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HomeMy WebLinkAbout11-24-08J 15056051047 REV-1500 PA Department of Revenue Bureau of Individual Taxes Po Box zaosol Harrisburg, PA 17128-0601 EX (06-05) INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year 2 1,, y 0 8 ~._ File Number 0 7 1 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 0 1 4 1 7 8 9 0 7 0 1 2 0 0 8 1 2 3 1 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name MI H E I N E M A N ~ L O U I S E ~j (If Applicable) Enter Spouse's Information Below Spouses 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 Retum O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limited Estate ~ 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) _ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8. Total Number of SDB's (Attach Copy of Will) (Attach a Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHALL BE DIRECTED TO: Name Daytime Telepho umber c-~_-, R O N A L D E J O H N S O N 7 1 7 3 1 2r. _,3 Firm Name (If Ap livable) :_...i C7 -" C t! A N D R E W S & J O H N S O N T,. ~,. First line of address ~ ~ C~ C. " ~ r-'~ ' 7 8 W E S T P O M F R E T S T R E E T ~ ©~~ • ~D C7 -~ Second line of address ~ --~ ' O ,:: DATE FILED (./'1 City or Post Office State Zi Code ` C A R L I S L E P A 1 7 0 1 3 Correspondent's a-mail address: and complete. eclaration of TURE OF P N RESPO Pomfret Street, Carlisle, PA 17013 is based on all the information oT which the preparer has a DATE Side 1 15056051047 15056051047 REV-1500 EX Decedent's Name: 15056052048 1. Real estate (Schedule A) 1. $0.00 2. Stocks and Bonds (Schedule B) 2. ~ _ $333,835.40 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 4. Mortgages & Notes Receivable (Schedule D) 4. ~ $117,621.98 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) 5. $2,958.24 6. Jointly Owned Property (Schedule F) Q Separate Billing Requested 6. ~ $2,731.27 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Q Separate Billing Requested 7. $18,624.14 8. Total Gross Assets (total Lines 1-7) 8. ~ $475,771.03 9. Funeral Expenses i?<Administrative Costs (Schedule H) 9. $18,408.77 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) 10. $491.4 11. Total Deductions (total Lines 9 8~ 10) 11. $18,900.20 12. Net Value of Estate (Line 8 minus Line 11) 12. $456,870.83 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13. $0.00 TAX COMPUTATION -SEE II 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 16.Amount of Line 14 taxable at lineal rate x .0 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. TAX DUE 12 minus Line 13) 14. Decedent's Social Security Number 00 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 19 ~- $20,559.19 15056052048 REV-1500 EX Page 3 File Number Decedent's Complete Address: Decedent's Name Louise J. Heineman STREET ADDRESS 130 Wilson Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts 3. Interest/Penalty if applicable D. Interest E. Penalty (2) Total Interest/Pentatty (D+E) (3) 4• If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Fill in oval on Page 2, Line 20 to request a refund $16, 000.00 $842.11 Total Credfts (A+B+C) (~) $20,559.19 $16,842.11 $0.00 5• If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $3,717.08 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $3,717.08 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 n0 a. retain the use or income of the property transferred: b. retain the right to designate who shall use the property transerred or Rs income: c. retain a reversionary interest: or d. retain the promise for Irfe of efther payments 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 disignation? ER 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 3% [72P.S. Sec. 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 0% [72 P.S. Sec. 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 deseased child twentyone 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 0 % [72 P.S. Sec. 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 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.9116(a)(1). The taz rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 % [72 P.S. Sec.9116(a)(1.3)j. 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. LAST WILL AND TESTAMENT OF LOUISE J. HEINEMAN I, LOUISE J. HEINEMAN, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I give, devise and bequeath the sum of $10,000.00 to each of my grandchildren and my step-grandchild living at the time of my death, namely, I~RISTOPHER V. HEINEMAN, ANDREA HEINEMAN, REGINA HEINEMAN, JAMES SHIRLEY, CHRISTINA HEINEMAN, STEPHANIE DYER, ABBY IiEINEMAN. THIRD: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to my children, equally, namely, DOUGLAS R. HEINEMAN, DALE L. HEINEMAN, JANE L. FIRESTONE and CARL W. HEINEMAN provided that should anv of my children predecease me their share shall be distributed to their issue, per stirpes, living at the time of my death and in default of such then living issue, such share shall be added to the share or shares for my other children and/or their issue. FOURTH: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my ~estaXe. FIFTH: I nominate, constitute and appoint, DOUGLAS R HEINEMAN and DALE L. HEINEMAN, or the survivor of them, Executors of this my Last Will and Testament. I further direct that my Executors shall serve without compensation. SIXTH: I direct my Executors and their successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and T stament, consisting of two (2) typewritten pages, each identified by my signature, this 3 day of 2007. (SEAL) Louise J. Heine Signed, sealed, published and declared by the above-named Testatrix, Louise J. Heineman, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have l~.ezeunto sc 'bed our names as COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND I, Louise J. Heineman, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or armed to and acknowledged before me by Louise J. Heineman, the Testatrix, this ~ day of 2007. COMMONWEALtH OF PENNSYLVANIA NOTARIAL SEAL SHELLY SEXTON, Notary Public Carlisle Boro, Cumberland County M Commission Ex 'res Agri! 26, 2011 COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND ) We, RONALD E. JOHNSON and ,the witnesses whose names are signed to the attached or foregoin instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that Louise J. Heineman, signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Swo or affirmed to and subscribed to before me by ONALD E. JOHNSON and s ,witnesses, this ~ day of ~~~,.~~ 2007. SEAL) COMMONWEALI"H OF PENNSYLVANIA ~ / (SEAL) NOTARIAL SEAL W less SHELLY SEXTON, Notary Public Carlisle Boro, Cumberland County M Commission Expires ril 26, 2011 Not u lac AFFIDAVIT SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUMBER Louise J. Heineman 21-08-0716 All ro erty jointly-owned with Right of Survivorship must be disclosed on Schedule F ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Recovable Living Trust with M&T Bank (see attached) $332,346.45 2 25 shares -Cisco Systems, Inc. @ #23.15 per share $578.75 3 Additional payment from M&T Bank -Revocable Living Trust $910.20 TOTAL (also online 2, Recapitulation) $333,835.40 ~ M&T Investment Group July 9, 2008 Ronald E. Johnson, Esquire Andrews & Johnson 78 West Pomfret Street Cazlisle, PA 17013 RE: Estate of Louise J. Heineman Deaz Ron: Private Client Services P.O. BOX 220 ONE WESTHIGHSTREET CARLISLE, PA 17013 717-240-4504 Toll Free I-800-822-2155 As you are aware, Mrs. Heineman had a Revocable Living Trust with M&T Bank at the time of her death. Below is the breakdown of the date of death values of the assets held in the Trust: Securities (See attached printout) 287,852.15 Principal Cash 37,067.59 Income Cash 7,426.71 $332,346.45 A letter containing date of death values for her retail accounts will be mailed under sepazate cover. If you have any questions or require any additional information, please do not hesitate to contact me. Very truly yours, ~t~ J e F. Burke Vice President Enclosure cc: Douglas R. Heineman Dale Heineman Manufacturers and Traders Tiust Company Private Client Services Estate Valuation Date of Death: 07/01/2008 Valuation Date: 07/01/2008 Processing Date: 07/02/2008 Shares Security or Par Description 1) 4641 MTB GROUP FDS (553767882) EQ INDEX I I Mutual Fund (as quoted by NASDAQ) 07/01/2008 2) 5959.584 MTB GROUP FDS (553767114) SMCP ST INST I Mutual Fund (as quoted by NASDAQ) 07/01/2008 3) 1768.602 MTB GROUP FDS (553767775) INTL EQTY I I Mutual Fund (as quoted by NASDAQ) 07/01/2008 9) 12781.795 MTB GROUP FDS (553767817) INTRM BD I I Mutual Fund (as quoted by NASDAQ) 07/01/2008 5) 6762.537 MTB GROUP FDS (55376V705) US GV BD I I Mutual Fund (as quoted by NASDAQ) 07/01/2008 Total Value: Total Accrual: Total: $287,852.15 Estate of: Louise Jane Heineman, TUA Account: 2003586 Report Type: Date of Death Number of Securities: 5 File ID: Heineman, Louise Jane, TUA Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 10.67000 Mkt 10.670000 49,519.47 9.99000 Mkt 9.940000 29,490.39 11.14000 Mkt 11.190000 19,702.23 9.86000 Mkt 9.860000 126,028.01 9.39000 Mkt 9.390000 63,162.10 5287,852.15 50.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations ~ Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4) SCHEDULE D MORTGAGES AND NOTES RECEIVABLE ESTATE OF FILE NUMBER Louise 7. Heineman 21-08-0716 All property jointly-owned with Right of Survivorship must be disclosed on Schedule F ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH Demand Note dated June 6, 2008 from Jane L. Firestone (daughter) to Louise J. Heineman in the principal amount of $10,800 with interest payable at the rate of 6% per annum: Principal balance due Interest to date of death 2 3 4 Demand Note dated March 18, 2004 from Douglas R. Heineman (son) to Louise J. Heineman in the principal amount of $38,000 wit interest payable at the rate of 6% per annum: Principal balance due Interest to date of death Demand Note dated September 28, 2006 from Douglas R. Heineman ~,i(son) to Louise J. Heineman in the principal amount of $60,000 with interest payable at the rate of 6% per annum: Principal balance due Interest to date of death Demand Note dated September 28, 2006 from Carl W. Heineman (son) to Louise J. Heineman in the principal amount of $8,000 with interest payable at the rate of 6% per annum: Principal balance due Interest to date of death $10,800.00 $44.50 $38,000.00 $81.38 $60,000.00 $30.51 $8,000.00 $665.59 TOTAL (also on line 4, Recapitulation) $117,621.98 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Louise 7. Heineman 21-08-0716 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with Right of Survivorship must be disclosed on Schedule F ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Certificate of Deposit no: 5060062292-Orrstown Bank $1,670.38 (see letter attached) 2 ~ Penn National Insurance -refund on auto insurance policy ~ $105.00 3 ~ U. S. Treasury -stimulus check $300.00 4 Miscellaneous coins, currency and silver pieces $459.00 (see appraisal attached) 5 Blue Cross/Blue Shield -refund $423.86 TOTAL (also on line 5, Recapitulation) $2 958.24 D~sTO~vN B~~ A Tradition of Excellence CERTIFICATES OF DEPOSIT 77 East King Street P.O. Box 250 ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCF~I}1 ~~{~E~-17257 5060062292 Beniamin R Heineman 11/28/98 $1 670.38 Louise J Heineman SAFE DEPOSIT BOX ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED 260006 Beniamin R Heineman 12/06/99 Louise J Heineman APPRAISAL REPORT OF PERSONAL PROPERTY OF LOUISE HEINEMAN for DOUGLAS R. HEINEMAN AS OF: DOD JULY 1, 2008 REPORTED ON: NOVEMBERl, 2008 BY: FRANK R. LONEY ~~s A~~raisa~ Services r¢SN. HanoverSt. P.O. Box2¢ Garlsle~ PA r~ol3 (717) 243-3474 info@iblsappraisals.com www. ibisappratsals. com Frank R. Loney NEINEIYIAN COIN/CURRENCY APPRAISAL MovemRor 1, 2008 COINAGE 1605 Indian Cenf_ __._.~. _.__ S 8.00 1921 Peace Dollar _____ _ 75A0 1904 Indian Cep ~ 1.OA 1976 Mint Set,_.. 11.00 [13l Sihror Dollars 104.00 [25l Silver Reands _. _._ 175.00 $5.50 OOX SNver coinage.._._...~ .._... 38.00 Misc. Foreign Coins___~.. ~. ._.. 5.00 TOTAL $ 417A0 CURRENCY [2) $5.00 nete~ . .~.~. $10.00 [11I $1.00 notes ~ 10.00 [4l $2.00 notes [19761 ~ 12A0 [4) $1.00 Hates [1069, ~ 4.00 TOTAL $ 42.00 COMBINED TOTAL OF COINAGE ~ CURRENCY $ 450A0 ~~ SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Louise J. Heineman FILE NUMBER 21-08-0716 if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G Surviving Joint Tenant (s): NAME I ADDRESS I RELATIONSHIP TO DECEDENT A Douglas R. Heineman ~ 130 Wilson Street, Carlisle, PA 17013 ~ son Jointl -owned ro e ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF INSTITUTION AND BANK ACCOUNT NUMBER OR SIMB.AR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE TOTAL VALUE OF ASSET DECD'S % INT. DOLLAR VALUE OF DECEDENT'S INTEREST 1 A 10/26/05 RMA checking acct no:26006 $823.21 50% $411.60 Orrstown Bank (see letter attached) 2 A 10/26/05 Money Market acct no: $4,639.33 50% $2,319.67 106202282-Orrstown Bank (see letter attached) TOTAL (also on line 6, Recapitulation) $2,731.27 ORRSTO~IIN six A Tradition of Excellence July 8, 2008 TO: Ronald E Johnson 78 W Pomfret St Carlisle, PA 17013 FROM: Andrew G Ott Branch Executive Officer 22 S Hanover St Carlisle, PA 17013 RE: ESTATE OF LOUISE J HEINEMAN DATE OF DEATH: JULY 1, 2008 77 East King Street P.O. Box 250 Shippensburg, PA 17257 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST 260006 (RMA Checking) 05/14/97 $ 823.21 Louise J Heineman Douglas R Heineman (Added 10/26/05) 106202282 (Money Market) 05/14/97 $ 4,639.33 Louise J Heineman Douglas R Heineman (Added 10/26/05) SAVINGS ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST SCHEDULE G TRANSFERS ESTATE OF Louise J. Heineman FILE NUMBER 21-08-0716 This schedule to be comaleted and filed if the answer of the question on the reverse of the cover is ves. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. TOTAL VALUE OF ASSET DECD.% INT EXCLUSION (if applicable) TAXABLE VALUE 1 M&T Bank checking acct no: 9843932568 transferred 8/14/07 from the decedent to the decedent, Dale Heineman (son) and Douglas Heineman (son) $3,638.28 1/3% $2,425.52 $1,212.76 Exclusion based on the 2/3's interest transferred to the two sons (see letter attached) 2 IRA account no: 1678229160 Sovereign Bank-primary beneficiary-estate $17,408.04 100% None $17,408.04 Interest accured to date of death $3.34 $3.34 (see attached) TOTAL (also on line 7, Recapitulation) $18,624.14 IfJ f 1Z YJU YJ f LU L"13V1 J 499 Mitchell 12nad Millsboro, 1)clawslJ•c .1.99GC 1-888-5U2-4349 (3U2) 934-2955 fax M&TBarik F~ i -0~3 1"11YJ1! YJYJl r-col 'Co: High Street Carlisle Branch From: Charlene Warrington Fax: (717) 240-4518 Pages: 1 Phone: llatc: 7/ 14/2008 Re: Louise Heineman-Date of Death 07/01/08 ^ Urgent ^ For Review ^ Please Comment ^ Please Reply ^ Please Recycle ~ Comments: Please find below the date of death balance you had requested for the above nai~ned decedent. ' 1. Account 74,ape ........................... Checking Account Account Number ....................... 9$43932568 Ownership (Names off .............. Dale Heineman, Douglas Heineman, Louise Heineman Open.ir~.g Date ...........................08/ 14/07 (account closed 07/U7/08) Balance on Date of Death...........$3,G38.19 Accn~ed b>.terest $ 0.09 Total .......................................$3,638.28 Sovereign Bank ESTATE OF Louise J Heineman SOCIAL SECURITY #: 180-14-1789 DATE OF DEATH: July 1, 2008 Account #: 1678229160 Type IItA Open date: 3/28/2000 In the name of: Louise J Heineman Date of Death Balance: $17,408.04 Int.(YTD) from 1/1/2008 to 6/30/2008 $302.86 Accrued interest to date of death: $3.34 Other Info: Beneficiary-Primary Estate ,Contingent- None Page 1 of 1 SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER Louise J. Heineman 21-08-0716 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. Funeral Expenses: 1 Ewing Brothers Funeral Home -funeral bill $6,840.70 2 B. Administrative Costs: 1 Personal Representive Commissions Name of Personal Representative(s) Social Security Number of Personal Representative: Street Address: City: State: Zip: Year(s) commissions paid: 2 Attorney fees to Andrews & Johnson $9,408.64 3 Family Exemption Claimant Street: City: State & Zip Relationship of Claimant to Decedent: 4 Probate Fees to Register of Wills $460.00 S Accountant Fees to Gerald Brenneman, CPA $850.00 6 Tax Return Preparer's Fees 7 Special Event Emergency Medical -ambulance service $52.00 s Computershare -premium for bond for lost stock certificate $70.00 9 Embarq-final phone bill $12.43 1o Register of Wills - PA Inheritance Tax Return filing fee $15.00 11 Reserve for closing and accounting $700.00 12 13 14 iS 16 17 18 19 TOTAL (also on line 9, Recapitulation) $18,48.77 SCHEDULEI DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Louise J. Heineman 21-08-0716 Report debts incurted by the decedent prior to death which remained unpaid as of the date of death, including unreimbutsed medical expenses. TOTAL (also on line lo, Recapitulation) $491.43 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Louise J. Heineman 21-08-0716 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spouse! distributions, and Vensfen under Sec. 911b(a)(L2)] 1 Douglas R. Heineman son 25% of residue 130 Wilson Street, Carlisle, PA 17013 2 Dale L. Heineman son 25% of residue 31 Longstreet Drive, East Berlin, PA 17316 3 Jane Firestone daughter 25% of residue 1851 Spring Road, Cazlisle, PA 17013 4 Carl Heineman son 25% of residue 201 Walnut Street, Carlisle, PA 17013 5 Regina Heineman granddaughter $10,000.00 87 Uptown Road #H104, Ithaca, NY 14850 6 Andrea Heineman granddaughter $10,000.00 31 Longstreet Drive, East Berlin, PA 17316 7 Kristopher V. Heineman grandson $10,000.00 111 Plymouth Drive, Apt. 1B, Norwood, MA 02062 8 Christina Heineman granddaughter $10,000.00 201 Walnut Street, Carlisle, PA 17013 9 Stephanie Dyer granddaughter $10,000.00 460 Fairground Avenue, Carlisle, PA 17013 10 Abby Heineman granddaughter $10,000.00 107 Touchstone Drive, Cazlisle, PA 17013 I 1 James Shirley grandson $10,000.00 11 Midland Drive, Mt. Holly Springs, PA 17065 II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. Charitable and Govemmrn[sl Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on Ime Is, xecapitwatton~ ~~