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HomeMy WebLinkAbout09-02-09 J . 15056051047 J REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN C°unty Cnde Year File Number PO BOX 280801 ? Harrisburg, PA 17128-0801 RESIDENT DECEDENT Z' ~ ~~`~ ~ 3 ~ 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth icy ©s"`oo,o oy~y2oos ~~~`31 goo Decedents Last Name Suffix Decedents First Name MI /'7 ~ LLCM C/~-~,4/ ~' ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix SE~ouses First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) S! 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 TO: Name Daytime Telephone Number t./~~Li~M ~ 1~~ip~r-LS ~-i~ Zy33&~31 Firm Name (If Applicable) REGISTEkl~F WILLS USF'E~NLY First line of address ~ '. r r *~ ' ~ --L-, .~_ Second line of address ~ -. ~ _... City or Post Office State ZIP Code L Bart FILED c q 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. SIGN URE OF PER/~SON R SPOnNSIBLE FOR FILING RETURN DATE ,f~ K ~~J~G~w~ _ ~ - 2 ~ 7~.r Q ADDRESS i< +/ J I /i , .r. i ~-.. --. O~~ARER OTHER DATE 9-Z - ADDRESS PLEASE USE ORIGINAL FORM ONLY :'_; :-) Side 1 15056051047 15056051047 J ly J REV-1500 EX Decedent's Social Security Number Decedent's Name: /Yf/ L L C /2. ~ G9 ,~,/L/{ C . ~ ~ ~ O.-S-~'/ ~ ~ ~ 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. ~ ~ 3~ ~tJ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. s 8. Total Gross Assets (total Lines 1-7) .. ............................... .. 8. J ~- .~~~I •~ 7 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~-~c..3-~ ~,~ 10. 9 9 ( ) ............. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 10. ... ~ ~ ~ ~ .~~ 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. l ~ ~ ~'Y .J~-~ 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ~ ~S~ ~ ~' / 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 5.0 d ~, an election to tax has not been made (Schedule J) ..................... ... 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. ~ ~ ~ ` 7" 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 _ 1 5. 16. Amount of Line 14 taxable 4` ~ ~ ~' G ~ 1 s at lineal rate x .o ~~ • . 17. Amount of Line 14 taxable at sibling rate X .12 • 17. 18. Amount of Line 14 taxable 15 / p~ ~ ~ ~ • p ~/ / CI / / 18 at collateral rate X . ~ ~ . 19. TAX DUE ..................... .................................. ..19. 15056052048 3 `~ ~ ~ `f 2~zy9q 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~~~ 15056052048 Side 2 15056052048 1 REV-1500 EX Page 3 Decedent's Complete Address: File Number ~/4~'~;0.~ G3 ~1 L L ~2 _ _ C. X22/-2 C . STREET ADDRESS _ ~t ~ ~~ /yy ~ sue`' CITY STATE ZIP ~iL ~~ s~lE , ~`'~ /~i Tax Payments and Credits: ? 1. Tax Due (Page 2 Line 19) (1) ,?j ~,~~ , dJ 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ~, ~~Q` G'G C. Discount ~3_/ C.o ~ y Total Credits (A + B + C) (2) 3 ~ /...?(O, C T 3. Interest/Penalty if applicable 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. Fill in oval on Page 2, Line 20 to request a refund. (4) /G ~/ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ' A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable fo: 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 :.................................................................................... ...... ^ f ~C 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. Ditl 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 designation? .................................................................................................................. ...... ^ 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)j. 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 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)j. 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. _ i I, CABBIE C. MILLER, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I give and bequeath the sum of Five Hundred (5500.00) Dollars, to GRACE UNITED METHODIST CHURCH at the corner of Pomfret and West Streets in Carlisle, Pennsylvania, for use in the Kindergarten Department. II. I give and bequeath all of my jewelry to my niece, RUTH WALKER. _ III. I direct my executor hereinafter named to convert into cash and sell at either public or private sale all real and personal property which forms a part of my estate and to add the same to my residua A. MILLER, if living, B. sister, MARY GIPE, ry estate which I give and bequeath as follows: One-third to my daughter-in-law, CAROL A. otherwise to lapse. ~, Two-thirds to be divided equally among my CLARA CLARK, and MARTHA CARBAUGH, if living,. otherwise to their surviving children by representation. ~l ~„ IV. I direct that all taxes that may be assessed in ',~ consequence of my death, of whatever nature and by whatever I' jurisdiction imposed, shall be paid from my residuary estate as a, V part of the expense of the administration of my estate. i V. I appoint my daughter-in-law, CAROL A. MILLER, executrix of this my last will. Should my daughter-in-law, CAROL A. MILLER, fail to qualify or cease to act as executor, I appoint FARMERS TRUST COMPANY of Carlisle, Pennsylvania, or its successor, executor of this my last will. VI. I direct that my executrix or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ~/ IN WITNESS WHEREOF, I have hereunto set my hand this i5 f~ day o f h'//~=a~ c.~ 19 9 2 . CARRIE C. MILLER The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, CARRIE C. MILLER, was on the day and date thereof signed,. published and declared by CARRIE C. MILLER, the testatrix therein named, as and for her last will, in the presence of us, who,. at her request, in her presence, and in the presence of each other have subsc 'bed our m s as witnesses hereto. ~ 1 a. "r., Rev-,~ ~x. c+-sn SCHEDULE E p ^~ ~+/+ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c MSC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All propeAy jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER / D//ESCRIPTION OF DEATH ,~ ,2 L ~ ~z ~ ~ G y 3 y ~4~, ~~ TOTAL (Also enter on line 5, Recapitulation) I S V ~ `~`~" / (If more space is needed, insert additional sheets of the same size) Z- J E W E L E R S Trust Your Special Moments To Mountz. July 6, 2005 Carol A Miller 144 E Street Carlisle, PA 17013 Dear Mrs. Miller, At your request I examined the jewelry you submitted for valuation and have provided an opinion of the Fair Market Value. This report is valid only in its entirety and the final figure excludes any applicable taxes. You may wish to take this into consideration when using the report. The value conclusions are subject to limiting conditions that are set forth in the body of the report. To the best of my knowledge and experience, I estimate the jewelry has a total Fair Market Value of $445.00 . I suggest that you keep your copy of this report in a safe place. This report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice (USPAP). If I can be of any further assistance, please call. Sincerely, Am S Rausch G.G. Gra ate Gemologist, GIA Enclosures _ Member x17¢Mr / fF: ~Y'ELERY °•^•uvotttrU= 153 North Hanover Street • Carlisle, Pt'P~e011~f'~ (717) 243-4936 • Fax (717) 243-8785 www mountzjewelers. com Prepared For: Carol A Miller Date: 7/6/2005 144 E Street Carlisle, PA 17013 Item 1 Ring One l Ok yellow gold signet ring. This ring is engraved with the letter "D" This ring is a size 5 1/2. This piece weighs approximately 3.37 DWT. Total Approximate Retail Value Excluding Tax $15.00 Item 2 Ring One double eagle coin pendant hanging. from a 24" gold filled rope chain. The coin and bezel weigh approximately 22.67 DWT. The bezel has a coin edge and attaches with a screw. The gold filled rope chain weighs approximately 10 DWT. Coin Attributes Make: Double Eagle Year: 1908. Condition: Extra Fine Total Approximate Estate Value Excluding Tax $425.00 Page 6 of 7 Item 3 Ring One yellow colored brooch with a blue and white cameo. Cameo Attributes Material: Plastic Scene: Classical lady, right profile Measurements: 25.00 x 17.50 mm Carving quality: Commercial Condition: Very Good Item Attributes Metal: Gold plated Finish: Polished Setting: Bezel set/Epoxy Condition: Very good Total Approximate RetailValue Excluding Tax Total Approximate Retail Value for All Items -Excluding Tax: Four hundred forty-five dollars and no cents Signature of Appraiser: --~-- Amy S Rausch G.G. Graduate Gemologist, GIA $5.00 $445.00 Page 7 of 7 ~'~ 00 1 04319M M 021 19295 CARRIE C MILLER C/0 CAROL A MILLER 144 E ST CARLISLE PA 17013 ~"~Cy~I ~ ~~ „~ HIGH STREET-CARLISLE errnlluT CIIMMARV BEGINNING BALANCE D .. S i OTHER ADDITIONS .. - CHECKS PA . SUBI'RAC7YONS CURRENT: INtEREST PD ENDING BALANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 34,235.75 9.6 1 , 00.00 0.00 78.07 ACCOUNT ACTIVITY POSTING DATE _ T ANSAG ION b SCRIP ION ' DEPQ TS,> TRRES i T R ADb IONS GNE KS.R QTHER SU8 C ONS - DAI Y BALANCE 04-14-05 BEGINNING BALANCE =34,235.75 04-14-05 CHECK NUMBER 1530 187.31 `,~ 34,x.44 04-19-05 PHONE TRANSFER WITHDRAWAL / 63 L ~ 34,000.00 48.44 78 07 05-02-OS UBS FIDUCIARY TR PENS PMTS 29. ~z / °__'v . 1 v ENDING BALANCE ~ ~ 578.87 ~HE6KS..P:AID SUMMARY / 1530 04-14-05 187.31 C/ l `~ ~~ IMPRESSED BY THE SERVICE YOU RECEIVED AT MiT? IF YOU'D LIKE TO NOMINATE AN M&T BANK EMPLOYEE FOR EXCEPTIONAL CUSTOMER SERVICE, PLEASE COKPLETE OUR MiT SERVICE EXCELLENCE FORM AT WWW.MANDTBANK.COM/EXCELLENCE. kE APPRECIATE YOUR FEEDBACK! S/~~~ ~- /~ ~~~g¢ '= 1 ©' ~,h ' ACCOUNT. NO. ACCOUNT;'TYP~ 15004200933263 M8T MARKET ADVANTAGE 00 0 04319M NM 017 58697 CARRIE C MILLER C/0 CAROL A MILLER 144 E ST CARLISLE PA 17013 INTEREST PAID YEAR 70 DATE 3.28 ACCf]IINT CIIMMARV STATEMENT PERIOD PAGE MAR.24-APR.23,2005 1 OF 1 ~~/ ~~ HIGH STREET-CARLISLE BEGINNING BALANCE PQS :07HER'ADD T ONS k k :O:,H R ' 3UBT IONS.'. UR EN : INTER S~>PAID ND NG ; BALANCE N0. AMOUNT N0. AMOUNT 2,940.49 8.00 ~ .5 1.08 0.00 errnlluT erTTVTTv POSTING_ DATE TRANSACtION DESCR 1 N - - - - DEPOSITSINTERE T: OTHER ADDITIONS ::N/DRAYIAGS i OTHER SUBTRACT ONS - - DAILY BALANCE 03-24-05 BEGINNING BALANCE 52,940.49 04-01-05 US TREASURY 312 CIVIL SERV 118.00 3,058.49 04-19-05 INTEREST PAYMENT 1.08 ~- 04-19-05 CLOSEOUT •• 3,059.57 0.00 ENDING BALANCE 50.00 a;l _/" ANNUAL PERCENTAGE YIELD EARNED = 0.50 MLT CHOICEQUITY, THE FLEXIBILITY TO CHOOSE FIXED RATE LOANS OR A LINE OF CREDIT ANYTIME. APPLY AT ANY MiT BANK BRANCH OR CALL THE MiT TELEPHONE BANKING CENTER AT 1-800-724-3222. EQUAL HOUSING LENDER. ,. ., 5~ EV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER /yi~~ ~~rL { c~~:E G . 1/05 = 0~3 ~3 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. S~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s)/t,Q~L ~, I~'7 l L.LC~Z~ Social Security Number(s)lEIN Number of Personal Representative(sZ~` 3~/" - • ~j ,Z '~ Street Address ~ y L~/ ,L~ •~ Sl`• City Cf~-/ZL-/ SL.L State ~/~ Zip ~~3 Year(s) Commission Paid: 2op'~j 2. Attorney Fees ~~'jE~ ~ ~,,~j~//~L,s" 3. Family Exemption: (If 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 ~Z~/sr~2 ~ ~~ Y/f' 5. Accountant's Fees 6. ~ Tax Return Preparer's Fees E . tiEc f`c.v~y,r~oL~ L EC ¢ L ~ /~ ~ VL 27''/Si~y~ ~i - ~ rs `~'. Cc~~,,lJ22~..gr ~ Lgs,i 7dai'.i.9 ~ ~ -~o .- /G. ~EGiSlE2 •L lvilj~S ~~n,~ ~8~,vo ALB, OG / G ~, 00 /2 Z, ~/ ~ ; ~c z.~ , 00 3~ . ~ TOTAL (Also enter on line 9, Recapitulation) I $ /~i /88 ~~ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER /~7/LL~/L !?~/~2/Z/C G-' , ~/dam --d3~3 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH /~J/f~vO.c e~~' Si, 399 , 3 y ~ • /~~~i,~-. a- ~~• e~-.s, .~~ ~ cam, ca C , ~-,¢) iv E2s i N' co.»~ 7~C ~ ns.~o /3~u~-~Y or`J y a~ ~!~ ~• /l/~T/orv.9C f~~ Pr,~•niu~j TOTAL (Also enter on line 10, Recapitulation) $ y/ ~~~, /'~~ (If more space is needed, insert additional sheets of the same size) REV-1517 E%~ ~2-87) COMMONWEALTH Of fENNSYIVANIA INHERITANCE TAX RlTURN RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER ~ l t~-rZ ~ c,~ rz rz.~ C- ~., ,~:/ ors` --03 ~ 3 SCHEDULE J BENEFICIARIES ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE ;4. Taxable Bequests: ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Goverrtmsntal Bequests: 1. ~ ~~. Gt ti ~ TLS ~» C I`"si f o.D i S1 `" e~vl2G~l~- o~c.~s% ~ O'er / ~~.~ ~s moo, cd TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS )Also enter on line 13, Recapitulation) I $ (If more space is needed, insert additional sheets of tame size) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) /~ z r Name of Decedent: CABBIE C. MILLER Date of Death: April 14, 2005 Will No. 2]-OS-0363 To the Register: Admin. No. I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on January 28, 2005. Name Address Helen Elizabeth Gipe Stover 648 Yorkshire Dr., Carlisle, PA 17013 ~ /~~i~kc. Betty Lee Gipe 1585 Sollerberger Rd., Chambersburg, PA 17201 ~~ /ec,~ David Henry Carbaugh 7207 Ruritan Dr., Chambersburg, PA 17201 ~ --a~ ~-- ' Sarah Jane Carbaugh Martin 802 First St., Inwood, WVA 25428 ~~j "' `~ -' Clinton Elmer Clark 4254 Charlestown Rd., Mercersburg, PA 17236 ~g ``~` '- n Ray Eugene Clark Claylick Rd., Mercersburg, PA ]7236 ~ ~ -' °~`~ Mary Grace Clark Brindle 1 1265 Worleytown Rd., Green Castle, PA l 7225 r~~ ~ ~ y Cora Cleone Clark Bonebrake 11384 Claylick Rd., Mercersburg, PA 17236 Ruth Walker 143 Downey Dr., Chambersburg, PA 17201 - ~~~jr.~, r/d '"~'~"~~ CGrace United Methodist Church 45~ S. West St., Carlisle, PA 17013 - c.y.}n.~ 1`~q-~~.~. 5' ~~) Carol A. Miller 144 "E" St., Carlisle, PA 17013 ~ ~Qcj-io~u.L, Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: 'Rune Date: July ~ , 2005 ~ ti, l ~- ley.-~ C Signature Name: William S. Daniels Address: 1 West High Street, Suite 205 Carlisle, PA 17013 Telephone: 717-243 -3 831 Capacity: Personal Representative X Counsel for Personal Representative