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Home My WebLink About03-06-12 1505611180 REV-1500 ~I02-„)1F') OFFICIAL USE ONLY PA De artment of Revenue Pennsylvania Count Code Year File Number p DEPARTMENT OF REVENUE y Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~ Hamsburg, PA 17128-0601 RESIDENT DECEDENT ~ ~~ I ~ I 'J ~I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 192-14-5621 06252011 03101923 Decedent's Last Name Suffix Decedent's First Name MI SMITH RAY E (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 BOXES BELOW Q 1. Original Return 0 2. Supplemental Return ~ 3. Remainder Return (Date of Death Prior to 12-13-82) 0 4. Limited Estate Q 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (Date of Death 0 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedules O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ROBERT G. FREY 7172435838 First Line of Address 5 S HANOVER ST Second Line of Address City or Post Office CARLISLE State ZIP Code PA 17013 Correspondent's a-mail address: R F R E Y a~ F R E Y T I L E Y. C O M REGISTER OF WILLS USE ONLY 7 . ~ C> ^a - :y ~ 77 =.:J ~ ~ -=j y: C i - ` ~. - .-ice Ln. r e ~ .f 4 - I T .' r . - C ^ -~^}~-J-:, ' ~ - 1~; - ~-' >~~'r~ 'T .F'. D/CT& FILED .. -J`-,-,' {-~ ~: ;: ; _, T} ~:~ _.,~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU _OF PERSON RESPONSIBLE FOR FILING RETURN (DATE ADDRESS 625 LSON ST CARLISLE PA 17013 SIGNA R OF PRE R AN R ESENTATIVE IRATE 03/06/12 ADDRESS 5 SOUTH HANOVER ST_ CAR LE_ PA 17103 LEASE USE ORIGINAL FORM ONLY Side 1 1505611180 1505611180 J J 1505611280 REV-1500 EX (FI) Decedent's Social Sec;urity Number Decedent's Name: RAY E SMITH 192-14-5621 RECAPITULATION 1. Real Estate (Schedule A) ......................................... 1. N 0 N E 2. Stocks and Bonds (Schedule B) .................................... 2. 17 4 2.0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ........................ 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. N 0 N E 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ....... 6. N 0 N E 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ....... 7, N 0 N E 8 Total Gross Assets (total Lines 1 through 7) .. ......... . 8. 17 4 2 . 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. N 0 N E 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. NON E 11. Total Deductions (total Lines 9 and 10) ............................ . 11. 0 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 17 4 2 • 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0 0 0 an election to tax has not been made (Schedule J) ............ ........ . 13. • 14 Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 17 4 2 • 0 0 TAX CALCULATION -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 0 1742.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X . 12 17. 0 • 0 0 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 0 0 19. TAX DUE .... .. .............................................. . 19. 0 . 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 1505611280 1505611280 J REV-1500 EX (FI) Page 3 File Number 192-14-5621 rlcrc~lant'c Cmm~lata Address DECEDENT'S NAME RAY E SMITH - STREET ADDRESS CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) 0.00 Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) 0.00 (4) 0.00 (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT -.-rr+r-.+-,. ...,..-.-----^. -^---""'""---•--~.~-+.,........-..,...~+.~--~-.~.*~..-r*aeq^^r•,en,,,-,s,w+.+.'a~.....r+..,.......,a..-...,.~..r w.-.,.r•~.++...w~?-.san•.^r-*.+.~^•~m--..n PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: ferred f th rt t i Ye., ^ No ^ ................................................................................. rans e prope y ncome o a. retain the use or ...... b. retain the right to designate who shall use the property transferred or its income .................................... ...... ^ ^ c. retain a reversionary interest .................................................................................................................... ...... ^ ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ...... ^ ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................... ...... ^ ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ...... ...... ^ ^ 4. Did decedent own an individual retirement 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [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 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 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the nei value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in (72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 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-1503 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Ray E Smith All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 95.255 shares of Sentinel Investments Mid-Cap @18.29 per share 1,742 TOTAL (Also enter on line 2 Recapitulation)~$ 1,7 (If more space is needed, insert additional sheets of the same size) SNTNX Historical Prices 'I SENTINEL MID CAP FUND CLASS AStock -Yahoo! Finance 3/6/1? 10:53 AM Search Search Weber __ ~_- -- Get Quotes Tue, (vlar e. 2D^2, 10:53Aiv1 ES i - U ci Iv9arkets close in 5 hrs ;miss Dow ~-1.33% Nasdaq 31.52,6 y f i.~ ~ _. f'.NE~i~'! NF6FEP,nGE SEN.V(CES Li{ __.. SENTINEL MID CAP FUND CLASS A (SNTNX) add to Portfolio ' 19.35 3o.~s~a.~sQio~ Mars - - ~~ --, Histoncal Pnces Get Historical Prices for: ~ G` 0.; Set Date Range _ Daily Start Date: ' lu` n' ~ I 25 2011 i. Eg. Jan 1, 2010 ~° _. ,,,~ Weekly a~'Monthly End Date: lun ~ 25 2011 • ,~zDividends Only '<Get Prices `';` First ~ Previous ~ Next ~ Last Prices Date Open Jun 24, 2011 18.29 High Low Cbse Volume Adj Close` 18.29 18.29 18.29 0 18.29 Close price adjusted for dividends and splits. First ~ Previous ~ Next ~ Last 14 "" ~ Dovrnlaad to Spreadsheet Currency in USD. :,dChaicest"' http://finance.yahoo.com/q/hp?s=SNTNX&a=05&b=25&c=2011&d=05&e=25&f=2011&g=d Page 1 oft