HomeMy WebLinkAbout11-14-07 (3)
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15056041147
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 Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
.
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 7
0831
Date of Birth
187164395
08222007
12181923
MILLER
KATHRYN
MI
E
Decedent's Last Name
Suffix
Decedent's First Name
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
o 1. Original Return
o 4. Limited Estate
9. Litigation Proceeds Received
0 2. Supplemental Return 0 3. Remainder Return (date of death
prior to 12-13-82)
D 4a. Future Interest Compromise D 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
0 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
D 1 0 Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A)
. between 12-31-91 and 1-1-95) (Attach Sch. 0)
[gJ
o
6. Decedent Died Testate
(Attach Copy of Will)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAMES D. BOGAR 717737~61
Firm Name (If Applicable)
BOGAR & HIPP LAW OFFICES
",
REGISTER OF W1LL~ USE 'ONL Y
First line of address
ONE WEST MAIN STREET
-", ;
Second line of address
DATE FILED
City or Post Office
SHIREMANSTOWN
State
PA
ZIP Code
17011
Correspondent's e-mail address:
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 other than the personal representative is based on all information of which preparer has any knowledge.
SIGN R OF PERSON RES NSI FOR FILING RETURN 0 TE
Patricia A. Peterson
/1
ADDRESS
James D. Bogar
II
hiremanstown, PA 17011
Side 1
L
15056041147
15056041147
--.J
~
15056042148
REV-1500 EX
Decedent's Name: Kath ryn E. Miller
RECAPITULATION
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D).......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested............. 7.
8. Total Gross Assets (total Lines 1-7).......................:............................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)................................ 10.
11. Total Deductions (total Lines 9 & 10)...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
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, of
transfers under Sec. 9116
(a)(1.2) X .00
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
0.00
15.
447,493.90
16.
0.00
17.
0.00
18.
19. Tax Due..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
Decedent's Social Security Number
187164395
25,031.84
186,325.58
61,966.48
182,287.82
455,611.72
7,710.06
407.76
8,117.82
447,493.90
447,493.90
0.00
20,137.23
0.00
0.00
20,137.23
D
15056042148
~
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-07-0831
DECEDENT'S NAME
Kathryn E. Miller
STREET ADDRESS
5225 Wilson lane
CITY I STATE IZIP
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 )
1,006.86
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 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.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
20,137.23
1,006.86
19,130.37
19,130.37
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or.......................................................................................................... ........
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?......................................................................................................................
Yes
D
D
D
D
No
[!]
[!]
~
[!]
[!]
D
D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
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.
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. 99116 (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. 99116 (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. 99116 (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. 99116 1.2) [72 P.S. 99116 (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. 99116 (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)
SCHEDULE B
STOCKS & BONDS
COMMONV\nW.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Kathryn E.
FILE NUMBER
21-07-0831
ESTATE OF
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Series EE U.S. Savings Bonds - 31 Bonds - date of 25.031.84
death values determined per attached Savings Bond
Calculator - total price $8,900.00; total value
$25,031.84; total interest $16.131.84
TOTAL (Also enter on Line 2, Recapitulation) 25.031.84
(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)
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205-09-6343
Harry F. Miller
348 Park Avenue
New Cumberland,
Pa. 17070
OR
Kathryn E. Miller 187-16-4395
lltlS IOND IS ISSUEDUNOEfI A
ANDISSUlJECT'rnTKETE
UIEI'I'TY IONDACT.ASAIIENOED,
no ON THE ...ex HEREOF.
DUA/lTMENTOFTHE TIIEASUIl'"
WASHINGTON
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Harry F. Miller 205 09 6343
348 Park Ave.
New Cumberland, Fa.. 17070
OR: Kathryn E. Miller 187 16 4395
DErAllTMENTOF THETIlEASUlty
WASHINGTON
~::~,0~
THIS 10ND IS ISSUED UNDlR
.o.NOISSUIJfCTTOTHETEII
UT~~~~~'H~II~:~DlD.
Harry F. Miller
348 Fark Ave.
New Cumberland Pa. 17070
OR Kathryn E. Miller
OUAIITMEUTOFntETIIEJoSUflY
W1<SHINGTON
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THIS 10NO IS IssueD UNDER AUTH
ANDISSUBJECTTO,THETER
;~~~Il6: :;~:g'H~~:.NDED.
ISSUE DATE
WHICH IS THE FIRST DAY OF
FEE 1985
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Sept 30 1985
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(MONTH) _--_ tYEARI
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SE]PlIES EE
SE:&IES EE
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HarryF. Miller
348 Park Ave.
New Cumberland, Fa. 17070
OR: Kathryn E. Miller 187 16 4395
TttlS 80ND IS ISSUED UNDEII
AND lSSlJIJECTTO THE T
UIE""" SONO ACT. ASAMENDED.
ON THE IACIlHEIIEOF.
OEI'ARTM~~~iN~RiASUJlY
~,,~t0<<-
July
1985
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HARRY F. MILLER 205-09-6343
348 Park Ave.,
New Cumberland, PA 17070
or KATHRYN E. MILLER
187-16-4395
DEP,,"TM~~:N~IIEASUIIY
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THJSI':::I~S=g,.UT~~~ET
OUIlEIITY 100000ACT.ASAMlNDEO.
"'TEOON THE IACKHEIIEOf.
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AT THE MATURITY HEREOF WIl.L PAY
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Harry F. Miller 205-09-6343
348 Fark Ave.
New Cumberland Fa. 17070
OR Kathryn E. Miller
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~ DE'ARTMENT OF TllE TIIEASURY
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Rev-1508 EX+ (6-98)
,*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Kathryn E.
FILE NUMBER
21-07 -0831
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolnlly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Bethany Village - refund
VALUE AT DATE
OF DEATH
1,250.00
2 Members 1st - Certificate of Deposit No. 239804-52 - date of death balance
$16,260.29; accrued interest $49.40
16,309.69
3 PNC Bank - Certificate of Deposit No. 31500250711 - date of death balance
$22,220.27; accrued interest $0.00
22.220.27
4 PNC Bank - Certificate of Deposit No. 31500257915 - date of death balance
$11,081.51; accrued interest $1.50
11.083.01
5 PNC Bank - Certificate of Deposit No. 31600261721 - date of death balance
$16,574.40; accrued interest $26.92
16.601.32
6 PNC Bank - Certificate of Deposit No. 31600290662 - date of death balance
$46,081.99; accrued interest $118.50
46.200.49
7 PNC Bank - Certificate of Deposit No. 31900230149 - date of death balance
$38,609.14; accrued interest $20.69
38.629.83
8 PNC Checking Account No. 5140043443 - date of death balance $2,513.37; accrued
interest $0.29
2.513.66
9 PNC Savings Account No. 5003783736 - date of death balance $31,072.27; accrued
interest $45.04
31.117.31
10 Personal Property - Sold at Private Sale
400.00
TOTAL (Also enter on Line 5, Recapitulation)
186.325.58
(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)
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
fvlt
MEMBERS 1st
FEDERAL CREDIT UNION
239804-00
12/31/2003
$63.54
$.04
$63.58
Patricia Peterson
12/31/2003
239804-05
07/26/2007
$10,001.08
$11.39
$10,012.47
Patricia Peterson
07/26/2007
239804-40
02/15/2007*
$22,353.35
$64.18
$22,417.53
Patricia Peterson
02/15/2007
239804-42
02/23/2004
$33,139.57
$84.08
$33,223.65
Patricia Peterson
02123/2004
*Rollover from certificate 239804-45, originally established 08/16/2004.
CERTIFICA TES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-51
09/27/2006*
$33,818.00
$102.73
$33,920.73
Patricia Peterson
09/27/2006
239804.52
10/10/2006**
$16,260.29
$49.40
$16,309.69
None
*Rollover from certificate 239804-46, originally established 09/27/2004.
**Rollover from certificate 239804-47, originally established 11/08/2005.
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-53
05/15/2007*
$34,209.23
$98.21
$34,307.44
Patricia Peterson
05/15/2007
239804.54
07/05/2007
$34,028.06
$100.43
$34,128.49
Patricia Peterson
07/05/2007
*Rollover from certificate 239804-48, originally established 06/15/2006.
5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (800) 283-2328 . www.memberslst.org
CERTIFICA TES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-55
07/30/2007*
$18,184.93
$53.67
$18,238.60
Patricia Peterson
07/30/2007
*Rollover from certificate 239804-50, originally established 08/30/2006.
Estate of: Kathryn E. Miller
Date of Death: August 22, 2007
Social Security Number: 187-16-4395
~BERS 1~:IkRALrm~
Dani~
Insurance Services Specialist
October 2, 2007
G PNCBAN<
October 10, 2001
James D. Bogar
Attorney at Law
One West Main Street
Shiremanstown, P A 17011
RE: Estate of Kathryn E. Miller, deceased
SSN: 187.16-4395
000: 8/2212007
Dear Mr. Bogar:
In response to your request for Date of Death balanoes for the customer noted above~ our
records show the following:
CertWtates of Deposit
Account #31900230149
KATIIRYN E MILLER
DaD balance: $38,609.14 + $20.69 accrued interest
Account #31500250711
K.A THRYN E MILLER
DaD balance: $22,22017 + $0.00 accrued interest
Account #31500257915
KATHRYN E MlLLER
DaD balance: $11j081.51 + $1.50 accrued interest
Account #31600261721
KATIIRYN E MILLER
DOD balance: $16,574.40 + $26.91 accrued interest
Account #31600290662
KATHRYNE MILLER
DOD balance: $46,081.99 + $118.50 accrued interest
Checking Account
Account #5140043443
KATHRYN E :MJLLER
DOD balance: $2j513.37 + $.29 accrued interest
Page 1 of2
Established 06/1&/2002
Established OS/21/2002
Established 03/21/2005
Established 05/10/2005
Established 05/03/2006
Established 04/01/1958
Savings Account
Account #5003783736
Established 12/24/2002
KATHRYN E :MILLER
DODbalance: $31,072.27 + $45.04 accrtJed interest
Please note that this office only provides date of death balances for deposit accounts
(IRAsl CDS; Checking and Savings accounts). We do not process any financial
transactions or provide statements. If you need assistance with any of these items,
please oalll-888-PNC-BANK (l.gg8-762-Z265) or stop by your local PNC Bank branoh
office.
Sincerely,
&\~~
Rachelle Wells
1-800-762.1775
P1-PFSC-04-F .
500 first Ave.
Pittsburgb.PA 15219
Page 2 of2
Member FDIC
Rev-1509 EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Kathryn E.
FILE NUMBER
21-07-0831
ESTATE OF
If an asset was made joint within one year of the decedenfs date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Patricia A. Peterson
ADDRESS
RELATIONSHIP TO DECEDENT
2 Ash Drive
Mechanicsburg, PA 17050
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 DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENTS INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 12/31/2003 Member's 1st - Savings Account No. 63.58 50.000% 31.79
239804-00 - date of death balance 63.54;
accrued interest $0.04
2 A 8/16/2004 Members 1st - Certificate of Deposit No. 22.417.53 50.000% 11.208.77
239804-40 - date of death balance
$22,353.35; accrued interest $64.18;
rollover from certificate 239804-45
established 8/16/04
3 A 2123/2004 Members 1st - Certificate of Deposit No. 33.223.65 50.000% 16.611.83
239804-42 - date of death balance
$33,139.57; accrued interest $84.08
4 A 9/27/2004 Members 1st - Certificate of Deposit No. 33.920.73 50.000% 16.960.37
239804-51 - date of death balance
$33,818.00; accrued interest $102.73;
rollover from certificate 239804-46
originally established 9/27/04
5 A 6/15/2006 Members 1st - Certificate of Deposit No. 34.307.44 50.000% 17.153.72
239804-53 - date of death balance
$34,209.23; accrued interest $98.21;
rollover from certificate 239804-48
established 6/15/06
Total of Continuation Schedule :>ee attached page
TOTAL (Also enter on Line 6, Recapitulation) 61.966.48
(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 F (Rev. 6-98)
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
fvl~
MEMBERS 1st
FEDERAL CREDIT UNION
239804-00
12/31/2003
$63.54
$.04
$63.58
Patricia Peterson
12/31/2003
239804-05
07/26/2007
$10,001.08
$11.39
$10,012.47
Patricia Peterson
07/26/2007
239804-40
02/15/2007'
$22,353.35
$64.18
$22,417.53
Patricia Peterson
02/15/2007
239804-42
02/23/2004
$33,139.57
$84.08
$33,223.65
Patricia Peterson
02/23/2004
'Rollover from certificate 239804-45, originally established 08/16/2004.
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-51
09/27/2006'
$33,818.00
$102.73
$33,920.73
Patricia Peterson
09/27/2006
239804-52
10/10/2006"
$16,260.29
$49.40
$16,309.69
None
'Rollover from certificate 239804-46, originally established 09/27/2004.
"Rollover from certificate 239804-47, originally established 11/08/2005.
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-53
05/15/2007'
$34,209.23
$98.21
$34,307.44
Patricia Peterson
05/15/2007
239804-54
07/05/2007
$34,028.06
$100.43
$34,128.49
Patricia Peterson
07/05/2007
'Rollover from certificate 239804-48, originally established 06/15/2006.
5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (800) 283-2328 . www.members1st.org
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-55
07/30/2007*
$18,184.93
$53.67
$18,238.60
Patricia Peterson
07/30/2007
*Rollover from certificate 239804-50, originally established 08/30/2006.
Estate of: Kathryn E. Miller
Date of Death: August 22, 2007
Social Security Number: 187-16-4395
&BERS 1" :rr;:Lrrn~
DaniQ-W-
Insurance Services Specialist
October 2, 2007
Rev.1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miller, Kathryn E.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-07-0831
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
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 Members 1st - Certificate of Deposit No. 34.128.49 3.000.00 31.128.49
239804-54 - date of death balance $34,028.06;
accrued interest $100.43. "(AN EXEMPTION IN
THE AMOUNT OF $3,000 IS CLAIMED IN
ACCORDANCE WITH THE PROVISIONS OF THE
INHERITANCE AND ESTATE TAX ACT, BEING 72
P.S. SECTION 9108(c) AND 72 P.S. SECTION
9107(c)(3))
2 Members 1st - Certificate of Deposit No. 18.238.60 18.238.60
239804-55 - date of death balance $18,184.93;
accrued interest $53.67; rollover from certificate
239804-50 established 08/30/2006
3 Members 1st - Savings Account No. 239804-05 - 10.012.47 10.012.47
date of death balance $10,001.08; accrued
interest $11.39
4 DWS Scudder Account No. 20784825 - DWS 60.012.25 60.012.25
Balanced Fund-S. This is a transfer on death
account which passed in equal shares to Patricia
A. Peterson and Jacqueline L. Miller, daughters
of Decedent, Kathryn E. Miller, upon her death.
5 DWS Scudder Account No. 20784825 - DWS 62.896.01 62.896.01
Capital Growth Fund-S. This was a transfer on
death account which passed, in equal shares, to
Patricia A. Peterson and Jacqueline L. Miller,
daughters of Decedent, Kathryn E. Miller upon
her death.
TOTAL (Also enter on Line 7, Recapitulation) 182.287.82
(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)
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
fvl~
MEMBERS 1st
FEDERAL CREDIT UNION
239804-00
12/31/2003
$63.54
$.04
$63.58
Patricia Peterson
12/31/2003
239804-05
07/26/2007
$10,001.08
$11.39
$10,012.47
Patricia Peterson
07/26/2007
239804-40
02/15/2007"
$22,353.35
$64.18
$22,417.53
Patricia Peterson
02/15/2007
239804-42
02/23/2004
$33,139.57
$84.08
$33,223.65
Patricia Peterson
02/23/2004
"Rollover from certificate 239804-45, originally established 08/16/2004.
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-51
09/27/2006"
$33,818.00
$102.73
$33,920.73
Patricia Peterson
09/27/2006
239804-52
10/10/2006"
$16,260.29
$49.40
$16,309.69
None
"Rollover from certificate 239804-46, originally established 09/27/2004.
""Rollover from certificate 239804-47, originally established 11/08/2005.
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-53
05/15/2007"
$34,209.23
$98.21
$34,307.44
Patricia Peterson
05/15/2007
239804-54
07/05/2007
$34,028.06
$100.43
$34,128.49
Patricia Peterson
07/05/2007
"Rollover from certificate 239804-48, originally established 06/15/2006.
5000 Louise Drive . Po. Box 40 · Mechanicsburg, Pennsylvania 17055 . (800) 283-2328 . www.members1st.org
CERTIFICA TES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest to Date of Death
Name of Joint Owner
Date Joint Ownership Established
239804-55
07/30/2007*
$18,184.93
$53.67
$18,238.60
Patricia Peterson
07/30/2007
*Rollover from certificate 239804-50, originally established 08/30/2006.
Estate of: Kathryn E. Miller
Date of Death: August 22, 2007
Social Security Number: 187-16-4395
~BERS 1~:U:Lrm~
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Insurance Services Specialist
October 2, 2007
P.O. Box 219151
Kansas City MO 64121-9151
1-800-728-3337
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October 2,2007
Patricia A Peterson
2 Ash Drive
Mechanicsburg P A 17050
Inquiry #:
Fund:
Account #:
20784825
DWS Balanced-Fund-S-
04295049717
Dear Patricia Peterson:
I am writing in response to your recent letter regarding the DWS Scudder account referenced above. Please accept
our condolences on the passing of Kathryn E. Miller.
Below I have provided the number of shares, share prices, and dollar values of the funds in this account as of
August 22, 2007.
Fund Name (S Class) Number of Shares Share Price Dollar Value
DWS Balanced Fund-S 6,098.806 $9.84 $60,012.25
DWS Capital Growth Fund-S 1,176.506 $53.46 $62,896.01
If you have any questions, please contact our Shareholder Services Department at (800) 728-3337. OUf
representatives will be happy to assist you Monday through Friday, 8:00 a.m. to 5:00 p.m. Central Time.
Sincerely,
~~
Josh Yates
Lead Mutual Fund Representative
REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Kathryn E.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07-0831
ESTATE OF
ITEM I DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 162.06
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 Bogar & Hipp Law Offices 5,330.00
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 368.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,850.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 7,710.06
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Kathryn E.
FILE NUMBER
21-07-0831
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Bethany Village - memorial services
60.00
2
Parthemore Funeral Home - remainder of funeral bill due
102.06
Subtotal
162.06
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1S00 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6098)
SCHEDULE H.B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miller, Kathryn E.
FILE NUMBER
21-07-0831
ITEM
NUMBER
1
DESCRIPTION
RESERVES: - Cost to conclude administration of Estate including filing fee for PA
Inheritance Tax Return, Inventory and First and Final Account; preparation of
Personal and Fiduciary Income Tax Returns
AMOUNT
1.850.00
Subtotal
1.850.00
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
COMMONWEAl. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Kathryn E.
FILE NUMBER
21-07-0831
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Millenium Pahrmacy Services, Inc. - miscellaneous pharmacy expenses
VALUE AT DATE
OF DEATH
12.60
2 Millenium Pharmacy System, Inc. - prescription drugs
108.32
3 Mobile X-Ray Imaging, Inc. - medical bill
17.84
4 Pennsylvania Department of Revenue - estimated Pennsylvania Income Tax
payment
140.00
5 United States Treasury - estimated Federal Income Tax payment
129.00
TOTAL (Also enter on Line 10, Recapitulation)
407.76
(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-'10)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Miller, Kathryn E.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
Peter F. Chamberlain
1647 Briarcliff Road, N.E., Unit 7
Atlanta, GA 30306
Grandson
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
I.
Jacqueline L. Miller
4611 Gann Crossing
Smyrna, GA 30082
Daughter
Patricia A. Peterson
2 Ash Drive
Mechanicsburg, PA 17050
Daughter
Andrew B. Shearer
1625 Shenandoah Court
Allentown, PA 18104
Grandson
FILE NUMBER
21-07-0831
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Ten percent of
rest, residue
and remainder
Forty percent
of rest, residue
and remainder
Forty percent
of rest, residue
and remainder
Ten percent of
rest, residue
and remainder
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Form PA-1500 Schedule J (Rev. 6-98)
..
LAST WILL AND TESTAMENT
OF
KATHRYN E. MILLER
I, KATHRYN E. MILLER, of Mechanicsburg, Cumberland
County, Pennsylvania, make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, unto my husband,
HARRY F. MILLER, provided he survives me by sixty (60) days.
SECOND: Should my husband, HARRY F. MILLER, predecease
me or die on or before the sixty-first (61st) day following my
death, I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and wherever situate, including
any property over which I hold power of appointment and together
with any insurance policies thereon, in equal shares, as follows:
(A) Forty (40%) percent thereof to my daughter,
PATRICIA A. PETERSON, provided, however, that should she
predecease me, then to her issue per stirpes by representation.
(B) Forty (40%) percent thereof to my daughter,
JACQUELINE L. MILLER, provided, however, that should she
predecease me, then to her issue per stirpes by representation.
(C) Ten (10%) percent thereof to my grandson, ~~DREW
B. SHEARER, provided, however, that should he predecease me, then
to my daughter, PATRICIA A. PETERSON.
(D) Ten (10%) percent thereof to my grandson, PETER F.
CP~BERLAIN, provided, however, that should he predecease me,
then to my daughter, JACQUELINE L. MILLER.
THIRD: Should any of my grandchildren not have
attained the age of twenty-four (24) years at the time for
distribution to him, I give, devise and bequeath the share of
each such grandchild to my hereinafter named Trustee or Trustees,
IN SEPARATE TRUSTS, to hold, manage, invest and reinvest the
shares so received, and to use and apply from time to time such
portion of income and principal for the said grandchild's post-
high school education (including college, trade school or other
similar training or education), as my Trustee or Trustees, in
their sole discretion, deem advisable. The Trustee or Trustees,
in exercising their discretionary authority with respect to the
payment of income or principal of the within Trust to my
grandchildren, shall take into consideration any income or other
resources available to my grandchildren from sources outside this
Trust.
Any income or principal not so applied shall be dis-
tributed to each grandchild when he attains the age of twenty-
four (24) years. In the event any of my grandchildren die prior
to the termination of the Trust established herein for their
benefit, the interest of my grandchild in said Trust shall cease
with any income and principal being divided evenly between or
among that deceased grandchild's brothers and sisters or the
separate trusts established hereunder for their benefit and, in
the absence of any brothers and sisters, to my other grandchil-
dren in equal shares.
FOURTH: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
2
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege glven by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
:----
-,
(8) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
--...
"-
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3
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FIFTH: I nominate and appoint my daughters, PATRICIA
A. PETERSON and JACQUELINE L. MILLER, as Co-Trustees of the
hereinabove described Trusts, who shall serve without bond and
shall receive fair and reasonable compensation.
SIXTH: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
SEVENTH: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
EIGHTH: I nominate and appoint my daughter, PATRICIA
A. PETERSON, Executrix of this, my Last Will and Testament. In
the event of the death, resignation or inability to serve for any
reason whatsoever of the said PATRICIA A. PETERSON, I nominate
and appoint my daughter, JACQUELINE L. MILLER, Executrix of this,
my Last Will and Testament. I direct that my Executrix, Trustee
or Co-Trustees and their successors, shall not be required to
post security or a bond for the performance of their duti~s in
any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this "':)---\h day of
2002.
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(SEAL)
-
KATHRYN E. MILLER
4
Signedt sealedt published and declared by the above-
named Testatrix as and for her Last will and Testament in our
presencet whot at her request, in her presence and in the
presence of each othert have hereunto subscribed our names as
attesting witnesses.
/---.. fJ
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Address
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