Loading...
HomeMy WebLinkAbout03-22-121505611185 REV-1500 EX (02-t1)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox 2aosot INHERITANCE TAX RETURN ~!1 11 1292 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 10172011 09241914 Decedent's Last Name Suffix Decedent's First Name MI COOVER HELEN T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number - - FILL IN APPROPRU\TE BOXES 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 ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust.) ^ 10. Spousal Poverty Credit (Date of Death ^ 1 1. 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 Day~lime Telephone Number STEVEN J SCHIFFMAN 7:L7-540'170 r., €~ _ REGISTE~ LLS USEr~1LY 'rI '~. ^,i ~: .~ C7 3:~• r First Line of Address , n. 5~ ~~ ~- . ~[] 2080 LINGLESTOWN ROAD t ~ ~`=~ ~ `~~ Second Line of Address .~ _ _ - ~ SUITE 201 y y ~- ' i<- ' ~~' City or Post Office ... ~~ State ZIP Code DATE FILEDCT'~ HARRISBURG PA 17110 correspondent's e-mail address: S S C H I F F M A N a S S B C -LAW • C O M Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and c te. Declarat' n of preparer other than the personal representative is based on all informatio f hi h n o w c preparer has any knowledge. SIGNA OF P ESPONS LE FOR FILING RETURN DAT +,,,f. ~ X D ~ ~ ~ AD ss , PO BOx~ 5 ~~}~ POCONO PINES, PA 18350 SIGNATURI,~J~REgAT#~42 OTHER THAN RE PRESENTATIVE ,,,,T~ AUUfttSS 208D LI CESTOWN ROAD, SUITE 201 HARRISBURG, PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 ]i~505611185 Estate of HELEN T. COOVER Executors (Page 1) Name VANCE C. COOVER, JR. Address PO BOX 845 POCONO PINES, PA 18350- Tax ID 172-40-7061 211-10-1703 1505611285 REV-1500 EX (FI) Decedent's Social Security Number _ Decedent's Name: C O O V E R H F N T RECAPITULATION 1. Real Estate (Schedule A) 1 0 • 0 0 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) ~ Separate Billing Requested g 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) 8 0.00 0.00 0.00 46,410.00 0.00 0.00 46,410.0^ 9. Funeral Expenses and Administrative Costs (Schedule H). g, 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 11. Total Deductions (total Lines 9 and 10) , 11 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 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 un~er Sec. 9116 16. Amount of Line 14 t xable 0 4~ at lineal rate x 17. . 0. 0 0 Amount of Line 14 taxable 1 g, at sibling rate X .12 0 • 0 0 18. Amount of Line 14 taxable 17. at collateral rate X .15 0 . 0 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505611285 5,962.00 121,488.00 127,450.00 (81,040.00) 0.00 (81,040.00) 0.00 0.00 0.00 0.00 0.00 Side 2 15I]5611285 J OM4648 3.000 REV-1500 EX (FI) Page 3 Decedent's Cemnlafa Orlrlroca• File Number cy JIL JlC7C DECEDENTS NAME V STREET ADDRESS aTv STATE ZIP A R A 7 - Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) Q " Q Q 2. CreditslPayments A. Prior Payments Q , Q Q B. Discount Q " Q Q Total Credits (A + B) (2) Q . Q Q 3. Interest (3) Q•QQ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Llne 20 to request a refund. (4) Q ~ Q Q 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ Q " Q Q 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 "in trust for" or payable-upon-death bank account or securit at his or h d th? ^ y er ea 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 Jan. 1, 1995, the tax rate imposed on the net value of transfer. 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 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. §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 1:0 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 decedent's lineal beneficiaries is 4.5 percent, except as noted in [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)]. 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. OM4671 2.000 REV-1508 EX+ (~ ~-10) pennsylvania SCHEDULE E DEPART1rENTOFREVENUE CASH, BANK DEPOSITS, & MISC. WHERITANCE TAX RETURN RESIOENTDECEDENT PERSONAL PROPERTY rime numestrt: HELEN T. COOVER 21 11 1292 Include the proceeds of litigation and the date the proceeds were received by the estate. All ro ert ointl owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. SOVEREIGN BANK CHECK ACCOUNT #0771024487 46,022 2 CAPITAL BLUE CROSS (REFUND) 388 3 Personal Property (The decedent lived in a nursing home at the time of death and her personal property did not warrant the cost of an appraisal and the property was donated to charity) 0 TOTAL (Also enter on line 5 Recapitulation) S ~ 46, 410 OwaBAD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania SCHEDULE H DEPPR'TN£NTOFREVENUE FUNERAL EXPENSES AND IJHERITANCETAXRETURN ADMINISTRATIVE COSTS RESDENTDECEDENT ESTATE OF FILE NUMBER HELEN T. COOVER 21 11 1292 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ . None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 500 Name(s) of Personal Representative(s) VANCE C . COOVER, JR Street Address PO BOX 845 City POCONO PINES State PA ZIP 18350 Year(s) Commission Paid: 2012 2. Attorney Fees: 5 , 050 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5. 6. 7. 1 Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: CU1I48ERLAND LAW JOURNAL (Estate Advertisement) Total from continuation schedules . 154 75 183 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 5 962 swasnc z.oao If more space is needed, use additional sheets of paper of the same size. Estate of: HELEN T. COOVER Schedule H Part 7 (Page 2) 21 it 1292 2 CUI~ERLAND COUNTY REGISTER OF WILLS (ACCOUNTING FEES) 100 3 THE SENTINEL (Estate Publication) 83 Total (Carry forward to main schedule) 183 REV-1512 EX+ (12-OB) Pennsylvania SCHEDULE I DEPAR71uENiOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF PILE NUMBER HELEN T. COOVER 21 11 1292 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1• DEPARTMENT OF PUBLIC WELFARE (MEDICAL ASSISTANCE RESTITUTION) 75,079 2 MESSIAH VILLAGE 46,409 TOTAL Also enter on Line 10, Reca itula_tion) I; 121 488 awasAH z.ooo If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) Pennsylvania SCHEDULE J OF3AR7Tr£NTOF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: HELEN T. COOVER FILE NUMBER: 21 11 1292 RELATIONSHIP T'O DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE [ TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. *NOTE: The Helen T Coover 2001 Trust named in the Will as 50$ residuary beneficiary was never funded. Trust 0 2 VANCE C. COOVER, JR. PO BOX 845 POCONO PINES, PA 18350 Son 0 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 S swaeni z.ooo If more space is needed, use additional sheets of 0 paper of the same size. REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No. 2011- 01292 PA No. 21- 11- 1292 Estate Of: HELEN T COOVER /First, Middle, Last) Late Of : UPPER ALLEN TOWNSH/P CUMBERLAND COUNTY Deceased Social Securi ty No : WHEREAS, on the 5th day of December 2011 an instrument dated June I3th 2001 was admitted to probate as the last: will of HELEN T COO VER !rust, Mladte, Lastl late of UPPER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 17th day of October 2011 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAIVIENTARY to: VANCE C COOVER JR who has duly qualified as EXECUTOR(R/Xl and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 5th day of December 2011. * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT OF HELEN T. COOVER ?~~. ~~ ~~ ~ ~7 S. ~ :-- ~~~? C> -_ _! i-~ r ~~ ~ ~ ~ ~s; x ,,~ ~ ~ '~ ~..J ~J -Y~'; ~~ ~ ~fjr ~ ~~ ~~ I, HELEN T. COOVER, now a resident of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all my WdLs and Codicils that I may have made previously. Article I My Executor shall pay my just debts, and all expenses related to my last illness, my funeral, and the administration of my estate, from the principal of my residuary estate as soon as may be done after my death Article II My Executor shall pay all inheritance, estate and succession taxes (including interest and penalties, if any, but not including any generation skipping tax) payable by reason of my death, out of the principal of my residuary estate, without reimbursement from any person. Article III I give my friend Lois Keller, of Lewisberry, PA, Five Thousand Dollars ($5,000.00). I give mY granddaughter, Abigail Coover, Twe~y Five Thousand Dollars ($25,000.00). I give, devise, and bequeath the rest of my estate as follows: 1 • One-half of my property, I give to my son, Vance C. Coover, Jr., per ~. ?tiw,it.. _.. HTC Page 1 of 2 Pages 2. The balance of the rest, remainder and residue, to a trust known as The HELEN T. COOVER 2001 TRUST, which I created today. Article IV I nominate, constitute, and appoint my son, ;Vance C. Coover, .Jr., Executor of my Last Will and Testament. In the event of his renunciation, death, resignation, or inability to act for any reason whatsoever as my Executor, I nominate, constitute, and appoint my granddaughter, Abigail Coover, to act as my Executor. I $ereby relieve my Executor, whether original, substitute, or successor, from the necessity of posting security or bond in connection with his/her duties as such in any jurisdiction in which he/she nay be called upon to act so far as I am able by i law to do so. My Executor shall receive reasonable compensation for services rendered to my estate. i IN WITNIESS WHEREOF, I have hereunder set my hand and seal to this my Last Will and Testament consisting of two typewritten pages; the first of which bears my initials in the margin for the purpose of better identification this ~ 13th day of 2001. l.. ', -{1~:~ ti! ~. t ~ ~~ v t ~ ~ --{SEAL) HELEN T. COOVER Page 2 of ! 2 Pages ACKNOWLEDGEMENT Commonwealth of Pennsylvania County of Dauphin ss: I, HELEN T. COOVER., the testator, whose name is signed to the attached or foregoing mstrutrient, having been duly Qualified. according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly anal as my &ee and voluntary act for the purposes therein expressed. Sworn to and acknowledged before me by HELEN T. COOVER;, the testator, this ~~`' day of _ _ ~ } t ~ h , 2001. ,~(~) _~ j i Notary Public My Commission Expires: My L~ ini~yfc ~~ dec. 18, 2004 SEAL AFFIDAVIT Commonwealth of Pennsylvania County of ~A~Q f~(~ : ss: We' ~ ~ ~ ~ ~ " L~~ ~ y and Lacy Hayes, Jr., the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last W~11, that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscn'bing witness in the hearing and sight of the testator steed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or. more years of age, of sound mind and under no constraint or undue influence. Sworn to and subscnbed to before me by -~~~~~~ and Lac Ha es Jr. Y Y , witnesses, this day of_ ~.t ~ _ , 2001. My Commission Expires: SEAL ~~ soel _ _ __-=_-= - __ __- - A1Goss~wt,G way 2i-os-02.r~m Fonda R. CoulMr Public ~ - - - My Cam' ~~~ - -_ - , T _ _ - 13, 2004 9 Public ~~ SERRATELLI SCHIFFMAN & BROW:>v P.c. ~~~ LORI K. SERRATELLI STEVEN J. SCHIFFMAN Register of Wills MICHAEL F. BROWN Cumberland County Courthouse JOHN D. SHERIDAN° One Courthouse Square Carlisle, PA 17013 F.R. MARTSOLF CARAA. BOYANOWSKI Re: ESTATE OF HELEN T COOVER PAIGE MACDONALD-MATTHES NO. 21-11-1292 MERRITT C. REITZEL Dear Sir/Madame: JENI S. MADDEN March 20, 2012 GARTH A. STEPHENSON Enclosed for filing please find the Inheritance Tax Return with regard to the of counsel (MD 8 DO bars omdy) above captioned matter. SPERO T.LAPPAS of cod,nsel Please time and date stamp the extra copy and return it to me in the enclosed NEIL E. HENDERSHOT self-addressed stamped envelope. Thank you. of counsel •ADMITTED IN PA K NJ 2080 LINCLESTOWN RD. STE 201 HARRISBURG, PA 1]110-g6]O tel ]1]•54o.g1]o fax 717.540.5481 WWW.SSBC-LAW.COM Very truly yours, SERRATELLI„ SCHIFFMAN & BROWN, PC e ~ r~ M / Deb a A. Evangelisti, Paralegal ~ ~~ /dae v~n ~z Enclosure =~; c,.."x ..; J~ cc: Vance C. Coover, Jr. -~ ._.~ ~.., ~_, r..y ~r av N 3 f~ ~~ .~ :-_ _~ ~-~ rn ~~ `~ ~l~ 5 w (n <!,~ _ N y 1i_ z '~ c ~ '? r s H b y o C~1 C~ Y z t'"' m C "' ~ c ~" \ a y ~ ~ ° ~: C~ Q° ~ ~ C cc ~ O H lyD~ On f~D ~ Z c: ~ N ~ N , co ~ =--~ 3 ~~ y ~b =n (D Hasler vT w O ~ ~ ~~ 4 'o r~ (~ n~ 3 A ~ ~ ~ N /'1~~ N ~ O V~ A IY7 o N 1 (~ rNn ow v OWN ~~ N O O ~ Q N M N ~ E N N N_ LL O O ~~ ~ ~ ~ ~ aa~spH ..:... ..;.. . . .«. ,,., ...r. ".. . ..,... .. ...,. ~. ~..-. .,.. r ~~ r. ~. .+~~ ^~ ~r L ^~ ~ C ~~~. ':~i~Ci ; ,_,:r~. CAF ''11 ~lAR 22 ,~~~ e . , . ` ` ~~. a~ N 0 J-~ ~ N O 3-I U td ~"~ ~r N ~r t7" O r-1 .G.1 (!~ h r--I ~ r- •rl '~ ~ 3 0 m ~ ow o ~ ,~ o b ,~ 3 ~ ~ ~ ° rn : ~ b ~ N N rl '~ r-I z ~ NU•rl ~ z ~ -~ A ~ a x b N ~ ~ ~ ~ G4000