REV-1648 EX (02-09)
                                                              SCHEDULE N
         Bureau of Individual Taxes                     SPOUSAL POVERTY CREDIT
         PO Box 280601                                        FOR DATES OF DEATH 01/01/92 TO 12/31/94
         Harrisburg PA 17128
START ESTATE OF                                                                                                                                                    FILE NUMBER
Ü
                            This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
      PART I - CALCULATION OF GROSS ESTATE

      1 . Taxable assets total from Line 8 (cover sheet)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             1 .
      2. Insurance proceeds on life of decedent   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            2.
      3. Retirement benefits   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   3.
      4. Joint assets with spouse   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    4.
      5. PA Lottery winnings   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   5.
      6a. Other nontaxable assets: List and attach schedule if necessary  . .   6a.
                                                                   6b.
                                                                   6c.
                                                                   6d.
      6. SUBTOTAL (Lines 6a, b, c, d)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         6.              0.00
      7. Total gross assets (Add Lines 1 thru 6)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            7.              0.00
      8. Total actual liabilities  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
      9. Net value of estate (Subtract Line 8 from Line 7)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                9.
         If Line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II.
      PART II - CALCULATION OF JOINT EXEMPTION INCOME - Attach copies of federal income tax return 
                for decedent and spouse.

      Income:                       1.           TAX YEAR: 19      2.              TAX YEAR: 19                                                                    3.  TAX YEAR: 19

      a. Spouse  . . . . . . . . . . . . . 1a.                     2a.                                                                                             3a.
      b. Decedent   . . . . . . . . . . . 1b.                      2b.                                                                                             3b.
      c. Joint   . . . . . . . . . . . . . . 1c.                   2c.                                                                                             3ci
      d. Tax-exempt income   . . . . 1d.                           2d.                                                                                             3d.
      e  Other income not
         listed above   . . . . . . . . . 1e.                      2e.                                                                                             3e.
      f. Total   . . . . . . . . . . . . . . 1f.              0.00 2f.                                    0.00                                                     3f.             0.00
      4. Average joint exemption income calculation
      4a. Add joint exemption income from above:
         (1f)                       0.00         + (2f)       0.00                     + (3f)             0.00                                                     =               0.00

                                                                                                                                                                       (÷ 3)
      4b. Average joint exemption income   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         =
         If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III.
      PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES

      1. Insert amount of taxable transfers to spouse or $100,000, whichever is less   . . . . . . . . . . . . . . . . . . . . . . . .                             1.

      2. Multiply by credit percentage (see instructions)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              2.
      3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
         in the calculation of total credits on Line 18 of the cover sheet .   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   3.
      4. For nonresidents, enter the ratio of the decedent’s gross estate in PA to the value of the
         decedent’s gross estate  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        4.
      5. Multiply Line 3 by Line 4 and enter the total here. This is the amount of the Nonresident Spousal
         Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet. . . . . . . . . . .                                5.
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