HomeMy WebLinkAbout08-24-15 e
--� REV-1 500EX(01-10) 1505610143
PA Department of Revenue OFFICIAL USE ONLY
P pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 15 0385
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 22 2015 01 26 1928
Decedent's Last Name Suffix Decedent's First Name MI
JEZ MILDRED A
(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
® 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(date of death
prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a.Future Interest Compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12.82)
® 6 Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 8, Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust) p
❑ 9. Litigation Proceeds Received ❑ 10.=Poverty Credit(date of death 11.Election to tax tinder 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
CRAIG A DIEHL ESQUIRE CPA 717 763 7613
REGISTER OF WILLS USE ONLY
First line of address
3464 TRINDLE ROAD c�
Second line of address C 7
�...A C�
r =DATE FILW M r.1
City or Post Office State ZIP Code E: -
CAMP HILL PA 17011
",.I -7
~ M
Correspondent's e-mail address: Cdiehi@Cadiehllaw.Com r_
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of n(mowledge-a belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATkUE OF PERSON RESPONSIP16,E FOR FILI Q RETURN DATE
Linda A. Smeltz —a I o20 f L
ADDRESS
4 Wheatland Drive, Mechanicsburg, PA 17050
SIGNATURE OF PREPARER OTHER THAN YEP ESENTATIVE DA/E
Craig A Diehl Esquire CPAh,!r
ADDRESS
3464 Trindie Road, Camp Hill, PA 17011
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: J E Z, M I L D R E D A
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1. 135 , 630 . 00
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 106 , 437 . 51
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 539 , 413 . 01
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 17 , 070 . 37
8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 7 98 , 550 89
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 15 , 031 1 7
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 325 . 01
11. Total Deductions(total Lines 9&10)..................... 11. 15 , 356 . 18
.................................................
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 783 , 194 . 71
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. 783 , 194 . 71
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.00 15.
16. Amount of Line 14 taxable 16. 35 , 243 . 76
at lineal rate X .045 7831194 . 71
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due..................................................................................................................... 19. 35 , 243 . 76
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 15 - 0385
Decedent's Complete Address:
DECEDENT'S NAME
Jez, Mildred A
STREET ADDRESS
412 Norman Road
CITY I STATE ZIP
Camp Hill I PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 35,243.76
2. Credits/Payments
A. Prior Payments 31,000.00
B. Discount 1,631.58
Total Credits(A +B) (2) 32,63.1.58
3. Interest
(3) 0.00
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 a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 2,612.18
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;.................................................................................. ❑ [_x_1
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑
c. retain a reversionary interest;or.................................................................................................................. ❑
EXI
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ Fx
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ Fxl
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?...................................................................................................................... 0 ❑
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 Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent[72 P.S.§9116(a)(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 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 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
•The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 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 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,wfiether by bloo�or adoption.
b
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF JeZ, Mildred A
21 - 15-0385
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 survivorship must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 412 Norman Road, Camp Hill, PA 17011 135,630.00
(Assessed Value = $137,000.00)
(Common Level Ratio = .99)
TOTAL(Also enter on Line 1, Recapitulation) 135,630.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTHOF TAX
I PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF JeZ, Mildred A 21 - 15-0385
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 VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 Members 1st Federal Credit Union Certificate of Deposit#12629-40 11,551.39
2 Members 1st Federal Credit Union Certificate of Deposit#12629-43 91,757.12
3 2002 Chevrolet Cavalier 2,629.00
4 Household Belongings 500.00
TOTAL(Also enter on Line 5, Recapitulation) 106,437.51
SCHEDULE F
COMM HERITANCETAX RETURN
LTH OF ANIA JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jez, Mildred A 21 - 15-0385
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
Linda A. Smeltz 4 Wheatland Drive Daughter
A Mechanicsburg, PA 17050
JOINTLY OWNED PROPERTY: pE N O p
ITEM LETTER DATE Include name of fina tial,nOstitu�tlon a pd bank account numbe DATE OF DEATH %OF DATE OF DEATH
NUMBER FOR JOINT, MADE or similar identifying number.Attach deed for'ointl -held real VALUE OF ASSET DECD'S VALUE of
TENANT JOINT ;estate. 9 I Y INTEREST DECEDENT's INTEREST
1 A 03/14/2012 Members 1st Federal Credit Union Regular 9,458.35 50% 4,729.18
Savings Account#12629-00
2 A 03/14/2012 Members 1st Federal Credit Union Life Savings) 4,000.23 50% 2,000.12
Account#12629-04
I
3 A 03/14/2012 Members 1st Federal Credit Union Investment 39,060.45 50% 19,530.23
Savings Account#12629-05
4 A 03/14/2012 I Members 1st Federal Credit Union 38.66 50% 19.33
Checking Account#12629-11
5 A 110/12/2013 Members 1st Federal Credit Union Certificate 112,639.55 50% 56,319.78
of Deposit#12629-42
6 A 03/12/2012 Metro Bank Checking Account#513245704 82,778.97 50% 41,389.49
7 A 03/12/2012 Metro Bank Statement Savings Account 46,748.64 50% 23,374.32
#626429872
I
8 A 03/12/2012 Metro Bank 6 Month Renewable CD Account 23,447.14 50% 11,723.57
#120001853
9 A 03/12/2012 Metro Bank 12 Month Renewable CD Account 21,706.15 50% 10,853.08
#120001955
TOTAL(Also enter on line 6, Recapitulation) i 539,413.01
` ~
SCHEULEF
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN Continued
RESIDENT DECEDENT
ESTATE OF Jez, Mildred A FILE NUMBER
1 21 - 15-0385
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
JOINTLY OWNED PROPERTY
I DESCRIPTION OF PROPERTY I %OF DATE OF DEATH
ITEM LETTER DATE include name of financial institution and bank account number DATE OF DEATH
FOR JOINT MADE DECD'S VALUE OF
orlsimilar identifying number.Attach deed forjointly-held real VALUE OF ASSET INTEREST DECEDENT's INTEREST
NUMBER TENANT JOINT estate.
10 A 03/14/2012 New Cumberland Federal Credit Union Savings 52.43 50% 26.22
11 A 03/14/2012 New Cumberland Federal Credit Union 6 Month 59,609.80 50% 29,804.90
i Certificate of Deposit Account#83344
12 A 03/14/2012 New Cumberland Federal Credit Union Savings 53.53 50% 1 26.77
13 A 03/14/2012 New Cumberland Federal Credit Union 12 31,177.96 50% 15,588.98
1 Month Certificate of Deposit Account#80610
14 A 03/14/2012 ' New Cumberland Federal Credit Union 18 82,330.93 50% 41,165.47
Month Certificate of Deposit Account#80610
15 A 03/19/2014 PNC Bank-Certificate of Deposit Account 49,460.93 50% 24,730.47
16 A 03/19/2012 PNC Bank-Certificate of Deposit Account 23,549.73 50% 11,774.87
17 A 03/19/2012 PNC Bank-Certificate of Deposit Account 78,327.53 50% 39,163.77
18 A 03/19/2012 PNC Bank-Certificate of Deposit Account 26,445.58 50% 13,222.79
19 A 03/19/2012 PNC Bank-Certificate of Deposit Account 12,044.87 50% 6,022.44
20 A 03/19/2012 PNC Bank-Checking Account#5140031944 122,444.46 50% 61,222.23
Page 2ofSchedule F
^ `
SCHEDULEF
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN continued
RESIDENT DECEDENT
ESTATE OF Jez, Mildred A FILE NUMBER
21 - 15 -0385
Ifonasset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
JOINTLY OWNED PROPERTY
I I DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE include name of financial institution and bank account number DATE OF DEATH VALUE OF
FOR JOINT MADE I IECD'S
NUMBER orlsimilar identifying number.Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT's INTEREST
TENANT JOINT estate.
21 A Various Paper Savings Bonds- EE Series 164,432.00 50% 82,216.00
(See Attached Itemization)
22 A Various Paper Savings Bonds-HH Series 87,000-00 50% 43,500.00
(See Attached Copies)
23 A 07/02/2012 1999 Chevrolet Cavalier 2,018.00 50% 1,009.00
Page 3ofSchedule F
Calculated Value of Your Paper Savings Bond(s) Page 1 of 2
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 03/2015
Total Price Total Value Total Interest YTD Interest
50,000.00 $164,432.00 $114,432.00 $2,788.00
Bonds: 1-100 of 100
Issu Next Final iInteresti
Serial # Seriesbenorn! :Issue Price:: Interest Value Note,
Date Accrual!Maturity: Rate
M86.678096EE .,EE .__$1 000;08/1990 08/2015 i_08/_2020;_ -,--_$500.00_;..,-__..__$1,168.00x__ 4.00% __..__$1�668.00x._-___.-
M86678095EE EE y$1,00008%1990;08/2015;_08%2020 $500.00 $1,168 00 4.00% $1,668 00
M86678099EE EE $1,000 11/1990 05/2015 11/2020 $500^00y $.W.q 20 4 00% $1,635 20
M86678098EE EE F$1,000 11/1990 05/2015; 11/2020_ $500.00 $1,135.20: 4.00% $1,635.20;
M86678097EEy EE $11000.11/1990;05/2015; 11/20206 $500,00 _ µ $1,135.20; 4.00%i $1,635.20Y .
M86678102EE EE
$1,000 11/1990 05/2015 11%2020 $500 00 $1,135.20 4 00% $1,635 20
M86678101EE EE $1,000 1/1990'05/2015 11/2020 $500,00 $1,135 20 4.00%' $1,635.20'
M86678100EE EE $1,000 11/1990;05/2015:-11/2020r $500.00 _$1,135.20, 4.00%, - __$1--,6--35-.-20;-_-_--_.
M86678103EE EE ,$1,000 11/1990;05/2015, 11/2020, $500 004 $1,135 20 4 00% $1,635.20
. _. .. ---
M86678104EE EE $1,000 11/1990 05/2015 11/2020 $500 00 $1,135 20' 4.00%< $1,635.20i ..
......... .,... ....
M86678105EE EE $1,000;11/1990:05/2015 11/2020 $500 00 $1,135.20; 4.00%i......$1,635.20
.. .<
M86678106EE: EE $1,000 11/1990 05/2015 11/2020r--------- WN --- --- -_-4 00%
M86678107EE EE $1,000 01%1991 07/2015 01/2021 $500 00 $1,135.20 4.00%a $1,635.20"
M86678108EE EE ,$1,000;01/1991 07/2015 01/2021 $500 OOh $1,135 20 4 00% $1�635.20i
M86678109EE EE 1 000,01-1991 07 2015! 01/2021 500 00 1,135.20 4.00%1
1,635 2U
M86678110EE EE„ 1�000a01/1991 07/2015;< 01/2021; 500.00: 1 135.201 4.00%' 1 635.20+
M86678111E0720151 01/2021 500.00 4.00%! , 35.201$
M86678114EE
EE $1,000 01/1991 07/2015 01/2021 $500.00 $1,135 20 4.00% $1,635 20
M86678113EE _EE. _ $1,000 01/1991:07/2015__01/2021r -___-$500.00,, $1,135.20, 4.00%,_-_-.$1,635. 201
M86678112EE EE $1,000,01%1991;07/2015; 01/2021 $500 00, $1,135 20 4 00% $1,635.20'!
M86678094EE EE $11000 08/1990 08/20154 08/2020 $500 00 $1,168 00 4 00%A $1,668 00
M86678116EE EE $1,000 01/1991 07/2015; 01/2021 $500 OOz $1,135.20 4.00%5 $1,635 20
M86678115EE EE„ i$1..00001/1991y07/2015 01/2021 $500 00 $1,135 20 4 00% $1,635 20w „-.
M86678091EE EE $1,000508/,1990 08/2015' 08%20201 $500 00 $1,168.00 4.00% $1,668.M
M86678092EE .EE , $1,000 08/1990;08/2015 08/2020 . $500,0.0 $1,168 001 4 00% $1668 00
M86678093EE, EE $1,000 08/1990 08/2015j 08%2020 $500.00: $1,168 00 4.--0--0---W-----
00W $1,668.W
M86678088EE EE $1,000 08/1990.08/2015E 08/2020 $500.00 $1,168.00 4 00% $1,668 0W
M86678089EE EE $1,000} 8/1
0990 08/2015 08/2020 $500.001 $1,168 00' 4.00% $11668 00
M86678090EE EE $1,000 08/1990 08/2015;08/2020 $500.00 $1,168.00 4 00%, $1,668 00
M4.1026375EE EE $1,000 08/1990 08/2015._08/2020 _______$500,00 $1,168.00 4.00%,_.___$1,668 00
M41026376EE EE $1,000 08_/1990 08/2015: 08/2020 $500 00 $1,168.00 4.00% $1,668.00,
M86678087EE' EE ..-%-. ----.
$1,000 08/1990 08/2015; 08/2020 $500 00 $1,168 00: 4.00/o $1,668 00'
M41026372E -; EE °
$1,00008/1990 08/2015; 08/2020 $500 00 $1,168 00 4.00/o $1,668.00s
M41026373EE EE $1,000 08/1990'08/2015 08/2020 $500 00 $1,168 001 4.00% $1,668 00
M41026374EE's EE !$1,000!08/1990 08/2015 08/2020 $500 00 $1,168 00 4.00%1 $1,668.00:
_. --
M41026369EE1, EE $1,000 08/1990 08(2015 08/2020 $500.0
0 $1,168 00 ^ 4.00% $1668 00
M41026370EE EE $1,000 08/1990 08/2015; 08/20206 $500.00--------------
$1,168.00 4 00%, $1,668 00
M41026371EE EE ° '
$1,000 08/1990.08/20151 08/2020 $500 00 $1,168.00; 4.00%: $1,668.00;
M86678086EE EE $1,000 08/1989 08/2015 08/2019 „$500 00 $1,235 201 4.00%; $1,735 20
M41026367EE EE _$1,000 08/1990 08/2015! 08/2020 $500 00, $1,168 00 4.00W $1,668.M
M4.1026368EE o
E- „$1,000 08/199008/2015 08/2020, _ $500,.00 $1,168 00 4.00/01 $1_,668 00
M86678079EE; EE $1,000F08/1989�08/2015; 08/2019/ $500.00' $1,235.20 4.00W $1,736 ZO
M86678080EE EE $11000 08/1989!08/20^15 08/2019 `
- 00,
M86678085EE EE $1,000 08/1989 08/20151 08/2019M1 $500.00' $1,235.201 4.00%4 $1,735.20;
M86678084EE ..EE„ $1,000 08 1989;-0,8,-20-1-5i-0-8/-2-0.19
8/2015 08/2019 $500.00! $1,235 20n 4 00%; $1,735.2W _..,
M86678077EE EE $1,000 08/1989 08/2015; 08%2019 $500.00 $1,235.20 4.00%. $1,735.20!
M86678078EEsEE o
.................... .., ......., ,$1,000 08/1989„08/2015,.08/2019r.......,$500 OOt _.,,$1,235 20 4.00% _$1,735.20;,__.,,
M86678081EE. EE $1,000 081989;08/2015;08/2019.._.-- $500 00 $1,235 20.' 4.00% $1735 20
http://www.treasurydirect.govBC/SBCPrice 4/22/2015
Calculated Value of Your Paper Savings Bond(s) Page 2 of 2
M86678082EE,' EE $1,000:08,q989:08/2015.08/2019 i ...... P:, -.�ql
-------------------- ------- --- ...........-----------
M86678083EEi EE i$l,OOOiO8/198908/2015� 08/2019
......if*0-0...0-"0-3/1989 09/2015 i 03/2019 $500.00:, $1,270.00! 4.000/.! 1,770.00
8.6 6Z8 0,7 5.EE i....EE... $1,0 00 i.0.311 9.8.9 i.0,9/2.0.1.5 03/2019 ......
$1,770.00!;
.......................................
M86678070ML. EE...i$1,000. 3 9 1 500.00: 4.000/o 770.00:;
---------- *O--- -/20-15�-0-3/2-0-9J _$�,270.00�--I-..----
M86678071EEi EE i$l,OOOiO3/1989iO9/2Ol5iO3/2019: $500.00,; $1,270.W 4.00% $1,770.00
M-66 67,66�6-ff It 'E-E------F$1,00W03/1989!09 2015� 03/201 ...... ... /b 770.00'
-------------------------------- ------- I..--------- -- - -------
9.... ...$500.OW $��,270.W 4.000 �$lj
M86678074EEi EE i$1,000:03/1989iO9/2015iO3/2019i $500. 0'
0
M8667806------...' ... " 'E"*E' "1",'0'......*�"0"31"9"8"-9"!"O",9",/,-2"015! 03/2019i
... - ---------1---------$
----------- ------- 70..00 4.00% $1,770.001
-M8-66.7.80�69E,E� EE �$1,00.0:03/1989 09/2015 i 03/2019 $500.00 $1,270.00 4.000/0 $1,770.00
-------------------- -------------- ------------
M86678072EEEE.......*$-'1"0"*0"0":"0"3"/"1"9"8"9i09/2015
9/2015 -0-3-/201..9.' .........$.5...0..0*....0..0.............$.1...,.2..7..0.....0.04.00/
1,770.W
''*"'"...''*'...,. ..-4��251342EEEE $100008/1989i08/201508i2019 $500.00 4.00%
---------------
-------------
_*1,735.20-
M35251343EEE08/2015 E
..... ....- . .......'--- .......�.....------------ --------- .........-----------�___ .. -
,... . 0 . 8/2019� /b $.1..,7.3...5.....
2
0:
.. EE $1,000 $500.00 �1,270. 4.00 $ 0
...... ....
M35251339EE� EE �$1.000�08/1989iO8/2015� 08/2019� 4.00% $1,735.20t
........... .......
43-5-2-5,""l,*3...4'0'-E...E-�;....EE .... ........* ! 0 -4--.b.'0....%--T ..................L......
--- ------------- --------- $],000108/1989,08/2015.08/2019! _ __$50 .00!_ _$�,235.2
�
M35251341EEi EE ;$1,000;08/1989 08/2015 08/2019, $500.00 $1,235.20: 4.00%. $1,735.20;
---------------.1------- --------------
5 j'j 6 E E� E E 8/1989M/2015� 08/2019,! .0W 1,235.20! 4.00% $1,735 20,
---------- ------------
M3 251337EEi EE i$l,OOOiO8/1989iO8/2015iO8/2019� $500.00: $1,235.20;
........... ..........
M35251338EE _��.--j08/1989;08/2015;-08/2019. !
---------------------- 1,00 01
--- ---- ...... .--- --__--_$500.00.------ ..... ........
M26970929EE EE !$1,000 03/1989 09%2015,103/2019;, $500.00,; $1,270.W7
...... 4.00 0/o $1,770.00
M35251334EE EE �$1,000�08/1989�08/2015iO8/2019� $500.00 -..$1,235.20; 735.20
.......... ...... .........
EE 1,235.
...........
�$�,POO;08 1989�08/2015 i 08/2019! ...$.500.00:
_.$1 735.20!
---------------
M26970932EEEEi$l,OOOiO3/1989iO9/201503/2019m: ,,.. $500.00: $1,270,00. ,
..........----.......
M,2670931'E E i EE �$1,000�03/1989�09/2015 03/2019 4.00 0
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COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Jez, Mildred A FILE NUMBER
21 - 15 -0385
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE
NUMBER Include the name of the transferee,their relationship to decedent I VALUE OF ASSET DECD'S (IF APPLICABLE)
and the date of transfer. Attach a copy of the deed for real estate. INTEREST
1 I Members 1st Federal Credit Union 18 Month IRA 17,070.37 100% 17,070.37
I� Certificate
II
I
I
I �
I
I
� I
TOTAL(Also enter on line 7,Recapitulation) 17,070.37
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES&
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF Jez, Mildred A FILE NUMBER21 - 15-0385
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Parthemore Funeral Home&Cremation Services, Inc. - Funeral Balance 38.64
2 Rolling Green Cemetery-Grave Stone 335.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Law Offices of Craig A. Diehl 14,000.00
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 Cumberland County Register of Wills 385.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 The Sentinel - Estate Advertisement 190.54
TOTAL(Also enter on line 9, Recapitulation) 15,031.17
ih ! Schedule H
COMMONWEALTH OF PENNSYLVANIA Funeral Expenses&
INHERITANCE TAX RETURN ! Administrative Costs continued
RESIDENT DECEDENT
ESTATE OF Jez, Mildred A FILE NUMBER
21 - 15-0385
2 Cumberland Law Journal - Estate Advertisement 75.00
3 Law Offices of Craig A. Diehl- Reimbursement of Certified Mail Costs for DPW Letter 6.49
I
i
Page 2 of Schedule H
SCHEDULEI
'h DEBTS OF DECEDENT, MORTGAGE
I
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN f
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Jez, Mildred A
21 - 15-0385
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Holy Spirit EMS -Wheelchair Expenses 137.23
2 Riverside Anesthesia - Medical Bill 17.34
3 PPL Electric- Final Electric Bill 35.46
4 UGI - Final Utility Bill 79.00
5 Pennsylvania American Water- Final Bill 55.98
TOTAL(Also enter on Line 10, Recapitulation) 325.01
REV-1513 EX+(11-08) Y�
SCHEDULEJ
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Jez, Mildred A FILE NUMBER
21 - 15 -0385
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustees)
I, TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Linda A. Smeltz Daughter 100% Estate
4 Wheatland Drive Residue
Mechanicsburg, PA 17050
2
(Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
IIS NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
I
I
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
i
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
x ,
LAST WILL AND TESTAMENT . ' =b i'
OF :
MILDRED A.JEZ G:: ' CO
I,Mildred A. Jez,a resident of Camp Hill,Pennsylvania declare this to b_e my Lig W� m
and revoke all former Wills and Codicils. = -
ARTICLE I
Identification of Family
At the present time I am unmarried. In making this Will I have in mind my one child,
Linda Smeltz, born 1950,but does not include any children hereafter born to or adopted by me.
Any reference to a"child of mine" or"my children" shall include the persons named or referred
to in this Article.
ARTICLE II
Appointment of Fiduciaries
A. Appointment of Personal Representative. I appoint my daughter, Linda
Smeltz,as Executor of my estate. If Linda Smeltz is or becomes unable or unwilling to serve,I
appoint my son-in-law,Robert L. Smeltz,Jr. as alternate Executor.
B. Bond; Court Supervision. My Executor shall have the right to serve without
bond and to administer and settle my estate without the intervention or supervision of any court,
except to the extent required by law. Nothing herein shall prevent my Executor from seeking
the assistance of the court in any situation where my Executor deems it appropriate.
ARTICLE III
Disposition of Residue
A. Provision for Descendants. I give all of the rest and residue of my estate,
wherever located (hereafter referred to in this Article as "residue"),to my daughter,Linda Smeltz
if she survives me.
1. Provision for Others. If my daughter,Linda Smeltz does not survive me
then I give 25%of the residue to my grandson,Robert L. Smeltz 111, 25%of the residue to my
grandson, Shawn M. Smeltz, Sr.,25%of the residue to my grandson,Jordan J. Rutherford,and
25%of the residue to Chelsea M.Rutherford. If-I am not survived by any of my descendants, or
by any party named in this provision,I give the entire residue of my estate,to be divided equally
33 1/3 %to my Great Granddaughter Shelby J. Smeltz, 33 1/3,to my Great Grandson Shawn M.
Smeltz.Jr and 33 1/3 %to my Great Grandson Zachary R. Smeltz.
Will of Mildred A.Jez Pagel of 5 Initials:/y Date:433.
ARTICLE IV
Alternative Methods of Distribution
A. Purpose of Article. Recognizing that under certain circumstances the terms of
this Will may direct that property be distributed outright to a person who is under age twenty-one
(21)or under a legal disability;I make the following provisions to facilitate the distribution of
property to such persons.
B. Alternative Methods. Whenever the terms of this Will direct my personal
representative(referred to in this Article as the "fiduciary")to distribute property outright to a
person who is then under age twenty-one(21) or under a legal disability,the fiduciary may retain
pursuant to Paragraph C.of this Article or distribute all or any portion of that property in any one
or more of the following ways:
I. Delivery directly to the beneficiary;
2. Delivery to the parent or stepparent of the beneficiary;
3. Delivery to the guardian of the beneficiary's person or property;
4. Delivery to any Custodian for the beneficiary under the Uniform Gifts to
Minors Act;
5. Delivery to any then existing trust created for the beneficiary;
6. Deposit in a financial institution in an account established in the name of
the beneficiary alone pursuant to the laws of the State of Pennsylvania;
7. Storage of any tangible personal property in safekeeping with the costs of
storage to be borne by the beneficiary;or
8. Sale of any tangible personal property and delivery of the proceeds in any
manner permitted by this Article.
Provided the fiduciary acts in good faith, upon delivery of any property in accordance
with the provisions of this Article,the fiduciary shall be discharged from all responsibilities in
connection with the property.
C. Discretionary Trust. Any property not distributed as provided in Paragraph B.
of this Article shall be retained by the fiduciary in trust for the beneficiary on the following terms
and conditions: During any period in which the beneficiary is under a legal disability or under
twenty-one(2 1)years of age,the fiduciary shall pay to or apply for the benefit of the beneficiary
so much of the income and principal of the trust as the fiduciary,in its sole and absolute
discretion,determines is advisable for the beneficiary's health, support,education and general
welfare. At such time as the beneficiary is neither under a legal disability nor under age
twenty-one (21),the fiduciary shall distribute any remaining trust assets to the beneficiary. If
Will of Mildred A.Jez Page 2 of 5 Initials:l .CGDate: — t .— df
the beneficiary dies before all of the trust assets have been distributed,the fiduciary shall
distribute any remaining trust assets to the beneficiary's estate.
ARTICLE V
Administrative Provisions
A. Powers and Duties of Personal Representative. My personal representative
shall have all of the powers and duties granted to or imposed upon personal representatives
serving with non-intervention powers pursuant to the laws of the State of Pennsylvania.
B. Debts and Expenses. All expenses of administration chargeable to principal,the
expenses of the disposition of my remains,and all my legitimate debts, if and when paid, shall be
paid from the principal of my residuary estate. No debt need be paid prior to its maturity in due
course and except as otherwise provided in this Will no interest in any property passing under
this Will need be exonerated.
C. Taxes. All estate,inheritance or other similar death taxes,together with any
interest or penalties thereon,arising by reason of my death with respect to any property
includable in my taxable estate, and any adjusted taxable gifts,whether passing under or outside
of this Will,shall be paid from the principal of my residuary estate without reimbursement from
the recipients or beneficiaries of such property,provided,however,that in the event any
proceeds of insurance upon my life or any property over which I held a power of appointment
are included in my estate for purposes of determining the federal estate tax liability of my estate,
then the residue of my estate shall be entitled to receive from the recipients of any such proceeds
or property the portion of such federal estate tax liability attributable to such proceeds or
property determined in accordance with IRC §§ 2206 and 2207.
ARTICLE VI
Miscellaneous
A. Number and Gender. Unless the context indicates a contrary intent,the plural
and singular forms of words shall each include the other, and every noun and pronoun shall have
a meaning that includes the masculine,feminine and neuter genders.
B. Survival. To "survive" me,as that term is used in this Will, a person must
continue to live for thirty(30)days after my death.
C. Descendants. The "descendants" of an individual include only the following:
X. All such individual's biological descendants,except any person not born in
lawful wedlock and his descendants,unless the biological parent who
would otherwise cause him or her to be a descendant has acknowledged
paternity or maternity in legitimation proceedings, or in an unambiguous
signed writing identifying such person by name,or by raising such person
Will of Mildred A.Jez Page 3 of 5 Initials-&_<Date: ,�, G;'
in the same household; and
2. Persons adopted by such individual or one of his or her descendants, and
their descendants.
If the parent,who would cause a person to be a descendant as defined above,is replaced in an
adoption proceeding, such person shall remain a descendant unless such parent voluntarily
consents to the relinquishment of his or her status as parent in connection with such adoption
proceedings.
D. Heirs. The term "heirs" shall mean those persons entitled to inherit under the
then-applicable laws of the State of Pennsylvania governing the descent of an intestate's separate
estate. They shall inherit in their statutory proportions.
E. Exclusion of Pretermitted Heirs. Other than as set forth in this Will,I make no
provision for any child of mine or descendant of a deceased child of mine. I specifically make
no provision for any person(whether now living or hereafter born), other than a child named or
referred to in Article I or a descendant of mine as defined in this Will,who may be entitled to
claim an interest in my estate under the laws of the State of Pennsylvania.
F. Legal Disability. A person is under a legal disability if my personal
representative determines, in good faith,that the person is incapable of managing her property or
of caring for herself,or both, or is in need of protection or assistance by reason of physical injury
or illness,mental illness, developmental disability, senility, alcoholism, excessive use of drugs,
or other physical or mental incapacity.
G. Title to Real property. Upon my death,title to any real property passing under
this Will shall vest in my personal representative in his fiduciary capacity and shall remain so
vested until my personal representative distributes or sells that property, at which time title shall
vest in the distributee or purchaser.
H. Disclaimer. Except as may be otherwise specifically provided in this Will, in the
event that any beneficiary disclaims an interest arising out of this Will or any trust created herein
it is my intention that the interest disclaimed shall be distributed in the same mariner and at the
same time as if the disclaiming beneficiary had died immediately preceding the event pursuant to
the laws of the State of Pennsylvania.
1. Governing Law. The provisions of this Will shall be interpreted in accordance
with and in light of the laws of the State of Pennsylvania.
J. Corporate Successors. Whenever a corporation or other business entity is
referred to herein,the reference shall include any successor organization.
K. References to Statutes. In this Will,the abbreviation "IRC" shall refer to the
Internal Revenue Code of 1986 as amended.
Will of Mildred A.Jez Page 4 of 5 Initials-14� Date:
I have initialed and dated for identification purposes all pages of this,my Last Will,and
have execute he entire instrument by signing this page on the** day of 20.
at a.
Mil ed A.16��
Attestation and Statement of Witnesses
Each of us declares under penalty of perjury under the laws of Pennsylvania that Mildred
A. Jez, the Testator, signed this instrument as her Last Will in our presence, all of us being
present at the same time, and we now, at the Testator's request, in the Testator's presence, and in
the presence of each other, sign below as the witnesses, declaring that the Testator appears to be
of sound mind and under no duress,fraud, or undue influence.
�c6c&
[Witness Signature] [Wjt6es&,§ignature]
[Print Name] [Print Name]
Residing at ,,, Residing at
\Zx- AUTO LICENSE U-33ROKERIG,
64830 CIASILISLEPIKE, SUITE 104
AAf-^I
1/-%N1eSF5 RU, FYA 170-50
Will of Mildred A.Jez Page 5 of 5 Initials: j-D
R ate: 'r
4_4_
SELF-PROVING AFFIDAVIT
STATE OF PENNSYLVANIA }
�� ��� }
COUNTYOF �t�✓z'1/.� } ss.
I,the undersi ed, an officer authorized to administer oaths,certify! Mildred J z,
the Testator, and col_€ S�rr ff_7 , and ILA�S F/ jM I - ,the
witnesses,whose names are signed to the attached or foregoing instrument and whose signatures
appear below,having appeared together before me and having been first duly sworn, each then
declared to me that: 1)the attached or foregoing instrument is the last will of the Testator;2)the
Testator willingly and voluntarily declared, signed and executed the will in the presence of the
witnesses; 3)the witnesses signed the will upon request by the Testator,in the presence and
hearing of the Testator, and in the presence of each other; 4)to the best knowledge of each
witness the Testator was, at that time of the signing, of the age of majority(or otherwise legally
competent to make a will), of sound mind and memory, and under no constraint or undue
influence; and 5)each witness was and is competent and of the proper age to witness a will.
c
Mildred A. J
[Witness ignature] W/'n s Signature.,'
Ak
[Print Name] [Print Name]
Residing at AUTO
Lt W� r_AXC'Y \ ,, 6483 CARLISLE PIKE, SUITE 1041
ISE u , A 17050
Section for Notary Public:
Subscribed, sworn and acknowledged before me by the said Mildred A. Jez,Testator, and by the
said A1xcvLC / 5-/UV 4'Z ,and J E'Z1='CRi`Ir� ,D,�,; Jy witnesses,this
M7 7'h day of Ake,� , 20�.
L4.1CAtflwl
�T1 FtttihO1 /sirnature of NotaNotarial SeaF" , -� xY]
Kiley b.Not.,Notary Public � , /V o'J- �� f1,�
Silver Spring Twp.,Cumberland Caen I
My Commission Expires Ock.n o Nota �[print or stamp name of Nota
. ••�"• ^^nnsrtvanla ncc--J.art,�n OF Notaries