HomeMy WebLinkAbout12-31-12
1505611185
REV-1500 EX(02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY
County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN 21 12 0293
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
196-14-3523 03032012 04271923
Decedent's Last Name Suffix Decedent's First Name M I
KAUTZ FRANCES I
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
7 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return (Date of Death
Prior 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 Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit (Date of Death ❑ 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 Nuqao.gr
KEITH 0. BRENNEMAN 717@327-852' riti n
u'>
GRG ER OF WIC USE("LTJ
M :C C"> ...14 t'-:)
;:0 t- C.T) G lit t
1741
First Line of Address 7o - 4,..
44 WEST MAIN STREET
Second Line of Address y
City or Post Office State ZIP Code DATE FILED
MECHANICSBURG PA 17055
Correspondent's e-mail address:
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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN + DATE
ADDRESS
TREVA L. BRYSON, CO-EXECUTOR LANDIS D. KAUTZ, JR•, CO-EXECUTOR
SI NATU F PREPARER OTHER THAN REPRESENTATIVE PA 7E
I L1_1'_
ADDRESS
KEITH 0• BRENNEMAN, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG
PLEASE USE ORIGINAL FORM ONLY PA 17055
Side 1
1505611185 OM4647 3,000 1505611185
.1 1505611285
REV-1500 EX (Fl)
Decedent's Social Security Number
196-14-3523
Decedent's Name K A U I Z FRANCES I
RECAPITULATION
1. Real Estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0.00
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , , , , , 3. 0 - 00
4. Mortgages and Notes Receivable (Schedule D) , , , , , , , , , , , , , , , , , 4. 0 - 00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) , , , , , 5. 711629 - 07
6. Jointly Owned Property (Schedule F) F~ Separate Billing Requested , , , , 6. 0 .00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . 7. 24,510-41
8. Total Gross Assets (total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8 9 6 , 13 9 -48
9. Funeral Expenses and Administrative Costs (Schedule H) . . . . . . . . . . . . . 9. 5-1935. 49
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) , , , , , . . . . 10. 680 .00
11. Total Deductions (total Lines 9 and 10) , , , , , , , , , , , , , , , , , , , , , 11. 6 , 615 - 49
12. Net Value of Estate (Line 8 minus Line 11) , , , , , , , , , , , , , , , , , 12. 89-1523- 99
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) , , , , , , , , , , , , , , , , 13. 0 - 00
14. Net Value Subject to Tax (Line 12 minus Line 13) , , , , , , , , , , , , , , , 14. 8 9 , 52 3 - 9 9
TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers unAer Sec. 9116
(a)(1.2)x.0- 0.00 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X.04 89,523.99 16. 41028.58
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18. 0.00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 4,028.58
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT X❑
Side 2
1505611285 1505611285
OM4648 3.000
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 12 0293
DECEDENT'S NAME
KAUTZ FRANCES I
STREET ADDRESS
MANOR CARE, 940 WALNUT BOTTOM
CUMBERLAND
CITY STATE ZIP
CARLISLE PA 1?015-
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 4,028-58
2. Credits/Payments
A. Prior Payments 41000-00
B. Discount 200-00
Total Credits ( A + B) (2) 41200-00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund. (4) 1? 1 • 4 2
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
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 . . . . . . . . . . . . . . . . . . . . ❑ 0
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? . . . . . . . . . . . . . . . . . . . . . . . . . . X❑ ❑
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)]. 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.
OM4671 2.000
REV-1508 EX- (11-10)
pennsylvania SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX
RESIDENTDECEDENTTURN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Frances I. Kautz 21 12 0293
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All propertjoint) owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Dr. Anstagt 107.22
refund due the decedent
2 Pennsylvania Department of Revenue 266.00
revenue refund due the decedent
3 Refund due 180.00
the decedent on 2011 income tax return
4 State pension 0.00
final state pension due the decedent in the amount of
$79.78. This is non-taxable and is listed for
informational purposes only.
5 Verizon 28.69
refund due the decedent
6 Wells Frago Advisors 71,047.16
investment account #58348052 / 3064522422
TOTAL (Also enter on line 5, Recapitulation) $ 71,629.07
OW46AD 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+(08-09) SCHEDULE G
pennsylvania
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Frances I. Kautz 21 12 0293
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.
DESCRIPTION OF PROPERTY o EXCLUSION TAXABLE
ITEM INCLLOETH=NAME OFTFETRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH /o OF DECD'S
NUMBS THE DATE OF TRANSFER ATTACH ACOPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IFAPPLICABLE VALUE
1. Wells Fargo Bank 204.55 100.0000 0.00 204.55
checking account #3064524915.
Jointly held with Treva L.
Bryson and Landis D. Kautz, Jr.
Account was made joint 2/3/12
within one year of death and is
fully taxable.
2 Wells Fargo Bank 12,127.87 100.0000 0.00 12,127.87
checking account
#1000665647386. Jointly held
with Treva L. Bryson and Landis
D. Kautz, Jr. Account was made
joint 2/3/12 within one year of
death and is fully taxable.
3 Wells Fargo Bank 12,177.99 100.0000 0.00 12,177.99
savings account 5284438446.
Jointly held with Treva L.
Bryson and Landis D. Kautz, Jr.
Account was made joint 2/3/12
within one year of death and is
fully taxable
TOTAL (Also enter on line 7, Recapitulation) $
24 510.41
If more space is needed, use additional sheets of paper of the same size.
9W46AF 2.000
REV-1511 EX- (10-09)
SCHEDULE H
pennsylvania
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Frances I. Kautz 21 12 0293
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 Brian Rice
organist for funeral services 100.00
Total from continuation schedules . . . . . . . . . 703.97
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2. Attorney Fees: Snelbaker & Brenneman, P.C. (Estimated) 3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 182.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Cumberland Law Journal
advertise Executors' Notice 75.00
2 Register of Wills
short certificates 12.00
Total from continuation schedules . . . . . . . . . 1,362.02
TOTAL (Also enter on Line 9, Recapitulation) $ 5,935.49
9w46AC 2.000 If more space is needed, use additional sheets of paper of the same size.
Estate of: Frances I. Kautz 21 12 0293
Schedule H Part 1 (Page 2)
Item
No. Description Amount
2 Camp Hill United Methodist Church
funeral luncheon 375.00
3 Marty Willard
assisted in funeral service 100.00
4 Neumyer Funeral Home
funeral services 228.97
Total (Carry forward to main schedule) 703.97
Estate of: Frances I. Kautz 21 12 0293
Schedule H Part 7 (Page 2)
3 Register of Wills
filing fee for Inheritance Tax Return 15.00
4 Somonic
preparation of income tax returns 90.00
5 The Sentinel
advertise Executors' Notice 232.02
6 Wells Fargo Advisors
fee to obtain date of death balances 25.00
7 Reserve
for filing fees, accountant fees and other
miscellaneous costs associated with the
administration of the decedent's estate 1,000.00
Total (Carry forward to main schedule) 1,362.02
REV-1512EXi(12-08) SCHEDULE
Pennsylvania
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Frances I. Kautz 21 12 0293
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
Darryl Guistwite, D.O.
medical services 30.00
2 Manor Care
nursing home care 650.00
TOTAL Also enter on Line 10, Recapitulation) $ 680.00
8w48AH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10) SCHEDULE J
pennsylvania
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Frances I. Kautz 21 12 0293
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Treva L. Bryson
20 Bayberry Drive
Mechanicsburg, PA 17050
One Half of Residue: 44,762.00 Daughter 44,762.00
2 Landis D. Kautz, Jr.
8448 S. Florence Avenue
Tulsa, OK 74137
One Half of Residue: 44,762.00 Son 44,762.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
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. $ 0.00
9W46Al 2.000 If more space is needed, use additional sheets of paper of the same size.
r 0- - C7
LAST WILL AND TESTAMENT JJ
FRANCES I. KAUTZ
L.-. "Tl
I, FRANCES I. KAUTZ, of Hampden Township, Cumberland
County, Pennsylvania (Camp Hill, PA 17011) being of sound and
disposing mind, memory and understanding, do hereby make, publish
and declare this to be my Last Will and Testament, hereby
revoking any and all wills and codicils at any time heretofore
made by me.
ITEM I - I hereby direct my hereinafter named personal
representative to pay all of my just debts, funeral expenses, and
estate and inheritance taxes as soon as after my death as may be
found convenient.
ITEM II - I direct that I be buried next to my husband in a
lot that I own in Woodlawn Memorial Gardens, Harrisburg,
Pennsylvania.
ITEM III - All the rest, residue and remainder of my
estate, whether real, personal or mixed, of whatsoever nature and
kind and wheresoever located, I give, devise and bequeath to my
children, Landis D. Kautz, Jr. and Treva L. Bryson, in equal
shares.
Page 1 of 4
If either my son or daughter should predecease me, then his
or her share shall be distributed to his or her issue, by
representation. If my deceased son or daughter shall have died
without issue surviving him or her, then the share of such
deceased child shall be distributed to my other child but if he
or she should also have predeceased me, then to his or her issue,
by representation.
ITEM IV - I appoint Landis D. Kautz, Jr. as co-executor and
Treva L. Bryson as co-executrix of this my last will and
testament.
ITEM V - I direct that my personal representatives shall not
be required to give bond for the faithful performance of his or
her duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal thisday of 2005.
Frances I. Kautz
Page 2 of 4
Signed, sealed, published and declared by the above
testatrix, Frances I. Kautz, as and for her Last Will and
Testament, in our presence, who, at her request, in her presence
and in the presence of each other, we, believing her to be of
sound mind and memory, have hereunto subscribed our names as
witnesses.
of -"'Mkn'JL
_ of SOS
Page 3 of 4
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF DAUPHIN
We, Frances I. Kautz , testatrix, Kent H. Patterson
and Christina V. Fields ,
witnesses, respectively, whose names are signed to the attached
or foregoing instrument, being first duly sworn, do hereby
declare to the undersigr_e3 authority that the testatrix signed
and executed the instrument as her Last Will and Testament; that
she signed it willingly and executed it as her free and voluntary
act for the purposes therein expressed; that each of the
witnesses, in the presence and hearing of the testatrix, signed
the will as witnesses; and that, to the best of their knowledge,
the testatrix was at that time eighteen (18) years of age or
older, of sound mind and under no constraint or undue influence.
Frances I. Kautz
Subscribed, sworn to and acknowledged before me by Frances
I. Kautz, the testatrix, and subscribed and sworn to before me by
Kent H. Patterson and Christina V. Fields
witnesses, this 14th day of January 200.
My Commission Expires: 'J\,,-Notary P`blic
'ulv'MQNWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
ISSA J. HARPLE, Notary Public
of Harrisburg, Dauphin County
ommissi
ry
on Expires May 10, 2005
Page 4 of 4