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HomeMy WebLinkAbout02-08-11 1505610101 REV-1500 ~"°'~°' ~' PA Department of Revenue pennsylvaMa OFFICIAL USE ONLY Bureau of Individual Taxes "`"""`"""°`"'~ Courgy Code Yeer File Number [ INHERITANCE TAX RETURN d ~ 7 Po sox zao6oi ~ Hartisbu PA a, ~z&o6os RESIDENT DECEDENT ~ ENTER DECEDENT MIFORMATION BELOW Social Security Number Date of Death h1MDDYYYY Date of Birth MI~DYYYY 197-26-0084 02/09/2010 09/27/1934 Decedents Last Name Suffix Decedent's First Name MI Smith Charles D (If Applicable) Eller SurvNing Spouse's IMonnaNon Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Soci~ Security Number THIS RETURN MUS'i Bf FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t>d 1. Original Retum O 2. Supplemental Retum O 3. Remainder RetLm (date of death prior to 12-13-62) O 4. Limited Estate O 4a. Future Interest CorrprorrNse (date of O 5. Federal Estate Tax Retum Required death after 12-12-62) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Tnut B. Total Number of Safe Deposit Boxes (Attach Copy of YtOA) (Attach Copy of Trust) O 9. Litlgation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election b tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS St:CT10N MUST BE COMPLETED. ALL CORRESPONDENCE ANO CONRDENTIAL TAx INFORMATION SHOULD BE DSIECTED TO: Name Daytlme Telephone Number Paula M. Lucas (717) 8p5-8700 First line of address 9 Ash Street Second line of address City or Post Olfioe State ZIP Code Palmyra PA 17078 RE61878Y~ yYILLB USE~LY ~O ~ CZ7 rn r~-- ~ ~ ~ m 1 ~vi~ ~ ~ 1 Q~ ~ ~; TE Flt Corrospondent's snail address: Under penaltles or penury, I declare that I have examMed M>IS realm, h~dudinp eowmperryirq aNadube and statements, and to the fast W my luwwledpe end tbNef. tt rs hue, coned and conpbla. Decleratlan of prsparer other tl~an the personal rapnaenratlve !a based on aA infornatlon of whch preparer has any Wnwledpe. SIGNATURE E~tSO~l~ifcr^aPONSIBLE FOR FILING RETURN DAB ADDRESS SIGNATURE OF PREPARER OTHER THAN -~-li ADDRESS PLEASiE l!S! OR161NAL F OfK.Y ~`~5 t~ C;7 r -v-~ Side 1 1505610101 1505610101 15056101.05 REV 1500 EX Decedents Social Security Number t]ewdenYa Name: Charles D. Smith 197-26-0084 RECAPITULATION 1. Real Estate (Schedule A) ......................................... .... 1. __ 0.00 2. Stocks and Bonds (Schedule B) ................................... .... 2, 0.00 3. Closely Hekf Corporetion, Partnership or Sole-Proprietorship (Schedule C) . .... 3. __ _ _ 0.00 _ 4. Mortgages and Notes Receivable (Schedule D) ....................... .... 4. 0.00 5. Cash, Bank Deposits and MisceNarreous Personal Property (SChedub E)... .... 5. 8,553.83 __ 6. Jointly Owned PropeAy (Schedule F) O Separate Billing Requested ... .... 6. 0.00 r- wos ransfers & Misceilaneous Non-Probate Property -_ _ (Schedule G) O SeparaM Billing Requested.... .... 7. 0.00 8. Total Gross Assets (total Lines 1 through T) ............................. 8, 8,563.83 9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. 5,117.33 10. Debts of Decedent, Mortgage Liabiilties, end Liens (Schedule I) .......... .... 10. 753.14 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. 5,870.47 12. Net Yalw of Estate (Line 8 minus Line 11) .......................... .... 12. 2,683.36 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - - - _ .,. an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Valor Subject to Tax (Line 12 mirws Line 13) ..................... ... 14. 2,683.36 TAX CALCULATION - 3l~ INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) x .o_ 4.50 15. 1B. Amount of Line 14 taxable _- _ _ . __ , .... _.. __. at lineal raN X .0 _ 16. 17. _ Amount of Line 14 taxable _ _ _ at slbling rate X .12 17, 18. Amount of Line 14 taxable at cdlateral rate X .15 18. 19. TAX DUE ...................................................... ...19. 120.75 20. FILL IN THE OPAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Sloe 2 150561D105 15D5610105 REV-7500 EX page 3 Decedent's Complete Address: tea. aoro - ooa~ o c rs e Chaties D. Smith -- STREETADDRESS 615 B Mallard Road an Camp Hill srAre PA zP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 120.75 2. CreditslPayments A Prior Payments ____ _ B. Discamt Total Credits (A + B } (2) 0.00 3. Interest 4. H Line 2 is greater than Line 1 + Line 3, enter the difference. Ttds is the OVERPAYNIEN7: (3) 1.03 FIN in oval on Page 2, Lina 20 to request a refund. (4} 5. H Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 121.78 Make check payable to: REGISTER OF WILLS, AGENT. ._ ,~~. . ~ : ~~,,~. _ ~.r.~ PLEASE ANSWER THE FOLLOWING QUESTK)NS BY PLACMrG AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: y~ ~ a. retain the use w Income of the properly transferred :.................................._...................................................... ^ b. retain the right to designate wta shah use the properly transferred or its incarrre :............................................ ^ c. retain a reversionary interest; or .................................................................. d. receive the promise for life of either payments, benefits or care? .................................................. 2. ff death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................... 3. Did decedent own an 9n trust for or pey~le-upondeath bank account or seaitity at his ar fier death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ K^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN;''- . .,., ,~ mt~ ..~>. . _ r~ ,. ..~.~ For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed an 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)J. 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 survivng spouse is 0 percent [72 P.S. §8116 (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 velum are stilt appNcable even if the surviving spouse is the only benefiaary. For dates of death on or after July 1, 2000: • The tax rate imposed an 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 im on the net value of transfers to or For the use of the deodents lineal t>etaefiaaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or far the use of the decedent's silNngs is 12 percent [72 P.S. §9116(a)(1.3)]. A sibNng is defined, under Section 9102, as an individual who has at least one parent in common with the decederd, whether by blood or adoption. • REV-i5o8 El(+ (u-w) Pennsylvania DEPARTMENT OF REVENUE [NNERn'ANCE TA% RETURN RESIDENT DECEDENT SCNE1D11LE E CASH, BANK DEPOSITS ~ MISC. PERSONAL PROPERTY TESTATE OF: _ FILE NUMBER: ,?e Chaises D. Smith -a~2yy Include the proceeds of I'~tlgatlon and tfie date the proceeds were received ty the estate. ~ Pro~Y 1~~Y ovvnad vrkh right of survivorship must be dtsdosed an Sdwduk F. 1. Members 1st Federal Cedit Union Checking Account 3,036.43 3512 Market Street Camp HiA PA 17011 2, Members 1st Federal Cedit Union Savings Axount 5.00 3512 Market Street Camp hitl PA 17011 3. Checks ~ 125.00 Debts due to the decedent and collected ~ 4. 2 cas - Payment from Salvage Yard ' 100.00 Faibr's Salvage Yard 452 Crossroad School Road Carlisle PA 17015 Ph 717-T71i-5200 5, Proceeds from sale of household 5,287.40 Horst Auction Company 50 Duriadi road Ephrata PA 17522 TOTAL {Also enter on Line 5, Reppitulation) ; I 8,553.83 If more space is needed, use additlonai sheets df paper of the same size. ~~ Camp Hill 3512 Markst Street Camp Hill PA 17011 717-737-1041 Inquiries Call: Acct XXXXXXX119 5MITH,CHARLE5 D 03/16/10 E£f: 03/16/10 Date: 1:28pm Tlr: 0366 Time: Deposit to CHECKING 0011 3,036.43 prey Bal: 125.00 Amount: 3,161.43 New Bal: #303776 5eq: Check Received Check Received 50.00 73.00 Authorized by ID Source: ~l D• LiC _____--- oau•. grd __ Kn:+n _ Other _ ,,.__.~r---'^ 10-Y nn E;u:ty Special Aates as low as ~ ,PR! No Prepayment penalties! No s! No Closing Costs! Ask for det>_ta• CHARLES J 7N1I iH Camp Hill 3512 Markst Street Camp Hill PA 17011 Inquiries Call: Acct XXXXXXX119 Eft: 03/16/10 Tlr: 0366 ~~ ~S :~~ r uMmr~ 717-737-1041 5pSITH,CHARLES D Date: 03/16/10 Time: 1:29pm Plithdrwl from CHECKING 0011 Prev Bal: 3,161.43 Amount: 3,161.43 Naw Bal: 0.00 Sey: X304043 Deposit to REGULAR SAVINGS 0000 Prav 8a1: 5.00 Amount: 3,161.43 New Bal: 3,166.43 Seq: X304044 ~~~ , 'uxs,xl~l ~,~1~ Authorized by ID Source: ~l Drv LiC SigCard Known (~ Other 10-Year Homa Equity Special Rates as low as 4.995 APR! No Prepayment Penalties! No Pcints! No Closing Costs! Ask for +tails. CHARLES D SMITH :~NN HORST & SONS, ANC., 50 DURLACH ROAD, EPHRATA, PA 17522 ~..- Consignor Number Sellers Name 403 Auction Number : 100710 ESTATE OF CHARLES D SMITH C/O PAULA M LUCAS 9 ASH ST PALMYRA PA 17078 33406 GROSS Proceeds from Auction Auction Commission & Expense(s) 680.00 : NET Seller Proceeds 136.00 544.00 Please see enclosed sheets for deta iled list CODE NO. - ---- ITEM DESCRIPTION ------- Nu. vaa ~...w ._.__-. GU 26 COLT .38 REVOLVER 1 110.00 110.00 22.00 88.00 .00 269 GU 27 JC HIGGINS 12 GA. SHOTGVN 1 65.00 65.00 13.00 52.00 .00 191 GU 28 INLAND DIVISION .30 CARBINE 1 475.00 975.00 95.00 380.00 .00 277•,. GU 310 CROSMAN BB RIFLE 1 5.00 5.00 1.00 9.00 .00 332 GU 311 GUN CLEANING KIT AND AMMO 1 25.00 25.00 5.00 20.00 .00 332 TOTAL GROSS SALE AMOUNT ACTUAL SALES TOTAL LESS COMMISSION JMPLETED YES NO TOTAL NET PROCEED6 TOTAL ITEMS: 5 TOTAL DUE TO SELLER AVERAGE ITEM COMMISSION AMOUNT NO. 33406 680.00 680.00 136.00 549.00 "//I (,` Il~~,.., (,,~/ 544.00 / rJ'~ 27.20 NOTE THANK YOU FOR USING HORST AUCTION SERVICE $~fN H©RST & SONS, INC., 50 DURU-CH ROAD, EPHRATA, PA 17522 Consignor Number 403 Auction Number 100414 Sellers Name ESTATE OF CHARLES D SMITH C/O PAULA M LUCAS 9 ASH ST PALMYRA PA 17078 GROSS Proceeds from Auction 6,410.50 Auction Commission & Expense(s): 1,667.10 NET Seller Proceeds 4,743.40 NO. 32818 32818 Please see enclosed sheets for detailed list 1 TRAY LOT JEWELRY 1 17.50 17.50 3.50 19.OU .00 79 2 TRAY LOT WRISTWATCHES 1 10.00 10.00 2.00 8.00 .00 76 ' 3~ BEAVER STADIUM PHOTO 1 25.00 25.00 5.00 20.00 .00 A02 -' 4 TRAY LOT PINS 1 8.00 8.00 1.60 5.q0 nn ro- 5 TRAY LOT LINENS 1 5.00 5.00 1.00 4.U0 ., 6 TRAYLOT JEWELRY 1 20.00 20,00 4.00 16.00 .UO /4 ,. 7 TRAY LOT JEWELRY 1 20.00 20.00 4.00 16.00 .00 74-" 8 2 TRAY LOT DECORATIVE PRIMITIV 1 3.00 3.00 .60 2.40 .00 194 9 TRAY LOT JEWELRY 1 12.50 12.50 2.50 10.00 .00 200 10 2 TRAY LOTS JEWELRY 1 130.00 130.00 26.00 104.00 .00 74 11 2 TRAY LOT PENN STATE ITEMS 1 20.00 20.00 4.00 16.00 .00 199 12 TRAY LOT JEWELRY 1 35.00 35.00 7.00 28.00 .00 74 13 BASKET AND KITCHEN PRIMITIVES 1 20 00 20.00 9.00 16.00 .00 114, 19 2 TRAY LOTS LINENS 1 15.00 15.00 3.00 12.00 .00 76 15 TRAY LOT JEWELRY 1 7.50 7.50 1.50 6.00 .00 74 16 TRAY LOT BLUE AGATEWARE 1 37.50 37.50 7.50 30.00 .00 207 17 TRAY LOT JEWELRY 1 15.00 15.00 3.00 12.00 .00 76 18 TRAY LOT COLLECTIBLES/DOLL 1 10.00 10.00 2.00 8.00 .00 172 19 TRAY LOT COOKBOOKS 1 2.00 2.00 .40 1.60 .00 194 20 TRAY LOT AGATEWARE 1 20.00 20.00 4.00 16.00 .00 194 21 TRAY LOT WOODENWARE/BASKETS 1 9.00 9.00 1.80 7.20 .00 207 22 BATTER JUG / AGATE STEAMER 1 22.50 22.50 4.50 18.00 .00 194 23 TRAY LOT KITCHEN PRIMITIVES 1 97.50 47,50 9.>C 38.00 .00 136 .4 TRAY LO'f PENF: ST.A'PE COLLEC?'S. "7.50 37.'i0 3.110 11.00 .UO 19d 25 TRAY L01' WOODEN BLOCKS 1 12.50 12.SU 2.50 10.00 .00 225 ~ 26 TRAY LOT PRINTS/PICTURE6 1 8.00 8.00 1.G0 6.9C .00 194 " 27 TRAY LOT FOLK ART PRITNS 1 7.00 7.00 1.90 5.60 .00 '!5 28 TRAY LOT BEADED NECKLACES 1 2.00 2.00 .90 1.60 .n0 1' 29 TRAY LOT REPRODUCTION POTTERY 1 8.00 8.00 1.6U 6.40 .UO lY9 , 30 TRAY LOT FOLK ART PAINTS 1 5.00 5.00 1.00 4.00 .00 76' 31 TRAY LOT JARS AND BOTTLES 1 25.00 25.00 5.00 20.00 .00 83 32 TRAY LOT QUILTED PADS/HANGINS 1 5.00 5.00 1.00 9.00 .00 76 33 TRAY LOT DOLL FURNITURE/ETC. 1 15.00 15.00 3.00 12.00 .00 76 34 TRAY LOT METALWARE 1 12.50 12.50 2.50 10.00 .00 90 35 TRAY LOT C;GAR MOLD/2 PCS GLAS 1 22.50 22.50 9.50 18.00 .00 194 36 TRAY LOT DECORATIVES 1 5.00 5.00 1.00 9.00 .00 76 37 TRAY LOT SMALL PRINT6 1 7.50 7.50 1.50 6.00 .00 76 C O N T I N U E D REV-1511 EX+ (30-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RENRN RESIDENT DECEDENT ADMINISTRATIVE COSTS: Personal Representative CommissiorE;: Name(s) of Personal Representative(s) Street Address ESTATE OF FILE NUM6EN ~10~ O6d~~ Decedarrt'a debts must be roported on SdKdaN I. ITEM NUMBER DESCRIPTION AMOUNT a FUNERAL EXPENSES: 1' NeiA Funeral Home 3401. Mlarket Street Camp FAA PA 17011 3,083.19 2 Peeler's Flower Shop 3720 Trindle Road Camp HiA PA 17011 169.55 3 Ross 5100 C Jonestown Road Harrisburg PA 17112 15.89 a. Aired's Victorian 38 North lhtion Street Middletown PA 17057 454.76 s. The Church of the Good Shepard Tritdle Road Camp HiA PA 17011 100.00 8. 1. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE CiOSTS State ______ ZIP City _ Year(s) CommLSSion Pafd; 50.00 2. Attorney Fees: 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 a. Probate Fees: 103.50 5. Accountant Fees: 6. Tax Return Preparer Fees: ~. Nary fee 5.00 Travel expenses Charlene Whiting (daughter) 533.30 Postage,Shr+edding-cAentresords 16.07 fuel and meals asaociatad wilh cleaning out of household and rented office spelre 221.63 Dump fee -household waste 101.00 Estate Notices (Patriot News Flanisburg PA and Hummelemwrt Sun Hummelstowrt PA) 263.44 TOTAL (Also enter on line 9, Recapitulation) ; 5,117.33 If more space is needed, use additional sheets of paper of the same size REV•1~12 EX+ (12-OB) Pennsylvania DEPARTMENT OF REVENUE INNERITANGE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8t LIENS ESTATE OF PILEtHlMBER C~'~5 ~• S~~h zor'o- 06~~1~f Report debts incurred by the decedent plies to daatll that reawinad unpaid st tie date of dH1h. InehidMa uardmbursed ercrNnl aTa>N~s. Ir more space is needetl, insert additional sheets of the same size. -~trer~ O A ClHzats Communia~tfau Canpnny 19 John Street Middletown, NY 10940 July 12, 2010 I~~~III,~~III~,~I~~~II~~I„~II~~I~~IIi~~~~ll~~ll„~I~I~~~I~I~I Smith Businessservices 9 Ash St Ste 104 Palmyra, PA 17078-3406 Re: 71754054991 Deaz Valued Customer, Re: 71754054991 ~ ~o~i ~~a ~o~ al Du : $81.32 ~ V~" At Frontier, A Citizens Communications Company, we recognize that in uncertain economic times, keeping up with one's financial obligations can sometimes be a challenge. At this time, we urge you to make every effort to send your outstanding balance in the enclosed envelope, or to contact us at 1-888-805-3960. We have options available that may reduce costs for new services, including our Financial Lifeline program. Our specially trained consultants will be glad to assist you in resolving your debt. You can also find information on our website regarding our Financial Lifeline progrem. Please visit us at www frontier conm/discountprosrams for details. Sincerely, ,: Middletown Collection Center 19 John St. 1Vliddletown NY 10940 ,,LL ATBT Mobility }~T 15901 East Skelly Drlve Tulsa. OK T4116 March 27, 2010 Mr. Charles Smith The Estate of Charles Smith lA N. Progress Avenue Suite 104 Harrisburg, PA 17109-3569 ll !'l~ C~ Re: AT&T Account 4640Q9918373 ,tI I Z~ 1 ~ (~ To the Estate of Charles Smith Thank you for contacting us regazding the death of Mr. Smith - we are very sorry for your loss. My name is Jenifer Robertson and I would be glad to assist in resolving any remaining issues regarding this account. L'pon receipt of this information, AT&T has cancelled this account effective 03/27/2010. At this time. I have waived all charges billed to this account after 02/09/2010; however, there is a remaining balance of $36.82 on the account for service through that date. Any payments may be made to the following address, as tong as Mr. Smith's account number is included with the payment: AT&'I' Mobility P.O. Box 537104 Atlanta, GA 30353-7104 Again, please accept our condolences on your loss. Tiianlc you for contacting u~. If' you have any further questions or concerns about this account, please contact AT&T Customer Service at 1-800-331-0500. Sincerely, Jenifer Robertson Special Operations Department AT&T i.~u~r 'r.i~riiv,~~ .ri ilia 1:.:~ rllympir. in. n~