HomeMy WebLinkAbout05-19-09 (3)1&056041046
REV-1500 EX (OS-04) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
INHERITANCE TAX RETURN 9' f°'+=•°°°°' `
Dept. 280601 { ~' `~".
Harrisburg PA 17128-0601 RESIDENT DECEDENT 2 ~ 1 ~~' 0 a S }0 ~8 17 a3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
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(If Applicable) Enter Surviving Spouse's Information Below
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
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nag ~ :alan <b :i_.~~ .i3 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Retum (date of death
pdar to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Fetlerel Estate Tax Retum Requiretl
death after l2-12-82)
O 6. Decedent Died Testate O 7. Decetlent Maintained a Living Trust 8. Total Number of Safe Deposit Bozes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 1 i. 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
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City or Post ORiCR State ZIP Code DATE FILED
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Correspondent's a-mail address:
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.
SIGNAT OF PERSON S N BLE FOR FILING RETURN DATE
y~~.a-09
4270 Wertzville Road, Enola, PA 17025
5922 T.inal sown Road. Harrisbnra. PA 171 T7
PLEASE USE RIGINAL FORM ONLY
Side 1
15056041046
15056041046
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REV-1500 EX
Number
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RECAPITULATION
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1. Real estate (Schedule A)... .. .. .. .... . . 1 >& e :> *' exus:nSa`b88tmfldf
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2.
.. ... .. .. .
Stocks and Bonds (Schedule B) .
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3. Closely Held Corporation, PartnersMp or Sole-Proprietorship (Schedule II) ... .. 3. '' w
4.
Mort a es & Notes Receivable Schedule D ........
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. 4 ( ) e i f i., t,
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5.
Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ......
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6.
Jointly Owned Property (Schedule F) G Separate Billing Requested .....
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7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) G Separate Billing Requested......
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8. Total Gross Assets (total Lines 1-7) ..... ....... ......... ........ . S ° S, „ -
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9. Funeral Expenses & Administrative Costs (Schedule H)...... _ . ......... 9 ~ 2 ~ 3 •' 9
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10.
Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .... .........
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Total Deductions (total Lines 9 & 10).... .. .. .. ....
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12.
Net Value of Estate (Line 8 minus Line 11) . .. .. .. ..
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13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ± ~ ~
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an election to tax has not been made (Schedule J) ...
........ .
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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 taz rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 15.
16. Amount of Line 14 t xable
~S
at lineal rate X .0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REnFUND OF AN OVERPAYMENT
'1
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15056042047
15056042047
3
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15056042047
J
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Susan A.__Miller-_____
STREET ADDRESS _--
4270~IQr_tzyi l l~_IIoasL_ _
CITY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Inlerest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + g + C) (2)
Total InteresUPenalry (D + E )
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3)
(4)
$5,120.47
(5) S, 120.47
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 5 , 120.47
Make Check Payable to: REGISTER OF WILLS, AGENT
i~t t3tt~#tE4fttttitdt~SiE?~t~it~ittFtttttttittEl€l~tt
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the properly transferred :..................................................................................
b. retain the right to designate who shall use the property tasnsferred or its income :....................................
c. retain a reversionary interest; or ..................................................................................................................
d. receive the promise for life of either payments, benefts 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 secudty at his or her death?......
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?
Yes No
....... ^
REKiWB Ex.fl.91)
SCHEDULE E
COMMONVYEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHREERIT~NT EDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Susan A. Miller 21-08 0873
Indude the proceeds of litigation and the date Me proceeds were receWed by the estate. All property jolMlyowned with the dpht of survHonth~ must be dicclesed on Schedule F.
NUMBER DESCRIPTION ~ ~V~~~ V~~
OF DEATH
~ First Bank of Marysville checking and savings account $19,132.16
2. Prudential Life Insurance 7,840.66
3. Prudential Life Insurance 7,442.63
4. Miscellaneous personal property 100.00
TOTAL (Also enter on line 5, Recapitulation) I S 3 4 , 515.4 5
more space Is needed, Insert addltlonal sheets of the same size)
REV-1511 EX+(12-99)
r SCNEDI~LE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES F.
INHERITANCE 7AX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Susan A. M;tlar 21-.08 0873
Debts of decedent moat be reported on Schedule I.
ITEM
A. FUNERAL EXPENSES:
1.
Gingrich Memorials (headstone) 125.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social SecuriTy Number(s)/EIN Number of Personal Representative(s)
Street Adtlress
City _- -__-.__ _._.___ _____ __. State __ Zip
Year(s) Commission Paid.
2. Attorney Fees 0
3. Family Exemption: (It 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
5. Accountant's Fees
6. ~ Tax Retum Preparer's Fees
7
114.00
TOTAL (Also enter on line 9, Recapitulation) I S 239.00
(It more space is needed insert additional sheets of the same size)
REV-1513 EX+ (9-00)
SCNEpULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Susan A. Miller
21-OR-OR74
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distdbutions, and transfers under
Sec. 9116 (a) (1.2)]
1. Susan L. Ferree daughter $100.00
468 R.R. 5
Mifflintown, PA 17059
2. Wilson G. Miller son $100.00
818 North High Street
Duncannon, PA 17020
3. Jimmie Shomper nephew rest, residue
4270 Wertzville Road and remainder
Enola, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
It 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 $
(If more space is needed, insen additional sheets of the same size)