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Home My WebLink About12-05-06 REV-1500 EX + (6-00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W o w () w o W I- li: :$C/) ult:li: w~u J: 1t:9 U ll.1Il ll. c( OFFICIAL USE ONLY FILE NUMBER 21 -0 6 o 267 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C5uiih'COOE -YEA~ - - NUMBER- - MILLER CHARLES E. DATE OF DEATH (MM-DD-Year) AlKlA CHARLES EDWARD MILLER DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 212-18-9726 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required !.. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under See, 9113(A) (Attach Sch 0) z o ;:: 01( ..J :J I- 0:: 01( () W 0:: z o ;:: 01( I- :J Q. :IE o o S 03/17/2006 12/03/1908 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [XJ 1. Original Retum o 4. Limited Estate [Xl 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death afler 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) PA 17055 OFFICIAL USE ONLY '=;;O -'7 :r) j~EQ ~23 /'. _ >~C) 213,612.21t)C:: ',1 . "-'~""'l =:.j ...:." (8) 9,042.25 3,239.08 (11) (12) (13) (14) '" = <:::> cr-. CJ Pl n I (.n I- Z W o z o ll. C/) W It: It: o U NAME MURREL R. WALTERS III FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS ~ :It' en N 213,612.26 12,281.33 201,330.93 201,330.93 9,059.89 9,059.89 54 EAST MAIN STREET TELEPHONE NUMBER 717-697-4650 MECHANICSBURG 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) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) 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)(1.2) X _(15) 201,330.93 X ~(16) X .12 (17) X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 2933 ARCONA ROAD CITY I STATE I ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 9,059.89 Total Credits (A of- 8 of- C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D of- E) (3) 4. If Line 2 is greater than Line 1 of- Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 of- 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) 8. Enter the total of line 5 of- 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 9,059.89 9,059.89 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 ~ 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 [RJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 [RJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 ~ 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 belief, it is true, correct and complete. Declaration of preparer othe than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P ON RESPONSIBLE FOR FILING f3 TURN . h' ADDRESS PA (7 ADDRESS PA 17055 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. ~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% [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 0% [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%, 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 12% [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-1509 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF MILLER CHARLES E. AlKJA CHARLES EDWARD MILLER FILE NUMBER 21 06 0267 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. JESSICA L. MARBAIN 2933 ARCONA ROAD MECHANICSBURG, PA 17055 DAUGHTER B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '10 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 JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 2000 BANK OF AMERICA 1,371.53 50. 685.77 CHECKING ACCOUNT 2. A. 2000 BANK OF AMERICA 12,544.57 50. 6,272.29 SAVINGS ACCOUNTS 3. A. 2000 PENNSYLVANIA STATE BANK 5,423.43 50. 2,711.72 MONEY MARKET ACCOUNT 4. A. 2000 PENNSYLVANIA STATE BANK 3,615.61 50. 1,807.81 CHECKING ACCOUNT 5. A. 2000 MERCANTILE SAFE DEPOSIT AND TRUST CO. 17,156.54 50. 8,578.27 CHECKING ACCOUNT 6. A. 2000 MERRILL LYNCH 274,792.80 50. 137,396.40 INVESTMENT ACCOUNT 7. A. 2000 ROCKTEN STOCK 112,320.00 50. 56,160.00 7,702 SHARES @ $16.00 PER SHARE TOTAL (Also enter on line 6, Recapitulation) $ 213,612.26 (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 ESTATE OF MILLER CHARLES E. AlKJA Debts of decedent must be reported on Schedule I. CHARLES EDWARD MILLER 21 06 0267 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 3,013.25 2. CREMATION URN 2,500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) .JESSICA L. MARBAIN . RENOUNCED Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 2933 ARCONA ROAD City MECHANICSBURG State PA Zip 17055 Year(s) Commission Paid: 2. Attorney Fees MURREL R. WALTERS III 3,000.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS - CUMEBRLAND COUNTY 529.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 9,042.25 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MILLER CHARLES E. FILE NUMBER A1K1 A CHARLES EDWARD MILLER 21 06 0267 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. WEST SHORE EMS AMBULANCE SERVICES 98.58 2. GRISWOLD HOME CARE 264.00 3. HOME CARE PROVIDERS ASSORTED HOME CARE INDIVIDUALS 2,876.50 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,239.08 '~_"'HX'"'' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MILL R SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] .JESSICA L. MARBAIN 2933 ARCONA ROAD MECHANICSBURG, PA 17055 DAUGHTER 1. 2 7 AMOUNT OR SHARE OF ESTATE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)