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HomeMy WebLinkAbout10-26-10' 1505610145 REV-1500 ~``°'-'°' pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN r ~ i ~ /~ ~ ~ ^ ~j- Harrisburg, PA 17128-0601 RESIDENT DECEDENT (.,_ (r) a ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 178-50-3352 01012010 01161934 Decedent's Last Name Suffix Decedent's First Name MI Myers Alverta J (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 WIITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 0 1. Original Return 0 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate Q 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death after 12-12-82) Ox 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9. Litigation Proceeds Received 0 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 CONFIDENTIAL TAX INFORMATION SHOIJ~LD BE DIRECTED TO: Name Daytime Telephone Numb r. __ r^ .; ROBERT G. FREY 7172435838 ~"=^~ ~-~ First line of address 5 SOUTH HANOVER STREET Second line of address City or Post Office State ZIP Code CARLISLE PA 17013 Correspondent's a-mail address: rf rey@f reyt i ley . com Under penalties of perjury, I declare that I ha a examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true correct a m lete. Declaration arer other than the nal se alive 's ased on all information of which re aver has an knowledge. SIGNATUR F PERSON RESP LE FOR FILING RET DAT ADDRESS . 431 DIEHL ROAD, MECHANCISBURG, PA 17055 SIGNAT OF PR ARE~TRER~'HAN RAP ESENTATIVE DATE ADDRESS ' 5 SOUTH HANOVER STREET, A LISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610145 n'' 1505610145 J J REV-1500 EX 1505610245 Decedent's Social Security Number Decedent's Name: Alverta J Myers 178-50-3352 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. NONE 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ...... 5. 2 5 2 8 . O O 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ........ 6. NONE 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ........ 7 NONE 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 5 2 8 . 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 110 2 . 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... . . . 10. 5 0 0 8 . 0 0 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 611 O . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. - 3 5 8 2 . 0 O 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. . ... . 13. 0 . O 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... 14. - 3 5 8 2 . O O TAX CALCULATION -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 .0 O 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. O. 0 0 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 0 0 19. TAX DUE ...................................................... .19. 0 . O O 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610245 1505610245 J REV-1500 EX Page 3 File Number 178-50-3352 Decedent's Complete Address: 21-10-0087 DECEDENT'S NAME Alverta J M ers STREET ADDRESS 31 Diehl Road CITY STATE Z:IP Mechanicsbur PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in 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. (3) (4) (5) 0.00 0.00 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: Yeas No a. retain the use or income of the property transferred : ............................................................................. C~ ~^ b. retain the right to designate who shall use the property transferred or its income : ................................ r~~ ©~ c. retain a reversionary interest; or ............................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? .......................................................... C~ ~r 2. If death occurred after Dec. 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? .... C] 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 AND FILE IT ~-S 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 transfers to or for tF~e use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (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. §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 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. §9116(x)(1.2)]. • 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, excerpt as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(x)(1)]. • 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. §9116(x)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1) 0.00 Total Credits (A + B) (2) REV-1508 Ex+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Alverta J Myers 21-10-0087 Include the proceeds of litigation and the date the proceeds were received by the estate. (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES AND Anllllll-IICTRATIV~ It'_C1STS ESTATE OF FILE NUMBER Alverta J Myers Decedent`s debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Persona{ Representative Commissions: Name(s) of Personal Representative(s) Robert H. Otto/Dean W. Otto Street Address 431 Diehl Ave/5 Mooreland Ave city Mechanicsburg/Mt. HoNy Springs state PA zIP Year(s) Commission Paid: 2010 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address __ 4. 5. 6. 7. City State ZIP _ Relationship of Claimant to Decedent - Probate Fees: Accountant Fees: Tax Return Preparer Fees: 500 500 102 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 1,102 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Alverta J Myers Report 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 additional sheets of the same size. LAST WILL, AND TESTAMENT' OF ALVERTA JANE MYERS I, ALVERTA JANE MYERS of One West Penn Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all Wills by me at any time heretofore made. 1, I direct my hereinafter-named Executors to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I direct that my funeral services be conducted by Hollinger Funeral Home, Mount Holly Springs, Pennsylvania in accordance with arrangements which have already been made there, and that my body be interred on the burial lot of my parents, David H. Myers and Mary A. Myers in Westminster Cemetery located in North Middleton Township near the Borough of Carlisle, Pennsylvania. 2. I direct that all inheritance, transfer, succession, estate and death taxes, including interest and penalties thereon, which may be payable on account of my death shall be payable from the residue of my estate regardless of whether the assets upon which such taxes are based are included in my probate estate. ~ 3. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath as follows: (a) 10% thereof to the official Board of 1VIt. Holly Springs United Methodist Church, 202 West Butler Street, Mt. Holly Springs, PA 17065, to be used for such purpose or purposes as the official Board of said Church shall deem best. (b} The remaining 90% thereof I give, devise and bequeath in equal shares to such of the following named ten (10) nephews and niece who shall survive me by a period of ninety (90) days, but should any of them fail to so survive me then the share which such deceased f person would have received shall lapse and be added to the shares of } those so surviving, my ten (10) nephews and niece being the following: DEAN W, OTTO, ROBERT H. OTTO, LELONNIA STAMM, CHARLES GITT, JR., TYRONE GITT, KIRK GITT, PAUL ALAN MYERS, LEE HARPER MYERS, GLENN EBER MYERS, and DAVID RALPH MYERS, SR. ' 4. I hereby nominate, constitute and appoint my two nephews, DEAN W, OTTO and '` ROBERT H. OTTO, or either of them, as Executors of this my Last Will and Testament, and I l further direct that neither of them shall be required to post any bond to secure the faithful `, performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. j IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and 't'estament written on three (3) pages, this ~~ may of G-r-~.~~ , 2006. i -~~,-~-~..~ (SEAL) ALVERTA JA E MYF,RS Signed, sealed, published, and declared by ALVERTA JANE M~'ERS the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Page) of 1 ~' ~~ Total Banking Statement ~PNCBANK For the period 112/22/2008 to 01/21/2010 For 24-hour information, sign on to PNC Bank Online Banking ALVERTA JANE 1~1YERS on pnacom. Primary account number: 51-4040-2629 Page3of4 Now is the time to contribute to your IRA. Making the maximum IRA contribution, (up to $5,000 or $6,000 if you, are age 50 or over), is a great way to achieve the retirement you want. Be sure to act before you file your i:axes if you are making a tax-deductible contribution for 2009. Income limits apply. Please consult your tax advisor for further information. Senior Checking Plan - _ Alverta Jane Myers Regular Checking Account Summary _ . _ _. Account number: 51-4040-2629 _ _ . _ ... .... _ _. . Overdraft Protection Provided By: Contact PNC to establish Overdraft Protection - - - - - Balance Summary _ _ Beginning Deposits and Checks and other Ending balance other additions ...deductions balance _ ...... _. _ _. 1,521.26 721.40 _ 248.88 _ 1,993.78 _. _ . ..... ......_ ._.. Average monthly. Charges ....balance _ and fees _ __ ..... _ .. .. _ _ ...1,875.27_ _ -.00 _ _ _ _ .._ _ .. ~ ___ Transaction Summary _ _ _ ~ _ _ ._._._ _ _. _ . _.... _ _ _ __.......__ .._._~ _. Checks paid! .........Check Card POS _`Check'Card/Bankcard° . _ .. .,_ ,. .., . .. ..... . ........... .. _........_ __............ withdrawals. signed-transactions. - POS PIN-transactions_ _ ....~. ....... ...__..._ ..................... _.... 5 0 _ 0 -. __... _ _ _ _ _ .. ~ ..._... _ . _. Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions - - - 0 0 0 Actiirrity Detail _ _ _ _ _ .. _ ....... ..._ . ~.._ _ _._...._ _....._ _ ..__._ .. Deposits and Other. Additions _ There,were 3 Deposits and Other.Additions .Date Amount Description _ totaling $7Z1 A0 .... .. 12/31 560.00 Direct Deposit-- Soc Sec - _ . .... .. .. .. ....~. _ _. _ _ .__ _ __ US Treasury 303 XXXXX3420C1 SSA _ .._ _ 12/31 134.00 ...Direct Deposit - Supp-Sec _ _ _ . __ _ . ~ _ _ _ _.. _ .... __._ _...... US Treasury 310 XXXXX3352 ~ .. _... .. _.. ..._.__. __. . . 12/31.. .27.40 Direct Deposit - Dpwbenefit _ .. ....~. ... _ _ _ . _ . _._. __.... _.~ _..._..._.._. .. _ .. _ . Comm Of PA Ssp XXXXXX352=Ssp00 _ ... .. .......... _ .. .... _. . _ _ . .. _ .w_.. _ ....._.._~._ ....... _.. Checks and Substitute Checks _ _ _ ~ _.__ .. ..._. _ _ _ _._ _____ Check Date Reference .number Amount paid number...... __. Check ~ number ..... _ Date Reference Amow~t _,. paid. .............number _..._ 2063 68.00 12/.31 _os431a1o9 2068 * 60.00 01/04 085222712 .....2070. _ _ 2071 .... 65.00 _. _12/30 osss7s29$ 34 47 01/ 15 5 5961 2069 3.34 01/04 os5222711 ... . . _ _ . 256 * Gap in check sequence There were 5 checks listed totaling $230.81. Online and Electronic Banking Deductions There was 1 Online or Electronic Banking Date Amount Description __ Deduction totaling $18.07: 1/24 18.07 Payment,E-Check Bill Pymt Embarq 2067 _.. Daily Balance Detail Date Balance Date Balance Date 12/22 1,521.26 12/30 1,438.19 01/04 Balance 2 028 25 12/24 1,503.19 12/31 2,091.59 01/ 15 , . 1,993:78 _ _ FORM953R-0709 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 January 29, 2010 FREY & TILEY ROBERT G FREY ESQUIRE 5 SOUTH HANOVER STREET CARLISLE PA 17013 Re: Alverta Myers CIS #: 170104261 SSN: ###-##-3352 Date of Death: 01/01/2010 Dear Attorney Frey: Please be advised that the Department of Public Welfare mainta~_ns a claim in the amount of $5,008.11 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is'the Department's itemized statement of claim. A portion of this medical expense, namely $.00, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $5,008.11, is to ,be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether th.e Commonwealth's claim is admitted and when payment may be expected. If the ,. ~- he est~te accQUntin ~~~ a~~~?~___~:t!- estateata uw,M' ~ii~ .. P~-}3 T . ~3 .ii ]E sAre~l' anc~ ~a Curren appraise ', ~ €-~~ -~ e.. Sincerely, r ~ r ~. ~~.~... Barbara E. Witmer Claims Investigation Agent 717-772-6611 717-772-6553 FAX Enclosure