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Home My WebLink About04-17-14 J 1505610143 REV-1500 EX(02-11)to OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Gods Year File Number Bureau of Individual Taxes am.areaararuvcxt PO BOX.280601 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 05 02 1945 Decedent's Last Name Suffix Decedent's First Name MI COOMBS EDGAR D (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI COOMBS WENDY L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return n 2. Supplemental Return 3, Remainder Return(Date of Death Prior to 12.1382) 4. Urnited Estate 41.Future interest Coin�for lsa S. Federal Estate Tax Return Required (detoofdesinaner 242-62) ® g D ttech Copy Died T Will) T DocedeM melr ried)a LNirig innt 8. Total Number of Safe Deposit Boxes (Attach Copy of eM (AUOm coPf R. Litigation Proceeds Received 18.= 11% 4d Deoth 41.Election to fax under Sec.9113(-6) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDWARD P SEEBER 717 533 3280 REGISTER OF WILLS USE ONLY c _ m First Line of Address M Cn. rn oA SUITE C400 m c- rn Second Line of Address 3.,- 555 GETTYSBURG PIKE v —p D C> City or Post Office DATE FIL'ED`> State ZIP Code �. M �Ei ECHANICSBURG PA 17055 r m > CD Correspondent's e-mail address: epsOjsde.com - Under penalties of perjury,l declare that I have examined this return,inducting accompanying schedules and statements,and to the best of my knowledge and belief, It is true,correct antl complete.Declaration of paperer other than the personal representative is based on all information of which preparer has any knowledge. E OF P N RES NSteLE F FItiNG RETURN 7E Tree. Edgar G. Coombs (o L A SS 3 Stone ftdrim Lane4Cam HiIIC'PA 17011 SIGNATUR FP ARER DTHER THAN REPRESENTATIVE DATE Edward P Seeber f t R Suite C-4004555 Gettysburg PikeCMechanicsburgCPA 17055 Side 1 L 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Dec .nfsName: Coombs, Edgar D. - RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 201 , 600 . 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. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous lyoq-Probate Property (Schedule G) u Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)., - - -- - .. .. .. ...... -- 8. 201 , 600 . 00 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 10 , 198 . 00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 90 , 260 . 41 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 100 , 458 . 41 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 101 , 141 . 59 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 101, 141 . 59 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES - ! r 15. Amount of Line 14 taxable ( at the spousal tax rate,or I transfers under Sec.9116 (a)(1.2)x.00 23, 090 . 62 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate x .045 78 , 050 . 97 16. 3 , 512 . 29 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 [ i 19. TAX DUE................................................................................................................ 19. 3 , 512 . 29 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-12-00$75 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,Line 19) (1) 3,512.24 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 3. Interest (3) 194.56 4. If Line 2 is greaterthan Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2FLine 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 3,706.87 Make Check Pa able to: REGISTER OF WILLSCIAGENT. 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............................................................................................................... x d. receive the promise for life of either payments,benefits or care?............................................................ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑ receiving adequate consideration?....._........................-......................-.........._.............................................- 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 which contains a beneficiary designation?............_...-......_...._..........._.................................................------ ........ .... ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES7rOU 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 tog 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)1. • The tax rate imposed on the net value of transfers to or far 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. Rov1502 EX.(01.10) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Coombs,Edgar D. 21-12-00675 All foal property owned solely or as a tenant in comnwn moat Da reported at fair market value.Fair market value is defined as the price in whigt propery would be e%Uanged Weveart a sdlag buyer and a M11111 seller,nelVror Wine compelled to buy or call,both haWfg reasonable kmwlotlpe of the relevaM fairs. Real property that Is pindyowned wim right of aurvivorShlp most be disclosed on schedule F. Attach a copy of the settlement Shoot tfhe property has been acid Include a copy of tie deed showlna decodom's interest If owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 443 Linden Street,Hampden Township,Cumberland County,PA-valued per tax assessment 201,600.00 "common level ratio(201,600 1) TOTAL(Also enter on Line 1.Recapitulation) 201,600.00 (If more space is needed,additional pages of the same size) Copyright(c)2010 farm software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01.10) REV4911 EX.(W09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERRANCE TAX RESIDENT DECEDENTrURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER CoombsLEdgar O. 21-12-00675 Decedent's debts must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: a. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State zip Year(s)Commission Paid 2. Attorneys Fees JamesCSmithEDietterick&ConnellyCLLP 101000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Wendy L.Coombs Street Address 3 Stone Spring Lane city _ Camp Hill State PA zip 17011 Relationship of Claimant to Decedent Spouse 4. Probate Fees 130.00 See continuation schedules)attached 5. Accountant's Fees 6. Tax Return Preparer's Fees T Other Administrative Costs 6$40 See continuation schedule(s)attached TOTAL(Also enter on line 9CRecapitulation) 10098.00 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1600 Schedule H(Rev.10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Coombs,Edgar D. 21-12-00675 ITEM NUMBER DESCRIPTION AMOUNT Probate Fees 1 Register of Wills,Cumberland County-reservation for additional probate fee 100.00 2 Register of Wills,Cumberland County-filing fee for supplemental Return H,Inventory 30.00 H-B4 130.00 Other Administrative Casts 3 Recorder of Deeds, Cumberland County-deed filing fee 68.00 H-B7 68.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) RW-1512 EX-(12-08) SCHEDULE i pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Coombs, Edgar D. 21-12.00675 Report debts Incurred by the decedent prior to death that mmalned unpaid at the date of death,Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Integrity Bank Mortgage No."9750-valued per statement-one-half of the value reported 90,260.41 since one-half of the value was reported on the original Pennsylvania Inheritance Tax Return and the property subject to the mortgage is fully owned by the Decedent TOTAL(Also enter on Line 10,Recapitulation) 90,260.41 (If more space Is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev.12-08) REV-1610 EX.(01.10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE HUMBER Coombs Edgar D. 21-12-00675 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) ](. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)1 1 Coombs Family Trust Trust Residue 101,141.59 3 Stone Spring Lane Camp Hill, PA 17011 Total 101,141.59 Enter dollar amounts for distributions shown above on lines 15 through icon Rev 1500 cover sheet as approp riate. NON-TAXABLE DISTRIBUTIONS: II• A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN S.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART If-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE Copyright(c)2010 forth software only The Lackner Group,Inc. Forth PA-1500 Schedule J(Rev.01-10) REV-1514 Ex+(409) SCHEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN & TERM CERTAIN RESIDENT DECEDENT (Check Box 4 on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER Coombs, Edgar D. 21-12-00675 This schedule should be used for all single life,joint or successive life estate and tern-certain calculations.For dates of death prior to 5.1-89, actuarial factors for single life Calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1.99 and thereafter, Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ®Will ❑Intervivos Deed of Trust ❑Other FE STATE NTEREST CAC ION NEARESTAGEAT TERM OF YEARS NAME OF LIFE TENANT DATE OF BIRTH DATE OF DEATH LIFE ESTATE IS PAYABLE Wendy Coombs 10/2711953 59 ® Life or ❑Term of Years ❑ Life or ❑Term of Years ❑Life or ❑Tenn of Years ❑ Life or ❑Term of Years 1. Value of fund from which life estate is payable $ 101,141.59 2. Actuarial factor per appropriate table .2283 Interest table rate- 171311/2% [16% ❑10°!0 ®Variable Rate 12% 3. Value of life estate(Line 1 multiplied by Line 2) $ 23,090.62 ANNUI I T REST CA CULAT ON NAME OF ANNUITANT DATE OF BIRTH NEAREST DEATH TERM IS YEARS ANNUITY IS PAYABLE ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years ❑Life or ❑Term of Years ❑ Life or ❑Term of Years 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding number Frequency of payout-0 Weekly(52) ❑13 weekly(26) ❑Monthly(12) ❑Ouarterly(4) ❑Semi-annually(2) ❑Annually(1) ❑Other 3. Amount of payout per period $ 4. Aggregate annual payment. Line 2 multiplied by line 3 S. Annuity Factor(see instructions) Interest table rate- ❑ 3112% ❑6% ❑10% ❑Variable Rate 6. Adjustment Factor(see instructions) $ T Value of annuity- If using 31/2%,6%, 10%or if variable rate and period payout is at end of period, calculation is:Line 4 x Line 5 x Line 6 $ If using variable rate and period payout is at beginning of period,calculation is: (Line 4 x Line 5 x Line 6)4 Line 3 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return.The resulting life or annuity interests)should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. Copyright(c)2009 forth software only The Lackner Group,Inc. Form PA4600 Schedule K(Rev.4-09)