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HomeMy WebLinkAbout04-02-13 REV-1500 EX(02-11)(FI) 1505611185 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File:Number PO BOX 280601 INHERITANCE TAX RETURN 21 12 374 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01132012 06021954 Decedent's Last Name Suffix Decedent's First Name M I MYERS-SHENK MELISSA J (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 El 2. Supplemental Return ❑ 3. Remainder Return(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 E� 7. Decedent Maintained a Living Trust 1 _ 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 ❑ 1 1. 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 SUZANNE S . FRIDAY ESQUIRE 717-236-30:p ` ' M REGISTER OF WAS;t$E ONLY r� M First Line of Address f�D :3 C> C:5 NAUMAN SMITH <: _I Second Line of Address t.. M 200 N - 3RD ST 18TH FLR ry City or Post Office State ZIP Code DATEitEID —J HARRISBURG PA 17101 Correspondent's e-mail address: S S F R I D A Y a@ N S S H - 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. SIGNATURE OF ERSON RESPONSIBLE F F ING IRE URN DATE ADDREW 200 N . 3RD/ST . , 18TH FLR - HARRISBURG, PA 17101 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 ,li Estate of Melissa J. Myers-Shenk 169-44-5655 Executors (Page 1) Name Suzanne Friday Address Nauman Smith Shissler & Hall, LL 200 N. 31-d St . , 18th fir. Harrisburg, PA 17101- Tax ID - - Name Er_dget IL. Myers Address 19432 Trar_shire Road Gaitherskurg, MD 20886- Tax ID 215-80-6- 31 J 1505611285 REV-1500 EX(F 1) Decedent's Social Security Number Decedent's Name: MYERS-SHENK MELISSA J RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 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) . . . . . . . . . . . . . . . . . q 0 • 00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) . . . , . 5, 731436 • 00 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . , . 6, 0 • 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . 7. 0 . 00 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8. 7 3, 4 3 6 • 00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . 9. 2 3,13 8 • 00 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . 10. 61795 • 00 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 1 1 29,9 3 3 • 00 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 12 43,503 • 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . 13 0 • 00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . 14. 4 3, 5 0 3 • 00 TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers un�er Sec 9116 (a)(1.2)x o- 0 . 00 15. 0 . 00 16. Amount of Line 14 t xable at lineal rate x.o45 43, 503 . 00 16, 1,958 • 00 17. Amount of Line 14 taxable at sibling rate .12 0 . 00 17, 0 . 00 18. Amount of Line 14 taxable at collateral rate X .15 0 . 00 18. 0 . 00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1,958 . 00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505611285 1505611285 J OM4648 3.000 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 12 374 DECEDENT'S NAME MYERS-SHENK .. _ MELISSA J STREET ADDRESS 2213 RENO STREET CUMBERLAND_ CITY STATE ZIP NEW CUMBERLAND PA 1,7070- Tax Payments and Credits: 1 Tax Due(Page 2, Line 19) 1) 1,958 - 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'I +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 . 00 5, If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1 9 5 8 • 0 0 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 properly transferred . . . . . . . . . . . . . . . . . . . . . . . . F7 No�U II b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . ❑ ❑ c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a d receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ a 2. If death occurred after Dec 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration's L-XJ 3. Did decedent own an "in trust for"or payable-upon-death bank account or security at his or her death? ❑ U 4. Did decedent own an individual retirement account, annuity, or other non-probate property,which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ F_Xj 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)(1)] 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 cne parent in common with the decedent,whether by blood or adoption. 0 M 4671 2.000 REV-1502 EX,(01-10) SCHEDULE A pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTAT E RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Melissa J. Myers-Shenk 21 12 374 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 having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if 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 1. Real Estate located at 226 Reno Street, New Cumberland, PA 17070 - SUSPEND I I i TOTAL (Also enter on Line 1,Recapitulation.) $ 9w46e5 2 000 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX,(11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE ED RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Melissa J. Myers-Shenk _ 21 12 374 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 1. Litigation proceeds payable to Decedent from the Estate of Myrel M. Shenk. 711236 2 1971 Chevrolet Chevelle - not running, no engine, unrestored 1,000 3 2007 Toyota 1,000 4 M&T Bank Checking Account 0 5 ITangible Personal Property of Decedent 200 I I I TOTAL(Also enter on line 5, Recapitulation) $ 1 73,436 OVV46AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX,(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN �_ ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Melissa J. Myers—Shenk _ _ 21 12 374 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERALEXPENSES 1. Stone & Murray Funeral Home 2,372 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 5,000 Names)of Personal Representative(s)Bridget A. Myers Street Address 19432 Transhire Road City Gaithersburg State MA ZIP 20886 Year(s)Comm,ssion Paid: 2. Attorney Fees: 10,000 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 Deceden- I 4. Probate Fees 384 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Forry's Auto Body Repair. 5,000 2 , Commonwealth of PA Duplicate Vehicle Title Fee 23 Total from continuation schedules . . . . . . . . . 359 TOTAL(Also enter on Line 9, Recapitulation) $ 23,138 9w46AC 2 000 If more space is needed, use additional sheets of paper of the same size. Estate of: Melissa J. Myers-Shenk 21 12 374 Schedule H Part 7 (Page 2) 3 Cumberland Law Journal 75 4 PIADA Special Services 158 5 The Sentinel 126 Total (Carry forward to main schedule) 359 REV-1512 EX,(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS _ ESTATE OF FILE NUMBER Melissa J. Myers—Shenk 21 12 374 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. SKO Brenner Collections 70 2 Pace Resources Visa 6,288 3 RJM Acquisitions - Mastercard 437 i I I I TOTAL(Also enter on Line 10 Recapitulation) $ 6,795 8w46AH 2 000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Melissa J. M ers-Shenk _ 21 12 374 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec. 9116(a)(1.2).] 1. Bridget A. Myers 19432 Transhire Road Gaithersburg, MD 20886 One Half of Residue: 21,,752 Daughter 21,752 2 Melissa M. Allen 101 S. 36th Street Camp Hill, PA 17011 One Half of Residue: 21,,752 Daughter 21,752 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 11 NON-TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN. 1. I i I B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ _ 0 9W46AI 2.000 If more space is needed, use additional sheets of paper of the same size.