HomeMy WebLinkAbout06-08-11 (2),~.,,,.
1505610143
J EX (01-10)
REV-151. •FFICIAL USE ONLY
PA Department of Revenue pennsylvania county code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60X.280601 INHERITANCE TAX RETURN 21 10 0 7 7 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
263 92 5937 07 03 2010 O1 25 1949
Decedent's Last Name Suffix Decedent's First Name MI
COOK RICHARD R
(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
lemental Return
Su
2
^ 3. Remainder Return (date of death
® 1. Original Return ^ pp
. prior to 12-13-82)
4. Limited Estate
^ ^ 4a. Future Interest Compromise
(date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
g Decedent Died Testate
^ ~. Decedent Maint fined a Living Trust
(Attach Copy of~-rust) 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
^ 9. Litigation Proceeds Received ^ 1 p. Spousal Povert Credit jdate of death
between 12-31 X31 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
N Daytime Tele~ione Numb
ame
MARK A MATEYA 717 2 4>~ 5 0 0 =.
~' ~.....
First line of address
55 W CHURCH AVENUE
Second line of address
City or Post Office State
CARLISLE PA
ZIP Code
Correspondent's a-mail address: mam@mateyalaW.COm
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 reparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATURE F PERSON RESP~7N91jLE F ILING URN DATE .
James R Cook
Soh ,rt Pine Circl
URE c~ F P PARER O HE
~....
L 32807
REPRESENTATIVE
Mark A. Mateya
REGISTEIf~~~S US~ONLIE:'
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C70 r ,
C7` `~':
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DATE FILED
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ADDRESS
s5 W_ Church Avenue. Carlisle, PA
L 1505610143
Side 1
1505610143 J ~~~,r
~• ~r
1505610243
REV-1500 EX
Decedent's Name: COOk, Richard R
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 8 Notes Receivable (Schedule D) ........................................................ 4.
5• Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Tra~isfers & Miscellaneous -Probate Properly
(Schedule G) ~ Separate Billing Requested............ 7.
g. Total Gross Assets (total Lines 1-7) ..................................................................... 8.
Decedent's Social Security Number
263 92 5937
1,010.09
1,010.09
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9.
10. Debts of Decedent, Mortgage Liabilities, 8~ 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.
12,729.22
6,752.35
19,481.57
-18,471.48
-18,471.48
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 15.
(a)(1.2) X .00
16. Amount of Line 14 taxable Q , Q Q 16.
at lineal rate X .045
17. Amount of Line 14 taxable
0 . 0 0
17.
at sibling rate X .12
18. Hmount of Line 14 taxabie
0 . 0 0
18.
at collateral rate X .15
19. Tax Due ................................................................................................................ .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
0.00
0.00
0.00
0.00
0.00
J
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4)
(5)
Make Check Payable to: REGISTER OF WILLS, AGENT.
0.00
0.00
o.oo
(1)
Total Credits (A + B) (2)
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 :.................................. x
c. retain a reversionary interest; or ................................................~............................................................. ~ IJ
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?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^
contains a beneficiary designation? .................................................................................................................. x
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 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 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 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 21 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 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 decedents lineal beneficiaries is 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 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-1500 EX Page 3 File Number 21-10-0776
Decedent's Complete Address: _
Rev-1508 ex+ (6-98) SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Cook. Richard R 21-10-0776
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.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (10-06) SCHEDULE H
FUNERAL EXPENSES &
COMMNHEWRIFTgN~EOFp,P~RET~RNANIA ADMINISTRATIVE COSTS
RESIDEN4~~DECEDEN
ESTATE OF FILE NUMBER
rnnk_ Richard R 21-10-0776
Debts of decedent must be reported on Sc#~edule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
! 2,196.18
See continuation schedule(s) attached f
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
10,000.00
2. Attorney's Fees Mark A. Mateya
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
388.04
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
145.00
7. Other Administrative Costs
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 12,729.22
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Cook, Richard R 21-10-0776
ITEM DESCRIPTION AMOUNT
NUMBER
Funeral Ex ep nses
1 Ewing Brothers Funeral Home -Funeral Expense Paid outside of Estate 2,196.18
H-A
Other Administrative Costs
2 Cumberland County Register of Wills -Exemplified Record -Expense paid by Mateya Law
Firm
3 Cumberland County Register of Wills -Filing Fee for Inheritance Tax Return ~ Inventory
4 Cumberland Law Journal -Legal Advertisement paid by Mateya Law Firm
H-B7
2,196.18
40.00
30.00
75.00
145.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-05)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Cook. Richard R
FILE NUMBER
21-10-0776
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
1 Carlisle Digestive Disease Associates -Debt of Decedent 211.98
2 Carlisle Regional Medical Center -Debt of Decedent 16.57
3 Carlisle Regional Medical Center -Debt of Decedent 204.18
4 CBL Path, Inc. -Debt of Decedent 18.14
5 Citifinancial -Debt of Decedent 5,888.16
6 Milton S Hershey Medical Center Physicians Group -Debt of Decedent 15.00
7 PPL Electric Utilities -Debt of Decedent 43.38
8 Verizon Wireless -Debt of Decedent 354.94
TOTAL (Also enter on Line '10, Recapitulation) I 6,752.35
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
ESTATE OF:
Richard R Cook 07/03/2010 263-92-5937
Item Name and Address of Person(s)
Number Receiving Property
1 Anthony Preston Cook
993 E. McKinnley
Chambersburg, PA 17201
2 Miranda Kay Cook
221 E. Willow Street
Wauseon, OH 43567
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
Relationship
Child
Child
Share of Estate Amount of Estate
(Words) ($~~)
Total
1
LAST WILL AND TESTAMENT
OF
RICHARD R. COOK
I, RICHARD R. COOK, of , 8 Peiper Court, Carlisle, Cumberland County, Pennsylvania,
make this my will. I revoke any other wills or codicils to wills made b3~ me.
ARTICLE I. DISTRIBUTION OF MY PERSONAL PROPERTY ESTATE
I give all my tangible personal property to my child Anthony Preston Cook, presently
residing in Chambersburg, Pa and my child Miranda Kaye Cook, presently residing in
Wauseon, Ohio, share and share alike. Tangible personal property includes stamp or
coin collections but does not include other money or stock certificates or other.
evidences of intangible rights or interests. Tangible personal property does not
include any property that is held primarily for investment purposes or used in
connection with any business in which I may be engaged or in which I may have any
interest at the time of my death.
ARTICLE II. DISTRIBUTION OF THE RESIDUAL ESTATE
TESTAMENTARY TRUST
A. I give the residue of my estate to my Trustee, IN TRUST fir the benefit of my child
Anthony Preston Cook, and my child Miranda Kaye Cook, (hereinafter "Trust
Beneficiaries") to share, as described more fully below. Interpretation of and
application of the distribution scheme described in Article II herein is to be carried
out by and is at the sole discretion of my Trustee.
B. My Trustee may accept funds from inside my estate or from outside of my estate,
including but not limited to, insurance proceeds payable at the incident of my death.
C. PROVISION FOR INTEREST VESTING IN BENEFICIARIES UNDER AGE
TWENTY-FIVE -- Notwithstanding the foregoing provisions, whenever any interest
in my estate, including this testamentary trust, vests absolutely in a Trust Beneficiary
under age twenty-five, my Trustee shall retain the interest upon a separate trust or
together in one trust with the other Trust Beneficiary, as my Trustee decides at his or
her discretion, keeping in mind the interests of the Trust Beneficiaries are best-served
by minimizing estate and trust expenses whenever possible, and to pay to each Trust
Beneficiary as much of the net income or principal according; to the following:
1. My Trustee address the health, education, maintenance and welfare needs of
my Trust Beneficiaries.
Page 1 of 5
2. My Trustee shall make every effort to utilize the Trust funds to assist the Trust
Beneficiaries with their post secondary education expenses.
3. My trustee may distribute to and among the Trust Beneficiaries, or any of
them from time to time, all or any portion of the net income and such portions
of the principal as my Trustee, in his absolute discretion, may deem advisable.
4. Such distribution of income and principal may be made in such proportions
among the Trust Beneficiaries as my Trustee, in his absolute discretion, may
deem advisable, without regard to equality, and the pattern of any distribution
of income or principal need not be followed at thf; time of any other such
distribution. Any of the net income not distributed by my Trustee in
accordance with the foregoing provisions in any calendar year shall be
accumulated and added to the principal of this trust.
5. If a. Trust Beneficiary dies before reaching the age oi' twenty-five years, his or
her interest shall constitute a part of the beneficiary's estate.
6. This trust shall terminate upon the earlier to occur of the following events:
(1) At such time as all of the Trust Beneficiaries shall have attained the age of
twenty-five years; or
(2) At such time as there is no Trust Beneficiaries of mine then living.
7. Upon termination of this Trust in accordance with the provisions, of
subparagraph C hereof, or if either of the events specified in Article II,
Subparagraph C 6 above has theretofore occurred, the balance of the principal
then remaining shall be distributed to the Trust Beneficiaries, per stirpes.
ARTICLE III. PAYMENT OF EXPENSES AND OTHER CHARGES
I desire a modest Christian burial. I direct my Executor to pay my funeral and burial
expenses (including the cost of a monument or marker over my grave). The estate, inheritance
and similar taxes assessable on my death (including taxes on assets not passing under this will)
shall also be paid as a cost of administering my estate and my Executor shall not request any
beneficiary tc pay any part of such tax.
ARTICLE IV. MISCELLANEOUS PROVISIONS
A. Spendthrift Trust. To the extent permitted by law, neither the principal nor income
of any trust shall be liable for the debts of any beneficiary or, except to the extent
otherwise specifically provided, to alienation or anticipation by a beneficiary.
B. Matters of Interpretation. For simplicity, I have expressed pronouns and other
terms in one number and gender, but where appropriate to the context these terms
Page 2 of 5
shall be deemed to include the other number and genders. 'The bold headings are for
convenience and shall not affect interpretation.
ARTICLE V. APPOINTMENT OF FIDUCIARIES AND POWERS
A. I name James Ronald Cook, presently residing in Orl~~ndo, Florida, to be my
Executor (hereinafter "Executor").
B. I name "Farmers and Merchants Trust Company of Chambersburg" to be my Trustee
(hereinafter "Trustee"). If administration of my estate or trust should be necessary in
any jurisdiction where my Executor or my Trustee is unable to qualify, or if my
Executor or my Trustee deems it necessary for any other reason, I give to my
Executor and my Trustee the power to designate any individual or corporation with
trust powers to serve with my Executor or my Trustee or in my Executor's or my
Trustee's stead. I request that no security be required of any Executor or Tr'astee,
including an Executor or Trustee named pursuant to the preceding sentence.
Reference in my Will to my "Executor" and my "Trustee" axe to the one or ones
acting at the time, except where otherwise specifically provided.
C. Any corporate Executor or Trustee shall receive for its services the compensation for
which it willing to undertake similar services for others at the time such services are
rendered, as evidenced by its published fee schedule in effect from time to time,
unless it is willing to agree upon a fee that is less than its customary fee. Any
individual who serves as Executor or Trustee shall be entitled to receive reasonable
compensation for his or her services and, whether or not such individual receives
compensation, shall be entitled to be reimbursed for exI-enses incurred for such
services.
D. I grant my Executor and my Trustee the powers set forth in 20 Pa. C.S. §3311-3332
and 20 Pa.C.S. §7771-7780 respectively. In addition, my Trustee may merge any
trust under this Will with any trust having the same trustee and substantially the same
dispositive provisions. If at any time after my death the si~;e of any trust under this
Will is so small that, in the opinion of my Trustee, the trust is uneconomical to
administer, my Trustee may terminate the trust and distribute the assets to the person
or persons authorized to receive the trust income in such shares as my Trustee may
deem appropriate. No Trustee who is also an income beneficiary of the trust at issue
shall exercise any discretion granted in the preceding sentence. My Executor and my
Trustee may distribute tangible personal property passing to a minor to any adult
person with whom the minor resides, and that person's receipt shall be a sufficient
voucher in the accounts of my Executor and my Trustee.
E. It is my desire that my Executor, herein above named, and my Trustee consult with
Mateya Law Firm in the handling of my estate and testamentary trust, they being
familiar with my affairs.
Page 3 of 5
ARTICLE VI. DEFINITIONS
The following definitions shall be applicable to all of the provisions of my Will except
where otherwise specifically stated:
1. The use of the masculine shall include the feminine or neuter and the use of the
singular shall include the plural, and vice versa.
2. The term "estate," where appropriate, shall include any trust hereunder.
3. The term "minor" shall mean an individual who has not attained the age of twenty-
one (21) years.
Executed this ~~~da of ,~ , 2010.
Y
.~-~-
Richard R. Cook
Signed, sealed, published and declared for his Last Will and Testament by the testator in
our presence, we all being present at the same time; and we, in his presence and at his
request and in the presence of each other, have subscribed our names as witnesses
whereof, all on the date last above-written.
. ~~~
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Page 4 of 5
COMMONWEALTH OF PENNSYLVANIA
CUMBERLAND COUNTY
Before me, the undersigned authority, on this date personally appeared RICHARD R.
COOK, Mark A. Mateya, and "?',~R,e ~/ (,~~T (,t.~,~ ~ ,known to me to be
the testator and witnesses, respectively, whose names are signed to the foregoing instrument and,
all of these persons being by me first duly sworn RICHARD R. COOK, the testator, declared to
me and to the witnesses in my presence that said instrument is his Last Will and Testament and
that he had willingly signed and executed it in the presence of said witnesses as his free and
voluntary act for the purposes therein expressed, that said witnesses stated before me that the
foregoing Will was executed and acknowledged by the Testator as his last Will and Testament in
the presence of said witnesses who in his presence and at his request and in the presence of each
other did subscribe their names thereto as attesting witnesses on the da;y of the date of said Will
and that the testator, at the time of the execution of said Will was over the age of eighteen years
and of sound and disposing mind and memory.
Sworn and acknowledge before me by RICHARD R. COOK, thE; testator,
Mark A. Mateya, witness, and ~ ~' ~~~2 ?~~/~~~-~C- _, witness,
this _~rVt%~- day of , 2010.
RICHARD R. COOK
Witness
-.~
Witness
ti~ ~•
My commission expires: Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Frances A. Aumiller, Notary PubNC pa e 5 of 5
South Middleton Twp., Cumberland County g
My Commission Ekpires Marcfi 16, 2014
Member, Pennsylvania Association of NotdriC~