HomeMy WebLinkAbout02-21-14 (2) 1505610140
REV-1500 EX (01-10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 2 0 1 2 2 3
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 1 2 1 2 0 1 2 1 1 0 1 1 9 4 8
I
Decedent's Last Name Suffix Decedent's First Name MI
H A I L E Y J 0 H N M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1.Original Return 2.Supplemental Return 3.Remainder Return(date of death
prior to 12-13-82)
4.Limited Estate El 4a.Future Interest Compromise(date of 0 5. Federal Estate Tax Return Required
death after 12-12-82)
❑X 6. Decedent Died Testate 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
F1 9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death ❑ 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
C H A R L E S E P E T R I E 7 1 7 5 6 1 1 9 3 9
REGISTER OF WILLS USE ONLY
First line of address �-
3 5 2 8 B R I S B A N S T R E E T to_`
Second line of address
�'("_' _w.
flAT£:FILED
City or Post Office State ZIP Code -:
H A R R I S B U R G P A 1 7 1 1 1 a'
Correspondent's e-mail address: PetrieLaw AOL.com
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.
SIGNATURE OF PER N RESPONSIBLE FOR FILING DATE
12/23/2013
ADDRESS
209 ST- JOHNS CHURCH ROAD CAMP HILL PA 17011
SIGNATURE OF PREP T ERAESENTATIVE DATE
C �1�� 12/23/2013
ADDRESS
3528 BRISBAN STREET HARRISBURG PA 17111
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: J O H N M - H A I L E Y
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 9 9 2 0 0 . 3 4
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 6 8 7 6 . 4 9
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. 8 1 5 8 5 . 3 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 8 7 6 6 2 . 2 0
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 2 0 5 2 5 . 6 7
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 2 6 9 7 7 . 2 3
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 4 7 5 0 2 • 9 0
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 4 0 1 5 9 . 3 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 1 4 0 1 5 9 • 3 0
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 _ 5 6 9 2 4 . 1 6 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 8 3 2 3 5 . 1 4 16. 3 7 4 5 . 5 8
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 .0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 19. 3 7 4 5 • 5 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505610240 1505610240 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 12 01223
DECEDENT'S NAME
JOHN M. HAILEY
STREET ADDRESS
1017 HARRIET STREET
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 3,745.58
2. Credits/Payments
A.Prior Payments 3,182.00
B.Discount 167.47
Total Credits(A+B) (2) 3,349.47
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference,This is the OVERPAYMENT.
Fill In oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 396.11
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; ...................................................................... ❑
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X❑
c. retain a reversionary interest;or ............................................................ El 0 d.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? ....................................................................................... El 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ X❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
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.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].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.
REV-1502 EX+(01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOHN M. HAILEY 21 12 01223
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. REAL ESTATE AT 1017 HARRIET STREET 99,200.34
CUMBERLAND COUNTY, PA
SEE ATTACHED SETTLEMENT SHEET
TOTAL(Also enter on Line 1,Recapitulation.) $ 99 200.34
If more space is needed,use additional sheets of paper of the same size.
OMB Approval No.2502-0265
r.`
HUD-1
A. Settlement Statement (HUD-1)
�g404 DF`IV-"C Page 1 of 3
B.Type of Loan
1.0 FHA 2.❑RHS 3.❑Conv.Unins. 6.File Number: 7,Loan Number: 8.Mortgage Insurance Case Number:
4.❑VA S.❑Conv.Ins. 401301366-CB 7128052508 446-1759404-703
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.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not Included in the
totals.
D.Name and Address of Borrower E.Name and Address of Seller F.Name and Address of Lender
ERIC S'WEIDNER AND MEGAN E.WEIDNER ADESSA R.MILLER AND MICHAEL HAILEY, ERA MORTGAGE
89 SPRING GARDEN ESTATES CO-EXECUTORS OF THE ESTATE OF JOHN 1 MORTGAGE WAY,
CARLISLE,PA 17015 M.HAILEY A/K/A JOHN MICHAEL HAILEY MOUNT LAUREL,NJ 08054
1017 HARRIET STREET
CARLISLE,PA 17013
G.Property Location H.Settlement Agent
SECURED LAND TRANSFERS,LLC
1017 HARRIET STREET, 485 ST.JOHNS CHURCH ROAD,
CARLISLE,PA 17013 SHIREMANSTOWN,PA 17011
Phone:(717)901-8342
COUNTY:CUMBERLAND
PARCEL ID:29-19-1639-132 Place of Settlement I.Settlement Date 05/17/2013
TOWNSHIP:NORTH MIDDLETON TOWNSHIP
19 NORTH BALTIMORE ST Disbursement Date 05/17/2013
DILLSBURG,PA 17019-1354
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 Price $114,000.00 401. Contract Sales Price $114,000.00
102. Personal Property 402. Personal Property
103. Settlement charges to borrower line 1400 $7,812.19 403.
104. 404.
105. 405.
Adjustment for Items paid by seller In advance Adjustment for Items paid by seller nn advance
106. City/Town Taxes 406. City/Town Taxes
107. County Taxes 317.88 r 5/17/2013 to 1/1/2014 199.44 407. County Taxes 317.88 r 5/17/2013 to 1/1/2014 $199.44
108. Assessments 408. Assessments
109. School Taxes 1 195.23/ r 5/17/2013 to 711/2013 147.36 409. School Taxes 1 195.23 r 5/17/2013 to 7/112013 147.36
110. 410.
111. 411.
112. 412.
120.Gross Amount Due from Borrower $122,158.99 1420.Gross Amount Due to Seller 114 346.80
200.Amounts Paid by or in Behalf of Borrower 500.Reductions In Amount Due to Seller
201. Deposit or earnest money $1,000.00 501. Excess Deposits
202. Principal Loan Amount from ERA Mortgage $111,935.00 502. Settlement Charges to Seller $17,141.46
203. Existing loans taken subject to 503. Existing loans taken subject to
204. Seller Paid Closing Costs $5,700.00 504.
205. 505.
206. 506. Seller Paid Closing Costs $5,700.00
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. City/Town Taxes 510. CI own Taxes
211. County Taxes 511. County Taxes
212. Assessments 512. Assessments
213. 513.
214• 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.Total Paid by/for Borrower $118,635.00 520.Total Reduction Amount Due Seller $22,841.46
300.Cash at Settlement from/to Borrower 600.Cash at Settlement to/from Seller
301. Gross amount due from borrower line 120 1$122,158.99 601. Gross amount due to seller line 420 114 346.80
302. Less amounts 2aid by1for borrower line 220 118 635.00 602. Less reductions in amount due seller line 520 $22,841.46
303.Cash X From To Borrower ;3,523.99 603.Cash I X I To From Seller ;91,505.34
The Public Reporting Burden for this collection of Information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not
collect 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. ` /
Initials MEW
. LiW
808 Lenders Inspection Fee to STARS
900.Items Required by Lender to Be Paid in Advance
901. Daily interest charges from 5/17/2013 to 6/1/2013 @ 7.67/day ERA (from GFE #10) $115.05
Mortgage
902. Mortgage Insurance Premium to DEPARTMENT OF HUD from GFE #3 $1,925.18
903. Homeowner's Insurance Pennsylvania National from GFE #11 414.00
904.
.000.Reserves Deposited with Lender
:001.Initial deposit for your escrow account from GFE #9 $1,195.23
:002.Hazard Ins. Reserve 3 Months @ 34.50 per Months ERA Mortgage $103.50
L003.Mortgage Ins. Reserve @ 122.48 per Months ERA Mortgage
1004.County Property Taxes 5 Months @ 26.49 per Months ERA Mortgage $132.45
L005.School Taxes 12 Months @ 99.60 per Months ERA Mortgage $1,195.20
1006.Aggregate Accounting Adjustment to ERA Mortgage -$235.92
1007.
.1OO.Title Charges
1101.Title services and lender's title insurance to Secured Land Transfers LLC from GFE #4 $1,480.00 $10.00
L102.Settlement or closing fee to Secured Land Transfers LLC $225.00
1103.Owner's title insurance to Secured Land Transfers LLC from GFE#5 $10.00
1104.Lender's title insurance to Secured Land Transfers LLC $1,160.00
1105.Lender's title policy limit $111,935.00
L106.Owner's title policy limit $114,000.00
L107.Agent's portion of the total title insurance premium to Secured Land $1,053.00
Transfers LLC
L 108.Underwriter's portion of the total title insurance premium to TRGC-Sale $117.00
L109.Insured Closing Protection Letter to TRGC $75.00
L2OO.Government Recording and Transfer Charges
1201.Government recording char es from GFE #7 150.00
L202.Deed 62.00 Mortgage 17 Pages) 88.00 Releases
1203.Transfer taxes from GFE#8 $1L140.00
1.204.City/County tax/stamps Deed $1140.00 Mortgage
1205.State tax/stamps Deed $1140.00 Mortgage $1,140.00
1206.
L30O.Additional Settlement Charges
1301.Required services that you can shop for from GFE#6 $19.50
1302.Tax Service Fee to STARS POCL$85.00
1303.Flood Cetification Feet to STARS $19.50
1304.Home Warranty to First American Home Buyers Protection $365.00
1305.2013 Count /Tw .Taxes to Robin K. Sollenber ,er Tax Collector $317.88
1306.Duplicate Tax Bill Fee to Robin K. Sollenber ,er Tax Collector $1.00
1307.Inheritance Tax Escrow to Secured Land Transfers - Mechanicsburg $7,695.00
1308.Pest Treatment to Howards Exterminating Services LLC $450.50
1309.Plumbing Repair Work to Del 's HVAC $150.00
1310.Final Water Sewer Bill to North Middleton Authority 119.08
1311.Chimney Flashing Repair to Sborn Renovations $100.001
L400 Total Settlement Charges(enter on lines 103,Section 7 and 502,Section K) $7,812.191 $17,141.46
If you have any questions about the settlement charges and loan terms listed on this form,please contact your lender.Settlement agent is not responsible for content of
lender's assessments on HUD.
The seller's and borrower's signatures hereon acknowledge their approval and signify their understanding that tax and insurance prorations and reserves are based on
figures for the preceding year or supplied by others or estimated for the current year,and in the event of any change for the current year,all necessary adjustments will be
made between borrower and seller directly.Any deficit delinquent taxes or mortgage payoffs will be promptly reimbursed to the settlement agent by the seller.
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is true and accurate statement of all receipts and disbursements
made on my account or by me in this transaction.I further certify that I have received a copy of the HUD-1 Settlement Statement.
BUYERS SELLERS
Adessa R.Miller and Michael Halley,Co-Executors of The Estate of John
Eric S:Weidner M alley a/k/a John Michael Hailey
Me ei ner By:A r,C -Exe for
G�
.Michae -a y -Executor
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transactid .I have caused or will cause the funds to be disbursed in
accordance with this statement.
Settlement Agent /7 //� n Date
05/17/2013
as
REV-1503 EX+(6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN M. HAILEY 21 12 01223
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 211 SHARES OF WELLS FARGO COMMON STOCK @$32.59/SHARE 6,876.49
TOTAL(Also enter on line 2,Recapitulation) $ 6,876.49
(If more space is needed,insert additional sheets of the same size)
REV-1508 EX+(6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN M. HAILEY 21 12 01223
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ORRSTOWN BANK IRA#1 13,940.24
2. ORRSTOWN BANK#2 60,693.70
3. PROGRESSIVE INSURANCE REFUNDS 71.00
4. PROCEEDS FROM AUCTION SALE OF PERSONAL PROPERTY 2,180.33
5. ACCOUNT AT CORNERSTONE FEDERAL CREDIT UNION 1,740.30
6. 1995 FORD 2,362.00
7. 1994 VOLVO 300.00
8. ACCOUNT AT CITIZENS BANK 180.80
9. ERIE INSURANCE HOMEOWNERS REFUND 117.00
TOTAL(Also enter on line 5,Recapitulation) $ 81 585.37
(If more space is needed,insert additional sheets of the same size)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN M. HAILEY 21 12 01223
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HEADSTONE 1,218.32
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) WAIVED
Street Address
City State ZIP
Year(s)Commission Paid:
2. AttomeyFees: CHARLES E. PETRIE 2,500.00
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: 693.76
5 Accountant Fees:
6. Tax Return Preparer Fees: 425.00
7. ATTORNEY MATEER 4,000.00
8. BANK FEES 5.00
9. HOME REPAIRS NECESSAY FOR SALE 11,258.59
TOTAL(Also enter on Line 9,Recapitulation) $ 20 525.67
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-06)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, &LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN M. HAILEY 21 12 01223
Report debts 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. NORTH MIDDLETON SEWER AUTHORITY 194.17
2. PA POWER & LIGHT 338.01
3. UGI UTILITIES 318.15
4. EMS 2,402.71
5. PATHOLOGY ASSOCIATES 911.00
6. PINNACLE HEALTH 20,221.88
7. CARLISLE HOSPITAL 1,907.16
8. PA STATE INCOME TAX 97.00
9. IRS 554.00
10. YORK WASTE 33.15
TOTAL(Also enter on Line 10,Recapitulation) $ 26 977.23
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOHN M. HAILEY 21 12 01223
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. TAMMY HAILEY Spousal 56,924.16
2. ADESSA HAILEY Lineal 41,617.57
3. MICHAEL HAILEY Lineal 41,617.57
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.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.