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HomeMy WebLinkAbout05-14-13 J 1505610105 REV-1500 D`(e 2-H)(FI) Pennsylvania OFFICIAL USE ONLY PA Department OF Revenue P.,,.., Count'Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 2/ 13 :o66Z Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 01/09/2013 1 12/13/1922 . ...... .... Decedent's Last Name Suffix Decedent's First Name MI Cowles Harry 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 M I.Original Return O 2.Supplemental Retum O 3. Remainder Return(Date of Death Prior to 12.13-52) p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5.Federal Estate Tax Return Required death after 12.12-62) OID 6.Decedent Died Tesele O 7.Decedent Malntalned a Living Trust B.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 1231.91 and 1.1-95) (Attach Schedule 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Ronald E. Johnson, Esquir (717)243-0123 REG}STERO�L�USE ONL rr rrl � c1 First Una of Address ✓� ,� rte— 78 West Pomfret Street G? -Z) ' Second Line of Address c'7 c7> . .. . .. ._...... ._.. . .. . n © 'vt City or Post Office state ZIP Code -PAT ILED I---. m Carlisle PA 17013 o Correspondent's*-mail address:rejohnson@Qa.net Under penalties of perjury I declare that 1 have examined this return,Including accompanying schedules and statements,and to the beat of my knowledge and belief, 11 13 We,correct and complete.Dedemeon of preparer other than the personal representative Is based on all Information of whkh preparer has any knowledge. SI OF PER3 R IBLE FOR FILING RETURN DATE _ ADORE C/o 78 est Pomfret Str et Carlisle,PA 17013 0 R A REPR SENTATIVE DATE /0 78 West Po 4t Street,Carlisle,PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) 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. Mortgages and Notes Receivable(Schedule D)........................... 4. : 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... S. 7,819.63 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. : 4,072.65 _._ .. : 7. Inter-VNos Transfers&Miscellaneous Nan-Probate Property ' (Schedule G) C=) Separate Billing Requested........ 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)............................. 8.: 11,892.28 9, Funeral Expenses and Administrative Costs(Schedule H)................... 9. : 16,329.96 10. Debts of Decadent,Mortgage Liabilities and Liens(Schedule 0............... 10. : 27,352.96 11. Total Deductions(total Lines 9 and 10)................................. 11. 42,682.92 12. Net Value of Estate(Line 8 minus Line 11).............................. 12. . -30,790.64 . 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 Tex(Line 12 minus Line 13) ........................ 14. -30,790.64 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9118 " (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 at collateral rate X.15 18. 0.00 19. TAX DUE......................................................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1600 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Harry Robert Cowles STREETADDRESS 770 South Hanover Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. CreditslPayments A.Prior Payments 0.00 S.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, FIII 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.......................................................................................... ❑ N b, retain the right to designate who shall use the property transferred or Its Income............................................ ❑ 0 c. retain a reversionary Interest.............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ E 2. if death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?....,........................................................................................................ ❑ 0 3. Did decedent own an'in trust form or payable-upon-death bank account of 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)(t)]. For dates ol death on or after Jan. 1, 1995, the tax rate Imposed an the net value of transfers to or for the use of the surviving spouse is 0 percent 172 P.S.§9116(a)(1.1)(it)).The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disdosure of assets and filing a lax 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 lax rate Imposed on the net value of transfers to or for the use of the decedents lineal benefidades h 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The lax rate imposed an the net value of transfers to or for the use of the decedents 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. LAST WILL AND TESTAMENT OF H.ROBERT COWLES I,H.ROBERT COWLES,of Carlisle Borough,Cumberland County,Pennsylvania,being of sound and disposing mind,memory and understanding,do hereby make,publish and declare this as and for my Last Will and Testament,hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses,including my grave marker,shall be paid from the assets of my estate as soon as practicable after my decease.. SECOND: I give,devise and bequeath the residue of my estate,of every nature and wherever situate,to my Wife,MARJORIE D. COWLES,providing she shall survive me by thirty(30)days, THIRD: Should my Wife,MARJORIE D.COWLES,predecease me or die on or before the thirtieth day following my death,I give,devise and bequeath 60%of the residue of my estate,of every nature and wherever situate,to my children,namely,Rebecca Cowles Swanson, Deborah Jane Cowles,Daniel Harrison Cowles and Esther Cowles Schaeffer,equally,provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death, shall be distributed to his or her issue,per stirpes, living on the thirty-first day following my death, and in default of such then living issue,such share shall be added to the share or shares for my other children and/or their issue. 3 FOURTH: Should my Wife,MARJORIE D.COWLES,predecease me or die on or before the thirtieth day following my death,I give,devise and bequeath 25%of the residue of my estate, of every nature and wherever situate, to my grandchildren, namely, Sarah Swanson Weisenbum, Robert Paul Schaeffer, Henry David Schaeffer, Stephen Andrew Schaeffer, Mark Daniel Schaeffer and Rebekah Lynn Schaeffer, equally, provided that the share of any my grandchildren who predeceases me or dies on or before the thirtieth day following my death,shall be distributed to his or her issue,per stapes, living on the thirty-first day following my death, and to default of such then living issue, such share shall be added to the share or shares for my other grandchildren. FIFTH: Should my Wife,MARJORIE D.COWLES,predecease me or die on or before the tbirtieth day following my death,I give,devise and bequeath 10%of the residue of my estate,of every nature and wherever situate,to the Great Commission Fund of the Christian and Missionary Alliance located in Colorado Springs, Colorado. SIXTH: Should my Wife,MARJORIE D. COWLES,predecease me or die on or before the thirtieth day following my death,I give, devise and bequeath 5%of the residue of my estate, of every nature and wherever situate, to the Chapel Pointe located in Carlisle, Pennsylvania, SEVENTH: I direct that all taxes that may be assessed in consequence ofmy death, of whatevernature and by whatever jurisdiction imposed,shalt be paid from my residuary estate as a part of the expense of the administration of my estate. EIGHTH: I nominate, constitute and appoint my Wife, MARJORIE D. COWLES, Executrix of this my Last Will and Testament. Should my Wife, MARJORIE D. COWLES, fail to qualify or cease to act as Executrix,I appoint my son, DANIEL HARRISON COWLES,Executor of this my Last Will and Testament.Should my son,DANIEL HARRISON COWLES, fail to qualify or cease to act as Executor, I appoint, REBECCA COWLES SWANSON,Executrix of this my Last Will and Testament. NINTH: I direct my Executrix and her successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF,I have hereunto set my hand and seal to this,my Last Will and Testament,consisting of two(2)typewritten pages,each identified by my signature,this 1?// day of April 2009. / ( r'1 . cow �j (SEAL) H.ROBERT COWLES Signed,sealed,published and declared by the above-named Testator,H.ROBERT COWLES,as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. C COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, H. ROBERT COWLES, Testator, whose name is signed to the attached or foregoing instrument,having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament;that I signed it willingly;and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by H.ROBERT COWLES,the Testator, this 'Z L day of April 2009. /� COMMONWEALTH OF PENNSYLVANIA /V R�y Cc w,& (SEAL) NOTARIAL SEAL H.7)BERT C9 S, Testator �C,C.C�, � • My Commission Expires April 26,2011 Ia at• Public AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) : SS, COUNTY OF CUMBERLAND ) We, RONALD E. JOHNSON and C oLitES , 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 Testator sign and execute the instrument as his Last Will and Testament;that H.ROBERT COWLES,signed willingly and that be executed it as his free and voluntary act for the purpose therein expressed;that each of us in the hearing and sight of the Testator signed the Will as witnesses;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 or affirmed to and subscribed to before me by RONALD E. JOHNSON and.[.[Nl ljt°"SX I L .l) da o ril 2009. (SEAL) nald E. 3ohnson 4ness COMMONWEALTH OF PENNSYLVANIA NOTAR►AL SEAL (SEAL) SHELLY SEXTON, Notary Public Carlisle Boro, Cumberland County ' _ //� rtness My Commission Expires A ril 26, 2011 ��/ „_ . Notary Putt i REVnSoB EXS(o8a2) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Harry Robert Cowles 21-13.0062 Include the proceeds of litigation and the date the proceeds were received by the estate. All propertylointly owned with right of survivorshfp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Checking account no:9344072252-CIEBank(see letter attached) 4,860.00 2, ChapelPointe-refund 1,317.31 3, CBMA pension distribution 1,367.74 4, Blue Cross-refund of premium 174.68 5, Hoffman-Roth Funeral Home-refund 100.00 TOTAL(Also enter on Line 5,Recapitulation) ¢ 7,819.63 If more space is needed,use additional sheets of paper of the same size. Citibank Service Center Citibank Drive C I Satz arr Antonio,TX 78245.3214 January 25,2013 ANDREWS &JOHNSON ATTORNEYS AT LAW 78 WEST POMFRET STREET CARLISLE,PA 17013 Dear Sirs, We received your inquiry concerning the Estate of Harry R. Cowles. Our records indicate the following information: Account#9344072252 • Title of Account: Daniel Cowles Rep. Harry R Cowles • Type of Account: Checking • Date of Death Balance: $4860.00 • Current Balance: Closed • Interest Accrued as of Date of Death: $0.00 If you have any questions,please call CitiPhone Customer Service at 1-800-627-3999. Speech or hearing impaired,customers imp'. ' 11 our text.telenhone service at 1-800-945- 0258. Representative ^',%°;,�;cyou 24 ht s a week. Sincerely, Jennifer R. Valdez Branch and Client Services Tire Citibank Service Centerprovides customer account services for Citibank,N.A. REV4509 EX+(01.10) • pennsylvania SCHEDULE F DEPARTMENT INHERITANCE TAX RET URN JOINTLY-OWNED PROPERTY RESIDE NT DECEDENT ESTATE OF: FILE NUMBER: Harry Robert Cowles 21-130062 If an asset became jointly owned within one year of the decedent's date of death,It must be reported on Schedule G. SURVIVING JOINT TENANT(S)NANE(S) ADDRESS RELATIONSHIP TO DECEDENT A•Daniel Cowles 23 East 10th Street#903,New York,NY 10003 son B, C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH THEM FOR JOINT IIADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BARK ACCOUNT NUMBER OR SIMILAR OATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST I' A, 08128/08 Checking account no:5003962728-PNC Bank,NA(sea letter attached) 8,145.29 50 4,072.65 TOTAL(Also enter an Line 6,Recapitulation) $ 4,072.65 If more space Is needed,use additional sheets of paper of the same size. Jan. 29. 2011 10:41AM W Bank Ito. 6252 P. 1 01 PNC I:mwor'foKv v January 29, 2013 Ronald E Johnson Esq. Andrews&Johnson Law Offices 78 L-" Pomfret St Carlisle,PA 17013 RE: H Roben Culxles SSN: 189-14-8696 DOD: 01-09-2013 Dear Mr. Johnson: In response to your request for Date of Death(DOD)balances for the customer noted above,our records show the following: ChecUng Account Account 4 5003962726 Established: 08-28-2008 H ROBERT CO'WLES DANIEL COWLES DOD balance: S 8,145.26+0.03 accrued interest Interest paid 01-01-2013 thru 01-09-2013 S 0.00 YTD Please note that this office provides date o£death balances for deposit aeeounrs(IRAs, CDs,Checking and Savings). We do not process any fluancial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-DAINTK(1.886-762-2265)or stop by your local PNC Bank branch DfIce. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC 712is message is inrendedfor the use of the Individual or entity to which it is addressed and may conrain information that is privileged, confidential and exempt from disclosure. under applicable 1mv. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error,please not fy me immediately by reply orb),telephone at 800-762-177:and immediately destroy this faxed documenr. Page 1 of 1 REV-1511 EX+(10-09) e ' pennsyLvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND IIIHERITANCE TAXRETURN ADMINISTRATIVE COSTS RESID6XT DECEDENT ESTATE OF FILE NUMBER Harry Robert Cowles 21-13-0062 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home 11,796.46 D. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Names)of Personal Representative(s) Street Address City State_ZIP Year(s)Commission Paid: 2. Attorney fees: 2,800.00 3. Family Exemption: (If decedent's address Is not the same as clalmant's,attach explanatlon.) Claimant Street Address City State_ZIP Relationship of Claimant to Decedent a. Probate Fees: 143.50 s. Accountant Fees: 125.00 6. Tax Return Preparer Fees: T- Register of Wills-exemplified copies 40.00 B. Estate check charge 10.00 9. Register of Wills-PA Inheritance Tax Return fiting fee 15.00 10. Reserve for closing and accounting 400.00 TOTAL(Also enter on Line 9,Recapitulation) $ 15,329.96 If more space is needed,use additional sheets of paper of the same slze. REV-1512 EX+(12.12) pennsylvania SCHEDULE I DEPARTMEMOFREVIUJUE DEBTS OF DECEDENT, mHERITAWTAXRETunri MORTGAGE LIABILITIES$1 LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Harry Robert Cowles 21-13-0062 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Checking account transaction In Citibank account no:9344072252(item 1,Schedule E)issued prior to death and outstanding on the date of death Check no:115 Payee Date Issued Amount Date cashed Chapel PuRta 115113 $1,612.00 1!11!13 1,612.00 2. Commonwealth of Pennsylvanlo-Dept of Public Welfare(see letter attached) 26,740.96 TOTAL(Also enter on Line 10,Recapitulation) $ 27,352.96 It more space Is needed,insert additional sheets of the same size. COMMONWEALTH OF PENNSYLVANIA BUREAU OF PROGRAM INTEGRITY DIVOON OF THIRD PARTY LIABILITY RECOVERYSECTION • PO Box 8488 HARRISBURG,PA 1710541488 January 26,2M STATMWENT OF CLAIM SUMMARY NAME7— Estate Di COWLES,HARRY ID. 440 308 087 MEDICAL CLASS3 . CLASS 5.1 TOTAL INPATIENT .00 .00 .00 OUTPATIENT .00 .00 ,00 LONG TERM CARE 16,892.64 8,669.22 25,461.76 DRUG 166.28 112.92 279.20 REIMBURSEMENTTODPW 17,056.82 8,682.14 26,740.98 COMMONWEALTH OF PENNSYLVANIA '" .. DEPARTMENT OF PUBLIC.WELFARE 'EIN= 23.6003113 Page i of 7 REV-1513 EX+(01.10) ' pennsytvania SCHEDULE J DEPART N ENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Harry Robert Cowles 21-13.0062 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(a) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal dlstrlbuU0n5 and transfers under Sec.9116(a)(1.2).) I. Rebeoca Swanson,198 South Pleasant-Coules Road,Benson,NC 27504 daughter 15% 2. Deborah Cowles,1211 Fleetwood Drive,Carlisle,PA 17013 daughter 15% 3. Daniel Cowles,23 East 10th Street,#903,New York,NY 10003 son 15% 4. Esther Schaeffer,23 East North Street,9903,New York,NY 10003 daughter 15% 5. Sarah Weisenburn,110 Bu(terbiggins Lane,Apex,NC 27539 granddaughter 4.17% 6. Robert Paul Schaeffer,1211 Fleetwood Drive,Carlisle,PA 17013 grandson 4.17% 7. Henry David Schaeffer,1211 Fleetwood Drive,Carlisle,PA 17013 grandson 4,17% 8. Stephen Schaeffer,1211 Fleetwood Drive,Carlisle,PA 17013 grandson 4,17% 9. Mark Schaeffer,Go Esther Schaeffer,23 East 10th St,NY,NY 10003 grandson 4.16% 10. Rebekah Schaeffer,clo Esther Schaeffer,23 East 101h St,NY,NY 10003 grandaughter 4.16% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 11 NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Great Commission Fund,Office of Donor Accounting,Christian and Missionary Alliance PO Box 35000,Colorado Springs,CO 80935 10% 2. Benevolent Care,Chapel Pointe 770 South Hanover Street,Carlisle,PA 17013 10% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LLNE 13 OF REV-1500 COVER SHEET. $ If more space Is needed,use additional sheets of paper of the same sf:e.