HomeMy WebLinkAbout03-15-13
1505610105
REV-1500 Ex (02.11) (FI)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 28o6ol HaBox rrisbu PA rg, PA 1 1'7128-0601 RESIDENT DECEDENT ` 0-14~-6 13, Y
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
482-52-6408 12/18/2012 07/10/1945
Decedent's Last Name Suffix Decedent's First Name MI
Daws Linda K
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
QD 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
CW 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number;--,;
(717) 938428 rrrt n
Brian K Daws
ca _ c> p
REGISI R2 5 WILLS 1.13~EONLYP 3
c~ -a -
rn
3r r"- t--" r "I
r-- m cn
First Line of Address r-,) 3 Q
160 Winding Hill Drive
Second Line of Address ! - f'1
r
."O
"HATE FILED CJ-]
City or Post Office State ZIP Code
Etters PA 17319
Correspondent's e-mail address: brian daws gmail com
Under penalties of perjury, I 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 PERSON RESPONSIBLE FOR FILING RETURN „ ATE
J vd a
ADDRESS
160 Winding Hill Drive Etters PA 17319
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
`iD
1505610205
REV-1500 EX (Fl) Decedent's Social Security Number
482-52-6408
Decedent's Name:
RECAPITULATION
1. Real Estate (Schedule A) 1. 253,500.00
2. Stocks and Bonds (Schedule B) 2. 42,812.64
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3.
4. Mortgages and Notes Receivable (Schedule D) 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 36,060.96
6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. 1,871.65
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 318,601.64
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets total Lines 1 through 7 8. 652,846.89
9. Funeral Expenses and Administrative Costs (Schedule H) 9. 18,137.80
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 12,524.98
11. Total Deductions (total Lines 9 and 10) 11. 30,662.78
12. Net Value of Estate (Line 8 minus Line 11) 12. 622,184.11
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. 622,184.11
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 45 622,184.11 16. 27,998.28
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
27,998.28
19. TAX DUE 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=:)
Side 2
1505610205 1505610205
REV-1500 EX (Fl) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Linda Kay Daws - -
STREETADDRESS
2470 Lobach Drive -
clTr STATE ZIP Mechanicsburg pq 17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 27,998.28
2. Credits/Payments
A. Prior Payments
8. Discount -1,399.91
Total Credits (A + B) (2) 1,399.91
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) 26,598.37
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 ❑ E
b. retain the right to designate who shall use the property transferred or its income ❑ N
c. retain a reversionary interest ❑ E
d. receive the promise for life of either payments, benefits or care? ❑ M
2. If death occurred after Dec. 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? ❑ 0
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 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)]. 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 decedents lineal beneficiaries is 4.5 percent, except as noted in [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)(1.3)]. 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.
REV-1502 EX+ (12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Linda Kay Daws 2012-01334
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 Residental Property at 2470 Lobach Drive Mechanicsburg PA 17055 253,500.00
TOTAL (Also enter on Line 1, Recapitulation.) 253,500.00
If more space is needed, use additional sheets of paper of the same size.
DENNIS ZERBE, TAX COLLECTOR TAXPAYER'S COPY
275 CUMBERLAND PARKWAY #325 1 KEEP THIS PORTION FOR YOUR RECORD
MECHANICSBURG. PA 17055
TEMP - RETURN SERVICE REQUESTED
M I
III llh~l1!(rii~'ells'~E'1U1'~lilli~lE!l111~'!~I!!'~'I'l11~'~~!'I~'
063147""`"AUTO 5-0iGl717055
DAWS, LINDA LINDA K I~I
2470 LOBACH DR
MECHANICSBURG PA 17055-5376
To review the assessment data for this pproperty, go to:
www.courthouseonline.com>AssessmentOfhce>Cumberland>PropertyRecords.
Then enter control # 00503450 and password CUBZTSAP
.
Payable To: DENNIS ZERBE, TAX COLLECTOR Office Hours: WED. THURS 9AM-11AM & 12-2PM
275 CUMBERLAND PARKWAY #325 EVENING HOURS
MECHANICSBURG, PA 17055 CONSULT UPPERALLENTWP.ORG
OFFICE AT 100 GETTYSBURG PIKE Bill No: 1500
PHONE (717)766-4238 Bill Date: 311113
Control Nu: 00503450
MAP NO: 42-30-2106-124. Assessed Value: Land: 58,500 Improvement: 195.000 Total: 253,500
Dese: 2470 LOBACH DRIVE !_tnILnt ace Pena.fty
ASHCOMBE FARMS
LOT 32 PH4 PB 84 PG 10 County RE 2.131 $529.41 $64021 3
Acres 0.22 Deed 0024901009 ~ County Lib _ 0.143 $35.52 _ $36.26 $3938
I lit II I Munic. 171E 1.5 5372.64 $380.25 $418.28
11111117111 f~Fire Protc 0.1 $24.84 $25.35 $27.39
$1.03 FEE FOR ADDITIONAL RECEIPTS 1 St Light 1 S36.73 $37.48 $41.23 i
Tax Payer: Fire H drt 0.05873 $14.59 $14.89 $16.38
DAWS, LINDA K TAX AMOUNT DUE $1,013.73 $1,034.43 $1.137.89
2470 LOBACH DR
MECHANICSBURG PA 17056-5376 If Date Of Payment is on 3:11',3 thru 4!30113 5/1113 thru 6130113 7/1/13 or Later
Cumberland County Pennsylvania
- •
M-19±1111:11 WK119AN&S
TAX COLLECTOR COPY - RETURN WITH PAYMENT FOR PROPER CREDIT Bill No: 1500
2470 LOBACH DRIVE Bill Date: 311113
DAWS, LINDA K ASHCOMBE FARMS Control No: 00503450
2470 MECHHANICSNKSBUe2ORG PA 170555376 LOT 32 PH4 PB 84 PG 10 MAP NO: 42-30-2106-124.
tJf Acres 0.22 Deed 0024901009
Assessed Value: Land: 58.500 Improvement: 195.000 Total: 253,500 l
Pa'~ak~ie T~: t Fa.;e Penalty j
DENNIS ZERBE. TAX COLLECTOR ' Dicoun.
275 CUMBERLAND PARKWAY #325
i1- ---County i'cE 2.131 S529.41 5540.21 $594.23
MECHANICSBURG, PA 17055 I County Lib 0.143 $35.52 _ $36.25 $39.88 j
PHONE (717)766.4238 Mu is R/E ...1.6 S37264 sIan 9 441g-21L
I (1 Fire Frotc 0.1 $24.84 $25.35 $27.89
I IN III lit f ill IN Ill NCI ICI NII I Fire'Hhdrt 0.05873 $14.59 $14.9 $16.38
TAX AMOUNT DUE $1,013.73 $1,034.43 $1,137.89
If Date of Payment 11 On I/j/13 t ru a/30/13 5/1/13 thru 6!301 7/1/13 Later
REV-15o3 EX+ (8-12)
A v W pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Linda Kay Daws 2012-01334
All property jointly owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
ITEM
NUMBER DESCRIPTION OF DEATH
1. Ameriprise Brokerage Cash 134.05
2 COLTX - Columbia Tax-Exempt Fund - A (Ameriprise) 17,604.68
3 CTEBX - Columbia Tax-Exempt Fund - B (Amedpdse) 6,409.15
4 EVPAX - Eaton Vance PA Municipals (Ameriprise) 6,709.82
5 OPABX - Oppenheimer PA Municipals (Ameriprise) 11,954.94
TOTAL (Also enter on Line 2, Recapitulation) $ 42,812.64
If more space is needed, insert additional sheets of the same size
REV-1508 EX+ (08-12)
i pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
2012-01334
Linda Kay Daws
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
rrEM NUMBER DESCRIPTION OF DEATH
1. Vehicle - 2012 Toyota Rav 4 24,000.00
2 Household goods 4,000.00
3 Furniture 5,000.00
4 Clothing 2,000.00
5 Capital One 360, P.O. Box 60, St. Cloud, MN 56302 - account # 145595087 1,060.96
TOTAL (Also enter on Line 5, Recapitulation) $ 36,060.96
If more space is needed, use additional sheets of paper of the same size.
Capital
#BWNJYZB
1099835 0009 AOJO
Linda K Daws
160 WINDING HILL DR
C/O BRIAN K DAWS
ETTERS, PA 17319-8821
LL. 1111111111,151,1111111gill .61d11 gill ~11111111un1vigil, 11
Since you became a Saver on 0511512011,
your account(s) have earned:
$55.96
Customer Number 117343843
F Go paperless today. Sign up for electronic communications and receive important account information, statements and updates sooner.
To enroll, sign in to capitalone3li0.com, select the 'My Info' tab, go to'Preferences' and click'Paperless'.
Your Savings Summary as of 01/03/2013
Account Type Nickname Account Number Account Balance Joint Name
360 Savings 145595087 $0.00
Your 360 Savings Activity
Account: 145595087 Current Interest Rate: 0.747% Annual Percentage Yield Earned: 0.69% Interest Life to Date: $55.96
Year to Date Interest: $0.04
Activity Date Amount Balance
Opening Balance 0110112013 $1,060.92
Savings Closeout by Check Interest $0.04, Closeout Amount $1060.96 01/03/2013 ($1,060.92) $0.00
Your email address is dawsik@vedzon.net. Update this and all your information at capitalone360.com in the My Into section.
RL-1099835-OOi-001-201301999.0
® Pr 0
St ClOu(t, 056,310,11 FDIC
REV-1509 EX+ (oi-10)
pennsytvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER:
ESTATE OF: 2012-01334
Linda Kay Daws
if an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Brian K. Daws 160 Winding Hill Drive Son
Etters, PA 17319
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY % OF DATE OF DEATH DATE OF
DEATH
LR JOINT DATE
DECEDENTS ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR VALUE OF ASSET NTER ST DECEDENTVALUE INTEREST
NUMBER TENANT JOINT IDENTIFYING NUMBER. MACH DEED FOR JOINTLY HELD REAL ESTATE.
1. A. 1,841.56 50 920.78
04/19/06 Savings Account - Belco Community Credit Union - 766312
1,398.98 50 699.49
2. A. 04/19/06 Checking Account - Beico Community Credit Union - 766312
502.76 50 251.38
3. A. 04/19/06 Money Market Account - Belco Community Credit Union - 766312
1,871.65
TOTAL (Also enter on line 6, Recapitulation) $
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Linda Kay Daws 2012-01334
This schedule must be completed and filed if the answer to any of questions i through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. Ameriprise - Individual IRA 295,931.34 100 295,931.34
Transferees - Brian Daws(Son) & Brice Daws(Son), Transfered after death
2 Ameriprise - Roth IRA 22,670.30 100 22,670.30
Transferees - Brian Daws(Son) & Brice Daws(Son), Transfered after death
TOTAL (Also enter on Line 7, Recapitulation) $ 318,601.64
If more space is needed, use additional sheets of paper of the same size.
Client Viewer Page 1 of 6
Client Viewer Ameriprise 0.
AdvisorCompass° Financial
Group: Household 0932 7527 9 001 Clients: MRS LINDA K DAWS
Group Status: Achiever Circle
Enrollment 03/08/2008
Date:
Grandfathered: Yes
Ameriprise Account Total: $361,414.28
ACTIVE ACCOUNTS- WITH POSITIONS / SUB-ACCOUNTS
NON-QUALIFIED ACCOUNTS
ONE Financial Account
AMERIPRISE ONE ACCT
LINDA K DAWS TOD
0000 0000 5838 7337 7 133
Transferred from: 0000 0000 6861 0849 9 021
CASH VALUE 134.05 ACCOUNT VALUE 18,798.81 (as of 12118/2012)
MARGIN VALUE 0.00
SECURITIES VALUE ($):18,664.76
Positions Description Symbol Quantity Price Price Date Market Value
V EV PA MUN INCM B EVPAX 701.86500 9.56 12/18/2012 6,709.82
V OPPEN PA MUN B OPABX 1040.46500 11.49 12/18/2012 11,954.94
Mutual Funds
TAX-EXEMPT FUND - B
LINDA K DAWS TOD
0000 0020 1478 9744 9 002
SYMBOL: CTEBX ACCOUNT VALUE 6,409.15 (as of 12/1812012)
SHARES: 448.749
COST BASIS ($):6,201.39
V TAX-EXEMPT FUND - A
LINDA K DAWS TOD
0000 0020 1518 6172 9 002 `U
SYMBOL: COLTX ACCOUNT VALUE 17,604.68 (as of 12/18/2012)
SHARES: 1,231.298
COST BASIS ($):17,027.66 Y1
Total Value of Non-Qualified Accounts: $42,812.64
QUALIFIED ACCOUNTS
MRS LINDA K DAWS - Individual IRA
https://www8.ex.is.ameriprise.com/ost/secure/Group/PrintPreview.asp?&chkAll=O&chk... 12/19/2012
Client Viewer Page 2 of 6
RiverSource Life Annuity
RET ADV ADVTG Q
LINDA K DAWS
0000 0931 0712 3227 2 004
CONTRACT DATE: 03/10/2003 ACCOUNT VALUE 95,550.65 (as of 12/18/2012)
TOTAL PURCHASE PAYMENTS 57,468.76
New Allocation Current Units Unit Value Value
Description Allocation
ALLBERN VPS INTL VAL CL 10.00 0.00 0.000 0.000 0.00
B
AMERICAN CENTURY VP 0.00 7.88 5,284.462 1.425 7,528.83
INTERNATIO
FIDELITY VIP 0.00 7.76 6,168.127 1.203 7,417.88
CONTRAFUND SVC 2
FIDELITY VIP 111 10.00 8.95 6,166.017 1.386 8,547.15
GROWTH&INCOME
FT VIP SMALL CAP VALUE 10.00 11.18 3,709.013 2.880 10,682.55
SEC
GOLDMAN VIT MIDCAP 10.00 11.28 3,500.240 3.078 10,775.42
VALUE
COL VP LRG CORE QUANT 10.00 0.00 0.000 0.000 0.00
FUND CL3
COL VP DIVERSIFIED 10.00 25.86 13,803.822 1.790 24,707.81
BOND FD CL3
COL VP DIVIDEND 10.00 12.37 6,504.831 1.817 11,820.65
OPPORTUNTY CL3
COL VP GLOBAL BOND 10.00 7.92 3,860.299 1.960 7,567.91
FUND CL3
COL VP HIGH YIELD BOND 10.00 6.81 3,033.621 2.143 6,502.45
FD CL3
COL VP MID CAP GRO OPP 10.00 0.00 0.000 0.000 0.00
FND CL3
MRS LINDA K DAWS - Individual IRA - Plan ID: 0001929 156
Premier Portfolio Services
SPS ADVANTAGE
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWS IRA
0000 0000 2979 4702 0 133
Transferred from: 0000 0000 3492 0017 0 021
CASH VALUE 41,464.54 ACCOUNT VALUE ($):192,726.93 (as of 12118/2012)
MARGIN VALUE 0.00
SECURITIES VALUE ($):151,262.39
G- -:r P._" Pre,.-ie;N-.ast)'&chk-AII=0&chk... 12/19/2012
Client Viewer Page 3 of 6
Positions Description Symbol Quantity Price Price Date Market Value
W BLAIR INCM N WBRRX 1686.13400 9.52 12/18/2012 16,051.99
CALAMOS GRW A CVGRX 299.86400 51.65 12/18/2012 15,487.97
LOOMIS STRAT INCM A NEFZX 855.99900 15.62 1211812012 13,370.70
MGRS BD MGFIX 965.10600 28.03 12/18/2012 27,051.92
MGRS SHRT DUR GOV MGSDX 1040.28000 9.65 12/1812012 10,038.70
OPPEN INTL BD A OIBAX 3581.20900 6.62 1211812012 23,707.60
ROYCE TTL RET INVT RYTRX 1356.04800 13.66 12/18/2012 18,523.61
TCW TTL RET N TGMNX 139210000 10.66 12118/2012 14,839.78
WESTCORE PLS BD WTIBX 1084.53100 11.24 12/18/2012 12,190.12
RET
Mutual Funds
MID CAP VAL OPPO - A
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWS IRA
0000 0020 1499 77314 002
SYMBOL: AMVAX ACCOUNT VALUE 2,236.17 (as of 12/18/2012)
SHARES: 261.847
/ COST BASIS Not Applicable
CONTRARIAN CORE - A
YYY AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWS IRA
0000 0020 1500 2892 4 002
SYMBOL: LCCAX ACCOUNT VALUE 5,417.59 (as of 1211812012)
SHARES: 333.390
COST BASIS Not Applicable
Subtotal for MRS LINDA K DAWS - Individual IRA: $295,931.34
MRS LINDA K DAWS - Roth IRA - Plan ID: 0001 929 157
Mutual Funds
DIVERSIFIED BOND - B
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWSROTH CONTRIBUTORY IRA
0000 0010 1433 4540 2 002
SYMBOL: ININX ACCOUNT VALUE 3,324.84 (as of 12118/2012)
SHARES: 660.572
/D COST BASIS Not Applicable
IVERSIFIED BOND - A
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWSROTH CONTRIBUTORY IRA
0000 0020 1517 4521 1 002
https://www8. ex.is.ameriprise.com/ost/secure/Group/PrintPreview.asp?&chkAll=O&chk... 12/19/2012
Client Viewer Page 4 of 6
SYMBOL: INBNX ACCOUNT VALUE 2,444.74 (as of 12/18/2012)
SHARES: 485.536
COST BASIS Not Applicable
MID CAP VAL OPPO - B
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWSROTH CONTRIBUTORY IRA
0000 0010 1075 6816 3 002
SYMBOL: AMVBX ACCOUNT VALUE 3,791.90 (as of 12/18/2012)
SHARES: 467.558
COST BASIS Not Applicable
CONTRARIAN CORE - B
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWSROTH CONTRIBUTORY IRA
0000 0020 1460 1614 0 002
SYMBOL: LCCBX ACCOUNT VALUE ($)-.6,913.77 (as of 12/18/2012)
SHARES: 456.958
COST BASIS Not Applicable
/CONTRARIAN CORE - A
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWSROTH CONTRIBUTORY IRA
0000 0020 1518 4674 6 002
SYMBOL: LCCAX ACCOUNT VALUE 2,006.79 (as of 12/18/2012)
SHARES: 123.495
COST BASIS Not Applicable
V/ SMALL CAP INDEX - B
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWSROTH CONTRIBUTORY IRA
0000 0020 1487 4289 1 002
SYMBOL: CIDBX ACCOUNT VALUE 3,368.45 (as of 12/18/2012)
SHARES: 190.955
COST BASIS Not Applicable
f SMALL CAP INDEX - A
AMERIPRISE TRUST COMPANY
C/O LINDA K DAWS
AS CUSTD FOR THE LINDA K DAWSROTH CONTRIBUTORY IRA
0000 0020 1518 57818 002
SYMBOL: NMSAX ACCOUNT VALUE 819.81 (as of 12/1812012)
SHARES: 46.422
COST BASIS Not Applicable
Subtotal for MRS LINDA K DAWS - Roth IRA: $22,670.30
Total Value of Qualified Accounts: $318,601.64
https://www8.ex.is.ameriprise.com/ost/secure/Group/PrintPreview.asp?&chkAll=O&chk... 12/19/2012
REV-1511 EX+ (10-09)
pennsyLvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Linda Kay Daws 2012-01334
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral Home-Funeral Services, Casket, Vault 10,693.62
2. Diocese of Harrisburg-Intemment Space and Internment Fee 2,385.00
3. St. Joseph Mechanicsburg - Donation for use of hall for social after funeral 125.00
4. L'Koste Villa - Catering for social after funeral 666.00
5 Diocese of Harrisburg - Grave Marker 1,875.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State _ ZIP
Year(s) Commission Paid:
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
613.50
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. United Water - Water service at decedent's house 74.99
8. PPL - Electric service at decendent's house 238.48
9. UGI - Natural Gas service at decendent's house 201.84
10. York Waste Disposal - Garbage removal service at decendent's house 39.03
11. Pinnacle - for decedent's hospital stay prior to death 150.00
12. Upper Allen Township - Sewer service at decedent's house 112.00
TOTAL (Also enter on Line 9, Recapitulation) $ 18,137.80
If more space is needed, use additional sheets of paper of the same size.
Page 2 of Schedule H of Inheritance Tax Return - Rev 1500
Item Number Description Amount
13 Verizon FIOS - Cable, internet, phone final payment 148.45
14 Lowes - Carpet replacement in decedent's house 664.89
15 Ashcombe Farms - Homeowners Association dues for decedent's house 150.00
These amounts are included in the total on Page 1.
REV-1512 EX+ (12-12)
Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Linda Kay Daws 2012-01334
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Boscov's Charge 425.27
2. QVC Charge 140.30
3. Wells Fargo Charge 200.00
4. Citizens Bank - Auto Loan 11,759.41
TOTAL (Also enter on Line 10, Recapitulation) $ 12,524.98
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Linda Kay Daws 2012-01334
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).)
1. Brian K. Claws Son 50%
2. Brice C. Claws Son 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II 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.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
T[Ust Vill awl TI-Pstammt
r~
O 7 ~
OF c, :J
LINDA K. DAWS i '
BE IT REMEMBERED, that I, LINDA K. DAWS, of 2470 Lobacl Drive
Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory ano_~
understanding, do make, publish and declare this as and for my Last Will and Testament,
hereby revoking and making null and void any and all Wills and Testaments and writings
in the nature thereof made by me at any time heretofore.
ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after
my demise as may be convenient.
ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, whether it be real, personal or mixed, including property over which
I have a power of appointment, I give, devise and bequeath unto my two children, BRIAN
DAWS and BRICE DAWS, in equal shares per stirpes.
ITEM 3: I direct my hereinafter named Executor to pay all inheritance, estate,
succession and legacy taxes of whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise passing by reason of my demise,
may be subject and to charge such taxes against my residuary estate, it being my intention
that none of the aforesaid taxes, either federal or state, on any property required to be
included in my gross estate, under the provisions of any state or federal law now in force
or hereafter enacted, shall be prorated among the persons interested in my estate to whom
such property is or may be transferred or to whom any benefit accrues.
ITEM 4: I appoint my son, BRIAN DAWS, as Executor or of this my Last Will
and Testament. Should my son, BRIAN DAWS, predecease me, fail to qualify, cease to
act, or renounce probate, I then appoint my son, BRICE DAWS, as contingent Executor of
this my Last Will and Testament.
ITEM 5: I direct that my Executor or his successor shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
1
ITEM 6: My Personal Representative shall have the following powers in addition
to those vested in them by Law and by other provisions ofthis, my Last Will and Testament,
exercisable without court approval, and effective until distribution of all property:
1. To retain any or all of the assets of my estate, real or personal,
without restriction to investments authorized for Pennsylvania
fiduciaries, as they from time to time may deem proper, without
regard to any principal of diversification or risk.
2. To invest in all forms of property without restriction to investments
authorized for Pennsylvania fiduciaries, as they from time to time
may deem proper, without regard to any principal of diversification
or risk.
3. To sell at public or private sale, to exchange; or to lease for any
period of time, any real or personal property and to give options for
sales, exchanges or leases, for such prices and upon such terms or
conditions as they from time to time may deem proper.
4. To allocate receipts and expenses to principal or income or partly to
each as they from time to time may deem proper.
5. To borrow money from persons or institutions, themselves included,
and to mortgage or pledge any or all real or personal property as
they in their sole discretion shall choose, without regard to the
dispositive provisions of this instrument.
6. To compromise any claim or controversy asserted by or against my
estate or trust estate.
7. To make distribution in cash or in kind or partly in cash and partly
in kind, and in such manner as they may determine, and at valuations
finally to be fixed by them.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this l Oth day of
April, 2008.
WITNESS:
c' (SEAL)
LINDA K DAWS
A
2
COINMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF YORK
We, LINDA K. DAW S, DAVID J. LENOX, ESQUIRE and APRIL L. CASPER,
the Testatrix and the witnesses respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her Last Will and Testament and
that she had signed willingly (or willingly directed another to sign for her), and that she
executed it as her free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and
Testament as witness and that to the best of their knowledge the Testatrix was at the time
eighteen (18) years of age or older, of sound mind and under no constraint or undue
influence.
LL ^ K. DAWS
WITNESS'-
WITNESS
Sworn to and subscribed
before me this1LLL day of
4 V C 1 , 2008.
. dl
NOTARY PUBLIC
MY COMMISSION EXPIRES:
RPk::arn?~21
S. Dawn G:eftler. Ncrtay Pd*
Dftb,sg 80m, York Coj*
W Cortrnission E &W 17.2W9
Member, Pennsy!vai!a Assodstion of Notaries
3
~~~D