HomeMy WebLinkAbout07-27-15 15056051047
REV-1500EX(06-05) OFFICIAL USE ONLY
PA Department of
u IndR
CounyCode Year File Number
PuOreBaOXo8060ual=
INHERITANCE TAX RETURN F- �AA �
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
_
Decedent's Last Name Suffix Decedent's First Name Ml
ILI K!J�
141� Ll r I J LIQ aj,
1 1-�� �[]1111 Ll Li
(if Applicable)Enter Surviving pouse's Information Below
Spouse's Last Name L Suffix Spouse's First Name IMI
Ili'-
F J'_-]!--11
7
Ll 1 Li I LJ liL ,�LiU!Ll!Li'-1LJ' [
� __]i _j I1 11-1 Li—1 --11-1
Ll
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
M 1.Original Return O 2.Supplemental Return C=) 3. Remainder Return(date of death
prior to 12-13-82)
C=) 4.Limited Estate C=D 4a.Future Interest Compromise(date of r-1 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate C= 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
C=) 9. Litigation Proceeds Received C=D 10.Spousal Poverty Credit(date of death C=) 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ILLI
7L]
7T
Firm Name If Applicable) REGISTER OF WILLS USE ONLY
First line of address
C=
Elj C) C_ C-�
1 2�0, [_Ll'
L
Second line of address
M r-n
-_ - __
�
ILEA_ Ca a-1 DA!
City or Post Office State ZIP Code
5
j_1 _]r L, I
J_j '—_ !n
17- M
r
Correspondent's e-mail address:
Under penalties 2jfpaq'uq4. declare that I have exarryned this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
!a) --N
it is true corRf and comple, .DeclaIdIll' orep
on &r other than the personal representative is based on all information of which preparer has any knowledge,
S NATURE PE *'P N81hE FILING REIURN DJE2Z
42
ADD ESS
SIGNATURE OF PREPARER OT r THAN REPRESENTATIVE, DATE/
VC k, ,,, -711
ADDRESS6., co PA 17c)
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051.047 15056051047 j
0Y
'7
15056052048
REV-1500 EX
Decedent's Social Security N'u�
RECAPITULATION
1. Real estate(Schedule A). ... .... ... .. .. ... .... .. .. .... .... .... .... .. . 1.
2. Stocks and Bonds(Schedule B) ... . ... . .... .... ... ... .. .. .. .... .. . . .. . 2. `. . '_ !'• •
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .... 3. - - I} �, !•
4. Mortgages 8:Notes Receivable(Schedule D). .... .. .. .. .. .... ... . .. .. .. ..
J
qq
5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E) ... . .. . . 5. �' � ,�j,�'_� a��.�__ {,; / ;• '
� I
J
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .... . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Proe ; r J•'`
-'
(Schedule G) O Separate Billing Requested..... ... 7. � r� ;��i ti3. _ a:• �
8. Total Gross Assets(total Lines 1-7). ..... ..... .. . . ...... . .... .... .... . 8. _
- - �yI•I
9. Funeral Expenses&Administrative Costs(Schedule H)... .... .. . ... . ... . ... 9. lx- ��� a
10. Debts of Decedent, Mortgage Liabilities,&Liens Schedule I 10. _
11. Total Deductions total Lines 9& 10 . .. . ........ .. .. .. .. ... .... . ... .... 11. J' f� t �� ;�;
( ) �7
12. Net Value of Estate Line 8 minus Line 11 .. .... .... .... .... .... ....... . 12.
Charitable
Governmental
s/Sec 9113
usts
13 an election t tax has of beenmade(Schedule J) .. .. for which
S� /
14. Net Value Subject to Tax(Line 12 minus Line 13) .. . .. .. .. .. ... . .. . . ... .. 14. i
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 -
(a)(1.2)X.0- . 15.
16. Amount of Line 14 tax ble
at lineal rate X.0!�tc_ ' Z :� `-C . 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17. / f. •
18. Amount of Line 14 taxable
at collateral rate X.15 • 18. x> _ +, •
19. TAX DUE .... . ... .. .. ... ... .. . .. .. .. .. .. .... . .... ........ .. . ... . .. J ./t�. ..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 15056052048 15056052048 J
REV
V--15o8 EX-F(ii-io)
c�C E 9�E
� pei1�15�'lVc�111a
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHE.:RITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER: -
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION_ OF DEATH
lJ.- IL'- 1��'4'{.0 -eJ ��b3�r'. �._ �'A-C 'e,�'� Co�—�
71
L f fW)�..ti kA
TOTAL (Also enter on Line 5, Recapitulation) $ l '�
If more space is needed, use additional sheets of paper of the same size.
Priority 50 Phis Statement
or the period 10/17/2014 to 11/17/2014��
For 24-hour information.sign on to,"PNC Ban:Online Banking ELBERT N SMITH
on pric,coni. Primary account number 50-7007-1755
Account number:50-7007-1755-continued Page 2 of 2
Activity Detail
Deposits and Other Additions There were 3 Deposits and Other Additions
Date Amount Description totaling $919.85
10124 677.98 Direct Deposit-Autopaynint
11 ic Pension Fund 603
10/31 24t.80 Direct Deposit-Annuity
Tiaa-CrefDistr.104519802
Interest Payment
Checks and Substitute Checks
Check Date Reference Check Date Reference
number Amount paid number number Amount paid number
7046 16.94 10/31 084614984 7049 50.00 10/24 083771290
7048 5,834,06 10/24 083771119
Oap in check sequence There were 3 checks listed totaling
$5,901.00 ,
Online and Electronic Banking Deductions There were 2 Online or Electronic Banking
Date Amount Description Deductions totaling $257.74
10121 15.94 Web Pint Single-Online Pint
Citicorp Choice Ckf933060722POS
11/06 241,80 Direct Payment-Reclaim
Tiaa-CrefDistr.104519802
Other Deductions There was I Other Deduction totaling
Date Amount Description $14,500.00
10,130 14,500,00 Withdrawal Reference No, 047212289
Daily Balance Detail
Da 10 Balance Rate Balance Date Balance Date Balance
M2.7.429 0/24 52.2r—) 10/31 477.13 11/17 235.40
1-0/2-1 19.958.35 10130 252.27 11/06 235.33
~ .
8taanontofValue and ActivityCURIAN Oct0/, 20Y4 - Oct 31' 2014
EApa / mG Elbert Smith
bu\ahnnan@oanturyUok.nei
Account#RAS27O280F
Your Referring Financial Professional is:
Tim Long Elbert NSmith, Arlene JSmith, Beverly kCStmhmmnn.
PooEqu(boa. |no. and Patricia/\JungbeitPDA
4225Molly Pitcher Highway C/O Phil Smith 654Royer Drive
Chambersburg, RA172O27388 Lancaster, RA17881
Tel: (717) 375-2138 Tel: (717) 689-6013
e-maU: hm@cs(one.00
5unnmnryof Activity
7h.isPeriod' `` LastPefix/
,October 3/' 2014September 30, 2014
Beginning Balance $115.550.72 $118.183.78
NewAddihonn/VVhhdnuwa|s ($3AG. 5) ($217.31)
Change <nBalance ($372.82) ($2.41575)
Total Ending Balance '� $114,781,95 $115`55072
�
Portfolio Allocation and Value �
/
/ Investment Balance
0 tow
.110
NUS Dollars 100% 114,78195
Total Portfolio Value 100% $114,781.95
Other Assets 0.00
Total Account Value $114,781.95
`y
Ll
2�7 2 Lf�. cf��
4��L (. 9�
'
u"ria"Clearing LLC,y"°oeremnwxmPC
,60,Technology Way|Denver,Coomm|,-8,7-o47-4,4,
Statement of Value and Activity
SrQc' Dec 01, 2014-Dec 31, 2014
,) CUIRIAT C I_>=A R I hi C9 Elbert
bstehman@centurylink.net
Account#RA9270700B
Your Referring Financial Professional is:
Tim Long US Bank N.A.
ProEquities, Inc. C/F Curian Clearing----------_-___
4225 Molly Pitcher Highway FBO Elbert N SmithTraditional IRA
Chambersburg, PA 172027366 POA Arlene Smith and/or Beverly Stehman and
Tel: (717)375-2139 Patricia Jungkeit
F e-mail: tim@cstone.co C/O Phil Smith 554 Royer Drive
Lancaster, PA 17601
Tel: (717)689-6013
Summary of Activity
This Period Last Period
December 31, 2014 November 30, 2014
Beginning Balance $47,342.42 $47,326.20
New Additions/Withdrawals x6$47,862.91 $0.00
Change in Balance $520.49 $16.22
Total Ending Balance $0.00 $47,342.42
Portfolio Allocation and Value
Investment Balance
Total Portfolio Value 0% $0.00
•Y
Other Assets 0.00
Total Account Value $0.00
Curian Clearing LLC,Member FINRA/SIPC
7601 Technology Way I Denver.CO 80237 11-877-847-4143
REV45t0 E%+(1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
COMMONWEALTH OF PNNSYLVANIA
INHERITANCE TAXER ETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
g� N' vin 9_'o 14—o
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %
ITEM INCLUDE T14E NAME 01:114C TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFEP, DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET — INTEREST or APPLICABLE)
4-7
rt f
TOTAL(Also enter on line 7,Recapitulation) 7,,3�;2,
(if more space is needed,insert additional sheets of the same size)
REV-1511 EX+ (10-09)
® pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
4�- c'�
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. 1 FUNERAL EXPENSES: �f LR-_N- k--, „- E jc-(\,Guar
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2: Attorney Fees:
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
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees: /� cy
7. ( C T" u: N ' (~ — 1" e t,c S 1,-, J"' b V C G.�P Pt Y v"G I,'<
C), C SJ i t' V(L,(, G—C ( ;, .L ,../ acr r— -( (�('G�' Fr G.u ""� —7�1'
12-1
TOTAL(Also enter on Line 9, Recapitulation) $ c, ° , 4�
If more space is needed, use additional sheets of paper of the same size,
QQc-_krjFuneral Home, Inc. Acct: Contract#415
3UN. Chestnut Street
Dilisburg, PA 17019 MEMORANDUM OF SERVICE
717-432-5312
SERVICES OF: Elbert N. Smith DATE: 10/29/2014
(A) Services:
S48 Roman 20 Ga. Steel Casket $3,115.00
Traditional Service Package $3,925.00
Graveliner �`Ja $950.00
Total (A)
$7,990.00
(B) Cash Advance Items: ? 1
Newspaper Notice-Harrisburg t �' $234.29
Newspaper Notice-Lancaster
r $273.70
Death Certificates $42.00
Flowers $15.00
Cutting Date on Stone $200.00
Cemetery Equipment $200.00
Color Copies of Tribute $210.00
Opening and Closing Grave $800.00
Total (B) $1,974.99
Total Amount $9,964.99
Less Amount Paid $0.00
Due $9,964.99
REV-1513 EX+ (01-10)
�'j Pennsylvania SCHEDULE ,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
q e-a-c" f��• �vv (mac i L- -- 0 0 q 9
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 and transfers under
Sec. 9116(a)(1.2).] 7'\
a-J\
6A r`
37 S St--
3 /-4-r L.L 1 10 AA r
S�r�
S�� �oY� �. .1✓�.
ZZ
r STCVG(-( AA- r�It So �
(� PL ts�J C7/7
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. hAE�5:, , (;4, (-r Cr,L�GG-i✓
Yu C;C la.•.
/oma 1� � L��tc� l2
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ j :S
If more space is needed, use additional sheets of paper of the same size.
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
No. 2014- 00998 PA No. 21= 14- 0998
N
Estate Of: ELBERT N SMITH
/First,Middle,Last)
Late Of: UPPER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No:
1750
WHEREAS, on the 27th day of October 2014 an instrument dated
August 30th 2005 was admitted to probate as the last will of
EL BERT N SMITH
(First,Middle,Last)
late of UPPER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 19th day of October 2014 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, LISA M. GRA YSON, ESQ. , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
PATRICIA A JUNGKEIT and PHILLIP N SMITH
who have duly qualified as EXECUTOR(RIX)
and have agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYL VA NIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 27th day of October 2014.
00' � fn
n Register of Ts
Deputy
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
WILL
OF
171 C?
ELBERT N. SMITH
I, ELBERT N. SMITH, currently of Upper Allen Township, Cumberlald ..;.i
County, Pennsylvania, declare this to be my Last Will and Testament, hereby,revokxr�g
any and all prior Wills and Codicils made by me.
ca
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence
of my death, shall be paid out of the principal of my general estate to the same effect as if
said taxes were expenses of administration and all property includable in my taxable
estate whether or not passing under this Will shall be free and clear thereof.
III. I bequeath unto my wife, Arlene J. Smith, all tangible personal property which I
own at my death.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I devise and
bequeath unto my wife, Arlene.
V. In the event that my wife, Arlene, does not survive me, I devise and bequeath my
entire estate that would have otherwise passed under Paragraphs III and IV above as
follows:
A. I intend to keep with this my Will a separate memorandum
concerning disposition of certain items of tangible personal property. I
bequeath the items on said memorandum to th>: persons designated.
B. The remainder of my estate I devise and bequeath as follows:
(1) Five percent (5%) unto Messiah College,
Grantham, Pennsylvania, to be used in its Endowment Fund;
' 7,
(2) Five percent (5%) unto Messiah Village,
Mechanicsburg, Pennsylvania, to be used in its Endowment
Fund;
(3) Ninety percent (90%) to be . divided equally
among my children who survive me.
VI. I appoint my wife, Arlene J. Smith, Executrix of this my Will. In the event that
she fails to qualify or ceases to act as Executrix, I appoint my daughter, Patricia A.
Jungkeit, Executrix in her place. In the event that she fails to qualify or ceases to act as
Executrix, I appoint my son, Phillip N. Smith, Executor of this my Will.
VII. I direct that no bond be required of my fiduciary for the faithful performance of
his or her duties in any jurisdiction.
IN WITNESS WHEREOF, I, ELBERT N. SMITH, herewith set my hand to this
my Last Will, typewritten on two (2) sheets of paper including the attestation clause and
signatures of witnesses, this ?,:.4-,_day of ALI
,•--� , 2005.
Y- (SEAL)
ELBERT N. SMITH
Signed by ELBERT N. SMITH, by him declared to be his Will in our presence,
who have hereunto subscribed our names as witnesses in his presence and at his request,
this day of fAv��«,n� , 2005.
residing at �
LZ residing at "A-612-( 14
, 1
C.l
C_
-2-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF !- ' ),==;mor,
WE, ELBERT N. SMITH, GERALD J. BRINSER and 4-v-)
the testator and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly affirmed, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his Last Will and that he
signed willingly (or willingly directed another to sign for him), and that he executed it as
his free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the testator, signed the Will as witnesses and
that to the best of our knowledge the testator was at that time eighteen years of age or
older, of sound mind and under no constraint or undue influence.
� rl
ELBE N. SMITH
WITNESS
WITNE�S,�/-
Subscribed, sworn or affinned and acknowledged before me by ELBERT N.
SMITH the testat,qr, GERALD J. BRINSER and
witnesses, this �, yet day of +, 2005. .
u�
IAL)
(,'Notary Public
NOTARIAL SEAL
WENDY L.CRAWFORD,Notary Public
Palmyra Boro.,Lebanon County
Commission Expires Sept.10,2005
-3-
REV-1500 EX Page 3 • File Number
Decedent's Complete Address:
DECEDENT'S NAME
STREETADDRESS �\
00 ,rn.rt—
CITY STA ZIP
Tax Payments and Credits: // ,,4//f/I
1. Tax Due(Page 2 Line 19) (1) b • (4(
2. Credits/Payments
A.Spousal Poverty Credit
B.Prior Payments 00a. o-D
C.Discount g% x-4.3�J�
Total Credits(A+g+C) (2)
3. Interest/Penalty if applicable
D.Interest
E.Penalty
Total Interest/Penalty(D+E) (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 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. (5)
A.Enter the interest on the tax due. (5A)
B.Enter the total of Line 5+5A.This is the BALANCE DUE. (513)
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;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income;............................................ ❑
c. retain a reversionary interest;or.......................................................................................................................... ❑ r
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ t
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ "g
3. Did decedent own an"in trust for"or payable upon death bank account or security at his or her death?.............. ❑
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before 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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers from a deceased child 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.