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HomeMy WebLinkAbout08-17-101505610101 REV-1500 °`tO1-1O' m PA Department of Revenue Pia OFFICIAL USE ONLY Bureau of Individual Taxes 'p""'"`"~°`""~ County Code Year File Number Po Box 28060>< INHERITANCE TAX RETURN Harrisburg, PA s~sz8-o6oi RESIDENT DECEDENT ~ ~ ~ ENTER DECEDENT INFORMATION BELOW Social Secundy Number Date of Death MMDDYYY~~.jjY / ®® / / / $ ®~J~rrL~ Decedents Last Name Suffix A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Soaal Security Number Date of Birth MMDDYYYY ~~ f• ~ ~ t Decedent's First Name MI /! (S ~ Spouse's First Name MI m THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ ~ 1~~~~~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limited Estate O 4a:~Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - TNIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name D~~ytim~~e Telephone Number i ~ 4 ~ ~ L1-~~0 ~ REGISTER OF tIYILl3 ~ ONLY - ~, o ~. ~ ~ --~ ~ r- n ~ .. ~~ First line of address ~ ~ ~-:. Second line of address ~ O ~t ~ - _ ~ , ~t --i~s _ ~ ~,7 ~~ ~ ~D : ^- City or Post Office State ZIP,Code ^i FILED ` ~C l ( ~ I ~ ~ Comssponderrt's e-mail address: Under penalties of perjury, I declare fturt I have examined this return, inGuding 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. SIGNATURE OF PERSON RESPON EE FOQ FILING. RETURN ne-rr= SIGNATURE E THAN REPRESENTATNE DATE /~ L ,~/ t & 1 r a ADDRESS~7 L( SF~ ~~~ ~ ~t~~t~ ~'/C~~/1(//I~ P ~~I 8E U8E RIGINAL FORM ONLY .Side 1 1505610101 1505610101 J J 1505610105 RE~15oo Ex Decedents Social Security Number RECAPfTULATION 1. Real Estate (Schedule A) ............................................. 1. 8 Q 2. Stacks and Bonds (Schedule B) ......... .. ................. .. 2. 3. Closely Held Corporation. Partnership or Sole-Proprietorship (Sd~edule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and M'~scellaneous Personal Properly (Schedule E)....... 5. ( /i '~ ( ~ ~ / 8. Jointly Owned Property ( F) O ~8 ....... 6. 1 ( G ~ a 7. Inter-Vnros Transfers B Fneous Non-Probe/e Property (Schedule G) O 3aparate BiNing Requested........ 7. , 8. Tonal Gross Assets (total Lines 1 through 7) ............................. 8. 9. Funeral Expenses and Administrative Costs (Schedub H) ................... 9. ,~j 10. Debts of Deceder-t, Mortgage Liabilities, and Liens (Schedule I) .............. t0. ,, . Total Do~Ctlons (total Lines 9 and , o) ................................. ,, . 3 j} 12. Net vdue of Estate (L~e 8 minus Line „) .....:..........:..:.......... 12. { Q 0 G ~ ~t 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts fir which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~ (~ ~ ~ww wa.~.v~.w~ win -see rna r rcuw: r runs rwc wrrucnrs~.e w-r es 15. Amount of Lure 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) x .o_ 16. Amount of Line 14 t ~ e at lineal rate X .0 17. Amount of Lie 14 taxable at sibling rate X .12 18. Amount ~ Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE ......................................................... 19.I 20. FILL IN THE OVAL fF YOU ARE REQUESTING A REFkJND OF AN 011ERPAYMENT O Side 2 L 15D561D1D5 15056101D5 ;EV 1500 EX Page 3 )ecedent's Complete Address: FIN Number or_c~Nrs N~ v~~ ~/ C ~(a 22 /.So N sTt~TnoorsESS a ~ -- anr ~~il l ~~~ c7 Tax Payments and credits: I. Tax Dus (Page 2, Line 19) t. ged'itslPaynrents A. Prior Payments B. Discount Interest fl Line 2 is greeter khan Line i + Line 3, enter the dilfererloe. Tlris ~ the OvERPIIYMENT. hiN M OViI dlt tape Z, L,iere ~ 1D nfpest g refund. g Line 1 + Line 3 Ls greeter than Line 2, enter the difference. Th~ is the TAX t31~. Make check payat~e tO: REG]STER QF WCL~S, AGENT. (3) (4) PLEASE ANSWER THE FOLLO~INING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLACKS 1. Did deoederd make a irar~r and: Yes No a. retain ills use or irloorne d the property trar~rred :.......................................................................................... ^ b. retain the right to designate who si>all use the property trarlsfe-red or its incxxne : ............................................ ^ c. retain a reversionary Merest; or .......................................................................................................................... ^ d. reoenre the promise for kfe d either payments, benefits or c~e? ...................................................................... ^ 2. tf dearth ocalrted after Dec.12,1982, did decedent transfer property wi~in one year of death ..................................................................... wdhout reoeivkrg ~? ........................... .............. ^ 3. Did deoederd own an 'Sn trust tor' a payable-upar}death bank account or security at Iris or her death? .............. ^ 4. Did deoederd own an irldividuell reteement acxolmt, annuity or other ran-probate property, which ,,,,,{ oontams a beneficiary designation? ........................................................................................................................ ^ ^LI S 1 i ~ F ~AITOa~n of" T~ au~srloNS ~YES,~rou r~r ~ sc~I~u.E G ~uro ~~ rrAS r~r ~ n~ R~uRN: Fa aaies of death on or sitar July 1,1994, and Before Jan. 1, ,995, the tax rate on the net value of transfers to or for the use of the g spouse is 3 pen;er>t [72 P.S. §9116 (a) (1.1) (i)]. Fa dales ~ death on a after Jan. 1, 1995, rite lax rate imposed on the net value of transfers to or for rite use of the surviving spouse is 0 percent (f2 P.S. §9116 (a) (1.1) {'n')I. The staluEe does not exempt a trartisfer b a surviving spouse from tau, and the stalutay rElr~iremeMs ~r d~dosure aE assets and fiirtg a taut rotrxr- ate sib appkcable evert if rite swvivirrg sprx~e is the onhr batreiiaary. For dales of dearir on or alter Jay 1,2000: s The tax role imposed at the net value of irartsfers from a deceased child 21 years of age ar younger at-death to or for rite use of a natal parent, ~an adoptive parent or a s~eroM of the chid is 0 per~oeM [72 P.S. §9116(a)(1.2)]. 1 • The tart rate ir~sed on the net vap~e of barrsfers to or for the use of the decedent's lineal i~netraa 'ales is 4.5 pint, except ~ noted in I 72 P.S. §9116(1.2) [72 P.S. §9116(aX1)]. ~. The ~x rate imposed on the net value of transfers to or for the use of the deoederrt's sibkrrgs is 12 percent [72 P.S. §9116(ax1.3)]. A sibiirg Ls defused; txlder Section 9102, as an individual who has at least one parent in commonwith the decedent, wherilerby blood or adoption. ~~3~-~J (1) Toth Credits{ A+ B) (2) 1505607121 ' REV-1500 Ex (~-05> ' OFFICIAL USE oNL~ PA DepaMrent of Revenue Bureau of individualTaxes County Code Year File Number INHERITANCE TAX RETURN Fro sox 280601 2 1 0 '~ 1 1 8 1 Hanisbur9, PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 1 2 4 4 3 0 6 1 1 1 8 2 0 0 9 1 0 2 1 1 9 3 3 ~' Decedent's Last Name Suffix Decedent's First Name MI N A U M A N H A R R I S O N ' C (If Applicable) Entsr Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE 1MITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder F pnorto 12-1 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Este death after 12-12-82) © 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total NumbE (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tt between 12-31-91 anti 1-1-95) (Attach Sch. ~~~ -Q ~, :v CORRESPONDENT - THIS SECTION MtfST BE COMPLETED. ALL CORRESPONDENCE AND CONFiDENTWL TAX INFORMATION Name Daytime Telephone M U R R E L W A L T E R S I I I E S Q 7 1? ~~p` Firrn Name (If Applicable) r - First line of address 5 4 E A S T M A I N S T R E E T Second line of address City or Post Office State ZIP Code M E C H A N I C S BU R G P A 17 0 5 5 ~tum (date of death 82) Tax Return Required of Safe Deposit Boxes under Sec. 9113(A) BE DIRECTED T0: 7 F4 6 ,~ }SE ONLY'.' r" ~" ~ ~.I = f ~ --: a :_ _ ~: ~ .C' FILED Correspondent's e-mail address: mwalters erizon. om b pen> ~ ~par~ry, I declare that 4 gave examined this return, i ing accompanying st~ledules and statements, and to the best of my and belief, complete. Dedaratbn of prepares other than personal repragentatives based on aN iMomration of which prepares has ImovAedge. SIGNATURE OF PERSONRES IBLE FOR FJLING R N srr: URSULA J • SHEAFFF,IRrE EJI!~5 YORK CIRC MECHANICSBURG PA I!~70~0 SIGNATURE OF PREPAR OTH N R SENTATNE i 1 TF_ 54 E• MAIN ST MECHANI PLEASE USE ORIGINAL FORM ONLY 1505607121 Side 1 PA--,-~ 1755 150560712 J 1505607221 REV-1500 EX Decedent's Social Security Number Decedents Name: H A R R I S O N C. N A U M A N 2 0 1 2', 4 4 3 0 6 RECAPITULATION 8 1~''~~ 1. Real estate (Schedule A) ........................................ 1. 9 8 8 . 2 0 2. Stocks and Bonds (Schedule B) .................................. 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship {Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ................. ....... 4. P h d l E S 5 1 6 4 1 7 ' 9 1 5. roperty ( c u e ) Cash, Bank Deposits 8 Miscellaneous Personal e ....... . 8. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 1 ICI 6 4 5. 4 0 7. Inter-Vivos Transfers & Miscellaneous N~Probate Property ar te Billin Re uested S S h d l G 7 ' g ep q a ( c e u e ) . ....... , 8. Total Gross Assets (total Lines 1-7) ................ ~.... ....... 8. 1 1 0 1 0 5 I 1. 5 1 9. Funeral Expenses & Administrative Costs (Schedule H) ......... ....... 9. ~ 7 6 5 7 . 9 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..... ....... 10. 6 0 3~ 5 . 8 1 11. Total Deductions (total Lines 9 810) .................... ....... 11. 9 ', 3 7 3. 8 0 12. Net Value of Estate (Line 8 minus Line 11) .................. ....... 12. 1 D D 6 7 ? . 7 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........... ....... 13. 10 6 7 D 7 • 7 1 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 I (a>(t2) x.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable 04 1 0 0 6 7 7. 7 1 4 ' 5 3 0. 5 0 5 at lineal rate x . 18. , 17. Amount of Line 14 taxable D 0 0 0 0 0 at sibling rate X .12 17. . 18. Amount of Line 14 taxable 0 0 0 0 D O at collateral rate X .15 . 18, j . 19. Tax Due ............ ............................. ..... .. 19. 4 ~'~5 3 0 . 5 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ', Side 2 1505607221 1505607221 REV-1500 EX Page 3 File Number Decedent`s Complete Address: 21 os 1181 DECEDENTS NAME HARRISON C. NAUMAN STREET ADDRESS 207 WILLOW MILL PARK ROAD CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) '~ 4,530.50 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) ~ 0.00 3. InterestlPenalty if applicable ! D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Une 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ' 4 530.50 A. Enter the interest on the tax due. (5A) _ B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) I 4,530.50 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS. BY PLACING AN "X" IN THE APPROp~tIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : .......... ........................................................ ~~ b. retain the nght to designate who shall use the property transferred or its income; ary ' ................................................................................................ c. retain a reversion interest; or Pro P Y ....................................................... d. receive the miss for life of either a ments, benefits or care? ^ 0 2. If death oaxured 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? ......... ^ I, 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 ~ transfers to or for the use oftf~e 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 z (0) percent [/2 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 discloseu~e of assets and filing a tax return are still applicable even if the surviving spouse is the only benefiaary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased childtwenty-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 [/2 P.S. §9116(x)(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(x)(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(x)(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-7502 EX + (8-98) CONMAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER ueQrarcnu r Ner ruetu ~~ no ~ ~ a~ All roal property owned solely or as a tenant in common must be reported at fair market value. Fair market vak-e is defined as the price at which party would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the releva nt facts. Real ro whk;h k owned with frt of survhronhi must be discbsed on Schedub F. ITEM VALUE AT DATE NUMBER DESCRIPTION ~ OF DEATH 1. 207 WILLOW MILL PARK ROAD I~ 81,988.20 MECHANICSBURG, PA 17050 ASSESSED 65,070 X C.L.R. 1.26 Ili II I I II TOTAL Also enter on line 1, 'tulation S 81 988.20 (If more space is needed, insert additional sheets of the same size) _ , REV-1508 EX + (8-98) SCHEDULE E CASH, BANK DEPOSITS & MISC. , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HARRISON C. NAUMAN 21 09 1181 Include the proceeds of litigation and the date the pproceeds were received by the estate. Ag property hrtly-owned wMh right of survivorship must be disclosed on achedub F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1995 CHEVROLET VAN 2,800.00 KELLEY BLUE BOOK 2. 2007 YAMAHA MOTORCYCLE 3,800.00 PER SALE PRICE 3. 2006 GMC PICK-UP TRUCK 9,055.00 KELLEY BLUE BOOK 4. ASPEN DENTAL 62.75 REFUND ~~ 5. CENTRAL PENN AUTO CLUB (AAA) 47.00 REFUND 6. ERIE INSURANCE 322.00 REFUND -AUTOMOBILE 7. VERIZON 6.59 PHONE REFUND 8. PROGRESSIVE INSURANCE ' 64.00 REFUND-MOTORCYCLE 9. BANKERS L{FE AND CASUALTY 229.52 REFUND -HEALTH INSURANCE 10. COMCAST 31.05 REFUND-CABLE TOTAL (Also enter on line 5, Recapitulatia~) I = (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT HARRISON C. NAUMAN 21 09 1181 ff an asset was made joint within one year of the decedents date of death, it must be reported on Schedule GF -; SURVMNG JOINT TENANT(S) NAME ADDRESS ' RELATIONSHIP TO DECEDENT A. URSULA J SHEAFFER 5 YORK CIRCLE DAUGHTER MECHANICSBURG, PA 17050 ', B SHANE K. NAUMAN 147 SALEM CHURCH ROAD MECHANICSBURG, PA 17050 SON C JOINTLY-OWf~D PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANgAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~, °~ OF ~ DECD'S NTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 3h 2/07 ORRSTOWN SANK 2,858.24 ~I 50. 1,429.12 CHECKING ACCOUNT 2. B 3/3108 ORRSTOWN BANK 20,432.55 50. 10,216.28 MONEY MARKET ~I TOTAL (Also enter on line 6, Recapitulation) 11 645.40 pr more space Is neeaea, Insert aoaroonal sneers or me same size) REV-1511 EX + (10-06} SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8- INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBED! HARRISON C. NAUMAN 21 09 1181 Debts of decedent must be reported on Schedule 11. ITEM ' NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. KIMMEL FUNERAL HOME ! 1,800.49 2. FIRE HALL RENTAL FOR RECEPTION 125.00 B. ADMINISTRATNE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) URSULA J. SHEAFFER (RENOUNCED) Street Address 5 YORK CIRCLE City MECHANICSBURG State PO- Zip 17050 Year(s) Commission Paid: 2 Attorney Fees MURREL R. WALTERS, III 3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address Cry State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 5 AcoountantsFees 6. Tax Return Preparers Fees 7 TOTAL (Also enter on line 9, Recapitulation) 3,500.00. 342.50 (If more space i9 needed, insert add'diorral sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 CONNNONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, .& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HARRISON C. NAUMAN 21 09 1181 Report delrts incurred by the decedent prior to deatll which remained unpaid as of the date of death, Including unreimbu~sed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION ~ OF DEATH 1. COMCAST 85,5.4 CABLE 2. PENN WASTE 133.05 TRASH SERVICE 3. PP&L 1,071.54 ELECTRIC 4. VER12ON 110.87 PHONE 5. COMMUNITY LIFE TEAM 150.00 AMBULANCE 6. SELECT MEDICAL 900.00 MEDICAL 7. PINNACLE HEALTH 900.00 HOSPITAL 8. TAXES 254.81 PERSONAL TAXES 24.42 & PROPERTY TAXES 230.39 TOTAL (Also enter on line 10, Recapitulation) I s (If more space is needed, insert additional sheets of the same size) __ - - _ _ i _ REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARfES ESTATE OF FILE NUMBER WeRR~snN r NeululeN o~ ~o „Q, RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONS} RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [nclude ~ spousal distributions, and transfers under Sec. 9116 a 1. 1. URSULA J. SHEAFFER Lineal 5 YORK CIRCLE MECHANICSBURG, PA 17050 2. SHANE K. NAUMAN Lineal 147 SALEM CHURCH ROAD MECHANICSBURG, PA 17050 3. DEVOE W. NAUMAN Lineal 1359 CREEK ROAD CARLISLE, PA 17015 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON V-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: i, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET s (~~ iiiuiC sµ~x is r~xaea, mser[ aaaiuonai sneers aT me same size}