Loading...
HomeMy WebLinkAbout03-29-07 . ~ --I 15056051058 REV-1500 EX (06-05) :==~Re= .. ,., ,C PO BOX 280601 Harrisburg, PA 171~1 eNTER DECEDENT INFORMATtON BELOW ~~~~.~~_~~_~.'?!r___.___.____.__~__._.~ Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth 188-32-5273 08/30/2006 021221193.9 Decedent's Last Name Suffix Decedent's Arst Name Carol MI Coble A (If Applicable) Enter Surviving Spouse'. Infonnatlon Below' ~.~~~'~. Last Name ~ffix. .~.~~s.:-~~'~__m..___.___,_.._, MI. .t_ ~~S!~_~~JS~~tY. ~~~. TH1S ReTtJRN-MUSTBE FILED IN DUPUCATE WlTK tHE REGISTER OF WILLS Fill IN. APPROPRIATE OVALS BELOW ca> 1. Original Return c=> c::> 3. Remainder Return (date of death prior to 12-13-82) c::::> 4a. Future Interest Compromise (date of c::::> 5. Federal Estate Tax Return Required death after 12-12-82) c::::> 7. Decedent Maintained a LMng Trust (Attach Copy of Trust) <:::) 10. Spousal Poverty Credit (date of death c:=> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 14-95) (Attach &:h.-O) CORRESPONDENT - THIS SECTION MUST BE COMPt.ETED. AlL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~~~~,!~~~~~-~~.~~, . 2. Supplemental Return c:=> 4. Limited Estate ca> 6. Decedent Died Testate (Attach Copy of Will) <=> 9.,lItigation..Prcca8ds Received 8. Total Number of Safe Deposit Boxes I (717) 766-9673 .~!nll ~,Q!_~plica~l__________._______.__._.___.____....._____'_________~___., f-- REGISTER OF ~LLS USE ON~5; ..., --...; f'...,) l.O First. fine of address Market Square Building Second tine of address :2~ State ZIP Code , '"", _-':C~l L__.. o.:~E i=.~LED 1'\) _._-~j or Post Office ,r:::- ef; Mechanicsburg 17055 Correspondent's e-mail address: lJndw-penaJtiesofperjuryoJdedlnJhaUhave examiAectthis1'8lum,lnGIudingaa:ompanying~ and sfafemenfs, and to the best of myMowredge end ballet. it is true, correct and complete. Declaration of preparer other than the personal representative is on an information of whic:h preperer has any knowledge. SIGNATURE PERSON RESPONSIBL 0 FILING URN DATE M~ 2-e-o"1 ss 214 S. York St., Mech. 337 15th St., New Cumberland SIGNATURE OF PREPARER OTHER THAN ,REPRESENTATIVE 4807 Brian Road, Mech. DATE ADDRESS Market Square Building, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM O~LY Side 1 L 15056051058 1'5056051058 ---I ~/l/ yo ---l 15056052059 REV-1500 EX Decedenfs Name: RECAPITULATION Carol A Cobl~ ~!t~!~_.~~I.:~~.~!Y..~,~~~!~_..__.,.. ! 188-32-5273 1. Real estate (Schedule A). ............................................ 1. 128,820.00 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . .. . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 20,405.17 ! 6. Jointly Owned Property (Schedule F) c:> Separate Billing Requested . . . . . .. 6. i ---,,~_.,- 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::> Separate Billing Requested. . . . . . .. 7. 567.09 I 8. Total GronAsaets (total Lines 1-7).................................... 8.! 149,792.26 I 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 8,214.88 1,663.81 9,878.69 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9-& 10). ...... . .......................... . 11. ! 12. Net Value of Estate (Line 8 minus Une 11) .. .. .. . . .. . . .. .. .. . .. .. . . . . . . . 12. I 139,913.57 . 13. Charitable and Governmental Bequests/See 9113 Trusts for which ~""'-'---"'---*"-"'-"____'__~__'_'__'~__"_'__"_",J an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. ! ;""""""_"~''''_'-'''_______.-.-.-,._..._".w.~_._.",__.__.__.._.,.~.,,__.._,~..-==-! 14. Net Value Subject to Tax (Line 12 minus Une 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. ! TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .O~ 139,913.57 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Une 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 139,913.57 1 15. 6,296.11 16. ! 17. I 18. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 6,296.11 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C) L 15056052059 Side 2 15056052059 --.J REV!1500 EX Page 3 Decedent's Complete Address: 21 File Number 06 0794 DECEDENT'S NAME DECEDENT'S SOCIAL seCURITY NUf.tiER Carol A Coble 188-32-5273 STREET ADDRESS 214 South York Street CITY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditsJPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 6,296.11 Total Credits ( A + B + C ) (2) 0.00 3. Interest/Penalty if appHcable D. Interest E. Penalty Total InterestlPenalty ( D + E ) (3) 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) 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. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 0.00 0.00 6,296.11 0.00 6,296.11 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;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 1KI c. retain a reversionary interest; or.... ..... ............. .......... ........... .......... ............ .......... .............. ........... ........... ........... 0 [il d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 1iI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .., .... .............. .............................. ....................... .................................... 0 liI 3. Did decedent own an Rin trust for" or payable upon death bank account or seaJrity at his or her death? .............. 0 liI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ., ............. .................... ............. ............. .......... .............. ................ ............ ....... D ~ 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent [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 flUng 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 zero (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 four and one-half (4.5) percent, 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 twelve (12) percent (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. 1& TA*E$A'RE.lnE:SPROw.FQRW~J.)...Tt-iI~~II.;J....''[Q M~aWGAGe'CO;$1;OQFESFOR~~HA[)DITIQNALat;9611?r TAXPA:'t1ER 2006.......~nt;o.f'a......ESbIt8.T-.. Im~tPv~~~: M.netal. 9.i40~ o' PAYABLE .TO: .DIICoUrit 2i%' 2.3.2~. '. )2"," 19\93 OQC: TAX ~AvEtt OfFJQe IQJAS: BlltNO: BillOate: Total 113.' ,000 Fa 248.26 5 310M2 ..... ~ 273 ~ 22 20.34 J 277 REV-1502 ~+ (6-9W COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ES-TATE Of FILE NUMBER Carol Ann Coble 21-06-07~4 All- real property' 0WMct..., or... t8II8IIt'in''CCJIIIIIIaft __ be .......... fair........... fair marbt wIue is defined 81 the price at which ProPertY'wouId be exchanged between a wifing buyer and a wiling seller, neither being compelled to buy or sell, both having reasonable knowledge d the relevant facts. Real property which i. jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM HUMBER 1. SCHI,DULI A REAL ESTATE DESCRIPTION South York Street, Mechanicsburg, Pennsylvania The current oommOJ I ievef ratio factor Cumberland County is 1.14. The property is currently assessed at $113,000.00 (land at $20,000.00 and improvements at $93,000.00). $113,000.00 multiplied at 1.14 gives this VALUE AT DATE OF {)EATH 128,820.00 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) 128,820.00 1 , Page 1 of 1 IXIS I ADVISOR FUNDS P.O. Box 219579, Kansas City, MO 64121-9579 CONFIRMATION STATEMENT September 21, 2006 0000 112 - 0000 112 1...111...111....1.1.11.....11.11......11.1..111...1...1..1.11 AMY E PUCHAlSKY BRETT P COBLE HOllY A CAMPBEll EXECUTORS ESTATE OF CAROL A COBLE 4807 BRIAN RD MECHANICSBURG PA 17050-3014 _ - -_-N.ews-F-.rom3XIS Advisor. F unds_u_ un Life is complicated. Investing doesn't have to be. IXIS Diversified Portfolio funds seek to simplify diversification by combining different types of investments in a single mutual fund. Please see the enclosed insert for further information on IXIS Diversified Portfolio funds. Loomis Ltd Term Govt and Agcy-A (1460) AMY E PUCHAlSKY BRETT P COBLE HOllY A CAMPBEll EXECUTORS ESTATE OF CAROL A COBLE Account~umber 4000014426 Tr.Hle l)oll.u Slut e ~,Ilcs Shares This Total D.He fr.lIls:lclion Amoufl( Pllce CILuge 'ltans:lclion Shares 09/20/06 09/21/06 Redemption Income Div Cash $20,059.68 $46. 1 2 $10.97 $0.00 N/A N/A 1,828.594 0.000 0.000 0.000 J ;(~ /tJ6.80 ) ,\C\" dliL In' ,':-,!!lW1 H 1 H.\ l'und I\.umbu A1l1(1U1H 'LtX\t'J.f AmountofChe~l... . ................ I $100 minimum inveStJbel1lperfund Nodlirdparty cbecks 0000000000 000 040000144269 0000182 0001460 2 REV-1508 a. (8-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Carol Ann Coble FILE NUMBER 21-06-0794 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of lurvlvorshtp mull be dllclosed on Schedule F. Blue Cross & Blue Shield, Refund DESCRIPTION IXIS Asset Management Distribution Account # 4000014426, see attached TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 20,405.17 Send Inquires to: 5000 Louise Drive ' PO Box 40 Mechanlcsburg, PA 17055 www.members1st.org Statement of Accounts Aug 25, 2006 thru Sep 24, 2006 MEMBERS 1st FEDERAL CREDIT UNION 17888 1 AV 0.293 35775-17888 \0 * !I!!!!!!!!!!! 1...111...111....1.1..1.1..11....11.11....1..1...11.1..1.1..1,1 ~~\'t- X ....~ CAROL A COBLE N c/o BRETT COBLE ~ 214 5 YORK 5T (\ c.:... n (\ ~ MECHANICSBURG PA 17055-6304 \ ~~/ Page: Give us your email address and you could win a $100 VISA Gift Cardl See the e'nclosed insert for more details. Main Switchboard: (717) 697-1161 or (800) 263-2326 EZ Call: (717) 697-4372 or (600) 263-4372 TOO: (717) 697-5312 or (600) 263-2326 eX!. 5312 TeleBranch: (717) 795-6049 or (600) 237-7266 Account Number: 154921 Account Balances at a Glance: Checking: 346 . 21 Savings: 40 . 67 Certificates: 0 . 00 Loans: 0.00 Money Management: 0 . 00 1 of 2 CHECKING" ACCOUNTS 11 -CHECKING Date AU(l25 - '. " , 'Aug31 : 26.54- Balance 1,660' .63 1,634.09 Aug: 3t"::,: A~~~1 :.: Sep0:1': . SepOt Sep 12 1.596~21 -';_,~I.3S6 ~1 1,302.37 1,024.42 692.42 40.67 - - - Continued on following page - - - ~~~ I ~~~715 ~E: ~2::;CF]#~,=;f~~ ' MEMBERS 1st FEDERAL CREDIT UNION - = . . .- ii - !!II - - Ma'n Swltohboard: (117) 687-1161 or (800) 283-2328 CaII-24: . (111) 697-4372 or (800) 283-4372 1'00: (717) 697-5312 or (800) 283-2328 ext. 5312 TeI.Branch: (717) ~604a or (800) 237-7288 DON'T LET LONG-TERM CARE BECOME A LONG-TERK FINANCIAL HEADACHE. SEETHE ENCLOSED INSERT FOR MORE INFORMATION. 111.111...11111111.1111.1..11111.11.11....1111...11.1111.11111 CAROL A COBLE 214 S YORK ST - PA 17055-6304 KECHANICSBURG 9063 ::A_Hf~:j::;;:~:j:j \:~.:.:.~Qgi::!.i:[ ---- 1tO.67 195.67 40.67 508.67 40.67 ~-- ~\:..'f\;; {:i:j.ti:j~ {~:[:j:j:~~ti[!j:~::i~::.::(:::::]:::\::~::::tm:~U:I~:~~:::::1::::::::::1:1.::\_~~::pi$ee'mQN::n:':}:":,:?:}:.:.:.:::::::::.':.:::.:'::i:;{.::::::.:.?='~:;:.F':)::~.:: '... 0709 0109 0713 0714 0715 0715 0716 0716 0720 0721 0721 0707 ---::J(J-1:;,. 0707 0701 0722 0722 0723 -; -..--...... ......... SUFFIXaOO SAVINGS PAYROLL DEDUCTION US TREASURY 303 - PAYROLL DEDUCTION US TREASURY 303 - PAYROLL DEDUCTION US TREASURY 303 - PAYROLL DEDUCT ION . US TREASURY 303 - SOC SEC - SOC SEe - SOC SEC - SOC SEC .00 TRUTH .I N_pSAVINGS I NFORKAT.I ON ANNUAL PERCENTAGE YIELD /. 1.00% 155.0.0 -155.00' 468.00 -468.00 ~-----~--~----------------~-----------------~-------~-~ -----~------- SUFFIX:ll CHECKING BEGJNNING BALANCE DEPO'S ITS DRAFTS DEBITS/FEES KAINT/SERVICE CHGS ENDING BALANCE 1689.82 1553.45 1595.02 300.00 .00 1348.25 TOTAL NUMBER DRAFT CLEARED YOUR AVG DAILY BAL CE WAS YOUR LOW MONTH BAl CE WAS SHARE DEPOfHSI SHARE DRAFT 2218 0706010816 MitE -DRAF' -.'. 221- -~ ~"""",-~'"",-- .~=-~ '07ut)v 1:llS.z11 - SHARE DRAFT 2222 0706009562 SHARE DRAfT .2220.. . 0706001692 ACH TRANSACTION REG-E TRANSACTION CREDIT CARD - 2223 - PAYMENT SHARE DRAFT I 2224 0708001~~O SHARE DRAFT I 2225 0708012879 TAKE DEPOSIT SHARE DRAFT' 2186 071206163~ SHARE DRAFT' 2226 0113008830 EASY DEPOSIT SHARE DRAFT i 2228 0714000913 SHARE DRAFT 2219 0714016906 SHARE DRAFT 2229 0715080269 SHARE DRAFT 2227 0715007272 SHARE DEPOSlj SHARE DRAFT 2230 0719012018 SHARE DRAFT 2233 072000997~ SHARE DRAFT 2231 0720009972 PAYROLL ALLOCATION FROM 154921-00 US TREASURY j03 - - SOC SEC SHARE DRAFT 2234 0721004421 SHARE DRAFT 2232 0721009282 SHARE DRAFT 2198 0722019047 50.00 - 11 ! 88 --- :'17 -130.00 -205.84 -300.00 -25.67 -143.91 192.45 -15.00 -36.00 388.00 -7.35 -111 .50 -25.00 -140.37 100.00 -130.88 -30.00 -68.55 155.00 -54. 10 -162.07 -25.00 .21 1195.92 861 .54 1739.82 1 9. 15~9 .57 1343.73 101t3.73 1018.'06 874.15 1066.60 1051.60 1015.60 1403.60 1396.25 1284.7~ 1259.75 1119. 38 1219.38 1&88..50-.. . 1 58.50 989.95 1144 . 95 1090.85 928.78 903.78 REV.1509 ~+ (....* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED. PROPERTY ESTATE OF Carol Ann Coble FilE NUMBER 21-06-0794 If an asset was made joint within one yea, of the decedenr. date of de8th, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATI,QNSHIP TO DECEDENT A. Amy E. Puchalsky a'Brett P. Coble c. JOINTLY-OWNED PROPERTY: 4807 Brian Road, Mechanicsburg, PA 17050 214 South York Street, Mechanicsburg, PA 17055 DESCRIPTION OF PROPERlY INCWOE NAME OF ~ INSnnTTION MD ~K ACCOUNT NUMBER OR SNllAR IDENTFYING NlMER. ATTACH DEED FOR JOIN1lY-HElD REAL ES~1E. DATE OF DEAllf w.ue OF ASSET TOTAL (Also enter on line 6. Recapitulation) (If more space is needed, insert additional sheets of the same size) 567.09 1lEV-1511 ex, (12-99. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Carol Ann Coble FILE NUMBER 21-06-0794 Debts of decedent must be reported on Schedule L ITEM NUMBER A. DESCRIPTION Church and Luncheon B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)JEIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation) Claimant Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal, estate notice 8. 9. First Federal Credit Union, Checks 10. Register of Wills - Filing Fee 11. Register of Wills - Filing Inventory 12. 'Register of Wills - Filing Account AMOUNT ; Zip TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size.) R&V-1512 EX~(12.Q3) * COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & UENS ESTATE OF Carol Ann Coble FILE NUMBER 21-06-0794 Report debtllncurred by the decedent prior to death which remained unpaid IS of the date of death. Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESC~PnON OF DEATH 1. Verizon, Telephone 2. 4. New Cumberland Alliance 9. Shipley Oil 1 O. Capital City Oil Holy Spirit Hospital, medical bill TOTAL (Also enter on line 10, Recapitulation) (If more space Is needed, Insert additional sheets of the same size) 1,663.81 ., ilEV.'513 Ei('. (9-00) .. COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE" BENEfiCIARIES ESTATE OF Carol Ann Coble FILE NUMBER 21-06-0794 RElATJONSHJP TO DECEDENT AMOUNT OR SHARE 00 Not UIt TlUlt8e(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S)RECENlNG PROPERlY I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec.9116J~)(1~1__ 1. Brett P. Coble 214 South York Street, Mechanicsburg, PA 17055 2. 33715th Street, NewCumber1and, PA 17070 3. 4807 Brian Road, Mechanicsburg, PA 17050 ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON UNES 15 THROUGH 18, AS APPROPRIA~ ON REV.1500 COVER SHEET n NON-TAXABLE DISTRIBUTIONS: A. SPOUSAl DISTRIBUTIONS UNDER SECnON 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)