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HomeMy WebLinkAbout01-0547 {!..,c ", i ,} )I., - :;; <3 5 -- Ef REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 260601 HARRISBURG, PA 17126-0601 DECE- DENT CHECK APPRO- PRIATE BLOCKS COR- RE- SPON DENT RECA- PITULA- TION REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) Miller, Claude W DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 09/11/00 04/29/1905 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Miller, Marqaret E ~ 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received ~ 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7, Decedent Maintained a living Trust (Attach acopy of Trust) 10. Spousal Poverty Credit(date of death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBERc)l/_t)/ ..s'17 ::, 'f'I will not Probated COUNTY CODE YEAR NUMBER SOCIAL SECURlrY NUMBER 212-10-7934 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURlrY NUMBER 3. Remainder Return B (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes D 11. Election to taxunder Sec. 9113(A) (Attach Sch 0) jjjl$:~"Mi)wti'Q_lifillii(tl\ij'~jj~~jQQ"~ij!iiji'fjjllWt&\I~I!l!lIlIllAl1p!!l!lIQlIiPjjiljllll!l!ft!llifPf NAME COMPLETE MAILING ADDRESS Robert G Chase P.O. Box 7899 RM 193-0205 FIRM NAME (If Applicable) Philadelphia PA 19101 Mellon Bank N .A., T:rustee TELEPHONE NUMBER (215)553-0308 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) None None None None OFFICIAL USE ONLY 3, Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested (6) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (7) 2,039.18 None 0.00 (6) 2,042.00 1,005.00 (11) (12) (13) 2,039.18 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value 01 Estate (Une 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 3,047.00 (1,007.82) None (14) (1,007.82) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amountof Line 14taxableatthespousaltal< rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X.O 0 (15) 16. Amountof Line 14taxableat lineal rate 0.00 X.O ~ (16) 17. Amountof Line 14taxableatsiblingrate 0.00 X .~2 (17) 18. Amountof Line 14taxableat cotlateral rate 0.00 x.15 (18) ~~: TaxDu~iCl(!l~lfW!@iMfil!~Ilj'i,$lj~Ailmll!"t~tllN_lIij!\mj;ijiijNI(19) """""""."".""""."""":""",:,,,:,,::,,::,:,',:,:',::::,::::,::~'i:,alii:$iR!1IoJl\!I$Wlij;UM:);::Qli!eimQli;I!,Ui1i!lJ\,(i!\.Qe:tJi!lPJil!\G*!1CK:MArn1~:-:-,::"""""""'" TAX COMPU- TATION 0.00 0.00 0.00 0.00 0.00 o PA15001 NTF 29755 Copyright 2000 Great!and/Nelco LP - Forms Software Only PA REV-1500 EX (6-00) Decedent's Com lete Address: STREET ADDRESS Bethan Villa e, Page 2 325 Wesle Drive CITY Mechanic Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE PA ZIP 17055 (1) 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Totallnlerest/Penalty (D + E) 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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. A. Enter the interest on the tax dUB. B. Enter the total of Line 5 + 5A. This Is the BALANCE DUE. Make Check Payable 10: RE~.ISTE:ROF W1LLli,jlGENT ; ::': "::::: :::::'= :;::::: ::::;': :::;' =:; :::: :;:;:;: ;::::: ;:::; :;:::;: ;:::;' ::::;: ;:::;:;:::::::::::::::::::::::::=,=:::=,=:::=,=:::=,=:::::~:::~:~:~:~:~:~:~t{:}~:~:~:)~:)}~:~;~:\)~;~;~ :~;~;::~:~~:~~:J})~(?t:tt~~:~:i~:~:': :':::;:::,: :::::::;::::::}::;::::;;:;:;;:.: .;.... . . (3) 0.00 (4) (5) 0.00 (SA) 0.00 (5B) 0.00 1. Did decedent make a transfer and: 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. . . . . . . . . . . . . . . . . . . . , . . , . . . , . . , . . . . . , . . . . , . . , . . , . . , . , . d, receive the promise for life of either payments, benefits or care? . . , . . . . . . . . . . . . , . . . . . . . . . 2. If death occurred after December 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? . . . . , . . . . . . . . . . . . . . , . . , . . . . . . . . . , . . . . . . . . . . , . . , . . . . . . . ,. D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 benef, it is true, correct and complete. Declaration oi preparer other ttian the personal representative is based on information of which crecarer has any knowledae, GNATURE OF PE N PONSI FOR FiliNG RETURN DATE . 5'/70/ Yes No ~ I B ~ ~ ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS ~t:~:~t))f)t:((/t:)}i\J::t::t::J:t{jt{))f)tf)t{)t:Jt(\}t~titU?:t(~t{)}fttfIfItft}:t::t::~ftt:~:~tit{tt}JJ:tt)tt)tfttt:~:~t::t::::It)tfitt:t{ttfttfIt:~:::~))I)t{tt:~:::~:tt:~:::~::::t:)'::::;;;::;;:;: ':':"'" For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3.y~" [72 P.S. 19116 (a)(1.1) (i)l. For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Ii 9116 (a)(1.1) (iill. The statute dn""~ nnt AICAmnt 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 twenty-one 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% [72 P.S.1i9116(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%, except as noted in 72.P.S.& 9116(1.2) 172 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% [72 P.S. Ii 9116(a)(1.3)J. 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. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco LP - Forms Software Only REV-150B EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claude W Miller SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Will-not- Probated Include proceeds of litigation & date proceeds were received by the estate. All DroD.lolntly-owned with rlClht of survlvorshlD must be disclosed on Sch. F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 Cash Value of Paid-Up Life Insurance Policy No. 022-528-065 with Prudential Life Insurance Cco:lpany, cashed in prior to but received after date of death 1,019.17 2 Cash Value of Paid-Up Life Insurance Policy No. 022-324-507 with Prudential Life Insurance Cco:lpany, cashed in prior to but received after date of death 1,020.01 TOTAL (Also enter on line 5. Rec.o;t"l.t;on' $ (If more space is needed, insert additional sheets of the same size) 2,039.18 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claude W Miller SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER Will-not-Probated This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S (IF TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) 1 On 11-10-92 the decedent and his 0.00 spouse, Margaret E Miller, created Inter-vivos Trust No. 10172726BNO with Mellon Bank (copy of instrument attached). Value as of date of death - $209,596.98 TOTAL (Also enter on line 7, Recacitulation) $ 0.00 7 CPA01 NTF 10910 (If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1997 Nelco, Inc. REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claude W Miller SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Will-net-Probated Debts of decedent must be reoorted on Schedule I. ITEM NO. A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1 Neill F\meral Hane - prepaid 0.00 2 Rolling Green Cemetery Association - staterrent 1,027.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Mellon Bank N .A. Social Security Number(s)/EIN No. of Personal Representative(s) Street Address City State 1,000.00 Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 0.00 0.00 4. Probate Fees 0.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Filing Fee 15.00 7 CPA11 NTF 109'1 Copyright Forms Software Only, 1997 Nelco, Inc. TOTAL (Also enter on line 9, Recanitulation) (If more space is needed, insert additional sheets of the same size) $ 2,042.00 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Claude W Miller Include unreimbursed medical expenses. ITEM NO. DESCRIPTION SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FlUE NUMBER Will-net-Probated AMOUNT 1 Miracle Ear - state1TeIlt 750.00 2 PA Depart1TeIlt of Revenue - state individual incare tax due 255.00 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,005.00 Copyright Forms Software Only, 1997 Nelca, Inc. MELLON BANK JOINT REVOCABLE LIVING TRUST We, Claude W. Miller and Margaret E. Miller, of Mechanicsburg, pennsylvania, as tenants by'the entirety transfer to MELLON BANK, N.A., the property described on the annexed schedule to be held IN TRUST under pennsylvania law as follows: I. Lifetime Trust: Until the death of the survivor of us, our trustee shall invest and manage the property, and make distributions as follows: A. Payments: Our trustee shall pay any part or all of the principal and income in accordance with written directions from either of us, which may be changed at any time by either of us. After the death of the first of us to die, payments, including any undistributed income, may be made only to the survivor or in accordance with the survivor's written directions; B. Balance: shall be however, Any remaining net income from time to time added to the principal or invested separately; C. Disability: If our trustee believes both of us are incapable of handling our own affairs it need not follow our previous directions regarding payments during our lifetimes. Instead, our trustee may apply part or all of the principal and income in any way it believes will benefit either or both of us, or any person dependent upon either or both of us. If only one of us is incapable, the other may act for either or both of us. II. Provisions After the Survivor's Death: After the death of both of us our trustee shall make distributions as follows: A. We direct that Ten Thousand Dollars ($10,000.00) je distributed to the First Christian Church (Disciples of Christ), or its successors, for the building fund, with the church currently being located at 442 Hummel Avenue, Lemoyne, pennsylvania, 17043. B. We direct that Five Thousand Dollars ($5,000.00) oe distributed to the perryhawkin Christian Church (Disciples of Christ), in care of its current financial secretary, with the church currently being located at perryhawkin Church Road, Princess Anne, Maryland, 21853. In the event that the Perryhawkin Christian Church (Disciples of Christ), is out of existence at the time of our death, I direct that this Five Thousand Dollars ($5,000.00) be paid to the National City Christian Church corporation, Thomas Circle, Northwest, ,Iashington, D.C., 20005. C. We direct that Eight Thousand Dollars ($8,000.001 be distributed to Paul Gordon Harvey, if he survives us, currently of 35 White Oak Trail, Gettysburg, pennsylvania, 17325. In the event Paul Gordon Harvey predeceases us, '.e direct that Eight Thousand Dollars ($8,000.001 be distributed to ~is wife, Ann Harvey, if she survives us and if she predeceases us, the Eight Thousand Dollars ($8,000.001 is to pass to her issue per stirpes. D. We direct that Five Thousand Dollars ($5,000.001 be distributed to Blaine Harvey, if he survives us, currently of 4309 Lancelot Drive, Minnetonka, Minnesota, 55343. In the event Blaine Harvey oredeceases us, we direct that this Five Thousand Dollars ($5,000.00) shall lapse. E. We direct that Five Thousand Dollars <$5,000.001 be distributed to Jeanne Dufour, currently of 2211 conestoga Road, Chester Springs, pennsylvania, 19425. In the event Jeanne Dufour predeceases us, we direct that this Five Thousand Dollars ($5,000.00) shall pass to her issue per stirpes. , we direct that Five Thousand Dollars <$5,000.001 be distributed to George Hankins, currently of 10501 Gateridge Road, cockeysville, Maryland, 21030. In the event George Hankins predeceases us, we direct that this Five Thousand Dollars <$5,000.00) shall pass to his issue per stirpes. G. We direct that Five Thousand Dollars ($5,000.00) be distributed to James Hankins, currently of 218 Beechwood Street, Princess Anne, Maryland, 21853. In the event James Rankins predeceases us, we direct that this Five Thousand Dollars ($5,000.00) shall pass to his issue pee stirpes. H. We direct that any al1d all remai~ing principal and net income held under t~is Trust aEter the afocesai:j distributions have been made, shall pas3 in equal shares as follows: 1) Fifty percent (50%) of the residue in said ~rus~ shall pass to the christian Church (Disciples of Christ) in pennsylvania, or its successors, currently located at 670 Rodi Road, ?ittsburgh, pennsylvania, 15235, for the endowment fund. 2) Fifty percent (50%) of the residue in said ~rusc shall pass to the Christian Theological Seminary, 1000 Wes~ 42nd Street, ?ost Office Box 88267, Indianapolis, Indiana, 46209-0876, or its successor, with said funds to be placed in t!le student fund to help defray tuition costs for students at tIle Semiilary. " C. We direct that Eight Thousand Dollars {$8,000.001 be distributed to Paul Gordon Harvey, if he survives us, currently of 35 white Oak Trail, Gettysburg, pennsylvania, 17325. In the event Paul Gordon Harvey oredeceases us, we direct that Eight Thousand Dollars ~$8,000.001 be distributed to his wife, Ann Harvey, if she survives us and if she predeceases us, the Eight Thousand Dollars ($8,000.00) is to pass to her issue per stirpes. D. We direct that Five Thousand Dollars {$5,000.001 be distributed to Blaine Harvey, if he survives us, currently of 4309 Lancelot Drive, Minnetonka, Minnesota, 55343. In the event Blaine Harvey predeceases us, we direct that this Five Thousand Dollars ($5,000.00l shall lapse. E. We direct that Five Thousand Dollars ($5,000.00) be distributed to Jeanne Dufour, currently of 2211 conestoga Road, chester Springs, Pennsylvania, 19425. In the event Jeanne Dufour predeceases us, we direct that this Five Thousand Dollars <$5,000.00) shall pass to her issue per stirpes. F. We direct that Five Thousand Dollars ($5,000.00) be distributed to George Hankins, currently of 10501 Gateridge Road, cockeysville, Maryland, 21030. In the event George Hankins predeceases us, we direct that this Five Thousand Dollars ($5,000.00) shall pass to his issue per stirpes. G. We direct that Five Thousand Dollars {$5,000.00l be distributed to James Hankins, currently of 218 Beechwood Street, Princess Anne, Maryland, 21853. In the event James Hankins predeceases us, we direct that this Five Thousand Dollars ($5,000.00l shall pass to his issue per stirpes. H. We direct that any and all remaining principal and net income held under this Trust after the aforesaid distributions have been made, shall pass in equal shares as follows: 1) Fifty percent {50%l of the residue in said Trust shall pass to the christian Church (Disciples of Christ) in pennsylvania, or its successors, currently located at 670 Rodi Road, Pittsburgh, Pennsylvania, 15235, for the endowment fund. ") Fifty percent (50%) of the residue in said Trust shall pass to the Christian Theological seminary, 1000 West 42nd Street, Post Office Box 88267, Indianapolis, Indiana, 46209-0876, with said funds to be placed in the student fund to help defray tuition costs for students at the Seminary. - 2 - III. Manaqement Provisions: We authorize our trustee: A. Retail/Invest: TO retain and to invest in any form of real or personal property anywhere which, 1n our trustee's opinion, is appropriate for our trust, without being required to diverpify; B. Sell/Lease: exchange or or personal leases; and To sell at public or private sale, to to lease for any period of time, any real property, and to give options for sales or c. Distribute: To distribute in cash or in kind. These provisions shall continue in full force until the actual distribution of the property. The investment provisions and all the other provisions, authorities and discretion given under our trust shall be in addition to those granted by law, shall continue until the distribution of the property, shall be exercisable without court authorization, and, unless exercised in bad faith, shall be conclusive upon all the beneficiaries. : IV. Protective provision: To the greatest extent permitted by law, before actual payment to a beneficiary no interest in income or principal shall be (il assignable to a beneficiary or (ii) available to anyone having a claim against a beneficiary. V. Accountinq: Our trustee shall send us statements at least quarterly showing the trust's transactions. Unless both of us are incapable of handling our own affairs, one of us must report any errors to the trustee, including the non-receipt of a statement, within 90 days after we normally receive a statement. Otherwise, we, at our trustee's discretion, may be deemed to have accepted the transactions as stated. VI. provisions Regarding Our Trustee: We direct that: A. Instructions: Our trustee may consider oral instructions as if they were written as long as our trustee believes in good faith they are genuine and any distribution is made only to either of us oc to any account in which either of us has an interest; B. conflicts of Interest: The fact that a trustee is active in any aspect of the investment business as that business is broadly understood shall not be deemed a conflict of interest. Purchases and sales of investments may be made through any department or affiliate of our trustee. Our trustee may pay the firm - 3 - its usual charges for the service. Any income beneficiary of his or her legal representative may cancel this power by a writing delivered to our trustee; C. Resignation: Our trustee may resign by paying all the funds to the income beneficiary or beneficiaries or, if a beneficiary is a minor, any distribution or payment may be made to his or her parent or anyone as custodian for the minor under the Uniform Gifts to Minors Act; and D. compensation: Our trustee shall receive compensation in accordance with its standard schedule of fees in effect while its services are performed. VII. this this Rights Reserved: Each of us reserves the right to revoke trust by a writing other than a will, and the right to amend trust or add to this trust with our trustee's approval. Signed /1./~ j('}$, 19 9(J. t ~i-=-at ,0/. ~etJv ' Claude W. Miller '7J; , . /' d "'wJ 'j b II /;l~ [(iAk / .e., /'F( .//L-CLb Margare E. Miller j Witness: 1:L4M*,c9 %/b0V / ' ~., di c:l.<-CY\ {, /~GL<-. Cu<- -- - 4 - STATE OF / .r;~;;... X":.J.:.,.i.' 1~.-/Zt ",:1.' .~ SS. COUNTY OF ~j'''LA'../.~' L.... -7 On~Lld"'~L;.<~' /,1..1')) , 19 (/;;< , before me, the undersigned notary public, personally appeared Claude w. Miller and Margaret E. Miller, who acknowledged the foregoing instrument to be that person's act and desired that the trust might be recorded as such. witness our signature and notarial seal on the above date. . / -lla )(u/ y <;:'~A4di/ Notary puJ:hic l NO",. ,,;; 5..1 My Co mm is s ion E xp ire s : Nancy L. Si'(:,'iV. t :Cl.t?1: P~bl:c ~ ~.~'i c~~~:;~':;~:},:, ~-~~~~~j~;.'~~~ 1983 The foregoing in pennsylvania, on tcust was delivered, and is :;l)\l(tlI'n:r IR , 19 'l? hereby accepted, MELLON BANK, N.A. By: / ~ /d /.- . .. I~'Z? 7:1 ..' / // - ~ - \ /h -d?.36""- 9 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP Cl2-DDl ROBERT G CHASE MElLON BANK NA PO BOX 7899 PHILA DATE ESTATE OF DATE OF DEATH FILE NUMBER C9UNTY ACN 07-16-2001 MILLER 09-11-2000 21 01-0547 CUMBERLAND 101 CLAUDE W Amount Remitted PA 19101 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is47-Ex--AFP--fi"2---ooY-NoTIcE--oF-i:NHERITAifcE-TAX-A-PPRAIS EiriNT:--A LToWAifcE-oii----------- -----_ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MILLER CLAUDE W FILE NO. 21 01-0547 ACN 101 DATE 07-16-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 2,039.18 .00 .00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax 2,039.18 (9) (10) 2,042.00 NOTE: 1.005.00 (11) (12) (13) (14) 3.047 00 1,007.82- .00 1,007.82- If an assessment was issued previously, lines reflect figures that include the total of abh ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS. 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .OOXOO= .00 X 045 = .00X12= .00 X 15 = (19)= .00 .00 .00 .00 .00 (15) (16) (17) (18) . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expresslY reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF lULLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administrativelY correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOl are: Year Interest Rate Daily Interest Factor Year Interest Rate DailY Interest Factor 198Z ZO% .000548 199Z 9% .000Z47 1983 16% .000438 1993-1994 n .00019Z 1984 117- .000301 1995-1998 97- .000Z47 1985 13% .000356 1999 n .00019Z 1986 107- .000Z74 ZOOO 87- .000Z19 1987 97- .000Z47 ZOOl 9% .000247 1988-1991 117- .000301 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.