HomeMy WebLinkAbout04-11-11 (3)I 15056051047
REV-15 0 0 EX (06-05) OFFICIAL USE ONLY _~
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes ~~ ~; ~ ( ~ ~ ~ n ~ n ~ j
PO BOX 280601 INHERITANCE TAX RETURN (~) "I
Harrisburg PA 17128-0601 -. RESIDENT DECEDENT r,
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 0 2 2 6 5 3 3 0 9 1 0 2 0 1 0 0 2 2 6 1 9 2 9
Decedent's Last Name Suffix Decedent's First Name MI
C o y R a Y A
(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 O 2. Supplemental Return O 3. Remainder Return (date of death
,~
O 4. Limited Estate
~ 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
O 10. Spousal Poverty Credit (date of death
bet~~veen 12-31-91 and 1-1-95)
prior to 12-13-8._)
O 5. Federal Estate ~-ax Return Required
0 8. Total Number of Safe Deposit Boxes
O 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULCI BE DIRECTED TO:
Name Daytime Telephone Number
Jos e h A. M a G a 1 u s o 7 1 7 _5 ~~-'~~ 4 8 ~3 .2 :.~~
Firm Name (If Applicable) ~ ~
REGISTE w~E ON'CY>~ ~ , ~ ~,
First line of address
~ , ~..> --F-~ .. - ..,
9 6 1 4 R owe R un Lo op `-~'~-~ ~~~' =,
~i
Second line of address ~ ~~~ '" ~ "~ ' r7
~,.
City or Post Office State ZIP Code ~
S hip p e n s b u r g P A 1 7 2 5 7
DATE FILED
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 and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PER O RESPONSIBLE FOR FIL NG R TURN D TE
~~ ' ~: ~ _ .~ ~ ~%r
-~~ =~°
ADDRESS
472 McCulloch Road,
SIGNATURE OF PREPP~ER OTHER
ADDRESS
1556051047
GP~Jpfil V E --
~~ PA 17257 _
PLEASE USE ORIGINAL FORM ONLY
Side 1
D.ArE
15056051047 J
~1.,LtiN
J
1,5056052048
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: 2 0 O 2 2 6 5 3 3
RECAPITULATION
1. Real estate (Schedule A) . ......................................... ... 1. 4 0 0 0 O. O O
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. ],. 3 O 4 , 9 $
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... ... 7.
8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 4 1 3 .O 4 • 9
9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 1_ 2 O 2 6 • O l
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. '] )_ 2 2 $ 3
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 1_ 9 l 4 $ + $ 4
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12 2 2 1 ' S 6 1 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... .. 13. O ,
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ~, 2 l 5 6 1 4
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 2 2 1 5 6 1 4 1 s. g ';g 7. 4 , 3
17. Amount of Line 14 taxable
at sibling rate X .12 . 17.
18. Amount of Line 14 taxable - -
at collateral rate X .15 s 1 g.
19. TAX DUE ....................................................... .. 19. 9 9 7 O 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056052048 15056052048
O
J
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Ray A. Coy
STREET ADDRESS
301 West Creek Road
-. ,
CITY STATE ZIP
Newburg PA 17240
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 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.
A. Enter the interest on the tax due.
C)
CI
(5) .~47~~
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 9'97~~
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 :.........................................................................:.......... ...... ^
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 tlesignation? ......................................................
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 (d) 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 they 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-1502EX+ (t-97)
SCHEDULE A
COMMONWEALTH OF PENNSY'~~VANIA RE/"~L EST/"~TE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ray A. Coy
FILE NUMBER
:2010-00998
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of
survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, -_
See attached Continuation Schedule
TOTAL (Also enter on line 1, Recapitulation)1 ~ 40 , 000.00
(If more space is needed, insert additional sheets of the same size)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Coy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULE A
CONTINUATION SCHEDULE -PAGE 1
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
Residence located at:
301 West Creek Road
Newburg, PA 17240
The real estate was sold on November 22, 2010,
for a purchase price of $40,000.00. Copies of
the deed and settlement statement are attached
to this Schedule A.
VALUE AT [)ATE
OF DEATH
$40, 000.00
TOTAL $40,OC10.00
A. Settlement Statement (HUD-1)
OMB Approval No. 2502-0265
R Tenn of 1 n __ -
I . ~ FHA 2, ~ RHS 3. []Conv. Unins.
4 ^VA ~ ^Conv tns b. File Number:
81:10-192 7. Loan Number: 8. Mortgage Insurance Case Number
C. NO"rE: 1his form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items
marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower(s):
Dennis 1. Little
Cathy R. Little
7 Chelsea Lane, Carlisle, PA 17015 E. Name & Address of Seller(s):
Estate of Ray A. Coy
472 h9cCulloch Road, Shippensburg, PA 17257
F. Name & Address of Lender
Bank of Land~sburg
100 North Carlisle Street, Landisburg, PA 17040 G. Property Location:
301 West Creek Road, Newburg, Pennsylvania 17240
Hopewell Township, Cumberland County
11-09-0505-028
Place of Settlement.
1 Irvine Row, Carlisle, Pennsylvania 17013 H. Name of Settlement Agent:
Duncan & Hartman, P.C. (717) 249-7780
1. Closing Date:
11-22-20]0 Disbursement Date:
i1-22-2010
J. Summer of Borrower's Transaction K. Summary of Seller's Transaction
101. Contract sales rice 40 000.00 401. Contract sales rice 40 000.00
102. Personal ro ert 402. Personal ro e
l 04. 404.
lUS. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
l 07. Count taxes I i -22-20 i 0 to 12-31-2010 11.57 407. Coun taxes 11-Z2-2010 to 12-31-2010 11.57
108. Assessments to 408. Assessments to
1 10. 410.
III. 411.
112. 412.
200. Amounts !'aid b or in Behalf of Borrower 500. Reductions in Amount Due to Seller
201. De osit or earnest mone 501. Excess de osit see instructions
203. Existin loans taken sub ect to 503. Existin loans taken sub ect to
204. 504. Payoff of first mortgage loan
205. 505. Payotl"of second mortgage loan
206. 506.
207. 507.
208. SO8.
Ad'ustments for items un aid b seller Ad'ustments Cor items un aid b seller
210. Cit /town taxes to 510. Ci Itown taxes to
21 1. Count taxes to 51 {.Count taxes to
213. 513.
214. 514.
5
216. 516.
Z17. 517.
218. 518.
c
220. Total Paid bvlCor Borrower 32 000.00 520. Total Reduction Amount Due Seller 3 402.90
300. Cash at Settlement Cro1nlto Borrower 600. Cash at Settlement to/from Seller
(~
F~-
302. lass amounts aid b /for Borrower line 220 32 000.00 602. Less reductions in amount due seller line 520 ~ 3,402.90
303. Cash From To Borrower 9 984.03 603. Cash To From Seller _ 36 857.63
700. Total Real Estate Broker Fees P
id F
° = a
rom
Borrowers Paid From
Seller's
Division of commission line 700 as follows: Funds at Funds at
701. $ to
Settlement
Settlement
703. Commission aid at Settlement
704.
800. Items Pa able in Connection with Loan
801 . Our on ination char e $ (from GFE # I r
from GFE #2 r
803. Your ad usted on ination char es (from GFE A)
804.
(from GFE #3 .~
805. Service Fee to E3ank of Landisbur (from GFE #3) 400.00 .___
from GFE #3 r
807. (from GFE #3) ....
808.
810.
8l 1.
812. ____
814,
900. Items Re wired b Lender to be Paid in Advance i
901. Dail interest char es from (from GFE # t o'
from GFE #3
903, Homeowner's insurance ears to (from GFE #1 t
404.
905.
1000. Reserves De osited With Lender
from GFE #9
1002. Homeowner's insurance months $ er month $
1003. Mort a e insurance months $ er month $
1004. Pro ert taxes months er month $ ._._.
1006. School taxes months er month
1007. A e ate Ad ustment _$
____
] 100. Title Char es _._._
from GFE #4
1102. Settlement or closin fee $
1 103. Owner's title insurance from GFE #5 58.00
1104. Lender's title insurance $ 434.50
1106. Owner's title olio limit $ 40 000.00
1 107. A ent's onion of the total title insurance remium $ 54b.13 ~
t 108. Underwriter's ortion of the total title insurance remium $ 96.37 _
l 10.
1111. _.__
1200. Government Recordin and Transfer Char es
from GFE #7
1202. Deed $63.00 Mort a e $68.00 Release $ r
1203. Transfer taxes (from GFE #s) 400.00 400.00
l 204. Ci lCoun taxlstam s Deed $400.00 Mort a e $
i 206. .r
1300. Additional Settlement Char es
1301. Re wired services that ou can sho for (from GFE #6)
1302. w
1304. 2010 school taxes to ffa Killian Tax Collector 302.90
1305. Inheritance tax to Re ister of Wills 2 "100.00
1400. Total Settlement Charees (enter on lines 103 Section J and 502 Section Kl ] 723 50 3 ~i02.!)0
CERTIFICATION I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true
and accurate statement of all receipts and disbursements made on my account or by me in this transaction. 1 further certify that
I received a copy of the HUD-1 Settlement Statement.
,~}
~ ~ `_l.(~C~.~11 1 ~~J4
V
Signature of Borr r Signature of Bon wer Signature of Seiler
Signature of Seller
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds disbursed or to 6e disbursed by the
undersigned as part of the settlement of this transaction.
,,Iii ~.-~' ~~ t c% `~
Signature of Settle A ent Date
ROBERT P. ZIEGLER
RECORDER OF DEEDS
CUMBERLAND COUNTY
1 COURTHOUSE SQUARE
CARLISLE, PA 17013
717-240-6370
Instrument Number - 201034240
Recorded On 11!23!2010 At 11:12:19 AM
* Instrument Type -DEED
Invoice Number - 77211 User ID - MSVV
* Grantor -COY, RAY A
* Grantee -LITTLE, CATHY R
* Customer - DUNCAN
* FEES
STATE TRANSFER TAX $400.00
STATE i~RZT TAX $0.50
STATE JCS/ACCESS TO $23.50
JvsTICE
RECORDING FEES - $12.50
RECORDER OF DEEDS
PARCEL CERTIFICATION $10.00
FEES
AFFORDABLE HOUSING $11.50
COUNTY ARCHIVES FEE $2.00
ROD ARCHIVES FEE $3.00
SHIPPENSBURG AREA $200.00
SCHOOL DISTRICT
HOPENELL TONI~TSHIP $200.00
TOTAL PAID $863.00
* Total Pages - 6
Certification Page
DO NOT DETACH
This page is now part
of this legal document.
I Certify this to be recorded
in Cumberland County PA
RECORDER O D EDS
4
* - lnformation denoted by an asterisk may change during
the verification process and~may not he reflected on this page.
~iiii~iiri~iiiiiuii
S~~ ~/
3~a~IO O4~Ca~ DEED ~Op U INIIIIIIIIIIII
002~F9
Tax Parcel No. ~ i - (,~ Q -~.S (J ~" -ea g
r
THIS DEED, made this _____ day of , 2010, by and
between Lola L. Cohick as Administratrx C.T.A. of the Estate of Ray A. Croy, 472
McCulloch Road, Shippensburg, Pennsylvania 17257, GRANTOR; and Dennis J. Little
and Cathy R. Little, husband and wifie, of 7 Chelsea Lane, Carlisle, Pennsylvania
17105, GRANTEES.
WHEREAS, Ray A. Coy, a resident of Shippensburg Township, Cumberland County,
Pennsylvania, died testate on September 10, 2010;
WHEREAS, said decedent left a Last Will and Testament dated Apri! 12, 1972,
which was duly admitted to probate on September 30, 2010 (File No. 2010-00998;
PA Fite ~. 21-10-Og98~, and by said Last Will and Testament he appointed
his wife Mildred M. Coy as Executrix, who predeceased decedent, and he also
appointed Victoria Jean Mozingo, a surviving daughter ofi decedent, a~ sut~cessor
Executrix of his Last Wiil and Testament;
WHEREAS, Victoria Jean Mozingo executed a renunciation dated September Z0, 2010,
in favor of Lola L. Cohidc, which was filed with the Register of Wilts for Cumberland
County on September 30, 2010;
WHEREAS, Dennis Coy, a surviving son of decedent, also executed a renunciation
dated September 20, 2010, in favor of Lola L. Cohidc, which was filed with the Register
of Wilts Cumberland County on September 30, 2010;
WHEREAS, the surviving children of decedent are Victoria Jean Mazingo, Dennis Coy,
and Lola L. Cohick;
,•
1NHEREAS, Letters of Administration C.T.A. on the Estate of Ray A. Coy were duly
granted by the Register of Wills of Cumberland County, Pennsylvania, to said Lola L.
Cohidc as Administratrix C.T.A. of the Last Wilf and Testament of Ray A. Coy;
WHEREAS, in Paragraph THiRO of the Last Will and Testament of Ray A. Coy„ the
decedent directed his executrix to self all his estate, of which the within-described real
estate is part;
WITNESSETH, that in consideration of the sum of One ($1.00) and 00/100 Dollar, paid
in hand, the receipt whereof is hereby acknowledged, the said Grantor does hereby
grant and cwnvey, in fee simple, to the said Grantees,
ALL that certain lot, together with the improvements erected thereon, situate in
Hopevrelt Township, Cumberland County, Pennsylvania, designated as Lot 5A on
Preliminary Final Ptan entitled "Land Subdivision for Douglas E. Henschel, "drawn by
Carl D. Bert, Registered Surveyor, dated June, 1985, which said plan has been
approved by the appropriate municipal authorities as a subdivision plan and is filed in
the office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in
Plan Book 48, Page 33, as follows:
BEGINNING at an existing railroad spike set in the centerline of public road known and
designated as T-331, also referred to as West Creek Road, at common comer of the
within described lot and land now or fom~erly of Gregory L. Apeman; thence along line
of land now or formerly of Gregory L. Apeman and along lot referred to as Lot 5B on the
above referred to plan and passing through an existing iron pin set in the previously
dedicated rfgfit-af-way line and an iron pin set at corner of land now or formerly of
Gregory L. Apeman, North seventeen (17) degrees zero (00} minutes zero {00)
seconds West, two hundred fifty and zero hundredths (250.00) feet to an iron pin set in
line of Lot 5B; thence along Lot 56, North seventy-three (73) degrees zero (04) minutes
zero (40} seconds East, one hundred fifty and zero hundredths (154.00} feet to a
concrete monument in edge of filly (50) foot wide private right-of-way designated as Lot
5H on the aforementioned subdivision plan; thence along Lot 5H, South seventeen (17}
degrees zero (00} minutes zero (04) seconds East, two hundred fifty and zero
hundredths {250.00) feet passing through an iron pin set in the edge of previously
dedicated right-of-way line to a railroad spike set in the centerline of the public road,
T-331; thence slang centerline of public road, T-331, and along tine of lands now or
fom~erly of Clarence M. Wickard, South seventy-three {73) degrees zero {04) minutes
zero (00) seconds West, one hundred fifty and zero hundredths (150.00) feet to the
existing railroad spike, the point and place of BEGINNING. CONTAINING 0.8609
acres.
UNDER AND SUBJECT #o previously dedicated right-of--way line.
BEING improved with existing well, existing sewage septic system and shed and mobile
home.
UNDER AND SUBJECT to notations as contained on the aforesaid plan.
BEING the same real estate which Bipy Jae Langley, single, by deed dated July 18,
1985, and recorded July 21, 1986, in the Deed Records of Cumberland County,
Pennsylvania, in Deed Book A32, Page 902, conveyed to Ray A. Coy and Mildred M.
Coy, husband and wife. Mildred M. Coy died on February 17, 2004, thereby vesting full
legal title to the premises in Ray A. Coy.
ALSO TOGETHER WITH AND SUBJECT TO all easements, rights-of--way, conditions,
set-back and other restrictions, and reservations recorded in the chain of title or visible
by inspection of the premises and all notes set forth in any survey of record for the
premises.
Joseph A. Macaluso served strictly as scrivener in connection with the preparation of
this deed and conducted no title examination for the within described premises.
AND the said Lola L. Cohidc as Administratrix C.T.A. of the Last Will and Testament of
Ray A. Coy, as aforesaid, for herself, her heirs, executors, administrators, successors
and assigns, does hereby covenant, promise and agree to Dennis J. Little and Cathy R.
Little, husband and wife, their heirs, executors, administrators and assigns, that she
has not done, committed or knowingly or willingly suffered to be done or committed any
act, matter or thing, whatsoever, whereby the premises hereby granted and conveyed,
or any part thereof, is, are, shall or may be encumbered in title, charge, estate or
otherwise, howsoever.
IN WITNESS WHEREOF, said Grantor has hereunto set her hand and seal the
day, month and year first above written.
Witness: Estate of Ray A. Coy
(SEAL}
By: Lola L. Cohick, Administratrix C.T.A.
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND SS.
On this day of ~ ~ 1u b ~ , 2010, before me, the undersigned
officer, personally appeared Lola L. Cohick, as Administratrix C.T.A. of the Estate of
Ray A. Coy, deceased, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument, and acknowledged that she
executed same in the capacity therein stated and for the purposes therein
contained. In witness whereof I hereunto set my hand and official seal.
Notary Public
Notsrial Sal
Kathy L. M~unmert, Notary Public
Carlisle Borough, Cumberland Count},, PA
My Commission Expires August 11, 2011
CERTIFICATE OF RESIDENCE
I hereby certify that the precise residence of the within Grantees is:
~~ ~ ~~ U
~ ~( S
Witness my hand this day of ~ , 20~4Q
REV-1508 EX + (1-97)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, a M~~^.
INHRESIDENTDECEDENTRN PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Ray A. Coy 201.0-00998
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
See attached Continuation Schedule
TOTAL (Also enter on line 5, Recapitulation) L~ 1, 304.98
(If more space is needed, insert additional sheets of the same size)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Coy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULE E
CONTINUATION SCHEDULE -PAGE 1
CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY
ITEM VALUE AT C1ATE
NUMBER DESCRIPTION OF DEATH
Bank Account
1. Checking account #549010 $504.98
Orrstown Bank
77 East King St.
Shippensburg, PA 17257
(No accrued interest)
(See statement bank attached
to this Schedule E.)
Vehicle
2. 1990 Oldsmobile Regency $600.00
The vehicle was sold on October 23,
2010, for a purchase price of $600.00,
to Andrew Evans, of 1025 Leroy Drive,
Newport, PA 17074.
Miscellaneous
3. 1975 trailer 200.00
TOTAL $1, 304.98
~~-,N~.
A Trudy#'Qn of Fx~slleric~e
February 2S, X01 z
,Joseph A. NYacaluso, ~scl.
~~ 14 Rowc Run Loop
Shippensb~rg, FA 17257
Fax S~~-432
Re: Estate of Ray A. day
Social. Security Numlaer 20p-22-533
Date ~f Death September 10, X010
I"1' IBS .I-IERE~,i~~ ~E~~'IF'IE~ ?'HAS' ~"I~E ABOVE IVAME,U L7E~E~DE.11tT .HAIL THE
~'(~LLC~WIN~ A~~C~~TN'I" WITH C~~STCWN ~'3A.N~:
CHECKING A C~c'~ tT1V'7"
Ae~~~nt No. -- 5~~~ ~ Q
Aocount 'I'yp~ - Free ~hec~.~ng
date opened - 3/ 1 J91
Joint Account (ria,rne/ciatc) -- None
F3alance -- ~S(7-4,98
Accrued Intere~t~ - ~~
~e~t Regards,
~Tieki L. Guliixc~n
Customer Service Specialist
77 fast King street
RO. Box 250
Shippensk~urg, F'A ~ 7257
'1.888.QRRSTC~WN
REV-1511 EX+ (12-99)
~•
/~F _"R`
~. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE N
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Ray A. Coy 201.0-00998
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
See attached Continuation Schedule
B.
1
2
3
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City -- - -- ------ --- ---- State ----
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
Street Address
City _ State ___
Relationship of Claimant to Decedent
Zip
4.
5.
6.
7.
Probate Fees
Accountant s Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulationll$ 12,026.01
(If more space is needed, insert additional sheets of the same size)
Zip
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Coy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULE H
CONTINUATION SCHEDULE -PAGE 1
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES
1. Fogelsanger-Bricker Funeral Home $8,76iD.89
2. Parklawn Cemetery $ 15+D.00
3. Repast (Kathy's Deli) X60.00
Total Funeral Expenses $8,970.89
B. ADMINISTRATIVE COSTS
1. Personal Representative's Commission NONE=
Name of Executrix:
Lola L. Cohick
Social security number:
Street Address: 472 McCulloch Road
City: Shippensburg
S#ate: PA Zip: 17257
Year Commission Paid: N/A
2. Attorney fees
Joseph A. Macaluso, Esq. $2,000.00
3. Family Exemption -~D-
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Coy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULE H
CONTINUATION SCHEDULE -PAGE 2
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
ITEM
NUMBER DESCRIPTION AMOUNT
B. ADMINISTRATIVE COSTS (continued)
4. Probate fees: $159.50
(Cumberland County
Register of Wills)
Return 15.00
Inventory 15.00 $189.50
5. Legal Advertisements
Cumberland Co. Law Journal $75.00
News Chronicle 121.25 $196.25
6. Adams Electric $227.0(1
204 W. King St.
Shippensburg, PA 17257
7. Realty Transfer Tax for sale of real estate
listed in Schedule A above (see settlement $400.00
statement attached to Schedule A above)
8. Real property taxes (see settlement
statement attached to Schedule A above)
school tax paid: $302.90
less credit (prorated school tax): (248.96)
less credit (prorated county tax): X11.57) 42.~~7
TOTAL ADMINISTRATIVE EXPENSES $3,O~i5.12
TOTAL FUNERAL AND ADMINISTRATIVE EXPENSES $12,C126.01
REV t5t? EX • (t-97)
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COMb10NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT-
ESTATE OF
Ray A. Coy
Include unreimbursed medical expenses.
ITEM
NUMBER
1,
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
DESCRIPTION
FILE NUMBER
201.0-00998
AMOUNT
See attached Continuation Schedule
TOTAL (Also enter on line 10, Recapitulation) ~ S 7 ,122.83
(If more space is needed, insert additional sheets of the same size) ~---
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Coy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULE I
CONTINUATION SCHEDULE -PAGE 1
DEBTS OF DECEDENT. MORTGAGE LIABILITIES, AND LIENS
ITEM
NUMBER DESCRIPTION AMOUNT
1. IWS of Pennsylvania $31.35
135 Vaughn Rd.
Shippensburg, PA 17257
(trash collection)
2. AT&T $103.14
P.O. Box 536216
Atlanta, GA 30353
3. Century Link $19.35
Box 4000
Carlisle, PA 17013
(telephone)
4. Cumberland County Landfill $32.95
620 Newville Rd.
Newville, PA 17240
(trash removal)
5. Dish Network $72.()7
Dept. 0063
Palatine, IL 60055
6. WSEMS Chambersburg $146.75
205 Grandview Ave.
Camp Hill, PA 17011
(emergency transport)
7. Citi $2,298.58
P.O. 6077
Sioux Falls, SD 57117
(credit card #xxxx xxxx xxxx 2555)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Coy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULEI
CONTINUATION SCHEDULE -PAGE 2
DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS
ITEM
NUMBER DESCRIPTION AMOIJNT
8. Citi $1 343 46
P.O.6077
Sioux Falls, SD 57117
(credit card #xxxx xxxx xxxx 9463)
9. American Infosource $669.43
P.O. Box 248852
Oklahoma City, OK 73124
(credit card #xxxx xxxx xxxx 4756)
10. American Infosource $689.45
P.O. Box 248852
Oklahoma City, OK 73124
(credit card #xxxx xxxx xxxx 9562)
11. First National Bank of Omaha $1,110.50
P.O. Box 3773
Omaha, NE 68103
{credit card #xxxx xxxx xxxx 4298)
12. Lowe's 605.80
P.O. Box 103103
Roswell, GA 30076
(credit card #816-0227-911152-6)
TOTAL $7,12~?.83
RE`/-15t3 EX ~ (t-97)
SCH~DULEJ
COMMONWEALTH OF PENNSYLVANIA 6ENEFICIARIES
INHERITANCE TAX RETURN
ESTATE OF
Rav A_ Cnv
FILE NUMBER
~n~n_nnaaQ
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
~. See attached Continuation Schedule
1000 of estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIAT E, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS;
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
I
f
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ -0_
fir more space )s neeaea, insert aaaltlonar sneers of the same size)
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Coy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULE J
CONTINUATION SCHEDULE -PAGE 1
BENEFICIARIES
NAME AND ADDRESS OF
NUMBER RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS
1. Lola L. Cohick
472 McCulloch Rd.
Shippensburg, PA 17257
AMOUNT
OR
RELATIONSHIP SHARE OF
TO DECEDENT ESTATE
daughter
2. Victoria J. Mozingo daughter
1025 Leroy Drive
Newport, PA 17074
3. Dennis Coy son
1105 South Spring Garden St.
Carlisle, PA 17015
TOTAL OF PART I.
1/3 residuary
estate
1I3 residuary
estate
1/3 residuary
estate
100% of
estate
PENNSYLVANIA INHERITANCE TAX RETURN
Re: Estate of Ray A. Goy
File No. 2010-00998
PA File No. 21-10-0998
SCHEDULE J
CONTINUATION SCHEDULE -PAGE 2
BENEFICIARIES
II. NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 -0-
FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONB- -0-
TOTAL OF PART II. -0-
'i
I, RAY A. COY, of R. D, 1, Shippensburg, South Newton Township,
Cumberland County, Pennsylvania, being of sound mind, memory and disposition,
do hereby make, publish and declare this my Last Will and Testament, hereby
revoking and making void all wills by me at any time heretofore made,
'. FIRST. I order and direct the payment of all my just debts and funeral
expenses as soon as may be convenient after my decease.
SECOND. I give, devise and bequeath all my estate, real, personal and mixed,
~.
~~ whatsoever and wheresoever situate, to my beloved wife, MIL:DRED M. COY,
absolutely.
THIRD, Tn the event that my said wife predeceases me or we die as the resul
'~ of a common disaster, I then direct my hereinafter named Executrix to sell a
either public. or private sale all my said estate, after first allowing each
i
of my children to choose what items they desire from my home, provided they
,! pay the appraised value of the same,
;~
,~
FOURTH. A11 the rest, residue and remainder of my estate to be converted
to cash, and I give and bequeath the same in equal shares tG my three childx
VICTORIA JEAN MOZINGO, LOLA LEE COHICK and DENNIS RAY COY.
i~
FIFTH. If DENNIS RAY COY is a m-in~r at time of ,;, cr,-;t,,,t;,-., T rho„ ,a; Y~„~ .,
'` Executrix to distribute his share to VICTORIA JEAN MOZINGO, as Guardian,
NEVERTHE'~ESS, to invest and reinvest the same during the mi.r_ority of my sai~
scn, with the following powers in addition to those given by law:
A. The power to expend the income for the healtl~i, support and
maintenance, and education, including a college education
or an education in a technical school subsequent to high
owl-,nn1 of rha jai ~i mj.nor:
C. The power to distribute the income and principal then
remaining to the said minor when the said minor reaches
the age of twenty-one (21) years, without the necessity
of a formal adjudication of a Guardian's Account in the
Orphans' Court Division of Cumberland County, upon receipt
of a good and valid release.
SIX'T'H. I nominate, constitute and appoint my wife, MILDRED M. COY, to be the
Executrix of this my bast Will and Testament, if she be unable to fulfill the
duties of Executrix, I then nominate, constitute and appoint my daughter,
VICTORIA J. MOZINGO as my Executrix.
IN WITNESS WHEREOF,I, RAY A. COY, have hereunto set my hand and seal
to this my Last Will and Testament, written on two pages, the first signed
for identification purposes only, this 12th day of April, 1972.
r1 ''~ f~~
~°~~ - ,r .~~,...~.~~~ (SEAL)
~-
1
Signed, sealed, published and
declared by RAY A. COY, .
the Testator, as and far his
Last ':~~i_11 and Testament, in
the presence of us who have, at
his request, signed our names
~ as witnesses hereto in the presence
of the said Testator and of each
other. .
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