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HomeMy WebLinkAbout03-23-12•, Lsa56~oa~~l~ REV-1500 Ex(°'-'°' PA De artment of Revenue y OFFICIAL USE ONLY p penns Ivania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.28osot {NHERITANCE TAX RETURN 21 11 00728 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 179 10 3913 04 23 2011 O1 12 1.914 Decedent's Last Name Suffix Decedent's First Name MI MYERS RUTH N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number ?HIS RETI!!?N MUST EE F!! ED iN QtIpLlvA?E M!!TH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS 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 ~ 5. Federal Estate Tax Retum Required (date otdeath af t er 12-12-82) g Decedent Died Testate W ll ~ a ~ 7• (qna ch Copy of Trusf a Living Trust ~ 8. Total Number of Safe Deposit Boxes ) (Attach Copy of i ) 9. Litigation Proceeds Received ~ 4 rty C 1 ~• between 14 3191 andrt fdatge5~f death ~ 11, Election to tax under Sec. 9113(A) 1 i (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOHN JAMES MOONEY III 717 632 4656 First line of address 230 YORK STREET Second line of address City or Post Office HANOVER State ZIP Code PA 17335 REGISTER OF WI~,.~S USE ONL`Y.; ~Q w~:~ s. ~~~ .x~ DATE FtL~? -- , <_:`; ~~ _~:r t~ r~ ~ r ,: l"a r, ,-t; ~: ~ T: _ ~ ~ - !~f` ~-~~ ~~ .,~ ~ Correspondent's a-mail address: Under penalties f ery'ury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct~/~i complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. L. C 9287 Mtxidr~Run Road. Orrstt5wn. PA 17244 SIGNATURF~OF REPARER OTHER THAN PRESENTATIVE DATE ~, John James Mooney III 3 ;;~ r l :3-,- ADDRESS 230 rk treet, ov , PA Side 1 51156 Z4 1S©5610143 PA Inheritance Tax Return Signature of Additional Fiduciaries I MyersERutfi N. 1 21 11 00728ER I 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. Signature #2 Name Address1 Address2 City, State, Zip Date 9407 Muddy Run Road Orrstown PA 17244 15~56~D243 REV-1500 EX Decedent's Social Security Number Decedents Name: Myers, Ruth N. 17 9 10 3 913 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. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits $ Miscellaneous Personal Property (Schedule E) ............... 5. ~ 0 - ~- 9 6. Join±•.y O4med Property (Schedule F) ^ Separate f3~lling Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous lyoq Probate Property Separate Billing Requested 7 ............ (Schedule G) u . 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 2 () - ~, 9 9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... 9. 1 ~. , 7 7 9 • 8 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 1 ~. , 7 7 9 • 8 7 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. -~. ~. , 75 9.68 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. -11 , 75 ~ . 6i3 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICA6LE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable ~ - 0© 16 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 ~ ~ 17 at sibling rate X .12 - . 18. Amount of Line 14 taxable at collateral rate X .15 "~~5 ~ 253.55 18. 19. Tax Due ................................................. ................................................................ . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ~.~~ ~.~~ 0.~0 66,7$8.03 66,788.03 Side 2 ~saS~~az43 Lsos6~o243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0072$ DECEDENT'S NAME Myers, Ruth N. STREET ADDRESS 121 Willow Drive CITY Shippensburg STATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 68,00r3.t}0 3,427.49 (1) 66,788,03 71,427,49 4,63a4s Total Credits (A + B) (2) 3. Interest 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check 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. Make Check Payable to: REGISTER OF WILLS, AGENT. . , :~.. , f (3) (4) (5) 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 :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ LxJ 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? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONSIS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. -.. - ~ 4~ 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 January 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 stilt 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 1.2) [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. Rev-1508 EX+ (6-98) sc~~au~~ E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Myers, Ruth N. 21-11-00728 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntlyowned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-15QQ Schedule E (Rev. 6-98) REY-1151 EX+ (10-06) COM INH~ITANCEOTAX RETURLVANIA R SIDENTTTT DECEDENT tJ SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Myers, Ruth N. 21-11-00728 Debts of decedent must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached i1,i50.87 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission paid 2, Attorney's Fees 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 29.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitu{ation) 11,779.87 Copyrigh4 (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Myers, Ruth N. 21-11-00728 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Fogelsanger-Bricker Funeral Home, Inc. -Funeral bill (See bill attached) 11,750.87 H-A 11,750.87 Other Administrative Costs 2 Citizens Bank -Bank fees 10.00 3 Register of Wills -Short Certificate 4.00 4 Register of Wills -Filing fee 15.00 H-B7 29.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (11-08) COMINOHRESI DENT DF-PE EE~RNANIA ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER M ers, Ruth N. ~ 21-11-00 728 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal ~ distributions, and transfers under Sec. 9116 a 1.2 1 Andrew C. Breneman Nephew 5,000.00 1304 Doubling Gap Road Newville, PA 17241 2 Charles R. Cisney Nephew 112 Residue 9207 Muddy Run Road Orrstown, PA 17244 3 Jeffrey L. Cisney Nephew 1/2 Residue 9287 Muddy Run Road Orrstown, PA 17244 4 Summr Ruth Myers Friend 1,000.00 1523 Hoffman Road Olmstedville, NY 12857 Total 6,000.00 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIO~IS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEJ Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08} 0064644750 ~. Adams Electric ~ operative, Inc. 1338 Biglerville Road PO Box 1055 1I~I~~ Gettysburg, PA 173?~5-1055 ~ A Tauehstone Energy Cooperative }~ 1-888-232-6732 r.-~ www.adamsec.coop 7301 1 AY 0.340 4 7301 RUTH N MYERS C-22 P-32 121 WILLOW DR SHIPPENSBURG PA .17257-9441 ~~(~~~II I'~'ll III~I~IIII~~~~~~~ll'llllll~l~l~„~'I~~I'111'~tll~'f Hetlrement RETIREMENT SUMMARY YEAR AMOUNT THIS RETIREMENT -------20.19- 198934 18:48 CHECK AMOUNT 20.19 ----------=-- 20.19 CAPITAL CREDIT NBR: 0064644750 ' CK#; 21124651 DATE: 12/1J/11 Adams Electric Cooperative, Inc. Patronage Capital Retirement Adams Electric Cooperative, Inc.' `'"""1~''r"~""` ' 1e Road acNS g' Void After 90 Days 21124651 s ~ ''"' ~ 1055 PO Box GettySbUrg, PA 173 5-1055 Gettysburg, Pennsylvania ~ so ssa e F ' Check Date Net Amount `~1~I~ ooperative l C. A Touchstai 313 i ~? 1-888-232-6732 CC # 0064644750 12/19/11 $20.19 i www.adamsec.coop, Patronage Capital Retirement ;PAY ~*~`*Twenty and 19/10 r~ollar-s*`~`** ITO THE 'oRDF>z o~ RUTH N MYERS ~ ~ ~dr ~~ ~' ~ 121 WILLOW DR i n . ~~-° ~, - '- SHIPPENSBURG PA 17257-9441 ,.... .: -. $}(3NATURE HA$A COLOPED BACKGAOIIND BORDER CONTAINS MIGFOPRINTINC%?' ~;~ n'00 2 L L 2465 Lip' x,03 i309945i: 238 9 26 6u' w c a N Q ~ N f!7 00• f- ^yr" OO~If) Z Q' d~OMNO CVN aSI~NO O VI O ~¢ ~o ~ 3 E W Z -~ ~~~ M =~ o ~~~~. n ~~~ W V ~ ~ O ti W O ~ N O ~ a -' is a4 ~ti 4•, N O ~ ~, ~ N O O ~ ~ ~ ~ ~ ~ ~ U ~ O n ~ ~--1 ~ o a y ~ ai ~ ~ .~ o ~ ~ U ~ U ~ V O~ w Q h Q y M ZU ~~ Q O Z ~~ W O ~„ °` F _ w o ~ r ~o ~ F o ~ d Q N x ~ W U W z H W x