HomeMy WebLinkAbout11-22-10 (2)a
,
J 15D561D140
REV-1500 °` ~°'~'°'
OFFICIAL USE ONLY
PA DsparUnent a Revenue
Bureau a individual Taxes INHERITANCE TAX RETURN Counti Cods Year F1e Number
Po eox 28080, 2 1 1 0 o a o b
Harrisburtl, PA 17128-0601 RESIDENT DECEDENT
ENT'dt DELxDEIIT M~OIWATION BEi,.OW
Soclal SaawNy Number a0s a Deatft MMOO~wYY t~1a a ektll wOOYmr
2 0 1 1 6 5 7 3 7 0 8 0 8 2 0 1 0 0 8 2 6 1 9 2 5
DaosdanCs Last Name Sufrbc DacadanCs Fkst Name MI
S M I T H J A C K S O N M
(N AppllcabN) Enlsr survhrirtp spawn's IMortnafion Below
Spowa's Lad Nanw SuMbc 3pousa's First Name
SpawNs 8oo1d Saourlly Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE W'ITM THE
RE~318TER OF WILLB
MI
® 1.Oripinal Rstum ^ 2.8~ Rstum ^ 3. Ranlafndsr Retum (daa a deal
prbr to 12-13.82)
^ 4. LknNsd Estate ^ 2 (~ a
~. F ^ 5• Fadsrel Estals Tax Ratum Required
daath altar 12.12-0
® 8. Decedent Dfsd Tsstals ^ 7. Decedent Maklblglsd a Lhdrp Tnwt 8. Trial Number a Satir DspaR 8ozss
(~ CePY a ~ CaPY a Tnwt)
^ 8. Lidpatlon Proceeds wcalwd ^ ~ 0. spa+•M PovaAy Credlt (daa a death ^ 1 ~ . ENctbn to auc urldar sac. 91 ~ 3(/A)
balwaan 12.31-8'1 ~Id ~-~-~~ ( aril. o)
- TiBf t16CT10N MMT BE CO~LETBD. ALL CCNI~MOIMEMCE AtEt f;O1FD91T1AL TAX ~ONMATt011 NIOIKD BE OIMCTBD TO:
Nait o af~~ TaMpliort• NlMnbar
S US A N J H A R TM AN ?17 X49 '~760~
-
REGIS71
lGOlF ISIS U>i~DNLY ~< <~,.7
C) 7
~.
~_ ~ ~ rn rv r,
< ~
~ ~ N i j
, F
First ores a address ~
1 I R V I N E R O W t-,~~ '
._ ~ '`
~ r.a ~ ,: .~ '-r'
second Nne a address `~ ~ ~
.v c..n ;
City or Pod Olllos
C A R L I S L E
Sta1s Z1P Code ~ DATE FN.ED
P A 1 7 0 1 3
cornapondnlCs a~tlaN ardlwr. S U S A N H A R T M A N a P A• N E T
tJ~dlr panawes d OM1Wf-,1 dediew that I hew aMamYne Ns rssn4 NtaMrdig aooonroarNYq adtediMs an0 eMMawM~, and b Ilrs t~set d mlr knowMdOs and t~Mef,
It ~e~Onaat and ~n~IMa. DaNsrsron d pia~ar otir tfian he prtonrl npwMN~a k esesd an ar inbnnran d ~MNd~ On1Pra- hes anlr b~oMMdOs.
r+Fnrwl raT6-,-~ ~ n
16 BE 'I~CEY PLACE CARLISLE PA 17013
SIQIIA OF PREPARtS! OTFER ATNE OA
_ ~. r /I
PL.EAiE WE ORIGINAL FORT ONLY
~~
L 1505610140 1505610140
J
1505610240
REV-1500 D( peoedenCs Social Security Number
2 0 1 1 6 5 7 3 7
~,,,~sNa,,,e: JACKSON M • SMITH
RECAPITULATION 4 0 0 0 0. 0 0
... 1.
..........................
1. Real Eateee (Schedule ~-) .............. 4 2 ? 8. 1 6
2. Stocks and Bonds(Schedub B) .•••••• ............................... 2.
3. Closey- Held Corpwalan, PaMersh4 a Sob-Propr~eto~sh~p (Sd~edub C) ..... 3.
4. Mort®eges and Notes Reoehn-ble (Schedub D) .......................... 4.
1
6
1
?
D.0
0
5. Cash, Bank Deposr~s and i~oe~ane~ Personal Property (Sci~edure E)....... 5.
6
3
2
4
1
3
4
Joir~t Owned PropeAy (Scfiedure F) ^ Separate 8~9 Re4 .......
s 8' .
.
7. Inter-Vnros Transfers d~ Mb~sneo~ ~fO~B Pr°perty
~~ ~~ ~ .......
7. 2 8 2 3 5. 9 7
(Schedub G) 1 5 1 9 2 7. 2 ?
...........................
ToW Gross Asssb (feral Lines 1 through 7)
8
8.
. 9 2 4 2 7 7. 5 1
....._•....•.
9. Funeral Expenses and Administrative Costs (Schedub H) .... . .
5
0
Debts of Decedent, Mlort®a~e ~ arrd Lbns (Schedub I) .............
10 10.
6
1
6
1.
. 11.
3
0
4
3
9. 0
1
Total Deductions (total Lines 9 and 10) ...............................
11
. 12• 1 2 1 4 8 8. 2 6
12. Nst VaMrs d Estaie (Nne 8 minus l.gre 11) ............................
Charitable and Goverrrrnerdar 8egtreatslS~ 9113 Tniats for which
13 13. '
.
an ebdion to tax has not been made (Schedub J) ..................... .
t4 1 2 1 4 8 8. 2 6
14.
tso lax (tine 12 minus nine t3)
Nst Vakrs Subjsst
...............
.......
.
TAX CALCULATION - Sil£ MISTRUC710N3 FOR APPLICABLE RATES
15. Amount of Line 14 taxabb
at the spousal tax rate, or
transfers under Sec. 9116
Q . 0
0
15.
0.
0
0
(ax1.2) x.o _
1 t3. Amount of Lino 1 a taxabb 1 1 8 0 2 5. 8 5 1 s. 5 3 1 1. 1 6
at lineal rate X •oa5
17. Amount of Line 14 taxable D . 0 D 17. 0 . D D
at sbiing rate X .12
5 1
9
3
6
18, Amourrt of Une 14 taxabb 3 4 6 2. 4 1 18. .
at collateral raEe X .15
......
19
.
5 8 3
0.
5
2
19. TAX DUE .............................. ................ .
20. FILL IN THE OVAL ~ YOU ARE REpUESTMG A REFUND OF AN OVERPAYIftENT
Side 2
1505610240 1505610240 J
Faei~rnba
REV-1500 D( Pape 3 21 10 0 8 0 6
pecedentYs Cotmpietis Address:
JACKSON M• SMITH
STREET ADDRESS
2 RUSH DRIVE APT ~ 307
clTr
(CARLISLE
Tax Payrnenls and Credits:
~. Tax cue (Page 2, Line 19)
2. cred~lPaymenis 5 , 2 2 D • 50
A. P"0f ~R1e"~ 2? 4.75
B. Discount
3. Interest
STATE
PA
ZIP
17013
(1) 5, 630.52
Total Credits (A + B) (2) 5 , 4 9 5.2 5
(3)
4. ff Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 0.0 0
FNI in oval on taps 2, Lhrs 20 to request a rotund.
(5) 335.27
5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX W E.
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING 4UESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes tVo
1. Did decederN make a transfer and:
a. retain the use a income of the property transferred : ...................................................................... ^
b. retain the right to designate wta shall use the property transferred a its insane; ............................... ^
interest or ................................................................................................ ^
c. retain a reversionary ................... ^
d. receive the prariise for fife of either paynierits, beriefds ar care? ....................................
2, ff deaffi assumed aftex Daoernber 12,198'2, did deoederit transfer propeAy within are year of death
without receiving adequate oonsidaa8on ................................................. ^ ^
bank account a security at his a her death? ......... ^
3. Did decedent awn an'in mist for apayable-upon~d~ti
4. Did decedei~ own an iridihdirat relirerrieM a ash a otlier non-pot-ale ProPertY,
coMakis a ber-efidary °n? .................................................................................................. ® ^
IF THE ANSVYER TD ANY OF THE ABOVE QUESTIONS 13 YES, YOU MUST COMPLETE SCHE~LE G AND FILE R A3 PART OF THE RETURN.
Far dales of death on a after July 1,1994, and before Jan. 1, 1996, the tax role Kr~sed on the n~ value of transfers th a for the use of the surviving spouse
3 percent (12 P.S. §9116 (a) (1.1) (~].
For dales of death on or after Jan. 1, 1995, the tax rate imposed on the net vakre of transfers b a for the use of the surviving spouse Ls 0 percent
(l2 P.S. §9116 (a) (1.1) (e)]. The statute do~not exemptsp~transfer~ro ~ ~ ~ from tax, and the statutory requirements for disclosure of assets and
ling a tax return are s~ appicat>fe even surviving
For dates of death on a after Juty 1,2000: at death th a for the use of a natural parent, an
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age a younger
adop`ve parent or a stepparent of the cfu7d is 0 percent [72 P.S. §9116(ax1.2)].
• The tax role imposed on the net value of transfers th a for the use of the deoedenCs lineal brenefiaaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2) (72 P.S. §9116(ax1)].
• The tax role unposed on fie net value of transfers b a for the use of the decedent's sr~ings is 12 percent [T2 P.S. §9116(ax1.3)]. A srbirtg is defined, urK=
Ser~on 9102, as an irrdrvidual who has at least one parent in oorrrrrron with the decedent, whetlter by blood or .
REV-1502 EX+ (01-10)
Pennsylvania SCHEDULE A
DFrAIrr~NT °F'~""E REAL ESTATE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
Eg7A1C VP: 21 10 08D6
JACKSON M• SMITH
IW reM P- owned coley or as a in camrwn muss be reported at fak market vakie. Fair market value is defined as the price ~ vrhich property
would be exdrarlged between a wiNklg buyer and a wring seNer, rleiltler being compelled to buy a seB, both having reasonable knoMAedge of the relevant fads.
Real try flyd b 'O wltlr ~ of amvilrorship nwst be dtsclossd on Sdredule F.
Attach a copy of the seltlernsrr-t sheet 'rf the property has bs~erl sold.
VALUE AT DATE
ITEM Irldude a copy of the deed showing decedent's interest if oMrrled as tenant in cor-xnon. OF DEATH
NUMBER DESCRIPTI~t
y. 3 STINE AVENUE, CARLISLE, PA 17013 40,000.00
[HUD SHEET ATTACHED]
TOTAL (Also enter on Line 1, Resxpitula6on.1 ~ : 4 0 , D D 0 •0 0
REW1603 EX + (d-~
scNEOV~ e
coMNONVYEUTFI of PENNSYWANIA STOCKS 8i BONDS
INHERRANCE TAX RETURN
RESIDENT DECEDENT
JACKSON M• SMITH 21 10 0806
N l~D•ewesd MSS ~ ~ nrrMrorsUiP awst bs dsdsssd as ! F.
~~ VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. METLIFE INC• 4,278.16
106 SHARES ~ 40.36
TOTAL, (Also enter on Nne 2, Reppilulatlon) I i 4 , 2 ? 6.16
REV-1508 EX + (8-98)
Co~oNwEA~TI~ ~ ~NNS~LVAN~
INHERRANCE TAX RETURN
RESIDENT DECEDENT SCHEDt~LE E
CASH, BANK DEPOSITS, ~ MISC.
PERSONAL PROPERTY
ESTATE OF FEE NUMBER
21 10 0806
JACKSON M• SMITH
Include me prooeetls of Iltlgadon and ale aale the were received br the estate.
~ be dtdoad on &Mdii F
b
hl
(
.
a~wv
ore
p
q ~,~,~ p~~Md wiw ~ o
VALUE AT DATE
ITEM
NUMBER
DESCRIPTION OF DEATH
~. REFUND POST OFFICE BOX 2.00
2. REFUND ALLSTATE INSURANCE 20.66
3. METLIFE DIVIDEND 41.45
4- ALLSTATE INSURANCE REFUND 292.23
5. REFUND ON VEHICKE - ENTERPRISE HOLDINGS, INC• 11,991.16
6• AAA REFUND 31.00
7- HOFFMAN-ROTH REFUND 100.00
8• U-HAUL REFUND 52.34
9• CENTURYLINK REFUND 0.97
10• ALLIED WASTE SERVICES REFUND 14•DO
11- SEVEN GABLES SECURITY DEPOSIT 140.03
12- ALLSTATE INSURANCE REFUND 56.00
13• REFUND AIRLINE TICKETS - UNITED AIRLINES 1,273.OD
14• PERSONAL PROPERTY 3D0.00
15• UGI REFUND 4.87
16• FEDERAL INCOME TAX REFUND 1,623.00
TOTAL (Also enter on line 5, Recaptulation) I = 16 ,17 0.0 0
Continuation of REV-15001nheritance Tax Return Resident Decedent
JACKSON M. SMITH 21 10 0806
Decedents Name Page 1 File Number
Schedule E -Cash, Bank Deposits, ~ Misc. Personal Property
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1?• TAX PRO-RATIONS ON REAL ESTATE TRANSFER 227.29
SueTOTAL sct~EDULE E 2 2 7.2 9
GRAND TOTAL SCHEDULE E f 16,170.00
REV-1'S0o EX+ (01-1~
pennsylvanla
~AR~
INHERRANCE TAX RETURN
RESIDENT DECEOEIR
aCMEDIJLE 1 ~
JOINTLY-OWNED PROPERTY
Cs l A 1 C ur: FILE LIMBER:
JACKSON M• SMITH 21 10 0806
r.n r>I~twM n~ joNitlgownrd wNhln on. r.-ortn. d.c.d«rr• aw. ate, It mint ~. npabd on ~,.~,~. Q
suRVniu~ roa~rT TENANr(s~ NAME(8)
A. AIY[atLA L
s.
c.
,IOMmrowl~o PROPERTY:
TO C~ECEDENT
rrElw FO~JgNi M~AO~E a+cxuoE NAA~E OF FNlANCIAL ~ A°Fw SANICACCOUNT NUA6ER OR SIMLAR DATE OF DEATH % of QATE OF DEATH
NU~ER TENANT JDINi IDENTIFYprG NU~ER ATTACH DEED FDR JoM(ILY-HELD REAL, ESTATE. VALUE OF ASSET ~~~~ VALID OF
MREfiEST DECEDENi'8 NiTEREST
~. a. 10/09 SOVEREIGN BANK ACCT• • 0511086146 1,169.19 100• 1,169.19
[SEE ATTACHED DOD LETTER]
2• A. 12/03 SOVEREIGN BANK ACCT. ~ 1691028797
[SEE ATTACHED DOD LETTER]
3• A• 07/09 SOVEREIGN BANK ACCT• ~ 1694061027
[SEE ATTACHED DOD LETTER?
18,881.45
105,266.43
50•~ 9,440.73
50 • ~ 52, 633.22
AODRES8
16 BENTLEY PLACE
CARLISLE, PA 17013
TOTAL (Also enNr on lble 6, Recapitulatlon) ~ = 6 3 , 2 4 3.14
REV 1610 EX+ (060%
Pennsylvania
~~
iNHERrr~NC~ Tex RETURN
RESIDENT oECEOe~r
SCHEDULE G
INTER VIVOS TRAN8FER8 AND
MI8C. NOH-PROBATE PROPERTY
ESTATE OF FILE LIMBER
JACKSON M• SMITH 21 10 0806
Thb eclledllN mwt be oanpNNd end IMd K tlIe enewe-lo eery d queWone 1 draph 4 on Pepe thus d the REV-1500 w rie.
fTEM DESCRIPTION OF PROPERTY
NU~ER NKXl~E1FE ~ of nE Tnea N6.ATIOIele-to oecEO~r,vo DATE OF DEATH % OF DECD'S EXCLUSION
1 TI#o+-TEanI ~Tru~IecavrOFn~OB®FDIt~~~~.
PRINCIPAL FINANCIAL GROUP VALUE OFASSET
nrTEREST
°` TAXABLE
~~
.
[SEE ATTACHED DOD LETTER] 10,922.61 100.00 10,922.61
2• WESTERN NATIONAL ANNUITY
POLICY~VV238260 15,579.63 100.00 15,579.63
3• SOVEREIGN BANK ACCT. 1674064918
ACCOUNT IN TRUST FOR JACKSON SMITH 1,655.57 100.00 1,655.57
CREATED 4/10
4. SOVEREIGN BANK ACCT. 0981103561 78.16 100.00 78
16
ACCOUNT IN TRUST FOR JACKSON SMITH .
CREATED 4/10
TOTAL (Also enter °" LfIIe ~, Recaplhllauon)~ ; 2 8 , 235.9 7
REV-1511 EX+ (10-09)
Pennsylvania SCHEDULE H
oEPHroFKEVEr~ FUNERAL EXPENSES AND
'""EwraNCE rAx RETURN ADMINISTRATIVE COSTS
RESIOENr oEC~oENr
ESTATE OF Ff~E NUMBER
JACKSON M• SMITH 21 10 0806
o.c.d.nrs a.bts nwa brt nporpd on ScMdub ><.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~. HOFFMAN ROTH FUNERAL HOME 8,D12.96
2• BPO ELKS ~ 578 - FUNERAL RECEPTION 1,2bb•DS
3- ANTHONY SMITH - TRAVEL EXPENSES 1,990.00
4- JACKSON M- SMITH, JR• - TRAVEL EXPENSES 1,190.00
5• ANGELA MULLIS - EXPENSES 112.00
6- MICHAEL SMITH - TRAVEL EXPENSES 2,639.90
7- DAWN SMITH - TRAVEL EXPENSES 2,253.18
8- GEORGES FLOWERS 212.00
9- CARLISLE MEMORIAL SERVICE, INC• 185.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Represerrfetive(s)
Sheet Address
City State ZIP
Year(s) Corrrmissior- Paid:
y, AtbrtreyFees: DUNCAN 8 HARTMAN, PC 5,000.00
3. Famr7y Exemption: (If deoederrts address 'snot the same as r~anCs, attach explanation.)
Claimant
Street Address
Cdy State ZIP
Relatiaslrip of ChurraM b Decedent
4. Prot>eteFees: REGISTER OF WILLS 327.50
5 Aaoour,r~xFees: RESERVED FOR 2010 TAX RETURN 300.00
6. Tax Rehrrrr Preparer Fees:
~. CUMBERLAND LAW JOURNAL - LEGAL NOTICE ?5.00
8• THE SENTINEL - LEGAL AD 176.92
9• REGISTER OF WILLS - FILING FEE 15.00
10• HELD IN RESERVE 500.00
TOTAL (Also enter on line 9. Recapitulation) ~ t 2 4 , 2 77 -
REY-1512 ~lC+ (12-08)
Pennsylvania SCHEDULE I
~P~ o~'~""'E DEBTS OF DECEDENT,
ireiEwrar~T~xi~rurw MORTGAGE LIABILITIES, 8 LIENS
R~~o~~r o~~oE~r
ESTATE OF FILE NUMBER _
JACKSON M• SMITH 21 10 0806
Report debt incwred by the decedent prior to death that re,nained unpaid at the dale of death, including unreitr~urlsed medial expe<ae:.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. SOVEREIGN BANK CHECK FEE 31.45
2• CENTURYLINK 62.77
3• PPL - ELECTRIC BILL 24.83
4- MINOL - WATER & SEWER BILL 10.71
5- UGI - GAS BILL 17.34
6- CUMBERLAND GOODWILL AMBULANCE 76.66
7• PPL - ELECTRIC BILL 38.75
8• MINOL - WATER & SEWER BILL 9.65
9• PINNACLE HEALTH SERVICES 33.20
10• UGI - GAS BILL 17.17
11• PINNACLE HEALTH MEDICAL SERVICES 62.25
12• PPL - ELECTRIC BILL 19.36
13- MINOL LP 8.92
14• PRICE-LESS STORAGE 203.40
15• LET'S MOVE IT, INC- 250.00
TOTAL (Also enter on Line 10, Recapitulation) I t 6 ,161-
t(mae space is needed. insert additlonal sheets d the same sme.
Continuation of REV-15pp Inheritance Tax Return Resident Decedent
2'I ~0 0806
JACKSON M. SMITH Page 2 Fib Number
pecedenYs Name
Schedule I -Debts of Decedent, Mprtgage Liabilities, ~ Liens
ITEM DESCRIPTION AMOUNT
NUMBER 150.00
16• U-HAUL
80.00
17. BARRY VINCENT - LAWN SERVICE
8.40
18• PPL - ELECTRIC BILL
1,245.00
20- FP SEVEN GABLES LP - RENT
3,000.00
21. REALTOR'S COMMISSION
22• DEED PREPARATION AND NOTARY TO DUNCAN 8 HARTMAN
110.00
400.00
23- 1~ TRANSFER TAX
24• 2010 SCHOOL TAX - ROBIN SOLLENBERGER
296.60
5.00
25- TAX CERTIFICATION
~~~ ~pU~ I 5 , 2 9 5.00
GRAND TOTAL SCFIEDULE I i 6,161.50
gEW1313 EX+ (01-10)
Pennsylvania
~~
INFIERITANCE TAX RETURq
RESIDENT DECEDENT
SCHEDULE J
BENEFICUIRIE8
ESTATE OF: . "` ..""".'"
JACKSON M• SMITH 21 10 Ob06
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do clot Llrt Trw1N(s) OF ESTATE
I dMlrbNon ~ ~~ under
TAXABLE DISTRIBUTIONS (IncM~ds
0
'
. T6 (a (1,~.'
~ 9
1
t ANGELA L• MULLIS Lineal
. 16 BENTLEY PLACE 2D~ SHARE
CARLISLE, PA 17013
2• JACKSON M• SMITH, JR• Lineal
30 WINDSOR APT 1 8 20Z SHARE
WHITE PLAINS, NY 10701
3• MICHAEL W• SMITH Lineal
5405 BUNKER COURT 20~ SHARE
RICHMOND, CA 94b06
4• ANTHONY L• SMITH Lineal
16 BENTLEY PLACE 2DZ SHARE
CARLISLE, PA 17013
5• EARL J• CHINAS Collateral
3522 SANTA ROSA LANE 2•b5i SHARE
SUGARLAND, TX 7747b
6• JACKSON M• SMTIH, III Lineal
30 WINDSOR APT 1 B 2•b5i SHARE
WHITE PLAINS, NY 10601
7• DAWN SMITH Lineal
726 E 24TH STREET 2•b5~ SHARE
OAKLAND, CA 94606
ENTER DOLLAR AMOUNTS FOR
1
1
SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART )n -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
H rtwva cnar~ ie no~vi ~ iaa arlrlilimal chE+nlc of nanw of fha carrw ci~a
s
Contlnwtlon of REV-1600 Inh~rftanc~ Tax R~urn R~sid~nt Drtc~rtt
JACKSON M. SMITH
21 1Q 0806
D~ad~nl's Narrw Pp~ 2 FNS Number
achuduN J - BeneAclarMs -1
NUMBER
NAME AND ADDRESS OF S RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not LbtT AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS (N~ckde~ Sou, ~g (al t~ ~l•1dfMibi~llone and tanefeta under
1~8 'l'~1.1
8 • DANIELLE SMITH Lineal
470 UNION STREET 2.85 SHARE
SAN FRANCISCO, CA 94133
9• MICHAEL SMITH Lineal
470 UNION STREET 2.85 SHARE
SAN FRANCISCO, CA 94133
10 JESSICA MULCTS Lineal
16 BENTLEY PLACE 2.851 SHARE
CARLISLE, PA 17013
11 JOSHUA SMITH Lineal
16 BENTLEY PLACE 2.851 SHARE
CARLISLE, PA 17013
.,,
C_~ _..;
c:, _i
LAST WILL _~'n~ -~ t
-~ c~ c'i
& ~ ~ `
TESTAMENT _ ::-: ~ ~ ty1 , ' 1
~--~
I, JACKSON M. SMITH, SR., of 2 Rush Drive, Apt. 307, Cazlisle, Cumb~rXand Coutaty, ,~ ~__}
Pennsylvania, being of sound and disposing mind, memory and understanding, d~hereby rr~lce,
publish and declaze this as and for my Last Will and Testament, hereby revoking any and all other
wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that I be cremated and my ashes be interred in the same place as my
wife, Geraldine W. Smith, in accord with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath all of my estate of whatever nature, be it real,
personal or mixed, and wherever situate unto my children as follows:
A. A Twenty Percent (20%) shaze unto my son, JACKSON M. SMITH, JR., per
stirpes;
B. A Twenty Percent (20%) share unto my son, MICHAEL W. SMITH, per stirpes;
C. A Twenty Percent (20%) share unto my son, ANTHONY L. SMITH, per stirpes;
and
D. A Twenty Percent (20%) share unto my daughter, ANGELA L. MULLIS, per
stirpes.
E. I give, devise and bequeath the remaining Twenty Percent (20%) of my estate of
whatever nature, be it real, personal or mixed, and wherever situate unto my
grandchildren in equal shares, per stirpes, as follows, to: DAWN N. SMITH,
EARL J. CHIVIS, JACKSON M. SMITH, III, DANIF,LLE A. SMITH,
MICHAEL W. SMITH, JR., JESSICA L. MULLIS, and JOSHUA A. SMITH.
I direct that any other grandchildren that may be born before my death share equally with
my above named grandchildren.
FIFTH. I direct that any and all Inheritance, Estate and Transfer tares imposed upon my
d
estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
SIXTH I hereby nominate, constitute and appoint my daughter, ANGELA L. MULLIS
as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation
or inability to act for any reason whatsoever of my daughter, ANGELA L. MULLIS , I nominate,
constitute and appoint my son, MICHAEL W. SMITH as Executor of this my Last Will and
Testament. I hereby relieve my Executor from the necessity of posting security in connection
with his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am
able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his
absolute discretion, to retain in the form received, and to sell either at public or private sale any
real or personal property owned by me at the time of my death.
SEVENTH. If any of the beneficiaries of this, my Last Will and Testament, shall be
under the age of Eighteen (18) at the time of my death, then any portion of my estate in which
they share shall be held in trust for them with my daughter, ANGELA L. MULLIS, as Trustee.
The trusteeship shall end when the child attains the age of eighteen (18) years. The Trustee shall
provide for the care, maintenance and education of said beneficiary and shall from time to time
use either principal or income from the inheritance to provide for these needs. If any beneficiary
by Trust dies prior to attaining the age of eighteen (18) years, the Trust terminates and all such
funds shall be paid over to the beneficiary's legal heirs. The trusteeship shall end when the child
attains the age of eighteen (18) years.
EIGHTH. I have "made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be
stored in conjunction with this Will.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, consisting of three typewritten pages this '~~{~`` day of c , 2010.
~~ °11 h-~~ -~
J ; KSON M. SMITH, SR.
Signed, sealed published and declared by the above named Testator JACKSON M. SMITH, SR.
as and for his Last Wilt and Testament, in the presence of us, who, at his request, in his sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
COMMONWEAL TH OF PENNSYL VANIA
. SS.
COUNTY OF CUMBERLAND
I, JACKSON M. SMITH, SR., Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed.
~~ICKSON 11~t. SMITH,~SR.
Sworn or affirmed to and
acknowledged before me, by COMMONWEALTH OF PENNSYLV~`,NIA
JACKSON M. SMIT , SR. this a 9~ day NOTARIAL SEAL
JOP.N D. ADA~1S, Notary Public
of / ~~ , 2010. Carlisle Boro., Cumberland County
r Commission Expires March 7, 2011
~j~' a ~ ~ is 2~'vL~~~~ ____
Notary Publ'
COMMONWEALTH OF PENNSYL VANL4
:SS.
COUNTY O/,,F CUMBERLAND
We, "/ IJ~.A ~ tfi f,~ GS ~'f ~~Nand ~/1~/ Glued ff /Ll ~ . ~ ~~ri~ N
the witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw JACKSON M.
SMITH , SR. sign and execute the instrument as his Last Will; that he signed willingly and that
he executed as his free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the will as witnesses; and that to the best of our
knowledge, the Testator was at that time eighteen (18) or more years of age, of sound mind and
under no constraint or undue influence.
Sworn or affirmed to and
subscribed fore me by~A,~„~~
Gf / y ~ N ~J, y and
ti//~cA~ ~ • y v ,witnesses,
this 2~' day of ~~~~~ 2010.
~U ~~
Notary Public
COMMONWEALTH OF PENNSYLVnNiA
NOTARIAL SEAL
JOAN D. ADAMS. Notary Public
Carlisle Boro., Cumberland Coun~
AAv Cnmmicsinn FYnires March 7. 2
Policy Access System -Provided by Western National Life Insurance Company Page 1 of 1
Appointment Poticy Psnding SLIT Flle My Contact lop
W E ST E EtN ~ NAT'tONAL informatlon Aceess Poiktes Servlee Sharing Pronle Us Out
- - - Policy Access System
Policy Seareh Policy Listing Polk Detail Notes RNatbnships Guarbrly Values Tax Fonns Heip
his 0[ Oi~t'i3~20'1~
• , n~~~~~~~ >Fbto~ tActhra .
' Agent Nante
Ownerfs) Ownerts) Address Ownerts) Phone Annuitangs) Agent Number
Smdh, Jackson M 27{ Longs dap Rd, CarNsla PA 170131224 (717)243-t22{ Smgh, Jacktan M Edward~t~
p-. ~ .s
-~,e - -
w~nw~w
Polley
Date Accumulabd
Valw Cash Surrender
Valw Penalty Fns
Amount Last VYkhdrawal
Dab Tobl
Deposits Total
Wlthdnwab IMenst
Earned
07101/200{ 116,67f.{3 {16,000.00 13,103.60 {1{,000.00 10.00 167{.{S
Com lee Inbrest duannbed Minimum Irttereat Rab I
..~., 4.00%
TEFRA Inbnst
w6.02 O 2010 VYNLIC. All rlghb resertred.
Page; 1 Document Name: untitled
~DDMAIN Demand Deposit Display Main 6017 10/15/10
Acct 0981103561 NOW ACCOUNT RATE INDEX 310 Pg 1 of 2
-----------------------CRF WINDOW------------------------------- 23
- ANGELA L MULLIS ITF Alpha-key MULLIAL.02 .
-
L JACKSON M SMITH BENEF TIN 202-42-5623 LL
C 16 BENTLEY PL Birth date 03/21/1964 0
CARLISLE PA 17013-4426 Home phone 727-245-0675 2
' Work phone 717-240-6753 RE
-------Account Holders-------- --Acct Rel-- -----Demand Deposit----- 0
10
ANGELA L MULLIS PRIMARY Branch 0167 Area 0167 10
JACKSON M SMITH BENEFICIARY Officer 023 Class 30001 10
A ~ -------------------Customer Comments------------------_
-Emp- --Date--
I ~
F (NO COMMENTS ON FILE FOR THIS CUSTOMER.)
I '
' ND
C '
F3=Exit
rate: 10/18/2010 Time: 2:33:51 PM
Page: l Document Name: untitled
~DDMAIN Demand Deposit Display Main 6017 10/15/10
Acct 1674064918 MMA ACCOUNT RATE INDEX 050 Pg 1 of 2
---------------------------CRF WINDOW-----------------------
.- -------
-. 23
- ANGELA L MULLIS ITF Alpha-key MULLIAL.02 -
L JACKSON M SMITH BENEF TIN 202-42-5623 LL
C 16 BENTLEY PL Birth date 03/21/1964 0
CARLISLE PA 17013-4426 Home phone 727-245-0675 2
' Work phone 717-240-6753 FF
-------Account Holders-------- --Acct Rel-- -----Demand
Deposit----- 0
10
ANGELA L MULLIS PRIMARY Branch 0167 Area 0167 10
JACKSON M SMITH BENEFICIARY Officer 023 Class 30002 10
A ~ -------------------Customer Comments------------
------- -Emp- --Date--
--
I
F
(NO COMMENTS ON FILE FOR THIS CUSTOMER.) 00
03
I ' '
' 00
' ND
C '
F3=Exit
gate: 10/18/2010 Time: 2:34:03 PM
Sovereign Bank
ESTATE OF Jackson M Smith
SOCIAL SECURITY #: 201-16-5737
DATE OF DEATH:
August 8, 2010
Account #: 0511086148 Type Premier Checking Open date: 10/19/2009
In the name of: Jackson M Smith or Angela L Mullis
Date of Death Balance: $1,169.19
Int.(YTD) from 1 / 1 /2010 to 7/ 19/2010 $0.12
Accrued interest to date of death: $0.00
Other Info: Closed 8/11/10
Account #: 1691028797 Type: _ Premier Checking Open date 2/12/2003
In the name of: Jackson M Smith or Angela L Mullis
Date of Death Balance: $18,881.45
Int.(YTD) from 1/1/2010 to 7/16/2010 $35.13
Accrued interest to date of death: $1.52
Other Info: Closed 8/11/10
Account #: 1694061027 Type: Money Market Savings Open date 7/1/2009
In the name of: Jackson M Smith or Angela L Mullis
Date of Death Balance $105,266.43
Int.(YTD) from 1/1/2010 to 7/19/2010 $254.80
Accrued interest to date of death: $57.68
Other Info: Closed 8/ 11 / 10
Page 1 of 1
' ~.
fMJAQIC%A/
Group
August 20, 2010
SUSAN J I-IARTMAN, ESQUIRE
DUNCAN & HARTMAN PC
1 IRVINE ROW
CARLISLE PA 17013-3019
Re: Jackson M Smith
Contract No. 8822643
Dear Susan J Hartman:
Principal life
Insurance Company
Princor Financial
Services Corporation
We received your request for information on Jackson M Smith's annuity contract referenced
above.
The date of death value (08-08-2010) is $10,922.61. Of this amount, $10,000.00 is cost basis
and $922.61 is taxable gain.
Our customer service representatives are available to answer your questions from 7 a.m. to 6 p.m.
CST, Monday through Friday, at (800) 852-4450
Sincerely,/
~~ ~t_~--
Vickie Linthicum
RIS Annuity Services
(800) 852-4450
Your representative
LPL Financial Corporation
A1705-000
Corporate Center: Des Moines, Iowa 50392-1770 (800- 852-4450
Securities offered through Princor t rnancial Services Corporation, (800) 247-1737, member SIPC.
Principal Life and Princor are members of the Principal Financial Group, Des Moines, IA 50392.
EE671T-B
A 1. FHA 2 FmHA 7. COIW. UtilPls.
U.S. D~ARZ'MENT OF FgUSllld i URBAN Dt;VB.OPE~/T 8. FNE NUMSEJC 7. LOAN ~
SETTLEMEM' STAT9NENT a ~roaZOAGE ~ cASE NLAI~6ER:
a NQf~ rnrronArA.rr-»dam.rW•,~•~n•^~a,~~,.urew~eao,a~. a~ww~F+ba,eabre+.«~wn~nc
~r,,.,,,~.a'~lw.,.p,leaa+n'n•dorna~•rwrwwnr»na-rrar~.~larvuv~ ~~~
DoL~LAE ~ zoolc
4!0 RUNNItX3 PUMP ROAD
LMK?AS'ISt, PA 17501
4 PRDP~rrwu+~iuc
3 STNIAVINU!
CJIRLISLE PA 17013
~., CUNEIERLAND County, r.nn~fi.~+•
saT>rLaAV~+uE
NORTH MIDDLEZON 10NINSIIP
tsa ptoasA4lourTDUEeuL~t
ssv-ZE or.lAacaoN M. SYffH
3 $TIPEAVENUE
CJiRLJSIr,PG117013
H. $ETf18YId(r ruen~:
~gT~T ~pgAZlB OF LIINCASZER INC
PLACEOrs~MENr
1903 L(TRZ POCE
lJMICASTBR PA t7S01
41,1.64 ~4i0. GROSSAMOUNTDVEI'OSQJdR
O0A6 NQ 2'.f02-04E3 '
A 6.rICONV.INS.
~now~.
v,~~
l 9ERLEMENT DOZE:
oc>oe.r 12. solo
~~~
asn ro~rAl.rAroEr~aRiurEre 1,oonoo argil TDrAC~DUC'r>a1rA~au~rTDMESS~R an+.
~.~,
~..~ .._._ . _ _ -- -- .o.+sre4 ~ eoa C4SN (x 70) c ~~ ssttE>! I "~`~ ~
3oa cASr~ t x F+~oa~ r rn~ auvee
TIM und~nM lrlr6>F oaVy dp~Ols ti4 dOlk s1rNm4d i ~y • n~ a lwwin.
iHAVECMERJU.Y 7HE ENT gp-ZEI~JQTANDZ'OTf1EBB'fOFYYg10WLQD0EAND~~.RISAZRUTA~~
AND D ~ ~ SON MY ACCOtkITOR/ M@ IN y~
MA71l11PR1~1IECA ~ SdYr / ~!
Buyr
1b t7! ~ ~ MY ENT SD1TE1lNT WHCN I HAVE PRIYAR® IS ATItJE AND RME ACODtNfT OF THE
~~ ~~ WERE ~ B1~N yyO,U ~ DISBtIRS® SY THE UNDERSEiNED AE PART OF ZFE 9ETiL9EKT Of ZlYS
TRIMISILCZIOK ~,/
lJ1N R~
WARNS10t R lSA CRE~t 1C+ ggYVNiOLY MA101 FALSE STA7~+EN1S ZO 114E VNtTED STATES oN MIS CR ANY S/S6AIt roiEr. PENAtZIFa UPON
CONVIC1101L CAN 01CWDE A ~ AND IMPRISDMiENL FOR DETALS SEA ZT1L~ iS us CODE SECTION 1001 l SECZION 1010.
~_
1 ~~ '
1001.
1
1 1fMi
i
~
-- s s or
Cartlbd b M s Yu~ a0pp.
~ Muroe iM~arw i w
BigCharts -Interactive Chart for MetLife Inc
IYIE 1 MetLife Inc (NYSE Delayed quote data
hide quote detailed quote options chain
Page I of 2
10/25/2010 3:35 PM
h 1 fl
Last: Change: Open: High: Low: Volume:
40 ~ ~ 9 ~ -0.15 40.70 40.87 39.86 4,240,659
Percent Change: Yield: PIE Ratio: 52 Week Range:
-0.37% 1.84% 17.07 32.16 to 47.75
~~ Follow arketwatch
News ~ Industry ~ Market Advisers (Analysts ~ SEC Filings ~ Insiders ~ Annual ReDOrt ~ Profile
R Create Alert ~ ^ Add to Portfolio ~ ^ Read Messaoes ~ $ Technical Analysis ~ ~ Hulbert Interactive
Vo I -u.
.i .. ~ '~
Nov Dtc 10
_ 60
40
20
- - ~
Sponsored L
Mortgage
2.67%!
Calculate
Mortgage
Now! (As
Good Mor
America )
,.....~.. ('.... ff ..I
Hottest
Penny Sti:
Explode. I
Free Join
Profit!
www.WallSti
Trader M
Million
California
Trader M~
Million in
Y IS
ear. ee
p
~9 email this chart
~ printer-friendly format Find a broker www.Virtual~
Easy stogy
Profits
Trade Sto
For Insan
Download
Trader Nc
www.Easy-5
Market C
10/31/2
Technical
suggest n
collapse r
October 3
www.stealth
~'
SCOf~I'81t
~8'~~ TRADE FREE
6
~
~ 1HBWALI.SfRff,1'.K1lRNAt.
~
~~
a *~ 0
0 ° R ~ LLa
,
•~••.. 3ma11 eiustness~
Scottrade: 57 Trades, Trade Free for 60 Days. Trade Now at Fidelity Visit Trade Currencies Online
Fast Executions E'TRADE Securities. WSJ.comismallbusiness
add to favorites list favorites
!.. 'p't'MI ~ 40
38
34
32
»~Ch7trtt~.aot;p
80
http://bigcharts.marketwatch.com/advchartlframes/main.asp?time=8&freq=l &compidx=a... 10/25/2010