HomeMy WebLinkAbout81-00528
"
.,~;
...
,:(
H
~
~
III
>< ~
r.l,
o-:l '"
H
~ .
~
'.~
. p
~ :J: ~
III
III ~
r.l "
~ '"
'"
H
::=
0 III
-i.
w-
o
j
:i(! _J('I - &-':>/S'
REV.519 EX+ (12.80)
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEOENT
I
INHERITANCE TAX RETURN
FOR INSOLVENT ESTATES
(Instructions on Roverse Side)
Estate of C-f.( A,.e.L~ S W. ME.I~
'Last oddress f'j?, 1) I (!,fS1{ 3).<1
SC\i:1 h t.k.",;l ~ 1/ (ST_?~T),
SIIIPPtSNSfI:,\A.(U:> a. \ 17~7
ICITYI tSTA.rE! (ZIP)
Date of Death ~!O
Social Security Ho. .;l.o~-.;l.O -:J.'f<l<l
TYPE OF ASSET
DESCRIPTION
l e17 S <j)oJ',iTlA-<...
/1(P1 t3u'(L(<,
COUNTY NO.
STATE NO. _
( ) Exec. () Adm. Other
'/ ," I; !, '\ I
Nome' //.1 /,'/.1 ( 'AI d..'{"l!..:..!.... l ,j , I) I ,;,c.L'_J
I rJ /" ' '
Social Security tol,o. 'I -I " ,..'II- ?~ .
>- ,J;j 1,:'. ,j ~,d/l /";(v'.;I(1'" ..J
~ Address 1/ ). / t_1 j, . ,:~ ., . I ..I ,~" t,' ...~. ~,'t " ,,/ /
u (STREETI ,..
~11"^.njl 'f 1<' ( 1;,1- --;- J
(CITY) ~ [STATEI IZIP)
Under penalties of perjury. I declare that I have examined this return and
to the hest of m~ knowledge 9nd ~elief it is tr~e, correct and complete.
_, '(' 'II -, 1
7")/1/1 . 1.tL4 / '.< -,~-y
Signature of Fiduciary Date
ESTIMATED MA.RKET
VALUE
1'/000 or::.
,
J CO ".t
DEPA.RTMENT VItoLU" TION
(OFFICIAL USE ONLY)
" oi
",'"
~ i,~~~
.-:".1
C' :x L.:!.C)
~ (1:>>
. - .10
, ~ "."
N ,<."'
::0
:=0
,0
-::-
TOT AL t I ' 1',''''' I ~ -" o<Jl
',)uC....... J,'::tJ."v-.,
I do hereby certify that the above assets were appraised in accordance with Pennsylvania law.
~. (J ~'
~ t: ,j,{.~,/..J:\.'l"!H~(-' - il-f/
APp(.ifAI5! r~ tH.Tl
I'3Uft(,Al. E;C P€NJ~ J
f',4ll'DW6 r/le1'~7 'f~€J (IN
J.lhM/i! 7Sl/!. fK4~fl~
PM! I> lI\.e' 'i>ll'Qf OVoltl) lle'AJ
ON f' /to P CM'l
C.((MIlE~TA1C ~~\.A.. WlfAolO BAL/wVc.e ~ T~J
OFFICIAL
USE
ONLY
DATE
NAME OF PAYEE
d--:J..~ -fI
Fe fl:'l..l O,V'(,lalt. f'lMIE' Il,4L
CM..", &G)t(.AAll) "\f141d Gwu:
~
%
o
;:
u
::>
Cl
'"
Cl
Cl
%
..
~
...
m
'"
o
,vOI..ANO~NOt.AIV!) Co.
I1ll<:EfU rO loiN , t\\i).
OFFICIAL
USE
ONLY
j/: 1-'1~r /' ?j
m:\)UC'tlONS ALLO","'LLl
NA lURE OF CLAIM
TOTA.L
,) , (,' ':
// 'j ('I " .;
, J ///'~\/, ./' >/'!....~/
fH;t1fit~I" vi .,i..i..:~,
1./
11
AMOUNT CLAIMEO
/I / o31.~3
S~~;01)
IS, ()'01) lfZ..
.;l.o~e
.~ ~/,if.~; .." ~
/ C ,7; ,\. l. )
tj~
[,/,'j
......
INSl RUC110NS
TYPE OF ASSET _Indicafc whether thc asset is real estate, personal property, transfer or jointly-owned.
DESCRIPllON _ List all assets owned solely by the decedent or owned jointly with another party or parties as tenants In
common or os joint tenonts with right o( suryiyorship at the time of death. Includo the decedent's percentage 01 ownorship,
the .,ame (s) and relationship to the decedent of the suryiying joint owners ond the estlmatad morket value 01 the decedent's
intarest as of the data of deoth. Include intongibie personol property titled in the nome of the decedent but poyable at deoth
to onather party or parties Including but not limited to P.O,D, U.S. Soyings Bonds and tentotiye trust accounts. Li st ony
property transferred by the decedent within two years of deoth for which he/she did not receiye yaluabie ond adequate
consideration.
Describe- all real estate located in Pennsylvania by lot and block number, street address, number of acres and include a
general description of the lond and buildings, Also, include the book ond poge number in which the deed is recorded and the
o)(act title 05 Indicated on tlte deed.
DEB1S & DEDUC110NS _ Unsatisfied liabilities incarred by the decedent prior to hi s/her deoth are deductible ogoinst
his/her taxable estate. In addition to debts incurred by the decedent, other items ore claimable including the cost of
administration, ottomcy feos, fiduciary fees, funeral and burial c.Il:penscs including the cost of 0 burial lot, tombstone or
grave marker. List the date on which each debt waS incurred and/or paid and the names of each payee. Provide 0 brief
explanation of the nature of each debt claimed and the amount being claimed,
Evidence to support the decedent's or the estt,ltc's liability for the debts being claimed should be attached to this return
A family exemption may be claimed by 0 spouse 01 0 decedent who died domiciled in Pennsylyanio. If there is no spouse,
or il the spouse hos forfeited his/her rights, then any child 01 the decedent who is 0 member of the some household con claim
the exemption. In the event there is no such spouse or child, the exemption cen be claimed by a parent or porents who are
members of the some household os tho decedent.
m
...
>
...
,~
l> :z;
'" ~ =
'" 0
'" rn .
rn ?
'"
'" ~
0
3
~
'<
.
,
."
ii
.
.
; ;,
";
. .
m "'
m .,.
:j ~
.
.
it
."
.
!!:
n
0
~
r- "II '" n l> rn l> !
:z; ,. 0 0 '" '" '"
rn Cl n c: '" -I ~ r-
m '" :z; '" ,. :z; ~ :z; r-
:z; :z; m ... m -I ? ?
? ? ... -c '" rn v.
:z; 0 '" 0 -I
? ." ." ""
,.
...
0
:z;
-I
m
r-
m
"II
::l:
o
:z;
m
:z;
?
~
...
<
-c
m
l>
""
-c
rn
,.
""
~
~
INFORMA liON
PLACE FOR FILING _ lhe retum is to be filed in duplicote with the Register of Wills 01 the county wherein, the decedent
resided.
liME FOR FILING _ lhr. return is due nine months alter the ,decedent' s death, unle.. on exten.ion lor filing has been opplied
tor und 9ronted by the Secretary of Revenue within the nine.month period.
FAILURE 10 FILE RE1URN _ Section 791 of the 1961 Stotute provide. thot " , . .ony person who willfully foil, to file 0
return or other report required 01 him sholl be personnlly liable. . .to 0 penalty of 25% of the tax ultimately lound to be
due or $1,000 whicheyer i. the Ie.. to be rocoyored by the Dcportment of Royenue os debh 01 like omaunt are recoyoroble
by law."
NOTE; Fee. poid to on estote representotivo; nomoly. on executor or odministrotor, lor .ervlce. perforrned in od.
ministering on estote I, reportable for pennsylvonio Incomo Tox purposos, lhis toxoblo income item .houd be reported on
form PA.~O.lndIYlduol Income lox Return.
COMMONWEALTH OF PENflSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
*'
COUNTY FILE NO:
" /.
/ .-
~./
,
i
OATE
//~, /",) 0~; //./ /
,
";'//
i:( ,~ I,
"
.i ' /
!
/ l
V
FILE NO,
,'j, ',iil' ,'lfl)'~;I/"r.l"
, -r-/
/ ,'. " ',/ /
, ".j /, ," K U
" .' -" - ,."",/ /-'
'/ .. j'" i
.' I' ii' ./ ,/
TO:' /1 .c:/ I. ,.I,d (d
,_I ,I
j' of /
I ,/1/
/
ESTATE
DATE OF DEATH
; .
i /1./;,.-(',-/..t.bA;(,A---
/ .- ., ",-:"1. -'~~}
r, ' "'/ /' ,I
i"';(M!" _',:/ "I
(
1;/"
/
./:,///,'()
-/.,"
;, ~/'r~
'-
":,<<",~:-~)
COUNTY
Appraised Value 01 Estate:
Real Estate
-...---.---
&
Personal Property
+ /' .~v ("
~.
, /1
,.
. ..---...---
Jointly Held PropertylTr.nslers
+
$ " ~;:>:',..)
"
Total Gross Estate
'/
Total Approved Deductions
';'/,1/
f/
J,/
:" ,I
&
-.--.--.------
Clear Velue of Estate
..__F'''-.'.-~
Less: Approved Charitable Exemptions
Cleer Value of Estate Subject to T..
&
...-..-
----
Amount Taxable @ 6% Rate
&
taxdue"
I
,o' C'
,r' ,,', ~"l/I~~~,;I :'
, /
,.oJ-. 1~'-'-'"
. IJ "I '
'l't)<-r'lP
Amount Taxable @ 15% ,Rele
,
tax due -",-
, I ,.y...., f
'" / d' ~' 'J/. / '
TOTAL PENNSYLVANIA INHERITANCE TAX~I.IEI'" /.'/ /, ,,' ,~"1~4/f,j)
( 1", ,.'
" .. .. . " .. A five percent discount totaling S
will be granted if the Inheritance Tax is paid bV
Less Credits:
DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
& + $ $ = $
+ =
+ =
--
'ntereSI Bccrues at the rate of six (61 percent per annum
on the unpaid balance of Inheritance Tox from
to da,e of payment. If'1terest due if paid by__
is
BALANCE OF PENNSVLVANIA INHERITANCE TAX llU!
,.!. (
,...
, (
,>1 ./ I '
/,,',/ / (,/-
"
Ass....dby'
St"8 Intolmlll0n on R"Yt"IU SIlt' .n,'ofl".
'/" " / C
~ettt~
I ~'
I " i<C;j"j
!
,/( t.....:)
,
I
"
IN FORM ATLQli.
To insure proper credit to your nccount, thll norno uf the eSlitttJ .IIIU lilo number should lH' Clt>;lrly pnnl.
ed on the check or money order.
This assessment is made in accordanw with Section 708 of tho lnhcriwnce and Estate Tax Act of
t 96t 172 P,S, 9 2465.706},
To the extent that inheritance lnx IS paid within threo (3) months after the death of tho decedent. It
discount of five 151 percent is allowed (72 P,S, 9 2485.7161
Inheritance Tax. other than tax on a future interest, is due allho date 01 the decedent's death and hecomes
delinquent at the expiration of nine (9) months alter the decedent's death (72 P,S, 9 2485.711 j, Inheritanco
Tax on a future interest is payable within three (3) months niter the tronsfer takes effect In possession and
enjoyment and is delinquent thereafter (72 P,S, 9 2485-712), Calculato interest from the delinquent date shown
on the face of this form to the date of actual payment usinn the following interest tnble:
--------------------- ---------- --- ---- ---.--- ,-- - -.. --- - --- --.------ -- -- - - - _._--
1 month .005 4 months ,020 7 months ,035 10 months .050
2 months .010 5 months ,025 8 months ,040 11 months .055
3 months ,015 6 months ,030 9 lTlonlhs ,045 12monttls ,060
1 days .00017 11 days ,00186 21 days ,00352
2 days ,00034 12 days ,00203 22 days ,00369
3 days ,00051 13 days ,00220 23 days .00386
4 days ,00068 '4 days ,00237 24 days .00403
5 days ,00085 15 days ,00250 25 davs 00420
,
6 days ,00101 16 days ,00267 26 days ,00437
7 deys ,00118 17 days ,00284 27 days .00454
8 day. .00135 18 days ,00301 28 days .00471
9 days ,00152 19 days ,00318 29 days .00488
10 day. ,00169 20 davs ,00335 30 da,s ,00500
- - --- ---------------- _._- - - -- - - - -- --- - - --- - - - --_._- - - - - - - ------ --- --- ..-.
Any party in interest. including the Commonweiilth and the personal representative, not satisfied with
the' assessment may object thereto within sixty (601 days after receipt of Ihis Notice as provided by Section
lOOt ot thelnheritence and ESlate Tax Act of 1961172 P,S S 2485.10011,
Make check or money order payable to:
"Register of Wills, Agent"
Mail 10 the address listed below: