HomeMy WebLinkAbout08-07-07
..:.J
REV -1500 EX (06-05)
PA Department of Revenue
Bureau of IndiVldua' Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
15056041158
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
21 07
File Number
0132
ENTER DECEDENT INFORMATION BELOW
Social Security Number
Date of Death
Date of Birth
195-07-8885
02032007
10281900
cox
GERTRUDE
MI
E
Decedent's Last Name
Suffix
Decedent's First Name
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
Original Return
D 2. Supplemental Return D 3. Remainder Return (date of death
prior to 12-13-82)
04a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required
death after 12-12-82)
!""I I. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
L: (Attach Copy of Trust)
[]]
D
[]]
o
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
JOHN J. SHORB~ ESQUIRE
717-846-9800
Firm Name (If Applicable)
c:'
1'-'. "'I
REGISTER OF WIl.l!:S::USE ONL Y--.,
STOCK AND LEADER
(j
I 1
. ,;
First line of address
SUSQUEHANNA COMMERCE CENTER EAST
.,.~-'....
I
_J
--~
Second line of address
221 W PHILADELPHIA ST~ STE 600
: '.}
City or Post Office
State
ZIP Code
DATE FILED
rq
~'- .
YORK
PA
17401--2994
Correspondent's e-mail address:
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.
SIGNATURE OF PFON ,,~~ TURN DATE
ADDRESS
C/O SUSQ COMM CTR E~ 2 1 W PH
SIGNATURE OF PREPARER OTHER THAN REPRE EN A I VE
STOCK AND LEADER~ BY:
ADDRt:.SS
SUSQ COMM
YORK~ PA
'-
RHILA ST~ STE bOO~
PLEASE USE ORIGINAL FORM ONLY
YORK~ PA
17401-2994
Side 1
L
15056041158
6M46473.000
15056041158
--.J
c:\{V\
---I
15056042159
REV-1500 EX
Decedent's Social Security Number
195- 07-88 85"
Deceaent's Name( 0 X
GERTRUDE
E
RECAPITULATION
1. Real estate (Schedule A)
. 1.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .
:3.
0.00
0.00
0.00
2. Stocks and Bonds (Schedule B) .
2.
4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . .
. 4.
0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .
. 5.
6, Jointly Owned Property (Schedule F) 0 Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested
6.
102334.80
0.00
7.
9. "'uneral Expenses & Administrative Costs (Schedule H).
9.
159000.00
261334.80
13803.49
8. Total Gross Assets (total Lines 1-7).
8,
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I).
10.
1626.13
11. Total Deductions (total Lines 9 & 10). . .
11.
15429.62
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) .
12.
245905.18
13.
0.00
14. Net Value Subject to Tax (Line 12 minus Line 13)
14.
245905.18
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers uJ:ler Sec. 9116
(a)(1.2)X.0_ O. DO
16. Amount of Line 14 Jaxable
at lineal rate X .o~ D . 00
17, Amount of Line 14 taxable
at sibling rate X .12 0 . DO
18. Amount of Line 14 taxable
atcollateralrateX.15 245905.17
15.
D.DD
16.
0.00
O.DD
17,
18.
36885.78
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19.
36885.78
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
[K]
Side 2
L
15056042159
6M4648 2.000
15056042159
--.J
Fi:V-1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
!COX
STREET ADDRESS
116 NOVEMBER DRIVE, APT 1
File Number
0132
GERTRUDE
E
!CUMBERLAND COUNTY
I CITY
iCAMP HILL
i STATE
IPA
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
ZIP
17011-
36885.78
0.00
34770.00
1830.00
Total Credits (A + B + C) (2)
36600.00
3 Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
TotallnterestlPenatty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund.
0.00
(4)
0.00
5 If Line 1 .,. Line 3 is greater than Line 2, enter the difference This is the TAX DUE.
(5)
0.00
A. Enter the interest on the tax due.
(5A)
285.78
B Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(56)
Make Check Payable to: REGISTER OF WILLS, AGENT
285.78
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
o
o
o
o
[X]
o
o
No
lXJ
lXJ
lXJ
lXJ
o
lXJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
[Xl
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. 89116 (a) (1.1) (i)].
FDr dates Df death Dn Dr after January 1, 1995, the tax rate impDsed Dn the net value Df transfers tD Dr fDr the use of the survivin9 spouse is zero (0) percent
[72 P.S. 89116 (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 use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 89116(a)(1.2)].
The tax rate impDsed 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 PS. 89116(1.2) [72 P.S. 89116(a)(1)J.
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.
6M4671 1.000
~!:V-1506 EX + (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gert.rude E. Cox
In~lude 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.
ITt=:M
NUMBER
DESCRIPTION
1
Household Furnishings
(per appraisal)
2
20,000 Par
Sovereign Bank, Certificate of Deposit No. 2335252959
Interest accrued to 2/3/2007
3
64,000 Par
PNC Bank, Certificate of
Deposit No. 31100301215
4
PNC Bank, Checking Account No.
50-7009-1456
5
Cash on Hand
6
Refund from Comcast
7
Refund from Verizon
8
,Annuity Payment Checks from
I Berkshire Life Insurance of America
9
Refund Commonwealth of Pennsylvania, 2006 Income Tax
10
Refund from 2006 Federal Income Tax Return
3W46AD 1.000
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
FILE NUMBER
21 07 0132
VALUE AT DATE
OF DEATH
2,595.00
20,000.00
7.04
65,606.12
11,832.14
1,179.00
6.11
9.97
208.72
20.70
870.00
102,334.80
-~
R!,V-151O EX. 16-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIP,
INH:oRITANCE TAX RETURN
R:oSIDENT D:oCEDENT
ESTATE OF
Gertrude E. Cox
FILE NUMBER
21 07 0132
This scnedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY I I I
ITEM J 1~.cLLU.:: n-E ~E OF TI-E TRANSFEREE, THEIR REL..ATJONSHlP T:::" DECEDEf\IT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBE TI-E DATE Or TRMSFER ,ATf ACH A COPY OF TI1:;: DEED FOR REAl EST ATE VALU'" OF ASSET INTEREST ! (iF APPLlCABLF; VALUE
1. ! I
I Transfer to Robert F. Cox I I
on 1/1/06 80/000.00 100.0000 3/000.00 77/000.00
2 Transfer to Dolores Sullivan on
1/1/06 85/000.00 100.0000 3/000.00 82/000.00
I
I I
I I
I
I
.
TOT AL (Also enter on line 7, Recapitulation) $
159/000.00
(If more space is needed, insert additional sheets of the same size)
W46Ar 1.000
REV-1511 EX + (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEAL TH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gertrude E. Cox
Debts of decedent must be reported on Schedule I.
ITEM I
NUMBER I
DESCRIPTION
A
i FUNeRAL EXPENSeS
I Robert F. Cox
i Reimbursement for funeral lunch
I
I
I
ITotal from continuation schedules
I
I
I
1.
B.
ADMINISTRATIVE COSTS
Personal Representative's Commissions
1.
Name of Personal Representative(s) Robert F. Cox
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 3751 Long Point Drive
City York
State PA
Zip 17402
Year(s) Commission Paid: 2007
2.
Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Stock and Leader
File Inventory
File PA Inh. Tax Return
Add. Fee for Letters
File Release
Telefax Charges
$15.00
15.00
75.00
9.00
1. 00
Total from continuation schedules
3W46AG 1.000
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
FILE NUMBER
21 07 0132
t
I
I
i$
AMOUNT
283.78
110.00
5,117.00
6,525.75
1,766.96
13,803.49
Estate of: Gertrude E. Cox
195-07-8885
Schedule H Part 1 (Page 2)
Item
No.
Description
Amount
2
Romberger Memorials
Letter monument
110.00
Total (Carry forward to main schedule)
110.00
Estate of: Gertrude E. Cox 195-07-8885
Schedule H Part 7 (Page 2)
1 Cert. Mail Costs 50.00
Photocopy Expense 35.00 200.00
2 Camp Hill Apartments
March Rent 852.00
3 Stock and Leader
The Sentinel, ad $151. 55
Photocopy Expense 5.55 157.10
4 Costea's Auction Service
appraisal fee 250.00
5 Stock and Leader
Probate Will $181.00
Cumberland Co.
Law Journal 75.00
Short Certs. 16.00
Telefax Charge .50
Photocopy Expense 1. 80 274.30
6 PPL
electric service 33.56
Total (Carry forward to main schedule) 1,766.96
R.cV-1512 EX + (12-03)
COMMONWECAlTH OF PENNSYLVANIA
INc-ERITANCE TAX RETURN
RECSIDENT DECEDENT
ESTAE OF
Ge,..trude E. Cox
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 07 0132
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER!
DESCRIPTION
VALUE AT DATE
OF DEATH
Return of Partial Social Security Payment
827.00
2
Camp Hill Apartments
Outstanding balance for utilities
Less Security
Deposit -100.00
$641.24
541.24
3
Heartland Pharmacy of PA, LLC
drug bill
8.07
4
PA Department of Revenue
2006 PA40 Tax
76.00
5 PPL
electric service
16.03
6 Verizon
telephone service
157.79
3W46AH 2000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,626.13
REV-1513 EX+ (9-00)
COMMONW=ALTH 0;:: PENNSYLVM""I,
INHERITANC= TAX RETURN
R=SIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
2.
NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY
i TAXABLE D I STRI BUTI 0 N S [include outright spousal distributions, and transfers I
II under Sec. 9116 (a) (1 ,2}j I
Robert F. Cox
13751 Long Point Drive I
I York, PA 17402
I
I
I Transfer to Robert F. Cox
Ion 1/1/06
Inventory Value: 77,000.00
FILE NUMBER
21 07 0132
RELATIONSHIP TO DECEDENT I AMOUNT OR SHARE
Do Not List Trustee(s) Or: ESTATE
ESTATE OF
Gertrude E. Cox
NUMBeR
I
One Third of Residue: 28,968.39
Nephew
105,968.39
I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II I NON-TAXABLE DISTRIBUTIONS:
I A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
I
I
I
I
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W45AI 1.00G
TOTAL OF PART II - 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
Estate of: Gertrude E. Cox
195-07-8885
Schedule J Part 1 (Page 2)
Item
No. Description
Relation
Amount
2 Dolores Sullivan
2439 N. Second Street
Harrisburg, PA 17110
Transfer to Dolores Sullivan on
1(1(06
Inventory Value: 82,000.00
One Third of Residue: 281968.39
Niece
110,968.39
3
Eleanor Cox
3015 Brookwood
Harrisburg, PA
Street
17111
One Third of Residue: 28,968.39
Sister-in-law
28,968.39
LAST WILL AND TESTAMENT
DE n REfvlEMBERED THAT
1. LiEl\TT\UDE E. COX. a resident of Cumberland County, Pennsylvania, heing or
sound and disposing mind, memory and understanding, do make. publish and declare this
I(! Ill' Il1V LAST WTLL and TESTAIvIENT, hereby revoklng any and all Wills and Codicils
!1(eviollsl \' made by me.
I direct that all my just debts and funeral expenses shall he paid hom my residuary
estate as soon as practicable aller my decease.
II
1 direct that all taxes that may be assessed in consequence of my death, of whatever
nature and bv \vhacever jurisdiction imposed, shall be paid from my residuary estate as a part
of the expense or the administration of my estate.
III
I give, devise and bequeath all of my property, whether real or personal, wherever
situate, including any property over which I may have a power of appointment to my niece
DOLORES SULLlVAN, my sister-in-law ELEANOR COX, and my nephew ROBERT F.
COX, in equal shares, per stirpes.
IV
I nominate, constitute and appoint my nephew ROBERT F. COX as Executor of this
LAST WILL, to serve without bond.
IN WITNESS 'WHEREOF, I, GERTRUDE E. COX, have set my hand to this LAST
WTLL this~l (, day of
,2002.
A,I} A _,,~ ...."'ri::":1Z-..- cg (!!./-t ~-V)
GERTRUDE E. COX
Signed, scaled, published ami declared hy the above-named (,ERTRUDE E, COX, as
:l1Icl 1m he'! Last \Vill and Testament, in the presence 01 us, who, at hel requesl and in her
presence, and In lhe preselll~e oleach (l[hel', have heceunto subsuibeci Ol/lllaJlJE.': as wilnesses,
c
'i-,ll k> ) Yi~:.,7*"Jilib/~.. __~
2
ACKNOWLEDGEMENT
CC)[vllvIONWEALTH 01 PENNSYLVANIA
ss
CClUf\T\' OF CUMBERLAND
1, CiERTRUDE E. COX, Testauix, whose name is signed to the attached or
Instrumcnt, h~lving been duly qualified accorcling to law, do herehy acknowledge
tlial I ami execlIted the instrument as 111'1 LAST \VILL; tbatl signed it as mv free and
vcdulllary act lor the purposes therein expressed.
J .1--- / c.' d' ~
~~-::~-'-_..::,c,~~_~~__,_______
GERTlZUDE E. COX
{.e
Sworn or afIirmed wand acknowledged before me this";;';' '-ddY
of , 2002.
i[~L'
Notary Public
-'/~I-/"
I ,/ L./../
_" 1(::
j
AFFIDAVIT
COIvflVlOGT\VEALTH OF PENNSYLVANIA
ss.
COUNTY OF CU1vIBERLAND
We,Nt. (.~ r'" Celli-. J~i and 1~:n.).3J\
the witnesses whose names are signed to the attdched or foregoing instrument being duly
qualified elccording ro law, do depose and say thelt we ,v ere present and SelW Testatrix sign and
execute the instrument as her LAST \\TILL; that GERTRUDE E. COX signed willingly and
that she executed it as her free and voluntary act for the purposes therein expressed; that each
UlllS in the hearing and sight of the TestatrL':: signed the Will as witnesses; and that to the best
of our knowledge, the Testatrix was at the time 18 years of age or more, of sound mind and
under 110 cOllstraint or undUE intJucncE. /
i/
L
'. / ,-1 .,..\. 1.(
"''':Lu.\-!'j '1).';1 .::>;~n~>() f'~_,1
Sworn or affirmed to and acknowledged before me this..i~ "-<day
of /2.L1J,[tc.tu t... , 2002.
(i, , .,)
"UU.'('~L k ,~~:-I!(,.~/.h
Notary Public I
3
(Rev. 3/02)
Before the Register of Wills of Cumberland County, Pennsylvania
Estate of Gertrude E. Cox, Deceased
: No. 21-07-0132
Inventory
I, Robert F. Cox, personal representative ofthe estate of the above named decedent,
verify that the items appearing in the following inventory include all of the personal estate of the
decedent wherever situate and all of the real estate of the decedent in the Commonwealth of
Pennsylvania, that the valuation placed opposite each item of the inventory represents its fair
value as of the date of the decedent's death, and that the decedent owned no real estate outside of
the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of
the inventory. I understand that false statements made in this inventory are subject to the
penalties of 18 Pa.C.S. S 4904 relating to unsworn falsification to authorities.
Date: 7-;lG .0'7
~rGr ~.
Robert F. Cox, Executor
-~ .,
I
-_J
-7"1
John J,\Sh b, Esqwre
Supreme-e'ourt 1.0. No.: 18020
Office Address: Stock and Leader
Susquehanna Commerce Center East
221 W. Philadelphia Street, Ste. 600
York, Pennsylvania 17401-2994
Telephone Number: (717) 846-9800
F;;:)
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UI
01
1
Estate of Gertrude E. Cox
\ Estate Inventory
Valued as of Date of Death
Cash & Cash Equivalents
Annuity Payment Checks from
Berkshire Life Insurance of America $ 208.72
Cash on Hand 1,179.00
PNC Bank, Checking Account No.
50-7009-1456 11,832.14
64,000 PNC Bank, Certificate of
Deposit No. 31100301215 65,606.12
Refund Commonwealth of
Pennsylvania, 2006 Income Tax 20.70
Refund from 2006 Federal Income
Tax Return 870.00
Refund from Comcast 6.11
Refund from Verizon 9.97
20,000 Sovereign Bank, Certificate of
Deposit No. 2335252959 20,000.00
Interest at Date of Death 7.04
Total Cash & Cash Equivalents $ 99,739.80
Tangible Personal Property
Household Furnishings
(per appraisal) $ 2,595.00
Total Tangible Personal Property 2,595.00
Total Inventory $ 102,334.80
Page 1
(1)