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IIURqAU or eXAMINATION INljER1TAf\lOE TAX RETURN
PBNN1VLVANIA OBPARTMBN T O,P ,R,BV"BNUB 'I RSS,IOHNT OSOEOHNT \
P,O, OOX B327 FII N I " 11" 0/_ .. ;1" II
HARRIBUURO, PA 17108' 0 um lor ,..c P v
DDooc,ceellllee~n"e NljI1e, 19l1uI', F;,lnu,',"} n~ Mk',hli;;-,lnIlIIU-, -~~~",,]' DIC;I.,lonl'lAlhh,OIl, __ " . /"
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OHIOK 1. Orlgln.1 ,Rol~rn I5S1 2, Ollllplomontol ROllI1ll 0 3, Remelnlllr Rotum 0
Under peoolllll 01 porlury Idoclare thlt I hlVo oKlmlnoll Ihle rO\llrn,lnoludlng ucocmllanylng IChld~lul and l'ltement., and,to thl bllt 01 my koqwledge
and blllll,l\ II truo, OOllICt, d comploto, Pocl.rotlon Ii' praplror othor than tho penonll rlprolont,tlvoll b8l0ll on elllnlormatlo,1l of whloh reparlr h81
any kRQWledge, .J'. I~-
BlliNATURE OF PE IBi'- AODRBS8 OATS
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APPRO,
PAlAte
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SPONPENT Hlmo
RECAP1T.
ULATION
ANP
TAX
CALCU,"'
LI,ITION
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, AOtll1ll Roqlllred,
0, Oocldont 111011 tOllo\9 rVl ' 7, Oocollo"t m,olntelnld a living 0 8, Numbar oll,elo dopolll 0
...Jt.ttooh Copy 01 WI~ till!' (Mlah copy 01 trllltl bOKlllnventorlnd
All uorrolllondonce ond oonllllonllol tOK InlormatlcnlhlllllJ bl dlroctld'\Ol
4, lllo 8110to 0
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Rmpltullllon
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2, 8tookllllll 8cnlll (80hOOlllo 01
3, Clololy HollI 8tuok/Portnonhlp Intomt (Soholllllo Cl
4. M0!100gUllnd Nolol (Soh odilia 01
D, COlh & Mlloollonoo(1l Porloll8l Proporty (Sohod~lo B)
0, Jointly Ownod Propot\y (Schodlllo FI
7, Tromforl,ISCholllllo G}
0, Tolol Oroll A"OIl (tolol 1111I1 1-7)
0, Fllnorll EKllonlol Admlnlltrotlvo Ccltl/MllcoilaneclI).
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12, NOI Vo" 0 cl 8ltoto (IIno 0 mlnlllllno 11)
13, Chorlloblo aeqllolll,(8chodlllo JI
14, Not Vohlo ,lIhloct to tox \lIno 12 rnlnulllno 131
computation' of TeK
16. Amollnt of Ihl014 tlKoblo It 0% rota (lBI ~~, 9f
Onoludo vlluOI from Schodlllo KI
18" Amcllnl of IIno 141exobll at 16% rato ' (181.,......."'-'-
(lnollldo valllol 'tom Bchodulo K)
17. Prlnolpll t,axd~9 (odd tlX fro""lIno 16, pllll taK IroOl,lIno 101
18, Totol Prior Plymlnlll
(II Amo~nt Palll _
'M Phil Olloollnl ~
(cl Mlnlll'lnlorll\ 1181
10, Bolance OliO U1nl 17 Inlnlllllno 18)
Mlko Chock POY9blo tc: Roolltor of Willi, Aglnt '
I I I PLEA8E REOHOCK MATH II I
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SIGNATURB OF PAEPARER OTHER THAN REPAEBENTATiVE""
AOOI\E8B
OATS
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rUitill'J..ililiJlilllliE.lil TAN C E T A X G ENE R A L I N I'D RM A TI 0 N
1. PERSO~S RESPONSIBLE FOR RETURN
Section 701 of Ihe Inl~erltaRce and Estate Tax Act of 1961 provides that the following persons shall prepare and file
a return: . '
a. The personal'representatlve of tha estate of the decedent as to property of the decedent administered by hl~
and such additional property which Is or may be sublect 10 Inheritance Tax of which he/she shall have or
acquire knowledge: .. .
01
b. The transferee of prorertyupon the transfer of which Inheritance Tax Is or may be Imposed by the 1961 StAtute,
Including a trustee 0 property transferred In trust, provided that no separate return need bs mada by the tr,ansferee
of property Included In the return of a personal representative. .
2,PLACE FOR FILING
The return Is to be fllelllndupllcate wllh the Register of Wills ofUle county wherein the decedent resided.
3, TIME FOR FILING
The rsturn Is, due nine months after the decedent's death, unless an extension for filing has been, applied fOLand
, grnntsd by the Secrotary of ~ovonue wllhlntho nlne-m,onth period. ' , ' ,
4. EAjLURE TO ,~ILE RETURN.
Section 791 of the 1961 Statute provideS that If. . .anyperson'whowlllfUlly falls.toflle a return or other.raport
requlrodofhlm, . ,shall be personallY lIabls, . .to a penalty of 25% of the tax ultimately found to be due or $1,000
whichever Is the lesser to be recovsred by the Department of Revenue as debts of like amount are recoverable 'by
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5. JAX RATES
, Inhedtent\! Tax Is payable at the rate of 6% on transfers'to IInoal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-In-law and daughter.ln-Iawand at the rate of 15% as to all oth8rs.
6. pAYMENT OF~
The,t"ax, as,sessed on the transfer of P,lO, "perty reported In the return Is due 9 months after the decedent's 'death, Interest
at the rate of 6% por an,n,Um accrues thsreafter until payment Is made. All p"ayments received are flrst applied to any
Interest w.llch may be due with any remainder applied to thll tax. I FTAX,IS PAlO W,ITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH\ A DISCOUNT OF 5%01' THE TAX PAYMENT IS,ALLOWED,
All, checks should be made payable to the Rsglster of Will,S ,of the county .whersln the decadent resided and are
received sublectto ,ths final determination of the Department of, Revanue,
7. E1\ILURETO PA.Y
',The taxe,s Imp"oS~d, tO~,'ether wllh any Interest thereon.. are a lien upon real ptopsrty; wh,lch,lIen ,remains In effect until
'tne taxss and Interest have been p~ldln full. The taxs~ may be sued for against any reel property In the decedent's
estate or agalnst.any property belonging to a transferee liable for the tax.
8. FILING OF FALSE RETURN
Any personwno WillfullY makes a false ratum or report requlrodof him shell, In accordMce with SeQtlon 793 of tho
1961, Statuto, be guilty of a misdemeanor and, on conviction thereof, sh~1I be sentenced to pay a fine not exceeding
$1,000 or undllrgolmprlSOnmlll1t not exceeding one year or both. .
~: COnlpenSaUoR paid to an estate representatlva: namelY, anexecutor or administrator. for servlces.p'erformed
In administering an estate Is reportable for Pennsylvania Income Tax purposes. This taxable InQome Item should be
reported on form PA.40.lndlvlduallncome Tax Retum, '
QUESTIONS CONCERNING PROrr:...RTY TRANSFm
1. Old decedent, wlthl,n two yoara ofdooth, mnko unylrnnsfor of nny malorlnlpnrt of his estato without rooolVlng
valunble and adequateconalderallon? (Answor "Yos" or "No" ,)-~
2.0lddecedonl, within two yoars of doath, haRslor property I,rolll hlrnsslf/ hersolf to hlmsol f/herself and ano,thor perty
or porllos (includlnR n spouse) In Joint ownorshlp?'(Answor "Yos" or IINo",) ~-
3. If the onSWer to one or two nlXlvo Is "Yes" nnd thotranslors oro clnlmod to bo nontnxable, provide tile following
Information: ,"
a, ASs of docedont III tlmo of transfor,
b, Copy of doath cortlflcate, ! . '
c, Affidavit by the alteRdlRg physlclnn Indlcnllng tho slnlo QI tlocedont's hoalth 01 lime cif transler,
d, All othor Infornlnllonsupportlnn nontaxablllty of tronsler, '
4, Old docedonl, In hls~lOr Ilfotlme, mako any transfer 01 properlY wllh'out recolvlng n voluablo or adequotecollsldelallol1
therefor which was to tak,o effect In possosslon or onjoyment at or aftor hls/hor doath? (Answer "Yos" or IINo".) ')1tJ
0, Was thero 8I1yposslblllty that tho proporty tronslorrel! IIIlght return \otronsforor or hls/hor ootote or be subJoct
to his/her powor of disposition? (Answor "V os" or IINo" ,)
b,Whot WO$ the tronsferee's age ot tlme.of docodoRl's deoth?
5, DI~ deCEdent In hls/hor Ilfollmo make ony tronsler without rocolvlRR 0 valuoble and adequote conslder~lIon thorefor
under which transferor expresslY or Impliedly resorvos for hls/hor Ilfeot ony porlod which does In fact ondbofore hls/hor .
death:' ..' .'
a, Tile possession or onjoymont of or the right to IRcomefrom tho proparty trnnslerrod?(Answer "Vos" or "No" SYl tJ
b, The right t.o designate 1I,le pBr~lI\s,WhO sholl possess or enjoy the, property, transferred or Incomo tlwolrom?
(Answer "Ves" or "No".) -110 . , .
6. If the answor to live b, above Is "V os," was tho rlghtrosorvod In donodonl olano ( ) or docodent nndothors ( ),
, .
. 7. Old decodentln hi~/hor Ilfotlme make 0 tronsfor, the consldorotl.on fur ~~c~\was tronsloroe'~proll\lso to pay,lrlcollle
10 or lor the bonefi,l or care 01 transleror? (Answer f'VOS" or "No" ,) .
8,Diddecedent,.atany tlnle, trimsler property, the hmellclal ~nloYlllont of which was subjoct to chaRge, because 01
a reserved power to alter, amond, or rev.oke, or which could revert to decedont uRdor terms 01 transfer or by operation of
law?, (Answer IIYes" or ,"No",) ~ .
,9, ,If Ihe answer to elRht abovo Is "Vos," was the power to olter, mnond or revoko the Interest 01 the beneficiary reserved
'In the IIEcodent olano ( ) or dOCOUBllt anclolhors ( ),
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9.llliERAL IN~RITANce TAX INFORMATION
Un.atl.fl.d Ilabllltlnlncutred by the decedent prior to hls/her death are deductible agaln.t hls/hor taxable
..tote, In addition to d.bt. Incurred by the decedent or ..tate, other \tems are claimable Including the co.t of
odmlnl.tration, oltgrney Ie.., fiduciary ffll" funeral and burloleMpen." Including the oo.t 01 a burial lot, tomb.tonl
or gravI marker and other relot.d burloltMp.n.... '
All debt. being clalm.d agaln.t an utat. are .ublect to tho approyal of the Regl.ter of Will. with whom the
Inherllance Tax Return I. f11.d. Evldeno. ,to .upport the deoedent'. or the OItate'.llablllty for the debt. b.lng
claimed .hould be atlClched to thl. sohedule. '
A family exemption may be olalmedby a .poun ,of 0 decedent who dled'doml~lled In Pennsylvania. If ,there I.
no .poun, or I,f the .poun has forfeited hla/her right,', then any ohlld of the deoedentwho I. 0 m.mber of the lame
hounhold oan 010110 the ox.mptlan. In the,.vent there I,' no .uch SPOUIO or child, the exemption 000 be al limed by'
o parent or parenti who are member~ of the same houaohold aa th,e deoede~t. The family exomptlon lullowable only
against as..ts whloh po.. by a will or by the PennsylVClnla IntOltate L.aws.
NOTE, 'Compen.ationpald to an eatate representatlvel namely, an, exeoutar or admlnletralor, far servloOl
perforll)ed In administering an OItate Is reportable for Pennsylvania Income Tax purpas,s. This 'taxable Income
Itllm shoulq be reported on form P A.40,.Indl vlduallnoame Tax Return.
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INSTRUCTIONS FOR COMPLe'tI~OSCMEOULe "f."
1. If the family exemption la being olalmed/lndlcate the clalmant'a name, addre" and hls/her(elaHanshlp to
the decedont. Entei"famlly .xemptlon" In the r.marks column anq the amount claimed In the am,ount column.
2. Anlgn conlecutlye, number. to each Item lI.ted.
3. Enter th',dat. on whl~h each debt waa Incurred and/orpold.
4. EtHel the names of each payee.
5. Proyldlla brl.1 explanation In the rel1\arka column for .aoh debt claimed.
6, Enter the amount of each debt being clolm.d.
7, The IorIO mu.tbe slgn.d by tho petlon who ha. assumed the reaponslblllty for paying tho debts.
IF ADDITIONAL. SPACE IS NECESSARY USE 8W' x 11" SHEETS.
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INFORMATION
,TI1II, d~oum.nl Ie the Nollo. r.qulred to b,' gl1/.n ~nd.r S.otlon 709 af Ihe Inh.rltlnoe, end Ellel. T.. Aot
of 1961 (n p,S, ..otlon 248~),
If the le~' II peld Within Ihrn (3) montha .Iler the d.o.d.nt'. deelh, . dl.oo~nt of 6,r. of the tex plld I. IlIoW.d,
Inh.rltlno' Tex b.oom,1 d.llnquenl nine (9) monthl eller the d.o.d.nl'. death, In"reet Ie oherg.d at' th.
tll. ,of elx (61 p.roent per .nn~m on the emolint of unpeld te~. ISEE EXAMPLE BELOW) ,
EXAMpLE: ,If. belenQ8' of ". due of. 12,000,00 II In I delinquent elelue from 3-3-130, and ,pIymenl II mId.
on 6-23-80, Ih. Inteteet 18 oeloulaled II Indloelld bel,ow: ' ,
Inter..t from 3-03";SO 10 6-23-80
Rtlulte Inl
, 2 Monthe. ,010
" ' " 20 OaYe . + ,003~5
,Rete of Int.rnt' ',. .013 5
Balanoe of Ie. d~e
B1\LJlf Inter..t
INTEREST
12,000,00
~ .01335
1 26,70
ST&P 3
Add tht IIII.rnt
10 the b.leno. 01
I , Ie. dU',
8elano.'of tex d~.
, PI~' Inl.t"t to
~t ~:/:~:rent (+1
Intereet 10 Oat.
of Paym.nt
12,000,00
$ 2ll...Ul.
STIP 1
DII.rmln. the rell of
'Internt from the leble balow,
STlP 2
Multiply, the bel'Hee of
te. d~e by th. r.te of
Inlernl,
$2,026,70
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I month ,006 4 month I ,020 7 month. ,035 10' mbnlhl ,080
2 monlhl ,010 5 month I ,026 13 monthl, ,04g H monlhl ,oe6
3 monlh. ,015 6 'month. ,030 9, manlh, ,04 12 monthl ,060
1 d.y ,000 \7 11 d.y. ,00186 2 1 dlY' ,00352
2 deYI' , ,00034 12 deyI .00203 " ' 22 daye ,00368
3 d'YI .00061 13 d.ye .00220 23 daye ,00388
4 day. ,00068 '4 'day. ,00237 24 deYI ,D0403
6 day, ,000136 16 dlyl ,00260 26 dey. ,00420
6 dlY' .00101 16 dlY' ,00261 26 d.y. ,00437
7 deye " ,00118 17 diY' ,00284 27 d.y. ,00484
8 dlye ,00136 18 d.y, .00301 28 d'YI .00471
9 dey. ,00162 '9 dey. ,00318 29, dlY' ,004e8
\ 0 dlYI .00189 20 ,d.y. ,00336 30 deYI ,00600
-~---------~----------------------------~-------~---------_._-~~------
AnY PerIY ,In Int.reel:lnoludln9 the Commonweal\hend th. p'rtonal rlprllent,U1/,. 'not &BIll/lid with the'
.ppre1lem.nt end ......m.nt m.y obJea\,Wllhln.I.IY (60) deYI 11\., rea,lpl of IhIINotlo'" pro1/ld.dby
Seol1on ,1001 of, the Inhltlt.no. end E"I" Te~ Aat of 1861 (72 P,S, 880,24135 - 1001).
,MIlK! OHICK" OR MONIV ORDIR PAYABLB ,TO I "AI(IlSTIR OP \lILLS,' AOINT"
DETACH THE TOP PORTION OP THIS FORM AND SI.ISMIT WITH YOUR PAYMeNT TO THE REOISTeR OF WILLS FOR
THIl COUNTY SHOWN ON THe REveRSE, SeE THE INHERITANCE TAX INSTRUCTION 800K FOR AODRESe,
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Rev, 1'~7IX '( Ha) ,
aUReAU OF eXAMINlITlON 'Nonol pr INHeRITANOe TAl< \AUUSMINT '
PENNSY.VANIA PEPARTMeNT OF ReveNue APPI\AISBMINT, ALLOW'.OI (jR DUALLOWANOICONTROL NO, 101
, P,O, sox 8327 ' u"" x
HARRISaURQ, PA 171 OS t1~ 1110 pnONI, ANl! A..~~NT ~ TAIDATI Q4~2fi-ij~
IITATI O~ MOSHlilR Ml\RIE II fiLl NO, 21 81~0764
WLop' O!ATI:l Q9~2D~Bl .. ' OOUNTV QUM\lBID.IAlUL-
NOTal To INsuRIPROPIR CRIPIT TO YOUR AOOOUNT SUBMIT THI UPPIRPQRTION o~ THII NOTIOI WITH YOUR TAK
PAVMINT TO THI RaOIlTlR O~ WIL~I P~ THe ,AIOVI COUNTY, MAKe OHIOKS PAYABLe TO "RIQIITIII' OP WILLI,
AOINT," I~ ,TAx PAVMeNTI ARe MADI \lITHIN a MONTH' O~ THI OIOIOINT'S DATI O~ DeATH, 'A, DUOoUNT
Op I"OP THI TAl< PAlO MAY II OIOUOTID,
a/.' {,!i ,fP-- PLEASE ~ETURN TflIS'
/ . I), 'J '1 PORTION TO REGISTER' OF
PII 17D70 ~lJro' 1 WILLSIF PAYMENrQUE '
FRANK II MOSHER
\l~ OIlROL ST
NEW,dUIIIlERL1\ND
CUT ALONa THIS LINB
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