The URL can be used to link to this page

Home My WebLink About04-21-09 (2)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 0 8 0 1 0 14 PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 19 2008 06 15 1919 Decedent's Last Name COX (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number Suffix Decedent's First Name MI GLADYS M Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW XD 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ qa. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) X^ g Decedent Died Testate (Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10• between 12 31 91 antlit'datge5jf death ~ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY R. DUFFIE (717) 761 4540 Firm Name (If Applicable) JOHNSON, DUFFIE, STEWART & WEIDNER First line of address 301 MARKET ST. Second line of address PO BOX 109 City or Post Office LEMOYNE Correspondent's a-mail address: State ZIP Code REGISTER OF ~LLS USE Of~RY ^ S__) s? ': Se s~~ 7 :; rv ,,.i ~ "'t7 DATE~tL~D f~J PA 17043-0109 ~_.~ __.I under penalties of pequry, 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. ~, DOROTHY A. BELL " LANE, STREETSBORO, OH 44241 ICN RF DRFCFf.ITATI~iF MARKET ST., Lemoyne. PA 17043-0109 Side 1 1505607120 1505607120 ~,~tt,~t t11 ttn~ ~E,~tttment oe ~ OO f~~ (~ltt~~,s ~i. Cnn~ I, GLADYS M. COX, of East Pennsboro Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I direct that all my legal debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expenses of the administration of my estate. I bequeath my household goods and personal effects and other tangible personalty of a like nature (not including cash or securities), together with any existing insurance thereof, to my son, WARREN LEROY COX, and my grandchildren, DOROTHY A. BELL, DAVID L. COMFORT, CHERYL L. GODSEY, KENNETH E. COMFORT, VIRGIL L. BEASTON, VICKY L. WOOD, LAURA K. McMILLAN and TARA J. TAYLOR, to be divided among them by my Executrix with due regard for their personal preferences, in as nearly equal shares as practical. III. 1 devise and bequeath the residue of my estate of every nature and wherever situate as follows: A. One-third (1/3) thereof to my son, WARREN LEROY COX. 1505607220 REV-1500 EX Decedent's Social Security Number oeceaenrs Name: G L A D Y S M. COX 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. 161,662.00 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............ . 6. 1 7 , 6 2 0 7 9 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............ . 7, 8. Total Gross Assets (total Lines 1-7) ...................................................................... . g. 1 7 9, 2 8 2 7 9 9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 16,035.17 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 2,751.67 11. Total Deductions (total Lines 9 8 10) .................................................................... .. 11. 1 8, 7 8 6 8 4 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12. 160, 495.95 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. 1 6 O , 4 9 5 9 5 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 .o0 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable 16 0, 4 9 5 9 5 at lineal rate X .045 16. 7, 2 2 2 3 2 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. 7, 2 2 2 3 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-01014 DECEDENT'S NAME GLADYS M. COX STREET ADDRESS MANOR CARE 1700 MARKET STREET CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable p. Interest E. Penalty 6,500.00 342.11 Total Credits (A + B + C) (1) 7,222.32 (2) 6,842.11 (3) (4) (5> 380.21 (5A) (5B> 3 8 0.21 Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT . .. , .~ .. ~. ,,,( 4 ,_ ~. _.~ ~•~' .." ..,f ' ..-~.. 'S.p,: ~~ 1.~. .' S~,""~ (^4. ~~ I~h ~41~i'~ .4 +;~~r r vl.'. Y k.~~. ~4 ~.~~ 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 its income :.................................... ^ c. retain a reversionary interest; or .................................................................................................................. ^ ^x 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? ....................................................................................................................... ^ ^x 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? ...................................................................................................................... ^ ^x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. R ~~x~ ~;'s ~w.'.. .r'} s~?i,v - .~~ .;., ,T '_b ;:~?'1~ ~., ~":. ~~~ St,ry,~ e'~~~dr :rt';} .~j~~~a For dates of death on or after July 1, 1994 and before January 1, 1995;the tax rate imposed on the net value of transfers to or for the use of the ' surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and 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) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER COX, GLADYS M. 21-08-01014 InGutle the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right oT survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Blue Shield Medigap Blue -premium refund 372.52 2 M8T Bank -Select checking account with Interest. -Account No. 00000002431878. 5,121.06 Date of death balance, plus interest. 3 M&T Securities, Inc. - MTB Money Market Fund Class A2 -Account No. 44,108.89 AZD-494847. Date of death, plus accrued interest. 4 PSECU -Certificate No. 8004000000-51 -Date of death balance, plus accrued 18,335.89 dividends. 5 PSECU -Certificate No. 8004000000-53 -Date of death balance, plus accrued 20,003.64 dividends. 6 PSECU -Certificate No. 8004000000-55 -Date of death balance, plus accrued 10,817.30 dividends. 7 PSECU -Certificate No. 8004000000-56 -Date of death balance, plus accrued 16,175.40 dividends. 8 PSECU -Certificate No. 8004000000-62 -Date of death balance, plus accrued 25,170.68 dividends. 9 PSECU -Certificate No. 8004000000-63 -Date of death balance, plus accrued 21,551.34 dividends. 10 PSECU -Share Account NO. 8004000000-01 5.28 11 Household Goods -Paragraph II of Will - Adeemed. 0.00 TOTAL (Also enter on Line 5, Recapitulation) I 161,662.00 (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-1609 EX+ (6.98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER COX, GLADYS M. 21-08-01014 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. Dorothy A. Bell 2151 Meadowsweet Lane Granddaughter Streetsboro, OH 44241 B C JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 10/15/2004 M8T Bank -Certificate of Deposit No. 35 241.58 50 000% 17 620 79 031003913324940 -Date of death , . , . balance, plus accrued interest. TOTAL (Also enter on Line 6, Recapitulation) I 17,620.79 (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 F (Rev. 6-98) REV-11b1 EX+(12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER COX, GLADYS M. 21-08-01014 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions DOROTHY A. BELL Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 2151 MEADOWSWEET LANE City STREETSBORO State OH Zip 44241 Year(s) Commission paid 116.00 7,818.00 2. Attorney's Fees JOHNSON, DUFFIE, STEWART 8. WEIDNER 7,500.00 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 318.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 283.17 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 16,035.17 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 COX, GLADYS M. 21-08-01014 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hoover Funeral Home -balance not covered under prepaid arrangement. 116.00 H-A Subtotal 116.00 Other Administrative Costs 2 Cumberland Law Journal -Legal Advertisement 75.00 3 Register of Wills -file Inventory and Inheritance Tax Return. 30.00 4 Register of Wills -reserve -additional probate charges. 30.00 5 The Patriot-News -Legal Advertisement 148.17 H-B7 subtotal 283.17 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER COX, GLADYS M. 21-08-01014 Include unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Camp Hill Fire Company -Basic Life Support/Emergency 849.00 2 Checks that cleared after death - M8~T Account No. 24341878 -Check #1538 -See Right Pharmacy- $3.59; #1539 -Helen Jones -Caregiver - $132.00; #1540 -Jackie B. Chie -Caregiver - $55.00; #1541 -ManorCare -Haircut - $26.00; #1542 -Tammy Spangler - helper to move decedent's items from Country Meadows - $200.00; #1543 -Shane K. Cox -move decedent's items into ManorCare - $200.00; #1544 - Lane F. Cox -Caregiver - $200.00; #1545 -Carroll R. Cox -Caregiver - $200.00. Dorothy A. Bell -Unpaid Expenses under Power of Attorney - 8/2008. - Radisson Hotel - $339.,00; Mileage -Ohio to Camp Hill - 309 miles @ 58.5 - $180.77; Camp Hill to Ohio - 309 Miles @ 58.5 - $180.77; telephone charges - $92.04 4 ~ Visiting Angels -unpaid private duty care. 1,016.59 792.58 93.50 TOTAL (Also enter on Line 10, Recapitulation) I 2,751.67 (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) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~~, ~~P-u r s m. 21-08-0 1014 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) Do Not Llst Trustees I. TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Virgil L. Beaston Grandson One-twelfth 701 N. Illinois Street Residue Arlington, VA 22205 2 Dorothy A. Bell Granddaughter One-twelfth 2151 Meadowsweet Lane Residue Streetsboro, OH 44241 3 David L. Comfort Grandson One-twelfth 44171 Mimosa Lane Residue California, MD 20619-2082 4 Kenneth E. Comfort Grandson One-twelfth 10121 Dyer St., Space 22 Residue EI Paso, TX 79924 5 Warren LeRoy Cox Son One-third 1819 NW 38th St., Suite B Residue Oklahoma City, OK 73118-2820 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0,00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J Tne BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: GLADYS M. COX 09/19/2008 204-03-5148 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) ti ~neryi L. Godsey Granddaughter One-twelfth Residue 3050 Thrower Road Hope Mills, NC 28348 7 Laura K. McMullen Granddaughter One-twelfth Residue 2387 Adamsville Road Zanesville, OH 43701 8 Tara J. Taylor Granddaughter One-twelfth Residue 1068 South Luck Avenue Zanesville, OH 43701 9 Vicky L. Wood Granddaughter One-twelfth Residue 701 N. Illinois Street Arlington, VA 22205 Total 1