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Home My WebLink About11-30-12 (3)1505610143 REV-1500 ex(°'-'°' , OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county cebe vear File Number Bureau of Individual Taxes °~°^"TMe"ROFRA'E"~ Po Box.2sosol INHERITANCE TAX RETURN 21 12 0650 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 15 2012 O1 12 1925 Decedent's Last Name SMITH (If Applicable) Enter Surviving Spouse's Information Below Suffix Decedent's First Name PAUL MI S Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ~ 4a. Future Interest Compromise (tlete of tleath aner 12-02-62) ^ B Decedent °ietl Testate (Attach Copy of Will) ~ T Decetlent Mainta netl a Living Trust (Attach Copy of 1'Nat) 0 9. Litigation Proceetls Received ~ 1°. Spousal Fove~CretliHtlete of tleath between 12-31- antl f-1 -95) 11.Election to tax under Sec. ~79(A) (Attach SQp O) C '~ CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR IOQ~y SHOUL68E DIR T Name Daytime Tel S ~iml>~ Cn ~ rTENNIFER B HIPP 717 7~7a8~61c.,;r az~ o '~'xy'n REGISTEI{'dRWll¢jS U$$bNL1~+t 'yt C? n -r1 .~_ii mNY. +r1 ~J C: First line of address ~ CrJ ~== 1 WEST MAIN STREET i,'. c~ ~ c9 Second line of address City or Post Office State ZIP Code SHIREMANSTOWN PA 17011 Correspondent's a-mail address: 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 try¢,~nect and wmplete. Declaration of preparer other than the personal represenlaUve Is based on all information of which preparer has any knowledge. Kenneth P. Smith 1505610143 1505610143 J MI 3. Remainder Retum (date of death poor to 12-13-62) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 1 West Main Street, Shiremanstown, PA 77011 Side 1 1505610243 REV-1500 EX Decedent's Social Security Number o~adem~:eama. Smith, Paul S. RECAPITULATION 1. Real Estate (Schedule A) ..................................................................................... .. 1. 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. 11 , 382.75 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6. 7. Inter-Vivos Transfers & Miscellaneous h{on,-Probate Property (Schedule G) u Separate Billing Requested........... . 7. 28 , 767 98 8. Total Gross Assets (total Lines 1-7) ................................................................... .. 8. 40 , 150.73 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 5 , 472.66 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) ............................. . 10. 11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 5 , 472.66 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. 34 , 678.07 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. 34 , 678.07 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. 0.00 16. Amount of Line l4 taxable 34 678.07 at lineal rate X .045 r 16. 1 , 5 60.51 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 0.00 19. Tax Due ................................................................................................................. . 19. 1,560.$1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-7500 EX Page 3 Decedent's Complete Address: File Number 21-12-0650 DECEDENT'S NAME Smith, Paul S. STREET ADDRESS 1100 Crandon Way, Apt. 622 CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits 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? ............................................................ x 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 fora or payable upon death bank account or security at his or her death?....... ^ ^x 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. Far 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 7, 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 ~z P.s. §sf is f.z) pz Ps. §sf fs (a> (f>]. . 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-1508 EXa I6-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVFNIq INHERITANCE Tq%RETURN RESIDENT DELEpENT ESTATE OF Inclutle the pmceetls o/ litigation antl the tlate the proceeds were received by the estate. All property jointly-owned with the right of survivorship moat be diaclosetl on schedule F. NUMBER w ~~~~~_ =Rak ~~ ~~cv~ueu, aaamonal pages or the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form Pq-1500 Schedule E (Rev. 6-98) Q MBTBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 June 29, 2012 James D. Boger One West Main Street Shiremanstown, PA 17011 Re: Estate of Paul S. Smith Social Security: 209-12-7994 Date of Death: March 15, 2012 Dear Sir or Madam: Per your inquiry on June 20, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued !merest Total Checking Account 80063721 Kenneth Paul Smith(POAJ Paul S Smith 0828/1964 $11,332.75 $ .00 _____ $11,332.75 For any additional information on the above accounts, including ownership and any changes, dosures and/or rdmbursement of funds, please ~ Ne Snmmerdale Hera at 717-755-2261. We were unable to ]ocnte any safe deposit box for the above-mentioned decedent. This letter does not indude any aarounfs in which the deceased may have been listed as power of Attorney, Custodian of Uniform Transfers, Representative payee, or Trustee under a Written Agreement Sincerely, Valerie Mercer Adjustment Services Rev-1510 EX~ (6-89) SCHEDULE G INTER-VIVOS TRANSFERS & LOMMONVYFALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY INHERITANCE Tq%RETORN RESIOENL DELEOENT tSrgrE OF FILE NUMBER Smith, Paul S. „ ,,, „~~„ This schetlule must be completetl and filed M the answer to any of questions i through 4 on [he reverse sitle of the REV-1500 COVER SHEET is yes. V ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S NUMBER INCLUDE NAME OFTRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND INTEREST EXCLUSION TAXABLE THE DATE OF TRANSFER. ATTACFf A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET (IF APPLICABLE) VALUE 1 PNC Investments - MetLife Annuity No. 9200593130. 28,767.98 28.767.98 The Decedent's two (2) sons were the named beneficiaries of this account. TOTAL (Also enter on Line 7, Recapitulation) I 28 767 98 (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 G (Rev. 6-98) REV-7751 EX~110-06) SCHEDULE H CDMMD~N~WqEAL~E TFpxpF,~r!$)RLVANIA FUNERAL EXPENSES & '"RESIDE D ED N N ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Smith, Paul S. 21-12-0650 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. I FUNERAL EXPENSES: See continuation schedule(s) attached 110.64 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Kenneth P. Smith Street Address 295 Church Street city Shermans Dale State PA zio 77090 Yearfsl Commission oaid 856.81 2. Attomev's Fees Bogar and Hipp Law Offices 2,625.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 719.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,760.77 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 5,472.66 Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith, Paul S. 21-12-0650 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Neill Funeral Home -obituary fee 110 64 H-A 110.64 2 OtherAdmini trativ o t~ Express Scripts -prescription medicine 19.19 3 Golden Living Center -nursing home bill 235.10 4 RESERVES: -Costs to conclude administration of Estate, including filing fee for PA 500.00 Inheritance Tax Return and Inventory, preparation and filing of final Personal Income Tax Returns and Fiduciary Income Tax Returns 5 West Shore EMS-ALS -ambulance service 1,006.42 H-B7 1,760.71 Copyright (c) 2002 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule H (Rev. 6-96) REV-1513 EX+(11-06) E T~ I SCHEDULE J COMM~ERITA~NCE T~RET~RL~ANIA BENEFICIARIES RE ID D DEN ESTATE OF Smith, Paul S. FILE NUMBER 21 _~ ~rlasn NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I• TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 Kenneth P. Smith Son One-half of rest, 295 Church Street residue and Shermans Dale, PA 17090 remainder Randy L. Smith Son One- half of rest, 328 B. Jackson Place residue and Honolulu, HI 96819 remainder Total Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet, as a r o 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 TOTA L 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) LAST WILL AND TESTAMENT OF PAUL S. SMITH I, PAUL S. SMITH, of the Township of Hampden, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give, devise and bequeath all the rest, residue and re- mainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situated, to my wife, Pauline R. Smith, absolutely and unconditionally. 3. In the event that my wife, Pauline R. Smith, should predecease me, or should she die at about the sable time as I do, such as in an accident common to both of us, then in eiCher s uch event, I give, devise and bequeath my entire estate, of whatsoever nature and wheresoever the same may be situated, to my two sons, to wit, Kenneth P. Smith and Randy L. Smith, share and share alike, per stixpes. LASTLY, I nominate, constitute and appoint my wife, Pauline R. Smith, Executrix of this my Last Will and Testament, and in the event that my said wide should predecease me, or should she -1- be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, Kenneth P. Smith,Executor of this my Last Will and Testament, in her place and stead, and in [he event that my said son, Kenneth P. Smith should predecease me, or should hebe unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, Randy L. Smith, Executor of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of A. D., 1984. "CZa C,C ,~. ~Yrv~,/.~~ (SEAL) Paul Smith Signed, sealed, published and declared by the above named, Paul S. Smith, as and for his Last Will and Testament, in the presence of us, who have subscribed our names hereto as witnesses, at the request of said Cestator, in his presence and in the presence of each other. -2-