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Home My WebLink About04-13-09 (2)1505607120 REV-1500 EX (06-05} OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of individual Taxes INHERITANCE TAX RETURN Po Box.2soso~ 2 1 0 8 0 1 1 2 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Oate of Birth 202 36 8519 11 01 2008 02 12 1909 Dectdent's Last Name Suffix Decedent's First Name MI MILLER NELLIE E {If Applicable} Enter Surviving Spouse's Information Below SpoLse's last Name Suffix Spouse's First Name MI SpoLse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~X~ 1. Original Retum ^ 2. Supplemental Return ~ J 3. Remainder Return (date of death ~ prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ I, 5. Federal Estate Tax Retum Required _ (date of death after 12-12-82) I v 1 ~; i_ g. Decedent Died Testate (Attach Copy Of Will) (-~ L - ~ Decedent Maintained a Living Trust 8. Total Number of Safe De (Attach Copy of Trust) poSlt BOXES - l ~ 9. Lttigatlon Proceeds Reserved ~ ~ 1 p. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113 A between 12-31-91 and 1-1-95) ~_ ( ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAN M WILEY 717 432 9666 Firm Name (If Applicable) THE WILEY GR(7UP, PC First line of address 130 W. CHURCH STREET Second line of address City or Post Office DI:LLSBURG State 21P Code PA 17019 -t5 a-t i C_ 7 z -~_, ,:;:.7 ~._~ i-'i '~ r1 C:~? -r~ Correspondent's a-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. SIGNATJ~If{~')OF PERSON f~ESFJONSIBLE Fj4yY~ILING RETURN neTc ADDRESS Gary L. Miller REGISTER gF~WILLS USE,"~VLY r ~~ rC~ '~ - __~ - -~. _- :;,7 ? ~ - C7 _ .. , .-. ~' , :=~3 t . ;T, __.., ~ `~ ~ w _ ,~ _~ .o-3 _" l DATE ED - - - r c_ ., =~'( 0 Blackberry Road, Dover, PA 17315 GNA 'RE OF PREPARER OTHER THAN REPRESENTATIVE DATE Jan M Wiley ~ ~~ ~~~ Church Street, Dillsburg, PA 17019 1505607120 Side 1 1505607120 1505607220 REV-1500 EX Decedent's Social Security Number ~ecedenPS Name: N e 11 i e E. Miller 2 0 2 3 6 8 5 1 9 RECAPITULATION 1. Reaf Estate (Schedule A) ................................................................................... ....... 1. 2. Stocks and Bonds (Schedule B) ........................................................................ ....... 2. 8 2, 1 0 4 3 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. 5 7 0 5 3 7 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... ...... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... ...... 7, B. Total Gross Assets (total Lines 1-7) ................................................................. ...... g, 1 3 9, 1 5 8 0 2 9. Funeral Expenses & Administrative Costs (Schedule H) .................................. ....... 9. 1 6 , _ 5 2 4 . ______ 0 8 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......................... ....... 10. 1 9 0 4 5 1'I. Total Deductions (total Lines 9& 10) ............................................................... ....... 11. 1 6 7 1 4 5 3 12. Net Vatue of Estate (Line 8 minus Line 11) ...................................................... ....... 12, 1 2 2 4 4 3 4 9 13. Charitable and Governmental Bequests/Sec 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, or transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 1 2 2, 4 4 3 4 9 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 122,443.49 0.00 5,509.96 0.00 0.00 5,509.96 Side 2 150560722D 15D5607220 J REV-1500 EX Page 3 Fite Number 21-08-01123 Decedent's Complete Address: Nellie E. Miller STREET ADDRESS Church of God Nursing Home 801 N. Hanover Street Carlisle ;STATE I ZIP PA ! 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InterestlPenalty if applicable p, Interest E. Penalty 4,275.00 ...--- 225.00 Total Credits (A + B + C) (1> 5,509.96 (2) 4,500.00 Total InterestlPenalty (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. p,, Enter the interest on the tax due. El. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF W/LLS, AGENT (3) (4) (5) 1,009.96 (5A) (56) - - -1, 0 0 9.9 6 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 :.................................................................................. ' ,', [ x; ~- _ b. retain the right to designate who shall use the property transferred or its income :.................................... 'r _-,' ; x c. retain a reversionary interest; or .................................................................................................................. ~~ I ~x^i d. receive the promise for life of either payments, benefits or care? .............................................................. i x I 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... '~ ! x i 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death?........, x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which __ contains a beneficiary designation? ...................................................................................................................... ! _J LX , IF THE ANSWER TO ANY OF THEABOVE 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. §9116 (a) (1.1) (i)J. 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. §9116 (a) (1.1) (ii)J. 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. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)J. 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. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. -...- ~~~~~ ilk ~xxt~~ C! ~~~~rrtrnt OF tiELLiE 1:. MILLER BE IT HFMEIVIBERED, that I, rye'iie E. Miner, of 7I. l). Z, I)i1_isbur~, fork County, Pennsylvania, being of sour:d mind, memory ace a.~derstand;ig, ;:_ make, publish and declare this as and for my Last Wili and `[ estament, hereby re~~nking and making null and void any ~~r;d alI txrills anc 1~e~'.: ~ ~ .~s a~~d ~~ti~ri in the nature thereof by me at any tune heretofore made. 1T1';M ? I direct that all my }ust debts and funera] expenses ~e paid ~:_, soon after my demise as may be convenient. ITEM 2 : fill the rest, residue and remainder of my estate, o` wha'.sr: ever nature and wheresoever situated, whether it be real, personal or mixed, including property over which 7 have a power of appointment, I give, devise and bequeath unto my issue per stirpes living on the thirty-first day following my death. ITF,'M 3 : I appoint The Commonwealth National Ban+., of Harrisburg, Pennsylvania, guardian of any property which passes either a^der this will or otherwise to a minor and with respect to which I am authorized ?o appoint a guardian and have not otherwise specifically done so, provided that this appoint- ment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's I1Pn Pf}t C4~n l-i n ,..d ",. ... L.._11 a~ ia,~ s,~a~~ have file power to use principal as well as income from time to time for the minor's support and education (including college ed:.ca- b tion, both graduate and. undergraduate) without regard to his o~- her parents ability to provide for such support and education, or to make payrr~ent for these purposes, without further responsibility, to the minor or to the r:~inor's oare;~,' ':_ to any person taking care of the minor. ITEM 4 : I nominate, constitute and appoint my so ,, Robert P. Miller, executor of this my Last Wi11 and Testament. Should my son, Robert P. Hitler, ~~'ITNESS ~~ ~ frr~~~~ ~,~i i ~ ~ 0~ ;~ , ;~ . NEI_.LIE E. MILLER fail to qualify or cease to act as executor, I appoint my~ aaaghtr.:, .loan M. Shambaugh, executriX of this my Iasi Wiil and Testamer,i. i ITEM 5 : I direct that my executor, guardian or ine:r ~.accesscar~~ ~. _~~__. ~ not be required to give bond for the faithful performance or their duties in arty jurisdiction. IZ~I WITNES ~ I h;IZEOF, I have ~erc~anto se my .._.. .._~ ~eai _ ~_ day of ;~i,f/, (/ 1°71. j ~_ ~ NELLIE E. i\-'IILLEK The preceding instrument, consistir_g of this and one (I) other typewritten page, was on the day and date thereof signed, sealed, published and declared be l~ELLIE E, MILLER, the testatrix herein named, as and for ner Last Will ana Testament, in the presence of us, who, at her request, in her presence and in the' presence of each other, have subscribed our names as witnesses hereto. of ~ ~ ~ ~ %'/t %ll i,l~~' ~ ~s w~ OF ~ ~ d ~~~ ~ ,1~ ~, /~ /,, ~/~, s r~ REV-485 EX (1-07) SAFE DEPOSIT µ BOX INVENTORY PA Department of Revenue ~~~~ _ 485DDD41,046 ~ ~-' ~~~ j1 ~~~ ~~ 3 v --~~ . ~ ___ _ _ ~ ~... ~ l17L, PLEASE USE ORIGINAL FORM ONLY County Code Year Fite Number Suffix First Name MI Social Security or Death Certificate Number Date of Death Decedent's Last Name ~:LLL~~ ~~~ ~ z~ ®P~DDR SS OF DECEDENT STREET: CITY: NAME AND ADDRESS OiF PERSON REQUESTING THE OPENING~OF THE SAFE DEPOSIT BOX NAME: `-~1-~~ ~ ~! ~l~r ~XeGL~r' 7E Z4P CODE STREET ADDRESS. 1 jt L'v~r - Sl,9,T} - ~ZI, ~O`E ~ NAME, ADDRESS AND RELATIONSHIP (tF NY) 70 DECEDENT, OF PERSON(Sj PRESENT AT THE BOX OPENING __ _ a_ NAM , RELATIONSHIP: _..~~~._~ __ m~-~~.r --- _ __ ---__ _ - --- - ----- ---- -__s;~~n- _ _ _ --- _- STREETADD ESS CITY: S TE: ZIP CODE - - -- b. NAME RELATIONSHIP STREET ADDRESS CITY ST TE ZIP CODE. c. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP GODS ~aME AND ADDRESS OF FINANCtAI INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: ±~i_~n ~- ~1~ - ~--- -------- -- - --- - ------- - - ---- -- --- STREET ADD~gESS: ~ITY: ST TE. ZiP CODE Ll C ~ n 0 ~,~r.~ t lrP . S~ ' ~ ",1 \ ~ Y~1 f 1t- iL ~~ ~ ~ (l NAME OF PERSON MAKING LAST ENTRY , DATE A~1D TIME OF LAST ENTRY ` -~- DATE OF C NTRACT TO RENT 80X NU BER OF BOX 1 TIT E UNDER W ICH SOX IS REGISTERED NAME AND ADD<'tESS OF PERSON(S) HAVING ACCESS TO BOX a. lVA E' S j)~EET ADDRESS: ~. ! ~ ~ t f CIT _ ~ STATE: ZIP CODE. ~GZ't°~ 111.[ ~ 1 t~"T ! ~~:+~~j b. NAME T, _,_ `1 ~~ -~-~ t __ -_ STREET ADDRESS CI~x. TATS ZIP CODE'. NAttAE AND TITLE OF EMPLOYEE TAKING THE INVENTORY ~~ ,- WA:i A WILL IN THE BOX? ^ YES [~ NO if yes, a. Date of wil b. Name and address of personal representative, if named in the wi11 NAME. i ~f t,'~,~ v --~e.~.. STREET ADDRESS: CITY: STATE: ZIP CODE. c. Name and address of attorney, if any NAME: STREET ADDRESS: CITY: STATE ZIP CODE 485DD041,046 48500041,046 REV-485 EX _ ~_~_~_~ ®~~®~'~ ~J'® ~1~ 1/ ~1~ 1 ®R~ Pale of IIWSTRl9CTl®~4S ('{) Cash: Report total only (2} Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stork. (3) Obligations of U.S. Government: Number of items.. date of issue, face value, names in which registered and type of ownership, i-e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (K) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible- (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fiully as possible. (8) All other contents. (9) Return completed form to: pEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISE3URG, PA 17128-0601 ITEM I ~- - --- - -------- NO. ~ % Q~L.I ~ ITEM DESCRIPTION I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGNATU M / /J e SIGNATURE PRINT E PRINT NAME AND CHECK APPROPRIATE BOX BELOW. PRINT TITLE ~ i DATE CHECK APPROPRIATE BOX rh,.~n, <~,~- f~ ~-i~- ~~ - >/ ~ Executor(Irix) ~ Administrator(tnx) ~ I - ~5.#~;~1 ~~ ~ ~/ / Ll ~ Estate Representative ~ Joint avner of safe dePOS~t box - ' ----..- NOTE Attalch additiona4 $'/2° x 11" sheets} if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i) to require disclosure of Social Security numbers in connection ~nrith administering state tax laws- The Department uses the i Social Security number to identify the decedent and personal represzntatives of the estate- The Commonwealth may also use the Information in exchange of tax information agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. 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Form PA-1500 Schedule B (Rev. 6-98) PNC' Historical Stock Quotes -PNC Historical Quotes -The PNC Financial Services Gro... Page 1 of 2 .~, ,:'~,~ ~~ i ((II r`,'I FRONT PAGE TOOLS 8 RESc:AI?Cfi Profille News Chan Malyst Info ,.-- - - -- More ~ f.~.rr(er iymtx(sj or reyen>rd(s1 ". SEAkCH L 4dalcome. F:ie:ase sign ln. fT+•~ PonfoGc • i;amreun't • VSE • fliers "Y Poet ....-.-i.xr - ~~.,. OU 11 z_C PNC Insiders Financials HistoricalOuotes SEC Oplions industry The PNC Financial Services Group, Inc PNC (NYSE) 46.36 Change:+2.s~ +6.11°~n L"~~nf=s%~_,l_i.~° volume_2.91M 4:OOpm 12/30/2008 After Hours. 46.18 Change -0.18 -0.39°o Volume: 135118 slf,vn• t23~r20Gn -___._ ._- _._ 1 Qv_ervtew Profile News Chart Analyst Info tns+der Actions Financials HIStOriLal flUOteS ~ Message Board SEC Optwns Industrv_ Enter Date: 10/31/08 RELATED LINKS . International Indices ETF_ Center Historical Quote For: PNC . My Portfolios Friday, October 31, 2008 Goeing Pace: 66.67 open 64.2, rwgn _. _ 68.98 Law 63.15 vdume: 5,365,200 FNC Da~Iy ~-- 12:00 Rn 30 f .1i. 7D ~* so so 30 Oct Nov No Splits Sponsored Links Unliimited Grants (Free) Are you Eligible for Free Grants? Find out Now and Apply online! JS(:rtmtGwne.or9 I qot;50,000 Grant Money Find Out Now I got Free Grant Money and Never Pay Them Back! gnaernmentg r. t- !?tri.rrg Satellite TV on PC;49 Watch 3,000+ Live TV stations on your PC. One fee, no monthly charges SateHiketvlpc c~nl T~ t, ~ ~l'~ ~ C~.a can ~~ - ~ -~3~ ~~i4--~-~~>r ~t cu,~~ ! ~ ~~ V uti---l. ~2, ~c~~ `- J ~~ ~,~. G~j~-- ~~- ~ ~ ~ h - WATCH iT Nt3W~ ~! 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( ~ Switch to SCOttrdde, ~ -rte r i-~'~ I get up to 5100 back L_ _ ___ _t~l7fillse T/Ddn - %'~ SO ~ ~? R ~• ~ ~~ I UDito 50100 back when ~.1-F.../~..,....., ,.... ~,..t...+.. ,..a,.. l.. .....,._!~-~~1_!~___•-__f1_'_`_.-.__t ni inn,.. ~..~n:...-. ,~.. .. ~__ _ .-.-___ PN(: Historical Stock Quotes -PNC Historical Quotes -The PNC Financial Services Gro... Page 1 of 2 More ~~-ntel- °~Vnlt)^;(i) CC %;f,~iword{S) SEARCH > VJt I mt p!easc sign in. ~ ~] r ~ j ~ f~ Pnr'in;ic • Commurn: • .Aarketv`,`IV,h r'rt'o~, y.: eda;y. VSE • Aiens FRONT PAGE: TOO!.5 %, i?F:Si::AR;7 Cll_C;Ti" 1 PNC Profile News Chart Analyst Info. Insiders Financials Historical Quotes SEC Options Industry The PNC Financial Services Group, inc PNC (NYSE) 46.36 Change:+2.6716.11% r::;„a~~,,T,.,; Volume:2.91M 4:OOpm72/302008 '------=" _..._ _ _ __ __ __ After Hours 46.18 Change: -0.78 -0.39! Volume 135118. 15prr~1~3.,u006 Overview Profile _ News _ Chart Analvst Info_ Insder Actions F nancials :Historical Quotes (Messa_ge Board SEC Options Industry Enter Date: 11/03/2008 RELATED LINKS • tnternation_al_indic_e_s_ HIsUxlcal Quote For: PNC • ETF Center • My Portfolios Monday, November 03, 2008 Closinst Pare: $$,a7 op•n: 66.60 wqh 68.80 tw,-. 65.70 vavmo: 3,565,700 Sponsored Links Goree Gift Shop Gift<_~ For Men, Women & Children. .v,~,v.q°r=_eq-Itshop com PNC 0a~ly » 12:00 NM 80 i:. 70 ~ * 60 sD ao 30 N.w Dec No Splits I got;50,000 Grant Money Find Out How I got Free Grant Money and Never Pay Them Back! Bever nment9. antaorl: OY.r,~ 9 Unlimited Grants (Free) Are you Eligible for Free Grants? Find ou[ Now and Apply online! OSGrenttiui,,;e.ar9 REAQ IT NQW~ MARKETS NEWS Elp-to-the-minute news & information front your industry-leading source. +...~. 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Trade free for 30 days m -~ °c N \~ m z ~ ~ -I > ..{ o N~ m ~ ~ H ~ ~ m ~.J = o ~ Z ~ Gi D 1~~ 1_ ` A ~ O a Z _ z ~ m D pr o N ~ A ~ D' H m ~ ~ Z o z ~ N a Z ~ D H i C z .U D m a N T m n A m H D s: 9 - v D m _N ~ O m z Z i -n C r -< _D 0 D z Q Z Z D y~ bo r m D O m D r C m 0 ~, 0 0 m D n O m n O z ~--~ Q n Z't Z n _ 1 Z D z D r O n 3 0 O v Z ~ F n m O m z ~ O ~ Z m p ~_ ~ O ti ~ < m Z - Z r L' D N i x_ N ~ ' fl ~m m D A Z Z y m m , n ~ 9 m O ^, ~ Z m ~ D F m i m m D rN ~ oA m Zm ~~ ~ m y = D O O,'O 9 2 Z ~n ` D m m U D m r m d e ~ m o m D ~ z a "~ 'S p 3m ~ n c t.- ~ r na a m 7Ze ~ ~ C n = m N O ~ Z CA A O N ~ ~ v 2 ~ D D iy n hn a n N N N -1 D O A D m n '_ m -~ D A n I D a 3 Z Z I T m l~ m n C y m n ~~ ~~ ,~~ ~~ , ~, ~\ I ~• O to s 0 ~ o o A Z ~ ~ ~ -o O ~ o --s ~ o -~ = N ~moo~ z z ~'°~ O cZi~ ~ ~ z ~ m Z_ ~ w x N CI _4 ZT Zn ~D Oy a xa za <z D m Rev-1608 E;K+ (g.98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMtAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Miller, Nellie E. 21-08-01123 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointlyowned with the right of survivorship must ne disclosed on schedule F. (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) ~~ Citizens Bank February 10, 2009 S DAWN GLADFELTER THE WILEY GROUP 130 W CHURCH ST STE 101 DILLSBURG PA 17019 Estate of NELLIE E MILLER Date of Death: November O1, 2008 ISSN: 202-36-8519 ]Dear Sir/Madam: 525 William Penn Place Suite 153-2618 Pittsburgh, PA 15219 ][n accordance with your request, the attached information sheet has been provided in the above decedent's name as of her date of death. "the decedent had Z active accounts at the time of her death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884. Sincerely, Phillip Lynch Operations Services ~~ Citizens Bank f~ccount Number 6100741923 j~Account Title Date Opened Account Type Principal Balance as of DOD NELLIE E MILLER 8!31/1971 Checking $3,666.51 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $3,666.51 STD Interest to DOD $ .00 ~~ Citizens Bank .Account Number 6140-178665 .Account Title NELLIE E MILLER :Date Opened 6/5/1972 ' .Account Type Savings :Principal Balance as of DOD $47,660.93 :[merest from Last Posting to DOD $1.17 Account Balance as of DOD $47,662.10 ' ~YTD Interest to DOD $382.16 REV-1151 f'.X+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Miller, Nellie E. 21-08-01123 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached ~ 9,367.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees The Wiley Group, PC 6,500.00 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 312.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 40.00 7. Other Administrative Costs 304.58 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 16,524.08 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Miller, Nellie E. 21-08-01123 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Gingrich Memorials: 130.00 2 Jack L. Kapp (reimbursement for funeral food): 467.50 3 Myers Funeral Home: 8,770.00 H-A Subtotal 9,367.50 Other Administrative Costs 4 Citizens Bank (safe deposit box): 25.00 5 Cumberland Law Journal (advertise estate): 75.00 6 Register of Wills (filing fee): 30.00 7 The Sentinel (advertise estate): 174.58 H-67 Subtotal 304.58 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1612 EX+Ig~88) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS CO~MAONWEALTH OF PENNSYLVANVI INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Miller, Nellie E. _ _ 21-08-01123 _ Inclutle unrelmbutsed medical expenses. (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-tb13 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA IT X T N BENEFICIARIES INHER ANCE TA RE UR RESIDENT DECEDENT ESTATE OF FILE NUMBER Miller, Nellie E. 21-08-01 123 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY Do Not List Trustee s) (Words) ($$$) I • TAXABLE DISTRIBUTIONS [include outright spousal ib ti d t f d t is r ons, an rans ers u under Sec. 9116(a)(1.2)] 1 Nancy C. Kapp Daughter 30,610.87 613 Charles Street Mechanicsburg, PA 17055 2 Gary L. Miller Son 30,610.87 890 Blackberry Road Dover, PA 17315 3 Robert P. Miller Son 30,610.87 2229 Bridge Road Enola, PA 17025 4 Joan M. Shambaugh Daughter 30,610.87 1236 McCormick Road Mechanicsburg, PA 17055 Total 122,443.48 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET , U.UU Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Jan M. Wiley David J. Lenox THE WILEY GROUP Attorneys at Law Apri18, 2009 Register of Wills Cumberland County Courthouse One Courtho~ase Square Carlisle, PA 17013 In Re: Estate of Nellie E. Miller, deceased File Number 21-08-01123 Dear Register: Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of $1,009.96 representing the tax due, and a check in the amount of $30.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. 'Thank you for your cooperation. Sincerely, K. Dawn Gl~ter/Le al As start g /dg encl. .L~f~C3J 5~1~~Nd~O ~G S;~~l~ 60 ~ i l ~~ ~ ! ~d~ 6QQZ ~~~ ,, 130 VV. Church Street, Suite 101 Dillsburg, PA 17019 Phone: (717) 432-9666 • (800) 682-4250 Fax: (717) 432-0426