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Home My WebLink About12-09-10 (2) 1505610148 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN 21 10 0 9 7 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 149-16-0930 09],02010 03061927 Decedent's Last Name Suffix Decedent's First Name M I HILLIER ANDREW J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Rel:urn (date of death ^ 4 Limited Estate ^ prior to 12-13-82) 4 F ^ ' . a. uture Interest Compromise (date of 5. Federal Estate Tax Return Required ^ 6 Decedent Died Testate ^ death after 12-12-82) 7 D ~ . . ecedent 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. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL J• CONNOR, ESQ• 717-262-21,85 ~, First line of address 247 LINCOLN WAY EAST Second line of address City or Post Office State ZIP Code CHAMBERSBURG PA 17201, Correspondent's a-mail address: M J C n! W C S L A W O F F I C E• C O M REGISTER OE$I~S USE ON~ ~ -~ 'V C7 1'ps ~i ~ ~ ~ ~"'~ ~ '."~' , ~ :.;.:~ ti e4y? ry j 1 , •~ ~ ~ . -z `~ , \J ~ ~ .._. --f W ' + ~.::~ i DATE FILED ~ ~ C 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. SIGNATURE OFPERSO ESPONSIBLE FOR FILIN RETURN ~~ DATE ADDRESS C/0 WALKER, CONNOR & SPANG, LLC _ 247 LWE, CHAMBERSBURG, PA 17201 51G RE~F~REPARER OTH~R THAN REPRESENTATIVE DATE ADDRESS ~.~ C~ ~ Z~' ~ ~ 247 LINCOLN WAY EAST CHAMBERSBURG, PA 17201 PLEASE USE ORIGINAL FORM ONLY ~'z "' E"` t'c `1 t ,....} ,......> ',. ,c =r~y "t'j Side 1 15 0 5 61014 8 gM4647 4.000 15 0 5 61014 8 J 1505610248 REV-1500 EX Decedent's Social Security Number 149-16-0930 ~ecedent'sName~ HILLIER ANDR EW ~ - RECAPITULATION 1. Real Estate (Schedule A) 1. 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2. 0 . 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • 3 0 . 0 0 4. Mortgages and Notes Receivable (Schedule D) 4. Q . 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 191, , 0 6 6.0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g, 10 , 9 0 2.0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property arate Billing Requested ~ Se 7 2 7 , 8 0 4 •0 0 p (Schedule G) . 8. Total Gross Assets (total Lines 1 through 7) g. 2 2 9 , 7 7 2.0 0 9, Funeral Expenses and Administrative Costs (Schedule H), • g, 3 0 , 6 6 4 •0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10, 2 , 3 7 4 • 0 0 11. Total Deductions (total Lines 9 and 10) , . 11. 3 3 , 0 3 8.0 0 12. Net Value of Estate (Line 8 minus Line 11) . 12. 19 6 , 7 3 4 •0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , . 13. 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 1, 9 6 , 7 3 4.0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 (a)(1.2) x .o ~ 0.0 0 15. . 16. Amount of Line 14 t xable 4~ 00 853 8 at linealrateX.O 196,734.00 16. . , 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17 0. 0 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 Q. Q Q 1 g. . 19. TAX DUE 19. 8 , 8 5 3.0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 9M4648 4.000 REV-1500 EX Page 3 File Number ai. i.n nq~q VVVVNV••- V • ~ DECEDENT'S NAME HI ER ANDR W ~ STREET ADDRESS CITY SHIPPENSBURG STATE PA ZIP 17257- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 8 , 410.0 0 B. Discount 4 4 3.0 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) (1) 8,853.00 8,853.00 (3) 0.0 0 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ • ~ ~ 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 d. receive the promise for life of either payments, benefits or care?. ~ ~~ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ^ ~~ without receiving adequate consideration? . ^ 1-~ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ~:1 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use ~of the surviving spouse is 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. X9116 (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(a)(1.2)J. • 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. X9116(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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least ane parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2} 9M4671 2.000 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 Andrew J. Hillier 21 10 0979 Include the proceeds of litigation and the date the proceeds were received by the estate. aw4sAD 1.oo0 (If more space is needed, insert additional sheets of the same size) r J A N U S ti:. .._ _- - --- __ ~ _ . __ . _ R_. _ ~.o - - ~-: - - - - " PO Box 193375 rE~~` 800 525 37,13 ~ '` 1 _y- - _ ' R• .c _ '~ v 1 ,s . ' Denver, CO 80217-3375' wEB ~anus:com ~°` , October 13, 2010 WALKER CONNOR SPANG LLC ATTN JULIE METZ 247 LINCOLN WAY E CHAMBERSBURG PA 17201-2235 REFERENCE: 02018654 Dear Ms. Metz: This letter is in response to a request for Janus account information. The balances provided below are unaudited. Date Fund/Account Number Transaction Share Price Shares Dollar Amount 09/10/10 42/200177134 Balance $25.96 544.183 $14,12b.99 09/10/10 62/200177134 Balance $10.43 3,485.142 $36,350.03 09/10/10 40/200177135 Balance $27.62 651.526 :17,995.15 09/10/10 42/200177135 Balance $25.96 377.835 $9,808.60 Mr. Hillier's accounts are registered as follows: Non-retirement account 200177134 ANDREW J HILLIER 305 N PRINCE ST SHIPPENSBURG PA 17257-1321 Retirement account 200177135 STATE ST BANK CUST IRA ANDREW J HILLIER 305 N PRINCE ST SHIPPENSBURG PA 17257-1321 The beneficiary designations on both accounts are as follows: Name: Patricia A. De Sturco ~o of Account: 50 __~ Name: David A. Hillier °,o of Account: 50 -~ Please note that there are no secondary beneficiaries listed on the accounts. ., _^S .,~.~.'"1',.1.._.~C} ~c."'L.1J ~~I~`i'?~L:i~i, ~_ i ~' _ ~..~-~ ~. , L1 ~ !~. ~~ ~i:2i~C. ZAUJAN5011 ~1i~ ~~~~~~~~ ~~~ CLOSING DEBIT -CHECKING !!~ ate ~i /~~ /- ~ BanWBranch ~~~~ / ~~ ~ Amount Debited ~ !°`~ ;, For: is amount has been charged to your account. Please adjust your records. ~-~ ~ ~~""~ 4 • Debit ~ ~ Prep. Sy Name ~ ~~ ~...;~~ ~~ ~_~':-, ~,~ ~ ~, ~ ACCt. ~ ~ ~....~ i ~' v a...: Address ~. r pr. By ~- ~~ _~---__ i, ustomer signature required when customer requests account be closed 1 ,,M;`y ~ ~=~ ~' Cumberland County Board of Assessment Appeals Old Courthouse, First Floor One Courthouse Square Carlisle, PA 17013 00516891-1A-9623 I~~~lll~~~l~~l~l~{~I~I~~~II~~I~~~~ll~~l~ll~l~~ll~~~i~~~l~~~lll 17754 HILLER, ANDREW J T51 P1 7 MICHAEL COURT SHIPPENSBURG, PA 17257-8129 --- Deadline for Scheduling an Informal Review Appointment: April 1.2, 2010 • • ~ • The Cumberland County Board of Assessment Appeals is providing you with notice of the value on this property, determined as a result of the Cumberland County countywide reassessment completed this year. The countywide reassessment values each property at current Fair Market Value, as of January 1, 2010, equalizing and establishing a uniform tax base so that properties of like characteristics and the same actual Fair Market Value will be taxed the same. VALUE NOTIFICATION MAILING DATE: March 1, 2010 Munic.: 39 - SOUTHAMPTON TOWNSHIP School: 7 - SHIPPENSBURG AREA SD Location: 7 MICHAEL COURT SHIPPENSBURG VILLAGE LOT 4 Taxable Property Unit/Lot ID: TP-0004 No Land, Improvements only Property Type: R ResidentialiUnder 10 Acres) ESTIMATED TAX IMPACT FORMAL APPEAL DEADLINE: April 12, 2010 Parcel Identifier: 39-13-0102-002.-TR10485 2010 Base Year Assessed Value Old Assessed Value Fair Market Value (2010 Market x 100%) (2004 Market) i Land 0 0 0 Buildings 139, 400 139, 400 131, 160 TOTAL 139,400 139,400 131,160 2010 Clean and Green Values Land NOT NOT NOT Buildings APPLICABLE APPLICABLE APPLICABLE TOTAL Clean and Green values apply to qualified farm and forest land and become effective only upon application and approval. Clean and Green applications must be received by the Assessment Office no later than 4:30 p.m. on October 15, 2010. Those L previously approved for Clean and Green do not need to rep-apply. The ESTIMATED impact statement printed below is our best estimate of change, based on 2010 COUNTY tax figures. THIS ESTIMATE DOES NOT INCLUDE ANY BOROUGH, TOWNSHIP, OR SCHOOL DISTRICT IMPACT. Current 2010 County mills = 2.465 Adjusted 2010 County mills = 1.982 ~ 323 2010 COUNTY Tax BEFORE Reassessment. ~ 276 2010 COUNTY Tax AFTER Reassessment. (see reverse side) !FIRST LIEN FAVOR OF: SECOND LIEN FAVOR OF; s cDOMETER STATUS 0 =ACTUAL. MILEAGE 7 =MILEAGE EXCEEDS THE MECHANICAL LIMITS 2 =NOT THE ACTUAL MILEAGE 3 = tJOT THE ACTUAL MILEAGE-ODOiVIETER "TAMPERING VERIFIED 4 = EXEMPT FROM ODOMETER DISCLOSURE ' TITLE BRANDS A =ANTIQUE VEHICLE C =CLASSIC VEHICLE D = COLLECTI3L~ VEHICLE F = QUT OF COUNTRY .. - vriiuiivi~ia i ir,~ uv. i v.. i~viv•i:..i. DISTRIBUTION H = AGF'ICULTURAL VEHICLE L =LOGGING VEHICLE P = IS/WAS A POLICE VEHICLE R =RECONSTRUCTED S =STREET ROD T =RECOVERED THEFT VEHICLE V d VEHICLE CONTAINS REISSUED-VIN W =FLOOD VEHICLE. X = IS/WAS A TAXI If a second lienholder is listed upon satisfaction of the first lien; the first lienholder must forward this Title to the Bureau of P~totor Vehicles with .the FIRST LIEN RELEASED appropriate form and fee. DATE _ BY SECOND LIEN RELEASED f AUTHORIZED REPRESENTATIVE DATE MAILING ADDRESS ~ ' s BY 6 AUTHORIZED REPRESENTATIVE A~1~F~EW ~ HTLLIEft ? ~ I CHAPEL ~T CHI t~PEIU~BU~~ P#~ ~?25? ~~ 0 V ~ ~LLE~# I~ SIEHLE~ I certify as of the date of issue, the official records of the Pennsylvania Department '` T'3. 3r..;:.~::~ ; ;e^;,.t tl:d: t,`.C p,;-5;,^~:,; :. ~C:'pW~~ ^:'-2~ hc~'.^.i:: :.. • o ® of the said vehicle. ~ C l,r.~lt.l C..^^r Secretary of Transportation t • • 1 a t ~ t~ ~r~.- ~ ~ ~ ~~ ~ •a• - e of • s •• 3USSCRIBED AND SWORN ro,~,13EFOR~. ME: F',i~w:~~l MO. DAY YEAR ; If a co-purchaser other than your spouse' is listed and you want the title to ; be listed as "Joint Tenants With Right of Survivorship" (On death ,of one - i owner;. title goes to surviving owner.) CHECK HERE O. Otherwise, the title ;will be issued as "Tenants in Common" (On death of one owner, interest of i deceased owner goes to his/her heirs or estate). ~ - ~~ SIGNATURE OF PERSON ADA,IINISTERING OATH ~ 1ST LIEN DATE: -~ IF NO LIEN, CHECK i "' j 1ST LEENHOLDER -t ~ . . ~ STREET !~ /? . - ;CITY STATE ZIP. I i IF THIS IS AN ELT, CHECK HERE ^ FINANCIAL ~ NOTE: FIN REQUIRED INSTITUTION NO, ` i 2ND LIEN DATE: ~ IF NO LIEN, CHECK _ The unCersigned hereby makes application to Certificate of Tnle to the vehicle described ` i ~ ~ibove, sub7~dt to theencumbrances and other legal claims set lorth here. . ! ~ - - '- ~ ' 2ND LIENHOLDER - .. STREET -~' SIGNATURE OF APPLICANT OR AUTHORIZED SIGNER CITY ;iTATE ZIP lF THIS IS AN ELT, CHECK HERE ^ F1NAIJCIAL SIGNATURE OF :O-APPLICANTlrITLE OF AUTHORIZED SIGNER NOTE: FIN REQUIRED INSTITUTION NO. REV-1509 l7(+ (01-10) pennsylvania DEPARTMENT OFREVENUE INHERITANCE TAX RETURN ESTATE OF: r~~~ ~wmvcr~. Andrew J. Hillier 21 10 0979 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVNN~G JOINTTEWAPfT(S) NAME(S) I ADDRESS ~ RELATIONSHIP'f0 DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY A Hillier, David A 305 N. Prince Street, Shippensburg, PA 17257 Son JOINTLY OWNED PROPERTY: ~~ NUMBER LETTER FOR JOINT TENANT DATE MADE I JOINT DESCPoP110N OF PROPERLY NCLUDE NAhE OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUM3ER at SIMLAR IDENTIFYING NUM3ER. ATTACH DEED FOR JgNTLY HELD REAL ESTATE. DAl1= OF DEATH VALUE OF ASSET % OF DECEDOYI'S INTH2EST [)R11=OF DEATH VALUE OF DECEDENTS INTEREST 1 A 2/15/1995 Cape Cod Cooperative Bank checking account #8002173070 - joint with son, David A. Hillier 21,803 50.0000 10,902 Interest accrued to 9/10/2010 0 50.0000 0 TOTAL (Also enter on Line 6, Recapitulation) S 10 , 902 swasAE 2.000 1f more space is needed, use additional sheets of paper of the same size. FROM : CAPECOUCGOPASD FAX N0. : 15t~83E~2~31 S 0 c t. Q5 2~i 1 ~1 ~~~ : 4~F'M F'2.r CAFE COd~~ COOP,ERA'I'IVE BANK "Ann i J~n~ canc. a qan of )e~u,fgr... October 5, 2010 To Whorn It May Concern: Re: Andrew J Hillier, deceased, date of death 9-10-2010 information Z. Account name -Andrew J Hillier, David A Hillier 2. Account #8442 x.73474 3. Date of Death Balance 9-10-2010 $21,803.24 ~. Accrued interest to September 14, 2024 - $2,42 pasted S-3Z-2414 for month 5. Joint Ownership date 2-15-1995 6. No IRA accounts 7. No loan accounts 8. No closed accounts within one year prior to death Linda DiNoia Deposit Services Representative Cape Cod Cooperative Bank 25 13~rijamin i-rc~nklin Way Hyannis, MA 02601 (508) 56$-3200 or (800 G41-1100 www.rnycapecodbank.c~~~m REV-1510 EX + (OS-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Andrew J. Hillier 21 10 0979 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 NUMBS DESCRIPTION OF PROPERTY INCUAE TFE NOME OF TFE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACHA COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET o ~ /o OF DECD S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~~ Janus IRA Account #200177135 - named beneficiaries are decedent's children: Andrew J. Hillier and Patricia A. DiSturco 27,804 100.0000 0 27,804 TOTAL (Also enter on line 7, Recapitulation) $ I 27 , 804 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 E ~ ~; _ - _ -,•--- ---~-----r ~~ _ _~ ----~ ` PO:,Box•f.73375'' TES 800 525 37]3 _ ~ -- ~ _ - - - --, _ _ _ -- ~ - --,.~_ .._. - - Denver, CO 8G277-3315 •,,ea ~arius.ccm: - October 13, 2010 WALKER CONNOR SPANG LLC ATTN JULIE METZ 247 LINCOLN WAY E CHAMBERSBURG PA 17201-2235 REFERENCE: 02018654 Dear Ms. Metz: This letter is in response to a request for Janus account information. The balances provided below are unaudited. Date 0 Fund/Account Number Transaction Share Price Shares Dollar Amount 9/10/10 42/200177134 Balance $25.96 544.183 $14 126 99 09/10/10 09 62/200177134 Balance $10.43 3,485.142 , . $36,350.03 /10/10 40/200177135 Balance $27.62 651.526 $17 995 15 09/10/10 42/200177135 Balance $25.96 377.835 , . $9,808.60 Mr. Hillier's accounts are registered as follows: Non-retirement account 200177134 ANDREW J HILLIER 30.5 N PRINCE ST SHIPPENSBURG PA 17257-1321 Retirement account 200177135 STATE ST BANK CUST IRA .ANDREW J HILLIER 305 N PRINCE ST SHIPPENSBURG PA 17257-1321 The beneficiary designations on both accounts are as follows: Name: Patricia A. De Sturco °,o of Account: 50 Name: David A. Hillier ;o of Account: 50 -~ Please note that there are no secondary beneficiaries listed on the accounts. -unas cis~ri Dui°c~ ;~y !~n!.;s ~tis~ributors LLC; i 5l Li~troit Vii., Denver ~C~, 8G2~i6 ZAUJAN5011 REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Andrew J. Hillier 21 10 0979 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Charles F. Snyder Funeral Home 7,266 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) David A Hillier Street Address 305 N . Prince Street City Shippensburg State PA ZIP 17257 Year(s) Commission Paid: 2010 and 2011 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant None Street Address 4. 5. 6. 7. 1 2 City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Shippensburg Village - homeowner's association fee Oct - $285; Nov - $285; Dec - $285 Penelec - electric services Oct/Nov/Dec Total from continuation schedules . 10,414 10,414 324 855 72 1,319 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 30 , 664 9wasAC z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: Andrew J. Hillier Schedule H Part 7 (Page 2) 3 Cumberland County Tax Collector - real estate property taxes 4 UGH - gas utility service Oct/Nov/Dec 5 Cumberland Law Journal - legal advertising 6 The News-Chronicle Co. - legal advertising 21 10 0979 1,100 39 75 105 Total (Carry forward to main schedule) 1,319 REV-1512 EX + (12-08) Pennsylvania DEPARTMENTOF REVENUE 1NHERiTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Andrew J. Hillier SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21 10 0979 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 8W46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Andrew J. Hillier 21 10 0979 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. David A. Hillier Son 1/Z of residue 305 N. Prince Street Shippensburg, PA 17257 2 Patricia A. DiSturco Daughter 1/2 of residue 54 Carriage Circle Williamsville, NY 14221 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 It more space Is needed, use aaaltlonal sneers or paper or the same size. 9W46AI 2.000