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HomeMy WebLinkAbout06-29-12 (2) 1505610105 REV-1500 Extpz-"'t~"m OFFICUIL USE ONLY PA Department of Revenue Pennsylvania "~""~"`"`~""`"~` County Code Year Fle Number Bureau of Individual Taxes PO BOx 280601 INHERITANCE TAX RETURN ~,r1-j" 1 L (:"LLB _ ~~ !` y Harrisburg, PA 17iz8-0601 R ESIDENT DE CEDENT ( p ~ I ~ ~ ' I I ' / ENTER DECEDENT INFORMATION BELOW Socal Securty Number Date of Death MMDDYYYY Date of Birth MMDDYYW 196-14-4993 10101 /2011 08/23/1926 Decedent's Last Name Suffix Decedent's First Name MI Richards Thomas (~ J (If Applluble) Enter Surviving Spousa's Information Below _ Spouse's Last Name Suffix Spouse's First Name MI -- ~---- ---.. ___ _-___... _ -____~_. ~~ ~ -m~m.~ ~J Spouse's Social Security Number _ ~_ FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Retum O 3. Remainder Retum (Date oT Death Prior to 12-13-62) O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) O 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHDULD BE DIRECTED TO: Name Daytime Telephone Number Marvin Beshore, Esquire __~ (717) 236-0781 REGISTER OFJI/LLS USE ~~ L r First Line of Address ~ ~ ~7 2 130 State Street 1 ~r-,'' 1~ "' to -: Sewnd Line of Address rr----~~ 1- ~ P.O. Box 946 v -- --_---- - -----.... --------. ._.._..._. - r1LEl1.._: City or Post Office State ZIP Code _ -_ ... - Harrisburg ~ PA 17108 ~ vW~ W ~ ~- correspondent's a-mail adaress: mbeshore(~beshorelaw.t~m Under penalties of perjury, 1 declare that I have examined this return, Induding aaompanying schedules and statemems, and to the best of my knowledge and Uelief, it is true, correct and comdete: Dedaretbn of preparer other than tha personal representative is based on all information of which preparer has anv knnvAwdne ~~~ SIGNATURE J,~ F~2EPABER ~YHER DATE ~t/~„~/~'~' ADDRESS t, - - / / 130 State Street, P.O. Box 946, Harrisburg, PA 17108 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J ADDRESS ~ ~ r f 4719 E. Trlndle Road. Mechaniosburp, PA 17050 `~ ~~ o ~ ~~ ~ v ~~ V v ~4. - " ~~ r J REV-1500 EX (FI) Decedent's Name: RECAPRULATION 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. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O 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. 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_ 16. Amount of Line 14 taxable at lineal rate X .0 _ 17. Amount of Line 14 taxable at sibling refs X .12 18. Amount of Line 14 taxable at collateral rate X .15 1505610205 15. i6. 17. 18. 19. TAX DUE .........................................................19. Decedent's Social Security Number 196-14-4993 74,950.00 24,503.30 72,557.83 95,211.25 267,222.38 17,447.71 135.00 17,582.71 249,639.67 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J r REV-1500 Ex (FI) Page 3 Decedent's Complete Address: File Number DECEDENTS NAME Thomas M. Richards STREETADDRESS 4719 E. Trindle Road CITt' Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 20,000.00_ B. Discount 1,052.60 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Page 2, Line 20 to request a refund. (1) 29,956.76 Total Credits (A+ B) (2) 21,052.60 (3) 0.00 (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8,904.16 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 trensferred .......................................................................................... ~ ^ b. retain the right to designate who shall use the property transferted or its income ............................................ ^ c. retain a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec.12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in wst fol' or payable-upon~eath bank account or secudty at his or her death? .............. ~ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designatbn? ........................................................................................................................ ^ 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 far 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 onty 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 far 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)]. e The fax 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(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 wfth the decedent, whether by blood or adoption. 105.805 REV (OV07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. /ee for this certificate, $6.00 This is to certify that the information here given-i correctly copied fiom, an original Certificate`of Deaf duly filed with me as Local Registrar: The origins certificate will be forwarded ,to the State Vita Reco ds Offi for permanent filing. P 177588.4 ~~© .. Certification Number Local Re ' tra Date Issued !' ~t.~ ~ I(r~~n_~.~`ICi_~~ ~.~ it __ l~ ~~~ - ----__------ _._~-~_?-~ ,. t~Ct-'fi't-L--------- Nloslu aEV Ilrzadd COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS iY~~~ MW ' CERTIFICATE OF DEATH (See instruatkns and examples on reverse) sraTE aie NubeFS - 1. Nana a 0ewdnb IRb, ~L, bat aaRe7 - - ~ k. kx l Sair smekr Nine. ~ /. pq d pen INOnk dar. f+N ~ . :' 'I?-iCflC~f Gl(a --i .-1993 October 1, 2011 a aq (laN e+,byl IhW I Lbda , 0. p4 d BMW ~ T. and,Waw d4 PNx d pNh aw uonb ewa w.x NiWe wspm: on.~ 85 vr,. C$ ~3 a,b Ashtabula, OH ^v,NUNV ^Ew/aap,dad ^oa xaeNd Nenb ^MabNba ^pbr. sper?~ • a.w~nyaoxn '. ,e4 GN.Bae, TUP.ap.n, ~. as PaeiN NamaPml:u+nam, k,+ao-nl ndu.rowJ a. w.a n.uauaalE,p~onpinr ENO ^Yx lo. a,u: dn.drn nsn em.w~w...r. p raa. aP~+r coven u W17 - abon nx won .bl 1 [e • II.Da:'ada/, a.akm m nW a a•. pmama law„ oamdNd ,ra b kN l a OxWNIa Enlodx (k7,nPd aiy Mpua 7ede mn Wbdr u. N,sN subs Nsap, lbwr Nanl,d, la saMekq kpm u n a., qu nvbn nsn+l - lalda WPt - 10Mdabbss/barley Ub. ApINd Fama7 Ebmaduyl S,artl,7 (o-1?) Glop, IliaSaJ~ Y/tloMd~ Q.a'a•1 (SP~YI ' S Self-Em lD ed [~v. ^ w 12 Never Married 16.D,cadwYS NaL9Add!ex fA,K de/bqn. alW,LP md,l OacedaKa '.- - D'q pnma - ~ - Arad Raibni. tTe. Sbla Pennsvlvania uxb. 174 ^YN panlW UndF Ty:' 4719 Trindle Rd. , rland Ta"°"yT na®rn:d,n.aawlixdadiNn ec snits urg C b Mechanicsbur PA 17050 um e 10'x°""" a~bNUama Gn/e«P Ik. faml(S NamiFM,mAle, btl, adla) .. w.MMNh Name (fkN, nidat,n~i(fen a,mn+) .. Ruth N. Shetran - Ip.Mdarwv'a N,ma (TYM/PIiQ - 20e. NnmlW'eMYYpMMn(&Yaµ'N/Ibnl mu, ap eom) Ruth P. Richards 47b9 E. Trindle Rd. Mechanicsburg, PA 17050 71,. wnodd OiNOaitinn r ^Game6en ^Oabeon sta. pu dpspodlm Wain. mY•nal 214 PIwdgepallnn lNmdm,Nry, aanbryaolrpbal 216 L4edm lGly/ban,wu, tlP rnaq C7cendN ^ PawNCaasNb ~wnCnm,IbnaOabdmAanaWdf1 r~ 10/G/20I1 East Harrisburg Cemetery Harrisburg., PA ^ M Wanl Eernew/CeewR LJ Yny . ~ ~ • t2a.spviuetlFaniN lorpadmubgnaahl IIO.L'clow/an0ar ~ ome ~ ~ " zd'.NemaandW3wdFacMy esse exg une • - FD-Oi4404-1 2100 Linglestown Rd. Harrisburg, PA 17110 pmppb ixu t7ac oNy nvWlirq ']m. fo Meebamr aenocnw.d al ne mb. Wlbx aWd.IkgNeirand'N4) ~ Yb. 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REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS ADMINISTRATION No. 2017- 07100 PA No. 21- 11- 1700 Estate Of : THOMAS M RICHARDS (Fast Middle, Lasil Late Of : HAMPDEN TOWNSH/P CUMBERLAND COUNTY Deceased Social Security No: 196-74-4993 WHEREAS, THOMAS M R/CHARDS !First Midd/e, LasU late of HAMPDEN TOWNSHIP CUMBERLAND COUNTY died on the 1st day of October 2011 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and . for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: RUTH P RICHARDS who has duly qualified as ADMINISTRATOR(RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 79th day of October 2077. v~.hr~(~S c~1.o~t ~~A ,~jL~';t~ 1 egrster o dTs ~~~~~~~ ~ ~> ~3~~ eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) REV-1502 EX+ (11-09) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDEM DECEDENT' SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Thomas M. Richards 21-11-1100 All real property owned solely ar as a tenant in common must be reported at fair market value. Fair market value is deFlned 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 iointlyawned with right of survivorship must be disclosed on Schedule F. Attach a copy of the setHement 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 1' One and one-half story concrete block dwelling house located at 4719 E. Trindle Rd., 74,950.00 Mechanicsburg, Pa 17050.; transferred to Decedent as tenant in common by deed recorded July 25,1958, in the Office of the Recorder of Deeds of Cumberland County in Book "0", Vol. 18, Page 142 TOTAL (Also enter on Llne 1, Recapitulation.) I $ 74,950.00 If more space is needed, Insert additional sheets of the same size. . ,-~- :~ ~ Map 10-22-0527-079 (1) Tsx Parcels fit hap://ccgis.ccpa.ueUaspnet cliei~/ESRUWebADF/PrilrtTaskLayoutTempla... lY7C Wrcek PIN OWNER dr~i ~° dro land Um Subdivldo O ~ ~ Deedbook pe S~ua ra Vnd Value ~~~ Tohl Ve SaM Prk~ W~ m Munki e 2 Coda es cr n t # Bu p RICHARDS, 719E 10-32-0527-07 OMASM ND 101 LAND 00180-00142 0.17 1496 3300 106600 149900 0 Null 1947 HAMPDEN ET UX ROAD OWNSHIP 1 Df 1 11/3/2011 12:05 PM Addreyss Cendldetes Tax Parcek i REV-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTM ENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERCfANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Thomas M. Richards 2011-01100 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with Nght of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. R ~ ~ 9fl ~~ j ~~ 9 ~ ~ Ql ` ~ , ` (~ Q ~ ~ ~ O ~ ~ ~ a 9 a W a o . _ J t~ ru N CL N ._. .a 1 o na ti W m rH J ~' ~`C '' ~ ~ ( ~^ ru 0 ^ ~ 1`~ . . a ~aa o a ~ ~. N ¢ v ~ p ~~~5 ~ Q' Q ~ ~ W ~ ~C O ~ ~ ~ •_ ~~ N~ LL W W Ga.~O LL ~iicH~Km Date: 10/25/2011 Gross payment amount Net payment amount This Month 188.05 88.05 0368834 REF03 Ref: 3161 Check No. 570687 Amt: $903.87 Dear Sir/Madam, We have received your request for an unearned premium refund on the above policy. Please accept oui condolences. Attached is our refund check representing the return of all unearned premiums paid. If you have any questions, please contact us at (800) 659-9206. Sincerely, CUSTOMER SERVICE DEPARTMENT ~~ L REV-i5og EX+ (oiao) Pennsylvania DEPARTMENT OF REVENUE INHERRAN[E TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Thomas M. Richards 2011-01100 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Ruth P. Richards 4719 E. Trindle Road, Mechanicsburg, PA 17050 Sister B. C. JOINTLY OWNED PROPERTY: REM NUMBER LETT9i FOR 101NT TBJANT DATE MADE IOINi DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMRER OR SIMILAR IDENRFYING NUMBER. ATTACH DEED FOR lOINRY HELD REAL ESTATE. DATE OF DFATH VALUE OF ASSEr % of DECEDENr5 INTEREST DATE of DEATH VALUE OF DKEDENT"S INTERg'T i. A. 06!26/96 PNC Bank checking account (xxxxx-9151) 55.16 50% 27.58 2. A. 05/02106 PNC Certificate of Deposit (xxxxx-6714) * 7,654.48 50% 3,827.24 3. A. 08/01/64 M&T Bank checking account (xxxxx5739) 86,306.62 50% 43,153.31 4. A. 10/01/08 M&T Bank (savings account xx:a7c-7052) 51,099.40 50% 25,549.70 " includes axrued Interest TOTAL (Also enter on Line 6, Recapitulation) I $ 72,557.83 If more space is needed, use additional sheets of paper of the same size. Jun, 27. 2012 11:23AM PNC i ~~ ]ane 27, 2012 Tara Swartz Attorney at i/aw 130 State Stxeet Harrisburg P.A. 17101 RE: Thomas M Richards SSN: 196-14-4993 DOD: I O/01/2011 Dear Sir/1Vladam: No, 9516 P. 2 In response to your request for bate of Reath (DOD) balances for the customer noted above, our records show the following: Certii`tcate of Deposit Account # 31000288714 THOMAS M RICHARDS RUTI;i P RICHARI7S DOA balance: $7,648.81 + 5.67 accrued interest Account # 31000291751 THOMAS M RICHARDS TTF RUTH p RICHARDS DOD balance: $3,682.55 + 1.56 accrued interest Account # 3 1 60029443 0 THOMAS M RICHARDS I'1'I' RUTH p lt)•CHARDS DOD balance: $3,127.75 + 0.33 accrued interest ACCOUrit # 31400302448 THOMAS M RICHARDS 1T•E RUTH P RICHARDS DOD balance: X87,482.59 + 23.18 accrued interest Established: 05/02/2006 Established: 06/ 14/2006 Established: 06/26/2006 Established: 09/08/2006 Page 1 of 2 Jun. 27. 2012 11:24AM PNC Certit5cate of Deposit Account # 317003513 81 THOMAS M RICHARDS DpD balance: $19,758.40 + 2.98 accrued interest Checkiing Account Account # 5000119151 • THOMAS M RZCHARDS RY7TH P 1t1Cf•IARDS DOD balance: $55.16 + 0.00 accrued interest No. 9516 P. 3 Established: 08/09/2010 Established: 06/26/1996 Please note that this afi"ice provides date of death balances for deposit accounts (T12As, Clls, Checking and Savings). 'We do not process any ~uat~cial transactio~as or pro'v~ide statelnet~tg. if you need assistant®wirh any of these items, please call 1-888-PNC-I3ANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intendedfor the use of the individuaX or entity to which it is addressed and may contain fnformation that is privileged, conf~dentuxl and exemptfrom disclosure under applicable law rf the reader of this message is not the in[ended recipient or the employee or agent responsible for delivering this message to the intended recipient, yors are hereby notifted that any dissemination, distribution or copying of this communications is strictly prohibited ,If ypu have received this communication iii error, please notify me immediately by reply or by telephone of 800 762-1778 and immediately destroy this faxed document. Page 2 0£2 ~~ ~ r i .r ~~ ~''-~_ ~ b ~~ ~ ~ r ____ ,~ ~ ...~ o°r, u ~ Zoa~~-I ~-la~w~ V`G ~ • M i~ ~ ~~~-!I i H w p ,~~ ^~~-,, cro"pp I ~-INV] i ~ V PdE H i ud'imr W I n ~--I M ~oPGE~Wf~i~W `Q''xW 2 Z 161C~M Nptn WOO~U~ Wx~n I Nn~-i ~~j W 4 • op; lono oN H rn Uuoi~v~i ~ ~ M O N OD Cn ^`,~ a~ ~1(~ (~AEAHU' ~ ~ a i ~" ~ G. V,tO~~ W W ~E~lW!]~U`...!' i~'O C7 H I ~- Ob~W~UO]~A aUrar-+ I 1.~ ao uaa xr~ E ~ x ~~ ,F- ~a v ~ IZ-i OFmmrn H N r-I ~o F Ul m di Oi tra u1 I o -~ p ~n A W t~- ~n A ao r-I o Au~000E-I n CGoO ~0~~~io (~[ M ~ l0 A,' N (7] I V H lf1 r~i z'`L' ~ G71 M ~ I H ~ Cxl C4 a Cr1 H E I M OO tf1 ~~ J QZlnwo ~ z a~ FH~'a ~ ~M~ m ae KC ~ ~ I r o0 0 ~ ~_ .u wa~1 ZE,~ AAUP i oa~oN ~~ ~_ b d~] E-~ ~y fx o yp~,~ yCa~ ~ii o m ~r '~'~ ~~ O W ."'~ ~n~Ao G7 W a V ~oao ~~ O C~ CnUp!,n ry' Oootn ~- ~' ~! I~ ~~a W oe~-I ~ ~ooo i q~ ~~~ ~ rl.~r~uaAAA ~I O ~oEx,+tEnK~J A q~ r.~w AAA Ai ~w~N a ~u~~A~~~ ~I p AcHn~~ ~W wa~~U ~ ^ ~ W d' ~ aa~ oo~~-,Ialooo ~ m q m as c 7 ~I a !~ ~~ h m a .~ M h d y ^ ~ V m da~°n~ o`: e;r E y~ ~~~ m c O h N J r LL0-3 Z000/Z000d LE6-Z -WOfi3 LS~LL Z~,-9Z-90 Q r r r C C E E c u Q CYNTHIA S. WEISE ~~` ~~~ 1200 MARKET STRI=Ef r~ LEMOYNE PA 17043 ~~~ FAX: (#) 719-761-6497 WEST SHARE PLAZA //~~,, To ~ From. • Date: ~ r- ~ >/ /~ Phone Number: - / ~~ . ~~ (.. ~~~CJ Fax: r~, ~~ ~7 - ~ ~Cr f - Total Namber of Pages: ~ • (IrrciuCing Cover Sheet) Re: S'„"1rr~ ~7 i Note: `~tFYY) l~/L /~~~ • .,; . . CONFlDEN71gLITY NOTICE: The fnformatiorf oontelned in ibis tacsmde may be iiorifidendal.'tiila lnfomradon is intended Dory for the use of the intlivkfual or endly to whom.R b addressed. M you are not the intended reolplent, ortlw empbye¢ or .agent re~otsible to delver h to the intended reolpieM, you Are heretry notilled that airy uae, dlssenunadon ;distnbudon or COpylnp Ot tole eommrmication is strictly prohibited. li you have revived tNs facsimBe In error, please Immedlat9ry ratify us fry tefaphone, end return the odylnal measapa to us at the address, above vle first doss mats. 71738739IRHLATIONBHIP CHECKING WITH INTEREBT 00 0 06117M NM 017 18988 RIITH P RICF~ARDS '1x30MAS M RIGHARD3 JR 4719 E TRINDLE R7] MECFIANIC38IIRG SSA 7.7050-3616 9EP.14-OCT.I3,IOII 1 OF 1 ACC UNT A TIVITY ~iPOS;C7:2gG:' ....,,, i:.9i: .'•:iri~~iC:YI. .T D ~BM` Ti , . «:• ' z:~QKB?: k;i~7' ,'; :?>~f . 1%YJ,§~;; i i'i a: ~ ~: ':Y:::C`: +yk:; . y , 09-14-11 BEGINNING BALANCE $85,106.99 09-2Z-11 CRYCK NUMBEA 8097 87.58 09•aa-11 CHECK NUMBER 8098 41.49 84,877,92 09-23-11 V13RITON AAC C~'CR PYMT 000000000008098 8.18 84,969.74 09.26-11 CHECK NUNB7;R 8095 36.00 84,933.72 09-30-11 EENEFIT$ PENSION 1,372.88 86,906.62 ~° 10-03-11 U8 TREASURE[ 303 ]G%SOC SEC 1,151.00 87,457.62 10.07-11 CHECK PUMBER 8099 10,817.00 10-07-i1 CHECK IitJMBER 8100 1,138,60 10-07-11 CHEC& NVMBER 8103 360.52 75,141.50 SO-19-11 INTER83T PAYMENT 0.69 10.13-11 CHECK NOM$YR 8102 155,23 74,986,97 BNDTDTG BAl.ANCB 74,986.97 : ,y~ .. ..~ w Y• i ;i, ~.\::A i.":i l: :••. 8095 09.26-11 36.00 8097+ o9-aa-11 87.58 809e 09-aa-il 41.d9 8099 10-07-11 10,817.00 8100 10.07-11 1,138.60 8102• 10-13-17. 155.22 9103 10-07-11 360.52 aimanar. p$RCSNTAGE YZSLD B;ARNEC 0.00 d COULD YOV OR SOMEONE YOU KNOW US8 ADDITIONAL RETIR~1801T 7NCCMi? M&T CAN ESLP. WHETHER IT'S FOR DAY-TO-DAY LIVING 8xP$N983 OR TO ENJOY A Hh'TTBR LIFESTYLE, HOME OWNER6 AGE 6Z AND OVER CAN CONVERT A PORTION OF THEIR NOME ffiQVITY 2N70 CASH WITH AN M&T R$VERSE MORTGAGE. TO LEARN MORE CALL 1-888-Z53-0712, OA VYBYT NW47.MTBR7EVSRSSMORTGAGE.COM FOR CU3TOMBR SBRVIC@ (ZIIESTIOPS, $LEABE CALL 1-800-724-2440. £ I O 'd £0£ZL£LL IL ~ Xdd }INbE-,b~W O i ~ 9I IlH1, I I OZ-OI-AON INTEREST BARNED FOR 3TATfiMENT PERIOD 0.68 MECKANICSBVRG INTEREST PAID YEAR TO DATE 6.18 150042200470521 M&T MARKET ADVANTAGE 00 0 Oae50M !II6 086 RUTH P RYC1iP+R10S THOMAS M RICHARDS JR 4719 EAST TRINDLF RD MECAANICSBVRG PA 17050-3616 INTEREST EARNED FOR STATEMENT PERIOD 12.'73 ZNT$R$ST PAZD Y$AR TO DATE 66.22 aC`('l'1TTNT CT7MMAY2Y it ~5 '~n''~,,' ....1:4',r4y.~~r.~X~. ~ :.::'. ....:•.. .: •::.;... ~rn..os-ocr.o7,ao11 1 of 1 TA71IDL8 ROAD OFFICE ~. :ri .~ ..~...i. n:}: i:i :'r,.: : i :;.D :•:L::4r V~•~r i.. .. .... wh ....w .::..:. i.... :: r: nu.. : ~ • ...A..... r..• .v ~. ~:~ .j :~~il~.'~n.~_'__-:~ ::...:::.M1:V %. . • :............ i ~ ~ niY': iY~(.%:~?. }'1;%- . .1 . . i. ~:::: .. . .. . n ... n .... •y ..•.. : .r r .w ............ N . o. AMo 0 1 51,086.66 0 O.DD 0 0. 12.74 .099.6 5 BEGINNING BALANCE INTEREST PAXMgP1T a_3a ZNTER$ST PAYMENT a_3a INTEREST PAYMENT 4.06 ANNUAL PERCENTAGE YIELD EARNED . 0.09 ~ HAVE YOV RAISED THS GREEN FLAOY PEOPLE BVERYRF3ER8 ARE RAISING TH6 GREEN FLAG FOR M&T TOTALLY PRLB.CIiECt(ING. NO MTNIMOt4 BALANCE REQUIREMENT & NO MONTHLY SERVZCS CHAROE• OPEN YOUR CHECKING ACCOUN'Z TODAY! STOP SY RNY BRAxCH, OPffiP ORT,YNFi AT MrB.COM/FREECHECKING OR CALL 1,-800-724-b222 •TRAN9ACTION AND SERVICL FEES, INCLUDING INSVFFiCifiNT FVNDS ABD OVERDRAFT FEES, MAY APPLY TO THIS ACCOUNT. MEl03SA FDYC_ FOR CUSTOMER 6SRVICE QUESTIONS, PLEASE CALL (80o17za-a6aD. $51,086.66 51,091.00 51,098.36 51,099.60 ZZO 'd EOEZL6LLiL ~Xbd }INdH-1,'9Ni [ i ~9I IlH,L I i0Z-OI-d REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER THOMAS M. RICHARDS 21-11-1100 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCWDE THE NAME DF THE 7RANSFERFF, THEIR REURIDNSNIP TO DECEDENT AND THE DATE OF TRANSFlcR ATTACH A CDPY DF THE DEED FDR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION F APPLICABLE) TAXABLE VALUE 1• Citizens Bank of PA checking account (xxxxx-0347), Ruth P. Richards, Sister, 7,786.58 50% 3 000.00 893.2E transferred June 7, 2011 , 2 PNC Bank certificate of deposit (xxxxx-1751), ITF Ruth P. Richards, Sister 87,505.77 100 0.00 87,505.71 3 PNC Bank certificate of deposit (xxxxx-4430), ITF Ruth P. Richards, Sister 3,128.08 100 0.00 3,128.0E 4 PNC Bank certificate of deposit (xxxxx-2448), ITF Ruth P. Richards, Sister 3,684.11 100 0.00 3,684.11 TOTAL (Also enter on Line 7, Recapitulation) $ I 95,211.25 If more space is needed, use additional sheets of paper of the same size. November 3, 2011 Law Offices of Marvin Beshore 130 State St PO Box 946 Harrisburg PA 17108-0946 Estate of THOMAS M RICHARDS Date of Death: Oct Ol, 2011 SSN: 196-14-4993 Dear Sir/Madam: One Citizens Drive ROP112 Riverside, RI 02915 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of hislher date of death. Per your request, the decedent's accounts became jointly owned with Ruth Richards on June 7, 2011. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667 um Decedent Aca REF#:517654 Account Number Account Title Date Opened Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD YTD Interest to DOD 6226150347 THOMAS M RICHARDS/RUTH P 11 /7/2009 $7786.58 $7786.58 $ .00 REV-1511 EX+ (10-09) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Thomas M. Richards 2011-01100 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS Decedent's debts must be reported on Schedule I. ITEM w junco ,.~ ................ A. FUNERAL EXPENSES: 1' Jesse H. Geigle Funeral Home 2. East Harrisburg Cemetery 8 Cremation Services 10,762.02 1,138.60 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Z. Attorney Fees: 5,000.00 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: 300.50 5. Accountant Fees: 6• Tax Return Preparer Fees: ~• The Patriot-News (legal publication) 102.59 a. Cumberland Law Journal (legal publication) 75.00 s. Cumberland County Register of Wills, filing fee for inheritance tax return 15.00 to. Marvin Beshore, Esquire (photocopies) 30.00 ~~. Marvin Beshore, Esquire (postage) 9.00 ~2_ Cumberland County Register of Wills, filing fee for inventory 15.00 TOTAL (Also enter on Line 9, Recapitulation) $ 17,447.71 If more spate is needed, use additlonal sheets of paper of the same size. Jesse H. Geigle Funeral Home Mailing Address 3125 Walnut St. Harrisburg, PA 17109 Phone # ~ 717-652-7701 Bill To Ruth P Richards 4719 E. Trindle Rd. Mechanicsburg, PA 17050 Invoice Date Invoice # 10/4/2011 571 ~~~~' Due Date ~ Terms ~ Client 10/4/2011 ~ COD Thomas Richards Quantity Description Rate Amount Professional Services of staff and directors. 2,295.00 2,295.00 Embalming 600.00 600.00 Other Preparation of the body (Dressing/Casketing, Cosmetology, Etc.) 325.00 325.00 Transfer of remains to funeral home. 295.00 295.00 Graveside Service 300.00 300.00 Funeral Coach 200.00 200.00 Classic Silver Pearl Finish Casket 2,775.00 2,775.00 Sentinel Vault 1,295.00 1,295.00 Bridge of Faith Register Book Package 130.00 130.00 Opening and Closing of Grave 1,675.00 1,675.00 Clergy offering 200.00 200.00 A2 Flowers 185.00 185.00 12 Death Certificates 6.00 72.00 Equipment Rental 295.00 295.00 Obituary 120.02 120.02 ~~'~ i~eenc cZ ~leaaaare ara u haul I Total ,!i , l31TN~R F.,'.11.Y FU_ti F.' :RL FtOMFS Payments/Credits Balance Due $10,762.02 $-10,762.02 so.oo SECURITY AGREEMENT FOR CEMETERY SERVICES AND MERCHANDISE EAST HARRISBURG CEMETERY & CREMATION SERVICES ^ Pre-Need ~ At-Need 2260 Herr Street Harrisburg, PA 17103 PHONE: (717) 233-6789 -FAX: (717) 233-4600 www eternal-memories,com t l•a Contract Purchaser's Phone: ~ ~- l ',' a ~- 1 } °~y ~ Email: f ~. . THIS AGREEMENII is made the ( day of i ; 20 1 1 by and, be~een you the Buyer, '`~~ a't~i1 ('1ti tt~:Li7` -~ ~ andustheSeller, EAST HARRISBURG CEMETERY 8r CREMATION SERVICES, 2260 HERB STREET, HARRISBURG, PA 17103. ~_ ~~'l~- ~ , ~ V ~ 1 l AGREEMENT OF SALE Subject to the terms and conditions hereof, we agree to sell and provide, and you agree to purchase, the burial space, cemetery merchandise and/or furneral merchandise specifically enumerated below. Seller intends to assign this Agreement to the Assignee named on reverse side. BENEFICIARY We shall deliver the burial space and/or merchandise enumerated below only upon your death unless you designate otherwise below, in which event such burial and/or merchandise shall be delivered only upon the death of such designee: } c i 5~ vll"t .5 ~~~~ ~ ''111 ~t,j`,'(~~.. .r (Name of Designee, if any) Social Security # i~+. (Name of Designee, if any) Social Security # For the purpose of this Security Agreement, the term "Beneficiary" shall mean the person upon whose death such burial space is to be used and/ or merchandise aze/is to be delivered, whether such person is Buyer or Buyer's designee: ^ BURLAL RIGHTS QTY RESERVED FOR: ^ Ground ^ Mausoleum ^ Niche Sect Lot Space _ Sect Lot Space_ Perp Care $ Price $ ITEMIZATION OF AMOUNT FINANCED: 1. CASH SALE PRICE $ 2. DOWN PAYMENT(Paid in cash or by check) $ 3. AMOUNT FINANCED $ FEDERAL TRUTH-IN-LENDING DISCLOSURES ^ MEMORL4I./MONUMENT See Desi~ Porm Price includes installation cost of $ ~ , ' "and memorial caze of $ and cost of MonumenUMemorial. Price $ '.~: ' ! is If installed at another cemetery these costs indicate maximum coverage Seller will provide ^ INSTALL ^ STORE TOTAL $ , . , : , LOT OWNER'S NAMH OR NAME OF CEMETERY 1F OTHER TTiAN EAST HARRISBURG. Annual Percentage Rate FINANCE CHARGE The cost of your Credit as a yearly rate. The dollaz amount your Credit will cost you. % $ AMOUNT FINANCED TOTAL OF PAYMENTS TOTAL SALE PRICE The amount of credit provided The amount you will have paid The total cost of your purchase to you or on your behalf. after you have made all pay- on credit, including your men[s as scheduled. dmvn payment of S $ $ ~ ^ VAULT(S)/URNS ^ Standard ^ Oversiz Quantity Type ~j~(p ~It Material '~` L Price ...........($ Each) ..................$ f ^ CASKET FOR ~ ~I ~ I Type ~, Price ................................................................$ ^ CASKET FOR Type Price ................. 1-~~ It Your payment schedule wIll be: Number of Amount of When Payments are Due Payments Payments On the day of each month beginning Late Charge: If any payment is not paid on the due date thereof or within !0 days thereafter, you will be charged a late charge of $5.00 or 5% of the unpaid portion of the payment, whichever is less, but not less than $1.00. Prepayment: If you pay off eazly, you may be entitled to a refund or pazt of the finance charge. See the General Provisions of this Agreement for additional information about non-payment, default, required payment in full before the scheduled due date and prepayment rebates and penalties. ATTORNEY IN FACT AND TRUST FUNDS ~ Buyer hereby appoints Seller as his agent and attorney in fact for the purpose of creating an IRREVOCABLE Trust with part of the funds to be paid hereunder as provided in the General Provisions hereof and for taking all proper, convenient, necessary or expedient coons incidental thereto. This IRREVOCABLE Trust shall be for the benefit of Buyer nd Beneficiary, as their interests may appear, and shall be created pursuant to an IRRE- OCABLE TkustAgreement with Bank Buyer empowers and directs Seller to deal with d handle this IRREVOCABLE Trust, and to change trustees, as permitted by such IRREVOCABLE Trust and income from this IRREVOCABLE trust as provided in such IRREVOCABLE Trust Agreement, and Seller shall have the right to withdraw principal and income from this IRREVOCABLE Trust as provided in such IRREVOCABLE Must Agreement. This power of attorney shall not be affected by Buyer's subsequent death, disability or incapacibtlity. Signature(s) of Buyer(s) ^ PROFESSIONAL SERVICE .....................$ ~~II.~1nF$ iE7 OTHER).~t'.•.'.r':::u`.if......:t....l.:..t.:::::.~........$ J 'V~b L1~ LESS TOTAL TRADE-IN ALLOWANCE (CREDIT) $ ..~ .' CASH SALE PRICE ....................................................... $ •, SERVICE FEE: For Document Processing and. Administration, Buyer agrees topay anon-refundable ` fee of $100.00 upon this Security Agreement ............. $ 100.00 6y7 TOTAL SALE PRICE AND SERVICE FEE ... $ ~ ~ ~~ ''3 I (WE), THE BUYER(S), HEREBY AGREE THAT IN CONS RATION OF GOODS ANDlOR SERVICES TO BE DELIVERED, THAT BUY ~ U- ALLY AND JOINTLY IS (ARE) HEREBY OBLIGATED TO PAY ALL AMOUNTS OWING AND SHOULD BUYER(S) DEFAULT IN THE AGREEMENT WITH SELLER, IN ACCORDANCE WITH THE TERMS OF THE CONTRACT BE- TWEENBUYER(S) AND SELLER, BUYER(S) HBREBY AGREE(S) TO PAY ALL COLLECTION COSTS, REASONABLE ATTORNEY FEES AND COURT COSTS UPON COMMENCEMENT OR INITIATION OF ANY COLLECTION EFFORTS GENERAL PROVISIONS-BUYERS AND SELLER RIGHTS AND OBLIGA- TIONS ARE PRINTED ON REVERSE SIDE. PLEASE REVIEW BEFORE SIGNING. East I~azrisburg Cemetery 8t Cremation Services U, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR By, MH)NIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS Memorial Counselor ANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR EXPLANATION OF THIS RIGHT. Accepted By Title teat Estate Recovery Fund exists to reimburse any person tvho has obtained a final IN WITNESS WHEREOF, Buyer and Seller have executed this Security Agree- d judgement against a Pennsylvania real estate licensee owing to fraud, misrepre- ment for Cemetery Services and Merchandise, the day and yeaz first above tation, or deceit in a real estate transaction and tvho has been aunable to collect the written. We also assign this Agreement to the "Assignee" named below, intend- gement afrer exhausting all legal and equitable remedies. For complete details about ing to be legally bound hereby at Fund, call (717) 783-3658. YER ACKNOWLEDGES RECEIPTS OF I) A GENERAL PRICE LIST FOR RETENTION AND 2) A COMPLETELY FILLED-IN AND ?CUTED COPY HEREOF SUBJECT TO THE GENERAL PROVISIONS OF THIS AGREEMENT ON REVERSE SIDE. of Buyer) (Date of Birth) (Signature of Buyer, if more than one) (Date of Birth) Any Co-Signer must receive and read a copy of this detachable notice before becoming obligated to this Contract. ORIGINAL-WHITE BUYER'S COPY-CANARY HANK•GOLD DEALER-PINK ' The Patriot-News Co. 2020 Technology Pkwy Suite 300 Mechanicsburg, PA 17050 Inquiries - 717-255-8213 MARVIN BESHORE ATTORN EY AT LAW 130 STATE STREET P.O. BOX 946 HARRISBURG ~epntriotNcws Now you know PA 17108 INVOICE ACCT# fJAttflE 53450 MARVIN BESHORE 53450 MARVIN gESHORE 53450 MARVIN BESHORE ADORDER# DATE EDITYON ADDTL.INFO. 0002176688 10/28/11 METRO WEST 0002176688 1.1/04/11 METRO WEST 0002176688 ii/ 1/11 METRO WEST ~~~ TOTAL: REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL Chicago; IL 60673-1237 ALL CHARGES ARE NET TYPE OF CHARGE AMOUNT BASIC AD CHARGE BASIC AD CHARGE BASIC AD CHARGE $32.53 $32.53 $32.53 AFFIDAVIT CHARGE $5.00 $102.59 Please include the Account # or Ad Order # (above) with your remittance--Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-9188 Fax: (71 ~ 249-2669 November 11, 2011 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Marvin Beshore, Esquire RE: Thomas M. Richards Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: October 28, November 4, and November 11, 2011 Advertising Cost $ 75.00 Proof of Publication $ 0.00 ~'~ ~ ~ ~ ~ ~ Second Proof Request $ 0.00 (J1 . __._-.~.~~_ NOV 1 5 2011 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director REV-1512 EX+ (12-08) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETLRN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGADE LIABILITIES ~ LIENS ESTATE OF FILE NUMBER Thomas M. Richards 2011-0100 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmbursed medical expenses. If more space is needed, insert additional sheets of the same size. Please Remit Payment To: ' Camp Hill Fire Company No 1 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 Emall: info(c~ambulanceblllingoffice.com Date of Service: 9/26/2011 21:19 Please visit our website to provide Insurance or make payment, and Patient Name: RICHARDS, THOMAS M. for additional payment options and frequently asked questions; From: RESIDENCE To: <TreatmenVNo Transport> www.ambulancebillingoffice.com * *Please read-this bill is your responsibility. * * We have not heard from you. Please provide insurance information If you have no insurance, please pay this bill in full or contact us for payment options Thank you. ..':.L'[ a r:~ ,.... al,~hfv ~a [ R~.rr.,,: x.. tLy~C .~4~N~~j~€ a~ ~e~rlal _ e..t i , .. ~ . 1 ~ .._~ _.~. .. _ .._ >Gel i ~triHi(e _;I ~ 4y6. wsv(.°A fY 3o4 .i~ifV<5..._ wNyse {& i~4 ..... 9/26/11 BLS Treatment/No Transport A0998 1.0 135.00 135.00 Total 135.00 0.00 0.00 . d ~~~iJ C~ ~~ ~ 1 s'' ~/~7 ~~~so ~ ~ ~~~~ err' <~~ ~ p ~~ ~ ~ ~~ DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. REV-1513 EX+ (O1-10) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Thomas M. Richards 2011-01100 NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Ruth P. Richards RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Sister 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. 100% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I$ If more space is needed, use additional sheets of paper of the same size.