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Home My WebLink About08-14-08 (2)15056051058 REV-7 500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual7axas INHERITANCE TAX RETURN PO BOX 280601 ~' ~~ O ~~'~ Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birlh 192-14-5979 03/06/2008 12!21 /1922 Decedent's Lask Name Suffix Decedent's First Name MI ._..._ _ _ Mumper William A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suifx Spouse's First Name MI 5pouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~~ 1. Original Return O 2. Supplemental Retum C=) 3. Remainder Return (date of death prior to 12-13-82) L~ 4. Limited Estate C~ 4a. Future Interest Compromise (date of C"_--~ 5. Federal Estate Tax Return Required death after 12-12-82) C'~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ___ _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Witl) (Attach Copy of Trust) C"7 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death f..°°~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ' Floyd Fahnestock (717) 258-6671 ___. __ _ .__ _____ Flrm Name (If Applicable) REGISTER OF WILLS USE ONLY Accounting Associates '~-~ <_' First line of address ' ~ - __ ____ _ _ _ _ _ _ _ c... 1849 W. Lisburn Rd. ~ `~~' Second fine of address ~- ~,,.t _ _ _ - _ _ __. _ _ _ __ _ _ DATE FILED _ . City or Post Office State ZIP Code ~ .-- - -t .. Carlisle Pa 17015 = ~~ c~ Correspondent's a-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. SIGNATURE OF P~F~RSO NSIBLE FOR FILING RE RN DATE - l/•J( t/~ ~~ 08-14-2008 ADDRESS4HOC Virginia Road Mechanicsburg PA 17050 _ SIGNATURE~iEPAR R O~THAN R~ATIVE DATE - 08-13-2008 ADDRESS 1849 W. Lisburn Rd. Carlisle Pa 17015 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 -.,-, ~~i; _ - ~ i --, _,~ 15056052059 REV-1500 EX Decedent's Name: William RECAPITULATION m A Mumper 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 Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. Decedent's Social Security Number 192-14-5979 182,000.00 12,247.55 194,247.55 8,245.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 186,002.55 _ _ V_ __ _ . _, ~ ...a ___. _.~ _ 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_ 15. 16. Amount of Line 14 taxable at lineal rate X .045 8,370.11 16, 8,370.11 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at ccllateral rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 8, 370.11 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER William A Mumper 192-14-5979 STREET ADDRESS 4806 Virginia Road CITY Mechanicsburg STATE ZIP Pa 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total lnterestiPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" !N THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ 0 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)]. Asibling 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+ (6-98) ~ -, SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER William A. Mumper 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. (If more space is needed, insert additional sheets of the same size) Michael R Ent (7171 730-30' 0 F h~ Nu 18061 ~'U5~ t ~~.~~~ .~ 480~~1'05C Uniform Residential Appraisal Report File #J ~t~o~,,~oSL _ _ ~ ] The purpose of this summary appraise ___ v provide the lendedclient with an accurate a"td adequatel7 supported. opinion c! m,e marker aue ~~ the ;~~ i Property Address 4806 VIRGINIA _ _ _ _ City_ MECHANICSBURG Sta?e F'f, ~i ~~'d~~ 1 i~)~~C :~ ; ':' Borrower WILLIAM MUMPER, E Owner of Public Record WILLIAM MUMFER.__ ~ounN CUfv1i3ERLANC? Legal Description DEED BOOK 2r. 35 { --- - - - - - ------ Assessor~s Parcel # 10-21-0279-: _ ____ _ TaxYear 2008__ _ _ ____ __ _ _ RE_~a ~~ ~ 614 OQ ~ DELBROOK r Nei hg borhood Name J ~L 1 ,_ ___ _ _ h'ap Referr nce 1rJ-21 0279-309 Cer~sr.s Tti.t ~ 1 ~'~ r ~;~~~ar' i - - . ~ - - P Occ~ant ~_~,_Owner Lnant _ _ PUD h C~+ S pFi e,:~ ~ ~~ f S eclat Assessments S 0 p - - - - - ~_ . property Rignb A~praisea ~" Fee Sir r-, easehold ~~ Other describe[ Assignment Type _ Purchase Tran ~~ Refinance Transaction ,X Other~describei ESTATE Lender,Clier.t WILLIAM MUMPS = Address 4806 VIRGINIA RD , MSCHANICSBURG_, PA _17050 , Is ;ne subject property currenff~ offered s it been offered for sale in the twelve months pnor to_ the effecti ~ date of this a_~ra~s,l _ 5 fJ~ I Report data ~ource(sl used offerng pric (s). CENTRAL PENN MLS dio did not an~~yze the c:~~ r the subject purchase transaction. Expl~,~n `,he rasiats of the .~n,~.lysis of the contr:rct'o ;ale ur .v r, t~ e ^, , ~ ; :~r ~ '[~ aertormed Contract Price S Darr Is the proper seller the owner of public records _! des 1 N ~ Data .Sou ~~ ~_~1_ '~ -- --- __ _ - - --- ------ 1 -- is there any financial as~is.ance pooh c~ ~ncessions, gift or downpayment assistai~~a~, etc) to be paid by any parry on behalf of the bo~row~:r" "e~ , , If ~ es. report the total dollar amount am.: - - -- _ --- --- -- ;[ems to be aid. p -- -- - - - - - - - - - -__ - _ _ _ _ ,____ Note: Race and the racial composrti, hborhood are not appraisal factors. __.~..~ Neighborhood Characte, One-Unit Housing ^Present Land U~P o i One-Unit Housing Trends _ Location Urban `°~~ Sururbr, _ Prope Values (~' Increasing _ -Stable _ _ Declining _~j PRISE r Gr ne-Jn~^ - ~ ' Cver 75°r~ ; 25 75°= Butt-Up ~5% Demand/Sup ly __Shortage ~ I~~ Balance_ ~ - Over Supply_I _S_000'~ i;r,~ ~-4 Uni? _ Gr~wm Rapid ~~ Stable Marketin Time =Under 3 mih; ~~ 3_6 r~ths _ _ Over G mtns 90 Lov, Nr_'~.^~1 f,1ult Fsrr.il~, ~ ; Neghbornood Boundaries THE CC ;INET CREEK TO THE NORTH~SI. JOHNS_CHUftCH RD I_ 45C Hig~~ 13U ~o~nm~~rca~ ~ I _ - - - T~ _ ~ _1.75 Prea :,C-60_ Gthei V C --- - ~ S O D _ -- - N[ borhood JPs~rR[n SUE;U p g ~~ ___ CREATION_AND EMPLOYfv1ENT. SHOPPING, RE SCHOOLS AVERAGE ACCESS TO - W TH - -__ _ -------- - SUBJECT NEIGHBORHOOD I "5 MINS. DRIVING TIME OF THE MAJOR JOB MARKET OF HARRISBURG, TriE STATE CAPITf.L - -- - Market CondiUOrs :including s~.,prs~~t fc~ ~clusions THE CENTRAL PENiJSYLVANIA HOUSING MARKET CONDITIONS REMAIN GOO)[ ~, DUE IN PART TO THE STATE= OMPLEX AND SUPPORTING AGENCIES & BUSINESSES PROVIDING AMFLE E_t`1Pi_OYMENT ' - --_ - - ----- - - __ - _ --- -- SING. - VALUES ARE INCREA +ARKETING TIME CURRENTLY 60-120 DAYS. ISEE ADDITIONAL COMMENTS PG 3 __ Dirtens~ons 0.23 ACRE _ _ _ Area 0.23 ACRE Shade RECTANGLE,_M!L V~nvr AVERAGE _-- Specific Zomng Classihcaticr R-~ Zoning Description RESIDENTIAL SINGLE FAMILY Lei: Zor ng Compliarce>~ Leal ping (Grandfathered Usk ~_1 No Zoning II!egal]describ~~ _ _ Is t~~re highest and nest use ~~ s~~~t e;t F oved or as proposed per plans and spec fi~atiors) t ie present ~ise~ _ ~<~ Yr~s We If 'd ~ de ,cbe Utilities Public Other (aescribe Public Other describe) Off-site Improvements -Type Public Pri.ete Ele_tncity , ' Water _^__ _ _. _ __ __ Street MACADAM x~ _ _ - Sa~ N,A Sanitary Sewer ~[ ~ Alley_ N/A _ _ FE1.1A Specia. Floor Hazard F~re., FEMA Flood Zone X FrPIA lV1ap #r 420C600010C F f ~A I~,iap Dale 1 ` 199t~ Are the utilities and ot1 site r proverne: ~ ~ market area? ,>[ Yes j No f No. describe Are there anv adverse site ~>>o~t~c~ > s' ~ ieasements, encroachments, em~ironm mat cond bons, lane u~e~~ etc ~? Yen ~ ~ V r 'Yes. de~orior NONE NOTED DURING IN~P PRAISER IS NOT EXPERT IN_ ENVIRONMENTAL MATTERS,_ _ _ __._.. General Description Foundation Exterior Description materials/condition Interior materials/cen~it cn Uni?s }, One One vicn AccFs~r~ cr?te Slab -_ ; Crawl S ace _ _ - -.~-_p Fuutdatlun J+,alls BLOCK/AVERAGE __ ----- -- _ __-__ rln~r, CPT/H~^J-VIN A / __ ~ Stories 2 Basement ~~ Partial Basement Exterior Walls BRICK/ALUM;AVv !'al's DRY`A'ALLi~a`'C err ?, Det___ Att _ _S 7-~ = ~ pit Area _ _594 sq_ft R~ci SuCace FIBER GL.SHINI~~VG T ImFn si~~ WDIS l-AINiPf~l~ J `;: rA~sting ProposeG Cn~:er ~t Finish 100 % G,it?ers & Do,vnspouts ALUMINUM/AVG 8att~ Four CPT/bIN~A\%C ~Ca Mgr ;S>v~le SPLIT-LE~!EL ,tile Entry/Exit^_1 Sump Pump _ V~mJowJype__ _ _~,NOOD/DBUHUNG Bath ~^la rsco: CER.I ILE'AV S `'ear Built 19~~ ~ of ~ Infestation Slorn Sash Insulated ALUM.STORM/,~VG C it Stx~ce None Efrect~~ve Age (~'rl 20 _, ~~pness _ ~ Settlement S,reens YES ~ Jrv e•.a7 ~ u` z's Htt~ FWA [~ NWBB L~ Rariant ~ A ~ noP~ ~ VJooastove~,;~ ~ D ~~~~ ~ ~ui'ar~ ON_ CR= Drop Stan :.s r uel ELEC B B _ - I Fuep~ace ~ # _ ~ Fen~~ RR. YARD - - --- - ~~ a rr yr, ~ of :rs - r -- _ _ _ I~ "loor ~~~: ~ Central Air Conditioning ~ Patio'Deck ~, Porch COVERD. C~.r(oit # ~t Cap _ Finished - ;id~tal ~ Other . _ ;Pool ~~ Other SUN RM. [; A1r_ De'. ~ r?-r -_~. i;po!iances Refrioerator ~ ~ , .~~~c _ sh,vasher [[ Disposal [~~~ Microwave ~. Washer,~Dryer ~ Other (descr~~be) Finished area above grade con~~~ns - ~oms 4 Bedrooms 1.5 Bath(s~ _ _ _ 2,060 ~ tuafe Fear o^ Gress Li.iny Ate A ~c ~~e ~:ar, .. ,^;~~_~ - - - _ . _ ~-_-_- -_____...._.......... NT CONTAINS A FINISHED RECREATION ROOM ......... ~.:....-~F ..~....._ _ .... _ _ _ adicated Value b Sales Com orison Ap roach $ 182 000 ndicated Value by' Sales Comparison Approach $ 182 000 Cost Approach (if developed) $ _ Income Approz-" ADEQUATE MARKET DATA IS AVAILABLE WITH SEVERAL SALES IN 7HE SUBJECT S PRICE RANGE AND M! )'HE SALES COMPARISON APPROACH TO VALUE IS THE BEST METHOD FOR THIS APPRAISAL. _ this appraisal is made ®"as is", ^ subject to completion per plans and specifications on the basis of a hypothetical condition that t' completed, [] subject to the following repairs or alterations on the basis of a hypothetical condition that the repairs or alterations have be. folloeving required inspection based on the extraordinary assumption that the condition or deficiency does not require alteration or re aip r: Based on a complete visual Inspection of the interior and exterior areas of the sublect property, defined scope of work, stater- conditions, and appraiser's certification, my (our) opinion of the market value, as defined, of the real property that is the sut S 182 000 , as of APRIL 21 2008 ,which is the date of Inspection and the effective date of this apprair eddie Mac Form 70 March 2005 Page 2 of 6 F~ ~,~eio of a ^REA.THE ;ements have been eted, or ^ subject to the assumptions and ;his report is tae Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. -1-800-ALAMODE _ _ il? Nq, J8C6' r 050 i' J ; 480617050 Jniform Residential Appraisal Report File# 4806,7056 __ There are 3 com arable ro erti: P P P offered for sale in the sub ect n ~'_ 1 et hborhood ran m in__rice trom S 165,000 to 1.95,__-_ _ _ 9 --- -~--9 p- --------------- -`.000 _ There are 9 com _ parable sales In a neighborhood within the past twelve months ranging in sale price from S 165,000 to 5 95,000 FEATURE SUE I COMPARABLE SALE # 1 ~ COMPARABLE SALE # 2 CQ~uIPARABLE SF,LF it ~ _ _ Address 4806 VIRGINIA RD. 305 KEITH RD. 4806 DELBROOK RD. 210 W. MAIN ST. PA MECHANICSBURG WN PA 1 'C1 t )MECHANICSBURG PA 17050 MECHANICSBURG, PA 17050 SHIREtAANSTO Proximity to Subject , -~- ~J.02 miles _ ____10.10 miles -_____ 0.71 miles _ ____ Sale Price S j S 1 92 000 $ 177,000 ~~ 09 SJrJ Sale Prlce,!Gross Liv. Area S ' ~ 97.46 sq.ft. S 95.99 sq.ft. ~ S 113 30 sq_ft _ __ _ Oats Source s O ' v1LS/ CO.TAX RECORDS ~MLS~ CO.TAX RECORDS MSS! CO 7AX RECORDS ---- - - --- - - - - _ _ - Verrfication Source(s) _ ---r-- i - - ~;_ISTING OFFC. 10152436 'LISTING OFFC. 10154755 LISTING OFFC_~10148962 _ VALUE ADJUSTMENTS - DESCf I DESCRIPTION +(-) $ Adjustment I DESCRIPTION_ +~S Adjustment _ DESCRIPTION _ +~~S Adi °.i ,r~t Sales or Financing _ _ TOM:122 DAYS ATOM 28 DAYS .I TOM: 4 DAYS Concessions -- ~ - I CONY. --- FHA 4 845~CONV. ___ _ _ ~) ~J~J - ----------fi------- - - - Date of Sale;Tlme -_ - ~ )3-14-08 -_-__ _ ____ _,.01_25_08 _ _ _ __ __ 09 05-07 I--_ _ __ - - - -_ _ - _- LO~ahOn - SUBUI - ~UBJCT.DEV. SUBJCT.DEV. _ . SUBURlEOUAL Leasehold/Fee Simple FEE SI S=EE SIMPLE 'FEE SIMPLE FEE SIfv1PLE__r _ Site 10.23 AC ' ).20 ACRE 0.23 ACRE 0.19 ACRE --t--- --- -- - View - !AVERA - - +VERAGE (AVERAGE AVERAGE - ~ -- - - - --- - - --- - - -- Design(S Itye) T (SPLIT-I SPLIT-LEVEL 'SPLIT-LEVEL +_________.SPLIT-LEVEL __ Ouali of Construction _ ~AVERA ' AVERAGE AVERAGE _ ___ (AVERAGE ------- - - - - --_ - - - _ - ActualA e - --- - - ~~ •5(20) _ --~ ti - 46~20~_-- ---'.44~20i-- __-- -- Concition Above Grade A~'ERi ~I Total &' AVERAGE I `otal Bdrms. Baths AVERAGE _ __,I~AVERA_~E _ ,Total Bdrms Baths~~ _ I total ~Bdim~ ~3aths ~ ~~ _ Roam Count 7 ~~ _ 7 4 2 ~ -750 6 750 7 ~ 3 ~ 2.5 -__ "_5J0 Gross Living Area _ ~ 2 --- 1970 sq.ft. _ ~ _1,844_sq.ft.i +4~320~____'1,496 sgft.l _ +1-,ZBU --- ~ - PARTIAL ~ ~ PARTIP.L Rooms Below Grade I REC R' _ M~RM/ 56ATH ~ _ -500)UN_FINISHED *",~~J~J 1,000 FAM,RM__ _ , ty o l l ~Tl PIC. YPICAL MKT TYPICAL MKT TYPICAL MKT ~ ___ _ ___ _ __ _ _ I Heatin /Cool n _ g g _ __ ELE.B.' ( SAS HW/CAC ' ~`2_000 -2 00o GAS HW/CAC ~O-iL_HJv/fJONE_ _- EnergyEfficientltems NONE ~EPLCMT.WIN -2,5001PART.RPL.WIN -1,000I,NONEfJOTED -- -- Gars e/Car ort _ 9 P 2 C AT - DONE ~1 C.INT3 GAR , ~:).~~ +3 500 1 C. CARPORT +2 X00 - ~~ _ Porch/Patio/Deck POR/S UN ROOM ~ - PATIO , )0': +500 PORCH/DECK *500~ ___ _. _ ,- - --- -~ _ --- ------- --- _-t ' -j _ - Nei Ad~ustment (Total -~--- _ j 1 - S + ~ _ _. _ -- + S 2 250 X S 1 775 X . ~~ L + ~ _ Ad usted Sale Price 1 zt Ad . 1.2 % _ __ ~_ _ _ _ _ - _{ _- fJet Adj. 7.0 /°~ Net Ad I 5.2 °~6 of Comparables ' ross Adj. 5.3 %,S 1 89,750 Gross Adj. 9.3 %~$ 175,225 Gross Adj 12.8 °i°' S 1 7~-_,?oC' I X did ~ did not research the sale u~ ,~ ry of the subject property and comparable sales. If not, explain 'research __ did X did not r~vea Data Source ~ CUMBERLAND C. __ _ ,-- -- M~ research _ did X did not revea~~ Data 5ourceis) CUMBERLAND C~ ii Report the results of the researc7 an_c ana __ ITEM _ 'Date of Prior Sale/Transter~ 1Nt- Price of Prior Sale/Transfer 3 '; Data_Source(s) ' CG Effective Date of Data Source( _ 04 Anal~sls of prior sale or transfer natcw o" Summary of Sales Comparison A~,prcach CONSIDERED TO 8E THE_BE_ST PARAMETERS INCLUDED TH_E r APPRAISER BELIEVES IT APPR AN ADJUST or transfers of the subject property for the threesears prior to the eifectlve date of this appraisal __ __ - - ---- - - - - {RECORDS. __ _ __ _ ___ __ _ or transfers of the comparable sales for the~ear Prior to the date of sale of the ~ o nparab e sa'.e. _~ _- {RECORDS. - _- - - ----- - - - - r sale or transfer history of the subject popery nrd comparable sales report ~ddi ions! pnor sales on Page 3) -_ 'ECT COMPARABLE SALE #1 ~ _ COMPARABLE SALE #2 CCMP_ARABL SALt J PREVIOUS NONE OTHER THAN NONE OTHER THAN rNONE OTHE R THAN ABOVE 'ABOVE iABOVE - - -- - -i-- - --- _ - ~.ECORDS COURT HS. RECORDS COURT HS RECORDS COURT HS RECOR[): 04_23-08 , __ _ __ _ 04-23-08 ~ G'4-23-08 perty and comparable sales ,_ NO PRIOR TRANSFER OF_SUBJECT'/VITHIN PAST 3 1 EARS. THOROUGH SEARCH OF THE SUBJECT MARKETPLACE, THE THREE SALES SL`-LECTED AF E RS OF VALUE. ALL SALES„SELECTED HAVE_UTILITY SIMILAR TOTHE SUBJECT SEARCF 8 MONTHS. SIMILAR MARKET CONDITIONS HAVE EXISTED DURING THIS PERIOD. THIS O ACCEPT GLA ADJUSTMENTS GREATER THAN 500 SC2.FT. ,ED FOR GLA DIFFERENCES. )escribe the condition of the property (including needed repairs, deterioration renovations remodeling etc) PROPERTY CONDI ~ ' D CONDITION OF MPROVEMENTS ARE TYPICAL OF THE NEIGHBORHOOD PRICE RANGE AND AGE OF IMPROVEMENTS. PF TY WOULD BE 2EADILY ACCEPTED IN THE MARKETPLACE. Ire there any physical deficiencies or adverse conditions that affect the livability, soundness or structural inte rity of the property [ 'i No If Yes, describe )oes the property generally conform to the neighborhood (functional utility style condition use construction etc )? ®Yes ^ No I Bribe ddie Mac Form 70 March 2005 Pa e 1 of 6 '~ 9 Far: ~:e Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. -1-800-ALAMODE REV-1503 EX+ (6-98) COMMONWEALTH OF PE INHERITANCE TAX i RESIDENT DECE. ESTATE OF ITEM NUMBER SCHEDULE B ANIA STOCKS & BONDS FILE NUMBER All orooarty iointiv-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1504 EXt (8-98) ~ ~, CGMMON`n,'EALTH OF ~ ENNSYLVANIA INHERITANCETA~ RETU-;N RESIDENT DECEDENT scwE~u~E c CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP Schedule C-1 or C-'~ nciudiny all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a soie-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorsnips. ESTATE OF FILE NUMBER TOTAL (Also enter on line 3, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ (6-98) ~ ~.; COMMONWEALTH OF P INHERITANCE TAX i' : Jk RESIDENT DECEt T ESTATE OF SCHEDULE C-1 CLOSELY-HELD CORPORATE -.NIA STOCK INFORMATION REPORT FILE NUMBER 1. Name of Corporation __ _ Address _ _ City _ _. 2 Federal Employer I.D. rd 3. Type of Business __ 4. T STOCK Votiny/F Vo Common Preferred ProducUService TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE y SHARES OUTSTANDING pAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK ___ Provide all rights and restrictions pretaining to each class of stock.. 5. Was the decedent eu~~ a~ ,~ the Corporation? ^ Yes ^ No If yes. Position Annual Salary $ Time Devoted to Business __ ___ 6. Was the Corporation it . to the decedent? ^ Yes ^ No If yes, provide amoun~ redness $ _ __ 7 Was there I!fe ins.;r: ~ le to the corporation upon the death of the decedent? .. ^ Yes ^ No If yes. Cash Surrender A ~u _ Net proceeds payable $_ _ ___ Owner of the policy _ __ 8. Did the dececant sel.. .r stock in this company within one year prior to death or within two years if the date of death ~.. ~ 12-31-82? ^ Yes ^ Ne li ~s, ^ Transfer ^ Sale Number of Shares Transferee or Purchas _ Consideration $ Date Attach a separate she::; jitional transfers and/or sales. 9. Was there a wrir,~n sn;; s agreement in effect at the time of the decedent's death? ^ Yes ^ No If yes. provide a cop, 2ement. 10 Was the decedents s~ ~~ .......... ............. ^ Yes ^ No If yes. provide ~ cop; c ~~ ~~ement of sale, etc. 11 Was the corporao:,n ca .liquidated after the decedent's death ~ .......... ...... ^ Yes ^ No If yes, provide a brea~.d istributions received by the estate, including dates and amounts received. 12 Did the corpcr~ti:; i I crest in other corporations or partnerships? ..... ^ Yes ^ No If yes. report the nec= y ormation on a separate sheet, including a Schedule C-1 or C-2 for each interest. • •- • e ~ A. Detailed calculations ..= valuation of the decedent's stock. B. Complete copies off ements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation, c~r~, :te, submit a list showing the complete address,res and estimated fair market value/s. If real estate appraisals nsva been secured, ~-t ~~ s D. List of principol at_ ~r,l : ~a date of death, number of shares held and their relationship to the decedent. E. List of officers. tf,t~r s.;,r ruses and any other benefits received from the corporation. F. Statement of dr~,u~n~_ a year. List those declared and unpaid. G. Any other infonr s:io, _ the valuation of the decedent's stock. State of Incorporation Date of Incorporation State Zip Code Total Number of Shareholders Business Reporting Year (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ (5-00 r,-~ COMMONWEAL'. INHERITF:f:~, RESIDct: CE" ESTATE OF SCHEDULE C-Z PARTNERSHIP NIA INFORMATION REPORT FILE NUMBER 1 Name of Part: Date Business Commenced Address __ Business Reporting Year City _ State Zip Code 2 Federal Emp~ i 3 Type of Busi ~- ProducUService 4 Decedent we. ~ ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5' R NAME T PERCENT PERCENT ' BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT A. 6. C. ---- D. ~ 6 Value of the _: t $ 7 Was the Pars - o the decedent? ^ Yes ^ No If yes, prcvia~ ~ tedness $ 8 Was there lif_ ~ le to the partnership upon the death of the decedent? .. ^ Yes ^ No If yes. Cash Net proceeds payable $ -- ------ Owner of the . 9 Did the dace.: _ i ,r an interest in this partnership within one year prior to death or within two years if the date of death N~:~ prior to 12-3' ^ Yes ^ Nc s, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Consideration $ Date _ ___ Attach a sep: ~ ________ _ _ .iitional transfers and/or sales. 10 . Was there a ~;. agreement in effect at the time of the decedent's death? ...... ^ Yes ^ No If yes. prcvic-_ reement. 11. Was the ae:x nterest sold? ^ Yes ^ No If yes. provide cement of sale, etc. 12. Was the party liquidated after the decedent's death? ......... ....... ^ Yes ^ No If yes. provide ~stributions received by the estate, including dates and amounts received. 13. Was the cece . of the partners? ^ Yes ^ No If yes, explai 14. Did the partr~ Brest in other corporations or partnerships? .. ^ Yes ^ No If yes. report ! ,rmation on a separate sheet, including a Schedule C-1 or C-2 for each interest. A Detailed calct:.. ., valuation of the decedent's partnership interest. B Complete cop.- ements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding yea s. C If the partners: te, submit a list showing the complete addressles and estimated fair market value/s. If real estate aporaisals hair been secures D Any other ,r,fc he valuation of the decedent's partnership interest. RE'/-1507 EX+ (3-98, SCHEDULE D connMONwE.., ~~N _vAwA MORTGAGES & NOTES INF+ERIT-. ~'ET ~~ RECEIVABLE RESiC: DEt. ESTATE OF ITEM NUMBER FILE NUMBER it property jointly-owned with right of survivorship must be disclosed on Schedule F. pt more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER William A. Mumper 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. (If more space is needed, insert additional sheets of the same size) Send Inquires to: ~ 5000 Loulse Drfve ~\ Q1 ,;, . PO Box 40 J Mechanicsburg, PA 17055 www.memberst st.org Maln Slerttchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (!17) 697-4372 or (B00) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 _ TeleBranch: (117) 795-6049 or (800) 237-7288 MEMBERS FEDERAL CREDIT UNI, 12275 1 :.. 24549-12275 l~~~lll~~~ll! ,IL~~I~~~I~~LIIL~~~II~J~I~J ~~ WILLIAM . C/O BON, _ 4806 VIR.. MECHAN, 17050-3072 Statement of Accounts Feb 25, 200$ thru Mar 24, 200a Account Number: 3154 Account Balances at a Glance Checking: 24,461.36 Savings : 33.7 Certificates : 0.00 Loans: 0.00 Money Management : 0.00 Page : 1 of Your current Member Loyalty Reward level is Gold :yip has its advantages! Your FREE VIP pass for Carlisle Events accompanies this statemettit. CHECKIN - , AUNTS 11 - CHECKIN Date Try. ;option Additions Subtractions C3a:unce Feb 25 8~ 1 24, &~ .42 Joie... 'JNITA L MARTELL Feb 29 D~ u 0.2.50% 4.94 24,869.36 Annual Penenta ed 0.250)6 from 02/01/2008 through 02/29/2008 Qased on A vex:,, ~~ce of 24, 848.57 Mar 03 D~ ck 90.00 24,959.36 Mar 13 W. 200.00- 24,759.36' Mar 17 C.. -racer 0001747483 298.00- 24,461.36 ~,. Mar 24 En 24,461.36 CHECK SUMMARY Check # Date Check # Amount Date ----- OG i 155 Mar 17 SAVINGS ±NTS 00 -REGULAR Date Tra dption Additions Subtractions Balance Feb 25 Bs 33.74 Jci, 'NITA L MARTELL Mar 24 E,~, 33.74 YTD SUN; TOTAL DID,'; 00 R EG U L.~- 0.00 11 CHECK! 10.20 --- Continued on following page --- REV-1509 EX+ (698; is COMMONWEAL ~Y~. JANIA INHERITAI. ~ ~i~ J RESIDE ~T ESTATE OF SURVIVIrdG A. B. C. JOINTLY-OWNED r LETTER ITEM FOR JOINT A. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER DESCRIPTION OF PROPERTY LUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATN VALUE OF ASSET st GF UECG'S INTEREST DATE OF DEATrI VALUE OF DECEDE:NT'S INTEEE~i TOTAL (Also enter on line 6, Recapitulation) 5 (It more space Is neetletl, Insert additional sheets of the same size) REV-1510 EX+ (6-9 ~: r COMMONWE IF INHERI? RESIL E ESTATE OF This s ITEM NUMBER c SCHEDULE G _vaN,A INTER-VIVOS TRANSFERS HL N MISC. NON-PROBATE PROPERTY FILE NUMBER npleted and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, DESCRIPTION OF PROPERTY OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDEN7AND .ANSFER. ATTACH ACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (lF APPLICABLE) TAXABLE VALUE I TOTAL (Also enter on line 7 Recapitulation) S (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER William A. Mumper Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUN-r A. FUNERAL EXPENSES: ~~ Myers Funeral Home 7,945.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Zip Zip 300.00 TOTAL (Also enter on line 9, Recapitulation) $ 8,245.00 (If more space is needed, insert additional sheets of the same size) eerenr~rr:, lr~ `~unerf STATEMENT' Charges are only for explain in writing bc: If you selected a funr.. you did not approve For the Service of _ Charge to: ~~ A. CHARGE FOR S 1. PROFESSlO\:~. Services of Fu:. Embalming . . Other prepar.u SUB-TOTAL OF 2. FACILITIES A`;. Use of facili[i~ viewing (Vis. Use of facilitir for funeral Use of facili[i Memorial Sr~ Use of equipr., for gravesit.~ Other use of :. SUB-TOTAL Ofi 3. AUTOMOTI~'i Vehicle [o tr:r„ Local...... Hearse (Caskr Local....... Limousine Local...... Family car Local....... Flower ear ttr Local...... Lead car/cler, Local..... , Car for palfo. Local....... OUf Of tol4'n SUB-TOTAL 0. TOTAL OF P: t FACILITIES Al EQUIPMENT B. CHARGE FOR ` Casket..... (Descri lion. Other Recep:. (Description, Outer burial contai, (Description) Acknowledgement r Register book(s) .. . Memory folders .. . Prayer cards , .... Temporary grave n. Burial clothing .. . J r~ ;; TrudillCCtc =~ J1.J >~ 3nre, Canc. BOYD L. MYERS, JR., Supervisor 37 E. MAIN STREET MECHANICSBURG, PE:NNSYLVANiA 170SS (717)766-3421 '.e1ERAL GOODS AND SERVICES SELECTED ~ , u you selected or that are required. if we are required by law or by a cemetery or crematory to use any items, we will ~;I,ire embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming .d arrangements such as ~ ` trect crematio mediate burial If we charged for embalming, we II expla' ~ why beiowB ~ ~ Z C L. A~^'1 ~ /~i/1.~.~ Date of D eath ' c. ~~ ~ Ad dress City State J,'° s-S ;;TED: Other clothing 8 E~~.f. ff S rl~.a .... ... 8~ Cremation urn ............ ...... S (Description) OTHER S S~ 8 ... -7~~ ~ S " ...L SERVICES........ . Al 8~_ f ~2 C; TOTAL MERCHANDISE SELECTED ... .... B E 5 ir)r C. SPECIAL CHARGES: a(„ 8~ Forwarding of remains to ,_.. C' (Funeral Home) S E-1-i'r" Receiving of remains from ~,r E g ~ (Funeral Home) fc~s Immediate Burial ................ E E•~G~ Direct Cremation . .............. E 8 .-- SUB-TOTAL OF SPECIAL CHARGES . ............ .. C S___ D. CASH ADVANCED i G O ~/ S %7~~ .... 8 /E,~UIPMENT ......... .. A~ °~ rave ........ ........ pen ng Cemetery Equipment .... ........ . . . 8~G_V-- ' Lot and Deed ................... . 8~~-~- Newspaper Notices-Local ........ . 8 ~,~~.`"~ Funeral Home. C Newspaper Notices-Out-of-town... . S 77.5 `~'- 8 ~,^?- Telephone & Telegrams .......... .E --~ .. 8~-. Airfare Clergy/A3ass Offering ........... . ---~' . 8L2=.~_~ ^~ /~ 8 / Pallbearers ..................... f th Deat tifi i d C C . S „ ~ es o e er e op ~ L' ~ ~ ~ ~` 0 r . Certifica[e ..... ~ , . E g --- Police Escort ................... Flowers .E "-" ~ E _ r n 8~,t ` ....... ........ Vault Service Charge ............. . E E --r~~r` -' $ .... 8 .--. L $ ..... E -~- E iJ 8 ADVANCES T ~ ~ 3rJ r D F 8 ......... OTAL OF SUB- .... __ - ~ 1`, E EQUIPMENT...... , . A3 V6'e charge you for vur services in obtaining: ~,~RVICES, (specrfy cash advances that are marked-up) ~ ~~~ .1 E ................... A E3S~~ ~ ~-.~ . 5ELECTEDs , ,,,,, S ~' ~~ ~, Cam' 8 .. f . 8 ~, .. S .. 8 .... 8 SUMMARY OF CHARGES A Professional Services, Facilities and Equipment, and Automotive ~ cu Equipment ...................... 83~ ~-S"` S / Z sc . ~ta3 B, Merchandise ................ ~~ C . Special Charges .................. S ll. Cash Advances .............. .... S z 3 3~ ~ ~ ~~S t~1 TOTAL OF ALL SECTIONS > _ PAID AT TIME OF OR PRIQ$,TO ~ Q~~ c.~ ARRANGEMENTS ..........kNt'/""~'t--."' _ BALANCE DUE .................................. 8 -- REASOpt'1!OR ~MBALMIN If any law, cemetery, or crematory requirements have required the purchase of any of the items list/~d ~~ove the law or requirement is explained below f agree chat I have examined ds and services selected above and found them to be correct and according to the arrangements 1 have reyuested. I acknowledge •eceipt of a copy of this Sta: i i ,al Goods and Services Selected. I re nt that a sufficient funds available for payment of the cash price for the goods ~nd services selected, 1 also : m: ,ayment off with' days. I agree ro be jointly and severally {fable with anyone cbr who igns below. A late charge t _ per month amounting. o per year will be applied to the unpaid balance beginning _ da} s rom the date of this agrees rri pay to the Funeral Direct all reasonable costs paid by the Funeral llirec[or to called amoun[s I owe under this agreement. 'hose costs may include ar fee curt costs and other costs. Any additional services or merchandise ordered or requested after the date of this agreement will e c~ red py3~,t of th' a ^: he cost thereof will be reflected on the final bill or statement. per) at eal) __ ,eC) (L tensed ^eral Directo WHITE-Funeral Director YEL W-Customer REV-1512 EX+ (12-03) COMMONWEALT'r NIA INHERITANC RESIDEN ESTATE OF SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS FILE NUMBER Report debts ~ decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM + NUMBER (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER William A. Mumper RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~ Bonita Martell 4806 Virginia Rd. Mechanicsburg Pa.17050 daughter 50% 2 Stephen Mumper 633 West 1st Street Boiling Springs Pa 17007 son 2 5 3 Edwina Cotsapas daughter 25% 612 Shadow Brook Drive Columbia SC 29210 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-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 II -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) REV-1514 EX+ (12-0.~ r <s.'; r.~ ~t• COMMONWEALTH OF PE'. INHERITALCE TAX RES'~DE'dT DEGF_ ~. ESTATE OF This schedule i, : ., _ ,.,. actstrial fa Actuarial t_: ors ca~ ndicate 1. Value of t~~,:_ 2. Actuarial fac' °=r ~:; Interest taole ~ a;e - C 3. Value of life estate ~~ t Value of funs ~..~,~ .. 2. Check ap, Frequency ., _ ,,,... ^ Qua,. ~ , t•'. 3. Amount of p~~, ~:.t pw 4 Aggregate ~,. , 5 Annuity F Interest ta::~,~ _ 6. Adjustment r ~ .~r , _ 7. Value of any,. ,,; - payout is _~. If using v; (Line 4 x ~,. NOTE: The va~u- ~ u ~_ G of this tax rya. r,_ SCHEDULE K LIFE ESTATE, ANNUITY ~'A & TERM CERTAIN Check Box 4 on REV-1500 Cover Sheet FILE NUMBER single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1 -E~9 >ingle life calculations can be obtained from the Department of Revenue. Specialty Tax Unit. din IRS Publication 1457, Actuarial Values. Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. of instrument which created the future interest below and attach a copy to the tax return. ^ Intervivos Deed of Trust ^ Other _rJANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ate is payable ..... ........ .. $ ;able ......... ..... ... ^ 6°i° ^ 10°i° ^ Variable Rate _ ___ _ °i° iltiplled by Line 2) ........ .$ JITANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUffY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of fears yis payable ......... ...... .. ......... ............$ nd enter corresponding (number) ... ......... ........... . ~. y (52) ^ Bi-weekly (26) ^ Monthly (12) -annually (2) ^ Annually (1) ^ Other ( j 2 multiplied by Line 3 ..... ............ ............ J 6°~ ^ 10% ^ Variable Rate °ro ,, ns) .2%, 6%, 10%, or if variable rate and period ation is: Line 4 x Line 5 x Line 6 ............. ........ .$ ;payout is at beginning of period, calculation is: 3 ........... u ~ create the above future interests must be reported as part of the estate assets on Schedules A thra_,cn or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18 (If more space is needed. insert additional sheets of the same size)