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Home My WebLink About02-27-13 (2) 1505610140 REV-1500 Ex (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po Box 2aosol INHERITANCE TAX RETURN County Code Year File Number Harrisburg PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 6 5 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Deat h MMDDYYYY Date of Birth MMDDYYYY 6 0 4 2 0 1 2 0 6 0 9 1 9 3 2 Decedent's Last Name Suffix Decedent's First Name MI S M I T H J A N E T L (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 OVALS BELOW ^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required ~X 6. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number W I L L I A M A D U N C A N 7~ 7 2 4~-::~ 7 ~,, 8 0 . -~,,, - First line of address 1 I R V I N E Second line of address R 0 W City or Post Office C A R L I S L E State ZIP Code --~- TER OF Wfpl-S U6li t~ Y rn .~~~ r,-, _, n LJ n C.~a ` C : 7 .,~ ':'t C~7 - - ~°w: cs Cox :..~ e,, .~ ~ _~ __ E ~ .... f. _r -. .^y -: ~ R _ ~~ DAT~FiLED P A 1 7 0 1 3 Correspondent's a-mail address: b i 11 a d u n c a n h a r t m a n l a w• c o m ~~iaer penaiues or penury, 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. SIGNA~IRE sf~ERSON R~ ~~~ E FAR FILING RETURN ~~ ~ DATE 34 E• PENN STREET CARLISLE PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE PLEASE USE ORIGINAL FORM ONLY Side 1 L 150561014D 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's rvame: JANET L• SMITH RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 0 . 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 1 0 1 3 4 5 . 0 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 0 1 3 4 5 , 0 6 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 11. Total Deductions (total Lines 9 and 10) ............................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .................. ........ .. 12. 13. Charitable and Governmental BequestslSec 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. TAX CALCULATION -SEE fNSTRUCTIONS 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 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 0 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 9 1 4 7 8. 8 8 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 Side 2 L 1505610240 8 3 6 0. 7 4 1 5 0 5. 4 4 9 8 6 6. 1 8 9 1 4 7 8. 8 8 9 1 4 7 8. 8 8 0. 0 0 0. 0 0 1 0 9 7 7. 4 7 0. 0 0 1 0 9 7 7. 4 7 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME JANET L• SMITH STREET ADDRESS 10 WESTMINISTER COURT CITY CARLISLE Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 10 , 0 0 0. 0 0 B. Discount 5 2 6.3 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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. File Number 21 12 0653 STATE ZIP FA 17103 (1) 10,977.47 Total Credits (A + g) (2) 10 , 5 2 6.3 0 (3) (4) 0.0 0 (5) 4 51.17 Make check payable to: REGISTER OF WILLS, AGENT 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 : ........................................................... ........... ^ 0 b. retain the right to designate who shall use the property transferred or its income; .................... ........... ^ Q c. retain a reversionary interest; or ........................... .......................................................... . ......... ^ ^ X d. receive the promise for life of either payments, benefits or care? ................. . .. ........................ : .......... ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receivin ad uate considerations 9 eq ............................................................................ ^ ........... O 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ....................................................................................... ........... 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 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 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)]. 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-1506 EX + (6-98) ~CHEDIJLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENTEDECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER JANET L• SMITH 21 12 0653 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F ITEM NUMBER DESCRIPTION VALUE AT DATE OF D 1 MEMBERS FIRST SAVINGS EATH . ACCT- # 163228-00 139.78 ESEE DOD LETTER ATTACHED] 2• MEMBERS FIRST CHECKING ACCT• # 163228-11 18,456.42 ESEE DOD LETTER ATTACHED] 3• MEMBERS FIRST INVESTMENT SAVINGS ACCT• # 163228-05 12,439.92 ESEE DOD LETTER ATTACHED] 4• MEMBERS FIRST IRA CERTIFICATE OF DEPOSIT # 163228-16 13,408.54 [SEE DOD LETTER ATTACHED] 5• VERIZON REFUND 20.30 6• SALE OF 2008 CHEVROLET COBALT 7,600.00 ESEE ATTACHMENT] 7• ALLSTATE AUTO INSURANCE REFUND 284.20 8• PACIFIC LIFE ANNUITY PROCEEDS 43,949.90 ESEE DOD LETTER ATTACHED] 9• MOBILE-REC INC• - REFUND OF INSURANCE PREMIUM 46.00 10• TRAILER SALE ESEE ATTACHMENT] 5,000.00 TOTAL (Also enter on line 5 Recapitulation) I S (If more space is needed, insert additional sheets of the same size) 1,345.06 REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ca i H i c yr FILE NUMBER JANET L• SMITH 21 12 0653 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME B 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: DUNCAN & HARTMAN, PC 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant 4 Street Address City State Relationship of Claimant to Decedent Probate Fees: REGISTER OF WILLS 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. 8• 9• 10• CUMBERLAND LAW JOURNAL - LEGAL NOTICE THE SENTINEL - LEGAL AD REGISTER OF WILLS - FILING FEE HELD IN RESERVE TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. ZIP AMOUNT 2,322.24 5,050.00 218.50 75.00 180.00 15.00 500.00 8,360.74 REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER JANET L• SMITH 21 12 0653 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. ROBERT E• GOODLING - LOT RENT & WATER & SEWER CHARGES 273.00 2• PPL 118.65 3• BANK OF AMERICA 482.50 4• AMERICAS 273.01 5• ROBERT E• GOODLING - SPECTRUM CHARGES 45.48 6• GEORGE'S FLOWERS 30.74 7• ROBIN SOLLENBERGER - TAX COLLECTOR 11.00 8• CENTURYLINK 37.83 9• SHIPLEY ENERGY 200.92 10• PPL 11.65 11• COMCAST 20.66 TOTAL (Also enter on Line 10, Recapitulation) 13 1, 5 0 5 4 4 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES t~ i ql t VF: FILE NUMBER: JANET L• SMITH 21 12 0653 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. LILLIAN R• WALTERS Sibling 34 E• PENN STREET 100X CARLISLE, PA 170],3 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1500 COVER SHEET AS APPROPRIATE II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ If more space Is needed, use additional sheets of paper of the same size. REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: _ 10 , 000 • 00 Discount: 5 2 6.3 0 Interest Table Year Days Delinquent this time period Balance Due this year Interest this period Before 1981 _ 1982 1983 __ 1984 _ 1985 1986 __ 1987 _ 1988 throw h 1991 1992 _ __ 1993 throw h 1994 __ 1995 throw h 1998 _ 1999 2000 _ _ _ 2001 2002 2003 2004 _ 2005 __ 2006 __ 2007 2008 _ _ 2009 _ 2010 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty LAST WILL TESTAMENT I, JANET L. SMITH, of 10 Westminister Court, Cazlisle, N. Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within my family's burial plot in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable mazker for my grave. FOURTH. I give, devise and bequeath all of my estate of whatever nature, be it real, personal or mixed, and wherever situate unto my sisters, LILLIAN R. WALTERS and HAZEL C. DEAVOR, in equal shares, to share and share alike. In the event that one predecease me, then the remaining sister shall inherit my entire Estate. In the event that both my sisters, LILLIAN R. WALTERS and HAZEL C. DEAVOR predecease me, then my Estate shall pass to my niece, BARBARA PARRISH, per stirpes. FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. SIXTH I hereby nominate, constitute and appoint my sister, LILLIAN R. WALTERS as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of LILLIAN R. WALTERS, I nominate, constitute and appoint my niece, BARBARA PARRISH as Executor of this my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he may be called upon to act insofaz as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of one typewritten page this ~Z day of ~-- 2009. "/ ET L. SMIT Signed, sealed published and declared by the above named Testatrix JANET L. SMITH as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. CL~~~ COMMONWEALTH OF PENNSYL VANL4 COUNTY OF CUMBERLAND . SS. I, JANET L. SMITH ,Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ANET L. S I Sworn or affirmed to and acknowledged before me, by n JANET L. SMITH this ~// ~ day of ~/~ ~~/ , 2009. Notary Public o~w~e~a~TM of ~r•-risnv rw NOTARIAL SEAL JOAN D. ADAMS. Notary Public Carlisle Boro., Cumberland Counh My Commission Expires March 7, 2611 COMMONWEALTH OF PENNSYL VANL4 COUNTY OF CUMBERLAND We, I' V f ~/f/l ~/Vl ~ ~ ~1~i(J~//r/v and :SS. the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JANET L. SMITH sign and execute the instrument as her Last Will; that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. E ~ Sworn or affirmed to and subscribed before me by vY~ 1.L! it M .~ ~ ~ ~`/~ ~-~ N and witnesses, this a day of ~ ~ 2009. /' Notary Public C MONWEALTH OF pENNSYLVANiA NOTARIAL SEAL JOAN D. ADAMS, Notary Public Carlisle Boro., Cumberland Counttyy My Commission Expires March 7, 2bf 1 • MEMBERS i't FEDERAL CREDTr iJNION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner IRA CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary "Hazel deceased 6!4/2009 163228-00 10/22/1996 $139.78 $0.00 $139.78 None 183228-11 10!22/1996 $18,456.27 $0.15 $18,456.42 None 163228-0l5 08/21/2009 $12,439.61 $0.31 $12,439.92 None 183228-18 02/20/2007 $13,407.93 $13,408.54 Hazel Deavor' Lillian Walters MEMBERS 1sT FEDERAL CREDIT UNION ~~ Tessa LL Klua~ Lending Insurance Support Specialist June 13, 2012 Estate of: JANET L SMITH Date of Death: 06104/2012 Social Security Number: 200-24-0292 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org <.. ~,~ .. .~. .,. .,. ca~taHA~ ~ A~~ :. ~. ~ ~ a ,~ C .~- '~~,~ s ° .r .~ ~, ~ ; y .,... 9 .. u ~ - ~. . .., . . '~' ~, ~, .,.. ~ 6P2~6-~~3 .TUB `` ~It7E_ "~~ ~ .. .~ .. ,r - v .~. .. ~ .. _, _ ~... .. ;w ~. .~ J ,.w6v... .' 'r.. +. ~ ~ / ~ s. V~ rt• /~ g 6 r w (j s V. ~ ~~ • _ ~ » • ,r : V 1 a ' Y: ` .. ,~'~'"'.wr aw- _ v ~/ "' r' • _ a., s F b 'r y ~;, ~, 1 . v r ~ r r 1I f ~ _ i A' _.^ t.. w ywy.y ~ .i ~W -. nv ._ •r r .,~ .v. 4. ,j" + yy ~. < K .. ~/~[ ... y,.. ,. 'a .. ... .. ~ f /C ~ ~=~ ~, Y ~-`"-~ ,~~. ,. tom. ,,-* '°-,;,-.~ ~ ;. .. :,~ .~ ~ : y ~ . ~ , _ K. ~ .,, ,~,.~ _ ~,. ~,~ _ ... , s u ~.. BALANCE DUE OF $ 4,000.00 PAID BY CHECK ON SEPTEMBER 5, 2012 = $ 5,000.00 TOTAL PAID FOR TRAILER AGREEMENT I, Robert E Goodling, agree to buy the home (and shed) situated on Lot#10, Westminster Court, for $5,000.00 upon receipt of the title of the home. t will pay lot rent, water and sewer charges until 1 receive the title. I must be allowed to take possession immediately and occupy the home. I will give a down payment of $1,000.00 to be held in escrow until the title has been received. t have received permission to let the home (and shed) on lot#10 Westminster Court. Date _ ~ ~ ~"~ Signed: Robert E Goodling Date%~~ Signed: Lillian Walters ROIBERY ~. ~~~~i ~_ ~ _ ~nao i t so-184/313 RU, BE7X B8 464Q CARLISLE, PA 47013 1llN7 ~ ~ CHECK AMdl1NT ~7B TU THI. opgER~Of . ,. oescwrrtav . ivu~~~ '~ 4~~~Qw~ ~~~~~ V~ N, v t !6(j J71 yy fF. Y~~ ~Gq JP Ste` M004640~~' ~:0 3 L 30 1846: 5 L 304 2 28 3~~' PACIFIC LIFE August 6, 2012 Duncan 8 Hartman P.C. Attn: William A Duncan 1 Irvine Row Carlisle, PA 17013-3019 Re: Accumulated Cash Value Contract: FA09023846 Annuitant: Janet L Smith Owner: Janet L Smith Dear Mr. Duncan: We are writing in response to information requested on the above-referenced contract. The Accumulated Cash Value as of June 04, 2012 is $43,949.90 If you have any questions, you may contact an Annuity Information Specialist at (800) 722-4448, Monday through Friday from 6 a.m. to 5 p.m., Pacific Time. You may also contact your registered representative with questions. Neither Pacific Life nor its representatives give tax or legal advice. Sincerely, ~~~~ ~ . Lorene C Gordon Vice President, Operations Retirement Solutions Division Pacific Life Insurance Company Retirement Solutions Division P.O. Box 2378, Omaha, NE 68103-2378 www.PacificLife.com Securities Distributed by Pacific Select Distributors, Inc., Member, FINRA & SIPC ~nuc~ce~* '~~~ Ia5