HomeMy WebLinkAbout03-26-07
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15056051058
REV.1500 EX (06-05)
PA Department of Revenue .
Buraeu of Individual Taxes
PO BOX 280601
Harr~u~,PA1712~1
ENTER DECEDENT INFORMATION BELOW
Social Number Date of Death
OFFICIAL USE ONLY
,c:ounty<?de Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
21
06
1016
Date of Birth
201-18-5007
11/04/2006
06/27/1926
Decedent's Last Name
Suffix
Decedent's First Name
une
(If Applicable) Enter SurvIvIng Spouse's Information Below
Last Name
~PCl~sE!'~,.~irstf\l~me
Spouse'sSo<;jaISecurity Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return C)
2. Supplemental Return
C)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C) 4a. Future Interest Compromise (date of
death after 12-12-82)
C) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:::> 10. Spousal Poverty Credit (date of death c:::> 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[)~ytirne TelephonE!lII~rnber
4. Limited Estate
<:::::)
ctJ
Om
8. Total Number of Safe Deposit Boxes
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
E. Robert Elicker, II
Firm Name (If Applicable)
r~.:l
(717) 240-6531J 5
....riii~i~i'~rib~~=-
'-...~" /-.......
First line of address
4330 Roth Farm Village
C)Cl
,~,~ .;? """C'1
--0
Second line of address
.-_. :D
--')
Circle
DATE FILED
State
ZIP Code
17050
Mechanicsburg
Correspondent's e-mail address:belicker@ccpa.net
Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of rrIJ knowledge and belief,
n is true, correct and complete. Declaration of preparer other than the personal representative is basad on all information of which preparer has any knowledge.
SIGNA ERS N RE 0 lE F R FILING RETURN DATE
~ 'J.1A ~ ~
ADDRESS
4330 Roth Farm Village Circle, Mechanicsburg, PA 17050
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051058
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15056051058
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15056052059
REV-1500 EX
Decedent's Name:
RECAPITULATION
June
R Clark
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) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total 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 Subject to Tax (Line 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 45 99,381.65
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15 2,000.00
19. TAX DUE. . . . . ... . . .. .. . .. . . . . . . . . . ... . . .. . . . . . . . ... . . . . . .. .. . . ... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052059
Side 2
Decedent's Social Seeurity Number
1-18-5007
160,000.00
262,708.10
107,881.01
20,190.65
550,n9.76
41,282.15
441.74
41,723.89
509,055.87
407,674.22
101,381.65
15.
16.
4,472.17
17.
18.
300.00
4,n2.17
-
15056052059
-.J
* The charitable amount to West Shore Baptist Church is computed as follows:
Net value.of estate
$509,055.87
Less:
(a)
Annuity value to children per
Schedule K and attachments which
is attached to return
76,191.00
(b) Jointly owned property subject to tax
which passes to surviving owner
as reported on Schedule F 20,190.65
(c) $2,000.00 specific bequest to Kathy Hooper 2,000.00
(d) automobile and jewelry to children 3.000.00
Total deductions from net value
of estate which are taxable 101,386.65
Balance to West Shore Baptist
Church in accordance with trust
provisions in will $407,674.22
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
June R Clark
STREET ADDRESS
1840 Holly Drive
1016
DECEDENT'S SOCIAL SECURITY NUMBER
201-18-5007
CITY
Camp Hill
STATE
PA
ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
4,772.17
15,000.00
241.39
Total Credits ( A + B + C ) (2)
15,241.39
3. InteresllPenalty if applicable
D. Interest
E. Penalty
TotallnteresllPenalty ( D + 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)
10,469.22
5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
A. Enter the interest on the lax due.
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 lransferred;.......................................................................................... D 00
b. retain the right 10 designate who shall use the property transferred or its income; ............................................ D 00
c. retain a reversionary interest; or.......................................................................................................................... D [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i]
2. If death occurrl1d after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D 00
4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D 00
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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax relum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The lax 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 of the 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-1502 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
June R. Clark
FILE NUMBER
21-06-1016
All rell property owl18d solely or I' I tel1lnt in conmon MIst be reported st fsir nltst Vllut. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Rill property which i. jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
and lot situate at 1840 Holly Drive, Lower Allen Township, Cumberland County, PA sold
22,2007, to Drago and Mira Savic, his wife, for $160,000.00
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed. insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
160,
REV-1503 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
June R. Clark
FILE NUMBER
21-06-1016
ITEM
NUMBER
1.
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
shares of Amer Inri Group (AIG) common stock
2
shares of Key Corp (KEY) common stock
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheels of the seme size)
VALUE AT DATE
OF DEATH
33,109.
229,598.
262,708.
REV-150B EX+ (6-98) .
COMMON\f,IEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DEOEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
June R. Clark
FILE NUMBER
21-06-1016
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
total
1,000.0
2,000.0
1. New Cumberland Federal Credit Union, Account No. 2004
accrued dividends
Watch and diamond rings given away before death. note to executor from deceased dated 10/06
wedding band and ring to daughter
ngible personal property sold at Bricker Auction 1/24/07. Net proceeds
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the seme size)
107,881.
REV-1509 EX+ (6-98*
COMMON'vVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLy-oWNED PROPERTY
ESTATE OF
June R. Clark
FILE NUMBER
21-06-1016
If an asset was mlde joint within one year fA the decedent, date fA daath, it nust be ..ported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Douglas Clark Langille
JOINTLY.OWNED PROPERTY:
LmER
ITEM FOR JOtH
NUMBER TENANT
1. A.
DATE
MADE
JOINT
09/24104
2.
ADDRESS
RELATIONSHIP TO DECEDENT
Company 3rd STB 3rd BCT
Airborne Division
Assault
KY 42223
DESCRIPTION OF PROPERTY
INCLUDE NAME OF FIiANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
Bank, Checking Account No. 536789720
Bank Certificate of Deposit No. 31500094260
accrued interest
Bank, Savings Account No. 5080417924
accrued interest
Cumberland Federal Credit Union, Accl No. 80978 S-1 Savings
Federal Credit Union, Acct. No. 80978 Cerl of Dep.
accrued dividends
787.14
TOTAL (Also enter on line 6, Recapitulation)
(If more space is needed, insert add~ional sheelli of the same size)
REV-1511 EX+ (12-99.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
June R. Clark
FILE NUMBER
21-06-1016
ITEM
NUMBER
A.
Debts of dectdtnt mUlt be reported on Schedule L
DESCRIPTION
AMOUNT
1.
Funeral Home, 408 N. Third Street, New Cumberland, PA Funeral
Green Cemetery, 1811 Carlisle Road, Camp Hill, PA Grave
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
Year(s) Commission Paid:
2. Attomey Fees
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanaUon)
City
Claimant
Relationship of Claimant 10 Decedent
4.
Probate Fees
5.
Accountanfs Fees
6.
Tax Return Preparer's Fees
7.
Cumberland Law Joumal - advertising letters
letters
fees, miscellaneous fees and
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert add~ional sheets of the same size)
REV-1512 EJ(+ (12-(3)
'*
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABILlnES, & LIENS
ESTATE OF
June R. Clark
FILE NUMBER
21-06-1016
Report debts Incurred by the decedent prior to death which remained unpaid II of the date of death, Including unrelmbur..d medical expen....
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, Verizon - Phone service charges
2. Peerless Insurance Company - payment for homeowne~s and auto insurance
3. PPL - electric service charges
4,PAWC - water service charges
5. UGI- gas service charges
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00) '*
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
June R. Clark
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9.116 (Ill (t~))
1. Clark Langille, A Company 3rd STB 3rd BCT
RELATIONSHIP TO DECEDENT
Do Not Lilt Trustee(l)
FILE NUMBER
21-06-1016
AMOUNT OR SHARE
OF ESTATE
101 Airborne Division, Air Assault, Ft. Campbell, KY 42223
2. !Betsy E. Clark, 42 A N. Lincoln Street, Palmyra, PA 17078
Kathy Hooper, 820 Lisburn Road, Camp Hill, PA 17011
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
(If more space is needed. insert additional sheels of the same size)
CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Shore Baptist Church, 21st and Market Streets, Camp Hill, PA 17011
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
ATTACHMENT TO SCHEDULE J (BENEFICIARIES)
Douglas Clark Langille payable $200.00 per month per trust provisions, Paragraph 5 of
Will, Annuity Value $40,569.00; Jewelry - 1 ring;
Betsy E. Clark payable $200.00 per month per trust provisions, Paragraph 5 of will,
Annuity Value $35,622.00; Jewelry - 1 band and ring
--,._1
~
Conrad Siegel
ACTUARIES
501 Corporate Circle. P.O. Box 5900 · Harrisburg, PA 17110-0900
Phone (717) 652.5633
Fax (717) 540-9106
The Employee Benefits Company
www.conradsiegel.com
ad M. Siegel, F.S.A.
, M. Leister, Jr., F.S.A.
~ E. Gingrich, F.S.A.
lrt J. Dolan, A.S.A.
d F. Stirling, A.S.A.
art J. Mrazik, F.S.A.
d H. Killick, F.SA
'lrf S. Myers, F.S.A.
mas L Zimmerman, F .S.A.
ln A. Hafer, F.S.A.
in A. Erb, F.S.A.
nk S. Rhodes, F.S.A., A.CAS.
Iy A. Ross, F.S.A.
lel M. Leymeister, CEBS
rk A. Bonsall, F.S.A.
10 W. Jeffrey, F.S.A.
nise M. Polin, F.S.A.
omas W. Reese, A.S.A.
lathan D. Cramer, F.S.A.
hn D. Vargo, F.S.A.
obert M. Glus, A.S.A.
uce A. Senft, CEBS
,ura V. Hess, A.SA
cki L. Delligatti
lSley A. Bausch-Ward, A.S.A.
mothy J. Patota, E.A.
March 15, 2007
E. Robert Elicker, II, Esquire
4330 Roth Farm Village Circle
Mechanicsburg,PJ\ 17050
Re: Estate of June R. Clark
Dear Mr. Elicker:
You provided us with various documents concerning the inheritance tax. return
for June R. Clark.
We understand that two of Mrs. Clark's beneficiaries, Betsy E. Clark, date of
birth May 22, 1963, and Douglas Clark Langille, date of birth J\pril 7, 1985, are
each to receive $200 per month from Mrs. Clark's estate for the remainder of their
lifetimes.
You requested that we calculate the present value of these $200 per month
payments to the beneficiaries. The instructions to PA Form REV-1500 for
Schedule K, Life Estate, Annuity & Term Certain, indicates that for decedents
dying on or after May 1, 1989, the present value of an annuity which is dependent
on the continuation or termination of the life of only one person will be
determined using tables which incorporate an interest rate equal to 120% of the
Federal mid-term annual rate in effect for the month in which the date of death
occurred. J\t the top of Schedule K, the instructions indicate that the actuarial
factors can be found in IRS Publication 1457, J\LEPH Volume for dates of death
from May 1, 1999, and thereafter.
Weare enclosing a completed Schedule K for your reference. We have completed
the annuity calculation at the bottom of the sheet. The annuity factors are based
on an interest rate of 5.6%. 120% ofthe Federal mid-term rate for the month of
November 2006, which was the month of death of Mrs. Clark, was 5.65%. Since
the tables in IRS Publication 1457 are provided in 0.2% increments, we used the
closest rate of 5.6%. The present value of the annuities is displayed on Line 7 of
Schedule K. We have provided individual entries for both beneficiaries.
We are enclosing copies of the tables which were used from IRS Publication 1457.
We trust that you are able to use this information to now complete the rest of the
inheritance tax. return for Mrs. Clark. If you have any questions concerning this
analysis, please do not hesitate to contact one of us.
.=====J Conrad Siegel
~ACTUARIES
E. Robert Elicker, II, Esquire
March 15, 2007
Page 2
You asked that we suggest what our fee will be for this work so that you may take it as a
deduction. Our bill will be $450 and will be released within the next week or so.
With best regards,
Yours sincerely,
d (11. ~~;9; ZJJ '
Harry . Leister, Jr., F.S.A.
Consu ing Actuary
~V.~
Jonathan D. Cramer, F.S.A.
Consulting Actuary
HML:JDC:kad
Encl.
REV. "" EX. '''.0.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
ESTATE OF
Check Box 4 on REV-1500 Cover Sheet
FILE NUMBER
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89.
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in LRS Publication 1457, Actuarial Values. Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and In Aleph Volume for dates of death from 5-1-99 and thereafter.
Indi~ the type of instrument which created the future interest below and attach a copy to the tax return.
r'- Will 0 Intervivos Deed of Trust 0 Other
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
1. Value of fund from which life estate is payable . , . . , . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
2. Actuarial factor per appropriate table ...................,.....,.......................
Interest table rate - 031/2% 06% 0 10% 0 Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) ......................................$
Geh e. C(",,1v
....:~iii~~i.~>
5/2:2//%3
4/-r1'915
43
l2-
o Term of Years
9lLife or 0 Term of Years
o Life or 0 Term of Years
!)u" lClJ CI~r" ~., ville,
o Life or 0 Term of Years
1. Value of fund from which annuity is payable . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
2. Check appropriate block below and enter corresponding (number) .. . . . . . . . . . . . . . . . . , . . , . . . .
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (28) ,. Monthly (12)
o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( )
3. Amount of payout per period . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . , . . . . , . . . . . . . . .$
4. Aggregate annual payment, Line 2 multiplied by Line 3 ..,................................
5. Annuity Factor (see instructions)
Interest table rate - 0 3 1/2% 06% 0 10% ).it Variable Rate 5. b %
6. Adjustment Factor (see instructions) .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50Q,93/
12
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period
payout is at end of period. calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . , . . . . . ',' . . ,$ 35, b 2..2.. +
If using variable rate and period payout is at beginning of period. calculation is:
(Line 4 x Line 5 x Line 6) + Line 3 .........,........................................$
J 00 ~e.,~ ~1\(lVl+~...+
'2.'100''1-' '-l'tob!":, '4~()o
~"") D<I,,~I~1
lit. lt1lt~ Ib.~~l.j~
1.()25~J I, 02~'"
.
40, 5 b~ = 1h.I'I1
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through
:3 of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18.
(If more space is needed, insert additional sheets of the same size)
Section 1
Table S (5.6)
Single Life Factors Based on Life Table 90CM
Interest at 5.6 Percent
Life Life
Age Annuitv Estate Remainder Age Annultv Estate Remainder
0 17.1944 .96289 .03711 55 12.3284 .69039 .30961
1 17.3242 .97015 .02985 56 12.1163 .67851 .32149
2 17.3073 .96921 .03079 57 11.8995 .66637 .33363
3 17.2851 .96797 .03203 58 11.6787 .65400 .34600
4 17.2597 .96654 .03346 59 11.4545 .64145 .35855
5 17.2316 .96497 .03503 60 11.2273 .62873 .37127 .
6 17.2014 .96328 .03672 61 10.9968 .61582 .38418
7 17.1690 .96146 .03854 62 10.7622 .60268 .39732
8 17.1346 .95954 .04046 63 10.5234 .58931 .41069
9 17.0977 .95747 .04253 64 10.2809 .57573 .42427
10 17.0582 .95526 .04474 65 10.0348 .56195 .43805
11 17.0162 .95291 .04709 66 9.7847 .54794 .45206
12 16.9720 .95043 .04957 67 9.5299 .53367 .46633
13 16.9261 .94786 .05214 68 9.2709 .51917 .48083
14 16.8796 .94526 .05474 69 9.0085 .50448 .49552
15 16.8330 .94265 .05735 70 8.7440 .48966 .51034
16 16.7865 .94004 .05996 71 8.4785 .47480 .52520
17 16.7398 .93743 .06257 72 8.2128 .45991 .54009
18 16.6926 .93479 .06521 73 7.9474 .44505 .55495
19 16.6439 .93206 .06794 74 7.6815 .43016 .56984
20 16.5932 .92922 .07078 75 7.4142 .41520 .58480
21 16.5401 .92625 .07375 76 7.1449 .40011 .59989
22 ~) .92315 .07685 77 6.8735 .38491 .61509
23 16.4270 .91991 .08009 78 6.6006 .36964 .63036
24 16.3663 .91651 .08349 79 6.3280 .35437 .64563
25 16.3022 .91292 .08708 80 6.0577 .33923 .66077
26 16.2348 .90915 .09085 81 5.7918 .32434 .67566
27 16.1636 .90516 .09484 82 5.5314 .30976 .69024
28 16.0890 .90099 .09901 83 5.2765 .29549 .70451
29 16.0109 .89661 .10339 84 5.0255 .28143 .71857
30 15.9293 .89204 .10796 85 4.7769 .26750 .73250
31 15.8442 .88728 .11272 86 4.5327 .25383 .74617
32 15.7555 .88231 .11769 87 4.2964 .24060 .75940
33 15.6627 .87711 .12289 88 4.0679 .22780 .77220
34 15.5659 .87169 .12831 89 3.8473 .21545 .78455
35 15.4645 .86601 .13399 90 3.6348 .20355 .79645
36 15.3589 .86010 .13990 91 3.4338 .19229 .80771
37 15.2486 .85392 .14608 92 3.2479 .18188 .81812
38 15.1333 .84747 .15253 93 3.0765 .17229 .82771
39 15.0130 .84073 .15927 94 2.9171 .16336 .83664
40 14.8872 .83369 .16631 95 2.7660 .15490 .84510
41 14.7556 .82632 .17368 96 2.6241 .14695 .85305
42 14.6182 .81862 .18138 97 2.4928 .13960 .86040
43 ~ .81059 .18941 98 2.3696 .13270 .86730
44 14.3255 .80223 .19777 99 2.2496 .12598 .87402
45 14.1707 .79356 .20644 100 2.1329 .11944 .88056
46 14.0104 .78458 .21542 101 2.0180 .11301 .88699
47 13.8449 .77532 .22468 102 1.9052 .10669 .89331
48 13.6741 .76575 .23425 103 1.7935 .10043 .89957
49 13.4978 .75588 .24412 104 1.6743 .09376 .90624
50 13.3158 .74568 .25432 105 1.5578 .08724 .91276
51 13.1281 .73518 .26482 106 1.4085 .07887 .92113
52 12.9355 .72439 .27561 107 1.2279 .06876 .93124
53 12.7380 .71333 .28667 108 .9484 .05311 .94689
54 12.5356 .70199 .29801 109 .4735 .02652 .97348
18
Table K Section 6
Adjustment Factors for Annuities Payable at the End of Each Interval
Frequency of Payments
Interest Semi
Rate Annually Annually Quarterly Monthly Weekly
2.2% 1.0000 1.0055 1.0082 1.0100 1.0107
2.4% 1.0000 1.0060 1.0090 1.0110 1.0117
2.6% 1.0000 1.0065 1.0097 1.0119 1.0127
2.8% 1.0000 1.0070 1.0104 1.0128 1.0137
3.0% 1.0000 1.0074 1.0112 1.0137 1.0146
3.2% 1.0000 1.0079 1.0119 1.0146 1.0156
3.4% 1.0000 1.0084 1.0127 1.0155 1.0166
3.6% 1.0000 1.0089 1.0134 1.0164 1.0175
3.8% 1.0000 1.0094 1.0141 1.0173 1.0185
4.0% 1.0000 1.0099 1.0149 1.0182 1.0195
4.2% 1.0000 1.0104 1.0156 1.0191 1.0205
4.4% 1.0000 1.0109 1.0164 1.0200 1.0214
4.6% 1.0000 1.0114 1.0171 1.0209 1.0224
4.8% 1.0000 1.0119 1.0178 1.0218 1.0234
5.0% - 1.0000 1.0123 1.0186 1.0227 1.0243
5.2% 1.0000 1.0128 1.0193 1.0236 1.0253
5.4% 1.0000 1.0133 1.0200 1.0245 1.0262
5.6% 1.0000 1.0138 1.0208 q.0254~ 1.0272
5.8% 1.0000 1.0143 1.0215 1.0263 1.0282
6.0% 1.0000 1.0148 1.0222 1.0272 1.0291
6.2% 1.0000 1.0153 1.0230 1.0281 1.0301
6.4% 1.0000 1.0158 1.0237 1.0290 1.0311
6.6% 1.0000 1.0162 1.0244 1.0299 1.0320
6.8% 1.0000 1.0167 1.0252 1.0308 1.0330
7.0% 1.0000 1.0172 1.0259 1.0317 1.0339
7.2% 1.0000 1.o1n 1.0266 1.0326 1.0349
7.4% 1.0000 1.0182 1.0273 1.0335 1.0358
7.6% 1 .0000 1.0187 1.0281 1.0344 1.0368
7.8% 1.0000 1.0191 1.0288 1.0353 1.0378
8.0% 1.0000 1.0196 1.0295 1.0362 1.0387
8.2% 1.0000 1.0201 1.0302 1.0370 1.0397
8.4% 1.0000 1.0206 1.0310 1.0379 1.0406
8.6% 1.0000 1.0211 1.0317 1.0388 1.0416
8.8% 1.0000 1.0215 1.0324 ,1.0397 1.0425
9.0% 1.0000 1.0220 1.0331 1.0406 1.0435
9.2% 1.0000 1.0225 1.0339 1.0415 1.0444
9.4% 1.0000 1.0230 1.0346 1.0424 1.0454
9.6% 1.0000 1.0235 1.0353 1.0433 1.0463
9.8% 1.0000 1.0239 1.0360 1.0442 1.0473
10.0% 1.0000 1.0244 1. 0368 1.0450 1.0482
10.2% 1.0000 1.0249 1.0375 1.0459 1.0492
10.4% 1.0000 1.0254 1.0382 1.0468 1.0501
10.6% 1.0000 1.0258 1.0389 1.04n 1.0511
10.8% 1.0000 1.0263 1.0396 1.0486 1.0520
11.0% 1.0000 1.0268 1.0404 1.0495 1.0530
11.2% 1.0000. 1.0273 1.0411 1.0503 1.0539
11.4% 1.0000 1.02n 1.0418 1.0512 1.0549
11.6% 1.0000 1.0282 1.0425 1.0521 1.0558
11.8% 1.0000 1.0287 1.0432 1.0530 1.0568
12.0% 1.0000 1.0292 1.0439 1.0539 1.05n
867