HomeMy WebLinkAbout11-08-12 (2)-~ REV-1500 Ex (o1-'°) 1505610143
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PA Department of Revenue pennsylvanla
Bureau of Individual Taxes e~~nrMEmoreE~ENUE
PO BOX.2S0601 INHERITANCE TAX
Harrisburg, PA 17128-0601 RcclncslT ncrr
trv I trr utctutN 1 I Nh V NMA 1 ION BELOW
Social Security Number Date of Death
070 32 9695 Ol 20 2012
Decedent's Last Name
MYERS
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
OFFICIAL USE ONLY
County Code Year File Number
~ 21 12 00300
Date of Birth
09 15 1940
Suffix Decedent's First Name MI
ELEANOR K
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. Odginal Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qa_ Futura Interest Compromise
(data of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
^ g. Decedent Dletl Testate
(Attach Copy of Will)
^ ~ Decedent Maintained a Living Trrst
(Attach Copy of Trust)
8. Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Cretin (date of death
between 12-31.91 antl 1-1.95)
^ 11. Election to tax under Sec. 9113 A
( )
(Attach Sch. O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
Daytime Telephone Number
SAMUEL L ANDES 717 761 5361
First line of address
525 NORTH 12TH STREET
Second line of address
City or Post Office State ZIP Code
LEMOYNE PA 17043
REGISTER Orww>=f_S USE OlILY
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DATE FILED ~
Correspondent's a-mail address: l a W a n d e 3@ a O I. 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 inforrnatlon of which preparer has any knowledge.
Sharon R. Myers
ADDRESS 1
320 W. Shady Lane, Apt. 2, Enola, PA 17025
Samuel L Andes
DATE
525 North 12th Street, Lemoyne, PA 17043
Side 1
1505610143 1505610143 J
1505610243
REV-1500 EX
Decedent's Social Security Number
oecedenc~s Name: M Y E R S, ELEANOR K. 0 7 0 3 2 9 6 9 5
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. 2 3 , 7 1 8 . 6 1
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ............ . 7, 1 6 , 6 0 0 . 0 6
8. Total Gross Assets (total Lines 1-7) ...................................................................... . 8. 4 0, 3 1 8. 6 7
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 4 , 7 91.7 2
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 , 5 2 5 . 5 7
11. Total Deductions (total lines 9 & 10) ...................................................................... 11. 6 , 3 17.2 9
t2• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 3 4 , 0 0 1 . 3 8
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. 3 4 . 0 01.3 $
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable
at lineal rate x .045 3 4, 0 01.3 8 16. 1, 5 3 0. 0 6
17. Amount of Line 14 taxable
at sibling rate X ,12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ..................................................................................................................... 19. 1 5 3 0. 0 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 _ 12 - 00300
Myers, Eleanor K.
STREET ADDRESS
320 West Shady Lane, Apt. 3
CITY
Enola STATE
PA ZIP
17025
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
Total Credits (A + B)
(1) 1,530.06
(2> 0.00
(3) 0.00
(4)
(5> 1,530.06
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.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ye^s No i
a. retain the use or income of the property transferred :.................................................................................. IrJ~
b. retain the right to designate who shall use the property transferred or its income :....................................
c. retain a reversionary interest; 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 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 Vansfers 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 rectum 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 ears 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) (j.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. §9118 (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. 59116 fa) (1.3)1. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w ether y blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERRPNCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Myers, Eleanor K. 21 - 12 - 00300
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Checking account No. 62588168 with M&T Bank. 14,004.62
2 Savings account No. 15004208639631 with M&T Bank.
3 Investment account No. AZD-053544-1 with M&T Securities, Inc.
4 Miscellaneous items of household furnishings, personal effects, and other tangible personal
property
1,706.05
7,657.94
350.00
TOTAL (Also enter on Line 5, Recapitulation) ~ 23,718.61
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF Myers, Eleanor K. FILE NUMBER
21 - 12 - 00300
This schedule must be completed and filed if the answer to any of questions 1 through 4 on ogee 2 is ves.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Include the name of the transferee, their relatlonship to decedent
and the tlate of transfer. Attach a copy °f the deed for real estate. DATE OF DEATH
VALUE OF ASSET ~ OP
DECD'S
INTEREST EXCLUSION
(IF APPLICABLE)
TAXABLE VALUE
1 IRA Annuity No. 02SP0753349 with TransAmerica ~2,a12.st 100% 12,412.31
Life Insurance Company
2 IRA Annuity No. 02SP0753426 with TransAmerica a,ie~.~s 100% 4,187.75
Life Insurance Company
TOTAL (Also enter on line 7, Recapitulation) 16,600.06
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Myers, Eleanor K.
Sa-IEDULE H
ARryJ~NpE~ F~iA}L~jD~''C~P~O~V/S/ES~&
MLAVYr M~711"W I I V G W~71 ~7
FILE NUMBER
21 - 12 - 00300
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Sullivan Funeral Home 3,385.00
B. ADMINISTRATIVE COSTS:
~. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Samuel L. Andes 1,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
a. Probate Fees Register of Wills 115.50
Register of Wills 12.00
Register of Wills 15.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Cumberland Law Journal (advertising) 75.00
TOTAL (Also enter on line 9, Recapitulation) 4,791.72
Schedtde H
Fta>el~l Eames &
COMMONWEALTH OF PENNSYLVANIA /~~,~,,,~~ ^~ ~,.d.
INHERITANCE TAX RETURN /.{,~ ~ p ~rW~ tN114
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Myers, Eleanor K. 21 - 12 - 00300
2 The Sentinel (advertising) 189.22
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMIMO ERR~CETAXREfURN~w LIABILITIES, & LIENS
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Myers, Eleanor K. 21 - 12 - 00300
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 United Healthcare (health insurance premium) 614.75
2 Verizon (telephone service) 28 28
3 Comcast of Central PA (television) 86.32
4 PA Water Company 55.86
5 PPL (electric) 740.36
TOTAL (Also enter on Line 10, Recapitulation) I 1,525.57
REV-1513 EXa (11-08)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
IN BENEFICIARIES
HERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Myers, Eleanor K. FILE NUMBER
21 - 12 - 00300
NUMBER
NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY Do NOt Llst Trustee(s)
I, TAXABLE DISTRIBUTIONS[includeoutrightspousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Sharon R. Myers Daughter
320 West Shady Lane, Apt. 2
Enola, PA 17025
Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriate.
III 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00