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1505607120
REV-1500 ~ (06-05) OFFICIAL USE ONLY
PA Department of Revenue county code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 9 015 6
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
165 16 9088 O1 11 2009 02 28 1920
Decedent's Last Name Suffix Decedent's First Name MI
BOTTONARI WILLIAM V
(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
X^ 1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
X^ g, Decedent Died Testate ~ ~ Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes
(Attach Copy of will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 1 p. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and i-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
LEE C. SWARTZ ESQ. 717 234 412,1,
Firm Name (If Applicable) - `'' -'
REGIST~Ft(~? WILLS ~ ONCY,~
TUCKER ARENSBERG, P.C. ~_
I,r-
First line of address ' `; iN . ~ . ;
111 NORTH FRONT STREET -; -~;-,
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Second line of address i ~ -
r ~ =~ y
P.O. BOX 889 '-'-~ _ --,
City or Post Office DATE FILED c. ~ '
State ZIP Code
HARRISBURG PA 17108-0889
111 North Front Street, Harrisburg, PA 17108-0899
SRlli~/~ EPARER~R THAN ~E~RESEN~E ' q. O DATE
~~~ /-~,,,r///~_'1 Neil E. Hendershot Es a~'
ADDRESS
111 North Front Street, Harrisburg, PA 17108-0889
Side 1
1505607120 1505607120
Correspondent's a-mail address:
Under penalties of perjury, I deGare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative rs based on all information of which preparer has anv knowledoe.
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REV-1500 EX
1505607220
Decedent's Name: W l i i l a IYt V. B o tt o n a r i
RECAPITULATION
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.
Decedent's Social Security Number
165 16 9088
170,000.00
23,119.04
1,878.09
194,997.13
9. Funeral Expenses 8 Administrative Costs (Schedule H) ......................................... 9. 9, 7 9 1. 4 8
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................................ 10. 4 , 14 9 . 2 5
11. Total Deductions (total Lines 9 8~ 10) ......................................................................11 • 1 3 , 9 4 0 . 7 3
12• Net Value of Estate (Line 8 minus Line 11) .............................................................12. 1 8 1 , 0 5 6 . 4 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13,
14. Net Value Subject to Tax (Line 12 minus Line 13) . ................................................ 14. 1 8 1 , 0 5 6 . 4 0
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 .o0 0. 0 0 15• 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x .045 181 , 0 5 6. 4 0 16. 8, 14 7. 5 4
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18• 0. 0 0
19. Tax Due .................................................................. ................................................ .19. 8 , 14 7 5 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505607220 1505607220
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-0156
DECEDENT'S NAME
William V. Bottonari
STREET ADDRESS
37 South 24th Street
CITY
Camp H[II STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenatty if applicable
p. Interest
E. Penalty
0.00
Total Credits (A + B + C)
Total InterestlPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
q, Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(1) 8,147.54
(2) 0.00
(3)
(4)
(5) 8,147.54
(5A)
t5B) 8,147.54
Make Check Payable to: REGISTER OF WILLS, AGENT
. ,.,
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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 :.................................................................................~
b. retain the right to designate who shall use the property transferred or its income :.................................... ~ a
c. retain a reversionary interest; or ...............................................................................................................~ ^x
d. receive the promise for life of either payments, benefits or care? .............................................................~ a
2. If death occurred after December 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? ...................................................................................................................~ ^x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
vur- t "'. '~ .,^~""'_".^' , S .~.. .... , r ';i .I ..~~c~........r>.e~, ... ~..r..... ~ .... ~ ~ w rt.~ ~_...__.~ ..'i}.. . `; . -.. ... ...
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. §9116 (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. §9116 (a) (1.1) (ii)]. The statute does not exemot 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. §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 four and one-half (4.5) percent,
except as noted in 72 P.S. §9116 1.2j [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 twelve (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.
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Rev-1502 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF - (FILE NUMBER
Bottonari, William V. 21-09-0156
All real propeAy owned solely or as a tenant in common must bs 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 which la jointlyowned with right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Residence -House 8t lot titled in Decedent's sole name located at 37 South 24th 170,000.00
Street, Camp Hill (Camp Hill Boro, Cumberland Co.), PA, valued per real estate
appraisal (attached to PIT Return filed with PA DOR), stated as of May 1, 2009, by
Rick Sellars, per Howard Hanna Real Estate
TOTAL (Also enter on Line 1, Recapitulation) I 170,000.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98)
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Rev-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, 8~ MISC.
PERSONAL PROPERTY
ESTATE OF (FILE NUMBER
Bottonari, William V. 21-09-0156
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedulo F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Cash -Cash found in Residence by Executor post-mortem 790.00
2 100 Stillwater CD -Certificate of Deposit, dated 01!30/08, due 01/30/09, at 3.5% by 10.000.00
Stillwater National Bank 8 Trust Co.
Accrued interest on Item 2 through date of death 331.53
3 100 Wachovia CD -Certificate of Deposit, dated 08/13/08, due 05/13/09, at 4.2% by 10,000.00
Wachovia Bank, N.A.
Accrued interest on Item 3 through date of death 233.33
4 Furnishings -Household contents 8 furnishings located in residence, valued per 500.00
estimate by Executor for used furniture in poor condition
5 Toyota Sedan -1994 Camry, in poor condition (does not start, needs repairs, not 500.00
inspected)
6 Debt Repayment -Payment received on balance owed by third-party purchaser 200.00
(Decedent's next-door neighbor's son) on pre-death sale 8: transfer of Decedent's
1994 Ford Taurus station wagon
7 Highmark -Refund issued by Highmark for unearned premium 561.18
8 PA Department of Revenue -Refund check 3.00
TOTAL (Also enter on Line 5, Recapitulation) I 23,119.04
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
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Rev-1509 EX+ (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bottonari, William V. 21-09-0156
If an asset was made joint within one year of the decedenYa date of death, it must bs reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. John K. Bottonari Harrisburg, PA 17102 Son
B.
C
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOIN
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
ALOE OF ASSE' % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1 M8~T Checking Account -Joint checking 3.756.17 50.000% 1,878.09
account No. 167706xxx held at M&T Bank
by Decedent with predeceased wife Jane
B. Bottonari and surviving son John K.
Bottonari, valued per Bank's balance as
of date of death, reported as a one-half
taxable interest
TOTAL (Also enter on Line 6, Recapitulation) I 1,878.09
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
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REV-1151 EX+112-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF I FILE NUMBER
Bottonari, William V. 21-09-0156
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached ~ 2,056.42
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Tucker Arensberg, P.C. 7,000.00
3. 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
4. Probate Fees 185.00
5. Accountant's Fees 100.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 450.06
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 9,791.48
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
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SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Bottonari, William V. 21-09-0156
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Church of the Good Shepard -Funeral luncheon 100.00
2 Hollinger Funeral Home 8 Crematory, Inc. -Funeral services for Decedent -- 1,956.42
Balance due after prepayment applied
H-A Subtotal 2,056.42
Other Administrative Costs
3 Adler 8~ Adler -Tax certification fee 5.00
4 Carlisle Sentinel -Publication of Estate Notice 145.06
5 Cumberland County Recorder of Deeds -Estimated fee to notarize 8~ record deed to 25.00
transfer property from Estate
6 Cumberland Co. Law Journal -Publication of Estate Notice 75.00
7 Recorder of Deeds of Cumberland County -Fee to notarize 8~ record Fiduciary 50.00
Warranty Deed for in-kind distribution of Decedent's residence to residuary
beneficiaries
8 Reserve for closing -Miscellaneous postage, copying, filing fees, and other 150.00
out-of-pocket expenses
H-67 Subtotal 450.06
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
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Rev-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
ESTATE OF (FILE NUMBER
Bottonari, William V. 21-09-0156
Include unreimburesd medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Albright College -Satisfaction of charitable pledge owed by Decedent 500.00
2 American Water Company -Water service to Residence .60.65
3 Camp Hill Borough -Sewer services 125.00
4 CitiBank Credit Card -Debt owed by Decedent on credit card issued by CitiBank 574.38
5 Comcast -Cable television services 185.15
6 Erie Insurance -Property insurance premium 60.00
7 Erie Insurance -Auto insurance coverage on Decedent's vehicle 307.00
8 Family Care -Emergency nursing services for Decedent while in New Jersey 44.36
9 Internal Revenue Service -Final income tax payment for Decedent 92.91
10 Milestone Staffing Services -Caregiver services at home for benefit of Decedent 514.50
before death
11 Miller, Janet K. -Tax Collector -County 8- borough municipal real estate taxes 954.26
assessed as of 01/01/09, owed by Decedent at death
12 Penn Waste -Trash collection service at Residence 48.75
13 State Employee Retirement System -Return of pension overpayment 120.29
14 UGI -Gas service to Residence 453.00
15 UGI -Repairs to furnace 8 water heater 109.00
-TOTAL (Also enter on Line 10, Recapitulation) I 4,149.25
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
rsononarl, vtrllllam v. 21-09-01 56
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
Do Not Llst Trustee s
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions and transfers
under Sec. ~116(a)(1.2))
John K. Bottonari Son 1/2 of tangible 90,528.20
252 Cumberland Street personal
Harrisburg, PA 17102 property; 112 of
net residuary
Diane Carroll Daughter 1/Z of tangible 90,528.20
355 Roberts Lane personal
Scotch Plains, NJ 07076 property; 112 of
net residuary
Total 181,056.40
Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cov er sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
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