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I fiLl NUMRIR
INIlSNITANCE TAX RETURN
nfSIDF.NT DECEDENT
cOMMo~~~I~\'~It'ij,Pim~Ul^"1A lTO l\E FILE~ IN DUPI.ICATE
HMlllfJlU~O~l\'~.06OI WITH REGISrER OF WILLS) COIJNIV CODE VfA~ NUMRltl
-=-'-=-'fiiIWC,ff'rnAM' 1;,,~r:-Iil!i.-mtJmoiil(1NffliO'---"~' ,---., -~-- --.--"'-- ,,",- - fiEcThHi1'S(6),ffirl-.m(;\''-- -- -... ...--~..--"-",-,--, .
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IC~lml'ftfilfi'N\il~pt, - -' 'jllAlnlf or,lt" -IDAft IJF ,.,,',f' 375 Claremont Drive
235-05-34] 4 6/29/93 3/] 6/16 (,~;~lr lisle, PA 17013
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Ii{] I, Ollglnol ~.'u(n II 2. Surpl.""/llol R.h',n 1:1 :I. R.mnlnd81 R.'urn
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MI.,~~~'h '01' 01 WI~tfli:C~N.iiiiiiijAlr-rii~~C.~i~r.;~ sitoiiI.o"i5' DI~.C -lih'OI"--'::;-",-7",-~"---'-:-' :;-,- -;--.
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I. R.al Ellol. (Seh.dul. AI ( II .....___..
2. Sln,kl and 6andl ISeh,c1ul. 61 ( 21 . ... ...._..__.__.....__..
3, Cla,.ly H.ld Slo,k/Patlnellhlp Inl.r.IIIS,h.dvl. C) (31.......... _.. _ . .... ...._ _... ..___..
4, Morlgag.1 ond Nal., R.,olvabl, (Scheuul. D) I 41 . '.... .......... .........m_'''_
5, Calh, Bank D.pallll & Mh"lIan.av. P."anol Properly I 51 ,.._1t Z;!;l_!}3 _.__...._....
(Sch.dul. E)
6, Jointly Own.d P'.p"ly IS,hedul. FI I 61 . ...._..... ..u.___.....___..._._
7, Tranol... ISeh.d.l. 01 (S,h.dul. L) I 71 .Uh__.._.._....'C'_.._......_
6, rolal Grall AII"III.'"ll1n.' 1,71
9, Fvneral E.P'OUl, Admlnlllrallv. Ca,", MI".lIan.aUl ( 91 ___...277.00
Exp.no'l ISch.d.I. HI
93.00
10, D.bll, Martgag. lIablllllll, ll.nl (S,h.dul. II (101_____..,______ 370.00
11. Talal O.ductlonlllalallln.. 9 & 10) (11) _______.__.__u...
12, N.I Valu. of Ellal.llln. 6 mlnUllln. 111 (121'..1,.361..33.......,.....__. ..,..
13, Cha,lIabl. and Governm.nlal 6ecIV.IIIIS,h.dvl. JI (131 ..__:9:,____.._._......
__._ 14, N.I V~I...Svblecl ,1~T~~J!!!>.!_12 mln.'!ll~~_I~L ...___..______,_,___..__.l!~. _ ~f~~:;;~_1=.:::-:--:.::..::,":::::.:,
15, Ama.nl of IIn. 14 laxabl. a, 6% rat. (l51__~.JE.3~33....___m...._)( ,06.. __.__BJ~~!L...u__.._._..n._
(Includ. valu.. I,am S,h.dvl. K or S,h,dul. M.I .
16, Amounl of IIn. 14 tOKabl. 01 15% ral. (161.._...____._._..._________)( ,15 II ..__..__...._..__ ..__
(Incl.d. valv., from S,h.dul. K or Sch.d.l. M.)
B1. 80
17, Prln,lpal lax dv. IAdd laxlrom Ilno 15 and Iram IIno 16,1 (171 ..____.._________..__.....
16, Credlll Prior Paym.nl' DIlCnvnl Inl.'.11 -0-
___.....__....._ + ..._.........___..u.... ..............._..._..... (16) __'___.m____..___.._......
19. If lin. 16 I. gllalerlh", 11,,017, .nt., Iho dlff.r.n,o 0' IIno 19, Thl,lllh. OVtiRPAYMfiNT, (l91...._.......,,_____.._u_...._..u..._..
1110 B1.80
20, If IIn. 1711 gllal.r Ihan IIno 16, .nler Ih. dllf...n,o on IIn. 20, Thh h Ih. TAX DUE, 120) ____..__..._._.u ._.____._..
A, Enler Ih. Inl""1 an Ih. balanc. due on IIn. 2DA. (20AI ...__....._._...__............_
B, Enler tho tolal 0111.. 20 and 20A '" IIn. 2DB. Thll h Ih. BALANCE DUE, (20BI ....__...__...........___..___..._..
Mak. Cbeck Payabl. '01 R.ghter of Will., Ag.nt
-.[,J "'eo" .,' - :',..,.~Uu..lo~iViiAi~ QU~.li'l)-~~~jlV.~..iD!lN!!.1b..ij 'H~C;K . . ,", 0:21.2'1;;",.~~_~':'~
Und.r Plnalll.. of perlury, I dedar. Ihall have uumlned Ihl. 1,lurn, Including accompanylno IChedulol and IICll0monll, and 10 Ih, bell of my MVllodgtl and ballur,
It It tru., corrlcl and complejo. I d.daro Ihal all r,ol 1.lulo hal been r,porled ollruo markt' valvo. Oeclarclllon of rroparor olher Ihon Ih, plrlDuol roprolonlullvo I~
:E!'~~~~~II~t! prep~:;;~IJ~~".Ov<.I'~2~timl~fi~~~~r~~o-'~6~tf"N~W;"'-'''------ --- ~~~'~'-;-q~ -/ ~9 ,{
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~) IN THE
APPROPRIATE BLOCKS... '.', .
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1. Old decedent make a transfer and:
f d 'b '
a. retain the use or Income 0 the property transferre , """.."""".."""......."".."
b. retain the right to designate who shall use the property transferred or Its Income,
x
x
1
c. retain a reversionary Interest or .., .....,.. t .... "'....... .t..... "I'.. ..... II'" fl.... '"" '" It II',
x
d. receive the promise for life of either payments, benefits or care~ """..."....""....
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adeauate conslderation~ If death
occurred after December 12, 1982, did decedent transf'Jr property within one year of
death without receiving adequate conslderation~ "".""""""."."""...."""""........
3. Old decedent own an 'In trust for' bank account at IllS or her deathL.""..",,".......
x.
x
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. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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ESTATE OF JAMES S. SMITH,
Deceased,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. cf 1994
PE~ITION FOR DISTRIBU~rON OF S~ ESTATE
UNDER SECTION 3102 OF THE PROBATE.
ESTATES AND FIDUCIARIES CODE
TO THE HONORABLE, THE JUDGES OF SAID COURT:
The Petitioner, Dora M. smith, by and through her attorneys,
Fowler, Addams, Shughart & Rundle, petitions the court as
follows:
1. The Petitioner is Dora M. Smith, an adult individual
residing at 817 Gertrude Place N.W., Atlanta, Georgia.
2. The Petitioner is the surviving spouse of James S.
Smith, deceased, who died June 29, 1993, while a resident of
Cumberland County Nursing Home, Carlisle, Cumberland county,
Pennsylvania.
3. The Petitioner and the deceased were lawfully married on
November 24, 1945, at the Wheat Street Baptist Church, Atlanta,
Georgia, with Pastor William H. Borders officiating.
4. James S. smith died intestate with no surviving parents
or issue.
5. The PetitioTler is the sole heir of the deceased.
6. The only property owned by the deceased at the time of
his death is a Guest Fund account at Cumberland County Nursing
Home, which on the date of his death had a value of $1,733.33,
and which has a present value of $1,696.79.
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VERIFICATION
"
Dora M. smith hereby verifies that the facts set forth in
" the foregoing petition are true and correct to the best of her
knowledge, J.nformation and belief, and understands that false
statements herein are made sUbject to the penalties of 18 Pa.
C.S. 54904 relating to'unsworn falsifications.
fJ.JL,'tJ,/ h-,. ~~
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.DATEINla.~ 1~1"94
\
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RIV.1547 EX APP (10.93*
CDltltOltWUlTH Of PtlNltSVLVlNU
IllPIIITIENT Of REYfNIJE
BUREAU Of INDIVIDUAL TAMES
IllP', 110601
""..IIIURO. PA mll.06Ol
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX
ACN 101
DATI 08-01-94
FILl NO.
DATI OF DEATH 06-29-93 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORN WITH YOUR TAX
PAYHENT TO THE REOISTER OF WILLS. HAKE CHECK PAYABLE TO "REOISTER OF WILLS, AOENT"
REMXT PAVMENT TOI
MICHAEL R RUNDLE ESQ
FOWLER ETAL
PO BOX 208
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
I
AMount R.M! Uad
-
CUT ALONG THIS LINE ~ RITAIN LOWER PORTION FOR YOUIt RECORDS ~
R IV: iii4'7 - E i("A FP- -i Hi: 9iT"iliii'"icE--oF - INHEiiiTAiiC'i. i'AX-iitijiii'A"i SEHiilr; -Ai. i."OWANC'i- iiii- __m_ ----- -- - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SMITH JAMES S FILE: NO. 21 94-0272 ACN 101 DATE 08-01-94
TAK RETURN WAS I (X) ACCEPTED AS FILED () CHANOEd ( ,
RESERVATION CONCERNING PUTURE INTEREST . SEI! REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Raal E.toto (Sohadull A) III
2. Stook. ,,"d Banda (Soh.d"l. BI 121
S. Clol.ly Hald Stook/Plrtnarlhlp Intaralt ISohadul. CI 151
4. Hortgagal/Not.1 R.oalv.bl~ (Schldul_ 01 141
S. C..h/Bonk Dapollh/Hllo. P.rlonll Proparty (Sch.wla EI IS)
6. Jointly Own.d Prop.rty (Schadula F) 161
7. Tr.nlfarl (Sch.dula 01 (7)
B. Total A..atl
.00.
,00 '
,00
,00
1.733,33
,00
.Ot
(8) _--L733.33
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. Fun.ral E.Pln..I/AdMlnlltr.tlvl CO.tl/
Hllc.Ulnlou. E.p.n... ISchadula HI (9) 277.00
10. Dabh/Hortgag. Ll8bIlIUu/L1an. (SohalMa II llDI 93.00
11. Totol Dlductlonl (UI
12. N.t Valua of T.. Rlturn 1121
15. Charltabla/Gov.rn..nt.l Baqu..to (Sohad\.la J) (131
14. N.t VIlua of Eltotl Subj.ct to Ta. 1141
If .n ......m.nt w.. illuld pr.viou.ly, lin.. 14/ 15 .nd/or 16 and 17 will
r.fl.ct figur.. th.t inolud. the tot.l of ALL r.turn. ...ell.d to d.t.,
ASSESSMENT OF TAXI ---
15. AMount of Llna 14 to.lbl. .t 6% rato 1151._.
16. AMount cf Llna 14 to.lbl. .t 15% r.to (161
17. Principal Tu Dua
TAX CREDITS I
PAYHENT
DATE
370.00
1,363,33
,00
1,363,33
NOTEI
1,363,33 K.06 =
,00 K.15 =
1171
81,80
,00
81.&!
RECEIPT
NUHBER
DISCOUNT It I
INTEREST (-I
All0UNT PAID
03-22-94
856060
.00
81,80
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
81,80
.00
.00
.00
It IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS TNAN II, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl, YOU HAV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
I.
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.IQYATlDlh Eltltll 01 cleo_tl dVlnt on 0. bolore Do<l_. II. 1912 .. If ..,y lutu.. Intl,"t In the IIllt. II 1'..,II...lId
In po.....lon or enJll~t to ell" B ('Ool1l',r.l.l IMIMflollI'l.. of thl decadent after thl l)lplnUon of 1f1~ ..tit, for
U(, or far Yllr., the t~.1th herebY l)Cpr...!v "..rvII the rJlht 1'0 IPPf,h. 1M 1..1.. trln.f.r InherJ.tInClITIXII
It thl lwful Cl... . (coUatlral) rata on eny IUQh future Inter..t.
PUlPDSl! Of
1I01ICEI To MIIII lhe ..",,1'_11 01 Stollon 1140 01 thl 1",,".11_ end Elt.11 11. Aol. 101 II 01 11m. 71 P,S.
Beollon 1140,
PAVttENTt DttKh thl top portion of thh Notlel and ,ubllt with your PlY""' to the A-ellter of Nllll prJnted on the r.var.. .ldI.
--110I<1 chook 0. ...,.yorder ply...11 101 REOISTER OF MILLS, AllEHT
AU plYMntl rea,lv" thlll Ur.' be ftPPllud to InY Int.r..t which ..y bl duI; with MY r..lnder .,pUtd to the tl)C,
RlFUND (eAJ I A r.food of I ta)C oredlt, which wa. not r.qullted on thl To Return, ..y tHI requt.~.d by oOllPltUng In "AppHoIUon
'or R.fund 0' Plnnlvhenl. Inhlr1tanc. and E,t,t, tllC" CREY.lSlS). Applioation. Ir. ..",111011 at thl OffiCI
of thl RIghtlr of Willi, BnV' of thl ZS Rlvlnue Olltriot Offic.., or by o.Ulng thl ,plotll Z4-hour
""Wlrlng ..rvIol nulbtr. for for.. orderlngl In PInt'l.ylvlI"Ill 1-100-162.2050, outside PIM.vlvM1S1 Ind
within 100111 Harrbburllr.. (711) 711.1094, TOOt (717) 77Z-2252 (Httrlng I"'llred OnlY).
aUCTIONS. Any Plrty ,In Int.r..t !MIt .,U.flad with the .,r.lI....nt, .UoNanCl or dl..llONInc. of dIdlJctlon., or ..........,t
of tlx Clnoludlnu dllcMt or Intar..\) .. .hown on thh Notloa ltU.t obJKt Nlthln .het)' (60) dlv' of rlCllpt of
thlt NotlcI bYI
.-wrltten prot..t to the PA Dlp.rt,,"t of RIVIf'MI, aolrd of AppI,h, DEPT. 2II0Z1, H.rrhtK.Irg, PA 17121-1021, OR
...llotlon to hlva the Jitter detarllned .t audit of thl ICCCQ\t of thl p.rlonll rlflrllent,Uv., OR
....IPIM.l to the Orphlll,l Court.
AllltIN
IITIlATlVE
toRftECrIOHII
FlCltull .rror. dhooVlrld on thlt ........,..t lhould be adcIrl..1d In writing tal PA Depart""t 01 NIVtnUI,
lur.au of Indlvldu,l Tin., ATTHI POlt A.....unt Atvl,w Unit, DEPT. 210601, H.rrhbYrg, PA 17121..0601
PI10M (717) 787-65OS. $" page ! of thl bookl,t "tn.truotlOM for tnhtrltana, ,.x R.turn for II Rlllcltnt
DMtdtnt" (REY"UOl) for." .)Cpll1f\.Uon of IdIlnhtr.Uv.IV correottbl. error..
INTERUT I
If ..,v t.x due h p,ld within thrH (]) clltnd1r IOOthl aft.r tt. dtctdent'. 91th, I flvl perc,"t un dltCCMM1t of
tM tax p.ld It IUolHld.
tntar..t It ch.rged bttimlng with first d.V of delinquency, or nln. (,) lonth. Ind OM (1) dlY 'roe thl d,t, of
dteth, to the dlta of Plveent. leXII Ilfhlch bee... d,Unquent before JlnUlrv .\, 1912 b..,. Interllt at the rl" of
.Ix (6:() Pfrc,"t plr IMJI cIlculatld .t . dlUv rlta of .0111'4. All tl)(l' Ilfhlch blc... dllInquent on II"Id .ft,r
JlnUlry 1, 1911 will bllr intlr..t .t I rat. which will VtrV frOll c.llndtr !l1.r to c.llndar v..r with thet r...
ennounCld by the PA DIp.,t.."t c, RlvlnUI. The epplloabl1 tntlrllt rKtl' for nlz throullh 19" ""
DllCOUNT I
'!!!t Intarllt Rlt. DIllv tntlr.'t Flctcr ~ Intere't Rite Oellv Intlrl.t FlGtor
19S1 lOX .00D5Qa 1986 lOX .000174
1915 16X .0004SS 19S7 'I ,000147
I9IQ. IlX ,000501 19aa-I991 IlX .000SOl
1915 15X ,ODO!!6 1991 9X ,000147
1995'1994 11 ,DDOI9Z
..tnttrllt I. uloul.tld II fc1l01lf1l
INTERElIT . BALANCE OF TAX UNPAID X lMlaER OF DAYS Df,LINQUEMT X DAILY INTERElT FACTOR
..Anv Motlc. ll1ued IU.r the tllC blCOH' dlllnquent will refl_t In Int.r..t celcullUon to 'ift"" UI) dlVI
blVond tM dnt. of thl ......-.nt. If PIV.."t II .Ide 1ft." thl Inttre.t caputlUen dati thown on thl>>
NotlcI, IddIUGnlll Intar..t lIU,t be c.lcuhtad.