HomeMy WebLinkAbout05-13-13 �to��o� ` 15Q561,0143
REV-�soo A:.
��� OFFICIAL.WSE ONLY
PA Department of Revenue pennsylvania County Code Year Fie Numbe�
Bureau of Individuai Taxes oEP�RT�+a*�REV�N�E
Po eox,2sosol fNHERITANCE TAX RETURN 21 12 0 4 5 8
Harrisburg,PA 17128-0601 REStDENT DECEDENT
EN?ER DECEDENT INFORMATION BELOW
Socia!Security Number Date of Death Date of Birth
04 Ql 2012 11 13 1931
DecedenYs Last Name Suffix DecedenYs First Name ��
COOPER EVA g,
(tf Applicable�Enter Surviving Spouse's InformaGon Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Sociai Security fVumber
THIS RETURN MUST BE FII.ED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
❑ 1. Originai Retum � 2. Supplementa�Retum � 3,Remairxier Return(date of death
prior to 12-13-82)
� Q. Limited Estate � qa,Future Interest Compromise � 5. Federal Estate Tax F2e1um Required
(daie of deafh aRer 12-12�2}
� g, Decedanl Died Testale 7 Decedent Maintained a Livfng Trust
{Aaaa,Copy of w�t� � (Anacn Copy of Trust� 8. Total Number of Safe Deposit Boxes
� 9. LiGgation Proceeds Received � �p,Spousal Poverty Credit(date of death ��,Eiection to tax under Sec.9173 A
bBtween ti231-91 and T-i•ss� O O
(Atiach Sch.O)
CORRESPONDENT-TH(S SECTION MtJST BE COMPLETE�.ALL CORRESPONDENCE ANU COMFIDENTIAL TAX INFORMATION SHOUL.D BE DIRECTED TO:
Name
Daytime 7el�shone Numbe.[
ROSFRT G RADEBACH 7 Z 7 8c�0 2 6 6 6� � �
nt
REGIS7�R O�V1�14LS Il3`�'ONLS�
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First Iine of address =:� �� '" �` �
;
912 NORTH RZVER RpAD -- � ' ' ._� � ,��
- ,,.�
Second line of address _ -� . `,�`
: , ._ , - :~�
City or Post Office DATE FILER:• � y;�
State �p��
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HALIFAX PA 17032
CorrespondenYse-maita e issysw rtz51@aol.com
Under penalties of perj ,I d that 1 have exa ' this return,including accompanyi,ng schedules and scatements,and to the best of my knowledge a�d hetief,
it is true,correct and laratlon of pre er pther than the personal representa4ve is based on all intormation ot which preparer has any knowledge.
SlGNA7 E OF P N S19LE FOR I RETURN DqTE
y y.�. Dianna L. Bentr
ADURES
824 iana Avenue, Lemoyne, PA 17043
SIG OTHER 7HqN REPRESENTA'fNE TE
� f Robert G Radebach � 3 (��
s
/912'IdortF�River Road, Ftalifax,PA 17032
Side 1
� 15�15k�1�143 15Q56101�43 J
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
o��ede��'S Name_ _ C O O P E R, E V A K.
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---- --
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ECAPITULATION --- - ---
1. Real Estate(Schedule A).......................................................................................... 1. 1 5 0 , 5 3 1 . 8 3
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5• Cash,Bank Deposits 8�Miscellaneous Personal Property(Schedule E)................ 5. 2 0 8 , 1 8 6 6 4
6. Jointly Owned Property(Schedule F�) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7,
8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 3 5 8 , 7 1 8 . 4 7
- - ---- -_____ --
9. Funeral Expenses 8 Administrative Costs(Schedule H)......................................... 9. 3 6 , 2 5 5 . 7 3
10. Debts of Decedent,Mortgage Liabilities,8 Liens(Schedule I)................................ 10. 6 , 0 6 8 . 0 2
11. Total Deductions(total Lines 9&1���...................................................................... i�. 4 2 , 3 2 3 . 7 5
12. Net Value of Estate(Line 8 minus L.ine 11)............................................................. 12. 3 1 6 , 3 9 4 . 7 2
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. �3,
14. Net Value Subject to Tax(Line 12 rninus Line 13)................................................. �q. 3 1 6 , 3 9 4 . 7 2
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TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at�ineal rate x .045 3 16 , 3 9 4 . 7 2 �s. 14 , 2 3 7 . 7 6
17. Amount of Line 14 taxable
atsiblingrateX ,12 ��
18. Amount of Line 14 taxable
at collateral rate X .15 �g.
19. Tax Due..................................................................................................................... 19. 1 4 , 2 3 7 . 7 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
X
Side 2
� 15�5610243 1505610243 J
REV-1500 EX Page 3 File Number 21 - 12 - 0458
Decedent's Complete Address:
DECED NT'S NAME
Cooper, Eva K.
--- --- --- --
--- —----— --- —__
STREET ADDRESS
520 Orrs Bridge Road
. ------_ —_ __.�—
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,�ine 19) (1) 14,237.76
2. Credits/Payments
A� Prior Payments 13,550.00
B. Discount 711.89
Total Credits(A +B� (2) 14,261.89
3. Interest
{3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. f,4) 24.13
Check box on Page 2 Line 20 to request a refund — -"— —
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. l5)
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:.................................................................................. � �x]
b. retain the right to designate who shall use the property transferred or its income:.................................... � ��
c. retain a reversionary interest;or.................................................................................................................. ❑ ��
d. receive the promise for life of either payments,benefits or care?.............................................................. � �i
2. If death occurred after December 12, 1982,did decedent transfer properky 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?......... `J
�'
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which I��
contains a beneficiary designation?...................................................................................................................... ❑ �J
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 January 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 applicabls 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 decedenYs lineal beneficiaries 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). A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by bloo�or adoption.
i SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA �� REAL ESTATE I
INHERRANCE TAX RETURN
RESIDENT DECEDEMT
-_-__-_-_.-_ _-______-. .
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ESTATE OF COO er, EVa K. FILE NUMBER
p 21 - 12-0458
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a wilfing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy�f the deed showing decedenYs interest if owned as tenant in common.
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ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
---- — -- - -- -- --__ —.—__—_—__.—_— _ -- -
1 Real Estate -520 Orr's Bridge Road, Camp Hill, PA 17011 149,000.00
2 Real Estate Taxes - Proration to Seller from Closing of Property 1,531.83
-- --—— --__ __ _— ----
TOTAL(Also enter on Line 1, Recapitulation) 150,531.83
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iSCHEDULE E �
COMMONWEAL7HOFPENNiYLVANIA CASH, BANK DEPOSITS� � MISC.
,N„ER,TAN�ETAXRET�RN PERSONAL PROPERTY
RESIDENT DECEDENT
__-.. -_-..-_-._.. __-____-�--
-_-.... _ ' ___-'- ._�- - -
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FILE NUMBER
ESTATE OF Cooper, �Va K. 21 - 12 0458
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
— --- ----—_ ___—.�-- -----——---
_— ------- —__---
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
----- -- ------— ---
- _ _ - — _ —— ----- —
1 2005 Toyota Camry-Sold to Robert Huber 16,000.00
2 Integrity Bank Savings Account 25,681.90
3 Integrity Bank Checking Account 8,780.54
4 Patriot News Refund 371.15
5 AARP Refund 44.94
6 AARP Auto Insurance Refund 103.20
7 Misc. Cash 30.00
8 The Ohio National Life Insurance Company-Annuity-Contract#: E1238308 41,215.08
9 The Ohio National Life Insurance Company-Annuity- Contract#: E1461804 55,773.74
10 SunLife Financial Annuity-Contract#: 77-7700-886285 57,414.71
11 United Healthcare Insurance Gompany 26.60
12 Cash Paid by George Bentz for Samsung TV 500.00
13 PA Rebate Refund 250.00
14 Savings Bond 34.84
15 Auction of Furniture and Personal Items 1,559.94
16 SunLife Annuity Checks 400.00
TOTAL(Also enter on Line 5, Recapitulation) 208,186.64
, SCHEDUL.E H
COMMONWEALTH OF PENNSYLVANIA ����
INHERITANCE TAX RETURN I ��K�TQ���(X�TC I
RESIDENT DECEDENT I� �+��r� vw�v
.- __ _.- ___-..- .. ... _...__-__---I-�-_---__ -_-_. ..__-._._ _ ___.---_.-__
. --'.-.--'. -'-'--
ESTATE OF Cooper, Eva K. FILE NUMBER
j 21 - 12-0458
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Debts of decedent must be reported on Schedule I.
ITEM -- -- — -- -- - —
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
- -- --
A. 1 Rolling Green Cemetary- Burial Plot 3,560.00
2 Rolling Green Cemetary-Memorial Marker I 1,698.90
3 Meyer-Harner Funeral Home 11,443.00
4 Pealer's Flowers -for Services 275.55
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5 West Shore Country Club- Funeral Luncheon 1,008.00
B. ADMINISTRATIVE COSTS: I
1. Personal Representative's Commissions
Name of Personal Representative(s)
Dianna L. Bentz i 14,000.00
Street Address 824 Indiana Avenue '
c�ty Lemoyne State PA zip 17043
Year(s)Commission paid '
2. Attorney's Fees Robert G. Radebach, Esquire 3,500.00
3. i Family Exemption: (If decedenYs address is not the same as GaimanYs,attach explanation}
Claimant
Street Address
Gity State Zip
IRelationship of Claimant to Decedent
4. Probate Fees Fee to Open Estate- Register of Wills I� 435.50
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5. AccountanYs Fees I
6. Tax Retum Preparer's Fees I
7. Other Administrative Costs Ii
1 Advertising Fee -Cumberland l_aw Journal � 75.00
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TOTAL(Also enter on line 9, Recapitulation) 36,255.73
Sd�ed��e H
Fu�ral E��
COMMONWEALTH OF PENNSYLVANIA I
INHERITANCE TAX RETURN �����
RESIDENT DECEDENT iL_ `�_
ESTATE OF Cooper, Eva K. FILE NUMBER i
21 - 12 -0458
- — —----- ---- —. . __— __ — — ---—— -
2 Advertising Fee-The Sentinel T 210.78
3 Register of Wills - Short Certificate 4.00
4 Filing Fee- Inheritance Tax Return 15.00
5 Filing Fee - Inventory 15.00
6 Filing Fee-Supplemental Return �, 15.00
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Page 2 of Schedule H
SCHEDULEI �
DEBTS OF DECEDENT, MORTGAGE I
COMNOHERITANCETAXRENJRNAN�A LIABILITIES� � LIENS �
RESIDENT DECEDENT
_. -_r_-.-_ _-_- ._
ESTATE OF �LE NUMBER
Cooper, EVa K. 21 - 12 -0458
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
--
- _—_ __ -- -----
ITEM - ------ ----
NUMBER DESCRIPTION AMOUNT
- ----__ ___- -- ---
---_-- -_
_ ___ - —
1 Notary Fees from Closing of Real Estate 10.00
2 Tax Certification Fees from Closing of Real Estate 50.00
3 2012 School Taxes 1,720.45
4 Sewer Charges from Closing of Real Estate 155.00
5 2012 County-Township Real Estate Taxes 440.25
6 AARP Automobile Insurance 194.20
7 Trugreen - Lawn Maintenance 119.99
8 Blue Jay Services- Lawn Maintenance 413.40
9 Comcast 25.17
10 Hampden Township-Sewer&Trash 155.05
11 Pennsylvania American Water Company 176.32
12 Shelly's Plumbing 295.00
13 Larry Hughes - Repair Kitchen Ceiling 100.00
14 AARP Homeowners Insurance 85.00
15 Goodwill Shredding 6.00
16 Appraisal - Michael R. Ent 200.00
--------- --__. _ _
TOTAL(Also enter on Line 10, Recapitulation) 6,068.02
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTHOFPENNS'YLVANIA LIABILITIES 8� LIENS
INHERITANCE TAX RETURN , 1
RESIDENT DECEDE�IT conti n ued
ESTATE OF Cooper, EVa K. FILE NUMBER
21 - 12 -0458
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
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ITEM - _- —_----
- _ _
_ - __- �
NUMBER DESCRIPTION AMOUNT
--- — ---
- - — _____ _ _ --�-----
17 Automobile Inspection -Tires Plus 48$$"
18 Automobile Repair- Rahal Toyota 53.58
19 Verizon 40.63
20 PPL Utilities 570.95
21 United States Treasury for 2011 Income Tax Payment 885.00
22 Postage Paid by Executor 23.15
23 Reserve for Income Tax Preparation 300.00
24
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Page 2 of Schedule I
REV-1513 EX+(11-08)
SCHEDULE J
COMMONWEALTH OF PENNSYWANIA , pENEFICIARIES
INHERITANCE TAX RETURN '
RESIDENT DECEDENT
-- --�------ �.— --� ------- ------�------------
-------------____._ — .—... ------ --------
ESTATE OF FILE NUMBER
Cooper, Eva K.
21 - 12-0458
- — -- -- -_ ------ -- -------- --- - -
RELATIONSHIP TO T SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER� NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY DoNotListTruatee(s)
_ �—_.—__—__..__— _
- — -- — _-- __. _ __ .__-- -----
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I� TAXAB�E DIS7RIBUTIONS[inGude autright spousal
distributions,and transfers
under Sec.9116(a)(1.2)] I
1 I Dianna L. Bentz Daughter ' 1/3 of the residue
824 Indiana Avenue
Lemoyne, PA 17043
��
2 Debra L. Buttorff � Daughter 1/3 of the residue
630 Allen Street
New Cumberland, PA 17070
3 Bruce W. Bentz Son 1/3 of the residue
529 Lamp Post Lane
Camp Hill, PA 17011
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Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. ��N-TAXABLE DISTRIBUTIOtJS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
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B.CHARITABLE AND GOVERNMENTAL DIS7RIBUTIONS '
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TOTAL OF PART II-ENTER TOTAL NqN-TAXABLE DISTRIBUTIONS QN LINE 13 OF REV-1500 COVER SHEET O.00