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Home My WebLink About95-0356a• -g5'03~ 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 200T Date H10a.fI3FW.?/a7 rr.Emarr N NAME r.AeE ``J i` 1 f Fran eropoli, `' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 oow~wE,~urH of ~sruaux~ • oEw-wnr~r of ern • v1r~~ r~coaos CERTIFICATE OF DEATH :~~~2~b3 Nr ~ DF DE[:EOO+1IFY~I, Ni(Iy,LYa sECUfarv NUraEn DRE OF DEATI(~lon/~, Deµ ly~q +.Keturah Smith :Feamle a,142 - 26 -8794 ~,Janurary31,1995 AOEllaraHh4,) UNDER1rEAR UNDER/DAY ORE OFaam1 91NTe1RACE1GYrd RACE OFDER11pNrA piper-wMur~arraYNr~ ' 1biM~ Oqr Her ~ AIYM4s Pb•*.Ogt M~ 9hMaFa~pnCwtY) 9 5 rp. 1 / 1 5 / 0 0 Phi 1 a . P a . ''~""" ^ ^ ooA ^ ~ Cat n.rsnr. ^ ~A,~ ^ m ~ DERH c :eono.~wFDFDERH ~NAAIEIMnatiririAOn.a~+wMarormer) DECmEHroFIasFANicowDaH nACE.Aprbrbar.aw.rAw.,.b ~ No ~ w ^ ayr..F.cw,c•en, , Cumberland ast Pennsboro CampHill Care Center ~~~~+> 10.White DECEOE i N b IaNDOF BIIaa1FAB1ai0U81RY W130ECEDENp EVEAN DECEDFNI'aEWCRgN MNEDIL$WU9•NW~YA '+~° aYwsuHV.~""a~~» a.~w ~~i~ '"°' Bergen Pines u' "" ~ w n,,, y w ^ Ho L.P.N. , Hospital , ,~ p1~2 ~" *~ ,~ Widow ~ oECEOarsw~ENOAOOnEaeati.~.a~rew,~.ser..av~ a Pa . as 1x.^ r.,e.w.ww.eb 10 S. 3 9 S t. eom~cE 178d fro °'°°" r +~Campflill, Pa. 17011 an.r.~ey /~ Cumberland Mb~^a? 1>a~~ ,~tl CampHill F/CIHME NAME~ie1, N10J~, Lrq MDT16i'aNAME 1FYr, NiOy. Yrlr~ auirny Harr W. Thompson Keturah Morgan 'sNAwEOrow•:o awwiNaAOaaESapa+.cywra.~.sw.avcmy Keturah E. Smith 128 Henry Rd. Enola,Pa.17025 IIE7110DOFD1aFOal+gN OFOMPOBIpgN RACE OIaPOER10N.HrirdOrrw%C~wrby lACR10N-CiKb~w48ur.24000~ ^ CrwnYbn® nrww har 9bY^ w%farl apnrRw De~raon^ Garr ^ r~February 6, 1995 Cremation Society Pa. _~~ Harrisburg, Pa. oFRNOa- on ~crw ASSUCH Nuuael NAMEANDADDRE99 of FACMJtY 012774-L ichardson 29S.EnolaDr.Enola,Pa.17025 . Cq~~Hi~ia ~~w~enwiaa~imm ~ re"~M1eili~'.ew~occ~ndrrr Nr.aw naowwwr~a u~HaE HU~aEn 04E aiOHED wayawaronw Ma+h D~%Mrl a+sae..~wr~.l.wa ocDERN DREFnoNO1NC®DEADnAa•r~.oxw.n vwacASEAEF>anEDmwEOlcAi~ o..r.no.~.b. e.... - n.rwrtc EM.rww.r.Nu~ram~ae.Nn..«ar~..an.e.r~ oonar+.n.~re.a W1p/pr.rwrrrA b. A~+w.w,~ru~a.e«~-rs,nw..naa~>i..nlr.a ~Maa+..b nurtc aw AIM MMEIprr11bE1irgbAMa1, G11 __ r~rr~ibb~V~rt ~eF PA11pL aaaalOWECAINE IF.W IpIM<~110d~~ i ha . '~ ~xa~P ~ ~I. . '~ y OUEIOfUgAgAC.ON5E0UENCE OFk . a.yN~.yrcp,aao,r e ! c: ii. s~o.- t=..,6.•. cE EAM,btlybbrtiAr~ DUE W(CRA9A OFk __ ~ rraEtirYMOalllriq ... CAgE(drwpij - py .i ~ iilrbdwrA~ DUEW ACONSEOUENCE OFk N tlI~aLAa- ~ ANAUR7PSY AIJIDYSrFa/D1110a AMw1EHOF DEIaN DAIEOFNAIR'/ 7alEOFIflN1F1Y NANYRWDR(Y DE9CNBEIIDWNANIY000UHRED rEHSDwAEm FRanro . D.r.xr1 arcAUSE ^ oFDER1n Nr.r [-I'` ~b,,,rb. q ACddry ^ rravb.n+ENb. ^ ~-- --~- w ^- NoU __.. ,~/ w ^ NnLJ w ^ No ~ 9uf'ie~ ^ Cpa.r+ae~r~.tiw ^ M' RACEOFNAUHr•Mlw~r lra ~w4frq%cak~ , , ~yK ~j~y,pr.yyU 2M ]!. Eutlip, r:. f3paeTyJ 70a ]Of. (dMCkaN mH • n r1FE:n ~rragrHrsiew~~,.r;..a,uN:wo.wae.r..+.r.~,.py.~,nra~.ae.rnwoa.~p^eormzN sioHRInEAHDrm.EOFCE ~ ~- 1 AI'IwwMM~M~MeeaYM4bhe~~)rMrrrwW ...................... ................... ............ ^-]7\ ~.Y K ~.- ~/ i •FDDIIDINCap AND CBMIFrE1a/IR'aIC1A/Iphy~~ OalFpmau'cinpOW~aMarlryipb~au~sd Qa~N) LI(~N3E NfM19ER OQE 91011EDMaM.ON. ~l _ Hoare.wr+nb~+s•.~rwoxw~wrw.+.r.e+.rrFrr.rrarbrrrrgNra....rr.rr.d ......................... ma OS c~v~ 5 ~~/ ~ L , / - 3 / %f ~ ~ AoonE~oF FEnaoHwfrocawtEr®c~u9E of pEpH ~~ ~ T Oa Dleee~barwMlWnwNOpMNtfp~110141n rYrPeanr.11~~111rrYlnaaflMWM.d~Y. rQplrer, raare+oM F.-~ ~~ CNN(s)rd /~ r.~c.`F+t li.:c.tu Id/J wINIKr Mkra . „ ............................................................................~... _................ ^ 72 ~..~~,,~ 7 4///.C /~~ /~F.• / FEO '981UNRIIHE AND FIIED (RbryA, 0aK IeBrJ _. '~ .EnrAwE E . 3 /~ 9~' REV-Nsoo Ex+(~19a) . INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 12/31/91 CHECK HERE IF A SPOUSAL i RESIDENT DECEDENT POVERTY CREDIT IS CLAIMED COMMON 1NEALTH OF PENNSYWANIA DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE FILE NUMBER DEPT. 280801 HARRISBURG, PA 17128-0601 WITH REGISTER OF WILLS ~ ~ X95 0356 COUNTY C DE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENTS COMPLETE ADDRESS ~~ ~~'~ 10 S. 39th Street DECEDENT SOCIAL SECURITY NUMBER DATE OF DEATH ~ PATE OF BIRTH Ca1i1p Hill, PA 17011 142-26-87 94 Ol 31 9 `"'' Ol 15 1900 County Ctimtberland )) RSTANDAMIDDLERNITIAL) SPOUSE'S NAME(LA SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) 1. Original Return 2. Supplemental Return 3. Remainder Return CHECK APPRO- (for dates of death prior to 12-13-82) ~ 4. Limited Estate ~ 4a. Future Interest Compromise a 5. Federal Estate Tax Return Required PRIATE (for dates of death after 12-12-82) BLOCKS ~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) .$~1+ID~1~~1~t4~~C?I!I~It~ENT11k~::T#~G.>iNF. A'.TJ .. O~: .:: R .::::::::::::::::::::::::::::~.:;::~:::::::::::;:::.:::<::::::::::::;::::.::::::'::::::::.'::::.:::: CORRES- E1 Se E ............................... COMPLETE MAILING ADDRESS PONDENT . ers 3401 North Front Street TELEPHONE NUMBER P.O.- BOX 5950 717-232-5000 H~ris Pa 17110-0950 1. Real Estate (Schedule A) (1 ~~~=~-~r~J. ~ ,~ , ;~ I 2. Stocks and Bonds (Schedule B) (2) ~ I ./' 3. Closely Held Stock/Partnership Interest (Sch. C) (3) u i 1 4. Mortgages and Notes Receivable (Schedule D) (4) ~,.--~'~ '" 5. Cash, Bank Deposits & Miscellaneous Personal (5 2, 019.10 - Property (Schedule E) ~,, . / .~ 6. Jointly Owned Property (Schedule F) (8) -- ~~ ~; ; . 7. Transfers (Schedule G) (Schedule L) (7) - ~ ' 7~~, ' ULATION 8. Total Gross Assets (total Lines 1-7) _ ~ '° r`` 8 ( ) 9. Funeral Expenses, Administrative Costs, _.12, 712.12 ~' -~ :? 2 ~, r. ; • .- ~~ ~ Miscellaneous Expenses (Schedule H) ...- __._._.. _~ ~ ~_ ~, ,__ {~ 10. Debts, Mortgage Liabilities, Liens (Schedule I) (1 18, 352.04 ,~W ~ ~ '~~~ 11. Total Deductions (total Lines 9 & 10) (11) ~ ,~~~~ 12. Net Value of Estate (Line 8 minus Une 11) (12) ~ 13. Charitable and Governmental Bequests (Schedule J) :, J , ~ (13) ,,~ . - 14. Net Value Subject to Tax (Line_12 minus Line 13) V ~ ~ `Pi b TAX COMPUTA-' TION OF ~~ Copyright Fa 15. Spousal Transfers (for dates of death after 6-30-94). See Instructions for Applicable Percentage on Page 2: (Include values from Schedule Kor Schedule M.) 16. Amount of Line 14 taxable at 6% rate (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (i5) x . _ (16) --4.g-~5 = ~ 2,457.30.. g (17) 0.00 x .15 = ` , r` ';' , '_ _. 0.00 _. 19. Credits Spousal Poverty Credit Prior Payments Discount Interest 0.00+ + _ (i 9) 20. If Line 19 is 0.00 than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) A. Enter the interest on the balance due on Line 21 A. (21 A) B. Enter the total of Line 21 and 21A on Line 216. This is the BALANCE DUE. (21 g) Make Check Payable to: Register of Wills. Agent 3s or per)ury, I declare that I have examined this return, including accompanying sch true, correct and complete. I declare that all real estate has been reported at true n is based on all information of which preparer has any knowledge. ~E~ O `ESP~SIBLE FOR FILING RETURN ADDRESS ~ ~' "'-~ w ~~~ See Schedule attached PREPA R OTHE T AN RE RESENTATIVE ADDRESS ~ ; ~~ 3401 North Front Street 8879 ~ Hc~urisbur5, Pa 17110-0'. oftware Only, 1994 Nelco, nc. N94PA001 value. 2,457.30 0.00 2,457.30 ana to the nest of my knowledge of preparer other than the personal DATE I~°~~"~~ DATE lC /~ , S ~. Estate of: Keturah Smith SL~RY OF ALLACATIONS TO BENEFICIARIES Class A Keturah E. Smith 20,477.47 Adrian F. Smith 20,477.47 40,954.94 -1995-00356 r Estate of: Keturah Smith The following persons are signing the return as representatives of the estate: Keturah E. Smith Adrian F. Smith 128 Henry Road 10 S. 39th Street Enola, PA 17025 Camp Hill, PA 17110 Jesse F. Smith 128 Henry Road Enola, PA 17025 -1995-00356 PA REV-1500 FCC (7-94) Page 2 Act #,48 of 1~4 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: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estates of decedents dying on or after 1!1/96 and before 1/1/97 • 1% (.01) 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 properly transferred or its income ........................................... }{ c. retain a reversionary interest; or ................................................................................ X d, receive the promise for life of either payments, benefits or care? ..... .................................................. X 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving d i a equate cons deration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................ X 3. Did decedent own an 'in trust for' bank account at his or her death? . . .................................................... X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. PA15002 NTF 6680 Copyright Forms Software Only, 1994 Nelco, Inc. N94PA002 :K±;1o _ Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters Testamentary No. 1995-00356 PA No. 2195-0356 ESTATE OF SMITH KETURAH Late of EAST PENNSBORO TOWNSHIP , i , Deceased Social Security No. 142-26-8794 WHEREAS, on the 9th day of May 1995 an instrument ted March 16th 1978 s admitted to probate as the last will of SMITH KETURAH ( . , to of EAST PENNSBORO TOWNSHIP CUMBERLAND County, who died on the lst day of January 1995 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for ie County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify iat I have this day granted Letters TESTAMENTARY ~ ADRIAN F SMITH and KETURAH E SMITH and JESSE F SMITH zo have duly qualified as Executor(rix} Zd have agreed to administer the estate according to law, all of which fully spears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, ~RLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal f my Office the 9th day of May 1995. ~ /' egis er o i s ; ~ **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) . _ .. - ---'~ gift ~ r"'~~fazzi~uf. of _; KETURAH SMITH _-- -~~i ~• _ ~ I> KETURAH SMITH, of the Township of Hampden, County o` Cumberland '"~'-~ '~' '-"~c1 and State of Pennsylvania, being of sound mind, memory and understanding, •-•~-"---i:.=~=~-~•~~ do make, publish and declare this my Last'rJill and Testament, hereby revoking ~~:~-~,~ and making void any and all will or ,rills by me at any time heretofore made. ~~~~>>_~,•~-•-:-.~ As to such estate as it bath pleased Sod to entrust me with, I dispose of in manner as follows: '-"'"~'" ~'' ~---~' 1. I order and direct my hereinafter named Executors to pay ail of my just dents, legally collectible, as soon as conveniently may be after ___ _~__ _____,_,_ my decease. ,_ _ _ ~_•-."_. _,,:__- 2. I give and bequeath all of my furniture, household goods and ----~ - furnishings unto my dauohter, Keturah E. Smith, absolutely. •-""-•~-'~-•-_---_= 3. I order and direct that the rest, residue and remainder of my estate, reel, personal and mixed, of whatsoever kind and nature, and whereso- ~~ ~~ ~ ~ ever situate at the time of my decease, shall be divided into two equal parts. ~`_:-___ ~ _ ^ The first par;, thereof I give, devise and bequeath unto my daughter, Keturah •.•-. E. Smith, unto her, her heirs and assigns forever. The second part thereof .~....__. ___........._. I give, devise and bequeath unto my son, Adrian F. Smith, with the proviso that he survives me. If and in the event that my said son, Adrian F. Smith, "~~-~~`~__~ does not s::rvive me, then, and in such event, I give, devise and bequeath his share unto my daughter, Keturah E. Smith, unto her, her heirs and assigns forever. - - ~ - - - a ?. I hereby nominate, constitute and appoint my son, Adrian F. Smith, and ~~,,~ dauohter, Keturah E. Smith, together with her husband, Jesse F. Smith, Executors of this my last Will and Testament, and I hereby authorize, empo~.ver and direct them, or the survivor or survivors of them to sell and convey, by good and sufficient deed, in fee simple estate, any and all of my real estate, at public or private sale, for such price or prices, upon such terms and conditions, as in their judgment is best for my estate, and to that end to sign, seal, execute, acknowledge and deliver all deeds or other in- struments necessary therefor, as effectively as I could do if I were personally -1- . ~' --.-----. _ f `fit[ a>~ ~gf amr~. of -- ~ -rte :. ".~ -. KETURAH SMITH . __. present. --~~-~~'~"""`.°"'~"' S. If and in the event that any of my said Executors should ., .: - .,_ ._. i happen to be anon-resident of Pennsylvania, it is my express direction that he cr she shall be excused from filing a bond for the administration _ _V_ r;;=`:~,~,._~~;:~ of my estate, for the reason that I have the utmost confidence in him or ~* her, and as authorized under Section 3174 (c) of the Act of June 30, 1972, .__....__..-. .-.. _. Act No. to=. ^^- I.1 WITNESS WHEREOF, I, KETURAH SMITH, the Testatrix, have to _ _ _ this my Last'rlill and Testament, tyoe~.+ritten on t~+~o (2) consecuti~rely _ _ Try` numbered pages, set my hand and seal this 16th day of March, A.O., 1978. _ .,.:..._....~...__-_~:. ._...1 .~r rte" ;~;'ii.i~' (StAL) ~, \r ~ / i .. ... _ ~ Signed. sealed, published and . _- -_- -~ -~ ~ declared by the above-named _.~.=s_..._~ _---_-•••--~--- Keturah S~ith, as and far her ._.,,r.._....-~-.-- Last Will and Testament, in the ~~~~R,_ • ~ presence of us, who have hereunto _ _ ... _-. .---~-- -• subscribed our names at her request _ _ _ ~~~- as witnesses hereto, in the presence ~__, of the said Testatrix and of each other. __ ~-c_, ^ ~; i ~ ~ ~~ . - .• :,1 ?T::. ~ . .. = . _ "fem..-.-.~____ -. .. REV-1502 EX ~ (12-85) ' ~ SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ` RESIDENT DECEDENT ea i A i t ~r FILE NUMBER Keturah Smith -1995-00356 (Property Jointly-owned with Right of Survivorship must be disclosed on Schedule F) A11 real estate should be reported at fair market value which Is defined as the price at which property would be exchanged between a wllling buyer and a wllling seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM VALUE AT DATE NO. DESCRIPTION OF DEATH 1 Residence situate at 10 S. 39th Street, C~~ Hill, Pennsylvania TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of same size.) PA15021 NTF tztt Copyright Forms Software Only, 7994 Nelco, Inc. N94PA027 70,000.00 0,000.00 ~~~~'soe EX+Iz-8>> SCHEDULE E " CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY Please Print or Type ESTATE OF FILE NUMBER Keturah Smith -1995-00356 (All property Jointly-owned wfth the Right of Survivorship must be disclosed on Schedule F) ITEM VALUE AT DESCRIPTION DATE OF DEATH N0. 1 PNC Bank Checxing Account 13.70 2 PNC Bank Burial Account #106-320-0174149. 1,542.63 3 1994 Pennsylvania Tax Rebate 233.86 4 Camp Hill Care Center Refund 228.91 _ TOTAL. (Also enter on line 5 Recapitulation) ~ $ ,,.~~'"~ 2, 019 10 (Attach additional 8 ~/2" x 11"sheets if more space is needed.) PA15081 NTF 1215 Copyright Forms Softwaro Only, 1994 Nelco, Inc. N94PA081 "`"-"" `"'`'-°°' SCHEDULE H FUNERAL, EXPENSES, COMMONWEALTH OF PENNSYLVANIA ADMINISTpAfili/~ C05TS AND IN RESIDENT DECEDEN TN MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF FILE NUMBER Keturah Smith -1995-00356 ITEM N0. DESCRIPTION AMOUNT A. Funeral Expenses: 1 Richardson's Funeral Home, Inc. 660.00 2 Richardson's Funeral Home, Inc. (PNC Bank Burial Account 1,542.63 #106-320-0174149) B. Adminlstratlve Costs: 1. Personal Representative Commissions 0.00 Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees 1, 500.00 3. Family Exemption 3 , 500.00 Claimant Adt'l.ari Shiith Relationship Sori Address of Claimant at decedent's death Street Address 10 South 39th Street City Camp Hill State PA Zip Code 17110 4. Probate Fees 126.00 C. Miscellaneous Expenses: 1 County/Township tax 131.25 2 Personal Tax 9.80 3 Ctinnberland Law Journal 40.00 4 The Evening Sentinel 102.44 5 Electric bill 100.00 6 Estimated Costs of Sale of Home: 4,900.00 (i) Real estate settlement commission - $4,200.00 (ii) Transfer tax - $700.00 7 Mette, Et~ans & Woodside, Cut of pocket expenses 1 0 TOTAL (Also enter on line 9, Recapitulation) $ 12, 712.12 (If more space Is needed, Insert additional sheets of same size.) / PAi5111 NTF 1218 / Copyright Forms Software Only, 1994 Nelco, Inc. N94PA111 REV-1572 EX+(1/93) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS please Print or ESTATE OF FILE NUMBER Keturah SYnith -1995-00356 Copyright Forms Software Only, 1994 Nelco, Inc. N94PA121 REV-1513 EX+f2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Keturah Smith _,ora~_nn~~c ITEM NO. NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: 1 Keturah E. Smith Datx~ter 20,477.47 128 Henry Road Enola, PA 17025 2 Adrian F. Smith Son 20,477.47 10 S. 39th Street Camp Hill, PA 17110 ITEM NAME AND ADDRESS OF BENEFICIARY AMOUNT OR NO. SHARE OF ESTATE B. Charitable and Governmental Bequests: None TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $ 0 00 (If more space Is needed, Insert addlUonal sheets of same size) PA15131 NTF 1220A Copyright Forms Software Only, 1994 Nelco, Inc. N94PA731 ~ _• inventory of the real and personal estate of Keturah Smith deceased Residence situate at 10•South 39th Street, Camp Hill, PA 70,000 00 PVC Bank Checking Account ~ 13 70 1994 Ta: Refund (Rent Rebate) 233 86 Camp Hill Care Center Refund 228 91 TOTAL X70,476 47 Ol`.:~+IONWEAL7H OF fE1~d1~d57LYAMII~, s: ~UNT7 OF CUMfERLAND .. Ke~urah E. Smith, :fesse F. SM~ r>, a-~rf Adriatt F. Smith ~eing du17 sworn accordinS to law, daposas and ta7s t{~at tbay a h E~ce-c~~~rora of }~~ l~ta}. o{ Keturah Smith eta of _ __Cam~ Hill Cumberland Countp, ta., deeaased and that tn. them Executors rithin is an inventory made by the said ,{ the entire .state of said decadent, consisting of all the personal prop+rtY and r. al •state, ~zeapt real •s'at• outside ha Commonweal?~ of Prnns7lvania, and that the figures opposite each item o{ the Inventory represent it's fair value is o{ the date of decedent's death, ~~/ . _:~l-,z,~L'w and subscribed baior. m., ~ x ~~ C '/ ~ ~ ~ bc~cvfwr A1n~~niifrator ~ ~ r 128 Henry Road, Enola, PA 17025 Notaral Seal Margaret L, Eo`,~d; Notari Public AJ d n - ~ •- Har*s!~,ra, Da~;,hin County 10 S . 3 9th S t r e e t , Camp Hill , PA 17110 My Comm ~'nn Ex,:~r=s June 27,1996 Met~:L'~r, Nenn:,ytianlrslv~o~.iaovn of Nvtaric;~ 31 January 1995 Day -donth You INSTRUC?lOHS 1. An inventory must be filed within three nenths after appointment o{ personal representative. 2. A supplement inventory must be filed wif=in thirt7 deys o{ discovery o{ additional assets. 3. Additional :Sects meY b• attached as to personalt7 or realt7 4. See Article IY, Fiduciaries Act of 1949. 1 0 Z Q Z W } Z F- su ~ ~ d ,... L1] ~ L1 ~ "'r ~ ~ Z ~ C1 D N Z w < d J E r s~ v x O 2 J -v u O d c 3 O U "D C • ..Q E U ~ ,~ d c 0 ~~ c M ~ „]t o 0 s% ao REa/-J500'EXt(7-94) FOR DATES OF DEATH AFTER 12/31/91 6 0 0 4 8 2 2 INHERITANCE TAX RETURN CHECK HERE IFA SPOUSAL RESIDENT DECEDENT POVERTY CREDIT IS CLAIMED COMMONWEALTH OF PENNSYLVANIA FILE NUMBER DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE a ~ X95 HARRISBURG, PA 17128-0801 WITH REGISTER OF WILLS - COUNTY CODE YEAR DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENTS COMPLETE ADDRESS ~-~ ~~~ 10 S. 39th Street DECEDENT SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH C31r1jJ Hill, PA 17011 (142-26-87))94 Ol 31 95 Ol 15 1900 County Glmlberland PIRSTPANDAMIDbLERNITIA GSPOUSE'S NAME (LAST, SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) CHECK APPRO- PRIATE BLOCKS CORRES- PONDENT RECAPIT- ULATION TAX COMPUTA- TION 1. Original Return 0 4. Umited Estate 6. Decedent Died Testate (Attach copy of Will) c--~ 1. Real Estate (Schedule A) (1) 2, 000 2. Stocks and Bonds (Schedule B) (2) Nolte 3. Closely Held Stock/Partnership Interest (Sch. C) { 3) rjo~ 4. Mortgages and Notes Receivable (Schedule D) (4) NOrle 5. Cash, Bank Deposits & Miscellaneous Personal (~5, 5,174.25 Property (Schedule E} 2. Supplemental Return 0 4a. Future Interest Compromise (for dates of death after 12-12-82) 7. Decedent Maintained a Uving Trust (Attach copy of Trust) NAM E E1 E. ers TELEPHONE NUMBER 717-232-5000 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) (Schedule L) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) 10. Debts, Mortgage Uabilities, Uens (Schedule I) 11. Total Deductions (total Unes 9 & 10) 12. Net Value of Estate (Une 8 minus Line 11) 13. Charftable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) 15. Spousal Transfers (for dates of death after 6-30-94). See Instructions for Applicable Percentage on Pape 2. (Include values from Schedule K or Schedule M.) 16. Amount of Une 14 taxable at 6% rate (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Unes 15, 16 and 17.) 19. Credits Spousal Poverty Credit Prior Payments If Une 19 is (15) x •_ _ ~. ~'/7`l-~5°- 3 ,TT~25 Norte .., a "~ (11)_ . 34) V (13) None 6 (17) 0.00 x .15 = ~f 3. Remainder Return (for dates of death prior to 12-13-82) 5. Federal Estate Tax Return Required _ e. Total Number of Safe Deposit Boxes S/ 7 ~1'• ~~_ 3 ,0356 NUMBER O.DO (1$) 229.96 Discount Interest T * - (1s) than Line 1s, enter the difference on Line 20. This is the OVERPAYMENT. (20) 21. If Line 18 is greater than Une 19, enter the difference on Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Une 21 A. B. Enter the total of Une 21 and 21A on Une 21 B. This is the BALANCE DUE. Make Check Payable to: Register of Wllis, Aaent 0.00 (21) 229.96 (21 A) 0.00 (21 B) 229.96 and belief, it is true; correct and complete. •I declare that ail~real estate Ihas been reported atntrgue market value SDeclaratioi representative is based on all information of which preparer has any knowledge. PE E ONSIB -E FO (LING R TU N ADDRESS See Schedule attached SIGNAT A PREPAR OTHER'T REPRESENTATIVE ADDRESS ~ ' 3401 North F~'ont Street PAi5001 NT ss7s ~- . ~ Ha~ig~~ pa 17110-0950 r'n n..rinhf Fn..ne ffw>•n rln lv 1°°d Nnlnn Inn Aled On nn. ~ COMPLETE MAILING ADDRESS 3401 North F~'ont Street P.O. Box 5950 HarrisbuY~, Pa 17110-0~ (6) None (7) None ~'' (a ) (9) 6 4j~~ (i o) ~ to the Dest of my I preparer other than DATE 1- DATE ~"~~'i(~ Estate of: Keturah Smith SUNIl~,RY OF ALIDCATIONS TO BENEFICIARIES Class A Keturah E. Smith Adrian F. Smith 1,916.29 1,916.30 3,832.59 -1995-00356 e ~ Estate of: Keturah Smith The following persons are signing the return as representatives of the estate: Keturah E. Smith Adrian F. Smith 128 Henry Road 10 S. 39th Street Enola, PA 17025 Cates Hill, PA 17110 Jesse F. Smith 128 Henry Road Enola, PA 17025 -1995-00356 PA REV-1500 UC 7 ~ (7-94) Page 2 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: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1% (.01) 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? .. ..................... . . . . . . . . . . . . . . . . X 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 occurr d ft D e a er ecember 12, 1982, did decedent 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? . ..................................................... }{ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. PA15002 NrFSSSo Copyright Forms Software Only, 1994 Nelco, Inc. N94PA002 Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters Testamentary PA No. 2195-0356 ESTATE OF SMITH KETURAH L , •, i No. 1995-00356 Late of EAST PENNSBORO TOWNSHIP , ~ i i , Deceased Social Security No. 142-26-8794 WHEREAS, on the 9th day of May 1995 an instrument ~aJ March 16th 19 7 8 admitted to probate as the last will of SMITH KETURAH ( , of EAST PENNSBORO T047NSHIP CUMBERLAND County, who died on the st day of January 1995 and, WHEREAS, a •true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LE64IS , Register of Wills in and for County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify t I have this day granted Letters TESTANIENTARY ADRIAN F SMITH and KETURAH E SMITH C .~ Q JESSE F SMITH have duly qualified as Executor(rix) have agreed to administer the estate according to law, all of which fully ears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, :LISLE, PENNSYLVANIA. IN TESTIti10NY WHEREOF, I have hereunto set my hand and affixed the seal my Office the 9th day of Mav 1995. ~,; , ~ /j aegis er oz wills ;~ 1 * *NnTF * * AT,T, NAMES ABOVE APPEAR ( LAST . FIRST, MIDDLE ) • `• . 1 i 1 7 -- + KETURAH S1•tITH ,:~~ - ~, ____ I, KcTURH SMITH, of the Township of Hampden, County of Cumberiznd and State of rennsylvania, being of sound mind, memory and understandinc, _-- •~_•-~=~=--~~ do make, publish znd declare this my Last 'dill and Testament, hereby revo;cirg - :: _-~._-~r~ and ma'<ing vcid zny and a]1 will or ,rills by me at any time here:o'or~ rzde. ~'"-ti='=~: AS tJ SUCh e5tdte dS it bath pleased uod t0 entrust me w1Ci1, I dispose of in ~;.znner as ;"allows: ~~~ ~~• _ ^__' 1. I order and direct my hereinzfler named Executors to pay ali o. my just d_~ts, legally collectible, as scan as conveniently ray be zr~=_r _,.... ,. _. my decease. . .__....__._..._. 2. I give and bequeath all o` ry furniture, household cccds zr,d -___r._ furnishings unto my dauohter, Keturah E. Smith, absolut_ly. '"'"'~"~`'`-"-'`` 3. I order and direct that the rest, residue and remainder of r•r ... - .. estate, reel, personal and mixed, of whatsoever kind. and nature, and whereso- - ever situate zl the time of my decease, shall be divided into t•~re equal p=_rts. .. .~ ----- -'~ __ - ~ _ ^ The first par;, thereof I give, devise and bequeath unto my dauchter, Keturah . -- ~ E. Smith, ur.o her, her heirs and assigns forever. The second part ther~o~ _..__. ___.__...._, I give, de•rise and bequeath unto my son, Adrian F. Smith, with the prc•riso . _ ~ thzt he survives me. If and in the event that my said son, Adrian F. S-it, ~~~~ ~_`R-__ does not s~:r•rive me, then, and in such e•rent, I give, devise and bequeath his share u;:•o my daughter, Keturah E. S pith, unto her, her heirs and assi_ns ---...__ ,. ._..........._ forever. ._. _ ....._ ..__. _.. 4. I hereby ncminate, constitul= and aopoinl my son, Adrian F. -"'~"--~`-"` ~~ Smith, and „-ar dauchter, Keturah E. Sr•,il'n, tccether with her husband, J=s_e '"'•y `-'-~`~ F. Smith, Ex=colors o` this m• o _~, _ y last Will and T,.stzmenl, and I hereby zulhcrize, '~~- ^_ e~power and direct them, or the survivor or survivors of them to sell znd • convey, by ecod and sufficient deed, in •fee simple estate, any and all of ,,-.y ~ real estate, zt -___:;:;~ public or private sale, for such price or prices, upon such t~r-is and conditions, as in their judg^ent is best for my estate, and to tzt -"`"'~' ~'~"'_' end to sicn, seal, execute, ac'<nowledee and deliver all deeds or other in- ~:_:;ti's::_..~.:c:wr;e~ struments necessary therefor, as effectively as I could do if I were personally -- - .. - - :-:.. -- -1- ~-a..'w- W c4•+a-merits.:.. .- ~__ . .. '-r.~--•'-- .... .... 's' '-' -' ... . _. _... ___.-..... . . ~-----1 r _ __ _~ KETURAH S;dITH __. _ present. 5. If and in the event that any of my said Executors should ~.= ~ - --• ~ hapoen to be anon-resident or Pennsylvania, it is ny express direction that he cr she shall be excused frem filing a bond fer the adainistraticn ,_~r:_;;z~-~;;.~=~:~ of my est_te, for the rzason that I have the ut-aast confidence in him cr her, and as authorized under Section 31i;(c) o` the Act o' June 30, 1472, Act Pao. 1~'.. I;1 ;JiTi1cSS 'riHER:OF, I, KcTU?~+' S~dITH, the Testatrix, hav=_ to ....._..y.--,: .. ~....~ ----~ . ~...__.~_ _.....-_.:J i s=_.__~ _.-_~_~_..___ ~:T--==_---- ~ ----: __~.._..~ _._,_..~..~.--r---~-,. =.._.. - this my Last 'dill and Testament, tyoewritten an t~,o (2) cons~cutivel_~ numbered paces, set my hand and seal this 16th day of March, A. D., 147c. Signed, staled, published and declared by the above-named Keturah Smith, as and far her Last 'dill and Testament, in tae pres~nc=_ of us, who have hereunto subscribed our Hanes at her request as witnesses hereto, in the presence o` tae said Testatrix and of each other. ~~~ ~_~ ~`\ / ~i ~- :, -2- REV-1502 EX + (12-135) COMMONWEALTH OF PENNSYLVANIA ~ SCHEDULE A INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT G TATC C Keturah Smith ` "` ""r"°"' -1995-00356 (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 at which property would be exchanged between a wllling buyer and a wllling seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM VALUE AT DATE NO. DESCRIPTION OF DEATH 1 Residence situate at 10 S. 39th Street, Ca1~ Hill, Pennsylvania (2,000.00) previously appraised at $70,000. Property sold for $68,000. TOTAL (Also enter on line 1 Recapitulation) $ (2, 000 (If more space Is needed, Insert addttlonal sheets of same size.) PA15021 NTF t2tt Copyright Forms Software Onlv. 1994 Nelco. Inc. N94PA021 REV-1508 EX+(2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or ~~~Mi~ yr FILE NUMBER Keturah Smith (All property )oinUy-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NO. DESCRIPTION 1 Miscellaneous artwork 2 Household goods and furnishings -1995-00356 VALUE AT DATE OF DEATH 2,200.00 2,974.25 TOTAL (Also enter on line 5, Recapftulation) $ 5 174.25 (Attach additional 8 1/2" x 11"sheets If more space is needed.) r PA15081 NTF 1215 Copyright Forms Software Onlv. 1994 Nelco. Inc. N94PA08t ~r 'k, REV-1511 EX+~7-E8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Keturah Smith ITEM N0. A. Funeral Expenses: None SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES DESCRIPTION B. Administrative Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: Yeaz Commissions paid 2. Attorney Fees 3. Family Exemption Claimant Address of Claimant at decedent's death Street Address City 4. ~ Probate Fees C, Miscellaneous Expenses: See Schedule attached State Zip Code (Total from continuation pa e(s) TOTAL (Also enter on line 9, Recapitulatio (If more space is needed, Insert additional sheets of same size.) pegs+~~ IJTF 191A -_ _. _. Relationship f7` Please Print or Type FILE NUMBER -1995-00356 AMOUNT 0.00 0.00 0.00 0.00 658.34 ) (658.341 + ~-:'~ t Page 2 Estate of: Keturah Smith -1995-00356 SCHIDUL~ H, PART C - Miscellaneous ~cpenses Item No . De-scription pmt 1 Frances Redell-White, Appraiser, appraisal of artwork 250.00=!~`i 2 Advertising for sale of house 534.74 -'~`( 3 Wayne Myers Auction Service, fee for selling household goods and 297 43 ~ furnish i rigs . 4 Costs of Sale of Home: (i) Real estate settlement conanission - $1, 360.00 , ~~ ~ . ~~ ~ (2 , 855.00) (ii) Transfer tax - $680.00 ~ ~ (iii) Notary fee - $5.00 Estimated costs on original return = $4,900.00 5 Camp Hill Animal Hospital ri °`'~ 135.00 6 Kathryn Fetrow, Hampden Tc~anship Treasurer U, 548.85 7 Nationwide Mutual, fire insurance 144.004'+~~ 8 Hamden Tcxunship, sewer/trash 98.00,: 9 PP&L r"~'~ 58.98 10 LJGI , f~ 105.00 11 Pennsylvania American Water Company ~` i r~ • r ,~ 24.66 1 3 5 • rlr1 +~- 1 iJ .a • J 0 += .~ r ,.. ~'~-(Carry forward to main schedule) (658.34) . ~ _, REV-t5t3 EX+(2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES wtait VF Ketur~h Smith ITEM NO. NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: 1 Keturah E. Smith 128 Henry Road Enola, PA 17025 2 Adrian F. Smith 10 S. 39th Street Camp Hill, PA 17110 ITEM NO. NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: None FILE NUMBER RELATIONSHIP Dauc,~ter Son TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) (If more space is needed, Insert addlUonal sheets of same size) PA1S131 NTF 1220A -1995-00356 AMOUNT OR SHARE OF ESTATE 1,916.29 1,916.30 AMOUNT OR SHARE OF ESTATE 0.00 P REV-1547 EX AFP (12-95) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101 BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 04-15-96 HARRISBURG, PA 17128-0601 w i,~ ~ c u~ ~~i ~ n ICt I UKAFI FILE N0. 21 95-03 DATE OF DEATH 01-31-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: ELYSE E ROGERS 3401 N FRONT ST PO BOX 5950 HBG PA 17110 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMITH KETURAH FILE N0. 21 95-0356 ACN 101 DATE 04-15-96 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAI SED VALUE OF RETURN BASED ON: SUPPLEMENTAL RET URN N0. O1 1. Real Estate (Schedule A) (1) .0 0 2. Stocks and Bonds (Schedul• B] (2) .0 0 3. Closely Held Stock/Partnership Interest (Schedul• C) (3) .00 4. Mortgages/Notes Rseeivabl• (Schedul• D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule El (5) 5,1 74.2 5 6. Jointly Owned Property (Schedul• F) (6) .00 7. Transfers (Schedule GI (7) .00 e. Total Assets (81 5,174.25 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedul• H) (91 - •0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0 11. Total Deductions (11) ~0 12 . Net Value of Tax Return (12 ) 5 , 17 4.25 13. Charitable/Governmental Begwsts (Schedule J) - (131 .00 14. Net Value of Estat• Subject to Tax ~ (14) 46,129.19 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL ret urns assessed to date. ASSESSMENT OF TAX: _ %' 15. Amount of Line 14 at Spousal rate (151 . 00 X .00_ '• '~ ~ '. 00 16. Amount of Line 14 taxable at Lineal/Class A rat` (16) 46,129.19 X .06. 2,767.76 17. Amount of Line 14 taxable at Collateral/Class B rats (17) .00 X .i 5. .00 18. Principal Tax Due (181 2,767.76 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST (-) AMOUNT PAID 02-06-96 TAIT Ct1CCT Tc AA082585 rllwn~~.. 67.00- 2,687.26 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT 2,620.26 BALANCE OF TAX DUE 147.50 INTEREST 2.81 TOTAL DUE 150.31 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS RE@UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE '' REV-1470 EX (6881 r~ COMMONWEALTH OF PENNSYLVANIA DEPARTMEN Of REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 2 8-060 1 DECEDENT'S NAME INHERITANCE TAX EXPLANATION OF CHANGES LE NUMBER ACN ~~i SCHEDULE ITEM NO. EXPLANATION OF CHANGES a ~. Fc~rtaar:Iec' your su~spleme=_nt<a3_ r^turn tc~ our Post tasstss*1~=nt <e,view i;ni r for further coresicieratic-~n raf this iter.._ - _ _ ~= f & Z t'rv ;:av, ~xece~it~~d ttais increase. _ :. ~,i ~ ForTw ;ri?ea ~*aur si.t~p~ e~ent:~"s r~ tur.n to c+ur F'or r~.- -;vs,~Pnt :~ _ furtn~=r consid;~a-aticn an the r.r_ciucti;an of rx}~fZS,~a. TAk', EXAMINER: fnh,n Ra.irrtp PAGE COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION I N H E R I TA N C E TAX DEPT. 280601 a, HARRISBURG, Pa l~lz8-o6o1 STATEMENT O F A C CO U N T REV-1607 EM AFD (US-961 DATE 12-02-96 ESTATE OF SMITH KETURAH DATE OF DEATH 01-31-95 FILE NUMBER 21 95-0356 ELYSE E ROGERS COUNTY CUMBERLAND 3401 N FRONT ST ACN 101 PO BOX 5950 Amount Remitted HBG PA 17110 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -____ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------- REV-1607 EX AFP (03-96) ~~~--'-'-""""""" ------------------------'-- INHERITANCE TAX STATEMENT OF ACCOUNT ~xx ESTATE OF SMITH KETURAH FILE N0. 21 95-0356 ACN 101 DATE 12-02-96 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: 10-22-96 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DATE DISCOUNT (+) NUMBER INTEREST (-) 02- 06-96 AA082585 65.05- 05-02-96 AA112806 1.38- 11-12-96 REFUND .00 2,687.26 AMOUNT PAID 2,687.26 195.70 129.27- TOTAL TAX CREDIT 2,687.26 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. TOTAL DUE ~ .00 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, ,~ RE1/-1593 EX AFP (12-95) ASSESSMENT COMMONWEALTH OF PENNSYLVANIA CONTROL N0. 101 DEPARTMENT OF REVENUE INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECORD ADJUSTMENT DATE 04-18-96 ESTATE OF SM K URAH FILE N0. 21 9 -03 6 DATE OF DEATH 01-31-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE ADDRESS SHOWN. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: ELYSE E ROGERS 3401 N FRONT ST PO BOX 5950 HBG PA 17110 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------ REV-1593 EX AFP (12-951 ~(~( ---------------------------------------------- INHERITANCE TAX RECORD ADJUSTMENT ~(~( --~------'------'- ESTATE OF SMITH KETURAH FILE N0. 21 95-0356 ACN 101 DATE 04-18-96 ADJUSTMENT BASED ON: VALUE OF ESTATE: ~- ~~ 1. Real Estate (Schedul• A) (1) ~OD 00 2. Stocks and Bonds (Schedule B) (2) . 00 3. Closely Hald Stock/Partnership Interest (Schedule Cl (3) . 00 4. Mortgages/Notes Receivable (Schedule D) (4) . DO 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 7 )q~ . ~ 6. Jointly Owned Property (Schedule F) (6) , 00 7. Transfers (Schedule G) (7) oo .~,J ~{~~~ ~ f= 8. Total Assets ~ DEDUCTIONS AND EXEMPTIONS: (8) __ - ---` 9. Funeral Expenses/Administrative Costs/ /Z G'SS ) ~' Miscellaneous Expenses (Schedul• H) (q) .__,,~ q__ 10. Debts/Mortgage Liabilities/Liens (Schedul• Il (10) _ 18.352 04 '~i c/G~~~~ 11. Total Deductions . 12. Nst Value of Tax Return (11) _ ~ - 13. Charitable/Governmental Bequests (Schedule J) (12) ' 6' 8~5_{_r-~- ~ ~ y""~~Y/ 14. Nat Value of Estate Subject to Tax (13) 00 TAX: (14l --$b-. S1 15. Amount of Line 14 at Spousal rata (15l p0 X. 00 = 00 16. Amount of Line 14 taxable at Lineal/Class A rat' (16) ~ 17. Amount of Line 14 taxable at Collateral/Class B rate (17l .~~ X. 15 = o0 18. Principal Tax Due TAX CREDITS: (181 --~~--~A- PAYMENT RECEIPT DISCOUNT (+) ' C<-~~ ~ ~~ `~~ DATE NUMBER INTEREST (-) AMOUNT PAID i . ~ 02-06-96 AA082585 I 68.04- 2,687.26 INTEREST IS CHARGED FROM 02-07-96 TO 05-03-96 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM AX CREDIT AX TOTAL DUE 195.70 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A RFFIINII. CFF RFUFRGF CTI1F AF THTC FARM FAR TNSTRIIf.TTnNS.1 a:C-~.~o ez la.eel `~ I ` INHERITANCE TAX r COMMONWEALTH OF PENNSYLVANIA DEPARTMEN' OF REVENUE EXPLANATION BUREAU OF INDIVIDUAL TAXES OF CHANGES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME i~ r ;~ ~ j/ FILE NUMBER iw~ ACN ITEM ~ `~~ SCHEDULE NO. EXPLANATION OF CHANGES .~ ,, ~ .~ .; ~~ ~~ - ~w p__ ~ .~ -, ,~ ;- f f TAX EXAMINER: ~ ~ ~~,.'~4!2_. ~~/,~,,,~!~~'~,,, / ' PAGE !