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HomeMy WebLinkAbout11-19-13 JREV-1500 EX`ez-.."F' 1505610105 t+s OFFICIAL USE ONLY PA Department of Revenue pennsylvania Bureau of Individual Taxes .P�.'. County Code Year File Number PO BOX 2806o1 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT at 13 o33� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth NMDDYYYY )& 02/19/2013 02/05/1956 Decedent's Last Name Suffix Decedent's First Name MI Long Michael P (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 CD 1. Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate C=) 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. 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 Dealt) 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 SHOULD BE DIRECTED TO: Name Daytime Telephone Number Andrew C. Sheely, Esquire 717-697-7050 SGISTER OF wIELS USE.003f n O JtJ Q IA First Line of Address G1 -o _ V1 %-3 127 South Market Street - ' o _ - CJ r'J CJ Second Line of Address P.O. Box 95 v C_ DATE D C> City or Post Office State ZIP Code - r f 1_ Mechanicsburg (DA 17055 Q Correspondent's e-mail address:andrewc.sheely @verizon.net 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. SII�G�NATURE OF PERSON RESPONSIBLE FOR FILING RETURN r' T� s Ill. t dS2 G - �� �o4yJ� �l77.7 2013 Annette S. Long,Administratrix, 773 Lancaster Avenue, Enola, PA 17025 SIGN RE OF PREP E AN REPRESENTATIVE ATP /5 3 Andrew C. Sheely, Esquire, South Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY , Side 1 L 1505610105 1505610105 J o- VF. 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: Long, Michael P. RECAPITULATION 1. Real Estate(Schedule A). . ... . ... . . . . . . .. . . . . ... . . . . . . _. . . . . . . . 1. 631,800.00 2. Stocks and Bonds(Schedule B) . . . .. . . .. . .... . . . .. . . . . . . ... . . . .. .. . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ... . . 3. F 4. Mortgages and Notes Receivable(Schedule D) . . ... . .... . . . . . . .. . . . . .... . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . ... 5. 115,345.48 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . .. . .. 6. 623.16 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 7,129.74 (Schedule G) O Separate Billing Requested.. . . .. . . 7. 8. Total Gross Assets(total Lines 1 through 7). ... . . .. . . . . . . . . .. . . .. . . . .. . . 8. $754,898.38 9. Funeral Expenses and Administrative Costs Schedule H 19,148.72 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).. . . . . . .. . .. . . . 10. . 571,096.21 11. Total Deductions (total Lines 9 and 10). .. . ... . . . .. . . . .. . . . . . . . .... . . . . . 11. 590,244.93 12. Net Value of Estate(Line 8 minus Line 11) .. . .... . . .. . . . ... . . . . . . .... . . . 12. $164,653.45 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. $164,653.45 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers und.r cec.9116 (a)(1.2)x .00 $100,891.60 15. $0.00 F; 16. Amount of Line 14 t=able at lineal rate x .045 $63,761.86 16 $2,869.28 17. Amount of Line 14 taxable at sibling rate X 12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE . . . . .. . .. ... . . . . . . . . ... . .... . .. .. . ... . . .. . . ... . . . . . . . . . . . 19. $2,869.28 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610205 1505610205 J REV-1500 EX(Fn Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Michael P. Long RTRFFT AnnRF&S 773 Lancaster Avenue ---- -- -— -- — - - Enola ------ — — — ------ 1 STATE ------_---' ZIP i 17055 Tax Payments and Credits: 1, Tax Due(Page 2,Line 19) (1) $2,869.28 2. Credits/Payments A. Prior Payments - B. Discount 3. Interest Total Credits(A+ B) (2) 1" - 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2,Line 20 to request a refund. (4) - ' 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) $2,869.28 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 ......................................................................................... ❑ N b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0 c. retain a reversionary interest .............................................................................................................................. ❑ 0 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 trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ r4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa beneficiary designation? .................................................................................._............._...._.............. ❑ R; IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1 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)(11)(1)]. 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 fling 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(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,whether by blood or adoption. 1 REV-1502 EX+ (11-08j ff pennsytvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael P. Long 21-13-0330 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 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 1. 124 Susquehanna Avenue,Enola,Cumberland County,PA. Tax Parcel#09-14-0832-255. See $119,900.00 attached settlement sheet 2. 13 High Street,Enola,Cumberland County, PA.Tax Parcel#09-15-1291-172. Cumberland $54,900.00 Countv assessed value of$54.900.00 X CLR of 1.0 ' 3. 212 Center Street,Enola,Cumberland County, PA. Tax Parcel#09-15-1290-086. Cumberland $176,500.00 Countv assessed value of$176.500.00 X CLR of 1.0 4. 773 Lancaster Avenue,Enola,Cumberland County, PA. Tax Parcel#09-15-1290-168. S200,500.00 Cumberland Countv assessed value of$200.500.00 X CLR of 1.0 5. West North Avenue,Enola,Cumberland County, PA. Tax Parcel#09-15-1291-359. $80,000.00 Cumberland County assessed value of$80.000.00 X CLR of 1.0 i d TOTAL(Also enter on Line 1, Recapitulation.) $ 631,800.00 If more space is needed, insert additional sheets of the same size. _ iT OMB Approval No.2502-0265 A.Settlement Statement HUD-1 B.-Type of Loan 1t�� 1--� 6.File Number 7.Loan Number 8 Mortgage Insuramde Case Number. 1. W FHA 2. l--!RHS 3. Q Conv.Unins. CAA-Sgrignoli- 4600046713 446-1879110-703 4 0 VA 5. Q Conv.Ins. A06116180 C.Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.Items marked "(p e.c)'were paid outside the dosing;they are shove here for informational purposes and are not included in the totals. 0.Name 8 Address of eonower E.Name 8 Address or Seller F.Name 8 Address of Lender. Jake R.Sgrigholi Estate of Michael Long,Annette S.Long, American Neighborhood Mortgage Eno/e,PA�17025 nve Administrator Avenue 7tb Eaet6aeoDrive, _go;'We Errata,PA 17025 Mt.Laurel,NJ 08054 G.Property Location: H.Settlement Agent- 1.Settlement Date' 124 Susquehanna Avenue Capital Area Abstract,Inc.,Michael J. 09848013 Enola,PA 17025 Pykash �� Phone Number,717-975.9446 Cumberland County 2132 Marker Street 41 Camp Hill PA 17011 r Place of Settlement: 3 Lemoyne Drive,Lemoyne,PA 17043 Disbursement Date 098412013 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 once $119,900.00 401.Contract sales once 319 900.00 102.Personal property 402.Personal property 103.Settlement charties to borrower line 1400 $5,834.42 403. 104. 404. 105. 405. Adjustments for items cold b seller in advance Adjustments for items Paid by seller in advance 106.CityAmn taxes to 406.Cilytiovan taxes to 107.County taxes 0912412013 to 1212112013 $96.57 407.Court taxes 09/2412013 to 1213112013 $96.57 108.Assessments 0912412013 to 0613012014 $837.73 408,ASSenalents 0912412013 to 0613012014 $837.73 109. 6.96 409. 6.96 110. 410_ 111. 411, 112, 412, 120.Gross Amount Due From Borrower $126,675.98 420.Gross Amount Due To Seller $120,84J.26 200.Amounts Paid By Or In Behalf Of Borrower 500.Reductions In AMOUM Due To Seller 201.Depositor earnest money $1,000.00 501.Excess deposit see instructions) 202.Principal amount of new loans $98,901.00 502.Settlement charges to selle! line 1400 $25t668600 203.Exisfin loans taken subject to 503.Existing loari taken subject to 204. 504.Payoff offirst mortgage loan Integrity Bank $55,528.30 205, 505.Payoff of second mortgage loan Y! .X' 206. 506. 207, 507. A 208. 508, 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210.City/town taxes +0 510.Ci ttown taxes to 211.County taxes to 511.County taxes to 212.Assessments to 1512.Assessments to 213. 513, 214. 514. 215. 515, 216. 516. 217. 517, 218. 518. 219, 519. 220.Total Paid By/For Borower $99,901.00 520.Total Reduction Amount Due Seller $71,196.30 300.Cash At Settlement From/To Borrower 600.Cash At Settlement To/From Seller 301,Gross amount due from borrower line 120 $126,675-68 1601.Gross amount due to seller line 420 $220,841.26 302.Less amounts paid ttor borower line 220 99 Sol.o0 602.Less reductions in amt,due seller.line 520 $71,196.30 303.Cash El From CI To Borrower 1 $26,774.68 603,Cash EI To ❑From Seller $49,644.96 1`I The public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and Fd reporting the data.This agency may not coifed this information,and you are not required to complete this form,unless,it displays a currently valid OMB control number.No Confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to ; a RESPA covered transaction with information during the settlement process. 1 Previous editions are obsolete Page 1 of 3 MUD-1 t L. Settlement Charges 700.Total Real Estate Broker Fees $5,995.00 Division of Commission(line 700)as follows: Pad!From Pam From 8onmvers Selleh 701. 5,995.00 t0 RSR Realtors Funds at Funds at 70 to $ememem Settlement 703.Commission paid at Settlement $5,995.00 704. P o C b, I 800.Items Payable In Connection With Loan 801.Our on ination charge $850.00 from GFE#1 802.Your credit or Charge(points)for the specific interest rate chosen $ from GFE#2 803.Your adjusted origination charges from GFE A $850.00 804.Appruisal fee to coaster 1 $475.00 P.0 C 6+BOrrower I from GFE#3 805-Credit re on to Dairersal Crdt Svc Pc c.6r 1(from GFE#3) $22.59 �( 606.Tax service to I P.O C.h I from GFE#3 / 807.Flood certification Core LOiC 1 ROC.by 1(from GFE R3) 512.00 ' u 808. P, d 609. 810. 811. 812. 900.Items Required By Lender To Be Paid In Advance 901.Daily Interest charges from 0912412013 to 1010112013 $ 12.1933 /day (from GFE#10) $85.35 902.Mortgage Insurance Premium for months. (from GFE 93) $1,701.00 to ROD 903.Homeowners insurance for 1.00 Years, $515.46 (from GFE#11) to Allstate - POC by Borrower 904. ears. to 905. 1000.Reserves Deposited With Lender 1001.Initial deposit foryourescrow account (from GFE#9) $477.48 1002.Homeowners insurance 3.00-months @$42.96 per month $128.88 1003.Mortgage insurance months @$104.53 per month $ 1004.Properly taxes 9.00 months @$26.70 per month $240.30 1005.school taxes 4.00 months @$89.50 per month $358.00 1006. months @$ per month $ 1002 Aggregate Adjustment -$ 249.70 1100.Title Charges 1101.Title services and lenders title insurance (from GFE#4) 51,233.50 1162.Settlement or closing fee $ 1103.Owners title insurance CAAbstract, IaC-1Security Title (from GFE#5) $105.50 I 1104.Lenderstitlelnsu2nce CAAhstract, I-C./Security Title $1,044.50 ,A 1105.Lenders title oli limit$98,901.00 1106.Owners title policy limit$119,900.00 1 1107.Agents portion of the total title insurance pmmium ra yrtc dt, Iac. $977.50 1108.Underwriters ortion of Me total title insurance remium security Title $172.50 1109. SALE ♦ PA 100, 300 A 900 1110. CPL Fee to security Title $75.00 1111. Rotary Fee to Michael J. Pykosh $25.00 $10.00 1112, Overnight Fee to CAAbstratt, Inc. $30.00 $30.00 1113. Wire Transfer Fee to CAAbstract, Znc. $24.00 1114. R-Rail DOC Fee to CAAhstract, Inc. $35.00 1115. Tax Certification Reim. Fee to CAAbstract, Inc. $10.00 1200.Government Recording and Transfer Charges 1201. Cumberland County Recorder of Deeds Government recording charges: (from GFE#7) $148.00 1202.Deed$67.00 ;Mortgage$81.00 Releases$ 1203.Transfer taxes Cumberland County Recorder of Deeds (from GFE#8) $1,199.00 $1,199.00 1204.City/County tax/stamps: Deetl$ 1,199.00 Mona i $ 1205.State tax/stamps: Deed$ 1,199.00 Mort e $ 1206_ $ 1207. $ 1208. $ 1209. $ 1300.Additional Settlement Charges 1301.Required services that you can shop for from GFE#6 1302. $ 1303. $ 1304. 1305. Pa ff to New Equipment Leasing, Inc. $5,700.00 1306. 2013 County/Township Taxes to Debbie Lupold, Tax Collector $359.69 .. 1307. 201312014 school Taxes to Debbie Lupold, Tax Collector $1,095.95 1308. 2012 Delia ent Taxes to Cumberland County Tax Clafm Bureau $1,258.36 1309. utilities Certification Fee to East Peonsboro Tawashi $10.00 / 1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) - $5,834.4Z $15,668.00 Previous editions;are obsolete Page 2 of 3 HUD-1 Comparison of Good Faith Estimate(GFE)and HUU-1 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our origination charge #801 $850.00 $850.00 Your credit or charge(points)for the specific interest rate chosen #802 $0.00 $0.00 Your adjusted origination cnarges is 803 $850.00 $850.00 Transfer taxes #1203 $1,199.00 $1,199.00 Charges That in Total Cannot Increase More Than t"a Good Faith Estimate HUD-1 Government recording charges #1201 $295.00 $148.00 Appraisal fee #804 $475.00 $475.00 Credit report fee 4805 $35.00 $22.59 Flood nertifieation fee #807 $13.00 $12.00 HI F8A OpFront Premium #902 ,$1,888.43 -$1,701.00 # $0.00 $0.00 # $0.00 $0.00 # $0.00 $0.00 At i $0.00 $0.00 If $0.00 $0.00 # $0.00 $0.00 Total $2,706.43 $2,358.59 Increase between GFE and HUD-1 Charges $ -347.84 or -12.85 % Charges That Can Change Good Faith Estimate HUD-/ Initial deposit for your escrow account #1001 $1,490.04 $477.48 Daily interest charges #901 $12,1933 /day $94.76 $85.35 Homeowners insurance #903 $540.00 $515.46 Title Services and lender's title insurance #1101 $631.00 $1,233.50 Owner's title insurance 21103 $1,000.00 $105.50 # $0.00 $0.00 # $0.00 $0.00 # $0.00 $0.00 # $0.00 $0-00 # $0.00 $0.00 Loan Terms Your initial loan amount is S 98,901.00 Your loan term is 30 years Your initial interest rate is 4.50 % Your initial monthly amount owed for principal,Interest,and $ 605.65 includes and any mortgage insurance is ED principal ®Interest ®Mortgage Insurance Can your interest rate rise? ®No.❑Yes,it can rise to a maximum of %.The first change will be on and can change again every after .Every change date,your interest rate can increase or decrease by %.Over Me life of the loan,your interest rate is guaranteed to never be lower Man %or higher than %. Even if you make payments on time,can your loan balance rise? ®No.❑Yes,it can rise to a maximum of$ Even if you make payments on time,can your monthly ®No.❑Yes,the first increase can be on amount owed for principal interest,and mortgage insurance rise? and Me monthly amount owed can rise to$ The maximum it can ever rise to Is$ Does your loan have a prepayment penalty? ®No.❑Yes,your maximum prepayment penalty is$ - Does your loan have a balloon payment? ®No.❑Yes,you have a balloon payment of$ due in years on Total monthly amount owed including escrow account payments ❑You do not have a monthly escrow payment for items,such as property taxes and homeowners insurance.You must pay these items directly yourself. ®You have an additional monthly escrow payment of$ 159.16 that results in a total initial mori amount owed of$ 764.81 .This includes rincipal,interest,any mortgage insurance and any items checked below: Property taxes - ®Homeowners insurance ❑Flood insurance ®school Taxes Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. •___ ___ _ ____________i__._. n n �, a 4ll IRS r «. M{.. Parcel S"rch is Q Features selected:i Site Addkess: 13 HIGH STREET Deedbook: rr LONG, C i-and Use Code: O06 / Squam Feet:764 Y it i:3lPfT' '"' Taxable Status:T Clean&Green Status: I-and Assessed Value$;26800 Building A:ssessed Value rr ( Ek 6 Total�d Value $:Z8100 Sale Prim V.57500 Sale Date:Mon Apr 28 2008 08:00:00 PH Heiglit In Stories:2 S7 Primary Exter Basernent Percentage:CS, : :. I, Total 20 Y t i i- 3�9ta5.120294 216296.]58529 Read Sis.¢pa.nea. in e1 fl, Parow Search ....Address.00277-00721 LONG,MIw Land Us;e Code; 101 Acreage:0.64 Square Feet. 1098 Clean&Green status: Land Assessed Value$: r f V SuAdInq e. i Total Assessed Value$:176500 Sale Price$: 13"00 Sale �y3 Daw,sun W is 2006 08;00:00 S �•. rl$ 4 '�' 4p• 'Y' Year Built:1923 7 Primary Exterior:Prefab SIB Basernent Percentage:100 Air Gondftlopinq�NO L �Ql { as" VV, � mto"5o+nassacssscs i.-. --''.�- .aiS.C[0.].7CI { Y z Deed � .... 0032W-01024 Owner. Codc 101 age-0.39 Own&Gmen Status: Land A�d Value S:45M 1} S �.r a f I I z , Sale Date-Tae Aug 25 i4. 444 PM y aYk - �i_n' ✓3 -. k. Year Built_-1975 Type of♦ DETACH Primary Extedor:Vinyl E ' Air Canditlonling:AC ..1� i i f :a � i X .., ft Deedbwk�201128714 Owner�LONG,MICHAEL P Land Use Code:303 Property Type:CI Acreage: 3.27 Square Feet. Clean&Gmeft states: LaM Assessed Value$;14700 Bulkling Assessed Value S:SWO $ Total Assesseo Value S;SWW sale Price$�SOGGO Sale Date!Her,Oct 17 2011 RM Year Built: T. heightm Stories: i Type of Dweillog! Tote t. .• fy J. C t ki l jk E r,. ,f .' Y yf } 226829L91a294 299212.929196 - .. _ ..... >. J 11 REV-1508 EX+(ii-io) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. SIDENT DE Tax RETURN R PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Michael P. Long 21-13-0330 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. ITEN NUMBER DESCRIPTION I VALUE AT DATE OF DEATH 1. Metro Bank Checking Account#0513095570 $51.70 2. Members 1st Checking Account#307720 $6,551.73 3. Integrity Bank Checking Account#2203002548 $3,072.38 4. 2009 Dodge 44 pickup truck-VIN 3D7MX38L19B550884 $13,750.00 5. 1995 Peterbilt VIN 1 XPBD99XXSN362097 $10'000.00 6. 1995 Mack VIN IMIAA09YISWO07131 $10,000.00 7. John Deere tractor/loader $24,500.00 8. Takiuchitractor/Excavator $33,500.00 7t} 9. Scagg Mower $6,500.00 F 10. ExtremeV Plow $2,000.00 f v 11. ING Brokerage Account#3Z1-400902 $57419.67 A �n t TOTAL(Also enter on Line 5, Recapitulation) $ 115,345.48 If more space is needed, use additional sheets of paper of the same size. �. 2 � _a . . $ � � ■ � )e!� � - r \ �\15 . \ »� E ) ! � f .. � . , 0 §(§ / . £ — . ! k � ■ « % , ■ REV-LSOg EX+(oJ-JO) � pennsyLvania SCNEDULE' F l: _ OEPARTMENT OF REVENUE �• �` INMERRANCE TAX RETURN JOINTLY=OWNMPROPERTY Y RESIDENT DECEDENT r •M_I +Ir'A"' �f ' - F - F. ESTATE OF: '•'• FILE NUMBER: Michael P.Long _ " _ 21=13-0330 If an asset became jointly owned within one year of the decedent's date of death,R must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.Colby J.Long 773 Lancaster Avenue,.Enola, PA. 1Z025�� Son _ B. C. R -_TI ♦t JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ,. _ - %OF, DATE OF DEATH, Irk, ` FOR JOINT �MADE�' INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR- DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT, - JOINT- - -IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY MELD REAL ESTATE! }_r.. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 423120 Members 1st Checking Account#383307 $601.03 50% $300.52 2 A. 423120' Members 1st Savings Account#383307 x.. } 645.27 50%R $322.64 kf 623.16 TOTAL(Also enter,on Line 6, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. .�. t t1>'`i 3".+'3?44fl'Vti3r.}'i'Aa°•,3O i - Cl 'fa Sa Olt rcr•mr WfH. cr ,-xr,.0 ""}'fjL3 ift3!rt'+,4Yi'!417T f ,7aa x,=t; n r5' .C3 t -; f=� anco:4F.eF1 lxiyrgxsT bnA I�Qr 1F « ✓S-tf4 r C gtr� »U iJ��t r :T2.tv.a:r:.^FY±S+_Y^,u1Y:s.�.:mmc'ea'eS':'zXi :rx.c.>F»ss.M'.za"4R.6e na.'PneY-WY. tieYP'Yiati��.t�F^^:C.,"fi3^ve![5vA�.Mx'TR__..r.-..3+sC:ti.'_'.»`S.v_'CM>9.u'.o-SC'x.::iF:CMMMxAV+rz„YFJx':`z to �.}'{Ti OO 0,M,%4 to y . 9 �� � #<r,tT" r € S.2f•�u t fraCi 3°tm>M� t4S..tlf+. x'..,..I C>1r3..tY39k,"U:' i' 'w3ciJ : �Yti3.7 $� Y&mot}? YE aSMON A! AJOW? 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"� '- .?*•F.'t�. 'P t 1a i.tr71^.,"1 W MOO fz a A.A '` 3t"iDP:fl"J"11j 3F;•e7;��L't1`z @1AWi QTU�d 0 v EE`�vY�,aTJE"i�W °!"L1' `K 4' .. --- 5t!i ,6erae;noob y++.f,.*14$11 z a i ill 4 gli-Lgt r'71MS,s'tiplt .; itC`:4 7'r'7Ui"H7tj 13rbo il(l r `y { atdlp#101,t og fz)py O vli a tvuji;fi'�,1413;4fi`C,° 1 yfiT ' .,. G`':? rr + .; ;S«y a,. .ua9 Mnt rr fj nac'in�++ :4r�Y1sa L".f{p$ x 6t1 2'.?S+�rtltt , 1 .t'- ii r " °Y5 r r{ „ .,,�{.t..�t N y -?11{'m ?`,D 'xi a z �^� 8Y C ➢ �.. wv y g:f eft �`}�z'y`*5 Ya- �f�. Nor vvv� `i tt'ti'+' i"€ a`•3-'#'v' e fr'scn :F,i S}o t�r'Sf'`? •:?tiJ $is'SC) .�,` I *!L 'd.0PWe k'�.ryKcYN!l,'"' � 40, BUREAU OF INDIVIDUAL TAXES PO BOX Pennsylvania Inheritance Tax pennsylvania HARRISBUURG RG ?PA A y 1112 8-0 6 81 Information Notice --- DEPARTMENT OF REVENUE asv-�scz U msxsc M-10 And Taxpayer Response FILE N0.2170 ACN 13110290 DATE 03-04-2013 ti Typ AcaqutrC Estate of MICHAEL P LONq; --a - �� Savings SSN 162-48-2096 m _ �� try --, Checking Date of Death 02-19-2013 w r– __q Trust COLBY J LONG County Cum BERLAND z rrt _ Certificate 773 LANCASTER AVE ENOLA PA 17025-2639 zo MEMBERS 1ST Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No.383307 Date Established 04-23-2010 REGISTER OF WILLS Account Balance $645.27 1 COURTHOUSE SQUARE j Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $322.64 Tax Rate 0.045 $ Potential Tax Due $14.52 NOTE': If tax payments are made within three months of the decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step l : Please check the appropriate boxes below. 1 A FJ No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B The Information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C The tax rate is incorrect. 71 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part F7 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships(including none). D ❑Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. i E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. REV-1310 EX+i08-09) yk pennsylvania SCHEDULE G , DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael P. Long 21-13-0330 This schedule must be Completed and filed if the answer to any of questions I through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY -CwDE TaE NAVE DE AE TRANSPEREE THE R RELKIONS';P Ta DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF'RNSFER. A-ACR A coar or-Re DEED FOR RE«ESTATE. VALUE OF ASSET INTEREST ;;r APPt:CAEEe, VALUE 1. ING Roth IRAAccount#3Z1-400910, Beneficiary:Annette S. Long,Spouse $7,12974 100% 50.00 11a J: r a� y i. TOTAL(Also enter on Line 7, Recapitulation) $ 0.00 If more space is needed, use additional sheets of paper of the same size. s rA y �1 Nye 'r � a d a so zw�� � aa tz ur � � M rAr cl ° m' a = b o o q � m A m j Y O W d V In � y ui 0 � a M C I 4 � P CL 2 o ' o � h^ 04 v a C C v-o,mau de b : cn� �aa m A �� mm N� �? g 1 N CC�V 8� REV-1511 EX+ (10-09? � pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE-AXRErURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael P. Long 21-13-330 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Michael J.Shalonis Funeral Home $7,487.22 2. Funeral accomodations/luncheon $83.34 $0.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s)Annette S. Long Street Address 773 Lancaster Avenue City Enola state PA Zip 17025 Year(s)Commission Paid: _ $5,700.00 2. Attorney Fees: Aforew C.5d1-e��Y ()I✓c— $3,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Annette S. Long Street Address 773 Lancaster Avenue - city Enola --State PA Zip 17025 Relationship of Claimant to Decedent_Spouse 4. Probate fees: $658.50 Gr.G Do w5 11 {� — 2-0\-L 5. Accountant Fees: �i a AIL C� $960.00 6. Tax Return Prepare,Fees: 7. Misc. Postage 59.66 S. Reserves to conclude estate administration,final accountings,final income tax preparation for 2013 $750.00 TOTAL(Also enter on Line 9, Recapitulation) $ 19,148.72 L`more space is needed,use additional sheets of paper of the same size. Michael J. Shalonis Funeral Home 206 Maple Avenue Marysville, Pennsylvania 17053 Fax(717)-957-2077 Michael J. Shalonis, Owner Phone(717)957-3451 We Care About Service To You Thursday,May 9,2013 Mrs. Annette S.Long 773 Lancaster Avenue Enola,PA 17025 Dear Annette, Thank you for selecting our funeral home to provide services for your family during your time of bereavement. t hope that you found our services,so far,to be of the highest standards that we always try to achieve. The following is a summary of the service charges as previously explained and provided in written form on the services for: MICHAEL P.LONG PROFESSIONAL SERVICES Basic scrvia of funeral director and staff $1800.00 Embalming $625.00 Dressing,Casketing,and Cosmetology $385.00 Total Funeral Service Selected TOTAL PROFESSIONAL SERVICES 32$10.00 FACILITIES?STAFF AND EQUIPMENT Use of Facilities&Stafr for Visitation S N/C Staff&equipment for church service $450.00 FACILTTIEs,STAFF AND EQUIPMENT $450.00 AUTOMOTIVE EQUIPMENT Transfer of Remains to Funeral Home S 200.00 Hearse/Funeral Coach $250.00 Flower/Lead Car $N/C TOTAL AUTOMOTIVE EQUIPMENT $450.00 OTHER MERCHANDISE SELECTED Casket: Marthews—Whitmire 11 $2,140.00 Outer Burial Container Grave Litter $875.00 Acknowledgement Cards $included Register Book $included Memorial Folders 400 $included Temporary Grave Marker $included TOTAL OTHER MERCHANDISE SELECTED $3,015.00 T CASH ADVANCES Grave Opening/Closing Cbwgc $500.00 ! Certified Copies of Death Certificate $90.00 Clergy Honorarium $100.00 Newspaper Notice Patriot News $274.72 Cemetery equipment $245.00 Flowers $225.00 CASH ADVANCE TOTAL $IAX72 LESS: Credits granted $672.50 Discount allowed $672.50 TOTAL OF SERVICES $7,487.22 LESS: Payments Made 7,48722 Annette Long $7,487.22 PAID IN FULL $0.00 if there are any questions or concerns that remain unanswered,please call me. Sincerely, Michael J.Shalonis Owner w RECEIPT FOR PAYMENT GLENDA FARMER STRASBAUGH Receipt Date : 3/20/2013 Cumberland County - Register Of Wills Receipt Time : 15 :25 :34 One Courthouse Square Receipt No . : 1073511 Carlisle, PA 17013 LONG MtICHAEL P Estate File No. : 2013-00330 Paid By Remarks : ANNETTE S LONG DMB ----- ------- ------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 460 . 00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 35 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN 1 INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ------- --------- Check# 2194 $558 . 50 Total Received. . . . . . . . . $558 . 50 a t REV-1512 EX+ i:12-03) Pennsylvania SCHEDULE I DEPARTMENT of REVENUE DEBTS OF DECEDENT, INHERITANCE N URN Re51DENT D MORTGAGE LIABILITIES & LIENS ED ESTATE OF FILE NUMBER Michael P. Long Page 1 21-13-0330 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Cumberland County Tax Claim Bureau-unpaid taxes. 13 High Street, Enola, Cumberland County, PA. $1.206.20 Tax Parcel#09-15-1291-172. 2. Cumberland County Tax Claim Bureau-unpaid taxes. 212 Center Street, Enola,Cumberland County, $2.149.83 PA. Tax Parcel#09-15-1290-086 3. Cumberland County Tax Claim Bureau-unpaid taxes.773 Lancaster Avenue, Enola, Cumberland $2,299.33 Counfv. PA. Tax Parcel#09-15-1290-168. 4. Cumberland County Tax Claim Bureau-unpaid taxes.West North Avenue, Enola, Cumberland County, $1,261.88 PA. Tax Parcel#09-15-1291-359. a 5. Cumberland County Tax Claim Bureau-unpaid taxes. 124 Susquehanna Avenue,Enola,Cumberland $1,258.36 Cnunty PA. Tax Parcel 109-14-0832-255. See attarhed settlement sheet. Decedent died February 19, 2013.At the time of his death,decedent owed delinquent taxes with spouse on inintly titled real esfafa. One half of delinonenf fax on iointiv owned real estate are set forth as follows: 6. Cumberland County Tax Claim Bureau-unpaid taxes. 348 Plum Allev, Lemoyne,Cumberland County, $923.54 PA.Tax Parcel#12-22-0822-114 7. Cumberland County Tax Claim Bureau-unpaid taxes.600 North Third Street,Wormleysburg, $69528 Cumherland Crnmtv. PA.Tax Parcel#47-19-1590-093 8. Cumberland County Tax Claim Bureau-unpaid taxes. North Third Street,Wormleysburg,Cumberland $154.12 Counfv.PA.Tax Parcel#47-19-1590-095_ 9. Cumberland County Tax Claim Bureau-unpaid taxes.967 Ridge Road,Cumberland County,PA.Tax $1,377.72 Parcel#08-13-0120-026 10. Cumberland County Tax Claim Bureau-unpaid taxes. 152 Salt Road, Enola,Cumberland County,PA. $923.06 Tax Parcel#09-13-1000-013. 11 Cumberland County Tax Claim Bureau-unpaid taxes. Plum Alley, Lemoyne,Cumberland County, PA. $743.38 Tax Parcel 412-22-0822-314 12. Cumberland County Tax Claim Bureau-unpaid taxes. Plum Alley,Lemoyne,Cumberland County,PA. $66564 Tax Parrel#12-22-0822-132 n 13. Cumberland County Tax Claim Bureau-unpaid taxes. 342 R 5th Street, Lemoyne,Cumberland County, $684.13 PA.Tax Parcel#12-22-0822-315 1 14. Cumberland County Tax Claim Bureau-unpaid taxes. S.5th Street,Lemoyne, Cumberland County, PA. $641.04 i Tax Parcel#12-22-0822-320 15. Cumberland County Tax Claim Bureau-unpaid taxes. 102A!toona Ave.,Enola,Cumberland County, PA. $638.66 Tax Parcel#09-14-0832-245 16. Cumberland County Tax Claim Bureau-unpaid taxes.532 West Cumberland Road, Enola,Cumberland $597.68 Count¢ PA.Tax Parcel#09-14-0834-176 17. Cumberland County Tax Claim Bureau-unpaid taxes.4 West North Avenue, Enola,Cumberland $1,806.47 County. PA.Tax Parcel#09-15-1291-198 TOTAL(Also enter on Line 10, Recapitulation) $ 18,026.32 au, If more space is needed,insert additional sheets of the same size. 4. .INt REV-1512 Ex+(12-08) 4` pennsytvania SCHEDULE. I. DEPARTMENT OF R6ENVE DEBTS OF DECEDEN i Tr INHERITANCE TAX RETURN MORTGAGE'LIAkUTIESt LIENS RESIDENT DECEDENT , f_i.'•`:.•f-j,l-i :� t"! i ESTATE OF FILE NUMBER Michael P. Long Page 2 21-13-0330 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. Balance due Integrity Bank Loan#1500262150-212 Center St.and 124 Susquehanna Ave.,Enola,PA. $56,815.33 b 19. Balance due Integrity Bank Loan#1500280885-212 Center Street,Enola,PA $18,132.18 :`4 20. Balance due Metro Bank Loan#3502350-773 Lancaster Avenue,Enola,PA $157,103.82 21. Balance due Metro Bank Loan#2717950-773 Lancaster Avenue, Enola,PA $10,262.79 '? 9 Decedent died February 19, 2013.At the time of his death,decedent owed mortgage balances with his snouse on inintiv titled real estate.Qne half of mortnane due on ininity owned real estate are set forth forth as follows: 22. Balance due Integrity Bank Loan#1500175150 -102 Altoona Ave.and 532 West Cumberland Street, $20,394.15 23. Balance due Integrity Bank Loan#001500262150-152 Salt Road,Enola,PA. $28,394,92 24. Balance due Integrity Bank Loan#1500373550-348 Plum Alley,Lemoyne,PA. $14,753.36 25. Balance due Metro Bank Loan#3472350-4 West North Street Enola,PA. $62,766.62 26. Balance due Metro Bank Loan#33331603-Ridge Road, Mt.Holly Springs, PA $15,305.39 m 27. . . Payoff/Satisfaction of claimfludgment against decedent from New Equipment Leasing,per settelment $5,700_.00._ sheet +ti 28. Real Estate Comissions and mist.closing costs due on sale of 124 Susquehanna Avenue,per attached $7,410.69 setNement sheet 29. Claimrjudgment due Yellow Pages Inc.for advertising costs of decedent's business $1,600.00 30. Claim/final bill due HIBU for business advertising due at decedent's death $1,310.68 31. Claim/final bill due Kerry's Lawn and Garden at decedent's death $1.174.79 32. Claim/final bill due American Rock at decedent's death $3,515.38 33. Claim/final bill due Fager's at decedent's death $713.94 34. Claim/final bill due AT&T-phone at decedent's death $53.32 35. West Shore EMS-ambulance bill,final bill $617.38 36. Pinnacle Health-final bill $250.00 37. Claim/balance due CNH Capital ECommerce business line of credit $2,852.30 38. FM Offel-final fuel bill $1, 251.86 I8! r• TOTAL(Also enter on Line 10, Recapitulation) $ 411,378.90 If more space is needed,insert additional sheets of the same size. 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AIq yImjvj,-)Irshqdmu3 6fon3,v-o,9 m8h AanoJ f?W Sf,'?• unmuO t-, !AO),8T y1moD PIU if+7mq XPTI "i, 017? j xv.1' Aq y),nooO brish9dmv3 x!cii3.,-unsvAntioW je&.V b-ussiu8 fnuU yv, ylnua tinhadmU211 A P!-I P.,t !-")Ca I x"m q 1 Kmcrii xCi yMo3 nApsO riw&,,3;hbt?vI jroFI rAwb15tbi5i- xr.T y,UOO wyauQ! T 1 1 sni-I 601Yfa9 c,'16; JATOT C-mail-Payoff Information Page I of I Annette Long<theannettelong@gmaii.com> -- --------------------- Payoff Information I message Gary KlIck<gklir-k@integritybankonline.com> Tue, Sep 24, 2013 at 1:26 PM TO:theannettelong@gmaii.com Annette Here is the payoff information on the loans as of February 19, 2013. Thanks Gary Gary G Klick Vice President Senior Commercial Lender Phone:717-920-3696 Cell: 717-395-6051 Fax: 717-920-3611 Email: gklick@integritybankonline.com This email and any files transmitted With it are confidential and intended solely for the use of the individual or entity to which they are addressed- This document(s) may contain information that is privileged, confidential, sensitive and/or otherwise exempt from disclosure under applicable law- If you have received this email in error please notify the originator of the message. in SKMBT C45213092412290.pdf 32K httn,•//mnil annale. Al 510 or)Ar)nii DataMotion SecureMail View Message Page 1 of 1 T RO BANK Member Center Inbox Track Sent Logout Help View Message Forward Reply To Sender Reply To All Download Message Tracking:#18480369 Sent:9/26/2013 1:40:18 PM (GMT-04:00) Expires:10/26/20131:40:18 PM (GMT-04:00) From:Mary.DeMuro @mymetrobank.com subjectLoan information To:TheAnnetteLong @gmail.com Annette, Below is the loan information you requested. The balances below are the Principal balances as of 2/19/13, not including any satisfaction fees. 2717950- $10,262.79 3472350-$125,53325 3502350- $157,103.82 33331603-$30,610.78 If you need anything else, please let me know. Thank you, Mary DeMuro Sr. Commercial Lending Assistant (717)412-6017 (717) 909-0589- FAX Reply via Secure Message METRO BANK CONFIDENTIALITY NOTICE:This email contains information from the sender that may be CONFIDENTIAL,LEGALLY PRIVILEGED,PROPRIETARY,or otherwise protected from disclosure.This email is intended for use only by the person or entity to whom ?• it is addressed.If you are not the intended recipient,any use,disclosure,copying,disbfbubon,printing,or any action taken in reliance on the contents of this email,is strictly prohibited.If you received this email in error,please contact the sending party by replying in an email to the sender,delete the email from your computer system and shred any paper copies of the emal you primed.The sender of this message will fully cooperate in the coil and criminal prosecution of any individual engaging in the unauthorized use of this message. Show Text Body '+J Security Envelope: Message Integrity IM ✓. Server Encryption: Message is protected with strong encryption. ✓ Secure Session: Securely view and download this message. ;SL Encryption Copyright t« . / �t i�r r „/rAa imc:arnv9h=1 Rf17R mint=7 RdR0�Fi9 9/27/2013 CC) 0 ( N Y O P m1M P O m 0N O\N\m m r. m rmvi m N Y• mom RAM\N 0e\Mi O 0 O mMM MwM\0M`I0 NMNm mmON - NN O p A NMme1 MNM P.N\MrOt O 0 .W Ni O M w •WYN W 009 , mm\ } M\ O N N d M W F O O m m O 4E S' N NNN�O q NMNN\OO•M-I N m N N O Y I F N N aU 4 R ri b O N O o Coco o 0 0 o 0099 M M w m t1 D o o O o oMOO 0000 0000 00 Ae+ (N (o yC' w 000° 0000 0000 0000 0000 O\1q fq &lua OOOO I}h�O fbE W OOMO 0ORO OOVI nI 000[ Oq WOp OoMM O O O R O O m N O O T M O O r{C m n aE E N O O Q N O O R 0 Oomo 0ow . O O M °p R m N w R M r r�1 ¢abx A.. I N M I I m V G t V N O O g q O N w F $ M m0R O 10 r O F M r O v Mff Om mp•Ip IO POOM ONiPOm g0'1 N • • N • f H . 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Long 21-13-0330 KtLAlIUNSHIP IU UtCLULNI AMUUIVI UK DHARt NUMBER NAME AND ADDRESS OF PERSONS)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. Colby J. M. Long, 773 Lancaster Avenue, Enola,PA 17025 Son/Child 25% (Intestacy) 2. Nikolas D. Long,773 Lancaster Avenue, Enola,PA 17025 Son/Child 25% (Intestacy) 3. yy ) I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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: 1. Annette M. Long, Spouse,Exemption per 20 Pa.C.S.A. Section 2012(3) 30,000.00 2. Annette M. Long, Spouse, Roth IRA Rollover per schedule G 7.129.74 3. Annette M.Long, Spouse,One Half of Instate Estate 50% (Intestacy) r t' 0. i1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. S TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ $100,891.60 If more space is needed,use additional sheets of paper of the same size. ,n