HomeMy WebLinkAbout09-03-0815056041125
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Indmidual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO sox 280601 2 1 0 6 0 2 4 7
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 3 3 8 6 4 2 1 0 2 2 0 2 0 0 6 1 2 0 7 1 9 4 9
Decedent's last Name Suffix Decedent's First Name MI
S H A F F E R D A V I D 'I'
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
M O R R O W J I L L
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return
4. Limited Estate
OX 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust „_.
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
S T R E E T
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
D A V I D W R E A G E R 7 1 7 7 6 3 ,~1, 3 8 3
v
Firm Name (If Applicable) ____ __~_____ ~ ~_
REGIS .WILLS U~EjONLY T : ~ _:'
R E A G E R & A D L E R P C ~ ~ ~ -,'-;i
First fine of address ~ ~rl 1 ~-~ ~ ~
2 3 3 1 M A R K E T
Second line of address
City or Post Office
C A M P H I L L
State ZIP Code
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
~ W _
(~~ ~j
~ - ~ .-. .
,
DATE FILED ~`
P A 1 7 0 1 1
Correspondent's a-mail address: DWREAGER@REAGERADLERPC.COM
Under penalties of perjury, 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 completfllDeclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RfxSPAtiJISfBLE 6/U1~F,fLING RETURN _ .,, mnr~
ADDRESS
310 INDIAN ~ EEK D IVE MECHANICSBURG PA 17050
SIGNATURE OF PREPAR OTHER AN NTATIVE DATE
2331 MARKET STREET CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125
15056041125
J
15056042126
REV-1500 EX
Decedent's Social Security Number
DAVID T. SHAFFER
Decedent's Name:
1 7 3 3 8 6 4 2 1
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1.
2. Stocks and Bonds (Schedule B) .................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 1 0 0 0 0 0 • 0 0
4. Mortgages & Notes Receivable (Schedule D) ........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 0 0 0 0 0 0 0
9. Funeral Ex enses & Administrative Costs Schedule H 9. 2 7 4 2 . 2 5
P ( ) ................
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10.
11. Total Deductions (total Lines 9 & 10) ........................... 11. 2 7 4 2 . 2 5
12. Net Value of Estate (Line 8 minus Line 11) .................. ....... 12. 9 7 2 5 7 • 7 5
13. Charitable and Governmental Bequests/Sec 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. 9 7 2 5 7 • 7 5
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.o _ 9 7 2 5 7 7 5 15. 0, 0 0
16. Amount of Line 14 taxable
at lineal rate X .0 _ 0. 0 0 16 0. 0 0
17. Amount of Line 14 taxable
0
0
0
0
0
0
.
at sibling rate X .12 17. .
18. Amount of Line 14 taxable
0
0
0
.
at collateral rate X .15 18 0. 0 0
19. Tax Due ................................................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
0. 0 0
15056042126 15056042126
REV-1500 EX Page 3
;decedent's Complete Address:
File Number
21 06 0247
( DECEDENTS NAME
"DAVID T. SHAFFER ___
STREET ADDRESS ---- -
320 INDIAN CREEK DRIVE
-- - ---- -
CITY ~ STATE ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1• Tax Due (Page 2 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + g + C) (2) 0.00
3. InteresUPena{ty if applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E) (3) 0.00
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) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (58) 0.00
Make Check Payable fo: 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 : ...................................................................... ^ X^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ 0
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^X
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q
4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 1T AS PART OF THE RETURN.
i=or 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. §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 or for the use of the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 rale 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 chid is zero (0) percent [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 four and one-half (4.5) percent, except as noted in
2 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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1504 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF
FILE NUMBER
:DAVID T. SNAPPER 21 06 0247
Schedule C-1 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Farrar- Morrow Ltd. 100,000.00
3750 Market Street
Camp Hill, PA 17011
TOTAL (Also enter on line 3, Recapitulation) ~ $ 100.000.00
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF FILE NUMBER
DAVID T. SHAFFER 21 06 0247
2.
3.
4.
5.
Name of Partnership Farrar-Morrow, Ltd. Date Business Commenced 9/1/2002
Address 375 Market Street Business Reporting Year
City Camp Hill State PA Zip Code 17011
Federal Employer I.D. Number 03-0473750
Type of Business Jewerly Sales, Repairs Product/Service Jewerly Sales, Repairs
Decedent was a ^ General ® Limited partner. If decedent was a limited partner, provide initial investment $ 131,430.00
PARTNER NAME PERCENT
OF INGOME PERCENT
OF OWNERSHfP BALANCE OF
CAPITAL ACCOUNT
A• Ro s array 33.33 33 3 - 2 973. 0
B. Jill Morrow 3 .33 33.3 63 88. 0
~• David T. h ffer 3 .33 33.33 37 01.00
D.
6. Value of the decedent's interest $ 100.000.00
7. Was the Partnership indebted to the decedent? ...................... . ......... ^Yes ®No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ........ ^Yes ®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?
^ Yes ®No If yes, ^ Transfer ^ Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
i 0. Was there a written partnership agreement in effect at the time of the decedent's death?........ IXI Yes LJ No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? .................................. ^Yes ®No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? ................. ^Yes ®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? ................................ ®Yes ^ No
If yes, explain Jill Morrow -Wife
14. Did the partnership have an interest in other corporations or partnerships? ................. ^Yes ®No
If 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 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 addressles and estimated fair market value/s. 1f real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DAVID T. SNAPPER 21 06 0247
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2, Attorney Fees Reager & Adler, PC 2,300.00
3, Family Exemptlon: (If decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 240.00
5 Accountants Fees
6. Tax Return Preparers Fees
7. Advertisement -The Sentinel 115.25
8. Advertisement -Cumberland Law Journal 75.00
9. Short Certificates 12.00
TOTAL (Also enter on line 9, Recapitulation) I S 2 742 2
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DAVID T. SHAFFER ~~ n~ n~a~
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)j
1. Jill Morrow Spousal 97,257.75
320 Indian Creek Drive
Mechanicsburg, PA 17050
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
_, II. NON-TAXABLE DISTRIBUTIONS:
1. 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 5
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
DAVID T. SHAFFER
I, David T. Shaffer, of Lower Paxton Township, Dauphin
County, Pennsylvania, make this my Last Will and Testament,
thereby revoking alI Wills and Codicils previously made by me.
FIRST: All of my property, bath real and personal, of
whatever kind and wherever situated, I devise and bequeath to my
wife, Jill Morrow if she survives me by sixty days.
SECOND: If my wife should fail to survive me for sixty
days I devise and bequeath all of the said property to her son,
Brian David Morrow.
THIRD: I appoint my wife, Jill Morrow as Executrix of my
estate.
IN WITNESS k~iEREOF, I have hereunto placed my hand and seal
to this my Last Will and Testament this 2nd day of May, 1988.
--.._
.,,. ~,
~-. ~`~~,
David T. Sha e
SIGNED, SEALED, PUBLISHED and
DECLARED by the testator as and
for his Last Will and Testament,
ir. the presence of us
t` .~c.s.~*-~~
~/ ~-~--
W - WILLS