HomeMy WebLinkAbout07-29-13 � ,,I� 15Q56Z0105
RGV�1�7oO�(a�.u7(ft)�ry
��T OFFICIAL USE ONLY
PA DepaRme�f of Revenve Pan�+Y���
6ure2u of Indtviduat Taxes °`"""�",°`"`"`""` Caunry Code Year File Num6er
PO eoXx8o6oi 1NHERITANCE TAX RETURN ,� � � ���
Hamsbur� pa i7tz8-u6oi REStDENT DECEDENT r�t.+
ENTER DECEOENT INFORMA7YON BELOW
Sociai Securiry Number Date of Death MMDDYYYY Date of Birth MMDDVYYV
_._. . _._ ._.. .. .., . . ___ ._... _... _ __ . .._..
02/10/2013 Q3(20l1930
Decedenfs Last Name ���� ��� ���� Saffix DeceCerrYS First Name ���� MI
_... ._ _ .__.. .._.. ...... _._. . _ ..... ..
DAVIDSON CATHERINE ° �/ ;
_ a
{if Appiicablej EMer Sutviving$pouss'E ItHormat(on Below
Spovse's Last Name Svffiz Spouse's First Name MI
,_. .. . . . .._ . ..._.. . . . .. ..... ._. . ..._ ._._ . ......
Spouse's 5acial Seaurity tvumber TNtS RETURN MUST 8E FtCED!N BUPLICATE WITH THE
REGISTEF2 OF WILLS
FILLlN APPR4PRIATE OVALS BE60W
O i.Original Retum � 2.Supplementel f2atum Ci 3. f2emairtdar ftetum(Date of Death
Priorto 72-73-82)
O d.tim'rtsd Esiate p 4a.Future lnterest Compromise(data o( p 5. Federal Estate Tax Return Required
deaN after 12-12-82j
O 6. Decedent Died Tastate p 7.Deeetlent MainTained a Living Trust 1 6. 7ota!Number of Safe Deposit Bozes
I (Attech Copy of Wiil) (Attach Copy of Trust.)
O S.Ldigsiion Proceeds Received O 10,Spousai Poverty Cretlii(Date of Oeath O 17. Election to Tax under Sec.9113(A)
Betwesn 12•3�-91 and�-9-46) {Attach Schedu�a 07
CORRESPONOENT- THIS SECTION MUST 8E COMPLE7ED.All CQRRESFQNDEtICE AND CONFIDENTtA!TA7t tNFORMATI6N SHW lD BE D�RfCTED T0:
Name .__ .._.. .._ .... _. _. _ ... . . DayUmsTalophoneNumber
Thames P. Gleason (717p��, i2-3270 �� �' �
.. . _._. ..__ .._ _. . _ ._.. .. . . . ._.. e-�a__. � ._..�� .._.;
ia.oiS,i�a ov wi rs us�aroara
rn _ n ' . �m
� X. r— r� -�i
First l.ine of Address � � ' ���' • �'
..__ _.... . ._ . ... . _... .. .._ . . . '_ `'.; � . C• .`.
49 W. Orange St. _� ,- _, � `i
__ r ° --'
�Second Line of Address � . � -
City or Post Qific:e_. . _.. . ._._ ...._ State ZIP Gode � OATE FltED �'� .
Shippe�sburg PA 17257 '
_ .
CorcesPOnaem•s e-maii addres.:tomgleason�tpmgiessoniaw.com
Undsr penaltisa of peQury,t tlec�am ihai i heve eneminetl thls return,IncWding ecaamp9nying scliedulea and statements,end to the Dest oi my knowledga anA belief,
It is Vue,correct antl camplate.DeclaraUOn of�ueparer other thfln Ne pgrwnat reprsssntetive ia based on a8 irttarmation of wMCh praparer has eny knawietlge.
N E OF SPpN6 E FOR FILING RETURN pq7E
Tl/L4.�2�I�
A�RESS
447 W. Main 5t.,WaNut Battom, FA 17266
SIGNATURE OFPREPARER OTH£RTHAN REPRESENTA7NE DATE
ADDRESS
PLEA$E IJSH QRlBINA�FORM OttlY
Side t
� 150561p105 15056101D5 �
� Lsos6lazas
Rev-�saa�t{Fi}
DecedenPs SSocclal Security Num6er
oeceaenrs Name: ... . . .........
RECAPITULATION
1. Resi Estate iSchedule A}. ..... . . ..................................... t.� O.OQ ���.;.
2. Stocks and Bonds(SChedule 9) ...... ................................. 2. ,. O.QQ ,..
t__..... _.__.__._._...._ . . . ..,..._,...,_�...�,._..__
3. Ciase�y Heid Cprporation,Padnership qr Sole-Proprietorship{Sahedule C) ..... 3. ! Q�4Q •.
4. Mort a es and Notes Receivable Sohedule D 4. '� 0.00 '�
9 9 ( )...........................
�.,�_.... ......_.._..._...._,__..._ ..._____'
5. Cash,Bank Deposits and Miscellaneous Personal Property{Schedule E)....... 5. ! 463.04 !.
8. Jointly Owned Property(Schedule F) d Separete 6illing R9quested ....... & ' Q.OQ '',
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Properly ������ ���� �� �� � � �� �� ��
{Scheduie Gj C7 Seperate BilOng Requ6st9d..... .. 7 14,477.48��.
......._,..._.._....__. ._ .. .__ .__...._.. _..�.,.._.,....�_
8. Totat Gross Assets(totai Lines i through 7}...... .... ... ... ........... 8. i 70,940.4$ '
...... ... 9. :�
9. Funerai Expenses and Administrative Costs(Scheduie H),... .... .. O.QO �::
f_._ ..._.._..__,�._.___._._..,___.._.__.__._... .,_ _..,
�
10, Debts of Decedent,Mortgage I.'rabiiities and Lfens(Scbedule�)........_. ... . 10. � 119.0$ '.
;..._..._...._..._._..._..m....�._.__...._..._.._,_..__.__.,_...�,
Tt. 7otal Dedaetiona(totei Lines 9 and 10). .... . ... ..... .... .._........... 11. i 118.0$ ��•..
� .. .. .. .. .. . ... .. _
� t2. Nat Yalue oi Es#sts{Line$minus Line 11} ...... ..... ................... 12. : 10,821.4Q �:.
13. Charitabie and Govemmentai 6equestsJSec 9113 Trusts for which i"�"- --��--���- - �..-..-._.__..�._. __.__.
an eiection to tax has not been made(Sahedule J) ... .. ... ... . .._........ 13. i Q.40 :.
,, w_,. �_____._ ._ .__.,_. ... . . .
14. Nat Yaiva Subjecf to Tax iLina 12 minus Line 13� ........................ 14. i 10�$21.44 '-�..
TAX CAI.CULATION-SEE INSTRUCTIONS POR APPtiCABCE RATES
15. Amount of Line 14 taxable
atthe spousaltau rate,or
trensferG und9r Sec.9N6 _._ _ _.. _... 0.0� I . ._.. ._. . . .... . .._..
ia)i72)X,0� ts. 0.00 '
16. Amount of Line 14 taxable ._.�.____..._..,.._...._..._...._._._........ _.._` ....__..._ _�„_...._. . ._._ .__..._,__.�
at Iineaf rate X.045_ 1 p,821.40 { �g,; 4$8.96 '
_.___ ______ _._ _. _. . . _,._.� _ _.._,._.__ __. _.�._..._ .
17. Amaunt of Line 14 tazabla ��
at sibling rete X J2 OAO ! �7.', 0.00 ;
_,_ _ � _��_.___.___.. .._._____.� _._. _.__._._.___.,,
18. Amount of Line 14 taxable � ������� '
at collateral rate X.15 0.00 � �$ '�_ Q,QQ �;
. .. ._. . _. _ ....�..,.._,. .......,_...____..,_.... .___..,._.._.
19. TAXDUE . ........ .......... ......... .......... .
_........ t9 ' 486.8fi ,,
20. FlC.l.IN THE OVAL IF YOU ARE REQUE8TIN6 A REFUN6 OF AN OVERPAYMENT O
SidB 2
� 15�56102D5 b505610205 J
REV-1500 EX tFij page 3 Flk Num6er
DecedenYs Complete Address:
o c t+r ru�rae
Gatherine V. Davidson
---�___ __.___._,.—._--------_._—__,_..----_ ---------__---_._.__ .
STREETA66RES5 ��
5Q Water Street
cin � sr,aTe :zia— ---
Wainut Bottom PA 17286
Tax Payments and Gredits:
1. Tax Due(Page 2,line 19} (1} 4$6.96
2. CreditslPayments
A.Pripr Paymenis
B.D�unt
—�ii�—ii—ii-- TotalCredlts{A+8) {2) 0.04
3. Interest
(3) O.OQ
4. !t Line 2 is greater thao Urre 1+��3,eMer tha difrerence. This is the OVERPAYMENT.
Fi11!rt aral on Page 2,Line 20 to reqaest a refund. (d} Q.qp
5. !!line t+Lir�e 3 is greater than Line 2,enter tfie diBerence.This is the 7h7(DUE. (5J 486.96
Make check payable fa: REGfSTER OF WIILS,AGENT.
PLEASE ANSWER THE FOLIOWING QUESTIONS BY PLACtNG AN "X"IN THE APPRdPRIATE BIOCKS
1. Did decedeni make a transfer and: Yes Na
a. retain the use or inrnme of Etre WapertY trarisierred.......................................................................................... � �
b. retsin the nght to c�signate who shait use the pmperty transiened or its income ............................................ ❑ (�
c. ret�in e reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for iife of either payments,benefits or care?...................................................................... ❑
2, if death occurred after Dea.12,1987,did decedent transfer propeAy within ane year of death
without receiving adequate consideration?.........................._.......,.......................................................................... ❑ �
3. Did decedent own an"irt Uust fw"or payable-upbn-death bank accotanY or securty at t�is or her death?..............� ❑
4. Oid decedent own an individuai retirement eccount,a�nuiry or other nan•probate property,which
�ntains a benefiaary designstian? ........................................................................................................................ ❑ �
IF 7HE ANSWER TQ ANY OF THE ABOVE QUESTIONS IS YES,YtiU MUST COMPCETE SCHEDULf G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and befare Jan.1,1995,the tax rate imposed an the net value of transfers to or for the use of the surviving spouse
is 8 percent[/2 P.S.§9116(a){1.1J(i)].
For dates af deafh an or after Jan. 1, 1995, ihe tax rate imposed on the net value of transfers to or for the use of the surviving spouse is Q percent
[72 P.S.§9116(a}(1,f}(ii}],The siatute does not exempt a transier to a surviving spouse from tax,and the statutory requirements for discbsure of assets and
fi(ing a tax retum are still applicable even if the surviving spouse is the oniy beneficiary.
Far dates of dealh on or after July t,2004:
: The taz rate imposed on the r�eY vaiue of iransfers from a decsased child 27 years of age or younger at death to or for ihe use pf a natural parent,an
adopdve parent or a stepparent of the ohiki is 0 percent[72 P.S.§9116(aj(12}j.
• The tax rate imposed on the oet value of transfers to or for the use of Ihe decedenE's lineal baneficiarres is 4.5�rcent,except as nated in(72 P.S,§9it6(aj{t}�,
. The fax tate imposed on the net value of transfers to or for ihe use of ihe decedenYs siblings is 12 percent(72 P.5.§9116(a){1.3)].A slbling is defined,
une�r Sec�ron 9102,as en indiaidoai who has at Ieasi one parent in common with the decedent,whether by blood or adoplion.
. _ .
REV-�SOB EX+(o8-�z)
�pennsylvania SCNEpt1LE E
DEPARTMENTOFpEVENUE CASH� BANK DEPOSITS & MISC.
RESIDAEMNDECEDENT �" PERSONAL PROPERTY
ESTATE OF:
CATHERINE V. DAVIDSON FILE NUMBER:
Include the proceeds of litigation and the date the proceeds were received by the estabe.
All property join[ly owned with right of survivonhlp must be dixlosed on Scheduk F.
[TEM
NUMBER DESCR1PTfON VALUE AT DATE
� . . .. ...... OF DEATH
1, Erie Insurance Refund for Car Insurance
304.00
2, Erie Insurance Refund for Homeowners Insurance
159.00
TOTAL(Also enter on Line 5, Recapitulation) ; � � 463�.00�
If more space is needed,use additional sheets of pa0er of the same size.
REV-1510 EX+(08-09)
�pennsylvania SCHEDULE G
w�a� DEVAHTMENTOFPEVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETUIIN MISC. NON-PROBATE PROPERTY
RESIDENT DKEDENT
ESTATE OF
CATHERINE V. DAVIDSON FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-I500 is yes.
ITEM DESCRIP170N OF PROPERTY
NUMBER �N���°F'"E'p°rvsre�,TM°"�na�smvroo�oennrio DATEOFDEATH %OFDECD'S EXCLUSION TAXABLE
�0.0�0f��' A�AO1A.�0F�D��+�gTAh� VALUEOFASSET INTEREST �vnn�utce� VALUE
1• Citizens Bank CD ending in#9686 in trust for decedenYs Son,Lawrence J. ` '
Davidson(February 10,2013). 10,477.48 100 10,477.48
3.
iOTAL(qlso enter on Line 7, Recapitulation) ; �10,477.48 �
If more space is needed,use additional sheets of paper of the same size. �
Rev-isix ex+(iz-iz)
�pennsytvania SCHEDULE I
AEPARTMENiOfftEVENUE DEBTS OP DECEDENT,
t""EUT^"c�T^u ftEn""" MORTGAGE LIABILITIES &IIENS
RE5(DENT DKEDENT
ESTATE OP FILE NUMBER
CATHERINE V. DAVIDSON
tiepart debtr incurred by the daedent pdor to death that remalned unpaid at the date af death,Including unreimbursed medical expenses.
REM VALUE AT DATE
NUMBER DESCAIP'(SON OF OEATH
i� Final payments to PP$L E(ecMc for pawer bill 119.08
TOTAL(Also enter on Line 10,Recapitulatlon) � 1�g.08
� If more space is needed,insert additional sheets oP the ume size.