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HomeMy WebLinkAbout11-21-13 (2) J 1505610140 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Cade Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 1 1 1 0 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 0 7 2 5 2 0 1 3 0 9 2 3 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI MI L L E R A R L E N E M (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 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) 6.Decedent Died Testate © 7.Decedent Maintained a Living Trust 0 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 Schedulg_O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX4WORMATION SIOMLD Bi TEDTO: Name Daytirt Telephone Number M �O S U S A N H CONFAI R 7 , 6F3-� 1_U�303 = r ry R rn EG1B= F Vill USEONEmY fn o 0 First Line of Address a> _ n 2331 MARKET STREET c� rm —1 r o Second Line of Address D f-, "*7 City or Post Office State ZIP Code DATE FILED C A M P H I L L P A 1 7 0 1 1 Correspondent's e-mail address: SCONFAIR -REAGERADLERPC.COM 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 rel5resentalive is based on all information of which preparer has any knowledge. SI URE OT F PJ=RSON RESP NSIB FOR FILING RE' DA ADDRESS 5006 GREENWOOD CI LE ENOLA PA 17025 SIGNATURE OF P3fP ROTHER THAN REPRESENTATIVE of,/ DATE ADDRESS � 2331 MARKET STREET CAMP HILL PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 7 L 1505610140 1505610140 1505610240 REV-1500 EX(FI) 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. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Ng�-Probate Property 6 9 8 7 4 . 4 1 (Schedule G) u Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . I . . . . . . . . . .... .... .... 8. 6 9 8 7 4 . 4 1 9. Funeral Expenses and Administrative Costs Schedule H 9. 1 2 0 4 1 . 6 5 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . .. . 10. 9 2 5 9 . 2 6 11. Total Deductions(total Lines 9 and 10) ... . . . . . . . . . . . . ............ .. .. 11. 2 1 3 0 0 . 9 1 12. Net Value of Estate(Line 8 minus Line 11) ....... . . . . . . .. . . . . . . . . . . . . . 12. 4 8 5 7 3 . 5 0 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. 4 8 5 7 3 . 5 0 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 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 4 8 5 7 3 . 5 0 16. 2 1 8 5 . 8 1 17. Amount of Line 14 taxable 0 • 0 0 17. 0 . 0 0 at sibling rate X.12 18. Amount of Line 14 taxable 0 • 0 0 at collateral rate X.15 0 . 0 0 18. 19, TAX DUE . . . . . ... . . .. . . .. . . .... .. . .. . . .. . . . . . . . . . . . .. . .. ... . .. . 19. 2 1 8 5 . 8 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X Side 2 L 1505610240 1505610240 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 1110 DECEDENT'S NAME ARLENE M. MILLER STREET ADDRESS 1100 GRANDON WAY _ CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 2,185.81 2. CreditslPayments A,Prior Payments 2,075.00 S.Discount 109.21 Total Credits(A+B) (2) 2,184.21 3. Interest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3) Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1.60 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 ..................................................................................................... F-1 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ Q 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ Q 1 Did decedent own an'in trust 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?.................................................................................................. © ❑ 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 fling 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(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)].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. REV-1510 EX,(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER•VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC.NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ARLENE M. MILLER 21 13 1110 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 DESCRIPTION OF PROPERTY INCLUDETHEIVAIEOF THETRANSFCREE,TH@RREUTM PTODECFMTAND DATE OF DEATH % DECUS EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL E STATE. VALUE OF ASSET INTEREST BfA ICABLE VALUE 1. MEMBERS 1ST FEDERAL CREDIT UNION -SAVING ACCT 8,07 100,00 8.07 IN THE NAME OF"MILLER FAMILY TRUST' 2. MEMBERS 1ST FEDERAL CREDIT UNION-SAVING ACCT 94.13 100.00 94.13 IN THE NAME OF"MILLER FAMILY TRUST' 3. FIRST COLUMBIA SANK&TRUST CO. -CHECKING 56,292.64 100.00 56,292.64 IN THE NAME OF"MILLER FAMILY TRUST' 4, PERSONAL PROPERTY 250.00 100.00 250.00 IN THE NAME OF"MILLER FAMILY TRUST' 5, EMERiTOUS CORP. -NURSING HOME REFUND 2,586.00 100.00 2,586.00 IN THE NAME OF"MILLER FAMILY TRUST' 6, THE JEWISH HOME REFUND 10,42374 100.00 10,423.74 IN THE NAME OF"MILLER FAMILY TRUST` 7. OPPENHEIMER &CO. INC. -INVESTMENT ACCOUNT 219,83 100.00 219.83 IN THE NAME OF"MILLER FAMILY TRUST' TOTAL(Also enter on line 7,Recapitulation) $ 69,874A1 If more space is needed,use additional sheets of paper of the same size. REV•1511 EX+(1e.e9) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESO NT DE ED RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ARLENE M. MILLER 21 13 1110 Decedent's debts must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. ALLEN FUNERAL HOME 8,21&00 00 2. ST. MATTHEWS LUTHERAN CHURCH 1,000.00 3. MARLEYS-VIEWING MEAL 316.65 4. ELAN MEMORIAL PARK- DEATH SCROLL FOR MEMORIAL 10.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Represenla ive(s) Street Address City State ZIP Years)Commission Paid: 2. Aftomey Fees: REAGER&ADLER, PC 2,500,00 3. Family Exemption:(If decedents address is not the same as claimant's,attach explanation.) Claimant Street Addross City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5 Accountant fees: 6. Tax Return Propmer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 12 041.65 If more space is needed,use additional sheets of paper of the same size. mi REV-1512 EX*(12-12) Pennsylvania SCHEDULE 1 DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHEWTANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ARLENE M. MILLER 21 13 1110 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. JEWISH HOME-NURSING HOME CARE 6,252.16 2. PAULA JONES-PERSONAL CARE GIVER 1,600.00 3. CMS EAST, INC. -GRAVE DIGGING 1,140.00 4. OMINICARE PHARMACY-PERSCRIPTIONS 17.56 5 BROCKIE PHARMATECH-PERSCRIPTIONS 67.76 6. CUMBERLAND FAMILY PRACTICE-MEDICAL 96.03 7. KREISER, JUANIATA M. DO-PHYSICIAN 65.75 TOTAL(Also enter on line 16,Recapitulation) $ 9,259.26 If more space is needed,insert additional sheets of the same size. REV-1513 EXt(0110) pennsy}vania SCHEDULE J DEPARTMENT Of REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ARLENE M. MILLER 21 13 1110 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [Include out,gqht spousal distributions and transfers under Sec.91t(a)(1.2).) 1. MILLER FAMILY TRUST DATED AUGUST 27, 2009 Lineal 46,573.50 5006 GREENWOOD CIRCLE ENOLA, PA 17025 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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ It more space is needed,use additional sheets of paper of the same size.