HomeMy WebLinkAbout03-31-15 (2) , �' 1505610143
��V-1500 EX(02-11} �, p�'FtCIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes �EPAFITMENTOFREYENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 14 0666
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEdENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
210 Q7 05 2014 09 23 5.920
DecedenYs Last Name Suffix DecedenYs First Name M�
MILLER VIOLET Y
{If Applicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name M�
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH TFfE
REGISTER C1F WiLLS
FiL�lN APPROPRIA7E OVALS BELOW
1. Orf inal Retum 2. Supplemental Retum f_ 3. Remainder Retum(Date of Death
n 9 ❑ Prior to 12-13-82)
4. Limited Estate � qa,Futu�e Interest Compromise ,j 5. Federal Estate Tax Retum Required
� (date of death after 12-12-82) '
;� g Decedent Dietl Testate �'�! � �ecede�c Ma�ncained a�iving rrust _�-___ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) I_i (Attach opy of Trusq
� 9. Litiga6on Proceeds Received � 10.Spousal Pove redit Date of Deatn ) 11.Election to tax under Sec.9113(A)
b8tween 12-3��and�-�-s5) �--� (Attach Schedule 0)
CORRESPONDENT-TH1S SECTION MUST BE GOMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
CHARLES E SHIELDS III ?l7 766 0209
REGISTER OF WILLS USE ON�Y
�v
First Line of Address � c."�"'i-, � M''
6 CLOUSER ROAD � � � � �
� �ac, ,..._ c�
� "'� �a cn �?
Second Line of Address � � � •� ��
�.� .�„ 1"`: W a�r� r;t
� � � �
`'' C:ta
. ��4TE FILED - q
City or Post Office State ZIP Code . �, Q -rt "T�
MECHANICSBURG PA 17055 � `" � � � �,
. ��i w � rn
r,,.� � � �
CorrespondenYs e-mail address: � � ��
Under penalties of perjury,i declare that.l have examined this return,inciuding accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and compiete.Declaration of preparer other than the personal representative is based on all infortnafion of which preparer has any knowtedge.
SIGNATURE OF PER50 SPONSIBLE FOR FILI,G RE/JURN �'} ! ��J jj C/ �.� 4a�1�'�, DATE
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A� REss LS/4'n _ Z>.S S f r; ,!�' ���c-�'%',G,c�.G`��¢<�ff',�c,���.
G'
77 E. Kin Street Shi ensbur PA �I72rJ7 DATE `
SIGN TURE OF PREP RER 0 TN EPRES�IVE � �I O�IS/
Charles E.Shields III
ADORESS
6 Clouser Road, Mechanicsburg, PA 17055
Side 1 �
� 150567,0143 15�56107,43
�
' � 1505610243
�J
REV-1500 EX
DecedenYs Social Security Number
Decedent'sName: MIII@r� V101etY.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 44 , 711 . 64
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ �l.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... Ei. Z2 9, 822 . 11
6. Jointly Owned Property(Schedule F) ', _��, Separate Billing Requested............ 6. 11 , 818 . 75
7. Inter-Vivos Transfers&Miscellaneous I��-Probate Property
(Schedule G) i__; Separate Billing Requested............ ��,
g. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 2$6,352 . 50
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 2 9, 97 0 . 0 9
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 8 ,2 9 9 . 1�
11. Total Deductions(total Lines 9 and 10)................................................................ ��. 3 8 ,2 6 9 . 19
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 2 4 8 , �8 3 . 31
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13. 9, Q Q Q . Q Q
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 2 3 9, �8 3 . 31
TAX COMPUTATION-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.00 15. � . 0 0
16. Amount of Line 14 taxable 239, 083 . 31 �s. 10 , 758 . 75
at lineal rate X .045
17. Amount of Line 14 taxabie
at sibling rate X.12 � . �� 1''. � . ��
18. Amount of Line 14 taxable
at collateral rate X.15 � . �� 1�. � . ��
19. TAXDUE................................................................................................................ 19. ZO � 7rJ8 . 7 'rJ
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENI". �
Side 2
� 1505610243 1505610243 J
' REV-1500 EX Page 3 File Number 21-1 9-0666
Decedent's Complete Address:
DECEDENT'S NAME
Miller,Violet Y.
_
__ _ - ____ _ _ _ __ __ __ _
STREET ADDRESS
100 Mt.Allen Drive
._ __ _ _ -- __ __ ._ __ _ _ ___ _ __ ___ _ __
_ _ - -- _
CITY STATE ,ZIP
Mechanicsburg __' PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 10,758.75
2. Credits/Payments
A. Prior Payments 9,500.00
B. Discount 500.00
_ __ _ ______
Total Credits(A +B) (2) 10,000.00
. _ _
3. Interest �3�
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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. (5) ]5$.75
Make Check Payable to: REGISTER OF W�LL.S, AGENT.
_
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "Xy' IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:.................................... ........................................ ' � I x',
b. retain the right to designate who shall use the property transferred or its income:................................. ', ,x_',
c. retain a reversionary interest;or............................................................................................................... i x;
d. receive the promise for life of either payments,benefits or care?.................. ........................................ . I, �_x I
2. tf death occurred after Dea 12, 1982, did decedent transfer property within one year of death without __
receivingadequate consideration?.................................................................................................................... '� 'x i
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... _ ', x I
4. Did decedent own an individual retirement account,annuity,or other non-proba4e property which __i __
contains a beneficiary designation?.................................................................................................................. ' �_X I
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEUWLE 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 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 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 sibiing is defined,
under Section 9102,as an individual who has at feast one parent in common with the decedent,whether by blood or adoption.
Rev-1503 EX+�08•72)
SCHEDULE B
pennsylvania STOCKS & BONDS
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Miller,Violet Y. ___ 21-14-0666
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP � VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 1,207.729 shares of INVESCO High Yield Municipal Fund 9.70 11,714.97
Accrued dividend on Item 1 through date of death 8.59
2 874.672 shares of Lord Abbett Muni Income Fund 11.06 9,673.87
Accrued dividend on Item 2 through date of death 5.34
3 31 shares of Prudential Financial Inc. 91.057500 2,822.78
4 115.264 shares of Prudential National Municipal Fund 15.06 1,735.88
Accrued dividend on Item 4 through date of death 0.73
5 1,654.209 shares of Prudential Short Term Corporate Borad 11.33 18,742.19
Fund
Accrued dividend on Item 5 through date of death 7.29
TOTAL(Also enter on Line 2,Recapitulation) 44,711.64
(If more space is needed,additionat pages of the same size)
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.08-12)
Rev-1508 EX+�08-12)
. SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MIS�.
DEPARTMENT OFREVENUE p E RS O NAL P RO P E RTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Miller,Violet Y. 21-14-0666
Include the proceeds ot 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 �4 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Edward Jones Money Market-balance at d/o/d 4,550.62
2 Pennsylvania State Employees' Retirement System -account balarace as of d/o/d 116.42
3 Harr's-proceeds from sale of personal property at auction 598.70
4 Internal Revenue Service-Refund on 2014 1040 1,512.00
5 American Equity Investment Life Ins.Co. -Annuity#575683, payable�o iEstate 45,278.36
6 Lincoln National Life Ins. -Annuity#954117046, payable to Estate 117,230.27
7 Prudential-Annuity#E0282679, payable to Estate 60,535.74
TOTAL(Also enter on Line�, Recapitulation) 229,822.11
(If more space is needed,additional pages of the same size) Y
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.OS-12)
Rev-1509 EX+(01-10)
� pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Miller,Violet Y. 21-14-0666
If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. James W. Miller III 8058A Lucas Drive Son
Clay, NY 13041
B.
C.
JOINTLY OWNED PROPERTY: _
DESCRIPTION OF PROPERTY o�o OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT pATE OF DEATH DECD�S DECED NT'S NTEREST
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE.
1 A 10/31/2009 M&T Bank-checking account ending in 8643, 23,637.50 50.000% 11,818.75
with accrued interest to d/o/d
TOTAL(Also enter on Line 6,Recapitulation} 11,818.75
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10)
REV-151TEX+(OS-73) SCHEDULE H
� pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Miller,Violet Y. 21-14-0666
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M ER --
q, FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Orrstown Bank __
Street Address 77 E. King Street
city Shippensburg state PA zio 17257�
Year(s)Commission Paid 2015 13,500.00
2. Attorney's Fees Charles E. Shields III 13,500.00
3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant _.__
Street Address �
City State Zio
Relationship of Claimant to Decedent �.._
4. Probate Fees 443.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 2,526.59
See continuation schedule(s)attached
TOTAL(Also enter on line 9, �tecapitulation) 29,970.09
Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13)
_..
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRAI���OE COSTS
continued
ESTATE OF FILE NUMBER
Miller,Violet Y. 21-14-0666
ITEM AMOUNT
NUMBER DESCRIPTION
Other Administrative Costs
1 American Equity Investment Life Ins.Co. -State and Federal Income Tax uvithheld 2,136.66
2 Cumberland Law Journal-advertising fee-Executor's Notice 75.00
3 Edward Jones-Estate Services Fees 100.00
4 Edward Jones-Estate valuation fee 50.00
5 The Sentinel-advertising fee-Executor's Notice 164.93
H-B7 2,526.59
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE MORTGAGE LIABILITIES AND LIE�S
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Miller,Violet Y. _ 21-14-0666
Report debts incumetl by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medlcal expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Charles E.Shields, III-Professional services rendered prior to death 1,191.45
2 Comcast Cable-final cable bill 59.37
3 James D.Bogar,Esquire-Professional services rendered prior to death 350.00
4 Messiah Lifeways at Messiah Village-monthly nursing home paymen� 4,467.69
5 Messiah Lifeways at Messiah Village-final nursing home payment 1,443.59
6 PA Dept of Revenue-Payment due on 2014 PA-40 412.00
7 R.WM.Wire Associates, P.C.-Preparation fee for 2014 1040 and PA-40 375.00
TOTAL(Also enter on Line 10, Recapitulation) 8,299.10
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1613'EX+�01-10)
� pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Miller,Violet Y. 21-14-0666
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY o DE CEDEN e S (WOrds) ($$$)
TAXABLE DISTRIBUTIONS [include outright spousal
I. distributions,and transfers
under Sec.9116 a 1.2
1 Christopher James Miller Grandson Une-half(1/2)of 114,066.09
704 Albernathy Street residuary estate
Liverpool, NY 13088
2 James W. Miller III Son One-half(1/2)of 114,066.09
8058A Lucas Drive residuary estate
Clay, NY 13041
�!
�
Total 228,132.18
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTIORI TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 National Shrine of Saint Elizabeth Ann Seton 3,000.00
2 St.Elizabeth Ann Seton Catholic Church 3,000.00
3 St.Jude's Children's Research Hospital 3,000.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 9,000.00
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
' ._._-_.-- _�..,.�.�
LAST WILL AND TESTAMENT OF VIOLET Y.MILLEI�
1,VIOLET Y.MILLER,unremarricd widow,currently of 3l2 Mcssiah Circic,
Mechanicsbur�,Upper Allen Township,Cumbcrland County,PennsYlvania,bcing o�soiuudl and
disposing mind,memory and understanding,do makc,pubGsh and declarc this my Last Vl{iiV and
Testamcnt,hcreby revoking and mak'sng void any and all prior Wills and Codicels by srre sut any
time heretoforc made.
1.
[dircct thc payment of aU my just debts and funeral expenses ax soon after tryy dei.�ease as
thc same cun canveniently be done.
2.
[makc the following spccific bequests and legacies:
A. I give and bequeath the sum of Threc"fhousand and No/100ths(S3,OOQ.O�)
llollars to ST.JUAE CHiLDREN'S RESEARCH H05P1TAL,cazrr�ntly of
501 So.Judc Placc,Memphis,Tennessee 38105.
13. I givc aud bcqutath the sum of Three Thousand and No/100ths($3,(9(1Q,009
RnUars to NATIONAL SHRINE OF SAINT ELIZABETH ANN�ETk)6�,
currently of 333 South Seion Avenue,Emmituburg,Maryland 2172�'.
C. 1 give and bequeath the sum of Three Thousand and No/IOQths{$3,f900.0�,
Dollass to ST.ELIZABETH ANN SETON CATHOLIC CHURC��,c��rarently
of 310 F{ertzler Road,Mechanicsburg,Pennsylvania 17055.
F012 PIJRPOSFS OF CLARIFICATION:1 am aware that by making thesc gv�'�t in ihc
form of a spcCific devisc and bcqucst thut it will have priority in thc distribution of my�I?s:dule.
Also,in ordcr to climinate any argument or confusion among rny bcneCiciaries as tcm my
understanding or desires in this respect,I dircct my Exccutor to pay frorn the residu�c�f nn;y
Estutc nli dcath wxcs associatcd with the valuc of these items and tcgacies. Additinn�U;y�„'l
specifically dircct that all debts,costs,charges,Eeccutor's commissions,anorncy'�,�7ppu�eser's
and accountant fees,and other expenscs and the like tha�wouid typically be calcul�teci m�ir taken
against thc valuc of thcse bcqucsts are Also to be paid from thc residuc of my Estat�.
3.
All the rest,residuc and remainder of my Estate,real,personal and mixed, uvh;ut�o�vcr
and wheresocvcr situatc,{direct my Exccutor to divide and distribute as follows:
A. Onc-half{%:)thcrcof to my son,JAMES W.MILLER itl. ]n the�:v�nt�:�
fails to survivc mc,then to my grandsan,CHIRiSTOPI�IER JtiM�S
N11LI.FR.
Page 1 � ��, �/►
Y��
�'
8. One-half('/:)thcrcof to my grandson,CHRISTOPHER JAMES 1WIILC,E;'��.
In the event he fails ta survivc me,then to my son,JAMES W.MiLtl'd,�R]illl�_
ln the cvent both my said son and said grandsan fai)to survive me,then I d"ar�c�th�Y
thc residue of my Esu�te bc distributed among my heirs as dctermincd by the laws o&"irr�es�u�cy
of the Commonwealth o!'Pennsylvania.
4.
In the event that any of the bcneficiarics named herein shall undertake�o cantesi tleas,my
Last Will and Tcstamcnt,in any way,form,or manner whatsoevcr,I direct that the�hare,;;yiivcn
in my Estatc hcrcin to her or to him,as the casc may he,shall bc forfeitcd and sh�l1 ll�c d�w�irtied
and distributcd among the other beneficiaries in the proportions as sec forth above. 'I �'iiuut�er
dircct that,insofar as I am legally authorized to do so,my said Eixecutor and its cou�s�l a�r�:eo
seck the payment of any attomey's fecs and court costs incurrcd in a defense of this,�iy V..ust
Will and Testament,from such contest or similar proceeding.
S.
lt is my intention that beneGciarics named bcfore or alier thc date of this W�11 r�ni i,�i,y
life insurance,Annuities,individual relirement accoums(IRAs),in Trust for or jain¢�auik
accounu and any other asscts for which 1 may designatc bc»cficiarics will rcccivc�uclh
investments and that my Will provisions shall not control such investmcnts.
6.
!t is my wish that my son and my grandson see to it that flowers are plAccd up�ni.�iy
and my husband's grave on the foUowing holidays:Eas►er,Christmas,Vetcran's��y arir.9
Memoriat Aay.
7.
1 nominatc,constitute and appoint ORRSTOWN BANK,to bc Exccutor. �fauhl!m�Y
direct that it shall not be required to file bond or other securiry in the�ffice of t}�e�te�gi�x�;r of
Wills(or the purpose of administering my Estate.
!N WITNE55 WHEREOF.1 havc hereunto sct my hand and scal this �_, dlay
of ,A.D.2013.
"'�'--�—,�.e� � �:'�SEAL)
C���,f�j�,���GGl�ti�� , VIOLET Y.MII ER
�`��� S.. �
Pago 2
Signed,scufed,published and declar�d by the uhovc-namcd'VIdLET�'.R�i[l�..t.l'�[Z.ns
and fon c�r T.ast Will and Tcstament,in the presence ofus,who At her rcquest and�n�1c�r
presence,and in thc pccsencc of cuch other,have hcrcunto subscribod atu nar�acs as v�irr��e�ses.
������.ki���..�_..._..—.
Page 3
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