HomeMy WebLinkAbout01-0746
PElITION FOR PROBATE a~d GRANT OF LETTERS
.:L , - 0 I - ? 'I~
Estate oj .WAN M DAVIS
also known as
No. .
To:
Register of Wills for the
I Deceased. County of t'1""hp,...h:mn in the
Social Security No. 1 R4-1 ?-4526 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executnr~
in the last will of the above decedent, dated Octob@X' 12
and codicil(s) dated
named
, 19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland . . County, Per:sylvania,' with )
h er' last family or principal residence at 335 SO! Sport1ng Hill Road, HA,i(PI)~/LI TOw/II'UtffJ/
MP("n;:m; esburg. PA 17050 /'l /ft/~
(list street, number and muncipality)
Decendent, then 82 years of age, died July 25, 2001
at wP~t Shore CountrY Meadows, Hampden Township
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: .
Decendent at death owned property with estimated. values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: 325 H~rm;::!n ZhTPnnp r T .pmnynp- Rorou.gh.
rnnntYr Pennsylvania
,Hk
$
$
$
$ 60000.00
CUmberland
38980.88
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
pre~ented herewith and the grant of letters t-p~t-~TT1Pn+-~ry
(testamentary; administration c.t.a.;'administration d.b.n.c.t.a.)
theron.
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William M. Dauia, Jr
, 3 7 ~C::, PT 1l,TPnllp
T.pmnynPr PA 17041
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hll rn~rlp~ gt-rppt-
Meehan; cshllrq r PA 17055
OATH OF PERSONAL REPRESENTATIVE
COMMON~EALTH OF PENNSYLVANIA } 58
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(~) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
.~r~
William M. Davis, Jr. 4
affirmed ~nd
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No.
21-01-0746
Estate of
JEAN M. DAVIS
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW AUGUST 13, th ~ 200~ in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated O::tober 12, 1965
described therein be admitted to probate and filed of record as the last will of
JEAN M. DAVIS
and Letters Testamentary
are hereby granted to William M. Davis, Jr. and Neil A. Davis
7na~fI: )/;;/~.)ljJ /~~~ !?Ll. ~~ ~+
Register of Wills
. FEES
Probate, Letters, Etc. ......... $ 200.00
Short Certificates(3 ) . . . . . . . . .. $ 9 . 00
Renunciation ................ $
JCP $ 5.00
. TOTAL _ $ 214.00
Filed . .aPl1.l!Sr. ,l.~,. ?QQL..............
Ralph H. Wright, Jr. ID 56113
JohnSOJ;1, Duffie, Stewart & Weidner
A ITORNEY (Sup. Ct. I.D. No.)
301 Market Street, PO Box 109
Tpmnynp PA 17041-0109
ADDRESS
717-761-4540
PHONE
MAILED L~TTERS TO ATTORNEY AUGUST 13, 2001
21-01-746
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
1
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same,~nd that / signed as a witness at the
request of testat_ in h'-pr~an,~n the presence of each other) (in the presence of the
other subscribing witness(es)). 7~
Sworn to or affirmed and subscribed b ~e ~
me this oayof ~ (Name)
19_ ~~~~
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a )1Jb~~riber hereto, (each) being duly qualified a ording to w, depose(s) and sW tha; "
~ d~ familiar with the signature of : ~ (J
co 1 i
testat~ of (one of the subscribing witnesses to) the il presented herewith and
~dicil
that eliev~the signature on the ~!V is in the handwriting of
:e-~
to the be~/ r . ~ knowledge and belief. ,/1J _ '
Sworn to.or affirmed and subscribed before ~c~-/:7 ?~.&;t1
me th~~<L . ~ jLt<~<'k! ramet!/C'-, 'M7cJ'
~"~ - ~t.(l.fi. ~...d--tAJ)/\~_--'.~ (Address)
Register
1/( Jh~1(;e) 001 L~~t5'o/~~ii!
/ /,
(Address) I 7 0 ( 3
21-01-746
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNES~
codicil
(each) a subscribing witness 0 the will presented herewith, (
law, depose(s) and say(s) that
h) being duly qualified according to
present and saw
the testat , sign the same and t
request of testat in h
other subscribing witness(es)).
signed as a witness at the
(in the presence of each other) (in the presence of the
Sworn to or affirmed and subscribe
me this
(Name)
(Address)
".... ~,...'
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(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
~. OATH OF NON-SUBSCRIBING WITNESS
-t"t~,t) \
B...
MARY)s. DEFIBAUGH
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
she is familiar with the signature of JEAN M. DAVIS
codicil
will presented herewith and
codicil
believes the signature on the will is in the handwriting of
testatrix
of (one of the subscribing witnesses to) the
that
she
JEAN M. DAVIS
to the best of her ~ knowledge and belief.
Sworn to or affirm~ and subscribed before )vl ~ ,4 jJ~
me this L ~- . day of (/jafne) .
{ t'.~ c1-4tU) I if W ~ jJJV
"1lud(l. >-611";' p'.. fl{1.~'iI;.w/~ [Address) jJ . .-_
. Register (J ~~"'r r It- ( 1 ().1. 1 -- s IT I
(Name)
(Address)
105.805 REV ')186
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~7/(~~
Local Registrar (]
Fee for this certificate, $2.00
p
7618974
JUL 2 8 2001
Date
-lev. 2117
COMMONWEALTH OF PENNSYLVANIA e OEPARTMENT OF HEALTH e VITAL RECOROS
CERTIFICATE OF DEATH
SEll
female
SWE fILE NUMBER
:.xranCUR: NU!82R _ 4526
~NAME OF DECEDENT IF....~. L"
~,. Jean M. Davis
_ AGE Il- Bir1I>day) UNClE" 1 YEAR
= MonlM 0..,.
PI.ACli OF DEATH ICNck """".".. - ... .....,u<:IoOl>S on Qltw -.
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CUll berland
SURVMHG SPOUSE
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PART .: 0IMr 1igI>iIIcanI-.dIIiDne CllKIlrIluIIng 10........ buI
1IIIl-*lng In" undarIyIng_ gMn In MAT I.
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DUE 10 (OA AS II. CONSEQUENCE Of):
DUE 1O(OR AS II. CONSEQUENCE Of):
NaIuraI
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DATE OF INJURY
(Won". Day. -I
TIME OF INJURY
INJURY AT WORK?
DESCRl8E HOW INJURY OCCURRED.
_MSAN AUlOPSY
~PEAFOfIMED?
WERE II.U1OPSY flNOlNGS
~PRIORl'O
COMPLETION OF CAUSE
DEATH?
MANNER OF DEATH
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.Cl!RTM'YINQ PHYSICIAN (Ptlrsoc-cerlIIyong.,... d -. _ __ phyIoc.... hasponounced _ iUlO c~ed Item 231
To...........'..........._llCCUII8d_....cauH(.land_'.._...........................................,........ .
21.
...Iii -PIIONOtJNaNG AND CERTIfYING fttYstCIAN (PhyKtan bOIh pronounc.og oeaeh andcttnlfylng 10 cause of de..,,)
To.......ol..._wladge.___.......... .te,andplaca. and_101tIechM(.landm.nne....................................
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"1EOlCAL EXAMINERlCORONER
On the baIIe oI...........1on 8lldlOIIlnv..tlgalion.1n my opinion. death occuned at !he 11lne. da'e, .nd place. lIIld due 10 ,he cauH(a) and
__.. alated.. . . . . .. . . . .. .. . . . . . . ... .. . . . . . . ... . . . .. . . ... ... ... ... ... . . . . . . . . . . . . . . . . . . . . . . .. . .. . . .. . . . . . . . .. .
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WILL
21-01-746
OF
JEAN M. DAVIS
I, JEAN M. DAVIS, of the Borough of Lemoyne, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
Item I: I direct that all my just debts ~d funeral expenses shall
be paid from the assets of my estate as soon as practicable after my
decease.
Item II: I bequeath the sum of Five Hundred ($500) Dollars to
i THE FOOT CHRISTIAN CHURCH of Lemoyne, Pennsylvania.
Item III: I devise and bequeath the residue of JIGT estate of every
nature and wherever situate to my issue, per stirpes.
Item IV: I appoint my sons, Wn..LIAM M. DAVIS, JR. and NEIL A. DAVIS,
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II by the signature of the testatrix, was on the day and date thereof signed,
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Item V: I direct that my personal representatives shall not be
required to give bond for the faithful performance of their duties in
~ jurisdiction.
m WITNESS WHEREOF, I have hereunto set my hand this I cl XX. day of
(f)d;cI'iJ-t/ ,1965.
(:-~p Ii Ai
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The preceding instrument, consisting of this typewritten page identified
published, and declared by JEAN M. DAVIS, the testatrix therein named as and
for her last will, in the presence of us, who, at her request, in her presence, I
and in the presence of each other have. ~ribed our n~es as witnesses hereto
\
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PAGE ONE OF ONE PAGE
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CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent:
Jean M. Davis
Date of Death:
July 25, 2001
Will No.: 2001-00746
Admin No.:
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on August 8, 2001
Name
Address
william M. Davis, Jr.
137 Bosler Avenue, Lemoyne PA 17043
Nei 1 A. Davis
611 Charles Street, Mechanicsburg, PA 17055
First Christian Church
216 South 5th Street, Lemoyne, PA 17043
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
t-bne
Date: 11/16/01
/!fi(~~~
Ralph H. Wright, Jr.
Name
301 Market Street, Ierroyne, PA 17043
Address
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717-761-4540
Telephone
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Capacity: D Personal Representative
~ Counsel for personal representative
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'COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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ss:
William M. Davis, Jr. and Neil A. Davis
being duly sworn according to raw, deposes and says that they rlrp r(")-RYPr'llt-nrs
of the Estate of Jean M. Davis
late of Hampden Township . ,Cumberland County, Pa., deceased and that the
within is an inventory made by them , the ~aid Co-Executors
ot the e~tire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's deat},.
5>; ,va t/
and subscribed before me,
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Executor. Administrator / .
~ct~bE~_.i'1lfOO' ~
dftufud. ~ ~WY
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. 137 Bosler Avenue
Lerroyne, PA 17043
~
Date of Death
Notarial Seal
Krlstee K. Myers, Notary Public
lemoyne.B~ro, Cumberland County
My CommIsSion Expires Dec. 2, 2002
Member, Pennsylvanra ASSOCIation ot Notaries
Day
Addrns
25th
July
2001
Month
Yen
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of dis~overy of additional assets.
3. Additional sheets may be. attached as to personalty or realty
4. See Article IV. Fiduciaries Act of 1949.
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Inventory of the real and personal estate of
.,-
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---
Jean M. Davis
deceased
IRS Tax Rebate
60000 00
21848 75
5008 23
125 00
1800 00
582 50
300 00
2000 00
Real estate located at 325 Herman Avenue, Lemoyne, Cumberland County, PA
PNC Brokerage: 2610.365 Shares GE FDS Govt Secs @ 8.37 per share
PNC Bank Certificate of Deposit #21001019595 $5,000 plus $8.23 interest
Personal Property
GE Capital lDnger Term Care (undeposited check)
PA State Retirement (7/1-7/25)
Country Meadows of West Shore II - Security Deposit
\,/6-o?,y-9-~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-1607 EX AFP (01-02)
"OL
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
. L; :~O\JNTY
ACN
08-19-2002
DAVIS
07-25-2001
21 01-0746
CUMBERLAND
101
JEAN
M
RALPH H WRIGHT JR
JOHNSON ETAL
PO BOX 109
LEMOYNE
'16
Allount Rellitted
i, _
PA 170431,'>.1;
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V:i6'ifj-ix--AFP--((ff:ii2.r------..ii-iNHERi.~fANCE--TAX--STAyEMENT-CrF'-ACCOUiiy--.-..------------------ - --
ESTATE OF DAVIS JEAN M FILE NO.21 01-0746 ACN 101 DATE 08-19-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-03-2002
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
4,689.03
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-18-2001 CDOO0413 131.58 2,500.00
04-25-2002 CDOOII09 .00 1,460.55
06-11-2002 CDOO1285 4.60- 602.87
08-05-2002 REFUND .00 1.37-
TOTAL TAX CREDIT 4,689.03
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
Ih-~~?-/~
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG. PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-1607 EX iFP <Ol-02l
RALPH H WRIGHT JR '02
JOHNSON ETAL
PO BOX 109
LEMOYNE
i'ii 1 C
0tjL J
'I f_\ '14
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DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-08-2002
DAVIS
07-25-2001
21 01-0746
CUMBERLAND
101
JEAN
M
Allount Rellitted
l,~
P~;;17043
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
R.fV"=i6'ifj-ix-AFP--foi-.:o21-------...--iNifERiYANc'E--fAX--SYjrfEttE-tif-o-F'-Aifcouirf--.-i.---------------- - - ---
ESTATE OF DAVIS JEAN M FILE NO. 21 01-0746 ACN 101 DATE 07-08-2002
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-10-2002
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
4,689.03
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-18-2001 CDOO0413 131.58 2,500.00
04-25-2002 CDOOII09 .00 1,460.55
06-11-2002 CDOO1285 4.60- 602.87
TOTAL TAX CREDIT 4,690.40
BALANCE OF TAX DUE 1.37CR
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1.37CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ"
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
BUREAU OF LND~YIDUAL TAXES
INHERITANCf TAX DI~ISIOH
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
RALPH H WRIGHT JR
JOHNSON ETAL
PO BOX 109
LEMOVNE PA 17043
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-10-2002
DAVIS
07-25-2001
21 01-0746
CUMBERLAND
101
*
REY-1547 EX AFP 101-02)
JEAN
M
Amount Rellitted
PtLJ~i'67
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
R'f\j=is4-j-EX--AFP--foi-:02i--NOTICE--OF-INHEiffTANci-TAx-jrpPRjrfsEiiENT~--AL1-owAN-Ci-(fR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DAVIS JEAN M FILE NO. 21 01-0746 ACN 101 DATE 06-10-2002
TAX RETURN WAS: J ACCEPTED AS FILED ( XJ CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule AJ
2. Stocks and Bonds (Schedule BJ
3. Closely Held Stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule DJ
S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule FJ
7. Transfers (Schedule GJ
8. Total Assets
(1J
(2J
(3J
(4J
(SJ
(6J
(7)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule HJ
10. Debts/Mortgage Liabilities/Liens (Schedule IJ
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule JJ
14. Net Value of Estate Subject to Tax
(9J
(10J
60,000.00
21,848.76
.00
.00
11,065.92
8,683.26
12,641.39
(8J
8..060.04
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (lSJ
16. Amount of Line 14 taxable at Lineal/Class A rate (16J
17. Amount of Line 14 at Sibling rate (17J
18. Amount of Line 14 taxable at Collateral/Class B rate (18J
19. Principal Tax Due
TAX CREDITS:
NOTE:
1.478.57
(11J
(12J
(13J
(14J
.00 X 00 =
104,200.72 X 045 =
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
114,239.33
9.538 61
104,700.72
500.00
104..200.72
(19J=
.00
4,689.03
.00
.00
4,689.03
ft . II~" I '~tI~~1' I (+] AMOUNT PAID
DATE tlBER INTEREST/PEN PAID (-)
10-18-2001 CD.OO0413 131.58 2,500.00
04-25-2002 CI.n101109 .00 1,460.55
N
.-
INTEREST IS CHARGEDSIHROUGH 06-25-2002 TOTAL TAX CREDIT 4,092.13
AT THE RATES APPLIC~LE AS OUTLINED ON THE BALANCE OF TAX DUE 596.90
REVERSE SIDE OF THI~ FORM, :: INTEREST AND PEN. 5.97
. ~)~: TOTAL DUE 602.87
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORti FOR INSTRUCTIONS.)
REV.'470 EX (6-88)
.
INHERITANCE TAX
EXPLANA TION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
Jean M. Davis
FILE NUMBER
REVIEWED BY
Sheila Megonnell
ACN
2101-0746
101
ITEM
SCHEDULE NO.
G
EXPLANATION OF CHANGES
The IRA is fully taxable as the decedent is the primary owner and the transferee is a
beneficiary not a joint owner.
H 2&6
Repairs to real estate cannot be used as deductions against the decedent's estate
unless the real estate has been sold.
'Fl
:......~
N
...-
~.3
'J
.........t
p
ORIGINAL
Page 1
s.
/6~ 2'1'9- /S
'. BUREAU OF INDIVIDUAL TAXES
<, INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-151i1 EX AFP (01-02)
RALPH H WRIGHT JR
JOHNSON ETAL
PO BOX 109
LEMOVNE
.07
JUL -1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
: i':4;OUNTY
ACN
06-10-2002
DAVIS
07-25-2001
21 01-0746
CUMBERLAND
101
JEAN
Allount Rellitted
~ ./
PA 1704S~\.li
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=is4-j-Ex--AFP-(cfi:oi-f-NoTIci--oF-'rtiHiififANCE-YA'X-APPRifiiiifENy-,--Ai::rOWANCE-oi---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DAVIS JEAN M FILE NO. 21 01-0746 ACN 101 DATE 06-10-20
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTIC~
RESERVATION 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)
3. Closely Held stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
S. Total Assets
60.000.00
21.848.76
.00
.00
111065.92
81683.26
12.641.39
NOTE: To insure pi
credit to your ac.
subllit the upper ~
of this forll with
tax paYllent.
(S) ~m m_ 11~,2~~~
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/GovernllBntal Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
8,060.04
(9)
(10)
1.478.57
lll)
ll2)
ll3)
ll4)
(Schedule J)
9.';38 6
104,700.~
500.
104,200.
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19
reflect figures that include the total of Abb returns assessed to date.
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (IS)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. AlIOunt of Line 14 at Sibling rate {17}
IS. Allount of Line 14 taxable at Collateral/Class B rate {IS}
19. Principal Tax Due
R TS:
NOTE:
.00 X 00 =
104,,200.72 X 045 =
.00 X 12 =
.00 X 15 =
4,689
ll9)=
4,68
+
INTEREST/PEN PAID {-}
131.58
.00
AMOUNT PAID
2,,500.00
1,460.55
DATE
10-18-2001
04-25-2002
NUMBER
CD000413
CDOOI109
INTEREST IS CHARGED THROUGH 06-25-2002
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENl
IF TOTAL DUE IS REFLECTED AS A ..CREDIT-- (CIt...
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ~
/:J",,__
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DAVIS WILLIAM M JR.
137 BOSLER AVENUE
LEMOYNE, PA 17043
_u_____ fold
ESTATE INFORMATION: SSN: 184-12-4526
FILE NUMBER: 21-2001- 0746
DECEDENT NAME: DAVIS JEAN M
DA TE OF PAYMENT: 10/19/2001
POSTMARK DATE: 10/18/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 07/25/2001
NO. CD 000413
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,500.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,500.00
REMARKS: WILLIAM M DAVIS JR
CHECK# 2732
SEAL
INITIALS: DO
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WRIGHT RALPH H JR ESQ
301 MARKET STREET
POBOX 109
LEMOYNE, PA 17043
____nn fold
ESTATE INFORMATION: SSN: 184-12-4526
FILE NUMBER: 2101-0746
DECEDENT NAME: DAVIS JEAN M
DATE OF PAYMENT: 04/25/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 07/25/2001
NO. CD 001109
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,460.55
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$1,460.55
REMARKS: WILLIAM M DAVIS JR
C/O RALPH H WRIGHT JR ESQUIRE
CHECK# 93
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
~::
STATUS REPORT UNDER RULE 6.12
Name of Decedent: JEAN M. DAVIS
Date of Death: July 25.2001
Will No.
2001-00746
Admin No.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the Estate is complete:
Yes X
No
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes
No
X
b. The separate Orphans' Court No. (if any) for the personal
representative's Account is:
c.
parties of interest?
Did the personal representative state an account informally to the
Yes X No
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
'''-
Date: November 11,2002
~~#~
RALPH H. WRIGHT, JR., ESQ.
JOHNSON, DUFFIE, STEWART & WEIDNER
301 Market Street
P.O. Box 109
LemoYlle, P A 17043
(717) 761-4540
Capacity: Personal Representative
(x) Counsel for Personal
Representative
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
,../
OFFICIAL USE ONLY
/~ - dlf9- /-.3
FILE NUMBER
21 2001 00746
D
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME {LAST, FIRST, AND MIDDLE INITIAL)
DAVIS JEAN M.
DATE OF DEATH(MM-DO-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
184-12-4526
THIS RETURN MUST BE FILED IN DUPlICATEWlTH THE
DATE OF BIRTH (MM-DD-YEAR)
07/25/2001
IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, FIRST. AND MIDDLE INITIAL
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X 1. Original Return
4. Limited Estate
X 6. Decedent DIed Testate
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12M82)
7. Decedent MaintaIned a Living Trust 0
(Attach copy of Trust)
(Attach copy of Will)
09. UtlgatlonProceedsReceived 010.
3 date of death
. Remainder Return prior to 12-13MB2)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1M 1-95) (Attach Sch 0)
:::::[fj($:$i;q[IPN::MQ$'j;::~g::qPM~~g'j;';P:I:~~1!;::qPBBg$~PNpgNqg::I!!::PQ'NF,pgN'j;I~ljjm~:;jNtQ!!MAm!QN$H5:!J~P::iig:J:j(ili;Q;'j;19p:;tpi::i;i::
NAME COMPLETE ~'.AILlNG ADDRESS
Ra1 h H. Wri ht,
FIRM NAME (If Applicable)
Johnson, Duffie,
TELEPHONE NUMBER
Jr.
301 Market Street
P.O. Box 109,
Lemoyne, PA 17~il',
Stewart & Weidner
R
E
C
A
P
I
T
U
L
A
T
I
o
N
6 -4540
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule 8)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Nan-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (totai Lines 9 & 10)
12. Net Value of Estate (Une 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(1)
(2)
(3)
60,000.00
21,848.76
None
(4)
(5)
None
11,065.92
(6)
8,683.26
8,683.23
1,478.57
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
1 a. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. ~\:Ig$.r!~iili:i~il!!im\:lI!~:Pfi~::~I!l$jf
. $W$!!;:~LL:QjjE$'j;!i:lN$::bNRlg"i;R$E:::.
~
P
I'..
OFFICIAL USE ONLY
i')
I.,_n
I=::
-0-
(8) 101,597.94
(11) 10 .161. 80
(12) 91,436.14
(13) 500.00
(14) 90,936.14
X .0 0 (15) 0.00
90,936.14 X .0 45 (16) 4,092.13
X .12 (17) 0.00
X .15 (18) 0.00
(19) 4,092.13
Copyright (cl 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
Countv Meadows West Shore III
4905 East Trindle Road
CITY I STATE I ZIP
Mechanicsburg FA 17055
Tax Payments and Credits:
,. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
4,092 .13
2,500.00
131.58
Total Credits ( A + B + C) (2)
2,6J1.5H
3. Interest/Penalty if applicable
O. Interest
E. Penalty
TotallnterestlPenalty ( D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4) 0.00
5. If Line 1 ... Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1 , 4 bU. 55
A. Enter the interest on the tax dUe. (SA) 0 . 00
B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) 1 , 460 . 55
Make Check Payable 10: REGISTER OF WillS, AGENT
l';;r,\\\\\\\\\\;!!; , ,1"\\\\\\\II\\\I\\I\\\\\\\\mllmm\\\\\\\\\\\\\\\\\\\\\\\\\\IIIll\\\\\\\m\\\\\\\\\\\\I!\\\m\\\\\Willl\\\\\\\\lm\\\\lUl\W:mm\\\\\\\\\\\\\\\\\\ll\\l\\\\mnml\!\\mmmm\l\\\mmll\\\l\\\
\\llmmm\mmlllllmmllmrimllmml\\\mmlml111\llllllmrilmlfimrtlll1l11mlmlllml'!111111m~11lmlll!':ml
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; . . . . . . , , . . . ~ ~Xi
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest or. . . . . , . . . , . , .
d. receive the promise for life of either payments, benefits or care? . , . .
2. If death occurred after December 12, 1952, did decedent transfer property within one year of death
without receiving adequate consideration? . .". . . . . . . . . . . D [!J
3. Did decedent own an ~in trust for" or payable upon death bank account or security at his
or her death? . . . . . . . . . . . . .. ......... 0 IT!
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? . . .. .......... . . . . . . . . . 00 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN.
Under penaltIes of perJury,l dedare that I have examined thIs return, Including accompanyIng schedules and statements, and to the best of my knowledge and bellef,lt Is trUll,
carre and complete. DeclaratIon of preparer other than the personal representative Is based on all Information of whIch preparer has any knowledge.
GNA RE9f'>EiRSoNRESP EF RFILlN;nRE RN WILLIAM M. DAVIS NEIL A. DAVIS
~~ . ~ 1
( 137 Bosler Avenue 61 Charles Street
~~ ~. ~ --i:e~;yne-,--PA---i'ii:f43---Mecftilll{Csburg,--PA-i7055
SIG/NA~ OF P~~~R O/~~ER T N REPRESENTATIVE DATE
- ,/ c/o Johnson, Duffie, Stewart & Weidner
'-01- Marke't - St; - p:6: - BOx- Y(j9~ - -i.eroyne-; -PA -n043
Hi ':;:;:ii;;'iii!!i'ii,,,:::;\\j\'::'i~:\:mm;;i::;; )';;~;\';':mr:~!!;;1;;~'i:'!ril~il:1~~1:;:~~; iiiiti;;,,;:;;;;:;:;:::ni mmmr:l))' ":, ',I" , ',l" ';, ' ,'\ 'j t" /\:lllmmmmmmr mm!
rmmmmmmmmmm1!l! !!iijliimmii: H!i!!::lll]nmm:::iil::i!!mm! :!:;!i:!!i;: !iif ;,;1,
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or far the use of the
surviving spouse is 3'(, [72 P.S. 9116 (a)(1.1) (il].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is O~/~
[72 P.S. 9116 (a) (1.1) (i0]. 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.
DATE
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased ch'lld twenty-one years at age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(.)(1IJ.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3l]. 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.
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6_00)
REV-15~2. EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FilE NUMBER
JEAN M. DAVIS SS# 184-12-4526 07/25/2001 21-2001-00746
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 w\\\ing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
DESCRIPTION
NUMBER OF DEATH
1 Real Estate located at 325 Herman Avenue, Borough of Lemoyne, 60,000.00
Cumberland County, Pennsylvania as per attached appraisal.
SCHEDULE A
REAL ESTATE
TOTAL (Also enter on line 1, Recapitulation) $ 60,000.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97)
REV~ 15?3 E'.X ~ (1-97)
SCHEDULE B
STOCKS & BONDS
COMMONWEAl.TH OF PENNSYLVANIA
INHERITANCET1J< RETURN
RESIDENT DECEDENT
ESTATE OF
JEAN M. DAVIS
SSfl 184-12-4526
07/25/2001
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21-2001-00746
ITEM VALUE AT DATE
DESCRIPTION UNIT VALUE
NUMBER OF DEATH
1 2,610.365 shares GE FDS Government Securities - FD C1 B 8.37 21,848.76
I
TOTAL (Also enter on line 2, Recapitulation) 21,848.76
(If more space is needed, insert additional sheets of the same size)
copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1503 EX (Rev. 1-97)
REV-15~8 EX+(1-97)
COM MONWEAL TH OF PEN N SYLVANIA
INHER\TANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JEAN M. DAVIS SS# 184-12-4526 07/25/2001 21-2001-00746
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ITEM
NUMBER
1 COMCAST CABLE - Refund
DESCRIPTION
VALUE AT DATE
OF DEATH
2.09
2
County Meadows West Shore II - Security Deposit
2,155.96
3
County Meadows West Shore - Pharmacy Refund
35.03
4
EMI/THORN - Cash Distribution
13 .21
5
General Electric Co
GE Capital Longer Term Care
1,800.00
6
General Electric Co
Capital Assurance
540.00
7
Guideposts - Guideposts Magazine Refund
48.86
8
Internal Revenue Service - Tax Rebate
300.00
9
Miscellaneous Personal Property
125.00
10
PA State Retirement - PA State Employees Retirement
582.50
11
PNC Bank Certificate of Deposit
Account No. 21001019595
Accrued
5,000.00
8.23
455.04
12
Prudential Financial - Cash
TOTAL (Also enter on line 5, Recapitulation) $ 11,065.92
(If more space is needed, insert add'ltional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-150a EX (Rev. 1-97)
REV-1509 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESICENT DECEDENT
ESTATE OF
JEAN M. DAVIS
SCHEDULE F
JOINTLY-OWNED PROPERTY
SSfft 184-12-4526
07/25/2001
FILE NUMBER
21-2001-00746
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
A.
SURVIVING JOINT TENANT(S) NAME
William M. Davis, Jr.
ADDRESS
137 Bosler Avenue
Lemoyne, PA 17043
RELATIONSHIP TO DECEDENT
Son
B.
Neil A. Davis
611 Charles Street
Mechanicsburg, PA 17055
Son
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of fInancial InstItutIon and banK DATE OF DEATH DECD'S VALUE OF
account number or similar Identifying number.
NUMBER TENANT JOINT Attach deed for}ol"tly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A,B 01/17/95 PNC Bank Certificate of 6,000.00 33.33% 2,000.00
, Depos it - Account
21001019582
2 A,B 01/01/78 PNC Bank Checking 20,049.78 33.33% 6,683.26
- Account No.
5140015098
TOTAL (Also enter on line 6, Recapitulation) $ 8,683.26
(If more space is needed insert additional sheets of the same size)
copyrlght(c:) 1996 form software only CPSystems, Inc:.
Form REV-1509 EX (Rev. 1-97)
REV-1510 EX +(1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERJTANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF
JEAN M. DAVIS
07/25/2001
SSII 184-12-4526
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
FILE NUMBER
21-2001-00746
DESCRIPTION OF PROPERTY % OF
ITEM RELAW8h~~I~ t~ 'b~~~5~~.l~~J~~~1f,tV~:EJF ~~~~SFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH ACOPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1 PNC Bank Individual 12,641. 39 12,641. 39 0.00
Retirment Account - No.
65001007439
Established: 2(211995
Beneficiaries:
William M. Davis, Jr.
Neil Davis, Son
TOTAL (Also enter on line 7, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1510 EX (Rev. '.97)
REV-15." EX+(1~97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETA)( RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
JEAN M. DAVIS
SSff 184-12-4526
07/25/2001
FILE NUMBER
21- 2001-007 46
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES,
Musse1m.n Funeral Home
Funeral Luncheon
Rolling Green Cemeeary
Organis
Ministe ..
B.
1.
2.
3.
AMOUNT
3,980.00
400.10
605.76
100.00
150.00
ADMINISTRATIVE COSTS,
Personal Representative's Commissions
Name oi Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
Attorney's Fees Johnson J Duffie J Stewart & Weidner
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
500.00
4.
Regiseer of Wills
214.00
Probate Fees
5.
Accountant's Fees
175.00
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Borough of Lemoyne - Maintaining sewer payments on residence of
Decedent
207.28
2
Borough of Lemoyne - Building Permits for Residence
10.00
3
Carlos R. Leffler - Maintaining heae for residence
1,506.37
4
Deaeh Certificaees
18.00
5
Inventory - Filing Fee
10.00
6
Maintenance of Residence - Roofing Repairs
613 .19
TOea1 of Coneinuation Schedule(s)
193.53
TOTAL (Also enter on line 9, Recapitulation) $ 8 ,683.23
(If more space \s needed, insert additional sheets of the same size)
Copyright (cl 1996 form software onlyCPSystems, Inc. Form REV..1511 EX (Rev, 1-97)
Estate of: JEAN M. DAVIS
Soc Sec #: 184-12-4526
Date of Death: 07/25/2001
Continuation of Schedule H-B7
(Other Administrative Costs)
Item
If
Description
Amount
7
The Cumberland Law Journal - Advertising Expenses
75.00
8
The Patriot News - Advertising Costs
118.53
193.53
REV-15.12 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERtt/I..NCE T/I.X RETURN
RESIDENT OEceDENT
ESTATE OF
JEAN M. DAVIS
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SSfj 184-12-4526
07/25/2001
FILE NUMBER
21-2001-00746
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
2001 West Shore School District Real Estate Tax - taxes
AMOUNT
738.11
2
Checks clearing after date of death
605.76
3
Internists of Central PA - Final Medical Bill
4.41
4
State Employees Retirment Service - Reimbursement of Overpayment
120.42
5
Verizon - Telephone charges
9.87
TOTAL (Also enter on line 10, Recapitulation) $ 1 ,478 . 57
(!f more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc:. Form REV-1512 EX (Rev. 1-97)
REV~1~13 E:X +(9-00)
COMMONWEA\.TH OF PENNSYLVANIA
rNHERITANCETPJ< RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
JEAN M. DAVIS
SSff 184-12-4526
07/25/2001
FILE NUMBER
21-2001-00746
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trust__(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS !Include outrIght spousal distributIons, and
transfers under Sec. 9 t 16(aXl.2)j
Will i,1m M. Davis, Jr
Neil 1. Davis
Son
Son
45,468.07
45,468.07
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
First Christian Church - Lemoyne, Pennsylvania
500.00
TOTAL OF PART 11- ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets oi the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
500.00
Form REV-1513 EX (Rev. 9-00)
WILL
OF
JEAN M. DAVlS
I, JEAN Moo DAVIS, of the Borough of Lemoyne, Cumberland County,
Pennsylvania, declare this to be Il\Y last will and revoke a.ny wil1.
previouely made by me.
Item II I direct that all JJV just debts ~d funeral oxpenses shell
be paid from the assets of' lI\Y estate as scon as practicable after nv
decease.
Itsm II: I beq.ueath the sum of Five Hundred ($500) Dollars to
TIlE FIIlST CHRlSTIAN CHURCH of Lemoyne, Pennsylvenia.
Item III: I devise: and bequeath the residue of lI\Y estate of' every
nature and wherever situate to my issue, per stirpes.
Item IV: I appoint JJV sons, WILLIAM M. DAVlS, JR. end NEIL A. DAVlS,
or the survivor of them, executors of this my last will.
Item V: I direct that my personal representatives shall not be
required -to give bond for the fail.hful performance of their duties in
any jurisdiction.
. XX
IN WITNESS WHEREOF, I have hereunto set JJV hend this l;:l _ day of
(j)ctc~
, 1965.
:;)" d
-;in
-
W,u'-AA--
The preceding instrument, consisting of this typewritten page identified
by the signature of the testatrix, was on the day and date thereof signed,
published, end declared by JEAN M. DAVlS, the testatrix therein named as end
for her last 'Will, in the presence of UB, who, at her reque8~, in her presence,
as witnesses hereto
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