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Home My WebLink About12-16-10J 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Count Code Year Bureau of Individual Taxes INHERITANCE TAX RETURN y PO BOX 280601 21 09 Harrisburg, PA 17128-0601 RESIDENT DECEDENT File Number 0449 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 206-10-9488 05/02/2009 08/29/1918 Decedent's Last Name Suffix Decedent's First Name MI Gotshall 'Dorothy M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate •' 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE: REGISTER OF WILLS ~,`~::4 2. Supplemental Return ...... 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 between 12-31-91 and 1-1-95) :... 3. Remainder Return (date of death prior to 12-13-82) _. 5. Federal Estate Tax Return Required ~_ 8. Total Number of Safe Deposit Boxes ....... 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 T0: Name Daytime Telephone Number Robert L. Knupp, Esq _ (717) 238-7151 Firm Name (If Applicable) _ _.. ', REGISTER OF WILLS USE ONLY Knupp Law Offices LLC ~ j , C~ _ _ _' ' First line of address c T,~~ `~ -`~ ~ ' -~ P O Box 630 ~ ~? ~~ .-`. j ~ 1 . . r t -y C~ ~ .. ' ~ Second line of address r__LJl tlx: ~ ~ J ..._~ ; 407 North Front Street -7 `--~ ~ ; --~ -~ :~, City or Post Office - State ZIP Code DAT~.I*I'b~~ .; .. ~..; Harrisburg +.~ PA 17108 -~~ _.._a ~. ,. tv ~._ '~ ~" -t,„ , Correspondent's a-mail address: 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.PE ON RESPpNSIB~OR FILJ~J DATE ADDRESS Elwood R. Gotshall, Jr., $ Manor Drive, West Chester, PA 19380 SIG ,+ F ~EPARE HER- REPRESE~lIA~iVE DA-fE ADDRESS ' -~ Flowers & Flowers, CPAs, 5775 Allentown Blvd., Suite 102, Harrisburg, PA 17112 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051658 .~ ~' J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's -vame: Dorothy M GOtshall 206-10-9488 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. 15,200.00 6. Jointly Owned Property (Schedule F) <:~n~;' 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. 15,200.00 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. ___ 15,200.00 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. 15,200.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers under Sec. 9116 __ _ _. (a)(1.2) X .0- 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 15,200.00 16. ' 684.00 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. 684.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~;-,., 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number_ _ n.....,.1.,.,~~~ r~r„r.lnfn Ar~lrlrncc• 21 09 '.0449 VVVVN~/~~~ V vV•••rr•v ~v • -v. ~.. ~~~• DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Dorothy M Gotshall ,_ _ ______ 206-10-9488 STREET ADDRESS 100 Mt. Allen Drive _~_`_____~ CITY Mechanicsburg STATE ZIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 tine 19) (1) 684.00 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 0.03 C. Discount - Total Credits (A + B + C) (2) 0.03 3. Interest/Penalty if applicable D. Interest E. Penalty - -- Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fitl 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) _ 683.97 A. Enter the interest on the tax due. (5A) - 24'97 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 708.94 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 :.................................................................................... ...... b. retain the right to designate who shall use the property transferred or its income :..................................... ....... ^ .......................................... c. retain a reversionary interest; or ......................................................................... ....... ^ ^ a 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? ....... ....... ^ 0 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 thf; 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 survivin~,~ 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 far 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY __ ESTATE OF FILE NUMBER Dorothy M. Gotshall 21 09 0449 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (It more space is needed, insert additional sheets of the same size) FzEV-1.51..:; Fx+ ;11-C~8; . ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy M. Gotshall 21 09 0449 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),J 1, Elwood R, Gotshall, 8 Manor Drive, West Chester, PA 19380 Son 50% 2. Ronald L. Gottshall, 1824 Hearthstone Lane, Middletown, PA 17057 Son 50% (Note: Two T's in Ronald's name is correct) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $ If more space is needed, insert additional sheets of the same size, Conestoga Memorial ParkC l November 10, 2010 To Whom It May Concern: 95 Second Lock Road • Lancaster; PA 17603-9343 Phone: (717) 291-1929 • Fax: (717) 397-7967 The current selling .price for the 32 grave spaces transferred to the First Reformed Church-LTCC is ~ I ~,200.C0. Any further questions, do not hesitate to call. Conestoga Memorial Park wunv.croseast.cam MEMORIAL PARR C~1VES`~~~A ~ZE~~~.~~ .P~~.I~. ~~e LANCASTER OFFICE Second Lock Hood ~ ab: Danvllle Pike 316 Fulton .Bldg. TeL 2.524s Lancaster's Modern Burial Es~tte TeL ~ THIS CONTRACT, made this........... ~........»day of......... , ~iaT~:: ........................... ...15».'~: ~; between CONESTOGA MEDdO . »..». - RIAI. PARE, INC., . (a Pennsylvania corporation) hereinafter called the "seller" ~,,, i:{~lf`Z',~ cJ ~ ailC~.~O.._1~,I1t11a....~,'1...~rU'~Sh1r1~.~....~~ilS...~Vl~E' ....:,1:~~laYa~,~.,,.. ~~.,,,~,~.~T1...~3.~;e'~~.»~3.~h»,kt1~~1~...~~' ~t~3'.~1'17TC~.~.Sh.~~.........»... hereinafter called .the ~~purthaser.•, WITNI~SSETH: That the purchaser agrees to purchase from CONEaTOGA MEMORIAL PARK, INC., the following burial site: ~ e~12 ~`: ~. '~ 8:~ .Lot No..205.~.....2.~,.7;.~......~`'.5~"...a.....°~..~:.a.s..4~2~.a....X21.~....~;~~.slob.~'..~.z....~~8...~r.-~°.£......... w ».of :Conestoga Memorial Park as per plat thereof on Ells in .the .office of said cemetery and .agrees io pay .therefor the sum o~})~-~~',...' i-`1 ?'l.d~'~ d ._'~a 1 ~.~;~F»..1~$ ($... 9 6Q ®~~... as iollows:l ~~~.E'... ~?~ 1?C ~~t~L 5~ ~,A t ~~ {~, ~ ~?~~ ~ ~ .:) cash. the receipt •vahezeaf . is -hereby. acknowledged end .................... ....... . ° 15 tI~ .~:~'S"r.~.~r.~°:~.~..~;~..~.....Doll~ra ($. ..,~r.~.@.Q»~..,....) on the ............. ............day of each and every month hereafter until the entire purchase money is _ .paid, with interest at the rate of 6°~ :(sir percent) per annum. (No interest will be charged if all payments are sonde .promptly when due-each month.) Ii, far nay reason, the locatfon hereby contracted for is not satisfactory to purchaser within a period.of 30 days .from the date of this- contract, .purchaser: may select and exchange #or any other location of equal sire. and value anywhere available in Conestoga' Memorial Park.. It is further understood and. agreed that no interment shall be made in said burial cite until the development and improvement of said block -shall have..progressed sufficiently m permit burials therein, otherwise temporary interment space will be supplied by Conestoga Memorial Park, lac. Upon payment by the purchaser of .all the above -described payments, the Conestoga Memorial Park, Inc., agrees and biad8' itself to c~avep to the..purchaser. by good and sufficient deed including PERP2:s°P(TAL CAfiE and far cemetery Purposes only.:the aforesaid -site`subject to all .rules :.and regulations of the Conestoga lYlemorial Park, Inc., now existing or which may hereafter be adopted for the,goverament of the cemetery. 'Said rules-and regulations map be seen upon request at the Company's office. Time is the es$ence of ..this agreement. It is mutually agreed that s;sould anq of the foregoing covenants and agreements remain unperformed by -the purchaser for a period of sixty days after the same .should have been performed under this contract, then ,#his ..agreement may, at the option ,af Conestoga Memorial :Park, Inc., be declared void, and the said Conestoga Memorial Park, lac., map re-enter upon the premises and hold the. same as of former estate, .anti all payments -made prior #o such re-entry shall.- belong to Conestoga `Memorial Park, Ina, .ae liquidated damages. And it is further agreed that the waiver by the Conestoga Memorial Park, Inc., of a breach of any .one of .the covenants herein contained shall not be construed as a waiver.:of the :.covenant itself or of any subsequent breach thereof. This agreement contains all the undertakings of the " .parties, and Conestoga Memorial Park, Inc, shall not be bound by .say repxesentations by the salesman in conflict .with the terms hereof... The above mentioned dov~a payment of ......:.......».....:............:....»...».......................:..............dollars will be refunded, upon the ..personal :inspection of Conestoga :Memorial Park, Inc., within ..............days after date'of purchase, should the purchaser decide that he or she fs dissatiefled with said purchase. It is hezebp understood that this refund clause fs in effect .only during the ............ day period stated above. It is mutually. agreed that the provisions of this Agreement shall apply io sad bind the heirs, executors, administrators and assigns of both seller and'purchasez. It is fiuther agreed that when ibis Agree~mea# is signed by more than one purchaser, each of such purchasers becomes `jo3ntlp .and :.severally bound sad liable hereunder. ~ y W~hTNESS ourfph~ands the day and :pear above written. h.i .1. Sb1~I'~ rd ~~t • ~ ~ ~ ~ - Salesman- . - ......» ....... ... .......»»».(L. f3.) .: .Accepted ........ «...-~ ....... ... c...».., ..... ........, . .. ~~.'-'?.~ l~~ C~ ~ ... ~'E..~~L? S t , ,r-~~, ..~h ~ ~.~. ... ..... .. ........ ..... v3 a L~'Rd ~ a~ ..... $.) CONESTOGA RIAZ. PARK, INC. .....". ......".. ........."....."...»".. .1lddress c~ 2e~`.-• '' a .fib. ~ ~~'~) By .............»................................. ~Sellez) ...................................»» .{L. S.) Phone ........ ».......: .............. ....... .. ......................»..............» .....».. IyiAff£ ALL CH£CSS PAYABLE TO- CONESTfJCGA ~+i£MORIAL PARS, Ems.' PLEASE ~ ~` CC?i~TRAC~ Practitioner Portal Penalty and Interest Calculations CALCULATION DATES- 02/02/2010 TO 12/31/2010 TAX DEFICIENCY $ 683.97 CALCULATED INTEREST $ 24.97 BALANCE AS OF 12/31/2010 $ 708.94 Start Aver Page 1 of 1 1lttps://www.doreservices.state.pa.us/pitservices/Default.aspx 12/1/2010