The URL can be used to link to this page

Home My WebLink About06-12-091505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box.2aosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 9 018 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 17 2009 10 10 1920 Decedent's Last Name Suffix Decedent's First Name MI EiILE RICHARD g (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 IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3, Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ qa Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required g Decedent Died Testate (Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe De osit Boxes p 9. Litigation Proceeds Received ~ 1 p_ Spousal Poverty Credit (date of death 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 SHOULD BE DIRECTED TO: Name Daytime Telephone Number FOREST N MYERS 717 532 9046 Firm Name (If Applicable) LAW OFFICE FOREST N MYERS REGISTER OF WILLS USE ONLY r.a First line of address n c-~ C ~ .°ca 137 PARK PLACE WEST ~ c- ~-~'=`~ ~ C ._~ c~J7 Second line of address ==~t~- ~ `~ t:-i j L~,,,,,, {'7'T ~ _r ..~ ,t .~CJa~ ~ ~:f' i~~j City or Post Office DA ~"' ^~ ~= State ZIP Code ,„.,_. SHIPPENSBURG PA 17257-9212 ~ ~ ~~~ Correspondent'se-mail address: fnmyers@lawofficeforestmyers.com 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. SIGI TURE OF PERSON RESPONSIB FOR FILING RETURN DATE ~ ~ Janet L SCOTT ~ ~ ADDR 12325 Buchanan Trail W, Mercersburg, PA 17236 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE _ Forest N Myers ADDRESS 137 Park Place West, Shippensburg, PA 17257-9212 Side 1 1505607120 1505607120 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF HILE:, Richard H 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 Hrhich preparer has any knowledge. FILE NUMBER 21-09-0185 Signature #2 X Name Address1 Address2 City, State, Zip 10005 Date Rp Shippensburg, PA 17257 ~' 1505607220 REV-1500 EX Decedent's Social Security Number oecedenes Name: R I C it a rd H H i i_ E RECAPITULATION -_. 1 . Real Estate (Schedule A) ...................................................................................... .... 1. 2 . Stocks and Bonds (Schedule B) ........................................................................... .... 2. 3 . Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)...... .... 3. 4. Mortgages ii< Notes Receivable (Schedule D) ...................................................... .... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. ... 5. 2 3 , 3 8 3 3 4 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .......... ... 6. 6 4 , 2 2.5 7 2 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ~ Separate Billing Requested .......... ... 7. 8. Total Gross Assets (total Lines 1-7) ...................................... _ ............................... .. g. 8 7, 6 0 9. 0 6 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... .................. .. s. ------ - 2 , 4 4 6 . 5 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 3 9 4 5 3 11. Total Deductions (total Lines 9& 10) .................................................................... .. 11. 2, 8 4 1 0 3 12. Net Value of Estate (Line 8 minus Line 11) ........................................................ .. 12. 8 4 7 6 $ 0 3 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. 8 4 , 7 6 8 0 3 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 .o0 0. 0 0 15. 0 0 0 16. Amount of Line 14 taxable . at lineal rate x .045 8 4, 7 6 8. 0 3 16. 3 814 5 6 17. Amount of Line 14 taxable , . at sibling rate X .12 0. 0 0 17. 0 0 0 18. Amount of Line 14 taxable . at collateral rate X .15 0 0 0 18. 0 0 0 1'9. Tax Due ..................................................................................................................... 19. 3,814.56 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 1505607220 J REV-1:100 EX Page 3 Decedent's Complete Address: cITY Shippensburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Inter•est/Penalty if applicable D. Interest E. Penalty Richard H HILE 299 Roxbury Road 3,000.00 157.89 File Number 21-09-0185 STATE ZIP PA 17257 Total Credits (A + B + C) 4. 5 Total Interest/Penalty (D + E) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check boz on Page 2 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1> 3,814.56 (2) 3,157.89 (3) (4) (5) (5A) (56) 656.67 656.67 Make Check Payable to: REGISTER OF W/LLS, AGENT 1. Did decedent make a transfer and a. retain the use or income of the property transferred :.............................. Yes No .. .................................................. I x 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? ......................... i ~x ......................... 2. If death occurred after December 12, 1982, did decedent transfer roe ~ u receiving adequate consideration? ....................... p p rtY within one year of death without .................................... 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?............ ^ ^ .. ....................... ................................................................................. 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, 1554 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving s~oouse 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 rates 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. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS LAST WILL AND TESTAMENT OF RICHARD H. HILE I, RICHARD H. HILE, of the Borough of Shippensburg, 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 Wi 11 s and. Codici 1 s thereto, heretofore, made by me. -- __ _ _ - __ FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as c:onveniently may be done. In the event I am not the owner of a cemetery lot at the time of my death, I direct my Executrix to purchase such lot with a contract for perpetual care and to improve the lot and have erected thereon a suitable monument and marker, using therefor funds from my estate in such amount as she i:n her sole discretion shall deem advisable. SECOND i~~ `~ r .1 ~J ,;; I give, devise and bequeath all my property, whether real or personal, tangible or intangible, together with all insurance policies thereon, unto my wife, VADA V. HILE, provided she shall survive me by thirty (30) days. In the event my wife fai 1 s to survive me by thirty (30) days, I then give, devise and bequeath all my estate whether real or personal property, tangible or intangible, together with all insurance policies thereon 1 unto my children, JANET L. SCOTT and BETTY J. GEPHART, provided they shall survive me by thirty (30) days, in as nearly equal shares as possible, er stirpes. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate unto my wife, VADA V. HILE, provided she shall survive me by thirty (30) days. In the event my wife fails _. _ __ to survive me by thirty (30) days, I then give, devise and ;bequeath all the rest residue and remainder of my estate, in as ___ nearly equal shares as possible unto such of my children as shall survive me by thirty (30) days, er stirpes. -----~-_ FOURTH I hereby direct that all inheritance, estate or transfer taxes imposed upon my estate, whether passing under this my Last Will and Testament or otherwise, be paid out of my estate. FIFTH Any and all sum or sums, whether in cash or in kind and whether for principal or income, payable to the beneficiaries, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made and free from anticipation, alienation, assignment, attachment or pledge and free from control by the creditors of such beneficiary. All shares of principal and income herein given shall be free from ..~ ani~icipation, assignment, pledge or obligation of any beneficiary -'~`-. and shall not be subject to any execution or attachment. c SIXTH I nominate, constitute and appoint my wife, VADA V. HILE, s,~ ~,~~ Executrix of this my Last Will and Testament. In the event of 2 the death, resignation, renunciation or inability to act for any reason whatsoever of my said wife, I nominate, constitute and appoint my daughters, JANET L. SCOTT and BETTY J. GEPHART, or the survivor, Executrices of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties as such in any jurisdiction in which.. she may be_called upon_to act,_insofar as I am able by law to do so. - ~ l~ (~LT1~E~~-WH-E32EE}F, ~-h-a-~r eYre~ e trn-t-ose ~ any-~ta~d_~nd- se-a~ to-- _ __ this my Last Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature :in the margin for the purpose of identification this ~ day of __ ..~~_ , 19 8 6 . Richard H. Hile Testator SIGNED, SEALED, PIIBLISHED AND DECLARED by the above named Testator, RICHARD H. RILE, as and for his Last Wi 11 and Testament, in the presence of us who at his request and in his sight and presence and in the sight and presence of each other have hereunto subscribed our names as witnesses: L', /~ ~ ~f~ Lr r C~ l'iZ Z.,~F' 3 COMMONWEALTH OF PENNSYLVANIA . SS COUNTY OF FRANKLIN I, RICHARD H. HILE, the Testator whose name is signed to the 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 1the purposes therein expressed. - -- Richard H. Hile Testator ~~worn or affirmed to and acknowledged before me by Richard H. Hile, Testator, the ~,~ day of ~zh rctc_rt 1986. N~)t"Glry Yub.LIC; .~~~r'iyC~s~~ip v1i f~'~J~~ ~V ~9f 3i1}' ~~iF~ ' COMMONWEALTH O~~m~~: 'A~ `~ °', F ~~ 7 1`Sj~;'i~A~ 1V1Ei Ai1f$ SS CC-UNTY OF FRANKLIN We, ~ ~"E~~S/-- /~}, l~le .r"s and -_ ~}~/Ctr•Lj ~a ~/c~r~~. witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw RICHARD H. RILE, Testator, execute the instrument as his Last Will and Testament, that he signed it willingly and that he executed as his free act and voluntary act for the purposes therein expressed; that each of us in the 4 r hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen or more years of age and under no constraint or undue influence. me by rc~ es ~ !V. ~~~-~r~ and _l~ ~lz'r-~f ~ C'~a r-~ witnesses, this ~rz~ da of ~" y F ~ f'Ltci-''"~~r , 1986. ~' ~~ "~ Notary Public My CommiFss~ ion Exnp{firfex^st :1 ~[t~fuL PS. LoY ~-~ei:3 Ci 6l L+li~~7 Y°V 'L.~'L~Qe so~r~F~r~~~~ra ~~a~. P~€~ra~i€~s ~~~r~r~ ~v c~~~ds~~~~~ ~n•~s~~~ .~~~. ~, z~R~ Pw9s~nb~r, pG?rsy~va~~aa ~s~G~ia~r~r~ of t~a4arr~, 5 Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY c~tHrC Vr HILE, Richard H Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on schedule F. ITEnn NUMBER DESCRIPTION VALUE AT DATE 1 Members 1st Share Savings OF DEATH 5.00 2 Orrstown Bank Checking 22,525.62 Accrued interest on Item 2 through date of death 1.42 3 Certificates of Deposit -Interest earned on various CD's 228.90 4 Deposit -tax refunds 613.00 5 Embarq -Deposit for refund 9.40 TOTAL (Also enter on Line 5, Recapitulation) I 23 383 34 (If more space Is needed, addltlonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) FILE NUMBER 21-09-0185 Rev-150SI EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF HILE, Richard H LE NUMBER 21-09-0185 A. Janet L SCOTT B. Betty J GEPHART C 10005 Newburg Rd Shippensburg, PA 17257 Daughter JOINTLY OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY NUMBER FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH % OF DATE OF DEATH TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET DECD'S ' O JOINTLY-HELD REAL ESTATE. INTEREST DECEDENT S IN TEREST 1 A ~ B 11/7/20 08 FPM Trust -Certificate of Deposit; ; 59 972 22 jointly held with Betty Gephart and Janet , . 33.333% 19,990.74 Scott; made joint 11/07/2007 2 A 8: B 5/12/2008 F&M Trust -interest to date of death on CD 33.81 33.333% 11.27 3 A 8t B 4/8/2008 Members 1st *63-41 -Certificate of 38,000.00 33.333% 12,666.67 Deposit; jointly held with Betty Gephart and Janet Scott; opened 04/05/08 from funds moved from matured F&M Trust CD that was originally made joint 04/07/2007 4 I A & B 14/8/2008 I de h on CDt *63-41 -interest to date of I 53.30 I 33 17.77 5 A & B 8/6/2007 Members 1st *63-42 -Certificate of 15,000.00 33.333% 5,000.00 Deposit; jointly held with Betty Gephart and Janet Scott; opened 03/07/08 from funds moved from matured Orrstown Bank CD that was originally made joint 08/06/07 Total of Continuation Schedule TOTAL (Also enter on Line 6, Recapitulation) attached page Rd 995 77 •• a•• ~~~~ was maae lomt wrthin one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT 12325 Buchanan Tr W Daughter Mercersburg, PA 17236 (It more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY continued ESTATE OF HILE, Richard H LE NUMBER 21-09-0185 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY DESCRIPTION OF ITEIM LETTER DATE PROPERTY NUME3ER FOR JOINT TENANT MADE JOINT INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR DATE OF DEATH % OF DECD'S DATE OF DEATH VALUE O JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST F DECEDENT'S INTEREST 6 A ~ B 2/5/2009 Members 1st *63-42 -Accrued interest to 16 03 33 333% date of death . . 5.34 7 A 8~ B 10/25/2004 Orrstown Bank *4722 -Certificate of 59,371.79 33.333% 19 790 60 Deposit; jointly held with Betty Gephart , . and Janet Scott; made joint 10/25/04 A 8 B 4/1/2008 Accrued interest on Item 7 through date 80 52 33 333% of death . . 26.84 8 A & B 11/8/2004 Orrstown Bank *4949 -Certificate of 20,132.79 33.333% 6 710 93 Deposit; jointly held with Betty Gephart , . and Janet Scott; made joint 11/08/04 A 8~ B 11/8/2004 Accrued interest on Item 8 through date 16 69 33 333% of death . . 5.56 TOTAL (Also enter on Line 6, Recapitulation) 64,225.72 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) REV-1151 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS HILE, Richard H FILE NUMBER 21-os_n~Qs Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: Fogelsonger-Bricker -balance of funeral expenses AMOUNT 170.00 B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Law Office Forest N Myers 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 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,917.50 359.00 TOTAL (Also enter on line 9, Recapitulation) 2,446 50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF HILE, Richard H ( FILE NUMBER 21-09-0185 ITEIM NUME3ER DESCRIPTION AMOUNT Attorney Fees 1 Law Office Forest N. Myers -fees as counsel for personal representatives for services including preparing and filing all necessary documents; office and phone 1.917.50 consultations with personal representatives and other work in connection with the administration of the estate H-62 Subtotal 1,917.50 Other Administrative Costs 2 Cumberland County Register of Wills -fee for Petition of Letters Testamentary 135.00 3 Cumberland County Register of Wills -fee for filing Will 15.00 4 Cumberland County Register of Wills -fee for Automation & JCP 15.00 5 Cumberland County Register of Wills -fee for Short Certificates 24.00 6 Cumberland County Register of Wills -additional probate fee for Petition of Lett ers Testamentary 125.00 7 Cumberland County Register of Wills -filing fee for filing Inheritance Tax Return 15.00 8 Tammy Gephart -tax preparation 30.00 H-B7 Subtotal 359.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-151:! EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT , MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HILE, Richard H FILE NUMBER 21-09-0185 Include unreimbursed medical expenses. ITEIM NUME3ER DESCRIPTION VALUE AT DATE 1 Embarq -payment for telephone service OF DEATH 56.75 2 Penelec -payment for electric service 91.24 3 Penelec -payment for electric service 29.52 4 Penelec -payment for electric service 2.22 5 Real Estate taxes -Two months prorated 74.19 6 Shippensburg Borough Authority -payment for water/sewer/garbage service 130.61 7 Shippensburg Healthcare Center -payment for cable service 10.00 TOTAL (Also enter on Line 10, Recapitulation) I 394 53 (If more space Is needed, addltlonal pages of the same size) Copyright (c:) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV•1513 EX+ (g_00) S CHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDE NT DECEDENT ESTATE OF HILE, Richard H FILE NUMBER 21-09-0185 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO PERSON(S) RECEIVING PROPERTY DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE I~ TAXABLE DISTRIBUTIONS [include outright spousal DO Not List Trustee(s) distributions, and transfers (Words) ($$$) under Sec. 9116(a)(1.2)] Betty J GEPHART Daughter 10005 Newburg Rd One-half (1/2) 42 384.02 ' Shippensburg, PA 17257 net distributable Janet L SCOTT Daughter 12325 Buchanan Trail W estate One-half (1/2) 42,384.02 Mercersburg, PA 17236 net distributable estate ~ I Total 84,768.04 _ Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 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 0 00 Copyright ( ) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)