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HomeMy WebLinkAbout06-20-11J 1505607121 REV-1 rJOO Ex (os-o5) OFFICIAL USE ONLY PA Deparhrlenl of Revenue Bureau of Individual Taxes County Code Year File Number POBOx2ti0601 INHERITANCE TAX RETURN 2 1 1 0 0 3 6 2 Hanlsbum, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Sociel Security Number Date of Death Date of Birth 1 9 5 3 8 8 4 1 2 0 3 2 6 2 0 1 0 0 3 1 7 1 9 4 8 Decedent's Last Name Suffix Decedent's First Name MI 8 I T N E R L A W R E N C E W (If AppNcable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI 8 I T N E R A N N K Spouse's Sodal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1.Original Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death pnor to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) ~ QX 8. 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. EleGion 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D A V I D W R E A G E R 7 1 7 7 6 3 1~3 8 3 Firm Name (If Applicable) `~ REGIST ILLS USP-'ONLY ' =rr", R E A G E R & A First line of address D L E R P C ~- n G r-r r" '~ !~. fi ~rn !V --a , ' ~i.7 -, `~ CIS ~ © _'~`ti~3 C 2 3 3 1 M A R K E T S T R E E T ~c~~ ~~,, . Second line of address ~ ~ ~ ..~` W `" ~~ City Or POSt Office State 21P Code DATE FILED C A M P H I L L P A 1 7 0 1 1 Correspondent's e-mail address: DWREAGERaREAGERADLERPC • COM Under penalties of perjury, I declare that I have examined this realm, including accompanying schedules and statements, and to the bast of my knowledge and belief, it is hue, correct and complete. Dedaretiorl of preparer other than the personal representative is based on all information of whk:h preparer has any knowledge. SIGNATUR~^SON RE$P_ ONSIBLE FOR FILING RETURN DATE ~ / ~ 1 ADDRESS - / 906 W• WALNU~T7STR~T WORMLEYSBURG PA 1703 SIGNATURE OF pRE RE LiE N REPRESENTATNE n Tt= . 1 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J~ 1505607221 REV-1500 EX Decetlenrs Name: LAWRENCE W• B I T N E R Decedent's Social Security Number 1 9 5 3 8 8 4 1 2 RECAPITULATION 1. ........................................ Real estate (Schedule A) 1 • • 2. .................................. Stocks and Bonds (Schedule B) 2. 5 0 7 9 5 0 1, 6 5 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 1 2 2 8 5. 8 6 4. Mortgages 8 Notes Receivable (Schedule D) ........................ 4. 6 1 6 1 1 4 , 6 9 5. Cash, Bank Deposks & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 , 0 0 7. Inter-Vivos Transfers 8 Miscellaneous N~;-Probate Property te Billin uested r Re S l 7 1 2 9 3 4 2 5. 8 9 ....... g q epa a e G) LJ (Schedu . 8. Total Gross Assets (total Lines 1-7) ........................... 8. 7 0 0 1 3 2 8, 0 9 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 2 9 9 5 8 , 7 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 1 5 0 0 1 1 9 , 2 7 11. Total Deductions (total Lines 9& 10) ........................... 11. 1 5 3 0 0 7 7. 9 9 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 5 4 7 1 2 5 0 , 1 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. 13. 5 4 7 1 2 5 0 1 0 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 5 4 7 1 1 2 5 0 0 15 0. 0 0 (a>(1.z> x.oo . . 16. Amount of Line 14 taxable 0 0 0 0. 0 0 at lineal rate X .0 _ . 16, 17. Amount of Line 14 taxable 0 0 0 0 0 0 at sibling rate X .12 . 17. . 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 . 1 g. . 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221 0. 0 0 Q J REV-1500 EX Page 3 Decedent's Complete Address: (1) 0.00 DECEDENTS NAME LAWRENCE W• BITNER STREET ADDRESS 906 W• WALNUT STREET CITY STATE ZIP WORMLEYSBUR6 PA 17043 Tax Payments and Credits: ~ • Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments _ C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + tJne 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Pape 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. A. Enter the interest on the tax due. 8. Enter the total of Line 5 +5A. This is the BALANCE DUE. (4) 0.00 (5) 0.00 (5A) (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT e ._ „~;w 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 ............................................................................................. ^ Q ... 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? ....................................................................................... ^ 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 Arx;ount, annuity, or other non-probate property which contains a beneficary designation? .................................................................................................. 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .~ , .- j~' mµ 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 exemot 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 'rf 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-ane 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 (O) 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(aH1.3)]. 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. File Number 21 10 0362 TotalCredits(A+g+C) (2) 0.00 Total InteresUPenalty (D + E) (3) p , D 0 REV-1503 EX + (8-98) SCHEDULE B CONMAONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT LAWRENCE W• BITNER 21 10 0362 All properly jointlyowned with right of survhorehip must ba diecbeed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. EASTERN INSURANCE HOLDINGS, INC• - 326,556 SHARES 3,298,215.60 2• ALLIANCE IMPAIRMENT MANAGEMENT 625,000.00 3• AMWINS GROUP - 84,736 UNITS 1,059,200.00 4• FNB CORPORATION - 1,121 SHARES 9,494.87 5• MARSH 8 MCLENNAN - 1,797.8510 SHARES 44,191.18 6• FNB - CONVERTIBLE NOTE 5,000.00 7• EASTERN RISK PARTNERS LTD - 256 SHARES 38,400.00 TOTAL (Also enter on line 2, Recapitulation) I s 5 , 079 , 501 (If more space is needed, insert additional sheets of the same size) REV-1504 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE•PROPRIETORSHIP ESTATE OF FILE NUMBER LAWRENCE W• BITNER 21 10 0362 Sdredule C-t or C-2 (indudirg all supporting information) must be atradred for each dosey-held corporationlpartnershipintere~t ofthedecedent, ottrer than a sole-proprie~rship. See instructions for the supporting infom~ation to be sutHnHbdfor sGe-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. UNDERWRITING SYSTEMS AND TECHNOLOGIES 12,285.86 906 WALNUT STREET WORMLEYSBURG, PA 17043 TOTAL (Also enter on line 3, Recapitulation) ~ S 12 , 285.86 (If more space is needed, insert additional sheely of the same size) REV-7505 EX + (e-98) SCHEDULE C-1 COMMONWE4LTH OF PENNSYLVANIA CLOSELY-HELD CORPORATE INRE3IDENTDECEDENTRN STOCK INFORMATION REPORT ESTATE OF FILE NUMBER LAWRENCE W. BITNER 21 10 0362 1. Name of Corporation ALLIANCE IMPAIRMENT MANAGEMENT, INC. State oflncorporatron PENNSYLVANIA Address PO BOX 1557 Date oflncorporation 6/19/1989 City LANCASTER State PA Zip Code 17608 Total Number of Shareholders 4 2. Federal Employer I.D. Number 23-254 4878 Business Reporting Year 3. Type of Business MEDICAL CASE MANAGEMENT ProducUService MEDICAL CASE MGMT. SERVICE PROVIDER 4. 5. Was the decedent employed by the Corporation? ....................................... ^ Yes ®No ff yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ....................................... ^ Yes ®No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ............... ^ Yes ®No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death w within two years if the date of death was prior to 12-31.82? ^ Yes ®No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers andlor sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ............ ^ Yes ®No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ................................................. ^ Yes ®No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissdved or liquidated after the decedent's death? ....................... ^ Yes ®No If yes, provide a breakdown of distributions received by the estate, induding dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ...................... ^ Yes ®No If yes, report the necessary information on a separate sheet, induding a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addresses and estimated fair market values. If real estate appraisals have Veen secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those dedared and unpaid. G. Any other information relating to the valuation of the decedent's stack. (If more space is needed, insert additonal sheets of the same size) Provide all rights and restrictions pertaining to each class of stock. REV-1506 EX + (g-oo) A. gRII,~M. B• LA4RENCE C. D. 6. Value of the decedent's interest $ ]2285.86 7. Was the Partnership indebted to the decedent? ................................ ^Yes ®No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ........ ^Yes ® No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-312? ^ Yes ®No If yes, ^ Transfer ^ Sale Percentage transferred/sdd Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers andlor sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death?........ ®Yes ^ No If yes, provide a Dopy of the agreement. 11. Was the decedent's partnership interest sold? .................................. ^Yes ®No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ............. ®Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts ~ceived. 13. Was the decedent related to any of the partners? ................................ ^Yes ®No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? ................. ^Yes ®No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 fw each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of finanaal statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market values. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1508 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT OF SCHEDULE C-2 PARTNERSHIP (FORMATION REPOR 4. Decedent was a ^ General ® Limited partner. If decedent was a limited partner, provide initial investment $ 500.0 D 5. 6. Value of the decedent's interest $ 62 5 , 000.00 7 8. 9. Was the Partnership indebted to the decedent? ................................ ^Yes If yes, provide amount of indebtedness $ Was there life insurance payable to the partnership upon the death of the decedent? ........ ^Yes If yes, Cash Surrender Value $ Net proceeds payable $ _ Owner of the policy Did the decedent sell or transfer an interest in this partnership within one year prior to death or within lwa years 'rf the date of death was prior to 12-31 ~2? ^ Yes ®No If yes, ^ Transfer ^ Sale Percentage transierredlsold Transferee or Purchaser Consideration $ Attach a separate sheet for additional Uansfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death?........ ®Yes ^ No If yes, provide a ropy of the agreement. 11. Was the decedent's partnership interest sold? .................................. ^Yes ®No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................. ^Yes ®No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ................................ ^Yes ®No If yes, explain Date 14, Did the partnership have an interest in other corporations or partnerships? ................. ^Yes ®No If yes, repot the necessary information on a separate sheet, induding a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of finandal statements or Federal Partnership Inwme Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submft a list showing the complete addresses and estimated fair market values. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's paRnership interest. ® No ® No REV-1508 EX + (8-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY IIW111de the ~ ProP~Y. ITEM NUMBER 1. PNC BANK - CHECKING 2. PERSONAL PROPERTY 3• MERCEDES CLK 350 4. MERCEDES 5550 the date the by the estate. on ScheduM F. TOTAL (Also enter on line 5, Recapitulation) I S (If more space is needed, insert additional sheets of lire same size) ~_~ VALUE AT DATE OF DEATH 4,882.69 500,000.00 48,654.00 62,578.00 REV-1509 EX + (8.98) SCHEDULE F CC+MMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERRANCETAX RETURN LAWRENCE W• BITNER 21 10 0362 Ban asset urea made joint rrifhin one year of the decedent's dab of death, k must be reported on Bcheduk G. SURVMNG JOINT TENANT(S) NAME ADDRESS TO DECEDENT A. ANN K• BITNER 9D6 W• WALNUT STREET LEMOYNE, PA 17043 B C JOINTLY•OWNED PROPERTY: WIFE ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PRDPERTY INCLUDE NAME OF FINANCUIL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FORJOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % ~ DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENPSINTERES7 1. A. 5/1984 REAL ESTATE HELD HAS HUSBAND AND WIFE AT 1,533,000.00 0• 0.00 906 WALNUT STREET, WORMLEYSBURG, PA 17043 2• A• 10/200 NATIONAL PENN BANK - JOINT CHECKING ACT• 2,150.70 0• 0.00 PHILADELPHIA 8 READING AVNEUE BOYERTOWN, PA 19512 TOTAL (Also enter on line 6, Recapitulation) I S 0 00 (If more space is deeded, Il~sert additional sheets o(the same size) REV-1510 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY `°'^" "~ FILE NUMBER LAWRENCE W• BITNER 21 10 0362 Thb schedule must be Completed and filedd the answer to any of questions 1 ihlough 4 on file reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDETXEN"MEOFiHETW~NBFEfiEE,TMEIRREUTION&IIPTOOECEUEMAND "~D1~0F7N"~R"rr"°""'n"''°`T'a°EE°F°""rxE$T^TE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION nFNel TAXABLE VALUE 1. 401 K - ANN K• BITNER - WIFE 1,107,555.99 100• ,107,555.99 2• MARSH ti MCLENNAN COMPANIES - ANNUITY 165,869.90 100• 185,869.90 ANN K• BITNER - WIFE TOTAL (Also enter on line 7 Rec~litulatian) I S 1, 2 9 3, 4 2 5 8 9 (If more space is needed, insert addltlalal sheets of the game slze) REV-1511 EX+(10-0a) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LAWRENCE W• BITNER 21 10 0362 DetHe of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOI INT A. FUNERAL EXPENSES: 1. NEUMYER FUNERAL HOME, INC• B. 1 2. 3. 4. 5. 6. 7. 8• ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Stab Year(s) Commissbn Paid: AttomeyFees REAGER 8 ADLER, PC Fatuity Exemptron: (If decedents address is not the same as claimant's, etfadi explanation) Claimant Street Address City Stab Relationship of Claimant b Decedent Zip ProbabFees CUMBERLAND COUNTY RECORDER OF DEEDS Aooounbnt'sFees KERN AND COMPANY Tax Retum Preparers Fees LEGAL ADVERTISEMENT - CUMBERLAND LAW JOURNAL LEGAL ADVERTISEMENT - JOURNAL PUBLICATIONS 1,755.50 500.00 75.00 79.00 TOTAL (Also enter on line 9, Recapitulation) I S ~ e e ~ , .,., Zip 25,000.00 2,549.22 (If more space a needed, insert additional sheets of the same siu) REV-1572 EX + (12-03) COMMONWEALTH OF PENNSYLVANW INHERITANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS tSIATE OF FILE NUMBER LAWRENCE W• BITNER 21 10 0362 Rsport debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medkal expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MORTGAGE - CHASE BANK - JOINT WITH WIFE ANN BITNER 635,701.14 2• LINE OF CREDIT - HOMETOWNE HERITAGE - JOINT WITH WIFE ANN BITNER 3• LINE OF CREDIT - PNC BANK 4• NOTE TO AmWINS GROUP 5• 2009 FED ERAL TAX PAYMENT - IRS 6• MERCEDES SUV LOAN TOTAL (Also enter on Iine 10, Recapitulation) I ~ (If more space is needed, insert additional sheets of the same size) 249,864.07 50,095.52 63,658.40 438,337.00 62,463.14 REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT I AI.IDCAIrC 1.1 OTTAICC ~~ - - - - - - -- cy yu LJ 7laC RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustea~s) OF ESTATE I TAXABLE DISTRIBUTIONS [mdude ht spousal disbibutbns, and transfers under Sec. 9116 (a (12)j 1. ANN K• BITNER Spousal 5,471,250.10 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 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 LINE 13 OF REV-1500 COVER SHEET : pl nXxe space Is neeaea, Insert aaa¢lonal sneers m the sarru3 stze) ~~~ ~,,. .~ ,ate ~_c . .~:.~c_ nnevn~n~ f ,G.,~p_o ~ ~~ ~cWX L .~cf _ i~'aeet2xa.,~..~ ~ ..i~ U <4~ua~~~[P~so(?~ ~~n~ ~.. a..~ .uccQ,~o .~Qs~-,rye Q.i` ~ --. ~ -'~~,__ U •na,Qe __. _ ~. a0 ,~tec~_~a~E. ,g,Ce _ ... ~ _ ,c~-~c .ate ___ ~w ~y~c y,,.=, a,CI.T,~c ~¢a~ _~ia-c~-L dn,Q/rema~,~c~_ 3 . ~ „~eiu.~~ Q-r~-o-~n..~ ~.~- .c~°e-~eaa~.~c. ~,~C . r - - _ ___ _ - _ ._ _- --- -~u~~ _ -- -- --- - _ /. A ~ . A O a __.. _~_ .....~ .. C JOT ~. ~ N a (.Tt ---_ - __ Q~ ~Ti' .) .^.. ~ ~-,, ._, .. -1 -.: __ ..~. ST C'a