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HomeMy WebLinkAbout04-24-12 (2)L J 1505610101 REV-1500 °"°'-'°' Ili OFFICIAL USE ONLY PA Department of Revenue P~Yt~ County Code Year File Number Bureau of Individual Taxes "~~"~~~`~'"` INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA i7i28-0601 RESIDENT DECEDENT at I _ ~~ C~ Q Q~ ENTER DECEDENT INFORMATNkI BELOW Socal Sewrily Number Date of Death MMDDYYYY _ _._ _ `o?~ 3 " L 4 - ~ ~~O ' 0722/2011 Decedent's Last Name Suffix r....... __. .. _.... .. _. .._ _.. EAnna 4.... . _ _. _ _ _. .. __ (H Applkoable) Ertter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number _" "_. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE .._ _ . __ REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O B. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election W tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIB 8ECTION MU8T BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION 8FN)UtA BE DIRECTED T0: Name Daytime Telephone Number _ .. __. ;Andrew C. Sheely, Esquire 71797-7050 REGISTER OF WILLS USE ONLY Correspondent's e-mail address:andrewc.sheely(d~COmcast.net ~ .:., ~~ -- 2a* ~~ C7 '-- ~ rn z to ~ rV .~' ~c7C7 ZIP Code FILED ~ ~ _,.._.. ,17055 n -' _ __... w cn i:"~ ~~~ .-r •, r--, T ~, Under Ities of perjury, I declare that I have examined this return, including axomparrying schedules and statemeMt;, arld to the best of my knowledge end belief, it is true and compote. Declare ' of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI RE OF ESPON E FOR FI NG RETURN ~ f+~~ ~~ / Lisa mith, Adminis ratrix, 222 East Main Street, Mechanicsburg, PA 17055 SIG E TH REPRESENTATIVE [tnrc ~~ Andrew C. Sheely, Esqui uth Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number _. _ Anna Mae Shuey ~ ~'~ o243"a!~'" ~~~~ , s Name; Deceeern RECAPITULATION __ __ 315.20 96 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 and Notes Receivable (Schedule D) ......................... .. 4. __ __ ._ . ~~ .m ,.-_ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ' $101,926.09', 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ', $9,702.07; 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 831 86 $62 (Schedule G) O Separate Billing Requested...... .. 7. . .. , 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. $270,775.22 9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. ', _. 6,947.10'? ., ., __ 10. 9 9 ( ) ............ Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 10. .. 9,476.65? .._. .. 11. Totat Deductions (total Lines 9 and 10) ............................... .. 11. $16,423.75` 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. $254,351.47[ .. _~_ .. 13. Charitable and Governmental BequestslSec 9113 Trusts for which . an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subjeet to Tax (Line 12 minus Line 13) ...................... .. 14. ' $254,351.47'::. TAX CALCULATION -..SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or _,, transfers und~~ cec. 9116 (a)(1.2) X .0. 15. m.-,~_ , ....~ ~, ... 16. Amount of Line 14 f~~~ble $254,351.47'. at lineal rate X .045 16. $11,445.81 ! 17. Amount of Line 14 taxable at sibling rate X .12 ..,. _ 17. _~ ~ _ _.. m w_..... 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. ', $11,445.81.. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 LX •Pape 3 Decedent's Complete Address: NTR NAAA Anna Mae Shuey 940 Walnut Bottom Road Carlisle sTar~A ' ~ 17013 file Number a~-~~- 040 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditsfPayments A. Prior Payments $8,000.00_ B. Discount $421.04 (1) $11,445.81 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FGI in oval on Page 2, Llne 20 to request a refund. 5. M Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 8,421.04 $3,024.77 Make check payable to: REGISTER OF WILLS, AGENT. ~.~ . _ _ n ., .. k .~ 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 properly transfened :....................................................................... ................... ^ (~ b. retain the right to designate who shall use the properly transferred or its income : ......................... ................... ^ c. retain a reversionary interest; or ....................................................................................................... ................... ^ d. receive the promise for life of either payments, benefits or care? ................................................... ................... ^ 2. ff death occurred after Dec. 12, 1982, did decedent transfer propeAy within one year of death witrxiut receiving adequate consideration? ....................................................................... .................... ^ ................... 3. Did decedent own an in trust for or payable-upon-death bank account or security at his or frer death? .............. ^ 4. Did decedent awn an individual retin;ment account, annuity or other non-probate propeAy, which contains a benefidary designafion? ........................................... .......................................................... ~{ ................... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS )S YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. u _ n. 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 p2 Ps. §s11s (a) (1.1) {i)]. For dates of death on or after Jan. 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 stahrte does not exempt a transfer to a surviving spouse from tax, and the stahrtory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficlary. 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 benefidaries 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)J. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT Of REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBUflG, PA 17128-0607 RECEIVED FROM: SMITH LISA M 222 EAST MAIN STREET MECHANICSBURG, PA 17055 -------- PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EXI11.9H1 NO. CD 015081 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 58,000.00 ESTATE INFORMATION: ssN: 203-1o-aaas FILE NUMBER: 21 1 1 -0908 DECEDENT NAME: SHUEY ANNA MAE DATE OF PAYMENT: 10j 19/ 201 1 POSTMARK DATE: 10/1$/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 07/22/201 1 P,EMARKS: RECEIPT TO ATTY CHECK# 594 SEAL TOTAL AMOUNT PAID: 58,000.00 INITIALS: HMW RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1502 EX+ (11-08) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Anna Mae Shuey 21-11-0908 All real property owed solely or as a tenant in wmmon must 6e reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION I. Decedents real property located at 5306 Locust Lane, Hamsburg, Lower Paxton Township, PA Tax Parcel No. 35-064-029-000-0000. $70,820.00 assessed value X 1.36 CLR = $96,315.20 $96,315.20 TOTAL (Also enter on Line 1, Recapitulation.) I $ $96,315.20 If more space is needed, insert additional sheets of the same size. www.DauphinCounry.org (Property & Taxes I Information for Property 35-064-029-000-0000, Tax Year 2011 9/20/11 10:08 AM 17AL~P~TN CC7UNTY P L N N S X 1. V A N t N Information for Property g5-o64-029-000-0000, Tax Year 2011 Property t of S (Ss~U) [*reire-e4g htlrarrt~uti~rrt Tax Year Ali a. Township LotwER vaxTOx TtNP Neighborhood 35042 - HUNTPIELD SUBDIVtS10N Owner Name and Address SHUh'Y BARRY C 222 E MAIN ST MECHANICSBURG, PA t705S- Property ID 3,5-064-029-000-0000 Property Use Roy - SP[1'C LEVEL RESIDENCE Site Address 5306 LOCUST LN Mailing Name and Address SHUEY HARRY C 222 E MAIN ST MECHANICSBURG, PA t70,5$- ;~.a€as t~tsim~y Year Document Sale Type Sale Sold By • Date oCONVtz3S6 12 Zero SHUEY HARRY C & SHUI:Y ANNA Value MAE :4tar~t:c+t E.and 1:+.tuatiott Property Type Descriptlon RF.S -Residential Primary Site Note: Market land values are roun< "3zt~ Story €4ta•urrure t of t.) Property Type Descriptlon RES -Residential One Story PatiosJStoops » Last >I .s:. 5 x..,.... Sold To Price SHUEY HARRY C & SHUEY ANNA $o MAE • Land Type Width Depth Sq. FY. Calc. Acres Deed Acres Value St -Primary Site 7,200 .t6oo .o0 2o,S2o ed to the nearest too for assessment purposes. Style Quality Living Area (sq. ftJ Year Built Age Yalue One Story C+ 880 tg52 So,3oo AtMbute Square Ft. Attribute Square Ft. Patio -Concrete t87 First Floor Attribute Square Ft. Attribute Square Ft. Frame Constntction 880 Attic, Partialty Finished Attribute Square Ft. Attribute Square Ft. Frame ConstruMion 880 Plumbing Detail Attribute Quantity Attribute Quantity Extra Fixtures 2 Full Bath t Foundation Adjustrnents Attribute Square Ft. Attribute Square FL Partial Basement, Frame 880 Porches Attribute Square Ft. Attribute Square Ft. Enclosed Frame Porch q5 ro wte To... Vi .w -,t n Information View Assessment info. View BiilinE & CnBeMion View LTrlin(tuettt'raxes Print this Pamra Start a New S~ +rch Cni to P rotterh~ &'Caxes ~~+ to D anpjlig 'o ~ ri~ 11f]J51I L' Got )a tnhin C'.n mtv +1 ' [nterar~ tit-e Ma cs http://www.dauphinproperryinfo.org/propertyinqulry.pRrm=vlew6parcel=3 5 06402 90000000&year~2011 Page 1 of 2 www.DauphinCounty.orq (Property & Taxes I information for Property 35-064-029-000-0000, Tax Year 2011 Accommodations Attribute Quantity Attribute Quantity Finished Living Area t,276 Number of Bedrooms 2 Number of Rill Bathrooms L Number of Stories t Exterior Walls Attribute Quantity AtMbute Quantity 1~'rame or Equal Occupancy Attribute Quantity Attribute Quantlty llwelling Copyright ;i?j zany-2oxn, ~%ti . In a All Rights Rksewkd. 9/20/11 10:08 AM County o! Unuphin, L>epartment u[ [ntomtadon Technology z South Second Street, Fitth Tenor Hnrsishurg, P.4 t7loS-x295 w *hmsex r(a~ is ~ohinc.orn http://www.dauphinproperryinfo.org/propertylnquiry.pl?rm=vlew&parcel=350640290000000&year=2011 Page 2 of 2 REV-1508 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpYLE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Anna Mae Shuey 21-11-0908 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jo1My-owned with Hpht of survivorship must be disclosed on Schedule F. {ti more space is needed, insert additional sheets of the same size) THIS PAYMENT IS BEING MADE ACCORDING TO THE TERMS OF YOUR ACCOUNT. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT OUR CUSTOMER SERVICE DEPARTMENT. DBTACN ALONG DOTTBD LIMB AND RETAIN TOP 80RTION FOA YOU RECORDS. ~~,F~ p .R y u~,+ ! w ,~~~ ^'tirf 3{e. Atfix i"n'{.~:i ~ x ':dF , <i~i ~~"'~F ; n~{I ~ 1'r { ~vji~.r' ! ~b ~~5 ~i~~i~~~-''~2 ~`<N~~ t.. six' wrk,,¢ ~, l ~ ~. 'S ~: y 3 ~ i ~ s / a, ~f" e ~ *~.'i^e:r .x ~s3~ " ` 4 . y 5 ~ ". s3 ~ ~ .v.~ s'r : k.t "` asy ~x,~ '~..az N.,,., ;fir .~a .« }+' t ' `k w K. C i"" 1 i ~ 5~. ``. ^w1` "~ ''a..~° v w x ^+ ,+ °+.~ 4 5 3,» 'e,., c. ° `' 3 ` sx ° .~~yy„~{~{~~"{•yi.~,`~5,~) "` .~ ,? ~ t ` i~rF 55 ~,er] ~ i 5 /~, 5 Yk y 37 s i w ..i xx .f ~ £ f.~ M~Y ii y r b ~yM1'rPS~e`I~F~.+ s 1 t ,~ ( Y !~ ! ~^.' w YY ^ wl'! µr \M~ • ~l \q\' ~\`\ ~k~ ~ ..< Y~Ns i+el' '~~Mta~~'4~' ~ \~~~~ yw y,A t J .~. xi d x!33 .~ ¢ q,& r v s d• ¢ ~" ww ¢L, ¢w Y+~ .Y ~' { N. LyyS~~ *'~\~1a \~y, q~Y • ty•, y /:. Y ~ ~ ~ 1M'1 YI1bIV.NM11~a.Pgr,INIR'!T~~n~'gWF 1 ~TIS ~ ~ F^J[T+1 3Y~ a i ~ i % i \\, ~~..~~yy~~~'~~. D4 ~1~~ 4'Q~$n~j~! " \ \ ~ \ pAY ~ FIVE Tli0U51W©TWO'HU f'OURTEL't+I 1~LC.ARS /tND EtGH~" CEMt~" ~ To THE ESTATE OF ANNA MAE SFiIfEY :- ,,.:.,C3RDER OF G10 LISf1 M-SMITH ADMIN .: !, , ', ,, 127 S. MARAFET,ST z , i ~~ MECMANiC~R~ PA 17055 ~ - "' ~~ { vaaoMUta,ztaAd ~; II.O 7 3808 2 7811' ~:0 L 10000 28~: 0 600 90 3 9 1N 4507 North Front Street Suite 201 Harrisburg, PA 17110 rel 717 255 G6GG fax 717 255 GG51 toll free S00 676 0673 MorganStanley SmithBarney September 15, 2011 Andrew C. Sheely Attorney At Law 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 P.E: Estate of Anra Mae Shuei~ Date of Death: 07/22/2011. SSN: 203-10-4488 Dear Atty. Sheely: Please be advised that Anna Mae Shuey held one account with Morgan Stanley Smith Barney (acct #410-058103=003) at Her time tif'death.' Accourit #4'10-05810 was an individually-owned brokerage account titled Anna Mae Shuey. The account was opened on August 30, 2010 `"I~~s~''a~s~ts were previously held in a joint brokerage account with her` cafe disbandl-Iarry;~"Shuey. The following information represents the date of death values for all securities held in acct #410-058103 on her date of death (July 22, 2011): Security Name/ Symbol No. of Shares Share rice dotal Value on 5/22/2011 AMERICAN INVESTMENT CO OF ~ 1,236.007shs $29.12 $35,992.51 AMERICA FUND C (AICCX) f i INVESC'O VK CQMCT(?r'K C; ~ 3,645.54? shs $16.65 $fi~.698.36 L(ACSYX? ~ Please feel free to contact our office at 717-255-b690 with any questions. Sin eiy, L~~~ ~ _ ,. , . ` .C/ ~'-~ Ermly L _ idea . ,.,.., ; 1~eg°d (~;a.enr S~. r+ice X#Ssor=iate• The >3esho•e~%(Jw~nlThoainas C,tr~up "~, ~ ' _ . investments and services offered'through Morgan Stanley Smith Barney LLC, and accounts canted by Morgan Stanley & Co. Incorporated; members SIPC. Morgan Stanley Smith l3uney LLC. Member SIPC. REV-l5o9 EX+ (ol->.o) Pennsylvania BCNEI~uLE DEPARTMENT OF REVENUE INHERITANCE TA%RETURN 70INTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Anna Mae Shuey 21-11-0908 If an asset became iofndy owned within one year of the decedent's date of loth, R must be reporbd on Schedule G. SURVNING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Lisa M. Smith 222 East Main Street Granddaughter Mechanicsburg, PA 17055 B•Charles E. Smith 1222 East Main Street Mechanicsburg, PA 17055 C. 70INTLY OWNED PROPERTY: Spouse of granddaughter ITEM NUMBER LETTHt FOR JOINT TENANT DATE MADE X) DESCRIPRON OF PROPERTY INCLUDE NAME OF FINANCIAL 1NSImlrTON AND BANK ACCOUNT NUMBER OR SIMILAR !D@!rt NG ATTACH DIED FOR X)INILY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENTS 1Nr9tEST DATE OF DEATH VALUE OF DC{C~ENT5 INTEREST i. A.g, 11/0X2009 Member's First Savings Aocount#371393-00, princpal balance as of date $25,027.46 331 /3 8,342.48 of death $25,023.86, akxxlred interest $3.60 2. A.13. 11107(2009 Member's Firsl Checking Account #371393-11, prinapal balance as of date $4,078.77 33 1 /3 1,359.59 of death $4,078.54, accured interest $.23 9,702.07 TOTAL (Also enter on Line 6, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. MEMBERS lrt FBDHRAL CRffi11T (ANION WINGS ACCOUNT: Acxount Number/Suffix. Date Account Es~blished Pnincipal Balance-at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 371393-00 11 /07/2009 $25,023.86 $3.60 $25,027.46 Lisa M. Smith 8~ Charles E. Smith 11 /07/2009 371393-11 11 /07/2009 $4,078.54 $.23 $4,078.77 Lisa M. Smith & Charles E. Smith 11/07/2009 EMBEFZS 1~ FEDERAL C DIT -N ~~ ~~ ~~~ anielle A. Kline Lending Insurance Support Specialist August 29, 2011 Estate of: ANNA M. SHUEY Date o[ Death: O7/22I2011 Social Security Number: 203-10-4488 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org REV-1510 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEQtifLE 6 INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Anna Mae Shuey 21-11-0908 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side Df the REV-1500 COVER SHEET is yes. ITEM NUMBE DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE QF ASSET % OF DECD'S INTEREST EXCLUSION ~ APPLICABLE TAXABLE VALUE t. Bankers Llfe and Casualty Company Annuity -Policy #7733631 $62,831.f 3 TOTAL (Also enter on line 7 Recapitulation) S $62,831.86 (If nwre space is needed, insert add'dional sheets of the same size) ESTATE OF FILE NUMBER Anna Mae Shuey 21-11-0908 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Zimmerman Auer Funeral Home $4,490.00 2• Royers Flowers $323.00 REV-1511 EX+ (10-09) Pennsylvania SCHEDULE H DERARTNENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: $0.00 Name(s) of Personal Representative(s) LISA M. Sn'tlth, Administratrix street address 222 East Main Street qty Mechanicsburg ___.. State PA zIP 17055 Year(s) Commission Paid: $1,200.00 ~. 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: $312.50 5. Accountant fees: 6. Tax Return Preparer Fees: ~• Filing fees $15.00 B. Misc. postage $6.60 9• Reserves to conclude Estate administration and final accounting $600.00 TOTAL (Also enter on Line 9, Recapitulation) I ¢ 6,947.10 If more space is needed, use additional sheets of paper of the same size. AVER GROUP Fax 7175d199d3 Apr 23 2012 01:13pm P002/003 tmmerrnan er FUN1rRA4 !i ME. lNC. 4100 Jonestown Road {717) 545-4001 ~ Da1e A Auer, Supervisor Harrisburg Pal 17109 Farr, (717) 541-9943 3.1075 G Lisa M. Smith 22z > Main st Mechanicsburg, Yc~ 17055 Anna Mae Shuey - Deceased SPE1(:l'AL (:HARGL~'b Direct Cremation E'orwarding Remains Receiving Remains lmmediat9 Burial Nationwide Guarantee Program Worldwide Travel Protection TU'1'AL SYL~CIAL' CHARGI~.S 80.00 NT~UE'1ti5S1UNA1.. SBIRVICES X Services of Funeral Director & Staff 31,595.00 X Embalming $725.00 X uresaing/CO6metizinglCasketing 5220.00 Facilities & Staff for Viewing (5200/hour) X Facilities & Staf£ for Funeral Service $550.00 Facilities & staff for Memorial service X start & Equipment for viewing (3200/hour) 8200.00 Staff & Equipment for Funeral Service Staff ar Equipment for Memorial Service Private Family Viewing WitneBSing the Cremation l,ackaging/J~'orwarding of Cremated Remains Personal Delivery o£ Cremated Remains Scattering of Cremated L~emains TOTA L YliC)FESSIONAL SERVICS$ $3,290.00 AUTOMOTIVE EQUIPMENT X ktemovai Veriicle 5250.00 X Casket Coach 5250.00 Flower Car X Lead car/Clergy Car 5175.00 Service Vehicle FamJ.ly Car 'iU'J'AL AU'lUMUTIVE )rQUIPMENT 8675.00 RUER GROUP Fax 7175419943 Apr 23 2012 01:13pm P003/003 MfiE2CFlANDISE Register Baok Memorial Cards '!'nank You Cards X Hememnrance Package 5115.00 6$ TaX 56.90 5121.90 X Casket - Woodlawn Memorial Gardens Cardboard Container Alternative Container X Uuter Hurial Container Woodlawn Veterans Flag Case Grave/Memorial Marker '!'UTAI, MT3RCkiANbTS}.~ 5122.90 CASH ADVP_NCED TTEM6 x gave Opening prepaid wi Woodlawn Cemetery EquS.pment Vault Service Charge X Newspaper Notice patriot 5165,00 Newspaper Notice X Clergy 5250.00 l:hurCn/Urgahi8t/Soloist Flowers Crematory Charge county coroner ~'ee X C:ert~.f:ied Copies of Death Certificate 990.00 TOTRL CASH AUVANCEIJ ITEMS $405.00 SUMMA£tY OI+ GijAf~G}SS Special Charges 50.00 Professional Services 53,290,00 Automotive Equipment 9675.00 Merchandise 5121.90 cash Advanced Items 5405.00 SUd TU"!'AL 84, 491 .90 c.'btFDIT6 -91 .90 AMOUN'T' PREPAID 80.00 TUTAL 84,490.00 AMUUN'r PAID Jul 23, 2011 -54,490.00 ~3HLHNCE DUL* 50.00 THIS STATEMENT MAY NOT EtEFLISCT ALL NEWSPAPF;R CHARGES RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER 5TRASBAUGH Receipt Date: Cumberland County - Register Of Wills Receipt Time: One Courthouse Sqquare Receipt No.: Carlisle, PA 17Q13 SHUEY ANNA MAE 826/2011 0:27:01 1066782 Estate File No.: 2011-00908 Paid By Remarks: LISA M SMITH DB ------------------------ Receipt Distrib ution ------------- ------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 260.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 16.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 586 ---------------- $260.00 Cash $44.50 Total Received......... $304.50 GLENDA EARNER STRASBAUGH REGISTER OF WILLS AND CLERK OF ORPHANS' COURT MARJORIE A. WEVODAU FIRST DEPUTY KIRK S. SOHONAGE, ESQ SOLICITOR REGISTER OF WILLS AND CLERK OF THE ORPHANS' COURT COUNTY OF CUMBERLAND ONE COURTHOU8E SQUARE caRUSU_, PA 17013 (717) 2406345 FAX (717)240.7797 [INVOICE Bill To: InvoiceNo: 3902 Invoice Date: 4/16/2012 ANDREW C. SHEELY, ESQ. Estate o~ ANNA MAE SHUEY 127 S. MARKET ST Estate No: 21-11-0908 PO BOX 95 hm,v MECHANICSBURG, PA 17055 Qty Fee Description Fee Total 2 Short Certificates 4.00 $8.00 Total: $8.00 REV-1512 EX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8c LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Anna Mae Shuey 21-11-0908 . Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRI TION Of DEATH 1. PPL Electiric Utilities -final bill $111.56 2. UGI -final bill $160.00 3. Lower Paxton sewer/water bill -final bill $360.00 4. State Farm Homeowner's Policy -final bill $383.24 5. Waste Management -final bill $300.00 6. Touch of Color Flooring - repair to flooring $1,076.05 7. Pincin Plumbing -plumbing repairs to toilet $135.00 8. Misc. hardware supplies $656.01 9• Decedent's Dauphin County 2011 propertylschool taxes $1,280.60 10. Cumberland Goodwill Fire Company $81,75 11. TrustAmbulance $100.00 12. ManorCare -final bill $4,102:50 13. Heartland Pharmacy of Pennsylvania, LLC $197.94 14. Holy Spirit Hospital $81.00 15. Pinnacle Health Emergency $451.00 TOTAL (Also enter on Line 1D, Recapitulation) I # 9,476.65 If more space is needed, insert additional sheets of the same size. ,t' '"4"' r.. ~ tfi."r Pa'""~' t ,'~ r ~ orgy, c _~ g Y yt t. ~•x,.~ ., r f e 4 ~x3~ Y+ k~4s~.` Clfl'~~ ~f?DC~Wif~" F1F2 I ~~~~~` '"'."`~ Blttirrg Otitce ~ 11-146729 P.O. Box 726 New Cumberland, PA 17070 12/27/2011 I $81.75 QUESTIONS ABOUT THIS BILL4 Phone: 877-214-6018 Espynol: 86G-7244114 Fax: 717-214-6020 Email: IMoOamfeulanoaWllinyoifice.w Date of Service: 7/2U/2011 15:25 Patient Name: SHUEY, ANNA M. From: Carlisle Regional Medical Center To: MANORCARE HLTH SVC-CARLISLE 7!20/11 Stretcher Van One-Way Trans A0130 1.0 80.00 80.00 7/20/11 Mileage S0209 1.0 1.75 1.75 Total 81.75 I 1 ~ i I ; Please visit our website to provide insurance or make payment, and for additional payment options and frequently asked questions: www.ambulancebillingoffica.com DETACH AND RETURN BOTTIOM PORTION WITH YOUR PAYMENT. I ®I 1-~j I 1 l ~ ~ 1 , , - ,olsao+ret ~ ) ^ vl sA ^ AMERICAN EXPR ESS ^ DISCO4ER ASTE RCARD Credk Card: ^ M _- -_ __ i C 1 s r __, _.._ --- n a k r i tab Numlxr f Name on Cartl Expiration Adl h / R fi n b l i d d / QR HC / l xme r pro n ow: erce sen a oo e c ec e o e P Routing Number o.oo o.oo 11-146729 I S 81.75 Amount Paid: Please make arty rnrrecttons to address below. ANNA M. SHUEY 222 E MAIN STREET C/O LISA SMITH MECHANICSBURG, PA 17055 Signature j *Retumed dlecl0 -You will be responsible for ell klcumad bink tees pe'ml$Ible undir state law. _. _. _ - - v r, N ~ ~ ~. m ~. m va~'d, ~ W ~ ° O ~ ~ ~ ~Qo ~ c d ~~ ",~ ~ m ~ .~e ~ ca~ ~ m G ~'.G n ~ '~ pp' a A p ~- N .- m ~ ~ ~ tT N G o O o ..i `' n N ~ b ~ i ~ ~. -~ ,~ _ ~` ~__ - o ~ ~• N --+_ O ,~ v i w~ W ~ c 0 x '{ o ~ ~ ~ o 3 ^ n ~ 4+ V~ O O ' ~ '~ • _ .`~j O '~ i 4, ~, IN Q O, .~ y ° ''. i b~ ~' ~ m ~ ., w1 ~ N ~ ~, z '~ Y ~~ \~ ~ ~~ O Estate Infomlation Services, LLC 2323 Lake Club Drive Suite 300 Columbus, OH 43232 estaa ;nforaindon aervicm, lia Honts: Mon-Thu Sam-9pm and Ari Sam-Spam EST Toll Frce: (877) 714-3739 Phone: (614) 322-2758 Fax: (614) 322-2761 www.probate~are.com 09/12/2011 LISA SMITH 222 E Main St Mechanicsburg, PA 17055-6519 1~~rlll~~~lll~~~~1rl~~l~lr~ll~~~l~1r~r~lll~l~r~~l~l~~lril~~~ll RE Estate Of: ANNA SHUEY Creditor NameTraaswor`)-d Systems Inc. ~ - _ -- Account Type: HCR Manor Care Amo~mt of Debt:$4,102.50 u Account Number:*"`**************9187 Reference #:2974287 Dear LISA SMTI'H Please accept our condolences for your loss and we appreciate that tbe family maybe going through a difficult time. Estate Information Services is writing this letter to yoru because we believe you to be the person responsible for Ong ~~ claims, PaYinB ~Y 8 bills f ANNA SHUEY out of the assets of the estate, or handling say Sasacial or business affairs for ANNA SHLTEY. There is ao personal liability to you associated with any bahvicx owed as this account from your personal assts or jointly owned assets. ANNA SHUEY was a valued customer of our client, jand they have engaged us to assist you and/or the estate in bringing to a reaoltrtion any outstanding balance owe oa the above account We need to rexxive from you pertinent estate information so that we may present an estate clhim on behalf of our client for the remaining balance. Please call the toll free number listed above with the requestgd estate information. If there is no formal estate filed with the probate co in which to present as estate claim, and you plea to take care of the outstanding balance from the personal a the late ANNA SHUEY, then we have inehrded a payment coupon on the reverse page of this letter for your con enience when forwarding the payment. If Y~ Pte. Y~ may make an elxtcoaic payment through our sexure ebsite at http://www.probate-care,com/payment. If.you have ~Y 9ueations, Ply give us a call and we would be more than happy to discuss with you any payment arraagament. _ .. ... -_ - _ _. Thank you for your assistance in this matter and we look forward to hearing fipm you. - _ _- _._ -~ Unless within thirty (30) days after receipt of this nonce you dispute the validity of the debt or any portion thereof, we will assume the debt is valid Ifyou notify us witfiix said 30 days that the debt or anyportion thereof is disputed, we will obtain verifrcation of the debt and will mail such verification to you. In addition, upon your writtex request within said 30 days, we will provide the Warne cmd address of the original creditor if differe-rt from the current cr~edttor. Estate Information Services is a debt collection company. This is an attempt to collect a debt from the assets of the estate ofA1VNA SXUEYaxd axy information obtained will be used for that purpose. Calls may be moxitored or recorded for quality assuraxce purposes. Sincerely, ESTATE INFORMATION SERVICES, LLC • COMPUTER CREDIT, INC. CLAIM DEPT 082515. 640 West Fourth Street . Post Office Box 5238. Winston-Salem, NC . 27113-5238 .336-761-1538 December O5, 2011 052 SH'7HS 402 0652454754 Anna Shuey For: Shuey, Anna M 4905 E Trindle Rd Apt 1041 7 Mechanicsburg, PA 17050-3695 PillldhldlillllhlliP6~llilpylilli4,ii11gh161nIpy1 Holy Spirit Hospitai Atterrtion: Patient Financial Servioea Telephone: (717) 783-2138 Accouat# 38838801 0 Date of Serviee: 01-08-11 r ~Pa>rST DUE ~MOt'JNT~'< k "`" ~`, ^~' Dear Anna Shuey: Despite out previous comtnunigiion to encourage you to pay Your delinquent account with Holy Spirit Hospital, you still have an outstanding balance. This is our FINAL N01TCE and you must take action to resobe this overdue account. Pay the amotmt due to discharge your debt owed to the hospital. This letter is sent as a final demand for payment in the amount of 581.00. Computer Coedit, Inc. is a debt collector and a member of ACA International, the Assodation of Credit and Collection Professionals. Be advised this is our LAST ATTl~Q'T to collect this debt and airy information obtained will be used for that purpose. We expect you to resolve your financial obllgaxion. C. Jordan Director of Ope><-ations Return this porUOn with your payment ^ ^ ^® ^ UM EXP DAiE U CODE AMOUNT NA E I A NAM BILLING 21P CODE YOY aaly ONlkt CrlaC/t /Ie~lebb to: Holy Spirit Hospital P.O. Box 822183 Phtladelphla, PA 18182-2'188 vv..,l.aaav, rw,a, •„~.. '°'6 z.ava sz '111I'~/'II IIIII'IIII11'If III III II'~'ll ltll"IIIIIII IIIII'IIII CCI KEY: 08524547b4 .x~~~a.~ ...... . . PHARMAI'Y OF PBNl1SYLVANIA, LLC 7010 SNDWDWFf im A~~ . P A ,e~ 1 ~ 7 RETURN SERVICE REQUESTED !sees o,o, FACILITY: 53720 CARLISLE PAY PLAN: 'Il~~ll~ll"III~1~'11'~I1~'~ill~~l~~l~~il~l~lil~~~~lil~~llll~lll~ C/O SHUEY 222 E M SN STH MECHANICSBURG, PA 17055-6519 ^ ors dr «k9~ olanq~idl~and~ In 1e'Iaa~Cllan i) OIl re,rerae side. 9ai78 MAIL 'TEE141R600,871 CHECK CARD USING FOR PAYMENT 33978 MAIL MASTERCARD DISCOVER ® ^ CA DNUMBER AMOU SIGNATURE p(p Oq STATEMENT DATE 12/31/2011 PAYTHIS AMOUNT $197.94 CUSTOMER ID 344937 SHOW AMOUNT PAGE NO. 1 of 1 PAID HERE 85286 N'I~~I""~I~I"~I~I'~'~I'I''~I°II'~~~p~111~11~IJudllpllld HEARTLAND PHARMACY OF PENNSYLVANIA PO BOX 72413 CLEVELAND, OH 44192-0002 3~7e'TEE148i18001371 PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMEN ~~~~Mt~~~~t~f~ SHUEY, ANNA 344937 CARLISLE 99187 ~I+OES Fh,encs are calculated Q monthly periodic rata of 1.5% (or a minanum of 51.00 per month) for a total annual rate of 18%. 195.21 - I' 0.00 I- 0.00 I- 0.00 I+ 2,73 I+ 0.00 I+ 0.00 IS DUE DATE: DAYS bUTSTANDING 1 - 30 31 - 60 61 - 90 91 - 120 121 + AMOUNT DUE: AGED BALANCE 0.00 2.73 2.73 2.73 187.02 197.94 1!30/2012 0197.94 AMOUNT ENCLOSED: 7010 SNOWDRIFT RD ALLENTOWN, PA 18106 800-270-6351 EXT 8050 ACCOUNTS RECOVERY BUREAU, INC. • P.O. Box 6768 • Wyomissing, Pa. 18610-0768 October 27, 2011 Account #: 112230792 Creditor: PINNACLE HEALTH EMERGENCY 451.00 TOTAL DUE: $451.00 OUR RECORDS INDICATE THAT YOU REFUSE TO PAY THE ABOVE REFERENCED BALANCE. PLEASE NOTIFY THIS OFFICE IF YOU CAN NOT PAY THIS BALANCE. YOU MAY QUALIFY FOR RELIEF FROM THIS DEBT. WE WILL BE HAPPY TO ADVISE YOU OF THE ELIGIBILITY REQUIREMENTS. TELEPHONE: (800) 220-1622 or (610) 750-8950 THIS COMMUNICATION IS FROM A DEBT COLLECTOR AND IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT ~' PO BOX 3495 TOLEDO, OH 43607 [., _v• ',+.l~i' 30724-0462 ^ Plwee check qqooxx d heknv address he iraorrect, end indicate cnanpa(a) on reverse side. •~ z 000281 °'°' 'lllllli'lll'll""ir'111111'illllllll'11i1illll'lllll'llllllllll ANNA M SHUEY COUNTRY MEADOWS MECHANICSBURG. PA 17050 ~~~~1~~~~1~~~~~~~~ is Raraws ar rAereRCARO, a~a eovm. nsi4 ~w eoeela oR sett °u% wt our se~ow. .. ° -~ D^iacwER ®° ~ ° EXP ~ F^LEX CARD CARD N R & NATURE pip. DA NCTICE l>ATE 10/27/2011 BALANCE $451.00 ARB ACCT. t 1-112230792- 11 PAGE: 1 Of 1 AMOUNT ENCL09ED PAYMENTS ACCEPTED ONLINE AT vwuw.payarb.oom~OF 30724-Q462'TC NON W K1.8001391 III'II'I'IIIII'I'III'Illllilllllelelilllullelll~leldll'Illllell ACCOUNTS RECOVERY BUREAU. INC. PO BOX 70258 PHILADELPHIA, PA 19178-0258 01112230792102720111300000451009 . __ -...... _ -~ DAUPHii~ c.~'t, . - .,~ CLAIM ~..~.r:Airr - • THIS NOTICE Is FoFe zotl ~ ~ UNPAID REAL ESTATE TAXES Abofi~9At1 Ilt~IwnNdaNArx1 '.7101 2090 7472 2207 3330 DATE APRIL 17,201z MAKEL~C`I~E(~(S flR'M'IONEYd~2$ PAYABLE TO: - DAUPHIN COUNTY TAX CLAIM eUR~-u PROPERTY PARCEL NUMBER: 35 064 029 1ST FL. DAUPH9J COUNTY ADMIN. BLDG, 2 S. SECOND ST. P.O. BOX 1295 HARRISBURG PA 17108-1285 PHONE (717) 7806125 HOURS: MON THRU FRI 8 AM to 4:15 PM 5306 LOCUST LN wE ACCEPT DNLV CASH. CERTIFIED CHECKS OR MONEv ORDERS NO PERtONAL OR tUlviBt CIECIO ACCEPTED ~ . CERTAIN CREDIT CARDS ACCEPTED IN PERSON WITH PROPER I D. 4pDITIONAL FEES APPUEp VIEfI Dw M Orl eu IIIIlRIf1 d W WM~. fICOY IF YOURTAxESAREwwPRa'uAMORTGacEESCROwACCOUNr,THE IF YOU FAIL TO PAY THIS TAX CLAIM NOW, THE AMOUNT MORrGAGE HOIDER DOES NOT RECENEACOPY OF THIS NOTICE DUE WILL CONTINUE TO INCREASE AS INDICATED BELOW. VOURDELINQUENTTAXESPLUSACCUMULATEDCHARGESARE: ;~ ~~ ~~ '~ ~ ~ APR 2012 1,280.60 DEC 2012 1355.00 COUNTY MAIL COSTS 7.50 MAY 2012 1.269.90 JAN 2013 1,~4.3p LIBRARY BUREAU COSTS 15.00 JUN 2012 1,299.20 FEB 2013 ~ 1,373.60 CITYBORORwP. INTEREST 18•~ JUL 2012 1,308.50 MAR 2013 1,382.80 1,239.50 AUG 2012 1,311.80 APR 2013 1,392.20 SCHOOL 1,239.50 SEP 2012 1,327.10 MAY 2013 1,401.50 TAX TOTAL OCT 2012 1,336.40 JUN 2013 1,410.80 TOTAL ? i,~ILis11 NOV 2012 1,345.70 -- ~ ~~ PLEASE PRESENT THIS NOTICE WHEN MAKING PAYME=N i. ALS`~1 ~~ WARNING IF MAILING PAYMENT AND YOU DESIRE A RECEIPT. ENCLOSE IF YOU FAIL TO PAY THIS TAX CLAIM OR FAIL TO TAKE SELF•ADDRESSED, STAMPED ENVELOPE WITH YOUR REMITTANCE LEGAL ACTION TO CHALLENGE THIS CLAIM, YOUR PROPERTY WILL BE SOLD WITHOUT YOUR CONSENT AS PAYMENT FOR THESE TAXES. YOUR PROPERTY MAY BE 35 064 029 SOLD FOR A SMALL FRACTION OF ITS FAIR MARKET VALUE. IF YOU PAY THIS CLAIM BEFORE JULY 1, 2013, OWNER OR REPUTED OWNER YOUR PROPERTY WILL NOT BE SOLD. IF YOU PAY THIS CLAIM AFTER JULY 1, 2013, BUT BEFORE ACTUAL SALE, SHUEY, HARRY C & ANNA MAE YOUR PROPERTY WILL NOT BE SOLD, BUT WILL APPEAR 222 E MAIN ST ON ADVERTISEMENTS FOR SUCH SALE. IF YOU HAVE MECHANICSBURG PA 17055-6519 ANY QUESTIONS, PLEASE CALL YOUR ATTORNEY, THE TAX CLAIM BUREAU AT (717) 780-6125 OR THE COUNTY• Notice is hereby given that the pro ty above described has been returned tot >le Tax Gaim Bureau of Dauphin Courriy far non-payment of taxes and a claim has been entered u r the provisions Act of 1947 P.L. 1368, as amended. If payment of These taxes r9 rat made to the Tax Claim Bureau on or before December 31 of this year, and no exceptions are filed, the claim will become absolute. On July 1, of this year a one (1) r period for discharge of tax claim shall corrarlerrce or flea oommraed to run and iF tuA payment of taxes is rat made during that pared as provided n~o redemlption aRer actual seam ~, tire propeAy shall be advertJsed for and exposed to sale under the provisions of such ad and ttlere shah tie Oauphc.~ad oarza~s zZu ~ REV 1513,D(+(3Wl ' scN~ou~ ~ ~TM °F ~N"~w'"u BENEFICIARIES MHHiITANCE TAX RENRN RESgENTDECEOENT ESTATE OF FILE N1)MBER Mna Mae Shuey 21-11-0908 RELAT40NSHlP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Lbt Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [k+dude outrght spousal dislTibullona, and transfers under See. 9116 (a) (12)j 1. Lisa M. Smith, Y12 East Main Street, Mechanicsburg, PA 17055 GranddaughOsr 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REW1500 COVER SHEET A NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUT10N3 UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF 4ART N -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV 1500 COVER SHEET I S (N nare apace ~ needed, insert addiUorrel stxets of the same sms)