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Home My WebLink About07-12-111505610101 REV-1500 EX (oiao)~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania ~",a'.,.,, ~ County Code Year File Number Bureau of Individual Taxes PO BOX z8o6oi INHERITANCE TAX RETURN RESIDENT DECEDENT ~~+*~~ CX ( ~j 7 ~y ~ LI Harrisburg, PA 1'7128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 178-16-6948 02/02/2007 10/16/1923 Decedent's Last Name Suffix Decedent's First Name MI MILLER LYNN B (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 O 1. Original Return ~ 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) O 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 T0: Name Daytime Telephone Number PHYLLIS J. MARISKOVIC (717) 761-1731 ~> c} First line of address 5246 DEERFIELD AVENUE Second line of address City or Post Office State ZIP Code MECHANICSBURG PA 17050 REGISTER OF 1t~1~lSE ONLY ~1 S C7 i__. -,"~ x- ;- N <r'_ Cf~ ~"~ J O -~ ,` --I '~ DATE FILED ~~ 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 islra~c6rrect and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 5246 DEERFIELWAVENUE MECHANICSBURG, PA 17050 SAT E OF PREP~R OTHE THAN REP E ~ ~~ IVE J ~TE ~ /, 7 ~ST MAIN STREET SHIREMANSTOWN, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J ~~ i~rl '` 7 r'~ ,:"-? -- _t:} _ or; `~'3 "~'A t 1505610105 REV-1500 EX Decedents Social Security Number oecedent•s Name: LYNN B MILLER 178-16-6948 ____ 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 and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 3,239.39 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. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 3,239.39 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 734.30 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 2,505.09 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. 2,505.09 TAX CALCULATION -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_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable 2 505.09 17 300.61 , at sibling rate X .12 . 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ...................................................... ...19. 300.61 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 150561D105 150561D105 J REV-1500 EX Page 3 File Number Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 300.61 2. CreditslPayments A. Prior Payments _ B. Discount Total Credits (A + B) (2) 3. Interest (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) 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) 300.61 Make check payable to: 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 :................................................................................ .......... ^ b. retain the right to designate who shall use the property transferred or its income :.................................. .......... ^ c. retain a reversionary interest; or ................................................................................................................ .......... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................................ .......... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................... ........... ^ X^ 3. Did decedent own an "intrust for" orpayable-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? ............................................................................................................. ........... ^ 7c^ 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 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 Jan. 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, 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 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-1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER LYNN B. MILLER 2107-0410 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. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsytvania DEPARTMENT OF REVENUE (NHER[TANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LYNN B. MILLER 2107-0410 Decedent's debts must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City _ ..._.------------ ....................-- Year(s) Commission Paid: _-._-.- -. _____ z. 3, 4, 5. 6. 7. State ZIP Attorney Fees: 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 Probate Fees: Accountant Fees: Tax Return Preparer Fees: ZIP TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 634.30 100.00 734.30 ~s~A~~ or LYnn (3 andlar, anning~ ~ osQnbQrg.«p ATT RNEYS AT LAW Phyllis Mariskovic 5246 Deerfield Ave. Mechanicsburg, PA 17050-6841 ~c~~ ~ ~~ r1L~ na ~i67- DY/v Gregory M. Feather Feather@hhrlaw.com Duly 29, 2010 Re: Vioxx Litigation -Estate of Lynn B. Miller Private Lien Resolution Refund Enclosed is a check for $3,239.39, representing a refund from the Vioxx Claims Administrators with regard to the money that had been withheld under the Private Lien Resolution Program. If you have any questions regarding this, please do not hesitate to contact me. Very truly yours, -~ ,// i~ i l HANDLER, HENNING& ROSENBERG, LLP -~ , Gregory M.' Feather GM F/bsv Enclosure Handler, Henning 8~ Rosenberg, LLP 1300 Linglestown Road, Suite 2, Harrisburg, PA 17110 Phone: 717-238-2000 'Fax 717-233-3029 `Toll Free 1-800-422-2224 www. h hrlaw.com Carlisle Office 717-241-2244 "Lancaster Office 717-431-4000 * York Office 717-845-7800 * Hanover Office 717-630-8200 m ~~~.~ ~ ~ ~~t -r~ ~ Estate of Lynn Miller c/o Phyllis J. Mariskovic 5246 Deerfield Avenue Mechanicsburg, PA 17050 Attention: DATE Feb-04-10 Feb-14-10 Jun-08-10 Ms. Mariskovic DESCRIPTION Word Process Status Report Draft Status Report Telephone call to Marsovic Totals llISBURSEMEN'I'S Jun-08-10 Fax from Phyllis Mariskovic Totals Total Fees & Disbursements Previous Balance Junr 24. 2010 -07-] ~? ?O87C) $200.00 Kcccihtti $0.00 5203.011 $0.00 Previous Payments ~ ~ $U.00 G~' ~- ~`~ Balance Due Upon Receipt ~~ /.~,~~! (~ 5203.00,; ~~ G + '~-.-~-'' Please remit the balance due on or before July 21, 2010. Interest will be charged on any unpaid balance after that date. For your convenience, we accept Visa and Master Card. File In~~ # Disburserncnts 3.U0 $3.00 28 North Thirty-Second Street • Camp Hill, Pennsyh~ania 170i i ~ i 17.9i~.?840woice • 71i.9i5.3924~fax 400 South State Road • Marysville, Pennsylvania • 17075 ~ 1i97?.347?jvoice • r 1i.95i?316~fa~~ Word Process Status Report Totals r/L~ X70 ~~o ~-U`/ $127.00 DISBURSEMENTS Disbursements Receipts Jun-24-10 Fax from Phyllis Mariskovic 4.00 Aug-04- l 0 Photo Copies 0. ; 0 Totals $4.30 $0.00 Total Fees & Disbursements $431.30 Previous Balance $203.00 Previous Payments -Thank You $203.00 Balance Due Upon Receipt $431.30 Please remit the balance due on or before August 21, 2010. Interest will be charged on any unpaid balance after that date. For your convenience, we accept Visa and Master Card. W ~ r N r ~ r ^ LCJ o r ~~ o. ~} 0 J_ Q j O O drLL V de°~LL ~~~ _~ { ~ _ - C .r ~ ; Q „~ ~ -- ~ - ~a +~'~ . ~Q ~ - tID