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Home My WebLink About09-01-09 (2)J REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128.0601 15056051058 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 21 05 Spouse's Social Security Number ~" "" " "" THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ___, _ , REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW tom? 1. Original Return 2. Supplemental Retum 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) Ct7 6. Decedent Died Testate 7. Decedent Maintained a Living Trust ~_..,,.,,,,_., 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) a"~~'" 9. Litigation Proceeds Received ~1 10. 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 T0: Name Daytime Telephone Number Nathan C. Wolf City or Post Office State _. __ __ _ i Carlisle PA (717) 241-4436 REGISTERmE 111~LS USE 1-:7 ="~-i -~= t"~"~ ~~ fT-f ':1)~ti -:t "i r~C ~ - -1 fl~F F11 FA fi'; f'" i ~J t ^"t f~) r~ ., " `'i ,. -.~ ZIP Code ?.__~~~~___~.._.~___~._~. 17013-2922 Correspondent's a-mail address: nathancwolf@embargrnail.com 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. SIGNATUNE OF PERSON RESPONSIBLE FOR FILING RETURN DATE, ADDRESS r ~ ' 144 E Street, Carlisle, PA 17013 SIGNATURE OF PR AN REPRESENTATIVE _ -DAT)` 10 West 15056051058 PA 17013-2922 Side 1 15056051058 ~~ 15056052059 REV-1500 EX Decedent's Name: C'arrle C Miller Decedent's Social Security Number 174-05-0070 RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) a Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) .............. . ...... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. # 13. Charitable and Governmental Bequests/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 .0_ 15. 16. Amount of line 14 taxable at lineal rate X .0 45 $,618.11 ! 16, 17. Amount of Line 14 taxable at sibling rate X .12 .. __,.,M.. .... .............M,.. _ ~. 17• 18. Amount of Line 14 taxable 17 497 37 ;, , . . at collateral rate X .15 18 19. TAX DUE ...................................................... ... 19., __.... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 387.81 2,624.61 3,012.42 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number __,., ~ 21 05 ;;0363 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Carrie C Miller 174-05-0070 STREET ADDRESS 144 E Street CITE( Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credil B. Prior Payments 2,980.00 C. Discount 149.00 3. InteresUPenalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. 1f Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 3,012.42 3,129.00 116.58 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 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 which ............................................................... contains a beneficiary designation? .................................................. ....... ^ X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 1T 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)]. 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)]. 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)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent p2 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) SCHEDULE Ep COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Carrie C. Miller 21-05-0363 Include the proceeds of litigation and the date the proceeds were received by the estate. All propeRy Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M & T BANK Account No. 2677028264 34,048.44 2! 'M & T BANK Account No. 15004200933263 (Money Market) 3,058.49 3' Jewelry -Valued 7/6/05 by Mountz Jewelry (Report Attached) 445.00 TOTAL (Also enter on line 5, Recapitulation) S 37, 551.93 (If more space is needed, insert addRional sheets of the same size) EV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDVLE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Carrie C. Miller 21-05-0363 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES:.. __ 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 1 800 OQ Name of Personal Representative(s) "Car01 A. Miller.., Social Security Number(s)/EIN Number of Personal Representative(s) ' Street Address 144 E Street city Carlisle state "PA zip 17013 Year(s) Commission Paid: ,2006 2. Attorney Fees 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. I Probate Fees 5. I Accountant's Fees 6. Tax Return Preparer's Fees ~. The Sentinel- Legal Advertising s.' Cumt>eriand Law Journal- Legal Advertising s' Mountz Jewelers -Valuation of Personal Property to'! Wagnel's Tax Service -Federal Return - 2006 11 Anticipated expenses and filing costs 3,505.00 128.00 122.31 75.00 100.00 40.00 375.00 T~T6L !Alen antar nn lino 9_ Reraoitulati~nl I ~ 6,145.31 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-US) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Carrie C. Miller 21-05-0363 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, includi ng unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 • Manor Care Nursing Home -Care provided date of death 4, 399.39 2 Manor Care Nursing Home -Medicare Deductible charge 87 95 3 'William S. Daniels - POA fee due 50.00 4 'Neighbor Care -Medications -Medical Expense 109.18 5 National Finance Center -Health Insurance Premium 119.99 6 'UBS Fiduciary Trust Co. -Reimburse Pension Payment 29.63 TOTAL (Also enter on Line 10, Recapitulation) $ 4,796.14 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) ~i g pennsylvania DEPARTMENT Of REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE ~ BENEFICIARIE5 FILE NUMBER Carrie C. Miller 1~-u5-u~tis RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2)•1 1 Carol A. Miller 'Daughter-In-Law 1/3 Residue 2 '.Helen Elizabeth Gipe Stover '.Cousin 1/9 Residue 3 Betty Lee Gipe Cousin 1/9 Residue 4 David Henry Carbaugh Cousin 1/9 Residue - S Sarah Jane Carbaugh Martin Cousin 1/9 Residue 6' Clinton Elmer Clark `Cousin 1/18 Residue 7 Mary Grace Clark Brindle 'Cousin 1/18 Residue 8i Cora Gleone Clark Bonebrake :Cousin 1118 Residue 9, Ray Eugene Clark Cousin 1118 Residue 10 Ruth Walker Niece $445.00 In Kind ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-15D0 COVER SHEET, A S APPROPRIATE. II NON TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 `Grace United Methodist Church, 451 S. West Street, Carlisle, PA 17013 $500.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 500.00 If more space is needed, insert additional sheets of the same size. ~.. r L-L . 1 f ..... ,....,,. e-.-,...... ,... ~~ - . F h ~ ~ ~ ! J-- SS( ~~i~~ I, CARRIE C. MILLER, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I give and bequeath the sum of Five Hundred (5500.04) Dollars, to GRACE UNITED METHODIST CHURCH at the corner of Pomfret and West Streets in Carlisle, Pennsylvania, for use in the Kindergarten Department. II. I give and bequeath all of my jewelry to my niece, RUTH WALKER. ~f III. I direct my executor hereinafter named to convert 'I into cash and sell at either public or private sale all real and personal property which forms a part of my estate and to add the same to my residuary estate which I give and bequeath as follows:' A. One-third to my daughter-in-iaw, CAROL A. MILLER, if living, otherwise to lapse. B. Two-thirds to be divided equally among my sister, MARY GIPE, CLARA CLARK, and MARTHA CARBAUGH, if living. otherwise to their surviving children by representation. IV. I direct that all taxes that may be assessed in i consequence of my death, of whatever nature and by whatever '~ jurisdiction imposed, shall be paid from my residuary estate as aj part of the expense of the administration of my estate. V, I appoint my daughter-in-law, CAROL A. MILLER, executrix of this my last will. Should my daughter-in-law, CAROL A. MILLER, fail to qualify or cease to act as executor, I appoint FARMERS TRUST COMPANY of Carlisle, Pennsylvania, or its successor, executor of this my last will. VI. I direct that my executrix or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS/ WHEREOF, I have hereunto set my hand this -~-jy~~~"day of ~r~ rCj~._ , 1992. ~~ CARRIE C. MILLER The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, CARRIE C. MILLER, was on the day and date thereof signed, published and declared by CARRIE C. MILLER, the testatrix therein named, as and for her last will, 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. ,~ ~ ~`~ ~~ ~ .~ ee _. .> ACCOUNT N0. ACCOUNT TYPE 2677028264 CLASSIC CHECKING CARRIE C MILLER C/0 CAROL A MILLER 144 E ST CARLISLE PA 17013 00 1 04319M M 021 19295 Af'Cf111NT Sl1MMARY STATEMENT PERIOD PAGE APR.14-MAY.13,2005 1 OF 1 HIGH STREET-CARLISLE BEGINNING BALANCE DEPOSITS 8 OTHER ADDITIONS CHECKS'PAID -0THER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 34,235.75 1 29.63 1 187.31 1 34,000.00 0.00 78.07 Af`f'f111NT Af TTVTTV POSTING DATE ' TRANSACTION DESCRIPTION DEPOSITS,xNTEREST 8 OTHER ADDITIONS - CHECKS 8 OTHER SUBTRACTIONS DAILY BALANCE 04-14-05 BEGINNING BALANCE 534,235.75 04-14-05 CHECK NUMBER 1530 187.31 34,048.44 f_ 04-19-05 PHONE TRANSFER WITHDRAWAL 34,000.00 48.44 05-02-05 UBS FIDUCIARY TR PENS PMTS i.~ . {. ~'-- 29.63 .' ~~- 78.07 ENDING BALANCE 578.07 CHECKS PAID SUMMARY 1530 04-14-05 187.31 IMPRESSED BY THE SERVICE YOU RECEIVED AT M8T? IF YOU'D LIKE TO NOMINATE AN M8T BA!!!C EMPLOYEE F3'4 cnCEFTiOii:.L CUSTui1ER ScRVi%E, 'r LEASE COriPLETE OUR MaT S[K"vYl:[ EXCELLENCE FORM AT WWW.MANDTBANK.COM/EXCELLENCE. WE APPRECIATE YOUR FEEDBACK! LOGBA { !03) >, _= y ._ ACCOUNT N0. ACCOUNT TYPE 15004200933263 MST MARKET ADVANTAGE CARRIE C MILLER C/0 CAROL A MILLER 144 E ST CARLISLE PA 17013 INTEREST PAID YEAR 70 DATE 3.28 00 0 04319M NM 017 58697 ACCf111NT SUMMARY STATEMENT PERIOD PAGE MAR.24-APR.23,2005 1 OF 1 HIGH STREET-CARLISLE BEGINNING BALANCE DEPOSITS S OTHER ADDITIONS WITHDRAWALS S OTHER SUBTRACTIONS CURRENT INTEREST PAID ENDING BALANCE N0. AMOUNT N0. AMOUNT 2,940.49 1 118.00 1 3,054.57 1.08 0.00 Af`f`f111NT Af'TTVTTY POSFING DATE TRANSACTION DESCRIPTION DEPOSITS,INTEREST & OTHER ADDITIONS W/DRAWAL5 S -0TNER SUBTRACTIONS DAILY BALANCE 03-24-05 BEGINNING BALANCE 52,440.49 04-01-05 US TREASURY 312 CIVIL SERV 118.00 3,058.49 04-19-05 INTEREST PAYMENT 1.08 04-19-05 CLOSEOUT 3,059.57 0.00 ENDING BALANCE 50.00 ANNUAL PERCENTAGE YIELD EARNED = 0.50 MST CHOICEQUITY, THE FLEXIBILITY TO CHOOSE FIXED RATE LOANS OR A LINE OF CREDIT ANYTIME. APPLY AT ANY MST BANK BRANCH OR CALL THE MST TELEPHONE BANKING CENTER AT 1-800-724-3222. EQUAL HOUSING LENDER. %~ Letter of Transmittal Table of Contents Purpose Intended Use Definition of Fair Market, Value: Approach to Value Market Limiting Conditions Subscriptions Retained for Value Consulting Metal Markets Certification List of Laboratory Instruments Item Descriptions This report is valid only in its entirety and-for its stated purpose. and intended use and was prepared in accordance with the Uniform Standards of Professional Appraisal Practice (USPAP): Statements and Limiting Conditions. Purpose. The purpose of this report is to describe and document the. quality of the, jewelry listed and to estimate it's Fair Market Value. Intended Use . The intended use of this report is for providing an estate appraisal listing: the Fair Market Value for use in the resolution of the Estate of Carrie C. Miller. Valuation Date: 7/6/05 Definition of Fair Market Value The fair market value is theprice at which the property would change hands between a willing buyer and willing seller, neither being under any compulsion to buy or self and.both having reasonable knowledge. of relevant facts. The fair market value of a particular item of property.... is not to be determined by a forced sale price." Nor is the: fair market, value of an item of property to be determined by the sale, price of the item in a market other than that in which such item is most commonly sold to the public,'taking into account location of the item wherever appropriate. Taken from Treasury Regulation 20.2031=1 (b) Approach to Value There are three traditional approaches to value that are as follows: Income approach:" Applies to income producing properties. and. is used only if an income situation or rental property can be identified. Market Data approach: Compares the,qualities of the subject. item to an article with similar or identical qualities, and researches and records current verifiable sales of sych merchandise. Cost approach: Establishes the total value of an item by considering the value of its component-parts (precious metal content, gemstone weights and qualities, aboi, and any other fees) together with the appropriate retail markup .according to the norms of the jewelers in the locale, supply and demand, and the current state of the marketplace. Page 2 of 7 Table of Contents Fair Market Value, is estimated using the market data approach. Neither the income approach nor the cost approach apply in establishing Fair Market Value. However; the cost approach to value was used to check on the reasonableness or market values found. Market To value an item a market (and market level) must be recognized. The most appropriate market for jewelry can vary depending upon the article's age, condition, quality, intrinsic content, aesthetic appeal, provenance, current fashion trends, artistic interpretation, period of manufacture among others. The type of retail outlet that most commonly carries the items being appraised is considered to be the most appropriate market. However, the auction market was also considered as another appropriate market in establishing Fair market Value for this type of jewelry. Limiting Conditions The jewelry described within has been analyzed and graded in accordance with prescribed grading standards using "state of the art" methods and precision laboratory equipment. Jewelry constructed solely of, or in combination with, precious metals (i.e. platinum, palladium, yellow or white gold and/or silver) is tested, analyzed and described for its type and content of such metal. Unless otherwise stated, all gemstone weights, grades and measurements are approximate and. stones have not been removed from their mountings. Diamonds are graded with the prescribed, grading nomenclature of the Gemological Institute of America (GIA) and the use ofpre-graded permanent master diamond color comparison stones. Colored stones are color graded with the use of the GIA Gem Set color grading system. Unless otherwise stated, all colored stones listed on this appraisal report have probably been subjected to various treatments to improve their appearance. Treatments are considered usual and customary practices when properly disclosed and when done without intent to defraud the consumer. The treatments are mostly stable and do not require special care. When a treatment is detected and considered unusual it will be so noted by this appraiser. Some treatments are reversible and re-treatable: It may be beyond the scope of an appraisal to determine exact treatment methods or the amount of treatment present. Some treatments require "' sophisticated equipment not found in a standard gemological laboratory. Prevailing market values are based on these universally practiced and accepted processes by the gems and jewelry trade. Sources are assumed to be reliable and the appraiser does not assume responsibility for their information. The appraiser assumes the ownership of the subject property is true as stated by the client. The fees paid for this appraisal do not include the services of the appraiser for any other matter. In particular, fees paid to date do not. include any of the appraiser's tithe or services in connection with any statement, testimony or other matters before an insurance company, its agents, employees or any court or other body in connection with the property herein described, If the ,appraiser is required to testify or to make any statements to a third party concerning the described property and/or appraisal, the applicant shall pay the appraiser for all of such time and services so rendered. This document is limited to its stated intended use and is invalid if all items listed in the Table of Contents are not present. Unless expressly stated, the items appraised are in good condition. Any serious deficiencies and repairs are noted. Ordinary wear and tear is not noted. The information in this report is confidential.. Page 3 of 7 This appraisal process does not discover liens, encumbrances, or fractional interests but, if known, they are noted. The limited owner of this appraisal is the party for whom the work was performed. Possession of this report does not provide title to the items appraised. Possession of this report, any portion of this report, or any copy thereof, does not include the right of publication without the appraiser's written consent. Use of the information contained in the appraisal is invalid if all items listed in the Table of Contents are not present. Each item described in this report has been photographed and file. copies of the photograph(s) as well as a copy of the report are maintained in the appraiser's files for at-least five years after the report date. Third parties may rely on the information in this report. for the defined purpose and intended use only. Third parties requiring further information than what is in the report must obtain the written permission of the owner of the appraisal before the appraiser will disc~ls the report.. No changes may be made to this report by anyone other than the appraiser. The appraiser cannot be responsible for unauthorized alteratigns. The professional relationship between the appraiser and the client ends with the delivery of this report. Subscriptions Retained for Value Consulting Drucker, Richard -The Guide. Northbrook, IL Rapaport, Martin -Rapaport Diamond Report, New York, NY Metal Market 7/6/2005 Gold $422.20 Silver $6.83 Platinum $854.00 List of Laboratory Instruments Binocular microscope Leveridge gauge Electronic scale Thermal conductivity diamond tester Touchstone and-acids Ultraviolet light unit Spectrascope Polariscope Dichroscope GIA Gem Set color grading system Refractometer Chelsea color filter Heavy liquids Diamond light and graded master compariso n diamonds Page 4 of 7 Certification • I hereby certify that, to the best of my knowledge and belief: • The statements of fact contained in this report are true and correct. • The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my unbiased professional analysis, opinions, and conclusions. • I have no present or prospective interest in the property that is the subject of this report and I have no personal interest or bias with respect to the parties involved. • My compensation is not contingent upon the development or reporting of a predetemuned value or dire~'tion in value that favors the cause of my client, the amount of the value estimate, the attainment of a stipulated result, or the occurrence of a subsequent event. • I have made a personal inspection of the property that is the subject of this report. • No one provided significant professional assistance to the person signing this report. • My analyses, opinions, and conclusions were developed, and this report has beeri prepared, in conformity with the Uniform Standards of Professional Appraisal Practice. Amy S Rau ch G.G. Graduate G urologist, GIA 7/6/2005 Page 5 of 7 .r ^^a~ll T C~ ~ C'7 vi ~r~ ai O ~ ~ m _ ~ N o ~ r' E Z ~ (~' 3 c~ U 3 T z ~~ of ~, ~O y~~ i ~~ r ~r rti If it ii z l II N Il d -+ nco nr u~ +.~ ~ II n +~ l ~' II ~ I) i?, .-t ~ .. r'_ o.t ii w ii w ~ 9 rl n ~ ~ ~ II it ~. ~ A. J It It ~ S+t1~~ + fl L1J ft II CJ II . II ~+ 14 ~ a # r_ ~ II ~ II S I ~ Fy r M a I! u. II 1 66 rt r.x fn .f.o II IIrv I Cfl Q ~ C ff II r 4 `tea ry ~ a+ ~ 11 l i .-~ i ~ ~ +~- w a o a Ci ;n 1 11 II i ~, CC MCI II tl ( -~-' ris 11 >- II f ~ ~~ If Cf II II II ~-+ tl II tl ll it 41 !I .- II II it X .-, II it b Ti !Li 11 ti o ~ o II _ ii ~ m n ~ i1 t ~ ~ U] u a II O II +?J •.~ II 1- II y1 +~ na ncz rc i I r.•, I I Ul U+ i l ~ 11 ~"+ G 41 ~ rt !I I H LL ~ l I~ !I 11 !! Q II f I 31 ltl fl il, }+ V~ fl fl I•- !I II Jl sr -a~ a !r !~ w ~ n .I ,s, ~ I a ::i n »-~ s, ...I f•7 II u fi .~- H T-! I{ 1{ Fjt II II ;y ~, r~ II II ,-+ ... ~ ~* n ~ n ( ~ J {-- :I >~ II .c rr W SI ~-+ .I tT W S ~.D II l>,. II a~ u c~ LL r~ a ~-+ It --~ ~ ,-,, . F-- I~'t H F- II r (.J 1 ~ U1 VJ II ~ II ~ ~ ~ ~ 1~ .fti ' II C] ~1' II r' .. G v LU ~ ~' If M It ~ ~. ~ = +--+ i?J II {i f CYO g 11 Il !~+ Ll, ~ d ~' ~' m t D~ wl X rr'• - ~~ ~~ ~ ~ ~ ~ ~ ~ - LLLL-4LL (Lt4+ Vd ~"`W317h11'SWtlOd 553NISf1B ~O11dV~ ~ ~-. ~f~ _ 1 ,l r. e~1 1.. .I '...r-.~ f, I~ 05/01/05 BALANCE FDRWARD 4,399.39 05/7.1/05 PAYMENT 3,228.74 05/11/05 PAYMENT 1,170.65 01/31/05 ADJ PART B DE7UCTIBLE 87.95 PAYMENT DUE UPON RECEIPT 87.95 __ __.___ __ , ,, , __ __ __ 3/01/05 BALANCE FORWARD 7.5b6.65 I/14/05 51801 INTERMIT INCONT-OLY FEE ( QTY 14 ) 63.00 3/14/05 52001 MATT 80 PRESSGUARD APM2 ( QTY 14 ) 87.50 l/14f05 53201 NTRTNL/ENTRL SERV GRP I ( QTY 14 ) 98.00 4/01/@5 REV LAST MO RC 6,386.00 3/01-04/14/05 ROOM CHARGE 2.980.24 PAYMENT DUE UPON RECEIPT 4,399.39 ~leigh~rCareTM Pharmacy Services ® 3419 CONCORD RD. YORK, PA 17403 NCPDP#. 3972634 PHONE: 888-565-6708 HOURS: M-F 8:30 AM - 5:00 PM RILL FOR SERVICES PAGE: 1 of 1 CUSTOMER NAME SELLING DATE I ACCOUNT N0. CABBIE C. MILLER 05/31/05 49842 FACILITY PRIMARY PHYSICIAN MCHS CARLISLE #21 BRANSCUM, JR., GEORG ,. ~ / ~ ~ ~ ~~' 05~16~05~~ CK103 `~GP I ~~ I ~ j ~ ' i I ~ ! ~ i , i PAYMENT. THANK YOU! I i ! ~ ~ ; f -109.18 i I ~ I ~ ~, ~ j ' i I I 1 I Our r~mittande addre s has chan~ . 7 u include the tear-off stub w your men i hat changq is re~Iected n the stub and n additional action on your part s recess ry. I you us i an on7llline deck ser ice and/or no st b is returned with your payment, please c ar_ge ur rem T ~ • 1 ~ / I 109.18 0.00 0.00, -109.1 ~_ 0.00 0.00 0.00 $0.00 ~ i DAYB OUTSTANDING AGFO BALANCE r>J 0 _D w ru 0 0 0 W -,J 0 t/ O N~ighborCare~M Pharmacy Services 3419 CONCORD RD. YORK, PA 17403 NCPDP#: 3972634 TEMP-RETURN SERVICE REQUESTED PHONE. 888-565-6708 HOURS: M-F 8:30 AM - 5:00 PM i cse check box ii ~~eloc~ add~ass is incorrect or.nsurance -- nso~ r,at~on has changed. and i~adicate change(s) on reverse side. 30713"iJ81369300003;5 ADDRESSEE: 1111'~IIII~I1111IIIIIIIIIIIIIIIIItllllllll~litlllllll l'~II11 CABBIE C. MILLER Ci0 CAROL MILLER 144 E STREET CARLISLE, PA 17013-1406 I >>hl ~ IICI Ihl III11 I!III 111!1 ill!I lllil 111111 ll! 119i nl!I tllll 11!11 II111 CII III! IF PAYING BY MASTERCARD, DISCOVER, VISA OR AMERICAN EXPRESS, FELL OUT BELOW. I I ~ MASTHFCARD CHECK CARD USING FOR PAYMENT I DISCOVER 1151 VISA ~ AMERICAN EXPRESS CARD NUMBER i AMOUNT SIGNATURE EXP. DATE CARDHOLDER NAME I CUSTOMEfl NAME 1 ~ f CABBIE C. MILLER 06/20/05 ACCOUNT NO. B ILLING DATE AMOUNT DUE ~ ~ ' • ~ _ I 49842 ~ -_ 05/31/05 - $0.00 - - PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT i~~~ MAKE CHECKS PAYABLE TO: ~~~ ss2sisa Ilil~l~l~lllll~'~IIIIII1~1 ~11~1'I~III~tI IIIIIIII11 i~~111IItll~ NEIGHBORCARE PHARMACY SERVICES, INC. BOX 8900 PHILADELPHIA, PA 19175-8900 4510000000004984200000000000000000000000000Q03 fe%t!!~~C/C/ UNITED METHODIST CHURCH October 24, 2005 Mr. & Mrs. Raymond Miller 144 E Street Carlisle, PA 17013 Dear Raymond & Carol: ^ 45 S. West Street Carlisle, PA 17013-2888 ^ (717) 249-1512 (717)249-6076 (717) 249-5710 ^ Fax (717) 249-6679 ^ www.gbgm-umc.org/graceum Thanks so very much for your gift of $500. This gift has been received as a charitable contribution and posted as such by Grace Church. The donation is being used to meet the ongoing ministry needs in our Children's Department. We have not provided you with any goods or services in exchange for this contribution. Please retain this document for your records. It is an important document necessary for any available federal income tax deduction for this contribution. We have provided you with intangible religious benefits consistent with the tenets of our faith and practices and only incidental tangible benefits. Yours truly, Pastor Ed and T. D'Agostino ETD/emo Rev. Sharonn D. Halderman, Senior Pastor Pastor Edward T. D'Agostino, Associate Pastor COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OG '~NDi ViDUAL TAXES DEP' 28060 .~,~RaiSBVRQ as '7128-060~ PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DANIELS WILLIAM S, ESQ. 1 W HIGH STREET CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX111~961 N0. CD 005560 AMOUNT 101 ~ $ 2, 980.00 ESTATE INFORMATION: ssN: ~7a-o5-0070 FILE NUMBER: 2105-0363 DECEDENT NAME: MILLER CABBIE C DATE OF PAYMENT: 07/13/2005 POSTMARK DATE: 07/13/2005 couNTY: CUMBERLAND DATE OF DEATH: 04/ 1 4/ 2005 REMARKS: SEAL CHECK#111 TOTAL AMOUNT PAID: INITIALS: JA RECEIVED BY: S 2, 980.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER