HomeMy WebLinkAbout08-01-06
REV-15OC EX + (6-00)
*'
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -05 0 8 1 4
couNh'COOE -VEAR- - - NuMsER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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COFFMAN NORMA MARY
DATE OF DEATH (MM-DD- Year)
DATE OF BIRTH (MM-DD-Year)
08/05/2005 06/12/1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1 60- 1 6 - 7 6 3 8
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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~ 1. Original Retum
D 4. Limited Estate
00 6. Decedent Died Testate (Attach copy 01 Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death afrer 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
o 3. Remainder Retum (date 01 death prior 10 12-13-82)
o 5. Federal Estate Tax Retum Required
1- 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
John M. Eakin Market Square Building
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717 7l36-3172
Mechanicsburg, PA 17055
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o 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 Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
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165,000.00
151,628.68
6FFICIAL~E ONLY
......,
. .-"'"
41,272.40
56,922.67
.)
13. Charitable and Govemmental Bequests/See 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, artransfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
388,422.64 X .045 (15)
X _(16)
X .12 (17)
X .15 (18)
(19)
20. [J
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(8)
414,823.75
21,300.07
5,101.04
(11)
(12)
(13)
26,401.11
388,422,64
(14)
388,422.64
17,479.02
17,479.02
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> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
121 Nittanv Drive
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
17,479.02
11.000.00
550.00
Total Credits (A + B + C)
(2)
11,550.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
103.76
Total Interest/Penalty ( 0 + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
103.76
(3)
(4)
(5)
0.00
6,032.78
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
6,032.78
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 [Z]
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [Z]
c. retain a reversionary interest; or ...................................................................................................... 0 [Z]
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [Z]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 [Z]
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 [Z]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .............. ......... ......................................... ........ ................. .............. 0 [Z]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
-',2 DC {,
DATE
'\VU.ktu-~ i
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. 99116 (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. 99116 (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 retum 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-Dne 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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.
Decedent's Complete Address:
STREET ADDRESS
121 Nittany Drive
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Pagel Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
17,479.02
11.000.00
550.00
Total Credits (A + 8 + C)
(2)
11,550.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
103.76
T otallnterest/Penalty ( 0 + E ) (3)
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)
J. If Line 1 + Une ~I is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
103.76
0.00
6,032.78
6,032.78
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 IKI
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IKI
c. retain a reversionary interest; or ...................................................................................................... 0 IKI
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IKI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 IKI
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 IKI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .......................... ............................. ............ .................................... 0 IKI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADD
~~Ah )~ ~D6
I
DATE
ADDRESS
h~tr-- At. ~
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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 retum 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)]. 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-1502 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
COFFMAN. NORMA MARY 21 05 0814
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller. neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with riaht of survivorshio must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
House and Lot of ground - 121 Nittany Drive, Mechanicsburg, PA - single residential
dwelling - See attached
VALUE AT DATE
OF DEATH
165,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
165000.00
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OMS NO 2S02.Q26~ q;-
8. TYPE Of LOAN:
3, Ocor~V. UNINS, 4 OVA
C LOAN NUM8ER:
SETTLEMENT STATEMENT
1 DrHA 20FmHA
e:Fii:'ENuMBER
.,_33.'Ql'1
a MORTGAGE INS CASE NUMBER:
u,s, DErAn IMEN 1 Of /lOUSING & URBAN DEVELOPMENT
5,OCONV INS
c r~on;' 711is rorm Is ful'r'....t:hEld fo gr-vr;! YOll a SM'~/T1~nt 0' actual s,.,fff~rtmnf cost,~. Amounts paid to and by the s~Nf~menr agent 8re show".
It~m.< m$rked "(PaC]" w~"e prio outside tn. C!OM'g; Ihe)" are shown h$1'$ '0' infonn"ffon~/ purposes end lJre not !ncluded in the tota!s
-----~.-. 1.0 3,/911 (.c34~h1.FFo,'4.34'H.lf7)
D, W,ME ArlO ADDRESS 01' BUYER' E N^ME NolO ADOHESS or SElLER: F, NAME AUD ADDRESS OF LENDER:
p.i'Ji~,rj E. R~ed. Sf and
r,.,1vgM{)1 TReed
~, ~-:r.:efer VV-:Jy
r.~0l...r,8niG..r;burg. PA 17055
F:~!:He of Norma Mary C7ffTflGfl
121 Nln,,,> Drive
Mechanlcsburg, PA 17055
n rnOf'ERTY LOC,\TION: H SEnLEMENl AGENT
1~'1 Nlttany Drive BAfley Snydot LLC
r,1~cN'lnic.sbtJ'Q, P^ 17055
Cumberland Covnly, Penns11vania f'V,CE OF SE rTLEMENT
100 East Mackel Street
Yo,l., PA 17101
"J. SUMM',RY OF OIJ,EH'S I RANSACTION
1~~.._~~.9~3_~_QYNl [)U.E.f.!~..o1!1 BUYER: ~_ ___
!QLS()n.)r~ct Sa.!.~,,_f.:ri~_ .=t=lli.000'(J()
'!~.E.~"1flall'r.2l'~!L_____--~-_E_____
i6t~~:~m:t (;1!!,rg,,~~~e~(Lille ~~.___ _ ~2:.2..~
105. i --
_'~M"S!!,~f$ FrY Itoms "aid By Sell')r In advance .--
l()~~ty!I.E'wn inx,,~__Q~!Q0'..QL!9_.2..!.!Q~I2L.~ 14343
1QL_f,,:~~._ 03/03iQ~_-,0 01101107 j 252,07
108 Scl'oollax OJ!OJ/06 to 07!01l06~ 59293
lli'9.sew8r jirfi..1OJiijjjQ6 I001/01i06-------'3f22
i lQ.-Lib-,_,!!y ;;:F"i,'e' Hydcalll r'axes03/03l06 10 01101707 __ 29:94,
111. -+
112 i
120 GROSS AMOUNT OUE FROM eVY'ER !, 6l<, 1 07,84
200. AMOUNIS rAID BY OR IN BEHALF Of BUYER:
~_~l'!?Sit or earnesl",,,n.ey
202. Principal Amount Of New Lo"~
203, ExlsUng lo..n(STt"ken sub'eel 10
204,
ZU5,
4~-._.------~-------___-+---
?Ol. ;
~(J~~~__. - -I
1.09, . '
__...Muslmenl< F-or Items Unpaid By Seller "
:/.10, Cltyrrown Tpxes to
~;'!'!lyl!i~____ to I
212, School Tax to I
21a I
214. I
215, I
216, I
217. I
218. I
219 I
220, TOTAL PAID BYIFOR SU)'ER
300. CASft AT SETTLEMENT FROMfTO BUYER:
301, (;wss Amount DueX~'!'..~~"!.2-"J
302. L".. Amounl Paid BylFor Buyer ILlne 220)
303 CASI! ( X rnO!,l) ( TO) BU)'ER
'5,000:00'
5.00000
169,107,84
5,0000Ql
164.107,B~
GASH
2J.1499S1~
-- ---~--
I. SETTLEMHH DATE:
March 3, 2006
K. SUMMARY OF SELLER'S TRN.SACT/ON
400. GROSS AMOUNT OUE TO SELLER:
401. Contract Sales Price
~~~....!'.,,-~~~I P'''l''"rty
403.
404.
4O~.
I 1 ii5,()'6Q.ijO
'-1---'
t
AcJivslmen/s r-or Itllm$ Paid 8X501l0( in actvsnoo
406, .9!Yrrown T~xes 0310~1Q6 to 01/01/07 I
407. Coun!}r Taxes OJ/03/06 to 01101107 I
40B, School T9x 03/03/00 to 07/01106 I
-409:' Sewer J/F/M 03/03/0S to 04/01106 I
t-;;10'- Ubra~ Fire fi:ttlr~"t Taxes 03/03/06 to 01/01/07 r
411,
412,
14343
25207
592,93
32.22
:/9,94
420 GROSS AMOUNT DUE TO SELLER
~HEOUcnONS IN AM_OUNT DUE TO SELLER:
501. Excess Deposit (Sae Instructions)
502. Seltlemeflt Cl1a'lles to Seller (Una 1400
503. Existrn\ll~:~!!!.~l takan svbiect to
504, Payoff of first Mortgage
505.Pax<>.fI of second MOr!g~ge
506, Deposit ratained by seller
507,
508.
....5Q!L...-
Adjuslmtlnl$ ~or I(em~ Unpaid Bv Seller
166,050,59
2.260.81
5.000 00
1---
L___
.510, Cltyrrown Tllxes
511, County T axas
512, School T9x
513,
514,
515,
516.
517.
51S,
519
520, TOTAL REDUCTION AMOUNT DUE S(;LLER
800, CASH AT SETTLEMENT TOIfROM SELLER;
601. Gro&& Amovnt Due To Seller (Una 420)
602, Less Reductions Due Seller Line 520)
603 CASH ( X TO) ( FROM) SELLER
to
to
to
1
I
l
7.2(10.e1
166.05o.GG
7.260B1
15e,78g.78
The "'1<.10'51'1".<1 h~reby a~noYlI(X.fge receipt of ~ ml11plele<1 C"Py of pages 1 &2 of II1ls stat~ment & any al!achm9nts referred 10 herein.
I H,WE CI',r{EFULL Y IlEVIEWED THE iiUD 1 SETTLEMENT STATEME'NT AND TO TIlE BEST OF MY KNOWLEDGE AND BEUEF, IT IS A TRUE AND
ACCUR,ArE STATt;;MENT OF ALL R[CEIP1S NID OISBUnSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY
THAI I HAVE RECEIVED A COpy OF THE HUD-1 SEnLEMENT STATEMENl
BIJ)'cr
RichardE"Reed. $,,--------
Seller Estate of Norma Mary Coffman
8Y,
Margaret TReed
TO THE 8EST OF MY KNOWLEDGE, mE HUD.1 SEtTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE
FUNDS WHICH WERE RECEIVED AND HAVE BEEN OR WILL 8E DISBURSED BY THE UNDERSIGNED AS PAR.T OF THE SETTLEMENT OF THIS
TR.ANSACTION
Pennl A. MladenoH. Avll10rized AgMI
SelUement Agenl
WARNING: IT IS A CRIME TO KNOWINGL Y MAKE FALSE STATEMENTS TO 'HE UNITED STATES ON THIS OR ANY SI",II ^R FORM, PENAlTIES UPON
CONV1CTION CAN INCLUDE A FINE AND IMPRISONMENT, FOR DETAILS SEE: TITLE 18 U,S, CODE SECTION 100< " nON 1010,
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P~Qe 'I
700. TUTAL COMMISSION B3~9d on Price
_'~--~D!.wsiony! COJ1;!1!ssi~!ji;,e 709) esFoI/oW$,'--- _
:';\ $ te
iiI'T -----.--~-
f03c~s\C'n-rafdRt Settlmoont
~'64 M"'ii~ F<<H to
soii'7iF.:M"SPAYADI.E III COtINIOCTlON VV1Ttl LOAN
~Q.l~S:~~ ~?~!g.i.OJi_!~.r6G_____ % to
eC~2 LQ1H' Dlsc'?tl,'t % to
Q05_-p:~;rree.-~- to -------
5o.r-Cr;&f Report to
fi65:'T~r-C1~(s lp!3pf'd\onFe, to --..--,..
~~, -~i?r;~\l~)ns. '\R~ ___ to
RUI. 1 ~x Service roe to
;juij,-fIOod certifieat;o;;-r;;e-----
SOg~-~,i('rreparation f:ce
iHo-~-.---------------
8-1i~~.----~~-------.-----------------------~.-'---~-.-- -~
~.':i,!!5~!LREQUIRl:U DY ~fml'Jl TO BE PAID IN ^DVAfl';E
901 Inlol.51 Fro,,, to @ $
_9(j2:J:\~:~ii~9i'.JD'LJ'ance Premium lor months to
~)()~.li!l~~~ Pre'~~i!'.(S 10
904.
905.
1000. RESERVES DEPOSITED VV1HI LENDER
122~..~~.zard Insurance ____~__1t $
!QQ~~2!'Jl,,-I~~yranC8 ~_
IQQ!, Cityflown Ta.e. @ $
.~f.o.u~tt 1 axes @_ $
1 DOS. School Tax I\1l $
10l)6, ---@ $
1007. @ $
'1008. A9~re9ale Account Adtvstmen\ tin T
1100. TITLE CIIARGES
!.!Q~ft[e'!'!!"t or Clo~ing Fee
1102. Abstract or Title Search
Ti53~1;H~';iion
ii04.i'iiielnsu'ance Binder
1105:' D2E.':!.menll'!!p':Hat1on
1_~Q\; ~~Il\on!~leS
1107. Cot/rler fees
_----1'I1C1udes 800ve item numbers.
.LLI1!LJitle Insurance to Commonwealth Land Title Insurance Comllanv
_...J!.nGiudas (loove item numbef$.1101, llQ.2, 1103,1104
1109. Lende(s CovClag. S
11 10. Owner's Coverage $
l11T-efID 100/JOOJe 1
1112. Closing Service Laner
It 13. Attorney FBM
1200. GOVE~NMENT RECORDING AND TRANSFER CHARGES
1201. ReCOrding Fees: Deed $ 38.50; Mortgage $
1202 CitY/County h><lStamps: DM<:l
',?OJ, State Tax/Stamps: Revenue Stamps
1204.
1205.
1300. ADDITIONAL SETTLEMEN T CHARGES
1301 Survey to
1302. Pest InspeCliofl 10
1303, Sewer JiFIM to Upper Allen Townsh',o
1304. Ta~ Certincation Fe. to Marlin A. Yohn. Sr , Treasurer
n05, 2006 Co7Twp Texe. 10 Marlin A. Yohn, Sr., T"'Bsurer
1400. TOTAl. SETTlEMENT CHARGES (Enter on Unes 103 Section J and ~oz. Sectlon Kl
B, tll1ntn9 p"Qt , 01 Utl& al!i19m<<l1. lhe :lIlgnlllcOe' 4lI('.lt!~~ ret.fJlpc rA a wn;:~ cory cf P-3Qe 2 Ofthl~ two P-Sl' ,~I'rTlElOl.
:>
L. SETTLEMENT CH^RGES
~
%
"AID fROM
BU're n's
FUNDS AT
SElllEMENf
P....'OI!RO'"'
SEll ~R$
fLNCS AT
SETTtEME..'lT
----~-
Iday
days
%)
eer
"er
per
per
pe'
-"er
per
"'"
10 Barley Snyder LLC
to
10
to
to
10
to
[l~lle1. Snvder LLC
Bartey Snytler LLC
15000
.-
10. 00 ..
20,00
)
1163.75
) .-
165,000.00 1.183.75
Commonwealth Land Title Insurance Company
~mmonw.alth Land Title Insurance Company
Releases $
36.50
1,650.00: MottQlllle
1,650,00: Mortgage
Cumberland County Recorder of Deeds
Cumberland County Recorder ef Deeds
, .650.00
1.650.00
Acet #536014
Involoe No. 64-06
Invoice No. 64-06
100,00
5.00
3,057.25
510.81
2,260.81
Pennl A. Mladenoff, Authorized Agent
Settlernenll'.genl
(f34V1-1' 43<f91.117,
REV-1503 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
COFFMAN. NORMA MARY
FILE NUMBER
21 05
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0814
ITEM
NUMBER
1.
DESCRIPTION
U.S. Series E Bonds - $100.00 denomination issued to Norma S. Coffman Dec. 1977
VALUE AT DATE
OF DEATH
465.36
2.
U.S. Series EE Bonds - $200.00 denomination issued to Norma S. Coffman or John S.
Coffman April 1990 @228.96
457.92
3.
14,190.716 Shares Wells Fargo Advantage Government Securities Fund @ $10.62,
See attached
150,705.40
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
151 628.68
Wt>IIs FiHgo AdvilnliH!t> Funds'"
P.O. f3c'x H)(lC) BostOIl, f\,1J';;d(1111~ptt.~ 0) :l('fi
vVV'vV/. INI,'II;f,1 IClO.( 0Ill/,)11\',1 ill ,:l(J('f lJ 11d <;
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February 6, 2006
c):'
John M. Eakin
Attorney at Law
Market Square Building
IVlcchanicsburg, P A 17055
)/
L~)y'
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Dear Mr. Eakin:
Thank you for contacting us regarding the estate of Nonna Coffman. We valued her
association with us.
Norma Coffman held individually registered VVells Fargo Advantage Government Securities
,-------- -'--~-'-' ._.-'
Fund Transfer on DeathCrOD) accowlt #3213-2500173865. The account value is pro\lided
'~)\vingtable-asoftheaate that she'died~-AUgust 5, 2005:
Share Balance
14,190.716
f' Share Price AeCoulltValue Dividcnds*
$10.62 ., / $150,705.40 JI $127.84
*Dividends accru{d August 1 througlr'August 5, 2005
'----..----- - ---~_/
Norman S. Coffman and John S. Coffman are the TOD beneficiaries of this account. As
beneficiaries, they may reregister their portions into individually registered accounts in each
of their names. To do so, please provide the following:
. One certified copy of Norma Coffman's death certificate
. A rv1edallion Guaranteed Request for Change of Registration form [rom each
beneficiary
I f a beneficiary chooses to redeem his portion of the account, we must first re-register his
portion. To do so, we must receive the certified death certificate and the following from that
beneficiary:
. A Medallion Guaranteed Request for Change of Registration form
. A letter that references the account number and instructs us to redeem his portion
of the account
Wells Fm:go Funds Management, LLC, a who!jJ;-owned subs~diary of Wells Fargo & Company, provides investment advisory and administrative
services jor the Wells Fargo Advantage Fund . Other affihates of Wells Fargo & Company prOVide sub-adVISOry and other services for the
Funds. The Funds are distributed by Wells Fargo Funds Distributor, LLC, Member NASD/SIPC, an affiliate of Wells Fargo & Company.
i'NOT FmCiNSURED-'~NOBANK GUARANTEE' MAY LOSE VALUE I
REV-1508 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
COFFMAN. NORMA MARY
FILE NUMBER
21 05
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.
0814
ITEM
NUMBER DESCRIPTION
1. Citizens Bank - Money Management Account 489840 .
2. Citizens Bank- Checking Account 703347
3. miscellaneous personal property
4. Citizens Investment Liquidation
5. Jefferson Pilot
6. Pa Dept of Revenue- refund
7. United Water Pennsylvania- refund
8. Encompass Insurance Co. of America
9. Aston Gardens - refund
10. National Financial Services - refund
VALUE AT DATE
OF DEATH
2,788.44
7,531.82
3,663.00
16,517.41
9,294.09
79.56
18.70
53.00
1,174.29
152.09
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
41 272.40
REV-1509 EX + (6-98)
'*
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COFFMAN. NORMA MARY
FILE NUMBER
21
05
0814
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. John Coffman, Jr.
6659 Daybreak Terrace
Baltimore, MD 12106
Son
8 Norman Coffman
8703 Hickory Lane
Tampa, FL 33615
Son
c
JOINTLY-OWNED PROPERTY:
LEDER DATE DESCRIPTION OF PROPERTY '10 OF UAIE OF DEATH
ITEM FOR JOltH MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. AD ACH DEED FOR JOINTLY-HELD REAL EST ATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A'+- B - 2004 MBNA America Bank CD 40-9607-09-9 issued 1/29/05 23,357.59 33.3333 7,785.86
(rolled over from 1/29/04) 3.16% - matures 1/29/06
Principal $23,345.05 interest $12,55
2. A&B - 2004 MBNA America Bank CD 40-966700-3 issued 8/1/05 23,230.35 33.3333 7,743.44
(rolled over from 8/1/04) 3.83% -matures 8/1/06
Principal $23,219.94 interest $10.41
3. A&B - 2004 MBNA America Bank CD 40-960701-01 issued 7/29/04 22,889.86 33.3333 7,629.95
(rolled over from 7/29/04) 3.64% - matures 7/24/06
Principal $22,872.80 interest $17.06
4. A&B - 2004 PSECU CD 1051 see attached 63,929.35 33.3333 21,309.76
Principal $63,911.14 interest $18.21
5. A&B - 2004 PSECU CD 1052 see attached 7,689.72 33.3333 2,563.24
Principal $7,687.61 interest $2.11
6. A&B - 2004 PSECU CD 1053 see attached 29,671.30 33.3333 9,890.42
Principal $29659.92 interest $11.38
TOTAL (Also enter on line 6, Recapitulation) $ 56.922.67
(If more space is needed, insert additional sheets of the same size)
--
Inbna tf-~
MONA AMERICA BANK. N.A.
1'. O. IJOX 15103
\~ILI\lNGTOU. DE 19850-5103
1- (800) -11111--6751
ACCOUNT NUMBER
"0-960701-1
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tIOIU\A S cor H\AN
JOliN S cor UMN ,/R
NOHflMJ S cor UlAN
121 NlfTAtlY OR
tl[LIIAN I CSIJUHG f'A 17055
-
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-
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-
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-
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-
:-
-
..,-
fOR CH"J~GE OF ADDRESS. PLEASE USE THE REVERSE S I DE OF Tff I S FORM.
GOLDCERTIFfCATE CD ACCOUNT
ST^TE'~HIT PER I 00 FRO" 710 I 105 Tl/fWUGII 9/30/05
NUMBER Of DAVS 92
ACCOUNT NUMBER
PAGE 1
"0-960701-1
ACCOUNT SUMMARY INFORMATION
TERH
ISSUE DATE
"I\TURITY VAlE
I NTEHEST HATE
9 MONTHS
Oll29/05
o t!29/0b
3.64%
CALENDAR YTD INTEREST PAID
CALENDAR YTO WITHHOLD I NG
CALENDAR YTD PENALTY
469.71
0.00
0.00
TRANSACTION HISTORY INFORMATION
POST EFF TRANSACTION TRANSACTION BALANCE
DATE DATE DESCR I PTI ON AMOUNT
7/01 BEGINNING BALANCE 22,82].~8
~/29 ~/29 I NTEREST PAYMENT 45.02 22.ar. 0
/29 129 RENEWED I MATURED DEPOS IT 22,8r .ao 22,8 2. 0
/29 /29 INTEREST PAYf1ENT 3. 11 22,9 ~.91
9/29 9/29 I'HEREST PAYMENT 1.04 23,01 .95
9130 ENDING BALANCE 23.0]6.9
1 OF 2 910
2916
MEMBER FDIC
111bilCI ~:'f'
t\l3NA AMER I CA BANK." '. .
P. O. BOX 15103
WILMINGTON. DE 19850-5103
)- (800) -4 JlI-675I
NonnA SCOff !'AN
JOHIl S cor r f\AN ,JR
NOf\I\AN S Corrf\M~
121 !J I TTMIY OR
mCIIMllCSBUHG F^ 17055
-
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FOR CHANGE OF ADDRESS. PLEASE USE THE REVERSE SIDE OF THIS FORM.
GOLDCERTIFICATE CD ACCOUNT
STATE'~ENT PER I 00 FROM 7/01/05 THROUGH 9130/05
NUMBER or DAYS 92
ACCOUNT NUMBER
PAGE 2
40-960702-9
ACCOUNT SUMMARY INFORMATION
TERM
ISSUE DATE
MATURITY DATE
ItHERE.ST RATE
12 MONTlIS
01/29/05
01/29/00
3.16%
CALENDAR YTD INTEREST PAID
CALENDAR YTD WITHHOLDING
CALENDAR YTD PENALTY
530.77
0.00
0.00
TRANSACTION HISTORY INFORMATION
POST ErF TRMISACT ION
DATE D^IE OESCR I PTI ON
fO! BEGINNING BALANCE
~/29 /29 INTEREST PAYMENT
/29 /29 INTEREST PAYMENT
9/29 9/29 INTEREST PAYHENT
9/30 ENDING BALANCE
TRANSACTION
AMOUNT
BALANCE
60.55
62. 74
62.90
23.284.41
23.345.0
23,407.7
23,470.0
23."70.68
2 910
2916
MEMBER FDIC
---..
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.. .
~ ~..~:.~
El~~:)~-.C4 "'f
f\UN~. MIERICA OMlK, N.A.
1'. n. BOX 15J03
~/ I LI \ 1 ! J. G r 0 N, 0 E I 9850 - 5 I 0 3
1.. (HOO) -414-6751
_._._,
--,..."
----
llOfl!lA S COrrt\Ml ITF
'/UIIII S cor IIArl JR
IWHIIAN 5 (OFFMAN
121 NITTAlIY DR
mCIIMl1 CSBURG PA 17055
~~'.'!'"
--.....
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FOR CHl\llGE OF MlOHESS, PLEASE USE THE REVERSE 5 I OE OF Till S FORI\.
GOLUCERTlrlCA1E CD ACCOUNT
S U\H"Un 1'(['11 au r IWH 7/0 I /05 THROUGH 9130/05
NUMBER OF DAYS 92
ACCOUNT NUMBER
PAGE 1
1~0"96070P-' 3
ACCOUNT SUMMARY INFORMATION
nFlI1
ISSUE UHE
f1ATun I TY UHE
INTEREST HATE
12 MONTHS CALENDAR YTD INTEREST PAID
OB/Ol/05 CALENDAR YTD WITHHOLDING
08/01/0b CALENDAR YTD PENALTY
3.63%
477 .95
0.00
0.00
TRANSACTION HISTORY INFORMATION
POST EFF TRANSACTION TRANSACTION BALANCE
OHE DAlE DI:.SCHIPTION At10UNT
7/01 BEGINNING BALANCE 49. 8'~ 23,120.15
6/01 6/01 I NTEREST PAYMENT 23,169.9(.
/01 /01 IIHEREST PAYf1ENT 49.9~ 23,219.9.
8/01 8/01, RENEWED / MATURED DEPOSIT 23,21S.9 23,21g.94
9/01 9/01 'INrEREST PAYMENT 7 .09 23,29 .03
9/30 ENDING BALANCE 23,298.03
919
7150
MEMBER FDIC
PSE.:,
'l
, , ,~ '" j
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~11ImrJffilElJJ7i{1i1!JTI~!rJillIIL1L1U
" " ""I
P.O. Box 67013 (717) 234-8484 (IImrishurg)
flarrishurg, PA 17106-7013 (800) 237-7328 (Nationwide)
website - htfp:/ /www.psecu.com
EASY & CONVENIENT
USE YOUR PSECU CHECK CARD
INSTEAD OF CAS" OR CHECKS!
1...111...111....1.1..1.1.11.1..1.11.11..1.111..1.1.1111...111
tlORtlA S corn IAN
121 tnnMIY DR
tj[CII^,UCSDURG PA 17055-5562
JOIN r ONNER
JOliN COFFtiAN
08/01 ID 52
08/31
======================~=============~==================================================
BALANCE
========:===============================================================================
,
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
COFFMAN. NORMA MARY
FilE NUMBER
21
05
0814
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral Home 9,789.00
B. ADMINISTRA TIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees John M. Eakin 10,500.00
3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 410.00
5. Accountanfs Fees
6. Tax Retum Preparers Fees
7. Central Penn Appraisals 250.00
8. The Sentinel, estate notice 166.07
9. Cumberland Law Journal, estate notice 75.00
10. Frank Potteiger- personal property appraiser 95.00
11. Filing Fee 15.00
TOTAL (Also enter on line 9, Recapitulation) $ 21.300.07
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COFFMAN. NORMA MARY
FILE NUMBER
21
05
0814
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
3,000.00
1. Aston Gardens - nursing home balance
2. Michael Voswald - stump grinding reimbursement, caretaker
445.00
3. PP&L- electric
304.23
4. Upper Allen Authority - water and sewer
306.06
5. Verizon - telephone
5.91
6. Citizens Bank - bank box rental
90.00
7. Capital Telecommunications - telephone
17.14
8. Shipley Energy - oil
830.78
9. United Water Co.
76.24
10. Alliance Care- medical bill
14.62
11. Gustav Serrano - medical bill
11.06
TOTAL (Also enter on line 10, Recapitulation) $
5101.0/
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE lAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
COFFMAN-,-NORMA MARY
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
21 05
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
OR14
AMOUNT OR SHARE
OF ESTATE
1.
John S. Coffman, Jr.
5529 Daybreak Terrace
Baltimore, MD 21202
Norman S. Coffman
8703 Hickory Lane
Tampa, FL 33615
Son
1/2 residue
2.
Son
1/2 residue
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.
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, insert additional sheets of the same size)