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FILE THIS RETURN WITH:
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1737-A
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
FILE NUMBER
~ ~ - 07_
COUNTY COOE YEAR
00681__
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DECEDENT'S NAME (lAST. FIRST. AND MIDDLE INmAL)
SMITH, NEVIN L. alkla SMITH. NEVIN LEROY
DATE OF DEATH (MM-D[)'YEAR) DATE OF BIRTH (MM-DD-YEAR)
12/2012006 03/26/1930
(IF APPliCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDlE INITIAl)
SMITH, JANICE L.
SOCIAl. SECURITY NUMBER
218-26-1879
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SOCIAL SECURITY NUMBER
212-54-3618
~ 1. Original Relum 0 2. Supplemental Return D 3. Remainder Return (date d cINIh !liar m 12.13-82)
o 4. Limited Estate D 41. Future Interest Compromise (date d deIlh a'ter 12-12-82) D 5. Federal Estate Tax Return Required
~ 6. Decedent Died Testate (AIlach ~ d WI) D 7. Decedent Maintained a Livilg Trust (AlIIdI CllIlY dTIUIt) Jl 8. Total Number of Safe Deposit Boxes
D 9. Utigation Proceeds Received 0 10. Spousal Poverty Credit (daleddealh be1MS112-31-91l1ld 1.1-95) D 11. Election 10 tax under Sec. 9113(A} (AIlachSc:b 0)
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NAME COMPlETE MAILING ADDRESS
JANE M. ALEXANDER, ESQUIRE
FIRM NAME (If ApplIcable)
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148 S. BALTIMORE STREET
DllLSBURG, PA 17019
TELEPHONE NUMBER
(717) 432-4514
REFER TO METHOD OF COIIPUTAnON IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736)
Check One: IX! Flat Rate 0 Proportionate (Complete Worksheet on Rev... Side)
,. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Sct1eduJe B) (2)
3. Closely Held Corporation, Partnership or SoIe-Proprietorship (3)
(Schedule C)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-VNOS Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Auets (total Unes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Oeceden~ Mortgage UabiHties, & Liens (Schedule I) (10)
11. Total Deductions (t~ Unes 9 & 10)
12. Net Value of Estate (line 8 minus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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1,131,575.10
14. Net Value Subject to Tax (line 12 minus Une 13)
(14)
1,131,575.10
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RAm
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under See. 9116 (a){1.2)
16. Amount of Une 14 taxable at &neaI rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due. Make check payable to Commonwealth of PA
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CHECK HERE iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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, REV:'737-4 EX + (9-0('*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE E, PART 1
MISCELLANEOUS
PERSONAL PROPERTY
FILE NUMBER
SMITH. NEVIN L aIkIa SMITH. NEVIN LEROY 21 07 00681
Part 1 must include all tangible personal property having its situs in Pennsylvania. Examples of tangible personal property are
jewelry, furniture, paintings, etc. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F.
Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF DEATH
1. One-third interest in an agreement of sale for a tract of land situate in the Borough of Mechanicsburg, Cumbertand
County, Pennsylvania. The Agreement of Sale dated October 22, 2004 was between Glenn E. Smith, George H. Smith,
Nevin L. Smith, and the Executor of the Joseph H. Hess Estate, sellers, and Cartino Development Group, Inc., buyer.
Consideration: $7,000,000.00. 1/3 interest of one-half of the net proceeds ($3,406,483.81) $1,135,494.61
2. Final funds received from Joseph H. Hess account $114.49
PART 1 TOTAL
S $1.135.609.10
PART 2 TOTAL
Proportionate Method Only from reverse side $
TOTAL (Also enter on line 5, Recapitulation) S $1135.609.10
(If more space is needed, insert additional sheets of the same size)
REV-17.37-6 EX + (9-0(\~
' R~RSE ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES Ie
ADIIINISTRATIVE COSTS
Use Schedule H ONLY for proportionate
method of tax computation.
FILE NUMBER
SMITH. NEVIN L aIkIa SMITH. NEVIN LEROY
ITEM NUMBER
A. FUNERAl EXPENSES:
1.
21 07 00681
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of P8fS0n81 Representative(s) None dairned
Social Security Number(s) EIN Number of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State
Zip
2.
AtIDmey Fees Jane M. Alexander, Esquire
$2,500.00
3.
Probate Fees Register of Wills
$799.00
4. Accountant's Fees
5. Tax Return Preparer's Fees
6.
7.
8.
9.
MisceIaneous Expenses
Register of Wills - filing Inheritance tax return and Inventory
Filing release
Notary fee on release
$20.00
$10.00
$5.00
TOTAL (Also enter on line 9, Recapitulation) S
(If more space is needed. insert additional sheets of the same size)
3 334.00
. REV-17117-7 EX + (9.0,*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE'
DEBTS OF DECEDENT,
MORTGAGE UABILITIES, & UENS
Use Schedule I, Part 2, ONLY for
proportionate method of tax computation.
FILE NUMBER
SMITH. NEVIN L a/kIa SMITH, NEVIN LEROY 21 07 00681
Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and
owing as of the date of decedent's death.
Complete Part 2 ONLY when the proportionate method of tax computation ia elected.
.
ITEM
NUMBER DESCRIPTION
1. Share of 2007 real estate taxes for 1017 South Mar1<et Street, Mechanicsburg, Mechanicsburg Borough, Cumber1and
County. Pennsylvania
AMOUNT
$700.00
PART 2 . ALL OTHER DEBTS OF THE DECEDENT
TOTAL PART t $
700.00
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
TOTAL PART 2 $
TOTAL (Also enter on line 10, Recapitulation) . S
(If more space is needed, insert additional sheets of the same size)
700.00
. REV-1767-7 EX + (9-0(l~_
RE~RSE ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
SMITH. NEVIN L. alkJa SMITH. NEVIN LEROY 21 07 00681
When flat rate method is elected, list the beneficiaries of the Pennsylvania property.
When proportionate method is elected. list all beneficiaries.
RELATIONSHIP TO
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDf~s' AMOUNT OR SHARE
NUMBER Do Not list T s OF ESTATE
I. TAXABlE DISTRIBUTIONS [InClude outright spousal distributions. and transfers under Sec. 9116 (aX1.2)}
1. Janice L. Smith
6 Wesley Court 100% of residue
Rockville. MD 20850
ENTER DOllAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE
SIDE OF REV-1737 COVER SHEET AS APPROPRIATE.
n. NON-TAXABLE D1STRIBUTlONS:
A. SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. None
TOTAL OF PART II
ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1737 COVER SHEET $
(If more space is needed. insert additional sheets of the same size)
" .
. .
NONRIIIDINT DICIDINT AFFIDAVIT O' DOMICIL. (continued) Page 2
9. Hid the decedent paid a tax on income or on intangible property to.ny stitt, county, or municipality during the last five years?
If yes. where and when was it paid? . Yo 0 No
State of Maryland, County of Montgomery, CIty of Rockville. April each year.
10. To what regional office of the Internal Revenue Service did the decedent forwIrd his Fed.rallncome Tax returns during the II.t five years
prececllng death?
Massachusetts
11. At the time of duth, did the decedent own, individually or jointly, any interest in.....~, including IeaH-hoIds or tangible perlOnal property
located in Pennsylvanl.? . Yu [J No
If yes, describe the property in detail.
Hess Farmland 112Hess & 1/2 Smith divided by 3 brothers.lnterest in an agreement sale for a trad of land situated in
the Borough of Mechanicsburg, Cumberland Co. ,Pa.Agreement of sale dated 10/22104 was between Glenn E. Smith,
George H. Smith, Nevin l. Smith and the Executor of the Joseph H. Hess Estate, sellers and Carlino Development
Group, Inc. buyer
12. In whit buaintlllctivltlu was the decedent eneaged during the last five ye.rs preceding death?
Indicate whether decedent was employed or otheFWtSEl engaged in business, and state the names and the addresses of the persons, firms or corporations
With which the decedent had such business affiliations. ( Except for employer listed in #5 )
Retired at age 64.
13. What i. the ..timated grou value of the dtc:edent't; estate, wheresoever situated, exclusive of real property and tangible property located outside
of Pennsylvania?
$1,145,947.82
Ie Yel
[J No
14. At the time of death, did the deeedent own or operate an automobile?
If ves, in which slate was it reqistered?
Owned vehicle - did not operate it. Registered in state of Maryland
15. At the time of death, was the decedent a member of a church or any other organization 1 II
If yes, provide the name and address of the church or any other organiZation.
Elks Lodge on Taft Street in Rockville, Maryland
v.. (J No
16. State the purpose or reason the decedent owned real property in Pennlylvanla.
Inherited interest in the farmland as described in #11.
17. Include any other information you wish to submit in support of the contention that the individual wa not domiciled In Penn.ylvanla at the time
of death. If more space is needed. insert additional sheets of same size.
All utility bills, phone bills, cable bills, property tax bills received at residence, 6 Wesley Court, resided in August, 1978
until date of death 12-20-06. Truck & private passenger vehicle registered & titled in the state of Maryland
Name of person completing affidavit
Janice L. Smith
Street Address
6 Wesley Court
CIty
Rockv.il1e
,_IonshiP 10_
Spouse
State
MO
Zip Code
20850
Under penaltie. of perjury, I declare that ba.ed on my personal knowledge of the decedent, the
Information provided on this form is true, correct and complete.
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. .
REV-1737-1 EX + (9-00) .
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
NONRISIDINT DICI.INT
AFFIDAVIT OF DOMICILE
This affidavit must be completed and sworn to by a person having personal knowledge of these
facts, preferably by a surviving spouse or member of the decedent's family.
Name of Decedent Date of Death
Nevin L. Smith 12/20/2006
Legal Address at Time of Death:
Street Address
6 Wesley Court
City/Borough
Rockville
State
MD
Zip Code
20850
The following information is submitted in support of the statement that the above individual was
not domiciled in the Commonwealth of Pennsylvania at the date of death.
1. Names and addresses of the decedent's surviving spouse and members of his/her immediate family:
Name and relationship to decedent
Janice L. Smith, Spouse
Street Address
6 Wesley Court
Name and relationship to decedent
Dennis E. Smith, son
Street Address
1108 Veirs Mill Rd.
Name and relationship to decedent
Melissa A. Morrison, daughter
Street Address CitylBorough State Zip Code
26844 Howard Chapel Drive Damascus MD 20~
2. Did the decedent ever live in Pennsylvania? ~ Yes 0 No ?-2 ::s
If yes, during what periods? ::: ~ CX) .~..:
over 30 years ago ".~ \~ - ::; ;T:. .~
3. Did the decedent spend time in Pennsylvania during-the five years preceding death '-" ja---Yes-----O No. --.~~~~+--~- ('---;--i~:'<
If yes, during what periods and at what address? '.~ ~~ ~ ~ ~~~: cj
September, 2005 for one day visiting brother George in Duncannon, PA ? (;0 > . . ~--.~
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4. What was the nature of decedent's places of residence during the five years immediately preceding death? J;!. --l ~;.: h <_:
Indicate whether decedent resided in a house or apartment and whether it was rented or owned by the decedent, and/or whether decedelt"resided in a I ,
hotel or the home of relatives or friends.
Resided in single family owned home.
City/Borough
Rockville
State
MD
Zip Code
20850
City/Borough
R ockville
State
MD
Zip Code
20851
Owned bv Nevin & Janice Smith.
5. Was the decedent employed during the five years preceding death?
If yes, list the name and address of employer(s).
DYes
JEI No
6. Old the decedent leave a will? IG Yes 0 No
If yes, state the court which admitted the will to probate. the date admitted, and attach a copy, including all codicils, and a certificate of issuance of
letters testamentary.
Montgomery County, Md., March 13,2007. See letter of administration
7. If the decedent did not leave a will, has an administrator of his estate been appointed? 0 Yes 0 No
If yes, state the court which appointed the administrator. the date of appointment, and attach a certificate of the issuance of letters of administration.
N/A
8. At any time during the last five years did the decedent execute a will, a codicil, trust indenture, deed, mortgage, lease or any other document in which
the decedent was described as a resident of Pennsylvania? 0 Yes Ja No
If yes, describe such document.