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Home My WebLink About05-22-06 .....J 15056051047 REV-1500 EX (06-05) PA Department of Revenue *' Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFiCIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 o 6 00039 ;;'..':"-~~~~~u.",";"":"-....:..m.~~~~~~ Date of Birth 1 68 4 8 2 9 4 6. Decedent's Last Name 6 5 Suffix Decedent's First Name MI 8M I T H J...R RA L. P H L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ,~ 1. Original Return c::::J 2. Supplemental Return c::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::> ~ 4a. Future Interest Compromise (date of death after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty Credit (date of death \::j 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 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received Q- 8. Total Number of Safe Deposit Boxes c::> 4. Limited Estate c:; C) KElT H o B R N N EM AN s 7 1 7 6 7 8".5, 2 8 Firm Name (If Applicable) _;.J S N EL B A K \/VILLS USe/ONLY First line of address 4 4 W EST MA EET Second line of address City or Post Office State ZIP Code DATE. FlLEO en M E C H. A N IC S B.U R G P A 17055 -_...................---_......."'^'~..............._~............... Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal repr:sentative is based ~~~~nformation of ~hich prepar.::~~ny knowl:dge. , Correspondent's e-mail address: SIG~7 R~PONS~LE FOR. FILING RETURN __ _ ])~/-.~ Jt ) ADDRESS . 1 Lee Court, Carlisle, PA 17013 ~~R OTHER THAN REPRESENTATIVE A[~.D.RESS ~4 w. Main Street, Mechanicsburg, PA 17055 ......_~~----- PLEASE USE ORIGINAL FORM ONLY DATE ___,_____._~flJnin i s t rat r i_~____..._b.__...,_..~lg~.:a.."CI.6b DATE .5 ;..../ ~ .- 2I:r" , Side 1 L 15056051047 15056051047 ~ ....J 15056052048 REV-1500 EX Decedent's Name: Ralph L. Smith, Jr. 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. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::> Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. Decedent's Social Security Number 6 8 4 82 9 4 6 o 0 8 4 · 8 4 8 2 · 4 6 2 7 0 3 6 7 .. 3 0 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. L 0 6 5 o. 4 .9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 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. 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_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 4 3 15. 16. . 17. 18. - 0 c::> 15056052048 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME File Number 21-06-00039 STREET ADDRESS 98 Longstreet Drive CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) -0- Total Credits ( A + 8 + C ) (2) 3. Interest/Penalty jf applicable D. Interest E. Penalty TotallnterestlPenalty ( 0 + 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) A. Enter the interest on the tax due. -0- 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;.......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D xlrn c. retain a reversionary interest; or...... .............. .............. ............... ....;... ......... .... ....... ........... ......... ................ ......... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 xRX 2. If death occurred after December 12, 1982. did decedent transfer property within one year of death without receiving adequate consideration? .. ...... ...... .......................... .............. .... ............. ............. ........ .................. 0 xiBt 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 xiBt 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? ...... ........... ............... ...... ....................... ....... ........... ............ ............ ................. IXtx D 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE REV-1502 EX + (6-98) ESTATE OF FILE NUMBER Ralph L. Smith, Jr. 21-0.6' -00039 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 knO'Medge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1, DESCRIPTION VALUE AT DATE OF DEATH All that certain parcel of land improved wLth a residential dwelling known as 98 Longstreet Drive, Carlisle, North Middleton Township, Cumberland County, Pennsylvania, more particularly described in Cumberland County Deed Book 266, Page 885 (sale price): $236,000.00 3W46951.000 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 236,000.00 REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Ralph L. Smith, Jr. FILE NUMBER 21-06-00039 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 . Cash on hand $ 29.78 2. Final wages received, Borough of Mount Holly Springs 1,567.88 3. Miscellaneous personalty, furniture, furnishings and household goods 4,200.00 Chevrolet Tahoe 4,108.00 24,379.18 4. 5 . 2005 Federal In.come Tax refund TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 34,284.84 REV-1509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY Ralph L. Smith, Jr. FILE NUMBER 21-06-00039 ESTATE OF 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 A. Cheryl D. Smi th ADDRESS 1 Lee Court, Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Mother B. C. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VAlUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 9/13/01 Cornerstone F.C.D. Savings Account $164.69 50% $82.35 Account No. 8584-01 2. A. 9/13/01 Cornerstone F.C.D. Checking .22 50% 0.11 Account No. 8584-07 TOTAL (Also enter on line 6, Recapitulation) $ 82.46 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Ralph L. Smith FILE NUMBER 21-06-00039 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. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH % OF DECD'S EXCLUSION VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE Life Insurance: Ohio National Financial Services, Beneficiary: Cheryl D. Smith (Decedent's mother) Date of transfer: December 20, 2005 $25,157.JO ,100% -0- Life Insurance: Fort Dearborn Life Insurance Company, Beneficiary: Cheryl D. $15,000.00 Smith (Decedent's mother) Date of transfer: December 20, 2005 100% -0- TOTAL (Also enter on line 7 Recapitulation) $ -0- (If more space is needed, insert additional sheets of the same size) REV.1511 EX+ (12.99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Ralph L. Smith, Jr. FILE NUMBER 21-06-00039 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Hollinger Funeral Home and Crematory, Inc. $3,107.68 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions waived Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees to Sne 1 baker &. Brenneman, P. C . 4,000.00 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 to Register of Wills (Initial) 112.00 5. Accountant'sFees, miscellaneous filing fees and reserve 500.00 7. Additional probate fee to Register of Wills 80.00 250.00 6. Tax Return Preparer's Fees to Wagner's Tax Service 8. Advertise grant of letters: a. Cumberland Law Journal: b. The Patriot News $ 75.00 225.81 300.81 2,300.00 9. Real Estate transfer fax: TOTAL (Also enter on line 9, Recapitulation) $ 10 , 650 . 49 (If more space is needed, insert additional sheets of the same size) REV-1512 EX'" (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & UENS ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ITEM NUMBER 1. 2. 3. 4. 5. 6. 7 . 8. 9. 10. 11 . 12. 13. 14. 15. 16. 17. 18. FILE NUMBER Ralph L. Smith, Jr. 21-06-00039 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. VALUE AT DATE OF DEATH DESCRIPTION North Middleton Authority - water/sewer service, payment on account $ 83.90 VGI Gas Service - payment on account 191.72 PP&L Electric utilities - payment on account 93.36 Chase Horne Finance - mortgage balance due: 198,198.42 Cornerstone F.C.V. -loan account balance due: loan 01: loan 06: 32,841.27 4,048.04 Kohl's Department Store, payment due on account 642.99 Discover Financial Services, LLC, payment due on account 6,380.77 Omnium Worldwide, Inc. for.American Express, payment due on accourt 11,109.37 Bronstein Jeffries, P A, payment due on account 29.54 Citifinancial, Inc., payment due on account 9,896.21 Moffet Heart & Vascular Group, payment due on account 63.04 Cumberland Pathology Associates, payment due on account 414.58 Blue Mountain Anesthesia Associates, payment due on account 22.00 Lancaster HMA Physcians Management, payment due on account 179.83 Quest Diagnostics, payment due on account 173.63 Belvedere Medical Corporation, payment due on account 29.93 Carlisle NeuroCare, payment due on account 14.11 Sprint, payment due on account 160.34 TOTAL (Also enter on line 10, Recapitulation) $ CONTINUED (If more space is needed, insert additional sheets of the same size) Estate of Ralph L. Smith, Jr. Schedule I Continued 20. 19. Lowe's, payment due on account Wells Fargo Financial, payment due on account 21. Carlisle Regional Medical Center, payment due on account Total: File No. 21-06-00039 2,464.39 2,400.00 50.00 $269,487.44 REV-1513 EX+ (9-00) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Ralph L. Smith, Jr. FILE NUMBER 21-06-00039 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Cheryl D. Smi tfic. 9116 (a) (1.2)] 1 Lee Court Carlisle, PA 17013 Parent 1/2 of residue pursuant to 20 Pa.C.S.A. 2103(2) 2. Ralph L. Smith (Sr.) 1 Lee Court Carlisle, PA 17013 Parent 1/2 of residue pursuant to 20 Pa.C.S.A. 2103(2) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)