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Home My WebLink About01-17-121505610143 REV-1500 Ex(°'-'°' } PA De artment of Revenue y OFFICIAL USE ONLY p Penns Ivania County Code Year File Number Bureau of Individual Taxes °QART1A°^°~" Po Box.2sosot INHERITANCE TAX RETURN 2]. 11 0367 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171 O1 4285 O1 04 2011 06 21 1917 Decedent's Last Name Suffix Decedent's First Name MI OTTER OLWYN MARY W (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' prior to d2r13 2j (date of death ^ 4. Limited Estate ^ 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) ^ ^ 6 Decedent Died Testate ~ p~cede^t Maintt ned a Living Truat ~ 8. Total Number of Safe De Slt B°Xe$ (Attach Copy of Will) ^ (Attach Gopy of~rust) ~ ^ 9. Litigation Proceeds Received ^ 10. b~tween?~~t~1 ~att(datee5of death ^ ~ t. Election to tax under Sec. 9113(A) )) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA;K INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number JANE O SHOOP (717) 737 0100 First line of address 1572 BOILING SPRINGS RO Second line of address City or Post Office State ZIP Code BOILING SPRINGS PA REGISTER Q~ WILLS USEONLY s~ _ , ~3 ..,7 ~:~ _ - r~ '- r-r-I .__. „~~ _~ _. '~ i~.._J -Z'3 -~ t __ _ ' .,: 3 - DATE FLED ' ° ~. ;-'-; -r": C~ Correspondent's e-mail address: Under penalties of perjury, I deGare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. aivnr~i c yr r~nwn//nnwrunaio~c r~rc riunu nt i unn L1ATE ` ~• ~~~ Jane O Shoop ///3 rll2. 1572 Boiling Springs Road, Boiling Springs, PA 17007 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Jane O Shoop ADDRESS 1572 Boiling Springs Road, Boiling Springs, PA 17007 Side 1 1505610143 1x05610143 REV-1500 EX 1505610243 Decedarn's Name: Otter, OIWyn Mary W 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous ton; Probate Property (Schedule G) u Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, Decedent's Social Security Number 171 01 4285 2,398.15 2,398.15 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ....................................... 9. 2 , 430.38 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 2 , 4 3 0 . 3 8 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. -32.23 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. -32.23 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 00 (a)(1.2) X .00 . . 16. Amount of Line 14 taxable 0 00 16 0.00 . at lineal rate X .045 . 17. Amount of Line 14 taxable 0 00 17 0 00 . at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 00 18 0 00 . at collateral rate X .15 . . 19. Tax Due .................................................................................................................. 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0367 DECEDENT'S NAME Otter, Olwyn Mary W STREET ADDRESS Messiah Village 100 Mount Allen Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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) Total Credits (A + B) (2) (3) (4) (5) 0.00 0.00 0.~~ Make Check Pa able 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 ............................................................................................................... ^x d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 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 January 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)]. 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)J. A sibling 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+ (6-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Otter, Olwyn Mary W 21-11-0367 Include the proceeds of litigation end the date the proceeds were received by the estate. All property Jolndyowned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+(10-06) SCHEDULE H coM~~n4To~we Dr~ sANIA FUNERAL EXPENSES & 1t~, €~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Otter, Olwyn Mary W 21-11-0367 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: B. 1. See continuation schedule(s) attached ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Yearlsl Commission paid 2,173.88 State Zio 2. Attomev's Fees Diane G Radcliff 150.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 76.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 30.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 2,430.38 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Otter, Olwyn Mary W 21-11-0367 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Allenberry -Cottage for funeral reception 2 Auer Funeral Services 3 George 8 Joan Newberry -Catering 4 Messiah Village Chapel 5 Rite Aid -Poster Board for Funeral (picture display) 6 Slcyview Cemetary 7 Wayne Noss -Flowers Other Administrative Costs 8 Register of Wills -Filing Fee Inheritance Tax Return and Inventory 97.00 414.45 399.99 200.01 64.00 794.97 203.46 H•~A 2,173.88 30.00 H-67 30.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (11-08) SCHEDULE J coMr~~c~^eF~.s~~rANIA BENEFICIARIES ESTATE OF I FILE NUMBER utter, vl n Ma W 21-11-0 367 NAME AND ADDRESS OF RELATIONSHIP TO SHARE: OF ESTATE AMOUNT OF ESTATE NUMBER PERSONISI RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 David W Otter Son 1/3 residue 243 N. Middlesex Road Carlisle, PA 17013 Mark V Otter Son 1/3 residue 9 Prospect Ridge Horseheads, NY 14845 Jane O Shoop Daughter 1/3 residue 1572 Boiling Springs Road Boiling Springs, PA 17007 Total ~~ Enter dollar amounts for distributions shown above on tines 15 throw h 18 on Rev 150 0 cover sheet as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) MESSIAH VILLAGE 100 MOUNT ALLEN DRIVE MECHANICSBURG, PA 17055 OLWEN W. OTTER JANE SHOOP 1572 BOILING SPRINGS ROAD BOILING SPRINGS, PA 17007 Fund: TF -Trust Fund Trust Fund Monthly Statement Report Period: 05/01/2011 To 05/31/2011 D FACILITY /UNIT STMT. DATE 98012 05/31/2011 RESIDENT(S) OLWEN W. C)TTER Tran. OS/O1/11 Descr[ptic~n ~ Beginning Balance Vendor Reference .Amount 2,374.82 05/31/11 CASH WITHDRAWAL ESTATE OF OLWEN OTT: 0000802279 -2,374.82 OTTER, OLWEN W -CLOSE TRUST FUND/CLOSE ESTAT>H:; 6/17/11 05/31/11 Ending Balance 0.00 '• ~ ~ ~ ~~ ~ ANNUAL PERCENTAGE YIELD EARNED 0.53% FROM 12/01/11 THROUGH 12/31/11 12/01 ID 04 CHECKING BEGINNING BALANCE 12/31 WITHDRAWAL DEC DORMANT FEE TOTAL DIVIDEND YID: YEAR TO DATE 25.33 2.00- 23.33 0.12 P.O. Boz 61013 (711) 234-8484 (Harrisburg) Harrisburg, PA 11106-1013 (800) 237-7328 (Nationwide) website - http://www psecu.com PLEASE NOTE: BASED ON IRS CRITERIA THIS ACCOUNT DID NOT RECEIVE AN IMPORTANT TAX RETURN DOCUMENT pOj ~ ~ ~ O O O ~ ~ ~ d v ~ ~ ~ fD ~ ~ ~ c c c m ~ ~ ~ h ~ V O'f W V~ O g $ 01 OD tG O V O S N N D N 0. 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