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Home My WebLink About04-0762 PETITION FOR PROBATE and GRANT OF LETTERS Estate of KIA. -t{ \ '1 (\ C. 5~cth No. ~* - ~ lJ12... also known as To: Register Of~ Deceased. County of . n the Social Security No. \41o - (I.. ~"l~"l<.. Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age ~lder an the execut c;> r 1Sd in the last will of the above decedent, dated ~c...". , 19 and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~' Pe~~ia, j]th PA h ~ u last family or principal residence at "!>.2."1.P.> U-<t 0....._ '':> .Q. . \40''3> - J q, (list street, number atrcipality) Decendent, then years of age, died ~.s- , ~ '2-00 ':I- at Except as follows, decedent did not marry, was not <;Iivorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: ~ooo.Oo (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ ,:alue of real estate in Pennsylvania ~ ~ ~ $ q..., 7'f/l...o Situated as follows: ~ 2-~ ~. ~~ . ~ I~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters T ~ W'-~ (testamentary; administra ion c.La.; administration d.b.D.c.t.a.) theron. -- ". ~ 41.,..~. ~/ ~ "- 0 c'''''; v!../Yo,-;, " " c__ ~Z --_.- o c 0:::::: f "':Ie ~ c'= .-.:1-= ~~ .oJ "J "-:T '" ::=) " ~ '~_.' OATH OF PERSONAL REPRESENTATIVE COMMONWE~Y~VANIA ") J 88 COUNTY OF ___ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(sj of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed v.--b~.;y d~~.d...$t-- '" before me this It-\::"" day of ,;;;. ~ Ol.DO-l- '" MI_ s:, - 'N " ~r . Cu.....o~ ~Regist <i1 :s: No.c:1I-04-1G,1. Estate of k~\01\J C <:'~l+h , Deceased . DECREE OF PROBATE AND GRANT OF LETTERS ~3 UJ() 'f ANDNOW~-= . L ~ ~_, in consideration of the petition on the reverse side hereof, satisfactory proof having ~sented before me, IT IS DECREED that the instrument(s) dated . '1 . I '1-, g described therein be admitt~ probate and filed of record as the la;t will of .ke.- '\i-... "'1 T\ c.. . S~, . and Letters --r-~"",. -.~..... , c:;' JU. l +h :s- ~ . are hereby granted to f' If> <' \ S -k2. . '-l e>"ct:. y- FEES W. \ \\~ -:r. ~D()41 Probate. Letters, Etc. ......... ~?,S .0., ~("Iz.Co Short Certificates( ).......... $ \ ':S CD ATTORNEY (Sup. Ct. LD. No.) " P'R"R.i.;ienQ.'L~ ~ $ 2> Ou Sr .j $ I 0 , (\)(') c..,...-, t ,S , ,o\DDR~SS e--. , [0 I) TOTAL _ $ Q(,,3.0D Filed... .<j.-.;;,.~ .~.OQ'i............. II' -z..~~ t190. PHONE -. * . " ~e!Ji!iter of Will!i of <!Cumberlanb <!Countp . -e OATH OF NON-SUBSCRIBING WITNESS . Estate of \(~~,^c..c.,,\\ -S-.~ No.2.J-04 - ,~Z Also known as , Deceased G ~<:>~ S "".....~s...:.~ I ~~ . (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that -:r. c..._ familiar with the signature of ~..Q_ \\ '5~ ,testat~ of (one of the subscribing witnesses to) the codicil/will presented herewith and that -:I: believes the signature on the codicil/will is in the handwriting of \!.~j"" r *-.)..\ S':"~ to the best ff ~ knowledge and belief. ~- ;J ~~t- --J ~7 ~\-s.:.~,~r. - -- (Name) (Address) Sworn to or affirme~~ subscribed Before me this I day of <::""-u...."'-'L , 20 bet ~-~ (Name) FortheReg~V"'%_~ (Address) 07/08/04 14:12 FAX 7172438955 DouKlafi Law OffjcE~ ',:,": O('~ . 3B.rgistrr ot WillS' of (I1umberlllub <!tount!' ... -. . . OATH OF NO~,SIJRSCRrnING WITNESS Estate of n _kO-~ (I~ '?HA No. - Also known as - -..- --- - , Deceased -. -~ L1Y"\0c.-..L. S:U 1+ h - - - (each) a suhsctibCl hr:retn, (each) bemg duly qualified ccording tD law. (kpuse(s) and say(s) that ~ t? I ') JamlltaT with the signature of , _~ cz.. Su..db ,testa! F."I' of (one nfthe suhscribing witnesses to) the codIcil/will present herewith and that ~ helieves the sip)lature 0~OdlCll1W11l1S III the handwriting of ,_,~ C~. r\. C~ . .5.u 1+'J.,., to the best of _ knnwledr,e and belief. - r;<) <( [L 0 V'd+rdv ~. ./;m;.'lA. c;: "'"' I J (Name) L (rJdiA L - S!'vI ,-I v\ 0... w ~; v.> , I q ~ \LJ 0.. t J\.f' r- .-(X - . (~":;: ;~ o ()) ....:J .:1) "X: ~ c. ,::: (Add[ct~>> \ .\ \ ':l \ -e . ~ :}:~ \-1() ,;-:-,-: a: ,.() ::::: u6 ~ ,-\-':)4, ":3 - ")~ t~ Swnrn tn OT afnmted ar~l 5uhsenbed Before me tlllS""3r"' day of ~ ,200~ - ~ (Name) L~O IL~. ~t, ~ For the Register~..- ~ ~~ - (Addn'ss) Hl05,11? REV, 8/88 WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR (FEE FOR THIS TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. CERTIf-ICATE S2.0OJ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH /.iIi/ii"ff~j;,~" A'(~\.1" Of i1;,.... ' l\l~ --~"" It.-~ l~ // ~~"=- i'~~~~\ ~( . \r, ~~ .... ~~ CERT. NO. T 5655711 ~~I ,.,~ Ih~ P7.r:;jMay 7, 2004 \*~ ....... ~,* [, Juil 17 ~~ /~., " - Oat" of Issue or This Certif,cation '\.~' ~/ ~~--~~MEN1 \\'~~Illl'" ~ .;)1. f)'f.7IP2. ;:, l, Name of Decedent Kathryn C. Smith hrst Mid(jl~ Last Sex Female Social Security No. 196-16-9496 Dafe of Death 5-5-2004 Date of Birth June 9, 1912 Birthplace Landisburg, . PA R.R.#l Residence '. Cumberland Lower Frankford TWP!Pennsylvania Place of Death radilyNamc County City, Borough Or Townohip Race Whit-p Occupation HnmAmt=lkpr Armed Forces? (Yes or No) No Decedent's Mantal Status Winr'l'W'PO Mailing Address 1~qR Rnnl.=. Rn.=.n (".=.rli~lp PlI 17011 Number Street City or rown StJI~ Informant George S. Smith Sr. Funeral Director James F. Nickel Name and Address of Nickel Funeral Home, Loysville, PA 17047 Funeral Establishment I I Interval Between Part I: Immediate Cause I Onset and Death I I (a) Congestive Heart Failure , Weeks I , Hypertensive Cardiovascular Disease , Years (b) , , , (c) I I I (d) I Part II: Other Significant Conditions I I Manner of Death Describe how injury occurred: Natural ~X Homicide 0 Accident 0 Pending Investigation 0 Suicide 0 Could not be Determined 0 Name and Title of Certfier Willis Willard M.D. 450 Gibner Rd., Carlisle (M.D., D.O., Coroner, ME) Address Barracks, PA 17013 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. 50-455 DistrictN[) May 7, 2004 St. , New Bloomfield, PA 17068 nateRec"i'JCd by LOCill I-\cqiSlrJr "i'""," ALid",,,~ Citv, BorOlO(jh, TOWllsllip LAST WILL AND TESTAMENT OF KATHRYN CRULL SMITH I, KATHRYN CRULL SMITH, a domiciliary of Carlisle~ Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. I hereby revoke any and all wills and codicils by me heretofore made. I IDENTIFICATION AND DEFINITION "~.' * I have one son, GEORGE STEWART SMITH, JR. "Survive me" is to be construed to mean that the person referrt:!:!l to must survive me by thirty days. If the person referred to dies within ~ thirty days of my death~ the reference to him shall be construed as~if he had failed to survive me. t II PAYMENT OF DEBTS AND TAXES '" I direct my ~xecutor to pay the following before any division or distribution under the following articles: 1. All of the expenses of my last illness, funeral and of the administration of my estate~ 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes~ My executor shall not require any beneficiary under this will to reimburse my estate for taxes paid on property passing under the terms of this Will. III RESIDUARY ESTATE A. I define limy Residuary Estate" as all of my property after the payment of debts and taxes under Article II above, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this Will, and property as to which 1 have an option to purchase or a reversionary interest, but excluding property as to which I have no interest other than a power of appointment. (Page 1 of 2 Pages) ~ B. I give my Residuary Estate to my son, GEORGE STEWART SMITH, JR. C. If my son, GEORGE STEWART SMITH, JR., does not survive me, I give my Residuary Estate to my grandson, JEFFREY STEWART SMITH. IV APPOINTMENT OF EXECUTOR I appoint my son, GEORGE STEWART SMITH, JR., as Executor of this Will. I request that my executor not be required to furnish bond or securi ties. IN WITNE~S WHEREOF, I have at Carlisle Barracks, Pennsylvania, this L day of~' , 1978, set my hand and seal to this my LAST WILL AND TESTAMENT consisting of two (2) typewritten pages, this included, the preceding page hereof bearing my signature. 7(~~ G(~, (SEAL) KAT YN CRULL SMITH Signed, sealed, published and declared by the above-named Testatrix, as her LAST WILL AND TESTAMENT', in the presence of all of us at one time, and at the same time, we, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do hereby attest to the sound and disposing mind and memory of said testatrix at the date hereof, and to the performance of the aforesaid acts ojJexecution at Carlisle Barracks, Pennsylvania, '" this 'j'Ttt day of ~~Om" ~H,,I1978. NAME JJ- ADDRESS .~~ 2~": ~ '\"""'- AutIl (\\j\R.~,...~b~ uJ ~ ~.U . ~' . ~:>.~~ :;20f ow.U..1I.U-- ?1.R., (?Air-4JSr:' , ,7. 4'-A__uJ &~/L/ ;<Jn~__.H~btl~~// . .- ., (Page 2 of 2 Pages) ~......~! ;:; '$... , r-. 0. - (:,., ",. ~. \ f::'. ~ :. " V'. _ ~U~0) . '" y\ " '- "", , " '. c,' Z I';\:J Lv \ I , , i (f , , ! "- .:::. ,::> '5\J , , ,., ? '" ... ~ 1 '" \.A ..... ....1 Q '" " C." ;;--",.. ......./ .... \....: ~ /to (.,f ~ ,'Ii " '. --. ~ i (d ':i;,.V t:> ~ (1.1 t.) 0,-r- (..I ...... i "\J '" [ ; <> ::- ~ ~-. ~ ) ^- === ~c;- r ::- === ::- ~ i' '\\~RIi' I; f " ~ 0- - (\)8: C- ::- '" D "" F /'10 c;:?: :s: C) . \> (.) < -<.,.D) , F <01/\ ~ ::- :- I(UlfI === ::- ::- ))))))) ::- :- - ~ :::... )J '- \ \ " I i \ \ ~4 I I . . " , , . . \ \ i , \ I \ , \ \ 1 " \ \ \ . ~ " \' \ 1 '.. \ ~ \ , I ~ ~ , ~ " \ , COMMONWEALTH OF PENNSYLVANIA REV- 1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004600 SMITH GEORGE STEWART JR 141 WAGNER DR CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER nnun told ---------- n____n 04138993 I $139.02 ESTATE INFORMATION: SSN: 196-16-9496 I FILE NUMBER: 2104,0762 I DECEDENT NAME: SMITH KATHRYN C I DATE OF PAYMENT: 11/08/2004 I POSTMARK DATE: 11/05/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 05/05/2004 I I TOTAL AMOUNT PAID: $139,02 REMARKS: CHECK#3130 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS ,--.. "" (/ /< j/ .'], /3 f_ "'/. - COMMONWEALTH OF PENNSYLVANIA *' ;I-~ '.) -C'1 DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 04- 'lo2- BUREAU OF INDIVIDUAL TAXES AND DEPT. ze0601 TAXPAYER RESPONSE ACN 04138993 HARRISBURG~ PA 1712B-0601 DATE 10'14'2004 REV-1545 EX.FP <09-0DJ TYPE OF ACCOUNT ,-l6l<V ES.T. OF KATHRYN C SMITH o SAVINGS R~t :- $,S, NO. 196,16'9496 [Xl CHECKING DATE OF DEATH 05-05-2004 o TRUST '0'))4 !" 'J\; _<l COl>>f!lY CUMBERLAND o CERTIF. n ~ U :56 RE"IT PAY"ENT AND FDR"S TO: GEORGE S SMITH REGISTER OF WILLS 141 WAGNER DR I?, CUMBERLAND CO COURT HOUSE CARLISLE PA 17013 , '. CARLISLE, PA 17013 '\~l DRRSTOHN BANK has provided the Depart.ent with the inforMation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this inforMation is incorrect, please obtain written correction frOM the financiai institution. attach a COPy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions .ay be answered by ualling (717) 787-&3Z1. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 143000132 Date 08'01'2002 To insure proper credit to your account, two Established (2) copies of this notice dust aCCOMpanY your Account Balance 1,853,64 payment to the Register of Wills. Hake check payable to: "Register of Wills~ Agent". Percent Taxable X 50.000 AItount Subject to Tax 926.82 NOTE: If tax payments are Made within three (3) months of the decedent's date of death, Tax Rate X .15 you .ay deduct a 5X discount of the tax due. Potential Tax Due 139,02 Any inheritance tax due will beco.e delinquent nine (9) Months after the date of death. PART TAXPAYER RESPONSE [I]~r~._iiiiMJji."ijijl~~J,!llii~_lijij!~llili.iili.~1~~~iiiii~.iiji__mjIIIRiili.liil.~!ilii.~Uiiilii .. ~The above inforMation and tax dUB is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK ] a discount or avoid interest~ or you daY check box "A" and return this notice to the Register of [ ONE Wills and an official assess.ent will be issued by the PA Department of Revenue. BLOCK B. c=l The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. D The above information is incorrect and/or debts and deductions were paid by you. You .ust cOlllplete PART 0 and/or PART ~ below. PART If you indicate a different tax rate, please state your ~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 , 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Du. e PART DEBTS AND DEDUCTIONS CLAIMED [!J DATE PAID PAYEE DESCRIPTION AMOUNT PAID \ I I TOTAL (Enter on line 5 of Tax Comput.tion) $ Under penalties of perjury, I declare th.t the facts I have reported above ara true, correct and complat. to the best of my knowledge and belief. HOME ( 7/1 ) ,~ 'i3-&J.')..31c . <f~~~?Rk~RE WORK ( ) 1/ -5-0'-1 J- TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor-Bation sub.itted by the financial institution. Z. Inheritance tax becomes delinquent nine eonths after the dBcadant.s date of dssth. 3. A joint account Is taxable Bven though the decedant.s nama was added as a matter of convenience. 4. Accounts (including those held betwBen husband and wife) which the decadent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointlY betwBsn husband and wife Bore than one yaar prior to death ara not taxable. 6. Accounts held by I!l decadent "in trust for" anathsr or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 , TAXPAYER RESPONSE 1. BLOCK A - If the infor~tlon and computation in the notice are correct and deductions are not being claiMed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it thell with your check for the lI.ount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent"s representative, place an nxn in block nBn of Part 1 of the nTaxpayer Response" section. Sign one copy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, HarriSburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforllation is incorrect and/or deductions are being clailled, check block "Cn and complete Parts Z and 3 according to the instructions below. Sign two copies and submit thell with your check for the allount of tBx payable to the Register of Wills of the county indicated. The PA Departllent of Revenue will issue an official assessment (Farm REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN , PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint nalles within one (1) year of death are taxl!lble fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the nUllber of accounts held. If a double asterIsk (M.) appears before your first nSMe In the address portion of this notice, the $3,000 exclusion already has been deducted frail the account balance as reported by the financial institution. Z. Enter the total balance of the account inCluding interest accrued to the date of death. 3. The percent of the account that Is taxable for each survivor Is determined as follows: .. Tha parcent taxable for joint assets established lIore than ona year prior to the decedent"s death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 10. . PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exallple: A joint asset registered in the nalle of the decadent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) ; .167 X 10. . 16.7X (TAXABLE FOR EACH SURVIVOR) .. The parcent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 10. . PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of daath by the decedent. 1 DIVIDED BY 2 (SURVIVORS) ; .50 X 10. . soX (TAXABLE FOR EACH SURVIVOR) .. The allount SUbject to tax (line 4) is deterllined by multiplying the account balance Uine 2) by the percent taxable (line 3). 5. Enter the total of tha debts and deductions listed in Part 3. .. The amount taxable (line 6) is deterllinad by subtracting the debts and deductions (line 5) from the allount subject to tax (line 4). 7, Enter the appropriate tBx rate (line 7) as deterMined below. Oat. of. Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31194 37. 67. 157. 157. 01/01/95 to 06/30/00 07. 67. 157. 157. 07/01/00 to present 07. 4.5%- 127. 157. .The tax rate iMPOsed on the net va~ue of transfers froll a deceased chIld twenty-one 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 OX. The lineal class of heirs includes grandparents, parants, Children, and lineal descendents. nChlldrenn includes natural children whether or not they have been adopted by others~ adopted children and step children. "lineal descendants" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. nSiblingsn are defined as individuals who have at least one parent in cOllmon with the decedent~ whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS , PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as fallows: .. You legally are responsible for paYMent~ or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible iteMS. 8. You actually paid the debts after death of the decedent and can furnish proof of paYMent. C. Debts being claiMed MUSt be itBMized fully in Part 3. If additionel space is needed, use plain paper 8 1/2" xlI". Proof of paYMent .ay be requested by the PA DepartMent of Revenue. - CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: ---1<-,,- +tt r~ e, S' M ~ +h Date ofDeath: I{ 1~/o Lf , Will No.: Admin No.: 2{ol..f- 01"'2- To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a?l11hrorPhans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on I tl () Y : Name Address I ./J I ""-- tIS.A:; ~ ~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except f./~ Il e.. Date:~/o'f Signature l)) ~ 'f V\-v j-- (lL\ Name 2.-"l lu . j...(,~ ~ '1r .' Co.-r-{I~Je,~ l'OI~ Address 2.lf~ 1110 Telephone _\ I;.) Capacity:" 0 Personal Representative L::;.~: /, CJ P. Counsel for personal representative ot 1 t'O. (r- - NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE R~Imq.~F,'~MS, COUNTY OF CUMBERLAND, EN VANIA INR.E:.. ESTATE OF KATHRYN C. SMITH, DECEASED .H. NO. 21-04,0762 TO: Jeffrey Stewart Smith and George Stewart Smith, Jr, 141 Wagner Dr. Carlisle, P A 17013 Please take notice of the death of decedent and the grant of letters to the personal representative named below, You may have a beneficial interest in the estate under the last will and testament of Kathryn C. Smith. Name of decedent: Kathryn C. Smith Last known address of decedent: 3298 Enola Road, Carlisle, P A 17013 Date of Death: May 5, 2004 Place of Death: Carlisle, Pa. County of Grant of Original Letters: Cumberland Decedent died testate. Name, address and phone number of all personal representatives: George Stewart Smith, Jr. 141 Wagner Dr. Carlisle, P A 17013 Name, address and phone number of counsel: William P. Douglas, Esquire 27 W. High St. Carlisle, Pa. 17013 Phone: 717,243,1790 Additional information may be obtained from the undersigned: Doug s La Offic By William P. Douglas, Esq 27 W, High St. Carlisle, Pa. 17013 717,243-1790 Dated: December 8, 2004 , "'~~~""-''''''"'''"-'''---'''---'___'>_d'_ I~~-- ',-' .~,~". .~ , .. ~ ~ , . , , i I I I I I I , LAST WILL AND TESTAMENT OF KATHRYN CRULL SMITH I, KATHRYN CRULL SMITH, a domiciliary of carlisle I Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. I hereby \\. revoke any and all wills and codicils by me heretofore made. I IDENTIFICATION AND DEFINITION c3 "'. .-', * I have one son, GEORGE STEWART SMITH, JR. c ~~ "Survive me" is to be construed to mea!! that tbe person referr~3l >it to must survive me by thirty days. If the person referred to dies ~~thin r thirty days of my death, the reference to hi~shal1 be construed as~f he had failed to survive me, ~ II PAYMENT OF DEBTS AND TAXES .. .. I direct my ~xecutor to pay the following before any division or distribution under the following articles; 1. All of the expenses of my last illness, funeral and of the administration of my estate, 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of ~ death, on any property or interest in my estate for the purpose of computing taxes. My executor shall not require any beneficiary under this will to reimburse my estate for taxes paid On property passing under the terms of this Will. III RESIDUARY ESTATE A. I define "my Residuary ~ tate,~~ as all of my property after the payment of debts and taxes und~r Article II above, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this W~ll, and property as to which I have an option to purchase or a reversiQnary interest, but excluding property as to which I have no interest other than a power of appointment. (Page 1 of 2 Pages) 9JJ - . - - B. I give my Residuary Estate to my son, GEORGE STEWART SMITH, JR. C. If my son, GEORGE STEWART SMITH, JR., does not survive me, I give my Residuary Estate to my grandson, JEFFREY STEWART SMITH. IV APPOINTMENT OF EXECUTOR I appoint my son, GEORGE STEWART SMITH, JR., as Executor of this Will. I request that my executor not be required to furnish bond or securities. IN WITNE~S WHEREOF, I have at Carlisle Barracks, Pennsylvania, " this L day of~. , 1978, set my hand and seal to this my LAST WILL AND TESTAMENT consisting of CWo (2) typewritten pages, this included, the preceding page hereof bearing my signature. _/[~~ CL".f~' (SEAL) KAT .. CRULL SMITH Signed, sealed, publiShed and declared by the above-named Testatrix, as her LAST WILL AND TESTAMENTi,- in the pres..ce of all of us at one time, and at the same time:> we, at her request and in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do hereby attest to the sound and disposing mind and memory of said testatrix at the da~e hereof, and to the performance of the aforesaid acts ~execut1on at Carlisle Barracks, Pennsylvania, this '17 ff day of rO",,~ ~ u,I 1~78, ... ,. NAME JJ.-- ADDRESS 2.g~ ~ ."i'...... _ p.,.,. (\\t\R."'''''t.I.:.~ .~.k.= . ~ t.u. . ';;0/ uJOZFijAf.u-~nL (?A.e;~WO' . . "'- C<."-' ~../ .;Ztrr~b~~ : ~/ ./ (Page 2 of 2 Pages) -. B. I give my Residuary Estate to my son, GEORGE STEWART SMITH, JR. C. If my BOD, GEORGE STEWART SMITH1 JR., does not survive me, I give my Residuary Estate to my grandson, JEFFREY STEWART SMITH. IV APPOINTMENT OF EXECUTOR I appoint my son, GEORGE STEWART SMITH, JR. J as Executor of this Will. I request that my executor not be required to furnish bond or secur! ties. IN WITNE~S WHEREOF, I have at Carlisle Barracks, Pennsylvania, ." this L day of~, . 1978, set my hand and seal to this my LAST WILL AND TESTAMENT consisting of two (2) typewritten pages, this included, the preceding page hereof bearing my signature. I't"cod Q..,J ~ ' (SEAL) KAT~iN CRULL SMITH e Signed, sealed, published and declared by the above-named Testatrix, as her LAST WILL AND TESTAMENT',' in the pre's:fl'ce of all of us at one time, and at the same time, we, at her request an' . dn her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do hereby attest to the sound and disposing mind and memory of said testatrix at the da~e hereof, and to the performance of the aforesaid acts ~execution at Carlisle Barracks, Pennsylvania, ~ this '1Ttt day of rO~~ ~ ,"",I 1978. - NAME JJ-. ADDRESS ~JJk., 2g~ ~ ,T......_ A... (\\t\R.-\'''~I.:.~ oj rv-.i r? lu" ;;0 / oM ~".I.(,.. "YLl Ai: ;..P-<.JsnO' , , a.... _J</~ .zln~...<.-/ b ~.;.....~ ~ . ./ .../ (Page 2 of 2 Pages) .,. Cumberland County , Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240'6345 Date: 12/06/2004 DOUGLAS WILLIAM P 27 W HIGH STREET CARLISLE, PA 17013 RE: Estate of SMITH KATHRYN C File Number: 2004'00762 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO, 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 12/13/2004 Your prompt attention to this matter will be appreciated, Thank You. Sincerely, ~~~ Clerk of the Orphans' Court cc: File Personal Representative(s) Judge Cumberland County , Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240,6345 Date: 12/06/2004 SMITH GEORGE STEWART JR 141 WAGNER DR CARLISLE, PA 17013 RE: Estate of SMITH KATHRYN C File Number: 2004,00762 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 12/13/2004 Your prompt attention to this matter will be appreciated. Thank You. JJ;:e~~ GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court cc: File Counsel Judge COMMONWEALTH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF I~r~"'l:"li~~'('E OF NOTICE OF INHERITANCE TAX INHERITANCE TA I bit.U LfTiv APPRAISEKENT~ ALLOMANCE OR DISALLOMANCE PO BOX 280601 lTf~~{:' .- 1}'j1 IS OF DEDUCTION J AND ASSESSKENT OF TAX ON HARRISBURG, PA 1 . _" ~ 1,': " ,.,L' JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (09.04) 200~ DEe 29 AM 9: II DATE 12-27-2004 ESTATE OF SMITH KATHRYN C DATE OF DEATH 05-05-2004 CLERK OF FILE NUMBER 21 04-0762 COUNTY CUMBERLAND ORPHAN'S COURT SSN/DC 196-16-9496 GEO~M8~RS::~~L3{1;l" P,\ ACN 04138993 141 WAGNER DR I Amount Remitted I CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....... ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 12-27-2004 ESTATE OF SMITH KATHRYN C DATE OF DEATH 05-05-2004 COUNTY CUMBERLAND FILE NO. 21 04-0762 S.S/D.C. NO. 196-16-9496 ACN 04138993 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. 143000132 TYPE OF ACCOUNT: ( ) SAVINGS (>0 CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 08-01-2002 Account Balance 1,853.64 NOTE: TO INSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 926.82 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 926.82 REGISTER OF WILLS AT THE Tax Rate X .15 ABOVE ADDRESS. MAKE CHECK Tax Due 139.02 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-05-2004 CD004600 .00 139.02 TOTAL TAX CREDIT 139.02 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. ~s"- SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004795 SMITH GEORGE STEWART JR 141 WAGNER DR CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER nnun fold ---------- -------- 101 I $4,640.98 ESTATE INFORMATION: SSN: 196,16-9496 I FILE NUMBER: 2104-0762 I DECEDENT NAME: SMITH KATHRYN C I DATE OF PAYMENT: 01/04/2005 I POSTMARK DATE: 01/04/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 05/05/2004 I I TOTAL AMOUNT PAID: $4,640.98 REMARKS: CHECK# 3163 INITIALS: CCP SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS . . REV-1500 EX (6-00) REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT -2- -1- - ---0- --4-- ----0-1-..6-..2..- COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Kathryn C. Smith 196 - 16 - 0762 Z W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W REGISTER OF WILLS 0 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C - - w [Xl 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) .., ~~(/) D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required ull::~ wl1.U J:oo D 6. Decedent Died Testate (Attach copy of Will) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes ull::-' l1.1lI - l1. D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) <( I- Z w NAME COMPLETE MAILING ADDRESS c z 0 l1. FIRM NAME (If Applicable) (/) 27 W. High St. w II:: II:: TEL B Carlisle, PA 17013 0 u 717-243-1790 1. Real Estate (Schedule A) (1) $111.000 2. Stocks and Bonds (Schedule B) (2) ,...., 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 = :::0 = S;o c.n ::op:j 4. Mortgages & Notes Receivable (Schedule D) (4) C- rTl ffi;;g :::l:"" C.12 ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 8,987.90 ';',,-0 Z (~CJ (Schedule E) ~2 :F; ~ I sj C'3 z -"-: :J..") CJl 0 3,240.00 (1) :r:. (::)CJ !;( 6. Jointly Owned Property (Schedule F) (6) 0 -0 it - Cl D Separate Billing Requested --n ~ -1'1 C--=) ..J no ::) 7. inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) t: (Schedule G or L) 00 0- c:( 8. Total Gross Assets (total Lines 1-7) (8) 171,777 90 0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 17,007.41 W ~ (10) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) 11. Total Deductions (total Lines 9 & 10) (11) 17.007.41 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 106.220.49 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 ~ rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) 106,220.49 x .0 h5 (16) $4,780.00 ~ 16. Amount of Line 14 taxable at lineal rate ::) 0- 17. Amount of Line 14 taxable at sibling rate x .12 (17) ::E 0 18. Amount of Line 14 taxable at collateral rate x .15 (18) 0 )( 19. Tax Due (19) $4,780.00 ~ Decedent's Complete Address: STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) $4,780.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments $139.02 C. Discount 139.02 Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $4,640.98 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) $4,640.98 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;.......................................................................................... 0 EJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 EJ c. retain a reversionary interest; or.......................................................................................................................... 0 KJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 KJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 EJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 EJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 complele. Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN George S. Smith, Jr. DATE 12/15/04 ADDRESS 141 Wagner Dr., Carlisle, PA 17013 DATE For dates on or after July 1,1994 and before January 1,1995, the tax use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) Ii)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) Iii)]. 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 beneficiary. 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 at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116{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%, except as noted in 72 P.S. 99116{1.2) [72 P.S. 99116{a){1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116{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. -, REV-1502EX + (1-97) '* SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathryn C. Smith 21-04-0762 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of sUNivorshiD must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real Estate, 3298 Enola Road, Carlisle, PA., selling price III ,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 111 nnn nn (If more space is needed, insert additional sheets of the same size) REV.\SOB EX' (1.97) '*' SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT I , ESTATE OF FILE NUMBER Kathryn C. Smith 21-04-0762 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUNivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. .Refund - Funeral Home 5,950.80 Personal Property 500.00 Checking Account, Orrstown 1,853.64 Real Estate Tax Proration received at sale of home 683.46 TOTAL (Also enter on line 5, Recapitulation) $ 8,987.90 (If more space is needed, insert additional sheets of the same size) REV,1511 EX+ (12-99). SCHEDULE H COMMONWEAlTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathryn C. Smith 21-04-0762 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Prepaid ADMINISTRATIVE COSTS: None B. 1. Personal Representative's Commissions Name of Personal Representalive(s) Social Security Number(s)/EIN NlIllber of Personal Representative(s) Street Address City State _ Zip .~~ Year(s) Commission Paid: 2. Attorney Fees $3,500.00 3. Family Exemption: (If decedent's address is notlhe same as claimant's, attach explanation) None Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees 263.00 5. Accountant's Fees , 6. Tax Return Preparer's Fees 7. Cumberland Law Journal 75.00 8. Evening Sentinel 136.00 9. Register of Wills, filing fees 45.00 10. Ann Sensenich, notary, sale of real estate 10.00 .ll. Recorder of Dees, 1% transfer tax on reab'estate $1,110.00 12. 9/16/03, replace wall pump to tank, kitchen faucet and drain pipes, 3298 Enola Road to prepare for sale of house 1,794.44 13. Replace vanity and pipes, to prepare for sale of house 531. 85 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) SCHEDULE H - PAGE 2 ESTATE OF KATHRYN C. SMITH File,No. 21-04-0762 14. Replace Tub and faucet in preparation for sale of house 357.92 15. Furnace cleaned in preparation for sale of house 105.00 16. Walls cleaned, in preparation for sale of house 250.00 17. Paint interior of house in preparation for sale of house 3,256.00 18. Carpet floor and vinyl kitchen and bath 3,292.75 19. Property appraisal 200.00 20. Replace toilet 243.90 21. Replace garage door and 3 storm doors 1,779.55 22. Replace Furnace nozzle 57.00 Total Schedule H expenses $17,007.41 REV.1509 EX _(1.97) '* SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT , ESTATE OF Kathryn C. Smith 21-04-0762 FilE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Katrina L. Smith c/o Jeffrey and Pamela Smith, her parents a minor aged 3 2704 Ruffin Drive, Fredericksburg, VA 22408 gr.gr.dau. B. George S. Smith, Jr. 141 Wagner Dr., Carlisle, PA son C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY 'Io0F DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1/16/0 Members First CD #213145-00 2,189.02 .50 1,095.00 2. A. 12/4/0 Orrstown CD #4000000680 2,610.41 .50 1,305.00 3. B. 8/1/0 Orrstown CD #143000132 1,679.00 .50 840.00 TOTAl (Also enter on line 6, Recapitulation) $ 3,240.00 (If more space is needed, insert additional sheets of the same size) - . . """0-"" '*' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT , ESTATE OF FILE NUMBER v ...1.- r <:'_....1.. ')1 _rof, ro7c',) RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) George S. Smith, Jr. , 141 Wagner Dr.,Car1is e Son 100% 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON,TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA 'l ss. COUNTY OF CUMBERLAND J. William P. Douglas sworn. is the attorney being duly according to law, deposes and says that he for ~ the Estate of K:athryn C ~mith late of Lowe:r:.._Fr<!!}k:fq!:.cl1'.9';~~Ig;hj2____ , Cumberland County, Pa., deceased and that the him attorney within is an inventory made by ,_ __ _, the said of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn to and subscribed before mel ,Executor . Aclmi";s December 15 ~2004 Willlam P. DougL @v........t { J --t ~ 27 II. High, St. . tary Notar~al Se~l Address Anne M. Cox, Notary Public ('-:-<!;;I,; borough, Cumberland COllflty 1 ",:ni.ssion Expires ,July 1 '1,'; '- Ma 2004 Dote of Death'-~-'--'L__L_-$ c - y Day Month Yen INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheeh mliY be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. 0- ~ E-< >- "0 -a I- W l-l:l: Ul >- ~ I- 0 IV co W -< 4-l Ql r-I ~ a. I- ~ U G O In s:: Ql ;::l ow W co 0 '" 0 >- ::r~ l-l IV AGl I- I- a. ..J u.. ..c: ~ IV a. E: Z u....J-<0 -I-J a. ',f W 0 -< W 'r-l, l-l - fJ,; + I > Z ~~ CJ) ~ f s -< I Z 00 0 ~ co o! - ~z c.,; H 0 ~ Z I W -< U - r-I a. s:: "U 'r-l C ~ l-l IV I ..c:1 ... -.: -I-J' 0 Ql I ..Q coi Ql E -a ~ ~ .... <II 0 I I IV U::l ._ 0 , ..J u.. llCl . Inventory of the real and personal estate of KATHRYN C. SMITH deceased l. Real estate, 3298 Enola Road, Carlisle, PA, selling price III ,000 00 2. CD @ Orrstown, Joint with Katrina L. Smith, a minor full amount $2,610.41, 1/2 value 1,305 00 3. CD @ Members First, Joint with Katrina L. Smith, a minor full amount $2,189, 1/2 value 1,095 00 4. CD @ Orrstown, Joint with George Smith, Jr. full amount $1679, 1/2 value 840 00 I 5. Refund ~ Funeral Home I 5,950 80 I ! 6. Personal property 500 00 7. Checking Account, Orrstown 1,853 . 64 8. Real Estate Tax Proration received at sale of home I 683 46 Total 123,227. 90 I I _..~.",-<....""......._,..,,,,-,,..~.__.... -,.,._- ~,-",,",-"--~'-' -- ;,.--"'""'.. DOUGLAS LAW OFFICE 27 W, HIGH ST. POB 261 CARLISLE PA 17013 TELEPHONE 717,243,1790 WILLIAM P. DOUGLAS, ESQ. Supreme Court I.D.# 37926 IN RE: ESTATE OF : IN THE ORPHANS COURT OF KATHRYN C. SMITH : CUMBERLAND COUNTY, PENNA. : NO, 21,04,0762 PETITION FOR APPROVAL OF DISTRIBUTION TO A MINOR 1. Your petitioners are Jeffrey and Pamela Smith, through their attorney, William p, Douglas, and are the natural parents of KATRINA 1. SMITH, a minor, age 3, who was born on March 7, 2001. Katrina resides with her parents at 2704 Ruffin Drive, Fredricksburg, Virginia 22408. 2. Kathryn C. Smith, the grandmother of Katrina, died testate on May 5, 2004, and Letters Testamentary were issued to her son, George Stewart Smith, Jr. on September 3, 2004, 3. At the time of the grandmother's death, she had a joint CD with her granddaughter, Katrina 1. Smith, at the Orrstown Bank, North Middleton Township Branch, Carlisle, P A, with a value at death of $2,610,41. 4. At the time of the grandmother's death, she had a joint CD with her granddaughter, Katrina 1. Smith, at Members First Federal Credit Union, Carlisle, P A, with a value at death of $2,189.02. 5. Inheritance taxes have been paid by the Estate of Kathrn C. Smith on the one,half value of the aforesaid CDs. 6, Your petitioner requests that the Court direct that the aforesaid sums be placed in a federally,insured savings account or certificate of deposit, to be marked, "Not to be withdrawn until age 18, or on further Order of this Court." 7, Your petitioner further requests that the Court direct that the federally' insured bank or savings institution be permitted to J.ay federal and state income tax on the money earned on behalf of the minor in e said account. WHEREFORE, it is prayed that the aforesaid proposed distribution be approved. DOUGLAS LAW 0 By\ ' William p, Douglas Attorney for Petitioners JA Affidavit This verification is made pursuant to Pa.R.CP 1024(c) by counsel for the plaintiff. To the best of the signer's knowledge, information and belief, the foregoing is true and correct, Dated: January 17, 2005 William P. Douglas Attorney for Petitioners .,. i ~ o OWN BANK - 2250 ~prtug ,!=oacl, carll.s~e. :U. 17013 'tel. pJ.7,) 43-5844 O( Fax (717) 243-1637 O( TO: nfle.. 'Ol FROM: 'lV'f 01 DAlE: 3 oy 8\ S\tnl+h I at SUBlliCT: c..- a v""+s l. 6. , S This ttBIlSlDittal of pages, including this covet' page. 3 4, COMMENTS: , 9' OP~- +/W a-1J~ - - ~ ~ iJ~~ - \Mv ~ . - . Please contact if there is a problem w:lth this tt . sian at (717) 243-5844 CONFIDENTIALITY NOTICE: This fi1csimil~ may contain confi , infurmation, wbichmay be legally priYlleged, and is intended only fur the use ofth~ ' 'vidual or addressee(s) 1;l~"3ed alxIve. If you m: not the JDt~rl~-d. recipient, you are by notified that any disclosure, copying, distribution. taking or aor action in reliance n the contents oftbis ttaJJsmissiOXl is III:rictlyprohibi:ted. Ifyouha.....uecei.ved this sionin error, please notify us h:omNliat.ely by telephone so that we can arrange fur the ofllie documents at no cost to you. Thank You. , PO Box 250' $hlppensburg, PA 17257 . (717) 532-6114' (717) 532-4143 Fax' .orrstown.com In 'J /JqI0711. ~n1~~nnlm IT ITI.nTnwun .,. - ... - .- - - -------.. CD ~ Cdculation 12:47:12 SMITH Issue/Last Ren wal...... 12/04/02 RINA L SMITH Next Payment D te....... 9/04/04 98 ENOL1-\. ROAD Maturity Date. ... ...... 12/04/05 CARLISLE PA 17013 Per Diem...... . .. .. .18 Current balanc . . . 2,605.14 Account Nuxnber.. . 4000000680 Interest Due F om.. .'.... 8/04/04 Orig/Renewal Amount. 5,000.00 Interest Rate. ....... . 2.4700% --------------------------------------------------------- ------------------- 03 FORFEIT SIX MONTHS INTEREST Date of penalty................ 90304 Partial withdrawal amount..... 260~14 Pa~ accrued interest (Y,N or P) .......... Y Prlncipal Due Depositor .O~ Accrued Int. Due Depositor 5.27 Pay penalty amount of....... .00 N C~t Settlement ------------~ 2,610.41 F12=Previous ~~~ I ~ y-lo'2.- I pM MEMBERS1ST Feu INS. DEPT 7177955178 P.01 . p.,r MEMBERS 1" fEDt!llALCREOIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 21314S -00 Date Account Established 01/16/2002 Principal Balance at Date of Death $25,00 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $25.00 Name of Joint Owner None CERnFICATE OF DEPOSIT: Account Number/Suffix 21314S -40 Date Account Established 01/16/2002 Principal Balance at Date of Death $2,188,08 Accrued Interest to Date of Death $,94 Total Principal and Accrued Interest $2,189.02 Name of joint Owner Katrina L. Smith Date Joint OWnership Established 01/16/2002 gRS ," FEDERAL CREDrr UNION ~~~ enise A. 01 e Insurance Supervl r September 7, 2004 Estate of: KATHRYN C, SMITH Date of Death: 05l0S12004 Social Securtty Number: 186.16-9496 ---..-.--.._._-,-~-_._._----- -.....-- 5000 Louise Drive . P.O.13ox 40 . Mechanic,burg,l'enmylvllllia 17055 . (717) 697-1161 . www.mcmbe...l,t.otj! DOUGLAS LAW OFFICE 27 W. HIGH ST. POB 261 CARLISLE PA 17013 TELEPHONE 717,243,1790 WILLIAM P. DOUGLAS, ESQ. Supreme Court I.D.# 37926 IN RE: ESTATE OF : IN THE ORPHANS COURT OF KATHRYN C. SMITH : CUMBERLAND COUNTY, PENNA. : NO. 21,04,0762 ORDER ---L.L- ~N=1 AND NOW, this day of faRuary, 005, the distribution as set forth in the attached Petition is approved, and the Court directs that the aforesaid distribution of $2,610.41 and $2,189.02 be placed in a federally,insured savings account or certificate of deposit, to be marked, "Not to be withdrawn until age 18, or on further Order of this Court." It is further directed that the federally insured bank or savings institution shall be permitted to pay federal and state income tax on the money earned on behalf of the minor in the said account. By the Court, J. \.0 :j) r'.' ~ 12.6 2.,1005: Il~1 W)TO be llll LAs LkllJ CPA t f:. , - , '. '- ( AN I) K0.T~I\Jf\-. L ~In i It--/- N (:; I LJ' I:::N V :-ffiGv i l) l-"D B \j lx)d b Lib L fhrJ D Ff1 t b ' C::) c: \. INRE: ESTATEOF KATHRYN C. SMITH : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY,PENNA. : ORPHANS' COURT DIVISION : NO. 21-04-0762 PETITION FOR THE SETTLEMENT OF A SMALL ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: George Stewart Smith, Jr., Executor of the Estate of Kathryn C. Smith, through his attorney, William P. Douglas, respectfully represents: I. Kathryn C. Smith, who resided at 3298 Enola Road, Carlisle, PA ,died testate on May 5,2004. 2. Letters Testamentary were granted to Petitioner on September 3,2004, and the estate was advertised in the Evening Sentinel and Cumberland Law Journal on December 8, 22,2004, and January 3, 2005, and December 17,24,31,2004, respectively. l. 2. 3. 4. 5. 6. 7. 8. 3. The only assets in the estate were as follows: Real Estate, 3298 Enola Rd., Carlisle, PA sale price CD@ Orrstown Joint with Katrina L. Smith, a minor, 1/2 value CD& Members First, Joint with Katrina L. Smith, a minor, 1/2 value CD@ Orrstown, Joint with George Smith, Jr., 1/2 value Refund Funeral Home Personal property Checking Account Orrstown Real Estate Tax Proration received at sale of home TOTAL ASSETS $111,000.00 1,305.00 1,095.00 840.00 5,950.80 500.00 1,853.64 683.46 $123,227.90 4. Expenditures in the amount of $17,007.41 have been made on behalf of the sald Kathryn C. Smith as is set forth in the attached return 5. Inheritance Taxes in the amount of $4,780.00 have been paid and approved as is evidenced by the attached Notice from the Department of Revenue. The total expenditures are therefore $21,787.41 6. The said Kathryn C. Smith was survived by her son, George Stewart Smith, Jr. ,to whom she left her residuary estate as is set forth in Paragraph III B. of her attached Will. 7. In addition, the proceeds from the three CDs in the name of Kathryn C. Smith and her granddaugher, Katrina L. Smith, a minor, born March 7, 2001, have been placed in a federally insured bank with her parents, Jeffrey and Pamela Smith as guardians, with the stipulation that said sums are not to be withdrawn until age 18, or on further Order of this Court. A copy of the Petition for Approval of Distribution to a Minor is attached hereto. Total Assets: Total Credits Balance RECAPITULATION 123,227.90 21.787.41 101,440A9 To Katrina L. Smith, a minor by her Guardian parents 1/2 value 1,305.00 1,095.00 $99.040.49 101,440.49 full value $2,610.41 $2.189.02 $4,799.41 To George Stewart Smith, Jr., residue Total distributed WHEREFORE, your Petitioner prays that Your Honorable Court approve the distribution of this estate as set forth herein, and that the said Executor, George Stewart Smith, Jr., be discharged from the duties of his appointment. By Attorney for Petitioner Dated: March 23, 200S COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND George Stewart Smith, Jr., being duly sworn according to law, deposes and says that the averments of the within Petition are true and correct to the best of affiant's knowledge, information and belief. .IJ___~_.:U:;I< J:- George tewart Smith, Jr. Sworn to and subscribed before me 2~ Netary <'~'--! c.,--,'"'""-"'- I '-----~.--=-...............~ Notarial Seal Anne M. Cox, Notary Public Carlisle Borough. c~mberland COU~IY MI Commission Expires July 14, 2005 BUREAU'OF IND~VIOUAL TAXES INHERITANCE TAX DIYISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX MAR 2 3 200+ APPRAISEHENT, ALLOWANCE OR DISALLOWANCE DF DEOUCTIONS AND ASSESSHENT OF TAX WILLIAM P DOUGLAS DOUGLAS LAW OFFICE 27 W HIGH ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-21-2005 SMITH 05-05-2004 21 04-0762 CUMBERLAND 101 AIIount Re"i Hod *' U'-1547EX AFP <12-811) KATHRYN C MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... ~W :r~?,"f'Eic"AFP-'rD1":6~rlloYi:'CE'OF'1'N'HEit"I'fA'f(CrtAX'A'Jl'IlRA'i'SEHlPli;..ALL'b"QANcf.liR'.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMITH KATHRYN C FILE NO. 21 04-0762 ACN 101 DATE 03-21-2005 TAX RETURN WAS: I X I ACCEPTED AS FILED I I CHANGED I~ an assesSBent was issued previOUSly, lines 14, 15 and'or 16, 17, 18 and 19 will r~lect ~igures that. include the total ~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. A.ount of Line l~ .t Spousal rat. (15) 16. ~t of Line 14 taxable at Lineal/Class A rat. (16) 17. AIIount of Line 14 et Sibling rate 1171 18. Aaount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Est.t. (Schedule A) 2. Stocks Wtd Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposlts/Hlsc. Personal Property (Schedule E) 6. Jointly Owned Property ISchedule FI 7. Transfers (Schedule G) a. Total Assets III 121 131 141 151 161 171 111.000.00 .00 .00 .00 8.987.90 3.240.00 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. Costs/Hisc. Expenses (Schedule H) 10. Debts'Kortgage Liabilities/Liens ISchedule II 11. Totel Deductions 12. Net Value of Tax R.turn 13. Charitable/Govenn.ent.l Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax 191 1101 17,007.41 .00 1111 1121 1131 1141 (Schedule J) NOTE: .00 X 106,220.49 X .00 X .00 X 00 = 045 = 12 = 15 = 1191= NOTE: To insure proper credi t to your account I sublrit the I..IPP8Jr portion of thIs form with your tax payaent. 123,227.90 17 .007 41 106,220.49 .00 106,220.49 .00 4,780.00 .00 .00 4,780.00 TAY CREDITS: (+J AIlOUIIT PAID DATE _BER INTEREST/PEN PAID I-I 11-05-2004 CD004600 .00 139.02 01-04-2005 CD004795 .00 4,640.98 TOTAL TAX CREDIT 4,780.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL OUE IS REFLECTED AS A "CREDIT"' ICRI, YOU HAY BE OUE A REFUND. SEE REVERSE SIDE DF THIS FORH FOR INSTRUCTIONS.I -" ~"~, \ L.) ~/O<f Inventory of the real and personal estate of KATHRYN C. SMITH deceased 1. Real estate, 3298 Enola Road, Carlisle, PA, selling price III ,000 00 2. CD @ Orrstown, Joint with Katrina L. Smith, a minor full amount $2,610.41, 1/2 value 1,305 00 3. CD @ Members First, Joint with Katrina L. Smith, a minor full amount $2,189, 1/2 value 1,095 :00 4. CD @ Orrstown, Joint with George Smith, Jr. full amount $1679, .1/2 value 840 00 5. Refund ,. Funeral Home 5,950 80 6. Personal property 500 00 7. Checking Account, Orrstown 1,853. 64 8. Real Estate Tax Proration received at sale of home 683 46 Total 123,22 . 90 COMMONWEA"TH OF PENNSYLVANIA COUNTY OF CUMBERLAND } $5: William P. Doul(las .' sworn d d being duly according to law, eposes an ..ys that he for :M. the Estate of Kathryn C. Smith late of Lower _~tord l'.Qw:J.E.h.~_._ . Cumberland County. Pa., deceased and that the him . attorney within is an inventory made by , the saId of the entire estate of ..id decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite eaCh item of the Inventory represent it's fair value as of the date of decedent's death. is the attorney Sworn to and subscribed before me, ho..a, - .Ac/mic(istrofo, . William P. DougLas, Attorney 27 W. High St. C4Lllblc, fA 17613 December 15 ~2004 . Notary AUress D.te of Death . 5 May Month 2004 Ooy V..r INSTRUCTIONS I. An inventory must be filed within three months an or appointment of personal representative. 2. A supplement inventory must be filed within thirty d~ys of discovery of additional a..ets. 3. Additiona' sheets may b. attached as to parsonalty or realty 4. See Articla IV, Fiduciaries Act of 1949. . t >- 'd .,; H .. ., ... w .. ~ cr: ... 0 .. ~ w -< .... .. ... ... ~ u .. ::J 0 V> .. ... ~ e w cr: W <II C .. 0 :I: ... H ... '" c ... ...I U. ..c: "" .; ~ Z ;:l 0 .... D.. . 0 U. ...I ~ H p.,~ W 0 -< "" 0> .i- > z ~ ~ Z 0 c 0 ~ " oM V> Z 0 .; "" U ...... Z w -< - ...... 0.. " oM c ;;t .. 1:1 ... "i: 0 ...., .. <II, ..D " ->< :.0:' .. E - ~ 0 I .. " 0 , ...l () REV-1500EX(6-001 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER -2- .l- - -0- -4- ....u L -6- .L _ COWTY CODf YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITiAl) Kathryn C. Smith DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OD-YEAR) SOCIAL SECURITf NUMBER 196 - 16 - 0762 I- Z W C W o W C THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF AFPLI LEI SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) w ... :!Il::!!;l>> 0"''' w"o rOo of~ .. " [i) 1. Original Return o 4. limite<! Estate o 6. Decedent Died Testate (AlIactIcopyofWIIIl o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death atler 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy afTNSl) o 10. Spousal poverty Credit (date ddeaCh between 12-31.Q1 and 1-1-95) o 3. Remainder Return (dale of death prior to 12.13-82) o 5. Fe<ieral Eslate Tax Retum Require<! 8. Tolal Number of S;lle Deposit Boxes o 11. ElecJiontotaxunderSec. 9113(Ali"""'Sd>0) 1. ReaIEstate(~leA) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Pa~ Of SoIe-ProprietOfsl\iJ> 4. MOf19ages & Notes Receivable (Schedule D) 5. Cash, Bonk Deposits & Miscel~neous Personal Property (Schedule E) 6. Joindy Owned Property (Schedule F) o S;lperate Billing Requested 7. Inter-VIVOS Transfers & Miscellaneous Noo-Probate Property (Schedule G Of l) 8. Tolal Gross Assets (lotallines 1-7) 9. Funeral Expenses & Administra6ve Costs (Schedule H) 10. Debts of DecedenL Mortgage liabilities, & liens (Schedule I) 11. ToIal De<!u<tions (tolallines 9 & 10) 12. Net Value of Estate (Une 8 minus Line 11) 13. Charita~e and Govemmenlal BequeslslSec 9113 Trusts for which an ..ection to lax has not been made (Schedule J) ... z w " z o .. ., w '" '" o o z o ~ :l l- ii: <( o w 0:: NAME FIRM NAME ('_I TEL 717-243-1790 14. Net Value Subject to Tax (line 12 minus l~e13) COMPLETE MAIUNG ADDRESS 27 W. High St. Carlisle, PA 17013 (1) (2) (3) (4) (5) OFFICIAL USE ONLY Ull,OOO 8,987.90 (6) 3,240.00 (7) (8) 17',777 90 (9) (10) 17,007.41 (11) (12) (13) 17.007.41 (14) 106.220.49 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxa~ at /he SjlOUSlIllax rale, Of transfe" under Sec. 9118 (aXl.2) z o ~ I-' :l ll.. :::E o o ~ 16. Amount of Une 14 taxable at lineal rate 11. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 106.220.49 x .0_ (15) x.oU (16) x .12 (17) $4.780.00 x .15 (18) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (19) $1'.7ll" 00 200 Decedent's Complete Address: I-~ CITY 3298 EnQl~ RQad. Car1~61e, STATE PA 17QB I liP Tax Payments and Credifs: 1. Tax Due (Page 1 Une 19) 2. CreditslPayments A. Spousal Poverty Credn B. Prior Payments C. Discount (1) $4,780.00 $139.02 Total Credits (A+ B + C) (2) 139.02 3. InterestlPenalty ff applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E ) (3) 4. ff Line 2 is grealerthan Line 1 + Line 3, enter the "IIIerence. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) 5. ff Line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (SA) H,61,9.98 B. Enter the loIal of Line 5 + SA. This is the BAlANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT $4,640.98 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X.'N THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transterred;.......................................................................................... 0 b. retain the right to designate who shaD use the property transferred or no income; ............................................ 0 o. retain a re\'el5ionary interest; or.......................................................................................................................... 0 d. receive the promise for Iffe of either payments, benelils or care? ...................................................................... 0 2. ff death llCCUIred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate conslde<ation? .............................................................................................................. 0 3. Did deoedenl own an 'in !rust for" or payable upon death bank aooounl or security at Ills or he! death? .............. 0 4. Did decedent own an Individual Retirement Accounl annuity, or other /lOl'11lfllbate property which contains a beneficiary designation? ........................................................................................................................ 0 \Jnderpenalfies oIp11)Jly, I decIaolllhatl_ _fils -. includi1g .'00"""./1, _ and sfaIements, and., II1e bestolmylnowlodge and belief, lis""'. COIl8Ct andcomple<e. ~oI__lI1anll1epelSOOlll__isbasedon..i1brrotionol__hasanylnootedge. SIGNATURE OF PERSON RESPONSiBlE FOR FiliNG RETURN George S. Smith, Jr. DATE 12/15/04 ADORESS 141 Wagner Dr., Carlisle, PA 17013 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS Wi 11 i.::lm P nnngl ~H~ 27 W. High St., Carlisle, PA 17013 17/1~/04 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the nel value of lransfers to or for the use of the suMving spouse is 3% [12 P.S. ~9116 (a) (1.1) @. For dates of death on or aft... January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the sut\'Mng spouse is O'li {72 P.S. ~9116 (a) (1.1) (i)). The statule does no! exemol a transter to a sUf'living spouse from tax, and the statutory requirements for disclosure of assets and filing a tax rel1Jn are stiR app/1Cllb/e even ff the surviving spouse is the only beneficiary. For dates of death on Of after July 1, 2000; .. The tax rate imposed on the net value of lransfers from a deceased child twenty-one years otage or younge< at death to or for the use of a natural parenl an adoptive parenl or a stepparent of the ohlld is O'li (72 P.S. ~9116(aX1.2)]. . The tax rate imposed on the net value oftransf... \0 or for the use of the decedenfs tineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [12 P.S. ~9116(aXl)]. The tax rate imposed on the net value of lransfers \0 or for the use of the deoedenrs siblings is 12% {72 P.S. S9116(aX1.3)1. A sibling is defined, under SectiolI 9102, as an individual who has at least one parent in common with the deoeden~ whether by blood or adoplion. ~.'-.(~. ~THOFP'CHNSYLVANlA INHERITANCE TAX RETURN RESIDENT DE DENT ESTATE OF FILE NUMBER Kathr~ C. Smith' 21-04-0762 1\11 real propeI1y 0_ 101ely or II . tenant In common must be reported at fair market value. Fair m8l1<et...1ue is defined..the price at which property would be exchanged betoeen a willing buyer and a willing seRer. neiIher being compelled b buy or seD. boIh having reasonable knowledge of the relevant facIs. Real property which is jolnUy-owned with right of survivondllo must be._ on Sohodule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SCHEDULE A REAL ESTATE Real Estate, 3298 Enola Road, Carlisle, PA., selling price 111,000.00 TOTAL (Also enler 00 line 1. Recapilulation) $ 1" t\t\t\ nn (If more space is needed. insert additional sheets of the same size) 1<<" REV-f5llllSC.(1-g]) '*' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECI'DENT Kathryn C. Smith FILE NUMBER 21-04-0762 ESTATE OF Include !he proceeds of litigation and !he date !he proceeds were Il!Cllived by !he es1ale. An property jolntly-owned with the right ofsulYivorshlp must be d_ on Sehodule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. .Refund - Funeral Home Personal Property Checking Account, Orrstown Real Estate Tax Proration received at sale of home 5,950.80 500.00 1,853.64 683.46 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of lf1e same sizel 8,987.90 REV-1511 EX+ {12-99) . '. CCJMMOlolWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAl EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Kathryn C. Smith FILE NUMBER 21-04-0762 D9b1$ 01 decedent must be reported on Schedule L -' ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1- Prepaid , fl. ADMINISTRATIVE COSTS: None 1, _~IaIiYe'. CoIMIssIons Name"'_~') SoclaISeCleilyNumbet1.)tEH-"'-~.) -- City SIaIe_~ YUf(.) CommIssIon PaId: 2. AIIomey Fees $3,500.00 3. FlO11IyElooqJlion: (II_._knal... .....as_.. -...-) None CIalmanI -- City SIaIe_~ -....;p", CIalmanIi>_ 4. """"" Fees 263.00 5. AiXounfanl'. Fees 6. T.. _ P1<paro(s Fees 7. Cumberland Law Journal 75.00 8. Evening Sentinel 136.00 9. Register of Wills, filing fees 45.00 10. Ann Sensenich, notary, sale of real estate 10.00 .11. Recorder of Dees, 1% transfer tax on real. 'estate $1,110.00 12. 9/16/03, replace wall pump to tank, kitchen faucet and drain pipes, 3298 Enola Road to prepare for sale of house 1,794.44 13. Replace vanity and pipes, to prepare for.sale of house 531. 85 TOTAl. (Also enfer on Uno 9, Recap<<ulalion) $ ~.; (n""", space Is needed. insert add'dionalshe<ls "'........ size) SCHEDULE H - PAGE 2 ESTATE OF KATHRYN C. SMITH File;No. 21-04-0762 14. Replace Tub and faucet in preparation for sale of house 15. Furnace cleaned: in; preparation for sale of house 16. Walls cleaned, in preparation for sale of house 17. Paint interior of house in preparation for sale of house 18. Carpet, floor and vinyl kitchen and bath 19. Property appraisal 20. Replace toilet 21. Replace garage door and 3 storm doors 22. Replace Furnace nozzle 357.92 105.00 250.00 3,256.00 3,292.75 200.00 243.90 1,779.55 57.00 Total Schedule H expenses $17,007.41 REV-ls:J9EX+lt-9l1 '*' . SCHEDULE F JOINTL Y.OWNED PROPERTY COMMONWEALTH Of PENNSYLVANIA INtERlTANCE TAX RETURN RESlDENT DECEDENT ESTATE OF Kathryn O. Smith 21-04-0762 FILE NUMBER . In ..... _ mode joint within one YNf of tho _...... dIle of _. . must be reported on ScMdule G. SURVlV1NGJOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Katrina L. Smith a minor aged 3 c/o Jeffrey and Pamela Smith, her parents 2704 Ruffin Drive, Fredericksburg, VA 22408 gr.gr.dau. B. George S. Smith, Jr. 141 Wagner Dr., Carlisle, PA son c. JOINTLY-OWNED PROPERTY: LETTER DATE oeSCRlPt~ Of PROPERTY "Of DATE Of llEATH ITEM FOR JOONT lIAllE Include .....01_ _SId bank """""numberor_1deotifyi1g number._ DATE Of DEATH OECO'S VALUE Of "-"lBER TENANT JOtIT _"joInay-heIdlOai_. VAlUE OF ASSET INTEREST DECEDENT'S IlITEREST 1. A. L/16/0 Members First CD #213145-00 2,189.02 .50 1,095.00 2. A. 12/4/0 Orrstown CD #4000000680 2,610.41 .50 1,305.00 3. B. 8/1/0 Orrstown CD #143000132 1,679.00 .50 840.00 TOTAL.(AIso enter 00 line 6. Recapitulation) $ 3,240.00 - (If more space is needed. insert additional sheets ri the same size) """"~~l'.n.. COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETlRN RESIDENT DECE NT . SCHEDULE J BENEFICIARIES ESTATE OF NUMBER I. ,.. ~......+-h 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributioos) George S. Smith, Jr. , 141 Wagner Dr.,Carlis e FILE NUMBER ')1. '" ".."... RELATiONSHIP TO DECEDENT Do Not list Trustee(s) Son AMOUNT OR SHARE OF ESTATE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) DEED MADE the 15th day of December, 2004 BEIWEEN GEORGE S. SMITII, JR and LINDA L. SMITII, his wife, of Middlesex Township, Cumberland County, Pennsylvania, hereinafter referred to as GRANTORS and FRANK KODADEK and KENNEll F. KODADEK, his son, as joint tenants with the right of survivorship, of 9750 Upper Strasburg Road, Box 63, Upper Strasburg, PA 17265 GRANTEES -. WITNESSETH, that in consideration of ONE HUNDRED AND ELEVEN llOUSAND ($111,000.00) DOLLARS, in hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and convey to the said Grantees, their heirs and assigns: ALL thatcertain tract of IOOd with the improvements thereon erected, situate in Lower Frankford Township, Cumberland County, Pennsylvania, and being more fully bounded and described according to survey made by Noel B. Smith, Registered Surveyor, dated January, 1970, as follows: BEGINNING at a point at the intersection of the center lines of Pennsylvania Legislative Route 944 and Township Route T-458; thence from said beginning point by the center line of said TownShip Route T -458 by property of J. Oausen, North 18 degrees 18 minutes West 162.00 feet to a spike; thence by property formerly of J. Bryan and Edna G. Ensminger and now or formerly of Glenn L. and Marcella E. Young North 85 degrees 44 minutes East 362.17 feet to an iron pin; thence by same South 18 degrees 18 minutes East 226.94 feet to a point in the center line of Pennsylvania Legislative Route 944; thence by the center line of Pennsylvania Legislative Route 944 the following three courses and distances: (1) North 83 degrees 34 minutes West 202.55 feet; (2) North 84 degrees 27 minutes West 97.37 feet; (3) North 88 degrees 14 minutes West 83.41 feet to the place of beginning. CONTAINING 1.54 acres and being improved with a one and one- half story dwelling house with an address of 3298 Enola Road, Carlisle, P A 17013. BEING the same premises which Kathryn C. Smith, widow, granted and conveyed unto George C. Smith, Jr., and Linda4 Smith, his wife, by deed dated (C(Q)[F?>lf August 5, 2003, and recorded in the Cumberland County Recorder of Deeds Office in Deed Book 250, page 2716. AND the said Grantors will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and seals the day and year first above written. SIGNED, SEALED AND DEUVERED IN THE PRESENCE OF: George S. Smith, Jr. (SEAL) (SEAL) Linda L. Smith . . COMMONWEAL1H OF PENNSYLVANIA ) :55:, COUNlY OF CUMBERLAND ) On this, the day of December, 2004, before me the undersigned officer, personally appeared George S. Smith, Jr., and Linda L. Smith, his wife, known to me or satisfactorily proven to be the persons whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Certificate of Residence I hereby certify that the precise residence and complete post office address of the within Grantees is Dated: Attorney for Grantees Sent By: PA Real Estate Services, Inc.; 2430946; Dec-10-04 5:28PM; Page 2/3 OMB ^i>proval No 2jQ20026' A U.s. ",..i>ARTMENT OF HOUSlNGANU UKUAN OEVHU;PMENT SETrLEMEI'(I ~"TATl:MENT B. TYPFOF l.OAN 6. File Nwnber: 7 ~~.~IDTlha; 1. PHA 2. fmHA 41147B 86 54 53 3. Conv. (Jnin!>. .. VA S. Conv.ln.'- to Mortgage 'm:urance C~ Number C. NOTE: This fonn is tianishcd to giw you. Ji14lcmc:nt nfactual ~ WIob. Amnemts paid." and by the sctdtmeA{ agent arc~. hems marlced "(I' t:)" ..- paid oul,ldc ll1c elo>iog; Il>ey ate shown "* ~":~ 9_ .nd.." norincl1lo\ed ih lhelOlols. 0 ; TlN = i..,;...... rd...r~alioll'N"",t,;" n. NAME AND AD!lIU:SS OF BORROWER: 1;;. NAME, ADI>lUlSS NID 11N OF m.LER.: F. N/IME J\ND AIlORFiSS Of WNUJ;R: Frank Kodadek George S. Sm1'th, Jr. Coun~rywj,de Home Loaft.~ Linda L. Sroith 4930 Ce.l'lisle .Pike, Suite 9'/;0 Upper Stragburg Road 41 Wa9n~r Drive 0-16 uppc:r ::;tranI:'Jurg, PII 1'1265 Carlislel PA 17013 Mechanic..burg. PA 11050 G. PROPERTY LOCATION; II. SLrrTU'.MJ;;N'T AOEI'(J" NAMe. ADORESS AND TIN 3298 Enola Road PAR~Al E~~nte Settlement Se,vicQ Carlisle, PII 17013 10 W@-t P""'f~". ~tr~"t,,_ Carlisle .. 170'3 PLACE OF SETI'LI'.MHNT I. SIrITU'.MI;NT DATE ,P8.ccel t 14-04-0363-011 ~;5 South Hanvoer StrQQt. 12/]5/2004 rli~1e 1'A 17013 ffiJJ> -1 UNll'()RM ,~F.1TLEMENT Sl'A TF.MENT J. SllMMARYOFBORROWER'STaA~~'TION 10, GROSS AM (IJ: FR RRrnwD' IOI.O>nlncl 111 000.00 'OZ.I'<<-.. IOJ.~cnl '04. !Q:i. ,1400\ ) G04.4S 400. <101 n. p 3. UN OF SF.1.u:tl'S TltA.....,CTION ot/ DUl! 1Yl sm't,ii; .. 111 000, on .... ;;; oul..... . It JeJlcrin .Citvllowu,.".., ~ 2 4- 8. ~.S h T4Ke 12 5 410. 411. 412 4211.0ROS DlIH'Il 'R n' 10.20 7 5 ''J''. '6 111. h83.~6 ".AM BY "a "" , 0 owrlb 500 REDt S D OS U..F.R; '1. ~ =- 1 0.00 ft.. 'I 2. PrJllc:i..l_ofnew'?M!SI . '15 ooo.no 1 .1~0. 00 3. Ex' s .. 10 L s. 504. S. Iou '. r. I SOl. , 509. -....t;'Il!SfrnenW urilerlu seller ~ "'......;.....--- '. boo:a 5tO. (; us laXCS $11. 512 512. .......,' ".... _.,.....~..._,...,.~ ... .... ~f~ .. -'~" . ~ 1. S 6. S 51. O. 1'0'I'AI. ""I') BVIOOR 16 OUO.OO S2O. TOTAL ON DUll RR for .no CAS! A ........ ,_I C HFR t'R 1 5 287 76 000 81 9 .C....'H TS, 60,....' SEllER 520 1 1 683.46 1 120.00 110 563.46 6D 0 Sl!I.tx.l\'SSTATHMllNl' n1CmullioA cunlau:ltld iIltl.lcxts.e. 0, H. and I and on linc<fOr (or, if1inc40t isatl:riakcd, tine: 403 and 4(4) 1$ irnpnrtanttax III~ and iSbaln, titrnbhcd (0 tlK: as Rcvenu< _ (... Seller eeltl1kadon).It)'Oll Ole requited.. tile......... q1i~_lty '" 0Itla' _ wlII~'" if . ......'011 ...s \be IRS _....... h loa DOt bceo _ed. V.. ... ~uU.d I<> pJVvido <Ioe S_ I.pGI wl<h """ Ifyou t pnwide the s.ttlomwl ^""'" wIIll)'Ollr _ '""po,", __ -.)'llU...y be _jcet., civil Q( crlmlMl 1m by ,of y, r 00fCif)' thU Ihe rw:mbcr 1bcrNIl-(ID thi& ~ is my COf1eC( ~pa)'W id-tntlrleJ.ttoH nun~. , ., Signoture) (SeIIo(S SigJu,I...) Pagel fonn HUO-l (3116) ref H..dbook 4305.2 GeorgQ S. Smith, Jr. Linda L. Smit:h iV S()l-~[,. me. tOOl P<<:vi~ cdhions &R ob.suMc tienc ~y: PA Real Estate Services, Inc,; 2430946; L SE"1"nXMEN'J' (:HARGES 1 700'-'l'OtALSA ROKER', CO 'I )N bued.. on.. SIll. flOO, (1U-' ) DivUwi nfCOrt1ll1iuion lline 100\ as (olWw6: '7tll t 702.$ 103. Commission ooid II! Sc:ttlcnlCot 704. .oo..n;MSfAYABLO:.NCONNl:CI10NWr'M 111AN &0 l. ...... (}ri.;/Wion Fcc; S M2. (..nlln Oiscowd S 803. AnnnIliuJ Pcc tn R-A ~e r-vi (,:P:~ sn4 Creditreooltto CountrvwidA Home Loans lOS, s . F 806. Flood Che. 10; Fee 'to LfIITld.,,!;,A"te Flood 807. Tax Se'v C& F5!~ t"O ("onnf-rvulrie T=-v 808. DO utnent Pr. arat on e.e tn. nt:.r ."". 810. Rl1. 1l2. 113. lOt. [ ~L f~ 102. '03. H.",m ; ~. us. 1Gf, Y 001. Hazard IMWaOOC M2 . n ~ XlJ. CUv_~. " )()4, CountvProoerlvTu:es IOS. AllAual 106. '07. ~. ~ 01. s_ Of .......Iilo '" 02. ",,,,,,,,,,<w,, D . TilIo 10 il4.l'ilIc _'" 15. ~""I lO . N to B S@nSII:! h n. to R eY. Bav ev and r I!!!!!ln; 0 -I' 0 '8. ~ .J>. ._'!J...j:"h~e ,,~.t ~ 01-1lJ& 9. !-!4 on. on O. 111 1In0 on I. Endor...m.. c: 00 0 8 1 2,Conestoua Title InsurAnCe CompanY f.or CPL J. J. GOV ItNMo:N'I' R~(.'OIlJ)IN(; AD' NII'I: (.' AK"i:l I. R<oonIi Ilocd .50 !.C' "" , ~ 1 110.0 I.~""""""'" ~ 1,110.00 I. Dec'10-04 5:29PM; Page 3/3 PAID FROM IJORROWER'S fUNDS AT . . IJNT PAIl> FROM SElLCRlS FUND~ AT SIi'I'n.F.MF.N'!' 310.00 J5. 0 v de H e. OM 26,00 00.00 ... 00.00 ItEDBVUNDI:R TOBl:l'AlD 'N"DVA,","" 12/1"~n04-12131120 4 1 00 ;...c~ d,,';- 222.70 !TiD wrrn J.vmn 0.00 r i QQ 10.00 10.00 100 7!> I 150 00 -..._..~- 35.no 0 0 1 110.00 1 !l .00 " AL HTT'.MJ:N1' CllARCU " AbDIT . Surv<v,o lO Overniaht Fp-e 0 PA Real ~ ~"'Wr-roent Se . Wire and Elect:ronic Fee to ~ 1 ~t 't.Q ~ v c n ~Qrvi--;:;;D; 17 .00 30.00 rrnCAllQN: t ....vc cwe.fbIIy nMc'M:d &he HlJD.l Scldcmeat SCak:mGnt and ~ IIlc bcft ofmy b'OWkxlac aacJ b.::1C( it Q; ..lrue and ~unlc stucmc:nt of.n n:c:c..ts and ...m.... madt 00 my _or toy me> 1ft \1\1. _. I fimhorCOllify IhaII_od. copy ora.. HUD-l S_t S_t 'n1l'AL~t:.. - GUI ,..ter.. j .. 2 . 5 1 120,no George S. Sml tit Frank l<odad~k aono- Linda L. Sm.i th I:knTo\m' UO-I S~t~mellf 5latemanl: whIch I MVC,.-cparcd hi. true n lCCUn.k account. bfthc timd.'t di.VMnod nr tn lK: d~ by (he InletSj~d ~" pari oflbe setdcment or ln$4CJtoa. metlt~ t'A RealEst.ate SQt:.'t.leItlQDt GorvicQs Da(e , ~INC: II ~. orirnc to knnwinrJy mob:: fofsc at:atcmencs \0 she UIdtcd Statca on tbh; arMy oCher ,imiIo.rAum. PIlNllticl upon conviction can include I. fill<:. .1\<1 .......1 Fo< cJ.:1llllI...: Till< JIU.S. C.... _1001... _1010. Y SOFT. Inc. 2001 previnus editions ~ obsal~ ~ 2. (ann HUD-I 0'*6) rcfHandhoak "305.2 12/15/200< SEP-07-B4 12:23 PM MEMBERS1ST Feu INS. DEPT 7177955178 ~EOULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Princlpal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interast Name of Jolnt OWner CERllFICATE OF DepOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint OWnership Established Estate of: KATHRYN C. SMITH Date of Death: 05105/2004 Social Seeurlty Number: 196.16-9498 P.l31 1- MEMBERS lit fEDlUt.ALCl.1IDIT UNtON ._--_.-._~-_. 213145 -00 01/16/2002 $25.00 $.00 $25.00 None 213145 -40 01/16/2002 $2.188.08 $,94 $2,189.02 Katrina L. Smith 01/1612002 ~B~RS 18T FEDERAL CREDIT UNION ~fdl dA~ enlse A Wbrle'- Insurance SupeNI September 7, 2004 5000 Louise Drive' P.O. Box 40 . Mechanicsburg.l'ennsylvania 17055 . (717) 697-1161 . www.mcmbcrslst.org ~WN BANK 2250 ~prlDg ~oad. Carlis~e. FA. 17013 Tel. J7J.7) 43-5844 Fax (717) 243-16:37 TO: nf\e.. \Mv~ ~ ~~~ ~ Please contact (717) 243-5844 CONFIDENTIALITY NOTICE: This fi1csimile may contain coDfi which may be legally privileged, 8.Illi is intended only fur the use of the . addressee(s) named above. If you are not the intended recipient, you are thaI any disclosure, copying, distribution. taking or any action in re1WJ.ce of this tJ:<l\l$)XJ;ssiOl1. is strictly prohibited. !iyou have received this trans pl.ea.se notify us hnmNtiately by telephone so that we can ammge fur the documents at no cost to you. Thank You. if there is a pro b1em with this tr . sion at in.func.atiOD. 'vidual or by notified n the contents sionin error. of the PO Box 250 . S.hlppensburgt PA 17257 . (717) 532-6114. (717) 532-4143 Fax. .orrstown.com rnn /rnn 'J IrnTr+.711' IT^T~~nnTm "Ulln'"UUn WT rr'+.n TU~ tnn7_Cn_J1C 9/03/04 KATHRYN C SMITH KATRINA L SMITH 3298 ENOLA ROAD CARLISLE PA 17013 Account Nwnber. - . Orig/Renewal Amount. CD ~ Calaulation Issue/Last Ren wal...... Next Payment D te....... Maturity Date. ......... Per Diem........... .......... Current balanc .,. 4000000680 5,000.00 Interest Due F Interest Rate. om... .......... ............ .. 12:47:12 12/04/02 9/04/04 12/04/05 .18 2,605.14 8/04/04 2.4700% --------------------------------------------------------- ----~----~--------- 03 FORFEIT SIX MONTHS INTEREST Date of penalty................ 90304 Partial withdrawal amount..... 260~l4 Pa~ accrued interest (Y,N or Prlncipal Due Depositor Accrued Int. Due Depositor Pay penalty amount of....... ~t Settlement F12=Previou5 P)........ ...... y .OU" 5.27 .00 N --2,610:~ ~ '4~fb"~\' ), ~ !~00/~00 " I,Qln711, I ~ y-102- ~nT~1nnlW u MunT0vun WI ~r'~n TV,l ~nn7 cn_l~0 9/03/04 KATHRYN C SMITH GEORG~ S SMITH JR 3298 ENOLA'ROAD CARLISLE PA 17013 Messages Available Balance: Collected balance: Current balance: Deposit Inquiry Page 01 of 10 12:50:20 CIF number: SCOTT S025048 Phone: (H) (717) 243-4595 ' Birth date: (B) (000) 000-0000 6/09/1912 Tax ID number: 196-16-9496 Br#: 043 Account type: CARRIAGE CLUB Account number: 143000132 1 of 1 8711/04 12.83 0/00/00 1,679.44 1,679.44 1,679.44 Yesterday's balance: Last stmt balance: Avg collected bal: Avg ledger balance: Interest rate: Stmt/Service chg/lnt cycle: Automatic NSF fee: Statement/Passbook code: User code: Waive ATM Foreign F1=Add1 functions F5=History 1,679.44 1,679.44 1,679.44 1,679.44 .0500% 25 25 25 Yes Not coded Fee (Y,N) ....... N F2=Image F6=Messages Date Last Date last active: deposit: 8/11/04 last overdrawn: Date opened: Date last statement: Date last contact: Closing balance: Accrued interest: Service charge: SC Waive expiration: Service charge code: F3=Exit F8=Maintenance 8/01/02 8/25/04 ~~~~:t Yes 0/00/00 11 More.. . F4=Sweep Inquiry F24=More Keys t ~;--..---"-----"~"---".. \ I . I \ j; \1' ~ \"" \ 0 W \ t g \ ~ ." C ~ , i , . , I , , \ I : , , \ \ , \ , 1 1 , . ! \ I , , 1 . I I I , I I I . I I . \ , 'i. ~ 0 0 ~ ... ::> '" 0 r ~ Ir> '" S' . - ., 0 >l-' ... >l-' ... 0 ru 0 Ir> - .. <. o is !I ':ll ~ o ~ '" .,. .. ,*" - qf. -.0 g cp" 0' ~ .fJ) .......__' Ell - ~-.-:---..-:-~.;":~:.;". .~ - :.C"::::::;'-~: - :Z~ ji:: l!.1 f. fl I f i II. II. ~ J J ~ ! ! ~ - - f - - I . 1 ( ~f f (9 "'1 1 I I ~i i i '. . ~- . -,~:~~ '._,.,-.,..i.. "'-. :~~~~ .-..,:- ORIGIlW.-F.F.D.OFA.19M .._/.~ ~ J- ...--........ .~. W. j ____......,..C1EHI' ::~- !tCD: lRF'UCATE.A>>EFW.HOIE .:-:- _~ ~ lig . ~ !!'~U~I m 1ft: 3r-,,:t~..:;~.-_- Q:l:f....Q 3:j....ogJ iZ2il-"'tEool'ijS II!!~ i.!!~i .~UUH?i~ii_;~ . I ! j J ~ I j j; iiifi~ ~ ~ i~~l rl · :I--~ 1--il;O J=:lt..r:.~J Ii ~ a.ll i a I U m ifill" E! ;;jJfiII ,..~':..Ill: IfF. ~ ~~,.'i~!!i ~."i~ .~lrll~l] ,:~J J J ! f f~: i,jU~t::~!iljJI' 8 '. ~ .::J,~:--- .::-! ~,:;_:'tlil=I::~:._,~.~ 1.1 d!~h!! " i!d~~f(,~;J '~~' !!! '~! .... nf;Ili,!irlli'l -- - ..- -- - .. t -.' 5- . . .. -'. . .~.. , . 1.1111 !II: .~ !!II:illn :;1.. ~ ;I :JJ In ~ ii ~ fll~;tl - -. ~ : 1: ~ ...+!! ... ... c > .. . ~ ~ ~ ;:,t~!i! .. J I [~ ~ ~ ~ r=-Ilil . - 01 . In e : -@ '!!- ~ II! ili . ~il~f" ~ - -~. 0 : ~: '.' " .. ~... -. -I C o 'I f -'f ~ i f . . ... ... $ ,,'r.. e-......".... . . '_.~-~~~ - '(Co" '. . ~~'} s ~ i: ~."t'~~ZGln 2. ~ J'i!~I:! I i :~E:~l~ i! : ~! g: If ~ i .i\i_.: n :-..,; . . : ~ ~ ~ : l~llll . ~a. 0 .. . : . : : : : f ... .. . . . .. .. -I J ......--......................1' - f! ~ ~~ rr I .~ tf P !~ I ~~ _ M 1"- I:::. . .-""v z - n 5 ~~ ~~;"D~~ ~ ' .::lI=Pc",c .. lD~Z' Z CDmo:l _ -';')11 0'Il5 -.-.. ~>~i~ := o-o.r> ....~ -"" t"" ~ b_ .. '- o :: .l"l DOUGLAS LAW OFFICE 27 W. ffiGH ST. POB 261 CARLISLE P A 17013 TELEPHONE 717-243-1790 WILUAM P. OOUGLAS, ESQ. Supreme Court I.D.# 37926 INRE: FSTATEOF KAlHRYN C. SMITH : IN THE ORPHANS COURT OF : CUMBERLAND COUNTY, PENNA : NO. 21-04-0762 ORDER F~'-/ ANDNOW,this [5T day of fantlll1'Y, 2005, the distribution as set forth in the attached Petition is approved, and the Court directs that the aforesaid distribution of $2,610.41 and $2,189.02 be placed in a federally-insured savings account or certificate of deposit;. to be marked, "Not to be withdrawn until age 18, or on further Order of this Court." It is further directed that the federally insured bank or savings institution shall be permitted to pay federal and state income tax on the money earned on behalf of the minor in the said account. ~~~lli1AJ u.. OU) I-Ll =i o"~ fE 5: r-..L~ "'-.....Ie) ~t$ 0-'" C") c) (i', uc:::; ~..:i 0.: co ~ ::II:: a.. N I t! M5 .:::. "" .......Cf cr: ' :::>0 tl-Ou OOe .;;: 0:> 'c' 0:;- ., lJ..J<~:7: '~_. - Q; o L' 0..>' CI:::~!.....! C5~ U DOUGLAS LAW OFFICE 27 W. HIGH ST. POB 261 CARLISLE PA 17013 TELEPHONE 717-243-1790 WILUAM P. DOUGLAS, ESQ. Supreme Court I.D.# 37926 INRE: ESTAlEOF KATHRYN C. SMITH : IN THE ORPHANS COURT OF : CUMBERLAND COUNTY, PENNA. : NO. 21-04-0762 PEITTION FOR APPROVAL OF DISTRIBUTION TO A MINOR 1. Your petitioners are Jeffrey and Pamela Smith, through their attorney, William P. Douglas, and are the natural parents of KATRINA L. SMITH, a minor, age 3, who was born on March 7, 2001. Katrina resides with her parents at 2704 Ruffin Drive, Fredricksburg, Virginia 22408. 2. Kathryn C. Smith, the grandmother of Katrina, died testate on May 5, 2004, and Letters Testamentary were issued to her son, George Stewart Smith, Jr. on September 3, 2004. 3. At the time of the grandmother's death, she had a joint CD with her granddaughter, Katrina L. Smith, at the Orrstown Bank, North Middleton Township Branch, Carlisle, P A, with a value at death of $2,610.41. 4. At the time of the grandmother's death, she had a joint CD with her granddaughter, Katrina L. Smith, at Members First Federal Credit Union, Carlisle, P A, with a value at death of $2,189.02. 5. Inheritance taxes have been paid by the Estate of Kathrn C. Smith on the one-half value of the aforesaid CDs. 6, Your petitioner requests that the Court direct that the aforesaid sums be placed in a federally-insured savings account or certificate of deposit, to be marked, "Not to be withdrawn until age 18, or on further Order of this Court." 7. Your petitioner further requests that the Court direct that the federally- insured bank or savings institution be permitted to pay federal and state income tax on the money earned on behalf of the minor in the said account. WHEREFORE, it is prayed that the aforesaid proposed distribution be approved. DOUGLAS LAW OFFICE By ~/'l,L.,.-; ?~ Willfa'in P. Douglas Attorney for Petitioners Affidavit This verification is made pursuant to Pa.R.c.P l024(c) by counsel for the plaintiff. To the best of the signer's knowledge, information and belief, the foregoing is true and correct. Dated: September 2004 /~ William P. Douglas Attorney for Petition ~WN BANK 2250 ~Pr1D8 ~oad. Garllsl.e. 1'A. 17Q13 Fax (J11) 243-1637 nile.. TO: 'N'f FROM: DATE: 3 oy SUBJECf: c.~ Yn. ,+ K > s pages, illCP1<:l1t!g this cover pege. 3 4. This trAn,..,.,Ttt"l of COMMENTS: o S-t-~' + Iv.> VP~ . , ~ , 'tel. -0)..7) 43-5844 , O( Ol ~Ol 01 81 a v""+s I 01 l 6. . 9' ~ Please colIt8ct (717) 243-5844 CONFIDENTIALITY NOTICE: This fi1cslmllo may con1ain coIIfi wDich may be legslly prlvi1eged, Ill3d Is ~"'li only fur the use of the ' addressee(s) n"~..c1 above. Ifyoullte not the ~ reoipie.ttt, you are tha:t any disolosme, copying, distrilnttIon. taking or I1fJ;f action in teli..noo of this t1Rn"mi"s.ion is ~pro1libited. Ifyouha:~:reoeIved this plea.se notify us ;wtrJAdjAt.,zy by telephone so that we can mange fur the documents at no cost to you. Thank You. if there is ap,roblE\D1 witl1 this . sion at infuntl.lltioD. 'vidual or notified. the co.D.tewts sian in =. of the '0 Box 250 . S,hlppensbut9, PA 17257 . (717) 532.6114. (/17) 532-4143 Fax . J ICOlet?.. .orrstown.com Account NUlI1ber... Orig/Renewal Amount. CD ~ Cellcul.ation Issue/Last Ren wal...... Next Fayment D te....... Maturity Date. ......... Per Diem........... ....... Current balanc ... ~-,-._.~_ :"0':; 12:47:12 12/04/02 9/04/04 12/04/05 .18 2,605.14 4000000680 5,000.00 Interest Due F om.. ... . ., 8/04/04 Interest Rate. ........ 2.4700% --------------------------------------------------------- ------------------- 03 FORFEIT SIX MONTHS INTEREST Date of penalty................ 90304 Partial withdrawal amount..... 2bU~14 Pa~ accrued interest (Y,N or Pl.......... Y Pr~ncipal Due Depositor .OU Accrued Int. Due Depositor 5.27 Pay penalty amount of....... .00 N ~t Settlement ------2:610:~ F12=Previous ~~~ , . ,~ 4-102- ~PM MEMBERS1ST Feu IHS~ DEPT 7177955178 p..e.1 . fvlR MEMBERS 1" I'I!IlUAL CIlEDIT llNIOH REGUlAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Prlnclpall3alance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint OWner 213145 -00 01/1612002 $25.00 $.00 $25.00 None CERnFlCATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date or Death Accrued In!erest to Date of Deatl1 Total Principal and Accrued Interest Name or Joint Owner Date Joint Ownership Es18bllshed 213145 -40 01/1612002 $2,188.08 $.94 $2,189.02 Katrlna L. Smith 01/1612002 ~B.ERS 1ST FEDERAL CREDIT UNION ~r4I /1?;f nlse A. Wb1~ Insurance Supervl September 7,2004 Eltate of: KATHRYN C. SMITH Date of Death: 0510512004 Soelal Seeurlty Number: 196.16-9496 SOOO l.ouise Dri\T . P.O. .I3ox 40 . Mechanksburg.I'erlllsylvan;. 17055 . (717) 697-1161 . www.mcmberslst.org f ~ t . LAST WILL AND TESTAMENT OF KATHRYN CRULL SMITH I, KATHRYN CRULL SMITH, a domiciliary of Carlisle, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. I hereby revoke any and all wills and codicils by me heretofore made. I IDENTIFICATION AND DEFINITION S? I have one son, GEORGE STEWART SMITH~ JR. L s:: "Survive men is to be construed to mean that the person referr~~ to must survive me by thirty days. If the person referred to dies ~~thin thirty days of my death, the reference to him shall be construed as~f he had failed to survive me. II PAYMENT OF DEBTS AND TAXES I direct my ~xecutor to pay the following before any division or distribution under the following articles; 1. All of the expenses of my last illness, funeral and of the administration of my estate~ 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxest MY executor shall not require any beneficiary under this will to reimburse my estate for taxes paid on property passing under the terms of this Will. III RESIDUARY ESTATE A. I define "my Residuary Estate" as all of my property after the payment of debts and taxes under Article II above, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this Will, and property as to which I have an option to purchase or a reversionary interest, but excluding property as to which I have no interest other than a power of appointment. (Page 1 of 2 Pages) ~ . .~ "0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' ! .., , :,. .... ., ." BUREAU OF INDIVIDtMl)TAXES' INHERITANCE TAX DIVISIcIf PO BOX 280601 HARRISBURG PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP 112-041 II: t; G DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-21-2005 SMITH 05-05-2004 21 04-0762 CUMBERLAND 101 KATHRYN C ORPHI'Srs WI L L I Ar-Ct,llV:UblJ'Gt'AS DOUGLAS LAW OFFICE 27 W HIGH ST CARLISLE PA 17013 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ~EV :r!4"'.E;t.i.Fp.rar:6~'..Na'r-fcE.oF.INHErtffAN.cl!.TAx.j;PP~AISEii€N'~.ALt'iwlNc'l.oR................- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMITH KATHRYN C FILE NO. 21 04-0762 ACN 101 DATE 03-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 111.000.00 .00 .00 .00 8.987.90 3.240.00 .00 (8) NOTE: To insure proper credit to your account. sub.it the upper portion of this forll with your tax pay_nt. 123.227.90 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdII. Costs/Misc. Expenses (Schedule H) 10. DebtslHortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 17.007.41 .00 (11) (12) (13) (14) 17.007 41 106.220.49 .00 106.220.49 I~ an assessmen~ Mas issued previously, lines 14, 15 and/or 16, 17, 18 and 19 Mill r~lect ~igures ~ha~ include ~he ~o~al o~ ALL re~urns assessed ~o da~e. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. AlIOunt of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due NOTE: .00 X 106.220.49 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= .00 4.780.00 .00 .00 4.780.00 ~ TAX CREDITS: 1(1C."'IC.~rl \+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-05-2004 CD004600 .00 139.02 01-04-2005 CD004795 .00 4.640.98 TOTAL TAX CREDIT 4.780.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR YNSTRlJr:TTnNc:. 1 r, J COMMONWEALTH OF PENNSYLYANIA DEPARTMENT OF REYENUE INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN *' BUREAU OF INDIVIOUAL.' ,TlXES INHERITANCE TAX DIVISIOIt, PO BOX 280601 ... HARRISBURG PA 17128-0601 REV-ln4 EX iFP <12-04) 03-18-2005 SMITH 05-05-2004 21 04-0762 CUMBERLAND 196-16-9496 04138993 Allount Re..itted KATHRYN C GEORGE S SMITH 141 WAGNER DR CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REY-1604 EX AFP (01-03) __ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS -- DATE 03-18-2005 ESTATE OF SMITH KATHRYN C DATE OF DEATH 05-05-2004 COUNTY CUMBERLAND FILE NO. 21 04-0762 ADJUSTMENT BASED ON: S.S/D.C. NO. 196-16-9496 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 04138993 FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. 143000132 TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE DATE ESTABLISHED 08-01-2002 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.500 .00 .00 .00 .15 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOYE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE 00 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A .'CREDlr' (CR), vnll MAY 81" DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ ,:,>\ REV-1470 EX (6-88) '* INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Kathryn Smith 2104-0762 REVIEWED BY ACN Emerson Luciano 04138993 SCHEDULE ITEM EXPLANATION OF CHANGES NO. The above referenced ACN has been reduced to zero, as this account was reported on the probate return. PaQe 1 ~ :7' ~ --"- e_:;."",:' ,~ . RECEIVED MAR 3 0 l( IN RE: ESTATE OF KATHRYN C. SMITH IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY ,PENNA. : ORPHANS' COURT DIVISION : NO. 21.04.0762 ORDER OF COURT AND NOW, this 7(( dayof v~~-:( ,2005, after a review of the within Petition, the Petition to settle IS small estate IS approved and distribution directed as set forth in the said Petition. This Estate is closed and George Stewart Smith, Jr. is excused from his duties of Executor of the Estate of Kathryn C. Smith. By the Court, ././ . I . C'-.-~lC\1::V , ,,~1)c,-,,\\:,.c, 'i;/::'q , \) --i..-' ->,. (-J -{ '-.,'-._,-, 6r",,",~"~~. '. I~.I/I I 0 c:; it?--- "'''-. .IIIIIIIIIIIII~ 111111111.1111..111....11111' STATUS REPORT UNDER RULE 6.12 Date of Decedent:_k~ C S"", +-~ Death: . 5' ( S-12..co 4- f-=t ?-\'O,+40-'<"~ Admin. No. Name of Will No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No , 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal represenEat've file~f'nal account with the Court? Yes X No . ibll\o- -to ( f D~ 51 tf- I (,)S"" b. The separate Orphans' Court No. (if an ) for Io,*,", the personal representative's account is: J o.JcLfOll"-L- c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. ~~ A()_~ Signature luldl~ (>. Dd'v~ Name (Please type or pri ) 2-, w, t4l~0- (~ Addres~\\ l ~ \ -€-. ~ I "1Q\) (71)1~~~ (,.,U Tel. No. Date: fj'3/o~ i;".,1, (MAH:rmf/AM3) Capacity: Personal Representative ~counsel for personal representative ~