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Home My WebLink About08-04-101505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau oflndividualTaxes INHERITANCE TAX RETURN h PO BOX 280601 2 1 1 0 0 0 3 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 7 8 1 6 6 2 2 3 1 2 0 5 2 0 0 9 1 1 0 1 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name MI M I L L E T I C S D O L O R E S C (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 IN APPROPRIATE OVALS BELOW ^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 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. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number M U R R E L W A L T E R S I I I E S Q 7 1 7 9 7 ~ 5 0 Firm Name (If Applicable) r'" c~ - ; ~ REGISTERy ILLS USNLY ~ ,- 7 .:7 Y, r-- First line of address r-- -> t-n 1 : ~ ;-;,~ ~ ~' -~ 5 4 E A S T M A I N S T R E E T >.~ ~-~ Second line of addres s J_~ T~ -i L'O r t C.d'1 `~ ~ --a f.3 City or Post Office State ZIP Code DATE FILED M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's a-mail address: mwalters54t7a.verizon.net Under penalties ofperjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is t ect and complete. D claration of prepay o er an the personal representative is ba d on all information of which preparer has any knowledge. SIG U E OF PERSON PON F TURN DATE ~ Z ~-~ ~ ~I 7-7-/0 112 N FREDERICK, ," 055 930 NIXON DR, MECH PA 17055 SIGNATURE OF PREPARER OTHER ~ R NATIVE ,,,~ :g1AT~ / O ADDRESS r ~/ ~~ ~ /' ) 54 E MAIN ST (/ MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J 1505607221 REV-1500 EX Decedent's Social Security Num ber oecedent'sName: DOLORES C• MILLETICS 1 7 8 1 6 6 2 2 3 RECAPITULATION 1. Real estate (Schedule A) ....................................... 1. . 9 1 9 3 0. 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. 8 7 2 6 9 • 3 4 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) .......................... . 8. 1 7 9 1 9 9. 3 4 9. Funeral Expenses & Administrative Costs (Schedule H) ............... . 9• 8 0 3 4 . 6 1 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........... . 10. 3 5 5 5. 8 8 11. Total Deductions (total Lines 9 & 10) .......................... . 11. 1 1 5 9 0 . 4 9 12. Net Value of Estate (Line 8 minus Line 11) ........................ . 12. 1 6 7 6 0 8 . 8 5 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 (Line 12 minus Line 13) ................. . 14. 1 6 7 6 0 8 • 8 5 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.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 1 6 7 6 0 8. 8 5 16. 7 5 4 2. 4 0 17. Amount of Line 14 taxable 0 0 0 0 0 0 . at sibling rate X .12 17, . 18. Amount of Line 14 taxable ~ 0 0 ~ 0 0 at collateral rate X .15 18. • 19. Tax Due ............................................... .19. 7 5 4 2. 4 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0034 DECEDENT'S NAME 'DOLORES C. MILL_E_TICS STREET ADDRESS '128 W. PORTLAND STREET, APT 5 CITY MECHANICSBURG - _ _ ----- STATE Zlp PA 17055 Tax Payments and Credits: 1• Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 7, 542.40 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 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. (3) 0.00 (4) 0.00 (5) 7,542.40 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 7,542.40 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 : ................................................................ ...... ^ Q b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ X^ c. retain a reversionary interest; or .......................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ ^X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................. ...... ^ X^ 3. Did decedent own an "intrust 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 exemot 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 [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. REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOLORES C. MILLETICS 21 10 0034 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 properly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 128 W. PORTLAND STREET, APT 5 91,930.00 MECHANICSBURG, PA 17055 ASSESSED VALUE $72,960. times CLR 1.26 = TOTAL (Also enter on line 1, Recapitulation) ~ $ 91.930.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E CASH BANK DEPOSITS & MISC COMMONWEALTH OF PENNSYLVANIA , , . INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER DOLORES C. MILLETICS 21 10 0034 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. 1996 SATURN 2,700.00 KELLEY BLUE BOOK 2. M&T BANK 11,735.43 CHECKING 3. PRUDENTIAL ANNUITY 13,039.91 BENEFICIARY ESTATE 4. PRUDENTIAL ANNUITY 15,554.08 BENEFICIARY 50% THOMAS MILLETICS 50% DAVID MILLETICS 5. PRUDENTIAL ANNUITY 10,198.15 BENEFICIARY ESTATE 6. PRUDENTIAL 660.58 BENEFICIARY THOMAS MILLETICS 7. PP&L 24.30 REFUND 8. AARP HEALTH 237.40 REFUND -POLICY CANCELLATION 9 CARPENTERS UNION 176.77 PENSION FUND 10 PRUDENTIAL 15,643.81 PRU-CO SECURITIES ACCOUNT 11 NATIONWIDE LIFE INSURANCE COMPANY 17,298.91 BENEFICIARY 50%THOMAS MILLETICS 50% DAVID MILLECTICS TOTAL (Also enter on line 5, Recapitulation) I $ 87 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DOLORES C. MILLETICS 21 10 0034 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. AVER CREMATION SERVICE -SERVICE AND URN 566.42 2 REVERAND JOHN WARD DIORIO 325.00 3 SARAH MYERS, ORGANIST 150.00 4 MIKE HATZ, JANITOR 100.00 5 ST. PAULS UCC -MEAL 176.69 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) THOMAS A. MILLETICS (RENOUNCED) Street Address 112 N. FREDERICK STREET City MECHANICSBURG State PA Zip 17055 Year(s) Commission Paid: 2. Attorney Fees MURREL R. WALTERS, III, ESQUIRE 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4• I Probate Fees REGISTER OFWILLS -CUMBERLAND COUNTY 5. I Accountant's Fees 6. I Tax Return Preparers Fees 7 Zip 6,370.00 346.50 TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent DOLORES C. MILLETICS 21 10 0034 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses ~ Administrative Costs - B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 2• Name of Personal Representative (s) DAVID S. MILLETICS (RENOUNCED) Street Address 930 NIXON DRIVE City MECHANICSBURG State PA Zip 17055 Year(s) Commission Paid: SUBTOTAL SCHEDULE H-B1 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 DOLORES C. MILLETICS 21 10 0034 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 1. AARP CHASE CREDIT CARD SERVICES 171.38 2. GOLDEN LIVING CENTER 262.06 BEAUTICIAN SERVICE, ETC 3. COMCAST 141.47 TELEVISION 4. UNITED WATER 73.14 WATER 5. WEST SHORE EMS 1,179.82 AMBULANCE 6. PPL 266.36 ELECTRIC 7. VERIZON 211.61 PHONE 8. BOROUGH OF MECHANICSBURG 215.60 SEWER/REFUSE 9. PORTLAND COURT 690.00 CONDO FEE 10 LIBERTY MUTUAL 116.04 HOUSE AND AUTO INSURANCE 11 AARP 228.40 HEALTH INSURANCE TOTAL (Also enter on line 10, Recapitulation) I $ (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 DOLORES C. MILLETICS 2~ ~n nn~a RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. THOMAS A. MILLETICS Lineal 112 N. FREDERICK STREET MECHANICSBURG, PA 17055 2. DAVID S. MILLETICS Lineal 930 NIXON DRIVE MECHANICSBURG, PA 17055 3. DEANN L. CHANDLER Lineal 5,000.00 350-B PROSPECT BLVD., APT. 302 FREDERICK, MD 21701 4. SCOTT A. MILLETICS Lineal 5,000.00 866 CARLWYNNE MANOR, APT. C-103 CARLISLE, PA 17013 5. KRISTI M. MILLETICS Lineal 5,000.00 930 NIXON DRIVE MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. 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 $ (If more space is needed, insert additional sheets of the same size)