HomeMy WebLinkAbout08-18-14 J 1505610143
Ex(02-„) 1
REV-1500
PA Department of Revenue y OFFICIAL USE ONLY
p Pennsylvania county coda Year File Number
Bureau of Individual Taxes of°Aft1NENTO°”
PO BOx.2W601 INHERITANCE TAX RETURN 21 14 0270
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 10 2014 11 14 1918
Decedent's Last Name Suffix Decedent's First Name MI
KAPP ELVERTA 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
C 1. Original Return 2. Supplemental Return 3. Remainder Return(Date of Death
Pnorto 12-13-82)
4. Limited Estate ❑ 4a.Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death a8er,2-12-82)
41 B Decedent Died Testate 7, oecede❑❑t Maintred a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach CM at will) (Attach l:oor of Trued)
9. Litigation Proceeds Received 10,kt eni Ven° 90Ar08d ❑ II.Etection to tax under Sec.9113(A)
(Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SAMUEL J TRUEBLOOD 610 935 2780
-.
REGISTEWOF WILLS USE ONLY
sw F11
- G"
First Line of Address EX)_T7 C
1288 VALLEY FORGE ROAD ' . 00 --:1 T- '
cr>-�' oD :.� r�D
Second Line of Address Q C-; -''
PO BOX 987 0 , - I—,
: _ r
Cl or Post Office i3tb7'E F1LED �. r
City State ZIP Code
VALLEY FORGE PA 19482 cc
Correspondent's e-mail address: g
u, true, aR6Ct a tl complete.Declaration of preparer o her than the personal representative is had 0 on allll morma non'ofw Ich preparterfhas any knowledge belief,
B NATU OF P SO R PONSIBLE FO FRWG RETURN
Jack L. Kapp
AIID S
813 Charles Street Mec anicsbum, P 17055
SIGNATURE OF PKAAR E RE SE TIVE DA
Samuel J.Trueblood
ADDRESS
1288 Valley Forge Road, Suite 62,Valley Forge, PA
(� 1505610143 Side 1 1505610143 j
l��
1505610243
REV-1500 EX
Decedent's Social Security Number
even+'aNa Kapp, Eiverta M.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 160 , 000 . 00
2. Stocks and Bonds(Schedule B),............ ............................... ........ ........ 2.
1 Closely field Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)....... .......................... 4. 147 ,317 . 00
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 26, 936. 74
6. Jointly Owned Property(Schedule F) 0 Separate Billing Requested............ 6. 8, 987 . 09
7. Inter-Vfvos Transfers&Miscellaneous No -Probate Property
n
(Schedule G) Separate Billing Requested............ 7. 988, 157 . 98
8. Total Gross Assets(total Lines 1 through 7)..................................._................... 8. 1 ,331,398 . 81
9. Funeral Expenses and Administrative Costs(Schedule H)........._................. 30 , 890 . 60
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule t)............................ 10. 3, 526. 54
it. Total Deductions(total Lines 9 and 10)..........................................._................... 11. 34 , 417 . 14
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1,296, 981 . 67
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 ,296, 981 . 67
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under See.9116
(a)(1.2)X.00 15. 0 . 00
16. Amount of Line 14 taxable
atlineatrateX .045 1,296, 981 . 67 16. 58, 364 . 18
IT Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.1 5 0 . 0 0 1s, 0 . 00
19. TAX DUE,........... ....................................... ...................-................. 19. 58,364 . 18
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 21-14-0270
Decedent's Complete Address:
DECEDENT's NAME
Kapp,Elverta M.
STREET ADDRESS
709 Charles Street
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 56,364.16
2. CreditstPayments
A. Prior Payments 50,405.26
B. Discount 2,652.91
Total Credits(A +B) (2) 53,05617
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. (5j $,306.01
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:.................................................................._..._...... Pli
b. retain the right to designate who shall use the property transferred or its income:.............................._..o. 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 property within one year of death without
receiving adequate consideration?................................................................................................____.......... ❑ M
3. Did decedent own an"in trust for" or payable upon deathpank 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?...........__............_....__.........................................__........ ............... ❑ LJx
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONSIS 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 fort he use of the surviving spouse
is 3 percent 172 P.S.§9116(a)(1.1)(1)).
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 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)1.
• 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 172 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.
Rev4fioz EX.(01-10)
SCHEDULE A
pennsylvania REAL. ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kapp Elverta M. 21-14-0270
Allreelpro pertyawned solelyor as a tenant In common must bomportedat fair market valor.Fair market valve is defined as the price at which ptopertyvy ld be
exchangao between a willing buyer and a vill'mg seller,neither Como cempened to dry or sell,both having resson rble knowledge of the relevant(teas.
Real property that is Jolydly ownetlMM right of survtvanhip must be disclosed on schedule F.
Attach a copy of the settlement shoot if the property has been sold
Include a copy of the dead showing decedent's interest it a of od as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 709 Charles Street, Mechanicsburg, PA-Decedent's real estate consisting of a single family 180,000.00
ranch style home sold on 712114 for$160,000; tax parcel#17-24-0789-222;assessed value
162,700.
TOTAL(Also enter on Line 1,Recapitulation) 160,000.00
Of 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)
Rew1507 EX-(6-98)
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMDN 1 OF PENNBY WXN!k
INHERR RANCITANCE TAR RETURN
eE810EM DECEDENT
ESTATE OF FILE NUMBER
Kapp, Elverta M. 21-14-0270
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Promissory Notes-Decedent loaned her daughter Nannette G.Forney a sum of$140,000,as 140,0W00
evidenced by two Promissory Notes,signed by Nanette and dated February 28, 2012. No
payments were made on either Note and$140,000 plus accrued Interest in the amount of
$7,317 was due at date of death.
Accrued interest on Item 1 through date of death 7,317.00
TOTAL(Also enter on Line 4,Recapitulation) 147,317.00
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc, Form PA-1500 Schedule D(Rev.6-98)
Rev4508 Ex.(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
iNHERFIANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kapp, Eiverta M. 21-14-0270
tnoidde the proceeds of Iitipetion and the date the proceeds were reeeNed by the astme.
All property jp nfiyc.Od th tha fight of s roe hfp must 4 discios on sehodula F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 2006 Toyota Camry-4 door,V-6,33,000 miles,sold privately for$15,500 15.500.00
2 Proceeds of Sale of Contents of House-Auction sale held at house by Chuck Bricker&Mike 8,247.00
Cease,Auctioneers;sale proceeds were$10,277 less auctioneer fee of$2,030
3 AAA-Membership refund 30,92
4 American General Life-Life insurance proceeds on fife of George Kapp 54.00
5 Bogar Law Office-Additional property tax refund 185.50
6 Borough of Mechanicsburg/County of Cumberland-County/Borough tax bill pro-rate refund 247.62
7 Comeast-Refund 28.92
8 Energy Services Providers- Pre-death refund on electric account 183.92
9 Erie Insurance-Car insurance refund 761.00
10 Erie Insurance-Homeowner's insurance refund 92.00
11 Patriot News-Refund on cancellation 11.31
12 Trugreen-Refund on cancellation 200.46
13 US Treasury-Income tax refund 1,361.00
14 Verizon-Refund on termination of service 33.09
TOTAL(Also enter on Line 5, Recapitulation) 26,936.74
(it more space is needed,addillonal pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1600 Schedule E(Rev. 11.10)
Rev-1509 EX«(01-00)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE ,JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
_ Kapp Elvecta M. 21-14-0270
If an asset was made joint within one yearof the decedent's data of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Jack L. Kapp 613 Charles Street Son
Mechanicsburg, PA 17055
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY aka OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATEOFDEATH DECD'$ DECEDENT'S INTEREST
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE.
1 A 01111/2013 Members 1st FCU -Savings Account 10,005.08 50.000% 5,002.54
2 A 01/11/2013 Members 1St FCU-Checking Account 7,969.10 50.000% 3,984.55
TOTAL(Also enter on Line 6,Recapitulation) 8,987.09
(If more space is needed,additional pages of the same sue)
Copyright(C)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
Revd610 EX�fOa-0g1
SCHEDULE G
Pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kapp, Eiverta M. 21-14-0270
This sdfadule must oe computed end filed H the answer to any of questions 1 0u'ough 4 on page throe of the REVA 500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THEE DATE OF TROAFNSFTRANSFEREE FEE CH A COPY OFT THEE DEED FOR DECEDENT ESTAATE. VALUEOFASSET INTEREST (IF APPLICA94E} VALUE
1 4,995 shares of Adams County National Bank- 91,483.43 91,483.43
Common stock;TOD to Jack Kapp,Winnie Sullivan&
Nannette Forney,decedent's children
2 American Century Balanced Fund-$031-000171438 126,686.36 126,686.36
3 American Century Diversified Bond Fund-#149 101.704.59 10VO4.59
-600003846
4 American Century Growth Fund-#020-001242927 74,270.36 74,270.36
5 American Century Prime Money Market-#921 2,952.06 2,952.06
-009585922
6 American Century Ultra Fund-#020-001597114 79,590.51 79,590.51
7 E Trade-Cash Account; TOD to Jack Kapp,Winnie 9,389.14 9,389.14
Sullivan&Nannette Forney,decedent's children
8 7,139.205 shares of PIMCO Investment Grade Corp 74,319.12 74,319.12
Bond Fund- TOD to Jack Kapp,Winnie Sullivan&
Nannette Forney,decedent's children
9 13,939.95 shares of PIMCO Real Return Fund D- TOD 156,127.44 156,127.44
to Jack Kapp,Winnie Sullivan&Nannette Forney,
decedent's children
10 T. Rowe Price -Cash Account;TOD to Jack Kapp, 8,226.17 8,226.17
Winnie Sullivan&Nannette Forney,decedent's
children
Total of Continuation Schedule ee attached page
TOTAL(Also enter on Line 7,Recapitulation) 988,157.98
(it more space is Deeded,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
Roy-1510 EX+(05-09)
SCHEDULE G
Pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT continued
ESTATE OF FILE NUMBER
Kapp Elverta M. 21-14-0270
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DEWS EXCLUSION TAXABLE
NUMBER INCLUDE ATE OFF TRANTRANSFEREE TCH A COPY RELATIONSHIP F'THH ED FOR REAL ESTATE. VALUEOFASSET INTEREST {IF AAPIICABIE} VALUE
11 4,279.394 shares of T. Rowe Price Equity income Fund 141.134.41 141,134.41
- TOD to Jack Kapp,Winnie Sullivan&Nannette
Forney,decedent's children
12 1,230.663 shares of T. Rowe Price Science& 50,309.50 50,309.50
Technology Fund- TOD to Jack Kapp,Winnie
Sullivan &Nannette Forney,decedent's children
13 1,573.347 shares of T.Rowe Price Science& 71,964.89 71.964.89
Technology Fund- TOD to Jack Kapp,Winnie
Sullivan&Nannette Forney,decedent's children
TOTAL(Also enter on Line 7, Recapitulation) 988,157.98
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08.09)
REV4611".(10-09t SCHEDULE H
Pennsylvania
OEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENTT DECEDENT'R" ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Kapp Elverta M. 21-14-0270
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 567.43
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid Waived
1 Attorney's Fees Morrow,Tompkins,Trueblood& Lefevre, LLC 25,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 373.50
S. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 4,949.67
See continuation schedules)attached
TOTAL(Also enter on line 9,Recapitulation) 30,890.60
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
Kapp, Elverta M. 21-14-0270
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Koss's-Funeral dinner 567.43
2 Parthemore Funeral Home-Pre-paid funeral(life insurance policy) 0.00
H-A 567.43
Other Administrative Costs
3 AAction Lock&Door-Upkeep expense 129.00
4 Amengas-House upkeep expense 68.90
6 Barbara Lehman-Help at sale of personal property 210.00
6 Borough of Mechanicsburg-Sewer/trash fee 74.10
7 Borough of Mechanicsburg-Sewer bill pro-rate 0.92
8 Cody Reid-Help at sale of personal property 100.00
9 D&D Septic-House upkeep expense 60.30
10 Gelco Carpet Cleaning-Prepping house for settlement 228.96
11 James D. Boger Law Offices-Tax Certs 10.00
12 Kirk Kapp-Help at sale of personal property 210.00
13 Landscape by Precision-Replacement of shrub 50.00
14 Mechanicsburg School District-School tax bill pro-rate 5.15
Copyright(c)2002 farm software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kapp, Elverta M. 21-14-0270
ITEM
NUMBER DESCRIPTION AMOUNT
15 Members 1st FCU -Money Order fee 3.00
16 Members 1st FCU-Estate check fee 14.95
17 Morrow,Tompkins,Trueblood&Lefevre,LLC-Cumberland Law Journal estate notice fee 75.00
18 Morrow,Tompkins,Trueblood&Lefevre, LLC -Postage reimbursement 38.34
19 Morrow, Tompkins,Trueblood&Lefevre,LLC-The Patriot News estate notice fee 288.98
20 Parthemore Funeral Home-Death certificates of decedent's late husband 18.00
21 PP&L-House upkeep expense 388.61
22 PP&L-House upkeep expense 201.67
23 PP&L-House upkeep expense 142.06
24 PP&L-House upkeep expense 18.10
25 PP&L-House upkeep expense 84.02
26 Recorder of Deeds-Realty transfer tax 1.600.00
27 Ron Derr-House grass cutting 270.00
28 Ron Derr-House grass cutting 225.00
29 Shawn Stiffler-Help at sale of personal property 105.00
30 Stacy Kapp-Help at sale of personal property 100.00
31 Stehr's Pest Treatment-Bug treatment for house 50.00
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kapp, Etverta M. 21-14-0278
ITEM
NUMBER DESCRIPTION AMOUNT
32 United Water-House upkeep expense 17.74
33 United Water-House upkeep expense 24.31
34 United Water-House upkeep expense 11.56
35 United Water-House upkeep expense 11.56
36 United Water-House upkeep expense 17.85
37 Verizon-Upkeep expense 38.07
38 Verizon-Upkeep expense 38.52
H-87 4,949.67
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-96)
R n,A512 EX.(12-08)
SCHEDULE i
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kapp,Etverta M. 21-14-0270
Report debut incurred by the decedent prior to death that remained unpaid at the date of death,including unmimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Barry L.Heckard,Tax Collector-2014 local real estate taxes 868.78
2 Comcast-Bill of decedent 80.18
3 H&R Block-2013 income tax prep 367.00
4 PA Dept.of Revenue-2013 income tax 889.00
5 PA Dept.of Revenue-2013 income tax balance due 211.64
6 Pinnacle Health-Hospital bill 262.50
7 Pinnacle Health-Medical bill 18.50
8 PP&L-Decedent's electric bill 674.80
9 Verizon-Bill of decedent 39.23
10 Verizon Wireless-Bill of decedent 12.39
11 West Shore EMS-Ambulance bill 102.52
TOTAL(Also enter on Line 10,Recapitulation) 3,526.54
(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 1(Rev. 12-08)
REV IM EXa(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kapp,Elverta M. 21-14-0270
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (words) ($$$)
Do Not Liftf Tn�tnotft
1`. TAXABLE DISTRIBUTIONS (include outright spousal
distributions,and transfers
under Sec.9116(a)(1,2)1
Nannette Forney Daughter One-third of
4685 Miles Standish Road residue
Virginia Beach,VA 23455
Jack L.Kapp Son One-third of
613 Charles Street residue
Mechanicsburg, PA 17055
Winnie M. Sullivan Daughter One-third of
709 Roberts Street residue
Mechanicsburg, PA 17055
Total
Enter dollar amounts for distributions Shawn above on lines 15 through 18 on Rev 1500 cover sheet,as approomate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
S.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
Copyright(c)2010 forth software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)