HomeMy WebLinkAbout11-22-78
LAW OFFICES
WILLIAM F. MAHTSON. P.C.
'I
,
~
IN RE: ESTATE OF
SARA STONE MILLER,
AN INCOMPETENT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 407 ORPHANS' 1978
FINAL DECREE
Ai'lD NOW, ~1L.{ , 197~ at l: ~O o'clock, P.M.,
upon consideration of the Petition filed herein and upon hearing
testimony presented at the hearing on said Petition, the Court
finds that it would be in the best interests of the incompetent,
Sara Stone Miller, for the Court to substitute its judgment
for that of the incompetent with respect to her estate and
affairs and permit the Petitioner to make an annual charitable
gift of $6,000.00 from the annual income of the incompetent to
Lafayette College.
BY THE COURT,
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LAW OFFICES
WILLIAM F. MARTSON. P.C.
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IN RE: ESTATE OF
SARA STONE MILLER,
AN INCOMPETENT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 407 ORPHANS' 1978
PRELIMINARY DECREE
AND NOW, this .-/ /
,J1{LF
, 197 (, at
, ,--Z
) I J
day of
0' clock, f .M., upon consideration of the annexed Petition and
upon the motion of WILLIAM F. MARTSON, P.C., attorneys for
Petitioner, it is hereby ordered that a hearing on said Petition
shall be held in the Cumberland County Courthouse, Carlisle,
Pennsylvania, on
r /L.UA'<i .
.
/Jb,-,_/
/y
197f,
, the
day of
at // :1 (
o'clock, ~.M., in Court Room No. ~.
At least ten (10) days' notice of said hearing shall be
given to the next of kin of said incompetent by personal service
or by certified United States Mail notifying them to show cause
why the Court should not exercise its judgment for that of the
incompetent with respect to the estate and affairs of the
incompetent and permit the Petitioner to make an annual charitable
gift of $6,000.00 from the annual income of the incompetent to
Lafayette College.
BY THE COURT,
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LAW OFFICES
WILLIAM F. MARTSON. P.C.
II
IN RE: ESTATE OF
SARA STONE MILLER,
AN INCOMPETENT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 407 ORPHPu~S' 1978
PETITION UNDER SECTION 5536(b)
OF PROBATE, ESTATES, AND FIDUCIARIES CODE
FOR PERMISSION TO MAKE INTER-VIVOS CrLARITABLE GIFTS
FROM AN INCOMPETENT'S ESTATE
TO THE HONORABLE, THE JUDGES OF SAID COURT:
Your Petitioner, FARMERS TRUST COMPANY, by its attorneys,
WILLIAM F. MARTS ON , P.C., respectfully represents that:
1.
This Petition for Court Approval pursuant to Section 5536(b)
of the Probate, Estates and Fiduciaries Code, 20 P.S. ~5536(b)
(1978-79 Supp.), is filed so that certain inter-vivos charitable
gifts may be made from the estate of Sara Stone Miller, an
incompetent.
2.
The said Sara Stone Miller was declared an incompetent and
Farmers Trust Company appointed guardian of her estate by decree
of this Court dated August 18, 1978, a copy of which is attached
as Exhibit "A".
3.
The names of the parties interested in said estate and
their addresses are as follows:
(a) Jake W. Stone, Box 483, Amherst, VA, 24521;
(b) B. F. Stone, Elizabethtown, NC, 28337;
(c) Ruth Stone, 61 Maxwell Road, Chapel Hill, NC, 27514;
(d) Steven J. Stone, Route 1, Orrum, NC, 28369;
(e) Bernice S. Porter, 3808 Craven Circle, Norfolk, VA, 2351
(f) Randolph C. Stone, 532 Avenue M.S.E., Winter Haven,
FL, 33880.
A proposed notice to said persons of the filing of this Petition
and the contents thereof is attached as Exhibit "B".
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4.
The said Sara Stone Miller now resides at Forest Park
Nursing Home, Carlisle, Pennsylvania. The cost of maintaining
the said Sara Stone Miller at Forest Park Nursing Home is
approximately $15,000.00 per year.
5.
The said Sara Stone Miller had a total income in 1977 of
$35,114.00 and a total income in 1976 of $36,309.00, as set
forth in her income tax returns which are attached as Exhibits
"c" and "D". It is anticipated by your Petitioner that the
total income of the said Sara Stone Miller for 1978 will be
approximately $30,000.00 to $35,000.00.
6.
In the past six (6) years, the said Sara Stone Miller has
made charitable gifts of $31,001.92 to Lafayette College in
Easton, Pennsylvania, as more specifically set forth in Exhibit
"E", attached hereto.
7.
The will of the said Sara Stone Miller provides for a gift
to Lafayette College of $100,000.00 for a memorial to the
husband of Sara Stone Miller with inter-vivos gifts to Lafayette
College being considered contributions made towards this
memorial as more specifically set forth in Exhibit "F" attached
hereto.
8.
Petitioner believes that an annual charitable gift of
$6,000.00 from the annual income of the incompetent to Lafayette
College for the memorial more specifically referred to in
Paragraph 7 would be in the best interests of the incompetent
in that said annual charitable gift would reduce the incom-
LAW OFFICES
WILLIAM F. MARTS ON. P.G. petent' s annual Federal income tax and proj ected State inheritanc
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and said gift would be in accordance with the testamentary and
inter-vivos mtentions of the incompetent.
WHEREFORE, Petitioner respectfully requests entry of a
Preliminary Decree to show cause why the Court pursuant to the
provisions of Section 5536 of the Probate, Estates and Fiduciarie
Code (20 P.S. ~5536 (1978-79 Supp.)) should not exercise its
judgment for that of the incompetent with respect to the estate
and affairs of the incompetent and permit the Petitioner to make
an annual charitable gift of $6,000.00 from the annual income
of the incompetent to Lafayette Colleg
FARMERS rr:tUST COMPANY
I /'
By l/fM
Dennis C. C
Senior Vice Presi
Trust Officer
Guardian of the state of
Sara Stone Miller, Incompetent
COMMOlfWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
SS.
Dennis C. Caverly, being duly sworn according to law,
deposes and says that he is Senior Vice President and Trust
Officer of Farmers Trust Company and that as such officer he
has authority to make this affidavit; that the facts set forth
in the foregoing
according to
the best of his information,
. . . . , , ~ I , f . 4 ( , #
.~.. ...... ~(J~€li 'Sworn to and subscribed before me
.i ,,' c. . ,...:...... 0 ..... ..JI
:::~-:'-'f:1.~';.~\.~.l.l: .~~s It, - day of '-/l~, 1978.
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,,-i<: ~W~FFIGES -...... .. IJ.. L _ _I J
w,LLi..A. ;"'MAoO'lSON' P.. ,,'I't.:" 'UIll/ .' ~
...l.;~.... 11t;S'i.. ~tary Pubi~c
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SMORA S. ECKE....
NOTMV PU8UC
CMUS\.E CUMBERLAND CO.. M.
MY COMMISisoN EXPIMI ocr. .. ""
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I~ RS: SSTATE OF
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IN TEE CC;ur{ T OF C01-".2101i PL~l. S OF
ClJ>LE:.:RL!ll~D COm~TY, PEh'I':SYLVANIA
.
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S!~f'-A STear: H1J~LER.
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CR:rl-J\!~S ·
COURT DIVISION
(;RPr{:'>:;S' 1978
.
.
AN !,LU::G-~D 1~1C(~1FiTLr{r
: -- 'NO. 407
/..,P~;,:IJ~nr:::Nx._O~C;;_~~~~~I Ati
AI~D Z;CJ"l, .!,U6ust /8, 1978, at d;{;O otc1cx:k 1'. M., UP::H)
consideration of the Petition filed herein and u?on hearing
testimony frc:;J CR.I\IG JURGE~~SEN, H.D., the Court finds from
cnid testim::>ny th:Jt the \<.O;?lfll1:c of S/IF__-\ STmiE HILLER \.:'::>uld
~ot be pro~~t0d by he~ presence in Court at the hearing held,
: <: nd the COctI t furthc:r ff ods fr~ the teE: tir::JCoLlY tha t the c<1id
i
I S!,?,.l.. S'!'O:ffi 1,aLL~R i g uil~b Ie to 1':~1n-3bc her property, i a 1 ikely
to dissip.:Jte or beccr:)~ the victim of designing perr,ons j it is
thErcfo:Le oL'dercd llnd <H.rected thLi.t the ~aid SAP.A STorm HILLER
be and she ia hereby adj~dged an ir:c03?cteot and FhRHERS TRUST
ca-:rANY, Carlisle, Pennsylvania is appointed gl..13rdinQ of her '
c:st3te.
By the Court
s!,[)ak Jr. ~
P.J.
EXHIBIT "A"
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LAW OFFICES
WILLIAM F. MARTSON. P.C.
Ii
IN RE: ESTATE OF
SARA STONE MILLER,
AN INCOMPETENT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 407 ORPHANS' 1978
NOTICE
TO ALL PARTIES INTERESTED IN SAID ESTATE:
NOTICE IS HEREBY GIVEN that FARMERS TRUST COMPANY, Guardian
of the above-entitled estate, has filed the enclosed Petition
praying for the Court to exercise its judgment for that of
Sara Stone Miller, the incompetent, with respect to her estate
and affairs and permit the said Farmers Trust Company to make
an annual charitable gift of $6,000.00 from the annual income
of the incompetent to Lafayette College.
A hearing on said Petition shall be held in the Cumberland
County Courthouse, Carlisle, Pennsylvania, on
the
day of
, 197 , at
o'clock,
.M. in Court
Room No.
at which time you may present evidence to show
cause why said Petition should not be granted.
WILLIAM F. MARTSON, P.C.
By
Attorneys for Petitioner
EXHIBIT "B"
.. Dep.rtmenl 01 the T....u')'--Inl.rn.' R.~nu. Se",iu
~ .1 040 u.s. Individual Income Tax Return
~y'rlr !Jr\Jary l--Oe-cer.,::'er 31, 1977, or other habIt )'tar ~ti'ir.ninf . __
:;";OIIl~ ...,..-. ,_. _. $..i::jV- ..,.
J Hlt r.Jme .nd :,nlll.i ",; JUIIlL Itlurn, e,l\"e tHlt name~ !!:!"!~ :!::~~~l~ of both}
.~@77 I
, 1977 "dine
, 19
Your social se-cL;rity nurr.~
III ~ tJ.;;. : J L/} .:?_
7013
I Spouse's social SKurity no.
For PriliaC)' Act Noiice, see
page 3 of Instructions.
-" ~;lJ' Yours ~ K E.t \ R E P
.;i'J...,-.....
i ~:-:7~~. Spouse's~
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Pi!~sidential ~././% Note: Checking "Yes" wil
Do you want $1 to go to this fund? , Yes ~~ No
Election ~ . . . . . . . . . . , . -I-mt-:/'/-- not increase your tax or r
Campaign / //-%/:
Fund If joint return, does your spouse want $1 to go to this fund? . Yes ,_~ No duce your refune!.
ZO~-~~ ~ Single
~mE-S';: I 1
Check Only 2 - M3rried filing joint return (even if only one had income)
Married filing separately. If spouse is also filing, give spouse's social security number in the space above
One Box 3 and enter full name here ~ -------. . . --- ---- -. ---- -- --- _ --- -- ---.. -- -- -- _ -. -. -- _ _ _ -- -- -- _ --- --------- ------ --------- ----- ----- --..... -- - .---. --. --
-
4 - Unmarried Head of Household. Enter Qualifying name ~________________..._______....____..___________. See page 7 of Inslructi)flS.
5 Qualifying widow(er) with dependent child (Year spouse died ~ 19 ). See page 7 of Instructions_
~i5~~ ~ ~ 0 j
Always check 6a Yourself -- 65 or over Blind Enter number of :L
. ~"Xl"S weded
the "Yourself" D D 0 on 6.a and b ~
box. Check b Spouse 65 or over Blind
other boxes if
they apply. c Fir5t names of your dependent children who lived with you ~ _... _.. _ _ __.._... .._ __ _.. _.n". _ _.n.... Enter number of
children listed ~
GI d Other dependents: '" '" ."', .. ~"o;. .. ".. ". (5) Did you provide more
... ~I'/~ :: ,"~;.:h., l"ed I h.ve incom. 01 th.n one.h.lf of de. ~D
ClI (I) N.me pendent's support? Enter number
J: .i, your ,h~~ $750 or more?
tr~/ U of oth.r
N :i \\}} dependents
:k '\....-./~
01\
E Add numbers ~
... .nlered In boxes
0 7 Total number of exemptions claimed. above ~
a.. . . . . . . . . . . , . . . . , . . .
- t'm~:'Ii51 I
0
to _ . " (At1.ch Forms W-2. If unlVlII. 8
>- 8 Wages, salanes, tipS, and other employee compensadon. .ble, see p.age 5 01 Instructions.) . . . . . . . . . .
a. 9 I, 8 33
0 9 Interest income. (If over $400, atta~ Schedule B.). . . . . . . . . . , '" . . . . , . . . . .
U
.s::; lOa .. (II over $400. Itl'Ch) 33 ~ I: . 100; IDe 33 :;J,BI
u DJliIdends Schedule B ._ ___:.>.__._________~m__. lOb le~ exclUSIOn ......_____......:_.....___. Balance ~ ,
aI (See pages 9 and 17 of Instructions)
:::
0< (If you have no other income, skip lines 11 through 20 and go to line 21.)
GI
<II 11 State and local income tax refunds (does not apply if refund is for year you took standard deduction) . 11
III , .
II>
a:: 12 Alimony received. 12 .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Business income or (loss) (attach S::hedule C) . . . , . . . . . . . . . . . . . . . . . . . . 13
14 Capital gain or (loss) (attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 50% of capital gain distributions not reported on Schedule D . . . . . . . . . . . . . . 15
- Net gain or (loss) from Supplemental Schedule of Gains and losses (attach Form 4797) . 16
16 .
17 Fully taxable pensio;1s and annuities not reported on Schedule E. . . . . - . . . . . . . 17
CD 18 Pensions, anliuities, rcds, royalties, p~rtncr5hips, estate" or trusts, etc, (attach Schedule E) . 18
...
CD 19 Farm income or (loss) (attach Schedule F) . . 19
J: . . . . . . . . . . . . . . . . . . . . . . .
... 20 Other (state nature and sour~ee page 9 of Instructions) ~ -. --- --------- _ ------- _ -- ---------- ---- ----- ----.- 20
II>
"C 21 Total income. Add lines 8.9. and 10c through 20 . ~ 21 3.5. / /4
0 . . . .
>- !":r.'ln_~." . -I't~if.-J~?:! (If none, skip lines 22 through 27 ani enter zero on line 28.) wr~'.ffi:t~Jr~
cu
c: 22 ~ ~ / / / :;:@i~t':/:'-0
0 22 Moving e:::pense (attach Form 3903) . . . . . . . . . . . . . . ';.~.iftpJ~
~ -
... 23 Employee business f:Xpenses (attach Form 2106) . . . . . . . 23 "':42>0
0 -
oX 24 Payments to an individual retirement arrangement (from at- . %< ~ %';;;;f{.%~ /~,<, ,~
... ,/ ~~/~~0 :>/; //h
C> 24 W/,$j... ~/ :.-; z:%'0 /,,'4//,/~/,"/;
.s::; tached Form 5329, Part III) . . . . . . . . . . . . . . . . . . ..~~0~&j:/,~
u Payments to a Keogh (H.R. 10) retirement plan. . . 25 ~" '% / /, /~~~/"
.s::; 25 . . . . ..~.~:,;g
... 26 Forfeited interest penalty for premature withdrawal 26
to . . . . . ;%:ff~/-<r"'~:;;'l:
::: "1'/ ~ '/. '/,/:y;.;i/ Z,... - "./
0< Z1 Alimony paid (see page 11 of Instructions) . . . . . . . . . . 27 W;/$~.JJ~WAf~~
c 28 Total adjustments. Add lines 22 through 27 ~ 28
'" . . . . . . . . . . . . , . . - . . . . -
to
C> 29
a:: 29 Subtract line 28 from line 2I . . . . . ....... . . . . . . . . . . . . . . . . . . . . .
30 Disability income exclusion (sick pay) (attach Form 2440) . 30
. . . . . . . . . . . . . . . .
31 Adjusted gross income. Suhtract line 30 from line 29. Enter here and on line 32. If you Vlant 35: 1/1
IRS to figurE" your tax for you, see page 4 of the Instructions . . . . . . . . . . :> 31
[ill
D
.,.- -.-.,....-------..,..-------.-
EXHIBIT "e"
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32 AmoDO' hom ,,,. 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. -E...U3..s+JJ!'f_'_=
': . 33 If you itemize deductions, enter excess itemized ded,uctions from Schedule A, line 41 . . . .} I _ _ I
" If you do NOT itemize deductions enter zero. . , . . . . '. . . . . . . . . . . . . . . . . " 33 0
/ Caution: ::ru~~,h:hv:C~~:~~n~ iDo~o::,:::.c::g~'l~'a~rt~~ ~~,;,:;~~~:';;,~:;;';.,::,;;'~~ ~~I~;j;;::i'J'~
>(i:;;}:ffft'-:C/,/ ;/,;;~ ///,:. /'.0'
:::V;~t~~;t;:;;~i:~ "'iog a "pa,," m'om eod yo", 'POD" ;"mi", d"'odioo<, OR W~~W3;;;Jh'" .,
C You fife Form 4563, OR I /
o You are a duaf-stet:.::; alien. 3 J.. I111
34 T"Tab'.'ocom..sobt,"'1i"33fmmlio.32........................ _34 ..;. '7 ._._
//':::/;~:>2'/;W.;/'/-:%:>>// ';' / /
~o'" S" 'O<''"C''oo< fM 'io. 35 00 pa,. 11. Th" food yo", '0> 00 'h. amoDO' 00 Ii" 34 !%-"W:;i&:'Y1':iYf'"f-",. _
io 'h. T" T>hl.,. Eo'" Ih. ,,, 00 I,,, 35. How.o", if Ii" 34 i, mo" 'hao $20.000 ,:i"Y0:!h .;;;f/,.", _,
($40,000 "f you checKed box 2 or 5) or you have more exemption!:. ~~an th.ose covered in the ;;;:>/':-%}'2:/~/:;%;:.'l";;(' ~,
", ;;;,/ ,%:;:{///;.?',"~ ;;'/;:;:;. /' ,
Tax Tables for your filing ~tatus, use Part I of Schedule TC (Forrn 1040) to fIgure your tax. You %'0;.'W_:0%?';:; './//;: /' '
m,,, al<o u" So',ec"I. TC if you ",. SOh'do" G ('o>m 1040), I com. A",a,i,O. ~-.fZ;/'ftYij,-,-, .- ,:
~3:fi:5/M##f'Y:}%'8;:%" /"q>;; /l'~//":I/ /--.//
35 Tax, Check if from 0 Tax Tables or 0 Schedule TC . . . . . . . . . . . . . . . . . . . . I' V:1
- --r--- _
36 Additional taxes, (See page 12 of Instructions) Check if from 0 Form 4970, 0 Form 4972,
L - 0 'o,m 5544, [J 'o,m 5405, 0, 0 5""0' 72(m)(5) peDO'ty to, . . . 36
" Tol,1. Add Ii", 35 aoif 36 . . . . . . . . . . . . . . . . . . . . . . . . . .. 37 C; H 't. ~ I
'f 38 i?0';;W~:i;~7;;;/~:'//~
: '" C,edit fo> 'oo',i5u"00, '0 "odiifal" '0, pob'ie offi". . . . . . ~%W,"-, w;q"'/-llin
39 Cred,'t for the elderly (attach Schedules R&RP' . . . . . . . .. 39 ~~~%*PJJi~i;jif{;,
J - J %,:?{';.(~~;.,:,/~;:;:~,,; :.;:",', ,
.. 4' Cmdit '0, '"itif aoif d'P"if", "" "p"", ('H"h 'o,m 2441) . 40 ~~ciV,fAi;:'-'L '.
~%m;;'/?:;,i%;?i:':f' ~:1;<@P" // /", /
"! In'.esT'ment cred,'t (attach Form 3468). . . . . . . 41 %~1%~///~''l Y/;>0:0'/;C/<<.:;/%C % ',',
' Wi!P,","Mi;'i';Y'<<.9X/ W,. ,
42 ?;;- 00/~~~/0X:/,it~;'%:~ ;/// ,/;%
4;! Foreign tax credit (attach Form 1116)...... ~'~~./.:%:'~~~~'/~i/;?::"::~";%"://;
///(~ wg;'.-%~~?%/"/r/;/'l%, /;
~' ~::~~~:':'~~:, ;:~~~hC~:~: (;::~ .'~'~ 4874) . :: "II~.@._..':~~J
45 ~~~;;~;;c,>>> /;;'0: /
45 5" po,. ]2 of ,,,,,",tio", . . . . . . . W;;X7%"A?iW.w'wA%:2WL:
46 To'al ""'it,. Add liDo< 38 'h"o,h 45 . . . . . . . . . . . . . . . . . . . . . . . " 46 I
47 B,'"". 50bl.." Ii" 46 '''m Ii" 37 aod '0'" ifi'mo" (bu' 00' ,," ,"eo '''0) . . . ... 47 . -'I. f} Lf G _
. -
48 Self-employment tax (attach Schedule SE) . . . . . . . . . . . . . . . 48
4S Minimum tax. Check here ~ 0 and attach Form 4625. . . . . . . . . . . . . 49
50 Tax from recomputing prior-year investment credit (attach Form 4255) . . . . 50
51 Social security tax on tip income not reported to employer (attach Form 4137) 51
52 Uncollected employee social security tax on tips (from Form W-2) 52
53 Tax on an individual retirement arrangempnt (attach Form 5329) . 53
54 To'alt". Add Ii"" 47 Ihm'Oh 53 . . . . . . . . . . . . . . . . . ~ 54 t; R L/ (,
55 Total Federal income tax withheld (attach Forms W-2, W-2G, and .~.~~_._./~.~
W-2P'o'mn')........................... 55 ~I~
56 1977 "limal.d ,,, paymoo', (;odud. amoDO' allowOO" ".dit 56 7 .sOt1 ~~_.gf~
from 1976 return) . . . . . . . . . . . . . . . . . . . . . . . .. _ ~ .~Y"'~$t%&1;~~
57 Earned income credit. If line 31 is under $8,000, see page 2 of - W:A'~.~.. ':;;;~.~,j)j_~@f;@
~.~/P~~""'.~;
le","ctio",. If .ligib'., "'" ,hitd', o,m. ~uuu.u__m_.__mm_.__m 57 _ -"~~41t1
58 AmoDO' pa;d with 'o,m 4B6B . . . . . . . . . . . . . . . . . . 5. _ ~~..~~}
5' Eoc", FlCA aoif RRTA I" w"hh"d ('wo 0' mo" .mploy.~) . . 59 ~.$.:A@
60 Credit for Federal tax on special fuels, etc. (attach Form 4136) . 60 - - ~1t!j~%t4::Pd'.%~'~
.~~:t:}%:t~~
::a c~:: ~:~: :~'~;'~~;;;:::.7~~~ ~~'~"1 ('~a", .'~": 2439) : : : : : ::./ __
62 To~1. Add lines 55 through 61a . . . . . . . . . . . . . ~ 621 /;..b 0 0 1_
63 If 1,00 62 i, '''''' 'han it" 54, 'nl" amouol OVERPAID. ~ .E'. . _
64 Amount of line 63 to be REFUNDED TO YOU. . . . . . . . . . . . . . . . . . . . . . ~ 64
65 Amouo, of/i" 63 '0 b""dit.d 00 197B ""m"ed '" . . . . .. I 65 I ~
66 If line 54 is larger than line' 62, enter BALANCE DUE. Attach check or money order for full amount I &\ I I
payable to "Internal Revenue Service." Write social security number on check or money order. . . ~ 66 0( 3 (L)
(Ch~k" ~ if room 2210 (2210f) i, attach,d. See pae"4 nf Io<'co,"oo<.) .)?'~~il!f'''
Un'" "n,,.,,, 01 "',,'0 'Y. I """, ,"" I ha,. "'mm" 'hO, "10m. ;ndo"n, ''''m"ny", "h"",,, 'DO "",m,o", .., '" th, b.~
of my k-'~::wJedge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of
"""h P"p"., h" "1 koo"'dO' ~
~ ~ e,;, ".." ,.e"i,n"o,..,:' n, "',m, nom /.~ ~.. ~~,:,:f"f!,~O )
y,", ",n"o~ o~. . B-".~.lC_E.._'\-__\S'.5~__,,_~._.._____
... --_C!._'d:_~-~--~-~jj_._-____B.:__l_2L;LL____
r Spouse's s'gnature (if filing Jointly, BOTH must ~ ~ I 5
S.gn ..ven It only one had income) Y P.id Prtparer':-.~~r= (O} .~Io~r" n.me, .ad,eu, .n~ Idenllfy,nr numbel)
I
- ~
-- ---~
EXHIBIT "e"
'"
\,-
~:..~'--jv!('~ f.r.? C.orrr. : :~.:.;, ?9 '7
S'...~!'': c: 'J ~ f: s- --1 r. terest 0 n d C; vie e nd 1 ncome
P~i:.
N~me(s) as shown on Form 1040 (Do not ente~ r,ame and socIal security number if shown on other side)
. S\\~~ S,__M',-\h="R.
[}lJl:I.r:J Interest Income "/tr;;;r:iiJIT:] Dividend Income
1 If you receil/ed more than $400 in interest, complete. Part I. 3 If you receil/ed more than $400 in gross dividends (in~kd;n'
Interest includes earnings from savings and loan cssoclatlons, capital gain distributions) and other distributions on stock
mutual savings banks, ccoperative banks, and credit unions caTPpfete Part II (see Note below and page 17 of instruct;::,ns)
as well as interest on ban" deposits, bards, tax refunds, etc. (List payers and amounts-write (H), (W), (J), for stock he;,
Interest also includes original issue discount on bonds and by husb3r.d, ,,,,'ife, cr jointly.)
other evidences of indebtedness (see rage 17 of Instructions).
(List payers and amounts.)
~~R~~~Lh\ ~\S?~C
F~~~~1'l _~ -S~;-t ""J-:r~L.
~!c j:f.. f1!L7- r.,.r;qL{7
k? + c+'-{ ~ F l~Jl'Ca, ~
~JL\"<"'P I -r~C~~L~
~ 3-7';)'51,5J../-'1 -4
Your soci'a security n~mber
Ill': .,;. ' I t.J 0 5
: ,""' ,I < I
~ R~U I h:~~ 'f\E"IlC\31
- -E=~'e~R ~ "'Sl'-'\~T:Kc,
5 5 7 _ ill ~ -~-.8!:L1~-6 99 L.{ 7
k~l~~y~~
- ~f~ ~~:'~R
~ ~ ~hC/(~~~\~~. EIEe
I--~I~
=!2.-!Ls'i [_
--.dS-E _ _
5LQ__
~~-~.
~2A- -
.3 ;) cL-
h. Jl.f~ p -t\ E C~ \! e-9 p: Vo 0 I c=: \)
--r '-< co 0 ~ '=- '-I Q... v "5 -t h, ..vv :>
~?J -=2..:1-.S1s.t..f 9
/,,88
Note: If you received capItal gain dIstributIOns and do not need Schedule 0 to report any other gaIns or losses or to compute i]
the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions on Form 1040, _' :~.
line 15. ~.
1Iil1i;IIr1 foreign Accounts and foreign Trusts
If you are required to list interest in Part I or dividends in Part II, OR if you had a foreign account or were a grantor of,
or a transferor to a forei n trust, you must answer both uestions in Part III. (See page 18 of Instructions.)
1 Did you, at any time during the taxable year, have any interest in or signature or other authority over a bank,
securities, or other financial account in a foreign country (except in a U.S. military banking facility operated by a
U.S. financial institution)? . 0 Yes C8J No
If "Yes," see page 3 of instrucFons.
/, 8 33
4 Total of line 3
5 Capital gain distribu.
tions (see page 18 of
Instructions, Enter
here af'!d on Schedule
D, line 7). See Note
below . ,
6 Nontaxable distribu.
tions (seepage 18 of
instructions) .
7 Total (add lines 5 and 6) .
8 Dividends before exclusion
7 from line 4). Enter here
1040, line lOa .
33.38/
.%.~
.....~...pt../.>.~.~.~
.~ 0, ~~~;1
% ~F/.{y;/;
~ 0~;%
..
.. ... ..
2 Total interest income. Enter here and
on Form 1040, line 9 .
(subtract line
and on Form
'3 3~jf:SJ
2 Were you the grantor of, or transferor to, a foreign trust during any taxable year, which foreign trust was in
being during the current taxable year, whether or not you have any beneficial interest in such trust? 0 Yes ~ No
If "Yes." you may be required to file Forms 3520, 3520-1<., or 926.
.. .-:-.....~-'--_._----_.~-=---=-----=-..::.=.._~"-' -- --------:-----
- ..- .- .- .--.-. - ~
EXHIBIT "e"
,
~.
S.cHEDVLE Te
(Form 1040)
Otpl."t.r1tnt of the TreiSury
Int~rr,l! Frvtrl1,,;t Service
, .
Tax Computation Schedule
~ Attach to FOrll1 1040.
~@71
Name(s) as shewn on Form 1040
5~R~
I Your!.0':. ial security nurr.~
t 17: '-!d! It/- 95
Instructions
Who Must FiJe.-This schedule is for
use by taxpayers who cannot use the Tax
.ables and for certain taxpayers who
must itemize deductions. If you must
itemize and the zero bracket <. -nount on
Schedule A (Form 1040), line 40, is
more than your itemized deductions on
Schedule A, line 39, YOu must complete
Part II before figuring your tax.
Part I.-You must use Part I to figure
your tax instead of using the T~x Tabl~s
if vour income on Form 1040, line 34, IS
m;re than $20,000 (more than $40,000
if you are married filing a joint return or
are a qualifying widow(er)) or if you claim
more exemptions than covered in the Tax
Tables for your filing status.
You will also need to complete Part I if
you figure your tax by using Schedule G
(Form 1040), Income Averaging.
S, M;\\b~
Part II.-If you are required to itemize
deductions and the zero bracket amount
on Schedule A. line 40, is more than your
itemized deductions on Schedule A, line
39, you must first complete Part !! to fig-
ure your Tax Table Income. Tre new zero
bracket amount"must be adjus.erl by cer.
tain taxpayers who must itemize deduc-
tions. This computation is necessary be-
cause the zero bracket amount is built
into the Tax Tables and Tax Rate Sched-
ules.
You MUST itemize'deductions if:
(a) You are married filing a separate
return and your spouse itemizes deduc-
tions (unless your spouse is described in
paragraph (b) and enters earned income
on Part II, line 3),
(b) You can be claimed as a dependent
on your parent's return and have $750
or more of unearned income and less
than $2,200 of earned income if you are
single (less than $1,600 of earned in.
come if you are married filing a separate
return),
Note: If your earned inco.le is more
than your itemized deductions on Sched.
ule A, line 39, enter your earned income
in Part 1/, line 3, unless you are married
filing a separate return and your spouse
itemizes deductions. (See page 11 of the
Instructions for Form 1040 for a defini-
tion of earned income.)
(c) You eJect to exclude income from
sources in United States Possessions
(see Form 4563 for details), OR
(d) You are a dual.status alien (see in-
structions for Dual.Status Tax Year on
page 4 of Instructions for Form 1040).
~
. .. ,,<
Tax Computation for Taxpayers Who Cannot Use the Tax Tables
Caution: Read the Instructions before completing this Part.
1 Enter your Tax Table Income from Form 1040, line 34 .
2 Multiply $750 by the total number of exemptions claimed on Form 1040, line 7 .
3 Taxable Income. Subtraclline 2 from line 1. . . . . . . . . . . .
(Figure your tax 0:1 the amount on line 3 by using Tax Rate Schedule X, Y, or Z, or
see page 12 of Instructions for Form 1040 for "Other Ways to Figure Your Tax.':>
4 Income Tax. Check if from: ~ Tax Rate Schedule X, Y, or Z, 0
or 0 Form 4726 .
General Tax Credit
5 Enter $35 multiplied by the total number of exemptions claimed on
Form 1040, line 7 .
Schedule D, 0 SChedul~ G: 4 10. 0 c:J. &
..-.~...~...
70 _..~~ff$~
-..-.....~
~
"'B~.@
......i%.~.:~.~..~ffi
-~-~
~
10 I / 8 0 I
111984'(0 I
5
Note: If you are married filing a separate retum, omit lines 6 through
9 and enter the amount from line 5 on line 10,
6 Enter amount from line 3, above.
{$3.200 if you are married filing a joint return (or a Qualifying widow(er)) }
7 Enter .. .
$2,200 If you are Single (or an unmarried head of household). . .
8 Subtract line 7 from line 6 .
'3 3~ &{4
rJ, d. 00
31, L{. I Lf
/80
6
7
8
9 Efiter 2 percent of line 8 (but do not enter more than $180) .
9
1 3.5 J 14
I
2 1.500
I
3 33,t,ILf
10 General tax credit. Enter the larger of line 5 or line 9 .
11 Tax. Subtract line 10 from line 4. Enter the difference (but not less than zero) here and on Form
1040, line 35 . . ~
a;r.r.:lI~ Computation of Tax Table Income for Certain Taxpayers Who Must Itemize Dedudions
Caution: Read the Instructions before completing this Part. I I
1 Enter your adjusted gross income from Form 1040, line 31 . . . . . . . . . . 1
2 Enter amount from Schedule A, line 40 . . . . . . . . . 2 1- ~~.'X'
3 Enter amount from Schedule A, line 39. (If you can be claimed as a _@%('Wkt-::
dependent on your parent's return, see the Note in the Instructions 3 _166"1
for Part" and check the box below line 33 of Form HMO.) . .
4 Subtract line 3 from line 2 . . . - . . . . . . . . . . . . 4 I I
.
5 Tax Table Income. ADD lines 1 and 4. Enter here and 0:1 Form HMO, line 34. (Do not m3ke an entry I I
on Form 1040, line 33. Disregard the instructIOn on Form 1040, line 34, i' nd go to the Note below
line 34.) . .~ 5
I .
EXHIBIT "c"
,
\..
Fo,m
2.210
1
Underpayment of
Estimated Ta'x by' individuals
~ Attach this form to Form 10.10.
De;;..lrtment of 1he Trt'.!'Sury
Inlr:rn.al F.t...~nut Sc",ice
'~@77
'5 \'\ B. Q S. \'1\\ \ \ E R I, 77" ;,:/'J.;Y 1':;'9'.5
.' . ',". ' How to Figure Your Underpayment (Complete lines 1 through 16) , .
If you r~_e_t~'I)' 01 the exceptions (see Instrudion D) wrich avoid the underpayment pEnalt~~i ALL quarters, omit lines 1 through 16 ;:.n~ b~ d;~ed!y 10 line 17.
Name(s) as shown on Form lC40
_ . _ ~_'. . -JI. ~.~.
, .
"
I
i
J'
1 1977 tax (from Form lC40, line 54) .
2 Earned income credit (from Form 1040, line 57) .
3 Tax credit claimed for special !uels, nonhighway gasoline and lubricating oil (flulll Fcrm 1040,
. line 60)',
'4 Minimum tax (from Form 1040, line 49)
5 Social security tax on u;;.eported tip income (from Form 1040, line 51)_
6 Uncollected employee social security tax on tips reported on Forms W-2 (from Form 1040,
Iir.e 52) . "
7 Tax on an individual retirement arrangement (from Form 5329, Part IV or VI included on Form
1040, Tin: 53) ~ .
8 Amount from line 61a of Form 1040 . . .
, '
, '
9 Total (add lines 2 through 8) .
10 Balance (line 1 less line 9) .
1~ Enter 80% of the amount shown on line 10.
~
,
"
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t
I
~. .
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f
I
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r
.
,,".... .
.' .
:
'.
.. ~ ~ .
Due Dates of Installments
June IS, 1977 Sept, 15, 1977
-~, -- ".
12 Divide amount on line 11 by the number of installments re-
quired for the year (see Instruction B), Enter the result in
appropriate columns.' ,'.
13 Amounts paid on estimate for each period and tax with-
.held (see Instruction E) "
14 Overpayment of previous installment (see Instruction F) .
Apr. IS, 1977
~),f@f~~
~. ','
-:. -' .....-::..-:.
t.
i
15 Total (add lines 13 and 14). ..
.. 16 .Underpayment (line 12 less line 15) OR .. ,.'
~ ' - Overpayment (line 15 !ess line 12).. .. ;.-: ..' : .:\:
" '. . .... Exceptions Which Avoid the Penalty (See Instruction D)
"- '. ' _ , ..' ' (Farmers and fishermen see Instruction H for special exception)
f'
t
1
"". '
,
!
I
17 Total, amount pdid and withheld from January 1 ,through
the instailment date indicated. .. ... -. . .
18 E~~eption 'I.-Prior year's tax. . I' '.
197~ tax .'. '.~, . . _ . ~ $ 7) I a e
19 E~ceptio~ 2.-Tax on prior ye'ar's income using 1977 rates
and exemptions (attach computation). . . .' . . .
20.. Exceptio~ 3.~Tax on ~nnualized 1977 income (attach
c~mputation) '. ~' . ,.- . : ." . . . . . .
21 Exception 4.-Tax on 1977 income over 3, 5, and 8'month
periods (attach computation).. ., ., .
.. .
-1,87,,) 3,1:S0 S G.;)$
,
25% al 1976 tax 50% 01 1976 tu 75% 01 1976 tu
1,78t/ ?JJ 5 b Cj 5, 3.53
Enter 25% 01 tu Enter 50% al tax Enter 75% of tu
. ' , . . ,
.'
Enler 20% 01 tu Enler .40% 01 tu Enter 60% of tax
. -
-
Enter 90% 01 tn I Enter 90% of tax Enter 90'*' of tax
" I "
j.
I
t .
iffj~0" /"//'/:";0<
~:fff%fl::};i:~;~
~~~k}i$;:;~/;. :->~:.~:;;:~
~f~7/--:._";-///'.0-'-' ",,' /~
%i(1?"0-YX~::/;;;:::~
~/#;;::,:;/'<:?~
~~~;'/<< -~~~;:)~~/;':.~
o .'( ;~;/F;'/;// ~
~:/:/,...,,<.,//A~
%~f~:;;-<' ;;"~~~;'_;/::~,'l},
~;0.':;:;;2///~/' / :{//~
:%/~//%'i/// :/,///' .-;'/-/-,/, i
?;~?/f{%?~::)},;)/:~'<~
~%&~<~/.";//~;/.. /..~
~if: 0/./;;;;///.'~<;%
Mt1?';8#///</;:%
~~0.'g;:;;:;;~/V/j
~&1?J;:/.%/};:;:;}~
.f.;~~i1t~.~
;?;;;332<<':;:;i<~:;;;::~
~~~x;ffi~,;);~
Jan. 16, 1978
:...,....
7, ..s 00
100% 01 ] 976 tax
7, J 38
En:er 100% 01 tax
~~:;/fj
I appli- ~
m cable ~~
~W/';y//';y,ij:0'{.@
.. ;~ -... -~:.. ..
-
.' ,How to Figure the Penalty (Complete lines 22 through 26 fur installments not a.oided by an exception)
"
. -_ .. ..... ~ ...... '. . ~ ..........' l ...... ..
22 Amount o~:un~:rpayment (from line 16)
"
:'.""p
, -~. :" -
i
l
t'
~
L.
.
, '
23 Date of payment (see Instruction G) .
24 ,(a). N~mber 01 d~}'S ~f1er ,9.ue. dat~ of inslallment to and including
. ':';":. date of payment' or 'l~ilUary 31, i978, whichever is earlier.
, . . (b) Number of days from 'and including February 1, 1978, to and
~ .' -' . -
'. ~ .'including date of payment or April 15, 1978, whichever is earlier.
25 (a) '7 percent a year ~~ 'the amount shown on line 22 for
. .. tI> -. - ~ . . -' "... -
'.: ' the number of days shown on line 24(a) .
oJ .' ... ~ ., _~ ' - ~'" ,"
_' (b).6 p,ercent 3, yea~ on the amount shown on line 22 filr
.' ,the number of days shown on line 24(b) :
,26 Penalty' (add a~o'ul]ts on lines 25(a) and 25(b)). Check the box on For~ 1040, line 66, and show this amount
in the bottom margin as "Penally for underpayment." Then increase the "Balance Due" or decrease the
amount "Overpaid" accordingly
..1
.
l-
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~
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i
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.,.
-.- .
~~~,~~--~_:...~.--.~.~~-- " ~,_..~~_.--
Form 2210 (19m
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-' . .
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.... .....
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-~-'-'=-'~I
EXHIBIT "e"
,
~,
-} 1040
ut;:;Ir1~t:n: O'f trot TrrJ::.:;ry-ln:trnll Fi("'ttnrJt Srrvlce
u.s. Individual Income Tax Return
~@73 J Th" '0'" for IRS u.. only
. 1976 end,ng
,
'. 19
for th~ yt-ar J~r.LJ~ry ]-De-:.emi:.rer 31. ];76. or o~her 'a):able y~a" bf:[.I'lnlnR
;0; :~rr:;~uCZ19:~
1 ~ Sine1e (Check only ONE box)
2 0 I.~arrjed filing joint return (z';en if only one h~1 income)
3 0 I.~arried filing S€,lar2tely. If spouse is ~!>o filing give
s;>2~se's >ocial security number in designated space above
'and enter full
/la;ne here ~.
4 0 Unmarried Head of Household. See page 7 of instructions
to see if
you Qualify ~
5 0 Qualifying widow(er)
spouse died ~ 19
7 Other dependents:
(a) N.:ne
8 Presidential Election ~ Do you wish to designate $1 of your t2xes for this fund? I I Yes I~I I No I Sole: If you check Ihe "r!3"
. - ~ ~~ - - bOl{es) it will no! i:"ll:rf!!:.t y'Jur
Campaign Fund . If jDint return, does your spouse wish to des;gnate $1? ., Yes % No In or r<'<luce your ..fund.
W~oes s.olaries tips ~nd other employee com~t::I~al;UI ;Anach ferm, '11-2. II u"....il. 9 I
:. , " y f able, 5~ pi~e 6 of Instrl.:cllons.)-
Dividends (i~eof~~~~ru~li~~~) -_~.C3?;.II:....._, lOb less exclusion_..I.QP__~......, Balance ~ 10c 3~ ~ / /
(If gross dividends and other distributions are over $400, list in Part I of Schedule S.)
I t t - {'f $400 or less, enter total without I;sting in Sched~le B} 11 /, g '1 _
n eres Income. If over $400. enter total and list in Part II of SchNule B _ L:;) _
Income other than wagf's, dividends, and interest (from line 37) 12 4" c; :3 I. _
Total (add lines 9, 10c, 11 and 12) . 13 -3 b J 3 a..!l.- __
Adjustments to income (such as moving expense, etc. from line 42) 14
Subtract line 14 from line 13 . 15a .3 &~ 309
Disability income exclusion (sick pay) (;:lttach Form 2440) 15b
Adjusted gross income. Subtract line I5b from line 15a, then compl-ete Part III on back.
(If Jess than $8,000, see page 2 of Instructions on "Earned Income Credit.")
lj Tax Table Tax Rate Schedule X, Y or zl tJ Schedule D
Tax, check if from:
Schedule G Form 2555 I OR Form 4726
Multiply $35.00 by the number of exemptions on line 6d 117a 13~1- l~~~~rr}
Enter 2% of line 47 but not more than $180 ($90 if box 3 is checked) 17b I B 0 :: b
Balance. Subtract line 17c from line 16 and enter difference (but notJ.ess .than zero)
Credits (from line 54)
Balance. Subtract line 19 from line 18 and enter differer,ce (but n:>t less than zero)
Other taxes (from line 62)
Total (add lines 20 and 21). . . . . . . .
(.ltlch Fonms W-2.
Total Fei:leral income tax withheld. or W-2P 10 Ironl)
(inded. amount allowed
1976 estimatei:l tax payments . IS cred.1 from 1975 return).
. . (horn p.\i' 2
Earned Income credit. of In,trutloons)
PJea~~
place
label
on furm
you Ide.
"I... all
ne-cll!"~~ary
ch"r.f;es
en Icbel.
3
~
en
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.=
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9
lOa
11
." 12
E
0 13
u
c
14
15a
b
e
16
17a
.~ b
"0 18
."
U 19
"0
c 20
...
~ 21
c
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E 22
>.
rQ 23a
c...
..; b
...
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GI
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Vi
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1_3;~~'~:1 r.S': In,I,.I, or bolh) I ~l; lJ.~ t;r,.me
PreHnt hCrlTlt J:jd(~s U'i~;-;-,~~r Ifld 1~'tet. intludin,& Ipar1ment numLer. or ];';!I! route)
7 8 B 'v{,--2~~T h,lace I~ 1:":e ------
Clly, t! Or~I~~\S~tesd r ~e! ~M' J 7 d , 3
For Pri,'acy Act NOlifica.tion'l Spou~e's social ~e(u"ty no.
~e p2ge 5 of Instructions.
'""CCW- I YJU,S ~ \~ E'"ti 'F_ r:;: 1)
p.tion I Spouse's ~
I I
.....
c
.~
C.
E
."
~
6a Reguiar f'7. Yourself 0 Spouse Enter number of
iC'Ji boxes cheCKed ~
b Fir$t ;;Jmes of your dependent children who
li,'ed with you
Enter
num~er
~ 1-'-
~
c Number of other dependents (from line 7)
d Total (add lines 6a, b, and c) . .
d f 0 S Enler
e Age 65 or 01 er. ~ Yoursel pouse number
Y f S of boxes
with dependent child (Year Blind.. . 0 oursel 0 pouse chec.ed ~
). See page 7 of Instructions. f TOTAL (add lines 6d and e) . ~
I (b) Rel.lion'hip I ~~~.':'c~;h. ~i::d oj; ~f~ ~.~!. ~~~cm~E;;;n:)e;6 -.<~) ~ounl furnished for d.pend-=-nt'~,";;>ort
durint )'tH. write B or D. Of more? ;~jteY~ If 100% ~:e ~e~~~~n~n::u;j-
I
7r
$
$
Ina
23b
23c
23d
23e
15c 8b,3rLl_
16 7 3 I 8
(If boJC on jine 3 is check~d
see page 10 of Instru.lions)
17e I 80
7) I .se-=
7/ I ~8
22 7 I 31f--
~~@%f~%~%~@~f7k't.....;;
@/..-; ;;((;(7g;;'{~((./, ~:'/-/:~."., .
Q I 0 0 ~ Pay amounl on ine 25 in "'"
c:J. _ _ @ full. with thi~ return. 'Orlie ~.:'"~
~ SOCial security number on .
~ check or mone" order and ~,'
- ~ ma.e payabr.. 'to Inlernal:'
. ~ Re....enue ServIce. or' "
@fJli%r~~J%P~r/%3.~:;2
24 t::>, /00
18
19
20
21
d Amount paid with Form 4868
e Other payments (from line 66)
TOTAL (add lines 23a through e)
If line 22 is larger than line 24, enter BALJl.NCE DUE IRS
(Check here ~ D. if Form 22iO or Form 2210F is attached. See page 10 or instructions.)
If line 24 is largef than line 22, enter amount OVERPAID . ~
Amount of line 25 to be REFUNDED TO YOU . . . . . ~
Amount of line 26 t:> be credited on 1977 estimatpd t~x ~ I 28 .~. I ~7.Y;;~'<:::~.{.0:z.&?gf,f/'~f~!*;,W/" ,
Under ~n.ltles cl ~fJury. I declare 1h.t I h'H t'lolmlneQ trill return. Inciu~lnf Il:cOmpi.n)'IOr scr.t'dul~ .r:d ~~':tmtnh. and 10 [he bt~t 01 my ir.no",l~&~ Ind bel lEi It Ii
lru., correct. .nd complete. Ctcllr..tlon of Jurp.a1ef (othn thin tu.p.ayer) is: bue-d en .11 ir.lorrr:.ti:m of whic..h prtp..arer has any k.no",ltdIL
24
25
~
.~
25
26 9& 'L
27
26
27
28
~
~
"-Ritter, Haayen & Keller
~ Plr::I'~r's".fllll',e:J..'n,: ~+mPlo~I~:(S name,
J so:;) IY', AA " Jh ~ "-
~Le:r.oyrie. Pa. 17043 .
., Wt:1tlf'JI:'I. "..mtitr (14' .r.1::n..c:tlonl)
Address (Ind liP "",ei
'rowr siln.lur.
If Iny)
0110
Doltt
5pol.lu'I si,oll"'.. (If fl!."t JOlntl,. BOTH melt 11&" ..,.n if onl,. on" ha::! incoml)
(23-1401013)
....
EXHIBIT liD"
,
\.
'F~rm I G40 (1976)
tt....Jm"';J Income
\,/-l+?.- \ 4'1 S-
other than Wages, Dividends and Interest
P2g. 2
~A
......
-- I
-----
3j~8 I I
9...,50
31 I
4;~
29, Business incG~e or (loss) (attach Schedule C)
30a Net gain or (loss) from sale or exchange of capital assets (attach Schedule D)
b 50% of capital gain dlstribut;ons (not reported on Schedule D--see paee 10 of Instructions).
31 Net gain or (loss) from Supplemental Sct:edule of Gilins and Losses (attach Form 4797)
32a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (a~ach Schedule E) .
b Fully taxable pensions and annuities (not reported on Schedule E--see page 10 of Instructions)
33 Farm income or (loss) (attach Sd:edule F) . . . . . . . . . . . .
(does net ap;:lly if refund is for y~ar in which you took the)
34 Sldte ir,c.Udle t2X refund5 s.andarri deducticn-------Gthers St:e p?ge 10 of JnstrlJctioll"S .
35 Alimony received
36~_S. htaA.R~r~.~ ~d ~ .~:.cFAB ~~.~.l-%~~~;t1~~.S)..~ ~......~._~ ......~-.~._-.-_-.-.-...-.-.._-.-.-_-_._..-.-_-_-_-_-_-_._-_-.-_~- 36
37 Total (add lines 2~~!ough 36):~~er here and on line 12 __ _' ~ 37
t%~j}lJ.-AdJuStment.~ to Income
38 Moving expense (attach Form 3903)
39 Emp!oyee business expense (attach Form 2106)
40.. Payments to an individual retirement 2frangement from attached Form 5329, P
b Payments to a Keogh (H.R. 10) retirement plan
41 Forfeited interest penalty for premature withdrawal (see page 12 of Instructions)
42 Total (add lines 38 through 41). Enter here and on line 14 .
Q~) Tax Computation
. 43 Adjusted gross income (from line 15c). If you have unearned income and can be claimed as a
dependent on your parent's return, check here ~ 0 and see page 9 of Instructions
44a If you itemize deductions, check here ~ ~, and enter lolal from Schedule A, line 40, and aliach Schedule A ])
b S12ndard deduction-If you do not itemize deductions, checl< here ~ 0, and:
If you checked 12 or 5, enter the greater of $2,100 OR 16% of line 43-but not more than $2,800
the box on 1 or 4, enter the greater of $1,700 OR 16% of line 43-but not more than $2.400
line . . .
3, enter the greater of $1.050 OR 16% of line 43-but not more than $1,400
45 Subtract line 44 from line 43 and enter difference (but not less than zero)
46 Multiply total number of exemptions claimed on line 6f by $750
47 Taxable income. Subtract line 46 from line 45 and enter difference (but not less than zero)
· If line 47 is $20,000 or less and you did nol average your income on Schedule G, or figure your tax On Form 2555, uemption of Income Earned Abroad, find
your tax in Tax Table. Enler tax on line 16 and check appropriate box,
· If line 47 is more than $20,000, figure your tax on the cmounl on line 47 by using Tax Role Schedule X, Y, Z, or if applicable, the allernalive tax from Schedule
0, income averaging from Schedule G, lax from Form 2555 or maximum lax from Form 4726. Enter fax on line 16 and check appropriate box.
~:rlia\'f..l Credits
29
30a
30b
31
32a
32b
33
35
. . . . 38
. . . . 39
crt "I . . . . 40a
. . . 40b
. . 41
~ 42
43 Jb;,,~(j?
44 9.487
~.~ I
%"".g:
~':::i
i4~ J~, 8cJ..o
~%.%
45
46 / OC>-
47 d.i: 3~ ()-
48 Credit for the elderly (attach Schedules R & RP) . . . . . . . . . 48 .
.
49 Credit for child care expenses (attach Form 2441) . . . . . . . . . . . . 49
50 Investment credit (attach Form 3468) . . . . . . . . . . . . :. . . . 50
51 Foreign tax credit (attach Form 1116) . . . . . . . . . . . . . . . . . 51
52 Contributions to candidates for public office credit (see page 12 of Instructions) . . . . 52
-
53 Work Incenlive (WIN) Credit (attach Form 4874) . . . . . . . . . . . . . 53
-
-
54 . Total (add lines 48 through 53), Enter here and on line 19 - . . ~ 54
ll:rlil'r....:] Other Taxes
55 Tax from recomputing prior-year investment credit (attach Form 4255) . . . . . . . 55
56 Minimum tax, Check here ~D, and attach Form 4625 . . . . . . . . 56
57 Tax on premature distributions from attached Form 5329, Part V . . . . . . . . . . 57
58 Self-employment tax (aliach Schedule SE) . . . . . . . . . . . . . . . . . 58
59 Social security tax on tip income not reported to employer (attach Form 4137) . . . . . . 59
60 Uncollected employee social security tax on tips (from Forms W-2)" . . . . . . . . . 60
61 Excess contribution tax from attached Form 5329, Part IV . . . . . . . . . . . . 61
..
62 Tolal (add lines 55 through 61). Enter here and on line 21 , . . . . . . . ~ 62
e;;r, a rl rl Other Payments
63 Excess FICA, RRTA, or F:IC~LR~TA tax w!thheld (two or more employers-see pole 13 of Inslructions) . 63
64 Credit for Federal tax on s~~~taf t:lelS,' nonhigh\I,:,iy gasolfn'e :;nd lubricaling oil (attact. I arm 4136). . '. . 64
65 Credit from a Regulated Investment Company (at~ach Form 2439) . . . . . . . . . 65
66 Total (add lines 63 throu?h 65)'. ~Ente-; hefti'and'on line 23e . , . ,~ 66
.ff:! fJ! fI;.! . .,:~: I
~-- -------
-
~-:-_. --'.----..---.----- _.-
EXHIBIT "D"
,
\..
, .,:)C~leLujes A& 8-Itemized
(Form 1040) Dividend
r t~;~~ t',~ c1 !"t Trr!],ury
l~l~r;:.l ~t"'-~;J" $tr"\':r:e
'Iome(s) as s~,o/(p. on form ](<40
Deductions AND
and ,Interest fncome
~ A!tJcl: to form 1040. ~ See I~s!ruct:ons for Schedules A and B (form 1040).
S ~1<~ S. M\U~\<
./
~ IQ\ Il::~ l''t
\.ul/,~
QVfV
-~---- --.---.------.- -------- -- - --.---- ---
Medical 2:-iC Dcn!al Expenses (not compensate,fhy insurance ConbbutionS(See p'age 15 of Instructions for examples.)
Or olh~rwjse) (See p2ge 13 of Instructicns.) ---------
21 a Ca:,h contributions for which you have ,
-- ,- - _._~-_.- I
1 Onehalnbut not more than $150) of in. I / ,,5 0 receipts, cancelled checks or other
Surance premiums for medic21 care. (Be written evidence S
Sure to incJu~e in fine 10 below) . --
2 Mejicine and drugs . - L Other cash contributions. list donees ~ I
3 Enter 1 % of line 15c, Form ]040. - and amounts. ~ ----nm______h..h.h____. L-.~_
4 Sub:ract line 3 from line 2. Enter differ- . - - - - - - - - - - - - - - - ~ - ~ - - - . . . - -. - ~ - - - - - - - - - - - - -- - - - - - - - - - - - - - - - .- E__:l-_I__
ence (if less than zero, enter ;-ero) - ----------- - - ---. - -. -- - - --- ------ ------ - - -------------------- -D t I
.. ~ -1L[-=
5 Enter balance of insurance premiums for ------------------------------------------------------------_.
medical care not entered on line 1 - -- - - - - - - -- - - - - - - - - - - -- - - - --- ----- -- - - -------- -- -- - ---- --- --- \ ~I
6 Enter other medical and dental expenses: - - ..J;'... .h-I=
------ --- - ---- ---- -- ---------------- -------------------------
a Doctors, dentists, nurses, etc. 22 Other than cash (see page ]5 of instruc- ej
b Hospitals. . . . . tions for reg uired statement) 1:)
c Other (itemize-include hearing aids, 23 Carryover from prior years . 1=
dentures, eyeglasses, transportation, 24 Total contribmions (add lines 21a through 0~ '-14-71
etc.) ~ _.h....-h--.....__.._._..__......h.U.. 23). Entcr here and on line 37 ~
----- - --- ------- ----- ------ - -- -- - ------- - --- - -- -- - - - - - - -- --- Casualty or TheH loss(es) (See page 15 of Instructions.)
Note: If YOiJ had more than one loss, omit lines 25 through 28
-- ---- ---.------------ --- ------- - ---- - - ---- -- -- --- -- -- -- -----. and see page 15 of Instructions for guidance.
---------------------------------- ---------------------------
---------------------- --------------------------------------- 25 loss before insurance reimbursement 1-
----------------------------------------- --------- ---- -----_. 26 Jr.surance reimbursement . .
------------------------------------------------------ ------- 27 Subtract line 26 from line 25. Enter dif. /-
--- ----------. ----------------- - - - -- -------- - --------- ------- - ference (if less than zero, enter Zero)
7 Tot21 (add lines 4 th rough 6c) 28 Enter $100 or amount on line 27, which.
a Enter 3% of line ]5c, Form ]040 ever is smaller . . . .
9 Subtract line 8 from line 7 (if less than 29 Casualty or theft loss (subtract line 28
zero, enter zero) . . . . from fine 2~). Enter here and on line 38 ~
10 Total (add lines 1 and 9). Enter here and J.sO Miscellaneous Deductions (See page 15 of Instructions.)
on line 34 ~ 30 Alimony paid
. . . .
Taxes (See page 13 of Instructions.) 31 Union dues
_&a~l_ . . . . . .
11 State and loca; income . . . 32 Other (itemize) ~
87to -- -- -~ - - - - ---- ---- ----- --------.
12 Real estate . .
~l;= --- -.--.~oo--.-\-...----.-.h--h..---h-.h-- -
13 State and local gasoiine (see gas tax tables) \ B~ c::- uRN I 7..5
-. - 4 Jr--
14 General sales (see sales tax tables) . --0 EU' uS.-n-b U--'''hhhoo..._ ,., 0
(.,Ljl; - ------- . - u.. - s._~n__.._~u Shoo_hhhhU
15 Personal property . . .
------- -. ---. --. ---- -- --. -- -------------- -- ------------------.
.16E~~~~:niZe) ~-L:F\j;..-u.----ubuu-- 57 - - - ---- - -- --- - -------- ---.. ----- ------------------------------- -
h. -- U"c:;::.---'1-Nh.n____Lh ~.€'Nu_,$____ ~ - - - -. ---- - - --- -- - -- - ----- - - - --- - --- --- --------- - -- --- - --------
._- - - - -. - - -- -- - - - - ---- -- - - - - -.- - - -- - - - - -- - - -. - - -. - - - -- -. - - - -- - . - - - - - -. - - --. - - - -. -- - - - - - - -- - - - - - - -- -- - - - - - ---- - - ----- -- -- ---. 1=
--- -- ----- - --------------------- - ---- ------ ---- -- -- - -- - -- ---- 7/ - ----- -- ---- -- - --- -. - -- - - -------- -. - ---- -------------- ---- ---.
17 Total (add lines Ii through 16). Enter ~, l., 9 33 Total (add lines 30 through 32). Enter / 9~
here and on line 35 ~ here and on line 39 ~
Interest Expense (See page 14 of. Instructions.) Summary of Itemized Deductions [@
18 Home mortgage . . . . . . .
19 Other (itemize) ~ . .....--....-...-.....--- ..--_. '_'''u 34 Total medical and dental-line 10 . /...s 0
~-;9 7- -
---------- -------- -- - ----- -- ------ ---- - - - - -- ----- --. --- - - ---- 35 Total taxes-line 17. . . . . f---
------------------- -----. --------- - - ------- -- ----. -. - - - - - --- - 36 Total interest-line 20 . .
- -- - - -- - - -- -- - -. - - - - - - -.. - - - -- - - - - -- - - - -- - - - - - - - - - - - - - - - - - --.. 37 Total contributions-line 24 . . ~,1-4 7
.
.. ---- -- --- --- ------ -- --. --. -- -- ---- --- -- --- - --- - -- -. --- - - --- 38 Casualty or theft loss(es)-line 29 .
------------------------------ ----------------------- ----- --- 39 Total miscellaneous-line 33 . . . . / 9.5
------ ----- - ---- -----. -- --- - ----- - --. - --- -- --- _. - -- --- -- ---.. 40 Total deductions (add lines 34 through 9; 18r
20 Total (add lines 18 and 19). Enter here 39). Enter here and on Form 1040, line
and on line 36. ~ 44 ~
Schedule JI.-Itemized Deductions (Schedule 8 on back)
I t7r70C!V~u:7;cf~
-
...
EXHIBIT "D"
,
\.
5u.~~~:~S MB (Form ]040) 1976 Schedule B-Dividend and Interest Income P~g~ 2
.' N~:-8SC zs ~hown on Form 10.-.0 (Dst enter na.-ne and s~'al ~PCj't r.~lo~'t s~c,.m on ot:Oer side) I /Y7ur S:~ rurf'it/-1!s'
----~ t\8 ~ S___t1 ----~--CJ_________.__._
rr2..ilT~ Dividend Income -~ -. - - :(::~,J Inferest Income
Note: If gross dividends (including capital bain distributions) and I Note: If interest is $400 or less, do not complete. this part. But
othe' distributions on stock are $400 or less do not complete thIS enter amount of Int",rest recelv",d on Form 1040, line 11,
part. But enter gross dividends leS$ t.'Je sum of capital gain dis- -'7--inte;est'incIL'd-esea;ningshom savi;:;-g.s andloanassoc'iai,;~s
tributions and non.taxable distributions, if any. on Form 1040, mutual savin.>:s banks, cooperative bar.~s, and credit unl::-~S
line lOa (SEe note be!ow). . ~___ ____._..___.______ 2S well as interest on bank dei-'osits, tonds, tax rEfunds, E::
j-G-r-;ss2i;;-2ends.{~cj~ding c?pitaIgai':; distributions) and other Interest also includes original issue discount on bonds 2nd
distributions on stock. (List payers and amo.u~ts-~'Wrrte (H). ot~"er eVidences of Indebtedness (see page 16 of Instructions)
~-,....Q~~~stock held by J2.usban~_~~or Jo'ntly)____ ~L~par.er~2nd amounts) __
$(A~~D__~.iJ..E"_
~e!])
--- b 1
CS'(!.... ~~_c;__j;:
=ti..n ~c.. h e p
I
[:-
1-
--1-
,
2 Total of line 1 . . . . . . . . . 3 ~ Cl.5 Z
~ ';'0%.'~ %O>;r;';::;:%Yi;:
3 Capital gain distributions (see page 16 of .;::.i'.#%4t;:~~
Instructions. Enter here ajnd on SChedUlte D'. ~..~.~.-0:
line 7). See note below _ _)?W%~.
4 Nontaxable distribu- II J ~$/k_
tions (see page 16 of 7'TV
Instructions) . .. - L/-~
5 Total (add lines 3 and 4) . . . .. I
6 Dividends before exclusion (subtract line
5 from line 2). Enter here and on Form
1040, line lOa .
3 ~ 31 I
8 Total interest income. Enter here and on
Form 1040, line 11 . .
/, g l 7
Note: If you received capItal gain dlstflbutlons and do not need Schedule D to report any other gaIns or losses or to compute
the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions on Form 1040,
line 30b.
DiF-riIIl[l Foreign Accounts and Foreign Trusts
1 Did you. at any time during the taxable year, have any interest in or signature or other authority over a bank,
securities, or other financial account in a foreign country (except in a U.S, military banking facility operated by a
U.S. financial institution)? . 0 Yes
II "Yes," attach Form 4683 (For definitions, see Form 4683.)'
2 Were you the grantor of. or transferor to. a foreign trust during any taxable year, which foreign trust was in
being during the current taxable year. whether or not you have any beneficial interest in such trust? 0 Yes g No
II "Yes," attach Form 4683 (For definitions. see Form 4683.)
~:;:]
~
~ No
EXHIBIT "n"
r-
,
\..
s (:\t<~--5~\'I\i\Ls~
------ - -
____~___Ed-B~'--Q-~ 0
I !ll~_
____D-l :-__+y - I ~ 15
lH I T I'" L-!.l-'~:-:;-;-~
""[P."I:D .,. ,I J
APPlltov[O .,. . i I
~---'
- -_.~-_._--~-~._----_....-
-.- _._---_._~
1 2
3
"
5
26
~. ..~._~~~~E~~~-c1i~i~~Et~ .'.l~]~OM~I=r
',- ~F/I'~i~UlI)!-~'l~'2 ~1!j2;l~;r:\.~~8 L- 11 I I rq T
2 1 _ _ I ~c~.L6te. B-~II_~J 1:5 Ml jftJ~{IE:~_ ..-~J j iJ - I / I
-; -- -- - 11'11'1 I i~~d -'I~:'fb:qli IIII II .. r',...l"I':
~~ ~', I~ -1 L.,~\I(1:-' '11 'i ~ '-;0]1/l, 1 --;-: I t I i f~f
- . I I II J_ Ip....II' I III I I II I I I' I
5 I, I \~~ ~~ J~~~~ t.,.-17c:J$'9,' 49 I ',J ~
6 1[J)- ~ ffi-' ~l-h~l~ -W~Jff-i1--}{ft-lli k I I.ky
~ . - _G:- ~ ~+ ~1};jJ~-h~ ~ ~ kJ I ,J;t
: +~ ~~LW~i!t1~-rfl~~~ 1.1 ~~
10 ~-W~ITJAt~~IJ4e~ ,I lV3
11 ~_~~1r1'1 N J]\t5~PtkW~JJ.J_ I i' I 1&1/
12 F--i -~~JJ.lN~ Et4t-L0o ti JO . I 1/3
13 l~ 1_ Jis~~ __IRT6. \1\1 ~. II V a
u (~ h. ,11L~ I ~ oJ I , I , _ ~ ~
" :c=.: ,!1l111\,,,,, 'f]~l"l".-,e I I I c)S:J
" I-E &Jd i f:::: ;~. "_~.. lJ I .~:sl i91~ -Af I I I t b
17 I It--=~~'./ L t?tL E_C~ dlJ_1 II e- ~) h q
" \..j~.~~~J~'il~il I J 3-;
: I [riP i .~ lf1~5111 '- EO' I I I 31( ~~~
21 I ;::::;;:;::
22J ill- ~ 1_J~E. ~sn~ T '~J.ME-
: Jlf:'_t~Jitli :~HP'1'_~~C~~f'~t{t~_'~~i~~jr~~Mf t.
25 , ",1~11!11' llllil--l!; -:#tf? _1. -Y(fl1-=t:~- (,
l;o",-~I~"'-I ~\\e; ~ l'Ie<:,.!~ :oc p::l)' L~(6 ~E
I ~.....J. I ..I..-. iI- I I ..:.A I II I , Ci' . L /I~
- IIIl ~ --Jt)DJ-~-5$ 3~ iQJ 'i.',~ ~ iff
~:\- ~ tI~~ kJ<. \ h' 0)., 1
I
I I
II II
II J
6
7
29
~
Ii
--]-
.._ t
1- I I.~
r- J ~J u
II Ii
1 TT- -1;-
L____.__
II II Ii'
. ~I IHII'
,-I! 8
. .l,:
,JIll
Jl~2
Ii 13
-!I-~
I I ,
I ": I Ii 16
tp::
'j+l~
I I 'i:<1
-in
I) --~
.~
I: ."
I .
1! 25
Ii 2b
1/27
1211
I
129
i 3~
Ii 31
132
Ii
71
:~!<,...;!,.o.
IT
1I[j!f~
I/k,~.
ItJql~h
28
30
31
I
32
. . I
EXHIBIT "D"
~
\.
'.
---
. .
,-
S_\:\E~_ s~~il \ ~R
t= oP~__L'L~~____
--1-9-1-~-----r;--
==~~~_~~__~_-=====~~-====-~=_j::Z:1~~'-t~ .~1t:l~-~c-----
I 2 3 4 5
_. - . __n. _ ,.~___
6 7
L::~=-~<~ ---~_=- - F- ~___~__m_____===_11
-----r
11Jl]]~T:-
.' d.! BA5JLff~Lj18-tI I Lh1-+-I, J1 ~rif II II_Ii
--' ,., +l_~ _~~~+ph- o:Uo:~i4'~ -{j \' f l~E~. L Jj_ - ! J+- I IlL .~-
:, ,rV<~~.Jd.ill"rl2kl ;CL)_ - J~ I,-~- ., c;'5vo~ "- m
~~~.-~~_~bl1k1 r ~,~~~,JL-bJ~~!'_CM _lJjJ_~__ III I II II II
-' ..' -Hl- +k ~~~ ~llJ,21h ~FH.i1-fJlF ,lh l-- I I I F =fr '
: .. - -- - -fI)Jr-~T:rrtJ~~IH~-j~ld~. '~~t>1r:fl I . . uti -II:
9 I, .JI f~it.l>-JJ~.. .lbmtfffi*~~T~",,>r Ni-}i}ffi\ I 1 ~S5 r--!~
; -- :;:'1.\ I :.ij[h1J1JTf- tftl I ,. IlrITn I T\'\--'11t II ,~~~-T-ll'
:: '~:~~~~~~ulH~-C~ 'I '1 I ~t' _,~+IJ., -lr:
13 ~.I .~~.- ~.j:a~l~~~~cl~~-~- - I J. i+--- ---.- ~~.b1. I ._Jfll-'
14 ~r,tiBI~ij ;,l^,It:t.v 'I II __'/ . ~~~ c-,_ Il~
JS 0 t ~ l t) Ie I 1 3H I I 11~
16 oW) I I 1116
17 t~ I.' ~;
I I -1_1~
~ 19
j;;
~I:~
I -,
--I;
-- TI---
" 25
12t
I
18
19
20
2J
22
23
24
25
26
Xl
28
. :l9
30 I I
31 I
32
-- --..--
" -~
,,",
Ji 2S
H2'i
it
)0
I
I
I 1131
---p
I IJ
.
EXHIBIT "D"
. _. -- -...
I .
,
\.
LAFAYET:rE COLLEGE
EASTON, PENNSYLVANIA 18042
"\
\f\~..
VICE Pl:fSIDENT FOll FINANCE
AND
TREASUIWl
September 5, 1978
Ms. Jane F. Burke
Vice President and Trust Officer
Fanners Trust Compa.'1Y
Carlisle, Pa. 17013
~ar Ms. Burke:
In response to your letter of August 31, 1978, the current book value
of Sara Stone ~li11er's Pooled Life Income Trust is $31,001.92. An analysis
of her contributions to the Trust follows:
Date Gift Securities
March 1972 100 shs. Consolidated Freightways
March 1972 32 shs. Beneficial Finance, 5~ Pfd.
,
September 1972 ISO shs. Utah Jnternationa1
June 1973 42 shs. Leasco, Pfd.
October 1973 98 shs. Amfac
October 1973 SO shs. Detroit & Canada Tunne 1
Ie cembe r 1973 SO shs. Certain-Teed, Pfd.
December 1976 11 shs. Norton Simon, Pfd.
December 1976 113 shs. Norton Siron
If I can be of any further assistance, please let me know.
SiJ:1cere ly ,
(', /' --
/~
,'J /1//'
. /:C/z ;_,/) //<{{ '--,
/ -John A. - Falcone
I Vice President for Finance
. ~/ lli,d Treasurer
JAF:pab
EXHIBIT "E"
,
\,
"
LAW OFFICES
WILLIAM F. MARTSON. P.C.
II
II
EXHIBIT "F" *
13. I give to Lafayette College the sum of One Hundred
I Thousand Dollars ($100,000.00) for a special memorial to my
husband, Walter M. Miller. This memorial may be designated
and contributions made toward it in my lifetime. In such case
my Executors shall deduct from this bequest such lifetime con-
tributions. Unless otherwise designated, all contributions
to Lafayette College made after the execution of this Will
shall be considered contributions made towards this memorial.
*For reasons of confidentiality, only that portion of the Will
of the said Sara Stone Miller concerning a charitable gift to
Lafayette College is set forth herein.
EXHIBIT "F"