HomeMy WebLinkAbout04-24-07
.-J
15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
.
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 6
0673
194427707
07242006
Date of Birth
12071950
Suffix Decedent's First Name MI
JR. CLARENCE W
Suffix Spouse's First Name MI
SALLY
Decedent's Last Name
TOOMEY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
TOOMEY
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of death
prior to 12-13-82)
0 4. Limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
0 6. Decedent Died Testate 0 7. Decedent Maintained a Livin9 Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal Poverty Credit ~date of death 0 11.Election to tax under Sec. 9113(A)
. between 12-31.91 and -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-" ~ -.-
GERALD J. BRINSER 71783g~~8 ~-,
Firm Name (If Applicable)
BRINSER, WAGNER & ZIMMERMAN
REGISTER OF yv\CL$ USEi'ONL Y
J:~-
First line of address
6 E. MAIN STREET
Second line of address
C"
P.O. BOX 323
DATE FILED
PALMYRA
PA
ZIP Code
17078
City or Post Office
State
Correspondent's e-mail address: w. crawford@ choiceonemail .com
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, mplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIp, ,N, " URE OF PERSON SPONSIBLE FOR FILING RETURN DATE
/.. 0
ADDRESS
~
Gerald J. Brinser
DATE
~plo ')
6 E. Main Street, Palmyra, PA 17078
Side 1
L
15056041147
15056041147
.-J
--.J
15[]5b[]42148
REV-1500 EX
Oecedenrs Name:
TOOMEY, CLARENCE W JR.
45,000.00
RECAPITULATION
1. Real Estate (Schedule A)...........................................................................................
2. Stocks and Bonds (Schedule B)................................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).............. 3.
4. Mortgages & Notes Receivable (Schedule D)............................................................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E).................... 5.
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested.............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested.............. 7.
8. Total Gross Assets (total Lines 1-7)........................................................................
9. Funeral Expenses & Administrative Costs (Schedule H)............................................
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)...................................
11. Total Deductions (total Lines 9 & 10).......................................................................
12. Net Value of Estate (Line 8 minus Line 11)..............................................................
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J)....................................................
14. Net Value Subject to Tax (Line 12 minus Line 13)...................................................
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~ 11 , 34 4 . 6 6
16. Amount of Line 14 taxable
at lineal rate X .045 11 , 3 4 4 . 6 5
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. Tax Due............................... ..................... .......................................................... .......
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15[]5b[]42148
Decedent's Social Security Number
194427707
1.
2,669.94
8.
47,669.94
20,783.25
4,197.38
24,980.63
22,689.31
9.
10.
11.
12.
13.
14.
22,689.31
15.
0.00
16.
510.51
17.
18.
19.
510.51
D
15[]5b[]42148
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 06 - 0673
DECEDENT'S NAME
Toomey, Clarence W Jr.
STREET ADDRESS
103 Wayne Avenue
CITY I STATE IZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
510.51
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
0.00
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 510.51
(SA)
(5B) 510.51
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
D [!]
D [!]
D [!]
D [!]
D [!]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.............. D [!]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?................... ...................................................... ................................ ..... ......... D [!]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?............................................................................................................... ..........
Yes
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P .S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P .S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P .S. ~9116 1.2) [72 P .S. ~9116 (a) (1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
*'
SCHEDULE A
REAL ESTATE
COMMONWEALlIl OF PENNSYlVANIA
INiERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Toomey, Clarence W Jr.
FILE NUMBER
21 - 06 - 0673
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be excflanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knoWledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Premises situate in East Pennsboro Township. Cumberland County, known as 103 Wayne 45.000.00
Avenue, Enola, Pennsylvania - Gross Sale Price
TOTAL (Also enter on Line 1, Recapitulation) 45,000.00
If'
A. U:~. DEPARn..n:'NT OF HOUSING AND URBAN DEVELOPMENT SETTI.EMENI !lT~
B. TYPE OF LOAN 6. File Number: 7. Loan Number:
1. FHA 2. FmHA c:lin103
3. X Conv. Unins. 4. VA S. Conv. Ins. 8. Mortpge Insurance Case Number
C. NOTE: This form is fiunished to give you a statement of actual settlement costS. Amounts paid to and by the settlement agent are shown. Items marked "(P.o.c )"
were paid outside the closing; they are shown here for informational purposes and are not included in the totals. .
NOTE: TIN - T-Mvets Identification Number
D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER:
Charles E. Cain II Clarence W. Toomey Jr Estate The First National Bank of
Christina L. Cain Marysville
126 Creekside Drive 101 Lincoln Street
Enola, PA 17025 Marysville, PA 17053
G. PROPERTY LOCATION: H. SE'ITLEMENT AGENT NAME, ADDRESS AND TIN
103 Wayne Avenue Robert P. Kline, Esq. 25-1797626
E. Penn Twp, Cumberland Co P.O. Box 461. New Cumberland PA 17070-0461
Eno1a, PA 17025 PLACE OF SETTLEMENT I. sETTLEMENT DATE
Tax Parcel i09-15-1290-052 714 Bridge Street 12/2712006
New Cumberland PA 17070
BUD _ 1 UNIFORM SETI'LEMENT STATEMENT
OMS Approval No 2502~26S
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GR~~ AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract sales nrice 4~noo.00 401. Contract sales nrice 45 :-n00. 00
102. personal nro- 402. Personal n~
103. Settlement chanres to borrower (l.ine 14(0) 1. 713.75 403.
104. 404.
105. 405.
Adiustments for items naid bv seller in advance Adiustments for items Raid bv seller in advance
106. Citvltown taxes 406. Citvltown taxes
107. Countv taxes 1272772006-1273172006 1.81 407. Coui\iVtaxes 12/27/2006-12/31/2006 1. 81
108. Assessments 408. Assessments
109. Sewer & Refuse Adiuitments 5.00 409. Sewer & Refuse Ad;ustments 5.00
110. School Tax 12/27106':n~J";lnJ07 311 .13 410. School Tax 1iI27/06..:06/30/07 <11.13
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 47.031.69 420. GROSS AMOUNT DUE TO SEllER 45.317.94
200. AMO=-'-'" ;w... BY ORIN Bi.i'AU' OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
20 l,-nenosit or earnest money 4.500.00 SO 1. Excess denosit
202. Princin8l amount of new loaiifs) 45.000.00 502. Settlement c:harll:es to seller (Line 1400) 2 238.00
203. Existilillloan(s) taken subiect to 503. Existinllloan(s) taken subiect to
204. 504. Pa_ffoffirst mortUlI:e loan
205. 50S. pavoffofsec:ond mortll8l!e loan
206. 506.PNC Bank ESCROW 10.000.00
207. 507.
208. 508.
209. 509.
Adiustments for items unnllidlW- seller Adlustments for items unnaid bv seller
210. Cltvltown taxes 510. Citvltown taxes
211. Countv taxes 511. County taxes
212. Assessments 512. Assessments
213. 513. --:-
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAl. PAID BYIFOR BORROWER 49 500.00 520. TOTAl. REDUCTION AMOUNT DUE SELLER 12 238.00
47 031.69
49 500.00
2 468.31
45 317.94
12 238.00
33 079.94
SELLER'S STATEMENT
The information contained in Blocks E, G, H, and 1 and on line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the
Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanc:tion will be imposed on you if this item is required
to be reported \lid the IRS determines that it bas not been reported. You are required to provide the Settlement Agent with your correc:t taxpayer identification number. If you
do not provide the Settlement Agent with your correct taxpayer identification number. you may be subject to civil or criminal penalties imposed by law. Under penalties of
perjury, 1 certify that the number shown on this statement is my correct taxpayer identification number.
(Seller's Signature)
(Seller's Signature)
Clarence W. Toomey Jr Estate
_ ___ ___ w__ .,.^^I n.-':ftnC! Mitions arc obsolete
Page 1
form HUD-l (3/86) ref Handbook 4305.2
700. TnTALSALI"JWROKER'. rOMMIR.fi;ION based OD DriCe $ 45.000.00 @ PAlO FROM PAID'FlOM
Division of Commission nine 700) u follows: BORJlOWER'S SEl.LER'S .
701. $ FUNDS AT FUNDS AT
702.$ SEm.EMENT S~....~-
703. Commission naid at Settlement
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
80 1. LollI Orilrination Fee S
802. Loan Discount 0.500% S 1st Nat Bank 225.00
803. Annraisal Fee to
804. Credit renort to
80S. Lender's Ins"""tion Fee
806. Annl ication IO'~~ to 1..t- N",t-i nnal B"'nk nf' M",-,..uavi11 F' 150,00
807. Documentation Fee to 1st National Bank of Marvsville 125.00
808.
809.
810.
811.
812.
813.
900. ITEMS REOUIRED BY LENDER TO BE PAID IN ADVANCE
90 1. Interest from
902. Mortl!8l!e Insurance Premium for
903. Hazard insurance Premium for
904.
90S.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance
1002. MOItlIIU!e insurance
1003. Citv PronMlv Taxes
1004. CounlV pronertv Taxes
1005. Annual usessments
1006.
1007.
1008. A........".te Accountinll Adiustment 0.00
1100. TITLE CHARGES
1101. Scttlement or closin" fee to
1102. Abstrac:t or title search to TriCountv Abstract (S135. 00\
1103. Title Examination to
1104. Title insurance binder to
1105. Document n........",tion to
1106. NolarV fees to
1107. Attornev's fees to
{includes line numbers:
1108. Titlc Insurance to Kline T.aw (\f'fi~e aaent for Securitv Title I 678 75 I I
{includes line numbers: 1101-1107' Endorsements 8.1 100 & 300
1109. Lender's covera"e ~ 45000.00
1110. Owner's covcralle $ 45000.00
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Rcc:ordinll fees: Deed S 38.50 Mortnlle S 46.50 Release S 85.00
1202. CilV/c:nlV tBXIstamn.~: Deed ~ Mort"..... ~
1203. State taxlstarnns: Deed S Mortn.e S
1204. Realtv Transfer Tax 450.00 450.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Su""'" to
1302. Pest insnection to
1303. Tax Cerification to Debbie Lunold Treasurer 2.00
1304.2006 Co/Twn Tax .to Debbie LUDold Treasurer 181. 55
1305. 2006-07 School Tax to Debbie LUDOld Treasurer 675.25
1306. 2005 Taxes to Tax Claim Bureau 929.20
1400. TOTAL SETTLEMENT CHARGES {eDter on IiDes 103 SeetioD J aDd 502 SeetloD K\ - 1 713.75 2.238.00
CER11FICATlON, ~~~IIy"'-"'" HUD-I _ S_........ ""'''''''' ~Of; .......... -- -"'...........
disbu~ments made on m account 1 Z me in this transaction. I further certify that I rcc:eived a copy ..?'% tt1emen~
j/;".p.t-t.. - rAjO;L-LJJ, "..J~ IJPd} /L I ~ ..
Seller / Clarence 'I. Toomey Jr Estate - Charles E. Cain II
~~A~
Seller Borrower Christina L. Cain
~ HUD-I ~; I ?re~ is a true and ac:c:urate account of the funds disbursed or to be disbursed by the undersigned as part of the settlement of
this transaction. ,,\) /'"')
~ 12/27/2006
Settlement Agent Robert Peter Kline, Esquire Date
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and
imprisonment For details see: Tide 18 U.S. Code Section 1001 and Section 1010.
C EASY SOFT, Inc. 2001 Previous editions arc obsolete Page 2 form HUD-l (3/86) ref Handbook 4305.2
i -
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONINEALTM OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Toomey, Clarence W Jr.
FILE NUMBER
21 - 06 - 0673
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jOintly-owned with the right of
survivorshIp must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Forfeited Down Money on Auction of Real Estate 750.00
2 Proceeds from Sale of Personalty 1.602.00
3 Prorated Taxes on Sale of Real Estate 317.94
TOTAL (Also enter on Line 5, Recapitulation) 2,669.94
~e:
09-13-2006 14:27:22
;ettlement
;eller: 1
Blmer Murry Auctions, Inc.
287 Limerock Road / Lititz, PA 17543
717 626-2636
www.hollingerphoto.com
Clarence B Toomey Bstate
Brinser Wagner & Zimmerman
PO Box 323
Palmyra PA 17078
Item Description
Price
Qty
Cle
Page:
1
.-------------------------------------------------------------------------------
Total
Ford truck
Shed
Wheels
Tool box
Garbage cans
Tire
Chairs
Rack
Box lot
Rug
China closet
Tool lot
Lawn mower
Weedeater
Fishing lot
Rack
Rake
Sign
Shovel
Tv
Table
Box
Rack
Key board
Ammo
Toys
Lot
Hatchet
Tools
Trinuner
Saw
Lot
Items:
Thank you for your business!
32
Amount:
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1,100.00
400.00
1.00
1.00
1.00
1.00
1.00
6.00
6.00~
4.00
1.00
1.00
11.00
1.00
5.00
5.00
3.00
1.00
1.00.
1.00
1.00
6.00
6.00
3.00
20.00
8.00
1.00
1.00
2.00
1.00
1.00
1.00
1,602.00
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATlVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 - 06 - 0673
ESTATE OF Toomey, Clarence W Jr.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES:
A. 1 Sullivan Funeral Home
B.
DESCRIPTION
AMOUNT
6,877.00
2 Funeral Luncheon
50.36
J..)
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Violet Rose Murry
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 608 Thrush Court
City Mechanicsburg State PA
Year(s) Commission paid 2007
Attorney's Fees Brinser, Wagner & Zimmerman
3,000.00
2,500.00
Zip 17055
2.
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Sally Toomey (Moved after death and sale of Real Estate)
Street Address 218Clay Street
City West Fairview State PA Zip 17025
3,500.00
Relationship of Claimant to Decedent
Spouse
4.
Register of Wills
167.00
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1
Register of Wills - Inventory Filing Fee
15.00
TOTAL (Also enter on line 9, Recapitulation)
20,783.25
.
Schedje H
FlI1eI'aI Expenses &
Ami. ~a6ve Costs contiooed
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Toomey, Clarence W Jr.
I FILE NUMBER
21 - 06 - 0673
2
Cumberland Law Journal - Legal Advertising
75.00
3
The Sentinel - Legal Advertising
107.99
4
Len Woodring Independant Service - Hauling Trash
445.50
5
Real Estate Transfer Tax
450.00
6
Debbie Lupoid, Treasurer - Tax Certification
2.00
7
Auctioneer - Cost of Sale
3,513.50
8
(2) People Searches for Daughter's Address
79.90
Page 2 of Schedule H
.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALlll OF PENNSYLVANIA
IIt1ERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Toomey, Clarence W Jr.
FILE NUMBER
21 - 06 - 0673
Include unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER AMOUNT
1 East Pennsboro Township - Real Estate Taxes 2.292.01
2 P P & L - Electric 22.73
3 RNCB Fishing - Magazine Subscripton .39.95
4 Jackson Gastroenterology 8.00
5 Clem Ciccarelli, M.D. 30.74
6 Howard Ray Cohen, M.D. 17.95
7 Debbie Lupoid, Treasurer - Taxes 856.80
8 Tax Claim Bureau - Past-Due Real Estate Taxes 929.20
TOTAL (Also enter on Line 10, Recapitulation) 4,197.38
REV,1513 EX:" (9~O)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Toomey, Clarence W Jr.
I FilE NUMBER
21 - 06 - 0673
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS[include outright sFrousal
distributions, and ransfers
under Sec. 9116 (a) (1.2)]
1 Diana L. Harren Daughter 1/2 Residuary Estate 11,344.65
R.R. #1
Liverpool, PA 17045
2 Sally Toomey Sppuse 1/2 Residuary Estate 11,344.66
clo Clay Street
West Fairview, PA 17025
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
.......-.-...-.-
----..
W
V>
;::)
o
:z:
r- M
~ M
V>;::) 0
.....10 I""-
.....Ie..> ......
-
:3:0
u-e..>~l
00 ."
z~
~c:(W\+1
W.....I>...:J
r-~OV')
v>wz-
_c:::lc:(.....I
c.!l===:Z:~
W;::) c:(
~e..>v>e..>