HomeMy WebLinkAbout02-0026 state of SHIRLEY FAYE SC(Ji~ COOK No.
also known as To:
PETITION FOR PROBATE and GRANT OF LETTERS
Social Security No. Deceased.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut r±;~
in the last wilt of the above decedent, dated June 2 9,
and codicil(s) dated
Register of Wills for the
County of CUMBERLAND
Commonwealth of Pennsylvania
in the .
named
., 19 2001
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
"Decendent was domiciled at death in Cumberland County, Pennsylvania, With
h' er last family or principal residence at 31 Fort Street
Borough of Lemoyne
(list street, number and muncipality)
Decendent,.then 85 years of age, died November 22, ., 19.2001.,
at 31 Fort..Street, Lemoyne
Except as-follows, decedent did not marry, was not divorced and did not ha~e a child born or adopted
after execution-of-the wl.lLOffered for probate; was not the victim of a killing and was never adjudicated
~ncompetent: -; "~./, -
Decendent at death,0wn.~d~'r~_perty with estimated values as follows:'
(If domiciled in Pa.) :; -- =All personal property $ 2,500.00
(If not domiciled in'P~a.)/~-r~ Personal property in Pennsylvania $
(If not domiciled in Pa,)'/f.( Personal property in County $
Value of real-estat¢l'nP~nn.~ylvania $ 100. 000.00
situated as follow, s:'<. 7'
31 Fort Street, Borouqh of Lemoyne,
Cumberland County. PA
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
pre~ented herewith and the grant of letters Tas tamantary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
Eulah Faye Cook Grugan
9 Fort Street'
Lemoyne, PA 17043
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF'Y~'? C'LIMBERLAND y SS
The petmo~ner(s) above-named swear(s) or affirm(s) that the statements in the .foregoing ~etition are
true and c~rrect/to the_~est'oCt~ kfiowledge and belief of petitioner(s) and that as person~ represen-
tative(s) of the above~ddeedent~pefitioner(s) wi8 well_and truly administer the estate ~cording to law.
Sworn to or affirmed.' arid~ ~subscribed r,
r, before me this 10th ~ day of [ Eulah Fay~ Cook Grugan
k J~U~Y~ i ~ ~ ~ 2002 J
' 21-02-26
Estate of EULAH FAYE COOK GRUGAN
, Deceased.
DECREE OF PROBATE AND GRANT OF LETTERS
· AND NOW JANUARy 14 ". lC Z__0012~_, in consideration of the petition on
the reverse, side hereof, satisfactory proof having been presented before me,
IT IS DECREED that'the in~strument(s) dated ' ' June 29', 2001 .....
described therein be admitted to probate and filed of record as the last will of
· Shirley Faye Sco.tt Cook. · "-
and Letters ' Tm.q~-mmmnq-~ry
are h~reby g/-ant~l't0 w.,~'~ mh ]~xd~
Pnnk C.'r'll ~nn ,
FEES
Probate, Letters, Etc.. ' $ 235.00
Short Certificates( ) . . $ 6.00
- a Rs . iz. Oo-
:~u~c,ation $
jdp · .
.... $. 5.00
" TOTAL $. 258.00.
Filed .... J.AN.....1.0.,...2.0.Q 2. .... : ......... ':
Ralph H. w~ight., Jr. '-
Jonson, ~ff~e,~ ~T~art & WeiSer
ATrORNEI)'(SUl~.'6t. I.D. _N,o.)
301 Market St., P. O. Box 109
Lemoyne, PA 17043-0109
ADDRESS
(717) 761-4540
PHONE
Fee:. for this
~-. , :...
012442-00001/6/29/01/RHW/KLT/147673.1
21-02-26
t 9ilI anl e tament
OF
SHIRLEY FAYE SCOTT COOK
I, SHIRLEY FAYE SCOTT COOK, of the Borough of Lemoyne, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and Testament, hereby revoking and making void
any and all Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of all my legal debts, and the expenses of my last illness and fimeral
from my Estate as soon after my death as conveniently may be done. I direct that all taxes that may
be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary Estate as part of the expense of the administration of my Estate.
ARTICLE II
SPECIFIC BEQUEST - TANGIBLE PERSONAL PROPERTY
I give and bequeath my household and personal effects and other tangible personal property
(not including any cash or securities) unto my deceased son FRANK A. COOK'S widow, ANNA
M. COOK, my daughter, EULAH FAYE COOK GRUGAN, and my daughter, SHIRLEY
MAXINE COOK COLEMAN, in as nearly equal shares as practical as they shall agree. Should
ANNA M. COOK predecease me, her share shall be added to the shares of my daughters, EULAH
FAYE COOK GRUGAN and SHIRLEY MAXINE COOK COLEMAN. Should EULAH
FAYE COOK GRUGAN predecease me, I give and bequeath her share to her husband, ROBERT
012442-00001/6/29/01/RHW/KLT/147673.1
LEE GRUGAN, or should he fail to survive me, to his issue, per stirpes. Should my daughter,
SHIRLEY MAXINE COOK COLEMAN predecease me, I give and bequeath her share to my
grandson, MICHAEL GLENN GRUGAN and my granddaughter, SUSAN KAY GRUGAN
RUDY, in equal shares, or to the survivor of them.
ARTICLE III
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever
nature and wheresoever situate unto my deceased son FRANK A. COOK'S widow, ANNA M.
COOK, my daughter, EULAH FAYE COOK GRUGAN, and my daughter, SHIRLEY
MAXINE COOK COLEMAN, in as nearly equal shares as practical as they shall agree. Should
ANNA M. COOK predecease me, her share shall be added to the shares of my daughters, EULAH
FAYE COOK GRUGAN and SHIRLEY MAXINE COOK COLEMAN. Should EULAH
FAYE COOK GRUGAN predecease me, I give and bequeath her share to her husband, ROBERT
LEE GRUGAN, or should he fail to survive me, to his issue, per stirpes. Should my daughter,
SHIRLEY MAXINE COOK COLEMAN predecease me, I give and bequeath her share to my
grandson, MICHAEL GLENN GRUGAN and my granddaughter, SUSAN KAY GRUGAN
RUDY, in equal shares, or to the survivor of them.
ARTICLE IV
UNIFORM TRANSFERS TO MINORS ACT
In the event that any beneficiary of my Will shall not have reached the age of twenty-one
(21) years at the time for distribution of his or her share, distribution of said share may be made in
the discretion of my Personal Representative after considering the age and needs of the beneficiary,
either directly to the beneficiary or to a Custodian under the Pennsylvania Uniform Transfers to
012442-00001/6/29/01/RHW/KLT/147673.1
Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform
Transfers to Minors Act in the state of residence of such beneficiary as the case may be. My
Personal Representative may designate as such Custodian any institution or person, including my
Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in
effect at the time such distribution is made. A receipt for any payment or distribution so made shall
be a full discharge therefor to my Personal Representative, who shall not be responsible to see to, or
be liable for, the application of such proceeds thereafter.
ARTICLE V
APPOINTMENT OF PERSONAL REPRESENTATIVE
I name, constitute and appoint my daughter, EULAH FAYE COOK GRUGAN, Executrix
of this my Last Will and Testament. Should my daughter, EULAH FAYE COOK GRUGAN, fail
to qualify or cease to so act, I name, constitute and appoint my grandson, MICHAEL GLENN
GRUGAN, and my granddaughter, SUSAN KAY GRUGAN RUDY, alternate Co-Executors to
complete the administration of my Estate. I direct that no fiduciary appointed herein shall be
required to post bond for the faithful administration of the duties required in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this 2 ~'?,'t' day ofx~]~ n,/~-' ,2001.
~HIRLEY~rE-SCO~ QbOK '
012442-00001/6/29/01/RHW/KLT/147673.1
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, in the presence of us, who ai her request, in her presence and in the presence of
each other, have hereunto subscribed our names as ~/~//. ~
AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND ·
SS
We, SHIRLEY FAYE SCOTT COOK, /~ors~,~'r /~, h/.~.~,~e,e and
~{~/~ ~. ~t6~r ) d~. , the Testaffix ~d the witnesses, respectively, whose
nines ~e si~ed to the a~ached or foregoing ~s~ent, berg first duly sworn, do hereby decl~e
to the undersized authod~ that the Testa~x si~ed ~d executed the ins~ent as her Last Will
~d that she had si~ed willingly ~d ~at she executed it ~ her' ~ee ~d vol~t~ act for the
p~oses therein expressed, ~d that each of the witnesses, in the presence ~d he~ng of the
Testa~x, si~ed the Will as wi~ess ~d that to the best of hisser ~owledge the Testa~x w~ at
thru time ei~teen ye~s of age or older, of sound mind ~d ~der no cons~aint or ~due influence.
' SHILEY F~ S~~O~K
Wimes~ ' ' -
~imess ~ '
012442-00001/6/29/~ 1/RHW/KLT/147673.1
Subscribed, sworn to and acknowledged before me by SHIRLEY FAYE SCOTT COOK,
Testatrix, and subscribed and swom to before me by ~,,C'~ ~ ~ . ~ ~ and
~. ,,.~t .,~x ~----~.M,3. ' _~,,L~.~. :.~x. ;, witnesses, this OC~ay of
Notary Public
,2001.
NOTARIAL SEAL
DIANNE LENIG, Notary Public
Lemoyne Borough Cumberland Co.
_My Commission Expires Dec. 21, 2001
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
000860
WRIGHT RALPH H JR ESQ
.301 MARKET STREET
P O BOX 109
LEMOYNE, PA 17043
........ fold
ESTATE INFORMATION: SSN: 208-38-7146
FILE NUMBER: 2102-0026
DECEDENT NAME: COOK SHIRLEY FAYE SCOTT
DATE OF PAYMENT: 02/14/2002
POSTMARK DATE: 02/1 3/2002
COUNTY: CUM BERLAN D
DATE OF DEATH: 11/22/200'1
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,000.00
TOTAL AMOUNT PAID:
$6,000.00
REMARKS: EULAH C GRUGAN
C/O RALPH H WRIGHT JR ESQUIRE
SEAL
CHECK#01
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: SHIRLEY FAYE SCOTT COOK
Date of Death: November 22, 2001
Will No.: 21-02-00026
Admin. No.:
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
Anna C. COok 31 Fort Street, Lemoyne, PA 17043
Shirley C. Coleman P.O. Box 2817, Aptos, CA 95001-2817
Eulah C. Grugan 9 Fort Street, Lemoyne, PA 17043
Notice has now been given to all persons entitled thereto under Ru!e 5.6(a) except. None..
Date: ~..Z ,¢' /_ ¢,¢¢ ~
!
Vd c,t_;
Name Ralph H. Wright, Jr., Esq.
Johnson, Duffle, Stewart & Weidner
Address 301 Market St.
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone (717) 761-4540
Capacity: Personal Representative
· X Counse~ for personal representative
Inventor'/of the real and personal estate of
SHIRLEYFAYE SCOTT COOK
deceased
1. Real. Estate - No. 31 Fort Street, Borough of Lemoyne, Cumberland
County, PA
Assessed value
2.Household Goods - appraised value
3. Automobile - 1987 Chrysler Fifth Avenue - date of death value
4. Blue Cross/Blue Shield - premium refund
5. The'Patriot-News - subscription refund
6. Blue Cross,Blue Shield - major medical premium refund
7. Comcast - cable service refund
8. U. S. Government - final pension payment
9. Maxine Fullenwider - payment for toll calls
10. New Cumberland Federal Credit Union - life insurance payable to the Estate
11. Automobile insurance refund
TOTAL
92,690
6,940
1,500
'158
15
59
29
426
100
3,000
148
105,066
COMMONWEALTH OF PENNSYLVANIA
cOuNTY OF CUMBERLAND
Eulah Faye Cook Grugan -
toeing duly sworn according fo law, deposes and says that ~e is Executrix
0~' the Estate of Shirley Faye Scott Cook
late of -- Lemoyne Borough , Cumberland County, Pa., deceased and fha+ the
w~fhln is an ;nventory made by Eulah Faye Cook Grugan , the sa;d ' Executrix
of the entire estate of said decedent, consisting of all the personal property and real. estate, except real estate outside
the Commonwealth of Penn,sylvania, and that the figures opposite each item ofth~ Inventory represent it's fair value
as of the date of decedent s death. I
Sworn to
and subscribed before me,
· ~ //7'~ ~,,' 2002
NOTARIAL $(~
DIANNE LENIG, Nolary Public
Lem0yne Borough Cumberland Co.
My Commission F~pires Dec, 21, 2005
'Eulah FaYe E~/'~)~'G6r~l~;c~t,°r Ex~utri'x .
9 Fort street
Lemoyne, PA 17043-0109
Addre,s
22nd November 2001
Dafi~ of Death.,
Day Month.. Year
2.
3.
4.
INSTRUCTIONS
An inventory must be 'Filed wffh~n three months after appointment of personal representative.
A supplement inventory must be filed wlth;n thirty days of discovery of additional assets.
Additional sheets may be affached as to personalty or realty
See Article IV, FiduclaHes Act of 1949.
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COMMONWEALTH OF
pENNSYLVANIA
DEPARTMEN~T OF REVENUE
· OEPT.~,280601
HARRISBURG, 'PA 17128-0601
REV.-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21 _ 0 2 0 0
COUNTY CODE YEAR NUMBER
02 6
DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) ' SOCIAL SECURITY NUMBER
~- COOK, SHIRLEY FAYE SCOTT 208 --38 -- 7146
Z
I!1 DATE OF DEATH (MM-DD-YEAR) IDATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
UJ 11/22/2001 J 08/23/1916 REGISTER OF WILLS
LLI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
E~ 1. Odginal Return E~] 2. Supplemental Return [] 3, Remainder Relum (date cf death pM to 12-13.82)
E~] 4. Limited Estate E~ 48. Future Interest Compromise (date 01death alter 12-12-82) D 5. Federal Estate Tax Return Required
[--'~ 6. Decedent Died Testate (A~c~ copy o! Will) r~ 7, Decedent Maintained a Living Trust (Aaach copy of Trust) 8. Total Number of Safe Deposit Boxes
E~ 9. Litigation Proceeds Received [-'-'] 10. Spousal Poverty Credit (date o!death between 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A)(Atmc~ Cch
~-C3'"Z NAME Ralph H. Wright ,' Jr-, E~q. ' [ICOMPLETE MAILING ADDRESS ' '
z I 301 Na~ket St.
0
m"' FIRM NAME(IfApp0cable) .... Weidner I P.O. Box 109
-' Johnson, Duffle, stewart a i
~ Lenoyne, PA 17043-0109
~' TELEPHONE NUMBER
O
u (717) 761-4540
1. Real Estate (Schedule A) (1) 92,690. O0 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation. Partnership or Sole-Proprietorship (3)
4., Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 9,376.44
) (Schedule E)
6. Jointly Owned Property (Schedule F) (6) 45,653.89
~:~ [] Separate Billing Requested
~ 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 5,194 · 54
I"- (Schedule G or L)
~:~ 8. Total Gross Assets (total Lines 1-7) (8) 152,914.87
LU 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,734.43
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1. 006. O0
11. Total Deductions (total Lines 9 & 10) (11) . 15,7 4 0.4 3
12. Net Value of Estate (Line 8 minus Line 11) (12). 1_37 ~ 1 ?A _ AZ[
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) -0-
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 137,174.44
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 .0 __ (15) -O-
~ 16. Amount of Line14 taxable at lineal rate 137,174.44 x .o 45 (is) 6,172.85
13. 17. Amount of Line 14 taxable at sibling rate - x .12 (17)
O x .15 (18) -0-
0 18. Amount of Line 14 taxable at collateral rate
19. Tax Due (19) 6t 172.85
:. ".': · ~'.~i~.:=w.".:<: .,, 5'> BE:SURE TO ANSWERALLQUESTIONS ON.REVERSE.:SIDEAND RECHECK MATH
Decedent's Complete Address:
STREET ADDRESS
9 Fort street ..... . ......... - ............ ~ ...~
CITY. L(mloyne IsTATE PA I ZIP 17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount.
(1) 6,172.85
Interest/Penalty if applicable
D. Interest
E. penalty
6,000.00
~31_5;'79
Total Credits (A + B + C ) (2)
Total Interest/Penalty ( D + E )
If Line' 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page t Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter ~he difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3)
(4)
(5)
(5A)
6,315.79
--0--
(142.94)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Pay, able to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
'IF THE ANSWER
Did decedent make a transfer and: Yes . No
a. retain the use or income of the property transferred; .......................................................................................... [] []
b. retain the dght to designate who shall use the property transferred or its income; ............... ~ ............................ [] []
~. retain a reversionary interest; or ................................................................ i ......................................................... [] []
d~ receive the promise for Iife of either payments, benefits or care? ................... ~ ........................... ~ ...................... [] []
If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideraiion? .............................................................................................................. [] []
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................... : ................................................................. []
TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THERETURN.
Under penalties of perju~/, I declare thai I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and. belief, ~ is line, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SlGNAT.~. E Of PERS~ON RES~PONSlBLE FO~ILING RETURN/') . ~
ADDRESS ~. ' Eulah Faye C~Dok Grugan, Executrix
9 Fort. St., L~moyne, PA 17043
DATE
301 Market St., P. O. Box 109
L~noyne, PA 17043-0109
DATE
For dates of death on or a~er 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 alter 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.
COMMONNVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEA
REAL ESTATE
ESTATE OF FILE NUMBER
COOK, SHI'RLEY FAYE ScoTT 21-02-00026
All real property owned solely or as a tenant in common must be reported at fair market va us. Fair market yalue is defined as the prlCu at which property would be excha.ged
be~een a willing buyer and a willing seller, ne~er being compelled to buy or sell, both baying reasonable knowledge of the relevant facts, Real property which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
Real Estate - No. 31 Fort
Cumberland County, PA.
(DeedBook V, Volume 12, Page 233)
Assessed value
(Copy of tax bill attached)
Street, Borough of L~noyne,
TOTAL (Also enter on line 1, Recapitulation)
VALUE AT DATE
OF DEATH
92,690.00
$ 92,690.00
(If more space is needed, insert additional sheets of the same size)
Ok-
En-
O0
U.lUJ
REV-1508 EX ~' (1.97~ ~
COMMONWEALTH OF PENNSYLVANIA
iNHERiTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, SHIRLEY
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
:ILE NUMBER
FAYE SCOTT 21-02-000'26
Include the proceeds of [iUgafion and the' data the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F.
VALUE AT DATE'
DESCRIPTION OF DEATH
ITEM
NUMBER
2.
3.
4.
5.
0
7.
8.
9.
Household Goods - appraised value
1987 Chrysler Fifth Avenue - date of death value
Blue Cross/Blue Shield - premium refund
The Patriot-News - subscription refund
Blue Cross/Blue Shield - major medical premium refund
Comcast - cable service refund
Maxine Fullenwider - payment for toll calls
U.S. Government'- final pension payment
Automobile Insurance refund
6,940.00
1,500.00
158.45
15.15
59.49
29.28
100.00
426.07
148.00
TOTAL (Also enter on line 5, Recapitulation) $ 9,376.44
(If more space is needed, insert additional sheets of the same size)
corv)MONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF '~ FILE NUMBER
COOK, SHIRLEY FAYE SCOTT 21-02-00026
If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G.
· SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
'A~ Eulah C. Grugan :; .;:.~ 9'~Fort Street, Lemoyne, PA 17043 Daughter
B. Anna M. Cook
c.'Shirley C. Coleman
1496 Simpson Ferry Rd., New Cumberland,.
PA 17070
P. O. Box 2817, Aptos, CA 95001-2817
Daughter-in-law
Daughter
JOINTLY-OWNED PROPERTY:
LE~ER DATE DESCRIPTION OF PROPERTY % OF DATE OF D~TH
EM FOR JOINT ~DE Include name d financial institution md bank ac~unt number or si~lar id~tiyng number. AUach ' D~E OF D~ DECD'S V~UE OF
NUMB~ TENANT JOl~ deed ~r ~inUy-held real ~te. V~UE OF ASS~ I~EREST DEaD.TS INTE~ST
1. A. 7/1997 PNC Bank - Acct. No. 31400195765 5,037.90 50% 2,5!8.95
2. A ~7/1997 PNC Bank - Acct. No. 31100195808 10,075.80 50% 5,037.90
3. A 9/1998 PNC Bank - Acct. No. 31700202238 10,002.53 50% 5,001.27
4. A 1/1978 PNC Bank - Acct. No. 5140012954 5,024.61 50% 2,512.31
5. B 7/1997 PNC Bank - Acct. No. 31700194461 5,037.90 ' 50% 2,518.95
6. B 3/1997 PNC Bank - Acct. No. 31700216484 10,135.96 50% 5,067.98
7. B 7/2000 PNC.Bank - Acct. No. 31200217304 10,135.96 50% 5,067.98
8. C 7/1997 PNC Bank - Acct. No. 31200195296 5,037.90 50% 2,518.95
9. C 2/1997,PNC Bank - Acct. No. 31000192683 10,084.35 50% 5,042.18
10. C 7/2000 PNC Bank - Acct. No. 31200217306 10,135.96 50% 5,067.98
11. A 3/1999 $500 - Series HH Bond dated 3/1999 500.00 50% 250.00
12. A 3/1999 - 2 - $1,000.00 Series HH Bonds - 3/1999 '2,000.00 50% 1,000.00
13. B 3/1999~2 - $1,000.00 Series HH Bonds dated 3/1999 2,000.00 50% 1,000.00
14. B 7/2000 $500.00 Series HH Bond dated 7/2000 500.00 50% 250.00
15. C 3/1999 $1,000.00 Series HH Bond dated 3/1999 1,000.00 50% 500.00
· 16. C '3/1999 $500.00 Series HH Bond dated 3/1999 500.00 50% 250.00
17. C 7/2000 2 - $500.00 Series HH Bonds dated 7/2000 .i,000.00 50% 500.00
18. A,B,C10/199[ New C~nberland Federal Credit Union
Account NL~nber 002911 6,197.75 25% 1,549.44
TOTAL (Also enter on line 6, Recapitulation) $ 4 5,653.89
(if more space is needed, insert additional sheets of the same size)
REV'1510 ED( ~ {1~97) ~~t~'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE
INTER-VIVOS TRANSFERS
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
COOK, SHIRLEY FAYE SCOTT 21-02-00026
This schedule must be completed and filed if the answer to any of questions I through 4 on the reveme side of the REV-1500 COVER SHEET is (es.
DESCRIPTION OF PROPERTY % OF
iNCLUDETHENAt~E OF THE TRANSFEREE THEIRR-CLATIO~ISHIPTO 0ECEDEtITANDTHE DATEOFTRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ITEM ATTACHA COPYOFTHE DEED FORREALESTATE. VALUE OF ASSET INTEREST ~ AP~ICA~)
NUMBER
1, PNC Bank - Savings Account No. 5002036431
Decedent and Eulah C. Grugan, daughter
as of 7/26/2001 6,087.40 ~,000.00 3,087.40
2. PNC Bank - Certificate No. 31900210441
Decedent and Shirley C i Coleman, daughter
as of 5/17/2001 5,107.14 3 000.00 2,107.14
TOTAL (Also enter on line 7. RecapitulaUoa) $ 5,194.54
(If more space is needed, insert additional sheets of the same size)
REV-1511EX + (1-97} ~,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, SHIRLEY
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
:iLE NUMBER
FAYE SCOTT 21-02-00026
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
B.
1.
5o
9.
10.
11.
12.
13.
14.
15.
16.
DESCRIPTION
FUNERAL EXPENSES:
Crenation Society of PA
Rolling Green - cemetery charges
Reverend Robert Graybill - M~morial Service
Reverend Nancy. Firestone - M~morial Service
Kay Shupp - organist - memorial service
An Olde Town Florist - flowers for memorial service
Susan Rudy - Memorial book for memorial service
Giant - food for m~norial service
Baughman Manorial Church - Memorial Service progrems
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Eulah Faye Cook Grugan
Social Securit7 Number(s) / EIN Number of Personal Representative(s)
9 Fort Street
Street Address
Lemoyne . Sta~ PA
C~
Year(s) Commission Paid: 2002
A~0mey Fees - Johnson, Duffle, Stewart & Weidner
Family Exemption: (if decedent's address is not the same as claimant's, altach explanation)
Claimant
17043
Zip
SffeetAddress
City State ~Zip
Relationship of Claimant to Decedent
PrebateFees - Register of Wills - Ct~nberland County
Accountant's Fees
Tax Return Preparer's Fees
C~nberland Law Journal - legal advertisement
The Patriot-News - legal advertisement
Register of Wills - short certificates
Register of Wills - file Inventory & Inheritance Tax Return
Chuck Bricker - household goods appraisal
Postmaster - postage
Horace Mann Insurance Co. - Insurance - 31 Fort St.
Horace Mann Insurance Co. - automobile insurance
PNC Bank - charge for estate checks
Royer's Flowers - cemetery wreath
Total from additional sheet
TOTAL (Also enter on line 9, Recapitulation) $
AMOUNT
1,394.00
455.00
100.00
50.00
100.99.
57.24
12.00
24.34
15.00
5,200.00
258.o0
75.00
102.67
9.00
25.00
60.00
40.80
303.00
150.10
10.00
9.53
2,782.76
14,734.43
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H - CONTINUED
Estate of: COOK, SHIRLEY FAYE SCOTT
21-02-00026
16. Comcast - final cable charges
17. Sprint - final telephone charges
18. Shipley Energy - oil deliveries - 12/01 - 3/02
19. PP&L - electric service - Dec.-July 2002
20. Verizon- final charges
21. PA Water Company - water service - Dec. - July 2002
22. Faith Nicola, Tax Collector - County/Borough real estate
taxes - 31 Fort St.
23. Camp Hill Distributors - envelopes for Estate mailings
24. Ken's Service Center- automobile inspection/repairs
25. Anna Cook - reimbursement for light replaced in dining
room.
26. Borough of Lemoyne - sewer/trash
27. Faith A. Nicola, Tax Collector - School District real estate
taxes - 31 Fort St.
28. The Patriot-News - advertising charges - sale of real estate
29. Weis, Home Depot and TruValue -"For Sale"' signs; brushes;
yard products; plastic bags
30. Reserve for close-out costs
33.80
82.88
411.61
188.09
5.05
112.50
316.02
29.42
129.32
11.65
139.47
917.45
185.45
45.05
175.00
Sub-total 2,782.76
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
SCHEDULEI
DEBTSOF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
COOK, SHIRLEY FAYE SCOTT 21-02-00026
Include unreimburse, d medical expenses.
ITEM
NUMBER
e
DESCRIPTION
U. S. Treasury - tax due on decedent's final Form 1040
PA DePartment of Revenue - tax due on decedent's final.PA 40
Baughman Memorial Church - balance of decedent's 2001 pledge
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
769.00
137.00
100.00
'$ 1,006.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DEC,~DENT
ESTATE OF
COOK, SHIRLEY
FAYE SCOTT
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-02-00026
NUMBER
I.
e
e
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Eulah Faye COOk Grugan
9 Fort Street
L~noyne, PA 17043
Shirley Maxine Cook Coleman
P. O. Box 2817
Aptos, CA 95001-2817
Anna M. Cook
1496 Simpson Ferry Road
New Cumberland, PA 17070
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Daughter
DaUghter-in-law
AMOUNT OR SHARE
OF ESTATE
One-third tangible
personal property;
one-third residue
One-third tangible
personal property;
one-third residue
One-third'tangible
personal'property;
one-third residue
II.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTF, IBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 1-1'. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additlonal,'sheets of the same size)
EAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 180601
HARRISBURG, PA 17118-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLOgANC~ ~R DZSALLOgANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
'02 OC? 10
RALPH H WRIGHT JR ESQ
JOHNSON ETAL
PO BOX 109
LEHOYNE '. t'Fh 'A" 1'704
DATE 09-$O-ZOOZ
ESTATE OF COOK
DATE OF DEATH 11-22-2001
FILE NUMBER 210Z-OOZ6
COUNTY CUMBERLAND
ACN 10!
Amount
REV-154? EX AFP (Oi-OZ)
SHIRLEY F
MAKE CHECK PAYABLE AND REM'rT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -.~
REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF COOK SHIRLEY F FTLE NO. 21 02-0026 ACN 101 DATE 09-$0-2002
TAX RETURN gAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnersh/p /nterest (Schedule C) ($)
fi. Hortgages/Notes Rece/vable (Schedule D) (~)
5. Cash/Bank Deposits/H/sc. Personal Property (Schedule E) (5)
6. Jo/ntly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND'EXEMPTIONS:
9. Funeral Expensas/Adm. Costs/H/sc. Expenses (Schedule H) (9)
10. Debts/Nortgage L/abil/t/es/L/ens (Schedule I) (10)
11. Total Deduct/ons
12. Net Value of Tax Return
92~690.00
.00
.00
.00
91576.44
451655.89
5~i94.54
(8)
14,754.45
NOTE: To /nsure proper
cred/t to your account,
subm/t the upper port/on
of th/s form w/th your
tax payment.
152,914.87
11006.00
(11), 15.7~0.~3
(12) 157,174.44
15.
NOTE:
Char/table/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15] . O0
Net Value of Estate Subject to Tax (lq) 157,174.44
Zf an assessment ~as issued previously, llnes 14, '15 and/or 16, 17, 18 and 19 ,ill
reflect figures that include the total of ALL returns assessed to date.
(15) .00 x O0 = .00
(16) 157,174.44 x 045 = 6,172.85
(17) .00 X 1Z .= .00
(1G) .00 x 15 = .00
(1~)= 6,172.85
ANOUNT PAID
ASSESSMENT OF TAX:
15. Amount of L/ne 1~ at Spousal rate
16. Amount of LAne 1~ taxable at L/neal/Class A rate
17. Amount of LAne lq at S/bl/ng rate
18. Amount of L/ne 1~ taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYNENT RECEIPT DISCOUNT
DATE NUHBER ZNTEREST/PEN PAID (-)
OZ-I$-ZOOZ CDO00860 $08.64
6,000.00
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
6,308.64
135.79CR
.00
155.79CR
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT 1S REQUIRED.
ZF TOTAL DUE 1S REFLECTED AS A "CREDIT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCTZONS.J
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying en or before December lZ, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commenaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful CIass'B (collateral) rate mn any such future interest.
To ~ulFi11 the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 91q0).
Detach the tap portion of this Notice and submit 'with your payment to the Register of Nills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF WILLS, AGENT
A refund of a tax c;edit, which was not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-Z313). Applications ara available at the'Office
of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special, lq-hour
answering service for forms ordering: l-&OO-36Z-ZOSD; services For taxpayers #Jth special hearing and / or
speaking needs: 1-800-qqT-30ZO (TT only).
~ny party in interest not satisfied mith the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within.sixty (60) days of receipt of
this Notice by:
--aritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, pAol71ZB-IOZI~ OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered en this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return Far a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is ~aid within three (~ calendar months after the'decedent's death, a five percent'(SZ) dis~ount of
the tax paid is allowed.
The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the Tame manner and in the tho same time period as you would appeal the tax and interest
that has been assessed.as indicated on this notice. '
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rat~ of
six (62) percent par annum calculated at a daily rate of .00016~. AIL taxes which became'delinquent on and after
January I, 1982 ail! bear interest at a rate ahich will vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rata Daily Interest Factor
m
1982 207. . O005qB 1992 97. . OOOZ~7
1983 167.* . O00q3B 1993-199q ' 77. .000197
198~ llZ ' . 000301 1995-1998 9Z . O00Zq7 '
1985 131 · 000356 1999 7Z . 000192
1986 IOZ . 00027~ 2000 8Z . 000219
1987 9Z .0002~7 Z001 9Z .0002~7
1988-1991 llZ .000301 ' 2002 6Z .O0016q
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID 'X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must bo calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF {NDIVIDUAL TAXES
DEPT. 280601 --
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA-
INHERITANC'E AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002877
JOHNSON DUFFLE STEWART &
WEIDNER ATTYS
301 MARKET ST PO BOX 109
LEMOYNE, PA 17043-0109
........ fold
ESTATE INFORMATION: SSN: 208-38-7146
FILE NUMBER: 2102-0026
DECEDENT NAME: COOK SHIRLEY FAYE SCOTT
DATE OF PAYMENT: 08/07/2003
POSTMARK DATE: 08/06/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 11/22/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $219.11
TOTAL AMOUNT PAID:
$219.11
REMARKS: ELUAH FAYE COOK GRUGAN
C/O JOHNSON ET AL
SEAL
CHECK//173
INITIALS: SK
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV - 1500 EX + (s-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
IF OFFICIAL USE ONLY
ILL NUMBER
21 02 00026
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOC!AL SECURITY NUMBER
COOK, SHIRLEY FAYE SCOTT 208-38-7146
Z~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
uJ
~ 11/22/2001 08/23/1916 REGISTER OF WILLS
IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death pdor to 12-13-82)
~..~' ~ '[] 4. Limited Estate [] 4a. Future12.12.82)Interest Compromise (date of death after [] 5. Federal Estate Tax Retum Required
~)~ [] 6. Decedent Died Testate (Attach copyof Will) [] 7. copyDecedent Maintained a Living Trust (AttachofTrust) 8. Total Number of Safe Deposit Boxes
< [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11.ElectiontotaxunderSec. 9113(A)(AttachSchO)
12-31-91 and 1-1-95)
4AME !COMPLETE MAILING ADDRESS
~ ~ RALPH H. WRIGHT, JR.
i :IRM NAME (If applicable) 301 Market Street
Johnson, Duffle, Stewart & Weidner P.O. Box 109
'ELEPHONE NUMBER Lemoyne, PA 17043-0109
717/761-4540
1. Real Estate (Schedule A) (1) N o n~
USE~NLY
2. Stocks and Bonds (Schedule B) (2) Non~'
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None55
4. Mortgages & Notes Receivable (Schedule D) (4) NoneC,. ~.~:
..... · ..,.,J ....
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 4,906.96P
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) NoneS:
~ [--~ Separate Billing Requested
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
~ (Schedule G or L)
~- 8. Total Gross Assets (total Lines 1-7) (8) 4,906.96
-- 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 2 7 5. O0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10) (11) 275.00
12. Net Value of Estate (Line 8 minus Line 11 ) (12) 4,63 1.96
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax(Line 12 minus Line 13) (14) 4,631.96
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
~ 16.Amount of Line 14 taxable at lineal rate
4,63
1
(16)
208
X
=~= 17. Amount of Line 14 taxable at sibling rate x .'12 (17)
O
~ 18. Amount of Line 14 taxable at collateral rate x .15 (16)
19. Tax Due (19) 208.44
20. []
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
31 Fort Street
CITY Lemoyne STATE PA ZIP 17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C) (2)
208.44
0.00
3. Interest/Penalty if applicable
D. Interest 10.67
E. Penalty
Total InterestJPenalty (D + E) (3) 10.67
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (4)
Check box on Page I Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 219.11
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) 2
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; .............................................................................
b. retain the right to designate who shall use the property transferred or ils 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 death2 ....... [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation.'?. ............................................................................................................... [] []
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.
SIGN~URE OF PERSON RESPONSIBLE FOR FILING R~TURN ADDRESS
~,.~.,.~= ='1~=.''~liru'lr'ah Faye Cook C~ugan (..~.~ ~/'/'4 ~ ~ ~BG~BR/~Ss
. ·
' SlGNATURE~)F PREF~RER (3"rHER THAN REPRESENTATIVE ADDRESS
RALPIt It. WRIGItT, .IR.
9 Fo~ S~eet
Lemoyne, PA 17043
301 Market Street
P. O. Box 109
Lemoyne, PA 17043-0109
DATE
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 statutedoes not exempta 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.
~ L~C~O
0
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
. SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
.PERSONAL PROPERTY
ESTATE OF FILE NUMBER
COOK, SHIRLEY FAYE SCOTT 21 - 02 - 00026
Include the proceeds of litigation and the date the proceeds were received by the estate~ll property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 4,906.96
Miscellaneous Coins - appraised value
(Copy of Appraisal attached)
TOTAL (Also enter on Line 5, Recapitulation)
4,906.96
MORGAN DOLLARS
Year
1879-P
1881-P
1882-P
1883-O
1884-0
1885-P
1886-P
1886-0
1888-O
1888-S
1889-P
1889-O
1890-P
1890-S
1891-O
1896-P
1897-P
1898-P
1900-O
1901-O
1902-P
1903-P
1921-P
1921-D
1921-S
1921-S
1922-P
1922-D
1922-S
1923-P
1923-S
1924-P
1925-P
1926-S
1927-S
1935-S
Quant. Face ~pp. Val/eaTotal Val.
3 $3.00 $9.00 $9.00
1 $1.00 $9.00 $9.00
2 $2.00 $9.00 $18.00
1 $1.00 $9.00 $9.00
2 $2.00 $9.00 $18.00
'3 $3.00 $9.00 $27.00
8 $8.00 $9.00 $72.00
I $ 1.00 $9.00 $9.00
I $1.00 $9.00 $9.00
1 $1.00 $9.00 $9.00
12 $12.00 $9.00 $108.00
1 $1.00 $9.00 $9.00
6 $6.00 $9.00 $54.00
3 $3.00 $9.00 $27.00
1 $1.00 $9.00 $9.00
5 $5.00 $9.00 $45.00
3 $3.00 $9.00 $27.00
12 $12.00 $9.00 $108.00
1 ~ $1.00 $9.00 $9.00
1 $1.00 $9.00 $9.00
1 $1.00 $9.00 $9.00
1 $1.00 $9.00 $9.00
20 $20.00 $7.00 $140.00
9 $9,00 $7.00 $63.00
1 $1.00 $7.00 $7.00
12 $12.00 $7.00 $84.00
PEACE DOLLARS.
16 $16.00 $7.00 $112.00
1 $1.00 $7.00 $7.00
7 $7.00 $7.00 $49.00
3 $3.00 $7.00 $21.00
7 $7.00 $7.00 $49,00
9 $9.00 $7.00 $63.00
6 $6.00 $7.00 $42.00
1 $1.00 $7.00 $7.00.
3 $3.00 $7.00 $21.00
1 $1.00 $7.00 $7.00
Total Old 166 $166.00 $1,284.00
Year
1971-P
1971-D
i972-P
1972-D
1974.-D
1976-P
1976-D
1977-P
1977-D
EISENHOWER DOLLARS
Quant. Face App. Vat/eaT oral Val.
6 $6.00 $1.00 $6.00
10 $10.00 $1.00 $10.00
10 $10.00 $1.00 $10.00
19 $19.00 $1.00 $19.00
2 $2.00 $1.00 $2.00
47 $47.00' $1.00 $47.00
5 $5.00 $1.00 $5.00
I $1.00 $1.00 $1.00
2 $2.00 $1.00 $2.00
Total Eiser 102 $102.00 $102.00
SUSAN B. DOLLARS
1979-D 25 $25.00 $1.00 $25.00
1979-S 27 $27.00 $1,00 $27.00
Total SB 52 $52.00 ' $52.00
SACAJAWEA DOLLARs
2000-P 34 $34.00 $1.00 $34.00
2000-D 6 $6.00 $1.00 $6.00
Total Sac 40 $40.00 $40.00
TOTAL DOLLARS - face $360.00
TOTAL DOLLARS - appraise $1,478.00
BUYING ' SELLING · APPRAISING ' TRADING
COINS · CURRENCY · GOLD · SILVER
224 FouRTH sTREET
NEW CUMBERLAND, PA. 17070
DALE & scOTT RIsHEL ' ' ~'"'"'""~ -
(717) 774-4182
LIBERTY HALVES App.
Year ~uanl Face Val/ea. Total Value
1934
1935
1936
1939
1940
1941
1942
1943
1944
1945
1946
2 $1.00 $1.55 $3.10
I $0.50 $1.55 $1.55
I $0.50 $1.55 $1.55
2 $1.00 $1.55 $3.10
1 $0.50 $1.55 $1.55
5 $2.50 $1.55 $7.75
5 $2.50 $1.55 $7.75
4 $2.00 $1.55 $6.20
7 $3.50 $1.55 $10.85
6 $3.00 $1.55 $9.30
I $0.50 $1.55 $1.55
Total Lib. 35 $17.50
$54.25
FRANKLIN HALVES
1948-P 5 $2.50 $1.55
1948-D 1 $0.50 $1.55
1949-P 1 $0.50 $1.55
1949-D 1 $0.50 $1.55
1950-D 1 $0.50 $1.55
1951-P 3 $1.50 $1.55
· 1951-D 4 $2.00 $1.55
1952-P 3 $1.50 $1.55
1952-D 5 $2.50 $1.55
1953-D 5 $2.50 $1.55
1954-P 2. $1.00 $1.55
1954-D 4 $2.00 $1.55
1957-D 11
1958-D 1
1959-P 2
1960-D 1
1961-P 2
1962-P 3
1962-D 6
1963-P 3
1963-D 9
$7.75
$1.55
$1.55
$1.55
$1.55
$4.65
$6.20
$4.65
$7.75
$7.75
$3.10
$6.20
$5.50 $1.55 $17.05
$0.50 $1.55 $1.55
$1.00 $1.55 $3.10
$0.50 $1.55 $1.55
$1.00 $1.55 $3.10
$1.50 $1.55 $4.65
$3.00. $1.55 $9.30
$1.50 $1.55 $4.65
$4.50 $1.55 $13.95
Total Fran 73 $36.50
$113.15
KENNEDY HALVES App.
Phila. Deny. Diff. Total Face Valu( Val/ea
1964-P 169
1965-P 11
1966-P 55
1966-D 1
1967-P 34
1968-D 80
1969-D 42
1971-P 91
1971-D 30
1972-P 47
1972-D 15
1973-P 22
'1973-D 7
1974-P 38
1974-D 6'
1977-D 5
1977-dif
1978-D 3
1978-dif
1979-P 5
1979-D 2
1980-P 6
1981-P 3
1982-P 2
1982-D 1
1983-P 3
1983-D 2
1984-P 2
1984-D 1
1985-P 1
1985-D 1
1986-D 1
1988-P 1
1988-D 1
1990-P
Total K~ 491 198
169 $84.50
11 $5.5O
55 $27.50
1 $0.50
34 $17.00
80 $40.00
42 $21.00
91 $45.50
30 $15.00
47 $23.50
15 $7.50
22 $11.00
7 $3.50
38 $19.00
6 $3.00
5 $2.50
· 5 $2.50
3 $1.50
3 $1.50
5 $2.50
2 .$1.00
6 $3.00
3 $1.50
2 $1.00
1 ,$0.50 ·
3 $1.50
~2 $1.00
2 $1.00
1 $0.50
1 $O.5O
1 $0.50
1 $O.5O
1 $0.50
1 $0.50
1 $0.50
8 697 $348.50.
$1.55
$0.60
$0,60
$0.60
$0.60
$0.60
$0.60
$0.50
$0.50
$0.50
$0.50
$0.50
$0.50
$0.50
$0.50
$0.50
$0.50
$O.5O
$O.5O
$O.5O
$0.5O
$O.5O
$O.5O
$0.50
$0.50
$0.50
$0.50
$0.50
$O.5O
$O.5O
$O.5O
$O.5O
$O.50
$O.5O
$O.5O
TOTAL HALVES
$402.50
Total
Value
$261.95.
$6.60
$33.00
$0.60
$20.40
$48.00
$25.2O
$45.50
$15.OO
$23.50
$7.5O
$11.00
$3.5O
$19.00
$3.00
$2.5O
$2.50
$1.50
$1.50
$2.50
$1.00
$3.00
$1.50
$1.00
$O.5O
$1.50
$1.00
$1.00
$0.50
$O.5O
$0.5O
$0.50
$0.50
$O.5O
$O.5O
$548.25
Unreadable
LIBERTY QUARTERS
Quant. Face App. Vi Total Value
4 $1.00 $0.25 $1.00
Total Unread. $1.00 $1.00
SPECIAL QUARTERS
State Quant. Face
DE-P mint 2 $0.50 $0.25 $0.50
DE-D 20 $5.00 $0.25 $5.00
PA-P 77 $19.25 $0.25 $19.25
CT-P 19 $4.75 $0.25 $4.75
CT-D 31 $7.75 $0.25 $7.75
GA-P 15 $3.75 $0.25 $3.75
GA-D 22 $5.50 $0.25 $5.50
NJ-P 17 $4.25 $0.25 $4.25
MA-P 3 $0.75 $0.25 $0.75
MA-D 42 $10.50 $0.25 $10.50
MD~P 31 $7.75 $0.25 $7.75
MD-D 26 $6.50 $0.25 $6.50
SC-P 24 $6.00 $0.25 $6.00
SC-D 8 $2.00 $0.25 $2.00
NH-P 16 $4;00 $0.25 $4.00
VA-P 69 $17.25 $0.25 $17.25
VA-D 12 $3.00 $0.25 $3.00
NY-P 53 $13.25 $0.25 $13.25
NY-D' 26. $6.50 $0.25 $6.50
NC-P 2556.25 $0.25 $6.25
NC-D 29 $7.25 $0.25 $7.25
RI-P 21 $5.25 $0.25 $5.25
VT-P 18 $4.50 $0.25 $4.50
Total 606 $151.50 $151.50
BICENTENNIAL QUARTERS
Total 963 $240.75 $0.25 $240.75
REGULAR QUARTERS
Year Phila. Denve~Total Face Valu{App. Val/eaTotal valu~
1935-6--9 5 14 $3.50 $0.775 $10.850
.1961-6 41 2 43 $10.75 $0.775 $33.325
1966, 21 21 $5.25 $0,25 $5.25
1967 21 21 $5.25 $0.25 $5.25
1968-6 7 7 $1.75 $0.25 $1.75
1970-8 32 32 $8.00 $0.25 $8.00
Total Rec~,
138 $34;50 $64.43
SILVER QUAR
Year. Phila.
1934-4. 19
1943-4 18
1950-5 26
1960-6 31
1964-6 54
Denver T~al~aceValue
6 25 $6.25 $0.775
5 23 $5.75 $0.775
20 46 $11.50 $0.775
18 49 $12.25 $0.775
23 77 $19.25 $0.775
Total Silver
220 $55.00
$19.375
$17.825
$35.650
$37.975
$59.675
$170.50
TOTAL QUARTERS
$482.75
$628.18
MERCURY DIMES App.
Year Rolled Loose Total Face Val, Tot. Face Val/ea.
Unreadable
1910
1917
1918
1919
1920
1923
1924
1925
1926
1927
1928
1929
1934-P
1935-P
.1936-P
1937-P
1938-P
1939-P
1940-P
1941-P
1942
1943
1944'
1945
50
5O
50
250
250
200
250
150
Tot.
Value
13 13 $0.10 $1.30 $0.31 $4.03
2 2 '$0.10 $0.20 $0.31 $0.62
6 6 $0.10 $0.60 $0.31 $1.86
4 4 $0.10 $0.40 $0.31 $1.24
2 2 $0.10 $0.20 $0.31 $0.62
10 10 $0.10 $1.00 $0.31 $3.10
.14 14' $0.10. $1.40 $0.31 $4.34
3 3 $0.10 $0.30 $0.31 $0.93
5 5 $0.10 $0.50 '$0.31 $1.55
6 6 $0.10 $0.60 $0.31 $1.86
6 6 $0.10 $0.60 $0.31 $1.86
3 3 $0.10 $0.30 $0.31 $0.93
3 3 $0.10 $0.30 $0.31 $0.93
17 17 $0.10 $1.70 $0.31 $5.27
41 41 $0.10 $4.10 $0.31 $12.71
7 57 $0.10 $5.70 $0.31 $17.67
40 40 $0.10 $4.00 $0.31 $12.40
12 12 $0.10 $1.20 $0.31 $3.72
9 59 $0.10 $5.90 $0.31 $18.29
25 75 $0.10 $7.50 $0.31 $23.25
24 274 $0.10 $27.40 $0.31
6 256 $0.10 $25.60 $0.31
16 216 $0.10 $21.60 $0.31
37 - 287 $0.10 $28.70 $0.3i
25 175 $0.10 $17.50 $0.31
Total Mere 1250 336 1586 $0.10 $158.60
CANADIAN DIMES
1957, 195~. 1957, 1959, 4
1961, 196~ 1961 1968
Total Can:
0.10
$0.40 $0.20
$0.40
TOTAL DIMES
$409;60
1946-P
1947-P
1948-P
1949-P
1950-P
1951-P
1952-P
1952-?D
1953-P'
1954-P
1955-P
1956-P
Roosevelt Dimes App.
Rolled Loose Face Val. Valtea. Tot. Value
50 46 96 $0.31 $29.76
50 16 66 $0.31 $20.46
32 32 $0.31 $9.92
10 10 $0.31 $3.10
31 31 $0.31 $9.61
48 48 $0.31 $14.88
50 24 74 $0.31 $22.94
1 1 $0.31 $0.31
50 8 58 $0.31 $17.98
50 9 59 $0.31 $18.29
2 2 $0.31 $0.62
50 19 69 $0.31 $21.39
1957-P 100 2
1958-P 38
1959-P 50 19
1960-P 100 19
1961-P 100 24
1962-P 150 23
1963-P 250 18
1964-P 900 12
102 $0.31 $31.62
38 $0.31 $11.78
69 $0.31 $21.39
119 $0.31 $36.89
124 $0.31 $38.44
173 $0.31 $53.63
268 $0.31 $83.08
912 $0.31 $282.72
$84.94· 1964-?D 1
$79.36 1965-P 22
$66.96 1966-P 12
$88.97 1967-P 24
$54.25 1967-P?sil; 1.
1967-?D 2
$491.66 1968-P 3
1969-?si1. 2
1969-?diff. 3
1970-P 6
$0.80 1970-?D 5
1971-P 4
1971-?diff. 1
$0.80 1972-P 7
1972-?D 1
1973-P 2
1973-?D 1
1974-P 9
1974-?D 3
1975-P 9
1975-?D 2
1976-P 12
1976-?D 5
1977-P 4
1977-?D 2'
1978-P. 5
1978-?D 1
1979-P .2
1982-P 1
1983-P 1
1987-P 1
$1,236.98 1997-P 1
I $0.31
22 $0.10
12 $0:10
24 $0.10
1 $0.10
2 $0.10
3 $0.10
2 $0.10
3 $0.10
6 $0.10
5 $0.10
4 $0.10
1 $0.10
7 $0.10
1 $0.10
2 $0.10
1 $0.10
9 $0.10
3 $0.10
9 $0.10
2 $0.10
12 $0.10
5 $0.10
4 $0.10
2 $0.10
5 $0.10
1 $0.10
2 $0.10
1 $0.10
1 $0.10
1 $O.lO
I $0.1o
$0.31
$2.20
$1.20
$2.40
$0.10
$0.2O
$0.30
$0.20
$0.30
$0.60
$0.50
$O.4O
$0.10
$O.7O
$0.10
$O.2O
$0.10
$0.90
$O.3O
$O.9O
$O.2O
$1.2O
$0.50
$0.40
$0.20
$0.50
$0.10
$0.20
$O.lO
$O.lO
$O.lO
$0.10
Total Rc 1950 556
Face Value Total $250.60
$744.52
JEFFERSON NICKELS App.
Year Rolled Loose Total Vat/ea..
Unreadable $0.05. $0.05 $0.05
1938-P $0.05 $0.05 $0.05
1938-P $6.00 $1.80 $7.80 $0.05
1940-P $22.00 $0.40 $22.40 $0.05
1941-P $26.00 $1.70 $27.70 $0.05
1942-P $2.00 $0.10 $2.10 $0.05
1942-S $0.05 $0.05 $0.05
1942-plain $1.35 $1.35 $0.05
1943-P $0.55 $0.55 $0.18
1943-S $0.15 $0.15 $0.18
1944-P $0.15 $0.15 $0.18
1944-S $0.10 $0.10 $0.18
1945-P $0.40 $0.40 $0.18
1945-D $0.10 $0.10 $0.18
1945-S .$0.10 $0.10 $0.18
1946-P $24.00 $1.20 $25.20 $0.05
1947-P $14.00 $1.75 $15.75 $0.05
1948-P $14.00 $0.15 $14.15 $0.05
1949-P $8.00 $0.85 $8.85 $0.05
1950-P $0.05 $0.05 $0.05
1951-P $2.00 $1.45 $3.45 $0.00
1952-P $8.00 $1.80 $9.80 $0.05
1953-P $12.00 $1.25 $13.25 $0.05
1954-P $20.00 $1.25 $21.25 $0.05.
1955-P $8.00 $0,35 $8.35 $0.05
1956-P $14.00 $0.65 $14.65 $0.05
1957-P $24.00 $0.80 $24.80 $0.05
1958-P $18.00 $0.60 $18.60 $0.05
1959-P $20.00 $1.40 $21.40 $0.05
1960-P $0.40 $0.40 $0.05
1961-P $0.35 $0.35 .$0.05
1962-P $0.50 $0.50 $0.05
1963-P $0.20 $0.20 $0.05
1964-P $1.45 $1.45 $0.05
1965-P $0.05 $0.05 $0.05
1966-P $0.10 $0.10 $0.05
1967-P $0.05 $0.05 $0.05
1969-P $0.15 $0.15 $0.05
1970-P $0.20 $0.20 $0.05.
1971-P $0.05. $0.05 $0.05
1972-P $0.15 $0.15 $0.05
1973-P $0.15 $0.15 $0.05
1974-P $0.2050.20 $0.05
1975-P '$0.30 $0.30 $0.05
1976-P $0.15 $0.15 $0,05
1977-P $0.50 $0.50 $0.05
1978-P $0.45- $0.45 $0.05
1981-P $0.10 $0.10 $0.05
1984-P $0.05 $0.05 '.$0.05
1985-P $0.05 $0.05 $0.05
1990-P. $0.05 $0.05 $0.05
1995-P $0.05 $0.05 $0.05
Tot.
Value
$0.05
$0.05
$7.80
$22.40
$27.70
$2.10
$0.05
$1.35
$1.98
$0.54
$O.54
$0.36
$1.44
$0.36
$0.36
$25.20
$15.75
$14.15
$8.85'
$O.O5
$3.45
$9.8O
$13.25
$21.25
$8.35 '
$14.65
$24.8O
$18.60
$21.4O
$O,4O
$O.35
$O.5O
$O.2O
$1.45
$0.05
$0.10
$O.O5
$0.15
$O.2O
$O.O5
$0.15
$0.15
$O.2O
· $O,3O
$0.15
$O.5O
$O.45
$0.10
$o.o5
$0;05
$O,O5
$0.05
Asst. date-,
Total Buff.
BUFFALO NICKELS App. Tot.
Rolled Loose Total Val./ea. Value
$2.00 $1.60 $3.60 $0.05 $3.60
$3.60 $3,60
CANADIAN NICKELS
1960, 1962, $0.15 $0:15
1968
$0.05 $0.15
Total Canad. $0.15 $0.,'15
TOTAL NICKELS $272.05 $276.08
Total Jeff. $242.00 $26.30 $268,30 $272.33
Vadous
Vadous
1943
WHEAT PENNIES
Quantity Rolled Loose
6796 $67.50. $0.46
REGULAR PENNIES
1545 $15.00 $0.45
STEEL PENNIES.
14 $0.14
Face Valu~App. VaFe~TotalVal.
$67.96 $0.02 $135.92
$15.45 $0.01 $15.45
$0.14 $0.05 $0.70
TOTAL PENNIES $83.55 $152.07
Appraised Value of MiSc. Items
$2.00
$3.50
$4.00
$4.00
$5.00
$5.00
$3.O0
$5.00
$140.00
'$3.00
$3.00
$16,00
$35.00
$16.00
$12.00
$37,50
$18.00
$108.00
Coins in plastic containers, in ziploc bag
Emergency wartime coins (incomplete)
Eisenhower dollar in box
Buffalo nickel book (incomplete)
Jefferson nickel book (incomplete)
Lincoln pennies book - barge blue (incomplete)
Lincoln pennies book- 1941- (smaller blue) (incomplete)
Lincoln pennies books - 2 green books (incomplete)
Morgan dollars books - 3 books (incomplete)
Peace dollars books - book (incomplete)
Kennedy halves in plastic case - 2 cases
1971 Eisenhower dollar- uncirculated (in envelope)
4 Proof sets - $7.00 each
Buffalo-Jefferson book (incomplete)
Indian pennies books (2)
One dollar Silver Certificates - 30 - worth $1.25 each
Two dollar bills with red seals - 8 - worth $2.25 each
Two dollar bills - regular -54 - worth $2.00 each
$420.00
Total Miscellaneous items
FACE VALUE OF COINS
Old Dollars $166.00
Eisenhower $102.00
Susan B. $52.00
Sacajawea $40.00
Total Dollars
Liberty Halves $17.50
Franklin Halves $36.50
Kennedy Halves. $348.50
Total Halves
Liberty Quarters $1.00
Spec. Quarters $151.50
Bicentennial Quar. $240.75
Regular Quarters $34.50
Silver Quarters $55.00
$360.00
$402.50
APPRAISED VALUE OF COINS
$1,284.00
$102.00
$52.00
$40.00
$1,478.00
$54.25
$113.15
$548.25
$715.65
$1.09
$151.50
$240.75
$64.43
$170.50
Total Quarters $482.75 $628.18
Mercury Dimes $158.60
Roosevelt Dimes $250.60
Can. Dimes $0.40
$491.66
$744.52
$0.80
Total Dimes $409.60 $1,236.98
Buffalo Nickels $3.60
Jeff. Nickels $268.30
Can. Nickels $0.15
Total Nickels
Wheat Pennies $67.96
Regular Pennies $15.45
Steel Pennies $0.14
$3.60
$272.33
$0.15
$272.05 $276.08
$135.92
$15.45
$0.70
$83.55 $152.07
Miscellaneous ltems $420.00
GRAND TOTALS $2,010.45 $4,906.96
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ESTATE OF FILE NUMBER
COOK, SHIRLEY FAYE SCOTT 21 - 02 - 00026
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Bo
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Johnson, Duffle, Stewart & Weidner
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant ~
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
State Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Register of Wills, file Supplemental Inventory & Inheritance Tax Return
TOTAL (Also enter on line 9, Recapitulation)
250.00
25.00
275.00
Register of Wills of Cumberland County,
SUPPLEMENTAL
INVENTORY
Pennsylvania
Estate of COOK, SHIRLEY FAYE SCOTT No. 21 - 02 - 00026
, Deceased
also known as
Date of Death 11/22/2001
Social Security No. 208-38-7146
Eulah Faye Cook Grugan
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said 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 this Inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Attorney: RALPH H. WRIGHT, .IR.
I.D. No.: 56113
Personal Represent~_ive
Signature:
Eulah Faye Cook Grffgan
Signature:
Signature:
Address: 301 Market Street Address: 9 Fort street
P. O. Box 109 Lemoyne, PA 17043
Lemoyne, PA 17043-0109
Telephone: 717/761-4540 Telephone: (717) 761-0856
Personal Property
Miscellaneous Coins - appraised value
(Copy of Appraisal attached)
Dated:
4,906.96
Attach additional sheets if necessary) Total Personal Property and Real Estate $4,906.96
BUREAU OF ZND'rVZDUAL TAXES
I*NHERTTAHCE TAX D/VZSZON
DEPT. zDn60].
HARRI'SBURG, PA 17128-06n].
COHHONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEMENT] ALLONANCE OR DZSALLONANCE
OF DEDUCT/OHS AND ASSESSHENT OF TAX
REV-~7 EX AFP COl-OS)
RALPH H WRISHT JR ESQ
JOHNSON ETAL
PO BOX 109
LENOYNE PA 17065
~y ,,:~: ~ESTATE OF COOK
DATE OF DEATH 11-22-2001
F/LE NUHBER 21 02-0026
'03 SEP -9 ~qu~ CUHBERLAND
ACN 101
Amoun'l: . Rem it ted
SHIRLEY F
HAKE CHECK PAYABLE AND REN/T PAYMENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLZSLE, PA' 17015
CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS
DZSALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF COOK SHIRLEY F FZLE NO. 21 02-0026 ACH 101 DATE 09-01-Z003
TAX RETURN NAS: (X) ACCEPTED AS FZLED ( } CHANGED
RESERVAT/ON CONCERN/NG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: SUPPLEHENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks andBonds (Schedule B) (2)
$. Closely Held Stock/Partnership Znterest (Schedule C) ($)
q. Mortgages/Notes Raca/vable (Schedule D) (q)
5. Cash/Bank Daposi~s/Misc. Personal Propar~y (Schedule E) (5)
6. Jo/n~ly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To*al Assa~s
APPROVED DEDUCTZONS AND EXEHPTIONS:
9. Funeral Expenses/Adm. Cos~s/M/sc. Expenses (Schedule H) ('9)
10. Debts/Hortgaga Liabilitias/L/ens (Schedule Z) (10)
11. Total Deduc~/ons
12. Net Value of Tax Return
NO. 01
.00
.00
.00
.00
6t906.96
.00
.0O
(8)
275.00
.'00
(11)
(12)
NOTE: To /nsure proper
credi~ ~o your account,
submi~ *he upper por*/on
of ~his form w/th your
~ax payment.
6,906.96
275.00
6,651.96
15.
NOTE:
Char/:table/Governmen:tal Bequests; Non-eXacted 9115 Trusts (Schedule J) (15)
Na~ Value of Es~a~a Sub,~ect ~:o Tax (lq)
Zf an assessment was issued previously, lines 16, 15 and/or 16, 17,
reflect flgures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Amoun~ of L/ne 1~ at Spousal ra~e (15)
16. Amoun~ of L/ne 1~ ~axable a~ Linaal/Class A ra~a (16)
'17. Amoun~ of L/ne lq a~ Sibling ra~a (17)
18. Amoun~ of L/ne.iq ~axable a~ Collateral/Class B ra~e (18)
19. Pr/noipal Tax Dua
TAX CREDZTS:
I P ADYAMT EN T
~,,1 I oz-~--~:~-zooz
~---~-1 O- 1 O- 2002
I08-06-Z005
· O0 x O0 =
161,806.60 x 065=
· 00 x 12 =
· O0 x 15 =
(19}=
RECEZPT
NUMBER
.00
1,61,806· 60
18 and 19 N111
.00
6,$81.29-
.00
.00
6,$81.29
CD000860
REFUND
CD002877
ZF PAZD AFTER DATE ZNDZCATED] SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
015COUNT (+)
ZNTEREST/PEN PAZD (-)
:515.79
.00
9.25-
AMOUNT pAXD
6,000.00
1:55.79-
219.11
TOTAL TAX CREDXT I
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
6,:589.86
8.57CR
.00
8.57CR
( XF TOTAL DUE ZS LESS THAN 91, NO PAYMENT ZS REgUZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CRED/T' (CR)~ YOU MAY DE DUE
A REFUND. SEE REVERSE S/DE OF TM/S FORM FOR /NSTRUCT/ONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (~R):
OBJECTZONS:
ADHIN-
ZSTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
iNTEREST:
Estates of decedents dying on or before December ZZ, 1981 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of'any estate for
life or for years, the Commonaaalth hereby expressly reserves the right to appraise and assess transfer inheritance TaXes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the reverse side.
--Hake check or money order payable to: REGZSTBR OF #XLLS, AGENT
A refund of a tax credit, mhich ams not requested on the Tax Return, may be requested by completin9 an "Application'
for Refund of Pennsylvania Inheritance e~d Estate Tax" (REV-IS13). Applications are available aG the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special 24-hour ~
answering service for forms ordering:'l-800-36Z-ZO50; servicesfor taxpayers aith special hearing and / ~r
-speaking needs: 1-800-447-3010 (TT only).
Any party in interest not satisfied mith the appraisemsnt, alloaance, or disallomrance of deductions, or assessment
of tax (including discount Or interest) as shown on this Notice must object mithin sixty (60) days of receipt of
this Notice by: .
--mritten protest to the PA Department of Revenue, Board of Appeals, Dept. 181021, Harrisburg, PA.17128-1021, OR
--election tn have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' CoHrt.
rectum! errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes~ ATTN: Post Assessment Reviee Unit, Dept. 280601, Harrisburg, PA 17128T0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a ReSident
Decedent" (REV-1501) for an explanation of administratively correctable errors. '.
If 'any tax due is paid aithin three (3~'calendar months after the decedent's death, a five percent (51) discount of
the tax paid is alloaed.
The 151 tax amnesty non-participation pen~lty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day pfter the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner end in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice. * '
Interest is charged beg~nnlng aith first day of delinquenoy~ or nine (9) months end one (1) day fram the date of
death, to the date of payment. Texas ahich become delinquent before January 1, 198Z beer interest mt the rate of
six ~61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent an and after
January 1, 1981 Hill bear interest at a rate which mill vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. 'The applicable interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest
Year Rate 'Factor Year Rate Factor Year Rate
1982 201 .0005~8 1987 9Z .000247. 1999 7Z
1983 161 .000~38 '1988-1991. 111 .000301 logo BZ
198~ IXZ .000301 1992 9Z .O00Z~7 ZOOl 9Z
1985 131 " .000356 1993-199~ 7Z .000192 ZOOZ 6Z
1986 IOZ .00027~ 1995-1998 91 .000147 2003
Daily .
Factor
.000191
.000219 '
.000147
.000164
.000137
--Tnterest is calculated as follows: ~ r
XNTEREST = BALANCE OF TAX UNPA'rD X. NUNBER-OF BAYS OE~ZNQUENT X DA'rLy XNTEI~EST FACTOR
"--Any Notice issued after the tax'becomes delinquent mill rtlflect an interest calculation to fifteen (15) days
beyond the date of the assessment. Tf payment is made after the interest computation date sho~n on the
Notice, additional interest must be calculated.
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE.-IF ESTATE IS NOT COMPLETED, FILE a 6.'12 FORM
YEARLY UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: SHIRLEY FAYE SCOTT COOK
Date of Death: NOVEMBER 22~ 2001
Will No.: 21-02-00026 Admin No::
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the'
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Date:
Yes X No
If the answer is No, state when the personal representative reasonably
believeS that the administration will be complete: .
If the answer to No. 1 is yes, state the following:
A. Did the personal rePresentative file a final account with the Court?
Yes No X
B. The separate Orphans' CoUrt No. (if any) fo~ the personal
representative's accoun't is:.. '-' ,, ... · . ' .... :~
c. Did the personairepresentative state an account informally to the
parties in interest? Yes X ' ' ' No
D. Copies of receipts, releases,'joi'nders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans;
Court and may be attached to this report..
~' Signatu"re -/ '
Ralph H. Wright, Jr.
Johnson, Duffle, Stewart & Weidner
301 Market Street, P.O. Box 109
Lemoyne, PA 17043-0109
Address
Capacity:
(717) 761-4540
Telephone No.
Personal Representative
'X' COunsel for Personal Representative
BUREAU OF TNDTVTDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171Z8-0601
CONHONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF'ACCOUNT
'03 ~'[ 27 ,~9':~-8 COUNTY
RALPH H WRIGHT JR ESQ ACN
JOHNSON ETAL
DATE .
ESTATE OF
DATE OF DEATH
FILE NUMBER-
09-29-2005
COOK
'11-II-ZOO1
21 02-0026
CUMBERLAND
101
Amoun~ Remi'~'l:ed
SHIRLEY F
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO' COURT HOUSE
CARLISLE', PA 17015
NOTE: To insure proper credi~ to your account, submit ihs upper portion of this form ~ith YOUr.tax paymont.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
· .:
ESTATE OF COOK SHIRLEY F FILE NO. 21'02-'0026 ACN 101 ' DATE 09-29-2003
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHONN BELON
ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE. -.
DATE OF LAST ASSESSMENT OR .RECORD ADJUSTMENT: 09-01r2005
PRINCIPAL TAX DUE: .........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
6,581.29
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
O2-1$-ZOOZ
10-10-2002
08-06-2005
09-15-2003
CD000860
REFUND
CDOOZ877
REFUND
315.79
.00
9.Z5-
.00
6,000.00
135.79-
219.11
8.57-
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR),
TOTAL TAX CREDIT 6,381.29
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
. PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT ~ECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT.
-- If NON-RESIDENT DECEDENT' make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND [CA): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance, and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 'g3 Revenue District Offices or from the DepaPtaent's Iq-hour
ansmering serv~c~ ~or forms ordering: l~BO0-36Z-ZOSO~ services for taxPayers with specJ*al hearing and / or
speaking needs: 1-800-fifi7-30ZO (TT only).
REPLY TO:
DISCOUNT:
PENALTY:
INTEREST:
guestions regarding errors contained on. this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessm&nt Reviem Unit, Dept. 280601, HarriSburg, PA 17128-0601, phone
(717) 787-6505.
If any tax due is paid mithin three ($) calendar months after the decedent's death, a five percent (SI) discount
of the tax paid is allowed.
The 15Z tax amnesty n~n-parti~ipation .penalty is computed on the total' of the= tax and interest assessed, and not
paid before January 18,'1996, the first day after th~ e~d of the tax amnesty period.*
Interest is charged beginning with first day of delinquency, or nine (9) months and'one (1) d~y. from the daCe. Of
death~ to the date of payment. Taxes ~hich became delinquent before January l, 19&Z bear interest at the rate of
six (BI) percent par annum calculatad at a daily rate of .00016q. AIl taxes ~hich became delinquent on and after
January 1, 19&Z mill bear interest at a rate which ~ill vary from calendar year'to calendar year with that rate
annaunced by ithe PA Department of Revenue. Th applicable interest rates for 19DZ through 2003 are:
Daily . Interest Daily Interest Daily
Factor Year Rate Factor Year Rate Fa~tor
Interest
Year Rate
198Z ZOZ .0005q8
1983 167. . O 00438
198q 11Z .000301
1985 13Z ' · .000356
1986 IOZ .... OOOZ7~
--Interest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPAID
--Any Notice
beyond tho
19871 97. .O00Zq7 1999 7Z .00019Z
1988L1991 117. .000501 Z000 87. .OOOZ19
_ 199~ ........... 9Z .q002~7 .... ZOO1 97. _ ._-O00Z~7 _.
1993-199~ 77. .000192 2002 62 .00016~
- 1995-1998 92 .O00Z~7 2003 5Z .000137
NUIfBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
issued after the tax be'comes delinquent alii reflect an interest calculatioh' to fifteen.tiS) days
da~e of the assessment. ~f payment is made after the interest computation date sho~n on the
Notice, additional interest must be calculated.