HomeMy WebLinkAbout01-0617
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Eswre of Clayton M. Smith
also known as
J., I- 0 ,- 1111
Social Security No.
Deceased.
187-60-2066
No.
To:
Register of Wills for the
County of Cumber land in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(ij, who is~~ 18 years of age or older, applies
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at 10 S. Filbert st., Apt. C-8, Mec~anicsburg
(list street, number and municipality)
Decendent, then 37 years of age, died June 8 ,~~ 2001 ,
~ 10 S. Filbert Street, Mechanicsburq, Cumberland County, PA.
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ 15,000.00
$
$
$
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Kurt Smith Brother R.D. 1 , Lock Haven,
Marc S. Smith Brother 527 Penn Avr Rd. Ca
PA 17745
mp Hil16 PA
17 11
THEREFORE, petitioner(~ respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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Marc S. Smith
527 Penn Ayr Road
Camp Hill, PA 17011
JGr)'Lf(J-q
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
"} ss
The petitionerOQ above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best "
of the knowledge and belief of petitioner<1.) and that as personal
representative(lj) of the above decedent Petitioner(ll)~
truly administer the estate according to law. ./
Sworn to. or affirmed ~nd subscribed f .
before ~hiS ~9 day of Marc S. Sm1 th
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No. 21-01-0617
Estate of CLAYTON M. SMITH
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW JULY 2, ~2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
lT IS DECREED that MARC S. SMITH
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to MARC S. SMITH
in the estate of CLAYTON M. SMITH
~ ~ ;(/JLUt; LU1, rt;t1. JtC.~ (L ~u 7:-
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Register of Wills .
FEES
Letters of Administration $ 50.00
Short Certificates( 1) . . . . " . . . .. $ 3 . 00
Renunciation ............. .1.. $ 5.00
JCP $ 5.00
TOTAL _ $ 63.00
Filed . ~p:~,;. ~.,..?9P.~ .. ... A.D. ~ 2001
Richard L. Flacey 07232
3631 ~:ro/~h~uPS'€~J>e~o.)
Harrisburg, FA 17110-1533
ADDRESS
(717)236-9577
PHONE
MAILED TO ATTORNEY JULY 2, 2001
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This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local R~gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7387067
No.
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Local egistrar ~ '1
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Date
Hl05 1.... Rev. 1191
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
D,I(J'E Of mSPOSfTtON
(MOOItl, Day. Yeill")
D 21,2001
L~Yf~ L
2ab.
10 the bnI of In)' knowledge, dealh occurred at lhe time, date and plau alated
(SigllatureandTitIe)
2".
TIME OF DERH DATE PRONOUNCED DEAD ~Month, Day. Year)
...Appx 1: 00 p.. 2.. June 20, 2001
27. PART I: EnIef the ctlIeeIM, k1;ur'IH ot compIicaUonl which caused the death. 00 notenle, the mode 01 dying, such as cardiac Of respiratory sneU. shock Of heart tailure.
Li5I onI~ OM CBUM on each line.
TVPE/PRjNT
'N
PERMANENT
BLACK INK
SEX
2Male
BIRTHPLACE (City and
State or Foreign Country,
17b. Count
CUmber land
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Effects of Chronic Alcoholism
DUe 10 (OR AS A CONSEQUENCE Of):
DUE 10 (OR AS A CONSEOUENCE Clf):
DUE TO (OA AS A CONSEOUENCE OF):
d
WERE AUlOPSY FINOtNGS MANNER OF DEATH
AWdlABLE PRIOR TO
COMPlfTtON Of CAUSE
OF DEATH? Natural
DATE OF INJURY
(Monltl, Day, Year)
v..D
Accident
~ Homicide [J
D Pending Investigation D
D Could not be determined D
No D
Suicide
2..
2... 21b.
CERTtflEA ~ 001)' one)
'CERTlFYlNQ PHYSICIAN (Physician Cforlll)'tog c.wse 01 death when another physician has J,Xooounce;J dealll ilmj COlnplcttJd lltJIIl <'3)
To the_I at my Il.nowM4ee. dea&h occurrH du810 the cauu(a) and.....nner.. ."Ied, . , . . . .
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'PRONOUNCIHQ ANa CERTtFYING PHYS&CIAN (PhY5lCiafl bottJ pronounCing dealtl and certlfying 10 caU:>tl 01 dtJatll)
To &he bHl at mv .~, dUlh occurredalthe tame. dat., and pIac., and due 10 the caUH(aJ and manner.. .'atad
'MEDICAL EXAMINER/CORONER
On &he HUe oil .lUUhlnatlon and/or 1""....lIon. In my opinion, daath occurrMl at the tlma, data, and placa, and due to tha cauaa.a) and
manner.....t.cl......,....,..............,.,.,.......,....,.........................,.,...................,...,. .
11.,
REG
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STATE FilE NUMBER
SOCIAL SECURITY NUMBER
,. 187-60-2066
2001
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RACE. American Indian. ENac.. Whil.. etc
tSpeclly)
white
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SURVIVING SPOUSE
(II wile. Uivem&iden name)
0"'
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live In a
kNln5hip?
twp
Mechanicsburq
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NoD
2
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I onset and d8aIh
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PARTH:
Olhef liQnUicant conditiona contlibuting 10 death, but
nol reding In the unQattying cause given In MAT I
INJURY AT \'tIORK? DESCAI8E HOW INJURY OCCURRED.
Yes 0 NoD
D
Coroner
u;:':"'I'I":l'ltll!
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NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE Of OEATH
(llem27) Type or Prino Michael L. Norris, Coroner
6375 Basehore Road, Suite #1
Mechanicsburg, Pa. 17050
)S
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Register of Wills of Cumberland County, Pennsylvania
RENUNCIATION
Estate of Clayton M. Smith,
Deceased
No. 21-01-617
The undersigned, Kurt A. Smith, brother of the above Decedent, hereby renounces the
right to administer the estate and respectfully requests that Letters of Administration be issued to
decedent's brother, Marc S. Smith.
~
WITNESS, my hand this :tl day of
~s(~
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF
On this, the ~ day of ~ ' 2001, before me, the undersigned
officer, personally appeared Kurt A. S th, known to me (or satIsfactonly proven), to be the
person whose name is subscribed to the within instrument, and acknowledged that he executed
the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
a~~~/~.~
( Notary Public
My Commission Expires:
NOTARIAL SEAL PublIC
c.amitla M. l'Iendrbt, Notary eountv
I ~~~=01.2001
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Clayton M. Smith
Date of Death: June 8, 2001
Administration No.: 21-01-0617
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court
Rules was given to the following beneficiaries set forth on the attached list on July 13,2001.
Notice has now been given to all persons entitled thereto
Ri d L. Placey, Esquire
ttomey for the Estate
3631 North Front Street
Harrisburg, P A 17110
(717)236-9577
~--~
Date: July 13, 2001
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ESTATE OF CLAYTON M. SMITH
NOTICE GIVEN TO:
Kurt A. Smith
R.D. #1, Box 480
Lock Haven, P A 17745
Marc S. Smith
527 Penn Ayr Road
Camp Hill, PA 17011
\RE\l-15l1O EX ~
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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
It,;, - ;l 'I tJ.. l'
FilE NUMBER
2 1_ 0 1 061 7
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DECEDENT'S NAME (lAST, FIRST, AND MIDDlE INITIAl)
SMITH, Clayton M.
DATE OF DEATH lMtMID-YEAR) DATE OF BIRTH (WMlD- YEAR)
June 8, 2001 January 24,
QF APPlICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDlE INITIAl)
n/a
IXJ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (AIIach QlpJ aiM)
o 9. Litigation Proceeds Received
COUNTY CODE YEAR NUMBER
SOCIAl SECURITY NUMBER
187 - 60
2066
1964
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAl SECURITY NUMBER
o 2. SuppIementaJ Return
o 4a. Future Interest Comprom~ (dale aI deaIl after 12-12-32)
o 7. Decedent Maintained a Living T rust(Allach QlpJ aI TIUSt)
o 10. Spousal Poverty CrediI(daIe aI deelh beIMM 12-31-91 .... 1.1-95)
o 3. Remainder RetUm (dale aI deaIl priot I!> 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit BOxes
o 11. Election to lax under Sec. 9113(A) (AIIadt SdJ 0)
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NAME
Richard L. Placey, Esquire
A"mgrr) Wright
TELEPHONE NUMBER
(717) 236-9577
COMPlETE MAILING ADDRESS
3631 North Front Street
Harrisburg, PA 17110-1533
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or ~ip
4. Mortgages & NOtes Receivable (Schedule D)
5. Cash, Bank Deposits & MisceIaneous Personal Property
(Schedule E)
6. Joi!!lJy Owned Property (Schedule F)
o Separate Billing Requested
7_ lnter-vlVO,'l Transfers & M"ISCe//aneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (1oIaI Lines 1-7)
(1)
(2)
(3)
(4)
(5)
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OfFICIAL ~ ONLY
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13,169.97
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(7)
(8)
13,169.97
9. Funeral Expenses & Administralive Costs (Schedule H) (9) 7 , 4 2 9 . 8 3
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1 0 , 3 7 2 . 0 0
11. Total Deductions (1oIaI Lines 9 & 10) (11)
12. Net Value of Estate (line 8 minus Line 11) (12)
13. ChaIiIabIe and GovemmenlliiBequeslslSec 9113 Trusts for which an election 10 lax has not been (13)
made (Schedule J)
17,801.83
.00
.00
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
.00
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPlICABLE RATES
15. Amount of Line 141axab1e at the spousaJ lax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19) .00
16. Amount of Line 14 taxable at lineal rale
17. Amount of Line 14 taxable al sibling rate
18. Amount of line 14 IaxabIe at collateral rate
19. Tax Due
Decedent's Complete Address:
STREET ADD'fas s. Filbert street, Apt~ C-8
CITY Mechanicsburg I STATE PA I ZIP 17055
tax Payments and Credits:
1. Tax Due (Page 1 Une 19) (1)
2. CreditsJPaymenfs
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A .. B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E.Penany.
. .. Total InterestlPenally ( 0 + E ) (3)
4... If line 2 is greater than line 1 + line 3, enter the difference. this is the OV$PAYMENT.
Check box on Page 1 line 20 to request a rvfund (4)
5~ If une 1 + line 3 is greater than line 2, enter the dilrerence. This is the TAX DUE. . . (5)
A. Enter the interest on the lax due. . (SA)
B. Enter the total of line 5 + SA. This is the BALANCE DUE. (56)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWlN(; QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE. BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;............................,............................................................. D
b. retain the right to designate who shaft use the property transferred or its income; ............................................ D
d. retain a reversionary interest; or.:......................................................................................................................... D .
d.. receive the promise for life of either .paymenls, benefils or care? ...................................................................... D . -
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
............ .. adequate conskIeration' ? D
"'UlUUl recewmg . .................,............................................................................................. .
3. Did decedent own an -m trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
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contains a beneficiary designation? .........................................................................................;............................... ~ .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
19
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DATE
r}::..t) /
Harrisburg, PA 17110-1533
ADDRESS Ric
Placey &
17110-1533
For dates ofdeath on or after July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. S9116 (a) (1.1) @.
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. 99116 (a) (1.1) (ii)~
The statute does not exempt a transfer to a surviving spouse from lax, and the statutory requirements for cflSClosure of assets and filing a lax return are sbll 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)J.
The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116{a){1)).
The tax rate imposed on the net value of transfers to or for the use of the decedenfs 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.
--~.- .
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
CLAYTON M. SMITH
FILE NUMBER
21-01-0617
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned willi the right of sUlViYorshlp must be disdosecI on Schedule F.
ITEM VALUE A T DATE
NUMBER DESCRIPTION OF DEATH
1.
PNC Bank Checking Account #5070009417
(See bank letter attached)
$
10,798.96
2.
Arnold Logistics - back-wages due
1,944.06
3.
Internal Revenue Service - tax relief
176.95
4.
1986 Oldsmobile
250.00
5.
Miscellaneous Personal Effects
NO VALUE
TOTAL (Also enter on line 5, Recapitulation) $ 1 3, 1 69 . 97
(If more space is needed, insert additional sheets of the same size)
AUG-23-2081 03:10
PNCBANK elF DEPARTMENT
412 705 0057 P.01/01
Q PNCBAl'K
Deeedent Reporting
Firstside Center
P7-PFSC-4-F
500 First Avenue
Pittsburgh, PA 15219.3128
ISCP
August 21,2001
Richard L. Placey
3631 North Front Street
Harrisburg, PA 17110-1533
RE: Estate of Clayton M. Smith, Deceased
SSN: 187-60-2066
DOD: 6/8/2001
Dear Mr. Placey:
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#507000'0117
Established 10/17/1991
CLAYTON M SMITH
DOD Balance: $10.798.96 (non-interest bearing)
Our omee only provides date of death balances for IRA '5, CD's, Checking and
Savings accounts. We do ~ Financial Tranl8Ctions or Statement Orden. For
Further information pleue caD 1-8004-BANKER or your local PNC Branch and
ask to speak with a Financial Servien Represeatative.
..
Sincerely,
~~
RachcJlc Sciullo
1-800-762-1775
A member Of lhe PHI: Financ=i., SeM<:e$ G*p
One PNC Plaza 249 Fifth Avenue Pittsbul'9h ~nnsv"'ar\ia 15222 2107
TOTrt. P. 01
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COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETlJRN
RESIDENT DECEDENT
ESTATE OF
CLAYTON M. SMITH
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-01-0617
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
NUMBER
1.
DESCRIPTION OF PROPERTY
INCl.UIlE !HE _ OF !HE lIWISfBlEE. 1IEIR RElAlIlHIH'TO DECEIlEHT AHJ!HE DAlE OF_
ATTACHACllPI' OF !HE IlfB) FOR REAL ESTAlE.
% OF DECDS
DATE OF DEATH INTEREST EXCLUSION
,
TAXABLE VAlUE
Putnam Investments IRA Account
A50-3-175-48-5476-BBB-K.
Beneficiaries siblings, Kurt A.
Smith and Marc S. Smith.
Reported for information purposes
only - nontaxable as decedent
was under the age of 59~.
(See statement attached.)
3,412.41 100% 100%
.00
TOTAl (Also enter on fine 7, Recapitulation) $
(If more space is needed, insert ad<frtional sheets of the same size)
.00
I,jOlJ-27-2D01 89:51
COMMONWEALTH LAND
P.03/04
Year-to-Date Statement
January 1,200 I -June 30. 200 1
PUTNAMINVESTMENTS
ClAYT~ M SMITH
12 S FllBE~T ST APT ca
MECHANICSBURG PA 17055-6551
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Inve&'DNnt firm:
NEW ENGLAND SEOJPJTIES
Reprcaem:ative:
MR.lCtRK M. MYERS
Representative phone number. 1-717.761-0100
For PutMm 1$$1scance: 1-800-225-1581
www.pumalnlnvesrmenu.com
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l:?,;'.i.,:.i~:;.:;i~~~~fi,~~,~~:j
.:,1.,'1' ,...~.t"l 'i~:(,iIj'i.
8~~.;_:{:: ~;;:_:ll1:.~Lfllii~'i~~~Ii1;~ lttn~~
What opporcunlties exi~ now for investan on the sideline~ In the summer 1SSUl! of Putnam EDGE, Jeffrey Knight. Senior ARet AIloation
5~st, points to some compenlng vafues and sugea ways to pt back in. Also in EDGE. read 2bout Putn:un'S new IRA Center at
www.putnamillvascmentS.CDm.
-
Putnam Monfl~ Marltetfund CJ..B
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3.412.41
, .~., '..
Fund CI-8
2.'21.80
$4.060.7D
0.00
$1,412.41
1,253.48
$1,413.41
- l68.li
. $6-41.19
0.00
$3,412.41
Total for tile qtart.I'
(April I . ,..n83O)
$3.25 1.17
$MI2.41
$],411.4'
$1"-24
SM! 2.41
Rath IRA c>>ntrilMlti_ for tax year 2000
$(I.eo RodIlltA Il:ontrlbudons for Ax ~ 200 I
$0.00 I
RoehlRA Start Daou I'"
IIIIII~ III f IIIII~IIII
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COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISlRA lIVE COSTS
ESTATE OF
CLAYTON M. SMITH
FILE NUMBER
21-01-0617
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2.
3.
4.
5.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
DESCRIPTION
FUNERAL EXPENSES:
Malpezzi Funeral Home
Rest Haven Memorial Park - grave opening
Rest Haven Memorial Park - headstone
Funeral flowers
Funeral luncheon
ADMINISTRATIVE COSTS:
Personal Representative s CommIssions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Year(s) Commission Paid:
A~yF~s Placey & Wright
Family Exemption: (If decedent s address Is not the same as claimant s. attach explanation)
Claimant
Street Address
CiIy
Relationship of Claimant to Decedent
Stale
ProbateF~ Cumberland County Register of Wills
Accountant s F~
Tax Return Preparers F~
Cumberland Law Journal - estate advertising
The Patriot-News Co. - estate advertising
Reserve for future costs, taxes and expenses
Zip
Zip
TOTAL (Also enter on line 9, Recapitulation) $
(If more space IS needed, IrlSert additional sheets of the same SIze)
AMOUNT
1,540.00
225.00
1,755.00
42.40
143.48
n/a
2,500.00
n/a
63.00
75.00
85.95
1,000.00
7,429.83
~."\."",, '*'
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
CLAYTON M. SMITH
FilE NUMBER
21-01-0617
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Verizon - debt of decedent
2. PP&L - debt of decedent
3. Commonwealth of PA - vehicle title replacement
4. Commonwealth of PA - vehicle registration
5. Purofirst Capital Region - emergency clean-up services
6. Purofirst Capital Region - repairs to apartment
7. Travelers Property Casualty - auto insurance
8. The Patriot-News Company - classified ad
9. Holy Spirit Hospital - debt of decedent
AMOUNT
48.13
82.87
22.50
36.00
1,007.00
2,570.38
58.66
23.00
6,523.46
TOTAl (Also enter on line 10, Recapitulation) $ 1 0, 372. 00
(If more space is needed, insert additional sheets of the same size)
RfV.1513 EX + (1-91)
+
'*
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
I.
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CLAYTON M. SMITH
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Kurt A. Smith
R.D. #1, Box 480
Lock Haven, PA 17745
FILE NUMBER
21-01-0617
RELA TJONSHIP TO DECEDENT
Do Not List Trustee(s)
Brother
Brother
AMOUNT OR SHARE
OF ESTATE
One-Half Estate
One-Half Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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
2.
Marc S. Smith
527 Penn Ayr Road
Camp Hill, PA 17011
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ .00
(If more space is needed, insert additional sheets of the same size)
I tr;J/-/tJ ~ 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG. PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
..,J;l~!~
,,1ll!!;TATE OF
DATE OF DEATH
FILE NUMBER
~~5Y
Recortk
Re~v
RICHARD L PLACEY
PLACEY & WRIGHT
3631 N FRONT ST
HBG
'02
JAN 25
ESQ
PA 17110
Clerk. ;
C.umbena;
ESTATE OF
SMITH
DATE 01-21-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.t. (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
01-21-2002
SMITH
06-08-2001
21 01-0617
CUMBERLAND
101
'*
C/
REV-1547 EX IFP U2-DDl
CLAYTON
M
Allount Rellitted
c..; { ~
CHANGED
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
13.169.97
.00
.00
(8)
PA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
R"EV=is4-j-E3f-AFP--n'2=OoY-NoTIcE--oF-YNHEifiTANcE-TAX-A-PPRAisEifENT~--AL'i.-OWAifCE-(rR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
CLAYTON M FILE NO. 21 01-0617 ACN 101
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. N.t Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
7,429.83
10.372.00
Ul)
(2)
(3)
(4)
(9)
UO)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax pay_nt.
13,169.97
17.801 83
4,631.86-
.00
4,631.86-
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rat.
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
X T :
US) .00 X 00 = .00
(6) .00 X 045 = .00
(7) .00 X 12 = .00
(8) .00 X 15 = .00
(9)= .00
AMOUNT PAID
REC PT
NUMBER
(-)
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION: Estatas of dacadents dying on or bafore Dac~bar lZ, 198Z -- if any futura interast in the astata is transferrad
in possassion or enjoymant to Class B (collataral) baneficiarias of the dacadent after tha axpiration of any astata for
lifa or for yaars, the Commonwealth haraby axprasslY rasarvas tha right to appraise and assess transfar Inharitanca Taxas
at tha lawful Class B (collataral) rata on any such futura intarast.
PURPOSE OF
NOTICE:
To fulfill tha raquiramants of Section Zl40 of the Inheritanca and Estata Tax Act, Act Z3 of ZOOO. (7Z P.S.
Saction 9140).
PAYMENT:
Datach the top portion of this Notica and submit with your payment to tha Registar of Wills printad on tha ravarsa side.
--Maka check or money order payabla to: REGISTER OF KILLS I AGENT
REFUND (CR):
A rafund of a tax cradit, which was not requested on the Tax Raturn, may ba raquestad by complating an "Application
for Rafund of Pennsylvania Inharitanca and Estata Tax" (REV-1313). Applications ara availabla at the Office
of tha Ragistar of Wills, any of tha Z3 Ravenua District officas, or by calling the special Z4-hour
answaring sarvice for forms ordaring: 1-800-36Z-Z0S0; sarvices for taxpayars with special haaring and I or
spaaking naeds: 1-800-447-30Z0 (TT only).
OBJECTIONS:
Any party in interest not satisfiad with tha appraisement, allowance, or disallowanca of deductions, or assessment
of tax (including discount or intarest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to tha PA Department of Revanue, Board of Appaals, Dapt. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR
--elaction to have tha mattar detarmined at audit of tha account of tha parsonal representative, OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovared on this assessmant should ba addrassed in writing to: PA Departmant of Ravenue,
Bureau of Individual Taxes, ATTN: Post Assassment Review Unit, Dapt. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6S0S. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Rasident
Dacadant" (REV-lSOl) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax dua is paid within threa (3) calendar months after the decadent's daath, a five parcent (SZ) discount of
the tax paid is allowed.
PENALTY:
Tha ISZ tax amnasty non-participation panalty is computad on tha total of the tax and interast assassad, and not
paid before January 18, 1996, the first day aftar tha and of tha tax amnasty period. This non-participation
penalty is appaalable in tha same manner and in tha the sama tima pariod as you would appaal tha tax and interast
that has baan assassed as indicated on this notica.
INTEREST:
Intarest is chargad beginning with first day of dalinquancy, or nina (9) months and ona (1) day from tha data of
death, to the date of payment. Taxas which bacame delinquent before January I, 198Z baar interast at the rate of
six (6Z) percent par annum calculatad at a daily rate of .000164. All taxas which becama dalinquent on and aftar
January I, 198Z will bear intarest at a rata which will vary from calandar yaar to calandar yaar with that rate
announced by the PA Department of Revenue. The applicabla interest ratas for 198Z through ZOOZ are:
Year Interest Rata Daily Intarast Factor Year Intarast Rate Daily Interast Factor
198Z ZOZ .000S48 199Z 9Z .000Z47
1983 16Z .000438 1993-1994 7Z .00019Z
1984 llZ .000301 1995-1998 9Z .000Z47
1985 13Z .0003S6 1999 7Z .000l9Z
1986 10Z .000Z74 ZOOO 8Z .000Z19
1987 9Z .000Z47 ZOOI 9Z .000Z47
1988-1991 llZ .000301 ZOOZ 6Z .000164
--Interast is calculatad as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notica issuad aftar the tax baco.es delinquent will reflact an intarast calculation to fiftaan (IS) days
bayond the data of the assessmant. If paymant is made after the interast computation data shown on tha
Notica, additional interast must be calculated.
{
,
fJ/f
Of}
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Clayton M. Smith
Date of Death:
June 8, 2001
Will No.:
2001-00617
Admin. No.: 21-01-0617
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ug No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No LI
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes @ No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: 2LL6 / 0 3
N
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a: 00
3631 North Front Street
Harrisburg, PA 17110-1533
Address
(717)236-9577
Telephone No.
Capacity: 0 Personal Representative
og Counsel for personal representative
~
Cumberland County - Register Of wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
,
Date: 5/07/2003
SMITH MARC S
527 PENN AYR ROAD
CAMP HILL, PA 17011
RE: Estate of SMITH CLAYTON M
File Number: 2001-00617
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 6/08/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
cc: JFile
Counsel
Judge