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Home My WebLink About01-19-10~ a ,~ 15056051058 REV-~ 500 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 ~ ~, D ~ p ~ ~, ~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT 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 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return • 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust $. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) Spouse's Social Security Number ---___ _ CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOHN R SCHREIBER JR ~ 7 ~ l~ 7~ ~ " c~ ~ ~ 3 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY t~.l ~ First line of address C7 C ° --' 940 S HUMER ST ~^ t_ '. ~ Z~ ~J ~ -_Y : - - -~^ ` ' - ~ Second line of address ~ ~ rte' ~ "~ ~' ' ' = ~ .. ' - . ~ ~ i r~,- r ` / te City or Post Office State ZIP Code ~ ~~, - ;- ~_ '~ ENOLA PA 17025 ~ <: ~'~ ~', . i ~ , J Correspondent's a-mail address: -- _ _ 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 complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA RE ERSO ESP~SIBLE R FI G RET N D~ TE /~ ~ /U : ' ~, A S --- / `~ - --- ~ --- ~~~ -- - `tea ~.[~G-~___~ v ~-I ~.~_~~~ o ~_ ~ ---- - ~~ _ 1 _? v ~. ~ SIGN E OF PREPARER OT}•l€R HAN REPRE NTATIVE D ~ E '1i /~ ~, ~ DTs / ADD S ~~ 5", ~ ---- ~~ . --.~Z'~c.~. ~~ l ~~~""~ PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 ~ ~J a 15056052059 REV-1500 EX Decedent's Social Security Number decedent's Name: 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 & Administrative Costs (Schedule H) .................... . 9. 25,387.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10. 38,995.00 11. Total Deductions (total Lines 9 & 10) .................................. . 11. 64,382.00 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 85,640.00 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. 85,640.00 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 85,640.00 16, 3,854.00 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ........................................................ . 19. 3,854.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER JOHN R SCHREIBER 171-28-5156 STREET ADDRESS 943 S HUMER ST CITY ENOLA STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 3,854.00 2. Credits/Payments 4,160.00 A. Spousal Poverty Credit B. Prior Payments C. Discount - Total Credits (A + B + C) (2) 4,160.00 3. Interest/Penalty if applicable 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) 306.00 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did dededent 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? .................................................................................................................. ...... ~ ^ 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)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)J. 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-1737-8 EX + (6-08) REVERE ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE H FVNERAL 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) 6, 526.00 Name(s) of Personal Representative(s) JOHN R SCHREIBER JR (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) 940 S HUMER ST City(ies) ENOLA State(s) PA ZIP(s) 17025 Year(s) Commission Paid 2010 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 ST AND ADJ VACANT LOT 9,416.00 PRORATION OF COUNTY TAXES PAID AND SCHOOL TAXES UNPAID AT SETTLEMENT FOR 943 S HUMER ST ENOLA PA 355.00 REGISTER OF WILLS 125.00 ADDITIONAL FEE TO REGISTER OF WILLS 240.00 TOTAL (Also enter on Line 9, Recapitulation.) I $ 25,387.00 (If more space is needed, use additional sheets of paper of the same size)