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HomeMy WebLinkAbout05-12-06 t' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 COUNTY CODE 0415 NUMBER '" ....... ... .........OFFiciA"L"USE.ONLY................. .... ~e................................................._........................ I- Z w Q w U w o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) STUTZMAN ALMA M. DATE OF DEATH DATE OF BIRTH APRil 16, 2005 AUGUST ;25,1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A SOCIAL SECURITY NUMBER 180-03-7991 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: c: NAME COMPLETE MAILING ADDRESS CD -g RICHARD C. RUPP ESO 355 N. 21ST STREET 8.. SUITE 201 ~ CAMP HILL, PA 17011 8 FIRM NAME (If Applicable) RUPP AND MEIKLE TELEPHONE NUMBER 717-761-3459 Q) ~itl) (J1:", Q) Co (J .c2.Q () 2:lD <( X 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 5 4. Mortgages & Notes Receivable (Schedule D) ~ 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) ....J 6. Jointly Owned Property (Schedule F) ~ D Separate Billing Requested a.. <( 7. Inter-Vivos Transfers & Misc. Non-Probate Property () (Schedule G or L) W 0::: 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities & LIens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 2. Supplemental Return 3. Remainder Return (_ 01 doa1h prior 10 12- 13-82) 4a. F4ture Interest Comprise (dat. of doelh after 12-12-82) 5. Federal Estate Tax Return Required 7. Decedent Maintained a Living Trust (Attach a copy of Trust) 8. Total Number of Safe Deposit Boxes 10 Spousal Poverty Credit(dateofdoalh botweon12-31-91 and 1-1-95) 011. Election to tax under Sec. 9113(A) . (Attach Sch 0) ~,.:J "c..':'). '.-'" (.:;'"'" ~, r"" !2-1 ( ) (~) (~) (t) (~) (El) ~......:;c ,_ -. ceFFICIAI:"lISE ONLy.:-::,l . -'- .' '-', -- ' '-----1 rv -" '-j ,C~ ,~ -.::.0 _. C) c .~ ,.11 .j, C~. $58,153.40 $3,186.52 -0 $0.00 $0.00 0J $237,914.84 $16,305.99 U1 -J (7) $0.00 (8) $13,185.45 $12,766.85 (11 ) (12) (13) (14) $289,608.45 I I (91 {10~ I I $315,560.75 $75 95' 30 $289,608.45 13. Charitable and Governmental Bequests/See 9113 Trusts for which an Etlection to tax has not been made (Schedule J) 14, Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPlICA LE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) z o i= ~~ ~:J (l :E o (,) 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 $000 x (15) $0.00 $289,608.45 045 (16) (17) (18) (19) x $13,032.38 $0.00 x .12 x .15 $000 20.D 19. Tax Due $13,032.38 :. :> BE,SbRE TO ANSWER ALL 'QUESTIO S.Otf~E"eRSe!'$'DE'ANDReSHECK MATH <<: t.' < ~. ;:~-;'-"~,,' Copyright 2000 David James ThQrpe, Esq. C Decedent's 'Complete Address: STREET ADDRESS MESSIAH VILLAGE 100 MY ALLEN DRIVE CITY MECHANICS8URG STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) $13,032.: $\::00.00 25.00 Total Credits (A'" 8 ... C) (2) $8,925.0 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 ... E) If line 2 is greater than line 1 ... line 3, enter the difference. This is the pVERPAYMENT. Check box on Page 1 Line 20 to request a! refund (4) If line 1 ... line 3 is greater than line 2, enter the difference. This is the iTAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 ... 5A. This is the BALANCE DUE. ' (58).. $4,107.38 ~~5~~~~~~' i I (3) 4. 5. $4,107.38 1. Old decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shali use the property transferred o~ its income; c. retain a revisionary interest; or d. receive the promise for life of either payments, benefits or care? ! If death occurred on or before December 12, 1982, did decedent within (two years preceding death transfer property without receiving adequate considera 'on? If death occurred after Dec:ember 12, 1982, did decedent transfer property within one yea of death without receiving adequate consideration?; Did decedent own an "in trust for" or payable upon death bank accOunt ~ security at his or her death? Did decedent own an individual retirement account, annuity, or other n01-probate property? Yes ~ No ;..'........~...................... ..~ .... X 2. 3. 4. ~ EE IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, OU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of peljury, I declare that I have examined this retum, including accompanying edulee and statemenle, and to the best of my knowledge and belief. ills true, oorrec;t. and c:ompleta. Declaration of prepater other than the personal representative is based on aN the Information of which preparer has any knowledge. SIGN URE OF PERSON PONSIBLE FOR FILING RETURN DATE APRIL 24. 2006 DATE APRIl. 24, 2006 For dates of death on or after July 1, 1994 and before January 1, 1995, t e tax rate imposed on the net value of transfers to (' spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on th net value of transfers to or for the use ( (a) (1.1) (ii)). The statute does no exempt a transfer to a surviving spous from tax: and the statutory requirements return are still applicable even if the surviving spouse is the only beneficia <3/U fa;/ J!U ciAA ;Jff OJ> J116 For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child enty-one years of age or younger at de adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a) (1.2)] an The tax rate imposed on the net value of transfers to or for the use of the ecedent's lineal beneficiaries is 4.5%, e: ~9116(a)(1 )]. ,. ! P.S. The tax rate imposed on the net value of transfers to or for the use of the d cedent's siblings is 12% [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 de dent, whether by blood or adoption. Copyright 2000 David James Thorpe, Esq. .:+ "''.;' :':~'i~,,'~'~C-;~,L!;l;' ... , . ..... WILL :i- ~.. I I, ALMA M. STUTZ N, of Llewellyn, Branch Township, Schuylkill County, Pennsylvania, being of sound mind and discretion, do hereby make my last Will and revoke all revious testamentary dispositions made by me. FIRST: I direct that 11 my just and lawful debts and funeral expenses be paid as soon as possible a ter my decease. SECOND: I give, beq eath and devise all of my property, real, personal or mixed, of whats ver nature or kind, or wheresoever situate at the time of my decease, u to my husband, Alvin Clyde Stutzman; in the event my said husband, Alvin Clyde Stutzman, should predecease me, then I give, bequeath and devise a I of my property unto my son, Philip M. Stutzman, his heirs and ass! ns forever. tt , ; t \ THIRD: In the event y son, Philip M. Stutzman, is under the age of twenty-one years, then I a point Myron L. Shelhamer robe his Guardian during his minority. ~ FOURTH: I appoint m husband, Alvin Clyde Stutzman, to be the Executor of this my last Will nd Testament; in the event that my husband, Alvin Clyde Stutzman, should e unable or unwilling to act as such Executor, then I appoint my son, Philip . Stut:z;man, to be my Executor if he has -r~ej his majority; tn the e ent that my son, Philip M. Stutzman, has ,-. . .,/~~"Qd.~y, then.I appoint Myron L. Shelhamer to be my IN WITNESS WHEREO , I have hereunto set my hand and seal this / ~~ day of AUGUST, One housand Nine Hundred and Sixty-two (1962). ~ ::t:~ (SEAL) ALMA M. TUT N =-:,t;.""\~~ SIGNED, SEALED, PUB ISH ED and DECLARED by AI.. .,e tzman, the above named Testatrix, as nd for her last Will and Te .. ", . . . the presence of us, who thereupon t her request, in her presence and in the presence of each other, subscr be our names hereto as witnesses this /",,-z::;z, day of August, 1962, and we an each of us now believe the Testatrix to be of sound mind and memory. / ~ --d'. /~ :/ / " COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF ALMA M. STUTZMAN FILE NUMBER 21-05-0415 All real property owned solely or as a tenant In common must be rep rted 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 compelle~ to buy or sell. both having reasonable knowledge of the relevant facts. Real property whlcl\ is jointly-owned with right of survivorship must be disclosed on Schedule f ITEM \ DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 1160 BUNTING STREET \ . LLEWELLYN PA : COUNTY OF SCHUYLKILL, PA SALE PRICE AFTER DEDUCTION OF CLOS NG COST $58,153.40 1 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed. ins~rt additional sheets of the same size) $58,153.40 Copyright 2000 David James ThOlpe, Esq. ^ ~~nm'ment ::statement I u.s. Department of Housing and Urban Development ......... ,r B T fL OMB Approval No. 2502-0265 . lypeO oan 1. 0 FHA 2. 0 FmHA 3. 0 Conv. Un/ns. 6. File Number 1. Loan Number 8. Mortgage Insurance Case Number 4.0 VA 5. 0 Conv. Ins. C. Note: This form is furnished to give you a statement of actua se ttiement costs. Amounts paid to and by the settlement agent are shown. items marked W(p.o.c.t were paid outside clo log ; they are shown here for informational purposes and not included In the totals. D. Name and Address of Borrower E. Name and Addr ss 0 f Seller F. Name and Address of Lender David M. Schultz. Jr. Philip Stutzma n, Executor of Estate of Alma M. CACL Federal Credit Union 44 Willing Street Stutzman 1800 West Market Street 354 Regent St eet L1ewellvn PA 17944 Camo Hill PA 17011 Pottsville PA 17901 G. Property Location H. SetUement Agent 1160 Bunting Street Edward M. Brennan. Esa. Place of SeWemenl I. 5alUement Date Llewellyn PA 1794~ 306 Mahantongo Street 01/16/2006 Pottsville PA 17901 Disbursement Date Lot: Block: J. Summary of Borrower's Transaction .. K. Summary of Seller's Transaction 100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller 101. Contract sales price 6.0 00.00 401. Contract sales orice 61 000.00 102. Personal DroD8rtv 402. Personal Drooertv 103. Settlement chames to borrower Wne 14001 852.37 403. 104. 404. 105. 405. Adlu.tments for Item. D.ld bY .eller In .dVlnce Adjustments for Items paid bv seller In advance 106. City/town taxes to 406. CllYftown taxes to 107. County taxes to 407. County taxes to 108. Assessments to 408. Assessments to 109. School Taxes 01/16/2006to 06/30/2006 383.22 409. School Taxes 01/16/2006to 06/30/2006 383.22 110. to 410. to 111. to 411. to 112. to 412. to 113. to 413. to 114. to 414. to 115. to 415. to 120. Gross Amount Due From Borrower 64, 35.59 420. Gross Amount Due To Seller 61,383.22 200. Amounts Paid By Or In Bahalf Of Borrower 500. Reductions In Amount Due To Seller 201. Deoosit or eamest money 501. Excess deposit (see instructions) 202. Principal amount of new loanCs) 48.l 00.00 502. Settlement charaes to seller /line 1400) 3,219.38 203. ExistiOllloan(s) taken subiect to 503. Existina loanlsl taken subiect to 204. Down Payment paid on date of auction 6 00.00 504. PallO" mf first mortaaae loan 205. 505. PaYOff Qf second mortaaae loan 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for Items unDald bv seller AdJustments for Items unDaid by seller 210. Cityltown taxes 01/01/200Sto 01/16/2006 0.44 510. Citvltowh taxes 01/01/2006to 01/16/2006 10.44 211. County taxes to 511. County tlixes to 212. Assessments to 512. AssesSnl1ents to 213. to 513. to 214. to 514. to 215. to 515. to 216. to 516. to 217. to 517. to 218. to 518. to 219. to 519. to 220. Total Paid BylFor Borrower 54. 91 P.44 520. Total Re<luctlon Amount Due Seller 3.229.82 300. Cash At Settlement From/To Borrower 600. Cash At Settlement TolFrom Seller 301. Gross Amount due from borrower (line 120) 64, 23 .59 601. Gross arriount due to seller (/jne 4201 61,383.22 302. Less amount oaid bvlfor borrower f1ine 220) 54 91 .44 602. Less redJctions In amt. due seller /line 5201 3 229.82 00 From o To Borrower ! l&l To o From Seller 303. Cash 9, 32 .15 603. Cash . 58,153.40 SUBSTITUTE FO R ~ 1099 SELLER S1rATEMENT The information contained In Blocks E. G. H. and I and on line 401 (or. line 403 anc 404) is important taxi information and Is being furnished to the Internal Revenue SeNice. If you are required to file a retum, a negligence penalty or other sanctio n w II be imposed on you lif this item is required to be reported and the IRS determines that it has not been reported. If this real estate is your principal residence. file Fo rm 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797. Form 62 2 and/or Schedule D~ Form 1040). You are required to provide the Settlement Agent (named above) with your correct taxpayer identification number. If you do not pro vid the Settlement Agellt with your correct taxpayer Identification number. you may be subject to ciVil or criminal penalties imposed by law. Under penalties of perjury. I ce Ufy that the number shown on this statement is my correct taxpayer identification number. ~~~~ (S:r's SI ture) . 700. Total SaleslBroker's Commission based on Drice S Division'of Commission (line 7001 as follows: 701. $ to ~$ ~ 61 000.00 @ 5.00 %= 3 050.00 Paid From Borrower's Funds At Settlement Paid From Seller's Funds At Settlement 703. Commission oaid at Settlement 704. Georae Blum Auctioneer 800. Items Payable In Connection With Loan 801. Loan Origination Fee 48,800.00 802. Loan Discount 48800.00 803. Appraisal Fee 804. Credit Report 805. lender's Insoection Fee 806. Mortgage Insurance Application Fee to 807. Assumotion Fee 808. Loan Application Fee to CACL Federal Credit Union ($350.00 POC) 809. Flood Determination to CACl Federal Credit Union ($19.50 P )C) 810. 811. 812. 813. 900. Items Reaulred By Lender To Be Paid In Advance 901. Inte....t from to 902. Mortgage Insurance Premium for 903. Hazard Insurance Premium for 3.050.00 % % to CACL Federa Credit Union ($3( O.OO-POC) to CACL Feders Credit Union ($1f .oo-POC\ , i I Exeludl last day in cates . Iln~ 901 lIIl$ IdlY months to years to years to 904. 905. Aaareaate Adlustment to CACl 1000. Reserves Deposited With Lender 1001. Hazard insural)ce 1002. Mortgage Insurance 1003. City property taxes 1004. County orooertvtaxes 1005. Annual assessments 1006. 1007. 1008. AOQreaate Accounting Adiustment 1100. Title Charae. 1101. Settlement or closlno fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document DreDllfltion 1106. Notarvfees 1107. Attomev'sfees (Includes above Items numbers: 1108. Title insurance (Includes above items numbers; 1109. lender's coveraae 1110. Owner's coverace 81.62 months@$ monlhs@$ months@$ months@$ months@$ months@$ months@$ per month per month per month per month per month per month oer month to to to to to to to Edward M. Bren an 675.00 1 to Central Penn Ab tractina Comoanv 11021103 1104 (End. 100$50.CO; End. 300$50.00; End. 8.1 $50.00 I $ 48 80 .00 $ 61 00 .00 624.75 150.00 1111. Richard C. Rupp, Eso. 1112. 1113. 1200, Government Recording and Transfer Charae. 1201. Recordina fees: Deed $ 1202. Citvlcountv taxlstamps: Deed $ 1203. State tax/stamps: Deed $ 1204. Schuvlkill County Treasurer-UPI Certification 1205. Schuvlkill County Recorder of Deeds($1 220.00- Transfer Tax' $4 .50-Mortoaae: $45.50 Deed) 1300. Additional Settlement Charae. 1301. Survey to 1302. Pest inspection to 1303. Blythe Township Municioal Authoritv-final bill 1304. 1305. 1306. 1307. 1308. 1400. Totat Settlement Charges (enter on line. 103, Section J and 502, Sectlo K) CEf TIFICA TION I have carefully reviewed the H,UD-1 Settlement Statement and to the best of my kn )Wledge and belief. it is a true and accurate fitatement of all receipts and disbursements on my account o~ by me in this transaction. I further certify that I have received a co y of the HUD.1 Settle"ent Statement. 1..1,. at- /7 g;~~ ~_ Seller ..!1J./..."J) 111.. (A Borrower Philip Stutzma;'- E;~t~;;Estate of Alma M. David M. SchultZ:?r-. . 125.00 ; Mortoaae $ ; Mortaaae ; Mortaaae ; Releases $ $ $ 10.00 1311.00 10.00 34.38 2 852.37 3 219.38 Seller Borrower Stutzman 44 Willing Street To the best of my knowledge the HUD.1 Settlement Statement which I have prepar~ d is a true and accurate account of the funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction. Settlement Agent Date Edward M. Brennan, Esq, WARNING: It Is B crime to knowingly make false stataments to the United States or this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: TiUe18 U.S. Code Section 1001 and Section 1010. U.S. GoveRNMENT PRINTING OFFICE, 'N' 0."",,, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ALMA M. STUTZMAN SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorship must be disclosed 0 Schedule F. ITEM DESCRIPTION NUMBER 1. METLlFE STOCK (82 SHARES) (fl 4 .3 ~, i.c,. TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, im~rt additional sheets of the same size) 21-05-0415 VALUE AT DATE OF DEATH $3,186.52 $3,186.52 \ Copyright 2000 David James Thorpe, Esq. I COMMONWEALTH OF PENNSYLVANIA SCHEDULE E INHERITANCE TAX RETURN CA~H, BANK DEPOSITS, & MISC. RESIDENT DECEDENT PE RSONALPROPERTY ESTATE OF ALMA M. STUTZMAN FILE NUMBER 21-05-0415 Include the proceeds of litigation and the date the proceeds were received t the estate. All property jointlyo()wned with the right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. 1ST NATIONAL BANK MINERSVILLE CERTIFICATE OF DEPOSIT # 1117802 $62,905.89 PA INCOME TAX REFUNDS $20.00 $97.36 $9.00 PEBTF REFUND OF PREMIUM $168.83 CERTIFICATE OF DEPOSIT #55 @ PSECU $22,185.71 CERTIFICATE OF DEPOSIT #56 @PSECU $14,790.39 CERTIFICATE IF DEPOSIT # 57 @ PSECU $15,024.33 SOVEREIGN BANK- CHECKING ACCOUNT $116,537.05 ACCOUNT # 8161010609 $208.00 TRAVELERS-REFUND FROM INSURANCE $5,968.28 BLUM'S AUCTION SERVICE-NET SALES PRO EEDS- OF CONTENTS Copyright 2000 David James Thorpe, Esq. - - . . 'I TOTAL (Also enter on line 5. Recapitulation) (If more space is need ed, insert additional sheets of the same size) $237.914.8' Copyright 2000 David James Thorpe, Esq. . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JC INTL V-OWNED PROPERTY ESTATE OF ALMA M. STUTZMAN FILE NUMBER 21-05-0415 If an asset was made Joint within one year of the decedent's d te of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S} NAME A. PHILIP M. STUTZMAN ADDRESS 354 REGENT S REET CAMP HILL, 17011 RELATIONSHIP TO DECEDENT SON B. C. JOINTLY-OWNED PROPERTY: ITEM LETTER NUMBER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF P OPERTY Include name of financlallnstitutlon and bank account n moor or similar identifying number. Attech deed for jointly-held n al estate. DATE OF DEATH %OF DATE OF DEATH VAlUE OF ASSET DECO'S VALUE OF INTEREST DECEDENT'S INTEREST $267.73 50% $133.87 $32,344.23 50% $16,172.12 1. A. PSECU ACCT SHARE 2. A PSECU CERTIFICATE OF DEPOSIT #50 TOTAL (Also enter on line 6, Recapitulation) (If more space is needed. inse additional sheets of the same size) $16,305.99 Copyright 2000 David James Thorpe. Esq. , COMMONWeALTH OF PENNSYLVANIA SCHEDULE H INHERITANCE TAX RETURN FU NERAL EXPENSES & RESIDENT DECEDENT OM INISTRATIVE COSTS ESTATE OF ALMA M. STUTZMAN FILE NUMBER 21-05-0415 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: 1. DUTCAVICH FUNERAL HOME $6.816.85 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number c f Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees RUPP AND MEIKLE $5.968.60 3. Family Exemption: (If decedent's address is not ~e same as claimant's. attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees- REGISTER OF WILLS $400.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $13,185.45 (If more space is needed, i nse t additional sheets of the same size) Copyright 2000 David James Thorpe, Esq. .. . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE' DEBTS OF DECEDENT, MOR TGAGE LIABILITIES, & LIENS ESTATE OF ALMA M. STUTZMAN FILE NUMBER 21-05-0415 Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT MESSIAH VILLAGE- MARCH 2005 MESSIAH VILLAGE- APRIL 2005 $4.757.30 $2.756.00 BLUM AUCTION SERVICES-PAYMENT $1.000.00 MISC EXPENSES: $4.65 $35.00 $11.52 $4.23 $15.99 $1,085.16 $71.27 $390.00 $206.25 $222.14 $727.22 $33.75 $88.35 $513.63 $658.00 $33.75 $60.52 $54.24 $37.88 SCHOOL REAL ESTATE TAXES AT&T SEWER WATER BILL TO MUNICIPAL AUTHORITY PP&l-ELECTRIC Oil BILL TO REEDY & SONS OIL TRASH VERIZON BRANCH TWP TAX COLLECTOR TRAVELERS INDEMNITY PREMIUM BAil BEDFORD, TAX COLLECTOR CENTER FOR NHUERO BEHAVIORAL HEAL TI-i INTERNIST OF CENTRAL PA D. PAUL DALBUY TOTAL (Also enter on line 10. Recapitulation) (If more space is needed, inse additional sheets of the same size) $12,766.85 Copyright 2000 David James Thorpe, Esq. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES . .... ., ESTATE OF ALMA M. STUTZMAN NAME AND ADDRESS OF PERSON(S) ECE/VING PROPERTY FILE NUMBER tR J - 0 ~ - (> V RELATIONSHIP TO DECEDENT AMOUNT OR SHA... Do Not List Trustee(s) OF ESTATE NUMBER I. TAXABLE DISTRIBUTIONS (include outrigh spousal distributions) 1. PHILIP M. STUTZMAN SOLE BENEFICIAR' WN 100 ENTER DOlLAR AMOUNTS FOR DISTRIBUTIONS SH WN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NUN- , IIUNt): A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 OR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE 01 TRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (If more space is needed, insert dditional sheets of the same size) $0.00 Copyright 2000 David James Thorpe, Esq.