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Home My WebLink About05-03-07 (3) , : rY7- c{ 9 FAMILY SETTLEMENT AND FINAL RELEASE IN EST A TE OF LOUISE K. KECK, DECEASED KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, LOUISE K. KECK, late of 1024 N. West Street, Carlisle, Cumberland County, Pennsylvania, deceased, died testate on January 7,2007, having made her last will and testament, which was duly executed on July 22, 1988; WHEREAS, letters testamentary for the estate of the said decedent were duly issued on January 12,2007, by the Register of Wills of Cumberland County, Pennsylvania, to BONITA L. HAMMAN, Executrix, hereinafter called personal representative, for the Estate of LOUISE K. KECK, Number 2007-00048; WHEREAS, the said personal representative has gathered the assets of the estate of the said decedent and the gross assets consist of personal property, to a total value of$183,945.28, as set forth in the Inheritance Tax Return, which is the estate tax return prepared by the said personal representative, and which is attached hereto and made a part hereof; WHEREAS, the debts and deductions amounting to $27,614.08, the payment of inheritance tax amounting to $21,135.00, leaving a balance for distribution of$133,772.62, as reflected in the Inheritance Tax Return attached hereto; WHEREAS, the balance for distribution of$133,772.62 has been reduced to cash and has been distributed as herein indicated in accordance with the last will and testament of tlw-~aid - ..1 ",../ decedent; D(;:Z If) r~-~ I I I, . L_ oJ -~" NOW, THEREFORE, KNOW YE, that, ARLENE F. MILLER, BONITA L. HAMMAN, ROBERT C. MILLER, JENNIFER L. HAMMAN and JOSHUA M. HAMMAN, being the testamentary heirs of the said decedent, and being the persons entitled to inherit under said last will and testament, do hereby, acknowledge that they have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sum or sums of money, less One Percent (1 %), as described below, the amount due them under said last will and testament, which amount they have received this day, less One Percent (1 %), and which amount is set opposite their name in the table and schedule of distribution in said statement attached hereto, unless modified herein, the One Percent (1 %) being withheld is to be held in the tax fund account in the amount of$I,109.00 and distributed upon the approval of the Inheritance Tax Return as set forth in Exhibit A, following is the distribution; Arlene F. Miller Bonita L. Hamman Robert C. Miller Jennifer L. Hamman Joshua M. Hamman $65,228.00 $15,337.00 (previously advanced $3,000.00) $13,337.00 (previously advanced $3,000.00) $ 6,407.00 (previously advanced $10,000.00) $11,357.00 (previously advanced $5,000.00) AND, they do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, they agree that no account is necessary and they do hereby agree that they consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans Court Division of the Court of Common Pleas, Cumberland County Branch. THEREFORE, they do hereby remise, release, quitclaim and forever discharge the said personal representative, her heirs, executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent, and they do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, they do hereby covenant and agree that they will contribute their share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals this 2nd day of May, 2007. WITNESS: /J4/ t~ (hJo ~</-;w~ ARLENE F. MILLER (SEAL) pt ~/k~(SEAL) BONITA L. HAMMAN ~ I~ ,V..j t. bC/ 1104. u?'~ ~(SEAL) ROBERT C. MILLER ~ ~kJrn~ NNIFE . GAMIvIAN ~~- (SEAL) (SEAL) COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the ;;>,~ day of ---IO~ ,2007, before me, a Notary Public, the undersigned officer, personally ap red ARLENE F. MILLER, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL CAROLE A ROSE Notary Public TWSP OF LOWER ALLEN CUMBERLAND COUNTY My Commission Expires Oct 21.2007 .~ '\ La ,UJl-l . (]. ~ XC Notary Public ~ My Commission Expires: (Xl - 21 f Z007 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the c;JfJd- day of fVltl..t.l.- , 2007, before me, a Notary Public, the undersigned officer, person~A L. HAMMAN, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL CAROlE A ROSE Notary Public TWSP OF LOWER ALLEN CUMBERLAND COUNTY M Convnlsslon Ex res Oct 21.2007 \ CJLLOLL G. W~ Notary Public My Commission Expires: 08- 2,1,7-007 .,/ COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the ~ f!i day of rn a.1..A---> , 2007, before me, a Notary Public, the undersigned officer, personaiiyappe~:ecOillNITA L. HAMMAN, POWER OF ATTORNEY FOR ROBERT C. MILLER, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL CAROLE A ROSE Notary Public TWSP OF LOWER ALLEN CUMBERLAND COUNTY Mv Commission Exoires Oct 21. 2007 \ c..fu_{)LL Q. i20~ Notary Public (' 17 My Commission Expires: [)cf. 2-1 ( 200 j COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the cJ.r!i. day of rnfl_LL_ , 2007, bef~"\~~ Notary Public, the undersigned officer, person~FER L. ~ known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL CAROLE A ROSE Notary Public TWSP OF LOWER ALLEN CUMBERLAND COUNTY My Commission ExOlres Oct 21. 2007 j ., ~(l,u)\L 0.. ~~ Notary Public My Commission Expires: Dc--f. 2- i \ 1.,007 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the ~~ day of fYL.tLt,y- ,2007, before me, a Notary Public, the undersigned officer, personall~d JOSHUA M. HAMMAN, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. NOTARIAL SEAL CAROlE A ROSE Notary Public TWSP OF LOWER ALLEN CUMBERLAND COUNTY Mv Commission Expires Oct 21.2007 ..,) '.~ CO AA)LL (). W~ Notary Public My Commission Expires: W . 21( ZOO 7 ....J 15056051058 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year 21 0'7 File Number DDD~~ Date of Birth 174-05-3935 01/07/2007 07/13/1918 Decedent's Last Name Suffix Decedent's First Name MI Keck Louise K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1, Original Return 2. Supplemental Return 3, Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 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 4, Limited Estate . 6, Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes William C, Kollas (717) 731-1600 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY Kollas and Kennedy First line of address 1104 Fernwood Avenue Second line of address City or Post Office State ZIP Code DATE FILED Camp Hill PA 17011 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, SIG ?::::ZZ?SP ADDRESS , " \ / f' I ( ! ~ L L c! I'\,~ 5 ,tul.{l U:I ~C1{:d U~,)l L_ , -SIGNATURE OF PRE ARER OTHER THAN REPRESENTATIVE DiTE ") -j. I c, 7 [ L\ OJ' rh IIC'L~ DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ---I -..J 15056052059 REV-1500 EX Decedent's Name: Louise K Keck RECAPITULATION 1. Real estate (Schedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . " 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 77,166.00 17. 79,166.00 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 174-05-3935 Decedent's Social Security Number 45,150.00 2,456.00 134,339.28 2,000.00 183,945.28 24,717.48 2,896.60 27,614.08 156,331.20 156,331.20 9,260.00 11,875.00 21,135.00 15056052059 ---I REV-1500 EX Page 3 Decedent's Complete Address: 21 File Number 07 00048 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Louise K Keck 174-05-3935 STREET ADDRESS 1024 N. West Street CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 21,135.00 19,000.00 950.00 Total Credits (A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty 19,950.00 TotallnteresVPenalty ( 0 + E ) (3) 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. B. Enter the total of line 5 + SA. This is the BALANCE DUE. (5) (SA) (5B) 1,185.00 A. Enter the interest on the tax due. 1,185.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i] 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 [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D [i] 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 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. ~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. REV-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Louise K. Keck FILE NUMBER 00048 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1024 N. West Street, Carlisle, PA 17013 1/2 Interest 45,150.00 Sold April 11 ,2007 HUD Attached TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 45,150.00 REV-1503 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Louise K. Keck FILE NUMBER 00048 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 2. DESCRIPTION Series EE US Savings Bond R6095506EE Series EE US Savings Bond R6095507E Series EE US Savings Bond R6095508EE VALUE AT DATE OF DEATH ITEM NUMBER 1. 3. 200.00 200.00 200.00 5. Series EE US Savings Bond R6095505E Series E US Savings Bond C2057050434E Series E US Savings Bond L1107144256E 200.00 100.00 4. 6. 7. Interest on above Bonds 50.00 1,506.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,456.00 REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Louise K. Keck FILE NUMBER 00048 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Cash 2. M&T Bank 3. M&T Bank 4. Social Security & Interest Checks 5. Defense Activities FCU 3MO-55007 -KE-42-3 6. Defense Activities FCU 3MO-55007 -KE-4-43 7. 2003 Honda Civic LX 8. Met Life Shares 9. Retirement 10. Interest 11. IRS 2006 - Reimbursement (anticipated) 12. Member's 1 st - Savings Account 13. Member's 1 st - Money Management VALUE AT DATE OF DEATH 2,200.00 19,718.33 44,556.12 1,252.15 21,015.29 19,112.63 8,250.00 1,789.54 608.70 396.52 440.00 4,406.38 10,593.62 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 134,339.28 REV-1509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Louise K. Keck FILE NUMBER 00048 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Bonita L. Hamman 1470 Long's Gap Road Carlisle, PA 17013 Niece B. C JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 01/01/86 Series HH US Savings Bond D142546HH 500.00 100 500.00 2. A. 07/01/79 Series H US Savings Bond D12414213H 500.00 100 500.00 3. A. 07/01/79 Series H US Savings Bond D12414212H 500,00 100 500.00 4. A. 07/01/79 Series H US Savings Bond D12414214H 500.00 100 500.00 TOTAL (Also enter on line 6, Recapitulation) $ 2,000.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Louise K. Keck FILE NUMBER 00048 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Ewing Brothers Funeral Home, Inc. George's Flowers 8,528.70 153.70 678.88 765.00 2. 3. Arlene F. Miller (Repast) 4. Westminister Cemetery B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Bonita L. Hamman Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1470 Long's Gap Road City Carlisle 8,250.00 State PA Zip 17013 Year(s) Commission Paid: 2. Attorney Fees 5,600.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Miscellaneous a. Pennsylvania Department of Revenue 2006 Taxes b. Carlisle Borough Tax Account 2007 Taxes State Zip 642.30 94.00 4.90 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 24,717.48 REV.1512 EX. (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 00048 ESTATE OF Louise K. Keck Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2. Kough's Oil Service 682.50 PPL Electric Utilities 190.68 Comcast 17.97 Embarq 78.17 Borough of Carlisle 75.44 Nationwide Mutual Fire Ins. Co. 38.00 Bon-Ton Credit Card 29.00 Boscov's Credit Card 29.00 FIA Credit Card 111.14 Visa Credit Card 74.11 SW. Barrett Appraisals 300.00 Subway Auto Body 500.00 Commonwealth of Pennsylvania 58.50 AAA 20.00 Cumberland County of Aging 5.88 Deluxe Checks 66.41 Michael Hamman, Snow Removal 60.00 Hoy's Greenhouse 37.10 Staples 110.99 Smith's Applicances 102.71 Bonita L. Hamman 300.00 Vital Records 9.00 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 2,896.60 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Louise K. Keck FILE NUMBER 00048 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Arlene F. Miller Sister 50% 2. Bonita L. Hamman Niece 12.5% 3. Robert C. Miller Nephew 12.5% 4. Jennifer L. Hamman Grandniece 12.5% 5. Joshua M. Hamman Grandnephew 12.5% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) One Percent Withheld Arlene F. Miller Bonita L. Hamman Robert C. Miller Jennifer L. Hamman Joshua M. Hamman $659.00 $135.00 $135.00 $ 65.00 $115.00 EXHIBIT" A" IRS 2006 Reimbursement (Anticipated) Arlene F. Miller Bonita L. Hamman Robert C. Miller Jennifer L. Hamman Joshua M. Hamman $220.00 $ 55.00 $ 55.00 $ 55.00 $ 55.00