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Home My WebLink About05-11-06 jgjiJD -.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes . PO BOX 280601 Harrisburg, PA 17128-0601 ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth 159-22-8760 12/26/2004 06/02/1928 Decedent's Last Name Suffix Decedent's First Name MI Cooper Joanne K (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 . 1, Original Return 2, Supplemental Return 3, Remainder Return (date of death prior to 12-13-82) 5, Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4, Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Michael S. Travis (717) 731-9509 Firm Narne (If Applicable) ~;E-GJSTe~~ OF 'INnL~) USf~ ()f\!iV Attorney at Law First line of address 3904 Trindle Road Second line of address City or Post Office State ZIP Code c:,&_"n,~ t:I~_,',~D- Camp Hill PA 17011 Correspondent's e-mail address:mst@mtravislaw.com ( .-, c..: s DATE -' ~> - //. L c,_ Side 1 15056051058 -.J L 15056051058 ;0\\ MSV) -.J 15056052059 REV-1500 EX Decedent's Name: Joanne K Cooper RECAPITULATION 1. Real estate (Schedule A). 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 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 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . .......11. 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . 12. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . 14. 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 .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . 19. 20. Fill IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 159-22-8760 Decedent's Social Security Number 1. 2. 4. 5. 39.634.80 5,065.55 44,700.40 9,744.50 69.010.00 78,754.40 (34,054. 101 (34,054.10; 0.00 15056052059 --.J Kl::V-10UU l::^ "age j File Number Decedent's Complete Address: DECEDENT'S NAME DECEDE~IT'S SOCIAL SECURITY NUMBER Joanne K Cooper 159-22-8760 ._~------_.__.._--- -_.._~--_..~----_._- ~---_._--~ .. _._____.'_U'_.__ "___ __'_'~___'"'____"___"'~_ -- ._-----.._~----._----- .'... --- - --- -------- STREET ADDRESS 108 May Drive No. 1 ~- CITY I STATE I ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresllPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon 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) A. Enter the interest on the tax due. (SA) (58) B. Enter the total of Line 5 + SA. This IS the BALANCE DUE. 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; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 Ii] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 (i] 2. If death occurred after December 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? .............. 0 IiJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [K] 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 PS. 99116 (a) (1.1) (i)l. 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 zero (0) percent [72 PS. ~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 zero (0) percent [72 P.S. 99116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)J. 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. ~EV-1503 EX+ ,6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURI,j RESIDENT DECEDENT :STATE OF Joanne K_ Cooper FILE NUMBER 2006-00094 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Value Decedent's bequest Bank of Lilly stock 16 shares at death of spouse VALUE AT DATE OF DEATH 39.634.80 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 39.634 80 REV-1508 EX+ (6-98) *' COMMONWEALTH OF PEI'INSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Joanne K. Cooper 2006-00094 FILE NUMBER 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 . Cash $0.00 2. Checking I savings accounts, Commerce Bank $2,128.55 3. Clothing discarded 4. 1994 Ford Taurus $2,937.00 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,065.55 REV-1511 EX4- (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PEI"II'ISYLVANIA li,IHERITAW:E TilX RETURN RESIDEIH DECEDE~IT ESTATE OF Joanne K. Cooper FILE NUMBER 2006-00094 Debts of decedent must be reported on Schedule L ITEM NUMBER A. FUNERAL EXPENSES: 1. B. 1. 2. 3. 4. 5. DESCRIPTION ADMINISTRATiVE COSTS: Personal Representative's Commissions Laurie J. Weller Name of Personal RepresentatlVe(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1 08 May Drive #1 City Camp Hi 11 , PA 17011 State _lip Year(s) Commission Paid: 2006 Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) CI' nt Laurie J. Weller alma Street Address 108 May Drive, #1 Camp Hill City State ~lip 17011 Relationship of Claimant to Decedent Probate Fees rOO. Tax Return Accountant's Fees 7. 6. Tax Return Prspllrer',. Fees AMOUNT $4,102.60 $437.80 $1,500 (est) $3,500.00 $189.00 $15.00 TOTAL (Also enter on line 9, Recapitulation) $ 9, 744.40 (if more space is needed, insert additional sheets of the same size)