HomeMy WebLinkAbout09-22-06 (2)
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RE'l.1500 EX + (8-00)
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OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
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DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
Miner, Ralph L.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
181-05-0468
ODyqL
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach
copy of W~I)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D
D
D
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal PovertY Credit (date of death between
. 12-31-91 and 1-1-05)
D 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sell 0)
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NAME
Jan M. Wiley
FIRM NAME (If applicable)
Wiley, Lenox, Colgan, & Marzzacco, P.C.
TELEPHONE NUMBER
717-432-9666
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05-10-2006
10-23-1915
COMPLETE MAILING ADDRESS
130 W. Church St
Dillsburg, PA 17019
(1) None
(2) None
(3) None
(4) None
(5) 255,755.20
(6) None
(7) None
(9) 8,414.10
(10)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8) 255,755.20
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(11)
(12)
(13)
(14)
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0 (16)
t= 16.Amount of Line 14 taxable at lineal rate 247,341.10 x .045
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Q. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
:I
0
CJ 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
)( x
j! 19. Tax Due
(19)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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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) D Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
8,414.10
247,341.10
0.00
247,341.10
0.00
11,130.35
0.00
0.00
11,130.35
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)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Copyright 2002 fonn software only The Lackner Group, Inc.
Fonn REV-1500 EX (Rev. 6.00;
. .
Decedent's Complete Address:
STREET ADDRESS
Cumberland Crossings
1 Longsdorf Way
CITY Carlisle
ISTATE PA
IZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
11,130.35
9,832.50
517.50
Total Credits (A + B + C)
(2)
10,350.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (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 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 780.35
(5A)
(5B) 780.35
Make Check Payable to: REGISTER OF WILLS, AGENT
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;.................................................................................. D [i]
b. retain the right to designate who shall use the property transferred or its income;.................................... D ~
c. retain a reversionary interest; or.................................................................................................................. D [i]
d. receive the promise for life of either payments, benefits or care?............................................................. D [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.............................................................................. ........................................ D [i]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..................................................................................................................... D ~
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 penllllies of~, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it Is true, correct and
complete. DecIaratlon 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
Leon tag
DATE
88 Warrington Road
DiIIsburg, PA 17019
r
~
ADDRESS
ADDRESS
130 W. Church St
DlIIsburg, PA 17019
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)].
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)]. 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 retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
~9116 1.2) [72 P.S. ~9116 (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. ~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, wh~prer by blood or adoption.
3JJaslIilUl: aub Wtslanttnl
OF
RALPiH L. MINER
I. RALPH L. MINER of the Township of'North Branch. County of Wyoming.
and State .of Pennsyl vania. 'be,ing of sound mind. memory. and understanding. do
make. ptlblish and declare this to' be IIty Last Win and Testament. hereby ,revoking
and making void any Wills by me heretofore made.
FIRST: I direct ttrI hereinafter-appointed Executrix to pay all of my
just debts and funeral expenses and administrative expenses of IIty estate ,as soon
as may be conveniently done after IIty decease.
, ,.
ALL I HAVE ON EARTH. 'real. personal and mixed. wheresoever the same may
be situate of whi~h I die seized I give. devise and bequeath unto mY wife.
JENNIE MINER. to be hers absolutely and forever. If. however. IIty wife. JENNIE
HINER. shall fail to survive'me. then and in that ~ase. I give. devise and
bequeath my property. real. personal -and' mixed. wheresoever the same may be
situate of which I die seized unto IIty step-son. Leon Montague. of RD#2.
Dillsburg. Pennsylvania. if'living. if not living then to his issue. per
sti rpes.
AND LASTLY. I do nomin~te. constitute and appoint IIty wife. JENNIE
HINER. E~ecutrix of this IIty Last Will and Testament; if. however. she fails to
survive me or otherwise fails to qualify as Executrix. then I constitute and
appoint IIty step-son. Leon Montague. Executor. with the following powers granted
in order to expedite the management of IIty estate. in addition to and not by
limitation of any powers gra~ted bylaw:
(a) To serve without bond.
(b) To retain any assets of IIty estate. real or personal. without
regard to any principle of'diversification. risk or productivity.
(c) To sell. at public or private sale. to exchange. to lease. and to
give options for sales. exchanges or leases. any real or personal property of
which I may die seised and' possessed. for such prices and on such terms and con-
ditions and to such persons as she deems reasonable and proper in her sole
discretion. for any period of time. ~nd without limitation as to the time within
which such sale. lease. option or exchange shall be made.
(d) To make distribution of any asset of IllY estate in kind, the
propriety of the said distribution to be within her sole discretion.
IN WITNESS WHEREOF, I have hereunto set IllY hand and seal this 18th day
of July, A. D. 1991.
I.;
g;~Nt 1?&~
. (SEAL)
Signed, sealed, published, and dec"ared by the above-named Testator as
and for his Last Will and~estament in the presence of each of us, who, at his
request and in his presence: and in the presence of each other have hereunto
subscribed our names as witnesses.
~/~~.
q~ j &'.,d.
. Residing atfi~",,_A..
Residing at ~ b.
. .1
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF WYOMING
,~
SSe
I, RALPH L. MINER, Testator wnose name is signed to the attached'or
foregoing instrument, h~ving been, duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as mY Last Will; that I
signed it willingly; and that 'I signed it as mY free and voluntary act for the
purposes therein expressed.
~~. ' {'~.". (SEAL)
a p . ne .
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Sworn or affirmed to and acknowledged before me, by Ralph L. Miner, the
Testator, this 18th day of July, 1991.
NOTARIAL SEAL
JAMES E. D.4VIS. Notary Public
Tunkhannor.k 6010, Wyoming Co., PA
My Co!~~r~:~:.'i:~::~.~:'~):~E:.~.~_
COMMONWEALTH OF PENNSYLVANIA:
SSe
COUNTY OF WYOMING
We, 1SoG&,e L.. Jl~/feg) Mq~ 1 f}/cI/<.e1
the witnesses
whose names are signed to the attached or foregoing instrument, being duly
qualified according to law,. do depose and say that we were present and saw the
Testator sign and execute the instrument as his Last Will; that he signed
willingly and that he executed it as his free and voluntary act for the pur-
poses therein expressed; that, each of us in the hearing and sight of the
Testator signed the Will as w1tnesses; and that to the best of our knowledge,
the Testator was at that time 18 or more years of age, of sound mind, and under
no constraint or undue influence.
~'2t~
. 0J7 :i#~
Sworn or affirmed ,to ~nd acknowledged before me, this 18th day of
July, 1991.
,.~
NOTARIAL SEAL
JAMES E. DAVIS, Notary PubliC;j
Tunkhannock Boro, Wyoming Co., PA
My Ccmmisslon Expires January 2, 1993
.
Rev:1108 EX+ (6-88)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
cow.toNWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDeNT
ESTATE OF
Miner, Ralph L.
FILE NUMBE~ n I ~
21-06- 00 4 '"'\u
Include the pI'OClIlIds of IllIgllllon and the datelhll proceeds WWlI received by lhlleslale.
All property joInt1y-owned with the right of survlvonhlp must be dlsclond on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Americhoice Federal Credit Union CD #60: 51.885.00
2 Americhoice Federal Credit Union CD#61: 41.002.74
3 Americhoice Federal Credit Union Checking: 2.112.64
4 Americholce Federal Credit Union Savings: 6.420.03
5 Cambridge Investment Account Number 74147535: 106.628.86
6 Cumberland Crossings (Refunds): 1.492.13
7 Peoples National Bank Checking Account: 6.326.48
8 Peoples National Bank Savings Account: 39.754.85
9 PSERS: 132.47
TOTAL (Also enter on Line 5, Recapitulation)
255.755.20
(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 E (Rev. 6-98)
. .
~ AmeriChoice
..... ~ FEDERAL CREDIT UNION
Building Relationships For Life
June 23, 2006
The Wiley Group
Attorney at Law
130 W. Church Street
Suite 100
Dillsburg, PA 17019
RE: Estate of Ralph L. Miner
SS#181-05-0468
The account is as follows:
Account Type #36136
Share Account #01 (savings)
Share Draft #13 (checking)
Certificate of Deposit #60
Certificate of Deposit #61
Date Opened
05/11/2004
05/11/2004
09/1 0/2004
04/01/2005
Date of Death Balance & Dividend Balance
$ 6,420.03 $ 15.34
$ 2,112.64 $ 4.05
$ 51,885.00 $ 314.97
$ 41,002.74 $ 1,002.74
The certificate of deposit #60 matures 9/10/2006 the interest rate is 2.47%. The certificate of deposit #61
matures 4/01/2007 the interest rate is 4.25%.
I have enclosed a statement for May 2006.
Mr. Miner did not have a safe deposit box with the credit union.
If you have any question please contact me at (717)591-1275.
Thank you.
Sincerely, _
~M.~
Beth M. Y orIets
Operations Supervisor
1St
fa'At.GlSt..
LlNDIIl
Main Office: 2175 Bumble Bee Hollow Road · Mechanicsburg, PA 17055 · Phone: (717) 697-3474 . Fax: (717) 697-3713
Website: www.americhoice.org 0
cRiDiT UNIONS'
RALPH L MINER
88 WARRINGTON RD
DILLSBURG PA 17019-9670
WITH 600 MEMBER REWARD POINTS YOUR NEW LEVEL WILL BE: BLUE RIBBON MEMBERS
ASK US HOW MEMBERS GET FREE UNLIMITED ATM TRANSACTIONS.
HOticel See rever.e .ide for t.partant inforaation regarding
your right to di.put. error. on your .tat_nt.
ACCOUNT NOMBERr
36136
PAGB NOMBERr
YTD DIV RBCBIVBDr
1 of 2
1,343.35
For ea.ier and more affordable
mortgage loan. contact Donna Go..
today at (717)541 89461
SUMMARY OF YOUR ACCOUNTS
1
SUFFIX 01 SBNIOR SHARES
JOINT: JENNIE MINER
STATEMENT PERIOD 05/01/06
BEGINNING BALANCE
DEPOSITS 2
WITHDRAWALS 0
ENDING BALANCE
DIVIDEND YEAR-TO-DATE
DIVIDEND THIS PERIOD
AVERAGE DAILY BALANCE
DAYS DIVIDEND EARNED
ANNUAL PERCENTAGE
YIELD EARNED
- 05/31/06
4,911.41
1,513.88
.00
6,425.29
20.60
5.26
6,225.37
31
1.00%
SUFFIX 13 SHARE DRAFT
JOINT: JENNIE MINER
STATEMENT PERIOD 05/01/06 -
BEGINNING BALANCE
DEPOSITS 1
WITHDRAWALS 0
DRAFTS CLEARED 1
ENDING BALANCE
DIVIDEND YEAR-TO-DATE
DIVIDEND THIS PERIOD
AVERAGE DAILY BALANCE
DAYS DIVIDEND EARNED
ANNUAL PERCENTAGE
YIELD EARNED
05/31/06
2,512.64
.99
.00
400.00
2,113.63
5.04
.99
2,319.09
31
0.50%
SUFFIX 18 MONEY MARKET
JOINT: JENNIE MINER
STATEMENT PERIOD 05/01/06 -
BEGINNING BALANCE
DEPOSITS 0
WITHDRAWALS 0
DRAFTS CLEARED 0
ENDING BALANCE
DIVIDEND YEAR-TO-DATE
DIVIDEND THIS PERIOD
AVERAGE DAILY BALANCE
DAYS DIVIDEND EARNED
05/31/06
.00
.00
.00
.00
.00
.00
.00
.00
31
SUFFIX 60 24 MONTH CERT
JOINT: JENNIE MINER
STATEMENT PERIOD 05/01/06
BEGINNING BALANCE
DEPOSITS 0
WITHDRAWALS 0
ENDING BALANCE
DIVIDEND YEAR-TO-DATE
DIVIDEND THIS PERIOD
AVERAGE DAILY BALANCE
DAYS DIVIDEND EARNED
MATURITY DATE
ANNUAL PERCENTAGE RATE
- 05/31/06
51,885.00
.00
.00
51,885.00
314.97
.00
.00
o
09/10/06
2.477111
SUFFIX 61 12 MONTH CBRT
JOINT: JENNIE MINER
STATEMENT PERIOD 05/01/06
BEGINNING BALANCE
DEPOSITS 0
WITHDRAWALS 0
ENDING BALANCE
DIVIDEND YEAR-TO-DATE
DIVIDEND THIS PERIOD
AVERAGE DAILY BALANCE
DAYS DIVIDEND EARNED
MATURITY DATE
ANNUAL PERCBNTAGE RATB
- 05/31/06
41,002.74
.00
.00
41,002.74
1,002.74
.00
.00
o
04/01/07
4.250111
SUFFIX 01 SENIOR SHARES
HISTORY
DATE DESCRIPTION TRANSACTION AMOUNT ACCOUNT BALANCE
5/05/06 DEPOSIT 1,508.62 6,420.03
5/31/06 DIVIDEND 5.26 6,425.29
SUFFIX 13 SHARE DRAFT
HISTORY
DATE DESCRIPTION TRANSACTION AMOUNT ACCOUNT BALANCE
5/17/06 Draft Number 1019 400.00- 2,112.64
5/17/06 AMERICHOICE F.C. PAYMENT
5/31/06 DIVIDEND .99 2,113.63
SUFFIX
13 SHARB DRAFT
LOCATION
DEPOSITS
DATE
5/31/06
DESCRIPTION
DIVIDEND
DRAFTS/CHECKS CLEARED
DRAFT# AMOUNT DATE
~ 400.00 5/17
SUFFIX 18 MONEY MARKET
(NO ACTIVITY)
SUFFIX 60 24 MONTH CBRT
(NO ACTIVITY)
SUFFIX 61 12 MONTH CERT
(NO ACTIVITY)
Notic.. Se. rev.r.. .ide for t.portmt iufoauti_ rell.rdi..g
your right to ISi.put. error. _ your .tat_..t.
ACCOUNT NUMBERI
36136
YTD DIV RBCBIVBDI
1,343.35
PAGB NUMBBRI
2 of 2
2
(CONTINUED)
TRANSACTION AMOUNT
.99
DRAFT#
(* DENOTES MISSING DRAFT SEQUENCE NUMBER)
~ ~ DRAFT# AMOUNT DATE
~ DATE
DRAFT#
. .
Ray Kelley, CFP-
Registered Representative
Investment Advisor Representative
120 Ferree Street
. Harrisburg, pA 17109
Phone: (717) 657-4955
Fax: (717) 652-3530
June 22, 2006
The Wiley Group, Attorneys at Law
130 W. Church Street
Dillsburg, P A 17019
Attn. Jan M. Wiley, Esquire
Re: Ralph L. Miner/Acct. 74147535
Dear Sir/Madam
I am sad to hear of the death Ralph Miner. The information that you have requested is as
follows:
1.
Date of death value
$106,628.86
2.
2006 accrued dividends
$1,070.95
3.
Ownership
Joint tenant with rights of survivorship with Jennie
L. Miner/deceased
4.
Account opening date
October 11, 2004
I am in contact with Mr. Montague in reference to the transition of this account to his control.
I hope that this information will allow you to be as expeditious as possible with this matter.
Securities offered through Cambridge Investment Research, Inc., a Registered Broker/Dealer, Member NASD/SIPC.
Investment Advisory Services offered through Cambridge Investment Research Advisors, Inc., a Federally Registered Investment Advisor.
American Funds - Historical Account Balance
Page 1 of 1
Historical account balance
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<< Return to Account SummarY
As of May 10, 2006
Total value: $106,628.86
Non-retirement accounts: $106,628.86
Retirement accounts: $0.00
Select a different date
i
i
i RALPH L MINER &
I JENNIE E MINER JT WROS
I
I Fund Name
i
~---_._._-_._.-
; THE BOND FUND OF AMERICA - A (08)
__w_~__~'.~'."~_'_'~
.,
i
Account: 74147535
Shares
May 10,
2006
NAV
May 10, 2006
Market Value
May 10, 2006
1,925.333
$13.07
$25,164.10
$28,674.83
$24,363.11
THE INCOME FUND OF AMERICA - A (06)
1,481.138
$19.36
$13.12
U.S. GOVERNMENT SECURITIES FUND - A
i (22)
I
I WASHINGTON MUTUAL INVESTORS FUND
i-A (01)
L..___~._...._.._.. .........___...... ..........................-.....-..-....-....-..-....--.............-.-.--.---.
!
1,856.944
858.557
$33.11
$28,426.82
Account $106,628.86
Total:
As of May 10, 2006
Total value: $106,628.86
Non-retirement accounts: $106,628.86
Retirement accounts: $0.00
View the historical balance for a different date:
To view your historical balances, enter a specific date or select a quarter-end period
using the drop-down menu and click Submit.
mm/
dd /
yyyy OR Select a quarter-end period:
-
Coovriaht @ 2006 American Funds Distributors, Inc. All rights reserved.
PRIVACY I Portfolio aareement I Business continuity I Comments?
https://accounts.americanfunds.com/tfIFANWeb
6/22/2006
. .
People' National Bank
D. IIN' III p.o. Box A, Hallstead, Pennsylvania 18822
~Admlnl.tratlve Office (570) 879.2175
June 23, 2006
The Wiley Group
Attorneys at Law
130 W. Church St. Suite 100
Dillsburg, PA 17019
Dear Mrs. Wiley:
Enclosed is the information that you requested for the Estate of Ralph 1. Miner, deceased
May 10,2006.
Mr. Miner had a checking account and a savings account open at Peoples National Bank
at the time of his death.
Checking account #7316313 was opened January 1,1991 as a joint account for Ralph 1.
Miner and Jennie Miner. After the death of Jennie, her name was removed from the
account and the account was then held by Ralph, individually. Mrs. Miner's name was
removed from the account February 10,2006. The date of death value was $6,324.49.
The accrued interest to the date of death was $1.99.
Savings account #8713455 was opened December 20, 1988 as a joint account for Ralph
1. Miner and Jennie Miner. After the death of Jennie, her name was removed from the
account and the account was then held by Ralph, individually. W.us. Miner's name was
removed from the account February 10,2006. The date of death value was $39,714.04.
The accrued interest to the date of death was $40.81.
If I can be of further assistance, please call me at (570) 879-2430 Extension 118.
ikJ; ~b4JJ
Nicole Hobbs
Deposit Processing Representative
Main Street. Hop Bottom, PA . (570) 289.4124 . Grow Avenue. Montrose, PA . (570) 278.4100
East Tioga Street. Tunkhannock, PA . (570) 836-2135 . Main Street. Nicholson, PA . (570) 942.2265
Route #6 . Meshoppen, PA . (570) 833.5171 . Hallstead Plaza. Hallstead, PA . (570) 879.2195 . Erie Boulevard. Susquehanna, PA . (570) 853.4901
10?R r.nnklln RnAtl .. r....riklln. NY . IR07\ 722.2114
COMMONWEALTH OF PENNSYLVANIA
PUBLIC SCHOOL EMPLOYE:ftS' RETIREMENT SYSTEM
Mailing Address
PO Box 125
Harrisburg PA 17108-0125
Toll-Free - 1-888-773-7748
(1-888-PSERS4U)
Local- 717-787-8540
Web Address: www.psers.state.pa.us
Building Location
5 North 5th Street
Harrisburg P A
June 27, 2006
LEON MONTAGUE
88 WARRINGTON RD
. DILLSBURG PA 17019
RE: Ralph L. Miner
S.S.# 181-05-0468
Dear Mr. Montague: .
This is a follow up letter. The Next Of Kin affidavit you have provided cannot be utilized'
for payment of the prorated amount due under the relationship of stepson. We are
returning the NOK affidavit to you. Please read the below updated information and
.request carefully.
A prorated payment of $132A 7 for the period of May 1, through May 10, 2006, was due
Ralph L. Miner, and is now payable to Estate or next of kin, of Ralph Miner.
. Unfortunately under the relationship of "Stepson" your only option for payment is to
petition the court for a "Settlement Of A Small Estate". Please contact you attorney or
the register of wills office at the courthouse for details on accomplishing this task.
Return the court appointed document for payment to be made.
There will be no further benefits payable from this account.
Please include the decedent's name and social security number with all
correspondence.
If you have any questions, please contact the Member Service Center by calling toll-free
1-888-773-7748 (local calls 787-8540). If you prefer, you may reach PSERS by FAX at
717-772-3764. For your convenience, the Member Service Center is staffed each
business day from 7:30 a.m. to 5:00 p.m.
Deceased Processing Center
ked
. .
.
REV.\11i1 EX+ (12-89)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miner, Ralph L.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attomey's Fees Wiley, Lenox, Colgan, & Marzzacco, P.C. 7,650.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 356.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 308.10
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 8,414.10
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
.
ReY-1\o2 EX+ (8-88)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
cor.NONWEALTH Of' PENNSYLVANIA
tlHERlTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miner, Ralph L.
FILE NUMBER
21-06- ~(p
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Nancy Montague (reimbursement for preacher):
100.00
Subtotal
100.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
.
Rev.1aoZ EX+ (8.88)
.
SCHEDULE H.87
OTHER
ADMINISTRATIVE COSTS
continued
CClMMClN'M:Al.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Miner, Ralph L.
FILE NUMBER
21-06- ooLtg U
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Continuing Care (prescriptions):
44.29
2
Cumberland Law Journal (advertise estate):
75.00
3
Register of Wills (filing fee):
30.00
4
The Sentinel (advertise estate):
158.81
Subtotal
308.10
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule H-S7 (Rev. 6-98)
REV-1513 EX+ (8-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Miner, Ralph L.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
C1istributions..l. and transfers
under Sec. l:I116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not Ust Trustlllllsl
FILE NUMBER
21-06- (')(') 4QI,
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Leon Montague
88 Warrington Road
DiIIsburg, PA 17019
Stepchild
one hundred
percent
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, 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)