HomeMy WebLinkAbout03-16-10 (3) 15056051058
REV-~ ~OO EX
06-0
PA Department of Revenue (
5) OFFICIAL USE ONLY
Bureau of Individual Taxes
Po eox 2eosol County Code Year File Number
INHERITANCE TAX RETURN "
Harristwrg,PA17128-0601 RESIDENT DECEDENT 21 ~' O ~ SO
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
.201-16-2511 12/16/2008 12/25/1925
Decedent's Las[ Name Suffix Decedent's First Name MI
;MILLER
__ HELEN
L I
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
_ __ >~'
Spouse's Social Security Number _
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
__ __ REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
'mow- 1. Original Retum ~ ~ 2. Supplemental Return - ;'° ~;~~ 3. Remainder Return (date of death
prior to 12-13-82)
.,. 4. Limited Estate ~° ag 4a. Future Interest Compromise (date of ~.' ;; 5. Federal Estate Tax Return Required
death after 12-12-82)
°"'- 6. Decedent Died Testate
(Attach C
f Will r'°°".~ 7. Decedent Maintained a Living Trust ,,,,,,,,,,,,,,,, 8. Total Number of Safe Deposit Boxes
opy o
) (Attach Copy of Trust)
,...,..~ 9. Litigation Proceeds Received 3.`"""? 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. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
RICHARD K MILLER JR
_ (717) 979-9958 ',
Firm Name (I(Applicable)
_. _ _ _ _ .
_... ..... ... ... I REGISTER OF WILLS USE ONLY
RECORDED OFFICE OF
First line of address REGISTER OF WILLS
_. _ 2010 MARCH 16
775 S HUMER STREET
CLERK OF
Second line of address
_ ORPHANS' COURT
_ CUn1BERLAND CO., P~
City or Post Office State ZIP Code __ GATE FILED
ENOLA ' PA 17025
Correspondent's a-mail address:
Under penalties of pe ''NA'Y I deGare that I have examined this return, including accompanying schedules antl statements, an~t'o the best of my knowledge and belief,
it is t~~~; ,~tnplete. DeGaration oT preperer other than the personal representative is based on all Informatiorf of which preparer has any knowledge.
775 S HUMER STREET EI~OLA PA 17025
- - _ - _._ - ~ ......~~. ~.~.~,.~ DATE
03/07/10
ADDRESS
430 N ENOLA DRI ENOLA PA 17025
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15056051058 15056051058
~t~
J 15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: HELEN L MILLER
__.._
_ 201-16-2511
m
,.....m.~..h_ ____.,.. .._~_.. ~~~.._
RECAPITULATION
1 . Real estate (Schedule A) .......................................... . 1. _ _ 142,300.98
2 . Stocks and Bonds (Schedule B) .................................... ... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3.
4. Mortgages 8 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 8 Miscellaneous Non-Probate Property " ' - -
(Schedule G) ~~ ~ Separate Billing Requested..... ... 7.
8. ,Total Gross Assets (total lines 1-7) .........................
__.~w..~., ~.._..- _ , ... 8.
__.....M. 142,300:80
9.
Funeral Expenses 8 Administrative Costs (Schedule H).. .
... 9 .:
5,278.65
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 90,830.73
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 96,109.38
.
_._..
12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. ~
46
191.60
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 (Erne 12 minus Line 13) ................
.-__ w._...,_... ..~._- .._.m.. _,__ .. 14. 46,191.60
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES -~ ~ ~~~~~~~~ ~~~~~ -~~ ~~~- ~~~--~-"~
15. Amount of Line 14 taxable
at the spousal tax rate, or
Vansfers under Sec. 9116 _ _ _
(a)(1.2) X .0_
15.
16. Amount of Line 14 taxable _ .,'
at lineal rate X .0 45 16. 2,078.62
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. 2,078.62
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ---,
i_ 15056052059 Side2 15056052059
REV-'1500 Ex Page 3
Decedent's Complete Address:
File Number
_..,., _~
21 08
.. ~_.. _:
DECEDENTS NAME
DECEDENTS SOCIAL SECURITY NUMBER
HELEN L MILLER
201-16-2511
STREET ADDRESS
804 S HUMER STREET
CITY STATE ZIP
ENOLA PA 17025
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditsJPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Diswunt
3. InteresUPenalty if applicable
D. Interest
E. Penally
(1)
Total Credits (A + B + C) (2)
Total InteresUPenalty (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)
(4)
(5)
(SA)
(SB)
2,078.62
2,078.62
Make Check Payable fo: REGISTER OF WILLS, AGENT
. , ..~ . _ w. ~r~ .. ». ~ _ ~ ~'
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 transfened :...................................................................................... .... ^
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? .......... .... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................... .... ^ ^x
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 eYPmot 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)].
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 Vansfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)j. 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-).502 F.:X+ ;11-D8j
~~~~pennsytvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TA% RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN L MILLER 2109-0150
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 6e exchanged between a willing buyer and a willing seller, neither being compelled to buv or sell, both havinD reasonahlP IrnnwinAnn ~+rt,P .aia„a„r r„+~
u more space is neetletl, insert additional sheets of the same size.
REV-1511. EXt (10-09)
~ ,~" pennsylvania
DEPARTMENT OF REVENUE
INHERrrANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
cain~c ur FILE NUMBER
HELEN L MILLER 2109-0150
Decedent's debts must be reported an Schedule I.
ITEM
NUMBER DESCRIPTION AMDUNT
A• FUNERAL EXPENSES:
I' FUNERAL DIRECTOR
2,062.00
2 HEADSTONE 135.00
s LUNCHEON 100.00
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State ZIP
Z• Attorney Fees: 1,990.00
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:
441.65
S• Accountant Fees:
50.00
6• Tax Return Preparer Fees:
500.00
7.
TOTAL (Also enter on Line 9 Recapitulation) I $ 5 278.65
If more space is needed, use additional sheetr of paper of the same size.
REV~4S1.7. EX+ BIZ-OB)
i`a-` Pennsylvania SCHEDULE I
__, DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN L MILLER 2109-0150
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' HOME EQUITY LOAN 73,489.48
2 UTILITIES 3,123.04
3 NURSING HOME 7,342.58
4 INSURANCE EXPENSE 692.32
5 PRESCRIPTION DRUGS 179 41
6 AMBULANCE 99.00
7 MEDICAL CO-PAY 30.00
8 REAL ESTATE TAXES 1,501.50
9 REPAIRS & MAINTENANCE 3,749.10
10 MISC BILLS 357.30
11 SUPPLIES-CLOTHING 267.00
TOTAL (Also enter on Line 10, Recapitulation) $ 90,830.73
If more space is needed, insert additional sheets of the same size.
REV-7.51.,', EX+ ;11-08)
~~~~-~ pennsylvania SCHEDULE
DEPARTMENT OF REVENUE
iNHERTTANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
rslnte of FILE NUMBER
HELEN L MILLER 2109-0150
NUMBER NAME AND ADDRESS OF PERSON 5 RECEIVING PROPERTY
() RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SNARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. RICHARD K MILLER JR 775 S HUMER ST ENOLA PA 17025 SON 25%
2 MARY~FRY 24 SHARON ROAD ENOLA PA 17025 DAUGHTER 25a/o
3 JOHN E MILLER 1315 FOX HOLLOW DRIVE STEELTON PA 17113 SON 25%
4 REBECCA A SUSAVIDGE 804 HUMER 5T ENOLA PA 17025 DAUGHTER 25%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON L1NE5 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUT10N5:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION 70 TAX IS NOT TAKEN
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 mare space is needed, insert additional sheets of the same size.
US.EUS [LL1' tU]/U71
C.4CAL F~EGtSTR~4R'S CERTfF~GATMC3~t OF ®E1~TH
WARNING: It is iifega! to duplicate this copy ny photostat or photograp~a,
~ee fur this certificate, 56.00
P 150U0608
Cerii33cation Number
This is t~, ccrtih; thu; the uiiix•mation here gig en i~
correctf~ copie~l~iiurrr an original Ceriiilcalc oC,DeutP
duly riled Frith me as Local Registrar. The urieina
~,;ertiiirnc tt~ili be for~{~arded to the State V'itu
Recordz• Oiiice fur pe~~maaetu Yilin**.
~~~ ~--- DEC 1__~ S 2gU8
Local 12egisll:~ -Date i~ss~ued
~~ COYYONWEALTH OF PENNSYLYAWA • DEPARTYENI OF HEALTH • VIT/LL RECORDS
vs/r
-.____, STATE RIE nIaBEA
t.lbbed Dea4itiad. bSYr la aay
29bt a9etlr Seeay Nrrer 40red OrWtlbr,~1.~
Helen L. Miller emale 201
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