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HomeMy WebLinkAbout04-15-09J 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 Po Box.z8osol 0~ X353 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 161 40 0832 06 17 2008 02 19 1949 Decedent's Last Name Suffix Decedent's First Name MI COOVER SR. STEVEN L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI COOVER MARY L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X ~ 1. Original Return 4. Limited Estate g Decedent Died Testate - (Attach Copy of Will) 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-122) 7 Decedent Maintained a Living Trust (Attach Copy of Trust) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes I~ 9. Ldigation Proceeds Received ~ 1 D. Spousal Poverty Credit (date of death I] 11. Election to tax under Sec. 9113(A) between 12-31-91 and i-1-95) (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY A. WEIGLE ESQUIRE 717 532 7388Q n o Finn Name (If Applicable) C © `O ~' *~'~ REGISTER OFJ1 USF~NLY - ~ '~ WEIGLE & ASSOCIATES, P.C. - ~ r ~ i .'1 First line of address ,,,~ ~ tat _ 3 C:) 126 EAST KING STREET `~'~~C'_-3 `~^~'`~-~ i C~~_ - y } Second line of address - ~7 _.. --~ .. O ~~ City or Post Office DATE FILED State ZIP Code SHIPPENSBURG PA 17257 Correspondent's a-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. cin_~inri goo nc oroc.,.~ .,.-~.,... ~....,. ~ ~.... ~.. ..... ___.._-. ADDRESS / 172 Kline Road, Shippensbur , PA 257 SI TURE OF PREPARER OTHER THAN REPR EN N DATE Jerry A. Weigle Esquire .7 ~ 2 ~ ~~ 12'6 East King Street, PA 17257 Side 1 1505607120 1505607120 J C, D 1505607220 REV-1500 EX Decedent's Name: SteVerl L. Coover Sr. 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) ................................_.................... .... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............ .... 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .......... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ........... .. 7, 8. Total Gross Assets (total Lines 1-7) .............................__.............................._... .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H) .................................... .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................... ..... 10. 11. Total Deductions (total Lines 9 8~ 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. Decedent's Social Security Number 161 40 0832 5,500.00 5,500.00 8,876.00 70.00 8,946.00 -3,446.00 -3,446.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .00 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 16. 0 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0 0 0 19. Tax Due ........................................................... .................................................. .. 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 15D5607220 J REV-1500 EX Page 3 File Number 21 -- Decedent's Complete Address: DECEDENT'S NAME Steven L. Coover Sr. STREET ADDRESS -- - - 172 Kline Road CITY - STATE ZIP Shippensburg PA 17257 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 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theDVERPAYMENT. (q) Check box on Page 2 Line 20 to request arefund - 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) ~ . Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................ . i b. retain the right to designate who shall use the property transferred or its income :................................ c. retain a reversionary interest; or ..............................._............................__............................._................ , ~ ~, i i~ d. receive the promise for life of either payments, benefits or care? ................. ~. ~ Imo, .......................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ _ ...._......, ~~ IX~ 3. Did decedent own an "m trust for" or a able u on death bank account or secunt at his or her death?......... P Y P ' y ~ IX~ 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. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exemota 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. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ` Rev-1508 EX+~6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC, PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Coover, Steven L. Sr. 2~-- 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. (If more space is needed, additional pages of the same size] Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ' REV-1151 EX+ (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Coover, Steven L. Sr. 21__ Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 8,786.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Weigle & Associates, P.C. 75.00 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. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 8 876.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Coover, Steven L. Sr. 21 __ ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Fogelsanger-Bricker Funeral Home 2 Spring Hil Cemetery -plot H-A Subtotal Other Administrative Costs 3 Register of Wills, Cumberland County -filing Insolvent PA Inheritance Tax Return H-B7 Subtotal 8,086.00 700.00 8,786.00 15.00 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) 'Rev-1512 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Coover, Steven L. Sr. 21-- Include unreimbursed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) ' REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Coover, Steven L. Sr. 21 __ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE Do Not List Trustee s) (Words) ($$$) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Not relevant as estate is insolve t. Tota I Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cover sheet 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 II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98)