HomeMy WebLinkAbout04-24-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue *'
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
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File Number
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Ob31'-
Date of Birth
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} 6 ~5 I 73--- r
Decedent's Last Name
Suffix
Decedent's First Name
MI
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(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C) 1 . Original Return
..
2. Supplemental Return
c:::::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
c:::::>
c:::::> 4a. Future Interest Compromise (date of
death after 12-12-82)
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. 9'113(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 Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
c:::::>
8. Total Number of Safe Deposit Bo)<es
4. Limited Estate
c:::::>
c:::::>
c:::::>
Firm Name (If Applicable)
City or Post Office
State
ZIP Code
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i REGISTER OF WILLS USE ONLY !
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DATE FILEI)~_~_~J
First line of address
Second line of address
Correspondent's e-mail address:
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF Ef N RESP NSIBL FOR FILlN RETUR '6/\,.t ~~ DATE
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ADDRESS {70 '3 {.cd. q~ Lit l (V ~l4J It!! fa ~ 170f {
SIGNATURE OF PREPARER OTHER THAN.JEPRESENTATIVE V J DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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15056052048
REV. 1500 EX
Decedent's Name:
Decedent's Social Security Number
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RECAPITULATION
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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:::::l Separate Billing Requested . 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::::l Separate Billing Requested.. . 7.
8. Total Gross Assets (total Lines 1-7). . .
f 0 :}() . /} g'
9. Funeral Expenses & Administrative Costs (Schedule H).
......... 9.
8.
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) . .
10.
11. Total Deductions (total Lines 9 & 10).... ..
12. Net Value of Estate (Line 8 minus Line 11) . . .
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) ..
12.
. . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . .
. . . . . . . . . . . . . . . . 14.
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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 LJ /I ~j )[ .1 ri
at lineal rate X .0_ { 1/ IT V "lS
17. Amount of Line 14 taxable
at sibling rate X .12 .
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE.
.................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
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15056052048
11.
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15.
16.
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17.
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18.
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15056052048
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