HomeMy WebLinkAbout05-04-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISE3URG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 012693
SMITH BERTUS C
2340 MOCKINGBIRD ROAD
HARRISBURG, PA 17112
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ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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ESTATE INFORMATION: ssrv: 2o~-~E~-5435
FILE NUMBER: 2109-1 179
DECEDENT NAME: SMITH HELEN L
DATE OF PAYMENT: 05/04/2010
POSTMARK DATE: 05/04/2010
couNTY: CUMBERLAND
DATE OF DEATH: 1 2/ 1 1 /2009
REMARKS:
SEAL
CHECK# 1009
101 ~ ;36.26
TOTAL AMOUNT PAID:
~~36.26
INITIALS: SAP
RECEIVED BY: GL_ENDA FAF3NFR STRA~~RAl1C;H
REGISTER 01= WILLS
REGISTEFI OF WILLS
INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
Steven M. Smith and Bertus C. Smith
File Number 21-09-1179
Personal Representative(s) of the Estate of Helen L. Smith
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal asseils wherever
situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each
item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate
outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this invenntory.
I verify that the statements made in this Inven-
tory are true and correct. I understand that false state- Steven M. Smith ~ ~~ ,~~Z~L~
menu herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to Bertus C. Smith '~
authorities. ~`
Attorney -- (Name) Jennifer B. Hipp (Supreme Court LD. No.) 86556
(Firm) Bogar and Hipp Law Offices
_-__---
(address) _1 West Main Street, Shiremanstown, PA 17011
(Telephone) 717-737-8761
DATE OF DEATH LAST RESIDENCE g24 Lisburn Road DECEDENT'S SOC;. SEC- NO.
12/11/2009 Camp Hill, PA 17011 201-16-5435
FIGURES MUST BE TOTALED
Personal Property
Cash .................................................................,.............................. r-7 58 392
Personal Pro ert `-~~
Stocks/Listed ................................................................................ . -~:. ~~a
Stocks/Closely Held ............................... r"r•1 - i
s -
......................................
Bonds ..............................................................,.............................. ,. ;
- =z~
- f:_:,' ~.,, .~- .'_?
,;-
Partnerships and Sole Proprietorships __ ,
'~ - --~ -=E
~.
Mortgages and Notes Receivable ................. ..~
~ "' ~
.........
All Other Pro ert
p Y ........................................................ N ~.J c-',,
................ ry _. ~
Total Personal Property .........................
............... 58,443.82
Total Real Property ................................................
Total Personal and Real Property ........................ 58,443.82
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b))
Form RIN-09 Rev. 10-13-2006
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland } SS File Number 21-09-1179
DATE OF DEATH LAST RESIDENCE g24 Lisburn Road DECEDE:NT'S SOC. SEC. N0.
12/11/2009 Camp Hill, PA 17011 201-16-5435
Cash
Cash
Highmark -Premium Refund
Medco -Refund
Morgan Stanley Smith Barney -Investment Account No. 724-18429-18-790.
Sovereign Bank -Checking Account No. 0571120504. Date of dearth balance
$11,495.15; accrued interest $0.02
U.S. Treasury - 2009 personal income tax refund
Total Cash
Personal Property
Personal Property
Total Personal Property
31.00
271.58
106.84
45,654.23
11,495.17
835.00
58.393.82
50.00
50.00
(Attach additional sheets if necessary) Total Personal Property and Real Estate 58.443.82