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HomeMy WebLinkAbout95-0349_ _ _ 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 16 200 Date H105.7 r3 qty. yBT nPEnHIBIT M' PERMANENT NAh1E BLACK NIK ,- ~h 0 Z Dw. (v I Vtn._,M+seucmwmd+•rSt.I Nour t wear IMtM.D•r.wt) sworcaagnLalmay) t Nom rr. ~ ~ ~ 5 - 3 ~ ~ ~ ~ ~ 1P°'r t I avrrd ^ ERlOyba,aat ~ • • ' S DDA ^ ~ FOERN T. t N " CDY,BDIIO, TNIP DF OFAM FAClIIY NAME pnr.rN,p., 9aawM anO nuMr1 , ^ - R•uCNtca^ Dauphin ~ Derry Twp. Kiversity. Hospital-Hershey Med Ctr YMSDECEDEMDF NIBPA,ACDIBBN„ H b^R~ ~QAaR NMa.kr® RACE •AmwltanM '~°•`"' BENTS USUAL PRIDN . IDNOOreu BBESSAMOUS7RY . L s. 'vJ V.;te_ aNnOd.otF Catrt~aq mot, aarMq Ca lrlurtailaa) =r'"N ~ U 2.(~-~..rG 6' YUSMFpgCEB,N DECEDENTS EDUCIQgN yXrypU SDWS ~~ ~ 10. a)C,?_1 /'1ikTOA..ri~.0 TX 11~If c T? V 1fe~ M.I7 Co4B. pyr~e.e~j9p,t~~' N D Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYW/WIA • DEPARTMENT OF HEALTH • VITAL RECORDS Gl ~ ~ 1 J p CERTIFICATE OF DEATH 1 Q ~ (~ MiCW. Laq 340E FNF lAINSFJI -{ Jy~ . /1'~ . socuL sECURm NoMSER o.y.'ArI _J 0.N'~Q 5 n P_ r SE% DRE OFDERHIMOryI, ~,~ ~~~~ ~~~ _ ,J~'l0.~¢. = / `l2 - 2(0 - 3~to 2 a April 28, 1995 ,,,,r,a BIRTIiLACBICiIyaaE PIACioPDE,vNIrAral ``s~~,~ l-1,' 1 ! e.re< ~ ~r. ~ '_~• RESIDENCE ,TaStaM I ,a y~lOrYV)~P.t.1S~Ol.I!T~j P~ !'~04-3 tnrn""`r„I`a" ` PRNER•S NANEfFar Cr0 { 170.r N Cla 4h10Q MOgIANY'S NAME RYPa~Raq 1 0.r Cd Y 2- ~ ~~ , Y'1.Q.4~ NET,IDO os olsPDarrgN Daarrl^ G+wrst~„A^ R•A10wrwwsrr.^ oArE on•nw~t~D" ~, aPUNFRALBEgyICE LICENSEE Oq PERSON ACTIIq AB SUCN LICFN$E NUMBER H nsOt27lo0-(., EMM'+rtYml w~ati6M~r YI~Md brnp ~ ~W~~•I•a'I•CY•'Carll otMrW rCm l:na.era ana qaw staaa oryonamwtll ~t•^lPlltaa•na rA4A tranC lM Carn. DO ndarartlla moo. d tl,ig, autll aatar6at r amuCla,a IE/BYINO o,.~lry LAST (SP•N,/ ^ ~,a n~tts.~.f.3 . , rr~e.c1 , -/~'~DLr'c1cLre.1' i7, Da ,Ta.^ w.aaca.rti.sln a.a.ern ~ r,. ~l a t'""NI"PT ,Ta®Nwa.a~irrnl~e. la )Of rn ~ 2u ~ ~~ U ~f 4 T/1ER'B NAMEfF•M, LAEda M,IMs~w tMyAi DRWwrs-w,wo!~oREBa I Ff , I l C ~~t,~ sw~,zgca'"WC,r-vv~ I s ~, tA,K t. ~ 1'~c ~ MCP DgPD81TIDN-Nraad ~ I"~d arPrt. `"'""'Ka'm"°~~ LacRaN.Dltr~.sw,mcoa. `doll',Itio1CSrQ~.~n,fl~2artmf-~a~l ~ }-~~ Il p x,a m lP ~ T f} t t'1 p t 1 NAME AN1D'AaDRESBaPTACErrv 1~1r ~A n2.ra tBe.~Tb I ~D..vr,~ E-~'i ~ 1 Cr 1 I")O ~ 1 LICEtISE DRESIfB,ED Qltt/I. Dry, 16x1 aaw ~ vwBCASEREiE1wEDrolAEDI~CAL E7lAYIgEy000f101/ER, x y6a ® Na^ OF O&OH~aF CADSE fMOnn. Day. Wr) --... _••.••,~••~^•,•, ~tsuweNDwOwRracCUgREp, Nwr ~ No.:cloa ^ AtCiCant ^ P«e,rolw.ngNhn ^ n. ^ No ^ ~. ^ Nefy~l ,,.. ^ Na ^ s~itra ^ CtWCarMCatum4isC ^ M• PUCE DPINJURY-N home. lum, aver, taclay, Nka LOCAfgN lsbaw. CMS . Smte) aa. ~, Sf. ta.,0lrq am. (SpaWyl •l,TIPIER Knack piy OMI ~•' 7of. 'TBI~PNYSNaANfPhyaCan rwMyry ~yy of Cahn rAan andhr ytyycian MapronounceC OeaM anC aamtlretl llrn 231 SIGNRURE AND TITLE CER IER mY kak,wMOga, MaM •ttaaaaE OtM b eM tauaalq and maviar a NNM ..................................................... ~ ^ a10 'PIgNOUNCBp AND t'ERTIFy1ND PNYSNaAN (PnYaCUn han panty LICENSE ORE SgNEpplpyi, Day.lban re tM MNNmykne+I•nB•. a.,e. oet...wNm. wn.. a.n. ana warn ana aan~ly~y loca~,saaaeaml .. ~..anee..tatMtw..1.t.nam.an..eaatw .......................... [,~ a, .J ~ a,a 4/28/95 'MEDICAL EXAINlIER/CORONER NAME AND ADDRESS OF PERsgyYYHD DCAUSE DFDE,Q„ on tlr e.w of aarMnNion anA/or lnrn,l albn,Nm Olen 27)TyPaor PCnl Hldn Hi rs berg M.D. IamNmN a •,ataA......... B Y ognion, daN~ otturrW r tM tlma, CNa, atM late, sM tlua to Na ewagat anC ........................................ `~"'~"--~-~-~ •~~~~~•• ................... ^ Hershey Medical Center,Hershey, PA 17033 RE ISTRAR'S SIGNRURE AND UMBER ~ u. Pz d DREPILEp ,I~~ y.~ ' /99a J ~3I ~~ ..___ ., ,T ,, _,,, ~, - . INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12131/91 CHECK HERE V R°UC P Eo ' -• RESIDENT DECEDENT O I IT is cwiMED ^ COMMONWEAIiH OF PENNSYLVANIA DEPARTME (TO BE FILED IN DUPLICATE FILE NUMBER NT OF REVENUE DEPT. 280601 HARRISBURG PA 17128 0601 WITH REGISTER OF WILLS 21 95 ~ 349 , . COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ' DECEDENT S COMPLETE ADDRESS Miner James M. 41 Hillcrest Road W 0 SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH Wormleysburg, PA 17043 "' p 172-26-3762 4/28/95 11/5/33 co~~r Cumberland IIF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIALI SOCIAL SECURITY NUMBER AMOUNT RECEIVED ISEE INSTRUCTIONS) Miner, Margaret D. 280-26-7301 '++ a ®1. Original Return ^ 2. Supplemental Return ^ 3 Remainder Return y Y W dcYa z ~ ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise . (for dates of death prior to 12-13-82) ®5. Federal Estate Tax Return Re ulred q c s a m ®6. Decedent Died Testate (for dates of death after 12-12-82) ^ 7. Decedent Maintained a livin Trust 0 8 T l (Attach copy of Will) g (Attach copy of Trust) . ota Number of Safe Deposit Boxes lir'€IAL TA%~1NFLi~.i]N,3HC'rtlLit'S~ RI~t 1`4 F N N , ; z ~ COMPLETE MAII4NG ADDRESS = Ronald D. Butler Es uire 300 North Second Street, P,O. Box 430 ~~ TELEPHONE NUMBER Harrisburg, PA 17108 717 236-1485 . . : ; 1 z 0 s a W s z 0 P- 0 x . ; : _ ~ ~~ Under penalties of perjury, i declare the it is true, correct and complete. I declare based on all information of which preaa 1. Real Estate (Schedule A) (1 ) 2. Stocks and Bonds (Schedule B) (2) 4, 926.00 3. Closely Held StocklPartnership Interest (Schedule C) (3) 4, 560, 000.00 4. Mortgages and Notes Receivable (Schedule D) (4 ) 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (5) 815 , 327.33 (Schedule E) b. Jointly Owned Property (Schedule F) (b ) 7. Transfers (Schedule G) (Schedule L) (7 ) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) (9) 72 , 316.40 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 390,089.41 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicable Percentage on Reverse Side. (Include values from Schedule K or Schedule M.) (15) -0- 16. Amount of Line 14 taxable at b% rate (Include values from Schedule K or Schedule M.) (16) 17. Amount of Line 14 taxable at IS% rate (17) (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + + _ >.0. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT ~^ . ! 1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A. B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE. Make Cbeck Payable to: Register of Wills, Agent (g) 5,380,253.33 (tl) 462,405.81 (t2) 4,917,847.52 (t3) 100.00 (14) 4, 917, 747.52 x.-= -0- x .06 = -0- x .15 = (18) -0- (19) -0- (20) -0- (21) -0- (21A) -0- (218) -0- this return, including accompanying schedules and statements, and to the bes ~ has been reported at true market value. Declaration of preparer other than 3dge. RESS 41 Hillcrest Road Wormlevsburg, PA 17043 CRESS 300 N. Second St., P,O. Box 430 ~T >f my knowledge and belief, ~e personal representative is DATE / ~ DATE ~ 2 3 ~~_ Act #48 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: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1 % (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98 • Spousal transfer: occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~j IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: x 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, ............... x c. retain a reversionary interest; or ................................................................................... % ....................................... 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 x death transfer property without receiving adequate consideration$ 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 death$ ...................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. REV-1503 EX+ (4-86i COMMONWEALTH OF PENNSYLVANIA SCHEDULE B STOCKS AND BONDS James M. Miner 21-95-349 (All property jointly-owned with Right of Survivorship musf 6e diseles.d s.. 5~6e.l~.te e ~ REV-150< EX+ (3.92) SCHEDULE C "'' ' ~'~ CLOSELY HELD STOCK, COMMrOERTANCE°Ti~zR~ueN""'" PARTNERSHIP AND PROPRIETORSHIP RESIDENT DECEDENT Please Print or ESTATE OF FILE NUMBER James M. Miner 21-95-349 ITEM NUMBER DESCRIPTION DATEAOF DEATH 1. 1,858,650 shares -American Fidelity & Liberty, Inc. 3,900,000.00 2. 1,000 shares - Insurance Management Specialists, Inc. 640,000.00 3. 500 shares -United Underwriters National, Inc. 10,000.00 4. 1,000 shares -United Underwriters of Camp Hill, Inc. No value 5. 1,000 shares - Security of Pa., Inc. No value 6. 500 shares - Pennsylvania Security Group, Inc. No value 7. 100 shares - Keystone Investors, Inc. 10,000_.00 _ TOTAL (Also enter on line 3, Recapitulation) I $ 4, 560, 000 00 (lf more space is needed, insert additional sheep of same size.) REV-1505 EX+ 13.92) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY HELD CORPORATE STOCK INFORMATION REPORT Please Type or Print ESTATE OF James M. Miner FILE NUMBER 21-95-349 A. Detailed description showing the method of computation utilized in the valuation of the decedent's stock. B. Complete copies of financial statements or complete copies of the Federal Tax Returns (Federal Form 1120) for the year of death and 4 preceding years. Attached C. Statement of dividends paid each year. List those declared and unpaid. None D. List names of officers, salaries, bonuses and any other benefits received from Corporation. None E. If the Company owned real estate, submit a list showing the complete address/es and estimated Fair Market Value/s. If Real Estate Appraisals have been secured, please attach copies. None F. List principal stockholders at date of death, number of shares held, and relationship to decedent. Attached G. Any other information relative to the valuation of the decedent's interest. 1. Name of Corporation American Fidelity & Liberty, Inc Stare of Inc. Pennsylvania Street Address P•~• Box 190 Date of Inc._ March 22, 1988 City Parkesburg Stare PA Zip Code 19365 Total Number of Shareholders 2. Federal I. D. Number 23-2519760 Business Reporting Year. January 1 to December 31 (Same As Federal Form 1120) 3. Type of Business Holding company Product Insurance 4 5. b. 7. 8. STOCK TYPE TOTAL # SHARES PAR VALUE # SHARES OWNED OUTSTANDING BY DECEDENT Common 6,370,500 $.10 1,858 650 Preferred Provide all rights and restrictions pertaining to each class of stock. Was decedent employed by the Corporation? ^Yes ~ No If yes, Position Annual Salary $ Time Devoted to business Was the Corporation indebted to the decedent? ^Yes ~ No If yes, provide amount of indebtedness $ Was there life insurance payable to the corporation upon death of decedent? ^Yes ®No If yes, Cash Surrender Value: $ Net Proceeds Payable: $ Owner of Policy Did the decedent sell or transfer stock of this company within one year nor to death if the date of death was on or after 12/13/82 or within two years if the date of death was prior to 12/13/82? ^Yes ~ No If yes: ^ Transfer ^Sale # of Shores Transferee or Purchaser Consideration $ Dote Attach a separate sheet for additional transfers and/or sales. 9. Did the corporation have an interest in other corporations or partnerships? ~ Yes ^ No If yes, report the necessary information on a separate sheet, including Schedule "C-1" or "C-2" for each interest. 10. Was there a written shareholder's agreement in effect at the time of the decedent's death? ^Yes ©No If yes, provide a copy of the agreement. 11. Was the decedent's stock sold? ^Yes ©No If yes, provide a copy of the agreement of sale, etc. 12. Was the corporation dissolved or liquidated after the decedent's death? ^Yes ®No If yes, provide a breakdown of liquidation distributions, etc. Attach a separate sheet. REV-1508 EX+')2-87) ~ ~ ~c.r~eou~e E ~ ; ~ CASH, BANK DEPOSITS AND ' COMMONWEALTH OF PENNSYLVANIA IN REESIDENTEDECEDENTRN MISCELLANEOUS PERSONAL PROPERTY ~ I coiAit ~r FILE NUM James M. Miner (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION 1. Personal property 2. Fulton Bank account No. 2218-72449 3. Commerce Bank checking account No. 512076134 4. Fulton Bank account No. 137-025088 5. Bumble Bee Hollow - Refund 6. 1987 Porsche (grey market) 7. 1990 Mercedez Benz (560 SEL sedan - 146,000 miles) 8. Lawsuit against United Security Assurance of Pennsylvania 9. Lawsuit against American Fidelity & Liberty, Inc. 10. Paul Revere Life - Refund TOTAL (Also enter on line 5, (Attach additional 8~/~" x 11" sheets if more space is needed.) Pleose Prin+ pr :y Pe ER 21-95-349 VALUE AT DATI: OF DEAT~i $ 10,000.00 979.33 831.12 278.55 200.00 10,000.00 18,000.00 25,000.00 750,000.00 38.33 r'~ ~ I~ ~~ L ' $ 815,327.33 REV-1511 EX+ (7-BB( ~:~~` ~` .~. ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES James M. Miner ITEM NUMBER DESCRIPTION A. Funeral Expenses: ~• Neill Funeral Home, Inc. - Funeral 2. Rolling Green Cemetery Co. - Lot and internment 3. Rolling Green Cemetery Co. - Headstone 4. Post funeral reception B. 1 2 3 4 C. 2 3 4 5. 6. 7. 8. Administrative Costs: Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid ,Attorney Fees Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Probate Fees Miscellaneous Expenses: Cumberland Law Journal - Advertising The Sentinel - Advertising Duquesne Light Co. - Research Notary fees Register of Wills - Short certificates Register of Wills - Inheritance tax return Federal Express Zip Code 369.00 40.00 75.72 10.00 8.00 6.00 25.00 10.00 J' TOTAL (Also enter on line 9, Recapitulation) $ 72,316.40 Please Print or Type 3ER 21-95-349 AMOUNT $ 7,525.00 3,640.18 407.50 200.00 60,000.00 (If more space is needed, insert additional sheets of same size.) REV-1512 EX+ (1-93) .~ SCHEDULE I COMMONVJEALTH OF PENNSYLVANIA DEBTS OF DECEDENT IN HE RITA RESIDENT DECEDENT NCE TAX RETU RN MORTGAGE LIABILITIES AND LIENS Please Print or Type ESTATE OF FILE NUMBER James M. Miner 21-95-349 ITEM NUMBER DESCRIPTION AMOUNT 1• Friedman & Friedman, P.C. - Legal fee and costs $ 2,913.14 2. Ballard, Spahr, Andrews & Ingersoll - Legal fee and costs 19,113.00 3. Crummay Parnes - Dermatology 21.98 4. A.Z. Ritzman - Medical bill 94.00 5. Dr. J. A. Gensbigler - Dental bill 3,287.00 6, Cooks Enterprises 107.90 7, Holy Spirit - Hospital bill 23.00 8. Commerce Bank - Business loan ~~12830 260,455.86 9, Commerce Bank - Personal loan 4/:0300202421 35,298.12 10. Nations Bank - Home mortgage 4000791526-7 66,266.04 11. Laboratory Language 133,43 12. IRS - 1994 income tax 1,149.94 13. Commonwealth of Pennsylvania - 1994 income tax 271,00 14. ArthurA. Kusic, P,C. - Arbitration fee 975.00 TOTAL (Also enter on line 10 Recapitulation) I S 390,089 41 (If more space is needed, insert additional sheets of same size.) REV-1513 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ~.a~e+ic yr James M. Miner FILE NUMBER 21-95-349 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: 1. Margaret D. Miner 41 Hillcrest Drive Wife Sole beneficia~ Wormleysburg, PA 17043 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. Zembo Shrine Temple of Harrisburg, PA $1,000,000 Club AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) (If more space Is needed, insert additional sheets of same size) $ 100.00 100.00 .y t 1 LAST WILL AND TESTAMENT OF JAMES M. MINER I, JAMES M• MINER, of the Borough of Wormleysburg, Cumberland County, do make and publish Pennsylvania, being of sound mind, memory and understanding, this my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time heretofore made. ITEM 1. I direct my Executrix, hereinafter named, to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. ITEM 2. I give and bequeath the sum of One Hundred ($100.00) Dollars to the $100,000,000 CLUB of the ZEMBO SHRINE TEMPLE of Harrisburg, Pennsylvania. ITEM 3. I give, devise and bequeath unto my wife, MARGARET D. MINER, the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and kind, and wheresoever the same shall be at the time of my death. ITEM 4. In the event that my wife, MARGARET D. MINER, should pre- decease me or if she and I should die as a result of a common disaster or under such circumstances that it is difficult or impossible to determine who died first, I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and kind, and wheresoever the same shall be at the time of my death as follows: `` ~ -~ r l~ ~ t/ 1 • (a) I give, devise and bequeath one-eighth (1/8) of said rest, residue and remainder to my mother-in-law, ELIZABETH GARVEN, if she survives me. (b) I give, devise and bequeath the balance of the rest, residue and remainder of my estate to my daughters, REBYL MINER of Massachusetts, ROBYN KLISS of Memphis, Tennessee, equally, share and share alike. In the event that one of my daughters is then not surviving, her share shall be distributed to her issue, if any, in equal shares, or if none, to my surviving daughter. ITEM 5. I hereby nominate, constitute and appoint my wife, MARGARET D. MINER, to be the Executrix of this my Last Will and Testament. In the event that she is unable or unwilling to serve in this capacity, I then nominate, constitute and appoint RONALD D. BUTLER, ESQUIRE, of Harrisburg, Pennsylvania, to be and act as Executor of this my Last Will and Testament. My Executrix is specifically relieved from the duty or obligation of filing any bond or bonds. IN WITNESS WHEREOF, I have set)my hand and seal to this my Last Will and Testament this ~ day of ~~7 /~2~,t.G, , A.D. , 1988. w- (SEAL) - 2 - WITNESS: residing at aW~s ~7 C9/LE~t~ S%~'~~' ~/ ~~~vv~d ~ ~ 71io ~ .L~ , ~ ^. ~,J~':. ..~. re~ding at '~ ~.O ~_,L (_~~ :~ ,_ A _y ~ ~ ~ l _ _ ~ t ? ~ ~~ ~ , ~. , - 3 - -- . -. .... COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF ~AUpu:~ nj ) We, JAMES M. MINER, R p A(,.~ ,~ ,~ ll'T'L~sQ and -~~~ Y,~XAmBA~G~f 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 that he had signed willingly (or willingly directed another to sign for him) 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 witness and that to the best of their knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~, ~ ~\ ~ - - __~~ ~~' Witness '~ Subscribed, sworn to and acknowledged before me by JAMES M MINER, the Testator, and subscribed and sworn to before me by ~ p AJQ Lfj .B~-rLE~. and (9.,)~NDY S~FAmBAr/~E/ the witnesses, this / ~' day of ~gy 1991. tary Pu lic My Commission Expires: / NOTARIAL SEAL CHc-RYL ~. s~i, rH. lto.nrY PaSllo hfzrrisburg,. P;~ Ja4;ii1;7 Co. ~Y Ccrnmiasion Expires April G. 1992 - 4 - ._ __ ~. RE_r 1547 EX AFP (12-95) CLM(A'1NMEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101 BUREAU OF INDIVIDUAL TAXES DEPT. 280601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 05-27-96 DATE OF DEATH 04-28-95 ~~ ~~ FILE N0. 21 95-0 49 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: RONALD D BUTLER ESQ 300 N 2ND ST PO BOX 430 HBG PA 17108 (1) .00 (2) 4.926.00 (3) 4,560,000.00 (4) .00 (5) 815.327.33 (6) .00 (7) .00 (8) 5,380,253.33 Amount Remitted CUT ALONG THIS LINE - RETA_IN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------- ------------------------------ REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MINER JAMES M FILE N0. 21 95-0349 ACN 101 DATE 05-27-96 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAI5ED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stooks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Reeeivabl• (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Lions (Schedule I) 11. Total Deductions 12. Not Value of Tax Return 13. Charitable/Governmen{al Bequests (Schedule J) 14. Nst Value of Estate Subject to Tax (9) 72, 316 .40 clo) 390.089 41 (11) -- 46 .405 S (12) 4,917,847.52 (13) 100:00 (14) 4,917,747.52 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: If an assessment was issued previously, reflect figures that incl d lines 14, 15 andior 16, 17 and 18 will u e the total ASSESSMENT OF TAX: of ALL returns assessed to date. 15. Amount of Line 14 at Spousal rat' (15) 4, 917, 747.52 X . 00_ 00 16. Amount of Line 14 taxable at Lineal/Class A rat' (16) .00 06 . 17. Amount of Line 14 taxable at Collateral/Glass B rat' (17) .00 = X . 15- .00 18. Principal Tax Due X . - .00 TAX CREDITS: (1s) .00 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) * IF PAID AFTER DATE INDZCATED, SEE REVERSE FOR. CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAV BE DUE .. cV-1470EX (5-94) "~:` ~ y COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 James M Miner SCHEDULE INHERITANCE TAX EXPLANATION OF CHANGES PROBATE 5N4/96 '~~'~"~"~ 2195-0349 ACN 101 EXPLANATION OF CHANGES Note; The amount on line 15 includes assets passing outright to the surviving spouse. These assets and the deductions associated with these assets have not been verified by the Department. TAX EXAMINER: J. Paul DihE+r+ PAGE 1 FILE Copy