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QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No",) No.
2. Did decedent, within two years of death, transfer property from himself/ herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) ~
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a. Age of decedent at time of transfer,
b. Copy of death certi ficate,
c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nontaxability of transfer,
4. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at or after hiS/her death? (Answer "Yes" or "No".) No.
a. Was there any possibility that the property transferred might return to transferor or his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No",)
b. What was the transferee's age at time of decedent's death?
5, Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her
death:
a, The possession or enjoyment of or tile right to income from the property transferred? (Answer "Yes" or "No".) ~
b, The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".)
6, If the answer to five b. above is "Yes," was the right reserved in decedent alone ( ) or decedent and others ( ),
7, Did decedent in hiS/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No",) No.
8, Did decedent, at any time, transfer property, the b61eficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) No.
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone ( ) or decedent and others ( ).
3ILat.~t ltHU tutti We~tht1tuntt
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KENNE'I.'l! M. MILLS
I, KENNETH M. MILLS, of the Borough of Camp Hi.ll,
cumberland county, Pennsylvania, being of sound mind, memory
and underst;;lOding, do make, publish <.1nddcclar.e the follow-
ing to be my Last "lill and 'l'estamcnt, hereby revoking and
making void, any and all wills, codicils and testamentary
dispositions by me at ;;my time her.et.ofore made.
n'EM I. I direct that all my just debts and funeral
expenses be puid and satisfied by my gxecutors hereinafter
named as soon as conveniently may be aft.er my decease.
I'l'EM II. All the rest, residue and remuinder of
my est.ate, reul, personal and mixed, I give, devise and bequeath
unto my duught.er, Pamela A. Mills, and my son, Kenneth Alan
~1ills, in equal shares.
If at the time of my death, either one of
my said children shall be deceased leaving issue him or her
surviving, said issue shall take the share of said deceased
child, per stirpes. If at the time of my death, either one of
my said children shall be deceased \'lithout leaving issue him
or her surviving, the share of suid deceased child shall be
given to the surviving child, or to his or her issue.
J.'l'EM III. I nominate, constitute and appoint my
daughter, Pamela A. Mills, and my son, Kenneth Alan Mills,
Executors of this my Last Will and Testament.
IN VIITNESS \mEREOP, I, KENNETH A. MILLS, have here-
unto set my hand and seul tl,lis 3rd day of December, A. D. 1970.
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Signed, scaled, publishe,l and declared by the above
numed Kenneth A. Mills, as and for his Last will and Testament,
in the presence of lIS, the subscribing witnesses, who at his
instance and request ;;,nd in his presence and in the presence of
each other have hereunto set our h"n<18 the duy and yeur afore-
said. ' ,
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<C::C{:": lli~lU rES'3 MAIN OFFICE 331 BRIOGF. STnEF.T NEW CUMOEIILAND, PENNSYLVANIA 17010 1111) 174,'/000
CCNn 1,1AN.~, N."'.
February 2, 1981
Frank L. Wright
Attorney At Law
31 North Second
Harrisburg, PA,
St.
l710l
Dear Atty, Wright:
Reference your letter of January 13, 1981, concerning
K. Alan Mills and Pamela A. Sheaffer, we have located
one checking account, number 006-000870-3,
The balance in said checking account as of November
23, 1980 (DOD) was $1,647.69,
The account was opened March 3, 1977 in the names of
Kenneth M. Mills or Pamela A, Sheaffer,
If you have any further questions, please contact us.
Very truly yours,
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-_ James."A, BOYle{ r~annger
--Jjookiieeping Department
JAB: sd
Exhibit "c"
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January 19,1981
Frank L. \{right
31 North Second St.
Harrisburg, Pa. 17101
Dear Mr. \{right:
This letter is in response to your recent request for information
concerning the estate of Kenneth M. Mills.
~Below is an itemized list of all accounts held by the decedent on
' November 23,1980, (date of death).
Account number: 2-19-019479
Account title: Kenneth M. Mills or Pamela A. Shaffer
Balance as of date of death. . . . . ... . .$10,261.75
Accrued unpaid earnings. . . . .. . . . . . . . . .' ..$ Jf3.18
Total value on date of death . . . . . . . . . . . . .$10,304.93
Opening date: March 23,1977
Account number: 2-19-619480
Account title: Kenneth M. Mills
Balance as of date of death.
Accrued unpaid ea.rnings. . . . .
Total value on date of death.
Opening date: March 23,1977
or K. Alan Mills
. . . .. ..
. .$10,261.'15
..s 43.18
. . .S10,30Lf.93
. . .
. . .
. . . .. . .
. Should you h'lVe any questions concerning this data, please feel free
to contact our office.
/
Sincerely, II /1
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23" NORTH SECO;~U SlHlLl . P.o. nox 1111 . lIi\FlnISGUnG, P^ 11'100' (717) 2:~:':.(iGGl
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REV-484 EX+ t~80)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
File Number ____a1-al:-OlJa.
Estate Name --
K~""atlLM~Mills
[i] Originol
o Supplemental
o Remainder
Dote of Death __t!9.Y_~.m1l!~J:--23..-1980
Social Security Number
172-32-210.2_
REPORT OF INHERITANCE TAX APPRAISER
I, tho undorsignod duly appointod Inheritanco Tox Appralsor in and lor tho County 01 _ Cumberland
Ponnsylvanla, do rospoctfully ropart that I havo appraisod tho roal and porsanal proporty as roportod tn tho lorogoing
retoln at the values set forth opposite each item in tho last column to the right in Schedules llA", liB", IIC", and liE"
Dated:
March 12, 1981
-f!I'/,(J/f/,JJ If/,A,} Hi )
INHERITANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISEO
ADJUSTMENTS
COOE (HARRISBURG USE ONLY) REMAINDER APPRAISEMEN'r CODE
Reol Property (Schedule A)
$
00+
92+
Personol Property (Schedule B)
Jolnt.Held Property (Schedule E)
Transfers (Schedule C)
TOTAL GROSS ASSETS
8,
11.128
tot
21H
30+
____ ____$l9L~8.8 19____
Leu Debts and Doductlons
(SCH EDULE F)
CLEAR VALUE OF ESTATE
40-
93.
FOR lISE OF REGISTER ONLY
Tax on $
fQQ.E.
PRINCIPLE VALUE CODE
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COMPUTATION OF TAX
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Tax on $
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TOTAL TAX
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TO
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DATE OF PAYMENT
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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESiDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
-
Estate of KENNET[-! M. MILLS Date of Death 11/23/80 FileNo, -,ll-S/-/Ie
WHEN CI.AIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
Claimant's Address at time of Decedent's Death
ITEM
NO,
NAME OF PA VEE
DATE
2
3
Ambulance Assn.
Bell of Pa.
Bunker Hill Management
Association
CCNB - Mastercharge
Holy Spirit Hospital
Radiology Associates
Laurie Korte
Myers-Hall Funeral Home
4
5
6
7
8
9
10
11
12
13
Bett Smith
Bell of Pa,
Sunmark
Re ister of Wills
Re ister of Wills
Martha M. Taschek
14
Frank L. Wri ht
Relationship to Decedent
REMARKS
AMOUNT
Outstanding check of decedent's
December 1980 rent for
decedent's apartment
Debt of decedent (Vario~s)
12.22
290.00
15.87
Debt of decedent (NewSpapers)
puneral expenses
A raisal of decent's ersonalt
Tele hone enses
Debt of decedent (Gasoline)
pilinq inheritance tax return
Piling debts and deductions
Notary fees re transfer of
automobile title
Attorne 's fees
7.50
1,866.00
40.00
1. 26
13.00
3.00
3.00
"
6.00
1,500.00
TOTAL $ 3 766.85
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of adminisYi'tion subl1)itted to tge estate as dedu~tion~, for Inheritance Tax purposes,
?-,//>-///;.-.'"/ , ,", \
..7'--,:,,- .' ./,.- :\:,,' ,'.' ',.'-.\1":'_'''- February 16, 1981
SIGNATURE or FIDUCIARY DATE
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S ,~ 1 tf; ~,,?6.-'" AT
I
/1-a0t./- :3
1/.7
% TAX RATE ,Ill \
fl
GENERAL INHERITANCE TAX INFORMATION
Unsatislied liabilities incurred by the decedent prior to his/her deoth ore deductible against his/her taxable
estate. In addition to debts incurred by Ihe decedent or estate, other items ore claimable including the cost 01
administration, attorney lees, liduciary lees, luneral and burial expenses including the cost 01 0 burial lot, tombstone
or grove marker and other related burial expenses.
All debts being claimed ogainst on estate Ole subject to the approval 01 the Register of Wills with whom the
Inheritance Tax Return is filed. Evidence to support the decedent's or the eslote's liability lor the debts being
claimed shauld be attached to this schedule.
A family exemption may be claimed by 0 spouse 01 0 decedent who died domiciled in Pennsylvonio. If there is
no spouse, or if the spouse has lorfeited his/her rights, then ony child 01 the decedent who is 0 member 01 the Some
household con claim the exemption. In the event there is no such spouse or child, the exemption con be claimed by
o parent or parents who ore members 01 the Some household os the decedent. The family exemption is allowable only
against assets which poss by 0 will or by the Pennsylvania Intestate Lows.
NOTE: Compensotion paid io on esiate representative; namely, on executor or administrator, for services
performed in administering on estate is reportable for Pennsylvania Income Tax purposes. This taxable income
item should be reparled on lorm PA.40.lndividllallncon.~ Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the lamily exemption is being claimed, indicate the c1aimont's nome, address and his/her relationship to
the decedent. Enter "Iamily exemption" in the remarks column and the amount claimed in the amount column.
2. Assign consecutive numbers to each item listed.
3. Enter the dote on which each debt was incurred and/or paid.
4. Enter the names of each poyee.
5. Provide 0 brief explanation in the ren,arks column lor each debt claimed.
6. Enter the amount of eoch debt being cloimed,
7. The form must be signed by the person who has assumed the responsibility for paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE a%" x 11" SHEETS.