HomeMy WebLinkAbout03-0979 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of t~t~'/~' ~ l~'//~"~ No. c~//- ED.--~-
also known as To:
Register of Wills for the
County of
Social Security No. / ~ff ' .~2 - ~j4~6eceased._ D
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut
in the last will of the above decedent, dated
and codicil(s) dated ~eaetn/~' 4t'.
in the
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cton~r/tma/ _County, Pennsyl,vania, with
h~t'_ last family or principal residence at ~.qloo ~en~ Ct~te/~ /'(aa~. ~~t~ .~
(list strut, number ~d muncipality)
Decendent, then ~/ yearsvf age, died ~~ ~/ , ~~Z.,
ExcePff~s f~llo~s' aecedent did not marry, w~ not ~v~ed ~d aia ~ot ffave a ~h[ld bom or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled ia Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa?) , Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully, re.quest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamem~ry; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 'l
COUNTY OF Ct,c~.(3ff'P-L/~M~ f ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of ti~e above decedent petitioner(s) will well~.~) .and truly~a~d..~ister the estate according to law.
Sworn to or affirmed and subscribed ~ -L-~-~"/~c~'~.j ~
{before me th~ /c~ 7'A/ day of ~ /'~/ATt4 R~b~el~l~t~tt'" ~'
Estate of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereof, satisfactory proof having be.~.~ presented before me,
IT IS DECREED that the instrument(s) dated ,~%-~z.~..~,J ,-~ ~o ,~
described therein be admitt~ed to probate and filed of record as the last will of
and Letters - J
are hereby granted
.~z~, in consideration of the petition on
FEES
~or t~at e ~L_~etter s, Etc ..........
rtificates( ) ..........
fiation ................
TOTAL
Filed . ~. x~-.~ ....................
ADDRESS
7/?~ ~6 - o~o~
PHONE
1/24/2003 00:22 7177957473 SHIELDS PAGE 02
Th~ is to certify that the Lr~rmadon here given is correctly copied from an original ce~ficatc of death duly filed wkh rae as
Local Kq~trar. The original cerfificam will be forward~ m the State Vital Records Office f~r permanent filing,
WARNING: It lis Ille~l to duplloate this oopy by photoe~t or photograph.
Fee for ~hi~ cer~, $2-00
P 9649834 NOV 0 12003
No. Date
CERTIFICAT~ OF DEATH
t,. Roxie J. Miller ~£em&le 98/,6 J& 10-31-2903
[ Harrisburg
2100 Bent Creek Road ~
~ ~ ..... ._.
~Mechanicsburg, Pa. 17050 -~
~ Walte~ G. Smith ~ ~elma Wiley.
L~ ~,,th s ~-~-hn,,~h ~__.5.500 ~ertmville Rd. Enola. Pa. 17025
i~~'~~~~O~ 0I~'~1~~ ~~~-~.~ 1~;~-~ ..........
:~~- ------ ~ .~.: ..... l~1~-05-2003 ~,~,~stminis~e~ Cemeter~ Carlisle. Pa.
~~.
~6~~~ X ..... ~ .............
I~,~~ ~m~ ~ ~ .........
~~ ~ ........ ~ ...... , ....
A ~ ~ ~,~l I
I
,,- ~ _._,.~" ---~. :~.' ~. ... · .................................................................................................. ,_,., .., . ....
REGISTER OF WILLS OF Ca ms~r~L~//b COUNTY
OATH OF SUBSCRIBING WITNESS
~ a subscribing witness to th/~presented herewith,-(cach} being duly qualified according to
law, depose(s) and say(s) that H~' present and saw
the testat r-;X , sign the same and that ]4~ signed as a witness at the
request of testat r}.~ in h--,-- presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)L
Sworn to or affirmed and subscribed before
me this /c~2 7'''''
day of
(Address)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
testat.~ of (one of the subscribing witnesses to) the will presented herewith and
codicil
that believes the signature on the will is in the handwriting of
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19
Register
(Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF C~/~-~z,,~-~ COUNTY
OATH OF SUBSCRIBING WITNESS
tgD~ /~ I L yA/ ~ J/~C~EEI~
~'aet) a subscribing witness to the ~ilL~presented herewith, ~ being duly qualified according to
law, depose(s) and say(s) that .5~' present and saw
, ¢~x/~ 3:.
the testat.~,~ , sign the same and that ~.4~e signed as a witness at the
request of testate;7 in h~v- presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this /2 ~ d~y of
IM' NOTA,R,,IAL SEAL -] ~
Charles E. Shie,ds, I~1, ~ Public ~a~
Monroe Twp. Cumberland Coun~ J
y C~m~on E~res ,June. 20~ 2004J
(Address)
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
testat of (one of the subscribing witnesses to) the will presented herewith and
codicil
that believes the signature on the will is in the handwriting of
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19
Register
(Name)
(Address)
(Name)
(Address)
his 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 9 6 4 9 8 3 4 Nov 0 2, 2oo
No.
cal Registrar
Date
Rev 2/e? COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
OF DECEDE.T,F,.St. M,dd,e. Las,, ISE× ISO ,ALBECUR, 'ZJ;;? ..... DArE OF DEAT., nth. D.y.
~. Roxie J. Miller [z female ~. 19~ 22 - 9846 ~. 10-31-2 3
AGE(kastB~ay) [ UNDERIYEAR [ UNDER1DAy ~ OATEOFBR/H ~ BRTHP~CE(Cya~ ~P~CEOFOEATH{gh~v~e-seei~s~ti~ono~r~e 00
I M~ths~ Days I H~m [ M~utas I (~th. Day, Year) [ S~te ~ F~eign Count~) I HOSPIT~: I OTHER
COUN~ OF DEATH C ' I" I ' ~ ~ ~ ~ ~ (Spe~) U
~, BORO. ~p OF D~TH ~ FACILI~ NAME (ff nm ins~tu~n, give slreet and nu~r) lWAS DECEDENT OF HtSP~{C ORIGIN? I~CE - ~e~n Indian, Slack, W~te,
C . . No Yes If ~s, S~d~ Cuban, (S~)
DECEDENTS USU~ OCCUPATION ~ KIND OF BUSINESS/INDUSTRY~AS DEC~DENT EVER N I DECEDENTS EDUCATiO~,I ;, i ........ , I ~o. wn[ t e
11a. I ~[] Itlb Sta~= ~,~4~11.- ~ E I (0-12) I ~4~s,) I I
OECEDEN~S~lLINGAODRESS(S~eet, Cityffown. S~ta, ZipC~e)lOECE~EN~S 17a ~ [ 12 [ I . !~o!~d [15.
2100 Bent Creek Road [~[~¢&c~ .S~te r~. ~.ent 17c.~Yes, dec~ent,ved~ ~p
Mechanicsburo Pa ]vnK~ I(~ mst~,~, ,~,~ m, ......
16. ~ ~ · ~.vJv,I on omar side) 17b. County Cumber 18 ..nd~ ~nshp? ltd. ~ ~m~"9:~eg~"veeacma, ,~t* ~
t,. Walter G. Smith
~NFORMAN3'S NAME (Type/Print)
2o~ Rul-h S. R~d~hm~h
METHOD OF DISPOSITION
it tim
cause of death.
MOTHER*S NAME (Firsl, Middle. Maiden Surname)
I~g. Thelma Wiley
IINFORMANT'S MAILING ADDRESS (Street, Ctiy/Town, State. Zip Code)
,12°~' 5500 Wertzville Rd. gnola, Pa. 17025
....
State,
Zip
Code
Ql,,b.'l~-05-2003I I-'-''----12~c.Westminister Cemeter~,~d. Carlisle, Pa.
~q SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY 13 3 4 N 2 nd
In~. ED 138182 ' 122c. Neumver Funeral Home Inc, Harris6ur~,'
To the best of my knowledge, death occulted at the time, da e and place stated [ LICENSE NUMBER IDATE SIGNED
(s,g,~,. ~d Tm) ........ , ~ · '~ I _ I(Mo~. Day. Ye,r)
.... ! · .~ r.~ 123c. I ~1-~)1
TIME OF DEATH I DATE PRONOUNCED DEAD (Month, Day, Year) I WAS CASE REFERRED TO A MEDICAL EXAMINER/CORONER? :
DUE TO (OR AS A tONSE~IENCE OF):
DUE TO (OR AS A CONSEQUENCE OF):~ ,
DUE TO (OR AS A CONSEQUENCE CFI:
Homicide
Pending InvesfigaUon
interval betweer
onset and death
IMMEDIATE CAUSE (Final
disease or condiUon
resulting in death).~ a.
Sequentially list condibens b.
i~ any, leading to latmediale [i
Enter UNDERLYING
CAUSE (Disease or injury
Y.sl-! NoJ, a'l yes[] Nol--I
DATE OF INJURY I TIME OF INJURY
~L~CE OF INJURY - Al home farm street, factor/,
PART I1: Other significant ceadibons contributing to
not resulting in the underlying cause given in PART I.
Could not be determined
Itn JURY AT WORK? I DESCRIBE HOW INJURY OCCURRED
I
Ye, E] NoEl
[30c. i30d.
CERTIFIER (Check only one)
'CERTIFYING PHYSICIAN (Physician ce~f'/ing cause of death when another physician has onounced death and c~m eted em 23
TO the beet of my kJlOWtadga, delth occurrld due ,o the causal(a) and manner a~ alaJ~e~ .............................. .¢. ............... { ................. E
*P~R_?~O~UNC. IN~G AND CE.R .TIFYI .NC PHYSICIAN (Physician both pronouncing death and cerli~ing to cause of death)
~o me i~el el my Knowle<~ge, aeath occurred at the time, data, and place, and due to the causes(i) end manner al stated ...................... F-
'MEDICAL EXAMINER/CORONER
On thi billl of examination andl(x Invaaflgatlon, In my opinion, death occurred at the lime, date, and place, and due to lhe causal a and
31a~annef aa ataled ............................................................................................. . .................. []
ILOCATION (Street, Cily/Town,
State)
30f.
3lb. / ~¢-~ ~e'~~ -
LICENSE NUMBER DATE SIGNED (~on~ay. Year)
~ME AND ADDRESS OF PER~N WHO CObPLETED CAUSE OF O~TH
(It~ 27) Ty~ P~
=YqTOVal(~ ~t , ~o~ ~. I~o~~
DATE FILED (Month. bay. Year) '
LAST WILL AND TESTAMENT OF ROXIE J. MILLER
I, ROXIE J. MILLER, currently of Silver Spring Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and
declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by
me at any time heretofore made.
I direct the payment of all my just debts and funeral expenses as soon after my decease as the
same can conveniently be done.
I make the following specific bequests:
Ao
To my trusted friend, RUTH RADABAUGH: recliner, vanity bench,
hassock, night stand, clothing (to be delivered to the Salvation Army),
three-way light, picture of the Last Supper, folding table, afghans, alarm
clock, bath chair, radio, walker, and Bible.
To my trusted friend, STELLA BRANDT: green chest and contents,
cardboard set of dramas in white color, quilt and blanket, trash
container, television and stand, tape player and tapes, ceramic birds, and
red bird rug.
In the event that either of them fails to survive me, then the items above shall go to
the other who does survive me. In the event they both fail to survive me, then these
bequests shall lapse and the items shall become part of the residue of my estate. Any
fees, commissions, death taxes and the like due upon the value of these items, shall be
first paid from the residue of my estate.
Co
I make it known hereby that the wall clock is the property of Stella
Brandt and has been loaned to me and that the blue chair is the property
of Bob and Connie Horst and it has been loaned to me. Accordingly,
those items should not be claimed nor assessed as a part of ny estate.
2a.
All the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to be divided and distributed, after the payment of
all bills, charges, expenses, fees, death taxes and the like that may be due by or upon my estate, as
follows:
to my nephew, JAMES W. SMITH, per stirpes currently of 4400
Linda Street, Vermillier, Ohio 44089, twenty (20%) per cent.
to my trusted friend, RUTH RADABAUGH, per stirpes, currently
of Hampden Township, Cumberland County, Pennsylvania, ten
(10%) per cent.
to my trusted friend, STELLA BRANDT, per stir_Des, currently of
Enola, Cumberland County, Pennsylvania, ten (10%) per cent.
D. to the SALVATION ARMY, ten (10%) per cent.
Eo
the balance to St. Paul's Lutheran Church, 6839 Wertzville Road,
Enola, Cumberland County, Pennsylvania, one-half (1/2) of this
gift shall be paid to or credited for the benefit and use of the
"Willing Workers" Group. The other one-half (1/2) may be used
as deemed best for the benefit of the Church and Congregation.
I nominate, constitute and appoint my trusted friend, RUTH RADABAUGH to be the
Executrix in its place and stead. In the event that she is unable or unwilling to act as Executrix, I
appoint my trusted friend, STELLA BRANDT to be the Executrix in her place and stead. I
further direct that they shall not be required to file bond or other security in the Office of the
Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ttt~ day of
~ ., A.D. 2002.
RoxIE J. MILLJ'
(SEAL)
Signed, sealed, published and declared by the above-named ROXIE J. MILLER, as and for
her Last Will and Testament, in the presence of us, who at her request and in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses.
CHARLES E. SHIELDS III
ATTORNEY-AT-LAW
6 Clouser Road
MECHANICSBURG, PA 17055
CERTIFICATION OF NOTICE UNDER RUI JE 5.6(a)
Name of Decedent:
Date of Death:
Will No.
Roxie J. Miller
October 31, 2003
Admin. No.
21-03-0979
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
December 3, 2003:
Nallle
Ruth Radabaugh
Stella Brandt
James W. Smith
Tamam Smith
Gerald Neidigh
The Salvation Army
St. Paul's Lutheran Church
Attorney General's Office
Address
5500 Wertzville Road, Enola, PA 17025
1014 Dogwood Lane, Enola, PA 17025
4400 Linda Street, Vermillier, Ohio 44089
2214 Adams Street, Lorain, Ohio 44052
214 N. 39th Street, Hamsburg, PA 17109
P.O. Box 2205, Harrisburg, PA 17105
6839 Wertzville Road, Enola, PA 17025
Charitable Trusts & Organizations Section, 21 S. 12th Street,
3rd Floor, Philadelphia, PA 19107-3603
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: Deceml~r 3, 2003
CHARLES E. SHIELDS, III
6 Clouser Road
Mechanicsburg, PA 17055
Telephone: (717) 766-0209
Counsel for Personal Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003482
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA
17O55
........ fold
ESTATE INFORMATION: SSN: 198-22-9846
FiLE NUMBER: 2103-0979
DECEDENT NAME: MILLER ROXIE J
DATE OF PAYMENT: 01/27/2004
POSTMARK DATE: 01/26/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 10/31/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $11,400.00
!REMARKS:
TOTAL AMOUNT PAID:
RECIEVED OF RUTH RADABAUGH
IN C/O CHARLES E SHIELDS,Ill
$11,400.00
SEAL
CHECK//1001
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH Of
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-I$00
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
~.1- z) 3 ~ ~
C~TY~E ~EAE NUMBER
SOCIAL SECURITY NUMBER
f-
Z
UJ
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE RLED IN DUPLICATE WITH THE
UJ /~ -"~/' ~'~ ~:)~' --/~' -/9/.~ REGISTER OF WILLS
I=1 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
,,v/,,f _ _
=o~
1.1.1
n,'
[]1. Odginal Return
[~4. Limited Estate
[~6. Decedent Died Testate (A[tach copy of Wdl)
[~9. Litigation Proceeds Received
~2. Supplemental Retum
~]4a. Future Interest Compromise {date of death after 12-~2-82)
[~7, Decedent Maintained a Living Trust (A~ch copy of Trus~)
[~10. Spousal Poverty Credit/da~e of dea~ between 12-31 91 and 1-1-95)
[~5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A)
FIRM NAME
TELEPHONE NUMBER
COMPLETE MAILING ADDRESS
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2) ~'7 ~.~./
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Properly (5)
(Schedule E)
6. Jointly Owned Properly (Schedule F) (6)
~] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & AdminiMrative Cosls (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
//$, ,5'3-7. ~0
i ~OFFICIAL USE ONLY~:7.j':;3D
(s) ~157, ?.~.1,
(12) ~117, q~ .Z~
(13) --'~ ~'~. ~'(~
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxabte at collateral rate
~ x .00~ (15)
~ x .o ~g' (16)
~) x .12 (17)
f.~'~'.~ ~ 2,~'. ~,~' x .~5 ¢8)
¢9)
19. Tax Due
Decedent's Complete Address:
ISTREETADDRESS
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit ,,g
B. Prior Payments //. ,{/~o ~
C.
Discount
Total Credits (A + S + C ) (2)
3. Interest/Penalty if applicable
D. interest
E. Penalty
Total IntereslJPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. ~,...~!
Check box on Page I Line 20 to request a refund (4)
(5)
(5Al
5. If Liner + line 3 is greater than Line 2, enter the differenca. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A, This is the BALANCE DUE. (5B)
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; .......................................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] []
o. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or cam? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decadent owen an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probata 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.
Under penalties of pedury, I declare that I have examined this return, including accompanying scheOules and statements, and to the best of my knowledge at~d belief, it is true, COrTect and complete.
Declaration of preparer other than the personal representative is based on all i~furmation of which preparer has any knowledge,
DATE
7.3~-oV
/7ezE
DATE
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 3%
[72 P.S. {9116 (al (1.1)(il].
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 0% [72 P.S. {9116 (al (1.1) (ii)],
The statute does not exemet 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 0% [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%, except as noted in 72 RS. §9116(1.2) [72 RS. {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% [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 decadent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128 0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 003482
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA
17055
........ fold
ESTATE INFORMATION: SSN: 198-22-9846
FILE NUMBER: 2103-0979
DECEDENT NAME: MILLER ROXIE J
DATE OF PAYMENT: 01/27/2004
POSTMARK DATE: 01/26/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 10/31/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 911,400.00
TOTAL AMOUNT PAID:
$11,400.00
REMARKS: RECIEVEDOF RUTH RADABAUGH
IN C/O CHARLES E SHIELDS,Ill
SEAL
CHECK#1001
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
A/~T'
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS& BONDS
All propelty jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 2, Recapitulation) $ 7,,?-,
(If more space is needed, insert additional sheets of the same size)
Glenbrook Life and Annuity Company
P.O. Box 94212
Palatine, IL 60094-4212
GLENBROOK LIFE
A Member of Allstate Financial Group
January8, 2004
Estate of Roxie Miller
6 Clouser Road
Mechanicsburg, PA 17055
Re:
Contract Number:
Claim Number:
Roxie Miller
GA16175270
AC0030935
Dear Estate of Roxie Miller:
We, at Glenbmok Life and Annuity Company, are sorry to hear of your loss and extend our sympathy.
Your claim for benefits under the above referenced annuity has been completed. A check has been
sent to you under separate cover and will arrive within the next seven to ten business days.
This payment was computed as follows:
Annuity Value as of 1/8/2004
Portion Payable to You:
Federal Withholding:
State Withholding:
Claim Interest:
Total Net Proceeds:
$72,868.15
$72,868.15
$0.00
$0.00
$o.oo
$72,868.15
This annuity is subject to federal income taxes (on non-qualified annuities, only the interest earned is taxable.)
A 1099 tax statement reflecting $2,868.14 as your taxable income will be sent next January to assist you in
preparing your tax return for 2004.
The annuity value on the date of dea~Was '$7~,-~is may be necessary for estate purposes.
If you have any questions or need furth~~P'l~'~"~--~h~A~ me at 1-877-499-6418.
Sincerely,
Life and Annuity Claims
Enclosures
Overnight Address: 300 North Milwaukee Avenue, Vernon Hills, IL 60061
Toll Free Fax: 1-866-635-4523
MaT Investment Group
December 31, 2003
Charles E Shields, Ill
Attorney-at-Law
6 Clouser Road
Mechanicsburg, PA 17055
RE: Roxie J Miller
Dear Mr. Shields:
Pursuant to your letter dated December 13, 2003 requesting information on investments
held with M&T Investment Group (M&T Securities, Inc.) in the name of the above listed
individual.
A review of our accounts has determined that the only account held with M&T Securities,
Inc. in the name of Roxie J. Miller was that holding the Glenbrook Annuity Contract
GA16175270. We understand that you are working with Glenbrook to obtain and submit
to them the required claim forms. No other M&T Securities accounts were found in Mrs.
Miller's name.
We have forwarded your letter to M&T Bank in order for them to perform a review of the
bank's database and have requested that you receive a response to your inquiry.
Thank you.
Christine M Ferdl
Assistant Vice President
Director of Operations
M/g:T Securities, Inc. · One M&T Plaza * Buffalo, New York 14203 2399
Member NASD/MPC · New York State L~-ensed Insurance Agency
CHARLES E. SHIELDS, HI
A TTORNEY-AT-LA W
GEORGE M. HOUCK
(1912-1991)
6 CLOUSER ROAD
Corr~r of Trindle and Clouser Roads
MECHANICSBURG, PA 17055
TELEPHONE (717) 766-0209
FAX (717) 795-7473
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF ,/~//~-~, /~,,~./~- ~ FILENUMBER
If an asset was made joint within one year of the decedent'e date of death, it must be mporled on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
B,
c. G~4,dzA /v.
JOINTLY-OWNED PROPERTY:
LETTER DATE ! DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial insi~u~on and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate VALUE OF ASSET INTEREST DECEDENT'$ INTERE,
TOT~ (Also enter ~. line 6, E~apitula~on) $ ~ ~2~ ~ ~
(if more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include the
ITEM
NUMBER
)mceeds of litigation and the date the proceeds were received by the estate. All pmpe~y jointly-owned with the right of survivorship must be disclosed on Schedule F.
DESCRIPTION
VALUE AT DATE
OF DEATH
~,¢, 7L,c-,/i
TOTAL (Also enter on line 5, Recapitulation) $ Z/],~/ 70~. 0 ~
(If more space is needed, insert additional sheets of the same size)
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-I2
Charles E Shields, III
Attorney At Law
6 Clouser Road
Mechanicsburg, PA 17055
Phone (888) 502-4349
Fax (302)934-2955
Janua~ 16, 2004
Re: Estate of Roxie .l Mi/ler
Social Security: 198-22-9846
Date of Death: October 31, 2003
Dear Sir or Madam:
Per your inquky dated December 3, 2003, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1. Type of Account Certificate of Deposit
Accowat Number 31003910107274
Ownership (Names 099 Roxie J Miller
Ruth $ Radabaugt~ POA
Opening Date 03/09/98
l~. ~5 ~ Balance on Date of Decah $3,670.87
~7 13 Accrued lnterest $ O. 11
Total --$-3-,~)?~ ..........................
Type of Account Certificate of Deposit
Account Number 31003910107282
Ownership (Names o~ Roxie J Miller
Ruth $ Radabaugh
Opening Date 03/09/98
Balance on Date of Death $2,447.25
Accrued Interest $ .07
Total '~-~$~2-,~71~-j~ ......................................
Type of Account
Account Number
Ownership (Names oJ)
Opening Date
Balance on Date of Death
Accrued Interest
Total
Type qf Account
Account Number
Ownership (Names 099
Opening Date
Balance on Date of Death
Accrued lnterest
Total
Type of Account
Account Number
Ownership (Names oJ)
Opening Date
Balance on Date of Death
Accrued Interest
Total
6. Type of Account
Account Number
Ownership (Names oJ)
Opening Date
Balance on Date of Death
Accrued lnterest
Total
Certificate of Deposit
31003910276350
Roxie J Miller
Stella Brandt
Ruth S Radabaugh, POA
04/16/99
$3,483. O8
$ 19.81
Certificate of Deposit
31003910276376
RoMe d Miller
Ruth $ Radabaugh
04/16/99
$3,483.08
$ 19.81
"':~SYoL~T~ ...................................................
Certificate of Deposit
31003910960648
Roxie,l Miller
Ruth S Radabaugh, POA
08/04/00
$5,785.11
$ 22.75
Certificate of Deposit
31003911156874
Roxie d Miller
Farmers Trust Co Burial
Ruth S Radabaugh, POA
05/18/91
$5,997.19
$ 28.60
--~;~37f~ .................................................
~r 6,, ozq,
10.
7. Type of Account
Account Number
Ownership
Opening Date
Balance on Date of Death
Accrued Interest
Total
Type of .4ccount
Account Number
Ownership (Names oJ)
Opening Date
Balance on Date of Death
Accrued Interest
Total
Type of Account
Account Number
Ownership (Names oj)
Opening Date
Balance on Date of Death
Accrued Interest
Total
Type of Account
Account Number
Ownership (Names oJ)
Opening Date
Balance on Date of Death
Accrued Interest
Total
Certificate of Deposit
31003911169786
Roxie J Miller
Gerald W Neidigh
Ruth S Radabaugh, PO.4
12/07/95
$1,000.00
$ 11.38
$1,011.38
Certificate of Deposit
31003911169794
Roxie J Miller
Gerald W Neidigh
Ruth S Radabaugh, POA
12/07/95
$1,000. O0
$ 11.38
Certificate of Deposit
31003911169801
Roxie d Miller
Gerald W Neidigh
Ruth S Radabaugh, POd
12/07/95
$1,000.00
$ 11.38
'- ~75#i7/]~ ......................................
Certificate of Deposit
31003911169819
Roxie J Miller
Gerald W Neidigh
Ruth S Radabaugh,
12/07/95
$1,000.00
$ 11.38
11. Type of Account
Account Number
Ownership (Names
Opening Date
~ 5 C~ Balance on Date of Death
~ $ N Accruedlnterest
Total
12. Type of Account
Account Number
Ownership (Names oJ)
Opening Date
f~ ~. Balance on Date of Death
~ ~ Accrued lnterest
Total
Checking Account
2675028647
Roxie J Miller
Ruth $ Radabaugh, POA
09/01/67
$3,722.53
$ .82
--~y,~?~ ..........................................
Savings Account
150042024092693
Roxie J Miller
Ruth S Radabtmgh, POA
10/15/02
$16,232.94
$ 8.21
~'~?~'~-¢-L']3 ......................................................
For further account information, closures and/or reimbursement of funds please call the West Shore Office at #71%737-2308.
Please be advised, there was no safe deposit box found for the above decedent.
Sincerely,
Sue Kimble
Records Management
Invemory of Roxie Miller's Room
Vanity bench
Hassock - R~
~ way ~t
Picture of Last
Fol~g table
Bath Ch~r-
Bible - ff~
Clothes
To be donated to Salvation Army
Green Chest and -- gNlla 8r~mdt' ~3. oo
contents (oda., cms, g~;e -/<.~cl~)(Oeab k~ f~s~d ea~-d bo. rd)
Cardboard set of_
drawers (white)
Quilt & Blankets-
Trash Can ~ Seth
Television and stand
Tape player and tapes
Ceramic Birds.--
Red rug (~roto~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
ESTATE OF 'FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the mveme side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE T~NSFEREE' T~EIR RELATIONSHIp TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATFACH A COPY OF THE DEED FOR ~ ESTATE.
NUMBER VALUE OF ASSET INTEREST I~F ^F~UC~.LE)
m G~ ~ &~ ~ ¢//~ ~1, ~&.~o /oo?. o tl,~&.~o
~ ~ oz~/ ~ /~//~ ~,~7.~ /~ ~ ~,~7.~
TO~AL(Alsoenteronline7,~e~pitulation)$ /~ ~. ~
(If more space is needed, inse~ additional sheets of the same size)
Savings Bond Calculator
12/3/03 4:53 PM
Update
Help
Savim
Bond
Series
IEE BOnds
Denomination Serial Number Issue Date
Add
# Bonds Total Price
11 $5,500.00
Serial Number Issue Date Series
M63585563EE 03/1985 EE
M63585564EE 03/1985 EE
M63585566EE 04/1986 EE
M63585565EE 04/1986 EE
M63585562EE 03/1985 EE
M27355037EE 04/1986 EE
M25387083EE 11/1987 EE
MI4565463EE 04/1986 EE
M14565459EE 04/1986 EE
M3950202EE 10/1982 EE
M3950201EE 10/1982 EE
~/ie~, 10 I ViewingBonds l-Il
Total Interest Total Value
$11,200.40 $16,700.40
Denom Issue Interest Value Interest
Price Rate
$1,000 $500.00 $962.80 $1,462.80 4.00%
1,000 500.00 962.80 1,462.80 4.00%
1,000 500.00 906.00 1,406.00 4.00%
1,000 500.00 906.00 1,406.00 4.00%
1,000 500.00 962.80 1,462.80 4.00%
1,000 500.00 906.00 1,406.00 4.00%
1,000 500.00 667.60 1,167.60 4.00%
1,000 500.00 906.00 1,406.00 4.00%
1,000 500.00 906.00 1,406.00 4.00%
1,000 500.00 1,557.20 2,057.20 4.00%
1,000 500.00 1,557.20 2,057.20 4.00%
YTD Interest
$609.20
Next Final
Note
Accrual Maturity
03/2004 03/2015
03/2004 03/2015
04/2004 04/2016
04/2004 04/2016
03/2004 03/2015
04/2004 04/2016
11/2003 11/2017
04/2004 04/2016
04/2004 04/2016
04/2004 10/2012
04/2004 10/2012
Del ~/n~W.~
Del ..~//~t ~
Del J~ ~g~
Del gc,~
http:/r/wwws'publicd~bt'tr~as'g°v/BC/SBCPric¢ Page 1 of 2
Savings Bond Calculator 12/3/03 4:53 PM
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-month interest penalty
ME Matured (Exchangeable for HH)
MN Matured (Not Exchangeable for HH)
Please rate this service.
(Please print and/or save this page before submitting your survey)
Service Excellent Good Fair
Savings Bond Calculator (~ (~ (~
[Submit Survey]
Poor
http://wwws .publicdebt.treas.gov/BC/SBCPfice Pagc 2 of 2
EV-1511 EX+ (12-99)~. ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
5.
6.
II.
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) "~ ~j[ "~/~I /'"~'~ ~' ~ 4/'/
Social Security Number(s)/EIN Number of Personal Representative(s/ /~ 1--/& ~' '~'~:~,~'~
StreetAddress ,.~"~' ~(,)4~'~'/"~'[////~' ~.~.
City_ ~",~/~,-~
Year(s) Commission Paid:
Attorney Fees C~"~I ~/.. ,~",~ ,,~"'.
State ~ Zip /70~,,.~'
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
75-,0o
TOTAL (Aisc enter on Jine 9, Recapitulatior $ o~)~. /q'~,/7
(If mere space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT OECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES~& LIENS
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
TOTAL (Also enter on line 10, Recapitulation) $ ,,~ ~", ~0
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
m
ESTATE OF /y] It L ~"~,,, ,,'~X/~ ~ FILE NUMBER ..~-./- O ) - p 79
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS (include outdght spousal distributions)
.55"O0
II.
1.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I(~. , ENOZ~t, p,4 17o,15
TOTAL OF PART ]]- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LiNE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size)
L~ST WILL ANB TESTAMENT OF ROXIE J. MILLER
I, ROXIE J. MILLER, currently of Silver Spring Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and
declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by
me at any time heretofore made.
I direct the payment of all my just debts mid funeral expenses as soon aRer my decease as the
same can conveniently be done.
I make the following specific bequests:
To my trusted friend, RUTH RADABAUGH: reeliner, vanity bench,
hassock, night stand, clothing (to be delivered to the Salvation Army),
three-way light, pietttre of the Last Supper, folding table, afghans, alarm
clock, bath chair, radio, walker, and Bible.
To my trusted friend, STELLA BRANDT: green chest and contents,
cardboard set of dramas in white color, quilt and blanket, trash
container, television and stand, tape player and tapes, ceramic birds, and
red bird rug.
In the event that either of them fails to survive me, then the items above shall go to
the other who does survive me. In the event they both fail to survive me, then these
bequests shall lapse and the items shall become part of the residue of my estate. Any
fees, commissions, death taxes and the like due upon the value of these items, shall be
first paid from the residue of my estate.
I make it known hereby that the wall clock is the property of Stella
Brandt and has been loaned to me and that the blue chair is the property
of Bob and CoImie Horst and it has been loaned to me. Accordingly,
those items should not be claimed nor assessed as a part of ny estate.
2a.
All the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to be divided and distributed, after the payment of
all bills, charges, expenses, fees, death taxes and the like that may be due by or upon my estate, as
follows:
to my nephew, JAMES W. SMITH, per stir~es currently of 4400
Linda Street, Vermillier, Ohio 44089, twenty (20%) per cent.
to my trusted friend, RUTH RADABAUGH, ver stirnes, currently
of Hampden Township, Cumberland County, Pennsylvania, ten
(10%) per cent.
to my trusted friend, STELLA BRANDT, per stifles, currently of
Enola, Cumberland County, Pennsylvania, ten (10%) per cent.
D. to the SALVATION ARMY, ten (10%) per cent.
the balance to St. Paul's Lutheran Church, 6839 Wertzville Road,
Enola, Cumberland County, Pennsylvania, one-half (1/2) of this
gifi shall be paid to or credited for the benefit and use of the
"Willing Workers" Group. The other one-half (1/2) may be used
as deemed best for the benefit of the Church and Congregation.
I nominate, constitute and appoint my trusted friend, RUTH RADABAUGH to be the
Executrix in its place and stead, tn the event that she is unable or unwilling to act as Executrix, I
appoint my trusted friend, STELLA BRANDT to be the Executrix in her place and stead. 1
fia-ther direct that they shall not be required to file bond or other security in the Office of the
Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of
/,/l~/.~.~. , A.D. 2002.
Signed, sealed, published and declared by the above-named ROXIE J. MILLER, as and for
her Last Will and Testament, in the presence of us, who at her request and in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses.
CHARLES E. SHIELDS III
ATTORNEY-AT-LAW
6 Clouser Road
MECHANICSBURG, PA 17055
~.~,'i~n notice of the filing o!
the la~ day to file written
and to every o~hef person
untan{ to I~ve of claim an
FIRST AND FINAL ACCOUNT
INCLUDING
PROPOSED DISTRIBUTION OF RUTH S. RAI)ABAUGH, EXECUTRIX
OF THE
ESTATE OF ROX1E J. MILLER
LATE OF SILVER SPRINGS TOWNSHIP
CUMBERLAND COENTY, PENNSYLVANIA, DECEASED
- 77 '
Date of Death
Letters Granted
Dates nf Publishing Notices
Dates of Publishing Notices
Cox ering lite Period
Cumberland l.ax~ Jourual
Patriot News
October 31. 2003
November 25, 2003
Dccember 19, 26, 2003 .lanuarx 2.
2004
Deceluber 30. 2003. Januar.; 6, 13.
2004
October 31, 2003 - September 30.
2004
Purpose of the Account: Ruth S. Radabaugh, Executrix offers this account to acquaiut interested
parties with the transactions that have occurred during his administration. The account also indicates
the proposed distribution of' the estate.
It is important tbat tbe account be carefully examined. Requests for additional information or
qnestions or objections can be discnssed witb Ruth S. Radabaugh, Executrix. c/o Charles E. Shields,
i11, 6 Clouser Road, Mechanicsburg, PA 17055.
SUMMARY OF ACCOUNT
TABLE OF CONTENTS
Proposed Schedule of Distribution
PRINCIPAL
Receipts
Real Estate
Stocks and Bonds
Cash and miscellaneous
TOTAL RECEIPTS OF PRINCIPAL
Disbnrsements
Funeral Expenses
Administrative Expenses
Inheritance Taxes
Fees and Commissions
Debts of Decedent
TOTAL DISBURSEMENT OF PRINCIPAL
Receipts of Income
Page #
6
4
4
4
4
4
4
4
5
Amount
88,150.81
-0-
72,155.69
44,709.08
116,864.77
8,674.55
1,000.62
8,502.37
10,775.00
28.00
28,980.54
365,58
Real Estate
RECEIPTS OF PRINCIPAL
~0-
-0-
Stocks and Bonds
Investments obtained through M & T investment
Group in form of Investment annuiD' through
Glenbrook Life
Cash and Miscellaneous
1. Cash in wallet and among personal effects
2. Rcfund from the Bridges at Bent Creek
3. Unity Financial Life Insur. Co. pre-paid funcral
4. M & T Bank pre-paid funeral fund
5. M&
A.
B.
C.
D.
E.
F.
G.
11.
1' Bank -
Cert. of Deposit #31003910107274
Accrucd interest to D.O.D. on Item A
Cert. of Deposit #31003910107282
Accrued interest to D.O.D. on Item C
Cert. of Deposit #31003910960648
Accrued interest to D.O.D. on Item E
Chccking account #2675028647
Accrued interest to D.O.D. on Item G
I. Savings accouot #150042024092693
J. Accrued interest to D.O.D. on Item i
lnveutoD' of Roxie Miller's room
Retired. US Treasury
Refund. cancer insurance
$72,155.69
$112.25
$3,851.06
$2,645.50
$6,029.05
3,670.87
.11
2,447.25
.07
5,785.11
22.75
3,722.53
.82
16,232.94
8.21
99.00
57.00
24.56
72,155.69
44,709.08
TOTAL RECEIPTS OF PRINCIPAL
116,864.77
116,864.77
DISBURSEMENT OF PRINCIPAL
Funeral Expense:
l. Ncumyer Funeral 1 lome, Inc. of Harrisburg
A. Payment from Unity Fund (Item 3 above)
B. Payment from M&T Bank ruud (Item 4
above)
2,645.50
6,029.05
8.674.55
Administrative Expenses:
1. Probate and short certificates
2. Fax Return - Larry Shoop Assoc. (fnr 1040
closeout, PA 40, 1041 Est. lnc. Return, PA 41 Est.
Inc. P, eturn
3. Additional Short Certificates
4. Advertising -Cumberland Law Journal
5.Advertising - Metro West Patriot News
6. Additional Probate Fee
7. t:'ilieg fee roi' Inheritance Tax
8. Filing Final Accounting with Court(Estimate)
9. Reimbursement to Charles E. Shields, copies,
postage, certified mailings, long distance phone calls,
etc. (estimated)
82.50
375.00
12.00
75.00
89.87
185.00
15.00
I32.00
34.25
1,000.62
Inheritance taxes:
Total paid *
· Informational Note: Please see covet' letter
accompanying the account and the lnber. Tax Return
provided as a specimen as well for an explanation of
Ihe calculation and apportionments. The figure used
here is net. There is an expected refund coming of
$2,897.63 in order to reach the net valne iuserted
here.
8,502.37
$8,502.37
Fees and Commissions:
I. Executor's fkes
5,675.00
4
2. Attorney's fees to Charles E. Shields, I11 5,100.00 $10,775.00
Debts of Decedent:
A[ect Pharmacy
TOTAL DISBURSEMENTS OF PRINCIPAL
RECEIPTS OF INCOME
M & T Market Index Account
Interest Payments:
Nov. 14, 2003
Dec. 15, 2003
Jan. 15, 2004
Feb. 13, 2004
Mar. 15, 2004
Apr. 15. 2004
May I4, 2004
June I5, 2004
July 15, 2004
M & T checking with interest
Interest Payments:
Jan. 2, 2004
Feb. 2. 2004
Mar. 2. 2004
Apr. 2, 2004
May 2, 2004
June 2, 2004
July 2, 2004
Aag. 2. 2004
Sept. 2. 2004
Oct, 1, 2004
28.00
14.44
13.41
11.74
34.65
56.17
56.21
52.62
58.10
54.51
.6O
.72
1.01
I .67
1.60
1.67
1,61
1.66
1.65
1.54
28.00
28,980.54
351.85
13.73
TOTAL RECEIPTS OF INCOME:
365.58
Disbursements of Income
Income Balance on Hand
0
365.58
Total Principal Receipts
Total Principal Disbursements
Total Income Receipts
lotal Income Disbursements
Balance on Hand for Distribution
RECAPITULATION
116,864.77
28,980.54
365.58
0
88,249.81
PROPOSED SCHEDULE OF DISTRIBUTION
Advance distribution nf items delineated in paragraphs 2A and 2B of the will in the form
of specific bequests*':
2A: Ruth S. Radabaugh - value: $61.00
2B: Stella Brandt - value: $38.00
Informational note: see paragraphs 2A ami 2B of the will and inventory attached to
Schedule E of the Inheritance Tax Return for valuation breakdown.
Subtotal preliminary net balance for ultimate distribution =
S88,150.81
James W. Smith .~20%
Ruth Radabaugh (&10%
Stella Brandt (a'~lO°/,,
Salvation Army ~ 10%
St. Paul's Lutheran Church
50%
S17,630.16
$8,815.08
$8,815.08
$8,815.08
$44,075.41
6
RUTH S. RADABAUGH, Execntrix of the Estate of ROXIE J. MILLER. deceased, hereby declares
under oath that she has fully and faithfully discharged the duties of her office, that foregoing First
and Final Account is true and correct and fully discloses all the significant transactions occurring
during the accounting period; that all claims now outstanding against the Estate; and that all taxes
presently due from the Estate have been paid.
RUTH S. RADABAUGH
Sworn and subscribed to before me this /,~,~'/'ff day of
A.D. 2004
Notary Public
COMMONVVEALTH OF PENNSYLVANIA
~1 Seat
Charles E, ,StY~Ids Ill, No{ary Pul:Jic
Moc~oe %~4>., Cumberland Co~
My Corn miss, ion Ex~ires June 20, 2008
Member, Pennsylvania Association Of Nolades
LAST WILL ANt i'ESTAMENT OF ROXIE J. MILLER
1, ROXIE J. hlILI,EIt, cmTcntly of Silver Spring Township, Comberland County,
Pclmsylx ania, being of sound and disposing mind, memory and nnderstanding, do make, publish and
declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by
mc at any time heretofore made.
I direct tile payment of all my jnst debts and flineral expenses as soon after my decease as the
sante call convenienlly Be done.
I make the following specific bequests:
To my trusted friend, RUTiI RADABAUGII: recliner, vanity bench,
hassock, night stand, clotbing (to be delivered to the Salvation Army),
three-way light, picture of tile Last Supper, fi~lding table, afghans, alarm
clock, bath chair, radio, walker, and Bible.
To nay trusted fi'ieud, STELLA BRANDT: green chest and contents,
cardboard set of dralnas in white color, qnilt and blanket, trash
container, television and stand, tape player and tapes, ceramic birds, and
red bird rug.
tn the event that either of them fails to survive me, then tile items above shall go to
the other who does survive me. In the event they both fail to snrvive me, then these
bcquests shall lapse aod the items shall become part of the residue of my estate. Any
k:es, commissions, death taxes and the like due upon the value of tlrese items, shall be
first paid fi'om tile residue of my estate.
I make it known hereby that the wall clock is the property of Stella
Brandt and bas been loaned to me and that the blue chair is the property
of Bob and Connie ttorst and it bas been loaned to me. Accordingly,
those items should not b: claimed nor assessed as a part of ny estate.
2a.
All the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to be divided and distributed, after the payment of
all bills, cbarges, expenses, fees, death taxes and the like that may be due by or upon my estate, as
follows:
to my nephew, JAMES W. SMITlt, per stirpes cun-ently of 4400
Linda Street, Vennillier, Ohio 44089, twenty (20%) per cent.
to my trusted fi'tend, RUTli RADABAUGtl, per stirpes_, currently
of Hampden Township, Cnmberland County, Pennsylvania, ten
(10%) per ceut.
to my tnlsted fiiend, STELLA IIRANI)T, per stir]ms, currently of
Enoh, Cnlnberland County, Pennsylvania, ten (10%) per cent.
D. to the SALVATION ARMY, ten (10%) per cent.
the balauce to St. Paul's Lutheran Church, 6839 Wertzville Road,
Enola, Cumberland County, Pennsylvania, one-half (1/2) of this
gift shall be paid to or credited fur tile benefit and use of the
"Willing Workers" Group. Tile other one-half (1/2) may be used
as deemed best for the benefit of the Church and Congregation.
I nominate, constitute and appoint my trusted fiiend, RUTH RADABAUGH to be the
Exccuuix in its place and stead. In the event that she is unable or unwilling to act as Executrix, I
appoint my trusted fi'tend, STELLA BRANDT to be the Executrix in her place and stead. I
thrthcr direct that they shall not be required to file bond or other security in the Office of the
Register of Wills for the purpose of administering my Estate.
IN WITNESS WIIEREOF, I have hereunto set my hand and seal this 5zff~ day of
/~c*.~4t~{z,~ , A.D. 24)02.
ROXIE J. 5'l[~fF~--
_(SEAL)
Signed, sealed, published and declared by tile above-named ROXIE d. MILLER, as and for
bcr Last Will and Testament, in the presence of us, who at her request and in her presence, and in
the tncscuce of each other, bare hereunto subscribed our names as witnesses.
COMMONWEALTH OF PENNSYLVANIA
OFFICE OF ATTORNEY GENERAL
Gerald J. Pappert
A tomev General
October 29, 2004
Charitable Trusts and Organizations Section
21 S. 12th Street, 3rd Floor
Philadelphia, PA 19107-3603
Telephone: (215) 560-21 72
Fax: (215) 560-2202
Charles E. Shields, I[I, Esquire
6 Clouser Road
Corner of Trindle and Clauser Roads
Mechanicsburg, PA 17055
RE: Estate of Roxie Miller, Deceased
Dear Mr. Shields:
Receipt is acknowledged of your [etter regarding the receipt and release settlement
in the above matter.
Please be advised that I have reviewed that letter as well as the Account and other
documents supplied and, on behalf of this office as patens ~, would advise you that
we are without objection to the informal settlement of this matter in accordance with those
documents.
Very truly yours,
,Mary~C. Kenne~x
Deputy ~,ttornev General
,,'viC;Cmo
.~ m
BUREAU OF INDIVIDUAL TAXES
INHERTTAN~E TAX DIVISION
DEPT. Z&O[,01
HARRTSBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-25q7 EX AFP (01-05)
CHARLES E S~ELDS Iii
6 CLOUSER RI~
MECHANICSB~G PA 17055
CUT ALONG THIS LINE
DATE 09-27-200q
ESTATE OF MILLER
DATE OF DEATH 10-51-2005
FILE NUMBER 21 05-0979
COUNTY CUMBERLAND
ACM 101
I Amount Remitted
ROXIE
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAHD CO COURT HOUSE
CARLISLE, PA I7015
RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MILLER ROXIE J FILE NO. 21 05-0979 ACM 101 DATE 09-27-200q
TAX RETURN HAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:
1. Real Estate (Schedule A)
2.
$.
q.
5.
6.
7.
8.
ORIGINAL RETURN
(1)
Stocks and Bonds (Schedule B) (2)
Closely Held Stock/Partnersh[p Interest (Schedule C) ($)
Mortgages/Notes Reca/vable (Schedule D)
Cash/Bank Deposits/M/sc. Personal Property (Schedule E) (5)
Jo/ntly Owned Property (Schedule F) (6)
Transfers (Schedule G) (7)
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expansas/Adm. Costs/Misc. Expanses (Schedule H)
10. Dmbts/Mortgagm Liabilities/Liana (Schedule Z)
11. Total Deduct/OhS
12. Nat Value of Tax Return
15.
lq.
(9)
(10)
Char/table/governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Nat Value of Estate Subject to Tax
.00
72z155.69
.00
.00
qq/709.08
5/525.6q
15z55Z.O0
(8)
20,q65.17
28. O0
NOTE: To insure proper
crmd/t to your account,
submit the upper port/on
of this form w/th your
tax payment.
NOTE:
l$7,922.q1
(11) 20.~9~. 17
(12) 117, qz9.2q
(15) 57,765.56
(1~) 59,665.68
If an assessment was issued previously,
reflect figures that include the total of ALL returns assessed to date.
lines 14, 15 and/er 16, 17, 18 and 19 will
(15) .00 x O0 = .00
(26) .00 x Oq5= .00
(17) . O0 x 1::' = . O0
(18) 59,665.58 x 15 : 8,9~9.86
(19)= 8,9q9.86
AHOUNT PAID
ASSESSMENT OF TAX:
15. Amount of L/ne lq at Spousal rate
16. Amount of Line lq taxable at Lineal/Class A rata
17. Amount of L/ne lq at S~bling rate
18. Amount of Line lq taxable at Collateral/Class B rata
19. Pr/ncipal Tax Due
TAX CREDITS:
PAYMENT REGEZPT OZS:OUNT (+)
DATE NUMBER INTEREST/PEN PA/D (-)
01-26-200~ CD005~82 ~7.q9
ll,qO0.O0
IF PAID AFTER DATE ZND/CATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT I 11,8q7.q9
BALANCE OF TAX DUEl Z,897.65CR
INTEREST AND PEN. .00
TOTAL DUE 2,897.65CR
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE{~UZRED. ~Y'~'
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying an or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class S (collateral) beneficiaries of the decedent after the expiration cf any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act 23 of 2000. (7Z P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make 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-1315). Applications ara available at the Office
of the Register of Rills, any of the 23 Revenue District Offices, or by calling the special Z~-hour
answering service for forms ordering: 1-800-36Z-ZO50~ services for taxpayers with special hearing and / or
speaking needs: 1-800-q47-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allomance, ar disalloaance of deductions, or assessment
of tax (including discount or interest) as shown an this Notice must object aithin 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-iOZ1, 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 Revise Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-650S. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z 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 mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning wlth first day of delinquency, or nine (9) months and one (1) da~ from the date of
death, to the data of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .00016fi. All taxes ehich became delinquent on and after
January 1, 1982 ail1 bear interest at a rate ehJch ail1 vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ lOX .0005~8 ~'~J'~'~-1991 11X ,goos01 ~ 9Z .O00Zq7
1983 161 .000fi38 1992 91 .000147 ZOOZ 61 .00016~
198q 11Z .000301 1993-199~ 72 .000191 2003 52 .000137
1985 132 .000356 1995-1998 92 .O00Zq7 ZO0q ~Z .000110
1986 lOX .OOOZTq 1999 72 .000192
1987 101 .00027~ ZOO0 7Z .000192
--Interest is calculated
INTEREST = BALANCE OF
as folloes:
TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY 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.
REV-1470 EX (6-88)
· ~ INHERITANCE TAX
EXPLANATION
COMMONVVEALT" OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Miller, Roxie J. 2103-0979
REVIEVVED BY ACN
Daniel Heck 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
ROW Page I
BUREAU OF ZNDZVZDUAL TAXES
INHERITANCE TAX DTVZSTON
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
ZNHERZTANCE TAX
STATEMENT OF ACCOUNT
REV-I&07 EX AFP (02-03)
CHARLES E SHIELDS III
6 CLOUSER RD
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-01-200~
MILLER ROXIE
10-31-2003
21 03-0979
CUMBERLAND
101
lm°un'~'¢**'* 'R'iBm i '1: ~c edr'-'~
HAKE CHECK PAYABLE AND RE~T PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT I'I_O_USE
CARLISLE, PA 17013
J
NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his fore wit~your ~axpaymen~.
CUT ALONG TH/S LINE ~* RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03)
ESTATE OF MILLER
~ ZNHERZTANCE TAX STATEMENT OF ACCOUNT ~
ROXIE J FZLE N0.21 03-0979 ACN 101 DATE 11-01-Z00~
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAHED ESTATE. SHONN BELO#
ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED ZNTEREST FZGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-20-200~
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
8,9~9.86
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-Z6-200~
10-13-Z00~
CD003~82
REFUND
ZF PA/D AFTER THIS DATE~ SEE REVERSE
S/DE FOR CALCULATION OF ADD/T/ONAL INTEREST.
( ZF TOTAL DUE 1S LESS THAN $1~
NO PAYHENT 1S REgUZRED.
IF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR),
~7.~9
.00
11,~00.00
2,897.63-
TOTAL TAX CREDIT 8,9~9.86
~ALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCTTONS.
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money ardor payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND OCR): A refund of a tax credit, which wes not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-i31$). Applications are available at
the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Iq-hour
answering service far forms ordering: 1-800-36Z-ZOSO~ services for taxpayers with specie! hearing and / or
speaking needs: Z-880-q47-3gZO (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individua! Taxes, ATTN: Post Assessment Review Unit, Dept. IS0601, Harrisburg, PA 171Z8-060l, phone
(717) 787-6S05.
DISCOUNT:
Zf any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI) discount
of the tax paid is allowed.
PENALTY:
The 15X 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 and of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine Eg) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 19BI bear interest at the rate of
six (6Z) percent per annum calcuIated at a daily rate of .000164. A11 taxes which became daIinquant on and after
January 1, IgBZ wiI1 bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for Z98Z through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 lOX .O00Sq8 1988-1991 11X .OOO30l ZOO! 92 .000247
1983 16Z .000438 199Z 92 .000Z47 ZOOZ 62 .000164
1984 llg .000301 1995-1994 72 .00019Z 2005 5Z .000137
1985 13Z .000356 1995-1998 92 .000Z47 2004 4Z .OOOlla
1986 lOZ .oo0274 1999 72 .OOOlgZ
1987 92 .oooz47 ZOOO 8z .ooo219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) 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.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Rnx; p.1 M; 11 pr
Date of Death:
10-31-2003
Will No.
Admin. No. :n -03-0979
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
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.
account with the
Did the personal representative
Court? Yes~ No .
file a final
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state
account informally to the parties in interest? Yes
an
No X
"
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~ f3.~6
Signature .
Date:
1/11/0.,(
-"",
::::~
-')
co,
c,7.;l
c:::;::J
c--'
>:::':c.'::-,
I','"::
l...!":::"::-:"
d:l:~.;-
0...,
O:':;~"
0"
C:,
Charles E. Shields, III, Esquire
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
cry
~~.
L,1;:::::.
<",~j CI '
LLJ --.
C)
LL~~
~:::'~ '
(' .
.'
0...
fi:\
c -.~
! .:~:
\_--'
( ,
l;_"
c:
cry
(717 ) 766-0209
Te l. No.
Capacity:
Personal Representative
x
Counsel for personal
representative
J
(MAH:rmf/AM3)