HomeMy WebLinkAbout08-28-13 (2) � 15�5611185
REV-1500 EX(02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes �NHERITANCE TAX RETURN 2]� 11 12?7
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
204-26-9861 06252011 06121933
DecedenYs Last Name Suffix Decedent's First Name M�
MILLER PATRICIA ANN
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M�
MILLER (Date of Death: 02/06/2013) JAMES W
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
174-20-1918 REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
� 1. Original Return � 2. Supplemental Return � 3. Remainder Retur,(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)
� 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 � ��' Attach Schedule Oer Sec.9113(A)
Between 12-31-91 and 1-1-95) ( )
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
KEITH 0 • BRENNEMAN, ESQ - 71?-697-8528
REGISTER OF WILLS USE ONLY
;Y9
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C"� c�-' ���,;� �..�
C_—�'. �...., .�-.+ x`?
First Line of Address -_� = , ' ••-�s
�,;�; : ,_: . � �,
44 WEST MAIN STREET '
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- a�
Second Line of Address ` � �.?
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P • 0 • B 0 X 318 =a �: ��i -'i
DATE FILED . " �a
City or Post Office State ZIP Code � `; �, , " ,
,� �..._
MECHANICSBURG PA 17055 " r-� �--, �' -�'r,
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CorrespondenYs e-mail address:
Under penalties of perjury, I declare that I have amined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and c mplete. Declaration of eparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAlURE OF R�SON RES NSI R FILING ETURN ATE
�... L' i f
ADDRESS
BARBARA A • HOUSE, AD NISTRATRIX 462 CHAMPLAIN STREET, TOMS RIVER, NJ
9ATE � 08757
SIGNF� OF PREPARER OTHER THAN REPRESENTATIVE D.B.N. �/�7/`
f
ADDRESS
KEITH 0 • BRENNEMAN, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG
PLEASE USE ORIGINAL FORM ONLY PA 17 55
Side 1
� 15�5611185 OM46473.000 1505611185 J
� 1505611285
REV-1500 EX(FI)
DecedenYs Social Security Number
2D4-26-9861
DecedenYSName MILLER PATRICIA ANN
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . • 1. � • ��
2. Stocks and Bonds(Schedule 8). . . . . . . . . . . . . . . . . . . . . . . . . 2 3,5 6 0 •6 4
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , . . , 3. Q •0 Q
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. � • 0�
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. 16,719 • 3 3
6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , g. 2 4,96 4 • 57
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . 7. � •��
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . g. 4 5,2 4 4 • 5 4
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. 2,8 0 9 • 2 5
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , , . . . 10. 8 8,9 3 9 •8 7
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. 91,7 4 9 •12
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , �2. (4 6,504 - 58)
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) , , , , , , , , , , , , , , , �q. (4 6,50 4 • 58)
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers un�er Sec.9116
(a)(1.2)X.0- � •�0 15. 0 • ��
16. Amount of Line 14 t xable
at�inea�rate x.0 4� 2 4 �9 6 4 •5 7 16. 1�12 3• 41
17. Amount of Line 14 taxable
at sibling rate X.12 � •�� 17. � - Q Q
18. Amount of Line 14 taxable
at collateral rate X.15 � . 0� �g Q • �Q
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. }r,12 3• 41
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
$Id@ 2
� 1505611285 1505611285 �
OM4648 3.000
REV-1500 EX(FI) Page 3 File Number
DecedenYs Complete Address: 21 11 1,2 7 7
DECEDENT'�NAME
MILLER PATRICIA ANN
STREET ADDRESS
CLAREMONT DRIVE
MIDDLESEX TWP • , CUMBERLAND
CITY STATE ZIP
CARLISLE PA 17013-
Tax Payments and Credits:
1. Tax Due(Page 2,�ine 19) (1) Z�12 3 • 41
2. Credits/Payments
A. Prior Payments 0 • ��
B. Discount � - 0� O . O a
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 box on Page 2,Line 20 to request a refund. (4) � -0�
5. if Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,12 3 • 41
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 . . . . . . . . . X
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
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.§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 Juiy 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.�9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.�9116(a)(1.3)]. A sibling 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-1503 EX+(698)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDEM'DECEDENT
ESTA7E OF FILE NUMBER
Patricia Ann Miller 21 11 1277
Ail property jointly-owned with right of survivorship must be disciosed on Scheduie F.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
1.U.S. Savings Bonds 3,560.64
39 EE bonds (see attached listing)
TOTAL (Also enter on line 2,Recapitulation) $ 3 560. 64
swasss i o00 (If more space is needed,insert additionat sheets of the same size) ,
REV-1508 EX+(11-10)
pennsylvania SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS, 8� MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Patricia Ann Miller 21 11 1277
Include the proceeds of litigation and the date the proceeds were received by the estate.
All prq�ert jointly owned with right of survivorship must be disciosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Residue from the Estate of James P. Miller, Decedent's
son. Date of death 8/19/2000 16,719.33
TOTAL(Also enter on line 5,Recapitulation) $ 16,719.33
owasnD 2 00o If more space is needed,use additional sheets of paper of the same size.
REV-1509 IX+(01-10)
pennsylvania SCHEDULE F
DEPMTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Patricia Ann Miller 21 11 1277
if an asset became jointly owned wkhin one year of the decedenYs date of death,k must be reported on Schedule G.
SURVNINGJOINTTENANi(S)tyAAT�S) ADDRESS RaAT10NSHIPTODE�EDEM
A House, Barbara A 462 Champlain Street, Toms River,
NJ 08757 Daughter
JOINTLY OWNED PROPERTY:
LETfER oA� oESCw�noN oF�o�Tr r oF a4�oF o�h+
�� FOF2JOINT MADE INCLUDENAMEOFFINANCIALINSTITUTIpJANDBANKACCWNTNUhEEROR5IMLAR DATEOFDFATH ���'S VALUEOF
NUNBBZ TENANT ,IOINT I�ENTIFYINGNUhBER.ATTACMDEEOFIXtJpNTLYHELOREA�ESTHTE. VALUEOFASSET INTBZEST DEC�B�IT'SI�ITER6ST
1 A 7/13/2009 Wells Fargo (formerly
Wachovia Bank) 48,020.53 50.0000 24,010.27
checking account ending
#8881
2 p� Inceptio U.S. Savings Bonds 1,908.59 50.0000 954.30
total of 14 E & EE bonds
(see attached listing)
TOTAL (Also enter on Line 6, Recapitulation) S 24,964.57
ewasnE z.000 If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+�,ao9, SCHEDULE H
pennsylvania
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Patricia Ann Miller 21 11 1277
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
� None
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
z. AttorneyFees: Snelbaker & Brenneman, P.C. (Estimated) 1,725.75
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Ciaimanl to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Bank service charges
deducted on estate accounts orginally opened by
James W. Miller 67.23
Total from continuation schedules . . . . . . . . . 1,016.27
TOTAL(Also enter on Line 9,Recapitulation) $ 2 809.25
9W46AG 2.000 If more space is needed, use additional sheets of paper of the same size.
Estate of: Patricia Ann Miller 21 11 1277
Schedule H Part 7 (Page 2)
2 Cumberland Law Journal
advertising Administrator Notice for James W. Miller 75.00
3 Register of Wills
filing fee for Inheritance Tax return and Inventory 30.00
4 Register of Wills
probate fees, file bond and renunciation filing fee 173.50
5 Snelbaker & Brenneman, P.C.
certified mail fee 5.75
6 The Sentinel
advertising Administrator Notice for James W. Miller 232.02
7 Reserve
for filing fees and other miscellaneous costs
associated with the administration of the decedent's
estate 500.00
Total (Carry forward to main schedule) 1,016.27
REV-1512EX+��2�08) SCHEDULE I �
pennsylvania
DEPARTMEMOF REVENUE DEBTS OF DECEDENT,
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS
RESIDEPfT DECEDENT
FILE NUMBER
ESTATE OF
Patricia Ann Miller 21 11 1277
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
VALUE AT DATE
ITEM
NUMBER DESCRIPTION OF DEATH
�• Commonwealth of Pennsylvania, Department of Public
Welfare
Class 3 claim in the amount of $26,356. 97 and a Class
5.1 claim in the amount of $62,582.90 88,939.87
TOTAL(Also enter on Line 10,Recapitulation) $ 88 939.87
8W46AH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513EX+(Ot-10) SCHEDULE J
pennsylvania
DEPARTMEMOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDEfYT DECEDEM
ESTATE OF: FILE NUMBER:
Patricia Ann Miller 21 11 1277
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).)
�. Barbara A. House
462 Champlain Street
Toms River, NJ 08757
U.S. Savings Bonds
Inventory Value: 954.30
Wells Fargo (formerly Wachovia Bank)
Inventory Value: 24,010.27 Daughter 24,964.57
2 James W. Miller
C/O Barbara A. House, Executrix
462 Champlain Street
Toms River, NJ 06757 Surviving Spouse 0.00
(Date of Death: 02/06/2013)
EMER DOLLAR AMOUPf(S FOR DISTRIBUTIONS SHOWN ABOVE ON I.INES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
�� 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. $ O.00
swasAi z.000 If more space is needed, use additional sheets of paper of the same size.
Calculated Value of Your Pape-Savings I�ond(s) , f� � L(!_� ;�' �� l , � �-P � t'age i ot �
``�,
i �'G��� () I �� ��i��(1
Calculated Value of Your Paper Savings Bond(s)
ESTATE OF PATRICIA A. MILLER
Calculator Results for Redemption Date 06/2011
Total Price Total Value Total Interest YTD Interest
$1 900.00 $3,560.64 $1 660.64 $53.38
Bonds: 1-39 of 39
Serial # Series Denom Issue Next Final Issue Interest
Interest Value Note
Date Accrual Maturity Price Rate
L359551710EE EE $50 05/1988 11/2011 OS/2018 $25.00 $53.58 4.00% $78.58
C638080675EE EE $100 05/1998 07/2011 05/2028 $50.Q0 $29.96 1.77% $79.96
_
C639107375EE EE $100 03/1998 07/2011 03/2028 $50.00 $31.68 1.50% $81.68
C634350604EE EE $100 02/1998 07/2011 02/2028 $50.00 $31.76 1.50% $81.76
C633384247EE EE $100 Ol/1998 07/2011 O1/2028 $50.00 $31.88 1.50% $81.88
C628820237EE EE $100 11/1997 07/2011 11/2027 $50.00 $32.08 1.77% $82.08
C622144314EE EE $100 10/1997 07/2011 10/2027 $50.00 $33.92 1.50%0 $83.92
C616159225EE EE $100 09/1997 07/2011 09/2027 $50.00 $34.04 1.50%0 $84.04
C614986046EE EE $100 08/1997 07/2011 0$/2027 $50.00 $34.12 1.50% $84.12
_
C602012315EE EE $100 06/1997 07/2011 06/2027 $50.00 $34.36 1.77% $84.36
C508410851EE EE $100 Ol/1995 07/2011 01/2025 $50.00 $45.80 4.00%' $95.80
C509090822EE EE $100 02/1995 07/2011 02/2025 $50.00 $45.48 4.00% $95.48
C514643437EE EE $100 03/1995 07/2011 03/2025 $50.00 $45.20 4.00% $95.20
C516101132EE EE $100 04/1995 07/2011 04/2025 $50.00 $44.88 4.00% $94.88
C516916134EE EE $100 05/1995 11/2011 05/2025 $50.00 $38.68 1.67% $88.68
C522784891EE EE $100 06/1995 12/2011 06/2025 $50.00 $38.68 1.67% $88.68
C531874753EE EE $100 07/1995 07/2011 07/2025 $50.00 $38.04 1.42% $88.04
C535413999EE EE $100 08/1995 08/2011 08/2025 $50.00 $38.04 1.42% $88.04
C537742637EE EE $100 09/1995 09/2011 09/2025 $50.00 $38.04 1,42% $88.04
C541172599EE EE $100 10/1995 10/2011 10/2025 $50.00 $38.04 1.42% $88.04
C463967026EE EE $100 03/1994 07/2011 03/2024 $50.00 $49.04 4.00% $99.04
C447340307EE EE $100 O1/1994 07/2011 01/2024 $50.00 $49.68 4.00% $99.68
C�}47913712EE EE $100 02/1994 07/2011 02/2024 $50.00 $49.36 4.00% $99.36
C435377048EE EE $100 12/1993 07/2011 12/2023 $50.00 $50.00 4.00% $100.00
C422922801EE EE $100 09/1993 07/2011 09/2023 $50.00 $51.00 4.00% $1Q1.00
C422921726EE EE $100 08/1993 07/2011 08/2023 $50.00 $51.36 4.00% $101.36
C422919041EE EE $100 06J1993 07/2011 06/2023 $50.00 $52.00' 4.00% $102.00
C422917383EE EE $100 05/1993 07/2011 05/2023 $50.00 $52.36 4.00% $102.36
C464783110EE EE $100 04/1994 07/2011 04/2024 $50.00 $48.72 4.00% $98.72
C468199487EE EE $100 05/1994 07/2011 05/2024 $50.00 $48.36 4.00% $98.36
C472780055EE EE $100 06/1994 07/2011 06/2024 $50.00 $48.04 4.00% $98.04
C480799273EE EE $100 07/1994 07/2011 07/2024 $50.00 $47.72 4.00% $97.72
C481463762EE EE $100 08/1994 07/2011 08/2024 $50.00 $47.40 4.00% $97.40
C486882009EE EE $100 09/1994 07/2011 09/2024 $50.00 $47.08 4.00% $97.08
C646223958EE EE $100 06/1998 07/2011 06/2028 $50.00 $29.84 1.77% $79.84
C640259157EE EE $100 04/1998 07/2011 04/2028 $50.00 $31.56 1.50% $81.56
C654844659EE EE $100 10/1998 07/2011 10/2028 $50.00 $29.44 1.50% $79.44
L267605360EE EE $50 07/1986 07/2011 07/2016 $25.00 $67.74 4.00% $92.74
C422920500EE EE $100 07/1993 07/2011 07/2023 $50,00 $51.68 4.00% $101.68
Totals for 39 Bonds 1 900.00 1 660.64 $3,560.64
Notes
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