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HomeMy WebLinkAbout03-05-13 (2)1505610101 REV-1500 EX `°1.1°' '~ enns lvania OFFICIAL USE ONLY PA Department of Revenue pr .a,,,E Y County Code Year File Number Bureau of Individual Taxes pINHERITANCE TAX RETURN PO BOX 280601 n Harrisburg, PA 1128-0601 RESIDENT DECEDENT ~ ~ ~ a ~ ~7` ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~~3 ?~ ~8~8 ~gt3Z,Dt~ Dn~.~i~?3 Decedents Last Name Suffix Decedents First Name MI 5 n ~S ~i e. !~ 'FE ~ r i ~ ~ l~ (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 p 2. Supplemental Return p 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate p 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (date of death Q 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ d- n ~ S DT ~T Q~ ~` '1 ~ ~ 9~( ~ ..~ 5 5 First line of address (~~ 3 why Second line of address City or Post Office (~ ©- ( 1`11 t sky SPrs ~prnGS Ra State^ ZIP Code /~ . ~^J2EGISTER OF`,_VffiLLS USE~fILY ~ ° ~, ~ m rn ~ ;.a ~ -x-x ~ ~, u~ t'rt ~ ~ ~~ ~ G~ rO M R`3 +C::.y C ~ . ft :~:3 :,.. m~f DAtfE`l=ILEA' ~ ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J Correspondent's a-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 COm°lete. Declaration of oreoarer other than the oersnnal representative is haled nn all infnrmatinn of which nrenarer has any knnwlarlno J 1505610105 REV-1500 EX Decedent's Social Securihhty Numrrb''er Decedent's Name: ~ ~ 3 ~ ~ V ~ 't ~' 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 and Notes Receivable (Schedule D) ......................... .. 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ' '~ 1 ~ . ~ 8 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ' (Schedule G) p Separate Billing Requested...... .. 7. • 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. f `~ ~ 5 • ( b 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. ~ ~ r .~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. j ~ g `~ . (~ (~ 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. ~ lD ~ ~ . CJ ~ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. I-~ ( (p 8 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. t ~ ~ . (fl TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 _ . 16. _ 17. Amount of Lirie 14 taxable at sibling rate X .12 • 17. . 18. Amount of Line 14 taxable at collateral rate X .15 ~ ~ • ~ `~° 18. ~ ~ s (A~ ~.,~_.. v 19. TAX DUE ....................................................... ..19. C ~ ~.~•ol 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME STREET ADDRESS k '~~!n ~ Cede ~ _ _. ITY i STAT- ---- ZIP ~ I~ ~ 1'~vr Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments ___ B. Discount 3. Interest 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. _ w ,_~. _ _ - 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; or ................................................................................................................... ..... ^ 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" orpayable-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~TpOy,ANY OF THE ABOVE QU~IwESTIONS\!~jl~S~gYES, YOU MUST COMPLETE SCHEDULEG3,jAND FILE IT AS PART OF THE RETURN. `:~-',~Ti~r'~ih.: a3 ar35 1_,ryrt.'" wx~?ti'~+K~`??"?5 .5wC-~`'it A'f',jp.l ~.~ f,wlrY~s~i ':tla LO=,. 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(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)]. 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. Total Credits (A + B) (2) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IED~ILE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: 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. ,~ ~iwie aNa~e is neeaea, use aaarcionai sneers of paper of the same size. •~ fL fL Q Q r .. r -~] O ti O r .a .a ru 0 r n _..,C Z _ ~ O _. ~ m -I _ _ ~ ~ Z `~r hh ,~ ~_ W ``%~~;, r- _... z m ,, o ~~ p~ } .... CUST -o ~ '~ O -{ m ~ W cw Dw o~ ~ ~ a Z~ ND- O O ~ ~ ~ Q ~ C N G D N 7 D m OMER O ^~ '/ ~~ n n Z C"r7 N O O N o CL? A w N (~~}~ N L'M O ~~~ m~~~ L_.~ x~~Y COPY REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF c FILE NUMBER ~av~.ri~-c~, ~ ~2n~~C~ ~l ~. io2. I~~ 1 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions .-- ~ "_ Name of Personal Representative(s) Street Address _ City _ State Zip Year(s) Commission Paid: 2 Attorney Fees O ,,,_ 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 $ ~ ~ ~~ 5• Accountant's Fees "' ~ ~; tl~vuc.~. ~ vl D ~° ~ " ,,.~, $ `~a~ 15 . CAD 6. Tax Return Preparer's Fees ._ 7. TOTAL (Also enter on line 9, Recapitulation) $ ~ ~~ (If more space is needed, insert additional sheets of the same size) RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 SNOKE MAURITA OTTO Estate File No.: 2012-01281 Paid By Remarks: ADIN L S OTTO JR wz ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCS FEE AUTOMATION FEE Cash Total Received......... Receipt Date: 12/07/2012 Receipt Time: 12:42:40 Receipt No.: 1072326 Receipt Distribution ------ ------- ------- ---- Payment Amount Payee Name 30.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 8.00 CUMBERLAND COUNTY GENERAL FUN 23.50 BUREAU OF RECEIPTS & CNTR M.D 5.00 ---------------- CUMBERLAND COUNTY GENERAL FUN $81.50 $81.50 REV-1512 EX+ (12-12) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT t51Alt of FILE NUMBER o~ ~ ~ Report debts inwrred by the decedent prior to death that remained unsaid ar rh. d~*e „E aesF~. :....~..•c_...._._:_~..___. __.:__. ____ __ _...._. _ T___ .....,,,.,,",, ~~„~~. ,,,,,~~,,,~„~ ,nneu or me same size. STATEMENT Forest Park Health Center Resident: Spoke, Maurits (23366) 700 Walnut Bottom Road Location: - Carlisle, PA 17013-3699 Statement Date: 12/1/2012 (888) 880-7090 ALL TRANSACTIONS PROCESSED AFTER Nov 30, 2012 WILL APPEAR ON YOUR NEXT STATEMENT Adin & Donna Otto 613 Whiskey Springs Road Boiling Springs, PA 17007 Amount Due $1,587.00 PLEASE DETACH AND RETURN WITH YOUR PAYMENT Amount Enclosed $ Forest Park Health Center Resident: Spoke, Maurita (23366) 700 Walnut Bottom Road Location: - Carlisle, PA 17013-3699 Statement Date: 12/1/2012 (888) 880-7090 Effective Date Description Units Unit Amount Amount BALANCE FORWARD $1,587.00 BALANCE DUE $1,587.00 PAYMENT IS DUE ON RECEIPT QUESTIONS REGARDING BILL? PLEASE CALL 888-880-7090/Nicole M. EXT 807 nicole.mocik@guardianeldercare. net WE ACCEPT VISA/MASTERCARD/DISCOVER/AMERICAN EXPRESS (SEE BACK OF B!L L) You have been approved for Medicaid benefits. Your account has been adjusted to reflect this change. Please remit payment of the balance due in full upon receipt of this billing statement. Please Circle One ~//',~. Card Account Number Card Expiration Date Payment Amount Date Cardholder Signature STATEMENT Forest Park Health Center Resident: Snoke, Maurits (23366) 700 Walnut Bottom Road Location: - Carlisle, PA 17013-3699 Statement Date: 2/1/2013 (888) 880-7090 ALL TRANSACTIONS PROCESSED AFTER Jan 31, 2013 WILL APPEAR ON YOUR NEXT STATEMENT Adin & Donna Otto 613 Whiskey Springs Road Boiling Springs, PA 17007 Amount Due $0.00 PLEASE DETACH AND RETURN WiTFi YOUR PAYMENT Amount Enclosed $ Forest Park Health Center Resident: Snoke, Maurita (23366) 700 Walnut Bottom Road Location: - Carlisle, PA 17013-3699 Statement Date: 2/1/2013 (888) 880-7090 Effective Date Description Units Unit Amount Amount BALANCE FORWARD 1 /24/2013 Payment - #tf459 $1,587.00 ($1,587.00) BALANCE DUE $0.00 PAYMENT IS DUE ON RECEIPT QUESTIONS REGARDING BILL? PLEASE CALL 888-880-7090/NICOLE M. EXT 807 Nicole.mocik@guardianeldercare.net WE ACCEPT VlSA/MASTERCARD/DISCOVER/AMERICAN EXPRESS (SEE BACK OF BILL) Please Circle One v~~ Card Account Number Card Expiration Date Payment Amount Date Cardholder Signature REV-1513 EX+ (11-08) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. ~ pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY REDoTNotSList T ust e(s)NT AMOOF ESOTATE ARE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under ` h~ 0_ ~bt4-U ~~-~~~ ~ . t`IDG~l II 1. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I$ ,.- ~ ~. If more space is needed, insert additional sheets of the same size. ~~~ J ~r :BAST WILL AND TESTAMENT OF ~'IP•URITA OTTO SNOKE r{ Maurits Otto Snoke, of Middlesex Township, Cumberland 'ounty, l~enns•ylvania, declare this to be my last Will and `~'estament and revoke all Wills and Codicils previously made by me . IT~d I: I direct that my legally enforceable debts and funeral. expenses, together with the expenses of the ~.tiministration of my estate, shall be paid from my residuary estate as soon as practicable after my decease, as a part of the ±~xpense of the administration of my estate. IT~bd 2I: I devise and bequeath all of my estate of every `~~ture and wherever situate, unto my brother, Adin L. S. Otto, -=.-. provided he shall survive me :by thirty {30) days. Should my ~a-sd br,~,th,~~•, Adin l,, S. ©tto, Jr. , predecease me or di.e on or ':~efore the thirtieth day following my death, I devise and ;,~,~ue~~ ~ ~~ 1 ; cif m}r estate of €~vPry nature anal wherever si ~ uate .:nfio m~,r ~,.~ster in-law, Donna M. Otto. -~"" l~~ r Al'1 Federal . State and other death taxes t~ayable ~~'t~;,~;e .-,:;- my death, with respect to the property forming my ...,~'.~!o •r,r,-;av-,a "-r.r t-av e~sµ~~J.~-r'~'.~i. S9rhe~hE?r .~_. .._•• - ~e~S'~'.2xsQ under t~'ll.e, vY'l~ f7 T' .~+- `~'r >;.~+~ i ~~' ~~c--L. ~zd<.t~.ic~ an~,r i. z~.terest or oena:i ty impc~spd ~. n. V ~ J Y ry . _~ ~~ ~ 1J.r _ L . -, r.7 'C7 ~ ~ t~,J ~. t1 Li.l J ~ ~ R r~ ~ f~.3 Q w~ ~. e`v ~ ~ ~ ~'^J n>...,.- ,,. ... .. connection with such taxes, such be considered a part of the :expense of the administration of my Estate and shall be paid out of the principal of my residuary estate without apportionment or Fight of reimbursement. ITEM Zv: I appoint my brother, Adin L. S. Otto, Jr., executor of this my last will and Testament. Should my said Brother fail to qualify or cease to act as Executor, I appoint my sister-in-law, Donna M. Otto, Executor of this my last Will and Testament:. ZTBM VI: I direct that all fiduciaries acting under this 'will, whether or nat named herein, shall not be required to give ~~ond far the faithful performance of their duties in any urisciiction. N WITNESS WHEREOF, I have hereunto set my hand and seal, this ~1~ day of April, 2007. Matirita tto Snoke -- `CSEAL] .. .:.w .. ~. .-. r .. > _„ -. '~ _. ... ~. ,, a The preceding instrument, consisting of two (2} other typewritten pages, each identified by the signature of the Testatrix, was on the date thereof, signed, published and declared by Maurita Otto Snoke, the Testatrix therein named, as and for her last WiII, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed. our names as witnesses hereto. J _ ~~ ~~ ~- ,~, - C{?MMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS We, Maurits Otto Snoke, Dale F. Shughart, Jr., and Lincoln E. Allard, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, dc> hereby declare to the undersigned authority that the Testatrix signed and executed the instrument ss her last will and chat she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and ghat each. of the witnesses, in the presence and hearing of. the Testatrix., signed the WiII as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of aqe or older, of sound mind and under no constraint car undue influence. Subscribed, sworn to and acknowledged before me by Maurits Otto Snoke, the Testatrix, and subscribed and sworn to before me by Dale F. Shughart, Jr, and Lincoln E. Allard, witnesses, this day of April, 2007. Nota ublic ,, ~ cow a~ ro. ~ °0'~ ». 200 _ r_c~-~--~ ~-- Witness i_~~__..--._- ~fl'Q~