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Home My WebLink About12-04-09~ REV-1500 15D56D712D EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county coca near File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.zsosol RESIDENT DECEDENT 21 0 7 0 0 6 41 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth f 164300047 06242007 02041936 Decedent's Last Name Suffix Decedent's First Name MI BOTTORF RICHARD E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI BOTTORF EMELYN R 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 ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate qa. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required ^ ^ (dace of death aver 12-1z-sz) e Decedent Died restate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes ® (Attach Copy of Will) (Attach Copy of Trust) 9. Liti anon Proceeds Received 1 p. Spousal Poverty Credd (date of death ^ 11. Election to tax under Sec. 9113(A) ® 9 ^ between 12-31-91 and 1-1-95) (gtta~ $011. O) `` CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SCOTT M. DINNER ESQ. 717761580.0 ~ ~~ Firm Name (If Applicable) ~'+ ~- REGIST WILLS ON~~ ;, "~ LAW OFFICE OF SCOTT M. DINNER C') i~`?.~ t -s =i 1 T First line of address ~, r C:' 3117 CHESTNUT STREET ~ _ .^` Second line of address City or Post Office CAMP HILL State ZIP Code PA 17011 ~p fiV ATE FILED ~~ Correspondent's a-mail address: d l n n e r@ I O C a I n e t. C O m Under penalties of perjury, I deGare that I ave examined this return, including accompanying schedules and statements, and to .the best of my knowledge and belief, it is true, correct and mplete. ara ' of the personal representative Is based on all information of which preparer has any knowledge. SIG~RE OF PER RESP ISLE IN TURN DATE Emelyn R. Bottorf DEC 0 6 2009 ADDRESS 108 echcliff Drive, Carlisle, PA 17013 pCgp SIGNATU F R THER T PRESENT IVE ~L~ 0 ~ 2009 Scott M. Dinner Esq. IJC ,7 A D SS 3117 Chestnut Street, Camp Hill, PA 17011 Side 1 15D56D712D 15D56D7120 J REV-1500 EX 1505607220 oeceaenrs Name. B O T T O R F, RICHARD E 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) ....................................................................... g. 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/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. 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 Decedent's Social Security Number 164300047 14,917.11 14,917.11 15,620.02 6,074.33 21,694.35 -6,777.24 -6,777.24 0.00 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 07 - 00641 E NA Bottorf, Richard E _ STREET ADDRESS 108 Beechcliff Drive CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penatty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total Interest/Penalty (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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 0.00 (2) 0.00 (3) 0.00 (4) (5) 0.00 (5A) (5B) Q . Q Q 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 :.................................................................................. [, x^ b. retain the right to designate who shall use the property transferred or its income :.................................... ^ x^ c. retain a reversionary interest; or .................................................................................................................. ^ 0 d. receive the promise for life of either payments, benefits or care? .............................................................. ^ x^ 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 "intrust for" or payable upon death bank account or security at his or her death?......... [l 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. ,, 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 1.2) [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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF BOttOrf, Richard E 21 - 07 - 00641 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. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 allocated settlement proceeds of personal injury claim net of legal fees and costs [see Order of Court -Cumberland County Ct. of Common Pleas -Orphans' Ct. Division dated 8/2712008] [$22,000. - $7,100. - $234.92] 2 I Verizon/other miscellaneous refunds 14,665.08 252.03 ~ TOTAL (Also enter on Line 5, Recapitulation) ~ 14,917.11 S H COMMONWEALTH OF PENNSYLVANL4 1-6I1~ ~../~I..~~ INHERITANCE TAX RETURN AI'1~~r~eTpA'7'7~ IC /'-/Y-T~- RESIDENT DECEDENT /1L~~~w~7 ~ IW ~ ~YG ~/lJv7 ~ ~7 ESTATE OF Bottorf, Richard EFILE NUMBER 21 - 07 - 00641 Debts of decedent must be reported on Schedule 1. ITEM - -------- NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Myers Funeral Home, Inc 7,247.00 Mechanicsburg, PA 17055 2 Rest Haven Memorial Park 1,905.00 Lock Haven, PA (cost of vault and opening/closing grave charges) 3 Gingrich Memorials 900.00 Mechanicsburg, PA 17055 B. I 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 Scott M. Dinner, Esq. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Emelyn Bottorf 4 5. 6. 7. 1 Street Address 108 Beechcliff Drive City Carlisle State PA Zip 17013 Relationship of Claimant to Decedent SpOUSe Probate Fees Cumberland County R-o-W Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs estate notices - Cumb. Law Journal & Patriot-News 1, 800.00 3, 500.00 72.00 196.02 TOTAL (Also enter on line 9, Recapitulation) 15,620.02 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF BOttOrf, Richard E ~21 - 07 - 00641 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 PA Dept. of Revenue sales tax liabilities for Account ID# 21138045 for 2004-2006 [see attached 6,074.33 Account report dated 8/29/2007] TOTAL (Also enter on Line 10, Recapitulation) ~ 6,074.33 (AUG ~ 2 Z~10~i IN RE: NO. 2007 - 00641 /~,, ORDER OF COURT ~-` AND NOW, this ~ ~ day of , 2008, upon consideration of the Petition fbr Court Approval of Settlement, it is HEREBY ORDERED that: A. settlement of all claims against Melvin Fetzer and Joan Fetzer for the injuries and damages sustained by Richard E. Bottorf as a result of the motor vehicle accident that occurred on October 28, 2006 is approved; ~ B. the execution of a General Release by Emelyn Bottorf of $31,000.00 for all claims for damages arising from the injuries and damages sustained by Richard E. Bottorf in the motor vehicle accident of October 28, 2006 is approved; i C. the allocation of $22,000.00 of the settlement proceeds to the Estate of Reichard Bottorf and $9,000.00 of the settlement proceeds to the loss of consortium claim o~ Emelyn Bottorf is approved; D. reimbursement to Medicare of $361.33 for the medical expenses paid on behalf of Mr. Bottorf by Medicare or in such other amount as finally determined by I~ledicare with appropriate adjustments to the amount payable to Medicare for Medicare's sure of the fees and costs incurred is approved; and E. payment to Tucker Arensberg, P.C. of $7,100.00 as fees and $234.92 as c sts from the proceeds of the settlement payable to the Estate of Richard E. Bottorf with t e balance of the fees and costs due to Tucker Arensberg, P.C. to be paid from that ortion of the settlement allocated to the loss of consortium claim of Emelyn Bottorf is pproved. ./~'`r`\ -=r ~~... ~- - ~-r ~, ,__i ~_ 111 ``,::' _. . L~ ~-' LL_~ ~ J ~~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, ESTATE OF PENNSYLVANIA RICHARD E. BOTTORF, DECEASED ORPHANS' COURT DIVISION THE COUR I r H,.~G. V ~. J C L. RURSArr ON COnni,UNC6 TAX CLCAi'ANf.7, C04f.Rf.77(IN rv nox ~ ujo f'ARR1~UIfC. PA 1712i•f'4eT CO'VIiMUNW>EALTH Ok' PENN~5YI,VANIa1, DEPARTMENT OF REVEIYL?E os/29/200~ R1C.H,f~,RD E BOTTORF ',108 BEECHCLIFF DR ''CARLISLE PA 17013-9+97 'Aeaz' Sir: RE: 23-2314183 BOTTORF,RICHARD E Our review of your account(s) with the Department indicates the following items are needed. ACCOUNT PERIOD PERIOD 'TYPE ID BEGIN END PAXMENTS EMPL 14052724 SALE 21138045 SALE 21.1.38045 .EMPL 14052724 'SALE 211.38045 ISA1.E 211.38045 SA1~E 21138045 'EMPL 14052724 'SALE 21138045 SAI,>/ 21138045 SALE 21138045 !EMPL. 14052724 !SALE 2l ].38045 SAI/E 21138045 'SALE 21138045 .~ 04/01/2007 osro 1 /2007 04101,'2007 O1 /01/2007 03/01/2007 ozrolrzo07 01/01/2007 10/U1/x4o6 12/01 /2006 11/O ~ /2006 10!01./2006 o7/av2aos 09101!2006 08; O1 !2006 07/01/2006 EMPL 14052724 04/0112006 ~! EMPL 14052724 O1J01~'2006 !ACCOUN ",21138045 11138045 121138045 12 1 1 38045 11138045 ;21138045 11.138045 x1138045 :?1138045 T ID PER END 45/31./2004 06/'3012004 07/31 /2004 08/31!2004 09/30/2004 1 0/3 1 12004 11 /30!2004 12/31/2004 01 /31/2005 06/30!2007 05,'31 /2007 04/30/2007 03131!2007 03/31 /2007 02/28/2007 01 /3.1 !2007 12!3112006 12/31 /2006 .11/3o/zoo6 10,'31 /2006 49/3o1zo46 09/30/2006 08/3112006 07131 /2006 06/30/2006 03/31/2006 TAX 22.97 292.55 97p•21 249.ao 228.89 33.96 154,15 176,33 15-2.29 0.00 0.00 a.oo 0.00 0.00 0.00 0, 00 0.00 0.00 a.oo 0.00 o.oo o.ao 0.00 0.00 0.00 0.40 I'ENI~LTY 1.43.12 139.84 417.19 44.86 98.45 1.4,65 65.33 75.$6 82.71 PERIOD STATt~S NON-FILED NON-F[L~D NON-FILED NON-FILED NON-FLLE.D NON-FII,Eb NON-FII,ED vON-F1L~D NON-FTLF):3 NON-FiL.ED NON-FTLEb NON-FILED NON-FILED NON-FILED NON-FILED NON-FILED NON-FILED INTEREST 29.07 55.84 181.x1. 45.87 41,38 6.02. 26.83 30.00 31.84 $ALANCE 195.16 488.24 1,569.31 339.93 368.72 54.63 247.31 282.19 306,84 _. _ _i ~ _C! G~_. Y ~!1138~45 02128/2005 186.11, 80,05 30.13 296.29 113E~745 0313,1/2005 1.14.71 49.35 18.10 182.16 1138045 0413012005 77.24 33.21 11.57 122.32 211.18045 05/31/2005 90.02 34.20 1.3.45 137.67 21!38045 06/30/2005 123.36 40.70 1.7,93 181.99 1138045 07/3112045 81.60 18.77 .1,1.49 11.1..86 ?! 138045 08131!2005 84.75 15.26 11.60 11 l .C~l. ''.1138045 09/30/20b5 159.94 28.79 21,23 209.96 ?1138045 10/31/2005 61.76 40.61 7.93 110.30 21138045 11130/2005 59.47 25.57 7.40 92.44 21138045 1213 U2005 229.62 87.25 27.33 344.20 X1138045 03!31/2006 38.93 27.41 3.96 70.30 21138045 04/30/2006 38.28 .18.28 4.33 60.89 21138045 05/3.1.!2006 57,29 13.17 S.I6 75.62 21138045 06/30/2006 90.48 16.29 7.62 114.39 ''TOTAL 3,814.11 1,61,1..92 648.30 6,0'74.33 >..IEN DOCKET :065643 LIEN FEE 14 00 1` IEN DOCKET :061230 LIEN FEE . 14,00 t IPIV .DOC.KfiT : 06-398 LIEN FEE 14.00 LIEN DOCKET : OS-1130 CML LIEN FEF 14.00 If there are any qucstions , please contact the undersigned at your harliest convenience. Sincearely, ~s 7 j Lois Clouse Division Chief Business License Clearance Division 717-214-1.962 FAX 717-783-60 55