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HomeMy WebLinkAbout11-26-12 (2)1505610105 REV-1500 Ex X02-~~, BFI, enns lvania OFFICIAL USE ONLY PA Department of Revenue P Y Bureau of Individual Taxes °EF.A,~,~~1oFRE•,E~~~E County Code Year File Number INHERITANCE TAX RETURN '~~ ~'° ~,~ -~ PO BOX 28o6oi Harrisburg, PA 1'J128-0601 RESIDENT DECEDENT -~ ~ ~. ~ ~ . i,! ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 202-50-4681 02/27/2012 09/19/1958 Decedent's Last Name Suffix Decedent's First Name MI OTT Patrick E (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 C>~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number F & M Trust Company (717) 960-1400 First Line of Address 1901 Ritner Highway Second Line of Address City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's a-mail address: daVe.gOflty@f-mtrUSt.COm REGISTER OF Vy1~LS USE ONLY:,: <r--- _ __ ._ f-., r..,..~ - .. t„ ,_ _. ~ l~d"S, r ~.J ` C. 3 _ . ~,. , -. _, , DAT FICED -~-- ~._ ~1M; "T"'~ -- '~ s `-~ ` =~ C7 ---, 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, rest and complete. Declar ion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN OF PER ON SP IBJ.F FnR FILING RETURN DATE AD ESS 1901 Ritner Highway, Carli e, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 ,~' ~ ~- ~? J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: 202-50-4681 RECAPITULATION 1. Real Estate (Schedule A) ........................ . .................... 1. 173, 000.00 2. ....................................... Stocks and Bonds (Schedule B) 2. 0.00 3- Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. 9 9 ( ) ........................... Mort a es and Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 49,405.70 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 222,495.70 9. Funeral Expenses and Administrative Costs (Schedule H) ....... ............ 9. 41,390.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ... ............ 10. 156,795.57 11. Total Deductions (total Lines 9 and 10) ..................... ............ 11. 198,186.57 12. Net Value of Estate (Line 8 minus Line 11) .................. ............ 12. 24,310.13 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. 24,310.13 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_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 24,310.13 16. 1,093.96 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. 1,093.96 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 150561025 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Patrick E. Ott STREET ADDRESS 112 Gilbert road CITY STATE ZIP Shippensburg, PA ~ 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,093.96 1,093.96 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 .......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c. retain a reversionary interest .............................................................................................................................. ^ ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 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 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? ........................................................................................................................ ~ ^ 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 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(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. R=V-15G2 EX-~ I ~ -J~? 3 ~ pennsyLvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Patrick E. Ott 2012-00322 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 willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. REV-iso8 EX+ (08-12) i pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Patrick E. Ott 2012-00322 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. F & M Trust Company Checking Account @ DOD 447.27 2 Patriot Federal Credit Union Draft Account @ DOD 15.44 3 Patriot Federal Credit Union Prime Share Account @ DOD 45.04 4 Volvo Construction Equipment Company -Vacation Pay 1,382.20 5 Volvo Construction Equipment Company -Payroll 4,135.99 g Volvo Construction Equipment Company -Expense Reimbursement 262.76 7 Hershey Medical Center -Refund 25.00 g 2010 Chevrolet Camero as appraised 21,000.00 g 2011 Chevrolet Silverado Pickup Truck as appraised 14,000.00 10 2003 Chevrolet Silverado Pickup Truck as appraised 6,000.00 11 Personal Property @ 112 Gilbert Road Residence as appraised 1,900.00 12 Erie Insurance Refund of overpayment of premium 192.00 TOTAL (Also enter on Line 5, Recapitulation) $ I 49,405.70 If more space is needed, use additional sheets of paper of the same size. REV-i5og EX+ (oi-io) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Patrick E. Ott 2012-00322 SCHEDULE F JOINTLY-OWNED PROPERTY If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Cole E. Ott 112 Gilbert Road, Shippensburg, PA B C JOINTLY OWNED PROPERTY: Son ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °/a OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 02/01/08 F & M Trust Company Savings Account 864676 180.00 50 90.00 TOTAL (Also enter on Line 6, Recapitulation) I $ 90.00 If more space is needed, use additional sheets of paper of the same size. ~ enns lvania SCHEDULE G p Y DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Patrick E. Ott 2012-00322 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. If more space is needed, use additional sheets of paper of the same size. ~ pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Patrick E. Ott 2012-00322 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' Funeral Expenses 3,531.50 Flowers & Sharing Urn 197.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 13,250.00 Name(s) of Personal Representative(s) F & M Trust COmp~, Executor Fee Street Address 1901 Ritner Highway_ _ __ city Carlisle state PA , zIP _.1701.3 Year(s) Commission Paid: 2012 $9,250.00 2013 $4,000_00 2. Attorney Fees: 20,000.00 3 500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) ' Claimant COIe Ott Street Address 112 Gilbert Road city Shippensburg ___ state PaZ1P _17257 Relationship of Claimant to Decedent SOn 4. Probate Fees: 298.00 5. Accountant Fees: 500.00 6. Tax Return Preparer Fees: 7~ Advertising Letters 113.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 41,390.00 If more space is needed, use additional sheets of paper of the same size. REV-1512 EXa- 12-:183 ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Patrick E. Ott 2012-00322 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• F & M Trust Company, Mortgage on 112 Gilbert Road, Shippensburg, PA 98,533.29 2 Interest accrued to DOD on Item # 1 471.11 3 F & M Trust Company Home Equity Loan @ DOD 4,309.60 4 Interest accrued to DOD on item # 3 27.43 5 Patriot Federal Credit Union Loan to Purchase 2010 Chevrolet Camero @ DOD 21,514.69 6 Interest accrued to DOD on Item # 5 64.84 7 Patriot Federal Credit Union Loan to Purchase 2011 Chevrolet Silverado Pickup Truck 26,914.81 8 MasterCard Balance due at DOD 2,762.03 9 Sunoco Credit Card due @ DOD 138.97 1 o Medical Services Provided prior to DOD net of Refunds 1,218.67 11 Medical Transporation to Chambersburg Hospital 236.96 12 Electric Service @ 112 Gilbert road, Shippensburg, PA 339.71 13 Phone Service @ 112 Gilbert Road, Shippensburg, PA 258.56 14 Per Capita Tax due for 2011 4.90 TOTAL (Also enter on Line 10, Recapitulation) I $ 156,795.57 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10} ~ pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Patrick E. Ott 2012-00322 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• Cole E. Ott, 112 Gilbert Road, Shippensburg, PA 17257 Son 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size.