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Home My WebLink About03-23-15 t 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 t Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 2 3 1 2 0, 1 2 1 0 0 1 1 9 8 7 Decedent's Last Name Suffix Decedent's First Name MI C O B L E H E A T H E R M (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N / A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ❑X 1.Original Return 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) 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 TO: Name Daytime Telephone Number J EDWARD BECK 71 7 762 , 3331 REGfS-TF,!t)OF WILLt' §E ON!�,!M [ 7 O -73 _ (z) First Line of Address KELLER , K E L L E R AND BECK Second Line of Address < Fj 3 4 3 - B S OU T POTOMAC ST City or Post Office State ZIP Code - DATE FILED r.... t"J (.r), WAYNESB0R0 PA 1 72 68 Correspondent's e-mail address: ebeck .kkfb.com 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. SIG TUR OF SON SPO IBLE FPR FILI RETURN ATE. AR S 1 SME SHIPPENSBURG PA 17257 SIG TURF F PA ROT E THAN REPRESENTATIVE DAT AS, ADMESS N 343-B SOUTH POTOMAC ST WAYNESBORO PA 17268 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: HEATHER M. COBLE 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 and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 9 1 1 2 4 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. 9 1 1 2 4 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . .. . . . . . . . . . . 9. 6 4 3 3 . 6 0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . .. . . . . . . . . .. 10. 11. Total Deductions(total Lines 9 and 10) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 6 4 3 3 . 6 0 12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . . . .. . . . . . . . . . . . .. . . .. 12. - 5 5 2 2 . 3 6 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. - 5 5 2 2 . 3 6 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 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.0_ 0 • 0 0 16. 0 . 0 0 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 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 1505610240 1505610240 REV-1500 EX(FI) Page 3 File Number Deceaent's Complete Address: 0 0 DECEDENT'S NAME HEATHER M. COBLE STREET ADDRESS CITY STATE ZIP 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 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) 0.00 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 ...................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income ............................... ❑ X❑ c. retain a reversionary interest ..................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X 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 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 F2 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. pennsylvania SCHEDULE DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: HEATHER M. COBLE 0 0 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. REIMBURSEMENT FOR LOSS OF VEHICLE 911.24 TOTAL(Also enter on Line 5,Recapitulation) $ 911.24 If more space is needed,use additional sheets of paper of the same size, I REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER HEATHER M. COBLE 0 0 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FOGELSANGER-BRICKER FUNERAL HOME 6,325.10 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption:(If decedents 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 OF WILLS 108.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 6,433.60 If more space is needed,use additional sheets of paper of the same size. RhV-1513 EX+(U1-1 u) { s pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HEATHER M. COBLE 0 0 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. TAYLOR M. BROWN Lineal 1700 ORCHARD ROAD 1/2 RESIDUE CAMBERSBURG, PA 17201 2. TABITHA M. BROWN Lineal 1700 ORCHARD ROAD 1/2 RESIDUE CHAMBERSBURG, PA 17201 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. KELLER, KELLER AND BECK, LLC ATTORNEYS AT LAW JOHN N.KELLER1035 WAYNE AVENUE DAVID S.KELLER+ 343-B SOUTH POTOMAC STREET CHAMBERSBURG,PA 17201 J.EDWARD BECK,JR. WAYNESBORO, PA 17268 TEL(717)264-1110 TRACY J.ROSS TEL(717)762-3331 FAX(717)264-5135 FAX(717)762-1810 OF COUNSEL E-MAIL law@kkfb.com DAVID C.CLEAVER DIRECT E-MAIL ADDRESS: ebeck@kkfb.com February 4, 2015 rn c>'' Glenda Farner Strasbaugh �n, C-7) =x' Register of Wills ,rz "�. Cumberland County Courthouse ) r !' One. Courthouse Square . Carlisle, PA 17013 `, ' : V :. RE: Heather Marie Coble Estate File No. : 2013-00210 Pennsylvania Inheritance Tax Return Dear Ms . Strasbaugh: Enclosed herewith please find the original and two copies of the Pennsylvania Inheritance Tax Return which we have prepared for the above-referenced estate, which has been executed by the Personal Representative. Please file the Return and return a time stamped copy to us in the enclosed envelope. Do' not hesitate to contact us with any questions. Thank you for your assistance in this matter. Very truly yours, KELLER, KELLER AND BECK, LLC Roxanne O. Martin Paralegal Enclosure •Certified Civil Trial Advocate by National Board of Trial Advocacy +Certified Criminal Trial Advocate by National Board of Trial Advocacy The National Board of Trial Advocacy is a Pennsylvania Supreme Court Accredited Agency. g 3 Ifs f � 02 1p � � {. Cr J 1 Gi 1 �'F `�3,F 4t?0167708.1 VAR 20 2015 ri.AILEDFROVVPOWE 17206 } ?Bill 23 Fl 2 27 �- CLERI OF Eivtl / I KELLER, KELLER AND BECK, LLC ATTORNEYS AT LAW 343-8 SOUTH POTOMAC STREET WAYNESBORO,PA 17268 i. GLENDA FARNER STRASBAUGH REGISTER OF WILLS I CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013 f I