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HomeMy WebLinkAbout05-12-06 t<t:V-10UU t:.A. + {b-UUJ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER .li 05 DECEDENT'S NAME (LAST FIRST. AND MIDDLE INITIAL) I- Z W o w u w o Miller, William Phillip DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 09-22-2005 08-20-1930 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) w ... >::~(/) Ua:>:: wa.U ::J:OO Ua:..J a.aJ a. <t x 1, Onglnal Return 2. Supplemental Return 00872 COUNTY CODE YEAR SOCIAL SECURITY NUMBER NUMBER 168-26-2963 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 3. Remainder Return (date of death pilar to 12-13-82) x 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 4a. Future Interest Compromise (date of death after 12-12-82) 7 Decedent Maintained a Living Trust (Attach copy of Trust) 10 Spousal Povertv Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes 4. Limited Estate 5. Federal Estate Tax Return ReqUIred 11 Election to tax under Sec. 9113(A) (Attach Sch 0) ... z w o z o a. (/) w a: a: o U :I1:I!.S2SI:C,.lgl'4l\1lUSl"~I:C_Ol\ll",tE"I:D,AtL CO~RE.SP9NDENCE/>,t:I[)i(39NFIDENTI/>,LTAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Jan M. Wiley FIRM NAME (If applicable) Wiley, Lenox, Colgan, & Marzzacco, P.C. TELEPHONE NUMBER 717 -432-9666 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) z 6, Jointly Owned Property (Schedule F) ~ Separate Billing Requested :s 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~ (Schedule G or L) Separate Billing Requested ~ 8. Total Gross Assets (total Lines 1-7) ~ 9, Funeral Expenses & Administrative Costs (Schedule H) 0:: 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11 Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 130 W. Church St Dillsburg, PA 17019 (1 ) 60,504.59 (2) None (3) None (4) None (5) 7,361.15 (6) None (7) 774.78 (8) 68,640.52 (9) 16,475.59 (10) 660.10 (11 ) 17,135.69 51,504.83 0.00 (12) 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) (13) (14) 51,504.83 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 2,317.72 0.00 0.00 2,317.72 20, D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURI: lOANSWER ALL QUI:STIONS ON REVI:RSE SIDE AND RECHECK MATH << Copyright 2002 form software only The Lackner Group, Inc. 15,Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 0 (16) j:: 16, Amount of Line 14 taxable at lineal rate 51,504.83 x .045 <I: I- ::l a. 17,Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :i: 0 u 18, Amount of Line 14 taxable at collateral rate 0.00 .15 (18) >< x <I: I- 19, Tax Due (19) Form REV-1500 EX (Rev. 6-~0"><..~' , ~' ~/}) ~/ Decedent's Complete Address: STREET ADDRESS 525 Boslar Avenue CITY Lemoyne STATE PA ZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1,710.00 90.00 Total Credits (A + B + C) 3. Interest/Penalty if applicable D. Interest E Penalty Total Interest/Penalty (0 + 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 + 5A. This is the BALANCE DUE Make Check Payable to: REGISTER OF WILLS, AGENT (1 ) 2,317.72 (2) 1,800.00 (3) (4) (5) 517.72 (5A) (5B) 517.72 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;" ' x b. retain the right to designate who shall use the property transferred or its income;"". x c. retain a reversionary interest; or""" x d, receive the promise for life of either payments, benefits or care? x 2, If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?" x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? x 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 pe~ury, f declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief. It is true, correct and con:tple_te. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ~bert C. Miller . (SIts-~'"6;t~~RE~~;-c!r~~;-;RETURN ADDRESS W': 0' ""l4;t":,kdb,,, ""'" n M. Wiley 2193 County Line Road Dillsburg, PA 17019 130 W, Church St Dillsburg, PA 17019 x DATE s/' 0 I 0 (. DATE ,-j'D/()~ ... /' DA~E 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 PS. S9116 (a) (1.1) (i)l. 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, S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary, For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 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 PS, S9116 (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 45%, except as noted in 72 PS S9116 1,2) [72 PS S9116 (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, S9116 (a) (1.3)], A sibling is rl~fined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption, fuast lIill ann ID.rsmm.rnt OF WILLIAM PHILLIP MILLER BE IT REMEMBERED, that I, WILLIAM PHILLIP MILLER, of 525 Bosler Avenue, Lemoyne, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my three children, WILLIAM P. MILLER, JR., ROBERT C. MILLER and BARBARA J. UNDERKOFFLER, in equal shares, per stirpes. ITEM 3: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force fN~~)1{~SEAL) WILLIAM PHILLIP MILLER -1- or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 4: I appoint my son, ROBERT C. MILLER, as Executor of this my Last will and Testament. Should my son, .Robert C. Miller, predecease me, fail to qualify, cease to act or renounce probate, I then appoint my son, WILLIAM P. MILLER, JR., as alternate Executor of this my Last Will and Testament. ITEM 5: I direct that my Executor or his successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ///}Jday of ()et:Ju,D , 2000. ~. uJ /? l/{1.k-'U-'~ ~~ft~SEAL) WILLIAM PHILL P MILLER -2- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We, WILLIAM PHILLIP MILLER, JAN M. WILEY, ESQUIRE and SHAWNA L. VARNER, the Testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed this Last will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ~~efrtM'~ ~~ Q..v\ n-., c.J: SS Sworn to and subscribed before me this //~ day of Oc-b)fu.o , 2000. s J)/J1Ml JutLdf €ful NOTARY PUBLIC MY COMMISSION EXPIRES: Rev.150Z EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Miller, William Phillip FILE NUMBER 21-05-00872 ESTATE OF All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Sale of property situate at 525 Bosler Ave., Lemoyne, PA: 60,000.00 2 Tax Proration due estate from sale of 525 Bosler Ave., Lemoyne, PA: 504.59 TOTAL (Also enter on Line 1, Recapitulation) 60.504.59 (If more space is needed, additional pages of the same size) Copyright (cl 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) ,u --..-... -. . '___"'1:1""""" .....'UCll. L.lcvt:IUplllt::/H UIVll;j NO. ,OU"::-U.lOO B. Tv~'e of Loan 1. FHA 2. FMHA 3. Cony. Unlns 6. File Number 7. Loan Number: 4. JA 5. Conv. Ins. 1222-05 MartQage Insurance Case Number. C. Note: thIs form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown, Items marked "(p.D.C.)" were paid outside the closing; they are shown here for information ourooses and are not included in the totals. D. Name/Address of Borrower: PATRICK A. AND PAULA M. MCCARTHY 83 KELLY DRIVE, CARLISLE PA E. Name/Address of Seller: THE ESTATE OF WILLIAM PHILLIP MILLER F. Name/Address of Lender: FIRST NATIONAL BANK OF MARYSVILLE 101 LINCOLN STREET MARYSVILLE, PA 17053 " G. Property Location: Settlement Agent: Arthur M. Feld, Esquire 525 BOSLER AVENUE LEMOYNE PA 1309 Bridge St., New Cumberiand, PA 17070 TIN: 23-2582769 Date of Settlement NOVEMBER 30, 2005 J. SUMMARY OF BORROWER'S TRANSACTION SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract Sales Price 60,000.00 401. Contract' Sales Price 60,000.00 102. Personal Prooertv 402. Personal Prooerty 103. Settlement charqe to borrower (Line 1400) 2,219.50 403.00 104.00 404.00 105.00 405.00 Ad'ustments for items paid by seller in advance Adjustments for items paid by seller in advance 106. City/town taxes 406. City/lown taxes 107 County Taxes 11/30/05-12/31/05 27.59 407. Countv taxes 11/30/05-12/31/05 27.59 108. SchoolTaxes 11/30/05-06/30/06 477.00 408. School Taxes 11/30/05-06/30/06 477.00 109. Refuse 409. Refuse 110.Waler 410. Water 111. Sewer 411. Sewer 112.00 412 120. GROSS AMOUNT OUE FROM BORROWER 62.724.09 420. GROSS AMOUNT DUE TO SELLER 60.504.59 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 6,000.00 501. Excess Deposit (see instructions) 202. Principal amount of new loan s) DISBURSE 62,724.09 502. Settlement charges to seller (line 610.00 $85,000. 00 NEW MGT AMOUNT 1400 203. Existinq loan(s taken sub'ect to 503. Existina loan(s taken subject to 204.00 504. Payoff of 1st Mortoaoe Loan 205.00 505. Payoff of 2nd Mortgage Loan 206.00 506.00 207.00 507.00 ADJUSTMENTS FOR ITEMS UNPAID BY SELLER ADJUSTMENTS FOR ITEMS UNPAID BY SELLER 21 O.City/town taxes 510. Cltvltown taxes 211. County laxes 511. County taxes 212. Assessments 512. Assessments 213. School Taxes 513. School Taxes 214. Refuse 514. Refuse 215. Waler 515. Water 216. Sewer 516. Sewer 217.00 517.00 218.00 518.00 219.00 519.00 220. TOTAL PAID BY/FOR BORROWER 68,724.09 520. TOTAL REDUCTIONS IN AMOUNT DUE 610.00 SELLER 300. CASH AT SETTLEMENT FROMrrO BORROWER 600. CASH AT SETTLEMENT TO/FROM SELLER 301. Gross amount due from borrower 62.724.09 601, Gross amount due to seller (line 60,504.59 (line 120 420) 302. Less amounts oaid by/for borrower 68,724.09 602. Less reductions in amount due 610.00 line 220 seller line 520) 303. CASH X)From TO Borrower 6,000.00 603. CASH ( FROM TO (X SELLER 59,894.59 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein Is Important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanctIon wHl be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales price described on line 401 above constitutes the Gross Proceeds of this transaction. SELLER INSTRUCTIONS: 111his real eslate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 andlor Schedule D (Form 1040) You are reqUired by law to provide Arthur M. Feld, Esquire with your correct taxpayer identification number. If you do not provide your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law, and Under penalties of pe~ury. I certify that the number shown on the additional documents signed at settlement is my correct taxpayer identification number. Seller #1 Buyer #1 Seller #2 Buyer #2 7to:T()TAi:'SA~E~/B~;;KiR'S COMMISSION BASED ON PRICE $ PAID FROM PAID FROM AI' %= BORROWER'~ SELLER'S Division of Commission line 700) as follows: FUNDS AT FUNDS AT 701. $ to SETTLEMENT SETTLEMENT 702. $ to 703. Commission paid at Settlement (Money retained by broker applied to commission 1$ I 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori jnatlon Fee $ 1/2 % First National Bank of Marvsville 425.00 802. Loan Discount % 803. ADDraisal Fee $ to First National Bank of Marvsville 325.00 804. Credit Report to 805. Broker Fee to 806. Tax Service Fee to 807. Processing Fee to 808. Courier Fee to 809. Flood Cert. To 810. Yield Spread to Broker 811. Admin Fee to 812 ADDlicatlon Fee $ to First National Bank of Marvsville 150.00 813.00 814.00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from to @ $ Idav 902.00 903.00 . 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance months $ oer month 1002. Mortoaoe insurance months $ per month 1003. City Dropertv taxes months $ oer month 1004. County property taxes months $ oer month 1005. School taxes months $ per month 1100. TITLE CHARGES 1101. Settlement Fee 1102. Title Examination to 1103. Document Preparation to 1104. Notary Fees cash 10.00 10.00 1105. Attomevs Fees to Arthur M. Feld 625.00 1106 Titie Insurance 1107. Endorsements 100/300/8.1 to 1108, Lender'S Coveraae $ 1109. Owner's Coverage $ 1110, Settlement X office to 1111. Extra Cooies to 1112. Recordino to 1113 Closina Service Letter fee to 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $40.00 ; Mortgage $44.50 ; Release $ 84.50 1202. City/county tax/stamos Deed $ 600.00 Mortaaae $ 600.00 1203. State Tax Stamos: Oeed $ 600.00 Mortaaae $ 600.00 1204.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survev to 1302. Pestlnsoection to 1303. Overni ht Fee 1304. Pav-off to 1305.00 1306.00 1307.00 1308.00 1309.00 1400. TOTAL SETTLEMENT CHARGES lenter on lines 103 and 502 2,219.50 610.00 I have carefully reviewed the HUD~1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. Borrower#~ ~ tC. Borrower #1 ?c;t.../. M, f'Y1lC"---d AA. ~~ seller#J<~ c... Nu.H tv-. c;. ,V~C Seller #2 To the best of my knowledge, the HUD_1 Settlement Statement which I have prepared is a true and accurate account of the funds which were r~and have bee~:bursed by the undersigned as part of the settlement of thiS transaction. ~ A Arthur M, Feld _ Settlement Agent , KeV.loUlS t:A.T lb-tflS) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Miller, William Phillip FILE NUMBER 21-05-00872 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1993 Chevrolet Cavalier (Fair condition): 450.00 2 Haar's Auction (sale of personal property): 408.90 3 Homeowners Insurance, Oil, other misc. Refunds: 951.02 4 PNC Bank Checking Account #5003506464: 2.355.09 5 PNC Bank Savings Account #5003509198: 3.025.77 6 State Farm & Patriot News Refunds: 170.37 TOTAL (Also enter on Line 5, Recapitulation) 7.361.15 (If more space is needed, additional pages of the same size) Copyriqht (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) NOV-09-2005 21:52 PNCl:3RNK 41~ '(bt:! ::>458 P.01/01 ~ PNCBAN< November 10,2005 S. Dawn Gladfelter 130 W. Church Street, Suite 100 DilIsburg, P A 17019 RE: Estate of William Philip Miller, Sr., deceased SSN: 168-26-2963 000: 9/22/2005 Dear Ms. Gladfelter: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5003506464 Established 10/23/2000 WILLIAM P MILLER DOD balance: $2,355.09 (non-interest bearing) Savings Account Account #5003509198 Established 10/23/2000 WILLIAM P MILLER DOD balance: $3,025.59 + $.18 accrued interest Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any tinancial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, MnnhnOoll ~ ~c~W~ 1-800-762-1775 P7-PFSC-04-F 500 first A v\::. Pittsburgh PA 15219 Member FDIC - "-- --- -- - TnTAI P_Vl1 (/) tD iT> n .... tD C. (/) .... Ql j 0.. Ql .., C. m .c "8 c: ~ "Cl ~ 3 o tD o j o .... -0)> o -. ~ -, (1)n ""' 0 (f)R rt __ (1) rt (1) o' :::!. :J :J -- to :J to r o n ^ (J) )> z --.... II Z (f) ...... CD , CD o ~O-4m < .., "':::l .... - -. OJ \C ,.. <D < :::l _. :T OJ<DlI':::l n ~ @ 3 ~ tD :::l ~ C o tD :::l Er ~ -n ~~ o o o o )>..,. C I ......n o -< :3 - OJ N ...... n N c: ...... ro , CIl .~.'." .~""""""';""""'I >< ............................1 CJ\ -.............I. .... '.' .' . ~ rT1 .~ :-'---'--.'W' V"\ .. ... r- (/) CIl tD .... tu -< .., n 0 :T c: r- .., 0 (/) n ('ll Ql C. Ql r- (') j CIl ::J ." .... QJ 0 j :J .., \Q 1.O CD (/) CIl m Ql .D ('ll C u :3 CD :J .-r '; ." OJ .., ~ o '0 c. m n x 0 n :l m c. """'" """" ,..,. ., m -. j 0 M' j ,....-., (f) < Q.~ -~ ~ OJ ~ ~ ~ 00 - ...... U1 0 ~~1 C CD 0.. 0 0 0 m r;:;o t"""" e- m ~ ""l;j ~ < ~ ~ m -.;j :;c.o ~ ~'-<1 -< ~ ::p.. r-' c::: m -i .. OJ Q. 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NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Miller, William Phillip FILE NUMBER 21-05-00872 ESTATE OF 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 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH TAXABLE % OF DECD'S EXCLUSION NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE 1 Office of Personnel Management (Amount of 774.78 77 4. 78 remaining pension): TOTAL (Also enter on Line 7, Recapitulation) 774.78 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, William Phillip FILE NUMBER 21-05-00872 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT See continuation schedule(s) attached 10,315.00 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions B. Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Wiley, Lenox, Colgan, & Marzzacco, P.C. 3,500.00 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 Register of Wills: 256.00 5. Accountant's Fees 6. Tax Return Preparer's Fees H&R Block: 53.00 7. Other Administrative Costs 2,351.59 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 16,475.59 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, William Phillip FILE NUMBER 21-05-00872 ITEM NUMBER DESCRIPTION AMOUNT 1 Gingrich Memorials: 3.300.00 2 Musselman Funeral Home: 7.015.00 Subtotal 10.315.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev 6-98) rteV--lou", t:^'t" \lJ;-~UJ SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, William Phillip FILE NUMBER 21-05-00872 ITEM NUMBER DESCRIPTION AMOUNT 1 Bill Miller (cleanup): 300.00 2 Closing costs from sale of real estate situate at 525 Bosler Ave, Lemoyne, PA: 610.00 3 Creedy's Hauling (cleanup): 300.00 4 Cumberland County Legal Record (advertise): 75.00 5 Hardy Auction Service (cleanup, commission): 895.90 6 PNC Bank (estate checks): 17.44 7 Register of Wills (additional short certificates): 8.00 8 Register of Wills (filing fee): 30.00 9 The Sentinel (advertise): 115.25 Subtotal 2.351.59 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev 6-98) Kev-1512 t:.X+ (6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA JNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, William Phillip FILE NUMBER 21-05-00872 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Lemoyne Borough: 2 PA American Water: 3 PNC Bank (Mastercard): 4 PP&L: 5 UGI: 6 Verizon: VALUE AT DATE OF DEATH 96.00 83.13 320.54 48.86 71.93 39.64 TOTAL (Also enter on Line 10, Recapitulation) 660.10 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) , SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Miller, William Phillip 21-05-00872 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) I. TAXABLE DISTRiBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 William P. Miller, Jr. Son one-third 2915 George St. Harrisburg, PA 17109 2 Robert C. Miller Son one-third 2193 County Line Road Dillsburg, PA 17019 3 Barbara J. Underkoffler Daughter one-third 2001 Sheepford Road Mechanicsburg, PA 17055 Total 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule J (Rev. 6-98) In the Court of Common Pleas of Cumberland County, Pennsylvania IN RE: ORPHANS' COURT DIVISION Estate of William Phillip Miller NO. 21-05-00872 Status Report Under Rule 6.12 Name of Decedent: William Phillip Miller Date of Death: 9/22/2005 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. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. 5 -(0 '-6~' //~ //1 I 1__' }/l"{ Signatur//\ . . Name: ~ian M. Wiley Address: 130 W. Church St. , ') ii L,.-' A~'i Date: Dillsburg, PA 17019 717-432-9666 ...n. ''00 ~-~ ' , (, i i'-" Telephone: Capacity: Personal Representative X Counsel for Personal Representative rC',:. ,{;\:I} Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of William Phillip Miller No. Date of Death ~J -CS-CC<fJ<1 ~ 09/22/2005 also known as William P. Miller, Sr. , Deceased Social Security No. 168-26-2963 Robert C. 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. IlWe verify that the statements made in this Inventory are true and c-er.rect. IlWe understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section4904 relating to unsworn falsification to authorities. / ; ""--- M.--. ~ ~ J~n M. Wiley I '6298 I Personal Representative ~f) Signature: l,,~~ Co V\;\.,,--,tC,--. Robert C. Miller Signature: Wiley, Lenox, Colgan, & Marzzacco, Firm: P.C. Signature: Address: 130 W. Church St Dillsburg, PA 17019 Telephone: 717 -432-9666 Address: 2193 County Line Road Dillsburg, PA 17019 Telephone: 717-432-8283 Dated: 5' l () 00 Personal Property Cas h n............................................................................................. Miscellaneous Property................................................................ Stocks/Listed.... .............. ...... ............... .......................................... Stocks/Closely Held ..... ..... ...... ... ................................ ......... ..... ..... Bonds............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receiva ble.. ............................................. 7,361.15 Total Personal Property......................................... 7,361.15 Total Real Property................................................ 60,504.59 67,865.74 I Total Personal and Real Property......................... Total Out-of-State Real Property.......................... /-. '" ,; ,c--.. (...~ Af\..J LTM103-1 01027275364001 McBEE , 800662-2331 021008091134 3: 0"'0 ITI ::o~ ::E 3: .." 0-1 9 <:' ~o r '"' ::r: 0-1 fTl c: "T1:t :< ::s ITI :;d 0.. r ... '"' '"' fTl <!S, 0.. :;d tn en '"' Z ~ (t '"' ()q 0 9 ... <: r;;' '"' ~ 0 ::s (t >< ...., (t ... "' ~ '"' 0 o!fl ~. ::s ...., r= Dr-l (") m )> ... ~ ~ _r)>::OO .., 0 ,tn C :::gJ!:j~r OJ 0.. m 0 > F ::::!C:--IG) en ()q -.J s: 0 '"' ~ > "'::O~)>)> 0 a ~G'lOn JJ 0 ()q ,- ::Onz 0 LIl 0 '"' ~"'tl1'T10 " LIl * a '" )> <.n c: R:>> OJ 7 * "'--Iz :::; .JJ * g~-I3: .., * s;s ... * <D1'T1 )> * -I '" * :::0 OJ - * 0 .. * N .., .., 0 * N 0 * s: * )> OJ U-I * 0 * (") JJ ... * (") 0 m * JJ U-I * P <fl 0 * * C1 * :-0 Q ru * b .JJ * (") :IJ * m * 0 LIl " * )> LIl * -; * .., m - * E;S- JJ .. * z * ~ )> * JJ * .., * T. * (J ('j * ~ * * '" OJ * ~II )> * .., OJ * m i~ JJ * s: .JJ * '" )> * 0 .1 \ JJ * ~ C5 " ru 0 * ~t[j z IP * JJ * t~ m IP * < * m * JJ ru en * m -u * <fl * is ru * m * s: 0 * * u: ... * '" * z * Q * " IT'; * )> * c * :IJ * m * z * 0 * [; * :::; * m * ~ " * )- * * " * V> ~ * * \0 * V> * :-J N * 0 * -.) 0 * N 0\ * * * o~ 0* r 0 r en > en ::0 CJI ill LUIVllVlUNWtALI H UI- f-'tNNSYLVANIA 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 WI LEY JAN M 130 WEST CHURCH STREET DILLSBURG, PA 17019 ____un fold ESTATE INFORMATION: SSN: 168-26-2963 FILE NUMBER: 2105-0872 DECEDENT NAME: MILLER WILLIAM PHILLIP DATE OF PAYMENT: 05/12/2006 POSTMARK DATE: 05/1 0/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/22/2005 NO. CD 006690 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $517.72 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 0559 SEAL INITIALS: MG RECEIVED BY: REGISTER OF WILLS $517.72 GLENDA FARNER STRASBAUGH REGISTER OF WILLS n M. Wiley avid J. Lenox mothy J. Colgan hristopher J. Marzzacco rM"~"'~'-'-="''''--l I... i ! I ! I :1 i 1m' ~ i I I I I '\;."'._...""'''''",....".,'''=.''''~...'''',.'._,...J David E. Hershey Bradley A. Winnid Thomas M. Clark Ari D. Weitzman THE WILEY GROUP Attorneys at La'W' May 10, 2006 Wiley, Lenox, Colgan & Marzzacco, P.c. Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 In Re: Estate of William Phillip Miller, deceased File Number 21-05-00872 Dear Register: Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of $517.72 representing the tax due, and a check in the amount of $30.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. Thank you for your cooperation. Sincerely, ~~felter/ Assi /dg encl. 130 W. Church Street, Suite 100 . Dillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426 Offices in Harrisburg · York · Carbondale www.wileygrouplaw.com I f ~ ~ -f< -f< -f< -f< -f< ","'00- ..... 0..... 0-00 o-NI'- 00 ..... lJ')0 IWl ..... OJ c.. >- CC :IE: w C o () Uo.I 0 e: ~ 'l:""'~ ~ f'l11 0 lI'l I fE ~ NI53 ~ O~ :;) 19 ::E 0","'0 NOON N ..... I'- .... I'- "'"