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HomeMy WebLinkAbout01-0025 REV-1500EX + (&-00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DE PT. 280601 HARRISBURG, PA 17128-0601 IIc-iQq-IY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z w c w (,,) w c w .... ~:$(I) Oil"" w"-O ,,00 0"'.... "-Ill "- " OECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL} Smile Doris DATE OF DEATH (MM-DD-Year) DATE OF BJRTH (MM-DD-Year) f- --- OFFICIAl USE Ol'-ll '{ FILE NUMBER ~1---12--L ___<<s:. COUN1"YCODf YEAR NUMBER SOCIAL SECURITY NUMBER 207-22-2472 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death pliorto 12-13-a2} o 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A)(....""o} 04/04/2000 05101/1931 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FJRST, AND MIDDLE INITIAL) 00 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (A1tachOOllyofWili\ o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death afler12-12-82) o 7. Decedent Maintained a Living Trust (Mach copy of Trust) o 10. Spousal Poverty Credit (dateofdeath between 12-31-91 and 1-1-95) .... z w c z o "- '" w '" '" o o COMPLETE MAILING ADDRESS 845 Sir Thomas Court NAME Marielle F. Hazen Es uire FIRM NAME (If Applicable) Jan L. Brown & Associates TELEPHONE NUMBER 717 541-5550 Suite 9 Harrisbur (1) (2) (3) (4) (5) z o i= :3 ::l ~ ii: c( (,,) w ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Morillages & Notes Receivable (Schedule D) 5. Cash, Bank. Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debls of Decedent, Morillage Liabilities, & Liens (Schedule I) (10) 11. Total Deduction. (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. NetValue Subject to Tax (line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES z o i= ~ ::l Q. ::E o (,,) g 15. Amount of line 14 taxable at the spousal tax rate, or transters under Sec. 9116 (a)(1.2) x _(15) 18,203.07 X .045 (16) X .12 (H) X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20 0 CHECK HERE IF YOU ARE REQUESTING A REFUND QF AN OVERPAYMENT .--"-,, ,_J-_." r' PA 17109 32,000.00 I OFFICIAL USE ONLY l I 2,000.00 2,850.67 J (S) 36,8~O.67 7,068.75 11 ,578.85 (11) (12) (13) 18,647.60 18,20307 (14) 18,203.07 B19.14 B19.14 o d C ece ent's omplete Address: STREET ADDRESS 115 E. Columbia Road CITY I STATE I ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 819.14 3. InteresUPenalty it applicable D.lnterest E. Penalty Total Credits (A + 8 +C) (2) TotallnteresUPenalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greaterthan Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check to: REGISTER OF AGENT 819.14 819.14 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 IXI b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IXI c. retain a reversionary interest; or ..............,...............................................................,....................... 0 lKJ d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IXI 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?........................ .............................. ................... .......... 0 [ZJ 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 IXI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 IXI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of peijury, J declare that I have examined this return, includinQ 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 mfofation ofwhich preparer has any knowledge. SIGNATUREOFPERSO jPO~BLEFOR~L1NGRET. RN/ DATE . '7C.'- ~ v' / /-3 -0/ ADDRESS 115 E. Columbia Road Enola SIGNATURE OF PR RER OTH , ~1 ~ PA 17025 DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (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% [72 P.S. 99116 (a) (1.1) (ii)). The statute does not exemot 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 twenty-one years of age or younger at deafh to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(I.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%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)). A sibling is defrned, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. """~""I""'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Smilev Doris 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 sUNivo~hiD must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Real property located at 115 E. Columbia Road, Enola, PA 17025 VALUE AT DATE OF DEATH 32,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 32 000.00 "",.'~8EX.I"". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Smilev Doris 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 NUMBER 1. DESCRIPTION 1994 Plymouth Acclaim - VIN #1P3AA46K6RF323917 VALUE AT DATE OF DEATH 2,000.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 2000.00 ''''509''.'''"* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL Y.OWNED PROPERTY ESTATE OF Smilav Doris If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER SURVIVINGJOINTTENANTISj NAME ADDRESS RELATIONSHIP TO OECEDENT A. Delores Henry Sister B c JOINTLY-OWNED PROPERTY: lETIER OA1E DESCRIPTION OF PROPERTY %0' DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUEQF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 7yrs. Belco Community Credit Union 5,000.00 50. 2,500.00 Savings Account #150360 "All joint assets used to pay outstanding debts of the estate. 2. A. 7 yrs. Belco Community Credit Union 701.34 50. 350.67 Checking Account #150360 "All joint assets used to pay outstanding debts of the estate. TOTAL (Also enter on line 6, Recapitulation) $ 2 850.67 (If more space is needed, insert additional sheets of the same size) ''''''''''''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE lAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Smilev Doris Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Richardson's Funeral Home 4,000.00 2. Minister 200.00 3. Organist 50.00 4. Janitor (Church) 50.00 5. Church Secretary 50.00 6. United Methodist Women (Funeral luncheon) 200.00 B, ADMINISTRATIVE COSTS: 1- Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~sJ / EIN Number of pe_al Representative(s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees Jan L. Brown & Associates 2,000,00 3, Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4, Probate Fees Register of Wills 93,00 5, Accountant's Fees 6. Tax Return Preparer's Fees 7, Eshenauer Appraisal Services 250,00 8, Legal advertising - The Cumberland Law Journal 7500 - The Sentinel 100,75 TOTAL (Also enler on line 9, Recapitulation) $ 706875 (If more space is needed, insert additional sheets of fhe same size) '''';''''''',.,''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Smilev Doris Include unrelmbursed medical expens... ITEM NUMBER FILE NUMBER DESCRIPTION AMOUNT 8,939.78 1. Belco Community Credit Union loan 2. Bell Atlantic (Pension overpayment) 1,588.86 3. Pinnacle Health (Pension overpayment) 1,050.21 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 11 578.85 "'"'''''''.,'"''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FilE NUMBER r ,MI. 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) t Donald R Smiley Son 100"00 115 E" Columbia Road Enola, PA 17025 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE t B" CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS t TOTAl OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Smiley PETITION FOR GRANT OF LETTERSJ= U ~__ E Doris No. eX I - D t ---- ;;:>S- also known as , Deceased Social Security No. 207222472 Donald R. Smiley Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) o A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut Decedent, dated and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: GJ B. Grant of Letters of Administration (c.I.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I Donald R. Smilev Son 115 E Columbia Rd. Enola PA 17025 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 115 E. Columbia Road, Enola, PA 17025 t:ad./'~/~.LJ / ~/ (list street, number and municipality) Decedent, then 68 years of age, died April 4 ,2000 ,at Polyclinic Hospital, HarrisburQ, PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property......................................... $ (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County.............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ 500.00 30,000.00 30,500.00 Real Estate situated as follows: 115 E. Columbia Road, Enola, PA 17025 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence Donald R. Smile 115 E. Columbia Road Enola PA 17025 /~-1?9'-11 <p~b /- S - () I Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this 5 th cay of " January . t.P 2001 'd'~ e.~fiA;'/ LJ~ "ary j70 LewiR ~~ ~~ Estate of Smilev DECREE OF REGISTER No. also known as Doris 21-2001-0025 Deceased Social Security No: 207222472 Date of Death: 04/04/2000 AND NOW, January. 23rd 2001 ,in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 0 Testamentary (&) of Administration are hereby granted to Donald R. Smiley ((c.I.a., d.b.n.c.l.; pendente lite; durante absentia; durante minoriate) in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters.. .................................. Short Certificates(s) .(0.)... Renunciation .......................... Extra Pages ( ) ............... I.T.R....................................... JCP Fee ................................. Inventory ................................ Other ...................................... $ 70.00 ~~~ ary C. Lewis $ 18.00 $ $ $ $ $ $ $ -0- Signature 5.00 Attorney: Marielle F. Hazen, Esq. I.D. No: 68003 Address: 845 Sir Thomas Court, Suite 9 Harrisburq PA 17109 TOTAL .............................$ 93.00 Telephone: 541-5550 DATE FILED: January 5th,2001 ORDER AND LETTERS TO ATTORNEY . > . . /J-.Lff. .- ~1ru4/LU/~cj~o;ZZ~ MAILED I r] Wi,?;II) RI-V'J/X() Thi, is to certifY thJt the information here given is correctly copied from ~m original certificate of death du~y filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent hlll1g. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. a...v /:l(? ,;j~ Local Registrar Fee for this certificate, $2.00 p 6496596 APR 0 8 2000 I hte 21-2001-0025 '4' 2187 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECOROS CERTIFICATE OF DEATH SEX ..F e mal e STATE FilE NUMBER SOCIAL SECURITY NUMBER 3. 207 22 -2472 68 v.. .. COUNTY Of DEATH PlACE OF DeAtH lCt>eclo. ()("\ly Qf'e ~- -.ee ,nSlfucl,Qfl::l 00 OCf'\er SlOe) HOSPITAL. Inpatiltnt ~ fRlOutpatlene 0 ... A\.AT>H I ~J Ie. DECEDENT'S USUAL OCCUPIJION (Give Iond oI_WOIk done duunQ most oI'M)tk.ngllf.; donex u_ 'ehred I Laborer 11.. llb. OECEDEN"f'S MAILING ADDRESS {Stlee'l. CI'lyf'fOMl. Stale. Zip Code} KINO OF BUSINESS/INDUSTRY SUfMVlNG SPOUSE {It 111II1.. 9ll/llJ ffiaIOef\ name) Villa Teresa 115 E. Columbia Rd. 1.. E n 0 1 a, P a. I 7 0 2 5 FATHER'S NAME (fllst Middle laSlI Gerald Kile DECEDENT'S ACTUAL RESIDENCE cSee tnSlructiOl'\S on OIher SIde) ora 17'b.Cou Did --- !fyelfla Cumb e ria nd __1 ,,0.0 ::C:.:='ot MOTHEA'S NAME (FtIS!. Mtd<:lIe. Malden Sulflam6) I.. The 1 m a Bog art INFQRM-'NT'$ ""lUNG ADORESS {Street. CllyllOwn. $tale. Zip Codel 115 E. Columbia Rd. Enola, Pa. _. c..._ II. INFORMANT'S N""'E (T ypelPflnlt :roo. Donald R. Smiley ""'HOO OF DISPOSITION &un.1 U CrefMllOn 0 Remow.lrom State 0 01.... ,Spec.." 17025 ICENSEE OR PERSON A.CTING AS SUCH LICENSE NUMBER ub.012774-L 10 lhe ~ knowhtdge, dealh OCCUlled allh. time, date and place S'a'ed Title) PlACE OF DISPOSITION. Name of Cemete/y. Crematory 01" Ott\et' P\ac. la, 2000 ~ndiantown Gap Nat. lOCATtON. CifylTown. $ta1.. rIP coo. Annville, Pa. l1d. hemtZ".28 must be COc'l'\~ed by peqon _ho pronounce. dealh -2000 NAME AND AOORESS OF fACILITY .,B i c h a r d son F . H . 295 . En 01 aD r . En 01 a , P a. I 7025 LICENSE NUMBER OAfe SIGNED (MonIh. Day, '\"earl 23b. 230. _S CASE REFERRED TO MEDICAL E)(At.AINERlCORONER1 Yo. 0 ...0 .....EDlATE CAUSE (Fll\a\ sease Of Cond!ll(lfl ~1n08a1h)~ AE~Of<r;"t!fONSEo~~f!!!b u(l.A'l- :!t. I "PPfOlltmate : it\\eNaI between ,OOMl M\d death I : PART II: OIher siOniAcanl concftt;ona c:oo.tfibuling to death. bu1 noI resutling in.". und8fty1ng ~UM giwtl in PART I Idy.. conditions MY,....ong to lI'T'IInedilit. Ene.. UND€RLYtNG USE (Orsease Of InlUry ~ IOIkated elf8nts resulJno In du1h) lAST I : OUE 10 (Of< AS A CONSEOuE NCE Of), DuE 10 (Of< AS A CONSEQuE NCE On .w.s AN AUTOPSY ~RFORMEO? WERE AUTOPSY FINO\NGS A~ILA8LE PRfOR 10 COMPLETION OF CAUSE OF OERH1 MA.NNER OF OEATH DATE OF INJURY (Monlh, Day, Year) TIME OF INJURY INJURY AT'M)AK1 DESCRIBt:: HOW INJURY OCCURRED. ...0 Nojtf v.. 0 No)21 Suicide ,i!J o o Homic:id8 o o o PlACE Of INJURY. Al home. 'ar~~;eef. factory. attic. U. building. etc, tSpecllll\ 3". ... 0 NoD Narur" -'<<dont Pending InvhhgalJon Could not bit determined o *'. 21b. :unIfiER (C~eck oniy one) &CERTIFYING PHYSICI"N IPtlys.c-an cerlllYII"\Q cause oIdea!fl ....tIe" anotner ptws.e:,an has plonounced deat" anocornp\e1ed"em 23) To 1he -.. 0' my know~"... <teeth occunecS duelo th. cauuCsJ and manne,.. st.ted. . . 2t. . PRONOUNCING AND CERTIFYING PHYSiCIAN tPh'(SlC-an bOlh i-lfOflOtJflC+ngl.lealh dnd certifYing 10 cause 01 dealt'll To thtl bHt 01 my knowl.dgft, de-oIlhoccurn,.d.. UWl time. date, and place, and due to the CaUM(.) and m.nne,.. .t.led. 'UEDICAl EXAUINER/CORONER On the bnia of ...minetlon and/or inveshgalion, in my opinion, death occurred.. the lime, date, and place, and due to the c.use(a) ..nd "'ann...- .a at.'ed. . . ... REG'STRAR.SSIGNATURE ~NONUMBER ~JL/ ;nc. 1/4/ AI I 11 32. DATE FILED ,M ~,. "'." ,.. g; t1cJ I STATUS REPORT UNDER RULE 6.12 C/. i/ Name of Decedent: DORIS SMILEY Date of Death: 04/04/2000 Will No . Admin. No. 2001-00025 Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State whether administration of the estate IS complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be compl~e: on or before 5/31/2003. This estate is being held open pending finalization of Ross H. Smiley's estate (decedent's 3 . If the answer to No. 1 is Yes, state the following: husband) . a. account with the Court? Did the personal representative file a final Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is : c . Did the personal representative state an account informally to the parties in interest? Yes No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: OS/20/2002 i!LqlrJ;1/;/ ~ ~/J1 Uyle Signa re / Marielle F Hazen Name (Please type or print) 845 Sir Thomas Court Suite 12 Harrisburg PA 17109 Address r' '- (717 ) - 5415550 Tel. No . .-",.1 Capacity : Personal Representative X Counsel for personal representative ..J ~ r '~ ..,,.>.' ~_.... OK, I ~E/~ ad-. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . BUREAb OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN C (f"..... .~. " .'" '. ~" , \.. , 7 MARIElLE F HAZEN STE 9 845 SIR THOMAS CT HBG PA 17109 06-25-2001 SMILEY 04-04-2000 21 01-0025 CUMBERLAND 101 I~V-1547 ~x AFP 02-00> DORIS Amount Rellitted (1) (2) (3) (4) (5) (6) (n 32,000.00 .00 .00 .00 2,000.00 31,337.61 .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=iSc,-j-E"X-AFP--fi'2=oOY-NOiicE--OF--iNHERifAifcE-TAX-]rpPRAisEMENT~--Ai:.LOWAtrCE-Olf"---------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMILEY DORIS FILE NO. 21 01-0025 ACN 101 DATE 06-25-2001 TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets NOTE: If an assessment was issued previously, lines reflect figures that include the total of Abk ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate US) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS. (9) ClO) 7,078.03 10,490.48 (8) (11) Cl2) Cl3) Cl4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 65,337.61 17.568 'il 47,769.10 .00 47,768.10 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = 31,368.83 X 06 = .00 X 00 = 16,400.27 X 15 = Cl9)= .00 1,882.13 .00 2,460.04 4,342.17 . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-04-2001 AA477847 .00 819.14 03-28-2001 AA478252 .00 2,047.01 INTEREST IS CHARGED THROUGH 07-10-2001 TOTAL TAX CREDIT 2,866.15 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1,476.02 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 110.15 TOTAL DUE 1,586.17 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME REV-1470 EX (6-66) ... . REVIEWED BY SCHEDULE ITEM NO. F 3,4 F 3,4 F H 8-8 INHERITANCE TAX EXPLANA liON OF CHANGES Smiley, Doris FILE NUMBER Daniel Heck ACN 2101-0025 101 EXPLANATION OF CHANGES Accounts #5140112947 and 5130187945 have been added to this schedule as per correspondence dated 03/20/2001. Please be advised that the execution of a joint tenancy contract (signature card) which provides that all monies are payable to either surviving party is sufficient to establish Commonwealth's right to the tax. The Supreme Court in Olson Estate 447 PA 483 (1972) held that under Section 241 (9108 of the Pennsylvania Inheritance and Estate Tax Act of 1995), such accounts are taxable in proportion to the number of joint tenants. The court rejected the convenience account argument by noting that under Section 241 (9108), it is improper to apply principles of ownership to determine the taxable portion of a joint bank account. Joint property is taxable even though the decedent's name was added as a matter of convenience. Jointly held assets are taxable to the survivors. No deductions can be claimed against joint property, as it was not the responsibility of the survivors to pay the debts. This amount has been adjusted to figures submitted by correspondence dated 03/20/2001. 1,2 This amount has been adjusted to figures submitted by correspondence dated 03/20/2001. Taxable at 6%. The tax rate change for lineal heirs is effective for dates of death after 07- 01-2000. Taxable at 15%. The tax rate change for siblings is effective for dates of death after 07- 01-2000. ORIGINAL Page 1 \.. /t- /99-/Y COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 7-( v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 2.0601 ..HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARIELLE F HAZEN STE 9 845 SIR THOMAS CT HBG PA 17109 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-25-2001 SMILEY 04-04-2000 21 01-0025 CUMBERLAND 101 REV-15~7 EX AFP <12-00) DORIS Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is4j-ex-AFP-fl'2=ooY-NoYicE--oF-YNHER-iTAtfce-YA'x-'APPR7risEifENT-,--ALrOWANce-oR"----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMILEV DORIS FILE NO. 21 01-0025 ACN 101 DATE 06-25-2001 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) 32,000.00 .00 .00 .00 2,000.00 31,337.61 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 7,078.03 10,490.48 (11) (2) (13) (4) NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 65,337.61 17.568 51 47,769.10 .00 47,768.10 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = 31, 368.83 X 06 = .00 X 00 = 16,400.27 X 15 = (9)= .00 1,882.13 .00 2,460.04 4,342.17 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-04-2001 AA477847 .00 819.14 03-28-2001 AA478252 .00 2,047.01 INTEREST IS CHARGED THROUGH 07-10-2001 TOTAL TAX CREDIT 2,866.15 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1,476.02 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 110.15 TOTAL DUE 1,586.17 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME REV-1470 EX (6-88) REVIEWED BY SCHEDULE ITEM NO. F 3,4 F 3,4 F H 8-8 INHERITANCE TAX EXPLANA TION OF CHANGES Smiley, Doris FILE NUMBER Daniel Heck ACN 2101-0025 101 EXPLANATION OF CHANGES Accounts #5140112947 and 5130187945 have been added to this schedule as per correspondence dated 03/20/2001. Please be advised that the execution of a joint tenancy contract (signature card) which provides that all monies are payable to either surviving party is sufficient to establish Commonwealth's right to the tax. The Supreme Court in Olson Estate 447 PA 483 (1972) held that under Section 241 (9108 of the Pennsylvania Inheritance and Estate Tax Act of 1995), such accounts are taxable in proportion to the number of joint tenants. The court rejected the convenience account argument by noting that under Section 241 (9108), it is improper to apply principles of ownership to determine the taxable portion of a joint bank account. Joint property is taxable even though the decedent's name was added as a matter of convenience. Jointly held assets are taxable to the survivors. No deductions can be claimed against joint property, as it was not the responsibility of the survivors to pay the debts. This amount has been adjusted to figures submitted by correspondence dated 03/20/2001. 1,2 This amount has been adjusted to figures submitted by correspondence dated 03/20/2001. Taxable at 6%. The tax rate change for lineal heirs is effective for dates of death after 07- 01-2000. Taxable at 15%. The tax rate change for siblings is effective for dates of death after 07- 01-2000. ROW Page 1 REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA E --- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Smiley. Doris Date of Death: 04/04/2000 Estate No. 2001-00025 SSN: 207222472 File No. 21-01-0025 Date Letters Granted: 01/23/2001 Will or Administration No. To the Register: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 02/02/2001 Name Donald R. Smiley Address 115 E. Columbia Road Enola PA 1702f Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Personal Representative X Counsel for Personal Representative ~! '.. : {~?JwjtJ~ Sign ture Marielle F. Hazen. Esquire Name (Please type or print) Jan L. Brown & Associates Address 845 Sir Thomas Court. Suite 9 Date: 02/02/2001 Capacity: ~ "\ Harrisburg PA 17109 Telephone No. (717) 541-5550 -t-- '" Ci!i-) 'li',I'.. PM It , . . ~,;s '~Gg,. I' . ."'"~ '/_~~_~.~ , . :: ~i-\-;. ~._-::-:~~~ "~.no_",:--:o_ ~ - -" . ....v - .~"- ':-0: '.~ - ;.- . - " '- ~ - -'. . 2 00 1 H" "t"""'~' f~f""" r"") I I [-) (~ ~ _ : - 'vl..:.iLED ='iCM 2!1' C~ . :,"," .1 7] 7) MAR 28 , , J1 I " [' r " r 0 ,- 13 n - ,~ :' '11""""""" - .. .. - - f] j; ~ JJ " J.. .-.II"~ __ - ~ f' .....~~. ~. .......... -'''""i ..----- - ~ A." ~--~- --.--....-- .~~ ~_A- _J~-.. 4!" 'aF -.... Jan L. Brown & Associates AITORNEYS AT UW 845 SIR THOMAS COURT SUITE 9 HARRISBURG, PENNSYLVANIA 17109 . LARRY SZOLLOSY MMONWEALTH OF PENNSYLVANIA PARTMENT OF REVENUE REAU OF INDIVIDUAL TAXES PARTMENT 280601 RRISBURG, PA 17128-0601 ,..,' '..,4 - " ..' ~ '" - ~.. JAN L. BROWN & ASSOCIATES ATTORNEYS AT LAW OLOE ENGLISH GAP 845 SIR THOMAS COURT SUITE 9 HARRISBURG, PA 17109 EMAIL jlbassoc@ptd.net CPfO JAN L. BROWN' MARtELLE F. HAZEN TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 . ADMITTED IN PA AND DISTRICT OF COLUMBIA March 20,2001 Mr. Larry Szollosy Commonwealth of Pennsylvania Department of Revenue Bureau of Individual Taxes Department 280601 Harrisburg, PA 17128-0601 Re: Estate of Doris Smiley File No.: 2101-0025 Dear Mr. Szollosy: It is my understanding from your telephone conversation with my legal assistant, Kristin, that we are not required to file a Supplemental Inheritance Tax Return since the original Inheritance Tax Return has not been processed yet. The following adjustments should be made to the original Inheritance Tax Return: 1. Schedule F - PNC Bank Interest Checking Account #51-4011-2947 was joint for at least 20 years with the decedent's sister, Delores Henry, 1875 Good Hope Road, Enola, P A 17025 and the decedent's mother, Thelma A. Kile, 1875 Good Hope Road, Enola, P A 17025. The date of death value of the asset was $4,205.29. The decedent's 1/3 interest was $1,387.75. 2. Schedule F - PNC Bank Savings Account #51-3018-7945 was joint for at least 20 years with the decedent's sister, Delores Henry, 1875 Good Hope Road, Enola, PA 17025 and the decedent's mother, Thelma A. Kile, 1875 Good Hope Road, Enola, PA 17025. The date of death value of the asset was $82,118.75. The decedent's 1/3 interest was $27,099.19. [Please note that the funds in both PNC Bank accounts belonged to Thelma A. Kile. Delores Henry's name and Doris Smiley's name were added for convenience only. No funds were contributed to these accounts by Mrs. Henry or Mrs. Smiley.] '. . ..., ~" Mr. Larry Szollosy Commonwealth of Pennsylvania Department of Revenue Bureau of Individual Taxes March 20, 2001 Page Two 3. Schedule H - The actual amount paid to The Sentinel for legal advertising was $110.03, not $100.75 as anticipated. 4. Schedule I - The amount of pension overpayment paid to Bell Atlantic was $882.70, not $1,588.86. 5. Schedule I - The amount of the debt with Belco Community Credit Union was $8,557.57 as is evidenced from the enclosed copies of Belco Transaction Descriptions. Note that the transfers to L5 are the loan payments. I am also enclosing a copy of the real estate appraisal and receipts from Belco Community Credit Union indicating the amount paid to them for Mrs. Smiley's loan. Please note that all expenses of the estate were paid from assets owned jointly with the decedent's sister, Delores Henry. Finally, we are enclosing the additional tax due of $2,047.01. Thank you for your assistance with this matter. If you require further documentation or if you have any questions, please feel free to contact my office. ~lz~ Marielle F. Hazen MFH/kwb Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JAN L BROWN 845 SIR THOMAS COURT HARRISBURG, PA 17109 ____hh fold ESTATE INFORMATION: SSN: 207-22-2472 FILE NUMBER: 21-2001- 0025 DECEDENT NAME: SMILEY DORIS DATE OF PAYMENT: 08/22/2001 POSTMARK DATE: 08/20/2001 COUNTY: CUMBERLAND DATE OF DEATH: 04/04/2000 NO. CD 000186 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,586.17 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DOLORES K HENRY C/O JAN L BROWN ESQUIRE CHECK# 2032 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $1,586.17 MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JAN L BROWN 845 SIR THOMAS COURT HARRISBURG, PA 17109 ______n fold ESTATE INFORMATION: SSN: 207-22-2472 FILE NUMBER: 21-2001- 0025 DECEDENT NAME: SMILEY DORIS DA TE OF PAYMENT: 10/01/2001 POSTMARK DATE: 09/28/2001 COUNTY: CUMBERLAND DATE OF DEATH: 04/04/2000 NO. CD 000329 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $14.94 I I I I I I I I TOTAL AMOUNT PAID: $14.94 REMARKS: DOLORES K HENRY C/O JAN L BROWN ESQUIRE CHECK# 2059 SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS /?-Jtjtj~/I BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT <j 1,1 ~ v~ REV-16D1 EX AFP 112-DDl AecorQ;:,/'i ('\<'''' R ~ -- _".4 ,.J-~--,'h~A9 of eg:ster of Wills DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-19-2001 SMILEY 04-04-2000 21 01-0025 CUMBERLAND 101 DORIS 'OJ NDV 26 AIl =47 MARIElLE F HAZEN STE 9 Cl~. ~(' 845 SIR THOMfQ ..' I. Court HBG 1."":io~o.. PA Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iffY' =ir,oi-Ex--AFP-n1f=ooY------...-ft:liiERITANc'E--iA3CsTATEiiiENT-oF'-AccoLitif--...------------------ - -- ESTATE OF SMILEY DORIS FILE NO. 21 01-0025 ACN 101 DATE 11-19-2001 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-25-2001 P R I NCI PAL TAX DUE: ...............................................................................................................................................-........................................................................ 4.342.17 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-04-2001 AA477847 .00 819.14 03-28-2001 AA478252 .00 2.047.01 08-20-2001 CDOOO186 110.15- 1.586.17 09-28-2001 CDOO0329 14.94- 14.94 TOTAL TAX CREDIT 4.342.17 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 If SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 - REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROUJOS JOHN ESQ 4 N HANOVER ST CARLISLE, PA 17013 ______u fold ESTATE INFORMATION: SSN: 184-26-4655 FILE NUMBER: 21-2001- 0024 DECEDENT NAME: LEED LOIS A DATE OF PAYMENT: 12/20/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/01/2000 NO. CD 000671 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $33.72 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: KIM I GILLAUGH C/O JOHN BROUJOS ESQUIRE CHECK# 531 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS $33.72 MARY C. LEWIS REGISTER OF WILLS ORIGINAL STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND ,PENNSYLVANIA Name of Decedent: DORIS SMILEY Date of Death: 4/4/2000 _____ File No. 2001-00025 _u_ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES _____ NO __A_~ 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: on or befor~June 2005. il'hi-s---estat-e- is being held open pending finalization of ~oss H. Smiley's 3 Ifth t N 1. "Y " t t th f II' estate (decedent s husband) e answer 0 o. IS es, sa e e 0 oWing: a. Did the personal representative file a final account with the Court? YES_~___ NO_~_ b. The separate Orphan's Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? YES ___ NO_~___ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date LLfLn~ __ ..-j-~ ---.. _______ n__. _____._.._... _.____...__..______ MarielleLHazen, Esquire ________ Name (Please type or print) 2000 Linglestown Road, Suite 303 Address '.r....{', Harrisbu!"9--__________...PA __ 17110~__ ?J 7 -p40-433~____ Tel. No. Capacity: Personal Representative ...1<.__ Counsel for personal representative JAN L. BROWN & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW OLOe ENGLISH GAP 845 SIR THOMAS COURT SUITE 9 HARRISBURG, PA 17109 Email: jlbassoc@ptd.net JAN L. BROWN" MARIELLE F. HAZEN, CELA'" TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 .. CERTIFIED ELDER LAW ATTORNEY BY THE NATIONAL ELDER LAW FOUNDATION "ADMITTED IN PA AND DISTRICT OF COLUMBIA September 28,2001 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle,PA 17013 Re: Estate of Doris Smiley File No. 2101-0025 Gentlemen or Ladies: Enclosed is a check in the amount of$14.94 payable to the Register of Wills, Agent. This check represents payment of the outstanding balance due because of interest and penalty charges. If you have any questions, please feel free to contact this office. Sincerely, t!:::t:f; ~ Legal Assistant bfk Enclosure E REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Smiley, Doris No. 02\- 01 - ;;JS also known as , Deceased Date of Death 04/04/2000 Social Security No. 207222472 ~ Personal Representative(s) of the above Estate, dec ""ed, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. /' ~ -0/ Personal Representative: Name of Attorney: Marielle F. Hazen, Esquire I.D. No.: 68003 Donald R. Smiley 115 E. Columbia Road, Enola, PA 17025 Address: 845 Sir Thomas Court Dated HarrisburQ Telephone: (717) 541-5550 PA 17109 Description 1994 Plymouth Acclaim - VIN #1 P3AA46K6RF323917 Value 2,000.00 Real property located at 115 E. Columbia Road, Enola, PA 17025 32,000.00 ;,."- Total (Attach Additional Sheets if necessary) 34,000.00 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 JAN L. BROWN & ASSOCIATES ATTORNEYS AT LAW aLOE ENGLISH GAP 845 SIR THOMAS COURT SUITE 9 HARRISBURG, PA 17109 EMAIL: jlbassoc@ptd.net JAN L. BROWN" MARIELLE F. HAZEN TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 "ADMITTED IN PA AND DISTRICT OF COLUMBIA January 4,2001 -.- ~- ~ '- - Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 CERTIFIED MAIL Re: Estate of Doris Smiley To Whom It May Concern: Enclosed for filing is the original and two copies each of the Inventory and the Inheritance Tax Return for the Estate of Doris Smiley. A check in the amount of $25.00 payable to the Register of Wills for the filing fee and a check in the amount of $819.14 payable to the Register of Wills, Agent for inheritance tax due are also enclosed. Kindly return a time stamped copy of each document for our file in the envelope provided. Thank you for your assistance in this matter. If you have any questions, please feel free to contact my office. Sincerely, ~~Jiz/;u tu, .J1L~It..a/~ Kristin W. Buchanan, Legal Assistant Enclosures cc: Donald R. 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C'.J I "" )J o :i: ~!N"I€b<J.'- ~~~ <\ ~!~~1 Vi ',' ~ 8 Ii f~\ 1 ~" " co ,ill;'" I,,' ',~I~ ~ "" () o o * >t- * N W ..D l.n I::-' -...J .t: IT" l.n IT" JRD/June 30,1992/17858 tIIA Y J. J LUUl r Estate No.: 21-2001-0025 MAY ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of Doris Smiley Late of East Pennsboro Township NO. 21-2001-0025 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Counsel for Personal Representative: Marielle F. Hazen, Esquire Date of Decedent's Death: 04-04-2000 Date of Delinquency Notice: 04-15-2002 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Register of Wills on 04-15, 2002, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 05-14-2002 Distribution: Personal Representative Counsel for Personal Representative Estate File 8..,oJ..-tJ:2 j" r;;}o ,t},)Jl, A hearing is scheduled for at in Courtroom No.3. prior to the hearing date, the hearing will automatically be c \ /6 ~/99-/~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-1U7 EX AFP (12-00) MARIElLE F HAZEN STE 9 845 SIR THOMAS CT HBG PA 17109 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-17-2001 SMILEY 04-04-2000 21 01-0025 CUMBERLAND 101 DORIS Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. sub..it the upper portion of this for.. with your tax pay..ent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i6ifj-Ex-AFP--n'2=OOr------...--iNHERITANc'E--T;;x-si';rfEMEN'T-OF'-ACCouiff--.-i.--------------------- ESTATE OF SMILEY DORIS FILE NO.21 01-0025 ACN 101 DATE 09-17-2001 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PRO~ECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-25-2001 PR I NCI PAL TAX DUE: .................................................................................................................................................................................................................... 4.342.17 PAYMENTS (TAX CREDITS): BAL PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-04-2001 AA477847 .00 819.14 03-28-2001 AA478252 .00 2.047.01 08-20-2001 CDOOO186 110.15- 1. 586 . 17 ANCE OF UNPAID INTEREST/PENALTY AS OF 08-21-2001 TOTAL TAX CREDIT 4.342.17 BALANCE OF TAX DUE .00 INTEREST AND PEN. 14.94 IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE 14.94 IE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR). -- -.-- . ~pr"'"" ,",cc DI'UI'RSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~[®®p3g m o ~ "L> iii a lz~ CJ~ ¢s., ~ ~~ ~ , 6 '~ ~SQ31iN~ ~~~ ~~ m ~~ ~n ~~ ~ ~o ~~ o^ o -~ o ~~ o -~ o -~~~ `~ ~_ ~ ~~ m ~.~~ ..n ~~ O ~~. O f~ 'O I ~~~<<~ GC~ -I P} ~:- ~~ ~ l ', ~ ~ ^ F _. ,'D ~^~ a~ 0 o a~ ~ ti O U ~ cn ~I ~ ~ ~ M . -r a ~ ¢, ~~~" ~ ~ O ~ ~ ~ p„ 3U o W ~N ~ O o ~ ~ Q. N ~ ~ a ~ ~ ~ `~°o~~ ~ ~ ~~ ~ ~ ~xN~x r~UOU I~[AZF,iv FI.DER LAw An Estate Planning and Elder Law Firm 2000 Linglestown Road, Suite 202 Harrisburg, PA 17110 ~[.: (71'7) 540-4332 Fax: (717) 540-4313 CERTIFIED MAIL Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 September 30, 2008 Re: Estate of Doris Smiley File No.: 21-01-0025 Supplemental Inheritance Tax To: The Register of Wills: www.HazenElderLaw.com Marielle F. Hazen, CELA* Marci S. Miller, Associate r,a ,- o `::; ~~ ~ ~ -.~ f'-' ; - - E - ; . ~ - ~ - ~ - _ . , _ ~ N cn Enclosed for filing please find the original and one copy of the above-referenced Supplemental Inheritance Tax Return and Inventory, along with a copy of the first page of the Inheritance Tax Return. Please date stamp the first page of the return and a copy of the Inventory and return them to my office in the enclosed self-addressed envelope. Also enclosed is a check for the filing fee in the amount of $30.00 and a check for the tax in the amount of $423.17. Along with a check in the amount of $4.00 as payment for invoice number 2097. If you have any questions or require any additional information, please do not hesitate to contact me. Sincerely, Enclosures cc: Don Smiley ! ~C , ~~~~~~~ Corinne Eggers Woodhouse Paralegal "Certified Elder Law Attorney by the National Elder Lace Foundation as authorized by the Pennsylvania Supreme Court COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: DONALD R SMILEY 1 15 EAST COLUMBIA ROAD ENOLA, PA 17025 -------- told PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EXI11-96) NO. CD 010351 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssN: 207-22-2a~2 FILE NUMBER: 2101-0025 DECEDENT NAME: SMILEY DORIS DATE OF PAYMENT: 1 0/01 /2008 POSTMARK DATE: 09/30/2008 couNTY: CUMBERLAND DATE OF DEATH: 04/04/2000 101 ~ 5423.17 TOTAL AMOUNT PAID: REMARKS: RECEIPT MAILED TO ATTY CHECK# 1008 SEAL INITIALS: JN 5423.17 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA _____ __ COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland File Number 2001-00025 ___ -__ -- - _ onald R Smiley Personal Representative(s) of the Estate of Doris Smiley -_ deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which a pears in a memorand at the end of this inventory. I verity that the statements made in this Inven- ~ tory are true and correct. I understand that false state- } ~ - - -- - ---~/ °--`ry~-_ '__ - - - ments herein are made subject to the penalties of ~ Donald R Smiley 18 Pa.C.S. § 4904 relating to unsworn falsification to - _ ___ - authorities. Attorney -- (Name) Marielle F Hazen (Supreme Court I.D. No.) 68003 _ _ _ --- (F'r"') Hazen Elder Law __ - _ --- - -- -_ --- (Address) 2000 Linglestown Rd., Harrisburg, PA 17110 _- ___ __ (Telephone) 717-540-4332 - _ __ DATE OF DEATH LAST RESIDENCE 115 E. Columbia Rd DECEDENT'S SOC. SEC. NO. 04/04/2000 Enola, PA 17025 207-22-2472 FIGURES MUST BE TOTALED Personal Property Cash ............................................................................................... Personal Property ......................................................................... Stocks/Listed ................................................................................. Stocks/Closely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... Total Real Property ................................................ Total Personal and Real Property ......................... c ; _.~ C7 ^- ; :~ 8,.62 ~~ .'~._ _ I _,,` ~ _ :__ ' `r~ :v 69.20 ~,~ _-{ - cn cr; 8,806.82 8',806..82 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b)) Form RW-09 Rev. io-~s-Zoos INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } File Number 2001- DATE OF DEATH LAST RESIDENCE 115 E. Columbia Rd 04/04/2000 Enola, PA 17025 Cash The Estate of Ross H. Smiley -Inheritance from spouse's estate Total Cash 00025 DECEDENT'S SOC. SEC. NO. 207-22-2472 Bond Savings Bond -Series EE, Serial #R97086259EE - as per attached Savings Bond inventory (joint owner on bond, Ross H. Smiley, died 11/2411993) Savings Bond -Series EE, Serial #R97086259EE - as per attached Savings Bond inventory (joint owner on bond, Ross H. Smiley, died 11124/1993) Savings Bond -Series EE, Serial #R97086846EE - as per attached Savings Bond inventory (joint owner on bond, Ross H. Smiley, died 11/24/1993) Savings Bond -Series EE, Serial #R97087407EE - as per attached Savings bond inventory (joint owner on bond, Ross H. Smiley, died 11/24/1993) Total Bond 8,237.62 8,237.62 151.28 141.60 138.16 138.16 569.20 C7 ~'~~ C -, G ~~? -' ~ __ r-, c- . r-_- -~-, ~, _~ .~. yU -{ ~? fJl U"t (Attach additional sheets if necessary) Total Personal Property and Real Estate 8,806.82 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes county code Year File Number Po Box.2soso~ INHERITANCE TAX RETURN Harrisburg, PA 77128-0601 RESIDENT DECEDENT 2 1 0 1 0 0 2 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207 22 2472 04 04 2000 05 01 1931 Decedent's Last Name Suffix Decedent's First Name MI SMILEY D~RIS (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 r 1. Original Return X~ 2. Supplemental Return --; L_ r~ 3, Remainder Return (date of death _ prior to 12-13-82) i ~ 4. Limited Estate ~I 4a. Future interest Compromise ~, ~ 5. Federal Estate Tax Return Re uired _ ~' (date of death after 12-12-82) 4 l_.---_ ~ g Decedent Died Testate ~ ~ Decedent Maintained a Living Trust (Anacr, copy or wll> Ll (Attach Copy of Trust) 0 8. Total Number of Safe Deposit Boxes _~ 9. Litigation Proceeds Received ~ 1 D. Spousal Poverty Credit (date of death `~ ~ 11. Election to tax under Sec. 9113(A) L-J 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 TO: Name Daytime Telephone Number MARIELLE F HAZEN 717 540 4332 Firm Name (If Applicable) HAZEN ELDER LAW REGISTER WILLS US~NLY C~ First line of address _ 2000 LINGLESTC7WN RD. '~~`-' a ' r-. ' - rrl Second line of address - "- SUITE 202 - J~ ~ %~= City or Post Office State ZIP Code DAT~LED fV , HARRISBURG PA 1 7 1 1 0 ~ cart Correspondent's a-mail address: Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corcect and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE PERSO ESPONSIBLE FOR F ING RETURN DATE Donald R Smiley %Z2 -08 ADDRESS 115 E. Columbia Rd., Enola, PA 17025 SIGy~ OF PREPATHAN REPRESENTATIVE DATE ~~ Marielle F Hazen (,~_ Z 9_ ~~ ~ 2000 Linglestown Rd., Harrisburg, PA 17110 Side 1 L 15056041147 15056041147 J 15056042148 REV-1500 EX Decedent's Social Security Number Decedents Name: D O r I S S m i l e y 2 0 7 2 2 2 4 7 2 RE CAPITULATION - - --- 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 5 6 9 2 0 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. 8 2 3 7 6 2 6. Jointly Owned Property (Schedule F) L II Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~~ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 8 8 0 6 8 2 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 2 0 3 4 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9& 10) ...................................................................... 11, 2 0 3 4 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 6 7 7 2 8 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. ti 7 7 2 8 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) x .00 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .O6 6, 7 7 2 8 2 16. 4 0 6 3 7 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17• 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18• 0 0 0 19. Tax Due ..................................................................................................................... 19. 4 0 6 3 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056042148 15056042148 J REV-1500 EX Page 3 File Number 21-01-0025 Decedent's Complete Address: DECEDENT'S NAME Doris Smiley -------- ------ STREETADDRESS 115 E. Columbia Rd ------ ---- ---- --------------...---- CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit g, Prior Payments C. Discount (1) 406.37 Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable -- p. Interest 16.8 0 E. Penalty Total Interest/Penalty (D + E) (3) 16.80 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 arefund - 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 42 3.17 q. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 423. ~ 7 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 :.................................................................................. b. retain the right to designate who shall use the property transferred or its income :.................................... ~ ~j c. retain a reversionary interest; or .................................................................................................................. ^ CJ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ Lx 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... r~ I 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... _ I xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... _xJ _~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. f - --------- --- - -_ - - _ - - Fordates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemat 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 twenty-one 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 zero (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 four and one-half (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 twelve (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-1503 EX+ (8-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smiley, Doris 21-01-0025 All property jointly-owned with right of survivorship must be disclosed on Schetlule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Savings Bond -Series EE, Serial #R97086259EE - as 151.28 per attached Savings Bond inventory (joint owner on bond, Ross H. Smiley, died 11/2411993) All bonds were just recently discovered. See attached inheritance tax interest calculation. 2 Savings Bond -Series EE, Serial #R97086259EE - as 141.60 per attached Savings Bond inventory Qoint owner on bond, Ross H. Smiley, died 1112411993) 3 Savings Bond -Series EE, Serial #R97086846EE - as 138.16 per attached Savings Bond inventory Qoint owner on bond, Ross H. Smiley, died 1112411993) 4 Savings Bond -Series EE, Serial #R97087407EE - as 138.16 per attached Savings bond inventory (joint owner on bond, Ross H. Smiley, died 11124/1993) TOTAL (Also enter on Line 2, Recapitulation) 569.20 (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 B (Rev. 6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smiley, Doris 21-01-0025 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntlyowned with the right of survivorship must be dlaclosed on schedule F to more Space I5 nEteO@O, 8001t1On81 pages Of th@ S8n1@ SIZQ) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EXr (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Smiley, Doris 21-01-0025 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER AMOUNT A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorneys Fees Hazen Elder Law 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 2,000.00 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 34.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 2,034.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-7b02 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Smiley, Doris 21-01-0025 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) REV•1513 EX+ (8-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smiley, Doris 21-01-0025 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s I~ TAXABLE DISTRIBUTIONS [include.outright spousal Donald R Smiley 115 E. Columbia Rd Enola, PA 17025 Son ~ 100% of estate Total I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0 00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Attachment to supplemental REV-1500 filed in the Estate of Doris Smiley The following is the inheritance tax interest calculation for the bonds listed on Schedule B. There is no interest due on the inheritance received from spouse's estate reported on Schedule E because it was just recently received. Tax due on bonds $34.15 Interest due for 2001 $3.05 Interest due for 2002 $2.04 Interest due for 2003 $1.71 Interest due for 2004 $1.37 Interest due for 2005 $1.71 Interest due for 2006 $2.39 Interest due for 2007 $2.73 Interest due for 2008 $1.80 Total interest due $16.80 Calculated Value of Your Paper Savings Bond(s) ~! Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 07/2008 Page 1 of 1 Total Price Total Value Total Interest YTD Interest $400.00 $794.40 $394.40 $18.80 Bonds: 1-4 of 4 Serial # Issue Series Denom Next Final Issue Interest Interest Value Note Date Accrual Maturity Price Rate R97086259EE EE $200 04/1993 10/2008 04/2023 - $100.00 $90.48 3.72% $190.48 R97086846EE EE $,200 ~ 07/1993 01/,2009; 0,7/2023" $100.00 $89.36 2.45% $189.36 R97087407EE EE $200 09/1993, 09/2008' 09/2023 $100.00" $85.60 4.01% $185.60, R715738622EE EE $200 02/1993 08/2008; 02/2023, $100.00 , $128.96 4.,00% $228.96 Totals for 4 Bonds , $400.00 $394.40 ' $794.40 Notes NI .Not Issued _ _ __ NE Not eligible for payment P5 Includes 3 month interest penalty„ MA Matured and not earnin interest http://www.treasurydirect.gov/BC/SBCPrice 7/31/2008 Calculated Value of Your Paper Savings Bond(s) Page 1 of 1 J Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 04/2000 Total Price Total Value Tota! Interest YTD Interest $400.00 $569.20 $169 20 $12 96 Bonds: 1-4 of 4 Serial # Series Denom Issue Date Next Final Accrual Maturity Issue Price Interest Interest Value Note R R715738622EE EE $200F 02/1993 , 08/2000 02/2023 $100.00 $51.28; ate 6.00% $151.28 R97087407EE EE $200 09/1993 09/2000 09/2023 $100.00 $38.16 -- 4.89% $138.16 R97086846EE EE $200 07/1993, 07/2000. 07/2023 $.100.00 $38.16 4.89%' $138.16 R97086259EE EE $200 04/1993 10/2000: .04/2023 $100.00, $41.60 4.88% $141.60' Totals for 4 Bonds $400 00 $169 20 $569 20 Notes NI Not Issued __.. _.._ _ ___ NE Not eligible for payment _ .. P5 :Includes 3 month interest penalty ...., .. MA Matured and not earnin interest http://www.treasurydirect.gov/BC/SBCPrice 7/30/2008 J ~~~~~~~ ~~~~~ SERIES EE _. ~"-~.1~l7}~~ ~ ~~ ~~f~ 5'111t3~~~t ~.~F.s INTEREST CEASES 80 VEAR6 FROM ISSUE DATE ~ /± a :K ~~ 3'~ l/l ~.. .3~ i~ ,. fir.. ~ ~ - 77 pp pp {~~ pp { t , _ ~.1 a DATING STAMP ~ ~ ~ 5 . r ~ _ ~ ___ x ;~~~~,;~~>~.~~ ~ R9~~08`~259E~ x:0000 8000 70 5 , OOG9 70~ 6 ~ 59-~' d~ML~Mnn. - ---- - -------_ ,: ~~~~~~ sE~:T~s EE I:YIY+~ /~~~~~j l'~j \~~~~~~=~yy. t.`~~. ~5~-/II~ ~ .~J `Y`S~ (M[ERBST CEASE9 70 YEARS . ~ FWOM ISSUE DA1C 2{37 22 2472 HPH +Q9 i993 7~, D05i~ ~CIS.UM~~A .RD E Nil Q PA i 702 ~ ,'14-~bb2 ~, _..~~~.. __. 9117/93; pATING.STAMP ,r, "'R 1 i~(3SS t~ ~L~Y ~,=..~ ~ ' 't~!$G._ PA,,, s E' d 4 _ ~: ~' ~~ I I t ~. 9 ~ ~:00009000 7~:0 S 4009 ?08 '' 40 ?t{! J ' ~,~ 5c~ - c~ ~ ~ 0 4-~ N~~° COMMONWEALTH OF PENNSYLVANIA r r~EPARTMENT OF REVENUE -~' ' "' :: INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES , INHERITANCE TAX DIVISION I',', ~ ~ ~ .~'~AT E M E N T Q F ACC 0 U N T PO BOX 280601 HARRISBURG PA 17128-0601 Cr~~ ~~r, r,~ ~r,- .i: - -~,a ((``I MARIELLE F HAZEIY'" STE 9 845 SIR THOMAS CT HBG PA 17109 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REV-1607 EX AFP C03-05) 11-03-2008 SMILEY DORIS 04-04-2000 21 01-0025 CUMBERLAND 1~D1 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -~ RETAIN LOWER PORTION FOR YOUR RECORDS F- --------------------------------------------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT **~ ESTATE OF SMILEY DORIS FILE N0. 21 01-0025 ACN 101 DATE 11-03-2008 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-07-2001 PRINCIPAL TAX DUE: 4,342.17 PAYMENTS CTAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID *** SUMMARY OF LL 005 PAYMENTS *** 09-30-2008 125.09- 4,890.43 TOTAL TAX CREDIT BALANCE OF T'AX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 4,765.34 423.17CR .00 423.17CR COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE _.~~ „~ _,~ „ ,.(}F INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES i'.~ , ,~~e}^~gl~~t, I_A'LLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION - DEDUI)T,IONB AND ASSESSMENT OF TAX PO BOX 280601 t ~~ { ~''~ ~~ +. i::.,... HARRISBURG PA 17128-06D1 REV-1547 EX AFP (D1-09) 2Q09 FEB 27 ~~ ~ ~: ~ g DATE 02-24-2009 ESTATE OF SMILEY DORIS DATE OF DEATH 04-04-2000 (;(-~~}~ ~~' FILE NUMBER 21 01-0025 QRPN~'~`S Ct~tJRT COUNTY CUMBERLAND MARIELLE F HAZEN C~~,rr~ r`~, ~1 •,"`.(1 ~~ ACN 101 HAZEN ELDER LAW APPEAL DATE: 04-25-2009 2000 LINGLESTOWN RD 2 (See reverse side under Objections) HBG PA 17110 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ ~ R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS !- _ _______________ REV-1547 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMILEY DORIS FILE N0. 21 01-0025 ACN 101 DATE 02-24-2009 TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1 1. Real Estate (Schedule A) C1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 569.20 credit to your account, .00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) C3) of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 8,237.62 6. Jointly Owned Property (Schedule F) C6) .00 7. Transfers (Schedule G) C7) .00 8. Total Assets fig) 8,806.82 APPROVED DEDUCTIONS AND EXEMPTIONS: 2,034.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .00 11. Total Deductions I11) 2.034.00 12. Net Value of Tax Return C12) 6,772.82 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00 14. Net Value of Estate Subject to Tax C14) 54,540.92 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) • 00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 38,141.65 X 06 = 2,288.50 17. Amount of Line 14 at Sibling rate (17) •00 X 00 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 16,400.27 X 15 = 2,460.04 19. Principal .-., ~ r~ _ Tax Due (19)= 4,748.54 ~~ PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID *** SUMMARY 0 ALL 05 PAYMENTS ** 09-30-2008 141.89- 4,890.43 BALANCE OF UNPAID INTEREST/PENALTY AS OF * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 10-01-2008 TOTAL TAX CREDIT 4,748.54 BALANCE OF TAX DUE .00 INTEREST AND PEN. 128.76 TOTAL DUE 128.76 ( IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TA%ES DEPT. 280801 HARRISBURG, PA 1 ] 128-0601 RECEIVED FROM: DONALD R SMILEY 115 EAST COLUMBIA ROAD ENOLA, PA 17025 -------- /uIE PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: zoo-2z-za7z FILE NUMBER: 2101-0025 DECEDENT NAME: SMILEY DORIS DATE OF PAYMENT: 05/14/2009 POSTMARK DATE: 05/13/2009 COUNTY: CUMBERLAND DATE OF DEATH: 04/04/2000 REV-1182 EXIt i-961 N0. CD 011229 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5128.76 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY CHECK#1013 SEAL INITIALS: WZ RECEIVED BY 5128.76 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~~ ~`lfj7 An Estate Planning and Elder Law Firm 2000 [rnglestown Road, Suite 202 www.HazenElderlaw.com Harrisburg, PA 17110 ' Marlelle F. Hazen, CEi,A• r©: (71~ 5444332 Marti S. Miller, Aseoctate enx: (717) 540x1313 May 13, 2009 ti 0 ,o rn~ .o s ~,', ~~~ c m ~ ~ ' , Register of Wills „ ~;, ~ ~.. Cumberland County Courthouse ~Op a. ~. ~=; One Courthouse Square ~~ a _ _'' ~ Carlisle, PA 17013-3387 ~-+ -- •~~' " ~~n N ~ Re: Estate of Doris Smiley File No.: 21-O1-0025 Inheritance Tax -Interest payment To: The Register of Wills: Enclosed please find check #1013 in the amount of $128.76 as payment for interest and penalty for the above-referenced Estate. Please send the receipt in the enclosed self-addressed envelope. If you have any questions or require any additional information, please do not hesitate to contact me. Sincerely, C~ 0 d ' " ~""zC Corinne Eggers Woodhouse Paralegal Enclosures ec: Don Smiley *Certified Elder Lam Attoraey by the National Elder Law Foundation as authorized by the Ft=nnsyluania Supreme Court P LL ZS rc U z~ = a~ %% 0 ~ ~ 6 < ~ J Z f x f N ~ w O w W W K Q a N aW .~.,wuwi ~ OC U N LL Z<` ~ f w 3 O =W ~a J Z o 6 m d kc_iu xs- O~ z`w,o _ w ~ (..OC ti: U i n Qi i. ' '> L_ < t- N Xw H J 2 ti ? O ~ ~ y e ~ N N .. a .. o z ~~ai pUeL9 a~~ aoe~.N. ~wmga m N 6 S O r .~+ w ~ _ o a -. a °o r a w N .C F' ~ ~ 01 x N;0 W p. 0 111 O p~ O ~.. en 0 0 o Q c ~• p N? o N N O J = J o n ~1 W ~? '1 W .. ~y a J U "'~ N J o o CO ^'~ ~ w i Z .ti F ;C J 3 0 N Z v ,~ 7 oa ~ m U a O f/1 o N U .+ p y 9 a G p a J y Y a R' a W ~ m ,. a wJJ W W d ~ ^ Y ~ OC V1 o G= a y ~ W H 10 J w ~ ~- _ W O Z Y C U~ U U W a W W 2 7 W ^ iwi.J.'o~ ~ p W O w U a a Z C7 N t-~ ~a c~pU U O Y cn ~-' ~ w'GG,, ~ ~I J ~S GL s C.~~-u-.~ o .ct ~= ..~ Z _ .y ~ U r r N .+ N D a z a z z w 3 3 , niao a J F- OL W W W J O U' W J Z J W til J J W Z t+ W o Q Q o PO S 2 N S H O O U W K K O Y K O W 2 O F O a m W 3 O J z M H W OC T W Z H J H FI fi Ni Zi Oi J~ ai F~ D~ UI i } w.~. ~_ ii ~ ~, ~_ m~..~ ~~ w ~~._~~ _ ~. ~a~~~. e ti se ~ a, ,, ~~ ~ ~ 6 ~ ~~' 0.m11 Y ~ ;~ :_, s0311Nn r.i o 5: N .. a. ~ _: _ ~ - (- -~ ' vJ. ~> ~ _ _ , ~ ,y; Q ., CJ~:,i rn O o (..J N 0 0 iy ~ C ~ ~ ~oa d 3 N y C N v Q ~ ~ S ~~ ~f~ ~ ~.,9 M M 3~ G M N ~ N p ~r O ~ ~ d ~yo~i NQU~ .~ ~ ~ .` ~ .~ c m ~UQCU r ~~ f t~i .M CJ ~',. .~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: Doris Smiley Date of Death: 04/04/2000 File Number: 21-01-0025 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? SigAagarc~ofP'erson Filing this Form Capacity: ~ Personal Representative ~ Counsel d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. ti~ _ ~'~ Date ~ ~~ ~` F v s ,,-;,~ r ~ - - `tf ~i J ~`~ ;j ~F`~ +~ ,, ~ . ~,~,r.i Form RW-10 Rev. fo-is-zoos Marielle F Hazen QX Yes ~ No Yes 0 No QX Yes ~ No #68003 rvame or rerson Filing this Form 2000 Linglestown Rd. Suite 202 Address Harrisburg, PA 17110 City, State, Zip 717-540-4332 Telephone Copyright (c) 2006 form software only The Lackner Group, Inc. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE __ r . BUREAU OF INDIVIDUAL TAxES ` -INHERITANCE TAX INHERITANCE TAX DIVISION i,,; ,iy, ;`: STAT E M E N T O F AC C O U N T PO BOX 280601 HARRISBURG PA 17128-0601 REV-16D7 IX AFP (12-OB) 265 JUG 26 FN I ~ 17 CLERK ~~~ ORPHA,N'S CO~JRT MARIELLE F HAZEN CUN;~~~~_th°lI~ rn„ ~A. HAZEN ELDER LAW 2000 LINGLESTOWN RD 2 HBG PA 17110 DATE 06-15-2009 ESTATE OF SMILEY DORIS DATE OF DEATH 04-04-2000 FILE NUMBER 21 01-0025 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -~ RETAIN LOWER PORTION FOR YOUR RECORDS 4~ --------------------------------------------------------------------------- REV-1607 EX AFP C12-08) *** INHERITANCE TAX STATEMENT OF ACCOUNT **~ ESTATE OF SMILEY DORIS FILE N0. 21 01-0025 ACN 101 DATE 06-15-2009 THIS STATEMENT IS PROVIDED TO ADVISE DF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: OZ-17-2009 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID *** SUMMARY OF LL 006 PAYMENTS *** 05-13-2009 270.65- 5,019.19 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ^ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 61, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 4,748.54 4,748.54 .00 .00 .00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES !' ~'3'NHE ~iTA~ICE TAX INHERITANCE TAX DIVISION ~ - ~~~C,; E~ET ';OF ACCOUNT PO BOX 280601 ~~ HARRISBURG PA 17128-0601 REV-1607 EX AFP (12-OB) 2~Gg Jlt~ ^~ t~~~` O~TE U u t1 06-22-2009 TATE OF SMILEY DORIS DATE OF DEATH 04-04-2000 ~~~ ~ FILE NUMBER 21 01-0025 ~~~ COUNTY CUMBERLAND MARIELLE F HAZEN GUN~~~„~„~!~ ~ ~ ACN 101 HAZEN ELDER LAW Amount Remitted 2000 LINGLESTOWN RD 2 HBG PA 17110 MAKE CHECK PAY ABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ --------------------------------------------------------------------------- REV-1607 EX AFP C12-08) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF SMILEY DORIS FILE NO. 21 01-0025 ACN 101 DATE 06-22-2009 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-17-2009 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 4,748.54 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID *** SUMMARY OF LL 006 PAYMENTS *** 05-13-2009 270.65- 5,019.19 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ^ IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS. ) 4,748.54 .00 .00 .00