HomeMy WebLinkAbout81-00121
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INHERITANCE TAX RETURN
FOR INSOL VENT ESTATES COUNTY NO.
(Instructions on Reverse Side) STATE NO,
RE.....'IO ~Xt (1.ao)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INNERITANCE TAX
RESIOENT DECEDENT
( ) Exec.
( ) Adm. Other
Estate of
WI i..L I A\14. i'v',cE L I..{I Y
Namp.
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~.I, "CFLROV (r:hT,,~nl,F)"
last address 10d' H J, c~ ii ! ~: 8 11 ,~ ." FIK\;"
(STREET)
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% CARLISLE 0:
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Date 01 Death U-Ic,-bO
Social Security No.
17+-'0"-11 ?:',
Social Security No.
10'9-0'3-4-10 I
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(STREET!
:~:....o\'LISl,: FJA. 11013
(ciTY) (STATEl (ZIP)
Under penalties of perjury, , declare that I have examined this return and
to the best 01 m, Y knOW,10dge and b,81i,ef tt Is true, correct and complete. 0
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Address
Signature 01 FIduciary
Date
TYPE OF ASSET DESCRIPTION
ESTIMATED MARKET
VALUE
DEPARTMENT VALUATION
(OFFICIAL USE ONLY)
gAN~ AC~uUNT - ~~OC.OO
COM.'0NWE~LTH ~4TlaNAL 9~NK
i~ 500,00)
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Ci, LI >iLE "H AF ON
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TOT AL
OFFICIAL
USE
ONLY
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APPRAISER
TE
DATE NAME OF PAVEE
NATURE OF CLAIM
AMOUNT CLAIMED
EWING :3tiOThERt:'
C,)Ft:' IN
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030 8. H".NJVER ~T.
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2,00
FLO',":~ R~'
CllME~: PLAN;) V/\LLEY L';;:\~O [~, t..L
(.:!~r-i~ENS
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,,9 :...00
TOTAL
; ;',270,00
OFFICIAL
USE
ONLY
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0." 7-~3-.J/
DATE
INSTRUCTIONS
ASSETS:
TYPE OF ASSET _ Indicate whether the asset is real estate, personal property, transfer or jointly.ownr.d.
DESCRIPTION _ List all assets owned solely by the decedent or owned iointly with another party or parties as tenants in
common or as joint tenants with right of survivorship at the time ol death. Include the decedent.ls perccntogq of ownership,
the name (5) and relationship to'the decedent of the surviving ioint owners and the estimated market value of the decedent's
interest os of the dote of death. Include intangible personal property titled in the nome of the decedent but payable at death
to another party or partic-s including but not limited to P.D.D. U.S. Savings Bonds and tentative trust accounts. List any
property transferre,d,by the decedent within two years of death for which he/shc did not receive valuable and adequate
. consideration. ,..
Describe all real estate located in Pennsylvania by lot and block number, street address, number of acre-s and include a
general description of the land and buildings_ Also, include the book and page number in which the deed is re-corded and the
e1(act title as indicated on the deed.
DEBTS & DEDUCTIONS _ Unsatisfied liabilities incurred by the decedent prier to his/her death are deductible against
his/her ta1(able estate. In addition to debts incurred by the decedent, other items ore claimable including the cost of
administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or
grave marker. List the dotr. on which each debt was incurred and/or paid and the names of each payee. Provide a brief
,explanation of the nature of each debt claimed and the amount being claimed..
Evidence to support the decedent's or the estate's liolJility for the debts being claimed should be attached to this return
A family exemption may he claimed by a spouse of a decedent who died domiciled in Pennsylvania. If there is no spouse,
or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of the same household can claim
the c'I(cmption. In the event there is no such spouse- or child, the exemption can be claimed by a panmt or parents who are
members of the some household as the decedent.
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INFORMATION
PLACE FOR FILING _ The return is to be filedin duplicate with the Register of Wills of the county wherein the decedent
resided. .
TIME FOR FILING _ The return is du~ nine months after the decedent's death, unlcss an extension for filing has been applied
tor and granted by thc Secretory of Revenue within the nine-month period.
FAILURE TO FILE RETURN _ Section 791 of the 1961 Statute provides that" .. .ony person who willfully fails 10 file 0
return or other report required of him sholl be personally liable. . .to 0 penalty of 250~ of the ta'll: ultimately found to be
due or S 1,000 whichever is the less to be recovered by the Deportment of Revenue os debts of like amount arc recoverable
by 10W.I~
NOTE: Fees paid to an estate representative; namely, an executor or administrator, for services performed in ad.
ministering an estate is reportable for Pennsylvania Income Tax purpo5es. This taxable income item shoud be reported on
form PA.40,lndividuollncome Tox Return,