HomeMy WebLinkAbout04-19-05 (3)
REV.1500EX(S-OO)
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'* COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COUNTY CODE YEAR
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NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
KUTZ KATHARINE E
SOCIAL SECURITY NUMBER
183-05-8847
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i DATE OF BIRTH (MM-DD-YEAR)
i 02/07/1901
I
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
N/A
DATE OF DEATH (MM-DD-YEAR)
11/14/2004
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
I REGISTER OF WILLS
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~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of WilQ
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale 01 death after 12.12.82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (dale of death between 12.31.91 and 1.1-95)
o 3. Remainder Return (date 01 death prior to 12.13-821
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 01
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NAME
ROBERT K. ROBITAILLE, Executor
FIRM NAME (If Appicable)
COMPLETE MAILING ADDRESS
ROBERT K. ROBITAILLE
82 LINDA DRIVE, Lot #32
MECHANICSBURG PA 17050
N/A
TELEPHONE NUMBER
(717) 796-6025
(1)
(2)
(3)
(4)
(5)
0.00
0.00
0.00
0.00
19,903.94
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(8)
8,243.28
4,829.43
(11)
(12)
(13)
(6)
0.00
(7)
0.00
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 x .0__ (15)
_____________Q.OO_ x .0 __ (16)
16. Amount of Line 14 taxable at lineal rate
_____ _____Q~OO x12
(17)
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
_€:)!.l!~.!-~3_ x .15 (18)
(19)
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
TO:
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19,903.94
13,072.71
6,831.23
0.00
6,831.23
0.00
0.00
0.00
1,025.00
1 ,025.00
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Decedent's Complete Address:
STREET ADDRESS
.S1\RAH A. TODD MEMORIAL NURSING HOME
1000 WEST SOUTH STREET
--------- ----- --~~---
CITY CARLISLE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
I STATEpA
_______m TifP170 13
(1)
1,025.00
0.00
0.00
0.00
Total Credits ( A + B + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
A. Enter the interest on the tax due.
(SA)
0.00
0.00
1,025.00
0.00
S. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (S)
B. Enter the total of Line S + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,025.00
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;.......................................................................................... 0 ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~
c. retain a reversionary interest; or.......................................................................................................................... 0 ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property w~hin 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? .............. 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalijes of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, ij is true, correct
and complete.
Declaration of preparer other than the personal representative is based on an infonnation of which preparer has any knowledge.
~~GNATU:~~:ER~ON RESPONSIBLE FOR FILING RETU~~ K. ~~~ATE '!l' q I C}.oo 5
ADDRESS
82 LINDA DRIVE, Lot #32, MECHANICSBURG PA 17050
-_.--- --- ----- --- _._----_._-_._"-~.._..-
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 twenty-one 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% [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.S%, 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 decedent's siblings is 12% [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.
KATHERINE E.KUTZ
I, Katherine E. Kutz, of Carlisle, Cumberland County,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A. I leave my desk and top cabinet to Stanley Doyle, Jr.
Should Stanley Doyle, Jr. predecease me, I leave his
share to Robert Robitaille;
B. I leave everything else to Robert Robitaille. Should
Robert Robitaille predecease me, his share shall go
to his heirs.
4.
I appoint Robert Robitaille as Executor of this my last
Will.
5.
The Executor of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
6.
I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
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M::OF, I have hereunto set my hand this
,2004.
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Katherine E. Kutz
LAW OFFICES ot
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 170 I3
The preceding instrument consisting of this and one other page
was on the day and date hereof signed, published and declared by
Katherine E. Kutz, 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.
~~
WITNESS.
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LAW OFFICES OF
,TEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
/
ACKNOWLEDGMENT
/
State of Pennsylvania
ss
County of Cumberland
I, Katherine E. Kutz, the testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the
instrument as my last Will; that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
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Ka erine E. Kutz (/
Sworn to or affirmed and acknowle
E. Kutz, the testatrix, this 27 day of
e me by Katherine
,2004.
NOTAAW. SEAL
STEPHEN J. HOGG. NOTARY PUBLIC
CARLISLE BORa, CUMBERLAND co PA
MY c;-....SION eXPIRES .EPTEM iER'3
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State of Pennsylvania
ss
County of Cumberland
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We,l./J e-el1 U1~"''';Tcp'1e-tr and 0 vote.- .=->KArvi"'AI.?~he
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 the testatrix signed willingly and
executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testatrix signed the Will as a witness; 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 constrain r undue influence.
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Sworn to or affir ed
this ~7 day of
NOTARIAL SEAL
STEPHENJ.HOGG,NOTARYPUBUC
CARLISLE BORO, CUMBERLAND co., PA
MY COMMIISIO~ EXPIRES SEPTEMBER 3, 2006
REV-1508 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
KATHARINE E. KUTZ
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. INTEREST-FREE CHECKING ACCOUNT (No. 610072-787-4) at CITIZENS BANK (Carlisle Pa. Branch)
2. CASH ON HAND
11,657.83
20.00
3. REFUNDED CHECKS
4. SECURITY DEPOSIT REFUNDED
179.29
206.00
5. PREPAID FUNERAL ACCOUNT (Forethought Life Insurance Company)
7,730.82
35.00
6. SMALL GOLD CLASS RING
7. COSTUME JEWELRY
10.00
8. ANTIQUE WOODEN ROCKING CHAIR
9. CHEST WITH DRAWERS
50.00
15.00
10. DESK WITH TOP CABINET (Bequeathed to beneficiary Stanley Doyle Jr. mentioned in the Will)
11 . Clothing and other household items given away
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19,903.94
REV-1511 EX+ (12'99.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
KATHARINE E. KUTZ
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
AMOUNT
B.
1.
10.
11.
12.
DESCRIPTION
1.
FUNERAL EXPENSES:
Prepaid Funeral Account from Forethought Life Insurance Company (paid to Myers Funeral Home)
OBITUARY ADVERTISEMENT
7,730.82
101.06
2.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) ROBERT K. ROBITAILLE, Executor
Social Security Number(s)/EIN Number of Personal Representative(s
0.00
City MECHANICSBURG
. State P A Zip 17050
Year(s) Commission Paid:
2.
Attorney Fees
0.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
0.00
Claimant
Street Address
City
State
.Zip
Relationship of Claimant to Decedent
4.
Probate Fees
94.00
5.
Accountant's Fees
0.00
6.
Tax Return Preparer's Fees
85.00
7.
LEGAL ADVERTISING (The Sentinel Newspaper, Cumberland Law Journal)
FlUNG OF INVERNTORY
FlUNG OF INHERITANCE TAX RETURN
ESTATE CHECKS COST (Citizens Bank, Carlisle PA)
Monthly maintenance fees for interest-free Estate Checking Account (Citizens Bank, Carlisle PA)
FIRST- CLASS POSTAGE (Federal Square Station, Harrisburg PA)
164.84
15.00
15.00
28.96
8.00
0.60
8.
9.
8,243.28
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTIES, & UENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KATHARINE E. KUTZ
FILE NUMBER
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1
SARAH A. TODD MEMORIAL NURSING HOME, 1000 West South Street, Carlisle PA 17013
4,553.95
2.
PHARMERICA (Harrisburg, PA) for medications not covered by regular health insurance
158.40
3.
HAULING AWAY OF FURNITURE
35.00
4.
TELEPHONE BILL
43.00
5.
ELECTRIC BILL
39.08
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,829.43
REV-1513 EX+ (9-00)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
FILE NUMBER
ESTATE OF
KATHARINE E. KUTZ
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
r TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Robert K. Robitaille, 82 Linda Drive, Lot #32, Mechanicsburg PA 17050 Friend 6,831.23
2. Stanley E. Doyle Jr., 237 Polecat Road, Landisburg PA 17040 Great Nephew
Receiving only one item of furniture as mentioned in the Will.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)