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HomeMy WebLinkAbout01-17-12 (3) 1505610143 REV-1500 Ex(~,_,~) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes ~~*~~~ Po Box.2sosot INHERITANCE TAX RETURN 21 11 0367 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171 0:1 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 INAPPROPRIATE OVALS BELOW a t. Origiinal Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 4. Limfted Estate ^ 4a. Future Interest Compromise (date of death after 12-,2-82) ^ 5. Federal Estate Tax Retum Required ^ g. Decedent Died Testate (Attach Copy of Will) ^ ~ ecede Maintained a Living Trust Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 8. Litigation Proceeds Received ^ tD• s~°~"$en1~=~t~~andt,~d 95pfdeath 1 ~ 11.Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JANE O SHOP (717) 737 0100 First line of address 1572 BOILING SPRINGS RO Second line of address City or Post Office State ZIP Code BOILING SPRINGS pp~ REGISTER ~@ WILLS US~-ONLY ~.-} - , ^i7 ~~ ~ i..7 , _~ , _ -?; _ _., ..~ ~ --_ . :~3 - DATE FILED ' ` ~. -r} ~, Correspondent's a-mail address: Under penalties of perjury, I declare 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. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. ~ ~St>!ijLG ~ ~~>~+y Jane O Shoop ///3 X12 1572 Boiling Springs Road, Boiling Springs, PA 17007 SIGNATURE OF PREPARER OTHER T AN REPRESENTATIVE DATE Jane O Shoop wurcts~ 1572 Boiling Springs Road, Boiling Springs, PA 17007 Side 1 150561D143 15D5610143 J • 1505610243 REV-1500 EX oeceae~nrs N~a: Otter, Olwyn Mary W Decedent's Social Security Number 171 O1 4285 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 8 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 & Miscellaneous ion; Probate Property (Schedule G) u Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 2,398.15 2,398.15 9. Funeral Expenses i£ 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 , 430.38 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. - 32.2 3 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. - 32.2 3 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 O . 0 0 (a)(1.2) X .00 16. Amount of Line 14 taxable 0. 0 0 16 0. 0 0 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 0. 0 0 . 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 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Pages 3 Decedent's Complete Address: File Number 21-11-0367 DECEDENT'S NAIUIE 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. CreditslPaymeints A. Prior Payments B. Discount 0.00 3. Interest 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~ Ma a 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 adequatle consideration? .................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ contains a beneficiary designation? .................................................................................................................. IF THE ANSWER'f0 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 stilfiapplicabie 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 ~f the child is 0 percent [72 P.S. §9116 (a) (1.2)J. . The tax rate imposed on the net Walue 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 defineii under Section 9'102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rsv-1506 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 pproceeds of litigation and the date the proceeds were received by the estate. All property )olndy-owned with tfie 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-OB) COMM~~41,r~D~Q~ANIA SCHEDULE H FUNERAL EXPENSES & 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: See continuation schedule(s) attached ~ 2,173.88 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission oaid 2. Attorney's Fees Diane G Radcliff 750.00 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 78.50 5. Ac'countant's Fees 6. Tax Return Preparers 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 97.00 2 Auer Funeral Services 414.45 3 Gearge & Joan Newberry -Catering 399.99 4 Messiah ~Ilage Chapel 200.01 5 Rite Aid -Poster Board for Funeral (picture display) 64.00 6 Slryview Cemetary 794.97 7 Wayne Noss - Flawers 203.46 H-A 2,173.88 Other Administrative Costs 8 Register of Wills -Filing Fee Inheritance Tax Return and Inventory 30.00 H-B7 30.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1b13 EX+ (17-08) ' SCHEDULE J coMr~~~p~~~~ANIA BENEFICIARIES ESTATE OF FILE NUMBER Otter, OI n Ma W 21-11-03 67 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT {Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • dlstnbutlons, 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 113 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 amoun for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a r o riate. ~. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 CIDVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) MESSIAH VILLAGE Trust Fund Monthly Statement 100 MOLfNT ALLEN DRIVE Report Period: 05/01/2011 To 05/31/2011 MECHANICSBURG, PA 17055 OLWEN W. OTTER JANE SHOOP 1572 BOILING SPRINGS ROAD BOILING SPRINGS, PA 17007 Fund: TF -Trust Fund I© FACILITY /UNIT STMT. DATE 98012 05/31/2011 RESIDENT(S) OLWEN W. OTTER Tran aescri tion Vender Reference Amoun# OS/O1/11 Beginning Balance 2,374.82 05/31/11 C,!~SH WITHDRAWAL ESTATE OF OLWEN OTT: 0000802279 -2,374.82 OTTER, OLWEN W -CLOSE TRUST FUND/CLOSE ESTATE; 6/17/11 05/31/11 Ending Balance 0.00 PSEC~ P.O. Boz 67013 (717) 234-8484 (Harrisburg) Harrisburg, PA 17106-1013 (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 00046129 1 AT 0.365 (lll'I~III~III/1" 111~111~'1~111~~11~1~11~~111'111111'1'/III~I OLWEN W OTTER C/0 JANE SHOOP 1572 BOILING SPRINGS RD BOILING SPRINGS PA 17007-9690 JOINT OWNER JANE 0 SHOOP I O171XXXXXX I 120111123111 PAGE 1 ..:....:..;.;::.. .:::::.:.::.::.::•~<;::::::>:..:.>:. ;iii. FNANCE :x::•I~Ft':;::;.'.:`~~TK1Ff..: :..,:::...:...:..::.:..........::.:..::...: ......... ................. .:,::.: :::.::.::.::::::.::...::. :.:.:.:........~.................,........................ ~...:...:::.:: .:.: pi . .:~.::;:;:;:.;. ....... ..................................................................................:.::.:.:::..::.::..:::...:..:.... .,::::::. CHARGE ...........~:.;:>:.::::.:;;;;:.::.:<.>.:.::.>:BN~AI.'. :::«i?:<'<';::s::: REGULAR SHARES BEGINNING BALANCE 22.14 12/31 PAYMENT: DIVIDEND 0.300% 0.01 22.15 ANNUAL PERCENTAGE YIELD EARNED 0.53% FROM 12/01/11_.THROUGH..12/3,1/11 _ __ 12/01 ID 04 CHECKING BEGINNING BALANCE 25.33 12/31 WITHDRAWAL DEC DORMANT FEE _. 2_..00- 23.33.. __ TOTAL DIVIDEND YID: YEAR TO DATE 0.12 oe' o00 W 07 d v C ~D O O O 3 3 ~ obi ~ ~ ~.~,'° N l~D f~D 3 3 c c c ~ ~ ~ ~3r rO~r .O-r V Cn W t0 N Vt O oo O .... V O o g N F-~ N O N Individual Expenses Shared Expenses 00 Cn Cn 01 D1 N 00 0 00 00 00 00 00 00 On 0 On Q1 C1 ~ L. 1~ V L V 1... ` 4.. t. ` f... i. 1... 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