HomeMy WebLinkAbout08-18-14 J ��.r �
REV-1500 EX 102-11'tFI' 1505610105
W
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
County Code Year File Number
Bureau of Individual Taxes ry
PO BOX 28o6o1 INHERITANCE TAX RETURN �� /1
_ Harrisburg PA 17128-0601 RESIDENT DECEDENT off/) iLq
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
� 105/26/2014 � 02!18/1942 1
Decedent's Last Name Suffix Decedent's First Name nn tt MI tt
Cooley Deis I E
(if
Enter Surviving Spouse's Information Below —I
Spouse's Last Name Suffix Spouse's First Name MI
Cooley Carol - --- -- --__ A❑
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 O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
(00 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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
David Cooley 713 446-7632
�� REGISTER OF WILLS USE ONLY
First Line of Address
6003 Skyhaven Ln = .
no.
Second Line of Address
. iJ
City or Post Office _ State ZIP Code DPIID FILED
Spring TX 77379 n
--- —
Correspondent's e-mail address:COOleyd2 @yahoo.COfn O
Under penalties of perjury,I declare that I have examined this return,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.
SIGNA UROF ERSOLJ RESBpNSIBLl/YOR FILIN,9 RETURN
ADDRESS
9 Joseph Dr., Boiling Springs PA 17007
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DAT
Li
AD PRESS
6003 Skyhaven Ln, Spring TX 77379 j
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
J 1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
_ Decedent's Name: Dennis E. Cooley
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. -
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. .. . . 6. -
7. Inter-Vivos Transfers& Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested... .. ... 7. 604,517.00
8. Total Gross Assets(total Lines 1 through 7).... ....... ... .. ... ... ... ... . 8. 604,517.00
9. Funeral Expenses and Administrative Costs(Schedule H)... .. . ... .. ... ... .. 9. 8,932.00
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)... . ..... ... .. . 10. -
11. Total Deductions(total Lines 9 and 10)... . ... ... ... . .. .. . ... ... ... ... .. 11. 8,932.00
12. Net Value of Estate(Line 8 minus Line 11) ... ......... ..... ... ... . .. ... . 12. 595,585.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ... . .. .... ... .. ... ... .. . 13. 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) . ... . ... .. . .. ... ... ... .. 14. 595,585.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 -I
(a)(1.2)X.0 0 595,585.00 15, 0.00
16. Amount of Line 14 taxable
at lineal rate X.0- 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 p
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Dennis E. Cooley
STREETADDRESS
9 Joseph Dr.
CITY STATE ZIP
Boiling Springs PA 17007
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0
2. Credits/Payments
A.Prior Payments 0
B, Discount
3. Interest Total Credits(A+B) (2) 0
0
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0
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 .......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ N
c. retain a reversionary interest .............................................................................................................................. ❑ E
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ N
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?,............. ❑ N
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 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 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)].
• 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.§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.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX TURN
RESIDENT DECEDENT EDENT MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Dennis E. Cooley
This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COW OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFANNUCABDi) VALUE
1. IRA-BlackRock Bal Capital Instl(MACPX)-935.574 shares @$25.62
$23,969
IRA-Dodge&Cox Stock Fund(DODGX)-139.409 shares @$173.72
2• $24,218
IRA-Fidelity Balanced(FBALX)-3514.380 shares @$23.46
3. $82,447
IRA-Fidelity Equity Inc(FEQIX)-4924.544 shares @$60.70
4. $298,920
IRA -Fidelity Spartan Ext Mkt Index(FSEVX)-950.968 shares @$53.50
5. $50,875
IRA-Hennessy Large Value(HLVFX)-645.093 shares @$33.14
5. $21,378
IRA-Raytheon Stock(RTN)- 1060.833 shares @$96.82
7 $102,710
TOTAL(Also enter on Line 7, Recapitulation) $ 604,517.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 Ex+ (08-13)
�pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dennis E. Cooley
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Basic services fee payable to Ewing Brothers Funeral Home 1,200.00
Transfer of deceased payable to Ewing Brothers Funeral Home 595.00
Use of facility/staff payable to Ewing Brothers Funeral Home 1,150.00
Document prep/recording payable to Ewing Brothers Funeral Home 395.00
Um/Crematorium Fee payable to Ewing Brothers Funeral Home 1,285.00
Printed material/obituary/death certificates payable to Ewing Brothers Funeral Home 489.00
Flowers payable to Ewing Brothers Funeral Home 318.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
Z. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
3,500.00
Claimant Carol A. Cooley
Street Address 9 Joseph Dr.
city Boiling Springs state PA ZIP 17007
Relationship of Claimant to Decedent Spouse
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 8,932.00
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+ (01-10)
y[' i pennsylvania SCHEDULE 7 DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dennis E. Cooley
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. Carol A.Cooley-9 Joseph Dr,Boiling Springs PA 17007 Spouse 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IB OF REV-1500 COVER SHEEP,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 ONLINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
Y
LAST WILL
TESTAMENT OF
DENNIS E. COOLEY, of 9 Joseph Drive, Boiling Springs, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and Testament, hereby revoking any and all
other wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred within my family's burial plot in accord
with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath any and all tangible personal property owned by
me at the time of my death unto my wife, CAROL A. COOLEY, provided she survives me by
thirty(30) days. In the event she fails to survive me by thirty(30) days, I give, devise and
bequeath all said tangible personal property unto my son, DAVID A. COOLEY, per stirpes.
FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of
my death,unto my wife, CAROL A. COOLEY, provided she survives me by thirty days. In
the event she fails to survive me by thirty(30) days, I give, devise and bequeath all said real
estate unto my son DAVID A. COOLEY, per stirpes.
SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate
unto my wife, CAROL A. COOLEY, provided she survives me by thirty(30) days. In the
event she fails to survive me by thirty(30) days, I give, devise and bequeath all the rest, residue
and remainder of my estate unto my son,DAVID A. COOLEY, per stirpes.
SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed
upon my estate passing under my will or otherwise, shall be paid out of the principal of my
residuary estate.
EIGHTH. I hereby nominate, constitute and appoint my wife, CAROL A. COOLEY as
Executrix of this my Last Will and Testament. In the event of renunciation, death, resignation
or inability to act for any reason whatsoever of CAROL A. COOLEY, I nominate, constitute
and appoint DAVID A. COOLEY as Executor of this my Last Will and Testament. I hereby
relieve my Executrix from the necessity of posting security in connection with her duties, as
such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to
do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute
discretion, to retain in the form received, and to sell either at public or private sale any real or
personal oropertv owned by me at the time of my death.
a
NINTH. I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be
stored in conjunction with this Will.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, consisting of two typewritten pages this 16`"day of APc', l 12002.
DENNIS E. COOLEY
Signed, sealed published and declared by the above named Testator DENNIS E.
COOLEY as and for his Last Will and Testament, in the presence of us, who, at his request, in
his sight and presence and in the sight and presence of each other, have hereunto subscribed
our names as witnesses.
Our zrc�J
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I,DENNIS E. COOLEY, Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will; that I signed it willingly;and that I signed it as
my free and voluntary act for the purposes therein expressed.
D �
DENNIS E. COOLEY
Sworn or affirmed to and
acknowledged before me,by #_
DENNIS COOLEY this day
of 2002. NOTARIAL SEAL
Cynthia L Darr,Notary Pub)tc
South Middleton UP.,County of Cumberland
My Commission Expires Aug. 14,2004
tAPublic
COMMONWEALTH OF PENNSYLVANIA
:SS.
COUNTY OF CUMBERLAND
We, Su S.4+2 .S�g riWW AJ and k K-( L-M(A m me r4-, the witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw DENNIS E. COOLEY sign
and execute the instrument as his Last Will;that he signed willingly and that he executed as his
free and voluntary act for the purposes therein expressed; that each of us in the hearing and
sight of the Testator signed the will as witnesses;and that to the best of our knowledge, the
Testator was at that time eighteen(18) or more years of age, of sound mind and under no
constraint or undue influence.
Sworn or affirmed to and
subscribed before me by
lljG r-+,,-k 0f,I and
McA m w-� , witnesses,
this)& day of 2002.
NOTARIAL SEAL
} Cynthia L Darr,Notary Public
N Public -" South Middleton Up.,County of Cumberland
�' My Commission Expires Aug. 14, 2004