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HomeMy WebLinkAbout09-18-15 REV-1500 EX(02-11)(H) i�1r 1505610105 OFFICIAL USE ONLY PA Department of Revenue pennsytvania =•^TMF�o.arF County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Ha 60x Harrisburg,PA 1 2� 15 �� Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02/11/2015 09/27/1924 Decedent's Last Name Suffix Decedent's First Name MI Hammaker Isabel B (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 tj 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 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 INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Andrew C. Sheely, Esquire 717-697-7050 REGISTER OF WILLS USE ONLY `J First Line of Address n , 127 South Market StreetCD s r� Second Line of Address n a E? r-'- P.O. Box 95 `"R co -DATE FILE City or Post Office State ZIP Code �t Mechanicsburg PA 17055 r� = N O� Correspondent's e-mail address:andrewc.sheely@verizon.net - W 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. SI,G,N�RE OF PERSO ESPEIBLE FOR FILING RETURN DATE ,r� ADDRESS Donna J. Cassell, 19 Glenwood Drive East, Camp Hill, PA 17011 SIGNOKIE OF P P REPRESENTATIVE AD ESS / Andrew C. Sheely, E h Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J � 1 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Hammaker, Isabel Beatrice RECAPITULATION 1. Real Estate(Schedule A). ... . . ... ... .. . ..... . .. .. . .. ... ... .. ..... . . .. 2. ,Stocks and Bonds(Schedule B) .. . .... .. .. .... .... . .. .. . . ... .. ... .. ... 2. i I 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. i 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. . ... . 6. 94,403.70 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ;(Schedule G) C=:) Separate Billing Requested... .... . 7 250,221 46 8. ,Total Gross Assets(total Lines 1 through 7). .. ..... .... . .. . ... .. .. ...... 8. 344,625.16 9. Funeral Expenses and Administrative Costs(Schedule H). ..... .. ... . .. .. .. . 9. ' 9,455.26 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)... .. .. ....... .. 10. 163.92 11. Total Deductions(total Lines 9 and 10). .. . . ....... .. .. . .. ... ... .. ... .. 11. ; 9,619.18 12. Net Value of Estate(Line 8 minus Line 11) .. ...... .. .. . .... .. .. ... . .. ... 12. 335,005.98 _...__._.... ..,:_.._. .. _....... ......... 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. 335,005.98 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_ 15. 16. Amount of Line 14 taxableat lineal rate X.0 45 335,005.98 16, 15,075.26 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. 15,075.26 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT t Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Isabel Beatrice Hammaker ................................. ........................ ....... STREET ADDRESS ......... 824 Lisburn Road, Room 114 ............ ...... ---._.._.__.....__......---L_.._.—_..._.__.......... ......... ........ ............. CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 15,075.26 2, CreditsIPayments A.Prior Payments ...... 19,000.00 B.Discount 999.97 Total Credits(A+B) (2) 19,999.97 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 4,924.71 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) Make check payable to: REGISTE.R.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.......................................................................................... ❑ b. 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?...................................................................... El 0 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................. ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. El 0 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ....................................................................................................................... N EJ 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)(I)I. • 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. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 020498 CASSELL DONNA J 19 GLENWOOD DRIVE EAST CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold 101 $19,000.00 ESTATE INFORMATION: SSN: FILE NUMBER: 2115-0406 DECEDENT NAME: HAMMAKER ISABEL B DATE OF PAYMENT: 04/14/2015 POSTMARK DATE: 04/14/2015 COUNTY: CUMBERLAND DATE OF DEATH: 02/11/2015 TOTAL AMOUNT PAID: $19,000.00 REMARKS: RCPT TO ATTY CHECK# 572 INITIALS: D131 SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS TAXPAYER ' r�rr�i�.r►� av�� rvn Pennsylvania� REFUND OF Official Use Only DEPARTMENT OF REVENUE PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES INHERITANCE/ESTATE PO.BOX 280601 TAX HARRISBURG, PA 17128-0601 See Instructions on Reverse TO: PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 FROM: Official Representative Decedent Information Name Andrew C. Sheely, Esquire Name of Decedent Isabel Beatrice Hammaker Address 127 South Market Street File Number P.O. Box 95 Date of Death 02/11/2015 Mechanicsburg, PA 17055 Social Security Number Phone Number 717-697-7050 Email Address andrewc.sheely@verizon.net The undersigned requests a refund in the amount of $ 4,924.71 for the above-referenced decedent's estate. REFUND REQUESTED ON: FlOriginal or Supplemental Joint/Trust Assets Remainder Return Estate Tax Probate Return EXPLANATION OF OVERPAYMENT Refund requested due to overpayment of inheritance tax. Refund should be issued and made payable to Donna J.Cassell as she make the,,original April 14,2015 prepayment of$19,000.00. i 04 CA S gnature bate Please allow six to eight weeks for the processing of your refund request. . , Isabel B. Hammokar REV-1Sog EX+(o1-10) pennsylvaMa SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Isabel B. Hammaker Page 2 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 REtATiONSHIP TO DECEDENT A.Donna J.Cassell 19 Glenwood Drive East,Camp Hill,PA 17011 Daughter B.Linda L.Shuff 4182 Kittatinny Drive,Mechanicsburg,PA 17050 Daughter C. 30INTLY OWNED PROPERTY: LEITER 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 AB 8/24/2012 Members ist CD Acct#22536-47 Principal$25,859.85,accrued interest 25,867.64 1/3 8,622.55 $7.79,A.account w/Donna Cassell and Unda Shuff,rollover 3/24/2014 6. AB 2/22/2013 Members 1 st CD Acct#22536-48 Principal$25,855.61,accrued interest 25,863.40 1/3 8,621.14 $7,79,A.account w/Donna Cassell and Linda Shuff,rollover 5/27/2014 7. AB 9/23/2013 Members 1st CD Acct#22536-50 Principal$28,827.34,accrued interest 28,832.47 1/3 9,610.83 $5.13,Jt,account w/Donna Cassell and Unda Shuff,rollover 8/25/2014 8. AB 7/08/2013 Members 1st CD Acct#22536-55 Principal$30,596.15,accrued'interest 30,601.60 1/3 10,200.54 $5.45,A.account w/Donna Cassell and Linda Shuff,rollover 10/14/2014 9. AB 7/11/2013 Members 1st CD Acct#22536-59 Principal$6,544.76,accrued interest 6,545.93 1/3 2,181.97 $1.17,Jt.account w/Donna Cassell and Linda Shuff,rollover 10/14/2014 10 AB 4/15/2013 Members 1st CD Acct#22536-84 Principal$33,612.19,accrued interest 33,624.53 1/3 11,208.18 $12.34,A.account w/Donna Cassell and Linda Shuff,rollover 11/13/14 11 AB 4/15/2013 Members 1st CD Acct#22536-85 Principal$22,287.27,accrued interest 22,291.24 1/3 7,430.42 $3.97,Jt.account w/Donna Cassell and Linda Shuff,rollover 11/13/2014 TOTAL(Also enter on Line 6, Recapitulation) $ 94,403.70 If more space is needed,use additional sheets of paper of the same size. rax tiftzootia niji o ru f j v;) i-min 1 vu 11 www A MEMBFM V REGULAR NGS ACCOUNT: FEMALCMrr UNWN Account Number/Suffix 22536-00 Date Account Established 08!I5II979 Principal Balance at Date of Death $39,753.18 Accrued Interest to Date of Death $1.09 Total Principal and Accruied Interest $39,75.4.27 Name of Joint Owner Donna Cassell Date Joint Added 08/15/1979 CHECKING ACCOUNT: Account Number/Suffix 22536-11 Date Account Established 02117/1989 Principal Balance at Date of Death $2087-84 Accrued Interest to Date of Death $0.04 - Total Principal and Accrued Interest $2087.88 Name of Joint Owner Donna Cassell Date Joint Added 06117/2009 VISA CREDIT CARD ACCOUNT Account Number 4672090000357897 Date Account Established 05f12/1992 Balance at Date of Death $111.74 Joint Cardholder- None CERTIFICATE OF DEPOW: Account Number/Suffix 22538-44* 22636-46 Date Account Established 05I10=13 01113/2014 Principal Balance at Date of Death $23,149.27 $23,662.06 Accrued Interest to Date of Death $2.54 $7.13 Total Principal and Accrued Interest $23,151.81 $23,669.19 Name of Beneficiary Donna Cassell Donna Cassell Linda Shuff Linda Shuff *Rollover from CD 22536-77 opened 02f08/2012. CERTIFICATE OF DEPOSIT: Account Number/Suffix 22636-47* 22536-48** Date Account Established 03124/2014 05/27/2014 Principal Balance at Date of Death $25,859.85 $25,855.61 Ac med Interest to Date of Death $710 $7.79 Total Principal and Accrued interest $25,867,64 $25,863.40 Name of Beneficiary Donna Cassell Donna Cassell Linda Shuff Linda Shuff *Rollover from CD 22536-82 opened 08/2412012. "Rollover from CD 22535-41 opened 0212212013. MEMBERS 1sT FEDERAL CREDIT UNION Tessa L KJughgh Lending Insurance Support Specialist March 5,2015 Estate of. ISABEL 8 HAMMAKER Date of Death:02/1112015 Social Security Number. 182-22-8228 5000 Louise T)rive P.0.I)ox 40 • 'NIL-chmicsburg,Pcnmcylvank 17055 (8(X))283-2328 %%--woa,.mcrnberslstorg Fax (1((9bb1f8 Rpr 6 2111b 1JU:=aM rUUZ/UUZ I,`OILF Ni NIBERS r rZYMPLAY.CREDIT UNIM. CERTIFICATE OF DEPOSIT: Account Number/Suffix 22636- 0* 22536-51 Date Account Established 08/2512014 09/1012014 Principal Balance at Date of Death $28,827.34 $16,587.52 Accrued interest to Date of Death $5.13 $6.09 Total Principal and Accrued interest $28,832.47 $16,593.61, Name of Beneficiary Donna Cassell Donna Cassell Linda'Shuff Linda Shuff *Rollover from CD 22536-57 opened 09/23/2013. CERTIFICATE OF DEPOSIT. Account Number/Suffix 22636-62 22536.W Date Account Established 09116/2014 10/14/2014 Principal Balance at Date of Death $44,819.58 $30,596.15 Accrued Interest to Date of Death $7.98 $5.45 Total Principal and Accrued Interest $44,827.56 $30,501.60 Name of Beneficiary Donna Cassell Donna Cassell Linda Shuff Linda Shuff *Rollover from CD 22536-45 opened 07108/2013. CERTIFICATE OF DEPOSIT: Account Number/Suffix 22536-59* 22636-60 Date Account Established 10/14/2014 10/1412014 Principal Balance at Date of Death $6,544.76 $8,868.39 Accrued Interest to Date of Death $1.17 $1.58 Total Principal and Accrued Interest $6.545.93 $8869.97 Name of Beneficiary Donna Cassell Donna Cassell Linda Shuff Linda Shuff *Rollover from CD 22536-63 opened 07111/2013, CERTIFICATE OF DEPOSIT: Account Number/Suffix 22536-84* 22536-W* Date Account Established 11/13/2014 11/13=14 Principal Balance at Date of Death $33,612-19 $22,287.27 Accrued Interest to Date of Death $12.34 $3,97 Total Principal and Accrued Interest $33,024-53 $22,291.24 Name of Beneficiary Donna Cassell Donna Cassell Linda Shuff Linda Shuff *Rollover from CD 22536-42 opened 0411512013, **Rollover from CD 22536-43 opened 04/1612013. MEMBERS I'FEDERAL CEDIT UNION Tessa L Klugh jor Lending Insurance Support Specialist March 5,2015 E$tate of:ISASF-L.0 HAMMAKER Date of Death:02/1112015 Social Security Number. 182-22-8228 5000 T.ouist Dtivc P0 .Do-,40 Nfechanic+utgvani ?ennsyl a 17055 (800)283-2-328 REV-1.510 EX+(08-09) l.�,. f� . : Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Isabel B. Hammaker 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 Members 1st CD Account#22536-60 Principal$8,868.39,accrued interest $1.58,Jt.account with daughter, Donna Cassell, 19 Glenwood Dr. East, 8,869.97 100 8,869.97 Camp Hill,PA 17011,and daughter, Linda Shuff,4182 Kittatinny Drive, Mechanicsburg, PA 17050 Members 1 st CD Account#22536-51 Principal$16,587.52,accrued interest 2' $6.09,Jt.account with daughter, Donna Cassell, 19 Glenwood Dr. East, 16,593.61 100 3,000.00 13,593.61 Camp Hill,PA 17011,and daughter,Linda Shuff,4182 Kittatinny Drive, Mechanicsburg,PA 17050 Members 1 st CD Account#22536-52 Principal$44,819.58,accrued interest 3' $7.98,Jt.account with daughter, Donna Cassell, 19 Glenwood Dr. East, 44,827.56 100 3,000.00 41,827.56 Camp Hill,PA 17011,and daughter, Linda Shuff,4182 Kittatinny Drive, Mechanicsburg,PA 17050 Ameriprise Investment Account#00022329058 133.Beneficiaries: Daughter 4' Donna J. Cassell, 19 Glenwood Dr. East,Camp Hill, PA 17011, Daughter 101,828.1 100 101.828.1 Linda Shuff,4182 Kittatinny Drive,Mechanicsburg,PA 17050 and son, William P.Graham,374 Green Road,Trenton, NC 28585 Ameriprise Annuity Account#93004026560 004. Beneficiaries: Daughter 5. Donna J.Cassell, 19 Glenwood Dr. East,Camp Hill,PA 17011,Daughter 56,985.24 100 56,985.24 Linda Shuff,4182 Kittatinny Drive,Mechanicsburg, PA 17050 and son, William P.Graham,374 Green Road,Trenton,NC 28585 New York Life Annuity-Policy#75613023.Beneficiaries: Daughter 6. Donna J.Cassell, 19 Glenwood Dr. East,Camp Hill,PA 17011,Daughter 25,345.98 100 25,345,98 Linda L.Shuff,4182 Kittatinny Drive, Mechanicsburg,PA 17050 and Son William P.Graham,374 Green Road,Trenton, NC 28585 Decedent's 2014 Federal Income tax refund-deposited into Member 1st 7' Saving Account#22536-00,Jt.acount with Donna J.Cassell 1,698.00 100 1,698.00 Decedent's PA 2014 Income tax refund-deposited into Member 1 st Saving 8' Account#22536-00,Jt.account with daughter,Donna J.Cassell 73.00 100 73.00 TOTAL(Also enter on Line 7, Recapitulation) $ 250,221.46 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) f . pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Isabel Beatrice Hammaker Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Shalonis Funeral Home 6,083.21 2. Funeral Luncheon 548.67 3. Rice Memorial Headstone 175.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: $0.00 Name(s)of Personal Representative(s) Donna Cassell Street Address 19 Glenwood Drive East city-Camp Hill State PA ZIP 17011 --- Year(s)Commission Paid: 2. Attorney Fees: 1,425.00 3. Family Exemption: (If decedents address is not the same as claimant's,attach explanation.) Claimant Street Address city'. State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 200.00 5, Accountant Fees: 6. Tax Return Preparer Fees: 7. Postage 23.38 8. Reserves to conclude Estate administration,decedent's 2015 income taxes 400.00 TOTAL(Also enter on Line 9, Recapitulation) $ 9,455.26 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ Y oennsvtvania SCHEDULEI DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Isabel Beatrice Harnmaker Rekrt 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 I. The Woods 41.00 2. Spartan Pharmacy-final bill 11.18 3. Members I st VISA credit card -account#4672090000357897 111.74 TOTAL(Also enter on Line 10, Recapitulation) $ 163.92 If more space is needed,insert additional sheets of the same size, REV'1513 EX+(01-10) �� -'Pennsylvania SCHEDULE ' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Isabel Beatrice Hammaker 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. Donna J.Cassell, 19 Glenwood Drive East,Camp Hill,PA 17011 Daughter 1/3 2. Linda L.Shuff,4182 Kittatinny Drive,Mechanicsburg, PA 17050 Daughter 1/3 3. William P.Graham,374 Green Road,Trenton,NC 28585 Son 1/3 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II — ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size.