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HomeMy WebLinkAbout05-29-15 12M 1505614134 EX(03-14)(FI) REV-1 500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 8 6 5 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDrM 0 9 0 3 2 0 1 4 0 6 1 3 1 9 3 7 Decedent's Last Name Suffix Decedent's First Name MI MCI NERNEY SUZANNE (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 a 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death Prior to 12-13-82) ❑ 4.Agriculture Exemption ❑ 5.Future Interest Compromise(date of ❑ 6. Federal Estate Tax Return Required (date of death on or after 7-1-2012) death after 12-12-82) 0 7.Decedent Died Testate ❑ 8.Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) ❑ 10.Litigation Proceeds Received ❑ 11. Non-Probate Transferee Return ❑ 12.Deferral/Election of Spousal Trusts (Schedule F and G Assets only) ❑ 13. Business Assets ❑ 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number D A V I D R GALLOWAY 71 7 697 4700 First Line of Address WALTERS & GALLOWAY , P L L C Second Line of Address 5 4 E MA I N S T City or Post Office State ZIP Code MECHAN I C S BU R G PA 1 7 0 5 5 Correspondent's e-mail address: David0waltersgalloway.com REGISTER OF WILLS USI�jLY r j G7 r1� C..n REGISTER OF WILLS USE ONLY DATE FILED MMDDYYW r N :Tl Tr "? co DATE FILED Sl_AMP __r: 'I. C) { c::) U) -rt PLEASE USE ORIGINAL FORM ONLY Side 1 1111111 VIII VIII VIII IIID VIII VIII VIII VIII VIII IN IN L 1505614134 1505614134 J 1505614234 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: SUZANNE MCINERNEY 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 and Notes Receivable(Schedule D) . . . . . . . . . . .. . . . . . . . . . . .. . . 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 1 8 2 7 8 9 . 3 9 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 4 5 4 0 .8 . 1 2 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 2 6 0 7 2 . 9 0 (Schedule G) [:] Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 2 5 4 2 7 0 . 4 1 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 5 2 5 1 0 . 7 2 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) .. .. . . . . . . . . . 10. 2 6 8 7 . 8 1 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . .. .. .. . ... . . . . . . . 11. 5 5 1 9 8 . 5 3 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . .. .. . . . . . . . . . . . 12. 1 9 9 0 7 1 . 8 8 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. 1 9 9 0 7 1 . 8 8 TAX CALCULATION-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. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.045 1 9 9 0 7 1 . 8 8 16, 8 9 5 8 . 2 3 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . .. . . . .. . . . . . . .. .. . . . . . . . .. .. . . . . .. . . . . . . . . . . . . . . . 19. 8 9 5 8 . 2 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATURE OF PER SP IBL ILING DATE ADDRESS STEPHEN A. SCHREIBER 6361 MCCALLUM ST PHILADELPHIA PA 19144 SIGNATURE FPR THEIR THAN PERSON RESPONSIBLE FOR FILING THE RETURN E ADDRESS DAVID R. GAL60WAY 54 E. MAIN ST. MECHANICSBURG PA 17055 1111111111111111111111111111111111111111111 Side 2 1505614234 1505614234 REV-1500 EX (FI) Page 3 Fite Number Decedent's Complete Address: 21 14 0865 DECEDENTS NAME SUZANNE MCINERNEY STREET ADDRESS 4831 E.TRINDLE RD. CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: t. Tax Due(Page 2,Line 19) (1) 8,958.23 2. Credits/Payments A.Prior Payments B.Discount (See instructions.) Total Credits(A+B) (2) 0.00 3. Interest (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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 8,958.23 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 ...................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X c. retain a reversionary interest ..................................................................................................... ❑ IZI d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑Q 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ X❑ 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?.................................................................................................. 191 ❑ 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 Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a step-parent of the child is 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 4.5 percent,except as noted in [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 12 percent[72 P.S.§9116(a)(1.3)].A sibling 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-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: SUZANNE MCINERNEY 21 14 0865 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. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 21 OLD CEMETARY RD. BREWSTER, MA 02631 TOTAL(Also enter on Line 1,Recapitulation.) $ If more space is needed,use additional sheets of paper of the same size. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: SUZANNE MCINERNEY 21 14 0865 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TD BANK 147,789.39 CHECKING-Acct x6687 2. SETTLEMENT 35,000.00 ESTATE OF THEODORE C. FRAZEUR See Attached Statement of Dispute TOTAL(Also enter on Line 5,Recapitulation) $ 182 789.39 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: SUZANNE MCINERNEY 21 14 0865 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. STEPHEN A. SCHREIBER 6361 MCCALLUM ST. SON PHILADELPHIA, PA 19144 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 7/3/10 CAPE COD 5 90,816.23 50. 45,408.12 CHECKING ACCOUNT x8190 TOTAL(Also enter on Line 6,Recapitulation) $ 45 408.12 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER SUZANNE MCINERNEY 21 14 0865 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE 1. TIAA CREF 26,072.90 100.00 26,072.90 Beneficiary-Stephen Schreiber, Son TOTAL (Also enter on Line 7,Recapitulation) $ 26 072.90 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER SUZANNE MCINERNEY 21 14 0865 Decedent's debts must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS BUHRIG FUNERAL HOME&CREMATORY 31,119.44 DEATH AND SERVICE IN PENNSYLVANIA SERVICE AND BURIAL IN MASSACHUSETTS B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) STEPHEN A. SCHREIBER 10,628.00 Street Address 6361 MCCALLUM ST. City PHILADELPHIA State PA ZIP 19144 Year(s)Commission Paid: 2. Attorney Fees: WALTERS&GALLOWAY, PLLC (Reserved) 9,000.00 3. Family Exemption:(If decedents address is not the same as claimant's,attach explanation.) Claimant NONE Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS, CUMBERLAND COUNTY 370.50 5 Accountant Fees: FIDUCIARY RETURN (Reserved) 1,000.00 & Tax Return Preparer Fees: NONE 0.00 7. REGISTER OF WILLS, CUMBERLAND COUNTY-ISSUE EXEMPLIFIED LETTERS 40.00 8. THE PATRIOT NEWS-ESTATE NOTICE 177.78 9. CUMERLAND LAW JOURNAL- ESTATE NOTICE 75.00 10. FEDERAL EXPRESS-Distribution to Beneficiaries(Reserved) 100.00 TOTAL(Also enter on Line 9,Recapitulation) $ 52 510.72 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER SUZANNE MCINERNEY 21 14 0865 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. HOLY SPIRIT EMS 1,292.46 AMBULANCE 2. CENTRAL MEDICAL EQUIPMENT CO. 8.46 WHEEL CHAIR 3. COUNTRY MEADOWS AT HOME 1,295.49 NURSING HOME 4. DIAMOND PHARMACY 63.63 MEDICINE 5. HOLY SPIRIT HOSPITAL 27.77 MEDICINE TOTAL(Also enter on Line 10,Recapitulation) $ 2,687.81 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: SUZANNE MCINERNEY 21 14 0865 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. STEPHEN A. SCHREIBER Lineal 0.17 6361 MCCALLUM ST. PHILADELPHIA, PA 19144 2. RONDA SCHREIBER Lineal 0.17 14590 CRESTLINE DR. POWAY, CA 92064 3. ANNE SCHREIBER Lineal 0.17 264 WILLINGTON WAY OSWEGO, IL 60543 4. DAVID SCHREIBER Lineal 0.17 11357 TENINO AVE. LOS ANGELES, CA 90066 5. KATHLEEN ZIMMERMAN Lineal 0.17 229 CHEROKEE DR. MECHANICSBURG, PA 17050 6. JOHN MCINERNEY Lineal 0.17 19 FAIRFAX LANE ANNVILLE, PA 17003 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 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. $ If more space is needed,use additional sheets of paper of the same size.