HomeMy WebLinkAbout12-03-10 (2)' 1505610140
REV-1500 EX (01-10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 0 0 1 3 5
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 5 2 4 0 1 4 7 0 1 2 9 2 0 1 0 0 5 1 1 1 9 3 1
Decedent's Last Name Suffix Decedent's First Name MI
BICKTA GLENWOOD M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security r:~,~mber
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 ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
^X 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)
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. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARK A MATEYA ESQ. 71 7 241 6500
f~3
First line of address
55 W. CHURCH AVENUE
Second line of address
City or Post Office State
CARL I S L E P A
ZIP Code
~d,..,
REGISTE
.l!>SILLS USE~ILY
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l D~$'fE FILED ~+= a, ~
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1 7 0 1 3
Correspondent's a-mail address: MAM@MATEYALAW.COM
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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 prepare~r has any knowledge.
SIGNAT E OF PERSON ~F NSIBL~ FOR FILING RETURN DATE
ADDRESS
837 HAMIL ON STREET CARLISLE PA 17013
SIGNATURE OF~PRE I~R C~THE HAN REPRESENTATIVE DATE
~U
ADDRESS
55 W CHURCH AVENUE CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140
1505610140
Jl
J 1505610240
REV-1500 EX
Decedent's Name: GLENWOOD M. BICKTA
Decedent's Social ;security Number
1 8 5 2 4 0 1 4 7
RECAPITULATION
1 4 3 3 7 5.0 0
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 and Notes Receivable (Schedule D) ....................... ... 4. •
2 7 8 0 8 . 9 1
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
uested
arate Billin
Re
^ Se
l
h
d
G
S
7 5 O 0 0 • 0 0
...
g
q
p
u
e
)
(
c
e .
....
1 7 6 1 8 9
3 1
8. Total Gross Assets (total Lines 1 through 7) ....................... .... 8. ,
9. Funeral Expenses and Administrative Costs (Schedule H) ........ .......... 9. 1 1 8 9 0. 4 6
2 6 3 1 6 5
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... .......... 10.
11. Total Deductions (total Lines 9 and 10) ..................... .......... 11. 1 4 ~ 2 2 • 1 1
12. Net Value of Estate (Line 8 minus Line 11) .................. .......... 12. 1 6 1 6 6 1 8 0
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. 1 6 1 6 6 1 8 0
TAX CALCULATION -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 .0 0 0 0 15.
16. Amount of Line 14 taxable
1 6 1 6 6 1 8
0
at lineal rate X .045 1 s.
17. Amount of Line 14 taxable
0 C
~
17
at sibling rate X .12 ~
18. Amount of Line 14 taxable
~ ~
0
at collateral rate X .15 18.
19. TAX DUE .................. ............................. ..... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
7 2 7 4. 7 8
0. v 0
0. 0 0
7 2 7 4. 7 8
^
Side 2
1505610240 1505610240
' REV-150G' EX Page 3
~....e~.~sr,f'~ ~'n.,,nlnto Arlrlracs•
File Number
21 10 0135
DECEDENT'S NAME
GLENWOOD M. BICKTA -
STREETADDRESS
837 HAMILTON STREET -
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments 6,000.00
B. Discount 315.78
3. Interest
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1) 7,274.78
Total Credits (A + B) (2) 6, 315.78
(3)
(4)
(5)
0.00
959.00
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;
^ X
0
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? .................................................................................
h?
"
" ......
^
^X
...
orpayable-upon-death bank account or security at his or her deat
in trust for
3. Did decedent own an ......
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ............................................................................................ ...... ^ 0
iF THE ANSWEFc TO ANY GF T HE ABOVE QUES T iONS IS YES, 'f0U MUST COPJiPLr=TE SCHEGULE G AND FILE !T A;3 PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse i;
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 0 percent [72 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 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 12 percent [72 P.S. §9116(x)(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.
GLENV~001) 1\~I,~ [~ (CKTA
1. Glenwood M. Bickta, of 837 Hamilton Stre,~~t, (='arlisle, Cumberland County, Pennsylvania,
mal:~~ t1~is my will. I revoke any other wills or codicils to wills made by me.
ARTICLE i. llISTR1BUTION OF MY ESTATI~~:;
A. I give such items of my tansible pers~~~r~al property as are designated below.
l . I hive my dob, Anbel, to my step-dau~I~~t:er Cindy Keck, presently residing in Boiling
Springs, Pennsylvania and Nicole S~m~th, presently residing in Boiling Springs,
Pennsylvania, and Lisa Haulman, pres,ent.ly residing in Carlisle, Pennsylvania, with
the understanding that my dog Anl;el i:> t+~ be cared for at my residence located at 837
Hamilton Street, Carlisle, Cumberland (~ounty, Pennsylvania.
2. I I;ive my real estate located at 837 H4lnailton Street, Carlisle, Cumberland County,
Pennsylvania to Cindy Keck, presentl~r residing in Boiling Sprinl;s, Pennsylvania.
~. I hive all of my household furnishings t~c- Cindy Keck, presently of Bc-iling Springs,
Pennsvlvania.
B. I give the balance of my estate to be divided as follows: one-half (%) share to Cindy
Keck, presently of Boiling Springs, Pennsylvania and the remaining one-half (%z) to be divided
evenly between Nicole Smith, presently residing in Boiling Springs, Pennsylvania, and Lisa
Hat~~ilman, presently residinb in Carlisle, Pennsylvania, provided the}~ survive me by si:~ty (60) days.
C. Whenever property is to be distributed to t:he descendants ofa person (the; "ancestor"),
sucl~l property shall be divided into equal shares, one share for each then living descendant in the first
generation below the ancestor in which at least one descendant is livinb, and one share for each
deceased descendant in such generation who has a descendant then livinb. Each share created for a
11VIIlb descendant shall be distributed to such descendant. Each share created fot• a deceased
ae~c:endant shall be divided and distributed accordinb to the directions in the two preceding
>~nt~~nc:t~~ until no property remains undistributed.
D. A person who has a relationship by or through legal adoption shall take under this will
CIS if the person had the relationship by or through birth, e;~cept that a person adopted a;Fter reaching
~Ige twenty-one and descendants of such a person shall not so take.
LAST WILL A1~D I'L~;~j"I'AIVIENT
~~~
OF
E. Any beneficiary or the lebal representative of any deceased beneficiary shall have the
ri`_>ht. ~~~ithin the time prescribed by law, to disclaim any benefit or power under my will and the
i»tcc-~•st so disclaimed shall be distributed as if such beneficiary had predeceased rne.
ARTICLE II. PAYMENT OF EXPENSES AND OTHER CHARGES
I desire to be cremated. I direct my Executrix to pay for my burial expenses (including the
cost of a monument or marker} and the cost of cremation. The estate, inheritance and similar taxes
assessable on my death (including taxes on assets not passim; under this will) shall also be paid as
a cost of administering my estate and my Executrix shall not request any beneficiac-}~ to pay any part
of such tax.
ARTICLE III. MISCELLANEOUS PROVISIONS
;Matters of Interpretation. For simplicity, I have expressed pronouns and other terms in one
;~, ~~: ~~ h~ ~~ and Gender, but where appropriate to the context these terms shall be deemed to include the
~..,! ~,. ~~ number and benders. The bold headings are for convenience and shall not affect. interpretation.
ARTICLE IV. APPOINTMENT OF FIDUCIARIES AND POWERS
A. I name Cindy Keck, to be my Executrix. It is my desire for the 1=~;xecutrix to be
remunerated accordinb to local custom. Should she fail or cease to act, I name Lisa Haulman to be
my Executrix. I request that no security be required of any Executrix. References in my will to my
"Executrix" are to the one actinl; at the time, except where otherwise specifically provided.
B. Any individual who serves as Executrix or Trustee shall be entit]'.ed to receive
reasonable compensation for his or her services and, whether or not such indiviidual receives
compensation, shall be entitled to be reimbursed for expenses incurred for such services.
C. I grant my Executrix and my Trustee the powers set forth in 20 Pa.C.S.
~~ ~_~ 1 1 ->>>? and 20 Pa.C.S. ~~ 7131-7143 respectively. In addition, my Trustee may merge any
~~ ~~~~ ~~n~i~r this will with any trust having the same trustee and substantially the same dispositive
l~ro~~i~ic~ns. If at any time after my death the size of any trust under this will is so small that, in the
opinion of my Trustee, the trust is uneconomical to administer, my Trustee may terminate the trust
and distribute the assets to the person or persons authorized to receive the trust income in such shares
as my Trustee may deem appropriate. No Trustee who is also an income beneficiary ~of the trust at
issue shall exercise any discretion granted in the preceding sentence. My Executrix and my Trustee
may distribute tangible personal property passing to a minor to any adult person with whom the
minor resides, and that person's receipt shall be a sufficient voucher in the accounts ofmy Executrix
and my Trustee.
D. I request that my Executrix confer with Mark A. Mateya, Esquire, in th~° handling of
my estate, he being familiar with my affairs.
ARTICLF. V. DEFINITIONS
The following definitions shall be applicable to all of the provisions of my Will except where
otherwise specifically stated:
1. The use of the masculine shall include the feminine or neuter and the use of the
singular shall include the plural, and vice versa.
2. The term "estate," where appropriate, shall include any trust hereunder.
3. The term "minor" shall mean an individual who has not attained the age of twenty-
one years.
Executed this ~~ day of ~ u'~"'`'~'"~- 200~'~'
~~~~,
--~C-l~ `~ ~ ~ - ~~..J SEAL
_ ~
G" Glenwood M. Bickta
Signed, sealed, published, and declared for and as his last will and testament by the
testator in our presence, we all being present at the same time; and we, in his presence
and at his request and in the presence of each other, have subscribed our names as
witnesses whereof, all on the date last above written.
6~'~1.~ ~ G~ of 1~} ~~ S~c. ~;.~~ ~~~" ~~
l ~•' ~. ~ ~~~ ~ ~ ~~ G;. ! "~ CL~~ ~i OF ~ I S I~~~C'(,,~i'~ ! Gr I ~~J'~('~ ) JAS k:)1,%ti'' ~ I"'~
1' y
C~OVIMONVVEALTH OF PENNSYLVANIA
CUMBERLAND COUNTY : to wit:
Bef ore me, the undersil;ned authority, on thi ate personally appeared Glenwood M.
Bickta, and 'U~i-~ ~ . ~~nfi~ ~ ,and ~ C1 b ~ ~ I Cc . + ~~- .known to me to
be the testator and witnesses, respectively, whose names a e signed to the foregoing
instrument and, all of these persons being by me f rst duly sworn, Glenwood M. Bickta,
the testator, declared to me and to the witnesses in my presence that said instrument is
his last will and testament and that he had willin~7ly signed and executed it in the
presence of said witnesses as his free and voluntary act for the purposes therein
expressed, that said witnesses stated before me that the foregoing will v~~as executed and
acknowledged by the testator as his last will and testament in the presence of said
~~-itnesses who in his presence and at his request and in the presence of each other did
subscribe their names thereto as attesting witnesses on the day of the date of said will and
that the testator, at the time of the execution of said will, was over the age of eighteen
years and of sound and disposing mind and memory.
Sworn and acknowledged before me by GLENWOOD M. BICKTA, the testator,
~ti~ , ~ ~'O~;~t z^t~i ,witness, and ~~~ ~ Ct t t / -~i-'iC~,~ ~c ~+~ bv~ _, witness, this
.~
_~ day of ..~ ~:~-,~~ 200. ~,
~.
Glenwood M. Bickta
~ ~~ ~ ~ _ _
Witi ss
~~ ~
Wltn - SS
(,~
~ ,
Notary Public
My commission expires:
..i,.
~~r,~~<<
/ _ . -~
' REV-150 EX+ (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GLENWOOD M. BICKTA 21 10 0135
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.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. 837 HAMILTON STREET
CARLISLE, CUMBERLAND COUNTY PA
FAIR MARKET VALUE -SEE ATTACHED ASSESSED VALUE
143, 375.00
TOTAL (A1so enter on Line 1, Recapitulation,) ~ $ 143,375.00
If more space is needed, use additional sheets of paper of the same size.
TaxDB Result Details
Detailed Results for Parce106-19-1641-216. in the 2004 Tax Assessment Database
DistrictNo 06
Parcel ID 06-19-1641-216.
MapSuffix
HouseNo 837
Direction
Street HAMILTON STREET
Ownerl BICKTA, GLENWOOD M & DORIS A
C/O
PropType R
PropDesc
LivArea 1120
CurLandVal 30250
CurImpVal 83540
CurTotVal 113790
CurPrefVal
Acreage .26
CIGrnStat
TaxEx 1
SaleAmt
SaleMo
SaleDa
SaleCe
SaleYr
DeedBkPage 0020P-00824
YearBlt 1962
HF File Date 10/18/2004
HF Approval_Status A
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:Page 1 of 1
httn://taxdb.ccpa.net/details.asp?id=06-19-1641-216.&dbselect=l 2/3/2010
' REV-15G8 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GLENWOOD M. BICKTA 21 10 0135
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ON STAR 110.86
REFUND ON PRE-PAID ACCOUNT
GPS/EMERGENCY SERVICE FOR AUTOMOBILE
2. CORNERSTONE FEDERAL CREDIT UNION 8,495.96
SAVINGS ACCOUNT NO 32-01
3. AETNA, INC. 107.15
REFUND ON INSURANCE PREMIUM
POLICY NO. OOA788139
4. M&T BANK 6,239.91
CHECKING ACCOUNT
ACCT NO. XXXXXX0921
5. SECURCHOICE 3,847.45
PRE-PAID FUNERAL INSURANCE POLICY
6. 2005 BUICK LE SABRE AUTOMOBILE 9,000.00
GOOD CONDITION
KELLEY BLUE BOOK VALUE
7. AETNA MEDICARE INSURANCE 7.58
MEMBER NO. MEBFPBSH
REIMBURSE FOR PRESCRIPTION MEDICINE
TOTAL (Also enter on line 5, Recapitulation) I $ 27,$08.91
(If more space is needed, insert additional sheets of the same size)
2005 Buick LeSabre -Suggested Retail Value -Kelley Blue Book Page 1 of 3
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' REV-15'i 0 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GLENWOOD M. BICKTA 21 10 0135
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPIICABIE)
TAXABLE
VALUE
1. MONETARY GIFT TO GRANDAUGHTER 5,000.00 100.00 5,000.00
TOTAL (Also enter on Line 7, Recapitulation) I $ 5,000.00
If more space is needed, use additional sheets of paper of the same size.
' REV-15'i1~EX+(10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
GLENWOOD M. BICKTA 21 10 0135
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN ROTH FUNERAL HOME 4,064.56
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: MATEYA LAW FIRM
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4
5
6
7,
8
9
City State ZIP
Relationship of Claimant to Decedent
Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS
Accountant Fees;
Tax Return PreparerFees: JACKSON HEWITT - 2009 INCOME TAX RETURN PREP
CUMBERLAND LAW JOURNAL -LEGAL ADVERTISEMENT
THE SENTINEL -LEGAL ADVERTISEMENT
CUMBERLAND COUNTY REGISTER OF WILLS -FILING FEE
7,000.00
327,50
174.00
75.00
219.40
30.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 11, 890.46
If more space is needed, use additional sheets of paper of the same size.
, ~
RSV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
GLENWOOD M. BICKTA 21 10 0135
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. US DEPARTMENT OF TREASURY 469.00
2009 PERSONAL INCOME TAX
2 DISCOVER CREDIT CARD 302.94
ACCOUNT NO.
3. CARLISLE HOSPITAL
MEDICAL SERVICES
4. PP&L
ACCOUNT N0.24730-74003
ELECTRIC SERVICE TO RESIDENCE
5. AETNA INSURANCE
AUTO INSURANCE
ACCOUNT NO.
6. CENTURY LINK
CABLE TV & TELEPHONE SERVICE
ACCOUNT NO.
7. HERO OIL
HEATING OIL FOR RESIDENCE
ACCOUNT NO. 143488
8. TERMINIX
PEST CONTROL
ACCOUNT NO. 2241-3054210
9. BOROUGH OF CARLISLE
WATER/SEWER SERVICE
ACCOUNT NO. 006318-000
10. CENTURY LINK
CABLE & TV SERVICE
ACCOUNT NO.
11. AERO OIL
HEATING FUEL
ACCOUNT NO. 143488
12. PP & L ELECTRIC SERVICE
ELECTRIC SERVICE FOR RESIDENCE
ACCOUNT NO. 24730-74003
13. DISCOVER
CREDIT CARD ACCOUNT
ACCOUNT NO.
14. AETNA
AUTOMOBILE INSURANCE
ACCOUNT NO.
15. PP & L
ELECTRIC SERVICE
ACCOUNT NO. 24730-74003
TOTAL (Also enter on Line 10, Recapitulation) I $ 2,631.65
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REV-151~E'X+(01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF:
FILE NUMBER:
GLENWU UU M. t31GK I A ~ ti i u u i ~~
RELAT{ONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s~ OF ESTATE
j TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. CINDY KECK Lineal 152,518.40
837 HAMILTON STREET
CARLISLE, PA 17013
2. LISA HAULMAN Lineal 4,571.70
7 EARL STREET
BOILING SPRINGS, PA 17007
3. NICOLE SMITH Lineal 4,571.70
6 EAST FIRST STREET
BOILING SPRINGS, PA 17007
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
jj, NON-TAXABLE DISTRIBUTIONS:
1, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
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