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Home My WebLink About01-0311 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION No. To: 21-01-311 Estate of Gr~l)l""lry Ronald Smith also known as Register of Wills for the County of Cum her land in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl ies d.h.n. (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. for letters of administration on the estate of Decendent was domiciled at death in Cumherland County, Pennsylvania, with h is last family or principal residence at 6206 Westover Drive, Hampden Township (list street, number and municipality) Decendent, then 33 years of age, died December 1 0 ,~ 2000 at Holy 8piri t Hospital, Camp Hill, CUmber land County, Pennsv I vania Decendent at death owned property with estimated values as folllows: (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 situated as follows: $ 79,130.00 $ $ $ Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Marci H. 800 th Relationship wife Residence Westover Drive en Township Westover Drive en Townshi 6206 Westover Drive Hampden Township 800 th dau hter Coleman G. Smith son THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. J~ (fl~v:X/ p~') '~-r ~westover~ve ~ g Mechanicsburq, PA 17050 co":: ~.= 3~ "''- 50 ~ c: Ol) Vi /b -.;219-~3 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } 58 The petitioner(s) above-named swear(s) or 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 above decedent petitioner(s) will well and truly administer the estate according to law. , 'if ~ Sworn to or affirmed and subscribed ~ fV/.A..- ' before me this 21st day of MAR~ ~OOl o//N/~ ",,~~~/a,-u"V '. .. RegISter (_ - '" - u ... = <<i r::: co Vi C'.>J No. 21-01-311 Estate of' ""' :":) c..: GREOGRY RONALD SMITH , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW MARCH 22, 2001 :If'_, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that MARCI H SMITH is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to MARCI H SMITH in the estate of 7:p?NYC! ;;#//L/L!P/L/~ ~J /~/ ~ister of Wills FEES Letters of Administration $ 200.00 Short Certificates( ).......... $ 9.00 Renunciation ................ $ JCP $ 5. 00 TOTAL _ $ 214.00 Filed ., .~:-~.:l"'7~O~U. .. . . . .. A.D. xii Mary Kallas Kennedv ID# 69246 ATTORNEY (Sup. Ct. J.D. No.) 1104 R':rnurrl n.'-P , GI(p Hi 11, PA 17011 ADDRESS 717-731-1600 PHONE H105.805 REV 9/86 This is to certifY that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State VItal Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. 1"'11/111/"""",,,,;,,, 1111'~ ~\.1" OF p{j:---___ ,"~,~',~ "-t-- ,\~, ~"" l~ Ii&". ~\ ~ ~ . - --,~- -- "P~ ~:liilc ... . ~~ ~C)f _ d., _:;:: ~c.->\_..."1,. ,::t..~ ~*~.. ..... "'/*~ >. a....... /..~~' \.~ /.~l "- :.t /> /~ '-\\. 'r "" ----~~;'IMENl \\~ ~'II,,1 "'"''''''UI,,"J/I''' ~~~~ (J Local Registrar Fee for this certificate, $2.00 P 7021670 DEe 1 3 2000 Date 21-01-311 Rev _ 2187 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT tFlrsr. Middle. lill, I. Gregory Ronald AGE (La"lIw1Nay) UNDER 1 VEAR _ Dayo ..------------- .. COUNTY Of' OEArH 33 v.. UlClER I DIfi -- 1 II...... SEX a. Male STAlE FilE NUMBER SOCIAl. SECURITv NUIIBER .. 203 - 64 9517 DAlE OF DEATH IMcnln. Oa.,. ''''J ..O~~~61t(.IO 00 Smith 8IRTHPlACli IC........ SIal. Of Fcre.gn Coooaryt 11.. Slate Pennsylvania IIAAlTAI. STATUS._ -..........-. ~~ 1.. Married 17C.:f&] .... dtcedInI.... in ~::....IO RACE . A-.c:an ...... -.. While. .... (Spec;,1 10. white SUAVIVING SPOuSE ,.......... gNIe ma.den NIne) DECEDENT'S USUAl OCCUPoVIOH I';_~,::, "=' ':::'J.:'l" ....Asst. Vice President l1..Financial/Bankin DECEDENT'S IoWI.ING ADDRESS (Su... c....'-. _. z., C_l DECEDENT'S 6206 Westover Drive ~~~ Mechanicsburg, PA 17055 ~~~ E. Ie. ~--., ~.nOI . """"1'-"-. -Z..211......._Odby ---_. "'lI 01 dNlh 10 1111. Cumberland DNl - Min. -....p. 11. Marci Hafer Hampden bOp. ... RIJHEA'S NAME (F.sl. Middle. la.) II. Ronald H. Smith 1NF0000000'SNAllErr_"", Marci H. Smith IIETHOO OF D1S1'OSlTIOH O -iJ c..........O __S1al.o - 0IIw-...., "" SIGNATURE OF FU OR PEIlSOH ACTING AS SUCH _. PA 17055 27. MAT I: EnIet m. diN..... injuries Of COmplicahgna which caused 1M dea'h Lilt onty one cause on each line. NoS-- ~..- ---.g..-- _.__VING -Io.o.a... ...... lhaI ~evenII f-.atlg.... dMh) lAST I : d. DUE 10 lOA AS A CONSEOUENCE On I Approaimate !=...-=: I I I PART": OIIwaignillc",_~,,_,bu1 not nnuIIing:... the ~ CMIM given in PART I. _U CAUU lFonao ~ClfCOf'ldibon r--.g... dNeh)-----.. .L!!~/l/e ~ PI Ce /c2: DUE 10 lOA AS A CONSeCiJENCE Oft DUE lO{llft AS A CONSeOUENCE OF), _AN AUlOPSY PERFOAIIED? WERE AUltlPSY FINDINGS -.uaE PAlOR 10 COMPlETION OF CAUSE OF OEArH' WAHNER Of DEATH ... 0 No~ No% ........ --- ......... .Ja'" o o ORE Of INJURY (MonIl. Dav. 'INf) TIWEOF INJUAY INJURY iii 'M>RK1 DESCAtllE HOW INJURY OCCURRED. .....0 - P........~lion o o o PlACE OF INJURV . AI ""me. "'m. ..,.... I....... _ II. "'-. ... '50<<"'" .... ... 0 NoD .MEDICAL EXAII_IIICOflONER On the b... of e.amlRaitlon and/or Investigation, in my opinion, d..th occurred at the tlm.. da.e, and placa, and due to the cau..(s) and ............. ..lated.. .. . . . . . . . . . .. . . . . '" . . . . " . ... ........ . . .. . . . ..... .. . ......... . .. . . . .. . . . . . ... 31.. REG'STRAR'S StGNATUAE AND NUMBER ~~ ~/ ~/ / I o rnD Coutd noI be detNfftlned -- _. CERTWlEll,C,*" """'...., -CUI1'IFYING PHYSIaAN (PhySICiOW\ celllfy1ng cause ~ death when anothef phYSlCoaI\ has QrClnOUnceo death ana C~1ed Kern 23) Tothe.....O'''''knowledoe.de.IhOCCurr.d.......C...H(.)..ndm.n...'.................................... .................... n. orfltONOUNClHQ AND CERTIFYING PHVStClAN IPhy5lClan bOlh oxooouoc,ng oealh and ceftAfyng IOcauseOl deathl To'" be.- of my knowledg., de.... OCC""ec:I .''''IIme, det., and ptee.. .nd due to ..... c.UM(.) .nd menn.,.. SlaiN.. . . . . . 35 54. ~I CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Gregory Ronald Smith Date of Death: December 10 , 2000 ~K~. Admin. No. 2001-00311 PA. No. 21-01-0311 To the Register: I certify that notice of (beneficial interest) 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 April 1 6, 2001 Name Address Marci H. Smith 6206 Westover Drive, Mechanicsburg, PA 17050 6206 Westover Drive Marci H. Smith, Guardian of the estate of Sabrina Renee Sm; th Mechanicsburg, PA 17050 6206 Westover Drive Coleman Gregory Smith in care of Marci H. Smith Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 4/16/01 Signature Name Mary Kollas Kennedy Address 1104 Fernwood Avenue Camp Hill, PA 17011 Telephone (717) 731-1600 Capacity: _ Personal Representative ~Counsel for personal representative :~ ,M"-! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KENNEDY MARY KOLLAS 1104 FERNWOOD AVENUE SUITE 104 CAMP HILL, PA 17011 -------- fold ESTATE INFORMATION: SSN: 203-64-9517 FILE NUMBER: 21-2001- 0311 DECEDENT NAME: SMITH GREGORY RONALD DATE OF PAYMENT: 08/10/2001 POSTMARK DATE: 08/09/2001 COUNTY: CUMBERLAND DATE OF DEATH: 12/10/2000 ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: REMARKS: MARCI HAFER SMITH C/O MARY KOLLAS KENNEDY CHECK# 2686 SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 000133 MARY C. LEWIS REGISTER OF WILLS AMOUNT $796.00 $796.00 ORPHANS' COURT DIVISION OF THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: WILLIAM A. FRAKER Date of Death: September 28, 1999 Admin. No. 21-00-0311 Pursuantto Rule 6.12 ofthe 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 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? Yes No ...x 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: Respectfully submitted, LAW OFFICE OF MICHAEL J. HANFT Jikf2J.f!l Attorney ID No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013-9142 (717) 249-5373 Counsel for personal representative F:\User Folder\Firm Docs\Estates\1534-lstatus.repon.wpd 16 -c:219-c.:3 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 Ell AFP 112-001 FILE NUMBER 21 01-0311 COUNTY CUMBERLAND MARY KOLLAS KENNEDY ACN 101 KOLLAS & KENNEDY I Allount Rellitted I 1104 FERNWOOD AVE 104 CAMP HILL PA 17011-1102 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 ...... REY=iS4j-Ex-iFP-n'2=ooY-NoYiCE-oF-YtiHEifiTANci-YAX-APPRAisEHEN:r;-ii:.l-owANci-o-i----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SMITH GREGORY R FILE NO. 21 01-0311 ACN 101 DATE 09-24-2001 TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 79,128.00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 tax paYllent. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 79,128.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 13,769.00 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 13.769 00 12. Net Value of Tax Return (12) 65,359.00 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 65,359.00 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 47,680.00 X 00 = .00 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17,679.00 X 045 = 796.00 17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 796.00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-09-2001 CDOOO133 .00 796.00 TOTAL TAX CREDIT 796.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 !Ii IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) DATE 09-24-2001 ESTATE OF SMITH DATE OF DEATH 12-10-2000 GREGORY R <II ~/~ or, .. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Greqory Ronald Smith Date of Death: December 10, 2000 Will No. Admin. No. 200 1 - 0 0 311 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 X No 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? Yes No X 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 X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date:~ Mary Kollas Kennedy, Esquire Name (Please type or print) 1104 Fernwood Avenue, Suite 104 Camp Hill, r,A 17011 Address (717) 731-1600 Te 1. No. Capacity: Personal Representative X Counsel for personal representative (MAH:rmf/AM3) ~ Cumberland County - Register Of wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 .~4 Date: 11/05/2002 MARCI H SMITH 6206 WESTOVER DRIVE MECHANICSBURG, PA 17050 RE: Estate of SMITH GREGORY RONALD File Number: 2001-00311 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS I COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 12/10/2002 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, MARY C. LEWIS REGISTER OF WILLS cc: vFile Counsel Judge ,~EV-15<"" EX (6-001 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 '" >- ::.::~tI) 0"'>: ",0.0 ",00 0"'-' 0.'" 0. '" INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z UJ o UJ o UJ o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Smith, Gregory R. OFFICIAL USE ONLY i.-/ DATE OF DEATH (MM-DD-YEAR) 12-10-2000 DATE OF BIRTH (MM-DD-YEAR) 06-27-1967 - &\0,- ~ FILE NUMBER ~L- t:)l COUNTY CODE YEAR _Dal1- NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Smith, Marci H. ~ 1. Original Retum o 4. Limited Estate o 6. Decedent Died Testate (Attach copy ot Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (dale of death ootwoa<m 12.-'31-\\1 am! 1-1-95) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 203 - 48 - 1063 o 3. Remainder Return (dale ofdeatll prior to 12-13.82] o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(1\) (AlIachSch0) .... z ~ ~ 0. '" ~ '" o o NAME Mary Kallas Kennedy FIRM NAME IIlAppH~bl'l Kallas and Kennedy COMPLETE MAILING ADDRESS 1104 Fernwood Avenue Suite 104 camp Hill, PA 17011 TELEPHONE NUMBER (717) 731-1600 OFFICIAL USE ONLY (8) 79,128.00 1. Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 79,128.00 (11) (12) (13) 13,769.00 65,359.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Rece(vabl~ {Sch~dule D) ~ ~ ...I ::l l- ii: < o UJ It: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6_ Jointly Owned Property (Schedul~ F} o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts 01 Decedent., Mortgage Liabilities, & Uens (Schedule 1) 11. Total Deductions (total Lines 9 & 10) (9) (10) 13,769.00 (14) 65,359.00 (oj (7) 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. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;( I-' ::l a.. ::E o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 47,680.00 x,O_ (15) 17,679.00 xill..5- (16) x .12 (17) x .15 (18) (19) o 796.00 796.00 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 OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 6206 Westover Drive CITY Mechanicsburg, I STATE PA I ZIP 170::0. Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 796.00 Total Credits (A + 8 + C ) (2) 3. InteresYPenalty if applicable D. Interest E. Penalty TotallnteresYPenalty ( 0 + E ) (3) 4. If Line 2 is grealer than Line 1 + Line 3, enfer fhe difference. This is the OVERPAYMENT. Check box on Page lUne 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (5A) 796.00 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58) 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 inceme offhe property fransferred;........ ..................... ...... 0 IZJ b. retain the right to designate who shall use the property transferred or its inceme; .......... 0 IZJ C. retain a reversionary interest; or.........."............... ........................ ....................... 0 Qg d. receive the promise for life of either payments, benefits or care? ..... ... . ................................. . 0 !Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death wifhouf receiving adequate consideration?.... ................ ..................... .................... 0 l!9 3. Did decedent own an "in trust for" or payable upon death bank account Dr security at his Dr her death?... .......... 0 l!9 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....... .................. 0 l!9 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESf \ r-.d. f ~ ! ~ ~-e-(' Y\W __, 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. ~9116 (a) (1.1) (i)J. AVe, r1Uup c#7 ~t \ rA- noli For dates of death on Dr after January 1, 1995, the tax rate imposed on the net value of transfers to Dr for the use of the survivin9 spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not axemo! 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, Dr a slepparent of the chiid is 0% [72 P.S. ~9116(a)(1.2)l. The lax rale imposed on Ihe nel value of transfers to or for the use of the decedent's iineal beneficiaries is 4.5%. 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 Iransfers to or for Ihe use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)J. 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. ""."""'.".,,'. COMMONWEAL ,H OF PENNSYLVANIA INHERITANCE TAX RETURN RESI ENT DECEDENT ESTATE OF Gregory Ronald Smith SCHEDULE B STOCKS & BONDS FILE NUMBER 21-01-0311 All property jointJy-owned with right of sUNivorshlp must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. DESCRIPTION 170 Shares of PNC Common Stock (12/21/1992) 44 Shares of PNC Common Stock (08/07/1998) 955 Shares of PNC Common Stock (12/07/2000) VALUE AT DATE OF DEATH 11,507.00 2,978.00 64,643.00 TOTAL (Also enter on line 2, Recapitulation) $ 79,128.00 (If more space is needed, insert adOilional sheets of the same size) REV.1511EX.(1.~71 '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN ESIDENT DECEDENT ESTATE OF Gregory Ronald smith FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Partherrore Funeral Heme Service 4,115.00 Casket 2,450.00 Vault 789.00 Clergy 150.00 spray/Pillow 189.00 COpies 30.00 Gingrich Memorials (marker and foundation) 1,144.00 West Shore COuntry club 1,111.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name Of Pe""nal Representative (sl Socal Security Numbe~sl I EIN Number of Pe""nal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees 77.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Marci H. Srni th 3,500.00 Street Address 6206 Westover Drive City Mechanicsbura State PA Zip 17050 Relationship of Claimaot to Decedent Spouse 4. Probate Fees 214.00 5. Accountanfs Fees 6. Tax: Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 13,769.00 (If more space is needed, Insert additional sheets of the same size) REV-1513EX+ (9-00) f:i ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Gregory Ronald Smith FILE NUMBER 21 - 0 1 - 0 3 1 1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON IS) RECEIVING PROPERTY Do Not ListTrustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 la) (1.2)] 1. Marci H. Smith Spouse 54,564.00 6206 Westover Drive Mechanicsburg, PA 17050 2. Sabrina R. Smith Daughter 12,282.00 6206 Westover Drive Mechanicsburg, PA 17050 3. Coleman G. Smith Son 12,282.00 6206 Westover Drive Mechanicsburg, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON liNES 15 THROUGH 18. AS APPROPRIATE, ON REV-15DD COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART [(- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-150D COVER SHEET $ (If more space is needed, insert additional sheets of the same size)