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HomeMy WebLinkAbout06-12-09 0 ^~ ^I I ^^ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year Fila Number Po eox zsosot INHERITANCE TAX RETURN q - Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 6 U 00305 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2'72522709 03 14 2007 05 26 1916 Decedent's Last Name B~urdge (If Applicable) Enter Surviving Spouse's Information Below Spcuse's Last Name Suffix Decedent's Frst Name MI Mary E Suffix Spouse's Frst Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) o a. Limited Estate O 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate (Attach Copy of Will) ~ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) ~ 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death I~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORIRESPONDENT -This section must be completed. All Correspondence and Conftdentlal Tax Information Should be Directed to: Narne Daytime Telephone Number Robert R. Church, Esq. 717 255 8059 Rrm Name (If Applicable) KE~efer Wood Allen & Rahal, LLP Frst line of address P.~O. Box 11963 Second line of address City or Post Office State ZIP Code H b REGISTEROF WILLS USE ONLY ~.o L :~ -~~~ :"'~ :~ =1;::9 1--.t`i erns urg PA 17108-196: C-~~j~ -~ ~ -, ~~ _.~ Correspondent's a-mail address: rchurCh~p keeferW00d.COm N c.'~ ~- ~~r Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and tothe bestof my knowledge and belief, it is true, correct and complete. Declaration of the preparer other than personal representative is based on all information of which preparer has any knowledge. SIGNf\TURE OF PERSON RESPONSIBLE FOR FILING R an , O-_ X~ClltOr ,~ DATE ADDFIESS oseph A. Macri, Vice President SE~e schedule attached SIIiNAIUHt Vh YHEFyA~RjlTtiE~FiQlJV REPRES@NTATIVE ~,,, DATE ~~/lIr``jj }I LY//y/~~{+l/~/LA//~/~/~ ~. trl n C ..~ ~ £~ ADDFESS Robert R. C urc ,Esq. ~~ 21CI Walnut Street, Harrisburg, PA 17108-1963 PLEASE USE ORIGINAL FORM ONLY Side 1 L I ^ ^^ ^I I ^^ I ^ ^^ ^I I ^^ Estate of: Mary E. Burdge Go-Executor Randall Q. Burdge 5712 Greenwood Shawnee, KS 66216 S.S.N.: 275444797 M&T Investment Group Attn: Joseph A. Macri, Vice President P.O. Box 2961 Harrisburg, PA 17105-2962 S.S.N.: 16-0538020 272522709 This return is being filed by M&T Bank, as Co-Executor, with the knowledge and approval of Randall D. Burdge, Co-Executor, who has not signed this return. ^ ^^ ^^I ^^ Rev-1500 EX Decedent's Social Security Number Decedent's Name: Mary E. Burdge 272522709 RECAPITULATION t. Real estate (schedule A) 335 000.00 2. ' .................................... Stocks and Bonds (Schedule B) 2, 82,235.18 3. Closel Held Co oration, Partnershi or Sole-Pro rietorshi Schedule C y rP P P P ( ) ...... 3. 1 ,411, 000.00 4. Mort a es & Notes Receivable Schedule D 9 9 ( ) ........................... 4. 0.00 .~. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ......... 5. 218,071.79 Ei. Jointly Owned Property (Schedule F) Q Separate Billing Requested ...... 6. 0.0~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property D S S h d l G Bi li 1 892 298 42 ( c e u e ) eparate l ng Requested ...... 7. . , E~. Total Gross Assets (total Lines 1-7) ................... 8. 3,938,605.39 9. Funeral Expenses & Administrative Costs (Schedule H) .................... 9. 406,016.73 10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 9 9 ( ) ............... 10. 89,766.47 11. Total Deductions (total Lines 9 & 10) ................................ 11. 495,783.20 12 Net Value of Estate (Line 8 minus Line 11) ..... 12 3,442,822.19 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, or transfers under Sec. 9116 ~ ~~ (a)(1.2) X .00 • 15. 16. Amount of Line 14 taxable 3 462 822 18 at lineal rate X .045 . , 16. 17. Amount of Line 14 taxable ~ ~~ at sibling rate X .12 • 17 18. Amount of Line 14 taxable O oO ai collateral rate X .15 . 18, 19. TAX DUE .................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L, I a ^a ^^I a^ 16 ^o ^^- ^^ 0.00 3,442, 822.19 0.00 155,827.00 0.00 0.00 155,827.00 LEI .___~ Rev-1500 EX Page 3 Decedent's Complete Address: Fle Number 21 00305 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Ma E. Burd a 272522709 STREET ADDRESS 846 Kiehl Drive - CITY Lemoyne STATE PA ZIP 17043 Tax Payiments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 151,200.00 C. Discount 4,800.00 Total Credits (A + B + C) 3. Interest/Penalty if applicable D. I riterest 0.00 E. Penalty 0.00 Total Interest/Penalty (D + E) 4. If LI ne 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. 5. If Lirn~ 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (1) 155,827.00 (2) 156, 000.00 (3) 0.00 (a) 173.00 (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 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;,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ~( 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 "intrust 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? .......................................... 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. Sect. 9116(a)(1.1)(i)J. 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. Sect. 9116(a)(1.1)(ii)]. The statue 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 df;ath on or after July 1, 2000: The tax rate irriposed 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. Sect. 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. Sect. 9116(1.2) [72 P.S. Sect. 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. Sect. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV -1502 EX+(6-98) SCHEDULE A COA4 NHERITANCEOTAXRETURNANIA REAL ESTATE RESIDENTDECEDENT ESTATE OF FILE NUMBER Mary E. Burdg~ 21 00305 All real property owned solely oras a tenant in common must be reported affair marketvalue. Fair marketvalue is defined as the price at which property would be exchanged between a willing buyerand a willing seller, neither being compelled to buy orsell, both having reasonable knowledge of the relevantfacts. Real property which isjointly-owned with right of survivors hip must be disclosed on Schedule F. ITEM VALUE AT DATE N:!l:913ER DESCRIPTION OF DEATH 1 Residence located at 846 Kiehl Drive, Borough of Lemoyne, Cumberland 335,000.00 County, Pennsylvania, per Deed to Mary Elizabeth Burdge, the Decedent, dated July 23, 1975 and of record in the Office of Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book "E", Volume 26, Page 104, et seq., valued per appraisal of Robert Jones and Associates TOTAL (Also enter on line 1, Recapitulation) I 335,000.00 (If more space is needed, insert additional sheets of the same size) REV -1603 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA I STOCKS & BONDS INHERITANCETAX RETURN RESIDENTDECEDENT ESTA"rE OF FILE NUMBER Mary E. Burdge 21 00305 (If more space is needed, insert additional sheets of the same size) REV -1!i04 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Mary E. Burdge 21 00305 Schedule C-1 or C-2 (includ ing all supporting information) must be attached for each closely-held corporation/partners hip interest otthe decedent, other than a sole-proprietorship. See instructions forthe supporting information to be submitted forsole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV -1508 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDlJLE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Mary E. Burdge 21 00305 T 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 Scheduel F. ITEM NUti1BER DESCRIPTION VALUE AT DATE OF DEATH 1 M&T Bank Checking Account #18620493 1 ~ ~-~_.- --- 2 703.01 Balance on Date of Death - $2,702.95; Accrued Interest - $0.06 2 Estimated Federal Income Tax Refund Receivable for Decedent's 2008 Form 62,500.00 1040 3 Estimated PA Income Tax Refund Receivable for Decedent's 2008 Form PA- 12,168.00 40 4 Decedent's federal income tax refund for 2007 Form 1040 73,098.00 5 Decedent's PA state income tax refund receivable for 2007 Form PA-40 11,502.00 6 Humphries Kirk, solicitor's client trust account cash (£1,707.48 x 2.03110 3,468.06 inter-bank exchange rate on date of death = $3,468.06) 7 £ 2,817.30 uncashed dividends from St. James Place plc (£ 2,817.30 x 5,722.22 2.03110 inter-bank exchange rate on date of death = $5,722.22) 8 Cash Receivable from Burdge MoKan Partners, L. P. 24,483.00 9 Estimated MO Income Tax Receivable for Decedent's 2008 Form MO-1040 136.00 10 Household Goods and Automobile, per appraisal of George E. Harr, 5,696.50 Auctioneer 11 Jewelry, per appraisal of Tom Tivol Jewelry and Gemstone Appraisals 16,595.00 TOTAL (Also enter on line 5, Recapitulation) 218,071.79 (If more space is needed, insert additional sheets of the same size) REV -1510 EX+(8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Mar}r E. Burdge 21 00305 This schedule must be completed and filed if the answerto anyof questions 1 through 4 on the reverse side of the REV-1500 COVER SH EETis yes. ITEM NUM DESCRIPTION OF PROPERTY INCLUDENAMEOFTRANSFEREE,RELATIONSHIPTODECEDENT& DATE OF TRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OFDEC'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 $12,000 Cash Annual Exclusion Gifts to 7 84,000.00 21,000.00 63,000.00 children/grandchildren (January 2008) 2 35,000 shares of Aetna Inc. 39,725.00 ex-dividend on above item 196.52 3 '25,000 shares of Harsco Corp common 1,371,000.00 4 Trust Account, Money Market (Principal) 207,084.17 Accrued Interest on Trust Money Market 813.26 (income) 5 Proceeds from pre-mortem liquidation: 42,219.53 2,200 shares Citigroup Cap IX Pfd 6% 6 Proceeds from pre-mortem liquidation: 50,396.94 2,125 shares BAC Cap Tr 11 PFD 7% 7 Proceeds of pre-mortem liquidation: 54,890.39 2,200 shares Gen Elec Cap PFD 6.1 8 Proceeds from pre-mortem liquidation: 47,426.97 2,250 shares JP Morgan Chase Cap XI PFD 5.875% ex-dividend on above item 826.16 9 Trust Account, Money Market (Income) 14,696.25 Accrued interest on above item 23.23 TOTAL (Also enter on line 7, Recapitulation) 1,892,298.42 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-OB) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mar)r E. Burdge 21 00305 Debts of decedent must be reported on Schedule I. ITEM NUMMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers-Harner Funeral Home, Inc. 2,248.00 2 Myers-Harner Funeral Home, Inc. -advertising mem. service 66.00 3 Unitarian Church of Harrisburg -Memorial Service 1,000.00 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions 160,000.00 Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: ~~. Attorney Fees 160,000.00 .,. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) CI ai mant Street Address 4. 5. 6. City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparel's Fees See schedule attached 410.00 82,292.73 TOTAL (Also enter on line 9, Recapitulation) I 406,016.73 (If more space is needed, insert additional sheets of the same size) Estate of: Mary E. Burdge Schedule H, Part B -Administrative Costs Miscellaneous Expenses Page 2 21 00305 Item Number Description Amount 7 George Harr Auctioneer -Appraisal Fee 100.00 8 Gavin F. Burdge -Reimbursement of Expenses 158.14 9 Randall D. Burdge -Reimbursement of Expenses 2,638.38 10 Gavin F. Burdge -Reimbursement of Travel Expenses 195.00 11 Tom Tivol Jewelry & Miscellaneous -Appraisal of Jewelry 609.00 12 Appraisal & Consulting -Appraisal of Burdge MoKan Partners real estate 5,250.00 (50%) 13 Gavin F. Burdge 213.00 Reimbursement of Travel Expenses 14 Gavin F. Burdge, Reimbursement of Expenses 70.01 15 Gavin F. Burdge, Reimbursement of Expenses 147.00 16 Gavin F. Burdge, Reimbursement of Expenses 186.82 17 Keefer Wood Allen & Rahal, LLP, Attorneys' Disbursements Incurred to June 358.21 30, 2008 18 Keefer Wood Allen & Rahal, LLP, Estimated Attorneys' Disbursements to 1,300.00 Complete Administration 19 Gavin Burdge -Reimbursement 114.61 20 RSR Appraisals & Analysts -Appraisal Fee 350.00 21 Robert Jones & Associates -House Appraisal Fee 325.00 22 Gavin F. Burdge -Reimbursement of Expenses 183.87 23 Randall D. Burdge -Reimbursement of Co-Executor's Expenses 4,744.42 24 Gavin F. Burdge -Reimbursement of Expenses 70.83 25 Beard Miller Company, LLP -Valuation of Burdge MoKan Partners, LP 3,950.00 26 Jeremey J. Burdge -Reimbursement for Memorial Service 1,923.61 27 Gavin F. Burdge -Reimbursement of Expenses 96.12 TOTAL. (Carry forward to main schedule) ...... 22,984.02 Estate of: Mary E. Burdge Schedule H, Part B -Administrative Costs Miscellaneous Expenses Page 3 21 00305 Item Number Description Amount 28 Clearwater Pool Care, Inc. 336.66 29 SES Insurance Brokerage Serv. Inc., homeowner's insurance 40.00 30 MCI, telephone service 115.15 31 Gavin F. Burdge -reimbursement 80.44 32 Gavin F. Burdge -reimbursement 348.43 33 Clearwater Pool Care, Inc. 220.64 34 Karns Foods, misc. expenses 372.19 35 Appraisal & Consulting, valuation of Burdge MoKan, LP real estate (final 50%) 5,250.00 36 Gavin F. Burdge -reimbursement 158.18 37 MCI, telephone service 116.36 38 Comcast Cable 101.69 39 Pennsylvania American Water 40.65 40 PPL Electric Utilities 12.93 41 Beard Miller Company, LLP -accountant services 3,580.00 42 Beard Miller Company, LLP -tax preparation services and advice 7,250.00 43 Gavin F. Burdge -reimbursement 295 82 44 Beard Miller Company, LLP -accountant -tax services and advice 12,625.00 45 Lemoyne Borough -sewer and refuse 116.00 46 Pennsylvania American Water 41.33 47 Gavin F. Burdge -reimbursement 87 32 48 PPL Electric Utilities 170.69 49 Gavin F. Burdge -reimbursement 36.24 50 Beard Miller Company, LLP -tax return preparation 1,267.50 TOTAL. (Carry forward to main schedule) ...... 32,663.22 Estate of: Mary E. Burdge Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description 51 MCI, telephone service 52 Clearwater Pool Care, Inc. 53 MCI, telephone service 54 Gavin F. Burdge, reimbursement of expenses 55 Gavin F. Burdge, reimbursement of expenses 56 PPL Electric Utilities 57 D.J. Maintenance, snow shoveling 58 Gavin F. Burdge, reimbursement of expenses 59 Gavin F. Burdge, reimbursement of expenses 60 D.J. Maintenance, snow shoveling 61 Gavin F. Burdge, reimbursement of expenses 62 D.J. Maintenance, snow shoveling 63 Gavin F. Burdge, reimbursement of expenses 64 Gavin F. Burdge, reimbursement of travel expenses 65 Gavin F. Burdge, reimbursement for final electric bill on house 66 PPL Electric Utilities 67 Pennsylvania American Water 68 Comcast Cable 69 Register of Wills, Short Certificate fee 70 Randall D. Burdge, reimbursement of Co-Executor's travel expense 71 Beard Miller Company, LLP - 2008 Form 1040 projection 72 MCI, telephone service 73 Comcast Cable Amou Page 4 21 00305 107.30 219.90 99.75 121.51 126.55 213.73 55.00 119.00 129.65 82.50 102.20 82.50 156.20 167.00 63.59 125.97 31.97 108.96 4.00 448.10 2,925.00 93.75 111.12 TOTAL. (Carry forward to main schedule) ...... 5,695.25 Estate of: Mary E. Burdge Schedule H, Part B -Administrative Costs Miscellaneous Expenses Page 5 21 00305 Item Number Description Amount 74 Pennsylvania American Water 37.86 75 PPL Electric Utilities 312.72 76 MCI, telephone service 139.38 77 Pennsylvania American Water 35.03 78 Comcast Cable 113.57 79 PPL Electric Utilities 242 74 80 Lemoyne Borough -sewer and refuse 120.50 81 MCI, telephone service 90.43 82 Pennsylvania American Water 33.62 83 Comcast Cable 164.00 84 SES Insurance Brokerage, Homeowner's Insurance 50.00 85 PPL Electric Utilities 128 77 86 Faith A. Nicola, Tax Collector, Borough and County Real Estate Taxes 1,439.57 87 Beard Miller Company, LLP, final accounting fees for 2008 tax returns 1,281.00 88 Beard Miller Company, LLP, final charges for valuation of Burdge MoKan 7,735.80 Partners, L. P. 89 Beard Miller Company, LLP, tax and accounting services 8,625.25 90 United States Treasury, estimated interest expense for federal estate tax 400.00 liability/underpayment per Est. of Chas. A. Bahr, 68 TC 74, acq. 1978-1 CB1 TOTAL. (Carry forward to main schedule) ...... 20,950.24 REV-1512 EX+(12-03) SCHEDULE I C:OMMONWEALTHOEPENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENTDECEDENT ~ ESTATE OF FILE NUMBER Mary E. Burdge 21 00305 Report debts incurred by decedent prior to death which remained unpaid as of date of death, including unrelmbursed medical expenses. ITEM NUMBER pESCRIPTION VALUE AT DATE OF DEATH 1 PPL Electric Utilities -Utility Payment 168.19 2 Secco Home Services -Air Duct Cleaning 1,851.19 3 Heritage Medical Group, LLP -Medical Payment 99.55 4 Faith A. Nicola, Tax Collector -Personal Taxes 9,80 5 Faith A. Nicola -Tax Collector-Real Estate Tax 1,262.71 6 Borough of Lemoyne -Utility Payment 116.00 7 Blue Mountain Health & Body Work 172.50 Massage Services 8 Comcast Cable -Cable Charges 101.68 9 Pennsylvania-American Water Company 62.13 10 Cumberland Apothecary -Prescription Expense 24.00 11 MCI, telephone service 107.58 12 Karns Food, decedent's account 441.47 13 Rescare, Decedent's Home Nursing Care, from 9-24-07 to 3-14-08 (all paid 75,474.00 post-mortem) 14 Keefer Wood Allen & Rahal, LLP 1,329.97 legal fees for pre-mortem services 15 Pennsylvania-American Water Company 44.58 16 Comcast Cable 101.68 17 PPL Electric Utilities Corp. 340.88 18 PPL Electric Utilities 509.07 Utility Payment 19 MCI, telephone service 144.19 20 Karns Foods, decedent's account 291.82 Total from continuation Schedule(s) 7,113.48 TOTAL (Also enter on line 10, Recapitulation) 89,766.47 (If more space is needed, insert additional sheets of the same size) Page 2 Estate of: Mary E. Burdge 21 00305 Schedule I -Debts of Decedent, Mortgage Liabilities, and Liens Item Number Description Value at Date of Death 21 Comcast Cable 101.68 22 Pennsylvania-American Water Company 35.69 23 Lemoyne Borough -Sewer and Refuse 116.00 24 Comcast Cable 101.68 25 MCI -Utility Payment 72.00 26 Pennsylvania-American Water -Utility Payment 34.99 27 Karns Foods 448.84 28 Chubb Group -Homeowner Policy 2,544.00 29 Jack Huggins -Lawn Care 245.00 30 Karns Foods 342.98 31 Comcast Cable -Cable Charges 101.69 32 Pennsylvania-American Water -Utility Payment 72,99 33 Faith A. Nicola, Tax Collector, School Real Estate Tax on 846 Kiehl Drive 2,895.94 TOTAL. (Carry forward to main schedule) ...... 7,113.48 REV -1513 EX+(g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES INHERITANCE TAX RETURN RESIDENTDECEDENT ESTATE OF FILE NUMBER Mary E. Burdge 21 00305 NuMee NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llst Trustees AMOUNT OR SHARE OF ESTATE r TAXABLE DISTRIBUTIONS [include outright spousal distributions and , transfers under Sec. 9116(a)(1.2)] Randall D. Burdge Son 1,133,274 06 5712 Greenwood Shawnee, KS 66216 Jeremy J. Burdge Son 1,133,274.06 3789 Cemetery Road Hilliard, OH 43026 Gavin F. Burdge Son 1,133,274.06 335 F Street, NE Washington, DC 20002 Annual Exclusion Donees (7) $9,000 each Children/Grandchildren 63,000.00 ENTER DOLLARAMOUNTS FOR DISTRIBUTIONSSHOWN ABOVEON LINES 15THROUGH 18, AS APPROPRIATE,ONREV-1500 0OVERSHEET Tz NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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)