The URL can be used to link to this page

Home My WebLink About02-05-07 .. ~ 15056051047 REV-1500 EX (06-05) PA Department of Revenue .. Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-{)601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHREE~~;:NCTE DT:;E~i1~N 0t .., 01 G o oS 21 Date of Birth 0 " 0 " Suffix Decedent's First Name MI ~o..b ~ ~ + L Suffix Spouse's First Name MI Decedent's Last Name o ' 8,- \e.." (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Retum <=> 2. Supplemental Return <=> 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required <=> <=> 4a. Future Interest Compromise (date of death after 12-12-82) <=> 7. Decedent Maintained a Living Trust (Attach Copy ofTrust) <=> 10. Spousal Poverty Credit (date of death <=> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ (..), "",..'.......> -, J ,7Zf.~?;f~~, 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes <=> 4. Limited Estate <=> <=> '"R 0 b ~ '1-" I B f.q, ~+- CJCl,.. \:...woiocl "Dr, v.q r,-> w o Firm Name (If Applicable) First line of address Second line of address City or Post Office State ZIP Code DATE FILED c.C\.~ Correspondent's e-mail address: ~6e;t\ Ob"lQ.", ~ 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. S~~SON RESPO~SIBLE FOR FILING RETURN ~AJ" A~eES&,* '~~ Ur- I c~h'l!lo\.Q.. '""?A \tOl$""" SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 2/"107 DAT ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 .-J ') ---I 15056052048 REV-1500 EX Decedent's Social Security Number 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 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 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 ~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 . 15. 16. 17. 18. c::> J..\.~u-* 1 "Z.. (.. 2, &.t r'2.. 15056052048 ---I REV-1500 EX Page 3 Decedent's Complete Address: ~=-t- 1-. 0' \\~ mmmmmmmmnmmmmmmmmmm~mmmmmmmmm STREET ADDRESS -i- L-. ~ ie ~~ O~~.~ File Number .. ~~ CITY ~\\.~"\tc.. I STA7A- \ ZIP \ 70 \ S- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount I 2-(P 3. Interest/Penalty if applicable D. Interest E. Penalty (1) Z53~ Total Credits (A + B + C ) (2) I '2.. ~ Total Interest/Penalty ( 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, Une 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 2." c.t 12 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5) (SA) (5B) A. Enter the interest on the tax due. :2'"112- 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;.......................................................................................... D 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ D lZJ c. retain a reversionary interest; or.......................................................................................................................... D lZl d. receive the promise for life of either payments, benefits or care? ...................................................................... D IZl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ~ D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D IZI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ 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 exemot 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 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use ofthe 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+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 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 DESCRIPTION VALUE AT DATE OF DEATH ~'\1-Q.~S"- ~~ ~ Ifc, 7 ID II <."87 3~ J 3,1./20 - TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) I 3. '-12.0 REV-1510 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY INCLUOE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO OECEOENT ANO DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE OATE OF TRANSFER. ATTACH A COPY OF THE OEEO FOR REAl. ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. ~~4- .....~ ~ 01!::r....A.- ( O,ODO CA-S"- 0151oe.:, ~~..",."+- S\SSoA-- O'~~ lo,C1d ~ S l ~ 1 0(" ~.~ '"'""" ~~ CJ~~ (OlO to!c /0J. O~~ to l 0 c...k.a.r\-.c, "'" "5" s.o-- lol,/Dr". ~.~ ~ O'~~lL- 5, c:rro ",l~' 1"- St~ ~lt..s... "S\)~- tJ '<5~ lO(.3L lo<' TOTAL (Also enter on line 7 Recapitulation) $ So ( CJ?JfJ C) c?"O ~ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99>W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ~ b...r: l....... ()'6r \.~ FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ho~ ~ G~ 2.~l~ :t.~~~ j- A~ ,~~~ V\c...~ S,DC>O ~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name 01 Personal Representative(s) Social Security Number(s)/EIN Number 01 Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (II decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship 01 Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 7,0 IS;- Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF~+ L_ ()&t1~ FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~+ L. CJ'~~~l2.V'oo \8 €a.S+ ~~~ Dt-. ~\\.~k ~ \IO\~ C~t"\es L. O\&~~~ \.3 '3.3 '2- Sr;1t-~J.. &")k... ~t' ~c.o -;r A 2 c;"..30S"" RELATIONSHIP TO DECEDENT Do Not List Trustee(s) ~v- S&vo- AMOUNT OR SHARE OF ESTATE '/2- \ I z..... 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT O'BRIEN ROBEERT L 18 EAST OAKWOOD DR CARLISLE, PA 17015 n_nn_ fold ESTATE INFORMATION: SSN: 051-16-0527 FILE NUMBER: 2107-0113 DECEDENT NAME: O'BRIEN ROBERT L DA TE OF PAYMENT: 02/05/2007 POSTMARK DATE: 02/05/2007 COUNTY: CUMBERLAND DA TE OF DEATH: 12/05/2006 NO. CD 007776 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,412.00 I I I I I I I I TOTAL AMOUNT PAID: $2,412.00 REMARKS: CHECK# 5222 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS