HomeMy WebLinkAbout01-04-07 (2)
REV.1600 EX + (8-00)
'*
W
I-
~Cl/l
Uii!~
~~g
UflD
II.
C
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
I-
Z
W
Q
W
o
W
Q
DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
Muller, Eugene A. II
DATE OF DEATH (MM-DD-YEAR)
125-38-1106
00353
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[J 3. Remainder Retum (date of death pIior to 12-13-82)
4a. Future Interest Compromise (date of death after
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)
I-
Z
W
C
Z
~
m
IX:
8
NAME
David J. Lenox
FIRM NAME (If applicable)
The Wiley Group, PC
TELEPHONE NUMBER
717-432-9666
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
COMPLETE MAILING ADDRESS
130 W. Church Street
Dillsburg, PA 17019
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
z
o
i=
:s
::)
I-
~
~
w
a::
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) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
DATE OF BIRTH (MM-DD-YEAR)
04-15-2006
04-05-1947
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
OFFICIAL USE ONLY
51,049.51
299,846.35
None
None
('")
l_O
0=B
<.I CJ
:~E~~
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
[!] 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach
copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
45,877.04
None
332,490.50
70,640.46
48,255.63
(11)
(12)
(13)
(14)
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z
0 .045 (16)
i= 16.Amount of Line 14 taxable at lineal rate 610,367.31 x
~
::)
n. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
::E
0
0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
><
~ 19. Tax Due (19)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
"-'
~
LJ
--.I
<..-
k::W
I
~-
118,896.09
610,367.31
0.00
610,367.31
0.00
27,466.53
0.00
0.00
27,466.53
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX {Rev. 6-00;
co
Decedent's Complete Address:
STREET ADDRESS
2109-101 Cedar Run Drive
CITY Camp Hill
I STATE PA
TZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
27,466.53
26,000.00
1,368.42
Total Credits (A + B + C)
(2)
27,368.42
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (0 + E)
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
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 98.11
(5A)
(5B) 98.11
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 [!]
b. retain the right to designate who shall use the property transferred or its income;.................................... D [!]
c. retain a reversionary interest; or.................................................................................................................. D [!]
d. receive the promise for life of either payments, benefits or care?.............................................................. D [!]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?... ................................................................................................................... D [!]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... [!] D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..................................................................................................................... [!] D
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 perjUIY, 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 other than the personal representative is based em all information of \\'h!<:!!RrEl.!'~rerl'a~_al1}'l<r1owtll~J1.e"'-_
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Vlc orijl J. Ambrose
DATE
fR
2435 Winona Drive
Columbus, OH 43235
I /~/(7?
DATE
ADDRESS
ADDRESS
DATE
130 W. Church Street
DlIIsburg, PA 17019
1/,;!/t7 /
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 exemDt 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-1502 EX+ (6-98)
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Muller, Eugene A. II
FILE NUMBER
21-06-00353
ESTATE OF
All real property owned solely or as a tanant In common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchenged between a willing buyer and a willing seller, ne~her being compelled to buy or sell, both having reasonable knowledge of the relevant lacls.
Real property which Is jolnUy-owned with rtght of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Sale of real estate situate at 2109 Cedar Run Dr, #101, Camp Hill, PA:
VALUE AT DATE
OF DEATH
50.500.00
2 Tax proration and adjustment due estate from sale of real estate:
549.51
TOTAL (Also enter on Line 1, Recapitulation)
51.049.51
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
Rev.1503 EX+ (6-88)
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEAl. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Muller, Eugene A. II
FILE NUMBER
21-06-00353
ESTATE OF
All property jolntly-owned wtth right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Perelman-Carley & Associates, Inc. (see attached): 265.638.16
2 Vanguard Account #1 9924731074: 4.280.87
3 Vanguard Account #29924731074: 29.927.32
TOTAL (Also enter on Line 2, Recapitulation) 299.846.35
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-15G8 EX+ (8-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAl.. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Muller, Eugene A. II
FILE NUMBER
21-06-00353
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntty-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 BELCO Credit Union Account #766832: 5.00
2 Geico Insurance (refund): 49.24
3 Nations Investments: 1.792.20
4 PA Central FCU Account #39375-017: 58.10
5 PA Central FCU Account #39375-077: 13.801.47
6 PA Survival Action Settlement: 17.621.03
7 Sale of Jeep: 12.300.00
8 Home furnishings and misc. personal property: 250.00
TOTAL (Also enter on Line 5, Recapitulation)
45.877 .04
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule E (Rev. 6-98)
Rev.1610 EX+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMO~THOFPENNSYlVAN~
INHERITANCE TAX RETURN
RESIDENT DECEOENT
Muller, Eugene A.II
FILE NUMBER
21-06-00353
ESTATE OF
This schedule must be compleled and filed W the answer to any of questions 1 through 4 on the reversa side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Vanguard Annuity Contract #700047672: 48.307.64 48,307.64
2 Vanguard Roth IRA #9927601431 - PRIMECAP: 11,943.63 11,943.63
3 Vanguard Roth IRA-#9927601431 - REIT: 23,785.50 23,785.50
4 Vanguard SEP IRA #9927743881 - ENERGY 192,903.84 192,903.84
FUND:
5 Vanguard SEP IRA #9927743881 - PRECIOUS 55,549.89 55,549.89
METALS & MINING FUND:
TOTAL (Also enter on Line 7, Recapitulation) 332,490.50
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
v....;., ...v. ~"'U~-UL..U~ --
I!. B. TYPE OF LOAN:
U.S: DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.L IFHA 2.DFmHA 3. L,gCONV. UNINS. 4. OVA 5.[ JCONV. INS.
6. FILE NUMBER: 7. LOAN NUMBER:
SETTLEMENT STATEMENT \("1
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the setDement agent are shown.
Items marked 7POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3J98 (KLAIBER21 09(06).PFDlKlAIBER21 09(06)115)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
DONALD A. KLAIBER and ESTATE OF EUGENE A. MULLER II MID PENN BANK
JOL YNN M. KLA.IBER 349 UNION STREET
2109 CEDAR RUN DR #101 MILLERSBURG PA 17061
CAMP HILL, PA 17011
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-2386065 I. SETTLEMENT DATE:
2109 CEDAR RUN DR#101 LEON P. HALLER ESC AGENT FIRST AMERICAN TITLE INS
CAMP HILL, PA 17011 August 10, 2006
CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT
1719 N. FRONT ST.
HARRISBURG, PA 17102
J. SUMMARY :JF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
1M r.:DnQQ AIlI\ r.Rn~o;: uu'"" ,c.""'~
1 01. Contract Sales Price 50,500.00 401. Contract Sales Price 50,500.00
1 02. Personal Prooertv 402. Personal Property
103. Settlement Charaes to Borrower (Line 1400) 2,906.20 403.
104. 404.
105. 405.
106. CitvfTown Taxes 07/31106 to 01/01107 84.48 406. CitvfTown Taxes 07/31106 to 01/01107 84.48
107. SCHOOL TAXES 07/31106 to 07/01107 418.33 407. SCHOOL TAXES 07/31/06 to 07/01107 418.33
108. WA TERlSEWER to 408. WATER/SEWER to
109. PAYOFF PER DIEM 812-8111 46.70 409. PAYOFF PER DIEM 812-8/11 46.70
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 53,955.71 420. GROSS AMOUNT DUE TO SELLER 51,049.51
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SB..LER:
201. Deoosit or earnest monev 500.00 501. Excess DeDOsit (See Instructions)
202. Principal Amount of New Loan(s) 48,000.00 502. Settlement Charaes to Seller (Line 140m 1,907.16
203. Existina 10an(S)taken subiect to 503. Existina loan(s) taken subiect to
204. 504. Payoff of first Mortgage to PA CENTRAL FED CR UN/M 35,970.43
205. 505. Pavoff of second Mortaaae
206. 506. Deoosit retained bv seller 500.00
207. 507. .
208. SELLERS COSTS CONTRIBUTION 3,000.00 508. SELLERS COSTS CONTRIBUTION 3,000.00
209. CLEAN OUT CONTRIBUTION 250.00 509. CLEAN OUT CONTRIBUTION 250.00
AC1Iustmen~ I-nT /tAms unoaid Bv Seller Adjustmen~ For Items Unnairl Bv Seller
210. CitvfTown Taxes to 510. CitvfTown Taxes to
211. SCHOOL TAXES to 511. SCHOOL TAXES to
212. WATERlSEWER to 512. WATERlSEWER to i
213. 513.
214. . 514.
215. 515. I
216. 516.
217. 517. :
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 51,750.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 41,627.59
300. CASH AT S~ I:UENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SB..LER:
301. Gross Amount Due From Borrower (Line 120) 53,955.71 601. Gross Amount Due To Seller (Line 420) 51,049.51
302. Less Amount Paid BYlFor Borrower (Line 220) ( 51,750.00 602. Less Reductions Due Seller (Line 520) ( 41,627.59)
303. CASH ( X FROM J ( TO) BORROWER 2205.71 603. CASH ( X TO)~ K>M) SELI..ER 9,421.92
The undersigned here~owlit~mPleted copy of pages 1 &2 of this statement & a~ atta~"1"ts herein. /
Borrower ~ ~ Seller I /~- / " / /
DONJIIClD pt KLAIBER .. ESTATE a EUGEN1A. MULL/~II
~~~1rJ. YJaJ~
J YNNa.1. KLA.IBER
HUD-1 (3-86) RESPA, HB4305.2
L SETTLEMENT CHARGES
. .
~. Division of Commission (line 7001 as Follows: BORROWER'S SELLER'S
!'u1. $ to FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. TRANSACTION FEES to
ROO. m:1I.~ C CTlON W1T1-11 nAN
801. Loan Oriaination Fee 1.0000 % to MID PENN BANK 480.00
802. Loan Discount % to
803. Appraisal Fee to THEODORE S. WEAVER 150.00
804. Credit Report to FACTUAL DATA 7.05
805. FLOOD SEARCH FEE to CBC INNOVIS 11.00
806. DOCUMENTATION FEE to MID PENN BANK 235.00
807. Assumption Fee to
808.
809.
810.
811.
ann
901. Interest From 08110106 to 09/01106 @ $ 7.855600/day ( 22 days %) 205.33
902. Mortaaae Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 vears toACORD POC $246.oob
904.
905,
1000. D \MTJ.I LJ;NDER
1001. Hazard Insurance months $ oer month
1002. Mortaaae Insurance months $ oer month
1003. CitvlTown Taxes months $ oer month
1004. SCHOOL TAXES months $ oer month
1005. WATERlSEWER months @ $ per month
1006. months @. $ oer month
1007. months @ $ per month
1008. ~ months @. $ oer month
1100. TITL~
1101. Settlement or Closina Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preoaration to
1106. Notarv Fees to
1107. Attomey's Fees to DAVID LENOX, ESQ.
(includes above item numbers: )
1108. TItle Insurance to LEON HALLER ESC AGENT FIRST AMERICAN TITLE INS 508.28
(includes above item numbers.1101-1104 )
1109. Lender's Coverage $ 48,000.00
1110. Owner's Coverage $ SO,500.00 508.28
1111. CLOSING PROTECTION LETTER to LEON P. HALLER ESC AGENT FIRST AMERICAN TITLE INS 35.00
1112. LOAN ONLY END 1001300/8.1 to LEON p, HALLER ESC AGENT FIRST AMERICAN TITLE INS 150.00
1113.
......... , ANn TRA'
1201. Recording Fees: Deed $ 38.SO; Mortgage $ 60.50; Releases $ 99.00
1202. Citv/CountvTax/Stamos: Deed 505.00' Mortaaae 505.00
1203. State Tax/Stamos: Revenue Stamos 505.00; Mortaaae 505.00
1204.
1205.
4'llftft ..~ ~MRn' C
1301. SurveY to
1302. Pest Insoection to
1303.
1304.
1305. See addit'1 disb. exhibit to 520.54 1,402.16
1400. TOTAL SETTLEMaff CHARGES (Enter on Unes 103, SectIon J and 502, SectIon K\ 2,906.20 1,907.16
By ,;gnlng.... 1 "'... .........nt, the .;go""" ._ge....;pt "'. com_ ~~e nta1emen<
LEON P.bW.LER ESC AGENT FIRST AMERICAN TITLE
Certified to be a true copy.
Settlement Agent
(KLAIBER2109(06) / KLAIBER2109(06) /15)
ADDITIONAL DISBURSEI'ttIENTS EXHIBIT ,
Borrower: DONALD A. KLAIBER and JOL YNN M. KLAIBER
Seller: ESTATE OF EUGENE A. MULLER II
Lender: MID PENN BANK
Settlement Agent: LEON P. HALLER ESC AGENT FIRST AMERICAN TITLE INS
(717)234-4178
Place of Settlement: 1719 N. FRONT ST.
HARRISBURG, PA 17102
Settlement Date: August 10, 2006
Property Location: 2109 CEDAR RUN DR #101
CAMP HILL, PA 17011
CUMBERLAND County, Pennsylvania
PAYEE/DESCRIPTION
NOTE/REF NO
BORROWER
SELLER
PURCELL KRUG & HALLER
UPS OVERNITE
TAX COLLECTOR
TAX CERTIFICATION
CEDAR RUN ASSOCIATION/DON KLAIBER
INITIATION FEE 1% PUR PR
CEDAR FruNASSO-COOIOf,f..
NOV 04-JUNE-06 DUES ESCROW
CEDAR RUN AsS-OelATION
JULY 06 ASSOC DUES
TAX COLLECTOR
2006 SCHOOL TAXES
CEDAR RUN ASSOCIATION
ASSOCIATION DUES 2X192
15.54
10.00
505.00
UNIT 101
.. \
UNIT 101 - H--e...\c4C\ -\-,t).S+ UNI-h" 620.00
0- m 0 llJ~ _ \ "S ~.~ \ r! ~~----'"31~otJ"~._-
UNIT 101
457.16
13230549234
184.00
UNIT 101
Total Additional Disbursements shown on Line 1305 $
520.54
$
1,402.16
(KLAlBER21 09(06).PFD/KLAIBER21 09(06)/15)
DEC~13-2006 08:05
PERELMRN CRRLEY & RSSOC
Pifim.,=OiitiV .-_ano.LL-
" . I ..~ t' ,) ;,1/'
TWIN TOWIM · .. ,... . ,!:". ":i.: .
OMMM. r__.. .,a1
C4tIJ ~2 1.11
:SIrc
'1M lItITlUtTZGHI ta US,
ST A TEM!NT HDI.D IlCUQtZl1 IH ACCDUNT
MII.D IfILl NOCIIDI 1M RCCGUHT
IUAII .... lOa .... .... 1M .... MOLD StCGIII JII IICCOUHT
IVC 0' EU8EtII AltTNDHY IIJUD
ll~101 emM lwe 011
CAIIP HILL PA 17011
DI'lTl
IICTMTY
~,....
0.....0 CREDiT DIU 100 OIL IUC ..... T.
041'0 lOT <<JO on IUC ML.DRI fa . 141.711IO
0.....0 SOLD 1100 THI ItIUIY IPDII . IS .1OClCIO
O.....J CREDIT DIU 100 DlL IUC HLMt T.
0.'1 CREDIT DIU 100 on. IUC NLDU T'
0.....1 CREDIT DIU 100 DD. IUC HL.DII ,.
0.....1 CREDIT DIU 100 OIL IUC ..... "
041'2 CREDIT DIU 1100 1111 IIUIY IPDI
OIH
VDE
.. I.CUII'" PaUTZDICI _ .....
OIL IUC ..... TI
UAHlUMD I UIPU
lIlCCCUIT ltut" ..,. .110.10
flkl IIiUt:l
111.11000
U.1IClOO
TDlIIL
SClO
l3S1
402 342 2486
P.01/01
K 14
.TATlMENl PABE 1
fell IUlHTN ENDI'" O""'Z"1OO5
AccatJHT tullE. DO-el!lIO-U
ACCOUNT TYPE CASH
YI.TD-DATI TDTALI.
lAXMLI INT 54 . ,,&0-
HClM-TAM INl .CO
DlutDIHDI 1.150.11-
IIMIlN INT . ClO
CAP IN DIll .00
....
UIILIJI
?1.411.OO
114,110.11
171.101.11
AI Dr:
04' 2"'IClOI
0'" 1"100I
&>'L 4-1 ~ 1/61~'l ~" / 161ctpY
500 OJ)-/- ~ :: If-I -O6? I 51, 1/6 ::. 71J 710
,
"2351 vDE@=~/ r 7-0h 7(), 2 cr ~ /t:j~)y
L;-(J ~ T~ 26St;;?~ 1(;, '~b~lr
CUlTClMIWI cort f
I per.1mIIh ~cmt& .- Alli5i5&t8:1nr- L 14
J
TOTRL P.01
. Vanguard'
P.O. Box 1105
Valley Forge, PA 19482-1105
June 21, 2006
www.vanguard.com
THE WILEY GROUP
DAVID LENOX
130 W CHURCH STREET SUITE 100
DILLSBURG, PA 17019
Contract #: 700047672
Dear Sirs:
Thank you for you continued interest in the Vanguard Variable Annuity. We
received your request to confirm the Date of Death Value for the above contract.
Our records indicate:
Owner: Eugene Miller
Annuitant: Eugene Miller
Date of Death Value: $48,307.64 as of 4/15/2006
Initial Purchase was made on 2/27/1998
If you have any questions, please contact the Vanguard Annuity and Insurance
Services at 1-800-522-5555. Our associates are available Monday through
Friday, from 8 a.m. to 8 p.m., Eastern time, and will be pleased to assist you.
For complete information about any of our investment services, please visit our
website at www.vanQuard.com to access and download information. You may
also want to become a registered user of vanguard.com to manage your
accounts, 24 hours a day.
Sincerely,
70,. -~
Kayann Cassidy
30169497
June 21,2006
& Vanguard"
VanguardQl> Voyager Service@
David J. Lenox
130 W. Church St. Suite 100
Dillsburg, PA 17019
P.O. Box 1120
Valley Forge. PA 19482-1120
www.vanguard.com
Estate of Eugene A. Muller
Dear Mr. Lenox:
We are responding to your request for the values of the following accounts as of April 15,
2006. Please convey our sincere condolences to the family of Eugene A. Muller for their loss.
Since that date fell on a non-business day, we are providing the values for April 13, 2006.
On that date, the number of shares, price per share, and the value of the account were as
follows:
Eugene A. Muller-Individual Account-1 9924731074
Opened 12/02/1998
Fund Name' Shares Price Value Accrued
Dividends
Vanguard Prime Money 4,273.010 $1.00 $4,273.01 $7.86
Market Fund
Eugene A. Muller-Individual Account-2 9924731074
Opened 06/15/2005
Fund Name Shares Price Value Accrued
Dividends
Vanguard Energy Fund 463.630 $64.55 $29,927.32 N/A
Investor Shares
Eugene A. Muller- Roth IRA-1 9927601431
Opened 01/25/2000
Fund Name Shares Price Value Accrued
Dividends
Vanguard REIT Index Fund 1,123.017 $21.18 $23,785.50 N/A
Investor Shares
Vanguard PRIMECAP Core 991.996 $12.04 $11,943.63 N/A
Fund
VSLH 122005
Eugene A. Muller- SEP IRA 9927743881
o d 01/29/1999
'pene
Fund Name Shares Price Value Accrued
Dividends
Vanguard Precious Metals & 1,933.515 $28.73 $55,549.89 N/A
Mining Fund
Vanguard Energy Fund 1,591.222 $121.23 $192,903.84 N/A
Admiral Shares
Please note that as of April 17, 2006 (the business day following the date of death), the
funds' share balances remained the same. However, the share price had changed to $65.57
for Vanguard Energy Fund Investor Shares, $21.11 for Vanguard REIT Index Fund, $11.99
for Vanguard PRIMECAP Core Fund, $29.28 for Vanguard Precious Metals & Mining Fund,
and $123.15 for Vanguard Energy Fund Admiral Shares.
As a reminder, date of death information regarding Mr. Muller's annuity will arrive under
separate cover.
If you have any questions, please contact your Voyager Service Team at 800-284-7245.
Voyager's business hours are Monday through Friday from 8 a.m. to 10 p.m. and on
Saturday from 9 a.m. to 4 p.m., Eastern time. One of our dedicated Voyager associates will
be pleased to assist you.
Sincerely,
~~
E. Brian Bonanni
Registered Representative
Correspondence Number 20047563
PA Central
MAIN - 959 East Park Drive
Harrisburg, PA 17111
BRANCH - 25 West Main Street
Shiremanstown, PA 17011
BRANCH - 5137 Jonestown Road
Harrisburg, PA 17112
FEDERAL CREDIT UNION
www.pacentralfcu.com
800-356-3875
FAX 717-564-1503
July 11, 2006
The Wiley Group
Attorneys at Law
Attn: David J. Lenox, Esquire
130 West Church Street, Suite 100
Dillsburg, PA 17019
RE: Estate of Eugene A. Muller, Deceased
Social Security Number: 125-38-1106
Date of Death: April 15, 2006
Dear Mr. Lenox:
Eugene A. Muller has a share savings, share draft checking and loan account with P A
Central Federal Credit Union. The share account was opened on November 1, 2004 with
an account number of 39375-017. The account was in his name only when it was
opened. It was changed to a payable on death account on October 21,2005. The balance
in his account as of April 15, 2006 was $57.99. The accrued interest to the date of death
was $.11.
The share draft account was opened on November 2, 2004 with an account number of
39375-077. The account was in his name only when it was opened. It was changed to a
payable on death account on October 21,2005. The balance in his account as of April
15,2006 was $13,793.84. The accrued interest to the date of death was $7.63.
The loan account was opened on February 28,2005 with an account number of39375-
037. The account is in his name only. The balance in his account as of April 15, 2006
was $37,948.85. The balance as of July 7,2006 is $36,648.60 with a per diem of$4.75.
The loan is currently past due for June 30,2006.
If you need any further information or have any questions, please do not hesitate to
contact me at 1-800-356-3875, extension 120.
Since~ely, . I I
~cLl, -R. +-tdlA.c,L
Michelle R. Houck
Member Products Specialist
/
07/11/2006
Re Estate of Eugene A MulleclJrnmitted to Ouality Service
Social Security Number 125-38-1106
,.-
BELCO
:c:.
Dear Mr. Lenox,
I have enclosed the information on Mr. Mullen's account here at Belco Community
Credit Union. I have also enclosed the letter I received from Victoria that stated to close
the account and to send the proceeds to the indicated address. Mr. Mullen's account was
titled solely in his name, and there were no dividends to claim. The account was opened
on 03/1912002. The account had a balance of $5.00 on the date of his death with no
dividends accumulated. If you need further assistance please call 1-800-642-4482.
Thank you,
Kristi Hampton
Camp Hill Office
BELCO COMMUNITY CREDIT UNION
MAIN OFFICE
403 N. 2nd Street · P.O. Box 82 · Harrisburg, PA 17108 · (717) 23-BELCO
Web Site: www.belco.org
"NeliA!
...._.e,_..-_....._...
."5~_
OCl S 12008 i.1.
.".
-
The Estate of Eugene A. Muller, II, ."
and *
Victoria J. ~mbro$e, Admin~stratrix, 11:
Petitioners '"
IN THE COURT OF COMMON PLEAS,
CUMBERLAND COUNTY
ORPHAN'S COURT DlV1SION
*
v.
*
Arjay A. Chambers,
Respondent
*
No.: 21-06-00353
*
ORDER
AND NOWthis 1,\\A day Of----tJf\~~t.I 2006, having reviewed the
enclosed Petition for Approval and Settlement of Wrongful Death and Survival Actions with
concurrences from all parties involved, it is hereby Ordered and decreed that:
1. Petitioner, Victoria J..Ambrose, as Administratrix of the Estate, is a.~thorized
and empowered to settle the above-captioned matter on' behalf of the Estate of Eugene A.
Muller, II, by accepting the sum of sixty-five thousand dollars ($65,000.00) for the claims
referenced within said Petition.
2. The amount of sixty-fIVe thousand dollars ($65,000.00) is hereby approved
and may be accepted by the representative of the Estate and distributed pursuant to the
laws of this Commonwealth as follows:
(a) Pennsylvania Wrongful Death Statute,
42 Pa. C.S.A. Section 8301.
Sixty (60%) percent of net
estate: ($26,431.54)
(b) Pennsylvania Survival Act; 42 Pa. C.S.A.
Section 8302.
Forty (40%) percent of net
estate: ($17,621.03)
$19,500.00
(c) /Wiley, Lenox, Colgan & Marnacco, P.C.
Counsel Fees (30%).
/(d) Wiley, Lenox, Colgan.& Marnacco, P.C.
Reimbursement of Costs.
$1,447.43
BY THE COURT:
J _
s:s 65,OOO..1IO
~"Q ::
. .~ ~~i r-~~ 5g
'._ '_ t
.: ~."";;~ W
, 'l ~\\
J.
. .' ~ ......~
. . :', :.:-:? :':'[':i
. -:.;"]
:':'J-~
,.,':.
~
.-{?
'-J'l
.-
DISTRIBUTION:
Christopher J. Marzzacco, Esquire, 130 W. Church Street, Suite 100, Dillsburg, PA 17019
David J. Lenox, Esquire 130 W. Church Street, Suite 1QO, DilIsburg, Pennsylvania 17019
Victoria J. Ambrose, 2435 Winona Drive, Columbus, OH 43235
Progressive Insurance Company, Attn: Tyeddie Williams, 5053 Ritter Road, Suite 101
Mechanlcsburg, PA 17055-6925
GEICO Insurance Company, Attn.:Michael Moeller, One GEICO Boulevard, Fredericksburg, VA 22412-0001
J. Paul Dibert, Business and Trust Valuation Manager, Inheritance Tax Division
Bureau of Individual Taxes, Department 28061, Harrisburg, Pennsylvania 17128.0601
.'
s.
,.i
,. ,.,
:-;;-J rri
";-] r",
f;g]
I r:I
_:'::i \:..-,
:.:.; l.=:-'~
..' ..
J:~ C)
,_ .. I
,./ ~ ':~~ --:~
\
~
.,\,\,
REV-1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Muller, Eugene A. II
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-00353
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 8,142.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees The Wiley Group, PC 9,174.75
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills: 535.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 52,788.71
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 70,640.46
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-86)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Muller, Eugene A. II
FILE NUMBER
21-06-00353
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Stone & Murray Funeral Home:
8.142.00
Subtotal
8.142.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMO~THOFPENNSYLVAN~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Muller, Eugene A. II
FILE NUMBER
21-06-00353
ESTATE OF
ITEM
NUMBER DESCRIPTION AMOUNT
1 Administrator's Bond: 2.125.00
2 Cumberland Law Journal (estate advertising): 75.00
3 Filing fee - Administrator's bond: 15.00
4 Filing Fee - Inheritance tax return & inventory: 30.00
5 Hershey Medical Center (final medical expenses): 45.000.00
6 Overnight courier fee: 8.95
7 Real Estate Closing Costs: 1.907.16
8 Real estate taxes: 211.53
9 Seller assistance in real estate sale: 3.000.00
10 Seller contribution toward real estate cleaning: 250.00
11 The Sentinel (estate advertising): 166.07
Subtotal
52.788.71
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Muller, Eugene A. II
FILE NUMBER
21-06-00353
ESTATE OF
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Balogh & Becker, Ltd. - Payoff Citiband Credit Card #5424180775817395:
VALUE AT DATE
OF DEATH
4.700.00
2 Chase Credit Card #4266841029244132:
3.448.11
3 Discover Financial Services Credit Card #6011002545894909:
3.807.00
4 HSBC Bank Account #5491098607978276:
62.99
5 Juniper Bank Account #5140217997121454:
226.99
6 PA Central FCU (payoff mortgage):
35.970.43
7 PP&L (electric):
40.11
TOTAL (Also enter on Line 10, Recapitulation)
48,255.63
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV.1513 EX+ (9-00)
*'
SCHEDULE ..
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Muller, Eugene A. II 21-06-00353
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trusteels)
I. TAXABLE DISTRIBUTIONS [include outright sgousal
distributionsg and ransfers
under Sec. 116(a)(1.2)]
1 Victoria J. Ambrose Daughter one hundred
2435 Winona Drive percent
Columbus, OH 43235
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
Jan M. Wiley
David J. Lenox
Timothy J. Colgan
Christopher J. Marzzacco
THE WILEY GROUP
Attorneys at LaW'"
Wiley, Lenox, Colgan & Marzzacco, P.c.
January 2, 2007
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
In Re: Estate of Eugene A. Muller II, deceased
File Number 21-06-00353
Dear Register:
David E. Hershey
Bradley A. Winnick
Thomas M. Clark
Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status
report with regard to the above captioned estate. Also enclosed' is a check in the amount of
$98.11 representing the tax due, and a check in the amount of $30.00 representing the filing fee.
Please return the recording receipts to my attention in the enclosed envelope.
Thank you for your cooperation.
Sincerely,
~
Dawn Gladfelter/ Assistan
/dg
encl.
o
Co
-z
;~,;;g
['ilIO
:;; ~ gj
. >': en :.A:
)no
.-,O-n
f'C
~J:o
, -l
:J!
r--.:>
<=
=
--'
<-
'J>
Z
I
.s:-
\)
::It
-
eo
c,.)
N
130 W. Church Street, Suite 100 · Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426
Offices in Harrisburg · York · Carbondale
www.wileygrouplaw.com
/
~O('!l~
. = r: fD
::!. fD S ~.
E~r;-
...fD :2 ... ...
.. - ~
~~=..
~Q..~
~r:~~
=r.~fIJ
_fDr:
tHC"I:l=
i~
. ~
t: ~
r:
...
Er
~
i
-~
. -~:l
;~'
. I
~
Vol n ~
0 0 tr1
o~ Iii" ~~
~
=(") :J:E g
- ;;r
&c: . -.
c: i=l ~iS' 8~
otl;;r ~"< ~
- V> N ·
~~ fI.
Nr- III
~ ~ ...
..... .... (') :J i~
" . (') 0
Ov> o X
~ 5. . ~
fii :'tl
..... 0
g e
~
~....,... *
.... .... C"'"
0\.... N *
O\U1Q
1-::
,..0 !II
SN
,~
,~,
...,<..=..
at
o CoH'
NVI
.... 00
"""N'()
oo'()
....0...
'O......~
.....
"'0'
~