HomeMy WebLinkAbout10-16-14 J 1505610140
REV-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 ], 3 0 3 9 2
Harrisbur ,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 3 2 6 2 0 1 3 0 6 0 9 1 9 2 5
DecedenYs Last Name Suffix DecedenYs First Name MI
M E T Z G E R J 0 H N W
(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
X 1.Original Return � 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)
Q 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust 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 � 11• Attach Schedule O r Sec.9113(A)
Between 12-31-91 and 1-1-95) � �
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
f1 U R R E L W A L T E R S I I I E S Q 7 1 � 6 9 7,� 4 6 5 0
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RE T�R OF WILL SE YTl
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First Line of Address � 5., ��y � ;;� ;�,1
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5 4 E • M A I N S T R E E T � �,
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Second Line of Address •„ r; � � -ri
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State ZIP Code ` DATE FILED ;—
City or Post Office -� �
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M E C H A N I C S 6 U R G P A 1 7 0 5 5
CorrespondenYs e-mail address: murrel@waltersclallowaV com
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.
SI NATURE OF PERSON S N E;FOR FILING R�TURN DAT
�, 1
J ��'
A SS
% C UELYN M T � 20 WARGO LANE MECHANICSBURG PA 17055
�S NPrfURE OF P E TH HAN REPRESENTATIVE DATE 'L
� !, '(5 �T
ADDRESS
MURREL R • . WALTERS, III 54 E • MAIN ST DILLSBURG PA 17�19
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1,505610140 15056],D140 J
�
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� 1505610240
REV-1500 EX(FI) Decedent's Social Security Number
�ecedenes Name: J 0 H N W - M E T Z G E R 2 0 9 1 2 5 3 2 2
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �•
5 6 8 7 0 0 . 0 �
2. Stocks and Bonds(Schedule B) . . . ..... . . . . . . . . . . . . . . . . . . .... . . . . . . . . 2• '
3. Closely Held 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. 1 1 1 1 0 4 . 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. •
8. Total Gross Assets(total Lines 1 through 7) ...... . . . . . . . 8. 6 7 9 8 � 4 . 1 0
9. Funeral Expenses and Administrative Costs(Schedule H) 9. 2 8 5 2 6 . 4 �
. . . . . . . . . . . . . . . . . .
10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. 2 0 4 5 8 . 3 1
9 9 ( ) . . . . . . . . . . . . .
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 4 8 9 8 4 . 7 1
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . .. .. . .. .. .. . . . . . . . �2• 6 3 � 8 1 9 . 3 9
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. 6 3 0 8 1 9 . 3 9
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. � . 0 �
16. Amount of Line 14 taxable
at�inea�rate X.045 6 3 0 8 1 9 . 3 9 �s. 2 8 3 8 6 . 8 7
17. Amount of Line 14 taxable
at sibling rate X.12 � • � � 17. � • � 0
18. Amount of Line 14 taxable 0 . 0 �
at collateral rate X.15 � • � � 18�
19. TAX DUE 2 8 3 8 6 • 8 7
. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT QX
Side 2
� 15�5610240 15D5610240 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 2� 13 0392
DECEDENT'S NAME
JOHN W. METZGER
STREETADDRESS
1004 APPLE DRIVE
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 28,386.87
2. CreditslPayments
A.Prior Payments 35,000.00
B.Discount
Total Credits(A+g) �2� 35,000.00
3. Interest
(3)
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) 6,613.13
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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 ............................... X
c. retain a reversionary interest ..................................................................................................... ❑ ❑
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? ....................................................................................... � �
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?.................................................................................................. ❑ 0
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,antl before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
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 chiltl 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in p2 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,
untler Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1502 EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OFREVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOHN W. METZGER 21 13 0392
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 selier,neither being compelled to buy or sell,both having reasonable knowletlge 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 soid.
ITEM Include a copy of the deed showing decedenPs interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 1004 APPLE DRIVE 90,000.00
MECHANICSBURG, PA 17055
NET SALE PRICE
2 340 FOX HOLLOW ROAD 478,700.00
SHERMANS DALE, PA 17090
MOBILE HOME PARK
COUNTY ASSESSED VALUE
$478,700.00 X COMMON LEVEL RATIO 1.00=$478,700.00
TOTAL(Also enter on Line 1,Recapitulation.) $ 568 700.00
If more space is needed,use additional sheets of paper of the same size.
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REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCETAXRETURN pERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOHN W. METZGER 21 13 0392
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 DESCRIPTtON OF DEATH
1. MEMBERS 1 ST FEDERAL CREDIT UNION 1,436.80
REGULAR SAVINGS
2. MEMBERS 1ST FEDERAL CREDIT UNION 33.02
INVESTMENT SAVINGS
3. M &T BANK 8,362.43
CHECKING
4. M &T BANK 20,000.26
SAVINGS
5. HIGHMARK 248'27
PREMIUM REFUND
6. VETERANS AFFAIRS 100.00
BENEFIT CHECK
7. 1935 FORD 6,000.00
SALE PRICE
g. 2010 DODGE TRUCK 32,000.00
SALE PRICE
9. UNITED WATER 11.32
REBATE
10. PA RENT REBATE 250.00
11. 1978 MUNCY MOBILE HOME 3,275.00
SALE PRICE
12. DAVID MUSSER 675.00
MONTHLY INTEREST-SALES AGREEMENT
1004 APPLE DRIVE, MECHANICSBURG, PA
13. PERSONAL PROPERTY 38,712.00
PUBLIC SALE PROCEEDS
MOBILE HOME PARK
TOTAL(Also enter on Line 5,Recapitulation) $ 111 104.10
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(OS-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN W. METZGER 21 13 0392
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. COCKLIN FUNERAL HOME 11,895.34
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) JACQUELYN L. METZGER
StreetAddress 9 S. CHESTNUT STREET
�i�y DILLSBURG State PA zIP 17019
Year(s)Commission Paid: (RENOUNCED)
2 AttorneyFees: MURREL R.WALTERS, III 15,000.00
3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 803.50
5 Accountant Fees:
6. Tax Return Preparer Fees: HAMMER BILLER - 2012 FEDERAL&STATE 400.00
7. ESTATE NOTICE PUBLICATION -CUMBERLAND LAW JOURNAL 75.00
8. ESTATE NOTICE PUBLICATION-PATRIOT NEWS-METRO WEST 102.59
9. ESTATE NOTICE PUBLICATION-CARLISLE SENTINEL 180.72
10. CITIZENS BANK- ESTATE CHECKS 24.25
11. METRO BANK- ESTATE CHECKS 45.00
TOTAL(Also enter on Line 9,Recapitulation) $ 2g 526.40
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN W. METZGER 21 13 0392
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. JANE M.ALEXANDER, ESQUIRE 1,196.11
LEGAL FEES
2. PPL 132.14
ELECTRIC-1004 APPLE DRIVE
3. MOYER'S LOCKSMITH 147.00
LOCKS
4. COMCAST 7'95
TELEPHONE
5. PINNACLE HEALTH 150.11
HOSPICE
6. UNITED WATER COMPANY 45.28
WATER
7, BOROUGH OF MECHANICSBURG 138.60
SEWER&REFUSE
8. NATIONWIDE INSURANCE 218.74
VEHICLE INSURANCE
9. NATIONWIDE INSURANCE 104.00
HOMEOWNERS
10. PATIENT FIRST 409.14
MEDICAL
11. UHAUL 105.00
12. GABE SELF-STORAGE 98'08
13. GRIBBLES GARAGE 23.32
DODGE TRUCK INSPECTION
14. PA DEPARTMENT OF REVENUE 644.50
2012 INCOME TAX
15. WEST PERRY SCHOOL DISTRICT 4,911.01
201212013 SCHOOL TAXES - MOBILE HOME PARK
TOTAL(Also enter on Line 10,Recapitulation) $ 20 458.31
If more space is needed,insert additional sheets of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JOHN W. METZGER 21 13 0392
DecedenYs Name Page 1 File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, 8� Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. AMERICAN PROFIT RECOVERY 64.66
SCOTT'S LAWN SERVICE
17. BRIAN D. IMES&SONS,AUCTIONEERS 8,340.95
AUCTION EXPENSE-MOBILE HOME PARK
18. GIANT FOOD 19.91
LUNCH-AUCTION ASSISTANTS
MOBILE HOME PARK
19. RDN ENTERPRISES 3,626.81
COMMISSION AND COSTS FOR SALE OF DODGE TRUCK
20. GRIBBLE GARAGE 75.00
TRUCK INSPECTION
SUBTOTAL SCHEDULE I 12,127.33
GRAND TOTAL SCHEDULE I $ 20,458.31
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOHN W. METZGER 21 13 0392
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. JACQUELYN L. METZGER Lineal
20 WARGO LANE
DILLSBURG, PA 17019
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. $
If more space is needed,use additional sheets of paper of the same size.