The URL can be used to link to this page

Home My WebLink About07-29-10 1505610148 REV-1500 EX ~°1.1°' OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 28°6°1 INHERITANCE TAX RETURN 2 0 10 0 0 513 Harrisburg, PA 17128-06°1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 201,-14-0403 04132010 021,01926 Decedent's Last Name Suffix Decedent's First Name M I MILLER JOI~1 F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 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) 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ th ^ 11 9113 A ti t t d t f d El S ^ 10 P C di d 9. Litigation Proceeds Received . ) on ax un er ec. ( ea ec o . Spousal overty re t ( e o 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 STANLEY A• SMITH, ESQUIRE 71,7-231-6632 First line of address RHOADS & SINON LLP Second line of address P - 0 • BOX 1,1,46 City or Post Office State ZIP Code HARRISBURG PA 171,08 Correspondent's a-mail address: REGISTER OF„J_NILLS USE ONlsYj ( _) ~: i) ~ ~ ~~~ ~ ... :rr7 ,.~~ -' ~.t`s -. ,, _, =;_ _-".' ~E FLED t ~`"~ 4 -.? ~ ~~ ...? -z_r ., . ~ i ~..•~ '~ ~„ ' ..t Under penalties of perjury, !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 cf which preparer has any knowledge. SIGNATURE OF PERSON RESPON2.S,.IB~LE FOR FILING R9E~~T,URN DATF_ ADDRESS ~.: ' C/0 RHOAD SINON LLP, PO BOX 1,1,46 HARRISBURG, PA 1,7108-1146 SIGNATURE P P HER NTATIVE DATE _r~ - /- - ADDRESS C/0 RHO & SINON LLP, PO BOX 1146 HARRISBURG, PA 17108-1,1,46 PLEASE USE ORIGINAL FORM ONLY Side 1 1,50561,0148 1505610148 J 9M4647 4.000 ~' J 150561D248 REV-1500 EX Decedent's Social Security Number 201,-14-0403 Decedent's Name: __ RECAPITULATION 1. Real Estate (Schedule A) 1, O . O O 2. Stocks and Bonds (Schedule B) . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3, 4. Mortgages and Notes Receivable (Schedule D) 4 5. Cash, Bank Deposits and 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) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) 8 55,668.31, 0.00 0.00 354.20 16,630.80 81, , 51, 9.31, 1,54,1,72.62 9. Funeral Expenses and Administrative Costs (Schedule H), , 9. 19 , 0 7 8.8 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) _ 10. 9 4 4 •9 5 11. Total Deductions (total Lines 9 and 10) , 11, 2 O , 0 2 3.8 0 12. Net Value of Estate (Line 8 minus Line 11) 12. ], 3 4 ,14 8.8 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , . 13. O • O O 14. Net Value Subject to Tax (Line 12 minus Line 13) . 14. 13 4 ,14 8.8 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 14 t xable o 4~ l t li x at nea ra e . 124,1,48.82 16. 17. Amount of Line 14 taxable at sibling rate X .12 O . O O 17. 18. Amount of Line 14 taxable at collateral rate X .15 10 , 0 0 0.0 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 9M4648 4.000 0.00 5,586.70 0.00 1,500.00 7, 086.70 J REV-1500 EX Page 3 Decedent's Complete Address: File Number ~n i,n nn!~i,~ DECEDENTS NAME STREET ADDRESS CUMBERLAND CITY f1ECHANICSBURGH STATE PA ZIP 17050- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 6, 7 0 0. 0 0 B. Discount 3 5 2.6 3 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) (1) __ 7,086.70 7, 052.6B (3> _ 0.0 0 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _~ 3 4 • 0 7 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 ~ a. retain the use or income of the property transferred; ^ ~ 1 n~ 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 Dec. 12, 1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? . . " " ^ ~~ or payable-upon-death bank account or security at his or her death? in trust for 3. Did decedent own an 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which ® ~~ contains a beneficiary designation? . . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §91 16 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 4.5 percent, e:KCept as noted in 72 P.S. X9116(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 12 percent [72 P.S. §91 16(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. Total Credits (A + B) (2) 9M4671 2.000 REV-15Q3 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER John Francis Miller 20 10 00513 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 3wasss i.ooo (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98} COMMONWEALTH OF PENNSYLVANIA {NHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER John Francis Miller 20 10 00513 Include the proceeds of litigation and the date the proceeds were received by the estate. 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV -1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE fNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: John Francis Miller 20 10 00513 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule Cx SURV N ING JOINT TENA NT(S) NA NH(S) A Miller, Daniel J JOINTLY OWNED PROPERTY: ADDRESS 1921 Monterey Drive, Mechanicsburg, PA 17050 RELATIONSHIP TO DE(~DENT Son ~~ NUMBER FOR JOINT TENANT MADE JOWT DESORPTION OF PROPERTY INCLUDE NAIvE OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUM3ER OR SIMLAR IDENTiFVING NIXvBER. ATTACH DEED FOR JgNTLV HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °!° OF DE~EDENT'$ INTEREST DATE OF DEATH VALUE OF DECEDBVTS WTEREST 1 A All 23, 000 Face Pre-date United States Savings Bonds 1991 - Series EE 33,261.60 50.0000 16,630.80 Date of Death Valuation Attached TOTAL (Also enter on Line 6, Recapitulation) S 16 , 6 3 0 . 8 0 9W46AE 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER John Francis Miller 20 10 00513 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCR1PTlON OF PROPERTY INCLIAE THE NOME OF T!£ TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACHA COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE _ VALUE 1. PNC Checking Account #1135739309 (Made joint within one year of death) 5,699.32 100.0000 3,000.00 2,699.32 2 Transamerica Life Insurance Company - Annuity #02IC0090450 Beneficiary: Daniel J. Miller, Son 6,247.60 100.0000 0.00 6,247.60 Date of Death Valuation Attached 3 Vanguard - Rollover IRA Account #09863721747 Beneficiary: Daniel J. Miller, Son 53,349.72 100.0000 0.00 53,349.72 Date of Death Valuation Attached 4 Transamerica Life Insurance Company - Annuity #O1SE0001212 Beneficiary: Daniel J. Miller, Son 19,222.67 100.0000 0.00 19,222.67 Date of Death Valuation Attached TOTAL (Also enter on line 7, Recapitulation) $ 81,519.31 If more space is needed, use additional sheets of paper of the same sizE:. 9b'V~16AF 2 000 REV-1511 EX+ (10-091 pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER John Francis Miller 20 10 00513 ___. Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Laughlin Memorial Chapel 9,375.40 Total from continuation schedules ~ 733.67 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Citv State ZIP Year(s) Commission Paid: 2. Attorney Fees: 4, 2 5 0 .0 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3 , 50 0 . 0 0 Claimant Daniel J. Miller Street Address 1921 Monterey Drive City Mechanicsburg State PA ZIP 17 0 5 0 Relationship of Claimant to Decedent SON 4. Probate Fees: 15 3 . 5 0 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 St. Mary Cemetery Grave 500.00 Total from continuation schedules ~ 566.28 TOTAL (Also enter on Line 9, Recapitulation) ~ $ _ 19 , 07 8 . 8 5 9wasA~ z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: John Francis Miller Schedule H Part 1 (Page 2) Item No. Description 2 Cafe J Restaurant & Lounge Funeral Luncheon 20 10 00513 Amount 733.67 Total (Carry forward to main schedule) 733.67 Estate of: John Francis Miller 20 10 00513 Schedule H Part 7 (Page 2) 2 St. Mary Cemetery Payment of footer for placement of the Veteran's Marker 230.00 3 Office Max, Mailing Costs 4.39 4 Cumberland Law Journal Estate Advertisement 75.00 5 The Patriot-News Co. Estate Advertisement 171.89 6 Rhoads & Sinon LLP - Reimbursement of expenses 85.00 Total (Carry forward to main schedule) 566.28 REV-1512 EX+ (12-08) SCHEDULE { pennsy{vania DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER John Francis Miller 20 10 00513 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 8L'V46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: John Francis Miller_ _ 20 10 00513 NUMBER I 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Daniel J. Miller 1921 Monterey Drive Mechanicsburg, PA 17050 Transamerica Life Insurance Company - Annuity #OlSE0001212 Beneficiary: Daniel J. Miller, Son Inventory Value: 19,222.67 Transamerica Life Insurance Company - Annuity #02IC0090450 Beneficiary: Daniel J. Miller, Son Inventory Value: 6,247.60 Vanguard - Rollover IRA 'Account #09863721747 (Beneficiary: Daniel J. Miller, Son Inventory Value: 53,349.72 X23,000 Face RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 _ ..-_ -__ _.__._.._... .,.... .... .... ...... .~ .... ~ ~.~~n .r r ~r. ~i ins ~ .~ !~c n~~i ~cnn l~n~ico CucCT AC AODD(1DDIATF~ If more space is needed, use aadltlonal sneers of paper or >:ne same size. 9W46AI 2.000 Estate of: John Francis Miller Schedule J Part 1 (Page 2) Item No. Description 1 United States Savings Bonds - Series EE Inventory Value: 16,630.80 100 of Residue: 28,698.03 2 Anne B. Headland 238 Parkwood Circle Canonsburg, PA 15317 Son Relation 20 10 00513 Amount 124,148.82 General Bequests: 10,000.00 Niece 10,000.00 LAST WILL AND TESTAMENT ®F John Francis Miller BE IT KNOWN THIS DAY THAT, I, John F. Miller, of Allegheny County, Pennsylvania, being of legal age and of sound and disposing mind and memory, and not acting under duress, menace, fraud, or undue influence of any person, do make, declare and publish this to be my Will and hereby revoke any Will or Codicil I may have made. ARTICLE ONE Marriage and Children I am divorced from Catherine E. Miller and have the following adult child: Name: Daniel John Miller Date of Birth: March 7, 1956 ARTICLE TWO Debts and Expenses 1 direct my Personal Representative to pay all costs and expenses of my last illness and funeral expenses. I further direct my Personal Representative to pay all of my just debts that may be probated, registered and allowed against my estate. However, this provision shall not extend the statute of limitations for the payment of debts, or enlarge upon my legal obligation or any statutory duty of my Personal Representative to pay debts. ARTICLE THREE Specific Bequests of Real and/or Personal Property I will, give and bequeath unto the persons named below, if he or she survives me, the Property described below: Name Address Relationship Daniel John Miller 3556 Shoreline Circle Son Palm Harbor, FL 34684 Property: My entire estate excluding the below bequeath to Anne Buckley Headland Name Address Relationship Anne Buckley Headland 238 Packwood Circle Niece Canonsburg, Pennsylvania 15317 Property: $10,000 or 10% of my financial holdings; whichever is the lesser. ~~ r ~~ Cinnarl by Tc~ctatnr/Tc~ctatrix• -~- In the event I name a person in this Article and said person predeceases me, the bequest to such person shall lapse and the property shall pass under the other provisions of this Will. In the event that I do not possess or own any property listed above on the date of my death, the bequest of that property shall lapse. ARTICLE FOUR Homestead or Primary Residence Will, devise and bequeath all my interest in my homestead or primary residence, if I own a homestead or primary residence on the date of my death that passes through this Will, to my child, Daniel John Miller. ARTICLE FIVE All Remaining Property -Residuary Clause I will, devise, bequeath and give all the rest and remainder of my property and estate of every kind and character, including, but not limited to, real and personal property in which I may have an interest at the date of my death and which is not otherwise effectively disposed of, to my child, Daniel John Miller. ARTICLE SIX Appointment of Personal Representative, Executor or Executrix hereby appoint Daniel John Miller, as Personal Representative of my estate and this Will. In the event my Personal Representative shall predecease me, or, for any reason, shall fail to qualify or cease to act as my Personal Representative, then I hereby appoint Linda Lee Miller to serve as successor Personal Representative of my estate and Will. The term "Personal Representative", as used in this Will, shall be deemed to mean and include "Personal Representative", "Executor" or "Executrix". ARTICLE SEVEN Waiver of Bond, Inventory, Accounting, Reporting and Approval My Personal Representative and successor Personal Representative shall serve without any bond, and I hereby waive the necessity of preparing or filing any inventory, accounting, appraisal, reporting, approvals or final appraisement of my estate. ARTICLE EIGHT Powers of Personal Representative, Executor and Executrix I direct that my Personal Representative shall have broad discretion in the administration of my Estate, without the necessity of Court approval. I grant unto my Personal Representative, all powers that are allowed to be exercised by Personal Representatives by the laws of the State of Pennsylvania and to the extent not prohibited by the laws of Pennsylvania, the following additional powers: 1. To exercise all of the powers, rights and discretions granted by virtue of any "Uniform Trustees' Powers Law," and/or "Probate Code" adopted by the State of Pennsylvania. Vii' ncsrl by TACtatnr/Tactatri~r• -~- 2. To compromise claims and to abandon property which, in my Executor's opinion is of little or no value. 3. To purchase or otherwise acquire and to retain any and all stocks, bonds, notes or other securities, or shares or interests in investment trusts and common trust funds, or in any other property, real, personal or mixed, as my Personal Representative may deem advisable, whether or not such investments or property be of the character permissible by fiduciaries, without being liable to any person for such retention or investment. 4. To settle, adjust, dissolve, windup or continue any partnership or other entity in which I may own a partnership or equity interest at the time of my death, subject, however, to the terms of any partnership or other agreement to which I am a party at the time of my death. I authorize my Personal Representative to continue in any partnership or other entity for such periods and upon such terms as they sha11 determine. My Personal Representative shall not be disqualified by reason of being a partner, equity owner or title holder in such firm from participating on behalf of my estate in any dealings herein authorized to be carried on between my Personal Representative and the partners or equity owners of any such partnership or other entity. 5. To lease, sale, or offer on a lease purchase, any real or personal property for such time and upon such terms and conditions in such manner as may be deemed advisable by my Personal Representative, al! without court approva{. 6. To sell, exchange, assign, transfer and convey any security or property, real or personal, held in my estate, or in any trust, at public or private sale, at such time and price and upon such terms and conditions (including credit) as my Personal Representative may deem advisable and for the best interest of my estate, or any trust. I hereby waive any requirement of issuing summons, giving notice of any hearing, conducting or holding any such hearing, filing bond or other security, or in any way obtaining court authority or approval for any such sale, exchange, assignment, transfer or conveyance of any real or personal property. 7. To pay all necessary expenses of administering the estate and any trust including taxes, trustees' fees, fees for the services of accountants, agents and attorneys, and to reimburse said parties for expenses incurred on behalf of the estate or any trust hereunder. 8. Unless otherwise specifically provided, to make distributions (including the satisfaction of any pecuniary bequest) in cash or in specific property, real or personal, or in an undivided interest therein, or partly in cash and partly in other property, and to do so with or without regard to the income tax basis of specific property allocated to any beneficiary and without making pro rata distributions of specific assets. 9. To determine what is principal and what is income with respect to all receipts and disbursements; to establish and maintain reserves for depreciation, depletion, obsolescence, taxes, insurance premiums, and any other purpose deemed necessary and proper by them and to partite and to distribute property of the estate or trust in kind or in undivided interests, and to determine the value of such property. 10. To participate in any plan of reorganization, consolidation, dissolution, redemption, or similar proceedings involving assets comprising my estate or any trust created hereunder, and to deposit or withdraw securities under any such proceedings. ~~ min ri hu Tac}atnr/TPCtatriv• -~- 11. To perform such acts, to participate in such proceedings and to exercise such other rights and privileges in respect to any property, as if she or he were the absolute owner thereof, and in connection therewith to enter into and execute any and all agreements binding my estate and any trust created hereunder. 12. To compromise, settle or adjust any claim or demand by or against my estate, or any trust, to litigate any such claims, including, without limitation, any claims relating to estate or income taxes, or agree to rescind or modify any contractor agreement. 13. To borrow money from such source or sources and upon such terms and conditions as my Personal Representative shall determine, and to give such security therefor as my Personal Representative may determine. All authorities and powers hereinabove granted unto my Personal Representative shall be exercised from time to time in her or his sole and absolute discretion and without prior authority or approval of any Court, and I intend that such powers be construed in the broadest possible extent. ARTICLE NINE Construction Intentions It is my intent that this Will be interpreted according to the following provisions: 1. The masculine gender shall be deemed to include the feminine as well as the neuter, and vice versa, as to each of them; the singular shall be deemed to include the plural, and vice versa. 2. The term "testator" as used herein is deemed to include me as Testator or Testatrix. 3. This Will is not a result of a contract between myself grid any beneficiary, fiduciary or third party and I may revoke this Will at any time. 4. If any park of this Will shall be declared invalid, illegal, or inoperative for any reason, it is my expressed intent that the remaining parts shall be effective and fully operative and it is my intent that any Court so interpreting same construct this Will and any provision in favor of survival. ARTICLE TEN Misc. Provisions I direct that this Wi11 and the construction thereof shall be governed by the Laws of the State of Pennsylvania. (I have placed my initials next to the provisions below that I desire to adopt. Unmarked provisions are not adopted by me and are not a part of this Wi11). <~ _/~_ If any person named herein is indebted to me at the time of my death and such % indebtedness be evidenced by a valid Promissory Note payable to me, then such / ,~ ~in~ ri by TPCtatnr/TPCtatrix• _a_ person's portion of my estate shall be diminished by the amount of such debt. Signed if Selected: ,`i-~~^ Any and all debts of my estate shall first be paid from my residuary estate. Any ~;~ debts on any real property left herein shall be assumed by the person to receive such real property and not paid by my Personal Representative. Signed if Selected: ~y~ I desire to be buried in the St. Mary's Cemetery tSharps Hill} cemetery in J Allegheny County, P nn ylvania. Signed if Selected: ~^ ~~- '" ~-1~)'~~` I direct that my remains be cremated and that the ashes be disposed of ~' according to the wishes of my Executor. v I, John Francis Miller, having signed this Will in the presence of and who attested it at my request on this the 3j s f day of ~ -~ ~ 20 ~ ~~ at r~ iTi J~~:'? ~'!~ ~~>>~/,N ,(' 7 L V~ yr ~ (address), declare this to be my Last Will and Testament. ,~ . -~ „ ~ /~ _ Tutor The above and foregoing Will of John Francis Miller (name of testator) was declared by John Francis Miller {name of testator} in our view and presence to be his Will and was signed and subscribed by the said John Francis Miller (name of testator) in our view and presence and at his request and in the view and presence of John Francis Miller (name of testator) and in the view and presence of each other, we, the undersigned, witnessed and attested the due execution of the Will of John Francis Miller (name of testator;} on this the ~ ~'rz day of /, ~ _ Witness Signature Witness Signature Print Name: ,,~ Print Name: Address: Address: _~ i- ~~ c=:, / Lit /S ~-..,~.,~` ~ t• ~r~ ~,~ ~ s~~~. City, State, Zip: City, State, ,Zip: Phone: Phone: ~:_~ / ~ _ j ~~ `_ ~ ry ~ ~' ~i 1 r~ '~ Ott " --7 `~. ~' nAri hu Tactatnr/Tr~ctatriv• -{- PENNSYLVANIA SELF AUTHENTICATiNC AFFIDAVIT Commonwealth of Pennsylvania County of Allegheny I, John Francis Miller, the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that l signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by John Francis Miller, the testator, this .~~`'t day of )'~'~~~ , 20 C~' Testator Typed Name ~hn ~anc' i le Signature of officer-er-~ttorrsey %1.~, ~ ^1 ~ ~ ~-~~1~ 1 l,. Seal and official capacity of officer ONW ` ti r rENNS YLV or state of admission of-at~e~e~p- ~ o e Lisa J. Anthony, Notary Pubiie lVtt. Lebanon 'I~vp., AlDegheny Co~~g~ Commonwealth of Pennsylvania My C~mtt~ission,Expires ay ~~, ~~~~~~< County of Allegheny `~~=~~~ -~~~-~~~~~=- ,--..,_~-__ ~~~%~?5 ,-. , ~ :~ We, f-- ~~..~, ~ ~~~ ,~ ~~.~/~,~ ~:~<~. and ~ . ~~ ~ ;' C" : ~ z r~~• ,the witnesses whose names are signed to the attached or foregoing instrument, being d qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; 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 to or affirmed and subscribed before me by and ,witnesses, this ~ I s~- day of ~~~ ~~z ~ 1 , 20 G ~7 ~ jv,% ~.-, -~ Witness f_ ~~~~-~ ~_.~ ~:%~~? ,~ :'.~i !'.%~:~~ _.~ ,,, Witness - -+-~ ~ ~y .. ~` ~ ~ - ,:~ Signature of officer-c~=-~t#or-ney ,~~~~~' ~ f: 7 ~ ~~~ ~"~ i Seal and official capacity of officer or state of admission~f--aver-r~ey- ~~~ti~~;~ ~ ~ ~ i <<'' \ c MONWEALTK ~F, PENNS YLV, L-'l. 7fl f~a ('. ~ 4 £ R1R7 1 PAnncul~iania half L~i~thAntiratinn Gffiria~iit Notarial Seal Lisa J. Anthony, Notary Pa~lro ~ r~~. Lebanon -~r~p., Alle eny ~~;~~~~, ivgy Co$nrnission Expires May ~ ll, ~. ~'?~<, filf~trr; .. ~+nRSv1~~~ AcenrMfirrr ~,` .~r;,~~ia: ~_ TR~vsA~~ucA ® LIFE INSURANCE COMPANY Transamerica Life Insurance Company 4333 Edgewoad Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 April 30, 2010 Daniel J Miller 1921 Monterey Drive Mechanicsburg PA 17050 RE : Annuity Number (s) 02100090450 Dear Daniel J Miller: We have received notification, John F Miller, annuitant of the above listed non-qualified tax deferred annuity is deceased. Our office wishes to extend sincere condolences for your loss. The following is the current information on this annuity: Annuitant: Owner: Primary Beneficiary(ies): Annuity Policy Date: Full Value as of 04/30/2010: Taxable Portion: Full Value as of 04/13/2010: John F Miller John F Miller Daniel J Miller 1000 April 22, 2003 $6,256.36 $1,256.36 $6, 247.60 The attached document reflects the options available to the beneficiary. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. Operations performed on an automatic basis when applicable have been terminated, such as; Systematic Payouts or Automatic Billing. The attached document contains general tax information based on Transamerica Life Insurance Company's interpretation and should not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the ~Ei.70N. Group .; :;: ._ ~.. ~~ ~~ ~ ~- ~~_~ ;. k .r< ~® LIF~URA~lOMPA~ Transamerica Life Insurance Company 4333 Edgewooa ~ ~:.d NE PO Box 3183 Ccdar Rapids, Iowa 52406-3183 April 30, 2010 Daniel J Miller 1921 Monterey Drive Mechanicsburg PA 17050 RE : Annuity Number (s) O1SE0001212 Dear Daniel J Miller: We have received notification, John F Miller, annuitant of the above listed non-qualified tax deferred annuity is deceased. Our office wishes to extend sincere condolences for your loss. The following is the current information on this annuity: Annuitant: Owner: Primary Beneficiary(ies): Annuity Policy Date: Full Value as of 04/30/2010: Taxable Portion: Full Value as of 04/13/2010: John F Miller John F Miller Daniel J Miller 100 January 17, 2002 $19,249.15 $14,249.15 $19, 222.67 The attached document reflects the options available to the beneficiary. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. Operations performed on an automatic basis when applicable have been terminated, such as; Systematic Payouts or Automatic Bi1lin.g. The attached document contains general tax information based on Transamerica Life Insurance Company's interpretation and should not be relied upon for your personal tax planning. :Lf you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the `EGON. Group ~~ ,, ;~_. John F. Miller 1921 Monterey Dr Mechanicsburg, PA 17050-8511 John F. Miller -Rollover IRA ,~- .~ Page > 1 of 1 T T ~~~'- ;Report for 04/13/2010 Flagship Services: 800-345-1344 Eric Anderson extension 17316 Total report value: ~ ~ $53,349.72 (Total report value includes any accrued dividends.) Account value summary i " Name I Fund & Account .Date i ' Price Per 1 Accrued i Number Opened ~ Shares Share I Value* Dividends Federal Money Mkt Fund 1 0033-09863721747 10/25/1993 I 0.000 ~ $1.00 ~ $0.00 $0 00 .Inter-Term Treasu Inv ~ ry i 0035-09863721747 .04/24/1996 1,176.968 ~ $11.13 i $13,099.65 . $.13.87 Short-Term Federal Inv ~ 0049-09863721747 ! I 02/25/1992 ~ 3,744.019 $10.74 ~ $40,210.76 $25.44 Totals $53,310.41 $39.31 " uoesn't include accrued dividends. 0351367026 05/2f3/2010 16:02:20 Calculated Value of Your Yaper savings t3ond~s l Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 04/2010 :gage 1 of 1 ~~t~l ~~-~~~ Total ~~~€~ ~4"otal Interest ~-' 1`~ In°terespt $11,500.00 $33,261.60 $21,761.60 $568.00 Bonds: 1-23 of 23 Serial Series Denorn Issue Next l=final Date Accrual Maturity Issue Price Interest Interest mate Value Dote M41159416EE EE $1,000 06/1990 06/2010 06/2020: $500.00 $868.00 4.00% $1,368.00 M36388460EE EE $1,000 01/1990 07/2010 01/2020 $500.00 $895.60 4.00% $1,395.60 M36388461EE EE $1,000 01/1990.07/2010 2020 01/ $500.00 $895.60. 4.00% $ 1,395.60. M36388487EE EE $1,000: 02/1 990 08/2010 . 02/2020 $500.00 $895.60 4.00% . $1,395.60 . M36388488EE EE . $1,000 03/1990 09/2010 03/2020. $500.00 $895.60 4.00% . $1,395.60 M34394592EE EE 89 08/2010 $1,000.08/19 2019 08/ $500.00 $923.60 4.00% $1,423.60 M34394568EE EE . $1,000 06/1989 06/2010 . 06/2019 $500.00 $923. 60 4.00% $1,423.60 M34394569EE EE $1,000.06/1989 .06/2010 06/2019 _ $500.00 , , $923.60 4.00% $1,423.60 M34394589EE EE $1,000 07/1989 07/20.10 07/2019 $500.00 $923.60 4.00% $1,423.60 ........... M34394590EE EE $1,000 08/1989 08/2010 08/2019 $500.00 $923.60 4.00% $1,423.60 M34394591EE EE $1,000 08/1989; 08/2010 08/2019 $500.00 $923.60 4.00% $1,423.60: ........... M26992695EE EE $1,000; 10/1988 10/2010 1.0/2018 _$500.00 $980.80 4.00% $1,480.80 M26992696EE EE $1,000 10/1988 10/2010 10/2018 $500.00 $980.80 4.00% $1,480.80 M26992697EE EE $1,000 10/1988 10/2010 10/2018. $500.00 $980.80 4.00% $1,480.80: M26992698EE EE $1,000.10/1988 10/2010 10/2018 $500.00 $980.80 4.00% $1,480.80 M26992699EE EE $1,000 10/1988 10/2010 10/2018 $500.00 $980.80 : 4.00% $1,480.80': M26992700EE EE $1,000_.10/1988 10/2010 1.0/20.18 $500.00: $980..80 4.00% $1,480.80 __. M26992701EE EE $1,000 10/19.88 10/2010 10/2018 $500.00 $980.80 4.00% $1,480.80 M26992702EE EE $1,000 10/1988 10/2010 10/2018 $500.00 $980.80 4.00% $1,480.80 M26992703EE EE $1,000 10/1988 10/2010 10/2018 $500.00 $980.80 4.00% $1,480.80 M26992704EE EE $1,000 10/1988 10/2010 :10/2018 $500.00 $980.80 4.00% $1,480.80 M26992706EE EE $1,000 10/1988 10/2010 :10/2018 $500.00 $980.80 4.00% $1,480.80 M26992705EE EE $1,000 10/1988.10/2010 10/201,8 $500.00 $980.80 : 4.00% $1,480.80 l_ _ Totals for 23 Bonds $11,500.00 $21,761.60 $33,261.60 Notes NI Not Issued ____ NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest http://www.treasurydirect.gov/BC/SBCPrice 7/6/2010