HomeMy WebLinkAbout01-05-12 (2),~
1505610140
REV-1500 °` ~'~~' `
PA Deportment of ~s ~,,,,,~~,.Y
e~aeau d Nldlriduad Taleea Caur~r Cade Yar Fb Mreher
~NHERITID~'E TAX REEIIRI~1
PO BCSC 280801 2 1 1 1 n 7 0 4
. . PA ~~t~e-oeal RESIDENT DECEDENT
a~ ostT INFORMATION BI3.o~ii
socW Saaulyr Number Date of DaaB- MYODYY1rY t)aie d Birth AIiaDGYYYY
1 6 7 1 6 2 3 4 3 0 6 1 8 2 0 3 1 1 1 2 3 1 9 2 3
DsoedsM's rest Name' Supbc aeoeasnCa Ftld Name w
R IP S O N ~ h A R T iN
{t/ ApplWable} 6ss~ Surrhrhrp Spaaate'a Wbrmauon Be1aw
Spouse's Last Name SuBbc spolas's First Name MI
t
Spouse's Social 8eardyr Number
TF118 REtURN MUST 8E Fu.ED IN DUPLICATE vINTFI THE
REGISTER OF WILLS
Fol. !N IIPP~ROPRIAI'E OVALS BELOAN
® 1.Odpinal Retum ^ 2. SuppNmsrrtal Retum ^ 8. I~errwtnder Rstum (dale of dselfr
pnor b 12 13.82) .
i ^ 4. Ltrrdbd Fatale ^ 4a Futuro irdanaet Camprombe {dais of ^ b. Fedora! Estate Tax Rerun fiequired
death albr 1212~82j
6. Deoederrt Died Taetab ^ 7. Decedent 6Aetntadned a Lirinp Trwt 8. Tatad Number of SeAe Deposit eoooss
U ~P'y d ~ (Ake Copy of Tnpq
^ 9. Litipdion Proceeds I~eaahred ^ 10. Spoinal Polrorly Credit (dab d deaM ^ ,,. EMclion b taut under Sac. 9113(A)
babaeen 121-81 and ,-,-Sbj pllleeh sch. 0)
- TNtB a~nol[ tittlBT BE I~I.ET®. ALL A18] ~OI~DBtITNLTAX ~ATI0118HOUtD BE DR6C'fED T0:
Name ~ . Daytime Tateptrare Number
R OG E R B IR W IN E SQUIRE 737 ~49 2~.~53
Fret Une of address
I R W I N A
second line of address
b 0 W E S T
CRy or Poet ORioe
C A R L I S L E
•
M c K N I G H T, P C•
P 4 M F R E T
S T R E E T I
stale zIP code L
P A 1 7 0 1 3
~~ ~ r- ~ `"
t' ~ C.?
_ ;L
`'~ T'r1
~
1
~
r-- _.
~~
i'" .~
Cl l 1 r
~~°
'~
~ -~-;
-~
A
~' --~ .c-
.~ ;
-~ ,~,T','
c-.:
o~-Ta: RLe~ r
Comespondeart's e~eaail addhas: •
tirMbrpanaMas d pagray, I dadara Onl 1 hers eearraned bls neae. e~q ~P~Y"sdNOIMe and arrirn~nla, and b the traaid ey laaatadp~ and bNM
it li true. oarwct and oanplale. DeaWarlon d prapatar aber arr-the pa~OrW rspwaertiaaya is haesd on all inlbrnraon daAYob pwRarar has argr krx~wladpa
98 LINDEN STREET ~ WYCKOFF NJ 07483
SKINIITURE 0?HER TitIIN ATNE ~TE
/L 38///
L.0 NEST POM ET STREET CARLISLE PA 17013
PL.FASE USE ORIGINAL FORM ONLY
L 1505610340
t3icb 1
15D5630140
J
~.~f~U
J 1505610240
RE1N1500 EX
DawdenCa SocY Ssaalgr Nuir~bsr
o.osasnratbrnc MARTIN RIPSON 1 6 7 1 b 2 3 4 3
>~alru.Ailo~
1. r;ce.t ~ ($dredule/g .........................~.................. t. 1 2 5 0 0 0. O D
2 Socks snd Bonds (Sdnr~lo ~ ... . ............................... . .. 2 •
9. tXoss~t Held Corpowtbn, Partnent*- a Sol-P+uPdelaahip (Sdisdttb ~ ..... l •
4. Morf~apes and holes RecsUnble (Sdisduls D) .......... ..... 4. •
5. Cash, tiartlc Depaib and ~oeWrrovs Penonai Arop.riy (schsdub q....... ~ 3 D 2 4 1. 1 9
s. ,toiMiy own.a propeiy (Sdieduta ~ ^ 8epaals ~ laequssled ....... 8. 1 3 5 0 D . 4 3
7. ItdsrANros Transias 311lsoelYnsous
(sa~edal
G
6
4
5
2
8
1
6
s
) ip R~e4ussiad ....... 7. .
8. Tow rheas Aaaets (tiow Mines t ttwuph 7) ... ~ ...................... 11 2 3 3 2 6 9. 7 8
9. Funeral Expsrwes and ~e cons (Schedule ~ .................. a 3 2 1 7 0. 1 1
10. Ds61s d Deosderd, tlAortpape lfablUdes, and Lbns~Sdrsdrrls 9 ............. to 1 0 3 5 8. 2 7
. 11. Tatal Dsductlorrs (lolal ones 9 and 10) ............................... 11. 4. 2 5 2 8 . 3 8
t2. Net Viltre d E~gibs Gins 8 mkws l.krb 11) ............................ 12 1 9 0 7 4 1. 4 0
13. pat8able and Oo~wnanentd 8squesblSsc 9115 Trusts for which
an ekcNon 1o Hor Iras not been mods (Sdrsduk.~, ...................... 19.
14. twt vauw sogset to TaR (Une 12 minus urw t~ t~. 1 9 0 ? 4 1. 4 0
TAX cAL.gILAll10N - tll~ NISTRII~.'f 10N8 FOR APPt.ICABt.E RATi~
15. Amount d LJns 14 iaoaitte '
at Urs spares tax rals, or
trandirrs under Sec. 9116
(ax1~ x A ,,,_, 0. 0 0 15. 0. D O
t s. Amaral d one t4 taxabb 1 7 8 3 8 9. 2 7
at heel was X .o~_ te. 8 0 2 7. 5 2
17. amount d Ltne 1! taxable ~
at ablrrg rats X .12 0. 0 0
t7.
0. 0 .
0
18. Amount d Ltns 14 taxable
d copaletal rate x .ts 3 2 3 5 2. 1 3
18.
1
8
5
2. 8
2
19. TAXDI>E ...................................................... t9. 9 8 8 D• 3 4
20. FILL M TFIE dVAL tf YOU ARE R~ItESTU1G A REFUND OF AN OVERPAYIIBrT
Side 2
1505610240 1505610240
Continuation of REV-1500 InherHance Tax Return Resident Decedent
MARTIN RIPSON 21 11 0704
Deoedenh Name Pape s FUe Number
Correspondatts
Name Daytine Telephone Nun~er
R O G E R B t R W l N E S Q U I R E T 1 7 2 4 9 2 3 5 3
9
l~ ^~ ~ eddre~
t R Wl N & Mc K N I G H T P C.
second Me of addroea
6 0 WE S T P OM F R E T S TREE T
Cat or Poet Oltioe State ZIP Code
CARL ! S L E P A 1 7 0 7 3
4205 CUMBERLAND AVENUE HARRISBURG PA 17110
,REV 1600 IX Papa S
FM rNraobar
D6cedetrYt's Complete Address: 1l „ UlU4
DECEOENI'S NAWE
MARTIN RIPSON
t`1'REETADDRESS
3D J~iNS DRIVE
CITY SLATE ZIP
ENOLA PA 17025
Tau Payments and Credits:
1. Tax Due ~ 2, the 19)
2 t~edithiPaymer~ts 9.300.00
A Prior Payments
B. Dleooure 494.02
3. krlerest
4. ff line 21s greater than the 1 + Line 3, enter the d8etertce. This is f~ OMERPAYtwENT.
FN N owl on Pipe 2. line Ytl ib ngrreeta rdrend.
(1) 9,880.34
Tofel Caedts (A+8) (2y 9.784.02
(4) 0.00
5. ff the 1 +Une 3 is greater than Una 2. enter the dr8erenoB. TNs k the TAX DUE (5} 813.32
r
Make dtedc payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER Tim FOLLOWING QUESTIONS BY PLACING AN'X" MI THE APPROPRUITE BLOCKS
1. Did decedera trratce a transfer arni: Yes No
a retaMr flre use a hcome of the property .....................................................................
b. retain the rl~rt to deeignate who shat ues the properly Uatreferred ar ith irraome : ...............................
a retain a rerrersbrrary iMeres~ a ...„ .........................................................................................
d receive the promise krr life of either payrtrerrts, benefits a care? ..............................•.••..................... ^
2. 8 death aorxned attar Decerrrber 12,1982, did decent irarwfer property ~Itlrtn one year d death
wlfircut receiving adequate oorrsidera8an? .......................................................................................
3. Did deoedetrt ovrrr an'h trust for or peyable•uporWeetlr bank aooourrt or securer at his or her deeth~ .........
4. Did decedent own an IrKlvidual retrernent account, annWty or ctlrer nan-pnobab property, wiriCh
oorrteirrs a berreflctery deelgnedrxr~ ............................„.................................................................... ® ^
IF THE ANSW6t TO ANY OF THE A80VE Ut)ESTiONS rS YES, YOU MIST tTE BCH~t1l.E 0 AND FILE R AS PART OF Tim RETI~N.
yam. '- _. ~ ist a..._:.
Fa' da8es ddeeth at or ~~ier,k>h-1,1994, and beUor~e Jan. 1, 1995, the tax rate imposed on be net v~ue oftransfers b of for the use dihe surviving spouse
3 percent [72 P.S. ~11ti (a] (1.1) (i)].
Fa dadBe ddeeth on er slier Jan.1,199ii, ttre tart race imposed on the net value dbarrsfers b arfor the use dthe aurvivirg spouse i6 0 paoent
172 P.S. X9'116 (a] (1.1) {fi]]. The statub does rat exempt a itansfer b a surviving spouse from tax, and the statutory requhemmrb tar disdostrre of assets and
fl~rtg a tart return are sfiil appBcmbleeven if fire surviving spouse is the oNy beneficiary.
For daiBS d dee9- on 4r ad6er July 1,2000:
• The Lac tale imposed on the net value dbrersfers from a deceased chNd 21 years d age ~ younger at der to orkx the use of a natural parent, err
adoptive parent a a stepparent d the child is 0 percent [72 P.S<§9116(a}(1.2)].
• The fax rab imposed al the net value dtransfers to or for its use tithe decedents meal berleflCiaries is 4.5 percent, except as noted in
TZ P.S. X918(1.2) (72 P.S. ~9111i(a](i]].
• The tax Hale imposed on the net value d fransilers b ar for the use d fire deoederlts siblings is 12 pereerlt 172 P.S. ~9118(aj(1.3)]. A sling is deflrled, untie
Section 9102, ag an it~viciual wta tree d least are parent in common wRt the decedent, vlhetlter by tdood a adoptlon.
aEw~soioc+~ot-~o~
pennsyivania SDHEDULE A
~~
__~......._.........,.... REAL ESTATE
MARTIN RIPSON ~ 21 11 x704
M oral pmpw~orrned solal~t or as a tenant In tomnwn aawCba r'poetd at tsar naatoetvaMee: Fair rnerkat w,rfue is defined as the pdoe at which propery
would be aoud<anged bebeeert a buyer and a w1Yng eeler, nearer being oompe~ed to buy a ael, both hewrg nreeorrebls la~oNeledge of the relerad facts.
tied propary-Ilgt b jot~oawad w~ right of sunlr~ip aawrt the 4Ndoaed as Sdrartule
~ Aitach a Dopy of the aeWerrient sued ~ the property hae been Bold.
~ Indude a copy of the deed showing deoedenCs in6arest if owned as in common. VALiIE AT DATE
OF DEATH
1. X30 JOHNS DRIVE, EIV~LA, PENNSYLVANIA 17025
125,000.00
TOTiwL(AleserMeron t.Ine i, ~.) :
ff maeapaca b needed, uee addiiaietahaeledpaperdthe sernesiaa.
REV 1Q08 EX+(8.98)
ca~aNwFUTt+oF r~ENKSw~.vANw
NHE~TANCE TAX RETURN
SCHEDULE E .
CASH, BA1~IK DEPOSRS, 8~ MISC.
PERSONAL. PROPERTY
~sr~-~ w.E wlnr~c
MARTIN RIPSON 21 11 0704
lndudefis d ~ end deb/is ~
~
u
nF.
b~~telo99do
I'lElui VAUJE AT DATE
IJUMBER DE~RIPTION OF DEATH
1. MEMBERS 1ST FEDERAL CREDIT UNION 23,514.38
SAVINGS ACCOUNT ~Ib995.00 -
2. MEMBERS 1ST FEDERAL CREDIT UNION 888.44
CHECKING ACCOUNT ~b895-11
3 PERSONAL PROPERTY 1,208.00
tTEM8 SOLD AT YARD SALE AND ON CRAIGSLIST. _
4. PSECU 212.23
CHECKING ACCOUNT
5. SUSQUEHANNA VALLEY FCU 3,594.11
SAVINGS ACCOUNT X384
8. SUSQUEHANNA VALLEY FCU 824.03
i CHECKING ACCOUNT #5384
TORAL ~Abo e~eran Ine 5, Recep~allon} ~ ~ 30.241.19
{If mas space is 8ied9d, MM9118d~019119h981b dtl~e name aimej
REV-1~ E](+(041
~rtnsylvania
~~~
IIe~ItfANCE7AKRfiUiN
Riff OEC~1lT
scHE~u~ F
,~N~Y.aAnrEO ~toPE~nr
ESTATEOF: F~1IUYBE(~
MARTIN RIPSON ~ ~ 21 11 0704
IF en wet wee made joNNh-uwped wNhh one yrr oEtt» decedent's data of deMb. K ~ be nporNd on Sdud~e 6.
suRVnn~ .-oerr ~nNr~ ~(~ AonRESS n~sreP ro oECEOENr
A MONICA J. ALLEN 4209 CUMBERLAND AVENUE DAUGHTER
B. GLADYS HARTMAN
I C.
JOMRLY~QMlIED PkOP@tTY:
PA 17110
IKORA PYTHIAN NURSING HOME
COVE ROAD
NCANNON, PA 17020
D
11EJi11
Mlk~Eit [EVER
FOR.IgI~f
T9Wff omn:
NAVE
JONr otoNOFrROPixn
qCflDE1iI11~OFFAii1NdN.N61RUIlONMdBI1N(AHJI~tGR8NrJ1R
IDEN11KVe~('IILIh6Ht ATfA~1DEF!?FORdON11LYa$DPHN.E$tAIE.
MTEOFOEA7H
YN.I~~ASBEf xaF
X1'8
NTEf~B! o~-hoFOeA~
W1LiE0F
DECEDBtT'SMTB~ST
1. A. 01/1988 MEMBERS 1ST FEDERAL CREDR UNION 813.76 50. 406.88
SAVINGS ACCOUNT#9975-QO
2. A. 06H976 MEMBERS 1ST FEDERAL CREDIT UNION 1,132.51 50. 566.26
CHECKING ACCOUNT X9975-11
3. A. 1012002 SUSQUEHANNA VALLEY FCU 295.34 50. 147.67
CHECKING ACCOUNT #13361
3. A 098002 SUSQUEHANNA VALLEY FCU 55.00 50. 27.50
SAVINGS ACCOUNT #13361.
4. B. M8T BANK 5,782.80 50. 2,891.40
CERTIFICATE OF DEPOSIT #31003917267485
5. B M$T BANK 4,898.52 50. 2,448.26
CHECKING ACCOUNT ~383370B1
8. B. M8T BANK 7,524.93 50. 3,762.48
ACCOUNT X15004205314806
7. B. VEHICLE 6,500.00 50. 3.250.00
TOTAL {Also enter on line 6, Ret~p~letlon) ~ t 13.500.43
B mae apace B asedeJ, use addt~onel wheels d peperdthe same eiae.
REV 1510 p(t (08.08)
Pennsylvania
a~~R
SCHEDULE G
BIER VIVOS'iRAN~ERS ANQ
NN9C. NON-PROBATE PROP~TY
MARTIN RIPSON 21 11 0704 .
This ad-edule suet be aompleled end Ned f fie anarerb any of quedon 1 fr5uph 4 on page free atM t~V-15001e fires.
ytEM
NLfdBER ra~n~we~avn~m,n~eneanaiar~mae®eRwa
~waEaFl.~rt~e0orrarnfa®woaac~:~na~. MiEOFDEA'tH
VALUEaFA88ET 140FDEt~'S
NYEREST DECL~ION
eF~~wa TAXABLE
VALtE:
1. MEMBERS 1ST FEDERAL CREDIT UNION 8,133.44 100.00 8,133.44
CERTIFICATE 01` DEPOSCT #6995-57
IN TRUST FOR BENEFICIARIES LISTED BELOW
2. MEMBERS 1ST FEDERAL CREDIT UNION 8,549.16 100.00 8,549.16
CERTIFICATE OF DEPOSIT #5995,43
INTRUST FOR BENEFICIARIES LISTED BELOW
3. MEMBERS 1ST FEDERAL CREDIT UNION ~ 8,220.02 100.00 8,220.02
CERTIFICATE OF DEPOSIT #5995,53
INTRUST FOR BENEFICIARIES LISTED BELOW
4. MEMBERS 1ST FEDERAL CREDIT UNION 8,146.18 100.00 8,146.18
CERTIFICATE OF DEPOSIT#6995-55
tN TRUST FOR BENEFICIARIES LISTED BELOW
5. MEMBERS 1ST FEDERAL CREDIT UNION i 0,175.53 100.00 10,175.53
CERTIFICATE OF DEPOSIT ~i995-58 ..
INTRUST FOR BENEFICARIES LISTED BELOW
8. PSECU - IRA~Q167162343 21,303.83 100.00 21,303.83
ALL BENEFICIARIES:
JUDITH A SOWERS
MARTIE E. RIPSON
MONICA J. ALLEN 0.00
TOTAL (Abo order on line7. latlai)~ = 84,528.16
Xnareapeoe b neoded, ~ addNond eheeie dpeperof Iieeerneaiae.
REY-1b17 D(+(10~OY)
Pennsylvania
~~
#~fANCFTAXRETURN
SCHEDULE H
FUNERAL EXPENSES AND
ADM~aISTRATNE CvsTs
~r~-~o~ ~
MARTIN RIPSON 21 11 0704
osaaeat"s debts nmst a nporUd ~ Schelde z
ITEM
NUMBER ~SCw~rION AMOUNT
a I~IERAt Des:
1. QATE OF HEAVEN CEMETERY
2. MALPEZZI FUNERAL HOME
1,200.00
11,875.90
B. ADMINISTRATIVE CD6TS:
•
1. Personal Repnsaen~eCorrm188bns:
tiaere(s) dPewad ttspreeerrmiee(a)
8tASetAddmes
l.i tdale ZIP
Year(s) Comerisaion Pakt
y, AUoareyFeex IRWIN & Md(NIGHT, P.C. 8,000.00
3. Fancy : (Sdecadenta address b not the sans ae dements, attadr er~pNrredon.)
Clement
sleet
CYy S1atie ZIP
ReletlorreMp of Clahbrdb peoederrt
4, pmp~ Feax REGISTER OF WILLS 332.50
5. A°°°uxentai eex
6. Tax Rehsn PreperorFeex PATRICIA A. RQSENDALE, CPA 375.00
FINAL FIDUCIARY RETURN
7. REGISTER OF WILLS - FiLiNG FEE 30.00
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
S. THE SENTINEL -ESTATE NOTICE 240.19
10. NORTH MOUNTAiPI APPRAISALS, INC. -APPRAISAL' ON REAL ESTATE 300.00
11. JANE REESE -HOUSE CLEANING 150.00
12. JOHN'S CARPET CLEANING 159.00
13. CLOSING COSTS FROM SALE OF REAL ESTATE 6,525.00
TGfK (Aieo eider en Uns 9, I~ecapq~datlon) ~ 32.170.11
M more apace tt needed, uae addlUorral sheets of peperdtresdae ame.
Continuation of REV-15001nheritant:e Tax Return Resident t)ecedent
MARTIN RIPSON 21 11 0704
Dscsdsnrs Nsms ~ Peps 1 Flb Nunbsr
8chsdule N -Funeral Expenses >~ Adminlstratfvs Costs - B2. Attomsy Fees
ITEM
NUMBER DESCRIPTION AMOUNT
Jt~tN M. EAICIN
907.52
SUBTOrTAL .E H$2 1 907.52
acv ~et2 a+ t1~s?
Pennsylvania
o~
M~itfANCETAXPE71~1
i OE~tr
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LlABIUTlES, 8 lIE~lS
ESFATE OF FLE M!i®L•R
MARTIN RIPSON 21 11 0704
IiNpat deble hicrNred Iry Nw decederR prior bo deems Unit reae~rred urptid atifre dare of dew, mad aMdiral eo~etreee.
NS TMTE
VA
E
R
NU DESCRIPTION ~
~
1. PA CENTRAL FCU - VISA #4109 7300 0001 509:3 89.92
2. • BANK OF AMERICA MASTERCARD -CREDIT CARD 192.43
i
• 3.
VERIZON -TELEPHONE
16.90
t
4.
JCPENNEY -CREDIT CARD
493.23
5. DR. STANKOVIC -MEDICAL - 15.00
a
i
1 6. ascOVER -CREDIT CARD 5,387.35
7. PP~L -ELECTRIC ~ 52.03
8. DIRECTV -CABLE UTILITY ~ 40.05
9. AMERICAN FIRE AND CASUALTY -INSURANCE 104.70
10. EAST PENN TOWNSHIP - SCHOOL T/~-XES 1,275.72
11. PENN TOVVriSHIP -PER CAP1TAi. TAXES 11.00
12. EAST PENN TOWNSHIP -REAL ESTATE TAXES 458.71
13. UGI -UTILITY ~ 9.04
14. CHASE MASTERCARD -CREDIT CARD 576.91
15. CENTRAL MEDICAL EQUIPMENT -MEDICAL 27.85
TOTAL Wea enter m ljne 10. Receghdatlon) 1 1<
ff more epeoe b needed inseiteddNoid eheele otb acme eiae.
Continuation of REV-16001nireritance Tax Return Resident Decedent
MARTIN RIPSON 21 11 0704
Deosdent's Nmme Nape 2 FGe I~a,mber
ScheduN 1- Debts aF Decedent, Mortgage LiaWlitles, 8 Liens
REM
NtJMBIR DESCRIP'iION Aii0lJNT
16. EAST PENNSBORO TOWNSHIP - SEWER/TRASH 138.00
17. PA AMERICAN WATER -WATER UTILITY 52.05
18. HERSHEYCARE - PRESCRIPTIONS 337.11
19. TRISTAN ASSOCIATES ~ MEDICAL 75.00
20. MOBILE X-RAY IMAGING -MEDICAL 39.53
21. HOLY SPIRfT HOSPITAL -MEDICAL 962.74
22. KINKORA -HAIR CUT
i
I
~ •
i
i
i
i
I
I
I
i
i
i
I 5.00
St~ToTAI. SCHEDUL>:1 1,9.43
QRAi1DT0YALSpIEDULEI f 10,358.27
__ _ _ _
~.
Iff=1F-13iS IXt (01-f0~ ~
pennsyfvania ~ SCHEDULE J
°®"~"~'~°"~'~"'~ ~ ~ I~EFlC~awEs
IN~ITMICETAXRETIJIiN
It88111aff 06CEDENT
611;TA1EOF: t*.E1Rlt~
MARTIN RIPSON 21 11 0704
RELATIONSHIP TO DEC®EM AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF S) RECEIVA+iG PROPERT1r Do Not LNE TnlsMee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [M~~S
6 aad tran~te~s older
1
116
1
~.~
ec. 9
1. JUDITH A SOWERS Lines 56,796.42
1704 PENNSYLVANIA AVENUE 1/3 REMAINDER
LANCASTER, PA 17fi02 '
2. MONICA J. ALLEN Lineal 58,796.42
4209 CUMBERLAND AVENUE 1/3 REMAINDER
HARRISBURG, PA 17110
3. MARTIE RIPSON Deal 58,796.43
98 LINDEN STREET n 1i3 REMAINDER
WYCKOFF, NJ 07481 -
4. GEORGE CHRISTOPHER KOH ER, III Lintel 2,000.00
4885 SW JOSHUA CT.
TUALATIN, OR 97062
5. GLADYS HARTMAN Collateral 12.352.13
KINKORA PYTHIAN NURSING HOME J7 ACCTS HELD WITH
25 COVE ROAD DECEDENTIVEHICLE
DUNCANNON, PA 17020
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SIiOWN ABOVE ON ONES 15 TF4i0UGH 18 OF REY 1500 COYH2 S HEET AS APPROPRUITE
II. NON-TAXABLE DISTt68UT~NS:
A. SPOUSAL DISTR~UTIONS UNDER SECTION 5113 FOR WFOCH AN ELECTION TO TAX IS NOT TAIQAN:
1. •
B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON L~ 13 OF REV-1500 COVER SHEET.
ff more space
E'er:-.]