HomeMy WebLinkAbout09-29-14 � � 1505610143
REV-1500 EX`°,_,°> �
PA De artment of Revenue OFFICIAL USE ONLY
P pennsylvania councy code Year File Number
Bureau of Individual Taxes DEPARTMEMOFREVENVE
eo aox.zsoso� INHERITANCE TAX RETURN 21 14 0199
Harrisburg, PA �7�2$-oso� RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
01 12 2014 06 27 1952
DecedenYs Last Name Suffix DecedenYs First Name MI
MYERS STEVEN R
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name 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. Original Return � 2. Supplemental Return � 3. Remainder Return(date of death
pfior to 12-13-82)
� 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� 6 Decedent Died Testate � � (AttacheCo aintained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Atfach Copy of Will) py of Trust)
� 9. Litigation Proceeds Received � 10.Spousal Povert Credit�(date of death � ��,Election to tax under Sec.9113(A)
between 12-31�J1 and -1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytir►�Telephone�inber
BRADLEY L GRIFFIE 71'7C?�3 5�1 � �
� � �� � n
RE61S7�R�WIL�' US'�{O�Y
�._ - r'�
. � � `r'7 Pr7
First line of address ," � • �`� `�
,.., s., . -.� "a Ca
200 NORTH HANOVER STREE - a � `�+ �
- `�
Second line of address � ..� �,4,� c�
_, ...: � m
o cn o
DATE�ED �
City or Post Office State ZIP Code
CARLISLE PA 17013
CorrespondenYs e-maii aadress: bgriffie@griffielaw.com
Under penalties of perjury,1 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.
SIGNATU OF PERSON RESP IBL OR FILING RETURN DATE
!
�1,-�,-��--�:.- • Connie F. Myers �'^ ZL- I
ADDRESS
2 Hicko tow Road Carlisle PA 17015
SIGNA P ER N REPRESENTATIVE DATE
Bradley L Griffie
ADDR
200 North Hanover Street, Carlisle, PA
Side 1
� 1505610143 150561�143 J
. �
�
� 1505610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 3 7 7 . 16
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. 3� , 62 7 . 4�
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous�q Probate Property
(Schedule G) U Separate Billing Requested............ 7, 9, 643 . 0 6
8. Total Gross Assets(total Lines 1-7)..................................................................... 8. 40 , 647 . 62
9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 1.2 , 253 . �2
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I).............................. 10. 5 , 353 . 99
11. Total Deductions(total Lines 9&10)................................................................... 11. 17 , 607 . 01
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 23 , 040 . 61
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. 23 , 040 . 61
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(�.2)x.00 16, 379 . 33 i5. 0 . 00
16. Amount of Line 14 taxable 6, 6 61 . 2 8 �s. 2 9 9 - 7 6
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. Tax Due.................................................................................................................. 19. 2 9 9 . 7 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21-14-0199
Decedent's Complete Address:
DECEDENT'S NAME
Myers, Steven R.
STREET ADDRESS
2 Hickorytown Road
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 299.76
2. Credits/Payments
A. Prior Payments 0.00
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest �3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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. (5) 299.76
Make Check Pa able 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:............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ �
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
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?..................................................................................................................
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)(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 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 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 decedenYs 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-1503 EX+(6-98�
SCHEDULE B
� , STOCKS & BONDS
. COMMONWEALTHOFPENNSYLVANIA .
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Myers, Steven R. 21-14-0199
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Wendy's Company- 377.16
Account No.XXXXXX6279
42.000 shares @$8.98/per share
(See attached statement)
TOTAL(Aiso enter on Line 2, Recapitulation) 377.16
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1508 EX+�6-98)
SCHEDULE E
� , CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTHOFPENNSYLVANIA .
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Myers, Steven R. 21-14-0199
Include the proceeds of litigation and the date the proceeds were received by the estate.
All propeRy jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 2005 Ford F250 Pickup Truck- 2.205.00
(Kelley Blue Book Value)
(See attached)
2 2006 Ford F250 Pickup Truck- 2,500.00
(Sold to private party)
3 Orrstown Bank Checking Account- 16,572.89
Account No.XXXXX2141
(See attached statement)
4 Wells Fargo Checking Account - 5,570.32
Account No.XXXXXX3553
(See attached statement)
5 Wells Fargo Savings Account- 1,806.19
Account No.XXXXXX9006
(See attached statement)
6 Progressive Refund 48.00
7 2003 Ford F250 Pickup Truck- 1,500.00
(Sold to private party)
8 2006 Yamati Moped 425.00
TOTAL(Also enter on Line 5, Recapitulation) 30,627.40
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.6-98)
_ . _
Rev-1510 EX+(6-98)
SCHEDULE G
� , INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTHOFPENNSYLVANIA .
INNERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Myers, Steven R. 21-14-0199
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DA E OF^TRANSFERSATRACH A COPY OF TI�HE DEIED F�OREREAL ES ATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Ameriprise Mutual Fund (IRA)- 7,929.31 100.000% 7,929.31
Account No.XXXXXXXXX28 002
(Spousal rollover to wife,Connie Myers)
(See attached statement)
2 Ameriprise Mutual Fund(IRA)- 1,713.75 100.000% 1,713.75
Account No.XXXXXXXXX53 002
(Spousal rollover to wife,Connie Myers)
(See attached statement)
TOTAL(Also enter on Line 7, Recapitulation) 9,643.06
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.6-98)
REV-1151 EX+�10-06) SC H E D U L E H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Myers, Steven R. 21-14-0199
Debts of decedent must be reported on Schedule 1.
ITEM DESCRIPTION AMOUNT
NUMBER
q, FUNERAL EXPENSES:
See continuation schedule(s) attached 3,897.32
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Connie F. Myers
Street Address 2 Hickorytown Road
city Carlisle state PA zio 17015
Year(s)Commission oaid 2014 2,000.00
2. Attornev's Fees Griffie&Associates, P.C. 5,000.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zip
Relationshi�of Claimant to Decedent
4. Probate Fees 178.50
5. AccountanYs Fees 200.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 977•2�
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 12,253.02
Copyright(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, Steven R. 21-14-0199
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exnenses
1 Fogelsanger-Bricker Funeral Home, Inc. 3,897.32
H-A 3,897.32
Other Administrative Costs
2 The Sentinel (Advertising) 169.30
3 The Cumberland Law Journal (Advertising) 75.00
4 Cost to complete title transfer of 2006 Ford 250 201.50
5 Orrstown Bank-bank fees 31.40
6 Reserves 500.00
H-B7 977.20
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-08�
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTHOFPENNSYLVANIA . . . �
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Myers, Steven R. 21-14-0199
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 2013 Personal Income Tax(IRS) 1,144.00
2 2013 Personal Income Tax(Dept. of Revenue) 443.00
3 2013 Personal Income Tax(Cumberland County Tax Bureau) 205.00
4 Verizon Wireless(final billing) 54.00
5 2012 Personal Income Tax(Dept.of Revenue) 304.16
6 United Refrigeration, Inc. - 114.12
(Supplies for decedent's business)
7 R.F. Fager,Co. - 291.33
(Supplies for decedent's business)
8 Holy Spirit Hospital 380.48
9 Holy Spirit Hospital 1,248.00
10 Pinnacle Hospital 654.00
11 Beth Carson,Tax Collector 11.00
12 United States Treasury- 504.90
(2011 Personal Tax)
TOTAL(Also enter on Line 10, Recapitulation) 5,353.99
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
_ _ _ __ _ . _
REV-1573 EX+(11-08)
� � SCHEDULE J
COMMNHERITANCE�T�RETURNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Myers, Steven R. 21-14-0199
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (�/�/ords) ($$$)
Do Not List Trustee s
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
Connie F. Myers Spouse One-half of net 16,379.33
2 Hickorytown Road distributable
Carlisle, PA 17015 estate
Gregory Myers Son One-sixth of net 2,220.43
2270 Tanya Drive distributable
Chambersburg, PA 17201 estate
Joshua T. Myers Son One-sixth of net 2,220.43
2 Hickorytown Road distributable
Carlisle, PA 17013 estate
Malena Rosenberry Daughter One-sixth of net 2,220.42
352 Sue Linn Drive distributable
Chambersburg, PA 17201 estate
Total 23,040.61
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. 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
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11-08)
Attachment to Schedule "B"
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Attachment to Schedule "E"
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A Tradition of Fxcellence
March 12,2014
Griffie&Associates
200 N Hanover St
Carlisle,Pa 17013
Fax:717-243-5551
Re: Estate of Steven R Myers
Social Security Number 164-38-b595
Date of Death 1/12/14
IT IS HEREBY CERTIFIED THAT TI�ABOVE NAMED DECEDENT HAD'THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account No- 146002141
Account Type- 50+Iriterest Checking
Account Title- Steven R Myers
Date Opened- 4/15/11
Joint Account(nameJ�ate) No
Balance- $16,572.89
Accrued Interest �0.00 Rexeived interest on day of death
Check 1106 to US Treasury on I0111/13 for�7262.00
Best Regards,
�•�
_.�
Kimberly Moyer
Deposit Processing Clerk
2695 Philadelphia Avenue•Chambersburg,PA 17201
_ _ _ _
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Attachment to Schedule "G"
1
Ameriprise n
Financial
Account Summary for the Estate Settiement of Steven R Myers, Client ID 18462261
1)Type of investment: Mutual Fund
Product Name: Mutual Fund
Total Account Value(as of Date of Death):$7,929.31
Account Number:01013233028 002
Account Registration:Ameriprise Trust Company C/O Steven R Myers As Custd For The Steven R Myers ira
Beneficiary Designation:
PRIMARY BENEFICIARY
CONNIE MYERS SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING� LAWFUL CHILDREN IN EQUAL SHARES 100.00%
How the account(s)proceeds will be settled:
We will transfer assets in this account to an account for the beneficiary(ies).
Important Details about this account:
N/A
2)Type of investment: Mutual Fund
Product Name: Mutual Fund
Total Account Value(as of Date of Death):$1,713.75
Account Number:02013991553 002
Account Registration:Ameriprise Trust Company C/O Steven R Myers As Custd For The Steven R Myers Ira
Beneficiary Designation:
PRIMARY BENEFICIARY
CONNIE MYERS SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
How the account(s)proceeds will be settled:
We will transfer assets in this account to an account for the beneficiary(ies).
Important Details about this account:
N/A