HomeMy WebLinkAbout08-06-07
--.J
15056041147
REV-1500 EX (06-0S)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
'.
County Code Year
INHERITANCE TAX RETURN 21 07
RESIDENT DECEDENT
-0059
169385658
09242006
Decedent's Last Name
Suffix
COOK
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's Social Security Number
File Number
Date of Birth
05211920
Decedent's First Name
ELETHA
Spouse's First Name
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return 0 2. Supplemental Return
0 4. Limited Estate 0 4a. Future Interest Compromise
(date of death after 12-12-82)
0 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (dale of death
between 12-31-91 and 1-1-95)
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
MI
P
MI
o
o
8. Total Number of Safe Deposit Boxes
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRADLEY L. GRIFFIE 7172435551
Firm Name (If Applicable)
GRIFFIE & ASSOCIATES
First line of address
200
STREET
NORTH
HANOVER
Second line of address
City or Post Office
CARLISLE
State
PA
o
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
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REGISTER oF~~LS USE ~L Y
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DATE'-FILED
ZIP Code
17013
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orrespon . en s e-mal a ress:
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 information of which preparer has any knowledge.
:li;:{;ONC:;O~ "'"" Beverly C. Wagner ;r;'d D 7
213 Brick Church Road, Newville, PA 17241
Bradley L. Griffie
Side 1
L
15056041147
DATE
2)7
15056041147
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J
/~-<- If? ~GeOrgeRCOOk r?..2...o~ate
,/' 2748 ~. ner Highway
Carlisle, P A 17013 /'?./
)(&...~ ~ DavidO.Cook ,-3/-47 Date
2113 oDden Bridge Road
Three Springs, PAl 7264
~
15056042148
REV-1500 EX
Decedent's Name:
COOK, ELETHA P
RECAPITULATION
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D)..........................................................
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................
6. Jointly Owned Property (Schedule F) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested............. 7.
8. Total Gross Assets (total Lines 1-7).......................................................................
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)...................................................................... 11.
12. Net Value of Estate:(Line 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X .00
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .1.5
15.
16.
17.
18.
19. Tax Due.....................................................................................................................
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
Decedent's Social Security Number
169385658
4.
5,437 00
5.
9,454 00
8.
14,891.00
10,564 86
17,16802
27,732.88
-12,841.88
-12,841.88
o . 0 0
D
15056042148
~
REV-15DD EX Page 3
Decedent's Complete Address:
File Number 21 - 07 - -0059
DECEDENT'S NAME
Cook, Eletha P
STREET ADDRESS
Green Ridge Village
CITY I STATE IZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 0.00
(5A)
(5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
D [!]
D [!]
D [!]
D [!]
D [!]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... D [!]
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.
1. Did decedent make a transfer and:
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; or............... ........................................................ ............ ....... .... ........... .........
d. receive the promise for life of either payments, benefits or care?.............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................. ....
Yes
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. 99116 (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. 99116 (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 zero (0) percent [72 P.S. 99116 (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 72P.S.99116 1.2)[72 P.S. 99116(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. 99116 (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.
SCHEDULE D
MORTGAGES & NOTES RECEIVABLE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Cook, Eletha P
FILE NUMBER
21 - 07 --0059
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Note balance due and payable from Tammy Cook 2,617.00
2 Note balance due and payable from Richard Cook 2,800.00
3 Note payment 20.00
TOTAL (Also enter on Line 4, Recapitulation) 5,437.00
~
~~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Cook, Eletha P
FILE NUMBER
21 - 07 --0059
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.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 First National Bank of Greencastle 7,502.80
Account No. 52 03819
2 Knobsville Burial Association 303.00
3 Northern Fulton Burial Association 975.00
4 Needmore Burial Association 550.00
5 Presbyterian Homes (Refund of overpayment) 40.00
6 Cash in purse/on hand 83.20
TOTAL (Also enter on Line 5, Recapitulation) 9,454.00
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Cook, Eletha P
FILE NUMBER
21 - 07 - -0059
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES:
A. M.R. Brown Funeral Home
AMOUNT
DESCRIPTION
2 Everett Marble & Granite Work, Inc.
(Engraving)
B. ADMINISTRATIVE COSTS:
1.
Personal Representative's Commissions
Beverly C. Wagner
ocial Security Number(s) I EIN Number of Personal Representative(s):
Street Address
213 Brick Church Road
State P A
Zip 17241
City
Newville
2.
Year(s) Commission paid 2007
Attorney's Fees .Griffie & Associates -- Bradley L. Griffie
3. Family-Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
Zip
State
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
Estate advertisement to Cumberland Law Journal
7,840.00
106.00
745.00
1,500.00
117.00
75.00
TOTAL (Also enter on line 9, Recapitulation)
10,564.86
Schedule H
Funeral Expenses &
Adminisbative Cos1s continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
2
Estate advertisement to The Sentinel
1 81 .86
ESTATE OF Cook, Eletha P
Page 2 of Schedule H
SCHEDULE H CONTINUED
B. Administrative costs:
1. Personal Representative's Commissions
George R. Cook
2748 Ritner Highway
Carlisle, P A 17013
SSN:
David O. Cook
2113 Wooden Bridge Road
Three Springs, P A 17264
SSN:
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Cook, Eletha P
FILE NUMBER
21 - 07 - -0059
Include unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER AMOUNT
1 Green Ridge Village 1,185.37
(Nursing Home Care)
2 Graham Medical Clinic 21.80
(Medical Services)
3 Continuing Care (Medication) 206.20
4 Griffie & Associates 564.50
(Legal fees-pre-death)
5 Department of Public Welfare 15,190.15
(Medicaid Claim)
TOTAL (Also enter on Line 10, Recapitulation) 17,168.02
REV-1513 EX+ (9-00)
'.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
I
I NAME AND ADDRESS OF PERSON(S)
I RECEIVING PROPERTY
ITAXABLE DISTRIBUTIONS [include outright spousal
, aistributions, and transfers
under Sec. 9116 (a) (1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
I FILE NUMBER
21 - 07 --0059
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
Cook, Eletha P
I.
1
Beverly C. Wagner
213 Brick Church Road
Newville, PA 17241
Daughter
one-third
I
2 I George R. Cook
12748 Ritner Highway
I Carlisle, PA 17013
I
I
3 I David O. Cook
12113 Wooden Bridge Road
Three Springs, PA 17264
!
son
one-third
son
one-third
I
I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
I
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 SHEETI
0.00
NAME OF DECEASED
SOCIAL SECURITY
NUMBER
DATE OF DEATH:
NAME OF FINANCIAL
INSTITUTION:
DATE PREPARED
PREPARED BY
ACCOUNT NUMBER:
ACCOUNT T'{l->E:
NAMES ON ACCOUNT
DATE OF JOINT
OWNERSHIP
DATE FIRST ,:)PENED OR
ISSUED
DATE OF LAST
ROLLOVER iF ANY
DATE ClOSE-D OR
MATURED
DATE OF DEATH
PRINCIPAL:
DATE OF DEP\TH
ACCRUED It,TEREST:
(DOD INT ON CHECKING
ACCOUNtS WilL NOT BE
POSTED TO ,"CCT IF
ACCT IS CLOSED
BEFORE STMT CYCLE
DATE:)
DATE OF DEATH TOTAL
PRINCIPAL 8. ACCRUED
INTEREST:
TOTAL INTEi{EST PAID
BEFORE DEATH FOR
CURRENt YEAR
National Bank
Eletha P Cook
169-38-5658
9/24/2006
First National Bank of
Greencastle - Main
3/26/2007
Michelle Miller
5203819
Checkin~
Eletha P Cook
n/a
6/1/1974
n/a
n/a
$7,502.72
$0.08
$7,502.80
$14.56
000-0481783
C/D
Eletha P Cook
n/a
6/26/1994
n/a
n/a
$0.00
$0.00
$000
$251.73
Account was closed on
2/8/06
$12,065.63 Prine Bal
$61.82 Int Paid
Total Paid Out-
$12,127.45
\^"^"M fnhnr..cOm
P.O. Box 8
Greencastle, PA 17225
Phone: (717) 597-2137
FAX: (717) 597-5033
000-0267077
CID
Eletha P Cook
n/a
4/1/1998
n/a
n/a
$000
$000
$000
$1563
Account was closed on
2/28/06
$8,000.00 Prine Bal
$3.53 Int Paid
Total Paid Out-
$8,003.53
Equal Housing Lender
PO. Box 8
Greencastle, PA 17225
National Bank
Phone: (717) 597-2137
FAX: (717) 597-5033
NAME OF DE.CEASED
SOCIAL SECURITY
NUMBER:
DATE OF DEATH
Eletha P Cook
169-38-5658
9/24/2006
NAME OF FINANCIAL
INSTITUTION
First National Bank of
Greencastle - Main
Office
DATE PREPARED:
PREPARED BY:
3/26/2007
Michelle Miller
ACCOUNT NUMBER:
000-0308294
ACCOUNT TYPE:
c/o
NAMES ON ACCOUNT:
Eletha P Cook
DATE OF JOIl'JT
OWNERSHIP
n/a
DATE FIRST OPENED OR
ISSUED:
11/30/1999
DATE OF LAST
ROLLOVER IF ANY
n/a
DATE CLOSED OR
MATURED:
n/a
DATE OF DEATH
PRINCIPAL:
$0.00
DATE OF DEATH
ACCRUED INTEREST:
(000 INT ON:;HECKING
ACCOUNTS WILL NOT BE
POSTED ;Oi~CCT l!=
$0.00
ACCT IS CLOSED
BEFORE STIVI'T CYCLE
DATE)
DATE OF DEATH TOTAL
PRINCIPAL &. ACCRUED
INTEREST:
$0.00
TOTAL INTEREST PAID
BEFORE DEATH FOR
CURRENT YEAR:
$62.63
Account was closed on
2/28/06
$10,000.00 Princ Bal
$.00 Int Paid
Total Paid Out-
$10,000.00
'AI\AI\AI fnhnr- r>flm
Equal Housing Lender
(j1U:f:fI'E & AsSOCI5\'T''ES
Attorneys and Counselors at Lcnv
Bradley L. Griffie, Esquire
Hannah Herman-Snyder, Esquire
200 North Hanover Street
Carlisle,PA 17013
(717) 243-5551
Robin J. Bassett
Office Manager
100 Lincoln Way East, Suite D
ChambersbUl'g, P A 17201
(717) 267-1350
Reply to: Carlisle
(800) 347-5552
Fax (717) 243-5063
May 17,2007
RE: Estate of Eletha P. Cook
Estate No. 21-07-0059
To Whom it may concer:
The three Certificates of Deposit referenced as being closed on February 8, 2006 were
liquidated with the proceeds disbursed to the Green Ridge Village/Swaim Health Center
Nursing Facility where the decedent was residing to pay for nursing home care.
Very Truly Yours,
Bradley L. Griffie
BLG/tbb