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Home My WebLink About02-10-11 1505610101 REV-1500 «~~=_=o, PA Department of Revenue perrrrsytvaMa OFFICIAL USE ONLY Bureau of Indtvidual Taxes PO BOx zsa6oi °`~""""°"'°` ""~'"" County Code Year File Number INHERITANCE TAX RETURN Hanisbu PA i i28-o60i ENTER DECED RESIDENT DECEDENT ~.I ~~ DO ENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 160-16-0795 11 /19/2010 07/17/1917 Decedents Last ~~ Suffia Decedent's First Name SMITH Ml MRS KATHLEEN W Iff AppNcable) Error SurvNing Spouse's Mfortnation Below Spouse's Last Name Suffix Spouse's First Name SMITH Ml MR WALLACE Spouse's Social Security Number K i 95-07-9148 ~~ RETURN MUST BE FILED IN DUPLICATE WRH THE REGISTER OF WILLS FlLL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (date of death O 4. Limited Estate O pnor to 12-13.82) 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Re uired de th ft ~! 6. Decedent Died Testate O q a a er 12-12-82) 7. Decedent Maintained a Living Trust 0 (Attach Copy of W1H) 8. Total Number of Safe (Attach Copy of Trust) Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec 9113(A) b t . e ween 12-31-91 and 1-1-95) (A~~ ~. O) CORRESPONDENT - TINS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE Name AND CONFIDENTIAL TAX INFORMATION SHOULD BE DNtECTED T0: WALLACE K SMITH Daytime Telephone Number .(717)591-8761 rte, . REGISTER USE o9L1 First Tine of address ~;~'b t''1 om ~.r rte? MAPLEWOOD SUITE 215 '- G.7 t ,-,.,~ ~ ~~ : Second line of address ~~~,~ ~ ~` ~ ~.-.y ~; `.. 5225 WILSON LANE ~ ~ ~' ~ _ -~ City or Post Office ~ ,. ' State ZIP Cade D FN.ED `~ MECHANICSBURG PA 17055 t'='' correspondent's e-mail addnrss: O'rder' penaltles of perjtay,l deaare that 1 travel u~n,e ~~ $c,les ara statements, and to u,e bast or my Inwrwedge amd bel(ef, it is true. correct and cwrrplete. DerJaratbn of peraorral-epreaentative is based on alt infonnaticn d which SIGNATU E PERSON RESPONSIBLE FOR FILING RETURN ~~ ~ arty knowledge. ADOREESs MAPLEWOOD SUITE 215, 5225 WILSON LANE, MECHANICSBURG, PA, 17055 SIGNATURE OF PRENARER OTHER THAN REPRESENTATNE DATE ADDRESS PLEASE U8E ORIGINAL FORM ONLY 1505610101 Side 1 1505610101 J __.! 1505610105 REV-1500 EX Decedent's Social Security Number Oecedern's Name: KATHLEEN W SMITH 160-16-0795 RECAPrtuuTwN 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 and Notes Receivable (Schedule D) . ......................... . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 21,210.63 8. Jointy Owned Propery (Schedule F) O Separate Billing Requested 8 ....... 7. inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly . (Schedule G) O Separate Bilpng Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............... . " 8 """"~~~ • 21,210.63 9. Funeral Expenses and Administrative Costs (Sc~redule H) ..... . ............. s. 12,342.50 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ..... _ ............................ 11. 12,342.50 12. Net Value of Estabs (Line 8 minus Line 11) ... ......... . 13. Charitable and Governmental ................. Bequests/Sec 9113 Trusts far which 12. 8,868.13 an election to tax has not been made (Schedule J) ................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .......... . ............. 14. 8,868.13 TAX CALCULATION -SEE INSTRUCT10N3 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (ax1.2) X .0 0 16. Amount of Line 14 taxable 15. 0.00 at Aneai 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 18. 19. TAX DUE ......................................................... 19. 20. flLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056101D5 1505610105 0.00 O J REV-1500 EX Page 3 Decedent's Complete Address: ~~~ N~e.r DEC S NAME KATHLEEN W SMITH STREETADDRESS - 5225 WILSON LANE CnY MECHANICSBURC ; SrATEPA i ZiP - 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Lure 19) 2. Credits/Paymer~ts (f) 0.00 A Prior Payments 0.00 B. Dint 0 00 3. Interest Total Credits (A + g) (2) 0.00 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. ff Line 1 + Line 3 is g,~~ U~an Line 2, errter the difference. This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deodent make a transfer and: a. retain the use or income of the No Property transferred :.......................................................................................... ^ b. retain the right to designate who shaA use the property transferred or iGs income : ...................................... ^ c. retain a reversions i ~•..•. ^ x .... ry nterest; w ............................................. .................................................................. ^ d. receive the ....... Promise for life of eitl~er payments, benefds or care? .......................... ^ 2. ff death occurred aRer Dec. 12, 1982, did decedent transfer ............................................ ^ x ProPertY x~tltin one year of death without receiving adequate consideration? ^ ............................................. ....... ................. ^ x .... ..................................... Did decedent own an 'in trust for' or Payable.uPon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement ac~carnt, annuity or other non-probate property, which contains a benefipary designation? ................................... Q IF THE ANSYYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivin [72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statut 9 spouse is 0 percent filing a tax return are still applicable even if the surviving spouse is the only benefiaary. ory requirements for disdosure of assets and For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 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 4.5 percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(aj(1jJ. • The tax rate imposed on the net value of transfers to or for the use of the decedenPs siblings is 12 percent [72 P.S. §91i6(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 Wood or adoption. REV-1$08 EX+ (1i-10) ' Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REStoENr oECEOENr ESTATE OF: KATHLEEN W SMITH 'JiCNEpVLE E CASH, BANK DEPOSITS A MISC. PERSONAL PROPERTY Include the proceeds of litigation and the date the proceeds were received ~, Ule ~~ ~ ProP~Y jolntlt/ owned with t1Eht of wrvlvorship must be dledoeed on Sdredub F. 1. ~ PREPAID FUNERAL ACCOUNT FILE NUMBER: 21-11-0061 AT I 8,765.00 Musselmart Funeral Services, Inc, 324 Hummel Ave, Lemoyne, PA 17043 ESTATE CHECKS FOR REFUNDS OF UNUSED INSURANCE PREMIUMS 2, Asbury Community Incorporated (Bethany ~Ilage Retirement Community) 2,842.26 3. Ability Insurance (Long Term Care) 787.62 4. Highmark Medical (Health Insurance) 5. Highmark Prescription Insurance 442.32 34.43 6. PNC BANK -CHECKING ACCOUNT NR. 50.0441-5572 3,457.00 7, PNC BANK -MONEY MARKET ACCOUNT NR. 50-0441-3841 4,882.00 PNC BANK, 5150 Simpson Feny Rd, Mechanicsburg PA 17055 TOTAL (Also enter on Line 5, Recapitulation) ; I 21 210 63 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvarria SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND '"NERITANCE rAx ReruRN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF KATHLEEN W SMITH ALE NUMBER 21-11-0061 Decedent's debt must be reported on Sehaduk I. ITEM - --~- A• FUNERAL EXPENSES: AMOUNT i' All paid to Musseiman Funeral Services, Inc, 324 Hummel Ave, Le moyne, PA 17043 Basic services induding embalming, viev-ting, transport, register book etc. , Casket 4,090.00 1,900.00 Vault Grave open & dose 950.00 1,395.00 Minister 100.00 Flowers, death cents, newspaper death notices 330.00 B. ADMINISTRATNE COSTS: i. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address ~ State ZIP Year(s) Commission Paid: Z• ~ Attorney Fees: 3• Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) 3,500.00 Claimant Wallace K Smith street Address 5225 wlson Lane _ City Mechanicsburg state PA ZIP 17055 _ Relationship of Claimant to Decedent Husband 4• Probate Fees: 77.50 S• Accountant Fees: 6• Tax Return Preparer Fees; 7. TOTAL (Also enter on Line 9, Recapitulation) $ 12,342.50 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: KATHLEEN W SMITH SCHEDULE ~ BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and tran~ers under Sec. 9116 (a) (1.2).] 1• ~ WALLACE KSMITH MAPLEWOOD ASSISTED LIVING, SUITE 215 5225 WILSON LANE, MECHANICSBURG, PA 17055 Do Not List HUSBAND ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE, II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. FILE NUMBER: 21-11-0061 AMOUNT OR SF Of ESTATE 8868.13 TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET if more space is needed, use addRional sheets of paper of the same size. # REGISTER OF WILkS T CUMBERLAND CBUNTY PENNSYLVANIA LOWER ALLEN TOWNSH/P CUMBERLAND COUNTY Deceased Social Securi ty No: 160-16-0795 WHEREAS, on the 13th day of January 2011 an instrument dated April 13th 1995 was admitted to probate as the Iasi wi11 of KATHLEEN WE/SEL SM/TH lfiist. Middle. cast! Ia to of LOWER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 19th day of November 2010 and WHEREAS, a true copy of the wi11 as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi11s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: WALLACE K SMITH who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to Iaw, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 13th day of January 2011, * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) CERTIFICATE 4F GRANT OF LETTERS No . 20 1 1- 00061 PA No . 21- 11- 0061 Estate Of : KATHLEEN WE/SEL SM/TH /First, MMdle, Last) ,;=~~, ' ~ ,_ ~`~ -. ~. 5~ i~~ S~ .a~ /ar~w..+.` /~ Q U~1 C"3 ,~: `-', ~'~ --- °- LAST WILL AND TESTAMENT _ re~ . .. _ -:~- ~,,~_ OF i .~': ~c r n --- r9 c~ ~ , ,_F RAT$L88N W. SMITH ._._ ~ ~ T t"i I, $~i,THLEEN W. SMITH, having my legal residence at 2110 ~~ Berryhill Street, Harrisburg, Dauphin County, Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by_me. I~ pNg; I direct tliat all my dust debts and the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM TWO: I give all of the residue of my estate, of whatsoever nature and wheresoever situate, to my husband, WALLACE K. SMITH, if he survives my death by thirty (30) calendar days. ITEM THREE: If my husband, WALLACE K. SMITH, does not survive my death, then I give all the residue of my estate, of whatsoever nature and wheresoever situate, to my grandchildren, KEITH D. LOBEL, BRIAN R. LOBEL and CINDA D. LOBEL, IN EQUAL SHARES, PER STIRPES. ITEI[ BOIIR: I appoint my husband, WALLACE K. SMITH my Executor. In case of his inability or unwillingness to act or to continue to act as my Executor, I appoint my brother-in-law, MAX J. SMITH, SR., Executor. I give to my said Executor, in addition to the authority conferred by law, the power to sell any or all of my personal and real property at public or private sale, at such time and for such price and upon such terms and conditions as he may see fit, or in his discretion to retain the same for distribu- tion in kind, and the power, but not the duty, to invest any l cash without being limited to "legal" investments. No bond shall be required of any fiduciary hereunder in any juris- diction. No fiduciary hereunder shall have any liability for any mistake or error of judgment made in good faith. I specifically authorize my Executor to file a joint income tax return with my husband for any period during which such a return is permitted, without requiring him to sign an indemnification agreement. ITEM FIVE: I direct that all estate, inheritance and other taxes in nature thereof, together with any inter- est and penalties thereon, becoming payable because of my death with respect to the property constituting my gross estate for death tax purposes, whether or not such property passes under this my Last Will and Testament, shall be paid from the principal of my residuary estate, and no person receiving or having a beneficial interest in any such prop- erty, whether under this my Last Will and Testament or otherwise, shall at any time be required to contribute to or refund any part thereof; PROVIDED, however, that this direc- tion shall not apply to the taxes on any property included in my estate solely because of a power of appointment there- over which I possess but have not exercised or on any quali- fied terminable interest or to any generation-skipping transfer taxes. ITEM BIY: I realize that Executors and Trustees are given discretion by law to make various elections which affect the income and estate taxes payable by estates, trusts and beneficiaries, as well as the relative shares of beneficiaries, such as taking administration expenses as deductions for either estate or income tax purposes, select- ing options for the payment of employee death benefits, -2- electing to take qualified terminable interest as part of the marital deduction, selecting alternate valuation dates, postponing the payment of taxes, filing joint income tax or gift tax returns and redeeming corporate stock. The deci- sions made by my fiduciaries in any of these matters shall be binding upon, and not subject to question by, any affect- ed persons; PROVIDED, however, that if a corporate fiduciary is serving, its decision shall also be binding upon any individual co-fiduciary. I rely upon my fiduciaries to take into consideration the total income and estate taxes payable by reason of their decisions including those payable by my survivors, and they are authorized in their discretion, but not required, to make adjustments between income and princi- pal as a result thereof. IN WITNESS WHEREOF, I have at Hershey, Pennsylvania, this ~ ~ day of ~:~ ~ ~~ , 1995, set my hand and seal to this my Last Will and Testament consisting of four (4) pages. --- _ - - _ y~ ~~ / KATHLEEN W. SMITH SIGNED, SEALED, PUBLISHED and DECLARED by KATHLEEN W. SMITH, the above named Testatrix, as and for her Last Wi ar~d 'Te~stameent, in the 11 presence of us, who, at her re and in her presence and i» the west • presence of each other, have ' hereunto subBCribed our names as witnesses. ~ r t ~~ r __-~- .,~. - Residence ~ zt, , ~n~ :~~p~ -f, , ~ .:.~~ F ~~~ Residenc e ~~ -3- We, KATHLEEN W. SMITH, MAX J. SMITH, JR. and ALISA M. KUNKEL, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instru- ment as her Last Will and Testament that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the wit- nesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraints or undue influence. TESTATRIX . ~~-. WITNESS C1 ~ : rv~ Bu _ ~..n k~...~ WITNESS Subscribed, sworn to and acknowledged before me by RATHLEEAt W. SMITH, the Testatrix, anti subscribed and sworn to before me by Max J. Smith, Jr. and.Alisa M. Kunkel, witnesses, this ~~ day of G~ '~ 1995. / ~ : ~ '~C , ~ r ~ f P NOTARY ` UBLIC ~' ~ ~" < ~~, ~?~ N~TAa~.ai sera. ~ ~Efr'!! !.. ; kHC~J~, Plotary Pt;bli~ `:.: is °. -.. , ... .. rtc .,_. -4- ~~ ,Q 4~ O Q M O tid ~g a M 0 n :~~-~ ~.,~. ~~ se ~_ ;~ ,• } ~~ g~ [~~' ~ w, ~~ ~~ °~ ~~ , __ of a -. ~ a~ u~ 'pp -- ~rn w~yo : m¢ ~o _:_ ,, N (~ol V C ~ .~ L Q~ to O m Z3 o .... _.