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HomeMy WebLinkAbout12-21-09 ~.~ 1 X056081 OSO PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year FGe Number PO BOX 284601 INHERITANCE TAX RETURN ~ ~~~ ~~ ~ ,-....-...m..--~ .... .... ..., arnsburg, PA 17128=0t301 nc~~.~.~..~..,...-------- - . 08 'i2o4 Date of Birth .._.._._.._.:_....... _..._ ..m._.._ _ .............. . f3ecember 31, 1923 .... ... __.. -.. _... Decedent's First Name MI ._ Lavere ~ - ` ~~' _.._ . .. _„-....._ ....affix e's ......~.. ...._........... Spous First Name 'Cook ... !~1i . _ ... ...___._....,.._,.,~__..__.._.._~M....__._~_..._._.._._M._-.....-....~... .... ~_ Elsie w ..-_... Numb ..... .. • -.. .. . ...... ...... .... _ ' ~ ~~ ._ .,Spouse's Social Security er _ . _ ...... ; K -.. ,.,...~w...,...~._-._.._.__._.,.-.._....._-,-.. __......w..-~ .. ....... .,. ....,,.......3 -. ....-.„.. .......,....~ ...,. ...w.. .... ......... ~.. .... 4 ~' D TMIS RkTURN MUST BE FILED IN DUPLICATE WITH THE _. R~GdS~'ER OF WILLS FILL INAPPROPRIATE g1fAl,...-~ ' •. ... 3 BELOW t. Original Return . ~~~, 7.. Supplemental Return ~ 3. Remainder Return (date ofd th ea ,:...'~ 4. Limited Estate { ~,~,~ 4a. Future Interest Compromise (date of Prior to 12-13-82) death after t2-'f2-82} ~~ 5• Federal Estate Tax Return Required ~ 6. Decedent Died Testate {:,,;D 7. Decedent Maintained a Livin Trust (Attach Copy of Will) (Attach Copy of Trust) 9 8. Total Number of Safe Deposit Boxes ""`~ 9. Litigation Proceeds Received t:,";:t 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~ 11• Election to tax under Sec. 9113(A} CORRESPONDENT - THIS gECTION MUST 8t: COMpt,ETEp, ALL CORRESPONDENCE AND CONFIDCNTIAL TAX INFORMATiOch O} Name N SWOULD BE DIRECTED T0: a-_._._. ,...,.... __ Andre ~ Daytime Telephone Number w C. Sheely, squire ... _.. _ .._.... _ __..._.....,._...._..._...... _„m......_._- _ . __.. ...... ,. Firm Na ,.~.... ~. - _ 717 fi97 me If A __ ...... ..,..., . 7050 _. _.. .. ~ PPlicable) __ .. _ ., .M..- ,...,_..M, .., . _._..._..__.~......w _ M .C,.~ ..w _....~.__.-. .. ~.. ~ Andrew C. Sheely, Attorney at Law ............,., ~.. ..... ........ ...... ':~ -- ._.~ _ #LLS u5 i-y First lin..-. - ..._......_... . . e of address _ _ ... _ _... ~ . , ~ --n r'*'t ~ ~ a . _. ~ ;- ~ - ~. . _ .... _ ~ r -r-E tv ~ ~ 127 South Market Street 1',.~ ~..~_,._ Second line of address i ~-- r_~ ~ ~ ~ •, _. : _. .. ,. ._ _... .. C_J PO _.. _ ~ , __ __ _.. . _ t- , y .Box 95 . _... __ . ~;~~~ ~- . p""," " ~ -~ ' V r ~ _. City or Post Office . ~ _ _ , .... , ...... .. _.. _ ~ D W ~ ~"~ ... . ,. ..._ . _... _ .,... State ZIF~ Code ~ ~__.__ ATE FILED C1't ~ -' Mech ~... _,._ .., anicsbur9 .. _..._ __.... , _ ,_ .-.... ~..._..~..-._...~..~_.~___.. - : PA ;17055 ......_., .... correspondent's a-mail address: andrewc. Sheely cx verizon. net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules an it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information d statements, and to the best of my knowledge and belief, SIGNATURE OF PERS~f,~! F~ESPONSIB~.E F ~FtLING RETURN of which preparer has any knowledge. ,~/~' Elsie K. Cook, Executrix, 3 Alliance Drive, WAC, Apt. 203 Carli ~ 1 ~I ~~ SIGN E of PR Sle, PA 17013 H REPFtESENIf+;rIVE V pnn c' __ r)ATF - Andrew C. Sheely, E ----~---- -----~__.---- -....._----~----------_ ^~~~-~~Q 7 South Market Street, 1~.0. Box 95, Mechanicsburg, PA 17055 PLEASE lJI:~E OlR1C;tNAIL PpRM QNLY 15056051058 Side ~ isos6osioss ..J J 1505b0520S9 REV-1500 EX Decedent's Social Security Number, ; ......... DecedenYsNeme: Cook, Lavere,.~.A.'.........~._.e.,ri_.~...~~.,....M,..,.,.~..,~~.....~,~„~....~..~...~.,.,...,~,,.~,...~ ...~.~...~..._.~_ RECAPITULATION 1. Real estate (Schedule A)....... • .... • ................................ 1 2. Stocks and Bonds (Schedule B).......•........~...••~•••~•~••••~•~••• 2• 3. Closely Held Corporation, Partnership or Sole-Proprie3torsF~ip {Schedule C) ... • . 3. 4. Mortgages & Notes Receivable {Schedule D) ...... 4• { .__,~ .w _ ..~..,~_ w., _..,. ,..._., •,_...-.,.~ ...-...--.,~..•. ~ $16,275.30 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E} • ....... , _ ,, µ µ.,_ .. 6. Jointly Owned. Property (Schedule F) t~ Separate Billing Requested .. , ... 6 * ~ ,,.-.,..,.~...~.-,M..w ~ ,M , 7. Inter-Vivos~Transfers & Miscellaneous Non-Probate Property (Schedule G) C~:~~ Separate Billing Requested....... • ' . 7. } .w_w~...~,...~.,M_...~..~, .....~._..... ~-..,.~..M-...,_~._,._.__.,~_..._.......~ f 8 $16,275.30 8. (total Lines 1-7}. Total Gross Assets • . , ....... ~ ' .~,:...w.~.:.~..~,-~~,.;. ... ..-~.... .,.,.,•: _ . . . .__A..~.~..~...,,-..,.~..-..aM.~,. ..~.~.,~ ~ .H~..,~,..~..~,~~.~.-~..~...-.. ~... ...... 9. ~.•.._.~.--. -.; ..._. ..... . ....... • H) L7chedule Funeral Expenses ~ Administrative Costs ( 9 ' ~......_..,_....._.__._.~....__._-~,....... $9,653.00 .,.~,..__~w_M.._~~......,~_~......_..._.., 10. Debts of Decedent, Mortgage Liabilities, & Liens {Schedule I) ........ . ... . .. 10. ~ ...,...,,..........~~......w..._...m ,,..M.......__..µ.M..... w~µ ._...._....._.. 11. Total Deductions {total Lines 9 & 10)... • .. • .............. • .. • • • • • • • • • • • 11 • _ ...,....~. ~.,~.~~.~M..,.Y...w...w.. , ~ x$9,853.00 .._~.._...... 12. N®t Value of Estate (Line 8 minus Line 11) ............ . .... . ............ 12 .AV ^ w w__. ~,...,,~w,..,~,_...... $6}fi22.30 , ~.., _....~ •Y ,, M ___...,, .. _... 13. Charitable and Govesmmental Bequests/Sec 9113 Trusts for which ! l d h r.. 13 ~ ) ........................ e . u e an election to tax has not been made {Sc . _ . -~. ,Vy, ._._.•.w.w,,.~µ ^. -µa,µ,.µ, 14. Net Value Subject to Tax (Line 12 minus Line; 13) ............... • . , . , ... • 14. TAX COMPUTATION ~ SEE INSTRUCTIONS FOR APht_ICABt.E RATES 15. Amount of Line 14 taxable $6,822.30 at the spousal tax rate, or r . .......... ... ... ....._. .. transfers unc+Qr Gee 9116 _ .. .._ ... __., ....... ........ .. .......... _. .. ......,......, .......,... f . . ... o oo $s,~22.30 1~ ~ (a}(1.2) X .0~ ~ . ..... .,.~~,_.._.__,.......~,,, ..._..w.~._ ..,..,.. ,.....w.,, 16. Amount of Line 14 +~~~ble at lineal rate X .0 16. ~ m..,.u.,w~.-,......~,,._.....w ,._.,,...µ . .. ..... .... ,., ........ ......:....:. .:..:, {....::.,.......~w. .,......w.... h.w.w w. ~~ ... . . Y :mwv~mn..d,. . . 17. Amount of Line 14 taxable ~ . . .. .. .. ... I at sibling rate X .12 ,,.. ,.~. _ y, ., .a. , . 17 ~,w ..v.._._._~._..,_.._._.._._...... .._..,.,.-,w.., . __.., .~.._._~ . r, ,. ~, ..,. _ . ~ . _... ~ M . _ ...,._._ . 18. Amount of Line 14 taxable at collateral rate X .15 E 18. _ i 4 00 F 3. 19 19. TAX.DUE.........•..,.......• ......... ....... ................•.•. . .. .............................. ...... ._. 20. FILL fN THE OVAL IF YOU ARE REQUESTING A REFIJND OF AN OVERPAYMENT 15056052059 S~de° 2 ~~ 15056052059 ~. ~~. REV-1500 EX Page 3. Decedent's Complete Address: n r-n rn.-, ~r... . Lavere A. Cook STREET ADDRESS 3 Alliance Drive HAC, Apt. 203 CITY Carlisle . 1204 DECEDENT'S SOCIAL SECURITY NUMBER 196-14-1018 STATE ZIP PA I 17013 `~ Tax Payments and Credits: 1. Tax Due {Page 2 Line 19) 2. CreditslPayments (~) $ 0.00 A. Spousal Poverty Credit B. Prior Payments - C. Discount - 3. Interest/Penalty if applicable ~ Total Credits { A + B + C) {2) D. Interest E. Penalty -~ Total InteresUPenalty (D + E } {3) 4. If Line 2 is greater than Line 1 + Line 3, -enter the difference. This is the OVERPAYMENT. Dill in oval on Page 2, Llne 2t) 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) $ o.oo A. Enter the interest on the tax duP. {5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (8B) .~ .. .Make Check Payable lo: REGIS TER OF WILLS, A GFI~T ~ -~ ~~ .. ,~ :,, . „ ,. , ... PLEASE. ANSWER THE FOi~LOWING QUESTIONS BY PLACING AN "X" IN T H`E APPROPRIATE BLOCKS 1 • Did decedent make a transfer and: Yes Na g - of the property transferred g ........................................... b. retain the n sht to'desmnate who shall use the r ................................................ ^ p operty transferred or its income• .................... ^ (~ c. retain a reversiona i ........................ ry merest; or ...................... ^ d. receive the promise for life of either pa ments, benefi ? 2: Y is or care ...................................................................... ^ 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. Di,d decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ,,,,,,,,,,,,,,,,,,,,,,,,,,,, IF THE ANSWER ............................................................................................ ~ ~ r - ~, TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE ~ AND FILE IT AS PART OF . &~ ~~:;~; ~~. i~i~,~~~~~~r~' ~ .., .. ~ ~. THE RETURN. or ates of death on or after Jul 1, 1994 and before Janua 1, ~ "°~~~ Y ry 1995, the tax rate irn osed on the net value of transfers to or for the us ~ ~ <E ~ ~ , is three (3) percent [72 P.S. §9116 {a) (1.1) (i)]. p e of the surviving spouse For dates of death on or after January 1, 1995, the tax -rate imposed on the net value of transfers to or [72 P.S. §9116 (a) (1.1) (ii)]. The statute des not exempt a transfer to a survivin s use from tax, for the use of the surviving spouse is zero (0) percent Fling a tax return are still applicable even if the surviving spouse is the only benefi ca ry and the statutory requirements for disclosure of assets and 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 far adoptive parent, or a stepparent of the child is zero (0} percent [72 P.S. §9116(a}(1.2)]. the use of a natural parent, an fhe 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 ~2 P.S. §9116(1.2) [72 P.S. §9116(a}(1)]. (4.5) percent, except as noted in 1'he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve 12 ercent 72 P Section 9102, as an individual who has, at least one parent in common with the decedent, whether by blood or ado lion. §9996(a)(1.3}]. Asibling is defined, under P ~. ,rr,- . C;CMMONWEALTFi OF PENNSYLVANIA -NFiE-RI fANC;E_ TAX RETURN fiESIC~F:N L DEC;EC?ENT CC'TATC nr SCHEDULE E CA5H, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~.....~..- v~ Lavere A. Cook Include the proceeds of litigation and the date the proceeds were received by the estate. __ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. The Bank of Landisburg -Money Market Acct. #723452 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) FILE NUMBER 21-08-1204 VALUE AT DATE OF DEATH ~16,Zi ~.3C 16,275.3C? ,r _ ~;, ~~i } ~; '1~ o ~~k ~': ,;; ~, L/~`l~-Ia~1~W ~15~ ~l'Y11 /{~~~~ ~~~"~Sf~~r~,c~t'~ .,, 3 ,yz; , ~; ,. ~'% Dec 31, 2008 Pg 1 of 1 LAVERE A COOK 3 ALLIANCE DRIVE APT 203 0 CARLISLE PA 17013 "Thank you for banking with us" To keep up with insurance limits on your funds held with The Bank of Landisburg, go to: www.fdic.gov 12/01/2008 Beginning Balance Money Market 3 Deposits and Other 't~d~"dons 16, 370.61 12/31/2008 3 Checks and Other Det~uctions _+ Ending Balance 5, ba s ~n St 1,519.02 17, 889' 63 - , y atement P eriod __._--------------- ~;~ ~ 00 _ __ _~- _-..W~,---------------------- ------------ ---------- _ 1~/-0~:/2C08 ------- Depos ' ~; ~.ts an~,,,,ther-~.,add,~.tit~h to F.CF~ Doposit ~~ ~, ,, your account - ,, ,,, , ---- ----------------- 12/01/2008 MASS MUTUAL PEI~'~ON ~ ~~~ ACF~ Deposit ~ - 325.55 _ 12/05/2008 DFAS-CLEVELAND ~~`>'SYM~d~~' ~~,~'2 , ~'~ ~.,~'RET NET Earnin s P 1, 190.76 a g yment ~~- ~ 2.71 ------- Checks listed in nume~~~"~~, af~~~~ Check pate ( ) indicates gap in sequence ------ ----------- Amount Check Date ----- _- ________ - Amount 210 1045.50 ------------------------ - 12/02. 211 12/01 - --------- 5Ei6.12 12/05- - /2008 r -~ "" Other Deductions from your account _______ Closing Withdrawal _______ -------- _ ~ 7.6, 278.01 _ 12/01 ---- -----------------,~ Daily Ending Balance ---____-_-____ 17, 320.80 12/02 ____ ~--------- --~---- 16, 275.30 12/05 0.00 ---- --`--**-Below is-an itarnings Summary ---------------- emization of the Earnings ** ** ------•---____-_ Interest Ea for this statement period ** rned This Period 0.00 Annual Percentage Yield Interest Paid YTD 232.58 Days in E Ea rned 0.00 $ arnings Period 5 Earnings Balance 13,229.34 _ _,__ _ A C C 0 U N T C L O S E D EV-151 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CQTATr n~ SCHEDVLE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS Lavere A. Cook ITEM NUMBER A. FUNERAL EXPENSES: t ~ Myers Funeral Home B. ~ ADMINISTRATIVE COSTS: FILE NUMBER 21-08-1204 Debts of decedent must be reported on Schedule I. DESCRIPTION ~ • Personal Representative's Commissions Name of Personal Representative(s) ElSle K. COOk Social Security Number(s)/EIN Number of Personal Representative(s) street Address 3 Alliance Drive, HAC, Apt. 203 city Carlisle _ State PA .Zip 17013 Year(s) Commission Paid: 2• Attorney Fees Andrew C. Sheely, Esquire 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Elsie K. COOk street Address 3 Alliance Drive, HAC, Apt. 203 city Carlisle _ state PA _ Z;p 17013 Relationship of Claimant to Decedent SpOUSe 4. Probate Fees 5• Accountant's Fees 6• Tax Return Preparer's Fees ~. Filing Fees TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) AMOUNT $5,440.00 600.00 3,500.00 98.00 15.00 9,653.00 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 COOK LAVERE A Estate File No.: 2008-01204 Paid By Remarks: ELSIE K COOK AJW ------- - Receipt Distribution Receipt Date: 12/04/2008 Receipt Time: 15:44:26 Receipt No.: 1054961 Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 60.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15.00 8 00 CUMBERLAND COUNTY GENERAL FUN JCP FEE AUTOMATION FEE . 10.00 CUMBERLAND COUNTY BUREAU OF RECEIPTS GENERAL & CNTR FUN M D ----------5_00 CUMBERLAND COUNTY GENERAL . FUN Check## 1269 Total Received......... -- 98.00 98.00 '~(g,:~1~~lA~.gti1•t4' rTf4(~yyz ~'lfiRtx<('~I''f;,1.;a+,.;.1rri .. ,.. •1•. .~ ~ ..,. .. . . '~ y F~ 1' . , ,, ,i ;,,,. ,. 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'.I.. .;iif. .1 h 1. ;'.. .~. ~y 1'. )' .1. i. t' 'i f. '1 .. .. •'t! ~ , ~1:: is ;, ST ~~Z 60 ~ ~0 ~IdW ~0d 0bL .;.:,•'. ':;;'';.•;•'~:: ~•! •i ~ , . ..... • • • • '~ ~~! ! `ifi : '';~7': ~~ ,; ~'. !',~a:;,•~ ~''`':„~';"• '•i r,.:. '3WOH ~d~3Nil.~ S~13~1W ~ TZb~-99L-LZLi •, .,'`';;~!'''•,:,...1';i:::..•!;!+;i•.'y, ;:.•' REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Cl~T ~ T~ w SCHEDULE ~ BENEFICIARIES Lavere A. Cook NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. Elsie K. Cook, 3 Alliance Drive, HAC, Apt. 203, Carlisle, PA 17013 FILE NUMBER 21-08-1204 RELATIONSHIP TO DECEDENT I AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Spouse 100% Rest, Residue, Remainder of Estate within Pennsylvania. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, 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 $ (If more space is needed, insert additional sheets of the same size) ~~ Np~'~