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HomeMy WebLinkAbout06-12-13 I REV-1500 EX(01-10' 155610143'{ OFFICIAL USE ONLY PA Department of Revenue pennsylvanis County Code Year File Number Bureau of Individual Taxes Day°"fMe?OF Residue PO BOX.280601 INHERITANCE TAX RETURN 21 12 0880 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 07 12 .2012 09 30 1920 Decedent's Last Name Suffix Decedent's First Name MI SMITH EDWARD S (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI III 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 E] 2. Supplemental Return 3. v eomainderlReturn(date of death 4. Limited Estate 4a_Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12.82) © 6 Decedent Died restate 7 Decoders PyighIneC)a Livmq bust 8. Total Number of Sate Deposit Boxes (Attach Copy of Will) Doff 9. Litigation Proceeds Received 10.Spousal Povert Cmdittidate of deem I1.Election to tax under Sec.9113(A) be on 1231-8i and f-1-95) (Attach Sch.O) CORRESPONDENT•THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number BRADLEY L GRIFFIE 717 243 5551 REGISTER&ELLS USQ0NLYr O warn- First line of address �•+ "'< C7 m 200 NORTH HANOVER STREE o to N n n Q C Second line of address - vn C 'TI —_3 X7 a -• w . AT E FILED r- City or Post Office State ZIP Code CARLISLE PA 17013 CorrespondenCs e-mail address: bgriffie @griffielaw.com 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 true,correct and complete.Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SI NATURE F PERSON NSIBLE FO ING RETURN ATE Jay E. Smith / ADD S 436 Good ear Road Gardners PA 17324 SIG RE F P P THAN REPRESENTATIVE. DATE Bradley L Griffis ORES 2 ofrtFi Hanover Street, Carlisle, PA Side'1 1505610143 1505610143 J u J .PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Smith, Edward S. 21A2-0880 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 true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature#2 Name Pamela S. Tate Addressl 4100 Carlisie Road Addressl City, State,Zip Gardners PA 17324 Date 2�/3 1505610243 REV-1500 EX Decedent's Social Security Number Dec enrsName Smith, Edward S. 185 10 3037 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. A. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 6,563 . 03 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 3 , 799 . 02 7. Inter-Vivos Transfers&Miscellaneous t�oq Probate Property (Schedule G) a Separate Billing Requested............ 7, 95 , 855 . 92 g, Total Gross Assets (total Lines 1-7)..................................................................... 8. 10 6,.217 . 97 9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 5, 587 . 41 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I).............................. 10. 1 ,289 ..25 11. 'Total Deductions(total Lines 9&10)_................................................................ 11. 6, 876 . 66 . 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 99 ,341 . 31 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. 99 ,341 . 31 TAX cOMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 34 . 51 15. 0 . 00 (a)(12)X.00 16. Amount of Line 14 taxable 98 , 953 .19 16. 4 ,452 . 89 at lineal rate X .045 17, Amount of Line 14 taxable 0 . 00 17. 0 . 00 at sibling rate X.12 18. Amount of Line 14 taxable 0 . 00 at collateral rate X.15 0 . 00 18. 19. Tax Due.................................................................................................................. 19. 4 ,452 . 89 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. EK Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-12-0880 Decedent's Complete Address: DECEDENT'S NAME Smith, Edward S. STREETADDRESS 770 South Hanover Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 4,452.89 2. Credits/Payments A. Prior Payments 4,500.00 B. Discount 225.00 Total Credits(A +B) (2) 4,725.00 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) .272.11 Check box on Page 2 Line 20 to request a refund 5. If Line 1+Line 3 is greater than Line 2,enter the dference. This is the TAX DUE. (5) Make-Check Pa able 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;.................................. �] 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 ❑ receivingadequate consideration?.................................................................................................................... x 3. Did decedent own an"in trust for' 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. 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-1608 Ex+(6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REt1RN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith Edward S. 21-12-0880 Include Me proceeds of litigation and the Said the proceeds were received by the estate. All property}olany-owned with the aW of Survivorship must be die cloead on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Medical expense refund from CRMC 117.49 2 Refund from Chapel Pointe at Carlisle -(Refund of Nursing Home overpayment) 5,214.54 3 Prudential Distribution -(Correction of interest payment error for 2009) 6.00 4 Internal Revenue Service refund (2012 tax return) 1,225.00 f TOTAL(Also enter on Line 5, Recapitulation) 6,563.03 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. Form PA4500 Schedule E(Rev.6-96) Rev-1609 EX-(6-99) SCHEDULE .F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith Edward S. 21-12-0880 If an asset was made}oint within one year of the decedents date of death,It must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jay E. Smith 436 Goodyear Road Son Gardners, PA 17324 B. Margaret S. Smith 1 Longsdorf Way Spouse Carlisle, PA 17013 C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY ya OF DATE OF DEATH VALUE OF ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND DANKACCOUNT DATE OF DEATH DECD'S DECEDENT'S INTEREST NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMDER.ATTACH DEED FOR VALUE OF ASSE INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 03124/2010 PNC Checking Account#5005251768 7:529.01 50.000% 3,764.51 2 a 0812311988 PNC Checking Account#5140401917 69.02 50.000% 34.51 -TOTAL(Also enter on Line 6, Recapitulation) 3,799.02 (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.6-96) Rev-1510 EXs(6-96) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT ESTATE OF FILE NUMBER Smith, Edward S. 21-12-0880 This schedule must be completed and filed if the answer to 8 n of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECORS EXCLUSION TAXABLE NUMBER THE DATENOF TRANTRANSFEREE CH A COPY OF TE EED FOR DECEDENT EL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Principal Financial Group -Annuity Contract No. 95,855,92 100.000% 95,855.92 8658277 (See attached statement) TOTAL(Also enter on Line 7, Recapitulation) 95,855.92 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. Fong PA-1500 Schedule G(Rev.6-98) REV-1151 EX-(1048) SCHEDULE H COMB NWEALT(i_OFeERNTS,Y�NANIA FUNERAL EXPENSES & 7 IIDEN` DTE' o NJ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Smith, Edward S. 21-12-0880 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: Hollinger Funeral Home 235.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State zo Year(s)_Commission,paid 2. Attomev's Fees Griffie &Associates, P.C. 4,000.00 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 247.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs ; 1,104.91 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 5,587.41 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, Edward S. 21-12-0880 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Advertising to The Sentinel 200.16 2 Advertising to the Cumberland Law Journal 75.00 3 Bank Fees 15.75 4 Cohick&Associates -(Professional fees/2012 Personal Tax Return) 314.00 5 Reserves 500.00 H-B7 1,104.91 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 6-98) Rev-1512 E%+(12-a9) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Edward S. 21-12-0880 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Darryl Guistwite(Medical)(2 statements) 145.26 2 Millennium Pharmacy Systems(Medical) 79.66 3 Carlisle Regional Medical Center(2 statements) 234.38 4 Philhaven(Medical) 11.20 5 Cumberland Goodwill Fire&Rescue 3 statements 781.89 6 Millennium Pharmacy Systems(Medical) 36.86 TOTAL(Also enter on Line 10, Recapitulation) 1,289.25 (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. 12-06) REV-0613 EXs(11-08) ��������qqqq CCII{{ pp�� NEN7U� SCHEDULE J COMNIORESIDE�tJiEDECEOtNTRNANIA BENEFICIARIES ESTATE OF FILE NUMBER Smith, Edward S. 21-12-0880 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List TW51201-1 I. TAXABLE DISTRIBUTIONS (include outright spousal distributions,and transfers under Sec.9116a 1.2 1 Margaret R.Smith Spouse One Hundred 5,366.54 Cumberland Crossings Percent of 1Longsdorf Way, Room 22 distributable Carlisle, PA 17013 estate 2 Jay E. Smith Son 51,692.47 436 Goodyear Road Gardners, PA 17324 5 Pamela J.Tate Daughter 47,927.96 4100 Carlisle Road Gardners, PA 17324 Total 104,986.97 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet,as appropriate. 'NON=TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS 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) r. aof MW ttn.b C71 utamrut rnf I, EDWARD S. SMITH, of 1028 Hill Place, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, for and in consideration of the mutual and irrevocable will of my wife, Margaret R. Smith 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 and further declaring that this will shall be irrevocable. 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 marker for my grave. FOURTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto my wife, MARGARET R. SMITH, provided she survives me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all said tangible personal property unto my children, Jay E. Smith, Perry S. Smith, Natalie R. Stare, Pamela Jo Tate and my wife's children, Tom D. Roth and Linda M. Roth, in equal shares. FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto my wife, MARGARET R. SMITH, provided she survives me by thirty days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all said real estate unto my children, Jay E. Smith, Perry S. Smith, Natalie R. Stare, Pamela Jo Tate and my wife's children, Tom D. Roth and Linda M. Roth, in equal shares. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto my wife, MARGARET R. SMITH, provided she survives me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate unto my children, Jay E. Smith, Perry S. Smith, Natalie R. Stare, Pamela Jo Tate and my wife's children, Tom D. Roth and Linda M. Roth, in equal shares. SEVENTH. 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. EIGHTH. I hereby nominate, constitute and appoint my wife, MARGARET R. SMITH as Executrix of this my Last Will and Testament. In the event of renunciation, death, r resignation or inability to act for any reason whatsoever of MARGARET R. SMITH, I nominate, constitute and appoint my children, Jay E. Smith and Pamela Jo Tate, as Co-Executors of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she maybe called upon to act insofar-as I am able by law to do so. In addition to the powers . conferred by law,I authorize my Executrix, 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. NINTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executrix and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF I have hereunto set m hand and seal to this, m Last Will Y Y and Testament, consisting of two typewritten pages this; ')14ay of February, 1999. EDWARD S. SMITH Signed, sealed published and declared by the above named Testator EDWARD S. SMITH-as and for his Last Will,and Testament,in the presence of us, who, at his request, in his sight and . presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANI4 SS. COUNTY OF CUMBERLAND I,EDWARD S. SMITH, Testator 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 voluntary act for the purposes therein expressed. EDWARD S. SMITH Sworn or affirmed to and acknowledged before me, by EDWARD S. SMITH this ��day of February, 1,979. Notarial Seal Gynthia�L.Darr,Notary Public U SouthMiddleton Twp.,Cumberland County My Commission Expires Aug.i4,2000 ary Public �� COMMONWEALTH OF PENNSYLVANIA :SS. COUNTY OF CUMBERLAND We, — and /�t — the witnesses whos names are s' ned to the attached or foregoing mstru ent, being duly,qualified . according to law, do depose and say that we were present and saw EDWARD S. SMITH sign and execute the instrument as his Last Will;that he signed wittingly and that he executed as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the .Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and s scribed be ore y and Gib a-4-Q-'-witnesses, this. day of Feb 1999. Notarial Seal O Pub11C Cynthia L.Dan,Notary Public South Middleton Twpp Cumberland County My commission Expires Aug. 14.2000 nug, ID. L IL II LYnm Irve uann Iru. LTIL I 1 t laftot>o.Ewiy August 28,2012 Bradley L Griffie Esq. 200 N Hanover St. Carlisle,PA 17013 RE: Edward S Smith SSN: 185-10-3037 DOD: 07-12-2012 Dear I& Griffie: In response to your request for Date of Death(DOD)balances for the customer noted above,our records show the following: Checking Account Account it 5005251768 Established: 03-24-2010 EDWARD S SMPPH JAY E SMITH DOD balance: $7,529.01 + 0.00 accrued interest Interest paid 01-01-2012 thru 07-12-2012 S 0.00 YTD Account#5140401917 Established:08-23-1988 EDWARD S SMITH MARGARET R SMITH DOD balance: $ 69.02 non interest bearing Please note that this office provides date of death balances for deposit accounts(IRAs,CDs,Cheoldng and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC Page 1 of 2 Hug. 10. LUIL 1I : OW fM, Ddn1 YV. 777G L This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged coodential and exempt from disclosure under applicable law. .Ifthe reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient,you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. Yf you have received this communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page.2 of 2 F6,oncial Principal Life ar 11 Insurance Company Princor Financial August 23,2012 Services Corporation TERRY BISHOP Re: Edward S Smith Contract No. 8658277 Dear Terry Bishop: The value of contract 8658277 as of 07/12/2012 was$95,855.92, Our customer service representatives are available to answer your questions from 7 a.m.to 6 p.m. CST, Monday through Friday,at(800)852-4450 Sincerely, The Principal Financial Groups RIS Annuity Services (800) 852-4450 Enc: Corporate Center:Des Moines, Iowa 50352-1770(800)852.4450 Secanfles offered through Princor Financial Sewoxis Corporation.(800)2471737,member,SIPC. Principal Life and Potwar'are members of the Prm,1,71 Rnonriai Group" nes Moines.M 50392.