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Home My WebLink About10-13-06 .....I 15056051058 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY _~~~ Code Year ,Z-l File Number 101 Date of Birth 09/04/2006 10/20/1913 Decedent's Last Name Suffix Decedent's First Name MI Griffith Grace M (If Applicable) Enter Surviving Spouse's Information Below Last Name SPCl~s~:~_~Cl~ial First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW <a,) 1. Original Return c::> 2. Supplemental Retum c::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required c::> 4. Limited Estate c::> c::> 4a. Future Interest Compromise (date of death after 12-12-82) c::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::> 10. Spousal Poverty Credit (date of death c::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number l-(!~!)>~~-~~~g~~~~~~-:~i--:~~_~~] REGIsTERji~LS USE 8.y "_'-'<::1 ('"'") ~~~~ : C}C")C) > ~-)O -11 :::::r: C)C ~:rJ \.0 -0 --l )> DATE FILED 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c::> c::> ZIP Code ::t,] j-'ll ~~ CO) !~c:~l ,::J o -T1 -n ('5 _,_ rTl ~) (~-) '~;'I FiErrI_~arn~(I!~ppli~li~I~) O'Brien Baric & Scherer First line of address 19 West South Street Second line of address CitYClf PostOffic~ ..r::- ex> I Carlisle 17013 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, 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 representative Is based on all information of which preparer has any knowledge. SIG URE OF PERSON RESPONSIBLE FOR FILING RETURN DA~ A ADDRESS 19 West South Street~ Carlisle. Pennsvlvania PLEASE USE ORIGINAL FORM ONLY 17013 L 15056051058 Side 1 15056051058 .....J -' 15056052059 REV-1500 EX ,I:l~_~!_~!'!~o~i~.~~c~~!y_~~".'~~~___ Decedent's Name: Grace M Griffith : 139-12-0701 RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 1,736.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.' r------.~".""'"_..."'.._--.......----""---~ 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. i r"---~" 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . I 5. i 5,112.00 ~ --,--,_.- 6. I 36,385.00 !'------_._----'--: 7. i 6. Jointly Owned Property (Schedule F) <::) Separate Billing Requested . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) <::) Separate Billing Requested. . . . . . . . 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. i i 9. i f-- 43,233.00 2,280.00 140,256.00 142,536.00 i 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. i 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. I c 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. ! 13. Charita~le and Govemmental Bequests/See 9113 Trusts for which i-- an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. i 0.00 i 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 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 .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 0.00 i 15. 16. 17. 18. 19. TAX DUE... ... .. . .. ... .. ... .. ... ... ... . ..... . ..... ... . ...... ..... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c::J L 15056052059 Side 2 15056052059 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENrs NAME Grace M Griffith STREET ADDRESS 137 Barricklo Street File Number DD [-~:~~~~---"--"-'''o_-~J DECEDENrS SOCIAL SECURITY NUMBER 139-12-0701 CITY Trenton I STATE NJ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) (5B) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT I ZIP 08610 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................0................................................................................... 0 No [iJ [iJ [i] [i] [iJ [iJ [iJ 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (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 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 zero (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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [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 twelve (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-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Grace M. Griffith FILE NUMBER All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 119 SHS Common, CenterPoint Energy, Inc. @$14.59 per share VALUE AT DATE OF DEATH 1,736.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space Is needed, insert additional sheets of the same size) 1,736.00 REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Grace M. Griffith FILE NUMBER ITEM NUMBER 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. 1. Fulton Bank Classic Checking Account No. 3622-32677 DESCRIPTION 2. Resident Account at Claremont Nursing Home TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 4,565.00 547.00 5,112.00 REV-1509 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leNIDULI F JOINRY-OWNED PROPERTY ESTATE OF Grace M. Griffith FILE NUMBER 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 A. Joan M. Miller ADDRESS RELATIONSHIP TO DECEDENT 503 Gettysburg Pike, Mechanicsburg, Pennsylvania, 17055 Daughter 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 DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. OW Scudder Balanced Fund-A, No. 2-55535939 15,788.00 50 1999 2. A. 1999 OW Scudder High Income Fund, No. 8-3211732 56,983.00 50 28,491.00 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 36,385.00 REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Grace M. Griffith FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Joan M. Miller Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 500.00 City State Zip Year(s) Commission Paid: 2. Attorney Fees O'Brien, Baric & Scherer 1,750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant None Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 30.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,280.00 REV-1500 EX Page 3 Decedent's Complete Address: D D L~~jJmber______---------] DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Grace M Griffith 139-12-0701 STREET ADDRESS 137 Barricklo Street CITY I STATE I ZIP Trenton NJ 08610 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C ) (2) 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. Fill In oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 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;.......................................................................................... D [iJ b. retain the right to designate who shall use the property transferred or its income; ............................................ D [iJ c. retain a reversionary interest; or.......................................................................................................................... D [i] d. receive the promise for life of either payments. benefits or care? ...................................................................... D [iJ 2. If death occurred after December 12. 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [iJ 4. Did decedent own an Individual Retirement Account. annuity. or other non-probate property which contains a benefICiary designation? ........................................................................................................................ D [iJ 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 January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (0) percent [72 P.S. ~9116 (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 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 zero (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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [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 twelve (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. RE'o'1512 EX' (12.3) .. COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Grace M. Griffith Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH "~ FILE NUMBER 1. Commonwealth of Pennsylvania 140,256.00 Department of Public Welfare TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 140,256.00