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HomeMy WebLinkAbout11-08-11 (2) 1505611185 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox 2sosof INHERITANCE TAX RETURN 21 11 0 4 56 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 184-26-2788 04062011 06271933 Decedent's Last Name Suffix Decedent's First Name M I MYERS DORIS L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Retum (Date of Death ^ ^ Prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required ® death after 12-12-82) 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.) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK D- HIPP, ESQUIRE ?17-232-5000 First Line of Address 3401 NORTH FRONT STREET Second Line of Address PO BOX 5950 city or Post office HARRISBURG State ZIP Code PA 171100950 ~") ,7 =z .,., c-:; r-r-, O r ,, --~-, Correspondent's e-mail address: M D H I P P a M E T T E• C O M 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. SICiNATURF (1F PFR.C(lnl r~r=conr.~cirai ~ rr,o r.. ~. ~.+ .,r., ..... JOHN E- MYERS, JR- 2794 BACK ROAD JICiNA I URE OF PREPARER OTHER THAN REPRESENTATIVE METTE, EVANS I~ WOODSIDE ALIFAX, PA 17032 //- /- // 3401 N- FRONT STREET, PO BOX 5950 HARRISBURG, PA 17110-0950 PLEASE USE ORIGINAL FORM ONLY 1505611185 OM4647 3.000 Side 1 REGISTER gF~IfILLS USE OI~P ~ O _.__ ~.~ ~ _.._ ~ _ ~ ~ ",' rn ` .,.. - -_ t_,~ -~' co c~ ~-., - v -=rye _ TE FILED 1505611185 ._I~ 1505611285 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name MY RC T DO 184-26-2788 C R RECAPITULATION 1. Real Estate (Schedule A) . •" " " " " " 1. 139,900.00 2. Stocks and Bonds (Schedule B) . . .......... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , , ... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) , ................ a. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) , • 5• 1,606.99 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 , . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 601 ' 17 (Schedule G) ~ Separate Billing Requested 7, 10 , 15 0 • 0 ~ 8. Total Gross Assets (total Lines 1 through 7) , " " " " " " 8. 152,258.16 9. Funeral Expenses and Administrative Costs (Schedule H). . ' ' 9• 18,995.34 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) , ••••....10. 141,125.27 11. Total Deductions (total Lines 9 and 10) , , """""•....11. 160,120.61 12. Net Vatue of Estate (Line 8 minus Line 11) , 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ 12 ~ 7 ~ 8 6 2.4 5 ) an election to tax has not been made (Schedule J) , , ..13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) , ..1a. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE.RATES (7,862.45) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 14 t xable 15. at linealrateX.O 4~ Q • ~ ~ 500 • 00 16. 17. Amount of Line 14 taxable 22 • 50 at sibling rate X .12 0.00 17. 18. Amount of Line 14 taxable 0.00 at collateral rate X .15 0 • ~ ~ 18. 0.00 19. TAX DUE .19. 2 2.5 0 20. FILL IN THE BOX tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX (FI) Page 3 File Numher Total Credits (A + 6) (2) (] • ~ ~ 3. Interest 4. If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. (3) (] 0 ~ Fill in box on Page 2, Line 20 to request a refund. (4) 0 • O 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _.__ 5lJ 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 ^ a 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)]. • 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)]. • 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)]. 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. OM4671 2.000 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2 2 • Jr (] 2. Credits/Payments A. Prior Payments _ 0 ~ ~ B. Discount ~ ~ ~ REV-1502 EX + (Ot-10) Pennsylvania DEPARTAENI'OF REVENUE WHERITANCE TAX RETURN RESQENTDECEDENT ESTATE OF: SCHEDULE A REAL ESTATE FILE NUMBER: Doris L Mvers 21 11 0456 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both hating reasonable knowledge of the relevant facts. Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settk3ment sheet it the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. Real estate situate in the Borough of New Cumberland, Cumberland County, Pennsylvania, numbered as 901 S. 16th Street; further identified as Tax Parcel Number 26-23-0543-170 139,900.00 Gross sales price; see settlement sheet attached TOTAL (Also enter on Line 1 Recapitulation) I S 139, 900 00 swasss 2.00o If more space is needed, use additional sheets of paper of the same size. REV-1508 EX+ (11-10) pennsylvania DEPARThENiOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: _ Doris L. Myers 21 11 0456 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. Final accrued pension benefits 85.05 2 Humana - refund of unearned health insurance premium 495.22 3 Miscellaneous items of personal property 500.00 4 Verizon refund 26 72 5 2010 Property Tax Rebate 500.00 TOTAL (Also enter on line 5, Recapitulation S 1, 606.99 owgsAD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1509 IX+ (Ot-10) ' Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF: FILE NUMBER: Doris L. Myers 21 11 0456 H an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G SI~iVNNG JOM TEMANf(S) htAWE(S) ADDRESS RELATIONSHIP TO DECEDEhli A Myers, Jr., John E 12794 Back Road, Halifax, PA 170 3 Son JOINTLY OWNED PROPERTY: IrEnn NUfuBER LETTER FDR JOMIT TENANT L14TE MODE JOr.TT DESCPoPiION OF PROPERTY uxLUDE Na.E aF FU~NCNLiNSTRUTaNUas~RU,~ccauNr NU,eER ORSnnIAR IDENTSVING MIGBER. ATTACH OEEO FOR JOINfLV HELD REAL ESTATE. Q4TE OF DEATH VALUE OF ASSET ~~ OF pS INT6iEST DATE OF DF11TH VALUE OF ~`T 1 A 10/27/20 9 PNC Bank Checking Account #5006447199; owned jointly with decedent's son, John E. Myers, Jr. 1,202.34 50.0000 601.17 See attached correspondence. NOTE: The joint transfere has used the monies in this joint account toward the payment of administrative expenses and debts of the decedent listed on Schedules Hand I. TOTAL (Also enter on Line 6, Recapitulation) S fi01 . 17 swasAE 2.00o ff more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (OS-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Doris L. Myers 21 11 0456 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCRIP710N OF PROPERTY NICU,pE7~{µy~EpF7FE7RVJ5FEREE,TFEIRREUT10N5F11PTO0ECE0EMMD newTEOFTParsrexATrscHACOwoFn~oEEnPORREALESrcTE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION IFAPPIJCABLE TAXABLE VALUE ~• Transfer made within one year of death. Decedent transferred cash to her son, John E. Myers, Jr., on April 26, 2010. 25,000.00 100.0000 14,850.00 10,150.00 The standard exclusion of $3,000 is claimed. In addition, the transferee made periodic transfers totaling $11,850 from this account to the joint checking account listed on Schedule F between the date of the initial transfer and decedent's death. In turn, these monies were used for the direct support and maintenance of the decedent and her residence. In addition, the transferee has used the remaining monies in this account toward the payment of administrative expenses and debts of the decedent listed on Schedules H and I. 9 W46AF 2.000 TOTAL (Also enter on line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 10,150.00 R6V-1511 EX+(QO-09) Pennsylvania SCHEDULE H DEPARiA~ENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris L. Myers 21 11 0455 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. PREPAID FUNERAL 0.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address Clty State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal Legal advertisement 2 The Sentinel Legal advertisement Total from continuation schedules . TOTAL (Also enter on Line 9 Recapitulation) ~ $ swasnc z.ooo If more space Is needed, use additional sheets of paper of the same size. 6,250.00 349.50 75.00 180.00 12,140.84 995.34 Estate of: Doris L. Myers Schedule H Part 7 (Page 2) 3 Settlement expenses Settlement expenses incurred in sale of decedent's residence, including realtor's commission, realty transfer tax, buyer's assist and additional interest and fees for pay off of 1st and 2nd mortgages, less credit for prorated real estate taxes and municipal utilities; see attached settlement sheet Total (Carry forward to main schedule) 21 11 0456 12,140.84 12,140.84 REV-1512 EX + (12_08) Pennsylvania SCHEDULE I DEPARTNENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDE MORTGAGE LIABILITIES ~ LIENS NT DECEDENT ESTATE OF FILE NUMBER Doris L. Myers 21 11 0456 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• 120,744.07 Par PNC Bank Loan #4001008113863963 120,744.07 Secured by decedent's residence; see attached correspondence 2 6,912.66 Par PNC Bank Loan #4003048113892167 6,912.66 Secured by decedent's residence; see attached correspondence 3 10,636.17 Par Department of Public Welfare Commonwealth of Pennsylvania 10,636.17 Claim for restitution of medical assistance; see attached correspondence 4 Tax Collector, New Cumberland Borough 2011 county/township real estate taxes 699.71 5 Borough of New Cumberland Sewer/Trash Paid from settlement proceeds 102.43 6 Holy Spirit Hospital - medical services 210.44 7 HRC ManorCare of Camp Hill - nursing home services 1,523.10 8 Pennsylvania American Water - water utilities at residence 32.30 9 UGI - gas utilites at residence 49.32 10 West Shore EMS - medical services 215.07 8W46AH 2.000 TOTAL (Also enter on Line 10 Re If more space is needed, insert additional sheets of the same size. .27 REV-1513 EX+ (01-10) pennsylvania DEPARTMENTOF REVENUE INHERRANCETAX RETURN RESIDENT DECEDENT ESTATE OF: SCHEDULE J BENEFICIARIES FILE NUMBER: uvris a,. ers 211 10456 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS Ilnclude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Bradley E. Myers 1726 Cornell Road Camp Hill, PA 17011 Miscellaneous items of personal property Inventory Value: 500.00 Son 500.00 2 John E. Myers, Jr. 2794 Back Road Halifax, PA 17032 Son 0.00 3 John E. Myers, III 21 Cardamon Drive Mechanicsburg, PA 17050 Grandson 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0.00 9W46A1 2.000 """ ° °r°~° " "°°ucu, uac °uuuwna~ aneo~s vi paper v~ cne same s¢e.