HomeMy WebLinkAbout06-27-06
_J
15056051047
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1, Original Return
c::::>
2. Supplemental Return
c::::>
4. Limited Estate
c::::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return ReqUired
c::::>
c::::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c::::> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c::::> 10. Spousal Poverty Credit (date of death c::::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
---D-
8. Total Number of Safe Deposit Boxes
-
c::::>
Firm Name (If Applicable)
~~l
\..0
Correspondent's e-mail address:
Under penalties of perjury, I declare that) 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 k wledge.
()
(fl#
~IGNATURE OF PERSON RESPONSIBLE ,F>?~tILlN,G R~!URN ,.,
BJ...aI:J . (J5~ t. .......c
ADDRESS 199 Conodoquinet Mobile Estates/
J:il.s'lAnri 11 ~ pn 1 7'241
SIGNATURE OF PREPARER OTHER THAN REPRESENTATI\f.
..E.,r
ADDRESS
200 North Hanover Street, r~rl;~lp. PA 1701i
PLEASE USE ORIGINAL FORM ONLY
DATb d.~O~
Side 1
L_
15056051047
15056051047
--'
.-J
REV-1500 EX
15056052048
Decedent's Name: Glenn E. Bauder
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . , . . . . . . . . . . . . , . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) c:::) Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non~Probate Property
(Schedule G) c:::) Separate Billing Requested.. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
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)................................... 11.
12. Net Value 'of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
Decedent's Social Security Number
1.
15.
16.
17.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L_
15056052048
Side 2
..
15056052048
--I
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
_~. ___Gl~mLE~_ BOlJ~~L
STREET ADDRESS
_._...5_W~B_L11aiLL..stLe~L_~___._____________________~____
CITY
Newville
i' STATE
PA
--ZlP'.-'" ..----~-..,-...-.-.-
17241
Tax Payments and Credits:
1, Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1) '20 444 i8
I
. 0-0-
21~00. OQ....
.00
Total Credits ( A + 8 + C ) (2) 21, 500 . 00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
.00
.00
~-~-_.-~-- Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in avalon Page 2, Line 20 to request a refund.
B. Enter the f.atal of Line S + SA. This is the BALANCE DUE.
(3) 20L444.38
(4) 1,055.62
(5) .00
(SA) .00
(58) .00
S. 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.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 []:
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 []:
c. retain a reversionary interest; or.......................................................................................................................... 0 G
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 Gl:
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 []:
3. Did decedent own an "in trust for" or payable upon death banl< account or security at his or her death? .............. 0 G
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ IKJ 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.
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 three (3) percent [72 P.S. S9116 (a) (1.1) (i)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 zero (0) percent
[72 P.S. S9116 (a) (1.1) (ii)J. 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 .af 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 zero (0) percent [72 P.S. ~9116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.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.
Rl;V-19111EX.{1-97) *
(
l' -
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
FILE NUMBER
21-05-0853
J
VALUE AT DATE
OF DE.A. TH
DESCRIPTION
Health Insurance refund (AFLAC)
7.87
Automobile accident settlement proceeds
100,000.00
Final paycheck from Newville Ribbon Mill
248.49
Failor- Wagner Post 421 Home Association, Inc.
100.00
white Circle Club
Donation
Fraternal Order of Eagles
200.00
500.00
2005 Federal Income Tax Refund
1,155.00
Social Security retirement benefit
813.00
TOTAL (Also enter on line 5. Recapitulation) \ $ 1 03 , 024 . 36
, _ '- _ _ <_ ~-,.L. ~ _ _ _ _: _\
RE'oI-1509 EX+ 112..8EI} *'
COMMONWEAI1H OF PENNSYLVANIA
INH1ERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
Glenn E. Bouder
I FILE NUMBER
21 05-0853
ESTATE OF
Joint tenalllt(s):
ADDRESS
RELATIONSHIP TO DECEDEN.T
Sister
NAME
A. Blanche Hefflefinger
C.M.E. 199
Newville, PA 17241
Sharon Hoover
77 Windy Hill Road
Newville, PA 17241
Niece
B.
C.
Jointly_wned property:
=fLmER
ITEM FOR
NUMBE JOINT
'rENANT
1. A
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
TOTAL V AWE
OF ASSET
DECO'S DOLLAR V AWE OF
% INT. DECEDENT'S INTEREST
1/2/0L
Checking Account
Farmers National Bank
a branch of Adams County
National Bank
Account No. 2163764
2,159.57
50% 1,079.79
2.
A
9/23/C6 Savings Account 6,691.59
Adams County National Bark
Account No. 9627448
50% 3,345.80
3.
A
h1/5/01 Vacation Club Account 501.48
,Adams County National Bark
Account No. 5985706
50%
250.74
I
i
TOTAL (Also enter on line 6, Recapitulation)
$4,676.33
(If more space is needed insert additional sheets of same size)
September 30, 2005
Griffie & Associates
Attorneys and Conselors at Law
200 North Hanover Street
Carlisle, PAl 73013
Re: Estate of Glenn E. Bauder
Dear Mr. Griffie:
~
ADAMS
COUNlY
NATIONAL BANK
The following information is being provided as per your request:
J1. wi Blanche
Hefflefinger
Jt. w / Blanche
Hefflefmger
Jt. w / Sharon
Hoover
Jnquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer
Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5116.
Acc1. Type Account
No.
Account
Principal on
D.O.D.
$2,159.57
Checking
2163764
Savings
9627448
$6,685.05
Club
5985706
$500.00
Sincerely,
-.-/l" .
I i {J-{A
M:~
Lois Kime
Deposit Services
Ownership
Date
Account
Joint
1-2-04
Accrued
Interest to
D.O.D.
$.00
$6.54
9-23-96
$1.48
11-5-01
PO Box 3129, GETTYSBURG, PA 17325 I PHONE 717.334.3161 I TOLL FREE 888.334.2262 I www.acnb.com
REV.1510 EX + (2-871
~.~..\)
...;Z~..~)\
.......~:!,>-
COMMONWEALTH OF PENNSYLVANIA
IINHEIUTANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
TRANSFERS
I
I PLEASE PRINT OR TYPE
FILE NUMBER
ESTATE OF
Glenn E. Bouder
21-05-0853
ITEM DESCRIPTION OF PROPERTY
NUMBER Indude name of the transferee, their relationship to decedent, date of transfer.
EXCLUSION
TOTAL VALUE
OF ASSET
THIS SCHEDU LE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES.
DECO. DOLLAR VALUE
% OF DECEDENT'S
INT. INTEREST
3,522.87 100% 3,522.87
1.
Lawrence Schiff Silk Mills,
401 (K) plan
(see attached statement)
Inc.
o
2.
Erie Family Life Insurance Compan~
Annuity #565-389
(see attached statements)
o
18,052.0l
3.
o
18,976.7
National Life Insurance Company
Annuity #NL9010001
4.
National Life Insurance Company
Annuity #NL9010052
o
22,104.2
TOTAL (Also enter on line 7, Recapitulation)
100% 18,052.06
I
100% 18,976.71
100%122,104.24
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
J
i
I
I
I
I
I
I
I
i
Is 62,655.80
(If more space is needed, insert additional sheets of same size.)
~ z Vl 0 ~
tT:I .- tTJ ? ("') o:i CP ~ ~ ~
;:l ;:l ~ 0 CP ~ l
Q.. <: -t:l ~ ;:l t1l:i m ..... ("ri
(D ,..;.. z ::...
:;r tll CP ..., ::t S' ~ ....... ~ ~
S- ;:l s-: cr: - ~
t1l:i tJ) ;:l .- ~CP l>' t:J:j ,...
"" {D g. :::: ::it ..... 0 - ,.,
tl t:J:j ;:l .....
~ ~ VJ .....- (TQ >- "'t:i c; ,..;..
l>' ... 0 0' Cfj ("ri
..... ..... :> ~
!v. ;;- ;:l o:i n ::i I;j ..
r:rJ r.n ::::I S
;:l tJ) l>' n - CP m ~
- C'l l>' ;;; ....,) ~
1__ -. 0 ~
.~ Cll ~ ;:l \-.J (b
... .... A ("ri
<::> :;r n - ~
.'" '" Cll = - =
0 ;;; 01:< ......
0 e VJ <::> ,...;. """t
u, -.J ~
." 8 (b
""
c:> TJ). S
v, i:l """d
"" ....
0 - (b
V; S ...-
== ~
; l""'l-
Z =
~
""1 ~ r...I'l
~ ""'"
~ ~
u. ~
""'" ""'" ~ ~ ~ """ 0 Q
0 ""1 ....,..
0
- ;=:;- ~
co e
w U-'
"VI - l.,.l ~
0 0 .", U-' co .-
0 0- 0 t...) :::> !J. ...,
i.o 0 00 0 \.0
0 0- 0 -l :::> .- ~
\ ~ ~
D
::; 0
~ ==
if.l
;:2 ~
;;:;
n
C1> TJ).
r
0 ~
- ~
-
~ ..-,j
n CD
~ ~
TJ1 (;)
.... [/.l CD
- ...,. w
S a
t.::> (\l 0
a -!4 S :::r
.......
i-'T'" ('D ~
~ ""'" :::l ~.
~ ell .....
to ~ ~ '"t:I r/).
l>' ~ (\l ~'"
iii' dr.J ..., .........
:l ''is _. v:t
n 0
C1> @ 0- ~
!1D
0
p-' 0 .......
--.l .........
~ .........
- r.n
0 ....
~ (l:> .....
Ge - .........
~ GO ~ ~
00 0 (')
g. t:ir.l 0
to .-, V'I ~
'" 00
iii' CJ', 0
::; "" 0 .......
n , '-0
C1> >- ,-..,.
....... r;-'
"'" w
1i- 00 0 '-"
. -- f-'O
~ .\!>o tv
S' 0 0 .........
(JQ ...... 0> :;l:l
;;. \J1 Vl ~
1-
~. t~e~~; :~:~~:~c:~~P INSURANCE COMPANY
.....~""l;". Home Oftlce . 100 Ene Insurance Place' Ene, Pennsylvania 16530 . (814) 870-2000
'.....~ Toll free 1-800-458-0811 . Fax (814) 870-2437 . www.enelnsurance.com
ERIJ~~
December 6, 2005
Griffie & Associates
Attorneys and Counselors at Law
?OO North Hanover Street
Carlisle, P A 17013
RE: Estate of Glenn E. Bouder
Annuity #565-389
Dear Attorney Griffie:
Please note that Mr. Bouderwas the OViner of the above annuity and had the sole right to
surrender the annuity at any time.
The date of death value, August 27, 2005 was $18,610.37.
The surrender value as of August 27, 2005 was $18,052.06.
I hope this information is helpful to you and if you have any questions, please call me at
1-800-458-0811 eA'tension 2243 or Melody Bokshan at 2292.
g~~
Sally Austin
Life Claims Specialist
Life Policy Administration
The ERIE Is Above AllIn SERVICE@. . Since 1925
-.,NATIONAL LIFE
ONE NATIONAL LIFE DRIVE
MONTPELIER, VERMONT 05604
CLAlMS
TEL: 800232-5246. FAX: 802229-7353
VlWW.NLV.COM
May 24, 2006
,I
:--'1
I'
. 'I
- ..-....-.----. . 1
i' "(I {,'\; '51 (:"::l
II ;:1 rdj 2J It'"
.." ..........---, ,\ I!.;
; ..,..... Ii
I {./~.._; j 1
Hi iH
en II'
~iJ l.r J
J I
. n 1"\ l
.J.J; l ,';-:~J !
. .. ....-..-----'
,"OJ,
#BWNCDPH
,
j
GRIFFIE & ASSOC
ATTN BRADLEY L GRIFFIE
200 N I-lANUVER ST
CARLISLE PA 17013
Re: NL90 1 0052, NT~90 1 0001 - Glenn E Bouder
Dear Mr. Griffie:
This is in response to your letter of April 28, 2006 regarding the above contracts.
According to our Retirement Services department, here is the information requested:
For NL9010052, the value of the contract on August 27,2005 was $23,458.41. A surrender penalty of $1,354.17 would
have been applied leaving the amount that Mr. Bouder would have received at $22,104.24.
For NL9010001, the value of the contract on August 27,2005 was $20,132.54. A surrender penalty of $1,155.83 would
have been applied leaving the amount that Mr. Bauder would have received at $18,976.71.
If you have any questions, please let us know.
Sincerely,
d~' .
_.. '. _...n__,_...__...
_. "_ _m" u_ ......__..
:,' '.:' 'B""~ <--~_..: _ __,;',:.,: ",,__:__,:::,:,';j:~::
. P.." . .. :...... ......, ','
. ... u_., _, ... . "...._ ._.....
,. ., .' .... d' ...'.. ; .c.' ._ ''''".'
.. , ,. --<
.. .... .. u"'"
" '. ""'c, :'. :--;. ..... , ",..'
... ......, "...u.,...... ...
Sherri S. Gause, ACS, AIAA
Claims Examiner
Telephone Extension 7215
c: 015
NATIONAL LIFE VARIABLE CONTRACTS DISTRIBUTED BY EQUITY SERVICES, INe. . BROKER-DEALER SUBSIDIARY OF NATIONAL LIFE INsURANCE COMPj,J,,'Y
ONE NATIONAL LIFE DpJVE . MONTPELIER, VERMONT 05604
REV.!511EX'P';7) ca;' /
~.
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Glenn E. Bouder
FILE NUMBER
21 05-0853
Debts of decedent must be reported on Schedule I.
ITEM ,
NUMBER
A. !! FUNERAL EXPENSES:
2.
3.
4.
s.
1.
2.
3.
4.
5.
6.
7.
8.
9.
1 O.
DESCRIPTION
AMOUNT
Egger Funeral Home
6,779.40
Eby Granite Works (Memorial stone)
95.00
Wayne Good, Pastor
50.00
Church of God Women's Ministry (Wake)
120.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Blanche He f f le f inqer
Social Security Numbe~s} I EIN Number of Personal Representative{s)
Street Address 199 Conodoquinet Mobile Estates
City Newville State PA Zip 17241
2006 (see attached) ,
Year(s) CommISSion Paid:
A~m~F~ Grifie & Associates
Family Exemption: (If decedenfs address is not 1tte same as claimanfs, attach explanation)
Claimant
8,500.00
4,000.00
Street Address
City
State
Zip
Relationship of Claimant to Decedent
Probate Fees
132.00
Accountanfs F~
Tax Retum Preparer's Fees Howard I s Accounting
150.00
Advertising to The Sentinel
144.29
Advertising to The Cumberland Law Journal
75.00
Jeffrey Bouder, financial adviser
RE: Annuities/Life Insurance policies
100.00
Reserves
500.00
TOTAL (Also enter on line 9, Recapitulation) $20, 645. 69
(If more space is needed, insert additional sheets of the same size)
Chloe Hefflefinge~
129 Fish Hatche~Y Road
Ne~ville, pA 17241
SSN:
\' /
J
I;
/
/
I
.I
i
/
//~
//
/
i
I
I,' ..
(
V
/'
'. /
,-._---_.~'
/~
,
/
....~/
---------------
()
//
/
i .
/ //~
---.------.........-- .... --.;/
/
;//
v/
,,/
/
/
/
//
/~
_._~.~--_.-..."'..;
.~::.~
/)
REV-1512 EX. /l.q,:) .
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or Type
'FILE NUMBER
21 05-0853
ESTATE OF
Glenn E. Bauder
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Pennsylvania Department of Revenue
2005 Personal Income tax due
1 .00
TOTAL (Also enter on line 10, Recapitulation)
is
I 1 .00
(If more space is needed, insert additional sheets of some siza)
RE'.1513 Ex+{l-97}
SCHEDULE J )
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERiTANCE TAX RETURN
HESJDENT DECEDENT
ESTATE OF
Clonn"R Bouder
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
L TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Dorothy Shoff
5 West Main Street
Newville, PA 17241
2. Dennis Shoff
2 Irish Gap Road
Newville, PA 17241
3. Steven Shoff
10 South Mont Drive
Enola, PA 17025
4. Terry D. Hefflefinger
129 Fish Hatchery Road
Newville, PA 17241
5. Jamie D. Hefflefinger
131 Fish Hatchery Road
Newville, PA 17241
(see attached continuation sheet)
FILE NUMBER
21 05-0853
RELATIONSHIP TO DECEDENT
Do Not List Trustee(5)
Niece
Nephew
Nephew
Nephew
Nephew
AMOUNT OR SHARE
OF ESTATE
10%
10%
10%
10%
10%
I I
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
Ilf mr'\r~ e::n:>"'''' Ie:: n".,,;1>I'i ine::~rt :>,.,,.,/tonn:>l. e::n"",le:: nf tn", e:::>m", e::,.,.",\
6. Sharon Hoover Niece 10%
77 Windy Hill Road
Newville, PA 17241
7. Carolyn Weller Niece 10%
1- Antler Court
.J
Shippensburg, PA 17257
8. JRichard Bouder Nephew 10%
415 Pinedale Road
Carlisle, PA 17013
9. Edward Bouder Nephew 10%
415 Pinedale Road
Carlisle, PA 17013
1 O. Donna Bouder Niece 10%
415 Pinedale Road
Carlisle, PA 17013