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Home My WebLink About07-21-101505610149 EX (01-10) REV-1500 ~ OFFICIAL USE ONLY pe~dnwlarinia PA Departmentof Revenue °m""'""'T°'""1Q""Q County Code Year Fila Number Bureau of Individual Texas INHERITANCE TAX RETURN Po sox asoeoi Harris burp, PA 17128-0801 RESIDENT DECEDENT 21 0 9 116 4 ENTER DEt~QENT INFORMATION-BELOW Social Security Number date of Death MMDDYYYY Date of Birth MMDDYYYY 282 48 4027 12 02 2009 09 21 1958 Decedent's Last Name Suffix Decedent's First Name MI Moore Stephen W (it Appiic~le) Enter Surviving Spouse's Infomtatlon Below Spouse's Last Name Suffix Spouse's Frst Name MI Moore Susan C Spouse's Social Security Number THIS RETURN MUST BE FILED IN DURI.ICATE WITH THE 19 8 5 4 6 0 5 7 REGISTER CAF V~ILLS FILL IN APPfI~PRiATE OVALS BELOW f• 1. Original Return C~ 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) p 4. Umited Estate t~ 4a Firture Interest Compromise (date of L~ 5. Federal Estate Tax Return Required death after 12-12-82) C~ 6. Decedent Died Testate l~ 7. Decedent Maintained a Uving Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death C7 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - This sectlon must be completlxL Ail Correspondence and Confldential Tax IntonYaltlon Should be Directed ta: Name Daytime Telephone Number Elyse E• R~og~rs, Esquire 717 612 5801 First line of address 635 N• 12th Street, Suite 400 Second line of address Qty or Post Office State ZIP Code Lemoyne PA 17043 REGISTER OF WILLS USE ONLY t~ ~ 4 ~ r~ ~ C T ~w r ,., ~ rn ~~ ~ ~ ~:; (". "3 -~^ D~t9~ ~" ~ _ { ~vt ,:_-, k ~.,- C-- . ;~ `'.: _:~ rm .~ .. ,,-._.. r°r-f .~~- ~ Cornespondent's a-mail address: erogers('p~keefel~nrood.com , Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the boat of my knowledge and belief, it is true, correct and complete. Declaration of the preparer other than personal representative is based on all information of which preparer has any knowledge. SIGNATUREOFP SON RESPONSIBLE FOR FILING RETURN ,, ~ ~ DATA Side 1 1505610149 1505610149 PLEASE USE ORIQINAL FORM ONLY 1505610249 Rev-1500 IX Decedent's Social Security Number 2 8 2 4 8 4 0 2? Decedent's Name: Stephen W. Moore RECAPITULATION 0 • 0 0 1. Real estate (Schedule A) • • • • • • • • • • ............................... 1 • 2. Stocks and Bonds (Schedule B) • • • • • ............................... 2• 0 • 0 0 3 8 , 2 9 5.6 6 3. gosely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • • • • • • 3. 4. Mortgages and Notes Receivable (Schedule D) • • • • • • • • • • • • - • • • • • - • • • • • 4. 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule ~ • • • • • • • 5. 6 ,118.5 4 6. Jointly Owned Property (Schedule l7 O Separate Billing Requested • • • • • • 6. 0 ' 0 0 7. Inter-~vos Transfers 8~ Miscellaneous Non-Probate Property 2 2 8 , 6 6 6.8 3 (Schedule G) l~ Separate Billing Requested • • • • • • 7. 8. Total Gross Assets (total tines 1 through 7)..... • . • • . • • • • • .. • • . • • • • • • • • 8. 2 7 3 , 0 81.0 3 2 0 ~ 4 9 9 • ? 4 9. Funeral Expenses and Administrative Costs (Schedule H) • • • • • • • • • • • • • • • • • • 9. 0 • 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) • • • • • • • • • • • • • 10. 11. Total Dsductlons (total Lines 9 and 10) .............................. 11. 2 0 , 4 9 9.7 4 252,581.29 12. Net Value of Estate(Line8minusUnell)•.•••.•••.••••••••••••••••••• 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0 . 0 0 an election to tax has not been made (Schedule J) • • • • • • . • • • • • • • • • • • • • • • • 13. 2 5 2 , 5 81.2 9 1a. Net Value Subject to Tax (Line 12 minus Line 13) .... • .... • . • . • • • • • • • • • • 14. 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.z) x .o0 2 5 2, 5 81.2 9 15• 0.0 0 16. Amount of Une 14 taxable 0' 0 0 0' 0 0 at lineal rate x .045 16, 17. Amount of Line 14 taxable 0.0 0 0 •0 0 at sibling rate X .12 17• 18. Arrwunt of Line 14 taxable 0' 0 0 0' 0 0 at collateral rate X .1 s 18, 0 • 0 0 19. TAX DUE .................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q S{de 2 `„~ 1505610249 1505610249 J Rev-1500 IX Page 3 ~"lerorlont'Q C`~mnle~l~ ecldr~~s~ 0.00 DECEDENTS NAME Ste hen W . Moore STREET ADDRESS 61 Windsor Wa CITY Cam Hill STATE PA ZI P 17011 Tax Payments and Credits: 1. Tax Due (Page 2 lane 19) 2. Credits/Payments A. Prior Payments B. Discount Fle Number 21 09 1164 (1) 0.00 0.00 Total Credits (A + B) (2) 0.00 3. 1 nterest {3) 0.00 4. If lane 2 is greater than line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Fill to oval on Page 2, Llne 20 eo request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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; • • • • • • • • • c. retainareversionaryinterest;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 withoutr+eceivingadequateconsideration? ••••••••••.•••••••••••••••••••••• • ••• 3. Did decedent own an intrust for" orpayable-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 cornainsabeneficiarydesignation? ••••••••••••••••.•••••••••••••••••••••• ••• Q ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS 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 Jan. 1, 1995, the tax rate imposed on the net value of trar~fers to or for the use of the surviving spouse is 3 percent [72 P.S. Sect. 9116(ax1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. Sect. 911 ti(ax1.1 xii)]. The statue 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 21 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 percent [72 P.S. Sect. 9116(ax1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. Sect. 9116(1.2) [72 P.S. Sect. 9116(ax1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. Sect. 9116(ax1.3)]. 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-1508 EX+(a-98) SCHEDULE E COMMONWEALTHOFPENNSnVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCETAxRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FIt.E NUMIBER Stephen W . Moore 21 09 1164 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 Schaduel F. (If more space is needed, insert additional sheets of the same size) REV-1510 EX+(8-98) COMMONWEALTH OF PENNSYLVANIA INH ERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE Nt~ABER Stephen W. Moore 21 09 1164 Thia schadula rnuat b• cornplotad and filed if the anawar to any of quoations 1 through 4 on th• nvra• side of the REV-1500 COVER SH EET is ysa. ITEM NUM r~scRl~noN ol= ~o~ITY INCLUDENAMEOFTRANSFEREE,RELATIONSHIPTODECEDENT& DATE OFTRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OFDEC'S INTEREST E)CCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 Vanguard 1RA Account Number 0540- 228,666.83 100 228,666.83 09909464667 2,227.419 shares of 500 Index Fund Adm Beneficiary: Decedent's surviving spouse, Susan C. Moore TOTAL (Also enter on line 7, Recapitulation) ~ 228,666.83 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-09) t'll'~~V811~a O£PARTH~NT DF R£Y~ti1iE INHERITANCE TAX RETURN AESIDENTDECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Stephen W . Moore 21 09 1164 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1 Myers-Hamer Funeral Home, Inc. 9,118.00 B. ADMINISTRATIVE COSTS: ~. Personal Representative Commissions: 4,500.00 Name(s) of Personal Representative(s~-~'1n M. McKinney Street Address 8 Honeysuckle Drive city Mechanicsburg State PA zip 17050 Year(s) Commission Paid: 2010 2. Attorney Fees 3,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 aaimarlt Susan C. Moore Street Address 61 Windsor Way city Cam Hill State PA zip 17011 Relationship of Claimant to Decedent Surviving Spouse a. Probate Fees: 70.50 5. Accountant Fees 6. Tax Return Preparer Fees: 7 The Sentinel, legal advertising 166.30 8 Cumberland Law Journal, legal advertising 75.00 9 Lynn McKinney, reimbursement for out of pocket expenses 54.66 10 Keefer Wood Allen & Rahal, LLP, out of pocket expenses 15.28 TOTAL (Also enter on Line 9, Recapitulation) 20,499.74 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+(01-10) pr~nr~v~lnia SCHEDULE J OERARTMENT OF REVENUE INHERITANCETAx RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Stephen W . Moore 21 09 1164 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBE NlAME AND ADDRESS OFPERSON S RECEIVING PROPERTY Do Not Ust Tru OF ESTATE z TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2).] Susan C. Moore Surviving spouse 252,581.29 61 W indsor W ay Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 180E REV-1500 COVER SHEET, AS APPROPRIATE. zz NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART it -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same size. '~ETRO BANK 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 December 22, 2009 Keefer, Wood, Allen & Rahal, l_l_P. Attn: Elyse E. Rogers 635 N. 12`h St Suite 400 Lemoyne, PA 17043 RE: Estate of: Stephen W. Moore Tax Identification Number: 282-48-4027 Date of Death: December 2, 2009 To Whom It May Concern: This fetter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 512083726 Date Opened: 12/28/1994 Primary Owner: Stephen W. Moore Date of Death Balance: $6118.54 Account Type: Checking Account Number: 512096132 Date Opened: 07/22/1996 Primary Owner: Stephen W. Moore Secondary Owner: Susan C. Moore Date of Death Balance: $69684.70 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, Diana Reynolds Metro Bank Research Associate/Deposit Services v~~a• January 29, 2010 ELYSE E ROGERS KEEPER WOOD ALLEN & RAHAL LLP 635 N 12TH ST STE 400 LEMOYNE PA 17043 Re: Estate of Stephen W. Moore Dear Ms. Rogers: P.O. Box 2600 Valley Forge, PA 19482-2600 www.vanguard.com We are responding to the letter we received requesting a valuation of S#ephen W. Moore's Vanguard account on December 2, 2009. The information requested is included on the enclosed account value report. if you have any questions about a transfer or a transition of assets, please call us at 888-237-9045. Specialists are available on business days from 8 a.m. to 8 p.m., Eastern time. Sincerely, 1. . ` ~~ Ry Sikora Transition Team Enclosure(s): **Stephen W. Moore Account Value Report 51394953 .... ;~ _ . E~ U~s~r !~: l~~P'S . ,. Stephen W. Moore 61 Windsor Way Camp Hill, PA 17011-1754 Page > 1 of 1 Y ~ . 1~ai'~g~at'd Client Services: 800-662-2739 Total report value: $228,666.83 (Total report value includes any accrued dividends.) .. ~. ... . .. Name FunN&nAccount Date ~ ~ ' ~' Pr1ce~Per ~ Accrued ber -Opened ~ Shares Share ~ Value* Dividends 500 Index Fund Adm 0540-09909464667 09/21/2005 2,227.419 $102.66 $228,666.83 - ., _ ~: . ... Totals , X228;668.83 $0:00 ,, .. _ Doesn't include accrued dividends. 1733218659 01 /29/2010 16:15:26 jr~~ KEEPER WOOD ALLEN &RAHAL, LLP RO®ERT L. wELDON ATTORNEYS AT LAW ESTABLISHED IN 1679 EU®ENE E. PEPINSKY, JR. 63°5 NORTH 12TM STREET. SUITE 400 JOHN H. ENOS ~ PA 17043 LEMOYNE OF COUNSEL: , GARY E. FRENCH N. DAVID RAHAL BRADFORD OORRANCE JEFFREY S. STOKES PHONE 717-612-5800 SAMUEL C. HARRY CHARLES W. RU9ENDALL 3 RO®ERT R. CHURCH FAX 717-612-05805 STEPHEN L. GROSE HARRIS®URG OFFICE: R. SCOTT SHEARER EIN NO. 23-0716135 2K) WALNUT STREET ELYSE E. ROGERS www.keefsrvvood.com HARRIS®URii, PA 17101 CRAIC3 A. LONC+iYEAR JOHN A. FEICHTEL J l 20 2010 PHONE 717-2lS5-6000 u STEPHANIE KLEINFELTER Y ~ DONALD M. LEW18 ~ TODD F. TRUNT2 Q 717-612-5001 LAUREN S. WELDON eroger8@keeferwood.com Register of Wills of Cumberland County One Courthouse Square Carlisle, PA 17013 ~ ~ .,~ ~~ Re: Estate of Stephen W. Moore F.~~ c File No 2009-01164 ~ A~ '~" ---- ~-` ~~ . : ~ Dear Madam: ~4 ~ ~~ ~- _ _ It~ ~ ~ ' R~ _~~ j ~y ~~ Enclosed herewith please find the following: =~ .~. ~:;•~a c ,~- 1. Pennsylvania Inheritance Tax Return (in duplicate); 2. Inventory; and 3. Check in the amount of $30 representing your filing fees. Schedule C has been filed directly with the Department of Revenue. Kindly stamp the enclosed extra copy of this letter and return it in the envelope provided. car Enclosures cc: Lynn M. McKinney Sincerely yours, lyre .Rogers Q OI ~ t~n 4 `~+ ~ ~ ~ ~ ~ p ry a_ `` ~} c .. 0 0 ~. ~v ~ d p ~ ^ ._ • = c - _._ _ ~. ~~ I i` ~~~ ~~ .~~.. 21 ` p~ Iii ~' ~~ ~~~~: ~~ .°~ .~ M ~. ..~ ~~ ~~ ~ a ~" ~ ~ "'~ ~ ~' ~ `" ~ ,~ ~ ~ .. c ~" '3 '~ 5~, r ~,~~~ xf ``~+, ~~; ~' -' i '~:``~' „~„. ' ~*~ tt:: 4 S r r 1 3 yy' T~ dr~E+:;r ry i ,,a~ :r, ~ ~Y ' ~' r. F ~~ i~ a ~, ~3 i' '~,; ri ~ r 5~ A+F ~~.