HomeMy WebLinkAbout08-22-14 .J REV-1500EX(01-10) 1505610143
'L17' OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF aevexua
PO BOX.280601 INHERITANCE TAX RETURN 2 1 13 0799
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 01 2013 09 23 1929
Decedent's Last Name Suffix Decedent's First Name MI
BURK RENA G
(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
® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(date of death
prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a, Future Interest Compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
❑ g Decadent Died Testate ❑ T Decadent Maintained a Living Trust 0 8. Total Number Of Safe De
(Attach Copy of W ll) (Attach Copy of Trust) Deposit Boxes
❑ 9. Litigation Proceeds Received ❑ 10.Spousal poverty Credit(date of death 11.Election to tax under Sec.9113 A
betwee 12-31-91 and 1-1-95)n ❑ ( )
(Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
CRAIG A DIEHL ESQUIRE CPA 717 763 7613
REGISTER OF WILLS USE ONLY
First line of address o
3464 TRINDLE ROAD c o L n
3' :;0 _ G')
Second line of address WD v
v N m rrn
City or Post Office State ZIP Code ^DATEPILEDN r.J
J c-3
CAMP HILL PA 17011 O O C,
c c->
t� r m
_1 r
Correspondent's e-mail address: cdiehl@cadlehilaw.com Cn
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, - rrect and complete.Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGN R F ERSON ESjj0J IBLEF FILING RETURN DATE L
kULGQP Kathy L Hughes
ODRESS
740 Kise Mill Road, York Haven, PA 17370
SIGNATURE OF PREPARER THER THA PRESENTATIVE DATE
l.a.heM Q �� Craig A Diehl Esquire CPA
ADDRESS
3464 Trindle Road, Camp Hill, PA 17011
Side 1
1505610143 1505610143 J
r0,
1505610243
REV-1500 EX
Decedent's Social Security Number
oeceaenr:Name: BURK, RENA G.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1. 159 , 900 . 00
2. Stocks and Bonds(Schedule B)............................................................................... 2. 8 , 822 . 44
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 1
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 52 , 939 . 65
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 1-7)....................................................................... 8. 221 , 662 . 09
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 57 , 953 . 78
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 46 , 696 . 73
11. Total Deductions(total Lines 9&10)...................................................................... 11. 104 , 6 5 0 . 51
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 117 , 011 . 58
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. 117 , 011 . 58
TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 16.
17. Amount of Line 14 taxable
at sibling rate X .12 117 , 011 . 58 17. 14 , 041 . 39
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due..................................................................................................................... 19. 14 , 041 . 3 9
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 - 0799
Decedent's Complete Address:
DECEDENTS' NAME
Burk, Rena G.
STREET ADDRESS
2704 Lisburn Road
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 14,041.39
2, Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. interest
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) 14,238.27
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;.....__........................................................................ 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 December 12, 1982, did decedent transfer property 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?......... ❑ Q
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which f`�
contains a beneficiary designation?.........................-........................................................................................... ❑ l X I
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)(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)(it)]. 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 172 P.S.§9116(a)(12)].
•The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 12)[72 PS,§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,w ether y bloo or adoption.
SCHEDULE A
wnDNwFacTHOF rEEeaunuuaw REAL ESTATE
INHERITANCETM% TURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Burk, Rena G. 21 - 13- 0799
At!real property awned 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 wiling seller,neither being compelled to buy or sell,both having
reasonable knowledge of the relevant facts. Real property which 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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 2704 Lisburn Road 159,900.00
Camp Hill, PA 17011
Parcel ID No. 13-10-0258-009, Deed Book and Page 25C-00888
(Value Based on Current Listing Price-See Exhibit°1"Attached)
TOTAL(Also enter on Line 1,Recapitulation) 159,900.00
8118/2014 Mew Uslings
Central Penn Multi-List, Inc.
Agent Detail Print
DENISE A MIG F!ont of Hone' °
PHONE(717)554-8611
RSR, REALTORS,LLC Active Al
damio(o)rsrrealtors com :>' y';;,br�l "• List Price
Address 2. e,
S City C.
I � Area
„I
County Cure
' Design Split t
Views c L # Bdrms 3 '�
Virtual Tour #FP 1
Agent 1 page Liv Rm Dim 19x12 Level2 Fireplace-wood, W
Din Rm Dim 12.7x10.3 Level 2 Wood Floor ;
Listings Kitchen Dim Level �l
Fam Rm Dim 26x15.10 Level 1 Wall To Wall Carpe
NIL& 10250103 Price:$159,900 Den Dim �
M BR Dim 14.6x13 Level Wood Floor
BD1 Dim
BD2 Dim 13x11.10 Level Wood Floor I
BD3 Dim 12.7x9.8 Level Wood Floor _
BD4 Dim
BD 5 Dim
Laundry Ro... 13x9.10 Level 1 Composite Tile
{f+I
Tax 2,355 Tax Year 2013-14 Acres 0,2600 Ai!
Square Ft Source Public Records Square Feet Above G Iry.
Condo No Fee 0 Fee Frequency q
i
Const Stick Built J
Ext Alurrnunj Brick
Roof Asphalt/Fiberglass �
APPI Refrigerator
Ext Fea Porch
Equip None
Dining Formal Dining Room
Parking 2 Car Garage, Detached �Fi
Cool Central Air l
Amen
Heat Oil
Aux Heat Fireplace
Basement Crawl Space
Hfi
1'
C X r\q�,�Lt Possible Short Sale: No
Public View SPECTACULAR backyard views!This spacious home
Remarks den/farrly room rain bath, laundry, and foyer and
Back yard has plenty of space for entertaining and t
shopping, restaurants, etc.
School District: West Shore
Elementary School: Middle S4
ir: FROM 15 S. to Slate Hill Rd. Exit, Left on Lisburn, home on
r is ..+b.. c L _ .,n:.-la b.d...f`w..a•�e,_ Ca•�r...
hffp://cprN.paregmrels.eonJpublinWdefault.asp#GUID=61f32566-b732-40b4-aac&9cala85650468Report=Yes 112
SCHEDULE B
COMMONW THOFPENNSYLVANIA STOCKS & BONDS
INHERITANCET"RETURN
RESIDENT DECEDENT
ESTATE OF Burk, Rena G. FILE NUMBER
21 - 13-0799
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 Comcast Corporation -92 Shares 40.17 3,695.64
2 27 Series EE U.S. Savings Bonds 2,187.64
(See attached Exhibit"2"for detailed listing)
3 AT&T, Inc. -84 Shares 34.99 2,939.16
TOTAL(Also enter on line 2, Recapitulation) 8,822.44
Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 06/2013
'Total 675.00 $2,187.64 $11M.64 $48.18
Bonds: 1-27 of 27
L546509820 EE $50 04/1996 10/2013 04/2026 $25.00 $25.00 0.59%
L449730956 EE $50 12/1989 12/2013 12/2019 $25.00 $5516 4.00% $8016 ,--
L448718280 EE $50 11/1989 11/2613 11/2019 $25.00. $55.16 4.00% $80 16;
L449603077 EE o
$50:10/1989;10/2013 10/2019 $25.00 $5516 4.00 , $80.16' _
1-433639665' EE o
$50'09/1989 09/2013 09/2019 $25.00 $55.16 ,4.00/o $80.16:
1-448518859 EE :_ $50 09/1989 09/2013 09/2019 $25.00 $55 16 4 00% .. ,-$80 16
1-432198197 EE $50 08/1989 08/2013 08/2019 $25.00 $55.16 4.00% $80.16
_ ._. _ ._
L432073413 EE $50 07/1989 07/2013 07/2019 $25.00 $55.16 4.00% $80.16
1-430471957 EE $50 07/1989 07/2013 07/2019 $25.00 $55.16 4.00% $80.16
L430330037 EE $50 06/1989 12/2013 06/2019 $25.00 $56.76 4.00% $81.76; _.
L416689677 EE
1-409983640 $50,05/1989 1.1/ ,. . ._ o
$8176
EE- . "_" 201305/2019 $25.00 $5676 ,4.00%
10/2013 04/201.9 $25.00 $56 76 4.00% $81.76
L416768637 EE .
$50.04/1989 10/2013 04/2019 $25.00, $56.76 4.00/o: $81.76;
1-409823248_ EE $50 03/1989 09/2013 03/2019 $25.00: _$56.76,_ 4.00%
L407633162 EE $50 02/1989108/2M 02/2019 $25.00 $56.76 4.00% $81.76
1-407498784 EE $50 01/ 99.07/2013. 01/ 019 $25.00 $56.76 4.00%
, ..$81.76
1-404925449 EE o
$50 12/1988 12/2013 12/2018 $25.00 $58.40 4.00/o $83 40
L404803964 EE $50 12/1988 12/2013 12/2018 $25.00 $58.40 4.004 $83.40-
L401833781 EE $50 11/1988 11/2013 1112018 $25.00
$587401 °
L396825613 EE $50 10/1988 10/2013 10/2018 $25.00 $58.40 4.00%'
1-396655480 EE $50 09/1988.09/2013 69/2018. $25.00. $58.40 4.00% $83.40:
1-396532296 EE $50 09/198809/2013 09/2018 $25.00 $58.40 4.00%
..
$83.40"
1-3 80592003 EE $50.08/1988'08/2013 08/2018 $25.00: $58.40 4.00% $83.40:
1-376816212 EE $50 0541988 11/2013 05/2018 $25.00 $60.66 4.00% $85.06:
1-369114439 EE $50 04/1988 10/2013 04/2018 $25.00 $60.06 4.000%. $85.06
1-368924550 EE $50 03/198809/2013 03/2018 $25.00 $60.06 4.06% $85.06.
L366440274EE EE o
$50 03/1988 09/2013 03/2018 $25.00 $60.06 4.00/o. $85.06.
Totals for 27 Bonds $675.W$1,512.64 2 187.64'
IS. F
NI 'Not Issued
NE Not eligible for payment
PS Includes 3 month interest penalty
MA Matured and not earnin interest
c 11
http://www.treasurydirect..gov/BC/SBCPrice 9/10/2013
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
CDNINHERAAN EDTMRMRNMw PERSONAL PROPERTY
RESIDENTDECEDE T
ESTATE OF Burk, Rena G. FILE NUMBER
21 - 13-0799
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 OF
NUMBER DESCRIPTION
DEATH
1 2000 Chevrolet Malibu 4,000.00
Fair condition, 60,000 miles
(Value Based on Sale Price to Private 3rd Party)
2 Belco Community Credit Union -Savings Account Ending in 80 7,552.26
3 Belco Community Credit Union-Whatever Club Account Ending in 80 124.75
4 Belco Community Credit Union -Checking Account Ending in 80 19,045.11
5 M&T Bank-Checking Account Ending in 9891 20,152.95
6 AT&T, Inc.- Uncashed Dividend Checks 102.47
7 Household Furnishings 50.00
8 Costume Jewelry 1.00
9 M&T Bank-Savings Account Ending in 924 846.92
10 Fidelity Investments - Pension Check 1,064.19
TOTAL(Also enter on Line 5,Recapitulation) 52,939.65
n'A' SpCAHL EDUL�E�HGF�f�
COMMONWEALTH OF PENNSYLVANIA r V1YE1�BE`S^`^
INHERITMCETAXREURN
ftES OECEOENT ADMINISTRATIVE COSTS
ESTATE OF Burk, Rena G. FILE NUMBER
21 - 13-0799
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Hoover-Boyer Funeral Homes, Inc. - Funeral Services - 8,840.00
2 Hoover-Boyer Funeral Homes, Inc. -Original Death Certificate Fee 19.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Kathy L. Hughes 9,799.86
Street Address 740 Kise Mill Road
city York Haven State PA zip 17370
Year(s)Commission paid
2. Attorney's Fees Law Offices of Craig A. Diehl 9,066.48
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 Cumberland County Register of Wills 423.50
Cumberland County Register of Wills-Additional Short Certificates 30.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Law Offices of Craig A. Diehl - Postage Reimbursement for DPW letter 6.11
TOTAL(Also enter on line 9, Recapitulation) 57,953.78
w
Schedule H p
COMMONWEALTH OF PENNSYLVANIA Funera) &
INHERITANCE TAX RETURN Administrative Costs continued
RESIDENT DECEDENT
ESTATE OF Burk, Rena G. FILE NUMBER
121 - 13 -0799
2 Cumberland Law Journal-Estate Advertisement 75.00
3 The Sentinel-Estate Advertisement 200,16
4 Jan L. Brown-Legal Advice 250.00
5 Roland Johnson -Appraisal Fee 200.00
6 Bonnie K. Miller-2013-2014 Real Estate Taxes 1,450.07
7 Derr's Trash Hauling- Removal of Household Items at 2704 Lisburn Road 1,150.00
8 Heather Johnson - House Cleaning at 2704 Lisburn Road 400.00
9 Ron Hoover-Painting at 2704 Lisburn Road 1,500.00
10 Kirby's Remodeling and Flooring-2704 Lisburn Road 828.31
11 Carpet Mart- Repair Bathroom Floor at 2704 Lisburn Road 80.41
12 Buchanan & Erb-Replace Furnace at 2704 Lisburn Road 1,072.00
13 Buchanan & Erb- Heating Oil for Furnace at 2704 Lisburn Road 2,369.46
14 Steve Billows -Floor Repair at 2704 Lisburn Road 1,805.45
15 Erie Insurance-Homeowner's Insurance at 2704 Lisburn Road 91.25
16 Boyer-Hoover Funeral Home- Original Death Certificate Fee 19.00
17 Fred Weiand-Repair Hardwood Floors at 2704 Lisburn Road 2,802.00
18 Comprehensive Remodeling, LLC-Plumbing at 2704 Lisburn Road 196.00
19 Sherwin Williams-Paint at 2704 Lisburn Road 99.85
20 Lowe's-Home Supplies and Materials for 2704 Lisburn Road 471.38
Page 2 of Schedule H
„ ,S�c Wula H
COMMONWEALTH OF PENNSYLVANIA �u���
INHERITANCE TAX RETURN Administ mWe Casts continued
RESIOENT DECEDENT _
ESTATE OF Burk, Rena G. FILE NUMBER
21 - 13- 0799
21 Rick Drawbaugh-Stove Installation at 2704 Lisburn Road 550.00
22 Home Depot-Supplies and Materials at 2704 Lisburn Road 45.53
23 Steve Billow-Trim Repair at 2704 Lisburn Road 200.00
24 Barbara Schorr-Reimbursement of Money Advanced for Painter at 2704 Lisburn 640.00
Road
25 Shatzer Roofing - Replace Roof at 2704 Lisburn Road 7,480.00
26 M&T Bank-Returned Check Fee 40.00
27 Pincin Plumbing-Install Dishwasher at 2704 Lisburn Road 198.00
28 Bonnie K. Miller-2014-2015 County Real Estate Taxes 778.92
29 Speedway Auto-Repairs to Chevy Malibu 201.40
30 Enders Insurance- 1st Quarter Homeowner's Insurance at 2704 Lisburn Road 757.42
31 Kathy L. Hughes-Reimbursement for Battery Replacement for Lawn Mower 40.00
32 Barbara Schorr- Reimbursement of Money Advanced to PP&L Electric for Electric 448.83
Bills Paid
33 Buchanan & Erb-Repair Air Conditioning Unit t Water Pipe 314.00
34 Law Offices of Craig A. Diehl- Legal Fees to Investigate Theft of Decedent's Money 1,500.00
35 Bonnie K. Miller-2014-2015 Real Estate Taxes 1,494.39
36 Cumberland County Register of Wills-File Family Settlement Agreement 20.00
Page 3 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COM1NH5RR1TMCETMRMRNMw LIABILITIES, & LIENS
RESEIENT DECEDENT
FILE NUMBER
ESTATE OF Burk, Rena G. 121 - 13 -0799
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
i Country Meadows West Shore 4-Health Care Services and Residency Fee 45,647.62
2 PP&L- Electric Bill 17.82
3 AT&T-Phone Bill 60.45
4 All Better Care-Medical Bill 31.84
5 Penn Credit- Cell Phone Bill 139.00
6 Huggler&Sons Masonry-Home Repair Bill 800.00
TOTAL(Also enter on Line 10,Recapitulation) 46,696.73
REV-1513 EX.(11.08) Q�
SCHEDULEJ
COMMONWEALTH INHERITANCE E DTAXR RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Burk, Rena G.
21 - 13-0799
NAME AND ADDRESS OF PERSON(S) ELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER RECEIVING PROPERTY ) on DE CEDENTeIs) (Words) ($$$)
I, TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Barbara B. Schorr Sister 1/5 Residual 20,594.04
110 Hampden Avenue
Camp Hill, PA 17011
2 Joan Enders Sister 1/5 Residual 20,594.04
439 Matamoras Road
Halifax, PA 17032
3 Lucille Havens Sister 1/5 Residual 20,594.04
1515 Ocean Drive
Vero Beach, FL 32963
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
REV-1513 EX.(9.00) V�
SCHEDULEJ
COMMONWEALTH INHERINCE TAX RETURN RN BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Burk, Rena G.
21 - 13 -0799
NAME AND ADDRESS OF PERSON RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER RECEIVING PROPERTY (S) DECEDENT (Words) ($$$)
Do Not List Teuslee(s)
I, TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
4 Randy Bowman Brother 1/5 Residual 20,594.04
3218 West Hood Avenue
Santa Ana, CA 92704
5 Owen Bowman Brother 1/5 Residual 20,594.03
3258 Peters Mountain Road
Halifax, PA 17032
Page 2 of Schedule J