HomeMy WebLinkAbout07-31-06
REV-1500 EX + (B-OO)
'*
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
-06 0 0 2 76
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF BIRTH (MM-DD-Year)
11/09/2005 01/08/1912
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
88- 0 3 - 4 0 5 1
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
[J 3. Remainder Return (date of death priorto 12-13-82)
[~ 5. Federal Estate Tax Return Required
__ 8. Total Number of Safe Deposit Boxes
[~ 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
James E. Reid, Jr. 3425 Simpson Ferry Road
FIRM NAME (If Applicable)
Shumaker Williams, P.C.
TELEPHONE NUMBER
717-763-1121 Cam Hill PA 17011
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
8. Total Gross Assets (total Lines 1-7)
77,684.28
(6)
,
,.,
(7)
c:.
77,684.28
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
10,291.56
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6 Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
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)
(8)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(11)
(12)
(13)
10,291.56
67,392.72
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
X _(15)
67,392.72 X .045 (16)
X .12 (17)
X .15 (18)
(19)
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(14)
67,392.72
3,032.67
3,032.67
> >BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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Decedent's Complete Address:
STREET ADDRESS
1457Raven Hill Road
Mechanicsburg
I STATE
PA
ZIP
17055
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2, Credits/Payments
A, Spousal Poverty Credit
B, Prior Payments
C, Discount
(1)
3,032.67
Total Credits (A + B + C) (2)
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)
S, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (S)
A. Enter the interest on the tax due, (SA)
B, Enter the total of Line S + SA. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
3,032.67
3,032.67
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; ........................................................................... 0 [Xl
b, retain the right to designate who shall use the property transferred or its income; ....................................... 0 [Xl
c, retain a reversionary interest; or ..................................................................................................... 0 [Xl
d. receive the promise for life of either payments, benefits or care? ............................................................ 0 [Xl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?........ ............. .......................... ......................... ......... "..... ....... 0 [Xl
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................ 0 [Xl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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PA 17055
, DATE
?,~C(/ffC
PA 17011
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. S9116 (a) (1,1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 PS, S9116 (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 PS. s9116(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,S%, except as noted in 72 P,S. S9116(1.2) [72 PS. s9116(a)(1 )].
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. s9116(a)(1.3)]. 14, 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.
REV-1508 EX + (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weibley. Dorothy. M.
FILE NUMBER
06
00276
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. M&T Bank - Checking with Interest
Account No: 76456382
2. M& T Bank - Time Deposit
Account No: 31003913934096
3. M& T Bank - Time Deposit
Account No: 31003914591168
4. Citizens Bank
Account No: 6140-788846
5. Citizens Bank
Account No: 6140-865344
6. Citizens Bank
Account No: 6140-864933
7. M& T Bank - Savings Account
Account No: 15004211054785
VALUE AT DATE
OF DEATH
4,468.50
5,927.13
4,099.92
5,119.09
4,000.96
4,002.67
50,066.01
TOTAL (Also enter on line 5 Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
77,684.28
rl:1M&fBank
499 Mitchell Street, Millsboro, DE 19966
June 7,2006
Shumaker Williams P.C.
P.O. Box 88
Harrisburg, PA 17108
RE: Estate of Dorothy Weibley
Date of Death: November 9, :2005
Social Security No.: 188-03-4051
Dear Mr. Reid:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account Type. ... .... . .. . .. . ... .. . .. . ... Certificate of Deposit
Account Number...................... .31 003913934096
Ownership (Names o.fl............. ..Dorothy M. Weibley
Opening Date...........................02/24/00 (account closed 04/04/06)
Balance on Date ojDeath.........$5,927.13
Accrued Interest
$ 17.80
Total....................... ............ ....$5,944.93
2. Account Type. ... .... . .. . .. . .. ... .... ... Certificate of Deposit
Account Number........... ........ ....31003914591168
Ownership (Names o.fl...............Dorothy M. Weibley
Opening Date......................... ..12/15/97 (account closed 04/04/06)
Balance on Date ojDeath.........$4,099.92
Accrued Interest
$
9.44
Total. . .. . .. . .. . .. . .. . .. . ... .. . .. . .. . .. . ... .$4,109.36
...
. Page 2
June 7,2006
3. Account Type..... .................... ..Checking Account
Account Number.... .... ......... ......76456382
Ownership (Names of)...............Dorothy M. Weibley
Opening Date................... ...... ..11/30/92 (account closed 04/04/06)
Balance on Date of Death......... ..$4,468.50
Accrued Interest
$
0.11
Total. ... . ... .. . .. . .. . ... .. . .. . .. . .. . .. . ... .$4,468.61
4. Account Type..... ................... ...Savings Account
Account Number.................... ...15004211054785
Ownership (Names of)...............Dorothy M. Weibley
Opening Date....... ................ ....04/05/04 (account closed 11/23/05)
Balance on Date of Death.. .... .. .. .$50,066. 01
Accrued Interest
$
16.11
TotaL... ........................ ....... ....$50,082.12
The above named decedent did not have a safe deposit box.
For any additional information on the above accounts, including ownership,
statements and closures please contact our West York branch at 717-849-5209.
Sincerely,
/(: i ," i 1,;/ It /J)'{iik:./
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Charlene Warrington, Records Management
1-888-502-4349
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Account Number 6140788846
Account Title DOROTHY W WEIBLEY
Date Opened 2/20/2001
Account Type Time Deposits
I Principal Balance as of DOD $5000.00 !
I--- . $119.09
Interest from Last Postmg to DOD
Account Balance as of DOD $5119.09
YTD Interest to DOD $8.51
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Account Number 6140864933
Account Title DOROTHY W WEIBLEY
Date Opened 3/27/1992
Account Type Time Deposits
Principal Balance as of DOD $4000.00 I
Interest from Last Posting to DOD $2.67
Account Balance as of DOD $4002.67
YTD Interest to DOD $57.97
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Account Number 6140865344
Account Title DOROTHY W WEIBLEY
Date Opened 4/5/1992
Account Type Time Deposits
I Principal Balance as of DOD $4000.00 I
Interest from Last Posting to DOD $.96
Account Balance as of DOD $4000.96
YTD Interest to DOD $63.88
REV-1511 EX + (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weibley. Dorothy. M.
FILE NUMBER
06
00276
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. LeRoy R. Leber Funeral Home, Inc. 7,033.99
2. Mount Rose Cemetery 236.00
3. Funeral Luncheon - Windows on the Green 243.57
B. ADMINISTRATIVE COSTS:
1. 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. Attorney Fees Shumaker Williams, P.C. 2,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 278.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 10,291.56
(If more space is needed, insert additional sheets of the same size)
OUR SERVICES including
Professional Services
Use of Facilities and/or Church / Equipment
Automotive Equipment
Special Selection -
Out-of-Town Removal Milage
TOTAL OF OUR SERVICES
$ 2262.00
$ 595.00
$ 650.00
$ .........................
$ .........................
$ 3507.00
MERCHANDISE SELECTED AND CASH DISBURSEMENTS
* At your request we have advanced monies for the following.
Casket - Livingston Oak
Burial Container -
Grave Opening - Mt. Rose Cemetery *
Cemetery Equipment
Vault Service Charge
Clergy - Pastor M. J. Romain, Sf. *
Flowers - Double Lid Spray
Pillow
Garland
Certified copies of Death Certificate 5 @ $6.00 each
Register Book and Memory Folders
Organist -
Obituary Notices - York Newspaper Co.
TOTAL CASH DISBURSEMENTS
GRAND TOTAL
MARC! L. DESFORGES
1457 RAVEN HILL RD.
MECHANICSBURG, PA 17055
$ 1918.00
$ Pre-Need
$ 995.00
$ Included
$ .........................
$ 150.00
$ 150.00
$ 30.00
$ 33.99
$ 30.00
$ 95.00
$ .........................
$ 125.00
$ 3526.99
$7033.99
3812
D December 2, 2005 60-1273/313
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Pay to the LeRoy R. Leber Funeral Home, rnc.
Order of
S th d thO t th d 99/100"""""""""""""""""""""" 6J .--
even ousan lr y- ree an -~-~'"h-~'--,,""h-~,-~-",,--~-,,"~1"*"'-~;-D-";>O-"'-~1"~,-~- ;;-~-
ollars I o.<MoOflDod<-
I $ 7033.99
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5 * ~O 280 SO 2111, :28. 2 '.L~y~
G~ PNCBAN<
PNC Bank., NA 040
Central P A
For Dorothy Wei bIey
.:0:2.:2.27:281:
r[jJl/ /-{ !{fllee
MOUNT ROSI ClMmRY
1- MOUNr lOlII AVI. · YOlK. PA 17_ . (717) ......1.
N: 803156
THIS AGREEMENT PROVIDES FOR ENDOWMENT CARE
CEMETERY INTERMENT RIGHTS, MERCHANDISE AND SERVICES PURCHASE/SECURITY AGREEMENT
Date: ( I / q ! ~ S- 64~o. I 0 C)~O~
The !1nders.igned, referred to as "Purchaser", hereby agrees to purchase the Interment Rights, Merchandise and Services described
herem, subject to acceptance and app.;oval of the above name metery, hereinafter referred to as "Seller".
PURCHASER 'If 0 r 1..1 (/'-- L ,O-P 5 () r c; ,(' ~ TELEPHONE: '/1 ']
ADDRESS 4 5/ <- LA l/ C'/"' r/ f r v,"'" ( ,.:?tJ
Slreel / Clly r Slale
Name of Deceased O..:Jr ~ -I A 7 . 0 [, ) <: /' b f 1-/
Description of Interment Rights: K Lj & W~t I ..5// a 0- +I "2-
Issue Certificate of Interment Rights to: -
Address
( 77- 5/7'1
/7.:5S
Zip
Street
City
Stale
Zip
INTERMENT RIGHTS, MERCHANDISE AND SERVICES
Interment Rights (including Endowment Care of$ ) ................................................................... $
Interment Fees................................................................................................................................. ............ ..... ...........
Memorialization - Type ............................
Size Design ...........................
-
Memorial Base - Type
Size'
Color
MenlOrial Endowment Care of .................................................... ,................................................................. ............
\
Memorial Installation/Inspection Fee.............................................................................................. ..........................
Outer Burial Container - Material
Model
Supplier
-
Crenlation Charge........................................................................................................................... .............................
Urn - Type Size ...........................
FlowerVase-Type ............................
::::::~:l:t~.::::::::::::::::::l..:::::~:::::..:/..:R..:.....:.~.................:::...~...........20..;~.....................!t~..:::::::::::::::::::::::::::::::::::...............:::..:::::::
Other
Other () (iJ l ( ) j,,,- ,
-..::\
2.021
Sales Tax
r
.....................................................................................................................................................................
3'5
TOTAL CASH PRICE ............................................................................................................................
LESS:
,;>3<0
Down Payment Cash .................................................................................... $
Other Credit ................................................................................................
Total Down PaYlnent .............................................................................................................................
UNPAID BALANCE OF CASH PRICE .............................................................................................
:) J J..
$<
$
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PRENEED COUNSELOR SALES REC-:-:.-OT
,,,jOUNT ROSE CEMETEr-:-. 645
1502 MOUNT ROSE AVE
YORK PA 174m
717 -8-15-6618
RECEIVED FROM (Y7 () ILl;' L 0 e:) f r:f.-W
THE AMOUNT OF --(iJJ i/ uC>~ ~} ,) /b-
AS: DOWN PAYMENT 5t REGULAR PAYMENT 0 f yO)
CASH 0 CHECK181
NO.0004715
DATE
/} /'7/00'
/ .
.;) /' t--..... _ DOLLARS
($ ~3 ~
CREDIT CARD CHARGE 0
CARD TYPE 0
FOR THE PURCHASE OF INTERMENT RIGHTS AND/OR MERCHANDISE AND SERVICES FROM THE ABOVE NAMED CEMETERY.
RECEIVED BY CEMETERY
DATE
BY
SAL~r
NAME v---- . v)
_.
GEN 8002 (6/02) @ 2002 Bel Management L.P.
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Relallonshlp
,.,- ~, '"''" ~f" · T\MI\, f'A '7411
A'''pt,d by, ~ j Iii ~r~1!lL.
counselO~ No.
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Purchaser
Relationship
NOTICE: SEE OTHER SIDE FOR ADDITIONAL TERMS AND CONDITIONS WHICH ARE PART OF THIS AGREEMENT
$18.000.00
$17.756.43
11/23/05
$15.00
12/13/05
Posting
Date
Transactions
NOVEMBER 2005 STATEMENT
Charges
Credits (eA)
PURCHASES AND ADJUSTMENTS
11/16 11/14 4535 VS C WINDOWS ON THE GREEN YORK PA
TOTAL FOR BILLING CYCLE FROM 10/26/2005 THROUGH 11/23/2005
243.57
$243.57
$0.00
_~~ll 7
I'?//OS
II IMPORTANT
I NEWS
CALL 1-800-660-6775 TO SIMPLIFY YOUR FINANCES INTO ONE MONTHLY PAYMENT.
MOVING? VISIT WWW.IBSNETACCESS.COM TO CHANGE YOUR ADDRESS AND MORE!
SUMMARY OF TRANSACTIONS
TOTAL MINIMUM PAYMENT DUE
Previous Balance (-) Payments (+) Cash (+) Purchases and ~+) Periodic Rate ~+) Transaction Fee (=) New Balance
and Credits Advances Adjustments INANCE CHARGES INANCE CHARGES Total
$0.00 $0.00 $0.00 $243.57 $0.00 $0.00 ~'243.57
Past Due Amount ................. $0.00
Current Payment.................. $15 _ 00
Total Minimum Payment
Due ...................................... $15.00
0.99%
24.74%
17.74%
$0.00
$0.00
$0.00
FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY
. For Customer Satisfaction and up 10 the minute automated information including,
balance, available credil, paymenls received. paymen/s due, due dale, &ayment
address information, or 10 request duplicale statements, caB 1-800-3 2-6299.
. For TOO (T elecommunicalion Device for the Deaf) assistance,
caB 1-800-346-3178.
. Mail payments 10: BANKCARD SERVICES, P.O. BOX 15289, WILMINGTON, DE
1988&5289 .
FINANCE CHARGE SCHEDULE
Category
Cash Advances
A. BALANCE TRANSFERS. CHECKS.0.002712% DLY*
B. ATM. BANK................ ,0.067780% DLY*
C. PURCHASES.................. '0.048602% DLY*
Perlodlc Rate
Corresponding
Annual
Percentage Rate
Balance
Subject to
Finance Charge
FOR THIS BILLING PERIOD: SEE ABOVE
ANNUAL PERCENTAGE RATE-..................
. Billing rights are preserved only by wriUen inquiry. Mail billing inquiries. using
form on the back, and other inquiries to:
* Periodic Rate May Vary BANKCARD SERVICES, POBOX 15026, WILMINGTON DE
19850-50215. '
6820 01J Y 7KB 0406 0300 00
USE011 4313 0400 2006 0901 PAGE 1 OF 1
PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION.
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Recetpt Date:
Rece=!-pt Time:
Recelpt No.:
3/29/2006
09:16:40
1043818
WEIBLEY DOROTHY M
Estate File No. :
Paid By Remarks:
2006-00276
DESFORGES MARCIA L
MG
------------------------ Receipt Distribution -------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 3859
Total Received.........
90.00
15.00
8.00
10.00
5.00
----------------
$128.00
$128.00
-+ I f) C CD pJ{i' L. ~(J
~1l'J1 ~ .() D
CUMBERLAND COUNTY GENERAL
CUMBERLAND COUNTY GENERAL
CUMBERLAND COUNTY GENERAL
BUREAU OF RECEIPTS & CNTR
CUMBERLAND COUNTY GENERAL
FUN
FUN
FUN
M.D
FUN
REV-1513 EX + (?_nm
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Weiblev Dorothv M. 06 00276
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Marcia L. Des Forges Daughter 100%
1457 Raven Hill Road
Mechanicsburg, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
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