The URL can be used to link to this page

Home My WebLink About12-14-11 (2)1505610101 --J REV- i JOO EX (oi-io) a OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number oE..~.~E~. o~ aE~Ex~E Bureau of Individual Taxes INHERITANCE TAX RETURN I I ~~~ PO BOX 280601 RESIDENT DECEDENT ,:~ ~ Harrisbur , PA 1 128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 201-18-0410 08/02/2011 12/02/1923 Suffix Decedent's First Name MI Decedent's Last Name Butler May I (If Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix Spouse's First Name N/A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Remainder Return (date of death O 3 ~ 1. Original Return O 2. Supplemental Retum . prior to 12-13-82) Limited Estate O 4 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required O . death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ation Proceeds Received O Liti O 9 (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death under Sec. 9113(A) O 11' a g . between 12-31-91 and 1-1-95) O Attach Sch ( ) ECTED T0: CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX D~y R me Te ephone Numbe t Name (717) 243-7135 Andrew H. Shaw First line of address 200 S. Spring Garden St Second line of address Suite 11 City or Post Office Carlisle State ZIP Code PA 17013 REGISTER (3)FyVILLS USE ONlY ~Q ~~, 11 ~ C? C-3 r•'" ~ ~- m _'.' -'} Cam} -i, _.. __; `_T t'~Z _~ .. .~.. ~:T=' ~ r ~'! "a __ ~-r't :~~;, c~ ..r ., Correspondent's e-mail address: andrew ashawlaw 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 inforcnation of which preparer has any knowledge. SIGN~URE OF PERSON RESPONSIBLE FOR„FILING RED RN DATE 808 Huckleberry R Bloomfield, PA 17068 SIGN RE aF?~2E~fC ER E HAN REPRESENTATIVE DATE 12~/~~/~ 200 S.~Spring Garden Street, Suite 11, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number 201-18-0410 Decedent's Name: M8 I. Butler RECAPITULATION 1 0.00 1. Real Estate (Schedule A) ........................................... .. _ 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... 4 . . 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 26,325.87 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 30,611.20 (Schedule G) O Separate Billing Requested..... ... . s 56,937.07. 8. ......................... Total Gross Assets (total Lines 1 through 7) . . ... 9. ................ Funeral Expenses and Administrative Costs (Schedule H) ... s. 5,724.28 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... 10 .. . 691.04 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 6 415.32 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 50,521.75 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 00 0 an election to tax has not been made (Schedule J) ..................... ... 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... . 14. . . 50,521.75 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 00 0 15 0.00 . (a)(1.2) X .0 0 . 16. Amount of Line 14 taxable 50,521.75 at lineal rate X .0 45 1s. 2,273.48 17. Amount of Line 14 taxable 0.00. 17 0.00 at sibling rate X .12 . 18. Amount of Line 14 taxable 0.00 18 0.00 at collateral rate X .15 . 2,273.48 19. TAX DUE ....................................................... .. 19. 20. FILL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15D5610105 1505610105 REV-1508 EX+(6-98) SCHEDULE Ep C~ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c M~.7~+• INHERITANCE TAX RETURN PERSONAL PROPERTY ctFSioENT DECEDENT ESTATE OF May I. Butler Include the proceeds of litigation and the date the proceeds were received by the estate. .... , .....~ _~_~. _. _....,~...,.~ti~~ M~~~+ hQ dlAClesed on Schedule F. FILE NUMBER 21-11-0867 pr more space is necuou, ~~~~~~~ a,,,,.,..,..a..,,,....... ,....._ __...- --_-, r . Ic~1 M&T Bank.._~ .,... -- GF-269(8/10) WIP TRANSACTION DEBIT ORIGINATING COST CENTER EMPLOYEE NUMBER AUTHORIZATIC)N DATE ra ACCOUNT # CUSTOMER NAME (PRINT). utsLhir i iurv: ~ PARTIAL WITHDRAWAL ^"CLOSING WITHDRAWAL CUSTOMER ID: ti Original -Processing Work Copy -Branch CUSTOMER SIGNATURE: - - m ~~ ~ ~ - SEQ. NO. t 2 1 9 0 7 8 7 ~ ~~ WEBB MASON IN C. A 00 v° co c ~ m cn n n ~ '~ '~ ~ ~ O n ~ ~ r ~~ _ ° z ~ F N o t S N ~ O D C J ~ ~ r ~ O ~ ~ ~O ~ ~ ~ m O n _ v m "_ a ` y D O r 00 ~ ~ ~] m 3 v V N ~ o ~ Z ~ m m C ~ z c ~ m ~ _ m ~ v 4' D . - c 0 m D-1 m A V1 ~ ~ ~ ~ ~ O !r ~ r ~ i ? :~ ~ ,°~- m ~ C'r" t"~' ry 1+ ~ • C F+ i y M.+ ~ ~ ~ 1 • • "! '7 G1 .. .. ~o O H ~ C 'v "(~ W m r a ~J N 0~ .r D H = Z 0 D Z 0 a m O x v c~ ~~ RI Ci ni ~~ S~ ~~ c- i~ c~ q in n t7 :z Ip z x ~' fl K ~ O ~ ~m ..r '~ ~" '~ --i ~ " ~ ~ '9t ».~ r ~-+ t!- o w Oo Z W ~ fir, `' `~ ~~ a "" O o y-, c r m ~ V1 O m I D ~' Z v ,. m G1 O C v h~ ~+ REV-1510 EX+ (08-09) ~ pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT FILE NUMBER ESTATE Of 21-11-0867 May I. Butler _.. , ,_ ___~ ~_ ____~_.,.a _..a fl~e.1 if fhe ,,,war r„ anv of nuestions 1 through 4 on Dage three of the REV-1500 is yes. If more space is needed, use addinonai sneers or paper Dr me same sicc. Western National Life Insurance Company P.O. Box 871, Amarillo, TX 7 91 05-08 7 1 NAME: POLICY: TRANSACTION: OWNER: AMOUNT OF CHECK CHECK# 15496780 INTERNAL REFERE:NCE# 2200703271 TRANSACTION STATEMENT MAY BUTLER August 31, 2011 XP233264 DEATH CLAIM PROCEEDS MAY BUTLER 5 19,004.02 PLEASE DETACH AND KEEP THIS STUB FOR YOiP.R RECORDS REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF May I. Butler Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION NUMBER a. FUNERAL EXPENSES: 1' Hoffman-Roth Funeral Home & Crematory, Inc. 2. Osiris Holding of Pennsylvania, LLC FILE NUMBER 21-11-0867 g, ADMINISTRATIVE COSTS: I, Personal Representative Commissions: Name(s) of Personal Representative(s) Diane Shurlk Street Address 808 Huckleberry Road city New Bloomfield state PA zIP 17068 Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation,) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 2,982.78 1,720.00 0.00 800.00 0.00 221.50 5, 724.28 219 Norfh Hanover Street Carlis{e, Pennsylvania 17013 717.243.451 1 toll free 1.866.451.451 1 fax 717.243.3723 vsnnvhoffrrianrath.com info@Yioffmanroth.corri August 30, 2011 plane M. Shunk 808 Huckleberry Road New Bloomfield, PA 17068 Statement of Funeral Expenses for: May I. Butler Date of Death: August 2, 2011 Account Id: 16307-172 PACKAGE: Package to set individual costs of funeral expenses CCC $ 2.,300.00 Sub Total: $ 2,300.00 FACILITIES AND PROFESSIONAL SERVICES: Services of Director and Staff $ 320.00 Sub Total: $ 320.00 MERCHANDISE: $ 090.00 "1 Casket: Kinsey , Sub Total: $ 1,090.00 TOTAL FUNERAL HOME CHARGES: $ 3,710.00 CASH ADVANCES: $ 00 72 12 Certified Death Certificates at $ 6.00 each . Newspaper Notice -Sentinel $ 100.48 Clergy $ 75.00 Flowers $ 159.00 Sub Total: $ 406.48 Total Funeral Expense: $ 4,116.48 Total Payments Made: $ 1,133.70 Payments Made: Micro Data Check 92939 Aug 30, 2011 1,133.70 ,, Balance: $ 2,982.78 <. t _.. ..~ : , c , °~ - C f ~. ~ ,~~ ~ - ~ r - . . w ~ ~-3 ~ ~ ~ N~ ~ ~ ~ ~~ .. .. y ~~ 0 ~ , ^ l t~ O ~ ti ~ ~ x x x o ~ ~ ~ w ~. 6 ~ ~ M ~ ~ o ~ I ~~ ~ x x x ~ ~_ a ~~ ~ ~, I o o ~~ ~~ ~ ~ .. W ~ ~ ~ O 's O S ;~- N ~ O `~ ~~i "G "C b ~ ~ m 0 -n 'a 0 O- a. ~~ -- ~ ~ ~ ~ ~'3 .~ o -~ cc~ Sao ~ ^ C, ~ A. w ~'' o. ~ C'1 ~ s 'o C~ ~ d ~ ~ ~ ~ a~ ~~~ ~ ~roz ~ ~ ~*, `G y ~ ~ v, ~ C~ Cr7 °_ W ~- N y S } 'O N ? y 0 ~ ~ ~ + .-. ~ N C ~ 2 ~ ~ ~ ~ ~: x-; ~ `i ^ o ^ ~ ~ ~ ~ ~ ~ n C G Q. n ~; ~~~~ ~~~ w ~ o 0 rn .n c a. o x I d z z y C'1 ~ L~ coo ~ ~ c ~ ~ c y (D ~ ~; ~~ d `~~ ~ r z Ky O ~ N d N 'C •• ~ d ~ '~ N d y 'O ~ d y `O z ~ r] ~3' ^ ~ ~ o -c z d n ^ ~ ~ ~' ~ ~ a ~ w ~ ~ ~' C~i9 ~. p ~ z ~ ~ oa ~; ~ ~ o ~ `° o ~ t~ ~ ~ a ~ N ^ , / ~ '~'h N ~ ~ ~ ~ ~ ~ Q. xs ~ ~ "a ~ c o .r ~ ~ ^O ~ p, ~ ~ ~ ~ ~ ~' ~. ~ ~ y ~ ~ o o ~ a~ ~ °~ o . r. o d ~ ~f ~ ~ ~ o ~ < ~ V ~ ~ ,~ ^ ~. ~ ~ N a-~ `~ ti y coo N ^ ~ ry ~ rn C. b ,~ a ~ ~ ~ .7 O O p- ~ N ~ A n ti N ~ ~ ~ N ti O E ~ ~ N. ~ ~ ~~ I ~~ I A~ P- ~' z + °, ~' wee ~~ .. c ~ ~, A W ~ 'ti O Z '~ ~ 7C ~ ~ x ~ ~ ~ d ~ ~ Y ~ k ~ co cCDO o' CC °' c 'T~ ~ =' ao N ~ ~ o ~ ~ ~ ~ ~ ~ C7 ~ ~ rn ~,' ~, _ C o t 1r Fo oa ~ co '-' l~ (~ v ~ a ~ b ~ ~ R ~ ~ n rb c~yo ',~ ~ ~ ~ ~ ~ '--i A'+ n UQ ~ ~ g ~ C~7 ~ ~ .° ~ ~. "b yj sF, ~ cfl sA sus ~ vi ss i . . En css ds ~ ~ s~ sA ~s Ess Fss O .~ ~. o~ x ~ ~ ~ w~ ~ ~ ~ ~. . ~ o• a r G ~ p, ~ ~~ . ~ ~ ~ n ~ } ^ ^ ~, O n nn a'w °° ~ ,b .d ~D ~ ~ ~ - f ~ ^ ^ m ~ ~+ . ~~° ~~ ~'~ `-y `° c `° ~ `° ~ ~ ~ ~ ^ ^ ~ ~ (D i O ~ ,o ~ ~ ~- ~-. ~ w ~ ~ -h eo ~ ^ ^ Cf7 O _ O ~ ~ Crl ~ ~ ~ ~ - o ~ v o ~ ~ ~ b ~ 6. "'C N ~ a ~~ V 3 ~ o• 0 5 ao y ~; ~; ~ ^ °' j °- g ~ x ~ d^ ~ a ~ . a ~ ~ ~ ~ o d ~ ~ °' a n. A. ~• o . ~ ^ ~ ~ s d R~ ~ ~ ~' ~a~ ~ o aR~ N O ~ w 7 .. . ~ ' ^ ~ g o o c c o io ~ b ~ c. ~ ~ ~ ~ o ~ a ~ ~ ~ m P; ~ ? ^ r C~~~' ~ O ~"3~~. ~n~i~ ~" x 0 a w ~ ~ ~ 0. w~ n'a 7~ ~x~~ o ~``- ~~~~ ~~~~ w~°~7 W N ~ ~ r 'bc~o~.(r'~ D_ ~ C"' ^ J^ ('~ C. ~~j^r' `'~3 0 ~J-a m ~.; ~ a ~. g ~. ~ .`- .JA C~ coo ("1 -~ ~~C ~C FBI `0 ~ ~7 ~ .~+ ~ O N rq' vwi ~ ~ H ~ ~ r~.i. O `~ Oy r.~ (/1 y ~ C M o a w ~ m e~ i~-+ ~°aN ~~ o ~ r ~vo o ~~~~ ~o -o o n r' rAi. ''d `~ ~ w f~D C x r~ ... a ~c ~ G7 ~ ~ ~"~ (JQ r' -~ ~ ~~~ ~ ~~~~y ~. N ~ a w .~ ~ C. ~ cZc ~ -p co ., ~ N~.N y N ~ N ~ `G M < ~ R. p co w io ~ a~ ~.~ ~ n~~ ~~~~ v, ~coar ~u ~~w ~ -0`2.~ n -~ a~ r~ o- o n w V n u REV-i51Z EX+ (12-OS) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mav I. Butler SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21-11-0867 ,__.~ .~_. ___._:__w ......~:d ~r r6e darn of death. including unreimbul'Sed medical expenses. Ii R10r2 SpBCE IS NeBOeU, maei~ auuiuvnai anc=~~ ..~ .•~.. ~~~••- -°-• Forest Park Health Center Resident: Butler, May (23271) 700 Walnut Bottom Road Location: - Carlisle, PA 17013 Statement Date: 8/112011 (888) 880-7090 Effective Units Unit Amount Amount Date Description BALANCE FORWARD $0.00 7/28"/2011 Room & Board charges Jul 28-29 2011 (STD) 2 $258.00 $516.00 BALANCE DUE $516.00 .__. Please call with any questions. ~~ , ~ ~ ; .~-~ ~ ~ Julie 814-265-7872 ~~%'~ ' https://www4.pointclickcare. com/admin/reports/statements_us.j sp 8/1 /2011 Please Remit Payment To: Cumberland Goodwill Fire Rescue EMS Billing Office P.O. Box 726 New Cumberland, PA 17070 QUESTIONS ABOUT THIS BILL? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-6020 Email: info@ambulancebillingoffice.com Date of Service: 7/22/2011 18:28 Please visit our website to provide insurance or make payment, and Patient Name: BUTLER, MAY for additional payment options and frequently asked questions; From: Carlisle Regional Medical Center H/H/W.ambulaincebillingoffice.com To: FOREST PARK HEALTH CENTER This type of strvrce is not covered b ambulance memberships, Medicare, Medicaid and most secondary insurances. Payment is your responsibility. 7/22/11 Wheelchair Van One-Way Tra A0130 1.0 48.00 48.00 7/22/11 Mileage S0209 1.2 1.75 2.10 50.10 0.00 0.00 Tota! ,. -~ ,~~ ~... DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. __ _ _ ____________._ MAY BUTLER 1513 Shirley Ave Carlisle, PA 17013-9370 Borough of Carlisle 53 W South Street Carlisle, PA 17013 www.carlislepa.org 717-249-4422 7:30AM - 4:30PM .fr -,, i,~ ~, -, t~; i\' ~ ,~ ~% / Account :~ ~:, ~ti Statement • •' • ACCOUNT: 013248-000 SERVICE ADDRESS: 1513 Shirley Ave SERVICE PERIOD: 5/3/2011 to 7/28/2011 (86 days) BILLING DATE: 8/12/2011 DUE DATE: 9/25/2011 .~ Previous Reading Current Reading Serial No Date Reading Date Reading Cons 03325610 5/3/2011 367 7/28/2011 369 2 ~ r )~ r 1 ~. ~, • 5/8" Meter -Water 40.14 PAY ONLINE AT www.carlislepa.org 32.76 This bill becomes delinquent 45 days from the bill date. A 5/8" Sewer late penalty of 1.5% will be added after 45 days and 72.90 additional penalties of 1% will be added every 30 days TOTAL CURRENT CHARGES thereafter. If payment has not been received within 72 days of the bill date, your water service will be discontinued. ,- • DUE IMMEDIATELY 72.90 Thank you for your payment! -72.90 3.5 0.00 ADJUSTMENTS 3 CURRENT CHARGES 72.90 2.5 2 ,_5 72.90 TOTAL AMOUNT DUE 0.5 n SEP OCT NOV DEC~JAN~hte ms~n nr~ ~^^• --~~ --- ~-jlr~7'iR}Ilf~~ ~'~t. l#T'Qr~t l"i~}1i'~ ~..... MAY BUTLER 1513 Shirley Ave Carlisle, PA 17013-9370 Borough of Carlisle 53 W South Street Carlisle, PA 17013 www.carlislepa.org 717-249-4422 7:30AM - 4:30PM ~n " ,,,.k~ J"- ..y,,~ f 1 rl ~..~7 ~~1, ' n ~~ Account Statement • •- • ACCOUNT: 013248-000 SERVICE ADDRESS: 1513-Sk~irley Ave SERVICE PERIOD: r'7/28/2011 to $723/2011 (26 days) BILLING DATE: - ~~ .._ _ 9/26/2011 DUE DATE: 111912011 METER READING ~ Previous Reading Current Reading Serial No Date Reading Date Reading Cons 03325610 7/28/2011 369 8/23/2011 369 0 . PAY ONLINE AT www.carlislepa.org 5/8" Meter -Water 11.60 46 9 This bill becomes delinquent 45 days from the bill date. A 5/8" Sewer . late penalty of 1.5% will be added after 45 days and TOTAL CURRENT CHARGES 21.06 additional penalties of 1% will be added every 30 days thereafter. If payment has not been received within 72 days of the bill date, your water service will be discontinued. • - DUE IMMEDIATELY 72.90 Thank you for your payment! -72.90 3.5 ADJUSTMENTS O.oo 3 CURRENT CHARGES 21.06 z.s z 1.5 o~ TOTAL AMOUNT DUE 21.06 DEC JAN FEB MAR APR MAY JUN JVL rv~ ~« ""• "_' CenturyLink~ P.O. Box 1319 Charlotte, NC 28201-1319 Page: 1 of 5 Account Name: MAY I BUTLER Bill Date: Jul. 25, 2011 Account Number: 314203106 Current Char e(!~ S SUt'ti'1t'Y1ar ___ Detail Page Contact Numbers _ _ _ Pay Online t CenturyLink Local Services ® 3 31 .15 www.centurylink.com/myaccoun _.- _- 5 0.17 CR Pay by Phone Account Charges __ __ _ --__ --- 1-86fi-712-1996 -_ _ _---------- -- -- - - 30.98 Customer Service Total Current Charges 1-800-788-3600 Customer Service Hours Mon-Fri 8 a.m.-7 p.m. Repair Service 1-800-788-3600 '~ Visit us online com k li . n www.century ~ ~ ~ Pf v r ~ ~ . ; , ~. s k L,. ,. L ~~. ~ ~~~ ~,,. I ~. It~- :- Previous Balance Payments & Adjs Balance Forward Current Charges ,Amount Due Date Due I I 30 . se I 30.9$ I Aug. 22, 2011 34.d2 34.42 CR 0,00 1 6 The Due Date On This Bill Aonlies to Current Charaes Onlv REV-1513 EX+ (01-10) ~~ _r~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN _ ncrcncNT SCHEDULE BENEFICIARIES ESTATE OF: May I. Butler NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [IncluSec. 9116 (a) (152);istributions and transfers under 1. Diane M. Shunk, 808 Huckleberry Road, New Bloomfield, PA 17068 2. Lawrence Butler, 1511 Shirley Avenue, Carlisle, PA 17013 3. Gerald Butler, 428 Limestone Road, Carlisle, PA 17013 4. Robert Trimmer, 350 Coffeetown Road, Dillsburg, PA 17019 5. Kirsten Trimmer, 2521 Ritner Highway, Carlisle, PA 17015 II RELATIONSHIP T'0 DECEDENT Do Not List Trustee(s) child child child grandchild grandchild $27,282.34 $8,278.32 $8,278.32 $2,204.63 $2,204.63 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TnTS~ AF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ FILE NUMBER: 21-11-0867 AMO~R SH nc ccreTF If more space is needed, use additional sheets of paper or me Sa~~~~ ~~~_•