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HomeMy WebLinkAbout06-17-09J 1505607121 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA DepeMrentdRevenue County Code Year File Number euraeudlndividualTaxes INHERITANCE TAX RETURN Po Box 2BO5at 2 1 0 8 1 0 4 3 Hertbbu PA 77128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 0 1 4 2 0 0 8 0 2 2 0 1 9 3 8 Decedent's Last Name COY Suffix Decedent's First Nama C H R I S T Y MI H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffer Spouse's First Name Spouse's Socal Security Number FILL IN APPROPRIATE OVALS BELOW © i. Original Retum ^ ^ 4. Limned Estate ^ ® 6. Decedent Died Testate ^ f Will MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Ratum ^ 3. Peon e'~ond2 1382) (date of death 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) (Attach COPY o ) ^ 9. LRigaBOn Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 72-31-91 and 7-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTK)N BWST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION BHOULD BE DIRECTED TO: Name Daytime Telephone Number Fenn Nama (If Applicable) REGISTER OF WILLS USE ONLY c J - First line of address L ~ n Z - r > ~ `•) ~~ r-' e~T-rr r ' +'f°1 G7 j~ ~.1 J s.:.7 Sewnd line of address ~ ~O Z + ,~`'~ sy ' OC -_ 'L~ILED - - ~ '. t'ri City or Post Office Stale ZIP Code - , O „ ,,. 7 y 15056'07121 Side 1 1505607121 ~5 \~ x~ ~ V ~~ 1505607221 REV-1500 EX Decedent's 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 ReceNable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 8. Jointty Owned property (Schedub F) ^ Separeta Billing Requested ....... 8. 7. Inter-Vivos Trenafere 8 Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Grose Assets (total Linea i-7) ........................... 8. 45145,80 93192,03 1 3 8 3 3 7, 8 3 9. Funerel Expenses 8 Administrative Costs (Schedule H) ................ 9. 8 4 1 8 , 0 0 10. Debts of Decedent, Mortgage Liabilftias, & Liens (Schedule I) ............ t0. 1 1 1 2 , 3 3 11. Total Deducdons (total Lines 9 & 10) ........................... 11. 9 5 3 0 , 3 3 12. Net Valus of Estate (Line 8 minus Line 11) ......................... 12. 1 2 8 8 0 7 , 5 0 13. Charitabb and Governmental Bequests/Sec 9713 Trusts for which an eleUion to tax has not been made (Schedule J) .................. 13. , 14. Net Value Subset to Tax (Line 12 minus Line 13) ........... ..... .. 14. 1 2 8 8 0 7 . 5 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable et lineal rate x .045 1 2 7 9 1 7, 3 3 76. 5 7 5 6. 2 8 17. Amount of Line 14 taxable at sibling refs X .12 0. 0 0 77_ 0, 0 0 18. Amount of Lina 14 taxable at collaterel refs X .15 0. 0 0 78 0, O Q 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 5756.28 Side 2 L 1505607221 1505607221 J REV-7500 EX Pape 3 Decedents Complete Address: File Number 21 08 1043 DE6EDENTSNAME - CHRISTY H. COY STREET ADDRESS -- 9RIDGE ROAD CITY SHIPPENSBURG STATE Zlp PA 17257 Tax Payments and Credits: 1 Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Pdor Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 5 756 28 Total Credits (A +B +C) (2) o.oo Total InleresUPenalty (D+E) (3) 0.00 4. If Line 2 is greater than Une 1 +Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Page 2, Line 20 to requeM a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5,756 28 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (SB) 5 756 28 Make Check Payable to: REGISTER OF WILLS, AGENT 'Eii((i~{` ~41~1~{))~~' .. r,..; ll . ~r;~~~~i~ l~hl' it~[s! 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 propeAy transferred : .............................................. ^ .................. b. retain the right to designate who shall use the property transferred a its income : ......................... ...... ...... ^ c. retain a reversionary interest; or ................................................................................ ^ .......... d. receive the promise to life of either payments, benefits a cere7 ................................................. ...... ...... ^ 2. If death occurred after December 12,1962, did decedent transfer property within one year of death without receiving adequate conaiderefion? .................................................................................. ..... ^ 3. Did decedent own•an'in tmst for' a payable upon death bank account a secudty at his or her death? .... ..... ^ ^X 4. Did decedent own an Individual ReOrement 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. I{~IIl~1){~E~~iii~~ ~. iId. ~ ~i~ ~ ~ _~~i~~N~i~Iii! For dates of death on or after July 1,1994 and beTore 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 [/2 P.S. §9116 (a) (1.1) (i)]. Fa dates of death on or after January 1,1995, the tax rate imposed on the net value of ransfers to or to the use of the surviving spouse is zero (0) percent [/2 P.S. §9116 (a) (1.1) (ii)J. 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 'd the surviving spouse is the only benefdary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of Vansfers from a deceased child twenty-0ne years of age or younger at death to a for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [/2 P.S. §9116(a)(1.2)J. The tax rate imposed on the net value of transfers to or fa the use of the decedent's lineal benefidades is far and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)J. The lax 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)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in wmmon with the decedent, whether by blood a adoption. REV-1502 EX ~ (e-99) ' ` SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERRANCE TAx RETURN RESIDENT DECEDENT OF All real property owed solely or u a tsurt In Common mut be reported rt hH market value. ezcharged betsvrerr a wiNirg lwyer end a wding seller, nekher being comoeXed to lwv or market value b deferred lwtll havMg rusorlable wn prepeny wauid ere relevant fads. ITEM VALUE AT DATE NUMBER nccroionnn~ ____.__ AND 1/3 ACRE LOT IN SOUTHA iYLVANIA,#39-16-0224-015 USED VALUE 35830 x 1.26 CLRF 45,145.80 TOTAL (Also enter on line 1 Recapilulahon) I S 45 145 80 (If more space b needed, Insert eddkbnal sheets of the same size) REV-1509 EJ(~ (8-9a) ' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERRANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUM CHRISTY H. COY 21 08 Include theyyreceeds of Iltlgatbn and the date the proceeds were received hY the estate. All property pirltly~ovmed vvllh rlpM of wnNorehip mast bs dkcbssd on SehsduN F. ITEM NUMBER DESCRIPTION 1. Refund from Embarq 2. Adams Electric Co-op Patronage Dividend 3. Orrstown Bank Savings Account#16689 4. Orrstown Bank Checking Account No. 526479 5. Refund from Postal Money Order 6. 2004 Chevrolet 7. State Farm (refund on auto policy) 8. Refund to Estate from IRS AT DATE DEATH 15.52 55, 063.56 24,119.62 32.50 12,920.00 78.00 949.91 TOTAL (Also enter on line 5, Recapitulation) ~ f more space is needed, Insert additlonal sheeb of the same sire) REV-1511 EX t (1a-0e) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS rlLC nUM6CK CHRISTY H. COY 21 08 1043 Debt of dacedaM moat be sported on Schedub I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fogelsonger-Bricker Funeral Home 6,366.00 2. Parklawns Memorial Gardens 285.00 B. 1. 2. 3. 4. ADMINISTRATIVE COSTS: Personal Representatlve's Commissions Name of Personal Repreaenbdve (s) StreetAdtlress City Year(s) Commiaebn Pall: State Zip Adonrey Fees Famlty F~cemptlon: (If decedents address is not the same as daimanra, atbdl ezpbnefbn) Claimant Seeel Address CtlY State _ Rebtlonahip of Claimant to Decedent Probate Fees 5 Aaounfanrs Fees 6. Taz Rehm Preparefs Fees 7. Zip 1,500.00 267.00 TOTAL (Also enter on line 9, Recapitulahdn) I S (If more space b needed, InseR additional sheet of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANW INHERRANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS CHRISTY H. COY 21 08 1043 Report debts Incurted by fhe deeadeM prior to death which remained unpaid as of the date of death, Including unreimbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Adams Electric Co-Op 198.84 2. State Farm Insurance Company 3. 4. State Farm Insurance Company 5. (Auto Zone (parts to prepare truck for sale) 6. Vivian Coy-tax collector taxes on estate real property 7. A&A Rolloffs (Dumpster for Estate) (H more space b needed, TOTAL (Also enter on line 10, Recapitulatlon) I S lets of the same size) 392.39 27.86 34.82 82.86 90.56 285.00 REV-1513 EX a (g-0°) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE J BENEFICIARIES ESTATE OF CHRIST Y H. COY 21 08 1043 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llat Trustoe(a) AMOUNT OR SHARE OF E I TAXABLE DISTRIBUTIONS [Indude Mappoousal tlistributiona, and transfers under Sec. 9116 (a (12)] STATE 1. Lisa C. Coy Lineal P.O. Box 119 50% Scotland, PA 17254 2. Teresa S. Coy Lineal 1258 Ashton Drive 50% Shippensburg, PA 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S pt more space Is needed, Insert atltlttional sheets of the same size) ~ " Z ~~ ~ t ~' ~ G~~ ti 0 ' aim.Pist o ,aa~ a~tc eQ _ ~ ~ . ~- -_~., -, ;~ _ ,, ,,=; -a ~ ~_, L ~ N O C'i I, CHRLSTY H. COY, of Southampton Township, Cumberland County, Pennsylvania, being of sound mind and memory declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. TI'EM I: I direct that all my just 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 administration of my estate. ITEM II: I give, devise, and bequeath all of my estate of every nature and wheresoever situate to my issue per stirpes living on the thirty-first day following my death, share and share alike. ITEM III: I appoint LISA C. COY and TERESA S. COY co-executrices of this my ~tigi~~ m~ar.~,~n.., ~..~.., ~r,ro, ») ara.vns Last Will and Testament. ITEM IV: I direct that my co-executrices or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on two (2) sheets of paper, dated this day of MARCH, 1996. _ (SEAL) CHRLSTY COY The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the testator, CHRLSTY H. COY, was on the day and date thereof signed, published and declared by CHRISTY H. COY, the testator herein named, as and for his Last Wffi, in the presence of us, who, at his request, in his presence, and in the presence. of each other, have subscribed our names as witnesses hereto. ~`~72~ residing at _~~ cz. , O'er` " ` residing at ~~~'r.~ i ~ //~ 2 dWEAL~ TH~ ~O~F~PENNSYLVANIA OF Ccr~~C~ : SS We, CHRISTY H. COY, the testator, and the undersigned witnesses to, the will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the testator, do hereby acknowledge that I signed the instrument as my will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testator sign and execute the instrument as his will, that he signed it willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the will as a witness and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. CHRISTY H. OY T b~ ~- Subscribed to and subscribed or affirmed and acknowledged before me by CHRISTY H. COY, the testator and the witnesses whose names aze signed above this /_S ay of MARCH, 1996. ~ ~1~~ ~~ otary Pu 'c Notarial seal Sally J. Winder, Notary PuhMc Shtppen y rp Twp ~ Cumberland County My Commission Expires Feb. 13, 1999