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Home My WebLink About09-03-0815056041125 REV-1500 EX (06-05) OFFICU\L USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number POBOx280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0801 RESIDENT DECEDENT 2 1 0 8 0 0 9 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 3 1 4 4 9 3 3 1 2 1 8 2 0 0 7 0 5 2 4 1 ;3 2 1 Decedent's Last Name Suffix Decedents First Name MI M I L L E R P E T E R (If Applicable) Enter Surviving Spouae's Information Below Spouse's Last Name Suffix Spouse's First Name MI M I L L E R A R L E N E Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 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. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number S U S A N H CON F A I R 7 6 3 3 8 3 ~ `'. Firm Name (If Applicable) .;~;:~ .:_ REGIS ~ S USE'LNLY " } ~_ j R E A G E R & A D L E R P C "~ cr' „~. t r-:', 1`r a First line of address ~~ ~,,,~ ~ rµ~ "v ..•_~ 2 3 3 1 M A R K E T S T R E E T ~~ ~``''~~ Z Second line of address - Ca z=' ,,,, s .,. ~. .... City or Post Office State ZIP Code DATE FILED ~ C A M P H I L L P A 1 7 0 1 1 Correspondent's e-mail address: Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the hest of my knowledge and belief, it Is true, collect and complete. Dedarafion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE_FOR FILING RETURN ,,.~~ ADDRESS 710 STERLING COURT ENOLA JIIiNA I UfiE OF PR ARER THER THAN REPRESENTATIVE 2331vMARKET STREET CAMP HILL PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 PA 17025 TnE ,l S~L~ PA 17011 15056041125 15056042126 REV-1500 EX Decedent's Social Security Number DecedenrsName: PETER MILLER 1 8 3 1 4 4 9 3 3 RECAPITULATION 1. Real estate (Schedule A) ................................... ..... 1. 9 7 6 1 3, 3 6 2. Stocks and Bonds (Schedule B) ................ 2 ............. ..... . 3. Closely Held Corporatlon, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ................... ..... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. ..... 5. 9 0 0 0 , 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .. ..... 6. 0 , 0 0 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested .. ..... 7. 2 3 2 7 6 6, 8 8 8. Total Grosa Assets (total Lines 1-7) , , , , , , , . , , . , 8_ 3 3 9 3 8 0 2 4 9. Funeral Expenses & Administrative Costs (Schedule H) ............ g, .... 1 1 7 4 9 , 8 4 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........ .... 10. 11. Total Deductions (total Lines 9 & 10) ....................... .... 11. 1 1 7 4 9 , 8 4 12. Net Value of Estate (Line 8 minus Line 11) ..................... .... 12. 3 2 7 6 3 0 , 4 0 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 3 2 7 6 3 0 , 4 0 TAX COMPUTATION -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.000 2 3 0 0 1 7. 0 4 15, 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16. 0. 0 0 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 0, 0 0 15056042126 J REV-1500 FJ( Page 3 Decedent's Comalete Address: File Number 21 08 0096 DECEDENTS AME PETER MILLER STREET ADDRESS 42 PERRY AVENUE CITY BLOOMSBURG STATE ZIP PA 17815 Tax Payments and Credits: ~ • Tax Due (Page 2 Line 19) (1) 2. Credits/Payments 0.00 A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + g + C) (2) 3. InteresUPenalty if applicable 0.00 D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 0.00 FIII in oval on Page 2, Llne 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APP ROPRIATE 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; ......... Q c. retain a reversionary interest; or ............................. .......................................................... 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? .................... ............................................ a ^ ....................... 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 Acx;ount, 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 January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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-0ne 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 zero (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 four and one-half (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 decedent's siblings is twelve (12) percent ]72 P.S. §9116(a)(1.3)]. Asibling 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-1502 EX + (8-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER PETER MILLER 21 08 0096 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 seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real ro whkh Is in -owned with ri ht of survhrorehi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 42 PERRY AVENUE, BLOOMSBURG, PENNSYLVANIA 17815, COLUMBIA. COUNTY 97,613.36 ASSESSED VALUE -25,961 X 3.76 COMMON LEVEL RATIO FOR FAIR MARKET VALUE -TITLED IN MILLER FAMILY TRUST __ TOTAL (Also enter on line 1, Recapitulation) ~ S 97 613 36 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE ___...__._ PETER MILLER 21 08 0096 Include the proceeds of litgation and the date the proceeds were received by the estate. All property jointty-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. MISC. CHECKS IN NAME OF DECEDENT 9,000.00 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (8-98) SCHEDULE G INTER-VIVOS TRANSFERS 8~ COM NHERITANCETAXERETURN~IA MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER PETER MILLER 21 08 0096 This schedule must be completed and 81ed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM NUMBER Ip0.U0E1HERAIAEOFTiffTRANSfEREE,TH6RRflATpNSFpPTODECEDENTANU T'~0"~OFrA""SCR.ITT'~c""cor,'°FT"EO~oFORRPxesrnTe. DATE OF DEATH VALUE OF ASSET °60FDECD'S INT EXCLUSION TAXABLE EREST pFnPPUCne~~ VALUE 1. MILLER FAMILY TRUST, ARLENE MILLER, TRUSTEE- 12,017.00 100. 12,017.00 SPOUSE /COLUMBIA COUNTY FARMERS NATIONAL BANK -CHECKING 2. MILLER FAMILY TRUST, ARLENE MILLER, TRUSTEE - 3,521.09 100. 3,521.09 SPOUSE/ COLUMBIA COUNTY FARMERS NATIONAL BANK -SAVINGS 3. MILLER FAMILY TRUST, ARLENE MILLER, TRUSTEE - 3,003.79 100. 3,003.79 SPOUSE/COLUMBIA COUNTY FARMERS NATIONAL BANK -CERTIFICATE 4. MILLER FAMILY TRUST, ARLENE MILLER, TRUSTEE- 41,178.05 100. 41,178.05 SPOUSE/OPPENHEIMER & CO. INC. -IRA BENEFICIARY -ARLENE MILLER -SPOUSE 5. MILLER FAMILY TRUST, ARLENE MILLER, TRUSTEE- 140,567.24 100. 140,567.24 SPOPUSE/ OPPENHEIMER & CO., INC. -INVESTMENT ACCOUNT 6. PETER MILLER/SHENANDOAH LIFE INSURANCE 30,399.55 100. 30,399.55 COMPANY-DEFERRED ANNUITY - BENEFICIARY- ARLENE MILLER -SPOUSE 7. PETER MILLER/MASS MUTUAL FINANCIAL GROUP- 2,080.16 100. 2,080.16 NON-QUALIFIED ANNUITY -BENEFICIARY - ARLENE MILLER -SPOUSE TOTAL (Also enter on line 7 Recapitulation) ~ s 232 766 88 (If more space is needed, insert addfional sheets of the same size) REV-1511 FJC + (~ p_gg) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF PETER N SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS 21 08 0096 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. FUNERAL - BUNNELL FUNERAL HOME, INC. 2. MEAL AFTER SERVICE - ST MATTHEWS LUTHERN CHURCH B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Sodal Security Number(suEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees REAGER & ADLER, PC 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 5. I Accountant's Fees 6• ~ Tax Return Preparer's Fees ~• CUMBERLAND COUNTY REGISTER OF WILLS -RENUNCIATION 8• CUMBERLAND COUNTY REGISTER OF WILLS -SHORT CERTIFICATES 9• ADVERTISEMENT -CUMBERLAND LAW JOURNAL 10. ADVERTISEMENT -THE CENTRAL PENN BUSINESS JOURNAL TOTAL (Also enter on line 9, Recapitulation) ~ S (If more space is needed, insert additional sheets of the same size) AMOUNT 8,398.84 500.00 2,600.00 75.00 10.00 12.00 75.00 79.00 49. REV-15t3 EsY + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT OF ~. SCHEDULE J BENEFICIARIES I ~- NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS pndude o ht sppoousal distributans, and transfers under Sec. 91166 (~a (1.2)j 1. ARLENE MILLER 42 PERRY AVENUE BLOOMSBURG, PA 17815 FILE NUMBI 21 08 1TIONSHIP TO DECED Do Not List Trustee(s) Spousal AMOUNT OR SH OF ESTATE 230,017.04 ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I : (If more space Is needed, Insert additional sheets of the same size)