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Home My WebLink About03-15-11c ~~r 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 0937 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 203-10-8515 07/30/2010 05/05/1915 Decedent's Last Name Suffix Decedent's First Name MI Goetze Josephine T (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 • 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) • 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Lisa Marie Coyne, Esq. (717) 737-0464 Firm Name (If Applicable) Coyne & Coyne, P.C. REGISTER OF WILLS USE ONLY First line of address c7 _ l ~=T ~'~ - - -i , ; --i _I_ _ 3901 Market Street , ``~--~ _ Second line of address _, _ ' '"~ - _- ::7 ~ ~~ _ _ City or Post Office State ZIP Code DATE,~ILED ~ / . . Camp Hill .; , PA 17011 , r' ~ ~ ~.~> ~~ ._.~_ 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 omplete. Declarati n preparer ther than the personal representative is based on all information of which preparer has any knowledge. SIGN URE F PE O R SPO SI FILI RET RN DATE ---- ~-_ ADDRES --- - - --- - K. Lee Goetze 114 Franklin Square, Mechanicsburg, P_A 17.050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE - - - - - -- ---- DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 ].5056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Josephine T GoetZe 203-10-8515 RECAPITULATION 1 . Real estate (Schedule A) . ......................................... ... 1. 0.00 2. Stocks and Bonds (Schedule B) .................................... ... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 100.00 6. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. 18,956.20 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested..... ... 7. 0.00 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 19,056.20 9. Funeral Expenses 8~ Administrative Costs (Schedule H) .................. ... 9. 12,398.38 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 78.50 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 12,47F>.88 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 6 579.32 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which , an election to tax has not been made (Schedule J) ..................... ... 13. 1,500.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 5,079.32 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 5,079.32 16. 228 57 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 .,, 19. TAX DUE ......................................................... 19. 228.57 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Josephine T Goetze - -- __ __---- STREETADDRESS 2100 Bent Creek Boulevard __ CITY - --- - Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount File Number 21 10 0937 DECEDENTS SOCIAL SECURITY NUMBER 203-10-8515 STATE PA _-- --- - Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest --- - . E. Penalty - _ - 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. (56) - -- __ j zIP 17050 Make Check Payable to: REGISTER OF WILLS, AGENT 228.57 0.00 0.00 0.00 228.57 0.00 228.57 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 (O) 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-i5o8 EX+ (ii-io) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY t~ I A 1 E OF: FILE NUMBER: GOETZE, Josephine T. 21-10-0937 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must hp disr~nao.l ,,., c..tisa..~.. -~ •••~•~ ..,,,..._ ~~ ~~==~=w u== a~~uwiim sneers o7 paper or the same size. REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY rILC IYUMCtK Josephine T. Goetz 21-10-0937 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. K. Lee Goetze 114 Franklin Square daughter Mechanicsburg, PA 17050 B. C JOINTLY-OWNED PROPERTY: LETTER DATE DES ITEM NUMBER FOR JOIN TENANT T MADE JOINT CRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH % OF DECD'S DATE OF DEATH VALUE OF IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST ~ ~ A. 03121108 Heritage Wealth Advisers Brokerage Account 36,407.32 50 18,203.66 2~ A. 03121108 Wachovia Bank Checking Account No. XXXXXXXXX6922 1,505.07 50 752.54 TOTAL (Also enter on line 6, Recapitulation) I S 18,956.20 (If more space Is needed, Insert addltlonal sheets of the same size) ransmittal 9122/2010 10:29:28 AM PAGE Wachoria Bank Balance Confirmation Services P O Sax 40028 Roanoke, VA 24022 September 22, 2010 coYrrE ~ cow ** __ _ 1!002 Fax Server Refera~ce ID: 3163608 SUBJECT: Verification /Confirmation of Account and Balance Infomtation provided for. Ctitstopier: JOSEPffiNE T GOETZE (SSN#i XI~C-XX.851~ Date of Death: July 30, 2010 Deposit Account Information Account Acrooud Date ofDeath Atierage I3alanoe Dale Maturity Interest Accrued TYPe Number gam YTD Date Op~ed Date Rate INemt Intemat Paid Closed CHECKING X6922 51,303.07 3RI/2008 x0.00 50.00 9/14/20]0 LEGALTITLE; JOSEPHINE T GOETZEjremo~ed 8f3/10) K LEE COETZE CLOSItd(3 EAIANCE: 5104.00 ` Other Informations ~ DECEDENT5 NAME HAS BEEN REMOVED FROM ANY OTHER ACCOUNT(S), PLEASE PROVIDE A LIST OF ACCOUNT NUMBERS. WE ARE UNABLE TO LOCATE ANY ADDITIONAL ACCOUNTS WITH THE INFORMATION PROVIDED. Pape 1 of Z HERITAGE WEALTH A D V I S E R S ,. Financial Strategies for Life September 3, 2010 Ms. Lisa Coyne Attorney At Law 3901 Market Street Camp Hill, Pa. 17011-422? Re: Josephine T. Goetze Dear Attorney Coyne: In response to your inquiry I am pleased to provide you the following information regarding the brokerage account of the late Josephine T. Goetze. ~ ~ ~° , s~' o G' '` . G..~ o ~~~~ l~ii The account was a Joint Tenants With Rights of Survivorship held in her name and that of her daughter, K. Lee Goetze. On July 30, 2010, the account had a total value of $36,407.32. Thank you for this opportunity to be of assistance to you. ordially, - ~ , l.u~~ John C. Custer Financial Adviser 635 NORTH 12TH STREET SUITE 102 LEMOYNE, PA 17043 PH:717-614-6100 FAX.717-614-6200 SECURITIES AND ADVISORY SERVICES OFFERED THROUGH INVEST FINANCIAL CORPORATION (INVEST), MEMBER FINRA, SIPG A REGISTERED INVESTMENT ADVISOR INVEST IS NOT AFFILIATED WITH HERITAGE WEALTH ADVISERS, LLC. REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS tSIATE of FILE NUMBER Josephine T. Goetze 21-10-0937 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Funeral, Lot, and Engraving 8,350.00 2. Burial0utfit 115.00 3- Reception 300.00 4• Honorarium 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)lEIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 2,000.00 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 75.50 5. Accountant's Fees 200.00 6. Tax Retum Preparer's Fees ~. Cumberland Law Journal -legal advertisement 75.00 13. Patriot News -legal advertisement 138.88 9. Inheritance Tax filing fee 15.00 1 D. Postage 44.00 11 ~ Estate Checks 25.00 12. Total from Continuation 910.00 TOTAL (Also enter on line 9, Recapitulation) $ 12,398.38 (If more space is needed, insert additional sheets of the same size SCHEDULE H-Continuation ESTATE OF GOETZE, Josephine T. File No. 21-10-0937 14. Toll Calls $25.00 15. Mileage at $0.50/mile $85.00 16. Reserves 800.00 Total Continuation Sheet: $910.00 • REV-1512 EX f- (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS tsiait uF FILE NUMBER Josephine T. Goetre 21-10-0937 Report debts incurred by the decedent prior to death that remained unpaid at the date ~f doarti h~I~~ah~ ,....e;...~...__~ __~:__, ____ __ __ _ •~ ~~~~~_ ~~4== ~~ ~~__~~~, ~~~~r<< auuaiDnai sneers Dr the same size. REV-1513 EX+ (11-O8j Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER Josephine T. Goetze NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) - V-VVV / AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. K. Lee Goetze daughter 100% of residual ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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 ]S NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Second United Church of Christ $1,500 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ ,~ nioic ,Na~c a neeuea, mser< aomuonai sneers of the same size. REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No . 2010- 00937 PA No . 21- 10- 0937 Estate Of : JOSEPHINE T GOETZE, /First, Middle, Last) Late Of : SlL VER SPRING TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : 203-10-8515 WHEREAS, on the 13th day of September 2010 an instrument dated October 10th 2003 was admitted to probate as the last will of JOSEPHINE T GOETZE (First, Middle, LasU I a t e o f SlL VER SPRING TOWNSHIP, CUMBERLAND County, who died on the 30th day of July 2010 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi11s in and for CUMBERLAND County, in ,the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: K. LEE GOETZE who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, alI of which full y appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 13th day of September 2010. n ° Regrste of Wr s Deputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ~c~t ~iYr ~~~ ~~~t~n~~~~ ~~ ~~ ~,~~ ~, ~7 ~ r '~ OF ~~~ - _~~ w JOSEPHINE T . GOETZE `'c' ~'~' -.~ -~ ~. I, JOSEPHINE T. GOETZE, of Silver Spring Township, Cumberland County, - Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. . 1 I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. 3. I give and bequeath $1,500.00 to the United Church of Christ, Green and Verbeke Streets, Harrisburg, Pennsylvania. 4. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my daughter, K. LEE GOETZE, --~ ~~ '. J is i .; _7 - -; cT`: - --:::_ ~-, - _- ~--> -.; -1- absolutely and in fee simple. 5. Lastly, I nominate, constitute and appoint my daughter, K. LEE GOETZE, to be Executrix of this my Last Will and Testament and I further direct that no bond or other security be required of my personal representative to guarantee faithful performance of his duties. IN WITNESS WHEREOF, I have hereunto set my hand and seal this~[~ j~'ay of October, 2003. i. ~Y-.~~~ i-~-V~ ,. ~ f ~` ,~ ~ ~ SEAL 1 ~ ~ ~ ' ~( ~' Jos: p me T. oetze ~~ ~`' Signed, sealed, published and declared by the above named JOSEPHINE T. GOETZE as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at her request, in her presence and in the presence of each other. ~,` Y~ . c-~c-~'~~ -2- COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND) SS I, JOSEPHINE T. GOETZE, the testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the same instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. ~~ ; r ~-.._. ,~; ., ~~~ ,-~:. ,~1 c'.-~~,.r (SEAL) Sworn and subscribed to before ~sep me ~. o~etze ~',~° me this %1~' day of October, 2003 -~` ~ ~ COMMONWEgLTH OF PENNS VANIA {,~l /• ~ `' ~ Notarial Seal otary Pu is beta M Nelson, COMMONWEALTH OF PENNSYLVANIA ~~~ S S "• P~>~raa ns~xw, or N~~ COUNTY OF CUMBERLAND ) We, the undersigned, ~~ ~ ~ M ~.L~- K~i~ l ~, and -~~~. ~ ~ j`-t' ,L ~ ~, ~v the witnesses whose names, aze signed to the attached or foregoing instrument, being duly qualified accordingg to law, depose and say that we were present and saw the testatrix, JOSEPHINE T. GOETZE, sign and execute the instrument as her Last Will and Testament; that the said testatrix executed it as her free and volun act for the ~y purposes therein expressed; that each of us, in the hearing and sight of the testatrix, signed the Will as witnesses; and that, to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. ~1 1 Sworn and subscribed to before me this t c 1'~ day of October, 2003. otary u is COMMONWEA~T~pENNS~VANIA Naharial Seal Hein M Nelson, Notary Put~lic ~, Cumberland County ~'h' Corrrr~sston E~ires June 27, 2007 ~~• PernaYlvania AssociaEon Of Notart~es -3- ~.~ -- -._.~a~:..,.._...~. __ .. . ~.u~ w ~~wy~ .n