HomeMy WebLinkAbout01-0144
Estate of C h a r 1 e s William M-iller
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
d-.J -[) / -111
No.
To:
Social Security No.
, Deceased.
'lOR-'lL.. L..591
Register of Wills for the
County of CUlUQiHlgRd in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut 0 r
in the last will of the above decedent, dated De cern be r 3
and codicil(s) dated
named
, 19....9.R-
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cum be rIa n d
his last family or principal residence at C h u r c h 0 f God
Carlisle, FA 17013 Carlisle Borough
(list street, number and muncipality)
County, Pennsylvania, with
Home 801 North Hanover St,
Decendeot,then 67 ,vears Qfage, died December 7 ~i~ 2000,
u ~Ul Nbrth HanoVer Street, Carllsle, FA 17613
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ 90,000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters t est am e n tar v
therqn.
(testamentary; administration c.I.a.; administration d.b.n.c.l.a.)
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Richard F. Miller
'106 Rolo Court
Mf>rhRnirRhllrg, PA 17055
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ss
COUNTY OF CUMBERLAND J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and bel' of p .. ner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) w' well a t d' iste te according to law.
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MARY C
/ /. ,n REGI
c.o -0100--/
No. 21-2001-144
Estate of
CHARLES WILLIAM MILLER
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
2001
AND NOW February 6th. xW_, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated Dee em be r 3. 1998
described therein be admitted to probate and filed of record as the last will of C h a r 1 e s W 11liarn Miller
and Letters Testamentarv
are hereby granted to R i c h a r d F. Mill e r
FEES
P b L E $ 200.00
ro ate, etters, tc..........
Short Certificates(~ ) . . . . . . . . .. $ 6 . 00
Renunciation ................ $
x Pages (4) $ 12.00
JCP TOTAL _ $ 5.00
Filed . .F.ebrua:r;v. 6.th, 200.1 . . $. .2.~~:- P.Q .
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Registe of Wills ARY C. LEWIS
REGISTER OF WILLS
John .1. RArRnski. Tr
ATTORNEY (Sup. Ct. I.D. No.) 82585
35 East High Street, Suite 203
ADDRESS Car 1 i s 1 e, PAl 7 0 1 3
(717) 241-4311
PHONE
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CALL ATIORNEY WHEN LE'ITERS ARE FINISHED
H 105.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the Stare Vital Records Office for permanent filing,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No,
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Local Registrar ;
Fee for this certitlcate, $2.00
p
7021427
DEe 0 8 2000
21-2001-144
Date
43 Rev.va7
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (FIf$l. Midch, Las,
I.
AGE (laSl -"'v)
UNDER 1 YEAR
......... 00,..
Charles W. Miller
UNDER 1 DIIr
...,... .......
SEX
2. Male
SWE FilE NUMBER
SOCIAL SECURITY NUMBER
DAlE OF DEATH ,MCIlIh. 08." ......
2. 208 - 24
4591
4. December 7, 2000
BIRTHPlACE ;c'Y...'"
State Of Fcre.gn CCJl.jN'yl
PlACE c:s DE.ttrH fCt>eck Of'Ily 0l"8 -- 'iH ,nSltucl.ons on om.. Stdel
HOSPITAL
I.......... 0 ERIOuIpulO'" 0 OOA 0
=..vI 0
....
Clmberland
DECEDENT'S USUAL OCCUMlON
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Sergeant
Ie. Carlisle Boro
RACE . ArMIICaIllndiM. Black, Whila. etc.
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10.
White
SURVMNG SPOuSE
III WIle. QMI rnaoen namel
IoWUTAl STATUS._
Never Married. Widowed.
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14. Never Married
801 N. Hanover Street
'" Carlisle, PA 17013
FRHER'S.....we (1'.... MKl<llO. laSl)
17a.StatII
Pe"no;:y 1 "~mia
Did
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Mina
Curri::>erland _? 17...Gl~-'::::::..
MOTHER'S NAME iFirl1. M.dde. M8Iden Surnamel
"..0,"".__"
.....
1711.
Carlisle
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H'llRMAHT'S NAME (T-",,,,,
Arthur F. Miller
Richard F.
METHOO OF DISPOSITION
_IX! c,_o __.....Sl...o
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21..
SlGHIlrURE OF FUNERAl SER
PA 17011
Z~-IVA...CPtLh...J 1u..''''H)r,..lt~
DuE lOtoR AS A CONSEOUENCE Of),
M.
I Approximat.
: W.enraI between
lonaM: and de.'"
! 'I <i
DUE lOtoR AS A CONSEOUENCE Of),
c.
DuE lOtoR AS A CONSEOUENCE Of),
d
WERE AU10PSY FINDINGS
_lA8lE PRIOA lO
COMPLETION OF CAUSE
OF DEATH?
"""NER OF DEATH ./
Nalwll Ia"
DATE OF INJURY
(MQnIh, Day. 'Naf)
TIWE OF INJURY
INJURY 1iJ WORK?
DESCRIBE HOW INJURY OCCURAED.
Homeide
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o PlACe OF INJURY. AI home. tarm, sa;.... lactofy, omc. M.
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NoD
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Could not ~ determmed
... 210.
ClllTW... IChCk orr, onel
-CERTIFYING PHYSICIAN (PhySICian cer"",""9 QUM of death wherl anoIher phys,c.an has pronounced de~ ana compieted Item 23)
To Ihe bHt 0' my knowledge, death occumNlldue1o the C8UM(I) and manner.. .1IIted. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2tI.
.PRONOUNCING AND CEATIF'YIHQ PHYStClAN IPhyscaan boIh ptonouncll'lQ oe.alh and cllf1Jfylf'lQ 10 cause 01 dealto\
To... bftt 0' mv knowtedQlt, death OCcur," at the...... d.... and plan, and dualo ltte nUN(') ancl manna, a. I'aleel
.MEDICAl EXAMINER/CORDNER
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~RAA'S SiGNATURE AND NUMBER
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21-2001-144
LAST WILL AND TESTAMENT
OF CHARLES WILLIAM MILLER
I, Charles William Miller, of Cumberland County, Pennsylvania, do hereby revoke
all my prior Wills and Codicils and hereby declare this Will to be my last Will and
Testament.
1. I appoint my brother, Richard F. Miller, as Executor of my Will. Should he,
for any reaSOJ1 fail to qualify, cease to act as such during the administration of my estate
or predecease me, then I appoint my niece, Kimberly A. (Miller) Brady, Executrix of this
Will, to act with the same duties, powers and discretions as if originally appointed. No
fiduciary acting under this Will shall be required to enter bond or furnish sureties in any
jurisdiction. Any executor may resign and appoint a successor without court approval.
2. My lawful debts and the expenses of my last illness shall be paid as soon as
practical after my death. It is specifically noted that the Executor(s) acting hereunder are
to take funds on deposit to pay for such expenses, and liquidate properties thereafter.
3. I request that I be buried at Rolling Green Cemetery, 1811 Carlisle Road,
Camp Hill, Pennsylvania, for which arrangements have been made and pre-paid. My
services are to be held at Myers-Harner Funeral Home, 1903 Market Street, Camp Hill,
Pennsylvania 'j 70i 'j.
4. All estate, inheritance, succession, and other death taxes, imposed or
payable by reason of my death, and interest or penalties thereon, with respect to all
property comprising my gross estate for death tax purposes, whether or not such property
passes under this Will, shall be paid out of the principal of my general estate as if such
taxes were administration expenses, without apportionment or right of reimbursement. I
Page 1 of 5
.. ..
Last Will & Testament of
Charles W. Miller
authorize my Executor to pay all such taxes at such time or times as he may deem
advisable.
5. My portion of the White Hill Hunt Club is to be divided equally between the
other surviving members.
6. All of the rest, residue and remainder of my estate, real, personal and mixed
shall be held, administered and distributed to Richard F. Miller and Pennsylvania State
Bank, 2148 Market Street, Camp Hill, Pennsylvania 17011, AS CO-TRUSTEES IN TRUST
to act jointly, with equal authority, to care for the benefit of my mother, Evelyn Miller, to be
used as follows:
(a) The Co-Trustees shall payor apply to or for the use of Evelyn Miller
in quarterly or other convenient installments, so much of the principal and so much of the
income thereon (even to the point of totally exhausting the same) as the Co-Trustees,
deem advisable to provide for the health, welfare, maintenance, support, and emergency
needs of Evelyn Miller.
7. The Co-Trustees are authorized, in its discretion, with respect to all property,
real, personal or mixed, at any time forming part of the trust estate, without limitation by
reason of enumeration and in addition to powers conferred by law:
(a) To retain any property received by it;
(b) To invest in all forms of property without restriction to investments
authorized for fiduciaries, including stock or other securities of the Co-Trustees, or of a
holding company controlled by the Co-Trustees, and to hold such property either
unregistered or in the name of a nominee;
(c) To give proxies, both ministerial and discretionary;
Page 2 of 5
Last Will & Testament of
Charles W. Miller
(d) To join in any merger, consolidation, reorganization, voting trust plan,
or other concerted action of security holders, and to delegate discretionary duties with
respect thereto;
(e) To compromise controversies;
(f) To exchange or sell property, real or personal, for cash, property or
credit, publicly or privately, to improve such property, to lease such property for any period
of time, and to give options for sales, exchanges or leases of the same;
(g) To borrow generally, including from the Co-Trustees, and to pledge
real or personal property as security therefore;
(h) To loan cash or securities upon such terms and conditions as the
Trustees deem appropriate;
(i) To retain non-income producing property;
(j) To allocate any property received or incurred to principal or income or
partly to each, without being obliged to apply the usual rules of fiduciary accounting;
(k) To distribute in cash or in kind or partly in each; and
(I) To convert undistributed income to principal.
8. The Co-Trustees shall have full power to pay from the trust estate any taxes,
charges or assessments for which the Co-Trustees, or the trust estate, or any interest
therein becomes liable, and any such payments shall be made from and charged to either
income or principal of the trust estate, as the Co-Trustees, in their discretion, deem proper.
9. In the event that Evelyn Miller predeceases me or dies prior to receiving final
distribution of the trust principal and income hereunder, the undistributed balance shall be
distributed to Richard F. Miller, if then living, if not then to Peggy L Miller and Kimberly A.
Brady in equal shares, minus five (5%) percent ofthe balance to be donated to the Forever
Page 3 of 5
Last Will & Testament of
Charles W. Miller
Caring Fund at the Church of God Home, Inc. located at 801 North Hanover Street,
Carlisle, Pennsylvania, 17013..
10. In case the following wish to contest this Will, I specifically request that Craig
Turner and Ronald Turner do not benefit from my estate for personal reasons as a result
of their actions towards me during the handling of Kathryn E. Zink's Estate and since her
death. In the event that Craig Turner and Ronald Turner contest any provision, they are
responsible for all parties litigation costs and shall not benefit from my estate even if their
claim is based upon probable cause.
Executed, this 31ti) Day of '()~e.E:....-, 1998.
~ ~ ~~--
Charles William Miller
In the presence of the above-named testator signed this and declared it to be his Will, and
now at his request, in his presence, and in the presence of each other, we sign as
witnesses:
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Wi ness
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Witness
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Witness
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Residence
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Residence 17()~ - ;2SOGf
Page 4 of 5
Last Will & Testament of
Charles W. Miller
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STATE OF PENNSYLVANIA
CHARLES WILLIAM MILLER
COUNTY OF CUMBERLAND
SSN: 208-24-4591
Charles William Miller, the testator whose name is signed to the foregoing
instrument, have been duly qualified according to law, do hereby acknowledge that I
signed it willingly and as my free and voluntary act for the purpose therein expressed.
~~~~
Charles William Miller
We have been duly qualified according to law, depose and say that we were present
and saw Charles William Miller sign the foregoing instrument as his Last Will; that he
signed it as his free and voluntary act for the purposes therein expressed; that each of us
in his sight and hearing at his request signed the Last Will as witnesses; and that to the
best of our knowledge he was at the time 18 or more years of age, of sound mind and
under no constraint or undue influence.
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Wi ness
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Witness
N.PL t:('. ~
Witness
Sworn to and subscribed
before me this ~ I2..D day
of P e...c...~---.. \o<.L. , 1998.
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Notary Public
NOtARIAL SEAL
THOMAS A. HAMILTON, Notary Publlo
Carlisle Bora, Cumberland County, PA
My Commllllon expires July 1, 2001
Page 5 of 5
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Charles W. Miller
Date of Death: December 7, 2000
Estate No. 21-2001-144
To the Register:
I certify that notice
Rule 5.6(a) of the Orphans'
the following beneficiaries
March 6, 2001.
of estate administration required by
Court Rules was served on or mailed to
of the above-captioned estate on
Name
Address
1. Benard Draisey
1552 Main Street Lisburn
Mechanicsburg, PA 17055-5941
2. Peggy L. Miller
106 Rolo Court
Mechanicsburg, PA 17055
3. Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
4. Kimberly A. Brady
617 Colonial View
Mechanicsburg, PA 17055
5. James Wertz, Sr.
128 Hummel Ave.
Lemoyne, PA 17105
6. "Forever Caring Fund"
Church of God Home
801 North Hanover Street
Carlisle, PA 17013
7. James Wertz, Jr.
128 Hummel Ave.
Lemoyne, PA 17105
8. David Draisey
1552 Main Street Lisburn
Mechanicsburg,.pb 17055-5941
9. Evelyn Miller
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801 North Hanover Street
Carlisle, PA 17013
r~" .:
10. PA State Bank,
Trustee for Evelyn Miller
2148 market Street
Camp Hill, PA 17011
.
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except None
Date: March 6, 2001
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John;S::; Baranski, Jr.
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Capacity:
Counsel for Personal Representative
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IMPORTANT NOTICE
NOTICE 01' ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL
RECEIVE ANY MONBY OR PROPERTY PROM
THIS BSTATE OR OTHERWISE
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-244
TO: Peggy L. Miller
106 Rolo Court
Mechanicsburg, PA 17Q55
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be obtained by contacting
the Register of Wills and paying the charges for duplication.
Date: February 9, 2001
Capacity:
JO~~
Attorney Supreme Court I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
~
DlPORTANT NOTICB
NOTICE OP BSTATB ADMINISTRATION
THIS NOTICE DOBS NOT MEAN THAT YOU WILL
RBCBIVE ANY MONBY OR PROPBRTY PROM
THIS BSTATB OR OTHERWISB
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-
TO: BENARD DRAISEY
1552 MAIN STREET LISBURN
MECHANICSBURG, PA 17055-5941
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died .testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
the
A copy of the Will or Petition may be obtained by contacting
Register of Wills and paying the charges for dup' tion.
/
/./
February ? , 2001
./
Date:
Capacity:
J J. Baranski,
Attorney Supreme Court 1.0. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
IMPORTAN'l' NOTZCB
NOTZCE OJ' ESTATE ADlaNZSTRATZON
THZS NOTZCE DOES NOT MBAN THAT YOU WZLL
RECEJ:VE ANY MONBY OR PROPERTY PROM
THJ:S ESTATE OR OTHERWJ:SE
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO: David Draisey
1552 Main Street Lisburn
Mechanicsburg, PA 17055-5941
Please take notice of the death of decedent and the grant of
letters to the personal representative{s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be obtained by contactiny
:::e~eg:::::a:: ;,l~s2::: paying the charges ~ation.
"
Capacity:
aranski, Jr.
Attorney Supreme Court I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
~
DlPORTAN'l' NOTICB
NOTICB OF BSTATB ADMINISTRATION
THIS NOTICB DOBS NOT MEAN THAT YOU WILL
RBCBIVB ANY MONBY OR PROPBRTY FROM
THIS BSTATB OR OTHBRWISB
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO: James Wertz, Jr.
128 Hummel Ave.
Lemoyne, PA 17105
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
the
A c~py 0f the Will or Petition may be obtained by contacting
Register of Wills and paying the charges for duplication.
JOhn~~
Attorney Supreme Court I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
February l~, 2001
Date:
Capacity:
:>>
DlPORTAN'l' HOTZC.
NOTICB OF BSTAT. ADmNZSTRATION
THIS NOTICB DOBS NOT MEAN THAT YOU WILL
RBCBIVB ANY MONBY OR PROPBRTY PROM
THIS BSTATB OR OTHBRWZSB
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO: "Forever Caring Fund"
Church of God Home
801 North Hanover Street
Carlisle, PA 17013
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be obtained by contacting
the Register of Wills and paying the charges fo d 'cation.
Date: February I' ' 2001
Capacity:
Jo aranski, r.
Attorney Supreme Court I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
'" "
DIPORTAlft NO'l'ICB
NOTICB OJ' ESTATE ADMINIS'l'RATION
THIS NOTICB DOBS NOT MBAN THAT YOU WILL
RBCBIVE ANY MONBY OR PROPBRTY FROM
THIS BSTATB OR OTHERWISB
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO: James Wertz, Sr.
128 Hummel Ave.
Lemoyne, PA 17105
Please take notice of the death of decedent and the grant of
letters to the personal representative(s} named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be ained by contacting
the Register of Wills and paying the ch ~~duPlication.
Date, February /(. , 2001 Y
Jo . Baranski, Jr.
Atcorney Supreme Court 1.0. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Capacity: Counsel for Personal Representative
... " ..
(
(
DlPORTAN'l' NOTXCB
NOTXCB OP BSTATB ADMXNZSTRATXON
THXS NOTXCB DOBS NOT MEAN THAT YOU WILL
RBCBXVE ANY MONBY OR PROPBRTY FROM
THIS BSTATB OR OTHBRWI:SB
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO : KIMBERLY A. BRADY
617 COLONIAL VIEW
MECHANICSBURG, PA 17055
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be obtained by cor..t:acting
the Register of Wills and paying the charges for du lication.
Date: February j? , 2001
Capacity:
Jo . Baranski, Jr.
Attorney Supreme Court I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
"'" III 4 .
(
r
DlPORTANT NOTICB
NOTICB OF BSTATB ADMINISTRATION
THIS NOTICB DOBS NOT MEAN THAT YOU WILL
RBCBIVB ANY HONBY OR PROPBRTY FROM
THIS BSTATB OR OTHBRWISB
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO: Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be obtained by contacting
the Register of Wills and paying the charges for duplication.
Date: February J ' 2001
Capacity:
~~
John J. Baranski, Jr.
Attorney Supreme Court I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
"" " .
DlPORTAN'l' NOTICB
NOTICB OJ' BSTATB ADMINJ:STRATION
THIS NOTICB DOBS NOT MBAN THAT YOU WILL
RECErvB ANY MONBY OR PROPERTY FROM
THIS BSTATB OR OTHERWISB
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO: PA State Bank
As Trustee for Evelyn Miller
2148 market Street
Camp Hill, PA 17011
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or petition m~y be obtained by contacting
the Register of Wills and paying the charges for duplication.
Date, March & , 2001 ~
Joh J. Baranski, Jr.
Attorney Supreme Court I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Capacity: Counsel for Personal Representative
'Joo I.. ..
:IMPORTANT NO'l'ICB
NOTICB OP BSTATB ADMINISTRATION
THIS NOTICB DOBS NOT MEAN THAT YOU WILL
RBCBlVE ANY MONBY OR PROPBRTY FROM
THIS BSTATB OR OTHBRWISE
Whether you will receive any money or property will be
determined wholly or partly by the decedent's will. If the
decedent died without a will, whether you will receive any money
or property will be determined by the intestacy laws of
Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Charles W. Miller, deceased
Estate No. 21-01-144
TO: Evelyn Miller
C/O Church of God Home
801 North Hanover Street
Carlisle, PA 17013
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent Charles W. Miller, died on the 7th day of
December, 2000, at Carlisle, Cumberland County, Pennsylvania.
The Decedent died testate.
The personal representative of the Decedent is:
Richard F. Miller
106 Rolo Court
Mechanicsburg, PA 17055
The will has been filed with the Office of the Register of
Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA
17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be obtained by contacting
the Register of Wills and paying the charge duplication.
Date: March G" 2001
Capacity:
J . Baranski,
Attorney Supreme Cou t I.D. #82585
35 East High Street, Suite 203
Carlisle, PA 17013
Telephone (717) 241-4311
Counsel for Personal Representative
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Register of Wills of Cumberland County, Pennsylvania
INVENTORY
, Deceased
No. 21-01-144
Date of Death 12/7/2000
Social Security No. 208-24-4591
Estate of Miller, Charles William
also known as
Richard F. Miller
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory
are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S.
Section 4904 relating to unswom falsification to authorities.
Attorney: Dale F Shughart, Ir. Esquire
perso~al Repres~~..$-
Signature: !
car.ler
Signature:
1.0. No.: 19373
Signature:
Address:
35 E. High Street, Suite 203
Address: 106 Rolo Court
Mechanicsburg, PA 17055
Carlisle, P A 17013
Telephone: (717) 241-4311
Telephone:
Dated:
Personal Property
Membership interest in White Hill Hunt Club, a A non-profit corporation, Value based on
attached bylaws and statement of redemption value provided by the corporate President
1,560.00
rocking chair, value based on sales price.
50.00
Pennsylvania State Bank, Time Ceritficate #40265, principal $30,690.76
accrued interest $ 40.20
30,730.96
Pennsylvania State Bank, account #26401653, principal 28474.49
accrued interest 33.15
28,507.64
Church of God Home, refund for prepaid expenses
3,196.00
Church of God Home, refund for Wheelchair payment
400.00
Church of God Home, refunttfor AIR priv payment
58.95
Health Now NY, Inc., medicare reimbursement
93.91
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$95,101.13
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of Miller, Charles William
. Deceased
No. 21-01-144
Date of Death 12/7/2000
Social Security No. 208-24-4591
also known as
Church of God Home, close out PCA
274.22
PNC Bank IRA, Account # 6001008163, death benefits payable to the estate
principal - $20,276.29
accrued interest - $140.29
20,276.29
Prudential Life Insurance Company, death benefit.
9,953.16
Total Personal Property
$95,101.13
2
! b --d(o Ii?-
S~c..-
REV_'~EX.(ll.oo1
'*
COMMON'NEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
niFICltd.lIS: ONL
FILE NUMBER
21
01
I
I
~.
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
208-24-4591
144
NUMBER
I OECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Miller, Charles William
i 1210712000 M-UU-Y.A"' ~;;~'~;3{~M-UU-Y.A"'
C (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
---+ II 1. Original Retum [J 2. Supplemental Retum
~ ~ i'J. ']. -lJ 4. Limited Estate . 4a. ,,'," '0'''.'' Compcom',. (d". of dee'h
~ ~ ~ after 12-12-82)
:z:: i 9 [] 6. Decedent Died restate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach
Ol1,lD of Will) copy of Trust)
~ D 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (dale of death between
12-31-91 and 1-1-95)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
i
o 3. Kema\{l.<1erR~teof<1eatl'lpnorto1:;H~'Z)
lJ
o
5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
o 11.Election to tax under Sec. 9113(A) (Attach Sc:h 0)
....
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~Q
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,,2
IRM NAME (If applicable)
~ELEPHONE NUMBER
~71241-4311
I :. Real Estate (Schedule A)
. 2. Stocks and Bonds (Schedule B)
35 E. High Street, Suite 203
Carlisle, PA 17013
(1) -0-
(2) 1,560.00
(3) None
.
(4) None'
(5) 83,587.97
(6) 7,432.88
(7) -0-
(8)
(9) 16,216.00
(10) 1,569.00
Q(CFICIII,I. USE ONLY
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, BanI< Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7, Inter~Vlvos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (Iolal Lines 1-7)
9, Funeral Expenses & Administrative Costs (Schedule H)
92,580.85
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)
11. Totat Deductions (totai Lines 9 & 10)
(11)
17,785.00
74,795.85
12. Net Value of Estate (Line 8 minus Line 11)
(12)
8f 13. Charitable and Govemmental 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)
--- -- - -
, SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(13)
2,492.22
(14)
72,303.63
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 16. Amount of Line 14 taxable at lineal rate 15,958.54 x .045 (16) 718.13
0
g 17.Amount of Line 14 taxable at sibling rate 54,785.09 .12 (17) 6,574.21
0. x
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"
S 18. Amount of Line 14 taxable at collateral rate 1,560.00 x .15 (18) 234.00
--
19. Tax Due (19) 7,526.34
20. lJ
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's G:omplete Address:
I ,TREET ADDRESS
805 North Hanover Street
I STATE PA
I ZIP 17013
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
5;000.00
263.10
Total Credits (A + B + C)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(1)
7,526.34
(2)
5,263.16
(3) 0.00
(4)
(5) 2,263.18
(SA)
(5B) 2,263.18
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 IS
b. retain the right to designate who shall use the property transferred or its income;................................ 0 a
c. retain a reversionary interest; or............................................................................................................ 0 a
d. receive the promise for life of either payments, benefits or care?......................................................... 0 a
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................. .......... ........ ...... ........... ...... ....... .... ......... ....... ... ....................... 0 a
3. Did decedent own an ~in trust for" or payable upon death bank account or security at his or her death?...... 0 a
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ... ...... .... ... .... .......... ....... .............. .... ............. '" .... ...... ... ... ...... ....... ........... a 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN.
Under penalties of perjury. I dedare 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.
E OF ON R PONSIBLE FOR FILING RETURN ADDRESS
106 Ralo Court
Mechanicsburg, PA 17055
AUUHt:SS
AUUKl:SS
35 E. High Street, Suite 203
Carlisle, PA 17013
6/J i2!
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a)(1.1) (i)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) (ii)J. The statute does not exemot 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)1.
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. ~9'16 (a) (1)1.
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 (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.
.
SCHEDULE B
STOCKS & BONDS
~THorPBNYLVNIA
lNi!fllTANC:eTAXR!'1\MN
-""""'"'"
ESTATE OF Miller, Charles William
I FILE NUMBER
21 - 01 - 144
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM I DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 I Membership interest in White Hill Hunt Club, a A non-profit corporation, Value 1,560.00
based on attached bylaws and statement of redemption value provided by the
corporate President
~
I
TOTAL (Also enlllr on line 2, Recapitulation) 1,560.00
Benard Draisey
President and Treasurer, White
Hill Hunt Club
1552 Main Street Lisburn
Mechanicsburg, PA 17055
June 1, 2001
Dale F. Shughart, Jr., Esquire
35 East High Street, Suite 203
Carlisle, PA 17013
RE: Estate of Charles W. Miller
Dear Mr. Shughart:
In response to your inquiry regarding the date of death value of
Charles W. Miller's interest in the White Hill Hunt Club, a
Pennsylvania non-profit corporation, I have examined the
corporate books and records of the Club, and determined that the
value of all the corporate assets as of December 7, 2000 was
$7,800.00.
Pursuant to paragraph 3(e) of the White Hill Hunt Club By-Laws,
copy attached, the value of Mr. Miller's interest is the total
value of the corporate assets on the date of death divided by the
total number of Club members. At the time of Mr. Miller's death,
there were five (5) members of the Club, including Mr. Miller.
Therefore, the value of Mr. Miller's interest on December 7, 2000
was $1,560.00
If you have any questions, please feel free to contact me.
Very truly yours,
Benard Draisey,
Treasurer, Whit
esident and
Hill Hunt Club
uwo"...ca.
M'TSON AND .NIU.......::all
WIIITE HILL HUNT CLUB
BY-LAWS
ARTICLE I - NAME
This corporation shall be named, known and styled as WHITE HILL
HUNT CLUB.
ARTICLE II - PURPOSE'
The purpose of this Corporation shall be to provide for the amuse-
ment and recreation of the members hereof by maintaining and making
available to them the various facilities of the corporation for camping
hunting and other recreational activities, and to further this purpose
by acquiring and holding real estate and other personal property necess l~
for the same.
ARTICLE III - MEMBERS
1. Certificates. Membership in the Corporation shall be evidence
by a Certificate which shall be issued to each member upon approval and
acceptance as hereinafter provide~which Certificate shall be executed
by the President and attested by the Secretary and which shali contain
the following statement: "The White Hill Hunt Club is a non profit
Corporation."
2. Qriszinal Members. The Incorporators of the corporation as set
...
forth in the Articles of Incorporation shall be the original members of
the Corporation and shall be entitled to Membership Certificates with-
out further restrictions, requirement or qualification whatsoever.
3. . Termination.
(a) Any member may, at any time, resign his membership
in the corporation by notice in writing' of his intention to
do so. Said resigning member shall thereafter present to
the corporation his Membership Certificate for redemption.
(b) A member may be expelled from the corporation for
conduct detrimental to the best interests of the corporation
LAW 0""".
"'T.ON AND .NII:~AIClPl
or failure to pay monthly assessments. Three or more votes
by the members in favor of expulsion are required before
a member may be expelled. The member subject to expulsion
shall not be entitled to vote.
(c) In the event of death of a member whose share in
the corporation is left to a specifically named beneficiary,
the person named as beneficiary shall not be entitled to
membership ~ess he receives the unanimous approval of
the remaining members.
Cd) In all circumstances involving a vacancy in the
membership with the exception of sub-paragraph (c) above,
the remaining members of the corporation shall be giv~n
the first opportunity to purchase the share of a resigning,
expelled or deceased member. In any event, any person ad-
mitted to membership following a vacancy must have the
unanimous approval of the remaining members.
(e) Upon the resignation, expulsion or death of a
member, that member's share of the corporation shall be
valued by taking an amount equal to the total value of all
corporate assets as shown on the books and records of the
corporation on the date of notice of resignation, expulsion
or death, as the case may be, divided by the total number of
members, including the resigning, expelled or deceased member.
The Membership Certificate of the resigned, expelled or de-
ceased member shall be presented to the corporation for
cancellation and upon receipt thereof, the corporation shall
pay the redemption value thereof.
(f) Neither membership nor the Membership CertificatE
shall be assigned, transferred, conveyed or terminated by
any member or his personal representative otherwise than as
set forth above.
-2-
. ol"Jl'tgs
"..D aMll:lJAxElll
(g) The membership in the Corporation shall be
limited to 5 persons.
(h) The Camp may be sold or otherwise disposed of
by a vote of 3 of the 5 members.
ARXICLE IV - BOARD OF DI RECTORS
All members of the corporation shall be on the Board of Directors
of the corporation. A member shall serve on the Board of Directors
until his membership in the corporation is terminated by resignation,
death or expulsion. The Board of Directors may from time to time pro-
mulgate and publish such rules and regulations for the general operatio
of the camp facilities as they may deem necessary and proper. These
rules. and regulations shall be known as "Special Rules" and are incor-
porated into the by-laws of the corporation and designated herein as
Article VI.
ARTICLE V - OFFICERS
The officers of the corporation.shall consist of the following:
.1. President. The President shall preside at all meetings of
the corporation and shall see that the members comply with
the by-laws, rules and regulations of the corporation.
2. Secretary-Treasurer. The Secretary-Treasurer shall
keep a record of all monies expended and received by the
...
corporation. He shall have the authority to sign checks
along with the Presid~nt and James fl. Wertz, the signatures
of any two of the three being required on all checks. The
Secretary~Treasurer shall also be required to maintain a
for
calendar of reservation&luse of the camp facility by members
and guests throughout the year.
The following shall be the first officers of the corporation,
who shall serve until successors are named:
Bernard L. Draisey, President
Charles w. Miller~ Secretary-Treasurer
-3-
..,
,.
LAWO.....1;&tI
'ON#oMD"'~AIC_
ARTICLE VI -. SPECIAL RULES
1. The camp facility will be reserved for the use of
buck
members only during the first three days of/hunting season.
During the remainder of the year, members and guests will be
permitted to use the camp facility and should notify the
Secretary-Treasurer of their intended periods of use.
Members should use their discretion "in limiting the number }
f . ~ .....''''~ ~ ,17 -;;--;r;.r 8(~ rc-' c/ yc: (!
o persons. -d / .4" . v .,. (T ~ /'
. v""''''1 H"'''' 'i",,? .>c:c-OI..[v_.!,
2. The lodging charge for guests shall be $3.00 per
day. and the .lodging and meal charge for guests shall be
$7.50 per day.
3. Any. damage by a guest to the camp facility shall
be the responsibility of the host member.
4. The cost for the initial stocking of food and
any subsequent food purchases shall be divided among the
members.
ARTICLE VII - J\MENIIoIENT
The by-laws may be amended by a majority vote of the members.
Dated:
..~.:e
~t??
Rcu
;:p /I~ /v~')
~~~~
7/u.r~ -3~..J)~
October 6. 1975
-'I-
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
~,""o,-PENN8Yl.VANA
INH!RITAHCl!!TAX~
....,.,.,.0'":0''.'''
I FILE NUMBER
21 .01 - 144
ESTATE OF Miller, Charles William
Include the croceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the right of
survlvol'8h p must be disclosed on schedule F.
ITEM
NUMBER
I rocking chair, value based on sales price.
DESCRIPTION
VALUE AT DATE OF
DEATH
50.00
2
Pennsylvania State Bank, Time Ceritficate #40265, principal $30,690.76
accrued interest $ 40.20
30,730.96
3
Pennsylvania State Bank, account #26401653, principal 28474.49
accrued interest 33.15
28,507.64
4
Church of God Home, refund for prepaid expenses
3,196.00
5
Church of God Home, refund for Wheelchair payment
400.00
6
Church of God Home, refund for AIR priv payment
58.95
7
Health Now NY, Inc., medicare reimbursement
93.91
8
Church of God Home, close out PCA
274.22
9
PNC Bank IRA, Account # 6001008163, death benefits payable to the estate
principal - $20,276.29
accrued interest - $140.29
20,276.29
83,587.97
TOTAL (Also enter on Una 5, Recapltulstlon)
Cumberland Parkway Office
91 Cumberland Parkway
Mechanicsburg, PA 17055
www.pastatebank.com
717-795-7200
FAX: 717-796-2699
February 23, 2001
Stock Trading Symbol: PLYN
Mr. Dale F. Shughart, If.
Attorney At Law
35 East High Street
Suite 203
Carlisle, Pa 17013
Re: Estate of Charles W. Miller
Dear Mr. Shughart,
Below please find the requested information on Mr. Miller's accounts as of the date of his death.
Account # Balance Accrued Interest
I. 10403129 9,522.74 10.68
2. 26401232 5,343.01 7.86
3. 26401653 28,507.64 33.15
4. CD 40265 30,690.76 40.20
These are the accounts with the balances on the date of death, 1217/2000. If you have any questions, please
feel free to call.
Sincerely,
cii;V^21:;;ANK
Kathy Grant
Community Office Manager
'*
SCHEDULE F
JOINTL y-oWNED PROPERTY
COMMONWEALn-t OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT CECEOeNT
ESTATE OF
Miller, Charles William
I FILE NUMBER
21-01-144
If an asset was msde joint within one year of the decedent's data of death, It must be reportsd on schedule G.
SURVIVING JOINT TENANT(S) NAME
A Richard F. Miller
ADDRESS
RELATIONSHIP TO DECEDENT
106 Ralo Court
Mechanicsburg, PA 17055
brother
JOINTLY OWNED PROPERTY:
DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER Include name of financial Institution and bank account number DATE OF DEATH
NUMBER FOR JOINT MADE '" similar identifying number. Attach deed for jolntiy-held real VALUE OF ASSET DECO'S VALUE OF
TENANT JOINT "state. INTEREST DECEDENT'S INTEREST
----- -- 1------
I I A 10/05/1999 Pennsylvania State Bank, joint savings acct. 5,343.01 50% 2,671.51
#26401232
principal 5,335.15, accrued interest
I 7.86
2 A 10/05/1999 Pennsylvania State Bank, joint checking acct. 9,522.74 50% 4,761.37
#10403129
principal 9512.06, accrued interest
10.68
I
TOTAL (Also enlllr on line 8, Recapitulation) 7,432.88
.
.
70",.-:-tl\"Jt,fLTHOP~VANA
INH!NTANCI! TAX I'ETtJRN
....OOHT OOCODEM"
SCII;;'H
RN3W.~&
AlJ\ll\lSTRAllVE UJtj I~
I FILE NUMBER
21 - 01 - 144
ESTATE OF Miller, Charles William
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
I Myers-Hamer Funeral Home, Inc., funeral bill 5,420.00
B. i ADMINISTRATIVE COSTS: 4,251.00
1. Personal Representative's Commissions
Richard F. Miller
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 106 Rolo Court
City Mechanicsburg Stale PA Zip 17055
Year(s) Commission paid 2001
2. Attorneys Fees -- Dale F Shughart, Jr. Esquire 5,277.00
3. Family Examption: (If deoedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City Slale Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 217.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
I Register of Wills, short Certificates 6.00
2 Bonnie L. Coyle, notary fees 20.00
Total of Continuation Schedule(a) 1,025.00
TOTAL (AI8o .ntar on line I, Recapitulation) U;,216.00
*'
SdlecUe H
ftnnII Expel U B &
M,'M"ri<CoslBoo.Add
COMMONMALTH OF PENNSYLVANIA.
INHERITANCE TAX RETURN
RESJDENT DECEDENT
ESTATE OF
Miller, Charles William
I FILE NUMBER
21-01-144
3
Register of Wills, filing Inheritance Tax Return and Inventory
25.00
4
Reserve for fees for preparing final income tax returns and filing final account
1,000.00
Page 2 of Schedule H
'*
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
\ FILE NUMBER
21- 01-144
ESTATE OF
Miller, Charles William
Include unreimbursed medical expenses.
ITEM
NUMBER
1
Brocky Medical Services, bill for medical supplies
AMOUNT
645.00
DESCRIPTION
2
H & R Block, preparing income tax retum.
143.00
3
Internal Revenue Service, income taxes.
781.00
TOTAL (Also enter on Line 10, Recapitulation)
1,569.00
'.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERrrANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I FILE NUMBER
21-01- 144
RELATIONSHIP TO AMOUNT OR SHARE
DECEDENT OF ESTATE
Miller, Charles William
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
I Benard Draisey
1522 Main Street Lisburn
Mechanicsburg, PA 17055-5941
None
1/4 interest in the
decedent's share of the
Hunt Club, $390
2 James Wertz, Sr,
128 Hummel Ave
Lemoyne, PA 17015
None
1/4 interest in the
decedent's share of the
Hunt Club, $390
3 James Wentz Jr.
128 Hummel Ave,
,Lemoyne, PA 17015
4 . David Draisey
1552 Main Street Lisburn
Mechanicsburg, PA 17055-5941
None
1/4 interest in the
decedent's share of the
Hunt Club, $390
None
1/4 interest in the
decedent's share of the
~unt Club, $390
I See Continuation Schedule(s) attached
,
i Enter dollar amounts for dlsbibutions shown above on lines 15 through 17. as appropriate, on Rev 1500 cover she t
II. I NON-TAXABLE DISTRIBUTIONS:
'I A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE T
'.
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I FILE NUMBER
21-01- 144
RELATIONSHIP TO AMOUNT OR SHARE
DECEDENT
Do Not list Trust.a(s) OF ESTATE
ESTATE OF
Miller, Charles William
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
5 , Evelyn Miller Trust,
Richard F, Miller and
PA STATE BANK, CO-Trustees
2148 Market Street
Camp Hill, PA 17011
I Trust
loo% of residue
.~
I
Page 2 of Schedule J
*'
SCHEDULE K
UFEESTAlE,ANNurlY
& TERM CERTAIN
(Check Box 4 on Rev-1500 Caver Sheet)
\
J
I FILE NUMBER
I 21- 01-144
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TM RETURN
RESIDENT DECEDENT
ESTATE OF
Miller, Charles William
ThiS schedule IS to be used for all single lite, JOint or successive life esIaIeanaferm certain calculations. For dates of deam pnor to 5-1-89.
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found
in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
[] Will [] Intervivos need of Trnst [] Other
NEAREST AGE AT
IDATE OF BIRTH,tATE O,F" OEATH I
1-- 06/01/1910 _91 III
, []
I=-_~-" ~
PAYABLE
ears
ears
ears
erm 0 ears
I e or
1. Value of fund from which life estate is payable
$
65,802.97
2. Actuarial factor per appropriate table
Inlerest lable rate - [] 31/2% [] 6% [] 10% III Variable Rate
3. Value of lite estate (Line 1 multiplied by Line 2)
.24252
$
15,958.54
~~~TE OF BIRTH
~
NEAREST AGE AT
DATE OF DEATH
TERM OF YEARS ANNUITY IS
PAYABLE
NAME(S) OF
ANNUITANTS
[]
[]
[]
[] I e or
ears
ears
ears
erm 0 ears
1. Value of fund from which annuity is payable
$
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - D Weekly (52) [] Bi-weekly (26)
[] Semi-annuaIly (2) [] AnnuaIlY (1)
3. Amount of payout per period
4. Aggregate annual payment. Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Inlerest table rate - [] 3 1/2% D 6% [] 10% [] Variable Rate
[] Monthly (12) [] Qnarterly (4)
[] Other
0.00
6. Adjustment Factor (see instructions)
7. Value of annuity - If using 3 1/2%, 6%, 10% or if variable rate and period payout is at end of period,
calculation is: Line 4 x Line 5 x Line 6
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3
NOll:: The vaiues of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through
this tax return. The resulting life or annuity interest(s) shouid be reported at the appropriate tax rate on Lines 13, 15, 16 and 17.
.
SCHEDULE M
RmJRE INTEREST COMPROMISE
(Check8ox4aoo Rev-1500CowrSheet)
I
I FILE NUMBER
21- 01-144
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miller, Charles William
This schedule -is appropriate only for Estates of decedents dying after December 12,1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and
enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return
o Will 0 Trust 0 Other
I --"
l'renefiCiaries
. 1. EvelymMlller
2. Rlchard~. Mlllei
NAME OF BENEFICIARY
RELATIONSHIP
AGEm
DATE OF BIRTH NEARESTBIRTlI>AY
o er
ro er
3.
4. Church at God Home
5:
~I=
anly
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9
months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
"' Ii : ex:ercises such withdrawal righb " ""..
o nlimited right of WIthdrawal 0 LImIted right of WIthdrawal
. III. Explanation of Compromise Offer:' '.
Pre-tax value of Residuary Estate into Trust will be for the benefit of decedent's mother with remainder of95% to brother
and 5% to Charily is $ 65,802.97. Actuarily computed value oflife estate and remainder, shown on Shcedule K, are
respectfully $ 15,958.54 and $ 49,844.43. Compromise offer based on assumption that trustees will only pay income to
or for life tenant (Mother).
~mmary of Compromise Offer:
- -"I -~. Amount of Future Interest:
; 2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet)
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One [J 6% [J 3% [J 0%
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 Taxable at 6% Rate
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 Taxable at 15% Rate
(also include as part of total shown on Line 17 of Cover Sheet)
6. Total value of Future Interest (sum of Lines 2 thru 5 must equal Line 1)
65,802.97
2,492.22
0.00
15,958.54
47,352.21
65,802.97
REV.1!11ll1EX.~1
I OFFiC>AL USE ON[ Y I c.
. /6 -G20<'?- / ~.
I FILE NUIIBER
21 01 00144
.~L_~.~~TY C<?D_E___r~______ ._~~_~~~
-1-"~S5cIAL SECURiW-NDMBER----~--- ----.
208-24-4591
THII RETURNMUsT'BEFILEtf..t'DUPucATEwiTil THE-
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
*'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
____ _________ _~.BURG, ~A 17128-060~___J_ ____ ____._~___
------OECEDENTS NAME (LAST, FIRST, ANi5"MIDDLE1NITIALj---- -.~-----
i Miller, Charles Willilam
~AiFOF""O~:nn:vo.~-'-~-
112/07/2000
...
ill
Iil
u
w
a
!lJATl:OFelRTR\M~OO~Y~RT-
101/31/1933
f0FAPPLlCASlE:)-StJRVMNG-SPbiJSE'S-NA"ME-tu..ST-:t=(RSTAND MioOle-JN]TJAl)
- --sOCiAL -SECURit'YNUMBER
REGISTER OF WILLS
~~-d --1:-0riginaT Return --- -.,---- --ii-2.Supplement'Ei Return -- 0 -'--s.-rre-lrialnaei'Rsiurn ~(08leo'-dealnpnorTD 12:f3:g2)--
II!!.. ,'0 4. limited Estate 0 4a. Future Interest Compromise (date of death D' 5. Federal Estate Tax Return Required
~~ ~12.1~)
:c: 9 III 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a LIving Trust (Attach 8. Total Number of Safe Deposit Boxes
If ID of Will} copy of Trust)
(J ~ 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between [J: 11.Etectlonto tax under Sec. 9113(A) (Allac:h Sch 0)
j 12-31-91 and 1-1-95)
:il!2-
I ~ rlRM NAMe (If applicable) - 1 35 E. High Street) Suite 203
u ~ ~ECEPHoNE NUM.ER--.~-- .--- ~-~- ~ --~~, Carlisle, P A 17013
I 717/241-4311 1
__=_=.--r=::-;---'. ---~~---------_.------:-:,=---=-=.::::---=----=--.-==::===--=----=-__~___..-----::=--~__~=;- _ .,___~_._~
1. Real Estate (Schedule A) (1) None OfFICIAL USE ONLY
2~ Stocks and Bonds (Schedule B)
~
e
!Ii
ld
..
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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
(Schedule G or L)
8. Total G..... _ (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(2)
(3)
(4)
(5)
(6)
(7)
1,294.8.0-
. ---. . ~-__"-J
Noni ('
.---------.----~f
NOIl~
None
None
None
~
::<
?':~.
-'
-""
-'0
(~
1,294.80
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11~ Total DlIductlons (total Lines 9 & 10)
12. NlIl V.lus of E_ (Line 8 minus Line 11)
(9)
15,00
! 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not
been made (Schedule J)
14, NlIlV.lueSubJscttoT8X(Line 12 minus Line 13)
(11) 15,00
(12) 1,279,80
---------- -
(13) 63,99
(14) 1,215.81
-----------
(15)
------ ----~
(16)
---------------~-- n_____.
(17) 145.90
(18)
(19) 145,90
----------~-- .-------
120. OJ
U!JHilEil!llJ~HII~llg~~!II~
Copyright 2000 fann -... only Ths lIIckns. Group, Inc, Form REV-1500 EX (Rev. HII)
SEE INSTRUcnONS 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)
~
"
..
"
8
E
16. Amount of Line 14 taxable at lineal rate
17.Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .00
x .045
1,215.81 x .12
x .15
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Dececlent's Complete Address:
S;rREET ADDRESS
805 North Hanover Street
--~---'ISTA
I STATE PA
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + 8 + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E)
4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT.
C~ box on Page 1 Line 20 to .....- e .-fund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This Is the TAX DUE.
A. Enter the Interest on the tax due.
8. Enter the total of Line 5 + SA This Is the BALANCE DUE.
Make Check Payable to: REGISTER OF WlLL.s, AGENT
.ZiP-.--.----n.
I 17013
(1)
145.90
(2)
0.00
(3)
(4)
(5)
(SA)
(58)
0.00
145.90
145.90
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: V_ No
a. retain the use or income of the property transferr&d;............................................................................. 0 181
b. retain the right to designate who shall use the property transferred or its income;................................ 0 a
c. retain a reversionary Interest; or.................................."........................................................................ 0 B
d. receive the promise for life of either payments, benefits or care?......................................................... 0 a
2. If death occurred after December 12. 1982. did decedent transfer property within one year of death without
receiving adequate consideration?..... .......................n..... ....... .... ...... ... .... ... ... ........ ...... ...... ...... ...,......... ..' .... 0 S
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...... 0 ISI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................................................................................................... a 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Grider- penaltiesOfp6rlury.Tdeciai-fj IhatThaveexamined this retum:including-accomlJanylng-schedules'-and statementS: and tCI'th8bestofmy-t<<\owiQ;:igean-d"bellef.\t-is.-iNe:-COiTect
anifcorr;pletB.---'~
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
---- - -~--N- PONsIEiLEF.QRFILlNGRE:TURN- -----Aoi5RESS." ----------,-----. ---------.- ------..-------.-----"-OATE---~
--.3L~~_2-
106 Rolo Court
Mechanicsburg" P A 17055
---AOQRESS----
---P;DORE:SS
S~;[Ct~R_~
35 E. High Street, Suite 203
Carlisle, PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1)(1)J.
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) (il)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1. 2000:
The tax rate imposed on the net value of transfers from a deceased child 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. 99116
1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .S. 99116 (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.
'*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
'NHE~ITANCE TAX RETURN
RESIDENT DECEDENT
__n_ __"___ ___.___0...___.__._____...____,,_'__'_ _
---,'--' -~----------_.- --. ----.-.-------
ESTATE OF. . .
Miller, Charles Wllhlam
----iFILENUMBER-- -- ----~
I
I 21 - 01 - 00144
All property Jolntly-owned with right of eurvlvorahlp muet be dlecloeecl on Schedule F.
N~~~:R ~-. -~- ----------DE~CRIPTlO;----------C~~VA~U~-
__ .__. .l__.______ n__________~___
I 13 $100 EE U.S. Savings Bonds, issued 6/89 through 5/90.
Principal $650.00
Accrued interest $644.80
__~__----i--____
I
,
i-VAUJE AT-DATE
OF DEATH
1~294.80
, These bonds were not discovered until October 15,2001.
I
I
!
-- TotAL (Also eriter ..lIiine 2;R.capltUlatJon) --
!
---1- -
- -i,294."80
u.s. Savings Bond Redemption Receipt
Redemption Date: 10/15/2001
CHARLES W MILLER 208-24-4591
2164 MARKET STREET
CAMP HILL, PA 17011
Transaction Number: 715613
Issue Interest Redemption
Serial Number Series Denom Date Issue Price Earned Value
C210995570-EE EE $100 08/1989 $50.00 $51. 64 $101. 64
C210980438-EE EE 100 07/1989 50.00 51. 64 101. 64
C211011188-EE EE 100 09/1989 50.00 51. 64 101.64
C226690075-EE EE 100 10/1989 50.00 51. 64 101. 64
C226706538-EE EE 100 11/1989 50.00 48.68 98.68
C226722134-EE EE 100 12/1989 50.00 48.68 98.68
C210966450-EE EE 100 06/1989 50.00 51.64 101. 64
C226768344-EE EE 100 03/1990 50.00 48.68 98.68
C226737602-EE EE 100 01/1990 50.00 48.68 98.68
C242919764-EE EE 100 05/1990 50.00 45.84 95.84
C226753053-EE EE 100 02/1990 50.00 48.68 98.68
C242889607-EE EE 100 03/1990 50.00 48.68 98.68
C242904808-EE EE 100 04/1990 50.00 48.68 98.68
Total number of bonds redeemed: 13
Total Total Total
Price Interest Value
$650.00 $644.80 $1,294.80
Customer Signature
PENNSYLVANIA STATE BANK
CUMBERLAND PARKWAY BRANCH
91 CUMBERLAND PARKWAY
MECHANICSBURG, PA 17011
717-795-7200
Page 1 Of 1
sa FN IE H
RMRALE:XF'DIES&
ADMNISIRA11\IECuu~ I
-- ~-~-~__---L~"
ESTATEOF M'l! Ch I w';n . . "" .-----]FILENUMBER--~----~
1 er, ares 1 lam 21-01-00144
---.,. -----~.~----'----,--~-~-- -._---. ---._-----"-
Debts of decedent must be reporl8d on Schedule I.
---ITEM
NUMBER
""A:---P=UNERAL EXPENSES:
.
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT OeCEDENT
---------.----.
---y-----------------
I AMOUNT
---~-- -~T ---~-~---~-
I
I
I
I
I
I
DESCRIPTION
--.---..-----.-----------------
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s} I EIN Number of Personal Representatlve(s):
Street Address
City State
Year( s) Commission paid
Attorney's Fees -- Dale F Shughar1, Jf. Esquire
Zip
2.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7.
1
Other Administrative Costs
Register of Wills, filing Supplemental Income Tax Return.
15.00
TOTAL (Also enter on line 9, Recapitulation)
-----.---------.--------
L_~
15.00
COMMONW~NNSYLVANIA i
INHERITANCE TAX RETURN !
RESIDENTOECEOE~~__~~_~~_._____~___
SCHEDULE J
BENEFICIARIES
.._-----'~--_._----_._--_._-----~_.__._----_._-_._---
--riLE N~~~~~~0144---
~-,._------ - ---...-..--.'.-..--,.,..-----
RELATIONSHIP TO AMOUNT OR SHARE
DECEDENT i OF ESTATE
___~_H_ot u.I:_T!'II-*e(.L____l
ESTATE OF
Miller, Charles Willilam
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
: Richard F. Miller
I
i 106 Rolo Court
'Mechanicsburg, PA 17055
Brother
1,215.81
n.
. I
iEnter dollar amounts for distributions shown above on lines 15 through 17, as appropri~te, on Rev 1500 cover She~t
I NON-TAXABLE DISTRIBUTIONS: I
IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT I
I BEING MADE I
I
I
lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I Forever Caring Fund, Church of God Home
I 805 North Hanover Street, Carlisle, P A 17013
I
63.99
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
63.99
,
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEKENTL ALLOKANCE OR DISALLOKANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
C/
*'
RICHARD F MILLER
c/o 106 ROLO CT
MECHANICSBURG
'"
PA17055
" 'I.
REV-1548 EX AFP 112-00)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
07-16-2001
MILLER
12-07-2000
21 01-0144
CUMBERLAND
208-24-4591
011 02956
Amount Rellitted
CHARLES
W
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 ~
Rifv=is41i-EX--AFP--rl1f=ool------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-16-2001
ESTATE OF MILLER
CHARLES
W DATE OF DEATH 12-07-2000
CUMBERLAND
FILE NO. 21 01-0144
TAX RETURN WAS:
COUNTY
S.S/D.C. NO. 208-24-4591
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PENNSYLVANIA STATE BANK
ACN
01102956
ACCOUNT NO.
10403129
TYPE OF ACCOUNT: () SAVINGS (X> CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 10-05-1999
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
9,522.74
0.500
4,761.37
5,965.55
.00
.12
.00
X
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"" ( CRl, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
.00
.00
.00
.00
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHUGHART DALE F JR
35 EAST HIGH STREET
CARLISLE, PA 17013
h______ fold
ESTATE INFORMATION: SSN: 208-24-4591
FILE NUMBER: 21-2001-0144
DECEDENT NAME: MILLER CHARLES WILLIAM
DATE OF PAYMENT: 10/22/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/07/2000
NO. CD 000421
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,115.83
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: DALE F SHUGHART JR. ESQUIRE
CHECK#1014
SEAL
INITIALS: AC
RECEIVED BY:
$1,115.83
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
I (P - dtJ6 - I
BUREAU OF INDIVIDUAL TAXES
INHERITAN'"J;o TAX DIVISION
DEPT. 280601
HA~ISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
5t*
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-15~1 EX AFP (12-001
DALE F SHUGHART JR ESQ
STE 203
35 E HIGH ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-16-2001
MILLER
12-07-2000
21 01-0144
CUMBERLAND
101
CHARLES
W
Allount R_i tted
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4j-EX-AFP-fiz=ofir-NCificE--OF-YNHEiiiTANCE-YAX-APPRAisEMENT-,--AL'LOWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MILLER CHARLES W FILE NO. 21 01-0144 ACN 101 DATE 10-16-2001
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 1.560.00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion
4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 83,587.97 tax paYllent.
6. Jointly Owned Property (Schedule F) (6) 7,432.88
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 92,580.85
APPROVED DEDUCTIONS AND EXEMPTIONS: 16,216.00
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 1.569.00
11. Total Deductions (11) 17.7RIi 00
12. Net Value of Tax Return (12) 74,795.85
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 3,290.15
14. Net Value of Estate Subject to Tax (14) 71.505.70
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15) .00 X 00 = .00
16. Allount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00
17. Allount of Line 14 at Sibling rate (17) 69,945.70 X 12 = 8,393.48
18. Allount of Line 14 taxable at Collateral/Class B rate (18) 1,560.00 X 15 = 234.00
19. Principal Tax Due (19)= 8,627.48
TAX CR,"-nITS:
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
03-07-2001 AA478115 263.16 5,000.00
06-14-2001 AA496723 .00 2,263.18
INTEREST IS CHARGED THROUGH 10-31-2001 TOTAL TAX CREDIT 7,526.34
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1,101.14
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 14.69
TOTAL DUE 1,115.83
lIE IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
REV-1470 EX (6-88)
, * INHERITANCE TAX
. EXPLANA TION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME FILE NUMBER
Charles W. Miller 2101-0144
ACN
101
SCHEDULE ITEM EXPLANATION OF CHANGES
NO.
M The trust estate is subject to tax under Paragraoh 9 of the decedent's will because the primary
-'~~'A.-.,...._-...W'W~__V_~~"~~_'_~m..,..~.'n~"'m' ~~'~'~"C ,~~.~~-, W~
beneficiary did not survive for nine months after the decedent's death. The charitable
~,W~Nn_,'_w'~~_~'~,wm_.,_____,_~~_^~.^, '^V.~~~,_ <,"'-'^W_"-__'.'^'_',W,WNuuu "'~'~cucumm'__=~~'c'm__..~~
exemption has also been adjusted from $2,492.22 to $3,290.15.
o'__'m-.vmm^w,w'''"_'_'_'~c~''~w._~_~.v'm_~~.,___~,__.~".w~~~W._.'V "~'''~w.v____v'=',,~w_ '~'_"W"'W~W"_""'^W_,',m~c.w.._.~~.~,w
mW~_.Wm.W -~""'_"'''~<~_.~~.-__...._.,,,,,,<~c.w.v__,,.,..,, c,<w'w_m~m~~~ww,,' ~.~N,w'_^_.Vm'~~ .~
- --^'-~^_w.m_~"~V'_'W~'W~'-~""""_''''C~__~.V~-cuk'An'_"'="_'C'~ 'W-_"'~_~____W^ _'A_____n~~~_~~~__.,~=~_ ..
~~._.'^'.'.,~_~_,<~='~_.m.<...v 'A~__...,w, '^.~, ~~'-~ ,-
".'k,~__m n'_.w_^~^~" ~~m^____"~N,'m_'~~v -
V_W^"___V~'~_~~,,__~~ 'C""P~_~_~_c_'_n=~,_k_~ 'A'~"_mm_'-"'_'~~A___= "~'~__V~~'_____'___._A=.~__W__A_~
w.,~ V___=~'.~,'_~m'~~~ "-~--~~ -'_'__"..~N,__..n~~~__k -
'~'-~~-__^~U~-'_~_~,."_.V'_N~_'~ ,. W""'_~~~ ~"'_mN._,.,,~_,
'--'''-~'---~'^-~'-~~~~_W_~"'''Y'_~~_'_'''^''''_''''_'VN,'^ cv_m_'__V'_'V""~~"k"~^ -
w__._ ~~-.~.=.-.,-=~~ _N~___'m "
~V'~"C'W'~__~~_~v=~_<....~_.._._,~",=__,.,..,.,w."_,<.'W_'_ V_"_"N'~~"<A__W~ .-,,=""'-_____"..k_m~=~AV~=~_~
_~~mn_'m'..'.,"~~<._,~~,,',.~.< ,- ~ '_^~~'m,_._.._.~^ ww .. vc~m_.~w ,.
w,~_~.__~.,~c__'w_._..'..~~~,..~ _ "-___WA,. -'^".~ -
'--~-~--~~-----~"'~~~_-",',^-m'~~'___"~'~~'m_'A_'V^ _ '-"_"',."w'~~w__ '~~~"~~~vm_~~~__~.~ AW
"=-~----'~'~'_~",'~~~m~~~,^,~~,o.._, '^'w~, _V~~W~''''''k",~.'nm.'~=_ ..
_.,.....~~ -__~_.k~_<_n.~~~., 'v~'~"_V_k"'wc_v ,~^ , -,-,,~-~ ..
- y ..~..__.'.~~.,~~_w"_."'m"w< _A_ "._~..._..~~~~n ^....,_..~~,~.__,.,=w..._~~..m.'c~ ..
""'w -~~""__~"~_W"'_'._'^Y~ CV""'..'.".'._m_", .. ..~, -
PROBATE 121 JBA 0 DATE: 1 015101
TAX EXAMINER: Shawn E. Young
PAGE 1
/6-~t/R-, /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
~t*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
REY-IU7 EX AFP liZ-DOl
DALE F SHUGHART
STE 203
35 E HIGH ST
CARLISLE
Aecoraed Groce of DATE
Register of Wills ESTATE OF
DATE OF DEATH
.01 NOV 30 P 3 :20 ~~~~T~UMBER
ACN
11-26-2001
MILLER
12-07-2000
21 01-0144
CUMBERLAND
101
CHARLES
W
JR ESQ
Cterk-O'
PA 179~beriand
Court
Co., PA
Allount Rellitted
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 forll with your tax paYllent.
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
R'Ev=i6cfj-i3c--AFP-fi'2=ooY------...--fNifERi'i"-ANc'E--TA3c--sTAYEH'E-tiT-cfF'-Accouiif--.-..---------------------
ESTATE OF MILLER CHARLES W FILE NO. 21 01-0144 ACN 101 DATE 11-26-2001
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A SU""ARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAY"ENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-16-2001
PR I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
8.627.48
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-07-2001 AA478115 263.16 5.000.00
06-14-2001 AA496723 .00 2.263.18
10-22-2001 CDOO0421 12.24- 1.115.83
TOTAL TAX CREDIT 8.629.93
BALANCE OF TAX DUE 2.45CR
INTEREST AND PEN. .00
It IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE 2.45CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR).
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
0.
c;,t-
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Charles W. Miller
Date of Death: December 7, 2000
Estate No. 21-01-144
Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court
Rules, I report the following with respect to completion of the
administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d.
approvals of
Clerk of the
Copies of receipts, releases, joinders and
formal or informal accounts may be filed with the
Orphans' Court and may be attached t this report.
~~
Dale F. h
Supreme Court I. . 19373
35 East High Street, Suite 203
Carlisle, PA 17013
(717) 241-4311
Date:
2/19/02
o
f.'~
Attorney for Executor
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DALE F SHUGHART JR ESQUIRE
35 EAST HIGH STREET
CARLISLE, PA 17013
n___n_ fold
ESTATE INFORMATION: SSN: 208-24-4591
FILE NUMBER: 2101-0144
DECEDENT NAME: MILLER CHARLES WILLIAM
DA TE OF PAYMENT: 03/14/2002
POSTMARK DATE: 0010010000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/07/2000
NO. CD 000950
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $145.90
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: DALE F SHUGHART ESQUIRE
CHECK#1029
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$145.90
MARY C. LEWIS
REGISTER OF WILLS
"\., / 6 -c:;.c; R- I
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISIDN
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DALE F SHUGHARiO:aR ~Q 21
STE 203
35 E HIGH ST ,
CARLISLE (~\ 'nPA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-17-2002
MILLER
12-07-2000
21 01-0144
CUMBERLAND
101
:2
Allount Rellitted
'*
REY-1547 EX IFP 101-021
CHARLES
W
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 ~
REV=is4-j-i3f-AFP-foY:oZY-NOTici--OF-YNHiifiTANCE-TAX-A"PPRjrisiMENT~--AL1-oWANCE-(rR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MILLER CHARLES W FILE NO. 21 01-0144 ACN 101 DATE 06-17-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
.00
1, 294.80
.00
.00
.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
15.00
.00
(1lJ
(12)
(13)
(14)
NOTE: I~ an assessment was issued previously, lines
r~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
1,294.80
15 00
1,279.80
63.99
72,721.51
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
.00 X 045 =
71,161.51 X 12 =
1,560.00 X 15 =
(19)=
DATE
03-07-2001
06-14-2001
10-22-2001
03-14-2002
K~l.;~~"1
NUMBER
AA478115
AA496723
CD000421
CD000950
(+J
INTEREST/PEN PAID (-)
263.16
.00
.00
14.69-
AMOUNT PAID
5,000.00
2,263.18
1,115.83
145.90
BALANCE OF UNPAID INTEREST/PENALTV AS OF 03-15-2002 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
8,539.38
234.00
8,773.38
8,773.38
.00
3.01
3.01
( IF TOTAL DUE 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.)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 1712B-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DALE F SHUGHART JR ESQUIRE
35 EAST HIGH STREET
SUITE 203
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 208-24-4591
FILE NUMBER: 2101-0144
DECEDENT NAME: MILLER CHARLES WILLIAM
DATE OF PAYMENT: 07/08/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 12/07/2000
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: DALE F SHUGHART JR ESQUIRE
CHECK#1034
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 001381
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$3.06
$3.06
/6-020'. /
'v
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISIDN
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-li07 EX AFP lDl-D21
DALE F SHUGHART
STE 203
35 E HIGH ST
CARLISLE
, E'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-12-2002
MILLER
12-07-2000
21 01-0144
CUMBERLAND
101
CHARLES
w
JR ES'~!~
:(0
Allount Rellitted
PA (1(7!O~3
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 forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv.:i6'ifj-Ex-AFP--foY.:o2Y------...--iNirERI,.-ANci:--fAx-S,.;ffEHEtif-'ifF'-AC-couiff--.-..---------------------
ESTATE OF MILLER CHARLES W FILE NO. 21 01-0144 ACN 101 DATE 08-12-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE.
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-17-2002
P R I NCI PAL TAX DU E : ...........................................................................................................................................................................................................................
8.773.38
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
~~~ SUMMARY OF ~LL 005 PAYMENTS ~~~
07-08-2002 263.16 .00
07-08-2002 17 .70- 8.527.97
TOTAL TAX CREDIT 8.773.43
BALANCE OF TAX DUE .05CR
INTEREST AND PEN. .00
1lI IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .05CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE 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. )