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Home My WebLink About06-24-15 J 1505670740 REV-1500 E"°�,,,"" Pn Depariment o(Revenue Bureau of Intlividual Taxes INHERITANCE TAX RETURN Counry CoCe Year Flle Number ao eox zeasoi 2 � � q � � � 6 Harris�urq, PA 1�128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW SOtidl 5¢CU�ity NUmp¢t Date o(Death MMDDVYVY Dd�e of Birth MMDOVYYY 1 1 1 1 2 0 1 4 0 8 1 1 1 9 2 8 Decetlenl5 Last Name Suffx Decetlenfs Firs[Name MI S M I T H D A V I D F (If Applicable)Enter Surviving Spouse's Information Below Spouse's Las�Name Sufflx Spouse's Firs[Name MI Spouse's Social5ewrity Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1.Origlnal Return � 2. SupPlemen�al ReNm � J. ftemaintler Re�urn(Date of�eatM1 Prior to 1243-82) � 4.LimiteG Estate � Ya. FNure Interes�Compromise(date of � 6 Fetleral Estale Tax ReWm Requlred death aker 1242-82) Q 6.DeceEent Died Tes�a�e � ]. Decedent Main�ained a Gving Tmst � 8.Total Number of Safe Deposi�Boxes (Attach Copy of Wll) (Attach Copy of TmsL) � 9.Litigation Pmceetls Rewivetl � 10.Spousal PoveRy Credil(Oate ot Oeath � 11. Election to Tax under Sec. 9113(A) Between 1231-91 antl 1-1-95) (Attach Schetlule O) GORRESPONDENT-THIS SECTION MUSi BE COMPLETEO.ALL CORRESPoNOENCE ANO CONFIUENTIAL TA%INFORMAiION SHOUL�BE DIRELTEO i0: Name Daytime Telephone Number M U R R E L R . W A L T E R S , I I I 7 1 7 6 9 7 4 7 0 0 REGISTFf1-0FWILLSJ�SEONLV � � s, rn i � FirsLLlneoFAtltlrass - I WALTERS & GALLOWAY , PLLC �� Secontl Line of Adtlress � . . 54 E MAI N ST -� . ' —�� City or Post Office S�ate ZIP Cotle �TE FKEP�' . . � — —r.� �^_. . MECHA NI CS BU RG PA 1 7 0 5 5 � ' w �-' -`; Conespondenese-maiiaddress: MURREL�WALTERSGALLOWAY.COM Unaer cenalties of periury,I tleclare iM1al I nave e:aminetl Inis reNm,indu0ing aaompanying SUetlules ana statemenis,ana to Vie test ol my knowle�ge ana belie[ M1 Is Irue,wrrect an0 wmplele.DeGaraGon o(preparer otM1ef @an Me p¢f50na1 reD�e�n�a�ive Is Dasetl on all inlortna�ion olwM1i<M1 preparer�as any knOxi¢tlqe. SIGNNT RE OF PERS ,RESP IBLE F ILING RENRN pATE � � `� C 72i v10/�i AD ES LISA A. N 5 STARE WAY DILLSBURG PA 17019 SIGNNN P � ERTHANREPRESENTATNE ONT �y /-/5 nooaE MU R WALTERS, III 54 E MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLV Sitle 7 ^ L 15�561�190 15�561�, 4� J I / `V J 1505610290 REV-0500 EX(FI) Decedenfs Social Secunty Number o�ee�rsHame: DAVID F. SMITH RECAPITUlATION 1. Real Estate(Schedule A) . . . .. .. .. . . . . . .. . . .. .. . . . . . . . . . .. . . . .. .. . . . 1. • 2. Srocks antl Bontls�Schetlule B) . . . . .. . . . .. .. . . .. . . . . . . . . . .. . . . . . . . . . . 2_ • 3. Closety Heltl Corporatioq PaRnership or5ole-Proprietorship(Schedule C) . . . . . 3. • 4. Motlgages antl Notes Receivable(Schedule D) . . . . . . . . . .. . . . . . . . . . .. . . . . 4. • i CasM1, Bank Deposits anC Miscellaneous Personal Pmperty(Schetlule E). .. . . . . 5. � 5 6 , 0 � 6. Join�ly Ownetl Pmperty(Schetlule F) ❑ Separate Billing Requested . . . . . . . 6. S 6 4 0 5 , $ 4 ]. Inter-Viws Transfers 8 Miscellaneous Non-Probate Property (Schetlule G) � Separa[e Billing RequesleE . . . . . . . �. . 8. Total Gross Assefs(to�al Lines 1 Ihmugh 1) . . . . . . . . . . .. . . . . . . . . 8. 5 6 5 6 � , 8 4 9. Funeral Exvenses antl Atlministrative Cosis(Schetlule H) . . . . .. . . . . . . . . . . . . 9. � 3 6 � $ . 4 3 10. Debls of Decetlent,Mortgage Liabilities,and Liens(ScheCule I) . . . . . . . . . . . . . 10. � 3 3 6 � . 9 8 ��. To�al Oeductions Qolal Lines 9 antl 10) . . . . . . . . . . .. .. . . . . . . . .. .. .. .. . . 11. Z 6 9 7 � . 4 � 12. Ne�ValueofEstate(LineBminusLinetl) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 9 S 9 � . 4 3 13. Charitable and Govemmental8equesis15ec 9113 Tms�s forwhich an election to tax has not been matle(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. � . � � 14. Ne[Value Subject lo Tax(Line 12 minus Line 13) . 14. 2 9 5 9 � . 4 3 TAX CALWLATION-SEE INSTRUCTIONS FOR APPUCq9LE RATES 15. Amount of Line 1G tazable atihe spousaltaxra[e,or translers untler Sea 9116 (a�(12)X 0 _ � . � 0 15. Q . � � i6. AmountofLinel4taxable ac o�eai�a�e x oas 2 9 5 9 1 , 4 3 ib. 1 3 3 1 . 6 1 11. Amounl of Line ib taxable atsiblingrate X.t2 0 . 0 0 n. 0 . 0 0 18. Amount of Line 14�axa�le at collateral rate %.15 0 . � 0 1g, � . � � is. rnxnue . . . . . . . . . . . .. . . . .. . . . . . . _ .. . . .. _ _ ._ i9. 1 3 3 1 . 6 1 2�. FILL IN THE OVAL IF VOII ARE REpUESTING A REFUND OF AN OVERPAYMENT � Sitle 2 L 1505610290 1505610240 J FEV-t500E%�FI) Page3 FileNumbe� Decedent's Complete Address: 2� �4 ��s oeceoeNrsNnMe DAVID F. SMITH SraEEraooaEss -�—-- 100 MT ALLEN DRIVE CItV STHTE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: �� TaxDue(Page2,L7ne19J (1) 1,33'1.61 2. CreditslPayments A.Prior Payments 1,300.00 e.Discounl 65.00 Total Credi�s(A«B� (2) �,365.00 9. Inlerest (3) 4. If Line 2 is greaterthan Line 1 �Line 3,enter the tliflerence.This is Ihe OVERPAYMENT. Fill in oval on Page 2,Line 2010 requesla refund. (4) 33.39 5. If Line 1 .Line 3 is greater�han Line 2,enler Ihe diHerence.This is the TA%DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. �id decedenl make a Iransfer and'. Ves No a. retaintheuseorincomeoflhe0�o0er�yVansfened ....... ......... .._....._... .......... ❑ ❑X b. re�ain�herigh��otlesignatewhoshalluselhepmpetlylrans(erretlorilsincome .._._._..................... ❑ ❑X c. re�ainareversionaryinterest ......_. .._.. .. .._...... ............ __...... _.._.._.. ❑ Q tl. receivethepmmiseforli(eofeitherpayments,benefiisorcare? _.........................._......__...___.._.. ❑ ❑X 2. If dealh occuned afler December 12,1982,did decedent Iransfer pmperly within one year of dealh wilhoWreceivingadequateconsideralion7 ............... ...__.. . .. .._................. ...... ❑ Q 3. Ditltlecedenlownan'intmsltoforpayable-upon�eath6ankaccoun�orsecunryathisorhertlealh? ..�...... ❑ � 4. Ditl tlece�enl own an indivi0ual re�iremen�accoun�,annuity oro�her non-proba�e pmpetly,which conlainsabeneficiarydesigna�wn'+ __._... . . ..._........... ... .... ❑ ❑X _._.. .._._._.................. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of tleath on or after July 1, 1994,antl before Jan. 1, 1995,ihe tax rate imposed on ihe net value of irensfers�o or for lhe use of the surviving spouse is is 3 percent[72 P.S.§911fi(a)(1.1)(i)]. For dates of death on or afler Jan. 1, 1995,the tax rate imposed on ihe net value of transfers to or for ihe use of Ihe surviving spouse is 0 percent �72 P.S.§9116(a)(1.1)(ii)J.The staNte does no�ezemp�a Vansfer to a surviving spouse from tax, and ihe staNtory requiremeNs for disclosure of asse�s antl filing a tax retum are still applicable even if the surviving spouse is�he only beneficiary. For da�es of tleath on or afler July L 2000: • The tax rate imposed on�he net value of transfers Gom a deceased chiltl 21 years of age or younger a�death to or�or the use of a naWral paren�,an adop�ive pareN or a s�epparent af ihe child is 0 percent[72 P.S.§9116�a)�12)�. • The�ax ra�e imposed on the net value of transfers to or for the use of Ihe decedenfs lineal beneficiaries is 4.5 percent,except as noted in pz P.S.§9iis�a�(ill. • The�az ra�e imposed on Ihe net value of Iransfers to or for the use o(the decedenfs siblings is 12 percent[72 P.S.§9116�a��1.3��.A sibling is defned, under Section 9102,as an individual who has at least one parent in common with ihe decedenL whether by blood or adop6on. aev-isoaex.�o�iz� pennsylvania SCHEDULE E oEaaarMENroraEVENUE CASH� BANK DEPOSITS 8 MISC. INHEFIiANCEiMRNUHN aesmervroeceoerv. PERSONAL PROPERTY ESTATE Oi: FILE NUMBER: DAVID F. SMITH 21 14 1116 incNtle ine proceeds o1 idigation and the date the proceeds were received by ihe estate. All propertyjointly ownetl with right o(survivorship mus[be tlisclosed on ScheAule F. ITEM VA W E AT�ATE NUMBER DESCRIPTION OFDEATH 1. 2014FEDERALINCOMETAX 156.00 REFUND TOTAL(AlsoenleronLine5,RecapiWlation) S 156.00 If more space is neetleQ use atlGitional sheets ot paper of[he same s¢e. REV-0509 EX�(01-00) pennsylvania SCHEDULE F oevnarMeH�aFReveHue ,JOINTLY-OWNED PROPERTY INHERIiANCEiAxREiURN RESI�ENi�ECE�ENi ESTATE OF: FILE NUMBER: DAVID F. SMITH 2� 14 �'116 H an asset was matle jointly ovmed vnihin one year ot lhe dttedenCs date of deaN,it musl be reported on Schedule G. SURVIVING JOINT TENANT(5)NAME(5) H��RE55 RELATIONSHIP TO D W EOENT q. LISA A. NEWTON 5 S7ARE WAY DAUGHTER OILLSBURG, PA 17019 s. GARY D. NEWTON 5 STARE WAY SON-IN-LAW DILLSBURG, PA 17019 C. JOINTLY�OWNE�PROPERTY: tEiiER DAiE OESCRIWIONOFPROPERN %OF DAiE0F0EAiH IiEM FORJOINi MAOE INGW�ENAMEOFFlNPNCIAlINSilipilONANDBANKNCCOUMNUMB[R00.SIMIlAR �AiE0F0EAiH �ECE�ENi'S VAWEOf NUM�ER tENANi JOINi IDENiIFIINGNUMBERAiiAGH�EE�fORJ01NILVHELDREPLESiAiE VAWEOPASSEi INiEFESi �ECE�EM'SINiERESi 1. A. 20'12 METRO BANK 16,232.03 50. 8,116.02 CHECKING-Acet No. 2086 2. A. 2012 METRO BANK 10,9'I8.53 50. 5.459.27 MONEY MARKE7-Acct No. 224'I 3. AB 7122113 MEMBERS 1ST FCU 129,789.56 33. 42,830.55 SAVINGS-AcctNo. 69�2 TOTAL(Also en�eron Line 6.Recapilulalion) S 56 405.64 I�more space is neetled use a0tlitional sM1ee6 oi Daper ol Ue same size. REV-1511 EX��OB-13) pennsylvania SCHEDULE H oePnarMeH.oFar�eNUE FUNERALEXPENSESAND wneai.nrvcErqxaeruaN ADMINISTRATIVECOSTS aEsioErvroECEOENr ESTATE OF FILE NUMBER DAVID F. SMITH 21 14 1116 DttetlenYs debis musl be reporteE on ScheEule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALExPENSES. 1. MALPEZZI FUNERAL HOME '10,270.25 2. STJOHNSLUTHERANCHURCH-LUNCH 127.68 B. ADMINISTRATNECOSTS'. 1. PersonalRepresentaliveCommissions�. Name�s�olPersanaiRevresen�ative�sl ��SA A NEWTON (RENOUNCED) 0.00 so-ee�neeass S STARE WAY Ciry DILLSBURG Stale P/a ZiP 17055 Veaqs)Commission Paid: p AnomeyFees: WALTERS&GALLOWAY, PLLC 2,800.00 3, FamityExemption'.QlaecetlenYsa4�ressisno�NesameasdaimanYs,allachexplanaGon.) Clalmanl so-�caaares: Giry S�ate ➢P Relationship o�Claiman�lo Decetlenl 4. PmbateFees�. CUMBERLAND COUNN REGISTER OF WILLS 360.50 5 Aaaun�aniFees�. 6. i�RewmPreparerFees: JOHNC. LEGLERTAX&ACCOUNTING 50.00 7. TOTAL(FlsoenleronLine9,RecapiWla�ion) 5 �3608.43 II more space is neetled,uu additlonal shee6 of paper of t�e same size. REV-05t2 E%�(12-02J pennsylvania SCHEDULE I oEvnarmEr�roFaEVErvuc DEBTSOFDECEDENT� iNH�airnHcernxaeruaN MORTGAGE LIABILITIES&LIENS aEsioEN*oFCEOENr ESTATE OF FILE NUMBER DAVID F. SMITH 21 '14 1'I'I6 Reportdebk incurted by Ih¢tlecetlenl priorto death Ihal remained unpaid a[the tlale of death,including unreimbursed medical ezpenses. ITEM VAW E AT DATE NUMBER �ESCRIPTION OF DEATH 1. MESSIAH VILLAGE 10,101.00 RESIDENTIAL CARE 2. CAPITA�AREAMEDICALASSOCIATION 10.00 MEDICAL CARE 3. SERS 830.29 REPAYMENT OF PRORATED RETIREMENT CHECK 4. VERIZON 13.88 CABLE 5. VETERAN'SADMINISTRATION 1,758.00 REPAYMENT OF BENEFITS 6. 2014 PENNSYLVANIA INCOME TAX 426.00 7. ALERT PHARMACY 222.81 MEDICATIONS TOTAL(Alsoen�eron Line 10,Recapi�ulalion) S �3 361.98 If more space is needed, insert atlditional sheets of Ihe same size. REV�1513 E%��01-10) pennsylvania SCHEDULE J oernAimeH.or aer�NUE BENEFICIARIES INHERITANCE TA%REiURN 0.ESIDENTDECEDENi ESTATE OF: FILE NUMBER: DAVID F. SMITH 2'I 14 '11�6 RElATIONSHIPTODECEDENT AMOUNTORSHARE Nl1MBER NAMEANDADDRESSOFPERSON�S)RECEIVINGPROPERTY DONotLiatTruske�s) OFESTATE � TAXABLEDISTRIBUTIONS pnclutleoutrphispousaltlistribWionsantltransfersuntler Seu 9116(a)(1.2�,� 1. LISA A. NEWTON Lineal 5 STARE WAY DILLSBURG, PA'17019 2. GARY D. NEWTON Lineat 5 STARE WAV DILLSBURG, PA 17019 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-0500 COVER SHEET,AS APPROPRIATE. ❑, NON-TAXABLEDISTRIBUTIONS'. A,SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN', 1. B.CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS'. 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0.00 I(more sDace is needed,use additional sheets ot paper oi ihe same size. �