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HomeMy WebLinkAbout12-30-09 (2)J 15056051058 REV- ^ 50o EX {06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 0390 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171-28-5156 04/07/2009 03/10/1936 Decedent's Last Name Suffix Decedent's First Name MI SCHREIBER SR JOHN R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW • 1. Original Return 4. Limited Estate !' 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number rv JOHN SCHREIBER JR (717) 732-38~p .°,~, Firm Name (If Applicable) REGISTER ~3~~~USE ~Y First line of address r /~i r.~ 0 ~ ~,h ~7-t ~' ~~ ~ 943 S HUMER ST 1..1 r-J ~ ~ ~~ ~ .. ~~"~;'~ r ~ ~ :~ Second line of address ~ -~-I -- r-= 1.13 C,O ~-~ W r~ City or Post Office State ZIP Code DATE FILED ENOLA PA 17025 Correspondent's a-mail address: Under penalties of perjury, 1 declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corcect and complete. Declaration of preparer other than the personal re re t ti i p sen a ve s based on all information of which preparer has any knowledge. SIGNAT OF PERSON RESP,pNSI FILING RETURN ~~ // 2 • d // DATE d..f ~_ ~ JIBOJJR ESS / -Q OF PREPARER (~ 15056051058 / 1~ ! 7~ ~U )RIGINAL FORM ONLY Side 1 DATE /02 - d ~-D 15056051058 _..I J 1505605205 9 REV-1500 EX Decedent's Social Security Number oecedent'sName: JOHN R SCHREIBER 171-28-5156 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 119,900.00 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. 10,660.00 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 19,462.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. 150,022.00 9. Funeral Expenses ii Administrative Costs (Schedule H) ..................... 9. 18,591.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 38,995.00 11. Total Deductions (total Lines 9 8 10) ................................ ... 11. 57,586.00 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 92,436.00 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. 92,436.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 45 92,436.00 16. 4,160.00 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 , o 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 09 0390 DECEDENTS NAME JOHN R SCHREIBER DECEDENTS SOC IAL SECURITY NUMBER STREET ADDRESS 171-28-5156 943 S HUMER ST CITY -- - ENOLA STATE ZIP PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments 4,160.00 A. Spousal Poverty Credit B. Prior Payments C. Discount -" Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable 0.00 D. Interest E. Penalty --- Total Interest/Penalty (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) 4,160.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4,160.00 Make Check Payable to: 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 :......................................................................................... . ^ b. retain the right to designate who shall use the property transferred or its income : ........................................... . ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................... 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? ......................................................................... . _ fxl f-1 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 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, 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)). 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-- pr F.-X~~ (11-08 i Pennsylvania UEPARTMF.NT OE REVENUE [NHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF JOHN R SCHREIBER SR FIDE NUMBER 2009-0390 All real property owned solely or as a tenant in common must be reported at fair market value, fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. NUMBER VALUE AT DATE DESCRIPTION OF DEATH I' RESIDENCE 943 HUMER ST ENOLA PA CUMBERLAND COUNTY PA ATTACHED VACANT LOT 119, 900.00 PARCEL # 09-16-1052-030A AND #09-16-1052-049 TOTAL (Also enter on Line 1, Recapitulation) I $ 119,900.00 If more space is needed, insert additional sheets of the same size. REV-1508 EX+ (6-g8) ~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF JOHN R SCHREIBER SR FILE NUMBER 2009-0390 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be di l d ITEM sc ose on Schedule F. NUMBER DESCRIPTION VALUE AT DATE 1. SOVEREIGN BANK CHECKING ACCOUNT #921709129 OF DEATH © 4,075.00 PO BOX 12646 READING PA 19612 2. SOVEREIGN BANK CD REDEMPTION 5,123.00 PO BOX 12646 READING PA 19612 LIBERTY MUTUAL INS CO REFUND CAR INSURANCE 87.00 4. GEISINGER HEALTH PLAN PREMIUM REFUND 51.00 5. SADLER OIL CO REFUND 452.00 6. PA REAL ESTATE TAX REBATE 250.00 7. ENCOMPASS INS CO HOUSE INSURANCE REFUND 36.00 8. SALE OF 1990 CHE+~CORSICA FAIR CONDITION 500.00 9. NGL INS CO LIFE INS REFUND 46.00 10. SALE OF HOUSEHOLD ITEMS 40.00 _ TOTAL (Also enter on line 5 Recapitulation) 5 I 10,660.00 (If more space Is needed, insert additional sheets of the same size) REV-1510 EX+ (p6-09j ~i Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY w ~A i t yr FILE NUMBER JOHN R SCHREIBER SR 21-09-0390 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV•15no is vec ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A CDPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET 9o OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1 AMERICAN EQUITY INVESTMENT LIFE INS CO 5000 WESTOWN PARKWAY SUITE 440 W DES MOINES IA 50266 IRA ACCOUNT FOR JOHN R SCHREIBER SR ACCT# 552332 19,462.00 100 0.00 19,462.Oi TOTAL (Also enter on Line 7, Recapitulation) $ I 19 462.00 If more space is needed, use additional sheets of paper of the same size. REV-1737.6 EX + (6-08) REVERSE ~' pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS Use Schedule H ONLY for proportionate method of tax computation. ESTATE OF FILE NUMBER JOHN R SCHREIBER SR 21-09-0390 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' SULLIVAN FUNERAL HOME 51 N ENOLA DR ENOLA PA 17025 4,637.00 FUNERAL LUNCHEON ENOLA FIRST CHURCH OF GOD 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commission(s) Name(s) of Personal Representative(s) (Submit requested information for additional personal representative's on additional sheets) Social Security Number(s) or EIN Number(s) of Personal Representative(s) Street Address(es) City(ies) State(s) ZIP(s) Year(s) Commission Paid 2• Attorney Fees 3,463.00 3. Probate Fees 300.00 4• Accountant's Fees 5• Tax Return Preparer's Fees 125.00 6. Miscellaneous Expenses CLOSING COSTS FOR SALE OF 943 S HUMER STAND VACANT LOT ENOLA PA 9,416.00 REGISTER OF WILLS 125.00 PRORATION OF COUNTY TAXES PD AND SCHOOL TAXES UNPAID AT CLOSING 355.00 TOTAL (Also enter on Line 9 Recapitulation) I $ 18,591.00 (If more space is needed, use additional sheets of paper of the same size) hEV-1512 EX+ (72-08j Pennsylvania DEPARTMENT OF REVENUE. INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER JOHN R SCHREIBER SR 2009-00390 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses, ITEM NUMBER nFCroiorTnni VALUE AT DATE 1' SOVEREIGN BANK MORTGAGE PO BOX 16255 READING PA 19612 LOAN # 4527028375 943 S HUMER ST ENOLA PA 17025 2. TIGER TRASH 3. QUEST DIAGNOSTICS 4. E PENNSBORO TOWNSHIP 5. D LUPOLD TREASURER E PENNSBORO RE TAX 6. COMCAST 7. PPL 8. AT&T 9. CUMBERLAND FAMILY PRACTICE 10. VERIZON 11. LEON GERLACH PROPERTY APPRAISAL 12. AMERICAN HOME PATIENT 13. ENCOMPASS INSURANCE 14. COMFORT CARE OF HOLY SPIRIT HOSPITAL 15. PATRIOT NEWS TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insert additional sheets of the same size. 36, 526.00 779.00 5.00 47.00 607.00 2.00 256.00 13.00 30.00 46.00 300.00 115.00 36.00 220.00 13.00 38,995.00 RF.~'-15I~ EXh (1.t-C18j ~` pennsytvania SCHEDULE ~ UEI>ARTMEN~T Of REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT CJIAIC Ut JOHN R SCHREIBER SR 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. JOHN R SCHREIBER JR 940 S HUMER ST ENOLA PA 17025 2. JUDY D JANIS 3416 SHERMANS VALLEY RD LOYSVILLE PA 17047 3. JENNIFER SCOBEE 833 WATER ST WEBSTER CITY IA 50595 4. MEGAN MORRIS 830 VALLEY RD ENOLA PA 17025 5. MICHELLE MORRIS 1179 WINTERTIVE DR HARRISBURG PA 17111 RELATIONSHIP TO DECEDENT Do Not List Trustee(sl SON DAUGHTER DAUGHTER GRANDDAUGHTER ..GRANDDAUGHTER ENTER DOLIAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ If more space is needed, insert additional sheets of the same size. FILE NUMBER 2009-00390 AMOUNT OR SHARE OF ESTATE .25 .25 .25 125 125