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Home My WebLink About10-27-11• J 1505610105 REV-1500 ac~_111 cFl, ~f PA Department of Revenue Pennsylvania Bureau of Individual Taxes °`"'""~~~~^~~ OFFICIAL US PO BOx z8o6o1 INHERITANCE TAX ONLv Harrisbur PAi 128-0601 RETURN ;counryCode Year ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT ~~~ Numper Social Security Number I ~ ( ORt~ S! 201-04-3483 Date of Death MMDpYYYy _' 08/31/2011 Date of Birth MMDDYYYY Decedent's Last Name 05/15/1907 SponSler Suffix Decedent's First Name _ _.... wlliam (If Applicable) Enter 3urvivln MI 9 Spouse's Information Below spouse's Last Name ? K __._ ._ _ _ _ Suffix _ __ Spouse's First Name ........... .................. Spouse's Social Securi _ _ _ MI ........... Number _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE PILL IN APPROPRIATE OVALS BELOW REGISTER OF OD 1. Original Return WILLS O 2. Supplemental Return O 4. Limited Estate O 3. Remainder Return (Date of Deafh O 4a. Future Interest Compromise (date of Prior to 12-13-x)2 eD 6. Decedent Died Testate death after 12-12-82) O 5. Federal Estate Tax Return Required {Attach SPY of Will) O 7. Decedent Maintained a Livin T O 9. Littgation Proceeds R {Attach SPY of Trust,) g rust __ eceived 8. Total Numb®r of Safe Deposit Boxes O 10. Spousal Pove CORRESPONDENT- Between 12-3 91 and 1D1 95)f Death O 11 Name (Attach Schedul$ O) 9113(A) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE ANp CONFIDENTIAL TAX INFORMATI coon to Tax under Sea John M. _ _ oN sliouup B Eakin _ E DIRECTED TO: _ --- Daytime Telephone Nufnber _ __ _ _ __ ' (717) 766-3172 _ _ _. First Line of Address _ REGISTER OF Vlpi,i g SSE C T _. Market Square Building ^ _ O - -- Second Line of Address ~ ? r7- n _ om _ -. ,_ _ ,t r-- City or Post Office '`~ v "~ ~_ j C Mechanicsburg - ~~ ~ _ State Z .~•, `", IP Code DATI PA 17055 __ - Correspondent's e-mail address: _ Under penalties of perjury I declare _ . _ it f=_-- plate. Dwcln.~a.._ _. ~, correct and corn that I have examined this return ;....~,.~:-- schedules and statements, a 3 ;s based on all info ~ to the best of rmation of wn;,.ti .,~__ CW:~~ "--i r~ ~.I c,. and belief, r ,--~~~ r-~, r-~ 1_ C~~ C 'r%~ r - r t .~ '~7 _-~__~; +_~ ~ r-j ~..7 1 1505610105 L 1505610105 Side 1 1505610205 REV-1500 EX (FI) ~ecedenrs Name: Wiliam K. Decedent s Social Security Number Sponsler - - RECAPITULATION :201-04-3483 1. Real Estate (Schedule A)......... - .................. 1. __ 2. Stocks and Bonds (Schedule B _...._.. ............................ ... .. _.: 3. closely Held Co ' ' " ' 2. ' 929 312 51 rporation, Partnership or Sole-Proprietorshi , ~.._..,..._... V._.____ _,. _.,. P (Schedule C) , , , , . 9. °' " 4. Mortgages and Notes Receivable (Schedule D) ...... _~ .. .......... : 5. Cash, Bank Deposits and Miscellaneous Personal Pro e 4 P rtY(Schedul ..~.._,~ ......... ._... __.. ~_ 6. Jointly Owned Pro e e E)' ' P rtY (scnedule F 7. Inter-Vivos Transfe u 8 Re o l ' ' ~ • • 5. - .._. _,.... ""' ~'~ 523,163.99 °' ° - --. ",,, - _.,,.. _ q rs ested .. , Miscellaneous No (Schedule G) n-probate Pr p em, , . ... 6• ,... O Separate Billing Requested... . 7 8. Total Gross Assets (total Lines 1 through 7) .. • , , . • • .. ... , • - ........ . ...... 9. Funeral Expenses and Administrative Costs (Schedule H)..... .... 8.! 1,452,476.50 10. Debts of Decedent, Mort gage Liabilities and li 9 ~. _,. ..~ _._. 77, 326 92 ens (Schedule I)... ........ 11. Total Deductions (total Lines 9 and 10).... ... 10 4,614.82 .............. 12. Net Value of Estate (Line 8 minus Line 11) ... 11.' ..~.. _.~.._ 81,941.74 ... , . ............... Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . • , , • .. 12 _ ~~ ~_~._...._,. 1,370,534.80 .............. 14. Net Value Subject to Tax (Line 12 minus Line 13) ... 13. 342, 633.70_.: •~•~•~ TAX CALCULATION .SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable •• 1a.' 1,027,901.10 at the spousal tax rate, or transfers under Sec. 9116 - - __ a)(1.2) X .0_ _ _ _ 16. Amount of Line 14 taxable _• __.. _. _ 15 _ _ _ at lineal rate X .0 _._ . _ 17. Amount of Li '. ..... _ ... ne 14 taxable """' at sibfi _~ ___--_~- ~ __.___ .. _.._......... ._,_._._. ng rate X .12 -~ 16. _. __ 18. Amount of L)ne 14 taxable at collateral rate X .15 µ.__ 17 ~-•--. .__.~ ~~ ~' 1,027,901.10 w... -- ~.._ w..~ .. 19. TAX DUE ............. .... 154,185.16 .................... 19. _ _ ......_... 154,185.16 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REF _ _ __ UND OF AN OVERPAYM ENT O L Side 2 1505610205 1505610205 J 1. Tax Due (Page 2, Line 19) ~ _ -- - 2• Credits/Payments A. Prior Payments 6. Discount 7, 709.25 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. (1) 154,185.16 Total Credits (A + B) (2) (3) 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) . .,. Make check payable to: REGISTER OF WILLS AGENT. >':xtaf „:r i.~ s i:~' .j'x „~r~i'icOih s ::~- ,', s't mn 7,709.25 146,475.91 _._.-_.,_..n PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE A 1. Did decedent make a transfer and: PPROPRIATE BLOCKS 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 .......... Yes No ..... c. retain a reversionary interest ..,.,,••, ^ ....................................................... .................................. O d. receive the promise for life of either payments, benefits or care?.,,,,,. •~•~~•~~•~••~•~~~••~~•~••~~"""""""""••••••••••••••• 2. If death occurred after Dec. 12, 1982, did decedent transfer ro •~~~~~~•~••~~~ ~' P perty within one year of death ^ without receiving adequate consideration? .............................................................................................................. O 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. ~ • 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 transf is 3 percent [72 P.S. §9116 (a) (1.1) (i)j. ~'~"~'~'~' ~~ . '~ , ,, For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net v ere to or for the use of the surviving spouse, [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statuto filing a tax return are still applicable even if the surviving spouse is the only benefic slue of transfers to or for the use of the surviving spouse is 0 percent For dates of death on or after July 1, 2000: ~ ry ry requirements far disclosure of assets and • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death t 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 benefiaaries is 4, o or for the use of a natural parent, an • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 2 P.S, under Section 9102, as an individual who has at least one parent in common with the d 5 percent, except as noted in [72 P.S. §9116(a)(1)]. (7 §9116(a)(1.3)], Asibling is defined, ecedent, whether by blood or adoption. REV-1503 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA sC1~iED1,ILE B INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT eeTwT~ ..~ -.. ~ ., ~ c yr William K. Sponsler FILE NUMBER® ;~; -~,, ~. O .ii ~ CO d0 ~ V ~ (1t ~ ~ W N ~ p ~ ? ~ f~D f~D ~ OW 0 ~ ~ ~ ~ ~ ~ C ~ ~ ~ ~ Q (Sp 0 N ~ ~ Q1 Vii ~ d ~_ Al N ~ _ ~ tD S ~ C O ~ "" S'' m N ,~,r cep C C~ ~' p, ~~p C C~ '~* W ~ N ¢~ ~ Q+' ~1 S ~ v ~'~' ~ c p• a ~: m c°n' ~ (n H m ~ ~ m ~: ~ ~ d cu ~ ~ ~$ ~ ~ o ~ ~ ai ~ .. cQ ~ ai ~ A D n' h 69 fA Efl <A f~ ffl i~ b9 69 b9 tf!N+ N ~ ~p ~p iy G Q ~ n ~ .~d ~. ~ 5{ p ~ N N ~~' 3~a O O A '']] cD ..i ~ LA ~D ~V,r t0 4NJ _G`.i)1 ~V ,Q ~ N ~~ (~ W IV ~ 1 ~ ~ W M a ~. ~ ~ I ~ ~ ~ ~ ~ ~ W 0 ~ O O ~ •V •C ~`~ ~,a ~~ ~~ ~ -+. ' O ~ N ~ ~,~ ~-~ ~.~ ~~ ~~ ~~ gN g ~ .~-- o~ ~~ ~ m~ O ~~ ~' ag ~~ ~ c °' a n N C S W fD D. ~ ~ 7 ~. a 8. a- ~g ~ N o S cad ~cl e. 3 -- .Z~-e M 1 ~a ~ ~ D Z 3 v N m VI REV-1508 EX+ (IS-io) ~ Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: William K. Sponsler 21-11-0945 Include the proceeds of litigation and the date the proceeds were received by the estake. All properly jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER „~~,.,,r,,,.,,,,, VALUE AT DATE 1. Vanguard Account No. 057788039520450, see attached 94,941.10 2, PNC Bank checking Account 85276, see attached 8,154.72 3, Brethren in Christ Foundation account 3730, see attached 268,818.17 4, United Methodist Church, Note 29822, see attached 151,250.00 interest 2.5% payable May and November Principal 3150,000.00 Interest 1,250.00 TOTAL (Also enter on Line S, Recapitulation) ~ + 523,163 99 If more space is needed, use additional sheets of paper of the same size. William Kitch Sponsler 312 Monroe St Mechanicsburg, PA 17055-4078 y~: ~; Page > 1 of 1 Vanguard. . Voyager Services: 800-284-7245 Total report value: 694,941.10 (Total report value Indudes any accrued dividends.) PA LT Tax-Exempt Investor 02439119359 09V19/2011 11:25:03 '.Account Transaction D;tail Report Page 1 oi~ 4 Ascending ~ Descending Account Transaction Detail Report Account Number: 5070085276 Post. Date Effect Date 06/21/2011 06/21/2011 Amount $250:66 Balance DCN Pin $12,808.47 C N Se Ref# Descri tion 027004916 INVESTMENTS DWARDJONES0001117101656417 06/22/2011 06/22/2011 $143.37 $12,951.84 C N 1 027004916 INVESTMENTS DWARDJONES0001117201122578 06/22/2011 06/22/2011 $3,979.00 $8,972.84 D N 3 083224901 CHECK 7086 083224901 06/23/2011 06/23/2011 $103.61 $9,076.45 C N 027004916 INVESTMENTS DWARDJONES0001117300627222 06/30/2011 06/30/2011 $427.50 $9,503.95 C N 4 000044 AP M ESSIAH HOME0001117900202496 07/01/2011 07/01/2011 $1,024.00 $10,527.95 C N 1 204013483A SSA XXSOC SEC U S TREASURY 3030001117900310658 07/01/2011 07/01/2011 $46.88 $10,574.83 C N 5 027004916 INVESTMENTS DWARDJONE50001118200776671 07/05/2011 07/05/2011 $1,507.95 $12,082.78 C N 9 027004916 INVESTMENTS DWARDJONES0001118600703943 07/05/2011 07/05/2011 $691.28 $12,774.06 C N 9 027004916 INVESTMENTS DWARDJONES0001118800703943 07/05/2011 07/05/2011 $179.01 $12,953.07 C N 8 11696 AUTOPAYMNTB ICF LOAN FUND0001118600697394 07/07/2011 07/07/2011 $0.38 $12,953.45 C N 0 INTEREST PAYMENT 07/11/2011 07/11/2011 $16.90 $12,936.55 D N 7177664358316 PAYMENTRECV ERIZON0001118900346852 07/12/2011 07/12/2011 $2,002.16 $14,938.71 C N 5 027004916 INVESTMENTS DWARD]ONES0001118300359982 3 https://www cct ncb k SC.hed K -e ~ - ~~~ 02 an • •P .com/ealmsg/sb/EalMessageServlet?SOURCE-CHANNEL=UNK... 9/7/2011 account Transaction L. etail Report Page 3 of 4 Post Date 08/04/2011 Effect Date 08/04/2011. Amount $1.24 Balance DCN Pfn #55,778.88 C N Se /Ref# Descri tlon INTEREST PAYMENT 08/08/2011 08/08/2011 $633.88 $56,412.76 C N 027004916 INVESTMENTS DWARD]ONES0001122000169702 08/08/2011 08/08/2011 $16.90 $56,395.86 D N 8 7177664358316 PAYMENTRECV ERIZON0001121700824183 08/10/2011 08/10/2011 $45,000.00 $11,395.86 D N 0 11696 AUTOPAYMNTB ICF LOAN FUND0001122200296089 08/16/2011 08/16/2011 $70.31 $11,466.17 C N 4 027004916 INVESTMENTS DWARDJONES0001122800484291 08/16/2011 08/16/2011 8 $12.96 $11,453.21 D N 083623671 CHECK 7090 083623671 08/22/2011 08/22/2011 $252.01 $11,705.22 C N 027004916 INVESTMENTS DWARD]ONES0001123400281970 08/22/2011 08/22/2011 $60.00 $11,645.22 D N 5 085807142 CHECK 7091 085807142 08/23/2011 08/23/2011 $380.00 $12,025.22 C N 027004916 INVESTMENTS DWARDJONES0001123500950084 08/23/2011 08/23/2011 $148.90 $12,174.12 C N 5 027004916 INVESTMENTS DWARDJONES0001123500950084 08/25/2011 08/25/2011 $103.60 $12,277.72 C N 4 027004916 INVSSTMENTE DWARDJONES0001123600804128 08/25/2011 08/25/2011 $4,123.00 $8,154.72 D N 083259229 CHECK ~~--~ 7092 09/02/2011 09/02/2011 $1,024.00 $9,178.72 C N ~- 204013483A SSA XXSOC SEC U S TREASURY 3030001124200547286 09/02/2011 09/02/2011 1 $698.87 $9,877.59 C N 027004916 INVESTMENTS DWARD]ONES0001124500911598 09/02/2011 09/02/2011 6 $256.59 $10,134.18 C N 11696 AUTpPAYMNTB ICF LOAN FUND0001124500913324 1 S~~~w~e ~ ~ ~.~~ ~ hops://www.cct.pncbank.com/eaimsg/sb/EaiMessageServlet?SOURCE-CHAIVNEL~UNK... 9/7/2011 ICS' Brethren in Christ FOUNDATION _ f~'irtc„acicrl.s~,~v„•~.~./~„~ /+ai/1i/ul,.S~Fca~ctrdc POST OFFICE BOX 290 431 GRANTHAM ROAD GRANTHAM, PA 17027 September 20, 2011 Estate of William K. Sponsler C/O Ronald C. Eckerd, Executor 312 Monroe Street Mechanicsburg, PA 17055-4078 Dear Mr. Eckerd: Below please find the values for each of the investments that William K. Sponsler had with the Brethren in Christ Foundation as of the date of his death, August 31, 2011. I have also included the interest earned on each investment from January 1, 2011 thru the date of death. Investment Date-of--Death Balance Accrued Interest Total Date-of- Death Value Interest Y-T-D at Death S ecial TAP #2306 98,444.94 126.07 98,571.01 510.13 Certificate #13552 50,000.00 81.37 50,081.37 656.38 Certifcate #13612 60,000.00 97.64 60,097.64 787.65 Certifcate #13818 60,000.00 68.35 60,068.35 68.35 Totals 268,444.94 373.43 268,818.37 2,022.51 If I can be of further assistance, please do not hesitate to contact me at 717-796-4788, x 5420, or at klehmanCa~bicfoundation org.. Sincerely, ~~- Kimberly J. Lehman Account Officer KJL/kj 1 Phone: (717) 796-4788 Fax: (717) 697-7714 E-mail: Info@bitfoundatfon.org ~~~du j ~ ~ - ~~eat 3 303 Mulberry Drive, P.O. Box 2053, Meohanicsbw~, PA 17055.2053 No 298u Date FEBRUARY 19, 2009 On demind we promise to pay to the order o! WtLUAM K. SPONSLER OR RONALD C. ECKERD, POA S *150.000.00 ****ONE HUNDRIrD FIFTY TNOUSANDAND 00/1.,.,----- - -- - - -- - -- -- - -- - - Dollars Without defalption or stay of ezecntion, for value recdved, with interest at 5.50yy per annum, waivlnK inquisition and exemption laws, and contess jndKmeat for above sum without oti'set, with (interest rind ~ o! snit, and with five percent for collection fees. There V a i'/. penalty oa all monies not left in the fund fog a period of one year. THE CENTRAL PENNSYLVANIA CONFERENCE COMMTi1 EE ON ILOAN3 UNITED IIZETHODI CH Attest• LOANS S'~e~~ ~ e ~ r ~~,tz y C~wt~a.l /"~ Ca~ti-te ~-c~ c~ c ~~ -t=. L~~~- rte. ~..~r _ _ United Methodist Church Note #29822 Issue Date 02/19/2009 J W 7~~` 7 crc 4~/' SIN 5,~ r"f ~ .Maturity Date 200 9 r~r t Ra[e ~Yo z Lo deb 1'9 I Interest received Ma & Nov. -~ ~ Wa ~ a 150 00 0 00 ----- ~ - o - __ e`' ~~- ~- 23 z 3~ c~ ~~.~. a ~'.. c ve ~. _ , ... ------- ---- _ ~--~-- --- - ~ ~ ~ -- e - --- __ - - -- - --- --- - i -- (~GCa..tar v 1CJ~. ------ 1 --- ---- - - o ~ . -~ O ~ - _ _ .,.~-~ c~4 a _ ~- --_.__------ --- . ~. i - ~'~,1~ e~u(e ~ - I % tit ~-1 - - __ REV-1511 EX+ (10-09) ~ Pennsylvania DEPARTMENT OF REVENUE INNERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATNE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Ronald C. Eckerd street Address 312_Monroe. Street _ _ _.. _._ city Mechanicsburg _ __ Year(s) Commission Paid: 2011-2012 ESTATE OF FILE NUMBER William K. Sponsler 21-11-0945 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' Myers-Buhrig, Funeral Home 914.37 2. Shepherdstown United Methodist Church- funeral luncheon 120.00 B. 1. __ State PA ZIp 17055 2. Attorney Fees: 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5. 6. 7, 2. 3. 4. Street Address City _ _ _ _ _ _ _ _ State _.. Relationship of Claimant to Decedent SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS .................__.._.._.............. .... . ZIP _ ___ _ ___ _ Probate Fees: Accountant Fees: Tax Return Preparer Fees: The Cumberland Law Journal, estate notice The Sentinel, estate notice Register of Wills, filing fee for inheritance tax and inventory Edward Jones Brokerage Fee, see attached 36,000.00 36,000.00 951.50 75.00 200.16 30.00 3,035.89 TOTAL (Also enter on Line 9, Recapitulation) $ 77,326.92 If more space is needed, use additional sheets of paper of the same size. Broker's Commissions & Fees Char ed b Edward Jones AT & T lnc. Stock Commission 1,152.28 Transaction Fee 4.95 Alcatel Lucent Stock Commission 50.00 Transaction Fee 4.95 AllianceBernstein Global Hi h Inc. Fd. Commission 198.13 Transaction Fee ~ •98 AllianceBernstein Global Hi h Inc. Fd. Commission 221.91 Transaction Fee 0.99 AllianceBernstein Global Hi h Inc. Fd. Commission 79.25 Transaction Fee 1.98 Berkshire Inc. Realty Inc. Commission 72.00 Transaction Fee 4.95 Centu link Inc Commission 63.66 Transaction Fee 4.95 Frontier Communications Cor . Commission 50.00 Transaction Fee 4.95 LSI Cor . Commission 35.21 Transaction Fee ~ 4.95 PPL Co . Commission 125.79 Transaction Fee 4.95 Verizon Communications Commission 513.86 Transaction Fee 4.95 Vodafone Grou PLC Commission 299.55 Transaction Fee 4.95 Fairfax Co. Vir inia Ind. Dev. Bond Transaction Fee 4.95 Indiana Munici al Power Boni Transaction Fee ~ ~ 4.95 General Electric Bond Transaction Fee 4.95 To ota Motor Bond Transaction Fee 4.95 Prudential Financial Bond Transaction Fee 4.95 Fee too en Estate Account 100.00 Total Commissions & Fees 3,035.89 REV-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 William K. Sponsler 21-11-0945 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, insert additional sheets of the same size. • h REV-1513 EX+ (O1-10) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESrDENi DECEDENT SCHEDULE ] BENEFICIARIES ESTATE OF: William K. S onsler NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY I TAXABLE DISTRIBUT10N5 [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1• Ronald C. Eckerd 312 Monroe St., Mechanicsburg, PA 17055 2. Ida Marie Sponsler 601 Locust Point Road, Dillsburg, PA 17019 3. Barbara Sponsler Ingle 5361 Carlisle Pike, New Oxford, PA 17350 4. Joel A. Watts 1920 Lula Lane, Enola, PA 17025 5. Lois A. May 601 Locust Point Road, Dillsburg, PA 17019 RELATIONSHIP TO Do Not Llst Tn Nephew Niece Niece Step Nephew Niece FILE NUMBER: 21-11-0945 AMOUNT OR Sh OF ESTATE 22.5% oi: ~ 39% 0~ t: 4.5% pF ~. 4.5°k ~ 4.5°k o ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN; 1. 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Shepherdstown United Methodist Church 1934 South York Street, Mechancisburg, PA 17055 TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. 25% 8~, z~ ~ " ~ .~ ,. , ~- { ~~ .' -~ ~. _ ~ ~ (~ \ri ~ V~ rr'f. r - ', ' S ~~ CLEP!~; ~~- CRP~-~~~,;`~ :;CURT ~ ~~ i Q ~~ \(1" C b V ,~ ~~ ~ ~v I 3~-L~ d~ S,~ C.1) `3