HomeMy WebLinkAbout08-26-11 1505610140
REV-1500 EX (01-10)
PA Department of Revenue
County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 1 1 0 7 0 6
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MNIDDYYYY
1 9 6 1 4 2 6 7 0 0 3 0 8 2 0 0 9 0 7 0 5 1 '9 2 3
Decedent's Last Name Suffix Decedent's First Narne MI
P O T T E I G E R N A N C Y C
(If Applicable) Enter Surviving Spouse's Infor mation Below
Spouse's Last Name Suffix Spouse's First NamE; MI
P O T T E I G E R E U G E N E H
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
2 0 1 1 8 0 7 x 8 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)
Q 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 oIRECttu I ~:
Name Daytime Telephone Number
M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4f 6 5 0
First line of address
5 4 E A S T M A I N S T R E E T
Second line of address
P t Off State ZIP Code
-~-~
.~
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~,
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:T;
_....~
:~= -;
City or os ice
~1 E C H A N I C S B U R G P A 1 7 0 5 5
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 rrect and comple eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI URE P O l ~ONSIBLE FOR FILING RETURN DATE j /
A RE
GAR E•~P T E GE 12 YORK CIRCLE MECHANICSBURG PA 17050
SIGNATURE QF P EP E T HAN REPRESENTATIVE
[ !~ ^ !'"
ADDRESS;
MURRE~ R•.WALTERS III, 54 E MAIN_ST• MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
1505610240
REV-1500 EX Decedent's Social Security Number
Decedent's tvame: NANCY C• P O T T E I G E R :L 9 6 1 4 2 6 7 0
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 and Notes Receivable (Schedule D) .......................... 4. •
0 . 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
^ Separate Billing Requested
l
G
h
d
S
7 4 3 9 3 . 0 4
.......
)
e
u
e
(
c .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 4 3 9 3 . 0 4
9.
..................
Funeral Expenses and Administrative Costs (Schedule H) 9. ? 9 2 ' S 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. •
11. Total Deductions (total Lines 9 and 10) ............................... 11. 7 9 2 . 5 0
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12• ~ 6 0 0 . 5 4
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. 3 6 0 0 • 5 4
TAX CALCULATION -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 3 6 0 0. 5 4 15.
16. Amount of Line 14 taxable
at lineal rate X .0 ~ ~ ~ 16.
17. Amount of Line 14 taxable
0
0
0
17
at sibling rate X .12 .
18. Amount of Line 14 taxable
~
~
0
at collateral rate X .15 18.
19. TAX DUE ..................... ....................... ... ..... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610240
Side 2
0. 0 0
0. 0 0
0. 0 0
0. 0 0
0. 0 0
a
155610240 J
REV-1500 EX Page 3
no~orlont'c C'_mm~lptp ArlrlrpSS'
DECEDENT'S NAME
NANCY C. POTTEIGER
STREET ADDRESS
100 MT. ALLEN DRIVE
CITY
MECHANICSBURG STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2, CreditslPayments
A. Prior Payments
B. Discount
3. Interest
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
File Number
21 11 0706
(1) 0.00
Total Credits (A + B) (2) 0.00
(3)
(4) 0.00
(5) 0.00
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
0
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? ................................................................................. ...... ^ 0
3. Did decedent own an "intrust 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? ............................................................................................ ...... ^X ^
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the uses of the surviving spouse is 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 21 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 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 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 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-1510 EX+ (08-09) I
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
NANCY C. POTTEIGER 21 11 0706
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1, PNC BANK 1,951.33 100.00 1,951.33
CD -IRA WITH EUGENE H. POTTEIGER, BENEFICIARY
2. PNC BANK 2,441.71 100.00 2,441.71
CD -IRA WITH EUGENE H. POTTEIGER, BENEFICIARY
TOTAL (Also enter on Line 7, Recapitulation) ~ $ 4,393.04
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
NANCY C. POTTEIGER 21 11 0706
Decedent's debts must be reported on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) GARY E. POTTEIGER (RENOUNCED)
Street Address 12 YORK CIRCLE
City MECHANICSBURG State PA ZIP 17050
Year(s) Commission Paid:
2, Attorney Fees: MURREL R. WALTERS, III
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
4
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
700.00
92.50
TOTAL (Also enter on LinE; 9, Recapitulation) I $ 792,50
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FIDE NUMBER:
wl A AInV P- onrTC~rco 7'I 11 n7na
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. EUGENE H. POTTEIGER Spousal 4,393.04
DECEASED 3/2212009
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE,
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $
If more space is needed, use additional sheets of paper of the same size.