The URL can be used to link to this page

Home My WebLink About04-09-13 (2) � � 1505610143 REV-1500�`�°,.,°> -�� PA De a�tment of Revenue OFFICtAL USE ONLY p pennsylvania County Code Year Fite Number Bureau of individual Taxes �PMT�"�M�REVENt/E PO BOX.280601 INHERITANCE TAX RETURN 21 12 0 0 3 2 2 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 27 2012 09 19 1958 Decedent's Last Name Suffix DecedenYs First Name MI OTT PATRICK E (If Appiicable)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 � 2. Supplemental Return � 3.Remainder Return(date of death prior to 12-13-82) � 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required (date of death after 12-12-82) � g. Decedent Died Testate � �, oecedent Ma(ntatned a uving rrust _ B. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy oi Trust) � 9. Litigation Proceeds Received � 10.Spousal Poverty Credit(date of death � ��,Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAXQ�FORMATION�UL[]�E ECTED TO: Name DayY�e'�ephone�,gmb� C'� HAMILTON C DAVIS 71� �� l� ��.v r �,. r- -�-� � R�@IS�R�F WILLS U Q O�Y � �' Ca � "� '��,.,,i First line of address Q C �`'� � �} � 2 0 EAST BURD STREET ..� --�� ^'' � � �• � Gn o Second line of address � � SUITE 6 DATE FILED City or Post Office State ZIP Code SHIPPENSBURG PA 17257 Correspondent'se-mailaddress: hdavis@Zullinger-Davis.COm Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowiedge and belief, it is true, rrect nd complete.Decla ion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN OF PERSON R NSIB OR FILING RETURN DATE F&M TRUST, DAVID GORITY DRESS 1901 RITNER HIGHWAY, CARLISLE, PA 17013 SIGNATU PREPARER THER THAN REPRESENTATIVE ATE � Hamilton C Davis � 8 �3 ADDRESS 20 East Burd Street,Shippensburg, PA 17257 Side 1 � 15�5610143 1505610143 � i ` � 150561�Z43 REV-1500 EX - -- - - __ _ _ __ -- -_ .__ --- ------- RECAPITULATION 1. Real Estate(Schedu(e A).......................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedufe C).......... 3. 4. Mo�tgages&Notes Receivable(Schedule D).......................................................... 4. 5• Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 7 , 4 9 2 . 0 9 6. Jointiy Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G} ❑ Separate Biiling Requested............. 7. 8. Total Gross Assets(total Lines 1-7)....................................................................... g. 7 , 4 9 2 . � 9 9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 11. Total Deductions(total Lines 9&10)...................................................................... 11. 0 . 0 0 12• Net Value of Estate(Line 8 minus Line 11) ......................... 12. 7 , 4 9 2 . 0 9 .................................... 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, 7 , 4 9 2 . 0 9 ................................................. 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.00 15. 16. Amount of Line 14 taxable at Iineal rate X .045 7 , 4 9 2 . 0 9 �6. 3 3 7 . 14 17. Amount of Line 14 taxable at sibling rate X .�2 17. 18. Amount of Line 14 taxable at collateral rate X .15 �s• 19. Tax Due......................................................:.............................................................. �9. 3 3 7 . 1 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 � 1505610243 1505610243 J � REV-1500 EX Page 3 File Number 21 - 12 - 0 0 3 2 2 Decedent's Complete Address: OTT, PATRICK E __ __ __--�_—--- __ __ __—_ ___ _ _ STREET ADDRESS _ __ _ __ _ 112 GILBERT ROAD ---__ ------__—___----_----__---__- -- .__ ________--- —---- -- ---,----______ __------—_____---______ _ __ _ CITY ;STATE ZIP SHIPPENSBURG ; PA � 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 3 3 7.14 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.0 0 3. Interest (3) 0.0 0 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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. �5) 3 3 7.�4 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:.................................................................................. ❑ ❑x b. retain the right to designate who shall use the property transferred or its income:.................................... � Ox 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 properry 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?......... � Ox 4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which containsa beneficiary designation?...................................................................................................................... ❑ ❑x 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 Jul 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.§91�6(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 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). A sibling is de�ned under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether 6y bloo�or adoption. S SCHEDULE E CASH, BANK DEPOStTS, & MISC. �°�°N�TM�PENNSn�,�� P E RS O NAL P RO P E RTY INHERfTANCE TAX RETURN RESIDENT DECEDENT ' _ _ _ _ _ _ . _ -- - _ -- --------- ---__ _ FILE NUMBER ESTATE OF OTT, PATRICK E '�21 - 12-00322 � Include the proceeds of litigation and the dafe the praceeds were received by the estate.Ail property jointly-owned with the right of survivorshtp must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 2011 PERSONAL INCOME TAX REFUND 4,175.00 2 REFUND FROM ERIE INSURANCE ON HOME OWNERS POLICY 400.00 3 PREMIUM REFUND FROM ERIE INSURANCE 51.00 4 ADAMS ELECTRIC REFUND 77.09 5 2012 PERSONAL INCOME TAX REFUND 2,789.00 TOTAL(Aiso enter on Line 5, Recapitulation) 7,492.09 REV•1613 EX+(11-0eJ . SCHEDULE J COMMONWEALTH OF PENNSYLVANIA pENEFICIARIES INHERITANCE TAX RETURN ' RESIDENT DECEDENT ESTATE OF OTT, PATRICK E 'FILE NUMBER _--- - -- --- --__- - _- --__ -- - __--- __ , --__------__--- - - _ 21 - 12-00322 RELATIONSHIP TO T SHARE OF ESTATE !AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) ' DECEDENT (Words) ; ($$$) RECEIVING PROPERTY �o Not ust Trustee(s) ; --------- -______________--_____ ----__--------- ° ____ -----------+ ----- _- r-------------_ ____ _ ___ I TAXABLE DISTRIBUTIONS[incfude outright spousal j i ' distributions and transfers I I under Sec.�116(a)(1.2)] ; 1 � 1 C�LE E. OTT E Son RESIDUE 112 GILBERT ROAD � SHIPPENSBURG, PA 17257 I � � � i � Enter dollar amounts for distributions shown above on lines 15 through 18 on 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 B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00