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Home My WebLink About05-14-14 � 1505610140 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 2 5 4 Harrisburq, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYw Date of Birth MMDDYYYY 0 2 2 6 2 0 1 4 0 5 � 9 1 9 2 6 Decedent's Last Name Suffix DecedenYs First Name MI C 0 0 K M A R Y E (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 a 1.Originai Retum � 2.Supplemental Return � 3.Remainder Return(Date of Death Prior to 12-13-82) � 4.Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required death after 12-12-82) QX 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) � 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number M U R R E L W A L T E R S , I I I E S Q _ 7 1 7 6 9 7 4 6 5 0 REGISTF$OF WILLS US'��NLY � M � � —,�, ;"*'T '"—sS.�'1 .� �Tf�} First Line of Address � 2t ._y � 1�7 � r.. —[ �%>C:"� W A L T E R S & G A L L 0 W A Y , P L L C ��`,:•=' — ; '' ��"{ ��ls- �r' _ �:.. Second Line of Address Cl�-,,~ !`'` "� _. � �,.. C'3 C::�: : —o --'-�� 5 4 E • M A I N S T R E E T �--��, °" �_='= c�;� City or Post Office State ZIP Code "C��FILED � � .�F� M E C H A N I C S B U R G P A 1 ? 0 5 5 � CorrespondenYs e-mail address: Il'IUPI'el(U�Walt@�SqallOWaV.COtII Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on ali information of which preparer has any knowledge. SIGNA E OF PERSON RESPONS LE FILING RETURN DATE DR S LYNDA A . COOK, -961 � OUFFER AVE CHAMBERSBURG PA 17201 SIGNATURE OF P A HER T REPRESENTATIVE DATE �_� ADDRESS MURRE WA R II 54 E • MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 150561�140 � 1505610240 REV-1500 EX(FI) DecedenYs Social Security Number �ecedent's Name: M A R Y E • C 0 0 K RECAPITULATION 1. Real Estate(Schedule A) . . . . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . �• • 2. Stocks and Bonds(Schedule B) . .. . . . . . . .. . . . . . .. . . . . . . . . . . .. . . . . . . . . 2• • 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. • 4. Mortgages and Notes Receivable(Schedule D) . . . . . . .. .. . . . . . . . . . . . . . . . . 4. • 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 2 8 5 2 8 � . 6 3 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .... . . . 6. • 7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. . 8. Total Gross Assets(total Lines 1 through 7) . . . . . . ...... . . . . . .. . . . . . . . . 8. 2 8 5 2 8 0 , 6 3 9. Funeral Expenses and Administrative Costs(Schedule H) .. . ... .. . ...... . . . 9• 2 � 9 5 4 . 4 1 10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule 1 10. 6 2 � 8 . 8 3 9 9 � ) . . . . . .. . .. . . . 11. Total Deductions(total Lines 9 and 10) . . . .. . . .... . . . . . . . . .. . . .. . .. . . . 11. 2 7 1 6 3 . 2 4 12. Net Value of Estate(Line 8 minus Line 11) .. .. . . . . . . . . . . . . . . . . .. . . . . . . 12. 2 5 8 1 1 7 . 3 9 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. 2 5 8 1 1 � . 3 9 TAX CALCULATION-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.0 _ � . � O 15. � . Q Q 16. Amount of Line 14 taxable at�inea�rate X.045 2 5 8 1 1 7 . 3 9 �g. 1 1 6 1 5 . 2 8 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 � • 0 � 1g. � • � � 19. TAX DUE . . . . . .. . . . . . . . . . . .. . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . 19. 1 1 6 1 5 . 2 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 150561024� 150561024� J Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARY E. COOK 21 14 0254 DecedenYs Name Page 2 File Number Correspondents Name Daytime Telephone Number M U R R E L W A L T E R S , I I I E S Q 7 1 7 6 9 7 4 6 5 0 First line of address W A L T E R S & G A L L 0 W A Y , P L L C Second line of address 5 4 E • M A I N S T R E E T City or Post Office State ZIP Code M E C H A N I C S B U R G P A 1 7 0 5 5 CorrespondenYs e-mail address:m U r r e 1 a�W a 1 t 21^S q a 1 1 O W 8 y • C 0 rtl Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE ON FOR G DATE , ,��-,--� ,- �� `y ��y ADDRESS � WILLIAM F • COOK, 2012 BRAEBURN DR MECHANICSBURG PA 17055 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 0254 DECEDENT'S NAME MARY E. COOK STREET ADDRESS MESSIAH VILLAGE 100 MT.ALLEN DRIVE CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 11,615.28 2. CreditslPayments A.Prior Payments B.Discount Total Credits(A+g) �2� 0.00 3. Interest (3) 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. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 11,615.28 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 ...................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X c. retain a reversionary interest ..................................................................................................... ❑ ❑X d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ � 2. If death occurred after December 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 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 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 stiil 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)j. � The tax rate imposed on the net value of transfers to or for the use of the decedenPs lineal beneficiaries is 4.5 percent,except as noted in p2 P.s.§s��s(a)(��. • The tax rate imposed on the net value of transfers to or for the use of the decedenPs 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. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: MARY E. COOK 21 14 0254 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SUSQUEHANNA BANK 31,514.75 CHECKING 2. SUSQUEHANNA BANK 1,614.00 CHECKING 3. AMERITRADE -BEACON CAPITAL MANAGEMENT 135,093.61 BROKERAGE ACCOUNT 4. SUSQUEHANNA BANK 108,018.53 MONEY MARKET 5. NATIONWIDE 1,956.07 SECURE MONEY MARKET 6. NATIONWIDE INSURANCE COMPANY 6,165.03 I RA/AN N U ITY BENEFICIARY-CARLTON P. COOK PREDECEASED-MAY 20, 1998 7 APARTMENT SECURITY DEPOSIT REFUND 637.59 8 MESSIAH LIFEWAYS 281.05 REFUND TOTAL(Also enter on Line 5,Recapitulation) $ 2g5 280.63 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. COOK 21 14 0254 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. AUER FUNERAL HOME-CREMATION-PREPAID 2. OBITUARY-PATRIOT NEWS 347.52 3. OBITUARY-WEST CHESTER, PA NEWSPAPER 471.81 B, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) LYNDA A. COOK 5,779.00 SveetAddress 961 STOUFFER AVENUE City CHAMBERSBURG State PA Z�p 17201 Year(s)Commission Paid: 2014 2. Attomey Fees: MURREL R. WALTERS, 111 8,000.00 3, Family Exemption:(If decedenPs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. ProbateFees: CUMBERLAND COUNTY REGISTER OF WILLS 423.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: BYERS ACCOUNTING &TAX PREPARATION 30.00 20131NCOME TAX RETURN 7, EXPRESS AND REGULAR MAIL 123.58 TOTAL(Also enter on Line 9,Recapitulation) $ 20 954.41 If more space is needed,use additionai sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARY E. COOK 21 14 0254 DecedenYs Name Page 1 File Number Schedule H - Funeral Expenses �Administrative Costs - B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2• Name(s)of Personal Representative(s) W�LLIAM F. COOK 5,779.00 StreetAddress 2012 BRAEBURN DRIVE City MECHANICSBURG State PA zIp 17055 Year(s)Commission Paid: 2014 SUBTOTAL SCHEDULE H-B1 5,779.00 REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. COOK 21 14 0254 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. PENNSYLVANIA OEPARTMENT OF REVENUE 78.00 2013 INCOME TAX 2. SPIRIT PHYSICIANS 43.41 MEDICAL 3. CENTER FOR NEUROBEHAVIORAL HEALTH 4.82 MEDICAL 4 ALERT PHARMACY 188.31 MEDICAL 5 MESSIAH LIFEWAYS 5,613.34 RESIDENTIAL CARE 6 PHILHAVEN 8.81 MEOICAL 7 CAMPBELL SOUP COMPANY 112.42 REPAYMENT OF PENSION 8 CAPITAL AREA HEALTH ASSOCIATES 31.26 MEDICAL 9 QUANTUM IMAGING 15.46 MEDICAL 10. STORAGE DEPOT 113.00 STORAGE UNIT RENTAL TOTAL(Also enter on Line 10,Recapitulation) $ 6 208.83 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(Ot-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARY E. COOK 21 14 0254 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).� 1. BETTY V. SPADONI Lineal 539 SPRING OAK DRIVE WEST CHESTER, PA 19382 2. LYNDA A. COOK Lineal 961 STOUFFER AVENUE CHAMBERSBURG, PA 17201 3. BONNY J. LAMPO Lineal 315 EASTLEIGH DRIVE BELLEAIR, FL 33756 4. RICHARD C. COOK Lineal 5178 UPPER VALLEY ROAD ATGLEN, PA 19310 5. WILLIAM F. COOK Lineal 2012 BRAEBURN DRIVE MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size.