HomeMy WebLinkAbout11-24-09 (3)1505607120
-~ REV-1500 EX (06-05} OFFICIAL USE ONLY
PA Department of Revenue County Coda rear F;le Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.zsosol 2 1 0 9 0 6 51
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
199 07 3533 02 262009 02 13 1920
Decedent's Last Name Suffix Decedent's First Name MI
MYERS DAVID N
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
X^ 1. Original Retum
4. Limited Estate
8 Decedent Died Testate
(Attach Copy of Will)
MI
THIS RETURN MUST $E FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Retum ~ 3. Remainder Retum (date of death
prior to 12-13.82)
qa. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
~ Decedent Maintained a diving Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. spousal Poverty Credit ldate of death ~ 11 .Election to tax under Sec. 9113(A)
between 12-31- 1 and i-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GARY L. JAMES ESQ. 717 533 3280
Firm Name (If Applicable)
JAMES, SMITH, DIETTERICR & CONNELLY, L
First line of address
134 SIPE AVENUE
Second line of address
City or Post Office
HUMMELSTOWN
State ZIP Code
PA 17036
REGISTER ¢~LLS US-~ILY ;~
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Correspondent's e-mail address:
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 Uve, correct and complete. Declaration of preparer other than the personal representative is based on all irtfonnation of which preparer has any knowledge.
'_ -~-. 1 ~7 l/~ i_ , Bonita F.
P O Box 367, Boiling Springs, PA`~17007
SIGIC- J,AF PREPAR OTHER THAN REPRESENTATIVE DATE
~.~ Gary L. James Esq. ~~ - ~'-'ymJ~
134 Sipe(/~v~nu~, Hummelstown, PA 17036
Side 1
~,~, 150560712D
1505607120
J
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PA Inheritance Tax Return
Signature of Additional Fiduciaries
I ESTATE OF I FILE NUMBER I
` Myers, David N. 21-09-0651
Under penalties of perjury, I deGare 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 I
of which preparer has any knowledge.
Signature #2
Name
Address1
Address2
City, State, Zip
Judith E. Wal
P.O. Box 404
Newport, PA 17074
Date
REV-1500 EX
oecedem~s name: David N . Myer s
Decedent's Social Security Number
199 07 3533
RECAPITULATION
111,000.00
1. Real Estate (Schedule A) .......................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortlgages & Notes Receivable (Schedule D) .......................................................... 4.
5. Cash, Bank Deposits 8~ Miscellaneous Personal Properly (Schedule E) ................ 5. 6 6 , 5 13.19
6. Jointly Owned Properly (Schedule F) ~ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines 1-7) .........:............................................................. g. 17 7 , 513.19
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
11. Total Deductions (total Lines 9 8~ 10) ...................................................................... 11.
12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12.
13. Charitable and Governmental BequestslSec 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.
13,908.11
1,389.57
15,297.68
162,215.51
162,215.51
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(ax1.2) X .00 Q . Q 0 15.
16. Amount of Line 14 taxable
215
51
16 2
16.
at lineal rate x .045 ,
.
17. Amount of Line 14 taxable
at sibling rate X .12 Q Q Q 17.
18. Amount of Line 14 taxable
at collateral rate X .15 Q • Q Q 18.
19. Tax Due ..................................................................... ............................................... . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1505607220
0.00
7,a99.~o
0.00
0.00
7,299.70
Side 2
1505607220 1505607220 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-0651
DECEDENTS NAME
David N. Myers
STREET ADDRESS
620 Gutshall Road
CITY STATE ZIP
Boiling Springs PA 17007
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 7,299.70
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 0.00
Total Credits (A + B + C) {2) 0.00
3. InteresUPenafty if applicable
p, Interest
E. Penalty
Total lnterest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) 7, 2 99.7 0
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 7, 299.7 0
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; .................................................................................. x
b. retain the right to designate who shall use the property transferred or its income :.................................... x
c. retain a reversionary interest: or .................................................................................................................. x
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? ....................................................................................................................... ^
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? ...................................................................................................................... ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS !S YES, YOU MUST COMPLETE SCHEDULE 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 for the use of the surviving spouse is zero
(0) percent [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 disGosure 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.
Rev-1502 FJC+ (11-08)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA I I
MNERRM1r.E TAX RETURN
RESDENT DECEDENT
ESTATE OF FILE NUMBER
Myers, David N. 21-09-0651
All real property owned solely W sea tenant In~common must be reported at felt market value. Fair market value is defined es the price at which property would be
exchanged between a wllOng buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real properly which Is Jdnttyownad with right of aurvlvorehip must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest ff owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate located at 620 Gutshall Road, Boiling Springs, Cumberland County, 111.000.00
Pennsylvania -real estate is under contract to be sold; valued per selling price and
appraisal
TOTAL (Also enter on Line 1, Recapitulation) ~ 111,000.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-OS)
Rev-1508 FJC+ (698)
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
PERSONAL PROPERTY
coteaoNwEUTN of PENNSVwANw
NHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NWMBER
Myers, David N. 21-09-0651
Include the proceeds of IRigation and the date the proceeds were Ieceived by the estate.
All property Jointly-ovrned with the right of survlvorsh{p mus/ be dfsdosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M ~ T Bank Certificate of Deposit # 31003917713090 -valued per letter dated July 23.260.85
22, 2009
Accrued interest on Item 1 through date of death 50.42
2 M 8t T Bank checking account number 1322184 -valued per letter dated July 22, 41,637.19
2009
Accrued interest on Item 2 through date of death 0.98
3 Personal Property -valued per executor 1,500.00
4 Comcast -refund 63.75
TOTAL (Also enter on Line 5, Recapitulation) I 66,513.19
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1757 EX+ (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDEN7 DECEDENT
SCHEDULE N
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Myers, David N. 21-09-0651
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached ~ 812.88
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name(s) of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attome~s Fees .fames, Smith, Dietterick 8~ Connelly, LLP 7,500.00
3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 341.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 5,254.23
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 13,908.11
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Myers, David N. 21-09-0651
ITEM DESCRIPTION AMOUNT
NUMBER
Funeral Expenses
1 Hollinger Funeral Home ~ Crematory Inc -funeral 812.88
H-A Subtotal 812.88
Other Administrative Costs
2 Capital City Oil -oil for residence 867.04
3 Charles E. Garner -real estate appraisal 350.00
4 Cheryl A. Meyer -mowing 700.00
5 Cumberland County Recorder of Deeds -reserve for real estate transfer tax 1,100.00
6 Cumberland Law Journal -estate advertisement 75.00
7 Durbin Wagner -lawn work, gas, hedges, clean up at property 600.00
8 James Smith Dietterick 8~ Connelly l.LP -reserve for estate administration closing 500.00
costs
9 Met-Ed -service for residence 44.65
10 Met-Ed -service for residence 39.68
11 Met-Ed -service for residence 43.14
12 Met-Ed -service for residence 45.70
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL. EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF (FILE NUMBER
Myers, David N. 21-09-0651
ITEM
NUMBER DESCRIPTION AMOUNT
13 Progressive Northern Insurance Co -homeowners insurance 225.00
14 The Sentinel -estate advertisement
15 Westfield Insurance -homeowners
230.02
434.00
H-B7 Subtotal 5,254.23
Copyright (c) 2002 form software only The Lackner Group, fnc. Fonn PA-1500 Schedule H (Rev. 6-98)
Rev-1512 FJ(+ (12-08)
coMMONwEn~TH ov PENNSVwANw
MHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8t LIENS
ESTATE OF FILE NUMBER
Myers, David N. 21-09-0651
Report debts inwrred by the decedent pAor to death that remained unpaid at the data of death, Inducting unreimbursad medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Church of God Home Inc -final nursing home bill 494.00
2 Comcast -service for residence 58.07
3 Embarq -service for residence 36.39
4 Met-Ed -service for residence 49.11
5 U.S. Treasury - 2008 personal income taxes 752.00
TOTAL (Also enter on Line 70, Recapitulation) I 1,389.57
(H more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ (11-05)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Myers, David N. 21-09-0651
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
Do Not List TNS s
I~ TAXABLE DISTRIBUTIONS [inGude outright spousal
d t
f
di
t
ib
ti
ons, an
rans
ers
s
r
u
under Sec. 9116(ax1.2)]
1 Michael .E. Garland Sr. Son 113 of residue 54,071.83
P.O. Box 434
Boiling Springs, PA 17007
2 Bonita F. Meyer Daughter 1/3 of residue 54,071.84
P.Q. Box 367
Boiling Springs, PA 17007
3 Judith E. Wagner Daughter 1/3 of residue 54,071.84
404 Winding Hill Road
Newport, PA 17074
I ~ Total I
Enter dollar amounts for distributions shown above on lines 15 ttrrough 18 on Rev 1500 cover sheet, as ap rop
~~ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
162,215.51
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 0.00
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
VIA HAND DELIVERY
November 24, 2009
Glenda Farner Strausbaugh
Register of Wills &
Clerk of Orphans' Court
1 Courthouse Square
Carlisle, PA 17013
RE: ESTATE OF DAVID N. MYERS, DECEASED
FILE N0.21-09-0651
Dear Ms. Strausbaugh:
Enclosed are the following documents to be filed in the above-referenced Estate:
1. An original and two (2) copies of the Pennsylvania Inheritance Tax
Return.
2. An original and one (1) copy of the Inventory.
3. A check made payable to the "Register of Wills, Agent" in the amount of
Seven Thousand Two Hundred Ninety Nine Dollars and Seventy Cents
($7,299.70) for the Pennsylvania Inheritance Tax due.
4. A check made payable to the "Register of Wills" in the amount of Thirty
Dollars ($30.00) representing the filing fee.
5. A copy of the Will.
6. A copy of the real estate appraisal.
Please time-stamp the additional copies of the Return and Inventory and return there to
me in the enclosed self-addressed, stamped envelope.
If you have any questions, please feel free to give me a call.
c~
Sincerely, ~ o
.TAMES SMITH, DIETTERICK & CONNELLY LLP ~~
~ ":'' V~ ~
7
(, 7
Denise M. Long .p ~~
Cc: Bonita F. Meyer
Judith E. Wagner
THE
ESTATE
SECURITY
FORI~~ItJLA~..,
Denise M. Long
dml@jsdc.com
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134 SIPE AVENUE
HUMMELSTOWN, PA 17036
MAILING ADDRESS
P.O. BOX 650
HERSHEY, PA 17033
TOLL FREE 1.800.942.3660
TEL. 717.533.3280
FAX 717.533.7771
www.jsdc.com