HomeMy WebLinkAbout07-13-15 pennsylvania 1505618403
DEPARTMENT OF REVENULIX(03-14)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOx.280601 INHERITANCE TAX RETURN
Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 14 0 7 2 4
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07 23 2014 �O 04 1920
Decedent's Last Name Suffix Decedent's First Name MI
SEIFRIED JANET M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return [I 2. Supplemental Return ❑ 3. Remainder Return(date of death
prior to 12-13-82)
❑ 4. Agricultural Exemption(date of 5. Future Interest Compromise(date of ❑ 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
® 7. Decedent Died Testate ® 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received ❑ 11 Non-Probate Transferee Return ❑ 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
[] 13. Business Assets ❑ 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THOS SECTION MUSTBE COMPLETED.ALLCORRESPONDENCEAND CONFMENIIALTAX INFORMATION SHOULD BE DIRECTEDTO:
Name Daytime Telephone Number
JEAN D SEIBERT 717 232 7661
First Line of Address
3631 NORTH FRONT STREET
Second Line of Address
City or Post Office State ZIP Code rn n
HARRISBURG PA 17110 C11�
rn
Correspondent's email address:
REGISTER Or WIIQ:�OS,E ON%
REGISTER OF WILLS USE ONLY
DATE FILED 3 C t J t -
;: r-
-� o N -n
DATE FILED STAMP
Side 1
1505618403 1505618403 j
J 1505618411
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: SEIFRIED, JANET M.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2•
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3•
4. Mortgages and Notes Receivable(Schedule D)...................................................... 4•
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)............. 5. 305 -v517 - 12
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 2 , 722 -1849 - 04
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 3 , 028 , 366 - 16
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 46 766 0 9
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 4 6 , 0 8 0 0 2
11. Total Deductions(total Lines 9 and 10).................................................................. 11. 92 , 84 6 . 11
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 2 , 9 35 , 52 0 • 05
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. 2 -, 935 , 520 - 05
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 21935 , 520 - 05 16. 132 , 098 - 411
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. 132 , 098 • 40
20• FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledg .
SIGNATU F PER N RESP ISLE FOR F G RETURN Wendy Shumaker E DAT �
7 T x015
ADDRES
1024 Rockledge rive, Carlisle, PA 17015
SIGNATURE REP R R O R THAN REPRESENTATIVE Jean D Seibert 7 TE
ADDRESS CWtdwell 8c Kearns P.C.
3631 North Front Street, Harrisburg, PA 17110
1111111111111111111111111111111111111 IN Side 2
1505618411 1505618411 �,.�
ADDITIONAL Personal Representatives
Seifried, Janet.. SU. 7/23/2014
Under penalties of perjury, the undersigned declare Ahat;they;have;examined this return,.
.including accompanying schedules and statements,and to the hest of their knowledge and
belief; It.is true; correct and complete.
2 Signature
Name Bruce SeiMed
Address: PO Box;125
City,State,Zip, Williamsburg, MA 01096
Date ✓ y�
3 Signature
Name
Address
city,state;Zip
Date
4 Signature
Name
Address:
City;State,Zip
Date
5' Signature
Name<
Address:
City;State;Zip
Date
6 Signature
Name
Address c
City,State,Zip
Date
REV-1500 EX Page 3 File Number 21 - 14 - 0724
Decedent's Complete Address:
DECEDENT'S NAM
Se[fried, Janet M.
STREET ADDRESS
83 Schimmel Way
CITY $TATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 132,098.40
2. Credits/Payments
A. Prior Payments 125,960.43
B. Discount 6,578.95
Total Credits(A +B) (2) 132,539.38
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 440.98
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)
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;.................................................................................. ❑
lil
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑
c. retain a reversionary interest;or................................................................................................................. ❑
d. receive the promise for life of either payments,benefits or care?.............................................................. 0
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ F
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?......... Q ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
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 spo
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
V?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
V?
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 21ears of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a step-parent 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)('
•The tax rate imposed on the net value of transfers to or for the use of the decedent's siblingsis 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.
Nil,
pennsylvania SCHEDULE E
DEPARTMENT OFCASH BANK DEPOSITS AND MISC.
EVENUE
RE
INHERITANCE TAXAXRETUURNRN �
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Seifried, .ballet M. 21 - 14-Q724
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER QESCRIPTIQN DEATH
1 Guilford Savings Sank Savings Account No. 502017195 15,211.67
2 Guilford Savings Bank Checking Account No. 01-0000527 2,296.06
3 Members 1 st FCU Checking Account No. 524717-11 16,795.61
4 Members 1st FCU Investment Savings Account No. 524717-05 1,038.78
5 Members 1st FCU Certificate of Deposit No. 524717-40 100,553.44
6 Members 1st FCU Savings Account No. 524717-00 5.00
7 Susquehanna Bank Checking Account No. 10010725074 1,182.64
8 $uquehanna Bank Savings Account No. 10010657830 6,408.91
9 Optimizer Plus Certificate of Deposit 26,155.14
10 Deposit from Cottage 135,100.00
11 Auction proceeds for personal items 769.87
TOTAL(Also enter on Line 5, Recapitulation) 305,517.12
REV-1510 EX+(08.09)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Seifried, Janet M. FILE NUMBER
21 - 14 -0724
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S (IF APPLICABLE)
and the date of transfer. Attach a copy of the deed for real estate. INTEREST
Wells Fargo Advisors, Account No. 4575-1231,Janet
M. SeifriedTrust is beneficiary-assets are as follows:
1 600 Units of 3M Co. @ $144.68 per share 86,808.00 86,808.00
2 50 Unit of Allegheny County PA Higher @ $1,057.61 52,880.50 52,880.50
per unit
3 300 Units of Altria Group Inc @ $41.72 per unit 12,516.00 12,516.00
4 228.071 Units of American Electric Power @ $53.97 12,308.99 12,308.99
per unit
5 700 Units of Amgen Inc @ $122.01 per unit 85,407.00 85,407.00
6 4,200 Units of Apple Inc. @ $97.19 per unit 408,198.00 408,198.00
7 2,700 Units of AT&T Inc. @ $ 35.88 per unit 96,876.00 96,876.00
8 1,000 Units of Centurylink Inc @ $37.57 per unit 37,570.00 37,570.00
9 20 Units of Clarion County PA Indl Dev @ $904.01 18,080.20 18,080.20
per unit
1.0 1,375 Units of Consolidated Edison Inc. @$57.25 per 78,718.75 78,718.75
unit
11 1,000 Units of Dominion Res Inc VA New @ $70.21 70,210.00 70,210.00
per unit
12 360 Units of Duke Energy Corp @ $73.40 per unit 26,424.00 26,424.00
13 1,000 Units of Eaton Vance Ltd @$15.37 per unit 15,370.00 15,370.00
TOTAL(Also enter on line 7, Recapitulation) 2,722,849.04
REV-1510 EX+(08.09)
pennsylvaniN SCHEDULE G
DEPARTMENT AXRET RN INTER-VIVOS TRANSFERS &
RESIDINHERENT
DECEDENT
MISC. NON-PROBATE PROPERTY
RESIgENT DECEgENT
continued
ESTATE OF Seifried, Janet M. FILE NUMBER
21 - 14 -0724
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECINT RD ST (IF APPLICABLE)
and the date of transfer. Attach a copy of the deed for real estate.
14 1,000 Units of Emerson Electric Co. @ $67.02 per 67,020.00 67,020.00
unit
15 1,137.73 Units of Empire District Elec Co. @ $25.41 28,909.74 28,909.74
per unit
16 653.639 Units of Europacific Growth Fd @ $50.55 per 33,041.45 33,041.45
unit
,17 500 Units of Exxon Mobil Corp @ $104.25 per unit 52,125.00 52,125.00
18 2,9Q0 Units of General Electric Co @ $25.91 per unit 75,139.00 75,139.00
19 400 Units of International Business @$196.63 per 77,452.00 77,452.00
unit
20 500 Units of JP Morgan Chase &Co @$59.00 per 29,500.00 29,500.00
unit
21 69 Units of Krafts Foods Group @$58.30 per unit 4,022..70 4,022.70
22 1,200 Units of McGraw-Hill Financial @$83.11 per 99,732.00 99,732.00
unit
23 207 Units of Mondelez Intl Inc @$38.29 per unit 7,926.03 7,926.03
24 1,000 Units of CIGE Energy Corp @ $37.51 per unit 37,510.00 37,510.00
25 1,012 Units of Paychex Inc @ $42.06 per unit 42,564.72 42,564.72
26 15 Units of Pennsylvania St Higher @$1039.83 per 15,597.45 15,597.45
unit
27 700 Units of Pepsico Inc @ $9Q.82 per unit 63,574.00 63,574.00
Page 2 of Schedule 0
REV-1610 EX+(08.09)
pennsylvania SCHEDULE G
DEPARTMENTNHERIINHERITANCE TAX
RETURN
INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT URN MISC. NON-PROBATE PROPERTY
continued
ESTATE OF Seifried, Janet M. FILE NUMBER
21 - 14 -0724
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S (IF APPLICABLE)
and the dale of transfer. Attach a copy of the deed for real estate. INTEREST
28 25 Units of Philadelphia PA Gas Wks @ $1,089.56 27,239.00 27,239.00
per unit
29 40 Units of Philadelphia PA Hosps @ $1,023.07 per 40,922.80 40,922.80
unit
30 30 Units of Philadelphia PA Pkg Auth @$1,102.83 33,084.90 33,084.90
per unit
31 300 Units of Philip Morris @ $85.08 per unit 25,524.00 25,524.00
32 700 Units of Procter& Gamble Co. @ $79.99 per unit 55,993.00 55,993.00
33 30 Units of Puerto Rico Comwlth Hwy @ $733.13 per 21,993.90 21,993.90
unit
34 525 Units of Scana Corp Com @ $53.07 per unit 27,861.75 27,861.75
35 15 Units of State Pub Sch Bldg Auth @ $1,071.34 16,070.10 16,070.10
per unit
36 105 Units of State Pub Sch Bldg Auth @$1,113.92 116,961.60 116,961.60
per unit
37 800 Units of The Southern Co. @ $44.81 per unit 35,848.00 35,848.00
38 1,334 Units of Unite[ Corp @$33.02 per unit 44,048.68 44,048.68
39 200 Units of UNS Energy Corp @$60.42 per unit 12,084.00 12,084.00
40 512.04 Units of Vectren Corp @$39.69 per unit 20,322.87 20,322.87
41 1,500 Units of Verizon Communications @ $50.91 per 76,365.00 76,365.00
unit
Page 3 of Schedule G
REV-1610 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS &
RESIDINHERENT
EDENAX TURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF Seifried, Janet M. FILE NUMBER
21 4-0724
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. INTEREST (1F APPLICABLE)
42 1,200 Units of Wal-mart Stores Inc. @$76.99 per 92,388.00 92,388.00
unit
43 500 Units of Wells Fargo & Co. 8% PFD @$29.50 14,750.00 14,750.00
per unit
44 1,600 Units of Wells Fargo Co @$51.33 per unit 82,128.00 82,128,00
45 1,111 Units of Xcel Energy Inc @ $31.54 per unit 35,040,94 35,040.94
46 Members 1st FCU Certificate of Deposit No. 62,512.40 62,512.40
524717-41 FBO Bruce Seifried, her son
47 Members 1st FCU Certificate of Deposit No. 31,256.18 31,256.18
524717-42 FBO Wendy Shumaker, her daughter
48 Athene Annuity Contract No. 808814AFB, 136,069.08 136,068.08
beneficiaries are Wendy Shumaker and Bruce
Seifried, her children
49 Federated Fund, beneficairy is Bruce Seifried, her son 23,903.31 23,903.31
50 Bruce Seifried, her son, gifted 4-07-14 14,000.00 3,000.00 11,000.00
51 Kyle Bjorkman. her great-granson, gifted 4-07-14 14,000.00 3,000,00 11,000.00
52 Sarah Bjorkman, her granddaughter, gifted 4-07-14 14,000.00 3,000.00 11,000.00
53 Mark Shumaker, her grandson, gifted 4-07-14 14,000.00 3,OQ0.00 11,000.00
54 Wendy Shunmaker, her daughter gifted 4-07-14 14,000.00 3,000.00 11,000.00
Page 4 of Schedule G
REV-1511 EX+(08.13)
;pennsylvania SCHEDULE
y� DEPARTMENT OF REVENUE FUNERAL EXPENSES
AND
INHERITANCE TAX RETURN DMINtS 1 RA 1 V E CWT+
RESIDENT DECEDENT rWIY1 �7
FILE NUMBER
ESTATE OF Seifried, Janet M. 21 - 14-0724
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Hoffman-Roth Funeral Home 585.85
2 Travis Monuments, Inc. 692.00
3
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 Caldwell& Kearns P.C.--Jean D Seibert 16,000.00
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 Register of Wills 318.50
Register of Wills-Additional probate fee 150.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Gifted amount on Schedule 0 on 8-22-14 28,000.00
See attached 1,019.74
TOTAL(Also enter on line 9, Recapitulation) 46,766.09
REV-1611EX+(08.13)
pennsylvania
DEPARTMENT OF REVENUE Schedule H
INHERITANCE TAX RETURN Funeral Expenses&
RESIDENT DECEDENT Administrative Costs continued
ESTATE OF Seifried, Janet M. FILE NUMBER
21 - 14-0724
2 Sentinel -Advertising letters 318.50
3 Cumberland County Law Journal -Advertising letters 75.00
4 Fax, mail and shipping 143.10
5 Auction Commission 370.33
6 09-03-14 UGI 11.47
7 09-03-14 MetEd Electric 19.54
09-03-14 Comcast Cable 31.80
9 Reserve for postage, copies, etc. 50.00
Page 2 of Schedule H
K DEPARTMENTpennsyovania REVENUE SCHEDULE I
INHERITANCE TAX RETURN DEBTS OF DECEDENT, MORTGAGE
RESIDENT DECEDENT LIABILITIES & LIENS
FILE NUMBER
ESTATE OF Seifried, Janet M. 21 - 14 -0724
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 07-24-14 Diakon Lutheran Social Ministries 7,448.00
2 07-24-14 Qiakon Lutheran Social Ministries 1,835.00
3 07-24-14 Stoken Opthalmology 12.40
4 07-30-14 Custom Communications 240.00
5 08-22-14 Gifted amount pledged prior to death ($14,000.00 x 2) 28,000.00
6 08-23-14 Citi Cards 25.93
7 08-23-14 UGI 12.44
8 08-23-14 Omnicare King of Prussia 80.95
9 08-23-14 MetEd Electric 49.36
10 08-23 14 Diakon Lutheran Social Services 725.00
11 08-23-14 Comcast Cable 31.81
12 08-23 14 Consumer Cellular 25.90
13 09-03-14 Pinnacle Health Medical Group 8.18
14 09-03-14 Apria Healthcare 10.37
15 09-03-14 Walnut Bottom Radiology 5.22
16 .09-15-14 US Treasury 5,730.00
TOTAL(Also enter on Line 10, Recapitulation) 46,080.02
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT continued
FILE NUMBER
ESTATE OF Seifried, Janet M.
21 - 14 -0724
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
17 09-15-14 PA Department of Revenue 990.00
18 10-01-14 Pinnacle Health 10.85
19 10-07-14 CVS Pharmacy, Inc. 147.72
20 10-07-14 Quantum Imaging 4.98
21 10-07714 Pinnacle Heath 243.21
22 10-07-14 Cumberland Goodwill Fire Rescue EMS 20.63
23 11-19-14 Pinnacle Health Medical Group 5.44
24 11-19-14 Spirit Physicians Services 4.50
25 01-15-15 US Treasury 10.00
26 01-15-15 PA Department of Revenue 10.00
27 04-11-15 Klinger&Assoc-Tax preparation 385.00
28 06-01-15 Transworl Systems Inc. ALT (Collections) 7.13
Page 2 of Schedule I
REV-1613 EX+(01-10)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULEJ
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Seifried, Janet M. 21 - 14 -0724
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS distributions,
outright spousal
and transfers
under Sec.9116(a)(1.2)]
1 Janet M. Seifried"RevocableTrust Under 100%
Agreement dtd November 23, 2009,
beneficiaries are her children and her
grandchild
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate,
11. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
9�Pses��
RECORDED 0F'F`' f O � �
�- PITNCY DOVfro
K
CALDWELL & EARNS REGIS�rEn OF WILLS 02 1P � ®®3.380,
HIS 13 PM 12 04 MAILED 2370 JUL 09 2015
3631 NORTH FRONT STREET � JUL1 ' � MAILED FROM ZIP CODE 17110
HARRISBURG, PA 1 7 1 1 0-1 533
CLERK 0
ORPHANS! COt:F;:
CUIrt BERU.110 c,n., PA
i
i
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013