HomeMy WebLinkAbout01-0791
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of SYLVA E GRUBB
also known as
No.
To:
,:),/ -0 I -7Q,
Social Security No.
Deceased.
209-46-1942
Register of Wills for the
County of ClInber I and in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner~), who is/~ 18 years of age or older, appl ies
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
d d. .1 d d h. Cmlberland C Pl.. h
Decen ent was omlcl e at eat III ounty,ennsy vama, Wit
h er last family or principal residence at 351 Ni ttary - Messiah Vi lla~e, Upper Al ~en Twp
(list street, number and munidpality) Mechanicsburg 17055
Decendent, then 81 years of age, died June 18
at Hershey Medical Center. Derry Twp. DauDhin Co.
~ 2001 ,
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$
$
$
$
76,674 00
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
C. KENNE'IH GRUBB
HUSBAND
351 NI'ITANY - Messiah Vi I I age
/
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form fO the undersigned.
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C. KENNE'IH GRUBB
351 NI'ITANY - MESSIAH VILLAGE
MEOJANICSBURG PA 17055
) '2 -~-iLf
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF aIVBERLAND
} ss
The petitioner(sJ above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and
before me this _ 23rd
~t
'/hcu . ~
EL .B, ~ ~
subscribed
day of
1IJf2001
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Register
No. 21-01-791
Estate of
SYLVA E. GRUBB
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW Augus t 23 ~~~, in consideration of the petition on
the reverse side hereof, satisfactory P!QQ.t.h~~inE-12~ presented before me,
IT IS DECREED that C. KENNElH GRUW
is~entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to C. KENNE1H GRUBB
in the estate of SYLVA E. GRUBB
FEES
Letters of Administration
Short Certificates( 1) .. . . . . . . , .
Renunciation ................
JCP
$ 200.00
$ 3.00
$
$ 5.00
TOTAL _ ~oe.oo
. .. . .. .P..P~.. .,23.1, . ,.. A.D. ~...2ill1L
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Register of ~ii1s
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-----
NEY (Sup. Ct. I.D. No.)
w.vI D samAQ{ I I I 15893
P 0 IX:>>{ 316
DILLSBURG ADDRESS PA 17019
(717) 432-9733
.
Filed
PHONE
maJ.J ~~~. ~"-~';'-c)1
/?-cQ,- //y
~. BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
-
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REY-1547 EX AFP [01-02)
WM D SCHRACK III .~
124 W HARRISBURG ST
PO BOX 310
DILLSBURG
i"I!\Y i 0
4
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-06-2002
GRUBB
06-18-2001
21 01-0791
CUMBERLAND
101
SYLVA
E
Allount Rellitted
l_ ..,. ~
r:rfh17019
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is4-j-E3f-AFP--(cff':02Y-NO'TicE--OF-YtitiEifiTAtfCE-i'Ai-A-PPRA-isEifENT~--A[l-oWAi'-cE-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GRUBB SYLVA E FILE NO. 21 01-0791 ACN 101 DATE 05-06-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
75,906.44
.00
.00
(8)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
75,906.44
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
4,673.00
.00
(11)
(12)
(13)
(14)
4.673 DO
71,233.44
.00
71,233.44
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
71,233.44 X 00 =
.00 X 045=
.00xI2=
.00xI5=
(9)=
.00
.00
.00
.00
.00
TAX CR~DITS:
.~.. . n~..~. l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
Vt/
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
SYLVA E GRUBB
Date of Death:
6/18/2001
Will No.
2001-00791 (PA 2101-00791) Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~. No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes Nor~
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? YesL:~o
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 03/14/0?
Cy~~
Signature
C. KENNETH GRUBB
Name (Please ~pe or print)
351 NITTANY - MESSIAH VICLAGE
MECHANICSBURG PA 17055-2015
Address
( 717) 790-1531
Tel. No.
Capac i ty: xx
Personal Representative
(MAH:rmf/AM3)
Counsel for personal
representative
HI05.805 REV 9/86
-r\is is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local R~gistraL The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
21-01-791
Fee for this certificate, $2.00
No.
~~ I(.JPA ~.
Local RegIstrar
p
7387051
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HI05 j4JAev 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPEJPRINT
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PERMANENT
BLACK INK
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MANNER Of OfATH
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DATE OF INJURY
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.MEDICAl EXAMINER/CORONER
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CERTIFICA TION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Estate No.
SYL VA E. GRUBB
June 18, 2001
21-01-0791
To the Register:
I certifY that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphan's Court Rules
was served on or mailed to the following beneficiary of the above-captioned estate on August 29.
2001.
Name
C. KENNETH GRUBB
Address
351 Nittany - Messiah Village
Mechanicsburg, P A 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
Date:
r?&JL
. . SC
124 West Harrisbu reet
Dillsburg, P A 17019-0310
(717) 432-9733
Counsel for Personal Representative
-a
-a .
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be
determined wholly or partly by the decedent's Will.
If the decedent died without a Will, whether you will
receive any money or property will be determined by
the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
In re:
THE ESTATE OF: SYLVA E. GRUBB
ESTATE NO. 21-01-0791
To: C. Kenneth Grubb
351 Nittany - Messiah Village
Mechanicsburg, PA 17055-2015
Please take note of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent, Sylva E. Grubb, died on the 18th day of June,
2001, Hershey Medical Center, Dauphin County, Pennsylvania.
The Decedent died Intestate (without a Will).
The personal representative of the Decedent is:
C. Kenneth Grubb
351 Nittany - Messiah Village
Mechanicsburg, PA 17055-2015
(717) 732-0277 (717) 432-1793
The Decedent died Intestate, and a Petition for the Grant of
Letters of Administration was filed with the office of the Register
of Wills of Cumberland County.
Register of Wills of Cumberland County
1 Courthouse Square
Carlisle, Pennsylvania 17013
(717) 697-0371
A copy of the Petition may be obtained by contacting the
Register of Wills and paying the charges for duplication.
Date: ~fd ;Z'i; c1cv/ WM~~eEswrRE
124 West Harrisburg Street
P.O. Box 310
Dillsburg, PA 17019
(717) 432-9733
Counsel for Personal
Representative
..
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
/ '7 ..
REV-15oo EX. (6-00)
CAPB
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CRAC
KOTK
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FILE NUMBER
D
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C
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG,PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Grubb Siva E.
DATE OF DEATH (MM-DO-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
209-46-1942
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
6
OFFICIAL USE ONLY
~-
I'-{
2001-00791
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
Grubb, C. Kenneth
X 1. Original Return
4. Limited Estate
6. Decedent Died Testate
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a Living Trust
1
3 date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
o 9. L1l1gatlonProceeds Received 010. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1-1-95) (Attach Sch 0)
Ill;mH!~il~;1~11MQ$)le[~QMPL~T~Q~i~CC!'CQij'ij'E$~~Nj)ENC~'&':CQNFIj)ENf!AlJfr'r'4X'II\iEQBMATJ~N!IEJqQl!Ij): .lij)i.8i;J!j)11;J;~~;tl!
NAME COMPLETE MAILING ADDRESS
Wm. D. Schrack III Es .
FIRM NAME (If Applicable)
Wm. D. Schrack, IllEs uire
TELEPHONE NUMBER
124 W. Harrisburg Street
Post Office Box 310
Di11sburg, PA 17019-0310
(1)
(2)
(3)
None
None
Ig9ae
R
E
C
A
P
I
T
U
L
A
T
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N
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
:-'1
(4)
(5)
None
75,906.44
(6)
None
None
4,673.00
None
C
o
M
P
T U
A T
X A
T
I
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N
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
x
X
X
X
.0 0
.0 45
.12
.15
71,233.44
OFFICIAL USE ONLY
o
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1'-;
C)'\
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(8) 0-'
75,906.44
(11)
(12)
(13)
4.673.00
71,233.44
(14)
71,233.44
(15)
(16)
(17)
(18)
(19)
0.00
0.00
0.00
0.00
0.00
.T()" RECHECI(M~tij::l~i;~~,~.i~:iR;;,]illITf4wJ~1illIDir!)
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
'"
Decedent's Complete Address:
STREET ADDRESS
351 Nittany - Messiah Village
CITY I STATE I ZIP
Mechanicsburg PA 17055-2015
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
.. - . - . '.. ". '. -. ,.".
0.00
0.00
0.00
0.00
0.00
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'iN"fH'EAPPROF)'R'liti"~(6'6~!~!!!i!WH!
Yes No
~~
~
~
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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.
;~:~S~ETURN
C. Kenneth Grubb
. _ _~~~.!!! ~~_~~y_ .-. _ ~~.s. ~ ~~h. Y.i}:~~tt~... _ _. _.... _..
Mechanicsburg, PA 17055-2015
Wm. D. Schrack, III Esquire
. _ _~~~_ ~: _ !1_~~~_i_s.l?'!!J~ _ ?~_r.:~~~.. _.. _. _ _. _ _ _ _ _ _. _ _._
Oillsbur PA 17019-0310
DATE
03 it/fa ;)-
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (j)].
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%
[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 twenty-one 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% [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%, except as noted in 72 P.S. 9116( 1.2)
[72 P.S. 9116(aX1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX 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.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
.
REV -1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sylva E. Grubb SS# 209-46-1942 06/18/2001 2001-00791
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.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ITEM
NUMBER
1
DESCRIPTION
PNC Bank, N.A. - Certificate of Deposit #3120110911
VALUE AT DATE
OF DEATH
75,906.44
TOT AL (Also enter on line 5, Recapitulation) $ 75 , 906 . 44
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
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412 705 0057
PNeB~NK elF DEPRRTMENT
412 705 0057
P.01/02
0. PNCBAN<
Decedent Reporting
Firstside Center
P7-PFSC-4-F
500 First Avenue
Pittsburgh, PA 15219-3128
ISCP
October 1.200 I
Wlr. ~) :-)chrack, III
124 W Harrisburg Street
PO B(,):. 310
Dilb:,urg. PA 17019-0310
RE. h!:ate of Sylva E. Grubb, deceased
>S\) 209-46-1942
DI.)D 6/18/2001
Dear Mr. Schrack:
Please tind the date of death balances you have requested listed below.
CERTIFICATE OF DEPOSIT
#3120110911
Established 11/21/1997
/
SYLVA E GRUBB
DOD Balance: $75,567.32 + $339.12 accrued interest
Page 1 of2
" m~ml>er of The PNC Financill ~rvices Group
'\cir PN( PJ;1Z;) 24~ Fifth Av,nuC' Pittsburgh Penn$Y!V"ni3 15222 2701
REV-1511 EX. (1-97)
,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Sylva E. Grubb
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
SSII 209-46-1942
FILE NUMBER
2001-00791
06/18/2001
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
3.
Attorney's Fees Wm. D. Schrack, III Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant c. Kenneth Grubb
Street Address 351 Nittany - Messiah Village
City Mechanicsburg State PA Zip 17055 - 2015
Relationship of Claimant to Decedent Spouse
950.00
3,500.00
4.
Register of Wills
208.00
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Register of Wills - filing fee
15.00
TOTAL (Also enter on line 9, Recapitulation) $ 4,673.00
(If more space is needed, insert additional sheets of the same size)
Copyright (e) 1996 form software only CPSystems,lne. Form REV-1511 EX (Rev. 1-97)
..
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIAR IES
Sylva E. Grubb
SS:fI 209-46-1942
06/18/2001
FILE NUMBER
2001-00791
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(aX1.2)]
1 C. Kenneth Grubb
351 Nittany - Messiah Village
Mechanicsburg, PA 17055-2015
Spouse Residuary
estate
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
/I. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART /I - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc.
0.00
Form REV-1513 EX (Rev. 9-00)