HomeMy WebLinkAbout08-28-06
REV-1500 EX (6-00) OFFICW. USE ONLY
COMMONWEAL TH OF REV -1500
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FilE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ~L - ~~ 1067 ___
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE:: INITIAL) SOCIAL SECURITY NUMBER
I- Schaedler Thomas Jr. J 186-34-1828
z
w DATE OF DIOATH (MM-DD-YEAR) i DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
a I 11/15/1944 REGISTER OF WILLS
w 11/27/2005
(J
w (IF APPlICJ\BlE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
a
Rosemary A. Schaedler
W CXJ 1 Original Return D 2. SuppleMental Return D 3. Remainder Return (date of death pnor to 12-13-821
f-
<l:Ul'D
:':12:.:
Ua..U
WOO
::r:a::...J
Ua..ClJ
a..
<l:
CXJ 6. Decedent Died Testate (Attach copy 0(',",1,11)
D 9. litigation Proceeds Received
D 7. Decedent Maintamed a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-'-95) D 11. Election to tax under Sec. 9113(A) (Allaen Sen 0)
4. Limited Estate
D
4a. Future Interest Compromise (date of death after 12-12-82)
[XJ
5. Federal Estate Tax Return Required
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ffi NAME I COMPLETE MAILING ADDRESS
~ Robert R Church, Esq. . P.O. Box 11963
~ FIRM NAIYIE (If Applicable)
rJ)
~ Keefe,r Wood Allen & Rahal, LLP Harrisburg, PA 17108-1963
0::
o TELEPHONE NUMBER
u
717-2:55-8059
I
I 1 Real Estate (Schedule A) (1)
I 2 Stock" and Bonds (Schedule B) (2)
3 Closely Held Corporation, Partnership or Scie-Proprietorshlp (3)
4. Mortgages & Notes Receivable (Schedule 0) (4)
5 Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6 Jointly Owned Property (Schedule F) (6)
0 i'
f.: L_J Separate Billing Requested
:3 7. Inter-VIvos Transfers & Miscellaneous Non-i'robate Property (7)
::J (SchEdule G or l)
!::
a.. 8 Total Gross Assets (total Lines ,--,
<l:
(J
W 9. Funeral Expenses & Administrative Costs . Scnedule H) (3)
0:::
10. Debts of Decedent, Mortgage Liab,li:les & 'L,ens (Schedule I) (10)
11 Totai Deductions (total lines 9 '" 10)
o
8,613
1,471,597
291,057
219,906
o
OFFICW. USE ONLY
621,575
2,612,748
II 12. Net Value of Estate (line 8 minus _ine 11)
13 Charitable and Governmental Bequests/See 9113 Trusts for Nh'Ch an election to tax has not been
, made (Schedule J)
1,4. N:t-Value Subject to Tax (line 12 minus ~.ne 13)
~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Ii 15. Amount of line 14 taxable at the spousal tax
Z rate, or transfers under Sec. 9116 (a)(1.2:
o
~ 16 Amount of Line 14 taxable at lineal rate
I-
::J
a.. 17. Amcunt of line 14 taxable at Sibling rate
~ 1, a Amcunt of Line 1 d taxable at cciia'era, ra18___________.
<l:1
I- l' 9 Tax Due
120 [J
67,020
2,545,728
279,999
2,265,729
1,084,065
x .0
L(15)
45 (16)
o
1,181,664
x .0
o
x 12
(17)
53,175
o
o
(19)
o
53,175
x 15
(18)
. .
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
RE'/.1500 EX (6-00) , OFFK;W. USE ONLY
COMMONWEALTH OF REV-1500
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ~L - ~L 1067 ___
COUN1Y CODE YEAR NUMBER
I DECEDENTS NAME (LAST FIRST, AND MIDCL:= INITIAL) SOCIAL SECURI1Y NUMBER
I- Jr. J 186-34-1828
z Schaedler Thomas
w DATE OF DEATH (MM-DD-YEAR) i DATE OF BIRTH IMM-DD-YEAR) THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
0 I
w 11/27/2005 11/15/1944 REGISTER OF WILLS
u
LU (IF APPUC"'BLE) SURVIVING SPOUSES NAME (LAST, FIRST. AND MIDDLE INITIAL) SOCIAL SECURI1Y NUMBER
0
Rosemary A. Schaedler 172-36-0874
w X " I
l- ,001
::,::~UJln
uO::::':: U4
wa.u
Onglnal Return
D 2. _upplellenta. Peturn
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 3 Remamder Return (date of death pnor to 12-13-82,
[XJ 5. Federal Estate Tax Return Required
limited Estate
J: 00 [X] 6. Decedent Died Testate (Attach copy of 'N,iI) D 7. Decedent Maintained a Living Trust (Attach copy oITrust) L 8. Total Number of Safe Deposit Boxes
uO::...J
a. CD D D 10. Spousal Poverty Credit (dale of death be'ween 12-31.91 ard 1-1-95) D 11. Election to tax under Sec. 9113(A) (A11a"" Sch 0)
a. Li:igation Proceeds Received
<( 9.
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
I- NAME I COMPLETE MAILING ADDRESS
z
w
0 Robert R Church, Esq.
z P.O. Box 11963
0 FIRM NArvlE (If Applicable)
Cl.
rn
w Keefer Wood Allen & Rahal, LLP Harrisburg, PA 17108-1963
Cl:
Cl:
0 TELEPHO/\E NUMBER
u
717-255-8059
1 Real Estate (Schedule A)
(1)
o
OFFICW. USE ONLY
(5
8,613
1,471,597
291,057
219,906
o
2. Stocks and Bonds (Schedule B)
(21
3 Closely Held Corporation, Partnership cr Sc,e-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D)
Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(4 I
z
o
i=
:5
:::l
l-
e:
<(
u
LU
c:::
I
I
I' 7. Inter-Vivos Transfers & Miscellaceou5 Noc-?robate Properly (7:
(Schedule G or L)
I 8. Total Gross Assets (total Lines 1-71
9. Funeral Expenses & Administrative '::osts SC.1edule H)
I
I :: :::: :::":::::::,:::::::, ~':""; , "0' ,,~""'" "0.
112. Net Value of Estate (Line 8 min'"" _Ine 1',)
13 Charitable and Governmental 3equests,Sec 9113 Trusts for which an eleclion 10 tax has nol been
! made (Schedule JI
i
I
\14 Net Value Subject to Tax (Line 12 rllnus~.ne 13)
6 Jointly Owned Property (Schedule F)
"----'u
Separate Billing Requested
(6
621,575
2,612,748
(9)
67,020
2,545,728
279r999
2,265,729
SEE INSTRUCTIONS ON REVERS" SIDE FOR APPLICABLE RATES
! 15. Amoun: of Line 14 taxable at the
5 I rate, or transfers under Sec. 9116
g 116 Amount of line 14 taxable at lineal rate
~ I:: :::::: :;~;:::: ::::~[i::tt::,':t:::,t:J:e__~____~___
~I
~ 119 T~~le
~
:ax
1,084,065
o
o
x .0 L(15)
x 0 ~(16)
x .12 (17)
x 15 (18)
(19)
o
2:
1,181,664
53,175
o
o
53,175
-, .
. .
.
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
Estate .::If Thomas Jr. J Schaedler
186-34-1828
Executo:rs
Name
Address
Tax ID
(Page 1)
Rosemary A. Schaedler
40 Golfview Road
Camp Hill, PA 17011-
172-36-0874
Decedent's Complete Address:
I STREET ADDRESS
I 40 Golfview Road
I Cumberland County
ICI1Y
Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
I STATE
PA
I ZIP
17011
(1 )
53,175
o
46,075
2~
Total Credits (A + B + C) (2)
48,500
3. InterestlPenalty if applicable
D. Interest
E. Penalty
o
o
Total Interest/Penalty (D + E) (3)
o
4. If line 2 is greater than line 1 + li:-8 3. enter the difference This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
o
5. If Line 1 + Line 3 is grea:er :rar: _~e 2 enter the differe0ce. This is the TAX DUE. (5)
4,675
A. Enter the interest on the tax due. (SA)
o
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
4,675
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did deceden: maKe a :cansfer and'
a retain the use or ,~come of the property transferred:. . . . . . . . . . . . . . .
b retain the right !O ceslgnate who shall use the property transferred or its income: .
c. retain a reversionarj' interest: or . . . . . . . . . . . . . . .
d. receive the promise ;or life of either payments. benefits or care?
2. If death occurred after December 12. 1 S82. did decedent transfer property within one year of death
without recelv'ng acec~ate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an .~ trust for" or payabie upon death bank account or security at his or her death?
4. Old decedent cwn arc -dividual Retirement Account. annuity. or other non-probate property which
contains a beneficia:! :esignation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [X] D
IF THE ANSWER TO ANY OF THE A30VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties (If perJury, I declare th3: i :- ,"',~ ;;x3:~:, ~ ~ ::-,,5 return. inc:ud:r;;; ac:::,f:i::;ar"ilrig schedules and statements. and to the best of my knowledge and belief. It is true, correct and complete
DeclaratIon of pf\:~parer other than the ::'2:5;':"',;::1 -::::-:~S.:;-:3::,..e jS ':Jased on ",;1 r.fcrmat.'::Jn :r '...-niGh p,eparer has any Knowledge.
SIGNATURE OF PERSON RESPONSI3l" FeR FIl,'.:; RETURN
Yes No
D og
[J og
D U
D U
D ~
D ~
~[)b
Rosemar' A. Schaedler, Executor
ADDRESS .
40 Golfview Road
SIGNATURE OF PREPARER OTHER i ri"'~. REPR::S::'HA TIVE
DATE
8' -2 5""~ 0 (p
Robert R. Church, Esq
ADDRESS
Keefer vlood Allen & Rahal, LLP, PO Box
11963, Harrisburg, FA 17108-1963
For dates of death on or aft<::r July 1 1 ;.S~ arc : ~:C1r2 January 1 ~ 995 the :ax rate imposed on the net value of transfers to or for the use of the surviving spouse IS 3%
[72 P.S. S 9916 (a) (11) (i)]
For dates of death on or after Januoc'j 1 199:: .." tax rate imposed on the net ';alue of translers to orlor the use of the surviving spouse is 0% [72 PS. S 9116 (a) (1 1) (ii)]
The statute does not exempt a transftJ to a s:.r ..;ng spouse from tax and the statutory requirements for disclosure of assets and filing a tax return are still app~icable even if
the surviving spouse IS the only beneficanj
For dates of death on or after July 1. 2COO
The tax rate imposed on the net value of :ranS:2'S Irom a deceased child twenty-one years 01 age or younger at death to or for the use of a natural parent. an adoptive parent,
or a stepparent of the child Is 0% [72 PS S 911"." i 12)]
The tax rate imposed on the net value of :rans'".s to or for the use 01 the decedent's lineal beneficiaries is 4.5%, except as noted In 72 P.S 39116(1.2) [72 P.S. S 9116(a)(1)]
The tax rate Imposed on the net value of !earsle,s :0 or for the use of the decedent's Siblings is 12% (72 P.S. 3 9116(a)(1.3)1. A sibling is defined. under Section 9102. as an
indiVidual who ras at least one parent In :orr"c-:-, With the decedent. whether by blood or adoption.
3W4646 1000
REV-1503 EX. (6-9<1)
COMMONlNEALTH OF PENNSYLVANiA
INHERITt\NCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Thomas Jl::. J. Schaedler
21 05 1067
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM I
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. 155.4952 Shares
,Hershey Co., NYSS
held. in Mellon Investor Services
Account # 12483173984
CUSIP: 427866108
Dividend accrued on 11/27/2005
8,575
38
TOTAL (Also enter on line 2. Recapitulation) $
8,613
3W46961.000
,if more space IS needed insert additional sheets of the same size)
REV-1504 EX + (6-98)
COMMONWEALTH OF PENNSYLVANiA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C
CLOSEL Y.HELD CORPORATION,
PARTNERSHIP OR SOlE.PROPRIETORSHIP
FILE NUMBER
Thomas Jr. J. Schaedler
21051067
Schedule C-1 or C-2 (inciud,cg ail suppertlng information) reust be attached for each closely-held corporation/partnership interest of the decedent. other than a
sole-proprietorship. See Ins:ruct,ons for :he supporting information to be submitted for sole-Prophetorships.
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
8,695.39 Shares
Schaedler Yesco Distribution,
Inc., a closely-held corporation
in l/,hich the deceden t owned an
11.333% interest. The decedent's
shares were valued according to
the attached appraisal pprepared
by Empire Valuation, LLC, using
the same methodology applied each
year in valuing these shares for
the company's ESOP.
Dividend accrued on 11/27/2005
1,452,130
19,467
3W4697 1 000
TOTAL (Also enter on line 3. Recapitulation)
(If more space is reeded. insert additional sheets of the same size)
$
1,471,597
REV.15G5 EX' (6-96)
COMMON\MEAL TH OF PENNSYLVANIA
INHEHITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
FILE NUMBER
Thomas Jr. J. Schaedler
21 05 1067
Address 951 S. 13th Street
State of Incorporation Pennsylvania
Date of Incorporation 7 /1/1944
1. Name of Corporation Scaed1er Yesco Distribution / Inc
City HaJ:risburg
State PA
Zip Code 17104
Total Number of Shareholders
4
2. Federal Employer 1.0 Number .23-1486799
3. Type of Business Wholesale distributio
Business Reporting Year 12/31/2005
Product/Service Electrical Supplies
4.
I STOCK I
I
commo'~
Preferred I
TYPE
Voting/Non-Voting
I TOTAL NUMBER OF
ISHARES OUTSTANDING
I
PAR VALUE
NUMBER OF SHARES VALUE OF THE
OWNED BY THE DECEDENT DECEDENT'S STOCK
8 , 6951 $ 1,452,130
1$
Voting
i
I
76/723;
!
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation~ . . . . . . . . . . . . . . . . . . . . . . . . 00 Yes
o No
if yes, Position Vice President
Annual Salary S
105 , 000 Time Devoted to Business 100%
6.
Was the Corporation indebted to the decedent? .
. 00 Yes
o No
If yes, provide amount of indebtedness S
288,000
7 Was there life insurance payable to the corporation upon the death of the decedent?
DYes 00 No
if yes, Cash Surrender Value S
o
Net proceeds payable $
o
Owner of the policy
8. Did the decedent sell or transfer a,~! sto:::,~ In this company within one year prior to death or within two years if the date of death was prior to 12-31-82?
DYes [RJ No If yes, Transfer 0 Sale Number of Shares 0
Transferee or Purchaser Consideration $ 0 Date
Attach a s=parate sheet for add:ticr&i 'racsfers ar,CiQr sales
9. Was there a written sharenolder's agreement In effect at the time of the decedent's death? . [RJ Yes
o No
If yes, provide a copy of the ag:eement
10 Was the decedent's stock sold? . . . .
. . . . . ... ..... . ...... .. . DYes
[}9 No
If yes, provide a copy of the agree,ment of sale, etc.
11. Was the corporation dissolved or iiql;:dated after the decedent's death? . . . . . . . . . . .. 0 Yes
~No
If yes, provide a breakdown of dls'riblittons received by the estate, including dates and amounts received.
12. Did the corporation have an Interest in other corporations or partnerships? . . . . . . . . . . .0 Yes
00 No
If yes, report the necessary infcrmat:on on a separate sheet, including a Schedule C-1 or C-2 for each interest.
. THE FO~OV'4~G)t.I~~RMATIOt" MUST BE SUBMITIED WITH THIS SCHEDULE
A. Detailed calculations used in the valuatlcn of the decedent's stock
B. Complete copies of financial statenoec,ts cr Federal Corpora~e Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C If the corporation owned real estate s~bmlt a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, altach copies.
D. lis! of prin~ipal stockholders at tr.e :::a:e of death, number 0; shares held and their relationship to the decedent.
E List of officers, their salaries, bonuses a,~d any other benefits received from the corporation.
F. Statement of dividends paid each jea- List those declared ard unpaid
G. Any other information relating to the n',ua::on of the decedent's stock.
~f more space is needed. Insert additional sheets of the same size)
4W46961.000
REV-1507 EX + (6.S8)
COMMONWEAL TH OF PENNSYLVANIA
INHEI~ITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomas Jr. J. Schaedler
SCHEDULE 0
MORTGAGES & NOTES
RECENABLE
FILE NUMBER
21 05 1067
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 Schaedler Yesco 6% Promissory Note
dated August 27,1999. $288,000
principal balance at date of
de,ath.
Interest accrued to 11/27/2005
288,000
3,057
~
TOTAL (Also enter on line 4. Recapitulation) $
291,057
3W46AC 1000
(If more space IS needed. insert additional sheets of same size)
REV-1508 EX' 16-9<l)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Thomas Jr. J. Schaedler
FILE NUMBER
21 05 1067
Incluee the proceeCs of litigation and the date the proceeds were received by the estate.
All property jointlY-Dwned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DE"CRIPTION
VALUE AT DATE
OF DEATH
3W46AD 1 000
1
$1,250,000 Guardian Life Policy
#3699005 on life of James
Schaedler. This was a
cross-purchase life 1nsurance
policy that was owned by the
decedent, valued at the
in1:erpolated terminal reserve
value on date of death
126,049
2
$700,000 Guardian Life Policy
#3699087 on life of Henry
Schaedler. This is a
cross-purchase life insurance
policy that was owned by decedent,
valued at the interpolated
tel~inal reserve value on date of
I death.
I
2005 1040 Federal Income Tax
Re1:urn refund due from US Treasury
8,883
76,871
3
4
2005 PA-40 Income Tax Refund from
PA Dept. of Revenue
106
5
Johns Hopkins Hospital
I refund of insurance co-pay
25
6
Schaedler Yesco Final Paycheck for
pay periood ending 11/28/05 due
dec:eden t
2,607
7
Schaedler Yesco Post-mortem Salary
Continuation Payment for Rosemary
A Schaedler for pay period ending
12/12/05.
2,693
8
i
I
I
I
I
I
I
i
I
I
$1
219,906
Schaedler Yesco Post-mortem Salary
Continuation for Rosemary A
Schaedler for pay period ending
12/26/05
2,672
TOT AL (Also enter on line 5. Recapitulation)
I'f more Sea:e IS needed. Insert additional sheets of the same size)
REV.15'Q EX. (6-SS)
COMMONV-IEAL TH OF PENNSYLVANIA
INHEHITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomas Jr. J. Schaedler
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 05 1067
This schedule must be completed anc f,ied if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROP::::RiY I
ITEM Ir-a.LCE Tl-€ NAME:)F TH: TRANSFE.~=:~, --;E:~ c,:.::'-.A -;- :. ~:,...,? 7:) DECEDE~T ;",'.c I DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER T'l-€ OATECF T'F"..ANSFER ,ATTAO-., -~?':' CF - HE :::E:;:: ~:R REAL ESTAT::: VALUE OF ASSET INTEREST IIF APPLICABLE' VAlUE
I. New England Financial Rollover
IRA Contract # V229515
(Val:,iab1e Annuity)
DOD Balance $124,172
BenE~ficiary : Rosemary A.
Schaedler 124/172 100.0000 0 124/172
2 Schaedler Yesco 401 K Account,
I including profit sharing and
employer matching
BenE!ficiary: Rosemary A.
Schaedler
DOD Value $469/629.36 4691629 100.0000 0 469/629
3 Schc:Ledler Yesco Distributionl
Inc'l ESOP Account including
166.3137 shares of Schaedler
Yesco closely-held stock valued
at $167 per share per attached
appJ:'aisal of Empire Valuation 1
LLC.
Beneficiary: Rosemary A.
Schaedler 27/774 100.0000 0 27/774
\
,
!
i
!
,
I
I
i
I
TOT AL (Also enter on line 7, Recapitulation) $ 621 575
:;'~~ore space IS ;"eed,~d. Insert additional sheets of the same size)
3W46AF 1 000
REV-1511 EX. (12-99)
COMMON'NEAL TH OF PENNSYLVANIA
INHEHITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Thomas ,Jr. J. Schaedler
FILE NUMBER
21 05 1067
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
FUNERAL EXPENSES
A.
1
Neill Funeral Home
funeral services
9,327
B.
ADMINISTRATIVE COS7S
Personal Representative s Comrcllssions
Name of Personal Representative(s) Rosemary A. Schaedler
Social Security Number(si I EIN Number of Personal Representative(s)
Street Address 40 Golfview Road
City Camp Hill
State PA
Zip 17011
Year(s) Commission Paid
2.
Attorney Fees
30,000
3. Family Exemption: (If deceaen~'s address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State WY
Zip
Relationship of Cla,,,,s,1t ~o Decedent
4.
Probate Fees
733
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Keefer Wood Allen & Rahal, LLP
reimbursement for expenses
advanced
114
Total from continuation schedules
1,000
-~
3W46AG 1000
TOT AL (Also enter on line 9, Recapitulation)
.If more space IS needed, insert additional sheets of the same size)
$
41,174
Estate of: Thomas Jr. J. Schaedler
186-34-1828
Schedule H Part 7 (Page 2)
2
Keefer Wood Allen & Rahal, LLP
reserve for estimated
administrative expenses
1,000
Total (Carry forward to ma~n schedule)
1,000
REV-1512 EX + (1,'-C3)
COMMONVVEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomas Jr. J. Schaedler
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 05 1067
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
2
Holy Spirit Hospital
hospital bill
!PA Dept of Revenue
pa~~ent on 4th quarter PA-40ES
taxes for decedent
256
2,030
3
US Treasury
pa~~ent of 4th quarter 1040ES
taxes for decedent
22,600
4
Wes:t Shore Local Income Tax
ta~:es due for deceden t
960
~
3W46AH 2.000
TOT AL (Also enter on line 10, Recapitulation) $
(if more space IS needed insert additional sheets of the same size)
25,846
REV-15~3 EX.. (S'-OO)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVA.NiA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thomas
;Tr. J. Schaedler
NUMBER
I
NAME AND ADDRESS C F PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [ir,eJude outright spousal distributions, and transfers
under See 9116 (a) (1.2)]
Elizabeth A. Schaedler
3960 Elmerton Avenue
Harrisburg, FA 17109
I
General Bequests: 1,000,000
1
2
Rosemary A. Schaedler
40 Golfview Road
Camp Hill, FA 17011
1100% Residue: 1,084,065
FILE NUMBER
21 05 1067
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Daughter
Surviving Spouse
1,000,000
1,084,065
ENTER DOLLAR AMOUNTS FOR D',STRIBUTIONS S-lOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUT,ONS
A SPOUSAL DISTRIBUTiONS U>.:::':R SECTION 9113 FOR WHICH AN ELECTION ,r, TAX IS NOT BEING MADE
B. CHARITABLE AND GC\jEqN~:::':'nAL DISTRIBUTIONS
I
TOTAL OF PART II - ENTC:R TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $
(If more space s needed, insert additional sheets of the same size)
3W46AI 1 000
279,999
Estate of: Thomas Jr. J. Schaedler
Schedule J Part 1 (Page 2)
Item
No. Description
3 Thomas J Schaedler Jr Bypass Trust
under Will
Robt R Church & Rosemary
Schaedler, CoTTee
PO Box 11963
Harrisburg, PA 17108-1963
General Bequests: 461,663
Trust
186-34-1828
Relation
Amount
461,663
REV-1514 EX+ (12-03)
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
COMMONWEALTH OF PENNSYLVANIA
INHERITN;CE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Check Box 4 on REV-1500 Cover Sheet
FILE NUMBER
Thomas Jr. J. Schaedler 21 05 1067
This schedule, is to be used for all single Lfe, joint or succeSSive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue. Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
~ Will [J lntervivos Deed of Trust D Other
~ ~#[; P, .4" ~UFEESTATEINTERESTCALCULATION
IIIAME(S) OF LIFE TENANT(S)
I
i DATE OF BIRTH
NEAREST AGE AT
DATE OF DEATH
TERM OF YEARS
LIFE ESTATE IS PAYABLE
Rosemary 1~. Schaedler
02/08/1946
59
Term of Years
Term of Years
Term of Years
Term of Years
1. Value of fund from which life estate is payable
2 Actuarial f;:lctor per appropriate :able . . . . .
Interest table rate - L 3 1/2% = 6% LJ 10%
3. Value of IWe estate (Line 1 multiplied by Line 2)
$
Term of Years
461,663
0.60650
IXl Variable Rate 5.00000%
$
279,999
. y, : - i ANNUITY INTEREST CALCULATION
NJIME(S) OF LIFE ANNUITANT(S)
I
DATE OF BIRTH I NEAREST AGE AT
DATE OF DEATH
TERM OF YEARS
ANNUITY IS PAYABLE
Term of Years
Term of Years
Term of Years
1. Value of fund from which annuit/s payable . . . . . . . . . . . . . . .
2. Check appropriate block below a.,d e..,ter corresponding (number) . . . . . .
Frequency of payout -0 Wee"y'S2 . ~ Bi-weekly (21)1 I I Monthly (12)
o Quarterly (4) 0 Semi-ann"ai.y (2) ~ Annually (1) ,--.-J OtherQ )
3. Amount 0" payout per period ..............
4. AggregatEl annual payment Line 2 mc;!Lpl1ed by Line 3
5. Annuity Factor (see instructions;
Interest tclble rate -LJ 3 1/2% = 5~(J I~ 10S'J D Variable Rate 0.00000 %
6. Adjustment Factor (see instructlc~S) ...................................
7. Value of annuity -If using 3 1/2'/, 6% '0%, or if variable rate and period
payout is at end of period caiclJation is. Line 4 x Line 5 x Line 6 . . . . .
If using variable rate and period payout :s at beginning of period. calculation is:
(Line 4 x Line 5 x Line 6) + Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
I n Life or
$
o Term of Years
o
0.000
o
$
o
o
0.00000
0.00000
. . . . . . . . . . . . $
o
o
NOTE: The values of the funds whic'l create the above future interests must be reported as part of the estate assets on Schedules A through
G of this tax return. The resulting :,:e or annuity Interes:(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18
If more space is needed. Insert additional sheets of the same size)
3W46AJ 3 GOO
REV-t649 EX' (6-ge)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
SPOUSAL DISTRIBUTIONS
ESTATE OF FILE NUMBER
Thomas Jr. J. Schaedler 21 05 1067
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act.
If the election applies to more than cne trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Bypass (Credit Shelter) Trust (marital, residual, A, B, By-pass, Unified Credit, etc.)
If a trust or similar arrangement meets the requirements of Section 9113iA). and'
a, The trust or Similar arrangement is listed In Schedule 0, and
b. Th,~ value of the trust or similar arrange~ent is entered In 'I.'hole or In part as an asset on Schedule 0,
then the transferor's persenal re~resentative '''i i s::ecilcaiiy ident.r!, tee trust la:1 or a fraelicnal portion or percentage) to be included in the election to have such trust or sim-
ilar property treated as a taxable transfer in this estate If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O. the personal
representative shall be considered to have made the election only as to a fraction ef the trust or Similar arrangement. The numerator of this fraction is equal to the amount of
the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the tnust or similar arrangement.
PART A: Enter the description and value of all interests. both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113(A) trust or similar arrangement.
DeSCription
VALUE
Bypass (Credit Shelter)
under Will of Thomas J.
Jr., for the benefit of
A. Schaedler, surviving
Trust
Schaedler,
Rosemary
spouse
461,663
Part A Total $ 461,663
PART B: Enter the desGrlDtion and,a,ue of all interests ncluded in Part A for which the Section 9113 A election to tax is bein made.
Description
Value
Bypass (Credit Shelter) Trust
under Will of Thomas J. Schaedler,
Jr., for the benefit of Rosemary
A. Schaedler, surviving spouse
461,663
P," B To"l
461,663
3W46E2 2 000
(If more space is needed, insert additional sheets of the same size)