HomeMy WebLinkAbout05-22-09-~ REV-1500 1505607120
EX (06-05) OFI'ICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.2soso~ 2 1 0 8 0 0 4 7 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
04032008 11171916
Decedent's Last Name Suffix Decedent's First Name MI
MEYERS LUELLA M
(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 Retum ^ 2. Supplemental Return ^ 3. Remainder Retum (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
® g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
SCOTT M. DINNER ESQ. 7'177615800
Finn Name (If Applicable)
LAW OFFICE OF SCOTT M. DINNER
First line of address
3117 CHESTNUT STREET
Second line of address
City or Post Office
CAMP HILL
State ZIP Code
PA 17011
Correspondent'se-mail address: dinner@IOCalnet.COm
REGISTER~OF WILLS USE'ANLY
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Under penalties of perjury, 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, corcect and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIG RE OF PERSON RESPON IB 0/`~ ~I NG RETURN MAY 1 D9T2009
/,yyyytp /~') -c'1~11'Jl ,, Lynne M. Fuller
8 en Circle, Camp 'll, PA 17011
SIGN UR F R OTHE THAI~R RESENTATIVE DATE
/ ~~ Scott M. Dinner Esq. MAY 1 9 2009
3117 Chestnut Street, Camp Hill, PA 17011
Side 1
1505607120 15056071211
1505607220
REV-1500 EX
RECAPITULATION
1. Real Estate (Schedule A) ......................................................................................... . 1.
2. Stocks and Bonds (Schedule B) .............................................................................. . 2. 9 0, 2 4 5. 6 4
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... . 3.
4. Mortgages 8~ 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. 8 , 8 8 2 3 2
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............ . 7, 2 6 , 2 1 8 . 9 4
8. Total Gross Assets (total Lines 1-7) ...................................................................... . g. 1 2 5, 3 4 6. 9 0
9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 9 , 9 2 4 . 3 8
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 8 4 7 . 0 1
11. Total Deductions (total Lines 9 & 10) ..................................................................... . 11. 1 0 , 7 7 1 . 3 9
12. Net Value of Estate (Line 8 minus Line 11) ............................................................ . 12. 1 1 4 , 5 7 5 . 5 1
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. 1 1 4 , 5 7 5.51
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 15.
16. Amount of Line 14 taxable
at lineal rate X .045 114 , 5 7 5.51 1s. 5 , 15 5 . 9 0
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. 5 , 15 5 . 9 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505607220 .1505607220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 08 - 00476
Meyers, Luella M
STREET ADDRESS
8 Green Circle
CITY STATE
Camp Hill 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
p. Interest
E. Penalty
5,000.00
257.80
Total Credits (A + E3 + 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) 5,155.90
(2) 5,257.80
(3) 0.00
(a) 101.90
(5)
(5A)
(5B) Q . ~ Q
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 :.................................... ~ x^
c. retain a reversionary interest; or .................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? .............................................................. ^ x^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ....................................................................................................................... ^ ^x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^x ^
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 SCHEDIJLE 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 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 1`or the use of the surviving spouse is zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemat 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.
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAK RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF Me ers, Luella M FILE NUMBER
Y 21 - 08 - 00476
All property jointly-owned with right of survivorship must lie disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 1,258.882 shs. -Delaware Large Cap Value Fd A 16.58 20,872.26
(sym: deldx)
2 1,085.917 shs. -Delaware Growth Opportunities Fd A 19.52 21,197.10
(sym: dfcix)
3 793.965 shs. -Delaware Ltd-Term Diversified Inc. Fd A 8.44 6,701.06
(sym: dtrix)
4 2,266.606 shs. -Delaware Corporate Bond Fd A 5.42 12,285.00
(sym: decax)
5 2,431.649 shs. -Delaware Ext. Duration Bond Fd A 5.43 13,203.85
(sym: deeax)
6 557.643 shs. -Seligman Inc. & Gwth Fund A 12.12 6,758.63
(sym: sinfx)
7 136.562 shs. -Seligman U.S. Gov't. Securities Fd A 7.04 961.40
(sym: susgx)
8 548.894 shs. -Seligman Large-Cap Value Fd A 15.06 8,266.34
(sym: slvax)
TOTAL (Also enter on tine 2, Recapitulation) 90,245.64
SCHEDULEF
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Meyers, Luella M FILE NUMBER
21 - 08 - 00476
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
Lynne M. Fuller 8 Green Circle Daughter
A Camp Hill, PA 17011
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT Include name o~Ffina vial It1StdUL10~ and bank account number
or similar identi In number. Attach deed for'ointl -held real
~ 9 i Y
estate. DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A Oct. 2003 M&T Bank account # 15004205739955 8,504.67 50% 4,252.34
2 ~ A July 2003 M8~T Bank account # 59850647
I
i
I 9,259.95 50% 4,629.98
TOTAL (Also enter on line 6, Recapitulation) 8,882.32
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
ESTATE OF Meyers, Luella M
FILE NUMBER
21 - 08 - 00476
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Indude the name of the transferee, their relationship to decedent
and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH
VALUE OF ASSET ~~' OF
DECD'S
INTEREST EXCLUSION
(IF APPLICABLE)
TAXABLE VALUE
1 Nationwide Life Ins. Co. annuity contract # 26,218.94 100% 26,218.94
01-5144086 designated beneficiary: Lynne M. Fuller,
daughter (see atttached account valuation)
I
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I
TOTAL (Also enter on line 7, Recapitulation) 26,218.94
SCHEDI~E H
COMMONWEALTH OF PENNSYLVANIA r~.71~ ~.../~~..1~
INHERITANCE TAX RETURN Ar1RA1~Ne•~~ATI~ /C /'y'-G~TSC
RESIDENT DECEDENT ~'1LJIYYI~7 ~ I~1 ~ ~YG \.-~.J~7 ~ u7
ESTATE OF Meyers, Luella M FILE NUMBER
-..- __ ___ 21 - 08 - 00476 _ _
Debts of decedent must be reported on Schedule I.
_T _
tM I
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1
2
3
B
2.
3.
4.
5.
s.
7.
1
Myers-Harner Funeral Home 3,374.00
Camp Hill, Pennsylvania
The Camp Hill United Methodist Church (columbarium) 135.00
bereavement luncheon 600.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Scott M. Dinner, Esq. 1,800.00
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Lynne M. Fuller 3,500.00
Street Address 8 Green Circle
City Camp Hill State PA Zip 17011
Relationship of Claimant to Decedent daughter
Probate Fees Cumberland County R-O-W 268.00
1
Accountant's Fees
Tax Return Preparer's Fees Wagner's Tax Service 45.00
Other Administrative Costs
The Patriot News/Cumb. Law Journal -advertisement of grant of letters 202.38
TOTAL (Also enter on line 9, Recapitulation) 9,924.38
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERRANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Meyers, Luella M 21 - 08 - 00476
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 ~ West Shore EMS - ALS [call # 3098445A]
847.01
TOTAL (Also enter on Line 10, Recapitulation) ~ 847.01
REV-1513 EX+ (9-00) _ ~
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Meyers, Luella M
21 - 08 - 00476
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not Llat Trustee(s)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Barbara G. Meyers Daughter-in-Law 1/8 of residue
48 Longwood Drive
Mechanicsburg, PA 17050
2 Jill S. Navarette Granddaughter 1/8 of residue
804 Fai~eld Street
Mechanicsburg, PA 17055
3 Jennifer M. Foster Granddaughter 1/8 of residue
4 Stone Run Drive
Mechanicsburg, PA 17050
i
Enter dollar amounts for distributions shown above on lines 1
5 through 18, as appropriate, on
Rev 1500 cover sheet i
Ili
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX I;i
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1 ri00 COVER SHEET ~ 0.00
REV-1513 tJt+ (9.00) _ ~,
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Meyers, Luella M
21 - 08 - 00476
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not ust Trustee(s)
I, TAXABLE DISTRIBUTIONS [include outright spousal
distributions and transfers
under Sec. X116 (a) (1.2)]
4 Michael R. Meyers Grandson 1/8 of residue
141 Peach Lane i
Carlisle, PA 17013
5 Lynne M. Fuller Daughter 1/2 of residue
8 Green Circle
I Camp Hill, PA 17011
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I
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Page 2 of Schedule J
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF w:.
GRANT OF LETTERS ~4
No . 2008- 00476 PA No . 2 9 - X08- 04 76
Estate Of: LUELLAMMEYERS
(Fits!, Middle, Lastl
Late Of: HAMPDEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No: 974-96-2425
WHEREAS, on the 25th day of April 2008 an instrument dated
August 29th 2000 was admitted to probate as the Iasi. will of
LUELLAMMEYERS
(Fits!, INiddle, Lastl .,~.~,
late of HAMPDEN TOWNSH/P, CUMBERLAND County, ~~
who died on the 3rd day of April 2008 and, ....,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi11s in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, .hereby
cez-tify that I have this day granted Letters TESTAME=NTARY to:
L YNNE M FUL L ER
who has duly qualified as EXECUTOR(R/X)
and has agreed to administer t_he estate according to law, all of which
fully appears of record in my office at CUMBERLAND C'OUNTYCOURTHOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal.,,;.
of my office on the 25th day of April 2008.
* *NOTE* * ALL NAMES A130VE APPEAR (FIRST, MIDDLE, LAST)
On Dour Side"°
May 18, 20as
Niles Miller
E-Mail Address:
ni!es~n~mfinancialsvs com
RE; Annuity C~~ntract Number. 01-:144086 (Surrendered}
Annuity Car;tract ~vner Luella M. iVieyers
Dear h'ir. Miller:
tJationvaide Financial
P Q Box i 82!21
Calurnbu:>, C+H 4328
www.n2ticnvride com
We appreciate your inquiry.
Recenty, the fend b'eakdo~h~n as of April 3, 2008 was requested fcr the above referen~,ed annuity
contra;;t.
Here is the requested irifarrnatian_
As of April 3 20x8
NVIT Multi-Sector Bond Fund = $2,400 51
American Century ~,~P Value Fund I = X7,849.96
Dreyfus VIF Growth 8~ income Fur;d = $6,248.2
Van Eck l~lcrldwide Bond Fund iC = $3,725,s3
Iota! Value =$26,218.94
We are here if you need us.
Please contaot us et 1-(i0u-fi48-6331; Monday through r=riday, 8:07 a.m. 40 8:aa p.m. Eaatem Time if
you wave any questions or need additional information.
Best Regards.
Service Management
Nationwide Financial
Date: Mon, OS May 2008 10:08:12 -0400
From: "DATE OF DEATH REQUESTS" <ERNABX4@mtb.com>
To: "SILVIA FOLEY" <SFOLEY@mtb.com>
Subject: Re: prod -Date of Death Request
}'lease find below the date of death balances foi: Luella Meyers, social security # 174-20-2435,
l .Account # 15004205739955, Balance $ 8,504.56 + Accrued Interest $ 0.11, Total $ 8,504.67
2. Account # 59850647, Balance $ 9,259.72 + Accrued Interest $ 0.23, Total $ 9,259.95
Records Management /DOD Unit
M&T Bank- "Understanding what's important."
»> <SFOLEY@mtb.com> 4/29/2008 11:56 AM »>
Account Information
Date of death: 04/03/2008
Account Number: 15004205739955
Product Type: Deposit Account
Account Number: 59850647
Product Type: Deposit, Account
Request Details
Deliver to: Requestor
Delivery Options: E-mail
Page 1 of 1
Delivery Details: ebrnsf5
Page 1 of 1
Scott,
~,ynrt was added on acct # 59850647 in July , 2003
Lynn was added on acct #15004205139955 in October, 2003.
if you need more information please let me know,
Silvia
~.ilvia L Foley
r'~ssistant Branch Manager
I'rindle Rd Office
Ph: 717-737-2308
'ax: 717-737-2303
sfoley@mandtbank.com
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.Y~~**~~*~:**~:**************~**********
- - - - - - _ ... ,.,.,,.,.,. .~,r.~.~rn _ _.._ u~i~nno
SCOTT M. DINNER, ESQUIRE
TEL: (717) 761-5800 31 17 CHESTNUT STREET
FAX: (717) 761-5008 CAMP HILL, PA 17011
May 22, 2009
Glenda Farner Strasbaugh
Register of Wills and Clerk of the Orphans' Court
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Luella M. Meyers ("Estate")
#21-08-00476
The following items are being submitted on behalf of the Estate:
1. REV-1 S00 Inheritance Tax Return Resident Decedent` [2 copiesJ.
2. A checkfor $IS. ~lingfees) payable to 'Register of ti~ills'.
Thank you.
Scott M. Dinner, Esquire
enclosures (3)
cc: Lynne M. Fuller, Personal Representative
HAND DELIVERED