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HomeMy WebLinkAbout08-15-08 (2)15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 116 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 208220492 12192007 10071927 Decedent's Last Name Suffix Decedent's First Name MI WAGNER R. E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3_ Remainder Return (date of death prior to 12-13-82) L-. 4. Limited Estate n qa, Future Interest Compromise ~J 5. Federal Estate Tax Return Required (date of death after 12-12-82) LX~~ g Decedent Died Testate l ~ Decedent Maintained a Living Trust Q 8. Total Number of Safe De osit Boxes (Attach Copy of Will) ~- (Attach Copy of Trust) P ~~ 9. Litigation Proceeds Received ~ 1 D. Spousal Poverty Credit (date of death -, between 12-31-s1 and i-1-ss) n 11. Election to tai: under Sec. 9113(A) - (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number WM. D. SCHRACK III 7174329733 Firm Name (If Applicable) SCHRACK & L INS ENBACH PC REGISTER WILLS USNLY i ~ Z"^ First line of address , - ~ ~ 124 WEST HARRISBURG STREET 4 - Second line of address - __, P . O . BOX 3 10 - -`- - City or Post Office I !~` r ~ rr~~u • • I State ZIP Code DILLSBURG PA 17019-0310 ~''' Correspond~nt~se-mail address: SChracklaW@COmcast.net Under penalti s of p 'ury, I decla th I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corr ct and omplete. D last n of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA P N RE E FO FILILJG RETURN DATE John J. Richardson Jr. ~~ </~ ~/IG" 26 irg, PA 17019 THAN REPRESENTATIVE Wm. D. Schrack III DATE 124 West Harrisburg Street, Dillsburg, PA 17019-0310 Side 1 15056041147 15056041147 ~ ~~' V PA Inheritance Tax Return Signature of Additional Fiduciaries TESTATE OF 121 07N167BER I WAGNER, R. Elinor Under penalties of perjury, I declare that l 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. Signature #2 ~' Name Beverly A. Dais Address1 311 Gettysburg Street Address2 City, State, Zlp Dillsburg, PA 17019 Date O ~ ` J REV-1500 EX 1505642148 Decedent's Name: R, E i l n O r~ 14(3 N E R 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) ~ 1 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 Governmental Bequests/Sec 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, of transfers under Sec. 9116 (a)(L2) X .00 0 0 0 15. 16. Amount of Line 14 taxable Q 0 0 16. at lineal rate X .045 17. Amount of Line 14 taxable 17 at sibling rate X .12 15 1, 3 7 2. 2 0 . 18. Amount of Line 14 taxable 18 at collateral rate X .15 13 1, 1 8 9. 1 9 . 19. Tax Due ............................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Sorial Security Number 208220492 385,610.70 1,73, 271.28 558,881.98 --__ -- - 46,183.03 8,125.00 54,308.03 504,573.95 222,012.56 282,561.39 0.00 0.00 ].8,164.66 19,678.38 37,843.04 Side 2 15056042148 15056042148 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-07-1167 R. Elinor WAGNER __ . STREET ADDRESS Messiah Village CITY STATE ZIP Mechanicsburg l PA j 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 37,843.04 2. Credits/Payments A, Spousal Poverty Credit _ ______ B. Prior Payments 35,500.00 C. Discount 1 ,868.42 Total Credits (A + B + C) (2l 37, 368.42 3. Interest/Penalty if applicable _- - - p. Interest E. Penalty _ Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theDVERPAYMENT. (~1) Check box on Page 2 Line 20 to request arefund - _-- 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) 474.62 A, Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) Q7Q~. 62 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; ............................._............................................... ~ i Lx~ __ xi b. retain the right to designate who shall use the property transferred or its income :............................... L c. retain a reversionary interest; or ..............................._..........................................................__................ r -, x~ d. receive the promise for life of either payments, benefits or care? ........................................................... ~_ J [x~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................... L___I ; x~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... j ~ [x~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _ contains a beneficiary designation? .........................................................................................._..................... ~~ l~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1955, 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 statutedoes not exemat 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. c: Un~leslwills~ElinorW agner(jsg) ±~~~t mill tt~t~ ~e~#~rrten~ OF R. ELINOR WAGNER BE IT REMEMBERED, that I, R. ELINOR WAGNER, unremarried widow, ofMessiah Village, Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory, and understanding, do make, publish, and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafter named Executors pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executors to expend for my funeral expenses and interment such amounts as may be considered necessary and proper, without regard to any limit that may be prescribed by a court of law. ITEM 2: I direct my Executors to pay all inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state `'`~ or federal law now in force or hereafter enacted, shall be prorated among the persons interested in ,~,~J my estate to whom such property is or may be transferred or to whom. any benefit accruE;s. TTEM 3: I direct that my Executors distribute my net residuary estate to the recipients ~~„ named, in the proportions enumerated: A. Sixteen Percent (16%) to MESSIAH VILLAGE; _ ~; B. Eight Percent (8%) to CALVARY UNITED METHODIST CHURCH; C. Eight Percent (8%) to the DILLSBURG L10NS CLUB; ~' D. Eight Percent (8%) to NEW HOPE MINISTRIES; E. Four Percent (4%) to the NORTHERN YORK COUNTY HISTORICAL SOCIETY; F. Thirty Percent (30%) to my sister, E. LORRAINE FOX, per capita; G. Thirteen Percent (13%) to BEVERLY A. DAMS, per stirpes; and H. Thirteen Percent (13%) to JOHN J. RZCHARDSON, JR, per stirpes. ITEM 4: I direct that a lapsed bequest become a part of my residuary estate, to be distributed as part of the remaining bequests. ITEM 5: I nominate, constitute, and appoint BEVERLY A. DAMS and JOHN J. RICHARDSON, JR., or the survivor of them, as Executors of this my Last Will and Testament instructing that they utilize the services of Wm. D. Schrack III, Esquire, in settling my estate because of his knowledge of my desires, and his familiarity with my affairs. ITEM 6: I direct that my hereinbefore named Executors shall not be required to give bond for the faithful performance of duties in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~' ~ day of ,~~ ~ , ~ C: ~- , 2003 . ~. R. ELINOR WAGNER The preceding instrument, consisting of this and one (1) other typewritten page, was on the day and date thereof signed, sealed, published, and declared by the Testatrix herein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. r~ -~-' OF t~ ~ ~~ OF COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK We, E OR W. ~ ~~~ ~ LLLL'uP and the Test~tfix and thf; witnesses, respectively, those names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses, and that to the best of their knowledge, the Testatrix was at the time eighteen (18) years ofage or older, of sound mind, and under no constraint or undue influence. -7 i t, R ELINOR WAGNER SWORN TO AND SUBSCRIBED BEFORE ME THIS `~~,~ DAY OF ~-~' `'~ , 2003. ~. ,S~'~et S. Gaye, hiotary Public Dit'sbu!g BGFO, Yofc Cauncl,7 ;,a~nmissicn ~~~ires Qct. 25, 2006 ~, pExns;+tv~ia p:,.r~~tior Of i~tar4~a Rev-1503 EX+ (6.98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF {FILE NUMBER WAGNER, R. Elinor I 21-07-1167 All property Jolnt{y-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUF_ VALUE AT DATE OF DEATH 1 Citizens Investment Services -Account #L7C150410 385,610.70 (see attached) TOTAL (Also enter on Line 2, Recapitulation) 385,610.70 (IF more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) ntgnir~i]C 1/:71lLVVl3 3:~tL !''P7 YAti~ L/u113 rax ~CfI°vtsx~ January 22, 20D8 Schrack 13~Lir~senbach 124 W. H2rri5burg St Dillsburg, PA 17019 RE: Account Number. 1.70150410 Registration: ROSE ELINOR WAGNER RE: Account Number. L7C161179 RegistraDOn: GtTIZENS BANK REGULAR IRA F80 R ELINOR WAGNER Dear Mr. Schradc; I am writing with regard to your recent rec~est for the above referenced accoarnt5. Please extend our conddences to the family of Rose Wagner. I am cxaricinq a summZrY of Ms. Wagners accounts in the tables below as of the close vF business on December 19, 2007 as you requested, 7AX MANAGED GROWTH A EMSTX EATON VANCE 2244.916 SZZ.Z9 ~.f' 8,039.18 LARGE-CAP VALUE GL B FDVAX• FIDELITY ADVISOR 2354.986 ;21.18 549,$78.se DIVERSIFIED INTL A FMCEX- FIDELPiY ADVISOR 2128,153 522.01 546,774.82 MID CAP CL C FASBX• FIDELITY ADVISOR 1716.822 5,23.84 540,929.04 YALLIE STRAT CL B OT(iBX OPPENHEIIIAreR 878.29 545.74 540,172.9H GAPITAL APPRECIATION CLASS B PAEAX• PUTNAM ASSET' 66362'.19 514.18 594,188.43 ALLOCATION t3ROWTH CLASS A PGEOX PUTNAM GEORGE 1542397 515.98 524.645,'81 OF BOSTON CLASS A This account was opened rn 0921!1999. Rev-1508 EX+ (8.98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER WAGNER, R. Elinor l 21-07-1167 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jofntlywwned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citizens Investment Services -Account #L7C161179 (see attached) (payable to 126,808.04 Estate of Rose Elinor Wagner) 2 I Transamerica Annuity #26140730 (payable to Estate of Rose Elinor Wagner) ~ 46,463.24 TOTAL (Also enter on Line 5, Recapitulation) I 173,271.28 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ..y~,aa.i an 1l~1/GVVRf ~:'~Z t'lrl l~'AG.~ ;ilV(d3 r~ax Server PRIME MMKT CL B SCt3SXs DINS CAPR'AM. t148.'JJ' 9 556.02 547,53628 GROWTH CL S SCDGX• DWS GROWTH ~ 419.893 517.SL S7,L87.33 INCOME CL S PAEAX- PUTNAM ASSET 2495.744 $14.19 ;34,56321 ALLOCATION GROWTH CLgSS A OPSIX- OPPENHEiMlrR 8456918 ~4.;0 X37,210.44 STftATEGiC INC CL A This acccxnt was opened on Q4/19/1994. Should you have any questions, please call our Customer Service Group at 1-500-942-$306. We ate available Mmday Uirou~ t=riday, 8:00 a.m. to 6:40 p.m. We will tae happy to assist you. Sincerely, Erica Haworth Operatsms Spedatist TR.~vSANiERICA ® LIFE INSURANCE COMPANY Transamerica Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 January 23, 2008 Estate of Rose Elinor Wagner cJo Schrack & Linsenbach (~ /' Attn Wm D Schrack III '~~ PO Box 310 Dillsburg PA 17019-0310 RE: Annuity Number(s) 26140730 Dear Personal Representative(s): We have received notification, Rose Elinor Wagner, annuitant of the above listed non-qualified tax deferred annuity is deceased. Our office wishes to extend sincere condolences for your loss. The following is the current information on this annuity: Annuitant: Owner: Primary Beneficiary: Annuity Policy Date: Full Value as of 01/23/2008: Taxable Portion: Full value as of 12/19/2007: Rose Elinor Wagner Rose Elinor Wagner Estate of Rose Elinor Wagner 100 November 08, 2000 $46,609.05 $13,352.78 $46,463.24 The attached document outlines the option available to the estate. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. Operations performed on an automatic basis when applicable have been terminated, such as; Systematic Payouts or Automatic Billing. The attached document contains general tax information baseci on Transamerica Life Insurance Company's interpretation and she>uld not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the ~EGON. Group ANNI€ITY ~~' FINANCIAL ~~ ~NTERMEDIpRV i SERVICE AtVARD ~ POST~SAIE $ERVICE'ANIAR D,' "204.6... ,. .20A6' % REV•1151 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WAGNER, R. Elinor 21-07-1167 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions John J. Richardson Jr. Beverly A. Davis Social Security Number(s) / EIN Number of Personal Representative(s): 186-38-2361 186-26-8169 Street Address 26 Park Drive City Dillsburg State PA Zip 17019 Year(s) Commission paid 2008 2. Attorney's Fees Wm. D. Schrack III 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 8,144.00 21,000.00 15,500.00 4. Probate Fees 506.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,033.03 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 46,183.03 Copyright (c) 2002 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Form PA-1500 Schedule H (Rev. 6-98) Rev1502 EX+ X6.98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER WAGNER, R. Elinor 21-07-1167 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ 16.98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER WAGNER, R. Elinor 21-07-1167 ITEM NUMBER DESCRIPTION AMOUNT 1 Clerk of Orphans' Court -Release fee 40.00 2 Cumberland Law Journal -estate advertisement 75.00 3 Miscellaneous expenses during administration (copies, Notary, postage, etc.) 50.00 4 Patriot News -estate advertisement 162.03 5 Pennsylvania Department of Revenue - 4th Quarter Estimated Payment 175.00 6 Register of Wills -additional Short Certificates 16.00 7 Register of Wills -filing fee 15.00 8 Reserve for future administrative expenses 500.00 Subtotal ~ 1,033.03 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev1512 FJ(+ (8-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER WAGNER, R. Elinor 21-07-1167 Include unrefmbursed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1 (Rev. 6-98) REV-1513 EX+ (gA0) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WAGNER, R. Elinor 21-07-11 67 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY Do Not List Trustee s (Words) ($$$) I+ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Beverly A. Davis Friend 65,594.61 311 Gettysburg Street Dillsburg, PA 17019 2 E. Lorraine Fox Friend 151,372.19 1114 26th Avenue Altoona, PA 16601-2950 3 John J. Richardson Jr. Friend 65,594.61 26 Park Drive Dillsburg, PA 17019 Total 282,561.41 Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cove r 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 See continuation schedule(s) attached 222,012.56 ~~~ ~. ~ ~~ TOTAL OF PART II-ENTER TOTAL NON-TAXABLE UIS I KIIiU I IVNS VIV uNt ~s yr rtty- Iwv ~,vvr.rc ~ncc i t ~~~,...`..~.. _ Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) ' Rev-7502 EX. (6-98) SCHEDULE J-IIB CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS COMMONWEALTH OF PENNSYLVANIA continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WAGNER, R. Elinor 21-07-1167 ITEM NUMBER DESCRIPTION AMOUNT 1 Calvary United Methodist Church (8% of net residuary estate, per Item 3 B of Last 40,365.92 Will) 2 Dillsburg Lions Club (8% of net residuary estate, per Item 3 C of Last Will) 40,365.92 3 Messiah Village (16% of net residuary estate, per Item 3 A of Last Will) 80,731.84 4 New Hope Ministries (8% of net residuary estate, per Item 3 D of Last Will) 40,365.92 5 Northern York County Historical Society (4% of net residuary estate, per Item 3 E of 20,182.96 Last Will) Subtotal ~ 222,012.56 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule)-11B (Rev. 6-98)