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Home My WebLink About12-16-14 ,� REV-1500 EX(02-11) 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 14 0873 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 08 31 2014 11 04 1914 Decedent's Last Name Suffix Decedent's First Name MI STROHM THELMA E (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 X❑ 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) 5 Decedent Died Testate ❑ 7. Decedent Maintained Trus a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) Copy ) 9. Litigation Proceeds Received 10.Spousal PovertyCredit Date of Death 11.Election to tax under Sec.9113(A) ❑ ❑ between 12-31J1 and 1`-1-95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number FOREST N MYERS 717 532 9046 REGISTER OF WILLS USE ONLY First Line of Addressrri 137 PARK PLACE WEST M ren �' Q cn i Second Line of AddressrTj t _� # AT€PILE C' I City or Post Office State ZIP Code c v SHIPPENSBURG PA 17257 ❑ : m Correspondent's e-mail address: fnmyers(a)lawofficeforestmyers.com Under penalties ofperjury,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. SIGNATU13E OF PERSON RR jSPONSIPIE FOR FILING RETUR DATE Robert A STROHM,Jr. ADDRESS 30 Burning Tree Court,York, PA 17404 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Forest N Myers ADDRESS 137 Park Place West, Shippensburg, PA Side 1 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: STROHM, Thelma E RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 279, 798 . 85 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. 126, 059 . 05 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 51, 591 . 89 7. Inter-Vivos Transfers&MiscellaneousIoq Probate Property (Schedule G) u Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 457 , 449. 79 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 19, 7 9 9. 5 6 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 9, 949. 80 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 29, 749 . 36 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 427 ,700 . 43 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. 427F700 . 43 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. 0 . 00 16. Amount of Line 14 taxable 427 , 700 . 43 16. 19,246. 52 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 at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 19,246. 52 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 21-14-0873 Decedent's Complete Address: DECEDENT'S NAME STROHM,Thelma E STREET ADDRESS 210 Big Spring Road CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 19,246.52 2. Credits/Payments A. Prior Payments 15,000.00 B. Discount 789.47 Total Credits(A +B) (2) 15,789.47 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) 3,457.05 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;.................................. ❑ ❑x 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 receiving adequate consideration?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑x ❑ 4. Did decedent own an individual retirement account,annuity,or other non-probate property which El ❑ contains a beneficiary designation?.................................................................................................................. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after 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)]. • 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[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. U1 -rj 7C --I T.-IF]JE: 11, TA Ct't l A L��C - I I r M tJ 1, THELMA E. STROH ,4, of Cun. berland :county, Pennsylvania, being of sou�& and --n disposing mind, memory and understanding, do make and pubiish this, my LAST WILL and TESTAMENT, hereby revoking and making void all fMller wills made by me at any time previously. FIRST: I direct that my funeral be conducted in a manner corresponding with my estate and situation in life and that, all my funeral expenses and legal debts be fully paid and satisfied from my estate as soon as conveniently may be after my decease. SECOND: I bequeath any and all i-notor vehicles owned by me at the time of my death to my son, Robert A. Strohm, Jr. THIRD: My personal effects, household goods and tangible personal property shall be divided among my son, Robert A. Strohm, Jr., and the surviving children of my deceased son, Edmund C. Strohm, Sr., by my personal representative with due regard for their personal preference in as nearly equal shares as practicable; provided, that if any beneficiary of mine is a minor at the time of such division, the guardian of the person of such minor shall select the personal effects, household goods and tangible personal property for such minor. Furthermore, my personal representative may distribute such minor'!, share to him or her or for his orher us.-- V4-- (SEAL) to the guardian or to any person with whom he or she is residing without further responsibility, and the distributee's receipt shall be sufficient discharge to my personal representative. Any and all items not selected or transferred to my beneficiaries shall be sold at a public or private sale and the'proceeds thereof shall be added to the residue of my estate. FOURTH: I give, devise and bequeath the rest, residue and remainder of my estate, of whatsoever kind and description and wheresoever situate, as follows: Fifty (50%) percent to my son, Robert A. Strohm, Jr. In the event my said son should predecease me, I give, devise and bequeath said fifty (50%) percent to his wife, Sandra P. Strohm, or her issue per stirpes. The sum of Twenty Thousand ($20,000.00) Dollars to each child of my deceased son, Edmund C. Strohm, Sr., who is living at the time of my death. The rest, residue and remainder to Fulton Bank, of Lancaster, Pennsylvania, or its successor, to be held in trust for the surviving children of my said deceased son, per capita, pursuant to an Amended Revocable Trust Agreement dated even date herewith. FIFTH: I hereby nominate, constitute and appoint my son, Robert A. Strohm, Jr., Executor of this my Last Will and Testament. Should my said son predecease me or for any reason fail to qualify, or having qualified, fail to serve as such Executor, then I nominate, constitute and appoint my son's wife, Sandra P. Strohm, Executrix of this my Last Will and Testament. Should my son's said wife predecease me or for any reason fail to qualify, or having qualified, fail to serve as such Executrix, then I nominate, constitute and appoint Fulton Bank, or its successor, Executor of this my Last Will and Testament. SIXTH: I direct that my personal representative shall not be required to post bond in this or any other jurisdiction for the performance of his or her duties as Executor or Executrix of this my Last Will and Testament. 9 C\1 e (SEAL) -2- IN WITNESS WHEREOF, I, THELMA E. STROHM, have hereunto set my hand and seal to this, my Last Will and Testament, written on three (3) pages and signed by me on each page, this day of �: , 1997. W' ess: f ^�a:t;�1< u ✓.4� c (SEAL) r -3- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK I, THELMA E. STROHM, testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn to �d( acknowledged before me by THELMA E. STROHM, the testatrix, this day of 1997. THEL RY PUBL' C/ 7 N ANN LAU,NOTAW FWAX YORK,YOM COUNTY,PA COMMONWEALTH OF PENNSYLVANIA 1SSDNEXP1RE-,%DE0.,"§1,,TW, - SS J COUNTY OF YORK We, Gary L . Snyder and MIL& 14L-"'.-0611-)A�'vitnesses whose names are signed to the attached instrument, being duly qualified according to law, do depose and say that we were 'present and saw THELMA E. STROHM, the testatrix, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of our knowledge THELMA E. STROHM was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. w rn to and subscribed to before me by the above named witnesses, this day of 1997. WITNESS Z IT S TAfZY'PU' Wlp--- 3;pm AW H L AU,N OTA.RY F U WD vrym"'Yom COUN PA / oocs\mord"--/ atep|anniogdmmrs ' 'the|ma.1st~di�/. zdnc ` FIM CODICIL OF THELMA ESTROEV }, [-HELK4A F STROHK4, a resident of the County of Cumberland, [Ornnnonvvea/th of Pennsylvania, declare that this is the First Codi,�11 to my Last Will and Testament, which is dated June l9, l997. | _ A. | revoke Paragraph FIFTH of my Last Will and Testament, which reads aSfollows: B. "i hereby nominate, constitute and appoint myson, Robert /\ Strohm, Jr., Executor ofthis, nnyLast Will and Testament. Should nnyson predecease nneorfor any reason fail to qualify, or having qualified, fail to serve as Executor, then | nominate, constitute and appoint rnyson's wife,Sandra PStrohm, Executrix ofthis, my Last Will and Testament. Should my son's wife predecease nneorfor on �� _ �o reason fail to qualify, O[ having qualified, fail to Serve 8s E��cmzix� then �� o rn � rn �'<�� cz' nn� co «p C-3ngroin31(, cnDsd '6� �ut8an�8ppo�ntFuit�nB�D�,�[itssu�c8ssO[, Ex�Cu� � -- �n'�c uv ~" Last Will and Test8Ol8nt`" In place ofthis revoked provision, | substitute the following: � ' �� m "| appoint my son, Robert /\ Strohm, Jr., Executor of my Will. In the~event 0fino death/ resignation, renunciation or inability Of my Son to act as Executor, ) appoint Robert Strohm, ||L' ' and Ginger LMcDennond, Co-Executors ofthis, try Will. Neither rnyExecutor, nor any successor shall be required togive bond." ||. | hereby confirm and republish my Will dated June 19, 1997 /n all respects other than those herein mentioned. / subscribe my name to this Codicil this ii��»"day of 2002, at Pennsylvania, in the presence of Scaki 6 Nuefc, and attesting witnesses, who subscribed their names hereto at my request and innnypresence. ' rix Page 0f2 \\SERVER\Share,dDocs\Word Procei ate planningkIient's work\strohm,'thelma.1st codidl..- 2.doc On the date last above written, THELMA E STROHM, known to us to be the person whose signature appears at the end of this Codicil, declared to us, the undersigned, that the foregoing instrument, consisting of two pages, including the page on which we have signed as witnesses, was the First Codicil to her Will dated June 19, 1997. She then signed the Codicil in our presence, and at her request, in her presence and in the presence of each other, we now sign our names as witnesses. (4m residing at (31 PcLrV— � -Aflfxp- 44 A �olla �residing at as(c) S (Vto�n CkAAL6tSeV .OA -A ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF We, THELMA E STROHM, &ASan &�cr' andA/lAe 40 the Testatrix, in and the undersigned witnesses to the CoUicil, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that 1, the Testatrix, do hereby acknowledge that I signed and executed the instrument as a Codicil to my Will,that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testatrix execute the instrument as her Codicil, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Codicil as a witness and that to the best of our knowledge, the Testatrix was at that time eighteen (18) years or more of age, of sound mind and under no constraint or undue influence. Testatrix THELMA E STROHM tWitn Sworn to before me a Notary Public this a"day of 2002. Notary F"O'Blic NOTARIAL SEA L FOREST N.AYERS,NOTARY P UBLIC S ippENSBURG BOROUGH,COUNTY OF FRANKLIN N Page 2 of 2My COMMISSION WIRES DECEMBER 11,2005 Rev-1503 EX+(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER STROHM,Thelma E 21-14-0873 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 092475102 1,350 shares of Blackrock Income Opportunity Trust Inc- 10.55 14,242.50 held at Wells-Fargo Accrued dividend on Item 1 through date of death 80.33 2 31428Q101 11,350.262 shares of Federated Total Return Series T-Total 11.1499999 126,555.42 Ret Institutional held at Clermont Accrued dividend on Item 2 through date of death 388.22 3 461320107 1,313 shares of Invesco Municipal Opportunity Trust-held 12.68 16,648.84 at Wells-Fargo Accrued dividend on Item 3 through date of death 86.66 4 46132K109 1,357 shares of Invesco Pennsylvania Value Municipal 13.15 17,844.55 Income Trust-held at Wells-Fargo Accrued dividend on Item 4 through date of death 101.78 5 693390700 5,248.686 shares of Pimco Funds Pacific Investment 10.9900002 57,683.06 Management Series T-Total Retrn PT held at Clermont Accrued dividend on Item 5 through date of death 72.35 6 742935489 1,920.502 shares of Professionally Managed Portfolios- 12.0100005 23,065.23 Oster Strategic Income held at Clermont 7 921937207 287 shares of Vanguard Bond Index Fund Inc-Short Term 80.2435889 23,029.91 Portfolio held at Clermont TOTAL(Also enter on Line 2, Recapitulation) 279,798.85 (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 B(Rev.6-98) Rev-1508 EX+(11.10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER STROHM,Thelma E 21-14-0873 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 ACNB Certificate of Deposit 01/07-Account No. 158489 5,582.18 Accrued income on Item 1 through date of death 8.31 2 ACNB Certificate of Deposit 07/07-Account No. 172677 22,319.60 Accrued income on Item 2 through date of death 31.67 3 Orrstown Bank Irr Burial Certificate of Deposit-Account No.4000014887 6,855.20 Accrued interest on Item 3 through date of death 1.57 4 Thelma E Strohm Rev Trust-cash sweep account at Fulton Bank/Clermont Wealth 12,586.32 Strategies 5 Wells-Fargo-sweep account 23,620.93 6 Capital Blue Cross-refund 215.27 7 Green Ridge Village-refund 54,838.00 TOTAL(Also enter on Line 5,Recapitulation) 126,059.05 (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) Rev-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER STROHM, Thelma E 21-14-0873 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Robert A STROHM,Jr. 30 Burning Tree Ct Son York, PA 17404 B. C. JOINTLY OWNED PROPERTY: LETTER DATEDESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'SVALUE OF NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUEOFASSE1 INTEREST DECEDENT'S INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 08/31/2009 ACNB Super Now-Account No.220574 103,183.77 50.000% 51,591.89 TOTAL(Also enter on Line 6, Recapitulation) 51,591.89 (If more space is needed,additional pages of the sable size) Copyright(c)2010 form software only The Lackner Group,Inc. 4Form PA-1500 Schedule F(Rev.01-10) REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENTDECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER STROHM,Thelma E 21-14-0873 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 13,160.64 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorney's Fees Law Office Forest Myers 4,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 490.50 See continuation schedule(s)attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,648.42 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 19,799.56 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 STROHM,Thelma E 21-14-0873 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Fogelsanger-Bricker Funeral Home-balance of funeral bill 6,299.17 2 Fogelsanger-Bricker Funeral Home-funeral bill 6,861.47 H-A 13,160.64 Probate Fees 3 Register of Wills; Cumberland County-Letters Testamentary 310.00 4 Register of Wills; Cumberland County-Letters Testamentary,additional probate due 50.00 5 Register of Wills; Cumberland County-Filing fees;Will and Codicil 30.00 6 Register of Wills;Cumberland County-filing fees; Inheritance Tax Return and Inventory 30.00 7 Register of Wills; Cumberland County-Short certificates 30.00 8 Register of Wills; Cumberland County-probate fees;JCS fee and automation fee 40.50 H-B4 490.50 Other Administrative Costs 9 Cumberland Legal Journal-legal advertisement of estate 75.00 10 The News-Chronicle-legal advertisement of estate 88.25 11 Wells-Fargo-Commissions&charges 1,485.17 H-B7 1,648.42 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER STROHM, Thelma E 21-14-0873 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 Green Ridge Village-healthcare facility bill 9,784.77 2 Millennium Pharmacy-medical bill 15.62 3 Millennium Pharmacy-medical bill 149.41 TOTAL(Also enter on Line 10, Recapitulation) 9,949.80 (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 STROHM,Thelma E 21-14-0873 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not LIst Trustee(s) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions,and transfers under Sec.9116(a)(1.2)] Thelma E.Strohm Revocable Trust Trust Fifty(50%) ATTN: Sandra Drummond percent of the c/o Fulton Bank; One Penn Sq net distributable Lancaster, PA 17602 estate Ginger L McDERMOND Granddaughter Twenty-thousand 120 Frytown Rd ($20,000.00) Carlisle, PA 17015 Dollars Edmund C STROHM,Jr. Grandson Twenty-thousand 17 E Main St ($20,000.00) Newville, PA 17241 Dollars Michael STROHM Grandson Twenty-thousand 14 Hope Rd ($20,000.00) Boiling Springs, PA 17007 Dollars Robert A STROHM Jr Son Fifty(50%) 30 Burning Tree Ct percent of the York, PA 17404 net distributable estate Total Enter dollar amounts for distributions shown above on lines 15 through 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. ' Form PA-1500 Schedule J(Rev.01-10)