HomeMy WebLinkAbout02-22-11EX (01-10)
-~ REV-7500 ~, 1505610143
~` OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 80X.280601 INHERITANCE TAX RETURN 2 1 0 9 0 1 0 2 4
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
172 24 7736 11 30 2005 03 05 1931
Decedent's Last Name Suffix Decedent's First Name
MILLER DORA
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
MILLER
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return
^ 4. Limited Estate
® 6 Decedent Died Testate
(Attach Copy of Will)
^ 9. Litigation Proceeds Received
Suffix Spouse's First Name
HERBERT
THIS RETURN MUST BE FILED IN DUPLICATE V'VITH THE
REGISTER OF WILLS
^ 2. Supplemental Return
^ 4a. Future Interest Compromise
(date of death after 12-12-82)
^ ~ Decedent Maintained a Living Trust
(Attach Copy of Trust)
^ 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
MI
M
MI
F
^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
0
_ 8. Total Number of Safe Deposit Boxes
^ 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
HAMILTON C DAVIS 717 532 5713
First line of address
20 EAST BURD STREET
Second line of address
SUITE 6
City or Post Office
SHIPPENSBURG
State ZIP Code
PA 17257
Correspondent's a-mail address: h d a V I S @Z u l l i n g e r-Davis . C O m
REGISTER OF VIIILLS USE ONLY
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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.
SIGNATURE OF PERSON RESPONSIB E FOR FILING RETURN DATE
~/~' u,,~ ~ VICKIE M. GALBRAITH _ ~~ _-- / ~ -, /~
ADDRESS
45 WINDY HILL ROAD, NEWVILLE, PA 17241
SIGNATUR F PREPARER OTHER THAN REPRESENTATIVE DATE
- ../ Hamilton C Davis ~~ _ ~ Gr' ~~
ADDRESS
20 East Burd Street, Shippensburg, PA 17257
Side 1
1505610143 ],50561143
:-~~
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedents Name: MILLER, D O RA M. 17 2 2 4 7 7 3 6
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.
2.5, 046.49
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) ....................................................................... 8.
2~5, 046 .49
2,211.50
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
2,211.50
11. Total Deductions (total Lines 9 & 10) ...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12.
2.2, 834.99
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13.
2'. 2, 8 3 4. 9 9
14. Net Value Subject to Tax (Line 12 minus Line 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
2 2, 8 3 4 9 9
15
0 0 0
(a)(1.2) x .o0 .
16. Amount of Line 14 taxable
at lineal rate X .045 16.
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.
0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 09 - 01024
DECEDENT'S NAME
MILLER, DORA M.
STREET ADDRESS
39 CLUGSTON ROAD
CITY ~ STATE ZIP
NEWVILLE PA 17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
Total Credits (A + B)
(1) 0.00
(2) 0.00
(3) 0.00
(4)
(5> 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box 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.
Make Check Payable to: REGISTER OF WILLS, AGENT.
! .. _ .. ~ ... ~. 1 _. .. _.. _. - ] ... _V, ~ ~. ~ ~ .. _ .. ~ ... d ~, a ..
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 :................................... '~ 0
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? .......................................................................................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ~I~ x~
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 I'T AS PART OF THE RETURN.
fi -~ - - - - - -- - -
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.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 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 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 child 21 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 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 4.5 percent, exempt 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 12 percent [72 P.S. §9116 (a) (1.3)1. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whethE~r by blood or adoption.
,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF MILLER, DORA M. 21 - 09 - 010;24
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 PRUDENTIAL ANNUITY CONTRACT NO. CS00000003977 PAYABLE TO THE ESTATE 25,046.49
(THE EXISTENCE OF THIS ANNUITY WAS RECENTLY DISCOVERED)
TOTAL (Also enter on Line 5, Recapitulation) ~ 25,046.49
SCHEDULE H
FUNERAL E)CCPENSES &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN /d1DM~N~~AT11/G G'~~'
RESIDENT DECEDENT ~v , , v-~ ~~ ~~ ~~ aa~~ vw
ESTATE OF MILLER, DORA M. I FILE NUMBER;
21 - 09 - 01024
_ _ Debts of decedent must be reported on Schedule I.
ITEM ~
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 PREPAID
B. ADMINISTRATIVE COSTS:
~. Personal Representative's Commissions
Name of Personal Representative(s)
i
Street Address
City State Zip
i
Year(s) Commission paid
2. Attorney's Fees HAMILTON C. DAVIS, ESQUIRE 2,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ~
Claimant ~
Street Address
~ City State Zip
i
j Relationship of Claimant to Decedent
i
4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 35.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 CUMBERLAND COUNTY LEGAL JOURNAL -LEGAL ADVERTISING
75.00
TOTAL (Also enter on line 9, Recapitulation) 2,211.50
. ,1° Schedule H
Funeral F~er~ses &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN Administrafirve C06f.5 confinued
RESIDENT DECEDENT
ESTATE OF MILLER, DORA M. FILE NUMBER'.
21 -09-01024
2 I THE NEWS CHRONICLE -LEGAL ADVERTISING
101.50
Page 2 of Schedule H
REV-1513 EX+ 111-08)
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~ SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DORA M.
MILLER
,
~ 21 -09'-01024
RELATIONSHIP TO SHARE OF ESTP,TE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 HERBERT F. MILLER ~ Spouse RESIDUE 22,834.9!
39 CLUGSTON ROAD
NEWVILLE, PA 17241
Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriatES.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
;,
I
it
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
i
i
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
LAST WILL AND TESTAMENT
I, DORA M. MILLER, of North Newton Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament anal. revoke any
will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decease as a part of the
administration of my estate.
ITEM II: I devise and bequeath all of my estate of every nature and
(wherever situate to my husband, HERBERT F. TALLER, providing he shall survive
~me by thirty days.
ITEM III: Should my husband, HERBERT F. MILLER, predecease me or die on o'
d
before the thirtieth day following my death, I devise and bequeath all of my
estate of every nature and wherever situate in equal shares to my daughters,
VICKIE M. ZEIGLER and SHERRIE L. SIMON, providing they survivE~ me by thirty
(30) days. Should either of my daughters, VICKIE M. ZEIGLER or SHERRIE L.
SIMON, predecease me or die on or before the thirtieth day following my death
but leaving issue who so survive me, such issue shall receive, per stirpes,
the share that such predeceased daughter would have received lzad she so
,survived me.
ITEM IV: I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY of
Shippensburg, Pennsylvania, guardian of any property which passes outright
either under this will or otherwise to a minor and with respect to which I am
authorized to appoint a guardian and have not: otherwise specifically done so,
provided that this appointment of a guardian shall not supersede the right of
any fiduciary in its discretion to distribute a share where possible to the
minor or to another for the minor's benefit. Such guardian shall have the
power to use principal as well as income from time to time for tl:ie minor's
support and education (including secondary, college education, both graduate
and undergraduate, professional and other education) without rE~gard to his or
her parent's ability to provide for such support and education, or to make
payment for these purposes, without further responsibility to 1:he minor or to
the minor's parent or to any person taking care of the minor,
ITEM V: I direct that all taxes that may be assessed in consequence of
my death, of whatever nature and by whatever jurisdiction imposed, shall be
paid from my residuary estate as part of the expenses of the administration of
Amy estate.
ITEM VI: I appoint my husband, HERBERT F. MILLER, executor of this my
last will. Should he fail to qualify or cease to act as executor, I appoint
Imy daughters, VICKIE M. ZEIGLER and SHERRIE L. SIMON, executrices of this my
'last will.
ITEM VII: I direct that my executor or guardian or their successors
shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on three (3) sheets of paper, dated this ~~~~~_.' .`" day of
1988.
~ ~ (SEAL)
Dora M. Iille.r
The preceding instrument, consisting of this and two (2) other
typewritten pages, each identified by the signature of the testatrix, was on
the day and date thereof signed, published and declared by 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 subscribed
our names as witnesses hereto.
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COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, DORA M. MILLER, the testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to :law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and
that I signed it willingly and as my free and voluntary act four the purposes
therein expressed.
~ ~~ (SEAL )
Dora M. Mi le-r
Sworn to or affirmed and acknowledged
before me by DORA M. MILLER,
the testatrix, this / 9~i~ day of
(~ e ~C ~ ~,- 1988 .
Notary Public
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VEDA I'Jt. SEf"-.~r, ~~ic~a!y Public
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( Ct!,y Ccm;nis~ion E~:pi~es f,pii.,_~.`.'' ~5~90-
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COMMONWEALTH OF PENNSYLVANIA
. ss.
COUNTY OF CUMBERLAND
we, /~O~rt ~ eke. ~- l~tl ~~ ~f and ~~~es~ .,.f. ~crr-~~~ c 1cLer ,the
witnesses whose names are signed to the attached or foregoing 'instrument,
being duly qualified according to law, do depose and say that we were present
and saw the testatrix sign and execute the instrument as her Last Will; that
the testatrix signed willingly and executed it as her free and voluntary act
for the purposes therein expressed; that each subscribing witneess in the
hearing and sight of the testatrix signed the Will as a witness; and that to
the best of our knowledge the testatrix was at that time eightleen (18) or
more years of age and of sound mind and under no constraint or undue
influence.
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Sworn to or affirmed and subscribed to before
me by /YfQ~,~e% ~. .GUS %~ and
I re.s~ -~/• ~~~~/~Giolde/ witnesses,
this ~jtti day of ~c.7Ld ~ ~'r 1988.
Notary Public
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