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HomeMy WebLinkAbout08-31-09 (4)15056051058 REV-1500 EXcos-o5) OFFICIAL USE ONLY PA Departrnent of Revenue Courtly Code Year Fde Number Bureau of Irxfwiduat Taxes INHERITANCE TAX RETURN PO BOX 280601 ENT ~, ~ rn ©~j ~ t ` " Harrisburg, PA 1~1za-osol RESIDENT DECED V b 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 181-03-5798 11 /03/2008 07!30/1915 Decedent's Last Name Suffix Decedent's First Name MI FINKENBINDER LEE F (N 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 Retum 2. Supplemental Retum 3. Remainder Retum (date of death prior to 12-132) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum Required death after 12-122) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe DeposR Boxes (Attach Copy of III) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 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 CONFOENiU1l TAX INFORMATION SHOULD BE DHtECTED TO: Name Daytime Telephone Number SALLY WINDER ~, Fim- Name (tf Applicable) EG S OF US O Yi° First line of address 221 DOUBLING GAP ROAD Second line of address P.O. BOX 341 City or Post Office NEWVILLE Correspondent's e-mail address: State ZIP Code PA 17241 R 1 TER E NL~ ~~n L7 f"rT ~'~ (,~ ~-•; t7 a. J ~ `r"1 ~" tta DAT~FILED G1 t'J Under penalties of perjury, 1 declare that 1 have examined this return, indudirg accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaretion of preparer other than the personal represerrtative is based on all infomration of which preparer has arty knowledge. SIGNATURE F PERSON RESPQNSIBLE FOR FILING RETURN DATE) ADDRESS ~) DATE ADDRESS! V. ~ 2 ~' nbw~~c~ P~A ~ ~a,~ ~ I I I FORM ONLY Side 1 15056051058 15056051058 ..~ .t . ':a ~a i C .i ~. , ~~:~ _ .. _.«~ {, . 7 ;_ i ~, 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: LEE F FINKENBINDER 181-03-5798 RECAPITULATION 1. Real estate (Schedule A) ......... . ........................ . . . ....... . 1. 2. Stocks and Bonds (Schedule B) ...................................... . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 4. Mortgages 8 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-V-rvos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested....... . 7. 8. Total Gross Assets (total Lines 1-7) ...... . . . .......................... . 8: 9. Funeral Expenses ~ Administrative Casts (Schedule H) .................... . 9. 10. Debts of Decedent, Mortgage Liab~ities, 8 Liens (Schedule 1) ............... . 10. 11. Total Deductions (total Lines 9 & 10) .................................. . 11. 12. Net Value of Estate (Line 8 minus Line 11) ...... . . . ..... . . . . .... . ...... . 12. 13. Charitable and Govemntental 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)(12) x .0 45 1,982.29 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 1B, 17. Amount of Line 14 taxable at sibling rate x .12 17. 18. Amount of Line 14 taxable at collateral rate X -15 18- 19. TAX DUE ........................................................ . 19. 20. FILL IN TFIE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 10,033.36 38.98 10,072.34 8,090.05 8,090.05 1, 982.29 1,982.29 89.21 89.21 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number DECEDENTS NAME DECEDENTS SOCIAL SECURffY NUMBER LEE F FINKENBINDER 181-03-5798 STREET ADDRESS --- 210 BIG SPRING ROAD __ _ _ -- - CITY STATE -- ZIP -- NEWVILLE PA 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit __ B. Prior Payments C. Discount InteresUPenalty 'rf applipble D. Interest E. Penalty 0.31 (1) Tonal Credits (A + g + C) (2) Total Interest/Penalty (D + E) (3) 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) 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 89.21 0.31 89.52 89.52 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 properly 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 I'rfe 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 m 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 benefiaary designation? ............................................................................................................... ......... ^ ^Q IF THE ANSYYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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~rre 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+ (11-08) jib Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER LEE F. FINKENBINDER Ali real property owned solely or as a tenarrt 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. Real property that is jointly-owned with right of survivorship must be disdosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Indude a copy of the deed showing decedents interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. I Real estate located in Hopewell Township, Currd>'eriand Couniy, PA, in which decedent had a life estate interest as shown by deed recorded in Cumberland Cty Recorder of Deeds Book 123, Page 421.Copy of deed is attached. Valuation of real estate is Ule assessed value of 67,460 rrrwwltiplied by the Common Level Ratio of 1.26 which equals $84,999.60. Using the Nov. 2008 annual AFR from IRS Publication 1457 at the rate of 3.57% and Tat~le S for the nearest percentage, the life estate interest forage 93 (that of the decedent) yields an int- erest of .11804 which when multiplied by the value of the real estate gives a value of $10,033.36 10,033.36 TOTAL (Also enter on Line 1, Recapitulation.) I $ 10,033.36 If more space is needed, insert additional sheets of the same sae. ~j RC3ERT ?. IIEClER RECORDER Op QEEDg CUMBERLAND COUNTY-Pq '9S JUN IZ /yy 9 X40 Tax parcel no. 11-10-0612-004 T H I S D E 8 D MADE this ~~~ day of ~4~ in the year nineteen hundred and ninety-five (1996}, BETWEHN LSE F. FINKENBINLIER, widow and single woman, of 117 Green Ridge Lane, Nexville, Cumberland County, Pennsylvania, Grantor, AND SETH R. FINKENBZNDER and FAY R. FINHENBINDSR, husband and xife, of 675 Ridge Road, Shippenaburg, Pennsylvania, an undivided one-half interest, and CYNTHIA BARLETTA, eiagle woman, of Box 2010, $dgartown, Msasachusetts, a one-half interest, the said one-half interests to be held as Point teoaats xith right oY survivorship and not ea tenants in common, Grantees. WITNIiSSBTH, that in consideration of the sum of ON6 DOLLAR (= 1.00), in hand paid, 'the receipt xhereof, i^ hereby acknowledged, the acid Grantor does grant and convey in fee si=plc to said Grantees, their hcira and assigns, as their interests appear above, ALL that certain real estate or tract of farm lead situate in the Township of Hopewell in the County of Cumberland and State of Pennsylvania, and bounded and limited sa follows: BEGINNING at a point is tho Ridge Road on line of land now or formerly of John Wonders; thence by same North 16 degrees Weat 23 perches to a point; thence by lands nox or formerly of George Commerer South 83 degrees West 32.2 parches to a post; thence by the same and land now or formerly o! Jos. Chsaberlain South 73.25 degrees West 102.5 perches to a post; thence by same South 17 degrees Sast 49.8 parches to a post or stake in the Ridge Road; thence by the same North 64 degrees East 14D perches, more or less, to the place of BEGINNING. CONTAINING 33 acres and B1 perches. LESS•the following tracts previoualq conveyed: • (1) Tract containing 1.019 acres conveyed by deed from Lee E. Finkenbinder and Simon R. Finkenbinder, her husband, to Clarence L. Chamberlin and Velma C., Chamberlin, his wife, e~~z X23 PACE 42~. f .A' 19gno •19•Qa•d9 pM CI IMRFRI ANTI t`lli ~NT'V dated August 12, 1969 and recorded in Cumberland County Deed Book "I", Volume 23 at Page 468; and C2? Tract containing 3.58b acres conveyed by deed from Simon R. Finkenbinder and Lee F. Finkenbinder. his wife, to Seth R. Finkenbinder and Fay R. Finkenbinder, his wife, dated October 8, 1975 and recorded in Cumberland County Deed Book "V", Volume 28, at Page 556. BEING TRS RBNAININ4 PORTION OF RBAL HSTATB WRICB L$8 F. FINKBNBZNDSR aad SIMON R. FINKSNBINDSR, her husband and RUTB F. GRAHAM, widow, by dead dated June 24, 1989 and recorded in the office of the Recorder of Deeds in and for Cumberland County in Deed Book Volume 0-23, Page 925, granted and conveyed to LHS F. FINSBNBINDBR and SINON R. FZNKSNBINDHR, The said SZMON R. FINKSNBINDSR having died on August 3, 1992, title to the same remained vested by operation of taw solely in his surviving spouse, LES F. FINKSNBINDSR, widow and single wonan,.who is the Grantor herein. RESHRVINO AND SUBJBCT TO A LIFH HSTATH in the Grantor, LES F. FINKENBINDSR, widow and single woman, whereby she shall have exclusive posaesaian of the above-described tract of real estate and improvements for her natural lifetime. AND the said Grantor will warrant generally the property hereby conveyed. THIS IS A CONVHYANCB PROM PARHNT TO CHILDRHN AND IS TBBRBFORB EXEMPT FROM PENNSYLVANIA REALTY TRANSFER TAX. IN WITNESS WREREOF, the said Grantor has hereunto set her hand and seal the day aad pear first above written. WITNESS: ~~// ,,,, T J ~i "•r~ . ~ SSpL ~ L$S F. FIN$ENBINDSR e~4~ 123 Face 4~ _. _..... ._ _ _T ._ r~ u,oco~ nn,n n~i u~r.. ACKNONLBDOHMENT CONMONG/HALTR OF pHNNSYLVANIA SS COUNTY OF CUNSBRLAND Oa this y3~~j day of ~S"~' 1996, before me. a Notary Public. the undersigned fficer, personally appeared LHE F. FINKHNBINDSR, widow and single woman, known to me for satisfactorily proven) to be the person whose name fa subscribed to the within instrument, and acknowlndged that they executed the same for the purposes therein contained. IN WITNHSS NBSRHOF, I hereunto set my hand and of ~- seal. ~~ '•+`, Notary Publi e:~ ' P y Rt~lnlt L ~iww_Y ..~l•_~~•~~~I~~,~~~yy ~A~ ~i lilt Q~wYef+w ipYhs Altai ~/. IT91 I certify that the precise residence pfd Poet Office address of the Grantees is: 6'~' Q:s~ I~a.>/j Sh%~o/oF+t~~~y~ P/) /'~JS"7, .~/~t ~~/ Attorney for ti~antees COMMONfiBALTH OF PENNSYLVANIA 33 COUNTY OF CUNBBRLAND RECORDED in the office oY the Re rder of Deeds, etc., in and P~ said County, is Deed Boak-L~+ Volume , Page ~a~, . MITNESS my hand cad Official Seal this .:~;~'~ \~._R_. , 1996. •+-:-r+ '~"": u:,,~,~ 123 PACE ~~ Dl2009 12:39:42 PM CUMBERLAND COUNTY Inca if 1U06~~Qn~ _ o.,..,, n _~ ~ REV-7509 EX+ (698) scNEODU~ F COMMONVJEAI.TH OF PENNSYLVANIA .~~Y Q~~p ~~ERN INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LEE F. FINKENBINDER ff an asset was made joint within one yMr of the decedent's date of deatlT, it must be nNwrted on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. SETH FINKENBINDER ~ 677 RIDGE ROAD, NEVIBURG, PA 17240 ~ SON B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT 7T7MN'r PATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSITTU110N APO BANK ACCOUNT NUMBER OR SIMLAR IDFJQTIFYRJG NUJ~R. ATTACH DEER FOR JOniTLY+ELD REAL ESTATE DATE OF DEATH VALUE OF ASSET x ~ DECDS INTEREST ~~ ~ DEATH VALUE OF DECEDENTS INTEREST t • A. ORRSTOWN BANK, CHECKING ACCT NO 514926 29.13 50 14.57 A MEMBERS 1ST FCU, SAVINGS ACCT NO 65135 48.82 50 24.41 D TOTAL (Also enter on line 6, Recapitulation) I s 38.98 llf more space is needed, insert additional sheets of the same size) URRS ~'F~RSTOWNBANK A Thadition of Excellence P.O. Box 250 Shippensburg, PA 17257 Return Service Requested ~n~~~~u~~~f~~~~~i~~~n~~~~~n~u~~u~~nt~~~~ni~n~~~~~~u~ 001040 0.4804 AV 0.324 TR00004 Lee F Finkenbinder Seth R Finkenbinder 671. Ridge Road Shippensburg PA 17257-9732 Building? Buying? Remodeling? We can help! 1.888.ORRSTOWN - orrstown.com Date 12/05/08 Page 1 Primary Account 514926 Enclosures C S S C K I N G A C C O U N T S Account Title Lee F Finkenbinder Seth R Finkenbinder _._ ..__. _ ~'x'ee_ C~ecka,n~s _ ...Check. Safekeeping Account Number 514926 Statement Dates 11/06/08 thru 12/07/08 Previous Balance 29.13 - Days In The Statement Period 32 Deposits/Credits .00 Average Ledger 29.13 Checks/Debits .00 Average Collected 29.13 Service Fee .00 Interest Paid .00 Current Balance 29.13 ' Daily Balance Information Date Balance 11/06 29.13 .~ N n O~ n N n THANK YOII FOR BANKING WITH ORRSTOWN BANK sew ~: soap ~ ao eox 40 ~, Pa gross wara-mamba~slat.org ~~~~z~ IMain 9rStefiboard: (Soo) gas-2~s ez can: p,~} ss7-4a~z ~ (eoo) 2a3~ Too: pn) 6s~-5312 or (eoo) za3 xi2e era. s3,2 TNeBranch: (800) 237-7288 10554 1 AV 0.324 10554-10554 L~~IIL~~l~~I~I~I~~I~~~IiLl~~~I~,II~~I~~L~I~~~II1~~~L~l~ll LEE F FINKENBINDER 117 GREEN RIDGE LN NEWVILLE PA 17249-9484 Statement of Accounts Nov 25, 2008 thru Dec 24, 2008 Account Number: fi5135 Balances at a G1ant~ Checking Savings Certificates Loans: Money Manac Swipe 5 YTD 0.00 48.82 0.00 0.00 dement : 0.00 Reward : 0.00 Page: 1 of 1 Your aggregate balance as of December 1st is $48.82. An aggregate bafance of $2,500 and having 3 products __-_ ___ _ _.__-- --._- ___wi_ll_Qlaceyouu in he Silver MLR.level. 1099-TNT's are not included in this statement. ff you earned at least $10 in dividends on your account for 2008, you will receive your 1099-INT in a separate mai{ing in early January 2009. 1099-INT information will also be available on Members 1st Online in early January. SAVINGS ACCOUNTS Of) - REGUWR SAVINGS Date Trar~sarfiort Description Additions Subtractions Balance Nov 25 a Fora~rnl 48.77 Joint Owner: SETH R FINKENBINDER Nov 30 Deposit Dividend 1.00096 0.05 48.82 Ar-rua! Yaeek! Eanred 0.9910% fia-n »iou~ , rv3aizaoa as~c 24 Balance 48.82 YTD SUMMARIES Total Year To Date Interest Paid ~ 0.00 NOTE: Total includes closed loans Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one _of .our Associates to allow us to take your photo. This member identification program wiN assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We`-are experiencing an increasing number of attempted fraudulent activdies and as a result, we need to be able to verify your identity immediately upon retrieving your account information. TOTAL DMDENDS PAtD 00 REGULAR SAVINGS 1.94 In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking: This is for your protection and security and we appreciate your ongoing cooperation and understanding. REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~ x FUNERAL EXPENSES 8~ ADMlNISTRATiVE COSTS ESTATE OF FILE NUMBER LEE F. FINKENBINDER Debts of decedent must be reported on Sdredule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 ~ EGGER FUNERAL HOME, fiuteral account 7,196.00 LISA'S FLOWERS, casket spray 37.05 FIRST UNITED PRESBYTERIAN CHURCH, felknrtfstt~- fdki'wing funeral 82.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissiars Name of Personal Representative(s) Soaal Security Number(s~EIN Number of Personal Representative(s) Street Address City Spate Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as dairnant'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. Tip Zip TOTAL (Also enter on line 9, Recapitulation) I S (If more space is needed. insert additional sheets of the same size) 750.00 25.00 8,090.05 REV-1513 EX+ (i1-08) ~i`1 Pennsylvania '..~' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER LEE F. FINKENBINDER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. SETH FINKENBINDER, 677 RIDGE/RD, SHIPPENSBURG, PA 17257 SON 50% 2. CYNTHIA BARLETTA ZQ (Z Vo 1~/t G~': DAUGHTER 50°i6 /Ulacltil~i~.s bs~v~ ~~ rZo SS II 1 1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I ~ If more saace is needed, insert additional sheets of the same size. REV-1514 EX+ (4-09) Pennsylvania DEPARTMENT OF REVENUE Bireau of Individual Taxes Po i3aoc zso6ol Flarrisbur9 X117328-0601 scNEOU~ K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON F~V-t5oo COYER ~ ESTATE OF FILE NUMBER LEE F. FINKENBtNDER 21- This schedule should be used for all single-life, joint or successive life estate and term-certain piculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in 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. Indicate below the type of instrument that created the future interest and attach a copy of ft to the tax return. ^ W!!! ^ Intervivos Deed of Trust ®Other NAME OF LD~E T~IANT OiATE Of BIRTH t~EAiIiEST AGE AT DATE OF DEATH TERM OF YEARS LIJ~ ESTATi 7S PAYABLE LEE F. FiNKENBINDER 07/30/1915 93 ®Life or ^ Term of Years ^ Life or ^ Term of Years p Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or O Term of Years 1. Value of fund from which life estate is payable .........................................$ 84,999.60 2. Actuarial factor per appropriate table ................................................ 0 11804 Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate °~ 3. Value of life estate (Line i muldplied by Line 2) ....................................$ 10.033.36 NMR OF LIFE ANNUITANT DATE Of BIRTH NEAREST AGE AT DATE OF DEATH Tit'i161 OF YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ...........................................$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26} ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1} ^ Other ( j 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10°~ ^ Variable Rate 6. Adjustment Factor (See instructions.} ................................................ . 7, Value of annuity - If using 3.5, 6, or 10°~, or if variable rate and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 ...........................$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line 6) + Line 3 ...............................................$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting fife or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed, use additional sheets of the same size.