The URL can be used to link to this page

Home My WebLink About05-11-84 . . Ie:< 702 /.t/ REV-1500 EX+ (8-83) . - - INHERITANCE TAX RETURN COMMONWEALTH OF PENNSYLVANIA RESIDENT DECEDENT DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE 21..78-527 BUREAU OF EXAMINATION FILE NUMBER P.O. BOX 8327 WITH REGISTER OF WILLS) HARRISBURG, PA 17105 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S ADDRESS to- Z DA VISI STEVEN CRAIG 74 Cave Hill Drive III CI III SOCIAL SECURITY NUMBER DATE OF DEATH Carlislel PA 17013 U III 199-50-1266 Feb. 181 1984 CI County Cumbe rland I IKh. Original Return o 2. Supplemental Return 03. Remainder Return ~1Il: '" UD.III~ 04. Life Estate o .40. Future Interest Compromise 05. Federal Estate Tax 1II0to-~ :Z;1Il:c(... Return Required U::: IIlI 06. Decedent died testate o 7. Decedent maintained a living trust ..Q. 8. Total Number of safe deposit boxes c( (Attach copy of Will) (Attach copy of trust) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: to- NAME ADDRESS J.z Robert M. FreYI Attorney 5 South Hanover Street 11I11I 1Il:C1 IIl:Z TELEPHONE NUMBER 00 UD. (717) 243-5838 Carlisle Pal 17013 CITY STATE ZIP 1. Real Estate (Schedule A) ( 1) (...) cD (- :;0 0_; .l::>. ~l~;~ 2. Stocks and Bonds (Schedule B) ( 2) ~!~t '=>o 3. Closely Held Stock/Partnership Interest (Schedule C) ( 3) :co ::,:~) u 'Cl ., --J .- - , :"'1 .4. Mortgages and Notes Receivable (Schedule D) ( .4) --" 11769.14 -.- 5. Cas~ Bank Deposits & Miscellaneous Personal Property( 5) .,. Z (S edule E) , )::> 0 ;:: 6. Jointly Owned Property (Schedule F) ( 6) '-C ~ ::;) 7. Transfers (Schedule G) (Schedule L) (7) to- 11769.14 i: 8. Total Gross Assets (total lines 1-7) ( 8) c( 21853.27 U 9. Funeral Expenses, Administrative Costs, Miscellaneous ( 9) III Ill: Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 21853.27 11. Total Deductions (total lines 9 & 10) (11) 12. Net Value of Estate (line 8 minus line 11) (12) (11084. 13) 13. Charitable and Governmental Bequests (Schedule J) (13) 14. Net Value subject to tax (line 12 minus line 13) (14) ..0- 15. Amount of line 14 taxable at 6% rate (15) x.06 = (include values from Schedule K or Schedule M) 16. Amount of line 14 taxable at 15% rate (16) X .15 = (include values from Schedule K or Schedule M) Z 17. Principal tax due (add tax from line 15 plus tax from line 16) (17) 0 ~ 18. Total Prior payments: Amount Paid Discount Interest to- + - (18) ::;) D. ~ 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19) 0 A. OCheck here if you are requesting a refund of your overpayment. U ~ 20. If line 17 is greater than line 18, enter the difference on line 20. This is the BALANCE DUE. (20) to- A. Enter the interest on the balance due on line 20A. (20A) B. Enter the total of line 20 and 20A on line 20B. (20B) Make Check Payable to: Register of Will., Agent ....BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH.... 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. I declare that all real estate has been reported at true market value. Declaration of preporer other than the personal representative is base n all informatio f w . arer has any knowt.dae . ^-4-A-' tL-1...-t..<.4-, 7"* Cave Hill Drive, Carlislel Pal 17013 Aprrl10, 1984 SI ATURE OF PERSON RESPONS BLE FOR FILING RETURN ADDRESS DATE , ~"- t::-- ). SIGNATURE OF PREPARER OTHER ';;;IN REPRESENTATIVE 5 S. Hanover St. I Carlisle. Pal 17013 ADDRESS April 10. 1984 DATE YES NO 1. Did decedent make a transfer and: a. retain the use or income of the property transferred, b. retain the right to designate who shall use the property transferred or its income, c. retain a reversionary interest or d. receive the promise for life of either payments, benefits or care? 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an 'in trust for' bank account at his or her death? .....1...... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. i r REV-I508 EX+ (9-81) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE liE" CASH AND MISCELLANEOUS PERSONAL PROPERTY FILE NUMBER STEVEN CRAIG DAVI S 21-78-527 (All property Jointly~wned with the Right of Survivorship must be disclosed on Schedule "F") ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Balance of patient account at Selinsgrove Center 1,620.14 2. Adjustment in patient's account due from Commonwealth of Pennsylvania 149.00 TOTAL (Also enter on line 5, Recapitulation) $ 1,769.14 (If more space is needed insert additional sheets of same size) COMMONWEAL TH OF PENNSYLVANIA OEPARTMENT OF PUBL\C WELFARE TELI!PHONE: 374-2911 SELINSGROVE CENTER BOX 500 SELlNSGROVE PENNSYLVANIA 17670 ARE.... CO['E 717 March 28, 1984 Robert M. Frey, Esquire 5 South Hanover St. Carlisle, PA 17013 Re: Steven Davis Estate Dear Mr. Frey: Enclosed is check no. 9882, in the amount of $1,620.14. This represents the balance of the estate except for $149.00 which was paid to the Commonwealth in error after Steven's death. As soon as this is refunded it will be forwarded to you. The Commonwealth has outstanding bills of $149.00 for January, 1984 and $185.27 for February, 1984 for care and maintenance. See enclosed bill. Sincerely, " 't.I{'1 J I) I .', Y..t~j,-l llonita J. Stahl Guardian Officer llJS:gw Enclosures cc: David E. Hassinger, Facility Reimbursement Officer VISITING HOURS DAILY 9:00 A.M. TO 7:00 P.M. UIMMONWEALTII 0" I'ENNSYLVANIA DEI'ARTME....... .It' PI;Hl.1L WELt'ARE Please Remit To: REVliJUE AGENT SELlNSGROVE CENTER SELlNSGROVE. PENNSYLVANIA 17B70 KINDLY RETURN THIS PORTlpN OF STATEMENT WITH REMITTANCE [", ALL CHECKS AND MO:'llEY ORDERS TO HE MADE PAY AHLE TO COMMON- WEALTH OF PEN;\/SYLVA:'lIIA. BILL TO steven C. Va.V.(-6 J MAILAI.I. IlEMIT/'A:'lICES TO THE IlEVENIIE AI;t;."T AT SEI.I;\/S(;ROVE CENTER. CHECKS ARE RECEIVED SIIHJECT TO HNAL I'AYMENT AND AT THE RISK OF THE PAYER. SEE NOTICE OF RIGHTS ON REVERSE SIDE PW353-B-77 CODE PREVIOUS fA TIENT AGREED BILUNG RATE BALANCE DATE NUMBER DESCRIPTION CHARGES CREDITS BALANCE 1-31-84 5190 149.00 2-29-84 5190 149.00 36.27 334.27 PW~ 8-77 REV-1511 EX+ (7-83) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE "H" FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES STEVEN CRAIG DA VIS FILE NUMBER 21-78-527 ITEM NUMBER A. 1. B. 1. 2. 3. 4. C. 1. 2. DESCRIPTION AMOUNT Funeral Expenses: Ewing Brothers Funeral Home 2,294.00 Administrative Costs: Personal Representative Commissions Social Security Number of Personal Representative: Year CommissiOlll Plid Attorney Fees 200.00 Family Exemption Claimant. Address of Claimant at decedent's death Relationship Probate Fees 2 O. 00 Miscellaneous Expenses: Register of Wills, filing Inheritance Tax Return Balance due Commonwealth of Pennsylvania for patient care and maintenance 5.00 334.27 TOTAL (Also enter on line 9, Recapitulation) 2,853.27 $ (If more space Is needed insert additional sheets of same size) f ' ,..... REV-1S13 EX+ (9-81) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE "J" BENEFICIARIES ESTATE OF STEVEN CRAIG DAVIS FILE NUMBER 21-78-527 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT A. Taxable Bequests: 1. Lewis G. Davis fathe r 100% Madeline A. Davis mother 74 Cave Hill Drive Carlisle, Pa. 17013 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT B. Charitable Bequests: 1. NONE TOTAL CHARITABLE BEQUESTS (Also enter on line 13, Recapitulation) $ (If more space is needed insert additional sheets of same size)