HomeMy WebLinkAbout02-18-05
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RE.... ~ 1500 EX + 1~1
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
'N~l
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Moyer, Richard L
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
06/06/2004
03/22/1936
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
Moyer, Jean C
~ 1. Original Return
o 4. Limited Estate
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o 2. Supplemental Return
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4a. Future Interest Compromise (date 01 death
after 12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy 01 Trust)
10. Spousal Poverty Credit (date 01 death between
6. Decedent Died Testate (Attach copy
01 Will)
9. Litigation Proceeds Received
THIS;SECTION MUST BECOMPi!ETED. ALL.:CORR
AME
.;, !z Robert G Radebach
ll:! :!l IRM NAME (II applicable)
8 ~ Law Office of Robert G. Radebach
ElEPHONE NUMBER
717/234-6655
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
OFFICIAL USE ONLY
FILE NUMBER
21
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
204-28-1993
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
181-32-3420
o 3. Remainder Retum (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
COMPLETE MAILING ADDRESS
107 Locust Street
Harrisburg, PAl 71 0 1
(1 ) None
(2) 12,410.37
(3) None
(4) None
(5) None
(6) None
(7) 85,847.22
(8)
(9) 7,245.00
(10)
OFFICIAL
ONLY
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98,257.59
(11 )
7,245.00
91,012.59
(12)
(13)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
91,012.59
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 91,012.59 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
S
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Q. 17.Amount of Line 14 taxable at sibling rate x .12 (17)
::Ii
0
0
S 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
0.00
0.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
411 West Main Street
CITY
Shiremanstown
ISTATE PA
I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(3) 0.00
(4)
(5) 0.00
(5A)
(5B) 0.00
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE 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: Yes No
a. retain the use or income of the property transferred;................................................................................ ~ I
~: ~::::~ ~h;e~;~:i~~~~s:~~;~s~:~. ~~~~~ .~~.~. .~~.~. .~.~~~~~ .~~~~~~~~~~~. ~~. ~~~. ~~~~.~.~.;.....................................................................
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? ............................................................................................................... D
D
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3.
4.
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D
E QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
DATE
411 West Main Street
Shiremanstown, P A 17011
;2.. I{)(J~
DATE
Sl
Rob
PREPARER OTHER THAN REPRESENTATIVE
adebach
ADDRESS
DATE
107 Locust Street
Harrisburg, PAl 71 0 1
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 99116 (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%
[72 P.S. 99116 (a) (1.1) (i1)]. The statute does not exemDt 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 twenty-one 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% [72 P.S. 99116 (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%, except as noted in 72 P.S. 99116
1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .S. 99116 (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.
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
ESTATE OF
Moyer, Richard L
I FILE NUMBER
21 - 04 -
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE
NUMBER OF DEATH
1 203.5458 shares Pepsico, Inc., common stock 11,060.68
2 14.3187 shares Deimler-Chrysler Corp. common stock 658.80
3 37.529 shares MatteI, Inc. common stock 652.25
4 3 shares Bon Ton Department Stores common stock 38.64
TOTAL (Also enter on line 2, Recapitulation) 12,410.37
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Moyer, Richard L
FILE NUMBER
21 - 04-
ESTATE OF
This schedule must be completed and filed if the answer to any of Questions 1 throua h 4 on Dace 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF
Include the name of the transferee. their relationship to decedent and the date of transfer. DECO'S EXCLUSION TAXABLE VALUE
NUMBER VALUE OF ASSET (IF APPLICABLE)
Attach a copy of the deed for real estate. INTEREST
1 Traditional IRA 85,847.22 100% 85,847.22
TOTAL (Also enter on line 7, Recapitulation) 85,847.22
.
SCHEDUlE H
FUNERAL EXPENSES &
ADMNSTRATlVECOSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Moyer, Richard L
I FILE NUMBER
21 - 04-
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
1 Hoover Funeral Homes, Inc. 6,545.00
2 United Willing Workers - Funeral Dinner 450.00
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Inheritance Tax Return 250.00
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
5, Accountant's Fees
6. Tax Return Preparer's Fees
7, Other Administrative Costs
1
TOTAL (Also enter on line 9, Recapitulation) 7,245.00
R~.1513 EX'!'lS-oO)
*'
SCHEDULE J
BENEFICIARIES
, COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Moyer, Richard L
I FILE NUMBER
21 - 04-
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Jean C. Moyer Wife 100%
411 West Main Street
Shiremanstown, P A 17011
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
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III
High:
53.97
54.68
53.89
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Go To Charting ... ~
\ 54.34
.....,-.
Enter Symbol: pep
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PepsiCo, Inc. "-
Friday. June 04,2004
Closing Price:
Open:
low:
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III
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45.73
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45.61
618,000
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Enter Symbol: dcx
Dalmlerchrysler Ag
Friday. June 04, 2004
Closing Price:
Open:
High:
Volume:
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Enter Symbol: mat
Mattei, Inc. '\
F(j~y. June 04, 2004
Closing Price:
Open:
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Volume:
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Enter Symbol: bent
Enter Date:
The Bon-Ton Stores Inc
Friday. June 04, 2004
,.~..,..~--.
Closing Price:
12.88
12.88
13.10
12.76
57,100
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Volume:
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LAST WILL AND TEST AMENT OF
RICHARD L. MOYER
I, Richard L. Moyer, a resident of Shiremanstown, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this instrument to be my Last 'ViII and Testament,
hereby revoking any and all wills by me at any time heretofore made.
ITEM I:
I direct my hereinafter named Executrix to pay all my just
debts, funeral expenses, administration expenses and inheritance, estate, succession or
excise taxes, which I owe or may become due on account of my death, as soon as may
be convenient after my decease.
ITEM II: All the rest, residue and remainder of my estate, be it real,
personal or mixed, of whatever nature and wheresoever situate which I may own or have
the right to dispose of at the time of my decease, I give, devise and bequeath to my Wife,
Jean C. Moyer, of 411 West Main Street, Shiremanstown, PA.
ITEM III: IT my said Wife should predecease me, or die simultaneously
with me, then I give, devise and bequeath those items of personal property that I have
marked with a tag be distributed to the legatees so named on the tag. A list of these items
is attached hereto and is hereby made a part hereof. This notwithstanding, I may mark
.) 'C t </ /l
1tA./I'rr.A/J'f"U J.., /I/l~:u./
nTroTT. n~ T '1""TT:'n>
(SEAL)
additional items to be transferred at the time of my death with tags bearing the name of
the donee.
ITEM IV: IT my said Wife should predecease me, or die simultaneously
with me, then I direct that my personal representative shall have all of my gold coins
appraised and divide them into three equal shares to be divided among my three
children, Tracey Lee Moyer Rawlings ofl5 Mack Drive, Las Vegas, Nevada 89115-1904,
Libby Sue Moyer of 105 West Keller Street, Mechanicsburg, P A 17055, and Richard J.
Moyer of 411 West Main Street Shiremanstown, P A 17011.
ITEM V: IT my said Wife should predecease me, or die simultaneously
with me, then I direct that my afore named children shall each have the right to select
items of personal property from my estate beginning with the oldest child then the next
oldest child and finally the youngest child. This pattern is to continue alternating until
each child has selected those items of personal property which they desire to take in
kind. The remainder of the personal property not selected by my children should be sold
at public sale and the proceeds distributed with the residue of my estate.
ITEM VI: IT my said Wife should predecease me, or die simultaneously
with me, then it is my desire that my son, Richard J. Moyer should have the right to
purchase my residence at 411 West Main Street, Shiremanstown, P A, provided that he
pay each of his sisters the sum of 1/3 the net equity in the premises as of the date of my
death.
In the event that my son, Richard J. Moyer does not desire
to purchase the property, I direct that the property be sold at
i~~ t fJ11,,~~ (SEAL)
nu...."1J J\ nn T ~.fr\V1:'D
public or private sale and the proceeds are to pass into my
residuary estate.
ITEM VII: If my said Wife should predecease me, or die simultaneously
with me, then I give, devise and bequeath all the rest, residue and remainder of my
estate, be it real, personal or mixed, of whatever nature and wheresoever situate which
I may own or have the right to dispose of at the time of my decease unto my children,
Tracey Lee Moyer Rawlings, Libby Sue Moyer and Richard James Moyer.
ITEM VIII: I hereby nominate, constitute and appoint my Wife, Jean C.
Moyer, of 411 West Main Street, Shiremanstown, P A, Executrix of this my Last Will
and Testament, with full power in her discretion to do any and all things necessary for
the complete administration of my estate, without being required to fIle bond for the
performance of her duties, with full power to sell at public or private sale and without
order of court any real or personal property belonging to my estate, and to compound,
compromise or otherwise settle or adjust any and all claims, charges, debts and demands
whatsoever against or in favor of my estate as fully as I could if living.
A. If my said Wife should predecease me or die simultaneously
with me, or be unable or unavailable to serve or complete her duties, then I nominate,
constitute and appoint my daughter, Libby Sue Moyer, with the same power and
authority as given my said Wife.
It I P . J II h/l/l. . h,-' lev J\ T \
,.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my
+~
Last Will and Testament this Q day of OL;k.~r- , 2000.
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Richard L. Moyer
(SEAL)
Signed, sealed, published and declared by the above-named Richard L. Moyer as and
for his Last Will and Testament, in the presence of us, who at his request, in his
presence and in the presence of each other, we believing him to be of sound and
disposing/~ilcf,)nem.rr, understanding, h~ve jlereunto subscribed our
names as/wltn~es tllis ~ day of t'[~\~ , 2000.
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COMMONWEALTH OF PENNSYLVANIA
:SS
COUNTY OF DAUPHIN
t~1
.. Before me, the undersigned authority, on this ~ day of
CJL~)\Jt...r , 2000, personally appeared Richard L. Moyer, Robert G.
Radebach, and f( 0 'ne.C{.c.. ~, ~~ known to me to be the Testator and the witnesses,
respectively whose names are signed to the attached or foregoing instrument and, all of
these persons being by me fIrst duly sworn, the Testator declared to me and to the
witnesses in my presence that said instrument is Testator's Last Will and Testament and
that Testator had willingly signed and executed it in the presence of said witnesses as
Testator's free and voluntary act for the purpose therein expressed; that said witnesses
stated before me that the foregoing Will was executed and acknowledged by the Testator
as Testator's Last Will and Testament in the presence of said witnesses who, in
Testator's presence and at Testator's request, and in the presence of each other, did
subscribe their names thereto attesting witnesses on the day and year above written, and
that the Testator, at the time of the execution of said Will, was over the age of 18 years
and of sound and disposing mind and memory.
NOT AAIAL SEAL
JOANNE M. BLOSE. Notary Public
City of Harrisbu~. Dauphin County
My Commission ,-x pires April 8. 2002
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