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HomeMy WebLinkAbout01-0802 . ... McNEES WALLACE & NURICK LLC ATTORNEYS AT LAW 100 PINE STREET P. O. BOX 1166 HARRISBURG, PA 17108-1166 TELEPHONE 17171232- 8000 FAX 17171237-5300 http://www.mwn.com STEPHANIE KLEINFELTER DIRECT DIAL: (717) 237-5228 E-MAIL ADDRESS:SKLEINFE@MWN.COM August 27,2001 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013-3387 RE: Estate of Shirley P. Freedman PA Inheritance Tax Return Date of Death: January 8, 2001 MWN File No. 20285-0002 Dear Sir/Madam: Please find enclosed for filing two original Pennsylvania Inheritance Tax Returns for the above-referenced estate (Letters Testamentary were not issued). We ask that you date stamp and return for our records the enclosed copy of the tax return. Also, please find a $20,077.16 check and a $25 check, respectively, in payment of the Pennsylvania Inheritance Tax and your filing fees. Thank you. Very truly yours, McNEES WALLACE & NURICK LLC ~ ( ~ 1(\..~Y\r- Stephanie Kleinfelter By sk Enclosure . COLUMBUS. OH HAZLETON. P A WASHINGTON. D.C. . Register of Wills Office August 27,2001 Page 2 c: Donald B. Freedman Sue Mauery, Trust Officer with Allfirst Trust . , Register of Wills Office August 27, 2001 Page 3 bc: Evelyn S. Harris . McNEES WALLACE & NURICK LLC HARRISBURG, PA. 17108-1166 106874 INVOICE INVOICE DATE DESCRIPTION NET AMOUNT 10000 08/27/01 Filing PA Inheritance Tax Return 25.00 SaI ~~~~.~ liTHO USA SFSL3 CKi'S08113L 11/00) $ 25.00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCNEES WALLACE & NURICK LLC C/O HARRIS EVELYN S POBOX 1166 HARRISBURG, PA 17108-1166 -------- fold ESTATE INFORMATION: SSN: 203-20-5602 FILE NUMBER: 21-2001- 0802 DECEDENT NAME: FREEDMAN SHIRLEY P DATE OF PAYMENT: 08/28/2001 POSTMARK DATE: 08/27/2001 COUNTY: CUMBERLAND DATE OF DEATH: 01/08/2001 ACN ASSESSM ENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: REMARKS: MCNEES WALLACE & NURICK LLC C/O STEPHANIE KLEINFELTER CHECK# 20233183 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 000206 AMOUNT -------- I $20,077.16 I I I I I I I I $20,077.16 MARY C. LEWIS REGISTER OF WILLS L8((-tlOLl Vd '~ls~{lB;) ~lBnbs ~SnOlnlnO;) ~UO ~snoql-mO;) AlUnO;) pUB{l;:)qrnn;) ~:)YJO smM. JO 19l5~'a~(l --/ ::>" - -- ca :E tn tn ca - o <1) Ul ;:$ o ~ ~ r-- <1)0<1)00 UUI-<M !.;::I ro M """'0 ~ g. M ~C/l- Ul ;:$ <1) 0 ::::::OUlr-- ....... U;:$- ~"OO-", .......~~...... Oro1::O-; I-< i:: ;:$ <1)~ <1) <1) 0..- 1;) ..0 U .~ ....... S <1)"- OJ) .... ~ t:a ~UOU ... tn I- -- U. 1 , I l I '\J BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN '* REY-485 EX AFP 112-DOl Recorck Rerw)c:, t EVElYN S HARRIS C/O MCNEES ETAL PO BOX 1166 HBG .02 JAN 18 of DATE ESTATE OF DATE OF DEATH FILE NUMBER P 3 :45cOUNTY ACN 01-21-2002 FREEDMAN 01-08-2001 21 01-0802 CUMBERLAND 201 SHIRLEY P Clerk PA 17~rnbG; Allount Rellitted - ;-,'..H [ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, sub.it the upper portion of this forI! with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ...... R'EV=483--EX-AFF.-Ti2:-00r----..-NCfffcE--OF-UETERMiNAfiCfN-AN-D-ASSESS-MEN.~f--------'-------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF FREEDMAN SHIRLEY P FILE NO.21 01-0802 ACN 201 DATE 01-21-2002 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 15.531.48 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 20.017.16 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 20.017.16 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) 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 THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) l1 ,4;---3- II COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE-~cur ; Rer _D~jfE ii_3TATE OF DATE OF DEATH FILE NUMBER ~~Y ACN 01-21-2002 FREEDMAN 01-08-2001 21 01-0802 CUMBERLAND 101 EVelYN S HARRIS C/O MCNEES ETAL PO BOX 1166 HBG 002 JAN 25 *~{ REV-l547 EX AFP Cll-on SHIRLEY P A.ount R_i Hed Clt;:rh rAlfnbena, PA 17108 FA 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 ~ REV=is4-j-iif-AFP--fi2-:ooTNOYici--OF-YtiHiifiTAifcE-TAi-A-PPRjrisiiriNT~--ALioWAiicE-OR------------ __ ___ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FREEDMAN SHIRLEY P FILE NO. 21 01-0802 ACN 101 DATE 01-21-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: lS. A.ount of Line 14 at Spousal rate 16. A.ount of Line 14 taxable at Lineal/Class A rate 17. A.ount of Line 14 at Sibling rate 18. A.ount of Line 14 taxable at Collateral/Class B 19. Principal Tax Due 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) S. 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) (S) (6) (7) .00 5.880.00 .00 .00 14.225.00 .00 1.405.524.82 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 26,139.00 27.750.00 (11) (2) (3) (4) NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax paynent. 1,425,629.82 1i3.RR9 DO 1,371,740.82 .00 1,371,740.82 US) 925,581.62 X 00 = .00 (6) 446,159.20 X 045 = 20,077.16 (7) .00 X 12 = .00 rate (8) .00 X 15 = .00 (9)= 20,077.16 TAX CREDITS. PAYMeNT REC~UT orSCOlJNl (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-27-2001 CDOO0206 .00 20,077.16 TOTAL TAX CREDIT 20,077.16 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.) - . ;~)J-O j - ~ {I ~ RELEASE WHEREAS, Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly known as Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, is the duly appointed Trustee under Agreement with Donald B. Freedman of Cumberland County, Pennsylvania; and WHEREAS, Donald B. Freedman has revoked his Trust and has asked that the assets be transferred to his Grantor Trust with LeTort Management and Trust Company; and WHEREAS, the said Trustee has submitted to the said Donald B. Freedman an account of its Trusteeship, which has been examined and approved by the said Donald B. Freedman; and WHEREAS, in order to save the expense and delay incident to filing said account in the Orphans' Court Division of the Court of Common Pleas of Cumberland County and having the same confirmed, the said Donald B. Freedman has requested his Trustee to make settlement with him at once. AND THEREFORE KNOW ALL MEN BY THESE PRESENTS that I, the said Donald B. Freedman, have this day had and received of and from Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, Trustee as aforesaid, the following assets: $313,365.94 ARK PA Tax-Free MMKT. #1886 $ 53,663.05 ARK PA Tax-Free MMKT. #1886 $50,000.0000 U. S. Treasury Note 3.625% due 3/31/04 $50,000.0000 Fed. Home Loan Bank 4.125% due 1/14/05 $50,000.0000 Fed. Home Loan Mtg. Corp. 4.250% due 6/15/05 $50,000.0000 Fed. Home Loan Banks 3.250% due 8/15/05 $50,000.0000 Federal Home Loan Mtg. 4.000% 2/08/06 $50,000.0000 Federal Home Loan Mtg. 4.000% 8/02/06 $50,000.0000 Federal Home Loan Mtg. 3.625% 9/05/06 $50,000.0000 Federal NatI. Mtg. Assn. 4.750% 1/02/07 $50,000.0000 Federal NatI. Mtg. Assn. 5.250% 4/15/07 $50,000.0000 Federal Home Loan Banks 5.100% 6/19/07 $50,000.0000 Philadelphia, PA ARPT. 5.75% 6/15/09 $50,000.0000 State Pub. School PA 4.600% 9/01/04 $50,000.0000 Pennsylvania St. Rfdg. 5.125% 9/15/05 $25,000.0000 Lehigh County PA Rev. 5.300% 11/05/06 $50,000.0000 York County, PA 4.650% 6/01/07 $50,000.0000 Dauphin County, PA Gen. 6.250% 7/01/08 $25,000.0000 Pennsylvania St. 5.000% 11/15/08 $50,000.0000 New Hope-Solebury, PA 4.100% 8/15/09 $25,000.0000 Crawford Cent. Sch. PA 5.700% 2/15/10 $50,000.0000 Muhlenberg PA School 5.100% 4/01/10 $30,000.0000 Lehigh County, PA Rfdg. 5.125% 11/15/11 $20,000.0000 Lehigh County, PA Rfdg. 5.125% 11/15/11 $50,000.0000 Susquehanna Twp. PA 3.500% 8/15/12 $50,000.0000 Manheim PA Cent. Sch. 6.100% 5/15/14 2,496.0400 Shares Delaware Tax-Free PA Fd.-A #007 in kind and in full settlement and satisfaction of all such sum or sums of money as are due me by reason of said Trusteeship, and THEREFORE I DO BY THESE PRESENTS remise, release, quit-claim and forever discharge the said Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust . Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, its successors and assigns, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or of and from all other acts, matters, and things whatsoever including gross negligence, to the day of the date hereof. jf- ~ IN WITNESS WHEREOF, I have hereunto set my hand and seal this I day of 2003. WITNESS: (;1[j.iJ-H,=~~ , I ! \ ' ~.-' ~ !6f-~tZ-(SEAL) Donald B. Freedman .. > . COMMONWEALTH OF PENNSYLVANIA ) ) SS: ) COUNTY OF (L,LC/Yl ~ On this, the l/.)t- day of ...J~ ,2003, before me, a Notary Public in and for said State and County, personally appeared Donald B. Freedman, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Release and acknowledged that he executed the same for the purposes therein contained and desires that the same be recorded as such. WITNESS my hand and Notarial Seal. NOtary~-~ ~ My Commission Expires: NOTARIAL SEAL JULIE ANN KRAMER. Notary Public Camp Hill, Cumberland County My Commission Expires February 18, 2007 j) J - 0 } - (~(\ A \. RELEASE WHEREAS, Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly known as Allfrrst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, is the duly appointed Trustee under Agreement Credit Trust with Shirley P. Freedman, late of Cumberland County, Pennsylvania; and WHEREAS, in accordance with Article 9, the Individual Co-Trustee has the right to remove the then-acting Corporate Trustee, so long as they shall substitute a Co-Trustee, which shall be a banking corporation with fiduciary powers; and WHEREAS, Donald B. Freedman is the Co-Trustee and he has requested to remove Allfirst Trust Company of Pennsylvania, N.A. now Manufacturers & Traders Trust Company; as Trustee and substitute LeTort Management and Trust Company as Trustee; and WHEREAS, the said Trustee has submitted to the said Donald B. Freedman an account of its Trusteeship, which has been examined and approved by the said Donald B. Freedman; and WHEREAS, in order to save the expense and delay incident to filing said account in the Orphans' Court Division of the Court of Common Pleas of Cumberland County and having the same confirmed, the said Donald B. Freedman has requested the Trustee to make settlement with LeTort Management & Trust Company at once. AND THEREFORE KNOW ALL MEN BY THESE PRESENTS that I, the said Donald B. Freedman, as Co-Trustee, have this day had and received of and from Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, Trustee as aforesaid, the following assets: $160,006.90 ARK Money Market PTF Inst. $ 50,000.0000 Fed. Natl. Mtg. Assn. 5.250% 4/15/07 $ 50,000.0000 Federal Home Loan Banks 5.100% 6/19/07 $ 50,000.0000 York, P A City School 2.000% 3/01/05 $ 50,000.0000 Troy, PA Area School 4.750% 9/15/09 $ 50,000.0000 Coatesville, PA Water 4.700% 10/01/09 $ 25,000.0000 Lawrence Cnty, PA 4.875% 8/01/10 $ 40,000.0000 Bristol Twp., PA Sch. A 5.250% 2/15/02 $ 50,000.0000 Delaware County, PA 5.125% 11/15/12 $ 30,000.0000 Bensalem Twp. PA Auth. 6.750% 12/01/14 in kind and in full settlement and satisfaction of all such sum or sums of money as are due me by reason of said Trusteeship, and THEREFORE I DO BY THESE PRESENTS remise, release, quit-claim and forever discharge the said Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, its successors and assigns, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or of and from all other acts, matters, and things whatsoever including gross negligence, to the day of the date hereof. or of and from all other acts, matters, and things whatsoever including gross negligence, to the day of the date hereof. IN WITNESS WHEREOF, I have hereunto set my hand and seal this / ~ay of (L~ 2003. (r- I WITNESS: SfulJrlA ~A~ v ~~ (SEAL) Do aId B. reedman .. COMMONWEALTH OF PENNSYLVANIA COUNTY OF t l{ IYl 0 Ut [A-/Vl ) ) ss: ) On this, the I/Jt- day of J u. ~ ' 2003, before me, a Notary Public in and for said State and County, personally appeared Donald B. Freedman, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Release and acknowledged that he executed the same for the purposes therein contained and desires that the same be recorded as such. WITNESS my hand and Notarial Seal. ~ L!d~ Not .. Public - My ommISSlOn ExpIres: JULIE AN~O;~R'AL SEAL - Camp Hill C ~R. Notary PUbliC My CommisslonE um rlFand County xptres ebnJary 18, 2007 /"" ...,\. "-', ...--" j: J - 0 J -- (~ C) A t.., ..~ .. RELEASE WHEREAS, Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly known as Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, is the duly appointed Trustee under Agreement Q-Tip Trust with Shirley P. Freedman, late of Cumberland County, Pennsylvania; and WHEREAS, in accordance with Article 9, the Individual Co-Trustee has the right to remove the then-acting Corporate Trustee, so long as they shall substitute a Co-Trustee, which shall be a banking corporation with fiduciary powers; and WHEREAS, Donald B. Freedman is the Co-Trustee and he has requested to remove Allfirst Trust Company of Pennsylvania, N.A. now Manufacturers & Traders Trust Company; as Trustee and substitute LeTort Management and Trust Company as Trustee; and WHEREAS, the said Trustee has submitted to the said Donald B. Freedman an account of its Trusteeship, which has been examined and approved by the said Donald B. Freedman; and WHEREAS, in order to save the expense and delay incident to filing said account in the Orphans' Court Division of the Court of Common Pleas of Cumberland County and having the same confirmed, the said Donald B. Freedman has requested the Trustee to make settlement with LeTort Management & Trust Company at once. AND THEREFORE KNOW ALL MEN BY THESE PRESENTS that I, the said Donald B. Freedman, as Co-Trustee, have this day had and received of and from Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Tmst Company, Trustee as aforesaid, the following assets: $ 12,939.96 ARK Money Market PTF. Inst. $ 25,000.00 Federal Home Loan Bank 4.125% 1/14/05 $ 25,000.00 Federal Natl. Mtg. Assn. 2.625% 4/28/06 $ 25,000.00 Federal Home Loan Mtg. 3.20% 4/30/07 in kind and in full settlement and satisfaction of all such sum or sums of money as are due me by reason of said Trusteeship, and THEREFORE I DO BY THESE PRESENTS remise, release, quit-claim and forever discharge the said Manufacturers & Traders Trust Company, successor by merger to Allfirst Trust Company of Pennsylvania, N.A., formerly Allfirst Bank, formerly known as FMB Bank, Successor by merger to Dauphin Deposit Bank and Trust Company, its successors and assigns, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or of and from all other acts, matters, and things whatsoever including gross negligence, to the day of the date hereof. IN WITNESS WHEREOF, I have hereunto set my hand and seal this / ~ay of (U 2003. tt.. - I WITNESS: 9~~ J j)~Af~ Donald B. Freedman (SEAL) ~ ........... COMMONWEALTH OF PENNSYLVANIA C. ().. fVl ~~I ) ) SS: ) COUNTY OF On this, the I,Q. I- day of .J LA- LY , 2003, before me, a Notary Public in and for said State and County, personally appeared Donald B. Freedman, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Release and acknowledged that he executed the same for the purposes therein contained and desires that the same be recorded as such. WITNESS my hand and Notarial Seal. ~k~ Nota ublic. My Commission Expires: NOTARIAL SEAL l JULIE ANN KRAMER, Notary Public Camp Hill. Cumberland County My Commission Expires February 18, 2007 _. r /7-3,-/1 .':lA, C"' REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE N~R /)9~;l HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2001 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER FreedrrBn , Shirley P. 203-20-5602 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 01/08/01 08/28/1927 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Donald B. Freedman '" 3. Remainder Return CHECK r Original Return r Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date 01 death alter 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy at Trust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between ~ 11. Election to tax under Sec. 9113(A) 12-31-91 and H-95) (Attach Sch 0) fiim$~ijMQ$TijiPQM.f~9.~AtijQqijR~$PQ.&;~:~PQijf!ptfitIAt:W~Jijj;@ijMArttm::$ijqijt&:iji:Qtij~ptij9.fP; NAME COMPLETE MAILING ADDRESS COR- Evelyn S. Harris P.O. Box 1166 RE- FIRM NAME (If Applicable) Harrisburg, PA 17108-1166 SPaN DENT McNees, Wallace & Nurick TELEPHONE NUMBER 717-237-5466 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1 ) None 2. Stocks and Bonds (Schedule B) (2) 5,880.00 3. Closely Held CorporatlOn, Partnership or Soie.Proprietorship (3) None 4. Mortgages & Notes Reeeivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 14,225.00 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) None RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 1,405,524.82 8. Total Gross Assets (total Lines 1-7) (8) 1,425,629.82 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 26,139.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 27,750.00 11. Total Deductions (total Lines 9 & 10) (11 ) 53r889.00 12. Net Value of Estate (Line 8 minus Line 11) (12) 1,371,740.82 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1,371,740.82 seE INSTRUCTIONS-QN PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxabie at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 925,581.62 X.O 0 (15) 0.00 TAX 16. Amount of Line 14 taxabie at lineal rate 446,159.20 x.o 45 (16) 20,077.16 0.00 - COMPU- 17. Amount 01 Line 14 taxabie at sibling rate X .12 (17) 0.00 TATION 18. Amount of Line 14 taxable at collateral rata 0.00 X .15 (18) 0.00 19. Tax Due (19) 20,077.16 20. 0 ICH~cKBe6IEJf{YQij:@ilf;!ijf;!QUeuJ~AR~NPQ#AN::QWiijpAYMf;!l'tt1 . . ... ... ..............................................}......<;;;.:*f3t$$Va~rQA1)il$Wl$fflAI,l:;QQ~IP.N:,$P.NRAG~~ANQaiqli~qKMAtlil'{~<>.................................... . o PA15001 NTF 29755 Copyright 2000 GreatlandlNelco LP . Forms Software Only Estate of: Shirley P. Freedman -2001- SUMMARY OF AI.J..CC'ATIONS 10 BENEFICIARIES Taxable at lineal rate The Shirley P. Freedrran Rev. Tr. Sanuel Freedman Karen Freedman Richard Freedrran Ellen Faye Venier 425,159.20 7,000.00 7,000.00 7,000.00 0.00 446,159.20 PA REV-1500 EX (6-00) Decedent's Com lete Address: STREET ADDRESS 517 Bri eview Drive Page 2 CITY Lerro e Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE PA ZIP 17043 (1 ) 20,077.16 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 5. Total Interest/Penalty (D + E) 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 If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of line 5 + 5A. This is the BALANCE DUE. Make Check Paya~l~ to:qFtEC;IS~J:~OJ=ViILL~, AGENT (3) 0.00 4. (4) (5) (5A) (5B) 20,077.16 0.00 20,077.16 . .....',..:.;.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.;.;.;.;.;.:.;.;.;.;-:.:.:.:.;.:.;.;.:.:.:.;.:.:-:.:.:-:.:.:.;.:.;.:.:.;.:.:.:.:-:.;.:-:.:-:.:.:-:.;.:-:-;.;.;.;.:.;.;.:-:-:.;.:.:-:.;.;.:.;.;.:.;. :.;-:.:.;.:.:.:.:.:.;.;.:.;...;.:.:.:-:.:.:.....:...:.:.:.......:.:.;.;.........................;...........:.:.:.:..'......:...:.....;.:.:.:';'....: PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. ..............................,..,...............-... ...,....._,...................,..,......,...........,. .'.....:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:,:.:.;.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:.:.;.:.;.:.:.:.: ...............................................................'........,..... . ..............,....,.... ......................,....... ...................... .. ............,......... ..-...,........... .............................,..... ...................,.............. ............................. . ............................ ................ ..... .-..'.........'...... Did decedent make a transfer and: 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; or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? .............................. 2. If death occurred after December 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? 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. 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 information of which re arer has an knowled e. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ..fl/.i 'illS,. ~~" DATE G OJ '1.. \ ~ ~#L ADDRESS ~~, See Schedule attached SIGNA~~RE OF. PREPARER OTHER THAN REPRESENTATIVE -;J~ QDRESS P.O. Box 1166, Harrisburg, PA 17108-1166 Yes No ~ ~ ~ B eg o DATE <p /(, Ie; J on on use spouse [72 P.S. ~ 9116 (a) (1.1) (i)]. For dates of death on or after January 1. 1995. the tax rate is Imposed on the net value of transfers to or fOrlhe use at the surviving spouse is 0% (72 P.S. ~ 9116 (a) (1.1) (Ii)]. The statute dOAs not exemot 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 at death on or after July 1, 2000: The tax rate imposed on the net value at 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)J. The lax rate imposed on the net value of transters to or for the use of the decedent's lineal beneficlanes is 4.5%, except as noted in 72.P.S. ~ 9116(1.2) [72 P.S. %9116(a)(1 )]. The tax rate imposed on the net vaiue of transfers to or tor the use of the decedent's siblings IS 12% [72 P.S. S 9116(a)(1.3)J. 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. o PA15002 NTF 29756 Copyright 2000 GreatJand/Nelco LP - Forms Software Only Estate of: Shirley P. Freedrran The following person (s) are signing the return as representative (s) of the estate: Allfirst Bank, Trustee 213 South Market Street Harrisburg, PA 17101 Ibnald B. Freedrran, Surviving Spouse 517 Bridgeview Drive lelTDyne, PA 17043 -2001- REV-1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. Freedrran SCHEDULE A REAL ESTATE FILE NUMBER -2001- All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 7 CPA21 NTF 10904 Copyright Forms Software Only, 1997 Nelco, Inc. RE\!-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. Freedrran SCHEDULE B STOCKS & BONDS FILE NUMBER -2001- All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 10 units Uniprop Manufactured Housing Fund Limited Partnership 5,880.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,880.00 7 CPA31 NTF 10905 Copyright Forms Sottware Only, 1997 Nelco. Inc. REV-1504 EX + (1-97) SCHEDULE C CLOSELY-HELD CORPORATION PARTNERSHIP or SOLE-PROPRIETORSHIP COMMONWEALTH OF PENNSYLVANI INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. Freedrran Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest other than a sole-propiertorship. See instructions for the supporting information to be submitted for sole-proprietorships. FILE NUMBER -2001- of the decedent, ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 7 CPA41 NTF 10906 Copyright Forms Software Only, 1997 NelcQ, Inc. REV.1507 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER Shirley P. Freedm3n All property Jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION -2001- VALUE AT DATE OF DEATH None TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 7 CPA71 NTF 10907 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. Freedrran SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER -2001- Include proceeds of litigation & date proceeds were received by the estate. All prop. Jointly-owned with right of survivorship must be disclosed on Sch. F. ITEM VALUE AT NO. DESCRIPTION DATE OF DEATH 1 Jewelry- See Attached Appraisals Total Appraised Values 2,225.00 2 Estate Of Frances S. pindar- Executor's Corrmissions 12,000.00 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 14,225.00 7 CPA81 NTF 10908 Copyright Fonnns Software Only, 1997 Nelco, Inc. REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. Freedrran SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER -2001- If an asset was made Joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR MADE Include name of financial institution and bank DATE OF DEATH DECO'S VALUE OF JOINT account number or similar identifying number. NO. TENANT JOINT Attach deed for jointly-held real estate. V ALUE OF ASSET INTEREST DECEDENT'S INTERES None TOTAL (Also enter on line 6, Recapitulation) $ 0.00 T 7 CPA91 NTF 10909 (If more space is needed, insert additional sheets of the same size) Copyright Forms SoftWare Only. 1997 Neico. inc. REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. FreedrrBn FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. -2001- ITEM NO. DESCRIPTION OF PROPERTY INCLUDE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECD & DATE OF TRANSFER. ATTACH COpy OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF EXCLUSION DECO'S (IF INTEREST APPLICABLE) 1 'The Shirel y P. Freedrran Qualified Personal Residence Trust, Agreement Dtd. November 20, 1995 Trustee: DJnald B. Freedrran BeneficiaIY: DJnald B. Freedrran Property: 517 Bridge Street Lerroyne, PA 17043 2 'ID: DJnald B. FreedrrBn Year 2000 Gift 100,000.00 100 3 'The Shirely P. Freedrran, Arrended and Restated Agreement of Trust, dated March 31, 2000 Trustee: Allfirst Bank See Attached List of Assets 4 Sarmel Freedrran - Stepson January 01, 2001 10,000.00 100 5 Karen Freedrran - Step-Dauphter-In-Law January 01, 2001 10,000.00 100 6 Richard Freedrran - Stepson January 01, 2001 10,000.00 100 7 Salorron Smith Barney IRA Account No. 724-60136-14-001 Beneficairy: DJnald Freedrran Ivbney Funds $ 24,250.00 2.230 Alliance Wrld Dllr Govt Fund H 19.79 505.889 Europacific Growth 15,970.92 Fund Class A 656.617 Growth Fund of .Arrerica Class A 17,354.39 2,051.081 Investment Company 7 CPA01 NTF 10910 TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Copynght Forms Software Only, 1997 Nelco, Inc. 3,000.00 3,000.00 3,000.00 3,000.00 TAXABLE VALUE 355,000.00 97,000.00 788,709.95 7,000.00 7,000.00 7,000.00 143,814.87 1,405,524.82 Estate of: Shirley P. Freedrran Page 2 -2001- SOffiDULE G -- Inter-Vivos Transfers and Non-Probate Property Item No. Date of Death Value of Asset Description 7 63{009.21 of America Class A 22.642 RCM Strategic Global 225.72 Govt. Fund Inc. 518.103 Smallcap World 13,600.20 Fund Class A 162 . 956 Van Karrpen Errerging 9{384.64 Growth Fund Class A 'IOI'AL. (Carry forward to rrain schedule) . . . . . . % Of Decd's Interest Exclusion Taxable Value 0.00 REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. Freedrran SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER -2001- Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: AMOUNT See Schedule attached Total frcm continuation page (s) 12,244.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address City State 0.00 Zip Year(s) Commission Paid: 2. 3 Attorney Fees >=amily Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant LorB'::"d B. Freedrran Street Address 517 Bridgeview Drive City I.erroyne State PA Zip 17043 Relationship of Claimant to Decedent Husband 9,500.00 3,500.00 4. Probate Fees 0.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Claude C. Wolfe & Associates - Auctioneers & Appraisers 395.00 8 M:Jllie B - Jewelry Appraisal 500.00 7 CPA11 NTF10911 COP n hI Fonns Software Only, 1997 Ne<<:o. Inc. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 26,139.00 Page 2 Estate of: Shirley P. Freedrran -2001- SGIEDULE H, PART A - - Funeral Expenses Item No. Description Arrount 1 Reese Funeral Horre, Inc. 6,954.00 2 R.J. Romberger Memorials - Memorial Stone 3,890.00 3 Beth El Cerretery Association 1,100.00 4 Rabbi Meyer Witz - Funeral Service 100.00 5 Terrple Beth El - Use Of Terrple 200.00 'IDTAL. (Carry forward to rrain schedule) . . . . . . 12,244.00 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shirley P. Freedrran Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER -2001- DESCRIPTION AMOUNT 1 Hareland Pledge Ibnald and Shirley Freedrran Joint Pledge Total Upaid Pledge $5,500 2,750.00 2 The Jewish Hare of Greater Hal::Tisburg Joint Pledge of Ibnald and Shirley Freedrn:m October 10 2000 Total Pledge $50,000 25,000.00 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 27,750.00 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Shirley P. Freedm:m No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) -2001- RELATIONSHIP TO DECEDENT AMOUNT OR Do Not List Trustee(s) SHARE OF ESTATE 1 The Shirley P. Freedm:m Rev. Tr. Allfirst Trust Co. 1 Trustee 213 Market Street Harrisburg 1 PA 17101-2127 2 :COnald B. Freedm:m 517 Bridgeview Drive l.erroyne 1 PA 17043 3 Samuel Freedm:m Portland 1 OR 4 Karen Freedm:m Portland 1 OR 5 Richard Freedm:m Charlottesville 1 VA Trust 425/159.20 Surviving 8p:)'Use 925/581.62 Step-son 7/000.00 Step-Daughter-In-Law 7/000.00 Step-son 7/000.00 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART 11-- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 7 CPA13 NTF 10913 (If more space is needed, insert additional sheets of the same size) Copyright Fonns Software Only, 1997 Nelco. Inc. REV-1514 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER Shirley P. Freedman -2001- This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. :..:......g:m'~eEts:;;e,.;;;e~$$;r~;GOLAtJ~N~~~~~......... NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS L1FETENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE D:mald B. Freedman T errn of Years Term of Years Term of Years Term of Years $ 754,925.95 .43682 % $ 329,766.75 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interest table rate -- D 31/2% D 6% D 10% 3. Vall!e of life estate (LIne 1 multIplied by LIne 2) D Variable Rate ...."............,.................-.................-................................... . . . . . . . . . , . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ............. .................. .......................,......................,......................................... ...................... ..................... ..............,........................... ...........................................,......... .......................,........ ........................................,............................................. .....,."..............................,..'...... ................................... ..... .................. ..............'... ........................................ ... ...... .... ................................ NAME(S) OF ANNUITANT(S) ANNUftYIN'tESESTCAtCOLAilOt:\lr. NEAREST AGE AT DATE OF BIRTH DATE OF DEATH ....................."...........-.......................... ........................,......................... ...... ...............,......,.............................. . ........................,.......................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . .......,................,................... ......................,.................. .......'................,............... . ............ .......... TERM OF YEARS ANNUITY IS PAYABLE Term of Years Term of Years Term of Years Term of Years 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout -- D Weekly (52) B Bi-weekly (26) B Monthly (12) D Quarterly (4) D Semi-annually (2) Annually (1) Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 muitiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate D 3 1/2% D 6% D 10% D Variable Rate 0/0 6. Adjustment Factor (see instructions) 7. Value of annuity -- If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: LIne 4 x LIne 5 x LIne 6 If using variable rate and period payout is at beginning of period, calculation is: (LIne 4 x LIne 5 x LIne 6) + LIne 3 $ $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) 7 PA15141 NTF 10881 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1649 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley P. Freedman -2001- Do not complete this schedule unless estate Is making election to tax assets under Section 9113(A) of Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the The Shirley Freedman Revocable Tr. Trust (marital, residual A. B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION VALUE 1 The Shirley Freedman Revocable Trust U/A dtd 03/31/2000 754,925.95 Allfirst Bank, Trustee 213 Market Street Harrisburg, PA 1701-2127 Part A Total $ 754,925.95 PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE 1 The Shirley Freedman Revocable Trust U/A dtd 03/31/2000 754,925.95 Allfirst Bank, Trustee 213 Market Street Harrisburg, PA 1701-2127 7 PA16491 NTF 1 0882 Part B Total $ (If more space is needed, insert additional sheets of the same size) 754,925.95 Copyright Forms Software Only, 1997 Nelco, Inc.