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Home My WebLink About04-25-14 � � 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 2 0 9 Harrisburq,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDVm' Date of Birth MMDDYYYY 0 2 1 4 2 0 1 3 1 1 1 0 1 9 3 6 DecedenYs Last Name Suffix DecedenYs First Name MI Tr i t t Na n c y C (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 � 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) Q 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 Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Kar I E . Romi ng er , Es q 71 7� 241 � 07'�� _ •__• ao RE W OF WILLS�SE OImqY� rn S c'� � �-R. O � � First line of address � � � tv ^�I rn -,w, Cn �., C!"i �� C7 Romi nge r & Ass oci at es � ;--� � o Second line of address � C � 3 �� 155 Sout h Hanover St reet • � � . �o ,,,� s,,,,, c� City or Post Office State ZIP Code � ~ DATE F ED P"` rn H � � C a r I i s I e P A 1 7 0 1 3 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 han the personal representative is based on all information of which preparer has any knowledge. $16�t E SON RES NSIB OR FI DATE .� ADDRESS' Karl E. Rominger, Esq., 155 South Hanover St Carlisle PA 17013 S��U�2�0�PARER OTHER��[V gE�RESENTATIVE �DAT��- �� x e i i�-� rx Tq ES Deborah M. Ott, 28 Airport Road Shippensburg PA 17257 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 1505610140 J `n � . � 1505610240 REV-1500 EX DecedenYs Social Security Number DecedenYs Name: Na11C�/ C. Trltt 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. 3 3 2 7 2 9 , � 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 6 � � � . 1 5 7. Inter-Vivos Transfers&Miscellaneous No -Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. . 8. Total Gross Assets(total Lines 1 through 7) . .. .. .... . . .. .. . . .. . . ... . . . 8. 3 3 $ 7 3 � , 3 � 9. Funeral Expenses and Administrative Costs(Schedule H) .. . .. . . . . . . . . . . . . . 9• � 9 5 8 4 . � � 10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. � 6 $ � � . 4 1 9 9 ( ) . . . . .. . . . . . . . 11. Total Deductions(total Lines 9 and 10) . . . . . . . .. .... . .. . .. . . .. . . .. . . . . 11. 3 6 3 8 4 . 4 2 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . .. . ... ... . . . . . . . . . . . . . �2. 3 O 2 3 4 5 . $ 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. 3 � 2 3 4 'rJ . $ 9 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 _ 0 . � O 15. O . 0 0 16. Amount of Line 14 taxable at lineal rate X•0 � • � � 16. O • � � 17. Amount of Line 14 taxable at sibling rate X.12 � . � � 17. � . � 0 18. Amount of Line 14 taxable at co��atera�rate X.15 3 0 2 3 4 5 . 8 9 �$. 4 5 3 5 1 . 8 8 19. TAX DUE . .. .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . ... . . .. . ... . . . . . . . . . . 19. 4 5 3 5 � . $ $ . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 L 1505610240 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 2� 13 0209 DECEDENT'S NAME Nanc C. Tritt STREET ADDRESS 86 Shi ensbur Mobile Estate CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1• Tax Due(Page 2,Line 19) (1) 45,351.88 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+g) �2� 0.00 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is theTAX DUE. (5) 45,351.88 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; ............................... ❑ ❑X c. retain a reversionary interest;or ................................................................................................ ❑ � d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ � 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a 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 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 decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is definetl,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or atloption. _ REV-1508 EX+(6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� Q[ MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Nancv C. Tritt 21 13 0209 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. M&T Bank account#9853258201 212,086.78 proceeds deposited in Estate Account#9861283316 3/4/2013 2. ACNB Bank interest from certificate of deposit 20.25 3/13/2013 3. Milville Mutual Insurance Company 132.00 refund of homeowners insurance 5/29/2013 4. JF Energy Corp. 301.32 refu nd 5. ACNB checking account#2294354($89,148.98) 120,188.81 Certificates of Deposit#160478($15,000.00)and#4990843 ($16,000.00) 3/11/2013 TOTAL(Also enter on line 5,Recapitulation) $ 332,729.16 (If more space is needed,insert additional sheets of the same size) ,� n �.. � .. � �� , � ��-� � _ � REV-1509 EX+(01-10) pennsylvania SCH,EDULE F � DEPARTMENT OF REVENUE �OINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Nancv C. Tritt 21 13 0209 If an asset was made 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. Deborah M. Ott 28 Airport Road Niece by Marriage Shippensburg, PA 17257 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYfNG NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 2010 Mobile home located at 12,002.30 50. 6,001.15 86 Shippensburg Mobile Estate Shippensburg, PA 17257 TOTAL(Also enter on Line 6,Recapitulation) $ 6,001.15 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H � • DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Nancv C. Tritt 21 13 0209 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Egger Funeral Home, Inc. 2,525.95 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personai Representative(s) Deborah M. Ott StreetAddress 28 Airport Road ciry Shippensburq state PA Zip 17057 Year(s)Commission Paid: 2, Attorney Fees: Rominger&Associates 16,613.78 3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: $158.50 158.50 5 Accountant Feex 6. Tax Return Preparer Fees: 7. Cumberland Law Journal, advertise Letters 75.00 8. The Sentinel, advertise Letters 210.78 TOTAL(Also enter on Line 9,Recapitulation) $ 19 584.01 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-OS) pennsylvania SCHEDULE I � � DEPARTMENT�OF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES, & LIENS . RESIDENT DECEDENT ESTATE OF FILE NUMBER Nancy C. Tritt 21 13 0209 Report debts incurred by the decedent prior to death that remained unpaid at the date af death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Direct TV, invoice 14.87 2. Willabee&Word, invoice 29.80 3. Hartzell Eye Specialists, invoice 110.00 4. Adams Electric, electric provider 107.75 5. Diversified Energy, heating oil provider 408:72 6. Barry Negley, Tax Collector 62.12 Real Estate$57.22/Per Capital $4.90 7. SME 372.57 April lot rent and water/sewer 8. Century Link, telephone service 46.69 9. Adams Electric, electric provider 76.20 10. Shippensburg Area EMS 150.00 ambulance service 11. Century�Ink, telephone service 6.23 12. Direct TV, invoice 3.54 13. MSHMC Physicians Group 3,837.43 health care providers 14. Adams Electric, electric provider 49.44 15. SME 355.13 May lot rent and water/sewer TOTAL(Also enter on Line 10,Recapitulation) $ 16 800.41 If more space is needed,insert additional sheets of the same size. ,', Continuation of REV-1500 Inheritance Tax Return Resident Decedent Nancy C.Tritt 21 13 0209 DecedenYs Name Page 1 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, 8 Liens ITEM NUMBER DESCRIPTION AMOUNT 16. Sailhamer Real Estate 100.00 appraisal fee 17. ESEMS, EMS service and invoice 1,024.54 18. Adams Electric, final electric invoice - 45.38 19. Expert fees for pending litigation of wrongful death/personal injury 10,000.00 SUBTOTAL SCHEDULE I 11,169.92 GRAND TOTAL SCHEDULE I $ 16,800.41 REV-t��3 EX+(01-10) a , pennsylvania SCHEDULE J � DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Nanc C. Tritt 21 13 0209 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. Deborah M. Ott Collateral 50.00 28 Airport Road Shippensburg, PA 17257 2. Roy Ott Collateral 50.00 28 Airport Road Shippensburg, PA 17257 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. $ If more space is needed,use additional sheets of paper of the same size.