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PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of David -g Srnitl,
also know as
Deceased.
Social Security No. 350-44-9940
No.
To:
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
21-01-380
Your petitioner who is 18 years of age or older, applied for letters of
administration (dbn; pendente lite; durante absentia; durante minoritate) on the
estate of the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
his last family Qr principal residence at 1008 Forbes Road, Carlisle, Pennsylvania
17013. C~~
Decedent, then 47 years of age, died September 27,2000, at Mercy Hospital,
Allegheny County, Pittsburgh, Pennsylvania.
Decedent at death owned property with estimated values as follows:
(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:
Petitioner after a proper search has ascertained that decedent left no will and was
survived by the following spouse (if any) and heirs:
Name Relationship Residence
Carla D. Smith Wife 1008 Forbes Rd, Carlisle, PA
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of
administration in the appropriate form to the undersigned.
Car/tL 1.;, :;:)1/; rth
Carla D. Smith
1008 Forbes Road, Carlisle, PA 17013
/6 -d23~/~
No. 21-01-380
Estate of David E. Smith, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW APRIL 16 , 2001, in consideration of the petition on the
reverse side hereof, satisfactory proof having been presented before me, IT IS
DECREED that C9r]9 D Smith is entitled to Letters of Administration
and in accord with such finding, Letters of Administration are hereby granted to
Ca:r18 D Sroith in the estate of Davirl R STflit]1
FEES
Probate, Letters, Etc. . .. $ 200.00
Short Certificates ( ) . . .. $ 30.00
Renunciation. . . . . . . .. $
~~l! . . . . . . . . . . . . $ 5.00
Total $ 235.00
Filed. Ap! ~ . !~ . . . . . . . . . .2001
~~'r1~L~~a/
~fW' s /-. -/~j7
(14Je ~~ /
ANDR~. JACOBSEN
JACOBSEN & MILKES
52 East High Street
Carlisle, P A 17013
[717] 249-6427
ATTY ID: 20952
~/ /') >--
~}/E:~~7
l'i RI1" I{l'\' ,)!Q(,
This is to certify that the information here given is correctly copied from an original certificate of death duly tiled with me as
Local Regisrrar. The original certificate will be forwarded to the State Vital Records Office for permanent tiling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
21,-- ~. ~eu-~~
Lo....al Registrar
Fee for this certificate, $2.00
p
6836614
OCT
4 2000
Date
21-01-380
H105 144 Aev. 1191
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
IPRINT
N
ANENT
;KINK
SEX
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
DATE OF DEATH (Montl1, Oay, Year)
2. MALE
3.
350-449940
4, SEPTEMBER 27, 2000
UNDER 1 YEAR
Days
UNDER 1 DAY
Hours Minutes
PLACE OF OEATH {Check O\1ly one - see instructions on olher Side)
HOSPITAL:
Inpatient 0
eo.
FACllliY NAME (II not lnstllullon, gIve street and number)
BIATHPLACE (C,ty and
Slare or Foreign Country)
g':;,ty) 0
7.Maywood I IL
White
WAS DECEDENT EVER IN
U,S, ARMED FORCES?
Yo. D NO~
SURVIVING SPOUSE
III wife. give matden name)
12.
Hb, Counl
P.lI. Did He,D Yos, decodenllivod in
decedent
live in 8
Cumberland township? 17d.~ ~~h~&~t~~7~i~~\~:Of
MOTHER'S NAME (Flfst. Middle. Maiden Surname)
19. Ma Haines
INFORMANT'S MAILING ADDRESS {Street. C.lylTown, State. lip COOe}
twp
170. Slate
Carlisle
citylboro
22b.
To b9s1 of my knowledge, death occurred at the lime, date and place stated
(Signature and Title)
LICENSE NUMBER
012748 L
23b. 23c.
WAS CASE REFERRED TO MEDiCAL EXAMINER/CORONEA?
Yo. 0 NoD
21, X
I Approximate PART 1/; Other !ionificant condit)ons contributing to death, but
: interval between not resulting in the unde(lying cause given in PART l.
! onset antS death
23a.
TIME OF DEATH D~E PRONOUNCED DEAD (Monlh, Day, Year)
24. 11: 10 P M. 25. SEPTEMBER 27, 2000
27. PART I: Enter the diseases. inju(\es or compl\Cations which caused the death. 00 not enter the mode at dying. such as cardiac or respiratory arr@s\, shock Of nearl1ailure
List only one cause on each. line
ARTERIOSCLEROTIC CARDIOVASCULAR DISEASE
DUE TO (OR AS A CONSEQUENCE OF)'
DUE TO lOR AS A CONSEOUENCE OF)'
DUE TO lOA AS A CONSEOUENCE OF)'
d
WERE AUTOPSY FINDtNGS MANNER OF DEATH
A~ILABlE PRIOR TO
COMPLETION OF CAUSE
OF DEATH? Notural
TIME OF INJURY
M. 30c.
Dil.TE OF INJURY
(Month, Day, Yeali
INJURY AT WORK?
Yo. KJ
No 0
Accident
Xl Homicide 0
0 Pendinglnvestigalion 0
0 Could not be determmed 0
300, 30b.
PLACE OF INJURY - At home. farm. streel. ractory. office
building, elc. lSpec,t~'1
30..
280. 21b,
CERTIFIER {ChOCk only one)
.CERTIFYING PHYSICIAN (PtryslClan cel1'llYlng cause 01 death when another phYSICian has pronounced dealll and compteted Item 23)
To the best of my Mow'edge, del'" oceur* due to the CIUle(s) and manner as.t.ted. . . . . . .. . . . . . . . . . . . ... . . . . .
Suicide
29.
o
DEPUTY CORONER
.PRONOUNCINC AND CERTIFYING PHYSICIAN (PhYSICIan both pronouncinQ death and certllYlng to cause 01 death)
To the bestoi my knowtedge, delth occurred It the time, d.le, and pllce. and due to the e.u'.(I) and manner I. st.ted.......
DATE SiGNED (Monlh, Day, Year)
o 31c. 3td. SEPTEMBER 28, 2000
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(Item 27) Type or Prinl
!vi crRIL H. WECHT, M.D.,J .D. ,CORONER
'Ai 542 4TH AVE., PGH., PA 15219
34.
.,30 ~~
.MEDICAL EXAMINER/CORONER
On the buls of exemlnatlon and/ol Investigation, In my opinion, death occurred et the time, date, end piece, and due 10 lhe csuse(o) and
mlnner I. atated.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ....................................................
310.
REGISTRAR'S SIGNATURE AND NU
~. '2~~&,.-t"~-uJ
\.d.t \ I~\ ,O!
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} ss
The petitioner(s) 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(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law. /' ~ ~f. '. ..' ~ /? ~
Sworn to ~r affirmed. and su. bscribed f ~~.. y~
before me thIS lZtlt day of (lay-fa. -.,J; /1-1' -t:h
~ APRIL ... ~ 2001
. '//rrL~;'<'''f'w) ~~
; ~ / R~~~
No.
-/
./ , Deceased
,."./
OF LETTERS OF AD~ISTRATION-
,/ :',
r""''''
AND NOW
the reverse side hereof, satisfactory pro
IT IS DECREED that
isl are entitled to Letters of Administration a
19~, in consideration of tf.le petition on
been presented before me, .
in accord with such finding, Letters of Administration
are hereby granted to
in the estate of
Register of Wills
FE
Letters of Administration ..... $
Short Certificates( ).......... $
Renunciation ................ $
$
TOTAL _ $
Filed ..................... A.D. 19_
ADDRESS
PHONE
-
fI)
-
u
....
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-
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co
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E
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: David E. Smi th
Date of Death: September 27, 2000
Will No. 2001- 00380
Admin. No. 21-01-0380
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on May 11, 2001 :
Name Address
Carla D. Smith 1008 Forbes Road, Carlisle, PA ]7011
Lindsey A. Smi th 1008 Forbes Road, C,gr1is1p, PA 17013
Abbey L. Smith 1008 Forbes Ro,gCl, C,gr1i~lp, PA 17013
Maggie A. Smith 1008 Forbes Road, Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
J..\j \l , 200 (
W7~
Signature ( .--
----
Name Andrea C. Jacobsen, Esq.
Address 52 East High Street
Carlisle, PA 17013
Telephone ( ) (717) 249-6427
Capacity: _ Personal Representative
~Coullsel for personal representative
--- FOLD HERE
~.,~~~~~~"-~~-~~O-----K-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
I"
.sE~FPEY COH I C~:.
-~-:::....., -'. __ --.r ~,---r _ ~.......-~
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CAr~L:SLE. PA 1~!013
390 ALEXANDER SPRING ROAD
ESTATE INFORMATION: I
FILE NUMBER
" 1 -2001 .. Co ::1 t3 C) ~:)SN ~~j=,f)--!~ !'.~-, 9940
.::
NAME OF DECEDENT (LAST) (FIRST) (MI)
~,f< 1 -r r--~ DAV I :) C
DATE OF PAYMENT
1 ,-,' : t~:'.)'..) 1
l~ .,.'
POSTMARK DATE
i) " " H) , . ; ~,~/. _....i )
COUNTY
C' U ("18 [ R L r-. hi L f
DATE OF DEATH
C) / (::...."J / C:(JOI)
.. - - . --
REMARKS.H:F f- '=<:L '( COH I CI<
C r--; f~' C, r'. ~ /-.~? '~?
SEAL
REGISTER OF WILLS
No.AA 496774 REV-1162 EX (11-96)
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101
$::1,500.00
'Ii>
FOLD HERE -
, .
\ '
, '
,,'
"Ie
~.
..
-:r<3 .~~I~)O~ 1.)(1
TOTAL AMOUNT PAID
\, /6 -~~t3- /-V
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
<'l
I
(/
(,.....-'
July 2, 2001
Telephone
(717) 787-3930
FAX (717) 772-0412
Carla D _ Smith
390 Alexander Spring Rd.
Carlisle, Pa.17013
Re: Estate of David E. Smith
File Number 2101-0380
Dear Ms Smith:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before December 27,2001. Because
Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional
extension(s) will be granted that would exceed the maximum time permitted.
Sincerely, ,__
/,J / ! ,t! ,1/1// l i! IJ)
.' .::.,., "..,.,.,.,..-/
Jeffrey D. Hollenbush, Supervisor
Document Processing Unit
Inheritance Tax Division
Q,,~
v
I
..
STATUS REPORT UNDER RULE 6.12
Name of Decedent: David E. Smith
Date of Death:
September 27, 2000
Will No.
21-01-0380
Admin. No.
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 No X
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
Unknown at this time due to dispute over value of partnership assets and
obligations of the decedent.
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
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
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report. 11 /7
"/IS!.Y;iJ:>.. ud~
Andrea -. obsen. Esq.
355 East Baltimore Street
Carlisle, PA 17013
Date:
Capacity: _ Personal Representative
--A Counsel for personal
Representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
'-
.
Date: 8/08/2002
CARLA D SMITH
1008 FORBES ROAD
CARLISLE, PA 17013
RE: Estate of SMITH DAVID E
File Number: 2001-00380
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: 9/27/2002
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
I71tUl d..~ 111<- ))ft-dR.01
MARY C. LEWIS
REGISTER OF WILLS
cc: /File
Counsel
Judge
I
INRE:
ESTATE OF DAVID E. SMITH,
Deceased
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: No. 2001-00380
NOTICE OF APPEARANCE
Kindly enter the appearance of John D. Sheridan, Esquire, as attorney for the Estate of
David E. Smith, Deceased, in the above-captioned matter.
SERRA TELLI, SCHIFFMAN,
BROWN & CALHOON, P.C.
ohn D. Sheridan, Esquire
J.D. No. 82275
2080 Linglestown Road, Suite 201
Harrisburg, PA 17110
(717) 540-9170
Dated:
C);;~v
REV-1500 .
IlI;Y-I;JlNtAlll.(JlJ/ OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA INHERITANCE TAX RETURN
DEPARTMENT OF REVENUE FILE NUMBER
DePT. 280601 RESIDENT DECEDENT AL -~.1. ~-:1JA._
HARRISBURG, PA 17128-0601 co__ ,IN! ......,
~ oeCEDEIfT"S NAtIE (lAST, FIRST, AND MIDDLE NlTIAl) SOCIAL SEClJRI1Y NUMBER
:z Smith David E. 350-44-9940
w DA1! OF DEATH (llM-DIJ.I<AA) DATE OF BIRTH (MM<lD-YEAR) THIS RE1UIlN MUST IE FILED IN D!.1'LlCATEWlTH THE
0
w 9-27-00 10-5-52 REGISTER OF WILLS
0
w (W APPLICABLE) SURVIVING SPOUSE'S NAME (lAST. FIRST, AND MIOOLE INli1Al) SOCVlL SECURITY NUMBER
0
Carla O. Smith
w !iJ t ongin~ RoIllm 0 2. S\lpplem",t,1 Relum 0 3, Remalnd.Retum(dlttfl~~\e12-13-B",
'""'
"'~~ o 4. Umiled Em," 0 4a FUklre ~teresl Co!l1)rnmlse (_olllelllJlttfJr 12.1HZl 0 0, Fedefal EIta1t! Tal: RelllTl Required
frla..u
:J:~g o 6. _D1odTesllll'(AJlocll"'!'I'f\WI 0 7. Oecedoot MainlelneQ I Living irust (AlltcllgPP'l or Ti'\II) _ 6. To~1 NurmerrJ Safe Depo<ll Balles
0,,-,"
~ o 9. ullgelioo_R_ o 1(1, Spousal Poverty Gmt" (cIiIt. or lIAlh Ntwten 12-Jl-911M j.1.fl$l 011. E1d0!\\otOl<lI11OerSGc-SI13iAII'll"",,"01
!i' .... 'I''''I$.&ECI'lGlNh\lilSt....;:~I;j;.Al:i~.t':~!l EAllti.eO/llmmlAtl;r~~'t:IliIN'S~i.,D\RE 151)'.'1'0,'.
w NAME COr.PlETE MAl.ING .ADDRESS
Q Carla D. Smith 1008 Forbes Road
z
~ FIRM NAI.E if ^""""'\ CarliSle PA. 17013
'"
w
~ TElEPHONE NUMBER
0 717/249-5608
<.>
f. Real E8taIe (S<:hedtJ. A) (1) OFFICIAL USE ONLY
1 Smd<S and aoncls (Sdled"l. B) (Z) O{"'~ ::0
3. CloseIyHeldClJllOl'lIe.,P~orsoo.P!"'"eltrSl>ip (J) 15,0~iQO g (!)
Q
4. MorIgeges & Noles Recelvabl. (Schedule 0) (4) 0"
("{ ="
=
5. C..~ _ Dopo~\. & t.lsooIIaneous Per_I Properly (5) ..... ;0
Z (Sdl.dule E) I
N
0 6. JOnIy OwneCl Properly (ScI1ec1u1. F) (5) '.
~ o Sep,.... Bili11y Requ..led -0
~
-' 7. Inler.l/iw. T"""'" & lJA.toIl"""", Non-Probate Properly (7) [00 ~ ;:~.
:;:)
I- (S<:hedul.Gor ")
ii: B. TOIIIllmee _(10l" Lines '.7) (6) 15,000.00
-t
0 s. r....llI E>penses & Ad",,,.....,,,, Costs (Sdl.OOI, H) (9) 9,685.00
~
10. Debls of Deeedent, l.b1gog. LieIlWU.., & u... (SChedule I) (10) 200.00
11. Tol>lDeduotlon.(1DlalUnes9& 10) (11) 9.885.00
12. NotValueofEslalll(1.ine6_.u.e 11) (12) 5.115.00
13. Chotilll>le and Govern_at Bequeslo'Sec 9113 nus. for which on ~edi'" 10 lax has nol b.... (13)
made (Schedule J)
14. Not 110I110 Sutlloctlo lIx(t~.1l minus Une 13) (14) 5,115.00
Sf.E INS1llUC'I1ONS Fa! APf'UCABLE AATES
Z 15. Amou"'otLlneI4IJlcableet~..pous"lax
0 5.115.00 x .O.....Q
!;( rare, or II3lSier1 undor See 9116 (.){!.2) (15) 0.00
~ 16. Amount or LInt 14 \O><e~e eUines! rate x.O_ (16)
t:l.. 17. ArnourrtofLiml14'~ableatiSiblingratl X .12 (17)
~
16. Amount oIlln. 14 _~ .1 oollal.ral raie X .15 (18)
(J
X 1S. Tax Duo (19) 0.00
~ 20. Ii] IdtlEeK:lIERll;lF,{bU;~'I'lEIU!QOl!$'I\ING;:Ai~".~~.M~J'l1.X~'rl
.
'I.....' . :::;'~':',.' ;,oJ':,,: 1'.;l,~,":V'\ ~ :il\eels~it(i)::AN$Wt:R',~oQttEST.)()N$~1bN;~S,~'SJO'E:A:r!&'t~IECffECl("~AtH'~:<iC:'
Sn:M4:2'021~.1
,>'., '~:,:,\ ";;;;, "I' I
,,' ,
Oecedent's Complete Address:
STREET ADDRESS 1008 Forbes Road
CIlY I STATE PA I ZIP 17013
Carlisle
Tax Payments and CredIts:
1. Tax Due (Page 1 Wne 19)
2. Credits/Paymenls
A. Spousal powrty Credil
B. Prior Payments
C. Discount
(1)
0.00
3 500.00
3. IntaresllPenally if applicable
D.lnt_t
E. PonoIty
Total Credits (A + 6 + C) (Z)
3.500.00
TolallnterestlPonal1y (0 + E) (3)
4. IlUne2 isgtellterthan line 1 + Une 3. enlerthe dllleren",. ms is 1I'e OVERPAYMENT.
Cheek box 011 P:lge 1 Lln. 20 10 request a refund (4)
5. If Une 1 + Line 3 is greater than Line 2. enler the dillerenca. This is the TAX DUE. (5)
3,500,00
0.00
A. Enter ths interest on the tax due.
(5A)
B. Enter the total of line 5 + SA. Tllis is the BALANCE DUE. (58)
Make Check Payable fa: REGISTER OF WILLS, AGENT
~". .,:,' ,. ""',.>:,"<:
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did clececfent make a transfer and: Yes No
a. rel.in the use or income of the properly Iransferred; .............................. . 0 [iJ
b. retain the "ght to designate who shall use the property transferred or lis ineome;, ......"......,.. 0 !Xl
c. retalnareverslonltyint....t;()( ...................................................... 0 !Xl
d. receiwthe promise for life ofelther paymenls. benefits or care? ..,..,.,....................... 0 !Xl
2. If deAth oCCUl1l!:d a~er Oecembef 12, 1982, did decedent lransfer property within one year of death
withoufreceiYingadequateconsideration?,........,....... .......,..,..."."........,..,.. 0 [Xl
3. Dill decadent own an "In tIu&t for" or payable upon death bank account or secunly at his or her death? . . , .. 0 iii
4. Did decedent own an Individual Reli"",enl Account. annully, or other ooo;>l1lbal. property which
COIl\ainaabelleficiarydesignation? ...........'......,....,......................,.....,.. IiU 0
WER TO NN Of THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCtalULE G AND FILE IT AS PART OF THE RETURN.
peojuIy, 'de _tnod relum, ~dud'''Il accomp.l1jing ,chodule$ and 'la1'_',lIId loth. b.st of my knOWledge and belief, it is 'lilt, corre<l and CllIllpl"..
lI'er an is bsS8d on ell irtormalion llfwhldl has a'1 kooNled e.
SON NG RETURN
, :: "?:: :~:::,; :;J':' ~/,;: ;:~:; :;', '::! :,:: 'i;~:'; l:~: \ 7:":: :':(:::'i:"} :":'1': Xii':, ::: I :::~: ';? ': ::'- :,' :,:,:,: ,~:F: ::7: :'~~:' ,:: \'1"',~:: :,!I~~:, ~ :.::
:;; '-'::! ~ Ie': :.~' , F: "T:': ."", " "::~';',' :,;.':: r':,'" ~,\ i:':'y :\i' r,:."", ;",'i", >, \ ':\i J;J\~':,,'
F()(dal.. of dealh on or after July 1. 1994 and before JanUll)' 1, 1995, II'e tax rat. imposed on the net value of transfe.. to or fortM use of the slJ'Ji~ng spouse is 3%
[72 P.S. ~9116 (a) (1.1) 0)].
For del.. of de.1th on or after January 1, 1995, the tax rate Imposed on the net value oftransm.. to or lor the us. of thesurviving spouse is 0% [72 P.S. ~9116 (al (1.1) (ii)].
The slatute does not exemDl a tr~sfi!r to a surviving Sllouse from tax. and 1M slll\!Jtory reqtjremenls tor disclosure of assets and filing a tax return are slm applICable ~
if the surviving spouse Is ths only beneficiary,
For dates of death on or an... July 1, 2000:
The lax rate ImpOSed on lhe net value of transfers from a daceased child twenty-one \'081$ of age or younger at death to or for the use of a natural parent. an adoptive
pa""'~ or a stepparent of the cl1ld Is 0% [72 P.S. ~9116(a)(12)J.
The tax rate imposed on the net value oftran,fern to or for 1!le use olthe decedent'slin.al beneficiaries iS4.5%, 8llC8P1 as noted in 72 P.S. 59116(1.2) [72 P.S. ~9116(a)(1)1.
T~!ax rate Imposed on the net vaiue ?f lrtn$fern t., or for the U$. of Ihe dececlent', siblings Is 12% (72 P.S. ~9118(al(1 ,311. A sibling is defined. undar Section 9102, aa an
indMdual who has at Iee,t .no parent In common With the decedent, whelher by blood or adoption.
S'lfPNl2Qt1F.2
. REV.1504 ~ ~ (1-911 (II
COMMON'M-ILTH (J' P"",SYLVANlA
\NH!~TAHCE TAX RETURN
ReSlIlENT oeC<CENT
SCHEDULE C
CI.OSELY..fiELD CORPORATION,
PARTNERSHIP or SOLE.PROPRIETORSHIP
ESTATE OF
Smith. David E.
FILE NUMilER
21-01-0380
SchoOihC-1 orM (~duamg oII''-l'P<JI1ing InformBlion) mU8l be _ flr each ei06eIr-held 1XII'II00000ilJ1/p'lrtner>hill intel..t (]( 1M decedenI, _1l\8n. sda-proprielO!1hlp.
SHIn_f,,\hes~inginformolionlobe submilledforaole-propHoIaships,
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1,
Decedent was a 50% partner in a PA partnership known as
Smith and Bowen. Per agreement attached, decedent's interest in
said partnership was sold. No other information Is available with
regard to assets or liabilities of partnership.
15,000.00
2.
1000 voting shares of J.K. Miller Corporation, a PA corporation.
Administratrix exchanged the shares in retum for a release of
liability that the deceased might have for debts of the corporation
as of decedent's death. No funds exchanged hands. See agreement
attached. No other information is availabe with regard to assets
or liabilities of corporation.
0.00
S,",PA~021F,S
TOTAL (Also erner on line 3, Recapitulation) $
(If more spece is needed. msert addlijonal sheelS of the StIlle size)
15 000.00
. REV-1510 EX oj. (1-97) (f)
COMU~LTH OFP!NN$YI.VANIA
NlERITANCE TA)( RETlIRN
ROSI ~ oo:E""'"
ESTAlEOF
Smith, David E.
SCHEDULE G
IHTER-V1VOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
FILE NUMBER
21-01-0380
ll'is sdtldufe I1iUst be co~ a1l(j filed if the answer to any ofquestlons 11hrough 400 Uwrevtl'Se side oflhll REV-1500 COVER SHEET is )'E!9.
DESCRII'TION OF PROPER1'f %0,
ITEM 11ICl.Ui:f: THE ~EOF 'tHI; tRANSfEREE. TI4I" AElATfONSIiI"TO ~eeOetlT MIJ THE DATE DATe 0, DEAlli DECO'S EXCLUSION TAXABLE VALUE
NUt.IleF< OFTIWGM, ~fTACHACOPY OF TH'::! Ol!:o FOR REAL ~A.TE- VAlUE 0, ASSET foITEREST ~F APPllCAIIll!)
1, AL.L. IRA accounts owned by the deceased
are payable to Carta D. Smith, spouse. 0.00
TOTAL (Also enter on line 7, Recapitulation) $ noD
..
STFPA42021fi.11
(If more space 1$ needed, lnoert a<!dltlonlll sheets of lI1e same siZe)
. FU:V-1511I;X'" (1.97)(1)
CQt.4MOt-MEAlTIi OF pe~6YlVA~A
INH~rtANCE TAX RETURN
RcSlOENT DtCCO<NT
SCHEDULE H
FUNERAL EXPENSES &
. ADMINISTRATIVE COSTS
ESTATE OF
Smith. David E.
RLENUMBER
21-01-0380
00Ills 01 dc.!orc must be -""<Ion Schodul.l.
ITEM
Nlto/BER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1.
e. ADMINISTRATIVE COSTS:
1. Personal Representative's CommiaaiOO!l:
Name of P..sonal Rop....enlaliver'}
Social Slcurlly Number(,} / EIN Number of Personal Ropresentalive(,)
SIreelAddm..
City Sial. ~p
Yea'('j Commi,sion Pa~:
2. AltOO1l1F... 2,500.00
3. Family E~ptlon: (W dec<<lent's addraas is nollhe SlIM liS claimant's, ab:h ~IMatiOO)
C_~ earla D. Smith
_Add...., 1008 Forbes Road
CJlyear/isle Sial. PA Zip 17013
ReIaijonS/lip of Clomsnt to Decedenl spouse 3,500.00
4. Probate Fees 235.00
5, _flJnI"F...
6. r",RehlmPreparor'. Fee,
7. Legal fees incurred to file lawsuit to force dissolution of partnership
on Schedule C-1 2,500.00
8. Appraisal fee for real estate owned by partnership for lawsuit purposes 950.00
TOTAL (AlSO enter on line 9, Recapitulation) $ Q,685.00
(If more 'Pace 1$ needed, Insert additIOnal sheets of the same SIZe)
S'tFPA420;1',12
~EV-1S13 ex.. (g.OO)
COf,f.IONWEAlTH OF PENN$\'I.VAMA
INHERITANCE TAX RETuRN
RE510ENT OecEOENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Smith David E
FILE NUMBER
21-01-0380
RELATIONSHIP TO OEC~DENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) R~CEIVlNG PROPERTY Do Not List Trustee<s) OF ESTATE
l. TAXABL~ DISTRIBlITlONS [include outright spousal distribution" and tran,fers
under See. 9116 (a) (1.2)J
1. Carla D. Smith
spouse 100%
Note: Decedent died intestate, survived by his
spouse and two sons. Since the value of the estate
is below $30,000, the spouse will receive the
entire residue of the estate.
eNTER DOLlAR AMOUNTS FOR DISTRIBlITlONS SHOWN ABOVE ON LIN~S 15 THROUGH 1 a. AS APPROPRIATE, ON REV.15oo COVER SHEET
II. NON-TAXABLE DISTRIBlITIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTiONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON liNE 13 OF REV-I500 COVER SHEET $
..
(II more spaca m needad. ,n,ert addlllonal,heet, oltha.ame ..~el
S.TP'PA42021 F.14
STOCK PURCHASE AGREEMENT
THIS AGREEMENT, made and entered into this 29th day of June, 2003, by and
between Estate of David E. Smith, by and through its Executrix, Carla D. Smith, of 1008
Forbes Road Carlisle. Pennsvlvania 17013 (hereinafter referred to as "Seller"); and CURTIS E.
, .. ,
BOWEN, an adult individual principally residing at 320 North 24th Street, Camp Hill,
Pennsylvania 17013 (hereinafter referred to as "Purchaser"),
WITNESSETH:
WHEREAS, David E, Smith Cdecedent") became deceased on September 27, 2000 at
which time he owned One Thousand (l,000) voting shares of the outstanding common capital
stock of .J.K. MILLER CORPORATION, a Pennsvlvania business corporation with One
Miilion (1,000,000) shares of common capital stock authorized ror issuance ("Corporation"); and
WHEREAS, said shares owned by the decedent constitutes tlfty percem (50%) or the
outstanding common capital stock of the Corporation; and
WHEREAS. Purchaser is desirous of purchasing and the Seller is desirous of selling and
conveying all of decedent's inrerest in the Corporation to Purchaser pursuant to a certain Stock
Restriction Agreement dated October 20 1 G06; and
WHEREAS. Seller and Purchaser are desirous of memorializing their understanding and
reducing the same LO writing upon the tern15 and conditions hereinafter set forth.
NOW. THEREFORE. in consideration of the above recitals and the respective
covenants. represemations, warranties and agreements herein contamed. and for other good and
valuable consideration, the receipt and sufficiency of which is hereby acknowledged, and
intending to be legally bound hereby. the parties hereto agree as follows
1. DELIVERY OF SHARES. At the closing (the "Closing'''') (as hereinafter defmed in
Paragraph 3 hereot), the Seller shall convey and deliver to Purchaser the appropriate stock
certificates representing One Thousand (1.000) shares of the outstanding shares of common
c:lpital stock in the Corporation in which Seller claims any ownership imerest. the same being free
and clear of ail liens. encumbrances or claims of others whatsoever. duly endorsed in blank.
together with any other appropriate instruments of transfer satisfactory to the Purchaser
~ PURCHASE PRICE. In consideration for the transfer of all of decedent's shares,
the Purchaser :lgrees to assume and be and become solely responsible for all debts of the
Corporation as of the date of decedent's death ("Effective Date") and thereafter
3. CLOSING. All of the transactions cantempiated herein shall be consummated such
place and time as the panics hereto may mutually agree upon in writing. Closing shall occur on or
before Julv 15. 2003. but for all purpose shall be effective as of the Effective Date (herein called
"Closing Datt" or "Closing").
4. Reserved
SALE AND ASSIGNMENT OF
PARTNERSHIP INTEREST
THIS SALE AND ASSIGNMENT OF PARTNERSHIP INTEREST, is hereby
entered into by and among CURTIS E. BOWEN, an adult individual principally residing at 320
North 24tl, Street, Camp Hill, Pennsylvania 17011 (hereinafter referred to as "c. Bowen" or
"remaining partner")~ and CARLA D. SMITH. individually and as Executrix of the Estate of
David E. Smith, with her principal residence being located at 1008 Forbes Road, Carlisle,
Pennsvlvania 17013 (hereinafter relerred to as "Smith" or"selling partner"); and KAREN J.
BOWEN. an adult individual principally residing at 320 North 24th Street, Camp Hill,
Pennsylvania 17011 (hereinafter referred to as "K Bowen" or "new partner")
WIT'iESSETE:
WHEREAS, Curtis E Bowen and David E. Smith had entered into a Partnership
Agreement dated July i5, 1996 ("Agreement") for the purpose of owning real estate and
improvements thereon or that propertv known and numbered as -8-96 Wabash Avenue,
Pittsburgh, ,Allegheny County, Pennsylvania. and all other associated business activities under
the name of Smith & Bowen pursuant to the Uniform Partnership Act of the Commonwealth of
Pennsylvania, as amended~ and
WHEREAS, David E. Smith became .je~e3sed ,:m Sep:ernoer 2"7. :000: and
WHEREAS. Curtis E. Bowen is desirous of continuing the partnership ',VIti] a uew
)artner, namel:' Karen !. 3owen: ~lnd
WHEREAS, under Paragraph 14 of the Agreement, the surviving partner, namely Curtis
E. Bowen, may elect to purchase the decedent's interest in the Partnership by serving notice of
such election within two (2) months after the death of the decedent upon the personal
representative thereof; and
WHEREAS, C Bowen by letter dated November 24, 2000, notified Carla D. Smith,
individually and as Executrix of the Estate of David E. Smith, of his intent to purchase the
decedent's interest therein; and
WHEREAS, the parties hereto are desirous of memorializing their understanding
concerning the purchase of such interest and subsequent assignment by C Bowen of said interest
unto K. Bowen as outlined herein.
NOW. THEREFORE, intending to be legally bound hereby, all of the parties hereto
agree as follows:
1 Pursuant to Paragraph 14 of the Agreement, Curtis E. Bowen has ele~ted to
purchase the entire fifty percent (50%) interest of the deceased partner, David E. Smith, in that
general Pennsylvania partnership known as Smith & Bowen effective as of the date of decedent's
deatlL September 27, 2000 ("Effective Date"). Carla D Smith, individually and as Executrix of
the Estate of David E Smith, hereby covenants and agrees to convey any and all interest which
she and the Estate may have in the partnership of Smith & Bow'en in exchange for the sum of
Fifteen Thousand Dollars ($15,00000), the same to be payable to C Smith within one (1) year
tram the date of this Agreement as evidenced by a PromissoI'J 'late fer said sum in form or'rhe
said Note attached ]1ereto as Exhibit ",:'," and incorporated herein bv this reference Beth C
Bowen and C Smith agree that ,he sum Jeing paid in consideration '1ereClnder ;s reasonable and
'1as 'Jeen clgreed 'Joon elt arms :ength. Funher. anv Jnd :.lil lnsuranc~[lroceeds that have made
payable to C Smith as a result of the decedent's death shall be retained solely by C Smith and
c. Bowen hereby \vaives any' interest therein.
'"'
As of the Effective Date, C Bowen is desirous of assigning any and all interest
which he has purchased from the Estate of David E Smith and C Smith to his spouse, Karen J.
Bowen Karen 1 Bowen is desirous of accepting such assignment and all parties hereto consent
to the same.
3. Upon execution hereof and as of the Effective Date, C Bowen and K. Bowen
hereby release C Smith and the Estate of David E. Smith from anv and all responsibility,
liability or other claim or amount due under the Agreement and agree to assume full
responsibility for the partnership and all of its liabilities thereof As of the Etl'ective Date, C
Bowen and K. Bowen shall indemnify and hold harmless C Smith and the Estate of David E.
Smith with respect to any liability incurred bv the partnership, or any obligations under the
Agreement not intentionally caused by C. Smith or the decedent's estate or their representatives.
4. Any elnd all liabilities, specificallv any loans through PNC Bank, "1-".. or any
other lending institurion, which the partnership has executed as of the Effective Date shall be the
sole responsibility of C Bowen and K. Bowen as partners under the Agreement. Additionallv,
C. Bowen and K. Bowen shall use their best efforts to helve C. Smith and the Estate of David E.
Smith released as guarantor from any obligation associated with the partnership of Smith &
Bowen.
" C. Smith. individually and on behaif of the E~tate 01 David E. Smith, hereby
c;)venams and agrees ,0 execute an': additional documentation which mav be necessary to
effectuate the intent terms and Gonditions o{this Sde ,:-~nd ;-\ssignrnent ofP:u1nershio Interest.
6 Each party agrees to indemnify and hold harmless the other pany for and from
anv and all liability or loss the other partv may suffer (including but not limited to court costs
and reasonable attorney's fees) on account of a party's breach of any term, covenant, warranty or
representation set forth herein or in any of the documems and instruments executed or delivered
in connection herewith. All the terms, covenants, warranties and representations set lorth herein
shall survive dosing and the execution and/or delivery of any documents and/or instruments
betore, at or after closing.
7 Neither party hereto shall be liable for anv broker's commission m connection
with the transactions hereunder, and each parry acknowledges and represems to the other party
that it has not had anv dealings, negotiations or consultations with any broker concerning the
transactions hereunder.
S This Agreement shall be construed under and governed by the laws of the
Commonwealth of Pennsylvania. This Agreement constitutes the entire agreement between the
panies with respect to the sale and transfer of the pannership' interests, and there are no
agreements, conditions or understandings, either oral or written, between the parties relating to
these matters other than those which are contained in this Agreement. For the purposes of
interpreting this ,-\greement, the masculine shall include the feminine and neuter, and vice versa,
and the singular shall include the plural, and vice versa, l,miess contrary intent appears. The
subject headings of the paragraphs of this Agreement are included for the purpose of
convenience only and shall in no way aiTect the meaning or construction of any term or pnwision
hereof The above WHEREAS clauses and the attached Exhibits are integral and substantive
pans of this Agreement and are herebv incorporated herein bv reference. This Agreement shall
inure to the benefir of and shail oe binding upon each of the pames hereto and their respective
heirs. execurors. administrators. successors (1nri asslgns. This Agreement may be altered ;,)f
amended 'Jnlv bv ~vritten agreement signed bv 1il panies and signatories hereof ';115
\greement may be executed ;n one 'Jr more ':oumerparrs. eachu! 'Nhich shail be deemed an
original. but aH ci \vhicn ~o~~ether snail (:.onstilute one lnd :he same AQrcernem. All :he terms.
covenants, warranties and representations set forth heretn shall survive Closing and the execution
and/or delivery of any documents and/or instruments before, at or after Closing
9. All parties hereto agree that all of the terms and conditions of this Agreement
shall remain confidential and shall only be relayed to the parties hereto or their duly appointed
representatives to the extent that such terms and conditions are not considered public knowledge
or a part of the public domain.
10. K Bowen hereby Joms in as a signatory of this Agreement evidencing her
acceptance of the assignment ofthe one-half (1/2) interest of the Estate of David E, Smith via the
re'naining partner, Curtis E. Bowen, and also hereby agrees to be bound by all terms and
conditions of the Partnership Agreement dated Julyl5, 1996, as :lmended, :lS though she h:ld
originally been m:lde a partner thereof
IN WITNESS WHEREOF, mrending to be legally bound hereby, tlle parties have
executed this Sale and Assignment of Partnership Interest the day and year tirst above wrinen.
WITNESS
''''':\'~vC.y
_>~:'; _f~
I " 1t!..-,/,- '/~,')<;>'~,~-----r-- lA,
.[r:r -,-~'... "_- - -
/
Carla D. Smith, Executnx. ~hiie'
Estate of David Et Smith
-\
/-',..
~'.,.{
i,_-i./
"-<'/.
/
:01"1
- ""jl,.. "
"
/,,~/-.-~
-'/,. ~ iJ,. J
/
/ "
/n /~ " /'7;;t/ (t'
,0... , f,,' l _" / . "
50 : A.V (~L'~V v ,d' _ ,~,. /, 'f ~
/1
,1
i/ ~
' _f 't. .
......-' /""" --/",,"
Curtis E. Bowen
.--'
.-7
0~, ___
(-_.// 'v '.- --------
p
Karen J. Sowen
BUREAU OF INDIVIDUAL TAXES
XNHERZTANCE TAX DTVZSTON
DEPT. 280601
HARRISBURG, PA 17128-0601
CARLA D SMITH
1008 FORBES RD
CARLISLE
COMNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF /NHER/TANCE TAX
APPRAISEMENT, ALLO#ANCE OR D/SALLO#ANCE
OF DEDUCT/ONS AND ASSESSHENT OF TAX
'04 I't/~¥ -7 P3
PA
DATE
ESTATE OF
DATE OF DEATH
F/LE NUMBER
COUNTY
ACN
05-10-ZOOq
SMITH
09-27-2000
21 01-0580
CUMBERLAND
101
Amount Ree/ttad
DAVID E
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SMTTH DAVID E F/LE NO. 21 01-0580 ACN 101 DATE 05-10-200q
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANBED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rea1 Estate (ScheduZa A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C)
q. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property {Schedule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/H/sc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10)
11. Total Deduct/ohs
12. Nat Value of Tax Return
.0O
.00
15z000.00
.00
.00
.0O
.00
(8)
9,685.00
200.00
NOTE: To /nsure proper
credit to your account,
sube/t the upper portion
of th/s form w/th your
tax payment.
15.
lq.
NOTE:
15,000.00
(11) 9.88~. O0
(x2) 5,115.00
CharitabXe/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Nat Value of Estate Subject *o Tax (lq)
:If an assessment was /ssued previously, lines 1~, 15 and/or 16, 17,
re~lect figures that lnclude the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rate
16. Aeoun~ of Line lq taxable at Lineal/CXass A rata
17. Amount of L/ne lq at S/bl/ng rata
18. Amount of Line lq taxabXa at Collateral/Class B rata
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEXPT DZacuUNT
DATE NUMBER INTEREST/PEN PAXD (-)
06-27-2001 AAq9677q .00
.00
5,115.00
ZF PA/D AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
18 and 19 will
(ts). 5,115.00 x O0 = .00
(~6). .00 x Oq5= .00
(17) . O0 x 12 : .00
(~8) .00 x 15 = .00
(19)= . O0
AMOUNT PAID
5,500.00
TOTAL TAX CREDIT I 3,500.00
BALANCE OF TAX DUEI 3,500.00CR
ZNTEREST AND PEN.I .00
TOTAL DUE I $,500.00CR
( 1F TOTAL DUE 1S LESS THAN $1, NO PAYMENT ZS REGU/RED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CA), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THZS FORM FOR ZNSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
11fa or for years, the Coaaanwealth hereby expressly reserves the right ta appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rote on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NXLLSj AGENT
A refund of a tax credit, which ams not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour
ansaering service for fores ordering: 1-800-36Z-ZOSO; services for taxpayers ~ith speciaI hearing and / or
speaking needs: 1-SOO-447-30ZO (TT only).
Any party in interest not satisfied with the appraisement, a11oeence, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-10Z1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-150I) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the dacedant's death, a five percent (5X) discount of
the tax paid is alloaed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to tho date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 198Z wi1! bear interest at a rate which wilt vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are:
Interest Daily Interest Oaily
Year Rate Factor Year Rate Factor
~ 20Z .0005q8 ~)T~- 1991 iix .000301
1983 16Z · 000438 199Z 9Z . DOOZY,7
1984 llZ · 000301 1993-1994 77. . O00laz
1985 13Z .000356 1995-1998 9Z .000247
1986 IOZ .00027~· 1999 77. . 00019Z
1987 IOZ . OOOZ7~, ZOO0 77. · O0019Z
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~ 9X .000Z47
EOOZ 6Z .000164
2003 5Z .000137
2004 4Z .000110
X NUNBER OF DAYS DELTNQUENT X DALLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is mede after the interest computation date shown on tho
Notice, additional interest must be caIculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No.:
Admin. No.'
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:
State whether administration oft he estate is complete:
Yes .'~ No
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:
ao
Did the personal representative file a final account with the Court?
Yes _ No ['--]
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
Date:
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 '
Signature
Capacity:
Address
Telephone No.
[~e~nal Representative
['-I Counsel for personal representative
Cumberland County - Register of Wills
Hanover and High Streets
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 8/03/2004
CARLA D SMITH
RE: Estate of SMITH DAVID E
File Number: 2001-00380
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 AMMENDMENTS 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: 09/27/2004
Your prompt attention to this matter will be appreciated.
Thank you.
Sincerely,
REGISTER OF WILLS
cc:
File
Personal Representative (s)
Counsel
Judge
August 9, 2004
Glenda Famer Strasbaugh
Register of Wills
Cumberland County
Hanover and High Streets
Carlisle, PA 17013
Re-'
Estate of David E. Smith
Your File No.: 2001-00380
Our File No. 01-167
Dear Ms. Strasbaugh:
I am in receipt of your correspondence dated August 3, 2004.
Please be advised that we were discharged as Counsel with respect to the
above decedent before any substantive estate work was performed. I
suggest that you direct inquiries to the decedent's surviving spouse.
Very truly yours,
/bc
Enclosure ;/' ~
cc: Carla Smith (w/enc)/' /
SERRATELLI, SCHIFF~}4"A-N, BROWN
BUREAU OF INDIVIDUAL TAXES
ZHHERTTANCE TAX DIVISION
DEPT. 280601
HARRTSBURG, PA 17128-060!
CARLA D SHITH
1008 FORBES RD
CARLISLE
PA 17013
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
ZNHERZTANCE TAX
STATEHENT OF ACCOUNT
REV-Il;07 EX AFP c01-~5)
DATE 06-14-2004
ESTATE OF SMITH
DATE OF DEATH 09-27-2000
FILE NUMBER 21 01-0380
COUNTY CUHBERLAND
ACN 101
I Amoun~ Remi~ed
DAVID E
HAKE CHECK PAYABLE AND REHIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credl~ ~o your account, submi~ ~he upper por~/on of ~his fore wi~:h your ~:ex payment.
CUT ALONG TH'rS L'tHE ~ RETA'rN LOWER PORT'rON FOR YOUR RECORDS *-~
REV-1607 EX AFP (01-03) ~ 'rNHERTTANCE TAX STATEHENT OF ACCOUNT ~
ESTATE OF SMITH DAVID E F'rLE N0.21 01-0380 ACN 101 DATE 06-14-2004
TH/S STATEHENT TS PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHO#N BELO#
TS A SUNHARY OF THE PRZNC/PAL TAX DUE, APPL/CAT'rON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPL/CABLE,
A PROJECTED /NTEREST FTGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-10-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
.00
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID
06-27-2001
05-24-2004
AA~96774
REFUND
.00
.00
ZF PAZD AFTER THIS DATE, SEE REVERSE
S/DE FOR CALCULAT/ON OF ADD/T/ONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQU/RED.
/F TOTAL DUE ZS REFLECTED AS A 'CRED/T" (CR),
3,500.00-
TOTAL TAX CREDZT
.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORM FOR /NSTRUCT/ONS.
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- if RESIDENT DECEOENT make check or money order payable to: REgiSTER OF NZLLSj AGENT.
-- If NON-RESIDENT DECEOENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND [CA): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" [REV-1515). Applications ara available et
the Office of the Register of Hills, any of the Z3 Revenue District Offices ar from the Department's Zq-hour
ansmaring service for forms ordering: i-BOO-36Z-ZOSO~ services for taxpayers with speciaI hearing and / or
speaking needs: I-BOO-qqT-3OZO (TT onIy)o
REPLY TO: Questions regarding errors contained on this notice shouId ba addressed to: PA Department of Revenue, Bureau
of IndividuaI Taxes, ATTN: Post Assessment Revise Unit, Oept. ZB060I, Harrisburg, PA ITIZB-060I, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount
of the tax paid is allo~ed.
PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, or nine (9) months and one £I) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .00016q. All taxes ~hich became delinquent on and after
January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for IgBz through ZOOfi are:
Interast Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor.
1982 ZOZ .0005q8 1988-1991 IXZ .000301 200X 9Z .O00Zq7
1983 16Z .O00~B 1992 9Z .O00Zq7 ZOOZ 6Z .00016~
198q llZ .000501 1993-199~ 7Z .O00IgZ 2005 5Z .0001~7
1985 132 .000356 1995-1998 92 .O00Zq7 ZOOq qZ .000110
1986 102 .O00ZTq 1999 72 .000192
1987 9Z .O00Zq7 2000 8Z .000Z19
--Interest is calculated as follows:
'rNTEREST = BALANCE OF TAX UNPA'rD X NUIiBER OF DAYS DEL'rNI~UENT X DA~L¥ 'rNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sho~n on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-10-2004
SMITH
09-27-2000
21 01-0380
CUMBERLAND
101
CARLA D SMITH
1008 FORBES RD
CARLISLE
...-7
PA 17013
*'
REV-1547 EX AFP (01-03>
DAVID
E
Amount Remitted
CHANGED
ll)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
15,000.00
.00
.00
.00
.00
(8)
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 ~
ifE'v =iStrj-EX-AFP--((ff=03j--NOYicE--OF-YNHEifiTANCE-Y,ijc-A"ppRA-isEMENT-,--AL1-oWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SMITH DAVID E FILE NO. 21 01-0380 ACN 101 DATE 05-10-2004
TAX RETURN WAS: (X) ACCEPTED AS FILED
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
IS. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
5,115.00 X 00 = .00
.00 X 045 = .00
.00 X 12 = .00
.00 X 15 = .00
ll9)= .00
(9)
llO)
9,685.00
200.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
15,000.00
ll1)
ll2)
ll3)
ll4)
9.885 00
5,115.00
.00
5,115.00
f'AYMENT KI:\.;I:.1,... n' l+J
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
06-27-2001 AA496774 .00 3,500.00
TOTAL TAX CREDIT 3,500.00
BALANCE OF TAX DUE 3,500.00CR
INTEREST AND PEN. .00
TOTAL DUE 3,500.00CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
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.)
i
.l
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-IU7 EX AFP {Ol-03l
CARLA D SMITH
1008 FORBES RD
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-14-2004
SMITH
09-27-2000
21 01-0380
CUMBERLAND
101
DAVID
E
Amount Remitted
PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iffv = ic;o-j-Ex--AFP-((ff:ii31-------...--iNifERIi"-ANc'E--;:AX--STA-fEH'E-ti;:-cfF'-AC-couiff--.-..---------------- - - ---
ESTATE OF SMITH DAVID E FILE NO.21 01-0380 ACN 101 DATE 06-14-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-10-2004
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-27-2001 AA496774 .00 3,500.00
05-24-2004 REFUND .00 3,500.00-
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
.. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
~\<-
Cumberland County - Register of Wills
Hanover and High Streets
Carlisle, P A 17013
Phone: (717) 240-6345
Date: 8/03/2004
CARLA D SMITH
RE: Estate of SMITH DAVID E
File Number: 2001-00380
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 AMMENDMENTS 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: 09/27/2004
Your prompt attention to this matter will be appreciated.
Thank you.
Sincerely,
k~~~A'kJ,
GLENDA FARNER!!R}JrB~dH
REGISTER OF WILLS
cc: File
Personal Representative (s)
Counsel
Judge
LAW OFFICES
SERRATELLI
SCHIFFMAN
BROWN &
CALHOON, ~C.
August 9, 2004
Glenda Farner Strasbaugh
Register of Wills
Cumberland County
Hanover and High Streets
Carlisle, P A 17013
Re: Estate of David E. Smith
Your File No.: 2001-00380
Our File No. 01-167
Dear Ms. Strasbaugh:
I am in receipt of your correspondence dated August 3, 2004.
Please be advised that we were discharged as Counsel with respect to the
above decedent before any substantive estate work was performed. I
suggest that you direct inquiries to the decedent's surviving spouse.
Very truly yours,
SERRA TELLI, SCHIFF
~\ & CALHOON
Jo)i&n
/ f
Ibc
Enclosure I
I
Carla Smith (W/enC)J
;
I
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Cumberland County - Register of Wills
Hanover and High Streets
Carlisle, P A 17013
Phone: (717) 240-6345
Date: 8/03/2004
JOHN D SHERIDAN, ESQ.
RE: Estate of SMITH DAVID E
File Number: 2001-00380
Dear sirlMadam:
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 AMMENDMENTS 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. 0 r:
..- . .'."
_.' rr'
g.~
g
This filing will become delinquent on: 09/27/2004
."'i
~
c::
GJ
Your prompt attention to this matter will be appreciated.
--"
Thank you.
-0
--"
Sincerely,
~.,v~
GLENDA ~
REGISTER OF WILLS
cc: File
Personal Representative (s)
Counsel
Judge
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
)) A II I h1=-. ,.$~ tTl-l
q /d~ /~UrnJ
, I
c2/- () 1- 3?O
Admin. No.:
Date of Death:
Will No.:
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 Kl 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 0
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 0 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 r~ ' C '
Date: g /d3/D '/ L:/~{/ .2t..f-{~
Signature
~r/a '~fr117 /1
Name
N
C""l
N
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::J
a::
!fJJe lDrhp-S -ft/.
Address {! d /// j /e; (7- /'70 /'3'
(7)7 )0< ~cJ-5btJ r
Telephone' No.
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Capacity: ~nal Representative
o Counsel for personal representative
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