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Home My WebLink About01-18-07 REV-1500 EX + (6-00) .' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) t- Z W o w o w o MOYER RAYMOND DATE OF DEATH (MM-OD-Year) R. DATE OF BIRTH (MM-DD-Year) 12120/2005 07/0411930 (IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ ~ :S If) CJ a:: ~ w A.CJ ZOO CJ f iil A. ~ [X] 1. Original Return D 4. Limited Estate [Rl 6. Decedent Died Testate (AIIach copy of WII) o 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (daleofdealh aller12-12-82) D 7. Decedent Maintained a Living Trust (AIlach copy of Trust) D 10. Spousal Poverty Credit (dale of deaIh between 12-31.91 and 1-1-95) OFFICIAl USE ONLY FILE NUMBER 2 1 -0 5 1 1 1 6 COiil'rYOOiiE -VEAR- - - Nti'iiBER- - SOCIAL SECURITY NUMBER 188-32-5112 THIS RETURN MUST BE FIlED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (daleofdealh priorlD 12-13-82) D 5. Federal Estate Tax Return Required !.. 8. Total Number of Safe Deposit Boxes D 11. Eleclion to tax under Sec. 9113(A) (AIlach Sch 0) NAME MURREL R. WALTERS III FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS ... z W Q Z ~ If) w a:: a:: o CJ 54 EAST MAIN STREET TELEPHONE NUMBER 717-697-4650 MICHANICSBURG z o 5 ::) t- it c( o w ~ 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or SoIe-Proprietorship (3) 4. ~ages & Notes Receivable (Schedule D) (4) 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. JoinUy Owned Property (Schedule F) (6) D 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 Uabilities. & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental BequestslSec 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 z o i= ~ ::J I:L ~ o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate x _ (15) 164.447.77 X ~ (16) X .12 (17) X .15 (18) (19) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 155.250.00 PA 17055 OFFICIAL USE ONLY o :.7) 11 .i-rO ~.... i s:;: F; 18,676.77 ..:. .<.":: ::n U- "-... - /" . ~E:.~ . )C.:-:: :' ::rJ --.; t-...) c::> ~ --.I <- > 2: ~.2.j C-;. ::-c;:J ;'''1-1 ,:J C.) ",Ol -n c-'=) In .f'.':' ---r"'f co ~ :x co + (8) 174.926.77 9,779.00 700.00 (11) (12) (13) 10,479.00 164,447.77 (14) 164.447.77 7,400.15 7.400.15 d tl C It Add Dece en-s ompl e e ress: STREET ADDRESS 4 WILLOW MILL PARK ROAD CITY I STATE I ~p MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 7,400.15 Total Credits (A + 8 + C) (2) 3. InterestJPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT (3) 0.00 7,400.15 7,400.15 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 l&l b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c. retain a reversionary interest; or ..... ................... ........... ................... .............. ............... ................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................. ............................................ 0 00 3. Did decedent own an "in trust for" or payable upon death bank account or security .at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................... ........... ...................................... 0 00 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 pen8ties d perjIJy, I declae lhat I have exanined this return, includi!!Q accompanying schedules and statements, and kllhe best of my knowledge and belief, it is true, correct and complete. DecInIion at preparer other lhllllhe personal representative is based on all informaIIon of which preparer has lilY knowledge. SIGNATURE OF ERSON RESPONSIBLE FOR FILING RETURN DA E ADDRESS MURREL R. WALTERS III, ESQUIRE 54 EAST MAIN STREET, MECHANICSBURG PA 17055 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.5. ~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 exemot 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 .5. ~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) .w COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MOYER RAYMOND R. 21 05 1116 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 wiDing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real Df'ODlrtv which is iointlv-owned with rlaht of survlvorshiD must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM. NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 155,250.00 4 WILLOW MILL PARK ROAD MECHANICSBURG, PA 17050 ASSeSSED VALUE TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheels of the same size) 155.250.00 REV-1508 EX + (6-98) ," . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER RAYMOND R 21 05 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of survivorship must be disclosed on Schedule F, 1116 ITEM NUMBER 1. 2. 3. 4. 5. 6. DESCRIPTION M & TBANK CHECKING ACCOUNT M & TBANK SAVINGS M & TBANK CERTIFICATES OF DEPOSIT CHUCK E. BRICKER, AUCTIONEER HOUSEHOLD ITEMS NET SALE PRICE STATE FARM REFUND - AUTOMOBILE INSURANCE PINNACLE HEALTH REFUND -MEDICAL VALUE AT DATE OF DEATH 488.85 8,411.16 9,630.76 1,060.00 36.00 50.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional shee1s of the same size) 19,676.77 REV-1511 EX + (12-99) .' . COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MOYER RAYMOND SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS R. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 05 1116 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 8,300.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) THOMAS D. MOYER renounced Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AtIDmey Fees MURREL R. WALTERS III 1,050.00 3. Family exemption: (If decedents address is not the same as claimants. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS. CUMBERLAND COUNTY 429.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9. Recapitulation) $ 9.779.00 (If more space is needed, Insertadditional sheets of the same size) REV-1512 EX. (6-98) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COUUONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MOYER RAYMOND R. Include unreimbursed medical expenses. FILE NUMBER 21 05 1116 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. WEST SHORE EMS AMBULANCE 700.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space Is needed, insert additional sheets of the same size) 700.00 REV:"'~~'!* COMMONWEAlTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER . -- -INI R 21 05 1116 MUYt-t< 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 pnclude o~ht ~I distributions. and tJansfers under Sec. 9116 (a (1. )] 1. THOMAS D. MOYER SON 1/3 4 WILLOW MILL PARK ROAD MECHANICS8URG, PA 17050 2. ROBERT .I. MOYER SON 1/3 " 244 SILVER SPRING ROAD MECHANICS8URG, PA 17050 3. TIMOTHY R. MOYER SON 1/3 387 RICH VALLEY ROAD CARLISLE, PA 17015 ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET ll. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART IT - 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)