HomeMy WebLinkAbout04-22-15 (2) pennsylvania 1505614105
J �m.,.�.�,� ���.�,�«,
REV-1500 OiFICIAI IISE ONLY
eureau of Individual Taxes Counry Code Year FJe Number
INHERITANCE TAX RETURN -
PO BOX 280fi01 �_I .. ... I ' I .. I �rl��
n � b g an vi28-obol RESIDENT DECEDENT "I V ...
ENTER OEGEDENT INFORMATION BELOW
Soaal Setun�y Number Dal¢Of�eafh MMD�YYYY Da�e of Birth . MMD�YYYY
........ . 10102014 ...... .10271938
Decedenfs Lasl Name � � � � � SURx Decetlen�s F rst Name�� MI
Noss.... . _.. .. .. ._... . ���. . �Donna ..._ .__.... L ,'.
.._ . __.. .._. �..... ..... . __.... .. .. . . . ._...
(It Applicable)Enter Surviving Spouse's Informa[ion 9elow
Spouse's Las[Name SuRiz Spouse's Firs[Name MI
� �� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Onginal ReWrn O 2.Supplemenlal Relum O 3. Remaintler ReWm(date of death
priortol2-13-82)
p J.AgriculWre Exemption(dale of p 5. FuWre Interes[Compromise(dale of p 6. Federal Esla�e Tax ReWm Requiretl
aeatn on or a%er]-1-204) death aflar 12-12-02)
� J. DeceOent�ied Tes�ale O B. Decetlent Maintainetl a Living Tmst 0 9. To�al Number of Safe Deposit Boxes
(Atlach copy of will.) (Atlach copy of wst)
p 10. Litigation Proceeds Received O 11. Non-Probale Tansferee ReWrn O 12 OeferrallElection of Spousal Tmsis
(Schedule F antl G Asse4 Onry)
O 13. Business Asse�s O 14. Spouse Is Sole 9ene(Iciary
(Na tmst involved)
CORRESPONOENT- THIS SECTION MOST BE LOMPLETE�.ALL W RRESPON�ENCE AN�CONFI�ENTIAL TA%INFORMRTION SNOUL�BE�IREQEO T0:
Name Daytime Telephone Number
RonaldE.�Johnson, Esq ��� ���� ���� ' (717) 243-0123
FlrslLineofAtltlress ��� ���� � � �
76 West Pomfret Street ���� �
SewntlLineofAtldress � ��� �
Ciry or Post Office ���� State ZIP Cotle ..�
____. _. . .. .. . .. ... .__ .. ._.. ...:� A
Cadisle PA 17013 n '�,
� m
. . . ..._ . ... . _.. .__ .o... m
._.... . ..... G =D ::'> p
CortespondenPs emall atltlress: f2jOhf150n@pa.OEt � �; � <.o �
�
REGI�`TEXQF yYILS�ONl�' p
.., ,�- ��; �
REGISiEROFWILL505EONLY - ' " � -� T T
DAtE FItEO MM�OYYYY ' J � 'T1
. . . . , , ' -' �.1 �` �
� _ ,
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.. . . . .... ..,.... .. -_j N I' O
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. (Jl
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
L ��������������������SOII56I1I41IQS�I���������������� 1505614105 � V
� 1505614205
REV-1500 EX(Fl) Decedenfs Social Secunty Number
oe�eea�rs Name: Donna L. Noss '. 198- �
RECAPITULATION �
1. Real Esta�e(Schedule A). .. .. ... 1 .... ... 0.00�����.
� ...__ . __-" ."'_
2. Stocks and Bonds(Schetlule B) ... ... ....... . ... .... . 2 0.00 '�.
""_ .. ___.- _-
3. Qosety Hela Coryoration,Partners�ip or Sole-Propnetorship(Schetlule C) . . . 3 �.�Q
___ ....._._ _____.
4. Mortgages antl Na�es Receivable(Schedule D) ...... ... 4 �.�0
. .. ..... .... .... __... _._......... . ........
5. Cash,Bank Deposils and Miscellaneous Personal Pmperty(Schetlule E�. ... . 5 I �25,645.2�
_._ . ___
6. Jointty Ownetl Property(Sc�etlule F) O Separale Billing Requested . , ... 6 ... 0 00
]. In�erUivos Transters 8 Miscellaneous Non-Proba�e Propeny 647,595.35 .
(Schetlule G) O Separe[e Billing Requested.. .... . . Z __.._..
8. Total Gmss Assets(total Lines 1 through]) . . . ..... .. 8 � 773�24�.56
4 Funeral Expenses antl Adminislra�ive Cos�s(SchedWe H).. ... . ... .... .... . . 9. �1,�90.57
10. Debls of Decedent,Morigage Liabilities antl Liens(Schetlule I). .. . ..... ... . .. ��. � 0.00
'. . ..._.__.._.__....._...
.._. ....._ .
11. Total �etluctions Ootal Gnes 9 and 10).. . ... ... . .... . .. .. . ..... .... . .. . it ' 11�090.57
..._ .._ ._ .. . . ......
12. Net Value ot Es[ate(Line 8 minus Llne 11) . . ... . ... . ... . . . .... .... . ... . . 12. 762,149.99
..... ._.. ......_.
13. Chantable and Govemmental BequesislSeu 9113 Tmsts for which O.00
an election to tax has not been matle(Schedule J) ...... ... ... .... . . ... ... 13.
_._. ..._.__.
........__. ._..........
14. Net Value Subject to Tax(Llne 12 minus Line 13) . . ... .... ... ... . ..... 14. 762,�4$.99
TA%CALCULATION�SEE INSTRUCTIONS FOR AGPLIGABLE RATES
15. Amoun�of Line 14 taxable
at[he spouul tax rate,or _.__. _ __ . . ... ....... ..
..... ._... . -.
VanstersuntlerSec.9116 ���� �� � ����� '
(a)(12IX.0_ �. 15.
�. .._.. . ...__ . . . ..._...
...... .._. _... .
18. AmowtotLlneiatexable 762,149.99 �6. 34,298J6
a�linealrete X.045
. ._.. _.. . . _.__... _._"__. .
1I. Amounl o(Line 14 taxable . �
atsiblingra[e X.12 � ��- _. ..
18. AmountofLinel4tazable ...-.� ..�.�.... ..-.�.: .. . .�. . ...�....
atcollaterol rale X.15 '� �8 .._ _ .._ ... .___.
19. TAX OUE .. . ... .. ..... _. . . . . .... .... .... . 19 ...._ _ .$4i296.75
. ... . .. .... . ... .
20. FILL IN THE OVAL IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT O
UnOer penal�ies of perjury.I tleclare I M1ave examined��is reWrn,IncluEing accompanying scbetlules antl slalemenis,antl lolM1e Ewc of my knowletlge ana Celle[
II Is Ime,wrrect an0 complere. Declaraiion of preparer ol�er Man Ne person responsible for filing tM1e relum is�ased on all inloimation o!wM1icM1 prepare�M1as
any knowl
ESP R FlLING RETUFN OATE
D 55
do 78 est PomfF Stre t, C le, PA 17013
IG O OTH ON RESPONSIBLE FOR FILING THE RETl1RN DHTE
A S
Go 78 West Pomfr � Street, Cadisle, PA 17013
I���I����������I��I�II�I��I I��II�I��I����������������������� Side2
L I,505614205 15�5614205 J
REV-150C EX �FI) Page 3 Flle Number
DecedenYs Complete Address:
DECEDENT'SNAME
Donna L. Noss
sTaeernooRess - � � �
387 Mooredale Road __ _ _.
cirv - _ �- sTnTe "- �.. na —. _
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (i) 34,29675
2. CreditslPayments
A.PnorPaymen�s __. ._.. 28,000.00
_ —_
B.�ismunt 1,473.68
(SealnsWaions) TatalCredlis(A+B) (2) 29,473-68
3. In�erest
(3) 0.00
4. If Line 2 is grealer than Line 1 �Line 3,en�er Ihe diflerence. This is�he OVERPAYMENT.
Fill in oval on Page 2,Line 20 to requasl a refund. (4) p.00
5. If One 1 i L+ne 31s grealer then Gne 2,enter�he�ifierence.Thls Is the TAX OUE. (5) 4,823-07
Make check payable to: REGISTER OF WILLS, AGENT.
� PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did deceaent make a Vansfer and: Yes No
a. re�ain Ihe use or income of Ihe proPerry trans�erred................................................._._........._....._._,..,...,,...... ❑ �
b. retain Ihe nghl to designaie who shall use�he property IrensfeneC or i�s income ............................................ ❑ �
c. retain a reversionary mterest ............... ..........._.. .............. .. ............_.. ........._.. ❑ �
d. receive Ihe promise for life of ei�her paymenis,benefits or care?................................................_.....__..._...... ❑ �
2. If dea�h occurted aRer Dec.12,1982,did decedent�ansfer propeM1y within one yearot death
wi�hoN receiving adequa�e considerz�ion? ............._ ...._._.. _.._.... ................_ � �
3. �ie decedent own an"in�ms�fol'ar paya6le-upon-Oeath bank accaunt or secunry at his or her death?.............. ❑ �
4. Di0 decedent own an individual reiiremen�accoun�,annuity or o�her non-pmba�e pmpeM�which
con�ains a beneficiary Oesignation? ,....... ............. ...,....... ,........... _._.,...,, � �
IF THE ANSWER TO ANY Of THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEOULE G AND FILE IT AS PART OF THE RETURN.
Pordates of dealh on oraflerJuly 1, 1994,and before Jan, 1,1995,ihe�ax rate imposed on�he ne�value of Iransfers to or for the use of ihe surviving spouse
�s a�ercem pz vs.gsne(a)(i.i)(pl�
For dates of dea�h on ar afler Jan. 1, 1995, Ihe tax rate imposed on Ne net value of transfers to or for Ihe use of ihe surviving spouse is D percent
[72 P.S.§9116(a)(1.1)(ii�J.The slaNte does not exempt a transfer to a surviving spouse hom tax,and�he s�atutory requirements for disclosure of assets and
fling a tax retum are still applicable even if ihe surviving spouse is�he only benefciary.
For dates of death on or after July 1,2000:
• The tax ra�e imposed on�he ne�value of Vansfers hom a deceased child 21 years of age or younger at dea�h�o or for the use of a naNral parent, an
adoptive varent or a slep�parent of Ihe child is 0 percent�72 PS.§9116(a)(12)].
. The�ax2teimpasedon�henetvalueofiransferstoorfortheuseof�hedecedenfslinealbeneficianes154.5Dercent,excep�asno�edin[72PS,§911fi�aJ(1�].
. The tax rote imposed on the net value of transfers�o or for Ihe use of Ihe decedenPs si6lings is 12 percent�72 P.S.§9116(a)(1.3)].A sibling Is defned,
under Section 9102,as an individual who has at least ane parent in common with the decedent,whether hy blood or adoption.
REV-i5o8 Ex+(a8-v)
�pennsylvania SCNEDULE E
�i7 oevnarmervroveevervue CASH� BANK DEPOSITS & MISC.
�r�nea�*<Hce.nxzcruxx PERSONAL PROPERTV
zesmexr oeceoexr
ESrATE OF: FIIE NUMBEN:
Donna L. Noss 21-14-1057
Include the pmreeds of litiga[ion and[he tla[e the proceeds were receive0 by[he erta[e.
All property)ointty awneE with right of survivorshi0 must be disclosed on ScheEule F.
REM VAWE AT DATE
NUMBER OESCRIPTION OF DEATH
�. Checkingaccountno:722190-MBTBank(sreletterattached) 106,74570
p_ PhiladelphiaAmericanLifelnsuranceCa-premiumreNnd 2,495.51
3. 2001 Honda CRV;VIN N JHLRE48747C112698-pmceeds hom sale 15,500.00
q, �eparlmentofTreasury-incometaxreNnd 904.00
TOTAL(Also enter on Line 5, Recapitula[ion) $ 125,64521
I!more spare is needed,use addl[ional shee[5 of paper of[he same size.
a ��
499 Miahdl Roa4 Mllsborq DE 19966 Rewras Menagemcnt
Phone 888-502-0349
F� (302)934-2955
November 19,2014
Andrews & Jo6nson
Attorneys at Law
78 West Pomfret Street��
Carlisle,PA 17013
Re: Estate of Donna L.Noss
Social Secur'tv' 19830.0281
Date of Death� October 10.201A
Dear Sv or Madam:
Per your inquiry on November 06,2014,please be advised that at the time of death,the above-named decedent .
had on deposi[with this bank the following:
L TypeufAccount CheckingAccomv
AccountNumber ����9�
Ownership(Names afJ Diana L.Fraker(POAJ
Danna L.Noss
OpeningDate 09.�0//1967
ealanceonOmeofDea�h $ I06,745.61
Accruedfnteres( $ .09
_. .. - __ ______.
_____. ...___- -
7otal $ 106,74570
Fnr�ny�ddirional ivform�tion on thc above ecmunts,iocluding ownershi0 and vuy cha�ges,closures antllor reimburxmrn�af funds,
plrose nll��e Spring Gvden v�91]-]AOA52i
We were uneblc ro loca�e any sa@ deposi�bov fm the abwomcutioved dccedeo�.
This letler drcs mt ioclude nny orcomb io wNN Me dcco�may have beeo Gstcd vs Pmver of Anorncg Cus�otlio o(Owform TnnsRrs,
ReprsenmfivePvyrs,arTrn.vrccuntleraR'ntteuAgrtement
$IIICCIC�j'�
V alarie Mercer
Adjustrnen[Services
REV-ISIO :lf+(OB-G5�
`'i�pennsylvania SCHEDULE G
..� ocPnx�mervrorAcvexue INTER-VIVOS TRANSFERS AND
'""E"'T""°E'"'"E"'°" MISC. NON-PROBATE PROPERTY
aesmervr oeceoem
ESTRTE OF FiLE NIIMBEN
Donna L. Noss 21-14-7057
This schetlule must be mmple[eE an0 filea If[he answer ro any o(ques6ons 1 t�rough 4 on page[hree o![he REV-ISOO ls yes.
IiEM DESCRIPTION OFPROPERIV
nneormem+xsrtT�,moeuunws.a>.00steorxnxo DATEOF�EATH %OFDECD'S E%CLOSION iAXAOLE
NUMBER o.orm.xsws.nnu.vnmPrevTMeoe�weee��.esurt. VALUEOFASSET INiERESr pvnrn¢win VAWE
�. AnnuityContracLWestemSouthemLifeAssuranceCompany
Coniract No:W0021496358
Beneficianes:
1l2 Diana L Fraker(daughter)
1/2 Debra A.Brehm(daughter)
DOD Value(see letter attached) 98)05.98 100 98)05.98
2 AnnuityConGact-OneAmerica-PolicyNo'.5820019330
Benefcianes:
112 Diana L Fraker(daughter)
1/2�ebra A.Brehm(daughter)
�O�Value(see letter atlached) 189,246.34 100 7892d6.34
3 AnnuiryContrac�-AmericanGeneralLifelnsuranceCompany
Contract No'UV218417
Beneficiaries:
1/2 Diana L Fraker(tlaugh�er)
1/2 Dehra A.Brehm(tlaugh�er)
00o vawe�see iene�anacnea� 201,fi43.03 100 201,64303
TOTAL(Also en[er on Line 7,RecapiNla[ion) f
If mare space is needed,use adtlilional shee6 ol paper of the same size.
xev-ism ex+�cxas7
,�i pennsylvania SCHEDULE G
�i1 oecnarnen.oreevervue INTER-VIVOS TRANSFERS AND
'""E""""cE'"`"F"'"" MISC. NON-PROBATE PROPERTY
aes��erv.oeceoervr
ESTRTE OF FILE NIIMBER
Donna L. Noss 21-14-1057
This schedule muY be ccmple[etl and fletl if Ne answer to any a!quesfons 1 Nrough 4 on page[hree of tM1e REV-1500 Is yes.
REM CESCRIPTION OF PROPERiV
inewoemervnxeorr.ervee�rteee,wexuunarvsxio.aoamex.�rvo �ATEOFDEATN °50FDECD'S E%CWSION iA%R9LE
NUMBER x�onuxsrexnmwnmwa.aeoe�oroassuesmrt. VAWEOFASSET INTERESi pv�wvue�.e� VAWE
4 Cash gifl to Oaughter Debra Ann 6rehm on FebNary ifi,2014 70,00000 70� 3,000.40 ].000.00
5 Cash gikto son-io-law Jefhey Brehm on Fe6mary 16,2014 10,000.00 70% 3,�00.00 �,000.00
6 Wshgi%�odaughterDianaLynnFrakeronFebmary1fi,2014 �p,ppp.00 70% 3,000.�0 7,000.40
� Cash giX ro son-in-law Thomas Fraker on Fehruary 16,2014 10,000.0a 70% 3,000.00 7,000.00
B PaymentstodaughterDianaLynnFrakerforhameimDmvements 65,000.00 100 65,OOOAO
y Cash giftro Debra Fnn Brehm to equalize a6ove gik fi5.000.00 100 65,OWA0
TO7Al(Also enter on Line 7, Recapi[ulation) ; 647, 595. 35
If more space Is needed,ese additional sheets of paper of[he same size.
J�C-19-2�715 'f"i ll ::� A'C N4NDP 3AS�q4344 AAX:7172474§26 P. 002
Annuity Opeqtions
� Westem & Southern L�fe PO Box2916
Cincinnati,OFI a5201-2918
F nem6erof Wgngm&Southem Finencial GropD toll frea 800926.1702
fax 513.3621353
January 73, 2015
KIMBERLY HEAVNER
1958 SPRING RD
CARSLILE PA 17013
Dear Kimberly:
7hank you for your request for information on the annuity contract. I hope the
following contract irrtormation is helpTul to you.
Annuitant: DONNA NOSS
Owner: DONNA NOSS
Western-Southern Life Assurance Company Contract Number: WOD21496355
Contract Value on 10/10/2014: $98,705.98
If you have any questions, please contact Client Services at 1-800-926-1702.
We can be reached Monday-Thursday 8 a.m. to 6 p.m. and Friday 9 a.m. to
5 p.m. EST.
Sincerely,
Annuity Operations Department
WPstern &Southem Life
DC0.931-f40]
WestemSouthem L"Ae Azsura�te Company
FE3-03-2715 TC� C_':73 FM MP�')P Bp.Nk,4344 FP.X;71724Ca523 F. 071/�7�1
FaX SarveY 2/3/2015 1 :49:33 PM PwGE 2/002 Fax Setvei
Mnuity Operetions
g� Western& 5outhern Life PO Box 2918
Cindnnati,OH a520b2918
A member 01 Weskm&So�,Atem financial G�ouO toll free 9009�4.7]02
faa 513362.2353
February 3, 2075
DONNA NOSS .
387 MOOREDALE RD
CARLISLE, PA 17015
S�bject Annuiy Confract Number W0021496358
Notice of Benefidary Confirma6on
Westem-Southern Life Assurance Company
Dear DONNA NOSS,
Our records reflect the fo�lowing benefiasry designaGon:
Primary Diana L. Fraker (Daughter)
Debra A. erehm (Daughter}
Contingent: None
Please keep this confirmation with your records. Shoultl}rou have any questions
or concerns, please call our Mnuity Operations �epadment at 1-804926-7702.
A representative will be happy to assist you.
Sincerely,
Annuity 6perations Department
ocosa�-uai
Wes±em-Sou[hem lite Assurence Company
i �
� The Sra�e L f Imvrance Company
ONEAMERICA° aorvwaewcam�ompany
One Amencan Squase.P.O.Box 6001
lndlanaooHe.M46109-91W
December 23, 2014
Ronald E Johnson
Andrews G,Johnson Attomeys at Law
78 West Pomfret St
Carlisle PA 17013
Insured: Donna L Noss
Policy: 5820019330
Claim: SD-20141209-005
Dear Mc Johnson
� As requested, the date of death value Q 0/]0/14) for this policy is $189,24634. The
policy was issued effective February 5, 2009. The primary beneficiaries are Debra A
Brehm and Diana L Fraker are both daughters and will receive equal shazes of the
curzen[ va!ue.
If you ha��e any questions or information, please contact us a[ 1-800-833-5569.
Sincerely,
Mwrl6yn :14arrl@8
Individual Claims
5EB-27-i715 FR' C9: 43 .ky". N�N�P 9A53`�344 P�X:71724�4526 %. �02
92/26/2815 09:16 BB63426966 WNL VALIC Pp�E 02/02
American General L'rfe Insurance Company
The United States Life Insurence Company in the City of New York
Febmary 24,2D]5
KR�IBERLY HEAVENflt
FAX# 717-249-4526 �
Re: AnnuiryContcact W218417 .
Deceased Donna L Noss
Deaz Ms Heavcner:
Thank you foc your recent ittquiry regnrding the above refereaced annuity rnnhacL We would
Iikc ro take tivs opporwnity w respond to your reqvest
The accumulated value of C'vs contract as of October 70,201A,tue date of death, is$201,6a3.03.
O�a records indicate that the bcneficiazies of flus Wnttae[axe Diana L Fraker and Dcbra A
Brchm.
Ms Heavcner,we appreciak the opporNniry la assist ycu. Should you have any qucstions,
pleese conhct ouc Client Canc Ceatv at 1-8001f24-4990.
Sin ly,
�U U�
� Linda Perez
P.nnuity Claims Depanmcnt
Mnuily SeMw CeMer•P.O.�%B71 •Am3�110.TX79105-0877
Admlrvstratartor Renaissance LiraS HeaIT I�urenca Campany of tvnerica • AdministralO�krJDM Nden Llfe In9U�nce ComOany
.u�r+nmr
REV45L EXr(0'�15; �
� pennsylvania SCHEDULE H
oEanalnen.oFaEvcvuE FUNERAL EXPENSES AND
w�en�.n�icernxaer�xx ADMINISTRATIVE COSTS
a_smEur oEceoervt
ESTqTE OF FILE NUMBER
Donna L. Noss 21-14-1057
Uecedent's Eebts must be reparteE on Schedule 1.
REM
NUMPER DESCAIPTION
AMOUNT
A. FUNERALEXPENSES:
1� Ewing BroNers Funeral Home-balance due 417.33
B. A�MINISTRATIVE COSTS:
1. Perscnal Represen[ative Commissions'. 7,500.00
Name(sJ a!Peaonal Representative(s) RO�ald E. JOh030�
Street Aecress 78 West POmfret Street �
. .._. ___- —. .
_ __—
c�v Cadisle...._ __. . ..... s��e PA Z�P 17013
____. ._— _..
Year(s)Conmission Paie�. 2015
1. AttomeyFees: 4,500.00
3. Family Exemption�. Qf GecedenPs address I5 no[the saae as c'almanPs,attach explanation.) 3,5��.�0
aa�man� Diana L.Fraker _ _
so-ee�aderess 387 Mooredale Road � � ��
C'iry Carlisle �� _ � � Sta[e PA zlP 17015 �
0.elationship of Oa'�manL'a DeceGen[ . dduqhtef_ ���
4. Probate Fees: 365.50
s, AcmuntaM Fees.
6. hx 0.eturn Preparer Fees: 250.��
�� CharlesBamett-autorepair-sta�einspection-HontlaCRV 57.7q
B. Reserve tor closing and accounting 500.00
TOTAL(Also enter on Line 9, RecapiNlation) S 11,090.57
If more space is neeDeQ use additianal sheets of paper of[he same size.
REV-1513 EXe(O1-10)
� pennsylvania SCHEDULE ]
oEP.a,MEry.oFa�.v�E
�xxEa�rnNce.nxA=ivaru BENEFICIARIES
eesmeert oecEoexr
ESTATE OF: FILE NIIMBEN:
Donna L. Noss 21-14-1057
RElAT10N5NIPT0�ECEDENT BM�UNTOASHARE
NUMBER NAME RN�A�DPE55 OF PERSON(5)RE[EMNG PROPERIV Do Nat Lirt imztee(s) OF ESTATE
I TF%A01F OISTRIBIIr10N5[Intluee ouMgM1t spousal dishibutians anE tmnsfers untler
Sec 9116(a)(11).�
1. Diana Lynn Fraker
387 Mooredale Rwd,Cadisle,PA ll015 daughter 50%
2. De6raAnnBrehm
923 Pine Road,Carlisle,PA 17015 daughter 50%
ENTER DOLIAR AMCUNTS FOR�ISTRIBUTIONS SHO'NN ABOVE ON LMES 15 THROUGH 18 OF REV�1500 C�VER SNEE[AS APPROPPIATE.
�I NON-TAXABLE�ISTRIBIlTI0N5
A. SPOUSRI DISTRIBIIilONS UN�ER SEQfON 9113 FOR WHICH AN ELECTION TO TA%IS NOTTAKEN:
1.
9. CHqRRABLE AN�GOVERNMENiAL DISrRIBMONS:
1.
TOTAL OF P�RT II- ENTER TOTAL NON-TAXABLE�ISTRIBUTIONS ON tINE 13 OF REV-1500 COVER SHER. ;
I(mare SDace is needee,use additional sheets of paper of[he same size.