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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANiA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
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Miller Dorian E.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
04/11/2005 09/13/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
D 4. limited Estate
D 6. Decedent Died Testate (AttachcopyofW~I)
D 9. litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death aftef 12-12-82)
D 7. Decedent Maintained a living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 3 7 5
""CciUNrvCOOE -YEAR- - - NuMiiER- -
SOCIAL SECURITY NUMBER
1 96- 1 4 - 3 1 9 0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Gerald J. Shekletski Es . 414 Bridge St.
FIRM NAME (If Applicable)
Stone Lafaver & Shekletski P.O. Box E
TELEPHONE NUMBER
717 774-7435 New Cumberland PA 17070
OFFICIAL USE ONLY
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
10. Debts of Decedent, Mortgage liabilities, & liens (Schedule i) (10)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/Sec 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
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _ (15)
142,764.97 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
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
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
5,373.90
765.84
149,130.04
155,269.78
12,504.81
(11)
(12)
(13)
12,504.81
142,764.97
(14)
142,764.97
Decedent's Complete Address:
STREET ADDRESS
30 South 24th St.
CITY I STATE I ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
6,424.42
321.22
Total Credits ( A + B + C )
(2)
321.22
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, A GENT
0.00
6,103.20
6,103.20
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 ofthe property transferred; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 1&1
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 1&1
3. Did decedent own an 'in trust fot"orpayable upon death bank account or security at his or her death? ................. 00 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 1&1
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
PA 17011
DATE
.-
.5
PA 17070
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. 99116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)).
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements fnr ,l;~~I~-. .-- ., , are still applicable even if
the surviving spouse is the only beneficiary. N
For dates of death on or after July 1, 2000: t\ P D
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or yc parent, an adoptive parent,
or a stepparent of the child is 0% [72 P .S. 99116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72
individual who has at least one parent in common with the decedent, whether by blood or adoption.
"T ~s.l
1.2) [72 P.S. 99116(a)(1)J.
der Section 9102, as an
LAST WILIJAND TESTAMENT
I, DORIAN E. MILLER, of the Borough of Camp Hill, in the
County of Cumberland and State of Pennsylvania, being of sound mind and
memoI)', do make, publish and declare this my Last Will and Testament, in
manner following that is to say:
First, I direct that all my just debts and funeral expenses be paid as
soon after my death as may be practicable.
I give, devise and bequeath my Baby Grand Piano to my grand-
daughter, Dorian I. Speed.
I give, devise and bequeath the sum ofTen Thousand ($10,000.00)
Dollars to each of my grandchildren, Dorian I. Speed, Allison E. Underhill,
Abby L. Swartz and Todd D. Swartz.
All the rest, residue and relJ1ainder of my estate I give, devise and
bequeath to my daughter, C~thy~. Swartz.
I hereby appoint my daughter, Cathy M. Swartz, to be the Executrix of
this my Last Will and Testament. In the event my daughter, Cathy M. Swartz,
should predecease me, I appoint my son-in-law, Michael E. Swartz, Executor
of this my Last Will and Testament.
In Witness Whereof, I have hereunto subscribed my name this c)l8.%if.
day of October, 2002.
~~r:m~
DORIAN E. MILLER
WE, whose names are hereunto subscribed, do certify that on the
c?S::ut Day of October, 2002, the Testatrix above named, subscribed her name
to this instrument in our presence and in the presence of each of us, and at the
same time, in our presence and hearing, declared the same to be her Last Will
and Testament, and requested us, and each of us, to sign our names thereto as
witnesses to the execution thereof, which we hereby do in the presence of the
Testatrix, and of each other, on the day of the date of the said Will, and write
opposite our names our respective places of residence.
~O%~~
Residingat ~. S. \~~ ~e:-+-..~H\\\
REV-1508 EX + (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miller. Dorian E.
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0375
ITEM
NUMBER
1.
DESCRIPTION
Yamaha grand piano, model G-2, E1508552.
Appraisal attached.
VALUE AT DATE
OF DEATH
5,373.90
TOTAL (Also enter on fine 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5.373.90
~
CUFF LESHER
Registered Piano Technldan
1217 Parle: Roed
Winfield, PennaylVallla17889
(570) 5~233 !e8her@jdweb.com
Inspection Findings. Yamaha grand. model G-2. E1508552:
Inspection date: April 29, 2005
Location: 30 S. 24th Street, Camp Hill, PA 17011 (Miller residence)
Manufacturer: Yamaha Piano Co., Hamamatsu, Japan, established in 1887.
Manufacturing date: 1972
Type: 57" grand piano, walnut finish
Pitchltension: Very close to standard pitch, within five cents.
Tone: Bright. Hammers should be filed and voiced to mellow tone.
Soundboard: Good. No discrepancies noted.
Bridges: Good. No discrepancies noted.
Pin block: Good. No discrepancies noted.
Trapwork (pedal mechanism): Good. Three pedals, center is sostenuto.
Dampers: Good. Damper lift 'even throughout scale. Damping is effective.
Action: Good. Moderately worn and dirty. Regulation is acceptable but not optimal.
Keys: Good. No overhang chips. Key bushings minimally worn. Keyboard plane
acceptable. '
Strings: Average. Some corrosion observed. All strings preseriCN'osplices or obvious
replacements.
Cabinetry: Case parts fit well.
Finish: Below average. Although the finish is free from major scratches and blemishes,
it is considerably faded. This is readily apparent against the unfadedlid areas protected
by the opened lid flap. On the positive side, the fading is fairly CQnsistent throughout.
Bench: Good. Sturdy. Upholstered top. Stain in comer of upholstery.
Summary:
This is a good, solid piano. It is in better than average condition for its 'age. Its one flaw
is its finish. Although the finish has been protected well from scratches and blemishes,
its faded condition detracts from the piano's value. However, this is only a cosmetic
shortcoming and if the lid flap is kept open, the fading is not apparent. Given a good
tuning, this piano will play well and sound quite nice. If the tone of the piano is too bright
for the player, I would recommend filing and voicing the hammers to calm it down some.
The piano should continue to perform well for years to come.
Today's Yamaha line has a comparable model, the C2. The suggested retail price of
this model, in walnut, is $25,590. I would expect a dealer in the central Pennsylvania
market to discount this price by as much as 30%, making the "real" price $17,913. This
price represents the replacement cost of your G2.
1
~
Inspection Findings. Yamaha. model G-2. E1508552. continued:
The present value of the piano is determined by a depredation schedule, which assigns
percentages based on age and condition of the piano. The percentage Is multiplied by
the replacement cost to arrive at present value. The assigned percentage in the case of
your G-2 is 300k. Therefore, the present value of the piano is 0.30 x $17.913 =
$5373.90
The following information may be of interest:
Moving: piano moves usually start at about $150 and the cost increases rapidly with
distance and difficulty. Fifty cents a mile is a typical mileage charge. Stairs will incur
extra charges ($5 per step is typical). Here are some experienced piano movers:
Keyboard Carriage, Elizabethtown, KY, 270-737-5797 - this is a company that
moves pianos allover the country. However, they will only move from dealer to
dealer. Therefore, you would have to work with dealers on each end of the move
to use this service.
Modem Piano Moving, Sullivan, MO, 800-737-5600 - this cross-country mover
has offices in MO, CA and VA. They will move home-ta-home.
O'Mara Meehan Piano Movers, Feasterville, PA, 800-938-0192 - I've seen these
guys at regional conventions and they seem pretty impressive. I don't know how
'far they go but since they're In PA, I thought I'd Indude them.
Piano service: I highly recommend using a Registered Piano Technician (APT) to
service and tune the piano. An APT has been certified by the Plana Technldans Guild
as having passed a series of tests proving one's general knowledge of pianos. skill at
tuning by ear, and performing effective repairs. Rates generally fall between $40 and
$60 per hour for repairs and regulation. Tunings range from $80 - $110 in this area.
Humidity-control systems: I highly recommend installing one of these systems in any
piano worth preserving; They stabilize the piano's wood. makingtunings last longer and ';',";'
protecting the plana's wooden components from stresses caused by humidity changes
through the seasons. It is my opinion that the life of a piano can be increased by a factor
of two with one of these systems installed and properly maintained. Installed cost in a
grand piano: $500 - $600.
I wish you the best with your piano situation. Please feel free to call if you have
questions or comments along the way.
~.
2
REV-1509 EX + (6-98)
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miller. Dorian E.
FILE NUMBER
21 05
0375
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Cathy M. Swartz
3 Eastgate Dr.
Camp Hill, PA 17011
Daughter
B
c
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTERES
1. A. 5/12/89 PNC Bank, N.A. checking account #514004337 1,531.67 50. 765.84
TOTAL (Also enter on line 6, Recapitulation) $ 765.84
T
(If more space is needed, insert additional sheets of the same size)
..JWI'1- .1.J-o:::.~~..;> o:::.~.;)~
iT'il,.tiHNK
412 768 3458
P. 01/1211
G PNCBAN<
June 13,2005
Gerald I, Shekletski
414 Bridge Street
P.O. Box E
New Cumberland, P A 17070
RE: Estate of Dorian E. Miller, deceased
SSN; 196-14-3190
DOD: 4/1112005
Dear Mr. Shekletski:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Account
Account #5140043371
Established 05/]211989
DORIAN E MILLER
CATHY M SWARTZ
DOD balance: $1,531.67 (non-interest bearing)
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings acc:ounts). We do not process aDY fioaDcial
transactions or provide statements. Jfyou need assistance with any of these itans,
please caU 1-888-PNC-BANJ< (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
&J~~
Rachelle Wells
] -800-762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
Member FDIC
TOTRL P.01
REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miller. Dorian E.
SCHEDULE G
INTER~VIVOS TRANSFERS &
MISC. NON~PROBA TE PROPERTY
FILE NUMBER
21 05
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
0375
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME Of THE TRANSFEREE. THEIR RELATIONSHIP TO OECEOENT ANO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE OATE Of TRANSFER. ATTACH A COPY Of THE OEEO FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLfI VALUE
1. Morgan Stanley Account 410-0182950024. 117,130.04 100. 0.00 117,130.04
Payable on death to Cathy M. Swartz
2 $11,000.00 gift to Todd D. Swartz on 3/3/05 11,000.00 100. 3,000.00 8,000.00
3 $11,000.00 gift to Abby L. Westhafer on 3/3/05 11,000.00 100. 3,000.00 8,000.00
4 $11.000.00 gift to Allison E. Underhill on 3/5/05 11,000.00 100. 3,000.00 8,000.00
5 $11,000.00 gift to William R. Westhafer on 3/5/05 11,000.00 100. 3,000.00 8,000.00
TOTAL (Also enter on line 7 Recapitulation) $ 149.130.04
(If more space is needed, insert additional sheets of the same size)
~
MorganStanley
4th and Walnut Streets
p.o. Box 12053
Hattisburg, PA 17101
toll-free 8006760673
tel 7172556666
fax 7172556651
Gerald J. Shekletski
Attorney At Law
414 Bridge Street
New Cumberland, PA 17070
April 25, 2005
Re: Account 410-018295-024 Date of Death Value
Mr. Shekletski,
Enclosed you will find the date of death information on the above referenced
account as of April 11,2005.
Thank you,
-V1)L!W tP.ed
Nicole Reviello
Registered Client Service Associate
"'I;l
MorganStanley
4th And Walnut Streets
P.O. Box 12053
Harrisburg, PA 17108
toll-free 800 676 0673
tel 7172556666
fax 7172556651
ACCOUNT 410 01829502401 RED FLAG:N 196-14-3190 OPERATIONS
DORIAN E MILLER TOD ACCT STATUS: 0 OPEN DATE: 2/22/79
CATHY M SWARTZ LAST TRADE: 3/22/05 LAST STMT: 5/31/05
ACATS FLAG: CLOSE DATE:
PREY ACCT: - NEW ACCT: -
**OTHER ACCOUNT INFORMATION** FED CODE:
CMDTY CREDIT LIMIT: 0??oo CMDTY CNTRCT LIMIT: 000
ALLY FOR INTEREST: 000 STATEMENT CONTROL: 0
MARGIN METHOD HNDLG: 0 CONFIRM CONTROL: 0
INTEREST HANDLING: 0 !NT HNDLG RATE: 0??oo
MAILING INSTRNS: 0 UNDELIVERABLE STMT: 0
CHOICE OVR TRD ALLOC: DATE OVR LMT:
PREY OVR LMT:
**NON-RESIDENT ALIEN INFORMATION**
BOND TAX RATE: DIVIDEND TAX RATE:
INTL ELlG:
*** OPERATIONS MEMOS ***
CATHY M SWARTZ IS AUTH CHKA SIGNER PER FAX RECD 6-16-99.
Dorian E Miller TOO Account 410-018295-024
Date of Death Account Value
Name Number of Shares close 4/11/05 Total Value:
Equities:
PLC Cap Trust V 6.125% 500 24.48 $12,240.00
Exelon Corp 300 46.37 $13,911.00
PPL Corp 200 54.21 $10,842.00
MRGN Stan Cap 117.25% 400 25.93 $10,372.00
Wachovia Corp 2nd New 800 50.93 $40,744.00
Petrofund Energy Tr 500 14.59 $7,295.00
Morgan Stanley Inc 734 15.48 $11,362.32
Name Number of Shares close 4/11/05 Total Value:
Fixed Income:
Firstbank Pr Fid 5.25% 10,000 95.365 $9,536.50
GNMA Pool 067905 6.4977 114.94 $746.85
GNMA Pool 38155 0.7338 109.53 $80.37
$117.130.04
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miller. Dorian E.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
05
0375
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Musselman Funeral Home & Cremation Services, Inc. 7,831.50
324 Hummell Ave., Camp Hill, PA 17011
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Stone Lafaver & Shekletski 3,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 248.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. The Patriot-News - Legal Advertising 113.61
8 Cumberland Law Journal - Legal Advertising 75.00
9 Cliff Lesher - piano appraisal fee 74.20
10 Funeral luncheon - Bricker House, Lemoyne, PA 632.50
11 Filing fee - inheritance tax return ($15.00) and personal inventory ($15.00) 30.00
THE PROBATE ESTATE IS INSOLVENT. CATHY M. SWARTZ HAS PAID
THE EXPENSES IN EXCESS OF THE VALUE OF THE PROBATE ESTATE.
TOTAL (Also enter on line 9, Recapitulation) $ 12.504.81
(If more space is needed, insert additional sheets of the same size)
R"."""".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
MillAr J( "ian E. 21 o&> 0375
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS Unclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Cathy M. Swartz Lineal 105,391.07
3 Eastgate Drive
Camp Hill, PA 17011
2 Todd D. Swartz lineal 8,000.00
3 Eastgate Drive
Camp Hill. PA 17011
3 Dorian I. Speed Lineal 5,373.90
150 Bishop Drive
Athens, GA 30606
4 Alison E. Underhill lineal 8,000.00
1751 Weatherburn Drive
New Cumberland, PA 17070
5 Abby L. Swartz. n/k1a Abby L. Westhafer Lineal 8,000.00
4194 Kittaninny Drive
Mechanicsburg, PA 17055
6 William R. Westhafer Lineal 8,000.00
4194 Kittaniny Drive
Mechanicsburg, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
..
(If more space IS needed, Insert additional sheets of the same size)
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Dorian E. Miller
No.21
05
0375
, Deceased
Date of Death4/11/2005
Social Security No. 196-14-3190
also known as
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 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 Decedent owned no
real estate outside 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 made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Gerald J. Shekletski, ESQ.
1.0. No.: 40486
Address: 414 Bridge St., P.O. Box E
New Cumberland
Telephone: )717) 774-7435
cafu~swa~cumx
Cd 1>>.~
Dated 6- / IJ - 115<
PA 17070
Description
1. Yamaha grand piano, model G-2, E1508552
Value
5,373.90
Total
(Attach Additional Sheets if necessary)
5,373.90
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX111-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHEKLETSKI GERALD J ESQ
P 0 BO X E
NEW CUMBERLAND, PA 17070
___~__n fold
ESTATE INFORMATION: SSN: 196-14-3140
FILE NUMBER: 2105-0375
DECEDENT NAME: MILLER DORIAN E
DATE OF PAYMENT: 06/30/2005
POSTMARK DATE: 06/30/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 04/11/2005
NO. CD 005506
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $6,103.20
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$6,103.20
REMARKS:
CHECK# 7882
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS