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Home My WebLink About07-10-091505607121 "~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po sox 2aosol RESIDENT DECEDENT 2 1 0 9 0 0 2 2 5 Harrisbu , PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 3 0 1 1 8 2 5 5 4 0 3 0 4 2 0 0 9 Suffix Decedent's First Name MI Decedent's Last Name L MI LLER NI NA (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI Spouse's Last Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OPALS BELOW ^ 3. Remainder Return (date of death ^ 1. Original Return ^ 2. Supplemental Return prior to 12-13-82) ^ 4a. Future Interest Compromise (date of te t d E ^ 5. Federal Estate Tax Return Required ^ s a 4. Limite death after 12-12-82) es it B ~ te ^ 7. Decedent Maintained a Living Trust t T ox 8. Total Number of Safe Depos a es 0 6. Decedent Died (Attach Copy of Will) (Attach Copy of Trust) eived ^ 10. Spousal Poverty Credit (date of death R d nder Sec. 9113(A) ^ 11 ~ a ec s ^ 9. Litigation Procee between 12-31-91 and 1-1-95) O) Attach Sch BE DIRECTED T0: THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIA L y T U 0 ~ m - CORRESPONDEN D ber ne N m e Telepho t i Name H ANTHONY ADAMS ___-- _ Firm Name (If Applicable) - ~ REGISTER OF WILLS USE ONLY ~ _ 7 ~. _. \. 7 G..-J First line of address ~ ` o `--~ ;''-a 'ti7 r__ 4 g WEST ORANGE STREET r r u _=, ~ ._.- ; c:~ address Second line of , ~ - _ ;;'7,"~ -~ II S U I T E 3 I -~} e~~ i - -- - .. ~A~FILED ~~ ~ ~ State ZIP Code _ ` - - - _ _~ .. ", t. -y . City or Post Office PA 17 -_ . , y 2 57 Iv SHI PPENSBURG Correspondent's a-mail address: htadamslaw embar mail.com belief, ~ t nowledge, k n~of wh ch preparer has any rmat o cDeclaration of p eparer other than the perso1nal repesentat ve scbased on aldl n o ae o pl de ee d . e c co ect an tru t s g ] % SIGNAT gE OF PERSON R~FSP~ SIBLE FO FIL,~I J~i~ URN } C, -7/ ~/ ADDRESS Side 1 1505607121 1505E.07121 J 1505607221 REV-1500 FX Decedent's Social Security Number Decedents Name: NINA L. MILLER 3 0 1 1 8 2 5 5 4 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 9 1 7 9 1 0 0 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) ........................... s. 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) .................. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........... 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ..... ..... ..... .. 12. 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.0 _ 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate x .045 1 2 0 8 7 2. 0 6 16 17. Amount of Line 14 taxable at sibling rate X .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 1 8 9 9 3, 8 2 2 3 7 0 3, 4 9 1 3 4 4 8 8, 3 1 1 2 4 7 3, 9 3 1 1 4 2, 3 2 1 3 6 1 6, 2 5 1 2 0 8 7 2, 0 6 1 2 0 8 7 2, 0 6 0. 0 0 5 4 3 9. 2 4 0. 0 0 0, 0 0 5 4 3 9, 2 4 Side 2 1505607221 1505607221 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 09 00225 DECEDENT'S NAME NINA L. MILLER _ - - _ --- STREET ADDRESS 448 NORTH EARL STREET - - -- CITY i STATE ZIP SHIPPENSBURG PA 17257 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 5,200.00 C. Discount 260.00 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 5,439.24 Total Credits (A + B + C) (2) 5,460.00 Total Interest/Penalty (D + E ) 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. 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. B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (3) 0.00 (4) 20.76 (5) 0.00 (5A) (5B) 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 : ...................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ c. retain a reversionary interest; or ................................................................................................ ^ X^ 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? ....................................................................................... ^ Q 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ 0 0.00 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 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 childtwenty-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)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent p2 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 + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE w~r~~~vr NINA L. MILLER FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the09 iceoOwhich ro exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevan facts.ould be Real roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. PARCEL LD# 36-32-2269-008 BEING A RESIDENCE LOCATED AT 448 NORTH EARL OF DEATH STREET,SHIPPENSBURG, PA 17257 AS PER DEED BOOK"V" VOLUME 14 91,791.00 PAGE 95 CUMBERLAND COUNTY 72850 X CLRF 1.26 TOTAL (Also enter on line 1 Recapitulation) ~ $_ 91,791.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER NINA L. MILLER 21 09 00225 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 94.82 2. 12001 PONTIAC GRAND PRIX GT COUPE 6,000.00 3. CITIZENS IRA #6255-995608 ~ 12,899.00 TOTAL (Also enter on line 5, Recapitulation) I $ 18, 993.82 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT TE OF NUMBER NINA L. MILLER 21 09 00225 If an asset was made joint within one year of the decedent's date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Harold A. Miller aka H. Alan Miller c JOINTLY-OWNED PROPERTY: SCHEDULE F JOINTLY-OWNED PROPERTY ADDRESS 438 Pemberton Blvd Browns Mill, NJ 08015 LATIONSHIP TO DECEDENT son 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 ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERESI 1. A. 1999 Circle checking Account at Citizens #610079-408-3 4,564.08 50. 2,282.04 2. A. 1999 PSECU Credit Union 42,842.89 50. 21,421.45 Shares Saving TOTAL (Also enter on line 6, Recapitulation) I $ 23 703.49 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER NINA L. MILLER 21 09 00225 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FOGELAGANGER-BRICKER FUNERAL HOME INC. 7,854.00 B. 2. 3. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedents address is not the same as claimants, attach explanation) (:laimant Street Address City State _ Relationship of Claimant to Decedent 4. Probate Fees 5 Accountants Fees 6, Tax Retum Preparers Fees 7. Income Tax to IRS State Zip Zip TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 3,000.00 290.00 40.00 1,289.93 12,473.93 REV-1512 EX + (12-03) SCHEDULE 1 DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF 21 09 00225 NINA L. MILLER the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. rred b i bt y ncu s Report de VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 00 180 1, CFJMA-SEWER UTILITIY TO ESTATE REAL PROPERTY . 120.52 2. PENELEC UTILITY 16.01 3, MCI UTILITY 194.35 4, TIMMONS OIL INC. 51.70 5. BOROUGH OF SHIPPENSBURG 79.53 6. COMCAST 251.94 7. BOROUGH OF SHIPPENSBURG 33.26 g. EMBARQ 26.01 g. Q CARD 189.00 10. U.S. TREASURY TOTAL (Also enter on line 10, Recapitulation) I $ 1,142.3; (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NINA L. MILLER 21 09 00225 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. HAROLD A. MILLER Lineal 438 PEMBERTON BLVD. 100% BROWNS MILL, NJ 08015 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE, ON REV-1500 COVER SHEET jj. 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 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) ~~ ~ ~ " ~ ~~ ~ , ~. 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