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Home My WebLink About06-27-06 _J 15056041169 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 Vear File Number INHERITANCE TAX RETURN RESIDENT DECEDENT /- ()' C, ,y I ?' oCiq 198-22-9630 10282005 Date of Birth 08031928 Decedent's Last Name Suffix Decedent's First Name Mi ........T\/'T fTTT C:J.l~ ~ n CARL E (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 BOXES BELOW [Xl Original Return Limited Estate o 2. Supplemental Return o 4a. o 7. o 10. D 3. Remainder Return (date of death prior to 12-13-82) 5 Federal Estate Tax Return Required LJ4 Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust (Attach Copy of Trust) Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) lXJ o 8. Total Number of Safe Deposit Boxes o 6 Decedent Died Testate (Attach Copy of Will) o 9. litigation Proceeds Received o 11 Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD Bi: DIRECTED TO: Name Daytime Telephone Number HP,RVEY OANOWITZ 717-238-8263 Firm Name (If Applicable) DEVANEY & CO. PC REGISTER OF-Vv'ILLS USE ONLY First line of address P.O. BOX 1024 Second line of address City or Post Office State ZIP Code DATE FILED EliRRI S3URG PA 17108 Correspondent's e-mail address: 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 representative is based on all information of which preparer has any knowledge. SIGN!ATU ?F PERSQN R!=9P~BL2:-f~R ~ILlNG~ETURN ~ .'/'. DATE '~ U 1-11<.' C ~c<-d't I ~ f_Jc.t.c.:....-',,:.? ... DG:. ADDRESS 1-035' Wr.r'U.";UC Q.~ SIGNATU~PREPARZi:T~EPRESENTATIVE ADDRESS / T 222 S. MARKET STREET, l..:too WutZ.~."L {d.. bol\,: t~olo... ~/(I ...\. _~ 19,. DATE. #6 i. 10 J. S STE. 202, ELIZABETHTOWN, PLEASE USE ORIGINAL FORM ONLY !?J'." 17022 Side 1 L_ 15056041169 15056041169 ---' ,- '-- -' 15056042160 REV-1500 EX Decedent's Social Security Number Decedent s Name CARL E S]\l I i'1-1 198-;::2-9630 RECAPITULATION 1. Real estate (Schedule A) . . 1. 153,000.00 2 Stocks and Bonds (Schedule B) . 2. 1,540,985.00 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. 118,984.00 6 Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested 6. 7. 1,634,735.00 8. Total Gross Assets (total Lines 1 - 7) . . . . 8 3,447,704.00 9. Funeral Expenses & Administrative Costs (Schedule H) . . 9 63,938.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. 11,680.00 11. Total Deductions (total Lines 9 & 10) . 11. 75,618.00 12. Ne~ 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) . 12. 3,372,086.00 13. 14. Net Value Subjectto Tax (Line 12 minus Line 13) . 14. 3,372,086.00 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) x .0_ 16. Amount of Line 14 taxable at lineal rate x04 5 3 , 372 , 086 17. Amount of Line 14 taxable at sibling rate x .12 18 Amount of Line 14 taxable at collateral rate x .15 15. 16. 151,'43.87 17. 18. 19 TAX DUE 19. 151,743.87 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT u Side 2 L.. 15056042160 15056042160 -' REV< 500 EX Page 3 File Number 21- 0 5 - 0 ~) 97 Decedent's Complete Address: DECEDENTS NAME I C;;8.L !~ . S)\1ITH STREETADDRESS 6200 iE8.':!:' ZVILLE ROJW CITY I STATE ZIP ENOLA ! ?A 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/lJayments A Spollsal Poverty Credit B. Prior Payments C. Discount (1) 151,743.87 1~0,000 7,368 Total Credits (A -'- B + C) (2) 147,368.00 3. Interest'Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty (D + E) (3) 4. If Line L. is greater than Line 1 + Line 3, enter the difference This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 -+- Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,375.87 B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5A) (5B) A Enter the interest on the tax due. 4,375.87 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 a. retain the use or income of the property transferred; . . b. retain the right to designate who shall use the property transferred or its income; . . c. retain a reversionary interest; or .. d. receive the promise for life of either payments, benefits or care? 2. !f death occurred after December 12. 1982, did decedent transfer property within one year of death without receiving adequate consideration? 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? . . . . . . . . . . . . Yes No n fR] '----' 0 ~ 0 ~ D ~ ~ fR] h IXJ lXJ n 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. 99116(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. 99116(a)(1.1 )(ii)J. 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. 99116(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. 99116(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 99116(a)(U)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. Hl\)~ 'd:, This IS to certify that the information here gIven is correctly copied from an ori!.!inal certificate of death dulv filed with Local Registrar. The original certificate will be forwarded to the Slate Vital Rec~)rds Office for permanent filing. me as WARNING: It is illegal to duplicate this copy by photostat or photograph. .\10. "IIII(~(1\rOrpi;'---___ ';.-'#~~cI';:","- I~'~ ' . ,..-;;~ '\I~_~ C ,~~ (!~! ", ,y~ I~c)i' -~--- ,~~ \~ (.,.), ---US', , ,I:b. ~ ,~ ' , - ,~. . -' ~ \'. ...-~,., ,.., \~ A, '~,' :~,~ ,,~, :. ........-,' \~ ~" /~ ,,1 "" ""'I/~--" ~~ ,I' """'"-. i,ffENl \\\ ~ ,11" ""'J""',#uu,,,,/J,,.,l /7 "t-Y1~ c.bn/n- /'(' /,:44~ Local Registrar Fee for this certificate. 56.GO NOV 0 1 Z005 Date Rev. 2'87 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH DECEDENT'S USUAL OCCUPATION (Giw IUnO of~ donll dUring matI ofworttr.g life; do n04' UIMI r-eflredl Mobil Pipe Lines . '11.. Meter Foreman 11b. DECEDENT'S MAIUNG ADDRESS (S'""(I, CltylTown. Stale, Zip Code) SEX STATE FILE NUMBER. SOCIAL SECURITY NUMBER 3198 22- 9630 DATE OF DEATH (Month, Day, Year) ~October 28, 2005 S. COUNTY OF DEATH 2, (h PlACE F DEATH HOSPITAL: InpatienlD 8a. FACILITY NAME (If not institution, give street and number) BIRTHPLACE (City and State Of Foreign Country) Blain, PA heck of one. 1. I.- AGE (Last Birthday) 77 Yrs. ER/Outpattenl. 0 KIND OF BUSINESS /INDUSTRY AS DECEDENT EVER IN U.S. ARMED FORCES? Yes~ No 0 12. MARITAL STATUS - Manied, Never Mamed, Widowed, Divorced (Specify) 14Widowed R....-. ~ =..v) 0- RACE. American IndIan. Black; White, et . (Spacily) 10.White SURVIVING SPOUSE (H .....if.,. QMI maidllfl name) Bb. Be. Hampden, TWp. Rd. 6200 Wertzville Rd. 16.Enola PA )7025 FATHER'S NAME (Rrst. Middle. Last) 18.Clarence T. Smith INFORMANT'S NAME (TYl',elPrintl 20a. Jean A. tlake - METHOD OF DiSPOSITION Donation 0 8unal [X] Cremation ~emoyal from State 0 21a. Other (Specify) 21b. SIGNATURE OF FUN!;RAL SERVICE LICENSEE OR PERSON ACTING AS SUCH . 22L ,/"'2 ".' ~"/" .'--:'- ," C~e items 23a-<: only when certifytng physrian is not avaitabk! al time of death 10 Certify cause of death. DECEDENT'S ACTUAL RESIDENCE (See instructions on other side) 17a. State PA Did decedenl live in a township? He. (2g Yes, decedent lived in Hampden twp, 17b. Count\! Cumberland 17d. 0 ~~~~~~7~i~i~ of city/bora Items 24-26 must be comp'eted by person 'Ntlo pronounces death. 2005 MOTHER'S NAME (First. Middle. Maiden Surname) 19. Edith C. Gutshall INFORMANT'S MAILING ADDRESS (Slreet. CityfTown. Slate. Zip Code) 20b. 6035 Wertzville Rd. Enola, PA ]7025 PLACE OF DISPOSiTION- Name of Cemelery, Cram.,ory LOCATION, CityfTown, State, Zip Code OC' Other Place ~~ Blain Cemetery NAME AND ADDRESS OF FACILITY uc,Richardson F. H. Ine. LICENSE NUMBER 21d. Blain, PA \ 7006 DUE TO (OR AS A CONSEQUEN OF): 28. : Approximate . interval betwElen : onset and death PART 11: Other significant conditions contributing to death. but not resulting in the underlying C8\.1segiven in PART I. 27. P.6.RT I: Entw tt't. dl..l..... injuries or compUe.UoMl wrNctl eau.ed the cMath. 00 "at en,., the mode of dy1nw. such .. CIIrdlae Of' ....pU'1Itory arNSl., shod{ or "..rt 1.111.1"', Ust oftty OMl cau... on ..ch line. IUUEOIAlt: CAUSE (Rnal diseBse or condition resulting in death)- a. SeQuentially Itsl conditions b if any. leading to immediatEI r c.' cause. Enter UNDERL YINl:; CAUSe: (Disease or iniury that initiated eVefllS resulting on death) LAST .... d WAS AN AUTOPSy WERE AUTOPSY FINDINGS PERFORMED' AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? DUE TO (OR AS A CONSEQUENCE OF) DUE TO (OR AS A CONSEOUENCE OF)- MANNER OF DEATH Yes D '0 l?P Yes D 28a. 28b. CERTIFIER (Ched< only one) *~;~~~tGor~~~~~~~s~<;:~cg~~~gad~ t~ ~:~a~~:)~~c1r~~~';;a~s~~~~~.~~~.~~.~~~.i~~?~.).. NoD Sulcide g D DATE OF INJURY (Mont/'l. Dav, YlI8r) TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED, Natural Accident Homicide D D D 30a. 30b. M PLACE OF INJURY - At home, farm, street. factory, office butiding. ete.. {SpeCIfy) 30a. Yes D No D JOe. Pending Invesligstion CoUld not be determIned 31b. LICENSE NUMBER 31c. /11/Je-I(7l{,J.}"-E. 31d. ).t/O'J NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF D TH (Item 27) Type or Print /('~'fJ-(..v-:J.f.t d. Cc....., "'"~ ;1-f t/ J.., 7 Jy.~1-t J.e. /1t/~ n. C:--rl-... #-T' II,/!. i 7r II DATE FilED (Month. Day. Year) JIIIf il 29. ~PRONOUNC1NG ANC~ CERTIFYING PHYSICIAN (Physician both pronounQng death and certtty;ng to cause of death) To ttM best of my knowledge, de.th OCCUlTed at the Ume. date. and place, and due to the cau.es(a) and manner as stat.d.... .... nnn..' D 'MEDICAL EXAMINEIVCORONER On the basis of eUl'nlnatlon and/or lnvestigatloo. in my opinion. death oceurred at the time, aate. and place. and d~ to tha cause.(s) and manner as stated. 31.11. RE~R'S SIGNA~~ A~BER D I ~ / ...:; 1/ ,/ I -n } A A ~ "POUll Oo-ei' LAsTOW'ILL..A)fD T2ST..A!v12)JT of Carl E. Smith I, Carl E. Smith, a resident of Enola, Pennsylvania, being of sound and disposing mind and memory and over the age of eighteen years, do hereby declare this to be my Last Will and Testament, and I expressly revoke all Wills, including codicils, heretofore made by me. ARTICLE I 1.1 I hereby declare that at the time of making this Last Will and Testament that I am a widower. 1.2 I declare that I have the below listed children at this time: Dale E. Smith, Jean A. Bake, Gary L. Smith, Lori J. Moore ARTICLE n 2.1 I declare the entire residue of my estate to the Trustee(s) then in office under that trust designated as "The C. E. Smith Living Trust" established ::rul i /0 , 191]ofwhich I am the grantor. I direct that the residue of my estate shall be added to, administered, and distributed as part of that trust, according to the terms of the trust and any amendment made to it before my death. To the extent permitted by law, it is not my intent to create a separate trust by this will or to subject the trust or the property added to it by this will to the jurisdiction of the probate court. c 2.2 I hereby direct that my Executor or my Trustee(s) may elect to: (1) use administrative expenses as deductions either for estate tax purposes or income tax purposes; and (2) to use either date of death values or optional values for estate tax purposes, regardless of the effect thereof on any of the interests under this Wtll. 2.3 I further direct that my Executor or Trustee(s) shall not be required to pay any debt in advance of the due date thereof, including installment obligations, but instead may pay the same in installments as each installment comes due. However if the Trustee(s) deem it to the advantage of the estate any or all debts may be paid in advance of their required installments. 2.4 I stipulate that any asset under litigation, lien, or claim that might cause the assets of the aforementioned Trust to be compromised in any fashion, be held separate from the said Trust until it is free of any claim or threat to the integrity of the Trust. ARTICLE ill 3.1 If the disposition in Article IT, above, is inoperative or is invalid for any reason, or if the trust referred to in Article IT above, fails or is revoked, I incorporate the terms of that trust herein by reference, as if executed on this date, without giving effect to any amendments made subsequently, and I bequeath and devise the residue of my estate to the Trustee(s) named in the trust as Trustee(s), to be held, administered, and distributed as provided in that instrument. Cr Signed 0~ ~~c;r Page 1 ( c'. c ARTICLE IV 4.1 I do hereby nominate the followin~ individual(s) as the Executor(s) of this Will, to serve in the order listed: Jean A. Bake and Dale E. Smith, acting together or separately, Gary L. Smith. 4.2 The Executor shall have full power and authority to carry out the provisions of the Will, including the power to manage and operate during the probate of my estate any property and any business belonging to my estate. However, the Executor should not compromise the referenced trust in any fashion by premature transfer of assets that may carry any claim or litigation into the Trust. 4.3 The Executor or Trustee(s) shall serve without bond. However, in the event that one (1) or more bonds are required for one (1) or more such individuals, in their capacities as Executors hereunder, then I request that such bonds be nominal bonds, and, my Executor shall pay any such bond premiums, as bonds premiums are due, as administration expenses of my estate, until the administration of my estate is completed. IN WITNESS WHEREOF, I have hereunto subscribed my name to this document, my last Will and Testament, which consists of two (2) typewritten pages, and for the purpose of identification, I have initialed or signed each page, all in the presence of the persons who are witnessing, at my request, the execution of this, my last Will and Testament on this /tb 1'-4day of JuJ.. Y . 19 '9 7 . at L5"~~.... All . P/1 . 17t:Jz'S" ~~.JZ 5-~~-- Carl E. Smith Signed c8~ cr ~ -- Page 2 ACKNOWLEDGEMENT OF THE EXECUTION OF THE LAST WILL AND TESTAMENT OF Carl E. Smith We, whose names are signed below, each declare under penalties of perjury: that Carl E. Smith, the testator, executed the foregoing instrument as the testator's last will and testament; that in our presence, the testator signed the testator's signature and declared that such signing was the testator's free and voluntary act for the purpose of executing the testator's last will and testament; that each of the Witnesses thereto,in the presence of the testator (and at the testator's request) and in the presence of each other, signed such instrument which the testator stated to be the testator's last will and testament; and, to the best of our knowledge, the testator was, at the time of the testor's signing and at the time of the signing of the witnesses, eighteen (18) or more years of age and of sound mind. ~-fL- e:' ~ ~ r:::;)J1 Carl E. Smith -- 0/6 /19~ ~p~ !-l r IV 0 '- D ? JeAl ,ca,: ~ (Witness Signature) 7 - I fc- q 'l Date (Print Name) / 5'" 2- ~ ~. oS,4,... 121') (Address) (- 'ft1.~C.l4r4.....r<: 8v....~) p~ t"7~S"A; (City, State, Zip Code) I .J~ a."tdJ~;"/(Witn.ss Signature) 7 - (b - "17 Date / bSLDle- A. ~ ,/lk.er.l, c... (Print Name) ~ n..f &Juz.1")vt.il-e ~i) ~& LA- PA 1"1 D2.~ (Address) (City, State, Zip Code) c LAST WILL AND TESTAMENT WITNESS PAGE: r- ( We, the undersigned, do hereby certify that Carl E. Smith on this 1..lL day of J ~ L 1 ' 19.1.L declared the above and foregoing instrument, consisting of four (4) pages, each of which is :signed by Carl E. Smith, to be his/her Last Will and Testament, and that thereupon he/she asked us to act as witnesses to such Will, and did in our presence of each of us sign his/her name to such Will; that, thereupon, we and each of us, in the presence of Carl E. Smith and in the presence of each other, do sign ,our names as witnesses to such Will. !2--~ PYJ'~ (Witness SignaluIe) ..l-1.; /~llf'7 Date (.J r"1>J I> c.. 0 "j) .J~ IV It!, t.; .s (Print Name) IS2.~ r:.s.I+c11 1<.0 (Address) IV( e~'../AP-lcs.6~~5, fl4- /7o'S5 (City, State, Zip Code) ~hl':"- t1 ~~....L.J~/(Witn.ss Signature) 7- 1<"-'1, Date r-; Dc... b J'; A J& A<:.elh c.. (Print Name) to n... ( tJ lA.. 1-') chi / <. {2l) (Address) C ~..LA- ()~ l'102JS (City, State, Zip Code) c. Signed ~--.p. $.~ Page 4 f c- L# Certificate of AcknowledgeDlent of Notary Public ammo.wealth of Pennsylvania) is. CowrY of Cumberland) (1l this I <0 day of :r J \y , A.D. 199'1.., appeared before me Carl E. Smith personally knc"-' to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is s111.scribed in this instrument, and acknowledged that he/she executed it. ~ Residing in Notary Public My Commission Expires NOTARY SEAL: Notarial Seal Glenn W. Hebert. Notary Public North Newton Twp., Cumberland County My Commission EXpirM May 8, aooo , \ Signed cfl.--~ 5::. _~r9/- Page 3 R!OV-1502 EX+ (6-98) I _L~ SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R!OSIDENT DC:CEDENT ESTATE OF FILE NUMBER CARL E. SMITH 21-05-0997 All rea! property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pnce at which property would be exchange between a wiliing buyer and a willing seller neither being compelled to buy or sell. both having reasonable knowleage of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBeR RESIDENT2:AL REAL ENOLA, ~A 17025 - WOOD REAL ESTATE. DESCRIPTION ESTATE, 6200 WERTZVILLE ROAD, APPRAISED VALUE BY PRUDENTIAL VALUEAT DATE OF DEATH 153,00C TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) __53,000.00 ~ Prudential ......... Prudential Thompson Wood Real Estate 3815 Market Street Camp Hill, PA 17011 Bus 717 761-8353 Fax 717 761-2563 info@prudentlalthompsonwood.com www.prudentialthompsonwood.com November 10,2005 Dale Smith Sr. Jean A. Hake Co-Executors Estate of Carl E. Smith RE: 6200 Wertzville Rd. Enola P A 17025 Dear Dale & Jean: On November 5th 20005 I previewed the referenced property in order to determine the current market value. The property is a 13 73 square foot brick ranch home with 3 bedrooms and 1 full bath. There is a 2 car attached garage as well as a detached/shop garage situated on .69 acres in Si~I IT=ivg Township. J-./ ().. ('h fJ ~ /1 I have found numerous comparables that have settled in recent months and are similar in size, location and amenities. Based upon its location on a busy road and the need for interior updating, I believe the indicated market value is as follows: One hundredfifty three thousand dollars and 00/100 ($153,000). Should you have any questions or comments, please don't hesitate to let me know. St p n J. Thompson Broker/Appraiser (Lie. # BA003424L) Prudential Thompson Wood RealEstate .-d un ''''1pnpl"'r!:Jr,r:v nwnpn .,nri :-:npr:1fPr1 i"T'p.r.J,pr :-:i ~~e ;::r',~aen'(lal Real Estate J.fflliates. :nc REV-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Cl\.RL E. SMITH 21-0:::.-0997 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBI,R VALUi::AT DATE OF DEATH 2.. 3.. 4.. 5.. 60' 7. 8. 9. 10. II. 12. 13. 14. 15. 16. 17. l8. DESCRIPTION I SMITH BARNEY CITIGROUP-ACCT.#724-03837-16 I i SMITH BARNEY CITIGROUP-ACCT.#724-08770-14 11,700 SHS. EXXON MOBIL CORP. i 4,900 SES. EXXON MOBIL CORP. 1338.5 SHS. FRANKLIN PA TAX EXEMPT , 100 SHS. JOHNSON & JOHNSON 110,000 BOND-MONTGOMERY CNTY PA HIGHER ED. 5% MATURES 06/01/28 I MONTGOMERY CNTY PA HIGHER ED. - ACCRUED INTEREST 1200 SHS. MGE ENERGY, INC. 1450 SHS. ERIE INDEMNITY CO. 600 SHS. UGI CORPORATION 400 SHS. CVS CORPORATION 8,338 SHS. EXXON MOBIL CORP. 1,058 SHS. PPL CORPORATION 24 SHS. MEDCO HEALTH SOL, INC. 200 SHS. MERCK & CO. ::"09,293.9 SHS. MORGAN STANLEY LIQUID ASSETS ~UND OPPENHEIMER & CO.-ACCT.#A09-0019777-128: 6,132 SHS. EXXON MOBILE CORP. 23,078 SHS. LIQUID MONEY FUND 2,359.219 SHS. VANKAMPEN US MORTGAGE CLASS A 6,242.433 SHS. JOHN HANCOCK TAX FREE BOND ~UND 495 SHS. ACM INCOME FUND, INC. 3 14,100 95,727 275,919 3,507 6,295 10,138 204 6,780 23,704 13,878 9,946 464,427 32,131 1,333 5,477 109,294 345,293 23,078 32,132 63,610 4,089 TOTAL (Also enter on line 2, Recapitulation) I $ 1 , 54 0, 9 S 5 . 00 (If more space is needed, insert additional sheets of the same size) jNJ c/:J "- D(jL) .J.... ~ -/tX;-- ~ ..-- SMITH BARNEY..... cltlgroupJ Balances As of 10/28/2005 Carl E Smith 6200 Wertzville Rd Enola PA 17025-1162 ::lrepared by FABIAN - FRIEDMAN 717-780-1700 Acct No. 724-03837-16 MARKET VALUE % OF ASSETS INCOME ACCOUNT BALANCE 3.28/ 100.00 TOTAL ACCOUNT VALUE 3.28 100.00% ( '- .. % of Assets refkcts account balances as a percentage oflong position & cash rounded to the nearest hundredth. As a result the total may not equal )()O%. l . 'ove summary/prices/quotes/statistics have been obtained from sources believed reliable but are not necessarily complete and cannot be guaranteed. ,-,formation contained in monthly account statements and confirmations reflects all transactions processed by Smith Barney, and as such supersedes all other reports for financIal and tax purposes. Smith Barney is a division and service mark of Citigroup Global Markets Inc. Member SIPC. .:---- SMITH BARNEY..... cltlgroupJ :Jrepared by FABIAN - FRIEDMAN -'17~780-1700 Holdings As of 10/28/2005 Carl E. Smith Ttee Fho C.E. Smith Living Trust U/AID 07/16/97 6200 Wertzville Road Enola P A 17025-1162 Acct No. 724-08770~14 Research Rating Quantity 14,082.07 1,700.00 4,900.00 338.50 SymlCUSIP #BDP XOM XOM FRP AX 100.00 JNJ 10,000.00 613604TP20BO ( "- 1L lL Price Market Value 1.000 14,100.16.1' / 56.310 95,727.00 ./ 56.310 275,919.00/ / 10.360 3,506.90/ i 62.950 6,295.00 v . 101.387 / 10,138.70 Description BANK DEPOSIT PROGRAM EXXON MOBil., CORP EXXON MOBil., CORP FRANKLIN PENNSYL V ANlA TAX FREE JOHNSON & JOHNSON MONTGOMERY CNTY P A HIGHER ED & Coupon 5% Mature 06/01/28 Accrued Int. $204.16 1L TOTAL ACCOUNT VALUE 405,686.76 (1hove summary/prices/quotes/statistics have been obtained from sources believed reliable but are not necessarily complete and cannot be guaranteed. '- ..mformation contained in monthly account statements and confirmations reflects all transactions processed by Smith Barney, and as such supersedes all other reports for financial and tax purposes. Smith Barney is a division and service mark of Citigroup Global Markets Inc. Member SIPC. Independent, third-party research on certain companies covered by the firm's research is available to clients of the firm at no cost. Clients can access this research at www.smithbarney.com or can call] -866-836-9542 to request that a copy of this research be sent to them Citigroup Invesrrnenl Research's research ratings are displayed within the Research Rating column in 'Holdings'. Page 2 C:0 "d 11::1101 ...---."" ~ -' ~ - "- .... '-, "-I ,. ~ Io;::l ~ ~ ~ ~ -l Iii ?Dl"... s::: o Q) ~ i~, i , . I I Nil "lII'~ t;> ~I COlll N >1 ,,< " >-1 91~CO ~I~ ~O - C~ ::s .- OJ: () U>- ll( CO .s:;Cl :t:'O E ~ rn..J w "t: ca Urn 1Il '0 tu G)'::' _en ca .- ~ W ~ "...., ",,-...:::1..',-'" ......... '......... ",~.>,:. '\,.~ "" I 101 QI IXl C\I -...' o -r- 0'01000 0[0 0 0 0 tt)or-...-mc:iJ,.....ooc:re>> ~ ~I~ ~ ~ ~ 6'1: ~ ~ -r-OIOC\lC')C')~C\1 ..... .... 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Q)'- c: (,) E > ! ~ <1)._ 1Il 0 u- w...Jcu-a; >>CC:rn o og,g<(lIl C)O.!!.!! lw W ~ ~ ~ u-U-Cl)1Ilr:::r ~~I-I-;:j !~I ,..., C!.l Cl) i Iii I I ! i I I N v 9 I~ 1Il ~~ ~ ... C Q)> I 0< ;~ _"0 Ie Q) [ ::J :: \0 - (,) 0 ()~ ll(.Ql _I CD 12i~ i~~1 I;!~ :;:i-l IE IE I~ ~ I 1(,)lc73i IOi It) - as - ~ w ..' ~ ~ ~ i ~ ,,l.I~ , ~.~ -:. t .~ \ f'."'\ \. \ "'-I G x.- V .~ It) 18 ~ g 81g ~ ~ g ~ Q [0 c? cO ccilcci ..-: c? ,...: C'i IXl oor---..;-C\IC'){")I'c:n C\I ,........1Xl0>..;--~..;-(\j <:5 u:) ri ri 0) ~ C\I~ ....: lD aj ..... ~C\I....(I)COC')(I)~O c: I ~~ ~ ~ ..... o f (I) ~ '~I'''>t"- ,..... '> I~ I ! g~g~8R~~8 1O<'!.....IXl":CI?~CI?..-: C')(\J{")~1t)01t)r--- (l')l()(\JC\lll){")It)(\J s.1 S< ~ g ~ ~lg ~ O~C\l.....COCX)CX)1t) -.i C\i c? It) to 0 I cO ,...: MIOC\lC\lIOC')It)C\I I I i ogoooooo 18 ..;- ~ ro ~ an~ ~ 1C'i t\i C\i -.i ~Iai ~ ,...: C')l()C\lC\lIt)(\JIt)C\l j f I 18 g 881~ffil~18 ~ C\I"I:tCO"l:tMO C\Ig 'I I'" -I II~II I I I' I I I I (,) .E E o U III ~ C < Cl) .,g ..Jz ~ :J U U c: s;; c: (5 'g'1 zog.Qooen I~ " .- - (,);;,.. u. >"",,- (\:J m-'- ~ eo-~:::oQ) Q)~~~O~lIl(')~ ~~08;;I~alS< ,. Zu C:(,)lo~"O w-_cn O-J.g 1::'3 C).~C)> ~a.. CIl CIl r:::r ~ LU => u LU 1l.1~ ~,::i \\\ \.\\\.\ ., .. ) oenw Z~~> :~50!Z ~ocn~W Zen _:::l~cn li~~U~~ o~~~=> Ii fE :::::i 0 en ~ wl->-u. ~a::rn:El.L. ~W<I-O ocnczz wowOO I Cl-~~i= >o-cza:tS W<:::l_ a:: a:: a:: ou.. n.wc(>cr eng:::l~LU I wcnc:lu> !I, U Z l- W a:: jr: a: 0 0 ~ 0 n.uZUu. 1 -I cC ... o ... ^3INI::I.LS-NI::I8~OW C:l:1l S00C:-10-)3G ~LI~~iL~~= ~~;~= i... ,. 'O.J./O~1 l..r-r"'~.l.!'1::.1": OFPENHEIME~ December 5, 2005 Ms. Jean A. Bake, Executor 6035 Wertzville Road Enola. P A 17025-1158 Re: Carl E. Smith Date-of-Death Valuation Dear Ms. Hake: t-'AC:it. 6: ~~Co.IK. 1015 Mumma Road 'Worml~I.>PA 17043 '00.721-2294 M<mbcr of All hmoIpal ialIup A5 per your request: dated November 16, 2005, please find below the dat&-of-death valuation for Mr. Smith. If you have any further qucstious, p1cue do DOt hesitate to caD.. Thank you. A87 -0920905-128, Carl E. Smith., Individual Retirement Account Name. of Jrrvestment TotQ/ Shtns Owned Price Per Shan Exxon Mobil Corp 3,552 Ivy Mid Cap Growth Fd A 331.557 Advamage Primary 2,398.540 Liquidity (Money) Fund A09-0019777-128, Carl E. Smith $56.31 11.01 1.00 Nome of Investment Tara! Shares Owned Price Per Share Exxon Mobil Corp 6,132 Advantage Primary 23,078.01 Liquidity (Money) Fund 40-0??oo396878, Carl E. Smith Trustee, C. E. Smith Living Trust $56.31 1.00 Name of J'ltllt:st:m.tmt Total Shan:s OwMd Friel! Per ShOf'e Van Kampen US Mortgage 2,359.219 Class A $13.62 Sincerely, ~~, Michatl G. Crouse.: MGC/db MtJI'Ut Vahmtion ./ $100,013.12 3,650.44 ~.. 2,39854 Market Valuation I $345,292.92 ,/ 23,078.01 5e"- 5~l e-JJ ~ B Mal'Ul IT alU(ltion ,/ $32,132.56 ]., Y rJ:i'i d~ WORlDWIDE. SPONSOlt. Trade elate 09/29/05 10/28/05 11/29/05 12f29/05 .II/! /ql/! -=ll:)'dri John Hancock Fund!>, LLC M.Me.R NASD , John Hancock Way, Suite 1000 "OSton, MA 022' 7 - , 000 Description Div Reinvest Div Reinvest Div Reinvest Oiv Reinvest Ending value on 1~0I05 Dvlldl amount $236.72 $230.36 $249.04 $248.37 $64,358.97 '. 2005 Year end summary January 3, 2005 - December 30, 2005 Page 2 of /. Slldl!:' price $10.29 $10.19 $10.18 $10.2.2 $10.23 Slldll:'~ Ljli~ transaction 23.005 22,606 24.464 24.302 TOlal shales owned 6,219.827 6,242.433 '* 6,266,897 6,291.199 6,291.199 ~ Do D Va jut:- t&,,~ '11. '1~!- >< / D ./9 ~ 6 S, 6:.1 c; 1/ ~T~~T~I~nri~ ~NnT7T~n JIIF SHR STM 2 2 ~57694 I) lOll:lA5493 )OH134',~ 121.1lM U - - ---- . = ---- === == - ~ NNNNNC' h!h77s:"!!T! hh:JQ QQQ71QTITQ ?k~ C{25~_ John Hancock Funds. LLC MEMBER NASD 1 John Hancock Way, Suite 1000 BOS1:on, MA 02217.1000 2005 VQar Qnd summary January 3, 2005 - December 30, 2005 Paqe 1 of 2 SH'()()3aSZIHF-JHi''2FBlti JE:AN A HAKE TTEE DALE E SMITH TTEE C E SMITH LIVING TRUST UlA DTD 7/16/1997 6035 WERTZVILLE RD ENOLA PA 17025.1158 Investment professional Name Dealer Branch Signata!" Investors Signator InVCSlors Jne Special Accounts 601 Congress St FI 9 Boston M^ 02210-2801 , ....Ol<l.l.lWIO.~ $r(lNSOll Contact information Web site www.jhfunds.com EASI-Line (24-hour automated line) '1-800-.B8-MU~U JHF customer service 1-800-225-5291 (Monday to Friday, 8:00 a.m. to 7:00 p.m. Eastern Time) Portfolio summary Begirlning value as of ~105 Total additions Change in value Ending value as of 12130105 Reinvested dividends & short-term capital gains 561.947.96 +2,910_61 -499.60 $64.358.97 Account details for non retirement account(s) I~an ~~ H;.ik~ TTEE Dale E Smith TTEE C E Smith Living Trust UJA Clrd 7L16J1997 - 21.412 22.349 26_261 22.464 22.669 - 25.450 22.531 25.154 ;;[II'i.I,'1 Total shares owned 6,008.532 6,029.944 6,052_293 6,078.554 6,101.018 6,123.687 --.6,149.13.]; 6,171.668 6,196.822 - - ~ ~ ~ ~ Trade date Description Beginning value on 01/03105 01/28/05 Div Rcinvc~t 02/2S/05 Div Reinvest 03/30/05 Div Reinvest 04/28/05 Div Rcinvc~t OS/27/05 Div Reinvest 06/29/0 5--DivReiFlvest ~ - 07/28/05 Div ReinVlIlSl 08/30/05 Div Reinvest Dollar amount $61,947.96 $221.83 $231.09 $267-07 $231.83 $234.85 $264.93- $233.1t2 $261.10 Share price $10.31 $10.36 $10.34 $10.17 ~ 1 0.32 $10.36 $10.41 $10.36 $10.38 ~ - - ~ ~ CIlII:C::: Iffi' $tul. $TM : 1 357693 )) 10838S49"3 JOB13477 12/31iUS 0 NNNNNO Invest by mail Jean A Hake TTEE Dale C Smith TTCC C E Smith Living Trust U/ A Dtd 7/16/1997 6035 W~llLville Ru Enola PA 17025-1158 Fund name Tax-Free Bond A FUnd-account number 52 - 5256895 To Invest by mall. fill out this slip, aetach and mail it in the enclosed envelope, along with your check m<lc1f' [1"Y:'lhlf' Tn Inhn H"nrn.-i( <;i'Jn<lTl.rf' ""rvlr",. ,nr Amount enclosed :> ;)Iease make any address cnanges on the reverse sid@ ana have all registered owners sign and return this slip. 0000 41013Y10 000052568~56 0000052 COMMONWEALTH OF PENNSYLVANIA INHERITANC':: AX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP REV-1504 EX+ (6-98) ESTATE OF FILE NUMBER f"7'RT ........r.:..;..\..LJ E. SM~TH 21-05-0997 Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership Interest of the decedent, otner tnan a sole-oroprietorship. See instructions forthe supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. N/F_ DESCRIPTION VALUE AT DATE OF DEATH I i I i I . TOTAL (Also enter on line 3, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) REV-1505 EX.;. (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT -------------- ---- -_._---------- _._-~_._- -.._-- ESTATE OF FILE NUMBER C]l~RL E. SMITH 1. Name of Corporation N/A Address City 2. Federal Employer I.D. Number 3 Type of Business 21-05-0997 State of Incorporation Date of Incorporation State Zip Code Total Number of Shareholders Business Reporting Year Product/Service 4. STC iCK I TYPE TOTALNUMBER OF PAR VALUE NUMBER OF SHARES I VALUE OF THE VotinglNon-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENT'S STOCK ! i$ mon I !rred I I 1$ Com Prefe Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? . If yes, Position Annual Salary $ . . . . . . . DYes D No Time Devoted to Business 6. Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ " DYes DNo 7. Was there life insurance payable to the corporation upon the death of the decedent? . . DYes D No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes D No If yes, D Transfer D Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers andlor sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . . . DYes D No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, provide a copy of the agreement of sale, etc. . DYes UNo 11. Was the corporation dissolved or liquidated after the decedent's death? . . DYes D No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . . DYes D No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market valuels If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock (If more space is needed, insert additiona! sheets of the same size) REV-1506 EX. (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT _. ESTATE OF C}:l.RL E. SMITH FILE NUMBER 21-05-0997 Name of Partnership 1'1/ A Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Product/Service 4. Dececient was a 0 General D Limited partner. If decedent was a limited partner, provide initial investment S B. PARTNER NAME PERCENT PERCENT BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT I I I I I I 5. A. C. D. 6. Value of the decedent's interest S 7. Was the Partnership indebted to the decedent? If yes, provide amount of indebtedness S . . . . . DYes D No 8. Was there life Insurance payable to the partnership upon the death of the decedent? . . . . . . . . . 0 Yes D No If yes, Cash Surrender Value S Net proceeds payable S Owner of the policy 9 Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes nNo Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. If yes, DTransfer D Sale Percentage transferred/sold Consideration S Date 10 Was Ulere a written partnership agreement in effect at the time of the decedent's death? . If yes, provide a copy of the agreement. . . . . . 0 Yes D No 11. Was the decedent's partnership interest sold? .......................................... 0 Yes D No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? . . . . . . . . DYes D No If yes, provide a breakdown of distributions received by the estate, including dates a!1d amounts received. 13. Was the decedent related to any of the partners? If yes, explain . . . . . . 0 Yes D No 14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . 0 Yes D No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE I A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-150? EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE I I I I _.__.__-----..L _ __ _ ______ _ -~---_._--_..._._-_._--_._---- ESTATE OF Cl\RL E. SMITH FILE NUMBER 21-05-0997 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH N/A TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF CZ',RL E. SMITH 21-05-0997 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. VALUEAT DATE OF DEATH ITEM NUMBE:R DESCRIPTION 1. CITIZENS BANK - CHECKING ACCOUNT - ACCT. NO. 22,133 610-0686647 CITIZENS BANK - SAVINGS ~Z',CCOUNT - ACCT. NO. 614-0162297 BANK OF LANDISBURG CHECKING ACCOUNT - I BANK OF LANDISBURG NO. 700012821 'I ACCRUED INTEREST BANK OF LANDISBURG - CERTIFICATE OF DEPOSIT NO. 700012494 IIKCRUED INTEREST I BANK OF LANDISBURG - CERTIFICATE OF DEPOSIT I NO. 700012471 I ACCRUED INTEREST I 2005 MERCURY SABLE SEDAN 1999 FORD ECONOLINE CARGO VAN ! HULL TKZ',ILER 'I MISCELLANEOUS HOUSEHOLD ITEMS ADVANCE PUBLICATIONS R2FUND PATRIOT N2WS REFUND 2. 7,943 - NON-INTEREST BEARING ACCT. NO. 2644177 - CERTIFICATE OF DEPOSIT 3.. 24,368 4.. 20,518 9 ~ -.J .. 6.. 12,331 2 7. 8. 11,972 1 Q 9. 10. ll. 12. 13. 14. , ~ ...:....0. 12,225 3,200 100 4,100 38 26 TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed. insert additional sheets of the same size) 118,984.00 DEe as 'as 09: 43 FR C I TI ZENS BFN, 717 766 a:JZ) lD 7~r"=' P. 01~'Ell t~ CITIZENS BANK December 6. 2005 Carl E Smith 6200Wcrtzville Road EnolB, Pa. 17025 RE: Checking Account 6100686647 Savings Accounl6i40162297 To Whom It May Concern: Per your request I have induded the balances ()D the above refcrena:d accounts as of October 28,2005. / Checking Account 6100686647 $22,132.77 I Savings Account 6140162297 $7,943-28 Please contact me at 717-766-4743 ifYOll have any additional qnestion!Oi Holly L Me et ASSt. Manager Mt:iChi:Ulic~burg Bruuch Yl{cdA ** TOTAL PAGE. 131 ** (;0/10 -=!t:)\;:irl t:)T~~T -II ;.jn,...l~ C:"lnT7T"n 12/:2/2B6S 11:39 I175:JG:J5'72 BAt-ll< OF LANDISBl.JRG PAGE fll The8anh.. of Landisburg ESTABLISHED 1903 P.O. BO).': 179 · LANDlSBURG. PA "0"0 Bank records indicate the rotIowinQ ~nt bIIancH on octOber 28, 2005 for. Carl E. Smith SSI 198-22-9630 8200 Wlltzville Road EnoIa. PJ'17025 ~ Sale Jt. Al:d..' Account Type Balance InterHt Accrued Openecl 0Wn0r8hip WIth Number BearinQ Irrtenlat 2644177 / 1o..1a..G4 Yes ODA $24.367.89 No Yes 700012821 CD j Yes 19.44 v 03-22-04 $20.518.54 Yes 700012494 CD .; Yes $1.62 v' 02-~4 $12,331.04 $11,972-28 /' / 1~-~a Y.. 7D0012471 00 v_ $10.50 I Re5peclfully, ~~~ Community OffIce r ~~ I.ANDISBURG - 71'-789-3213 . DlAlN - 5S6-31lB . SIICRMANS DALE - ~-8S'I1 L0 /t>Vj -=J1~\;1.-1 ~T~~T~I~n.-1~ ~NnT7T~0 h,'h77,,' ..' T,' hh~}Q QQQ7/DT/Tn Keilej Blue Book - Private Party Pricing Report - Mercury, Sable " ~~ls!~U~~ ,- '- /'~, " ~., ---,~",,-,~ - ---.-,.---,.. -~-- . .--.- advertisement What is New (ar Blue Book'" ? Page 1 of 2 " USED CARS " Quick Dealer Price Quote Search Used Car Listings List Your C. REVIEWS & RAnNGS ADVICE FlNANClNG & INSU BLUE BOOK'( PRIVATE PARTY REPORT Pennsylvania · December 6, 2005 2005 Mercury Sable LS Sedan 40 ;.:..:!!.:. .....:.~----....c.,\_ . , ':\ -, -- .1 ~- , '. r,;:J ,-- '..;ill"" - - Search Listings for This Car List Your Car For Sale Online Quick New Car Price Quote Free CARFAX Record Check Auto Loans from 5.390/0 APR Insurance Quote Print "For Sale" Sign Payment Calculator Extended Warranty Quote L3 ~ ~ \ \~~ \-. '" Engine: V6 3.0 Liter 24V Trans: Automatic Drive: FWD Mileage: 11,670 Equipment Air Conditioning Power Steeri ng Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Single Compact Disc Dual Front Air Bags ABS (4- Wheel) Leather Power Seat Alloy Wheels Consumer Rated Condition: Fair "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title histoC{ , the paint, body and/or interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. BLUE BOOK CLASSIF' ) tUlch U,~ll (u' Ldilil]S Quickly brc through 0' 600,000 u~ vehicle listir find exactly the car you want. - advertise mer SEARCH USED CP- lISTING~ ON KBB. cwtli '*' "~, More than 600,0 online listings Make: I Acura Model: I Select a Model ZIP Code: GO Powered by: . Keiley Blue Book - Private Party Pricing Report - Mercury, Sable Private Party Search Local Listings I List This Car for ValuE~ Sale $12,225 Private Party Value is what a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (other than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Get a Used Car Trade-In Value Get Invoice & MSRP on New Cars Get a 15 Minute Response When You Apply for a Blank Check@ Auto Loan ~~';~5~tj Copyright @ 2005 by Kelley Blue Book Co., All Rights Reserved. Nov- Dec 200S Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or other particular circumstances pertim~nt to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the individual use of the person generating this report only and shall not be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for errors or omissions.(v.05115) Page 2 of2 .. Kelley Blue Book - Trade-In Pricing Report - Ford, Econoline .~!!!~J ovc;1S' ye~lf:?...,., 2I..~. l '" ,,"_,~ " _ ..""",J"i._~.- ,.,,-' ..-. '.'.'- advertisement Whot is New (or Blue Book@ ? Page 1 of2 USED CARS o Quick Dealer Price Quote Q Search Used Car Listings C Lis REViEWS 8. rATINGS ADVICE. FiNANCING BLUE BOOK~ TRADE-IN VALUE PEmnsylvania . November 30, 2005 1!~99 Ford Econoline E150 Cargo Van ~_. ~' .,.--tA-.- . . - ~.- ., ~, ' - -......- . ' Search Listings for This Car l,!~L~(Qll LC~rEoL.s~l~ .QI1Ji[le Quick New Car Price Quote F.l~~_CAR[M_ R~cord~hec1s Auto Loans from 5,39% APR 111?JJrgDCe Quote payment C_~Gulator - - -- - -~ ,_ H Engine: V6 4.2 Liter Trans: Automatic Drive: R V!D Mileage: 56,000 Eqluipment AM/FM Stereo Dual Front Air Bags aliff, ~ 'i2'v-~ -pkb-' C()nsumer Rated Condition: Fair "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title history, the paint, body and/or interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. Air Conditioning Power Steering Trade-In Value List Your Car For Sale Online $3,225 Trade-in Value is what consumers can expect to receive from a dealer for a trade-in vehicle assuming an accurate appraisal of condition. This value willlikety be tess tr.an i the Private Party Value because the reselling dealer incurs the cost of safety . ..,.. ...... t inspections, reconditioning and other cose; of doing ~uSilJ!'~'\.. . <' ^~___, c;;j~f', ~IEXT STEP: 0 Get New Car Pr :~' ',.~1JomtII:IIALUE : , ., FEEJIIIACK L~_ 111 BLUE BOOI Lis! Y OUI Cal k cars.com other P01 -ad' ~ t ~ Be tc.D ~; REV-1509 EX + (6-98) COMMONWEAL-;-H OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CP,RL :t=. SMITH FILE NUMBER 21-05-0997 If an asset was made joint within one year ofthe decedent's date of death, it must be reported on Schedule G .SURVIVING JOINTTENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A N/li B. C. JOINTLY-O\IVNED PROPERTY: ITEM NUM8ER LETTER FO, JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE DATE OF DEATH VALUE OF ASSET I %OF T , DECO'S i INTEREST I DATE OF DEATH VALUE OF DECEDENT'S INTEREST A. _1 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA 1~IHERITANCE TAX RETURN ReSIDENT DECEDENT FILE NUMBER ESTATE OF CARL E. SMITH -------- -------.----------- ------------...-- ----~_._-- 21-05-0997 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of tne REV-1500 COVER SHEET is yes. I DESCRIPTION OF PROPERTY I I ITEM i INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DE CD'S EXCLUSION NUMBER L THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IIC APPLICABLE! 1. SMITH BARNEY CITIGROUP - ACCT. NO. 724-67516-16 - INDIVIDUAL RETIREMENT ACCOUNT - SEE ATTACHED DETAIL 2. MORGAN STANLEY - ACCT. NO. 410-037726- 042 - INDIVIDUAL RETIREMENT ACCOUNT: 200 SHS. ORACLE CORP. 206 SHS. M&T BANK CORP. 5,808 SHS. EXXON MOBIL CORP. 44 SHS. FREESCALE SEMICONDUCTOR 120 SHS. AMERICAN ELECTRIC POWER 500 SHS. GENERAL ELECTRIC CO. 100 SHS. HOME DEPOT, INC. 400 SHS. MOTORO~A, INC. 200 SHS. RITE AID CORP. 200 SHS. TECO ENERGY 8,878.692 SHS. MFS GOVT. SEC. 5,769.761 SHS. MFS GOVT. LIMITED MAT. 1,596.631 SHS. TEMPLETON DEV. MKTS. 5,497.18 SHS. TEMPLETON FOREIGN FUND 32,523.46 SHS. MORGAN STANLEY LIQUID ll,SSET FUND 3. OPPENHEIMER & CO., INC. - ACCT. NO. A87-0920905 - INDIVIDUAL RET. ACCOUNT: 3552 SHS. EXXON MOBIL CORP. 331.557 SHS. IVY MID CAP GROWTH FUND 2,398.54 SHS. LIQUID MONEY FUND 779,601 100 2,525 100 21,734 100 323,506 100 9981 100 4,486 100 16,902 I 100 4,010 100 9,680 100 679 100 3,377 100 84,170 100 45,004 100 33,018 100 66,461 100 32,523 100 200,013 100 3,650 100 2,398 100 , I' TAXABLE VALUE I I r79,601 I l 2,525 21,734 23,506 998 4,486 16,902 4,010 9,680 679 3,377 24,170 45,004 33,018 66,461 32,523 !00,013 3,650 2,398 TOTAL (Also enter on line 7, Recapitulation) $ 1, E 3 4 , 735 . 00 (If more space is needed, insert additional sheets of the same size) SMlTHI3ARNEY.... -:j}1 *** Carl E Smith cltlgroUpJ CGM IRA Custodian Holdings 6200 Wertzville Rd As of 10/28/2005 Enola P A 17025-1162 Prepared by FABIAN - FRIEDMAN AcctNo.724-67516-19 717-780-1700 Research Quantity SymlCUSIP Description Rating Price Market Value 38,292.35 #BDP BANK DEPOSIT PROGRAM 1.000 38,339.48 500.00 ABBC ABINGTON COMMUNITY BANCORP INe 12.000 6,000.00 8.00 AGR AGERE SYS INC 10.080 80.64 10.00 AV AVAYAINC IS 11.100 111.00 150.00 BMY BRISTOL MYERS SQUIBB CO 3M 21.140 3,171.00 300.00 CSCO CISCO SYS INC IH 17.140 5,142.00 400.00 CPRZ CITIGROUP CAPITAL vrn 6.95% 25.340 10,136.00 200.00 KO COCA-COLA CO 2M 42.830 8,566.00 200.00 CMTY COMMUNITY BKS INC MILLERS BURG 27.880 5,576.00 400.00 KNO COR TS TR 1 FOR AIG 6.7% 25.200 10,080.00 66.00 DLM DEL MONTE FOODS CO 10.600 699.60 C 100.00 DELL DELL INC 1M 31.060 3,106.00 200.00 DD EIDUPONTDENEMOURS&CO 1M 42.000 8,400.00 7,128.00 XOM EXXON MOBIL CORP lL 56.310 401,377.68 800.00 GABPRB GABELLI EQUITY TRUST 7.20% 25.590 20,472.00 250.00 GE GENERAL ELECTRIC CO lL 34.050 8,512.50 200.00 HLSH HEAL THSOUTH CORP 4.100 820.00 600.00 HMYRQ HEILIG MEYERS CO 0.000 0.30 150.00 HNZ H J HEINZ CO 35.710 5,356.50 100.00 HPQ HEWLETT PACKARD CO 2H 27.960 2,796.00 200.00 HD HOME DEPOT INC 2M 40.520 8,104.00 100.00 HON HONEYWELL INTL INC 2H 33.600 3,360.00 100.00 INTC INTEL CORP 1M 23.330 2,333.00 400.00 JPMPRJ JP MORGAN CHASE CAP X 7.0% 25.600 10,240.00 300.00 KNBT KNBT BANCORP lNC 15.830 4,749.00 325.00 LU LUCENT TECHNOLOGIES INC 2H 2.790 906.75 18.00 MHS MEDCO HEALTH SOLUTIONS INC 55.750 1,003.50 ( Ibove summary/pnces/quotes/statistics have been obtained from sources believed reliable but are not necessarily complete and cannot be guaranteed. \.-.._, Information contained in monthly account statements and confirmations reflects all transactions process cd by Smith Barncy, and as such superscdes all othcr reports for financIal and tax purposes. Smith Barney is a division and service mark of Citigroup Global Markcts Inc. Member SIPC. Independent, thIrd-party research on certain companies covered by the firm's research is available to clients of the firm at no cost. Clients can access this rescarch at wwvl.smithbamev.com or can call 1-866-836-9542 to request that a copy of this research be sent to thcm. Cingroup lnvesl:ment Resear~h's research ratings are displayed within the Research Rating column In 'Holdings'. Page 2 SMITHI~ARNEY.... *** Carl E Smith cltlgroUpJ CGM IRA Custodian Holdings 6200 Wertzville Rd As of 10/28/2005 . Enola PA 17025-1162 Prepared by FABIAN - FRIEDMAN 717-780-1700 AcctNo.724-67516-19 Research Quantity Sym/CDSIP Description Rating Price Market Value 150.00 MRK MERCK & CO INC 2M 27 .540 4,131.00 200.00 MSFT MICROSOFT CORP 1M 25.530 5,106.00 200.00 MWG MORGAN STANLEY CP TR N 6.25% 24.180 4,836.00 400.00 MWJ MORGAN STANLEY CAP TR II 7.25% 25.200 10,080.00 300.00 NRY NATL RURAL UTILITY CFC 7.625% 25.420 7,626.00 100.00 ORCL ORACLE CORP 2H 12.710 1,271.00 200.00 PTV P ACTN CORP 8Z 19.850 3,970.00 97.00 PG PROCTER & GAMBLE CO 2L 55.920 5,424.24 550.00 RAD RITE AID CORP 3.440 1,892.00 425.00 RVTPRB ROYCE VALUE TRUST INC 5.9% 24.370 10,357.25 200.00 SBC SBC COMMUNICATIONS INC 2M 23.890 4,778.00 C 200.00 SO SOUTHERN CO 2L 34.360 6,872.00 200.00 SUNW SUN MICRO SYSTEMS INC 3S 3.880 776.00 200.00 SUSQ SUSQUEHANNA BANCSHARES INC-P A 22.670 4,534.00 40.00 TEN TENNECO AUTOMOTNE INC 16.290 651.60 200.00 TWX TIME WARNER INC 1M 17.750 3,550.00 100.00 TYC *** TYCO INTL L m NEW 1M 26.750 2,675.00 400.00 USBPRC USB CAPITAL N 7.35% 25.450 10,180.00 100.00 VZ VERIZON COMMUNICATIONS 2M 31. 700 3,170.00 150.00 WB W ACHOVIA CORP 2ND NEW 1M 50.090 7,513.50 400.00 WSF WELLS FARGO CAPITAL TRUST N 25.460 10,184.00 200.00 WDC WESTERN DIGITAL CORP 2H 11.820 2,364.00 200.00 WGBC WILLOW GROVE BANCORP INC 15 .460 3,092.00 100.00 XRX XEROX CORP 2S 13 .250 1,325.00 200.00 FWL TZ *** WTS FOSTER WHEELERLm 1.310 262.00 10,00 FWLT *** FOSTER WHEELER LTD BERMUDA 27.530 275.30 C" 'Jove summary/prices/quotes/statistics have been obtained from sources believed reliable but are not necessarily complete and cannot be guaranteed. ..,nformatlon contained in monthly account statements and confirmatIOns reflects all transactions processed by SmIth Barney, and as such supersedes all other reports for financial and tax purposes. Smith Barney is a diviSIon and service mark of Citigroup Global Markets Inc. Member SIPc. Independent, third-party research on certain companies covered by the firm's research is available to clients of the firm at no cost. Clients can access this research at www.smlthbamey.com or can call 1-866-836-9542 to request that a copy of this research be sent to them. Citigroup Investment Research's research ratings are displayed W1thin the Research Ratmg column in 'Holdings'. Page 3 SlvlITH l3ARNEY,... cltlgroupJ Holdings As of 10/28/2005 *** Carl E Smith CGM IRA Custodian 6200 Wertzville Rd Eno1a P A 17025-1162 Prepared by FABIAN - FRIEDMAN 717-780-1700 Acct No. 724-67516-19 Quantity Sym/CUSIP 20,000.00 GMA.GWF Research Description Rating GENERAL MOTORS ACCEPTANCE CORP Coupon 7.35% Mature 03/15/17 Accrued Int. $53.08 Price Market Value 80.863 16,172.60 10,000.00 VZ.IO GTE CORP DEBS-BK/ENTRY Coupon 6.84% Mature 04/15/18 Accrued Int. $24.70 106.037 10,603.70 10,000.00 HLGAK HOUSEHOLD FIN CORP INTERNOTES Coupon 7.6% Mature 04/15/22 Accrued Int. $27.44 103.000 10,300.00 10,000.00 m.AAH HOUSEHOLD FINANCE CORPORATION Coupon 7.5% Mature 05/15/22 Accrued Int. $27.08 103.500 10,350.00 12,000.00 38374BDD20BO GENERAL MOTORS CORP Coupon 6.75% Mature 05/01/28 Accrued Int. $365.06 FORD MOTOR CO DEL GLOBAL Coupon 6.375% Mature 02/01/29 Accrued Int. $184.87 GINNIE MAE SERIES 2003-62 Coupon 5% Mature 07/20/33 BANK OF AMERICA FUNDING CORP Coupon 5.75% Mature 10/25/34 67.000 7,370.00 11,000.00 GM.GL C 12,000.00 F.GX 68.250 8,190.00 94.000 11,280.00 20,000.00 05946XGT40BO 95.000 19,000.00 TOTAL ACCOUNT VALUE 779,601.14 ( Jove surnmary/prices/quotes/statistics have been obtained from sources believed reliable but are not necessarily complete and cannot be guaranteed. 1r.~lnformation contained in monthly account statements and confirmations reflects all transactions processed by Smith Barney, and as such supersedes all other reports for financial and tax purposes. Smith Barney is a division and service mark of Citigroup Global Markets Inc. Member SlPc. Independent, third-party research on certam companies covered by the firm's research is available to clients of the firm at no cost. Clients can access this research at www.smithbamey.com or can call 1-866-836-9542 to request that a copy of this research be sent to them. Citigroup lnv'~strnent Research's research ratmgs are displayed within the Research Rating column in 'Holdings'. Page 4 ill'd 1\:1101 --... ...;..) ~ .. <:::. ~ '"'- "' Clt:. ~ (:::. ~ Q.) - :!" - It ~ ~ \../\ ~~ \.f'\ r .A..... '0.. ... '-....-..::::1.. ", ",,, '- '" --. ... ." ... " ,;.. '- ~ .). 8'8'g,~ ~1~lglg 8181 ~1~lml~ m NiOI,o ~I'~ (\II(\') 0 0) co 0'- co I'- ,.... ll) ""'Ill) 0) ~ 0> 0 W co (\') 1'~I~li 0 ~ ~1~lizi 0:g ! i I I I I' I [ I!, I' ll) ll) 0 ll)' ll) ll) I 0 0 ll) Ill) (\IO,....,....coO-C\lenc:o CO ll) 'CO (\') CO . . (\') CD , ,ll) . , -O~ . . t\I ll) ll) (\I I'- C') ~ (\II C') CO -0 C\lC')M __ ! ~I. .-! 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Q" We: o ~' S. 0..:. a:fi: 11.i.i en s:- we. u.:. ~c 11.( G~:~\'\:\ ).-a_;;":'_,_ 10 ll) 0/810 colv 0 0 Ii 0""'0 CO~VOQ) 10 c<5 cO '<01<0 ..: M ~ M o 0 I'- ~ 1C\l e") (\') "'" 0) I',....COO)~-(\').C\l 1~la t,lJ: l ~ vi:li!1 ' I, , g Ie gl~ 8 ~ ~ ~ 8 !. ll)(t)-CD""'(\')ll)(\')""; " M N Ml~ &ri ci &ri ~ ~ (f)1t) (\I (\110 C? lOC\I III I I I I I ' i I II r I , ~~oooooo O>CO-~ll)"'" (\1,- CO CD CD It) ~ N M/'U; cO 0 cO ~ (\')ll)C\I(\Ill)C')ll)C\I I I I 00000000 8 lO..... 1'-0> 01'-0 . Q)ll)",enC\l (\I criC\iN~~oi~~ ('I)ll)(\IC\lIt)(\IIt)C\I 8 0 8 olCD CD . 0 0 ll) O('l)ll)(\IOO> t\I ~ co ~ ~ ~ C\l1~ I I I~I I E o -' C t- O .... \\\ \\\\, 1 ::r11-.1H I C_I-.IHn:>lnl.1 "?T.TT C~~_T~~ ~2/e5!2BB5 11:1S 71 77531 755 OPPENHEIMER PAGE 02 OYPENHEIME~ Opp<mho:imer tic Co. 1= 1015 MIIIIIIDI. Road Wormh'r-\""&' PA 17043 80~ n2.2194 December 5,2005 M....ba of All hmclpaJ ~ Ms. Jean A Bake, Executor 6035 Wertzville Road Enola. PA 17025-1158 Re: Carl E. Smith Date-of-Death Valuation Dear Ms. Hake: As per your request dated November 16, 2005, please find below the date-of-death valuation for Mr. Smith. If you have any further questions, please do not hesitate to call. Thank you. A87-0920905-128, Carl E. Smith, Individual Retirement Account Name of Investment Total Shar&s Owrtcd Price Pel' Market Shon Vahuztion $5631 $200,013.12 'See.. 11.01 3,650.44 S c he c1 v Ie. 1.00 2,398.54 G- Exxon Mobil Corp 3,552 Ivy Mid Cap Growth Fd A 331.557 Advamage Primary 2,398.540 Liquidity (Money) Fund A09-0019777-128, Carl E. Smith Name of Investment T oral Shores Owned Price Per Share Market Valuation Exxon Mobil Corp 6,132 Advantage Primary 23,078.01 Liquidity (Money) Fund 40-0??oo396878, Carl E. Smith Trustee, C. E. Smith Living Trust $56.31 1.00 $345,292.92 '\ 23,078.01 \ ,-. ; .. A, .~ i \ ~ r,c\: I . 'd "-l ....~~ --- Name of lnvesttnJtnt TotalShJ:;ve$ Owned Price Per Shore Market Valu(ltion j I $32,132.56 ) Van Kampen US Mortgage 2,359.219 Class A $13.62 REV-1511 EX~ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 2~-05-0997 G~RL E. SMITH Debts of decedent must be reported on Schedule I. ITEM NUMBER A AMOUNT DESCRIPTION FUNDERAL EXPENSES RICHARDSON FUNERAL HOME JEAN HAKE - MEAL AND EXPENSES IN CONNECTION WITH FUNERAL MEMORIAL STONE INSCRIPTION , ,. B. ADMINISTRATIVE COSTS Personal Representative's Commissions 2. I Name of Personal Representative(s) JEAN A. HAKE & DALE E. SMITH I I SOCIal Security Number(s)/EIN Numberof Personal Representative(s) StreetAddress 6035 AND 6033 WERTZVILLE ROAD City ENOLA State P A ZIP 1 7 0 2 5 Year(s) Commission Paid 200 6 Attorney Fees 3. Famiiy 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 5. 4. Probate Fees Accountant's Fees 7. 6. Tax Retum Preparer's Fees 8. 9. 10. ADMINISTRATIVE COSTS CONSULTANT FEES MISCELLANEOUS ADM. FEES PRUDENTIAL THOMPSON WOOD - APPRAISAL FEE 7,609 1,:05 110 15,000 15,000 20,000 3,064 1,400 500 150 I TOTAL (Also enter on line g, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 63,938.00 REV-1512 !OX+ (12-03) COMMONWEALTH 01= P!ONNSYLVANIA INHERITANCE TAX RETURN R!OSIDENT DEC!::DENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF CARL E. SMITH FILE NUMBER 21-05-0997 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM II VALUEAT DATE NUMBER . DESCRIPTION OF DEATH 1. EXPENSE OF FINAL I~LNESS: CONNER RICH ASSOCIATES ASSOCIATED CARDIOLOGIST HOLY SPIRIT HOSPITAL HERITAGE DIAGNOSTIC QUANTUM IMAGING CENTRAL PENN HEM. & MEDICAL 9 2 19"7 88 436 43 2 . 2005 FEDERAL INCOME TAX RETURN - BALANCE DUE I I I DUEl I 10,892 3. 2005 PENNSYLVANIA INCOME TAX RETURN - BALANCE 13 TOTAL (A'", eele; oc 'm, 10, "='""''''0) I $ (If more space is needed. insert additional sheets of the same size) 11,680.00 REV-1513 EX+ (9-00) ESTATE OF C::AP.L E~. NUMBER I 1. 2 . 3. 4 . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER 2~-05-0997 RELATIONSHIP TO DECEDENT I AMOUNT OR SHARE Do NotListTrustee(s) i OF ESTATE I I I ] I I DAUGHTER ') , ( .:::....)-:5 SMITH NAME AND ADDRESS OF PERSONrS) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] JKlI"N A. HAKE 6035 WERTZVILLE ROAD ENOLA, PA 17025 DALE E. SMITH 6033 WERTZVILLE ROAD ENOLA, PA 17025 GARY L. SMITH 3300 SE 56TH ST OCALA, FL 34471 LORI J. MOORE 7825 TOLEAND AVENUE LOS ANGELES, CA 90045 SON 25 SON 25 DAUGHTER 25% I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE. ON REV-1500 COVER SHEET Il--=rNON~TAxABLE DISTRIBUTIONS ----- ~===c-~~~= I A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I I i I i I i i I I I I I I B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER s~1 $ I (If more space is needed, insert additional sheets of the same size) I COMMONWEALTH OF PENNSYLVANIA I INHERITANCE TAX RETURN ~ RESIDENT DECEDENT -..-.----------- ~- .-- - - .----.------..-......-- ESTATE OF REV-1514 EX~ (12-03) SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on REV-~~OO Gove, Sheet) FILE NUMBER CARL E. SMITH 21-05-0997 This schedule is to be used for all slngie life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. DWiIl [J Intervivos Deed of Trust D Other I UFE ESTATE INTEREST CALCULATION I NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE N/A D Life or D Term of Years I D Life or D Term of Years o Life or D Term of Years D Life or D Term of Years D Life or n Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . ... $ 2. Actuarial factor per appropriate table. . . . Interest table rate - D 3 1/2% D 6% D 1 0% DVariable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) . $ ANNUITY INTEREST CALCULATION , NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGEAT TERM OF YEARS DATE OFDEATH ANNUITY IS PAYABLE D Life or D Term of Years D Life or D Term of Years I D Life or D Term of Years i I I D Life or D Term of Years 1. Value of fund from which annuity is payable s 2. Checl, appropriate block below and enter corresponding (number) Frequency of payout - DWeekly (52) D Bi-weekly (26) []Quarterly (4) DSemi-annually (2) DAnnually (1) DMonthly (12) DOther ( ) 3. Amount of payout per period .. $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate - D 3 1/2% D 6% D 10% D Variable Rate 6. Adjustment Factor (see instructions) . 7. Value! of annuity -If using 3 1/2%,6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 . % $ $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18 (If more space is needed, insert additional sheets of the same size) R::'/-1544 EX+ (3-04) i INHERITANCE TAX I 1 SCHEDULE L I REMAINDER PREPAYMENT I _ OR INVASION OF TRUST PRIN~_IPAL I FILE~UMBER2 =:~~-=-~ 7 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I. ESTATE OF SIvE'I'H Cp"RL E (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: B. Name(s) of Life Tenant(s) or Annuitant(s) N/A (Date) Date of Birth Age on date of election Term of years income or annuity is payable A. Election to prepay filed with the Register of Wills on C. Assets: Complete Schedule L-1 1. Real Estate. . . . . . . . . . . . . . . . . 2. Stocks and Bonds 5. Cash/Misc. Personal Property. . . . . . . . . . . ............. $ $ $ $ $ 3. Closely Held Stock/Partnership . . . . . . . . . . . . . . 4. Mortgages and Notes. . . . . . . . . . . 6. Total from Schedule L-1 . . . . . . . . . . . .........................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . $ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . . .. $ 3. Value of UnincludableAssets. . . . . . . . . . . . . . .. $ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $ F. Remainder factor (see Table I or Table II in Instruction Booklet) G. Taxable Remainder value (Line E x Line F) . . . . . . . . . . . . . . (Also enter on Line 7, Recapitulation) ...$ III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) or Annuitant(s) Date of Birth Age on date corpus consumed Term of years income or annuity is payable C. Corpus consumed ................................. . . . . . . . . . . . . . . . . . . . . . . . . . $ D. Remainder factor (see Table I or Table II in Instruction Booklet) E. Taxable value of corpus consumed (Line C x Line D) (Also enter on Line 7, Recapitulation) ............... $ REV-1647 EX~ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE (Chec~ Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER CARL E. SMITH 21-05-0997 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. D Will D Trust D Other I. I Beneficiaries r- I ~: N/A ~~. I I 4. NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY I I I -I I F I I i ,- .). II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. D Unlimited right of withdrawal D Limited right of withdrawal III. Explanation of Compromise Offer: IV. I Summa,!, of Compmm;se Qffe" ~1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... $ I :2. Value of Line 1 exempt from tax as amount passing to charities, etc. I (also include as part of total shown on Line 13 of Cover Sheet) $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One D 6%, D 3%, D 0% .................. $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One D 6%, D 4.5% ........................ $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) $ 6 Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . .. $ (If more space is needed, insert additional sheets of the same size) REV-1648 EX (1i-99)(1) SCHEDULE N SPOUSAL POVERTY CREDIT i 1 I I 1 I I FILE NUMBER 12=--05-0997 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31194) ESTATE OF CAEL E~. SMITH This schedule must be completed and fiied if you checked the spousal poverty credit box on the cover sheet. ~RT I - CALCULATION OF GROSS ESTATE 6. SUBTOTAL (Lines 6a, b, c, d) 5. I 6al I 6b. 6c. 6d. 16. I 0 00 I I ,1. i I I 12 I I ti I N /j.\. 1. Taxable Assets total from line 8 (cover sheet) 2. Insurance Proceeds on Life of Decedent. 3. Retirement Benefits . 4. Joint Assets with Spouse 5. PA Lottery Winnings. 6a. Other Nontaxable Assets: List (Attach schedule if necessary) . 8. Total )~ctual Liabilities. . . . . . . . . . . . 9 N t V31 e of Estate (S bt a~t In 8 from I'ne 7) lJ I' I 9 I 0.00 7. Total Gross Assets (Add lines 1 thru 6) e ; u u r " Ie I . . ...... . ...... . .. . ...... . I If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit If not. continue to Part 11 I 0.00 I PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income Tax I Return for decedent and spouse.) Income: 11. TAX YEAR: 19 2. I TAX YEAR: 19 3. I TAX YEAR: 19 1 I 12a. T a. Spouse .... . 1a I 3al b Decedent ... . .. . 1b.1 2b. 3bl 1cl 2c. I c. Joint ....... . . . 3cI 12d I d. Tax Exempt Income 1d. 3d.1 e. Other Income not 11e I 3e1 listed above . . 12e. f. Total .. . .... . 1f. 0.00 2f. 0.00 3f I 0.00 4. Average Joint Exemption Income Calculation 4a. Add .Ioint Exemption Income from above: o . 0 0 .,. (2f) o . 0 0 + (3f) 0.00 0.00 (1 f) ( "'3) 4b. Average Joint Exemption Income. . . . . . . . . . . . . . . . . . . . . . If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part m 0.00 I PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES I 1 Insert amount of taxable transfers to spouse or $100,000, whichever is less. ... . .... . .. . 1. 2 Multiply by credit percentage (see instructions) . . . . . . . . . . . ...... . . . . . . . . ... . ... . ...... . 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure 0.00 in the calculation of total credits on line 18 of the cover sheet. . . . ........ . ... . ... . 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate . ....... . .. . ..... . ........ . ...... . 4. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. . ... . 5. 0.00 REV-1649 E)(~ (6-98) COMMONWEALTH OF PENNSYLVANIA, INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) I ! I I "--------. ~~--- -----.-.---- -.. ------_._~----------- -- ESTATE OF CARL E. SMITH FILE NUMBER 21-05-0997 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement. a separate form must be filed for each trust. This elecilon applies to the N / A . Trust (marital, residual A. B, By-pass, Unified Credit. etc.! If a trust or Similar arrangement meets the requirements of Section 9113(A), and a The trust or similar arrangement is iisted on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in thiS estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse unoer a Section 9113(A) trust or similar arrangement. Description Value I I I Part A Total I $ Part B Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made, Description Value Part B Total I $ (Ii more space is needed, insert additional sheets of the same size)