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Home My WebLink About05-28-14 ' � 1505610101 REV-1500 EX�°1_1°, L� OFFICIAL USE ONLY PA Department of Revenue pennsylvania Bureau of Individual Taxes �"pT�""T County Code Year File Number PO BOX28o6oi �p�NHERITANCE TAX RETURN / / � � ,Z Harrisburg,PA i'7128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY �«:��:� DecedenYs Last Name Suffix Decedent's First Name MI BEL n l L L / (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE v REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2.Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) p 4. Limited Estate Q 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number e N � ,� � s ! � v � � � 7 °1 � �E�TER OF NI�LS l��QdLY r..:� � ^ C? �� { U7 .�I :.i: .. � __ C3 First line of address � � � c-� N �'�� m , -..3 CX'� ;':J C7 � C �. v uS o M ��' - :�: , � � - c-, �, -� ;� ..�� Second line of address �� -� !r7 � �°- � ''�J C-- ....� ! ; � c..� r— rn � � DATE LE � p City or Post Office State ZIP Code C N n� ! C � �t � !� CorrespondenYs e-mail address: CG�S�l P•IC�S31�t/ L�111�I�i S1� n�i� 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 PERSON RESPONSIHLE FOR ILING RETURN �A��/`.� �s S,1-L.r�,._.F�.-..— � 2,,� .,-� / /nl !I ADDRESS SNn+C�/A/ S. l�1ODT�/V a'Z/IS �t�I'��P�C`N1I?/CS�L[I7��!"rl �7OSS-S8/ / SIGNATUR REP ER OT R TH P SENTAT^IV= DATE S�9 A DRESS CNl�RG�S �, SHIEZOS /7 , ESQ. 6 Clouser^Roa,�; r17GChan�csbte�, /�A /7o5s' PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610101 1505610101 J � 1505610105 REV-1500 EX DecedenYs Social Security Number � � ; DecedenYs Name: ��/Q�} � �� - - RECAPITULATION , .�,� �. �� s � 1. Real Estate(Schedule A). . .. .. .. .. . . . .. .. .. ... .. .. .. ... .. .. ... . . .. .. . 1 : ��`, � �� 2. Stocks and Bonds(Schedule B) . . . .. .. . .. .. .... . .. .. .. ... . . .. .. .... . . � � � y� � 2.- `�.` u , � � � � � � �_ . 2 � � � � � � ;� ��,� ,�a� ��a,��'��`� `` � �' �� 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. ... 3 � � � � � � � � � > � �t�,.� � �� ,�� ro �_ �� . � � O � y 4. Mortgages and Notes Receivable(Schedule D). ..... .. .. .. ..... .... . . ... . 4 � � , � . � �� '� � � � 5. Cash,Bank Deposits and Miscellaneous Personai Property(Schedule E).. .. .. . 5 � � � � ; � � t' �� +��m .� " � � � 6. Jointly Owned Property(Schedule F) p Separate Biliing Requested . . . .. .. 6 � � s� �S�3�, � S' ��g� ��,�°�� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property � � � � � � �� (Schedule G) p Separate Billing Requested.. .. .. .. 7 � � � � � � � � : �� w�� . KK 8. Total Gross Assets total Lines 1 throu h 7 •• •• •• •• ••• •• 8 � � �3� ��u �� d � � � g ).. .. .. . . ... .. .. . � � �-�' . . .. .. . .. .... .. s � � �� (p�� 7� � 9. Funeral Expenses and Administrative Costs(Schedule H). .. .. . � �� a � ��:�� `'��, � � ` � � 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) .... .. .. . . ... 10 � � � ��p�fi � � �n�,7j �� '� "*� �Fl , . � � -,. 11. Total Deductions(total Lines 9 and 10).. .. .. .. .. .. .. . .. .. . .. .. .. . .. . . .. 1 L� � � � � � _ ��0 '�� O� � - �, �� . e,n f .. 12. Net Value of Estate(Line 8 minus Line 11) .. . . .. .... .. . .. .. . .. .. .. .. .. . 12 * � � � � �Q� � �-/ � .� D �� „ a s .� � � 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which � � ' � � �� an election to tax has not been made(Schedule J) . .. .. .. . .. .. .. . .. . . .. .. 13. � � � � � d�� k�� , � � �� 14. Net Value Subject to Tax(Line 12 minus Line 13) .. .. .. .. . . . . . .. .. . .. .. . 14 � ; �� ! :t ��" � ; x ��,� � TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or ��.r+z� F ,s �tiu�w..�...a.� �� .� :,;� x �a� e�r ;�-'; transfers under Sec.9116 ° � �`' °' �' � � �� ' �a)�1.2)X.O� � � � ' � � �� Q�O� 15. �° .�� . � � ;� �� ,.';� .�� w��` �'_ � � � 16. Amount of Line 14,taxable , ; � � � /�; at lineal rate X.0� � � � � b , �� "l 16' � � � � � �� E��4:�� R�� „` A 17. Amount of Line 14 taxable � � � � � � � � � p ` 17. �� at sibling rate X.12 N s �� -� � � � � �w �a, � � � � � �� _. �.�. 18. Amount of Line 14 taxable $ � � � � Q Q at collateral rate X.15 � ` � � � � � � �� $'� �� x,�� s�n��:� �,� �_ °� �- � � � � �.� .��. s � � 19. TAX DUE .... ... .. .... . .... ..... ... .. .... .. .. .. ..... .. .. ... .. .. . .. 19. � ��.� ��,��.�. �.�� ' �. �p�� 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 � 1505610105 1505610105 � REV-1500 EX Page 3 File Number ��'�LT— Decedent's Complete Address: DECEDENT'S NAME • � !.v//�/a�'1 f f3�l�vrz� - - STREETADDRESS /OO �y A�� ^�/✓� L /r // CITY • i STATE ZiP !?�lecl�anics6 — - P/� i7ass Tax Payments and Credits: � 1. Tax Due(Page 2,Line 19) (1) �� g 2,�D 2. Credits/Payments A.Prior Payments � -- B.Discount � � --— – Total Credits(A+B) (2) 3. Interest ' � (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. D 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) �� /��'�0 • Make check payabie to: REGISTER OF WILLS, AGENT. PLEA3E 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:.......................................................................................... � 0 b. retain the right to designate who shall use the property transferred or its income:............................................ ❑ � c. retain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... � � 2. If death occurred after Dec.12, 1982,did decedent transfer properry 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 contains a 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 suroiving 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 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 transfers from a deceased child 21 years of age or younger at death to or for the use of a naturai 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 lineai beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)j. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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. � � � �� .�� .��.�� n�. . REV-iso8 EX+(ii-lo) � � pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RENRN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: � r�/,Gm J, &/�� FILE NUMBER: � 2l-/SF-- 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 l��d�n�f �u.ut. a,� nr l��uiclar,�d� ��v ��c -�=��na � i�u h°�x/e„p� yle��r�urrz �i Ar.o..t � `uoy�e�.r� `ItG� r%/��t.�r� TOTAL(Also enter on Line 5, Recapitulation) $ lf more space is needed,use additionai sheets of paper of the same size. REV-t509IX•(tA� � . SCHEDULE F COMMOMNEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY � INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ,. � FILE.NUMBER Z/,��w I�U��Qn9 �• 'Be�r� if an asset was made joint within one year of the decedenYs date of death,k must be reported on Scheduk G. SURVMNG JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. �hwror► S. woo�n a l/S ifi�6or C'L":, /ylecla�i�s6a�. P,¢ /7oSS d 4 u�tjf'e,� a. c. JOINTLY-0WNED PROPERTY: LETTER DATE DESCRIPTION OFPROPERTY %OF DATE Of DEATH ITEM FOR JOINT MADE Include nar�e of financial institution and bank aaounl number a similar identifying number.Allach y�ALUE OF A83ET INTEREST DECEDENTS INTEREST NUMBER TENANT JOINT deed for jointly-Aeld real estate. 1. A. N�/•t�� GM� �St �C�� .SM�iJ7�jS /Y�Di. No. �390 �.Z�SS�. �7 �� 1g/. Z7.!7�f / �Sf' �-L'u� �'� � No, 373�'10 ��3, 9QD�SfI SDlco �5�6,95D.Z9 �. /�. �i��4d� n'leml�rs Ac 9�2 8�f /l?�rr'►�Crs �� CU , G�ec.k; �No. �7390 �//, 5/8.09 Sbfo �S, 7S9.o� 3. I d� �SGG Se�G /7s� �� Bf G✓ertttG .�t�»/'/►1- �� N�o��ces �9�ac<u�l f1�'o) . TOTAL(Atso enter on iine 6,Recapitulation) S s3� 98S D$ (If more space is needed,inseR additional sheets of the same size) ,: ,., P:.,_ �--� .n �� :�. ,�� .�.�.�.��,a .a. ,-.�,.� .�.�.,�..� : ��,� x�, , . R . . wR� ,,_ . r�UREAU OFv INDIVIDUAL T�ES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 HARRISBURG PA 17128-0 6 01 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response REV-156S E7 DxEYEC tOD-12) FILE NO.21 ACN 13166851 DATE 12-09-2013 Type of Account Estate of WILLIAM J BELFORD Savings SSN 190-14-4473 Checking . Date of Death 11-26-2013 Trust SHARON S WOOTEN County CUMBERLAND Certificate 2118 ARBOR CT MECHANICSBURG PA 17055-5879 MEMBERS isT 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. Account No.37390 Remii Payment and Forms to: Date Established 0412-1984 REGISTER OF WILLS Account Balance $2,551_47 1 COURTHOUSE SG�UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $1,275.74 Tax Rate X 0.045 Poteniial Tax Due $57.41 NOTE': If tax payments are made within three months of the decedenYs 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 1: Please check the appropriate boxes below. 1 A �No tax is due. 1 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 noi check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above information is correct,no deductions are being taken,and payment will be sent correct. with my response. Proceed to Siep 2 on reverse. Do not check any other boxes. C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part � �p�o I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships(including none). p �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. E a 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. 5.. � ,. � , ,:� �� .,��>��..,�.,�.� �>, �;� �,��.�.�,,�. , v.. _ �.�� BUREAU OF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 HARRISBURG PA ��ze-o6o� Information Notice DEPARTMENT OF REVENUE And Taxpayer Response RFV-75�3 E%DotE%EC�.a-,�� FILE NO.21 ACN 13166852 DATE 12-09-2013 Type of Account Estate of WILLIAM J BELFORD Savings SSN 190-14-4473 Checking Date of Death 11-26-2013 Trust SHARON S WOOTEN County CUMBERLAND Certificate 2118 ARBOR CT MECHANICSBURG PA 17055-5879 MEMBERS isr 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. Account No.37390 Remit Payment and Forms to: Date Established 01-15-1998 REGISTER OF WILLS Account Balance $93,900.58 1 COURTHOUSE SOUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $46,950.29 Tax Rate X 0.045 Potential Tax Due $2,��2.7g NOTE`: If tax payments are made within three months of the decedenYs 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 1 : Please check the appropriate boxes below. 1 A �No tax is due. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years otd or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown atiove as Potential Tax Due. g �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. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part � 12% I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships(including none). p �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 ihis form. 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. P��eed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. ._., . ,.�. . . ,. . �,��-a.�.-..�.�,..�.,.: ,,,�� aw. : �H,�,�,,� BUREAU qF INDIVIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania PO BOX 280601 HARRISBURS PA 17128-D6ol Information Notice DEPARTMENTOFREVENUE And Taxpayer Response REY-1545 EII DeeEXEC f�l-12) FILE NO.21 ACN 13166853 ' � DATE 12-09-2013 ' Type of Account Estate of WIILIAM J BELFORD Savings SSN 190-14-4473 Checking • Date of Death 11-26-2013 Trust SHARON S WODTEN County CUMBERLAND Certificate 2118 ARBOR CT MECHANICSBURG PA 17055-5879 MEMBERS isT 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. Account No.37390 Remit Payment and Forms to: Date Established 04-12-1984 REGISTER OF WILLS Account Balance $11,518.09 1 COURTHOUSE SGTUARE Percent Taxable X 5p CARLISLE PA 17013 Amount Subject to Tax $5,759A5 Tax Rate X 0.045 Potential Tax Due $259.16 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 1 : Please check the appropriate boxes below. 1 A 0 No tax is due. I am the spouse of the deceased or 1 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. g �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 othe�boxes. C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,eta.)of the deceased. (Select correct tax rate at right,and complete Part � 12% 1 am a sibling of the deceased. � 3 on reverse.) � 15% AII other relationships(including none). p �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. 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 Retum filed by the estate representative. REV-1500. Proceed fo Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. � .�:� ��,� � �,�� REV-1511 EX+(10-06) ' ' SCNEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8t INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT ESTATE OF ,_ . FILE NUMBER �cli��Q/rI T. $G//�rc/ 21-��—. Debts ot decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: �iO S o '. lriyers —Qkhr,� Ficnor� �lo�re �f �1tee�ta�t��'s6sr,►� , 56,, o B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name oi Personal Representative(s) �1Q/^p�J �, �vArJ/B/� w��V� Street Address .?�/8 �/� �. City �N�J��✓1�C S�ll/-4 � State��Zip T DS Year(s)Commission Paid: 2. Attorney Fees C�4I'!�3 � ��s �. ��S�M 1 � 8'DO,o0 3. Family Exemption:(If decedenfs address is not the same as claimanYs,attach explanation) Claimant /v0 OiYF �L/6Y,l�L G Street Address City State Zip Relationship of Ciaimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees 6'ru„nQ��fc(�o, B(' ��/C'I��CS�l�lhri ��75-' �D 2 J �. �r�%/iy FeeS � /Q�yiS�tr �f' �M��s ��;Dd d Rc�m bars�m�nf�� G�has. �: �h�elds � �- c�fi� nna�►. plwfvcop,'�s, c�.(�3�,,.) �/� 7s 1 I Sb • � TOTAL(Also enter on line 9,Recapitulation) $ Q 7S (If more space is needed,insert additional sheets of the same size) , REW15k2 EX+(12-08) � �� pennsylvania SCHEDULE I DEPARTMENT OF REVENUE � . DEBTS OF DECEDENT� . � INHERFfANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF ��///a m �, �e/�� FILE NUMBER a/ ��— ( Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical eupenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �. �'Iess%ah v%/q9e �/o .Z y3, bo f�s� p merv�'s wu�� mAd� an ��ks • � /r/�ss�al� !:%/a � t.�1h�'�h ��flur w�r� !�r/�,�i 6�iti a/• �` ��. �s 9 � a�d C1ta� �ti',�.�ls or w u� � 3. /j1�ss;ah !�!/ay� �vr�,fhri a�i�i- d�..�! S, yo�.o0 'f� l.��e lSmG �YK as, r�✓r14ii��r/t� ��izc� �� . �'��S�. U TOTAL(Also enter on Line 10, Recapitulation) $ �� jl�, 3,j If more space is needed,insert additional sheets of the same size. _ r < _ . �.s,�E,�.�,.��.�,.�.�,w��M,�,. � � -�� .�- ..�.., .� .�..__ �- ' REV-1513 EX+(01-10) � pennsylvania SCHEDULE � DEPARTMENTOFREVENUE � pENEFICIARIES � � INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: , , FILE NUMBER: BG�fvrril� Gt1�l�►li►yl .7. .�-�'�`J� RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVIN6 PROPERTY Do Not List Trustee(s) Of ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and t2nsfers under Sec.9116(a)(1.2).] i• s, lcvice�n Sha ron � G�ctuc��? �'' ,Zl/g A-r-bor /Do�o /Ylp�anicsb�.r9 , PA 17oSS'-5's7q <� �TUe �tlla� Corre�' Ce�7�r�1eG� L'� � ori ha w,%l �i�rs bee� Q�firc�� e,��) - 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. 70TAL 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. , .:... � � ,� � ��.�. �..��.,.,�.�, _�: ��:.�., .�.��, ��:-� LL �� _ _ �,�,�,�..�.� � LAST WILL AND TESTAMENT OF WILLIAM J.BELFORD I,WILLIAM J.BELFORD,unremarried widower,currently of 1 East Factory Street, Apartment 3,Mechanicsburg,Cumberland County,Pennsylvania,being of sound and disposing mind, memory and understanding,do make,publish and declare this my Last Will and Testament,hereby revoking and making void any and all prior Wills and Codicils by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest,residue and remainder of my Estate,real,personal and mixed,whatsoever and wheresoever situate,I give,devise,and bequeath to my daughter,SHARON S.WOOT'EN,to her own use and benefit absolutely. 3. In the event,however,that my said daughter,SHARON S.WOOTEN,should predecease me,1 give,devise and bequeath my said Estate to be divided equally between my two granddaughters,JODI FAWBER,RN.and KELLI CASTELLANO. 4. It is my intention that beneficiaries named before or after the date of this Will on my life inswance,annuities,individual retirement accounts(IRAs),in Trust for or joint bank accounts and any other assets for which I may designate beneficiaries will receive such investments and that my Will provisions shall not control such investments. 5. I nominate,constitute and appoint my daughter,SHARON S.WOOTEN,to be the Executrix of this my Last Will and Testament. In the event that she is unable or unwilling to act as Executrix,I appoint my granddaughters,JODI FAWBER,R.N.and KELLI CASTELLANO,to be Co-Executrices in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF,I have hereunto set my hand and seal this 1�If,� day of Df,�r�Rr' ,A.D.2010. s�/w•%�%ant J. /�e��r./ (SEAL) WILLIAM J.BELFORD �<;x�,�,.��,��-�,�. � � .,�.,..�„�,�--_� �... �<T. �,�z.�.��,,� ��.��.� ��,. Signed,sealed,published and declared by the above-named WILLIAM J.BELFORD,as and for his Last Will and Testament,in the presence of us,who at his request and in his presence, and in the presence of each other,have hereunto subscribed our names as wimesses. S� Cltur(�s E: �%e�s� S�f�?�o,�t T. �'kr,�k CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG,PA 17055 GEORGE M.HOUCK TELEPHONE (717) 766-0209 (1912-1991) FAX (717) 795-7473 May 27, 2014 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of William J.Belford No. 21-14- � Dear Register of Wills: Please find enclosed for filing 2 copies of the Inheritance Tax Return for the William J. Belford Estate as well as Check No. 2353 in the amount of$15.00 for the filing fee and Check No. 2354 in the amount of$1,182.60 for the Inheritance Tax due. Thank you for your kind attention to this matter. Very truly yours, Charles E. 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