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HomeMy WebLinkAbout02-09-121505611188 t~; REV-1500 Extoz-„)(FI> pennsytvania 01=FICIAL USE ONLY PA Department of Revenue ""'«°'"'"""" County Code Vear File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO Box zaosot Harrisburg, PA 17128-0801 RESIDENT DECEDENT 21, 11 12 4 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 182 22 8406 10 16 2011 10 D1 1928 Decedent's Last Name Suffix Decedent's Frst Name MI Cover Betty L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Frst Name MI Cover Richard E 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 Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received l~ 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -This section must be completed. All Correspondence and Confidential Tax Information Should be Directed to: Name Daytime Telephone Number John A• Feichtel, Esquire '717 612 580 -a: ,:..y -cx Ce-'~ r,..~ ~ i,..,1 RE~ST,J~'A OF WILL~'tl'SE ONL*Y-~ :~ ~ ~ i r--~ ,. Ftst Line of Address l f ~ ~ ~ Saidis, Sullivan 8 Rogers ~ ~~ ~ ~_ -~, f-- Second Line of Address -"' ~ ~ rte. 635 North 12th Street, Suite 400 ~~ .w City or Post Office State ZIP Code DATE FILED Lemoyne PA 17043 Correspondent's a-mail address: jfelChtel@SSf-attOrneyS.COm Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledgeand belief, it is true, correctan~,~mplete. Declaration of the preparer other than personal representative is based on all information of which preparer has any knowledge. SIGNAT~~F ERSO R O SIBLE FOR FILINGRETURN ATg ~~^~~~ ~rj~ i 1-oxnunt Lane Side 1 1505611188 1505611188 PLEASE USE ORIGINAL FORM ONLY Rev-1500 EX (FI) 1505611288 Decedent's Name: Betty L Cove 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 and Notes Receivable (Schedule D) ......................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ..... - • 5. 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 through 7) ............................ 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 11. Total Deductions (totalLines9and10) ...•....••.•..•..•.•.••.•. 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 CALCULATION -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.oo 35,209 • 76 1s. 16. Amount of Line 14 taxable at lineal rate X .045 D • D D 16. 17. Amount of Line 14 taxable at sibling rate X .12 D • D D 17. 18. Amount of Line 14 taxable D ' D D at collateral rate X .15 18 19. TAX DUE ..........:............................... ......... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611288 Decedent's Social Security Number 182 22 8406 0.00 0.00 0.00 o•Do 9,861.75 0.00 25,348.01 35,209.76 0.00 0.00 D•OD 35,209.76 0.00 35,209.76 0.00 0.00 0.00 0.00 o•oD t~ 1505611288 J Rev-1500 EX (FI) Page 3 Decedent's Complete Address: File Number 21 11 1245 DECEDENTS NAME Betty L. Cover STREET ADDRESS 2100 Bent Creek Blvd CITY Mechanicsbur STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments 0.00 B. Discount 0.00 Total Credits (A + B) (2) 0.00 3. Interest (3) 0, pp 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. (5) 0.00 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 . • • . • .. • . - ...... • .. • • . • • • • • . • .. • • • • • • • • • • • • • • • • • • • ^ d. receive the promise for life of either payments, benefits or care? . • .. • ... • • • • • ... • . • . • . • . • • ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......... • ...... • • ......... • .. • . • • ... • ^ 3. Did decedent own an "intrust for' orpayable-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 containsabeneficiarydesignation? ...•.•.••.••.•••••••••••••••-••••-•-•-••••••• © ^ 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. Sect. 9116(a)(1.1)(i)]. For dates of death on or after Jan. 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. Sect. 9116(a)(1.1)(ii)]. The statue does not exempt a transfer to a surviving spouse from tax, and the :~atutory 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 de<rth to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. Sect. 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 4.5 percent, except as noted in [72 P.S. Sect. 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. Sect. 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-508 EX+(~~-10) Pennsylvania SCHEDULE E IMF NAP IN.ENf of Nt;VF:NUF CASH, BANK DEPOSITS, & MISC. INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Betty L. Cover 21 11 1245 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolnUy owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Continental Casualty Company, refund of long term health care insurance 140.42 premium 2 Continental Casualty Company, Tong term care benefit payment (8/24/1 1- I 6,080.00 9/30/11) 3 Continental Casualty Company, long term health care benefit payment: 2,560.00 (10/1/11-10/16/11) 4 ~ Bridges at Bent Creek, refund of rent 10/16/11-10/21/11 ~ 545.00 5 Citizens Finance, refund of overpayment of auto loan paid off prior to 9.90 Decedent's date of death 6 Capital Blue Cross, refund of health insurance for the period 10/17/11- 526.43 12/31 /11 TOTAL (Also enter on line 5, Recapitulation) ~ 9,861.75 If more space is needed, insert additional sheets of the same size REV-1570 EX+(OB-09) `r~ Pennsylvania l)k VAF1IA~Nr OP NF VPNUk INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Betty L. Cover 21 11 1245 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the 13EV-1500 is yes. ITEM NUM DESCRIPTION OF PROPERTY INCLUDE NAMEOFTRANSFEREE,RELATIONSHIPTODECEDEN7~& DATE OFTRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 Belco Community Credit Union IRA 25,348.01 100 25,348.01 Beneficiary: Decedent's surviving spouse, Richard E. Cover Per letter 1/13/2012 TOTAL (Also enter on Line 7, Recapitulation) I 25,348.01 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+(01-10) ~ Pennsylvania SCHEDULE J INHERITANCETAX RETURN BENEFICIARIES RESIDENTDECEDENT ESTATE OF: FILE NUMBER: Betty L. Cover ~-I I I IL40 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not Llst Trustees OF ESTATE T TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116(a)(1.2).] Richard E. Cover Surviving spouse 35,209.76 Bridges at Bent Creek 2100 Bent Creek Blvd Mechanicsburg, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES iSTHROUG H is OF REV-1500 COVER SHEET, AS APPROPRIATE. zz NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX I:i NOT TAKEN: 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, use additional sheets of paper of the same size. ~,~: -_ - ' ~ = -~ :. - - _„ ~ , LAST WILL AND TESTAh1ENT OF - -- BETTY L. CODER - - - t. I, BETTY L. COVER of the Borough of ^.echanicsburq, Cumber. ].and County, Pennsylvania, declare this to be my Last Will and Testament, Hereby revoking any will previously made by me. ~ y.,, , ~u ~,,;, II I - I direct the payment of all my just debts and funeral expenses out. of my estate as soon as may be practical after my death. II - I devise and bequeath all of my estate of whatever nature and wherever situate unto my husband, Richard E. Cover, providing he survives me by sixty (6C) days. III - Should my said husbanc? fail to be living on the sixty-first (61st) day following my death, then I devise and bequeath a:11 of my estate of whatever nature and wherever situate unt=o my issue per stirpes.. Ia' - I appoint my husband, Richard E. Cover, Executor of this, my Last Will and Testament. Should my said husband fail to qualify or cease to act as such, then I appoint my son, Plichael S. Cover, to act in this capacity. Neither of my personal representatives shall be required to post bond i.n this or any jurisdiction. ID. WITNESS WHEREOF, I have hereunto set my hand and seal on this, the ~~' --- ~~'' day of ~~~ ~Y-E'- r.~ -~; ( o ~ `f/r~y ~~ ~~ ~ ~.L ~' (SEAL) B. tty L. Cover i:'~ page 1 ~# Signed., sealed, published and declared by F3ET`I'Y L. COVEP,, 'Pes- tatrix therein named, on this and one (1) other. sheet of paper as and for her Last Alill and Testament in our presence, who, in her presence, at her request and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~ , i ~ J Dame ddiess ( - __ ___ ~ ~.,.-4~Q Name -- ~~~ l~Q, Address -- Paqe 2 COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY ~ OF' CUMBERLAND) I BETTY L. COVER the testatrix whose name is signed to the attached or foregoing instrument, having been duly quali- fied according to law, do hereby ,acknowledge that I signed and executed the instrument as my Last Will; that I signed it will- ingly; and that I signed it as my free and voluntary act for the purposes tYaerein expressed. Sworn or affirmed to and acknowledged before me, b}'~'! BETTY L. COVER,, the testat rix this L~ day o f ~ LF~.uLZ..~I:~ , / 19 7 9 ~ 1 ~ ~ l //. 1 i ; r- . J Notary Public tlsehna 5.:ti9[Caaslin, N~,!e;p ..Sf;: Mr Commisinn _ranes ! - COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) WE, the undersigned, the witnesses whose names are siclned to the attached or foregoinc instrument, being duly qualified according to law, do depose arPd say that we were present and saw the testatrix sign and execute the instrument as her Last Will; that BETTY L. COVER signed willingly and tYiat BET'T'Y L. COVER executed it asher free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatrix, signer the will as witnesses; and that t:o the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mint and under no constraint or undue influence. ARNOLO. SLII(E b BAYEEI' nnnNN[rs Ar 1Aw »ny Mngnf t SinFkt I nM~' !Illl PfNNSYt VA NIA 11011 Sworn to and subscribed before mla 1, this ~' day of t.~L~,._d-~rti~ 19_79 Notary Public TheUna 5. C!(,f.a::>lin, tlatar,l ~s:!;lit M4 Commiumn `.xpire; Ll!~ }, PiSJ Canrp Nill, PA _ _ ~.umb^_da1x1 Caanp, DECEDENT ESTATE INFORMATION(~n Date of Death) 1. Name(s) in which the account was held: BETTY L COVER (PRIMARY OWNER.) RICHARD E COVER (JOINT OWNER ) 2. Account number: 187130 3. Balance as of date of death: $27,510.32 Balance Accrued Dividends YTD Dividends Opened Regular Saving: S1 $1,003.25 $0.12 $2.83 3/29/1988 Christmas Club: S2 Money Market: S6 Checking: S4 $1,159.06 $0.38 $2.15 2/26/2009 IRA S5 $25,348.01 $71.82 $307.58 2/26/1991 Certificates: Balance Accrued Dividends Certficate Number YTD Dividends $ $ 4. Date the account was initiated: 5. Name(s) in which Safe Deposit Box was held: 6. Date the box was initially rented: 7. Branch address at which the box is located: 8. Loan Information: Balance Accrued Interest Per Diem Int A, Unsecured Loans: L14 Classic Visa Card B. Secured Loans: C. Mortgage Loans: $ $ $ $ $ $ $ $ 9. Miscellaneous: Richard Cover only joint fo r the S1 Savings and the S4 Checking