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HomeMy WebLinkAbout11-30-09 (2)J 15056051058 REV-1500 Ex (D6-05, PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 1111 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 002-03-3618 10/24/2008 02/07/19 Decedent's Last Name Suffix Page (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number 17 Decedent's First Name MI John F Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate _ _ 7. Decedent Maintained a Livin Trust 1 (Attach Copy of Will) (Attach Copy of Trust) g 8. Total Number of Safe Deposit Boxes 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Joseph A. Macri Trust Firm Name (If Applicable) M & T Investment Co-Ex. First line of address PO Box 2961 Second line of address 213 Market St. City or Post Office Harrisburg ra ca REGISTER ~VyjLLS USE ~Y _ . Y ~ f... J r,, ;- r-r~ W -. . _~ ._ - . ~ ~~ _t\ _ C ~ ~ ._.J r ) -:-t ~ .; .~ ~ ' --+ t State ZIP Code Da~FILED .~- :; PA 17101 - ~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIC~NA;.t~}~E,O~F PERSON RESPONSIBLE FOR FILING RETURN ~ ~, ~ Lam, _~7 ~~~~~ DATE ADDS ~~ - ---- _ , ,~~~, PO @ax 2961 H rrisburg P 171 ~~ ~ ~ - _ _ SIGNATURE F PR ARER OTHER T" N P ESENTATIVE ~^~ "'~ -_ DATE ~ 607 S. Market St. Selingsgrove PA 17870 T PLEASE USE ORIGINAL FORM ONLY 1 505605 1 058 Side 1 15056051.058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name John F Page - •~----- , ._ _ ._._ _,_,,_ . ~ 002-03-3618 RECAPITULATION " _~~~~ `° °`" °"°` 1. Real estate (Schedule A) . ... .. ... .... ..... ...... ... 1 140,000.00 2. Stocks and Bonds (Schedule B) ... .... ....... ............ ...... .. . 2. 389,866.63 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3 . .... . 0.00 4. Mortgages & Notes Receivable (Schedule D) .................. ..... ... . a. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5 . 139,420.61 6 Jointly Owned Property (Schedule F) :: ~'° Separate Billing Requested g .... 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property , ... 0.00 (Schedule G) ~ •--~ b~. Separate Billing Requested_ ... Z ... 0.00 8 Total Gross Assets (total Lines 1 7) .. . _„ _ _,_._~_ __ ~~ _~_,. ~ ~ ~ " ~ ~ ~ .e $ 669,287.24 9. Funeral Expenses & Administrative Costs (Schedule H) .. . 9 82,996.28 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........... 10 .. . . 2,695.89 11. Total Deductions (total Lines 9 & 10).... .. 11. 85,692.17 12. Net Value of Estate (Line 8 minus Line 11) .. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12. 583,594.54 an election to tax has not been made (Schedule J) . ........... ...... .. . 13. 0.00 14 Net Value Subject to Tax (Line 12 minus Line 13) ~.. -__~_ .~_~~~_,~._. ~ _..~...~._ ~ ~ ~ ~ ~._ .., TAX COMPUTATION -SEE IN ~~ ~--~- 1a. 583,594.54 STRUCTIONS FOR APPLICABLE RATES _. .z_ -__ 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 ~~ ~' "" `-~~~ -~ 15. at lineal rate X .0 45 583 594 54 , . 17. Amount of Line 14 taxable ~ 1s 26,261.75 . at sibling rate X .12 18 Amount of Line 14 taxable ' 17. at collateral rate X .15 _ 18 19. TAX DUE.......... 1 s 26,261.75 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 Ktv-iSUU EX Page 3 Decedent's Complete Address: John F Page STREET ADDRESS 711 South Market St. - - -- -- --- ------ - clTV Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit ______ B. Prior Payments C. Discount _ ------- 3 Interest/Penalty if applicable D Interest E. Penalty File Number 21 08 1111 DECEDENT'S SOCIAI SECURITY NUMBER ______ 002-03-3618 STATE ------~ ZIP --- PA I 17055 (1) 25,000.00 1,315.79 Total Credits (A + B + C) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal Interest/Penalty (D + E) (3) Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (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 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 ................................................ ............................................................ . 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? . ^ ^ . ............................ . .......... K 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............ x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^ contains a beneficiary designation? ................................_ r-, 26,261.75 26, 315.79 54.04 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a} (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does no_ t 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 race 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. Kt. .... ~ ~.-t.-'. Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF John F Page FILE NUMBER 21-08-1111 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. NUMBER ITEM include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE DESCRIPTION OF DEATH 1' Safe Value- Single family dwelling situate 711 South Market Street in Second Ward of the Borough of Mechanicsburg, further identified in the Recorder of Deeds, Deed Book H21 Page 1014 County of Cumberland, If more space is needed, insert additional sheets of the same size. TOTAL (Also enter on Line 1, Recapitulation.) I $ 140,000.00 140.000.00 REV-1503 EX+ (6-98j SCI~iEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN F PAGE FILE NUMBER 21-08-1111 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ 250 SHARES ALCATEL-LUCENT SPONSORED ADR OF DEATH 0 491.25 2 480 SHARES ALTRIA GROUP INC COM 0 9,115.20 3 485 SHARES ARCHER DANIELS MIDLAND CO COM ~ 8,245.00 4 1045 SHARES AT&T INC COM p 25,461.43 5 AT&T INC COM ACCRUED INT p 418.00 6 400 SHARES AVON PRODS INC COM © 9.756.00 7 100 SHARES BAKER HUGHES INC COM © 2, 970.00 8 422 SHARES BANK OF AMERICA CORPORATION COM 0 10, 354.85 9 50 SHARES BOEING CO COM p 2,224.75 10 100 SHARES BURLINGTON NORTHERN SANTA FE CP COM 0 7,913.00 11 749 SHARES CITIGROUP INC COM 0 9,268.88 12 600 SHARES CMS ENERGY CORP COM 0 5.931.00 13 193 SHARES COMCAST CORP NEW CL A 0 2, 774.38 14 COMCAST CORP NEW CL A ACCRUED INT ~ 12.06 15 103.8418 SHARES CONOCOPHILLIPS COM 0 4,960.00 16 400 SHARES CORNING INC COM 0 4,158.00 17 161 SHARES DOW CHEM CO COM © 3,816.51 18 DOW CHEM CO COM ACCRUED INT 19 79 SHARES DUKE ENERGY CORP NEW COM ~ 67.62 © 1,232.40 20 127 SHARES ENTERGY CORP NEW COM 0 9, 737.73 21 200 SHARES EXELON CORP COM ~ 9,548.00 22 528 SHARES EXXON MOBIL CORP COM © 35,634.72 23 5 SHARES FAIRPOINT COMMUNICATIONS INC COM 0 23.15 24 552 SHARES FIRSTENERGY CORP COM 25 p 26,714.04 TOTAL (Also enter on line 2, Recapitulation) $ 190,827.97 (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN F PAGE FILE NUMBER 21-08-1111 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 ~ 100 SHARES GENERAL ELECTRIC CO COM OF DEATH ~ 1, 775.00 26 GENERAL ELECTRIC CO COM ACCRUED INT p 31.00 27 100 SHARES GENERAL MLS INC COM 0 6,391.50 28 GENERAL MLS INC COM ACCRUED INT 29 200 SHARES HELMERICH & PAYNE INC COM 0 43.00 p 5.255,00 30 135 SHARES HOST HOTELS & RESORTS INC COM © 1,001.03 31 200 SHARES INTERNATIONAL BUSINESS MACHS COM 0 16,313.00 32 312 SHARES JP MORGAN & CHASE & CO COM © 11,269.44 33 JP MORGAN 8 CHASE & CO COM ACCRUED INT p 118.56 34 127 SHARES KEYCORP NEW COM 0 1,207.77 35 186 SHARES KIMBERLY CLARK CORP COM 0 10, 255.11 36 332 SHARES KRAFT FOODS INC CL A 0 9,045.34 37 85 SHARES KRONOS WORLDWIDE INC COM © 909.08 38 300 SHARES MARATHON OIL CORP COM 0 6, 960.00 39 500 SHARES MARRIOTT INTL INC NEW CL A 0 8,875.00 40 10 SHARES MEDTRONIC INC COM 0 372.80 41 148 SHARES NEW JERSEY RES COM 0 4, 74$.59 42 165 SHARES NL INDS INC COM NEW ~ 1,810.88 43 52 SHARES NORTHROP GRUMMAN CORP COM 0 2,249.26 44 480 SHARES PHILIP MORRIS INTL INC COM 0 19, 320.00 45 200 SHARES PINNACLE WEST CAP CORP COM 0 5,907.00 46 50 SHARES PONIARD PHARMACEUTICALS INC COM NEW 0 172.75 47 200 SHARES PPL CORP COM © 5, 776.00 48 200 SHARES PRAXAIR INC COM 0 10, 744.00 49 200 SHARES PUBLIC SVC ENTERPRISE GROUP COM 0 5,450.00 TOTAL (Also enter on line 2, Recapitulation) $ 136,001.11 (If more space is needed, insert additional sheets of the same size) rcty-1503 EX+ (6-98) SCNED~ILE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT wiHlt ur JOHN F PAGE ITEM NUMBE 1. 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 240 SHARES OWEST COMMUNICATIONS INTL INC COM 16 SHARES RALCORP HLDGS INC NEW COM 100 SHARES RAYTHEON CO COM NEW RAYTHEON CO COM NEW ACCRUED INTEREST 450 SHARES RNM RES INC COM 39 SHARES SPECTRA ENERGY CORP COM 300 SHARES SUPERIOR UNIFORM GP INC COM 100 SHARES TEXAS INSTRS INC COM 56 SHARES TRAVELERS COMPANIES INC COM 120 SHARES UNICOURCE ENERGY CORP COM 100 SHARES UNITED TECHNOLOGIES CORP COM 266 SHARES VERIZON COMMUNICATIONS INC COM VERIZON COMMUNICATIONS INC COM ACCRUED INT 421 SHARES WACHOVIA CORP NEW COM 11 SHARES WHIRLPOOL CORP COM 300 SHARES WILLIAM COS INC DEL COM $1,000 US SAVINGS BOND M45862351EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862350EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862349EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862348EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862347EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862346EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862345EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862344EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862343EE ISSUE DATE 10/1992 D D D D D D D D D TOTAL (Also enter on line 2, Recapitulation) ~ 3 FILE NUMBER 21-08-1111 VALUE AT DATE OF DEATH 544.20 1,012.80 4,421.00 28.00 3,748.50 656.57 2,542.50 1,656.50 2,219.84 3,075.60 4,697.50 6, 747.09 122.36 2,357.60 545.99 4,837.50 1,191.20 1,191.20 1,191.20 1,191.20 1,191.20 1,19120 1,191.20 1,191.20 1,191.20 49.934 :~ (It more space is needed, insert additional sheets of the same size) rcty-1503 EX+ (6-98) SCI~IEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ITEM NUMBER ~ 76 All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION $1,000 US SAVINGS BOND M45862342EE ISSUE DATE 10/1992 $1,000 US SAVINGS BOND M45862341EE ISSUE DATE 10/1992 VALUE AT DATE OF DEATH 1,191.20 77 $1,000 US SAVINGS BOND M45862340EE ISSUE DATE 10/1992 1,191.20 78 $1,000 US SAVINGS BOND M45862339EE ISSUE DATE 10/1992 1,191.20 79 $1,000 US SAVINGS BOND M45862338EE ISSUE DATE 10/1992 1,191.20 80 $1,000 US SAVINGS BOND M45862337EE ISSUE DATE 10/1992 1,191.20 81 $1,000 US SAVINGS BOND M45862336EE ISSUE DATE 10/1992 1.191.20 82 $1,000 US SAVINGS BOND M45862335EE ISSUE DATE 10/1992 1,191.20 83 $1,000 US SAVINGS BOND M45862334EE ISSUE DATE 10/1992 1,191.20 84 $1,000 US SAVINGS BOND M45862333EE ISSUE DATE 10/1992 1,191.20 85 $1,000 US SAVINGS BOND M45862332EE ISSUE DATE 10/1992 1,191.20 1,191.20 TOTAL (Also enter on line 2. Reranit~~lar~,,,,i ~ c (If more space is needed, insert additional sheets of the same size) 13,103.20 REV-1508 EX+ (6-98) SCHEDULE E p COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c M~$C , INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF John F. Page FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of sur i 21-08-1111 ITEM v vorship must be disclosed on Schedule F. NUMBER DESCRIPTION VALUE AT DATE 1 M & T Bank DDA 67110088 DOD value OF DEATH 2 M & T Bank DDA 67110088 Accrued Int. 31,472.57 3 PNC DDA 5030002798 DOD value 1.29 4 PNC DDA 5030002798 Accrued Int. 35.408.72 5 PNC DDA 5130062835 DOD value 5.03 6 PNC DDA 5130062835 Accrued Int. 9.818.20 7 Fulton Bank DDA 3622-32818 DOD value 1.40 8 Fulton Bank DDA 3120-02773 DOD value 8.106.27 9 Fulton Bank DDA 3120-02773 Accrued Int. 46,514.33 10 Household Affects- Appraised 3.30 11 1985 Chevrolet Sedan- Appraised 3,025.00 12 Uncashed Altria dividend check 200.00 13 Uncashed Fairpoint dividend check 153.60 14 Uncashed Host dividend check 1.29 15 Uncashed Kraft dividend check 27.00 16 Uncashed Medtronic dividend check 96.28 17 Uncashed Philip Morris dividend check 1.88 18 Suburban Heating Oil refund 259.20 19 Alcatel-Lucent Spon ADR due 6/29/07 merger 70.95 20 Travelers -homeowners refund 7.77 21 Nipple Convalescent Home -resident refund 474.00 22 Affiliated Settlement Group- refund sewer/refuse 711 S. Market 1, 319.00 23 SES Ins. Master Trust -refund premium 711 S. Market 113.32 24 Cumberland County taxes reimbursement 8/4-12/31/09 456.00 25 Total from cont. 276.46 1,607.75 TOTAL (Also enter on line 5. Recanir~~lar~~„~ e (If more space is needed, insert additional sheets of the same size) 139,420.61 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, MISC. PERSONAL PROPERTY ESTATE OF John F. Page FILE NUMBEF 21-08-1111 Item Number Description Value of Date 25 School Tax 8/4/09-6/30/10 per settlement sheet of Death 26 Sewer 8/4-9/30/09 per settlement sheet 1,536.96 27 Trash 8/4-9/30/09 per settlement sheet 43.73 27.06 1,607.75 Commonwealth of Pennsylvania Schudule H Inheritance Tax Return Funeral Expenses Administrative Costs Resident Decedent Estate of John F. Page File Number 21-08-1111 Item # Description 12 William J Daylor MAI -appraisal of 711 S. Market St Amount 13 . Borough of Mechanicsburg- trash removal Jan09-Aug09 375.00 14 Verizon Jan09-Aug09 329.86 15 Register of Wills- short cert. 134.97 16 Barry L Heckard, Sr. Real estate Taxes 2009 72.00 17 Class Car Co.- Title Transfer of 85 Chev 663.69 18 y Archer Pest Control- termite treatment 711 S. Market St 108.00 19 . K M Daugherty- House cleaning 1,187.20 20 1-800-Got Junk- removal of final house items 218.00 21 Real Estate Commission paid at Settlement 711 S. Market St 1,961.00 22 . Notary fees for real estate closing 8,400.00 23 City/County tax/ stamps for 711 S Market St 24.00 24 . Tax Cert. Reimbursement 1,400.00 25 2009/10 School Tax to Barry L Heckard Sr. 5.00 26 , Sewer 7/1-9/30/2009 to Mechanicsburg Borough 1,699.97 27 Trash 7/1-9/30/09 to Mechanicsburg Borough 70.00 28 Credit for new furnace installation 43.32 3,323.00 Total 20, 015.01 Personal Representative's Commissions- Breakdown M&T Bank Gordon Page 24,500.00 8,900.00 Total Personal Representative's Commissions 33,400.00 Kt. ,. ; ~-ri~' Pennsylvania SCHEDULE I ~ DEPARTMENT OF REVENUE DEBTS OF DECEDENT , INHERITANCE TAx RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF John F. Page FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death including unre mb ITEM , ursed m edical expenses NUMBER DESCRIPTION . VALUE AT DATE 1. Borough of Mechanicsburg- Trash C ll ti OF DEATH o ec on 2 United Water of PA 119.15 3 Heritage Medical Group LLP 17.62 4 Susquehanna Valley Foot & Ankle 120.15 5 Moffitt Heart & Vascular Group 15.14 6 Medical Billing Services Inc 4.51 7 Millennium Pharmacy Systems 29.86 8 James R Harty MD 1,533.61 9 PP&L Electric Utilities 29.86 10 Verizon 86.66 11 PA Dept. of Revenue- 2008 Individual Income Tax 67.33 12 Alan J Ceperich CPA- 2008 Tax Prep. fee 497.00 175.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 2 695 89 If more space is needed insert additional sheets of the same size. ESTATE OF John F. Page SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Gordon W. Page 607 S. Market St. Selingsgrove PA 17870 2 Jonathan R. Page 3566 Hemlock Farm Hawley PA 18428-9160 3 Frances Thatcher 2705 Woodmont Dr. York PA 17404 II 1 1 1-V&'~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 08-21-1111 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(sl r,~ ~~r~r~ Son Son Daughter 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. $ 1 /3Residue 1/3Residue 1/3Residue Ir more space is needed, insert additional sheets of the same Siva