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Home My WebLink About9-28-12 (2)J 1505610143 REV-1500 Ex(o,_,o> PA Department of Revenue OFFICIAL USE ONLY pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 12 0063 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 194 40 4562 O1 O1 2012 06 06 1949 Decedent's Last Name Suffix Decedent's First Name MI SMITH GARY L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3, Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required g Decedent Died Testate (Attach Copy of Will) ~'~ ~J ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 0 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 1 p. Spousal Povertyy Credit (date of death between 12-31 zJ1 and 1-1-95) ~ 11. Election to tax under Sec. 9113 A ( ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONF IDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MA RK A MATEYA 717 241 6500 _.:~ First line of address 55 W CHURCH AVENUE Second tine of address City or Post Office State CARLISLE ppl Correspondent's a-mail address: r17aIY1@I'YlateyalaW.COrn ZIP Code REGISTER~~ILLS US~ONLY-C' ~ _ ~-. __ ~'' ` (V r~ . .~ ~~~.` ~ ~r c _ G ~ .~ to D FILED N ~- h ~~ ~--~ ~: ~:~: ~~ unaer penalties or penury, I tleclare 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. SIGNATURE OF PERS9N RESPONSIBLE FOR FILING RETURN ./~ _ ADDRESS ~a Adam Smith ,TE ~~,~ _ 101 E. Count side Drive Boilin S rin s PA 17007 SIGNAT RE OF PREPARER.OTHER S.ktA1a REPRESENTATIVE DATE ~~;~ - ~+~,G Mark A. Mateya ~ ~,` -1~.. ADDRESS 55 W. Church Avenue, Carlisle, PA L 1505610143 Side 1 1505610143 J J REV-1500 EX Decedent's Name: Smith, Gary L Decedent's Social Security Number 194 40 4562 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 13 7, 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 3 , 5 90.8 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 38 , 948.23 7. Inter-Vivos Transfers & Miscellaneous I~Oq Probate Property (Schedule G) S t Billi ^ epara e ng Requested............ 7. 33 9 , 17 7 . $ 4 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 518 , 716.93 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 18 , 9 7 8 . 0 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 14 , 67 0.65 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 33 , 648.71 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12, 4 $ 5 , 0 68.2 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 485 , 0 68.22 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 4 8 5, 0 6 8. 2 2 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 _ 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ..................................................................... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 21,828.07 0.00 0.00 21,828.07 Side 2 15U5610243 15U5610243 J 1505610243 REV-1500 EX Page 3 File Number 21-12-0063 Decedent's Complete Address: DECEDENT'S NAME Smith, Gary L STREET ADDRESS 684 N Middle Road CITY STATE ZIP Newville PA Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 21,828.07 2. Credits/Payments A. Prior Payments 20,560.00 B. Discount 1,082.11 Total Credits (A + g) (2) 21,642.11 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check 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. (5) 185.96 Make Check Payable to: REGISTER OF WILLS, AGENT. ~; e,~-- ~. -- W 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 :............................................................................... ^ b. retain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... ^ ^x d. receive the promise for life of either payments, benefits or care? ................. .. . ....................................... . 2. 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" 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? .................................................................................................................. 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~. _.. a -.-_ ___ _ ___ _ __ ___ _ __._ __. ___-__ __.... ~... _ a -.. - ~,~. __.. ___ .. ~: ~ a R 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 January 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 net 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 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 percent [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. Rev-1502 EX+ (11-08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith, Gary L FILE NUMBER 21-12-0063 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Smith, Gary L 21-12-0063 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 PNC Bank -Checking Account No. xxxxxx8974 1,595.41 2 PNC Bank -Mortgage payment for June 2012 and funds to correct overdraft of bank account 960.36 3 PNC Bank -Funds to refresh personal checking account 150.00 4 Comcast -Refund on account for Cable. Account No. 09547-24098006 117.56 5 Dominion -Refund 1.41 6 GMG Management -Apartment rental refund for 703 Louisa Lane, Mechanicsburg, PA 600.00 7 State Farm Fir & Casualty Co. -Refund on Policy No. 38-BO-C329-2 64.38 8 State Farm Mutual Automobile Ins. Co. -Refund on Policy No. 1109379613 101.74 TOTAL (Also enter on Line 5, Recapitulation) I 3,590.86 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF riot Num~tK Smith, Gary L 21-12-0063 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Adam C Smith B. C. JOINTLY OWNED PROPERTY: ADDRESS 107 E. Springville Road Boiling Springs, PA 17007 RELATIONSHIP TO DECEDENT Child ITEM NUMBER LETTER F~ENANITT DATE JOOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 New Cumberland Federal Credit Unioin - 60,489.32 50.000% 30,244.66 Checking account No. 76979-S4 2 New Cumberland Federal Credit Union - 1,059.21 50.000% 529.61 Savings Account No. 76979-S1 3 New Cumberland Federal Credit Union -IRA 16,347.92 50.000% 8,173.96 Account No. 76979 TOTAL (Also enter on Line 6, Recapitulation) I 38,948.23 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith, Gary L FILE NUMBER 21-12-0063 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. (Ir more space Is neeaed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Smith, Gary L Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission raid i 2. Attorney's Fees Mark A. Mateya 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. ~ Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 2,085.00 16,000.00 472.50 7. Other Administrative Costs 420.56 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 18,978.06 FILE NUMBER 21-12-0063 AMOUNT Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith, Gary L 21 12 0063 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hetrick Cremation Services -Funeral Services 2,085.00 H-A 2,085.00 Qther Administrative Costs 2 Cumberland County Register of Wills -Additional filing fee for Renunciations filed at time of 10.00 probate 3 Cumberland Law Journal -Legal Advertisement for Estate Administration 75.00 4 State Farm Insurance -Insurance Premium on real estate 5 The Sentinel -Legal Advertisement of Estate Copyright (c) 2002 form software only The Lackner Group, Inc. 114.16 221.40 H-B7 420.56 Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Smith L FILE NUMBER 21-12-0063 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Asset Acceptance LLC -Collection for HSBC Fortis Capital Credit Card -Bon Ton 450.00 2 Emergency Medicine Associates -Medical Services 32.54 3 Fort Belvoir Federal Credit Union -Overdraft for account No. 00400057230073 39.83 4 Frances E. Oiler, Tax Collector - Reaf estate taxes for 684 N. Middle Road 274.56 5 Milton S. Hershey Medical Center -Medical services 406.79 6 MS Hershey Medical Center -Medical Services -Account No. 16802511 366.32 7 I PNC Bank -Mortgage on real estate located at 684 N Middle Road, Newville, PA I 13,100.61 TOTAL (Also enter on Line 10, Recapitulation) I 14,670.65 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-08) i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE J BENEFICIARIES wi~-i~ yr Smith, Ga L NUMBER NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)1 FILE NUMBER 21-12-0063 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Do Not List Trustee s Adam Smith Child 1/3 of residual 101 E. Countryside Drive minus 1/3 value Boiling Springs, PA 17007 of the real estate disclaimed Jason Kirk Smith Child 1/3 of residual 3 Terri Drive minus 1/3 value Carlisle 17015 of the real estate -disclaimed Tyrone Dee Smith Child One third of 684 N. Middle Road residual estate Newville, PA 17241 plus the real estate Total Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a ro riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) TaxDB Result Details Page 1 of 1 Detailed Results for Parcel 44-OS-0411-010. in the 2010 Tax Assessment Database DistrictNo 44 Parcel ID 44-OS-0411-010. MapSuffix HouseNo 684 Direction N Street MIDDLE ROAD Ownerl SMITH, GARY L C/O PropType R PropDesc LivArea 1344 CurLandVal 44600 CurImpVal 92400 CurTotVal 137000 CurPrefVal Acreage 1.07 CIGrnStat TaxEx 1 SaleAmt 1 SaleMo 10 SaleDa 13 SaleCe 19 SaleYr 94 DeedBld'age 00113-00238 YearBlt 1968 HF File Date 02/25/2009 HF Approval_Status D http://taxdb.ccpa.net/details.asp?id=44-OS-0411-010.&dbselect=l 1/9/2012