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Home My WebLink About08-23-13 (2) � 15�561p140 REV-1508 � {°2_„'{F", PA Department af Revenue ` � �` " `-` �°t Bureau of Individual Taxes �NHERI7ANCE TAX RETURN Counry Gode vear Fi�e Numoer Pf?60X 28QBQt C� 1 Z � p 5 9 5 tiarrisaurc.Pa t7�za-�ot REStDENT QECEDENT ENTER DEQEDENT INFORMATION BELOW � Social Securiry Numbar Data of Death MMDDYVYY qate of Birth MnnpoYVYr � 5 2 4 2 � 1 3 0 3 2 2 1 9 2 7 DecedenPs Last Name Suffix pecedenPs First Name MI i} T T 0 G L A D Y S P (If Applicable)Enter 3urviving 8pouse's IMortnation Below Spouse's Last Name Suftix Spouse's First Name MI Spouse's 3ocial Securiky Number THIS RETURN MU3T BE FILED IN DUPLICATE WITH THE REGISTER C?F WI��S FiLL IN APPROPRIATE OVALS BELOW � 1. Original Return � 2.Supplementsl Return � 3. Remaindar Retum(Date of Death Pri�r to 22-13-62) � d.I�Imfted Estate � 4a.Future IMerBSt Compromise(date of � 5.Fedarai Estate Tax Retum Required death after 12-12-82) QX 6.Decedent died Testate � 7.Decedent Maintained a Living Trust � 9.Total Number o�Safe Deposit Boxea {Atiach Copy of Wfit} (Attach Gapy of Trus#.} �] 9.Lftigation Praceeda Received � 16.Spousai Poverty Credit(Dete of Death � 11.Eiection to Tax under Sec.9t 13(f1) Belween 12-3i-91 and 7-t•95) (Attach 5ahedule O) CORRESPONDENT�THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AN�CONFIDENTIAL TAX INFORMATIOt!SHOU6p BE UIRECTE070: N�� Daytime ll�aphone Num�eS � m C -i I V 0 V . 0 T T 0 I I I 7 1 � ,�-� 4 3��3 3� �' 1 � -c; ��, . , ::y � ' "�--- ---�_, , � ...-REGIS OFWI�GD�pBEO,N4Yr�� , � 'L ��" �..? '„' !`J I n v, ,; • FlrstLineotAddre3s p �.� r..� :'.^� s ' +� �. t 1 0 E A S T H I G N S T R E E T � c} � � ,— <�a j 5econd Line of Addresa I �a -i �-� �J� �.y I �` � � I City or Post tiffice 5tate ZIP Code �.,._—._--DATE FlIEO _ ..._.� C A R L I S L E P A 1 7 0 1 3 Gorrespandenea e-mall address: IOTTO(�u,MAR,TSONLAW.COM Untler penalUea ot perJury,!dedare Nat I have enaminetl this retum,I�rcJutling aceqmpanyinp neM1etlulas and statements,errd to tAe beat of my knawbdge nntl kelief, it is We� a� .DeUaratVOn d preparer ott�ar pran Me peraonai repraserdative is Oased on ait inComsatien W which preparer has arty kr�ge. SIGNA E qF R R PONSIBLE FOR FILING RETURN DATE AODRESS \ �� 1 ' y� E T HIGN STREET CAR�IS�E PA 7,7013 SIGNATUR E N REPRESENTATIVE DATE -,�( �L1, � ACIORESS T--' b� EAST HI6H STREET CARIISLE PA I,7013 PLEASE USE ORIOINAL FORM ONLY Side 1 � 15�5610140 1505610140 � � � J 1505610240 REV-1500 EX(FI) Decadent's Social Securiry Number oeeeeenesName: GLADYS P. OTTO RECAPITULATION 1. Real Estate(SChedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 , 0 � 2. Stocks and Bonds(SChedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. � . 0 � 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. 2 5 7 0 , � 0 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. � . 0 0 7. Inter-Vivos Trensfers&Miscellaneous N -Probate Property (Schedule G) � Separete Billing Requested . . . . . . . 7. 0 , 0 � 8. Tohl Gross Asseb(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 2 5 7 0 , 0 0 9. Funerel Expenses and Administrative Costs(SChedule H) . . . . . . . . . . . . . . . . . . 9. 2 � 5 . � � 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. � . 0 � 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 7 5 . 0 0 12. Net Value of Esfate(Line 8 minus Line 1 t) . . . . . .. . . . . . . . . . . . . . . . . . . . . . 12. 2 2 9 5 . 0 0 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. 2 2 9 5 . U � TAX CALCULATION-SEE IN3TRUCTION3 POR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(�.2)x.o _ 0 . 0 0 �5. 0 . 0 0 16. Amount of Line 14 taxable at�inea�rate x.045 2 2 9 5 . 0 0 �s. 1 0 3 . 2 8 17. Amount of Lina 14 taxable at sibling rate X.12 � . � 0 17. � . � � 18. Amount of Line 14 taxable at collateral rete X.15 0 . � 0 �g, 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 0 3 . 2 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 150561U240 1505610240 J _ �� REV-t9pQ EX{FI) Page 3 Flia Piumber Decedent's Camplet� Address: z> >s os�s DECEDENT'S NAME GLADYS P.OTTO .-- ------ STREETADDRESS .._—..�..-- � ------�--------- �-----_--_.------.._—..-----�°- -- 12l Walnut Bottom Road _ _.._—— --_—__ _ ---- . __-- ---- ------.. _ —— — -- CITY �STATE ZIP Shi ensbur PA 17057 Tax Payments and Credits: � Tax Due(Page 2,Line 19) (t} 103.28 2. Grediis/Payrr�nts A.Pripr Payments B.Discount 516 Total Credits{A+g} �p� 5 1� 3. i�tetest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. �3) Ffll In oval un Page 2,Une 20 W requsst a retund. (4} p,pp 5. if Line t +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 98.12 Make check payable to: REGISTER OF WILLS, AG�NT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t. pid decedent make a transfer and: Yes Na a. retain the use or income of the propertY transferred ...................................................................... ❑ � b, retain the right to designate who shall use the property transfened or its income ............................... ❑ � c. retairt a reversionary interest ..................................................................................................... ❑ � d. rec�ve the promise#�Iife of either payments�benefit9 or cere? .............................._....................... ❑ �C] 2. If death occurred afler December 12,1982,did decedent Iransfer propeRy within one year of death without receiving adequate consideralion? ....................................................................................... ❑ � 3. Did dacadent wm an'in trust fot'a p2ya6ie-upon�deafh bazrk account or security at his�her c�ath9 .._..... ❑ X(� 4. Did decedent rnm an individuai relirement account,annuity or Mher non-probate property,which onntains a baneflciary designation?.................................................................................................. ❑ � IF THE ANSWER TO ANY OF TNE ABOVE QUE3TlONS IS YES,YOU MUS7 COMPI.ETE SCHEDUIE G ANQ FIIE IT AS PART OF THE RETURN. For dates of death on or after July t, ]994,and before Jaa t,1995,the tax rate imposed on the net valae of transfers ta ar for the use of the surviving spouse is 3 percent[72 P.S.§911fi(a){1.1}(�}]. For dates of death on or after Jen. 1, 1995,the tax rate imposed on the net value of transfers to or for the use oC the surviving spouse is 0 percent [72 P.S.§9116(a){t,t�(ii)].The statute does not exempt a transfer to a 3urviving spouse from tax,and the statutory requirements for disclosure of assets and fliirtg a t�retum are stiil appiicab(e sven if the surviving spouse is the only 6eneficiary. For dates of death on or after July 1,2000: + Tha tax rate imposed an the nei value of transfers from a deceased child 21 years of age or youngar at death to or for the use of a naturel parent,an adaptive parent or a stepparent of!he child is 0 percent jl2 P.S.§9116{a}{f 2}l. • The tax rate imposed on the net value of transfers to or for the use of the deGedenfs lineal beneficiaries is 4,5 percent,except as noted in�2 a.S.§9�is(a)it)�, • The tax rate imposed ort the net value of transfers to ar for the use of the decede�t's siblings is 12 percent[72 P.S.§9116(a){7.3)J.A sibling is defined, u�der Section 91 Q2,as an individuai who has at ieast one parent i�common wi�the decedent,whether by biood or�op8on. tzev-�sas Ex.{oa-�2) pennsylvania SCHEDULE E OEPARTMENTOFREVENUE �ASH, BANK DEP4SIT8 & MISC. RESioEUr�aeceoENiT��' PEftSONAL PROPERTY ESTATE OF: F��R. GLADYS P.OTT{} 2I t3 0595 Mclude tha proceeds of litigation and the date the procseds were received by the estate. All propsrCy Jointly ow�red with right of survlvorohtp must be diaolosed on 8chedule F. ITEM VALUE AT 6ATE NUAlBER DESCRIPTION OF DEATH 1. Shippensburg Health Care Center,refund 2,570.00 TOTAL(Also enter on Line 5,Recapitulation) S 2 570.OQ If more space is needed,use sddNanal sheets of paper of the same size. REV-#Stt HX+(1449� pennsylvania SCHEDULE H �EPARTMENT OF REVENUE FUNERAL EXPENSEB ANd ir�RrrANC�rnxReruaN ADMiNISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF fiLE NUMBER GLADYS P.OTTO 21 13 0595 DecedeM's debb muat be reportad on Schedula[. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: t. Ivo V.Otta III,reimhursement for funerat]unehean expense GQ.06 B. ADMINISTftATIVE COSTS: 1. Personal Representative Commissions: Name�s)of Personal Representative(s) SVeet Adtlress �nY State ZIP YeBr(s)Gommissipn Paid: 2, Atromey Fees: Martson Law Offices 200.00 3. Famiry Ezempdon:pf decedenYs eddress Is not tl�e same as claimanYS,atlad�enplanatianJ Cdaimant Sireat AdOress �+tY State ZIP Reiationship ot Gafmant M Decedenl 4. ProCate Pees: 5 AccounfantFees: 8. Tax ReNm Preparer Fees: 7. Cumberland County Register of Wills,filirtg fee,Supp(emental Inheritanoe T�return lS.Od T07AL(Also enter on Line 9,Recapitulatian) S 275.00 If moce spase is neeGed,use a�itlonaf shee�of paperof the same sfze. REY-tbt3 EX+(Ot-to) pennsylvania SCHEDULE J OEPARTb1EMT OF REVENUE gENEFICtAR1ES INHERITANCE 7AX RETURN RESIDENT pECEDENT ESTATE OF: FILE NUMBER: GLADYS P.4TTfJ 21 13 0595 RELATIpNSHIP TO pECEDENT AMOUNT OR SHARE NUMBER NAME AND AQDRESS OF PERSpN(S)RECEIVING PROPERTY Do Not List Truatee(s) OF ESTATE T TAXABI.E 6(S7RIBUTIONS p� ht i distrl6utbns a�trz�s uadw Sec.s�t 6(a (iz}.j L Ivo V.C)tto[II Lineal 765.00 1 Q Easi High Street CarHsle,PA 170I 3 2 Cathy O. Pasdiora Lineal 765.00 6785 Sererity Drive Troy,MI 48048 3. VictariaL.Otto Lineal 765.00 759 York Road Carlisle,PA 27205 ENTER DC?LtAR AMOUNTfi FOR DISTRIBUTIONS 9NOWN ABOVE ON llNES 15 THROUGH 18 4F REV-15U�COV£R SHEET,AS APPRQPRIATE. II. NON•TAXABLE DISTRIBUTIONS; A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTIqN TO TAX IS NOT TAKEN: 1. I. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 1. TOTAL qF PART il-ENTER TOTAL NON-7AXABLE DISTRIBUTIONS ON LINE 19 OF REV-1500 COVER SHEET. S If more space is neede�i,use additional sheeta of p�ec of the same size.