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Home My WebLink About10-21-13 1 1505610143 .�.# REV-9500 Ex(oz-itYT , 1 , 7,14 OFFICIAL USE ONLY • - - PRA Department of Revenue Pennsylvania county code Year Fife Number Bureau of Individual Taxes PO BOx280601 INHERITANCE TAX RETURN 21 13 0806 Harrisburg,PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW ' 07 06 2013 03 02 1916 Decedent's Last Name Suffix Decedent's First Name MI SMITH WALLACE - R (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 INAPPROPRIATE OVALS BELOW. •w - Q 1. Original Return 2. Supplemental Retum : 3, Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate -48,Futura Interest Canpomise 5, Federal Estate Tax Return Required (date of death after 2-12-82) fl M ® 8.Decedent Died Teatale - 7;, �acede�I MaMtelneda Living,Trust 8 e. Total Number of Safe Deposit BOxes..• (Aftsch Cqh of Will) A ePY n+s) 9. Litigation Proceeds Received El -10 bsgWAPiTVI?redlj,!;%r Deeth ,7 11,Eledion to tax under Sec.9713(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Dairtime Tolephone.-Number EDWARD P SEEBER 1 7113 .4,533 3980= rn Fri C7 REEISr'N�,F WI LS Uu49ON.LY Fz First Line of Address SUITE C400 v CD r' Second Line of Address m - r--+ M 555 GETTYSBURG PIKE a WED City or Post Office State 2'fP Code DATE FIL - : MECHANICSBURG PA . 17055 ri Correspondent's e-mail address: eps@jsde.cOtl't tis atrimmmarNreet amf��ry,I declare that I h die examined this return.including accompanying schedules and statements,and to the best of my knowledge and belief, prepater other than the personal representative is based on all Information of which preparer has any knowledge. AT E OF PERSON RE NSMLE F FILVG RETU DATE Max J. SmithCSr. 0 J. ADDRE S E 1 1 �. 6311 Blue Flag AvenueCHarrisburplEPA 17112 SIGNATURE OF REP OTH✓ER•,ILIAN REPRESENTATIVE DATE v^ �dvrard P Seeber JQIJ)8/y ADDVS Suite C-4000555 Gettysburg PikeCMechaniesburgCPA 17055 Side 1 1505610143 1505610143 J c J 1505610243 REV-1500 EX 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. 5 , 817 . 72 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nt Probate Property (Schedule G) a Separate Billing Requested............ 7. 1 , 924 . 55 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 7 , 742 . 27 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. - 7 , 051 . 92 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 45, 180 . 43 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 52 , 232 . 35 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -44 , 490 . 08 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. -44 , 490 . 08 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 15 0 . 00 (a)(1.2)X.00 16. Amount of Line 14 taxable 0 . 00 16. 0 . 00 at lineal rate X .045 17. Amount of Line l4 taxable 0 . 00 17. 0 . 00 at sibling rate X.12 18. Amount of Line 14 taxable at collateral rate X.1 5 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-13-0806 Decedent's Complete Address: DECEDENT'S NAME Smith,Wallace K. STREETADORESS 6225 Wilson Lane CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1, Tax Due(Page 2,Line 19) {1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0,00 3. Interest (3) 4, If Line 2 is greater than Line I +Line 3,enter the difference, This is the OVERPAYMENT. (4) Check box on Page 2LLine 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) 0,08 Make Check Pa able to: REGISTER OF WILLSLAGENT. 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;...-....................................................... ................._ �-X 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 after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................:......_............__._....___........._.___.........._.............._.....,._.----- ❑ 0 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 containsa beneficiary designation?...___......._............................................................................................... ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESFjYOU 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)(11)(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.§9118(a)(11)(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(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 172 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-1506 EX+(H-101 SCHEDULE E pennsyivania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith,Wallace K. 21-13-0808 Include the Proceeds of litigation and the date ins proceeds were received by the estate. All property jomtly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 9 PNC Bank Checking Account No. 50-0441-5572-valued per bank letter dated 916113 5448.91 2 Highmark-refund of insurance premium 250.85 3 Omnicare King of Prussia-refund of patient account 117.96 TOTAL(Also enter on Line 5, Recapitulation) 5,817.72 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-05ta 2Xa(08-0s) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith,Wallace K. 21-13-0806 This schedule must be=totaled and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % oEcus EXCLUSION TAXABLE NUMBER HELCATE O NAME OF A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPUCnecej VALUE 1 Musselman Funeral and Cremation Services-prepaid 1,924.55 100.000% 0.00 1,924,56 funeral TOTAL(Also enter on Line 7,Recapitulation) 1,924.55 (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 G(Rev.08-09) REV-1811 EX-(10-0) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCF RESIDENT DECEDENT URN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER SmithEWailace K. 21-13-0806 Decedent's debts must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 3[204.50 B. - ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Max J.SmithC]Sr. Street Address 6311 Blue Flag Avenue city Harrisburg state PA zin 17112 Year(s)Commission Paid 300.00 2. Attornev's Fees JSDC Law Offices 310W00 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 126.50 5. Accountant's Fees 6, Tax Return Preparer's Fees 7, Other Administrative Costs 418.92 See continuation schedule(s)attached TOTAL(Also enter on line 9ERecapitulation) 71051.92 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith Wallace K. 21-13-0806 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Musselman Funeral and Cremation Services-funeral services 2,006.50 2 Roiling Green Cemetery-gravemarker 1,19800 H-A 3,204.50 Other Administrative Costs 3 Cumberland Law Journal -estate notice publication fee 75.00 4 Register of Wills,Cumberland County-reservation for accounting fee 165.00 5 The Sentinel-estate notice publication fee 178.92 H-B7 418.92 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) R"48i2 EX-(i2A8) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith,Wallace K. 21-13-4806 Report debts Incurred by the decedent prior to death that remained unpaid at the date pt death,including umeimbursed medical expenses. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Asbury Bethany Village-unreimbursed nursing home bill 1,485.55 2 PA Department of Public Welfare-medical assistance recovery-Class 3 claim 3,978.82 3 PA Department of Public Welfare-medical assistance recovery-Class 5 claim 39,716.06 TOTAL(Also enter on Line 10,Recapitulation) 45,180.43 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA4504 Schedule I(Rev. 12-08) REV-Y Si3 EX+t4Y-Y01 ' pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith,Wallace K. 21-13-0806 RELATIONSHIP TO NUMBER NNAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT $$ESTATE PERSOS)RECEIVING PROPERTY (Words) {$$$) 0 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sea 91 16 a 1.2 Cinda L.Kauffman Granddaughter 1/3 of the residue 4442 Green Park Drive Mount Joy, PA 17552 M Brian R.Lobel Grandson 1/3 of the residue 4 Elmhurst Road Camp Hill, PA 17011 Keith Lobel Grandson 113 of the residue 100 Sunset Boulevard#403 West Columbia,SC 29169 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as approp riate. NON-TAXABLE DISTRIBUTIONS: II. 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)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 01-10) Z \ \ / § ® \ -3 ƒ ) . n / nA A / / / / 7 / ƒ / \� 2,0 / / c � HASLM ■ o ig _ \ { 9 Vj ) . S POSTAGE Tams SmTrH DIErrE cK&CONNELLY LLP Cheryl L.Baker,CP Certified Paralegal clb@jsdc.com October 18, 2013 R.o.BOX 650 HERSHEY,PA 17033 Courier Address: 134 SIPE AVENUE HUMMELSTOWN,PA 17036 Glenda Farner Strasbaugh,Register of Wills TEL. 7,7ss3szao Cumberland County Courthouse 1 Courthouse Square WWW.JSDC COM Carlisle, PA 17013 Re: Estate of Wallace K Smith File No. 21-13-0806 Dear Mrs. Farner Strasbaugh: Enclosed are the following documents to be filed in the above-referenced Estate: GARY L.JAMES 1. An original and one(1) copy of the Inventory. MAx J.sMm,,JR. A. ER 2. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. JOHN J.SCOTT DNNELLY,K DIERICK JAMES F.SPADE MI CHABAL,111 Please time-stamp the extra copies and return them to me in the enclosed self-addressed NEIL R YARN RONALD P.SEEDIER stamped envelope. RONALLD r.TomAsK DMASKo SUSAN M.KADEL COURTNEY K.POWELL If you have any questions,please feel free to contact me. KIMBERLY A.BONNER KAREN N.CONNELLY CHRISTINE T.BRANN Sincerely yours, JESSICA E.LOWE GREGORY A.KOGUT,JR. THOMAS J.CAR C�L� i RALPH M.SALVIA JSD LAW OFFICES TERESA M.REIRSNYDER JAMES D.YOUNG 1 CAYLA M B. MiLO ALFxis M.MILGSZEWSKI 1 L. Balser, CP OR COUNSEL: GREGORY K.RICHARDS Ce 'fled Paralegal ANDREW H.BRIGGS Enclosures cc: Max J. Smith, Sr., Executor Reply to: Suite C-400 555 Gettysburg Pike Mechanicsburg,PA 17055 Direct Dial: 717-298-2094 Direct Fax: 717-298-2095