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HomeMy WebLinkAbout01-03-12 (2)1 1505610140 ~J REV-1500 ~` t°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County (:ode Year File Numtler PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 0 6 1 4 Harriabum, PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 1 8 4 1 2 2 3 4 5 0 5 1 3 2 0 1 1 0 4 1 5 1 9 2 3 Decedent's Last Name Suffuc Decedent's First Name MI OTT MARY E (if Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Flrst 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 poor 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 DeposR Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. LiBgation Proceeds Received ~ 10. Spousal Poverty Crodft (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 CONFDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ,._ , H ANTHONY A DAMS 71 7 5~~ 32~:~0 ..~-, First line of address 4 9 WE S T Second line of address SHI T E 3 City or Post Office ORANGE STREET SHI PPENSBURG State ZIP Code ~ PA 17257 ~~ ~ _ =, REGISTER OF , ~t~ E ONt11t _ - 2, .:. n .z- '-.n t...: ~ DATE FILED correspondents tr-maH address: htadamslawt~embargmail.com Under penalties of perjury, I declare that 1 have examined this velum, indudirq accompanying seheduba end statements, and to the best of my knowledge and belief, it is true, totted and complete. Dedaration of preparar other than the personal representative is based on all information of which preparer has arty knowledge. SIGNATUbtE~OF P~RSO S LE FOR ING RETURN meTF Road Chambersburcl PA 1701 49 WEST ORANGE STREET, SUITE 3 SHIPPENSBURG f5A 1757 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 J J 1505610240 REV-1500 EX Decedent's Social Security Number oecedenrs Name: MARY E. OTT 1 8 4 1 2 2 3 4 5 RECAPITULATION t. Real Estate (Schedule A) ....................................... .... t. 6 0 0 0 0, 0 0 2. Stocks and Bonds (Schedule B) .............. •.................... .... 2. 3. Closely Hek! Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 4. Mortgages and Notes Receivable (Schedule D) ...................... .... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Pro party (Schedule E)... .... 5. 4 8 7 5 8 • 6 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ... .... 6. 7. Inter-Vivos Transfers & Miscellaneous NQp;Probate Property (Schedule G) u S t Billi epara e ng Requested ... .... 7. , 8. Total Gross Assets (total Lines 1 through 7) ....................... .... 8. 1 O 8 7 5 8 , 6 3 9. Funeral Expenses and Administrative Costs ($chedule H) .............. .... 9. 7 3 7 1 1 1 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... .... 10. 8 9 2 3 5. 7 4 11. Total Deductions (total Lines 9 and 10) ........................... .... 11. 9 6 6 O 6. 8 5 12. Net Value of Estate (Line B minus Line 11) ........................ .... 12. 1 2 1 5 1 7 8 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. 1 2 1 5 1 , 7 8 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.o _ 0, 0 0 15. 0. O O 16. Amount of Line 14 taxable at lineal rate x _ is. 0 . O 0 17. Amount of Line 14 taxable at sibling rate X .12 O. O O 17. O, O O 18. Amount of Line 14 taxable at wllateral rate X .15 1 2 1 5 1 7 8 16. 1 8 2 2. 7 7 19. TAX DUE ................................................... ...19. 1 8 2 2. 7 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 1505610240 1505610240 J REV-t 500 EX Pap4 3 Decedent's Complete Address: File Number 21 11 0614 DECEDENTS NAME MARY E. OTT STREET ADDRESS 33 SCRAFFORD STREET CITE SHIPPENSBURG STATE PA ZIP 17257 Tax Payments and Credits: t ~ 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. (1) 1,822.77 Total Credits (A + B) (2) 0.00 (3) (4) 0.00 (5) 1.822.77 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 w income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred w its income : ............................... ^ c. retain a reversionary interest w ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. ff death occurred after Decemtx~r 12,1982, did.decedent transferproperty within one year of death without receiving adequate consideration? ........................... 3. Did decedent own an 'in wst for" orpayable-upon-death bank acx:ount w security at his w her death? ......... ^ 4. Did decedent own an individual refinement 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 Juiy 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 3 percent [72 P.S. §9116 (a) (1.1) (i)J. For dates of death on or after Jan.1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even 'd 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) (12 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)J. Asibling is defined, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) - • pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARY E. OTT 21 ~ ~ 0614 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a v~illing buyer and a willing seller, neither being compelled to buy w sell, both having reasonable knowledge of the relevant facts. Real property that is jolntly~owrled with right of survivorship must be diacbsed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. LOT OF LAND IMPROVED WITH RESIDENTIAL REAL ESTATE THEREON 60,000.00 TOTAL (Also enter on Line 1, Recapitulation.) I S ff more space Is needed, use addftlonal sheets of paper of the same size. REV-1508 EX +,(898) ' ' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. IN R S DENT DECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER MARY E. OTT 21 11 0614 Include the proceeds of IiUgaffon and the date fhe proceeds were received try the estate. All property joindyowned with rlgM of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TRANSAMERICA LIFE ANNUITY 5,637.53 2. TRAVEL TRAILER (sold privately through craigslist) 3. PIONEER INVESTMENTS 4. CHECKING ACCOUNT CITIZENS BANK #146-8 5. LINCOLN TOWN CAR 2006 (SOLD TO DEALER) 6. 2005 FORD F-150 SUPERCAB 7. I NET PROCEEDS OF ITEMS SOLD AT AUCTION (SHEET ATTACHED) 8. REFUND CHAMBERSBURG HOSPITAL TOTAL (Also enter on line 5, Recapitulation) ~ S (If more apace is needed, insert additional sheets of Cie same size) 10,000.00 3,528.48 2,903.97 11,000.00 14,185.00 1, 500.65 3.00 REV-1511 EXr (tp.D9) • ~ pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. OTT 21 11 0614 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. SPRING H1LL CEMETARY 250.00 2. FOGELSONGER-BRICKER FUNERAL 4,471.52 3. SHULL-KOONTZ 250.00 B. 1. 2. 3. 4. 5. 6. 7. 8. 9. ADMINISTRATIVE COSTS: Personal Representative Commissions Name(s) of Personal Representative(s) Street Address Ctiy State ZIP Year(s) Commissan Pald: Attortley Fees: Family Exemption: (If decedents address is not the same as daimaM's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 2,000.00 Probate Fees: Accountant Fees: Tax Retum Preparer Fees: CUMBERLAND LAW JOURNAL ESTATE ADVERTISEMENT NEWS-CHRONICLE ESTATE ADVERTISEMENT U.S. POSTAL SERVICE-CERTIFIED MAIL FOR INVENTORY 222.50 75.00 96.50 5.59 TOTAL (Also enter on Line 9, Recapitulation) I S 7 371 11 If more space Ls needed, use additional sheet of paper of the same size. __ REV-1512 EX+ t12-OS) • • Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. OTT 21 11 0614 Report debts incurred by the decadent prior to death that remained unpaid at the date of death, including unreimbursed medical expensea. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MORTGAGE LOAN TO M8T BANK 60,354.34 ACCOUNT # 12044441503994998 2. AUTO LOAN TO CITIZENS 11,233.74 #2723985764 3. AUTO LOAN TO CITIZENS 14,701.96 #2725104703 4. SHIPPENSBURG EMS 15.00 5. BOROUGH OF SHIPPENSBURG-UTILITY 38.20 6. MANORCARE NURSING 1,720.00 7. PENELEC 81.39 8. CFJMA-UTILITY 94.50 9. UROLOGY ASSOC-LAST ILLNESS 15.00 10. CENTURY LINK-UTILITY 96.50 11. UGI-UTILITY 86.52 12. MACK TRUCK-REIMBURSEMENT OF PENSION 430.23 13. BALHARA MED 280.00 14. WEST SHORE EMS 88.36 TOTAL (Also enter on Line 10, Recapitulation) I S ti more space is needed, insert additional sheets of tl1e same size, 74 REV-1513 EX+ (01-10) • ~' pennsylvania DEPARTMENT OF REVENUE INHEWTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: ~~nov ~ nrr - - ~ G 1 1 1 VV IY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AMD ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pndude ou ''pht spousal distrihufions and transfers under Sec. 91 i6 (a) (1.2).~ 1., ANDREW NAUGLE Collateral 12,151.78 4530 EDENVILLE ROAD CHAMBERSBURG, PA 17201 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: L A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. s .~ ~ ~,,,.o o1+wc IJ ~IGLUGN, YJC wuiuullal aneera or paper o1 u1e same s¢e. LAST WILL AND TESTAMENT OF MARY E. OTT KNOW ALL MEN BY THESE PRESENTS, that I, MARY E. OTT, of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts,. funeral expenses and all expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving ail specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath all my property be it real, mixed or personal to Andrew Glenn Naugle, per stirpes. THIRD: I nominate and appoint, Andrew Glenn Naugle, as the Executor of this my Last Will and Testament. No Executor appointed herein shall be required not to post bond of any nature or kind. IN WITNESS WHEREOF, I, Mary E. Ott, to this my Last Will and Testament set my hand and official seal, this ~ day of i~r~,,~:~ 2011. ,~ .- ~- ~; _~o.. ' (SEAL) Mary .Ott Sworn to and subscribed, declared and Published by Mary E. Ott, as Her Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at her request, And in her presence, and in the presence Of each other. U ii COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, Mary E. Ott, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. Cam" Mary E. Ott Sworn to and acknowledged, before me, By Ma ~ Ott, the Testatrixrr This ~ day of U~/`CPt..y~ 2011 f Notary Public ~u.Tr+ of ~snvnri~ H. nnu+an a~a. tamer Shlpp ~' Mpy 31, 2014 pf Nc COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND VNE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Wili as witnesses, and that to the best of our knowledge and belief the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this ~ ~ day of ~~ 2011. ~rrr+ aF ve~v~ ram ser ~ H. MIta~Y Add NaRarlr _ Notary Public °,°"~~ 10~" .. .,~. ,~ • ~ DAN IRSHEY AUCTION SERVICES LLC 790 West High Street Carlisle, PA 17013 (717) 532-4647 ,,:~ Stev~~e---Ege 717-385-5438 Cell • .Chris Bream 717-226-1920 Cell SELLERS NAME ~S1r 1t cs ,! ~~ °~k'v~i ~~- DATE _~i.int 7r~~/ - ADDRESS PHONE OTHER AUCTIONEER %, Z ,-- •- AUCTION DATE/LOCATION CLERK ~'- DESCRI ON OF MERCHANDISE /~/ 1« ~ ~'1 S i.~~ a S~~n k / ~i f .+ n ~ 1 f~' ~t L ~~r r-r 7~~ ~S~ C'E^ r !Jr r ~° ~s .. .,,. . ~~.....:...:.:J Y~ I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized representa- tive of the merchandise, goods and/or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in th' ee nt. Trash fee applied if applicable. ,.-. f _- , < r'' : ~;" AU TION SIGNATURE ~ ~ .r' SELLERS SIGNATURE Total Sales (Clerking Tickets Attached) $ ~ 2 ~ Less Sale Expense: ~y Commission Auctioneer $ ~ ~ ~~ ~/ ~,, 44, Commission Clerks --~ $ OTHER:: iL~(,A.C, ~ d'" ~?~~~i. ~ U~~f TOTAL SALE EXPENSE DEDUCTED SELLERS NET $ ~~'tG'Est.t~'f ) TI SIGNATURE r pennsylvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES July 7, 2011 H ANTHONY ADAMS 49 WEST ORANGE ST STE 3 SHIPPENSBURG PA 17257 Telephone 717-787-6201 Re: Estate of Mary E Ott File Number 2111-0614 Social Security 184-12-2345 Dear Sir: The Department issues this waiver for the following security held in beneficiary format by the decedent. The security will be subject to Pennsylvania inheritance tax. The Department will not issue an information notice to the transferee of the potential Pennsylvanian inheritance tax due for this asset as the estate representative has informed the Department that the asset(s) will tie reported on the REV-1500 filed by the estate representative. A copy of this waiver is to be used by you to notify the transfer agent that the reporting requirements of Section 6411 of the Probate Estates and Fiduciaries Code (Title 20, Chapter 64, Pennsylvania Consolidated Statutes), have been satisfied. Name of Company: PIONEER INVESTMENTS Type of Account: ^ Capitol Stock ^ Registered Bond ^ A Security Asset ®A Security Account ID Number: 00009234495 Account Balance: $3,348.27 Sincerely, C~ Judy Watts Tax Examiner II Inheritance Tax Division Department of Revenue I PO Box 2806011 Harrisburg, PA 17128 1 717.787.8327 1 www.revenue.state.pa.us