HomeMy WebLinkAbout09-05-121505610101
REV-1500 Exl°"°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN n ~y
PO BOX 280601 oomncuT ncr^_FnFNT ~ I ~ ~ '°/.~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth NIMDDYYYY
02/14/2012 03/23/1933
Decedent's Lasl Name Suffix Decedent's First Name
COOPER MARY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
N/A
Spouse's Socal Securlty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
MI
A
MI
O 1. Original Return O 2. Supplemental Return O <I. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O ri. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust E1. 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 1'I. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Dayl.ime Telephone Number
Andrew H. Shaw, Esquire (717) 243-7135
First line of address
200 S. Spring Garden St
Second line of address
Suite 11
City or Post Off ce State ZIP Code
Carlisle PA 17013
Correspondent's a-mall
Un penalties of perj I d
it i e, correct and ~mplat
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I have examined this return, it
i of preparer other roan the
LE FOR FllANG RETURN
REGISTER OF WILLS USE Qy~.Y
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PA 17007
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200 SSpring Garden Street, Suite 11, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
L 1505610101
Side 1
1505610101
J~
1505610105
REV-1500 EX Decedent's Social Security Number
Decade r Na a Mary A Coope
RECAPITULATION
1. Real Esiate (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. Mongages and Notes Receivable (Schedule D) .... ......... .. 4 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ,.... 0.00
6. Jointly Owned Property (Schedule F) Op Separate Billing Requested ..... .. 6. 27,¢00.00
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7.
8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 27,500.00
9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. 365.00
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ ...... 10. 0.00
11. Total Deductions (total Lines 9 and 10) ............................ .. .... 11. 365.00
12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 27,135.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
0
00
an election to tax has not been made (Schedule J) .................. ...... 13. .
14. Net Value Subject to Tax (Line 12 minus Line 13) .............. ... ...... 14. 27,135.00
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
00
0
(a)(t2) x .0 0 .
16. Amount of Line 14 taxable
0
00
at lineal rate X .0 Q .
17. Amount of Line 14 taxable 0
00
at sibling rate X .12 .
18. Amount of Line 14 taxable 27,135.00
at collateral rate X .15
15.. 0.00
16. 0.00
17 _ _ 0.00
1e. _..... ..........4,070.25
1 s. rnx ouE ....... 4,070.25
.................................................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0
Side 2
L 1505610105 1505610105 J
REV-1500 E% Page 3
Pile Number
Decedent's Complete Address:
DECEDENT'S NAME
Mary A. Cooper
STREET ADDRESS
248 Goodhart Road _ _ _.
.._ -__ --._-_-.- -_.--__- .- STATE ZIP
cln PA 17257
Shippensburg
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
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.
Fill In oval on Page 2, Line 20 to request a refund.
(i)
Total Credits (A+ 8) (2)
(3)
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 15)
Make check payable to: REGISTER OF WILLS, AGENT.
4,070.25
0.00
0.00
4,070.25
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 properly transferred :............................................................................._..... ......
^
b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ><
c. retain a reversionary interest; oc ................_....................... .. ^
d. receive the promise far life of either payments, benefits or care? ................................................................ ......
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
^
^x
without receiving adequate consideration? .......................................................................................................
? .......
^ ^x
.......
3. Did decedent own an "in Wst far" orpayable-upon-death bank account or security at his or her death .......
Did decedent own an individual retirement account, annuity or other non-probate property, which
4
.
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.
~,.' ~~,u i ,i~R,,. , ~,;, ~ I _
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 decedents lineal bs:nefciaries 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)]. 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-a5D9 EX+ (oi-ao)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
0.E5[DENT DECEDEM
SCHEDULE F
]OINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
MaN A. Cooper
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schetlule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Vicki Lynn Loesch 1344 Kuhn Road Friend
Boiling Springs, PA 17007
B.
C.
1niuT1 V nW NFB DDflDFDTVe
I1FM
NUMBER ~ETrER
FOR JOINT
TENANT DATE
MADE
JDIM DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUnON AND BANK ACCOUNT NUMBER OR SIMILAR
IDEN9Fl'ING NUMBER. ATTACH DEED FOR ]OINTLY HELD 0.EAL ESrATE.
DATE OF DEATH
VALUE OF ASSET % of
DECEDENTS
INIERESr DATE OF DEATH
VALUE OF
DELEDENr5 INTEREST
1. A. 05114/93 Real Estate located at 248 Goodhart Road, Shippensburg, PA 55,000.00 50 27,500.00
TOTAL (Also enter on Line 6, Recapitulation) I $ 27,500.00
If more space is needed, use additional sheets of paper of the same size.
i
~~~~~
Parrxl LD. No.:
Property Address:
39-13-0104-O15C
248 Goodhart Road
Sbippensburg,PA 17257
THIS DEED,
MADE THE ~~day of ~^~~~~ in the year of our Lord two thousand
twelve (2012). -
BETWEEN VICKI LYNN I.OESCH, Joined by JEFFREY M. LOESCH, Her
Husband, of 1344 IGrlrtl Road, Boiling Springs, Cumbethutd County, Pennsylvania,
GRANTORS,
AND RAYMOND R ADAMS AND PATRICIA M. ADAMS, Husband and wife, of
18152 Spring Run Road, Spring Run, Cumberland County, Pennsylvania,
GRANTEES,
WTTNFSSETH, that in wnsideration of Fifty Five Thousand and 00/100 Dol]azs
($55,(X10.110) in hand paid, the receipt whereof is hereby acknowledged, the said Grantors do
hereby grant and convey to the said Grantees, their successors and assigns,
ALL that certain tract of land situate in the Township of Southampton, County of
Cumberland and Commonwealth of Pennsylvania, bounded and described as follows, to wit:
BEGINNIIVG at a pohd in the center of Township Route T-320, more connnotily
referred to as Goodhart Road, at land now or formerly of James Godfrey; thcnx along the center
of said Township Route T-320, North forty-two (42) degrees thirty-one (31) minutes terr (30)
seconds Weer, one hundred and zero hundredths (100.00) feet to a point at rho corner of other
lands of the Grantor herein, known and Lot No. 1 on the hereinafter described Subdivision Pian;
thence by Lot No. 1, North forty-two (42) degrees eightcen (18) minutes twenty (20) seconds
East, three hundred twenty-six and thirty-four hundredths (326.34) feet to an existing iron pin;
thence by Lot No. 1, South forty-two (42) degrees thirty-one (31) adnutes ten (10) seconds East,
one hundred sad zero hundredths (100.00) fiat to an iron pin; thence by lands now or formerly of
Godfi+ey, South forty-two (42) degrees eighteen (18) minutes twenty (20) seconds West, three
hundred twerrty-six and thirty-four hundredths (326.34) feet to an point in the center of
Township Route T-320, the place of BEGINNING:
CONTAINING 0.746 acre and being known as Lot No. 2, on a Pina! Subdivision Plan
for Randolph A Green, prepared by Larry V. Neidlinger, R.S., dated October 2, 1990, and
recorded in Cumberland County Plan Book 61, at Page 122.
..,... ,,
SUBJECT TO a twenty-five (25) foot right-of--way from the center of the aforesaid
Township Route T-320 and a buildwg setback line restrictions.
BEING the same prenrises which Randolph A. Green, by deed dated May 14, 1993 and
recorded in the Office of the Recorder of Deeds in and for Cumberland County at Record Book
3frG, Page 1180, granted and conveyed to Herman M. Cooper and Mary A. Cooper, husband
and wife, and Vicki Lynn Loesch, as Joint Tenants With Rights of Survivorship. Herman M.
Cooper died on November 2, 1996, thereby vesting his interest in said property to Mary A.
Cooper and Vicki Lynn Loesch. Mary A. Cooper died on February 14, 2012 thereby vesting her
interest in acid property to Vicki Lynn Loesch. Jeffrey M. Loesch joias in this deed to mnvey
any interest hd has by way ofmatriage to Vicki Lynn I.oesch, the Grantorherein. --
AND the said Grantors do hereby covenant and agree that they wID warrant SPECIALLY
the property hereby cotweyed.
IN W1TlVFSS WHEREOF, said Grantors have hereunto set their hands and seals the
day azrd year Srst above written.
SIGNED, SEALED AND DELIVERED
IN TAE PRESENCE OF
.... ... _..o-..-~..... _. ~- ...... _,.......
i~~ ~ ~~
M.LOESCH
COMMONWEALTH OF PENNSYLVANIA ,
. SS:
COUNTY OF CUMBERLAND
On this, the ~ day of 2012, before me, the
undersigned officer, personally appeared KI LYNN LOESCH AND JEFFREY M.
LOESCH, Ioaown to me (or satisfactorily proven) to be the persons whose names are subscribed
to the within instrumertt, and aclrnowledged that they executed same for the purposes therein
contained.
IN WTfNESrS WHEREOF, I hereunto set myh~d and
Coaunission Expires:
CERTIFICATE OR RESIDENCE
I do hereby certify that the precise residence and complete post office address of the
within named Grantees is: ~ ~ ~ /' __ 1~.1_ ~.~- ~ ~ rt~
DATED: 20
~.J
~mey for Grantees
Pnepmed By:
Andrew X. Shaw, Bsgnirs
200 S Sping Gandsn St, SaFls II
Cadls4, PA770I3
. ._ _.
ROBERT P. ZIEGLER
RECORDER OF DEEDS
CUMBERLAND COUNTY
1 COURTHOUSE SQUARE
CARLISLE, PA 17013
717-240-6370
Instrument Number - 201225796
Recorded On 8/24/2012 At 8:35:52 AM
* Instrument Type -DEED
Invoice Number -115783 User ID - SW
* Grantor -COOPER, HERMAN M
* Grantee -ADAMS, RAYMOND R
* Customer -SECURED LAND TRANSFERS LLC
* FEES
STATE TRANSFER TAR $550.00
3TATE WRIT TAX $0.50
3TATE JCS/ACC833 TO $23.50
JUSTICE
RECORDING FEES - $11.50
RECORDER OF DEED3
PARCEL CERTIFICATION $10.00
FEES
AFFORDABLE HOUSING $11.50
COUNTY ARCHIVES FEE $2.00
ROD ARCHIVES FE8 $3.00
SHIPPEN38URG AREA $275.00
SCHOOL DISTRICT
SOUTHAMPTON TOWNSHIP $275.00
TOTAL PAID $1,162.00
* Total Pages - 4
Certification Page
DO NOT DETACH
This page is now part
of this legal document.
I Certify this to be recorded
in Cumberland County PA
RED' Cp E~ D DS
• -Information denoted by en asterisk may change during
the verification process and may not be re0eeted on this p^ge.
002~E0
II I~IIIII~NIINWIIII
REVd 511 EX+ (10-09J
` ~ ' pennsylvania
pfPARTMENT OF REVENUE
INHERITANCE TA% RETllRN
RESIDENT DECEDENT
START ESTATE OF
.~ Mary A. Cooper
~FUNERALEXPENSES:
1.
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Decedent's debts must be reported on Schedule 1.
g, ADMINISTRATIVE COSTS:
1, Personal Representative Commissions:
_.__ _
Name(s) of Personal Representatives ._. _.. .-----~----
_._
Street Address _ _.__. -----.-_.-----._--.-_._--._. -.
State _ ZIP -
City
Year(s) Commission Paid: __
Z. Attorney fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
_.__.._.
Claimant __. _.. __. ..__. _.... __.
.._ .. _._
Street Address ---- ~-- ~_-
State .-.- ZIP ____ ____...
City _.__ _.. ... ____--__ _-.. ---.-.--
Relationship of Claimant to Decedent _. _._ - _-~~ __"~--
4. Probate Fees:
5, Accountant Fees:
6, Tax Return Preparer Fees:
7.
350.00
15.00
365.00
TOTAL (Also enter on I ine 9 Recapitulation) ;
If more space is needed, use additional sheets of paper of the same size.
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