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Home My WebLink About08-21-06 (2) .' 'f V-1500 EX (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L COUNlY CODE ~~ 1121___ YEAR NUMBER I- Z W C w frl c DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Coords Gertrude DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 12/12/2005 5/11/1918 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Not]l.;. licable [i] 1. Original Return D 4. Limited Estate [i] 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received F SOC~LSECURITYNUMBER 084-01-8686 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w ... ,~U) . a::~ 10..0 !OO 'a::.J Ia..m a.. 0( D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) [i] 5. Federal Estate Tax Return Required [X] 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (date of death between 12-31-91 end H.9S) 0 11. Election to tax under Sec. 9113{A)(AtlachSchO) THIS SECTiON MUST BECOMPL.ETED.AL.L.CORRESPONDENCi:ANDCONFIDENTIAl..TAXINFORMATIONSHOUL.D BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS .... Z W o Z o Q. In W a:: a:: o o ire 3401 North Front Street METTE, EVANS & WOODSIDE TELEPHONE NUMBER 717-232-5000 PO Box 5950 Harrisbur , PA 17110-0950 z o i= :5 '""l 6. J~ Owned Property (Schedule F) U Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) (6) 0.00 0.00 0.00 0.00 6,335.00 14,860.83 o/fflAL USE ONLY ~ ~ :. c::;) o CJ""' ::-7 :!> -;-:~C) ~ f.~':; N .'"XJ --~;: PS ) "::::> ..5:) h::~ ! \.J i c) : :~-R (") ;n :'::J -('"I 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 (Schedule E) (5) U 3: 1,276,005.46 w o w 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) (8) 29,827.26 0.00 1,297,201.29 -, -- 1 II ~ 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) {13} 29,827.26 1,267,374.03 0.00 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) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 1,267,374.03 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a){1.2) 18. Amount of Line 14 taxable at collateral rate x .15 (18) ( 19) 0.00 57,031. 83 0.00 0.00 57,031. 83 0.00 1,267,374.03 0.00 0.00 x.O L (15) x .0 45 (16) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x .12 (17) 19. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 15 1.000 o , C Add Decedent s amp ete ress: SlREET ADDRESS 100 Mount Allen Drive Cumberland CllY I STAlE 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) 0.00 53.000.00 2,789.47 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E Penalty 0.00 0.00 Total Interest/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) 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. (5A) 57.031. 83 55.789.47 0.00 0.00 1.242.36 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 1.242.36 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes [K] D D D 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 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Ii] D 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 tha best of my knowl. . Declaration of preparer other than the pel1lonal representative is based on aU information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . 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? . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death No D ~ ~ [j [Jg ~ If) Peter G. Forman, Executor ADDRESS 3107 Rolling Knoll Drive SIGNA1URE OF PREPARER OTHER THAN REPRESENTATIVE Mark D. Hipp, Esquire ADDRESS (?..z:: g.,~ iEKe~ 90 ~I J Dallas, TX n t 5 Qv...-e... - I S A- PD ~ 3401 N. Front St., PO Box 5950 Harrisburg, ~ _ L 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. ~ 9916 (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-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent ofthe 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. 9 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. 3W4646 1.000 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Gertrude F Coords FILE NUMBER 21 05 1121 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Jewelry - see attached appraisal 4,335.00 2 Tangible Personal Property 2,000.00 ,6AO 1.000 TOTAL (Also enter on line 5 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,335.00 REV-1509 EX + (&-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gertrude F Coords SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21 05 1121 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 RELA 110NSHIP TO DECEDENT A. Cincotta, Janet F 350 Wellsville Road, Wellsville, PA 17365 Daughter B. Forman, Peter G 3107 Rolling Knoll Drive, Dallas, TX 75234 Son c. JOINTL V-OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERlY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FItw'lCIAL INSTITllTlON A/Cl BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF N..M1lER OR SIMILAR IDENTIFYING I'AJMBER. ATTACH DEED FOR NUMBER TENANT JOINT JOINT\. Y -l-ELD REAL ESTATE. VALUE OF ASSET INlEREST DECEDENT'S INTEREST 1. A. 1 BA 3/14/1986 M&T Bank Checking Account #9655804; owned jointly with Peter G. Forman and Janet Cincotta 4,680.25 33.3300 1,560.08 Interest accrued to 12/12/2005 0.32 33.3333 0.11 2 BA 3/14/1986 SunTrust Bank Checking Account #391-0058-10534; owned jointly with Peter Forman and Janet Cincotta 39,901. 92 33.3300 13,300.64 TOTAL (Also enter on line 6 Recaoitulationl $ 14,860.83 46AE 1.000 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONVVEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gertrude F Coords FILE NUMBER 21 05 1121 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERlY ~LOE THO NOME OF THO TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THO DATE OFlRANSFER. ATTACH A COPV OF TIE DEED FOR REAL ESTATE. Gertrude F. Coords Revocable Trust Under 2000 Restatement of Trust Agreement Dated July 25, 2000, as amended. SunTrust Bank, Trustee. See attached 2000 Restatement of Trust Agreement, First Amendment and Second Amendment. Trust assets held under SunTrust Bank Trust Account Number 52-01-215-5200839. See attached date of death valuation of trust assets. 2 Individual Retirement Account, SunTrust Bank Account #52-01-110-5202037 See attached correspondence for valuation and beneficiary designation for IRA. 3 FOR DISCLOSURE PURPOSES ONLY: Decedent was receiving monthly pension and retirement annuity benefits from Mattel/Fisher Price, East Aurora, NY; however, all benefits from both the pension and the annuity ceased at decedent's death. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST 976,739.90 100.0000 299,265.56 100.0000 o . 00 100.0000 ;AF 1.000 (If more space Is needed, Insert additional sheets of the same size) TOTAL (Also enter on line 7, Recapitulation) $ EXCLUSION (IF APPUCABlEI 0.00 0.00 0.00 TAXABLE VALUE 976,739.90 299,265.56 0.00 1.276.005.46 REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gertrude F Coords SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 05 1121 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. E.J. Nuwer Florist 87.00 Total from continuation schedules 6,157.83 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 20,000.00 3. Family Exemption; (If decedent's address is not the same as claimant's. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 125.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Cumberland Law Journal - legal notice 75.00 Total from continuation schedules 3,382.43 TOTAL (Also enter on line 9, Recapitulation) $ 29.827.26 ~6AG 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Gertrude F Coords Item No. 2 3 4 5 6 084-01-8686 Schedule H Part 1 (Page 2) Description Amount Malpezzi Funeral Home, Mechanicsburg, PA Cremation services 2,006.00 Memorial service invitations, programs and postage 96.36 Roycroft Inn, East Aurora, NY Memorial service luncheon 1,587.92 Wood Funeral Home, East Aurora, NY Memorial service and grave opening 1,580.55 Wood Funeral Home, East Aurora, NY Grave marker 887.00 Eotal (Carry forward to main schedule) 6,157.83 Estate of: Gertrude F Coords 084-01-8686 Schedule H Part 7 (Page 2) 2 Peter G. Forman, Executor Travel expenses related to probate of decedent's Will and inventory and possession of contents of safe deposit box 1,975.88 3 Munn's Diamond Gallery - jewelry appraisal 1,255.00 4 Sentinel - legal notice 151.55 Total (Carry forward to main schedule) 3,382.43 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gertrude F Coords SCHEDULE J BENEFICIARIES FILE NUMBER 21 05 1121 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Janet F. Cincotta 350 Wellsville Road Wellsville, PA 17365 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE NUMBER I Individual Retirement Account, SunTrust Bank Account #52-01-110-5202037 Inventory Value: 149,632.78 Jewelry - see attached appraisal Inventory Value: 2,167.50 Tangible Personal Property Inventory Value: 1,000.00 50% of Residue: 480,886.73 Daughter 633,687.01 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~46AI1.000 TOTAL OF PART 11- 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) $ 0.00 Estate of: Gertrude F Coords 084-01-8686 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 2 Peter G. Forman 3107 Rolling Knoll Drive Dallas, TX 75234 Individual Retirement Account, SunTrust Bank Account #52-01-110-5202037 Inventory Value: 110,728.26 Jewelry - see attached appraisal Inventory Value: 2,167.50 Tangible Personal Property Inventory Value: 1/000.00 36% of Residue: 346/238.45 Son 460,134.21 3 Clark Formaniak c/o Ellen Hartwig Thompson 307 Ponderosa Trail Murphy, TX 75086 Individual Retirement Account, SunTrust Bank Account #52-01-110-5202037 Inventory Value: 11,970.62 4% of Residue: 38,470.94 Grandson 50,441. 56 4 Andrea Hart 6843 La Vista Drive Dallas, TX 75214 Individual Retirement Account, SunTrust Bank Account #52-01-110-5202037 Inventory Value: 11,970.62 4% of Residue: 38,470.94 Granddaughter 50,441. 56 , .' Estate of: Gertrude F Coords 084-01-8686 Schedule J Part 1 (Page 3) Item No. Description Relation Amount 5 Ellen Thompson 307 Ponderosa Trail Murphy, TX 75094-3639 Individual Retirement Account, SunTrust Bank Account #52-01-110-5202037 Inventory Value: 14,963.28 6% of Residue: 57,706.41 Granddaughter 72,669.69