HomeMy WebLinkAbout07-26-05
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'9s.' COMMONWEALTH OF
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, . ,'." DEPT 280601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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,If APPICABLE. SUR'J".jING SPOUSES NAME (LAST fiRST AND MIDDLE INITIAL:
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9 '~,T.go'J81\ ProceeGs Received
SCCIA~ SeCURiTY f\.,J~"tRE.R
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
St:C"R'TY N;v'~,1G:::;:;;
2 Sli;)f!IPmental Rotur!'
[J 4a Future Interest COmDrOnllSe
n 7 Decedent Maintained i;l LIVing TrJs~
U 10. SPOUS3- Poverty Credit
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
'W,lt CAlc (1. ~ 5 ') COMPlc Tc MAILING ADDRESS
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FIR~J' ~MAE \' ;';J~; '~d~;'e ()l r
c.tilrnp fI.:!/) PA /70 J /
TELEPHONE NUMBER
717 - 73/- /3 4Lj.
Real Estate ISchedule Aj
2 Stocks rFld Bonos jSchedule B)
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',1ongaqes & Noles ReceIVable (Schedule DJ
3 CloS81Y Helc Corporation, Part'1ersn:p or Sole-Proprietorship
141
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CaSf1 Bank DepIJ511S & Miscellaneous Personal Property
;Schedule E,I
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Separate Bllllrg Requested
(61~370.37
7 Inter'\/Ivos Transfers & M.scellaneous Non-Probate Property
I,Scnedule G or L'
(71
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Total Gross Assets itaL':)1 Lines 1-7)
rJileral Exoenses & AdllllrllSlrCl!lve Costs (Schedule HJ
10 Debts ul Decedent Mortqage LJabilltles & Liens (Senedule II
(101
11 Total Deductions Itolal lines 9 & 101
12 Net Value of Estate ':lme 8 r:1lnUS Line 11:
19: 3,5"73. "Co
c.;n2r:1ClOie ar~,d GovernrT18n:aI6ec,1.l8stsiSec 9113 Trusts tor 'Nhlct\ 31" election to ta~ ~1as not bee'l
made :Scheduie J)
1.:t Net Value Subject to Tax (llne'2 nllnus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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18 A.~l:JJrl Of Line 14 taxable at SQllateral rate
:: Tax Due
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Stocks & Bonds
Jointly Owned
Gross Assets
Deductions
TAxable
% Tax Rate
TAx Due
$21,937.63
$41,370.37
$63,30800
$5,573.66.
$57,734.34
0.045
$2.598.05
REV-1500
INHERITANCE TAX RETURN RESIDENT DECEDENT
\\ \(\() D
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,
REV.1502 EX+ (6.9*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
All real property owned solely or as a lenanl in common musl 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
NUMBER
1.
DESCRIPTION
vALUE AT DATE
OF DEATH
ViA
TOTAL (Also enter on line 1, Recapitulation) $
(Ii more space is needed. insert additional sheets of the same size)
REV-1503 EX+ (5-98)
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jr) 0ry L R"~
All property jointly-owned with right of survivorship must be disclosed on Schedule F
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
I.
J.
3
354 5~l9re~ - Lu<:''f>(\+ lttl1nd.o6\C5 (CbMfflOt1)
c..un ?54 '1L{(p3 J 01
$ J ./7 ) Sh6re (go.--fe. of cge~4vl ')
( a q 3 5~tl~-es - A -r; T (com Morl )
tus P 030 \ 7 7 10 <1
1(~. ff 5 /Sh()-"e.. ( Qcate bf &u.~ ')
IJ334 ,6.[>
JOJ bo3,Q S
Q-J.y 6s') r:E Bo,,<9~ (iSS()~ ~ /'1~ ')
De no tY'i1()fD.."\-\QV') 600 (1.5SIJe.. 'J 60 )
::tmtv...s4 0 II. a 0
lJCl.l~e CtN~ ') 5" I. ~o
{ ,~
- (5') ~ (f< (77fj,(\~ly Ol()n~J) \
$ -ee. ~Q.'UQ., 'F- )
1r1i'tl'~d Kwfe. 'iv/a
{; If II ( In (J.- "'v;;f~f a / rJod.lJ
TOTAL (Also enter on line 2, Recapitulation) $ 0} { 137." 3
(If more space is needed, insert additional sheets of the same size I
REV-1504 EX+ (1-97) I'
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF
FILE NUMBER
Schedule C-t or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
NJA
TOTAL (Also enter on line 3, Recapitulation) $
(If more space Is needed, insert additional sheets of the same size)
,REV.1505EX. (1-97)
SCHEDULE C.1
CLOSEL Y.HELD CORPORATE
STOCK INFORMATION REPORT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
lv/A
1. Name of Corporation
Address
City
2. Federal Employer I.D. Number
3. Type of Business
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
State
Zip Code
ProducVService
4.
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting I Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5, Was the decedent employed by the Corporation? 0 Yes o No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? 0 Yes o No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8, Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
Consideration $
Date
9. Was there a written shareholder's agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
DYes
o No
10. Was the decedent's stock sold?
DYes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? 0 Yes 0 No
11 yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock,
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 pneceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s, If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G, Any other information relating to the valuation of the decedent's stock.
REV-1506 EX+ (9-00)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
)//1+
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
FILE NUMBER
1 . Name of Partnership
Address
Date Business Commenced
Business Reporting Year _"
State
Zip Code
City
2. Federal Employer 1.0. Number __
3. Type of Business
ProducVService
4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $
5.
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................. 0 Yes 0 No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ..... 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $_
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
DYes 0 No
If yes, 0 Transfer 0 Sale
Percentage transferred/sold
Consideration $
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? 0 Yes 0 No
If yes, provide a copy of the agreement.
Date
11. Was the decedent's partnership interest sold? ....................................... 0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? .."..............". 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? ................"................... 0 Yes 0 No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . " 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-1507 EX+ (1-97)
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FilE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
IV /Pr
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets 01 the same size)
REV-1508f"X'+(1-97j
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
Include the proceeds of I~igation and the date the proceeds were received by tl1e estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
/filA
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
".~P
r"" ,~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
In 6Y) ~ grA-e~
If an asset was made joint within one year 01 the decedent's date of death, it must be reported on Schedule G.
SCHEDULE F
JOINTL Y.OWNED PROPERTY
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A
C ;'~r/~S
1-1 R-. fte,.
d / Nt!? pons:+ }...1Gr/ e
Comy H~lI) fA no ( /
SoN
8
c
JOINTLY -OWNED PROPERTY
lETTER DATE DESCRIPTION OF PROPERTY %OF DA TE OF DEATH
ITtM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number Attach DATE OF DEA TH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly.held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A / /8'S W61ChOVi4. .5ev;1\6~ &Vl9ch~\::.t\fr
74,3JJ.. iL/ 500;1:1 37) ,,, I. 37
(see. O.:1tOt.~-e.o ')
J. p. a/lio EE Bor1E)S ( ; ssv-eD J)l"t~\))
D 'E?l1o/YI; f'\az..i.. 011 41. (j 00 -
1n-f€ttJs-f 3/1.()'o
V <J.I v e... S"ro /. ~o {~-t(> of.9r.f1I,)
X IS b0r7<95 ~4JI? 50(.:> '-1/ J 0 '1
TOTAL Also Ii i , i
enteron ne6, Recaptuaton) I $ 4/) 370.37
(If more space is needed, insert additional sheets of the same size)
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WACHOVIA
Consolidated Statement
01 1000060404483 752 40
11/23/2004 thru 12/21/2004
2 14 2.722
1..,111".111."..,11".1111.,.1
HARY L RITTER OR
CHARLES H RITTER JR
21 HEPONSIT LN
CAHP HILL PA 17011
PB
Summary of Accounts
Checking & Sa,ings
Account number Account Balance As at Interest
rate
1000060404483 CROWN CLASSIC BKG 112.15 12/21
1040238121286 HIGH PERFORMANCE MMI 89.83 12/21
3000043492889 PREMIUM SAVINGS 74.120.76 12/21
Total $74,322.74
Matunty
date
WACHOVIA BANK, N.A., SOUTH MOUNTAIN
page 1 of 5
--
,REV-1510 EX+ (1-97)
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
This schedule must be ccmpleted and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSfER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABlE)
1. )//'1+
TOTAL (Also enter on line 7, Recapitulation) $
..
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',1'
REv.,IE;. (1~.99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
...
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1 (see ~~~e.Q. ')
5~YlgerS m 01'+ U 0"'-1 ~ 513 . " (.,
B ADMINISTRATIVE COSTS tJ/~
1 Personal Representative's Commissions
Name of Personal Representatlve(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City ~-~--~~--_._- State _Zip
Year(s) Commission Paid:
2 Attorney Fees
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
5 Accountant's Fees
6, Tax Return Preparer's Fees
7
,
I
I
-
TOTAL (Also enter on line 9, Recapitulation) $ 51573.(P(P
--...,
Debts of decedent must be reported on Schedule I.
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REV.1512 EX+ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including un reimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
/filA-
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00) ~
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and translers under
Sec. 9116 (a) (1.2)]
1.
th()./es j.) f?,tter
JI l\JepOIl$i-t /"Or'le
Ctlm{J H;/I, pf:} (loll
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
AMOUNT OR SHARE
OF ESTATE
57) 734.3LJ
11
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
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
TOTAL OF PART [1- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets 01 the same size)
If//~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
/II}
REI/.1S'14 EX+ (12-03)
'*
,Check Box 4 on REV-1500 Cover Sheet
FILE NUMBER
ESTATE OF
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 from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
o Will 0 Intervivos Deed of Trust 0 Other
LIFE ESTATE INTEREST CALCULATION
NAME(S) OF LIFE TENANT(S)
DATE OF BIRTH
NEAREST AGE AT
DATE OF DEATH
TERM OF YEARS
LIFE ESTATE IS PAYABLE
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
1. Value of fund from which life estate is payable . . . . . . .
... .$
2. Actuarial factor per appropriate table ..............................................
Interest table rate - 0 3 1/2% 06% 010% 0 Variable Rate __%
3. Value of life estate (Line 1 multiplied by Line 2) ......................................$
ANNUITY INTEREST CALCULATION
NAME(S) OF LIFE ANNUITANT(S)
DATE OF BIRTH
NEAREST AGE AT
DATE OF DEATH
TERM OF YEARS
ANNUITY IS PAYABLE
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . .
............... .$
2. Check appropriate block below and enter corresponding (number) ........... . . . . . . . . . . . . . . .
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( )
3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
4. Aggregate annual payment, Line 2 multiplied by Line 3 ...................................
5. Annuity Factor (see instructions)
Interest table rate - 0 3 1/2% 06% 010% 0 Variable Rate
%
6. Adjustment Factor (see instructions) . . .
7. Value of annuity - If using 31/2%, 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 and 15 through 18.
(If more space is needed, insert additional sheets of the same size)