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Home My WebLink About09-18-09• 15056051058 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY PO BOX 280601ua1 Taxes County Code Year File Numtter INHERITANCE TAX RETURN - `-C~ ~-----~' 21 ' Harrisburg, PA 17128-0601 I i~eagca d I ~U ; 6 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 17405-0571 01/25/2009 ; 07/06/1912 Decedent's Last Name ___.---_-____- --__-__-_-_---_ .__.._.. .._ .._ ___.._._ Suffix _ Decedent's First Name MI _- __-- __._ _-_ __ Smith __. _.. _ _ _. _ . ___ ~ _._._ i ~ Flo ~ W z ; ; -. ~ ~ ~ ~ - ____.,__~ ._--__._ .._ _ _ .__ __.. __._ ... ..._-.._ .- ___ __-------_ (H Applicable) Enter Surviving Spouse's Irtfonnation Below Spouse's Last Name _ Suffix Spouse's First Name MI S_pouse's S oci al S r e cu iry N u m ber i ~ i _ _ _ _ _ _ __ _ _ _ ~- -- -' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C!D 1. Original Retum t~ 2. Supplemental Retum 3. Remainder Retum (data of death priarto 12-13-82) ~3 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) 6. Decedent Died Testate u 7. Decedent Maintained a Living Trust _ 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received .-^, 10. Spousal Poverty Credit (date of death '~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION NUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlOENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number -_ -- --- - David A. Boric, Esquire (717) 249-6873 Firm Name (IfA licabl -._ .------ PP--- e) O'Brien Boric & Scherer First line of address 19 West South Street Second line of address City or Post Office -- --------- Carlisle State ZIP-Code PA `17013 REGISTER OF~1Mjt1S USE ONL '~ I _:= n '~' i ~, u t} ~~ r r--. ~ G> ~ W xsh I ~ ~~ I 1 C ' '~ ~. j DATE r-it~D -~ j .. ---- ---- -- -may„ td? Correspondent's e-mail address: dbariC@ObSIaW.com Under penalties of perjury, I declare that I have examined this return, Induding accompanying schedules and statements, and to the best of my knowledge and belief, h is true, correct and comp) te. D ration of pr they than the per,onal representative Is based on all information of which preparer has any knowledge. SIGNATU P S ISLE F R FI G RETURN qTE .~ ~ ,,, ~1`~~--/~~ r ADDRESS ~ ` SIGNATURE ADDRESS ~ - _ 19 West South Street, Carlisle, Pennsylvania 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 __~ -~ ~ -, .~i ._ i 7 { - `,> ~_ ` ~ C r"k ., f t~ -~ 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: FIo W Smith 174-05-0571 RECAPITULATION 1. Real estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 6. Jointly Owned Property (Schedule F) ..~~~ Separate Billing Requested .... ... 6. 229,673.00 7. nter-Vivos Transfers & Miscellaneous Non-Probate Property _...... . (Schedule G) .-' Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 229,67$.00 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 28,443.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 11. Total Deductions (total Lines 9 ~ 10) ................................. .. 11. 28,443.00 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 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. 201,230.00 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. _._ Amount of Line 14 taxable __ . at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 201,230.00 18 19. TAX DUE ....................................................... ..19. 30,184.50 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~ 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-~ 07 00779 _ .~~- - ~ ~DECEDE DECEDENT'S NAME NTS SOCIAL SECURITY NUMBER Flo W Smith 174-05-0571 STREETADDRESS 41 Greystone Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 31,130.00 C. Discount 1,556.50 3. InterestlPenalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 30,184.50 32,686.50 2,502.00 Make Check Payable fo: 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 : ........................................ . .... ^ ^X c. retain a reversionary interest; or ...................................................................................................................... . ^ 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? .......................................................................................................... .... ^ 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? ....................... ......................................................................... ..................... ... a 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 and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV~1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Flo W. Smith 21-09-0180 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Linda H. Carns 41 Greystone Road niece Carlisle, PA 17013 B C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~ A. 12/01!2001 M & T Bank, checking account no. 950843132 100,015.00 50 50,007.50 2• A. 12/01!2001 M & T Bank, checking account no. 950843140 46,830.00 50 23,415.00 3• A. 06/30/2008 M & T Bank, certificate of deposit no. 31003915943459 101,106.00 50 50,553.00 4• A. 06/3012008 M & T Bank, certificate of deposit no. 31003915943459 51,026.00 50 25,513.00 5• A. 01101/2003 Smith Barney, account no. 73H0098116142 160,910.00 50 80,455.00 TOTAL (Also enter on line 6, Recapitulation) I $ 229,943.50 (If more space is needed, insert additional sheets of the same size) REV•1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIFI INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Flo W. Smith SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-09-0180 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Hoffman Roth Funeral Home 1,981.00 2. WestministerCemetery 1,080.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Richard Carns Social Security Number(s)lEIN Number of Personal Representative(s) street address 17B Burgners Mill Road city Carlisle state PA zip 17015 Year(s) Commission Paid: 2009 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant NONE Street Address City State .Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees z. Millineum Pharmacy 8. Mobilex USA s. Thornwald Home ~ o. The Sentinel > > Cumbeliand Law Journal TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 10, 620.00 10,620.00 426.00 110.00 88.00 135.00 3,047.00 261.00 75.00 28,443.00 LAST WILL AND TESTAMENT OF FLO W. SMITH a/k/a FLO D. SMITH .~ ~~ c7 --, - --- ,_~= - c=i - ~. f;~ (~, I, FLO W. SMITH, a/k/a FLO D. SMITH, residing in the County of Sarasota and State of Florida, being of sound and disposing mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. FIRST: I direct that my legal debts, including funeral expenses, and the cost of administration of my estate be paid as soon as practicable after my death, and I hereby authorize and empower my Personal Representative, in case of any claim made against my estate, to settle and discharge the same in the absolute discretion of my Personal Representative. SECOND: I give and devise my diamond solitaire ring to my niece, LINDA H. CARNES, per stirpes. THIRD: I give and devise all the rest, residue and remainder of the property which I may own at the time of my death to my husband, FOSTER L. SMITH, Page 1 of 4 __~ ~ ..-. a/k/a F.L. SMITH, if h~e survives me, or if he predeceases me, to my niece, LINDA H. CARNES, per stirpes. FOURTH: I hereby nominate and appoint my niece, LINDA H. CARNES, as Personal Representative of this my Last Will and Testament, and I request that no bond be required of her in connection with the administration of my estate. In the event my niece should predecease me or be unwilling or unable to serve as Personal Representative, I appoint RICHARD CARNES, son of my niece, Linda H. Carnes, to serve as successor or substitute Personal Representative, without bond. FIFTH: I hereby give to my Personal Representative full power and authority, at any time or times, to lease, sell, mortgage, pledge, exchange or otherwise deal with or dispose of the property comprising my estate, real or personal, upon such terms as shall be deemed best; to settle and compromise any and all claims in favor of or against my estate as shall be deemed advisable and for any of the foregoing purposes to make, execute and deliver all deeds, contracts, mortgages, bills of sale or other instruments necessary or desirable therefor. My Personal Representative is expressly authorized to postpone final distribution of my estate, pending final determination of tax liabilities in connection therewith. IN WITNESS WHEREOF, I have hereunto set my hand and seal, at Sarasota, Florida, on this ~'~ day of July, 1996. ,_=?_.~` ' ~:~' u ~r~~~7'~ (SEAL) FLO W. SMITH Page 2 of 4 The foregoing instrument was signed, sealed, declared and published by FLO W. SMITH as her Last Will and Testament in the presence of us, the undersigned, who, at her special instance and request, do attest as witnesses, after said Testatrix has signed her name thereto, and in her presence and in the presence of each other. of Sarasota, Florida ¢J of Sarasota, Florida STATE OF FLORIDA ) COUNTY OF SARASOTA ) We, FLOW. SMITH, THOMAS A. DOZIER and MILLICENT B. DOZIER, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, having been sworn, declared to the undersigned officer that the Testatrix, in the presence of witnesses, signed the instrument as her Last Will, that she signed, and that each of the witnesses, in the presence of the Testatrix and in the presence of each other, signed the Will as a witness. FLO W. SMITHY THOMAS A. DOZIER /~ MILLICENT B. DOZIER ~X- Page 3 of 4 Subscribed and sworn to before me by FLO W. SMITH, the Testatrix, and THOMAS A. DOZIER and MILLICENT B. DOZIER, the witnesses, who are personally known to me, on this ~~'? day of July, 1996. ~iY P OFFICIAL NOTARY SEAL aARBARA A pALMER ~~ ~. N~ ; Yr; ~ t+ONMISS1284d3~£R BARBARA A. PALMER, Notary Public ~a CCU ~'.~^ ctQ t~Y 041911s61'~510N EDIP. ~+:yF F:~ t~CT. ~~ 1397 C:1cl\flosmith\will. frm Page 4 of 4