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Home My WebLink About02-09-121505611185 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 1 7 1 28-0601 RESIDENT DECEDENT ~ ~ ~ ~ C "~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 182-16-2543 11112011 Decedent's Last Name Suffix MILLER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth MMDDYYYY 07051920 Decedent's First Name M I ERMA R Spouse's First Name M I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 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) Decedent Died Testate ^ 6 ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes . (Attach Copy of Will) (Attach Copy of Trust.) ^ A ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death 95 1 1 ) 11 EAttach Schedule O) r Sec. 9113( ) - - Between 12-31-91 and BE DIRECTED TO: ayX CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL F D Te ephone Number me Name TRIMMER 717-620-2440 ~--~; VICKY ANN First Line of Address PERSUB & HEIM, PC Second Line of Address PO BOX 659 City or Post Office State ZIP Code MECHANICSBURG PA 170550659 Correspondent'se-mail address: VATRIMMERbIPERSUNHEIM • COM c~ REGISTER BLS USE ~ ~.~ ~s ....n ,E ~ 7 r ' rl s.~ r . _T- ~ GJ r , ~» ~ .t .~\ lC! " I) . Y' ~ ~ `~ F ~ =i7 ~~ - -~ ~ _ ~ 6J DATE FILED 't--;' +"i _~ .~ ~-?' i t-"? f-17 C'7 t?`t 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 t it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer hasweny knowledge. LINDA L• MILLE 27 CONWAY DR MECH, PA 170 SIGNP,T E OF Pf~ARE THER THAN REPRESENTATIVE DAT Z ~--- r~uun~.~v PERSUN 8 HEIM PO BOX 659 MECH, PA 17055-0659 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 1505611185 OM4647 3.000 J ~ ~; 1505611285 REV-1500 EX (FI) Decedent s Name MILLER E R M A Decedent's Social Security Number 182-16-2543 R RECAPITULATION 1. Real Estate (Schedule A) 1 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2, 0 • 00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3, 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) 4. 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 3 9 5 ' 0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 4 , 619 •0 D robate Property 7. Inter-Vivos Transfers & Miscellaneous N 3 , 4 5 5. 0 0 ~ (Schedule G) Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) g. 8 , 4 6 9 • 0 0 g. Funeral Expenses and Administrative Costs (Schedule H). 9. 1 , 8 7 0 • 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 801 ' 00 11. Total Deductions (total Lines 9 and 10) , 11. 2 , 6 71 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) . 12. 5 , 7 9 8 •0 0 Charitable and Governmental BequestslSec 9113 Trusts for which 13 . an election to tax has not been made (Schedule J) , . 13. 0 14. Net Value Subject to Tax (Line 12 minus Line 13) . 14. 5 , 7 9 8 •0 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, or transfers unSier Sec. 9116 0 • 0 ~ 16. Amount of Line 14 t xable at lineal rate X .0 4~ 5, 7 9 8. 0 0 16. 261 •00 17. Amount of Line 14 taxable 12 0 X 0 0 17 0 • O 0 • . at sibling rate . 18. Amount of Line 14 taxable at collateral rate X .15 0 • 0 0 18. ~ • ~ 261.00 19 19. TAX DUE. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 J OM4646 3.000 REV-1500 EX (FI) Page 3 File Number U CI.CUCIK .I Vv1111J~Gw r+uu~c.~u. DECEDENTS NAME MIL ER ERMA R STREET ADDRESS UM R A CITY STATE ZIP CARLISLE PA 17013-3742 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 2 4 8. 0 0 B. Discount 1 3 •0 0 Total Credits (A + B) (2) (1) 261 • 00 261.00 3. Interest (3) 0 •00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Filf in box on Page 2, Line 20 to request a refund. (4) 0 • 0 0 5. If Line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ' 0 0 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: X 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 ^ 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 X 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? 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 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. §91 16 (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)j. • 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(a)(1)j. • 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)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. OM4671 2.000 REV-1508 EX+ (11-10) pennsylvania DEPPRTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. DCI?C~1AIA1 PRCIPFRTY ESTATE OF: Erma R ITEM NUMBER 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. ~.ICapital Blue Cross Refund 2 Personal property in nursing home room FILE NUMBER: VALUE AT DATE OF DEATH 195 200 TOTAL (Also enter on line 5 Recapitulation) S I 395 owasAD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1509 IX+(01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN oeelne SIT ncrc nc uT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Erma R. Miller If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVNINGJOINTTQJANT(S)NANFIS) I ADDRESS I RELATIONSHIP TO DECEDENT A Miller, Linda L JOINTLY OWNED PROPERTY: REM F NUMBER LETTER OR JOINT TENANT DATE MADE IN JOINT DESCRIPTION OF PROPH~IY CLUDENANEOFFINANCIALINSTITUTIONANDBANKACCOUNTNUM3ERORSIMLAR IDENTIFYING NUM3ER ATTACH DEED FOR JgNi LY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET rv-n% OaFm DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 5/2/2005 Fulton Bank #0076-61405 Checking 6,743 50.0000 3,371 2 5/2/2005 Fulton Bank # 0076-61405 495 2 50.0000 1,248 Svg , TOTAL (Also enter on Line 6, Recapitulation) $ 4 , 619 27 Conway Drive, Mechanicsburg, P7~, 17055 I Daughter swasAE z ooo If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF ri~c rvumocrc Erma R. Miller This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCLLOETFENM/IEOFTFETRANSFEREE.THEIRRELATIONSHIPTODECEDEMAND TFEDATEOFTRANSFERATTACHACOPVOFTHEDEEDFORREALESTATE DATE OF DEATH VALUE OF ASSET o /o OFDECD~S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1 Mainstay IRA 3,455 1 00.0000 0 3,455 TOTAL (Also enter on line 7, Recapitulation) $ I 3 , 455 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+(10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Erma R. Miller Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 704 ~ Funeral Costs - not covered by advance payment 2 Tombstone - inscription 100 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address C: itv State ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 4 5. 6. 7. 1 9W46AG 2.000 City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: UHaul Move mist items from nursing home TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. 1,000 66 1,870 REV-1512 EX+ (12-OS) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF L'.rmn R Mi 1 1 sar SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8 LIENS FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. STEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Thornwald Home TOTAL (Also enter on Line 1 801 801 swasAH z.ooo If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMEPfT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1, Linda L. Miller 27 Conway Drive Mechanicsburg, PA 17055 100$ of Residue: 5,798 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO 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. ~ $ If more space is needed, use additional sheets of paper of the same size. FILE NUMBER: AMOUNT OR SHARE OF ESTATE 5,798 0 9W46AI 2.000 0 0 v7 N N 0 0 u-> o~ O N M M O H O l0 I- J O ~~ ~~ ~.w ~_u'_ P.O. Box 4887 l~,~j ~]j~ Lancaster, PA 17604 LISTENING IS JUST THE BEGINNING.' fultonbank.com Temp-Return Service Requested I~~~IIi~~~lll~~~~l~l„I~I~~II„~~~II~~II~~II~~~~I~II~~~I1~~~11 006565 0.8500 AT 0.365 TR00024 ERMA R MILLER LINDA LOU MILLER 27 CONWAY DR MECHANICSBURG PA 17055-6136 2 ENCLOSURES 4 RELATIONSHIP BANKING ACCOUNT: 0076-61405 PREVIOUS DEPOSITS/ CHECKS/ SERVICE ENDING STATEMENT BALANCE CREDITS 5 DEBITS 4 FEES BALANCE 5,985.73 1,125.97 1,169.67 2.00 5,940.03 ACCOUNT/INTEREST INFORMATION INTEREST PAID THIS YEAR 6.15 DATE ACTIVITY DESCRIPTION REFERENCE 10-24 BEGINNING BALANCE 10-31 CHECK. 2576 04740109920 11-O1 DEPOSIT 04981607470 11-01 CAPITALBLUECROSS 00077900000 INS. PREM 111027 XXXXX9371 M 11-03 US TREASURY 303 00077900000 XXSOC SEC 110311 XxXXx2543A SSA 11-07 UNITEDHEALTHCARE 00077900000 PREMIUM 0222648021 11-09 2547: HIGHYLDINV 00077900000 INVESTMENT 000000055516921 11-10 DEPOSIT 04902706790 11-21 CHECK 2577 00317704770 11-22 SERVICE FEE 11-22 INTEREST CREDIT 11-22 ENDING BALANCE DEPOSITS/ CHECKS/ CREDITS DEBITS BALANCE 150.00 5,985.73 90.00 5,835.73 195.07 985.00 5,730.66 6,715.66 23.30 29.59 6,692.36 20.85 6,721.95 6,742.80 801.30 5,941.50 2.00 .53 5,940.03 5,940.03 CHECK SUMMARY '` INDICATES SKIP IN CHECK NUMBERS CHECK NO AMOUNT CHECK NO AMOUNT 2576 150.00 2577 801.30 TOTAL NUMBER OF CHECKS 2 TOTAL AMOUNT OF CHECKS 951.30 """ ANNUAL PERCENTAGE YIELD EARNED DISCLOSURE FROM 10-24-11 THROUGH 11-22-11 ~~~•~ ANNUAL PERCENTAGE YIELD EARNED .10% AVERAGE DAILY COLLECTED BALANCE 6,407.34 INTEREST EARNED .53 1057 0406 17574 Y STATEMENT OF ACCOUNTS 0076-61405 STATEMENT PERIOD FROM THROUGH 10-24-11 11-22-11 0 PAGE 1 OF 3 X INQUIRIES: PO BOX 504, EAST PETERSBURG, PA 17520; 1-800-FULTON4 1057 0406 17575 Y ~~ P.O. Box 4887 STATEMENT OF ACCOUNTS Lancaster, PA 17604 l15TENING IS JUST THE BEGINNING.' fultonbank.com 0076-61405 STATEMENT PERIOD FROM THROUGH 10-24-11 11-22-11 0 PAGE 2 OF 3 ERMA R MILLER 2 ENCLOSURES ~~ LINDA LOU MILLER 4 27 CONWAY DR MECHANICSBURG PA 17055-6136 RELATIONSHIP BANKING ACCOUNT: 0076-61405 ""''` SERVICE FEE DISCLOSURE FROM 10-24-11 THROUGH 11-22-11 is i; is IMAGE FEE 2.00 TOTAL SERVICE FEE 2.00 SERVICE FEE BALANCE INFORMATION FROM 10-24-11 THROUGH 11-22-11 AVERAGE LEDGER BALANCE 6,407.34 AVERAGE COLLECTED BALANCE 6,407.34 MINIMUM LEDGER BALANCE 5,730.66 MINIMUM COLLECTED BALANCE 5,730.66 EFFECTIVE JANUARY 5, 2012 THE NON-SUFFICIENT FUNDS FEE (PER RETURNED ITEM) AND OVERDRAFT FEE (PER PAID ITEM) WILL BE $39 FOR CHECKING AND MONEY MARKET ACCOUNTS. THIS FEE APPLIES TO OVERDRAFTS CREATED BY CHECK, IN-PERSON WITHDRAWAL, ATM WITHDRAWAL OR OTHER ELECTRONIC MEANS AS APPLICABLE. THIS FEE CHANGE WILL APPLY TO SAVINGS ACCOUNTS AS OF FEBRUARY 1, 2012. EFFECTIVE 1/5/2012, THE MAXIMUM DAILY OD FEE THAT MAY BE IMPOSED ON A CONSUMER ACCOUNT IS $273. N i:.,.......;i::..ci :...................................:i:.............;i:...:i:...........:i:.....;ic.....,.......:i;i:................ .. .. .: is .. ., .. .. ., ., .. .. .. .. ., STATEMENT SAVINGS 0 N ACCOUNT No: 0070-10967 FROM 10-24-11 THROUGH 11-22-11 PREVIOUS DEPOSITS/ STATEMENT BALANCE CREDITS WITHDRAWALS/ INTEREST 0 DEBITS 0 ENDING 0 2,495.37 PAID 00 00 BALANCE 0 . . .10 2.495.47 0 ° ACCOUNT/INTEREST INFORMATION INTEREST PAID THIS YEAR 1.16 0 0 o DEPOSITS/ CHECKS/ DATE ACTIVITY DESCRIPTION REFERENCE CREDITS DEBITS BALANCE J ~ 10-24 BEGINNING BALANCE 2,495.37 11-22 INTEREST CREDIT .10 2,495.47 11-22 ENDING BALANCE 2,495.47 DIRECT FULTON BANK, N.A. INQUIRIES TO: PO BOX 504 EAST PETERSBURG, PA 17520-0504 TELEPHONE: 1-800-FULTON4 x Fulton &vd:. N. A. Mznd>er FDIC fvlmuoa~il;.com Page 3