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HomeMy WebLinkAbout12-30-10 (2)1505610143 REV-1500 Ex(o1-1a> OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year Bureau of Individual Taxes oEPARTMErar of REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 10 Harrisburg, PA 17128-0601 RESIDENT DECEDENT File Number 1022 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 201 03 5882 10 03 2010 Decedent's Last Name POLK (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Date of Birth 07 30 1912 Suffix Decedent's First Name MI MARY L Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 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 death after 12-12-82) ~ 5. Federal Estate Tax Return Required g Decedent Died Testate (Attach Copy of Will} ~ ~• AttacheCoMaint fined a Living Trust py of~rust) ~ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10, Spousal Poverty Credit date of death between 12-31 zJ1 and -1-95) ~ 11.Election to tax under Sec. 9113(A) (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LAUREN E BOGAR 717 737 8761 First line of address ONE WEST MAIN STREET Second line of address City or Post Office SHIREMANSTOWN REGISTER OF LS USE Of'd' ~~ ...,.. t~ ~ ~ ~ r,^~ .M~ ~ ~ C~ © `~'' ~~ ~ ~_^ -. rj ~j DA F+6tED Cp , ~.~• " r't1 State ZIP Code r ~ ~ PA 17 011 Correspondent's a-mail address: Ibogar@bogarlaw.com 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 OF PERSON RESPONSIBLE FOR FILING RETURN DATE _ ~Qi.~, ~ ~`' Lauren E. Boger lc~~.q ~/y n Gcc T --* One West Main Street, Shiremanstown, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ~~,,y~„r ~j Lauren E. Boger ~y~~ f~a nRFCC One West Main Street, Shiremanstown, PA 17011 Side 1 L 1505610143 1505610143 J J 1505610243 REV-1500 EX DecedenPs name: Polk, Mary Louise Decedent's Social Security Number 2 01 03 5 8 82 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. 318,781.72 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous I~q Probate Property arate Billin Se Re uested ............ p g q (Schedule G) ~J 7. 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, 318 , 7 81.7 2 19,039.48 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 997.44 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 8~ 10) ................................................................... 11. 20,036.92 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 298,744.80 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. 298,744.80 TAX COMPUTATION -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 .00 15. 16. Amount of Line 14 taxable 2 9 8 7 4 4. 8 0 16. , at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ................................................................................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 13,443.52 0.00 0.00 13,443.52 Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-10-1022 DECEDENT'S NAME Polk, Mary Louise STREET ADDRESS 325 Bethany Drive Apt. 3325 CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 672.18 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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) Total Credits (A + B) (2) (3) (4) (5) 13,443.52 672.18 12,771.34 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 b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 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? .................................................................................................................. ^ ^x 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 January 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 (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 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 12 percent [72 P.S. §9116 (a) (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-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Polk, Ma Louise 21-10-1022 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Janney Montgomery Scott -Investment Account #6687-7075. Date of death value 236,065.51 $235,788.22; accrued interest $277.29 2 M&T Bank -Certificate of Deposit #31003915188584. Date of death balance $11,475.09; 11,480.75 accrued interest $5.66 3 PNC Bank -Checking Account #500489163. Date of death balance $4,056.26. This account 4.056.26 was non-interest bearing. 4 PNC Bank -Savings Account #5005797955. Date of death balance $40,243.81; accrued 40,243.85 interest $0.04 5 PSECU -Regular Share Account S01. Date of death balance $52.42; accrued interest $0.00 52.42 6 PSECU -Checking Account SO4. Date of death balance $877.32; accrued interest $0.00 877.32 7 PSECU -Money Market Account S07. Date of death balance $9,332.35; accrued interest 9,332.61 $0.26 8 PSECU -Certificate of Deposit C52. Date of death balance $5,856.00; accrued interest $0.32 5,856.32 9 PSECU -Certificate of Deposit C53. Date of death balance $5,821.22; accrued interest $0.48 5,821.70 10 Public School Employees' Retirement System -final prorated retirement benefit payment 494.98 11 Personal Property -Sold at private sale 500.00 12 U.S. Treasury - 2009 Personal Income Tax Refund 4,000.00 TOTAL (Also enter on Line 5, Recapitulation) I 318,781.72 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (10-06) COMMONWEALT~i QF PENNSYLVANIA INHEI~ITAN E I gX RETI~RN RESIDENT DE EDEN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Polk, Mary Louise 21-10-1022 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) 313.00 Street Address City State Zio Year(sl Commission paid 2. Attorney's Fees Bogar & Hipp Law Offices 15,750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 381.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 2,594.98 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 19,039.48 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) Estate Valuation Date of Death: 10/03/2010 Estate of: M. Louise Polk Valuation Date: 10/03./2010 Account: 6687-7075 Processing Date: 12/06/2010 Report Type: Date of Death Number of Securities: 10 File ID: M. Louise Polk 6687-7075 DOD 10--03-10 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 1} 300 SOURCE CAP INC (836144105; SOR) COM New York Stock Exchange 10/01/2010 46.67000 45.75000 H/L 10/04/2010 46.50000 45.52000 H/L 46.135000 13,840.50 2} 5000 LANCASTER PA AREA SWR AUTH REV SWR REV B {514288AP4} Financial 'l'imes Interactive Data DTD: 06/15/1972 Mat: 04/01/2012 6% 10/01/2010 104.94200 Mkt 10/04/2010 104.92800 Mkt 104.935000 5,246.75 Int: 10/01./2010 to 10/03/2010 1.67 3} 50000 GNMA PASS-THRU X SINGLE FAMILY {3621bFV80} Financial Times Interactive Data Mat: 07/15/2016 8.000% Fact: 0.00802898 10/01/2010 102.15822 101.78322 A/B 10/04/2010 102.11149 101.73649 A/B 101.947356 409.27 Int: 10/01/2010 to 10/03/2010 0.18 Int: 09/01/2010 to 09/30/2010, payable 10/15/2012.72 Prin: 09/01/2010 to 09/30/2010, payable 10/15/2010 6.54 4} 25000 GNMA PASS-THRU X SINGLE FAMILY {36217QJ71} Financial Times Interactive Data Mat: 04/15/2017 8.000% Fact: 0.00278958 10/01/2010 101.97165 101.59665 A/B 10/04/2010 101.92457 101.54957 A/B 101.760609 70.97 Int: 10/01/2010 to 10/03/2010 0.03 Int: 09/01/2010 to 09/30/2010, payable 10/15/2010.47 Prin: 09/01/2010 to 09/30/2010, payable 10/15/2010 0.71 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 10/03/2010 Estate of: M, Louise Polk Valuation Date: 10/03/2010 Account: 6687-7075 Processing Date: 12/06/2010 Report Type: Date of Death Number of Securities: 10 File ID: M. Louise Polk 6687-7075 DOD 10-03-10 Shares Security Mean &/or Div & Int Security or Par Description Hi gh/Ask Low/Bid Adj'ments Accruals Value 5} 30000 GNMA PASS-THRU X SINGLE FAMILY (362170TK8} Financial Times Interactive Data Mat: 10/15/2017 9.5000 Fact: 0.00750996 10/01/2010 113.67594 A/B 10/04/2010 113.63675 A/B 113,656346 256.07 Int: 10/01/2010 to 10/03/2010 0.12 Int: 09/01/2010 to 09/30/2010, payable 10/15/2011.80 Prin: 09/01/2010 to 09/30/2010, payable 10/15/2010 2.12 6) 10000 FNMA PASS-THRU LNG 30 YEAR ~31373UF28) Financial Times Interactive Data Mat: 10/01/2025 7.000% Fact: 0.01426047 10/01/2010 113.01289 A/B 10/04/2010 113.00441 A/B 113.008654 161.16 Int: 10/01/2010 to 10/03/2010 0.06 Int: 09/01/2010 to 09/30/2010, payable 10/25/2010.84 Prin: 09/01/2030 to 09/30/2010, payable 10/25/2010 1.24 7} 30000 GNMA REMIC TRUST 2004-53 (38374HGS3) Financial Times Interactive Data Mat: 08/20/2032 5.000 Fact: 1 10/01/2010 107.74945 Mkt 10/04/203.0 107.76679 Mkt 107,758120 32,327.44 Int: 10/01/2010 to 10/03/2010 8.33 Int: 09/01/2010 to 09/30/2010, payable 10/20/2125.00 8) 30000 FHLMC REMIC SERIES 3186 (31396UK90) Financial Times Interactive Data Mat: 07/15/2036 5.5000 Fact: 0,389642 19 10/01/203.0 100.53288 Mkt 10/04/2010 100.50485 Mkt 100.518865 11,749.92 Int: 10/01/2010 to 10/03/2010 3.57 Int: 09/01/2010 to 09/30/2010. payable 10/15/2055.07 Prin: 09/01/2010 to 09/30/2010, payable 10/15/2010 325.45 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information. provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. Date of Death: 10/03/2010 Estate of: M. Louise Polk Valuation Date: 10/03/2010 Account: 6687-7075 Processing Date: 12/06/2010 Report Type: Date of Death Number of Securities: 10 File ID: M. Louise Polk 6687-7075 DOB 10-03-10 Shares Security Mean &/or Div & Int Security or Par Description High/Ask Low/Bid Adj'ments Accruals Value 9} 3503,501 FRANKLIN CUSTODIAN FDS INC (353496607; FKUSX} US GOVT CL A Mutual Fund {as quoted by NASDAQ} 10/01/2010 6.80000 Mkt 6.800000 23,823.81 0.0221 E 10/01 R 09/30 P 10/05/10 77,43 10} 147566.27 Cash (CASH} 147,566.27 'T'otal Value: $235,788.22 Total Accrual: $277.29 Total: $236,065.51 Page 3 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. Janney Montgomery Scott LLC assumes no responsibility for accuracy or completeness of the information provided, the Date of Death and the specific securities, which are valued. While we deem this information to be reliable, we do not warranty or guarantee its accuracy, This service is not intended to constitute legal or tax advice. You should consult with your tax professional and attorney to discuss estate settlement and any legal matters. p ~s~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 October 21, 201.0 James D Bogar Attorney At Law One West Main Street Shiremanstown, PA 17011 Re: Estate of Mary Louise Polk Social Security: 201-03-5882 Date of Death: October 3, 2010 Dear Sir or Madam: In response to your request, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following accounts: 1. Type of Account Certificate of Deposit Account Number 31003915188584 Ownership (Names of) M Louise Polk Opening Date Balance on Date of Death Accrued Interest Total 08/29/05 $11,475.09 $ 5.66 $11, 480.75 *We were unable to locate any safe deposit box for the above-mentioned decedent. **For further account information, closures and/or reimbursement of funds please call the Lehighton Office at #570-386-5931. **'k1'his letter does not include any accounts in which the deceased may have been listed as Power of Attorney, C~staiian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement S' rely, Suzanne M Kimble Adjustment Services ~prvc ~.~~~~8 T~~ ~~~ November 15, 2010 Lauren E Bogor James D Boga~r A,tto~rtey at Law One West Main St Shiremanstown, PA 17011 1ZE: M Louise Polk SSN: 201-03-5852 DOD; ~IO-03-2010 Dear Ms. $ogar: In response tv your request for Date of Death (DOD) balances for the cust~orner noted above, our records show the following: Checking Account Account # 5004$94163 Established; 03-22-2007 M LOUISE POLK DOD balance: $ 4,056.26 non ix~,texest beariztg Saving$ Accon~t Account # 500797955 Established: 03-03-2008 M LOUISE POLK DOD balance: ~ 40,243.81 + 0.04 accrued interest Interest paid 01-O1-ZO10 thxu 10-03-2010 $ 2.29 YTD Please note that this office provides date of death balances for deposit accounts (BAs, CDs, Checking and Savings). ~Ve do nQt proces9 any financial transactivn9 yr provide statements. If you need assistance with any of these items, please caiI 1-888-PNC-BANK (1-888-76Z-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial SeFvices Center PNC Bank, N.A. Member FDIC Page 1 of 1 PSEC~k October 18, 2010 Account # 8405XXXXXX LAUREN E BOGAR ONE WEST MAIN ST SHIREMANSTOWN, PA 17011 Dear MS. BOGAR: The following is the status of MARY LOUISE POLK's account with PSECU as of the date of death. Joint Owner's Name NONE Date of Death 10.03.2010 Date of Birth 07.30.1912 Share Description Open date Balance Accrued Dividend S O1 Regular Shares 05.03.2001 $ 52.42 $0.00 S 04 Checking 07.11.2001 877.32 0.00 S 07 Money Market 11.09.2006 9,332.35 0.26 C 52 12 Month Certificate* 08.30.2006 5,856.00 0.32 C 53 12 Month Certificate* 11.09.2006 5,821.22 0.48 *The fu nds to setup the Certificates were transferred from S 1/Regular Shares. The dividend earned from January 1, 2010 through the date of death was $179.52. The decedent had no loans with us. We do not have safe deposit boxes for our members. When ready to close the decedent's account, you may mail or fax the completed Authorization to Close Account form to us. If you have any questions, please ca11234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. of\Sinpcerely, ;. v f Meade Fairfax Member Service Representative Finance Support Unit Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 1 71 1 0-2990 • 717.234.8484 • 800.237.7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 1 71 06-701 3 • 717.777.2100 (TDD) • 800.472.1967 (TDD) psecu.com This credit union is federally insured by the National Credit Union Administration. Equal Opportunity Lender SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Polk, Mary Louise 21-10-1022 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Myers Harner Funeral Home -Funeral bill 313.00 H-A 313.00 Other Administrative Costs 2 Janney Montgomery Scott -fee to obtain date of death valuation 200.00 3 Myers Harner Funeral Home -Fee to obtain corrected Death Certificates 60.00 4 Pennsylvania School Employees' Retirement System -Benefit reclamation 330.98 5 Register of Wills -Short Certificate 4.00 6 RESERVES: -Costs to conclude administration of Estate, including filing of PA Inheritance 2,000.00 Tax Return and Inventory, preparation and filing of final Personal Income Tax Returns and Fiduciary Income Tax Returns. H-B7 2,594.98 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Polk, Ma Louise 21-10-1022 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-08) ,- COMMONWRE~ALT OFq PJ~ENN YLVANIA IN RESIDEN~EDECEDEN RN SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Polk, Ma Louise ~ 21-10-10 22 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 Rosemary Polk Daughter One-third of rest, 624 Greenway Terrace residue and Kansas City, MO 64113 remainder Thomas E. Polk II Son One-third of rest, 160 Riverview Road residue and Athens, GA 30606 remainder Timothy H. Polk Son One-third of rest, 1388 Englewood Drive residue and Saint Paul, MN 55104 remainder Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. 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 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)