Loading...
HomeMy WebLinkAbout03-14-13 (2)15115610105 IX(aa-aa)(Fl) REV-1500 ~~L DSE DNLY PA Department of Revenue perrr~rsyWarda . Coda Year FlM Ihan6ev Bureau of Indivtduat7axes INHERITANCE TAX RETURN ~ , I ~ ~~ PO BOX 28d6D1 ., DCGInFaIT nFf'FnFNT ENTER DEGEDEMT rNFORMg11Vn 6tLVarl Socisl Severity Number Dale of Death MMDDYYYY 12/13/2012 Decedent's Last Name SuKrz Miller Sr. (N Applluble)Enter Surviving Spoutse's lrrWnTlaUonBebvr Spouse's Las[ Nama _ .... SuRrx Dale ~ Bitth t4MDDYYYy 0 7/3 111 9 3 8 Decedent's First Name MI John C Spouses First Name _.._.... M{ Spouse's SoGal Severity Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 1. Original Retum O 2. Supplemental Realm O 3. Remairder Realm (Date of Death Prior b 12-73A2) O 4. Limited Estate O ba. Future Interest Compromise (data of O 5. Federal Estate Taz Retum Required tleath after 12-12-82) r>p 6. DeoedeM Died TesFata O 7. Decedent Maintained a Living Trust 0 e. Torel Number of Safe Depose Boxes (Attach Copy of Will) (ABafh Copy of Trust.) O B. Lidgauon Proceeds Received O 10. Spousal Poverty Credit (Date of Death t~ 11. Election to Taz antler Sec. 9113(A) BBNVeen 12.31.91 and 1-1-95) (Atach Schedule O) CORRESPONDENT- THIS BECTIDN MUST BE CpIPLETEO. ALL CORRESPDNUENCE AND CONFlDENTULTAX 91FDRWl10N SNDULD liE 09tECTED TO' Name Daytime Telephone NurMr@r Samuel A. Gates, Esquire {717)~i2p 971 `" m m First Line of Address _ _. 250 York Street Second Line of Atldress Ciry or Post Office Stase ZlP Code Hanover PA ..17331 ~ A r ti,., ~ S nT _a e-d i~T nT ~ ~ ~ ~ ~ ~ • ~ Q t~ -eY .....~ i- CortesPOndent'a e•mall address: Urder peneltiea or 4equrY, I tleWre dm f Move rsrenAnad ttNa realm, inclWinp acmnpam/zg eclredulea aiM shbmeMS, and m the bast d my xnawied9e erd betleL it is Nre. and canpNte. Declaretbn d preparer Darer than tna IxxsMel represeManve is based on all inbmwtion at whim preparer has any tnowledge. SIGMA OF SON RESPONSIBLE FOR FILING RETURN ~ OPTfc ` t ? 400 PA 17062 ADaTFSS 250 York Street, Hanover, PA 17331 PLEASE U$E OR161NAL FORM ONLY Side 1 L 15056101D5 1505610105 1505607222 REV-1500 EX DecedenYS Social Security Number Decedent's Name: JOHN MILLER RECAPITULATION t. Real estate (Schedule A) 1. 1 3 2 2 0 0. 0 0 2. Stocks and Bonds (Schedule B) 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 4. Mortgages & Notes Receivable (Schedule D) 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5 ' 1• 9 8 2 8 5 1 0 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 4 8 4 0 6 6 ~ 0 8(Schedule G) o Separate Billing Requested 7 8. Total Gross Assets (total Lines 1-7) 8. 8 1 4 5 5 1 8 0 9. Funeral Expenses 8 Administrative Costs (Schedule H) 9. J_ ~ J_ 2 9 2 J. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule p 10. 5 ' g 0 2 0 4 11. Total Deductions (total Lines 9 & 10) 11. 2 3 : 0 '. 3 1 2 5 12. Net Value of Estate (Line 8 minus Line 11) 12. ~ , g 1 5 2 0 5 5 13. Charitable and Governmental Bequests/Sec 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. ~ 9 1 5 2 '. 0 5 5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X 0. 15. 16. Amount of Line 14 taxable 7 9' 1 5 2 0 5 5 3 5 6 ' 1 8 4 3 at lineal rate X 0.45 16 17. Amount of Line 14 taxable at sibling rate X .12 1 Z 18. Amount of Line 14 taxable : at collateral rate X .15 18. 1s. TAxDUE 1s. 3 5 6 1 8. 4 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o Side 2 1505607222 1505607222 _ _ _ __ _ i REV-1500 EX Page 3 Flle Number Decedent's Complete Address: DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER JOHN MIL _. ___ _.. ___ _ __ _. STREET ADDRESS 1904 Kent Drive CITY _._ _. ._ _ __ it _ __ !STATE -_. 'ZIP Camp Hill , PA .17011 j ', Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2 Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $1,780.93 _.. _.. __ Total Credits(A+B+C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty ~ ~ _ Total InteresUPenalty (D + E) (3) $0. i 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. (4) $0. 5. If Line t + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $33,837. ' A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $33,837. 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 consideration? ^ 3. Did decedent own an"in trust fof'or payabfa 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 designation? ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fling 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 zero (O) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, 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 twelve (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. I T REV-1504aX • (e-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF JOHN MILLER SCHEDULE A REAL ESTATE FILE NUMBER All real property owned solely or as a tenant In common must be reported at falr market value. Fair market value is tlagnetl as me pots m which property vrou10 be I e%changetl beNreen a willing buyer and a willing seller, neither heing compalle0 to buy or sell, bom having reasonable knawledga of the relevant fads. ~ Rem property wmm~ Is lomnycwned won ngnt or survrvoremp must oe msdosw on scnegwe F. ITEM NUMBER DESCRIPTION VALUE AT DAT OF DEATH 1. 1904 Kent Drive, Camp Hill, PA 17011 $132,20 . I I OOi i TOTAL (Also enter on line 1, Recapitulation) $132,200. 0 (If more space is needed, insert additional sheets of the same size) ftEV-1500 EX+(690) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF JOHN MILLER FILE NUMBER InGUtle the proceeds of litigation and the tlate the proceeds were received by the estate. '~ All property lolnttyownetl with the right of survivorship must lte di:closed on Schedule F. ITEM VALUE AT DA7 ' NUMBER DESCRIPTION OF DEATH 1. 1989 Ford Ranger $3,500 0 0~.. 2. 1995 Buick Century $2,500 0 0'. 3. PSECU #3018387274111 (St Savings) $26,172 8 0' 4. PSECU #3018387274111 (S4 Money Handler) $1,163 7 5 5. PSECU #3018387274111 (S50 Certificate) $2,903 0 5 6. PSECU #3018387274111 (S51 Certificate) $3,726 4 0'x, 7. PSECU #3018387274111 (S52 Certificate) $3,726 4 0~ 8. PSECU #3018387274111 (S53 Certificate) $3,911 2 3 9. PSECU #3018387274111 (854 Certificate) $3,911 23 10. PSECU #3018387274111 (855 Certificate) $2,878 70', 11. PSECU #3018387274111 (S56 Certificate) $2,878 69, 12. PSECU #3018387274111 {857 Certificate) $2,853 22I 13. PNC Checking #5140258364 $1,275 66~, 14. PNC Savings #5130179427 $70,764 121 15. AmeriChoice FCU Savings #39598-0001 $50,038 30 16. AmeriChoice FCU Checking #39598-0013 $503. 131 17. AmeriChoice FCU Certificate#39598-0060 $2,937. Iii 18. Patriot News Refund $50. 9, 19. Ameriprise Long Term Care Policy Refund $975. 6 20. Personal Property $11,615. 01 f TOTAL (Also enter on line 5, Recapitulation) $198,285 . 0 (If more space is needed, insert additional sheets of the same size) REV45ID E% ~ (898) I I SCHEDULE G INTER-VIVOS TRANSFERS 8 COMMONWEALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RE (DENT DECEDENT ESTATE OF JOHN MILLER FILE NUMBER This schedule must be completed antl fled if the answerto any of questions 7 through 4 on the reverse side of Ne REV-i5W COVER SHEET is yes. I ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT ANO THE GATE OF TRANSFER. ATTACHACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH i OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABL VALUE Ameriprise Accounts: Benefciaries - 50°h: John C. Miller, Jr. (Son); 50%: Lori A. Crum (Daughter) 1. Ameriprise Mutual #010113131436002 $1,270.58 100.0% $1,27 .58 2. Ameriprise Mutual#014372019811002 $5,541.18 100.0°10 $5,54 .i8j 3. Amerirpise Mutual #021372019816002 $3.11 100.0% $ .1111 4. Ameriprise Annuity #930076132024004 $95,323.51 100.0% $95,32 .51'i 5. Ameriprise Annuity#930078625165004 $79,383.78 100.0% $79,38 .781 6. Ameriprise Annuity #931073344547004 $34,877.23 100.0% $34,67 .231 7. Ameriprise Annuity#992500692700141 $53,143.56 100.0% $53,14 .561 8. Ameriprise Annuity #992500695463141 $53,522.16 100.0% $53,52 161 9. Ameriprise Annuity #992500692775141 $53,143.56 100.0% $53,143561, 10. Ameriprise Annuity #992500088602141 $11,017.62 100.0% $11,017 821 11. Ameriprise Annuity#992500687486141 $54,314.63 100.0% $54,31463~'~ 12. Ameriprise Annuity#992500687494141 $25,296.12 100.0% $25,296121 ~ 73. Ameriprise Basic Brokerage #000610601726133 $15,528.96 100.0% $15,528 96 'ii 14. Ameriprise Basic Brokerage with ONE #000578060519133 $17,000.50 100.0% $1,700 501 TOTAL (Also enter on line 7, Recapitulation) $484,066. 0 (If more space is needed, insert additional sheets of the same size) REV-1511 EX ~ p0-a8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF JOHN MILLER FILE NUMBER I Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES '~ 1. Geigle Funeral Home $10 . 28! 2. Pastor Mike Leonzo $1,50 . Od 3. Pastor Andrew Thomas $50 . OO 4. Living Water Community Church $50 . OOi 5. Military Honor Guard -Funeral Service $20 . OO 6. Osiris Holding of PA -Headstone $2,62 . 00, B. ADMINISTRATIVE COSTS: ' 1. Personal Representative's Commissions ', Name of Personal Representative (s) ~., Street Address '. City State Zip '~, 2. Year(s) Commission Paid: Attorney Fees: Gates & Gates, P.C. $9,900 '. 00, 3. 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 Cumberland County Reg. Of Wills $683 0 5. Filing Fee Inheritance Register of WiAS $15 . 0 ~I, 6. Tax Return Preparer's Fees Kelly financial Services $389 . 0 7. Estate Advertising -Cumberland Law Journal $75 . 0 B. Estate Advertising -The Sentinel $221 . 0 9. Lower Allen Twp -Sewer & Trash $117 . 0 10. PA American Water $88 . 7 11. Verizon $55 . 6 12. UGI -Electric $150 .10 l TOTAL (Also enter on line 9, Recapitulation) $17,129 . 1 (If more space is needed, insert additional sheets of the same size) ~ RER1512 EX ~ (t2-04) COMMONWEALTH OF PENNS INHERITANCE TAX RETI RESIDENT OECEOEN' ESTATE OF JOHN MILLER SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8r LIENS FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbureed medical expense . ITEM VALUE AT DAT NUMBER DESCRIPTION OF DEATH 1. Drs. Andrew & Patel $2 . Otl 2. American Home Supply -Medical Equipment $ . 59 3. Home Instead -Medical Care $23 . 48 4. Apria Pharmacy -Medical $1 . OQ 5. U.S. Treasury - 2012 Income Tax $5,62 . Oq 6. PA Dept of Revenue - 2012 State Tax $ . Oct TOTAL (Also enter on line 10, Recapitulation) $5,90 2 04I {If more space is needed, insect additional sheets of the same size) REV-1513 EX+(9-00) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHA E NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not use Truetaete) OF ESTATE i I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] '~, ~ 1. Jahn C. Miller, Jr. - 400 Iron Mountain RoaQ Millerstown, PA 17062 Son ~~ 50% 2. Lori A. Crum - 1507 Embassy Drive, Hartisburg, PA 17109 Daughter ~5p /p ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRWTE, ON REV- 1500 COVER SHEE ~~ II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ~'. ~'','.. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I I ~I '. '', '.. ''~.. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ .p0 (If more space is needed, insert additional sheets of the same size) ~~.b ~e~t~n~er~t D~ ~®1~~c~~ro ~.~~~~~ Wsl~s ~+ .~ 3; ~ ~, r~7 rc~ Ql '~ " `ii ~ G'* m t• c'a ~~ ca xi ~ ?~ ?s r ~._~ r r~ i,y .r: ~.,< ., ., ~- ~, ~ , F,. . ~., ~~ .. :...~ `Tl ~, John C. Miller, also known as Curt Miller, of 1904 Kent Drive, Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, do make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. ~IRST : I do direct that all my just debts, including funeral. expenses, be paid by my hereinafter named Executor as soon after my decease as may conveniently be done. All inheritance, estate, txansfer, succession and death taxes of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this will, shall be paid out of my residuary estate. ~ECOND : I specifically give and bequeath all my tools unto my son, John C. Miller, Jr. Page 1 of 3 T John C. Miller ~ ~HIRD : I do give, devise and bequeath the rest and remainder of my estate unto the John Curtis Miller Living Trust dated N~"~""`~~ $ , 2004. ~OURTH : Tn the event the John Curtis Miller Living Trust had been revoked or not existent at the time of my death, I do give, devise and bequeath the rest and remainder of my estate unto my children, John C. Miller, Jr. and Lori A. Crum, per stirpes. ~IFTH : I do nominate, constitute and appoint as Executor of this my Last Will and Testament, my son, John C. Miller, Jr.. In the event the said John C. Miller, Jr. is unable or unwilling to serve as the Executor of this my Last Will and Testament, I do nominate, constitute and appoint my daughter, Lori A. Crum, as the Alternate Executrix of this my Last Will and Testament. No fiduciary shall be required to enter bond or furnish sureties in any jurisdiction. IN WITNESS WHEREOF, I, John C. Miller, Testator, have to this my Last Will and Testament, contained on this page and the foregoing pages, set my hand and seal, this ~~ ,~~ day of ~.%~` U ~= 7,. ~ t~ ~ ~~~~~ 2004. ~~_~~ _ ` -y ~ (SEAL) John C. I~ filler ~., The foregoing instrument, contained on this and the preceung pages, was by him signed, sealed, published and declared as and for his Last Will and Testament, in the presence of us, who, in his presence and in the presence of each other, and at his request, have hereunto subscribed our names as witnesses. Page 2 of 3 of F trl z, :`v`~1` u ~., WE, ~i-Gi._., ~-~~Ii~1~~'~(!~~.--~ ~.,...~A and t ~`~'~~ ,the Testator and 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 witness- es, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of his/her knowledge, the Testator was at the time eighteen (18) years of age or older, of sound mind and under no constraint of undue influence. TESTATOR ~~ o . WITNESS~- d _~ ~~.-,+-.L~ ~~,~r~ WITNESS SUBSCRIBED, sworn to and acknowledged before me by John C.~M' il--l{{1e--r,~, the Testator, and subscribe and sworn to before me by=~~~ ~~ t GG1X.f.% and ~~ ~'1 ~ ~ ~ t Witnesses, this day of ~ '~6 ~~~ F' 2004. OTARY PUBLIC COMMCNWFAL'TH GF PFN~ISYL_VA_nl~ Notarial Seal Card M. Sweitiar, Notary Publlc i Harwver eoro, York County Page 3 of 4 wy Canmissta, Expires oec.11, 2007 Member: PennsAvania Association Of Notaries ~__ . PSE(~ RECEIVED 0l/3o/zo13 FEB 04 2013 SAG Gates & Gates P.C. Samuel A. Gates, Esq. 250 York St. Hanover, PA 17331 Re: JOHN C MILLER, Deceased. PSECU Reference # 30 1 83 872741 1 1 Dear Attorney Gates: The above referenced person has an account with PSECU which was opened on December 13, 1989. The Share accounts were individually held by JOHN C MILLER. The following are the Date of Death Balances for JOHN C MILLER'S account with PSECU: Date of Death Interest Accou nt Balances Decemberl-13 Open Date (S1) Savings $26,17 1.40 $1 .40 12/13/1989 (S4) Money Handler $1,163. 71 $0 .04 12/13/1989 (S50) Certificate $2,902. 64 $0 .41 08/31/2006 (S51) Certificate $3,726. 07 $0 .33 04/02/1999 (S52) Certificate $3,726. 07 $0 .33 04/02/1999 (S53) Certificate $3,910. 67 $0 .56 01/02/1999 (S54) Certificate $3,910. 67 $0 .56 01/02/1999 (S55) Certificate $2,878. 29 $0 .41 10/31/2006 (S56) Certificate $2,875. 28 $0 .41 11/30/2006 (S57) Certificate $x,852. 81 $0 .41 Oi/31/2007 Please provide us instructions on closing the decedent's account. If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237- 7328, press 6, extension 3120. Sincerely, r ~` ~~~ Sandy FagYey Member Service Representative PSECU Pennsylvania State Employees Credit Union 1 Credit Union Place, P.O. Box 67013, Harrisburg, PA 17106-7013 • 800.237.7328 • »psecu.com THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION. EQUAL OPPORTUNITY LENDER. PNC January 29, 2013 Gates & Gates Attorneys at Law c/o Samuel A Gates 250 York St Hanover PA 17331 RE: John C Miller SSN: 204-30-7043 DOD: 12/13/2012 Dear Sir/Madam: RECEIVED FEB 0 4 2013 SAG In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5140258364 Established: 12/01/1980 JOHN C MILLER DOD balance: $1,275.66 + 0.00 accrued interest Savings Account Account # 5130179427 Established: 12/01/1980 JOHN C MILLER DOD balance: $70,763.73 + 0.39 accrued interest Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. if you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 2 AmeriChoice F E D E R A L CREDIT U N I O N Building Relationships For Life January 24, 2013 Gates & Gates Trial Attorneys 250 York St Hanover, PA 17331 Re: Estate of John C. Miller Attorney Gates: RECEIVED FEB Y 2 2013 SAG The decedent had one member number 39598 titled John C Miller. This is an individual account held in John C Miller's name only. Account 39598 Regular Savings (suffix 0001) -opened 08/12/2006 Checking (suffix 0013) -opened 08/12/2006 12 Month Certificate (suffix 60) -opened 08/12/2006 Date of death balances are as follows: Balance Accrued Dividends 39598-0001 - $ 50,034.74 $ 3.56 39598-0013 - $ 503.13 $ 0.00 39598-0060 - $ 2,936.29 $ 0.78 The above balances do not include the accmed/unpaid dividends as of December 13, 2012. Mr Miller did not have a safe deposit box with AmeriChoice. I have enclosed the most recent statement for your records. Please feel free to contact me directly with any questions you may have. Sincerely, Bonnie R. Seagraves Operations Specialist Phone (717) 591-1282 Fax (717) 697-3713 Email bsea rg aves(a)americhoice.org Main Office: 2175 Bumble Bee Hollow Road • Mechanicsburg, PA 17055 • Phone: (717) 697-3474 • Fax: (717) 697-3713 Website: www.americhoice.org ''~ ® EVUeI ..''~.`~ OpportunHy ~ ~F LENDER EouN xNNN CREDIT UNIO#t5- LINOIR 0_'!05/2P13 '." '~ 7'.73373379 SANDOE&ASSOr PAGE 02!08 Bowers-Miller, Whitney S From: Meath, Christine A on behalf of SDLife6vent5CommuniCationCenter Sent: Friday, December 21, 2012 3:05 PM To; Sandae, Mark E Suhjed: 16737502 1 001 JOHN C MSLLER ESTATE SETTLEMENT Fallow Up f=lag: Flag Status: Follow up Flagged Please do not reply to this email. this database does not support incoming mail. Please call the phone # within the letter you require assistance. Thank you. Life Events Team Company December 21, 20].2 MARK ERIC SANDOE FL 1 1105 SHRIVERS CORNER RD GETTYSBIJRG, PA 17325-8369 Dear MARK ERIC SANDOB: glvaraourca Llh Ineurarlce AmMpnae Flnandal Cempany 70YOD Amarlprlse Flnandal Cents MBnneapolla, MN 55474 We have received nadfication of JOHN C M1LI.ER's death. The deceased's name appears on the fallowing account-c. Account values as of 12/13/2012 ate listed below. At the end of this letter, you will find a list of beneficiaries shown in our initial review of the accounts A,ccotmt Information Mutual Funds Account Number Owners ' 01011313143 6002 IRA - beneficiary designated 01437201981 1 002 IRA -beneficiary designated 02137201981 b 002 Individual - TOD Anrrolties -Post 1;985 Account Number ers 93007613202 4004 Individual 93007862515 5 D04 Individual 93107334454 7 004 IRA -beneficiary designated _ _ _ _ ___ __ SANDCE&ASSOC °AGE 03 23 ,,.._, t~3/P5l2013 ~.~._4 7173373379 99250069270 0 141 99250069546 3 ]41 99250069277 5 141. 99250008860 2 141 99250068748 6 141 99250068749 4 14] IRA -beneficiary designated IRA -beneficiary designated IRA - beneficiary designated Individual Individual Individual LTC Premitttn Return Account Number wnershi 91006033714 4 004 individual Basic Brokerage Account Nur,2ber wners i 00061060172 6 133 IRA -beneficiary deslgna[ed Basic Brokerage with ONE Account Number Ownership 00057806051 9 133 Individual - TOI) Mutual 11 tends Account Number Total Value o#_ f shareg Asset Valua Per Share 010113131436092 $1270.58 1,270.580 1 014372019811002 $5541.18 521.768 10,620 02137201981 b 002 $3.11 3.110 1 Annuities -Past 1.985 ~cwunt Number Total Value # ° shares Asset Value Per Share 93007613202 4004 $95323.51 93007862516 5004 $79383.78 931073344547004 $34877.23 44250069270 0 141 $ 53143.56 99250069546 3 141 $53522.16 99250069277 5141 $531.43.56 99250008860 2 141 511017.82 99250068748 b 141 $54314,G3 99250068749 4 141 $25296.12 LTC Premium Retut~l Account Number Total Value ~ of h s Ass-gt Value Per Share 91006033714 4 004 $0.00 Basic $rokerage Account Number T Va a of s es Asset Value Per Share 00061060172 6133 $I5528.96 Basic Brokerage with ONE Account Number T slut # of sltazes Asset Value Per Share 000578060519133 $17000.5 2 03/95/2012 7.1:3a 7173373379 SANDOE&ASSOC PAGE 04/08 asat4aaeil..,prtraro.,,a.Aeeara,. at,watohasE7ta16TCOS1PMNr Wdt>Fnseats,r.~aR,tisnusxovoRn+s .ro~rw c suuett nµ ~xs R«a000+01a/71 tea asst *rpwrmnauK, Obi ;NWYiyv ~'I'!^` ~ pJ ~':~~~(,'a;t`v ~,1! n'~ f~~{rlu, i-~ jr;; ~Y-~Wltlfy i~:c'~ ''~i",;',-'VOflii,'~'A4 dew warnauwnusns ~ata raa alas tRl4rllAl~~~~E'5tM1E Oaltll PEN.E890ti 1;7dD.tD ?.ZZ 411Tas ~0901lE OIOeSreO:nr taell~ REK EtTATS raaa0p 6:r0 OADa00 aeeenilTNt ftaJArAq aaatRpnrAa,wyxW Gnli fOwr'~MAaew+t, A4W'CMR1-aR700 aeq pe'.00761leEVit t55 e~tryp~.ylen-py~MA 1NIWYF WW~wI`~~" ~°~!.jliU ii ~I P~~ ..I ~:'~ ,!i ~ i i v I~ ~ S'(f~1'I i~d ":^:"'~ :d' ~,, .. ~~1, ~.i~u. n tl,~{il~~~'~~~ i1~if~ {~.1~ ~yt li -. M9r1 G19nFOa11n1EnTa f,ObL06 7.00 TAR!! ~0-rCi~r~ 'F'mYC ~' 15Aa tAM.Ot fAgOra6 IiswulNtl! H7AOal0 The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by tech product Please note that the values indicated for any Life Insurance products with the insured deceased reflect the gross death benefit at date of death and not the easri value. Values indicated for Life Insurance products with only! the owner deeeaud reflect the cash value as of the date of death. Values for any proprietary mutual Ivnds include aeerved dividends ', as applicable. Values provided far brokerage products are manually calculated, and should be used as estimates only. The prices used '', to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a ', service to its clients. Actual values used in preparation of tax remms or for planning purposes should be verified by your legal and accounting advisors. ', Account Aisposition Account disposition is based on how an account is owned (the ownership type). The following information will help you understand the ptroeess that will be used to settle the accounts. Accounts maybe subject to market fluctuation as gvvemed by each product. Disposition for DIA -beneficiary designated ownership Upon the death of the owner, all IRA accounts pass to the named beneficiaries. If you are inheriting multiple IRA plans of the same plan type, they will be settled. into one Inherited IRA plan. To determine the distribution options available, please consult a tax advisor. If all IRA accounts will not be fully distribuud to the beneficiaries within the year of the owner's death, we reromznend the accounts be transferred into beneficial ownership by year end. This ensures we are able to meet IRS Porm 5498 reporting requirements. Transferring to inherited ownership is not a taxable distribution to the beneficiary. If an account in an IRA was subject to a Special Beneficiary Restriction, the distribution option for that particular account will be restricted. Disposition for Individual - TOD ownership Upon the deatlt of the owner, all accounts registered as individual-transfer on death pass to the named beneficiaries. Although the assets da not become part of the estate for distribution., we understand they should be included foe inheritance and/or estate taz purposes. Disposition far Individual ownership Upon the death of the ownerfinsured, ail premiums paid after the date of death will be refunded to the estate. Disposition for ind[vidvnl ownership Upon the death of the owner and annuitant, account proceeds typically pass to the named beneficiaries. If no beneficiary is named and tits contract includes a default beneficiary provision the proceeds will be paid according to the beneficiary default language. In all other cases where no beneficiary was designated, the proceeds become part of the owner's estate for distribution, DEFSRAED ANNUITX NOTIC&: Tf the beneficiary(s) wishes to elect an annuity payment plan, we must receive wriuen notice of this election within 60 days of our receipt of complete requirements from any individual beneficiary. The conTrael value will remain invested in the separate account until we receive a completed claim. If there are multiple beneficiaries, each claim will be processed separately and each beneficiary's share will remain invested in the separate account until it is claimed. 'f'ire bencficiares bear the market risk during [his time. 031051'201' 11:3 7;.73373379 SANDOE&ASSOC PAGE 05/08 Ihsposltion £or IItA - beneficiary designated ownership The deceased was the annuitant on at least one annuity account previously listed Upon the death of the annuitant, account proceeds typically pass to the beneficiaries named at the time of death. If no beneficiary was designated the proceeds become par[ of the estate for distribution. DEFERRED ANNTII7'Y NOTICE: If the bcneftciary(s) wishes to elect an annuity payment plan, we must receive written notice of this election within 60 days of our receipt of complete requirements from any individual beneficiary. The contract value will. remain invested in the separate account until we receive a completed claim. If thtre are multiple brneFiciaries, each claim will be processed separately and each beneficiary's skate will remain invested in the separate account until it is claimed. The beneficiaries bear the market risk during this time. Disposition for ]individna] - TOD ownership The deceased was the annuitant on at least one annuity account previously listed, Upon the death of flee annuitant saount pznceeds typically pass to the benefdaries named at the time of death. If no beneficiary was designated the proceeds become part of the estate ' far distrhutien. DEFERRED ANNUITY NOTTG)r: If the beneficiary(s) wishes to elect an annuity payment plan, wa must receive written notice of this election within 60 days of our receipt of complete requirements from any individual beneficiary. The contract value will remain invested in the separate account until we receive a wmpleted claim. If there are multiple beneficiaries, each claim will be processed separately and each beneficiary's shore will remain invested in the separate account until it is claimed- The beneficiaries bear the market risk during this time. Disposition for IRA - benefidary designated ownership Upon the death of the owner, all I,RA accounts pass to the named beneficiaries. If you are inheriting multiple IRA pions of the same plan type, they will be settled into one Inherited 1RA plan. To determine the distribution options available, please consult a tax advisor. If a]I IRA accounts will not be fully distributed to the beneficiaries within the year of the owner's death, we recommend the accounts be transferred into beneficial ownership by year end. This rnsures we are able to meet IRS Form 5498 repotting requiretttents. Transferring to inherited owncrsltip is not a taxable distribution to the beneficiary. If an account in an IRA was subject to a Special Beneficiary Restriction, the distribution options for that particular account will be restricted. Rt:~gtrired Docnmeats In order to take appropriate steps to settle the accounts we will need these documents: Certified Death Certificate (For accounts: 01011313143 6002, 01437201981 1 002, 021.3720 t 981 6 002, 93007613202 4004, 93007862516 S 004, 931073344541 7 004, 99250069270 0 141, 99250069546 3 141, 99250069277 5 1.41, 99250008860 2 141, 44250068748 fi 141. 94250068744 4 141 ,00057806051 9 133,00061060172 6133) The death certificate must be an original document that bears certification from the health department or local registrar and includes fkre cause of death. Estate Settlement Fotat (3248) (For accounts: 01011313 ] 43 6002, 01437201981 1002, 02137201981 6002, 00057806051.9 1.33, 00061060172 6133) To process a settlement on a Mutual Fund, Certificate or Brokerage account each claimant must complete an Estate Settlement Form (Form 3248). This form includes separate sections for qualified and non-qualified accounts as well as sections at the end of the form to be signed and dated by all new account holders for all accounts. The accottnt level suitability information requested on the form is required if you intend to retain the investments you receive through this process. If suitability information is incomplete we will not delay settlement, however, activity allowed on any accounts created through settlement wiN be limited to liquidation only. We will not contact you to complete the suitability information. Instructions for completion of the Estate Settlement Form are available as Form 3248-INST. Both fornts are available through an Ameriprise Finandal Advisor or online at httpa/www.ameriprise.com/amp/global/customer-scrvicelaccount-service.asp under the list heading "fiatate Settlement". Death Claim Statement Form (33047) (For accounts: 9300761.3202 4004, 9300786251E 5004, 93107334454 7 004, 9925006927D 0 141, 99250069546 3 I41, 99250069277 5 141., 99250008860 2 141, 99250068748 6 141, 99250068749 4 lat. To process a death claim on an annuity or life insurance account, we must receive a completed Insurance and Annuity Death Claim Statement form 33047 from each claimant. A completed death claim statement must contain the deceased's client information and account number, a completed claimant information section, and an acceptable mode of settlement. The form moat also contain a Taxpayer Idcntificadon Number and withholding election. Failure to select a withholding election on an annuity requires mandatory 10~, withtro]ding which is forwarded to the IRS that we cannot refund. In addition, the claimant(s) must sign the form end their signaturo(s) must be witnessed by an __ SANPOE&A550C PAGE 06105 G3/05/^^<013 :.1.:3c 7.73373379 Ameriprise Finaucia] Services advisor or a notary. If any of this information is incomplete, the form will be returned. This form is available through an Ameriprise Financial Advisor or online at http:llwww.ameriprisc.conn/atnplglobal/customer-service/ancount- service.asp, under the list heading "Estate Settlement", Additional Account Features Form 1.5028 version AD (01/10) • Important Notice for ONE Fiuandal Accottats and SPS Advantage Accrottats with ONE Features -Potential Loss of Features (For accounts: 00057806051 9 133) ONE Financial Account features include the following: Check Writing, ATM Card, Credu Card. On-Line Bill Payttrent, Over Draft Protection, High-Yield Savings. The estate settlement process may impact the availability of the features associated with. a deceased client's Arrreriprise ONE Financial Account or SPS Advantage Account with ONE features. Tire account features will still be accessible to a surviving joint owner or trustee(s), currently listed an the account, until we have received all requirements [o complete senlement To ensure the continuation of features for the new account registration please submit a completed Additional AccounC Features Fornr 15028, as well as a signed end completed W-9 for any new fiduciary that will be on the new account registration. If these forms have not been received in our office at the time of settlement, features may be removed during the settlement process. Please contact our office at 1-800-862-7919, Option 2 ask for Estate Settlements, it Request for Waiver or Notice of Transfer (Po~ible) (PA) Fotm R$V-516 EX II (For accounts: 010113) 3143 6 002, 014372D 1981 1 002, 02137201981 6002, 9300761 3202 4 004, 93007862516 5004, 931073344541 7 004, 00034032203 1 133, 00045238160 1133, 00057806(!51 9 133, 000610601.72 6133) This document verifies that the state tax bureau is consenting to the transfer of the assets. FarmREV-51.6 should be completed by the beneficiary and mailed to the Pennsylvania Department of Revenue. A waiver will be sent to Ameriprise Financial stating that the assets can be released. i, In order to be compliant with fair claims practices of many states we will be immediately corresponding with the beneficiaries listed for any Life and Annuity accounts held by the deceased client. Similarly we will be cot'rcaponding with the beneficiaries or claimants of all accounts held by the decedent within a minimum of slat months of the date of this letter. Please contact us if you wish to ace a copy of these correspondences. We also request any information you may have that may facilitate our efforts to contact other beneftciarics on the accounts involving the deceased. fa an effort zo improve our process, we invite you to share your feedback with us by sending a Lotus Note to: Life Events Mailbox. If you wish to complete settlement prig to the end of the 2012 tax year, all requirements must be received by December 14, 201.2. We will put forth our best efforts to handle all requests before year-end even if received after that date; however, we cannot guarantee that processing will be completed for the 2012 tax year. If there are IRA assets involved with this claim and the decedent's Itequirett Minimum Distribution fur 2012 has not yet been fulfilled,, please contact our office for additional instructions. If you have questions about this letter or need assistance determining next steps, please call 1-(800)-297-6663 and say Death Settlements to be connected with an operator. Ask to be connected to the Estate Settlements Team. You will be connected m one of cite knowledgeable Life Events Custotrrer Service Professionals who will be ready to assist you tl[rovgh this process. More information regarding the Estate Settlement pmceas 9s available on [he Ameriprise.com website. 7o view the "Estate Settlement Frequently Asked Questiotts" page on the website, type "Estate Settlement FAQs" in the search field on the website homepage. press the "Enter" key and select the first item on the "GLOBAL" list. Sincerely, Death Settlements Processing Team 70100 Ameriprise Financial Center Minneapolis. MN $5474 Death Settlements Processing Team: 800-297-fi663, PIN, say Death Settlements Life Insurance Claims: 800-297663, PIN, say Life Claims Attachrtxnt: Beneficiary information g3/g5l2013 7.1:34 7173373379 SANDOE&ASSDC Beneficiary Information We have the following benet"iciaries on record for the deceased's accounts, Account Number: 01011313143 6002 Designation: PRIMARY BENEFICIARY 50% JOHN CURTIS MILLER JR 50N, IF LIVING, IF NOT, LORI ANNE CRUM, DAUGHTER 50°lo LORI ANNE CRUM, DAUGHTER IF LIVING, IF NOT, SOgo TO f EPIANNE FRAZIER. GRANDCHILD, PF.R STAtPE5, AND 504'o TO MARK FRAZIER, GRANDCHILD, PER STIRPES. Account Number: 01 437201981 1002 Deslgnation: PRIMARY BENEFICIARY 5096 JOHN CURTI5 MILLER .iR, SON, IF' LIVING, IF NOT, LORI ANNE CRUM, DAUGHTER 509b LORI ANNE CRUM, DAUGHTER, iF LIVING, IF NOT, 5090 TO LEEANNE FRA7.IER, GRANDCHILD, PER STIRPES, AND 5045 TO MARK FRAZIER, GRANDCHILD, PER STIRPFS. Acrnnnt Number: 02137201981 6002 Designation: PRIMARY BENEFICL4RX 50~ 70HN CURTIS MILLER JR SON, IF LIVING, IF NOT, LDRI ANNE CRUM, DAUGHTER 50~+ LORI ANNE CRUM, DAUGHTPRR, IFLIVING, IF NOT, 509'o TO LEE ANNE FRA2SER, GRANDCHILD, PER STII2PES, AND 509'o TO MARK FRAZIER, GRANDCHILD, PER STIRPF.S. Account Number: 41006033714 4004 Designation: No record on file, Accnnnt Number: 93007613202 4004 Denfignutiou: 50% JOHN CURTIS MILLER JR, SON. IF LIVING, IP NOT, LORI ANNE CRUM, DAUGHTER 50~, LORI ANNfi CRUM, DAUGHTER, IP LIVING. IF NOT, 5040 TO LEE ANNE FR?,ZIER, GRANDCHILD, PER STIRPES, ANA 50% TO MARK FRAZIER, GRANDCHJLD, PER STIItPES. Account Number: 93007862516 5004 Designaton: PRIMARY BENEFJCIARY 50% JOHN CURTIS MILLER JR, SON, IF LIVING, IF NOT, LORI ANNE CRUM, DAUGHTER 509'a LORI ANNE CRUM. DAUGHTER. IF LIVING, IF NOT, 509b TO LEE ANNE FRAZHIR, GRANDCHILD, PER STIRPES, AND 509b TO MARK FRAZIER, GRANDCHII.D, PER STIRPES Account Number: 93107334454 7004 Designation: 5096 JOHN CURTIS MILLER JR, SON, IF LIVING. TF NOT, LORJ ANNE CRUM, DAUGHTER 5096 LORI ANNE CRUM, DAUGHTER, IF LIVAVG, IF NOT, 5096 TO LEE ANNB FRA7.IBR, GRANDCHiT.A, PfiR STIRPES, nND 5096 TO MAItiC FRAZJBR, GRANDCHILD, PER STIItPES. PAGE E7/08 o SANDOE&ASSOC PAGE ©S/00 0319512q;.^- 11:30 717337_.379 Account Number: 99250069270 0 141 99250069546 3 141 44250069277 514] Designation: PRIMARY BENEFICIARY 5096 JOHN CUBITS MILLER JR, SON, IF LIVING, IF NOT, LORI ANNE CRUM, DAUGHTER 5D9o LORI ANNE CRUM, DAUGHTER, IP LfVA3G, IF NOT, 5D'9n TO L6EANNE FRAZIER, GRANDCHILD, PER STIRPPS, AND 50% TO MARK FRAZIER, GRANDCHILD, PER STTRPE5. Account Number: 99250008860 2 141 99250DQ8748 6141 99250068749 4 141 Designation: PRIMARY BENEFICIARX S09o JOHN CUBITS MILLER JR, SON, IF LIVING, IF NOT, LORI ANNE CRUM, DAUGHTER 50~ LORI ANNE CRUM, DAUGHTER, IF LIVING, IF NOT, 50°.b TO LEE ANNE FRA2IER, GRANDCIIILp, PP.R STRIPES, AND 50~% TO MARK FRAZIER, GRANDCHILD, PER STRIPES. Account Number: 000578060519 1.33 Designation: PRIMARY $SNEFICIARY 50~ JOHN CURT15 MILLER JR, SON, IF LIVING, IF NOT, LORI ANNE CRUM, DAUGHTER 50~ LORI ANNE CRUM, DAUGHTER, IF LIVING, IF NOT, 5096 TO LEE ANNE FRA23F'R, GRANDCHILD, PER STIRPBS, AND 504io TO MARK FRAZIER, GRANDCHILD, PIsR STIRPES. Account Number: 00061060172 6 133 Designation: PRIMARY BENEFICIARY 50% JOHN CUBITS IvIILLBR JR, SON, IF LIVING, IF NOT, LORI ANNE CRUM, DAUGHTER 50'Yo LORI ANNE CRUM, DAUGHTER., IF LIVT1vG, IF NOT, 50°k TD LEEANNE FRAZIER, GRANDCHILD, PER STIRPES, AND 50~ TO MARK FRAZIER, GRANDCHILD, PER STIRPES. When submitting the required documents please attach this covet sheet to the documents. Please include all documents related to the claim or estate settlement including new account applicatiosls, claim farms, etc. Please do not include any documents not related to the death claim or estate settlement. This will allow for quicker processing of your claim or estate settlement, Please note that as of August 14, 2007 original documents (i.e. Certified Death Certificates, Letters of AdminislrationJTestamentary, court orders, etc.) will, no longer be returned to the client or advisor. Power of Attorney documents, however, will continue to be returned. u~~~ a7w~ ~' NI.?N CNO ~ N~N 7LLry O Z02Y96W CZ ..,:~ u.~ .^i ~ i~__ ~° ~' ''" 'r W 'I. J U! !,A ~-i J ~ CL' t_ ~`~' cmc U~xm V u E-= 0 ~ ' 7 lU ~ ~ j " V W ~, ~r Z'' r~ a V o,. r' t- ~ ~. ..::..~.. _.__- W [- C7 rn '-I 3 W N 00 N E +~+ O m O •~.N ~ ~ ~ ~ ~O G Q' ~ 7 cn cg °~' w rox~ s+ ~+ w o~ v ~ro+ U .--~ cd M a d 'o d 0