HomeMy WebLinkAbout01-12-07 (2)
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes w
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
/ <?;4 /2. 4: {,~ I
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
^ 107.
VOG I '1-
Date of Birth
/ :Lo 4;;1.. a a ~
, 9 I <1
Decedent's Last Name
Suffix
Decedent's First Name
MI
'-H- .F~LM.' A'
N\
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Sp'~use's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
FILL IN APPROPRIATE OVALS BELOW
.. 1. Original Return ~
2. Supplemental Return
~
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
_ 4. Limited Estate ~
4a. Future Interest Compromise (date of
death after 12-12-82)
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)
~
-<::) 6. Decedent Died Testate 1:3
(Attach Copy of Will)
<=:) 9. Litigation Proceeds Received <=:)
o
1\"
8. Tofal Number of Safe Deposit Boxes
<=:)
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Da time Telephone Number
1f'7P
REGISTER OF WILLS USE ONLY I
RECORDED OFFICE OF
REGISTER OF \v1LLS
2007 JAN 12 PM 3:31 ,
CLERK OF )i~
ORPH.\NS' COURT'
CUMBERL\ND CO" P.\
I
~
Firm Name (If Applicable)
First line of address
IIN
Second line of address
State
DATE FILED
City or Post Office
.,
Hlt-R-t-/ S IS IJ.t2-G
PA
Correspondent's e-mail address:
JiV,-s-heate-r (,,\ I/~,,~. neJ-
Under penalties of pe~ury, I declare that 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 personal representative is based on all information of which preparer has any knowledge.
DATE
ai-I 0 "~<J7
DATE
A
.
ADDRESS '"
#tt,r-r/s VI"7
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,/
/111~
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
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15056052048
REV-1500 EX
Decedent's Name:
.._.._~_.._._-
Decedent's Social Security Number
I f '-f I ~-I fa.".(
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.
6. Jointly Owned Property (Schedule F) c:::::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::::> Separate Billing Requested. . . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . .
. . .... .. .... .... 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). .. .. ...... .. ....... .............. . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 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.
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_ .
16. Amount of Line 14 taxable
at lineal rate X.O ~ !5 . 3 "
17. Amount of Line 14 taxable
at sibling rate X .12 .
18. Amount of Line 14 taxable
at collateral rate X .15 .
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
NAPD
\ 4]..-6 7
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Side 2
48
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15056052048
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REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAMrh~ \ M~ M.. _ c; v..... ~ e........ {e ~
STR~RESS ~ &- I I
._.-'- ....0 ('VI. W 6...-. .......... ~t1f\E:.~ u_. _1~J. (;Jc\-\ ~tA.. ~ ~ 0 -{{ ()/M. '"K ~(LJ
"U-r\~-\-~ c..~v..C/l OQ. C'nr~-s-{ ~~~5 ,(
_____...__..___u__n________
LQ.~\ ~ ~\~
CITY
1 ST&E
i J-L.
ZIP
\"70 t ~
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
~'J . 3'-
,z..<t
Total Credits ( A + B + C ) (2)
.2 f
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + E ) (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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(58)
~oF
5. 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.
~ uf
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
D 'xl
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; ............................................ D ~
c. retain a reversionary interest; or.......................................................................................................................... D ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [K]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D [E]
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. 99116 (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. 99116 (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. 99116(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. 99116(1.2) [72 PS. 99116(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. 99116(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-1508 EX. (1-97)
. .
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
C;; d I ~ rye-z.----
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ./ I
--rh~I~G.
r\,(,
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.
ITEM
NUMBER
1.
c~e.-,-I~ ~ At) ~a Ov'--tl-t
-* 7.21971 ,,-,
DESCRIPTION
!II\. -t', b(,V\.k
l+(\tlt~,:>J~ f>~~
652.~ C~v"(I'sl~ ~:~
I { n 1,~5o
~v\Q"','c..s 'ou<,\, uc:~
VALUE AT DATE
OF DEATH
"3 '"JCf;J . 9'-/
(cJo5e-l) ~ J.~~jxe~~
.\)~C-, f', 2-D (3 (.
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ 3. 792. '9 J
REV-1511 EX+ (12-99) .
. ~.
."~'~
....' ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF l
--r11e.- ~c;;..
fu\.
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I
FILE NUMBER
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule I.
1.
FUNERAL EXPENSES:
f:v\ev-~ )v\e.d G~ ~sc;;.r
E~~N\u; /\\ heo.&-s+Or\e - \\c\<t-\-e- 3\- c\e5d{" _~.n?{;cl ~~~~lAo-o{;J.{
DESCRIPTION
AMOUNT
;..)51. /<1-
I~.~
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
C)
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 Fees
o
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
(ll
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees
~&
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 63,~. )f
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE O~--r--lJ
, V\ Vv\A.
'v( . G;u- -t ; er-~e~
FILE NUMBER
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 ESCRIPTION OF DEATH
1. 'Yre.sG....; \~ t)('cC\re. - ~r C 4..t't
?Ie...SGr,' p~ ~ f 5~. 7~
~
3. --rl;~rY\v.!d.tl \-hl"\ef . ~r-' ~~ I~ I {~ 28 (.:(. ~ ~
TOTAL (Also enter on line 10, Recapitulation) $ 3j 037, b 7
(If more space is needed. insert additional sheets of the same size)
REV-1513 EX+ (9-00)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
I
FILE NUMBER
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 5o~ (59. >(. '>
Sec. 9116 (a) (1.2)] S\'\
1. ~o~"' ~' -S:kett~~r d-
11'-!Q 5l~ \~ ~-{,-ee-
~6. f ('~ ~L II ra ;?e:.- 17 "l.-
2.. J-,,..k c' ~o~l~+lLf Dc-~J (JJV' ~~70 G~. S-S-)
3(P/(., kohtU'J:>L,.c.~
o H-1/l ~- 1'70,1
L:lw.~ I
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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, insert additional sheets of the same size)
REV-1645 EX + (7-85) INHERITANCE TAX
..
SCHEDULE L-l
COMMONWEALTH OF PENNSYlVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN
RESIDENT DECEDENT -ASSETS- FILE NUMBER
I. Estate of ~"-+/ e....rt"~ ......--- .-tt~J~ ~
(last Name) (First Name) (Middle Initial)
II. Item No. Description Value
A. Real Estate (please describe)
'""1\ ~ 'Y\..e-
Total value of real estate S
(include on Section II, line C- 1 on Schedule l)
B. Stocks and Bonds (please list)
..y\1n\. fi-
Total value of stocks and bonds S
(include on Section II, line C-2 on Schedule l)
C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2)
(please list)
no"V\~
Total value of Closely Held/Partnership S
(include on Section II, line C-3 on Schedule l)
D. Mortgages and Notes (please list)
Total value of Mortgages and Notes S
(include on Section II, line C-4 on Schedule l)
E. Cash and Miscellaneous Personal Property (please list) 3 ,~1~.9</
c-heJ'~1 Au--f
Total value of Cash/Misc. Pers. Property S 3j 77~ - <)Y-
(include on Section II, line C-5 on Schedule l)
11/. TOTAL (Also enter on Section II, line C-6 on Schedule l) S ~ ?9A'c;y
(If more space is needed, attach additional 8% x 11 sheets.)
REV-1646 EX + (3-84)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I. Estate of
II. Item No.
~.
't.
III.
INHERITANCE TAX
SCHEDULE L-2
REMAINDER PREPAYMENT ELECTION
-CREDITS-
FILE NUMBER
~.j-, 'p V"""..., ....---
(Last Name)
-ri-L
(First Name)
I,
Description
A. Unpaid liabilities Claimed against Original Estate, and payable from assets
, reported, on ~chedule l: 1 ,(please list) . 0 j
"7 res c. r \ F~ CV\ 5- JJ <i?-:,~k ~u ~c-c"('N?.- - ~ .
D '~A-<.A! =-1> hc:.\,. vtA~nc"'--
j {'~ sc.n fur
~orl'\.~ LJ.... \-\-otlAe ~ 04..\ (s\€-.
r"'MfJl. ~e.J - $CS'^-.. G-+- ~~%~)
J
hr'\.
(Middle Initial)
Amount
J-/, 2..{
~T6. 7 l?
2-, q "i?.;l. to j-
45/.1'--(
Total unpaid liabilities S ? i}. t"C C I
(include on Section II, line 0-1 on Schedule l) ...) I 6 <S"
B. Unpaid Bequests payable from assets reported on Schedule l-l (please list)
Total unpaid bequests S
(include on Section II, line 0-2 on Schedule l)
C. Value of assets reported on Schedule l-l (other than unpaid bequests listed under
"B" above) that are not included for tax purposes or that do not form a part
of the trust.
Computation as follows:
c lJ~l\l ~C-L-+
Total unincludable assets
(include on Section II, Line 0-3 on Schedule l)
TOTAL (Also enter on Section II, line 0-4 on Schedule l)
(If more space is needed, attach additional 8% x 11 sheets.)
3. '1 q;;J. q '+
s
3 , ~1 Cf J.. c: '-'-
s