HomeMy WebLinkAbout06-22-10 (2)1505607121
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
POBOx28oso1 INHERITANCE TAX RETURN 2 1 0 9 1 1 9 4
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 2 3 0 4 3 2 2 1 2 1 7 2 0 0 9 1 2 2 3 1 9 3 9
Decedent's Last Name Suffix Decedent's First Name MI
S C H I L L E R JANET M
(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
Q 1. Original Return
4. Limited Estate
Q 6. Decedent Died Testate
(Attach Copy of Will)
0 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) 0
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
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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
H ANTHONY ADAMS 7 1 7 5 3 2 3 2 7 0
Firm Name (If Applicable) ---- --~, , ,
First line of address
49 WEST ORANGE STREET
Second line of address
S U I T E 3
City or Post Office
S H I P P E N S B UR G
~REGISTF~R10F WILLS U NLY _
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State ZIP Code - _ ~ ____ .__- _ _~_ __ -:
P A 1 7 2 5 7
Correspondent's a-mail address: htadamSlaW@embargmalLCOff1
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 tru correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI A UFtE OF PERSO PON BLE F (LING RETURN iDATE I ~
ADORES D ~ - ~ ' .~ Qn Q/I ~~1, rl~^`/~ A~ ~ a p J~ I ~7c~~7~
SIGNATURE O REP~R7• ESENTATIVE-/T C?ATfe / _ _
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I/~zrY~~- LEASE USE ORIGIN L FORM ONL
Side 1
1505607121 1505607121 ~ -~;
REV-1500 EX
1505607221
Decedent's Social Security Number
Decedent's Name: JANET M. SCHILLER 1 9 2 3 0 4 3 2 2
RECAPITULATION
1. Real estate (Schedule A)
..................................... 1.
... 8 4 5 0 0, 0 0
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. 4 5 4 • 5 2
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) ........................ ... 8. 8 4 9 5 4, 5 2
9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 6 4 1 0 . 8 8
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......... .. 10. 6 6 6 6. 8 8
11. Total Deductions (total Lines 9 & 10) ......................... .. 11. 1 3 0 7 7 . 7 6
12. Net Value of Estate (Line 8 minus Line 11) ....................... .. 12. 7 1 8 7 6. 7 6
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. 7 1 8 7 6 . 7 6
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 _ 0 . 0 0 15.
16. Amount of Line 14 taxable
at lineal rate x .045 7 1 8 7 6. 7 6 16.
17. Amount of Line 14 taxable
0 0
0
at sibling rate X .12 17.
18. Amount of Line 14 taxable
0
0
0
at collateral rate X .15 . 1 g
19. Tax Due .............. ........................... ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505607221
0. 0 0
3 2 3 4. 4 5
0. 0 0
0. 0 0
3 2 3 4. 4 5
1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 1194
DECEDENT'S NAME
JANET M. SCHILLER
- - -- -
-- - ---
STREET ADDRESS --- - -
- - - --
--- ___
CITY STATE ~ ZIP _ -
Tax Payments and Credits:
Tax Due (Page 2 Line 19)
Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
5.
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.
If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(4) 0.00
(5)
3,234.45
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 3,234.45
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and:
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 "intrust 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? ......................................................................................
Yes No
^ ^X
^ 0
^ 0
......... ^ a
......... ^ 0
.......... 0 0
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.
(1) 3,234.45
Total Credits (A + B + C) (2)
0.00
Total Interest/Penalty (D + E) (3)
0.00
REV-1502 EX + (6-98)
SCHEDULE A
COMMNHERITANCE TAX RETURN ANIA REAL ESTATE
RESIDENT DECEDENT
tJlAlt OF
FILE NUMBER
JANET M. SCHILLER 21 09 1194
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 roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 20 COVERED BRIDGE ROAD 84,500.00
NEWBURG, HOEWELL TOWNSHIP
CUMBERLAND COUNTY, PENNSYLVANIA
TOTAL (Also enter on line 1
84
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
JANET M. SCHILLER 21 09 1194
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 disclosed on Schedule F.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1. TAX PRORATION ON SALE OF HOUSE 204.52
ESCROW PAYMENT ON CONTRACT DEFAULT
250.00
TOTAL (Also enter on line 5, Recapitulation) I $ 454 52
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JANET M. SCHILLER 21 09 1194
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FOGELSANGER-BRICKER FUNERAL HOME 405.38
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Paid:
State Zip
2, Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation)
Claimant
4,225.00
1, 500.00
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 280.50
5 Accountants Fees
6. Tax Return Preparers Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 6 410.88
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12.03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
scHE~u~E ~
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JANET M. SCHILLER 21 09 1194
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CHAMBERSBURG HOSPITAL 100.80
2. ADAMS ELECTRIC COMPANY 90 88
3. CENTURY LINK 61.00
4. AUSHERMAN BROTHERS REAL ESTATE 300.00
5. HARRY KILLIAN TAX COLLECTOR 199.20
6. SAILHAMER REAL ESTATE 5,070.00
7. RECORDER OF DEEDS (TRANSFER TAX) 845.00
TOTAL (Also enter on line 10, Recapitulation) I $ 6 666 88
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
JANET M . SCHILLER 21 09 1194
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 ouVight spousal distributions, and transfers under
Sec. 9116 (a) (1.2)j
1. BRUCE ALEXANDER, JR. Lineal
75 FALLING SPRING ROAD 1/6
CHAMBERSBURG, PA 17257
2. JEFF ALEXANDER Lineal
191 GUM RUN LANE 1/6
SHIPPENSBURG, PA 17257
3. JOHN SHETTER Lineal
476 THREE SQUARE HOLLOW ROAD 1/6
NEWBURG, PA 17240
4. GARY ALEXANDER Lineal
20 COVERED BRIDGE ROAD 1/6
NEWBURG, PA 17240
5. WANDA GUERRERO Lineal
46 LENWOOD PARK 1/6
SHIPPENSBURG, PA 17257
6. DIANE OSBAUGH Lineal
101 N. SHADY ROAD 1/6
NEWBURG, PA 17240
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
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