HomeMy WebLinkAbout06-20-14 (2) J
REV-1500 EX(02-11) ],505610143
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania county code Year His Number
Bureau of Individual Taxes itv reenore.ress
PO 60x.260601 INHERITANCE TAX RETURN 21 13 1124
Harrisburg,PA 17126-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
10 02 2013 10 26 1941
Decedent's Last Name Suffix Decedent's First Name MI
STOVER JAMES 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
Q 1, Original Return 2. Supplemental Return ❑ 3. Remainder Return(Date of Death
Prior to 52-13-82)
4. Limited Estate 41L Future J acres Carr P:sent 82) ❑ S. Federal Estate Tax Return Required
o g Decadent Died Testate 7, Recede I Majger atl a Living Trust 0_ e. Total Number of Safe Deposit Boxes
(Attach Copy of will) ❑ (Aileron AGopy of Trust)
9. Litigation Pmceads Received ("� 10.Spousal P0,, Credit(Dat9 01 Death 11.Election to tax Under Sec.9113(A)
❑ LJ baMreen 12-35 X31 and t-t-95j
(Attach Schedule O) ry
CORRESPONDENT-THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAVTI(Zt HOULO�E DIF115
Name Daytime Tele6orw Number G->
MARY. A MATEYA 717 245 SgQ0 ua
7 W i
rn ^> r m
REGISTER�OF WILLS USE ONLY-,y C>
First Line of Address CO r-
55 W CHURCH AVENUE % C/»
Second Line of Address tV
DATE FILED
City or Post Office State ZIP Code
CARLISLE PA 17013
Correspondent's e-mail address: mam(wmatevalaw 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 6etief,
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.
SIGNA RE OF PARSON RESPONSIe FOR F ING RETURN DfATE
7r���!� /'yam, Linda Watson ZT lc —��
ADDRESS
523 Springfield Road Shippersburg, PA 17257
SIGNATURE OF P EP OTHER THAN REPRESENTATIVE DATE
Mark A. Mateya Ga
ADDRESS
55 W.Church Avenue,Carlisle PA
Side 1
15115610143 150561143
1505610243
REV-1500 EX
Decedent's Social Security Number
D} de fsName. Stover, James Monroe
RECAPITULATION
1. Real Estate(Schedule A)..................................................................._................,. 1. 83 ,. 700 . 00
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........___... ... .....___............ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)....____ 5. 56, 928 . 55
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested,.......... 6.
7. Inter-Vivos Transfers&Miscellaneous t{on,•Probate Property
(Schedule G) �{ Separate Billing Requested_.......... 7, 164 , 994 . 03
8, Total Gross Assets(total Lines 1 through 7)........ .........................._.,..... 8. 305, 622 .58
9. Funeral Expenses and Administrative Costs(Schedule H)._..........._............. 17 , 965 . 46
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule l)1_1..."I...... 10. 1, 659. 58
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 19, 625 . 04
12. Net Value of Estate(Line 8 minus Line 11)........................................................_ 12. 285, 997 .54
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. 285, 997 . 54
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sao,9116 184,079 20 15 0 . 00
(a)(1.2)X.00
16. Amount of Line 14 taxable 101, 918 . 34 16. 4,586 . 33
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable 0 . 00 18. 0 . 00
at collateral rate X.15
19. TAX DUE...................... ....... ........................... ................................. ..... 19. 4 ,586.33
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-1124
Decedent's Complete Address:
DECEDENT'S NAME
_ Stover, James Monroe _
STREET ADDRESS 1638 Williams Williams Grove Road
CITY STATE ZIP
Dillsburg PA 17019
Tax Payments and Credits:
1, Tax Due(Page 2, Line 19) (1} 4,586.33
2. Credits/Payments
A. Prior Payments 2,500.00
B. Discount 131.58
Total Credits(A +B) (2) 2,631.58
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) 1,954.75
Make Check Pa able to: REGISTER OF WILLS, AGENT.
7777 7777777777,
„,...
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;....._........................................................................ x
b. retain the right to designate who shall use the property transferred or its income;.._..............................
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 rr11
receiving adequate consideration?................................................................................................................_.. 11 Exi
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?....._,..._.................................._ ...................................._........................,. ❑x ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE 0 AND FILE IT AS PART OF THE RETURN.
For dates of death an 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 172 P.S.§9116(a)(11)(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's 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 prior the use of a natural parent,an
adoptive parent,or a stepparent of the child is 0 percent 172 P.S.§9116(a)(11)).
• The tax rate imposed on the net value of transfers to or forthe use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 172 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.
LAST WILL AND TESTAMENT
I, JAMES M. STOVER, of the Township of Monroe, County of
Cumberland and Commonwealth of Pennsylvania, being of sound and
disposing mind, memory and understanding, do make, publish and
declare this as and for my Last Will and Testament, hereby
revoking and making void all former wills and codicils by me at
any time heretofore made.
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executor or Executrix, as the case
may be, hereinafter named, as soon as conveniently may be done
after my decease.
SECOND. I give, devise and bequeath my automobile and my
home real estate at 1638 Williams Grove Road, Monroe Township,
Cumberland County, Pennsylvania, together with the furnishings,
fixtures and furniture therein, unto my wife, MARY E. STOVER,
Absolutely and in fee simple', if she survives me. If my said
wife does not survive me, then and in that event, I give, devise
and bequeath said automobile and real estate in equal shares unto
my daughters, namely, JAMIE S. LEBO and SONYA S. McGUIRE, share
and share alike, absolutely and in fee simple.
THIRD. I order and direct that all the rest, residue and
remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situated, shall be converted into cash as soon as
practicable after my death, and then divided into four (4) equal
parts which shall be distributed and disposed of as follows:
a. I give and bequeath two (2) such equal parts
of my residuary estate unto my wife, namely, MARY E.
LAW OFF'.0 Tt
u'NELBAKER STOVER, absolutely, if she survives me. If my said
BRENNEMAN
wife should predecease me, then and in that event, I
give and bequeath one (1) such equal part unto each of
my daughters, namely, JAMIE S. LEBO and SONYA S.
McGUIRE, absolutely.
b. I give and bequeath one (1) such equal part
unto my daughter, namely, JAMIE S. LEBO, absolutely.
c. I give and bequeath one (1) such equal part
unto my daughter-, namely, SONYA S. McGUIRE, absolutely.
LASTLY. I nominate, constitute and appoint my brother,
namely, GERALD R. STOVER, to be the Executor of this, my Last
Will and Testament, but if for any reason he should fail to
qualify as such Executor or cease so to serve, then and in that
event, I nominate, constitute and appoint my sister, namely,
LINDA G. WATSON, to be the Executrix hereof, each and both to
serve without bond or other security as a condition of
qualification hereunder.
IN WITNESS WHEREOF, I, JAMES M. STOVER, have hereunto set
my hand and seal to thus, my Last Will and Testament which
consists of two (2) typewritten pages to each of which I have
affixed my signature this .2rAt. day of r�/��y�- A.D. , One
Thousand Nine Hundred Ninety-four (1994) .
M(SEAL)
James M7 .over
The preceding instrument, consisting of this and one (1)
other typewritten page, each identified by the signature of the
Testator, was on the date thereof signed, sealed, published and
declared by JAMES M. STOVER, the Testator therein named, as and
for his Last Will and Testament, in the presence of us, who, at
his request, in his presence and in presence of each other,
have subscribed our names as witnesses
LAW OFFICES �Y.l-C. .:L4'.(!sG�Cl+t°L--•"
" $NELHAKEft - '
BRENNEMAN
-2-
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
We, JAMES M. STOVER, RICHARD C. SNELBAKER and JANET R.
STEGNER, the Testator and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testator signed and executed the instrument as his Last
Will and Testament and that he had signed willingly, and that he
executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the Will as a
witness and that to the best of his or her knowledge the Testator
was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
e tar
Witness
Witntrss
Subscribed, sworn to and acknowledged before me by JAMES M.
STOVER, the Testator, and subscribed and sworn to before me by
RICHARD C. SNELBAKER and JANET R. STEGNER, witnesses, this
day of 1994. _,,,L�
Not try Public
tAw ays�ces
SNELBAKER NO2�iiil SEA
g P,aMaL+J.7tKx��son. P�At��+I..C„..ww
aRENNEMAN �rydLt'((��p apftY,�wwy
My Cbnu'f��lon E�yrres Gac 31,1994
vsyFs�Ass�in d
Rav41602 EX-(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stover,James Monroe 21-13-1124
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
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate-1638 Williams Grove Road -Pin#22.12-0350.014-Assessed value See Attached 83,700.00
TOTAL(Also enter on Line 1,Recapitulation) 83,700.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10)
Property Mapper
Cumberland County, PA
FERRY COUNTY
COI-
'tea t � 1 C � y� •� � I. 1 r ..
YORK COUNTY
1 1
WILLIAMS ROVE ROAD
Land t 1�p Code: 101
Arrpage� 0.08
Squaie Feet: 1290
w � `
r.
4 �
m
pi
5.-1
d V31Ue $: 27500
Copyright 2011 Esri. All rights reserved. Fri Oct 4 2013 11:41:16 AM.
1638 WILLIAMS GROVE ROAD
PIN: 22-12-0350-014
Deedbook: 0026U-00672
'Owner: STOVER, JAMES M,
Land Use Code: 101
Property Type: R
Acreage: 0.08
Square Feet: 1290
Taxable Status: T
Clean & Green Status:
Land Assessed Value $: 27500
Building Assessed Value $: 56200
Total Assessed Value $: 83700
Sale Price $: 1
Sale Date: Tue Sep 21 1976 08:00:00 PM
Year Built: 1910
Municipality: MONROE TOWNSHIP
Height in Stories: 2
Type of Dwelling: DUPHLF
Primary Exterior: Vinyl
Basement Percentage: 75
Air Conditioning: NO
Total Rooms: 6
Bedrooms: 2
Full Bath: 1
Half Bath:
Rev-1509 EX-(11-10)
SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAI(RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stover James Monroe 21-13-1124
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 M&T Bank-Checking Account-1136585 11,712.36
2 M&T Bank-Savings Account No. 15004198353771 28,360.14
3 Novitas Solutions-Refund of Medicare Part B Insurance 7.35
4 Pershing LLC-Investment account No. AZD803849 (formerly M&T Securities) 5,034.00
5 Automobile -2001 Toyota Tacoma Truck-See Kelley Blue Book Appraisal attached 5,300.00
6 Automobile-1999 Toyota Carl-See Kelley Blue Book Appraisal attached 1,500.00
7 Miscellaneous Household 5,000.00
8 Novitas Solutions, Inc-Refund of Medicare Part B 14.70
TOTAL(Also enter on Line 5, Recapitulation) 56,928.55
(If 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)
Kelley Blue Book Page 1 of 2
5 Kelley Btue Book The Trusted Resource"
CHEVROLET HNIIN[WROA03'
Pewstisemen[ Why ads?
2001 Toyota Tacoma Regular Cab
Pricing Report
---- Style:Short Bed
Mileage:i50000
Private Party Value
Excellent
$5,868
Very Good
$5,543
Good
$5,368
Fair
$4,743
Vehicle Highlights
Fuel Economy: Max Seating:3
City 19/Hwy 23/Comb 21 MPG
Doors:2 Engine:4-Cyl,2.4 Liter
Drivetrain 2WD Transmission:Manual,5-Spd
EPA Class:Small Pickup Trucks Body Style:Pickup
Country of Origin:Japan Country of Assembly:United States
Your Configured Options
Our pre-selected options,based on typical equipment for this or.
/Options that you added while configuring this car.
http://www.kbb.com/toyota/tacoma-regular-cab/2001-toyota-tacoma-regular-cab/short-be... 10/11/2013
Kelley Blue Book Page 1 of 2 /
Keltey Btue Book The Trusted Resource*
dig
CHEVROLET
:s
FINDNFWpbh
MQ emaflMlh Wily ads?
1999 Toyota Camry
Pricing Report
Style:CE sedan 40
Mileage:tsg000
Private Party Value
Excellent
$2,233
Very Good
$2,058
Good
$1,958
Fair
$1,558
Vehicle Highlights
Fuel Economy: Max Seating:5
City 20/Hwy 28/Comb 23 MPG
Doors:4 Engine:4-Cyl,2.2 Liter
Drivetrain:FWD Transmission:Automatic
I
EPA Class:Midsize Cars Body Style:Sedan
Country of Origin:Japan Country of Assembly:United States
Your Configured Options
Our pre-selected options,based on typical equipment for this car.
l Options that you added while configuring this car.
http://www.kbb.com/toyota/camry/1999-toyota-camry/ce-sedan-4d/?pricetype=private-pa... 10/11/2013
Rev-1510 EX+(08.09)
SCHEDULE G
Pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stover,James Monroe 21-13-1124
This sohedde must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OFDECDS EXCLUSION TAXABLE
.NUMBER THE DATE OF TRANSFERS ATTACH A COPY OF RELATIONSHIP DEED OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Allstate Life Insurance Company-Performance Plus 153.736.31 153,736.31
Annuity-Acct GA17666612
2 Central Pension Fund-International Union of 1,229.88 1,229.88
Operating Engineers-Oct. Pension -check No.
02984697
3 M&T Bank-IRA Account No. 35004110092779 10,027.84 10,027.84
TOTAL(Also enter on Line 7, Recapitulation) 164,994.03
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 Ex-(1049)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENT ED RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stover, James Monroe 21-13-1124
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
UMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,377.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attorney's Fees Mateya Law Firm, P.C. 12,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 368.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 3,219.96
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 17,965.46
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Stover,James Monroe 21-13-1124
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Ewing Brothers Funeral Home-Funeral Services 2,377.00
H-A 2,377.00
Other Administrative Costs
2 Cumberland Law Journal -Legal Advertisement 75.00
3 Direct TV-Cable Television Service at residence-Acct No. 82660975-Service for 10/12/13- 77.72
11/11/13
4 Mateya Law Firm, P.C. -invoice 3890; Legal work to secure guardianship prior to decedent's 2,625.00
passing;Total $3,375.$750 was paid in cash from outside of the estate on September 20,
2013;the balance is$2,625.00
5 Met Ed -Electric Service-Acct. 100 020 784 862; Service from 09/14/13 -10116/13 138.91
6 The Sentinel -Legal Advertisement for Estate 221.40
7 Three Springs Family Practice-Expert opinion for Guardianship proceedings 50.00
8 Verizon-Telephone service at residence-Account No. 717 432-4935 555 27Y-Service dates 31.93
10104/13-11103113
H-B7 3,219.96
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 E%-(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stover, James Monroe 21-13-1124
Report debts Incumed by the decedent prior to death that mmalnod unpaid at the dale of death,Including unmlmbursed medical expanses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Dillsburg Ambulance Service-Ambulance Service on 9/16113 975.50
.2 Direct TV-Cable Television Service at residence-Acct No. 82660975 -Service for 9/12113- 77.72
10/11/13
3 Met Ed-Electric Service-Acct. 100 020 784 862; Service from 08116/13-09113/13 35.12
4 Pinnacle Health -Medical Services-Account No. 51755 539.39
5 Verizon -Telephone service at residence-Account No. 717 432.4935 555 27Y-Service dates 31.85
09/04113-10/03/13
TOTAL(Also enter on Line 10, Recapitulation) 1,659.58
(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. 12-08)
REV-1513 EX-(01.10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stover, James Monroe 21-13-1124
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Tn.te.
I TAXABLE DISTRIBUTIONS (include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Jamie S Lebo Child Twenty-five
910 Penn Street (25%) percent of
Steelton, PA 17113 residue
2 Sonya S Shealy Child Twenty-five
480 Mt.Airy Road (25%)of residue
Lot#15
Lewisberry, PA 17339
3 Mary Stover Spouse Fifty(50%)
1638 Williams Grove Road percent of
Dillsburg, PA 17019 residue, real
estate,autos&
140ti 5 ElS oLD
(,00,D5
Total
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet,as appropriate.
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 It -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 01-10)