HomeMy WebLinkAbout95-00646
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(OMMONWUI'" 0' '(NN,nVANIA
INH"I'.NC' tu 'IfU'H
.nIOIH' DfCIDI,..t
ESTATE OF
ITEM
NUMBER
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
PI.a.. Print Dr T .
FlU NUMBER
SMITH, Ann L.
21-95-646
DESCRIPTION
AMOUNT
1.
Carlisle Cardiopulmonary: Account payable
Smithkline Beecham: Account payable
Bronstein & Jeffries: Account payable
Carlisle Pathology Asso.: Account payable
Belvedere Medical Center: Account payable
Carlisle Hospital: Account payable
Carlisle Imaging: Account payable
215.00
640.00
133.00
2.
126.00
16.55
135.40
215.00
3.
4.
5.
6.
7.
!
,
!
I
!
I
I.
I
TOTAL (AIaD onlo, on IIno 10, Rocopltulollon) $
'" mo,. spoce il n..d.d, insert additional .h"ts 01 lome siz8.'
~' ... '- -- ~, .., -- . - -
v....."'__ ______-..;0._ ___ ____ ___ _ _ ___ _____ _ _ _ __ ___ _ _ _ _ _ _ _ _ __ ___
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Do" 'c. : \'A':A"" \"082251J. .'CO~MONWEALTH OF PENNSYLVANIA '.
"0.", I. . . ,", ., DIPARTMINTOPRIVINUI .
m.};~;.ii.~(i"i;r:.:O"'ICIAL ~ECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
..
RECEIVED FROM.
&
ACN
ASSESSMENT P:'
CONTROL Ii:.I
NUMBER
AMOUNT
BLOOM STEPHEN L
10 E HIGH STREET
!01
.e,67!.10
CARLJSLE, PA 17013
lOtDH",
SSN 176-34-9048
(FIRSTI 1M II
REMARKS
m TOTAL AMOUNT PAID
.e,67l.10
PB
HELEN W HENDLEY
C/O STEPHEN L BLOOM ESQ.
CHECK" l8e6
SEAL
REGISTER OF WILLS
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REV-1547 EX AFP 112-95*
CDH"ONWfALTH OF PENNSVLVANIA
DEPARTHEHT or REVENUE
BUREAU OF INDIVIDUAL TAkES
DEPT. Z.D6U
HARRISBURG, Pi 11121.06Dl
ACN 101
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE D2-27-96
FILE NO.
08-02-95 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTIDN OF THIS FORH WITH YOUR TAX
PAYHENT TO THE REDISTER OF WILLS. HAXE CHECX PAYADLE TO "REDISTER OF WILLS, ADENT"
REMIT PAYMENT TO:
STEPHEN L BLOOH ESQ
HARTSON ETAL
ID E HIGH ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Allount R..Uted
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FDR YOUR RECORDS ....
iiE'v=isW-ii("AFP-nif:95Y-ilorIci--oF-YriHiififAHCE-TAx-jippR'A-isiiiEilT-,--,H.'i."owAHcE-oli--m-m-n--m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ANN L FILE NO. 21 95-0646 ACN 101 DATE
C~ED SEE ATTACHED
ESTATE OF
SMITH
02-27-96
NOTICE
TAX RETURN WAS, ~ I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE DF RETURN BASED ON: DRIGINAL AND SUPPLEMENTAL
1. R.d E.t.to (Sch.dul. AI III
2. stock. and Bond. (Schedul. HJ (2)
3. Clo..ly Held Stack/Partner.hip Int.r..t (Schedule C) (3)
4. "ortgaga./Not.. Rocelvable (Schedule OJ (4)
S. C..h/Dank Depolita/nllc. Parlanol Property (Sch.dul. EJ (5)
6. Jointly Owned Property (Sch.dul. f) (6)
7. Transflrl (Sch.dul. OJ (7)
8. Total A...ta
RETURN ND. Dl
,OD
437,5D
,OD
.00
2.000.00
47,976.43
.00
Illl
5D,413,93
APPROVED DEDUCTION~ AND EXEMPTIONS:
10,435.20
9. Funaral E)(pan.../Am.. Colta/Hhc. E)C'pen.e. ISchedule H) 19)
10. D.bh/Hod;o;. L1.bUlt1.o/L1on. (Soh.dub II nOl 1.480.95
11. Total Deduotion. Ill)
12. Net Value of TaH Return 112)
1S. Charitable/Gover""ent.l a.qu..t. ISchedule J) 11S)
l~, N.t Voluo of E.t.t. Subj.ct tD To. (14)
NOTE: I~ Dn a.....m.nt was i..UDd previou.ly, line. 14, 15 Dnd~or 16, 17 and 18 will
re~lect ~igure. that include the total o~ abb return. e.....Dd ta date.
ASSESSMENT OF TAX:
15. A.~unt of Lin. 14 at Spou.el rat. CIS)
1'. AMount of Line 14 taxabl. .t Lin.al/Cla.. A rate 116)
17. A_ount of Line 14 taxable .t Collateral/Cia.. 8 rate 117)
18. Prlnolpal Tax Due
Tl.qH TG
38,497.78
,00
38,497,78
.00
46,861.43
.00
,00
2,811.69
.00
2,811.69
X .OD.
X .06.
X .15.
lIBl
TAX CREDITS:
PAYHENT
DATE
10-25-95
RECEIPT
HUHBER
AA082257
DISCOUNT 1+1
INTEREST I-I
140 . 58
AHOUNT PAID
2,671.10
PAYMENT MUST BE MADE BY 05-D3-96M.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TGTAL DUE
2,811.68
.01
.00
.01
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN tl, NO PAYHENT IS REqUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" fCRl, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS. I
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RESERVATION. [.tata. of dac.~t. dVlng on or b,'or. D.c..o.r II, 1911 -. If anw future Int.r..t In the ..t.t. 1. tr,",'.rred
In po.....lon Dr enJovaent to CI... I (co11.t.r.l) bene'lcl.rl.. D' thl d.c.dent .ft.r th. .xplr.tlon 0' any ..t.t. fDr
llf. Dr fDr v..r., the Co.aonw..lth herlby IMpr...lv r...rv.. the right to ."ral.. and ...... tren.f.r Inherlt8nC' T.x..
at thl law'ul Chll I (coll.ter.1) nt. on any such future Interllt.
PURPOSE OF
NOrICEI To fulfill the requlrellent. Df S.ctlon nu of the InhlrltMC' and Eltlt. T.IC Act, Act U 0' 1991. 71 P.S.
S.cUon ''''0.
PAYHEHT. D.t.ch the top portion of thl. Hotlcs end lub.lt with your p....nt to thl A.gI.tlr of will. prlntld on the r.v.r.. .Id..
u"ak. ch.ck Dr .oneV order payebh tal REGISTER OF MILLS, ADENT
All p,Ylant. r,cllv.d .h.ll 'Ir.t b. applied to anv Int.r..t which "V ~ due with any r.,.lnd.r applied to the tlM.
AEFUND (CR), A rl'und of . t.1C credit, which w.. not r.qu..tld on the TIIC A.turn, .av b. r.que.tld bV coeplltlng an "Appllc.tlon
for R.fund of Penn'VlvMh Inh.rltanc. and E.ht. hlC" (REY-UUI. Appllcltlon. er. .vIUabl. .t the Offln
of the R.gI.t.r 0' Will., anv of the IS Alv.nue DI.trlct o'flc.., or by c.lllng thl .p.cl.1 I.-hour
an.w.rlnG ..rvlcl nueblr. for for.. ordlrlng' In Pann.vlvanla l-IDO-S62-1050, out.ld. Plnn'vlvanl. and
within locII H.rrhburg ItU 1717) 717-1090\, TOOl (7171 771.2151 murlng 11P.lred Onhl.
DIJECTIOKSI Anv p.rtv In Intlrs.t not .atl.fl,d with the .ppr.I....r.t, Illowlnc. or dl.allow8nC' of dlductlon., Dr ......eent
of t'M ClncludlnG dl.count or Int.r..tl I' .hown on thl. Hotlc. lU.t obJ.ct within .IMtV (601 d.y. of r.c.lpt 0'
this HoUn by,
ADHIH
ISTRATtY!
CDRREClIOHS.
DISCDUH'I
IHlERU',
"wrltt.n pratllt to th. Pi D.pert'ent of A.v.nu., lo.rd of App..lI, D.pt. 211021, ttl"hburg, PA 17121.1021, OR
u.l.ctlon to hlvl thl ..thr d.tareln.d .t .udlt of the ICCount of th. plr,on.1 npn.."t.Uv., OR
--.pp..l to the Orphan.' Court.
Faotu'l .rror. dl.cov.r.d on thl. ........nt .hould bl .ddr...ld In writinG tal PA Dlp.rte.nt of A.VInU4,
lur..u 0' Indhddu.l 'IU', ATTNI Po.t A......ent R.vll'" Unit, D.pt. 280601, Illrrhburg, PA 17UI-0601
Phone (717) 717-6505. I.. p.g. S 0' thl bookl.t "In.tructlon. 'or Inh.rltsnc. T'M R.turn for I R..ldent
Dlced."t" (REy-nOll 'or In ,"planltlon of .dllnhtratlv.h correctabl. .tror..
If any tllC dUI I. p.ld within thr.. (J) c.l.ndlr lIonth. .ftlr the dlCld.nt'. dl.th, a flvl plrclnt (SX) dl.count 0'
the t.1C p.ld I. .llow.d.
Int.r..t I. ch.rg.d big Inning with flr.t d.y of dlllnquency, or nln. (9) lonth. end on. Cl) d.y fro. the dlt. of
dl.th, to the dlt. of p'Ylant. TlIIII, which b.c... d,lInql,Mnt ~'ors Januarv I, 1982 bIer Interllt It the r.t. of
.he (6X) perc.nt per lMUII c.lcul.tld It . d.lly ret. of .00016,.. All tUII Which b.e... d.lInquent on Ind .ft.r
Janulrv I, 19., will b..r Int.r..t .t I r.t. which will vlrv fro. c.llndlr Y.lr to ell.nd.r YI.r with th.t r.t.
~ced bv the PA O.part'.nt 0' R.v~._ 'hi epplleabl. Interllt rltll 'or 1911 thrOUGh 19" erll
~ Interllt R.t. O.Uv Interllt F.etor !!!r Int.rllt A.t. DIlIv Inter..t F.ctor
1911 ..~ .OD05"" 1917 " .00020\7
1913 16~ .OOOUI 1911-1991 1I:C .GOnOl
I". IIX .000301 I'" .~ .00DU7
1915 UX .000156 I99S-I". 'X .000192
1916 I'~ .00027. 1995-1996 .~ .00010\7
--Inter..t II c.lculatld .. followlI
INTEREST. BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAlLY INTEREST FACTOR
--Anv Hotlc. I..u.d .ft.r the tllC blC~' o.llnquent will r.,l.ct an Int.rl.t cllcul.tlon to fl't..n (15) deYI
blyond the dltl of the 1""'lant. If p.y,ant I, ,.d. Ift.r the Int.rl.t coeputatlon dltl .hown on the
Hotlce, Iddltlon.1 Interllt MI,t b. c.lculated.
REGISTER OF WILLS OF CUMBERLAND COUNTY
STATUS REPORT UNDER RULE 6.12
(For Resident Deeedents Dying After July I, 1992)
Name of Decedell/:
ANN L, SMITH
Date of Death:
August 2, 1995
File No.:
21-95-646
Social Security No,:
176-34-9048
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to completion ofthe administration ofthe nbove-captloned estate:
I. State whether admll/lstratiol/ of Ihe estate Is complete:
Yes--x_ No_
2. If the al/swer Is No, state whelllhe persol/al represell/allve reasol/ably believes Ihatthe
admlnlstratlol/wiil be complele:
3. If the allswer to No. I Is Yes, state thefollowlllg:
a, Did the persol/al represell/atlvej/le aj/llal accoul/lwith the Court?
Yes_ No x
b. The separate Orphal/s' COl/rt No. (If allY) for the persollal represelltatlve's
accoulll Is:
e. Did the persollal represelllat/ve state all accoUIII ill/ormally to Ihe parties In
III/erest?
Yes No x
Estate was insolvent other than for jointly-owned assets which passed automatically
on denth to joint owner. No account was necessary.
d.
Caples ofrecelpls, releases,joll/ders alld approvals offormal or III/ormal accoulI/s
may be flied with the Clerk of the Orphal/s' Courl and may be attached to lhis
reporl.
.,. '
~!gl/alilre :
Name:
Address: MARTSON, DEARDORFF, WILLIAMS & OTIO
Or:: Z diE lflf'TeNEast High Street
Carlisle, PA 17013
(717) 243-3341
Counsel for personal representative
: '.>tl
'J1n~
SiCP1i' L, Bloom
-P~
t1<-. &2""~.~
Date: July 31, 1997
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21-95-646
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CERTIFICATION OF NOTICE UNDER RULE 5.6Ia\
Name of Decedent:
ANN L, SMITH
Date of Death:
August 2, 1995
File No.
21-95-646
To the Register:
I certify that notice of beneficial Interest required by Rule 5,6(a) of the Orphans' Court Rules wab '
served on or mailed to the following beneficiaries of the above-captioned estate on or about October 25,
1995:
~
Address
Raymond C. Smith, Jr,
Michelle Ann Dymond
Raymond C. Smith III
295 Old Stone House Road, Mechanicsburg, PA 17055
Box 25, R.D, 7, Landlsburg, PA 17040
73 Channel Drive, Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A
Date: October 25, 1995
Signature
Name
__~ ~ ~c.-
Stephen L, Bloom
MARTSON. DEARDORFF, WILLIAMS & 0110
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Counsel for personal representative
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21. If lint 18 II gr'OI" thon lIn. 19, .nl., th. din."n,. on L1n. 21. Thh I, the TAX DUE.
A. En't' the Inl.,.., on the balone. due on Line 2 t A.
B. Enl" thl tala I of Lint 21 and 21A on Lint 218. Thl, i. th. BALANCE DUE.
Malee Check Payabl. tal Regll'" of Will., Ag,n'
~ ~ BI SUR! TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHICK MATH -<-<
Und.r plnclli.. 01 perjury, I did or. Ihot I have uomin.d Ihl. relur", including accompanying Ich,dul.. Dnd ,Iaflm.nll. and to Ih, bill of my knowledgl and b,li,f.
it II 'rue, (O"I,t and comple't. I declor. thot 011 '101 1.laf. has b..n '.ported 01 trUt market valu.. O.c1aration 01 pr.por., alh" than th, p,nonol rtpr..,nlah..., i.
b on all Information a. which pr.por., hOI any kn Ildg..
SID TURI O' 'USON 'p"SJlU . ILING.n 'N "'DO.U~ 9 5 0 1 d DAn
~ ~ Stone House Road
... -- ~; /u,,).C/Cjs-
:zUIIII 0' "1Il'. Itl;2U ftI If~. eNfA11'1 A,OD.U:tr. 0 E t H' h ~t t OAf!
-' .' .i ~as .1.9 .;I ree J J
_ .>' _" , ----- C'arlialo..--AA--1-7-0.l-J 10, ? ", 'i!;(
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'01 DAmO.DlATHAFTIR 12/31191 CHICKHIRI
" A SPOUSAL
POVIITT CRIDIT IS CLAIMID 0
PILI HUMIII
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
8
lil
bl
co
COMMONWIAUH Of 'IHNSoYLYANIA
Df'AIfMINf Of R1YINUf
DIPr 210bO
H''''''UOO.'' 17 "....,
D (I (N'S AM LA . I . AND MIDDlI INI IAll
SMITH linn L
$OCIAl UCUII" NUMIU
Road
17055
21
COUNTY CODE
01 lOIN" MPU I A 11.I15
95
VEAR
646
NUMBER
295 Old Stone HOllE
Mechanicsburg, PA
c..
AMOUNT IIIICII\I(O 1IIlIN".UClIONII
176-34-9048
SMITH Ra mond C.
[l! 1. O,lglnol Rllu,n
o 4. lImll.d Ellol.
o 6. D.c.d.n, DI.d T .stal.
(AHoch copy 01 Willi
AND
Jr.
o 2. Suppl.m.ntal R.lurn
03.
05,
R.malnd.r R.lurn
(10' dol.. of d.olh prlo' 10 12.13.821
F.d"al Eliot. Tax R,'urn R.qui"d
040.
o 7.
Future Inl"It' Compramllt
(10' dol.. 01 d.o,h ok.. 12,12.821
D.c.d.nl Malntaln.d 0 living Trusl
(Alloch copy of T rutl)
TAX INFOlMAnON SHOULD I. DlRICTID TOt,,"," .
COM'lUI MAILING ADOIUS
_ 8. Tolo1 Number of saf. D.poslt Bo..s
~m
52
MARTS ON , DEARDORFF, I'II LLIlIMS & OTTO
Ten East High Street
....'.. ';--t. ,'.,
,I ~. '"
Bloom, Es uire
..
s
I
1. R,ol EIIOI. (S,h.dul, Al
2, Slock. ond Bond. ISch.dul, 8)
3. Clo.,ly H,ld Slo../Porln."hlp Inl...II ISch.dul. C)
.c. Mongag.. and NaIll Rec.lyabl. (Sch.dul. 0)
5. Cosh. Bonk D.poslll & Milc.lloneous P.nonol Prop'rlY
(Sch.dul. EI
6. Jolnlly Own,d P,op.rly (Sch,dul. F)
7, T,on.I." ISch.dul. 01 (Sch.dul. l)
B. Tolol Grall Au.,s (talallln.s 1,71
9. Fun.ral bp.n..s, Admlnlstrotl.... CasU. Mlscellan.aus
Ellp.nlt. (Sch.dule HI
10, D.bl., MOrlgog. 1I0bllltl... 1I.n'ISch.dul. I)
11. Tolol D.ductlon.(lolollln.. 9 & 10)
12. N.l Valu. of Eslal. (lIn. 8 minus lIn. 11)
13. Charllabl. and Go....rnm.ntal B.qu"lI (Sch.dul. J)
U. N.t Valu. Sub Id 10 Tax (lIn. 12 minus Un. 131
15. Spousal Trand.rs (far dolll of d.ath aft., 6.30.9~J
5.. Inslrudlons for Applicabl. Per"nlag. an R.v.n.
Sid.. (Includ. ...alu.s from Sch.dul. K or Sch.dul. M.)
16. Amount of lIn. 1~ tOllabl. at 6% ral.
(Includ. \lolu.. from Sch.dul. K or Sch.dul. M.)
17. Amount of lIn. 1~ ,alCobl. 01 15% rat.
(Includ. ...alu.. 'rom Sch.dul. K or Sch.dul. M.I
18. Pr'nclpallall due (Add lax from lIn.. 15, 16 and 17.)
19. C"dils Spousal Pa....rty C,.dit Prior Paym.n,s
o
437.50
o
o
2,000.00
(I)
(21
131
(4)
(51
(61
(71
47.g76.~,
o
10,435.20
(8 )
50,413.93
(9)
(10)
, ,tRO q<;
(111
(12)
(131
(141
11 . Q16 _ 1 <;
38,1,97.78
o
38,497.78
o
~:.Q1.
o
(15)
(161
[See
117)
46,861.43
explanation
g
?, RT T (,q
)C .06.
attached]
)C .15.
8
..
9
S
~
:II
'"
u
1181
2,P'11.6g
Discount
+ + 140.59
20. If lIn. 19I1g"al" than L1n. 18. .nt., th. diff.r.n" an lIn. 20. Thlslllh. OVERPAYMENT.
iii 0
Inl.,.sl
1191
1201
(140.59)
~
...
C'w.dt ''''f{' ., you UIC f(..quustinq n refund 0' your ovcrpuvmenl.
(211
121AI
(218)
? r 671
10
?,671
TO
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Ad .48 of 1994 provld.. for Ihe r.ductlon of the tax rol.. Impa..d on the n.t valu. of Iran"." to or for
the u.. of the .pou.e. Th. rat.. a. pr..crlbed bV the .Iatut. will b..
· 3% (.03) will be appllcabl. for ..tal.. of deced.nl. dvlng on or aft.r 7/1/94 and b.fore 1/1/96
e 2% (.02) will b. appllcabl. for ..101.. of dec.d.nll dvlng on or oft.r 1/1/96 ond b.fore 1/1/97
· 1% (.01) will b. appllcabl. for ..101.. of deced.nl. dyIng on or aft.r 1/1/97 and b.fore 1/1/98
e Spou.allran"." occurring on or aft.r 1/1/98 will b. .x.mpl from Inh.rllance lax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (....) IN THE APPROPRIATE BLOCKS.
YO NO
1. Old deced.nt make a tran.f., and:
o. retain the use or income of the property transferred, .......................................................
x
b. r.taln th. right to d.slgnate who shall use the prop.rty transferr.d or Its Income, ...............
x
c. retain a reversionary int.rslt; or ...................................................................................
x
d. r.c.lve th. promise for 1If. of elth.r payments, ben.flls or car.9.......................................
2. If d.ath occurr.d an or b.fore D.c.mb.r 12, 1982, did decedent within two y.ars pr.c.dlng
death transf.r property without r.c.lylng adequate con sid. ration' If d.ath occurred aft.r
O.c.mber 12, 1982, did dec.denltranaf.r property within one y.ar of d.ath without r.celvlng
adequate consideration.,....... Of.........,............................... I 0..............................................
x
x
3. Old d.c.d.nt own an 'in trust for' bonk account at hi. or h.r d.ath9............,...........,.............
x
".., .
:~; ,IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU M'UST ;COMPUTE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1(')
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ESTATE OF SMITH, ANN L.
NO, 21-95-646
EXPLANATION OF TAX COMPUTATION, LINE 16
Value of transfer of jointly-owned property
47,976.43
Less expenses paid by joint transferee pursuant to 72 PS. 9126 (expenses
to be paid by transferee because estate Is Insufficient to pay):
Attorney's fee 950.00
Probate fee, short certificates 100.00
Filing fee 15.00
Additional probate fee, etc. 50.00
\.115.00
46,861.43
11'#.11&111.'11"
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
~
COMMONWEALTH O' PENNSYLVANIA
tNKllltANel TAX lnu.H
IIIIDINT DICIDINT
21-95-646
Est E OF
SMITH, Ann L.
(All pt.,."'" lolntly-owno" wlth tho Right .f Su",lvonhlp ,"u.t b. dllcloMd on Sch.dul. .)
VALUE AT
DATE OF DEATH
2,000.00
ITEM
NUMBER
DESCRIPTION
1.
1985 Mercury cougar, VIN 1MEBP92FXFH665300
S 2,000.00
(Altath additlanal 8W" )( 11" ,h..tall mor. spa" Is n..dod.)
lIIV.ltotUtIIJ"'1
..
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWfAUH O. rfNNIYLVANIA
lNHUnANCf TAX .nUIN
.!lIDeNT DeCeDeNT
ESTATI OF
SMITH, Ann L.
FlU NUMBER 21-95-646
Joint 'onon'('I'
NAME
A. Helen W. Hendley
- -'-----ADDRE5S------.P- -RELA,.iO-NSHIPTO DECED~
290 Walnut Bottom Road Mother
Carlisle, PA 17013
B.
C.
Joln.IYoOwnod prop,r1y.
ITEM LmER DATE
FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBiI~ JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A 12/87 Farmers Trust Co., checki g
acct #5-58842 5,158.12 50 2,579.06
2. A 12/87 Farmers Trust Co., savings
acct #2-051277 10,372.80 50 5,186.40
3. A 1/89 Dauphin Deposit Bank, money
. market acct #0094245584 19,935.52 50 9,967.76
4. A 4/89 Dauphin Deposit Bank, C.D.
#8000080184 24,656.73 50 12,328.37
5. A 4/88 York Federal S&L a=t
nOO-0157360 7,565.58 50 3,782.79
6. A 11/91 York Federal S&L acct
nOO-0207666 28,264.10 50 14,132.05
TOTAL (AI.o onlor on Iino 6, Rocopltulollon) S 47,976.43
(If more .pace i. needed in.ert addjlional .h..II of .ome lize)
- _.....-_..."~.... -'~....,--~,....,........."..--~"-""---"'~_._'_..,-'"'..~.~-""'~-'~.'"'"~~.. :;.;.
.f'i:'\i;-".''"r.".
FARMERS mr5iiI
TRUST __
,
September 19, 1995
Martson, Deardorff, Williams & Otto
10 E HICh Street
Carlisle PA 17013
Re: Estate of Ann L. Smith SS#176-34-9048
Date of Death: Aucust 2, 1995
Dear Corrine Myers:
In answer to your request concerninc accounts owned, either
separately or Jointly, by the above referenced decedent and the
balance in each account as of the date of death, we have checked
our records and are submittinc the foliowlnc information in
duplicate. We succest that you fiie one of these ietters attached
to the Pennsyivania Inventory forms (RCC) to substantiate the
balance you report.
Note that we have shown the correct recistration for each account.
Aiso, interest accrued to the date of death. if any, Is listed as
a separate ficure,
Checkinc account 11558842 was oricinally opened on 1/1/79. The
account was a joint account titled Heien W, Hendiey or Ann L.
Smith. Ann L. Smith was added to the checkinc account on 12/3/87,
The baiance as of 8/2/95 was $.5,1.52.91 pius accrued interest of
$5.21 for a total of $5,1.58.12. The account was a now checklnc
account earninc 2,10% at the date of death.
Savincs account 1/2-051277 was orieinally opened on 2/11/82. The
account was a joint account tll tied Helen W. Hendley or Ann L.
Smith. Ann L, Smith was added to the checkinc account on 12/3/87,
The balance as of 8/2/9.5 was $10,322.91 plus accrued interest of
$49.89 for a total of $10.372,80, The account was a statement
savincs earnlnc 2,80% at the date of death.
Sincer'dl',
Sh3UJWJ. ~ SlLd-/--.
Shawn~e F.. Smith
Customer Service
One West High Street P.O. Box 220 Carlisle, Pennsylvania 17013 (717) 243-3212
Sc H. "F") ..L~s I Q.. 02.
D
Dauphin Deposit Bank
and Trust Company
MAIN OI'fICE: 213 MAIV<ET STREET, IWlRI8BUno. PENNBYLVANIA 17101
717-2118-2121
Decedent Confirmation
Name: Ann L. Smith
Social Security No.: 176-34-9048
Date of Death (000): 08/02/95
Account No.
Type
Date Opened
or Issued
8000080184
0094245584
------------------------ ------------------------ --------
Certificate of Deposit
Insured Money Market
------------------------ ------------------------ ------------------------
04/03/89
01/19/89
------------------------ ------------------------ -
Date Closed
or Matured
09/25/95 (Maturity)
------------------------ ------------------------ ----------
Date of Death
Balance $24,210.98
$19.902.07
------------ --------------
PLUS
Date of Death
Accrued Int. $445.75
$33.45
------------------------ ------------------------
Joint Owners
(if any) Helen W. Hendley
Helen W. Hendley
----------------
Date of Joint
OWnership 04/03/89
01/19/89
------------------------ ------------------------ ------------------------
------------- ------------------------ ------------------------ ----
Special Call1lents: N/A
Additional ;nfor~.tion .vall.bl. at $20.00 p.r hour. an. hour mini.UN.
Date Prepared: September 7. 1995 Prepared by: Carolyn A. Berkebile
Customer Management Information Dept. (CMI)
Talephone No. (7171 255-2054
FDrM 00-020-218 (REV 7/93)
Page 1 of 1
SCH. "F/~ ~s 3'1--,,/
I ,York
~ ~ ~~!!al
,. 7 ":ASSOCIATION
, .
September 8, 1995
Martson, Deardorff, Williams & Otto
Attorneys and Counsellors At Law
10 East High Street
Carlisle, PA 17013
RE: ANN L. SMITH ESTATE
Dear Ms. Myers,
In reference to your letter dated August 29, 1995 regarding
accounts held in the name of Ann L. Smith, the following
account(s) are held at York Federal.
ACCOUNT
NUMBER
DATE
OPENED
DOD
BALANCE
ACCRUED
INTEREST
HOW TITLED
---------------------------------------------------------------
100-0157360
Helen W. Hendley 04/18/88 $ 7,563.34
Ann L. Smith
$ 2.24
100-0207666
Helen W. Hendley 11/12/91 $28,256.74
Ann L. Smith
$ 7.36
If you have any questions, please call me at (717) 846-8777
between the hours of 8:30AM and 4:00PM,
Sincerely,
.~ FEDERAL SAV.;::<;. i:.LOAN
-.!-J-~.
Donna Shultz
Assistant Manager
Deposit Servicing
ASSOCIATION
sc. H. \1 r .~ I.~15 5 q. b
1n1 !;nllth C:;Aorm~ StrAAt. po. Box 15068. York. Po. 17405.706B
__ .._.____.-..-.~..- ~..__.n."..... ......'.....4..."".."~"...
'IYUII 'h II III .- SCHEDULE H
FUNERAL EXPENSES,
COMMONWIAUH 0' 'lNNSYlVANIA ADMINISTRATIVE COSTS AND
INHUlfANCl fAX lUrUIN MISCELLANEOUS EXPENSES Plea.. Prlnt ar T e
IlSIDINf DlClDlNf
SMITH, Ann L. 21-95-646
ITEM DESCRIPTION AMOUNT
NUMBER
A. Funeral Exp.nlell
1. Myers Funeral Home, Mechanicsburg, PA 6,882.70
B. Admlnlltratlve CDlt.:
4.
C.
1.
2.
3,
4.
5.
6,
7,
8.
1.
P.nanal R.p....ntDtlv. CDmmllllon.
SodDI S.curlty Numb.r Df PenDnDI R.p....nlotlvo.
Y.ar Comml..IDns pDld
None
2,
AIIDrnoy FoIS: MARTSON, DEARDORFF, WILLIAMS & OTTO
950.00
3,
family Ex.mptlon
ClolmDnt Raymond C. Smith JIll.lotlDnshlp Spouse
AcId.... Df ClolmDnt Dt deced.nt's deoth
SI..et AcId.... 295 Old Stone House Road
City Mechanicsburq SIDle PA Zip CDd. 17055
2,437.50
Probale Fe.. I short certificates
100.00
MlleeUaneDul bpenl.1I
Register of Wills: Filing fee
Reserved for additional probate fee and other
miscellaneous expenses
15.00
50.00
TOTAL (AI'D enter an IIn. 9, RecDpllulatlon) IS
(If mDre Ipace II n..d.d, In.ert addlllDnallh..tl Df lame II.e.1
10,435.20