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"I, ,. , ,','. ,I', " d'1' Ijj" " 'J~ . . .,'1' ., ",\ ,:" ('" , , " , " ,,:', '1'" " " " .' ", ., " " I,,,. .,' , " " (\ ,~ J'r;, " ,,, . ' , . {." ,,, .." 01', i " " , '. '" . . ,I'" " ,,' ,i.. " 'i \ ~ , " {"l : ,', !",! ,('.:,.: ',,' ,:~. , , ,. ",', " '. f , '.l"l ~ ,," :';1 ',' ,,' , ,. , .. ,',['J " i"'" " , ' ;.1::1, ':i.lf' :'-',..... -.......' ","" " ,t.' .,,: " :.\" "'1'.- 1. Reol Ellal. (Sch.dul. A) ( 1) 2. Slack, and Band. (Sch.dul. B) ( 21 3, Claltly H.ld SlacIcJPartn."hlp Inlt'"1 (Sch.dul. q (31 ~, Martgcg.. and Naill R.c.lvabl. (Schedul. D) ( ~) 5. Ca,h! Bank D.po.II, & MllCtllantou. P."onal Prop'rty( 5) (Scnedul. E) 6. Jalnlly Own.d Prop.rty (Schedul. F) ( 6) 7. Tranller. (Sch.dul. 01 (Sch.dul.l) ( 7) 8. Tolal Oroll AII.I. (10101 IIn.. 1.7) 9. Funeral Expon,.., Admlnl.trallv. Ca.II. Mhcollantou. ( 9) Exp.nlt. (Sch.dul. H) 10. D.bl., Martgag. Uablllllll, U.n. (Sch.dul. I) (10) 11. Total D.ductlan. (Iolalllnll 9 & 101 12. N.I Valu. of E.lal. (IIn. 8 mlnu. IIn. III 13, Charl1abl. and Gavernm.nlal Bequ,", (Schedul. J) 1~, N.I Valu. Sub oct 10 Tax IIn. 12 mlnu.lln. 13) 15, Amount of IIno 14 laxabl. 01 6% ralt (Indud. valu.. from Schedul. K or Sch.dul. M.I 16. Amounl of IIn. 1~ laxabl. 01 15% ral' (Indud. valu.. from Sch.dul. K or Sch.dul. M.) 17. Prindpallax du'IAdd 10. from IIn. 15 and from IIn. 16.) 18. Credl" Spou,al Puv.rty Credll Prior Paym.nl' +--+ 19. If IIn. 181. grealer Ihan IIn. 17, .nler Ih. dlffer.nco on IIn. 19, Thl.l. Ih. OVERPAYMENT. I'lJO 20. If IIn. 17 I. grealer Ihan IIn. 18, .nlt' Ih. dlffer.nco on IIn. 20, Thl.I.lh. TAX DUE, A. Enlor Ih. Inltrell an Iho balanco duo an IIn. 20A. B. Enltr Ih. 10101 olllno 20 and 20A on IIn. 20B. Thh I. Ih. BALANCE DUE, Mak. Ch..k Payabl. to, R.gI.lor of Will., Ag.n' .. liE SURE TO ANSWI1l ALl. QUIST10NS ON REVIRSI SIDE.AND TO RECHECK MATH.. Under p.nalllfll of plrjury, I dlclar. thai I havI ..amln.d thl, relur", Including accompanying IChtdul.. and Ilollment., and 10 the bttt of my knowledge and b.ll.f, It I. tru., carr," and comple'l. I d.c1ore Ihal 011 ,.01 ,"01. has bltn ,eport.d at IruI mark.t volu.. Declarallon 01 pr.par., oth" Ihan ,h, plrsonal r'pt..entatlve II baled on alllnformallon 01 whlc prepar., hat any knowledge. N/ L llN ~ U N ADOR ~. / I --- .(.;1-/:.:/"._ 907 1>etcrsburg Road. Cllrli~le. Ph 17013 C'/(I' _'I i( A HAN N A IV A RU!. DAlf .te'L"L,C,.!...?"' /'Itc P.O. Box 93, IllIrrisburg, Ph 17108 ,_ ~~/(~L( I ~I~ Ii ~Q 8'% 2 ~.~~,~ ~1'tWJ>,: COMMONWIAlllt O. "llNSVlVANIA DI~"ftb~W.T1iJJ,VINUI H"..IIIU.O 'A 17111.0601 JLI -),/7 -/0 INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) S~6 NUMaeR ,ORDATUO.DIATHAnlR 12/31191 CHICI(HIRI I' A IPOUIAL POYIRTY CRIDn II CI..lUMID 0 .ILI HUMI.. '" do/- COUNTY <;'ODE 94 ve~ MIODU INITIAll Miller, David M. Leader Nursing Home 940 Walnut Bottom Road Carlisle, Ph 17013 Cumberland Count o 3. R.malndor R.lurn (for daf.. of d.alh prior to 12.13.82) o 5. Fedora I E,tatt To. R.lurn R.qulred .ll:. 8, Tolal Numbor of Saf. D.pa.11 Box.. A 174-05-0935 m 1. Original R.lurn o ~. Umll.d E.lolt Jered L. Hock, Enquire Metzger, Wickersha~, Knauss & Erb 1'.0. Box 93 III Market Street Hsrrisbur ,Ph 1710B-0093 717 ) 2~-BI87 1,627.27 z o i I 8) 1,627.27 531. 50' 1,293.04 (11) (121 (13) (1 AI 1,824,54 o o o o (15) o )(.06 . (16) o o )( .15. z o ~ 5 ~ o u ~ (17) o Inler..I Olteollnl o o (181_. (19) CliNk Il('fC if you Oil' fcquu..hn1 0 refund 01 your overpoymonl. 120) (20AI (20B) o o o " IIV.UII'1t P.lfl''' ITEM NUMBER A. I 1. . COMMONWIAIIH 0' "NNIYIVANIA INHlRllANCI lAX U1UIN RIlIDINT DICIDINl SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES David M. Miller DESCRIPTION Funeral BlIpenlell Gingrich Memorial, monumant engraving B. Admlnlllratlve COI'II I. Penonal Repre"ntat/ve Commllllonl Social Securlly Number 01 Penonol Repre.enlatlve. Ye~r Commllllonl pold 2. AIlornay Feel Hetzger, Wickersham, Knauss & Erb 3. family Exemption Claimant' Relatlon.hlp Addre.. 01 Clalnlanl at decldenl'l dlath Slreel Addre.. City Statl Zip Code 4. Probate Fee. C. MI.eellaneou. Expen.... 1. Register of Wills, inventory snel filing fees 2. Reserve for Closing 3. 4, S. 6, 7, 8. TOTAL IAho In I" on line 9, Recapitulation) (II more .pacel. needed, In.ert addltlonal.heel. al.ame .lIe,) AMOUNT $ 75.00 $391. 50 $ 15. 00 $ 50.00 5 531. 50 ,~/ 1 REV-1547 EX AFP (08"94* COI1HONWf:AL Hj OF PENNSVlVANIA DEPARTMENT Of RrVEHUE BUREAU Of INOIVIDUAL fAMES DEP'. Z&0601 HARRISBURO, PA 11128-0601 bTATE Ojr-'""RILLER"~-- -IlAVl M- -- FILE NO. 94-0535 DATE OF DEATH 10-16-93 COUNTY CUMBERLAND NOTE I TO INSURE PROPER CREOIT TO YOUR ACCOUNT, SUBHIT TIlE UPPER PORTION OF THIS FORH WITH YOUR TAX PAYHENT TO THE REGISTER OF WILLS. HAXE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TOI NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR OISALLOWANCE OF OEOUCTIONS AND ASSESSHENT OF TAX ACN 101 DATE 11-07-94 JERED L HOCK ESQ METZGER ETAL PO BOX 93 HBG PA 17108 REGISTER OF WILLS CUMBERLAND CO COURT HDUSE CARLISLE, PA 17013 [ A.ount R..ltt.d l CUT ALONG THI8 LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiiV': i siii "ii," AF P -" ios-; 94 Y - iioT fo r -OF ""iNHiifii' AiiC'i -TAx" 'A-PPR'A"i i iH!Nr;" Ai. i:owAiiC' i" iiri...." - - --"." - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MILLER DAVID M FILE NO. 21 94-0535 ACN 101 DATE 11-07-94 TAX RETURN WAS, 1 X) ACCEPTED AS FILED C I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL 1. Rul E.tot. (Soh.dul. Al III 2. Stook. .nd Bond. (Soh.dull BI C21 S. Clo..ly H.ld Stook/Port,or.hlp Int.r.lt (Sohodul. CI (51 4. Hortglg../Not.. R.o.lv.hlo CSoh.dulo D) (4) 5. Cuh/Bonk Dlpoo! h/Hilo. P.r.onol Prop.rty ISoh.dull E) (5) 6. Jointly Ownod Prop.rty CSoh.dul. FI (6) 7. Tr.n.f.rl (Soh.dulo 01 (7) a. Totol AII.h ,00 ,00 .00 .00 1,627.27 .00 .00 (81 1,627.27 APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funlrol E,plnl.I/Ad.. Co.tI/Hllo. E.pon..1 (Sohodul. HI (91 10. D.blo/Hortglg. LloblllUu/Lllnl (Soh.dull Il 1101 11. Totol Dlduotlonl 12. N.t Volu. of To. R.turn IS. Chlritlbl./Qovorn..ntol Boqu..t. ISoh.dul. JI 14. N.t Volu. of E.t.t. Subj.ot to Tox 531.50 1.293.04 Ill) 1121 1151 1141 1 . A'4 lie. 197.27- .00 197.27- If an a.....m.nt WI' i..u.d pr.viou.1Y, lin.. 14, IS Ind/or 16, 17 and 18 will r.fl.ot figur.. thlt inolud. the total of ~ r.turn. a......d to dlt.. ASSESSMENT OF TAXI IS. A.ount of Lin. 14 ot Spou.ol rot. liS) 16. A.ount of Lin. 14 t..obl. ot Lin.11/C1... A roto C161 17. A.ount of Li~ 14 to..bl. .t Coll.t.r.l/Clo.1 B rot. (17) la. Prlnoipol ,.. Duo TAX CREDITlIl PAVNENT DATE NOTE I .00 X .00. .00 X .06. .00 X .15. 118) .00 .00 .00 .00 RECEIPT NUHBER DISCOVNT I') INTEREST C-) AHOVNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION DF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN tl, NO PAVHENT IS REQVIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) o ,> . RtlSERVATlON, ElIII.. of doamnll d~ln. on or bofa," DoaHbor IZ. I'll .. If In~ lulu," Intorlllln IMUIII. 10 Iron,larred In Po.....lon or enJoVltnt to Cl'.. I (aoll,tlrll) blneflolarl,. of thl dlc.dlnt ,'tar thl IMpArltlon of InYI"'" for II'. or for V'.fl, thl COllOnw..lth her.by Ixpr..'IV rl.lrv.. thl'rlsht to .ppr,I,. end ....11 trant'.r 'InherltanG' T.~.. at thl lawful Cl,.. . (00111',r..) rat. on .n~'.uoh future 1nttr..t, PURPQSE 01' 'HOTlCEI To fulfill thl'fff1\llr...ntl 0' StoUon 21U of thl Inherltlnc' and Eltat. Till Act, Aat 220' 1991. 12 P.'. '.oUon 2UO. PAVMENT, Oetloh thl top portlon of thll NoUo. and tub_U with your plv..nt to thl A,gllt,r Q' Willi prJnted on thl r.".r.. ,Id.. .'"0111 ahlak or Ion.. ardor pI~lbh tal REllISTER DF HILLS, AllENT All Plv.,ntl rlo.IVld .hlll fir.t b, applied to anv Intlr..' wh1ch ..y ba dul with InV r...lndtr IIlPplhd to thl tlM. REFUND (CR)I A refund of . t.~ oredlt, whloh WI' not r.qu'tt.d on thl Tlx Rlturn, ,.~ bl rlqulltld by oOIPI.tlng an "Applloltlon far R,fund of P~lvlv'nI. Inherltlno. ftnd E.t,t. T.x" (REV-Illl). Appllo.tlonl Irl ,vltllbl, .t thl Offlo. of thl A,gI.t,r of Will., In~ of thl 25 Rlv,nu. Olltrlot Of'loI., or b~ cllllng thl .p.clll 2~.hour Inewlrlnl ..rvlcl nueb,r. for for.. ordlrlngl In Plnn.vlvlnl. l.aOO-56Z-20S0, outtldl P,nntvlv.nl. .nd within 100.1 H.rrJlburg Ir,1 (117) 7a7.IO'~, TOO' (717) 772-2l52 (H..rlna IIp.lrld Onlv). OIJECTIONSl Anv p.rtv In Intlr..t not ..tl.fl.d with the .ppr.I....nt, .llowlnc. or dlllllowlnc. of d.ductlon., or .......-nt 0' t.x (Including dl.oaunt or Int.r'lt) .. Ihown on thl. Hotlo. IUlt obJ.ot within .Ixtv (60) d.v. of rlellpt of this Notlcl bVI ..wrlttln protllt to the PA OIP.rt.lnt of Rlv,nut, laird of APPIII., DEPT. 211021, Hlrrl.bur" PA 17121-1021, OR --.llatlon to hlv, the ..tt.r d.taralnld It audit of tha aaeount of th, parson.1 raprll.ntltlv., OR --appa.l to thl Orphtn.l Court. IONIN IITRATlYE CORRECTIONS, F.atuII .rror. dllcovlrld cn thI. ........nt .hould bl Iddrl..td In writing tal PA O.p.rt.lnt of AIV.nut, Burllu 0' Indlvldull TIXI., AlTHI Po.t A".....nt RIVllw UnIt, DEPT. 210001, Hlrrl.burg, PA 17121-0601 Phonl (117) 717-6505. SII Pili ! of thl bookl.t "In.truotlon. fJr Inherltlncl Tlx R.turn for t A.lldent O,oldtnt" (REV-ISO!) for In Ixpl.nltlon of ndMlnl.trttivllV corr.ctlbl. Irror.. DIICOUHT' T"TEREII , If tnv tax due It Pbld within three CU alhndar ,onthl liter the dlo.d.nt', dllth, I fly. plroent (IX) dltcount of thl tlM Plld I. allowld. Intlrllt It ohlrg.d blglnnlng with flrlt dlv of dlllnqulncv, or nlnl (,) aOl1thl end one (1) dev frol the dlt. of dtlth, to the d,tl 0' pIYllnt. TIXI. whloh b'OI"1 dlllnqulnt blfor. Jlnulrv 1, 1"2 b..r Intlr..t It thl rat. of .Ix (6~) plrolnt p.r InnUl olloulatld It . dlllv rltl of .000164. All taxI' whloh biOI" dlllnquent on and .ft.r Jenuarv 1, 1912 wll1 bltr Intlrllt .t I rlt. whloh will vary fro. clllndar yllr to oal.ndar VI., with thlt r.tl ennounold by thl PA OIPlrtmlnt of Rlvlnul. the IPpllolbl1 lntlr..t r.tl' for 1'12 through 1994 Irll '!!!! lnterllt Rltl Dilly Int.rl.t Flctor ~ Intlrllt Rlt~ DIllv Intlrllt FlGtor 1911 IDX .ODOSU 1916 IDX .ODDI16 I'IS 16X .DDOlSa 1911 'X .00D161 1916 1IX .DD01DI 1'11-1991 lIX .DOO1DI I'IS m . D001S6 1991 'X .000161 1991-1996 1X .DODI'I "Interltt 1. olloultt.d I' followl! INTEREIT . BALANCE OF TAX UNPAID X NU"SER OF DAYS DELINQUENT X DAILY INTEREST FACTOR -,Anv HottCI I.,utd .ft.r thl t.M bleD'" d.llnqulnt will r,'..ot In Int.r..t ollouletton to fIfteen (11) dlV' 'blVond Uti dltl of thl ......Hnt. If p.v..nt It "dt IItlr the Intlrllt aotputltlon dltl ,hftwn on the ' Nottel, addltlon.l Interllt IItIlt bl c.loul.tld.