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HomeMy WebLinkAbout03-0537Estate of Charlotte also known as , Deceased Leon M. Miller Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS P. Miller No. Social Security No. 164- 30- 3806 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 02/13/89 and codicil(s) dated 05/27/93 named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 2015 Messiah Village, Decedent, then 89 years of age, died 06/22 Upper Allen Township (liststreet, number, and municipalS) ~03,at Messiah Village, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as follows: (Location) 3o0,. ooo. oo Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this petition and the grant of letters in the appropri~-~=r~ to the undersigned: I . ~ ~-- kSignatur~e~ /I ~, Typedorprintednameandresidence Leon M. Miller 30 Walnut Drive, Wellsville, Pa 17365 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, inc. Form RW-1 (19911 Commonwealth of Pennsylvania County of Cumberland Oath of Personal Representative 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)~lnd that, asj3ersona~-r~presentative(s) of the Decedent, Petit'oner(s)will well and truly administer t~°%?~,-} ~'/'O Sworn to or affirmed and subscribed J ¢.-~ ' ~eon H. M{ller ~ -- before me thisj~u~.~ay of ~ ~ .(~%~or the R~,~.ter- '--- ~ L r"-- g .o. Estate of Charlotte P. Miller Deceased Social Security No: 164-30- 3806 Date of Death: 06/22/03 AND NOW, ~~ --] : ~,/,~00~,~3 ,~, , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~1 Testamentary ["--1 Of Administration (c.t.a.; d.b.n.c.ta.; pendente lite; durante absentia; durante minoritate) are hereby granted to Leon H. Miller in the above estate and that the instrument(s) dated 02/13/89 05/27/93 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Renunciation ........ $ Affidavits ( ) .... $ Extra Pages ( ) .... $ R'-;o .oO IZ.O q.oo Io, lO, co Attorney: Ja~ M. Wi y, q ' I.D. No: 06298 The Wiley Group Address: One S. Baltimore St. Codicil ........... $ JCP Fee .......... Inventory .......... $ Other ........... $ TOTAL ......... Prepared by the Pennsylvania Bar Association Dillsburs, PA 17019 Telephone: 717/432-9666 Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Ix)cai 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. ~' ~"~ ~'~' JUN 2 4 2003 2 7 8 0 9 3 No. ~ Date Charlotte 89 y~ Cumberland County ,,~ Post Master COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH . Miller [,.Female J,. 164 --30 -- 3806 J,. June 22, 2003 ,~S Postal Service ~ech~n~c~burs, PA 17055 James Hill ,~ Myrtle Burkholder ~Mr. Leon H. Miller · ~ 30 Walnut Drive, Wellsvtlle, PA 17365 ~ .... ~[,,~ June 2~, 2003 J~rant~am~ Memorial Park ,~rantham, PA 17027. 0 I ~N~. · , , o c~ ,). 0 i~,7,~,~,fj CODICI~ · I, ~ B. ~, of Upper Allen Town~hip, Cumberland County, Pennsylvania, declar% ~hi~ to be the sole Codicil to my Last Will dated February 13, 1989. T. I hereby revoke Paragraph VI of said Will and in lieu thereof provide as follow~: ·VIt. I appoin~ my husband, Harvey M. w{ller, hfs pla~. ~ ~e ~ ~t he fa~ ~ ~~ or ~ ~ a~ ~ ~, I a~~ ~ s~, ~1~ L. II. In all other respects, I hereby ratify, confirm and republish my Last Will dated February 13, 1989, together with this sole Codicil as and for~yLast Will. IN WITNESS ~OF, I have h~reunto set my hand th~s ~ ~ day of May, 1993. -- Signed, published and declared on the date t/lereof by the above named CHARLOTTE B. MILLER, as and for the sole Cod/cil to her Last Will dated February 13, 1989, An the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our na~e~ hereto. COMMONWEALTH OF PENNSYLVANIA : CO~ OF CUMBERLAND ~ -.a~e~_~ , the t~tatr~x and ~he witnee~ respeotively, Whose n~ ~e si~ed to ~e attaohed ~ f~oing ins~ent, ~ing first duly alfred, do h~y decl~e =o ~e ~ersign~ authority ~at ~e testa~ix si~ed and exe~t~ ~e i~st~t as ~e sole Codicil eo her Last Will ~d that she s~ed will~gly (o= willingly direotea ~o~er to si~ for her) , n~ ~at she.exe~t~ it as her free ~d vol~ta~ a~ for ~e p~os~ ~ereln e~essed, ~d ~t ~ of ~e wt~esses, in ~e Dresenoe and he.ring of' ~e testa~, signed the Codicil gn=een ye~s or age or older, of sold ~nd ~d ~der no co~a~t or ~e ~fl~nce. CUUICIL TO LAST WILL AND TESTAMENT OF CHARLOTTE B. MILLER GERALD J. BRINSER ATTORNEY-AT-LAW 100 Mt. Allen Drive Mechanicsburg, PA 17055 JUN 26 P1:04 WILL CHARLOTTE B. MILLER I, Cb. arlotte B. Miller, currently of Upper A].len Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I I direct tha? all my just debts and fur~ral expenses paid from the assets of my estate as soon as practicable after my {~emise. II. I direct that all estate and inhere[tahoe taxes that may be assessed in consequence of mi' death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in m,. taxable estate whether or not passing under this Will shall be free and clear thereof. !II. I bequeath unto my husband, Harvey M. Miller, all tangible personal property which I own at my death. IV All the rest res[due and remainder of my e..tate of whatever nat~.~re and wherever s~tuate, including property over which I hold a power of appointment, I devise and bequeath unto my husband, Harvey M. Miller. V. In the event that my husband, Harvey M. Miller, does not survive me, I devise and bequeath my entire estate that would have otherwise passed under' ~ar'agr'apbs III ~_~nd IV above as fol lows: A. Ten percent (]_0%) unt(~ Messiah Village, Mechanicsburg, Pennsylvania, to be t~.sed as it. sees best. B. Ten .t-:ercent (10%) unto Grantham Brethren in Christ Church, Grantham, Pennsylvania, to be :_~sed as it sees best. C. Ten percent (10%) unto Messiah Col 1 e~_~e, Grantham, Pennsylvania, to use as it sees best. D. All the rest, residue and remai, nder of my estate I devise and bequeath equally unto my children, namely, games H. Miller, Rona].d L. Miller and Leon H. Miller. If any s~-'~n predeceases me, his share shall pass unto his issue per stirpes. If he leaves no issue, said share shall laps~ and be added to [he shares passing to my other sons or their issue per stirpes. VI. I appoint my husband, Harvey M. Miller; Execut:©r of this my Will. In the event that he fails to qualify or ceases to act as Executor, I appoint my son, Ronald L. Miller, Executor in his place. In the event that he fails t,-~ qualify or ceases to act as Executor, I appoint my son, James H. ~filler, Executor in his place. In the event that he fails to qualify or ceases to act as Executor, I appoint my son, Leon H. Miller, Executor in his place. VII. I d-i. rect that no bond be required by my_ fiduciary Eot the faithful performance of his duties in any jurisdictio'n. IN WITNESS WHEREOF, I, Charlotte B. Miller, herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper including the attestation c]aus~ and signatures o~ witnesses, this ~5~ day o~ ~~~ , 1989. CHARLOTTE B. MILLE~ Signed by Charlotte B. Miller, by her declared to be her Wil~ in our presence, w~o have hereunto subscribed our names as witnesses in her presence and at he~ request, this ~ day of -2- COHHONWEALTH OF PENNSYLVANIA : : COUNTY OF C~-~-~-~£ ..... L : WE, Charlotte B. Miller, Id~-,o.=~,~ ~. t%or'~*'~ and [~,u=~r ~,~-~-~ , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing ~nstrumerlt, being first duly sworn, do hereby declare to the underslgned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed ~t as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing c~f the testatr:ix, signed the Will as witnesses and that to the best of our knowledge the ~estatrix was at that time ei.~[lhteen years o[ age or older~ of sound mind and under no constraint or undue influence. CHARLOTTE B. MILLER ~5TNESS [/ ~ ~ Subscribed, sworn or affirmed and acknowledged before me by Charlotte B. Billet, the testatrix, Ke~.~e~.. a~ {%,,...~ and ~,;xe~r 3 ~,~e~ , witnesses, t. his ta ~ da5~ of ~,~ , 1989. (SEAL) , f P .T.~LIC No.'mia! Soal Robert L. Fry, NoEry Pub!lc Upper Allen Twp., Cumbs~l~ncl County My Corn mission E×pir~ Aug. 19, 1991 -3- WILL OF CHARLOTTE B. MILLER BrlNSEr & WAGNER ATTORNEYS-AT-LAW 22 NORTH RAILROAD STREET P. O. BOX 323 PALMYRA, PENNSYLVANIA 17078 (717) 838-6348 '03 jUtl2i; 71 .L'~ CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Charlotte B. Miller Date of Death: June 22, 2003 Estate Number: ,~/~d.~ - ~..~---~ '7 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 July f0 ,2003: Nanle Address Messiah Village Messiah College Grantham B.I.C. Church Ronald L. Miller James H. Miller Leon H. Miller 100 Mt. Allen Drive, Mechanicsburg, PA 17055 Administration Office, Grantham, PA 17027 421 Grantham Rd., Grantham, PA 17027 Box 283, Crrantham, PA 17027 1216 Westhrooke Ct., Goshen, Indiana 46528 30 Walnut Dr., Wellsville, PA 17365 Notice has now been given to all persons entitled the!ye~der Rule 5.6 (a) except N/A. Date: July [0 ,2003 . . Name: Jan M. Wiley, Esquire Address: One S. Baltimore St. Dillsburg, PA 17019 Telephone: (717) 432-9666 Capacity: Counsel for personal Rep. Jan M. Wiley David J. Lenox Timothy J. Colgan Christopher J. Marzzacco September 16, 2003 THE VZILEY GROUP Attorneys at Law Wiley, Lenox, Colgan & Marzzacco, P.C. David E. Hershey Diana Woodside Bradley A. Winnick Jennifer L. Frechette Stephanie L. Mihalko Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 In Re: Estate of Charlotte B. Miller Number 21-03-0537 Dear Register: Enclosed please find a check from the Estate of Charlotte B. Miller in the amount of $13,595.00 for prepayment of inheritance tax. This payment is being made on an estimated estate as follows: $318,000.00 ~ 4.5% for a total tax of $14,310.00 less the 5% discount of $715.00 equals the payment of $13,595.00 Please remm a receipt to my office in the envelope provided. Thank you for your assistance. Sincerely, JMW/sdg encl. cc: Leon H. Miller, Executor 1 South Baltimore Street · Dillsburg, PA 17019 · Phone: (71 7) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426 Offices in Harrisburg · York · Carbondale www. wileygrou plaw. com THE XVILEY GROUP Attorneys at Law Wiley · Lenox Colgan · Marzzacco · P.C. 1 South Baltimore Street Dillsburg, PA 17019 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 I,,,llh,,llh,,,,,Ih,lhh,hl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ::)80601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003032 THE WILEY GROUP C/0 JAN M WILEY 1 SOUTH BALTIMORE STREET DILLSBURG, PA 17019 ........ fold ESTATE INFORMATION: SSN: 164-30-3806 FILE NUMBER: 2103-0537 DECEDENT NAME: MILLER CHAROLETTE P DATE OF PAYMENT: 09/18/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/22/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $13,595.00 TOTAL AMOUNT PAID: $13,595.00 REMARKS: LEON H MILLER, EXECUTOR,THE WILEY GRP, CANNOT READ POSTMARK SEAL CHECK# 501 INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Jan M. Wiley David J. Lenox Timothy J. Colgan Christopher J. Marzzacco November 25, 2003 THE ~TILEY GROUP Attorneys at Law Wiley, Lenox, Colgan & Marzzacco, P.C. David E. Hershey Diana Woodside Bradley A. Winnick Jennifer L. Frechette Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 In Re: Estate of Charlotte B. Miller, deceased File Number 21-03-00537 Dear Register: Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of $111.73 representing the tax due, and a check in the amount of $25.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. Thank you for your cooperation. Sincerely, /dg encl. cc: Leon H. Miller 130 W. Church Street, Suite 100 · Dillsburg, PA 17019 · Phone: (717) 432-9666 ° (800) 682-4250 · Fax: (717) 432-0426 Offices in Harrisburg ° York ° Carbondale www. wileygrou plaw.com COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003285 WILEY JAN M 1 S BALTIMORE STREET DILLSBURG, PA 17019 ........ fold ESTATE INFORMATION: SSN: 164-30-3806 FILE NUMBER: 2103-0537 DECEDENT NAME: MILLER CHAROLETTE B DATE OF PAYMENT: 11/26/2003 POSTMARK DATE: 11/25/2003 COUNTY: CUMBERLAND DATE OF DEATH: 06/22/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $111.73 TOTAL AMOUNT PAID: $111.73 REMARKS: LEON H MILLERC/O JAN M WILEY ESQUIRE SEAL CHECK# 506 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV - 1500 EX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128~601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 03 00537 I DECEDENT'S NAMI:: (LAST: FIRST: AND MIDDLE INITIAl_) .... :' Miller, Charlotte B. ~ i DATE OF DI:ATH (MM:DD-YEAR) ~ DATE OF BiR'FH (MM-DD-YEAFti ........ ~ ,?, !06/22/2003 01/28/1914 ¢3 :(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) original Re~Jrn COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 164-30-3806 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) [] f ~H ..... 12-31-91 and 1-1-95) ME Jan M. Wiley, Esq. ;FIRM The NAME Wiley(ii applicabie)Group TELEPHONE NUMBER 717/432-9666 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 1 S. Baltimore St. Dillsburg, PA 17019 (1) (2) (3) (4) (5) (6) (7) None None None None 130,497.91 None ' ' 256,588.25 (9) (10) .... : OFFICIAL USE ONLY 17,922.14 9,520.00 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) (8) 387,086.16 (11) 27,442.14 (12) 359,644.02 (13) 39,149.37 (14) 320,494.65 (15) 16. Amount of Line 14 taxable at lineal rate 320,494.65 x .045 (16) 14,422.26 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 14,422.26 20. [] Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: t · I STREET ADDRESS Messiah Village CITY Mechanicsburg STATE PA , i7055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 13,595.00 715.53 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 14,422.26 14,310.53 0.00 111.73 111.73 (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; .................................... c. retain a reversionary interest; or .................................................................................................................. d. receive the promise for life of either payments, benefits or care? .............................................................. 2.If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons derat on? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary des gnat on? ........................................................................................................ [] [] IF THE ANSWER_ __ TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tree1 correct and complete. Declaration of ~i+A~I~RE OF" PERSON RE~"~'~FOR FILING R.~,,]iURN j,/ ~N.AT.U.R~..OF PR_.EPARER OTHE~THAN REPRESENTATIV~ /l'a~ M. Wiley~, Esq. preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS DATE 30 Walnut Drive Wellsville, PA 17365 ~ ADDRESS 1 S. Baltimore St. Dillsburg, PA 17019 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 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. lhe statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 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 decedenrs lineal beneficiaries is 4.5% except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. ' The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 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 decedent, whether by blood or adoption. CODICIL County, Pennsylvania, declar~ thi~ to be the sole Codicil to my Last Will dated ~ebruary 13, 1989. I. I hereby revoke Paragraph vi of said Will and 'in lieu · thereof provide as follow~: II. In all other respects, I hereby ratify, confir~ and republish my Last Will dated February 13, 1989, together with th/s sole Codicil as and for my Last Will. IN WITNESS WHEREOF, I have hereunto set my hame this ~ '7 day of ~y, 1993. -- C~LLOT2E B. MILT]~ Signed, published and declared on the date thereof by the above n~ed CHARLOTTE B. MILLER, az and for the sole Cod/cil to her Last Will dated February 13, 1989, in the presence of us, who, at her request, in her presence, and in the presence of each other~ have subscribed our name~ hereto. COMMONWEALTH OF PENNSYLVANIA COUNT~ O~ CUMBERLAND respectively, whos~ n~ ~e s~e~ to ~ atta~ ~ forgoing ~~ent, ~ing ~st ~uly alfred, do h~y de=l~e _~ .... .~ ~e .~o~e _'coulcll t~. her s~eu wl~gly (or willlngly d~reote~ ~o~er to si~ for was at ~at t~e eighteen ye~s of age or o1~, of sold ~4 ~er no =o~a~t or ~e ~fluenca. WITNESS x WILl O ? C'HARI,C)TTK ~ ~a.n~ ~u~:tv Pennsylvania declare this and Testament ~ ':~r ~t- y ~ ;~l - - ..~- .... ~ revokinq any and .... ! t"~''~,''~c Wil ! s anc~ , - ....... : L ~!.d be assessed ].n oonsen'uence of m.,, death shall be paid principal of my general ~:~s+- '. to the same ef~-,~ t ;~s tlas~es were exDer~ses ,-~'~ admJnistra~-~ - .. ~,at..e whelThe~ or i]c: .... passiqq t~'ld~,l" T;~'iS Will be ~ree and clear thereof, V -rn th? .... ;.,il t:he, t m!,' h~,~sba!.~d, H4~, ,.e}.' ?~. Hi 'i. ler, ..... ' ............... :,- .......... .. ~.:,,~.~re es.~.,~. :. that WC,'L:iG h B V' e .... '~ ....... ' u,~,..n~: ¥,I se passed under' [',:;'~['~c~Naohs -[ TT :'~r r-! TV ?]%}r- ~'r~ :~.:; ~OZiOWS: namely, James !{. Milter~ Ronald L. Miller and Leon H. Miller. If any sor~ predeceases me~ his share pass ur~to his issue per stirpes~ !f .he leaves n<: issue, seid share shall laps:~ and be added to the shares passing ?o my other soY:s or their iss~e per stirpes. Vi, ! appoint:: m.y husband, Harvey M~ MJ~tler, Y:,:ecutof of ~' - ........ ..:.~ event that P~e fails ..................... - ........ ~.DDoi N f- B~%' son ~or~ ..... ' ...... . ....... ;~,._z.~ex , Bxecut. or ir_ his place, in the event that be fails t.::, qualify 8c~ as m>~eo[~t()'r' i appoint my oc.. James H his X;,lace !r, t~''~'' ~v~pt ~,;; fy na:ncl +.-, t:h2s ~'rv , .... b, Wi]i ~ .... ,_: two { o~-~,,~ papeF i nc! ut~.[.i:~g tlhe a t:llleS t ation c! a-use and si :¢nattt~res wit:nesses, ~",~ '5~ CHARLOTTE B. MiLLE~ Signed by C. haxq. otte B, Miller', by her declared t) be her Will in c.~r presence, who have heret:~nto s:bscribed (::,rjr names wit'nesses :{.r~ her presence and at he~7 request, th:~s t3~s day -2- ....................... ~.~.~ OF PENNSYLVANIA WE,. Charlotte B. H:i. ile.~:, ~d~., .... .?~,. B ~,~-~ , the testatrix anc~ the witnesses, respectively, whose "~'~ qioned to ~h .... attach~,d or e~' ~ ,-.~ first duly sworn ,~-- ~. ~ +- ..... , -.~ h=r ..... ~ declare ~..o the unier~i n~d that the testatrlix signed and executed the i~strument as her Las~ Will and that she signed willingly {or willingly directed another to sign for hel') , end that. she exect!t:ed itl as her' free and voluntary act ~o:r the pnrposes ther'ein expresse,t, and That each ~'" ~::i as witnesses and that to the best of o~r S i. ~ ~ ..... : ......... knowledge th~ [esta- o'_der, of sound mind and under n,::~ ~c,--, 't.r'aint ~'~r- ~' WiE~NFJSE, - ..................................... Subscribed, sworn or affirmed and ack~'tow2edged before me bv (PE,IL~ ~ UbLtC ~ ...... Robert L. F,S,, No.fy Pub!ic Upper NIcn Twp., Cumberland Count~ My Commission Expires Aug. 19, 1991 -3- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Charlotte B. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 - 03 - 00537 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 2 4 5 6 7 DESCRIPTION Wienken & Associates MML Investors Services Brokerage Account: Pharmerica (refund): Citizens Bank Checking Account #6100706222: Citizens Bank Time Deposits Account #6140694671: Commonwealth of PA (refund): Federal Income Tax (refund): Discover Bank (Certificate of Deposit): TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 108,556.86 29.19 5,322.88 1,350.27 128.29 5,211.00 9,899.42 130,497.91 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ITEM NUMBER Miller, Charlotte B. This schedule must be completed and filed if the answer ~ DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer, Attach a copy of the deed for real estate. 1 I Wienke~ & Associates Mass Mutual Odyssey'Annuity: -- ' (3 children beneficiaires) Wienken & Associates Mass Mutual Pan Passage Annuity: (3 children beneficiaries): Wienken & Associates Lincoln Benefit Annuity: (3 children beneficiaries) Federal Government Benefits: (3 children beneficiaries) FILE NUMBER 21 - 03 - 00537 to any of questions 1 through 4 on pa$.~ 2 i~es. DATE OF DEATH % OF _. _ ~ VALUE Of ASSET DECD'S I(iEFXACppLLUicSAIBOLEN~ I TAXABLE VALUE [INTEREST ~' -'l 32,016.13 100% i 32,016.13 169,040.29 44,443.08 11,088.75 100% 100% 100% TOTAL (Also enter on line 7, Recapitulation) 169,040.29 44,443.08 11,088.75 256,588.25 COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Charlotte B. SC~.EXJLE H ~EXPENSES& ADr~I~-"TRATIVE COSTS FILE NUMBER 21 - 03-00537 Debts of decedent must be reported on Schedule I. iTEM NUMBER A. l j FUNERAL EXpENSE~:' i Cocklin Funeral Home: ADMINISTRATIVE COSTS: Personal Representative's Commissions DESCRIPTION AMOUNT 8,592.74 Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Wiley, Lenox, Colgan, & Marzzacco, P.C. Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills: State ~ Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal (advertise): The Sentinel (advertise): Vernon Martin, CPA: Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 7,222.11 317.50 415.00 75.00 102.11 1,197.68 17,922.14 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Charlotte B. Filing Fees: ~H Funeral Exl3enses & Admin~ ~ (xx~nued 1 Citizens Bank (check fee): Verizon: Pharmerica (prescriptions): PSERS Health Options Program: Union Central Life Insurance (return of payment): FILE NUMBER 21 - 03- 00537 / 25.00 30.42 10.70 332.45 476.00 323.11 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Charlotte B. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 - 03 - 00537 Include unreimbursed medical expenses. ITEM NUMBER 1 Messiah Village (rent): PA Dept. of Revenue (state income tax): Messiah Village (balance due): DESCRIPTION TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 5,799.00 108.00 3,613.00 9,520.00 REV-1513 EX+ (9-00) ~, ~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Miller, Charlotte B. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY L TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Ronald L. Miller Box 283 Grantham, PA 17027 James H. Miller 1216 Westbrooke Ct. Goshen, IN 46528 Leon H. Miller 30 Walnut Drive Wellsville, PA 17365 FILE NUMBER 21 - 03 - 00537 RELATIONSHIP TO ~ DECEDENT Do Ne~t List Trustee(s) son ~son son AMOUNT OR SHARE OF ESTATE one-third of residuary estate one-third ofresiduary estate one-third ofresiduary estate II. Enter dollar amounts for distributions shown above on lines 15 through 18, 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 lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Messiah Village, Mechanicsburg, PA: Grantham Brethren In Christ Church, Grantham, PA: Messiah College, Grantham, PA: 13 OF REV 1500 COVER SHEET TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE - , 13,049.79 13,049.79 13,049.79 39,149.37 214 Senate Avenue, Suite 303 ~,, Camp'Hill, Pennsylvania 17011 717-763-7365 · 717-763-5569 Fax 1-888-359-7718 Toll Free acarr@finsvcs.com WIENKEN&ASSOCIATES Financial Services Allen W. C~,rr, CLU, ChFC, MSF$ Certified Family Business Spec~biist September 15, 2003 Mr. Leon Miller 30 Walnut Drive Wellsville, PA 17365 Dear Mr. Miller: As you requested, the following are the values as of June 22, 2003 (date of death) on your mother's investments: Mass Mutual Odyssey Annuity - Mass Mutual Pan Passage Annuity - Lincoln Benefit Life Annuity - MML Investors Services Brokerage Acct - $ 32,016.13 $169,040.29"~ $ 44,443.08 $108,556.86 Enclosed please find a copy of the August statement for the new brokerage account (#APJ-190659) in the name of Charlotte Miller Estate. You should begin receiving monthly statements for this account. As we discussed this morning, I am in the process of obtaining the distribution information for your files. I will forward this information upon receipt. Should you need additional information or have any questions, please feel free to contact us at 763-7365. Your kind attention is appreciated. Sincerely yours, Monica S. Wright Administrative Assistant Enclosure ',: Securities and investment advisory services offered through MML Investors Services, Inc., · 214SenateAvenue, Suite303, CampHilt, PA 17011 · 717-763-7365 CITIZENS BANK Account Number Account Title Date Opened Account Type Principal Balance as of DOD Interest from Last POsting to DOD 6100706222 CHARLOTTE B MII,LER 06/06/1966 Checking $5,322.88 $0 Account Balance as of DOD $5,322.88 YTD Interest to DOD $13.33 CITIZENS BANK Account Number 6140694671 Account Title CHARLOTTE B MII,LER Date Opened 02/11/1995 Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD Time Deposits $0.46 $0 $0.46 YTD Interest to DOD $11.53 P~01×01 Command ~=~> STI2 ACCOUNT HISTORY INFORMATION Account 00006140694671 Ctl2 060 Ct13 000 Ctl4 000 Ctll 01 Prod Type 312 12 MONTH CD (1 YEAR) Name CHARLOTTE B MILLER SEQ BATCH TRAN 00793 90294 0304 00794 90294 0302 PF1-Fwd PF2-Bkwd STPCI2S1 ST0048 I: FIRST PAGE 11/zo/o3 15:32:25 AMOUNT / SVC C~G/ RATE DATE DESCRIPTION TAX/RA 1.27 C 07/11/02 01 INTEREST EARNED 1.97 C 08/11/02 01 INTEREST EARNED 2.470000 08/09/02 INT RT CHG 1.734900 2.470000 08/09/02 REN 081102 TRM M 012 OLD TYP 901 INTF~REST EARNED INTEREST EARNED INTEREST EARNED INTEREST EARNED INTEREST EARNED INTEREST EARNED INTEREST EARNED INTEREST EARNED INTEREST EARNED LAST 2.80 c o9/11/o2 ol 2.72 C 10/11/02 01 2.11 c 11/11/o2 Ol 2.73 C 12/11/02 01 2.83 C 01/11/03 01 2.83 c 02/11/03 Ol 2.56 C 03/11/03 01 2.85 C 04111/03 01 8.14 D 04/16/03 n-~_~..~6c 04/16/03 01 ~1350.~?_/0 0~/~6/03 PF12-Hel]~-~-Z~rompt Conh~and ----~=> STI2 ACCOUNT HISTORY INFORMATION Account 00006140694671 Ctl2 060 Ct13 000 Ctl4 000 Ctll 01 Prod Type 312 12 MONTH CD (1 YEAR) Name CHARLOTTE B MILLER SEQ BATCH TRAN 00619 90319 0302 AMOUNT / RATE DATE DESCRIPTION 1.000000 08/11/03 INT RT CHG 2.470000 1.000000 08/11/03 P~N 081103 TRMM 012 0.00 10/08/03 INTEREST ADJUSTMENT 0.46 D 10/08/03 li/2o/o3 15:32:4§ SVC CHRG/ TAX/RA PF1-FWd PF2-Bkwd PF12-Help STPCI2S1 ST0047 I: LAST PAG~ PA2 -Prompt LAST TOTAL PAGE.O1 ~ Jl-JlJ~lllJJllllJ~l~JlJlll~lJJJllllllJJlJlJllJilJJ 1~ SBCDRAO! 0001985 CHAELOTTE B HZLLEE PO BOX 20t5 55~ HESSZAH VZLLAGE HECHANZCS~URG PA 17055-2015 CD Account Quarterly Statement March 18, 2003 to June 16, 2003 DISCeVER BANK Summary Page 1 of 1 Account number 303-001-0331803 Issue date ......................................... September 10, 2002 Maturity date ........................ '. ......... September 10, 2003 CD Account Term .............................................. 12 months Interest payment plan ........................................... reinvest Interest paid year to date ....................................... $94.71 Beginning balance .............................................. $9,840.44 Current balance ................................................... $9,888.43 Interest rate ................................................................ 1.93% Annual pel:centage yield earned ............................... 1.95% Interest accrued but not paid .................................... $3.66 Interest paid during statement period ........................................................................................................................... $47.99 Annual Percentage Yield Earned is based on the following information: Days in interest payment period ................................ 92 Average daily balance ........................................ $9,856.94 Interest F..arned during interest payment period 3/10/2003-6/9/2003 ................................................................ $47.99 Account Activity Mar 18 BEGINNING BALANCE ................................................................................................................ $ Apr 9 INTEREST PAYMENT CREDIT .................................................................................................... + 9,840.44 May 9 INTEREST PAYMENT CREDIT 16.14 Jun 9 INTEREST PAYMENT CREDIT ...................................................................+ 15.65 Jun 16 ENDINGSALANCE ................................................................................ + 16.20 ...................................................................................................................... $ 9,888.43 Announcements OPEN A NEW DISCOVER CD ACCOUNT TODAY! Discove~- Bank gives you: GREAT RATES - consistently high week after week. SECURITY - Over $20 billion in assets, a bank th~t~s been around since 1911, and FDIC Insurance. CONVENIENCE- Open an account without leaving home, call 1-800-347-7000 or visit Discoverbank.com, Mention code SM2OO3P. Questions? call 1-8oo.347.7ooo Or write to: Discover Bank, General Correspondence, P.O. Box 7112, Dover. DE 19903-9955 For TDD (Telecommunications Device for the Deaf) assistance only, please ca I 1-800-347-7454 ,L~A. re^CH ^T ~rr~, .,.~ ^,o~;~' ............................................. Account number 303-001-0331803 Please send me the following: CHARLOTTE B MILLER PO BOX 2015 53g MESSIAH VILLAOE MECHANICSBURG PA 17055-2015 [] Discover Money Market Account Information [] Discover CD Account Information Please mail this form to: Discover Bank General Correspondence P.O. Box 7112 Dover, DE 19903-9955 s Register of Wills of Cumberland County, Pennsylvania Estate of Miller, Charlotte B. also known as INVENTORY , Deceased No. 21 - 03- 00537 Date of Death 6/22/2003 Social Security No. 164-30-3806 Leon H. Miller The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/VVe understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: I.D. No.: Personal Represer~ti~ Jan M. Wiley, Esq. Signature' ./_~ /q/, ~"./ /~/.~ geoffH. Miller 06~98 ........ Signature: Signature: Address: 1 S. Baltimore St. Dillsburg, PA 17019 Address: 30 Walnut Drive Wellsville, PA 17365 Telephone: 717/432-9666 Personal Property Telephone: 717-432-9407 Dated: ///~:~ z///l~ .~.- - f f Wienken & Associates MML Investors Services Brokerage Account: Pharmerica (refund): 108,556.86 29.19 Citizens Bank Checking Account #6100706222: Citizens Bank Time Deposits Account #6140694671: Commonwealth of PA (refund): 5,322.88 1,350.27 128.29 Federal Income Tax (refund): Discover Bank (Certificate of Deposit): Total Personal Property 5,211.00 9,899.42 $130,497.91 (Attach additional sheets if necessary) Total Personal Property and Real Estate $130,497.91 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Charlotte B. Date of Death: 06/22/2003 Will No. 21-03-00537 Miller Admin. No. 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: If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No Date: d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Jan M. Wi l~v. Esouire Name (Please %/15e or 15rint) 1 30 W. Church St., Suite 1 00 Address Dillsburg, PA 1 701 9 .(,717) 432-9666 Tel. No. Capacity: Personal Representative Counsel for personal representative BUREAU OF INDIVIDUAL TAXES TNHER/TANCE TAX DZV/SION DEPT. 280601 HARRISBURG, PA 17128-0601 JAN H WILEY ESQ THE WILEY GROUP I S BALTIMORE ST DILLSBURG COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF /NHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR D/SALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ~ : gC OF DATE ~'~ ' Oi \'~JillS ESTATE OF DATE OF DEATH FTLE NUHBER FEB25 AS:30COUNTY ACN PA 170[[~l~bSiiA~'~ C-O., PA 01-12-200~ HILLER 06-22-2005 21 05-0557 CUNBERLAND 101 Amount Remitted REV-lSd? EX AFP (01-05) CHARLOTTE P HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LTNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHERTTANCE TAX APPRATSEHENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF HILLER CHARLOTTE P FZLE NO. 21 03-0537 ACN 101 DATE 01-12-200R TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHAN~ED RESERVATION CONCERNING FUTURE ZNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B} {2). 3. Closely Hold Stock/Partnership Zntorost (Schedule C) ($) 4. Nortgagos/Notos Rocoivablo (Schodule D) (~) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) ($) 6. Jointly O~ned Property (Schedule F) (6) 7. Transfers (Schedule O) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expenses/Ado. Costs/Nisc. Expenses (Schedule H) (9) 10. Dobts/Hortgago Liabilities/Liens (Schedule 1) (10) 11. Total Deductions N®t Value of Tax Return 1501497.91 .00 .00 NOTE: To insure proper .00 credit to your account, .00 sub,it the upper portion .00 of this fore ~ith your tax payment. 256;588.25 (8) 387,086.16 17,92Z.1~ 15. 1~. NOTE 9,520.00 (11) 27.~2.1R (12) $59,6~.02 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) $9,1~9.$7 Net Value of Estate Sub~ec~ to Tax (1~) ~20,~9~.65 Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill reflect figures that include the total of ALL returns assessed to date. (15) .00 X 00 = .00 (16) 520,fi94.65 X 0~5= lq,fi22.26 (~7) .00 X 12 = .00 (18) .00 x 15 = .00 (19)= 14,~22.26 ANOUNT PAZD 13,595.00 111.75 TOTAL TAX CREDIT BALANCE OF TAX DUEI ZNTEREST AND PEN. TOTAL DUE ASSESSHENT OF TAX: 15. Amount of Line 1~ at Spousal rate 16. Amount of Line lq taxable at Linoal/Class A rate 17. Aeount of Line 1~ at Sibling rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYNENT RECETpT DTSCOUNT {+) DATE NUNBER INTEREST/PEN PA]:D (- 09-18-2005 CDO0$O~Z 715.53 11-25-2005 CD005285 . O0 1~,~22.26 .00 .00 .00 ( TF TOTAL DUE IS LESS THAN $1~ NO PAYNENT IS RE~UTRED. TF TOTAL DUE TS REFLECTED AS A "CREDTT" {CR)~ YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF TH/S FORH FOR TNSTRUCTTONS.) ZF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZT/ONAL INTEREST. RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (coIletaraI) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commoneaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class S (collataral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Rills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, ehich ems not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Rills, any of the Z3 Revenue Oistrict Offices, or by ceiling the special Iq-hour answering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers with specie! hearing and / or speaking needs: 1-800-~q7-30ZO iTT onIy). Any party in interest not satisfied eith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --mrittan pretest to the PA Department GE Revenue, Board of Appeals, Dept. 28lO[l, Harrisburg, PA 171ZS-1OZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Oept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6SOS. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOl) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is allowed. The lex 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. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date 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 .00016q. A11 taxes ehich became delinquent on and after January 1, 1982 will bear interest at a rate which wili vary from caLendar year to calendar year with that rate announced by the PA Department of Revenue. The applicabZa interest rates for 198Z through ZOOS ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .0005q8 1987 92 .O00Zq7 1999 7Z .00019Z 1983 162 .000fi38 1988-1991 112 .O00SOX ZOO0 8Z .O00219 198~ llZ .000301 199Z 9Z .0002q7 2001 9Z .OOOZq7 1985 132 .000356 1993-199~ 72 .O0019Z ZOOZ 6Z .00016~ 1986 IOZ .O00Z7q 1995-1998 92 .O00Zq7 2003 5Z .0001~7 --Interest is calculated INTEREST = BALANCE OF as follows: 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. Zf payment is made after the interest computation date shown on the Notice, additional interest must bm calculated.