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HomeMy WebLinkAbout04-30-13 (2) "�. REV-1500 EX(02-11) 1505610143' OFFICIAL USE ONLY PA Department of Revenue pennsylva ila Cagy code Year File Number Bureau of Individual Taxes ea"araearerrreuw■ PO BOx.280601 INHERITANCE TAX RETURN 21 13 0147 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 02 01 2013 12 25 1931 Decedent's Last Name Suffix Decedent's First Name MI SCHEER EUGENE B (N 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 of Death Prior to 4. Limited Estate 4a.Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-,2-82) ® g, Decadent Died Testate pemde M�i,"ned a Living Trust 1 8. Total Number of Safe R Boxes (Attach Copy of Will) ® (Attecn�Gtopy oT Trust) Depos ❑ 9. Litigation Proceeds Received ❑ 10.=n'P2J1 91 anti 1<-D1-&5r Death 11.Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number EDlAARD P SEEBER X17 53: 32@00,1 c o m h OF��ILL"S@63NLY w rnm First Line of Address r- :,D O Q V-) SUITE C400 0 -t1 o n cn ,� Second Line of Address ry rn 555 GETTYSBURG PIKE City or Post Office State ZIP Code p" DATEi1LED MECHANICSBURG PA 17055 Correspondent's*-mail address: OpstetadC.Com Under penalties of perjury,I declare that I have examined this return,including accomp n ing schedules and statements,and to the best of m k it is true,twrretM and complete.Declaration of preparer other than the personal representative is based on all irrcon,ation of which hag arty n edge and belief, preparer owledge. I E OF PERSON RESPONSIBLE FOR FILING RETURN /� DATE rl.wiG L _ Cheryl L.Scheer '� I ADDRESS 716 3rd Street NAERochesterCMN 55901 SIGNATURE OF EP OTHER THAN REPRESENTATIVE DATE Edward P Seeber ADORE at.C-400 55 Gettysburg Pik"echanicsburgCPA 17055 Side 1 L 1505610143 1505610143 J 1505610243 REV-1500 EX 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&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 129,240.51 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous I�oq Probate Property (Schedule G) u Separate Billing Requested............ 7. 636,580.82 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 765,821 . 33 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 59,331. 46 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)..........................:. 10. 2 , 164 .48 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 61 ,495. 94 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 704,325.39 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. 704,325.39 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.00 15. 0. 00 16. Amount of Line 14 taxable at lineal rate x .045 704,325.39 16. 31, 694 . 64 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0. 00 18. Amount of Line 14 taxable at collateral rate x.15 0. 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 31, 694 . 64 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 J Rev-11!09 EXt(11.10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTWNT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 Include me pprroo seas of Ii d-p "the date the proceeds were received by the ester. All properly) Inwovmed r h right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Members let Federal Credit Union Checking Account No.25894741 -valued per Dank letter 44,906.70 dated 2!11!13 2 Members lot Federal Credit Union Savings Account No.258947-00-valued per bank letter 76,442.81 dated 2111113 3 Andrews&Patel Associates,PC-refund of account 150.00 4 Endodontics Associates-refund of account 1,388.00 5 Kllmore Eye Associates-refund of account 20.00 6 US Treasury-2012 income tax refund 6,333.00 TOTAL(Also enter on Line 5,Recapitulation) 129,240.51 (If more space is needed,additk nai pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1510 EXa SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 This ahadule must be completed and filed if the answer to any of questions 1 through A on paps three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH Is OF MCXI S EXCLUSION TAXABLE NUMBER .E D naWTHEOREALS TEaAA COPYY RELATIONSHIP DEED REAL ESTATE. VALUE OF ASSET INTEREST (IF ApKICAKE) VALUE 1 Anita Scheer-cash gift on 4127/12 600.00 100.000% 600.00 0.00 2 Anita Scheer-cash gift on 12119/12 100.00 100.000% 100.00 0.00 3 Boyd Scheer-cash gift on 12/19/12 200.00 100.000% 200.00 0.00 4 Boyd Scheer-cash gift on 3112/12 500.00 100.000% 600.00 0.00 5 Cheryl Scheer-cash gift on 12/19112 200.00 100.000% 200.00 0.00 6 Erik Scheer-cash gift on 12/19/12 50.00 100.000% 50.00 0.00 7 Erik Scheer-cash gift on 615112 500.00 100.000% 500.00 0.00 8 James 1.McMillen MO-2011 Cadillac STS gifted to 23,700.00 100.000% 3,000.00 20,700.00 stepson in January 2013;valued per appraisal 9 Karl Scheer-cash gift on 12/19112 200.00 100.000% 200.00 0.00 10 Karl Scheer-cash gift on 311`12112 500.00 100.000% 500.00 0.00 11 Sam Scheer-cash gift on 12/19/12 50.00 100.000% 50.00 0.00 12 Myers-Hamer Funeral Home,Inc.-prepaid funeral 2,702.58 100.000% 0.00 2,702,58 account 13 100 shares of Abbvie Inc held In Scottrade Brokerage 3.686.00 100.000% 0.00 3,686.00 Account No.`243-titled in the Eugene B.Scheer Living Trust;valued per statement Total of Continuation Schedules See attached Dages TOTAL(Also enter on Line 7,Recapitulation) 636,580.82 (M more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Farm PA-1500 Schedule G(Rev.06-09) Rew1510 EX+(08-05) SCHEDULE G Pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE MERMANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 ITEM DESCRIPTION OF PROPERTY E DATE OF DEATH s OF DECD•s EXCLUSION TAXABLE NUMBER � T �.ERECE+AHMORPVEOF THE DEED O D REWINT AND VALUE OF ASSET INTEREST IF APPLICABLE) VALUE 14 300 shares of Aberdeen Asia-Pac Prime Inc held in TD 2,367.00 100.000% 0.00 2,367.00 Amentrade Brokerage Account No.*0117-titled in the Eugene B.Scheer Living Trust;valued per letter date 2114/13 15 200 shares of Annaiy Capital Management Inc held In 2,974.00 100.000% 0.00 2.974.00 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 16 400 shares of Apex Silver Mines Ltd Ord held In 0.00 100.000010 0.00 0.00 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 17 400 shares of AT&T Inc held in Scottrade Brokerage 14,132.00 100.000% 0.00 14,132.00 Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement 18 Cash held in Scottrade Brokerage Account No.*243- 136,217.92 100.000% 0.00 136,217.92 tided in the Eugene B.Scheer Living Trust;valued per statement 19 Cash held In TD Ameri&ade Brokerage Account No. 18,547.99 100.000% 0.00 18,647.99 *0117-titled in the Eugene S.Scheer Living Trust; valued per letter date 2!14/13 20 400 shares of Cheniere Energy Inc held in Scottrade 8.620.00 100.000% 0.00 6,620.00 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust;valued per statement 21 300 shares of Chesapeake Granite Wash Tr hold in 5,592.00 100.000% 0.00 5,592.00 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement Copyright(c)2009 famr software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) Rev-1610 EX+("."I SCHEDULE G Pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE �a�+ INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECUS EXCLUSION TAXABLE NUMBER ITS D 4F TRANSFER SFE�RSATRE A ETRA i`F TtiE DEED FOR DECEDENT EsTAITE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 22 400 shares of Coca Cola Cc held in Scottrade 15,016.00 100.000% 0.00 15,016.00 Brokerage Account No.*243-titled In the Eugene B. Scheer Living Trust;valued per statement 23 100 shares of Crestwood Midstream Partners held in 2,582.00 100.000% 0.00 2,582.00 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 24 100 shares of Encana Corp held In Scottrade 1,932.00 100.000% 0.00 1,932.00 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust;valued per statement 25 16 shares of Engility Hidgs Inc held in TD Amerltmde 304.64 100.000% 0.00 304.64 Brokerage Account No.*0117-titled In the Eugene S. Scheer Living Trust;valued per letter date 2114113 26 30 shares of We Gold Tr She held in Scottrade 4,949.40 100.000% 0.00 4,949.40 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust valued per statement 27 100 shares of Etfs Palladium Tr Sh held in Scottrade 7,398.00 100.000% 0.00 7,398.00 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust;valued per statement 28 75 shares of Etfs Platinum Tr Sh Ben Int held in 12.424.50 100.000% 0.00 12,424.50 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 29 100 shares of Freeport McMoran Copper&Gold held 3,560.50 100.000% 0.00 3,560.50 In TD Ameritrade Brokerage Account No.*0117-titled In the Eugene B.Scheer Living Trust;valued per letter date 2114113 Copyright(c)2009 form software only The Lackner Group,Inc. Fonn PA-1500 Schedule 0(Rev.08.09) Rw4510 EX-("I SCHEDULE is pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Scheer, Eugene B. 21-13-0147 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD's NUMBER INCLUDE TRAFNSFTFsAf AASN A c0 Y O�DEPT FOUR R"L ES E. VALUE OF ASSET INTEREST (EXCLUSION TAXABLE E7 TVALUE 30 500 shares of Gamco Global Gold Nat Res held in 6,755.00 100.000% 0.00 6,755,00 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 31 100 sham of General Dynamics Corp held in TD 61569.50 100.000% 0.00 6,589.50 Ameritrade Brokerage Account No.*0117-titled in the Eugene B.Scheer Living Trust;valued per letter date 2114113 32 38,000 shares of Gold American Mining Corp held in 345.60 100.000% 0.00 345.60 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement 33 Gold coins located in safe deposit box-personal 144,735.00 100.000% 0.00 144,735.00 property titled in the Eugene B.Scheer Living Trust; valued per sales price 34 100 shares of Johnson&Johnson held in Scottrade 7,425.00 100.000% 0.00 7,425.00 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust;valued per statement 35 100 sham of Kellogg Co held In Scottrade Brokerage 5.878.00 100.000% 040 5,878.00 Account No.*243-tided in the Eugene B.Scheer Living Trust;valued per statement 36 1,000 shares of Kimber Resources Inc held in 380.00 100.000% 0.00 380.00 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement 37 100 shares of Kimberly Clark Carp held In Scothade 8,993.00 100.004% 0.00 8,993.00 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust;valued per statement Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule 0(Rev.08-09) Rov1510 EX+(00-06) . SCHEDULE 0 pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 ITEM ��ADNESCRIPTION OF PROPERTY EpE DATE OF DEATH %OF DECD`S EXCLUSION TAXABLE NUMBER THE NAVE OF TTRAN FER.SATTACi{A COPY OFTTH�E DEED FOR�EAI ESTATE. VALUE OF ASSET REST IF APPLICABLE) VALUE 38 1 share of Kinder Morgan Management held In TD 82.66 100.000% 0.00 82.66 Ameritrade Brokerage Account No.*0117-tided in the Eugene B.Scheer Living Trust;valued per letter date 2/14/13 39 100 shares of L-3 Communications Group held in TD 7,561.50 100.000% 0.00 7,561.50 Ameritrade Brokerage Account No.*0117-titled in the Eugene B.Scheer Living Trust;valued per letter date 2/14/13 40 50 shares of Lokheed Martin Corp held in Scottrade 4,354.00 100.000% 0.00 4,354.00 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust;valued per statement 41 200 shares of LRR Energy LP held in Scottrade 3,540.00 100.000% 0.00 3,540,00 Brokerage Account No.*243-titled in the Eugene B. Scheer Uving Trust;valued per statement 42 200 sham of Market Vectors Etf held in Scottrade 3,826.00 100.000% 0.00 3,826.00 Brokerage Account No.*243-tided in the Eugene B. Scheer Living Trust;valued per statement 43 401.893 shares of Mork Hard Currency Fund held in 4,987.49 100.000% 0100 4,987.49 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer Uving Trust;valued per statement 44 200 shares of Mesabi Tr Royalty Sh Ben int held in TD 4,945.00 100.000% 0.00 4,945.00 Ameritrade Brokerage Account No.*0117-titled in the Eugene B.Scheer Living Trust;valued per letter date 2/14113 45 Metro Bank Checking Account No.0513301507-titled 57,225.84 100.000% 0.00 57,225.84 In the Eugene B.Scheer Living Trust;valued per statement Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) Rw•1610 EX+(06.o6y SCHEDULE 0 Pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %of OECD•s EXCLUSION TAXABLE NUMBER 4E oAD� T&VEAt AT�TntvN A CoPrE�`F SDeEU a "EsTa4. VALUE OF ASSET INTEREST {IF APPLICABLE) VALUE 46 100 shares of Nestle S A Sport Adr held in TO 7,052.50 100.000% 0.00 7,052.50 Amerhmde Brokerage Account No.*0117-titled in the Eugene B.Scheer Living Trust;valued per letter data 2/14113 47 600 shares of Nord Amer Tankers Lmtd held in 5.220.00 100.000% 0.00 5,220.00 Scottrads Brokerage Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement 48 250 shares of Northrop Grumman Corp held In 16.290.00 100.000% 0.00 16,290.00 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 49 4,000 shares of Pacific Energy Resources held in 0.00 100.000% 0.80 0.00 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 50 200 shares of Procter&Gamble Company held in 15,114.00 100.000% 0.00 15,114.00 Scottade Brokerage Account No.*243-titled In the Eugene S.Scheer Living Trust;valued per statement 51 200 shares of Proshares Tr 11 Shrt Siiv held in 8,928.00 100.000% 0.00 8,928.00 Scottrade Brokerage Account No.*243-titled In the Eugene B.Scheer Living Trust;valued per statement 52 100 shares of Proshares Tr Pshs Ultsht held in 2,918.00 100.000% 0100 2,918.00 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement 53 200 sham of Proshares Tr Uitsht Oil held in 3,538.00 100.000% 0.00 3,538.00 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement Copyright{c}2009 form software only The Lackner Group,Inc. Form PA-1580 Schedule G(Rev.06-09) R6v-1610 EX+(0B-W) SCHEDULE 0 pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECUS EXCLUSION TAXABLE NUMBER THEE DATTE TROAt4SFTRERSAW n co FO EIEO Fo°ER RFEa�i ESTATE. VALUE OF ASSET CREST (IF APPLICABLE) VALUE 54 100 shares of Proshares Ultra SP500 held In Scottrade 4,809.00 100.000% 0.00 4,809.00 Brokerage Account No.*243-titled in the Eugene S. Scheer Living Trust;valued per statement 55 200 share of Proshares Ultrashort Euro held In TD 3,546.00 100.000% 0.00 3,646.00 Ameritrade Brokerage Account No.*0117-titled In the Eugene B.Scheer Living Trust;valued per letter date 2!14113 56 200 shares of Parshs DB Gold Doub Shrt Etn held in 896.00 100.000% 0.00 896.00 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer Living Trust;valued per statement 57 1,000 shares of Rubicon Minerals Corp held in 2,390.00 100.000% 0.00 2,390.00 Scottrade Brokerage Account No.*243-titled in the Eugene S.Scheer living Trust;valued per statement 58 400 shares of Teekay Lng Ptnm held in Scottrade 15,984.00 100.000% 0.00 15,984.00 Brokerage Account No.*243-tided in the Eugene B. Scheer Living Trust;valued per statement 59 1,200 shares of Thompson Creek Metals Co held in TD 4,884.00 100.000°/6 0.00 4.884.00 Ameritrade Brokerage Account No.*0117-titled in the Eugene B.Scheer Living Trust;valued per letter date 2!14113 60 100 shares of Transcanada Corp held In Scottrade 4,776.00 100.000% 0.00 4,776.00 Brokerage Account No.*243-titled in the Eugene B. Scheer Living Trust;valued per statement 61 100 shares of United Technologies Corp held in 81905.00 100.000% 0.00 8,905.00 Scottrade Brokerage Account No.*243-titled in the Eugene B.Scheer living Trust;valued per statement Copyright(c)2009 form software Only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) aEV.ta+l Ex«trooal pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RMDENT DECEDENT ANCE TAX RETURN ADMINISTRATIVE COSTS RESIDE ESTATE OF FILE NUMBER ScheerCEugene B. == 21-13-0147 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedules)attached 3115.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Cheryl L.Scheer Street Address 716 3rd Street NW city Rochester state MN zio 55901 Year(s)Commission Paid 251900.00 2. Attornev's Fees JamesaSmithEDietterick&ConnellyELLP 26x700.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Rio Relationship of Claimant to Decedent 4. Probate Fees 343.50 5. Accountant's Fees 8. Tax Return Preparer's Fees T Other Administrative Costs 3172.96 See continuation schadule(s)attached TOTAL(Also enter on line 9L R&capitulatton) 591331.46 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1508 Schedule H(Rev.10.09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Scheer, Eugene B. 21-13-0147 ITEM NUMBER DESCRIPTION AMOUNT Funeral ExR&W= 1 Myers-Harner Funeral Home,Inc.-funeral services 3,215.00 H-A 3,215.00 Other Administrative Casts 2 Cheryl Scheer,ExecutrixtTru stes-reimbursement for travel expenses&hotel for funeral and 1,512.04 Executrix appointment 3 Cheryl Scheer,ExecutrixlTrustee-reimbursement for travel expenses&hotel for safe 1,107.00 deposit box inventory 4 Cumberland Law Journal-estate notice publication fee 75.00 5 James,Smith,Dietterick&Connelly,LLP-reservation for trust estate administration 300.00 6 The Sentinel-estate notice publication fee 178.92 H-B7 3,172.96 i Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rw-1612 EX*!11.08! SCHEDULE I pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Scheer,Eugene B. 21-13-0147 Report debts incurred by the decedent prior to death that remained unpald at the dab of Math,Including unreimbursed nwmftW expends. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Aprla Healthcare-unnitimbrused medical equipment bill 41.40 2 Cabela's Club-credit card account 303.42 3 Country Meadows-apartment rent 140.78 4 Diamond Pharmacy-unreimbursed prescription bill 8.00 5 Eric G.Unger,DDS PC-unreimbursed dental bill 27.00 6 Harrisburg Pharmacy-unreimbureed prescription bill 12.00 7 Hospice of Central Pennsylvania-unreimbursed medical bill 1,125.00 8 James 1.McMillen MD-unreimbursed medical bill 102.68 9 Verizon-cellular phone bill 179.96 10 West Shore EMS-unreimbursed ambulance bill 202.21 11 West Shore Pathology-unreimbureed medical bill(lose reimbursement) 22.02 TOTAL(Also enter on Line 10,Recapitulation) 2,164.48 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Forth PA-1500 Schedule I(Rev.12-08) REV-1013 EXa(01.10) penneylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Scheer Eugene B. 12143-0147 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [Include outright spousal • distributions,and transfers under Sec.9116(a)(1.2)] 1 James J.McMillen Stepchild Gift 20,700.00 1001 S Market Street,Ste D Mechanicsburg,PA 17055 2 Anita Myrie Scheer Daughter 25%of the 170,906.35 11838 26th Avenue South,Apt 241 residue Seattle,WA 98168 3 Boyd Lawrence Scheer Son 25%of the 170,906.35 11516 31st Avenue NE residue Seattle,WA 98125 4 Cheryl Lynn Scheer Daughter 25%of the 170,906.34 716 3rd Street NW residue Rochester,MN 55901 5 Karl Adam Scheer Son 25%of the 170,906.35 310 21 at Avenue East residue Seattle,WA 98112 Total 704,325.39 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet as a ro nate. NON-TAXABLE DISTRIBUTIONS: u• A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)