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Home My WebLink About05-04-10 (2)~ ~r ~ J PA Department of Revenue ~ County Code Bureau of Individual Taxes -,::~_ INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 's RESIDENT DECEDENT 2 ~- 15056071120 REV-1500 EX (06-05) OFFICIAL USE ONLY Year File Number 09 1179 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 201 16 5435 12 11 2009 Decedent's Last Name SMITH (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number Date of Birth 06 14 1920 Suffix Decedent's First NamE~ MI HELEN L Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE W11'H THE REGISTER OF 11tiILLS FILL IN APPROPRIATE OVALS BELOW I~ 1. Original Return ~ 2. Supplemeni.al Return 4 Limited Estate ~ 4a. Future Interest Compromise . (date of death after 12-12-82) .!~J 6 Decedent Died Testate (Attach Copy of Will) ^ 7 Deia deCtoMaiof Tru d a Living Trust PY ) !~ 9. Litigation Proceeds Received ~ 10. betweenP2V31 y91 and~tl(dat~e5~f death 3. Remainder Return (date of death ~~ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) prior to 12-13-82) ~] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD~E DIRECTED TO: Name Dayltime Telephone Numb - JENNIFER B. HIPP 7:L7 7'c-$761c ":'I:"` Firm Name (If Applicable) ,I~~ - REGISTER O~ r~~ USE ONLY BOGAR AND HIPP LAW OFFICES • --- _~~ •~' _ _, ... _ ,:~ t First line of address ' '~- ~ : j ~° -~~ ~' .. i .~ } 1 WEST MAIN STREET .-~~~--~~ ~' .T Second line of address ~-=~ N .' i . ti^J City or Post Office State ZIP Code ~- DATE FILED SHIREMANSTOWN PA 17011 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statement, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all informatior~ of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FO FILING RETURN DATE Steven M. Smith ~ " 2;2 - K~!-~ C L'~ ADDRESS 2 Marv Avenue, Mechanicsburg, PA 17055 SIGNF~T RE OF PREPARER OTHEF; THAN REPRESENTATIVE DATE ~• ti~ Jennifer B. Hipp -7 ~~ (~ AD6R~SS ~ ' ~ ` 1 Wes Main Street. Shiremanstown. PA 17011 Side 1 1505607112 1!5056071120 ~ ~ Jf PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Smith, Helen L. 21-09-1179 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. r Signature #2 '~1Q~ .... Name Bertus C. Smith Address1 2340 Mockingbird Road Address2 city, State, Zlp Harrisburg, PA 17112 Date ~~ - ~- ~-- ~'~ 1 ~ ~ 15056072120 REV-1500 EX Decedent's Social Security Number Decedents Name: Helen L. Smith ['. O 1 16 5 4 35 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. 5 8 , 4 4 3 . 8 2 5. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. ;7. Inter-Vivos Transfers & Miscellaneous N,Qn-Probate Property arate Billin Re uested ^ Se 44 988 08 ............ g q p (Schedule G) 7. , . g. Total Gross Assets (total Lines 1-7) .................................................................... g. 1 O 3 , 4 31.9 0 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 19 , 72 9.23 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 19 , 7 2 9 . 2 3 1 ~'-~ Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 8 3 , 7 O 2 . 6 7 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. 83 , 7O2 . 67 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 1'.i. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15' O . O O 16. Amount of Line 14 taxable at lineal rate x .045 83 , 702 _ 67 16. 3 , 7 66.62 17. Amount of Line 14 taxable at sibling rate X .12 O. O O 17. O. O O 1 i. Amount of Line 14 taxable at collateral rate X .15 O. O O 18. O. O O 19. Tax Due .................................................................................................................. 19. 3 , 7 6 6.62 2G. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056072120 1,~i056072120 ,,~ r REV-150G EX Page 3 Decedent's Complete Address: File Number 21-09-1179 DECEDENT'S NAME Helen L. Smith __ STREET,ADDRESS 824 Lisburn Road CITY Camp Hill STATE. PA ZI P 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 3,766.62 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 3,543.84 C. Discount 186.52 Total Credits (A + B + C) (2) 3,730.36 3. Interest/Penalty if applicable p. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 36.26 A. Enter the interest on the tax due. (5A) g, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 36.26 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 :............................................................................... ^ ^x 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? .................................................................................................................... i-] ^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 i~ND 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 cif transfers to or far 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 lase 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 benefi~~iary. 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 ~~t 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. §91 '16 (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. • 4 J Rev-1508 EX+ (6-98) SCHEDULE E t • CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Helen L. 21-09-1179 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash 31.00 2 Morgan Stanley Smith Barney -Investment Account No. 724-18429-18-790. 45.654.23 3 Sovereign Bank -Checking Account No. 0571120504. Date of death balance 11.495.17 $11,495.15; accrued interest $0.02 4 Personal Property -Sold at private sale 50.00 5 Highmark -Premium Refund 271.58 6 Medco -Refund 106.84 7 U.S. Treasury - 2009 personal income tax refund 835.00 TOTAL (Also enter on Line 5, Reca~~itulationl I 58.443.82 (If more space is needed, addil.ional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PQ,-1500 Schedule E (Rev. 6-98) .~ ~ NiorganStanley Srnit~~arney January 14, 2010 James D. Bogar Attorney At Law One West Main Street Shiremanstown, PA 17011 Re: Estate of Helen L. Smith Dear Attorney Bogar: At the time of her death on December 11, 2009, Helen L. Smith maintained one account at Morgan Stanley Srnith Barney. The following is the information you requested concerning that account: Account name: Helen L. Smith, Individual Account number: 724- ~~ 8429-18-790 Beneficiary information: There were no benef ciary arrangements Opening date: July 27, 1994 Account value as of December 11, 2009: $45,654.23 I have enclosed a statement for the account as of the date of death which lists the positions in the account and their values as of that date. How the account is liquidated) will depend on whether the executors want. the assets liquidated under Helen's social security number or under and estate tax identification number. In either case, we will need written instructions from the executors. Please call us at 717-730-1835 (Bill) with any questions. Sincerely, ~~ ~ Bill Barton Client. Service Associate for Marilynn R Kanenson Vice President -Wealth Management Financial Planning Specialist ' ~. /:~ ~ Helen I, Smith :~~~~~ smith Barney Steven M. Smith, Poa Brook-view Suite Room X32 Balances 824 Lisburn Road As of 12 / 11 / 2009 Camp Dill PA 17011--7110 Prepared by MARILYNN I~ANENSON 717 730 1877 Acct No. 724-18429-18-79 Market Value ~% Of Assets** Closed End Funds $3,115.98 6.83% Preferred Stocks 37,<`382.10 82.98 Money Funds 4,E~56.15 10.20 Total Account Value $45,654.23 100.00% '* ° o of Assets reflects account balances as a percentage of long position & cash rounded. to the nearest hundredth. As a result the total may not equal 100%. Third-party and Morgan Stanley research on certain companies is available to clients of the firm at no cost. Clients can access this research at «~ww.smithbarney.com or contact their Financial Advisor to request a copy of this research be sent to them. Investment and insurance products: Not FDIC insured •No bank guarantee •Not in:;ured b_y any i~ederal government agency •Not a bank deposit •May lose value Citigroup Investment Research's research ratings are displayed within the Research Rating column in ':=loldings'. Page 1 of 4 ' ~ Helen L Smith ...- sm s t h ba rne~r Steven M. Smith, Poa_ Broo kvi°w Suite Holdings Roorn 232 824 Lisburn Road As of 12/ 11/2009 Camp L:~ill PA 17011-7110 Prepared by MARILYNN KANENSON 717 730 1877 _ Acct No. 724-18429-18-79 Re:;earch Quantity Symbol/ CUSIP Description Rating Price Market Value 4,656,02 #SBCX WESTERN ASSET MONEY MARKET - $1.OC- $4,656.15 Accrued Div. $0.13 521.82 KTBB CORTS FOR BELL,SOUTH CAP FDG - 24.89 12,988.23 442..13 ISP *** ING GROEP IVV 6.2% PFD - 16.6Ei 7,365.95 674.36 MWO MORGAN STANLEY CAP TR V 5.75`% - 19.7E> 13,325.35 419,.15 JQC NUVEEN MULTI-STRATEGY INCOME - 7.43 3,115.98 191,.89 PNU PNC CAPITAL TRLJST D 6.125% - 21.9C? 4,202.57 Total Account Value $45,654.23 Page 2 of 4 ti ~ ~f smith Barney Helen L Smith Steven M. Smith, Poa Brookviev~i Suite Roorn 232 824 Lisb~_rn Road Camp Hil:~ PA 17011-7 ]_ 10 Holdings by Asset Class As of 12/ 11 /2009 Prepared by MARILYNN KANENSON Acct No. 724-18429-18-79 717 730 1877 Fixed Income 89.8% Cash & Equivalents 10.2% Long Positions and Casa Page 3 of 4 ~ ~ ::-.smith Barney I'he above summary /prices/quotes/statistics have been obtained from sources believed reliable but are not necessarily complete and cannot be ,uaranteed. The information contained in monthly account statements and confirmations reflects all transactions processed by Smith Barney, ;end as such supersedes all other reports for financial and tax purposes. ~,' 2009 Citigroup Global Markets Inc. Member SIPC. Smith Barney is a division and service mark of Citigroup Global Markets Inc. and its lffihates and is used and registered throughout the world. Citi and Citi with Arc Design are trademarks quid service mal-ks of Citigroup Inc. and is affiliates, ar~d are used and registered throughout the world. Citi~;roup Global Markets Inc. and Citibank are affiliated companies under the ommon control of Citigroup Inc. Page 4 of 4 Morga,nStanley SmithBarney Recently, the Global Wealth Management Group of Morgan Stanley & Co. Incorporated and the Smith Barney division of Citigroup Global Markets Inc. combined into Morgan Stanley Smith Barney LLC, a new investment advisor and broker-dealer registered with the Securities and Exchange Commission. Investment products and services are offered to you through Morgan~StanlE~y Smith Barney LLC, member SIPC, and your account is carried by Citigroup Global Markets Inc., member SiPC. Iln general, references to Smith Barney or the Smith Barney division of Citigroup Global Markets Inc. should be read as Morgan Stanley Smith Barney LLC. However, some services will still be available to you through Citi or Citigroup Global Markets Inc.. Please contact your Financial Advisor if you have any questions about theses changes. 8501-1Y;S/2009) ~ '~ MA1 MB3 02-10 Court Ordered Processing/Decedent P.O. Box 84100 Boston, MA 0?284 February 24, 2010 Attn: Jennifer B. Hipp James D. Boar Attorney at Law One West Main Street Shiremanstown, PA 17011 RE: Estate of Helen L. Smith Date of Death: December 11, 20C-9 Dear Jennifer B. Hipp: Per your request, enclosed please find account information as of the date of death for the above-named decedent. For your information, accrued il~lterest in loot included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, p~ ( ,.; ~'t ~~ ' ~~ Nicole Job ~~....~ COP Specialist III Decedent Department (617) ~3 ~-1364 Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: 201-16-5435 December 11, 2009 Account #: 071120504 Type: Checking Open date: 12/22/1983 In the name of: Helen L Smith (Darryl E Smith POA) Date of Death Balance: $11,495.15 Int.(YTD) from 1/1/2009 to 12/4/2009 $2.66 Accrued interest to date of death: $0.02 Other Info: Account closed on 12/24/09. Helen L. Smith Page 1 of 1 1 . Rev-1510 EX+ (6-98) SCHEDULE G t ,~~. INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Helen L. 21-09-1179 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY 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 °r° OF DECD'S INTEF;EST Exc;LUSION (IF APPLICABLE) TAXABLE VALUE 1 Allianz Life Insurance Company of North 16.793.68 16.793.68 America -Annuity No. 490367. The Decedent's six children are the named beneficiaries of this annuity. 2 Midland National -Annuity No. 8520176904. The 28.194.40 28.194.40 Decedent's six children are the named beneficiaries of this annuity. TOTAL (Also enter on Line 7, Recapitulation) I 44.988.08 (If more space is needed, addii:ional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Allianz Life Insurance Company of North America ~ PO Box 59060 ~~ ~ ~ ~~ ~/ '~' Minneapolis, MN 55459-0060 800!950-1961 January 6, 2010 THE ESTATE OF HELEN L SMITF-I C/O JAMES BOGAR ONE WEST MAIN ST SHIREMANSTOWN PA 17011 F:e: Helen L Smith ,deceased Annuity Policy Number: 490367 Dear Executor: This letter is in response to your request for the date of death value as of December 11, 2009 on the above policy number. Please be advised that the above policy number has been anniaitized. The present value, future payments discounted at the prime rate, a:> of the date of death was $16,793.68. This policy was held individually by Helen L Smith. The contract date was 12/6/1989. Enclosed you will find the death claim notification letter and Continuing Annuity Option Settlement .Claim Form which outlines the requirements for filing claim. Should you have any questions, please feel free to contact our office. Thank you. Sincerely, Annuity Claims V MIDLAND NAT/0/VAL: ,e ~- ~~ Life Insurance Company Annuities at their Best January 26, 2010 JENNIFER I-IIPP ATTORNEY' AT LAW 1 WEST MAIN ST SHIREMANSTOWN PA 17011 Re: Helen L. Smith, deceased Policy: 8520176904 Beneficiary(s):Estate of Helen L. Smi1:h 100% Dear Ms. Hipp: 4b01 Westown Parkway, Suite 3011 West Des Moines, IA 502bb *~*712 Letter** This contract is an Annuity. Below is the information that is needed to complete the estate tax return. Decedent: Social Security Number: Date of Issue: Type of Contract: Date of Death Value (as of 12-11-2009): Helen L. Smith 201-16-543 5 OS-14-198,7 Non-Qualified $28,194.40 (estimated payout of 26 payments remaining of $1,084.40 each) If you have questions, please call us tall-free at 877-880-6367. We are available lvlonday through Thursday from 7:30 am to 5:00 pm (CST) and Friday from '1:30 am to 12:30 pm (CST). A service professional within the Claims and Benefit Department will be happy to take your important call. Sincerely, Larissa Schaefer Claims and 13enefit Specialist Claims and Benefit Department cc: File Annuity Division ~ P.C~. Box 79907 ~ Des Moines, IA 50325-0901 Phone: 877-5$b-0240 ~ Fax:617-586-0249 ~ www.midlandannuity.rorn REV-1151 EX+ (10-06) S COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER. Smith, Helen L. 21-09-1179 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 Name of Personal Representative(s) 11,288.00 Street Address City State Zip . Yearlsl Commission paid 2. Attorney's Fees Bogar and Hipp Law CJffices 5,880.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City _ State Zip Relationship of Claimant to Decedent 4. Probate Fees 206.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 2,354.73 See continuation schedule(s) attached TOTAL_ (Also enter on line 9, Recapitulation) 19,729.23 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-'1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith, Helen L. 21-09-1179 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Myers Funeral Home -funeral bill 10.788.00 2 St. Paul's Lutheran Church -funeral luncheon 500.00 H-A 11.288.00 Other Administrative Costs 3 Accounting Associates -Fee for preparation of 2009 Personal Income lax Returns 50.00 4 Alert Pharmacy 112.46 5 Register of Wills - 3 Short Certificates 12.00 6 Register of Wills -Short Certificate 4.00 7 Register of Wills -filing fee for PA Inheritance Tax Return and Inventory 30.00 8 RESERVES: -Costs to conclude administration of Estate, including filing fees for 1.500.00 PA Inheritance Tax Return and Inventory, preparation of Fiduciary Income Tax Returns 9 Sovereign Bank -Fee for date of death valuation 20.00 10 The Woods at Cedar Run 591.00 11 U.S. Postal Service -Certificate mail to Allianz 6.66 12 Verizon -Phone Bill 11.65 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith, Helen L. 21-09-1179 ITEM NUMBER DESCRIPTION AMOUNT 13 Verizon -Phone Bill 16.96 H••B7 2.354.73 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (11-08) i 1 ,~: COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DE=CEDEPJT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Smith, Helen L. ~ 21-09-11 79 NAME AND ADDRESS OF RELATIONSHIP TO SHARI= OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S1 RECEIVING PROPERTY DECEDENT Words) ($$$) Do Not List Trustee s I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.~'. See attached schedule Tote I Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as appr opriate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, 'Taxable Distributions) ESTATE OF: Helen L. Smith 12/11/2009 201-16-5435 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Marlene R. Dippery Daughter One-sixth of rest, 10936 E. Apache Trail #1075 residue and Apache Junction, AZ 85120 remainder 2 Steven M. Smith Son One-Sixth of rest, 2 Mary Avenue residue and Mechanicsburg, PA 17055 remainder 3 Bertus C. Smith Son One-sixth of rest, 2340 Mockingbird Road residue and Harrisburg, PA 17112 remainder 4 Clifton A. Smith Son One-sixth of rest, 1398 Dunkleberger Road residue and Elliottsburg, PA 17024 remainder 5 Darryl E. Smith Son One-sixth of rest, P.O. Box 308 residue and 2718 High Street remainder Grantham, PA 17027 6 Stanton T. Smith Son One-sixth of rest, 6441 Miriam Circle residue and East Petersburg, PA 17520 remainder 1 i • i e LAST WILL AND TE STAM E~~TT OF HELEN L. SMITH ~~ I, HELEN L. SMITH, of Camp Hill, CurnbE~rland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby :revoking all other W~~11s and Codicils heretofore made by me. ,FIRST: I devise and bequeath all the rest, re:~idue and remainder of my estate of whatever nature and wherever s~~_tuate, including any property over which I hold power of appointment and together with any insurance policies thereon, irl equal shares, to my children, STEVEN M. SMIT]i, BERTUS C . SMITH, ~~TANT0:1V T ., SMITH, DARRYL E. SMITH, CLIFTON A. SMITH, and MARLENE FZ. DIPPERY. Should any of my children predecease me, then I direct that his or her share be given to hi:~ or her spouse. Fuz-thermore, should any of my children and that child's spouse predE~cease me, I: direct that said child's sh<~re, as set forth hez-ein, should pass to that child's children or step-children, as the case may be, in equal shares, per stirpes b_y representation. SECOND: Should any of my grandchildren or ~step- grandchild:ren not have attained the age of twenty-two ( 2 ~ ) years at the time for distribution to him or her, I give, devise and bequeath the share of each such grandchild or step-grandchild to my hereinafter named TrusteE~ or Trustees, IN SE1:'ARATE TRUSTS, to hold, manage, invest and reinvest the shares so received, and to use and apply from time to t=ime such portion o~ income and principal :for the said grandchild's or step-grar.~dchild's education ( including college, trade school or other s:imi l.ar training o.r education) , support and welfare as rtty Tru;~tee or Trustees, .in their sole discretion, deem advisa~>le . I~Iy 'T'rustee or Trustees may make the payments for the support and maintenance • ,. of my grandchildren directly to said grandchildren or step- grandchildren or to their Guardian or Guardians. Any payments made by my Trustee or Trustees pursuant hereto ;hall be made without further responsibility to the said grandchildren or step- grandchild.ren, their Guardian or Guardians, or j~o any person taking care of my grandchildren or step-grandchildren. ~Phe Trustee or Trustees, in exercising their discrel~ionary authority with respect to the payment of income or princi~~a1 of the within Trust to m.y grandchildren or step-grandchildren,, shall take into consideration any income or other resources ava_~lable to my grandchildren or step-grandchildren from source: outside this Trust . In addition, my hereinafter named TrustE~e or Tru:~tees shall have the right, in their sole discretion, to purchase and pay for out of the principal, as well as income,. such in:~urance policies as will provide for the grandchild's oz~ step-grand- child's medical care. Any income or principal not so applied. shall be dis- tributed to each grandchild when he or she attains the aqe of twenty- two { 22 ) years . In the event any of ny grandchildren die prior to the termination of this Trust established herein for their benefit, the interest of said grandchild in said Trust J shall cease with any income and principal being divided evenly _ ~. between or among that deceased grandchild's brothers or sisters ` or the separate Trusts esta]~lished hereunder for. their benefit and, in the absence of any brothers or sisters, or any Trust ti established hereunder for t]~eir benefit,, to ny other grandchil- ~' dren, or t:he Trusts established hereunder for trieir benefit, in equal shares. 2 ~ r THIRD: In addition to all powers granted t:o them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all propertr.y: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security} or conditions> as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the pr~ope:rty and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition., subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no v~~.lue. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investmE~nt funds,. without l~ restriction to investments authorized for Penns~Tlvania fiduci- _ aries, as are deemed proper, without regard to piny principle of ~ diversification, risk or productivity. (E) To exercise any option, _right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege givE~n by the Federal and other tax laws, including, but not necessarily being limited to, personal income,. gift and estate or inher:itar~ce tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. 3 (H) To borrow me>ney from themselves or others in order to pay deh>ts, taxes, or estate or trust. administration expenses, to protect. or improve any property held under my wil=!, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock o~,nmership plan, or any other type of qualified pla:n) to the extent the plan or the law permits them. to do so, and to exercise any other rights which they may have under the :plan, in whatever manner they consider advisable. FOURTH: I nominate and appoint my friend, BRAD LAWYER, as Trustee of the hereinabove described Trusts. I direc1~ that my Trustee shall serve without bond and shall receive fair and reasonable compensation. FIFTH: I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind wh~~tsoever, which may be payable by reason of my death, whether or not with respect to property passing under t]zis Will, shall be p~~.id out of= the principal of my residuary estate. SIXTH: All inters=sts hereunder, whet~ler principal or income, which are undistributed and in the possE~ssion of the fiduciarie:~ acting hereunder, even though vested or distribut- able, shall not be subject too attachment, execution o:r sequestra- tion for any debt, contract,. obligation or liability ~~f a.ny beneficiary, and furthermore, shall not be subjE~ct to pledge, assignment, conveyance or anticipation. ~ SEV~IVTTH: I nominate and appoint my sons, STEVEN M. SMITH anal BERTUS C . SMITH, C;o-Executors of this, my Last Will and Testament. I direct that my Executors and Trustee and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. 4 ~ - IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this /,.~~day of ~~~~,f~J 2006. ~' / ~ r .~ ,1~~ (SEAL ) HE;LEN L . SMITH Signed, sealed, published and declared by t;he above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~ r~:f X ~I I~` Address Address 5