HomeMy WebLinkAbout08-06-15 pennsytvania 1505614105
DE.RTMENTOFPEVEWE EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
i,01272015 07311922
Decedent's Last Name Suffix Decedent's First Name MI
Myers Gordon [D
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
NA
r
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of O 5. Future Interest Compromise(date of C=) 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
OiD 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets CD 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Patricia Armstrong Morgan 1 !(717)418-1501 i
First Line of Address
212 Locust St
Second Line of Address
Suite 600
City or Post Office____.___._--_—_.—._..�__�—_..."."_ State—WZIP Code
Harrisburg
PA � � ;17101 1
gI I
Correspondent's email address: parmstrong@tntlawfirm.com
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY
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PLEASE USE ORIGINAL FORM ONLY
Side 1 fw c ti
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cnX505614105 1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Gordon D. Myers
RECAPITULATION
1. Real Estate(Schedule A). ..... .............. ... ......... ......... .... 1. 0.00
2. Stocks and Bonds(Schedule B) 2. 55,381.00
... .. ........ .... . ......... .... .. ... .. .
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. 0.00
4. Mortgages and Notes Receivable Schedule D 4. 75,858.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . .... . 5. 358,786.32
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... ... 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested... .. ... 7. 1,217,718.00
8. Total Gross Assets total Lines 1 through 7 8. 1,707,743.32
9. Funeral Expenses and Administrative Costs(Schedule H)......... .... ... ... 9. 77,983.14
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)..... ..... ..... 10. 9,511.98
11. Total Deductions(total Lines 9 and 10). ............... ...... ........... 11. 87,495.12
12. Net Value of Estate(Line 8 minus Line 11) ... ............ ...... .. .. ..... 12. 1,620,248.20
13. Charitable and Governmental Bequests/Sec.9113 Trusts for which T _
an election to tax has not been made(Schedule J) ..... .... ....... .. .... .. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) .. .......... .......... .. 14. 1,620,248.20
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 000
(a)(1.2)X.0 .
_ 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X.0 45 1,573,465.00 16, 70,805.92 .
17. Amount of Line 14 taxable �-
at sibling rate X.12 0.00 17, 0.00
18. Amount of Line 14 taxable
at collateral rate X.15 46,783.20 18 7,017.00
19. TAX DUE ... . .... .. .. . .. ..... ....... .. ..... .. .. . ............. . .... 19. 77,822.92
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
Sl, ATURE OF PERSON ESPON IBLE FOR FILING RETURN DTE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS
Side 2
L 614 1505614205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Gordon D. Myers
STREET ADDRESS
5225 Wilson Lane
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1)
2. Credits/Payments
A.Prior Payments 70,000.00
B.Discount 3,684.21
(See instructions.) Total Credits(A+B) (2) 73,684.21
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 41138.71
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.......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ E
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"or payable-upon-death bank account or security at his or her death?.............. ❑ 0
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,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 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 step-parent 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 one parent in common with the decedent,whether by blood or adoption.
REV-1503 EX+(842)
Pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gordon D. Myers 21-15-0159
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 376 Shares PNC stock
32,236.00
2 JP Morgan Short Duration Bonds 23,145.00
TOTAL(Also enter on Line 2, Recapitulation) $ 55,381.00
If more space is needed, insert additional sheets of the same size
REV-1507 EX+ (04-13)
lo , pennsylvania SCHEDULE D
DEPARTMENT OF REVENUE MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gordon 0. Myers 21-15-0159
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Loan to Stephen Myers I 45,031.00
2 Loan to Stephanie Myers and Tyler Johnson I 30,827.00
TOTAL(Also enter on Line 4, Recapitulation) $ 75,858.00
(If more space is needed,insert additional sheets of the same size.)
REV-i5o8 EX+(o8-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Gordon D. Myers 21-15-0159
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. Cash in Wells Fargo Account 881-0851 35,862.00
2 Asbury Deposit Refund 318,600.00
3 Asbury monthly refund 535.90
4 Verifone Securities Litigation check 26.92
5 Sanofi Aventis Securities Litigation check 14.81
6 2014 Federal Tax Refund 3,260.00
7 Miscellaneous property in one room in Continuing Care facility 200.00
8 Progressie Insurance Refund 75.00
9 Pall Corp Securities Litigation check 30.11
10 Bank of America litigation check 181.58
TOTAL(Also enter on Line 5, Recapitulation) $ 358,786.32
If more space is.needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
��, pennsylvania SCHEDULE G
1 W DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gordon D. Myers 21-15-0159
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 DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE
INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. IRA account 6123-6582(Wells Fargo) 294,376.00 100 0.00 294,376.00
2 IRA account 6123-6637(Wells Fargo) 316,485.00 100 0.00 316,485.00
3 IRA account 6123-6666(Wells Fargo) 396,104.00 100 0.00 396,104.00
4 Lincoln Financial Annuity(Wells Fargo) 191,753.00 100 0.00 191,753.00
5 Gordon Dale and Linda Myers-Christmas gift 12,000.00 100 6,000.00 6,000.00
6 Steve Myers-Christmas gift 6,000.00 100 3,000.00 3,000.00
7 Suzanne Enders-Christmas gift 12,000.00 100 3,000.00 9,000.00
8 April Enders-Christmas gift 4,000.00 100 3,000.00 1,000.00
TOTAL(Also enter on Line 7, Recapitulation) $ 1,217,718.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gordon D. Myers 21-15-0159
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Obituary,Flowers,Church 3,258.14
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 40,000.00
Name(s)of Personal Representative(s) Patricia A Morgan____ __
Street Address 34 Shellwind Dr
City_Savannah....__..._ _—__.....-- ._._state GA.....ZIP 31411 _....._
Year(s)Commission Paid:
2. Attorney Fees: 26,000.00 '
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: 526.00
5. Accountant Fees: 8,000.00
6. Tax Return Preparer Fees:
7. Death Certificates 199.00
TOTAL(Also enter on Line 9, Recapitulation) $ 77,983.14
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,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gordon D. Myers 21-15-0159
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• Medicinne Shop 1982 361.98
2 Thomas Niesen and Thomas 8,450.00
3., Pennsylvania Income taxes 700.00
F
TOTAL(Also enter on Line 10, Recapitulation) $ 9,511.98
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania . SCHEDULE J
i DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Gordon D. Myers 21-15-0159
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. Gordon D.Myers II-percentage after Kay Cooper's Son 25%
2 Stephen C. Myers-same Son 25%
3 Suzanne Enders-same Daughter 25%
4 Stephanie Myers Johnson-same Granddaughter 8.33%
5 Leigh Ann Enders-same Granddaughter 8.33%
6 April Enders-same Gradndaughter 8.33%
7 Kay Cooper(age 91 -$1000/month up to$120,000)(Per Bill Lyons- none 46,783.2
3.8986x12x1000=46,783,2
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.
REV-1514 EX*(1-15)
Q]pennsylvania SCHEDULE K
' DEPARTMENT OF REVENUE LIFE ESTATE, ANNUITY
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 & TERM CERTAIN
HARRISBURG PA 17128-0601
ESTATE OF FILE NUMBER
Gordon D. Myers 21-15-0157
This schedule should be used for all single-life,joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single-life calculations can be obtained from the Department of Revenue.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return.
■ Will O Intervivos Deed of Trust O Other
LIFE ESTATE INTEREST CALCULATION
NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH LIFE ESTATE IS PAYABLE
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 120,000.00
2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest table rate - ❑ 3.5% ❑ 6% ❑ 10% ❑Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
ANNUITY INTEREST CALCULATION
NAME OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH ANNUITY IS PAYABLE
Kay Cooper 04/23/1924 91 ❑ Life or ❑Term of Years
calculation on Schedule J per Bill Lyons ❑ Life or ❑Term of Years
3.8986 X 12 x$1000 = $46,783.20 ❑ Life or ❑Term of Years
❑ Life or ❑Term of Years
1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 120,000.00
2. Check appropriate block below and enter corresponding number . . . . . . . . . . . . . . . . . .. . . . . . . .
Frequency of payout- ❑ Weekly(52) ❑ Bi-weekly(26) ■ Monthly (12)
❑ Quarterly (4) ❑ Semi-annually (2) ❑ Annually (1) ❑ Other( ) seescheduleJ
3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 1,000.00
4. Aggregate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,000.00
5. Annuity Factor(see instructions)
Interest table rate - ❑ 3.5% [16% ❑ 10% ❑Variable Rate
6. Adjustment Factor(See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Value of annuity- If using 3.5, 6, or 10%, or if variable rate and period
payout is at end of period, calculation is Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . .$ 46,783.20
If using variable rate and period payout is at beginning of period, calculation is
(Line 4 x Line 5 x Line 6) + Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of
the tax return.The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return.
If more space is needed, use additional sheets of the same size.
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND SS File Number 21-IS-0159
Personal Representative(s)of the Estate of Gordon D.Myers
deceased,depose(s)and say(s)that the items appearing in the following inventory include all of the personal assets wherever situate
and all ofthe real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven-
�_4 d"I"
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney-- (Name) Patricia Armstrong (Supreme Court I.D.NO) 23725
(Address) 212 Locust St Suite 600 Harrisburg,Pa 17108
(Telephone) 717-418-1501
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC.SEC.NO.
1/27/2015 5225 Wilson Lane,Mechanicsburg,PA 193-18-5282
FIGURES MUST BE TOTALED
Stocks and Bonds 55,381.00
Notes Receivables 75,858.00
Cash,refunds and Personal Property 358,604.74
IRA Accounts-Wells Fargo(non Probate) 1,198,718.00
Did not include Christmas gifts from Schedule G of$19,000
(Attach additional sheets as needed)
TOTAL: 1,688,561.74
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item,but such figures should not be extended into the total of the Inventory. (See 20 Pa.C.S.§3301(b))
Form RN'09 ren. 10.13.06