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HomeMy WebLinkAbout03-29-10 (2)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Count Code Year File Number Bureau of Individual Taxes Y i Po Box 28oso1 INHERITANCE TAX RETURN ~~ D Harrisburg, PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 020-24-8872 ~~ 11 /17/2009 03/15/1931 __ _ _1 ___ __ _ __ __ __ Decedent's Last Name Suffix Decedent's First Name MI r__~.. __. ___ ._~._________.__..__~W___ ___.~...____ ____. ~_... .~.~..., ADKINS ~ E ~~._._.__..._.~._.~.._.__....__ ~ ~ MARY -~_._~ _e ~_....._.___._.__._ ._... _. ~ _.___~ i i ` J (If Applicable) Enter Surviving Spouae's Information Below Spouse's Last Name Suffix Spouse's First Name MI I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ _ _ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~.7 1. Original Return {'~.3 2. Supplemental Return i~ 3. Remainder Return (date of death c~ 4. Limited Estate C~ 6. Decedent Died Testate (Attach Copy of Will) C~ 9. Litigation Proceeds Received CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number DEBORAH F. FUNT Firm Name (If Applicable) _..._ _ .. _ _~ •• - ; REGISTER OF WILLS USE ~Y _ _ ~ ~ ~. ir` First line of address t ~ __.__.. ~__.w.__,... _ ~ ~_ _ _ _.._~ ~__ ..1865 WEST LISBURN ROAD ~ ~i ~ rte-- ~° '`` ' ~~ _ .. _ j ` C,. .. ~ ~ _. ..~ Second line of address _ _ ; r;~ C.r'J ~ _ _. _ ; ~ f -. ` City or Post Office _ __ _ _ State ZIP Code DIl1~ED © _ _.... -~..... y s ...__ _ _ __ _ ~ rn __ ! ... ~. •~:. ~ CARLISLE T> .G" PA 17015 _ _; ~ Correspondent's a-mail address: Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS C~ 4a. Future Interest Compromise (date of death after 12-12-82) C'"~3 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O~ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes G~ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) PLEASE USE ORIQINAL FORM ONLY «,';" 15056051058 Side 1 15056051058 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE J REV-1500 EX 15056052059 Decedent's Social Security Number decedent's wame: MARY J ADKINS :020-24-8872 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) C? Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) {i Separate Billing Requested........ 7. 8. Total Gross Aasets (total Lines 1-7) .................................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 8~ 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. , , ~_, „~ , 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ""'p" "'° ~~`"`~"` "'" `°"" `°~"~ °'~°'~°°~~"`°"°°~° an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 11,271.64 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ __ ,__.. _~_._.___ ___...~........ __..__ ..,._~_._.~, 16. ~..F....~....~~~.~,~ .~~...,..,_._..,.,,.~m~, _. _.. Amount of Line 14 taxable ~.._.....~ ~__.. ____._.. ~ ........_ ~_......_ ~_.._.__.... at lineal rate x .0 45 11,271.64 16. ' 11,271.64 17. ;___....______ . _ _.__... ........._ ~...._.._. ~ Amount of Line 14 taxable ~.~ ~~~,.~.~.~,. ~ ,,.m.. _ ~m_..... __ ~..., at sibling rate X .12 17, 18. Amount of Line 14 taxable "~''~ m "° ~-°~°°zM~~°.. at collateral rate X .15 1 g, ', 19. TAX DUE ......................................................... 19. 507.22 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV 1500 EX Page 3 Decedent's Complete Address: ~File_N,~mber ~ _ ..__...._._._ ~~ ~ ~ ,, ~..~ a..~~~~ .:..x....aw DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER MARY J ADKINS 020-24-8872 STREET ADDRESS 1271 GETTYSBURG PIKE APT.202 CITY STATE ZIP DILLSBURG PA 17019 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. 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. (q) 5. 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) 507.22 Make Check Payable to: REGISTER OF WILLS, AGENT . . ,.n~~-• ,. 7 xy1~,~n~c ~'~ _ '. .:~~~ rkv.-~ r~ ~.. _.# :~~,. s~." rW, ~..«...4 .. ,~. 'r ;ru. »t i'"a4 t :"~ivr.. .i ~~.: '.: `..:. ,M` f-> M. ~. .~ ,_k4,,1~kk, .~,.:._ .`'~~.».~,. ..."`c,~.,.a:.=t.,,'.,~~r.~~5._.~~1 :~: »:,3'V~... `~<~:~i:~.rt..u= +i<n. .. .. ,s ~~ ~3~`t' €i'~ i~ ~-~r"~ vs - 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 "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? ........................................................................................................................ ^ ^Q 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 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 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 1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER MARY ADKINS 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. tir more space ~s needed, insert additional sheets of the same size) Move Out Statement Code 0000541 Property Name Deborah Funt Unit Address 1865 W. Lisburn Rd. Status Rent Date: 12/8/2009 sch ~ Lease From 10/01 /2009 202 Lease To 09/30/2010 Past Move In 09/13/2007 -~ 794.00 ~ Move Out 11 /30/2009 City Carlisle, PA 17015 Notice 11/16/2009 Telephone (O)-() - (H)-() - Date Description Char a Pa ment Balance Chg/Rec Balance as of 11 /01 /2009 0.00 11/01/2009 CABLE (11/2009) 25.38 25.38 192017 11 /01 /2009 RENT (11 /2009) 794.00 819.38 192018 11 /03/2009 chk# 2517 819.38 0.00 175146 11/30/2009 :SECURITY DEPOSIT credit (745.00) (745.00) 199860 11 /30/2009 Amount to be refunded 745.00 0.00 199861 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~ILE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER MARY ADKINS If an asset was made joint within 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 A. DEBORAH FUNT 1865 WEST LISBURN ROAD DAUGHTER CARLISLE PA 17015 B. C JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION ANO BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST ~' A. CITIZENS BANK ACCT N0 610067-560-2 . . 32,928.41 0 50 /0 16,464.21 TOTAL (Also enter on line 6, Recapitulation) I s 16,464.21 (If more space is needed, insert additional sheets of the same size) __ __ _ _ _ ~~ . Circle Gold `~ ..Citiz~e~ns Bank ~~ Account Statement 1-800-773-7373 O of 4 Call Citizens' special, dedicated Gold Customer service line any time for account information, current rates, and answers to your questions. Beginning November 18, 2009 ' through December 15, 2009 US002 BR301 MARY J A D K I N S COnt@I1t5 1271 GETTYSBURG PIKE. APT 202 ~ Summary page 1 DILLSBURG PA 17019-9218 Checking Page 2 Overdraft Line of Credit page 3 Circle Gold Summary Account Account Number ialana Last Statement DEPOSIT BALANCE Checking Circle Gold Checking w/Interest 610067-560-2 Savings Circle Gold Savings 6254-635977 CDs 1-8 month CD 6249-682835 7-8 month CD 6254-107184 7-8 month CD 6254-107792 8 month CD 6251-642565 8 month CD 6253-096738 8 month CD 6253-096146 8 month CD 6255-209491 LOAN BALANCE Overdraft Line of Credit 610061-560-2 Monthly combined balance to waive monthly fee is Your monthly combined balance this statement period is '.tor„per ~Di~ fl tgcci nou,!ny ~endcr 32,372.53 .00 .00 .00 .00 .00 .00 .00 .00 .00 20,000.00 32,095.10 Balance MARY J ADIQNS This statement DEBORAH F FONT Circle Gold Checking w/Interest 610061-560-2 32,928.41 .00 .00 .00 .00 .00 .00 .00 .00 n Total Deposit Balance 32,928.41 .00 /~1 Total Loan Balance .00 ~1 Total Relationship Balance 32,928.41 __ ,..T.~.»,.~.._...~,,,~......~ ,,,._ . ....,~.,. y~ ~ ~ Circle Gold ~,~ Citizens Bank Account Statement 1-800-773-7373 © of 4 Call Citizens' special, dedicated Gold Customer service line any time for account information, current rates, and answers to your questions. Beginning November 18, 2009 through December 15, 2009 ,~ ., Checking SUMMARY Balance Calculation Balance Previous Balance 32, 372.53 Average Doily Balance 32,038.64 Checks .00 - Withdrawals Interest 1,048.33 - Deposits & Additi ons 1, 602.98 + Current Interest Rate .05~ Interest Paid 1.23 + Annual Percentage Yield Earned .05~ Current Balance 32 , 928.41 = Number of Days Interest Earned P8 Interest Earned 1.23 Interest Paid this Year 6, g~ TRANSACTION DETAI LS Withdrawals ATM/Purchases Date Amount Description 11/23 302.00 3952 ATM Cash • W43008 6280 Carlisle Pikemechanicsb Urgpa 11/23 11/23 102.00 40 56 3952 ATM Cash - W43007 US Army War Collegcarlise PA ' . 3952 Dbt Purchase - 8658 L koste Villa Cafemechaniscb Urgpa 11/24 302.00 3952 ATM Cash - 087100 6480 Carlisle Pikemechanicsb Urgpa 11/24 113.23 3952 POS Debit - 04516 Wegmans Mechanicbu Rg PA 11/24 62.00 3952 ATM Cash - P95903 900 Market St Lemoyne PA 11/24 32.05 3952 POS Debit - 419542 CO-Op #7605 Su Camp Hill PA 11/24 12.76 , 3952 Dbt Purchase - 6837 Flap Jacks Dlllsburg PA Other Withdrawal s Date Amount Description 11/24 21.73 Verizon Paymentrec 112409 7174320608712 Deposits & Additions Date Amount Description 11/30 141.98 PA Treasury Dept Annuitant 091130 12/08 96.00 Deposit 12/14 765.00 Deposit Interest Date Amount Description 12/15 1.23 Interest Daily Balance Date Balance Date Balance Date Balance 11/23 31,927.91 11/30 32,066.18 12/14 32,927.18 11/24 31,324.20 12/08 32,162.18 12/15 32,928.41 MARY J ADlQNS DEBORAH F FONT Circle Gold Checking w/Interest 610067-560-2 Previous Balance 32,372.53 n Total Withdrawals 1,048.33 n Total Deposits & Additions • 1,602.98 n Total Interest Paid . 1.23 _ Current Balance 32,928.41 y~ ~ ~ ~„~ Citizens Bank 1-800-773-7373 Call Citizens' spedal, dedicated Gold Customer service line any time ' for account information, current rates, and answers to your questions. Circle .Gold Account Statement © of 4 Beginning November 18, 2009 through December 15, 2009 Overdraft Line of Credit SUMMARY MARY J ADKINS balance Calculation Balance DEBORAH F FONT Previous Balance .00 Average Daily Balance .00 Overdraft Line of Credit Advances & Debits .00 + Credit Limit 2,500.00 610061-560-2 FINANCE CHARGE .00 + Available Credit 2,500.00 Payments & Credits .00 - Current Balance Interest .00 ANNUAL PERCENTAGE RATE I8.00~ Daily Periodic Rate .04932% Days in Billing Cycle P8 Payment Statement Beginning Date 11/18/09 Statement Closing Date 12/15/09 Past Due Amount .00 Payment Due Date Minimum Payment Due .00 TRANSACTION DETAILS Previous Balance .00 No activity this statement period n Current Balance .00 MEMO --We provide you important information on your Overdraft Protection Line of Credit via your monthly account statement. Your monthly payment will not be considered late for any purpose (including late fees) if we receive your payment within 21 days after your statement was mailed or delivered. NEWS FROM CITIZENS --This is a reminder of how you can use your debit card or ATM card. You enjoy free access to more than 2,600 ATMs operated by Citizens Bank or Charter One. Effective January 1, 2010, Citizens Bank and Charter One will no longer participate in the SUM surcharge-free program offered by the NYCE network. You can continue to use millions of ATM locations worldwide that display the STAR, PLUS, NYCE or SUM logos, but fees may apply. --Do you need a home equity line, loan or mortgage? Citizens Bank has the solution for all your borrowing needs. See a banker today or call the number below for current rates, which are still at historical lows. Mortgage customers -get 1/8% off mortgage rates with Circle Gold Mortgage Advantage(TM). (1/85'° off already low mortgage rates when you open a Circle Gold Checking(R) account with automatic payment.) Citizens Circle Gold Banking(R) customers enjoy benefits such as having monthly checking maintenance fees waived, our Circle Gold Savings account, credit card offers with great rates and more. Cali our exclusive customer service number and start saving today: 1-888-514-2300. --Looking for high yields and easy access to your cash savings? Look no further! Citizens Bank offers savings and money market accounts with great rates and the peace of mind of FDIC insurance. Whether you are just starting out or looking to preserve your liquid cash deposits, we have an account to suit your needs. We also have new products that reward you for saving for college or a new home! For more information, to open an account, or add to your existing balance, visit your local branch today or call 1-800-773-7373. Member FDIC. See a banker for FDIC coverage amounts and transaction limitations. --The Citizens Bank TruFit Student Loan. Featuring a choice of repayment plans, the TruFit Student Loan provides eligible students and families with a financing alternative after `i~: '[=r =~~~ ~ E~udi ncus~ng Lenaer y~ ~ ~ Circle. Gold ~,~ Citizens Bank Account Statement 1-800-773-7373 O of 4 Call Citizens' special, dedicated Gold Customer service line any time for account information, current rotes, and answers to your questions. Beginning November 18, 2009 Overdroft Line of Credit continued from previous page through December 15, 2009 NEWS FROM CITIZEN 5 (continued) MARY J ADIQNS they've maximized grants, scholarships and federal loan options. Discuss your needs with our education finance specialists today at 1-888-333-0128. Visit us online at DEBORAH F FUNT Overdraft Line of Credit citizensbank.com/TruFitStudent. 610067-560-2 --A message for all Citizens Bank MasterCard Debit Card customers, you should have received your new Visa Debit Card which replaced your MasterCard Debit Card. If you have not received your new Visa Debit Card, please call us at 1-888-850-4070. To activate your new Visa Debit Card call 1-800-527-1800. Or simply use your card at any ATM or merchant and make aPIN-based purchase. IMPORTANT: Your card number and expiration date have changed. If you use your current debit card for recurring payments, we'll make every reasonable effort to ensure your payments are not impacted. To ensure there is no interruption in service we recomm d th t , en a you contact your bitters to update your information. '.Sen,oer FDIC Q Equal Housing Lender REV-1511 EX+ (10-09) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY ADKINS Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' MALPEZZI FUNERAL HOME 8 MKT PLAZA WAY MECHANICSBURG PA 17055 5,462.57 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: - Name(s) of Personal Representative(s) Street Address City _ _ State ZIP Year(s) Commission Paid: 2. Attorney Fees: 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 Fees: 350.00 6• Tax Return Preparer Fees: 125.00 ~. TOTAL (Also enter on Line 9, Recapitulation) $ 5,937.57 If more space is needed, use additional sheets of paper of the same size. Malpezzi Funeral Home ,.~ 8 Market Plaza Way __.__~ , , ~ _, :. ~ -_ ; ~ _. :.~ ' - .. _ , w...._._. (717) 697-4696 Mechanicsburg, PA 17055 www.mal ezzifuneralhome.com Jeremy J. Shartzer, FD Michael J. Malpezzi, Owner, FD Kyle C. Knipe, FD February 15, 2010 Deborah Funt 1865 W. Lisburn Road Carlisle, PA 1701 S The Funeral Service for Mary Joyce Adkins We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES: Services, Facilities and Cremation $3,365.00 FUNERAL HOME SERVICE CHARGES SELECTED MERCHANDISE: $3,365.00 Casket Alternate Container $165.00 Acknowledgement cards $375.00 Prayer Cards $20.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE $20.00 THAT YOU HAVE SELECTED .qT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTST 0.00 OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES: Opening Grave Cemetery Equipment $600.00 Certified Death Certificates $233.20 :newspaper Notices -Patriot $6.00 Cler.~y/Mass Offering $242.87 Flowers $250.00 $185.50 TOTAL CASH ADVANCES AND SPECIAL CHARGES CONTRACT PRICE 1 51 7 HISTORY: $5,462.57 12/ 14/2009 Payment 12/ 14/2009 Payment $53.70 TOTAL AMOUNT DUE $5,316.30 $92.57 :;1 REV-1513 EX+ (11-08) ~ pennsylvania DEPARTMENT Of REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE G MARY NUMBER I 1. 2 3 4 5 6 II 1 1. ~F \DKINS NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER AMOUNT OR SHARE OF ESTATE DEBORAH F. FUNT 1865 W. LISBURN RD. CARLISLE PA17015 .DAUGHTER 1916.18 GERALDINE ADKINS 26 DOGWOOD LANE APT B DILLSBURG PA DAUGHTER 1871.09 CARY EMLET 13 GRINNELL DR. CAMP HILL PA 17011 DAUGHTER 1871.09 ANDREA 23A HIDDEN COVE VALPARAISCO FL 32580 DAUGHTER 1871.09 KATHERINE WITHJACK 6404 GLENNWOOD ST. MECH. PA 17055 DAUGHTER 1871.09 DEAN ADKINS 4143 ELIZABETH LN. ANNANDALE VA. 22003 SON 1871.09 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. $ If more space is needed, insert additional sheets of the same size.