HomeMy WebLinkAbout06-17-14 J 1505610105
REV-1500 EX(oz-ii)(FI).�;
enns lvania OFFICIAL USE ONLY
PA Department of Revenue P Y Counry Code Year •File Number
Bureau of Individual Taxes "�"�
PO BOX z8o6oi INHERITANCE TAX RETURN �/ / � /' /-� /
Harrisburg,PA i�i28-0601 RESIDENT DECEDENT ���
ENTER DECEDENT INFORMATION BELOW �
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01/19/2014 06/04/1927
Decedent's Last Name Suffix DecedenYs First Name MI
Dutrey ' Richard ',W
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Dutrey ' 'Marjorie ' B '
Spouse's Social Securiry Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
�s2-22-ss3o REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
m 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 SHOU�Lg BE DIRECTEDc
Name Daytime Telephort�Number � �'a �
John C Oszustowicz (717)243-74�� �' � "�' �
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REGISTER iOF WICLS-USE C�FiLY f r3
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First Line of Address � <� . 'TJ -'��t
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104 S Hanover St. ,-� ,� N �-,,
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Second Line ofAddress � G�
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City or Post Office State ZIP COde DATE FILED
Carlisle PA 17013
CoRespondenYs e-maii address:johno@carlislepalaw.com
Under penalties of pery'ury,I declare that i have examined this retum,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 F R FILIN RETURN DATE �/
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ADDR S
205 Co y St., Carlisle, PA 17013
SIGNATUR OTHER THAN REPRES NTATIVE DATE / �
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ADDRESS
104 S anover St., Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 J
� 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenYs Name: ,
RECAPITULATION
1. Real Estate(Schedule A). .... ................... ..................... 1.
2. Stocks and Bonds(Schedule B) 2. 7,770.10 !
...... .................................
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ;
4. Mortgages and Notes Receivable(Scheduie D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 90,974.12 !
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ...... 6. '
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ',
(Schedule G) O Separate Billing Requested........ 7. , ',
8. Total Gross Assets(total Lines 1 through 7)............................. 8. 98,744.22 '
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 15,692.04
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)..... ... ...... . 10. ,
11. Total Deductions(total Lines 9 and 10)................................. 1L '
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. ;
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which '
an elec6on to tax has not been made(Schedule J) ...................... .. 13. '
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 83,052.18 '
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 _ 83,052.18 _
(a)(1.2)X.0 0 15. , 0.00 :
16. Amount of Line 14 taxable __ __ _ __
at lineal rate X.0_ ' 16. '
17. Amount of Line 14 taxable
at sibling rate X.12 17. '
18. Amount of Line 14 taxable
at collateral rate X.15 , 18.
19. TAX DUE ......................................................... 19. ' 0.00 ';
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Richard W Dutrey
-— -------___ __ __-- ------- _ ----. —__ ----
STREETADDRESS
205 Conway St.
--__ .— --- _— _
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. CreditslPayments
A.Prior Payments
B.Discount
------ ------ --______
Total Credits(A+B) (2)
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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 ............................................ ❑ �
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?.............................................................................................................. ❑ �
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
containsa 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)J.
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 decedenYs 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.
REV-i5o3 IX+(8-�z)
� pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCETAXREfURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Richard W. Dutrey 21-14-0126
Ali property jointly owned with right of survivorship must be disclosed on Schedule P.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' 86 sh Prudential Common Stock @$90.35 7,770.10
TOTAL(Also enter on Line 2, Recapitulation) $ 7,770.10
If more space is needed,insert additional sheets of the same size
REV-15o8 EX+(o8-1z)
� pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX REfURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Richard W. Dutrey 21-14-0126
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. Avalon SecureRx insurance refund 64.30
2 Prudential Dividend 34.40
3 Ohio National Life insurance policy M0019314 16,367.16
4 Nationwide Life Insurance policy 0079512510 25,320.00
5 Prudential Life Insurance policy 10033979 1,009.74
g Prudential Life Insurance policy 20274703 23,341.81
7 State Farm Life Insurance policy 9201236690 24,836.71
TOTAL(Also enter on Line 5, Recapitulation) $ 90,974.12
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-13}
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Richard W. Dutrey 21-14-0126
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A, fUNERAL EXPENSES:
1' Hoffman Roth Funeral Home,Carlisle,PA 10,244.08
z WestminsterCemetary 1,926.00
3 The Rustic Tavern-Memorial service 827.26
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City-_------_-- ----.— _ State ZIP --. -
Year(s)Commission Paid:
2,250.00
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's,attach expianation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 253.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
�• The Sentinel-legal advertising 116.20
s Cumberland County Law Journal-legal advertising 75.00
TOTAL(Also enter on Line 9, Recapitulation) $ 15,592.04
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
��� pennsylvania SCHEDULE �
� DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BE N E FICIARI ES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Richard W. Dutrey 21-14-0126
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRE55 OF PERSON(5)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• Marjorie B.Dutrey 205 Conway St.,Carlisle,PA 17013 spouse 100%
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.
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LAST WILL AND TESTAMENT
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RICHARD W. DUTREY :'��-,�` `
I, RICI-�ARD W. DUTREY of Cumberland County Pennsylvania, being of sound
and disposing mind, memory and understanding, do hereby make, publish and declare this
as and for my Last Will and Testament, hereby revoking all other Wills and Codicils
heretofore made by me.
FIRST
I direct the payment of my just debts and funeral expenses, including a suitable and
proper grave site and grave marker, as soon as conveniently can be done following my
decease. I direct that all State and Federal Transfer Inheritance Tax, Estate Ta�c,
Succession Taxes any other tax, including any interest, assessments or penalties thereon,
that may become due and payable by virtue of my death, or by virtue of the passing of any
property under my Last Will and Testament shall be paid by my estate,just as if such taxes
were my debts, and no beneficiary shall be required to pay or refund any part thereof.
SECOND
I give and bequeath my tangible personal property to my wife, MARJORIE B.
DUTREY. If my wife does not survive me, I give and bequeath certain items of my tangible
personal property to those persons who are named in a memorandum which is signed by me
and which can be found with this, my Last Will and Testament. The remaining items of
tangible personal property (excluding money, securities and the like) not set forth in my
memorandum, or all of such articles if there is no memorandum found with this, my Last Will
1
and Testament, I give unto my children JOHN DUTREY and MARY ANN THEWLIS and
my daughter-in-law LYNN DUTREY, in three (3) equal shares. If my children cannot agree
on the distribution of such property, it shall be sold and the proceeds derived therefrom shall
be added to my residuary estate.
THIRD
All the rest, residue and remainder of my estate of whatsoever nature and
wheresoever situate, I give, devise and bequeath to my wife MARJORIE B. DUTREY if
she survives me. If my wife does not survive me then I give, devise and bequeath the rest,
residue and remainder of my estate as follows: 20%to my daughter in law, LYNN
DUTREY; 20%to my son JOHN DUTREY; 20% to my daughter MARY ANN
THEWLIS; and 8%to each of my five (5) grand children. If any of my children or my
daughter in law do not survive me, his/her share shall lapse and his/her share shall be
divided equally between my children and daughter in law who survive me. For example, if
one of my children does not survive me, then my surviving child and my daughter in law
shall each receive 30% of my residuary estate. If any of my five (5) grandchildren do not
survive me,then his/her share shall lapse and his/her share shall be divided among my
grandchildren who survive me. For example, if one (1) of my five (5) grandchildren does
not survive me, then my surviving four(4) grandchildren shall each receive 10% of my
residuary estate.
FOURTH
In addition to the powers conferred by law, I authorize any personal representative
acting under this instrument, in his or her absolute discretion:
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A. To retain in the form received, or to sell either at public or private sale any real
or personal property;
B. To exercise any options to subscribe for stocks, bonds or other investments;
C. To join in any plan of lease, mortgage, consolidation, exchange, reorganization
or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or
other securities;
D. To sell, transfer, convey, mortgage, pledge, lease or exchange any property,
including real estate, for the payment of debts or taxes, or for any purpose of
administration or distribution, for such prices and upon such terms as my personal
representative, in his or her sole discretion, may deem wise, and to execute and deliver
deeds of conveyance or transfer thereof;
E. To make settlements and compromises on such terms as my personal
representative in his or her sole discretion may deem wise without the necessity of
obtaining any court approval thereof;
F. To make distribution hereunder either in cash or kind, as my personal
representative in his or her discretion may deem wise.
FIFTH
I do hereby nominate, constitute and appoint my wife, MARJORIE B. DUTREY, to
act as Executrix, of this my Last Will and Testament. Provided, however, that if she is
unwilling or unable to act as Execurix, I direct the duties of Executor, be performed by my
son JOHN DUTREY. If my son JOHN DUTREY is unable or unwilling to serve as
Executor, I direct the duties of Executor be performed by JOHN C. OSZUSTOWICZ. No
bond shall be required for any Executor.
3
IN WITNESS WHEREOF, I have hereunto set my hand and seal this LG`�day of
t�, ,v'r r�� ��'r , 2012.
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RICH��D W. DUTREY
Signed, sealed, published, acknowledged and declared by the above-named Testator,
RICHARD W. DUTREY, as and for his Last Will and Testament, in the presence of us, who,
at her request, in her presence and in the presence of each other,have hereunto subscribed our
names as witnesses thereto.
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COMMONWEALTH OF PENNSYLVANIA )
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COUNTY OF CUMBERLAND )
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I, RICHARD W. DUTREY, Testator, who signed the foregoing instrument, having
been duly qualified according to law, acknowledge that I signed and executed the instrument
as my free and voluntary act for the purposes therein contained.
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RICHARD W. Di�TREY
Sworn to or affirmed and
acknowledged before me by
RICHARD W. DUTREY,
the Testator,this ?i;"�day
Of ���Ly�-��'��y' , ZO12. COMMONWEALTH OF PENNSYLVANI/1
NoWrlal Seal
n Kimberly R.Leo,Notary Public
�` � � � �� Carlisle Boro,Cumberland County �
Nota['y PubI1C My Comm�ss�on�cp�res Oct.�o,zo�3
COMMONWEALTH OF PENNSYLVANIA )
) SS:
COUNTY OF CUMBERLAND )
We, the undersigned witnesses who signed the foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw Testator sign and
execute the instrument as his Last Will and Testament; that he signed and executed it
willingly as his free and voluntary act for the purposes therein expressed; that each of us in his
sight and hearing signed the Will as witnesses; that Testator is known to each of us; and that
to the best of our knowledge and observation the Testator was at the time of sound mind and
under no constraint or undue influence.
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Sworn to or affirmed and subscribed
to before me by �)��I�v� l'_ V`_�Zi;���.��G Z
and 1�UV �<-�. K ML_t Z witnesses,
this 2�day of (�1;; ���-,1�,�.� , 2012.
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Notary Public
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