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J 1505610105 REV-1500°``02_ll"�' :` lvanid OFFICIAL USE ONLY PA Department of Revenue pennns Y County Code Year File Number Bureau of Individual DE-7—Taxes OF FEV UE PO BOX 28o6oi INHERITANCE TAX RETURN Harrisburg,PAi7i28-06oi RESIDENT DECEDENTI ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY . . ...... ..................................................................................................._............_.... ._............_.............._...._.......................................................................... 04/16/2013 07/03/1948 .............:...._.............._.........................._.............................._.............._............_..................... .................................................................................._............... ............................_........................................................................................ Decedent's Last Name. Suffix Decedent's First Name MI Bartlett David A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI _............._............................._........................._.................... _....... ................_..............._....................._........_......................__.................-............_............................. ..............., Bartlett Helen S .... Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ........_ FILL IN APPROPRIATE OVALS BELOW CID 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 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 Schedule O) CORRESPONDENT— THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATICt"HOULD BE DII'R CTED TO: Name Daytime T� e NumbeF M ................................_.._............................................................_............................................................_........................................................._................_....................................................................................._........ . ......._............................................. i...... .............., i S ? C'S Michael Cherewka, Esquire (717) 2g1.'-4 01 0 -' e . REGISTER O'WIL"SE ONLY r�W First Line of Address 624 North Front Street .._....._.__..............__..... .............._............_........................................-................................._..-....: rV rte- rn Second Line of Address t–` Cn O __...........__.._........_..._....._.__._.._......-._..-......................-........ ..............-...-.... .._..._.-......_.........--._._...._._-_................._....-.._... ........_........-.............-....._.-......._..........., G) `T7 ........................_......................................................................._..........-......_......._..................._......_............._..._..........__..........._.............................. DATE FILED City or Post Office State ZIP Code Wormleysburg PA 17043 Correspondent's e-mail address: mcherewka@cherewkalaw.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 PERSON RESPONSIB FOR FILING RET •N DATE ADDRESS 480 Nursery Drive, North, Mechanicsburg, PA 17055 SIGN PA T E THAN REPRESENTATIVE DATE n ^� IU O • ADD E 'S 624 North Front Street, Wormleysburg, PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number ..........................1--1.1---_-........... ............ Decedent's Name: David A. Bartlett RECAPITULATION ................................................ ................................................................................ 1. Real Estate(Schedule A). .......... .................. ................ 1 0.00 2. Stocks and Bonds(Schedule B) . ...................................... 2. 37,961.27 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .... . 3. 0.00 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)...... . 5. 1,000.00 6. Jointly Owned Property(Schedule F) C=:) Separate Billing Requested ....... 6. 383,134.50 .......... 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C=D Separate Billing Requested..... ... 7. 122,651.82 8. Total Gross Assets(total Lines 1 through 7)..... ........................ 8. 644,747.59 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 25,511.18 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)..... ..... ..... 10. 1 0.00 11. Total Deductions(total Lines 9 and 10)................................ . 11. 25,511.18 12. Net Value of Estate(Line 8 minus Line 11) ........................... ... 12. 519,236.41 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ....................... . 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 619,236.41 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 o 45 519,236.41 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 16. 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. .................................................................................................................................................... 19. TAX DUE . .. ........... ......................... .................. 19. ` 0.00 ........................................................................................................................................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=) Side 2 15051310205 1505610205 REmamsx(Fl) Page u rile Number Decedent's Complete Address: 21'13'1174 DECEDENT'S NAME David A. Bartlett 480 Nursery Drive, North Mechanicsburg PA 17055 Tax Payments and Credits: l. Tax Due(Page 2,Line 19) (1) 0.00 l Credits/Payments A.Prior Payments B.Discount Total Credits(A+8) C2) 0.00 3. interest (3) (lUO 4. IfLine 2isgreater than Line I +Line 3.enter the difference. This inthe OVERPAYMENT. Fill inoval omPage 2.Line 2Otorequest urefund. WU 0.00 5. IfLine 1 +Line 3isgreater than Line 2.enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OFWILLS, AGENT, 7171 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make mtransfer and: Yes No a. retain the use mincome o[the property transferred.......................................................................................... �� b retain the right todesignate who shall use the property transferred mits inoome --------------' El E � c. retain areversionary interest ------------------------------------------ El N d. receive the promise for life ofeither payments,benefits or care?..................................................................... �l l Ifdeath occurred after Dec. 12, 1O82 did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. E:1 M 3. Did decedent own an"in trust for"or bank account msecurity atNomhmdooth?----' 4. [id decedent own anindividual retirement account,annuity or other non-probate property,which contains ubeneficiary designation? ----------------^-----------------------. 0 El |FTHE ANSWER TOANY OFTHE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates ofdeath onorafter 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 io3percent[72PS.§9118(o)(11)UD. For dates of death on or after Jan. 1. 1006, the tax rate imposed on the not value of transfers to orfor the use of the surviving spouse is O percent [72PS.§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 o[death onorafter July 1.2OOO: w 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 orastepparent ofthe child iaOpercent[72RS.§9118(a)(1.2)]. w 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)]. w The tax rate imposed onthe net value nftransfers 0omfor the use ofthe decedent's siblings io12percent[72pS. §91i8(a)(1.3)].Asibling 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+ (12-12) pennsytvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: David A. Bartlett 21-13-1174 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 None 0.00 _-... --------- .. - i i i ..._....... ... i ....................... t f i TOTAL(Also enter on Line 1, Recapitulation.) $ 0.00 If more space is needed,use additional sheets of paper of the same size. REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Bartlett 21-131174 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Rite Aid Employee Stock Option Account. 25,300 shares 2.25 28,024.00 2 Prudential Financial,Account. 41 Shares @$56.72 2,325.52 3 Rite Aid Employee Stock awards Account#3516-8906,3,383 shares @$2.25 7,611.75 TOTAL(Also enter on Line 2, Recapitulation) $ 37,961.27 If more space is needed, insert additional sheets of the same size C o c� g o o g o 0 0 0 0 o z N O o 0 0 0 0 0 o z D 3 A p D 0 0 0 0 0 0 o g o o r 0 0 0 0 0 0 0 0 to `o 0000 00 -4 co_ aO c � m > cD 0 W N N N � m W A 0 0 0 3 W W N N N tT 0) W 01 A tb 0t W + t)t W N M d tT W N f0 w a A O W y f)t A L" to A O (Ofl OGD W ONE A N V W f071 O � toff � ifl � `" p T O to N W N t0 A A O J N J x (D W 0 t0 to t0 O Zy a N rnrnmta rnrntnm N � o � � - mrnmrn rnmrn m � Wer � N N N NN N N N t�i N 0 N N N N O N N N C p m W t" J w to N 07 O W A O W O t` N J W 01 N 01 N N N N N N N N N N N' Z N N N N N N N 0 0 0 0 0 0 0 0 0 cc O m W 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 w (0 O C O O O Z N -+ m 0(0 tb J 0) (Jt A N t0 J N — O W to J to Ut V N N N N N N N w N N w w t0I•g w N N N N w N wI'1, D 0 0 0 0 0 0 0 0 0 0 0 w O 0 0 0 0 0 00 0 M` w 0 cp 00) 0 0) O A A 0 N O CD 00) c" CD A A O C r 3 r 11 Z Z Z Z Z Z Z Z Z Z Z Z ZCL cl) y C AfJfJfJ �JfJODOAADfJf� cncncnc� �ncn (ntnl�e I D D D D D D D Dlu y G N d 1 � 06 cn n Q u (a m - , to w rn c)t L" rr w w a w _ _ V J 0* O O O (T V -� V 0 M tT O O (D i0 W ' + N 0 -4; O O 7 0 0 0 0 A tT 0 O O O O to O O O O O J O J (�• to o O O O O W w O O 0 0 0 0 -4 0 0 0 0 0 tD Ut W V m 0 nwo ; 40 #A 44 4» fA fa to 46 (p f� w v+ En En to to to to t 1 D O. M o m A A v, [fit 0 0 0 0 0 0 0 0 3 7�Z N m W N O N O O 0 0 C O O C O G G O -D (a m N A D A t0 J N tD �I O 0 0 0.0 O O \ 00 0 0 0 0 0 0 0 0 0 0 0 00088 y =z D 0000 0 00000 �� c; t�i 00000 .. Fmrn � t• - m 70 7 r0x CD V, 0 ., 0 � d ?> a � e,"c, o m 00 w - wWmm -9� o ; 0 0 0 0 0 0 0 0 0 0 0 0 0 0 rn m m a W w m v+ A O < < \ Se n o 0 c a ( w P 0) (n vttoaw w G� J m Cl 0 0 t)t J J OD (Jt A J N J_ O) -4 .r co O O O O O to 0) Of �,�7 w o o J O N ' O C O O O w tD (0 0 8 0 0 0 0 O O L A 0 0 — (h W N n Or( Mm m 0. a J to 0) A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N O 01 0 0 0 073 , < m CL t° a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I� a -1021-u (� p 3 O7 (v to t0 1. N W W C• m CO o 0 o O w N OJ) 0+ [� f0. 0)O L" 0 0 0 0 0 0 0 0 to O O O O O 1 N o m w M A W K3 0 3 m a D w"` �l CD to La rn w w to cn 0 a w tD J 00 O O Cl Ln V -) Co MM o 0 o o.o w (NO o oD 0 . . " 1 t Bartlett RAD Stock Option calculation as of date of death # options Stock Value Strike Price Value of options C55010 2.25 .897480.00 Y - 5000 2.25 1.24 5050.00 5000 2.25 1.07 5900.00 6000 2.25 1.24 6060.00 3800 2.25 1.32 3534.00 25300 2.25 28,024.00 Bartlett RAD stock calculation as of date of death 3383 shares X 2.25 per share = 7611.75 Prudential Financial Inc.,PRU Historical Quote - (NYSE)PRU, Prudential Financial Inc. ... Page 1 of 1 �J Enter Symbols or Keywords SEARCH MCharts* From MA.Atrh Pru Basic Chart Advanced Chart Interactive Chart Home Quotes News Industries Markets Historical Quotes BigReports This Historical Quotes tool allows you to look up a secudtys exact closing price. Simply type In the symbol and a historical date to view a quote and mini chart for that security. . Enter Symbol: pru Enter Date: 4116113 Prudential Financial Inc. Tum,Apr 16,2013 cbsing Pd-: 56.72 Open: 56.27 High: 56.84 Low: 55.875 volume: 2,398,055 No Splits Sponsored Links This Stock Will Explode You Need to Know About this Next Awesome Penny Stock!Read More. www.PennystockClrcle.com Warren Buffett Confesses Warren Buffetts Shocking Confession Will Change your Investing Strategy www.Ma rketTrend Sig nal.mm Billionaire Battle! Which billionaire will win this fight? euroworidnews.com/637/ (1200%)Stock? If This$0.50 Stock Hits$6.00,$10,000 Will Tum Into$120,000. TheUfeVMki.mm Find a broker 1 so FREE TRADES Afide/ice • " 1.~Sco rade:: vanguaird a Open an Account Trade free for 60 days+ $100 in Transfer Fees Tools,Education and getup to$6001 Open an Refunded.No set-up Support all for$8.95 per --nt tndav f.—Nn Anmwl F.- nnlinn P.—IN tmda Home I About I Job Opportunities I Contact Us I Feedback I Help Copyright 2013 MarketWatch,Inc.All rights reserved. By using this site,you agree to the Terms of Use and Privacy Policy(updated 10/18/2011). Intraday Data provided by SIX Rnanclal Information and subject to terms of use. Historical and current endof-day data provided by SIX Flnancial information.Intraday data delayed per exchange requirements.S&P/Dow Jones Indices(SM)from Dow Jones 8 Company,Inc.All quotes are In local exchange time.Real time fast sale data provided by NASDAQ. More Information on NASDAQ traded symbols and their current financial status. Intraday data delayed 15 minutes for Nasdaq,and 20 minutes for other exchanges. S&PIDow Jones Indices(SM)from Dow Jones d Company,Inc. SEHK Intraday data Is provided by SIX Financial Information and is at least 6l)-minutes delayed. All quotes are in local exchange time. http://bigcharts.marketwatch.com/historical/default.asp?symb=pru&closeDate=4%2F 16%... 6/20/2013 REV-1507 EX+(04-13) pennsylvania SCHEDULE D DEPARTMENT OF REVENUE MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Bartlett 21-13-1174 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 None L 0.00 L ......... _. .. ... I .. ..;... I . i> TOTAL(Also enter on Line 4, Recapitulation) $ 0.00 (If more space is needed,insert additional sheets of the same size.) REV-1508 EX+(o8-i2) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: David A. Bartlett 21-13-1174 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. Personal Items 1,000.00 TOTAL(Also enter on Line 5, Recapitulation) $ 1,000.00 If more space is needed, use additional sheets of paper of the same size. REV-i5og EX+(oi-1o) ._-... L� pennsylvania SCHEDULE F j° s DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: David A. Bartlett 21-13-1174 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A'Helen S. Bartlett 480 Nursery Drive, North Spouse Mechanicsburg, PA 17055 ..... ........ ... . B. C. .. .. ........ _ __ JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT's INTEREST i. A. 02/20/06 Parcel#42-10-0256-064,480 Nursery Drive,North,Mechanicsburg, 451,700.00 . 50% 225,850.00 Cumberland County,Pennsylvania 2. A 04/17/00 M&T Bank,Checking Accouint#950279500 28,981.24 50% 14,490.62 3. A. 12/28/87 M&T Checking Account#61290289 43,121.14 50% 21,560.57 i 4. A. Prudential Non-Retirement Account#3800618633 22,166.61 50% 11,083.31 5. A. 11/30/87 902 Norway Street,Mechanicsburg,Cumberland County, 220,300.00 50% 110,150.00 Parcel#17-24-0789-279 TOTAL(Also enter on Line 6, Recapitulation) $ 383,134.50. If more space is needed,use additional sheets of paper of the same size. z��� - .•:?8 NURSERY DR4E_t:F.111 �� 40D NURSERY DRIVE NORTH • - -�, y P1N:42-10.0256-064 '?' +_ �'`,�r,:• Dee+lbeok:00273-01195 - �' O„eel:9.JMJ=71,DAVID A - Land Use Code:101 .. Pmperth Tyne:R ; Aaeaae:0.46 E' SJuare Feel:3092 Taxable Status:T . �y 1;5•�y CIn,Tn R Green Ct ale^: T '_•':.�i,�r,. V ' Ila.d Assessed Valu9 1::95700 + =''•`�"t �+.•ir% y Adv r t' •.. uildmg Assessed valve 5:366000 q: "nn..'"�•f, _,k':•^i'. Total Assessed Value 4;451700 rX 5a !`� {+T ; •r Y Sale Pnie S:493865 t,w?3�3,,.C�, ,c. :.: ,•.."� '•` Sala Date:I•tun Feb 20 2006 07:00:00 Ph1 Year Bolt:2001: if \ + R. • '•��? �Tfst,i .76 Itl!r<KM'DRi`d'-1JRznl,, .l•!pp'e'I"•-,+s"T� ri J k ZIZI S, a b I !j,y H w� r LiJrdF.SEF'rUFl:'EIkFT11 �yrk�'-T. .. •�'f�.i � 'U I: I• - - - .I I I 11 _ 1• • I I. . Page 1 of 4 Ali Prudential Your Representative PRUCO.SECURITIES LLC TERRY S BISHOP LUTCF (717)512-2516 00005378 Your SSNlTin#:ON FILE DAVID A BARTLETT HELEN SIPE BARTLETT JTTEN Your Account = . 480 NURSERY DR N 3800618633 Non-Retirement MECHANICSBURG PA 17055 Mutual Fund Statement—April 1, 2013 to June 30, 2013 :. . . ...... ..... ...................................... <;::.:....... ..... i:: «'Ria .............................. ......................................................... .. ........................ :. .............. X. ><< :<:<; > : >:......: < < €<»<S irtl a >".>:cf` oil.:: $fii r rm:..:.:.:..:.:n:..,......:...:.:.:..:.:.:....::.:.:::.::.:................................................ ...:::::::::.::::.:::: — : .:. 6. .................:.......................................................................................................... .. 2nd Qtr Year-to-Date Investment Allocation _ Apr 01,2013 t0 Jun 30,2013 Jan 01,2013 to Jun 30,2013 z z Z Opening Balance $22,086.00 $21,845.24 z Additions $80.00 $320.00 Subtractions ($22,166.61) ($22,166.61) Your Investment Results +$0.61 +$1.37 of be displayed t ebecaunt tse on Pouie c curhart Y Y o Closing Balance $0.00 $0.00 have a zero closing balance. Dividends $0.64 $1.40 Capital Gains $0.00 $0.00 Personal Performance* 0.00% +0.01 % N N r O O O U 4' 0 U C O O O 0 O 2 0 O LL H a LL Q f U O 4 LL 6 U a 'Calculated using a dollar-weighted rate of return method for the periods)listed. Results are based on your specific activity and may not reflect overall fund performance. m Information on standardized fund performance is available by speaking with your financial professional or by visiting www.prudenUalfunds.com. Note:There are other personal c performance formulas that may yield different figures,and past performance is not indicative of future results. NN O ?! 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DAVID A BARTLETT .Page 2 of 4 HELEN SIPE BARTLETT JITTEN Non-Retirement Account Summary for the Period April 1, 2013 to June 30, 2013 "R, q IE tt g, Money Market Prudential MoneyMart Assets Fund#:0075/NASDAQ:PBMXX Account#3800618633 $22,086.00 $80.00 ($22,166.61) 0.000 $1.00 $0.00 0.00% Total Money Market $22,086.00 $80.00 ($22,166.61) $0.00 0.00% ... .......... .......... wfrirr ... ... ........ ..... ........ "'I'M ff In! 1::,f Ni -WI: -*-4*.;;;?1#1: l' 11; A W.. krr Non-Retirement Account Transactions for the Period April 1, 2013 to June 30, 2013 -0 M f4f."IFF ffg-fffffrfff1,f."Flin f!.1 4 1 M "Imb-fib-M Ot 0 .0 ag ff f, 80 It. 'A pip A-1 0, 2 z Fr ifl�1111;11::Z " N' i., "M ff r f:;Ml;M4Rrf:#YF:Fr`:,qfr f IF R-'[ `�11rrcrreH 41rr0 11" 2 F U Features&Services: Representative: DIVIDENDS:REINVEST CAPITAL GAINS:REINVEST TERRY S BISHOP LUTCF(717)512-2516 TELEPHONE REDEMPTION TELEPHONE EXCHANGE CHECKWRITING NAV ACCOUNT Detailed Transaction Activity Sales Charges Transaction Dollar Shares This Share and/or Total Shares Date Description Amount = Transaction X Price Taxes W/H Owned 04/01/13 Opening Share Balance 22,086.000 04/15/13 PURCHASE-SYS ACH $80.00 80.000 $1.00 22,166.000 04/30/13 DIVIDEND-REINVEST $0.29 0.290 $1.00 22,166.290 05/31/13 DIVIDEND-REINVEST $0.32 0.320 $1.00 22,166.610 06/05/13 REDEEM-CHECK ($22,166.61) (22,166.610) $1.00 0.000 ACCRUED DIVIDEND $0.03 06/30/13 Closing Share Balance 0.000 "MI T I d 1`0 -A,id- ff ni, Zg� ff a R AN .-.tell;:..IE Ix fm kk. IN , -�-.;: .;:: I�, * k -�� �.*'M:::1:�.:,i4 "I. i - ;;:. �m -., rr! x-N.: mf �:.f m P�... :1 -.ix, _Mx K ,•li, Non-Retirement Account Additional Information o Current Quarter Account Fund Name Open Date Dividends Capital Gains 3800618633 Pru MoneyMarl Assets 10/09/1995 $0.64 $0.00 $0.64 $0.00 To help reduce the mailing costs of your mutual funds,please contact us If any of the above addresses should be changed or deleted.Please call us,toll-free,at(800)225-1852 Monday through Friday,between 8:00 a.m.and 6:00 p.m.Eastern time. • • AS . • • " ' -.. - t f�ry,r�k ,�� t _��� sff 1�. • �•j�lr it ©, G�LtAVEL1UV �•r•r �8r1'.r? a �R ✓ r 902NORWAYSTRFFT + v ta_ 5 ` • ! w�. -24-0789-279u7PIN:17 ++ Deedbook:00338-00658 owner;BARTLEIT,DAVID A&HELEN -''r -. Land Use Code:101 r. Prop ` r ertY Type:e:R *"• "at,, ti`i 'E '+. s, i �•- ..r'. ? _ .• ».�'• Acreage:0.21 Square Feet:197016 3 '' L90 Taxable Status:T Clean&Green Status: 'fir• „� ti . Land assessed value$:56300 r�Yp n k Building Assessed Value$: 164000 Total Assessed Value$:220300 C$c� Sale Price$:103900 i yap _ aSHAh'+7NAfEFtUE t� ,,5 '," - Sale Date:Mon Nov 30 1987 y,,s'' ° R✓'• y�+s. » 01� 07:00:00 PM i A .c�tr�"d «���r���.- � f i ,� iii "1,�� -:. ��• n �._f} ✓.�` �.✓ r'r�r�ry^y. yC tf'ta`; a '` -.j.• �r2(dC �br+(�C1#r*+ y' ♦>-' ..tr r r'-r ,r.+C✓''�.' ter" 's'� �i? 4 4SHAROyaE; i?t 1 x ,<�� rte` ,�-' if r✓r 3 r. '`.✓:' era ':,k � r •� ....r�� `, ',iC,.. s.+. � y�,++'r ". ��q,.r ri,d".s-frrY,+��,rv�i f::+� w tyi{ R ✓* +3 P^ :C c } r r,�., r".r' .%,}'•.»r :i'rrs:rx �' <. r tr .�.-,�•.%'►' W '.- '"L`df •+s'�', fkr °` :��„ t"�:'+ }"";l..' r t•. ., C..+ rr�r r �-• 1'"S:rxr'�",n,,:+t�.,/�,..�� ,+.fit ' 711r ,�� ��'' �.r x.'� ° V• r'i'+ t d"'�.j`. + ar.;,:r �.� # y r �7»�-il✓ E L34 t it,'„„"�' ; d' rk '� °• 1 t .'<' .,J,: dr .w `"... '�' ,y.,..- .,�` ``+��%^. 'J,+ r�G l��y "�i» .^!�Rx$' ✓F >?t � '"'.r!.��``�,5...•t,�c.: �,,x'S/,s,:�. 'err=�W ✓�?i.;��'9�,,��.�y,�'� }.4+-t *{�:art„�r}. � v�� ,` { ,•. �JJ��£� _ Y.!'KK 'r`•^ �K r}"r'/, Y r' + ,''r.i''`ce.r✓Ir� _1 J.F•' ,C i•✓�".„++o�' `r'»' �, i Pttd- r ,..+• r .-r""" .,!'� e .;x.. r a/' �>'w" 4r�R'^ .. � *S11 Ytq' a r'.f f },'.t- +c -:a` � r-rY: .+� >+.""'rix" /• r'r ,."v.++>�. r,r 14 .. -.'• ,•�{ ,� - r �, '- !'� i. :r'� „fs f.r F.." l.,e'a '"`i .'2 .re _ i,r„r"r."SR` 04 �, .I 4 _ .[�.i »Y �r ,.y.y;.( /,.�"yr r r� :'�,„+r' .wr,� ..'"• 'x` i, rwy:�" 'r'•' SJa CARLA Fr-AD r"`1w .r -j .. 'q..'" i , a"r�s# "'" .` ° "/'' r., ,Jak ,,.ai.+.,✓y., "c rf J Iv. %{ ,�. ,��% ,r,.^ f:-+-s c ..� '•' .tom r x 4 .:�' ,,. ! " + .f � .,�,_ �;, � ,J( "»i/ '��•'''rl.rJ� a.0 a„ a. W, +f} ...�._..r,.rai�/.,tY r`rr�.✓` i+' ��� � �I � 7° .r'+r r+'r /, -,:`..,L'S`"1 y r+' r^,�T� M„la+� '"T'+-' r �"✓�'�tif�'�j� 1 w.. _ :r�' -: .i. � ;; .+.'.r'(-+�„. 1 fir' ✓',.,.�� .��r .�f��' ; �.+r'+."r�; •r�•� - ''i d y� _ "v 4 �. v .rf jar, ,,,r•^'�,r »'e� r�,r .r.�- �"-.1"..' 'r ramc�Pra .� ytt � �n,8j1 s ��Ij{{� M, w,,hri- '�i.�5 � f,rs'"'✓' p"Y,..'.f+C ✓ �x �.,.f.r,,.ti!'.n»' f},N 4ir. �W'' r r.w� - '�f'". 1,' .M1 h".4['.»v.�kl ,V' •i1 � 1. {�•.' .YM"=✓i "-F. !. .�✓'•I'.:.•"^'- r�:e ^" ,J�y t�'.t`Y. .4 .LI': 0. ' •' 1 A 1 ` f • 1 • '•• REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Bartlett 21-13-1174 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Wells Fargo,Retirement Account#531110050045723 2,724.63 100: 0.00 2,724,63 2 Wells Fargo, Retirement Account#531110100045721 5,382.04 100 0.00.: 5,382,04 3 Wells Fargo, Retirement Account#531110100045722 12,417.89 100 0.00 12,417.89 4.:I Rite Aid 401K 1,426.55 : 100: 0.00 1,426.55 JC : Prudential Command Account#xxxx-0751 47,866.92 100 0.00. 47,866.92 Prudential Standard IRA, Contract#E0110958 52,833.79 100 0.00 52,833.79 TOTAL(Also enter on Line 7, Recapitulation) $ 122,651.82 If more space is needed,use additional sheets of paper of the same size, Harry S,Patel Page I of I Personal Banker NMLSR ID:819319 Sign Off Quick Profile I Customer List{0} 113Clear List Camp Hill Store M c"c-app081praVprocUwp_252.02_h MAC Y0600-010 3205 Trindle Road Camp FL11,PA 170U Tel: 717 737 3479 Fax 717 737 3707 BankeC Notes Rewards i Transfers I Packages 800 TO WELLS ins I Spapsho Customer Tools I Customized Summary Is Fargo Bank,NA hebiUmmar.s.patel@weRsfargo.com Consumer I Business I Brokerage I Other I Services Consumer Accounts Wells Fargo Financial I Wells F��o—Tin`suran Account Product/ Account Nickname I Relationship I Ledger Account Title Status Transaction Authority Balance Retirement Time Account<$100k 531110050045723 — PLAN SUMMARY Sole Owner $2,724.63 DAVID BARTLETT Yes Active Retirement Time Account<$100k 531110100045721 Sole Owner $5,382.04 DAVID BARTLETr Yes Active Retirement Time Account<$100k 531110100045722 Sole Owner $12,417.89 DAVID BARTLETF Yes Active Consume 'iBrokerageI s I Brokerage er I Services Wells F Business Accounts u aro Fin s Fargo Insurance Account Product/ Account Nickname i Relationship I Ledger Account Title Status Transaction Authority Balance None Consume I Business I Brokerage I the I Services Brokerage Wells Fargo Financial I Wells Fargo Insurance This list may include Business and/or Consumer products Account/ Product/ Account Nickname Relationship Ledger Account Title Status Transaction Authority Balance None Consumer I Business I Brokerage I Other I Services Other Wells Fargo Financial I Wells Fargo Insurance This list may include Business and/or Consumer products Account/ Product/ Account Nickname Relationship I Ledger Account Title Status Transaction Authority Balance None Cansume I Business I Brokerage 1Other lServices Services Wells Fargo Financial I Wells Fargo Insurance Product Status None Consumer I Business I Brokerage I Other I Services Wells Fargo Financial Relationships Wells Fargo Financia I Wells Fargo Insurance Account/ Account Nickname I Product Status Relationship None Consumer I Business I Brokerage I Other I Service Wells Fargo Insurance Relationships Wells Fargo Financial I Wells Fargo Insurance Account/ Account Nickname Product Status Relationship None Search I Sales I Banker Toolbox I Administration I Main I Siqn Off cci-ncepp011ptod/proCsvp_252.0.2�_h m.custAcdUst http-sl/rIc-site I.salesandser.vice.... 3:39:30 PM 6/5/2013 1b-'0'2-2014 12:40 THOMAS W ROWAN 7177309010 PAGE2 MAILING ADDRESS P.O. Box 3165 Harrisburg,PA 1710 GENERAL OFFICE 200 Newberry Commons Etters, PA 17319 October 2. 2014 (717)761-2633 Re: David Bartlett 401(k') To Whom It May Concern: Mr.Bartlett had a 401(k)account balance of$1,426.55 on the date of his death, April 16, 2013. If you need anything further, please let contact ine at isearfossL&itmtid.coni or 717-761-2633 x4595. Sincerely, Joel Searfoss Manager, Retirement Benefits LECA LU640907M Prudentia Pruco Securities,LLC r l,ldl COMMAND Service Center PO Box 70198 Philadelphia,PA 19176 (800)235-7637 www.prudenti6l.com 1/17/14 Terry S.Bishop LUTCF The Prudential Insurance Company of America Greater Harrisburg Agency 150 Corporate Center Drive, Suite 104 Camp Hill,PA 17011 Re:Account#xxxx-0751 D A Bartlett DECD Roth IRA Dear Terry S.Bishop LUTCF: Per your request,we are confirming the balance on the above-referenced Pruco Securities Investor Account. Our records indicate that as of 4/16/13,the value of this account was: Investment Shares Price Value PNBAX 112.434 17.19 $1,932.74 PNBBX 416.601 17.36 $7,232.19 AMCPX 128.743 22.08 $2,842.65 AMPBX 120.383 20.81 $2,505.17 CVGRX 83.100 36.80 $3,058.08 SGOVX 299.330 22.03 $6,594.24 PS IAX 35.761 34.73 $1,241.98 PEEAX 46.886 32.66 $1,531.30 PEEBX 48.404 28.60 $1,384.35 PDBAX 323.132 14.77 $4,772.66 PJFAX 42.285 21.58 $912.51 PJIAX 143.596 16.50 $2,369.33 PJ I BX 281.970 14.60 $4,116.76 ES PAX 190.523 24.03 $4,578.27 ESPBX 123.208 22.39 $2,758.63 Money Market/Free Credit $36.06 Total Portfolio Value $47,866.92 If you have any questions or need additional information,please contact the COMMAND Service Center at(800)235-7637. Customer Service Representatives are available to assist you between 8:30 a.m. and 7 p.m.ET,Monday through Thursday,and between 8:30 a.m. and 5:30 p.m.ET Friday. (Registered Principal of Pruco Securities, LLC (Pruco). Securities products and services are offered through Pruco. The Prudential Insurance Company of America, Newark, NJ and Pruco are Prudential Financial companies. 1-800-201-6690 Prudential Prudential Annuities - A Business of Prudential Financial,Inc. P.O.Box 7960 Philadelphia,PA 19176 (888)778-2888 V 1-7y David A Bartlett Contract Number: E0110958 480 Nursey Drive N Mechanicsburg, PA 17055 December 5, 2013 Dear Mr. Bartlett: Thank you for your recent inquiry concerning the value of your Discovery Select. As of April 16, 2013, the Contract Fund Value was: Investment Option Value Prudential Money Market Portfolio $5,157.76 Prudential Diversified Bond $7,867.16 Prudential Equity $6,816.57 Prudential Value Portfolio $6,390.03 Prudential High Yield Bond $7,853.76 Prudential Stock Index Portfolio $5,439.60 Prudential Jennison Portfolio $7,934.31 MFS Growth Series $5,374.60 Total Contract Fund Value $52,833.79 Your satisfaction is important to us. If you have questions, please contact your fmancial professional or our Annuities Service Center at (888) 778-2888. Representatives are available to assist you Monday through Thursday between 8 a.m. and 7 p.m., and Friday between 8 a.m. and 6 p.m. Eastern time. Thank you for choosing to do business with Prudential Annuities. Sincerely, Annuities Service Center Annuities are issued by The Prudential Insurance Company of America and Pruco Life Insurance Company(in New York,by Pruco Life Insurance Company of New Jersey), all located in Newark, NJ, or by Prudential Annuities Life Assurance Corporation, Shelton, CT. Annuities are distributed by Prudential Annuities Distributors,Inc., Shelton, CT. All are Prudential Financial,Inc. companies and each is solely responsible for its own financial condition and contractual obligations. CFECCContVal112012 REV-1511 EX+ (08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Bartlett 21-13-1174 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Myers-Buhrig Funeral Home and Reception 18,018.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 7,076.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation,) 0.00 Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 183.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Cumberland Law Journal-Legal Notice 75.00 8. The Sentinel-Legal Notice 158.68 I TOTAL(Also enter on Line 9, Recapitulation) $ 25,511.18 If more space is needed,use additional sheets of paper of the same size. 137-10-2914 10:94 THOMCG W RCAJAN' 7177394910 t C1 Pq(E:3 tail Main Street Rla'lr'r(q with Thr se in Gr r( ecfmarraburk,PA 17033 Robe&'Bab"L.Bahri'g,Jr.,F7).Suporvur A:www.Myer ldlduig,en,n Willam"®DN L Christopher,FU recmra�ryMycr[-Buhrig,gorn Phone:(7l 1)70,1421 4W Fax:(717)798.7291 TATEMENT OF FUNERAL GOODS AND SERVICE'S SELECTED mrgc,arc cnfy frn'Stam:items that.yvu seiec['nd rn(but un tnyvinal.if we ue reWMed by im or by a cmicitry er otemutury'to w:4.uny i www,v- will=plain the renou in wriulg below. you sclxtei a f ncral rhAi Huy require ambul[rling,such as a funciul with viewing,yrw any have to pay Ibr embuhning.Y,u do not have to pry fir.ttab3Lu*,you did not ap- -we if you selteted Arru ger ntara cuch"a directQ.,miCion or im,nodi[de burial,If we ehvgo far=bslmir.$,we will explain why beinw. tike FArv4h:nf „a' �q l r+1e, IlateutDuathffr[wed at'Sa lo: L•�+ s' .�t<s-7�,ff ��/ t'I FVIA ,ear ,' p�W ,Ife�`d'�- .7•�cd'tf a•.,'r.I L,..i r::r f Nsnu Addrea9 City - - - &Ifo CHARGES rOR SERVICES SUECTED: t.SPECIALCHARG&9 t.PR0FE9SIONA"RkV1f:Kl uu ncd akLtwui...,:..,......._................_.._...._......... Haaie S—i ..•_.. to of Pl!aemlDueu6xA 51aR'........._........_._.....Y�lI y DIroC[CiCmetinn_,.,,._,._•. ...$ --�� kmara.. bolmingi0nint C . ............._...................._....... .%��S' Ansiornicai l'ii9.............................................,......._........... 3 Other Prepuuicn of ROdyS-w' e ....:...:::::.:.......:..........,........._...:..... Fo[w•md;.agolFtrsms_....................... ._....__....._......._.1---- iiroermg6cf;tuom:eg........................... .......5ReoeWingefRemeine.......__.................. .__..... CaskelingorRepaaing...............:.::..:..,,::,:,:::.,,..,,,,Y """. 608•TCyrALOFL+P6CIALCFtARCRS._,..,..,.......................CY Coauaolofy A Duiu RweOns ion_.......................... D.CASK ADVANCES UigniryBamm:y Cue............................................................5 -� FFBarge Hu fb!rev avr•v:eh is"hwinn g. -: _ V 011ie rPteparatioaOfDAY With UlCptltyKenitaryCan...........5�+ Grave Opening__...._.._..._.,..rt............... r_....._....... Addisiolal Care forAutupty andt.Domtton_...._.......... 'r Other C.Mail:e[v Chu c.......�,{,/..,,.ff Additiunld SoMom of runwL(nlmcwr/Emhihunr...............f (inveairic It ui.: 07-10-2014 10:01-4 THOMAS W R014R.14 7177'309010 PROEM RECEIPT F04R PAYMENT GLMNDA WARNER STRASBAUGH Receipt Elate: 11 OS42013 Cumberland County - Register Of Wills Receipt Time: �4 : 53 ;52 One Courthouse Square Receipt No . : 1076129 Ca.-lisle, PA 17013 BARTLETT DAVID A Estate File No, : 2013-01174 Paid By Remarks : HELEN S BARTLETT wz ----------- - - -- -- -- -- Receipt Distribution ------ ---- - ------ -- - - --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 90. 00 CUM13ERL1 D COUNTY GENERAL FUN RENUNCIATION 10. 00 CUABERLAND COUNTY GENERAL FUN SHORT CERTIFTCATS 25. 00 CUMSERLJNND COUNTY GE14ERAL FUN JCS FEE' 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5100 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15. 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COLWTY GENERAL FIN ----- - ---- ------ Check# 183 183 . 50 Total Received. . . . . . . . . ;183 . 50 c0G t �Rlssoc►P��c� CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 January 3, 2014 Cumberland Law Journal is published every Friday by the Cumberland County Bair Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Michael Cherewka, Esquire RE: David A. Bartlett Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: December 20, December 27, 2013, and January 3, 2014 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 r Becky H. Morgenthal, Executive Director is intend d e lusively for the *individuals and entities to which it is addressed. This L information ary, commmu ati including any attachments,may containo tion that is propriet ,e privilege c dential,including information that is protected under HIPAA privacy rules, or othe e gally exempt from disclosure. If you are not the named addressee,you are not authorize read, authorize read,print,retain,copy or disseminate this message or any part of it. If you have received this message in error,please notify the sender immediately by email and delete all copies of this message. This message is protected by applicable legal privileges and is confidential. For Discussion Purposes Only. This workis intended to provide general information about the tax and other laws applicable to retirement benefits. The author,his firm or anyone forwarding or reproducing this work shall have neither liability nor responsibility to any person or entity with respect to any loss or damaged caused,or alleged to be caused, directly or indirectly by the information contained in this work This work does not represent tax;accounting,or.legal advice. The individual taxpayer is advised to and should rely on their own advisors. -----Original Message From: "Christina Corica"<cwoIfe@cumberIink.com> To: "Leslie Leach"<Ileach@cherewkalaw.com> Cc: Sent: Tue,22 Apr 2014 16:27:27-0400 Subject: RE: Receipt- Hi Leslie, I have all the ads entered,and just on hold for now. Each Estate Notice came to$158.68.. The total due to run them all would be Thank You, Chrissy Corica Advertising Sales Executive The Sentinel Cumberland Valley's Only Daily Newspaper Phone:717-240-7171 Fax:717-243-3754 REV-1512 EX+ (12-12) uv Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER David A. Bartlett 21-13-1174 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 None 0.00 TOTAL(Also enter on Line 10, Recapitulation) $ 0.00 If more space is needed,insert additional sheets of the same size. REV-1513 EX+ (01-10) 11-7 Pennsylvania SCHEDULEJ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: David A. Bartlett 21-13-1174 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• Helen S.Barlett,480 Nursery Drive,N., Mechanicsburg,PA 17055 Spouse 100% 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 None 0.00 _.._.......... ... ........ . . ...:................ .. . . B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: _. . . ... ..... ... .. . ......... _..... .. ... None 0.00 _..... . ..... ........_ _. ... TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $: 0.00 If more space is needed,use additional sheets of paper of the same size.