HomeMy WebLinkAbout06-22-06
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i:V-1500 E~ (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST FIRST, AND MIDDLE INITIAL)
Rotz, Catherine E.
REV-1500
DATE OF DEATH (MM-DD-YEAR)
03-07-2006
DATE OF BIRTH (MM-DD-YEAR)
08-02-1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
lliJ 1. Original Return
o 4. Limited Estate
[!J 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trusl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
FILE NUMBER /"
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NUMBER
SOCIAL SECURITY NUMBER
179 - 10
3891
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date 01 death prior 1012-13-82)
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 0)
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THIS SECTION MUST ae<COMPlETEP. .ALL CORRESPONOENCE ANP'CQNfllbEsNT~Il'TAX.II1lFORMATIONSHOUtD S$bIRECTEOTO:
NAME COMPLETE MAILING ADDRESS
Jerry A. Weigle, Esquire 126 East King Street
FIRM NAME (If Applicable) G & A OCIA C Sh1' ppensburg, PA 17257
WEI LE SS TES, P. .
TELEPHONE NUMBER
717-532-7388
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)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly 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)
(1)
(2)
(3)
(4)
(5) 1,802.89
(6)
(7)
(8)
(9) 498.59
(10) 2,002.37
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
> > BE SURE TO ANSWER ALL QUESTIONS ON REVER.SE. SIDE AND RECHECK MATH < <
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x.O _ (15)
x.O _ (16)
x .12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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(11)
(12)
(13)
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Q--; 500.96:"1
(698.07)
(14)
NONE - INSOLVENT
(19)
'Decedent's Complete Address:
STREET ADDRESS
Outlook Poiute
CITY
129 Walnut Bottom Road
Shippensburg
PA
I STATE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
1 ZIP
17257
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
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
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 within 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
No
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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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
ERSON RESP,OOpIBL.EE.. F fiP? ,R. G RETURN
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Patricia A. Watson
17257
Jerry A. Weigle, Esquire
Street, Shippensburg, PA.
& ASSOCIATES,
DATE
~7-1 S--06
DATE
17257
For dates of death on or after July 1, 1994 and before Ja uary 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. 39116 (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. 3S1116 (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 return are still applicable even
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 paren
or a stepparent of the child is 0% [72 P.S. 39116(a)(1.2)J.
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. S9116(1.2) [72 P.S. 39116(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. 39116(a)(1.3)). A sibling is defined, under Section 9102, as a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (2-87)
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Catherine E. Rotz
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
l. M & T Bank Checking Account II 97480045 1,674.79
2. Final Pension Check 3-21-06 28.10
3. Personal Property - 2 dressers, night stand 100.00
TOTAL (Also enter on line 5, Recapitulation) S
_~,802.89
(Attach additionol 8%" X 11" sheets if more space is needed.)
REV-1511 EX+ (7-88)
ESTATE OF
ITEM
NUMBER
A.
1.
B.
1.
2.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Catherine E. Rotz
Funeral Expenses:
Clothing
Administrative Costs:
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or Type
FILE NUMBER
DESCRIPTION
AMOUNT
33.59
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
Attorney Fees
Weigle & Associates, P.C.
450.00
3. Family Exemption
Claimant
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
Street Address
Address of Claimant at decedent's death
Relationship
City
Probate Fees
Miscellaneous Expenses:
State
Zip Code
Register of Wills, Cumberland County - filing Insolvent PA
Inheritance Tax Return
15.00
TOTAL (Also enter on line 9, Recapitulation)
s
498.59
(If more space is needed, insert additional sheets of same size.)
REV-1512':~1-931
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or Type
I FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Catherine E. Rotz
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Shippensburg Health Care Center
16.50
2.
Orthopaedic Associates
49.14
3.
Chambersburg Imaging Associates
12.51
4.
Barry L. Negley, Tax Collector
5.00
5.
West Shore Advanced Life Support
600.37
6.
Chambersburg Hospital
18.85
7.
Patricia A. Watson - reimbursement for funds paid to Outlook
Pointe on behalf of decedent
1,300.00
TOTAL (Also enter on line 10, Recapitulation)
$ 2,002.37
(If more space ;s needed, insert additional sheets of same size.)
REV-1513 EX + (2-87)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF P~NNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Catherine E. Rotz
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
NUMBER SHARE OF ESTATE
A. Taxable Bequests:
1. Not relevant as estate is insolvent.
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $
(If more space is needed, insert additional sheets of same size)
m1M&rBank
MAR 2 6 2006
499 Mitchell Road, MiIIsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
March 24, 2006
Weigle & Associates, PC
Attorneys At Law
126 East King Street
Shippensburg, Pennsylvania 17257-1397
Re: Estate of: Catherine E Rotz
Social Security: 179-10-3891
Date of Death: March 7. 2006
Dear Sir or Madam:
Per your inquiry dated March 21, 2006, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
Account Number
97480045
Ownership (Names of)
Catherine E Rotz *
Robert L Rotz, Patriciia A Watson, PDA 's *
Opening Date
01/28/80
Balance on Date of Death
$1,674.79
Accrued Interest
$ 0.00
Total
$1,674.79
Please be advised, there was no safe deposit box found for the above decedent.
* For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call
the King Street Office # 717-532-4132.
Sincerely,
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Nancy Clagett
Records Management
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LAST WILL AND TESTAMENT
I, CATHERINE E. ROTZ, of 201 East Burd Street, Apartment 310, Shippensburg,
Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and making void all wills by
me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I direct my hereinafter named Executor to sell all of my estate, real personal
and mixed, whatsoever and wheresoever situate, at either public or private sale as soon as may be
convenient after my death, and to distribute the net proceeds therefrom to my children as follows:
A. One share to my granddaughter, SANDRA GOSSERT, who is the only child
of my deceased daughter, Doris J. Fogelsanger, on a per stirpes distribution
basis.
B. One share to my son, HARPER W. ROTZ, JR., on a per stirpes distribution
basis.
C. One share to my son, ROBERT L. ROTZ, on a per stirpes distribution basis.
D. One share to my daughter, PATRICIA A. WATSON, on a per stirpes
distribution basis.
E. One share to my son, RICHARD A. ROTZ, on a per stirpes distribution basis.
It is my further direction that no stepchild of any of my children or grandchildren shall inherit
under this my Last Will and Testament.
THIRD. I nominate, constitute and appoint my son, ROBERT L. ROTZ, to be the
Executor of this my Last Will and Testament; if he be unable to fulfill the duties of Executor, I then
nominate, constitute and appoint my daughter, PATRICIA A. V,r ATSON, to be the Executrix of
this my Last Will and Testament.
FOURTH. I direct that my personal representatives shall not be required to give bond for
the faithful performance of their duties in any jurisdiction.
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MARK, WEIGLE AND PERKINS _ ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
IN WIlNESS WHEREOF, I, Catherine E. Rotz, have hereunto set my hand and seal to this
my Last Will and Testament, written on one page, the first page signed for identification only, this
21
day of 1~.
,1997.
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(SEAL)
This instrument was by the Testatrix, on the date hereof, signed, published and declared by
her to be her Last Will and Testament, in our presence, who at her request and in the presence of each
other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our
names as witnesses.
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MARK. WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
1-
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, Catherine E. Rotz, the person whose name is signed to the 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 that I signed it as my free and voluntary
act for the purposes therein expressed.
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NOt SEAL
Jeny A. WeIgle, NoIaty Public
ShIppenIburg. PA Cumberlllld County
My CommIssIon &pillS July 31, 1998
MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 1725'7-1397
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND : ~
We, /f)(PM., X fur and 0~ Y1. i2 c:'-d
the witnesses whose names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw Catherine E. Rotz, the Testatrix, sign and
execute the instrument as her Last Will; that she signed 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 the
time eighteen (18) or more years of age and of sound mind and under no constraint or undue
influence.
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NOT, IAL SEAl
Jeny A. WeIgle, NotIIy Public
8hippenIburg. PA CumbertInd County
My CommIssIon ExpIII8 July 31, 1998
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MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397