HomeMy WebLinkAbout08-24-15 1505610143
� REV-7500 �"°�"'
(j� OFFlCIAL USE ONLY
PADepatlmentofRevenue pennsylvania cwniycoae vear F�cN�mee,
BureauoflndlvldualTaxes °°°w*"�"°`°°'�"�°
Po Box 2easoi INHERITANCE TAX RETURN p l 15 0 5 7 0
Harrisburg.PH in28-0601 RESIDENT DECEDENT
ENTER DEGEDENT INFORMATION BELOW
Social Security Number Date of Dea�h �ate of Birth
OS 13 2015 11 15 1952
�ecedenfs Las�Name Suffix �ecedenfs Firs�Name MI
MYERS SUSAN J
Qf Applicable)Enter Surviving Spouse's Intormation Below
Spouse'sLaslName Suffix Spouse'sFirsWame MI
Spouse's Sacial Securiry Number THIS RETURN MUST BE FILEO IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. OriglnalReNm ❑ 2. Supplemen�elRaWm � 3 RemalnderReNm(�e�eofDea�h
'Priarto 124582)
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CORRESPONOENT-THIS SECTION MIlST BE LOMPLETED.ALL CORRESPON�ENCE RND CONFIDENTIAL TW(INFORMATION SHOULO BE OIRECTEO TO:
Name Day[ime Telephone Number
VICP.Y ANN TRIMMER ESQ 717 724 9821
REGISTER OF WILLS USE ONLY
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Fire[LineofFddress r O ,� � �
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635 N 12TH STREET SUITE ��=i " ci �- U
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Secontl Line ot Atldress . � s '�. �
� DATEPI � �' '�'��
CityorPostOffice SGIe ZIPCotle � '
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LEMOYNE PA 17043 . rv �- �.�
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Correspontlent'se-mailaddress: `/I�Irt11fICf�dZRIrt112W.COR1
Upder enaltles gi pe�um le�e Decle�atlon o!e minee��s�re�um inUuaing ae�sen�etive�s ease�a on e�ll INo�rmar�n'ofwM n e besrer�nas an�knowle0nd�eliet
p pr parero persona pre prepa y ge.
�G .�/P�o� E�a�oh,L„��.E.,� p`�y�
/t�i Pa[ricia A.M. Havens / /�
ADfJRE55
1275 Crestfield Drive,Williamsport, PA 17701
�$IGNAT EOFPRy�"0.EROT flEFFF$FNTATNE �ATE
:�/�.� Vicky Ann Trimmer Esq Q,'�.(I� �'
nooaes
Daley Zucker Meilton 8 Miner, LLC
635 N 12th Streel Suite 101 Lemoyne PA 17043
Side 1
L 1505610143 1505610143 J �
J 1505610243
REV-0500 EX
Oecedenfs Social Securi[y Number
n..:ea�r�Hama MYERS, SUSAN JANE
RECAPITULATION
1. RealEstate(ScheduleA)._ ____. .......... ._........ 1.
2. Stocksantl6onds(SchetluleB) ................ ...........__ ___.._ 2.
3. Closely Heltl Corporation,Partnership or Sole-Pmprie�o5hlp(Schetlule C).......... 3.
4. MortgagesBNotesReceivable(ScheduleD) ____. .___... 4.
5. Gash,Bank Oeposits 8 Mlscellaneous Personal Pmperry(Schetlule E)................ 5. 1 3 , B 3 2 . 9 5
6. Jointly Owned Propetly(Schetlule F) ❑ Separate Billing ReQues�etl..._........ 6. 5 � 4 z z . �4
]. Inter-Vlvos Transfers 8 Miscellaneous Non-Pmbate Pmperty
(ScheEule G) ❑ Separate Blllinq Reques�ed.___.__ ).
g, To[alGrossAssetsQotalLinesl �M1mugM1]) ____. .____. 8. 19 , 255 . 69
_'___--
& Poneral Expenses and Adminisiretive Costs(Schetlule H)..............__................... 9. 2 1 � 7 8� . 5 2
10. DebisofDecedenLMotlgageLiabilitiesantlLiens(Schedulel)._____________.. 10. 46 . 41
11. TOGIOeductions(ro�alLines9antl10)......_ ____. .__.__ ��. 21 � 626 . 93
�Z. NetValueofESWte(LineBminusLinell)_ ____. ........_. 12 -2 � $71 . 24
�3. CharitableandGovemmentalBeQuesisl5ec9113Tmsisforwhich
an elecYion to tax has not been made(Schetlule J) ......... ..____ 13.
14. Ne[ValueSubjectroTax(Linel2minusLinel3) .____ .____. iq, -2 , 571 . ZQ
TAX GOMPUTATION-SEE INSTRIICTIONS FOR APPLICABLE RATES
15. AmountofLine141axable
at Ihe spousal tax rate,or
Vansfers untler Sec.9116
(al(t 2)x DO 15.
16. Amount of Gne 141axable
allinealreteX .�45 �6-
1]. AmountofLinel4�axable
atsiblingrate% ,�p »-
18. AmountofLineib�axable
atcollateralrateX .15 �8-
19. TAX�OE _. . . . ......... ............... ...___ .___._ 19. 0 . 00
20. FILL IN THE OVAL IF VOU ARE REQUESTING A REFOND OF AN OVERPAYMENT. ❑
Side 2
L 1505610243 1505610243 J
REV-1500EXPage3 FileNumber 27 - 15 - 0570
DecedenYs Complete Address:
DECEDENT'SNAME
Myers, Susan Jane
STREETADDRE55
1004 Havenwood Court .. .
qTY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
L Tax Due(Page 2.Llne 19) (1) 0.00
2. CreditslPaymenls
A. Prior Payments _
e. Discount
� TotalCretlits(A +B) (2) Q.00
3. Interest (3) Q.00
4. If Line 2 is greater[han Gne 1 +Line 3,enterthe tliRerence. TM1is Is Ihe OVERPAYMENT. (4)
Check boz on Page 2,Line 20 to request a refuntl
5. If Line 1 t Line 3 is grealer�han Line 2,enter Ihe difference. This is IM1e TAX OUE. (5) _ 0.0�
Make Check Payable to: REGISTER OF WILLS, AGENT.
€".� �.r�•€��ar A�.� ,�a '�fi�� `x�?��i� :�.� ., �. *�� �„ ��, ��
PIEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. �itl decedent make a lransfer antl'. Ves No
a. retaintheuseorincomeofihepmperty[ransferretl ....__. ___. .._. ._. ❑ �
b. retainlherightrotlesignatewhoshallusethepmpeM��ansferretlon�smwme;. .__ __ � I �
c. re�ainareversonaryinterest or _...._ __ ._. .. � 0
� I�I
tl. receivethepromireforlifeofeilFerpaymen�s benetlsorcare9 __. � `.J
2. If death occurred afler Dec. 12, 1982 dd tlecedent �ransfer property withm one year of dea�h withou�
receivingadequateconsitlera�ion? ._....... ........._ _-....- ---�-�. � �
3. �itldecetlentownan"in�ms�for" arpayableupondea�h�ankacwunto�secuntyathisorherdeath2___. U �
4. Ditl tleceden[own an indlvidual rehrement account,annwty or other non pmbate pmpetly which
rqntainsabene(ciarydesignation"+ ._..... .____ ____. _....... ... U U
IF THE ANSWER TO ANV OF THE ABOVE Ol1ESTIONS IS YES,VOU MUST COMPLETE SGHEDULE G AND FILE IT AS PART OF THE RETURN.
' ,. , i. r R^ . . : . .
-c? s,ft. � . . '�m2�24�i .� .
For tla�es of death on ar afier July 1,1994 and before Jan. 1, 1995.the�ax rate imposetl on�he nel value of�ransfere�o orforthe use of�he surviving
spouse is 3 percenl�]2 PS.§8118(e)(1.1)(�}
Por dates of tleath an or afler January 7, 1995,the tax rate impose0 on ihe net value of Vansters to or for the use of the surviving spouse is 0 percent
[72 P 5.§9118(a)(1.1)(ii)]. The statute tloes mt exempt a trensferto a survlving epouse from tax,antl ihe staNtory requlrementa tor tllsclosme of
assets and fling a tax refum are s[ill applicable even if the surviving spouu is the only benefciary.
Por tlates of Geath on or aker July 1,2000�.
•The tax rate imposed on the net value of transters fmm a tleceased child 21 years olage or younger al death to or br the use of a nahral parent,an
atlaplive parent,or a stapparent of ihe chlld is 0 parcent p2 P.S.§9116(a)(1 2)]
•The tax rate Imposed an ihe net value of irawfers lo or for the use of Me tlecetlenfs lineal beneficiaries is 4.5 percen�,except as noted in
�]2 P.S.§91181a)(1)I.
•The tax rale imposed on ihe net value of iransfers to orfor ihe use of Ihe tlecedenPs siblings is 12 percent[]2 P S.69116(a)(1.311. A
sibling is tlefinetl untler Sedion 91�2,as an indivitlual who has a�least one parent in common wi�h lhe decedent wFether by blood or atloption.
� pennsylvania SCHEDULE E I
�� °E""a'""`"To"'E°E"°E CASH, BANK DEPOSITS AND MISC.
wHEairnHCEracHeruaru
Resior�roeceoeNr PERSONAL PROPERTY
-� - � � � FILE NUMBER �
ESTATEOF Myers, Susan Jane � 2� - �5-o570 � .
Include the proceeds of litigation antl ihe date ihe proceeds were received by the eslate. All property jointly-owned with lhe righ[of
survivorship must be disclosed on schedule F.
ITEM � DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 PSECU Savings Account � � 162.01
2 PSECU Checking Account 1,909.10
3 PSECU Savings Account 514.92
4 PSECU Checking Account 96.45
5 M8T Bank Checking Account No. 950263015 384.10
6 M8T Bank Savings Account No. 15004225671757 7,967.95
7 Household Goods and Furnishings 1,000.00
8 Genworih Long Term Care Insurance Refund 1,636.17
9 Highmark Insurence Refund �2�25
10 Retina Specialis[Refund 35.00
TOTAL(Also enler on Line 5, Recapitula[ion) 13,832.95
REV 1509 Eb(Di-00)
� pennsylvania SCHEDULE F
DEPARTMENTOFREVENOE
���ER��A��E��aET�R� JOINTLY-OWNED PROPERTY
aesioEuroECEocrvr
.. - - . _ ._ -- _ —._ — — - —
ESTATE OF I FILE NUMBER
Myers, Susan Jane . 21 - 15 - 0570 _
If an asset was made joint wilhin one year of the tlecetlent's date of death, it must be reported on schedule G.
SURVIVINGJOINTTENANT(S)NAME � � �ADDRESS RELATIONSHIPTO�ECEDENT
Jane C. Myers Testamentary Trust Patricia A.M. Havens, Tmstee Trust
q FBO Susan J. Myers 1235 Cres�eld Drive
Williamsport, PA 17701
Patricia A.M. Havens 1235 Cres�eld Drive � Sister �
g Williamsport, PA 17701
JOINTLY OWNED PROPERTV:
LETTER DATE RF�SCRIPTIO�(�FPRO�ERTY %OF onrEOFOEnrH
ITEM InGude name o inanaal ins i u ion an �ank account numbe OATE OF�EATH pECD'S vnwe or
NUMBER FORJOINT MA�E orsimilaritlentifyingnumber.Attachdeetlforjointly-heldreal VAWEOFASSET INTEREST �Eceoeurswreaesr
TENPNT JOINT es�ate.
1 A � � 2009ToyotaCorolla +o,000.00� � 50% 5,000.00
2 B Schwab One Account No. 6570-1292 ea5 aa Sp/� q227q
� ����I _ .._.
� TOTAL(Also enter on line 6, Rewpitulation) 5,42274
PEV-0Sfl EX��10J19�
�,-;�. pennsylvania SCHFDl1LEH
!�� oevna.meHroraeveHue FUIF`FRRALD�QJSE$/1ND
irvHEairnHceracaFruaN �N$�1��.�.
aEsioEHroECEOENr
� ���� � FILE NUMBER
ESTA7E OF Myers, Susan Jane 21 - 15-0570
__
Decetlent's debts must be reported on Schedule I.
ITEM . _- ._ __ ..__ _. _
NUMBER FUNERALEXPENSES: DESCRIPTION AMOUNT
A. 1 Myers-Hamer Funeral Home, Ina � � 13,800.00
2 Isaacs (catering of funeral luncheon) 430.62
3 Decedenfs dothing for funeral 200.58
4 Gingrich Memorials 3,263.00
5 Trindle Springs Cemetary 750.00
B. ADMINISTRATIVE COSTS:
�. PersonalRepresenlative'sCommissions
Name of Personal Representa[ive(s)
SireetAtltlress
Ciry Sta�e Zip
Vear(s)Commisslon Peltl
z. a�mmey's Fees Daley Zucker Meilton & Miner, LLC 3,000.00
3. Famity Exemption�. (If tlecedenYs adtlress is not the same as claimanfs,atlach explanation)
Claimant
SireetAdtlress
Giry State Zip
Relationshlp of Claimant to Decetlent
q. pmbare Fees Regis[er of Wills Office of Cumberland County, PA 135.50
5. AaountanfsFees
6. Taz Re[urn Preparers Fees
). Other Ftlminlshative Cosis
� �� Cumberland Law Journal (advertise Estate Notice) 75.00
See attached 125.82
TOTAL(Also enter on line 9, Recapitulation) 21,780.52
Schedide H
�_ . Fu�eral E�er�s 8 .�.
COMMONWEAITHOFPENNSYLVPNIA wy:�Mr��_.�-J
NHERIiANCETMRENRN /�YI�INIIQYYGVIAV IIIIW
aesioervroeceoeHr
� � �-� - FILENUMBER -
ESTATE OF MyefS, SUSan Jane 2� - 15 - 0570
z The Sentinel (advertise Estate Notice) 125.82
Page 2 of Schedule H
s;, pennsylvania SCHEDULE I
�» i"""�"'E"To�aE°`rv0� DEBTS OF DECEDENT, MORTGAGE
NHERITANCE TM RENRN
Resioer�roeceoeNr LIABILITIES & LIENS
__ � ... . .. . ._ --- —,— .._ __. ..
FILE NUMBER
ESTATE OF Myers, Susan Jane z� - �s-os�o
Report debts inwrred by�he decetlent prior to dealh�hat remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
� DESCRIPTION AMOUNT
NLIMBER
1 Susquehanna Internal Medicine 10.00
2 Medicine Shoppe 36.41
TOTAL(Also enler on Line 10, Recapitulation) 46.41
REV 15ll E%��0110�
� pennsylvania SCHEDULE J
oEaaarmEHraFaEVErv�� BENEFICIARIES
INIICRITPNCE TM RETVRN
aEsioErvr oEceoervr
_ _. _. __. . ._ . ._-__—
_ _. ___. _ -.... .. —_
ESTA7E OF Myers, Susan Jane �FILE NUMBER
I 21 - 15-0570
�� �ROPERTV R�L4,LON9 HI�;O � � � SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER '� NNMEANOADDRESSOFPERSON(5) OECEOENT (Wo�tls) ($$$)
I _ _.
�. �TAXABLEDISTRIBUTIONS[inclutleoulrightspousal �i
disVibulions,antl,rans(ers
� under Sec.9116(a)(12)] �I
1 Patricia A.M. Havens Sister 50% �ii
1235 Crestfield Drive ��
Williamsport, PA 17701 �i
2 George Robert Myers Brother 50%
1004 Havenwood Court
Mechanicsburg, PA 17050
�Enter tlollar amounts for distributions shown above on lines 15lhmugh 18 on Rev 15�0 cover sheep as appmpriate. ��
II. NON-TAXABLEDISTRIBUTIONS'. '�,
A.SPOUSAL DISTRIBIITIONS UNDER SECTION 9113 FOR WHICH AN ELEQION TO TAX IS NOT TAKEN �,
I B.CHARITABLE AN�GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LME 13 OF REV-1500 COVER SHEET 0.00
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Ofrice of the Register of Wills
� Cumberland County Courthouse
� One Courthouse Square
Cadisle, PA 17013
Rc: Estate of Susan Jane Myers
Filc No. 21-IS-0570
Uca� Gendeperson:
anlaicin enaev zuckea PLease find enclosed for filing an original and three (3) copies of an Inheritance
snNoan� Mei�roN Tax Remm and two (2) copies of an Inventory i� the above-refecenced Estatc.
srsveN a. Mwea Please retum the date-stamped copies to me in the enclosed sclf-addressed,
ouwrwn m.�nuoeaMi�cn stamped emelope.
VICKY ANN TRIMMER
susnH e_o00o I havc cnclosed a check in the amount of$30.00 made payablc ro the Rcgister of
_ Wills for the additional probate fces due.
PATRICIA A. PATfON
oFFice nomiHisranroa 'I�hank you for your assistancc wi[h this filing. Should you havc any questions,
please do not hesitate to contact me.
Very t[uly yours, _
� � m
DALEY ZUCKER � p �'� m o
G
MEILTON & MINER, LLC ;� � c� � '; �
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Courtney M. Jurin� . rv m
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Enclosures
UAI. EY ZUCKER MEII.TON & MINLR. LLC
635 N. 12TH STFEET. SIJITE 101. �EMOVNE PA I]043 • �I�O24-9821 • �1�024-9826 F�x • DZMMLAW.COM
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