HomeMy WebLinkAbout07-11-12 1505610140
REV-1500 EX (01-10j
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 2sosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601
RESIDENT DECEDENT 2 1 1 2 0 1 2 4
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 1 1 7 2 0 1 2 0 6 1 5 1 9 3 4
Decedent's Last Name Suffix Decedent's Firs t Name MI
K R A U S S E J E W E L L M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE VWITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
Q 6. 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. Election to tai: under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O}
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND GONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone tVumber
M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 5 0
First line of address
5 4 E A S T
Second line of address
City or Post Office
M E C H A N T
M A I N S T R E E T
State ZIP Code
C S B U R G P A 1 7 0 5 5
Correspondent's a-mail address:
REGISTER OF WILLS USE O,NbY
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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 information of which preparer has any knowledge.
S TUBE OF PERSON RESPONSIBLE FOR FILWG RETURN ATE
annRFGc
ROXANNE M• BEAV 590 ERNEY ROAD DOVER PA 17315
SIGNATURE OF~R AR OT R T AN REPRESENTATIVE ATE
,t/ ~s° e%
ADDRESS
MURREL AL ERS III ESQ, 54 E• MAIN STMECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 ],505610140
],5D561,024D
REV-1500 EX
Decedent's Social Security Number
oecedent'sName: JEWELL M KRAUSSE
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1. 1 3 9 2 3 7, 7 5
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.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .... ... 7.
8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8.
9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10.
11. Total Deductions (total Lines 9 and 10) ............................ ... 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14.
1 8 6 8 8 ],. 1 2
3 2 6 1 1 8. 8 7
1 6 4 1 6. 1 9
3 7 6 8. 4 3
2 0 1 8 4. 6 2
3 D 5 9 3 4. 2 5
3 D 5 9 3 4. 2 5
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.0 _ D D D 15.
16. Amount of Line 14 taxable
at lineal rate X .045 3 D 5 9 3 4 2 5 16.
17. Amount of Line 14 taxable
at sibling rate X .12 D D D 17.
18. Amount of Line 14 taxable
at collateral rate X .15 D D D 1 g,
19. TAX DUE ......................................................19
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
D. D D
1 3 '~ 6 7. D 4
0. D D
a. D D
1 3 ~' 6 7. 0 4
Side 2
150561D240 15D561D24D J
REV-1500 EX Pzg? ? File Number
Decedent's Complete Address: 21 12 0124
DECEDENT'S NAME
JEWELL M. K_R_AUSSE ___
STREET ADDRESS -----
486 BRIGHTON PLACE __
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1} 13,767.04
2. CreditslPayments
A. Prior Payments 13,000.00
B. Discount 650.00
Total Credits (A + B) (2) 13,650.00
3. Interest
(3}
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. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 117.04
Make check payable to: REGISTER OF WILLS, AGENT
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 : ................................................................... ... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ............................ ... ^ ^X
c. retain a reversionary interest; or ............................................................................................. ... ^ 0
d. receive the promise for life of either payments, benefits or care? .................................................... ... ^ 0
2. If death occu«ed after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................... ... ^ ^X
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ...... ... ^ ^X
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 transfers to or for the use of the surviving spouse is
3 percent (72 P.S. §9116 (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 statute does not exempt 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 if 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 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 beneficiaries 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)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whelher by blood or adoption.
REV-15^2 FX+ in~_~^~
pennsylvania ~ SCHEDULE A
DEPARTMENT OE REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER:
JEWELL M. KRAUSSE 21 12 0124
All real property owned solely or as a tenant in common must be 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 6e 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
486 BRIGHTON PLACE, MECHANICSBURG, PA 17055
NET SALE PRICE
139,237.75
TOTAL (Also enter on Line 1, Recapitulation.) ~ $ 139,237.75
If more space is needed, use additional sheets of paper of the same size.
~_ ~ettlemer?t Stat~me~~':
s. Type of Loan
U.S. Department of Housing and Urban Development
OMB Aooroval No. 2502-0285
CIFHA 2 [;FmHA ? CCon': ~cins, 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number
Lc OVA 5 [;Cony lrs 12142
-~Tofm :s ur-T nlsn aT; gi~: e yon e sTmen o ac ua se amen cos s. moun s pal o an y e se amen agen are own.
(; Note. Items marked "(p c c I" .+ere paid ou!;.da the closing, they are shown here for inrormation purposes and are not included in the totals TiteExpress Settlement System
WARNING II is a rime to .inowingly make raise stalemenls to the Unitetl States on this or any other similar form. Penattles upon
convictio^ can i_clcde a_ fine and .imp. iscnment For details see: Title 78 U. S. Code Section toot and Section t of o. Pflnted O6IO7/2012 of 1 O
C! NAME OF BORROWER: Ronald F. ;ihuey and Louise A. Shuey
ADDRESS: _ __314 Berkshire Road Mechanicsbur PA 17055
NAME OF SELLER'. Estate of Jewell M. Krausse
ADDRESS: _,._ _486 Brjghtan Place Mechanicsbur PA 17055
F NAME OF LENDER.
ADDRESS. _
G PROPERTY ADDRESS: 486 Brighton Place, Mechanicsburg, PA 17055
Upper Allen Township I
H SETTLEMENT AGENT: Keystone land Transfer, Ltd, Telephone: 717-731.4200 Fax: 717-731.1799
PLACE OF SETTLEMENT: 3421 Market Street Cam Hill PA 17011
I. SETTLEMENT DATE: 0 610 712 0 1 2
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice _ 150 000.00 401. Contract sales rice 150 000.00
102. Personal ro art ___ 402. Personal ro art
103. Settlement char es to borrower line 1400 2 970.75 403.
104. _ 404.
105. __ 405.
Ad ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
106. Cit /town taxes 406. Cit /town taxes
t07. Count taxes 06107112to12131112 306.79 407. Count taxes 06107112to12131112 306.79
108. School Taxes 06107/12to06130112 117.24 408. School Taxes 0fi107112to06130112 _
117.24
109. Sewer 06/07112 to 06/30/12 29.53 409. Sewer 06/07/121006130112 29.53
110. HOAMDnthl Fee 06107112to06130112 111.19 410. HOAMonthl Fee 06107/12to06130112 111.19
11t __ 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 153 535.50 420. GROSS AMOUNT DUE TO SELLER 150 564.75
200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or earnest mone 2 500.00 501. Excess De osit see instructions
202. Princi al amount of new loans _ 502. Settlement char es to seller line 1400 11 327.00
203. Existin loans taken sub'ect to 503. Existin loans taken sub'ect to
204. 504. Pa off of First Mort a e Loan
205. 505. Pa off of secrond mon a e loan
206. __ 506.
207. 507.
208. 508.
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
210. Cit Mown taxes 510. Cit (town taxes
211. Count taxes 511. Count taxes
212, School Taxes 512. School7axes
213. 513.
214. 514.
215. 515.
216. 516.
217, 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 2 500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 11 327.00
300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R
301. Gross amount due from borrower line 120 153 535.50 601. Gross amount due to seller line 420 150 564.75
302 Less amounts aid b lfor borrower line 220 2 500.00 602. Less reduction amount due seller line 520 11 327.00
303. CASH FROM BORROWER 151 035.50 603. CASH TO SELLER ~ 139,237.75
SUBSTITUTE FORM 1099 SELLER STATEMENT. The information contained herein is important tax inrormation and is being rumished to the Internal Revenue Service. I( you are required to Tile a return
a ne 09 above consii~tes thesGros~s Proceeds oP Uatlt ansacfionhis item is required to be reported and the IRS determines That it has not been reported. The Contract Sales Price described on
line
Vou are required by law to provide the settlement agent (Fetl. lax ID No: )with your cortect taxpayer identification number. Ir you do net provide your correct taxpayer idenli/ication
number, you may be subject to civil or Criminal penalties imposed by law. Under penalties o perjury, I certify that Iha number shown on this Statement is my correct taxpayer'identiflcation number.
TIN. _
SELLER(S) NEW MAILING ADDRESS
SELLER(S) PHONE NUMBERS
SELLER(S)SIGNATURE(S).
form HUD-1 (3l86)ref Handbook 4305.
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number 12142 aAGE
SETTLEMENT STATEMENT TitleExpress Settlement Svstem FrlnrRri nRm~l~nf~ ~r fn n cu
I L. St 1 I LtMENT CHARGES
700. TOTAL SALES/BROKER'S COMrAISSION based Dn price $150 000.00 = 9 195 00 PAID FROM PAID FROM
BORROWER'S SELLER'S
Division of cc_mmission line 700. zs',adows: FUNDS AT FUNDS AT
701. $ -V 4500.00 _e_RelMaxReal Associates InC. SETTLEMENT SETTLEMENT ~
702. $ 4 695ArJ o_GRA-NRT Inc.
703. Commission ,paid at Settlement 9 195.00
704. Broker Fee ;o R_elMax Real Associates Inc. 295.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori inaton Fee _
802. Loan Discount °r;
803. A raise/ Fee ___ _ _
804. Credit Re ort
~ ---- -
\
805.
i
806.
-- -
807.
_
808.
V- -
809.
_
810.
81L
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From tD _ $ Ida
902. Mort a e Insurance Premium far to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard insurance _ mo. $ Imo
1002. Mort a e Insurance mo. $ /mo
1003. Cit Pro ert Tax mo. $ Imo
1004. Count Pro ert Tax mo. $ !mo
1005. Scho01 Taxes mo. $ !mo
1009. A re ate Anal sis Ad'ustment 0.00 0.00
1100. TITLE CHARGES
1101. Settlement or Closin Fee
1102. Abstract or Title Search
1103. Title Examination
1104. Title Insurance Binder
1105. Document Pre aration
1106. Notar Fees to Kristen D. Skive 5.00 10.00
1107. Attome 's fees
includes above items No:
1108. Title Insurance to First American Title Insurance Com an 1 108.75
includes above items No.
1109. Lender's PDlic
1110. Owner's Polic 150 000.00 •1 108.75
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed $ 62.00 'Mart e $ 'Release $ 62.00
1202. Cit /Count tax/stam s Deed $1 500.00 ~ Mort a e $ 1 500.00
1203. Stale Taxlstam s Deed $1 500.00 Mort a e $ 1 500.00
1204. Deed $ Mort a e $
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Home Warrant to American Home Shield 420.00
1302. Reimb for Resale Cert to Dave Wenthe 90 00
1303. Sewer 411-6730 to U er Allen Townshi 112.00
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 2 970.75 11 327.00
HUD CERT7F1CAT10N OF BUYER AND SELLER
I have c awed the HUD- ett ant S ement and to the best of my knowledge and belie(, it is a true and accurate statement of all receipts and tlisbursemenls made on my acoount
or by m 'n t - t nsactien. I fuRhe N' I ve received a cop of the HUD-t $etllement Statement.
uey / owe uey
WARNING. IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this
UNITED STATES ON THIS OR ANV SIMILAR FORM. PENALTIES UPON CONVICTION eansaction. 1 have ceuse0 or will cause the funds I be disbursed in accordance with this statema 1.
CAN INCLUDE A FINE ANO IMPRISONMENT. FOR DETAILS SEE TITLE 18'
U. S. CODE SECTION 1001 AND SECTION 1010.
SETTLEMENT AGEN DATE'
~• /~
REV-158 EX ~ rP-9°`
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c MASC.
IN RES DENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
JEWELL M. KRAUSSE 21 12 0124
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2011 CHEVROLET 15,198.00
CRUZE
KELLEY BLUE BOOK VALUE
2. MEMBERS 1ST FEDERAL CREDIT UNION 8,137.53
CHECKING
3. MEMBERS 1ST FEDERAL CREDIT UNION 19,756.22
SAVINGS
4. MEMBERS 1ST FEDERAL CREDIT UNION 24,659.72
CD
5. MEMBERS 1ST FEDERAL CREDIT UNION 24,659.72
CD
6. MEMBERS 1ST FEDERAL CREDIT UNION 18,069.94
CD
7. MEMBERS 1ST FEDERAL CREDIT UNION 13,914.35
CD
8. MEMBERS 1ST FEDERAL CREDIT UNION 22,678.81
CD
9. MEMBERS 1ST FEDERAL CREDIT UNION 12,627.59
CD
10. MEMBERS 1ST FEDERAL CREDIT UNION 21,215.14
CD
11. SIRIUS XM RADIO INC 63.27
REFUND
12. JOHN HANCOCK 2,278.11
LONG TERM CARE PREMIUM REFUND
13. JOHN HANCOCK 1,170.00
LONG TERM CARE CLAIM PAYMENT
14. VERIZON 92 47
REFUND
15. LAWRENCE CHEVROLET 830.14
EXENDED WARRANTY REFUND
16. ERIE INSURANCE EXCHANGE 276.00
CAR INSURANCE REFUND
TOTAL (Also enter on line 5 Recapitulation) I $ 186,881.12
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JEW ELL M. KRAUSSE 21 12 0124
Decedent's Name Page 1 Fiie Number
Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17. INTERNAL REVENUE SERVICE 1,177.00
2011 INCOME TAX RETURN
18. SUBURBAN PROPANE
REFUND
77.11
SUBTOTAL SCHEDULE E 1,254.11
GRAND TOTAL SCHEDULE E $ 186,881.12
REV-1511 `_X 'lL' ,'+;
Pennsylvania SCHEDULE H
DEP.4RTMEN70F REVENUE FUNERAL EXPENSES AND
wHERiraNCEra,xREruRN ADMINISTRATIVE COSTS
RESIDEN t DECEDENT
ESTATE OF FILE NUMBER
JEWELL M. KRAUSSE 21 12 0124
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. 'MALPEZZI FUNERAL HOME 10,178.69
2. FLORAL PARK CEMETERY -HEAD STONE INSCRIPTION 190.00
g, ADMINISTRATIVE COSTS:
~, Personal Representative Commissions.
Name(s) of Personal Representative(s) ROXANNE M. BEAVER
Street Address 1590 ERNEY ROAD
City DOVER State PA ZIP 17315
Year(s) Commission Paid: (RENOUNCED)
Z Attorney Fees: MURREL R. WALTERS, III 5,600.00
g, 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: CUMBERLAND COUNTY REGISTER OF WILLS 438.50
5 Accountant Fees.
6, Tax Return Preparer Fees:
7. MEMBERS 1ST FEDERAL CREDIT UNION -ESTATE CHECKS
9.00
TOTAL (Also enter on Line 9, Recapitulation) ` 5 1
If more space is needed, use additional sheets of paper of the same size.
REV-1612 F_X~+!12 `:~;
pennsylvania
DEPAF',T MENT OF REVENUE
INHERfTANCE 7AX RETURN
RFSIDFFNT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JEWELL M. KRAUSSE 21 12 0124
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE A7 DATE
NUMBER DESCRIPTION OF DEATH
1. BRIGHTON PLACE ASSOCIATION 581.50
2. V{SITING ANGELS 1,620.00
CARE
3. UNITED 98'82
WATER
4. VERIZON 161.84
TELEPHONE
5. AL WHITCOMB 155.00
TAX PREPARATION
6. MEALS ON WHEELS 35.00
MEALS
7. YORK WASTE 77.70
REFUSE
8. DENNIS ZERBE, TAX COLLECTOR 539.84
2012 COUNTY/TOWNSHIP TAXES
9. PPL 386.73
ELECTRIC
10. UPPER ALLEN TOWNSHIP 112.00
SEWER
TOTAL (Also enter on Line 10, Recapitulation) I $ 3,768.43
If more space is needed, insert additional sheets of the same size.
2EV-1513 EX+Ip1-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE NUMBER:
JEWELL M. KRAUSSE 21 12 0124
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. ROBERT W. KRAUSSE Lineal 50.00
107 W. COOVER STREET
MECHANICSBURG, PA 17055
2. ROXANNE M. BEAVER Lineal 50.00
1590 ERNEY ROAD
DOVER, PA 17315
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
jI. 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
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