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Home My WebLink About06-18-07 (2) .-J 15056051047 REV.1500 EX (06-05) PA Department of Revenue *' Bureau of Individual Taxes PO BOX 280601 Hanisbu ,PA 17128-0601 EliITER EC DENT INFORIIATloN BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth ~ Decedent's First Name MI 13 Suffix [IlJ (If Applicable) Enter Surviving Spouse's Information Below S use's Last Name Suffix [IlJ MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Retum c::> 2. Supplemental Retum c::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::> 4. Limited Estate c::> 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 Daytime Telephone Number c::> 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c::> First line of address REGISTER OF WILLS USE QNLY () :3 ~~ ~ ;-" -~ S~~ .IC; ~;n, ,~ ~l? co . ._) -r: _.31.", (,) en L.) Correspondent's e-mail address: Under penalties of perjury, 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. SIG RE F PERSON RESPO SIBLE FOR FILING RETURN , 1':;C"?~G VCcr140 BII ..,.." SIGNATURE OF PRE PARER OTHER THAN REPR SENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY ". Side 1 L .-J % 15056051047 15056051047 --.J 15056052048 REV-1500 EX Decedent's Name: mAn..., H. O'T~6UJ RECAPITULATION 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Real estate (SchedUle A'). . .'. . . :. . ; . . . . . :. . .: . . . . . .'. . . : . . . '. . '. . . .". . .'. .. ,1. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 'i''' ;l; . Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . .. 6. Inter-Vivos Transfers & Miscellaneous Non-PlObate Property (Schedule G) c:) Separate Billing Requested.. . . . . .. 7. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . ... . .. 9. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . , . . . . . . . . . . 10. Total Deductions (total Lines 9 & 10)..... ... ...................... ...... 11. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . 12. Charitable and Governmental Bequests/See 9113 Trusts for which an electioo to,tax.has ~ot 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_ 15. 16. Amount of Line 14 taxable at lineal rate X.O _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT " ~~~ ~ Side 2 15056052048 ~ Decedent's Social Security Number <=) 15056052048 --.J REV-1S11 EX+ (12-99) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF rn~r?y 1-1.1) lTLOv-J FILE NUMBER t.L ~OO? - DO;;" y. T Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. DESCRIPTION FUNERAL EXPENSES: n A ~ · '-,....-r:= tc;O'" \J .."" ... en." (. 1"'78 _ S"( Yo~"\ t7.~~ C'AO..,S"e-) P4 ,.... ~ AMOUNT '0, I)q'!.. CfJ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant 10 Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ I () ? "3. 'I! (If more space is needed, insert additional sheets of the same size) __M'" '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE IDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY "\ \ ~ lTLO' ) FILE NUMBER t (Y') ~ n 'I r' ."y \J-' f) OCJ?' DO} 'f _ Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Ct,Utc;&..(I"'6- ,qCC.""T- C.W\ftt"f'&C.s: B4tJ~ pt4 t:t, -- 1'1 iii' , ",_,0.-.. 1\,(:r. ~ ~'$3.'Jl5ct"!. TOTAL (Also enter on line 5, Recapitulation) $', D' SO. 'I (If more spaCe is needed, insert additional sheets of the same size) Decedent's Complete Address: DECEDENT'S NAME yY) ~ rt. '" t..t STREET ADDRESS_ 1 ""G~(i.E File Number ~ 06? - 00 J. 4 t REV-1500 EX Page 3 D\ TLO uJ Qo~'D B 01&., tv{,. S'p<<., N &.1 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0..00 CITY STATE P 14- ZIP I ') on? 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 Total Credits ( A + B + C ) (2) TotallnterestlPenalty ( 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, Line 20 to request a refund. (4) 0" 00 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 tax due. 0..00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QU~STlONS 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 transferred;.......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D [BI c. retain a reversionary interest; or..........................................~.:............................................................................ D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?'...... ....... .... ....... ......... ......... ......... ........................................................... D RI 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, anntJity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D Del 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. ~9116 (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. ~9116 (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 return are still applicable even if the surviving spouse is the only beqeficiary. For dates of death on or after July 1, 2000: The tax 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) percenl[72 P.S. ~9116(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. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use offhe.deced.ent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common witli the decedent, whether by blood or adoption.