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Home My WebLink About10-26-12 (2)15056051058 REV-1500 EX (06-05) OFFICYAL USE ONLY PA Department of Revenue Bureau of Intlivldual7axes Counly Code Year Flle Number Pofioxza6sol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 D9 0449 ENTER DECEDENT INFORMATION BELOW Social Security Number _ _ Date of Death Dale of Birlh 206-10-9488 ;05/02/2009 08/29!1918 _ _ ~ _ Decedents last Name _.. Suffix Decetlent's First Name MI Gotshall i Dorothy M I (If Applicable) Enter Surviving Spouse's InformaQon Below Spouses Last Name __._ Suffix Spouse's First Name MI ~ ',, Spouse's Social 8ecurlty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - ! REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Retum OID 2. Supplemental Ratum O 3. (Remainder Return (date of death O 4. Limited Estate Prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. 1=ederal Estate Tax Return Required death after 12-72-82) ~ 6. Decedent Died Testate O 7. Decedent Maln[ained a Living Trust .._ 0. 8. -total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigatlon Proceeds Receivetl O 10. Spousal Poverty Credit (date of death O 11. !Election to tax untler Sec. 9173(A) between 12-37-91 end 1-t-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAx INFORMATION SHOULD BE DIRECTED TO: Name _ _ Daylimr: Telephone Number Robert L Knupp, Esq (717) 238-7151 _ _.. Rrm,Name (If Applicable) ~ ~~~~- ~ ~;;;; ,;_ -- - __._ ~~~ ~ ~- -"-"' '--"--'--'- ~ REGISTER Of WILLS USE ONLY Smigel Anderson & Sacks I `"' n ,' Frost line of address _- "~ ~~~ ~O "' P.O. Box 630 4431 North Front Street Clty or Post Office _ State __. ..... Harrisburg ~ PA _... ...... _... _.-. ...-_. ___ t m T: m-L~ a' ; ~~'i' uc-; .. ZIP Cotle 1..-... unrc 17106 D ~~ W W Correspondent's a-mall address: Under panallias of perjury, 1 declare mat I have axeminetl (his return, Including accompanying achetlules antl slatemenls, end to the best of my knowledge and belief, If is true, correct antl complete. Dederetion of preparer other than Iha personal represenlatlve is based on all information of which preparer has any knowledge. cir_ueT~ ieo nv o~o~..., ,,. .............. _ ___ _.. .__ __. ADDRESS - /T~Yi/~_/? Elwood R. G~tshall, Jr. 8 MgnArDrive, West Chester, PA 19380 DATE . ~ Flowers & Flowers, CPAs, 5775 Allentown Blvd__Suite 102, Harrisburg, PA 17112 15056051058 Side1 1;5056051058 l m C7 '~'~ C=i ='' c i .; r-n '_zi v `-~i~; ~- T ::= ."7 ~,/~ ('7 ~~ J 15056052059 REV-1500 EX Decedent's Name: Dorothy M Gotshall 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. fi. Jointly Owned Property (Schetlule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requestetl........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. _._._ 9. Funeral Expenses & Administrative Costs (Schetlule H) ..................... 9. Decedent's Social Security Number ,206-10-9488 1,361.91 '' 10. Debts of Decetlent, Mortgage Liabilities, & Liens (Schedule I) ........... ..... 10. '.. ~ ~~~~ 11. Total Deductions (total Lines 9 & 10) ..................... ~~~r 11 ' ......... ..... . ' 300.00 ---- 12. Net Value of Estata (Line 8 minus Line 11) ................ __....-._...._.~.____._._.._..r....__..... 12 ' 13. ......... Charitable and Governmental Bequests/Sec 9113 Trusts (or which ..... . . 1,061.91 ~-` ----------------- ~~ an election to tax has not been made (Schetlule J) ................... '. .... 13. I 14. Net Value Subject to Tax (Line 12 minus line 13) . 14 .................. ..... , j 1,061.91 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. i6. Amount of Line 14 taxable at lineal rate X .045 i6 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O 15056052059 Side 2 L :15056052059 REV.1son EX Page 3 Flle N m r ~o _____ Decedent's Complete Address: 21 Os oa49 DECEDENTS NAME DOrOthy M GOtshall DECEDENTS SOCIAL SECURITY NUMBER STREET ADDRESS 206-10-94$8 100 Mt. Allen Drive CITY Mechanicsburg STATE ZIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Pdor Payments C. Discount 3. InleresUPenalty if applicable D. Interest E. Penalty Total Credits (A + $ + C ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYME Total InteresUPenalty (D + E ) fill In oval on Page 2, Llne 2D to request a refund. 5. If Line t + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 47.79 (2) (3) (4) (5) 47.79 (5A) 4.37 (5g) 52.16 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS fi 1. Did decedent make a transfer and: a, retain the use or income of the ro P pertytrensferred :............................................................................~....... Yes ...... ^ No b. retain the dght to designate who shall use the property transferced or its income :.............................. o retain a reversionary interest; or .......................................... . .................................................... d. receive the promise for I'rfe of either payments, benefAS 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 secudty 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 172 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 fo 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 far 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 paren(, 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 an~i one-halt (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 F'.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-i5tle EX+(6-9e) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY t51Alt OY Dorothy M. Gotshall FILE NUMBER 21 09 0449 InGude (he proceeds of liligatlon and the dale the proceeds were receivetl by the estate. f All property Jointlyowned with rlghl of aurvlvonhlp moat be dlacloaed on Schedule F. L Decedent, as a one thiM beneiiciary to the Estate of Leander H. Hamm, (Pile #21-07-0290) -this supplemental return reports Decedent's share of proceeds of net value of subsequently discovered shares of Zimmer Holdings, Inc. as reported on a supplemental retum fled for the Leander H. Hamm Estate. REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT estwle or FILE NUMBER Dorothy M. Gotshall 21 D9' 0449 Debts of decedent moat be reported on Schedule I. A. FUNERAL.EXPENSES: nMUUrvI 1. _... R. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions - - Name of Personal Representative(s) 'Elwood R. Gotshall Social Security Number(s)/EIN Number of Personal Representative(s) .207-34-7175 Street Address iB Manor Drive city West Chester state+PA 'Zip 19380 Yeags)CommissionPaid 2009 2. Attorney Fees 3. Family EXemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant _. _...... __.... ....._.. .. Street Address ~ ' City Slate Zip .. Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 265.00 6. Tax Retum Preparer's Fees - ~. Postage __ __ _ . 15.00 TOTgL (Also enter on line 9, Recapitulation) $; 300.00 (If more space is needed, insert additional sheets of the same size) REV-1513 E%+ (]]-OB) pennsylvania SCHEDULE ] DERARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy M. Gotshall _ NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] RELATIONSHIP TO DECEDENT Do Not List Truatee(s) G I Uy V44`J AMOUNT OR SHARE OF ESTATE 1. Elwood R. Gotshall, 8 Manor Drive, West Chester, PA 19380 :.Son 530.96 2. Ronald L. Gottshall, 1824 Hearthstone Lane, Middletown, PA 17057 Son 530.95 (Note: Two T's in Ronald's name is correct) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. IS NON-TAXABLE DISTRIBUT]ONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOi TAKEN . ... ......._ _.... 1. _..... _ ._ _... L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS _ _ _ TOTAL OF PART II -ENTER TOTAL NONTAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $' =V=~~ n neeueu, insert d001[IOndl srleets of the same site. Personal Income Tax e-Services Center ~~G-v9-~~~~ Penalty and Interest Calculations CALCULATION DATES- 02/02/2010 TO 10/31/2012 TAX DEFICIENCY $ 4i'.79 CALCULATED INTEREST $ 4.,37 BALANCE AS OF 10/31/2012 $ 52.16 Page 1 of ] https://www, doreservices.state.pa.us/pitservices/Default.aspx 10/18/2012