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Home My WebLink About07-27-11~ 1505610105 REV-1500 EX (oz-ii) (FI) 1 ~ iii OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Cou Code Year File Number ULNNNLMFNi 01~ HEVENUF Bureau of Individual Taxes PO BOX 280601 ~. ~.. I INHERITANCE TAX RETURN ~ /, ~ ~~ (1 Harrisburg, PA 1128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDWYY 164-56-5670 12/ 14/2010 02/10/1922 Decedent's Last Name Suffix Decedent's First Name MI Myers Pauline 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 Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) Name Daytime Telephon~umber w :~~ C ~ ~ (717) 834-5701~~ r-rt r] ~~; ,, ~~ ramer R. Scott .~. f,, . . ~ _.,._ =. F ' REGISTER Q-~ 6NSE O~ '` ~ .1 ; `'' First Line of Address ~~'T'I ""'~; ; 7 .-- ~~- . ~ ! . ~ ~_ . - '> P.O. Box 159 _ _~~ ~ ,-~ t'n ~~ a Second Line of Address State ZIP Code t- G~,TE FILED City or Post Office Duncannon PA .17020 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA U E OF PERSON RESPONSIBLE FOR FILING RETURN DATE SIGNATU REPRESENTATIVE G~0 L 1505610105 1505610105 PLEASE iJSE ORIGINAL FORM ONLY Side 1 REV-1500 EX (FI) Page 3 np~pc~Pnt's Complete Address: File Number Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. CreditslPayments A. Prior Payments __..... _...._..__.... _._...___........_..__._ ................._._......___----............_......... B. Discount Total Credits (A + B) (2) 3. Interest (3) 4. 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) 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. retain a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 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? .............. ^ 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 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 transfers to or for the 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(a)(1.2)J. • 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. §9116(a)(1)J. 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(a)(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. 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: Pauline M. Myers 164-56-5670 RECAPITULATION 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. 9 9 ( ) ........................... Mort a es and Notes Receivable Schedule D 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 8,204.73 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. ( g ) ............................. Total Gross Assets total Lines 1 throw h 7 8. 8,204.73 9. Funeral Expenses and Administrative Costs (Schedule H) ........... ........ 9. 8,726.56 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ....... ........ 10. 159,665.11 11. Total Deductions (total Lines 9 and 10) ......................... ........ 11. 12. Net Value of Estate (Line 8 minus Line 11) ...................... ........ 12. 0.00 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. 0.00 TAX CALCULATION -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 at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 0.00 19. TAX DUE ................................................... ......19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVE RPAYMENT O Side 2 1505610205 1505610205 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Estate of Pauline M. Myers _ No. - 2011-00357 All propertyjointly-owned with Right of Survivorshiu must be disclosed on Schedule F.) ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Bank Accounts First National Bank of Marysville P.O. Box B Marysville, PA 17053 (Bank letter attached) Checking - # 435201 DOD accrued interest $ 2,255.00 .00 $ 2,255.00 Checking - # 911372 DOD accrued interest 2. Miscellaneous Manor Care Rebate Checks ( see attachments) $ 2,341.39 .00 $ 2,341.39 $ 3,608.34 TOTAL $ 8,204.73 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Estate of Pauline M. Myers No. - 201:1-00357 Debts of decedent must be reported on Schedule I ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Ronald C L Smith Funeral Home $ 8,500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commission - Name of Personal Representative (s) - Social Security Number(s) /EIN Number of Personal Representative(s) Address: 2. ATTORNEY FEES - $ 3. FAMILY EXEMPTION: (If decedent's address is not the same as claimant's, attach explanation) Claimant - Street Address - City - State Zip - 4. Register of Wills -Probate Fee $ 81.50 5. Carlisle Sentinel -Estate notice $ 145.06 so enter on me ecap~tu anon ~ 8,726.56 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Estate of Pauline M. Myers No. - 201.1-00357 ITEM DESCRIPTION AMOUNT Commonwealth of Pennsylvania Department of Public Welfare (see attached letter) $ 159,665.11 TOTAL (Also enter on line 10 Recapitulation) ~ 159.665.11 (If more space is needed, insert additional sheers of same size.) lung 24, 2011 MAIN OFFICE One Centre Square • P.O. Box B • Marysville, PA 17053 • Phone: 717-957-2196 • Fax: 717-957-4578 R Scott Cramer 5 S Market St PO Box 159 Duncannon PA 17020 RE: Estate of Pauline M Myers DOD: 12-14-10 Here is the information you requested per you letter dated: 6-23-11. Checking 435201 Checking 911372 Pauline M Myers Pauline M Myers Gary L Myers, Rep Payee Open: 6-26-95 Open: 6-16-08 Int Rate: .10% Int Rate: 0% DOD Bal: $2,341.39 DOD Bal: $2,255.00 DOD Int: .00 DOD Int: .00 need $2,500 to earn interest No interest earned for 2010 on either account. Sincerely, ]~,, ~'_JJ(Z v v"f Barbara Recher, Manager First National Bank of Marysville ~ ~ .._. ~ ~_ .` ' ~ • S2U32~ }.. ~~. t s n K ~, . ~' ' a ~ A ~ e ~~Y tp `~` s ~ i °_ ~ i J~ ~` r r ~ t} 3!~ ~ "r t 1 :s ~`a~t',~~', ~,~~r~.:kt 'r~ +4w ~, -~~~` «i ~ ~ ~' ~ ~ t r, t •+ ' ?r. m._ .n- o >s : -~ t t Y ~ } ~ ~y i%i ~ ,F' 4 : £ ~ ?'fie x?~~~"` y i ,... y 7 s. s r - .~4 f '4 _ }.• er:~ ...~. .~.,k~~, ..~~1!-~~~'~': * cY.''wsas . .~'R...i ...,, o. .y .. .. ~ ~! ~'~r l .~y4'Lry~4~~??.//,,i~ rN"k"~.: ;. + a ', ' , REMOVE DOCUMENT ALONG THIS PERFORATION Resident Trust Transaction Receipt O l /25/2011 11:05 AM Transaction #: 38105 .. . . Resident Name Pauline Myers Medical Record # 27110 Transaction: O 1/25/20 11 11:03 AM Withdrawal: $3,321.65 Current Balance: 0.00 The Managing Trustees HCR ManorC Check #: 3707 Resident Personal Trust Fund 5th floo Authorized Signature: f~~y .~~ ..~~ ~'`/~(.~'1l'~~t~.. Description: If Signed by marking "X" Obtain Two Witness Signatures final payout Witness: s~c~n cr~1, rc~tw~~n ~~~5 Ali, ~ RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt. Date: 3/18/2011 Cumberland County - Register Of Wills Receipt Time: 13:58:45 One Courthouse Square Receipt. No.: 1064850 Carlisle, PA 17613 MYERS PAULINA Estate File No.: 2011-00357 Paid By Remarks: PAULINE M MYERS CJ ------------------------ Receipt Distribution ----- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 30.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 8.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN ---- Cash ------------ $81.50 Total Received......... $81.50 LAST WILL A1vU TESTAMENT GF PAULTNE M. MYERS I, PAULINE M. r,YERS, of Fenn Township, Ferry Cour_ty, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last v~ill and,Testament, hereby revoking any and all Wills by me heretofore made. FIP.ST: I direct payment of all my just and lawful debts, including any mortgage or lien on my real estate or any lien or encl;a~brar,ce or pledge on any item of personalty, as well as the expenses of my last illness, funeral and burial casts from my Estate as scon after my death as conveniently may be done. All Federal, State anal other death taxes payable because of my death, with respect to the property forming my gross Estate for tax pl:rposes, whether or not gassing under this N'ill, including any interest or penalty impcsed in connection with such tax, shall be considered a part of the administration of my Estate and shall be Faid from my residuary Estate without = apportionment or right to reimbursement. SECOND: I give and bequeath my automobiles and personal effects, such as furniture and household goods, if any_, as may be my individual property and nat the property of my spouse, Glenn F. Myers a/k/a Glenn F. Myers, Sr., or owned jointly by me with my spouse, Glenn F. Myers a/k/a Glenn F. Myers, Sr., and other tangible personalty of like nature, not including cash or securities, together. with any existing insurance, to my spouse, Glenn F. Myers a/k/a Glenn F. Myers, Sr, provided my spouse shall survive me by sixty (603 days. THIRD: All the rest, residue and remainder cf my estate, whether real, personal or mixed, of which I shall die seized and possessed, and to which I may be entitled at the time of my decease, and wheresoever the same may be situate, I give, devise and bequeath unto a:y spouse, Glern F. Myers a/k/a Glenn F. b;yers, Sr., provided my spouse shall survive me by sixty (60) days, FOURTH: In the event my spouse fails to survive me , they. ALLEN E. NENCM Attorney at Law 2Z7 Walnut Street Newport, h. 17074 Si7.31 ~! A. I give, devise and bequeath my automobiles and personal effects, such as furniture and household goods, to be divided in equal shares among the following: r-, Gler_n F. Myers, Jr. _% Gary L. Myers _ -~ '~ --. Connie J. Hoffman __ Ray D. Richmond _-~ ~ _ Kathy S. Hummel :~. ` B. I direct that my real estate~be sold' ana;-:._. the proceeds therefrom be c.ivided into fitie equal shares an,or.6 tY:e ber•eficiaries listEd ire Paragraph Fourt?n A above. C. All the rest, residue ar_d remainder of my estate, whether real, personal or mixed, and wheresoever situate, I direct be divided into five equal shares among the beneficiaries listed in Paragraph Fourth A above. D. In the event a beneficiary listed in Paragraph Fourth A abcve Ices not survive, I give and bequeath that share to his or her issue, per stirpes. FIFTH: In additicn to all powers granted to him by Iaw, I gire my Executor, hereunder, the following powers, which may be exercised without leave of court: A. To retain and to invest in all forms of real and personal property; B. To compromise claims and to abandon any property which is of little or no value, if deemed appropriate to my Executor; C. To sell a~t private sale, to exchange, or to lease for any period of time, any real ar personal property, or interest therein, and to give cption for sales or leases, and to give a good deed of conveyance or bill of sale for the transfer thereof; D. To allocate any property received or charge incurred to principal or income or partly tc each, without being obliged to apply the usual zules of Trust accounting; , E. To distribute in cash or in kind (according to the fair market value prevailing at the time of distribution? or partly in each. SIXTH: I nominate, constitute and appoint my spouse, Glenn F. Myers a/k/a Glenn F. Myers, Sr., as the Executor of this my Last Will and Testament. In the event my spouse is unable or unwilling to serve, then I nominate, constitute, and appoint Gary L. Myers and Rathy E.. Hummel as co-Executors. SEVENTH: I direct that no fiduciary acting under this Will created therehy shall be required to enter bond . for the faithful performance of duties, in any jurisdiction. IN WITNESS WHEREGF, I, the said FAULINE M. MYERS, have hereunto set my hand and seal, to this my Last Will and Testament, this 22nd day of August, 19851 ^~ ~ ~: '~, ~! ., ;7 j ~ SEAL PAULINE M. MYE&S~' ThE writing contained in this and the preceding sheet o:as signed and. ,sealed by tree shove r.ared, FP_rLINE M. MYERS, ar_d by her published and declared as and. For her the Last,~Will and Testa~ent, in the presence of us, who have hereunto subscribed our nacres as witnesses at l:er request, ALLEN E. HENCH ~ ~ ~r: 'ter _r>rese:tice. Attornsy at Law ~ -_.~ ~~•~` ,~ 227 Wslnut Street ~ ' i ~' ' r Newport, Ps. 17074 ,d _, ~~ , ~ ~ R, , ( . •~. t? ~/, ~ ~w"-'r • ;f _ rt--~'""~=°- -- -= '- -- __- ~--------------- -'' ^- 567-313! - ~, ~ i :_ i i f U HF -~1 ~BI" R FL :AL H~wIE, INC. 31'25 walnut Strec., Harris ; PA 17109 '-' 7) 545-3774 Fax (717) X45-2325 Nathan A. Bitner, Supervisor Graham S. Hetrick, Funeral Director RONALD C. L. SMITH FUNERAL HOME A branch of Hetrick-Bitner Funeral Home, Inc. 325 North High Street, Duncannon, PA 17020 (717) 834-4515 Fax (717) 834-9287 Timothy A. Hobbs, Supervisor Ronald C. L. Smith, Funeral Director ^ JESSE H. GEIGLE FUNERAL HOME, INC. 2100 Linglestown Road, Harrisburg, PA 17110 (717) 652-7701 Fax (717) 652-2405 Vaughn Miller, Supervisor Funeral Expense Agreement This is an explanation of charges as -well as a sales agreement presented in accordance with the regulations of the Pty. State Board of Funeral Directors. -STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you Selected or are required. If we are required by law or by a cemetery or crematory to, use any items, we will explain the reasons in writing below. If you selected a funeral which may require embalming, such as a funeral with a viewing, you may have to pay. for embalming. You do not have to pay for embalming you did not approve, if you selected arrangements such as direct cremation or immediate burial. If we charge for embalming we will explain why below. Legal, cemetery, cremator or other requirements compelling the purchase of any items listed below: Reason for Embalming w,~. ~:..t. ~~ ~ ~ .., ~ -~ f. ~ ~~ ~ l Funeral Services for ~r-~ i, ~,~ ~` {~1 ~ ~ ~' ~ ~ Date of Death_~ ~ - ~ `~ ~ ~~ ~.~ r ~r' Date of Service ~ ~ - ~ ~~° ~~, GOODS AND SERVICES SELECTED TYPE OF SERVICE AUTHORIZED TO BE PROVIDED Prayer Cards .............................. $ ^ Traditional Full Service ^ Viewing day of Service Crucifix .............................. .. $ 0 Graveside service only ^ No Viewing Temporary Grave Marker .................. $ ^ Cremation ^ Immediate Disposition Memorial Board 1Zental .... .............. $ ^ Public Viewing ^ Anatomical Gift Casket Rental ............................. $ T ^ Private Family Viewing ^ Memorial Service Clothing .................................. $ ^ Evening Viewing ^ Shipping Service Flag Case ................................. $ 0 Receiving Service Other $ A. Package Arrangement Total of Merchandise Selected (C}..... . D. Special Charges $ Forwarding Remains to B. Chaige for Services Selected: $ 1. 7.'ROFESSIONAL SERVICES Basic Services Fee ..................... $ l ~ ~~ ' ~, ), Receiving Remains from $ Embalming ......:....:..... ........ $ ~ ~} Immediate Burial....................... .. $ t - ° - Cremation ............................ $ Equipment Rental ......................... , ~, $ Other Preparation of Body ~.-- $ (~`~ ~ Direct Cremation .......................... $ ` ~ Total of Special Charges (D) ................... $ ~~/ Transfer of Remains to Funeral Home ... $~(~N 1 Sub Total of Professional Services (B1) ..... $ ~ ~~} E. Cash Advances ~~ ,~ ~ Opening of Grave ......'~. ~ ................ ,~~,,, '~ $ 2. ADDITIONAL SERVICES AND FACILITIES Visitation ............................. $ 2.'? -Sy ~ 1 Cemetery Equipment . ..... .......... Clergy / M s Offering .~ t` ~.: ..~........... $ $ $ S L~ ~ i F l S ~' ~ Flowers ~ ~ ~ $ ~- , ce ........................ erv unera ~ . . ............ ...... . : , " $ Memorial Service....... ............. Hairdresser................_--- Q ~ t l T1•~VPC1r~P Ccr~~+.•^ ` _. i, a3n3ao~ ~~° ~. - . r ~ ,_ J ~'., k a3n3a0a t { r ~~.~ j F ~ ~. ~ j ~ f_1`~ -} 6 ~~ y r~ ~ ¢I ~ ', ~~r= k ~ U ~11L • t 4 ~``' Q~ U 7 ,,W^ VI '~' 1 '1"~ W U ~ M !l~~CTO ~ ~ ~ ~ ~ ~ ~ e~- 3U ~ ~ ~+ o a ~"1 ~ M W M ~ ~ U -~ •~ ..Q ~ b~ ~ N ~ ~UOU a3„3aoj ~~