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Home My WebLink About10-28-08 (2)~--~ REV-1500 15056041147 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 O ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171284474 01222008 10131935 Decedent's Last Name Suffix Decedent's First Name MI MYERS GLORIA S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Sociai 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) ^ 4. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® 8. Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number Of Safe Deposit BOX2S ^ 9. Llttgation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-3t-91 and 1-1-95) ^ (Attach Sch. O) ,C,ORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ryname Daytime Telephone Number GREGORY M KERWIN 7173623215 Firm Name (If Applicable) KERWIN & KERWIN First line of address 4245 ROIITE 209 Second line of address City or Post Office State ZIP Code ELIZABETHVILLE PA 17023 REGISTER OFQ~ILLS USE O[+~Y L=C~ r-~ __~ ~~ o -~ r-I ' r-, _ . ,; iU ~ - <`~~';~ " ~J DAT D .. ~~ `: -' Correspondent's a-mail address: g m k e rw i n@ h o t m a i I, c o m Under penalties of penury, 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. 1 ~ /?~ Richard E. Myers ~ ~ 2 7~0 ADDRESS 109 South 17th Street, Camp Hill, PA 17011 lG ~ ~ D SIGNATUR F P PARER OTHER TH REPRESENTATIVE DATE Gregory M Kerwin ADD SS 4245 Rout4 209, Elizabethville, PA 17023 Side 1 15056041147 15056041147 J O ~~ 1 ~~ J 15056042148 REV-1500 EX Decedent's Social Security Number oeceaenc~s Name: M Y E R S, G L O R I A S 17 12 8 4 4 7 4 RECAPITULATION 1. Real Estate (Schedule A) ........................................................................................ .. 1. 2. Stocks and Bonds (Schedule B) ............................................................................. .. 2. 87,302.24 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ .. 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ .. 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............ . 7, 8. Total Gross Assets (total Lines 1-7) ...................................................................... . g. 8 7, 3 0 2 2 4 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... .. 9. 3,116.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. .. 10. 11. Total Deductions (total Lines 9& 10) .................................................................... .. 11. 3, 1 1 6 0 0 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12, 8 4 , 1 8 6 2 4 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................ . 13, 14. Net Value Subject to Tax (Line 12 minus Line 13) ......................... ...................... . 14. 8 4 , 1 8 6 2 4 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 .00 8 4, 1 8 6 2 4 18. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................................................................................................................... . 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056042148 15056042148 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 08 Myers, Gloria S STREET ADDRESS 109 South 17th Street CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1> 0.00 (2) 0.00 (3) 0.00 (4) (5) 0.00 (5A) (5B> 0.00 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 :.................................................................................. ^ b. retain the right to designate who shall use the property transferred or its income :.................................... ^ 0 c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ a 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?......... [~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ANO 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 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 zero (0) percent [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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent (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. COMAADNWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Myers, Gloria S 21 - 08 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 14 Series HH Bonds dated from 07/1997 and 08/1998 total face value 39500. 39,500.00 $39, 500.00 2 1081 Shares AT&T ~ I 35.96 38,872.76 3 140 Shares Vodafone Group PLC I 3.51 491.40 4 5 shares Fairpoint Communications, tnc. 11.01 55.05 5 174 shares Qwest Communications 5.44 946.56 6 29 shares Lucent Technologies Inc. 5.70 165.30 7 97 Shares Comcast Corporation 16.65 1,615.05 8 144 Shares Verizon Communications, Inc. 37.83 5,447.52 9 14 shares Idearc Inc. 14.90 208.60 TOTAL (Also enter on line 2, Recapitulation) 87,302.24 COMdONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Myers, Gloria S SCF~DULE H //~Fry~U~I~~E/~~ RA~~I_D~~ (~~PE~~N~S/E~S~&~ /'1N111NIM~711V'\I IYG VW 1~7 FILE NUMBER 21 - 08 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION A. B. 1. AMOUNT ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 2. 3. City State Zip Year(s) Commission paid Attorney's Fees Kerwin & Kerwin -- Gregory M Kerwin Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 2, 750.00 Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 144.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Notary fee on Affidavits of Domicile 45.00 I~ TOTAL (Also enter on line 9, Recapitulation) 3,116.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral Expenses & Administrative Costs continued ESTATE OF Myers, Gloria S FILE NUMBER 21 - 08 2 ~ Register of Wills, short Certificates 3 ~ Mid Penn Bank, signature guarantees 4 ~ Register of Wills, filing inheritance tax return 5 ~ Reserved for closing costs 12.00 35.00 30.00 100.00 Page 2 of Schedule H SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Myers, Gloria S 21 - 08 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I~ TAXABLE DISTRIBUTIONS [include outright s ousel distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Richard E. Myers Spouse Entire Estate 109 South 17th Street Camp Hill, PA 17011 ~I I Enter dollar amounts for distributions shown above on lines 1 5 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 I, Gloria S. Myers, a resident of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understand- ing, do make, publish and declare this as and for my last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments, or writings in the nature thereof, by me at any time heretofore made. I. I nominate, constitute and appoint my husband, Richard E. Myers, to be Executor of this, my last Will and Testament. Should a substitute or successor be required, I nominate, constitute and appoint as such my son, Jeffrey S. Myers. I direct that neither; my said husband nor my said son shall be required to give bond for the faithful perforniance of his duties hereunder in this or any other jurisdiction, and that if, notwithstanding this direction, any bond is required by any law, statute or rule of court, no surety be required thereon. II. I give, devise and bequeath all of my property and estate, of whatsoever kind and wheresoever situate, of which I shall die seized or possessed, or of which I shall be entitled to dispose at the time of my death, to my husband, Rich- ard E. Myers, the same to be his absolutely, provit~ing my said husband survives me by a period of three (3) months . III. In the event my said husband, Richarcl E. Myers, should fail to survive me by a period of three (3) months, then I give, devise and bequeath all of my property and estate, of whatsoever kind and wheresoever situate, of which I shall die seized or possessed, or of which I shall be entitled to dispose at the time of my death, in equal shares to my son, Jeffrey S. Myers, and my daughter, Vicki L. Mathias, the same to be theirs absolutely. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last Will and Testament, this ~ day of August, 1989. ~..1 ~ :.:_ ~- cv ~ -~ _ (Seal ) _ ' ~' ~ ' ~ C: ~ -~ Gloria .) _~UC: t _ ~ ~ Lr- ~ : ..._ c:a ~ ~~ 7 U CV