HomeMy WebLinkAbout03-06-09Rev-346 EX (05-04) 3 4 6 0 0 0 7121
ESTATE INFORMATION
SHEET FOR REGISTER'S OFFICE USE ONLY
PA Department of Revenue County Code Year File Number
DECEDENT INFORMATION: Enter data as it will appear on all ~ ~ (~G\ ~ 2 Z
documents submitted to the De artment.
Decedent's Social Security Number Date of Death Date of Birth
1 6 5 2 6 7 3 6 2 1 2 1 5 2 0 0 8 1 2 3 1 1 9 3 2
Last Name
S M I T H
Suffix First Name
P H Y L L I S
MI
I
TYPE FILING: Fill in oval to indicate the nature of the return to be filed with the Department.
J Probate Return l' Joint Assets Only ~~ Estate Tax Only ~~-I Litigation Purposes (No Other Assets)
LETTERS GRANTED: Fill in oval to indicate the nature of the proceedings at the Register of Wills Office.
(Attach additional sheets if explanation is necessary.)
'__~ Testamentary __' Administration x! No Letters ', ~ Other (Please Explain)
ATTORNEY/CORRESPONDENT INFORMATION: Enter all data concerning the attorney or other individual to receive all tax
information and correspondence.
Last Name Suffix First Name MI
S T O N E D A V I D H
Supreme Court I.D. #
3 9 7 8 5
First line of address
4 1 4 B R I D G E
Second line of address
Telephone Number
7 1 7 7 7 4 7 4 3 5
S T R E E T
p 0 B O X E
City or Post Office
N E W C U M B E R L A N D
Correspondent's a-mail address:
DSTONE S(c~ TONf2bAW.NET
,._,
__ Q `'~? '--1
_..T"j _~ _...~
_, i-
~, ;, TTI
~C=~:~ ~ -
State ZIP Code =x% .,
*~ --i ~--_ " i i
P A 1 7 D 7 0 r ~ `' `--~
PERSONAL REPRESENTATIVE INFORMATION: Enter all data concerning the personal representative(s) of the estate
authorized by the Register of Wills.
Executor/Administrator
Social Security Number Telephone Number
7 1 7 9 7 2
Last Name Suffix
L A N S E R
First line of address
1 6 C O U R T L A N D R O A D
Second line of address
City or Post Office
C A M P H I L L
8 7 5 7
First Name
D E B R A
OFFICIAL USE ONLY
i TRANSACTION COUNT
L- _ - _ -- - --- - -
State ZIP Code
P A 1 7 0 1 1
Complete general estate information questions and indicate additional personal representatives on reverse side.
PLEASE USE ORIGINAL FORM ONLY
Side 1
3460007121 3460007121
MI
A
J
J
REV-346 EX
Decedents Name: PHYLLIS I. SMITH --___
Co-Executor/Administrator
Social Security Number Telephone Number
Last Name
First line of address
3460007221
Decedent's Social Security Number
1 6 5 2 6 7 3 6 2
Suffix
First Name MI
Second line of address
City or Post Office
State
ZIP Code
Co-Executor/Administrator
Social Security Number Telephone Number
Last Name
Suffix
First Name MI
First line of address
Second line of address
City or Post Office
State ZIP Code
GENERAL ESTATE INFORMATION: Enter all applicable data.
Did the decedent own real property in PA? ~ -_j Yes X~' No
If yes, List the location(s) and an estimate of the value(s) for each parcel.
Location __ Value $ _ _ _ _ _ -_ _----_ __
_ . _ __.
Location _ Value $ _ - _ __
-- --
What is the approximate value of the decedent's personal property? $ -- - - - --------
Was abond required in order to obtain Letters Testamentary I ~ Yes I X~ No
or Letters of Administration? -
Was the decedent survived by a spouse? 'L J Yes `X~ No
If yes, what is the surviving spouse's full name? -- - - _
-_ __ r 1 No
Was the decedent survived by other heirs? I X Yes
If yes, list their name(s) and their relationship to the decedent below.
Name DEBRA ANN LANSER Relationship DAUGHTER ______ _ ____ ___ __
---
- _ __
- --
The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The
Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information
in exchange of tax information agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential
tax information except for official purposes.
Side 2
3460007221 3460007221 J
STONE LAFAVEI3 &SHEKLETSKI
ATTORNEYS AT LAW
414 BRIDGE STREET
DAVID H. STONE POST OFFICE BOX E
GERALD J. SHEKLETSKI NEW CUMBERLAND. PA 17070
ELIZABETH B. STONE www.stonelaw.net
March 5, 2009
Register of Wills of Cumberland County
1 Courthouse Square
Carlisle, PA 17013
Re: Phyllis I. Smith, deceased
Social Security No.: 165-26-7362
Date of Death: December 15, 2008
Greetings:
OF COUNSEL
CHARLES H. STONE
JON F. LAFAVER
TELEPHONE (717) 774-7435
FACSIMILE (717)774-3869
Please find enclosed an original and a copy of an Estate Information Sheet for Phyllis I.
Smith, deceased. This matter has not been probated. Also enclosed is our check number 45096
in the amount of $15.00 for the required filing fee.
Enclosed is check #506 in the amount of $1,800.00 representing payment for prepayment
of Inheritance tax for the above mentioned deceased. Please note the timely postmark of this
correspondence.
Please send the receipt and the filed copy of the Estate Information Sheet to my office in
the stamped addressed envelope enclosed.
Your attention to this request is certainly appreciated.
~'tl-~~ truly yours,
STONE LaF~VER &SHEKLETSKI
~' . St0`xl~, Esquire
DHSijam '~JV iiJ
J ~-~~
Enclosures ~' `y ~ `~' ~ '"~
~;'~s ;~;~ ~~IJ
cc: Debra A. Lanser, Executrix
- --