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Home My WebLink About04-25-1115056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY _ PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes ~'+ INHERITANCE TAX RETURN tY Po Box 2sosol 21 10 0936 Harrisburg, PA 17128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204-12-2012 08/28/2010 01/28/1926 Decedent's Last Name Suffix Decedent's First Name MI FOX SHIRLEY L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return 4. Limited Estate • 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS __ 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT _ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD IBE DIRECTED T0: Name Daytime Telephone Number LISA MARIE COYNE, ESQ. (717) 737-0464 Firm Name (If Applicable) REGISTER OF WILL:> USE ONLY.. -. COYNE & COYNE, P.C. ~-;~ ::_„ _ _ `,~ First line of address --' _i~ - ~,F ~~,i = '; ~:_~~j f- - r .. 3901 Market Street ~ .k. ' ' ' ~-- c7 ~~` :a -- `^~ r ~ , Second line of address ~~ '~ ~~ -~ C_~`i `J,~ _-~~ _.` ` `_? ~; ,.... r..~ -: ;..~ Cit or Post Office y DATL~)h -~-~--- State ZIP Code - .~~ _ . _r~, ~; ~:7 ,~ Camp Hill °--i PA 17011-4227 ~~ ~." ``~ Correspondent's a-mail address: II$a@COyneanCOyne.COm under penalties of perju , 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 plete. Declaration of pre r other than the personal representative is based on all information of which preparer has any knowledge. SIGN RE~OF P SON RE ONSIBLE FOR LING RETURN DF~TE 1 -L _ __ __ ADD S Charles Fox 124 Deerfield Road, Camp Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE __ ADDRESS - - PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Sec:urity Number decedent's Name: SHIRLEY L FOX 204-12-2012 RECAPITULATION 1 . Real estate (Schedule A) . ........................................ .... 1. 0.00 2 . Stocks and Bonds (Schedule B) ..... . ............................. .... 2. 18,572.50 3 . Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 0.00 4 . Mortgages & Notes Receivable (Schedule D) ......................... ... . 4. 0.00 5 . Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .... 5. 19,138.36 6. Jointly Owned Property (Schedule F) Separate Billing Requested ... .... 6. 0 00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) _: Separate Billing Requested.... ... , 7. 0.00 8. Total Gross Assets (total Lines 1-7) ................. 8 .. .... . 37,710.86 9. Funeral Ex enses & Administrative Costs Schedule H ......... p ( ) g .. . ...... . . . . 15, 888.91 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .. 10 ........... ... . 7, 537.10 11. Total Deductions (total Lines 9 & 10) ........................ 11 ........ ... . 23,426.01 12. Net Value of Estate (Line 8 minus Line 11) ....... .......... 12 13. ....... Charitable and Governmental Bequests/Sec 9113 Trusts for which ... . 14,284.85 an election to tax has not been made (Schedule J) ............... 13 ...... . . . . 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ ~~~ 14 ........ ~~ ... . 14,284.85 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 14,284.85 16. 642 82 17. Amount of Line 14 taxable . at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ....................................................... .. 19. 642.82 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ,, ~: 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 10 0936 DECEDENT'S NAME SHIRLEY STREET ADDRESS 3605 Kohler Place L FOX DECEDENT'S SOCIAL SECURITY NUMBER 204-12-2012 CITY Camp Hill _ __ _ ...STATE _ __ _ _ - - -- ,ZIP _ PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 642 82 2. Credits/Payments _ . 0.00 A. Spousal Poverty Credit -- - B. Prior Payments 760.00 _ _ _ iscount 32.14 __ Total Credits (A + B + C) 3. Interest/Penalty if applicable (2) -- 792.14 D. Interest --- - _. _ E. Penalty _ __ _ _ - Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) - 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 149.32 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A, This is the BALANCE DUE. (5B) 0.00 IVlake 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 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. 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 i~or 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)]. 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) ~ ~~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE WUMBER Shirley Louise Fox 21-10-()936 All 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) 1 ~;' "' '~ ~' ~ E? 1. ~? ~ r : ?' r '1 r 7 611 ~ 7:~ W I EI~KEI~ Helping ~ t`ofi tomo>cz~ow.' COREY ~.. BA9EN4RE. CFP", GhFC~', CLU'~ Partner ~(~~ rrbasehore~ifinsvcs.cam October 19.2(? 10 _Facsimile: ?1;7~ ~3 i-,~'a r5.1 Coyne & Coyne, P.C. 39Q 1 11rlarket Street Catnip Hill, P~1 1'01.1 lte: ~hirl.ey Fox ~staxe Pr~GE 01 ~ 01 To whoz~cz this may concern: The value o.f Shirley k'ox's individual Account 1~MA-71501$ at t1~c date~of her death is b~roi~en down. fund by fund as of 08!27!2010., We are using the death valor of 08!,27!201 t3 as this ys a Friday which is the last day tb.e market ~vould have t't open for busianess before Shirley died. All der share prices arc as of close Qn 08/27/201 Q. Fund Name & Class $ per shirr Shares Ow>nied Total .& PIMCO Real Return Class C $11.3 5 G75.Od8 $7,662.02 FIMCa Total Return Class C $11.48 672.646 $7,721..98 Prime Fund (Money Marken 0 0 $10,.6~~7.05 Grand Taal ~26,0?r~.OS If you have azay questions about the information provided please feel. free to contact my c-ffice at ? 1 ?-763-73 6~ . Sincerely, _ .~`~ Corey L Basehore, CFP~, CLUB, ChFC~ coos t~lrmh~r .~ CorEy 1. Basehore is ~ registered represent five of and offers securities, investment odvisory, and financial planning 9etvices through M~~]. MML Investors Services, Inc., member SIPC ]. TfM lRi+„Irr A.w,nri,,,inn nr FiniswW i'mfnwnnal.•* 2~~~C !:~.;AM Wells Fargo Advisors, F.LC Thug Lemoyne T3rivt Lez~.oy»~-, PA I?~~3 WE'!_~~fi FA~~GC~ AD`diSCR Te171?-7~1 ~3$¢ Fr~c 71?-875-8426 SOO~r88,8685 October 11, 20,10 Coyne and Coyne Fax: '737-5.61 RE: Este of Shirley Fox DOS 08rL8/2010 bear Lisa, fisted below is the date of death value for Smiley Fox. I have provided'~alues for Friday, .august 27, 2010 and Monday, August 30, X010 since the date of death was a Saturday, Atig113t ~7, 2Q~0 Shares Company Name F~ice per share 'V'atue 228.0760U Prudential Jen~,icson Blend Fund $14.20 $3,238.6$ August 30, 2010 ' 2Z8.0760a Prudential Jennison Blend Ft~d $13.98 $3,18$.SO $$22.7b in money rx~~urket ,., F Pie~ase let me know which value you want nae to use for cost basis for the aecount..If I cam. ~be of furthez assistance, please give me a caU. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY tJIAIt OF Shirley Louise Fox Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned wi4h ~inh4 of ~„~,,.,.,..,~.:_ _.._. ~_ _.__ _. _ - FILE NUMBER ~:1-10-0936 • _ _-- ..__........,,,,,~~~~ ~nccw ui ~~~C same size Sovereign Bank ESTATE OF Shirley L. Fox SOCIAL SECURITY #: 204-12-2012 - DATE OF DEATH: August 28, 2010 Account #: 2331037981 Type: Checking Open date: 1 /2 /1997 In the name of. Shirley L Fox or Charles D Fox Jr . . -- Date of Death Balance: $1,471.83 - Int (YTD) from 1 /1 / 0 . 2 10 to 8/28/2010 - $0 00 Accrued interest to date of death: $0.00 . - Other Info: Charles D Fox Jr was added onto account on 07/30/10. Account #: 2334021918 Type: Savin s In the name of: Shirley L Fox or Charles D Fox Jr g Open date: 1 /2~ 1997 Date of Death B l a ance: $195.75 _ Int.(YTD) from 1/1/2010 to 6/30/2010 ' $0 86 Accrued interest to date of death: $0.10 . - Other Info: Account closed on 09/08/10. Charles D Fox Jr was added onto account on C-7/30/1 Account #: 2334087750 Type: Money Market In the name of: Shirley L Fox or Charles D Fox Jr Open date: 7/29/2010 - Date of Death Balance: $5,500.87 - Int.(YTD) from 1 /1 /2010 to 8/27/2010 - 87 ~ $0 Accrued interest to date of death: $0.00 . - Other Info: Account closed on 09/03/10. - Page 1 of 1 REV-1511 EX+ (12-99) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Shirley Louise Fox 21-10-0936 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION _ AMOUNT A. FUNERAL EXPENSES: t' Neill Funeral Home 3,519.67 2~ Honorarium 200.00 s. Flowers 122.00 4. Reception 891.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 3,000.00 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 173.50 5. Accountants Fees 6. Tax Return Preparer's Fees 600.00 7. Cumberland Law Journal -legal advertisement 75.00 $. Patriot News -legal advertisement 140.00 9. Inheritance Tax filing fee 15.00 ~ o. Brokerage charges 300.00 ~ ~ . Postage ~ 88.00 12~ Total from Schedule H, page 2 6,764.74 TOTAL (Also enter on line 9, Recapitulation) $ 15,888.91 (If more space is needed, insert additional sheets of the same size) SCHEDULE H: FUNERAL AND ADMINISTRATIVE COSTS, PAGE 2 Item No. Description 13 Reserves 14 Mileage for Executor @ $0.55/mile 15 Cleaning and removal of trash from apartment 16 Executor's missed days of work 17 Income Tax due 18 Estate checks and bank fee 19 Penske Repairs 20 Toll Calls Amount $1,000.00 $890.00 $500.00 $3,800.00 $350.00 $45.00 $144.74 $35.00 TOTAL: $6,764.74 REV-1512 EX+ (12-08) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Shirley Louise Fox 21-10-0936 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Shirley Louise Fox 21-1~0-0936 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 and transfers under Sec. 9116 (a) (1.2).] 1. Charles Fox son 100%_residual ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, insert additional sheets of the same size,