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REV.l!IIO!J(I~}
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUiirvCOOE
FILE NUMBER
21 05
-----
NUMBER
~ COMMONWEALTH OF
.. PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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0999
YEAR
SOCIAL SECURITY NUMBER
192-01-7250
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DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
Akers, D. Richard
DATE OF DEATH (MM-DD-YEAR)
11/03/05
DATE OF BIRTH (MM-DD-YEAR)
01/01/17
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPUCABLEj SURVIV1NG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INmAL)
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~ 1. Original Return
o 4. Umiled Estate .
o 6. Decedent Died Testate (AlIach coPY olWil)
o 9. Utigation Proceeds Received
o 2. Supplemental Return
o 4a Future Interest Compromise (dale Ii death 81ler 12-12-82)
o 7. Decedent Maintained a Living Trust (AIIal:h coPY olTJUSI)
o 10. Spousal Poverty CredK (date Ii dellh ~ 12.J1-91 n '-1-95)
o 3. Remainder Return (date lidealh prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
B. Total Number of Safe DeposK Boxes
o 11. Election to tax under Sec. 9113(A) (AllachSd10)
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NAME COMPLETE MAIUNG ADDRESS
Daniel C. Miller Miller Dixon Drake PC
FIRM NAME (1l Appic:alllo) S '
Miller Dixon Drake, PC 701 ~. Second t.
TELEPHONE NUMBER Harnsburg, PA 17102
(717) 234-2250
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(1)
(2)
(3)
(4)
(5) 6.67
(6) 97,139.53
(7)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & MisceDaneous Personal Property
(Schedule E)
6. Jolndy Owned Property (Schedule F)
o Separate BaOng Requested
7. Inter-VIVOs Transfers & MisceUaneous Non-PlObate Property
(Schedule G or L)
B. Total Gross Assets (total Unes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Deceden~ Mortgage Uablllties. & Uens (Schedule I) (10)
11. Total Deductions (total Unes 9 & 10)
12. Net Value of Estate (Una 8 minus Una 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 (Une 12 minus Une 13)
(B)
17,883.51
2,176.36
(11)
(12)
(13)
(14)
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SEE INSTRUCilONS ON REVERSE SIDE FOR APPLICABLE RA i'ES
15. Amount of Une 14 taxable at 1I1e spousal tax
rate, or transfers under Sec. 9116 (a)( 1.2)
x .0 _ (15)
16. Amount of Une 14 taxable at ineal rate
77,086.33 x.O ~ (16)
17. Amount of Une 14laxable at sibfing rate
_____..__,,__.___.._______ x .12
(17)
(18)
18. Amount of Une 14 taxable at collateral rate
x .15
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97,146.20
20,059.87
77 ,086.33
77,086.33
3,468.88
3,468.88
19. '1i.v Due (19)
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REV-1500 EX (6-001
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUNTY CODE YEAR
NUMBER
COMMONWEALTH OF
, PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
FILE NUMBER
21 05
0999
SOCIAL SECURITY NUMBER
192-01-7250
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Akers, D. Richard
-6ATE6F-DEATHiMM~D-YEAR)--[1 DATE OF BIRTH (MM-DD-YEAR)
11/03/05 01/01/17
-----------
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
I SOCIAL SECURITY NUMBER
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[!] 1. Original Return
o 4. Limited Estate
o 5. Decedent Died Testate (Allaell copy 01 Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dalo 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AIlaell copy olTf1Jst)
o 10. Spousal Poverty Credit (dele 01 death between 12.31-91 and 1,1-95)
D 3. Remainder Return (dale 01 dealh prior 10 12,13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A)(Allach Sell 0)
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l'fns..seCTlON'MUST'aECOMPLETEO.ALL.CO~RSSPO/llDE/IICEA/IIOCONFIOENTlAL."'A)(I/IIF()~MAnONSHQ\JL.O..BeOI~EcteD.TO:
NAME COMPLETE MAILING ADDRESS
Daniel C. Miller Miller Dixon Drake, PC
FI~M NAM~ (If Applicable) 701 N. Second St.
MIller DIxon Drake, PC .
TELEPHONE NUMBER Harnsburg, PA 17102
(717) 234-2250
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(1)
(2)
(3)
(4)
(5) 6.67
(5) 97,139.53
(7)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
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 of Estate (Line 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)
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(8)
17,883.51
2,176.36
(11)
(12)
(13)
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20,059.87
77,086.33
(14)
77,086.33
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seE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(l.2)
x.O _ (15)
16. Amount of Line 14 taxable at lineal rate
_________77.,_Q~6.33 x.O 45_ (16)
3,468.88
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
x .15
(16)
(19)
3,468.88
Decedent's Complete Address:
STREET ADDRESS
--
_____~~~~_~eny!:!!!L St.__________
CITY Harrisburg
I STATEpA
I ZIP 17104---~--
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,468.88
4,008.82
210.99
Total Credits ( A + B + C ) (2)
4,219.81
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E ) (3)
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 (4)
750.93
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(SA)
(5B)
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 due.
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;.......................................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 00
c. retain a reversionary interest; or.......................................................................................................................... 0 ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? .............. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 00
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 pe~ury. I declare that I have examined this retum. including accompanying schedules and statements. and to the best of my knowledge and belief, ij is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge.
__ ~~TE'ZJ~_~j~? __~___
SIGNATURE OF PERSON RESPONSIBLE FOR FILI~
- - - - --- {2L-----------
ADDRESS
2344 Ber hill t., Harrisburg, PA H1~4
SIGNATUREt!/!!:tR t!J1jfFt~SENTATIVE------------------ -
ADDRESS t (
701 N. Second St., PA 17102
...... .....--.._.-..-.
DATE
S'-/7' 0 (,
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%
[72 P.S. 99116 (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% [72 P.S. 99116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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-1508 EX+ (6~98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
D. Richard Akers
FILE NUMBER
21 05-0999
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.
ITEM
NUMBER
1. Church lottery ticket
DESCRIPTION
VALUE AT DATE
OF DEATH
6.67
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6.67
REV-1509 EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
D. Richard Akers
FILE NUMBER
21 05-0999
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 Akers
John Akers
2344 Berryhill Street, Harrisburg, PA 17104
1012 Chippewa Road, Johnstown, PA 15904
Son
Son
B.
C.
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %Of DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 08/01/03 Cash Reserve Fund - Ferris Baker Watts Account # 10575405 42,513.92 33 14,171.31
2. A. 08/01/03 Advent Claymore Enhanced Closed Fund. Ferris Baker Watts Account # 5,145.00 33 1,715.00
10!'i7!i40!'i
3. A. 08/01/03 American Balanced Fund Class C - Ferris Baker Watts Account # 11.411.89 33 3,803.96
10!'i7!i40!'i
4. A. 08/01/03 Cohen & Steers Select Utility Fund. Ferris Baker Watts Account # 10,075.00 33 3,358.33
10!'i7!i40!'i
5. A. 08/01/03 Dividend Capital Realty - Ferris Baker Watts Account # 10575405 6,865.00 33 2,288.33
6. A. 08101/03 Eaton Vance Fit Rate & High C - Ferris Baker Watts Account # 10575405 50,364.21 33 16,788.07
7. A. 08101/03 Lehman Brothers/1st Tr Inc Opp . Ferris Baker Watts Account # 9,821.50 33 3,273.83
10!'i7!i40!'i
8. A. 08/01/03 Madison Claymore Covered - Ferris Baker Watts Account # 10575405 9,360.00 33 3,120.00
9. A. 08/01/03 Pioneer Global High Yield B - Ferris Baker Watts Account # 10575405 12,539.21 33 4,179.74
10. A. 08/01/03 21 st Century CD - Ferris Baker Watts Account # 10575405 15,000.00 33 5,000.00
11. A. 08/01/03 FHLMC 5% 1/15/33 - Ferris Baker Watts Account # 10575405 18,900.00 33 6,300.00
12. A. 08/01/03 FHLMC 4% 5/15/10 - Ferris Baker Watts Account # 10575405 40,000,00 33 13,333.33
13. A. 08/01/03 Republic Bank 3.5% 1/15/06 - Ferris Baker Watts Account # 10575405 15,000.00 33 5,000.00
14. A. 08/01/03 GMAC Coml Mtg Bank - Ferris Baker Watts Account # 10575405 25,000.00 33 8,333.33
15. A. 08/01/03 Regular Shares - PSECU Account # 8870228767 463.99 50 232.00
16. A. 08/01/03 Checking - PSECU Account # 8870228767 2,932,54 50 1,466.29
TOTAL (Also enter on line 6, Recapitulation) $ ~
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (6-9S.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
D. Richard Akers
FILE NUMBER
21 05-0999
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 J. Akers
John Akers
2344 Berryhill Street, Harrisburg, PA 17104
1012 Chippewa Road, Johnstown, PA 15904
Son
Son
B.
C.
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER DR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 08/01/03 Total from Page 1 92,363.52
17. A. 08/01/03 Money Market - PSECU Account # 8870228767 3,521.32 50 1,760.90
18. A. 08/01/03 6 Month Certificate. PSECU Account # 8807228767 3,015.80 50 1,508.17
19. A. 08/01/03 3 Month Certificate - PSECU Account # 8807228767 3,013.43 50 1,506.94
TOTAL (Also enter on line 6, Recapitulation) $ 97,139.53
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 05-0999
ESTATE OF
D. Richard Akers
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Funeral Home
Flowers
Thank You stamps
Grave opening
Dry Cleaning
Honorariums
Funeral Luncheon
8,670.54
225.00
25.00
625.00
9.63
200.00
1,009.79
2.
3.
4.
5.
6.
7.
1.
B. ADMINISTRATIVE COSTS:
4,857.31
2.
Personal Representative's Commissions
Name of Personal Representative(s) James R. Akers
Social Security Number(s)/EIN Number of Personal Representative(s) 199-50-0474
Street Address 2344 Berry Hill St.
City Harrisburg . State PA Zip 17104
Year(s) Commission Paid: 2006
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Attorney Fees
831.24
Claimant
Street Address
City State .Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Miscellaneous Fees to Estate
180.00
1,025.00
225.00
17,883.51
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03) .-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
D. Richard Akers
FILE NUMBER
21 05-0999
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including un reimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Utilities
42.30
2.
Medical Expenses
2,134.06
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,176.36