HomeMy WebLinkAbout09-21-05 (3)RFV-1 WO EX « ~~-00)
- COMMONWEALTH OF ~ ~ ~~
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
H
Z Kocher, Marie A
LiJ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year)
D
U 1 /4/2005 7/7/1916
LJJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
a QX 1. Original Return
rn
w a ~ ~ 4. Limited Estate
Op
c=i a m 0 6. Decedent Died Testate (Anacn copy or wilq
a I ~ 9. Litigation Proceeds Received
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OFFICIAL USE ONLY
_--- - -
FILE NUMBER
2 1- 0 5 0 0 2 1_
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
2 0 5- 0 9- 4 7 4 5
t FITS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
suagL SECURITY NUMBER
2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82)
4a. Future Interest Compromise (dateordeafb seer fz-i2-az) ~ 5. Federal Estate Tax Return Required
7. Decedent Maintained a Living Trust (Aeacb copy of Trust) _ 8. Total Number of Safe Deposit Boxes
1 O. SpoUSal POVerty Credlt (date of death between 12-31-91 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A) (Anacb scr, O)
--- ...~ ..vrnr-~.c i cu. HLL I:uKKESPONDENCERND CONFIDENTIAL TAX INFOI
NAME COMPLETE MAILING ADDRESS
David H. Stone, Es uire 414 Bridge Street
FIRM NAME (If Applicable)
Stone LaFaver & Shekletski
TELEPHONE NUMBER
717-774-7435 New Cumberland
SHOULD BE
PA 17n7n
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) 1,795.95
3. Closely Held Corporation, Partnership orSole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 19,946.09
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9 Funeral Ex & A
(8)
21,742.04
penses dminlstratlve Costs (Schedule H) (9) 8,114.43
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 4,018.52
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
CCC 1\ICTnI ~nT~~~~w ..
(11) 12,132.95
(12) 9,609.09
(13)
(14)
9,609.09
_ ..._...,,,,.,.,,.,, ..~. n~.~rcoc ~ru~ run ArruGAl3LE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X (15) 0.00
16. Amount of Line 14 taxable at lineal rate 1,441.36 X .045 (16) 64.86
17. Amount of Line 14 taxable at sibling rate 4,324 09 X 12
17
(
) 518.89
18. Amount of Line 14 taxable at collateral rate 3,843 64 X 15
18
.
(
) 576.55
19. Tax Due
(19)
1,160.30
20. ~ • w ~ • •
> > ac aunt t v aNSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address•
STREET ADDRESS
1700 Market Street
CITY
Camp Hill
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
STATE ZIP
PA
17011-
(1) 1,160.30
Total Credits (A + B + C) (2)
0.00
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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) 1,160.30
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT 56) 1,160.30
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 ...................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................. ^ 0
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? ................. ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................
............................................................................... ^ a
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
~ ~ ~~
Earl Drive
sbura
Cum
DATE
'L' 1~
PA 17109
DATE
PA 17n~n
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[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% [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 twenty-one 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% [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%, except as noted in 72 P.S. §9116(1.2) [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% [72 P.S. §9116(a)(1.3)]. Asibling 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-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
K Cher Mari A
21 0 0021
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1 45 shares MetLife Inc. stock OF DEATH
@ $39.91 each
1795.95
TOTAL (Also enter on line 2 Recapitulation) I $
(If more space is needed, insert additional sheets of the same size) 1 795
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. UO UU11
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1 East Pennsboro Ambulance Service-refund OF DEATH
964.96
2 PNC Bank-Checking Acct. #5140130467
18981.13
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size) 19,946.09
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Koch r M rie A
21 0 0 21
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES:
1 • W. Orville Kimmel Funeral Home-funeral expenses
2. Romberger Memorials-services rendered
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
AMOUNT
6,400.00
127.00
City
2
3.
Year(s) Commission Paid:
Attorney Fees David H. Stone, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
1,087.00
Street Address
City
State Zip
Relationship of Claimant to Decedent
4• I Probate Fees
102.00
5 Accountant's Fees
6• Tax Return Preparer's Fees
7• Cumberland Law Journal-advertising grant of letters
8. The Patriot News Co.-advertising grant of letters 75.00
9. Verizon-telephone service at home 113.61
10. Reserve for closing expenses 9.82
200.00
State Zip
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size) 8,1 14.43
REV-1512 EX + (6-98)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
K h r Mari A
21 21
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Internists of Carlisle-debt of decedent
152.21
2. I Manor Care-balance due on last month
3. (Associated Cardiologist-debt of decedent
1,391.00
5.22
4. INeighborCare-pharmacy charges I
1,292.87
5• Quantum Imaging-services rendered
11.04
6• East Pennsboro Ambulance-services rendered
162.27
7. Hal S. Fineburg, MD-debt of decedent
51.80
8. Philhover-services rendered
18.96
9. Holy Spirit Hospital-services rendered
894.65
10. Mobile X-Ray Imaging-services rendered
38.50
TOTAL (Also enter on line 10, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size) 4 018 52
REV-1513 EX `+ (o_nni
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ko h r Marie A
FILE NUMBER
21 0021
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Do Not List Trustee(s) OF ESTATE
Sec. 9116 (a) (1.2)]
1. Louise Vance
5021 Earl Drive Sibling
4,324.09
Harrisburg, PA 17109
2. Donna Shiprak
286 Dogwood Road Collateral
1,921.82
Millersville, MD 21108
3. William R. Diehl
12969 Via Del Valedor Collateral
1,921.82
San Diego, CA 92129
4. Shirley Cole
4601 Hillcrest Street Lineal
1,441.36
Harrisburg, PA 17109
~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV 1500 COVER SHEET
II. NON TAXABLE DISTRIBUTIONS.
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space Is needed, Insert addltlonal sheets of the same size)
LAST WILL AND TESTAMENT
OF
MARIE A. KOCHER
I, MARIE A. ROCHER, of Fairview Township, York County, Pennsylva-
nia, declare this to be my last will and revoke any will previously
made by me.
ITEM I: I direct that my Executrix hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease.
ITEM II: I devise and bequeath all the rest, residue and remain-
der of my estate, of every nature and wherever situate, as follows:
A. 45~ to my sister, LOUISE VANCE, if she survives me.
Should my sister, LOUISE VANCE, fail to survive, I devise and bequeath
her share as follows:
1. 25$ of my estate to CINDI DIXON.
2. 20$ of my estate to STEWARD VANCE.
B. 20$ to my niece, DONNA SHIPRAR, or her issue.
C. 20$ to my nephew, WILLIAM R. DIEHL, or his issue.
D. 15~ to my step-daughter, SHIRLEY COLE, or her issue.
ITEM III: I appoint my sister, LOUISE VANCE, Executrix of this
my last will. Should my sister, LOUISE VANCE, fail to qualify or
cease to act as Executrix, I appoint my niece, CINDI DIXON, Executrix
of this my last will.
Page 1 of 4
ITEM IV: My Executrix shall not receive compensation for the
performance of her functions hereunder as I have made ample provisions
in my will for my said Executrix.
ITEM V: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of her duties in
any jurisdiction.
IN WITNESS WSEREOF, I, MARIE A. ROCHER, have hereunto set my hand
and seal this ~~~ day of _ l'~~4~Da~`p
1997.
MARIE A. KOCHER
SIGNED, SEALED, PUBLISHED and DECLARED by MARIE A. KOCHER, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed our names as witnesses.
Wi
Address
~~A~ ~
emu- ~?.u,~ mac. P/~
Witness Address
Page 2 of 4
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND ~ SS:
I, MARIE A. ROCHER, the Testatrix whose name is signed to the at-
tached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it '
as my free and voluntary act for the purposes therein contained.
~'/,~~o a ~~,
` MARIE A. ROCHER
Sworn to or affirmed to and acknowledged before me by MARIE A.
ROCHER, the Testatrix, this f t da of C~~j Q~,2
1997.
Notary Public
NOTARIAL SE,gL
CONSTANCE !, KARLI Notary PubNc
New Cus~kerland, PA Curnberfand Co.
My Commission Explr~s April 13,1999
COMMONWEALTH OF PENNSYLVANIA ;
COUNTY OF CUMBERLAND = SS:
and _ .' JOn~rl~ ~/'Ll. ~i.~~.l
the witnesses whose names are signed to the attached or foregoin '
instrument bein dul g
~ 4 y qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
Page 3 of 4
her last will;chat Testatrix signed willingly and that she executed
it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the
will as witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influenc .
_.
fitness
/1'D./t-v~~,.ra '177 ~7~a..Q ! ~
Witness
Srw~orn to or affirmed to and acknowledged before me by
- 1:.~~C/i;~ e~ .J~C~ and
witnesses, this t ~( day of ~~~~~ ~
1997.
~~
Notary Public
CONSTAN ~ ~ RIAL SEAL.
barland, p~ 1'~' trbta
My Commiss(on CumLerryland Co
Fxplres AArtl 13,1999
Page 4 of 4
MAR-20-2005 22 10 PNCBRNK
~ PNCBAIV<
March 21, 2005
David H. Stone
414 Bridge Street
P.O. Box E
New Cumberland, PA 17070
RE: Estate of Marie A. Kocher, (Deceased)
SSN: 205-09-4745
DOD: O 1 /04/2005
Dear: Mr. Stone
412 768 3458 P. 01/01
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Cltiecking Account
Account # 5140130467 Established 04/05/1983
MARIE A KOCHER
DOD balance: $18,981.13 + $1.44 accrued interest
Please note that this office only provides date of death balances for deposit accounts
(IltAs, CDs, Checlamg and Savings accounts). We do not process any flaincial
transactions or provide statements. If you need assistance with any of these items,
please call 1-888-PNC-BANYC (1-888-762-2265) or stop by your local PNC Bas-lc branch
office.
Sincerely,
Jessica Seheller
1-800-762-1775
P7-PFSC-04-F
500 First Ave.
Pittsburgh PA 15219 Member FDIC
TOTAL P.01
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Capital Gains Ana~sis
Name or Symbol: US:MET I Go Find Symbol Print Report
Page 1 of 2
.~?`G:~Y
IGoI
- CN Help
t .. _
Metlife Inc
Date High Low Close
VUIUniE?
1/31/2005 40.9500 38.9400 39.7500 6,513,300
1/28/2005 40.8200 39.7100 39.9400 1,599,200
1/27/2005 41.0700 40.5700 40.6500 1,478,800
1/26/2005 40.8500 40.3500 40.8300 1,228,800
1/25/2005 40.7200 40.4300 40.5200 1,585,000
1/24/2005 40.7600 40.2700 40.2900 1,220,700
1/21/2005 40.5200 39.9800 40.2800 2,122,300
1/20/2005 41.2200 40.2000 40.3500 2,514,400
1/19/2005 41.8100 40.9000 41.2200 2,128,300
1/18/2005 41.0300 39.9200 41.0300 1,518,800
1/14/2005 40.2100 39.5000 40.0700 1,723,900
1/13/2005 40.2500 39.5700 39.9300 1,421,500
1/12/2005 40.1800 39.5500 40.0800 1,373,400
1/11/2005 40.3900 39.6200 39.6200 1,594,700
1/10/2005 40.4900 39.5700 40.3900 1,631,500
1/7/2005 40.3200 39.6800 39.7100 1,295,500
1/6/2005 40.3000 39.5500 40.1100 1,700,600
1/5/2005 402500 39.6500 39.6500 1,347,900
1/4/2005 40.3400 39.6400 39.9100 2
461
800
,
,
C
~ J S ~
1/3/2005 40.8200 40.0200 40.1600 1,679,400
^
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