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HomeMy WebLinkAbout06-06-08 15056041158 REV-1500 EX (os-o5) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2soso~ INHERITANCE TAX RETURN 21 07 1098 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204-01-9091 10112007 09051919 Decedent's Last Name SMELTZER Suffix Decedent's First Name MARION MI R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 4 Li it d E . m e state 6. Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^ 2. Supplemental Return ^ 4a. Future Interest Compromise (date of ^ 7. death after 12-12-82) Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~, LOWELL R• GATES 71'7-731~~0 -T - Firm Name (If Applicable) - ~7 ,~-- REGISTEFtd~ LS U3L'-0NLY GATES, HALBRUNER 8~ HATCH, P • C • 'f~T? I r-` ` =, G.~ _ -.. First line of address -, r', r1 - j 1013 MUMMA ROAD, SUITE 100 = ~ -t, `- =-_ , ~r ..r ,__ , _.I ~-i Second line of address ~ ~ - GJ ' City or Post Office LEMOYNE State ZIP Code PA 17043 ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) Correspondent's a-mail address: L• R• G A T E S a9 G A T E S L A W F I R M• C O M MECHANICSBURG, PA 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. ~•~-~~ 1605 REVER IV SIGNATURE OF PREP OTHER " ~~~ ~ ~~~ USE ORIGINAL FORM ONLY 15056041158 Side 1 DATE FILED DA' 6M46473.000 15056041158 Estate of Executors (Page 1) Name Pamela S. Grissinger Address 1605 Revere Drive 204-01-9091 Mechanicsburg, PA 17050- Tax ID 209-46-1014 15056042159 REV-1500 EX Decedent's Social Security Number 204-01-9091 oe~edenrSName:SMELTZER MARION R RECAPITULATION 1. Real estate (Schedule A) 1. 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2. 0 . 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • 3. 0 • 0 0 4, Mortgages & Notes Receivable (Schedule D). . 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5. 9 6 3 5 , 81 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested . 6. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 0 • 0 0 8. Total Gross Assets (total Lines 1-7). 8. 9 6 3 5 • 81 9. Funeral Expenses & Administrative Costs (Schedule H) . 9. 6 2 9 8 • 7 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 10. 0 • 00 11. Total Deductions (total Lines 9 & 10) • 11. 6 2 9 8 . 7 0 12. Net Value of Estate (Line 8 minus Line 11) 12. Q 3 3 7 • 11 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . 13. 0 . Q 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 3 3 3 7.11 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- 0.00 15. 0.00 16. Amount of Line 141axable at lineal rate X .04-`~ 0.0 0 16. 0.0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. TAX DUE 19. 0 • 00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042159 snnasaez.ooo 15056042159 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 1098 DECEDENTS NAME SMELTZER MARION R STREET ADDRESS 576 LUCINDA LANE CUMBERLAND CITY STATE ZIP MECHANICSBURG PA 17055- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0 • 0 0 B. Prior Payments 0 • 0 0 C. Discount 0 • 0 0 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 (1) 0.00 Total Credits (A + g + t;) (2) 0 0 0 Total InterestlPenalty (D + E) (3) 0 • 0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 . 0 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) 0.00 (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (581 0 • 0 0 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: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest; or d. receive the promise for life of either payments, benefits or care? Yes ^^ ^ ^ No X 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ^^ X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 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. 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 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 6 M 4671 1.000 REV-1502 EX+i~ggl SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Marion R. Smeltzer 21 07 1098 AI I real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointlyowned with right of survivorship must be disclosed on S~:hedule F. swasss i.ooo (If more space is needed, insert additional sheets of the same size) ' REV-15037=X+(s-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER Marion R. Smeltzer 21 07 1098 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 3wasss ~.ooo (If more space is needed, insert additional sheets of the same size) REV-1504 EX+1~-98, SCHEDULE C COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATION, INHERITANCE TAX RETURN PARTNERSHIP ORSOLE-PROPRIETORSHIP OF Marion R. Smeltzer 21071098 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. REV-1505 EX + (698) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FILE: NUMBER Marion R. Smeltzer 21 07 1098 1. Name of Corporation Address City State 2. Federal Employer I.D. Number 3. Type of Business 4 5 6 7 Total Number of Shareholders 0 Business Reporting Year STOCK TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE Voting/Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THIc DECEDENT DECEDENT'S.STOCK... Provide all rights and restrictions pertaining to each class of stook. Was the decedent employed by the Corporation? ^ `res ^ No If yes, Position Annual Salary $ 0.00 Time Clevoted to Business Was the Corporation indebted to the decedent? ...... ... ............ .. ^'fes ^ No If yes, provide amount of indebtedness $ 0.00 Was there life insurance payable to the corporation upon the death of the decedent?.. .. ^ 'ales ^ No If yes, Cash Surrender Value $ 0.00 Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years ii' the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares CI Transferee or Purchaser Consideration $ 0.00 Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death?, ^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? . ........ .. ... .... .... ... ..... ... ^ `fes ^ No If yes, provide a copy of the agreement of sale, etc. 1 1. Was the corporation dissolved or liquidated after the decedent's death? .... ..... ... ^ `fes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? .. ........ .^ `fes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • ~ •- ~ ~ ~ A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of d~sath and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) State of Incorporation Date of Incorporation Zip Code Product/Service 0.00 4 W4698 1.000 REV-1506 EX + (g_00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER Marion R. Smeltzer 21 07 1098 1. Name of Partnership Date Business f~ommenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Product/Service 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide inii.ial investment $ 0.00 5. PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT 6. Value of the decedent's interest $ 0.00 7. Was the Partnership indebted to the decedent?, _ ..... ^ Yes ^ No If yes, provide amount of indebtedness $ 0.00 8. Was there life insurance payable to the partnership upon the death of the decedent? ^ Yes ^ No If yes, Cash Surrender Value $ 0.00 Net proceeds payable $ _ 0.00 Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/solo 0.0000 Transferee or Purchaser Consideration $ 0.00 Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ^ Yes ^ No If yes, provide a copy of the agreement. 1 1. Was the decedent's partnership interest sold? . .... .. .. .... ...... ........ ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death?.. ... ..... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .... .. ..... . ...... . .... .. . .. ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for e~~ch interest THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. 4 W 4699 1.000 REV-1507 EX + (6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES ~ NOTES INHREERSIDENT DECEDENTRN RECENABLE ESTATE OF FILE NUMBER Marion R. Smeltzer 21 07 1098 All property jointlyowned with right of survivorship must be disclosed on Schedule F. 3wasAC i.ooo (Ii more space is needed, inseR additional sheets of same size) REV-1508 EX + (~g8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Marion R. Smeltzer 21 07 1098 3wasno i.ooo (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (~g8) SCHEDULEF COMMONWEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY II~kiERRA NCE TA X RETURN RESIDEPTi DECEDENT ESTATE OF FILE NUMBER Marion R. Smeltzer 21 07 1098 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURV N ING JOINT TByA NT(S) NAME JOINTLY-0WNED PROPERTY: RELATIONSHIP TO DECEDB~IT ~~ NUMB9~ LETTER FOR JOIN TENANT DATE MADE J~IrfI' DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILARTLY HELD REAL SBAREATTACH DEED FOR DA'f'E QF~TM VALUE OF ASSET °k OF DE(;D'S INT6~EST DATE OF DEATH VALUE OF DECEDENTS N~ITEREST None TOTAL (Al o enter on line 6 R a~itulationl ~ $ 0.00 (If more space is needed, insert addRional sheets of the same size) 3W46AE 1.000 REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF (FILE NUMBER Marion R. Smeltzer 21 07 1098 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 DESCRIPTION OF PROPERTY INCLLOETFEPYUAEOFTFETRANSFEREE,THEIRRELATIONSHIPTODECEDEMAPD TFE DATE OF TRAISFER ATTACHACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE ~ ~ None _ TOTAL (Also enter on line 7, Recapitulation) ~ $ 0.00 (If more space is needed, insert addRional sheets of the same size) 3W46AF 1.000 REV-1511 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1=1LE NUMBER Marion R. Smeltzer 21 07 1098 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Auer Memorial Home and Cremation Services, Inc. (funeral) 2,186.80 Total from continuation schedules . B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Pamela S . Grissinger Social Security Number(s) / EIN Number of Personal Representative(s) 209-46-1014 Street Address 1605 Revere Drive City Mechanicsburg State PA Zip 17050 Year(s) Commission Paid: 2008 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Pamela S. Grissinger Street Address 1605 Revere Drive City Mechanicsburg State PA Zip 17050 Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 The Patriot News (estate publication) 2 Cumberland Law Journal (estate publication) 3 Postage 3W46AG 1.000 SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS TOTAL (Also enter on line 9, R (If more space is needed, insert additional sheets of the same size) 342.40 500.00 2,800.00 87.00 282.50 75.00 25.00 $ 6,298.70 Estate of: Marion R. Smeltzer Schedule H Part 1 (Page 2) Item No. Description 204-01-9091 Amount 2 Funeral luncheon 342.40 Total (Carry forward to main schedule) 342.40 REV-1512 EX+ (12.03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS BILE NUMBER Marion R. Smeltzer 21 07 1098 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. 3wasAH z ooo (If more space is needed, insert additional sheets of the same size) REV-1513 EX+(g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mari nn R Cmcl t~cr 71 (17 1 r1~Q RELATIONSHIP T(~ DECEDENT v , y AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Pamela S. Grissinger 1605 Revere Drive Mechanicsburg, PA 17050 Daughter 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 swasAi i.ooo (If more space is needed, insert additional sheets of the same size) REV-1514 EX+(12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN k Box 4 on REV-1 FILE NIIMBER ESTATE OF Marion R. Smeltzer 2:107 1098 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereaftE;r. Indicate the tvoe of instrument which created the future interest below and attach a coov to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE Life or ^ Term of Years Life or ^ Term of Years 1 Life or ^ Term of Years Life or ^ Term of Years 1 Life or ^ Term of Years 1. Value of fund from which life estate is payable , 2. Actuarial factor per appro riate table .. .. ... .. .... . Interest table rate - ~ 3 1 /2% ^ 6% ^ 10% ^ Variable Rate 0.00000% 3. Value of life estate (Line 1 multiplied by Line 2) , 0.00 0.00000 0.00 NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE Life or ^ Term of Years Life or ^ Term of Years Life or ^ Term of Years ~~ Life or ^ Term of Years 1. Value of fund from which annuity is payable .. .... .. .. ..... .. .. $ 2. Check appropriate block below and enter corresponding (number) , Frequency of payout -^ Weekly (52) Bi-weekly (26 Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) Other ( ) 0 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 , 5. Annuity Factor (see instructions) Interest table rate -^ 3 1 /2% ^ 6% ^ 10% ^ Variable Rate 0.00000 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 .. $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 . _ $ 0.00 0.000 0.00 0.00 0.00000 0.00000 0.00 0.00 NOTE: The values of the funds which create the above future interests must be reported as part of tl~e estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) 3W46AJ 3.000 REV-1647 EX+ (g00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE Box 4a on Rev-1500 Cover Sheet FILE NUMBER Marion R. Smeltzer 2:L 07 1098 This schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return, Will ~ Trust ~ Other Rn ncf is is riuc NAME OF BENEFICIARY RELATIONSHIP DATE Of= BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decendents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. Unlimited ri ht of withdrawal Limited ri ht of withdrawal III, Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest $ 0.00 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) , $ 0 , 00 3. Value of Line 1 aasing to s ouse at a propriate tax rate ~ ~ ~ Check One 6%, 3%, 0% $ 0 , 00 (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check one ~ 6% ~ 4.5% . $ 0 „ 00 (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) , $ 0 , 00 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) . $ 0.00 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) $ 0.00 (If more space is needed, insert additional sheets of the same size) 3W46AN 1.000 PHOTOCOPY OF DEATH CERTIFICATE LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: !t is illegal to duplicate this copy by photostat or photograph. ee for this. certificate. 56.00 P 13359594 C~rtiiicatiolE Number This is fo eertif~ that the information here given i correctly copied from an original Certificate of Deat duly 61ed with me as Local Registrar. The origi>iz certificate will be forw~uded to the State Vita Records Office for pem~anent filing. :~%~r~._ ~ ~ ~ OCT 151407 / -1----- Local Registrar ~ Date Issued Ev tl;zoa COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS 'RIM IN t^Etn CERTIFICATE OF DEATH K INK (See instructions and examples on reverse) S-FATE FIt F NI IMRFR 1. Nor of Decedent (First, miaae, lest, weizl 2. Sez 3. Serial Secunry Number 4. Date d Oealh (Month. day, year) Marion R. Smeltzer Female 204 -O1 - 9091 October 11,.2007 5. Age (Last BMAday) Under 1 year Under 1 day 6. Dale of BiM (Month, day, year) 7. BiMpWce (CHy and state a for eign country) tsa. Place of Deam (check Dory one) Nnwz: oarx ~ sw.xes NospitaL omar 88 vrs. Sept. 5, 1919 Harrisburg, PA ^mpauem ^ERy Oulpatiem []DOA ~NUrdng Npne ^Resimnce ^ou,er-speciy: M. Ceunry of Death &. Ciry, Borg. Twp- of Death Bd. FacBity Name (II rot uisUlWion, give street antl number/ 9. Waz Decedent of Hispanic Origin? ®No ^ Yes 10. Race: Amerkan hbian, Black, While, att. (If yes, spedly Cuban (Specify) Cumberland Camp Hill Golden Living Nursing Home Mezkan, Puerto Rican, etc} White 11. Decedent's Uwa1 Q ion (Kind of work done moll d w ~ We. Do not sate retired 12. Was Decedent ever kt the 73. Decedent's Education (Specify Dory highest grade canpleled) t4. Marital Slal'J5: MarieQ Never Married, 15. 5•,rviving Spouse (If wile, give maimn name) I(ind d Work uc u Or U.S. Armed Fomes7 Elementary /Secondary (0.t 2) GoNegeSS1-4 or 5+) Widowed, Clivorcxd (SpedM Secretary ~ Indust ^ves ®NO 1 Widowed 16. OecMenys Mailxg AdNess (SbeeL city! town, stale, zro rode) Drxedaol's Did Decedent Pennsylvania 1605 Revere Drive Adud Residence 77a. Slate we in a 1yc ^ yes, Decedent Lived in Twp. Mechanicsburg, PA 17500 Township? tl e tT6.Covnty Cumberland ,2d~~~~e MOwedwidun Camp Hill ~ d s cmla«o 1 B. Earner's Name IFrsL midme, last. suffix) 19. Monier s Name (FKSI, mWdle, maiden surname) Josiah Reinbold Mary Brenneman 20a. mlamenl'S Name (iyge /Prim) 20b. Inldrtanl's Mtilmg Address (Street ciy /sown, state, zip cods) Pamela S. Grissin er 1605 Revere Drive, Mechanicsburg, PA 17050 2I a. Method d Disposition ®Cremaf ^ Donation 216. Date of Disposition (Monty. day, year/ 21c. Place d Disposition (Name of cemetery, crematory a omer plate) ltd. Laatiot (Ciry f cacao, stale, tip code) ^ &eiat ^ Removal Irom State ;Was Cremation err Donation AuNodzed I ^ Other-Speciry byAlediplExam6rer/Cwoner7 [ Jvas^NO Oct. 15, 2007 Cremation Societ of PA Harrisburg, PA 17104 22a. S' tw oIF Sxvke licensee (or persm actuq as such) 22b. License Number 22c. Name antl Addressd FadliryAUCr MemOrlal Hdme and Cremation Services, IIIC. - ti ~~ FD 013376 - L 4100 Jonestown Road, Harrisburg, PA 17109 Hems 23a~ Dory when cenHyin 23a. To the best of my krtowktlge, death ocaured al the lime, dale and place staled. (SignaNre ant 611e) 236. License Number 23c. Date Signed (Month, day year) ptryStGan B not available al time of deeU to , certify tease of deem. Ilms 2446 must be cartpleled M person 24. lime of Deam 26. Date Pmrwurked Dead (Monty, day, year) 26. Was Case Relemrd to Medical Examirer /Coroner la a Reason Other Than Cremation m Dortalan7 who prmwices ma"_ 12:55 a. M. October 11, 200+7 ^ves ~)Nn CAUSE OF DEATH (See Mstruclion5 erM examples) ~ Approzxnate imenal: uem 27-Pan I: Elver bte darn of events -diseases, inryries. or mmpkations -that 3recny caused lAe deem. W NOT enter terminal events sucn az cartliac aresl, t Onset to Death i ' Part IC Enter other i5a(IgdDLtorMHons caunbW'tw IP math, but not rewltirig in ms~. uMenyitg cause glean m Pan I. 26. Did Tobacco Use Conln6ule to Dea1h1 ^ Yes ^ Vrobabty resp ratory artesl, w vadncular fibnllat rort wltlwul showbg me etiology. Usl gory one pose on each late, r ^ No ~nwpwn INNEDIATE CAUSE FrW dsease or ' I ~ • ~ mrldition resWtng n ~alh( ,1 / yr-x] ~ ~ ' -~ a. :? f " r . L9 ~7 J ~ ~ ~^ ~~ t ~ t ~ ' I ~ .1 l~ , I, 29. If emale: Due Ic (or as a ratseguence of): I preynad within pass year Segue tiaAy Asl cond'gkrts. 4 any, 6 1e to Hie pUSe A5180 m Ane a. 1 / j V ^ Pregnant al lime of death Enter Lha UNDERLYING CAUSE Due to (or az a consequence oQ: Nm ^ !xegnanl, but pregrlad within 42 days ldsease a nryry oral ina6letl Ina worts resdang n death) LAST. t d death Due b (or as a consequence ol/. ^ Nd pregnad, fwt pregnam 43 days to t year d. heron morn ^ llNCnmwn it pr2gnanl within the Pad Yea[ 3Da. Was an AWOpsy P d 0~ 30h. Were Autopsy Findngs A 31 ner of Death 32a. Oale d Iryury (Month, day, year) 326. Describe How Inju7 Occurre0 32c. PWce of Injury: Nome. Farm. 9reel, Factory, orrre e vailable Prror to Completion Natural ^ HMxcim OHKx &nldng, ek. (Spedty) ~ d Cause of Death? ^ Yes p N~ ^ Yes ^ Nt ^ Acddenl ^ Pend:g Investigelion 32d. Tune o1 Injury 32a. IrMuy at WoM1n 32f. II Trarrsponation Injury (Spedty/ 329. Location d Injury lSlreel. Illy /town, state) ^ Sukide ^ Cant Nd be Determined ^ Yes ^ Nt Dmcer, Dpa~a,pr P ^ ^ assenger ^Petlesldan M ^Other ~ Specify: 33a. Certifier (thetk only me) 33b. Signature andTlle d CertAier • Cenitying physcian lPnynnan ceniMrg puce of math when andher physician has pmnpurz:ed deem ant [ompleleO Item 23) i' ., ~ j -- To the Dest of my Anowkdge, mom ottumd due to the cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (] - _ - _ _ - ` ~ ~ • Pronouncirg end cenilYin9 Pt+YSidan (Physkian boor proratmcing deem and prtityag to cause of death) ~ TO the be5f of m knowledge death btcprred at 162 tlrra dat a d l d d t th ^ 33c. license Number J3d. Dale Sgried (MaHh. mY• Year) y , , p a, n at!, am pe p e CBaSe(S) ant manna/ a5 slatbd . . . . . . ..... . .. . .. . • MedicN Examiner /Coroner ~ ~ / ~ ~ ~ ~.~,~ ~ y ~ ~ ~ J._ ~ .~ y ~~. .r ~. On the basis of examination and ! a investigation, in my opinion, death occurred al the Time, date, and place, and due Lo the cause(s) and manner as saled_ ^ ~ Nan 89~ AQNess of Pefso~~lro Ce] Gaus~ Death Qtem 2]( Type /Print 35. Ragislrar'S Signature and Distrkt Number 36. Dale FNed (MOnm, tlay year) ' , , ~ , / A . ,_ _ ` ~ ~, , / v% Dlslpsilion Permit No. (J~ I li' "I ? 1 LAST WILL AND TESTAMENT OF MARION R. SMELTZ~ER LAST WILL AND TESTAMENT Off' MARION R. SMELTZER I, MARION R. SMELTZER, now of 104 Old Ford Drive, Camp Hill, Cumberland County, Pennsylvania 17011, do publish and declare this to be my Last Will and Tf;stament, hereby revoking all other prior wills and codicils made by me. FIRST: Family Background and Appointment of Executor. (A} Family and Background Information. I am married to 1JAVID L. SMELTZER. Our child is PAMELA S. GRISSINGER. Throughout this Will, DAVID L. SMELTZER will be referred to as "my husband" or "my spouse", and PAMELA S. GRISSINGER will be referred to as "my issue" or "my child." The word "issue" will include our child as well as our other descendants. (B) Appointment of Executor. I appoint as my Executor anal successor Executor (all hereinafter referred to as Executor or Executor(s) under this Will), the fo[Iowing named persons or corporations to serve without bond and without being required to account to any Court: Executor: My daughter, PAMELA S. GRISSINGER. Successor Executor: My son-in-law, GARRETT GRISSINGER. (C) Inter Vivos Trust. The inter vivos trust agreement referred to in this Will is entitled "THE SMELTZER FAMILY SPECIAL NEEDS TRUST, dated May 7, 2004", by and between my daughter, PAMELA S. GRISSINGER, as Settlor, and COMMUNITY TRUST COMPANY, a Pennsylvania trust company, now of 3907 Market Street, Camp Hill, Cumberland County, Pennsylvania 17011, as Trustee. SECOND: Funeral and Last Illness Expenses; Taxes. (A) Expenses of Funeral and Last Illness. I direct my Executor to pay my funeral expenses and the expenses of my last illness from my estate. VGC~ 1_ .' -1 ~._-. _. LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 2 (B) Taxes. I direct my Executor to pay any and all estate, inheritance, succession, legacy, transfer and other death taxes or duties, by whatever name called, including any and all interest and penalties thereon, imposed under the laws of any jurisdiction by reason of my death upon or with respect to any and all property included in my gross estate for the purpose of such taxes, whether such property passes under or outside of this Will. Without any apportianment otherwise required bylaw and without being prorated or apportioned among or charged against the respective devises, legatees, benef curies, transferees, or other recipients of any such property or charged against any property passing or which may have passed to any of them, I direct that any taxes so paid shall be charged against my residuary estate. My Executor shall not be entitled to reimbursement for any portion of any such taxes from any such person. The foregoing provisions of this Article SECOND shall not apply to such portion or portions of said taxes, interest and penalties which may be required to be paid, or are actually paid or reimbursed, by the Trustee of the Trust described in Paragraph FIRST (C), above. THIRD: Tangible Personal Property. Except for those items excluded below and those items enumerated in the Letter of Instruction, I bequeath to my spouse, DAVID L. SMELTZER, all tangible personal property, including but not limited to clothing, jewelry, heirlooms, furniture, personal effects, motor vehicles, and all other similar articles, which I own, and the insurance thereon, if my spouse survives me by sixty (60) days. Tangible personal property shall not include: (1) any and all property used by me in any business, (2) cash on hand or on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness, and (5) any life, health or accident insurance policies. If my spouse, DAVID L. SMELTZER, is not living on the sixty-first (61st) day after my death, I bequeath such tangible personal property to my child, PAMELA S. GRISSINGER, per stirpes. If my spouse does not survive me and I have no living children, I leave such tangible personal property to my closest living relatives, per stirpes. If there is any disagreement as to distribution, I direct my Executor to make such distribution. The decision of my Executor shall be final and binding. Any items not selected or any items which my Executor considers unsuitable for my children maybe distributed or sold in the sole discretion of my Executor and, if sold, the net proceeds therefrom shall be added to the residue of my estate. Any such ~u-ticle allocated to a minor may, as my Executor deems advisable, either be delivered to the minor or to any person to safeguard on behalf of the minor. '~~ { 1 ~ ~ 1... ~;.:..._ LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 3 Notwithstanding any other provisions in this Article THIRD, I may leave a separate, dated and unsigned Letter of Instruction, which I shall place with my Will, containing directions as to the ultimate disposition of certain of the property bequeathed under this Article THIRD, and such Letter of Instruction shall determine the distribution of such items. FOURTH: Residuary Estate. I devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wherever situated to which I am legally or equitably entitled, to the then-acting Trustee of the Trust described in Paragraph FIRST (C) of this Will, to be held, administered and distributed pursuant to the terms thereof, as the same may be amended from time to time. By this devise and bequest of my residuary estate I hereby exercise all Powers of Appointment I possess at the time of my death except any power of appointment which I possess under the Trust described in Paragraph FIF:ST (C) of this Will. FIFTH: Powers of Executor. In addition to the powers and duties as may have been granted elsewhere in this Will, but subject to any limitations stated elsewhere in this Will, the Executor shall have and exercise exclusive management and control of the; Estate and shall be vested with the following specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon the Executor bylaw: (A) In the management, care and disposition of the Estate, the Executor shall have the power to do all things and to execute such instruments, deeds, or other documents as may be deemed necessary or proper, including the following powers, all of which maybe exercised without order of or report to any Court: (1) To sell, exchange or otherwise dispose of any property at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the periodl of the Estate, and to grant options, including any option for a period beyond the duration of'the Estate. (2) To invest all monies in such stocks, bonds, securities, mortgages, notes, chosen in action, real estate or improvements thereon, and any other property as the Executor may deem best, without regard to any law now or hereafter enforced limiting investments of fiduciaries. (3) To retain for investment any property deposited with the Executor hereunder. -, (, ~~ ~~~ LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 4 (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security. (5) To use attorneys, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand ley or against the Estate and to agree to any rescission or modification of any contract or agreE°ment affecting the Estate. (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Estate;. (S) To retain and carryon any business in which the Estate may acquire an interest, to acquire additional interest in any such business, to agree to the liquidation in kind of any corporation in which the Estate may have an interest and to carry on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Estate may have an interest, to become or remain a partner, general or limited, in regard to any such business or property and to hold the stock or other securities as an investment, and to employ agents and confer on them authority to manage and operate the business, property or corporation, without liability for the acts of such agent or for any loss, liability or indebtedness of such business if the management is selected or retained with reasonable care. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that such security is a Estate asset and the Executor shall be responsible for the acts of such nominee. (B) Whenever the Executor is directed to distribute any Estate assets in fee simple to a person who is then under twenty-one (21) years of age, the Executor shall lie authorized to hold such property in Trust for such person until he/she becomes twenty-one (21) years of age, and in the meantime shall use such part of the income and the principal of the Estate pis the Executor may deem LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 5 necessary to provide for the proper support and education of such person.. If such person should die before becoming twenty-one (21} years of age, the property then remaining in Trust shall be distributed to the personal representative of such person's estate. (C) In making distributions from the Estate to or for the benefit of any minor or other person under a legal disability, the Executor need not require the appointment of a guardian, but shall he authorized to pay or deliver the same to the custodian of such person, to pay or deliver the same to such person without the intervention of a guardian, to pay or deliver the same to a legal guardian of such person if one has already been appointed, or to use the same for the benefit of such person. (D) In the disbursement of the Estate and any division into separate trusts or shares, the Executor shall be authorized to make the distribution and division in money or in kind, or both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Executor shall be binding and conclusive on all persons taking hereunder. The Executor may in making such distribution or division allot undivided interests in the same property to several trusts or shares. (E) The Executor shall be authorized to lend or borrow, including the right to lend to or borrow from any trusts which I may have established during life or by will at an adequate rate of interest and with adequate security, and upon such terms and conditions a.s the Executor shall deem fair and equitable. (F) The Executor shall be authorized to sell or purchase at the fair market value as determined by the Executor, any property to or from any trust created by me during life or by Will, even though the same person or corporation may be acting as Executor of my estate or as Trustee of any of my other trusts. (G) The Executor shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal ors the Executor may deem equitable and fair under all the circumstances, including the power to arriortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution of any investment as income or principal, or apportion the same between income and princip~il, to charge any expense ~ ,_ _ ' \. ~~~~ ,; LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 6 against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any assets subject to depreciation or obsolescence, all as the Executor may reasonably deem equitable and just under all the circumstances. If the Executor does not exercise the above discretionary power, the cash or accrual allocation shall be in accordance with Chapter 81 of Title 20 of the Pennsylvania Consolidated Statutes, or the corresponding provisions of subsequent state law. (H) If at any time the total fair market value of the assets of Amy Trust established or to be established hereunder is so small that the corporate Trustee's annual'. fee for administering the Trust would be the minimum annual fee set forth in the Trustee's regularly published fee schedule then, in effect, the Trustee in its discretion shall be authorized to termin~ite such Trust or to decide not to establish such Trust, and in such event the property then held in or to be distributed to such Trust shall be distributed to the persons who are then or would be entitled to the income of such Trust. If the amount of income to be received by such persons is to be deaermined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as tree Trustee in its discretion shall determine. (I) Except as otherwise provided in this Will, when the authority and power under this Will is vested in two (2) or more Executors or Trustees, the authority and powers are to be held jointly by the Executors or Trustees, respectively. A majority of the Executors or Trustees may exercise any authority or power granted under this WiII or granted bylaw, and may act under this Will. Any attempt by one such Executor or Trustee to act under this Willl on other than ministerial acts shall be void. The action of one such Executor or Trustee under this Will may be validated by a subsequent ratification of the act by a majority of the Executors or Tru;~tees. SIXTH: Rights and Liabilities of Executor and Trustee. (A) No bond or other security shall be required of any Executer. (B) This instrument always shall be construed in favor of the validity of any act or omission by any Executor, and any Executor shall not be liable for any act or omission except in the case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any investment, the overall performance of the entire Estate shall be taken in1:o account. ,y//~~ i ` ~' ~ r ~.__... LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 7 (C) Each Executor shall be entitled to receive reasonable compensation for services actually rendered to my estate, in an amount the Executor normally and customarily charges for performing similar services during the time which he/she performs the services. SEVENTH: Tax Elections. (A) In determining the estate, inheritance and income tax liability relating to my Estate, the Executor's decision as to all available tax elections shall be conclusive on all concerned. In accordance with IRC Section 2632(x) and without regard to whether a Federal estate tax return is actually filed, my Executor shall allocate so much of the Federal Gene;ration Skipping Transfer (GST) exemption amount as will fully exempt any generation skipping transfer which may occur under this Will. (B) The Executor may, in its discretion, determine the date as of which my gross estate shall be valued for the purpose of determining the applicable tax payablf; by reason of my death. (C) The Executor may, in its discretion, decide whether all or any part of certain deductions shall be taken as income tax deductions (even though they may equal or exceed the taxable income of my estate and whether or not claimed or of benefit on my estate's income tax return) or as estate tax deductions when a choice is available; and in the event that all or any part of such deductions are taken as income tax deductions, no adjustment of income and principal accounts in my estate shall be made as a result of such decisions. EIGHTH: ~endthrift Provision. No beneficiary shall have the power to anticipate, encumber or transfer his or her interest in the estate in any manner other than by the valid exercise of a power of appointment. No part of the estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. NINTH: Definitions and General Provisions. (A) Survival. Any beneficiary who dies within sixty (60) da}~s after my death shall be considered not to have survived me. `4 '~ c {' LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 8 (B) Captions. The captions set forth in this Will at the begirvning of the various articles hereof are for convenience of reference only and shall not be deemed to define or limit the provi sions hereof or to affect in any way their construction and application. (C) Children. As used in this Will, the words "child" and "children" shall include persons who are legally adopted and the issue of said persons, whether born in or out of wedlock, so long as any person born out of wedlock is acknowledged in a written i nstrument executed by the one of their natural parents who is a descendant of mine to be the child of said descendant. The word "issue" shall include descendants of all generations including adopted persons. A posthumous child shall be considered as living at the death of his parent. The birth to me or the adoption by me of a child or children subsequent to the execution of this Will shall not operate to revoke this Will. (D) Code. Unless otherwise stated, all references in my Will to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any subsequent federal tax laws applicable to my estate. (E) Other terms. The use of any gender includes the other genders, and the use of either the singular or the plural includes the other. (F~ Powers of Appointment are Exercised. By this Will I e~:ercise any and all Powers of Appointment which I possess at the time of my death except any power of appointment which I possess under the Trust described in Paragraph FIRST (C), above. [THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK] _~ '` f _~ ~; - , Ld/IG~ LAST WILL AND TESTAMENT OF MARION R. SMELTZER PAGE 9 IN WITNESS WHEREOF, I, MARION R. SMELTZER, the Testatrix, have to this my Last Will and Testament, typewritten on ten (10) pages, including the Acknowledgment and Affidavit, set my hand and seal this ~ 7 ~~ day of May, 2004. _~ ,~ ~ ~;, ~` ~- . ' . ~ SEAL MARION R. SMELTZER Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and in the presence of each other. Each of us further declares that he or she believes the Testatrix to be of sound mind and memory. The preceding inst ent consists of this and nine (9) other consecutively nwmbered typewritten pages including Ac, owledgment and Affidavit. `~~/~ ~..-" residing at _~~~12 C G 6~ G~ ;~~`~- 1`~ r , (print ame) ~ = ; :. ~, %``~4.-< <, r ~:, ~ residing at ~" _t i` ~~_ ~ .~ ; ~ - , (print name) i` ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF C ~ : N-,~~e ~-1 ~:<, r ` ~ : The Testatrix and the witnesses whose names are signed and subscribed to the attached or foregoing instrument, being first duly sworn and qualified according to lave, do hereby acknowledge, depose and say to the undersigned authority, that the Testatrix signed and executed the instrument as her Last Will in the presence of the witnesses; that she signed it willingly or willingly directed another to sign it for her; that she executed it as her free and voluntary act for the purposes therein expressed; that each of the witnesses were present and saw the Testatrix sign and execute the instrument as her Last Will; that each subscribing witness in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. -, Sworn to or affirmed, subscribed to, and acknowledged, before me by the above-named Testatrix and witnesses, this ~~ day of May, 2004. . ~~ .~ :`•, r •- . ~ ~ ,~ Notary Public ~_, _ `'`" My Commission Expires: Notariat Seaf ~~ .~ Victoria M. Ra~~kin, (rotary Public Lemoyne Boro, C+rrbe~anci County . ~ My Commission f=xpires mutt. 27, ?+A~S f~1emfaer. ~'enn•.fv.e,f, c•_.Y:v~~ .~,~-_~ ~infa+ir~. .._ ~ r ~,-~, ~ ---f" ~Y, ~ Witaaess ~ ~~ CERTIFICATE GRANT OF LETTERS TESTAMENTARY STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND estate of MARION R SMELTZER (First, Middle, Lastl in said county, deceased, I, SHORT CERTIFICATE EARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do herE~by certify that on the 3rd day of December, Z'wo Thousand and Seven Letters TESTAMENTARY in corrli~non four, were granted by the Register of said County, on the 1 a to of MONROE TOWNSHIP to PAMELA S GRISSINGER (First, Middle, Last/ and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 12th day of December Two Thousand and Seven. File No. PA File No. Date of Death S.S. # 2007- 01098 21- 07- 1098 10/1 1/2007 204-01-9091 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPR~?SSED SEAL PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY December 28, 2007 Gates Halbruner & Hatch, PC 1013 Mumma Road Suite 100 Lemoyne, PA 17043 RE: Estate of: Marion R. Smeltzer Tax Identification Number: 204-01-9091 Date of Death: October 11, 2007 To Whom It May Concern: Commerce CBank This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 523029734 Date Opened: May 6, 1988 Primary Owner: David L. Smeltzer (deceased 8/5/07) Secondary Owner: Marion R. Smeltzer Date of Death Balance: $7,135.81 Accrued Interest: $.62 Principal Balance: $7,135.19 Please feel free to contact me at (717) 412-6127 if I may be of furthE;r assistance. Sincerely, Cindy Shultz Research Associate/Deposit Services Commerce Bank Commerce Bank /Harrisburg, N.A. PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com ~~~~ If you have any questions, please call: 1.800.445.0402 OFFICE .. _ _ ._ , ,_,..f....va ..~a.....~.~ ~.,n ,..artrotc nn nrand of Unum Grouo and its insuring subsidiaries. i249-G3 SAVE FOR YOUR RECORDS ------ - -- --- - -------------- _-- -------- ---_--------------- ------- -- -- ----------------___------, 1-44 0802812 119 ~~~~ Unum Life Insurance Company of America j __ Portland, Maine i Group Account Claimant `; $*****2,500.00** GASSERV David L. Smeltzer 'Pay This Amount Claim Number Policy Number Date ~ Not Valid After 90 Days Bank of ~-------------- ------------ America 0101412175 00117995-0010 October 23, 2007 Marion R. Smeltzer Pay To 576 Lucinda Ln The Order Of Mechanicsburg, PA 17055 i t.tS'~ PSC L•J: SECURITY FEATURES INCLUDED. DE TA1lS ON BkCK 8~ _, _ _ _ __~ ~~'08D 28 i 28~i' ~:D ~ X90044 5~: 6 7 7 3 7~i' PA REV-1500 SCHEDULE H FUNER.A,L EXPENSES and ADMINISTRATIVE COSTS ~~~~,~oRIAL~ ~~ AUER MEMORIAL HOME ~~D CREl~2ATION SERVICES, INC. ~~ ~~, ~~'~ATIpN ~V`C~S1 4100 Jonestown Road • Harrisburg, P.A 1?1C~) • 1-R00-720-8221 • Fax 71 i-541-9943 • Shawn E. Carper, Supervisor 271013 3T-5 10-21-20@7 Mrs. Pamela S. Grissinger 1605 Revere Drive Mechanicsburg, PA 17@50 Marion R. Smeltzer - Deceased SPECIAL CHARGES X Direct Cremation $1,295.@0 Forwarding Remains Receiving Remains Immediate Burial Nationwide Guarantee Program Worldwide Travel Protection TOTAL SPECIAL CHARGES $1,295.00 PROFESSIONAL SERVICES Services of Funeral Director & Staff Embalming Other Preparation of the Body Facilities & Staff for Viewing ($200/hour;) Facilities & Staff for Funeral Service Facilities & Staff for Memorial Service Staff 1~ Equipment for Viewing ($200/hour) Staff & Equipment for Funeral Service Staff & Equipment for Memorial Service Private Family Viewing Witnessing the Cremation Packaging/Forwarding of Cremated Remains X Personal Delivery of Cremated Remains $125.0@ Scattering of Cremated Remains TOTAL SPECIAL SERVICES 5125.00 AUTOMOTIVE EQUIPMENT Removal Vehicle Casket Coach Flower Car Lead Car/Clergy Car Service Vehicle Family Car TOTAL AUTOMOTIVE EQUIPMENT $0.00 MERCHANDISE Register Book Memorial/Prayer Cards Thank You Cards Remembrance Package Casket X Ivory Plastic Container Alternative Container Burial Vault Veterans Flag Case Grave/Memorial Marker TOTAL"MERCHANDISE CASH ADVANCED ITEMS Grave Opening Cemetery Equipment Vault Service Charge Newspaper Notice X Patriot News X Clergy Church/Organist/Soloist" X Flowers Crematory Charge X County Coroner Fee X 5 Certified Copies of Death Certificate TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES Special Charges Professional Services Automotive Equipment Merchandise Cacti Advanced Items 5UB TOTAL CREDITS TOTAL AMOUNT PAID 10-19-2007 BALANCE DUE $1,295.0@ $125.00 $0.00 $35.00 $376.90 $1,831.90 -$56.00 $1,775.9@ -$1,775.90 $0.00 $35.00 $96.90 $150.00 $75.00 $25.00 $3@.0@ $35.00 $376.90 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES ~~~~ ~ V M ~ n m u~c~mco..-'r va`, ~o,"~mw y$pmpppoo$Npp ~WGOW W-M ~ ~ w ~ ~ ~ N ~ `~ ,n ~; ~ z ~~ ~o~~ v =w~a-O ~~ I y ai 7 "~ m C G ~ ~ Q1 ~. ~pa cn "' E c ~ 3 C ~ 1'C Q. 6 ~~ Qp w N a~ u~ ~ ~ m ~ Qf _U Z ~ W ~+Ow Q ~ d ~~-° s~ucrn ~'~ amp' ~m~ ?~ U S E Q D E ~ r dad a~~ ~ ~ m e =>~ ' ~ ~ $ y U ~ ~ v U .° ~ m m a U.~~~ o}~~~ ~ -- d U d ` j-~. ~. ~ ~~ ^--ft 1' ~ ' ~ Q ~.r G ~_ I- _~ NN U ~_ y V C ~ ~ U m ~' V v ~ ~ ~ ai m ~ o m ~ m Q da. ~ '~N Of+ O n v N N>~ ~~ (fl iFi j m O 9~ U N y N ~ J ~- b ~ 4 ~ L~ CN ~°d~ m e N p f°- ~' ~y~~~ ~ c ~ ~ ~ b p ~~ 3 ` Am fLU G L E m X S rn .7 ro 5 47 o ~ ~ y~ Vi 9~ ,~ c~ a~ ~~~°rn ~~~~ ~ ~ ° ~ `° ~^ W ~ :$~~~~ a ~ T ~ 4 p ro m ~ ~, ~ ~. 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O cC ~ ~ a A E VLI VVI LVVV 1~. ~~ i~ ~.........-- RECEIPT FOR P~IYMENT ------------------- GLEND.A F'.A.RNER STRASBAUGH Cumberland County - Register Of Wills One Courtihouse S uare Carlisle, PA 1713 SMELT7ER MARION R Receipt Date: 12/03/2007 Receipt Tame: 11:05:35 Recea.pt No.: 1050786 - Estate File No.: X007 -01098 ,, - Paid By Remarks: D RISSINGER PAMELA S t -------------------____- - Rece~.pt Di.stra.b ut,ian ~-----~ -------- --------- -,- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 45.00 CUMBERLAND COUNTX GENERAL FUN WILL 15.00 CUMBEPLAND COUNTY GENERAL FUN SHORT CERTIFICATE x.2.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF ~'.ECEZPTS & CNTR M.D AUTOMATION ~'EE 5.00 CUMBERLAND COUNTY GENER7IL FUN Check# 1615 ---------------- $87.00 Total Received......... $87.00 °The Patriot-News Co. 812 Market St. Harrisburg, PA 17101 Inquiries - 717-255-8292 GATES, HALBRUNER & HATCH, P.C. ATTN: ACCTS PAYABLE 1013 MUMMA ROAD SUITE 100 LEMOYNE PA 17043 c~he ~latriot•News Now you know THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Joseph A. Dennison, being duly sworn according to law, deposes and says: That he is the Assistant Controller of The Patriot News Co., a corporation organizlsd and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot~~News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in tf ie City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuous{y published ever since; That the printed notice or publication which is securely attached hereto is exactly ~~s printed and published in their regular daily and/or Sunday/ Metro editions which appeared on the date(s) indicated below. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded iin the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION COPY This ad # 0001791787 ran on the dates shown below: December 19, 2007 December 26, 2007 January 02, 2008 ESTATE NOTICE ETTERS OF TESTAMENTARY for . t Estate of_MARIONR:SMELTZER, . .......... ~ ' d eased, lots of the,;TownshlP of Mon r Cumberland County. Pennsylvania, h InObeenwanted`totheundisrsl0ned o ecember 3, 2007.-all parsons Indebt - the Estate are reagested to make ' n to an~ub"scribed befor me ~ 0 clay of January, 2008 A. D. ImmedlotePCyment and those hovtny clatms hbolnsf the Estate are reg3ested to present them for settlsment without lay to d r ~ ~/ y l `\ ( ' ~ 1C . e P/tN1ELA'S:GRt55INGER,ExK Ix 1605 RevereOrtve _ ., - _ _ ___ ~ Notary Public MethanlesburorPA 17050 onto: LOWELL R. GA7E5, ESQ: batessr~-~Halbruner 6:HOtch, P.C. ~ 1073 Ntummb Road Sutte 100 COMMONWEALTH OF PENNSYLVANIA Lemoyne, PA 17043 - _ Notarial Seat - :ihertie L. Kisser IV~ary public C~:V Of htartisb~ D } ~; auphin ~~ MY Commissipn f=xpirt~ Nov. 26 209 9 [ , Member, Pennsylvania association of Notaries PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the ;aid Cumberland Law Journal on the following dates, viz: December 28, 2007, January 4, and January 11 2008 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ~---~- Lis Marie Coyn ,Editor SWORN TO AND SUBSCRLBED before me this 11 day of January, 2008 5meltzer, Marion R, deed. Late of the Township of Monroe. Executrix: Pamela S. Grissinger, 1605 Revere Drive, Mechanics- burg, PA 17050. Attorneys: Lowell R. Gates, Es- quire, Gates, Halbruner & Hatch, P. C., 1013 Mumma Road, Suite 100, Lemoyne, PA 17043. Notary NOTARIAL SEAL DEBORAH A COLLINS Notary PublEc CARL{SLE BORO, CUMBERLAND COUNTY My Commission Expires Apr 28, 2010 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 January 11, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Lowell R. Gates, Esquire RE: Marion R. Smeltzer Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal.. Advertisement inserted on following dates: December 28, 2007, January 4 and January 11, 2008 Advertising Cost 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director ~~~ END OF ATTACHMENTS *** INVENTORY REGISTER OF WILLS OF Cumberland COMMONWEALTH OF PENNSYLVANIA ~ SS COUNTY OF Cumberland Personal Representative(s) of the Estate of Marion R. Smeltzer COUNTY, ]PENNSYLVANIA File Number 21-07-1098 deceased, depose(s) and say(s) that the items appearing in the following inventory include all of'the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent awned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of thi:~ inventory. ~} I verify that the statements made in this Inven- r ~ I` 1 ~ ~- ,_ tory are true and correct. I understand that false state- ~~ >7ti~ `" ~~ ~ ~~ ~-~-~~'' ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) Lowell R. Gates (Supreme Court LD. No.) 46779 (Address) Gates, Halbruner & Hatch, P.C., 1013 Mumma Road, Suite 100, Lemoyne, PA 17043 (Telephone) 717-731-9600 DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO . October 1 1, 2007 576 Lucinda Lane, Mechanicsburg, Pennsylvania 17055 204-01-9091 FIGURES MUST BE TOTALED Commerce Bank checking account number 523029734 7,135.81 Unum (check for insurance proceeds from David L. Smeltzer 2,500.00 -~- © ~ ~ ~ ~ ,~ ~ ~ -a - r-T-; ~ t ' c~ r ~ ,~ .-, - __ _ : _ ~ _, t ; ._ ~~tt--aa 1tJ JJ..J~. 1 .. -- . _., _' ~ ' W (Attach additional sheets as needed) TOTAL: ~ 9,635.81 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the person:il representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 330/(b)) Farm RW-09 rev. 10.13.06 LAW OFFICES OF GATES, HALBRUNER & HATCH, P.C. 1013 MOMMA ROAD • SUITE 100 • LEMOYNE, PENNSYLVANIA 17043 LOWELL R. GATES, LL. M. LL. M. in Taxation Also Admitted to Massachusetts Bar MARK E. HALBRUNER CRAIG A. HATCH, CELA Certified as an Elder Law Attorney by the National Elder Law Foundation CLIFTON R. GUISE Also Admitted to practice before the U.S. Patent & Trademark Office SARAH E. McCARROLL (717) 731-9600 • FAX: (717) 731-9627 CORRESPONDENCE ADDRESS: Lemoyne Office WEB SITE: www. G ales Law Fi rm . co m June 5, 2008 Cumberland County Courthouse Office of the Register of Wills One Courthouse Square Carlisle, PA 17013 RE: Estate of Marion R. Smeltzer Estate No. 21-07-1098 Dear Register of Wills: BRANCH OFFICE: 3 WEST MONUMENT SQUARE, SUITE 304 LEWISTOWN, PA 17044 (717) 248-6909 STACEY L. NACE Paralegal/Office Manager TRACT L. SEPKOVIC Paralegal VALERIE LONG Paralegal TRACT L. SHERIDAN Paralegal Enclosed for filing are the Pennsylvania inheritance tax return (in duplicate) and Inventory for the Estate of Marion R. Smeltzer. There is no tax liability due on t]ie return. Please time-stamp the photocopy of each document and return them to our office in the enclosed envelope. Please also find enclosed a check in the amount of $30.00 as payment for the filing fee of the Pennsylvania inheritance tax return and Inventory. Please notify Attorney Lowell R. Gates or myself if you need a.ny additional information. Thank you for your assistance in this matter. Sincerely, L~~ ~. Traci L. Sheridan Paralegal Enclosures cc: Pamela S. Grissinger, Executrix !~J'd'!~~)d Sfi ~> c. ~ ~ a ~~, ~ , _ Y Q' caa ~ ~~' ~ - ,~ ? LL .~ _ ~~~ ~ v _ ~ rx• J~ ' ` A ~. `''. Sri. ~~_. ~, r.~ o E~-~ . _ ~} .r F-- ~ r . ~> .1..~ ~J ~---- -c^ 1 ~ ~..~ f .G* ~~ ` ~ ~, ~ ~ ' _ .L1 , .7 _ C Y G V N ^U 1~ U C:.. ~~ W .J w ti y ~ ~ W d C7 M O ~ H Q ~ ~ J Q ~' O~ p~ Z z ~~ ~w ~z M 0 O W ~ ~ ~o+ F ~ ~ ~ U w ~ ~ +-+ r'w • •~'' C/~M-y ~ ~ y) O U~' ~~-'' ~~ ~aQ.a o o ai ~ ~ U ~~~~ UOOU 0 H