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HomeMy WebLinkAbout04-0789PETITION FOR PROBATE and GRANT OF LETTERS , also known as Deceased. Social Security No. C~ _5:~ ! ~'~ ~'/ ~ To: Register of WjJls fo[ the County of Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut~ ~" in the last will of the above decedent, dated ,~q ~ ~ ,a~ and codicil(s) dated in the named ,19 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~Of~!l~g~.]~:'L-DF~ ~ County, Pennsylvania, with h ~o~-- last family or principal residence at_/~/~'~5'$/~Ith (list street, number and muncipality) Decendent, then ?2 years of age, died ~ t ~ , 4.9. Except as follows, decedent did not marry, was not divorced 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: (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 Value of real estate in Pennsylvania situated as follows: ~,/OA_~e~~' $ WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters. theron. request(s) the probate of the last will and codicil(s) (testamentary; administration c.t~ ~.ministration d.b.n.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } COUNTY OF C'~ ~ r..~- t._ ~ ~_~ ~s The petitioner(s) above-n~ed swe~(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 person~ represen- tative(s) of the above decedent petitioner(s) will we~d trul~~ e~ate according to law. Sworn to or affirmed a~ subscribed r ~~5~~~ befo~ me this~ ~ ~-' dgy of, [ ~ -o Estate Of ~'_Y~ ~'~-/~-~.~,~ ,5/~'_/7'/-~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated described therein be admitted to probate and filed of record as the last will of and Letters O (-~ '3'3 ~~J-~/c/ ., ; are hereby granted to ' //~,'6.[r~ ~ /-~ ~-tn~ .-~ FEES Probate, Letters, Etc ........... $. Short Certificates({o) .......... $ l$'.dE) e.=::.~,.;.,,i,,,, . $..~.q.~..:... $. 3,c0 'TL? · $. lO.Ob TOTAL __ S Filed ................................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is lo certify that the information here given is correctly copied fron] an original certificate of death duly filed with me as l.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WAFINING: It is illegal to duplicate this ¢op¥ by photostat or photograph. P 10529450 No. ~Local Registrar AUG 1 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMAR (First. Middle, Lest) ISEX I SOCIAL SECURITY NUMBER J DAT~F DEATH (Mo~h Day Year) IzFemale I'. 084- BIRTHPLACE (C'~ and 1~ OF ~ATH tC~ ~ ...... ,ns~t, S~ ~ F~mgn Comte) ~ las' C~NTy OF DEATH Ci~, 80~O, T~ OF DEATH lvia Swanson Smith AGE (Last B~lhday} a. 79 Y~ Cumberland DECEDENT'S USUAL OCCUPATION 11s. Homemaker Mount Mechanicsburg, PA 17055 DATE OF BIRTH (Month, Day. Yea*) ,.8-23-24 East Pennsboro I~,ic' KIND OF BUSINESS I INDUSTRY DECEDENT'S ACTUAL RESIDENCE (See irmtrucPons on other ada) .ITY blAME (If not Institulion. give slreet and number) IWAS~D. ECEOENT OF HISPANIC ORIGIN? ~RACE - American Indian Black, Wh,te, eb I Mex~. PueTFffRican. etc I ~0 White /VAS DE~'J=P.~NT ~VER IN DECEDE~T'S EDUCATION 19, I MARITAL STATUS- Mamed. US. ARMED FORCES? [ (sp.~- O,aF ~ F,,,~ eo~,.a) SURWWNG SPOUSE Ele~m~l~/$econdacfCollege ~ (S~¢) IZ I'3' "I 4 1,4.widowed ~, s~m PA m~ ~, ~ w~,~nu~,~m East Pe~sboro ~7~. C~ Cumber lMnd t~n~ip9 ~7~.~ FATHER'S NAME (Fkst, Middle Lest) MOTHER S NAME F rst Mi cltyfooro I ' ( , ddle, Maiden Surname) ~a, Beinard G. Swanson J~ Nellie Lind~ren INFORMAi~ l~S NAME (Type/Print) i I * , . ~' Michael Smith INFORMANT'S MAILING ADDRESS (Street, Clty/To~n. State, Zip Code} ME~HODOFE~SPOSITION J~.404 South Lewisberry Road~ Lewisberr¥, PA 17339 · 12~- c,;, ~q ~ 12~,. PA Crematory 12~. Harrisburg, PA 17109 22a.SIGNATURE. '~'~ [ I (~NERAL ~ SERVICE ~-* MCI L ~'~ ~ [' P. ER~ ~4 ~ AC ~ SUCH I 22b. LICENSE NUMBERI NAMEalo AND ADDRESS OF FACILITY ........ r .-e'~ v ~ on oclety ' of 17109 ~c.,',a-~,~m, 23~-con~tw~nce~ying Toth .................. I ..... I~c. 0 Jonestown Road~ Harrisburg, PA PA ph¥ .~Ja~ m mol avmlable at brae of deem to Sidneture and Tit ~ ' ~ SE NUMBER IDATE SI~;gI~D I CASEREFERREDTOA.E .. L .L'LCORONER? result*ng in death) ~ ou~ TO (OR AS A CO~$EQUENCE OF~: Sequemlially ~st com:liUon~ b. ~ any. lea~ng to imrnecSate ~ DI~ TO (OR AS A CONSEQUENCE OF}: Enter UNDERLYING r'AU~E (Disease o~ injury c ) LAST d WAS AN AUTOPSY I ~'~RE AUTOPSY FINDINGS I MANNER OF D~ATH PERFORMED? I AVAILABLE PRIOR TO I I COMPLETION OF CAUSE I Naif'al~] o/l~[OF DEATH? IAO=~' [] Y..m, Y..m Nora [] interval betwee onset and dear Hormc~de Investigation I~aLA~C,E OF INJURY - At home fa*m sires, aclory, office I LOCATION Street, City/Town State CERTIFIER (C~eck only one) · .,.oo,~ .o ~u..~,o.?j..~ ~ ?_~ Yi.. G .~. Y s,~ ,~ .. (~¥.,~an ,,oth ,.o~o~ ..e,. end ~,,,,~ i ..... o, O.a,. · ,,.I .,,u.wge, ~lm occurred et the time, date, and place, and due lo the causes(e) end manner as Stated ...................... [] 'MEDICAL EXAMINER/CORONER On the bells o~ examlnaUon and/or levelllgetlon, In my opinion death occurred et the time dete and piece end due t~ the cause s and $1e,m&nnlr el itated ........................................................... j ................................... ,.,.....,., s( ) E REGISTRAR'S SIGNATURE AND NUMBER NAME AND ADDRESS OF PJ~SON V~O COMPLEI][D C~SE OF DEATH DATE FILED (M~th, Day, Year) OATH OF NON-SUBSCRIBING WITNESS Estate of %~ 4'x e,,._. ~---~5cx r~E,e~'h.~m,'~¥~ Also known as ,Deceased (each) a subscriber hereto, (each) being duly qualified according to law, de~0se(s) an~g~ay(s) .tha~ ~ ace_. familiar with the signature of 5~',t~ ~ax~h ~,:.~ ,testa~ of (one of the subscribing wimesses to) the codicil/will presented herewith an~.? ~elieve~ the signature on the codicil/will is in the handwriting of to the best of 0 '~ f' knowledge and belief. (Name) (Address) Sworn to or affirmed and._s~bscribed Befo~ me this ,~ ~'''! day 9f ,200 - (Name) (Address) LAST WILL AND TESTAMENT OF SYLVIA S. SMITH I, SYLVIA S. SMITH, of 415 Black Latch Lane, Camp Hill, Cumberland County, Pennsylvania, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any Wills or Codicils by me at any time heretofore made. ITEM I. I order and direct that all my just debts and funeral expenses be paid out of my estate by my Executor herein- after named, as soon as conveniently may be done after my death. ITEM II. If my husband, JOHN BYERLY SMITH, is living sixty (60) days after my death, I give, devise and bequeath to him, all the rest, residue and remainder of my estate, of every kind and nature and wheresoever situate and, without in any way limiting the generality of the foregoing, all property acquired by me or to which I may become entitled and all property which I now have or may hereafter acquire by any power of appointment. If my husband is living at the time of my decease, he shall have the right during the aforesaid sixty (60) day period to the use and enjoyment as life tenant of any proper~.hereby given, devised or bequeathed. ~"¢. ITEM III. If my said estate shall n°t passk~to my husband, GOH~ BY~RBY S~IgH~ under IgE~ II of this :Will, ~hon deviso and bequeath all the rost, rosiduo and rema:~ndor~f to my son, MICHAEL B. SMITH. ITEM IV. No interest of any beneficiary under this Will, or any Codicil hereto, shall be subject to anticipation or Witnes, ses: ~ ~ (SEAL) to voluntary or involuntary alienation. ITEM V. Ail estate, inheritance, legacy, succession or transfer taxes (including any interest and penalties thereon) imposed by any domestic or foreign laws now or hereafter in force with respect to all property taxable under such laws by reason of my death, whether or not such property passes under this, my Will, and whether such taxes be payable by my estate or by any recipient of any such property, shall be paid by my Executor out of my general estate as part of the expenses of the ad- ministration thereof, with no right of reimbursement from any recipient of any such property. ITEM VI. I hereby nominate, constitute and appoint my son, MICHAEL B. SMITH, as Executor of this, my Last Will and Testament. IN WITNESS WHEREOF, I, SYLVIA S. SMITH, the Testatrix, have to this Last Will and Testament, written on two (2) sheets of paper, set my hand and seal this ~day of / Signed, Sealed, Published ) and Declared by the above- ) named, SYLVIA S. SMITH, as ) and for her Last Will and ) Testament, in the presence ) of us who have hereunto ) subscribed our names at ) her request as witnesses ) thereto, in the presence ) of the said Testatrix and ) of each other. ) Sylvia S. Smith (SEAL) 1981. -2- CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Date of Death: /~/--) C~ Will No.: 2 ~ -- ~ ~D~: ~' To the Register: Admin No.: certify that notice of (benelicial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules w~erved on or mailed to the following beneficiarie'-~ of the above-captioned estate on : Name Address Notice has now been given to ail persons entitled thereto under Rule 5.6(a) except Date: /Z~ [~ [O~ Address Telephone Capacity: .J~P~ersonal Representative LJ Counsel for personal representative Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 12/06/2004 SMITH MICHAEL B 404 SOUTH LEWISBERRY ROAD LEWISBERRY, PA 17339 RE: Estate of SMITH SYLVIA SWANSON File Number: 2004-00789 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 12/03/2004 Your prompt attention to this matter will be appreciated. Thank You. CC: File Counsel Judge Sincerely, GLEN]DA FARNER STRASBAUGH Clerk of the Orphans, Court Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 SMITH MICHAEL B 404 SOUTH LEWISBERRY ROAD LEWISBERRY, PA 17339 RE: Estate of SMITH SYLVIA SWANSON File Number: 2004-00789 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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 two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/13/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~tt~-'~:B4J! ,. A // Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: 5~ I v,-Ci ~. S--~; k Date of Death: ? 1/3/C?f Estate No.: 2604 - 0& 7vCf Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion oftlle a~il"1istration of the above-captioned estate: 1. administration of the estate is complete: NoD 2. If the ans"ver is 1'Jo, state ,x:,hen the personal represerltative reasonably belie,res that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the person~ep~tive file a fmal account with the Court? Yes D No ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal r~ntative state an account informally to the parties in interest? Yes Err-N; 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk 0 he Orphans' Court and may be ~attaChed to this report. //--~~ I>ate: ~ i m(CI.f/J--tFL ~. :5M)Ttf- Name /tof -S , /EV/5 ,?~;Zf2-'f /2]) . Address /..LF tv '5il!>~ fZ..'-{ ( ,> Il-, (7 3.3/ h? 7~c; 7Lf-37 Telephone No. Capacity: ~nal Representative o Counsel for personal representative ) \ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 77128-0607 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMITH MICHAEL B 404 SOUTH LEWISBERRY ROAD LEWISBERRY, PA 17339 told ESTATE INFORMATION: ssN: oa4-ta-area FILE NUMBER: 2104-1789 DECEDENT NAME: SMITH SYLVIA SWANSON DATE OF PAYMENT: 08/18/2008 POSTMARK DATE: 08/ 1 8/2008 couNTY: CUMBERLAND DATE OF DEATH: 08/13/2004 REV-1162 EX(11-96) NO. CD 010160 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 58,437.05 TOTAL AMOUNT PAID: REMARKS: CHECK# 219 SEAL INITIALS: AKK 58,437.05 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS '~ 15056041046 REV- ^ 5OO EX (05-04) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~,, County Code Year File Number Dept.28o6i)1 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~-- ~ ~ ~ '~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Dg~- / ~ (~ i ~ g og ~3Z~sa~ o ~ Z 3 ~~~ ~4 Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~~ Crt~}-~~ I~ S~~ uhf ~~7 7~~ ~~3$ Firm Name (If Applicable) First line of address ~- ~~ S G t W/ s~ E/Ztz ~~ Jz Second line of address City or Post Office Sptate 1iC~~ / S~E/2/Z y /`/7~, ZIP Code REGIS~2 OF WILLS h/5f ONLY i-~- (~~ 47i ~v 3 -~-; ..J. L.~ /~. `~ -ri :i TDA~E FILED ~~ Correspondent's a-mail address: 1/bl S yVl i T~.~ g n7 ~~ ~ ~d ~,~ ©/.r~ 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 and96rr/¢lete. Declaration of preparer oth~n they personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P ON SP U / nnrF _. / ADDRESS ~ ,~s ~h~v~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 15056042047 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership. or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. . 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ~.~~ D. v o D.o© o.ov ~•~ ~,~ (~. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. l ~ ~ 7 ~ ~ .O 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. l / 6 I D ~~ ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. v ~~ t/ . ( 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. ~ (1 Q ~'. K~ O 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 1 ~Z ~ 3 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ' ~l an election to tax has not been made (Schedule J) ...................... .. 13. ~ ~. CJ i Li 13 T Li 12 14 1 ~~ G ~j ~ / > ~ 14. ) ...................... m nus ne ax ( ne Net Value Subject to .. . . ` TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 . 15. 16. Amount of Line 14 taxa~! Je at lineal rate X .0 ~ 1 SZ ~ ~ g . ~~ 16. ~ p ~^f 4 0 ~. 7 7 17. Amount of Line 14 taxable at sibling rate X .12 • 17. • 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Wiz. 7 7 O Side 2 15056042047 15056042047 J 1,5056042047 REV-1500 EX Decedent~~s{,t-SociJal ~Sx7ecurity N/umbx/er Decedent's Name' D ~ 1 ( v ~ / U RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. ~. D 2. Stocks and Bonds (Schedule B) ................................:.... .. 2. ~• U 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. D . ~ D 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. D . ~ U 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. r~.D 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. ~ lp Z ! ~ / . D 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. ~. ~ 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~ ~ ~ , 7 ~" / • O ~ 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. // p ~~ / b / D . ~C/ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. d ~~ ~ .~ U 11. Total Deductions {total Lines 9 ~ 10) ................................. .. 11. ~ ~" ~ (~~ ~ D 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~ S z ~ 3 9 • ~[ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which l ti t h ~l ~ an e ec on to ax as not been made (Schedule J) ...................... .. 13. V Q. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. f ~~~ ~ ~ .~ (~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 tax,~J.e / ~7 C ~ 4 ~ at lineal rate X .0 ~ l ,j L 16 ~ 2 • / 7 17. Amount of Line 14 taxable at sibling rate X .12 17. • 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ ~s Wiz. ~ ~ O Side 2 15056042047 15056042047 J • REV-1500 EX Page 3 File Number Decedent's Complete Address: STREET ADDRESS ~~ ~ ~ . ~~~~ s3e/~Zy ~2~ CITY ~ ~ ~/S~ ^~~`/ STATE !~ ~/f ZIP / 7 n~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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. A. Enter the interest on the tax due. ~v~8'Z.7-7' ~. J ~i ~ 0 c5) ~ `~ 3 7.OS (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ ~ ~ 7 . (~~ Make Check Payable fo: 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 :.................................................................................... ...... ^ ,[~v],~/ b. retain the right to designate who shall use the property transferred or its income : ..................................... ...... ^ ~c~' c. retain a reversionary interest; or .................................................................................................................... ..... ^ ~-~/ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ Ltd 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ,~,/ without receiving adequate consideration? ........................................................................................................ ...... ^ tom" / 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ........ ..... ^ ~/ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, anti 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 zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1502 EX+ (6-98) SCNEDIJLE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ 16-98) ~',;(s ','~te :h.~.:ry- Ci?MMONWF_H~l-H OF PEPINSYLVANI,4 INHERIT.-.NCE TAri RETURN RESIGFt~)T DF!,EDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER S `/L- I/~~ S. S~ ~ i~ -- Include the proceeds of litigation and the date the proceeds were received by the estate. All grogertY jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF ~, l/ ~, J~ ~ ~ . ~~ (1 r~ 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 (Ewes 3~R-,zY pA~ i± y ~~ 9' r B C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY•HELD REALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST ,. A. /~~9 ~ZS--Sti, j~~;~l`~y~~-s 5' v;~ moo. ZB3r•So .s`d J~~ F~,' z A. ~ 9S4 lad sti-7ycv /~.~~.GS~~, ~~w Cam. ZD~'~CP. Sv /off? •~ 3 ~}. ~ ~ Q~ ~ ~a s~ ~ Gt~ac~v; ~ L`ol~r , O~e~ 7~rS s~ 3 ~ r ~. ~ . l q 4' ~ ~'S~.~5~ S~. Loren R~~"f~'%l~~cC. •f "~A z,~-July .6 sd r 20 S v. 5 ~! • r~ r ~Zr G ~~s~. ~.1,~.'`1C`I. V~(J~ 'lfJ~~ / ~s ~ . ry~~ /oo~v S~~rul(~~`(t~~ ~-YC~b ~t$ 77 ~o S~ ~,~ 3~ /~ . / 4~ P, I'~2cs~~ ~v. Sv~,OI)o`fi~ ~D,O~ rD~~o, 5~ Sz~p l o ,Q , 1 /.s'oDv ~h~ ~ ~~ Ste. ~s~• ~~ ~6 /~~ ~ ~ -~' ~D •70 l~ R ~ ~ r9 f /ooa~ ~h~~'~ f~~~, /~vn. g-~ ~e~ /o rzF~• ~7~ ,~3~4 ~3 /~ • ~~'~~ /~1 •~ • ,$~,~ DP,~os~l a`o~. `f z~~• 3 b~ 2 ~ 2 7 I ~f- ~ • ~ ~ ~(~ ~/" ~ ~, ~'G i se a oc7`• ~d~/s3Fsg'7s~! f~l~. 7L- S`v 7~-{~ SI ~ lG e4 • 1 ~'~~ `~ 4 r• ~3~a~vo~%z~ 7~ TS3~. 7 ~~ 3~ i 7 r~ 3v ~a ~U Z3 n 75~ 5~ ~z~ ~S 15 ~ / V .~7 . ~~ 53 3~ TOTAL (Also enter on line 6, Recapitulation) I S l (P ~ 7~ 1 , Q (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION _. AMOUNT A. FUNERAL EXPENSES: 1. ~ eve ~- f~~r•~~dr!• ~rC c~~~ ~v~e~k~d~~elrv,~~j (~c /~/D, Dd ~~ B. ADMiN1STRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: d 2. Attorney Fees 3. Family Exemption: (If decedent's address is nol the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees D . 5. Accountant's Fees o 6. Tax Return Preparer's Fees D 7. State .Zip TOTAL (Also enter on line 9, Recapitulation) I $ ~~ ~~ ~d (It more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEfICiARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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, and transfers under Sp ~ l d0 `8 Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 8. CHARITABLE ANO GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART It -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1'i00 COVER SHEET I $ (If more space is needed, insert additional sheets of the same si::e) LAST WILL AND TESTAMENT OF SYLVIA S. SMITH I, SYLVIA S. SMITH, of 415 Black Latch Lane, Camp Hill, Cumberland County, Pennsylvania, do hereby make, publish a. declare this as and for my Last Will and Testament, hereby revof._.;.g any Wills or Codicils by me at any time heretofore made. ITEM I. I order and direct that: all my just debts and funeral expenses be paid out of my estatE~ by my Executor herein- after named, as soon as conveniently may be done after my death. ITEM II. If my husband, JOHN BYERLY SMITH, is living sixty (60) days after my death, I give,- devise and beque~,'-h to him, all the rest, residue and remainder of my estate, of every kind and nature and wheresoever situate and, without in any way limiting the generality of the foregoing, all property acquired by me or to which I may become entitled and all property which I now have or may hereafter acquire by any power of appointment. If my husband is living at the time of my decease, he shall have the right during the aforesaid sixty (60) day period to the use and enjoyment as life tenant of any propert~~,hereby given, _ c, devised or bequeathed. ~~` c~ f ITEM III. If my said estate shall not passyto my ~..;J husband, JOHN BYERLY SMITH, under ITEM II of this 'Will,__then I,give, .,a devise and bequeath all the rest, residue and remainder,~_of my estate i.~ to my son, MICHAEL B. SMITH. ITEM IV. No interest of any beneficiary under this Will, or any Codicil hereto, shall be subject to anticipation or Witnesses: ~ ~. l 't.' Cc , u-1'... ~ ~ ; , t~ ~~d~. ~.. ~ ~~~,_.. 1 I j '.~~ ~,~' ~ p '.6 f ~~ C ~~ ~ n r t`~ ~ ~ ~ ( SEAL ) (.%• .~--; Jam. /'T ~ 'r^. '/ ` e~ to voluntary or involuntary alienation. ITEM V. All estate, inheritance, legacy, succession or transfer taxes (including any interest and penalties thereon) imposed by any domestic or foreign laws now or hereafter in force with respect to all property taxable under such laws by reason of my death, whether or not such property passes under this, my Will, and whether such taxes be payable by my estate or by any recipient of any such property, shall be paid by my Executor out of my general estate as part of the expenses of the ad- ministration thereof, with no right of reimbut.:,;~ment from any recipient of any such property. ITEM VI. I hereby nominate, constitute and appoint my son, MICHAEL B. SMITH, as Executor of this, my Last Will and Testament . IN WITNESS WHEREOF, I, SYLVIA S, SMITH, the Testatrix, have to this Last Will and Testament, written on two (2) sheets of paper, set my hand and seal this ~ ~`~"day of { `~' f;-.~(~ 1981. 1 Signed, Sealed, Published ) and Declared by the above- ) named, SYLVIA S. SMITH, as ) and for her Last Will and ) Testament, in the presence} of us who have hereunto ) subscribed our names at ) her request as witnesses ) thereto, in the presence ) of the said Testatrix and ) of each other. ) ~- ).. ~ ; .. d ~~..) rl ~,df f "~ i[J k/%?!.~'trfr'7 r.,J ~. ~"rf" *T/' t% (SEAL) ~;~ Sylvia S . Smith _ 2 ... BUREAU OF INDIVIDUAL INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~ _ NOTICE OF INHERITANCE TAX TAXES - -AppRA,ISEMENT, ALLOWANCE OR DISALLOWANCE _.", . ''. ~; OF 'DEDUCTIONS AND ASSESSMENT OF TAX ?~~..., t~,_ - i F,~~ ~.. ~~ i ~1~~^II~ ~,~~ /; ,,1, - ~i r~- - ti.-; . ~. _ -: - , INICHAEL B SMIrifi ~+04 S LEWISBERRY RD ILEWISBERRY PA 17339 C1) REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --! RETAIN LOWER PORTION FOR YOUR RECORDS E'- REV-15'47 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMITH SYLVIA S FILE N0. 21 04-0789 ACN 101 DATE 11-24-2008 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) 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 APPRO\IED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; 14. Net Value of Estate Subject to Tax 00 (z) .00 (3) .00 (4) .00 (5) .00 (6) 162, 741.08 (7) .00 (B) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 162,741.08 1,010.00 C9) (lo) 8,791.60 C11) 9,801.60 (1z) 152, 939.48 Non-elected 9113 Trusts (Schedule J) C13) .00 (14) 152,939.48 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Lane 14 at Spousal rate (15) •00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 152,939.48 X 045 = 6,882.77 17'. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 lE{. Amount of Line 14 taxable at Collateral/Class B rate C18) •00 X 15 = .00 19. Principal Tax Due C19)= 6, 882 • 77 Twv rornrrc. PAYMENT ])ATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 08-1.8-2008 (0010160 1,554.28- 8,437.05 11-1.7-2008 SBADJUS~ .00 2.27 REY-1547 EX AFP (06-05) DATE 11-24-2008 ESTATE OF SMITH SYLVIA S DATE OF DEATH 08-13-2004 FILE NUMBER 21 04-0789 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 01-23-2009 (See reverse side under Objections) Amount Remitted -~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: TOTAL TAX CREDIT 6,882.77 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS RECIUIRED. FOIR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE - ~~~~~.~.. ~~r orvrocr crnF nF THIS FORM FOR INSTRUCTIONS.)