HomeMy WebLinkAbout02-06-07
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes . INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2 1 0 6
File Number
1 0 0 0
Date of Birth
17418 3 883
1 1 032 006
12051920
Decedent's Last Name
Suffix
Decedent's First Name
S M I T H
J A N E
MI
B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[Xl 1. Original Return
o 4. Limited Estate
o
o
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 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
E D M U N D J B ERG E R
71792 0 8 9 0 0
Firm Name (If Applicable)
B ERG E R LAW FIR M P C
IGISTiR' OF~ILcS U~ONL V
First line of address
Second line of address
2104MARKETSTREET
City or Post Office
State
ZIP Code
DATE FILED ,.
CAMPHILL
P A
17011
Correspondent's e-mail address:tberqer@berqerlawfirm.net
Under penalties of perjury, 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA E OF PERSONj}ESPONSIBLE FOR FILlN RETUR PO;r-- DATE
dM S 2/1/2007
ADDRESS
2104 Market Street
SIG
PA 17011
DATE 17
/ b
St - C.eR ~ 1ft) (
PLEASE USE ORIGINAL FORM ON Y
f 11- (70/ 1_
Side 1
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15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Jane B. Smi th
RECAPITULATION
17418 388 3
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B)
.................................. 2.
43613268
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D)
........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested. . . . . .. 7.
6662173
8. Total Gross Assets (total Lines 1-7)
........................... 8.
859438
51134879
2072030
258978
2331008
48803871
9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10)
. . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 4 8 8 0 3 8 7 1
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O _ 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable 4 7 8 0 3 8 7 0
at lineal rate X .012- 16. 2 1 5 1 1 7 4
17. Amount of Line 14 taxable 5 0 0 0 0 0 6 0
at sibling rate X .12 17. 0 0 0
18. Amount of Line 14 taxable 5 0 0 0 0 0 7 5 0
at collateral rate X. 15 18. 0 0
19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 2 2 8 6 1 7 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
D
Side 2
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15056042126
15056042126
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Jane B. Smith
STREET ADDRESS
~l>_\lYesley Drive, Apt. 3132
File Number
1000
-
I STATE
I PA
-T~
ZIP
17055
CITY
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
22,861.74
1,143.09
Total Credits (A + B + C) (2)
1,143.09
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
0.00
21,718.65
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
21,718.65
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 [Xl
b. retain the right to designate who shall use the property transferred or its income; ............................... D [Xl
c. retain a reversionary interest; or ................................................................................................ D [Xl
d. receive the promise for life of either payments, benefits or care? ....................................................... D [Xl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D [Xl
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... D [Xl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. [Xl 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.
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 three (3) percent [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 zero (0) percent
[72 P.S. ~9116 (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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [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-1503 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Jane B. Smith
FILE NUMBER
1000
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Avaya Inc. -- 145 Shares @ average price of $12.63/share at date of death
VALUE AT DATE
OF DEATH
1,831.35
2.
Agere Sys Inc. -- 47 Shares @ average price of $17.27/share at date of death
811.69
3.
AT&T Inc. -- 2,238 Shares @ average price of $33.78/share at date of death
75,599.64
4.
Bellsouth Corp. -- 4,948 shares @ average price of $44.30/share at date of death
219,171.66
5.
Comcast Corp. -- 330 shares @ average price of $39.80/share at date of death
13,132.35
6.
Lucent Tech Inc. -- 1,748 shares @ average price of $2.38/share at date of death
4,151.50
7.
NCR Corp -- 168 shares @ average price of $41.14/share at date of death
6,910.68
8.
Verizon Communications -- 2,472 shares @$36.84/share at date of death
91,068.48
9.
Alliance Bernstein Balance Shares Class C
665.478 shares @$17.040 share price at date of death
11,339.75
10.
Blackrock Global Allocation Fund Class C
716.474 Shares @ $16.910 price at date of death
12,115.58
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
436132.68
REV-1508 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Jane B. Smith
FILE NUMBER
1000
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.
ITEM
NUMBER
1.
DESCRIPTION
Merrill Lynch Bank Deposit Program Money Market Fund
VALUE AT DATE
OF DEATH
3,150.00
2.
Belco Community Credit Union -- Checking account
11,598.16
3.
Belco Community Credit Union -- Savings Account
2,092.51
4.
Belco Community Credit Union -- Money Market
35,443.06
5.
Personal Possessions -- Household Goods, Furnishings, Appliances, Electronics,
See Attached Schedule
4,338.00
6.
Estimated Proceeds from Settlement of Personal Injury Claim
10,000.00
TOTAL (AlSO enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
66,621.73
REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Jane B. Smith
FILE NUMBER
1000
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OFTRANSFER. ATTACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST VALUE
I'F APPLICABLE)
1. Individual Retirement Account Held at Belco Community 8,594.38 100. 8,594.38
Credit Union -- Transferees (Post Date of Death) Nancy
Stinson and Eric M. Smith, Jr.
TOTAL (Also enter on line 7 Recapitulation) $ 8 594.38
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jane B. Smith
FILE NUMBER
1000
ITEM
NUMBER
A.
1.
2.
3.
4.
5.
6.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Rolling Green Cemetery -- opening of grave, burial service
St. Stephen's Music Director -- music for service
Rev. Churchill Pinder -- officiating church service
St. Stephens Episcopal Cathedral -- use of Cathedral for service
Joan Esham, Sextant, St. Stephans
Musselman's Funeral Home -- Services, casket, etc.
1,195.00
150.00
300.00
150.00
75.00
7,204.26
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Nancy Stinson
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 212 Governor's cou rt
0.00
City Philadelphia
State P A
Zip 19146
Year(s) Commission Paid:
Attorney Fees Estimated Attorney's Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
10,000.00
Street Address
City
State
Zip
Relationship of Claimant to Decedent
Probate Fees Cumberland County Register of Wills
380.00
Accountant's Fees
Tax Return Pre parer's Fees
Carlisle Sentinel -- Legal Notice
Cumberland County Legal Journal -- Legal Notice
Mailboxes, Etc. -- Overnigh Mailing of Bequests
Canada Post -- Registered Mail of Bequests
Hartman & Scheuchenzuber -- Advice regarding Administration of Assets
Turnpike Tolls
Printing Supplies
Truck Rental
CSS -- Storage Unit
Boxing Supplies
Postage Costs
144.29
75.00
80.55
34.12
390.00
30.00
52.67
15.90
282.40
78.30
82.81
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
20 720.30
REV-1512 EX + (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jane B. Smith
FILE NUMBER
1000
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Verizon Communications -- telephone bill 55.30
2. Com cast -- cable bill 28.13
3. AT&T 12.83
4. Bethany Village Skilled Nursing 32.00
5. US Treasury -- 4th Quarter Estimated Taxes 350.00
6. Pa. Dept. of Revenue -- 4th Quarter Estimated Taxes 100.00
7. Bethany Village -- Maintenance Fee 2,011.52
TOTAL (Also enter on line 10, Recapitulation) $
2,589.78
(If more space is needed, insert additional sheets of the same size)
",.",,,,, '"*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jane B. Smith
SCHEDULE J
BENEFICIARIES
FILE NUMBER
1000
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not ListTrustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Nancy Smith Stinson Lineal 224,019.35
212 Governor's Court
Philadelphia, PA 19146
2. Eric M. Smith, Sr. Lineal 224,019.35
4946 Meganwood Lane
Jacksonville, FL
3. Eric M. Smith, Jr. Lineal 10,000.00
207 Wander Ct.
Lexington, SC 29072
4. James D. Smith Lineal 10,000.00
66 Craig St, Apt. 11
Somerville, MA 02143
5. Mr. Daniel Smith Lineal 10,000.00
4654 Wetz
San Antonio, TX 78217
6. Richard P. Black Sibling 5,000.00
44 Lillis Rd
New Milford, CT 06776
7. Ms. Carolyn Black Collateral 5,000.00
2485 Robinson Park Trail, Lot 9
Supply, NC 28462
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)
REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death:
Discount:
Interest Table
i Year
I
I ...~.~--.-
'I Before 1981
. 1982
11983
i 1984
: 1985._._.__
i 1986
! 1987
[J 988 through 19
1.1992
U993J!:uough 19
11995 through 19
1_1999__
~..?ooo
12001
12002
I 2003 _...._
I
l_?.Q9~_____
· 2005
i 2006
t--
1....-.-
I
I
I~~'--~---
i
i.m_-~
l..._.._.._
L TOTALS
22.861.74
1.143.09
.----..-I.---~ I -.--- .- I
Days Delinquent Balance Due Interest
this time period this year this period
...~
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Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Penalty: _______.
Total Balance Due on January 17, 1996:~.
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NOTICE
THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE
PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE
YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE
DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE
NOTICE TO YOU OR APPROVAL BY YOU.
THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR
AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE
EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR
BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE
THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME
INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF
THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON
YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR
AGENT'S FUNDS.
A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT
FINDS YOUR AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF
ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO
EXPLAIN IT TO YOU.
I HA VB READ OR HAD EXPLAINED TO ME THIS NOTICE AND I
UNDERSTAND ITS CONTENTS.
~
Jle.e-. / J-. 0 (p
,
Nancy Stinson Executrix of the Estate
Of Jane B. Smith
(Date)
Power of Attorney Notice for Nancy Stinson, Executrix of the Estate of Jane B. Smith
Page 1
DURABLE POWER OF AITORNEY
OF
NANCY STINSON,
EXECUTRIXOF THE ESTATE OF JANE B. SMITH
Edmund J. "Tad" Berger
Berger Law Firm, P .C.
2104 Market Street
Camp Hill, PA 17011
TABLE OF CONTENTS
ARTICLE I
Introductory Provision 1
Statement of Intent to Create Durable Power of Attorney Under State Statute 1
Delegation of All Powers Lawful to Delegate 1
ARTICLE II
Introduction 1
Power With Respect to Legal and Other Actions 1
ARTICLE ill
Sign Documents and Incur Costs in Implementing the Agent's Instructions 2
Power to Do Miscellaneous Acts 2
ARTICLE IV
Third Party Reliance 2
ARTICLE V
Immediate Power 3
ARTICLE VI
Introduction 3
Waiver of Acts of Omission and Commission 3
Waiver of Duty to Produce Income, Authority for Transactions between Agent as
Agent and Agent as Individual and Eligibility of Agent to Serve in Other
Fiduciary Capacities for Principal 3
Severability 3
This Instrument Unaffected by Lapse of Time 3
Agent Authorized to Sign Power of Attorney Forms 3
Revocation and Amendment . 4
Agent's Resignation and Selection of Substitute 4
Agent's Death, Incapacity, or Resignation and Selection of Substitute 4
Counterpart Originals 4
Photocopies 4
Binding Effect 4
Notarial Acknowledgment 6
DURABLE POWER OF ATTORNEY
OF
NANCY STINSON
ARTICLE I
INTRODUCTION
Introductory Provision. I, NANCY STINSON, Executrix of the estate of Jane B.
Smith as principal (the "Principal") have this day appointed Edmund J. Berger to serve as my
agent ("Agent") in my capacity as Executrix and to exercise the powers set forth below.
Statement of Intent to Create Durable Power of Attorney Under State Statute. By
this instrument I intend to create a Durable Power of Attorney under Pennsylvania law.
Delegation of All Powers Lawful to Delegate. I herewith delegate to my Agent the
powers identified in this instrument.
ARTICLE n
ASSET POWERS
Introduction. My Agent is authorized from time to time and at any time, with respect to
any and all of the property and interests in property, real, personal, intangible and mixed, of the
Estate of Jane B. Smith, to perform .the following acts as permitted under the law and to the
extent allowed by Section 3319 of the Probate, Estates and Fiduciaries Code ("PEF Code"), and
as set forth more specifically in Chapter 56 of the PEF Code:
(1) Power to Engage in Real Property Transactions;
(2) Power to Engage in Tangible 'Personal Property Transactions;
(3) Power to Engage in Stock, Bond and Other Securities Transactions
(4) Power to Handle Interests in Estates and Trusts;
(5) Power to Pursue Claims and Litigation;
(6) Power to Pursue Tax Matters.
Nancy Stinson, Executrix of the Estate of Jane B. Smith
Page I
ARTICLE m
INCIDENTAL POWERS
In connection with the exercise of the powers herein described, my Agent is fully
authorized and empowered to perform any acts and things and to execute and deliver any
documents, instruments, affidavits, certificates and papers necessary or appropriate to such
exercise or exercises.
(1) Sign Documents and Incur Costs in Implementing the Agent's Instructions.
My Agent is authorized to sign, execute, endorse, seal, acknowledge, deliver, and file or record
instruments and documents appropriate to effectuate the powers delegated herein; to incur costs
on my behalf and to promptly pay such costs, and to expend my funds and to liquidate my
property or to borrow money to produce such funds needed.
(2) Power to Do Miscellaneous Acts. My Agent is authorized to open, read, respond
to, and redirect my mail; to represent me before the U.S. Postal Service;; to take and give or deny
custody of all of my important documents; to execute documents on my behalf.
ARTICLE IV
TIDRD PARTY RELIANCE
Third Party Reliance. For the purpose of inducing all persons and entities, including
but not limited to any physician, hospital, nursing home, health care provider, bank, broker,
custodian, insurer, lender, transfer agent, taxing authority, governmental agency, or other party to
act in accordance with the instructions of my Agent as authorized in this instrument, I hereby
represent, warrant, and agree that: i) if this instrument is revoked or amended for any reason, I
and my estate will hold any person or entity harmless from any loss suffered, or liability incurred
by such person in acting in accordance with the instructions of my Agent acting under this' .
instrument prior to the receipt by such person of actual written notice of any such revocation or
amendment; ii) the powers conferred on my Agent may be exercised by my Agent alone and my
Agent's signature or act under the autltority granted in this instrument may be accepted by
persons as fully authorized by me; iii) no person who relies in good faith on the authority of my
Agent under this instrument shall incur any liability to me; iv) no person who relies on any
affidavit or certificate under penalties of perjury that this instrument specifically authorizes my
Agent to execute and deliver to such person shall incur any liability to me; v) all persons from
whom my Agent may request information regarding me are released from any legal liability
whatsoever to me, my estate, or my personal representative for complying with my Agent's
requests; and vi) I hereby authorize all physicians and psychiatrists who have treated me, and all
other providers of health care, including hospitals, to release to my Agent all information or
photocopies of any records which my Agent may request and I hereby waive all privileges which
may be applicable to such information and records.
Nancy Stinson, Executrix of the Estate of Jane B. Smith
Page 2
ARTICLE V
DURABILITY PROVISION
Immediate Power. This power of attorney shall not be affected by my subsequent
disability or incapacity, or lapse of time.
ARTICLE VI
ADMINISTRATIVE PROVISIONS
Introduction. The following proyisions shall apply:
(1) Waiver of Acts of Omission and Commission. My Agent (and my Agent's estate
and executor or administrator), acting in good faith, are hereby released and forever discharged
from any and all civil liability and from all claims or demands of all kinds whatsoever by me or
my estate and executor or administrator arising out of the acts or omissions of my Agent, except
for willful misconduct or gross negligence.
(2) Waiver of Duty to Produce Income, Authority for Transactions between Agent
as Agent and Agent\ as Individual and Eligibility of Agent to Serve in Other Fiduciary
Capacities for PrincipaL My Agent shall have no responsibility to make my property
productive of income, to increase the ,:,alue of my estate or to diversify my investments. My
Agent shall have no liability for entering into transactions authorized by this instrument with my
Agent in my Agent's individual capacity as long as my Agent believes in good faith that such
transactions are in my best interests o~ the best interests of my estate and those persons interested
in my estate. My Agent shall be eligible to serve in all other fiduciary capacities, for me or my
benefit (but not in my place where I may serve as a fiduciary for others), including but not
limited to serving as Trustee, Guardian, Conservator, Committee, Executors or Administrators.
(3) Severability. If any part of any provision of this instrument shall be invalid or
unenforceable under applicable law, such part shall be ineffective to the extent of such invalidity
only, without in any way affecting the remaining parts of such provision or the remaining
provisions of this instrument.
(4) This Instrument Unaffected by Lapse of Time. This power of attorney shall be
legally unaffected by reason of lapse of time or staleness.
(5) Agent Authorized to Sign Power of Attorney Forms. In carrying out the
authorizations set forth in this instrument, if in the sole opinion of my Agent it is necessary or
convenient for my agent to sign my name, as principal, on forms of powers of attorney (the
"Forms") required by governmental agencies, corporations or other entities in transactions with
me, my agent is authorized to execute such Forms, and to appoint an agent or other person on the
Forms to represent.
Nancy Stinson, Executrix of tile Estate of Jane B. Smith
Page 3
(6) Revocation and Amendment. 1bis instrument may be amended or revoked by me
at any time by the execution by me of a written instrument of revocation or amendment delivered
to my Agent and to all Alternate Agents.
(7) Agent's Resignation and Selection of Substitute. If my Agent desires to resign as
my Agent, and there is no successor Agent named in this instrument who is willing and able to
serve as my Agent, and I am incapacitated at the time of such resignation, then on such
resignation my Agent is authorized and empowered to appoint a substitute Agent to act and serve
as my Agent, such appointment to be made in a written instrument that shall be (i) signed by my
Agent, (ii) delivered to my substitute Agent, and (iii) attached to this instrument.
(8) Agent's Death, Incapacity, or Resignation and Selection of Substitute. At any
time after my incapacity, my Agent at any time may appoint a future successor Agent to act and
serve as my Agent in the event that my Agent shall die or become mentally incapacitated or shall
resign prior to my death, and my Agent at any time during my Agent's service as Agent may also
revoke any such appointment theretofore made by my Agent, provided, however, that my Agent
may not revoke, modify or supersede any appointment of a successor Agent made by me in this
power of attorney. Any appointment made by my Agent shall be made in a written instrument
that shall (i) specify the event or events on which such substitution shall become effective, (ii) ~e
signed by my Agent, (Hi) be delivered to my substitute Agent, and (iv) be attached to this
instrument.
(9) Counterpart Originals. If this instrument has been executed in multiple
counterpart originals, each such counterpart original shall have equal force and effect.
(10) Photocopies. My Agent is authorized to make photocopies of this instrument as
frequently and in such quantity as my. Agent shall deem appropriate. Each photocopy shall have
the same force and effect as any original.
(11) Binding Effect. 1bis instrument and actions taken by my Agent properly. .
authorized hereunder shall be binding on me, my estate and my executor or administrator.
NBllcy Stinson, Executrix of the Estate of JBlle B. Smith
Page 4
IN WITNESS WHEREOF, I have executed this Durable Power of Attorney this
December ) "}f , 2006.
-pt S-j-t~
NAN~ON, PRINCIPAL
it 7 -- Y J- -:l.J 7 t.j
Social Security Number
~
Nancv Stinson. Executrix of the Estate of Jane B. Smith
Page 5
I, j have read the attached power of attorney and
am the person identified as the a ent for the principal. I hereby acknowledge that in the
absence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S.
when I act as agent:
I shall exercise the powers for the benefit of the principal.
I shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on
~.. I._~ Pri.'
l{I'~~ . ,ll~
Edmund J. Berger
Ativ.."l'p ni...."tive for Nancv Stinson
/ .~.- ( <6 - <<) (f?
(Date)
Pae;e I
BERGER LAW FIRM, p.e.
A TIORNEYS AT LAW
2104 MARKET STREET
CAMP HILL, PA 17011
TELEPHONE: (717) 920-8900
FACSIMILE: (717) 920-8901
EMAIL: tberger@bergerlawfirm.net
February 5, 2007
Ms. Glenda Farner Strasbaugh
Register of Wills & Clerk of Orphan's Couret
Cumberland County
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Jane B. Smith, Deceased
Dear Ms. Farner-Strasbaugh:
On Friday, February 2,2007, the attached Inheritance Tax Return was filed in
your office. At that time, I was informed that in order for the return to be processed, a
$15.00 filing fee was due to your office. Enclosed please find check number 3026 to
cover the filing fee. The professional courtesy displayed by your staff at the time of my
visit was outstanding.
I have included a copy of the return for date-stamping and return to our office. A
stamped, self-addressed envelope is attached. Please return the date-stamped copy of
the return at your earliest convenience.
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Enclosures
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