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Home My WebLink About07-25-12 15D561,D1,05 R C~ n n EX (oz-u) (FI) 'S~ ^ ~~~~ ~ ~+`~+i+ ~ PA Department of Revenue pennsytvania OFFICIAL USE ONLY Bureau of Individual Taxes ~E" ,M`~-.,. ~ County Code Year INHERITANCE TAX RETURN PO BOX28o6o1 Harrisburg, PA 1~i28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 178-50-6352 10/28/2011 06/16/1958 Decedent's Last Name Suffix Decedent's First Name Cohick Kevin (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Cohick Juanita Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 196-48-4917 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C/~ 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) O 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 O 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 Taylor P. Andrews, Esq (717) 243-0123 First Line of Address 78 West Pomfret Street Second Line of Address City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's a-mail address: tpandreWS@pa.net 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. G ATURE OF P~RSb~A R ^ PObUSIBLFdFOR FILING RETURN ~AT~~~„ %/, 91CDDRESS `" - / r c/o 78 West Pomfret Street, rlisle, PA 17013 S TU P P ~fJ, ER T N R RESENTATIVE ~ D~ E ,~ / File •~ _..~ ~:-t r. ;-.,a C ,: -1> /_1- ~ l ~3 '?"t REGISTER OF WILLS US~.C{NLY f..-._ j...f. ~ `- ~ .., ~~ ~O r., r 4...7 ~ - c ~ ' . ~? ,. 7 l._-_ `DA FILED fti.7 ~, C~ ~a MI L MI E West Pomfret Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY ],5D567,O1,D5 ynl ~~: Side 1 15D567,D1D5 1,50561,0205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: Kevin L. CohlCk 178-50-6352 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mort a es and Notes Receivable Schedule D 9 9 ( ) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 18,276.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 18,276.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 12,785.44 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 25,099.30 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 37,884.74 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. -19,608.74 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 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. -19,608.74 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 .0_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 0.00 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable 0 00 at collateral rate X .15 18. . 19. ........................ TAX DUE .............................. ...19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1,50561,0205 1,50561,0205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Kevin L. Cohick STREET ADDRESS 239 Bobcat Road CITY i STATE :ZIP Carlisle PA 17105 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) 0.00 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) 0.00 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 "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 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 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 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 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}]. 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. SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF Kevin L Cohick Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER A. Funeral Expenses: 1 Hoffman Roth Funeral Home 2 B. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Administrative Costs: Personal Representive Commissions Name of Personal Representative(s) Juanita Chhick Social Security Number of Personal Representative: 196-48-4917 Street Address: 239 Bobcat Rd City: Carlisle State: PA Zip: 17015 Year(s) commissions paid: Attorney fees to Andrews & Johnson Family Exemption Claimant Juanita Cohick Street: 239 Bobcat Rd City: Carlisle State & Zip PA 17015 Relationship of Claimant to Decedent: Wife Probate Fees to Register of Wills Accountant Fees Tax Return Preparer's Fees Legal Advertising Probate fees FILE NUMBER 21-11-1233 AMOUNT $5,820.90 $750.00 $2,000.00 $3,500.00 $264.54 $450.00 --- TOTAL (also online 9, Recapitulation) $12,785.44 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Kevin L Cohick 21-11-1233 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with Right of Survivorship must be disclosed on Schedule F ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Insurance payout for damage to motorcycle caused in fatal accident $11,442.00 2 paycheck earned during life received after death $1,281.00 3 2004 Chevy Cavalier [subject to auto loan of $5774.21 ] $5,553.00 4 ~ 1985 Grand Am in very bad shape, unregistered, on blocks I $0.00 TOTAL (also on line 5, Recapitulation) $18,276.00 SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Kevin L Cohick 21-11-1233 Report debts incurred by the decedent prior to death which remained unpaid as of [he date of death, including unreimbursed medical expenses. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH Wells Fargo Financial Inc $8,265.56 People's Credit Co, Inc [auto loan secured by lien on Cavalier] $5,774.21 The Bureaus Inc. for HSBC/Orchard Bank $1,484.73 Eggar Funeral Home for Ruth Cohick funeral $6,574.80 Kathy Failor -loan for motorcycle $3,000.00 TOTAL (also on line ]0, Recapitulation) $25,099.30 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Kevin L Cohick 21-11-1233 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBOTIONS linclude outright spousal distributions, and trausfcrs undor Sac. 91 I (,(a)(L2)] 1 Juanita Cohick, 239 Bobcat Road, Carlisle, PA 17015 Wife $30K + 1/2 bal of estate in this instance = 0 2 Michelle R. Junkins, 7 N. Corporation St., Apt.l, Daughter 1/4 bal of estate after $30K Newville, PA 17241 in this instance = 0 3 Kevin L. Cohick, Jr., 4A Watershed Dr., Duncannon, PA Son 1/4 bal of estate after $30K 17020 in this instance = 0 II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. Charitable and Governmental Bequests. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0