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15056051058
R~~~~ ~ O EX (~5)
~ Department ~ ~ OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOx 280601 INHERITANCE TAX RETURN -_ . _ , _.. . _.._.. _..... ._
Harriabury, PA 17128-0801 21 ! 09 ', 1087
RESIDENT DECEDENT
ENTER iDECEI)ENT INFORlNAT10N LOW
Social Securtty Number Date of Death Date of Birth
203-01-7456 .10/01/2009 11/17/1920
. ,.~. ,_.
Decedent's Last Name
Suffix Decedents First Name ' MI
Miller 'Elizabeth ~~ J
(If Applicable) Enter 8urvhrlnM 's Information EINow
Spouse's Last Name Suffix Spouse's First Name ', MI
~..... ..
Spouse's Soaal Searrity Number
__
~.. _........._.. .........._ , THIS RETURN MUST BE FILED IN DUPLICATE WITH TH~
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BBL
CfiE? 1. Original Return O 2. Supplemental Return O 3. Remainder Retta (date of death
O 4. Limited Estate
O 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litlgation Proceeds ReceNed
CSI 4a. Future Interest Compromise (date of
deatfi after 12-12-82)
C~ 7. Decedent MakNairred a Living Trust
(Attach Copy of Trust)
O 10. Spousal Poverty Credit (dabs of death
between 12-31-91 and 1-1-95)
prbrto 12-13-82)
t~ 5. Federal Estate Ta Return Required
_,_ 8. Total Number of Safe Depostt Boxes
O 11. Electbn to tax t! er Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THIS SECTION
Name
L. Rex Bickley, Esquire
_.
Finn Name (If Applicable)
First bne of address
114 South Street
Seoond tine of address
City or PostCHtioe
___ _
Harrisburg
' ___ _ _ __
Correspondents e-mail address:
BE COMPLETED. ALL CORRESPONDENCE AND CONFIDt:NT1AL TAX INFORMATION 8HOU BE DIRECTED T0:
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Under penaltla of perjury, l declare that I have this return. including aooompanyirrg schedules and stalemerrts, and to the bat of knovvbdfle and belief,
tt is true. correct Dedaration of rer other than the peraorrsl is based on aN iMarrnaaon of which preperer s any knowledge.
SIGNATURE OF ERSON RESPON E URN Oq
3901 Picardy Ct. Alexandria, V~- 22309 ' ~
SIGNATURE OF PREPARER OTHER THAN EPRESENTA7NE nn~c
ADDRESS
t•LE/I~E lJt3E ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
ICI
0
(717) 234 05 ~ ...-
c _.
............: .... .. .. .... ... .. ........... t,M,,......
~ REGISTER LS USE aILY
i ___
J
REU--1500 EX
De~aern,s Elizabeth
J Miller
15056052059
Decedent's Social Security Number
203-01-7456
RECAPITULATION _ _ __ ___ -_
1. Real estate (Schedule A).... ...................................... 1. ~ 0.00
2. Stocks and Bonds (Schedule B ...................................... 2. ~I 1,213,620.00
3. Closely Held Corprxation, P rship or Sole-Proprieton;hip (Schedule C) ..... 3. ~ ! 0.00
4. Mortgages A Notes Receivable Schedule D) ............................. 4. ? 0.00
5. Cash, Bank Deposits 8 Misoal sous Personal Property (Schedule E) ........ 5. ?
;.___.._ 66,679.00 '
_._._._...__.~ ...____.M._;..V _M..._.__,_.....~....~.~.......;
6. Jointly Owned Property (Schad le F) G"'~ Separate Billing Requested ....... 6 ~ 0 00
...M,,~ ...___.._.,,~.~_ ....
7. Inter-Vivos Transfers 8 Miscella sous Non-Pr~obede Property
(Schedule G) C~3 Separate Billing Requested........ 7. ' 0 00
8. Total Gross Assets (total Lin 1-7) .................................... 13. 1,280,299.00
^~J
9. Funeral Expenses 8 Administra ve Costs (Schedule H) ..........:.......... 9. j ~~ 15,549.00
'
_......... ~_...m,_._._.....~.._._ ...,.,......_........._..._..._...,_
,~ _.
10. Debts of Decedent, Mortgage L' bilities, A Liens (Schedule I) ................ 10. { 11,843.00
11. Total Deductions (total Lines 9 & 10) ................................... 11.1 ~I 27,392.00 '!.
12. Nst Valuo of Estate (Line 8 mi us Line 11) .............................. 12. ', 1,252;907.00 !,
13.
Charitable and Governmental
uests/Sec 9113 Trusts for which „_.._..
; ~_..,.......M ........ .,_._....,..._._._ .......:
an election to tax has not been a (Schedule J) ........................ 13. ~ ! 0.00
14. Net Valus t3ubHct to Tax (Line 12 minus Line 13) ........................ 14. ~ 1,252,907.00 ';
TAX COMPUTATION -SEE INSTR CTlON8 FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 _ __
(ax1.2) X .0_ 15.
16. Amount of Line l4 taxable "..'°°"~"'°.'""°°~ °_'_.,_._.._.~......,.__.._..._ ~ .
at lineal rate X .045 1,252,907.00 ` 16, ', 56,380.82 ;
17.
Amount of Line 14 taxable ._....~..._.~...~. ......~... .~,...,.wr_...__ .~~_~_..-~ ,..,.. _...._._.~._ , ...._.___. ...r..___....,..,,,V.,._,
at sibling rate X .12 17.
18.
Amount of Line 14 taxable _~..._.~...,_.. ~...~.~...~....._. __._..._..~_..._........ ~...,.... _..~..__.._,.._. _,_..._ ~;._... . _,.....,,.. ..r
at collateral rate X .15 ? 1 g, j ',
19. TAX DUE ..............
...
.
...................................... 19.1 ', 56,3$0.82
20. FILL IN THE OVAL IF YOU AR REQUESTING A REFUND OF AN OVERPAYMENT ~
15056052059
Side 2
1505605059
REV-15b0 EX Page 3
Decedent's Complete Address:
~~---~ ~ r...._,........~._.~...__...,..~~._.:.
# L1 1 09 1087
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
Elizabeth J Miller 203-01-7456
STREETADDRESS
Messiah Village Nursing Home,
100 Mt. Allen Drive ~i
ciTY ~ srATE ~ ziP
Mechanicsburg PA ' 17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments 0.00
A. Spousal Poverty Credft
B. Prior Payments 0.00
C. Discount 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4. ff Line 2 is greater than Line 1 + Line 3, enter th
FlN in oval on Page 2, Line 20
(1)
Total Credits (A + B + C) (2)
0.00
Total InterestlPenalty (D + E )
difference. This is the OVEfRPAYMENT.
~ roquat a refund.
56,380.82
i~
I
0.00
I
0.00
~I 0.00
56,380.83
'~ 0.00
56,380.83
5. ff Line 1 + Line 3 is greater than Line 2, enter they difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Eater the total of Line 5 + 5A. This is the BAL~IINCE DUE.
PLEASE ANSWER THE
0.00
(3)
(4)
(5)
(~)
(56)
Make r~heck Payable to: REGISTER OF IMLLS, AGENT
1. Did decadent make a transfer a
a. retain the use or income of t
b. retain the right to designate
c. retain a reversionary irrteresl
d. receive the promise for life c
2. If death oaxured after Decemb~
without receiving adequate ~
3. Did decedent own an "in trust tr
4. Did decedent own an Individual
contains a beneficiary designati
IF THE ANSWER TO ANY OF THE ABOVE
For dates of death on or after Juty 1,1994 and b~
is three (3) percent (l2 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995,
[72 P.S. §9116 (a) (1.1) (ii)]. The statute ~.IIS
filing a tax return are stal applicable even if the st
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfe
adoptive parent, or a stepparent of the child is ze
The tax rate imposed on the net value of transfe
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers
Section 9102, as an individual who has at least o
QUESTIONS BY PLACING AN "X" IN THE
d: Yes
e property transferred :......................................................................................... ^
tto strati use the property transferred or its income : ............................................ ^
or .................................................................................................. ................... ^
.....
either payments, benefits or cere? ...................................................................... ^
12,1962, did decedent transfer property within one year of death
deretion? ......:....................................................................................................... ^
" or payable upon death bank account or security at his or her death? .............. ^
tetirement Account, annuity, or other non-probate property which
n? ........................................................................................................................ ^
TE BLOCKS
No
a
IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A$ PART OF THE RETURN.
~ January 1,1995, the tax rate imposed on the net value of transfers to or fortt~e use of the surviving spouse
tax rate imposed on the net value of transfers to or for the use of the survhn~ spouse is zero (0) percent
a transfer to a surviving spouse from tax, and the statutory requiremen for disdosure of assets and
ing spouse is the only benefdary.
from a deceased child twenty~ne years of age or younger at death to or for the use of a natural parent, an
(0) percent (J2 P.S. §9116(a)(1.2)].
to or for the use of the decedent's lineal benefidaries is four and one-half (4.5~ percent, except as noted in
or for the use of the decedents siblings is twehre (12) percent [72 P.S. §9116(a)(1 ~3)]. A sibling is defined, under
parent in common with the decedent, whether by Wood or adoption. j
i_ _ _ - - -- III - --- --
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REV-1508 EX+ (8-98)
SCMEp1~LE E
COMMONWEALTH OF PENNSYLVANIA ~/ BANK DEPOSRS, & MISC.
INHERITANCE TAX RETURN ~RSC~N/11. ~~~
RESIDENT DECEDENT
ESTATE OF
NUMBER
Include th proceeds of titigadon and the date the proceeds were reoaved by the estate.
All joMtly-owned with right of wrvivorshfp must bs diadosed on SchsduM F.
H mae space is needed, insert additional sheets of the same size)
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-- -_ L
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
scN~ou~E N
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FlLE NUi41BER
Elizabeth J. Miller 2120091087
~ Det>TS of deoedsrlt must be reported on Sctlsdule L
ITEM
NUMBER _.
DESCRIPTION
~' AMOUNT
A• FUNERAL EXPENSE;
_ ',
1.
Parthemore Funeral home _
- _ ~i
10,028.00 '
Z•' :Pastor Bowersox 150.00
` 3•
Hoss's ,:-... ,
380.00
a.
Grave Opening :, __ ..
_. _. _..
600.00
s. ',Grave Stone Engraving. _
-
..,. 140.00
B.
ADMINISTRATIVE COSTS:
_ ___ i,:
1. Personal Representative's Com fissions
Name of Personal Re tative(s) ' i
Sodal Security Numbers IN Number of Personal Repreaentative(s)
'~i
Street Address '
___
_ _ _ __
Cdy _ _ _ ~ _ Zip _ _ ~~
Year(s) Commissbn Paid: ._
2. Atbmey Fees 500.00 "
3. Family Exemption: (N decedent's raua is not thw ~~ ~Q ~~~s~r~ erre~, e„,~fl..wi,.,,~
~ ,<
4. Probate Fees
4
5. Accountant's Fees ,
__ .
6. ~ Tax Retum Preparer's Fees Ir
i ___
~. Register of Wills 964.00
8. Autopsy _,
2, 500.00
__
9• Legal Advertising - Patriot N s ~ 287.00 '
i TOTAL (Also enter on line 9, Recapitulation) s ~ 15,549.00
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REV-1512 EX+ (12-08)
pennsytvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RERIRN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
If more space is needed, insert additional sheets of the same size
1 ,CE~t-1513 EX+ (11-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Elizabeth J. Miller j2120091087
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS F PERSON(S) RECEIVING PROPERTY DO Not Lint Truatea(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Se .9116 (a) (1.2).]
1. Samuel C. Miller, III 3901 PI rdy Ct., Alexandria, VA 22309 Son ' 1/5
2. Linda Wagner, 800 Siddonsb rg Rd., Lewisberry, PA 17339 Daughter 1/5
3. Debra M. Latsha, 827 Siddon~ burg Rd., Lewisberry, PA 17339 Daughter ', 1 /5
4. John R. Miller, 825 Siddonsbu g Rd., Lewisberry, PA 17339 Son 1 /5
5. Allison L. Wagner, 55014th R ad South, Apt. 434, Arlington, VA 22202 Granddaughter ' 1 /20
6. Adriene L. Wagner, 800 Siddo sburg Rd., Lewisberry, PA 17339 Granddaughter ', 1 /20
7. Emily M. Miller, 3901 Picardy t., Alexandria, VA 22309 Granddaughter 1 /20
8. Lance E. Miller, 825 Siddonsb~
i
i Irg Rd., Lewisbeny, PA 17339 Grandson 1 /20
ENTER DOLIAR AMOUNTS FOR DI
BUTIONS SHOWN ABOVE ON LINES 15 THROUGH
18 OF REV-1500 COVER SHEET, A i
S A I ROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UN ER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
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B. CHARITABLE AND GOVERNMEN~fAL DISTRIBUTIONS
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TOTAL OF PART II -ENTER OTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $' ~,
SCHEDULE ~
BENEFICIARIES
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