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HomeMy WebLinkAbout11-13-06 II .-J 15056051058 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 RETU N RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 194-44-7557 08/14/2006 ~IOV Decedent's Last Name Suffix MI Bucher A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MI N/A Spouse's Social Security Number . .....- "".....--,.......... THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER F WILLS FILL IN APPROPRIATE OVALS BELOW ca; 1. Original Retum c::) 4. Limited Estate c:::::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c.> 2. Supplemental Return C-:"J t.-:::J 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 ':::::J 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 CONFIDEN tAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received Q 8. Total Number of Safe Deposit Boxes C:J Jacqueline M. Verney Finm Name (If Applicable) . (717) 243-9190 City or Post Office Carlisle ZIP Code ... . ..................................................ww .................f'>.............................. .. REGI~R OF WllLsijE ONLY Co c::T' ~ :z: Po~ (.':) =:l :r: (") ..c: ,-~):;:>-r -7fTl :=U3~ ::;'00 --,O-n .:)C ::0 0 --i .. ~~!~~I~~[) .c..>. . W w Second line of address :r:- :x ~ cr.:J '-~"-1 trj First line of address 44 S. Hanover Street ~") , ..1 -r":'\ o 1m State i~~~ Correspondent's e-mail address:JMVerney@AOL.com Under penalties of perjury. I declare that I have examined this retum, including accompanying schedules and s tements. 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 knowledge. SIGN :r RE OF P RSON RESPONS LE FOR FILING RETURN DAT. o ADDRESS Gretchen l. Miller 63 H. Street Carlisle, PA 17013 GNATURE OF P PARER OTHER THA REPRESENTATIVE DATE I J-r~ anover St. Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -.J L -.J 15056052059 REV-1500 EX Decedent's Name: RECAPITULATION Patricia A Bucher 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 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. '''w...'''......."..........'''''"''''''"....."...."'''''''''''''''''',....",,.........,,''''''....................''''''''''''''''............~~='''~"'..".,,,......~......,............,,.,,........,WM''''w.w..'M".'M,,'''M''''''''"''',,..........,,''''......w....'''.,.,''......WN'''''''''..........'....""""'...........,...,..","',,,._,,,,,,.....v.w........,,,,"',,,,,,,,,,,,,,..w,w... 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 24,450.58 18. Amount of Line 14 taxable at collateral rate X. 15 15. 16. 17. 18 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMEN L 15056052059 Side 2 Decedent's Social Security Number 194-44-7557 39,645.63 39,645.63 2,934.07 15056052059 ---I II Decedent's Complete Address: DECEDENTS NAME Patricia A Bucher STREET ADDRESS 119 Pine Road DECEDENTS SOCIAL SECURITY NUMBER 194-44-7557 REV.1500 EX Page 3 . CITY Mt. Holly Springs S JE PA ZIP 17065 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 2.9 4.07 146.70 Total Credits ( + B + C ) (2) 1 6.70 3. Interest/Penalty if applicable D. Interest E. Penalty Totallnterest/Pena ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 0.00 2,7 7.37 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 2,7 7.37 Make Check Payable to: REGISTER OF WIL SJ AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X I IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income ofthe property transferred;........................................................ ................................. 0 [iJ b. retain the right to designate who shall use the property transferred or its income; .......... ................................. 0 [i] c. retain a reversionary interest; or........................................................................................ ................................. 0 Iil d. receive the promise for life of either payments. benefits or care? .................................... ................................. 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year f death without receiving adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his 0 her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate prope which contains a beneficiary designation? ....................................................................................... ................................ 0 [iJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCH DULE G AND FILE IT AS PART OF THE RET N. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net v lue of transfers to or for the use of the surviving is three (3) percent [72 P.S. ~9116 (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 0 for the use of the surviving spouse is zero (0) rcent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, an the statutory requirements for disclosure of asse 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 y unger at death to or for the use of a natural par adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiari s is four and one-half (4.5) percent, except as n 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) ercent [72 P.S. 99116(a)(1.3)]. A sibling is defined, Section 9102, as an individual who has at least one parent in common with the decedent, whether by blo or adoption. ' __11_- 1[- REV-1508 EX+ (6-98) . . '* SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC I INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Bucher, Patricia A. 21-06-0908 Include the proceeds of litigation and the date the proceeds were recei ed by the estate, All property jolntly-owneel with right of survivorship must be disclol eel on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PNC checking acct# 5140181504 7,038.8 2 PNC money market acct # 5004930267 28,106.8 3 1995 Buick Park Avenue 4,500.0 - -, TOTAL (Also enter on Ii ne 5, Recapitulation) $ 39,645.6: (If more space is needed, insert additional sheets of the sam size) --- - ----- --- ---- - ------ - ,I NQV-07-2006 22: 02 PNCBf::lNK ~PNCBAN< November 8, 2006 Jacqueline M Verney Attorney at Law 44 South Hanover St. Carlisle, PA 17013 RE: Estate of Patricia A Bucher (Deceased) SSN: 194-44-7557 DOD; 08-14-2006 scp Dear Ms. Verney: In response to your request for Date of Death balances for the orner noted above, our reconIs show the fOllowing: CIaeddq ACCftllt Account #5140181504 Est. Jished 01-01-1969 PATRICIA A BUCHER DODbaIance; S7,037.17 + 51.03 acaued interest SaYlap Aceeut Account #5004930267 Esu lished 04-26-2006 PATRICIA A BUCHER DOD bal8nce: 128,061.32 + 545.51 accrued interest for deposit accOUllU ., tlBDCiaI any of these items, local PNC Bank branch Please note that this office only provides date of death balanc (IRAs, CDs, ChedOng and Savings acoounts). We de .. trusaetiou or provide .tatemelltl. If you need usistlnce please call1-888.PNC.BANK (1-888-162-2265) or stop by office. Sincerely, ~<:<.... ':2.~ Erica L Schlege1 1-800-762-1775 P7-PFSC-04-F 500 First Aft. PittlburJh PAl ~219 Member FDIC TOTAL p.e1 I ~EV.'511 ~X+ 112.991.. SCHEDULE H i COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATM COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Bucher, Patricia A. 21-06-0908 Debts of decedent must be reported on Schedule . ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Auer Memorial Home & Cremation Services, Inc. 4100 Jonestown Rd. Harrisburg PA 17109 1,280.( P B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.0 Name of Personal Representative(s) Gretchen L. Miller Social Security Number(s)/EIN Number of Personal Representative(s) - Street Address 63 H. Street City Carlisle State P A Zip 17013 Year(s) Commission Paid: Nt A 2. Attorney Fees 2,500.0 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 130.01 5. Accountant's Fees 6. Tax Return Preparer's Fees 100.0( 7. Cumberland Law Joumal-advertise letters of administration 75.0C 8 Sentinel-advertise letters of administration 144.2~ TOTAL (Also enter 01 line 9, Recapitulation) $ 4,229.29 (If more space is needed, insert additional sheets of the same ize) ~ AUER MEMORIAL HOME AND C MATION SERVICES, INC. 4100 Jonestown RQad. Harrisburg, PA 17109. 1-800-720-8221. ax 717-541-9943. Shawn E. Carper, Supervisor 260883 J -5 8-14-2006 Mr. Erwin Hess 119 Pine Road Mount Holly Springs, PA 17065 Patricia A. Bucher - Deceased SPECIAL CHARGES X Direct Cremation Forwarding Remains Receiving Remains Immediate Burial X Nationwide Guarantee Program Worldwide Travel Protection TOTAL SPECIAL CHARGES $895.00 $295.00 $1,190. 0 PROFESSIONAL SERVICES Services of Funeral Director & Staff Embalming Other Preparation of the Body Facilities & Staff for Viewing ($200/ho r) Facilities & Staff for Funeral Service Facilities & Staff for Memorial Service Staff & Equipment for Viewing ($200/hou ) Arrange/Deliver Remains To A National C meter Staff & Equipment for Memorial Service Private Family Viewing/Witnessing Crema ion Special 48 Hour/Weekend Cremation Servi e Packaging And Forwarding Cremated Remai s Personal Delivery of Cremated Remains Scattering of Cremated Remains Medical Documents/Courier Fee TOTAL PROFESSIONAL SERVICES $ 0. 0 AUTOMOTIVE EQUIPMENT Removal Vehicle Casket Coach Flower Car Lead Car/Clergy Car Service Vehicle Family Car TOTAL AUTOMOTIVE EQUIPMENT $0. 0 MERCHANDISE Register Book Memorial Folders Thank You Cards # Remembrance Package Casket X Syrocco Cultured Marble Urn Cremation Container Urn Burial Vault Veterans Flag Case Grave/Memorial Marker Other Other TOTAL MERCHANDISE CASH ADVANCED ITEMS Grave Opening Cemetery Equipment Vault Service Charge Newspapers Newspaper Clergy Church/Organist/Soloist Flowers X Crematory Charge X County Coroner Cremation Approval Fee X Certified Copies DNA Preservation TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES Special Charges Professional Services Automotive Equipment Merchandise Cash Advanced Items SUB TOTAL DISCOUNT TOTAL AMOUNT PAID 8-14-2006 BALANCE DUE $1.190.00 $0.00 $0.00 $245.00 $545.00 $1.980.00 -$700.00 $1.280.00 -$1.280.00 $0.00 $245.00 $245. 0 $400.00 $25.00 $120.00 $545. 0 THIS STATEMENT MAY NOT REFLECT ALL N WSPAPER CHARGES REMITTANCE AD RE S THB SENTINEL - LBGAL P.O. BOX 130, CARLISLE, PA AD NUMBER LAS 317405 10 AD DESCRIPTION ADMINISTRATRIX NOTICE PUBLICA TION 3 THE SENTINEL - LEGAL TOTAL AD CHARGE 17013 LINES 38 * 2 STOP DATE 11/08/06 GROSS AMOUNT PUBLIC NOTICES LETTERS OF A INSERTIONS RATE 3 LGL 3 PROOF OF PUBLICATION 01PRF 6.35 DAYS RUN PURCHASE ORDER Est. Pat. Bucher PAY THIS AMOUNT 144.29 173.15* * AFTER 1 2/08/06 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Mo day is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday's Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednes ay at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal b'll please call Tammy Shoemaker 243-2611, ext 203. Fax your legals to 243-3754, attention Tammy Sho aker You can also EMAIL yourlegaltoClassifiedads:classified@curnberlink.co Please send a cover letter including your name a address as an attachrne t PROOF OF PUBLICATI State of Pennsylvania, County of Cumberlan Tanuny Shoemaker, Classified Advertising Manager, of The S ntinel, of the County and State aforesaid, being duly sworn, deposes and says that E SENTINEL, a newspaper of general circulation in the Borough of Carlisle, C unty and State aforesaid, was established December 13th, 1881, since which da THE SENTINEL has been regularly issued in said County, and that the printed noti e or publication attached hereto is exactly the same as was printed and publish d in the regular editions and issues of THE SENTINEL on the following day(s) October 25, November 01, 08, 2006 COpy OF NOTICE OF PUBLICATION ADMINISTRATRIX ~ Letters of Administration on the Estate of PATRICIA A. I BUCHER, late of the TQWflahlp ot South Middleton, Cumberland County, P.nnsylvanla, deceas.d, have . been g,.n~ to the und....lgned. : All persons knowing thenlaelveSto b.lnd.bted'to said . Estate win make payment Immediately, and those hav- Ing claims will present them for eettIament. Gretchen L. Miller, Administratrix c/o Jacqueline M. Vemey, Esquire 44 South Hanover Street . Carlisle, PA 17013 Affiant further dep ses that he/she is not interested in the su ject matter of the aforesaid notice or dvertisement, and that all allegations in th foregoing statement as to time, place an character of publication are tru . , Jacque""e M. Vemey. Attomey i 44 South Hanover Street < "', Carlisle. PA 17013 Sworn to and subsc 'bed before me this 08th. day of Novem er 2006. My commission exp' es: q \ \ \0<6' COMMONWEAL H OF PENNSYLVANIA nal Seal Chnstina L. oIfe. Notary Public Carlisle eumbef1ancl County My .' Expires Sepl1, 2008 Member. Pennsylv nia Association Of Notaries f:!fr( ~EV.1512 ~'I12~3} .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leNIDULI I DEBTS Of DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Bucher, Patricia A. FILE NUMBER 21-06-0908 , Report debts incurred by the decedent prior to death which remained unpaid as of the date of de~th. including unreimbursed medical expenses. ITEM VALUE AT DATE , NUMBER DESCRIPTION OF DEATH 3 Quest Diagnostics 875.11 7,018.0il\: 26.01 1. Bon Ton credit card 2 Discover credit card #6011 3007 0059 3773 7 Carlisle Regional Medical Center 228.2~' 1,528.9~ 167.5E 1,121.8C 4 Lancaster HMA Phys Mgmt #475692 Bank of America Visa credit card #4427100014478908 5 6 Belvedere Medical Center , " TOTAL (Also enter on line 0, Recapitulation) $ (If more space is needed, insert additional sheets of the same siz ) 10,965.76 \ ..."'" Quest ffijj} Diagnostic~ 170130140004319 4083600895 1 12778 PATRICIA BUCHER 119 PINE RD MOUNT HOLLY SPRINGS. PA 17065-1810 1.1.111...111....11...1.11.1.1111.1..1.1111......11111.1.1.111 LABORATORY SERVICE CBC & PLATELET COUNT VENIPUNCTURE BASIC METABOLIC PANEL DISALLOWANCE CPT CODE / DATE RECEIVED 85027 36415 80048 08/24/06 AMOUNT $29.41 $15.90 $34.29 $53.54 - PATIENT AMOUNT DUE $26.06 ICD-9 Codes: 401.9571.5 Tax ID # 38-2084239 Sevices Performed by: QUEST DIAGNOSTICS HORSHAM HORSHAM, PA Sevices Performed by: QUEST DIAGNOSTICS BElVEDERE MEDICAl. CENT CARLISLE, PA P ge 1 Laboratory Inv For services not included in your physician' Invoice Number 408360 Lab Code 1m ortarit Notice THE BA NCE DUE REPRESENTS YOUR COPAY OR DEDUC IBLE AS INDICATED BY CAPITAL BC OF PA. THE CH RGES RESULTED FROM LABORATORY TESTIN ORDERED BY YOUR DOCTOR AND PERFO MED BY QUEST DIAGNOSTICS. THESE CHARG S WERE NOT INCLUDED IN YOUR DOCTO 'S BILL AND REPRESENT YOUR FINANCIAL RESPO SIBILlTY. WE APPRECIATE YOUR PROMPT PAYME T. THANK YOU FOR USING QUEST DIAGN STICS. PATRICIA SUCH R August4,200 $26.0 10/26/200 PATRICIA BUCHE JURGENSEN,JOHN October 5. 200 If you have dicare, Railroad Medicare or Medicaid as your primory or secondary insu once, please send us the information. see reverse side billing inquiries or to pay by phone: ave your invoice available for reference. Weekdays 8AM - 6PM 1-800-766-2604 Fax: 1-800-601-6608 Or visit our website at www.auestdiaanostics.com Se Ha la Espanol 9AM-6PM Tiempo del Este The CPT co es provided are based on AMA guidelines and withoul reg rd to specific p yor requirements. ... Please fold and tear payment coupon along perforation and remit with paym nt in the envelope provided ... -4ft. Quest ~ Di;wl1ostics """ n It. Payment Coupon Please make check payable to: Quest Diagnostics Please include invoice number on your check. Quest Diagnostics also accepts MasterCard, Visa & American Express. Please complete credit card information on reverse or visit our website at www.questdiagnostics.com MAIL PA YMENTS ONLY TO: o Check here if address has changed. Indicate change on back. Quest Diagnostics re5elVe5 Ihe righlto assign Ihis receivable 10 any or its affiliates. Amount Due Payment Du Date $26.06 1 0/26/2006 er 4083600895 Lab Code KOP PATRICIA BUCHER sed 608 QUEST 01 GNOSTICS INCORPORA TEO PO BOX 41 52 PHILAOEL HIA PA 19101-1652 1.11111111..1.111..1.1.11.1111.111 1.1.11 1.1.1.1111..1.11...11 01KOP48014083b0089S00002bOb410052170191013589000000S r~RUSLE · ~EN;~I~~ PO Box 4100 Carlisle, P A. 17013-4100 2541-96 STATEMENT 004345043 PATRICIA A BUCHER 119 PINE RD MT HOLLY SPRG PA 17065 PATIENT: PATIENT #: BALANCE: ADM. DATE: DEAR PATRICIA A BUCHER October 24, 2006 PATRICIA A BUCHER 9346309 $1,121.80 08/08/06 Thank you for choosing Carlisle Regional Medical Center fo your healthcare needs. We value your use of our facilities. If is unfortunate that we have to inform you that your account is now past due! please keep the healthcare costs down by paying your balanc promptly within the next 10 days. To ensure proper crediti account, please return your payment in the envelope enclose the lower portion of this letter. For your convenience, we MasterCard, Discover and American Express. If you have any questions regarding your bill, please call phone number listed below. in full, g of your along with accept Visa, s at the If you have made this payment within 5 days of the above da e, please disregard this request. ...and thank you. PLEASE RETU~T LOWER PORTION WITH YOUR PAYME T CARLISLE REGIONAL MEDICAL CENTER PATIENT REPRESENTATIVE (717) 243-6550 8:30 A.M. TO 5:00 P.M. PIA 47 PATIENT: PATIENT #: BALANCE: ADM. DATE: PATRICIA A BUCHER 9346309 $1,121. 80 08/08/06 ** CREDIT AUTHORIZATION ** ) DISC ( ) AM)( ( ) VIN# CARLISLE REGIO AL MEDICAL CENTER 246 PARKER STR ET CARLISLE PA 7013 VISA( )MC( EXP DATE ( CARD # ( PMT AMT ( SIGN ( 47 ) ) ) ) ) *CALLS/INQUIRIES MAY BE MONITORED FOR QUALITY CONTR L* 96 ~V.1S13~'(""1 .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Bucher, Patricia A. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Gretchen L. Miller 63 H. Street Carlisle, PA 17013 2 Nick Vrataric 119 Pine Road Mt. Holly Springs, PA 17065 3 Heidi Blauser 257 Old Cabin Hollow Road DiIIsburg, PA 17019 4 Joseph Vrataric 2121 B. Keli Koli Lihue, HI 96766 FILE NUMBER 21-06-0908 RELAT ONSHIP TO DECEDENT AMOUNT OR SHARE Dc Not List Trustee(s) OF ESTATE half s' ster 250": half bother 25~ half si~ter 25% half blpther 25% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, A:) APPROPRIATE, ON REV-1500 COVER SHEET II NON.TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NO BEING MADE B. CHARITABLE AND GOVERNMENTAl DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1:>OO COVER SHEET $ (If more space is needed, insert additional sheets of the same si e)