HomeMy WebLinkAbout12-11-09 (2)rJL~f' ..~
J REV-1500 E><cos-os>
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Hamsburq, PA 17128-0601
15056051058
OFFICIAL USE ONLY
Countv Code Year File Number
INHERITANCE TAX RETURN ~~,~
RESIDENT DECEDENT oL
Date of Birth
03/06/1937
Decedent's First Name MI
Clair C
Spouse's First Name MI
________......._ _....,. -.----..-..-,- - THIS RETURN MUST BE FILED IN DUPLI ATE W
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
f~3 1. Original Retum t".,:~.~ 2. Supplemental Retum 5 3. Remainder Retum (date of death
prior to 12-13-82)
> 4. Limited Estate t 4a. Future Interest Compromise (date of C~ 5. Federal Estate Tax Return Required
death after 12-12-82)
C,~3 6. Decedent Died Testate C3 7. Decedent Maintained a Living Trust __.~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
C_ 9. Litigation Proceeds Received t~ 10. 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 CONFIDENTU\L TAX INFORMATION SHOULD BE DIRECTED T0:
Name
--~__ _._ ___w_.._.._____r_ _..._ ~ ___ ____ ~ ....._. _
_._ _
_...._~ ~_w_____..~__.._ ~......_ _..__... , ...~.._. _. Daytime Telephone Number
~, ~..~._,_ ___...._...~._~ ___.__ __ .._ .:
John M. Eakin ! (717) 766-3172
Firm Name (If Applicable)
First line of address
Market Square Building
Second line of address
.~ ._ P ~t Off ~ . _ ._ .. _~ _ _ ...State _ ZIP Code __..._ ,
REGISTER OF WILLS USE O(>~LY
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Correspondent's a-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 true, rd-i'ect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
PERSON RESPONSIBLE FOR FJLlP1G RETURN
ADDRESS
SIGNAT E OF/RtR,E~q.I~O~jHER THAN REPRESENTATIVE .DATE /~ ~ 9
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ADDRESS
15056051058
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USE ORIGINIAL
Side 1
15056051058
J
15056052059
REV-1500 EX
Decedent's Name: Clair C Byers
Decedent's Social Security Number
_._ _ ._._
198-28-6795
.:
RECAPITULATION
1. Real estate (Schedule A) ............................................. L
2. Stocks and Bonds (Schedule B) ....................................... 2.
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) C;~ Separate Billing Requested ....... 6.
7. Inter-Vvos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) C~ Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9.
81, 558.61
81,558.61
12,248.73
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10.
11. Total Deductions (total Lines 9 & 10) .................................. . 11.4 12,248.73
12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 69,309.88 ',
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which _~..w...~ -....M.~.,._....-.-...~_~.,._.
an election to tax has not been made (Schedule J) ....................... . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 69,309.88
TAX COMPUTATION -SEE-INSTRUCTIONS FOR APPLICABLE RATES .
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
17. Amount of Line 14 taxable i ~~
309.88 i
69
17
8,317.19
,
at sibling rate x .12 N ~~ .^.._ ...~_
~ . ; ~_~^ ~~µ~ _ ~
18. Amount of Line 14 taxable ~
at collateral rate X .15 18.
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
8,317.19
15056052059 Side 2
15056052059
EV-1500 EX Paae 3
File Number
)ecedent's Complete Address:
~....
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
Clair C Byers 198-28-679~i
STREET ADDRESS
6 East Main Street
CITY
Mechanicsburg STATE
PA ZIP
17055-6230
'ax Payments and Credits:
Tax Due (Page 2 Line 19) (1) 8,317.19
Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 415.86
Total Credits (A + B + C) (2) 7,901.33
Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (D + E) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7, 901.33
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 7,901.33
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 : ............................................ ^
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
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? ........................................................................................................................ ^ ^x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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~r 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
three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
~r 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
2 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
ing a tax return are still applicable even if the surviving spouse is the only beneficiary.
~r dates of death on or after July 1, 2000:
~e 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
ioptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)J.
ie 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
'. P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
ie 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)]. Asibling is defined, under
action 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
,,
s
ESTATE OF FILE NUMBER
Clair C. Byers 21-09-0913
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUEAT DATE
NUMBER DESCRIPTION OF DEATH
Sovereign Bank Account 3484053488 See Attached 81,502.54
Golden Living Center, Patient Account 56.07
_ __
TOTAL (Also enter on line 5, Recapitulation) s 81,558.61
(If more space is needed, insert additional sheets of the same size)
'1
EV-1511 EX+(t2-99)
SCNEDt~LE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
~:
ESTATE OF FILE NUMBER
Clair C. Byers 21-09-0913
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:...
1 ~ Cocklin Funeral Home 8,154.70
Funeral Luncheon
__ 24.87
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 2,000.00
Name of Personal Representative(s) Jal'YteS C. Byers
Social Security Number(s)IEIN Number of Personal Representative(s) 164-28-0286
street Address 14 Belair Drive
City',Dillsburg State PA Zip 1701.9
Year(s) Commission Paid: 2010
__
2. Attorney Fees 1,600.00
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 181.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
z. .Filing Fee.... _ _ _ _ 15.00
a. Estate Notice, Cumberland Law Journal
__ _ 75.00
9. Estate Notice, Sentinel _ _ 198.16
rnTei /Alsn antar nn lino 9 Reranitulationl I S- 12,248.73
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-OS}
~`-~`~ pennsylvania ~ SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT *~
ESTATE OF FILE NUMBER
Clair C. Byers __ 21-09-0913
ReDOrt debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert admaonai sneers oI me same sae.
REV-.1513 EX+ (11-08)
~"~`~ pennsylvania ~ SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Clair C. B yers 21-09-0913
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 [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. James C. Byers 'Brother Entire Estate
14 Belair Drive, Dillsburg PA 17019
__ _ _ __ _
_
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
__ _ _ __ __
TOTAL OF PART II -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.
LAST WILL AND TESTAMENT
OF
CLAIR C. BYERS
I CLAIR C. BYERS, of the Borough of Mechanicsburg, County of Cumberland and
State of Pennsylvania, being of sound and disposing mind, memory and understanding, do
'hand declare this my Last Will and Testament, hereby revoking and making
make, pubhs
void any and all former Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can be conveniently done.
2.
I give and bequeath all the rest, residue and remainder of my estate, of whatsoever
nature and wheresoever the same may be situate, to my brother, JAMES C. BYERS,
absolutely and unconditionally.
LASTLY, I nominate, constitute and appoint my brother, JAMES C. BYERS,
Executor of this my Last Will and Testament and direct that he be excused from posting
bond or other security for the faithful performance of his duties, in any jurisdiction.
ESS WIIEREOF, I have hereunto set my hand and seal this '7, ,~ day of
IN WITN
~ ~ ~ (SEAL)
June, A. D. 2006. Clair C. Bye
-1-
COMMONWEALTH OF PENNSYLVANIA )
SS
COUNTY OF CUMBERLAND )
I, CLARIR C. BYERS, the testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the same instrument as my Last Will and Testament; that I signed
it willingly, and that I signed it as my free and voluntary act and deed, for the purposes
therein expressed.
(SEAL)
Clair C. Byers
Sworn and subscribed to before
me this 2~ day of June, 2006.
Notary Public
COMMONWEALTH OF PENN'
HEIDI M. NEL ON, Notary Pubik
- My Comm ~o ~' Cumberland Co.
Expires ]une 27, 2007
~YLVANIA )
SS
COUNTY OF CUMBERLAND )
We, the undersigned, J. ROBERT STAUFFER and JOHN M. EARN, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testator,
CLAIR C. BYERS, sign and execute the instrument as his Last Will and Testament; that
the said testator executed it as his free and voluntary act for the purposes therein expressed;
that each of us, in the hearing and sight of the testator, signed the Will as witnesses; and that,
to the best of our knowledge, the testato as, at the time, eighteen (18) or more years of
age, of sound mind, and under no co s un ''~fluenc .
Sworn and subscribed to before
me this 7~ day of June, 2006.
Notary Public
HQDI M. NELSON, Notary Public ' 2
Mechanksburg 8or+o, Cumberland Co.
My Commission Expires one 27, 2007