HomeMy WebLinkAbout81-00641
Unaatllfled lIobllltl08 Inourred by tl10 dooodont prior to I1ls/hor doo.tl1aro doduotlblo against hla/hor t8Koblo oltote,
In addition to dobtalnourred by tl10 dooedont or estOla, othor IWms aro olall11l1blo Including tho OOlt of administration,
attornoy feol, flduolory fOOl, funoral and burial oKponsol Inoludlng the OOBt of a burial lot, tombstono or grovo m~rkor,
, All dobll being ollllrnod agoltla\ all oatoto aro aubldot to tl10 opprovol of tho Roglator of Wlllawlth.Whom the
Inhorltanoo TOK.Roturnll flied, !ivloonoo to aupport tho docodont'a or tl10 oltato'allablllty for tho dobll baing clolmod
Ihoule! bO attaohed to thla lohadulo,
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A family oltemptlon of $2,000 may bo olillmod by 0 aPouso of a dooodont wl10dlad domiciled Iii Ponnsylvalilo,
If thoro II no Ipoula,or If tho 8poulol1oa forfoltod hla/har rlol1ts, than onyohlld oltha dooodont who.la a mombar of
tho I8mo housohol.d oan ol.olln tho oxornptlon, In 1110 swnt thoro la no auch ,paUlO Ilr child, tho oKomptlon oan bo
clolmod by B poronl Ilr parontB who oro mom bora of tho loiM houaohold oa thodocodont, Tho family oKomptlonla
ollo""oblo only ooalnat llaaetl whlo!l poaaby 0 will or by tho Ponll8ylvonla Intoatotll LoWa, . .
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~RUCTION8 FOR COMPLeTING 80HEOUL~ "F~
1, lItho fomllyoKomptloli la bohlo ololmod, Intllooto thoqlolmant'a noma, oddrotB and hla/hor relationship to tho
dooodont,Entar "family aKempllon" In the romarks oollunn and tho omount clolmod In tho om.ount oolumn,
2, Anion conlaouUvo nut\1bera.to oooh Item lIatod,
3, Entor the doto on whloh aooh dobt WOI lI1cutrod and/or. paid,
4, Entor tho nomu of oooh payoo, ".
6, Provide a br!ol.oxplanotlon In tho remarka oolumn for oooh dobt olalmod,
6, Entor tho OI'llIlUIlI of oaoh do!?t bolnl! ololmod,
7, Tho form '1luatbo slgnad by tho porson Who haa ~..umod tho responalblllty lor paying the debtS,
QUESTIONS CONCER~ING PROPERTY TRANSFERS
I, Oldde~.,.edent,wlt"'n .twP years of death, make any tr.ansfer61 any motorial part of his eslate Wlthout..rec. elvlng
va,luable and OdeQlIOleconslderatlon? (AnSWer flYes" or"No",) Yn" . .
2, 01 d de. oe.denl, wl.th,n twP .years .01 death., transfer property. 1 rOIl1 h"nsell/ hersel f to hlmsel f/hersel f aiI'd another party
or parties (Includlns aspollse) Inlolnt oWnership? (Answer "Yos" or "No",) ~ .
~, II the answer 10 ono or two above Is flVOS" and the trllnsfors'are.clalrned 10 bo nontaxable, provide the followlns
Information: , . . ..' .
o. ARMf Mcodent at time 01 transfer, __ .
b, Copy of doathoertlllcate, . , . .,. . ..
0. Af.f1davlt.bY.lheattendlns p. h.YSlclan In.dlcallns tl.le slate of decedent's health at time of transfer,
d. All other.lnformatlon supportlns nontaxablllty of transfer, '
4,.Old. deoe. dent, In. h.'s/herllletl!l1.e, make any transfer of property without receiving a valuable or adequate consl deratiOn. N
therefor'Whlcn wa,s to take effeotln possession or enjoyment at or after his/her death? (Answer flYes" or "No",) . ' 0
a. Wu thereAtly posslblllty.thatlhe property transferred might return to transferor or hlslherestate or be SUbJect
to his/her power of disposition? (Answer "Yes" or "No",) , . .
b. What \'ins the transferee's aRe at time of decedent's death?
5, Ol~decedent In his/her lifetime make any transfer without recelvlnR a valuable and adequate consldeiatlon therefor
under whlohtransferor expressly or Impliedly reserves for his/her life orony period Which does In fact end before his/her
death: , , .
a, The possession or enjoyment of or the rlRht to Incomo fromlho properly transferred'l (Answer flYes" or IINo",) No
b, The right todeslsnate the persons Who shall possess or enjoy the properly transferred or Income therefrom?
(AnswarIlYes" or IINo",) _ Nn
6, If the answe.r 10' rive b, above Is IIYes," was the right reserved!rl decedent alone ( ) or decedent and'others( ),
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7, Old deced&nt .In hls/het lifetime make a transfer, ..lhe eonsld&tatlon for which wastranslere~'s prOmise to pay Income
, to or for t.he behefltor cere.of transferor? (Answer "Yes" o'r. "No",) No .
8,Plddecedent, at any time, transfer property, t~e baleflelal enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transf~r or by QP~ratlon of
law? (Answer "Yes" or IINo" ,) No ' .
9, If the ansW&rtoelghlabove Is "Yes," was the power to rilter, amend or revoke the Interest of tho benefiCiary reserved
In the'decedent alone ( ) or decedent and others ( ). . .
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