HomeMy WebLinkAbout10-09-08s
15056041147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX.280601
Harrisburg, PA 1712&0601 RESIDENT DECEDENT 2 1 0 8 0 4 7 8
ENTER DECEDENT INFORMATION BELOW
04 23 2008 05 03 1915
Decedent's Last Name Suffix Decedent's First Name MI
SCHRACK RAE W
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
g. Decedent Died Testate
(Attach Copy of Will)
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13.82)
4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(date of death after 12-12-92)
~. Decedent Maintained a living Trust Q S. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
9. Litigation Proceeds Received ~ 1 D. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and i-1-95) (Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
WM. D. SCHRACK III 717 432 9733
Firm Name (If Applicable)
SCHRACK & LINSENBACH LAW
First line of address
124 W. HARRISBURG STREET
Second line of address
P.O. BOX 310
City or Post Office
DILLSBURG
State ZIP Code
PA 17019-0310
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correspondent'se-mail address: Schracklaw@comcast.net
Under penalties of perju 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 c~plete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
Wm. D. Schrack III /~ ~ °y,~ ~"~
ADDRESS
124 W.
SIGNATURE
P.O. Box 310, Dillsburg, PA 17019-0310
N REPRESENTATIVE
Wm. D. Schrack III
DATE
ADDRESS `'~ C - "'
124 West Harrisburg Street, Dillsburg, PA 17019-0310
Side 1
L 15056041147
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REGISTER!OFc®ILLS USE°~NLY_:.
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15056041147
J
PA Inheritance Tax Return
Signature of Additional Fiduciaries
I SchrackORae W. I 1i-08-04 86ER I
I Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my I
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.
Signature #2
Name
Address1
Address2
City, State, Zip
Susan S. Rout
1129 NW 23rd Terrace
Gainesville, FL 32605
Date
REV-1500 EX
oecedenPs Name: Rae W. S C h r a C k
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.
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) .............................~.................................. g.
36,710.64
109,481.61
146,192.25
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/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.
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 .00 0 . 0 0 15.
16. Amount of Line 14 taxable
at lineal rate x .045 12 7, 3 4 3. 2 8 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due ............................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
15056042148
13,808.29
5,040.68
18,848.97
127,343.28
127,343.28
0.00
5,730.45
0.00
0.00
5,730.45
Side 2
15056042148 15056042148 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-0478
DECEDENT'S NAME
Rae W. Schrack
STREET ADDRESS
100 Mt. Allen Drive
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
p. Interest
E. Penalty
5,500.00
286.52
Total Credits (A + B + C]~
Total Interest/Penalty (D + E;1
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(1) 5,730.45
(2) 5,786.52
(3)
(4) 56.07
(5)
(5A)
(56)
Make Check Payable to: REGISTER OF WILLS, AGENT
~' ~'t'~g '~~ ~. 9~"^k :. "tiK':~<; .. .. , S ~;,xm Saar'.<. t ~ ~.~,:aii. r.~{,y x~. ~Se h ''.:i 'S~.. i'.~;d,~ ~ ~
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 :................................ ^ ^x
c. retain a reversionary interest; or .............................._........................................................................... ^
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? ................................................................................................................. ^ ^x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................................................................................................................ ^ ^x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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
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 statutedoes 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 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 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 twelve (12) percent [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.
Judge\Bill\CLIENTS\Schrack, Rae\Will - June 2005
'~wst ~il! ttua ~estautresif
OF
RAE W. SCHRACK
BE IT REMEMBERED, that I, RAE W. SCHRACK, presently of 539 Dogwood Drive,
(Messiah Village), Upper Allen Township, Mechanicsburg, Cumberland County,
Pennsylvania, being of sound mind, memory, and understanding, do make, publish, and
declare this as and for my Last Will and Testament, hereby revoking and making null and
void any and all Wills and Testaments and writings in the nature thereof by me at any
time heretofore made.
ITEM Z: I direct that my hereinafter named Executors pay all my just debts,
my funeral expenses, and the expenses of the administration of my estate. With this
direction, I authorize and empower my Executors to expend for my funeral expenses and
interment such amounts as maybe considered necessary and proper, without regard to
any limit that may be prescribed by a court of law.
ITEM Z: i direct my Executors to pay all inheritance, estate, succession, and
legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any
property passing hereunder or otherwise passing by reason of my demise, may be subject
and to charge such taxes against my residuary estate, it being my :intention that none of
the aforesaid taxes, either federal or state, on any property required to be included in my
gross estate, under the provisions of any state or federal law now in force or hereafter
enacted, shall be prorated among the persons interested in my estate to whom such
property is or maybe transferred or to whom any benefit accrues.
ITEM 3: I give and bequeath the sum of Ten Thousand Dollars ($10,000.00)
to each of my grandchildren, namely: ALLEN S. ROUT, CHRISTOPHER S. BARBER,
SUSAN S. WOOD, JENNIFER A. SCHRACK, and HENRY E. BEAVER III, absolutely.
ITEM 4: All the rest, residue and remainder of my estate, of whatsoever
nature, and wheresoever situate, whether it be real, personal or mixed, including
property over which I have a power of appointment, I give, devise and bequeath unto my
children, namely WM. D. SCHRACK III, SUSAN S. ROUT, MARTHA S.
MacPHERSON, and ANN S. BEAVER, in equal shares, per stirpes, subject only to
adjustments for advancements as detailed in my personal records that have been
entrusted to my executors. In making adjustments for advancements, my Executors shall:
A. Calculate an amount (the "augmented residue") equal to the sum of (i) the
residue of my estate and (ii) the total of all cash advancements made by me
as reflected by my personal financial records.
B. Divide the augmented residue into the number of shares necessary to create
one (1) share for each child of mine who survives rne, and each child of
mine who fails to survive me but is represented by descendants who
survive me.
C. Reduce each share created under Section B above by the amount of any
advancements made to a child representing such share and/or such child's
descendants, as reflected in my personal records that have been entrusted
to my executors.
D. Pay each share so calculated to the child for whom i:he share is created, or
if such child fails to survive me, to such of the descendants of such child
as survive me.
ITEM 5: I appoint my son, WM. D. SCHRACK III, and. my daughter, SUSAN
S. ROUT, as Executors of this my Last Will and Testament.
ITEM 6: I direct that my hereinbefore named Executor shall not be required
to give bond for the faithful performance of duties in this or any jurisdiction.
ESS WHEREOF, I have hereunto set my hand and seal this ~~ay
of , 2005.
/1 r ~(~ ~
RAE W.SCHRACK
The preceding instrument, consisting of this and two (2) other typewritten pages,
was on the day and date thereof signed, sealed, published, and declared by the Testatrix
herein named, as and for her Last Will and Testament, in the presence of us, who, at her
request, in her presence and in the presence of each other, have subscribed our names
as witnesses he eto.
OF
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/'~~ y---`~` OF
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COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF YORK
e, RAE W~ SCHR~~C,, ~~~/ (•
~~~C:~ and
/ ,the Testatrix and the witnesses,
respect ely, whose es are signed to the attached or foregoing instrument, being first
duly sworn, do hereby declare to the undersigned authority that the 'Testatrix signed and
executed the instrument as her Last Will and Testament, and that she signed willingly,
and that she executed it as her free and voluntary act for the purposE:s therein expressed,
and that each of the witnesses, in the presence and hearing of the Testatrix signed the
Will as witnesses, and that to the best of their knowledge, the Testatrix was at the time
eighteen (18) years of age or older, of sound mind, and under no constraint or undue
influence.
~~~ ~ ~~
RAE W.SCHRACK
SWORN TO AND SUBSCRIBED
THIS /S~ DAY
Seal
~iarfec S. bore. Notary PuCb
E1>Asburg 6om, York Coungt
OotrYNselon Expires Od. 25.2006
INerrrber. ~ytv~nia assoaa6on Of nlolarles
,~ .
- ~ Rev-1508 F~(+ (6.98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWFILLTH OF PENNSYLVANIA
INHERITANCE TAX RETURN '
RESIDENT DECEDENT ~ ~ '
ESTATE OF FILE NUMBER
Schrack, Rae W. 21-08-0478
Include the proceeds of litigation and the date the proceeds were received 6y the estate.
All property tointlywwned with the right of survlvorahtp must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER ~ DESCRIPTION OF DEATH
1 Capital Blue Cross - refund'of unearned premium for Medicare supplement 287.25
2 Citizens Bank Account No. 6100769992 35,696.60
3 U. S. Treasury -federal income tax refund 418.00
4 United States Treasury - "Stimulus" disbursement 300.00
5 Verizon -refund 8.79
TOTAL (Also enter on Line 5, Recapitulation) I 36,710.64
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98}
Citizens Bank
Account Number 6100769992
Account Title RAE SCHRACK
Date O ened 2/2/1979
Account T e Checkin
Princi al Balance as of DOD $35696.60
Interest from Last Postin to DOD $ .00
Account Balance as of DOD $35696.60
YTD Interest to DOD $139.37
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Chcck No.
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05 16 08 13 AUSTIN, TEXAS 2308 65251594
2308 65251594 20090900 I30 0"SCH'R~ .KAN'S CYSTIMULUS
Pay to ~m~~~n~~~~nn~~~~~r~n~~nnr~~~rn~~~~~~nn~~~~ti~~~n~~
the order or POEBOXS310ACK 94f07
DILLSBURG PA 17019-0.310 $****3'00*00
VOID AFTER'ONE YEAR
~.~. flrogNAL CmBU14111o 01AClli
11- + -1 j -_ 007J LL _ - ,~ - _ ~.
_ ~ ~~! 171 '~ -
2008 ECONOMIC STIMULUS PAYMENT ~T,.~,. 7rLtlra'-t+$htf;;`i+~i i
nTl++.~. r T ~~~ ~ -
~:DODD00 5 LBO: 6 5 2 5 L 594 Lii' 040 50'8
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CHECK NUMBER: s2-a
300'7049 311
Capital ~i~ss
® Capital Advantage Insurance Company'senres as claims paying agent O5I15/O8
ott~l)ehdlt o+iltselt, Capital BlueCross, and Keystone,Health Plar~ Central
,,
+ridepegdcensees of the Blue Cross and E'er Stiiaki Pi@sOGiatwn
PAY TO THE ORDER OF: VOID AFTER 180 DAYS
RAE W SCIfiRACK
C/0 THE ESTATE OF RAE W. SCHRACK16_ol
ATTN= WM. D. SCHRACK III
124 W. HARRISBURG ST., PO BOX 310
DILLSBURG, PA 17019-0310
Mellon Bank, N A , Philadelphia, PA
PayableThrougk#1ITor~E~riEk(DE) N.A. Wilm~]~~COxt, F}E
u' 300 L ?009u' ~:0 3 i X0004 ?~:
CHECK
AMOUNT: *'**"`*;`$287.25
~~~~~~~~
2„96? 636ii'
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Rev-1509 Ex* (8.98) SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Schrack, Rae W. 21-08-0478
If an asset was made )oIM wtthin one year of the dacedanNs date of death, It must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Wm. D. Schrack III P.O. Box 310 Son
• Dillsburg, PA 17019
g, Susan S. Rout 1129 NW 23rd Terrace Daughter
~~` Gainesville, FL 32605
C. Ann S. Beaver X401 Mahantongo Street Daughter
P~!tsville, PA 17901
JOINTLY OWNED PROPERTY:
DESCRIPTI ~~ OF PROPERTY
ITEM LETTER
FOR JOINT DATE
MADE INCLUDE NAME OF FINANCIAL INSTn .-ION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUti, .;R
ATTACH DEED FO DATE OF DEATH % OF
DECD'S DATE OF DEATH
NUMBER
TENANT
JOINT .
R
JOINTLY-HELD REALESitE VALUE OF ASSET
INTEREST DECEDENT'S INTEREST
1 A 1120/2006 Citizens Bank Account No. 6:,406954 46,563.22 50.000°!0 23,281.61
2 A, B, C, 10/25/2002 Morgan Stanley Active Asset Accou.t 431,000.00 20.000°!e 86,200.00
p No. 410 054032 003
TOTAL (Also enter on Line 6, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
109,481.61
Form PA-1500 Schedule F (Rev. 6-98)
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
(CANrI1~IJED)
ESTATE OF FILE NUMBER
Schrack, Rae W. 21-08-0478
if an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
D. ' Martha S. MacPherson 1045 Yocumtown Road Daughter
Etters, PA 17319
.IOINTLY-OWNED PROPERTY:
ITEM
NUMBER U=TiER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY~IELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET x of
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
TOTAL (Also enter on line 6, Recapitulation) I S
(if more space is needed, insert additional sheets of the same size)
~~ Citizens Bank°
Account Number 6247406954
Account Title RAE SCHRACK OR WILLIAM SCHRACK III
Date O ened 1/20/2006
Account T e Time De osits
Princi al Balance as of DOD $46539.06
Interest from Last Postin to DOD $24.16
Account Balance as of DOD $46563.22
YTD Interest to DOD $951.10
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REV-7151 EX+(12.99) SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Schrack, Rae W. 21-08-0478
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached ~ 6,855.29
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2, Attorney's Fees Wm. D. Schrack III 5,000.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Ciry State Zip
Relationship of Claimant to Decedent
4. Probate Fees 306.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,647.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 13,808.29
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6.98)
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Schrack, Rae W. 21-08-0478
ITEM
NUMBER
DESCRIPTION
AMOUNT
1 Churchill G. Pinder -funeral service 750.00
2 Cocklin Funeral Home 2,698.95
3 Costs associated with funeral luncheon for the extended family 2,431.34
4 Joan Esham -church sexton 75.00
5 Michael Shoemaker -organist 150.00
6 Shawn I. Crumling -opening/closing grave 150.00
7 St. Stephen's Episcopal Cathedral -facilities fee 500.00
8 St. Stephen's Flower Guild 100.00
Subtotal
6,855.29
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98)
' Rav-1502 F,(+ (8.88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Schrack, Rae W. 21-08-0478
ITEM
NUMBER DESCRIPTION AMOUNT
1 Clerk of Court -Release filing fee 25.00
2 Executrix' airfare through Southwest Airlines returning home to Gainesville, Florida 109.50
from Harrisburg, Pennsylvania
3 Executrix' airfare through US Air from Gainesville, Florida to Harrisburg, 442.50
Pennsylvania
4 Marlin A. Yohn Sr., Treasurer -debt of decedent (personal tax) 5.00
5 Miscellaneous expenses during period of administration (postage, copies, etc.) 50.00
6 Register of Wills -filing fee 15.00
7 Reserve for future administrative expenses 1,000.00
Subtotal ~ 1,647.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98)
' Rev-1512 EX+ (8.98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Schrack, Rae W. 21-08-0478
Include unreimbursad medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Alert Pharmacy -debt of decedent 77.91
2 AT&T -final bill 15.66
3 Balance owed by decedent for income tax returns for 2006 1,252.47
4 Messiah Village -final bill 3,473.92
5 Pinnacle Health Medical Services (last illness) 205.00
6 Verizon -debt of decedent 15.72
TOTAL (Also enter on Line 10, Recapitulation) I 5,040.68
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
REV-1573 EX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Schrack, Rae W. 21-08-04 78
NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY
Do Not Llst Trustee s (Words) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions and transfers
under Sec. ~116(a)(1.2))
1 Christopher S. Barber Grandchild 10,000.00
110 Water Street
Hackettstown, NJ 07840
2 Ann S. Beaver Daughter 1/4 of residuary 19,335.82
1401 Mahantongo Street estate
Pottsville, PA 17901
3 Henry E. Beaver III Grandchild 10,000.00
41 N. 10th Street
Lemoyne, PA 17043
4 Martha S. MacPherson Daughter 114 of residuary 19,335.82
1045 Yocumtown Road estate
Etters, PA 17319
5 Allen S. Rout Grandchild 10,000.00
1428 NW 7th Road
Gainesville, FL 32603
See continuation schedule attached Continuation 58,671.64
Total 127,343.28
Enter dollar amounts for distributions shown above on lines 5 through 18, as approp riate, on Rev 1500 cove r sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI U.UU
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98)
r
SCHEDULE J
BENEFICIARIES
(Part 1, Taxable Distributions)
ESTATE OF:
Rae W. Schrack 04123/2008 173-38-5800
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Susan S. Rout Daughter
1129 NW 23rd Terrace
Gainesville, FL 32605
7 Wm. D. Schrack III Son
124 W. Harrisburg St., PO Box 310
Dillsburg, PA 17019
8 Jennifer A. (Schrack) Knuth Grandchild
4113 Westview Road
Baltimore, MD 21218
9 Susan S. Wood Grandchild
113 Chelsea Way
York, PA 17406
114 of residuary 79,335.b
estate
114 of residuary 19,335.82
estate
10,000.00
10,000.00
Total 58.671.64
1