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HomeMy WebLinkAbout08-24-06 (2) LAW OFFICES BARBARA SUMPLE-SULLIVAN 549 BRIDGE STREET NEW CUMBERLAND. PENNSYLVANIA 17070-1931 PHONE (717) 774-1445 FAX (717) 774-7059 August 11, 2004 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 Re: Estate of Charles D. Cushing No. 2006 - 00688/ Cumberland County Dear SirlMadam: Enclosed for filing are two (2) Original Pa. Inheritance Tax Returns in the above- captioned matter along with one (1) copy and a check in the amount of $4,500.00 which represents the balance due on the above referenced Estate. I have also enclosed a check in the amount of $15.00 to cover the filing fee. / li ery trol / / J~ {/ Barbara Sumple-Sullivan Should you have any questions please contact myp.ffice. BSS/ld Enclosures cc: Ms. Helen B. Cushing, Executrix C<-l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY REV-1500 EX (B-OO) INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Cushing, Charles D. (Ho YEAR (pgr NUMBER DATE OF DEATH (MM-DD-YEAR) November 26, 2005 DATE OF BIRTH (MM-DD-YEAR) July 29, 1915 SOCIAL SECURITY NUMBER 186-07-8933 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Helen B. Cushing )( 1. Original Return 4. Lirnited Estate SOCIAL SECURITY NUMBER 2. Supplemental Return 3. Remainder Return (Date of d"'" pnorto 12-1=1 5. Federal Estate Tax Return Required 4a. Future Interest Comprise (date of death after 12-12-62) 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 7. Decedent Maintained a Living Trust (Attach a copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes 11 Flp.r.tion to t~x Ilnnp.r Sp.r. 91131A \ (Attach Sch 0) THIS SECTION MUST BE COMPLETED. NAME Barbara Sumple-Sullivan, Esquire FIRM NAME (If Applicable) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS 549 Bridge Street New Cumberland, PA 17070 TELEPHONE NUMBER (717)774-1445 1. Real Estate (Schedule A) (1) $ 0.00! $ 000 ~ $ 0.00 ~ $ 0.00 ~ OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) (6) $112,00000 ! $ 0.00: 6. Jointly Owned Property (Schedule F) [=:J Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Probate Property (Schedule G or L) r'" .1 (7) $ 0 00 L.................................................................................... ..... 8. Total Gross Assets (total Lines 1-7) 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (9) (10) (8) $3,131.00 $ 0.00 (11) (12) (13) (14) $112,000.00 9. Funeral Expenses & Administrative Costs (Schedule H) 11. To,tal Deductions (total Lines 9 & 10) $3,131.00 12. NE,t Value of Estate (Line 8 minus Line 11) $108,86900 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. NE't Value Subjectto 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) $5,000.00 $108,869.00 16. Amount of Line 14 taxable at lineal rate 100,000.00 x .045 (15) (16) (17) (18) $ 0.00 $4,500.00 $ 0.00 x 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 $ 0.00 19. Tax Due 20.[~ (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT $4,500.00 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent'l; Complete Address STREET ADDRESS 45 W. Lauer Lane CITY Camp Hill I::ATE !ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) $4,500.00 Total Credits (A + 8 + C) (2) $ 0.00 3. IntereistlPenalty if applicable D. Interest E. Penalty 4. TotallnterestlPenalty (0 + E) (3) If line 2 is areater than line 1 + line 3. enter the difference. This is the OVERPAYMENT Check box on Page 1 Line 20 to request a refund (4) $ 0.00 $ 0.00 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) $4,500.00 A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE (58) Make Check Payable to: REGISTER OF WILLS, AGENT $4,500.00 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes 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 revisionary interest; or d. receive the promise for life of either payments, benefits or care? If dealth occurred after December 12, 1982, did decedent transfer property within on year of death without receiving adequate consideration? c=J 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? C:::=J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? C:::=J CJ IF THE AN..c;WER TO ANY OF THE ABOVE QUESllONS IS YES, YOU MUST COMPLETE SCHEDULE G AND RLE IT AS PART OF THE RETURN. No 2. ~ B Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge. Helen B. Cushing, Executrix SIGi2~;F PERSON RESPO ADDRESS 45 W. Laue DA Barbara Sumple-Sullivan, Esquire /ADDRESS 549 Bridge StrEiet, New Cumberland, PA 17070 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 survivina spouse is 3% [72 P.S. 9116 (a) (1.1) (i)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116(a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(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. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-15D8 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CHARLES D. CUSHING FILE NUMBER 2006-00688 Include the, proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Actual distribution to Estate from Trust held by Ameriprise in accordance with the Last Will And Testament and Trust. On May 12, 2000, the Decedent had created a trust in which he transferred his financial assets. The trust assets were held at the time of his death by Ameriprise Financial Advisors. An Amendment to the Trust on August 4, 2000 directed that upon the Decedent's death, as much of the remaining principal and income as was necessary to meet certain bequests and expenses of his estate were to be transferred to his probate estate. This included charitable bequests and special bequests to his daughters. Any remaining assets passed to his spouse. A copy of the amendment to the trust, which was in effect at the time of Decedent's death, is attached hereto. Also attached is the section of the Will documenting the special bequests. The total sums taxable transferred from the trust to the Estate is $112,000.00. Tax is tendered on these bequests to Decedent's children. The remainder of the Estate (probate and otherwise) passes to the Decedent's wife and is not taxable. VALUE AT DATE OF DEATH 112000.00 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $112,000.00 - SORS PHONE NO. 717 761 199' Ma'::j. 05 2006 09:22RM P4 FlLECOPY THIS AMENDMENT to Revocable Estate Trust is made this ~daY of ~ .2000 by and betv.reen CHARLES D. CUSHING (Settlor) and FULTON FINANCIAL ADVISORS, N.A. (Trustee) WITNESSETH WHEREAS, on May 12, 2000, Settlor entered into a Revocable Estate Trust with Trustee reserving the right.to amend the Trost; WHEREAS, Settlor and Tl1lStee wish to amend the Trost. NOW THEREFORE, in consideration of the mutual promises and covenants set forth herein, the parties agree as follows: 1. Recitals. The Recitals are incorporated herem. 2. Modification of Section 2. Section 2 of the Revocable Estate Trust is amended to provide as follows: Upon my d~ the Trustee shall distn'bute to my Personal Representative so much of the then-remai"ing principal and income accrued and unpaid to the date of my death, which after consultation with my Personal Representative, Trustee deems necessary, considering the assets in my probate estate, to satisfy the following: A- All income taxes payable. with respect to ~ income received by Settlor prior to Settlor' s de~th or payable to Settlor's estate after Settlor's death; FROM : AMER I CAN EXPRESS FIN.. SORS PHONE NO. 717 761 199~ Ma~. 05 2006 09:23AM P5 ,. '-."I ""'" . .."-." I . B. -Ail- estate and' inheritance taxes (including intei~'''"''and 'penaitleS-not caused '~by . n.egligent delay) payable with respect to all property included in Settlor's estate :;, . ) whether or not such property constitutes part of the trust estate; C. All unpaid gift taxes on any gifts made by or attnbuted to the Settlor during Settlor's lifetime; D. All debts, claims, funeral expenses and administrative expenses (including , commissions and legal, fees) which, in the sole and exclusive judgment of the Trustee, properly arc payable by and duly chargeable against, the Settlor's_probate estate or the trust estate; E. All other taxes, costs, ,expenses, fees, disbursements or interest (other than' as provided in Pa.ragraph A above) and/or penalties not caused by negligent delay which the Trustee, in its sole and exclusive judgment, shall deem to be properly payable by or on behalf of Settlor's probate estate or by the trust estate; F. So much thereof as is necessary to satisfy in full the pecu:IDary ~egacies set forth in Settlor's Will so that such legacies and bequests IDay,pe_,~~tisfied; and G. , The balance thereof shall be distributed unto Settlor's wife, HELEN B. CUSHING, provided she survives Settlor, and in the event Settlor's wife,HELENB. CUSHING, . predeceases Settlor, the balance thereof shall be distributed in equal shares unto those of Settlor's children, ELEANOR L. WELLS and DOROTHY G. CUSHING, and stepchildren, CINDY S. SHEAFFE~ CARRIE S. MCCREARY, CHARLES SIDERS, JR., and GARY SIDERS, who survive Settlor. 3. In all other respects, the Revocable Estate Trust dated May 12, 2000 shall remain in full force and effect. 2 FRnM : AMERICAN EXPRESS FIN~ 'SQRS PHONE NO. 717 761 199; Ma~. 05 2006 09:24AM P6 .. ~ ~'. .,>~ ~''':..-..','.-.." :.;.. . "'0' - - ....;,. '" .~.. '. " " . ",;.,' .,. .c~:, ..;ii>'..'. :'. ~:~'" ;. ,~,~ ~.;~~; ":;'~::'f'"W,",*,'.I~f~;;/.<~~~:-:::~~~i~~~:;:r:t':;~'/!:i'~;;~";;7"'-::%'1~1t~~~~S:i?*:;f"::~fP"~;;'Y:~"': IN 'WI'fN}':SS ~REOF, the parties ~ve caused these presents to be duly executed on the day and year first above written. 1^.h.r~)S ~ ~. <: SETTLOR: ~; Dad: j/ a.{~ . Ch~r1es D. Cushing. . (SEAL) ----., TRUSTEE: FULTON FlNANCIAL ADVISqRS, N.A. 3 I 012131-OOOO1/07.06.00IEGMIKL':' ~5857.2 I' '~. . 1Ualit mill anD Wtlltamtnt OF CHARLES D. CUSHING L CHARLES D. CUSHING~ of 45 West Lauer Lane, Camp Hill, Cumberland County, Pennsylvania, being of sOlli""1d and disposing mind, memorj and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE n I give and bequeath my motor vehic1e(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance r thereon,. unto my w..fe, HELEN.B. CUSHING, provided she survives me. If my wife, HELEN B. . CUSHING, predeceases me, I give and bequeath the same unto my daughters, ELEANOR L. 'WELLS, Orlando, Florida, and DOROTHY G. CUSHING, Pennfield, Pennsylvania, or the survivor of them, to be divided between them in as nearly equal shares as is practicable. 012131-OOOOlI07.06.00/EGMIKL'"T' '15857.2 ARTICLE III I give and bequeath the sum of FIFTY THOUSAND ($50,000.00) DOLLARS unto my daughter, ELEANOR L. WELLS, provided that should she predecease me, I give and bequeath the same unto my daughter, DOROTHY G. CUSHING, provided she survives me. ARTICLE IV I give and bequeath the sum of FIFTY THOUSAND ($50,000.00) DOLLARS unto my daughter, DOROTHY G. CUSHING, provided that should she predecease me, I give and bequeath the same unto my daughter, ELEANOR L. WELLS, provided she survives me. ARTICLE V I give and bequeath the sum of ONE THOUSAND ($1,000.00) DOLLARS unto BETHESDA MISSION OF HARRISBURG, INe., 611 Reily Street, P.O. Box 3041, Harrisburg, Pennsylvania 17105. ARTICLE VI I give and bequeath the sum of ONE THOUSAND ($1,000.00) DOLLARS unto the AMERICAN RED CROSS OF THE SUSQUEHANNA VALLEY, 1804 North Sixth Street, Harrisburg, Pennsylvania 17102, for its endowment fund. '"' ~ ,I 012131-OOOO1JO:.06_()()/EGMIKL~15857.3 ARTICLE vn I give and bequeath the sum of ONE THOUSAND ($1,000.00) DOLLARS unto the SALVATION ARMY, HARRISBURG CHAPTER, 1122 Green Street, Harrisburg, Pennsylvania 171 02, for its program purposes in the area including Dauphin, Perry and Cumberland Counties. ARTICLE vm I give and bequeath the sum of ONE THOUSAND ($1,000.00) DOLLARS unto the AMERICAN DIABETES ASSOCIATION, CENTRAL PENNSYL VANIA AFFILIATE, 3544 No~ Progress Avenue, Harrisburg, Pennsylvania 17110. ARTICLE IX I give and bequeath the sum of FIVE HUNDRED ($500.00) DOLLARS unto THE LEUKEMIA & LYMPHOMA SOCIETY INe. - CENTRAL PENNSYL VANIA CHAPTER, 800 Corporate Circle, Harrisburg, Pennsylvania 17110. ARTICLE X I give and bequeath the sum of FIVE HUNDRED ($500.00) DOLLARS unto the MUL TIPLE SCLEROSIS SOCIETY, CENTRAL PENNSYL VANIA CHAPTER, 2209 Forest Hills Drive, Harrisburg, Pennsylvania 17112, to be restricted for local use. 3 012131-OOOOl/07.06.00/EGM/KL T "'5857.3 ARTICLE XI I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate unto my wife, HELEN B. CUSHING, provided she survives me. Should my wife, HELEN B. CUSHING, predecease me, I give, devise and bequeath all the rest, residue and remainder of my Estate in equal shares unto those of my children, ELEANOR L. WELLS, and DOROTHY G. CUSHING, and my stepchildren, CINDY S. SHEAFFER, CARRIE S. MCCREARY, CHARLES SIDERlO:, JP~, and Gft~y SIDERS, who su..rvive me. ARTICLE XII My Personal Representative(s) shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my Personal Representative may determine. B. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. C. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. 4 .012131-QOOOlI07.06.00fEGMIKl' 15857.2 D. To sell at public or private sale, to exchange, or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. E. To allocate receipts and expenses to principal or income or partly to each as they from time tO,time think proper. F. To compromise any claim or controversy. G. To make such elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift, generation skipping or other tax refunds and the payment of such taxes without obligation to adjust the distributed share of any person thereby affected. ARTICLE xm I name, constitute and appoint my wife, HELEN B. CUSHING, and FULTON BANK, Co-Executors of this my Last Will and Testament. Should my wife, HELEN B. CUSHING, fail to qualify or-cease to so act, I direct that my corporate Executor shall complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this 4 [i. day of I1Vf (j tr , 2000. ~L?Jth ~ J) (17 (SEAL) CHARLESD.CUSHING 5 012131-QOOOl/07.06.00IEGM/KL7 ~5857.2 ,- Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~!Jhy-- ~ .(J -Iyh~ q~ 6 '. J . 012131-OOOOl!07.06.00/EGM/KL~ ~5857.2 'i ," .' .~ AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We, CHARLES D. CUSHING, ~JJ. J;::,.~~ and \" ~ ~."' N-rv-.-J , the Testator and the witnesses, respective y, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~M4~ ~4d1 CHARLES D. CU BING ~/J' Witness ~ ~!dcj}~~ Witness Subscribed, sworn to and aclmowledged before me by CHARLES D. CUSHTI'~G, Testator, and subscribed and sworn to before me by ~ ~. ~~ and \., ~ ~~......... ~j , witnesses, this ,\":Ui' day of ~ ' 2000. SJ. ~ . ~ < . Notary Public '" "T I I NOTARIAL SEAL . DIANNE LENIG, NoWy Public i I Lemoyne Borough Cumberland Co. ," I My Commission Expires Dec. 21. 2001 I REV-l509 EK + (5-98) * COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL Y -OWNED PROPERTY ESTATE OF CHARLES D. CUSHING FILE NUMBER 2006-00688 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SLlRVlVING JOINT TENANT(S) NAME ADDRESS 45 W. Lauer Lane, Camp Hill, PA 17011 RELATIONSHIP TO DECEDENT Spouse A. Heh~n B. Cushing B. C. JOINTLY-OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH NUMBER FOR JOINT MADE Include name of financial insliIuIion and bank account number or similar identifying number. DATE OF DEATH DECO'S VALUE OF TENANT JOINT Attach deed for joinlly-held real estate. VALUE OF ASSET INTEREST DECEDENrSINTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ 0.00 .. (If more space IS needed, Insert additional sheets of the same sIZe) REV-1511 E:(. (12-99) .~..... ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CHARLES D. CUSHING 2006- 00688 FILE NUMBER Debt!. of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative'~ Commissions Name of Personal Representative (s) j Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attomey Fees 2500.00 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 ,t Probate Fees Cumberland County Register of Wills; Cumberland County Law Joumal; Patriot News 631.00 .- Accountant's Fees .>. El. Tax Retum Preparer's Fees j'. TOTAL (Also enter on line 9, Recapitulation) $3,131.00 .. (If more space IS needed, Insert additional sheets of the same sIZe) REV-1513 EX + (9-00)) . SCHEDULEJ BENEFICIARIES COMMONW"'-AL TH OF PENNSY'SA!\IIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE: OF CHARLES D. CUSHING FILE NUMBER 2006-00688 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AM:ll.NrQR Do Not Ust Trustee(s) SI-WlE TAXABLE DISTRIBUTIONS pnclude outright spousal distributions. and OFESrATE I transfers under Sec. 9116 (a) (1.2)] . 1. Helen B. Cushing. 45 Lauer Lane. Camp Hill. Pa 17011 Spouse 100% . (Except for special bequests) 2. Eleanor L Wells. 4111 Salmon Drive. Orlando. Florida 32835 Daughter $50,000.00 3. Dorothy G. Cushing, 183 Gary Lynn Drive, Pennslield, PA 15849 Daughter $50,000.00 ENTER 00I.lAR AMOUNTS FOR D1STR1BlIT1ONS SI-O\MIIABOVE ON UNES 15 THROUGH 18, PS APPROPRIATE, ON REV-1500 COVER SHEET n. 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. Bethesda Mission of Harrisburg, Inc. $1,000.00 2. American Red Cross of the Susquehanna Valley $1,000.00 3. Salvation Anny, Harrisburg Chapter $1,000.00 4. American Diabetes Association, Central Pennsylvania Chapter $1,000.00 5. Leukema & Lymphoma Society, Inc. - Central Pennsylvania Chapter $500.00 6. Multiple Sclerosis SoCiety, Central Pennsylvania Chapter $500.00 TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET $5,000.00 .. (If more space IS needed, Insert additional sheets of the same sIZe)