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Home My WebLink About08-08-14 fin/ 5 0 Lt T (f- T& -rc REV-1500 {Q21j 1505610143 - `W1 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county cane rear File N=ber Bureau of Individual Taxes a AWE PO BOX.280601 INHERITANCE TAX RETURN 2 1 14 0446 Harrisburg,PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 12 18 2012 03 25 1928 Decedent's Last Name Suffix Decedent's First Name MI DEAVEN DOROTHY M (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 IN I. Original Return ❑ 2.. Supplemental Return ❑ 3,Remainder Return(Date of Death Prior to 12.13-82) ❑ 4. tholted Estate ❑ 4a.Fm Interest Com7xaaeae ❑ 5. Federal Estate Tax Return Required (date or death after 1242-82) ❑ 6, Do,edent Died Testate ❑ 7, Debedhd Maintained a tMng TNSt S. Total Number of Safe Deposit Boxes (After Copy m Win) (Aneth Copy of riust) ❑ 9. Lftation 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 TO; Name Daytime Telephone Number LISA MARIE COYNE 717 737 0464 REGISTER WILLS USI�dNLY ' First Line of Address _ C M��' 3901 MARKET STREET Zz: f r Second Line of Address T ILED tV m City of Post Office D-State 21P Code _ O T CAMP HILL PA 170114227 0 Correspondent's e-mail address: IiSa @Coyna nd00yne.Com Under penalties of perjury,I declare that I have examined this retum,including accnmpanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and Complete.Declamfion of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNA RE OF PER ESPONSIUL FQR FILING RETURN DATE � Gj �. LISA MARIE COYNE 8-7- 2.0t t( ADDR 3901 MARKET STREET, CAMP HILL,PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE LISA MARIE COYNE ADDRESS Coyne&Coyne, P.C. 3901 Market Street, Camp Hill, PA 170114227 Side 1 L 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number oMZasnesNrom®: DEAVEN, DOROTHY M RECAPITULATION 1, Real Estate(Schedule A)...................................-....................................,............_.. 1. 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. 3 , 411 . 18 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)..,-........... 5. 4 , 432 . 34 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 through 7).......................................................... 8. 7 , 843 . 52 9. Funeral Expenses and Administrative Costs(Schedule H).... 4 , 084 . 29 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)_........................... 10. 45 , 715 . 04 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 49 , 799 . 33 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. -41 , 9 5 5 . 81 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................ 13. 14. Not Value Subject to Tax(Line 12 minus Line 13)................................................. 14. -41 , 955 . 81 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 lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE.....................___....................................................................................... 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21 - 14 - 0440 Decedents Complete Address: DECEDENrs NAME DEAVEN, DOROTHY M STREET ADDRESS 770 POPLAR CHURCH ROAD CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 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. (4) 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. (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;...._................-................-...............1. x b. retain the right to designate who shall use the property transferred or its income;............. H 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, 1952, did decedent transfer property 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?......... ❑ Q 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 dales 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)(1)]. 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) n)]. 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 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 p2 P.S.§9116(a)(1.2)]. •The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.59116(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. 9116 fa)(1.3)t. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,S.§ether y bloodd or adoption. pennsylvania DEPARTMENT OF REVENUE SCHEDULE D INHERITANCE TAX RETURN MORTGAGES & NOTES RECEIVABLE RESIDENT DECEDENT FILE NUMBER ESTATE OF DEAVEN, DOROTHY M 21 _ 14-0446 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Refund due from Golden Living 3,411.16 TOTAL(Also enter on line 4,Recapitulation) 3,411.18 GG SG Administrative Services, LLG. " ��"k of Am""`a o:a 1e.7:3oaT ,Canko -Am eric -641178 ;1000 FIANNA WAY. A anbaoxA k#AA . FORT SMITH,)AR 72919.25001 VOID AFTER'90 DAYS TELEPH04E:(479)201.2500 VENwA N4, LNECX MB. • V LATE NE7 AMgUNt 81873085 02/I7/14 ! *.&***3,411 :.18, PAY- THREE -TM_OUSA`NO FOUR HUNDRED 'ELEVEN AND 18/1'00 TO DOIvTHY. DEJ VEN THE C%0 .PRICILLA, WHITMAN_ arOBH OF 1 1100 CALREMONT RD. CARLISLE : PA 1,7015 1148 i8730a5110 1:061IU7861: 329 904 3473116 L pennsylvania SCHEDULE E DEPARTMENT F REVENUE CASH BANK DEPOSITS AND MISC. INHERITANCE ANCE TAX RETURN f RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF DEAVEN, DOROTHY M FILE NUMBER —_— -- ---- --- 21 - 14-0446 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 METRO BANK CHECKING ACCOUNT XXXXXXX1481 -- 4,432.34 — TOTAL(Also enter on Line 5,Recapitulation) 4,432.34 tv JrTell KLA- METRO 3801 Paxton Street 888.937.0004 ( � BANK Harrisburg, PA 17111 mymetrobank.com May 21, 2014 Lisa Marie Coyne Coyne & Coyne, PC 3901 Market St Camp Hill PA 17011 RE. Estate of: Dorothy M. Deaven Tax Identification Number: Date of Death: 12/18/12 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type:Checking Account Number: 2833821481 Date Opened: 7/12/11 Owner: Dorothy M. Deaven Guardian: Cumberland Cou e of Aging & Community Services Date of Death Balance: ,432.3 Please feel free to contact me at (888) 937-0004 if I may be of further assistance. Sincerely, Cindy Stan ery Support Associate/Deposit Services Metro Bank REVAS11 EX-(10-08) pennsylvania p��pp�� y��E�E�E�H�� //��.�1(� DEPARTMENT OF REVENUE FLNE AILIW/K"G1w74'r AM INHERITANCE RETURN RESIDENT DECED ENT IDNR415TW TTYG MW CTS FILE NUMBER ESTATE OF DEAVEN, DOROTHY M 21 - 14-0446 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Parthemore Funeral Services, New Cumberland, PA 544.11 B. ADMINISTRATIVE COSTS: t. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorney's Fees COYNE &COYNE, P.C. 1,500.00 3. Family Exemption: (if decedent's address is not the same as claimant's,attach explanation) Claimant Street Address city State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OR WILLS 98.50 5. Accountant's Fees 200.00 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 Cumberland Law Journal—Legal Advertisement 75.00 TOTAL(Also enter on line 9,Recapitulation) 4,084.29 C Schedule H COMMONWEALTH OF PENNSYLVANIA F„un�erW,,,,E,,Vm�,,,„�,,,,&y,,�,,�� INHERITANCE TAX RETURN - qu�}uyC�{�(1t*u*d RESIDENT DECEDENT ESTATE OF DEAVEN, DOROTHY M i FILE NUMBER 21 - 14-0446 2 Patriot News-- Legal Advertisement 173.78 3 Postage 15.00 4 Reserves 500.00 5 West Shore EMS 977.90 1 Page 2 of Schedule H pennsyivania SCHEDULE 1 DEPARTMENT TAX DEBTS OF DECEDENT MORTGAGE INHERITANCE TAX RETURN RN , RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF DEAVEN, DOROTHY M 21 - 14 -0446 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 DPW Class 5.1 or 6 45,715.04 TOTAL(Also enter on Line 10,Recapitulation) 45,715.04 R_Ev.tsls EX-401-10) 4 pennsylvania SCHEDULE J !B, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF DEAVEN, DOROTHY M FILE NUMBER 21 - 14 -0446 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Net UM Trustees) I, TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 DONNA DEAVEN Daughter 100%of Residual 145 EAST MAIN STREET MECHANICSBURG, PA 17055 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 5113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 0.00 COYNE & COYNE, P.C. A PROFESSIONAL CORPORATION ATTORNEYS AT LAW Henry F.Coyne 3401 Market Street (717)737-0464 Lisa Marie Coyne Camp Hill,Pennsylvania Facsimile(717) 737-5161 Austin F.Grogan 17011-4227 www.coyneandcoyne.com August 7,201.4 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle,PA 17013 Re: Estate of Dorothy M. Deaven,Deceased No. 21-14-0446 Dear Madam: We represent the Estate of the Late Dorothy M. Deaven. Enclosed please find an original and two (2) copies of the Inheritance Tax Return for this insolvent Estate. Please docket the original and return a "clocked-in" copy of the Return to this office with the enclosed envelope. Thank you for your assistance. If you have any questions,please contact me. Very truly yours, COYNE& COYNE,P.C. aakMarie Coyne LMC/cmc O 9 g7 Encl. - c ' tC+ co .13 C7 D —' ,C;s0 1 �1, ,r �M • b �i cu 3LNT 0 z gws > acnn o 0 v U � 14 > QM _ Q Q j y W per = 1 •— o y O Z �o a 3U � — 0 < c° Q U ° ;? y o 0 y n U ¢ L a U_O a j1 J �C CL�co Cr — C� c N