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Home My WebLink About02-05-09 r; ~ ~ ~ , ~ ~ ~, ~: ` I 15 X 5 6 0 4114 7 ~'--' ~ ~ ~;~ ~:i I ~ R~~~~ ~~~ EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2sosol .. RESIDENT DECEDENT 2 1 0 7 0 3 0 1 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 194 34 0073 03 18 2007 05 04 1944 Decedent's Last Name Suffix Decedent's First Narne MI SCHEAFFER LOUISE R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X 1. Original Return '~ 2. Supplemental Return -' 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~' qa: Future Interest Compromise ~ 5. Federal Estate Tax Return Required __ ~- (date of death after 12-12-82) 6 Decedent Died Testate ~, ~, Decedent Maintained a Living Trust O 8. Total Number of Safe Deposit Boxes - (Attach Copy of Will) - (Attach Copy of Trust) 9. Liti ation Proceeds Received ~ 10. spousal Poverty Credit (date of death -, 11. Election to tax under Sec. 9113(A) 9 between 1231-91 and 1-1-95) (Attach $Ch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GARY L. JAMES ESQ. 717 533 3280 Firm Name (If Applicable) JAMES, SMITH, DIETTERICK & First line of address 134 SIPE AVENUE Second line of address City or Post Office HUMMELSTOWN Correspondent's a-mail address: 9 I1 @J S d C. C O m State ZIP Code PA 17036 REGISTE~F WILLS U~ ONLY w t ~,~~~ ~ ~ ~ = ?,- ~ I C ' <7 r,-7 C~'7 -= t C: ~ ~~ ~~Ti: FILED-. -' C' l 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 corn ete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SI ATURE OF PERSON -SPONSIBLE FOR FILING RETURN DATE Jessica R. Scheaffer 6 Drexel Hills Blvd, New Cumberland, PA 17070 SIGNAbl1RE OF PREPARER OT R THAN REPRESENTATIVE -- DATE _ 1~' Gary L. James Esq. ~~ - ~~~ ~ ~'0~ ~' 134 Sipe AIGerJlu~, Hur}hmelstown, PA 17036 ,_~ Side 1 15056041147 15056041147 ~fj 1556042148 REV-1500 EX Decedent's Social Security Number oe~ede~~sName Louise R. Scheaffer 194 34 0073 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 8 Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6 2 5 0 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ............. 6. 9 0 4 1 7 ( ) Probate Property ISchedlu esGransfers & Miscellaneous Non- Separate Billing Requested ............. 7. 4 6 , 0 8 3 . 9 ~ 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 4 6, 7 9 9. 3 1 3. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. ~' 6 • 7 6 7 0 9 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 2 , 5 9 8 ' 4 ~ 11. Total Deductions (total Lines 9 8 10) ...................................................................... 11. 1 9, 3 6 5. 4 9 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 2 7 , 4 3 3 8 2 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. Z 7 , 4 3 3 8 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 Q 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 7, 4 3 3 8 2 16. 17, Amount of Line 14 taxable at sibling rate X .12 0 ~ 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 ~ ~ ~ 18• 19. Tax Due .................................................... ................................................................ . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ~ ~ 0 1,234,52 ~ ~ 0 0.00 1,234,52 Side 2 15056042148 15056042248 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-07-0301 DECEDENT'S NAME Louise R. Scheaffer _ _ __ STREET ADDRESS 143 Fifteenth Street Apt . 5 _____ _ CITY STATE ZIP New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Paymenfs q. Spousal Poverty Credit g. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 3. Interest/Penaity if applicable p. Interest E. Penalty _ Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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 the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT (1) 1,234.52 0.00 1,234.52 1,234.52 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 :.................................................................................. Vii, ~z ji b. retain the right to designate who shall use the property transferred or its income :.................................._ C; %~ c. retain a reversionary interest; or .................................................................................................................. ~ x d. receive the promise for life of either payments, benefits or care? .............................................................. CI, X Ij 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... ~ X ii 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... x I, JI 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 dales 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)j. 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)j. The statute does 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, art adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)J. 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)j. 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. Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY Scheaffer, Louise R. FILE NUMBER 21-07-0301 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Members 1st Checking Account Number 277572-11 -valued per letter dated June 415.00 18, 2007 2 I Members 1st Holiday Ciub Account Number 277572-02 -valued per letter dated ~ 100.00 June 18, 2007 3 I Members 1st Savings Account Numebr 277572-00 -valued per letter dated June 18, I 50.00 2007 4 I Members 1st Supplemental Savings Account Number 277572-01 -valued per letter I 60.00 dated June 18, 2007 TOTAL (Also enter on Line 5, Recapitulation) I 625.00 (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) Rev-15119 EXt (6-98) ,, , COMMONWEAITH~OF PENNSYLVANIA INHERrIANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF (FILE NUMBER Scheaffer, Louise R. 21-07-0301 If an asset was made joint within one year of the decedent's tlate of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Lena E. Ricci 1026 Drexel Hills Blvd Mother New Cumberland, PA 17070 B. C JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FWANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 9/12/2000 PNC Checking Accoutn # 5140086806 - 76.76 50.000% 38.38 valued per letter dated August 6, 2007 2 A 2/4/2003 PNC Savings Account # 5004081445 - 104.05 50.000% 52.03 valued per letter dated August 6, 2007 TOTAL (Also enter on Line 6, Recapitulation) ! 90.41 (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 F (Rev. 6-98) Rev-1510 EX+(6-98) SCHEDULE G ~, ` - I INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OE PENNSYLVANIA INHERITANCE TAk RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Scheaffer, Louise R. 21-07-0301 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse sitle of the REV-1500 COVER SHEET is yes. ITEM NUMBER DE CRIPTI N F PR PE TY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Pacific Life Annuity Contract #VR06017620 - 46,083.90 46,083.90 Bneeficiaries are children Jessica Scheaffer and John Scheaffer TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 46,083.90 Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX* (12-99) COMMONWEALTH OF PENNSYLVANIA INHERfTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMfNtSTRATIVE COSTS ESTATE OF FILE NUMBER Scheaffer, Louise R. 21-07-0301 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Years} Commission paid 2. Attorney's Fees James, Smith, Dietterick 8~ Connelly, LLP 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. I Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 13,448.40 2,425.00 58.00 174.00 7. Other Administrative Costs 661.69 See continuation schedule(s) attached TOTAL (Also enter on fine 9, Recapitulation) 16,767.09 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 PENNSVIVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Scheaffer, Louise R. 21-07-0301 ITEM NUMBER DESCRIPTION AMOUNT 1 Cemetery Plot -funeral expense 825.00 2 Funeral Expense -Clergy and altar boy 150.00 3 Headstone -funeral expense 1,600.00 4 Parthemore Funeral Home - funeral 10,873.40 Subtotal 13,448.40 Copyright (c) 2002 form software only The Lackner Group, inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) ,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DEDEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Scheaffer, Louise R. 21-07-0301 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-961 SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Scheaffer, Louise R. 21-07-0301 Include unreimbursed medical expenses. (If more space is needed, additional pages of the same size} Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1540 Schedule I {Rev. 6-98) REV-1513 EX+(g-00) y` ' ' ~ - SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES WHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Scheaffer, Louise R. 21-07-0301 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words} ($$$) Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS [include outright spousal . distributions, and transfers under Sec. 9116(a)(1.2)] 1 Lena E. Ricci Mother Joint Bank 90.41 1026 Drexel Hills Blvd Accounts New Cumberland, PA 17070 2 Jessica R. Scheaffer Daughter 50% Pacific 13,671.71 1026 Drexel Hills Blvd Life Annuity New Cumberland, PA 17070 Net of Expenses 3 John M. Scheaffer Son 50% Pacific 13,671.70 167 Franklin Street Life Annuity Apt. # 2 Net of Brooklyn, NY 11222 Expenses Total 27,433.82 Enter dollar amounts for distributions shown above on fines 1 5 through 18, as appropri ate, 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 It -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.OO Copyright (c} 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule J (Rev. 6-98) REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } Jessica R. Scheaffer File Number 21-07-0301 Personal Representative(s) of the Estate of Louise R. Scheaffer deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate In the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's de~h, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a m orandum at the end of this inventory. I verify that the statements made in this Inven- ~ ~~ tory are true and correct. I understand that false state- - - -- ~ - ,may ments herein are made subject to the penalties of Je sica R. Scheaffer f7 ~ 18 Pa.C.S. § 4904 relating to unsworn falsification to } _ ,'i_ ____ _ ___ _ _ __ _ _____ ~Q_ __ _ `-'~ ~__ authorities. ~ ,°~-~o ~ ' I _ ~ ~ C17 r_ :_ ._ i~-yrn 1 -.I -r't -~ Attorney -- (Name) Gary L James Esq. (Supreme C ~. No.) ~ 27752 . (Firm) James, Smith, Dietterick Sz Connelly, LLP --t ro .. - ___ -- -~ (Address) 134 Sipe Avenue, Hummelstown, PA 17036 --~ (Telephone) 717/533-3280 DATE OF DEATH LAST RESIDENCE 143 Fifteenth Street DECEDENT'S SOC. SEC. NO. 03/18/2007 New Cumberland, PA 17070 194-34-0073 FIGURES MUST BE TOTALED Personal Proaert Cash ............................................................................................... Personal Property ......................................................................... Stocks/Listed ................................................................................. Stocks/Closely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... Total Real Property• ............................................... Total Personal and Real Property ......................... 625.00 625.00 625.00 INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b}) Form RW-09 Rey. io-rs-loos INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } File Number 21-07-0301 DATE OF DEATH LAST RESIDENCE 143 Fifteenth Street DECEDENT'S SOC. SEC. NO. 03/18/2007 New Cumberland, PA 17070 194-34-0073 Cash Members 1st Checking Account Number 277572-11 -valued per letter dated June 18, 2007 Members 1st Holiday Club Account Number 277572-02 -valued per letter dated June 18, 2007 Members 1st Savings Account Numebr 277572-00 -valued per letter dated June 18, 2007 Members 1st Supplemental Savings Account Number 277572-01 -valued per letter dated June 18, 2007 Total Cash 415.00 100.00 50.00 60.00 625.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate 625.00 February 4, 2009 Glenda Farner Strausbaugh Register of Wills & Clerk of Orphans' Court 1 Courthouse Square Carlisle, PA 17013 RE: ESTATE OF LOUISE R. SCHEAFFER, DECEASED FILE N0.21-07-0301 Dear Ms. Strausbaugh: Enclosed are the following documents to be filed in the above-referenced Estate: ._T ~wN ESTATE SECURITY Denise M. Long dml@jsdc.com 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. An original and one (1) copy of the Inventory. 3. A check made payable to the "Register of Wills, Cumberland County" in the amount of Thirty Dollars ($30.00) representing the filing fee. It is my understanding that Jessica Scheaffer, Administrator for the estate, has made an arrangement with the Department of Revenue to pay the tax due in installments. Please time-stamp the additional copies of the Return and Inventory and return them to me in the enclosed self-addressed, stamped envelope. If you have any questions, please feel free to give me a call. C .~'~ Sincerely, ;~ ~ rn ,`=Y; ' - ~, ~ C'> Q7 t ~ cy _i ~ 'n r"' JAMES SMITH, DIETTF.RICK & C NELLY, LLP ~ c ~ ~ ~ I ; ? `_ _, c~c~~ ~ a ~ .~ .. :,~ ..,~~~ Denise M. Long ~ -~ , 134 SIPE AVENUE HUMMELSTOWN, PA 17036 MAILING ADDRESS PO. BOX 650 HERSHEY, PA 17033 TOLL FREE 1.800.942.3660 TEL. 717.533.3280 FAX 717.533.7771 www.jsdacom Lwi - (_`i .'~` ~, ~('. v ~~ ., - '~. S§`~ > L:~'' Yea ', ,. y~ ~~ ~ ` ~~. 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