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HomeMy WebLinkAbout10-29-0915056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 1 ~ ~1 j I ~"'v ~~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT Q Ll t ~J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 293-18-9437 11 /13/2007 08/10/1913 Decedent's Last Name Suffix Decedent's First Name MI Coons Maudie C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED iN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return " 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of WIII) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Lynn L Reed (717) 263-8361 Firm Name (If Applicable) REGISTER OF WILLS USE ONi`YJ - r, _:r VrJ - ~ - - ~ ~. -_ First line of address : ~. r , "; c""") M-Wi ~ .. t 1318 Brechbill Rd ~ , `. i - -~ . ua ' '!.~~ Second line of address .. r- ..-~ -"7 -- - t City or Post Office DATE FILED _.... State ZIP Code =`rj ~,- - ~' Charmbersburg Pa 17202 -~ ~ Correspondent's e-mail address Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct an plete lar eparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR SON S R FILING RETURN DATE <-r -~o~ _yx ~ ~ __~J C.yCy ADD S ~~ ,.-s'`tJ~ -~ <' ~'~~ ~~ 99 ~ ~ , ~ ~1(]! i~ b c? ;r.-C~j a.l fYj ~ ~ l ~~ . t? DATE SIGNrATU~RE OF PREPARER OTHER THAN REPRESENTATIVE ( ~ l '~.~~~...~ V ~yX ~ :.~.t~.~-~sz-~ ~ -`~-- 1. ADDRESS ~ + _ (/}~ n ONLY !___ 15056051058 Side 1 15056051058 ..1 REV-1500 EX 15056052059 Decedent's Name iViBUdle C COOn$ 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 & 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. 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 .0 _ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 13,948.99 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 4,649.67 ~R 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 Decedent's Social Security Number 293-18-9437 28,649.40 -20,073.97 10,023.23 18, 598.66 18,598.86 627.70 697.45 1,325.15 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Maudie C Coons 293-18-9437 STREET ADDRESS 102 Hollenbaugh Rd. CITY STATE ZIP Carlisle Pa 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable 90 19 D. Inkerest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Llne 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT 1, 325.15 0.00 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 :.................................................................................... ...... ^ ^x b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... ....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................. ....... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS lS YES, YOU MUST COMPLETE SCHEDULE G AND FILE {T 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 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 stiil applicabVe 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)]. Asibling 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-1503 EX+ (6-98) ~.` ~ Y SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All property jointlyowned with right of survivorship must be disclosed on Schedu{e F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) Y COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FfLE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. Afl property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) >~ ~ _~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 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' Terri L Coleman PO Box 70966 Fairbanks, Alaska 99707 Daughter B C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE PAADE JOINT DESCRIPTION OF FR~C~PERTY INCWD'c NAME pF FINANCIRL INSTITUTION AND BANK ACCOUNT NU'NBER OR SIMILAR IDENTIFYING NUMBER. ATTACH GEED FOR JOINTLY-l1ELD REAL ESTATE. DATE OE DEATH VALl1E OF ASSET `~ OF DECD'S fNTEREST DATE OF DEATH VALUE OF DECEDENTS WTEREST ~ A. __ rolled from a joint acct made joint in 96- orrstown checking 20,046.45 50 10,023.23 TOTAL (Also enter on line 6, Recapitulation) S 10,023.23 (If more space is needed, insert additional sheets of the same size) Wagner's Tax & Accounting Service 34o E Louther St, Suite i Carlisle, Pa i~oi3 ~717)243-g314 To: Pa Dept of Revenue Re: Estate Supplemental Return For Maudie C Coons estate F~C717)243-0266 This supplemental return is being filed to correct two situations. The first is an omission of Series E Bonds that were not promptly reported To us from Orrstown Bank. Enclosed is a listing of this bond income which Needs to be included in this filing. Next is a CD that was originally reported on Schedule E from Orrstown Bank. This CD vas in fact in joint names and should have been reported on Schdule, F as Jointly owned property. As such, we are reducing the figure on Schedule E by 20,073.97• We are then adding this to schedule F which then causes $io,o23.23 to be taxable. After netting these changes, we are providing you with the attached supplemental Return. 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N J .v N G ~ c ~ a~ fl.~ o ~ c o ~ w- '~ -cs N ~n coo d N N" N ~ y o ° ~ ~ ~~ W ~ , zza p ~ ~. o s / 17 / 07 ~~,. _ 7 MoNTl3ts -~ ., Certificate of I3eposit Account Number: __ 4 0 0 0 018, 8 6 5 Amount of , Depceit: Twenty thousand rx no/ 100 ~ 2 0 , 0 00 _ 0 0 Thffi Time Deposit ~ Issued to: Issuer: • Maudie C Coons Terri Lynn Coleman 102 Holienbaugh Road Carlisle PA 17013-9715 Nat Negotiable -Not Tra>osfei<•able -Additional terms are below. Tax ID; 293-18-9437 N~~.; 4000018865 Orrstown Bank 427 Village Drive Car ~ i~A 37013 B zinelda Stevison Additional Ternns and Disclosures This form. ,contains the terrns for your time deposit. ;.Ii is also. ;the M~ui~um Balance Iiequfr~emeut: You-must make a minimum deposit to Truth-in-Savings disclosure for those deposioors entikled to one. 3`tiere , are additional terms. and disclosures on page two of this form, some of ~ this,acco~int of $ ~ 2 , 0 A 0.0 0 which explain or expand on those below. You should. keep one copy of ~ Yon must ~, ~ ~~ balance on a dYis form. ' - daily basis: to earn the Maturity Date: This account.matares 0 3 / 17 / 0 8 annaal:percenrage yield disclosed. (See below for -recewal information.) Withdrawals oT' Interest: Interest ^ accrued ' ~ cred8ed daring a 1•I'~o~afion: The interest ram for this account is S . 00 ~ term'can tie withdrawn:.:: ~Y' Ti:me After Crediting To wig an annual percentage yield of 5.0 0 %. This rate will be paic~f-i~1 the maturity.date specified above. Interest begins to accrue on the business day you deposit any noncash item (for examp}e, a check). Interest wt71 be cvm~omaded . Interest will be credited And Deposited to Account # 706001811 Every month ® The affiual percentage yield assumes that interest remains on deposit until mahuity. A.withdrawal of interest will reduce earnings. ^ If you close your account before interest is credited, you will' not receive the accrued interest. The NUI~ER OF ENDORSEMENTS needed for withdrawal or any other purpose is• 1 The Account `During The Current Term Early Withdrawal Penalty: )f„we consent to a request for a withdrawal that is otherwise not permitted you Y~ay have to pay a penalty. The penalty will be an amount equal to: three moi3.ths Renewal Policy: ^ Single. Maturity: If checked,. this accoum wi71 :not automatically renew. Interest ^ wiIl ^ will not accrue after maturity. ~ Automatic Renewal; If checked, this account .will automatically renew oa the maturity date., {see,page two for ternts) .Interest ~:wi'II ^ will not accrue after final maturity. interest on the amount withdrawn: ACGQUNT OVVNER55ffiP: You have requested and intend the type of account marked below. ^ Individua] ~ Joint Account -Willi Survivorship ~~~° ^' Joint Account= No Survivorship c•• ~ m > ^ Trust: Separate Agreement Dated ^ Revocable Trust Designation as defined in this agreeir}ent (Beneficiaries' names and addresses) BACKUP WITHHOLDING CERTIFICATIONS ~; 293-18-9437.. ® Taxpayer I.D. Number -The Taxpayer Identification Number shown above ('I'IN) is my correct"taxpayer idescation number. ® Backup WiWholding - I am not subject to backup withholding either because I have not been notified that>L-am.subject to .backup vn ~ a result of a failure to report all t or dividends, or the Internal Rev" Service has notified me that I am no longer subject to backup withholding. ^ Exempt Recipients - I am an .exempt recipient under the Internal lievemie Service Regulations. A provision for my signatare, oest~iqug under penalty of perjury the status checked in this section and that I am a U.S. person {inclndiag a U.S. resident alienj, is contanned on the 6'ast copy of Phis certificate. ONLY WHEfI YOU R$QUEST WITHDRAWAL ~~ior~i : O 1993 Bankers Systems, (nc., St. Cloud, MN Form CD-A~-/~j?~j {71 1/3/2001 X X REVD PAGE TR'O FOR ADDI'T'IONAL TERMS Ivaye ~ o~ 10/29/09' ~, Maudie C Coons Terri Lynn Coleman 1318 Brechbi,~l_ _mRd Chambersburg PA 17202 Redeemed Transfer Current balance: Accrued interest: Penalty amount: Current cash value: Issue date: Original balance: Time Deposit to New CD @ Orrstown .00 .00 .00 .00 3/14/07 20,000.00 Last payment date: 8/20/07 Last renewal date: 8/14/07 Last renewal balance: 20,000.00 Date redeemed: 8/20/07 Interest pmt freq: 1 M Interest disposition: Deposit F1=Addl functions F2=Image FS=History F6=Messages ,. .._._. ~ . ~, ', v~ ~! ro Inquiry page 1 of 5 12:03:24 CIF number: BERTHA 0001054 Phone:(H) (717) 263-8361 Birth date: (B) (000) 000-0000 8/10/1913 Tax ID number: 293-18-9437 C/D type: 63 03-05-Mon th Income Account number: 4000015619 Bank Has messages 1 of 1 Certificate no: Interest rate: 3.700000% APY: 3.70% C/D term: 5 M Maturity date: 1/14/08 Hold amount: .00 Y-T-D interest: .00 Per diem: .00000 Next payment date: 9/14/07 Next pay amount: .00 Value after next pmt: .00 Renewable: Yes Deposit Acct/Type: 706001811 S More... F3=Exit F4=Sweep Inquiry F8=Maintenance F24=More Keys } j j 'V~ 1 ,~ ~.~1;L.1iu ~'~`~Z t C Reprint - l0/29/~~109, ~2c03pm TAME DEPOSIT /IRA j ~J DEBIT DATE ~r~~17 ~t fig ~ ACCOUN'T NttMBER ~~ ~ /~ CUSTOMF~ NAM ., ~"1-~ ~ ~~ TAX YEAR KEAS{Jiti COUE:.._......._..,,.~ CODES /? i~ ~ of TRANS~.R To NF:w cn wml x DESCRIPfiON L 5t PREMAttSREW/D -~^ -~-7 "''DFZ7tA5NFFiF"'ft~ t5~'~ 7 A~ 03 TRANSFER T(i iRl(5T gt NURMAI_ Di.ST PENALTY AMOUNT ~ (13 FA\+1ik.Y Fl1Fl2CthN€."1" SS XT TRANSt~.R OttT OS PERSUNAL REASON O51yUlr TU bEAi'H N£1>+' $ALANCE _ ___ 07 TRAN5FEFt TO ANOTHER INS i'ITLtTtQN ~1 68 Dk5SA'iISFSk~D A'i BANK RATE CUST70:KER SlGNATU E ~j 09 SPLIT f'UNDS itiiTHtN oB 70 NO CURE PROVIDED $Y BRANCIi PREPARED BY W'i'i'tiI?RAIi'AL AF~IOUNT ~: goo i..t ~ooo~: ~. 2 ~ ~ zo~• REprint - 10%29/2009, 12:[7~pln TTME DEPQSIT I IRA DATE Q= /'~__l+, /~ CREDIT ~~.~ (:USTOMF:It NAMl: DESCR1PTIt?N ~"~ ~ Ct)STQME S1URE`, ~~''~ w ACCOUNT NUMBER ~~~~~~{stJ CODE TAX YEAR CODES Ot CURRENT YEAR UEYOS[T I 1 PR[OR YEAR UEPOSIT ~ ROLLOVER [N 43 INTERNAL TRANSFER IN 4& llIRECT 7RANSt•ER M DEPOSIT :0.MOUNT ~: 5ao ~a, ~0 20~: 4 ~ ~ ~ ~a~ ao3aao~i a~F~ s~a~oao.oa ab4B10=~5AMa8-17-a? #40oa019865 Reprint - 10%'d5/2UOa, 12: f74pm TaRAYiitCS UNlVEf?SAL INC THE ORRSTOWN BANK sr©n~E~~t~~~ oanrE oFE~cE SASH t~UT T1~KET TELLER N{:~. ~~ CTIP-tA i Q~3#~Q5~. ~R~dUT #~ , 0~ ~3bt}E~1Q~5 i~~4t~8-.1?-~7 #~[lODd1~8b5 ~.5 ~ ~ ~„,q9o~~: oa 3 6~6~~ .11~t....., ,...k.e ..•t wii.+e •e..:.PY!~..s r/ w1ss.. .x~.s.:fa, s _ - .w. r' i~. .r,.~.. .cn x,..+,,.~, ~~ Pot .. v`,~wlr - .aim` ~-w - ~ "'s •...~~` i rirF~r iis-'lrl~i rtr~# Ti'.•#`- i..I 'l.i t i ~} p r,~ w! .~ .~• U 4,~ W ~•, 4.~ a ~J 4~