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HomeMy WebLinkAbout10-10-12 1505610105 REV-1500 Exl°=-" 't~' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes PO BOx z8o6ot `"'~`"'~` "`~`""` Co ty Code Year File Num~~ INHERITANCE TAX RETURN ~~ 11') _ Harrisburg, PA a,71z8-o6ot RESIDENT DECEDENT ~(,+ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYV Date of Birth MMDDYYYY 092-22-5357 01/14/2012 ~ 08/22/1921 Decedent's Last Name Suffix Decedent's First Name MI MILLER LILA S (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Spouse's First Name MI _ __ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - TINS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number LYDIA KELLER (717) 608-6046 N First Line of Address 2703 COLUMBIA AVENUE Second Line of Address City or Post Office CAMP HILL State ZIP Code PA 17011 REGISTER OF SE ONLNV O ~ ~ ~~ ~.. ~ :-. O C`; S~ ~ ..~ ~ y ~ ~~ DAT ILED ~~ C'? f"`t r`f-r ~:~ C.'~ L fI-~ ~~ Y~ 47 Correspondent's a-mail address: 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 true, correct and complete. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSI6LE FOR FILING RETURN /' _/'~ ' ~ crj~D~OO- DATE n//' /, ADDRESS SIGNATURE _ R OTHE PRESE VE D T ADDRESS Q ! 70 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 h\~ J 1505610205 REV-1500 EX (FI) Decedent's Sociai Security Number ~ecedenrs Name: LILA MILLER 092-22-5357 RECAPITULATION 1. Real Estate (Schedule A) ..................... . ...................... . 1. 170,000.00 2. Stocks and Bonds (Schedule B) ...................................... . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 2,543.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Q Separate Billing Requested....... . 7. 8. Total gross Assets (total Lines 1 through 7) ............... . ........... . . 8. 172,643.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 3,338.74 10. Debts of Decedent, Mortgage liabilities and lJens (Schedule I) ............ ... 10. 118,019.71 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............ . ............... .. 12. 54,184.35 13. Charitable and Governmental BequestalSec 9113 Trusts for which an election to tax has not been made (Schedule J) ..... . .. . ... . ......... .. 13. 14. Net Value Subject to Tax (Line 12 minus line 13) ..... . . . .............. .. 14. 54,184.35 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable et the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 ~` 54,184.35 16. ` 2,438.30 17. _. Amount of Line 14 taxable at sibling rate X .12 17. 18, Amount of Line 14 taxable at collateral rate X .15 ig, 19. TAX DUE ........... ....................................... .. 19. 2,438.30 20. FILL IN THE OVAL IF YOU ARE REQUESTINt3 A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME LILA S MILLER -- --- -. STREET ADDRESS _--- ------ ---.___._- 2703 COLUMBIA AVENUE CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments __ B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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. (1) 2,818.19 Total Credits (A + B) (2) (3) (4) (5) 2,818.19 Make check payable to: REGISTER OF WILLS, AGENT. . 1 ~~.i4 M:#~.dYiaY542e ~...t (1{~.~tP3~59~4%1161YB6~$~IEr~~. =4 A6~Y:,~~4atMlll~~'.. ~.$'1h~'~~Yl~ 1 ~t .'ry$15 ~~'~.. i'~ n v. "f } ttfyi,n t. 4} ~~}} ~i~ t fSbF~ >ltLLLL:.' ie {4y f, Y [ y(3( {R f µ,~~,, `~'MiT' 3 .X :' ..:. . .'I 2.Yf ;'i{°~a $elRT4 '(.. ~1Re3 .>.~~i.4:~l~§4 fiISG4En <. ~I^;f9f.^iRk ~~vittft.v. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t. 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 ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust for" or payable-upon~eath 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 designation? ................................................................................................................... ..... ^ IF THE ANSWER gTO ANY OF THE ABOVE QUESTIONS IS YES,~YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, ., '#~f`~"-"~` 1~ .~ `'E `.lif V Id's ~ .)~"*~47 K+l ~( ~ , x~3~~ to 1'.,i.~i.. dt~ ~n}~~~y+i.~tgsN~,t ~~yt x.~yC'~yn,g~ yq~~{ Et r h^ k,.. ~3 ~. ~ .: ~ a! Y~, ie i i, tl ~)'»F%r~kt'iP' ik+F,., ~e. 4F a n fpE~OC„i"~IBP' Y ~k~l~~ .~ ,P4%~s'a'i~" ,.f(. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)I. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (11-08) ~pennsylvania SCHE~UL-E A DEPARTMENT OF REVENUE INNERCfANCE TA% RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER LILA S. MILLER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy ar sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 2703 COLUMBIA AVE. CAMP HILL PA 17011 ~ 170,000.00 TOTAL (Also enter on Line 1, Recapitulation.) ~ $ 170,000.00 If more space is needed, insert additlonal sheets of the same size. EWING RESIDENTIAL APPRAISAL8 A 8vmn~y 141153787 PERSON VYHO PLACED ORDER M a T BAt~rc ONE FOUNTAar PLAZA - 7111 FLOOR BUFFALO, NY 14203 Fie Nranbec: 1]811-03AH,4 In accordance with your request, I have appraised the real property at: 2703 CoMrnbia Avenue Camp Hi, PA 17011 l The purpose of this appraisal k to develop an opinion of the mortal vaWe ~ the sutrject prapeny, as knprowd. The property rights appraised are the lee simple interest in the site and improvements. In my opinion, the market value at the property as of Auyust2, 2011 is: 1170,000 One Flrrrdred SererAy Thntsand Dofars The attached report contains the deuriptfon, analyysis and supportive data for the conclusions, final opinion of value, descriptive photographs, Ilmiting conditions and appropriate certlticetiops. t.irrda D. YYdNams PA Caroled Appraiser LeoYl Dezaaiolbn . YYiiYMiK tt a voltt op tbp NYCNrn liaa of Colutal• 11repN vtiab plat 1. lii tape put et sad potcaput eerapt se cM ltte»aetion pt COlYY/a twaN alt lVpaty~Y1{hth ttsept 1De cb1eA Nlat la et ebp llte ttvleltq 4ata Na. 7{. aM te! op ttp Mraltatiar Nntieaad -1an of Wtal NuN tlptq Nid divlelnq lltp Yeuc4 2 Ngsaap >• rinutps Ma llt tNt is • Nlat at the tereNra UN of lath tN Or 1iG at TNe tialpl taanac •lene tbp 11N 01 r1d1N Let. Yoa. 2tl cad ite Oa •tse vln, Yogi/ al dgnas i7 ditYNa YNt 12/.27 bat tp a ya1dY. w Laa wpHq lltp •t Nettt»t /wtwl taeaN t3oty to pup dad dlotq tN poYlMSd 1tN et ColYalr twtN by sn d» purvinq t0 W lets and being a rblad p[ N late pt arp t11t.Yep Ot 17. et Lppt t0 t N11LI LMtap 00YS1ttiAg {lot! Laa NYiaan llap et CO3Yta1p 4aante YYYta gt dd{spep N tlttteY reef ii leer to ilia gOltt e! DMIYYIYt. tY1Yt Lot Yo. 2te N tN µcn e! Cbcrtip» vLw, rbiab Nla llaa l^ »pacead la ti,a CuiwLael.aa ooensy Mevpa•'. Otilot 1p r1aD /vat !. ydga ef. tY1W iM Ntp vratlNa paloa JeM P. rsYor cnd Jdaqupllae J. vcyps, tia r!!p, ty tMls dapd dtNd 1lvsil 32, laze eae eaoeeMa la taa Cnaltatletd Ceatiy Mewraer et ONta Otllap in Nad YOOk _ Miller, ail Mita.d li ta~ldvaa~itp. Y. Mt13 Y d1a01N teuiatLNY of Janudsy, lq:, aaprpay title aONe pOlp{y 1p L3L t. Millar W wrvivlag eNdat 1y utinsied. i TM vitbin tsMpfes L a ooavdypaoa trot Lila 8. Mi11er co Mtpwll !or tM putvwd et e'wtx+ving hex devpeted ppowa from cltla snd 1t CM»!o» tap pYd/Iyt. r ~ ~ IY>~.. ~: ~~ N 4rcYry ~ `~ .. ~I "' w ~' o ~ !" -.. ,.. • ~~ t I wa 16'cJ rid ~ ~~ .~ !F i' { ~ ~ a ~~~1\ ~ r~ t,. e I_ -i li I'. 10. ~ ~ AH - _ AR..~ ~~~ MUI:EL IFA IP33i i2 S! 3 200] oi~ focus J `!"F iG H _ _ EU u, '_ _ _ ,Vl. ABLF °EA CA Ci 011 9z 1 3Lu0 ~,, ^ +~+1•.cx 1ti-21, zolz ~. .1 BI U1 F K Vi L1 [ - ! ~, H I .~_J v c _ - _ _ __ _ _ _ _ i , ~I 1~ OUOf,lEI6fi IHAUSFER OAIE FURCHASE PflICE aJT OA C .,I S~~. I' ~EALFFSHIP CONTACT L. B. SMITR FORD LINCOLN ERETT CORCORAN 1100 MJIRKET STREET GEN SALES MNOR LEMOYNE, PA 17043 1-717-761-6700 ~ F ~'._ 'i iL. T,L . dr A.nl_LP LISTED, PLEASE CONTACT THE I i li lil~~ III ~~ ~uirl ii '' irl il~,uiuii~l'iiri IS:_ C ILC. i. EF SI IP IMMf01ATFLY flEGAfl~ING YOUfl BUY d,,IT Ls iF ;U. '.L OPIG Efl OWN THIS VEHICLE, PLEASE UTC `~ -L r 1T'' 1 i ](I;' L I:~~E 7i ;r. ?q'.IH ~' F.) THAT YOUfl FECOROS CAN BE I S ier 4 3 umta JE n. JPUni F'. IF Y~~tI F!dCW W~~O OWNS THIS VEHICLE, PLEASE LET US ~~ i I lr I, PF 1 11 312 KhOVJS-hA"'N-C4N CUNTACT THEM CIflECTLY IN flEEAflOS TO Pl'~NCHA'J IN G'NI£'JE HICLI. I HI3[ERT 1[ -E VES r1 C .LERE iI)FCIvLAU 1'HORIi ATION TO PURCHASE SPECIFIED VEHICLE FOR OFFERLIBTEO. REOIETERED w ;IYJN. R IS ~~ P lu^~ n O IRCH sf 'i 4 . EN ~I$. ~"~ VRDLR TO HECEIV F. OFF-: F. OFFER IS ONLY AVAILABLE FOR DATES THAT l If..F, + ~ A .L PIRI F Ti ARE DATE M'. ~ P~ SSED. l•rr I r.e~ ~ ~ - ~ . ~.. .~_ --~-.~_.~. ~, #~~ F ° gJc . ~ - ~ !~~1 I {}} '- I N c ° L N OFFERS AVAILABLE ;;. t~ ' ,~ 4r MARCH 16 - MARCM 2 ~ ,-~ ~~a - ~ ,ta ~~ . ,~ ,-, ear .il l S 1ilier, ~1 s r or le tc re-stock our inventory, L. B. Smith Ford Lincoln is hosting It's Official elle~ DI ie 3cok Buy Back Event from March 16T" thru March 21sT! We have official ~. .lth: ri , ti. n :o purchase select pre-owned vehicles at unbelievabe Kelley Blue Book to ~~ ~,~ alue 1 :h cl: your- purchase authorization form above to see what offer we are :Jq- ~ ~th< •i I d o L~res~ l It to you for your vehicle during this event! L~, ~. '~ W?are willing to pay up to $1,991.00 for your Ford•Foeusll ~~ .~~ ~ la S, n , rt :o ds in.-lieate that you are driving a 2002 Ford Focus. Please contact me, - k71, ~„~ nett :c r ;o. an, imlTTediately. I would like to make you a very aggressive offer for this ~JN ~ !hicl a. P ~-rwned Fords are in high demand and with this special offer, yours may be worth more now than ever. lis i! a o lu chase necessary offer; however, if you do need something to replace lur I o : , ^ its offer will provide you with the best trade In offer we have seen in rer ~ year:. Light now s the perfect time to upgrade to a new Ford or Lincoln and ve ~ u . sa ~d> of dollars. with all of the phenomenal programs we have available for .u. ease c ~ ('~ L%~ 761-6700 to schedule a convenient time for us to take a look at your hicl[ . I vi , jai inspeetio l is very important because it will allow us to mak@ y4,r~the ,,,,, ;hes i : ss NI offer. Onu> again, we have only a few days to purchase these vehicles. ease bra ig your purchase authorization form and come early because this special -'er i; av ail: ble for a limited time! rcen h rc~ i (a ~>^~ [rl~z Feral iE < ; P ar lger '' rc m xese' le t lee ~r befi pricer godatlons begin. A/2/X/b Plan or other Friends & Family pricing is not cornpatible wi of ~. offer i rJ s ! elt Must s. hj ~ices are based on Kelley 131ue aook• Good Market Trade-In value and are subject m m ag Id mr ~ tk an' leE dve e i . y mus le paid or refinanced into new loan, subject to bank approval See dealer fixtpnlpktet all He lot vt I I c nu ~aL ®2 . rMaiF~ !orks, UC. All rights [o this mail campaign and promotion are reserved by Mai4wruir. I REV•1511 EX+ (1U-D9) pennsylvania SCHE©ULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND [NNERRANCE 7A% RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LILA S. MILLER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1' MUSSELMAN FUNERAL HOME 400.00 2. DEATH CERTIFICATES 60.00 s• PATRIOT NEWS OBITUARY 562.37 a. BERNE WITNES NEWSPAPER OBITUARY 55.00 e. SCRANTON NEWSPAPER OBITUARY 71.00 B, 1. 2. 3. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City .- ----- __ _---------- - --- _ . _----- -- State -_ ..ZIP __ Year(s) Commission Paid: Attorney Fees: 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 4. Probate Fees: S• Accountant Fees: 6. Tax Return Preparer Fees: ~~ VIDEO PRODUCTION SERVICES a. FLOWERS s. CAMP HILL PRESBYTERIAN CHURCH 10. WAKE » APPRECIATION EDIBLE BOUQUET t2. THANK YOU GIFT FOR ANNEROSE CHPC STAFF GWEN FOURSON MARYLOU MORAN 200.00 979.00 275.55 150.00 454.00 102.82 29.00 TOTAL (Also enteron Line 9, Recapitulation) I # 3,338.74 If more space is needed, use additional sheets of paper of the same size. ~ ~,_._, .... r .... ...,9 ~ =+~I.. .,.-,..-. .,:--.-....T.GSrT1'SIR'~._-~~4-._~..rni.~..:.:y,_..e Y..n..yw - .... .. _ _ ~~ .. ~ '•° :v ORIGINAL ~ F. F. D. OF A, ~ ~ O W D ~ I I { II I I { I ~ I ^ ~ ^ ~ DUPLICATE • CLIENT a AW y c _a -Di ~, ~ .i °, ,f R: a o. ~,z,.-. n ~y ,;, o q D,:, ;?`?.. e i ~• . `' ~,~ 4 ~i %Y N. 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PA 1AS10,2312 a ' ~ ' rv Tae owae a~ t ~~ ~ i, f ! . s ., .. ;. - C ~ ~ ~ PEEN EJ115Y FFI7ZRAt.' C~W'1' triNON ` ' . Mt Nantn nr~ Avea~ ,~ ' SCa1NciDP1. Pw 1ei.~~ ?~00 ~ ~ ~:23L3&545Da: ClggOt3Q3~87g' 5L5i -1 MK W(Y ! ~.nN1~{I..w fti1YMYAIM`. .IrrbMltlOlRFf.MV~ ~ ~ ' y n~ ~ 2.01 ~- ~. i ., ~ - ~~ a ,' . F~,~^ ~ cow ~ ~~.d~ ~ti~ ~. vl~~~-,a.~ f„/c '~` ~~ `N . , ~. •. ' ,= ~ ~, l~ S~tiu n!j en r112;14~c ~ /a cco( ~,., 72v '% ~ . ;: ;, !. ~ . ~ P€11'1t~^ i ;dose ,. ~,..V..., . ~~"'T' Na ~48~~3 ,DATE ~ GL=~r~ FROM i1~ Ke pD, ~1 ~ J`S. ~f1~ ' DOLLARS Q FOR RENT Q FOR ~ 7~' .? O !A nccr ®,L3 PAID ~ ~ FROM TO 'MONEY OROEn DUE ~ EY ~(7'j,/~ MItSY - ! -W 7MLtEi 1of1 5/2/12 7:15 PM 2300 Forster Street Praductian Agreement Harrisburg, PA 17103 info~mediaboomtown.com This is an agreement for video production services between Lydia Keller and Media Boomtown LLC. Any additional production or services not described below will be billed under a separate agreement. Media Boomtown agrees to shoot, edit, and deliver a video of the memorial service for Lila Miller at Camp Hill Presbyterian Church on Saturday, February 18`" 2012. This service includes: Location Production: Coordinating all necessary materials, Two hours of on {ocatlon shooting with camera and field audio package and a 2-person crew. Post-Production of video includes 1 day of editing, and file conversion to make DYDs and a digital file for family upload. Media Boomtown will provide 6 DVD copies of the final~video for the night of the show. We will also provide an uploadable movie fHe of the videos to post on Youtube, Facebook, or any other manner of their choosing. Media Boomtown LLC reserves the right to licate, use, promote and exhibit moving and still images from the competed video. The above production services are value at S979.00. alf of that amount (5489.50) is due upon agreement with the remaining balance du on etion and delivery of the f(nal product (15 days, net). Any other production services requested will be billed at the discretion of Media Boomtown LLC. Purchaser: Service Provider: Ly is eller Date Media Boomtown Date www.medfaboomtown.com 717-307-0354 or 717-670-2667 ORDER NO: II2YY4II~~6gq9~Y~'I7''I7~/'1I Io~~fII1 l~~l~%AUA{N~IIINI~~~~~~ CUSTOMER: Keller Lidia 2703 COLUMBIA AVE CAMP HILL, PA 17011 P:717 975 9443 ORDER BY: W©1'kSi1@@t DELIVERY DATE: Sat, 02/18/2012 DELIVERY T{ME: Peeler's Flower Shop DLV T0: Lila Miller Camp Hill Presbyterian Church PAYMENT: Credit AP 101 N 23RD ST SALESPERSON: Donna Eptirtg Page 1!1 CAMP HILL, PA 17011-3819 OCCASION: Sympathy COPY NO: 3 SALE DATE: 2/11/2012 1:10:52PM ACCT. NO: PRODUCT QUANTITY PRICEIUT DISCOUNT EXTENDED DELIV Delivery Charge 1 9.95 9.95 ~ARR Arrangements for on altar spray done in Berbers pink red 1 150.00 150.00 and yellow, white lilliea, and lots of white xith yellox center daaiea. ~ARR Arrangements 2 alter vases in ahuroh liners (pick up) to 2 50.00 100.00 coordinate with alter spray .. r. ~~ ~ ~ ~~ „,.. ~ ' ~ ~" SUB-TOTAL 259.85 ,. p ~ .,, ' "" `' Sales Tax 15.80 -, ~ ~ . ~ '~ 3 ' ~ ^u ~~; w: . z v ,, ,fir ~ , a w er~ ~~~~ «. ";. ~, ;`. ~;. ~,. '~ TOTAL 2T5.S5 Card: na ORDER NO: Lila M111@r 2469r7H of 1 Camp Hiipl Presbyterian Church DELIVERY ZONE: 101 N 23RD ST Camp Hifl CAMP HILL, PA 17011-3819 Sat, 02N8l2012 Peeler's Ffow®r Shop RECEIVED BY a"'~°~"~'r"1°"Q°"»"16r DELNERY DATE: S$t, 02/18/2012 ~ is ssn COPY NO: S Hydra Search Images Maps Ptay YouTttlee Mews Gmail Oocurnents Calendar More - Goggle Gmail ;or,~wusr. Intxox (21Y) stared r~ ..~~~,~~zouit. . ydfa ksger Set status Mra CaN plane Crap Hrnarth Rare Robotl Sareh DsvNs Ctalre MlYsr Wren Moser ShMsy Ros Nan t3roes Devld Rogwmone eYw quayaals laude karsplannie Molt' Grose Mor. __ _. Mothers Day Berdas i18+- www.BsnMs.oonvA~btMr's.0ay - Sharre tlsnMs®mab Moms hlappy. Guanrtlssd Motlnrs Day Dstfwlyf Edible Arrangements Confirmation W'0009g13882 rroox x _ . __ ... taeta Artaww+rrks doawta»wY~bMen.npements.oom a~ PM ro mYabs apo) Ynages an not dlap4ysd. DIpNy Irropas below - Nways dlaplay MnaWs from do-not-cep~t~atllWpmrgsmsnb,ogn _ . _. _,_._.._._ Ed~Is ARarperrrrks Logo Order Confirmation Order Number WOOODD130t12 Par~»nt tnbmrtlon Lydla KNNr Order Data Monday, January 16, 2012 7103 Cahrnbia Avenue Vlsa~laa~! 4P0 pNrK ~~ Order Total s102.ez ~tieatl ~ tlnlrQll~ a~ ltlada ilddrllN'ldlrNtl fly i IOL+ff ataaa WOOONI~pY•1 r 10Q9263924.pdf FIN VNw Help t~ } _., 3 ~~ . ,.r.Floooy.ooc. gownbaloKylAd spar. Starch the dununenL ~~ M/MR! 1Y03A KlIIKR R!q RAN3lY 7703 ~LIM3A AYR LAID NILIr RA 17011 URIN3R pA7'C 0!r'RVI2 C4Tf0.11NA NUMY?R ti`1~"': WIIM~t 111YlNR IwaAS~stl OYDER INFORAIATNNI Wv hp w Me uluthYr vR»~ w INYO 1uu m Ily elN1 flltlrv. Tu elNtlal a pkFt ci CtlAUSer i. 111p'IV. 1NM tl1AtF t'ANY INI I YMIAtlYIlNI, Itli \ 11NN KI, I:AW NNI. NA ILII Nerlr Ih01eYr: 1W MvM.II~~tl. 1M iLw. 11rM1 N W /w O1 fu m) IrJI W w Amv 4ww 1"\µ. W.<1"\.14M5a wNtl/01/ 1 IlapWl 1;1M1 YWy1 IFf1 !'oNu 1 YIIN TO: 11R.1f .\~\i. Npl, 110 COfitIYrtS IA. YCf.AlIF1Y1'11.1.Y. YA 11MY { IYrp Aw 11rYr' I Ir A~w. ]wr lau ....aa IC Jv WYN N'1u/11 I4YM 1yN. I.OW 7NM / REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT Of REVENUE lNNER[TANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER LILA S. MILLER Report debts inwrred by the decedent prior to death that remained unpaid at the dace of death. h~I~~ah~ ~~,,..tm~„~.~.n M_.:..,~ ________ ~~ mme syace is neeoeD, insert aamnonai sheets Df the same size. RECIPIENTS/LENDER'S name, address and telephone number M&T BANK P,O. Box 1288 Buffalo, NY 14240-1288 Phone No. 1-800-7242224 PAYER'SIBORROWER'S name, slrset address ('mduding apt. rp.), dly, state and ZIP code x750-55700.OOfi1 sst -013-1.001.000-000.000 (-. ' LILA S MILLER 2703 COLUMBIA AVE CAMP HILL PA 1 701 1-531 2 CORRECTED (if checked) 01/17/12 ' Cauoort: ljre amount shown OMB No. 1545.0901 may not be Tully dsducfibH by you. Cimlta based on gre loan amount MO~ry$9@ s and th. casl and v.lue of tM seeurod pronerh' maY aOMY~ Alan, 2011 Irrt@rest you may Dory deduct interest b the extent it was interred by yw Stat@ment , actually paid by you, aM not Substitute reimbursed by anofn. person. I For,,, 109$ Mortgage Interest reserved from paYer(s)Iborrowmr(q- Co y B $ 1,(367.83 p p~ Points paid on purohass of prindpal resWsnce Payad6orrower $ 0.00 w,ro~ersontia.aa Refund of overpraid interest ~. _. s, ens s h $ 0.00 ~~ Alortgage Insurance premiums a..ania s..ts.. nroa r. $ 0.00 r.aa~!aeerarv~. 16-0538020 ~ XXX-XX-5357 ~ n.:w«ar Account number (see instrudbns) °~ia'r 0014153787 r'"id d1"' n~yomn Form 1098 (Keep for your records.) Department of the Troasury -Internal Revenue Service ESCROW RECONCILIATION PRINCIPAL RECONCILIATION 50.00 BEGINNING BALANCE 51,980.09 PRINCIPAL APPLIED 50.00 ENDING BALANCE 5118,019.91 ENDING BALANCE 5880.13 CURRENT TOTAL PAYMENT PROPERTY ADDRESS: 2703 COLUMBIA AVENUE CAMP HILL PA 17011 2011 INTEREST CALCULATIONS -- TOTAL INTEREST APPLIED 2011 2011 MORTGAGE INTEREST RECEIVED FROM PAYERIBORROVifER(5) E1,867.83 51,667.83 e PLEASE CONTACT OUR CUSTOMER SERVICE DEPARTMENT AT 7113.82&7010 OR 1.800.724-2224 IF YOU HAVE ANY QUESTIONS ABOl1T THfS STATEMENT. REV-1513 EX+ (03.10) Pennsylvania DEPARTMENT OF REVENUE INNERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 7 BENEFICIARIES ealAit ur: FILE NUMBER: LILA S. MIL ER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY REDO Not List TruOstae( )~ AMOOF ESTATE ARE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• MARK MILLER 44 SAN RAMONWAY NAVATO CA. 94954 SON 1000.00 2. DAVID MILLER 504 COLFAX AVE. SCRANTON PA 18510 SON 1000.00 3. J LLEWEILYN MILLER 540 HARRISON ST. SCRANTON PA 18510 DAUGHTER 1000.00 4. SARAH DAVIES P. 0. BOX P POCONO PINES PA 18350 DAUGHTER 1000.00 5. LYDIA KELLER 2703 COLUMBIA AVE. CAMP HILL PA 17011 DAUGHTER 58626.41 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBl1TI0NS ON LINE 13 OF REV-1500 COVER SHEET I $ If more space is needed, use additional sheets of paper of the same size. lll9S.a7 RIN (9111{ LOCAL REGISTRAR''S CERTlFIGATiON OF DEATH WARNING: h b Illptl to dtt~klsb t3i>it oopY t-Y phetastit or Photop^t~h/ Hee fur .this certificate, $6:qt) P 18155762 CertiGcrdun Number TYtltl/ftrML In Tttie is' to ce-t3tyf that the ie-~tmosdcM bare Evan it ro~i1Y ~Pkd from ah asi~inal Cer'ti~t:ate of dudY fltatl edfh ttse as ~ Rl~ictrar. 'Ilse el>~iga cerdiftcut+e Vvill be fo~tii+arded to thl: State Vittb Recants Utlicb for permanent Ming. ~~rr~~ JAt~.19 ~Bi1 ~ >ti~~~ nape mMMON\wRtTN G •rMl.rrw~N1A . ed«w11nACNT•o•.Nr1u.Tw . vTAl Rtf%Laba . • ~ Y.lis 9. -1i.a.a.1a .vw 1'rmsl 092- ~..d 37 J n. 1 • 7 a w •. Mtln1I/. N a ~ #-VO. C7 Y•IN NN/1•IIIRW4M ~ Iw LI,T ~.T .L a.,d N. I//tl. Qq'h IbY.WAL RwW wNNYI •/nF a I • M LNY/MnL C r« • O u.gntlrn 4 91.NwY rUY Iln/a. .... N unLn•w\ . 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