Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
03-18-14 (2)
-J 1505610105 REV-1500 Ex foZ_1,,�F„ LIJ OFFICIAL USE ONLY PA Department of Revenue pennsytvania Bureau of Individual Taxes DEYaxlxCxiDluNEnUC County Code Year File Number PO BOX28o6oi INHERITANCE TAX RETURN �� ���) Harrisburg,PA 1'7128-0601 RESIDENT DECEDENT b ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 10/01/2013 01/10/1924 Decedent's Last Name Suffix Decedent's First Name MI Miller Roy L (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) 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 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- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Jacqueline M.Verney, Esq REGISTER OFMLLS USE ONL'K- C. First Line of Address 44 S. Hanover St ca ( D Second Line of Address ©c- -' City or Post Office State ZIP Code DAT Lr=_6 C�Q Carlisle PA 17013 Correspondent's e-mail address:jmyerneyt@aol.COm 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.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ,ERSON RE LE I DATE x'18-I� ADDRESS e S ATURE OF PRE ARER OTHERTH N EPRESENTATIVE DATE PpbRES -7 3 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) . Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate(Schedule A). ....... . .................................... 1. 186,000.00 2. Stocks and Bonds(Schedule B) .:............................. 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. 21,803.47 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)... .......................... 8. 2079803.47 j 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 14,221.18 10. Debts of"Decedent,Mortgage Liabilities and Liens(Schedule 1)......:........ 10. 225.96 11. Total Deductions(total Lines 9 and 10)................................. 11. 14,447.14 I 12. Net Value of Estate(Line 8 minus Line 11) ............................... 12. 193,356.33 ! 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.I 193,356.33 { TAX CALCULATION-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_ I ` 15. i ; 16. Amount of Line 14 taxable at lineal rate X.0 45 j 8,701.03 16.f 8,701.03 17. Amount of Line 14 taxable i at sibling rate X.12 ! 17. 18. Amount of Line 14 taxable j at collateral rate X.15 19. TAX DUE ......................................................... 19.1 8,701.03 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Roy L. Miller STREET ADDRESS 1031A Waggoners Gap Road CITY STATE I ZIP Carlisle PA I 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 8,701.03 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 8,701.03 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.......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0 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?.............................................................................................................. ❑ N 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary 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 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)].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)]. • 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)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) 7pennsytvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Roy L. Miller 21-13-1068 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 or sell,both having reasonable knowledge of the relevant fads. 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 1 1031 A Waggoners Gap Road Carlisle,PA 17013 186,000.00 i i TOTAL(Also enter on Line 1, Recapitulation.) $ 186,000.00 If more space is needed,use additional sheets of paper of the same size. Main File No.102413M Pane#] APPRAISAL OF REAL PROPERTY i7 �y LOCATED AT 1031A Waggoners Gap Rd Carlisle,PA 17013 P.O.Deed Book 32J 109 FOR Estate of Roy L.Miller OPINION OF VALUE 186,000 AS OF October 1,2013 BY Susan B.Burkholder Burkholder Appraisal Services 328 Garland Drive Carlisle,PA 17013 (717)254-6823 sue.burkholder@gmall.com PA Sate Certified Residential Appraiser Form GAW—'WinTOTAL'appraisal software by a la mode,Inc.—1-800-ALAMODE Burkholder Appraisal Services Main file No 102413ae#21 RESIDENTIAL APPRAISAL SUMMARY REPORT File No.: 102413M Property Address: 10 1AWaggonersGapRd City:Carlisle State:PA Zip Code:17013 County: Cumberland Legal Description: P.O.Deed Book 32J 109 tl Assessor's Parcel#: 29-07-0469-002A Tax Year:2012 R.E.Taxes:$3 070 Special Assessments:$0 Borrower it applicable): n.a. o Current Owner of Record: Estate of Roy L.Miller Occupant: 1 Owner ❑Tenant Vacant ❑Manufactured Housing Project Type: n PUD M Condominium Cooperative ❑Other describe HOA:$ per year ❑per month Market Area Name: North Middleton Townshio 22p Reference: 29-07-0469-002A Census Tract: 0119.02 The purpose of this appraisal Is to develop an opinion of: LQ Market Value as defined),or r7 other type of value describe _ This report reflects the followin value if not Current,see comments: Current the Inspection Date is the Effective Date Retrospective F]Prospective Z Approaches developed for this appraisal: X Sales Comparison Approach Ll Cost Approach Income Approach See Reconciliation Comments and Scope of Work Property Rights Appraised: N Fee Simple I D Leasehold _ Leased Fee Other describe Intended Use: To establish value for estate. y 4 Intended Users)(by name or type): Estate of Roy L.Miller Client: Estate of Roy Miller Address: 1031AWaggoners Gap Rd Carlisle PA 17013 Appraiser: Susan B.Burkholder Address: 328 Garland Drive,Carlisle,PA 17013 Location: Urban A Suburban Lj Rural Predominant One-Unit Housing Present Land Use Change in Land Use Built up: ❑Over 75% ®25-75% ❑Under 25% Occupancy PRICE AGE One-Unit 60% ®Not Likely o Growth rate: ❑Rapid 0 Stable ❑Slow ®Owner $(000) (yrs) 2-4 Unit %❑Likely* n In Process r= Property values: ❑Increasing M Stable ❑Declining ❑Tenant 120 Low 20 Multi-Unit 5% *To: _ a Demand/supply: ❑Shortage [In Balance ❑Over Supply Z Vacant(0.5%) 600 High 250 Comm'I 10% V Marketing time: ❑Under 3 Mos.Z 3-6 Mos. Ej Over 6 Mos. ❑Vacant >5% 175 Prod 50 Vcnt4nstug 25% o Market Area Boundaries,Description,and Market Conditions(including support for the above characteristics and trends): Marketing conditions are average with a properties selling within three to six months. Conventional and insured financing is readily available to quailed buyers at reasonable rates and terms This is an established residential neighborhood with stable ownership patterns within reasonable commuting distance to schools,places Fof worship shopping and transportation. The subiect neighborhood is bordered on The North by Route 944,on the South by Newville Road,on the East by Spring Road and on the le West by Meadowbrook Road i Dimensions: irregular Site Area: .92 ac Zoning Classification: A Agricultural Description: Existing use is permitted Zoning Compliance, ®Legal ❑Legal nonconforming grandfathered ❑illegal ❑No zoning Are CC&Rs applicable? ❑Yes ❑No Unknown Have the documents been rev ewed? Lj Yes No Ground Rent it applicable) $ ! Highest&Best Use as Improved: N Present use,or ❑Other use(explain) Actual Use as of Effective Date: Single family dwelling Use as appraised in this report: Single family dwelling Summary of Highest&Best Use: Continued use as a single family dwelling O. a cat Utilities Public Other Provider/Description Off-site Improvements Type Public Private Topography Slightly slope to rear and side W Electricity ❑ Street Macadam ® ❑ Size Typical for the area o Gas (] ® n.a. Curb/Gutter None ❑ ❑ Shape Irregular CI water ❑ ® Well Sidewalk None ❑ ❑ Drainage Appears adequate y Sanitary Sewer❑ ® On site Street Lights None ❑ (] View Average Storm Sewer n.a. Alley None ❑ Other site elements: �Inside Lot ❑Corner Lot ❑Cul de Sac ❑Underground Utilities ❑Diller describe FEMA S ec'I Flood Hazard Area Yes No FEMA Flood Zone x FEMA Map#42041 CO229E FEMA Map Date 03/16/2009 Site Comments: General Description Exterior Description Foundation Basement N None Healing #of Units 1 ❑Acc.Unit Foundation Concrete Slab 100% Area Sq.Ft. Type Baseboard #of Stories 2 Exterior Walls Brick/Aluminum Crawl Space None %Finished Fuel Electric Type®Det.❑Att. ❑ Roof Surface Shingles Basement None Ceiling Design(Style) Bi-level Gutters&Dwnspts.Aluminum Sump Pump❑ Walls Cooling ®Existing❑Proposed❑Und.Cons.Window Type Dbl-hung Dampness ❑ Floor Central Yes t� Actual Age(Yrs.) 34 Storm/Screens Screens Settlement None Outside Entry Other w Effective Age(Yrs.) 20 Infestation None N Interior Description Appliances Attic❑None Amenities Car Storage ❑None �i Floors Carpet Refrigerator M Stairs ❑Fireplace(s)#1 Woodstove(s)#0 Garage #of cars( 4' Tot.) Walls Drywall Range/Oven 0 Drop Stair Z Patio Conc _ Attach. QL TrirNRnish Wood Disposal ❑ Scuttle ❑Deck Detach._ w Bath Floor Linoleum Dishwasher ❑ Doorway ❑Porch Front Bit-In 2 2 Fx Bath Wainscot Drywall Fan/Hood ❑Floor ❑Fence _ Carport LL Doors Wood Microwave ❑Heated ❑Pool _ Driveway 0. -2 Washer/Dryer er Finished z ry ❑ ❑ I Surface Macadam 0 Finished area above grade contains: 7 Rooms 3 Bedrooms 2 Bath(s) 2,348 Square Feet of Gross Living Area Above Grade aAdditional features: Porch,sun porch,fireplace with pas insert. U w Describe the condition of the property(including physical,functional and external obsolescence): The interior of the home is in average condition.it was nicely maintained but no major upgrades were done. �RESIDENTIAL I tr^y �-{��p Copydght®2007 by a fa mode,Inc.This form may be reproduced unmodified without written permission,however,a la mode,Inc.must he acknowledged and credited. 'R C 9«f k p form GPRES2—"WnTOTAL°appraisal software by a la mode,Inc.—1-800-ALAMODE 3/2007 Rain File No.I 02413M Paoe#3 RESIDENTIAL APPRAISAL SUMMARY REPORT PileNo.: 102413M My research IJdid Z did not reveal any prior sales or transfers of the subject property for the three years prior to the effective date of this appraisal. a Data Source(s): Courthouse records _ O 1 st Prior Subject Sale/Transfer Analysis of sale/transfer history and/or any current agreement of sale/listing: The subject is not currently listed for sale. m Date: 12/11/1986 Title last transferred on 12/11/1986 for a reported consideration of$17,184. Price: 17,184 w Source(s): y 2nd Prior Subject Sale/Transfer Date: r Price: Source(s): SALES COMPARISON APPROACH TO VALUE if develo ed The Sales Cam arjson Approach was not developed for this ap hralsal. FEATURE I SUBJECT COMPARABLE SALE#1 COMPARABLE SALE#2 _ COMPARABLE SALE#3 Address 1031A Waggoners Gap Rd 1157 Easy Rd 51 Spur Rd 108 Cumberland Dr Carlisle PA 17013 Carlisle PA 17015 Carlisle PA 17013 Carlisle PA 17013 Proximity to Subject 3.89 miles NW 4.11 miles NW 1.75 miles NE Sale Price $ $ 185,500 $ 190,00 $ 200,000 Sale Price/GLA $ /s.ft.$ 99.46/s.ft. $ 85.74/s.ft. $ 108.23/s.ft. Data Sources Courthouse Courthouse Courthouse_ Verification Sources Crthse/Ins ection MLS MLS MLS VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION +- $Adjust. DESCRIPTION +- $Adjust. DESCRIPTION +• $Adjust. Sales or Financing Other FHA FHA Concessions None known Closing cost -5,700 None known Date of Sale/Time As of 10/01/2013 02/01/2013 08/17/2012 05/03/2013 Rights Appraised Fee Simple Fee Simple Fee Simple Fee Simple Location Average Average Similar Superior 10 000 Site .92 ac 3.08 ac -21,600 1.06 -1,400.3 ac +6,200 View Average Average Average Menace Design(Style) Bi-level Bi-level Bi-level Bi-level Quality of Construction Brick/Alum Brick/Alum Brick/Stone/Alum BrickNin I Age 34 32 31 39 Condition Avera a Avera a Superior -5,000 Su erior -5,000 Above Grade Total Bdrms Baths Total Bdrms Baths Total Bdrms Baths Total Bdrms Baths Room Count 7 1 3 1 2 7 3 1.1 +1,000 8 1 3 1 2 -2 000 8 1 4 1 2.1 -3.0001 Gross Living Area 2 348 s.ft. 1,865 S—ft—1 +14.50 2,216 s.ft. +4,000 1,848 s.ft. +15,000 Basement&Finished Wn None None None Rooms Below Grade Functional Utility Avera a Average Average Heating/Cooling Fha Oil CA Heat um CA Fha Oil CA = Energy Efficient Items None None None Gara e/Car ort 1-car are a +5 000 2-car ara a 2-car ara e Porch/Patio/Deck Porch atio +2 000 Porch deck +2 000 Porch deck +2 000 Shed Shed Fence Q; Fireplace Wood stove Coal stove Z Fireplace O y _ Q X Net Adjustment(Total) + $ 900 ❑+ _ - $ -8,100 ®+ - $ 5 200 0 Adjusted Sale Price w of Com arables $ 186,40 $ 181,900 $ 205 200 I Summary of Sales Comparison Approach Sales 1 and 2 are located in similar areas with larger sines and no public water and sewer.A location A adjustment was made for sale 3 since it Is in a neighborhood with sidewalks,public water and sewer. Sale number 1 was given the most consideration since this home is in similar condition and sold recently. Indicated Value b Sales Com arison A roach S 186,000 — ®!,p 1= Copyright#2007 by a W mode,Inc.This form may be reproduced unmodified without written permission,however,a la mode,Inc.most be acknowledged and credited. Form GPRES2—'WhTOTAL"appraisal software by a la mode,Inc.—1-800-ALAMODE 3/2007 REV-15o8 EX+(o8-12) " Q4 pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT - ESTATE OF: FILE NUMBER: Roy L. Miller 21-13-1068 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ' 1.' .M&T Bank checking acct#539287 1�+ 17,334.00 f2,1 Mutual of Omaha Ins.Co.refund 744.761, 3 Proceeds from sale of truck to Family Ford,Carlisle,PA I 3,500.00;f � 4. IThe Hartford Ins.truck insurance refund 96.00�[ 5. Comcast cable refund i 128.71 11 L ( ji' i =^.Reis' �s...+w+'.v.w- ...r. _r.a,..�_v..n.'..,y..� ..-.r — -�+..w•«....,..�.w........s..r.� ,�� 1i { q - TOTAL(Also enter on Line 5, Recapitulation) $ 21,803.471 If more space is needed,use additional sheets of paper of the same size. ACCOUNT.NO..: ACCOUNT•TY:PE ::.::.. STATEMENT:::PERIOD..:.. .: 539287 M&T SELECT OCT.10-NOV.08,2013 1 OF 1 00 0 04319M NM 017 000000037 FIDS1549DO1711081311 07 001000 54238 ROY L MILLER GLADYS L MILLER 1031 WAGGONERS GAP RD �( CARLISLE PA 17013-8376 j �' O1° INTEREST EARNED FOR STATEMENT PERIOD 0.00 HIGH STREET-CARLISLE ACCOUNT SUMMARY BEGINNING DEPOSITS'& OTHER-: CURRENT" '> ENDING BALANCE b7HER ADDITIONS CHECKS PAID SUBTRACTIONS. . .. . INTEREST::PD BALANCE'.::..: NO. AMOUNT NO. AMOUNT NO. AMOUNT 17,334.00 01 0.00 0 1 0.00 1 1 17,334.00 0.00 0.00 ACCOUNT ACTIVITY PASTING DEPOSITS,INTEREST CHECKS B OTHER DAILY TRANSACTION. DESCRIPTION.:... ::' & OTHER::AbD1TI0NS :.. ::SUBTRACTIONS. . . ;::. BAl ANCE.. N S 10-10-13 BEGINNING BALANCE $17,334.00 0 10-11-13 CLOSEOUT 17,334.00 0.00 o ENDING BALANCE $0.00 N O SAVE MONEY ON GIFTS AND MORE AT MAJOR RETAILERS THIS HOLIDAY SEASON. FIND OUT o HOW TO GET ADDITIONAL SAVINGS BY USING YOUR M&T VISA DEBIT CARD OR M&T VISA m CREDIT CARD AT MORE THAN 50 RETAILERS WHEN YOU VISIT MTB.COM/SHOPPING. FOR CUSTOMER SERVICE QUESTIONS, PLEASE CALL 1-800-724-2440. MEMBER FDIC. o o a 0 i; 0 a L008(6/12) I I I kD On i ! Ln N m i ON t.0 C-) i N oo� ! l0 �O l0 LO, D O O i w -< I � + g On Fr+ ~ r O(D N -0 O r ao Dm:m = C iv C ;v a N r= d m0 m N s C-) < z m g o to , i C r m D F, U) = = > m= O CD n a x i C) C7 O D � � c s a r C) w o c r i � -� C m W y I z Op 01 m I C:). o` I � I > z K- ! O i r I r m I m i^ r i zD m m cn I r c i _ 4A C CJ� � Z �p 4::-= c Z .o ! m M� FAMILY FORD G/L# Control# Amount PURCHASE STOCK 995413 1360 995413 3500 . 00 [T0400 . . THE ESTATE OF ROY LEON MILLE10/31/2013 11131 TOTAL 3500 . 00 11131 fA 'Date:11/05/13 Page 1 of 1 Check No.0033497759 004068 AM Kr MILLER ROY : 1031 WAGGONERS GAP RD THE CARLISLE PA 17013 HARTFORD ti� IF YOU HAVE ANY QUESTIONS,PLEASE CONTACT THE COMPANY AT: (800)423-6789 % A W vu �Vd PAYEE:MILLER ROY 0 REG POLICY SYM POLICY NUM PROD CODE INSURED ACCOUNT NUM CHECK AMOUNT S055 0313920 83970965 $**********k"96.00 © CHECK DESCRIPTION _ 83970965 55 PHH915667 POLICY CANCELLED 1= Form T-258-8 Printed in U.S.A. v• .. No. 2 9 2 8 4 5 16 8 . I COMCAST 1555 SUZY STREET ATTN: LEBANON SUPPORT SERVICES LEBANON, PA 17046 o- omcast„ ROY MILLER 27596 0020-60-13-AADC 211 FIREHOUSE RD SHIPPENSBURG, PA 17257-9733 . �„,111��11,�„I,�I�II�II'II'I'II'IIIl��II11��11����11,1�111�,1,1 PAYMENT S U VLWARY CHECK NO: 0012208233 ACCOUNT NO: 09547-37404502 CHECK DATE: 12/04/13 Dear ROY MILLER, ,ed check represents refund fdr account number 09547-37404502 in the amount of $ .71. If you are a Comcast XFINITY customer and have questions regarding your. refund check, you can .'write us at the address above, call Comcast's toll free customer service number at 1-888-COMCAST (1-888-266-2278), or chat with us at www.comcast.com/chat. Our representatives are available to assist you 24 hours a day, 7 days a week. If you are a Comcast Spotlight client or agency; please contact your local Spotlight office. DETACH AND RETAIN THIS STATEMENT THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE. IF NOT CORRECT,PLEASE NOTIFY LIS PROMPTLY.NO REGEiPT DESiREG. • . . . •.: .. • w• •e o • .• • 1 •.......•....-.........•............................................................... ................................ •• .. ..... •. ... .•• • ... •.. • • •• n :. : •• • o•k 1W , • REV-1510 EX+(08-09) ",Ipennsylvania SCHEDULE G ;' DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Roy L. Miller 21-13-1068 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DEO=DENT'AND NUMBER THE DATE OF TRANSFER.ATTACHA COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPPUCAKE VALUE 1. Transamerica Annuity to Ann Motter,daughter,transfer upon death 19,127.56 100 19,127.56 0.00 2 Transamerica Annuity to Cynthia J.Welsh,daughter,transfer upon death 19,127.56 100 19,127.56 0.00 3 Transamerica Annuity to Martin Miller,son,transfer upon death 19,127.56 100 19,127.56 0.00 4 Transamerica Annuity to James L.Miller,son,transfer upon death 19,127.56 100 19,127.56 0.00 5 Nationwide Annuity to Ann Motter,daughter transfer upon death 51,271.41 100 51,271.41 0.00 6 Nationwide Annuity to Cynthia J.Welsh,daughter,transfer upon death 51,271.42 100 51,271.421 0.00 7 Nationwide Annuity to Martin Miller,son,transfer upon death 51,271.41 100 51,271.41 0.00 8 Nationwide Annuity to James L.Miller,son,transfer upon death 51,271.41 100 51,271.41 0.00 TOTAL(Also enter on Line 7, Recapitulation) $ 0.00 If more space is needed,use additional sheets of paper of the same size. TRANSA MERICA Adrninistrative Office. 4333 Edgewood Road NE ® LIFE I N S U R A N C E COMPANY Cedar Rapids,IA 52499 www.transamCricaan nuitiCS.cnm October 11, 2013 ANN M MOTTER 211 FIRE HOUSE RD SHIPPENSBURG PA 17257 RE: Annuity Number(s) 02PSLO19987 Dear Claimant: We have received notification of the death of Roy L Miller. We extend our sincere condolences to you for your loss . The information in this letter is being provided to assist you in submitting death claim paperwork. Our records reflect the following information regarding this annuity: Annuitant: Roy L Miller Owner: Roy L Miller Claimant: Ann M Motter 25% Annuity value: $7.6, 510 . 24 as of 10-01-2013 Annuity type: Non-Qualified Tax Information This letter includes general tax information that should not be relied upon for personal tax planning. Transamerica Life Insurance Company does not give legal, tax, or accounting advice. You may want to consult your attorney, tax advisor, or accountant with questions regarding the direct tax consequences when selecting an option. General information The financial professional of record will remain on this annuity unless we are notified of a change in writing. Please be advised automatic operations such as- Systematic Payouts and Automatic Payments have been stopped. / A an AEGON company TR - SA WRICA Admitzistr�tive Office. 4333 Edgewood Road NE ® LIFE I N S U R A N C E COMPANY Cedar Rapids,IA 52499 www.transamericaannuities.com October 11, 2013 CYNTHIA J WELSH 260 MOUNT ROCK RD NEWVILLE PA 17241 RE: . Annuity Number(s) 02PSLO19987 Dear Claimant: We have received notification of the death of Roy L Miller. We extend our sincere condolences to you for your loss . The information in this letter is being provided to assist you in submitting death . claim paperwork. Our records reflect- the following information regarding this annuity: Annuitant : Roy L Miller Owner: Roy L Miller Claimant: Cynthia J Welsh 25% Annuity value: $76, 510 . 24 as of 10-01-2013 Annuity type: Non-Qualified Tax Information This letter includes general tax information that should not be relied upon for personal tax planning. Transamerica Life Insurance Company does not give legal, tax, or accounting advi-ce. You may want to consult your attorney, tax advisor, or accountant with questions regarding the direct tax conaegiaences when selecting an option. General Information The financial professional of record will remain on this annuity unless we are notified of a change in writing. Please be advised automatic operations such as Systematic Payouts and Automatic Payments have been stopped. an AEGON company TRe �T�`A�,ERIC J, 433'3 isgewoe Office: L11�I J 1Vlli 1Z 4333 Edgewood Road NE to LIFE I N S U RA N C E COMPANY Cedar Rapids,IA 52499 www.transamQricaannuities.com October 11, 2013 MARTIN H MILLER 2312 WALNUT BOTTOM RD CARLISLE PA 17015 RE: Annuity Number (s) 02PSLO19987 Dear Claimant: We have received notification of the death of Roy L Miller. We extend our sincere condolences to you for your loss.. The information in this letter is being provided to assist- you in submitting death claim paperwork. Our records reflect the following information regarding this annuity: Annuitant: Roy L Miller Owner: Roy L Miller Claimant: Martin H Miller 25% Annuity. value: $76, 510 . 24 as of 10-01-2013 Annuity type: Non-Qualified Tax Information This letter includes general tax information that should . not be relied upon for personal tax planning. Transamerica Life Insurance Company does not give legal, tax, or accounting advice. You may want to consult your attorney, tax advisor, or accountant with questions regarding the direct tax consequences when selecting an option. General Information The financial professional of record will remain on this annuity unless we are notified of a change in writing. Please be advised automatic operations such as Systematic Payouts and Automatic Payments have been stopped. an AEGON company TRANSAMERICA 4333 Administrative Office. 4333 Edgewood Road N)✓ feet LIFE I N S U RA N C E COMPANY Cedar Rapids,IA 52499 www.tranSaMCricaannuities.com October 11, 2013 JAMES L MILLER RE: Annuity Number (s) 02PSLO19987 Dear Claimant: We have received notification of the death- of Roy L Miller. We extend our sincere condolences to you for your loss . The information in this letter is being provided to assist you in submitting death claim paperwork. Our records reflect the following information regarding this annuity: Annuitant: Roy L Miller Owner: Roy L Miller Claimant: James L Miller 25% Annuity value: $76, 510 . 2,4 as of 10-01-_ 2013 Annuity type: Non-Qualified Tax Information This letter includes general tax information that should not be relied upon for personal tax planning. Transamerica Life Insurance Company does not give legal, tax, or accounting advice. You may want to consult your attorney, tax advisor, or accountant with questions regarding the direct tax consequences when selecting an option. General information The financial professional of record will remain on this annuity unless we are notified of a change in writing. Please be advised automatic operations such as SlYstematic Payouts and Automatic Payments have been stopped. an AEGON company ❑ CORRECTED(if checked) PAYER'S name,street address,city or town,province or state, 1. Gross distribution OMB No. 1545-0119 Distributions From Pensions, country,and ZIP or foreign postal code $51,271.41 Annuities,Retirement or NATIONWIDE LIFE AND ANNUITY INS CO 2a Taxable amount 2013 Profit-Sharing Plans,IRAs, IIP INDIVIDUAL ANNUITIES $1,271.41 Insurance Contracts,etc. P.O.BOX 482021 Form 1099-R COLUMBUS,OH 43218 2b Taxable amount Total 800-848-6331 not determined ❑ distribution ❑ Copy 2 PAYER's federal identification RECIPIENTS identification 3 Capital gain(included in box 2a)4 Federal income tax withheld File this copy with number 31-1000740 number _*•-1606 $127.14 your state,city,or RECIPIENTS name,street address(including apt.no.),city or town,province 5 Employyee contributions/Desig- 6 Net unrealized appreciation in local income tax or state,country,and ZIP or foreign postal code. nated Rolh contributions or employees securities return,when ANN M MOTTER insurance premiums required. 211 FIRE HOUSE RD ^$50,000.00 SHIPPENSBURG,PA 17257 s";b „ !R'v '_P' 1^ 7 c I V Giber code(s)1V` Sfmp,J,E 4D l 9a Your percentage of total 9b Total employee conmoutions distribution 11 1 st year of desig.Roth contrib. 12 State tax withheld 13 State/Payer's state no. 14 State distribution. 10 Amount allocable to 1RR --_-_- PA/18354860 ________ within 5 years Account number(see instructions) 15 Local tax withheld 16 Name of locality 17 Local distribution 071180547 M --------- ------------=--------t----------------=----------- Form 1099-R www.irs.gov/formIO99r Department of the Treasury-Internal Revenue Service ..... .........:....... ......... ...._........ .. .. . ........_....... ti 03/17/2014 07:36 FAX 7172492142 MASLAND 0 001 CORRECTED(h checltod) 1, Gross disiritxdion OM8 No.1545-0119 Dish'Ibutions From Pensions, PAYER'S name, -et address,city at town,province or stato, 551,271.42 2013 Annuities,Rotir^ern ent or eauttry,and Z1P or foreign postal code — profit-Sharing Plans,IRAs, NATIONWIDF LIFE AND ANNUITY INS CO 2a Taxable amount Insurance Contracts,etc. )IP3NDIVIDUALANNUITIES $'1,271.42 Form 1099-R P.O.BOX 182021 2b Taxable amount Total Copy 2 COLUMBUS,0H 4$218 not determined distribution 800-848-6331 3 Capbnt gain Induded In box 2a)4 Federal income laxwithheld File this copy with PAYER'sfsderal IdentincaUon RECIPIENTS identification 9 t $126.89 year state,city,or number number �* ".6815 31-1000740 local income tax c ortown,provlrx e 5 Ent 11 as cortdhulldnslDo:�g- tl Ne!unreafiyed appreciation h rat jm,when RECIPIENTS nemo,street address(including apt,no,),city naled Rotth colt botiens or employer's secuttles repaired. or slate,country,and Zip or foreign postal code insurance prenflums CYNTHIA J WELSH $50,000.00 '260 MOUNT ROCK RD 7 011trlbution 1RA/SEE B OU1ar NEWVILLE,PA 17241 code(s) 9s Yo of Iota[ 9b Total emptdyea cortlributlons distribution 13 State1Pay4r'=state nd. -14 a!o distrlbtRlon titstyearofdesig,RclhcoMrib. ---------- --- PAl183154'86D 9 7142 -_ 16 ArttiOlint allocable m IRR '---`����------ �- within 5 years 17 Local distribution account numbsr(see Instructions) 15 local to t Withhold 18 Name of locality 071180547 O _-- www.1rs,pw 1form109Br Department of the Treseury-intornal Revenue Sorvkc Form 1099-R Mar 171412:18p Deitch Buses Inc. (717)249-1969 p.1 ❑ CORRECTED(*checked) PAYER'S name,street address,city or town,province or state, 1. dross distrbulim OMB NO. 1545-0119 Distributions From Pensions, country,and ZIP or foreign postat code I t5 O Annuities,Retirement or WI NATIOXDE LIFE A14DANNUITY INS CO 22 Tanble amount 1 Profit-Sharing Plans,IRAs, IIP INDIVIDUAL ANNUITIES P.O.BOX 182021 $',271.41 Form 1099-R Insurance Contracts,etc COLUMBUS,OH 43216 2b Taxable amount Total 800-848-6331 not determined ❑ distribution Q Copy 2 PAYER's federal Iderntillcation RECIPIENT'S identlncatlon 3 Capital gain(Included in box 2a)4 Federal income tax withheld File this copy with number 31-1000944 number .._ 23 $126.89 your state,city,or RECIPIENTS name,street address(including apt.no.),city ortown.province 5 Emplgee corgdbutions/Desig- 6 Net unrealized appreciation h local income tax or state,country;and ZlPorforeign postal code insuranceprernt ms or employer's securities return,wben MARTEN H MILLER $50.000,00 required. 2312 WALNUT BOTTOM RD 7 Distribution IRA16EP/ a Other CARLISLE,PA 17015 code(s) SI E 4D 9a Yourpercentage of total gh Total employee contributions disnlbtAlon 111styeaiofdesig.Roth contrib. 12 Statetaxwithheld 13 Statemayer's state no, 14 State dstlibution 10 Amount allocable to IRR ----------------------- -PA116354860--------- ---$$1 2Z1 41----------------» — ------ YAW 5 years Account number(see Instructions) 15 Local tax withheld 16 Name of locality 17 Local distrilMon 071180547 P --------------------- --------------------- ---------------------------- Form 1099-R wwwJrs.gov/fomr1099r Department of the Treasury-Internal Revenue Service Mar 17 14 11:54a Rosenberger of North Amer 717-859-7044 P.1 t _ 00RECTED chnckadll PAYER'S name, trertaddrev.Myarlown,prcvinoe ce%tate, L Groeedislea ion OMB No. 1545-0119 Distributions From Pensions, country,and ZIP r kr6p postal code $51,271.41 +�]f +1 Annuities,Retirs�trit or NATIONM IFE AND ANNUITY INS CO h T,,,hie 3rocwd AGO 1 3 Profit-Sharing Plnnsr IRAs, IIP iNOIVIDV ANNUITIES P,O.BOX 182 21 57.271.41 Form 7099•R (nsuranca Contracts.etc. COL.UIVICA H MIS 2b Taxatrle um amo Total 800.848-&331 not determined dxrlboon E Copy 2 PAYER'!Mderi I"Witcaaon REOPiEM'S idanlirimlian 3 capital pain Iieduded in box Ta)4 Federal mcnma Iaxw INKld File this copy with number 37,1 00740 nudes -7269 $127.64 your stat<,city,or RECIPIMrs street address Ian hiding Ppt.no.)vdly or town,praMPCe Er�nyee ennfnb!abnSIDesiB. 8 Na tmrea)tud appreclatlan In loedl Income tax natedR h conlraur,ona Or aritite,COU11ry, 21P Q forelpn postal cede Inpwanca pren+4m5 employers securtle5 return,when JAMES L MIL ER =p Qootc required. 1054 TEMPE ANCE HILL RD Dwsb bulran lftAlc�pr a Qlher LITITZ,PA i 43 oode(s) E 4D 9a Yourpercertitpe ertoeal % Total employee aontrlbutlom dlstrlCUlbn it lei year ardeeg.ROM contrlb, 12 Sra[elax w0held-------- 13 Statefpeyer'e state no. 14 late disfnbuiGn 10 amount eacc le to IRR -------------- PFV1t)3i4R60___------ --. 5�3Z1�?__-__--------. -[Nn 5 yea ----------- Accountnunaer see no storm) 15 LatellaxvAthneld 10 Nameoflueally IT Lamldislrimtion 0711160547 ---------------�------ --------- ----- ------ porm 1090-R +wunVJrs.povlfolmif>BBr Department of Cn Treasury.iraernai Revenue Service REV-1511 EX+(08-13) IPennsylvania SCHEDULE H F" DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Roy L. Miller 21-13-1068 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Ewing Brothers Funeral Home, Inc Carlisle, PA 17013 5,946.50 2. Cumberland Valley Memorial Gardens(open grave) 254.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2• Attorney Fees: 5,000.00 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: 500.00 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. EC Suite-obtain EIN# 150.00 8. Advertise letters-Cumberland Law Journal-$75.00;Sentinel-$168.30 243.30 9. Real Estate Appraisal Fee-Burkholder Appraisal Services 350.00 10. Truck Mechanic-Jason Corman(repair to get truck started) 50.00 11. Peck's Septic Service 185.00 12. PP&L Novermber,2013-February,2014 771.19 TOTAL(Also enter on Line 9, Recapitulation) $ 14,221.18 If more space is needed,use additional sheets of paper of the same size. Ewing Brothers Funeral Home, Inc. 630 South Hanover Street,Carlisle,PA 17013(717)243-2421 - $teven A.Ewing,FD,Supervisor,Owner Email: admin @sincel853.com www.Sincei§53.com Fax: (717)243-75U . DATE 101112013 SERVICE NO. Miller,Roy'L. DECEASED NAME Roy Leon Miller DATE OF DEATH 101112013 PLACE OF DEATH Char es,are.nl for this items that vUU s lecled r that are re.uired If we are re uired by I w b a,cemetery or a crematory to use any items, we will e?Jain khe rea5�9rs m�rn In below..�f xYu select2a a�unerp t st max rein em�almm�such�s rurteral w'1�1 y4ew6n y may hose to�aXmbelminbgallm ill exp�., why below.° pay or em a m g you dt n approve r you se ecte ama ge en s suc as a recV crema ion or immedia a al.9Y we char ed fo STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED,AGREEMENT&PROMISSORY NOTE A. SERVICES,STAFF,FACILITIES, Special Charges EQUIPMENT AND MOTOR EQUIPMENT Forwarding of Remains to Basic Services of PA L.F.D. $ 1,295.00 $ -0- Bathing and Embalming $ 895.00 Receiving of Remains from Other Preparation of Deceased $ 295.00 $ -0- Basic Use of Facility $_250.00 $ -0- Documentation Prep/Recording $_375.00 $ .0- FD/Staff Supervision ViewNisiUService $_385.00 $ -0_ Facility/Equip ViewNisiUService $ 385.00 $ -0- FD/Staff Supervision ViewNisiUService $ -0- $ -0- Facilily/Equip ViewNisiUService $ -0-• $ _0- FD/Staff for Interment Service $ 140.00 $ _0- Extended FD/Staff Usage $ -°- Extended Facility Usage $ -0- D. ITEMS INVOLVING CASH Transfer Deceased to Funeral Home $ 295.00 Grave Open&Close(Prepaid) $ -0- Hearse Usage $_295.00 Rock breaking charge $ -0- Safety/Lead Vehicle $ 140.00 - The Sentinel Obituary w/Photo(Est) •$ 400.00;j b Utility Vehicle $_140.00 The Patriot Obituary $ -0- Family Vehicle $_ -0- Clergy Honorarium $ 200.00 $ -0- Organist at Church $ -0- $ -0- Soloist/Cantor $ .0. $ -0- Altar Servers $ -0- $ -0- Death Certificates $ 36.00. $ -0- Flowers $ 185.50 $ -0- Other Newspaper Obituary $ -0- $ -0- Professional Hair Styling $ 0- $ -0- Cumb.County Honor Guard $ 100.00 $ -0- $ -0 $ -0- $ -0 $ -o- _ $ -o- $ 90.00 $ -0- B. CHARGES FOR 4,8 � $ -0- Casket $ -0. $ -0- From Cemetery $ 0 Outercontainer $ -0- $ 921.50 From Cemetery Vault $ -0- We charge you for our services in oblaining:(specify cash advance items). Register Book $ 40.00 Memorial Folders $ 85.00 SUMMARY OF CHARGES: Thank You Notes $ 10.00 $ -0- A. CHARGES FOR SERVICES $ 4.890.00 $ -0- B. CHARGES FOR MERCHANDISE $ 135,00 $ -0- C. OTHER CHARGES $ -0- • $ -0- D. CASH ADVANCES $ 921.50 $ 0. E. SALES TAX,IF APPLICABLE $ -0- $ _.0- TOTAL FUNERAL HOME CHARGES $ 5,946.50 $ 0- LESS CREDIT AND PREPAYMENTS: : ° $ 0- $ .0- $ -o- $ =o- $ ° $ _0_ TOTAL CREDIT $ . $ 135.00 BALANCE DUE $ 5 94&5J The only waranty on the casket and I or outer burial container sold in IF any law,cemete�or crematory requirements have required the purchase of . connection with this service is the express written warranty, if any, granted any of the items lis ed above the law or requirement is explained below. by the manufacturer. This funeral home makes no warranty,express or implied, OBC by Cemetery , wdh respect to the casket and/or outer burial container. OBC by cemetery Billing To Ann M.Motter Reason for Embalming Required for viewing., V I 1 211 Firehouse Rd.Shippensburg,PA 17257 Required for viewing. n y Shippensburg PA 17257 I hereby aggree that I have examined the above stated items and found them to be correct and according to the arrangements requested and I hereby acknowledge receipt of a copy of this memorentlum and agreement I hereby represent that I have sufficient funds and assets legally available for payment of cash price and hereby agree and covenant jointly and severally to make payments off 1 946 50 within 30 days.A late charge of Inter2yA per month amounlin to 12.8/per YYear is applied tq th��l nce beginning 30 days from be reflected on the ma Statement. I acknowledge the have received the general price list and have be n offere or revlBw the casket pnce uter bunal container price li st.the date of this agreement.Any additional services or merchandise ordered or requested after the d o reement will be considered pement and the cost thereof will Dated Re/af onship to Deceased x Co-signed Dated Relationship to Deceased Steven A Ewing Name of funeral home representative _ Initials - l w D n OO {mj r p0 m O z z � m y m -a i. fn 0 I i m / � -- - ~� 00 0 nm wo x v sum Oz N Og 7 x m 03 T co � � h O V 0 0 C=:) . D 777 ƒ cg- ; (' E . . r CL § { ; ( . = t � \ . g ! . ¥ § . . \ � ( . g 2 0 3 m R o § 2( § \ \ ) 7 . M 0 ; 2 S § K 7 \ . 2\� § � �\ \ ) j ' q 3 } ; E o ` 4 @ - m ��� � _ _ C \k� \ \ , \\ k m ° / &{ « k C ` 7 ; § . " D \ — * . ND G CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 November 1, 2013 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: -Jacqueline M. Verney, Esquire RE: Roy L. Miller Estate Legal advertisements must be received by Friday Noon*. 'All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal.. Adverticernent inserted on following dates: October 18, October 25, and November 1, 2013 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587,approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: October'18, October 25, and November 1, 2013 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject :ratter.of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time,place and character of publication are true. �Aisa Marie Coyne, Ed' or SWORN TO AND SUBSCRIBED before me this 1 day of November, 2013 Notary Miller, Roy Leon a/k/a Roy L. Miller,dec'd. Late of North Middleton Township. Executrix:Ann M.Motter c/o Jac- queline M.Verney,Esquire,44 S. Hanover Street,Carlisle,PA 17013. - NOTARIAL SEAL Attorney: Jacqueline M. Verney, Esquire, 44 S. Hanover Street, DEBORAH A COLLINS Carlisle,PA 17013. Notary Public CARLISLE BOROUGH,CUMBERLAND COUNTY r,,fy Commission Expires Apr 28,2014 The selithiel JACQUELINE M.VERNEY AD NUMBER PAGE NO. w w w.c u m b e r I i n k.c o m 44 SOUTH HANOVER STREET 425659 1 Of 1 CARLISLE, PA 17013 BILL DATE SALESPERSON 717-243-9190 10/23/13 wolfc - START DATE STOP DATE 10/09/13 10/23/13 AD NUMBER AD DESCRIPTION CLASS LINES 425659 EXECUTRIX NOTICE LETTERS TESTAMENT 10 PUBLIC NOTICES 30 * 2 cols Publication Insertions Rate Net Amount Gross Amount 3 THE SENTINEL-LEGAL 3 LGL $159.30 . TOTAL AD CHARGE $159.30 3 PROOF OF PUBLICATION 01 PRF $7.00 3 MOBILE SITE MOB2 $2.00 Purchase Order Est. Roy Miller PAY THIS AMOUNT $168.30 $201.96* *AFTER 11/17/13 Lee Enterprises no longer accepts credit card payments sent via e-mail. Emails containing credit card numbers will be blocked. Please use the coupon below to send credit card payment to our lockbox. You may also send the coupon to a secure fax at 319-291-4014. THE SENTINEL c/o LEE NEWSPAPERS Thank you for advertising with The Sentinel! Deadline for PO BOX 540 in-column legal ads is 4:00 p.m.two business days prior to WATERLOO IA 50704-0540 date of insertion. For questions, call (717)240-7130. Return this portion with your payment Legal THE SENTINEL Check# [:]Credit Card Ad Number 425659 c/o LEE NEWSPAPERS ❑ ❑ = ❑ ❑ R Billing Date 10123/13 PO BOX 540 WATERLOO IA 50704-0540 Acct#: Amount Due $ 168.30 Exp.Date:❑ ❑ Amount Narne on credit card I Enclosed W Signature Please make checks payable to: THE SENTINEL { 000175 THE SENTINEL F JACQUELINE M.VERNEY c/o LEE NEWSPAPERS 44 SOUTH HANOVER STREET PO BOX 742548 CARLISLE, PA 17013 CINCINNATI OH 45274-2548 21 5402000000042565900000000000000020 19600000],68302 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tackie Cox, Director of Sales, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid,was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s): October 9, 16, 23,2013 COPY OF NOTICE OF PUBLICATION EXECUTRIx Ors TICE Affiant further deposes that he/she is not Letters Testamentary on the.Estate of ROY LEON MILLER,late of the interested-in the subject matter of the Township of North Middleton,Cumberland County,Pennsylvania, deceased,have been granted to the undersigned. aforesaid notice or advertisement, and that All persons knowing themselves to be indebted to said Estate will make all allegations in the foregoing statement as payment immediately,and those having claims will present them for settlement. to time, place and character of publication Ann M.Motter,Executrix ar ue. Jacqueline M.Verney,Attorney 44 South Hanover Street Carlisle,PA 17013 • � f Sworn to and subscribed before me this 9 ' czt, rrAh4vrU1.3 o I AOIL tary Public My commission expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Bethany M.Holtry,Notary Public Carlisle Boro,Cumberland County MY Commission Expires sept.26,2015 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES FRCM: Burkholder Appraisal Services 328 Garland Drive INVOICE DATE REFERENCE .Carlisle,PA 17013 102413M 10/24 2013. Phone(717)254-6823 Fey 717 258-6145 Tax ID#166-46-3215 TO: Estate of Roy L.Miller DESCRIPTION AMOUNT. Paid $350 on10/11/2013 on check#1505. Thank,you for using Burkholder Appraisal Services SUBTOTAL Rate % ADJUSTMENT SUBTOTAL i Rate % ADJUSTMENT SUBTOTAL TOTAL $ Burkholder Appraisal Services Form D2NIL—'WInTOTAV appralsal software by a la mode,Inc.-1-800•ALAMODE -� ,, _ T r�' � �� � w�3� .- �� ��� �a � � h �o���� ��, �l�r�� � ��, �d .� ��r�_ IlPeck' s Septic Servicell II 68 Pine School Road 1I II Gardners Pa. 17324 II II (717) -486-5548 II i A 11 II CUSTOMER BILLING II II II ll ROY MILLER ll 10 31. WAGGONERS GAP ROAD II II CARLISLE PA 17013 II II I II 11 BILLING INFORMATION ll 11 IlPrevious Date Pumped: II I IlDate Pumped: 12/27/201311 1 I IlBilling Date: 1/6/201411 I IlPumping Charge : $185 . 0011 I IlLabor Charge: $0 . 0011 I 1IMaterial Charge : ', i $0 . 0011. I . I1 Service Charge : $o . 00 C�- II I IlTotal Due : 10% Added After 30 Days11 �] $185 . 0011 Vo WORK DONE (PUMPED SEPTIC TANK, LOCATED AT) ************* II II*************** (1031 WAGGONERS GAP ROAD, CARLISLE) *********** II IINORTH MIDDLETON TOWNSHIP INSPECTION. II II �� • ll u II ***************** THANK YOU, PLEASE CALL AGAIN *************** II IlNext Scheduled Pumping: 1I �I 1�11 PECK'S SEPTIC SERVICE, SERVING THE COMMUNITY SINCE 1965 1l 11 II THANK YOU FOR LETTING US SERVE YOU. II r Questions?Please Visit us online at Page 1 contact us by Nov 12. U pplelectric.com 1-800-DIAL-PPL Bill Acct, No. r ` Date Due •«' (1-800-342-5775) 80150-68003 Nov 12,2013 $88.39 PPL deaCttic Utilities M-F:Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Oct 21,2013 $0.00 ROY L MILLER Charges: 1031 WAGGONERS GAP RD Total PPL Electric Utilities Charges $88.39 CARLISLE, PA 17013 Meter:98916606 Total Charges $88.39 Your next meter reading is on or about Nov 19,2013. mount flue By Nov.12,203 This section helps you understand your year-to-year Account Balance $88.39 electric wise t onth. Meter readings are actual unless other noted., PPL Electric Utilities'price to compare for your rate is'$0.08777 per kWh. This changes the 1st of Mar,Jun,Sept, and Dec.Visit papowerswitch.com ®2012 02013 or www.oca.state.pa.us for supplier offers. 60 Your Message Center 3: • A new price for the quarterly distribution system 40 improvement charge is effective from Oct. 1, 2013 n 30 through Dec. 31,2013 L 20 • Go Paperless,and receive a FREE LED at tw i0 pplelectric.com/gopaperless _0 • Information about appliance energy use and tips on J F M A M J J A s o N D saving energy are available through the Energy Library 8 on our Web site,pplelectric.com/e-power Months . Keep light bulbs and fixtures clean. Dust and dirt absorb light and can reduce light output by as much as half. Monthiy Days Average Average kWb • Save postage and late charges-sign up for Automated Billed Comparison . Bill Payment. Oct 2013 32 624 20 611 Oct 2012 30 646 22 58F 13111ing Pedod Type Reading Payment Methods Oct 21 Actual 78084 Online at: ®By phone:1-800-342-5775 Sep 19 Actual 77460 pplelectric.com or call BIIIMatrix(service fee applies) s at 1-800-672-2413 to pay using Visa, = 32 Days kWh Billed 624 MasterCard Discover r debit d —_ , V CUf VPr4• „ t ® By Mail: Correspondence should be sent to: Nov 2012-Oct 2013 1234!7!908 028 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Nov 2011-Oct 2012 10893 Allentown, PA 18101-1175 Allentown, PA 18104-9392 _ Other important information on the back of this bill 4 •• "°••;� ® Return this part in the envelope ;, Due Da Due PIP, �;�w provided with a check payable to PPL Electric Utilities. 80150-0068003 Nov 12, 2013 $88.39 PPP; cleeffin UPtlitiao Amount Enclosed: AV 01 005959 274666 22 A**5DGT n n n� n n 1llttlllttlllll`1'1'IItlflttl'1'11llllltlttlllllll'I1I1111111111 + 7` I ❑L�L�! ✓ [3] ROY L M{LLER ' \ . PPL ELECTRIC UTILITIES 1031 WAGGONERS GAP RD \ ('' /°` CARLISLE,PA 17013-8376 � � � 2 NORTH 9TH STREET CPC-GENN1 \ ALLENTOWN, PA 18101-1175 y , ��` !�� IIIIIIII'!Il'!I'I�!'lllll"111!1!!I'll"Ill'lllll'lll'lll'lllllll 1 4300000883930000088395 8015068003 Questions?Please Visit us online at Page 1 �,;. ® contact us by Dec 10. pplelectric.com Bill Amount i4,. (1-800-342-5775) 80150-68003 Dec 10, 2013 F77$izoJ,q PPL Electric Utilities M-F:gam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Nov 19,2013 $0.00 ROY L MILLER Charges: 1031 WAGGONERS GAP RD Total PPL Electric Utilities Charges $120.79 CARLISLE, PA 17013 Meter:98916606 Total Charges $120.79 Your next meter reading is on or about Dec 19,2013. Amount Due By Dec $120:29 This section helps you understand your year-to-year Account Balance $120.79 electric use by month. Meter readings are actual unless PPL Electric Utilities' rice to compare for our rate is$0.08777 per kWh. otherwise noted. p p y p This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com E2012 ®2013 or www.oca.state.pa.us for supplier offers. L 5o Your Message Center Y ao • Go Paperless,and receive a FREE LED at pplelectric.com/gopaperless ao . Information about appliance energy use and tips on a 20 saving energy are available through the Energy Library com/e-power 10 0 11AL • Before digging around your home or property, you N I F M A M I J A s o N D should always call the state's One Call notification S system to locate any underground utility lines. You can o Months do this by simply dialing 811,which will connect you to the One Call system. Be safe and call 811 before you monthly s.ys Average Average dig. Comparison • Save postage and late charges-sign up for Automated Nov 2013 29 897 31 47F Bill Payment. Nov 2012 31 1 1002 32 47F Period Type Reading Payment Methods Nov 19 Actual 78981 Online at: By phone:1-800-342-5775 Oct 21 Actual 78084 ppielectric.com ®or tail BillMatrix(service fee applies) _ at 1-800-672-2413 to pay using Visa, -' 29 Days kWh Billed 1 897 i MasterCard, Dicrover or debit card. _ Total ® By Mail: Correspondence should be sent to: Dec 2012-Nov 2013 12237 1020 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Dec 2011-Nov 2012 11102 925 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill 4 PP� • ® Return this part in the envelope Bill Acct.No. Due Date F provided with a check payable to PPL Electric Utilities. $0150-680303 Dec 10, 2013 $120.79 PPL Electric utilities f Amount Enclosed: AV 01 000482 39538 8 2 A**5DGT I n n n / I '7)1 5 •� n, f liiIIIIIIIIniilli,Illlulliill111111i,IIII,III,III,111111,1,h1, U U LV ��U� ROY L MILLER PPL ELECTRIC UTILITIES 1031 WAGGONERS GAP RD CARLISLE,PA 17013-8376 � 2 NORTH 9TH STREET CPC-GENN1 ALLENTOWN, PA 18101-1175 II„ilhh-1,li 111111,11.1-111111,,IIII11111111111,is III III III III 1 6000001207900000120795 8015068003 Questions?Please Visit us online at Page 1 contact us by Jan 9. pplelectric.com 1-800-DIAL-PPL Bill Acct.No. Due Date Amount Due P ':" • (1-800-342-5775) PPL Mectric 0111 oba M-F:Sam to 5pm 80150-68003 Jan 9,2014 $274.38 Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Dec 19,2013 $0.00 ROY L MILLER Charges: 1031 WAGGONERS GAP RD Total PPL Electric Utilities Charges $274.38 CARLISLE, PA 17013 Meter: 98916606 Total Charges $274.38 Your next meter reading is on or about Jan 21,2014. Amount Due By Ja.n'.;9,2014 `;,. $274:38 This section helps you understand your year-to-year Account Balance $274.38 electric use by month. Meter readings are actual unless PPL Electric Utilities' rice to compare for our rate is$0.08754 per kWh. otherwise noted. This changes the 1st of Mar,Jun,Sept,and Dec. Visit papowerswitch.com ®2012 2013, or www.oca.state.pa.us for supplier offers. L 75 Your Message Center so • With paperless billing,you can receive and pay your PPL Electric Utilities bills online.The process is free, 45 quick,convenient and secure.To learn more or sign up, 30 visit pplelectric.com. a • Information about appliance energy use and tips on is saving energy are available through the Energy Library 0 on our Web site,pplelectric.com/e-power F M A M J J A s o N D • Before digging around your home or property,you $ Months should always call the state's One Call notification system to locate any underground utility lines. You can Monthly Days Average Average do this by simply dialing 811,which will connect you to Comparis Billed l(Wh/Day Temp. on RWh ! the One Call system. Be safe and call 811 before you dig. Dec 2013 30 2194 73 33F Dec 2012 30 1058 35 39F — Reading Payment Methods Dec 19 Actual 81175 Online at: By phone:1-800-342-5775 Nov 19 Actual 78981 pplelectric.com ©or call BillMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, I 30 Days i 1, h Billed i 2194 I MasterCard, Discover or debit card. ° E _I W-g-M emn,im ® By Mail: Correspondence should be sent to: Jan 2013-Dec 2013 13373 1114 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Jan 2012-Dec 2012 11040 920 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill 4 ® Return this part in the envelope Bill Acct.No. Due Date Arnount Due provided with a check payable to PPL Electric Utilities. 80150-68003 Jars 9, 2014 $274.38 Amount Enclosed:[]AV l.n01 lll000465 1u 5411611610 11„B I2 l llAn*,"5lDrGlT l lllllll.11lllllll ,,jr�`'7 ll! n n - U L � U ROY L MILLER 1031 WAGGONERS RD PPL ELECTRIC UTILITIES RS GP 2 NORTH 9TH STREET CPC-GENN1 CARLISLE, O RS AP ALLENTOWN, PA 18101-1175 - Illllrllllll!'Ells„ll,.I..In,llllllIllnlllllI1111111 1 4700002743870000274385 8015068003 ® Questions?Please Visit us online at Page 1 contact us by Feb 11. pplelectric.com PPI 1-800-DIAL-PPL Bill Acct. No. Date • (1-800-342-5775) 80150-68003 Feb 11,2014 $287 63 r�*t crm;srkc vrautir�•t M-F:Sam to 5pm Your Electric Usage Profile _ Billing Summary (Billing details on h Service to: Balance as of Jan 21,2014 $0.00 ROY L MILLER Charges: 1031 WAGGONERS GAP RD Total PPL Electric Utilities Charges $287.63 CARLISLE, PA 17013 Meter:98916606 Total Charges 7.63 Your next meter reading is on or about Feb 20,2014. mount Due'B Epb'11,2014�`' , This section helps you understand your year-to-year Account Balance $287.63 electric use by month. Meter readings are actual unless otherwise noted. PPL Electric Utilities'price to compare for your rate is$0.08754 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec. Visit papowerswitch.com 2013 2014 or www.oca.state.pa.us for supplier offers. 90 75 Your Message Center 60 • With paperless billing,you can receive and pay your 0 45 PPL Electric Utilities bills online.The process is free, quick,convenient and secure.To learn more or sign up, 30 visit pplelectric.com. • Information about appliance energy use and tips on a 15 w saving energy are available through the Energy Library on our Web site,pplelectric.com/e-power F art A M J J A s o N 0 . Before di gg in around your home or property,You � Months should always call the state's One Call notification system to locate any underground utility lines_ You can Monthly - do this by simply dialing 811;which will connect you to • the One Call system. Be safe and call 811 before you dig. Jan 2014333 2290 69 30F Jan 2013 33 1310 40 35F Billing ' `• •• ' ' Payment Methods Jan 21 Actual 83465 Online at: By phone:1-800-342-5775 Dec 19 Actual 81175 pplelectric.com or call BillMatrix(service fee applies) „ ,,,, , at 1-800-672-2413 to pav using Visa, D°Y' """h Gi„_"cam I 2270 1 MasterCard, Discover or debit card. Yearly-COmPariSOn'. . .lifte- -'-:Avg,Montbi By Mail: Correspondence should be sent to: Feb 2013-Jan 2014 14353 1196 2 North 9th Street Customer Services — CPC-GENN1 827 Hausman Road = Feb 2012-Jan 2013 11071 923 Allentown, PA 18101-1175 Allentown, PA 181049392 Other important information on the back of this bill 3 Retum this part in the envelope Acct. Due Date Amount Due provided with a check payable n Pei.Cioctric u::fNiac to PPL Electric Utilities. 80150-68003 Feb 11, 2014 $287.63 Amount Enclosed: j I AV 41 044443 67240 S 2 A`*5DGT 4K 7-1 X17 1�F- I -1 F/1 I I 1° IIIllllllll'IIII•IIIIInIIIIIlI �u•llallInl,n,Illlnlll L _1 L_1 L�?I U7 � ` r ROY L MILLER 1031 WAGGONERS GAP RD r. / PPL ELECTRIC UTILITIES CARLISLE,PA 17013-8376 i 2 NORTH 9TH STREET.CPC-GENN1, , w ALLENTOWN, PA 18101-1175 � 'IIIIIII`tlfl"'iliflllill'II`IIIIIIII,II"iIiillilllliiIIIII + 1 0400002876340000287635 8015068003 REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ' ESTATE OF _ FILE NUMBER Roy L. Miller 21-13-1068 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PP&L Electric bill 10-10-13 94.13, U2. Century Link Telephone bill 10-15-13 48.58 []3. Cumberland Goodwill Fire Rescue EMS � " 83 25 jj - •^l.^"_..� �.�.sue-.—_.'91 iti_'-_^._",z�'t.i^.��,i 29.':S.^.^.�-t-�':IC a n—�-..Y'..^G^2.�c.�' TOTAL(Also enter on Line 10, Recapitulation) $ 225.96Ji If more space is needed,insert additional sheets of the same size. ® Questions?Please Visit us online at Page 1 contact us by Oct 10. pplelectric.com 1-800-DIAL-PPL Due Date , (1-800-34 ) 80150-68003 Oct 10, 2013 i'L Clmetrlc M-F:Sam to 4JttEEtios� •• t0 F5 5p 5pm Your Electric Usage profile Billing Summary (Billing details on back) Service to: Balance as of Sep 19,2013 $0.00 ROY L MILLER Charges: 1031 WAGGONERS GAP RD Total PPL Electric Utilities Charges $94,13 CARLISLE, PA 17013 Meter:98916606 Total Charges $9413 Your next meter reading is on or about Oct 21, 2013. moon#pE�E*�yt?ct 10,,2013 $94:13• This section helps you understand your year-to-year Account Balance $94.13 electric use by month. Meter readings are actual unless otherwise noted. PPL Electric Utilities'price to compare for your rate is$0.08777 per kWh. M2012 02013 This changes the 1st of Mar,Jun,Sept,and Dec.Visit papower witch.com or www.oca.state.pa.us for supplier offers. 60 5o Your Message Center 40 • Go Paperless,and receive a FREE LED at ao pplelectric.com/gopaperless - a • Information about appliance energy use and tips on 20 saving energy are available through the Energy Library Q io on our Web site, pplelectric.com/e-power o • Before digging around your home or property,you J F M A M J J A s o N D should always call the state's One Call notification system to locate any underground utility lines. You can S Months do this by simply dialing 811,which will connect you to Monthly the One Call system. Be safe and call 811 before you - dig.RWb Comparison " • Save postage and late charges-sign up for Automated Sep 2013 30 686 70F Bill Payment. Sep 2012 30 637 ��211 70F Period Billing 'Reading payment Methods _ Sep 19 Actual 77460 Online at: By phone:1-800-342-5775 Aug 20 Actual 76774 pplelectric.com or call BIIIMatrix(service fee applies) _ 30 Days kWh Billed 6g6 at 1-800-672-2413 to pay using Visa, - r kliasteiCaid, Discover or debit card. set s . ® By Mail: Correspondence should be sent to: Oct 2012 Sep 2013 12364 1030 2 North 9th Street Customer Services =.. CPC-GENN1 827 Hausman Road Oct 2011-Sep 2012 10813 901 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill 4 Return this part in the envelope - r Date' „.W.. r P provided with a check payable PL Mectr're Wtiiiisrb• to PPL Electric Utilities. 80150_68003 Oct 10, 2013 $94.13 Amount Enclosed: A`f 01 005777 12611E 22 A*xSDGT n n n n 'u u H�H I ROY L MILLER 1031 WAGGONERS GAP RD ` PPL ELECTRIC UTILITIES CARLISLE,PA 17013-8376 2 NORTH 9TH STREET CPC-GENN1 ALLENTOWN, PA 18101-1175 l�if �i�lldit� 1�11.11'111'�IIIN--III-I,IIEIO`1111h,I...liall t 1 4100000941310000094135 8015068003 r'f � el �- Centur Linkmm a� �� y Ca M P.O.Box 1319 6�-Ile-,I Charlotte, NC 28201-1319 �� Account game: ROY L MILLER Page: 1 of 5 Account Number: 313886961 Bill Date: Sep.25,2013 Contact Numbers Current Charges Summary Detail Page Product,Services and Billing 1-800-201-4099 CenturyUnk Packages 3 32.45 Repair Service Package Taxes 3 1.60 1-800-788-3600 CenturyLink Local Services 3 9.55 Payment or Account Balance 2417 1-800-201-4099 Q CenturyLink Long Distance Services 5 4.98 _ High Speed Internet Tech Support 2417 1-800-788-3600 Total Current Charges 48.58 Dial-up Internet 2417 Tech Support 1-888-872-7313 Financial Services/Payment Arrangements 1-888-646-0004 Visit us online www.centurylink.com C/ c �V Previous Balance Payments&Adjs Balance Forward Current Cfiarges Amount Due Date Due 55.43 I 55,43 CR I 0.00 I 48.58 48.58 OCt.21,2013 6 The Due Date On This Bill Applies to Current Charges Only Please Remit Payment To: • •- • - - • Cumberland Goodwill Fire Rescue EMS Billing Office 13-214445 10/7/2013 1 V I $83.25 PO Box 726 New Cumberland, PA 17070-0726 QUESTIONS ABOUT THIS BILL? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-6020 Email: info @ambulancebillingoffice.com Please visit our website to provide insurance or make payment, and Date of Service: 9/27/2013 17:43 for additional payment options and frequently asked questions: Patient Name: MILLER, ROY From: RESIDENCE www,ambulancebillingoffice.com To: <Treatment/No Transport> ----IMPORTANT This type of service is not covered by ambulance memberships, Medicare, Medicaid and most secondary insurances Payment is your responsibility. 9/27/13 BLS Treatment/No Transport A0998 1.0 83.25 83.25 Total 83.25 0.00 0.00 DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. ------------------------------------------------------------------------------------------------------------- ------------ REV-1513 EX+(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES, RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Roy L. Miller 21-13-1068 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. )Ann M.Motter 211 Firehouse Rd Shippensburg,PA 17257 (daughter r--�� 252.j ) 2.R James L.Miller 1054 Temperance Hill Rd.Lititz,PA 17543 + son ~ 25/o � 3.f Cynthia J.Welsh 260 Mt.Rock Road Newville,PA 17241 [daughter 25%0 I I 3 Martin H.Miller 2313 Walnut Bottom Road Carlisle,PA 17013 f son 25% 71 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II - NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: �-r-�'�r,.--i`a-""s -x .•.C�• •• .,- ^t� _�-s.r r,rs x-.-r- _,r..._.a.�--�a�^'^rr:-+a:. 'a^�iCG�M�aL7Cios�� ,� +^s.'S�"-"'_-lL-�R+==S.7'a—.< c-�sF?"'�..'�.-..-_.T- ""`^ma.:s�.,a�rr_-�re-•cs�' sa�??� B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART 13—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ f If more space is needed,use additional sheets of paper of the same size. LAST WILL AND TESTAMENT I, ROY L. MILLER, of North Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make,publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property)shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executrix(ors) shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give,devise and bequeath all of my estate,both real and personal property,unto my spouse, GLADYS L. MILLER, absolutely, if she survives me by thirty (30) days. 3. In the event my said spouse shall predecease me or fail to survive rkiq by thirt y30)dy ; hen I give, devise and bequeath all of my estate, both real and personal prop;;,in equ`4 shdf�sY unto My children, ANN MARIE MOTTER, JAMES L. MILLER, CYNTHI J.aRiffTZ, and M IN H. MILLER, absolutely. 4. I nominate, constitute and appoint my said spouse, GLADYS L. MIl✓L,ER, a&Exe&'Rtff* of r--a my estate. In the event she is unwilling or unable to so act, then I appoint my said children, ANN MARIE HOTTER, JAMES L. MILLER, CYNTHIA J. RUTZ, and MARTIN H. MILLER, as Executors of my estate. 5. - I direct that my Ex,ecutrix(ors) shall not be required to file a bond to secure the faithful performance of their duties in any jurisdiction. R.L.M: Page I of 3 Pages 6. Fil authorize and empower my Executrix(ors),in their sole and absolute discretion,to purchase or otherwise acquire and retain any investments ofwhich I die seized or any real or pers-Grial property of ally nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to.any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate;to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash,property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my Executrix(ors) consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition,I direct that my Executrix(ors) shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this day of (SEAL) Roy L.M- iller SIGNED,SEALED,PUBLISHED AND DECLARED by the above-named Testator,as and for his Last Will and Testament,in the presence of us,who at his request,have hereunto subscribed our names as witnesses thereto, in the presence of the said Testator and of each other. 4 CIL,? V'VA-1 It Page 2 of 3 Pages a COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND : SS. We,Roy L.Miller -T 1J �'� Q and ae r atO6re the Testator and the witnesses, respectively, whose names are signed to the fore being first duly sworn, do hereby declare to the undersigned authority that the Testator g Instrument, executed the instrument as his last Will and that the Testator has signed signed and Testator executed it as his free and voluntary act for the Purposes there* fined willingly, and that the of the witnesses, in the presence and hearing of the Testator, signed m expressed, and that each the to the best of his/her knowledge the Testator was at that time eighteen W111 as a witness and that years of age or older,of sound mind and under no constraint or undue influence. - i Testatrix i Itpess fi -''� Witness I' Subscribed, sworn to and acknowledged before me by Roy . . Y Miller, the TPsru+,,,. � subscribed and sworn to before me by .,,., uiiu �1 cc-fa__. � � and � �'��''�° , the witnesses,-this ? day of , 2000. I Notary Public U t I . NOTARiAt SEA!�� CORRIN- � m Car?fr,1� n PAYERS,I�ot�r�pub n,ru h 4-2 7 20f�3 ' i � j m Page 3 of 3 Pages