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This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
AUG 1 ~ 20p~
Date
S f
Fran eropoli, ct
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNBYLI~NM • OEPMTMENT OF HEALTH • VITAL nECOaos ~ 3 6 $ ~ 6
CERTIFlCATE OF DEATH
ti
I, FLOYD R. MILLER, of the Township of North Middleton,
County of Cumberland and Commonwealth of Pennsylvania, being of
sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament,
hereby revoking and making void all former wills and codicils by
me at any time heretofore made.
c,
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executor, hereinafter named, as
soon as conveniently may be done after my decease.
SECOND. I give and bequeath the sum of One Thousand
($1,000.00) Dollars unto my friends, namely, JOHN RUPP and
PAULINE RUPP (or either of them in the event that one should
predecease me), absolutely.
THIRD.\`:I give, devise and bequeath all the rest, residue
and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situated, unto THE CHURCH OF GOD HOME, INC., of
the East Pennsylvania Conference, absolutely and in fee simple.
LASTLY. I nominate, constitute and appoint my attorney,
RICHARD C. SNELBAKER, Esquire, to be the Executor of this, my
Last Will and Testament, but if for any reason he should fail to
'qualify as such Executor or cease so to serve, then and in that
event, I nominate, constitute and appoint KEITH O. BRENNEMAN,
Esquire, to be the Executor hereof, each and both to serve
without bond or other security as a condition of qualification
hereunder.
IN WITNESS WHEREOF, I, FLOYD R. MILLER, have hereunto set
Amy hand and seal to this, my Last Will and Testament which
consists of two (2) typewritten pages to each of which I have
affixed my signature this 24th day of January A.D., One Thousand
Nine Hundred Ninety-four (1994).
~`'~~G / j (SEAL)
F oyd R. M ller
The preceding instrument, consisting of this and one (1)
other typewritten page, each identified by the signature of the
Testator, was on the date thereof signed, sealed, published and
declared by FLOYD R. MILLER, the Testator therein named, as and
for his Laet Will and Testament, in the presence of us, who, at
his request, in his presence and in the presence of each other,
have subscribed our names as witnesses hereto.
1. ~ ... _ . , ~ ~...,,
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SNELBAKER
6
BRENNEMAN
-2-
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND ~ SS.
We, FLOYD R. MILLER, JANET R. STEGNER and CATFIARINE E.
BOUSUM, the Testator and the witnesses, respectively, whose names
are signed to the attached or foregoing instrument, being first
duly sworn, do hereby declare to the undersigned authority that
the Testator signed and executed the instrument as his Last Will
and Testament and that he had signed willingly, and that he
executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
'presence and hearing of the Testator, signed the Will as a
witness and that to the best of his or her knowledge the Testator
was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
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Testator
/ Y- W~tness.~
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Witness
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SNELBAKER
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BRENNEMAN
Subscribed, sworn to and acknowledged before me by FLOYD R.
KILLER, the Testator, and subscribed and sworn to before me by
TANET R. STEGNER and CATHARINE E. BOUSUM, witnesses, this 24th
day of .;anuary, 1994.
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Notary Public
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My Corr Dec.81,1981
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REV-1500 EX'+ (7.9~)
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~;~ ,~ INHERITANCE T ETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE
DEPARTMENT OF REVENUE WITH REGISTER OF WILLS)
DEPT. 280601
HARRISBURG, PA 17128.0601
DKEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAu DECEDI
~ MILLER FLOYD ~'
W SOCIAL SECURITY NUMBER DATE OF DE DATE OF BIRTH
183-12-2833 ~ 4 19 9 10 20 cDU~
p (IF APHICABLEI SURVrviNG SPOUSE'S NAME MAST, FIItSi AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER /
FOR DATES OF DEATH AFTER 14131 1{91 CHECK HEE
IF A SPOUSAL
POVERTY CREDIT IS CLAIMED ^
Flu NuMSER
21 1995 0313
COUNTY CODE YEAR NUMBE
COMPLETE ADDRESS
Church of God Home
801 North Hanover Street
~C.arlisle,,PA 17013 i* '""`
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Original Return
^ 2. Supplemental Return 1
^ 3. Remainder Return '
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^ 4. Limited Estate
^ 40. Future Interest Compromise
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f (for dates of death prior to 12-13-8:
^ 5. Federal Estate Tax Return Required
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ter 12-12-82)
~ Decedent Died Testate
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ll ^ 7. Decedent Maintained o Living Trust ~8. Total Number of Safs De
osit B
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copy o
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(Attach copy of Trust) p
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rsss. a.uscscs:~rVnDENGi: AND GvNFIDENTIAL TAX' INFORMATION SHOULD: $E DIRECTED TO: - - `- •~ .-
z NAME Richard C. Snelbaker, Esquire / COMPLETE MAILING ADDRESS
c°aS TELEPHONE NUMBER ~ West Main Street
717 697-8528 / Mechanicsburg, PA 17055
1. Real Estate (Schedule A) (1 )
2. Stocks and Bonds (Schedule 8) _ 290 00
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) (4 )) 7~'
5. Cash, Bank Deposits 8 Miscellaneous Personal Property y~'- 1 ~
0$7 ~i4
_ (Schedule E) /~ ' ,
~°-_ b. Jointly Owned Property (Schedule F) (b )
~ 7. Transfers (Schedule G) (Schedule L) (7 )
~ 8. Total Gross Assets (total lines 1-7) (8) T ~~
377 64
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H) ,
12,774,21
1 0. Debts, Mortgage Liabilities, liens (Schedule I) (10)
11. Total Deductions (total Lines 9 8 10) (11) 72,4 27
12. Net Value of Estots (line 8 minus line 11) (12) 1113,603.43
13. Charitable and Governmental Bequests (Schedule J) (13) T U2,fin3 U~
14. Nst •lalue Subject to Tax (Line 12 minus Line 13) (14) 1,000.00
15. Spousal Transfers (for dates of death after b-30-94)
See instructions for Applicable Percentage on Reverse
Sid I l d I f (15) x. _=
z
0
f=
0
v
x
t is
e. (nc u e va uea ram Schedule K or Schedule M.)
16. Amount of Line 14 taxable at 696 rate (16)
(Include values from Schedule K or Schedule M.) x .06 =
17. Amount of Line 14 taxable at 1596 rats (17) 1,000.00 X
15 = 150
00
(Include values from Schedule K or Schedule M.) .
.
18. Principal tax due (Add tax from Linea 15, 16 and 17.) (18) 150 00
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ + - (19)
20. If Line 19 is greater than Line 18, enter the difference on line 20. This is the OVERPAYMENT. (20)
~C ..
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 150.00
A. Enter the interest on the balance due on line 21A. (21A)
B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21 g) _ 7 50 00
Make Check Payable to: Register of Wills, Agent
~ `~- BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE'AND TO RECHECK MATH ~ ~
s of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
7 and complete. I declare that all real estate has been reported at true market value
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fosmakCtt`of which preparer has any knowledge. preparer other than the personal representative is
44 West Main Street
~rsri,u~u15 tt 1VElIlAN, P.C. -'---~' •° i""•'
~.._ ~ , ~_ _ , 44 West Main Street
`~ Mec:hanicsbure _ PA 17055
DATE
GATE
~~/~ ~~'
Act X48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
• 39'6 (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 29'6 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 196 (.O1) will be applicable for estates of dee~derKs dying on or after 1/1/97 and before 1/1/98
• Spousal transfers occurring on or after 1 /1 /98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (r) IN THE APPROPRIATE BLOCKS.
YES NO
X
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, .......................................................
x
b. retain the right to designate who shall use the property transferred or its income, . ..............
x
c. retain a reversionary interest; or ................................................................................... ~ x
d. receive the promise for life of either payments, benefits or care$ .......................................
x
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate considsration$ If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving x
adequate consideration$ ...................................................................................................
x
3. Did decedent own an 'in trust for'. bank account at his or her dsath$ ......................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE, G AND.. FI~ IT AS PART OF THE RETURN.
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REV-1503 EX+ (4-86) r
MILLER, FLOYD R
SCHEDULE B
STOCKS AND BONDS
21-95-0313
(All prop~rfy jointly-owned with Right of Survivorship must b~ diselos~d on Sch~dul~ F.)
ITEM
NUMBER DESCRIPTION
~• 29 shares, Cumberland Valle Coo
y perative Association, Preferred
stock, fully paid non-assessable, valued at $10.00 per share
---.--_ _ TOTAL (Also enter on line 2, Recapitulation) I $
VALU E AT DATE
OF DEATH
$290.00
0_on
i, ~ ',
REV-1SOBEX+Is-871 SCHEDULE E
CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT oECEeENT Please Print or
:STATE OF __ _
MILLER, FLOYD R 21-95-0313
(All propeefy IoiMlyovvsud Wills ~ Ri,ihf of Survivorship must be dhuiwed on Sehodule Fl
ITEM
NUMBER DESCRIPTION VALUE AT
1 Certificate of Deposit, No, 0413220026328, PNC Bank N
A
2
Interest on Certificate No. ,
0413220026328 .
.
3 Certificate of Deposit, No. 0413240031732, PNC Bank N.A
4
Interest on Certificate No. ,
0413240031732 .
5 Certificate of Deposit, No. 0413240050153, PNC Bank N.A
6
Interest on Certificate No. ,
0413240050153 .
7 Certificate of Deposit, No. 0413240060426, PNC Bank N.A
8
Interest on Certificate No. ,
0413240060426 .
9 Certificate of Deposit, No. 0413240073213, PNC Bank N.A
10
Interest on Certificate No. ,
0413240073213 .
11 Certificate of Deposit, No. 0413200173041, PNC Bank N.A.
12 Interest on Certificate No. ,
0413200173041
13 Certificate of Deposit, No. 0413200173042, PNC Bank N
A
14
Interest on Certificate No. ,
0413200173042 .
.
15 Certificate of Deposit, No. 0410900186478, PNC Bank N
A
16
Interest on Certificate No. ,
0410900186478 .
.
17 Checking Account X5070082542 , on deposit at PNC Bank N
A
18
Interest accrued on checking ,
accaant IIE5070082542 .
.
19 1982 Pontiac Sedan automobile, valued at sale price
20 Household goods, retained by Church of God Home, on
appraisal by Chuck Bricker , Auctioneer
21 Household goods, sold at public sale by Chuch Bricker
22 Church of God Home, refund of equity in apartment
23 Cash, delivered by Church of God Home, Prom Mr. Miller's
personal account
24 Cash, recovered from apartment clean-up
25 Capital Blue Cross, refund of medical premium
26 Patriot-Nexs Company, refund of subscription
TOTAL (Also enter on line
DATE OF DEATH
6,000.00
63.58
5 ,000.00
55.89
16,000.00
2.32
5,000.00
33.80
16,000.00
12.80
10,624.66
20.96
10,624.66
20.96
10,000.00
245.83
32,608.25
3.58
1,575.00
970.00
825.00
39,634.48
629.08
2.29
127.20
7.30
(Attach additional 8Yi" x 11" sheets if more space is needed.)
gsv.istl ax-,P•u-
scNEOU~~H -
~~ FUNERAL EXPENSES,-
AlTMI Ot' -9dNSYlYANIA ADMINISTRATIVE COSTS AND
ANCE TAX RETURN MiSCf:LLANECUS EXPENSES
LENT DECEDENT
MILLER, FLOYD R.
ITEM
NUMBER
A.
B.
c.
1
2.
3.
4.
1.
2.
3.
4.
S.
6.
T.
8.
9.
Funeral Expen:•s:
DESCRIPTION
Pled Print or Typo
21-95-0313
-_____
AMOUNT
Administrative Costs:
Personal Representative Commissions Richard C. Snelbaker _
Social Security Number of Personal Representative; _ 168 26 631
Year Commiss~orois ~ aid ] 996
IAttorny Fee, Snelbaker A Brenneman, P, C,
Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Srreet Address
C'h' State Zip Cod
Probate Fins Register of Hills, Cumberland County
Miscellaneous EYpenses:
Register of Wills, filing Pee this return
Patriot-News Company, advertise Executor*s notice
Cumberland Law Journal, advertise Executor's notice
Chuck Bricker Auctioneer, commission public sale
Chuck Bricker Auctioneer, appraisal fee household goods
Shermansdale Family Practice, medical services
I
~ Patient Accounting Service, medical services
i Young's Medical Equipment, final monthl
y equipment rental
Reserve Por filing fees, taxes, etc.
TOTAL Also enter on line 9, Recapitulation} $
(If more space is needed, insert additivna) sheets of terms size.}
7,800.00
3,900.00
106.00
15.00
66.34
40.00
270:00
20.00
57.70
20.00
29.17
450,x00
.21
SCHEDULE .1
°°""'°'''"~"'"°"`""""~"eA OENEFiCIARIBS:
~~;
ESTATE OF
FELE NUMBER
1KILLER, FLOYD R .
21-95-0313
ITEM
NUMBER NAME AND ADDRESS OF BENEFIQARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. Taxoble 8equats:
~• John Rupp and Pauline Rupp
RDi#2, Franklin Church Road NONE $1,000.00 per Item
Dillsburg, PA 17019 u~ Second of will
l~ ~
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR
SHARE Of ESTATE
B. Charitobie and Gowrnmenta) Bequem:
1• Church of God Home, Inc, of the Eastern PA Conference
801 North Hanover Street 100x of the residue
Carlisle, PA 17013 as per Item Third
of the will
TOTAL CHARITABLE AND GOVERNMENTAL BEG~UESTS (Also enter on line 13, Recapitulation) IS 142,603 43
(If more :pace ~s needed, insert additional sheets of same size)