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Home My WebLink About02-0894 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-, '62 EX(' '-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 ___h___ fold ESTATE INFORMATION: SSN: 189~O9~4144 FILE NUMBER: 2102-0894 DECEDENT NAME: MILLER THEODORE R DATE OF PAYMENT: 10/03/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: OS/26/2002 NO. CD 001687 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $6.73 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ROGER B IRWIN ESQUIRE CHECK#18992 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS - $6.73 MARY C. LEWIS REGISTER OF WILLS 1'/- 902-0 ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-ISO EX AFP (U-D2l ROGER B IRWIN ESQ IRWIN ETAL 60 W POMFRET ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-19-2002 MILLER 05-26-2002 21 02-0894 CUMBERLAND 101 THEODORE R Allount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REij:E;'4TEX--"FP--foFoz'--NOYicE--OF-i:iiiiEifiTiii.rClrTAX-A-PPRA-isEifENT:--"Li-owiii.rci-oii----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MILLER THEODORE R FILE NO. 21 02-0894 ACN 101 DATE 11-19-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. stocks and Bonds (Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule OJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets [1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 250.80 1,618.99 .00 (8) NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule HJ 10. Debts/Mortgage Liabilities/Liens (Schedule X) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule ~J 14. Net Value of Estate Subject to Tax 1,869.79 (9) (10) 785.00 NOTE: IT an assessment was issued previously, lines reTlect Tigures that include the total OT ~ ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16J 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due 935.17 (11) (12) (13) (14) ] .7?D ] 7 149.62 .00 149.62 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = 149.62 X 045 = .00 X 12 = .00 X 15 = (19)= .00 6.73 .00 .00 6.73 TAX CJ>EDITS: .., " [+T AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10 03-2002 CDOO1687 .00 6.73 TOTAL TAX CREDIT 6.73 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL OUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) -- /?-/O -:5> BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN - REV-485EXAFP{Ol_05l MICHAEL CHEREWKA CHEREWKA & RADCLIFF 624 N FRONT ST WORMLEYSBURS PA 17043 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-24-2003 STETlER 09-21-2001 21 01-0894 CUMBERLAND 201 KATHRYN H Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: RESISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ RE;;=483--Ex-iiFP--Coi:-03j-----.li-No-iicE--oF--OETE-RHINiiiIifN-ANii-As-sESS-MENT----------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF STETLER KATHRYN H FILE NO.21 01-0894 ACN 201 DATE 11-24-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 32.735.01 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 42.093.45 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 42,093.45 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEl PT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE [IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I MICHAEL CHEREWKA CHEREWKA & RADCLIFF 624 N FRONT ST WORMLEYSBURG PA 17043 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 2806Dl HARRISBURG, PA 17128-0601 REV-75'EXAFPCUl_021 12-01-2003 STETLER 09-21-2001 21 01-0894 CUMBERLAND 202 KA THRYN H Allount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forI! with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES .... R"E-.;:736--EirAFP-Tcii:-oiin-----..-Nlj'fIc"E--or,--IiEi'rRHIijiiTIlfti-Aifli-As-sESS-MENT----------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF STETLER KATHRYN H FILE NO.21 01-0894 ACN 202 DATE 12-01-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 32,735.01 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 42,093.45 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 42,093.45 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE DF THIS FORH FOR INSTRUCTIONS.J --- REV 1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R D E E S N T C o M P T U A T X A T I o N REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT o E C E D E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OEPT. 280601 HARRISBURG, PA "128~0601 DECEOENT'S NAME(lAST, FIRST, AND MIDDLE INITIAL) Miller Theodore R. DATE OF DEATH (MM-DD~YEAR) X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust / OFFICIAL USE ONl Y FILE NUMBER -5 21-02-~c.{ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 189-09-4144 THIS RETURN MUST BE FILE.D IN DUPLICATE W\TH THE REGISTER OF WILLS so IAL S CURITY NUMBEA 3. date of death . Remamder Return prior to 12~ 13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes (Attach copy of Trust) o 10. Spousal Poverty Credit 0 11. Ejection to tax under Sec. 9113(A) (date of death between 1'2~3\~91 a\'\d \-1-95) (Attach Sch 0) THIS SECTION MUST BE CoMPLETED. ALL CORRESPONDENCE & CONFIDEIIITIALJAX INFORMAtIoN SHOULD BEOIRECTEll'TO: NAME COMPLETE MAILlNG ADDRESS (Attach copy of Will) o 9. Litigation Proceeds Received Ro er B. Irwin Es . FIRM NAME (If Applicable) 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 71 49-235 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net ValLie of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) IRWIN McKNIGHT & HUGHES TELEPHONE NUMBER (1) (2) (3) R E C A P I T U L A T I o N (4) (5) (6) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Une 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 2D. 149.62 None None None None 250.80 1,618.99 None 785.00 935.17 x X X X .0 0 .0 45 .12 .15 OFFICIAL USE ONLY (8) 1,869.79 (11) 1. 720.17 (12) 149.62 (13) (14) 149.62 (15) (16) (17) (18) (19) 0.00 6.73 0.00 0.00 6.73 Copyright (c) 2000 form software only The Lac!cner Group, Inc. FormREV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 700 Walnut Bottom Road CITY I STATE ~I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page lUne 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 6.73 Totol Credits ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Tolollnlerest/Penolty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WillS, AGENT ii:~:ti~~~~i:~~~!~~iy~~:;~i~tt8!~~~ii:~J~~y~i8i~i~:i~~:i:~t~~I~~ii~~i 1. Did decedent make a transfer and: 0.00 0.00 6.73 0.00 6.73 "X" i;~my~i~iii~~~i~i8~i~i;~Y~:~t~~i~~i:i:::: 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 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. o o o IT] IT] IT] 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 pre parer has any knowledge. SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN Lester W. Mi ller _ _ _1.~?9_ _C:?O_,!y,,!,_": _ll.?_"c1_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Gardners, PA 17324 GNA URE OF PREPARER OTHER THAN REPRESENTATIVE IRWIN McKNIGHT & HUGHES 60 West Pomfret Street ---c,,;:'l-{si,,- -. PA - - i i6i'l- -- -- - --- - - -- - ---- - ---- DATE /,p /~~/.d~ DATE.... For dates 0 deat 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 survivingsp is3%[72P.S.9116(0)(1.1)(;1]. 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 0% [72 P.S. 9116 (a) (1.1) Oi)]. 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 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 0% [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%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(0)(11]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)j. 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. Copyright (cl 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV -1508 EX + {1-97} COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Theodore R. Miller SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 55!1 189-09-4144 OS/26/2002 FILE NUMIlER 21-02- Include the proceeds of litigatJon and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 Cash on hand DESCRIPTION VALUE AT DATE OF DEATH 250.80 TOTAL (Also enter on line 5, Recapitulation) $ 250.80 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1S09EX ~(l-91) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Theodore R. Miller SCHEDULE F JOINTLY-OWNED PROPERTY 55!1 189-09-4144 OS/26/2002 FILE NUMBER 21-02- If an asset was made jOint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT T~NANT(S) NAM~ Lester W. Miller ADDR~SS 1250 Goodyear Road Gardners, PA 17324 RELATIONSHIP TO DECED~NT son B. c. JOINTLY-OWN~D PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF D~ATH IT~M FOR JOINT MADE Include name of financial institution and bank DATE OF D~ATH D~CD'S VALUE OF account num'oeT or similarldentlfying number, NUMB~R T~NANT JOINT Attach deed for Jointly-held real estate. VALU~ DF ASS~T INTER~ST D~C~DENT'SINT~R~S 1 A 09/01/67 '1&T Bank, checking account 3,237.98 50.00% 1,618.99 TOTAL (Also enter on line 6, Recapitulation) $ 1,618.99 T (It more space is needed insert additional sheets of the same size) Copyright (c::) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1S" EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Theodore R. Miller 551ft 189-09.4144 OS/26/2002 FILE NUMBER 21-02- Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Grace United Methodist Church 20.00 B. 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State IIp Year(s) Commission Paid: Z. 3. Attorney's Fees IRWIN McKNIGHT '" HUGHES Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 750.00 City Relationship of Claimant to Decedent State IIp 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Register of Wills . filing fee 15.00 TOTAL (Also enter on line g, Recapitulation) $ 785.00 (It more space is needed. insert additional sheets of the same size) Copyright (c) 1996 form software onfy CPSystems.lnc. Form REV-1511 EX (Rev. 1-97) REV -15'2 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERl1 ANCE TAX RETURN RESI DENT DECEDENT ESTATE OF Theodore R. Miller SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS 55ft 189-09-4144 OS/26/2002 FILE NUMBER 21-02- Include un reimbursed medical expenses. ITEM NUMBER 1 Continuing Care RX DESCRIPTION AMOUNT 48.10 2 Forest Park Health Center 887.07 TOTAL (Also enter on line 10, Recapitulation) $ 935.17 (If more space IS needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev, 1-97) REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Theodore R. Miller OS/26/2002 FILE NUMBER 21-02- RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not ListTrustee(s) OF ESTATE 88/1 189-09-4144 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [inctudeoutrightspousal distributions,and. transfers under Sec. 9116(a)(1.2)] SON 1/2 REMAINDER LESTER W. MILLER 1250 GOODYEAR ROAD GARDNERS PA 17324 DAUGHTER 1/ 2 REMAINDER AILEEN Z. MONISMITH 1515 LONGS GAP ROAD CARLISLE PA 17013 WINIFRED GOSSARD (deceased) DAUGlITER ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS. A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space \s needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) LAST WILL AND TESTAMENT I, THEODORE R. MILLER, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. I. I direct my executor to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I give and bequeath all of my estate of every nature and wherever situate to my three children, share and share alike, or to the survivors or survivor if any of my children predecease me. If my daughter Winifred has not repaid me the $2,700.00 which she borrowed in September, 1990, this amount will be deducted from her share if she is still living at the time of my death. 3. If all of my three children have predeceased me, I give and bequeath all of my estate of every nature and wherever situate to my eleven (11) grandchildren, share and share alike. 4. I nominate and appoint Lester W. Miller to be the executor of this my Last Will and Testament; he is to serve as such without bond. Should he die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint Aileen Z. Monismith, as substitute executrix, also to serve as such without bond, with the same powers as are given herein to my executor. 5. I hereby suggest that my personal representative retain the services ofIrwin, McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this t." day of March, 1995. ~~--- k ::!t.s'fL (SEAL) THEODORE R: MIU ER Signed, sealed, published and declared by THEODORE R. MILLER, the testator above named, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ~jJ/~( 2 ACKNOWLEDGMENT ANDAFFIDAVIT WE, THEODORE R. MILLER, BETZI A. MORRISON and CHERYL L. CLELAND, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~)Z~L THEODORE R. LER 13J.j;~ 11 ~}(l1l:Mfl B ZIA.MO SON ~~il / ~-tJffid HERYL L. CLELAND COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by THEODORE R. MILLER, the testator herein, and subscribed and sworn to before me by BETZI A. MORRISON and CHERYL L. CLELAND witnesses, this 1.1'.' day of March, 1995. ( ~M&rBank August 27, 2002 RE: Estate Search The Estate of: Date of Death (D.O.D.) THEODORE R MILLER 5/26/2002 To Whom It May Concern: Identified below is the account information requested. l. M&T Bank accounts in which the decedent's name appears: CHK 720275 o.PENED 9/67 THEo.Do.RE R MILLER LESTER W MILLER 4319 D.o..D. Accrued Interest Balances (Includes ACCL Int.) $3237.98 $.00 Account Type Account Number Account Title o.pening Branch 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount o.wed Account Description NO. Safe Deposit Box titled in the Decedent's name existed at our office. rfyou have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK Co.RPORA nON BY: -etU~~ ~~'-' Authorized Signature DATE: 'Y~;Y7~()~ Manufacturers and Traders Trust Company. 1100 Wehrle Drive, Po. Box 701, Buffalo, NY 14240-0767