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HomeMy WebLinkAbout12-07-09 (2)15056041046 ` REV-1500 EX (05-04) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Dept. 280601 INHERITANCE TAX RETURN ,, f q , Harrisburg, PA 17128-0601 RESIDENT DECEDENT L I ~ l d ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~- _ ~~L_-, ~ , 1 .~. 8~3 y 1 Z}~7 ,6 1 2 0 8 0 7 2 0 0 9`- 0 8 1 8 1 9 2 '3 - Decedent's Last Name Suffix Decedent's First Name Cl L=L~ E,Y ~ B E R T R A M (If Applicable) Enter Surviving Spouse's Irtformation Below Spouse's Last Name Suffix Spouse's First Name ~~_.~ O~L~L EY ~ JO AN Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE t 1 ;~ 7 2 ~~, 3 0 ,:::o b 6 6 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) MI W MI R Q 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total. Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number J O; A N R O L L Fs Y 7 1 7 2 2 1 3 9 7 0 Firm Name (If Applicable) First lire of address 4 7 ', 0 B R E N T W A T E R R O A D Second line of address City or Post Office C A ', M P H I L L t ~ LS USE O Ii iLY ~ ~ ~ // \J ~~~'''~~~''''''[[[''' ZZZ / ~~~ /. ~ I J> 1 ~~ ~ t7 C"1 ~ A O~ _ -0 -'~ D .: DATE FILED ~ ~, State ZIP Code PA 1'7 0 11 Correspondent's a-mail address: N/A 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. SIGNATU OF PERSON R SPONSIBLE FOR FILING RETURN DATE u fir, DO Qoi~ 12 / '% /09 ADDRES 470 Brentwater Road, Camp Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041046 15056041046 j ry:.t ~,..~ ..l.J CJ t'~"1 J~ 15056042047 REV-1500 EX ' Decedent's Social Security Number ' t 6 1 2 1 ~ ~ 3 1 r2 ~ Decedent s Name: Bertraa W_ O7 7 p~ ~~ . .. RECAPITULATION 1. Real estate (Schedule A) ........................................... .. 1. ~:_ ,. .. ~.,:w. [ .<- . ` i r~ - 1 3 2 ~ 6 8 2. Stocks and Bonds (Schedule B) ..................................... .. 2. ~ , , , ., Z...,a. ~ ,,~,~ 3. Closely Held Corporation, Partnership or $.ole-Proprietorship (Schedule C) ... .. 3 ,~ } ~~, ; ~~~,~ „~,i~s ~ ;.~,~,~+~ *~. 4. Mort a es & Notes Receivable Schedule D 9 9 ( ) ........................... 4. .. ~ ' ~ ~ ,. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. # s ~ 1 5 ', 3 4 5 ~ ~ © ' 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ~ 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Pro e ny s ~' Re nested...... Schedule G Se crate Billi ( ) P 9 q .. 7. ~ 1 a _ ~ ; l 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~ 2 3 '4 7 ~' 7 ~3 ~ 9. Funeral Expenses & Administrative Costs.(Schedule H) ................... .. 9. 1 2 8 ~ 7 2 ~ 7 ' S ~.. 10. Debts of Decedent, Mortgage Liabilities, 13< Liens (Schedule I) .............. .. 10. ,~ 11. Total Deductions (total Lines 9& 10) ................................ ... 11. 1 2 8 7 2 7 5 ,.. .. .~ 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. _ F 1 ~ 0 6 ` 0 + 4 ~ 6 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. ~, 14. Nef Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 0 ~ 0 * 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 _ . 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. ~~ ~ a ~ 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 15056D42047 15056042047 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 2009-00824 DECED NT'S NA E Bertram W. Oll~__ __ _____ STREET ADDRESS 470 Brentwater Road ____ _ _ _-- - - -- CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) (1) 0 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0 - _ -- - Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty 0 Total InteresUPenalty (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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0 Make Check Payable fo: 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 :.......................................................................................... ^ 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 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. 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 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. §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)]. Asibling 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-1503 EX+ (6-98) SCI~IEDVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bertram ia. Olley 2009-00824 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (B more space is needed, insert additional sheets of the same size) REV-1508 EX + (157) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Bertram W. Olley 2009-00824 tndude the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~• Checking Accout -Integrity Bank $ 345.00 2. 2004 - Cadilla Deville Sedan 15,000.00 TOTAL (Also enter on line 5, Recapitulation) I $ 15 , 345.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Bertram id. Olley 2009-00824 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1• Musselman Funeral Hone # 7,872.00 2. Rolling Green Cemetery 1,345.00 3. Patriot-Nees -obituary 380.00 4. Miscellaneous (Minister, Honor Guard, luncheon) 921.75 5. Gingrich Memorial (marker) 2,240.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2• Attorney Fees none 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. 6. 7. Street Address City State _ Relationship of Claimant to Decedent Probate Fees Accountant's Fees none Tax Return Preparer's Fees none none Zip 114.00 TOTAL (Also enter on line 9, Recapitulation) I ~ 12,872.75 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCFIEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bertram W. Olley FILE NUMBER 2009-00824 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~ none ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1~ Joan R. Olley -wife of decedent $10,604.61 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 10, 604.61 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTA~~IENT OF BERTRAM W. OLLEY I, BERTRAM W. OLLEY, of Camp Hill, Cumberland County, Pennsylvania, do declare this to be my last Will hereby revoking all prior wills and codicils hereto by me made. lst. I give, devise and bequeath my entire estate to my wife, Joan R. Olley. :' ,. 2r~'d. In the event my said wife shall not survive me or shall die within a period of thirty (30) days after my death, I give, devise and bequeath my estate as follows: (a) One -half (1/2) thereof to Isabel J. Reitz, mother of Joan R. Olley, absolutely. 'If Isabel J. Reitz predeceases me this portion shall be given to H. Wesley Reitz, brother of Joan R. Olley, or his issue, absolutely. (b) One-eighth (1/8) thereof to my daughter, Bonnie Louise Hostetler, or her issue, absolutely. (c) One-eighth (1/8) thereof to my son, Donald Russell Olley, or his issue, absolutely. (d) One-eighth (1/8) thereof to my daughter, Sandra Arlene Olley, or her issue, absolutely. (e) One-eighth (1/8) thereof Wayne Leroy Olley, or his issue, to my son, absolutely. ''` U C~ w _ ._.i - ~t--, ~ ~ ~'~ C '.1=.~ "i ; -~_.lJ ..n ---~ ~~ ' N 1 3rd. I constitute and appoint my wife, Joan R. Olley, Executrix of this Will. IN WITNESS WHEREOF, I, BERTRAM W. OLLEY, the testator„ hereunto set my hand and seal this ~~ day of ~,~~...,;,,cc.`.,--z-~ .(.SEAL) Signed, sealed, published .and declared by the above named Bertram W. Olley as and for his Last Will and Testament, in the presence of us, the subscribing witnesses, who at his instance and~'request, and in his presence, and the presence of each other have hereunto set our harycl~s and seals the day and year aforesaid. ~ j, _~ _~ --,