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Home My WebLink About11-15-13 (2) , � ��p�n��nsyn�an�a �5 D 5 6 ZO�4 3 dc cos-ta� � R�V-'1�00 °��'"�.'�°�.Y � �� 8ute�nt ot h�tldt�el Taxes ! Po�x.2�o1 INHERITANCE YAX RETtlRN 21 �� ' Hs�r�bu PA 171 1 RESID�MT DEC�D�NT � ENTFJ�DECEDENT lNFORMi►"CION BEt,oW' . Sooiad Ssouri(�t Number Dafie of Deaih Date of Bfrth � 05 OS 20*3 Q2 1� 1960 ' [)evsd�nCs t.a�t Name SuHbc Deoedent's Flr�t Name Mt ; L08'BI.AD �R�:D$RI Cl+� J ; {It Applbsblsj Er�r Survivirp 8pouss's lnbrmatlon B�ow � 3pows's L�sst Nams SufR�c � Spouee's First Nama MI � Spouee�s So�d Se�rky�mb� THIS RE7URA1 MU87 BE FlLED 1N QUPLICATE WE'fH YHE : a�c�.srER o�wi��s FILL IN APPRaPR1ATE OVALS BELOW � Q 1.Or�prial Rebum � 2. Suppiemenfal Retum � 8. �b��(DNe of D�d� � � f � 4.Umiled Eat�Ee � 4a.��d�an�i�12�.a� ❑ �. Fe�lera Eii�ie Ta�t Rs�um RpulroO � ❑ 8'�c.�r�►otrvUw) �—J �' �ea�a c+ .a�!►�?'��w7hat 8. 'fdN Ntxribst d 8ede DspoNt 8000es , � � p e�. u�,.no�,,�oo��a ❑ �o.�;��6�"'.�-�'°..r' f] ,,.��s�9„aw � �n�r-n�ssecroN Musr ee co��a�u.c �wo co��rrw.rauc�N�or�u►roN sHOU.��o�c�u to: � Nsrqs D�ryrtlms Telephons Nt�nbsr 1 �b�B�RT C S�►.tDIB (717j 243 6222 ° � � � fir�tun.orA�+aaro.. � 2 6 1�' 8��s8 S!1'R�T ; Second une otAddrsss � j� CNy�or Post Othce � St� 7JP Code � � � t�1 ! C�lItL38i� PA 17013 � � � +� � ... , ��rr��r�w�� . . . . ��Y � �. � � rn�,:� , i � � � � � � � ' I Mli1 �Q D Y Y Y Y d �,; � --o .° � , � � c� ..,n � � � , � �� 5. Corrs�ponda�rNs s�nMl addross: : ��i�t aai�d ,I eoMr�e I I�s��atl�r��n Ih"s p�nor�l'�ia°0p��on� �+s be�t , O�ef� �x � Gre�chen L+�blad � � � �3 ; 1 F '1 �� SIC�NAIURE OF 1FUM REPRESEN1rATNE D�IkT� ! Robert C.Saidls � � �s '. 26 W,High Street,Carl�Sle,PA �r.��.ir.i.�..�. � ■..rr�. ...�� ..�■ i r �i�■w i.�.�r�� Side 1 � Z505610543 y505610143 ,,,,,� W � 1505610243 REV-1500 EX DecedenYs Social Security Number o��,t'$Na�: Lofblad, Frederick J. RECAPITULATION 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 8�Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits 8�Miscellaneous Personal Property(Schedule E)............... 5. 252,337 .36 6. Jointly Owned Property(Schedule F) ❑ Separate Billinq Requested............ 6. 7. Inter-Vivos Transfers 8�Miscetlaneous Mnq Probate Property (Schedule G) �J Separate Billinq Requested............ 7. s. Total Gross Assets(total Lines 1 through 7)........................................................ g. 2 52,33 7 .3 6 9. Funeral Expenses and Administrative Costs(Schedule H).................................... s. 9,2 0 9. 68 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 3 9 9• 7 7 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 9, 60 9. 45 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 2 4 2,7 2 7. 91 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an eleation to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 2 42,72 7. 91 TAX COMPUTATION-SEE INSTRUCTtONS 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. 0. �0 16. Amount of Line 14 taxable at lineal rate X .045 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.�2 2 4 2,714 .5 0 �7. 2 9,12 5. 7 4 18. Amount of Line 14 taxable at collateral rate X.15 0 . �0 18. 0 . 0 0 19. TAX DUE................................................................................................................ 19. 29��.25. 74 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 � REV-1500 EX Page 3 File Number 21-13-0574 Decedent's Complete Address: DEC�DENTS NAME LofUlad,Frederick J. STREET ADDRESS 210 Walnut Bottom Road � CITY STATE ZIP Carlisle PA 17013 Tax Payranents and Credits: 1. Tax Due(Page 2,Line 19) (1) 29,125.74 2. Credits/Payments A. Prior Payments 25,000.00 B. Discount 1,315.79 Total Credits(A +B� (2) 26,315.79 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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) 2 809 95 � • Make Check Pa able to: REGI�T�R OF WILLS AGENT. PLEASE ANSW�R THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use o�income of the property transferred:............................................................................... x b. retain the right to designate who shall use the property transferred or its income:.................................. x c. retain a reversionary interest;or..............................................................................:................................ x d. receive the promise for life of either payments,benefits or care?............................................................ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑ receiving adequate consideration?.................................................................................................................... x 3. Did decedent own an"in trust fo�' or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ � � contains a beneficiary designation?.................................................................................................................. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST EOMPLETE 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 January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 peroent (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 retum are still applicable even if the suroiving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfe�s from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive pa�ent,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)J. . The tax rate imposed on the net value of transfers to or for the wse of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individuaf who has at least one parent in common with the decedent,whether by blood or adoption. Rav-1508 EX+(11-10) scH��u�E E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE iNHeRrr�wce T,vc Ren,,RN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Lofblad, Frederick J. 21-13-0574 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1990 Pontiac 6000-See attached valuation and also Tax Receipt from The Humane Society 359.00 da#ed July 12,2013 2 M�T Bank Checking Account No.9838892140-See attached letter dated June 24,2013 618.02 3 M�T Bank Savings Account No.15004214149830-See attached letter dated June 24,2013 43.986.00 4 M&T Securities,Inc.Account No.AZD4Z2665-See attached letter from M�T Securities,Inc. 206.T06.49 dated July 30,2013 and also a valuation of the account 5 Refund fro�Capital BlueCross 545.05 6 Refund from Department of Revenue for 20091ncome Tax 13.41 7 Refund from Direct Energy Services,LLC-electric 26.39 8 Refund from Donegal Insurance-car insurance 83.00 TOTAL(Also enter on Line 5.Recapitulationl 252.337.36 pf more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.11-10) 1990 Pontiac 6000 Sedan LE What Your Car is Worth Page 1 of 2 __ __ _ p��. Car Car 5g$��►�dmunds.com �� Make Modei : Year _ .. ._.,,�___�.._,. ! p�� , Type Research Submit Query �,Qp�> S sed Cars> Pontiac> 6000> 1990 6000 Sedan> psjces with O�tlons> Pncas wfth Optfons Results ....__... _.._ _........ __._._.. .._._. _ _. _ _ _ .. �ov�ns�ar�" ;. _._ _...... , Use Edmunds.com to accu�ately appraise yaur used car. ��"��,�'��I"��,�„t �� Ifp Code&Style Calors&Options Conditian&Mileape True Market Value• , 1990 Pontiac 6000 Sedan - What Your Car is Worth ' ' _ _ _ _ '17013�, uPO�� aNan9 ro. i , Carlisle,PA ..._. __... . True Market Value� ��v�� An�+ev�td�`"in»�Sg V'V�t C1k►a��st�t. w.�. Trade-fn Dealer Retaii ' �F�� ; ;914 -- . _ �359 ��„.�� y ha�� ? E g,�,� F ' SHOP FOR Tk18 GAR A#�!!'�C W�CzI! �s�s ��.: �r��s� h�:-x Z��k��.s s��'�r'�"s� ra� : .. . . . . .. . . . .. � y �'�i[�^7�'�!� �,x� �'`�� t1�1$�1'1N��+1� �� Private Party Sale 5565 . k' #s . . . . . . . .. . . . , : :.:..�:; ' ...:. x .. �.. �. '�.� _ . . .... ..... ......... ... ....... .... . . .;....,,. . ^.�•r • • �.� .�..n:.v.. �. Videos �¢Q '' _ __ _ _ _ __ __.. _.___. , Pricinp Details for a 1990 Pontisc 6000 Sedan �+��"T ' LE 4dr Car ��!-�Yl.l�� f�iew G!r 8eintfitic. Customized True Market Value�Prices , used t�r�rce. Trade-In Private Party Dealer Retail ' ��A� . � National Base Price 5300 i863 51,800 _ _ __. _, _.._ __ ;� _ __ _.._....—. � Optional Equipment #4 s12 =28 � �rr�a.r�aras�s uttt.� !I AM/FM/Cassette Audio System #4 ;12 ;28 " Save I�i�! Color Adjusdnent- White ;0 ;0 ;0 ,;, ;;, S�a?rrh far c�r Int+�n Regbnal Adjustment- for Zip Code 17013 ;-23 =-67 #-140 � a�� 'j , i ' ; the tl�+le�r : Mileaye Adjustment- 48,673 miles s254 �254 ;254 � ' �'` _ Cf..�C HERE► Conditfon Adjustment- Rough j-176 ¢-497 #-1,028 ,_.,,_ _ _._. _. _ _......... __ _ _ _ _ . __. _ _ TOt�I �359 fi565 ;914 ' ! _ ; ' Tips and Advice _ ! Buying a Certffied Uaed Vehicie Dealer Retail i a,0 Steos to,�yvino a New Car Certifled Used Price Vehicle not elf�ible for certifitation. 10 Steos to Seltina Your Car �(gw Car B�vina Guides ., ..,..,,._.,_�,..�_......:... ... ......,. �....�.w. ..._. .w.._...�,��.M .,._...._..�.,..._�.��.... .,_w.��....,.._�. _w...,�,..,. .�._..�.;._..__.��..�.._�.�. ' puel Economv !, _. __ __... . __ _.., ; ' ', �r Safetv AutoCheck Vehicle History Report ' ' Car Technolouv __ __ _ _ Your research lsn't complete until you see the vehicle history report. �wveir,sc�err . ,, Buy an AutoCheck report now! __ -.-_ ___ . _ _..... Enter VIN � CHHCK VIN �� _ .._. ._. _. _ _ _ ; ; _. _._ _ _._ _ __ _ __ ___ __., ; ; ; Know Before You Go to the Dealershfp _. _ _. . ___ _ _- __ < : Get Pre-Annroved for a Loan �� ' , Take control of your auto purchase with an up2drive drive check°. ��,�y�� Au,r�d�Y�r��1Af t�me�r�p. �, ` Get FlnandnLLQ�llltl��4t@�Y , _,_.._..w_�.�,.�� Af�caw�rm�zt __ . _ _ , , Get flnancing before you buy,reqardless of your credlt history. ��;,,�,M,,,��;,..��; ' Fre�!!l�Sd.C��.@ Qld4S� �� ' Shop,Save and Switch to GEICO today!Instant online quotes. http://www.edmunds.com/pontiac/b000/1990/tmv-appraise-results.html 1 Q/15/2013 � , % � "ti � �`�.,��'�` ��: !�!��1�"� �� Federal Tax ID: 53-0225390 Tax Recei�t 7/12/2013 Gretchen Lofblad REF#037691 138 Fieldstone Drive STOCK# 11425711 Carlisle PA 17015 Dear ponor, Thank you for supporting The Humane Society of the United States with your donation listed below.The funds from your donation truly help make a difference in furthering our mission. •DONATION INFORMATION: -Donor: Frederick Lofblad Gretchen Loftblad -Date of Donation: 5/28/2013 -Vehicle:1990 Pontiac 6000 -VIN: 1G2AF84TSL6212386 -Drivable: No -Mileage: 48673 -The vehicle is in Fair condition,and was NOT visually inspected by the non-profit organization prior to donation. -Date of Sale: 07/10/2013 Your vehicle has sold as is for$500 or less, in an arms-length transaction between unrelated parties;no material improvements were made. It hereby certifies that no goods or services were received by the donor in exchange for the donation of this vehicle. The deductible value of your contribution is equal to the fair market value up to $5�0. Now,more than ever,our charity appreciates the money raised from donations like yours. We are constantly striving to be the best we can by listening to our donors. Please take a few minutes to complete a simple survey. Visit�,ttus://s.zoomerang.com/s/VehicleDonation to access the survey. More than half of our donations come from people who tell their friends and family about our services. Help spread the word,and thank you again for your generous donation!! Warm Regards, The Humane Society of the Uni�ed States Processing Center-PO Box 280-69 Hinckley Rd-Clinton ME 04927 (877)836-6674,http://www.hsus.org Originally Issued On 07/12/2013 JUN 2 7 2013 499 Mitchell Road,Millsboro,DE 19966 Adjusrtment Services Phone 888-502-4349 F ax (302)934-2955 June 24,2013 Law Offices Of Saidis,Sullivan&Rogers 26 West High Street Carlisle,PA 17013 Re: Estate of Frederick J.Lofblad � �ocial Security: 193-38-0538 Date of Death:Mav O5,2013 Dear Sir or Madam: Per your inquiry on June 13,2013,please be advised that at the time of deaxh,�e above-named dece�nt had on deposit with this bank the following: 1. 7j�pe of Account Checking Account Account Number 9838892140 t Ow»ership(Names o�f} FrederickJ.Lofblad Opening Date 07/28/2006 Balance on Date of Death $618.02 Accrued Interest $ .DO Total $618 02-....��'___._._...____.._....___.._.._..____._. 2. Type ofAcco:alt SaviregsAccount Accountll�umber 15004214149830 Ownership(Names o,� FrederickJ.Lofblad Opening Date 07/28✓2006 0 Bala�ce on Date ofDeath $43,985.03 Accrued Interest $ .97 Total �,S 43,986.00._______....______.__________ t For any additiooal information on the above accounts,including ownership and any changes,closures and/or reimbursement of fnnds, please caU the Stocehalge at 717 24t1�4524. We were unable to locate any safe deposit boz for the above-mentioned deceden� This letter das not indude a�socounts in w6ic6 t6e deceased may have been lis�ed as Power of Attorney,Custodian of Uniform Trnnsfers, Representative Payee,or Trusbee under a Written Agreement S111C81�1y, Valarie Mercer Adjusrment Services A!� �0�� 2013 � M&T Se�curities,Inc. 285 Delaware Avenue,Suite 2000,Buffalo,NY 14202 July 30,2013 Robert C. Saidis Re: Date of Death Valuation To Whom It May Concern, Enclosed you will find the date of death valuation for account AZD422665, registered as, Frederick J. Lofblad. This information is obtained from sources believed to be reliable, but no independent verification has been made and M&T Securities does not guara.ntee the accuracy. The prices per share on the valuation date differ for each security. Stocks are priced per share based on the low,high and close. Mutual funds are priced per share at NAV.Fixed income is priced at the bid. Previous business da.y price is used if DOD falls on a weekend or holida.y. Please note if the client held an annuity position at the time of death then the valuation should be obtained by the carrier. If you have additional questions regarding this information you can contact the Client Solutions desk at (800)724-7788,option#1. Sincerely, � � � G/1-�iv�ti Step en P. Scrivani Brokerage Opera.tions Specialist M&T Securities Inc. � Investment and Insuranc;e Products:•Are NOT Deposits•Are NOT FDIGlnsured Are NOT Insured By Any Federai Govemment Agency•Have NO Bank Guarantee•May Go Down In Value Brokerage services and insurance produds are offered by M&T Securities,Inc.(member FINRA/SIPC),not by M&T Bank. M&T Securibes,Inc.is licensed as an insurance ageM and acts as agent for insurers.Insurance policies are obligations of the insurers that issue tl�e poNaea Insurance products may not be available in ail states. � MBcT Securities,Inc. 285 Delaware Avenue,Suite 2000,Buffalo,NY 14202 Date of Death Holdings as of 05/05/2013 Account:AZD422665 Historical Symbol �ecurifiy Name Quantity Prices CASH MMKT WILMINGTON US TREAS MMKT SELCT .00 $1.00 STOCK Closing Price MUTUAL FUND Closing Price THE INCOME UND OF AMERICA CLASS AM ECX A 2639.305 $19.70 THE GROWTH FUND OF AMERICA CLASS AGTHX A 1063.286 $38.49 CAPITAL WORLD GROWTH &INCOME CWGIX FUND CLASS A 1224.914 $41.15 ABNDX THE BOND FUND OF AMERICA CLASS A 2176.632 $12.95 AII�JERICAN HIGH INCOME TRUST CLASS AHITX A 3018.329 $11.66 . 7otal 10122.466 Investment and insurance Products:•Are NOT Deposits•Are NOT FDIC-insured Are NOT Insured By Any Federal Govemment Agency•Have NO Bank Guarantee•May Go Down In Value Brokerage services and insurance products are offered by M&T Securities,Inc.{member FINRA/SIPC),not by M&T Bank. M&T Secu�ities,Inc.is I'�censed as an insurance agent and acts as agent for insurers.Insurence policies are obligatbns of the insurers that issue the poliaes. Insurance products may not be availeble in all states. FREDERICK J. LOFBLAp M T SECURITIES, INC.ACCOUNT N0.AZD422665 Security Value MMKT 0 AMECX $ 51,994.30 AGTHX $ 40,925.88 CWGIX $ 50,405.21 ABNDX $ 28,187.38 AHITX $ 35,193.72 Total $ 206,706.49 REV-1611 EX+(10-09) SCHE�ULE H pennsyivania DEPARTMENTOFREVENUE FUNERAL �XPENSE� AND R SEDENpTDEC ENTTURN �DMINISTRATIVE CO�TS ESTATE OF FILE NUMBER Lofblad, Frederick J. 21-13-0574 Decedent's debts must be reported on Schedule L ITEM DESCRIPTION AMOUNT q, FUNERAL EXPENSES: See continuation schedule(s)attached 2,080.00 B. ADMINISTRATIVE COSTS: � 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attomev's Fees Saidis,Sullivan&Rogers s,0o0.00 3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zin Relationshi�of Claimant to Decedent 4. Probate Fees 343.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Qther Administrative Costs 786.18 See contin�ation schedule(s)attached TOTAL(Also enter on line 9,Recapitulation) 9,209.68 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.10-09) ':SCHEDULE H �UN�RAL EXP�N��S AND ADMINISTRATIVE COST� continued ESTATE OF FILE NUMBER Lofbiad, Frederick J. 21-13-0574 ITEM NUMBER DESCRIPTION AMOUNT Funerai Exne� 1 Hoffman-Roth Funeral Home 2.080.00 H-A 2,080.00 Other Administrative Costs 2 Cumberland Law Journal-advertise fetters 75.00 3 H&R Block-Income tax return preparation for tax years 2009-2012 240.00 4 Register of Wills-Short Certifcates 10.00 5 Reimbursement to Gretchen Lofblad for payment to Lowes for cleaning supplies and gloves 35.99 6 Reimbursement to Gretchen Lofblad for payment to Lowes for plastic tubs 35.20 7 Reimbursement to Gretchen Lofblad for payment to U-Haul for moving van and supplies 54.42 8 Reimbursement to Gretchen Lofblad for payment to Walmart for plastic tubs 135.41 9 The Sentinel-advertise letters 200.16 H-B7 786.18 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1812 EX+(12-08) SCH�D�lLE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Lofblad,Fred�rick J. 21-13-0574 Report dsbts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PA Department of Revenue-Penalties and Interest for Tax years 2009 and 2010 85.86 2 PA Department of Revenue-2009 Taxes 203.00 3 PA Depar�ment of Revenue-2010 Taxes 42.00 4 PA Department of Revenue-2011 Taxes 20.00 5 PPL Electric Utilities 48.91 TOTAL(Also enter on Line 10,Recapitulation) 399.77 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev.42-08) _ _ REV-1513 EX+(01-10) pennsylvania �CHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BEN�FICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Lofblad, �rederick J. 21-13-0574 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE MOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (N/ords) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousai • distributions,and transfers under Sec.9116 a 1.2 1 Gretchen Lofblad Sister 242,72T.91 138 Fieldstone Drive Carlisle,PA 17015 Total 242,727.91 Enter doll�r amounts for distributi:on$sh�uvn above on lines 15 throu h 18 on Rev 15p0 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART il-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,inc. Fort�n PA-1500 Schedule J(Rev.01-10)