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Home My WebLink About03-0559 ~ Register of Wills of Cumberland County, Pennsylvania ,. PETITION FOR GRANT OF LETTERS Estate of DAVID O. SMITH No02/-QE- 6"t5"'9 also known as , Deceased Social Security No. 248-35-1278 Petitloner(S), who is/are 18 years of age or older. apply(tes) for: (COMPLETE "A" OR "B" BELOW:) [;I A. Probate and Grant of Letters and aver that Petitioner is the executor named in the Last Will of the Decedent, dated 11/30/98 and codicil(s) dated 8/8/02 State re$evant circumstances, e.g., renunciation. death of executor. etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [;I B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate) Petitioner after a proper search has ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Dauphin County, Pennsylvania, with his last family or principal residence at 32 Burwick Drive. Mechanicsbura, Silver Sprina Township. Cumberland County. PA 17050 (list street, number and municipality) Decedent, then~ years of age, died May 30, 2003, at Community General Osteopathic Hospital. Lower Paxton Township. Dauphin County, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ................................................ $ 200,000.00 (If not domiciled in PA) Personal property in Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ (If not domiciled in PA) Personal property in County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ Value of real estate in Pennsylvania ........................................................... $ Total ............................................................................ $ 200,000.00 Real Estate situated as follows: Wherefore, Petitioners respectfully request the probate of the last Will and Codicil presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence Carolyn R. Smith 32 Burwick Drive Mechanicsburg, PA 17055 //-/~/-S · Oath of Personal Representative - Commonwealth of Pennsylvania County of Cumberland The Petitioners above-named swear and affirm that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioners and that, as personal representatives of the Decedent, Petitioners will well and truly administer the estate according to law. ~ Sworn to and affirmed and subscribed C109&~. ~ 9: me this !?r,,; day of Carolyn R. S ith " .u~ . ,2003. ~r:bS~j/~~ ~ DECREE OF REGISTER Estate of DAVID O. SMITH Deceased No.t\.').!-Q.:::J -6-~9 also known as Social Security No: Date of Death: May 30. 2003 AND NOW, t.A../ , 2003, in consideration of the Petition on the reverse side hereon, satisfactory pro f havin been presented before me, IT IS DECREED that Letters. Testamentary 0 of Administration (c.t.a.; d.b.n.c.t.; pendentelita; durante absentia; durante minoritate) are hereby granted to CAROLYN R. SMITH in the above estate and that the instrument( s), if any, dated 11/30/98 and 8/8/02 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters........................... ~.:?o:OO f)r~~~/ >>z 1'Y7;) /p~, At] /uo/ Register of Wills ~ ~~ Short Certificate(s).......... $ cQ/.(XJ Renunciation.......... ... ..... $ Affidavit ()................. $ Extra Pages ()............ $ .y'~l"':n Codicil.......................... $ 'O.~ JCP Fee........................ $ 1<:1.00 Attorney: Vicky Ann Trimmer Inventory & Tax Forms... $ I.D. No: 49679 Other............................ $ Address: 3401 North Front Street Harrisbura. PA 17110-0950 TOTAL................ $,,~1J.l/:l)(')' Telephone: 717-232-5000 DATE FILED: :329109_ . .. iil~J I;:;) ./ . 60: Dill tS- lnf' [0. ) r.,' 8 !-110,),XO"i REV ')/~(, This is co certify rhar rhe informarion here given is correcrly copied from an original certificare of dearh duly filed wirh me as Local Regisrrar.' The original certificare will be forwarded co rhe Srare Viral Records Office for permanenr filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 at4V ~ ~~ft-- Local Registrar ~ p 9265913 JUN o 2 Z003 No. Date Ht;!\I' 2/87 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER NAME OF DECEDENT (Flrsl_ MlCIdIe, lasrl ----- SEX SOCIAL SECURITY NU.\4BER I. Vav.id O. 2. Ma.f.e 3. 248 - 35- 1278 ,3 AGE (l asl BlfthOay) UNOEA 1 YEAR UNOER I DAY SIRTHPLACi: rely ar.d Momh. i Do.. Hou.. 1 Mlnu... $lale Of FCf&tg(l Counlfy) 65 Yr.. 00A0 g';:"Yl 0 .. COUNTY OF DeATH RACE - Amencan Indian, Black, White. etc. . PQLlrh~n (S""",",) 1.. Wh-ite MARITAL STATUS. Married SURVIVING SPOUse Never Married, Widowed, (It WIle. 9''18 maiden namel DiYorc:ed (Specify) .. 11.. 11b. CAV 13. 14. MOJr.JI..ied u. CaJr.olljn RO-6-6 DECEDENT'S MAILING ADDAESS ($Ireef, CirylTown, Slale. Zv Codel DECEDENT"S Penn-6lj.f.van-ia 17c.o Yes,decedenClivedin c:;; .(1\1(J/r C:;p/r -in.g.6 32 Bwr.w-ic.k VJr..ive ACTUAL 17.. Stale ();d .... RESIDENCE -.. Mec.han.ic.-6bwr.g, PA 17050 (See rnSlrUC11Of\l l;v.in. on oIhef SIde) Cumbvr.land township? No._...... II. 17b. County 17d.O witfUn actual kmil. of city/bom FATHER'S NAME (First. MIddle. Las!) MOTHER'S NAME ,First. Middle. Malden Surname) II. INFOAMANT'S NAME iT ',l->&IPrinl) 17050 . CrlJrnation ~ 2003 23b. 230. w..S CASE REFERREO TO MEDICAL EXAMINERlCORONEA? Yo. IX] JL NoD M. 25. 21. 27. PART I: Em., the dise.MS, injuries or complica1ions which caused lhe death. 00 notenler the mode of dyin ,such a$ car I Approximate PART": OIh., J9'tiRcant co~ c:onIribl.lling 10 death, but lisl only one cause on eech line. 1== not relUking in !he undertying CauH given in PART I. 1....EDlATE CAUSE (Final . disease Of COOOtItOn : resultlngmdealh)_ o. , SeQuentidy ... condition. . . II any, fNding 10 il'nmediale I ~UM. Enter UHOERlYINO I CAUSE (OIS88S8 or mlllr)! [ c. DUE m (OR AS A CONSEQUENCE On , . lhaIirutialedell80la I fesutllng In 08aIh1 LAST · &L>..Y7.Jn=- /'A-..vr,;:=;p /lntD &/""K,....,..;lAk~ aN. .J, I;) , WAS AN AUlOPSY WERE AUTOPSY FINDINGS MANNEA OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT VvOAK? DESCRIBE HOW INJURY OCCURREO. PERFORMED? AVAU..ABlE PRtOR TO (Month. Day. Year) t COMPLETION OF CAUSE 0 0 OF DEATH? Natural Homicide V.. 0 NoD ACc:idenl 0 Pending Investigation 0 0 o ;~CE OF INJURY - Al home, ,ar;,':;eel. factory, otfk:. M. -. Yo. 0 NoD Yea 0 NoD Suic:ide Could not be delennmed building, etc:, ISPOCllv) 2". 21b. 2.. 300. CERTIFIER ICt18dl, only one) ?:> .CERTIFYING PHYSICIAN IPhysIClaO Cefl.'Vmg cause of dealt1 when anOIt1er phySIClaIl has pronounced death ana completed lIem 23) o 310. To lhe beat 0' my kl'lOwtedg., d..thoccurr~dueloth.c:.u..(s).ndm.nn.r...t.I~......,......, ...... _...........,...,..,...... 'T"'Q ; LK:EN DATE SIGNED (Month. Day. Year' . PRONOUNCING AND CERTIFYING PHYSICIAN (PhtSICliln both pfonounclng Oedlh and Cer1IIYIllg 10 cause of death) ~Gl'9L 31d. /7/4 ~'3'<" .:;JC>C"'3 To th. Mal 01 my knowl.dge, death OCcurred al thaUme, da.e, and plac:e, and due 10 I~ cau.ee.) and mannar.. stated.. o 31c. NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF EATH .& 'MEDICAL EXAMINER/CORONER (IIem 27) Type 01 P,inl 7/&"'..30 ctrn~/?n,(u-1A.1 On Ihe b..I. ot examination end/Of' Investlgtltion, in my opinion, de.fh OCcurred.1 the time, dale, and place, and due 10 the causeCs) and 0 ///lK e/:!u'!3~( d ~ /4 /;1/0J manne,.. stated.. . , , , . . , . , . . . , . . , , . . . . . . . . . . . . . . . , . . . . . . . . . . , . , . . . . . . . , , . . . . . . . . . . . . . . , , . , . . . . , , . . . . . . . . . . . . . . . . , 3b. 32. REGIS?7'S SIGNATU~~~~!, NU~~~~ JJv'CP?VII' I DATE FilED (Monltt, Day, Yean (. .~". 'IY./ ,--. .7 (/., f. . .~......-.. t,;,.- . ( .-:.t,I' _" ..-t.,(/~;.:_.~ t"_ _ 33. _.. '._, .~.__.__ 34. r} ~ 1- o3;~~9 .- ' "::cquu:) qJ'"?':J 60: OlV 8- lnr (0. -i'""'\ , J ;~f;"X!L-! . CODICIL TO THE WILL OF DAVID O. SMITH I, DAVID O. SMITH, of Franklin Township, York County, the within named Testator, do hereby make and publish this Codicil to my Last Will and Testament, dated November 30,1998. I hereby modify said Last Will and Testament as follows: ITEM I: ITEM IV of said Last Will and Testament is deleted and replaced as follows: ITEM IV: I make the following gifts: My Merrill Lynch CMA Sub-Account #872-50942 shall be divided as follows: I (a) Four Thousand Three Hundred ($4,300) Dollars to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. (b) Five Thousand ($5,000) Dollars each to my then living grandchildren. (c) One-half of the balance to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. (d) One-half of the balance to my daughter, JOANNA CLAIRE MOREMAN, or her then living issue, per stirpes. In all other respects I confirm and ratify my aforesaid Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 9.~ day of August, 2002. ~" .Qe. <?- ~) DAVID O. SMITH We, the undersigned, hereby certify that the foregoing Codicil was signed, sealed, published and declared by the above-named Testator as and for a Codicil to his Last Will and Testament, in the presence of each of us, who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. ~ ,,:Lc::..,s;:, (SEAL) Residing at //3 c:-'A-, ~VJJ?C l1- /lfc" (fr--/c) ~v~ ~ (7f)J7- ~ (SEAL) Residing at ~~ ~~ /)r. file IS PA , 7 ~/7 Residing at . c:; f/ . 3) SI Sf . Nlr~b~, fA J7 )07 . . ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA) COUNTY OF' '])utplu~; ) SS: ) I, DAVID O. SMITH, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~ ,~) . ~~~.Q (1,<< DAVID O. SMITH Sworn to and subscribed before me this _ gL"~v_day of August, 2002 d I ~'(ltrr ',tU)\ .'.... Notary Public My Commission Expires: (SEAL) Notarial Seal , N tary Public Tina L. otto. 0 Dauphin County SUsquehanna T~ires Sept. 14,200'~ My Commission ,~'\(';hir:~ MEJnbeI',~,rat".a. .. -,'" . . . AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA) ) SS: COUNTY OF ) We, y;(.~ A~-" Trl ""fl4 t;V- ,H01'\LUiJ. ~ and l:Jlu h L . ~V?r 1t1(~he Witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, DAVID O. SMITH, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as Witnesses; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~-.C ~ -~ Witness Sworn t.o and subscribed before me this gat' day of August, 2002. j~'!Ji ~~" L ;', iD Notary Public My Commission Expires: (SEAL) Notarial Seal public Tina L. Otto, NO~;Gphin County Susquehan~a T~;res Sept. 14. 2002 My commiSSion . !\cs:dt.~r~a!ie6 ~~'t1rret .. :270462 _1 Recu, c;, c t Rt" " .03 JUL -8 mo :09 L,;;: Crmb ' o I!l Q W m o q o ~ 00- .0 ~ g ~ H 0 ~ ~ , ' ~ 3: j z ~~ . , .;w f- ~ ...,......... . ~ ~ . \U <( .J i-t ,......... 0 0 00 ~ ~ ...... _ ~ Z ~ ~ ~ ~ ~ 8 w ~~ 0 W f- ~ ~ . ~ ci .... W 0:: a ~~ ~ Ul W - :E ~ ~ J: ," J - , Last Will and Testament OF DAVIDO. SMITH I, DAVID O. SMITH, of Franklin Township, York County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death shall be borne by the recipient of the property and shall not be borne by the residue of my estate. The Executor shall have a duty or obligation to obtain reimbursement for any tax paid by my estate from the recipient of the property upon which the tax is imposed. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the residue of my estate as an expense and cost of administration of my estate. ITEM III: I may leave a written list in my safe deposit box or elsewhere disposing of certain items of my tangible personal property. The Executor shall dispose of items of my personal property as specified in the written list. If no written list is found in my safe deposit box or elsewhere and properly identified by the Executor within thirty (30) days after the probate of my Will, it shall be presumed that there is no list; any subsequently discovered list shall be ignored. If I die before my wife, CAROLYN R. SMITH, I give to her all of my household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment and all policies of insurance thereon not found on the written ~ ~~1 . . . do not die before my wife, I make this gift to my children living at the time of my death, to be divided among them as they shall agree. Should there be no agreement, the Executor shall divide this property among them in as nearly equal portions as the Executor, in the sole discretion of the Executor, deems appropriate, having due regard to the personal preferences of my children. ITEM IV: I make the following gifts: My Merrill Lynch CMA Sub-Account #872-50942 shall be divided as follows: (a) $5,000 each to my then living grandchildren. (b) One-half of the balance to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. (c) One-half of the balance to my daughter, JOANNA CLAIRE MOREMAN, or her then living issue, per stirpes. ITEM V: I give the residue of my estate, not disposed of in the preceding portions of this Will, to my wife, CAROLYN R. SMITH, if she survives me. If she does not survive me, I give the residue to: (a) One-quarter to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. Page 2 ~. (b) One-quarter to my daughter, JOANNA CLAIRE MOREMAN, or her then living issue, per stirpes. (c) One-half to ELLEN L. ROSS, as Trustee, for the benefit of my stepson, MICHAEL SCOTT COBERLY, if then living, to be administered pursuant to ITEM VI. If MICHAEL SCOTT COBERLY should predecease me, this share shall pass in equal shares to my then living grandchildren. ITEM VI: The following provisions shall apply to the Trust established by ITEM V(c): (a) The Trustee, during the lifetime of MICHAEL SCOTT COBERLY, shall pay so much of the net income arising from the principal of this Trust as the Trustee, in the sole and unfettered discretion of the Trustee, deems advisable, to or for the benefit of MICHAEL SCOTT COBERLY. I make this trust for MICHAEL SCOTT COBERLY with full understanding of his physical and mental disabilities. I intend that the Trustee accumulate income for the benefit of the remaindennen, including the Trustee, to the extent the Trustee deems accumulation appropriate. I understand that various entitlement programs exist for which he may qualify. If eligible, I wish him to receive the benefits available through these programs. I do not intend, by this trust, to provide support or maintenance for MICHAEL SCOTT COBERLY. MICHAEL SCOTT COBERLY shall be deemed to have predeceased me upon the occurrence of any of the following eVk Page 3 . (1) A ruling that the provisions of this paragraph are void as against public policy; (2) A ruling that the net income or principal of this Trust is subject to the claims of an agency or governmental entity for services rendered to him; or (3) A ruling that the income or principal or this Trust is a resource of MICHAEL SCOTT COBERLY for the purpose of determining his eligibility or entitlement to benefits from any agency or governmental entity. (b) Upon the death of MICHAEL SCOTT COBERLY, the trust shall terminate and the principal shall be distributed to my then living grandchildren, in equal shares. ITEM VII: If any beneficiary under this Will is under the age of twenty-five (25) years at the time of my death, or at the time they become entitled to any interest under this Will, their share shall be held in a trust by Merrill Lynch and my children, SIMON JOHN SMITH and JOANNA CLAIRE MOREMAN, or the survivor of them, as Trustee, IN TRUST NEVERTHELESS, and shall be administered and distributed as follows: (a) The Trustee shall pay to or for his or her benefit, in convenient, at least annual, installments, all of the net income. The Trustee shall also pay to or for the benefit of that issue (the "Beneficiary") so much of the principal of this Trust as the Trustee, in the sole discretion of the Trustee, considers necessary to maintain the Beneficiary in the proper station in life, including proper support, maintenance, medical care and college or higher education. ~, Page 4 " - (b) Upon the attainment of the age of twenty-five (25) years by the Beneficiary, the Trust shall terminate, and the Trustee shall distribute to the Beneficiary all the assets of the Trust, (c) If the Beneficiary dies before final distribution of the assets of the Trust, but is survived by then living issue, the Trustee shall quarterly pay the net income from this Trust to or for the benefit of the Beneficiary's issue, per stirpes, living at each time of quarterly distribution, As soon as anyone of the Beneficiary's issue attains the age of twenty-one (21) years, but in no event later than twenty (20) years following the death of the Beneficiary, the Trustee shall pay over all of the assets in the Trust to the then living issue of the Beneficiary, per stirpes, Should such Beneficiary die before final distribution of this Trust and not be survived by issue, the provisions of subparagraph (d) shall apply. (d) If, before final distribution of the assets of any Trust established for my children or issue of a deceased child, there is no living beneficiary of that Trust, it shall terminate. The principal of the Trust shall be divided and distributed pursuant to the terms of ITEM V. If any Trust created for issue of deceased children had previously been terminated, the beneficiaries who received the principal of that Trust shall collectively be considered a "Trust" for the purpose of this paragraph, and one share shall be paid directly to each beneficiary in the same proportion by which each received the principal of the Trust. If any beneficiary is deceased, the share of the deceased beneficiary shall be paid to his or her then living issue, per stirpes. Page 5 ~ ITEM VIII: No part of the income or principal of any Trust created by this Will shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior to his or her actual receipt of income or principal distributed. The Trustee shall pay the net income and the principal to the beneficiaries specified by me, as their interests may appear, without regard to any attempted anticipation, pledging or assignment, and without regard to any claim or attempted levy, attachment, seizure or other process against the beneficiary. ITEM IX: The Executor and the Trustee shall each possess the following powers, each of which may be exercised without court approval and in a fiduciary capacity only: (a) To retain any investments I have at my death, including specifically those consisting of stock of any bank even if I have named that bank as the Executor or Trustee. (b) To vary investments, and to invest in bonds, stocks, notes, real estate mortgages or other securities or in other property, real or personal, without being restricted to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. (c) In order to divide the principal of a Trust or for any other purpose, including final distributions, the Executor and Trustee are authorized to divide and distribute personal property and real property, partly or wholly in kind, and to allocate specific assets among beneficiaries and Trusts so long as the total market value of each share is not affected by the division, distribution or allocation in kind. The Executor and Trustee are each authorized to make, ~ Page 6 . and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale real and personal property severally or in conjunction with other persons, and to consummate sale(s) by deed(s) or other instrument(s) to the purchaser(s), conveying a fee simple title. No purchaser shall be obligated to see to the application of the purchase money or to make inquiry into the validity of any sale(s). The Executor and Trustee are authorized to execute, acknowledge and deliver deeds, assignments, options or other writings as necessary or convenient to any of the power conferred upon the Executor and Trustee. (e) To mortgage real estate, and to make leases of real estate. (f) To borrow money from any person, including the Executor or Trustee, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate and other taxes, and to assign and pledge assets of my estate or any Trust established by this Will. (g) To pay all costs, taxes, expenses and charges in connection with the administration of my estate or any Trust established under this Will. (h) To make distributions of income and of principal to the proper beneficiaries, during the administration of my estate, with or without court order, in such manner and in such amounts as the Executor deems prudent and appropriate. ~ Page 7 (i) To vote shares of stock which form a part of my estate or any Trust established under this Will, and to exercise all the powers incident to the ownership of stock. (j) To unite with other owners of property similar to property in my estate to carry out plans for the reorganization of any company whose securities form a part of my estate. (k) To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee of an inter vivos transfer, and as a donee under a third-party beneficiary contract. (1) To prepare, execute and file tax returns of any type required by applicable law, and to make all tax elections authorized by law. (m) To employ custodians of property, investment or business advisors, accountants and attorneys as the Executor or Trustee deems appropriate, and to compensate these persons from assets of my estate or trust, without affecting the compensation to which the Executor and Trustee are entitled. (n) To divide any Trust created in this Will into two or more separate Trusts so that inclusion ratio for purposes of the generation- skipping transfer tax shall be either zero or one, in order that an election under Section 2652(a)(3) of the Internal Revenue Code may be Page 8 ~ made with respect to one of the separate Trusts, or for any other reason. (0) To allocate administrative expenses to income or to principal, as the Executor or Trustee deems appropriate. However, no allocation to income shall be made if the effect of the allocation is to cause a reduction in the amount of any estate tax marital deduction or estate tax charitable deduction. (p) To do all other acts in their judgment necessary or desirable for the proper and advantageous management, investment and distribution of the estate and Trusts established under this Will. ITEM X: The Trustee is authorized to distribute principal and/or income in anyone or more of the following ways if the Trustee, in the sole discretion of the Trustee, considers the beneficiary unable to apply distributions to the beneficiary's own best interests, or if the beneficiary is under a legal disability: (a) Directly to the beneficiary; (b) To the legal guardian or conservator of such beneficiary; (c) To the Trustee, or to another person selected by the Trustee, as custodian under the Pennsylvania Uniform Transfers to Minors Act as to a beneficiary under the age of twenty-one (21) years; (d) To a relative of the beneficiary, to be expended by that relative for the benefit of the beneficiary; or Page 9 ~ (e) By directly applying distributions for the benefit of the beneficiary . ITEM XI: Should my wfe, CAROLYN R. SMITH, by Will or Agreement of Trust, establish Trusts similar to the Trusts I have established for the benefit of my issue, the Trustee of each Trust created in this Will shall have the right to merge it with the similar Trust created by my wife for the same beneficiaries. If merged, the Trustee shall operate the merged Trusts as a single Trust. ITEM XII: Any person who has died within thirty (30) days of my death, or under such circumstances that the order of our deaths cannot be established by proof, shall be deemed to have predeceased me. Any person (other than myselO who has died at the same time as any beneficiary under this Will, or in a common disaster with that beneficiary, or under such circumstances that the order of deaths cannot be established by proof, shall be deemed to have predeceased that beneficiary. ITEM XIII: If I survive my wife, CAROLYN R. SMITH, I appoint my sister-in-law, ELLEN L. ROSS, to be the Guardian of the person of my stepson, MICHAEL SCOTT COBERLY. If she is unable or unwilling to act as Guardian, I appoint my sister-in-law, DOROTHY KNIGHT, to serve as Guardian of the person. ITEM XIV: I appoint my wife, CAROLYN R. SMITH, to be the Executrix, referred to in this Will as "Executor". In the event of her death, inability or refusal to serve, I appoint my sister-in-law, ELLEN L. ROSS, to be the Executor, Trustee, or both. In the event of the death, inability or refusal of both to serve, I appoint my sister-in-law, DOROTHY KNIGHT, to serve as the Page 10 ~ . . Executort Trustee or both. The Executort Trustee and Guardian are specifically relieved from the obligation of filing bond or entering security. IN WITNESS WHEREOFt I have set my hand and seal to thist my Last Will and Testamentt consisting of this and the preceding ten (10) pages, at the end of each page of which I have also set my initials for greater security and better identification this 3~day of ~ ~ V , 1~ ,--"., QG.<=? ~ -&sEAL) DAVID O. SMITH We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. \9.- C!)?~ !l:>JVJ (SEAL) Residing at 36-, ;J i )( 7/Uf-iJeP'.... C-J- 11 Pj)frrd 11/ /7 tJ7 'f ~d ';;"/1) (SEAL) Residing at ~ D l ~ ~ L ~ ~b vi \~I '7A- c:o</-;i-- (SEAL) Residing at . 4 , ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ])/lJj7,y~ ) SS: COUNTY OF ) I, DAVID O. SMITH, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expres~ ~ ' &..EAL) . ~' --'-6R DAVID O. SMITH Sworn to and subscribed before me this cJa tl day of Alil/,Al/v- ,1991: /;; 4'J~ Notary Public My Commission Expires: (SEAL) NOTARIAL SEAL VICKY ANN TRIMMER, Notary Public SuSQuehanna Twp., Dauphin County . My Commission Expires MaiCh 11, 2002 \ . . .. , AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) 7)/lJ,PH~ ) SS: COUNTY OF ) We, ~.2)J1e,~ ffi.R/\l '~\Q. ~~ and , the Witnesses whose n es are signed the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, DAVID O. SMITH, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as Witnesses; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~'V~ ~/ '-/ / Witness Witness Sworn to and subscribed before me this JO t( day of ##11#-""'4 AI"" , 19~ 4Vo Notary Public My Commission Expires: (SEAL) . --.~...... ~--- i NOTARIAl SEAL [;' .~i('( ANN TRIMMER, NolaI}' PobIic 156042_1 S:"'1"p,r,~l')na Twp., Dauphin County My i .. ..::' ,"'~ ',</>;res March 11,2002 ROc.;(:i .-~; of fie" - , '. ;;.... '03 JUL -8 mo :09 C's';" GWnb: 0 \!) I.LI 01 0 C 0 iii c !::: ::x:: o :s: <( o < - 8 ~ .J ~ ---.. H I- ~ ~ ~ < t (fl Ul >- ) (I) >- oo . Z w z ') t 0 .:( ~ Q > ~ c.. . 'OJ{'" Cl I.LI I- . H <( Cl 0:: ~ :> I.LI :J F:t: I- al Cl l- (/) I.LI cr ~ 0:: <( I I . . ~- - - CERTIFICA TION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DAVID O. SMITH Date of Death: May 30, 2003 File No. 21-03-0559 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Julv 15. 2003: Name Address Carolyn R. Smith 32 Burwick Drive, Mechanicsburg, PA 17055 Simon John Smith Greengages, Gunville Hill, Winterslow Salisbury Wilts England SP51 PU Joanna Claire Moreman 24 Clayfurlong, Kemble Glos England GL76AP Archie William Fooks-Smith Greengages, Gunville Hill, Winterslow Salisbury Wilts England SP51 PU Jade Louise Moreman 24 Clayfurlong, Kemble Glos England GL76AP Jacob Aaron Moreman 24 Clayfurlong, Kemble Glos England GL76AP Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: Julv 15. 2003 ~d~ Signatur Vicky Ann Trimmer, Esquire 3401 North Front Street Harrisburg, PA 17110 Address ':;lUI;'~) ~-.~) (717) 232-5000 Telephone 9C' 1[" 9l lW' &pacity: c.' l. tJ I _ Personal Representative ---X- Counsel for Personal Representative lc:-~)etl :331255 _1 . \ METTE. EVANS & WOODSIDE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW HOWELL C. METTE KATHRYN L. SIMPSON 3401 NORTH FRONT STREET VICKY ANN TRIMMER ROBERT MOORE P. DANIEL ALTLAND P.O. BOX 5950 TIMOTHY A. HOY - CHARLES B. ZWALLY ANDREW H. DOWLING HARRISBURG. PA 1711.0-0950 KATHLEEN DOYLE Y ANINEK PETER J. RESSLER MICHAEL D. REED JAMES M. STRONG OF COUNSEL LLOYD R. PERSUN PAULAJ. LEICHT IRS NO. JENNIFER A. Y ANKANICH JAMES W. EVANS CRAIG A. STONE GARY J. HElM 23-1985005 RANDALL G. HURST* - JAMES A. ULSH DAVID A. FITZSIMOSS MARK D. HIPp DANIEL L. SULLIVAN GUY P. BENEVENTA."iO TELEPHONE FAX RONALD L. FINCK STEVEN D. SNYDER THOMAS F. SMlDA (717) 232-5000 (717) 236-1816 ScOTT C. SEUFERT 'MARYLAND BAR JEFFREY A. ERNICO JOHN F. Y ANINEK* - http://www.mette.com September 2, 2003 ...._". ,,'" " ~'-' 0 VIA CERTIFIED MAIL \..,,--'. RETURN RECEIPT REQUESTED Mary C. Lewis 1 '........,J Register of Wills Office - .., ,- Cumberland County Courthouse -'\. . . One Courthouse Square .'-"- '-- Carlisle, PAl 70 13 RE: Estate of David O. Smith 11843.1 S.S.N. of Decedent: 248-35-1278 File No. 21-03-0559 Dear Ms. Lewis: Enclosed is a check payable to "Register of Wills, Agent" in the amount of $8,500.00, representing a prepayment of inheritance tax in the above-referenced estate. Please send a receipt for the inheritance tax payment to my attention in the enclosed envelope. Thank you for your assistance. Very truly yours, ~fV\t)~ LisaJ. Kn e Paralegal to icky Ann Trimmer Enclosures cc: Carolyn R. Smith, Executrix :335519 _I r- .~ METTE, EVANS & WOODSIDE f"i~~-- -.S-~~-~~):;~--~ A PROFESSIONAL CORPORATION ()(.,\~. li- '~l' I'~~ --;:,\.", ~.I~I ATTORNEYS AT LAW \ SEP. 2'~3 '., '1', ? 10:' ~L . \. \.";, i'.~ {i<il 3401 NORTH FRONT STREET '''~ "''''''''I1i P,O, BOX 5950 '"L!~/IJ'''''''"' : HARRISBURG, PA 17110-0950 ;;) 1- 03 - 5-S-C] Mary C. Lewi s Register of Wills Office Cumberland County Courthouse One Courthollse Square Carlisle, PA 17013 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 002970 METTE EVANS & WOODSIDE 3401 NORTH FRONT ST PO BOX 5950 HARRISBURG, PA 17110-0950 ACN ASSESSMENT AMOUNT CONTROL NUMBER ___~__n fold _____w____ -------- 101 I $8,500.00 ESTATE INFORMATION: SSN: 248-35-1278 I FILE NUMBER: 2103-0559 I DECEDENT NAME: SMITH DAVID 0 I DATE OF PAYMENT: 09/03/2003 I POSTMARK DATE: 09/02/2003 I COUNTY: CUMBERLAND I DATE OF DEATH: 05/30/2003 I I TOTAL AMOUNT PAID: $8,500.00 REMARKS: VICKY ANN TRIMMER ESQUIRE C/O METTE EVANS & WOODSIDE CHECK# 872-10843 INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX (6-00) OFFICIAL USE ONLY COMMONWEALTH OF REV-1500 PENNSYLVANIA DEPARlMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 - 03_ ~55L__ COUNlY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Smith, David O. 248-35-1278 z w DAlE OF DEATH (MM-DD-YEAR) DAlE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C 05/30/2003 02/06/1938 REGISTER OF WILLS w fd (IF APPLICABLE) SURVNlNG SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C Smith, Carolyn R. 402-72-3313 w !Xl 1. Original Retum D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) I- ~ ~fJ) D 4. Limned Estate D 4s. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required U D::lIC: wll..O ~ 6. Decedent Died Testate (Attech copy of ~II) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposn Boxes :tOO U D::..J ll..U1 D 9. Litigation Proceeds Received D 10. Spousal Poverty Credn (date of death between 12-31-91 and 1-1-95) D 11. Election to tax under See. 9113(A)(AtlachSchO) ~ nllSSECTION MUST BE COMPLETED.AL.L CORRESPONDENCE AND CONFIDENTIAL.TAX!NFORMATlCii'\l SHOULD BE DIRECTED TO: I- NAME COMPLElE MAILING ADDRESS z w Vicky Ann Trimmer, Q Esquire z 3401 N. Front Street 0 FIRM NAME (If Applicable) D.. Ul PO Box 5950 ~ Mette, Evans & Woodside a:: lELEPHONE NUMBER Harrisburg, PA 17110-0950 8 717-232-5000 1. Real Estate (Schedule A) (1) 0.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 0.00 4. Mortgages & Notes Reeeivable (Schedule D) (4) 0.00 5. Cash, Bank Deposns & Miscellaneous Personal Property (5) 204,286.25 (Schedule E) Z 6. JO Owned Property (Schedule F) (6) 0.00 0 i= Separate Billing Requested ::s 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 67,195.78 :) (Schedule G or L) I- 0: 8. Total Gross Assets (total Lines 1-7) (8) 271,482.03 ~ 10,302.03 w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) a::: 1 O. Debts of Decedent, Mortgage Liabilnies, & Liens (Schedule I) (10) 0.00 11. Total Deductions (total Lines 9 & 10) (11) 10,302.03 12. Net Value of Estate (Line 8 minus Line 11) (12) 261,180.00 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 0.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 261,180.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 67,581. 82 X.OO_ (15) 0.00 Z rate. or transfers under See. 9116 (a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 193,598.18 x .045-- (16) 8,711. 92 <I: I- :::::l 0.00 0.00 ll.. 17. Amount of Line 14 taxable at sibling rate x .12 (17) :E 0 0.00 0.00 0 18. Amount of Line 14 taxable at collateral rate x .15 (18) >< ~ 19. Tax Due (19) 8,711. 92 20. [2g CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE; TO ANSWER ALL dUESTION$ CJN ~EV!:~$E S'P~ AND~!:C..t1;!::l'( M~TH< < 2W4645 1.000 .' Decedent's Complete Address: STREET ADDRESS 32 Burwick Drive CITY I STATE I ZIP Mechanicsburq PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1 ) 8,711.92 2. Credits/Payments A. Spousal Poverty Credit 0.00 8. Prior Payments 8,500.00 C. Discount 435.60 Total Credits (A + 8 + C) (2) 8,935.60 3. Interest/Penalty if applicable D. Interest 0.00 E. Penalty 0.00 TotallnteresUPenalty (D + E) (3) 0.00 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) 223.68 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) b. --"_ 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;. . . . . . . . . . . . . . . . . . . . . . . D [Xl b. retain the right to designate who shall use the property transferred or its income;. . . . . . . . . D [Xl c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D [Xl d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . D [Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . D [R] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D [R] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !Xl D IF THE ANSWER TO ANY OF THE ABOYE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I ha"" examined this return. including accompanying schedules and statements. and to the bast of my knowledge and belial. It is lNe. correct and complate. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 17110-0950 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 3% [72 P.S.~ 9916 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the nat value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~ 9116 (a) (1.1) (Ii)) The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 perent, or a stepparent of the child is 0% [72 P .S. ~ 9116 (a)( 1 .2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries Is 4.5%, 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 12% (72 P.S. ~ 9116(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. " 2W4646 1.000 RE;.y-150e EX +,(1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Smith, David O. 21-03-0559 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Fulton Bank Money Market Account #9932-35794 2,087.85 Accrued interest on above account 0.22 2 Merrill Lynch Account #872-50942 192,771.55 Accrued income on above account 826.63 3 Vehicles - motorcycle and 1996 Dodge Neon owned by Decedent 8,600.00 .,. TOTAL (Also enter on line 5 Recaoitulation\ $ 204,286.25 2W46AD 2.000 (If more space is needed, insert addKional sheets of the same size) . REV-1510 EX + (1-97) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, David O. 21-03-0559 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPER1Y . %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBEF DECEDENT AND THE DAlE OF TRANSFER. ATTACH A COpy OF THE VALUE OF ASSET INTEREST (IF APPUCABLEl DEED FOR REAL ESTAlE. 1. Merrill Lynch IRA Account 67,195.78 100.00 0.00 67,195.78 #872-77155. Beneficiary: Carolyn R. Smith TOTAL (Also enter on line 7, Recapitulation) $ 67,195.78 (If more space is needed, insert additional sheets of same size.) 2W46AF 2.000 REV-1511 EX: (1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, David o. 21-03-0559 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cremation Society of Pennsylvania 1,300.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Name: Mette, Evans & Woodside 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Smith, Carolyn R. Street Address 32 Burwick Drive City Mechanicsburg State PA Zip 17055 Relationship of Claimant to Decedent Spouse 4. Probate Fees 321. 50 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. The Sentinel - legal advertising 105.53 8 Cumberland County Law Journal - legal advertising 75.00 ~ TOTAL (Also enter on line 9, Recapitulation) $ 10,302.03 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith David O. 21-03-0559 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DI STRI BUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Smith, Carolyn R. Spouse 67,581. 82 32 Burwick Drive Mechanicsburg, PA 17055 2 Smith, Simon J. Son 89,299.09 Greengages, Gunville Hill Winterslow Salisbury Wilts England SP51PU 3 Moreman, Joanna C. Daughter 89,299.09 24 Clayffurlong Kemble Glos England GL76AP 4 Fooks-Smith, Archie W. Grandson 5,000.00 Greengages, Gunville Hill Winterslow Salisbury Wilts England SP51PU 5 Moreman, Jade L Granddaughter 5,000.00 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 2W46A11.000 (If more space is needed, insert additional sheets of the same size) . Page 2 Estate of: Smith, David O. 21-03-0559 Schedule J Part 1 -- Beneficiaries Item Amount or No. Name and Address of Person(s) receiving property Relationship Share of Estate - 5 24 Clayfurlong Kemble Glos England GL76AP 6 Moreman, Jacob A. Grandson 5,000.00 24 Clayfurlong Kemble Glos England GL76AP . . CODICIL TO THE WJ[LL OF DAVID O. SMITH I, DAVID O. SMITH, of Franklin Township, York County, the within named Testator, do hereby make and publish this Codicil to my Last Will and Testament, dated November 30,1998. I hereby modify said Last Will and Testament as follows: ITEM I: ITEM IV of said Last Will and Testament is deleted and replaced as follows: ITEM IV: I make the following gifts: My Merrill Lynch CMA Sub-Account #872-50942 shall be divided as follows: , (a) Four Thousand Three Hundred ($4,300) Dollars to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. (b) Five Thousand ($5,000) Dollars each to my then living grandchildren. (c) One-half of the balance to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. (d) One-half of the balance to my daughter, JOANNA CLAIRE MOREMAN, or her then living issue, per stirpes. In all other respects I confirm and ratify my aforesaid Last Will and Testament. . . IN WITNESS WHEREOF, I have hereunto set my hand and seal this B-1t day of August, 2002. ~,Qe.~~ . ~) DAVID O. SMITH We, the undersigned, hereby certify that the foregoing Codicil was signed, sealed, published and declared by the above-named Testator as and for a Codicil to his Last Will and Testament, in the presence of each of us, who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. ~~~(SEAL) Residing at /IJ cA;e., tvn.1't:;$ 4 (lf~GJ.'AM~~J ,'-'~ /: /70.]7- ~ (SEAL) Residing at ~r; ~~ /)r. <altrs p^ , 7#;/7 Residingat ,C) n. 0) S1 Si. lYlr~~,0 J! )0:} . . ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA) COUNTY OF ~U"u ) SS: ) I, DAVID O. SMITH, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~.-.::...,.Q ,~) . ~ 0.~ DAVID O. SMITH Sworn to and subscribed before me this. gt:Jv_day of August, 2002 0LWclOito Notary Public My Commission Expires: (SEAL) - Notarial Seal N tary Public TIna l.. Otto. 0 au hln County SUsquehanna T~r~ s~pt. 14, 200'2 J My CommiSSion . ~~2JY.:!S - MEJnbel'.~ ., ," AFFIDAVIT cOMM:GNWEALTH OF PENNSYLVANIA) ) SS: COUNTY OF ) We, ~ c~ A,.;,., T ri ~ r"v- , H01'\~J. ~ and , he Witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, DAVID O. SMITH, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as Witnesses; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. 14(1-t:::: ~ -~ Witness Sworn to and sribscribed.before me this ~day of August, 2002. J~(fJlo Notary Public My Commission Expires: (SEAL) Notarial seal public Tina L. Otto, NO~~phln County SUSQuehanna T~rBs Sept 14. 2002 My comm\SSlon . ~Ndat'/;:S MEJnbef.~JariaA! :270462 _1 " Last Will and Testament OF DAVID O. SMITH I, DAVID o. SMITH, of Franklin Township, York County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death shall be borne by the recipient of the property and shall not be borne by the residue of my estate. The Executor shall have a duty or obligation to obtain reimbursement for any tax paid by my estate from the recipient of the property upon which the tax is imposed. ITEM IT: I direct the Executor to pay the expenses of my last illness and funeral expenses from the residue of my estate as an expense and cost of administration of my estate. ITEM ITI: I may leave a written list in my safe deposit box or elsewhere disposing of certain items of my tangible personal property. The Executor shall dispose of items of my personal property as specified in the written list. If no written list is found in my safe deposit box or elsewhere and properly identified by the Executor within thirty (30) days after the probate of my Will, it shall be presumed that there is no list; any subsequently discovered list shall be ignored. If I die before my wife, CAROLYN R. SMITH, I give to her all of my household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment and aJl policies of insnrance thereon not found on the writteu ~ Page 1 _ '.. . , , do not die before my wife, I make this gift to my children living at the time of my death, to be divided among them as they shall agree. Should there be no agreement, the Executor shall divide this property among them in as nearly equal portions as the Executor, in the sole discretion of the Executor, deems appropriate, having due regard to the personal preferences of my children. ITEM IV: I make the following gifts: My Merrill Lynch CMA Sub-Account #872-50942 shall be divided as follows: (a) $5,000 each to my then living grandchildren. (b) One-half of the balance to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. (c) One-half of the balance to my daughter, JOANNA CLAIRE MOREMAN, or her then living issue, per stirpes. ITEM V: I give the residue of my estate, not disposed of in the preceding portions of this Will, to my wife, CAROLYN R. SMITH, if she survives me. If she does not survive me, I give the residue to: (a) One-quarter to my son, SIMON JOHN SMITH, or his then living issue, per stirpes. Page 2 ~. (b) One-quarter to my daughter, JOANNA CLAIRE MOREMAN, or her then living issue, per stirpes. (c) One-half to ELLEN L. ROSS, as Trustee, for the benefit of my stepson, MICHAEL SCOTT COBERLY, if then living, to be administered pursuant to ITEM VI. If MICHAEL SCOTT COBERLY should predecease me, this share shall pass in equal shares to my then living grandchildren. ITEM VI: The following provisions shall apply to the Trust established by ITEM V(c): (a) The Trustee, during the lifetime of MICHAEL SCOTT COBERLY, shall pay so much of the net income arising from the principal of this Trust as the Trustee, in the sole and unfettered discretion of the Trustee, deems adVisable, to or for the benefit of MICHAEL SCOTT COBERLY. I make this trust for MICHAEL SCOTT COBERLY with full understanding of his physical and mental disabilities. I intend that the Trustee accumulate income for the benefit of the remaindermen, including the Trustee, to the extent the Trustee deems accumulation appropriate. I understand that various entitlement programs exist for which he may qualify. If eligible, I wish him to receive the benefits available through these programs. I do not intend, by this trust, to provide support or maintenance for MICHAEL SCOTT COBERLY. MICHAEL SCOTT COBERLY shall be deemed to have predeceased me upon the occurrence of any of the following ev~ Page 3 .. - (1) A ruling that the provisions of this paragraph are void as against public policy; (2) A ruling that the net income or principal of this Trust is subject to the claims of an agency or governmental entity for services rendered to him; or (3) A ruling that the income or principal or this Trust is a resource of MICHAEL SCOTT COBERLY for the purpose of determining his eligibility or entitlement to benefits from any agency or governmental entity. (b) Upon the death of MICHAEL SCOTT COBERLY, the trust shall terminate and the principal shall be distributed to my then living grandchildren, in equal shares. ITEM VII: If any beneficiary under this Will is under the age of twenty-five (25) years at the time of my death, or at the time they become entitled to any interest under this Will, their share shall be held in a trust by Merrill Lynch and my children, SIMON JOHN SMITH and JOANNA CLAIRE MOREMAN, or the survivor of them, as Trustee, IN TRUST NEVERTHELESS, and shall be administered and distributed as follows: (a) The Trustee shall pay to or for his or her benefit, in convenient, at least annual, installments, all of the net income. The Trustee shall also pay to or for the benefit of that issue (the "Beneficiary") so much of the principal of this Trust as the Trustee, in the sole discretion of the Trustee, considers necessary to maintain the Beneficiary in the proper station in life, including proper support, maintenance, medical care and college or higher education. ~, Page 4 . (b) Upon the attainment of the age of twenty-five (25) years by the Beneficiary, the Trust shall terminate, and the Trustee shall distribute to the Beneficiary all the assets of the Trust. (c) If the Beneficiary dies before final distribution of the assets of the Trust, but is survived by then living issue, the Trustee shall quarterly pay the net income from this Trust to or for the benefit of the Beneficiary's issue, per stirpes, living at each time of quarterly distribution. As soon as anyone of the Beneficiary's issue attains the age of twenty-one (21) years, but in no event later than twenty (20) years following the death of the Beneficiary, the Trustee shall pay over all of the assets in the Trust to the then living issue of the Beneficiary, per stirpes. Should such Beneficiary die before final distribution of this Trust and not be survived by issue, the provisions of subparagraph (d) shall apply. (d) If, before final distribution of the assets of any Trust established for my children or issue of a deceased child, there is no living beneficiary of that Trust, it shall terminate. The principal of the Trust shall be divided and distributed pursuant to the terms of ITEM V. If any Trust created for issue of deceased children had previously been terminated, the beneficiaries who received the principal of that Trust shall collectively be considered a "Trust" for the purpose of this paragraph, and one share shall be paid directly to each beneficiary in the same proportion by which each received the principal of the Trust. If any beneficiary is deceased, the share of the deceased beneficiary shall be paid to his or her then living issue, per stirpes. Page 5 ~ , . ITEM VIII: No part of the income or principal of any Trust created by this Will shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior to his or her actual receipt of income or principal distributed. The Trustee shall pay the net income and the principal to the beneficiaries specified by me, as their interests may appear, without regard to any attempted anticipation, pledging or assignment, and without regard to any claim or attempted levy, attachment, seizure or other process against the beneficiary. ITEM IX: The Executor and the Trustee shall each possess the following powers, each of which may be exercised without court approval and in a fiduciary capacity only: (a) To retain any investments I have at my death, including specifically those consisting of stock of any bank even if I have named that bank as the Executor or Trustee. (b) To vary investments, and to invest in bonds, stocks, notes, real estate mortgages or other securities or in other property, real or personal, without being restricted to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. (c) In order to divide the principal of a Trust or for any other purpose, including final distributions, the Executor and Trustee are authorized to divide and distribute personal property and real property, partly or wholly in kind, and to allocate specific assets among beneficiaries and Trusts so long as the total market value of each share is not affected by the division, distribution or allocation in kind. The Executor and Trustee are esch authorized to make, ~ Page 6 . and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale real and personal property severally or in conjunction with other persons, and to consummate sale(s) by deed(s) or other instrument(s) to the purchaser(s), conveying a fee simple title. No purchaser shall be obligated to see to the application of the purchase money or to make inquiry into the validity or any sale(s). The Executor and Trustee are authorized to execute, acknowledge and deliver deeds, assignments, options or other writings as necessary or convenient to any of the power conferred upon the Executor and Trustee. (e) To mortgage real estate, and to make leases of real estate. (f) To borrow money from any person, including the Executor or Trustee, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate and other taxes, and to assign and pledge assets of my estate or any Trust established by this Will. (g) To pay all costs, taxes, expenses and charges in connection with the administration of my estate or any Trust established under this Will. (h) To make distributions of income and of principal to the proper beneficiaries, during the administration of my estate, with or without court order, in such manner and in such amounts as the Executor deems prudent and appropriate. ~ Page 7 . (i) To vote shares of stock which form a part of my estate or any Trust established under this Will, and to exercise all the powers incident to the ownership of stock. (j) To unite with other owners of property similar to property in my estate to carry out plans for the reorganization of any company whose securities form a part of my estate. (k) To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee of an inter vivos transfer, and as a donee under a third-party beneficiary contract. (1) To prepare, execute and file tax returns of any type required by applicable law, and to make all tax elections authorized by law. (m) To employ custodians of property, investment or business advisors, accountants and attorneys as the Executor or Trustee deems appropriate, and to compensate these persons from assets of my estate or trust, without affecting the compensation to which the Executor and Trustee are entitled. (n) To divide any Trust created in this Will into two or more separate Trusts so that inclusion ratio for purposes of the generation- skipping transfer tax shall be either zero or one, in order that an election under Section 2652(a)(3) of the Internal Revenue Code may be Page 8 k made with respect to one of the separate Trusts, or for any other reason. (0) To allocate administrative expenses to income or to principal, as the Executor or Trustee deems appropriate. However, no allocation to income shall be made if the effect of the allocation is to cause a reduction in the amount of any estate tax marital deduction or estate tax charitable deduction. (p) To do all other acts in their judgment necessary or desirable for the proper and advantageous management, investment and distribution of the estate and Trusts established under this Will. ITEM X: , The Trustee is authorized to distribute principal and/or income in anyone or more of the following ways if the Trustee, in the sole discretion of the Trustee, considers the beneficiary unable to apply distributions to the beneficiary's own best interests, or if the beneficiary is under a legal disability: (a) Directly to the beneficiary; (b) To the legal guardian or conservator of such beneficiary; (c) To the Trustee, or to another person selected by the Trustee, as custodian under the Pennsylvania Uniform. Transfers to Minors Act as to a beneficiary under the age of twenty-one (21) years; (d) To a relative of the beneficiary, to be expended by that relative for the benefit of the beneficiary; or Page 9 ~ . (e) By directly applying distributions for the benefit of the beneficiary. ITEM XI: Should my wfe, CAROLYN R. SMITH, by Will or Agreement of Trust, establish Trusts similar to the Trusts I have established for the benefit of my issue, the Trustee of each Trust created in this Will shall have the right to merge it with the similar Trust created by my wife for the same beneficiaries. If merged, the Trustee shall operate the merged Trusts as a single Trust. ITEM XII: Any person who has died within thirty (30) days of my death, or under such circumstances that the order of our deaths cannot be established by proof, shall be deemed to have predeceased me. Any person (other than myself) who has died at the same time as any beneficiary under this Will, or in a~common~disaster,withthat-beneficiary-,o~ under-such-circumstances--- that the order of deaths cannot be established by proof, shall be deemed to have predeceased that beneficiary. ITEM XIII: If I survive my wife, CAROLYN R. SMITH, I appoint my sister-in-law, ELLEN L. ROSS, to be the Guardian of the person of my stepson, MICHAEL SCOTT COBERLY. If she is unable or unwilling to act as Guardian, I appoint my sister-in-law, DOROTHY KNIGHT, to serve as Guardian of the person. ITEM XIV: I appoint my wife, CAROLYN R. SMITH, to be the Executrix, referred to in this Will as "Executor". In the event of her death, inability or refusal to serve, I appoint my sister-in-law, ELLEN L. ROSS, to be the Executor, Trustee, or both. In the event of the death, inability or refusal of both to serve, I appoint my sister-in-law, DOROTHY KNIGHT, to serve as the Page 10 ~ '. " Executor, Trustee or both. The Executor, Trustee and Guardian are specifically relieved from the obligation of filing bond or entering security. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding ten (10) pages, at the end of each page of which I have also set my initials for greater security and better identification this ..3~day of ~ (hV , 1~ '-_.~-Qg.<? ~~EAL) DAVID O. SMITH We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. ~tNuj #JVJ (SEAL) Residing at 3to /$ i k ~ left. (!j- /181>>;rrd III /7t17'f- (SEAL) Residing at ~ D l ~'y,. L ~ ~bV\\~I~A: I~ (SEAL) Residing at .. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) l).4v.,P#~ ) SS: COUNTY OF ) I, DAVID O. SMITH, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expres~ .... , ~AL) ~ --Q3~ DAVID O. SMITH Sworn to and subscribed before me this r.f() tl day of AI,wAII IV" , 199j: 1/-14J~ Notary Public My Commission Expires: (SEAL) NOTARIAL SEAL VICKY ANN TRIMMER, Notary Public SUSQuehanna Twp., Dauphin County . My Commission Expires March 11, 2002 . - AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ])/lJ,PH~ ) SS: COUNTY OF ) We, ...:;,)h~ /10M! ,_~L.~~~and , the Witnesses whose n es are signed the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, DAVID O. SMITH, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as Witnesses; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~~ ~ ./ ~ Witness Witness Sworn to and subscribed before me this 30 t( day of !yP" ,FM4av- , 19'~ ~4/0 Notary Public My Commission Expires: (SEAL) --...... . : NOTARiAl SEAL [;.' .',1('( ""N TRIMMER. NO/al)" Public 156042_1 s:..'~~Ip,"Hma Twp., Dauphin County My f.... . ..;' ."!~ r:'.(~;res MaiCh 11,2002 . FUlton BaDk JUl 2 " 2003 CAPITAL DIVISION · LANCASTER/CHESTER DIVISION DROVERS BANK DIVISION · GREAT VALLEY DIVISION (717)291-2589 July 23, 2003 Tina L. Otto Mette, Evans & Woodside 3401 North Front St. PO Box 5950 Harrisburg, P A 17110-0950 Dear Ms. Otto: RE: David O. Smith, deceased May 30, 2003 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: Checking #3629-34721, open 9110/91, balance $728.16, joint with Carolyn R. Smith. Check Credit (overdraft protection account open 10/19/98 for $500, date of death balquce owing $ -0-. Money Market #9932-35794, open 11120/87, balance $2,087.85 plus accrued interest $.22, in his name only. Mortgage #5700222235, open 10/7/02, date of death principal balance owing $53,765.08, joint with Carolyn R. Smith. Please fax any payoff requests directly to our Direct Banking Center (717)569-6316. If you have any further questions, please do not hesitate to contact me. 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OJ 1:: '8l.c: .l!l "0 .c: _ UJ. > '_ ~ l'Cl .... C c: c ~ 8 a 0 ~ 5 ::I ~:8 ~ g't: E ~ ~ ~ ';t Q) eel ~ :ll """"M"go o,g,lHI.. '" ~o~.... -1(1)wa z ;: E g.2:!_ W ~'-eel>'E z ~ ~-E -g (l) "'" eel Q) eel:E Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of David O. Smith No. 21-03-0559 also known as Date of Death May 30, 2003 , Deceased Social Security No. 248-35-1278 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IM/e verify that the statements made in this Inventory are true and correct. IM/e understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Personal Representative: Attorney: Vicky Ann Trimmer, Esquire caro;:a SmRh I.D. No.: 49679 W r.W~ Address 3401 N. Front Street, PO Box 5950 Dated: i 1.. 1111/ \', 3 Telephone: Harrisburg, PA 17110-0950 DESCRIPTION VALUE 1. Fulton Sank Money Market Account #9932-35794 $ 2,087.85 Accrued income on above account .22 2. Merrill Lynch Account #872-50942 $ 192,771.55 Accrued income on above account 826.63 3. Vehicles owned by decedent $ 8.600.00 TOT AL: $204.286.25 (Attach Additional Sheets If Necessary) --- NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. 388096v1 \ \.. COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1m EX AFP IOI-DSI L,~AJ~ 03-01-2004 \h'U'ATE OF SMITH DAVID 0 DATE OF DEATH 05-30-2003 FILE NUMBER 21 03-0559 004 FEB 27 fC,ufj:BY CUMBERLAND VICKY ANN TRIMMER ESQ ACN 101 METTE ETAL I '.o~t _moO I PO BOX 5950 t ;c'iV- ._,~ourt HBG PA 17110 ClnnnenanG Co., PA 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=is'4-j-E3f-AFP-COY:oiY-NCfficE--OF-YtiHEififANCE-"AX-A-PPRA-isEi"-ENT~--ALioWAirCE-'i:rR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMITH DAVID 0 FILE NO. 21 03-0559 ACN 101 DATE 03-01-2004 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) (1).00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2).00 credit to your account. 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subnit the upper portion 4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this forn with your 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 204,286.25 tax paynent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 67 .195. 78 8. Total Assets (8) 271.482.03 APPROVED DEDUCTIONS AND EXEMPT~ONS: 10.302.03 9. Funeral Expenses/Adn. CostS/HISC. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 10.302 03 12. Net Value of Tax Return (12) 261.180.00 13. Charitable/Governnental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 261.180.00 NOTE: I~ an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate (15) 67.581.82 X 00 = .00 16. Anount of Line 14 taxable at Lineal/Class A rate (16) 193,598.18 X 045= 8.711.92 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 8.711.92 TAX CREDITS: n~_~.. l+j DATE NUHBER INTEREST/PEN PAID (_) AHOUNT PAID 09-02-2003 CD002970 .00 8.500.00 INTEREST IS CHARGED THROUGH 03-16-2004 TOTAL TAX CREDIT 8.500.00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 211.92 REVERSE SIDE OF THIS FORM INTEREST AND PEN. .37 TOTAL DUE 212.29 y-- · IF PAID AFTER DATE INDICATED. SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. 0 FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)~ RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-30Z0 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z003 are: Interest DailY Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZO% .000548 1987 9% .000Z47 1999 7% .00019Z 1983 16% .000438 1988-1991 11% .000301 ZOOO 8% .000Z19 1984 11% .000301 199Z 9% .000Z47 ZOOl 9% .000Z47 1985 13% .000356 1993-1994 7% .00019Z ZOOZ 6% .000164 1986 10% .000Z74 1995-1998 9% .000Z47 Z003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. I ~ COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REV-1607 EX AFP (01-05) Rec)( ::dATE 03-08-2004 R00 !SESTATE OF SMITH DAVID 0 DATE OF DEATH 05-30-2003 FILE NUMBER 21 03-0559 '04 MAR 12 P 1 ItHiJNTY CUMBERLAND VICKY ANN TRIMMER ESQ ACN 101 METTE ETAL '.'.-... I Anount Renitted I PO BOX 5950 (>'::1 . HBG PA 1711 0 Curnb~" MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i6'ifj-ix--AFP--foY:oiY------...--fNHERIY-ANc'E--TAx--sTA-fEH'E-NT-'ifF-AC-COl.itif--.-..---------------- - - --- ESTATE OF SMITH DAVID 0 FILE NO. 21 03-0559 ACN 101 DATE 03-08-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-01-2004 P R I N C I PAL T A X DUE: ........................................................................................................................................................................................................................... 8 , 711 . 9 2 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (_) AMOUNT PAID 08-30-2003 CD002970 435.60 8,500.00 03-02-2004 REFUND .00 223.68- TOTAL TAX CREDIT 8,711.92 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REYERSE TOTAL DUE .00 SIDE 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 INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. __ If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS. AGENT. __ If NDN-RESIDENT DECEDENT make check or money order payable to: CO""ONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "'Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Dffice of the Register of Wills, any of the 23 Revenue District Offices or from the Department.s 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent.s death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The l5Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor - - - - - - - 1982 20Z .000548 1988-1991 nz .000301 2001 9Z .000247 1983 l6Z .000438 1992 9Z .000247 2002 6Z .000164 1984 nz .000301 1993-1994 7Z .000192 2003 5Z .000137 1985 13Z .000356 1995-1998 9Z .000247 2004 4Z .ooono 1986 10Z .000274 1999 7Z .000192 1987 9Z .000247 2000 8Z .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 4/15/2005 TRIMMER VICKY ANN 3401 NORTH FRONT STREET HARRI SBURG , PA 17110-0950 RE: Estate of SMITH DAVID 0 File Number: 2003-00559 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) 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 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: 5/30/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge vJ - PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: David O. Smith Date of Death: Mav 30. 2003 Will No. 2003-00559 Admin. No. 21-03-0559 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~ NoD 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.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? YesD No~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: - c. Did the personal representative state an account informally to the parties in interest? Yes ~ No D d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: b /;l/C} ~ ~14-~ Signatu / Vickv Ann Trimmer. ESQ.. Attv. ID #49679 Name (Please type or print) 3401 North Front Street. P.O. Box 5950 Address Harrisbure-. PA 17110-0950 (717) 232-5000 Telephone Capacity: D Personal Representative ~ Counsel for Personal Representative cuf 426244v1 ~ Estate of SMITH DAVID 0 : ORPHANS' COURT DIVISION Late of SILVER SPRING TOWNSHIP : COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY Estate No. : 21-03-00559 : PENNSYLVANIA : Date: 6/10/2005 : NO. : 21-03-00559 SMITH CAROLYN R 32 BURWICK DRIVE MECHANICSBURG PA 17055 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6. 12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: SMITH CAROLYN R Personal Representative Counsel: TRIMMER VICKY ANN Date of Decedent's Death: 5/30/2003 Date of Delinquency Notice: 5/30/2005 The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans' Court, in accordance with rule 6.12, Supreme COurt Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of CUmberland County, that neither the above named personal representative nor their counsel, have filed with the Register of Wills or Clerk of Orphans' Court, hiS/her Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule, and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orhans' Court Rules, was given by the Clerk of Orphans' Court on 4/07/2005 and that the ten (10) day notice to file the status report has expired. Accordingly, in aCCordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or their counsel. cc: File ~~~ Personal Representative Glenda Farner Strasbaugh Counsel Clerk of Orhans' Court at 9:30 AM in cd