HomeMy WebLinkAbout06-03-15 pennsytvania 1505614105
DVOMMOFREVEWA EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year t File Number
PO BOX 2806010�41
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ! I I _j
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 1 04142014 12101920
Decedent's Last Name Suffix Decedent's First Name Ml
Kotschessa Ernest A
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
n/a
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C@D 1.Original Return C= 2.Supplemental Return ri 3. Remainder Return(date of death
prior to 12-13-82)
C=) 4.Agriculture Exemption(date of C=) 5.Future Interest Compromise(date of c= 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
c@D 7. Decedent Died Testate C=:) 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
10. Litigation Proceeds Received C=) 11.Non-Probate Transferee Return C=) 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
13, Business Assets C=:) 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Ronald E. Johnson, Esq 1(717)243-0123
First Line of Address
178 West Pomfret Street
Second Line of Address
City or Post Office State ZIP Code
Carlisle PA 17013 ---��
Correspondent's email address: rejohnson@pa.net
REGIST&�OF WILLS UE`t-6NLY
M
REGISTER OF WILLS USE ONLY
E
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C-3
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DAi�F1'LS
jD__ �AMP_:3 :2
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PLEASE USE ORIGINAL FORM ONLY
Side I
I lllill 11111 11111 llllllli 11111 11111 11111 11111 11111 1111 1111
1 05614105 1505614105
J 1505614205
REV-1500 EX(FI)
Decedents Social Security Number
Decedent's Name: Ernest A. Kotschessa
RECAPITULATION
i
1. Real Estate(Schedule A). ............................................ 1. 0.00
i
2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ... .. 3. ' 0.00
4. Mortgages and Notes Receivable(Schedule D).......... ................. 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. 4,007.07
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ! 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 0.00
B. Total Gross Assets(total Lines 1 through 7)............................. 8. ' 4,007.07
9. Funeral Expenses and Administrative Costs(Schedule H)............. ...... 9. 1,793.88
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)......... ...... 10. 15,435.72
11. Total Deductions(total Lines 9 and 10)..... ....... ..................... 11. 1 17,229.60
12. Net Value of Estate(Line 8 minus Line 11) ............... ............... 12. -13,222.53
13. Charitable and Governmental Bequests/Sec.9113 Trusts for which
an election to tax has not been made(Schedule J) ........ ................ 13. 0.00
i
14. Net Value Subject to Tax(Line 12 minus Line 13) ........ ................ 14. -13,222.53
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 15.
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 p
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN,, / DATE
ADDRESS ADDRESS
c/o West Pomfret Stre t, Carlisle, PA 17013
SI ER O ERSON RESPONSIBLE FOR FILING THE RETURN DA
r
IAV
DRESS
c/o 78 West Po et Street, Carlisle, PA 17013
Side 2
1505614205 1505614205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 2 O f112—
DECEDENT'S NAME
Ernest A. Kotschessa
STREETADDRESS
210 Big Spring Road
CITY STATE ZIP
Nevvville PA 17241
Tax Payments and Credits:
1, Tax Due(Page 2,Line 19) (1) 0.00
2, CreditslPayments
A.Prior Payments 0.00
B.Discount OM
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
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) OM
5, If Line I +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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.............................................................__....................................................... F-1 E
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 F2 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 s'pouse 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 step-parent 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 F2 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 F2 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.
OF
ERNEST A KOTSCHESSA y ��
n Cn 2
I,ERNEST A.KOTSCHESSA, of Middletown,Dauphin County,'Pevanma,
3
being of sound and disposing mind,memory and understandin& do makeapublish inti rn
-_a Cl) o
.
declare this to be my Last Will and Testament hereby revoking all other Wills and N '*1
Codicils by me at any time heretofore made.
ITEM I: 1 direct that all of my just debts and currently due debts and
fimeral expenses shall be paid from my estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II: I give,devise and bequeath my entire estate,whether real or
personal, or wheresoever the same may be situate or located,to my wife,GRACE
TELESK KOTSCHESSA.
ITEM III: In the event that my wife,GRACE TELESK KOTSCHESSA,
should predecease me,I give, devise and bequeath my entire estate,whether real or
personal or wheresoever the same may be situate or located,in equal shares,to my
children,ERNEST A KOTSCBESSA,JR-,RICHARD L.KOTSCHESSA,SHERRY
ANN BINKLEY and BONNIE MARIE KOTSCBESSA CORBETT,per stirpes,and the
WATCHTOWER BIBLE AND TRACT SOCIETY OF PENNSYLVANIA,located at
100 Watchtower Drive,Patterson,New York 12563-9204. It is my intention that my
children and the Watchtower Bible and Tract Society of Pennsylvania each receive a one-
fifth(1/5th)share of the residue of my estate.
ITEM IV: I nominate,constitute and appoint my wife,GRACE
TELESK KOTSCHESSA,as Executrix of this my Last Will and Testament. In the event
that she is unable or unwilling to serve in this capacity,then I nominate,constitute and
appoint my son,ERNEST A.KOTSCHESSA,JR,as Executor of this my Last Will and
Testament
I
ITEM V: It is hereby directed that my Executrix shall pay all
inheritance,estate,succession and legacy taxes to which my estate for the transfer of any
property hereunder may be subject,and to charge such taxes as a part of the expense of
the administration,payable out of my residuary estate.
ITEM VI: I direct that no Executrix or other fiduciary named,nominated
or appointed in this my Last Will and Testament shall be required to post any bond or
give any security of any type for any purpose whatsoever,any law or rule of the Court of
the Commonwealth of Pennsylvania or any other jurisdiction to the contrary
notwithstanding.
IN WITNESS WIEREOF,I have hereunto set my hand and seal this_ day
of f (I' 1998.
Ernest A Kotschessa
Signed,sealed,published and declared by the said Ernest A Kotschessa,the above
named.Testator,as and for his Last Will and Testament,in the presence of us,who at his
request and iAhis presence and in the presence of each other,all being present at the
same tinye,�have
�yhereunto su ycribed our names as witnesses hereto.
Z•'�'Z.'L� ` f i ResidingY.
F f
,r
;. y� t -jtit�;• �!z.� �"_ Residing
• f
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I,ERNEST A KOTSCBESSA,,2 ,.r s � �and
the Testator and the witnesses respectively,whose names are
signed to the attached or foregoing instrument,being duly qualified according to lave,do
hereby declare to the undersigned authority that we were present and saw Testator sign
and execute the instrument as his Last Will,that he signed willingly(or willingly directed
another to sign for him),and that he executed it as his free and voluntary act for the
purposes therein expressed,that each of the witnesses,in the presence and healing of the
Testator signed the Will as witnesses;and that to the best of our knowledge the Testator
was at that time eighteen(18)or more years of age,of sound mind and under no
constraint or undue influence,and I,the said Testator,do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament,that I signed it
willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
;,TOR
rf S /
:k S A
Subscribed, sworn to and
acknowledged before me by
Ernest A-Kotschessa,the Testator,
and subscribed as ad sworn to
before rme by/J�`-�£!^'°,�z�c• •�`;:' c �.��-
wit �sses,this _tf�Y day of
1998.
� Public
N5 i AP:.I L SELL
KAY!'.lW.0 i=:<Nntsy Public
Cll +i'.!=r,:u ury,L'n ip,5in Count,PA
[Oy Connireion Exal;es P.Jarch 18,2002
' �ti
REV-15o8 EX+(o8-12)
QpennsyLvania SCHEDULE E
07 DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE DECEDAX ENT PERSONAL PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ernest A. Kotschessa 21-14-0412
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.� .Checking account no:0513123695-Metro Bank(see attached statement) ^»µ 4,007.07'
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? t4
TOTAL(Also enter on Line 5, Recapitulation) $ 4,007.07
If more space is needed,use additional sheets of paper of the same size.
fir
F*JR.w. ice-
•
BANK t r—"Bark
F.zai=burg PA -7,••
ERNEST A KOTSCHESSA
14.70E BURNT MILL RD
SHIPPENSBURO FA 1-72577
We?ehere 7 days a week,24 hours a day atl4UM-337-0004-
50 PLUS CHECKING 0513123695 ,
Stabamerk Batanca as of 03fMid $4.890.57
Plus 2 Deposits and Other Credds 41.326.00.
'Less 5 Checks andOfher Debits $2,210.04
s
Plu1Marest Paid '. '50.54.
Stateretent Eialam' as of 04114114' 54.007.07-
Transactions By Date
Date Oescripfion Dabif Credit Balance
03118A47—CHECK-9230 5778.72. 54.911.83•.
03125/14 PpS YYAL Wal-Mart Sup WAS $4.063.37
RFr037634 03125 105s34 CARLISLEPA
0410i1i4.. US TRFASERY 314 MA 6ENEF....
ERNEST A MTSCNESSA
04!03!?Q SSA TREAS 310 XXSOC SEC $1.236.00 $5.389.37 t
ERNEST A KOTSCHESSA
04/071.14 Unhadl•lealthcare PREMIUM. 5206.40 $5.183.37
KDTSCHESSA...: . . ...p
04!10114 CHECK 4 231 $1.84 $5.181.53
04114/14 CHECK 11232 $1;175.OD 54.006.53
04!11114 INTEREST 'PAYMENT 50.54 $4,007-07
0
Check Transactions
Humber Date Amourit Number Date Amount Number Dare Amourd €
4
230 03118 $778.72 231 04110 $1.84 232 OQt14' S1_179.00
dente,r3 h an'=are 0--=ft en ies and::itf rrt ha,e a check irage. tem-dem*ed th an"`irdi:ate p!cceasse4 ctecks ctr cf sewueroe,
ec
o:
G
Interest Summary
'Number of Days in this.Ststememnt.Period 29
Irderest Earnad!hie.Statement. Period
$0.54
Armuat Perve7i,6 a Yield Fawned thia�fl"rreer* Period(HPY) 0.7514
Jrrterest,7°s7d Year to Daft.
0
e cycle Page 1 of 6
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'REV-1s
T-Wil7-70EPARTMENT OF REVENUE FUNERAL EXPENSES ANDINHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ernest A. Notaohesoa 21-14-0412
Decedent's debts must hereported oxSchedule l.
ITEM
NUMBER DESCRIPTION AMOUNT
Boyko Funeral Services 151.00
2. Funeral luncheon 210.00
ADMINISTRATIVE COSTS:
L Personal Representative Commissions: 200.00!4
Name(s)of Personal Representative(s) Ernest Kotschessa, Jr.
Street Address 311 E. Vine Street
city Stowe State PA ZIP19464
Year(s)Commission Paid: 2015
875.00
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as clalmant's,attach explanation.)
Claimant
Street Address
city State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 118.50
5. Accountant Fees:
6. Tax Return Preparer Fees* 'S4
7. Ernest Kotschessa,Jr.-reimbursement for miscellaneous expesnes 39.38
Reserve for closing 200.00 i��
1,793.88
TOTAL(Also enter on Line 9, Recapitulation)
ifmore space isneeded,use addiUuna[sheets ofpaper of the same size.
REV-1512 EX+(02-15)
h--vPennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ernest A. Kotschessa 21-14-0412
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
?Commonealth of PA-Dept of Public Welfare(see statement attached) — 15,435.72 '
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TOTAL(Also enter on Line 10, Recapitulation) $ 15,435.72'
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COMMONWEALTH OF PENNSYLVANIA
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABILITY
' RECOVERY SECTION
PO BOX 8486
HARRISBURG,PA 17105-8486
October 28,2014
STATEMENT OF CLAIM SUMMARY
NAME Estate of KOTSCHESSA,ERNEST
AD 630 188 137
MEDICAL -CLASS.3 ;-CLASS 5.1 . TOTAL. '
INPATIENT .00 .00 .00
OUTPATIENT .00 .00 .00
LONG TERM CARE 15,415.72 .00 4 15,415.72
DRUG 20.00 .00 I 20.00
REIMBURSEMENT TO DPW 15,435.72 .00 t 15,435.72
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT.OF PUBLICWELFARE
EIN 23-6003113
Page 1 of 3
REV-1513 EX+(02-15)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT'
ESTATE OF: FILE NUMBER:
Ernest A. Kotschessa 21-14-0412
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. i Emest A.Kotschessa,Jr.,311 East Vine St,Stowe,PA 19464 'soy on �^- ' 20%
L �....
2.' iSherry Binkley,14708 Burnt Mill Lane Shippensburg,PA 17257 daughter 20%
L-
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s 3. Bonnie Corbett, Rose 8915 Jennifer RCourt, au Peoria,AZ 85345 'daughter 20%
_ - _ _. _ _ _
4_1 dMelinda Dolts,2265 Spinnerstown Road,Quakertown,PA 18951 1 1grarddaughterH ^H - 10%y
5.1 David Kotschessa,3535 Palm Crossing Drive,Tampa,FL 33613 ''grandson 10%
_
:.. ......~ —�� ..._. . ........... .._..-.._ ....... _._. ....._----
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ii
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:
L.j -
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. ...._._....._......--........-._......._._...---........--....... ...-- ........ .
Watchtower Bible and Tract Society of Pennsylvania,100 Watchtower Dr.,Patterson,NY 12563 20%
E 1
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TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $'
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