Loading...
HomeMy WebLinkAbout03-0988 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estateof AnnaM. Miller No. ,-~'i'~3' 70(/OOt also known as To: Register of Wills for the Deceased. County of Cumberlan~j in the Social Security No. 203109713 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl les (d.b.n.; pendente lite; durante absentia; durante minontate) for letters of administration on the estate of the above decedent. Decedent was domiciled at death m Cumberland County, Pennsylvania, with h er last family or principal residence at 720 s. Frederick Street. Mechanicsbur~ Borough. Cumberland Count5,. PA (list street, number, Twp. or Boro.) Decedent, then 79 years of age, died 10/4/9~ at Camr~ Hill Care Center. E. Pennsboro Townshim Cumberland County. PA Decedent at death owned property with estimated values as follows: (If domiciled m Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 720 s. Frederick Street. Mechanicsburg Borough, Cumberland County, PA Petitioner the following spouse (if any) and heirs: Name Kay Miller after a proper search ha, ascertained that decedent left no will and was survived by Edward Miller Patr/cia Miller (Deceased [ l/13/01 Frank Miller (Deceased 5/14/93) Relationship Daughter Son Daughter Residence 1012 S. Market Street Mechanicsburg PA 125 W. Main Street Mechanicsburg PA 179~ THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. -7' ~!. 500 N. Third Street, 12th Floor Hamsbur~ ~ Ronald D. Butler PA 171Ol /7-/x5 -/¢ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ SS COUNTY OF Cumberland The petitioner(s) above-named swear(s) or af£Lrm(s) that the statements m the foregoing petition are mae and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly admmister the estate according to law. Sworn to or affirmed and subscribed ,-. before me this 26th - ~ / ] Ng~em~r , F~ aay or 2003 Donna lq. Otto, 1st 13ep~ty ~ster ~~_~1, NO. 21-2003-988 Estate of Anna M. Miller , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW December 1st, 2003 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Anna M, Mi 1 1 er is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Ronald D. Butler in the estate of AnBg M. Miller FEES Letters of Administration ...... $18.00 Short Certificates ( 5 ) ...... $ Renunciation. (.2.) ......... $10.00 10.00 JCP $ TOTAL _~ $ 5_3 Filed . N. Qv.e.m~.r. 26th~ 2003A. D. Benjamin J. Butler ~1941~ ATTORNEY (Sap. Ct. I.D. No.) 500 N. Third Street, 12th Floor ]tamsbur~ PA 17101 ADDRESS PHONE Mailed Letters to 717.236.1485 httorney on 12/01/2003 Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of Anna M. Miller also known as , Deceased No. 21-2003-988 The undersigned,~:ay Miller - Daughter (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters oTAdministrati,bn b~ issued Io P. anald D. Butler Witness her hand this /tW/clay of November 2003 (Signature) 1012 S. Market Street Mechanicsburg (Address) PA 17055 of (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this day of Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of Anna M. Miller also known as , Deceased No. 21-2003-988 The undersigned, Edward Miller- Son (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Lettem of Adrmnistrauon be Issued to Ronaid D. Butler Witness her hand this ] ~ ~ . day of November 2003 125 W. Main Street Mechanicsburg (Signature) PA 17055 (Address) of (Signature) (Address) (Signature) (Address) Sworn to or affirmed and subscribed before me this day of Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 105.905 REV.(01/03) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, Pi. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. 3023661 No. Charles Hardester State Registrar NOV 1 7 ZOOL Date H105 ~43 Rev 2/B7 TYPE/PRINT PERMANENT BLACK INK COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME DE DECEDENT [First M~le. Las~) STATE FILE NUMBER 1. ARraS M. Miller ,. femal 203-- 10 -- Monlhs ; Days Hours ; Minutes [ n Day. Yea) S~aleo, Fo~e~gnCount,y) HOSPITAL: , 79 ¥~. ,1/19/1916 W. Fairview, ,,le.,[] ,B Cumbewrland . Pennsboro Tw ~.R~. ,,,.retired custodia~,~school di DECEDENT'S MAILING ADDRESS (St,eel, City/Town. State, Zip Code) ,7a. State 720 S. Frederick.~St. FATH~[~ ~M~F~ Midge. LaaT .... William Eckert .~.Patricia A. Miller METHOD OF DISPOSITION Burlel.l~] Cremation[]:] RemovallromSlate[~ IDATE OF DISPOSITION (MeRit1. Day. Year) [] ~ct. 6,1995 9713 4' Oct.4~1995 Nursing Other I RACE - American Ind an. Black, White mc. (Sp~ify) ' ,0. white SURVIVING SPOUSE (11 wile, give maiden name) DECEOENT'S EDUCATION MNA~RITAL STATUS ' M ar dad ever Married, WitJowed, .... i 17c.[~ '1fie s, decedenl lived in C~mberland ,7..~ ~ith~.~,..H~it.o, Mechanlcsb~rq MOTHER'S NAME (F~rsl. Midd~ Maiden S~rname} ,,. Mary Ellen unknowQ IINFORMANT'S MAILING ADDRESS (Street Citron, Stale, Z~ C~) J,,720 s. ~rick St. ~c~g, PA 17055 ~csb~g ~te~ ,,,.M~icsb~g, PA  N~EANDAD~ESSOFFACILI~ 8 ~ket Plaza Way ~]~zzi ~ral H~ M~hani~h,rn. PA UCENSE NUMSER iDATE WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER? (MO~lh. Day, Year) r~ po,. I~. a. u I~ LACE Otc INJURY. Al home. latin, sir,e(, faclo~7, office building mc (Spe~ily) 21-2003-988 Register of Wills of Cumberland County, Pennsylvania Name of Decedent: Anna M. Miller Date of Death: 10/4/97 Will No. To the Register: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Adm. No. 2003-0098~ I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 12/4/03 : Name Kay Miller c/o Susan Janis Edward Miller Estate of Patricia A. Miller c/o Ronald D. Butler, Administrator Estate of Frank Miller c/o Ronald D. Butler, Administrator Address 1012 S. Market Street Mechanic~l~[lrg 125 W. Main Street Mechanicsb[~rg 500 N. Third Street, 12th Floor Harrisburg 500 N. Third Street, 12th Floor H~rri~b~rg P~ 17075 170~7 17191 17101 None Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: 12/'4/03 7L. (Signature) Name: Beniamin J. Butler Address: 500 N. Third Street, P.O. Box 1004 Harrisbur~ Telephone (717) 2361485 PA 1710~-1004 Capacity: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE2 NUMBERi ' COUNTY CODE 0 3 0 9 8 8 YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) use a blank block to separate words Z M i 1 I e r , A n n a M III SOClAt SECURITY NUMBER DATE OF DEATH t'"t DATE OF BIRTH o : o : t , o /o 4 /t o , /]9 /t 9 '6 III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS LU r~.~ fl. E- Z UJ Z 0 fl, UJ rY 0 Z [] 1. Original Return [] 2. Supplemental Return [] 3. RemainderRetum (dateofdeathpriorto12-13-82) [] 4. Limited Estate [] 6. Decedent Died Testate (Attach copyofWill) [] 9, Litigation Proceeds Received [] 4a. Future Interest Compromise (date of death alter 12-12-82) [] 7. Decedent Maintained a Living Trust (Attach copyofTrust) [] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [] 5. Federal Estate Tax Return Required O 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Beniamin J. Butler FIRM NAME (If Applicable) Butler Law Firm TELEPHONE NUMBER 717.236.1485 500 N. Third Street P.O. Box 1004 Harrisburg PA 17108-1004 1. Real Estate (Schedule A) (1) 2. Stocks and Elonds (Schedule El) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages 8, Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (7) 8. Total Gross Assets (total Lines 1-7) 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) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 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) 9 5 0 0 ~F~AL USE ONLY (8) (11) (12) (13) (14) 9 ~5 0 0 .0 0 9 1 7 0 ,2 5 ~3 2 9 .7 5 ~3 2 9 .7 5 15. Amount of line 14 taxable at the spousal tax rate ~ See instructions on reverse side for applicable percentage 16. Amount of line 14 taxable at 6% rate , 17. Amount of line 14 taxable (15) 3 2 9 · 7 5 X .06 (16) ~ ~ I 9 · 7 9 ~ at 15% rate , , X .15 (17) O ~ 18. Tax Due (18) ~ I 9 ? 9 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE 81DE AND RECHECK MATH < < Under penalties of perjury, I declare that I have exam ned 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 inf,~rmation of which preparer has an}, knowledge. SIGNATURE OF P,~,'~ON RE/9~O~IB~4~ FOR FJ,I_ING RETURN ADDRESS 500 N. Third Street, P.O. Box ]004 , -- . DATE SIG NATU R E d'~E R/T~N~RE P~;,~ E NTATIVE ADDRESS 500 N. Third Street, p.O. Box ]004 DATE Harrisburg PA 17108-1004 Decedent's Complete Address: STREET ADDRESS CITY 720 S. Frederick Street J Mechanicsburg STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty $0.00 SQ.QQ $0,0o $o.oo $0,00 Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) if line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 19 to request a refund (4) If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT ZIP 17055 $19.79 $0.00 $0.00 $0.00 $0.00 $0.00 $19.79 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; .............................................................. [] [] 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 on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... [] [] 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? ..... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 72 P.S. §9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995. 72 P.S. §9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving spouse from 3% to 0% for dates of death on or after January 1, 1995. 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 JANUARY 1, 1995 - Please answer the following question by placing an "x" in the appropriate space. Did the decedent create a trust or similar arrangement which is soley for the surviving spouse's benefit for his or her entire lifetime? Yes [] No [] If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(les). Enter the value of the trust on Schedule J, Part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule O in order to make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate, and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must attach Schedule © to a timely-filed tax return, along with Schedule(s) K and/or M in order to show the apportionment of the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). ?EV-1502EX+{~971 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Miller, Anna, M 21 OS 0988 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION Property at 720 S. Frederick Street, Mechanicsburg Borough, Cumberland County, Pennsylvania based on appraisal - see attached TOTAL (Also enter on line 1, Recapitulation VALUE AT DATE OF DEATH $9,500.00 %500.00 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT BECEBENT ESTATE OF Miller, Anna, M SCHEDULE B STOCKS & BONDS FILE NUMBER 21 0~, All property jointly-owned with right of survivorship must be disclosed on Schedule F. O988 ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH , REV-1508EX~(1 97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT BECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Miller, Anna, M 21 05 0988 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH , REV-1509EX+~(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Miller, Anna, M 21 0:~ 09~8 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. 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 number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES' TOTAL (Also enter on line 6, Recapitulation) $ (If more space ~s needed, insert additional sheets of the same size) REV 1510 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Miller, Anna, M 21 03 0988 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 Ees. DESCRIPTION OF PROPERTY % OF ITEM iNCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APFLICAI3LE) 1. TOTAL (Also enter on line 7, Recapitulation) $ (If more space ~s needed, insert additional sheets of the same s~ze) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Anna, M SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 03 Debts of decedent must be reported on Schedule I. 0988 ITEM NUMBER 8. 9. 10. 11. 12. DESCRIPTION FUNERAL EXPENSES: Malpezzi Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Butler Law Firm Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Mark E. Hilbert & Associates - Appraisal Cumberland Law Journal - Estate Advertising The Sentinel - Estate Advertising Cumberland County Register of Wills - Filing Fee Barry L. Heckard - Tax Certification Photocopies State Zip TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT $4,557.10 $4,000.00 $75.00 $275.00 $75.00 $143.15 $25.0O $10.00 $10.00 9,170.2> (If more space is needed, inse~ additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Miller, Anna, M 21 03 0988 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT REV 1513EX+(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Miller, Ar ~a, M NUMBER [. 1. 2. 3. 4. 1, I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Kay Miller c/o Susan Janis 1012 S. Market Street Mechanicsburg, PA 17055 Edward Miller 125 W. Main Street Mechanicsburg, PA 17055 Estate oF Patricia A. Miller c/o Ronald D. Butler, ADM 500 N. Third Street, P.O. Box I004 Han'isburg, PA 17108-1004 Estate of Frank Miller a/k/a Franklin F. Miller, Jr. c/o Ronald D. Butler, ADM 500 N. Third Street, P.O. Box 1004 Harrisburg, PA 17108-1004 FILE NUMBER 21 03 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Son Daughter Son 0988 AMOUNT OR SHARE OF ESTATE 1/4 entire intestate estate 1/4 entire intestate estate 1/4 entire intestate estate 1/4 entire intestate estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If' more space is needed, insert additional sheets of the same size) Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Anna M. Miller also known as , Deceased No. 21 03 0988 Date of Death 10/4/95 Social Security No. 203-10-9713 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/VVe verify that the statements made in this inventory are true and correct, lANe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. P ersona~/~~ Name of Attorney: Beniamm J. Butler I.D. No.: 81948 Ronald D. Butler Dated Address: 500 N. Third Street, P.O. Box 1004 Harrisburg PA 17108-1004 Telephone: 717.236.1485 Ileal Estate Description Property at 720 S. Frederick Street, Mechanicsburg Borough, Cumberland County, PA based on appraisal - see attached Value c'": $9 500.00 <;' ,::5 Total (Attach Additional Sheets if necessary) $9,500.00 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003559 BUTLER BENJAMIN J 500 NORTH THIRD ST HARRISBURG,, PA 17108-1004 ESTATE INFORMATION: SSN: 203-10-9713 'FILE NUMBER: 2103-0988 DECEDENT NAME: MILLER ANNA M DATE OF PAYMENT: 02/13/2004 POSTMARK DATE: 02/1 2/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/04/1995 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $19.79 REMARKS' TOTAL AMOUNT PAID: 919.79 SEAL CHECK#007355 INITIALS' JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DZV]'SIOH DEPT. Z8060! HARR][SBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-lSd7 EX AFP ¢01-05) BENJAMIN J BUTLER BUTLER LAW FIRM PO BOX 100q HaG DATE 0$-Z9-Z00q ESTATE OF MILLER DATE OF DEATH 10-0q-1995 FILE NUMBER 21 05-0988 COUNTY CUMBERLAND ANNA M Amount Remitted /.MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~" RETAIN LOWER PORTION FOR YOUR RECORDS 4 REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MILLER ANNA M FILE NO. 21 05-0988 ACN 101 DATE TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) $. Closely Held Stock/Partnership Interest (Schedule C) q. Mortgagas/No~ms Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9 Funeral Expmnsms/Adm. Costs/Misc. Expanses (Schedule H) 10 Debts/Mortgage Liabilities/Liens (Schedule Z) 11 Tote1 Deductions 12 Net Value of Tax Return 15 lq (1) (2) ($) (5) (6) (7) (9) (10) Charitable/Governmental Bequests; Non=elected 9115 Trus*s (Schedule J) Net Value of Estate Sub,act to Tax 9/500.00 00 O0 O0 O0 O0 O0 (8) 9,170.25 NOTE: To ~nsura proper credit to your account, submit the upper portion of this form with your tax payment. 9,500.00 .00 (11) 9.170.25 (la) :529.75 (15) .00 (1,~) :529.75 NOTE: Zf an assessment Has lssued previously, 1/nas 14, 15 and/or 16, 17, 18 and 19 reflect flgures that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amoun~ of Line 1~ at Spousal rate (1.6). 16. Amoun~ of Line lq taxable at Lineal/Class A rate (16) 17. Amoun~ of Line lq at Sibling rate (17). 18. Amoun~ of Line lq taxable at Collateral/Class B rate (18). 19. Principa! Tax Due TAX CREDITS: PAYMENT RECETpT DT$COUNT will · O0 x O0 = :529.75 x 06 = · O0 x O0 = · O0 x 15 = (19)= .00 19.79 .00 .00 19.79 DATE 02-1Z-200q NUMBER CD00:5559 INTEREST/PEN PAID (-) .00 BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-1:5-200q IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID 19.79 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 19.79 .00 11.q7 11.~7 ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THIS FORM FOR ZNSTRUCTZONS.~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUR['~'~,~,OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003738 BUTLER BENJAMIN J 500 NORTH THIRD ST HARRISBURG,, PA 17108-1004 ........ fold ESTATE INFORMATION: SSN: 203-10-9713 FILE NUMBER: 2103-0988 DECEDENT NAME: MILLER ANNA M DATE OF PAYMENT: 03/30/2004 POSTMARK DATE: 03/29/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/04/1995 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $11.47 REMARKS: TOTAL AMOUNT PAID: $11.47 SEAL CHECK//007441 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 500 North Third Street Twelfth Floor Harrisburg, PA 17101 Mailing Address: Post Office Box 1004 Harrisburg, PA 17108.1004 Tel: 717.236.1485 Fac 717.236.7777 lawyers@butlerlawfir m.com Ronald D. Butler April 15, 2004 Jana Butler Toole Benjamin J. Butler Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 of Anna M. ~ No. 2003-0098~ Dear Sir or Madam: I have enclosed an original and one copy of a Status Report Under Rule 6.12 for the Estate of Anna M. Miller. Please clock in the extra copy of the Status Report Under Rule 6.12 and return it to me in the enclosed self-addressed stamped envelope. Let me know if you have any questions. Very truly yours, Benjamin J. Butler BJB/mot Enclosures STATUS REPORT UNDER RULE 6.12 Name of Decedent · Anna M. Miller Date of Death' 10/4/95 Will No Admin. No. 2003-00988 Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate' State whether administration of the estate is complete' Yes × No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete · 3. If the answer to No. 1 is Yes, state the following: account with the Court ? Did the personal representative file a final Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is' n/a c. Did the personal representative state an account informally to the parties in interest ? Yes 3[ No ~ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Beniamin J. Butler Name (Please type or print ) 500 N. Third Street, P.O. Box 1004 Hamsbur~ PA Address 17i08-1004 (717) 2361485 Tel. No Capacity Personal Representative Counsel for personal representative BUREAU OF ZNDZVZDUAL TAXES INH£RXTANCE TAX DTVZSTON DEPT. 280601 HARRISBURG, PA Z71ZS-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT RE¥-i&07 EX AFP (01-D5) BENJAMIN J BUTLER BUTLER LAW FIRM PO BOX lOOq HBG PA 17108 DATE Oq-Z6-ZO04 ESTATE OF HILLER DATE OF DEATH 10-04-1995 FILE NUMBER 21 03-0988 COUNTY CUMBER LAND ACN 101 I Amoun~ Rem1 ~:'l:ed ANNA M HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To Lnsure proper cred/~: ~o your account*' submi* ~he upper por~/on of ~h/s form wi~h your *ax payment. CUT ALONG THZS LINE ~ RETA'rN LONER PORTZON FOR YOUR RECORDS REV-1607 EX AFP (01-03) ### 'rNHER'rTANCE TAX STATEMENT OF ACCOUNT ESTATE OF MILLER ANNA H FZLE NO. 21 05-0988 ACN 101 DATE 04-26-2004 THIS STATEHENT TS PROVTDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELON TS A SUHHARY OF THE PRZNC'rpAL TAX DUE., APPLZCAT'rON OF ALL PAYHENTS*' THE CURRENT BALANCE, AND., TF APpLTCABLE, A PROJECTED /NTEREST F'rGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-29-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 19.79 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) OZ-1Z-Z004 05-29-2004 CD003559 CD005758 .00 11.47- ZF PAID AFTER THZS DATE, SEE REVERSE SIDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. I~ ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), 19.79 11.47 TOTAL TAX CREDZT YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR TNSTRUCTIONS. ) 19.79 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 PAYNENT: Detach the top portion of this Notice and submit .ith your payment made payable to the name and address prlntad on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHHONNEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, ahich was not requested on the Tax Return, may bm requested by compZeting an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices or from the Department's Z~-hour ansaaring service far forms ordering: 1-800-361-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-~q7-3010 (TT only). REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17118-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedsnt's death, a five percent (51) discount of the tax paid is allowed. PENALTY: The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of tho tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 1982 ail1 bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200~ are: Interest Daily Interest Daily Interest Year Rats Factor Year Rats Factor Year Rate 1981 201 .0005~8 1988-1991 III .000501 ZOO1 91 1983 16Z .000~38 1992 198~ 112 .000301 199~-199~ 72 .000191 Z003 52 1985 132 .000356 1995-1998 1986 lOZ .00017~ 1999 72 .000192 1987 92 .0002~7 2000 Daily Factor .0002q7 .00016q .000137 .O00ZXO --interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (lS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.