HomeMy WebLinkAbout10-09-81 (7)
REV-449 EX+ (9-80)
. COMMONWEAL TH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
STATEMENT OF
FIDUCIARY
(Instructions on Reverse Sid~)
Estate of
.Jacob H. Miller. Sr.
Church of God Home
801 Ilarrisburg Pike
Carlisle. PA 17013
Dote of Death
.January 13, 1 qg 1
Lost Address
Sociol Security No.
204-30-84g~
Stote Fi I e No.
(CITY)
(STATE)
(ZIP)
County File No.
21-78-121
1. Decedent died:
( ) Intestate (without 0 will)
(X) Testate (leaving 0 lost will--copy ottoched)
2. Is the filing of 0 Federal Estote Tax Return required for this estote?
Yes_ No X
3. (X) Executor
Nome
( ) Administrator
Gerald K. Morrison. Esquire
Social Security No.
Address Center Square
New Bloomfield
(el TY)
PA
170(,8
(ZIP)
(STATE)
4. All correspondence should be moiled to ( X) Attorney
Fiduciary.
5. If on attorney is representing the estate, indicote:
Nome
Robert R. Black
Telephone No. (717) 243-3727
Address 36 South Hanover Street
Carlisle
(CITY)
PA
(STATE)
17010
(ZIP)
List 011 safe deposit boxes registered in the decedent's individual nomehor jointly with, or os on agent or deputy
of another, or in decedent's individual nome with right of access by onot er os ogent or deputy. Include the nome
and address of the bonk or other institution where the safe deposit box is located, the nome (s) in which the box
is registered and the relationship of the joint holders to the decedent.
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION NAME OR NAMES IN WHICH RELATIONSHIP OF JOINT
IN WHICH DECEDENT MAINTAINED A SAFl: DEPOSIT BOX SAFE DEPOSIT BOX IS REGISTERED HOLOERS TO DECEDENT
None
Under penalties of perjury, I declore that I hove examined this return, including accompanying schedules and
statements, and to the best of my knowledge ond beHef i is true,correct ond complete.
l/ . A
~- (~-1.tL (d/2/ 'i//{t {tL.~'c'tDberc1 , 1981
DATE
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION
1. PERSONS RESPONSI BLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides that the following persons shall prepare and file
a return:
a. The personal representative of the estate of the decedent as to property of the decedent administered by him
and such additional property which is or may be subject to Inheritance Tax of which he/she shall have or
acquire knowledge;
b. The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute
including a trustee of property transferred in trust, provided that no separate return need be made by the transf~ree
of property included in the return of a personal representative.
2. PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills of the county wherein the decedent resided.
3. TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for filing has been applied for and
granted by the Secretary of Revenue within the nine-month period.
4. FAILURE TO FILE RETURN
Section 791 of the 1961 Statute provides that" . . .any person who willfully fails to file a return or other report
required of him. . .shall be personally liable. . .to a penalty of 25% of the tax ultimately found to be due or $1,000
whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by
law."
5. TAX RATES
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in-law and daughter-in-law and at the rate of 15% as to all others.
6. PAYMENT OF TAX
The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest
at the rate of 6% per annum accrues thereafter until payment is made. All payments received are first applied to any
interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED.
All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are
received subject to the final determination of the Department of Revenue.
7. FAILURE TO PAY
The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for against any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax.
8. FILING OF FALSE RETURN
Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or both.
NOTE: Compensation paid to an estate representative; namely, an executor or administrator, for services performed
in administering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income item should be
reported on form PA-40-lndividuallncome Tax Return.
.
:
LAST WILL AND TESTAMENT
OF
JACOB H. MILLER, SR.
I, JACOB H. MILLER, SR., of Silver Spring Township, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory, and
understanding, do hereby make, publish, and declare this my Last Will
and Testament, hereby expressly revoking all other writings in nature
testamentary by me at any time heretofore made.
FIRST: I direct that all my debts and funeral expenses be paid
as soon after my decease as may be practicable.
SI':COND: I horl'by 9ivo and boqueath tho uum of: ONg '1'1l0USJ\ND '1'WO
HUNDRED FIFTY DOLLARS ($1,250.00) to Saint Paul Evangelical Lutheran
Church, Wertzville Road, Hampden Township, Cumberland County, Pennsylvania.
THIRD: I hereby give and bequeath the sum of ONE THOUSAND TWO
HUNDRED FIFTY DOLLARS ($1,250.00) to Stone Hill Cemetery, Wertzville Road,
Hampden Township, Cumberland County, Pennsylvania.
FOURTH: I hereby give and bequeath the sum of ONE THOUSAND TWO
HUNDRED FIFTY.DOLLARS ($1,250.00) to Tressler Lutheran Home for Children,
Camp Hill, Pennsylvania.
FIFTH: I hereby give and bequeath the sum of ONE THOUSAND TWO
HUNDRED FIFTY DOLLARS ($1,250.00) to Elizabethtown Hospital for Children
and Youth, Elizabethtown, Pennsylvania.
SIXTH: I hereby give and bequeath the sum of ONE THOUSAND DOLLARS
J~J;c <I //17 tc !~ )A~AL)
JACOB H. MILLER, SR.
PAGE ONE OF TWO
,
?
. .
~
.,.
($1,000.00) to my friend, Grace Ryan, provided she survives me.
SEVENTH: I hereby give and bequeath my 1979 Buick Riveria to
Jennie Peters of R. D. #3, Duncannon, Pennsylvania.
EIGHTH: I hereby give, bequeath and devise all the rest and
residue of my estate and property, real, personal and mixed, of what-
soever nature and wheresoever situated, of which I may die seized or
possessed or to which I may be entitled or of which I may have the right
to dispose at the time of my death, absolutely and in fee simple as follows:
(a) 25% to my friend, Jennie Peters.
(b) 75% to my great grandchildren living on the date of my death.
NTN'1'1I1 I hpt'pby appoint GerRld 1<' MorriFlOIl of T,alldiFlhurq, P"IlI1Ayl-
VrtIlL" "nd Janll.Ja Pt,La:c.,; ot H. U. #3, LJuIIO"nllulI, t'allll.,;yJv,m.J<i, <II; l1IxaDl.I!-I):C1;
of this, my Last Will and Testament, and I direct that they shall not be
required to give bond or other security in any jurisdiction wherein
proceedings may be held in connection with my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 12th
day of May, 1980.,
~--t GUf
,
(;/27'
JACjlB H.
/' /
?" .- J/1'l2i/ld 7 Jfl
MILLER, SR.
(SEAL)
P/lr,p, 'T'WO OF' TWO
REV"450 EX+ (lo-ao)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
ESTATE OF
JACOB H HILLER SR
SCHEDULE "A"
REAL PROPERTY
(Instructions on Reverse Side)
c '-. ..
ITEM DESCRIPTION ESTIMATED DEPARTMENT
NO. MARKET VALUATION
VALUE rOFFICIAL USE ONL Yi
None
TOTAL -0- ~ ~
. . /T7.t.J
If add'lranal space IS necessary, use 8Y," x 11" sheets.
INSTRUCTIONS FOR COMPLETING SCHEDULE "A"
Schedule "A" should include a detailed description af all real property located in Pennsylvania
and held solely by the decedent ar held jointly with anather individual (s) as tenants in comman. List the
decedent's percentage of awnership and the estimated market value of the decedent's interest. (Praperty held
as jaint tenants with the right af survivorship ar tenants by entireties should be reported on Schedule "E".)
All real estate located in Pennsylvania shauld be described by lot and block number, street
address, number of acres and general description of land and buildings. Also, include the book and page
number in which the deed is recarded and the exact title as indicated on the deed. If the properly has been
sold, attach a copy af the settlement sheet. If the property is subject to a martgage encumbrance, include
the name of the mortgagee, date, rate of interest and the outstanding balance on the date af death and
attach a statement from the mortgagor verifying the autstanding balance.
Property taxes and interest an martgages as of the date of death, assessments and ather
encumbrances should be listed on Schedule "F". Do not deduct them on Schedule "A".
i "'~451 EX+ (8-80)
SCHEDULE "B"
PERSONALPROPERTV
COMMONWEALTH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
(Instructions on Reverse Side)
Estate of
JACOB H. MILLER, SR
I rEM
NO.
DESCRIPTION
UNIT
VALUE
1.
Cumberland Valley Cooperative Association,
Certificate No. 13271 for twenty-two (22) shares
of preferred stock @ $10.00. Patronage dividend
on said stock. 10.00
~brtgage given by the Mechanicsburg Club to
Jacob H. Miller dated April 27, 1978 and recorded
in Cumberland County Mortgage Book 640, page 344,
at 7-1/2% interest.
Principal Balance as of 1/13/81: $41,750.00
Accrued Interest as of 1/13/81: 111.54
See copy of First & Final Account of Commonwealth
National Bank, Guardian of the Estate of Jacob H.
Miller, attached hereto and marked Exhibit "A."
Cash and amounts temporarily invested in Common-
wealth National Bank Common Fund A-I:
Principal $58,968.25
Income 647.00
See Fxhibit "A," page 2.
Church of God Home: Refund of prepaid care
Church of (',od Home: Refund of prepaid care
Atlantic Breeders Co-Operative
Medicare Payment: F.S. Bryan, M.D.
Cumberland Valley Co-Operative Assn.: Dividend
Medicare Payment: K. Guistwite, M.D.
2.
3.
4.
5.
6.
7.
8.
9.
TOTAL
If additional space is necessary, use Sv," x 11" sheets.
----
ESTIMATED
MARKET
VALUE
DEPARTMENT
VALUATION
[OFFICIAL USE ONL Yl
220.00
69.16
41,861. 54
59,615.25
2,156.00
5.04
8.36
75.96
8.80
610.40
104,630.51
/c7 ~ 0'?,f!,7/
~
INSTRUCTIONS FOR COMPLETING SCHEDULE "8"
Schedule "B" must include all tangible and intangible personal property
owned individually by the decedent at the time of death. Property owned
jointly with another party or parties should be listed on Schedule "E" - - Jointly
Owned Property. Intangible personal property titled in the name of the decedent
but payable at death to another party or parties, including but not limited to
P. O. D. U. S. Savings Bonds and Tentative Trust Accounts, must be listed on
Schedule "B."
Tangible personal property should be listed first. Examples of tangible
personal property are jewelry, wearing apparel, household goods and furnishings,
books, paintings, automobiles, boats, snowmobiles, aircraft, etc.
Intangible personal property includes cash-on-hand and in the bank, stocks,
dividends, bonds, mortgages, treasury certificates, notes, tdgether with accrued
interest, salaries or wages, insurance payable to the estate or fiduciary in said
capacity, partnership interest, etc. An interest in any undistributed estate or
income from any property held in trust under the will or agreement of another
even though located outside of Pennsylvania at the time of death should be
listed on Schedule "B."
A completed Partnership Interest Report (REV-894) must be attached for
each partnership or joint venture, and a completed Closely Held Corporate Stock
Information Report (REV-893) must be attached for each closely-held business
interest or sole proprietorship reported on Schedule "B."
"
IN THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
No. 121 of 1978
ESTATE OF JACOB H. MILLER
FIRST AND FINAL ACCOUNT OF
THE COMMONWEALTH NATIONAL BANK, GUARDIAN
ACCOUNT STATED FROM OCTOBER 10, 1980 TO FEBRUARY 28, 1981
PRINCIPAL
SUMMARY AND INDEX
PAGES
Receipts
Net Gain/Loss on Conversions
Sub Total
Less Disbursements
Balance Before Distributions
Distributions to Ward
Investments
Capital Changes
Principal Balance Remaining
3
$104,275.14
-0-
104,275.14
3,555.89
100,719.25
3
4
$100,719.25
INCOME
Receipts
Less Disbursements
Balance Before Distributions
Less Distributions to Ward
Income Balance Remaining
Combined Balance Remaining
5
5
$ 8,089.24
7,442.24
647.00
647.00
$101,366.25
F'XllIBIT "A"
---
COMPOSITION OF NET BALANCES
PRINCIPAL
Mechanicsburg Mens Club Mortgage
22 shares Cumberland Valley Co-op Association
4% preferred
Cash and amounts temporarily invested in
Commonwealth National Bank Common Fund A-I
TOTAL PRINCIPAL
INCOME
Cash and amounts temporarily invested in
Commonwealth National Bank Common Fund A-I
TOTAL INCOME
TOTAL PRINCIPAL AND INCOME
2
--
Account Value as of
Value 02/28/81
$ 41,750.00 $ 41,750.00
1. 00 1. 00
58,968.25 58,968.25
100,719.25 100,719.25
647.00
647.00
$101,366.25
647.00
647.00
$101,366.25
PRINCIPAL RECEIPTS
Per inventory attached
Transferred from income
TOTAL PRINCIPAL RECEIPTS
CONVERSIONS INTO CASH NO GAIN/LOSS
11/19/80 16,013 units Commonwealth National Bank
Common Fund A-I
12/03/80 1,516 units Commonwealth National Bank
Common Fund A-I
12/04/80 200 units Commonwealth National Bank
Common Fund A-I
12/08/80 1,188 units Commonwealth National Bank
Common Fund A-I
12/10/80 425 units Commonwealth National Bank
12/31/80 Mechanicsburg Men's Club Mortgage
PRINCIPAL DISBURSEMENTS
10/20/80 Handy-Man Services - securing residence
door at R.D. #4 Mechanicsburg Pa.
12/02/80 Joseph G. Saxon, M.D. - professional services
12/02/80 MGM Pharmacy - ethical drugs
12/02/80 Carlisle Hospital - professional services
12/04/80 Holy Spirit Hospital - professional services
12/04/80 Church of God Home - institutional care
12/04/80 Kenneth R. Guistwite, M.D. - professional
services
12/08/80 Fishman & Hess - legal services
12/10/80 William A. Sulliven, M.D. - professional services
3
---
$100,477.64
3,797.50
$104,275.14
$ 16,013.00
1,516.00
200.00
1,188.00
425.00
41,750.00
$ 30.00
275.00
47.94
3.90
147.55
1,393.00
346.00
712.50
425.00
\ .'
Principal Disbursements (continued)
Reserves:
Robert L. O'Brien - attorney fee
Closing Cost
75.00
100.00
$ 3,555.89
TOTAL PRINCIPAL OISBURSEMENTS
PRINCIPAL INVESTMENTS
10/21/80 2,400 units Commonwealth Natioal Bank
Common Fund A-I
$ 2,400.00
13,613.00
16,200.00
528.00
41,750.00
3,994.00
11/03/80 13,613 units Commonwealth National Bank
Common Fund A-I
11/20/80 16,200 units Commonwealth National Bank
Common Fund A-I
12/31/80 528 units Commonwealth National Bank
Common Fund A-I
01/09/81 41,750 units Commonwealth National Bank
Common Fund A-I
01/26/81 3,994 units Commonwealth National Bank
Common Fund A-I
4
---
'.
.'
INCOME RECEIPTS
12/10/80 Medicare Claim Payment
$
106.72
Mechanicsburg Men's Club Mortgage
01/01/80 -
12/31/80 Interest
6,262.50
Social Security
11/11/80 -
01/09/80 Benefit payments
727.20
11/03/80 -
02/03/81 Earnings
TOTAL INCOME RECEIPTS
Commonwealth National Bank Common Fund A-I
992.82
$ 8,089.24
INCOME DISBURSEMENTS
10/10/80 Register of Wills - certified copy of guardian
appointment
$
2.50
11/18/80 Carlisle Camera Shop - film for pictures of
household contents, R.D. #4, Mechanicsburg Pa.
11/19/80 Chair City - purchase of recliner chair
for Jacob Miller
13.76
11/26/80 Seidle Memorial Hospital - professional services
11/26/80 Carlisle Hospital - professional services
01/12/81 Church of God Home - institutional care
253.34
17.50
9.70
2,748.00
103.29
01/14/81 MGM Pharmacy - ethical drugs
11/12/80 -
02/11/81 Commonwealth National Bank - compensation
on income
Transferred to Principal
496.65
3,797.50
$ 7,442.24
TOTAL INCOME DISBURSEMENTS
By:
5
---
,
'.
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
I, Robert K. Reitzel, Trust Manager of The Commonwealth National
Bank, accountant in the annexed Account, being duly sworn according to law,
depose and say that the foregoing Account is true and correct to the best of
my knowledge and belief.
By
Sworn to and subscribed before me
this ~ day of ~
A.D. 1981.
~~,~
Notary Pub] ic
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Inventory of the real and personal estate of
Jacob H. Mi 11 er
deceased.
Rea 1 Esta te
None
Tanqible Personal Property
1.
Household goods, sold at
496 00
:\;.:;t~Y'{
Intangible Personal Property
2. 22 shares Cumberland Valley Co-Op Association,
4% preferred
3. Mechanicsburg Mens Club Mortgage
4. Checking Account # 1421097468 with
The Commonwealth National Bank
Total Personalty
1 00
I 83,500 100
i
Ii 2,845 60
Ii
1113,613 168
!' 2135
I
i 100,477 ,64
[I I
I
I
i
5. Checking Account # 172-2032 with
First Bank and Trust Company of Mechanicsburg
6. Refund from Community Physicians Incorporated
-----
.~ .\,
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The Commonwealth National Bank
Robert K. Reitzel, Trust Manaqer
being duly sworn
l
J
By
55:
according to law, deposes and says that he
of the Estate of Jacob H.
Guardian
Miller
late of ' Cumberland County, Pa., deceased and that the
within is an inventory made by The Commonwealth National_ BanL ., the said quardian
of the entire estate of said decedent, consisting of all the personal propt!rty and real estate, except real estate outside
the Commonwealth. of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
~ ~3
~n-" ~
ROMAVN M. LINTNER, Notary PublIC
PENN TWP. CUM6(RLAM' COl'NfV
MY CDMMI3S\DN EiPmrs ~IOV. 12. 1~82
Me!'nb8r, P~nnc~'~I'ljl!) !1.~/;~c.~h!,)i1 c~ N(far~.,
19 81
sworn
and subscribed before me,
TiJe Commonweol1h Nationa! Bonk
1 N. Haflover St
'. /')'r~'~'.le, ~';'?Md'r...sJ J;','f'1
Date of Death
D.y
Month
Y..r
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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~EV~452 EX+ (8-S0)
'COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "C"
TRANSF E RS
Estate of
JACOB H. '!ILLER, SR.
INSTRUCTIONS:
1. Answer t:le questions on reverse side.
2. If the answer to any of the questions on the reverse side is "Yes," provide a description of the property transferred per
Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
relationship of transferres to decedent. Attach a copy of any trust, deed, or instrument relating to the transferred property.
ITEM
NO.
DESCRIPTION
ESTIMATED
MARKET VALUE
DEPT. VALUATION
[OFFICIAL USE ONL Yl
1.
Real estate transferred from William James Birtleand
Susan Agnes Birtle to Jacob H. Hiller and Naomi E. Fishel,
as joint tenants with right of survivorship, by Deed
dated June 4, 1979 and recorded in Cumberland County Deed
Book "M," Volume 28, page 140. This property was subse-
quently transferred by Jacob H. Miller, Widower, and Naomi
E. Fishel, a married woman, to Naomi E. Fishel, a married
woman, by Deed dated August 6, 1979 and recorded in Cumber
land County Deed Book "P," Volume 28, page 600
41,000.00
TOTAL
4l,ono.00
'7'11-# t"tJ
..d~
If additional space IS necessary, use By," x 11" sheets.
---
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".) Yes
2. Did decedent, within two years of death, transfer property from himself/ herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) ..1:!0....-
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a. Age of decedent at time of transfer.
b. Copy of death certi fi cate.
c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nontaxability of transfer.
4. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) '10
a. Was there any possibility that the property transferred might return to transferor or his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No".)
b. What was the transferee's age at time of decedent's death?
5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her
death:
a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".) No
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".) No
6. If the answer to five b. above is "Yes," was the right reserved in decedent alone ( ) or decedent and others ( ).
7. Did decedent in hiS/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) No
8. Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) No
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone ( ) or decedent and others ( ).
R~tI-453. E~+ (IO-BO)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "0"
BENEFICIARIES
(Instructions on Reverse Side)
Estate of
JACOB H. 'lILLER. SR.
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
St. Paul Evan~elical Lutheran None Yes h_ Bequest - $1,250.00
..
Church 6839 Wertzville Rd.,
Enola, PA 17025
Stone Hill Cemetery, 6839 Wertz- None Yes _h Bequest - $1,250.00
"ill" Road Enola PA 17025
Tressler Lutheran Home for Child- None Yes - -- Beauest - $1.250.00
ren 2331 Narket Street,
Camn Hill. PA 17011
Elizabethtown Hospital for Child- None Yes - -- Bequest - $1,250.00
r"n F. 1"1 i P6
170220710
Grace Rvan a/k/a Helen Grace None Yes h_ 1]couest - ~l,oon.no
D""n Bnx 47 Glendale Drive
~1echanicsburg, PA 17055
,Jennie Peters Toland None Yes - - 25% of Residue
R.T). 3, TJuncannon, PA 17020
Jason H. Vonhauser, 841 Hummel Great-Grandchild Yes 4/17/77 18.75* of Residue
Avenue. Lemovne PA 1704.3 .- ---- ---- -----
Jared M. Vonhauser. 841 Hummel
Avenue Lemovne PA 17043 Great Grandchild Yes 51 8/79 18.75% of Residue
Sue Ellen Miller clo Donnie G. Great-Grandchild Yes 5/1 \/oe) 18.75% of Residue
Miller, 1013 Allen Street, New
Cumberland, PA 17070
l.Amv Marie t1iller, c/o William A. Great-Grandchild Yes 5/21/77 18.75% of Residue
Miller R.D. 1, Box 500,
Ten'" P6 17ndn
rhe above beneficiaries were living at the time of the decedent's death except for the following:
NAME
DATE OF DEATH
f additional space is necessary, use 8Y.z" x 11" sheets.
INSTRUCTIONS FOR SCHEDULE "0"
1. List full names and addresses of all who have an interest in the estate
either vested, contingent or other interest.
2. I ndicate the beneficiary's relationship to the decedent. Specify if
stepchildren or illegitimate children are involved.
3. Indicate "Yes" if the beneficiary survived the decedent or "No"
if the beneficiary did not survive the decedent.
4. Indicate the date of birth of the beneficiary if the interest is a life
interest, term certain interest or a future interest.
5. Indicate the interest of the beneficiary in the decedent's estate.
For example: Specific bequests of a diamond ring, savings bonds
or cash of $5,000; bequest of 25% of residue; remainder interest; etc.
6. At the bottom of Schedule "D", state those beneficiaries who were
not living at the time of the decedent's death and include the date
of death of the beneficiary.
l' ...
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. ........I.L Hi Of PENNSYLV.NIA
.'rARTMINT Of REVENUE
TUHSFfR iHHf~IT~N<:E TAX
tUIOEH1. DECEDENT
sCHEDuLE "E"
JOINTL Y OWNED rROPERTY
I/nnrucrion. on R""fNfIIJ Side)
. I ~\\,
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Emt. of
JACOB H. MILLRR. SR.
DESCR
TOTAL FE VALUIOf DIPUnllDlT
.
IPTIOM MARKET C DICIDINT'S VALUATION
VALUE I INTlIIST {OffICIAL un ONL Y.
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TOTAL
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4.
"~F".;~>,~,1,T, u~e 8IS" " 11" sheets.
-----
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included. List real estate first.
1. Describe all real property as indicated in the instructions for Schedule "A." Describe all personal property
as indicated in the instructions for Schedule "B." Include the name, address and relationship to the
decedent of the co-owner[s] and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest.
4. Indicate the market value of the decedent's interest.
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NOTICE OF FILING OF APPRAISEMENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
Mr. Gerald K. Morrison
Center Square
New Bloomfield, PA 17068
RE: Estate of
County of
File No.
JacobH. Miller, Sr.
Cumberland
21-78-0121
Dear Mr. Morrisonl
You are hereby notified that the original
appraisement in the estate of Jacob H. Miller, Sr.
has been filed in the office of the Register of Wills of rllmnp1"l ~nil
County an November 16 , 19 81. Said appraisement reflects the fallowing valuations:
Real Estate $ None
Personal Property 104,630.51
Jointly Owned None
Transfers 41.000.00
Total $ 145,630.51
As to such tax that is paid within three months from date of death, a five (5%) percent
discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months
when death occurred from December 22,1965 to June 16, 1971, inclusive; and twelve months when
death occurred prior to December 22, 1965) from date of death, interest at the rate of six (6%) percent
per annum is charged.
Any party in interest who is aggrieved by this notice may abject thereto within sixty days
after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Date
November 16, 1981
Signed
~~xJ~
Title Chief Appraiser
NOTE: This is not a bill.
----
REV-484 EX+ (5-80)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
[j] Original
o Supplemental
o Remainder
File Number
21-78-0121
Estate Name
Jacob H. Miller, Sr.
Date af Death
January 13, 1981
Social Security Number
204-30-8483
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing
return at the values set forth opposite each item in the last column to the right in Sc dules "AU, uBu, "C", and liE"
'"
Dated:
November 16, 1981
AISER
ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Real Property (Schedule A) $ Nnnp 00+ 92+
Personal Property (Schedule B) 104,630 51 to+
Jolnt.Held Property (Schedule E) None m+
Transfers (Schedule C) 41,000 00 30+
TOT AL GROSS ASSETS $ 145,630 51
Less Debts and Deductions 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate
o Annuity
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONLY
s;QQ[
COMPUTATION OF TAX
$
$
$
$
$
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Tax on $
6%
T ax on $
15%
Tax on $
Tax on $
T ax on $
Exemptions
Totol Estate
Less Credits
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT INTEREST
+ $ $ =
+ =
BALANCE $
TO $
S
TAX CREDIT
S
$
INTEREST FROM
BALANCE DUE
.
QORIGINAL
o SUPPLEMENTAL
REV"'457 EX+ (7-80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
Estate af
Jacob H. Miller, Sr.
File Na.
21-78-0121
Caun ty
Cumberland
Date af Death
January 13, 1981
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the
expiration of any estate for life Dr for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral tate on any such future interest.
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
ASS.!:T SUMMARY, DEPARTMENT'S
APPRAISED VALUE
1. Total Real Property - SCH. "A". . . . .. $ None Unreported $ $ None
2. Total Personal Property - SCH. "B". . . . $ 104,630.51 Unreported $ $ 104,630.51
3. Total Jointly Owned Property - SCH. "E" $ None Unreported $ $ None
4. Total Transfers _ SCH. ItCt!. . 0" . . . . '$ 41.,000.00 Unreported $ $ 41,000.00
TOT AL GROSS ASSETS $ 145,630.51
o LIFE ESTATE DANNUITY DREMAINDER
TOTAL VALUE $
I do hereby certify that the abave appraisement is made in con~formit with Pennsylvania law and has been filed this
day with the Register af Wills. ~
~ ~?!2 November 16, 1981
APPR R DATE
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