HomeMy WebLinkAbout03-1052 Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
~ .Estate of Kenneth R. Miller, Sr, No. ,~l'-~,} ~2. i 0 5 ~
'-~~enneth Richard Miller, Deceased Social Security No. 204-01-4296
Petitioner, who is 18 years of age or older, applies for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of
the Decedent, dated October l?th~ l!)85 and codicil(s) dated
State relevant circumstances, e.g. renunciation, death of Executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of
the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following
spouse (if any) and heirs:
Name Relationship Residence
COMPLb I b IN ALL CASES: Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at
934 Hummel Avenue, Borough of Lemoyne, Cumberland County, Pennsylvania
(List street, number and municipality)
Decedent, then 85 years of age, died November 27, 2003 at Holy Spirit Hospital, Camp Hill, PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property ..................................................................... $ 25,000.00
(If not domiciled in PA) Personal property in Pennsylvania ..................................... $
(If not domiciled in PA) Personal property in County .................................................... $
Value of real estate in Pennsylvania ...................................................................................................................... $ 80,000.00
Total ......................................................................................................... $ 115,000.00
Real Estate situated as follows:
County, Pennsylvania
Residence located at 934 Hummel Avenue, Borough of Lemoyne, Cumberland
Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature
Typed or printed name and residence
SUSAN/ff. SCORDO
4508 Dunley Court
Harrisburg, PA 17112
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF CUMBERLAND
The Petitioner above-named swears and affirms that the statements in the foregoing:.~'etition are true
and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the
Decedent, Petitioner will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
Before me this I C~ __ day of
' SUSAN,,~. SCORDO
20(
NO.
Estate of
KENNETH R. MILLER, SR. a/k/a Kenneth Richard Miller
, Deceased
Social Security No: 204-01-4296
Date of Death:
November 27, 2003
AND NOW,'I, r~ I..)~L2 · 'Z~ , 2003, in consideration of the Petition on the reverse side
hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters Testamentary
d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate
are hereby granted to SUSAN B. SCORDO in the above estate and that the
instrument(s) dated October 17th, 1985 described in the Petition be admitted to
probate and filed of record as the last Will of the Decedent.
FEES
Letters ........................... $
Short Certificate(s) $
Renunciation .............. $
Affidavit ( ) .................. $
Extra Pages ( ) ....... $
Codicil ............................ $
JCP Fee ............... : ....... $
Inventory ...................... $'
Other .............................. $
TOTAL ......... $
5.00
(¢,00
q.O 0
10- 0
Register of Wills if ,,¢/(...~.~~%~~
Attorney: Edmund G. Myers
I.D. No: 20558
Address: Johnson, Duffle, Stewart & Weidner,
301 Market Street, P.O. Box 109, Lemoyne, PA 17043-
Telephone: 717-761-4540
S.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar· The original certificate will be forwarded to the State Vital Records Office for permanent filing·
WARNING:. It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9852983
No.
Date
H10'5 143 ReV 2J~7
BLACK INK
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
BIRTHPLACE (City and
Slam ~r Fe~,gn
~I~I~;~L
· C~y/Tawn. Sine,, Ze) Coae)
I"lll~
PART Ih
OF
KENNETH RICHARD MILLER
I, KENNETH RICHARD MILLER, of the Borough of Lemoyne, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this as and for my last Will and testament, hereby
revoking all other wills heretofore made by me.
ARTICLE I
I direct that all my just debts and funeral expenses, including my gravemarker,
and all expenses of my last illness, shall be paid from my estate as soon after my
death as conveniently may be done. Ail of the foregoing shall be considered
expenses of the administration of my estate.
ARTICLE II
I give and bequeath all my estate of every nature and wherever situate to my
wife, I~_RRECCA GRACE MILLER, provided she shall survive me by thirty (30) days.
ARTICLE III
Should my wife, RRRECCA GRACE MILl.RI{, predeeease me or die on or before
the thirtieth day following my death, I devise and bequeath all of my estate of
every nature and wherever situate, in equal shares, to my issue, K&TIILEEN D.
SWARTZ, EILEEN MARIE CLARK, SUSAN SCORDO, MARY HILL, KENNETH It.
MILLER, JR., and WILLIAM MILLER, per stirpes.
ARTICLE IV
I appoint my daughter, SUSAN SCORDO, Executrix of this my last Will. Should
my daughter, SUSAN SCORDO, fail to qualify or cease to act as Executrix, I
appoint my daughter, EILREN MARIE CLARK, Executrix of this my last Will
ARTICLE V
I direct that Executrix, or their successor, shall not be required to post bond
for the faithful performance of their duties in any jurisdictiom
IR WITNESS WHEREOF, I hereunto set my hand and seal this /'7~ day of
Kennetl~' Richard Miller
Signed, sealed, published and declared by the above-named Testator as and for
his last will and testament in the presence of us, who, at his request, in his
presence and in the presence of each other have hereunto subscribed our names as
witnesses.
¥
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
**
** SS**
,*
I, KENNETH RICHARD MILLER, Testator, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that
I signed and executed the instrument as my Last Will and Testament; that I signed
it willingly; and that I signed it as my free and voluntary act for the purposes
therein expressed.
\
KENNETH RICHARD MILLER
Sworn or affirmed to and acknowledged before me, by KENNETH RICHARD
MILLER, the Testator, this J']~day of~~,~_ , 1985.
Notary Pub lic ~ ~5~
NOIAItY PUBUC .. r 7'
LEI/OYNF., P~ CUMSL'RLAND ~.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND :
We, ~ ~. ~ and ~z~_~o . ~),_ q~..~, the witnesses whose
names areOsigned to" ~ ~'~the foregoing instrument, being du~qualified according to law,
do depose and say that we were present and saw Kenneth Richard Miller sign and
execute the foregoing instrument as his Last Will and Testament; that he signed
willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator signed
the Will as witnesses; and that to the best of our knowledge, the Testator was at
that time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subseribed to before me by~,~.~_
witnesses, this
Notary Public
NO'~ARY PUBLIC
MY CQMMISb'ION EXPIRES DEG.
~ £MOYNE, PA CUMKRLAND
OF
KENNETH RICHARD MILLER
MYERS, MYERS, FLOWER & JOHNSON
A-(~ORNeYS AT LAW
LEMOYN E, PENNSYLVANIA
CARLISLE, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: KENNETH RICHARD MILLER a/k/a KENNETH R. MILLER,
Date of Death: NOVEMBER 27, 2003
Will No.: 2003-1052
To the Register:
I certify that notice of beneficial interest 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 January 13, 2004.
Name
SUSAN SCORDO
KATHLEEN NYE
Address
4508 Dunley Court
Harrisburg, PA 17112
1003 S. 3r" Street
Lebanon, PA 17043
EILEEN CLARK 1118 Draymore Court
Hummelstown, PA 17036
MARY HILL
KENNETH R. MILLER, JR.
WILLIAM MILLER
508 West Simpson Street
Mechanicsburg, PA 17055
1803 Letchworth Road
Camp Hill, PA 17011
304 Fishburn Street
Harrisburg, PA 17109
Notice has now been given to all persons
None.
Date: January 13, 2004
entitled thereto under Rule 5.6(a) except
Signature
Name Edmund G. Myers
Johnson, Duffie, Stewart & Weidner
Address 301 Market St.
P. O. Box 109
Lemoyne, PA 17043-0109
Telephone (717) 761-4540
Capacity:
Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003575
MYERS EDMUND G
301 MARKET STREET
P O BOX 109
LEMOYNE, PA 17043
........ fold
ESTATE INFORMATION: SSN: 204-01-4296
FILE NUMBER: 2103- 1052
DECEDENT NAME: MILLER KENNETH RICHARD
DATE OF PAYMENT: 02/18/2004
POSTMARK DATE: 02/1 7/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1/27/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $4,000.00
REMARKS:
TOTAL AMOUNT PAID:
RECEIVED OF SUSAN B SCORDO
IN C/O EDMUND G MYERS, ESQ.
$4,000.00
SEAL
CHECK//119
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
D
E
C
E
D
E
N
T
CAPB
HpRL
EpIO
cRAC
KOTK
ES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
M]'T.T,FR Sr. Kenneth Richard
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
11/27/2003 I 01/19/1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Original Return ~ 247! Supplemental Return
4, Limited Estate . Future Interest Compromise (date of death after 12-12-82)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
I--I 9. LItigatlonProceedsRecelved I 11°. spou.,
Poverty
Credit
(date of death between 12-31-gl and 1-1
NAME
OFFICIAL USE ONLY
FILE NUMBER
2003-01052
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
204- 01 - 4296
THIS RETURN MUST BE FILED IN DUPMCATE WII'H THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
. (d.ate.of death
3. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
0 6. Total Number of Safe Deposit Boxes
~ 11 sec. 9113(A)
Election
to
tax
(Attach Sch O)
COMPLETE MAILING ADDRESS
C
O
R
R
E
S
R
E
C
A
P
I
T
U
L
A
T
I
O
N
C
O
M
T
I
0
Edmund G. Myers
FIRM NAME (If Applicable)
Johnson, Duffie,
Stewart & Weidner
TELEPHONE NUMBER
717/761-4540
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
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.
14.
P. O. Box 109 .
301 Market Street
Lemoyne PA l~-010g
78, OOO'; 00
None
None
Nqne
24,167 ;07
None
None
OFFICIAL USE ONLY
10,389.65
5,037.49
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
(5) 102,167.07
(11)
(12)
(13).
(14)
15,427.14
86,739.93
86,739.93
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
86,739.93
X .0 0 (15) 0.00
X .0 45 (16) 3,903.30
X .12 (17) 0.00
X .lS (16). O. O0
(19) 3,903.30
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
934 Hummel Avenue
CITY
Lemoyne
STATE
ZIP
17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2, Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
4,000. O0
195.17
3,903.30
Total Credits ( A + B + C )
(;) 4,195.17
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestJPenalty ( D + E ) (3) 0.00
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 (4) 291.87
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (SA) 0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 0.00
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
;. retain the use or income of the property transferred; .........................
· 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? ................................
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-probata property
which contains a beneficiary designation? ................................ ~ r~
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 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Susan B. SCO~)O DATE
G~; ~'~~ 4508 Dunle Court ~c~3 ~/
s ~ " Harrisburg, PA 17112 ......... '
I PAREROTHERTHAN REPRESENTATIVE Johnson, Duffie, Stewart & Weidner DATE
......................
For d~t~ o~ d~ath on or a~r Ju~ 1. 1~4 and b~[ore Janua~ 1, 1~5, th~ tax rat, impo,~d on th~ n~t valu~ o[ transf, rs to or ~or th~ u~, o~ th~
For dat~ of d~ath on or ~,r Janua~ 1, 1~, th, tax ret~ impo~,d on th~ n~t valu~ o~ trane, rs to or [or th~ u,~ o[ th~ ,urvNin~ ~pou~ i~ 0%
[7~ ~.S. $1 ~8 (~) (~.1) (ii)]. Th~ ~t~tut, do~ not ~x~mpt a transf, r to a ~urvivin~ ~pou~ from ta~, and th, ~tuto~ raquire~nts for di~clo,ure of as~t~
and filin~ a ta~ return are ~till applicabl, ,v~n ~ th, ~u~ivin~ ~pou~, i, th, onl~ b~naficia~.
For dats~ o[ d~ath on or a~r ~ul~ 1, ~000:
lh~ ta~ rata impo~d on th~ n,t valu, of transf~r~ ~rom a d~e~a**d child twang-on, ~rs o~ a~, or ~oun~r at d,ath to or for th, us~ of a natural
parem, an adoptiv~ parent or a ~t~pparent of th, child i~ 0% [72 ~.S. ~118 (a) (1.2)].
lh~ tax rat, impo~,d on tho n,t valu~ of transf~r~ to or for th, u~ of th~ d*c~d~nt'~ linaal b,n,ficiari** i~ 4.~%, ~xc~pt a~ noted in 7~ P.S. ~1 ltl{1.2)
lh~ ~ rat~ impo~,d on th, n~t valu~ of transf~m to or for th~ u~o of th~ d,ced~nt's ~iblin~ i~ 12% [72 ~.S. $1 l~{a~l.~)]. ~ siblin~ is d~fin,d, under
S,ction ~0~, a, an individual who ha~ at I~ast on, parent in common with th~ d~c~d~nt, wh~th~r b~ blood or adoption.
Copyright (e) ~oo0 ~orm *oftw~m on¥ Th* Caekn,r Group. Inc. ~orm ~-~ $~ ~X {~. $-00)
REV- 150Z EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kenneth Richard MILLER Sr.
SCHEDULE A
REAL ESTATE
FILE NUMBER
SS~/ 204-01-4296 11/27/2003 2003-01052
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 price
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 iointly-owned with ricjht of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Residence located at 934 Hummel Avenue, Borou§h of Lemoyne,
Cumberland County, PA. Residence sold on March 24, 2004. A copy
of the Settlement Sheet is attached to this Return.
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
78,000.00
$ 78,000.00
FormREV-1~ZEX(Rev. 1-97)
REV- 1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kenneth Richard MILLER Sr.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SS# 204-01-4296 11/27/2003
FILE NUMBER
2003-01052
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1
2
3
4
5
Comcast Cable - Refund on Account
Erie Homeowners Insurance -Refund on Policy
Erie Insurance Refund on Automobile Policy
M&T Bank Relationship Checking with Interest Account No. 60588136
Refund to Estate for prepayment of the School Taxes at time of
settlement on sale of Real Estate. A copy of the Settlement
Sheet is attached to this Return.
Senior Blue Refund
1995 Chevrolet Lumina
Personal property valued and appraised by Chuck E. Bricker,
Auctioner AU094-L. - Appraisal is attached to this Return
Pinnacle Health Final Pension check received prior to date of
death
19.21
18.00
9.00
20,388.64
193.57
94.00
2,300.00
960.00
184.65
TOTAL (Also enter on line 5, Recapitulation) $ 24,167.07
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1508 EX (Rev. 1-97)
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kenneth Richard MILLER Sr.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
SS# 204-01-4296 11/27/2003 2003-01052
Debts of decedent must be reported on Schedule I.
iTEM
NUMBER DESCRIPTION AMOUNT
2
2
3
4
FUNERAL EXPENSES:
Gingrich Memorials
Neill Funeral Home
- Engraving
on Headstone
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Susan B. SCORDO
Social Security Number(s) / EIN Number of Personal Rel
Street Address 4.508 Dunle¥ Court
City Harrisbur~ State__
PA zip l7112
Year(s) Commission Paid:
Attorney's Fees Johnson, Duffle, Stewart '& Weidner
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimam to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Pmparer's Fees
OtherAdministr~ive Costs
Advertising for sale
in the Patriot News
Chuck E. Bricker, Auctioner
Clement A. Leo, Appraiser
Cumberland County Register of Wills Office
Certificates
Cumberland County Register of Wills Office
Inheritance Tax Return $15.00 and
Total of Continuation Schedule(s)
of Residence at 934 Hummel Avenue, Lemoyne
- Additional Short
- Filing Fees for
Inventory $16.00
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, inc.
140.00
196.90
5,108.00
3,500.00
260;00
70.50
75.00
300.00
6.00
31.00
702.25
$ 10,389.65
Form REV-1511 EX (Rev. 1-97)
Estate of: Kenneth Richard MILLER Sr.
Soc Sec #: 204-01-4296
Date of Death: 11/27/2003
Continuation of Schedule H-B7
(Other Administrative Costs)
Item Description
Amount
6 Renovations made to Residence as per Sales Agreement
7 The Cumberland Law Journal - Notice of Estate Administration
8 The Patriot News - Notice of Estate Administration
499.50
75.00
127.75
702.25
REV- 151Z EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kenneth Richard MILLER Sr.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SS# 204-01-4296 11/27/2003
FILENUMBER
2003-01052
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
AT&T
Kathleen Nye - Purchase of gifts items by the Decedent prior to
Death
Lemoyne Borough - Sewer Payment
Lewis B. Buchanan, Inc.
PA Department of Revenue 2003 Income Taxes
Pennsylvania American Water
Penn Pest Termite Treatment
Pennsylvania Power and Light
Settlement costs Settlement sheet is attached to this Return
State Employees Retirement System
UGI Gas Company
Verizon Telephone Company
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
8.37
165.00
54.00
597.28
1.46
108.32
450.50
81.87
3,449.78
18.47
76.45
25.99
$ 5,037.49
Form REV-1512 EX (Rev. 1-97)
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kenneth Richard MILLER Sr.
SCHEDULE J
BENEFICIARIES
SS# 204-01-4296
11/2:/2003
RELATIONSHIP TO DECEDENT
NUMBER
2
4
I1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(aX1.Z)]
Eileen Clark
1118 Draymore Court
Hummelstown, PA 17036
Mary Hill
508 West Simpson Street
Mechanicsburg, PA 17055
Kenneth Miller
1803 Letchworth Road
Camp Hill, PA 17011
William Miller
304 Fishburn Street
Harrisburg, PA 17109
Kathleen Nye
1005 South 3rd Street
Do Not List Trustee(s)
Daughter
Daughter
Son
Son
Daughter
FILE NUMBER
2003-01052
AMOUNT OR SHARE
OF ESTATE
One-Sixth of
Residue
One-Sixth of
Residue
One-Sixth of
Residue
One-Sixth of
Residue
One-Sixth of
Residue
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 0 o 00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) ZO00 form software only The Lackner Group, Inc. Form RI=V- 1513 EX (Rev. 9-00)
Estate of: Kenneth Richard MILLER Sr.
Soc Sec #: 204-01-4296
Date of Death: 11/27/2003
Continuation of Schedule J, Part I
(Taxable Bequests)
Item
Name and Address of Beneficiary
Relationship
Amount or
Share of Estate
Lebanon, PA 17042
6 Susan Scordo Daughter
4508 Dunley Court
Harrisburg, PA 17112
One-Sixth of
Residue
LISTING OF EXHIBITS FOR
ESTATE OF KENNETH RICHARD MILLER a/k/a
KENNETH R. MILLER, SR.
EXHIBIT A
EXHIBIT B
EXHIBIT C
Last Will and Testament of Kenneth Richard Miller signed
and dated on October 17, 1985.
Settlement Sheet for Sale of Residence located at 934
Hummel Avenue, Borough of Lemoyne, Cumberland
County, PA. Property sold on March 24, 2004.
Valuation of Personal Property by Chuck E. Bricker,
Auctioneer A UO94-L.
:224385
EXHIBIT A
OF
KENNETH RICHARD MILLER
I, KENNETH RICHARD MILLER, of the Borough of Lemoyne, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this as and for my last Will and testament, hereby
revoking all other wills heretofore made by me~
ARTICLE I
I direct that all my just debts and funeral expenses, including my gravemarker,
and all expenses of my last illness, shall be paid from my estate as soon after my
death as conveniently may be done. Ail of the foregoing shall be considered
expenses of the administration of my estate.
ARTICLE II
I give and bequeath all my estate of every nature and wherever situate t° my
wife, tlE[IECCA GRACE MILLER, provided she shall survive me by thirty (30) days.
ARTICLE III
Should my wife, I~_RRECCA ORACE MILLER, predeeease me or die on or before
the thirtieth day following my death, I devise and bequeath all of my estate of
every nature and wherever situate, in equal shares, to my issue, KATHLEEN D.
SWARTZ, EILEEN MARIE CLARK, SUSAN SCORDO, MARY HILL, KENNETH R.
MILLER, JR., and WILLIAM MILLER, per stirpes.
ARTICLE IV
I appoint my daughter, SI]SAN SCORDO, Executrix of this my last Will. Should
my daughter, SUSAN SCORDO, fail to qualify or cease to act as Executrix, I
appoint my daughter, EII.REN MARIE CLAR~ Executrix of this my last Will
ARTICLE V
I direct that Executrix, or their successor, shall not be required to post bond
for the faithful performance of their duties in any jurisdiction.
IN WITIg~SS W~I~REOI~, I hereunto set my hand and seal this /~7~· day of
Kennetl~ ' Richard Mfll~r
Signed, sealed, published and declared by the above-named Testator as and for
his last will and testament in the presence of us, who, at his request, in his
presence and in the presence of each other have hereunto subscribed our names as
witnesses.
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
: ss;
I, KENNETH RICHARD MILLER, Testator, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that
I signed and executed the instrument as my Last Will and Testament; that I signed
it willingly; and that I signed it as my free and voluntary act for the purposes
therein expressed.
KENNETH RICHARD MILLER
Sworn or affirmed to and acknowledged before me, by KENNETH RICHARD
MILLER, the Testator, this t~day of'~.~[a_..~_. , 1985.
Notary Pub lie
NO'i'ARY PUBUC
O011MISS, IOI4 EXPIRES
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: SS.'
COUNTY OF CUMBERLAND :
namWe-r~n'~es ~~ed ~(~' ~'-' and C~C~)' ~)L ~._.~, the witnesses whose
to the foreg?mg instrument, being du~qualified aeeording to law,
do depose and say that we were present and saw Kenneth Richard Miller sign and
execute the foregoing instrument as his Last Will and Testament; that he signed
willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator signed
the Will as witnesses; and that to the best of our knowledge, the Testator was at
that time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me~bY~'-x~
and~ ~ ~. ~~witnesses, this t~ ~day of ~~.~ 1985.
Notary Public
NOTARY PUBUC
OF
KENNETH RICHARD MILLER
MYERS, MYERS, FLOWER & JOHNSON
ATTORNEYS AT LAW
LEMOYNE, PENNSYLVANIA
CARLISLE, PENNSYLVANIA
EXHIBIT B
OMB NO. 2502-0265
A. 1.~]FHA B. TYPE OF LOAN: .................
,U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 2.E]FmHA , 3. E}CONV. UNINS. 4. [-]VA 5. [~CONV. INS.
I 6. FILE NUMBER: I 7. LOAN NUMBER:
SETTLEMENT STATEMENT CLEMENSI 1029801
~ 8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs Amoun s paid to and by the settlement agent are shown.
Items marked "[POC]" were paid outside the closing: they are shown here for informational purposes and are not included in the totals.
1.0 3f98 (CLEMENS PFD/CLEMENS/23)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
JANEL E. CLEMENS BROADVIEW MORTGAGE COMPANY
SUSAN B. SCORDO, EXECUTRIX 95 EAST WILSON BRIDGE ROAD
of the Estate of Kenneth R. Miller WORTHINGTON, ON 43085
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-2402316 I. SETI'LEMENTDATE:
934 HUMMEL AVENUE PURITY ABSTRACT COMPANY
LEMOYNE, PA 17043 March 24, 2004
CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT
3329 Market Streel
Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 78,000.00 401. Contract Sales Price 78,000.00
102. Personal Propedy 402. Personal Property
103. Settlement Charges to Sorrower (Line 1400) 8.66 403.
104. 2004 CO/BORO TAX to FAITH A. NICOLA, TC 307.64 404.
105. 405,
Adjustments For items Paid By Seller in advance Adjustments For Items Paid By Seller in advance
106. County/Boro Taxes to 406. C'ounty/Boro Taxes to
107. City Tax to 407. City Tax. to
108. SchooITax 03/24/04 to 07/01104 193.57 408. School Tax 03/24/04 to 07/01/04 193.57
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 78,507.87 420. GROSS AMOUNT DUE TO SELLER 78,193.57
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Depositor eamestmoney 1,000.00 501. Excess Deposit (See lnstructions)
202. Principal ,Amount of New Loan(s) 74,100.00 502. Settlement Charges to Seller (Line 1400) 3,207.01
203. Existing loan(s) taken subject to ; 503. Existing loan(s) taken subject to
204. 504. Payoff of first Mortgage
205. I 505. Payolt ot second Mortgage
206. 506.
207. 507. (Deposit dish. as proceeds)
208. 508.
209. 509.
Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller
210. County/BoroTaxes 01/01/04 to 03/24/04 69.77 510. County/Boro Taxes 01/01/04 to 03/24/04 69.77
211. CityTax to 511. City Tax to
212. School Tax .to 512. School Tax to
213. 513.
214. 514.
215. 515.
216. 516,
217. 517. SEWER BILL - 7/15/03 - 3/24/04 to LEMOYNE BOROU~ 173.00
218. 518.
219. 519.
220. TOTAL PAID BY/FOR B(~RROWER 75,169.77 520. TOT~J-REDUCTION AMOUNT DUE SELLER 3,449.78
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross ,Amount Due From Borrower (Line 120) 78,507.87 601. Gross Amount Due To Seller (Line 420) ( 78,193.57
302. Less Amount Paid By/For Borrower (Line 220) ( 75,169.77 602. Less Reductions Due Seller (Line 520) 3,449.78
303. CASH( X FROM)( TO)BORROWER 3,338.10 603. CASH( X TO)( FROM)SELLER 74,743.79
The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein
NEL E, CLEMENS ' ' SUSAN B. SCOREJO, EXECUTRIX
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ @ % PAID FROM PAID FROM
Division of Commission (line 700) as t'ollows: SORROWER'S SELLER*S
101. $ to
FUNDS AT FUNDS AT
102. $ to
703. Commission Paid at Settlement SETTLEMENT SETTLEMENT
704. to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to
802. Loan Discount % to
803. Appraisal Fee to F. SL;UI ~ ARCHIBALD $325.00 H'OL;
804. Credit Report to CUP BUSINESS SL)LU ¥10N5
805. Lender's inspection Fee to BI~OADVIEW MOF~r(~ALSE L;(JMPANY 75.00
606. Flood Cert Fee to FDSi
1507, lax Service Fee to 18.00
180U. Document Prep Poe
,809.
810.
811.
000. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901.Interest From 03/24104 1o 04/01/04 @ $ 10.150000/day ( 8days %) 81.2~'
902. Mortgage insurance Premium lot months to
903. Hazard Insurance Premium for 1.0 years to ERIE INSURANCE $295.00 POC
904.
905.
1800. RESERVES DEPOSITED WITH LENDER
1001, Hazard Insurance 2,000 months @ $ 24.58 per month 49.16
1002. Mortgage Insurance 0.000 months @ $ 48,17 per month
1003. County/BoroTaxes 2,000 months @ $ 25.64 per month 45.80 5.48
1004. CttyTax months @ $ per month
1005. SchooI Tax 9,000 months @ $ 59,64 per month 536.76
1006. months ~ $ per month
1007. months @ $ per month
1008. AGGREGATE ESCROW ADJ. months @ $ per month -141.29
1100, TITLE CHARGES
1101. E-Mail Document Retrieval lo
1102. Abstract or Title Search to
1103. Title Examination to ,
1104. Insured Closing Letter to First American Title tnsurance Co.
1105. Document Preparation/Deed to Johnson, Duffle, Stewart & Weidner POC
1106, Notary Fees to PURITY ABSTRACT COMPANY 6.001
1107 Attorney's Fees to
(incluCles adore item numbers: )
1108, Titletnsurance to PURITY ABSTRACT COMPANY/ 25% PHFADISCOUNT P.04-057 545.06
(includes above item numbers: )
1109. Lencierls (.;overage $ /'4,100.00 102914382PAL
1110. Owner's Uoverage $ 78,0D0.00 102144109PAd
1111. PAEr, JDOHSEMENI5:IO0,300,900 to PUHI1YABSlRACI (JOMPANY 150.00
1112. Overnight Poe/package to PUHI I Y ASS I RACT COMPANY 15~5'~
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 39.50; Mortgage $ 66.50; Releases $
1202. (Jityl(Jounty I axJStamps: Deed 7;50.00; Mortgage 780.01
1203. State Tax/Stamps; Revenue Stamps 780,00; Mortgage 780.00
1204. ASSIGNMENT OF MORTGAGE to RECORDER OF DEEDS 27.01
1205. RECORDER OF DEEDS
1300, ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest inspection to PENN PEST & HOME INSP/$275 POC
1303. STRUCTURAL INSP & REINSP to BIECHLER & TILLERY 50.0C 50.01
1304. IST QTR. TRASH $34.00 to LEMOYNE BOROUGH 2.99 31.01
1305. TERMITE REMEDIATIO~/ PENN PEST $450.50 pd by seller
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502. Section K') 6.6{ 3,207.01
Certified to be a true copy.
*CLOSING COST CREDIT, TOTAL $2,340.00
CLEMENS/CLEMENS 124 )
EXHIBIT C
APPRAISAL
Per~nal~Property of ~.(La.jiffy ,,~, ~ L ~ ~.5 7¥/'7~ ~ff q I/d/%,~ ~ L ¥ 0,'~, &6~/ ~/J~
Appraised by Chuck E. Bricker AU094-L Date/~ -,~.~ - d~
ITEM VALUE ITEM VALUE
/~ ~, .~ ssI', ~ o~s ~. o o
Register of Wills of
INVENTORY
County, Pennsylvania
Estate of Kenneth Richard MILLER, Sr.
also known as Kenneth R. Miller, Sr.
, Deceased
No. 2003-01052
Date of Death 11/27/2003
Social Security No. 204-01-4296
Susan B. SCORD0,
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 reat estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
I.D. No.:
Address:
Telephone:
Edmund G. M,~ers Signature:
20558 Signature:
P. O. Box 109 Address:
Lemoyne, PA 17043-0109
Personal Representative
717/761 - 4540 Telephone:
Dated:
4508 Dunley Court
Harrisburg, PA 17112
717/652-4934
Description
(See continuation page(s) attached)
(Attach additional sheets if necessary)
Value
Total: 102,167.07
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.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form #Ri-? (199Z)
INVENTORY
Estate of: Kenneth Richard MILLER, Sr.
Date of Death: 11/27/2003
County: Cumberland
CASH:
Comcast Cable
Account
Refund on
Erie Homeowners Insurance
-Refund on Policy
Erie Insurance Refund on
Automobile Policy
M&T Bank Relationship Checking
with Interest Account No.
60588136
Pinnacle Health Final Pension
check received prior to date
of death
Refund to Estate for
prepayment of the School
Taxes at time of settlement
on sale of Real Estate. A
copy of the Settlement Sheet
is attached to this Return~
Senior Blue Refund
19.21
18.00
9.00
20,388.64
184.65
193.57
94.00
20,907.07
-1-
PERSONAL PROPERTY:
1995 Chevrolet Lumina
2,300.00
Personal property valued and
appraised by Chuck E.
Bricker, Auctioner AU094-L.
- Appraisal is attached to
this Return
960.00
3,260.00
REAL ESTATE/PA:
Residence located at 934
Hummel Avenue, Borough of
Lemoyne, Cumberland County,
PA. Residence sold on March
24, 2004. A copy of the
Settlement Sheet is attached
to this Return.
78,000.00
78,000.00
TOTAL RECEIPTS OF PRINCIPAL ...............
102,167.07
-2-
JERRY R. DUFFLE
RICHARD W. STEWART
C. ROY WEIDNER, JR.
EDMUND G. MYERS
DA VID W, DELUCE
RALPH H. WRIGHT, dR.
MARK C. DUFFLE
MICHAEL d. CASSIDY
MELISSA PEEL GREEVY
ROBERTM. WALKER
WADE D. MANLEY
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Dear Register of Wills Office:
LAW OFFICES
JOHNSON, DUFFIE, STEWART & WEIDNER
A Professional Corporation
301 MARKET STREET
P.O. BOX 109
LEMOYNE, PENNSYLVANIA 17043-0109
WEBSITE: www.jdsw.com
HORACE ,4. JOHNSON
COUNSEL TO THE FIRM
TELEPHONE 717-761-4540
FACSIMILE 717-761-3015
E-MAIL: mail~jdsw.com
April 23, 2004
WRITER'S EXT. NO. 114
~ E'MAIL dlw@jdsw.com~,,
Re:
Estate of Kenneth Richard Miller, Sr.
SSN: 204-01-4296
Our File No. ~
Your File N~.' 2003-01052 ~
Enclosed for filing please find the following documents for the above referenced
decedent:
2 Original PA Inheritance Tax Returns. There is no tax due. The Estate is
entitled to a refund in the amount of $73.50.
Estate Check No. 131 in the amount of $31.00 as follows:
a. $15.00 Inheritance Tax filing fee
b. $16.00 Inventory Fee.
2 copies of Pages 1&2 of the Pa Inheritance tax return, which we ask that you
time-stamp and return to us in the enclosed envelope.
Inventory
Inventory (2 copies), which we ask that you time stamp and return to us in the
enclosed envelope.
Should you have any questions, please do not hesitate to contact our office. Thank you
for you assistance in this matter.
Very truly yours,
~L.-'Wl~s~man
Legal Assistant
c: Susan B. Scordo, Executrix
#227771
STATUS REPORT UNDER RULE 6.12
Name of Decedent: KENNETH RICHARD MILLER
Date of Death:
Will No.
a/k/a KENNETH R. MILLER, SR.
November 27, 2003
2003-01052
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the Estate is complete:
Yes X No
2. If the answer is No, state when the personal representative reasonably
believes that the administration will be cOmplete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No X
b. The separate Orphans' Court No. (if any) for the personal
representative's Account is:
Co
parties of interest?
Did the personal representative state an account informally to the
Yes X No
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
Date: November 1, 2004
JOHNSON, DUFFIE, STEWART & WEIDNER
301 Market Street
P.O. Box 109
Lemoyne, PA 17043
(717) 761-4540
Capacity: ~Personal Representative
(x) Counsel for Personal
Representative
BUREAU OF ZNDIVTDUAL TAXES
TNHERTTANCE TAX DTVTSTON
DEPT. 18060!
HARRTSBURG, PA 17128-D601
COHNONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DISALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
EDHUND G HYERS
JOHNSON ETAL
PO BOX 109
LEHOYNE
PA 170q$
DATE 06-1q-ZO0~
ESTATE OF HILLER SR
DATE OF DEATH 11-27-2005
F/LE NUMBER 21 05-1052
COUNTY CUHBERLAND
ACN 101
I Amount Remitted
KENNETH R
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF HILLER SR KENNETH R FILE NO. 21 0:5-1052 ACN 101 DATE 06-1~-Z00~,
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate (Schedule A) {1)
2. Stocks and Bonds (Schedule B} (2)
3. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Mortgages~Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule O) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
78,000.00
.00
.00
.0O
Zq~167.07
.00
.00
(8)
10,389.65
5,057 .q9
(11)
(12)
15.
lq.
NOTE:
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Net Value of Estate Sub~ect to Tax (lq)
If an assessment was $ssued previously, lSnes 14, 15 and/er 16, 17,
reflect fSgures that Snclude the total of ALL returns assessed to date.
(16)
(17)
(18)
· 00 x 00 =
86,7:59.93 x Oq5=
· 00 x 12 =
· O0 x 15 =
(19)=
q,000.00 I
AHOUNT PAID
ASSESSHENT OF TAX:
15. Amount of Line lq at Spouse1 rate
16. Amount of Line lq taxable at Lineal/Class A rate
17. Amount of Line lq at Sibling rate
18. Amount of Line lq taxable et Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECETp1 DISCOUNT
DATE NUMBER INTEREST/PEN pATD (-)
CD006575 ,.~ ?'~*:r- ';'~-i 195.17
OZ-17-ZOOq
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
102,167.07
15.~27.1q
86,7~9.95
.00
86,759.95
18 and 19 wil1
.00
5,903.30
.00
.00
3,905.~0
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
q,195.17
291.87CR
.00
291.87CR
( IF TOTAL DUE KS LESS THAN $1, NO PAYMENT TS REI~UTRED.
ZF TOTAL DUE KS REFLECTED AS A 'CRED/T' (CR), YOU HAY BE DU
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.)
RESERVATION:
Estates of decedents dying on or before December 12, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate far
life or for years, the Coaeon#ealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such futura interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATZVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 21q0 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 91q0).
Detach the tap portion of this Notice and submit with your payment to the Register of gills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special 2~-hour
answering service for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-q47-5020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6S05. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-iSOl) for an explanation of administratively correctable errors.
If any tax due is paid within three (2) calendar months after the decedant's death, a five percent (52) discount of
the tax paid is allowed.
The 152 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 the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, ar nine (9) months and one (13 day from the date of
death, to the date of payment. Taxes ahich became delinquent before January l, 1982 bear interest at the rate of
six (DX) percent per annum calculated at a daily rate of .00016{. All taxes which became delinquent on and after
January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year #ith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 202 .OOOSq8 ~'~-1991 112 .000501 2001 92 .O00Zq7
1982 16Z .000q58 1992 9X .0002~7 2002 6X .00016~
ZOOS 5Z .000157
198~ 112 .000501 1995-199q 72 .000192
1985 15Z .000556 1995-1998 9X .0002~7 ZOOq ~Z ,000110
1986 102 .00027~ 1999 72 .000192
1987 IOZ .O00Z7q 2000 7Z .000192
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) 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.
BUREAU OF ZNDZVTDUAL TAXES
ZNHERTTANCE TAX DTVTSTON
DEPT. Z80601
HARRTSBURG~, PA 171Z8-0601
COMMONgEALTH OF PENNSYLVAN'rA
DEPARTMENT OF REVENUE
ZNHERZTANCE TAX
STATEHENT OF ACCOUNT
REV-I~07 EX AFP
EDMUND G MYERS
JOHNSON ETAL
PO BOX 109
LEMOYNE
PA 17043
DATE 07-12-2004
ESTATE OF MILLER SR
DATE OF DEATH 11-27-2003
FZLE NUMBER 21 03-105Z
COUNTY CUHBERLAND
ACN 101
I Amount: Remi'~'l:ed
KENNETH R
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF NTLLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credi~ ~:o your account, submi~ ~he upper por~:ion of ~:his form wi~h your ~cax payment.
CUT ALONG TH'rS LINE ~ RETAIN LOgER PORT'rON FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) x#tl ZNHER'rTANCE TAX STATEMENT OF ACCOUNT x~ll
ESTATE OF MTLLER SR KENNETH R F]:LE NO. ::'1 03-1052 ACM 101 BATE 07-12-2004
TH'rS STATEHENT 'rs PROV'rDED TO ADV.rSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHONN BELO#
TS A SUHHARY OF THE PR'rNCZPAL TAX DUE, APPL.rCAT.rON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, I'F APPL/CABLE,
A PROJECTED 'rNTEREST F'rOURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-07-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
3,903.30
PAYHENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT P.~.
02-17-2004
06-21-Z004
CD003575
REFUND
195.17
.00
ZF PAZD AFTER THZS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT .rS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT"
TOTAL TAX CREDIT 3,903.30
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF TH.rS FORH FOR ZNSTRUCTZONS. ]