HomeMy WebLinkAbout12-20-06
~V-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
RLE NUMBER
II
05
COUNTY CODE YEAR
SOCIAL SECURIlY NUMBER
DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
Miller, Alice M
DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-OD-YEAR)
20.0
201-16-0753
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
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08-27 -2005
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
02-05-1925
REGISTER OF WILLS
SOCIAL SECURllY NUMBER
[!] 1. Original Return
D 4. Limited Estate
[!] 6. Decedent Died Testate (Attach
copy of 1Ni1l)
D 9. Litigation Proceeds Received
D
D
D
D
0866
NUMBER
2. Supplemental Retum
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 1-1-95)
D 3. Remainder Retum (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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COMPLETE MAILING ADDRESS
NAME
Richard L Webber, Jr., Esquire
FIRM NAME (If applicable)
Weigle & Associates, P.C.
TELEPHONE NUMBER
717-532-7388
126 East King Street
Shippensburg, PA 17257
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) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
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11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(11)
(12)
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)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
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0 0.00 .045 (16)
~ 16. Amount of Line 14 taxable at lineal rate x
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A. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
~
0
0 18. Amount of Line 14 taxable at oollateral rate 86,189.75 .15 (18)
~ x
19. Tax Due (19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
12,114.91
86,189.75
0.00
86,189.75
0.00
0.00
0.00
12,928.46
12,928.46
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-15DO EX (Rev. 6-00:
Decedent's Complete Address:
STREET ADDRESS
971 Green Spring Road
CITY Newville
ISTATE PA
IZIP 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
12,928.46
0.00
Total Credits (A + 8 + C)
(2)
0.00
3. InterestJPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
12,928.46
12,928.46
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN ''X'' IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. 0 ~
b. retain the right to designate who shall use the property transferred or its income; .................................... 0 [!]
c. retain a reversionary interest; or.................................................................................................................. 0 ~
d. receive the promise for life of either payments, benefits or care? .............................................................. 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .......................................................................................... ......... .................... 0 [!]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................... ~ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties d peljury, I declare that I have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true. correct and
ccmplete. Declaration of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RET RN ADDRESS DATE
Tamm S. Gutshall 328 Doubling Gap Road
Newville, PA 17241
ADDRESS
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SIGNATURE OF PREPARER OTHER REPRESENTATIVE ADDRESS
Ri~ L "b~. r, _J:~ Es/qUire ."f 126 East King Street
IIIIiIiIII '-(. _,-,~I Shippensburg, PA 17257
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 return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1 , 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
~9116 1.2)[72P.S.~9116(a)(1)].
838 Shed Road
Newville, PA 17241
I ~!16-1{) 6
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1508 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDBIT DECEDENT
ESTATE OF
Miller, Alice M
FILE NUMBER
21-05-0866
Include the p~ of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be dillClosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 American Prog - Refund 87.64
2 Cremation Society - Refund 337.00
3 Cremation Society - Refund 520.00
4 F&M Trust #015-2968102 - Certificate of Deposit 17,900.00
Accrued income on Item 4 through date of death 30.94
5 F&M Trust #05-08680 - Savings Account 300.00
Accrued income on Item 5 through date of death 0.61
6 F&M Trust #32-92657 - Checking Account 8,961.59
Accrued income on Item 6 through date of death 4.56
7 Hilliard Lyons - Refund 1.55
8 Liberty Mutual - Refund 125.00
9 Liberty Mutual Home Owners Insurance - Reimbursement 119.00
10 Liberty Mutual Home Owners Insurance - Reimbursement 87.00
11 Mutual Omaha Insurance - Reimbursement 33.93
12 PNC Bank #21001053677 - Certificate of Deposit 10,000.00
Accrued income on Item 12 through date of death 9.67
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 5, Recapitulation)
38,555.95
(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)
R..-1508 EX+ (6-98)
*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
continued
COMMONWEALlll OF PENNSYlVANIA
INHERITANCE TAX RETURN
. RESIDENT DECEDENT
Miller, Alice M
. FILE NUMBER
21-oS-0866
ESTATE OF
ITEM
NUMBER
'13
DESCRIPTION
VALUE AT DATE
OF DEATH
William Rand. Reimbursement for water/sewer
37.46
TOTAL (Also enter on Line 5, Recapitulation)
38.555.95
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev.-1509 EX+ (6-98)
*
SCHEDULE F
JOINTL V-OWNED PROPERTY
COMMONWEALTH a: PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Miller, Alice M 21-05-0866
If an asset was made joint within one year of the decedenfs date of death. It must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Tammy S. Gutshall
ADDRESS
RELATIONSHIP TO DECEDENT
Niece
328 Doubling Gap Road
Newville, PA 17241
B.
C.
JOINTLY OWNED PROPERTY:
DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
LETTER DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAl INSTITUTION AND BANK ACCOUNT DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMIlAR IDENTIFYING NUMBER ATTACH DEED FOR IvALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 10/1/1999 1997 Jeep Cherokee Limited Motor 1,800.00 0.500% 900.00
Vehicle
2 A 7/1/2002 2005 Chevrolet Cobalt motor vehicle VIN 4,009.50 0.500% 2,004.75
#1G1AKS2F057567135 - Value listed at
gross insurance proceeds minus
decedent's $12,000.00 contribution listed
under Item 3 of Schedule G
TOTAL (Also enter on Line 6, Recapitulation) 2,904.75
(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 F (Rev. 6-98)
Rev-1510 EX+ (6-98)
*
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH Of PENNSYlVANIA
INHERITANCE TAX RE1\JRN
RESIDENT DECEDENT
Miller, Alice M
FILE NUMBER
21-05-0866
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 . ._.. Uf"' P~U,...t:~ I T DATE OF DEATH 0/0 OF DECO'S EXCLUSION TAXABLE
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 Allstate Financial - Life Insurance Policy, 9,470.94 100.000 9,470.94
conveyed to Tammy S. Gutshall, niece as of date
of death
2 Insurance proceeds relating to 2005 Chevrolet 12,000.00 100.000 3,000.00 9,000.00
Cobalt motor vehicle VlN #1G1AK52F057567135-
portion relating to contribution by decedent
towards purchase price of vehicle
3 MONY Life Insurance Company of America - 38,373.02 100.000 38,373.02
Conveyed to Tammy S. Gutshall, niece as of date
of death
TOTAL (Also enter on Line 7, Recapitulation) 56,843.96
(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
RESIOENT DECEOENT
Miller, Alice M
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-0866
ESTATE OF
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
95.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Tammy S. Gutshall Connie L. Rand
Social Security Number(s} I EIN Number of Personal Representative(s}:
Street Address
City Newville State P A
Year(s) Commission paid 2007
Zip 17241
4,915.23
2.
Attorney's Fees
See continuation schedule(s) attached
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4,915.23
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Acoountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
313.00
TOTAL (Also enter on line 9, Recapitulation)
10,238.46
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-9B)
R.".1502 EX+ (6-98)
'*
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALlli OF PENNSYlVANIA
INHERITANCE TAX RE1lJRN
RESIDENT DECEDENT
Miller, Alice M
FILE NUMBER
21-05-0866
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Eby Granite Works - Head Stone
95.00
Subtotal
95.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
'*
SCHEDULE H.B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Alice M
IFILE NUMBER
21-05-0866
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Weigle & Associates, P .C.
4.915.23
Subtotal
4.915.23
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
ReY-1502 EX+ (6-98)
*'
SCHEDULE H.87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALlH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Alice M
FILE NUMBER
21-0~0866
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County - Probate Fee
140.00
2
Cumberland Law Journal- Advertising
75.00
3
F&M Trust - Researching Fee
15.00
4
Valley Times-Star - Advertising
83.00
Subtotal
313.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rw-1512 EX+ (6-98)
*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAL lH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Miller, Alice M
FILE NUMBER
21-0~0866
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Chase - Credit card balance
VALUE AT DATE
OF DEATH
139.95
2 Disbursement
313.00
3 Ed Mullen - Invoice for renovations as of date of death
335.00
4 Kough's Oil
382.50
5 Newville Water and Sewer - Bill
138.12
6 PA Dept of Revenue - 2005 personal income tax
52.67
7 PPL - Electric Bill
167.11
8 Sprint - Telephone Bill
11.10
9 Tammy Gutshall - Invoice as of date of death
337.00
TOTAL (Also enter on Line 10, Recapitulation)
1,876.45
(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 ..
BENEFICIARIES
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Miller, Alice M
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal
aistributions. and transfers
under Sec. 9116(a)(1.2)]
Christopher Gutshall
260 Ridge Road
Shippensburg, PA 17241
Tammy S Gutshall
328 Doubling Gap Road
Newville, PA 17241
RELATIONSHIP TO
DECEDENT
Do Not list TrustINIIsl
FILE NUMBER
21-05..0866
SHAREOFESTATE AMOUNTOFESTATE
(Words) ($$$)
ESTATE OF
I.
Nephew
One-third (1/3)
of residue
18,522.61
Niece
One Third (1/3)
of residue
61,259.44
Connie L Rand
838 Shed Road
Newville, PA 17241
Niece
One-third (1/3)
of residue
18,522.61'
Total 98,304.66
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 \I - 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)
LAST WILL AND TESTAMENT
OF
ALICE M. MILLEll
I, ALICE M. MILLER, of 97l Green Spring Road, North Ne~ton
.;~. .
.~.~
Township, Cumberland County, Pennsylvania, bei.ng of sound mind,
memory and disposition, do hereby make, publish and declare this my
Last Will and Testam~nt, hereby revokin9 and making void a.ny and
all Wills, Codicils, or writings in the nature thereof, by me at
any time heretofore made.
FIRST:
DEBTS - I dir~ct that my debts and expenses of my last
illness, if any, be paid from my estate as soon as conveniently may
be done.
}:I'urther,
in this connection,
I authorize my personal
representative to expend funds from my estate, in such amount as my
personal representative shall consider necessary and desirable, for
the purchase, erection, and inscription of a suitable marker for my
grave.
SECOND: DEVISE OF CERTAIN REAL ESTATE - I devise my real estate,
together with improvements thereon, loc~ted at 971.Green Spring
Road, in North Newton Township, Cumberland. County,
Pennsylvania, to my niece, TAMMY S. GUTSHALL and my niece C~.
~. However, if any of those persons does not survive me and
leaves children who so survive me, such children shall receive, per
stirpes, the share that the deceased person would have received had
she so survived me.
"'7-"-~'" '~-'.~"._w"""'" '_.'.
THIRD:
RESIDUE OF ESTATE - I give, devise and bequeath all the
rest, residue and remainder of my estate, be it real, personal, or
mixed, of whatsoever kind and wheresoever situate, unto TAMMY S.
GUTSHALL, ~FE~~B, and CHRISTOPHER GUTSHALL.
However, if any
I.. " ,
, '~
of those persons does not survive me and leaves children who'l<< 13b .
survive me, such children shall receive, per stirpes, the share
that the deceased person would have received had he or she so
survived me.
FOURTH: EXECUTRICES - I appoint my nieces, TAMMY S. GUTSHALL and
~, Co-Executrices of my will. Neither my Executrices nor
an~ successor shall be required to give bond for the performance of
their duties.
I grant to my Executrices the power to compromise claims
without court approval and without the consent of any beneficiary.
FIFTH:
POWERS FOR EXECUTRICES
In addition to the powers
conferred by law, I authorize my Executrices in their absolute
discretion:
A. To retain in the form received, and to sell either at
public o'r private sa.le any real ot" personal property i,
B. To manage real e~tate;
C. To invest and reinvest in -all forms of property without
being cQnftned to legal investments, and without regard to
the principle of diversification;
D. To exercise any option or rights arising from ownership of
investments; and
PAGE 2
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w~th6ut court approval, and without
the consent of any beneficiary and to'abandon any property
which is of little or no value.
IN WITNESS WHEREOF, I hereunto have signed my n'a:'me tG' this" my
"~~..,.- ';' ~
Last Will and Testament, the text of which consists of THREE (3)
J) /} reX.
t)~ewritten pages,-th!s OUX day of
mO-Lj
, 1997.
aJ2(~~- .'-H1 ~ Y;1~(SEAL)
ALICE M. MlLLER, Testatrix
In our presence, the above-named Testatrix signed this and
declared it to be her Will, and now, at her request and in her
presence and in the presence of each other, we sign as witnesses:
(J~c.~
~A;u, cJ vJ~
STATE OF PENNSYLVANIA
: SS
OOUNTY OF CUMBERLAND
I, ALICE M.MILLER, having been duly qualified according to
law, acknowledge that I signed the foregoing instrument as my Will
and that I signed it as my free and voluntary act for the purposes
therein expressed.
O~~,)11 ~J11~
ALICE M. MILLER, Testatrix
PAGE 3
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We, having been duly qualified according to law,
say that we were present and saw ALICE M. MILLER sign the foregoing
instrument as her will i that she signed it as her free and
voluntary act for the purposes therein expressed; that each of us
in her sight and hearing and at her request signed tqe will as
. ~r. ,: ",.
witnesses; and that to the best of our knowledge she was at the
time 18 or more year~~of age, of sound mind and under no constraint
'.
or undue influence.
.....
(J);/1.J~A"O )~l
~ a.uJ~
Subscribed, sworn. to or affirmed,
and acknowledged before me by the
above-named Testatrix and by the
w~tnesses whose names appear
opposi te on this & Btnd day of
-7lI ~H' 1997.
Notary Public '.
. . ~
-an:
PAGE 4
,'.'
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dstonline.com
TRUSl
October 3,2005
OCT 4 2005
Weigle & Associates, P.C.
Attorneys at Law
126 East King Street
Shippensburg, PA 17257-1397
RE: Alice M Miller
Mr. Webber:
In reference to the above customer, our records show the enclosed information to be
accurate as of August 27, 2005. Our researching fee for the information we have
provided is $ 15.00. . Please send your remittance to the following address:
Farmers and Merchants Trust Company
A TIN Karen Davis
20 South Main Street
Chambersburg, PA 17201-0819
If I may be of any further assistance, please contact me.
Sincerely,
~[~
Karen E. Davis
Deposit Operations Manager
717-264-6116
888-264-6116
P.o. Box 6010
Chambersburg, PA
17201-6010
I:' I JlIA.ALLloIA '--me:: nIl/ TIn N .c;: FROM PEOPLE YOU KNOW
RE: Alice M Millpy
DATE OF DEATH 8//.7/05
ACr.OTWT INFORMATTON
x
CHECKING
SAFE DEPOSIT
SAVINGS ____CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED
ACCOUNT NUMBER
Oq//.7/96
DATE CLOSED
Atill oppn
.12-<:)/.61:)7
ACCOUNT BALANCE AT 'DATE OF' DEATH $ H 961 S9
ACCRUED INTEREST $ 4 1:)6
TOTAL ACCOUNT BALANCE $ 8 966 15
NAME(S) ON ACCOUNT Alicp M Mi 1 1 er
REGISTRATION OF ACCOUNT
TndjvinllAl
---------------------------------------------------------------
ACCOUNT TNFORMATION
CHECKING
SAFE DEPOSIT
X SAVINGS ___CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 11/08/02 DATE CLOSED
ACCOUNT NUMBER OS-08680
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT Alice M Millpr
REGISTRATION OF ACCOUNT Tndjvidllal
At;ll open
$ .100 00
$ 0 61
$ 100 61
RE: Alir.e M Miller
DATE OF DEATH OR/?7/0S
Ac.c.OTmT INFORMATTON
_CHECKING
SAFE DEPOSIT
SAVINGS X_CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED Ol/OR/Ol DATE CLOSED
ACCOUNT NUMBER 01S-?96Al0?
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
. TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
Rr i 11
open
$ 17 900 00
$ 10 c)4
$ 1 7 910 94
Alir.e M Miller
Tnniv;nllal
---------------------------------------------------------------
Ac.c.OTmT TNFORMATION
CHECKING
SAFE DEPOSIT
SAVINGS ___CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED DATE CLOSED
ACCOUNT NUMBER
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
NAME(S) ON ACCOUNT
REGISTRATION OF ACCOUNT
~CT-12-2005 20:47
PNCBANK
412 768 3458
P.01/01
o PNCBAN<
October 13,2005
Weigle & Associates, PC
Attn: Richard L Webber, Jr., Esquire
126 East King St.
Shippensburg, P A 17257-1397
RE: Estate of Alice M Miller (Deceased)
SSN: 201-16-0753
DOD: 08-27-2005
seplal
Dear Mr. Webber:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Certificate of Deposit
Account #21001053677
Established 05-19-1994
ALICE M MILLER
DOD balance: $10,000.00 + $9.67 accrued interest
The decedent maintained investment account (lNV # 58821454). For more information
please contact the Brokerage department at 1-800-762-6111.
The decedent did not rnaiDtaiD any safe depollit box, loan or mortgage with PNC
Bank.
Please note that this office only provides date of death balances for deposit accounts
(1RAs, COSt Checking and Savings accounts). We do not process any financial
transactioDs or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-752-2265) or stop by your local FNC Bank: branch
office.
Sincerely,
~ -;;:?~ ~
Erica L Schlegel
1-800-762-1775
P7.PFSC-04-F
500 First Ave.
Pittsburgh P A 152] 9
Member FDIC
TOTAL P.01
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(J1
Allstate Life Insurance Company
544 Lakeview Parkway
Vemon Hills, II. 60061
Telephone: (877) 499-6418
Facsimile: (866) 635-4523
OCT 1 4 2005
~Allstate.
FINANCIAL
October 10,2005
Weigle & Associates, P.C.
Attn: Richard L. Webber, Jr., Esquire
126 E. King St.
Shippensburg, PA 17257-1397
Re:
Contract No:
Alice M. Miller
GA0595664
Dear Mr. Webber:
We have been requested to complete IRS Form 712 with regard to the above referenced contract. The
purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its
proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract).
lIDs contract is an annuity contract, which is not reportable on IRS Form 712. The following information is
provided for estate purposes only as of the date specified:
Date Account was Opened:
Date of Death:
AnnuityValue* as of Date of Death:
Cost Basis:
Named Beneficiary:
May 30, 2000
August 27, 2005
$ 9,470.94
$ 9,468.64
Tammy S. Gutshall
*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges.
If you have any questions, please contact our Customer Care Unit at 1-877-499-6418.
Sincerely,
Isela Balderas
Life and Annuity Claims
ffi/sn
ImmD
~~
An AXA Financial Company
MONY Life Insurance Company
PO. Box 4830
Syracuse, New York 13221
(315) 477-3000
October 18, 2005
Weigle & Associates, P.C.
.Attn: Richard_L, Webber, Jr. _
126 East King Street
Shippenburg, P A 17257-1397
Re: ContractB1402-88-65
Annuitant - Alice M. Miller
Dear Mr. Webber:
On behalf of MONY Life Insurance Company of America, please extend my heartfelt
condolences to the family of Alice M. Miller.
I will be assisting you personally throughout the claim process and have enclosed the forms and a
list of documents we will need to expedite processing of the claim. Please be assured I am here to
help if you need assistance in completing the forms or if you have any questions throughout the
claim process.
The beneficiary is Niece, Tammy Sue Gutshell, if living, if not, niece, Connie L. Rand, The
approximate amount payable is $38,373',02, of which $13,373.02 is taxable, and the options
available are listed below. Tammy may want to consult with a tax advisor to determine which
option is best for her:
1. Electing an Installment or Life Option can spread the taxable amount out. To obtain
election forms or for more information about these payment options, please call toll free at 1-
800-326-6744. Please note: If a Settlement Option is elected, it must be elected within 30
days of the date we received due proof of death (the Death Certificate).
2. Immediate Payment Option:
(J Proceeds are immediately made available by means of an interest-bearing checking aCCulmt
called a MONY Access Account. This account earns a competitive rate of interest, and will
provide you the ability to settle immediate needs, without making major decisions about
future investment options. We will send you several blank checks so you can withdraw part
or all of the funds when you are ready to do so.
Please submit the following forms and documents to my attention at MONY Life Insurance
Company of America, PO Box 4720, Mail Drop 32-52, Syracuse, NY 13221.
· The enclosed Request for Payment of Benefits form #3582.
· Certified copy of the Annuitant's Death Certificate.
· The original Contract, if available.
10894L (9/2004)
Cat. #134223 (9/04)
,
IPB1
MONY Life Insurance Company
P.O. Box 4830
Syracuse, New York 13221
(315) 477-3000
An AXA Financial Company
October 18, 2005
Weigle & Associates, p.e.
. Attn: RichantL, Webber, Jr.
126 East King Street
Shippenburg, P A 17257-1397
-.- . - .-.....~,- --......---.-
Re: Contract B1402-88-65
Annuitant - Alice M. Miller
Dear Mr. Webber:
On behalf of MONY Life Insurance Company of America, please extend my heartfelt
condolences to the family of Alice M. Miller.
I will be assisting you personally throughout the claim process and have enclosed the forms and a
list of documents we will need to expedite processing of the claim. Please be assured I am here to
help if you need assistance in completing the forms or if you have any questions throughout the
claim process.
The beneficiary is Niece, Tammy Sue' Gutshell, if living, if not, niece, Connie L. Rand. The
approximate amount payable is $38,373.02, of which $13,373.02 is taxable, and the options
available are listed below. Tammy may want to consult with a tax advisor to determine which
option is best for her:
1. Electing an Installment or Life Option can spread the taxable amount out. To obtain
election forms or for more information about these payment options, please call toll free at 1-
800-326-6744. Please note: If a Settlement Option is elected, it must be elected within 30
days of the date we received due proof of death (the Death Certificate).
2. Immediate Payment Option:
It Proceeds are immediately made available by means of an interest-bearing checking account
called a MONY Access Account. This account earns a competitive rate of interest, and will
provide you the ability to settle immediate needs, without making major decisions about
future investment options. We will send you several blank checks so you can withdraw part
or all of the funds when you are ready to do so.
Please submit the following forms and documents to my attention at MONY Life Insurance
Company of America, PO Box 4720, Mail Drop 32-52, Syracuse, NY 13221.
· The enclosed Request for Payment of Benefits form #3582.
· Certified copy of the Annuitant's Death Certificate.
· The original Contract, if available.
10894L (9/2004)
Cat. #134223 (9/04)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WEBBER JR RICHARD L
WEIGLE & ASSOCIATES PC
126 E KING STREET
SHIPPENSBURG, PA 17257-1397
_____n_ fold
ESTATE INFORMATION: SSN: 201-16-0753
FILE NUMBER: 2105-0866
DECEDENT NAME: MILLER ALICE M
DA TE OF PAYMENT: 12/20/2006
POSTMARK DATE: 12/20/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/27/2005
NO. CD 007586
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $12,928.46
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$12,928.46
REMARKS:
CHECK# 112
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS