HomeMy WebLinkAbout11-07-14 1505611101
REV-1500 Ex(02-11)
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania
Bureau of Individual Taxes CFMA-11 OFR-E County Code Year File Number
PO BOX 28o6oi INHERITANCE TAX RETURN l l 4 5
Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 , o92.01 L4 O61 21G27
Decedent's Last Name Suffix Decedent's First Name MI
OTTC- Y F E "r 7,Y
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
i
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)
Q 4. Limited Estate Q 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate O 7.Decedent Maintained a Living Trust Q 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 SHOULD BE DIRECTED TO:
Name Daytime Telephonef_Number
u
D ^ V I D R OTTE Y 7 7 7kz� Nt � t
C:)
OF41$G_LS USE Q JLY
First Line of Address p
442 (3oSL_ Ez AVE `, -) T ' -n
Second Line of Address O r— M
t t ,-� Crl) n
C n -rt
City or Post Office State ZIP Code DATE FILED
LEMOY N E PA 17o 4 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 than the personal representative is based on all information of which preparer has any knowledge.
SIGNAAT`WE OF PERSON RESP NSI LE FOR FILING RETURN DATE
3-0 Cft a- 2-014
ADDRESS 17
442 $osl�r Av.�..LLemo rne_,A 17043
SIGNATURE OF PREPARER OTHER THA REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505611101 1505611101 J
61\01
J 1505611201
REV-1500 EX
Decedent's Social Security Number
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. 905- 00•
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. .. .. . 5. 1 t 9 0 j. Q 0
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. .. . 6. 17, 1 -1 5 . 00
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. Z q, 000.00
9. Funeral Expenses and Administrative Costs(Schedule H). .... . .... .. . . .. . .. 9. 1 3 5 S $. 2
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. .. .. ... ... . .. 10. 7 -5. 5 G
11. Total Deductions(total Lines 9 and 10)... .. . . .... .... .... .... .. .... . ... 11. , �'{ 5 (o 4. ( $
12. Net Value of Estate(Line 8 minus Line 11) .. .. .... .. .. .... .. . . ... .... .. . 12. 1 4 4 3 5A S 2
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. ( L+ L 3 .5 A 2
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_ . 15. .
16. Amount of Line 14 taxable t
at lineal rate X.0-45 ( 4 3 5 . 8 2 16. i 4 c( • (o
17. Amount of Line 14 taxable
at sibling rate X.12 . 17.
18. Amount of Line 14 taxable
at collateral rate X.15 ,f 4V 18. •
19. TAX DUE . .. . .... .. .. ... .. . .. .. ... .... .. .. ... .... ... . .... .. .... .. . 19. 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505611201 1505.611201
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
[BETTY A, OT`i'EY
STREET ADDRESS
$2(0 1305LIER ME .
CITY STATE ZIP
t_eMOY N C— CPA 170
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) (p t{9 o (D
2. Credits/Payments
A.Prior Payments (03-51(a-0-
B.
03- .. (OB.Discount 3 :2. 4
Total Credits(A+B) (2) (067. 4%
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) 1 7.$7
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.......................................................................................... ❑ 59
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?...................................................................... ❑ I�
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?.............. ❑ I
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a 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.
a .h` "K.. .�,.
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(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-1508 E%-(1-97)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE
RESIDENT D DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Betty A. 0++ey 2.114-0541
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
'. Cash oti hand %0..00
2. Au totnob i lv. 2007 HiOnda Fit �j 7 50.00
3. Household goods 600. 00
4, llurnishie%15 400.00
5. J evtet ty 175 .00
G. Gksthi n9 300-00
TOTAL(Also enter on line 5,Recapitulation) 11 ,0005-00
(If more space is needed,insert additional sheets of the same size)
REV-1509 EX+(ol->o)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
6 e-t-t�r A, Otter 2t l 4-0 5R I
If an asset became jointly own 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.
David R. Ottey Lott Scskv Ave, son
Lemoyne FAA 17043
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 IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 4�14
JA MST, BahkF 3413Q0.00 5Ol t'7, Ig5.00
344 S. IoWs tv L.ernoyr_ted PA ('1043
Account No. 65540S16�checkin9)
TOTAL(Also enter on Line 6, Recapitulation) $ 170 -.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX-RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Betty A. Ottey 21114-05"41
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Rolling Green 0--me" il$uriat) 1144 5 ,00
2. l•Eanorariuhn 1150 ,00
3. Memorial pra} 200.00
q, kotlin9 Greern Cetnetety memorial) I)424 .00
5. Musselmart F�nera( Home (sevvius) do, t t 5 •00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
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: Clind. Atdvertis it�) 4 1 -3 .56
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Costs C; K.10W 3' Prot" 01
�z.
Ren+ 310. 00
l i�iti>CS
733. 2/o
lrts+uracrc�e 49f. 4q
tfovSeE�t�dd
79. 60
0 1er 124,71
TOTAL(Also enter on Line 9, Recapitulation) $ 131592.�pz
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
�£ pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Belt, . 0-E- e% 2-04-0591
Report debts in urred by the decedent rior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ses incurred in'trea-'in9 decedehfis las+ i tliness:
Vilest Share EMS 4q O .q 7
Hoty '3etVt+ Hosti+a 1 3153 .00
2. Q�Eher debF or�st�{andiv� on 5�9:
H ouse holld I b q . SQ
TOTAL(Also enter on Line 10, Recapitulation) $ C?75.56
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
6
N. Ott 2-114 —05QI
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. D air i d R. O-ttey Soh
'141 Bos(el, Ave.
L.e"ne,, Ply 17043
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.
_N
WILL c M
3� C-) C10
rv _0 c G' c�
OF �� h cn
BETTY A. OTTEY w U? v
"" c) O
c� o -n
cac ; n
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I, BETTY A. OTTEY, of the Borough of Lemoyne, Cumberland Countf, Pennsyvnia, Q
declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my
gravemarker and all expenses of my last illness, and any and all taxes and assessments
imposed by any governmental body as a result of my death, whether on property passing
under this will or otherwise, shall be paid from my residuary estate as soon as practi-
cable after my decease as a part of the expense of the administration of my estate.
ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and
all other articles of household and personal use, equipment and ornament, together with
all insurance thereon and relating thereto, to my son, DAVID R. OTTEY, of Port Aransas,
d Texas.
� ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to my son, DAVID R. OTTEY,
of Port Aransas, Texas.
ITEM IV. I appoint my son, DAVID R. OTTEY, of Port Aransas, Texas, executor of
this my last will.
ITEM V. In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will,
1
I hereby give to my personal representatives the following powers and authorities
effective without court approval and until actual distribution of all property: to
compromise any claim or controversy; to make distribution in cash or in kind, or partly
in cash and partly in kind, and in such manner as my personal representatives may
determine and at valuations finally to be fixed by them; to invest in all forms of
property, including any stock or other securities in any corporate fiduciary or its
successor without restriction to investments authorized for Pennsylvania fiduciaries,
as my personal representatives deem proper, without regard to any principle of risk or
diversification; to retain any or all assets of my estate, real or personal, without
regard to any principle of risk or diversification; to sell at public or private sale,
to exchange, or to lease for any period of time, any real or personal property and to
give options for sales, exchanges, or leases, for such prices and upon such terms or
conditions as my personal representatives deem proper; and to allocate receipts and
expenses to principal or income or partly to each as my personal representatives deem
proper in their sole discretion.
ITEM VI. I direct that my personal representatives and fiduciaries shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this « - day
of 1992.
BETTY A. TTEY
2
The preceding instrument, consisting of this and two other typewritten pages, each
identified by the signature of the testatrix was on the date thereof signed, published,
and declared by BETTY A. OTTEY, the testatrix therein named, as and for her last will,
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.
10
3
COMMONWEALTH OF PENNSYLVANIA )
{ SS.:
COUNTY OF CUMBERLAND )
The undersigned, being the testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, does hereby
acknowledge that I signed and executed the foregoing instrument as my last will,
that I signed it willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
G-. -
Sworn or affirmed to and acknowledged
before me by the testatrix named above
this i 0+l, day of NRi , 1992.
Z
Notary lic NOSEAL
LYNN KINDER. Notary Public
Lei,ioyna Coro, Cumberland �7 992
hM1y Commission Expires Aug.
COMMONWEALTH OF YLVANIA )
( SS..
COUNTY OF CUMBERLAND )
WE, GEORGE A. VAUGHN, III, and MICHAEL L. BANGS, the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw the testatrix sign and execute
the instrument as her last will; that she signed it willingly and that she executed
it as her free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the testatrix signed the will as witnesses; and that
to the best of our knowledge, the testatrix was at that time 18 or more years of
age, of sound mind, and under no constraint or undue influence.
Sworn or affirmed to and
acknowledged before me this
{0"^ day of A fAJ , 1992.
L
Notary Piablic
NOTARIAL SEAL
LYNN KINDER, Notary Public
Lomoyne Born, Cumborland Co., Pa.
My Commission 1xpiros Aug, 17, 1992