HomeMy WebLinkAbout01-16-15 (2) 1505611185
REV-1500 EX(02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN 21 13 1217
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
10232013 07201923
Decedent's Last Name Suffix Decedent's First Name MI
SWARTZ LEWIS D
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES 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(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
a6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust — 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 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 INFORMATION SHOULD BE DIRECTED TO: .
Name Daytime Telephone Number
R. THOMAS MURPHY 717-762-1032
REGISTER OF WILLS USE ONLY
First Line of Address cr rrn
237 EAST QUEEN STREET -'
ZI .X_ c-> c.»
Second Line of Address =� �'^ r` f--� `I
r-rT
N F 1 CD
City or Post Office State ZIP Code DATE'ALED
CHAMBERSBURG PA 17201 -=
.`.f o rte-- rrT
Correspondent's e-mail address: TOMM@RTHOMASMURPHY.COM C0 -?7
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 whic preparer has any knoWedge.
SIGNATURE OF PERSON RESPONSIBLE F G E N DATE
Jan 1_y 2015
Sh r e Inger er war z a Gape
9 Hillop�Road 60 Bear Hollow Road 23 x Hill Road
Newburg. PA 17240 NPwb„rg, PA 17248 nTewblsrP�1 17940
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
January 15, 2015
ADDRESS
237 EAST QUEEN STREET CHAMBERSBURG, PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611185OM4647 3000 1505611.185
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1505611285
REV-1500 EX(FI)
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . • . . . . . . . . • • • 1, 0. 00
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. 46,514 - 00
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. 4011539 . 00
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . , 6. 0 • 00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . 7. 113 2 4,5 7 2 . 0 0
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8. 1,772,625 .00
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. '94 ,826 • 00
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . , . . 10. 21570 • 00
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 97-1396 •00
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 12. 1,675,229-00
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. 1,6 7 5,2 2 9 •0 0
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.0 0 0 .00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate x.0 4-5 1,675,229 . 00 16. 751385 . 00
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. 75-1385 -00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505611285 1505611285
OM4646 3.000
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 13 1217
DECEDENTS NAME
STREET ADDRESS
,95 HILLTOP ROAD
CUMBERLAN� COUNTY
CITY STATE ZIP
NEWBURG PA 17240
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 75,385-00
2. Credits/Payments
A. Prior Payments 68,400 - 0
0
B. Discount 31600 - 0 0
Total Credits(A+B) (2) 721000 - 00
3. Interest
(3) 0 .00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 31385 -00
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 . . . . . . . . . . . . . . . . . . . . . . . . 11b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . ❑
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . .
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
FAI
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ® ❑
4. Did decedent own an individual retirement account,annuity, or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 Jan. 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.
OM4671 2.000
REV-1503 EX+(8-12)
Pennsylvania
DEPARTMENT OF REVENUE SCHEDULEB
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lewis D. Swartz 21 13 1217 '
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
i. Proceeds from sale of Cumberland Valley stock 160
2 2706 shs. Orrstown Financial, common stock @17.13 per
share 46,354
TOTAL (Also enter on Line 2,Recapitulation) $ 46,514
2W4696 2.000 If more space is needed,insert additional sheets of the same size
REV-1508 EX+(08.12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX
RESIDENT EC ENTTURN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Lewis D. Swartz 21 13 1217
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. Citizens Bank, Circle Gold Checking Account No:
6234770189 35,694
2 Citizens Bank, Money Market Savings Account No:
6236792562 64,965
3 Citizens Bank, Revocable Trust Checking Account No:
6300744497 507
4 Rolling Acres, proceeds from sale of straw, ck dated
10/11/13 1,152
5 Rain & Hail, crop insurance premium refund ck dated
10/11/13 225
6 Travelers Checks 280
7 US Treasury USDA FCC, CCC, crops fund 1,191
8 Senior Health Insurance, long term care refund 1,298
9 Gross proceeds from private sale of 1979 Chevrolet van 1,500
10 Gross proceeds from private sale of 1968 Pontiac auto 475
11 Adams Electric Cooperative, capital credit 153
12 Gross proceeds from public sale on 3/14/14 of wagon
loads small items and misc personal property 20,454
13 CenturyLink, telephone refund 3
14 Gross proceeds from public sale of farm equipment and
vehicles on 3/26/14 178,419
15 Erie Insurance Co. , endorsement credit 233
16 M&R Grains, sale proceeds of shelled corn 10,738
17 Everett Cash Mutual Insurance, farmowner policy premium
refund 343
Total from continuation schedules . . . . . . . . . 83,909
TOTAL(Also enter on line 5,Recapitulation) $ 401,539
2w48AD 2.000 If more space is needed,use additional sheets of paper of the same size.
Estate of: Lewis D. Swartz 21 13 1217
Schedule E (Page 2)
Item Value at Date
No. Description of Death
18 Gross proceeds from public sale on 4/18/14 of guns,
butcher equipment, antiques and household contents 42,539
19 Erie Insurance, auto policy premium refund 144
20 Everett Cash Mutual Ins. , farmowner premium refund 1,206
21 Pa Board of Finance & Revenue, liquid fuels refund 280
22 US Treasury, 2013 federal income tax refund 165
23 EZ Recycling, salvaged 1991 Chevrolet Corsica auto 343
24 Greencastle Livestock Auction, sale of calves 7,399
25 Greencastle Livestock Auction, sale of cows 24,620
26 Pa. R.E. Settlement Services, tax pro-ration refund 7
27 Tuscarora Wayne Ins Co. , farmowners policy premium
refund 42
28 Tuscarora Wayne Insurance, farmowners premium refund 170
29 Tuscarora Wayne Insurance, farmowners premium refund 26
30 Appraised personal property taken in kind by
beneficiaries 1,733
31 Gross proceeds from sale of 1974 Chevrolet dump truck 3,500
32 Refund of pro-rated real estate taxes on the property
sold to John Nolt 920
33 Refund of pro-rated real estate taxes from sale of
property to Kim H. Wenger 7
34 Refund of pro-rated real estate taxes from sale of
property to Brad Gardner 12
35 Refund of pro-rated real estate taxes on sale of real
estate to Blevens L. Zinn 675
36 Retirement Provider, pro-rated benefit for October 121
Total (Carry forward to main schedule) 83,909
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
Lewis D. Swartz 21 131217
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 INCLUDER-ENAME OF TFE TRANSFEREE,TFEIRRELATIONSHP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER TFE DATE OF TRANSFER AT[ACHACOFY OF TFf DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IF APPUCABLE) VALUE
1• Ameriprise Management,IRA
Annuity no: 1506 4514 9 002
with three children as the
designated beneficiaries
(valuation statement attached) 5,484 100.0000 0 5,484
2 Gross sale price of real estate
known as Old Sawmill Drive,
Newburg, Hopewell Township,
Cumberland County, PA to Brad
E. Gardner (HUD and Deed
attached) 76,000 100.0000 0 76,000
3 Gross sale price of real estate
known as 85 Hilltop Drive,
Newburg, Hopewell Township,
Cumberland County, Pennsylvania
to John Nolt (HM and Deed
attached) 606,000 100.0000 0 606,000
4 Gross sale price of real estate
located along Shuman Road,
Newburg, Hopewell Township,
Cumberland County, PA to Kim H.
Wenger (HUD and Deed attached) 59,000 100.0000 0 59,000
5 Assessed value of real estate
located on Old Sawmill Drive
consisting of a cabin and nine
acres of land in Newburg,
Hopewell Township, Cumberland
County, PA
Assessment of $110,400. X .97
(common level ratio)
$107088.00 107,088 100.0000 0 107,088
6 Gross sale price of real estate
known as Bear Hollow Road,
consisting of 62 acres,
Newburg, Hopewell Township,
Cumberland County PA to Blevens
L. Zinn (HUD and Deed attached) 299,000 100.0000 0 299,000
Total from continuation schediijes . . . . . . . . . 172,000
TOTAL(Also enter on line 7,Recapitulation)$ 1,324,572
If more space is needed,use additional sheets of paper of the same size.
9W46AF 2.000
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Estate of: Lewis D. Swartz 21 13 1217
Schedule G (Page 2)
Item DOD Value Taxable
No. Description of Asset Interest Exclusion Value
7 Gross sale price of real estate
located on Bear Hollow Road,
Newburg, Hopewell Township,
Cumberland County, Penna. taken in
kind by beneficiary, Robert L
Swartz (Deed attached) 172,000 100.0000 0 172,000
Total (Carry forward to main schedule) 172,000
REV-1511 EX+(08-13) SCHEDULE H
pennsylvania
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lewis D Swartz 21 131217
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Newburg Church of God, Eveready Class
Funeral luncheon donation 350
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: R. Thomas Murphy & Associates, PC 35,450
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:
5. Accountant Fees:
6. Tax Return Preparer Fees: 420
7.
1 Cumberland County Register of Wills
1% realty transfer tax from sale of Bear Hollow
Road, Newburg, PA to Blevens L Zinn 2,990
Total from continuation schedules . . . . . . . . . 55,616
TOTAL(Also enter on Line 9,Recapitulation) $ 94,826
3w46Ac 2.000 If more space is needed, use additional sheets of paper of the same size.
Estate of: Lewis D. Swartz 21 13 1217
Schedule H Part 7 (Page 2)
2 Harry Killian, Tax Collector
2014-15 school real estate taxes on Bear Hollow Road
property sold to Blevens L. Zinn 1,050
3 Harry Killian, Tax Collector
pro-rated real estate taxes on real estate located
on Old Sawmill Drive, Newburg to Brad Gardner 7
4 Cumberland County Register of Wills
1% transfer tax on sale of Old Sawmill Drive,
Newburg to Brad Gardner 760
5 Cumberland County Register of Wills
1% transfer tax on sale of real estate along Shuman
Road, Newburg to Kim H. Wenger 590
6 Cumberland County Register of Wills
1% transfer tax on sale of real estate to John B.
Nolt 6,060
7 Shirley J. Mellinger
Reimbursement for cat food and care 50
8 Greg Swartz
lawn/weed maintenance services at cabin 20
9 Greg Swartz
lawn/weed maintenance services at farm 30
10 Tuscarora Wayne Insurance Co
farm insurance policy premium 960
11 Tammy Shearer, Recorder of Deeds of Cumberland
County
Additional fee to record Robert Swartz deed for
joint tract 15
12 Shirley J. Mellinger
Reimbursement for lawn mower, fuel, cat food, cat
medicine, and stamps 653
13 Cumberland County Register of Wills
Record Deed in Distribution to Robert Swartz 80
14 Harry Killian, Tax Collector
2 properties real estate taxes for 2014-15 school
tax 2,846
Total (Carry forward to main schedule) 13,121
Estate of: Lewis D. Swartz 21 13 1217
Schedule H Part 7 (Page 3)
15 Robert Swartz
Reimbursement for Brehm Lebo Engineering of
subdivision services; notary services, Shetrons Tire
for tire repair, and diesel fuel 6,333
16 Tuscarora Wayne Insurance Co
farm insurance policy premium 1,434
17 Hoover Plumbing
clean furnace at residence 94
18 Robert Swartz
Reimbursement for expenses of trash removal to
refuse center and fuel for off road vehicles 210
19 Duane Gipe
Reimbursement for expenses of wheel cylinder for
1974 dump truck, Honda 4-wheeler hose clamp, fuel
valve of Honda 4-wheeler; and battery cable end for
Super H tractor 78
20 Robert Swartz
Reimbursement for expenses of batteries for Farmall
806, remove trash to refuse center, Hydrovac part
for 1974 Chev dump truck, used battery for Chev
Corsica, salt blocks for cattle and repair flat tire 527
21 Shirley J. Mellinger
Reimbursement for expenses of Jeep battery, Pontiac
battery and Honda 4-wheeler battery 233
22 Shirley J. Mellinger
Reimbursement for battery to Farmall tractor to
ready for sale 93
23 Martin's Auction Service
commission and costs of public sale on 4/18/14 of
guns, butcher equipment, antiques and household
contents 6,374
24 Martin's Auction Service
commission and costs of public sale of farm
equipment and vehicles 12,012
25 Martin's Auction Service
commission and costs of public sale of wagonloads
small items and misc personal property 1,022
Total (Carry forward to main schedule) 28,410
Estate of: Lewis D. Swartz 21 13 1217
Schedule H Part 7 (Page 4)
26 Cumberland County Register of Wills
Initial probate of Will fee 484
27 Shirley J. Mellinger
Reimbursement of dog care and Horst seed 639
28 Everett Cash Mutual
farm insurance premium 2,027
29 Hoover Plumbing
clean furnace at residence 217
30 Weavers Tire Co.
purchase tires for skidloader to ready for sale 600
31 The Sentinel
advertise estate notice 221
32 Cumberland Law Journal
advertise estate notice 75
33 Robert Swartz
Reimbursement for expenses of trash removal, wire
wheel, Honda cycle battery and tire repair, skid
loader battery and starting fluid and saw blade 339
34 Everett Cash Mutual
farm insurance premium 193
35 Duane Gipe
Reimbursement for expenses of Jeep points and
condenser and Super C tractor battery 96
36 Watsons Truck Repairs
repairs to 1974 Chevrolet dump truck to ready for
sale 523
37 Horn & Co. Appraisal Service
5 separate real estate appraisals 2,400
38 Harry Killian, Tax Collector
properties real estate taxes county & township 928
39 EE Shank Sons, Inc.
shell and transport corn services 1,246
40 Tuscarora Wayne Insurance Co
insurance policy premiums 1,899
Total (Carry forward to main schedule) 11,887
Estate of: Lewis D. Swartz 21 13 1217
Schedule H Part 7 (Page 5)
41 Chamberlin & Wingert Sanitary
portable toilets for public sale 140
42 Newburg Hopewell Fire Dept
parking services at public sales 500
43 Erie Insurance Co.
auto insurance policy premiium 147
44 Greg Swartz
lawn maintenance of cutting weeds around house and
farm buildings 30
45 Deluxe for Business
supply of estate checks and deposit tickets 64
46 Blevens Zinn
Reimbursement for Agreement recording fee 33
47 Tammy Shearer, Recorder of Deeds of Cumberland
County
Record Robert Swartz deed for joint tract 81
48 Citizens Bank
outstanding expense processed after death 1,203
Total (Carry forward to main schedule) 2,198
REV-1512 EX+(12-12)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lewis D. Swartz 21 13 1217
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• Adams Electric Cooperative
electric service 29
2 Adams Electric Cooperative
electric service 29
3 Adams Electric Cooperative
electric service 29
4 Adams Electric Cooperative
electric service 29
5 Adams Electrid Cooperative
electric service 122
6 Adams Electric Cooperative
electric service 42
7 Adams Electric Cooperative
electric expense 34
8 Adams Electric Cooperative
electric expense 29
9 Adams Electric Cooperative
electric service 34
10 Adams Electric Cooperative
electric service 29
11 Adams Electric Cooperative
electric service 29
12 Adams Electric Cooperative
electric service 66
13 Adams Electric Cooperative
electric service 29
14 Adams Electric Cooperative
electric service 80
15 Adams Electric Cooperative
electric service 29
Total from continuation schedules . . . . . . . . . 1,931
TOTAL(Also enter on Line 10,Recapitulation) $ 2,570
2W46AH 2.000 If more space is needed,insert additional sheets of the same size.
i
3
5
Estate of: Lewis D. Swartz 21 13 1217
Schedule I (Page 2)
Item
No. Description Amount
16 Adams Electric Cooperative
electric service 108
17 Adams Electric Cooperative
electric service 29
18 Timmons Oil
oil service 260
19 Adams Electric Cooperative
electric service 129
20 Adams Electric Cooperative
electric service 116
21 Timmons Oil
oil service 375
22 Adams Electric Cooperative
electric service 35
23 Adams Electric Cooperative
electric service 110
24 CenturyLink
telephone service 36
25 Adams Electric Cooperative
electric service 28
26 Adams Electric Cooperative
electric service 234
27 CenturyLink
telephone service 36
28 Adams Electric Cooperative
electric service 32
29 CenturyLink
telephone service 36
30 Adams Electric Cooperative
electric service 32
31 Timmons Oil
oil service to residence 335
Total (Carry forward to main schedule) 1,931
REV-1513 EX+(01-10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Lewis D. Swartz 21 13 1217
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. Shirley J. Mellinger 1/3 residue as per Item
9 Hilltop Road III of LW&T
Newburg, PA 17240 Daughter
2 Robert L. Swartz 1/3 residue as per Item
60 Bear Hollow Road III of LW&T
Newburg, PA 17240 Son
3 Cathy L. Gipe 1/3 residue as per Item
234 Fox Hill Road III of LW&T
Newburg, PA 17240 Daughter
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
NON-TAXABLE DISTRIBUTIONS
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0
9W46A[2.000 If more space is needed,use additional sheets of paper of the same size.