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HomeMy WebLinkAbout02-05-15 (2) 15�05610101 J REV-1500 OFFICIAL USE ONLY PA Department of Revenue pennsyLvania F 1EP F.101 County Code Year File Number Bureau of Individual.Taxes ——----- INHERITANCE TAX RETURN PO BOX 280601 _.AJ Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ............ .................................. j 05/15/2014 04/15/1926 .................................... ................ ................................................... .................................................... Decedent's Last Name Suffix Decedent's First Name MI A David Davis--------................... ...... Davis ................. .................................... ................. ................................... .............................................. (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 1. Original Return C=:) 2.Supplemental Return C=:) 3. Remainder Return(date of death prior to 12-13-82) O 4. Limited Estate C=) 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) C:5 6. Decedent Died Testate C=:) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C=:) 9. Litigation Proceeds Received C=:) 10.Spousal Poverty Credit(date of death C=:) 11. Election to tax under Sec!9113(A) between 12-31-91 and 1-1-95) (Attach Sch.0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Tel. ephone Number ............. James W. Kollas, Esq. (717) 731 -1600 E R _6TER OF WILEnSE I q%,Yrl First line of address i Kollas and Kennedy M, cn ... ....... ... ......................................-...................................................... ......................................................................................................................................... Second line of address -—---------------- ............... 1104 Fernwood Avenue 1ZD DATE FIL ........................................ ..........- ............................................................................................................................... City or Post Office State ZIP Code ErB I Camp Hill PA 17011 N ..................... .................. .......... Correspondent's e-mail address: james@kollasandkennedy.com 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.,QRclara'orj of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN RE OF P SON SP N ISLE F0lT)It4QNG RETURN DATE , 11A ADDRM_Y 353 Willow Avenue, Camp HIll, PA 17011 SIGNATU �#,PA2EROLFJER THAN REPRESENTATIVE 2215— ,.o@5RESS 1104 Fernwood Avenue, Camp Hill, PA 17011 , PLEASE USE ORIGINAL FORM ONLY Side I 1505610101 1505610101 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: David A. Davis RECAPITULATION __...__...._..._........._........---........__._......... ..........._.___-._._..... 1. Real Estate(Schedule A). ..... .. ...... ... .. ...... .. ... .. .. .. .. ..... .. 1. 140,165.00 2. Stocks and Bonds(Schedule B) ...... .................. .. ............. 2. 35,500.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00! 4. Mortgages and Notes Receivable(Schedule D)....................... . 4. 0.001 p Property(Schedule E).. .. ... 5. 22 599.67 ? 5. Cash,Bank Deposits and Miscellaneous Personal Pro e 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. .... 6. 9,218.75 I 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) CM Separate Billing Requested........ 7. 0.00 F 6. Total Gross Assets(total Lines 1 through 7).. .. .. ........ . .. .......... 8. 207,4 G 9. Funeral Expenses and Administrative Costs(Schedule H)..... .. ......... .. . 9. 31,375.76 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule"1) .......... . . . . 10. 5,452.63 11. Total Deductions(total Lines 9 and 10).. .... ........... ................ 11. 3,682,839.00 12. Net Value of Estate(Line 8 minus Line 11) ..... ................ ... . .... . 12. 170,655.03 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . ... . .. ........... . . .. . 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ........ . . ........... ... 14. 170,655.03 t 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_ 0.00 15. 0.00 16. Amount of Line 14 taxable t at lineal rate X.0 45 170,655.03 16. 7,679.48 17. Amount of Line 14 taxable I at sibling rate X.12 0.00 17. 0.00 18. Amount of Line 14 taxable i at collateral rate X.15 0.00 18 0.00 19. TAX DUE ........... .. .. .. .... ...................... . . ............ 19. 7,679.48] a 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME David A. Davis STREETADDRESS 127 N. 4th Street CITY STATE ZIP Lemoyne PA 17043 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 7,679.48 2. Credits/Payments A.Prior Payments 414.84 B.Discount 0.00 Total Credits(A+B) (2) 414.84 3. Interest (3) 0.00 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) 7,264.64 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;.......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income;............................................ ❑ u❑ c. retain a reversionary interest;or.................................................:........................................................................ ❑ FAI d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ FRI 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ x❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ ❑X 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ..................................................................................................................:..... ❑ FRI 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 decedent's lineal beneficiaries is 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 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+ (11-08) A pennsylvania SCHEDULE A DEPARI"MENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Davis 21-14-0507 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' 127 N.4th Street,Lemoyne,PA 17043(144,5000.97=140,165) 140,165.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 140,165.00 If more space is needed,insert additional sheets of the same size. REV-1503 EX+(6-98j SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Davis 21-14-0507 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Treasury Bonds(Series HH) 35,500.00 TOTAL(Also enter on line 2,Recapitulation) $ 35,500.00 (If more space is needed,insert additional sheets of the same size) REV-1508 EX+(6-98) t* SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Davis 21-14-0507 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M&T Bank account 9,516.00 2 NCFCU account 12,983.67 3 Cash on Hand 50.00 4 Misc.Personal Items 50.00 TOTAL(Also enter on line 5,Recapitulation) $ 22,599.67 (If more space is needed,insert additional sheets of the same size) REV-15o9 EX+(oi-io) pennsylvania SCHEDULE F UEPARI'MENIOF REVENUE IJOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: David A. Davis 21-14-0507 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. Sandra D. Fenton 353 Willow Avenue Daughter Camp Hill, PA 17011 B. C. JOINTLY OWNED PROPERTY: 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 DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 10101109 PSECU Time Certificate 14,579.73 50 7,289.87 2 A 10101109 PSECU Savings Account 3,857.75 50 1,928.88 TOTAL(Also enter on Line 6, Recapitulation) $ 9,218.75 If more space is needed,.use additional sheets of paper of the same size. REV-1511 EX+ (10-09) - pennsytvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Davis 21-14-0507 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Musselman's Funeral Home,funeral services 9,368.00 2 Rolling Green Cemetery,burial 1,495.00 3 Repast 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 9,000.00 Name(s)of Personal Representative(s) Sandra D. Fenton Street Address 353 Willow Avenue city Camp Hill State PA ZIP 17011 Year(s)Commission Paid: 2015 2. Attorney Fees: 4,000.00 3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 3,500.00 Claimant Pamela O'Hearn Street Address 127 N.4th Street city Lemoyne State PA zip 17043 Relationship of Claimant to Decedent Daughter 4. Probate Fees: 670.28 5. Accountant Fees: 0.00 6. Tax Return Preparer Fees: 7• Lemoyne Sewer 224.60 s PP&L(June and July 2014) 175.64 9 Real Estate Taxes 1,316.77 10 PA Water(June and July 2014) 124.47 11 Donegal Insurance 701.00 12 Leffler Energy 600.00 TOTAL (Also enter on Line 9, Recapitulation) $ 31,375.76 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania SCHEDULE 1 DEPARTMENTS OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Davis 21-14-0507 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 I. Lemoyne Sewer(May 2014) 86.80 2 PP&L(May 2014) 149.32 3 West Shore EMS 932.74 4 Penn Waste 113.24 5 Verizon 24.80 6 Comcast 121.33 7 Cropf Bros. 244.00 8 Manor Care Nursing Home 3,780.40 9 TOTAL(Also enter on Line 10, Recapitulation) $ 5,452.63 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) ,;1Pennsylvania SCHEDULE J DEPARTMEN7'OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: David A. Davis 21-14-0507 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• Sandra D.Fenton,353 Willow Ave,Camp Hill PA 17011 Daughter 1/3 2 Donna Davis, 15 Campbell Place, Camp Hill PA 17011 Daughter 1/3 3 Pamela O'Hearn, 127 K 4th St.,Lemoyne PA 17043 Daughter 1/3 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. c 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. LAST WILL AND TESTAMENT OF DAVID A. DAVIS I, DAVID A. DAVIS, also known as D. Allen Davis, of the Borough of Lemoyne, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament,hereby revoking all prior Wills and Codicils. FIRST: I have provided for my funeral expenses, but I direct that my Executor or Executrix pay all other debts as soon after my death as may be practicable. I further direct that all state, inheritance, transfer, legacy, or succession taxes which may be assessed to my estate, or any part of my estate, whether passing under my will, shall be paid out of my residuary estate as an expense of administration and without apportionment. SECOND: I devise and bequeath all of my estate of every nature and wherever situate to my wife, STELLA E. DAVIS, provided that she shall survive me by Thirty(30) days. In the event my wife predeceases me or dies on or before the thirtieth(30th) day following my death, I devise and bequeath all of my estate in equal shares to such of my children, SANDRA LEE FENTON, DONNA DEE BUTTON and PAMELA BEE DAVIS, as survive me by Thirty(30) days. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall.be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I appoint my wife, STELLA E. DAVIS, Executrix of this, my last will. Should my wife, STELLA E. DAVIS, fail to qualify or cease to act a s Executor, I appoint my daughter, SANDRA LEE FENTON, Executrix of this, my last will. FIFTH: I direct that my Executor, or their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this 17 day of 1999. � � (SEAL) DAVID A. DAVIS SIGNED, SEALED,PUBLISHED and DECLARED by the above, DAVID A. DAVIS, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses: WWLOf C So ��e4 l 1�d2lU� WITNESS .r of UJQ0 WITNESS