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HomeMy WebLinkAbout04-0501FAMILY SETTLEMENT AND FINAL RELEASF ESTATE OF WILLIAM D. MOTTER KNOW ALL MEN BY THESE PRESENTS, that William D. Motter, late of Silver Spring Township, Cumberland County, Pennsylvania, deceased, died intestate on October 28, 1990. Jean P. Motter, his wife, applied for Letters of Administration to the Office of the Register of Wills of Cumberland 'County, on May 28, 2004. WHEREAS, Letters of Administration on the Estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executrix, hereinafter called personal representative; WHEREAS, the personal representative has gathered the assets of the Estate of the said decedent and the assets consist of personal and real property with the total value of $4,777.37 as set forth in Exhibit "A", which is a copy 'of the p~nnsylvania Inheritance Tax Return filed and approved by said personal representative,'~nd whicl~ is attached hereto and made a part hereof, and marked Exhibit "A"; WHEREAS, the debts and deductions, including the payment of inheritance tax in the said Estate, which have now been paid, leave no balance for distribution, als° as set forth in the statement of said personal representative, which is attached hereto and marked Exhibit "B"; NOW, THEREFORE, Jean P. Motter, being the only heir of the said decedent, and being that person entitled to inherit under Pennsylvania statute, does hereby acknowledge that she has this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sums of money, legacies, bequests, and devises as are given, devised and bequeathed to her under Pennsylvania law, which amounts she has received this day or prior to this day; and, she does hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, she agrees that no account is necessary and she does hereby agree that she does consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said personal representative, Jean P. Motter, her heirs, executors, administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the Estate of the said decedent, and I do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, I do hereby covenant and agree with the aforesaid personal representative, that I will contribute pro-rata my share of the Estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said Estate or the aforesaid personal representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. Da{e' ' ~/~ness / ~v/eran P. Motter / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28060I HARRISBURG, PA 1712&-0601 JAMES M ROBINSON TURO LAW OFFICES 28 S PITT ST CARLISLE PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ll-01-Z00q ESTATE OF MOTTER DATE OF DEATH 10-28-1990 FILE NUMBER 21 0q-0501 COUNTY CUMBER LAND ACN 101 Amoun~ Rami~ed REV-15~? EX &FP (01-05) WILLIAM D MAKE CHECK PAYADLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15q7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTTONS AND ASSESSHENT OF TAX ESTATE OF HOTTER WILLIAH DFILE NO. 21 0q-0501 ACM 101 DATE 11-01-200q TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED 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) 5. Closely Held Stock/Partnership Interest (Schedule C) ($) fi. Mortgages/Notes Receivable (Schedule D) (fi) 5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (S) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) {10) 11. Total Deductions 12. Ne~ Value of Tax Return 15. lq. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate Subject to Tax q~,777 57 O0 O0 O0 O0 O0 O0 (8) 6,523.97 .0O (11) (12) (15) NOTE: xf an assessment Nas issued previously, lines lq, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed NOTE: To insure proper credit to your account, subeit the upper port/on of this form with your tax payment. ASSESSMENT OF TAX= 15. Amount of Line lq at Spousal rate 16. Amount of L/ne lq taxable a~ Lineal/Class A ra~e 17. Amount of Line lq at Sibling rate 18. Amount of Line lq taxabZe at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT' DATE NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) EXHIBIT q,777.57 IF PAID AFTER DATE INDICATED, SEE Re FOR CALCULATION OF ADDITIONAL INTEREST. 6. 523.97 1,7q6.60- .00 1,7q6.60- 18 and 19 wi11 to date. (15) .00 X 00 = .00 (16) .00 X 06 = .00 (17) .00 X 00 = .00 (18) .00 X 15 : .00 (19)= .00 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 IS LESS THAN $1, NO PAYMENT ZS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALll-I OF PENNSYLVANIA DEPARTMENT OF R~E DEPq'. 280601 HARRISBURG, PA 1712~-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE OHL'/ ILE NUMBER 21 04 00501 COUNTY CODE YEAR NUMBER z DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INmAL) Motter, William D DATE OF DEATH (MM-DD-YEAR) DATE OF B~RTH (MM-DD-YEAR) 10/28/1990 11/21/1932 (IF APPLICABLEJ SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INmAL) Motter, Jean P SOCIAL SECURITY NUMBER 177-24-3230 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 190-26-6754 [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) [] 4. Limited Eslale [] 4a. Future lnterest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverly Credit (date of death between [] 11.Election to lax under Sec. 9113(A)(AttachSchO) 12-31-91 and 1-1-95) THIS sEcTION MUST BE COMPLETED. ALL coRREsPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: qAME James M Robinson :IRM NAME (If applicable) Turo Law Offices tELEPHONE NUMBER 717/245-9688 COMPLETE MAILING ADDRESS 28 South Pitt Street Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-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 (total Lines 9 & 10) 4,777.37~ None None None None None' 6,523.97 12. Net Value of Estate (Line 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) OFFICIAL USE ONLY c...,3 . z::i I (8) 4,777.37 6,523.97 insolvent (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 or transfers under Sec. 9116(a)(1.2) x .00 (15) 16. Amount of Line 14 taxable at lineal rate 0.00 x .06 (18) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .12 (17) x .15 (18) (19) >~: BE SuRE TO AN~-WF.R---:-/~L-~-QUESTioNs ON ~R~,E SIDE AND ira=CHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: I STREET ADDRESS 6612 Carlisle Pike CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 21) to request a refund 5. If Line1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.0 0 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 er income of the properly transferred; ..................................................................................... [] [] b. retain the right to designate who shal use the property transferred or its income; ......................................... [] [] c. retain a reversionary interest; or .................................................................................. d. receive the promise for life of either payments, benefits er care? .................................................................. 2. 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" or payable upon death bank account or security at his or her death? ............... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] 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, 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Jean P. Motter 6612 Carlisle Pike ('~.~'~, ~ ~'~ r~o ~--j-~) ~ Mechanicsburg, eA 17050 q /..O_. /'C) ¢/ SIGNA~I~o~- ~=.~,~ON RE~SPOI~ISfBgE FOt~'IL]~G'~-'fDRN ADDRESS SIGNATURE OF PREPAREIC, flDTHER II-lAN RE. PIq~I~rrA'I;I~/E .. ADDRESS DATE /i~/// J(%a-4-~ 28 South Pitt Street For .da. res 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 survmng spouse is 3% [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 survMng spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a survMng 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: lhe 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 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 a.2) [72 P.S. §91m (a) 0)1. lhe tax rate imposed on the net value of transfers to or for the usa of the decedent's siblings is 12% [72 P.S. {}9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an indMdual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONVVEALIH OF PENNSYLVAt~IIA IM.~ERrrA.NCE TAX REI!JRN RESIDENT DECEDENT ESTATE OF Motter, William D SCHEDULE A REAL ESTATE FILE NUMBER 2l - 04 - 00501 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 which is jointly-owned with rightof survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1/3 interest in .8 acres, more or less, located in Potter County, Pennsylvania, recorded at Book 179, Page 52 l 1/2 interest in .4 acres, more or less, located in Potter County, Pennsylvania, recorded at Book 226, Page 189 1/2 interest in .5 acres, more or less, located in Potter County, Pennsylvania, recorded at Book 229, Page 1036 TOTAL (Also enter on Line 1, Recapitulation) VALUE AT DATE Of DEATH 3,840.17 429.55 507.65 4,777.37 COMMOt4~/VEALTH OF PENNSYLVANIA INHERITANCE TAX RE'RJRN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & AOIV~Ix~'RATNE (X)STS ESTATE OF Motter, William D FILE NUMBER 21 - 04 - 00501 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 4o FUNERAL EXPENSES: Myers-Hall Funeral Home, Inc. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Jean P. Motter Street Address 6612 Carlisle Pike City Meehanicsburg Relationship of Claimant to Decedent Probate Fees Register of Wills Cumberland Law Journal The Sentinel - Legal Accountant's Fees State PA Zip 17050 Sppuse Tax Return Preparer's Fees Other Administrative Costs TOTAL (Also enter on line 9, Recapitulation) 4,242.50 2,000.00 77.00 75.00 129.47 6,523.97 EXHIBIT "B" GROSS ESTATE $ 4,777.37 LIABILITIES B. C. D. E. Myers-Hall Funeral Home, Inc. Family Exemption The Sentinel- Legal Register of Wills Cumberland Law Journal $ 4,242.50 2,000.00 129.47 77.00 75.00 $ 6,523.97 AMOUNT REMAINING TO BE DISTRIBUT~=n Jean P. Motter TOTAL DISTRIBUTION 0.00 $- 1,746.60 $ 0.00+ Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estateof William D. Motter v No. also known as , Deceased Social Security No. 177- 24- 3230 Jean P. Motter Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut the Decedent, dated and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia;-~lurante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spguse (if any) and heirs: Ct~ I Name Relationship ResT~ence Jean P. Motter ISpouse Daughter Daughter S on Son Barbara Yowler Mary Kay Via Stephen Motter David Motter (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland 6612 Carlisle Pk, Mechanicsburs, PA 154 Parkway Dr., Carlisle, PA 18 Warwick' Cir., Mechanicsburg, PA 15 Pine Hill Ave., Mechanicsburs, PA 95 Bea~le Club Rd., Carlisle, PA County, Pennsylvania with his/her last family or principal residence at 6612 Carlisle Pike, Silver Sprin~ Township, Mechanicsburs, (list street, number, and municipality) Decedent, then 57 years of age, died 10/28/1990 at Mechanicsbur~, PA Decedent 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 PA 17050 (Location) 4,777.37 situated as follows: Potter County, Pennsylvania Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersi~lned: Sic~nature Typed or printed name and residence Jean P. Motter 6612 Carlisle Pike, Mechanicsburs, PA 17050 Prepared by the Pennsylvania 8ar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me thi of No. Estate of William D. Motter Deceased Social Security No: 177-24-3230 Date of Death: 10/28/1990 of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary ~'] Of Administration are hereby granted to Jean P. Motter , inconsideration (c.t,a.; d.b.n.c.ta,; pendente lite; durante abs. entia; durante minoritate) in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Renunciation ........ $ Register cf Will~- ~__ ~ Attorney: James M, Rob:inson Affidavits ( ) .... $ Extra Pages ( ) .... $ I.D. No: 84133 Turo Law Offices Address: 28 South Pitt Street Carlisle, PA 17013 Telephone: 717/245 - 9688 Codicil ........... $ I O - O O JCP Fee .......... $ Inventory .......... $ Other ........... $ TOTAL ......... $ ~'O' Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) William D. Motter PETITION FOR GRANT OF LETTERS Additional heirs: Name Andrew Motter Mark Motter Relationship Son Son Residence 104 E. Simpson St., Mechanicsburg, PA 6612 Carlisle Pike, Mechanicsburg, PA 105,905 REV. 2-86 This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate:this copy by phot~tat.or phOt0gr~h. Fee for this certificate, $:3.00 1783342 No. 21-o4 -.5©1 ,Date :~Charles: Hg~ester Statel ~¢~istrar !,DEC 07 1990 COMMONWEALTH OF PENNSYLVANIA CERTIFICATE OF DEATH Mechanicsburg, Pa. 17055 :00 A. October Acute Myocardial Infarction 28, 1990 ri 405 Mech Coroner 28,1990 Norris,Coroner r Drive Pa. 17055 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: William D. Motter Date of death: October 28, 1990 Will No. 2004-00501 '04 jUi'i -2 /',~ ~, :l~i() Admin. No. 21-04-0501 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above captioned estate. Name Jean P. Motter Barbara Vogler Mary Kay Via Stephen Motter David Motter Andrew Motter Mark Motter Address 6612 Carlisle Pike, Mechanicsburg, PA 17050 154 Parkway Drive, Carlisle, PA 17013 18 Warwick Circle, Mechanicsburg, PA 17050-2642 15 Pine Hill Avenue, Mechanicsburg, PA 17050-1642 95 Beagle Club Road, Carlisle, PA 17013 104 E. Simpson Street, Mechanicsburg, PA 17055-3866 6612 Carlisle Pike, Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Respectfully Submitted TURO LAW OFFICES Date (~TleS M. Robinson, Esquire ~.8 South Pil~ Street Carlisle, PA 17013 (717) 245-9688 Capacity as Counsel for Personal Representative 8 REV-'1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY fiLE NUMBE~ 21 04 00501 Mottc~, Wffi~am D 177-24-3230 OATE OF DEATH (MM-DO-Y~AR) DATE OF BIRTH (MM-DD-YEAR) THLS RETURN MUST BE FILED I. DUFUCATE WITH THE l 0/28/1990 11/21/1932 REGISTER OF WILLS Motter, Jean P 190-26-6754 [] 1. OflglnalRMum [] 2. SupplementalRMum [] 3. RemainderRetum(daM(~(Mathl~i°rt°12*13'82) [] 4. Limited Estate [] 4e. Future Interest Co(~mbe (date of death [] 5. Federal Estate T;~ RMom Required [] 6. Decedent Died TeBtate (Ntach cow [] 7. DecedentMelntainedaLivingTruM(^bac~ 0 8. TotalNumberofSafeDe~Boxe~ [] 9. LitlgafionProceeqsRecMved [] 10.$lx:)usalPovertyCredit(dateofdeathbeMeen [] 11.ElecfiontotaxunderSec. 9113(A)(^ttaohSchO) lAME James M Robinson Turo Law Offices 717/245-9688 28 South Pitt Street Carlisle, PA 17013 1. Rea Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. ClMaty Held Corporation, Pmtnemhlp (x Sole-Proprletomhip (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Misceilene(xls PerBEnsl Property (5) (Schedule E) 6. Jointly Owned Property (Bohedule F) (6) [] Separate Billing Requested 7. Inte~-Vivns Transfers & Miscellaneous Non-Probate Properly (7) (Schedule G or L) 8. ToMI Gross Assets (to~al lines 1-7) 9. Funeral E~)enses & Administrative Co~s (Schedule H) (9) 10. Dates of Decedent, Mcxtgnge Liabilities, & Liens (Schedule I) (10) t 1. ToMI Deductions (total UnBE 9 & 10) 4,777.35 Non~: None None None 6,523.97 . ...j (8) 4,777.37 (11) 6,523.97 (12) insolvent (t3) (14) 12. N~ Value of Estate (Line 8 minus line 11 ) 13. Chalitable and OeernmBEtat Bequests/Sec 9113 Trusts for v/nleh an election to tax has not been made (Schedule J) 14. Ne~ Value Subject to Tax (Uss 12 minus Use 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.AmBEnt of Line 14 taxable at the slx..~at tax rate, 0.00 x ~ transfers under Sec. 9t t 6(a)(1.2) 16.ArED(Jnt of Une 14 taxable at linEDI rate 0.00 x .0~ 17.Amount of Line 14 taxable at sibling rate x ,12 18. Amount of line 14 taxabie at collateral rate x .15 19. Tax Due I-II I~ (15) (17) (19) Copyright 2008 form software only The Lad(net Group, Inc. Form REV-Ir)00 EX (Rev. 6-00) Decedent's Complete Address: /STI~EET ADDRESS I 6612 Carlisle Pike CITY Mechm~icsburg ISTATE PA ]ZIP 17050 Tax Payments and Credits: 1. Ta~ Due (Page I Line 19) A. Spousal Poven~ Credit B. Prior Payments C. Discount Interost/Peaalty if app#cable D. Intoreat E. Penalty Te{al Credits (A + B + C) Total Intoreat/Penalty (D + E) O) (2) 0.00 (3) 0.00 If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Erie 20 to request a rofund if Une I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the intemat on the tax due. (SA) B. Ente~'thet(~tolof LineS+SA. This is the BALANCE DUE. (5B) 0,00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS I. Did denedent make a transfer and: Yes No a. re~ain the use or inosme of the property trsuetorred; ..................................................................................... I~ b. ratain the right to dneignete who shall ose the property trsusferred or RS income; ......................................... c. retain a reverstona~ inta'eat; or ..................................................................................................................... d. recatve the Ixornine fo~ life of atther payments, boneflts or care? .................................................................. 2. If death occurred after Denamber 12, 1982, did decedent banafer property within one year of death without receiving adequate conaldefatlon? .......................................................................................................................... [] 3. Did donedont own an 'in truet fo~' or payable upon dosth henk account or oscurity at hisorherdeath? ............... [] 4. Did denedont own an Individuat Ratirermmt Aconunt, annuity, or other non-probate pmperb/which contains · t~ener=isry de~r~on? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE Gl AND FILE IT AS PART OF THE RETURN. J~ma P. MoOer DATE 6612 Carlisle Pike Mechanicsburg, PA 17050 ~/~ ADORESS bA"i'E 28 South Pitt Street Carlisle, PA 17013 For datos of dosth on or; ~ 1, 1994 and hethre Januarff 1, 1995, the tee(rate impnaed on the net value of tmnafers to or tor the use of the saneang spouse is 3% [72 P.S. §9116 (e) (1.1) (i)]. For datos of death on or after January 1, 1~5, the tax rate imponed on the nal value of transfers to or for the use of the eurvivlng spoune is 0% F/2 P.S. §9116 (a) (1.1) (ii)]. The statute does nat e~emnt a transfer to a surviving spouse from tax, and the statutofit requirements for disclosure of assets end filing · tax tatum are still applicable even if the surviving spouse is the only benatlcisry. For dates of dseth on or after July 1,2000: The tax rate imposed on the nat value of tmnefers from a deceaned child twonty-one yearn of age or younger at death to or for the une of a natund parent, an adoptive parent, or a stepparont of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tox rate imposed on the nat value of fl'ansfe4's to or thr the une of the decede~t's linabl beflefiblafles is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imlx3~ed on the nat value of transfers to o; for the use of the decedont's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Sechon 9102, os an individual who has at Iosst one parent in common with the decedent, whether by blood or adoption. SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Motter, William D 21 - 04 - 00501 All real properbj owned solely or aa a tenant in common must be reported at fair market value. Fair market value is defined as the price et which @roper~ would be exchanged between a willing buyer and a willi.n.g seller neither being compelled to buy or sell both h. avin~l reasonable I~no~ledge of the relevant facts. Real property which is Joiney.owned with right-of survivorship must be discmse~ on schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH l 2 3 1/3 intcrcst in .8 acres, more or less, located in Potter County, Pennsylvania, rccorded at Book 179, Page 521 1/2 interest in .4 acres, more or less, located in Pot~cr County, Pcansylvama, recorded at Book 226, Page 189 1/2 interest in .5 acres, more or less, located in Potler County, Pennsylvania, recorded at Book 229, Page 1036 3,840.17 429.55 507.65 TOTAL (Also enter on Line 1, Recapitulation) 4,777.37 SGI-1~31JLE H FUI~E~& ESTATE OF FILE NUMBER Motter, WJl[Jam D 21 - 04 - 00501 Debts cH'decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER 1 Bo FUNERAL EXPENSES: Myers-Hall Funeral Home, Inc. ADMINISTRATIVE COSTS: Personal Repre~,~ti~e's Commisaions Seclal Security Number(s) / EIN Number of Pemonat Reprsaontatlve(s): Stmat Address C~ State __ Zip Year(s) Commission paid Attorney's Fees Family Exemption: (If decddeflt's address la not the same ae claimant's, attach mq~anafion) Claimant Jean P. Motter Street Address 6612 Carlisle Pike City Mechanicsburg State PA Zip Relationship of Claimant to Decedent Probate Fees Rcgist~ of Wills Cumberland Law Journal The Sentinel - Legal Accountant's Fees T~x Re{urn Preparers Fees Other Administrative Casts 17050 TOTAL (Also enter on line 9, Recapitulation) 4,242.50 2,000.00 77.00 75.00 129.47 6,523.97 BUREAU OF INDIVIDUAL TAXES TNHERTTAHCE TAX DZVTSZON DEPT. Z80601 HARRISBURG,, PA 171Z8-0601 COHMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-i$¢? EX &FP JAHES M ROBINSON TURO LAW OFFICES 28 S PITT ST CARLISLE - DATE 11-01-ZOOq , : ESTATE OF HOTTER DATE OF DEATH 10-28-1990 FZLE NUHBER 21 0q-0501 "04 '~ n~ 'i6 COUNTY CUMBERLAND ACN 101 PA 170'~ 5.': Amount Remitted WILLIAM D HAKE CHECK PAYABLE AND REHTT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS L'rNE ~ RETA'rN LOWER PORTION FOR YOUR RECORDS REV-15q7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCT'rONS AND ASSESSHENT OF TAX ESTATE OF HOTTER WILLIAM D FILE NO. 21 0q-0501 ACN 101 DATE TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RES~¥ATZON CONCERN'rNG FUTURE 'rNTEREST - SEE REVERSE APPRA'rSED VALUE OF RETURN BASED ON: 1. Real Estate (Schedule A) 2. $. q. 6. 7. 8. ORIGINAL RETURN (1) Stocks and Bonds (Schedule B) (2) ClosoZy Hold Stock~Partnership Interest (Schedule C) ($) Mortgages/Notes Receivable (Schedule D) Cash/Bank Deposits/Misc. Personal Property (Schedule E) Jointly Owned Property (Schedule F) (6) Transfers (Schedule G) (7) Total Assets APPROVED DEDUCT'rONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs~Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule 1) 11. Tote1 Deduct ions 12. Not Value of Tax Return 15. lq. (9) (10) CharitabZo/Govornmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate Subject to Tax q;777.$7 NOTE: To lnsura proper · O0 credit to your account, · O0 submit the upper portion · O0 of this form with your · O0 tax payment, .00 .00 (8) 6,525.97 .00 NOTE: q,777.$7 (ti) 6.523-97 (12) 1,7q6.60- (15) .00 (14) 1,7q6.60- Zf an assessment Nas 1ssued previously, lines lq, 15 and/er 16, 17, reflect flgures that include the total of ALL returns assessed to 18 and 19 w111 ASSESSMENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Amount of LAne 1~ taxable at Lineal/Class A rate 17. Amount of Line 1~ at Sibling rate 18. Amount of Llno lq taxable at Collateral/Class B rata 19. Prlnctpal Tax Duo TAX CREDITS: PAYMENT RECE~P1 DISCOUNT 1+) DATE NUMBER TNTEREST/PEN pAID (-) ZF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. date. (~s) .00 x O0 : .00 (~6) .00 x 06 = .00 (~7) .00 x O0 = .00 (~8) .00 x 15 = .00 (19)= . O0 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE · °°I .00 .00 .00 ( XF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. XF TOTAL DUE XS REFLECTED AS A "CREDXT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THXS FORM FOR XNSTRUCTXONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CE): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CoaaonNaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful CIass B (collateral) rate on any such future interest. To fulfill the requirements of Sect[on ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit aith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313}. Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Z4-hour ansaering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied eith the appraisement, allowance, or disalloaance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court, Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Ravtea Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the docedent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning .ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year ~ ~ .ooos~s WE~-1991 llx .oeo:sot ~ 1983 16Z .0000,.38 199Z 92 .00026,7 ZOOZ 1984 112. .000301 1993-1994 77. .000192 2003 1985 13Z .000356 1995-1998 9Z .000247 2004 1986 lOX .000274 1999 7Z .000192 1987 102 .000274 ZOO0 7Z .00019Z --Interest is calculated es falloas: INTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DELINQUENT X DA/LY /NTEREST FACTOR Interest Daily Rate Factor 9Z .000Z47 62 .000164 5Z ,000137 47. .000110 --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.