HomeMy WebLinkAbout03-11-15 J 1505614139
ex�as+a�(Fp
REV-1500
Bureau oflntlivitlualTaxes County Coae Year File NumUer
Po eox zaosoi INHERITANCE TAX RETURN 2 � 1 5 0 1 3 8
Harr�sbura,Pn nt2e-o5ot RESIDENT DECEDENT
ENTER OECEDENT INFORMATION BELOW
Social Securi�y Number pate of Death Mmoovvn Date o(Birth MMODW W
1 1 2 0 2 0 1 4 1 2 1 6 1 9 3 0
DecetlenCs Last Name Suffx DecetlenCs First Name MI
P O T T E I G E R R U T H E
(If Applicable)Enter Surviving Spouse's Intortna[ion Below
Spouse's Last Name Suffx Spouse's First Name MI
P O T T E I G E R J A C K J
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FlLL IN APPROPRIATE OVALS BELOW
O 1.Original Retum � 2. Supplemental Retorn � J.Remaintler Retum(tlate o/dea�h
Prior�o 12-13-82)
� 6.AqncWture Exemplion � 5. FUWre In�erest Compmmise(tlate of � 6. Fetleral Estate Tax Retum Required
(tlateof�eafhonoratler]-0-2012) tlea[hafter1242-82)
Q ].��ceEe��Dr�)eslate � 8.Decetlent Maintained a Livinq Tmst � 9.Total Number of Safe Deposil Boxes
(A�lach mpY ol wst)
� 10. Li�iga�ion Pmceetls Received � 11.Non-Proba�e Transferee Re[um � 12. peferraVElection of Spausal Tms�s
(Schedule F and G Assets only)
❑ 13. Business Assets ❑X 14. Spouse Is Sole Benefciary
(No tmst involved)
CORRESPONDEXT�TMIS SECTION MUST BE COMPLEiED.RLL CORRESPONOENCE HND LONFIDENTIAL TA%INFORMqTqN SMOULD BE DIRECTED T0:
Name Daytime Telephone Number
M U R R E L R . W A L T E R S , I I I 7 1 7 6 9 7 4 7 0 0
First Line of Address
WALTERS & GALLOWAY , PLLC
Secontl Line of Atltlress
5 4 E . M A I N S T
CityorPostOKce State ZIPCode
MECHA NI CS BU RG PA 1 7 0 5 5 -�
c� ,_, ..., ,�
_ � ��
correspondenCse-maiiaaaress: MURREL(dWALTERSGALIOWAY.COM -_ _., ';���
- -„
� REGISFERQFJNILLSOSEONLV
REGISTER OF WILL$USE ONLV ~
_. DFTEFlLEDMMO�YYTY � _._� .
I . . . �I � � - �'.
(D �_ I�.I
� n
�._._. ~ �. ...1.. .
DATE F�STAMP �I
PLEASE USE ORIGINAL FORM ONLY
Siee 1 '
I I�IIII IIIII IIIII I'IIIIIIII IIIII IIIII IIIII IIIII II�II IIII I'll � �
L 1505619134 1505619139
J 1505614234
REV-1500 E%(FI) Decedenfs Social5ecurity Number
o�aem'srvame�. Rl1TH E • POTTEIGER
RECAPITULATION
1. RealEstate(ScheduleA) . . . . . . . .. .. .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . �- '
2. Sbcks antl Bonds(Schetlule B) . . .. . . . .. .. .. .. .. .. .. . . . . . .. . . .. . . . . .. 2- '
7. Closely Heltl Coryoration,PaMership or Sole-Proprietorship(Schedule C) . . .. . 3. '
0. Mortgages and Notes Receivable(Schetlule D) . . . . . . .. .. . . . .. . . . . . . .. .. . 4. '
5. Cash.Bank Deposi�s antl Miscellaneous Personal PropeRy(Sc�eCule E�.. . . . . . 5. 1 2 1 4 6 , 9 6
6. Jointty Ownetl Pmperty(Schetlule F) ❑ Separa�e Billing Reques�ed . . . .. .. 6. '
]. In�er-Vivos Transfero&Miscellaneous N mProba�e PropeRy
(Schetlule G) � Separate Billing Requested . . . . . .. ]. •
a. rowi cro:s nsse�(ro�ai u�es i mro�qn�� . _ . . . _ . . _ . s. 1 2 1 4 6 , 9 6
& Ponerel Expenses and Atlminis�rative Costs(SCM1etlule H) . . . . . . . .. .. . . . . . . . 9. 1 1 7 2 � . 5 �
10. Debts of Decetlenq Mortgage Liabili[ies,and Gens(Schetlule 1) . . . . . . . . . .. .. 10. 7 2 2 � . 0 0
i i, ro�i oed�oeo�s(m�ai o�es s a�a io) . . .. . . . . _ . . .. . . . . . . . . . . . .. . . . . i i. 1 8 9 4 � . 5 0
12. Net Value ot Estate(Line e minus Line 11� . . . . . . . . . . .. . . . . . . . . . .. . . . . . ��� - 6 7 9 3 . 5 4
13. Charitable antl Governmen�al Bequests/Sec 9113 Tmsts(or wM1ich
an eleUion to[ax�as not been matle(Schetlule J) . . . . . . . . . .. . . . . . . . . . . . 13_ •
ia. Neevamesucje«rora=(u�eizm�o�suoeia� . . . . . _ _ ia. - 6 7 9 3 . S 4
TA%CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amoun[of Line M taxable
at t�e spousal�ax rate,or
transfers under Sec.9116
(a)(12)%.0 _ . 15. .
16. Amoun�of Gne 14 taxable
atlineal�ate X 0_ • is. •
1�. Hmounl of Line 10�axable
atsiblingrate %.12 • ��� '
18. Amount of Line 14 taxable
atwllateralra�e X.15 • �8- '
19. TAX DUE . .. .. . . . . . .. . . . . .. . . . . .. .. . . . . .. . . . . .. . . . . 19. •
20. FILL IN THE OVAL IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT ❑
Untler penaltles of perjury,I EerJare I M1are e+aminetl I�is reW m,induding accompanying sc�etlules antl sUtemenls,an0 to iM1e best ol my knw.letl9e antl Deliel,
i�Is We,corzM anC complete.DeGaralion ot preparer o��er t�an�M1e person responslWe(orlJing t�e reW m Is basetl on all NbrmaGon ot whicli preparer�as
any knowletl9e.
Sf8(JNTJ�RfrOFPE[ISOtyRESP. S�FlL�NGRETURN ��AT
(/ /� h,j � o � � /J /S
� oREss �
JOHN MICHAEL OTTEIGER 76 SILVER CROWN DR MECHANICSBURG PA 1705�
SIGNATUFEO PREPAREROTNE$THANPERSONRESPONSIBLEFORFlLINGTHERETURN ORTE
� ./1 .' �J "� �? 5
qooaess ;
MURREL� � �WAL� ERS. I 54 E nAIN ST MECHANICSBURG PA 17055
I IIIIII IIIII IIIIIIIIII IIIII IIIII IIIII'IIII IIIII IIIIIIIIIIIII Side 2
L 1505614234 1505614234 �
REV-1500EX (Fq Page3 FileNumber
DecedenYs Complete Address: 2� ts o�ss
oECEOENrsNnME
RUTH E. POTTEIGER . _ .
_ _..__— . ._ __ . _ _ _._ - - _
srREETaooRess-
524 DOGWOOD DR ... _. _ .__ . .
CITV - ..- STATE ZIP ...�.
MECHANICSBURG PA ' 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 79) (�)
2 Credils/Payments
A.PriorPayments . . _..
B.Discouni ._
(See insWclions.) io�al Credits(A*B) (2)
3. Inleres�
(3)
4. If Cine 2 is greater�han Line 7 �Llne 3,enter the tllfference-Thls Is Ihe OVERPAVMENT.
Fill ia oval on Page 7,Line 201a request a rePond. l4)
5. I�Line 1 +�ine 3 is greater than Line 2,entenhe difference.This is theTA%DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. �idtleceden�makealransferan�: Ves No
a. relain�heuseorincomeoflheproperlylransferted ... ........._ "-" ����-���� ❑ ❑
b. retainlhengh��otlesigna�ewhoshalluselhepropertylransfertedoritsinwme .._... ....... x
c. retainareversionaryin�eres� ......... ............_ .. ..... .... ...._ ....... x
d. receive�hepmmiseforldeotei�herpayments,benef�sorcare� .... ....... . ....._ ....... ❑ �
2. If dealh occuned afler�ec.12,1982,tlitl decedent Vans(er pmpetly wilhin one year of death ❑ ❑
wi�houtreceivingadequa�econsideration� .............._.. .........._._ ........_.._.. ........ x
3. Did deceeen�own an'in Ims�fof or payable-upon-0ealh bank acwun�or secun�y a�his or her tleatM ......... ❑ �
4. Diddecedenlownanindividualretiremen�aaoun�,annuilyorolhernon-probalepropedy,whic�
conlainsabeneliciarydesignation?...... ....._._.... .._._.._.. ............_. .........._.._ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Por da[es oi tleath on or afterJuly 1,1994,antl before Jan. 1, 1995,ihe t�ra[e imposetl on Ne net value of tansiers to or for ihe use oi ihe surviving spause
is 3 percent[/2 P.S.§9116(a)(1.1)(i)�.
Por tlates of death on or after Jan. 1, 1995,�he tax rate imposed on�he net value of Irans(ers to or for the use of ihe suniving spouse is 0 percent
[/2 P.S.§9116(a)(1.1�(ii)�.The staWle does not exemp�a transfer to a surviving spause from taz,and the stlWrory requiremenk for disclosure of asse6 antl
filing a tax reWm are s[ill applicable even if ihe surviving spouse is the only beneficiary.
For dates of deaU on or after July 1,2000:
• The lax rate imposed on�he net value of Iransfers from a deceased child 21 years of age or younger at deaM to or for�he use of a natural parent,an
adoptive parent or a slep-paren�of Me child is 0 percent[72 P.S.§9116(a�(1.2)�.
• The Wc rate imposeA on the ne�value af�ronsfers to or br Ne use o�the Oece4enTs lineal beneficiades is 45 percenL excep�as notetl in[72 P.S.§9116(a)(1)J.
• The taz rale imposed on the net value of transfers�o or for�he use of ihe decedenfs siblings is 12 percent[72 P.S.§9116(a)(1.3�J,A sibling is defined,
under Section 9102,as an individual who has a[least one parent in common with the deceden�,wheMer by blood or adoption.
REV450B EX+(OB-02)
pennsylvania SCHEDULE E
oeoAarMenroFaeve�+ue CASH� BANK DEPOSITS & MISC.
iNHEairnrvcEr�aEruRN pERSONAL PROPERTY
aEsioENroECEOErvr
ESTATE OF: FILE NUMBER:
RUTH E. PO7TEIGER 21 15 0'138
Inclutle t�e proceetls of litiga�ion antl tM1e date�he proceetls were receiveE by t�e esta�e.
qll property joinlly ownetl wit�nght of survivorship must b¢disclosed on ScheOule F.
ITEM VALUE AT DATE
NUMBER DESCRIPiION OF DEATH
1. M&T BANK 7,346.04
CHECKING ACCOUNT
2. CONTINENTIAL CASUALTY 4,800.92
LONGTERM HEALTHCARE POLICY
TOTAL(Also en�er on Line 5,RecapiNlalion) 5 �2 146.96
If more space is needeQ use adtlitional sheets of paper of the same s¢e.
REK1511 E%�(0&ll)
pennsylvania SCHEDULE H
oevaarmer�roFaevenuE FUNEfu1LEXPENSESAND
ir�HEairancErnxaEruRN ADMINISTRATIVECOSTS
aEsioENroECEOENr
ESTATE OF FILE NUMBER
RUTH E. POTiEIGER 21 15 0138
OeceCenCs tleCts musl be reponed on ScheCule 1.
ITEM AMOUNT
NUMBER �ESCRIPTION
q. FUNERALExPENSES'. 9,755.00
1. COCKLIN FUNERAL HOME
g. A�MINISTRATNECOSTS'.
�, PersonalRepresenlativeCommissions'.
Name�s�ofPersonalRev�esentativHs� ��HNMICHAELPOTTEIGER (fenounCed) 0.00
svee�Aeeress 76SIWERCROWN �R
Ciry MECHANICSBURG Siz�e PA Zla 17050
Vear�s)Commission Paie'.
p AnameyFees: WALTERS&GALLOWAY, PLLC �,600.00
3, FamilyExemp�ion�.Q(4ecetlenYsadtlressisnolNesameasdaimanYs,a�lac�explanation.) 0.00
qaimant NONE
StreelAtldress
Gity Sta�e ZIP
Rela6onship of Qaimant�a Deceaen�
4. PmbateFees�. REGISTEROfWILLS-CUMBERLANDCOUNTY �65.50
PcmunUntFecs'.
5.
6. TaxReWmPreparerFees'
7.
TOTAL�AIsoenteronLine9,RecapiWlation) S �� �p0.50
I(more space is netdtN,use a0eitbnal shee6 0l papero(Me same size.
REV-0512 EXt(t2.12)
pennsylvania SCHEDULE I
oePaarMENroraEVEx�E DEBTSOFDECEDENT�
iw�EairaHCEraxaEruarv MORTGAGE LIABILITIES 8 LIENS
atsioErvroECEOErvr
ESTATE OF FILE NUMBER
RUTH E. POTTEIGER 21 15 0138
Repoh tlebts incurted by the decedent pnor to dealh Nat remained unpaid a�ihe date of death,including unreimburseE medical ezpenses.
ITEM VALUE AT�ATE
NUMBER DESCRIPTION OF�EATH
1. MESSIAH VILLAGE 7,220.00
RESIDENTIAL CARE
TOTAL(Alsoenler on Line 10,Recapitulation) S 7 pp0.00
If more space is needed,insert additional sheets of the same size.
aev-i ei a ex.m�.�o�
pennsylvania SCHEDULE J
oeanarrnervr oF REvervue
iNHeai.nNCE ra�reeruar� BENEFICIARIES
aEsioEnroECEOEr�r
ESTATE OF: FILE NUM6ER:
RUTH E. POTTEIGER 21 15 0'138
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON�S)RECEIVING PROPERTY Da Not List Trustee�s) OF ESTATE
� TA%ABLEDISTRIBUTIONS pncludeoufrgMspousaldisNbufionsantltrans�ersuntler
Sec9118(a1(127.1
t JACKJ. POTTEIGER Spousal 100.00
524 DOGWOOD DR.
MECHANICSBURG, PA 17055
ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE515 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL�ISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL�ISTRIBUTIONS'.
7.
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV4500 COVER SHEET. §
If more space is needed,use additional sheets of paper of ihe same size.