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This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
AUG ~ 6 200 ? ;~
Date Fran eropoli, ct
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONYIfEALTH OF PENNSYLININM • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
115818
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REV-1500 EX+ (7-94) ~,
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INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 14131191 CHECK HERE
POVERTY CREDIT IS CLAIMED ^
RESIDENT DECEDENT FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE ~~ Cl~r' ~l~•
J
DEPT. 280601 WITH REGISTER OF WILLS)
HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL( DECEDENT'S COMPLETE ADDRESS
SMITH, JAMES R. 2 Palmer Drive
uz, SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH Camp Hill,
PA Oll
20~+-30-8600 12-30-94 1-25-~+2 .
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p (IF APPLIGBLEI SURVIVING SPOUSE'S NAME (LAST, FIRST AN D MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
SMITH, CAROLS E. 162-32-3550
u+ ~ 1. Original Return ^ 2. Supplemental Return ~ ^ 3. Remainder Return
~ a rn (for dates of death prior to 12-13-82)
W d cY.+ ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
~ s ° (for dates of death aker 12-12.82)
c m ~ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
ALL CORRE ~.
„ •.
H~TIAL TA~4 tp~(;. _ ~;, :°.`
~ NA;aE COMPLETE hSAtLIN ' ADDRES
~o EYVONNE LOUISE STUCK 203 Reed Drive
v~ TELEPHONE NUMBER Marysville, PA 17053
1 - 22
1. Real Estate (Schedule A) (1) $91, 000.00
2. Stocks and Bonds (Schedule B) (2 )
3. Closely Held Stock/Partnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4 )
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) -~~.~02 • 91
z (Schedule E)
b. Jointly Owned Property (Schedule F) (6 )
~ 7. Transfers (Schedule G) (Schedule L) (7 )
~
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8. Total Gross Assets (total Lines 1-7)
(8) )'/
1~6•s902 • 91
9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 13 X039.60
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 51, 3+5.70
1 1. Total Deductions (total Lines 9 & 10) (11) 6~F, 385 • 30
12. Net Value of Estate (Line 8 minus Line 11) (12) ~2 s • 61
13. Charitable and Governmental Bequests (Schedule J) (13)
14. Net Yalue Subject to Tax (Line 12 minus Line 13) (14) _~2 ,~`~' • 61
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15. Spousal Transfers (for dates of death aker b-30-94)
See Instructions for Applicable Percentage on Reverse (15) $7-92235.00
x.03 =
577.05
Side
(Include values from Schedule K or Schedule M
)
.
.
1 b. Amount of Line 14 taxable of b% rate (16) ~3 , 22.61 x .Ob = 3 ,7 ~6~~5
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rate (17) x .15
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) ~s3.71+• 00
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ $3,860.00 + $218.70 _ (19) x+07$,.70
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20)
~^
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 295.30
A. Enter the interest on the balance due on Line 21 A. (21A)
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 B) 295•.30
Make Cheek Payable to: Register of Wills, Agent
I- ~ T ~' ~
Under penalties of perjury, I declare that I have
it is true, correct and complete. I declare that al
based on all information of which preparer has
SIGNATUAf Of PERSON RESPONSIBLE-FOR FILING RETURt•
/ ~~ c
return, including accompanying
been resorted at true market
~, "`~
statements, and to the best of my knowledge and belief,
ion of preparer other than the personal representative is
j~~~////jj~,pv //.~,'~}~JJ'~`J~~~, // ~~JJ DATE
/3~~ ~ DA~
Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
• 39'6 (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 29/0 (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 190 (.O1) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (~~ IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transFer and:
.......................................................
a. retain the use or income of the property transferred, ~~
b. retain the right to designate who shall use the property transferred or its income, ............... ~
c. retain a reversionary interest; or ...................................................................................
d. receive the promise for life of either payments, benefits or care$ ....................................... ~'`
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate consideration$ If death occurred after
December 12, 1982, did decadent transfer property within one year of death without receiving
adequate consideration$ ...................................................................................................
3. Did decedent own an 'in trust for'. bank account at his or her death$ ......................................
~'~ .~~F Tlt~ ANWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU `'MUST ~OMPI~ETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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REV•1508 EXa 12.87) T ~ SCHEDULE -E
' ~ CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS
INHERITANCE TAX RRTURN PERSONAL PROPERTY
RESIDENT DECEDENT PI@GS@ Prlnt Or
JAMES RICHARD SMITH
(All property (ointly-owned with the Right of survivorship must M diseks~d on Schedule F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
1. 1989 Ford XLT Lariet Diesel Pick-up Truck w/Cap $11,000.00
2. Whirlpool Clothes Dryer 50.00
3. Whirlpool Clothes Washer 50.00
~+. 5000 BTU .Air Conditioner 25.00
5. GE Upright Freezer 75.00
6. Welbilt Apt. size Refrigerator i+0.00
7. Couch, Chair, Recliner, End Table; Coffee Table; Lamps 75.00
8. Gun Cabinet 75.00
9. 2 Single Hol],ywood Beds; Night Stand, Small Dresse'r' 50.00
10. Desk and Chair 20.00
11. Double Bed, Dresser, Mirror, Night Stand; Chest of Drawers 175.00
12. Stereo with 8-Track Tape Player and Radio 35.06
13. Dining Room Set - Table; 6 Chairs; Hutch, Stand with Mirro 250.00
1~. Kitchen Table and Four Chairs 25.00
15. Couch, 2 Love Seats, Chair; Coffee Table; End Tables 55.00
16. Clothes 250.00
17. 32 Special Rifle Winchester 250.00
18. 357 Magnum Dan Wesson 225.00
19. 22 H and R Pistol 100.00
20.' -"~ 270 Remington BDL 275.00
21. i+~+ Magnum Pistol 225.00
22. 32 Special Pistol 75.00
23. 22 Derringer Pistol 100.00
2i+. 12 Guage Pump Remington Model 870 175.00
25. 25 Caliber Pistol 60.00
26. 20/22 Magnum Over and Under Savage 100.00
27. Makita Table Saw Model 2708 120.00
28. Makita Electronic Jig Saw Model i+302C 25.00
29. Makita Power Planer Made1 1900B 25.00
30. Makita Circular Saw Model 5007 nb/185 65.00
31. Makita Disk Grinder Model 6510 LYR 35.00
32. Makita Drill Model 6510 LYR lOmm 70.00
33. Makita Miter Saw Model L51111020 10" 100.00
34. Set of 8 Cresent Wrenches 30.00
35• Set of 18 Open End Wrenches 20.00
36. Set of ~+ Vise Grips 13.00
37. Set of 4 Misc. Pliers 6.00
38. Set of 6 Hammers 15.00
39• Set of ~+ Chisel Sets x+.00
i+0. Set of 25 Hex Keys 3.00
~+1. Set of 3 Channel Locks 6.00
1+2. Set of 8 metal Files 5.00
i+3. 3 Hand Saws 13.00
~+i+. Set of "C" Clamps 8.00
i+5• Set of Quick Grip Bar Clamps 20.00
TOTAL (Also enter on line 5, Recapitulation) I $
(Attach additional 8Yi" x 11" sheets if more space is needed.)
REV-1508 EX+ (2.87)
~~,
COMMONWEALTH OF PENNSYLVANIA
INNERITANCE TAX RETURN
RESIDENT DECEDENT
JAMES RICHARD SMITH
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or
(All property loinfly-owned with the Righf of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
46. Wood Carving Set $ 12.00
47. Set of 36 Drills 18.00
48. Set of Pony Clamps 10.00
49. Set of 18 Screwdrivers 10.00
50. Hand Sander 15.00
51 Set of Nail Punches::.; 4.00
52 Set of Wire Cutters 8.00
53 Floor Jack 50.00
54 Ladder 50.00
55 Extension Cords 20.00
56 Drill Press (12" Chicago) 100.00
57 Black and Decker Bench Grinder 40.00
58 6 & 12 Volt Battery Charger 25.00
59 Masonry Tools (14 Pieces) 40.00
60 Miscellaneous Tools sold en tote to single buyer 3,200.00
61 Single Axle Trailer 300.00
62 Double Axle Trailer 1,500.00
63 Cash in Checking Account at Meridian Bank #52167361 30,832.91
64 1971 14' John Boat and Trailer 250.00
65 Collection of Toy Trucks w/cases 5,000.00
TOTAL (Also enter on line 5, Reca
(Attoch additional 8'/s" x 11" sheets if more space is needed.)
S 55 ,q~ . 91
REV-1502 EX+ 11285) a ~
COMMONWEALTH Of PENNSYLVANIA
SCHEDULE A
REAL ESTATE
JAMES RICHARD SMITH
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which is defined as the price of which property would be exehcnaed between a willing 6uver wed .....:Il:......ue. ..e:.L.e. L._:__ __~__u_
~..
IftV-1511 tVl+ (7-88)
SCHEDULE H
FUNERAL EXPENSES,
COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISCELLANEOUS EXPENSES
Please Print or Type
ESTATE OF FILE NUMBER
JAMES RICHARD SMITH
ITEM
NUMBER DESCRIPTION
AMOUNT
A. Funeral Expenses:
~• Beaver-Urich Funeral Home -complete funeral and burial service $5,072.00
B. Administrative Costs:
1. Personal Representative Commissions Eyvonne Louise Stu,~,k
_
Social Security Number of Personal Representative: ~ ~~~3n3n
Year Commissions paid 1995 5, 000.00
2. Attorney Fees N/A
3. Family Exemption
Claimant Carole E. Smith Relationship Spouse
Address of Claimant at decedent's death
Street Address 2 Palmer Drive
City (',a.mn Hi 11 State ~A-Zip Code ~ 7~],l 2, 000.00
4. Probate Fees Cumber.l.~nd County Register of Wills
~13~~00~
C. Miscellaneous Expenses:
~• Miscellaneous Court Documents
32.00
2' Real Estate Appraisal (Leod D. Gerlach)
~+~+5.00
3. Ne~~paper Notices (Harrisburg Patriot and York Paper) 20
$• 73
4' Mail, postage, copies
20.00
5.
6.
7.
8.
TOTAL (Also enter on line 9, Recapitulation) S 13,03$.3
(It more space is needed, insert additional sheets of same size.)
REV-7512 ~X+ (7.93) ~
SCHEDUL
EI
COMMaNWEAITH OF PENNSYLVANIA DEBTS OF DECEDENT
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF Please Print or Type
FILE NUMBER
JAMES RICHARD SMITH
ITEM
NUMBER DESCRIPTION AMOUNT
~' 199+ Individual Income Tax of James Richard Smith
$ 1,861.00
2. Vehicle Loan -Dauphin Deposit #61338279001001
8, 806. o~+
3. Mortgage an residence at 2 Palmer Drive -Mellon Bank
#0275 . o~+00~+5-6~+1 ~+o, 678.66
TOTAL (Also enter on line 10, Recapitulation) $ 51 s 3~+5 , 70
(!f more space is needed, insert additional sheets of some size.)
REV-1513 E7~+j_g7i
~a
J a ii Y
(OMMONWEALTM OF PENNSYLVANIA
INNERITANCE TAX RETURN
RESIDENT DKEDENT
SCHEDULE J
BENEFICIARIES
calH~e ~r FILE NUMBER
JAMES RICHARD SMITH
ITEM
NUMBE; NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
1• Carole E. Smith Spouse
2 Palmer Drive Camp Hill, PA 17011
2. Douglas James Smith Son
45+0 North ~+~+th Street, #12, Phoenix, AZ 85018
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
1.
25% of taxable amt,
75% of taxable amt.
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $
(If more space is needed, insert additional sheets of same size)
,~ . ~.
SCHIDULE K
ESTATE OF : JAMS RICHARD SMITH
FILE NUMBER:
Pursuant to decedent's will, his residence at 2 Palmer Drive, Camp Hill, PA
17011 , Goes to his wife, Carole E. Smith, foe life (assuming she does not remarry),
remainder in fee simple absolute to his son, Douglas James Smith. The life estate
has b eea valued at $19, 235.00 (See real estate appraisal attached to Schedule A) , the
remainder at $71, 765.00.
TCIARY Il~TBRE.ST IN 2 Palmer Drive, Camp Hill, PA VAIUP OF T~~T
1. Carole E. Smith Contingent Life Estate l9, 235.00
2 Palmer Drive
Camp Hill, PA 17011
DOB:
SS#:
2. Douglas J. Smith
1+51+0 N. l+4th Street
#12
Phoenix, AZ 85018
DOB: 2-12-61
sS#: 188-52-~+64~+
Remainder in Fee Simple Absolute
$71, 765.00