HomeMy WebLinkAbout04-07-06
REV-1500 EX (6-00)
Rev-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE THIS RETURN WITH:
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Koppenhaver, Betty Jean
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
10-01-2005 11-05-1923
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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x 1. Original Return
4. Limited Estate
4a. Future Interest Comprise (date of death after 12-12-82)
2. Supplemental Return
x 6. Decedent Died Testate (Attach copy of Will)
OFF~{~~~~l U~)E Of~~L ""f
FILE NUMBER
21 ~ 00933
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
204-18-2603
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
3. Remainder Return (date of death prior to 12-13-(2)
5. Federal Estate Tax Return Required
9. Litigation Proceeds Received
7. Decedent Maintained a Living Trust (Attach a copy of Trust) 8. Total Number of Safe Deposit Boxes
10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D. 11. Election to tax under Sec. 9113(A)
(attach Sch 0)
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THIS SECTION MUST BE COMPLETED.
NAME
Reeta M. Otto
FIRM NAME (If Applicable)
ALLCORRESPONDENCEAND~ONFIDENTIALTA){.INFORMATJONi SHOQlOBE.DIRECTED TO;
COMPLETE MAILING ADDRESS
C/O Joel O. Sechrist, Esquire
568 Old York Road
Etters PA17319
TELEPHONE NUMBER
717 938-3396
1. Real Estate (Schedule A)
(1 )
(2)
(3)
(4)
(5)
(6)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I)
(10)
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)
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14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x
16. Amount of line 14 taxable at lineal rate
x
17. Amount of line 14 taxable at sibling rate
x
.12
18. Amount of line 14 taxable at collateral rate
19. Tax Due
$103,908.06 x
.15
20. D
$0.00;
;
$0.00;
;
$0.00 ~
$0.00;
~
$123,110.71 ~
OFFICIAL USE ONLY
$000 i i
! I
$0.00: " ;
......... ...... ........................ .. .................. ~."I'!....... .......... .......... ................ ....,.
(8)
$17,816.50
$1,386.15
(11 )
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
L..\ $123,110.71
$1920265
$103,908.06
$000
$103,908.06
$0.00
$0.00
$0.00
$1558621
$15,586.21
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Decedent's Complete Address:
STREET ADDRESS 100 Mt. Allen Drive
CITY I~TATE IZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
$15,586.21
$1::\ 000 00
$RR4 ?1
Tota/ Credits (A + 8 + C) (2)
$1368421
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
Tota/lnterest/Penalty (0 + E) (3)
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)
If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
$0.00
5.
$1,902.00
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE.
(5A)
(58)
$1,902.00
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
~: ~:::~ :~:~:~~~:~~;~:~; t:~::o:a~~s:at~:fe;':~rty transferred or fts income; I.... .............1
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration? r--l
Did decedent own an "in trust tor or payable upon death bank account or seculity at his or her death? 0
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? E=:J
No
2.
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3.
4.
[2]
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 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 the information of which preparer has any knowledge.
DATE
SIGNATURE OF~. SON RE.. SPONSIBLE FOf3_FILlNG R.. ETURN
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ADDRESS
DATE
SIGNAT
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 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 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 4.5%, 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.
LAST WILL AND TESTAMENT OF
BETTYJ.KOPPENHAVER
I, BETTY 1. KOPPENHAVER, of Cumberland County, Pennsylvania, being of sound mind
and memory, do make, publish and declare this my Last Will and Testament, hereby revoking and
making void arty and all wills by me heretofore made.
FIRST: I order and direct that all of my just debts and funeral expenses be paid by my
hereinafter named Executrix as soon after my death as may be found convenient.
SECOND: All the rest, residue and remainder of my estate, real, personal and mixed, of
whatever nature and wheresoever situate, which I may own or have the right to dispose of at the time
of my death I give, devise and bequeath to my cousin, REETA M. OTTO. In the event that Reeta
fails to survive me, then I give my entire estate to her husband, GEORGE OTTO.
THIRD: I hereby nominate, constitute and appoint my cousin, REETA M. OTIO, as
Executrix of this, my Last Will and Testament, and I do direct that no bond shall be required of such
Executrix hereunder. My said Executrix shall have full power at her discretion to do any and all
things necessary for the complete administration of my estate, including the power to sell at public
or private sale and without order of Court, any real or personal property belonging to my estate, and
to compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and
demands, whatsoever, against or in favor of my estate, as fully as I could do if living.
In the event that my cousin, REET A M. OTTO, does not survive me or fails to qualify, then
I nominate, constitute and appoint her husband, GEORGE OTTO, as the alternate Executor. Said
alternate Executor shall have all of the powers, privileges, duties and immunities as hereinbefore
more fully set forth for my original Executrix.
13~~. (~Lv-e~
Betty.. oppenh v r
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IN WITNESS WHEREOF, I, BETTY J. KOPPENHAVER, the above Testatrix have set my
hand and seal to this my Last Will and Testament, which consists of two (2) pages, to each of which
I have affixed my signature this )..~ dayof;r1 R Y , 2005.
~(l/~t.~ (SEAL)
Betty J oj{penhav. r
Signed, sealed, published and declared by the above named Testatrix as and for her Last Will
and Testament, in the presence of us, who at her request and in her presence and in the presence of
each other have hereunto subscribed our names as witnesses.
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~EV-1508 EX +.(6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
21-05-0933
Koppenhave~ Betty Jean
FILE NUMBER
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
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.
DESCRIPTION
PNC Bank Certificate of Deposit
PNC Bank Checking Account
Sovereign Bank Checking Account
Sovereign Bank Certificate of Deposit
Messiah Village Refund
PA State Employee Retirement System
Verizon Refund
Erie Insurance Refund
2005 Federal Income Tax Return
VALUE AT DATE
OF DEATH
$15,289.33
$12,797.61
$19,316.25
$15,381.20
$59,160.00
$53.59
$11.75
$50.00
$1,050.98
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$123,110.71
.REV-1511 EX ~ (12.99)
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
21-05-0933
Koppenhaver, Betty Jean
FILE NUMBER
ITEM
NUMBER
A.
1.
2.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Buffington & Reed Funeral Home
Funeral Meal
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State lip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
lip
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Register of Wills - File Return
Register of Wills - Additional Fee
Register of Wills - File Release
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
$10,889.50
$500.00
$6,150.00
$132.00
$15.00
$125.00
$5.00
$17,816.50
gEV-1512 EX ~ (12-03)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Koppenhaver, Betty Jean
FILE NUMBER
21-05-0933
Record debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
$30.20
$57.10
$48.98
$50.26
$1,189.61
$10.00
1.
2.
3.
4.
5.
6.
PP&L
Citicard
Verizon
Family Physician Associates
Messiah Village
Division of Vital Statistics - Birth Certificate
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$1,386.15
REV-1513 E~ + (9-00))
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SCHEDULE J
BENEFICIARIES
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
21-05-0933
NUMBER
I.
2.
Koppenhaver, Betty Jean FILE NUMBER
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116 (a) (1.2)]
Reeta M. Otto cousin
106 Sunset Drive, New Cumberland PA 17070
AMOUNT OR SHARE
OF ESTATE
100% of Residue
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
(If more space is needed, insert additional sheets of the same size)
$0.00
OCT-19-2005 20:47
Pt~CBAt-.JK
412 768 3458
o PNCBA"N<
October 20, 2005
Joel 0 Sechrist
Attorney at Law
568 Old York Rd.
Etters, PA 17319
seplal
RE: Estate of Betty Jean Koppenhaver (Deceased)
SSN; 204-18-2603
DOD: 10-0 }-2oo5
Dear Mr. Sechrist:
1n response to YOW' request for Date of Death balances for the customer noted above, our
records show the following:
Certifieate of Depollt
Account #3 I 900256779 Established 02-25.2005
BETIY J XOPPENHA VER
DOD balance: $15,282.62 + $6.71 accrued interest
Interest paid 01-01-05 thru 10-01-2005 $282.62 YID
C.ecldag Aceoaut
Account #5004591214 Established 11...04-2004
BErry J KOPPENHAVER
DOD balance: $12,794.91 + 52.70 accroed interest
Interest paid 01-01-05 thru 10-01..2005512.21 YTD
Please note that this office only provides date of death balances for deposit accounts
(IRA" CDs, Checking and Savings accounts). We do Dot proeess ..y fiIlaacw
traD'actioDS or provide Itatementl. If you need assistance with any of these items,
please call1-888-PNC-BANK. (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~ ;;I. ~
Erica L Schlegel
1-800-762-1775
P7 -PFSC-04-F
SOO First Ave.
Pittsburgh PA 15219
Mes:nba FDIC
Exhibit for Schedule E
P.01/01
TOTAL P.01
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Betty Jean Koppenhaver
204-18-2603
October 1,2005
Account #: 0771044739 Type:
In the name of: Betty J Koppenhaver
Date of Death Balance:
Int.(YTD) from 1/1/2005 to
Accrued interest to date of death:
Other Info:
Checking
Open date: 8/20/2003
$19,316.25
9/30/2005
$0.00
$207.22
Account #: 2295250829 Type:
In the name of: Betty J Koppenhaver
Date of Death Balance:
Int.(YTD) from 1/1/2005 to
Accrued interest to date of death:
Other Info:
CD
Open date: 6/24/1997
$15,329.33
7/31/2005
$51.87
$291.30
Exhibit for Schedule E
Page 1 of 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
OTTO REET A M
106 SUNSET DRIVE
NEW CUMBERLAND, PA 17070
-------- fold
ESTATE INFORMATION: SSN: 204-18-2603
FILE NUMBER: 2105-0933
DECEDENT NAME: KOPPENHAVER BETTY JEAN
DATE OF PAYMENT: 04/07/2006
POSTMARK DATE: 04/06/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 10/01/2005
NO. CD 006535
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,902.00
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TOTAL AMOUNT PAID:
$1,902.00
REMARKS:
CHECK# 108
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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