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Home My WebLink About08-13-09 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes county code veer File Number Po Box.2aosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 8 12 5 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 199 07 1208 11 09 2008 10 30 19151 Decedent's Last Name Suffix Decedent's First Name MI SMITH DOROTHY S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name SMITH Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Retum 4. Limited Estate g Decedent Died Testate (Attach Copy of Will) Suffix Spouse's First Name MI ROBERT E THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return qa Future Interest Compromise (date of death after 12-12-82) 7 Decedent Maintained a Living Trust (Attach Copy of Trust) 3, I~emainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 0 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death X 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) ~ (Attach SCh. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOHN A. GOLDSTAN, ESQUIRE 610 372 3500 Firm Name (If Applicable) LEISAWITZ HEELER ABRAMOWITCH PHILLIPS, First line of address 2755 CENTURY BOULEVARD Second line of address City or Post Office State ZIP Code READING PA 19610 Correspondent's a-mail address: REGISTER OF VI ILLS USE 01~' ~~ r ~ O "=' - ~.I_ ~ ~ - ~~ : . . w _ DATE FIL-L~$ N ~' ~~ ~~, . :..~ ..J cn .c~- ~, 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, corcect and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE Dale W. Grove ~~ life , ~r•~p~0 f ADDRESS 71 Majestic Lane, Reading, PA 19608 SIGNATURE OF PREPARER OTHER THAN EPRE NTATIVE ~ )~~. John A. Goldstan, Esquire D ~~~~+ annRFa. 275YCentury Boulevard, Reading, PA 19610 Side 1 1505607120 1505607120 15D5607220 REV-1500 EX Decedent's Social Security Number Decedent's Name: D O [r O t Il ~/ S. Smith 1 9 9 0 7 12 0 8 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 1 2 8, 3 3 3. 0 0 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 12 9, 8 9 8 6 9 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. 5. 6. 7. 8. Mortgages & Notes Receivable (Schedule D) .......................................................... Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. Total Gross Assets (total Lines 1-7) ....................................................................... 4. 5. 6. 7, 8. 6 9 , 4 9 0 . 4 0 4 8 , 7 7 0 . 4 2 3 7 6, 4 9 2. 5 1 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 2 3 x 9 8 7 6 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 , 1 8 4 1 0 11. Total Deductions (total Lines 9& 10) ...................................................................... 11. 2 5, 1 7 1 7 3 12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12, 3 5 1 , 3 2 0 . 7 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................................. 14. 3 5 1 , 3 2 0 7 8 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 .00 4 5, 17 0.71 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 3 0 6, 15 0 0 7 16. 13 , 7 7 6 7 5 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. 1 3, 7 7 6 7 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 15056D7220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-1258 DECEDENT'S NAME Dorothy S. Smith STREET ADDRESS 484 Lucinda Lane CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable p, Interest E. Penalty 0.00 Total Credits (A + B + C) (1) 13,776.75 Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (2) 0.00 (3) (4) (5) 13,776.75 (5A) (56) 13,776.75 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: Yes No 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 :.................................... ^ a c. retain a reversionary interest; or .................................................................................................................. ^ ^x d. receive the promise for life of either payments, benefits or care? .............................................................. ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................................................................................................... ^ ^x 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? ...................................................................................................................... ^x ^ 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 the 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 :end 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1602 FJt+ (6.98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Smith, Dorothy S. 21-08-1258 All 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 Duyer antl a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is Jolntlyowned wkh right of aurvlvorehlp must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-1603 EX+ (8-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-1258 Ail property Jointly~owned wkh right oT survlvonhip must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 500 shares of ABN Amro Cap Fd Tr V -Merrill Lynch 12.50 6,250.00 Brokerage Acct. #872-56886 2 500 shares of ABN Amro Cap. Fund Tr VII -Merrill 12.45 6,225.00 Lynch Brokerage Acct. #872-56886 3 500 shares of Aegon NV Pfd -Merrill Lynch Brokerage 10.3015 5,150.75 Acct. #872-56886 4 500 shares of BNY Capital V -Merrill Lynch Brokerage 21.0975 10,548.75 Acct. #872-56886 5 400 shares of Deutsche Bank Cap Fndg -Merrill Lynch 15.7525 6,301.00 Brokerage Acct. #872-56886 6 200 shares of Enbridge Energy Partners -Merrill 33.46 6,692.00 Lynch Brokerage Acct. #872-56886 7 400 shares of Federal National Mtg. Assoc -Merrill 2.6075 1,043.00 Lynch Brokerage Acct. #872-56886 8 500 shares of Financial Sec Assur Hld Senior Note Pfd 5.445 2,722.50 5.6% -Merrill Lynch Brokerage Acct. #872-56886 9 300 shares of First Industrial Realty -Merrill Lynch 11.82 3,546.00 Brokerage Acct. #872-56886 10 300 shares of Ford Motor Credit -Merrill Lynch 8.(1075 2,402.25 Brokerage Acct. #872-56886 11 400 shares of General Electric Capital -Merrill Lynch 21.4625 8,585.00 Brokerage Acct. #872-56886 Totai of Continuation Schedule See attached page TOTAL (Also enter on Line 2, Recapitulation) 129,898.69 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev1b03 EX+ (6.88) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-1258 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 12 500 shares of ING Group NV -Merrill Lynch Brokerage 12.7575 6,378.75 Acct. #872-56886 13 400 shares of Morgan Stanley Cap Tr IV -Merrill Lynch 14.775 5,910.00 Brokerage Acct. #872-56886 14 700 shares of Natl Rural Utility CFC Int Note -Merrill 17.8092 12,466.44 Lynch Brokerage Acct. #872-56886 15 500 shares of PPL Capital Funding Inc. Senior Note 23.6575 11,828.75 6.85% -Merrill Lynch Brokerage Acct. #872-56886 16 300 shares of PPLUS Series LMG Ser LD Class A Trust 9.6025 2,880.75 Cer Due 211!2030 -Merrill Lynch Brokerage Acct. #872-56886 17 500 shares of PPLUS Tr Cert Class A Series GSG-2 14.6275 7,313.75 5.750% Feb 15, 2033 -Merrill Lynch Brokerage Acct. #872-56886 18 1,000 shares of Renaissancere Hidgs Ltd -Merrill 14.4275 14,427.50 Lynch Brokerage Acct. #872-56886 19 400 shares of Royal Bk Scotland Group -Merrill Lynch 10.0475 4,019.00 Brokerage Acct. #872-56886 20 500 shares of SLM Corp. -Merrill Lynch Brokerage 10.415 5,207.50 Acct. #872-56886 TOTAL (Also enter on Line 2, Recapitulation) 129,898.69 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1b08 E%+ (6.98) SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN - RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-1258 InGude the proceeds of litigation and the tlate the proceeds were received by the estate. All property joinhyowned with the right of survivorahlp must be disclosed on achedul•e F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Cash -Merrill Lynch Brokerage Acct. #872-56886 186.06 2 Deposits clearing after death Citizens Bank Checking Acct. #6400051280 1,236.05 3 Citizens Bank Checking Acct. #6400051280 55,294.29 4 Merrill Lynch Bank Deposit -Merrill Lynch Brokerage Acct. #872-56886 7,564.00 5 2000 Chrysler automobile -Proceeds from sale 5,200.00 6 Chase -Credit card refund 10.00 TOTAL (Also enter on Line 5, Recapitulation) I 69,490.40 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1810 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-1258 This schedule must be completed and filetl 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER I INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DE=CD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 AIG Sun America Annuity Contract 32,502.03 32,502.03 #P0497541590 -Beneficiaries -113 -son, Dale Grove; 113 -son, Keith Grove; 116 -grandson - Jon Grove; 116 granddaughter -Daphne Grove Bartlett 2 Hartford Annuity Contract #310108734 - 16.268.39 16,268.39 Beneficiaries -1/3 • son, Dale Grove; 113 -son, Keith Grove; 1/6 -grandson -Jon Grove; 1/6 granddaughter -Daphne Grove Bartlett P TOTAL (Also enter on Line 7, Recapitulation) 48,770.42 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1161 EX+ (12.89) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-1258 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Leisawitz Heller Abramowitch Phillips, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Robert E. Smith Street Address 484 Lucinda Lane city Mechanicsburg state PA zip 17055 Relationship of Claimant to Decedent SpOUSe 9,737.09 10,000.00 3,500.00 4. Probate Fees 124.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 626.54 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 23,987.63 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) .SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE CCISTS continued ESTATE OF (FILE NUMBER Smith, Dorothy S. 21-08-1258 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Cocklin Funeral Home -Funeral 5,729.75 2 Range End Country Club, Inc. -Funeral luncheon 4,007.34 H-.A subtotal 9,737.09 Other Administrative Costs 3 Cumberland Law Journal -Estate notice advertising 4 Leisawitz Heller -Notary reimbursement 5 Leisawitz Heller -Notary and postage 6 Robert E. Smith -Reimbursement for appraisal fee 7 The Sentinel -Estate notice advertising 75.00 10.00 26.00 325.00 190.54 H-67 Subtotal 626.54 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 FJ(+ (6-98( SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Smith, Dorothy S. 21-08-1258 Include unrelmbursed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-151 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-12 58 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT ~Nords) ($$$) Do Not Llat Trustee a I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Dorothy S. Smith Credit Shelter Trust u/w Credit Shelter 100% of dated 9/1/1999 Trust residuary Robert E. Smith, Co-Trustee estate 484 Lucinda Lane Total Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on F2ev 1500 cove r 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 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) REV-1647 EX+ (8-0O) SCHEDULE M COMMONWEALTH OF PENNSYLVANIA FUTURE INTEREST COMPROMISE INHERITANCE TAX RETURN (Check Box 4a on Rev-1500 Cover Sheet) RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-1258 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 1. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH At~Tn NEARESTBRTFDAY 1. Robert E. Smith Surviving Spouse 12/12/1919 89 2. Dale W. Grove Son 10/22/1947 61 3. Keith E. Grove Son 04/08/1950 59 4. Patricia Grove Daughter-in-Law 04/14/1942 67 5. Jon A. Grove and Daphne Grove Bartlett Grandchildren 10/2811969 39 II. For decedents 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 right of withdrawal ^ Limited right of withdrawal Explanation of Compromise Offer: The allocation of the trust's assets between the interest of the spouse and the remainder beneficiaries was determined using the IRC Section 7520 interest rate of 3.6% in effect during the month of the decedent's death. The surviving spouse has adequate assets outside the trust to meet his foreseeable needs. Therefore, no discretionary principal distributions to the surviving spouse from the trust were assumed. A copy of the calculation using Brentmark's Factuary Software is attached. IV. Summary of Compromise Offer: 1. Amount of Future Irterest: 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) 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6% ^ 3% ®0% (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate ^ 6% ®4.5% (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) 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) 302,550.00 45,170.71 :!57,379.29 302,550.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule M (Rev. 6-98) Rev-1161 EX (1-97) (1) SCHEDULE O COMMDNwEALTH DF PENNSYLVANIA. ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN SPOUSAL DISTRIBUTIONS RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Dorothy S. 21-08-1258 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113,(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Dorothy S. Smith Credit Shelter Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9t 13(A), and: a, The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. T'he numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION See continuation schedule(s) attached VALUE Part A Total 302,550.00 Part B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is be g made. DESCRIPTION U~- Part BTotal (It more space is needed, insert additional sheets of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule O (Rev. 6-98) SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) continued ESTATE OF (FILE NUMBER Smith, Dorothy S. 21-08-1258 y Dorothy S. Smith Credit Shelter ITEM NUMBER DESCRIPTION AMOUNT 9113A Trust 1 Dorothy S. Smith Credit Shelter Trust u/w dated 911/1999 302,550.00 01-A subtotal 302,550.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule O (Rev. 6-98) :_ _ ,. -,~ ;.~,,., ~ 7 ~;~i ~~~~ ~~ ~ _ ... l^~~ .:'i ~ ~ryT OF _'7 Dr+ DOROTHY S. SMITH I, DOROTHI' S. SMITH, of the County of York, and Commonwealth of Pennsylvania, being of sound and disposing mind and memory, mindful of the uncertainty of life, make, publish and declare this my Last Will and Testament, revoking hereby a.ny and all former Wills made by me at any time heretofore. I. I order and direct my hereinafter named Executors to pay all my just debts and funeral expenses as soon as practicable after my death. II. I give all my tangible personal property, not including any property used in a trade or business or any property held primarily for investment purposes, together with all my rights, with respect to all insurance relating to this property, (i) as may be provided in a separate memorandum, dated and signed by me, making specific reference to this will, or (iij if and t:o tie ex~.ent tie property is not effectively disposed of pursuant to the preceding clause, to my husband, ROBERT E. SMITH, of York County, Pennsylvania, if my husband, ROBERT E. SMITH, survives me, or, if my husband, ROBERT E. SMITH, does not survive me, to my children and grandchildren who survive me, to be divided a~:nong them as they may agree, or, if and to the extent they cannot agree, by each of them selecting an item or items of equal value in turn, with the order of selection to be determined by lot, so that the division among them will be as nearly equal in value as pos;~ible. All costs of insuring, packaging, shipping, and delivering this property shall be paid by my executors as a general administration expense of my estate. III. I direct that all the residue of my estate, of whatever nature and wherever located, includi::g any property described in but not effectively disposed of by preceding provisions of this will, shall be disposed of as follows: If my husband, ROBERT E. SMITH, survivE~s me, I give my residuary estate to my trustees, to be held in trust. During the life of my husband, ROBEF:T E. SMITH, my trustees shall pay or apply the net income ofd this trust at quarterly or other convenient intervals but at lea:~t annually to or for the benefit of my husband, ROBERT E. SMITH. T_n addition, my trustees may at any time or from time to time pay to or apply for the benefit of my husband such amount or amounts from the principal of the trust, as my trustees may in their sole discretion deem necessary, after taking into account other resources of my husband, for the health, support and maintenance of my husband, provided that no amount shall be paid to or applied for the benefit of my husband from the principal of the trust until the :principal of any trust held under the preceding article has been e:~thausted. Upon the death of my husband, ROBERT E. SMITH, my 2 trustees shall distribute all property then belonging to the income and principal of the trust of my residuary heirs or their surviving issue in the following shares per stirpes: A. One-third (1/3) to my son, DALE W. GROVE, of Berks County, Pennsylvania. B. One-third (1/3) to my son, KEITH E. GROVE, of the Commonwealth of Massachusetts. C. One-third (1/3) to be divided in three equal shares among my daughter-in-law, PATRICIA GROVE, of Exeter Township; Berks County, Pennsylvania, my grandson, JON A. GROVE, of the Commonwealth of Virginia, and my granddaughter, DAPHNE A. BARTLETT, of Pennsylvania; In the event that JON A. GROVE or DAPHPdE A. BARTLETT shall predecease me, then and in that event the respective share of that predeceased grandchild shall pass to his or her issue per stirpes and, failing issue, shall pass to the survivor of JON A. GROVE and DAPHNE A. BARTLETT. In the event that my daughter-in-law, PATRICIA GROVE, shall predecease me, then and in that event her share shall pass to JON A. GROVE and DAPHNE A. BARTLETT or their surviving issue in equal shares. If my husband, ROBERT E. SLiITH, does r..ot st:~~i~~e me, I give my residuary estate to my residuary heirs as stated in the immediately preceding paragraph. If at any time any property belonging to my estate or any trust under this will is not effectively disposed of pursuant to the preceding provisions of this will, I direct ghat the property 3 shall be distributed to those persons who would then be entitled to inherit from me in accordance with the intestate succession laws of Pennsylvania then in .effect as if I had then died intestate owning the property and domiciled in the Commonwealth of.' Pennsylvania. IV. I direct that all legacies and all sharE~s and interests in my estate, whether principal or income, while in the hands of my Executors, or Trustees, shall not be subject to attachment, execution or sequestration, for any debt, contras:t, eblig alien or liability of any legatee or beneficiary, and shall not be subject to pledge, assignment, conveyance, or anticipation; and the personal receipt by such legatee or beneficiary shall be the sufficient and only discharge of my Executors or Trustees. V. In the event that there be any person or persons participating in the distribution of my estate who is suffering any incompetency or incapacity or minority, I order and direct hereby that any income or principal which, under the provisions hereof, may become payable to an incompetent or incapacitated or minor beneficiary, either legally or physically, shall, during such incompetency or incapacity or minority be held and expended by my Trustees, without necessity of bond and without intervention of a guardian, to such extent and in such manner as said Trustees shall deem best and necessary for the maintenance, education, support and welfare of such incompetent or incapacitated or minor beneficiary. 4 VI. I hereby authorize and empower my Executors, hereinafter named, in addition to and not in limitation of any authority given them by law, to exercise any or all of the following powers: A. To settle, compromise and adjust a:ny and all claims in favor of or against my estate. B. To pay all inheritance, estate,, succession and legacy taxes to which my estate, or the transfer of any property hereunder, may be subject and to charge such taxes. as a part of the expenses of administration. C. To sell all or any part of my rea]_ estate, at private or public sale, for such prices and upon such terms as to cash and credit as he may deem best, and to execute deeds of conveyance thereof, without liability on the part of the purchasers to see to the application of the purchase moneys. This power shall not be construed to work a conversion of my real estate unless and until the power is actually exercised. D. To make distribution in kind. E. To exercise all powers, authorities, and discretions given by this Will after the termination of alzy trust created herein until the same is actually distributed. F. Should the share of a minor or incompetent, in the sole opinion of my Executors or Trustees, as the case may be, be or become too small to warrant continuing such fund, in Trust, or should its administration be or become impractical for any other reason, my Executors may pay such share absolutely to the person 5 maintaining the minor or incompetent or may deposit such share in a savings account in the minor's or incompetent's name payable to the minor or incompetent at majority. VII. I nominate, constitute and appoint my husband, ROBERT E. SMITH, and ALLFIRST BANE, to serve as Trustees of <~ny trust created under this will. Any trustee may resign at any time arld without court approval. Any resignation shall be accomplished by a signed instrument. Any corporate trustee may be removed at any time and without cause by my husband. Any removal shall bE~ accomplished by a signed instrument. Upon the resignation or removal of any corporate trustee, a successor corporate trustee shall be appointec~ by my husband. The successor trustee may be any qualified financial institution that would not be treated as related or subordinate to my husband for grantor trust income tax purposes. Any appointment shall be made and accepted by a signed instrument. My husband shall not have authority to participate in making any determination as to whether or how a:ny discreticnary power shall be exercised if the exercise or failurE~ to exercise the power or the manner in which the power is exerciseci may directly or indirectly benefit my husband. Any determinatiol~ of this nature shall be made solely by my corporate trustee. No trustee shall be required to give a bond or other 6 security in any jurisdiction. VIII I nominate, constitute and appoint my sons, DALE W. GROVE, and KEITH E. GROVE, or the survivor of them, to be Executors of this my Last Will and Testament. My Executors shall not be required to enter bond or furnish sureties in any jurisdici~ion in which my estate may be administered. IX I direct that JOHN A. GOLDSTAN, ESQUIRE? be consulted in the administration and distribution of my estate„ IN WITNESS WHEREOF, I, Dorothy S. Smith, have hereunto set my hand and seal to this my Last Will and Testament, this ~- ~ day o f ~ , ~ ~ ~ 1Lr%'-- , A. D. , :L999 . _ ~.m, f ~ ~~. %1-~~,z-~.~1`~- _ (SEAL) Signed, sealed., published and declared by the above named Testatrix, Dorothy S. Smith, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses. ~~ ~' _ ~ , G ~ '~/~ 7 ACRNOT4LEDGMENT AND AFFIDP~VIT State of Pennsylvania . ss. County of Berks ;, On this, the 1 ~ ~ day of _.~i -~~`'-•'~-.' ?`~ °-1999, before me, the undersigned officer, personally appeared John A. Goldstan, Esquire, known to me (or satisfactorily proven) to be a member of the bar of the highest court of said state and a subscribing witness to the within instrument, and certified that he was pE=_rsonally present when Dorothy S. Smith, whose name is subscribE_d to the within instrument, executed the same and that said person, Dorothy S. Smith, acknowledged that he executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. Life Estate and Remainder Factors 8/6/2009 Dorothy Smith Estate CST tax calculation Transfer Date: 11/2008 §7520 Rate: 3.60% Calculation Type: One Life Principal: $302,550 Age: 89 Life Estate Remainder Factor: 0.14930 0.85070 Value: $45,170.71 $257,379.29 ,, `"~". .~. r'~~ ~ ,~t ~w O~rn ~(~ ~~~a ~ ~ O ~ ~ O N ~ ~ ~ ~" ~ ~ ~ LLa v o `° ~ o ~. ° - VJ ~~ xo5t~oa~ ,;: 1-tcu;.: ~ ~. ~ ; -. . 2Q09 ALG 13 PM IZ : ~ ~~ "C jl"~ VL~t ~~~ _ll _ c~;~ . a y y a v H t/~ ~. 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