HomeMy WebLinkAbout03-13-07
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15056051047
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue '* County Code Year
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisbu ,PA 171~1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
~~
File Number
Decedent's Last Name
Suffix Decedent's First Name
[[[]
MI
~
(If Applicable) Enter Surviving Spouse's Infonnatlon Below
Spouse's Last Name
Suffix
[[[]
MI
o
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::J
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c::J
c::J 4a. Future Interest Compromise (date of
death after 12-12-82)
c::J 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c::J 10. Spousal Poverty Credit (date of death c::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
L
8. Total Number of Safe Deposit Boxes
4. Limited Estate
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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15056052048
REV-1500 EX
Decedent's Name: GIZA C E
RECAPITULATION
~- SWAN
Decedent's Social Security Number
~
1. Real estate (Schedule A). ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. ~ I 3. B q 7 q ~
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. ~ 7 3 / ~ ,
Jointly Owned Property (SChedlJle F) C separate Billing Requested. . . . . . . '2 .~ ~ Sf
6. 6. '-1 i"!
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C Separate Billing Requested. . . . . . . . 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. ~ ;< 3 3 ~ g- Co 19
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . . 9. ~ I 0 7 5" / ~
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . .. . . . . 10. ~ to ~t;,~ (eJ
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 3 ~ 7 tol f{ I
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. ~ ~. p ~ 7 ~ .t
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. .I ~ ~ /~ I';; 7 ~!
TAX COMPti,rATION . SEE INSTRUCTIONS. FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.O ifS- 16.
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.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Side 2
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15056052048
15056052048
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDEN~ NAME
0::JRA C ~ C. S lJJ oN
STREET ADDRESS
3~~ RiVe
~
File Number d I CJ ro 0 S- 0 S-
CITY
NIC.5~uRG
Tax Payments and Credits:
1. Tax Due (Page 2 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
~ 3 OJ 8-'. ;{3
l/eJOO,OO
;2/0.5d-.
Total Credits (A + 8 + C ) (2)
,/:; Ie;. 5";l
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
6. (J [)
~.DO
'//>?7.7/
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
tf/87.7/
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did deaPdent make a transfer and: . Yes No
a. retain the use or income of the property transferred;.......................................................................................... D IZI
b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~
c. retain a reversionary interest; or............................:................:............................................................................ D ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D cg
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D I2{l
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 beryeficiary.
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 p.arent, or a stepparent of the child is zero (0) percen\ [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.
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ALLEN E. HENCH
ATTORNEY AT LAW
2M MMKET ST.
NEWPdRT. PA 17074
TEL (717) 1187-31311
~AX (717) 587-3130
I.OVSVLLE OFFICE:
WEST MAIN ST.
(RT. 274)
I.OVSVILLE. PA 17047
Tel. 1717) 78t-3S47
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I, GRACE C. SWAN, of Bethany Court, 325 wesley
Drive, Mechanicsburg, Pennsylvania, being of sound mind,
memory and understanding, do hereby make, publish and
declare this to be my Last Will and Testament, hereby
revoking any and all Wills by me heretofore made.
FIRST: I direct payment of the expenses of my last
illness, funeral and burial costs from my. residuary
Estate, as an expense of my Estate, as soon after my
death as conveniently may be done. All Federal, State
and other death taxes payable because of my death, with
respect to the property forming my gross Estate for tax
purposes, whether or not passing under this Will,
including any interest or penalty imposed in connection
with such tax, shall be considered a part of the
administration of my Estate and shall be paid from my
residuary Estate without apportionment or right to
reimbursement.
SECOND: I give and bequeath my :automobiles and
tangible personal property, such as furniture, household
goods, and personal effects, if any, and other tangible
personalty of like nature, not including cash or
securities, together with any existing insurance thereon
to my children, RALPH EDWARD SWAN and DARLIS JEAN SWAN,
in equal shares, share and share alike.
THIRD: All the rest, residue and remainder of my
estate, whether real, personal or mixed, of which I shall
die seized and possessed, and to which I may be entitled
at the time of my decease, and wheresoever the same may
be situate, I give, devise and bequeath unto my children,
RALPH EDWARD SWAN and DARLIS JEAN SWAN, in equal shares,
share and share alike.
FOURTH: In addition to all powers granted by law,
I give my Executor, hereunder, the following powers,
which may be exercised without leave of court: to retain
and to invest in all forms of real and personal property;
to compromise claims and to abandon any property which is
of little or no value, if deemed appropriate to my
Executor; to sell at public or private sale, to exchange,
or to lease for any period of time, any real or personal
property, or interest therein, and to give option for
sales or leases, and to give a good deed of conveyance or
REV-1503 EX + (6-98)
*
SCHEDULE.
STOCKS & BONDS
COMMONWEAlTH OF PeNNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEpENT
ESTATE OF
GRACE C. SWAN
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
FILE NUMBER
21 06 0565
All property joInIIvoOWllld with right of survivorship must be dllc:loMd on Schtclule F.
DESCRIPTION
105 Shares of A l& T stock with date of death value of 26.29 per share. See attached
Historical Price sheet and August 1 Dividend confirmation sheet. Also see copy of 1099
dated October 1 (!) attached
117 Shares of Bellsouth Corporation with date of death value of 44.59 per share. See
attached copy of chart and valuations, copy of 1099 showing 117 shares, and Statement
from Mellon Investor Services.
U.S. Treasury HH bond Serial # M7639795HH issued July 1996. See copy of Bonds
attached.
VALUE AT DATE
OF DEATH
2,760.4E
5,217.0~
1,OOO.OC
U.S. Treasury HH bond Serial # M7639796HH issued July 1996. See copy of Bonds
attached.
1,OOO.OC
U.S. Treasury HH bond Serial # X1046239HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
U.S. Treasury Ht't bond Serial # X1 046238HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
I
U.S. Treasury HH bond Serial # *1046237HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
U.S. Treasury HH bond Serial # X1046236HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
U.S. Treasury HH bond Serial # X1046235HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
U.S. Treasury HH bond Serial # X1046234HH issued July 1996. See copy of Bonds
attached. .
10,OOO.OC
U.S. Treasury HH bond Serial # X1046233HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
U.S. Treasury HH bond Serial # X1046232HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
U.S. Treasury HH bond Serial #X1046231HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
U.S. Treasury HH bond Serial # X1046230HH issued July 1996. See copy of Bonds
attached.
10,OOO.OC
1180 Shares Wyeth Stock with date of death value of 43.56 per share. See attached
Historical price sheet and Statement from Smith Barney.
51,400.5C
900 Shares Exxon Mobil Corporation Stock with date of death value of 57.80 per share.
See attached Historical price sheet and Statement from Smith Barney.
52,020.0C
TOTAL (Also enter on line 2. Recapitulation) $
(If more space is needed. Insert additional sheets of the same size)
213397.9€
eat~
(pmputershare
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Computershare Shareholder Services Inc
P.O. Box 43078
Providence RI 02940-3078
I J., I Within the US, Canada & Puerto Rico 800 351 7221
IMPORTANT TAX RE, j"RN DOCUMENT ENCLo.SED . . Outside the US, Canada & Puerto Rico 781 575 4729
~ '." .... c:" U .... ) i~ "([' ", Vi '~ij'..:.... WWN.computershare.corrVatt
H L..:::.::J ~~' L!::J G \~.i t:-S I
GRACE C SWAN 1 ,
AnN RAlPH F SWAN~ .;'\ !~ . ForachangeofaddnlSlpleesecall1e8bcMt
165 DOWlIN FORGE 0 number or visit us at www.computershare.mmlatt
OOWNINGTOWN PA 9335 BY'
. ~--~---------______~ Holder Account Number
'11I11I.111111111I1111,1.111I.11.'11'11,.1.1111I1111I1.'111.1.1 C 0013961581
INO
nlnl6111111111
Record Dale
Check Number
SsNmN CerIIIed
10 0cI2006
0002531391
Y..
ent /2008 TIX Form1018wD1V '
Dividend Conflnnatlon
Payment Date I CIaIt ~ptIon I partie::: I
DIvidend I Gross I Deduction .,
Rate DIvidend ($) Amount ($)
Deduction I
Type
Net
Dividend ($)
01 Nov 2006
COMMON
Ytar.To-Oate PaId
105
$0.3325
34.91
139.84
0.00
0.00
N/A
34.91
138.84
.
~6UTX
ATT
+
002CS70003
OOMOMA(1 )
Page I of3
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Wyeth (WYE)
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At 1:59PM ET: 49.69 ...
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Get Historical Prices for: I
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SET DATE RANGE
Start Date: I.Ju,~lIl14 ..1 l?oQ~.. . .: ~go~an 1,
End Date: l~un.114' I?Q9~
(i: Daily
o Weekly
l Monthly
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PRICES
Date
Open
High
Low
Close
Volume
Adj
Close*
14-Jun-Q6 43.40
43.96 43.13 43.56 4,949,200 42.89
* Close price adjusted for dividends and splits.
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III
SET DATE RANGE
Start Date: IJun .114
End Date: IJun. 11114
Eg. Jan 1,
2003
<i. Daily
r Weekly
r Monthly
C Dividends Only
12oQ6
12006
First I Prev I Next I Last
PRICES
Date
Open
High
Low
Close
Volume
Adj
Close.
14-Jun-06 56.65 57.99 56.64 57.80 24,867,900 57.04
· Close price adjusted for dividends and splits.
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3/8/07
REV-1508 EX + (6-98)
.
SCHE'DULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GRACE C. SWAN
FILE NUMBER
21 06 0565
Include the proceeds of IlIigation and the date the proceeds were received by the estate.
All propelty Iolntly-owned wIIIi'rtg'ht of lUfVlyonhlp IIIUIt be dllcloHd on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
3 Antique coins with appraised value of 249.00. See attached appraisal from R. F. Hess
dated December 11, 2006
VALUE AT DATE
OF DEATH
249.0C
2.
2005 Income tax refund
1,166.0C
3.
Refund from Boyer Funeral Home
306.0C
4.
Travellers Checks
280.0C
5.
New York Life Insurance benefit 1160.94 Non Taxable
O.OC
6.
Miscellaneous furniture and personal effects
3,500.0C
7.
SB Money Funds in Smith Barney Account # 724-07625-13 205. See attached
Statement from Citigroup Smith Barney dated May 31, 2006
1,230.7i
TOTAL (Also enter on line 5, Recapitulation) $
(If more space Is needed, Insert additional sheets of the same size)
6731.7i
R. F. Hess
Appraisals: SpeciaIzJng
in antique tools & coins
185 Idle Road
Marysville, PA 17053
Ph 717-957-4079
Dee 11, 2006
RE: Coin Appraisal for Grace C. Swan Estate; DOD 6/1412006
Quantity Description
1
1
1
1901-8 Gold Half Eagle
1921-5 Morgan Silver Dollar
1893 Columbian Exposition Half Dollar
Appraised Value
$ 225.00
$ 14.00
$ 10.OQ
Total Appraised Value $ 249.0Q
Appraiser: ~.. R.(J ~ "'-.,
Ronald F. Hess
Auctioneer.:+-4"~.
Dave Magee, PA Lie AU-3753 L
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REV-1509 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEbuLE F
JOINTLY-OWNED PROPERTY
ESTATE OF
GRACE C. SWAN
FILE NUMBER
21 06 0565
If an allet was made joint within one year of the decedent. date of death,lt must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Ralph E. Swan
165 Dowlin Forge Road
Son
Downingtown, PA 19335
B
c
JOINTL Y-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 DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrS INTERES
1. A. 1/18/02 Checking Account #8606283283 at PNC Bank with date 6,517.87 50. 3,258.9.0:1
of death value of 6516.55 plus accrued interest of 1.32.
See attached letter from PNC Bank dated 10/25/06
TOTAL (Also enter on line 6, Recapitulation) $ 3 258.9.0:1
(If more space Is needed, insert additional sheets of the same size)
~ ll::j; ca::l
PNCBR'lK
412 768 3458 P.02
0PNCBAN<
October 25. 2006
Allen E Hench
Attorney at Law
220 Market St.
Newport, PA 17074
RE: Estate of Grace C Swan (Deceased)
SSN: 188-32-4561
roD: 06-14-2006
phVal
Dear Mr. Hench:
In response to your request for Date of Death balanClCs for the CWltomer noted above, oW'
records show the following:
CIleeldlll Accoa_
Account #8606283283 Established 01.18.2002
GRACE C SWAN
RALPH E SWAN ~
DOD ba1mc.e; $6,516.55 + $1.32 accrued intaest
Interest paid OI-Ol.Q6 thru 06-14-2006 $12.14 YTD
The decedent did not maintain any loans with PNe Bank.
Safe deposit box
Tho deoeOent maintained safe deposit box #5b. It was in two names.
RALPH C SWAN
GRACE C SWAN
It is located at:
Bethany VilJaae Bnnch
325 Wesley Dr.
Mecbani"bufa. P A 17055
717-691-4087
Our office does not close accounts. Please contact the branch listed before of iMtructiona
on how to close the aceount.
LIONVILLE and OENUARDIS
260 BaaIe View Blvd.
Exton, PA 19341
484-875vI8SO
Page 1 of2
REV-1511 EX + (12-99)
.
sCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GRACE C. SWAN
FILE NUMBER
21 06 0565
ITEM
NUMBER
A.
1.
2.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Debts of decedent mUlt be reported on Schedule..
DESCRIPTION
FUNERAL EXPENSES:
Boyer Funeral Home
Additional Funeral Expenses (Minister, etc.)
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Allen E. Hench
Social Security Number(s)/EIN Number of Personal Represenlative(s)
Street Address 220 Market Street
City NewPort Slate PA Zip 17074
Year(s) Commission Paid: 2007
Attorney Fees Allen E. Hench Esquire
Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees
Accountants Fees
Tax Retum Preparel's Fees
Estate Notice and proof of publication in Cumberland Law Joumal
Estate Notice and proof of publication in The Sentinel
Six Death Certificates
Certified Mailing
Register of Wills 6 Short Certificates 12.00 + 12.00
R. F. Hess Coin appraisal
Death Certificate for Ralph C. Swan
Miscellaneous
AMOUNT
7,306.0C
300.0C
11,165.0C
11,165.0C
306.0C
75.0C
122.51
61.0C
4.&1
24.0C
30.0C
16.0C
500.0C
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
31.075.1 E
REV-1512 EX + (12'()3)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GRACE C. SWAN
FILE NUMBER
21 06 0565
Report debts Incurred by the decedent prior to death which remllned unpaid I' of the date of death, Including unrelmbursed medlcll expenses.
ITEM
NUMBER DESCRIPTION
1. Bonnie K. Miller tax collector
VALUE AT DATE
OF DEATH
11.0C
2. Bethany Village Skilled nursing
4,001 .2E
3. Public School Employees Retirement. Repay overpayment. 489.45 + 684.56
1,174.01
4. Miscellaneous
500.0C
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5686.2€
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Trustee(l) OF ESTATE
I. TAXABLE DISTRIBUTIONS [mclude ~ht rl dlstrlbutlons, and transfers under
Sec. 9116 (a (1. ))
1. Darlis J. Swan Lineal
4307 Wimbledon Drive 50%
Harrisburg, PA 17112
2. Ralph E. Swan Lineal
165 Dowlin Forge Road 50%
Downingtown, PA 19335
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 TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
""'-""".'W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GRACE C. SWAN
~ ---~~
.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 06 0565
(If more space is needed, insert additional sheets of the same size)