HomeMy WebLinkAbout08-12-13 (2) �co,-,o> 1505610143
� REV-1500 �� OFFICIAL USE ONLY
PA De artment of Revenue !��
p pennsylvania CountyCode Year FileNumber
Bureau of Individual Taxes DEPARTMEMOFREVENUE
Po eox.2soso� INHERITANCE TAX RETURN 2 1 13 0 0 3 5 0
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
181 32 4651 03 20 2013 05 28 1915
DecedenYs Last Name Suffix DecedenYs First Name MI
DENISON DOROTHY J
(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 WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return ❑ 2. Supplemental Return � 3.Remainder Return(date ot death
priorto 12-13-82)
� 4. Limited Estate � 4a.Future interest Compromise � 5. Federal Estate Tax Retum Required
(date W death after 12-12-82)
6 Decedenl Died Testate � Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
� (Attach Copy of Will) � (Attach Copy of Trust)
� 9. Litigation Proceeds Received ❑ �� between 12 31-y91�it,(d;t�e5jf death � ��.Election to tax under Sec.9113(A)
(Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Nur(ih�r �
SAMUEL L ANDES 717 �64 53 � �t �
_F =`� c�-� �
REGISTER�IMLLS�IS�E ODY�Yr�
:x �,. E'_' 1--� �tt SY{
i-' -,,. �__0 h� �Y� C?
First line of address �'. c.� � �� �
525 NORTH 12TH STREET « r' �'"� � �� t
� c , .�� .� �� �
e:? C- �`' n
Second line of address . � L� ��
� r
� � 4 �
�DATE FILED�
City or Post Office State ZIP Code
LEMOYNE PA 17043
CorrespondenYs e-maii address: I a W a n d e S ca a O I.C o m
Under penalties of perjury,I declare that 1 have examined this return,including accompanyi,ng 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.
SIGNATURE OF ERSON RESPONSIBLE FOR F�L,1+1/G RETURN DATE
��„� Dian D. Alling t.?S �ZU/�
ADDRESS
125 North 28th Str , Camp Hill, PA 17011
SIG P E OTHER R PRESENTATIVE DATE
Samuel L Andes �j
AD
525 North 12th Street, Lemoyne, PA 17043
Side 1
� 1505610143 1505610143 �
. �1 1505610243
�J
REV-1500 EX
Decedent's Social Security Number
oe�eae���5 Name: D E N I S O N, D O R O T H Y J. 18 1 3 2 4 6 5 1
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2. 1 5 , 5 1 8 . 0 4
3. Close�y Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages 8 Notes Receivable(Schedule D).......................................................... 4.
5• Cash,Bank Deposits 8 Miscellaneous Personal Property(Schedule E)................ 5. 1 8 5 , 1 6 1 . 6 3
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 1 , 3 9 0 . 2 9
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7. 7 4 , 6 9 2 . 8 4
8. Total Gross Assets(total Lines 1-7)....................................................................... g. 2 7 6 , 7 6 2 . 8 0
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 1 5 , 2 2 5 . 3 8
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 5 , 4 5 4 . 4 9
11. Total Deductions(total Lines 9&10)...................................................................... 11. 2 � , 6 7 9 . 8 7
12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 2 5 6 , 0 8 2 . 9 3
13. Charitable and Govemmental 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. 2 5 6 , 0 8 2 . 9 3
TAX COMPUTATION-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.00 15•
16. Amount of Line 14 taxable
at�ineal rate X .045 2 5 6 , 0 8 2 . 9 3 �s. 11 , 5 2 3 . 7 3
17. Amount of Line 14 ta�cabie
at sibling rate X .12 ��•
18. Amount of Line 14 taxable
at collateral rate X .15 �8•
19. Tax Due..................................................................................................................... 19. 1 1 . 5 2 3 . 7 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
$IC�@ Z
� 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21 - 13 - 00350
� Decedent's Complete Address:
DECEDENT'S NAME
Denison, Dorothy J.
STREET ADDRESS
309 Messiah Circle
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 11,523.73
2. Credits/Payments
A• Prior Payments 10,0 0 0.0 0
B. Discount 526.32
Total Credits(A +g� (2) 10,526.32
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (q)
Check box on Page 2 Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 9 9 7.4�
Make Check Payable to: REGISTER OF WILLS, AGENT.
1 ,. _ , .. �_.. .. .�, _ ,. ._...._��_�.. _. .�._. . '� _�. . .._. .w '� ��, � . _
�a_ �.� _ .<w ��.;, .,hk�,i�s'�..^�.��_ _ �a=.,.�:�'4m,ws . ., <��,a.#.�,�+,�..^�:� ,t_
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:.................................................................................. � �
b. retain the right to designate who shall use the property transferred or its income:....................................
c. retain a reversionary interest;or.................................................................................................................. ❑ LJ
d. receive the promise for life of either payments,benefits or care?.............................................................. '
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?........................................................................................................... ❑ �
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... � �
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which � ❑
containsa 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.
� ... ..�,a �..�si.- , �.,.§:.,�� a54. .�ax. . . .� �#. a _. ,. . . ._ �.v. ._„ .-s.q,....d. n, v- x .a � 3 v�.te+._e _eaz ;r. ..n F. .. -
. , rt�s-��r,'44n 2.-,_. ... . �-
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.§9196(a)(1.1)(i)].
For dates of death on or after January 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)(n)j. 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 retum 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 decedenYs 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). A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,w�iether by bloo�or adoption.
� ._ . . a . ��. ��... .� � � �..�.�,�.��, �. ��� -�� � �.� i-��
SCHEDULE B
COMMONWEALTHOFPENNSYLVANIA STOCKS 8� BONDS
INHERRANCETAXRETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Denison, Dorothy J. 21 - 13-00350
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 300 shares of common stock of PPL 30.26 9,078.00
2 134 shares of American Electric Company 48.06 6,440.04
TOTAL(Also enter on line 2, Recapitulation) 15,518.04
� - ,�.�. � „� .�� � �_., ��_�..�..,,v �.��., �-�.-.�...�,.����,� � _ _..�.,,.��. ..
' � SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTHOFPENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TA%RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Denison, Dorothy J. 21 - 13-00350
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Mutual fund account with American Funds (after transfer on 19 March 2013 as reflected on 180,038.54
Schedule G)
2 Ameriprise Credit Union account 4,623.09
3 Miscellaneous items of personal property and personal effects 500.00
TOTAL(Also enter on Line 5, Recapitulation) 185,161.63
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SCHEDULE F
COMMONWEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Denison, Dorothy J. I FILE NUMBER
21 - 13-00350
If an asset was made joint within o�e year of the decedenYs date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
Dian Denison Alling 125 North 28th Street Daughter
q Camp Hill, PA 17011
JOINTLY OWNED PROPERTY:
ITEM LETTER DATE Include name of fina cialin�stitut,on an�d bank account numbe DATE OF DEATH %OF DATE OF DEATH
NUMBER FOR JOINT MADE or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET DECD'S DECEDENTS INTEREST
TENANT JOINT estate. INTEREST
1 A 05/06/2010 Checking account#5140015717 with PNC 2�780�58 50% 1,390.29
Bank
TOTAL(Also enter on line 6, Recapitulation) 1,390.2$
�. ��.��,� � ��.:,� -:�,�. ��,.�.� �.�,��� m��, ---� �;�...��.�.�,�.��„�ds, , .�.„���.,.�,..� � ._.
COMMONWEALTHOFPENNSYLVANIA SCHEDULE G
INHERITANCETAXRETURN INTER-VIVOS TRANSFERS 8�
RESIDENTDECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Denison, Dorothy J. FILE N2MBE3-00350
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH °�°OF EXCLUSION
Include the name of the transferee,their relatlonship to decedent VAIUE OF ASSET DECD'S TAXABLE VALUE
NUMBER and the date of transier. Attach a copy of the deed for real estate. INTEREST ��F APPLICABLE)
1 Annuity No. A64001214S with Union Central 2�,ss2.sa 100% 21,692.84
2 Transfer from decedenPs American Funds mutual 53,000.00 100% 53,000.00
fund account(the transfer was initiated several days
prior to decedent's death, but had not been completed
at the time of her death and, therefore, was not
reflected on her bank account statements)
TOTAL(Also enter on line 7, Recapitulation) 74,692.84
� �. . �� ,� ,.�a- �,.-� �._� ,. �,�.,� �.�� �.� ,�_� � ,.,.: � ..t_�, �.
CSS Re#erence F,Aanuai � Locsout
�m�r�t��� ____._�
�!� --
G[ie;�i 5etvice S)��tent - Con1.�'acf ;r;;�r`';�i;;n .�,I...��c• sy�,��i�./2�t�zs
_..�. � <
Sc;krcij Contract Ga>>e.�:.c�es F�rifoltc �--Dacunienis �iiu�itssiir,ri f�o;rr=• €�,�)ic;-�'s>+ue Sia.icrr;e„t _ _._ ._ ---
/`� �_ (,.�.t�.�,.
3��:��mei�i ldisicr} �t�.i�rr�eni l�iev�Laiances C�ete
-�_�„ ,—.
Number: A64001214S Annuitant: Dorothy J Denison � °'
Billing Status: Paid Up Single Premium Product Type: Fixed Annuity
Plan Description: SPDA TDA Empioyee Before Tax Issutng Company: Union Central
Clients of the Contract...
Name Relationships Tax ID Birth Date
I?cra!;�?..l;�;;��i.��i Annuitant, Payor Owner 1$1-32-4651 OS/28l1915 %
Dian Allinq Beneficiary 06/12/1946 2
William M Denison Beneficiary 05/07/1951 �r
Correspondence Information...
Agent Number,Name and Status Agency Number,Name and Status
Contact Information Contact Information
AG00081959 Michael J Garofalo Jr Active EN00001691 Glatlelter Ins Grp Terminated
Michael J Garofalo Jr Glatfelter Ins Grp
PO Box 211 Leader Heights Brokerage
Shrewsbury, PA 17361 Susquehanna Commerce Ctr E
Ph:717-759-8939 Fax:717-755-0271 PO Box 2926
qaro(almC«�vahoo.com York,PA 17405
Ph:717-852-8000 Fax:717-849-5149
? Print Agent Address wbayer(caleadbroker.com
Important Information...
Issue Date: 07/31/2000
Next Anniversary D�y: 07/31 Billed To Date: 07/31/2000
Issue State: Pennsylvania Base Issue Age: 85 �
Policy Source: New Coverage/Contract
Product Specific Informstion... ------------__
Account Value: � $21,692.84 -
----_
..
Surrender Value: � $21,692.84 : Show Surrender Value Detail
Surrender Charge: $.00 '� Shov�Surrenrler Schedule
Svstemstic Withdrawals
Amount: MDR Calculated tJext Monthly Withdrawal: 04/11/2013
Tsx Withholding: No Distrlbution Method: EFT
Payout: Single Payout Calcul�tion Metho�: Recalculation
https://css.unificompanies.com/contract.asp?contract=A64001214S&CoCode=U&CoType=... 4/3/2013
- 1 ransacuons rage i or �
�
A►MlER(CAi�I �l�NDS'
Transactions
; 82447127 DOROTHY J DENISON DEC'D Account Value
� P�rOD $O.00
� As of 05131/2013
�
Share 5hares this Share Transaction
Trade date Fund name Activity detaii transaction
price balance amount
The Bond Fund of fi'UivDSLifvK
03/19/2013 $12.88 310.5590 2,839.106 —$4,000.00
America—A(8) REDEMPTION
03/19/2013 The Growth Fund of FUNDSLINK $36.65 218.2810 983.602 —$8,000.00
America—A(5) REDEMPTION
03/19/2013 The Growth Fund of FUNDSLINK $36.65 136.4260 1,201.883 —$5.000.00
America—A(5) REDEMPTION
03/19/2013 The Income Fund of FUNDSLINK $18.88 264.8310 1,875.517 —$5,000.00
America—A(6) REDEMPTION
03/19/2013 The Income Fund of FUNDSLINK $18.88 317.7970 2,140,348 —$6,OOO.QO
America—A(6) REDEMPTION
03/19/2013 New Perspective Fund— FUNDSLINK $33.03 181.6530 1,068.738 —$E,000.00
A(7) REDEMPTION
03/19/2013 New Perspective Fund— FUNDSLINK $33.03 181.6530 1,250.391 —$6,000.00
A(7) REDEMPTION
03/19/2013 Washington Mutual FUNDSLINK $33.57 177.1480 1,061.711 —$6,000.00
Investors Fund—A{1) REDEMPTION
03/19/2013 Washington Mutual FUNDSLINK g3,$7 �06.6730 1,238.859 —$7,000.00
Investors Fund—A(1) REDEMPTION
Transaction totat —$53,000.00
� Saies charge rate.Sales charges are based on the size of your purchase,current hoidings or future purchases.The;ales charge rate
you may have paid ca�vary from the rate disdosed in the prospecius due to roundiny when calculating ihe shara price ar.d ni.imbar of
shares purchased.For informat+on on sales charges and disco�.mis;please refer to thp funn's prospectus.
Pending transacfions on your account will be shown above. Pending transactions have be2n successfuily t.ensmit;ed to kmerican Funds;
however.because the transactions have not yet bsen accepted or posted t�your acc.nur,t;rliey are not refiected in your r.urrQnt shaie
balanrz American Funds reserves the right to reject any transaction.If pending iransactions aie ac.c;epteQ,your updateci shaiz bzlarce wi!!
be available the following moming.Pending transactions are subject to wiitten confirmaiion irc?m Ame;ic�n Funds.
https://advisers.americanfunds.com/bob/account/account-activity.htm?accountRecordNo=O 6/3/2013
�, � ,�, F � _�-u.�„�-� � � � ,s-..:.���... -..
� SCHEDULE H
FUNERAL EXPENSES&
COMMONWEALTH OFPENNSVLVANW �'p n/�
INHERRANCE TAX RETURN ��'NIJ 1 RATI Y G��
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Denison, Dorothy J. 21 - 13-00350
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Myers-Harner Funeral Home 3,848.00
2 Rolling Green Cemetary(burial lot and opening) 1,330.00
3 Yellow Bird Cafe and West Shore Country Club(post-funeral reception) 486.58
B. ADMINISTRATIVE COSTS:
�. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission paid
2. Attorney's Fees Samuel L. Andes 8,300.00
3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 373.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees David Barbush, CPA 215.00
7, Other Administrative Costs
1 Gov Services Corp (to obtain EIN) 129.00
TOTAL(Also enter on line 9, Recapitulation) 15,225.38
Sd�ed�e H
COMMONWEALTH OF PENNSYLVANIA F��«
INHERITANCE TAX RETURN �y�tr"'���C�'��
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Denison, Dorothy J. 21 - 13-00350
2 John Welsh (furniture mover) 300.00
3 Cumberland Law Journal(advertising) 75.00
4 The Sentinel (advertising) 168.30
Page 2 of Schedule H
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTHOFPENNSYLVANIA LIABILITIES 8� LIENS
INHERRANCE TAX RETURN 7
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Denison, Dorothy J. 21 - 13-00350
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medicai expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Visa credit card 522.69
2 Internal Revenue Service (tax bill) 373.00
3 Pennsylvania Department of Revenue 72.00
4 Messiah Village(final bill) 3,772.80
5 Alert Pharmacy 353.35
6 Janet Miller, Tax Collector 4.90
7 Apria Healthcare 10.61
8 Community Life Team Ambulance Service 109.40
9 Public Service Retirement System (refund of overpayment of pension) 207.28
10 Capital Area Health Associates (final doctor bills) 28.46
TOTAL(Also enter on Line 10,Recapitulation) 5,454.49
,_,_ . � �-n �- ;� ,�,�,�,,�,
_�� w . ,.�.�,��:,�.,.,�.a. � -�.n,.���,_.��.� ��,� � -�
REV-1513 EX+(11-OB)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA B E N E F IC IARI E S
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Denison, Dorothy J. I FILE NUMBER
21 - 13-00350
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(a)
I� TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Allison W. Spooner Grandchild 5,000.00
166 Prospect Street
Providence, RI 02906
2 Douglas D. Widmann Grandchild 5,000.00
320th MP Company
FOB Walton
APO AE 09367
3 Heather S. Denison Grandchild 5,000.00
P.O. Box 1267
Westford, MA 01886
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.00
�_- �, ��.�: . ,n � v.�,�� ,.� ��.,�. �.,�,�..�
REV•1513 EX+(9-00)
SCHEDULE J
COMMONWEALTHOFPENNSYLVANIA BENEFICIARIES continued
INHERITANCE TAX RETURN
RESIDEN7 DECEDENT
ESTATE OF Denison, Dorothy J. I FILE NUMBER
21 - 13 -00350
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
4 Hannah D. Denison Grandchild 5,000.00
P.O. Box 1267
Westford, MA 01886
5 Dian D. Alling Daughter Balance of residue
125 North 28th Street
Camp Hill, PA 17011
Page 2 of Schedule J