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Home My WebLink About02-20-13 (2)~ r 1505610105 REV-1500 ~` ~°~-"' ~~`' PA Department of Revenue p~Yt~a OFFICIAL USE ONLY Bureau of Individual Taxes °°'"RTMe1 ~`"~~"'~ County Code Year PO BDX 2806oi INHERITANCE TAX RETURN ~ i //~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT vc ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDWYY 09/22/2012 05/22/1926 Decedent's Last Name Suffix Decedents First Name MYERS ETHEL (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI P 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 Retum Q O 4. Limited Estate O O 6. Decedent Died Testate O (Attach Copy of ~IQ O 9. Litigatbn Proceeds Received O 2. Supplemental Retum 4a. Patios Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust. ) 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE ANO CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number David L. Myers {717) 439-8484 First Line of Address 2144 PINE ROAD Second Line of Address State ZIP Code REGISTER OF WILLS USE ONLY n C ~ ~y ~,; ~p ~ '1 ~ ~' ~,,, t- ~ r*t >~ ~ ~*I ~ ~, Uj : T7 CJ :~1 ~ ~ TE~tLED ~ C3 ~ NEWVILLE PA 17241 ... ~ ~`~' "' '~ .~ --t ~....~ rte- rn ~- rv ~ a Correspondent's e-mail address: dmyers24~dishmail. net ~ ~ City or Post Office Under penalties of pery'ury, 1 declare that 1 have examined this return, including accompany~g schedules and statements, and to the hest 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. SIG E OF P SIBLE FOR FILING RETURN DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE OR181NAL FORM ONLY 1505610105 Fle Num/ber/~' ~-- / U! J c Side 1 1505610105 r~ ~~ JG~ ~ i J 1505610205 REV-1500 EX (FI) Decedent's Soaal Security Number RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Hekl Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 2,572.00 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. 9,125.98 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 11,697.98 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 832.07 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule t) ............... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 832.07 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 10,865.91 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. 10,865.91 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_ ~ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 10,865.91 16, 489.00 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. 489.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 150561025 1505610205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME ETHEL P. MYERS STREET ADDRESS Elmcroft Assisted Living Center 129 Walnut Bottom Road CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} (1} 489.00 2. Credits/Payments A. Prior Payments 0.00 B. Discount 0.00 Total Credits (A + B) (2) 0.00 3. Interest (3} 0.00 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) 489.00 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 (ife 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" orpayable-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 benefiaary 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 surv'IVing spouse is 3 percent [72 P.S. §9116 (a) (1.1) {i)]. For dates of death an 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 benefiaaries 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)]. 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. REV-~,5o8 EX+ (08-12) pennsylvania SCMEp~/LE E DEPARTMENT of REVENUE CASI"I, BANK DEPOSITS &. MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT OKEDENT ESTATE OF: FILE NUMBER: Ethel P. Myers 2112-01258 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 Sd~eduk F. If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (OS-09) ~Vns Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE I~MBER ETHEL P. MYERS 2112-01258 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 NUMBER DESCRIPTION OF PROPERTY INCUIDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AID THE DATE DF TRANSFER. ATTACH A Coax OF tHE OEED Fit REAL ESTATE DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1• IRA- Transfer 9,125.98 2 Dorothy J. Myers (Daughter) 34% 0.00 3,103.00 3. Ruth Ann Myers 33% 0.00 3,012.00 4 David L. Myers 33% 0.00 3,012.Oa TQTAL (Also enter an Line 7, Recapitulation) $ I 9,127.00 If more space is needed, use additional sheets of paper of the same size. ~ M REV-1511 EX+ (10-09) pennsytvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DKEDENT ESTATE OF FILE I~JMBER ETHEL P. MYERS 2112-01258 Decedent's demos must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Paid to Hollinger Funeral Home ~ Crematory Inc Death Certificates 12.00 Coroners Authorization 25.00 Opening Grave 350.00 Flamers 31.00 Neauspaper obituary 180.77 Total 749.57 749.57 B. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) DeVld L. Myers Street Address 2144 Pine Road C;ty Nevwille State PA ZIP 17241 Year(s) Commission Paid: NONE 0 00 2. Attorney Fees: . 0 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 4. Probate Fees: 67.50 5. Accountant Fees: 0.00 6. Tax Return Preparer Fees: 0.00 ~• Filling Fee 15.00 TOTAL (Also enter on Line 9, Recapitulation} (; 832.07 If more space is needed, use additional sheets of paper of the same size. .. w REV-1513 EX+ (01-10) pennsytvania SCHEDULE ~ DEPARTMENT OF REVENUE INt1ERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NIUMBER: ETHEL P. MYERS 2112-01258 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 {a) (1.2).] 1• David L. Myers Son 33°~ 2 Ruth Ann Myers Daughter 33% 3 Dorothy J. Myers Daughter 34% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. I~ 0 If more space is needed, use additional sheets of paper of the same size.