
APPROVED BEBUCTIONS ANB EXENPTZONS:
9. Funeral Expenses/Adm. Costs/N/sc. Expanses (Schedule H) (9)
10. Debts/Nortgaga L/abilitias/L/ens (Schedule Z) (10)
11. Total Deduct/ohs
12, Nat Value of Tax Return
15.
14.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Net Value of Estate Subjec~ to Tax
.00
1~599.00
.00
.00
.00
155~335.00
.00
(8)
1~,558.69
.00
NOTE: To insure proper
cred/t to your account,
submit the upper pore/on
of this form w/ih your
tax payment.
NOTE:
156,93R.00
(11) 14.558.69
(12) lq2,375.31
(15) . O0
(14) lq2,375.31
Zf an assessment was issued previously, 11nas 1~, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
18 and 19 will
ASSESSNENT OF TAX:
1.6. Amount of Line 14 mt Spousal rata
16. Amount of Line 14 taxable ai Lineal/Class A rate
17. Amount of Line 14 at S1bl/ng rate
18. Amouni of Line 14 taxable at Collateral/Class B rate
19. Prlnc/pal Tax Due
TAX CREBZTS:
PAYHENT RECETpT DISCOUNT (*)
DATE NUHBER ZNTEREST/PEN PA/D (-)
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(15). lr42,375'31 x O0 : .00
(16). .00 X 0~5= .00
(17). . O0 x 12 = . O0
(18) .00 x 15 = .00
(19)= .00
AHOUNT PAZD
TOTAL TAX CREBTT I .00
BALANCE OF TAX BUEI .00
TNTEREST ANB PEN. .00
TOTAL BUE . O0
IF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS REI~UTRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE _
REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) -~)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADH/N-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
ZNTEREST:
Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B [collateral) beneficiaries of the decedent after the expiration of any estate for
lifo or for years, the Commonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NXLLS, AGENT
A refund of a tax credit, mhich Nas not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Znheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special 24-hour
ensaering service for forms ordering: 1-800-36Z-Z050~ services for taxpayers aith special hearing end / or
speaking needs: 1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shomn on this Notice must object aithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021,
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviaa Unit, Dept. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is pald within three (3) calendar months after the decadent's death, a five percent (5Z) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This nan-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated et a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 mill bear interest et a rate which will vary from calendar year to calendar year mith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO3 are:
Interest Daily Interest Daily Interest Daily
Yea.~r Rate Factor Year Rate Factor Year Rate Factor
198Z gOZ . 000548 1987 9Z . 000247 1999 7Z . 00019Z
1983 16Z ,000438 1988-1991 117. .000301 ZOO0 8Z .000Z19
1984 117. . 000301 199Z 97. · 000247 ZOOZ 97. . 000247
1985 137. .000356 1993-1994 72 .O0019Z ZOOg 67. .000164
1986 107. · 000274 1995-1998 97. · 000247 2003 57. · 000137
--Interest is calculated as follows:
XNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DELXNQUENT X DATL¥ XNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.