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Home My WebLink About10-10-08 (2)15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code rear File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 OS 00163 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 161 20 3777 01 29 2008 01 16 1925 Decedent's Last Name Suffix Decedent's First Name MI MILLER THELMA M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW I^ 1 1. Original Return 4. Limited Estate Ir ~ g Decedent Died Testate J xJ (Attach Copy of Will) ~-- MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return ~ 3. Remainder Retum (date of death prior to 12-13-82) 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ~ Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) i ! 9. Liti ation Proceeds Received L-~ 10' be~ueen1231 y9lCandtlal 95jf death ~, 11.Election to tax under Sec. 9113(A) J g (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DAVID M LAUCKS ESQ. 717 244 3272 r-s Firm Name (If Applicable) LAUCKS &LAUCKS, LLP First line of address 105 WEST BROADWAY Second line of address City or Post Office RED LION State ZIP Code PA 17356 -t ,, - O -c j~ N DATE FILED ~ Correspondent'se-mail address: dlauCkslcDlauCksandlauCks.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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETUCily DATE Donna L. Witmer ~U 635 Herman Avenue, Le oyne, PA 17043 SI RE EP ERGOT TH REPRESENTATIVE DATE ,~ , ~~ David M Laucks Esq. OC 1 - 8 2000 105 West Broadway, Red Lion, PA 17356 Side 1 15056041147 15056041147 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 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. Signature #2 Name Address1 Address2 City, State, Zip Date ~c.,~ ~~ Lin a C. Ferich 115 Chelsea Loop Lancaster, PA 17602 ~~ ~ /d~ REV-1500 EX 15056042148 DecedenPS Name: T h e l Ill a M. M l l l e r• __ -__ RECAPITULATION 1. Real Estate (schedule A) ...................................................................................... 1. 2. Stocks and Bonds (Schedule B) ..............................__........................................... 2. 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. 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 1-7) .............................__.................................. 8. Decedent's Social Security Number 161 20 3777 73,992.65 21,887.74 95,880.39 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ................................................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................._........................... 12. 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. 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 .00 0 . ~ ~ 15. 16. Amount of Line 14 taxable 118 51 72 1s. at lineal rate X .045 . , 17. Amount of Line 14 taxable at sibling rate :K .12 0.0 0 17' 18. Amount of Line 14 taxable at collateral rate X .15 0.0 0 18. 19. Tax Due ............................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 22,798.44 963.44 23,761.88 72,118.51 72,118.51 0.00 3,245.33 0.00 0.00 3,245.33 Side 2 15056042148 15056042148 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-00163 DECEDENT'S NAME Thelma M. Miller _ STREET ADDRESS 635 Herman Avenue CITY STATE ZIP Lemoyne PA 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments q. Spousal Poverty Credit g, Prior Payments C. Discount 3. InterestlPenalty if applicable p. Interest E. Penalty 3,098.39 162.26 Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. 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 theTAX DUE q. Enter the interest on the tax due B. Enter the total of Line 5 + 5A. This is theBALANCE DUE Make Check Payable to: REGISTER OF WILLS, AGENT (1) 3,245.33 (2) 3,260.65 (3) (4) (5) (5A) (58) 15.32 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 :............................................................................. [J ~~ b. retain the right to designate who shall use the property transferred or its income :................................ [~ 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? ................................................................................................................. ^ 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 designations .................... ^ 'i] 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, 1955, 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)J. The statutedoes not exemota 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-one 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)J. 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)]. 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointlyrowned with the right of survNOrship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Commonwealth of Pennsylvania -Rent rebate check 500.00 2 United States Treasury -Economic stimulus check 300.00 3 Deposit -Return of overpayment 3.00 4 Sovereign Bank -Cert. of Deposit # 39994 -Date of Death Balance (Principal) 72,894.48 Accrued income on Item 4 through date of death 295.17 TOTAL (Also enter on Line 5, Recapitulation) I 73,992.65 (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-7509 EX+ (g.g8) SCHEDULE F COMMONWEALTH OF PE:NNSVLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 If an asset was made Jolnt within one year of the decedent's date of death, k must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Donna L. Witmer B. C. 635 Herman Avenue Daughter Lemoyne, PA 17043 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 6/30/2003 Sovereign Bank Checking Acct. # 43784 - 43.771.71 50.000% 21,885.86 Date of Death Balance (Principal) 2 A 6/30/2003 Sovereign Bank Checking Acct. # 43784 - 3.76 50.000% 1.88 Accrued interest through date of death TOTAL (Also enter on Line 6, Recapitulation) I 21,887.74 (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 F (Rev. 6-98) REV•1151 Ex+ (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 13,411.97 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Sealrity Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Loucks & Loucks, LLP 4,030.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Donna L. Witmer Street Address 635 Herman Avenue city Lemoyne state PA zip 17043 Relationship of Claimant to Decedent Daughter 4. Probate Feels 181.00 5. Accountant':s Fees 650.00 6. Tax Return Preparer's Fees 480.00 7. Other Administrative Costs 545.47 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 22,798.44 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EXf (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-A FUNERAL EXPENSES continued ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 ITEM NUMBER DESCRIPTION AMOUNT 1 Burg's Funeral Home -funeral costs 52.00 2 Golden Memorial -Fee to engrave stone 225.00 3 Witmer, Donna L. -Reimbursement to Donna L. Witmer, for payment of funeral, paid 12,283.46 to Burg's Funeral Home 4 Witmer, Donna L. - Reimbursement to Donna L. Witmer for food for funeral 851.51 luncheon„ honorariums to Church, and funeral flowers Copyright (c) 2002 form software only The Lackner Group, Inc. Subtotal I 13,411.97 Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (8.98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 ITEM NUMBER DESCRIPTION AMOUNT 1 Laucks &Laucks, LLP -Reimbursement to Laucks &Laucks, LLP, for costs 344.47 advanced (Advertisement to Sentinel and Cumberland Legal Record, fax transmissions and postage costs) 2 Register of Wills -Filing fees to file Inheritance tax return, inventory, Petition for 160.00 Adjudication and Accounting 3 Witmer, Donna L. -Reimbursement to Donna L. Witmer for cost of mailing supplies 41.00 Subtotal ~ 545.47 Copyright (c) 2002 form sofb~vare only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Camphill Emergency Physician -Fee for services rendered 112.51 2 DJO, LLC -Fee for services rendered 10.34 3 NCO Financial System - Bmg music 59.93 4 Quantum Imaging -Fee for services rendered 1.71 5 Spirit Physicians Service -Fee for services rendered 135.00 6 Witmer, Donna L. -Reimbursement to Donna L. Witmer for payment to West Shore 75.00 Ambulance 7 Witmer, Donna L. -Reimbursement to Donna L. Witmer for payment to Riverside 119.64 Ambulance Association 8 Witmer, Donna L. - Reimbursement to Donna L. Witmer for payment for decedent's 40.75 purchase of Jerry Baker's Bird Book 9 Witmer, Donna L. -Reimbursement to Donna L. Witmer for payment to Orthopedic 405.27 Institute -fee for services rendered 10 Witmer, Donna L. -Reimbursement to Donna L. Witmer for payment to Quantum 3.29 Imaging $ Therapeutic Assoc. for fee for services rendered to decedent TOTAL (Also enter on Line 10, Recapitulation) I 963.44 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form softy/are only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) „_,_._._~. ,___, gCHEDULE J ANIA COM ET X TA N BENEFICIARIES A RETURN H RI NC I RESIDENT L)ECEDENT ESTATE OF FILE NUMBER Miller, Thelma M. 21-08-00163 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT Do Not List Trustee s (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. ~116(a)(1.2)} See attached schedule Total 72,118.51 Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cov er sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS UN ulvt ~ 3 Or rtty-i 5uu L;OVtrc srytt I ~ v.vv Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Thelma M. Miller 01/29/2008 161-20-3777 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 7 Linda C. Ferich Daughter 50% interest in estate 25,115.39 115 Chelsea Loop Lancaster, PA 17602 2 Donna L. Witmer Daughter 50% interest in estate 47,003.12 635 Herman Avenue and Jointly held Lemoyne, PA 17043 Sovereign Bank Acct. Total 72.118.51 1 ~~~t ~i11 ~n~ C~IE~t~mPrtt OF THELMA M. MILLER I, Thelma M. Miller, now residing at R.D.#l, Airville, Lower Chanceford Township, York County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare the following as and for my Last Will and Testament, hereby revoking and making void any and all Wills and Testaments, or writings in the nature thereof by me at any time heretofore made... I. I give all of my estate to my husband, Ibnald R. Miller, in the event that he should survive me. II. In the event that my husband, Donald R. Miller, should not survive me, then I~ give all of my estate to my two daughters, Ibnna L. Witmer and Linda C. Ferich, share and share alike. A. In ithe event that either of my two daughters should predecease me, then I gave the share to which she would have been entitled, if living, to her issue, per stirpes. B. In the event that either of my two daughters should predecease me ~ witYwut issue surviving or there should be a total failure of issue, then I direct that the share to which she would have been entitled, if living, shall be paid to my surviving daughter, or issue of deceased daughter, per stirpes. III. I appoint my husband, Donald R. Miller, r~ecutor of this my Will. In the event that my husband, Donald R. Miller, cannot or does not desire to act as Executor, then I appoint my two daughters, Donna L. Witmer and Linda C. Ferich, Executrices in his place and stead. IN WITNESS V~iERECF, I have hereunto set my hand and seal to this my Will this ~ ~ ~~ day of ~u. ~ , 1986. I / 6 i .~.~=%~-~.. ~'C ~~~. ~ SEAL) Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the .presence of us, who, at her request, in her presence and in the presence of each other, all being present at the scene time, have hereunto subscribed our names as witnesses. -2- OOMMONWEALTI3 OF PENNSYLVANIA ) ( SS. COUNTY OF YORK ) I, Thelma M. Miller, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed acid executed said instrument as my Last ri~7il1; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~° /? cJ,k'c.eY~~ ~'1~_ _~~ -tit=Gee-c; The a M. Miller, Testatrix Sworn or affirmed to and acknowledged before me this /~ ~~ day of ~~c~~r' , 1986. l i'~-~~i~i~- ~. ~i~1=*r, ~®T~RY P~U~SLte~ Red Lion. Mork C:uunty, Pa. Notary 3? lc Y Commrssiorf Expires ~dov. ~i. 99i'37 COMMONWEALTH OF PENNSYLUALVIA ) ( SS. COUNTY OF YORK ) We, the undersigned witnesses whose names are signed to the attached or foregoing i~lstru_ment, being duly qualified according to law, do depose and say that we werE: present and saw the Testatrix, Thelma M. Miller, sign and execute the instrument as her Last Will; that the said Thelma M. Miller signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; ghat each of us in the hearin3 and sight of the Testatrix, Thelma M. Miller, signed the will as witnesses; and that to the best of our knowledge the Testatrix, ~Chelma M. Miller, was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. . ~~ ~~ULc%~~' Witness ~. v ' Witness Witness Sworn or aff:inned to and subscrik>ed to before me, 's /iL~ day of G~~.Cc~'~` 1986. `~ ., ~ ` C ~. Notary is PATRPCP~`a A. FR~1(~ WOTAt~Y R I~ i~8ft PJ041, York aunty, Pa. itRy f:~snmiss~inn Expi~a~s P~ov. ~I, 19$? ~' Sovereign Bank Court: Ordered Processing \ Decedents - MA1-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284 f March 7, 2008 David M. Laucks Laucks &, Laucks 105 West Broadway Red Lion, PA 17356-2103 RE: Estate of Thelma M Miller Date of Death: 1 /29/08 l~;R 14 '08 r+ Dear David M. Laucks: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, L/la ffu"~~r"i~e~~DiGiando enico Team Leader 617-533-1789 Sovereign Bank ESTATE OF Thelma M. Miller SOCIAL SECURITY #: 161-20-3777 DATE OF DEA'CH: January 29, 2008 Account #: _0571143784 Type: Checking Open date: 6/30/2003 In the name of: Thelma M. Miller or Donna L. Witmer Date of Death Balance: $43,771.71 Int.(YTD) from 1 /1 /2008 to 1 /22/2008 $16.26 Accrued interest to date of death: $3.76 Other Info: Account #: _0575539994 Type: CD Open date: 3/6/2007 In the name of: Thelma M. Miller Date of Death Balance: $72,894.48 Int.(YTD) from 1/1/2008 to 1/29/2008 $0.00 Accrued interest to date of death: $295.17 Other Info: Page 1 of 1