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Home My WebLink About06-13-13 (2) 1 1505610143 J REV-1 S00 Ex`°2.,,, � PA De artment of Revenue y OFFICIAL USE ONLY p psnns Ivania ca,mrcoaa ve�r FileNUmber Bureau of Individual Taxes °°'"11°^°"�101• PO BOX.28060t INHERITANCE TAX RETURN 21 12 00675 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 06 06 2012 O5 02 1945 DecedenPs last Name Suffix Decadent's First Name MI COOMSS EDGAR D (If Applicable)Enter Survlving Spouse'a IiMormatlon Below Spouse's Last Name Suffix Spouse's First Name MI COObIDS qPENDY L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Onginal Retum � 2. Supplementel Retum ❑ 3� pnor o�2-13e 2�(Date ot Death � 4. Limited Estate � 4a.Fuwre irneres�Can�raniee 5. Federel Estate Tax Return Required (Gele W deaN efter 2-12-82) ❑ � g DeceGent Dietl Testata �, Mei�I ned e Living Truat � 8. Tofal Numbef Of Sefe De i�BO%es (Altach Copy M Wilp ❑ Atle opy o(T�ual) � � 9. Li6palionProceedaReceived � 10.�n?�,f!'��oa��aoeaen � 11.ElectiontotaxunderSec.9113(A) (Adacli ScheAule 0) . CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INPORMATION ULD BE�ECTED T0: Name DaytlRlTelephone�mWp rn EDpPARD P 3EEBER 7� �33 32B0� a � � � N � REl�l�t�WI I�U�b�Y D N 7J 4 First Line W Addreas p n o '27 � 'n SVITE C400 � ° � r, '� c� � N c— m Seeond Ltne of Addreas � —� � O 555 GETTYSBURG PIRE y' w � Clly or Post Office DATE FILED State ZIP Code L�CHANIC3BVRG PA 17055 CortsspondsM's e-mail address: eP�Bdc.com d ia�true,�cara re�ct�W��mry'p�De lei�atl�oT pr�epa�othe$tl enCie�p�e so�n�al re{�reaentaWe i�aed on slUl ink�rmsUOn'or�wlnroi the�°'t a my krawledpe arw belief. prcperer hea arry knowledge. S�IGNoAT�URE OF PER ON RE NSIBL R FILING R TURN DATE �/,ys __ � �¢�_ Edgar G. Coomba G/« /�3 nooR 3 8tone S dn La eoCam Hf11�A 17071 SIC.NA7URE REPM O R THAN REPRESENTATNE OATE Edward P Seeber � �i � no ss Suite C-400d1Aechanicsburg�A 77055 Side 1 L 1505610143 1505610143 J � J 15U5610243 REV-1500 EX DecedenPs Social Security Number ��'aNe�: Coombs, Edgar D. RECAPITULATION 7. Real Estate(Schedule A)....................................................................................... 1. 937 ,200 . 00 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&Miscellaneous Personal Property(Schedule E)............... 5. 101 , 194 . 53 6. Jointly Owned Property(Schedule F) ❑ Separate Billing ReQUested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous P{nq Probate PropeRy (Schedule G) LJ Separete Billing Repuested............ 7. 8. Total Gross Asseta(total Lines 1 through 7)........................................................ 8. 1, 036,394 . 53 9. Funeral Expenses and Adminiatrative Costs(Schedule H).................................... 9. 4 6, 621 . 92 10. Debts of Decedent,Mortgage Liabililies and Liens(Schedule I)............................ 10. ff23 , 750 . 92 11. 7ota1 Deduetlons(total Lines 9 and 10)................................................................ 1 t. 67 O ,372 . 84 12. NetValueofEstate(LineBminusLinell).......................................................... 12. 368, 021 . 69 �3. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subjectto Tax(Line 12 minus Line 73)............................................... 14. 3GH , 021 . 69 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 74 taxable at the spousal ta�c rate,or transfers under Sec.9t 16 2 2 g� �2 6.2 3 15. 0 . 0 0 (a)(1.2)X.00 t6. AmountofLinel4taxable 139�295 . 46 �s, 6�268 . 30 at lineal rate X .045 17. Amount of Line 14 taxable �� at sibling rate X.12 0 . 0 0 1�. 0 . 0 0 18. Amount of Line 14 taxable . at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 6,2 68 . 30 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � $idB 2 L 1505610243 1505610243 � REV•1500 EX Page 3 Flle Number 27-12-00675 Decedent's Complete Address: DECEDENT'S NAME Coombs, Edgar D. STREETADDRESS 3 Stone Spring Lane CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2, Li�e 19) (1) 6,268.30 2. Credils/Payments A. Prior Payments B. Diacount 0.00 Total Credits(A +B) (2) 0.00 3. Interest � (3) q. If line 2 is greater than Line t +�ine 3,enter the difference. This is the OVERPAYMENT. (4) Cheek box on Page 2CLine 20 to request a refund 5. If Line 7 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 6 26$.$Q � Make Check Pa able to: REGISTER OF WILLS❑AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t. Did decedent make a trensfer 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;or............................................................................................................... x d. receive the promise for life of either payments,benefits or care?............................................................ x 2. If death occurted after Dec. 12, 7982, did decedent trensfer property within one year of death without receiving adequate consideretion?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property whieh containsa baneficiary designation?.................................................................................................................. ❑ ❑x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESdYOU 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. t, 1995,the tax rate imposed on the net value of trensfers to or for the use of the suniving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)1. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of trensfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9716(a)(1.1)(ii)]. The statute doas not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax retum are atiil applicable even if the surviving spouse is the onry beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfen from a deceased child 27 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 p2 P.S.§9116(a)(1.2)]. . The tau rate imposed an the net value of transfers to or for the use of the decedenPS lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)1. . The tax rata imposed on the net value of trensfers to or for the use of the decedenPs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined under Sedion 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rw-7607 EXi(07.70) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENTOFREVENUE INMERRANCETNERETURN ftESIOENT OECE�ENT ESTATE OF FILE NUMBER Coombs, Edgar D. 21-72-00675 1111 ntl propxty owmd wlNy w r a bnuN In eommon muH M�porlstl a!/alr mrtk�t vNw.Fcir merkel velue is defirietl ee ihe price al whiM propeity xroultl be ezcherqed beMaen e willirp buyer eM e willirp seller,neRMrDertg compellW to buy a sell,Coth hevirp reeaoneble krioMedpe of ihe robvant fecte Red P�WNY t�H b 1dMlYawmd wNh rlpM W suMVOnhIP�t M Abelmetl on�cMdub F. AM�ch s copy o/ths uplsmsnt MM MtM qopsrty h�s bssn�old Mel Wa a copy of Hw G�tl�IwwLp CscetlsM's IMSrnt H mMad u bnem In eommon. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1 Orrs Bridge Road, Hampden Township,Cumberiand County, PA-valued per listing 189,000.00 2 2 Stone 3pring Lane, Hampden Townshfp,Cumberland County, PA•valued per appreisal 420,000.00 3 3 Stone Spring Lane, Hampden Township,Cumberiand County, PA-valued per tax 328,200.00 assessment•common level reUo TOTAL(Also enter on llne 1, Recapitulation) 937,200.00 pf more spece ia needed,atltlitional peges of the same size) Copyright(c)2010 fortn soflware only The Lackner Group,Inc. Form PA-7500 Schedule A(Rev.01-10) Rav-1EOB EXi�71-70) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERRANCETA%RETURN PERSONAL PROPERTY RESIDENT OECEOENT ESTATE OF FILE NUMBER Coombs, Edgar D. 21-12-00675 i�dwa ma v�=a re lion entl�he tlela ihe proceatla w9re reteivetl by Ihe es�ete. NI ProWK1'IaM1Y�b��e�i0ht o1 turvlvonhip muH M dbcleaM on schstluls F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Nittany Ventures, LLC-membership interest-valued per sales price 37,500.00 2 7966 FoM Mustang-valued per Kelley Blue Book 25.000.00 3 2 Carts-valued per Kelley Blue Book 2,500.00 4 2001 ford F250-valued per Kelley Blue Book 10,999.00 5 2005 Cadlllac XLR-valued per sales price 21,000.00 6 2012 Ford F750-valued per sales price(less loan) 4,795.53 TOTAL(Also enter on Line 5,Recaqitulation) 107,794.53 (M more space is neetle4 atltlitbnal papas of the same size) Copyright(e)2070 fortn soflware only 7he Laekner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) REV-06H EX+�70-09) pennsylvania SCHEDULE FI DEPARTMENTOFREVENUE FUNERAL EXPENSES AND RESIDENTDEC ENETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Coombs�dgar D. 21-72-00675 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT q, FUNERAL EXPENSES: See continuation schedule(s)attached 6m53.50 B. ADMINI3TRATIVE COSTS: t. Parsonal Representative's Commissions Name of Parsonal Representative(s) Streat Address City State _ Zio Year(s)Commission Paid p, Anornev's Fees JamesoSmithmletterick&Connelly�LP 35600.00 3. Family Exemption: (If decedenPa address is not the same as claimant's,attach explanation) 3�00.00 Claimant Wendy L.CoOmbs streecnddress 3 Stone Spring Lane ciiy Camp Hill s�a�e PA zio 17011 Relationshio of Claimant to Decedent SpOUB@ a. Probate Fees 633.50 See continuation schedule(s)attached 5. Accountant's Fees 6. Tau Retum Preparer's Fees 7. Other Adminiatretive Costs �34•9Z See continuatlon schedule(s)attached TOTAL(Also enter on Iine 9�tecapiWlation) 46821.92 Copyright(c)2009 form software only 7he Lackner Group,Inc. Fortn PA-1500 Schedule H(Rev. 10.09) SCNEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Coombs, Edgar D. 21-12-00675 ��M DESCRIPTION AMOUNT NUMBER Funarel Exoenses 1 Edgar G. Coombs-trevel expenses for Executor to attend funerel 2,500.00 2 Neill Funeral Home-funerel services 3,553.50 H-A 6,OS3.50 Probate Feas 3 Register of Wilis,Cumberland County-probate fee 483.50 4 Register af Wills,Cumberland County-reservation for additional probate fee 350.00 H-B4 833.50 Othar Administrative Costs 5 CumbeAand Law Joumal-esfate notice publicatlon fee 75.00 6 James,Smith, Dietteriak&Connelly, LLP-reservation for estate administration closing 250.00 costs 7 Recorder of Deeds,Cumberland County-filing fee for deeds 207.00 8 Rsgister of Wills,Cumberland County-flling fee for Retum S Inventory 30.00 9 The Sentinel-estate nodce publication fce 178.92 H-B7 734.92 Copyright(c)2002 form software only The Lackner Group,Inc. Fortn PA-1500 Schedule H(Rev.6-98) . . _. .__ ... . . .. Rw.7673 EX*�1R-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE �IABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Coombs, Edgar D. 21-12-00675 rs.r�asun iM�R.a nv m.a.o.w��wbr ro a.m m.e rem.io.a�op.ia n m.a.n oe a.,m,i�mam��me��.a m.ak.i.•a.�.... ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 American Express-credit card-claim flled 3.000.89 2 Bank of America-credit card-claim filed 837.85 3 Best Line Equipment-balance due 377.82 4 Bob Means Plumbing-balance due 7,782.29 5 Home Depot•credit card 463.63 6 Integrity Bank Line of Credit No.'4385-valued per statement 97,254.59 7 Integrity Bank Line of Credit No.•4785-valued per statement 78.709.82 8 Integrity Bank MoRgage No.'4250-valued per statement 786,808.11 9 IntegNty Bank Mortgage No.'9750-valued per statement-one-half of the value reported 80,260.47 70 Lebanon Farms Disposal-balance due 485.99 11 Lowes•credit card 8.035.95 12 M8T Bank Home Equily Loan No.'998-valued per statement 14,853.83 13 MST Bank Insfallment Loan No.'0001 -valued per statement 740,682.99 14 SuperMedla-balance due 676.75 TOTAL(Alao enter on Line 10, RecapiWlaUon) 623,750.92 pf mare spece is neede4 atltlttional pages ot the same size) Copyright(c)2008 form soflware only The Lackner Group, Inc. Fortri PA-1b00 Schedule I(Rev. 12-08) rsev-�s�s ex.�m-io� pennsylvania SCHEDULE J OEPARTAENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RE810ENT DECEDENT ESTATE OF FILE NUMBER Coombs Ed ar D. 27-12-00675 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE MOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT �ob8� �$$$� I TAXABLE DISTRIBUTIONS [inctude outright spousal distributions,and trensfers under Sec.9t 16 a 1.2 7 Coombs Family Trust Trust Residue 180,504.68 3 3tone Spring Lane Camp Hill, PA 17011 2 Wendy L. Coomba Spouse Residence 787,577.01 3 Stone Spring Lane Camp Hill, PA 77011 TOtal 368,027.69 Enter dollar amounts for diatributions shown above on linas 15 throu h 18 on Rev 1500 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 POR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE Copyright(c)2010 fortn software only The Laekner Group, Inc. Fortn PA-7500 Schedule J(Rev.01-10) qEV-1571 EX.I�bl SCHEDULE K LIFE ESTATE, ANNUI'TY c°"""°"`�"'-,�°FPE""sn"""'" &TERM CERTAIN INMERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4 on Rev-1500 Covsr 3heek) ESTATE OF FII.E NUMBER Coambs Edgar D. 21-12-00673 This schedule shouid be ased for�i{sing4C life,joi�t or succesaive life estate and term-certain calculationa.For tlates of death pdor ro 5•1-89, aduariai factors for smgie iife caicutations can be obtsined from ihe 4epartment of Revenue. Actuariai fadors can be fourW in IRS Publication 1457,Aetuariaf Values.Alpha Volumc Por dates of death from&1-89 to 430-99, and in Afeph Voiume for detes of death from 5-t-99 and thereaBer. indicate the type af instrumeM which created the future interest befow antl attach a copy to the tax retum. WiU Intervivos Daed af Trust Other � � � NE4RESTAGEAT TERM Qf YEARS NAME OF LIFE TENANT DATE OF BiR?H DATE OF DEATH LIFE ESTATE IS PAYA6LE Wendy Coombs 1dt27t1953 r 59 �fe or Tertn af Years �ite or Tertn of Years Life or Tertn of Yeare Lffe or Term of Years 1. Vaiue of furni from whioh Iife estate is Payabie � ��5�.� 2. Actuariai factor par appropriate tabie �� intereSt table rate- ❑3 112°k ❑6°� ❑10°k �Yarfable Rate 1.2°le 3. Valur of 11}a estate(Line 1 multlplied by Line 2) $ �.�1,�.� NEARESTAG£AT TERMOFYFARS NAME OF ANNUITANT DATE GiF BIRTH �ATE OF DEA7H qNNUITY IS PAYABLE Life or Temf of Years Llfe or Term ot Yearo Life or 7erm of Years Ltfe or Term of Yesrs �. Value of fund from whiCh annuNy is payable $ p, Check appropriate block below and enter corresponding number Frequency of payout�Weekly{52} ❑BI•waekly(26} ❑Mattttly(12) ❑Quarterty(4) ❑Semi-annuallY!7? ❑Mnua11Y 4�1 ❑Qther 3. Amaunt of payout per period $ 4. Aggregate annuai paymen[. Line 2 muftiplied by li�3 5. Annuiiy Fadar{see instn�ctions} Interest table raCa- ❑ 3�Jyoh ❑6°k ❑ 10% ❑Varfdble Rate 6. Adjustment Factor(see instructions) $ 7. Yalue of annuity-If using 31/2%,8%, 10%or if variable rate and period payout is at end of pedod, calouiatian is: Line 4 x Line S x Lit�e 8 $ if using variadie rate and period payout is at beginning pf perlod,calculaUon is: (Line 4 x Ltng 5 x Line 6)+Line 3 pp'{�; The values of the fvnds wh6ch creato the above tuture interests must be reported as part o(the estate sssets on Schetlules A through G of the tax return.Tbe resutting life or annuity interest(s)should be reported at the appropriate tax rete on Lines 13 and 15 through 18 of the return. CopyrigM(c}2009 form soitware onVy The t.ackner Group,lna Form PA•1500 Schedule K{Rev.4-06)