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Home My WebLink About05-07-08 (2) 1" ~ 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 07 0712 Date of Birth 206-10-8173 07/15/2007 01/20/1907 Decedent's Last Name Suffix Decedent's First Name MI Potteiger Russell L (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 <e;; 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 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 Telephone Number ~ Mark W. Allshouse, Esq. (717) 582i@g . ; F~{ [8 Firm Name (If Applicable) G:J;;g ...............,..... ....G~) REGIS~QE@LS uSI!C)NL y ~?.:'.~ eQ :.- ~ h1 I rT'j r'fl :F-:; ~6 :;0 -.J :Ti C'J '~"-J ?' CJ.' 0 '-- ('")0 ):110 "~i-n () 0." :x ;.. "".II OC _ :::':1. (~ ::::0 _ ....t rn :0 -of .. f} ..') )> U"I ~''''fl't Q) , 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Christian Lawyer Sol. First line of address 4833 Spring Road Second line of address City or Post OffICe Shermans Dale State ZIP Code DATE FILED PA 17090 Correspondent's e-mail address:mark@christianlawyersolutions.com Under penalties of perjury, I declare that I have e amined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is . co and complete. Declaratio of parer other than the personal representative is based on all information of which preparer has any knowledge. slq AT RE FP~~~P_o:_ _~:~N~~~__.____ -.------~/l~;:;~--------.- AD S .~8 R~~e Hi!'Boad, Mec~_ ics~urgJ:~EQ.~Q._.___..__ _____._._. __._.____.______.________.___ SIGNATURE OF PRE OTHE , PA 17090 PLEASE USE ORIGINAL FORM ONLY _ ~/2I#ATE --_._.._~_.- Side 1 L 15056051058 15056051058 .-J ~ ,. .....I 15056052059 REV-1500 EX Decedent's Name: RECAPITULATION Russell L Potteiger 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) - . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . - .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value SUbjectto Tax (Line 12 minus Line 13) ... . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - 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_ 16. Amount of Line 14 taxable at lineal rate X.O 45 10,223.48 17. Amount of line 14 taxable at sibling rate X .12 18. Amount of line 14 taxable at collateral rate X. 15 15. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number 206-10-8173 10,223.48 10,223.48 0.00 10,223.48 10,223.48 16. 460.06 17. 18. 460.06 15056052059 ---I t' REV-1500 EX Page 3 Decedent's Complete Address: DECEDENrs NAME Russell L Potteiger STREET ADDRESS 118 Ridge Hill Road DECEDENrs SOCIAL SECURITY NUMBER 206-10-8173 CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 460.06 Total Credits ( A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty ~------ ---~-~- Total Interest/Penalty ( D + E) (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) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 460.06 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 460.06 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 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i] c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 Ii] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 Ii] 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)). 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 zero (0) percent [72 P.S. 99116 (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 twenty-one 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 zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. 99116(a)(1)). The tax rate imposed on the net value of transfers to or for the use ofthe decedent's siblings is twelve (12) percent [72 P.S. 99116(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-1S0. EX. (6-9.* COMMON\lVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Potteiger, Russell L. FILE NUMBER 21-07-0712 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Allegheny County Hospital Development Authority - Hospital Revenue Bond, Series A of 1994 (South Hills Development Project) Cusip: 01728AHA7, Certificate # R-0231 VALUE AT DATE OF DEATH 10,223.48 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10,223.48 P.02/02 APR-09-2008 12:11 ~bank." ~ Pi.eS'w~~(l~ Corporate Trust SSNices P.O. Box 64111 St. Paul, MN 55164-0111 Fax: (661) 495-8141 Web aite; www.usbank.comlcorpotat&trust April 9 t 2008 Rerere.~e Number: 1D426119 DIANN ARMSTRONG Re: ALLEGHENY CNTY HOSP DEV AUTH HOSP REV DDS SER A 94 (SOUTH BILLS HEALTH SYSTEM), CUSIP 01728AR\7. Certificate R_231. Dear Madam: Thank you for your inquiry to u.s. Bank Corporate Truh1 Services dated April4~ 2008, requesting information on the above referenced bond issue. Our re~ords indicate that certificateR....23) has been called and was due for payment on May 14,2004. The original boRd must be presented to U.S. Bank in order to receive the principal payment. The back of the bond does not need to be endorsed for the holder to receive payment. Our mailing address is as foUows: U.S. Bank Corporate Trust Servi~es P.O. Bo~ 641I I St. Paul, MN 55164-0111 We recommend that the certificate be sent by regi5tercd Or certified mail. In addition, please submit a letter of instruction listing the address to which'the proceeds should be mailed. The amount payable is $10.223.48. Premium- $200.00, In1:erest~ $23.48, Principal- $10,000.00. If the original bond cannot be located or you have additional questions. please contact Bondholder Services at 1 (800) 934-6802 or (65 I) 495~ 7026. Our customer service representatives are avaiJable Monday through Friday 8:00 a.m. to 6:00 p.m. Centtal Time. Sincerely. Apri~tomer 80m Bondholder Services nCOM.S95I TOTAL P.02 ,.-., < ..... z ~ ~~ ~.>- ~~ ~z o~ =~ "-' r;~ zQ ;;>~ 0= Uf- >c~ z~ ~~ ~z ~,~ ~~ ..J~ <0 ~ ~ > ~ Q i~ """0 u...1IJ 0.., cO (/)G: We.. -2 tCw wI- <nU) -> aU) z 0:1: co'" ..... we :)1&.1 z:r: wen >..... W...J a:- -14 ~~ -:;:) 0.0 t.nfl) o~ X W f- g i ~ <( :e ~ < cr fn w a: e! ~ r~, 0.: as ::> (,) r~". kt-; t' " "'4 1<'<'1 "1<< .~ o t.;,;) [C' '* f{ <If 4.' "1( .+, .,,' '/I: * +: Vi 4c .<< -1t * -0: "" ~ "'" "'" 'l< *' '~_0_ i ~ z ~ o Q ~ :c = ~ c ~ t:lr:; .~ z ;.;J o :! -< ..J <: Q,. o !i Ci c.. tn a: :3 ....J o Q .... !-t it ~ ~ ::J << ,.. z w ~ "" o ..J to >- ~ Q ...J < f- a; ~ .. >- I:- ~. o t.I ;;... Z w ~ ~ :: <' << +; 1'; k +; .1{. 1'; ). .%~ 4l '" ok << 'f< ~ 14 1( +; ~.'!.., J ;.,r, .,' , ~ " ji *",' ~ .'. .'. ..... ..'......'.:?:..' $ f ~ <1 ~ M ,1 LAST WILL AND TESTAMENT OF RUSSEL, L. POTTEIGER I, Russel L. Potteiger, of New Kingstown, PA, declare this to be my Last Will and Testament hereby revoking all prior Wills and Codicils. ARTICLES I. I have one child who 1S now living, whose name 1S Robert L. Potteiger. I have intentionally made no provision in this will for my son. II . The expenses of my last illness and funeral shall be paid from the funds of my estate. Page 1 of 8 III. I give to my grandchildren li ving at the time of my death, all of my jewelry, clothing, furniture and furnishings, chinaware, silver, pictures, works of art, books, personal automobiles, boats and other tangible articles of a personal nature, not otherwise specifically disposed of by this Will and not including intangible property such as cash or securities, together wi th any insurance thereon, in equal shares. IV. In the event my gross estate at the time of my death is worth more than $400,000.00, I give my real property known as Rear 43 Carlisle Pike, New Kingstown, PA as set forth in Deed Book "F" , Page 2 of 8 Volume 29, Page 335, recorded in the office of the recorder of deeds of Cumberland County on November 24, 1980, to my granddaughter, Bonnie L. Barnes, of York Springs, PA. In the event my gross estate valued at the time of my death ~s worth $400,000.00 or less, I do not give this real property to Bonnie Barnes, and it shall be added to my residuary estate. If I do not own or have an interest in the specifically bequeathed property at the time of my death, this gift shall fail, and my residuary estate shall be distributed according to Article V. V. In the event that my granddaughter, Bonnie L. Barnes, receives my home pursuant to Article IV Page 3 of 8 . . herein, I give the remainder of my estate to my grandchildren, Bonnie L. Barnes, Ronald L. Potteiger, of Florida and Diannl L. Armstrong, of Mechanicsburg, PA, in equal shares. The value of the real estate given to Bonnie will be counted against her share in the div;sion of the remainder. In the event that my granddaughter, Bonnie L. Barnes, does not receive my home pursuant to Article IV herein, I give the remainder of my estate to my grandchildren, Ronald L. Potteiger, of Florida, Diann L. Armstrong, of Mechanicsburg, PA, and Bonnie L. Barnes, in equal shares. VI. If a grandchild named in Article V does not survive me by 30 days and leaves issue who so Page 4 of 8 survive me, such issue shall receive, per stirpes, the share the grandchild would have received had he or she so survived me. In case of the failure of such issue, then such grandchild's share shall pass in equal shares unto my grandchildren who are to receive part of my estate under Article V who survive me.. VII. All taxes and interest and penalties thereon payable by reason of my death with respect to property comprising my gross taxable estate, whether or not passing under this Will, shall be paid from the principal of my residuary estate.. VIII. I appoint my son, Robert L.. Potteiger, as Executor of this, my Last Will and Testament. If Page 5 of 8 . . Robert L. Potteiger is unable or unwilling to act or continue as Executor for any reason whatsoever, I appoint my granddaughter, Dianni L. Armstrong, successor Executor. No fiduciary acting hereunder shall be required to post hond or enter security in any jurisdiction. IX. In all references herein to "Executor or" or "Testator" the use of any particular gender or plural or singular number is intended to include the appropriate gender or number as the text of the within instrument may require. IN WITNESS WHEREOF, I, Russel L. Potteiger, hereunto set my hand and seal this 'L.'~ day of ~1"")f~!AN\ L'\P~ , 2001, to this my Last Will and Testament which consists of 8 typewritten pages. SIGNED, SEALED, _ ,,\. /) '.' Rus::e.l) L. 'll"bt /9gef t./I,AJJ--v~t ,~-- PUBLISHED AND DECL n-) ~qJ~sel L. Page 6 of 8 . . Potteiger, the Testator above named, as and for the Testator's Last Will and Testament, and in the presence of us, who, at the Testator's request, in the Testator's presence and in the presence of each other have subscribed our names as witnesses. i{/l tff~ {,:~ '(Itt'tf 7- ' :~ Witness 1I~.r-hC7b/, PA Address CJ/!cl(/tl j),<-<- i(t,r- Witness1 1h.'r,;~uJ f'A Address COMMONWEALTH OF PENNSYLVANIA ss. : COUNTY OF DAUPHIN I, Russel L. Potteiger, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed this instrument as my Last Will, that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. AJU~~\PR~t:1f Potteiger . /llJlKvV Sworn or affirmed to and ackno~eagijd before me by Russell L. Potteiger, the Testa tor, this ?~~.jl, day of ~/~""'$f~&"v1 Ae'-/'-- , 2001. "\ COMMONWEALTH OF PENNSYLVANIA C~h~~'~ ~"-~ 'L ubI I I NOTARlAL SEAL I JOD: GOLDRING, Notary PUblic , Harnsburg, Dauphin Ccunty PA l My Commission Expires Nov 03, 2001 55. : i c J I COUNTY OF DAUPHIN ) "~ 'l~'t/ j;/ Ji r- WE, 0) ; . r.t-{ c.V\. L .~id: (~ , and the witnesses whose names are signed to the atta Page 7 of 8 . .. I ... ~ instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and Executore the instrument as the Testator's Last Will; that the Testator signed willingly and that the Testator executed it as the Testator's free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time Eighteen or more years of age, of sound mind and under no constraint or undue influence. ii' ilBk :~ I~/I c/ 1 {l&J14U~ t" ! {- Witness c.lftt,tLo.. Witnes#' "">, (j) ~ (*rL(~I Sworn or affirmed to and LI),~llr~tVl L f .4/k-F , and subscribed before me by 1J-lcyJ!_ J.)ra~ L-) ,.,~-,) J -...;'7 }- :-e1'~"?-ll1 /j:~~ witnesses, this 7 ~,f6 day of 2001. /" /) I r~oT;AIAL-SEP.;--1 , JOO:( GOLDR!NG, Nclary Public I I Harrisburg, Dauphin County PA l My Commission Expires Nov 03, 2001 -------- Page 8 of 8