HomeMy WebLinkAbout04-20-10
15056051047
REV-1500 EX (os-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280501 2 1 0 9 0 0` 3 3 3
Harrisbu , PA 17128-0601 .. RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 6 3 8 2 9 6 0 0 4 0 1 2 0 0 9 0 4 3`0 - l 9 4 8
Decedent's Last Name Suffix Decedent's First Name MI
S C H' E U R E N P E T E R J
(if Applicable) Enter Surviving Spouse's In#ormation 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
Original Return '~
O 1 2. Supplemental Return O 3. Remainder Return (date of death
. prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
0
~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) {Attach Copy of Trust)
Litigation Proceeds Received O
O 9 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A)
. between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
MAR L I N R M I C A L E B 7 1 7 6 9 1 7 7 7 0
Firm Name (If Applicable)
First line of address
2 1 9 E A S T M A I N S T R E E T
Second line of address
P O B O X 2 3 0
City or Post Office State
M E C H A N I C S B U R G P A
REGISTER OF WILLS USE ONILY
C7 `~'
~ .
-~~ ~ ~
~ J
, ,
,.~ } , m
~''~ ~
:
Iv
C7 ~
~ ~-.;
~ 7
~~~
:-~
=--~
~"~ ~ ~
~ , _ ~
,
._ ~..i a
~
~
r~
E FILE
r
-- D
--Tj ~ r._...
ZIP Code `-
1 7 0 5 5
~ ::.~
.r.. ~ f
Correspondent's e-mail address: __
Under penalties of perjury, t declare that I have examined this return, including accompanying schedules and statements., and to the best of my knowledge and bellet,
it is tn~e, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
NATURE OF P RESPONSIBLE F FILING RETURN DATE
Executrix d
ADDRESS Teresa Lafey
621 or tan Place H rris PA 17111
SIG ~RE O~F~PR~ARE P ENTATIVE _ /~D~~' ,Q,
ADDRESS 1Rarlln K. mc~.:aien
219 East Main Street, Mechanicsburcr, PA 17055 ---
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15056051047 15056051047
1556052048
REV 1500 EX Decedent's Social Security Number
Peter J. Scheuren 2 0 6 3 8 2 9 6 0
f~cuprtE±nt'c Name'
RECAPITULATION
1.
.............................
Real estate (Schedule A) . ...............
1. 0 • 0 0
2. Stocks and Bonds{Schedule B) ....................................... 2. 0. 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0 , 0 0
4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 0 + 0 0
5.
p party ( ) ....... .
Cash, Bank De osits 8 Miscellaneous Personal Pro Schedule E 5. 5 2 6 + ~ ~
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0 • 0 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
0
0
0
(Schedule G) O Separate Billing Requested........ 7. +
8. Total Gross Assets (total Lines 1-7) .................................... 8. 5 2 6. 8 ~
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ..................... 9. 1 5 . 0 0
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. 0. 0 0
11. Total Deductions {total Lines 9 8~ 10) ................................... 11. 1 5 + 0 0
12. Ne# Value of Estate (Line 8 minus line 11) .............................. 12. 5 1 1, 8 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an elec#ian to tax has not been made (Schedule J) ........................ 13. +
5 1 1 8 5
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
15 0 ~ 0 0
(a)(1.2) X .0 ~ . .
16. Amount of Line 14 taxable
45 5 1 1 8 5
16
2
3
0
3
at lineal rate X .0 .
17. Amount of Line 14 taxable
17
0.
0
0
at sibling rate X .12 . .
18. Amount of Line 14 taxable
18
0.
0
0
at collateral rate X .15 + .
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
2 3, 0 3
O
Side 2
15056052048 1505605204B
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 - 09 - 00333
DECEDENT'S NAME
Peter J. Scheuren
------------- --
---- -------- - --- ----
STREET ADDRESS
6 Mellwood Lane
--- -------
CITY
- STATE --
Mechanicsburg PA ZIP -- -
17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 23.03
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.00
3. lnterest/Penalty if applicable
D. Interest 0.3 0
E. Penalty
Total Interest/Penalty (D + E) (3) 0 . ~0
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) 23 ~ 33
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 2 3.3
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? .............. ^ X^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ® ^
1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1S YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of dea#h 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 #ax ra#e 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)].
--- -T-he-tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is four and one-half 4.5 r '
( ) pe cent, except as noted m
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-1508 EX + (1-97)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ M~cC.
INRESIDENTDECEDEN TN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Peter J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
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.
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
REV-1511 EX+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES ~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Peter J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
B.
1.
ADMINISTRATIVE COSTS:
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's Fees
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Register of Wills, - filing Supplemental Inheritance Tax return.
15.00
TOTAL (Also enter on line 9, Recapitulation) ~$ 15.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 199fi form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
__ RESIDENT DECEdENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Peter J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
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)]
1 Mae M. Scheuren Mother 511.85
404 Main Street
Lavelle, PA 17943
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON R EV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT OF
PETER SCHEUREN
I, PETER SCHEUREN of _6 Mellwood Lane, Mechanicsburg ,
Pennsylvania, 17050 being of sound and disposing mind, memory and understanding,
do hereby make and declare this as my last will and testament and revoke all wills and
codicils heretofore made by me.
FIRST
I direct the payment of my debts and expenses of my last illness and funeral from
my estate as soon after my death as conveniently maybe done.
I authorize my personal representative to expend reasonable funds from my estate,
in such amount as my personal representative shall consider necessary and desirable, for
the purchase, erection and inscription of a suitable marker for my grave.
I direct that my remains be cremated and my ashes disposed of as my personal
representative sees fit.
SECOND
a. I give my mother, Mae M. Scheuren, my house located at 6 Mellwood Lane,
Mechanicsburg, Pennsylvania and whatever automobile(s) is/are owned by me at the time
of my death.
l~~
b. I give the proceeds of my non-retirement funds-' mud al funds mac.
~~ ~~ o my sisters, Teresa Lafey and Mary Ann Snyder, share
and share alike.
3~1~/~ THIRD
I give all the rest, residue and remainder of my estate real, personal or otherwise,
to my
-~ds~~~
FOURTH
I direct that any and all inheritance, estate and transfer taxes imposed upon my
estate passing under my will or otherwise, shall be paid out of the principal of my
residuary estate.
FIFTH
Any and all payment or payments of any sums or sums, whether in cash or in kind
and whether from principal or income, payable to my beneficiaries, or any of them, shall
be made upon the sole receipt of the respective individual to whom the payment is made,
and free from anticipation, alienation, assignment, attachment, and pledge, and free from
control by the creditors of any such beneficiary. All shares of principal and income
herein given shall be free from anticipation, assignment, pledge or obligation of any
beneficiary, and shall not be subject to any execution or attachment.
SIXTH
Finally, I nominate, constitute and appoint my sister Teresa Lafey Executrix of
this my last will and testament. I hereby relieve my Executrix from the necessity of
posting security in connection with her duties as such in any jurisdiction in which she
maybe called upon to act insofar as I am able by law to do.
IN WITNESS WHEREOF, I have hereunto affixed my hand and seal to this, my
last will and testament.
This 5th day of March, 2009.
~ ~~~ i~~~ (SEAL)
ER SCHEUREN
Signed, sealed, published and declared by the above-named Testator, Peter
Scheuren as and for his last will and testament in the presence of us, who, at his
request, in his sight and presence, and in the sight and presence of each other, have
yes.
,.
Si ature
~i /~% ~9~sf~
Address
~~~,~ 7~0
21\ N. ~d ~~- s~-
Address
A ~o~
-.._
2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
We, Peter Scheuren ~ . AND
S~mr~,(`~ ~~zsm.~~s ,the Testator and the witnesses, resp ively, whose names
are signed to the attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator signed and executed this instrument
as his last will, and that he signed willingly, and that he executed as his free and
voluntary act for the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the will as witnesses, and that to the best of
their knowledge, the Testator was at the time eighteen (18) years of age or older, of sound
mind, and under no constraint or undue influence.
~ ~~
j . Wirn~~ •
Witness
Sworn or affirmed to and acknowledged before me, this 5th day of March, 2009.
o Pu 'c
MONWEALTFI OF ~n~vsYi.v lq
~. s ,, icy
Oily OF Hart, p, ~y
~-G a~. ~o, ao~o
Member PennsYlvanla Ase~~ of Notartee
S~
~~ 3~0.~
~~ ~~~o~
~,~
~1~'~L7