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HomeMy WebLinkAbout98-00918REV-1BODIX+(ti7) REV-1500:.. ~ OFFICIftI. USE CHaLY SYLVANIA cO~toN L INHERITANCE TAX RETURN _ ~~ ~ ~ °~ ~ ' ~ ~ 1 DEPARTMENT OF REVENUE RESIDENT DECEDENT ~ r 8 d -~ ~ ~~ g „ DE(~BITS OIA1E (lABT, FlR8T, MD 1tIDOLE MIITIAL~ ,uM ~ bink bbdr, b •~P!!+r •ordt,... ....... Q SOCIAL SC-CURfrY Nl DATE OF TH DATE OF BIRTH W ~ nF AppucAa~- suRmw~c spouses r~ rust, ~atsT, AID raoor.E n~i socu~ sECxxstTr rnarerR TtaS 8E FILED IN WPLICATE YYRH THE ~ t31STER OF WILLS F 1.OriginalRetum ^ 2. SupplementalRetum ^ 3. Remain Retumla.ieade.mplabtzasezl ~ ~ ~ ^ 4. Limited Esta~ ^ 4a. Future Interest Compromise Imie aaern attar tz-tza21 ^ 5. Federal stake Tax Retum Required W ~ ~ m ^ 6. Decedent Died Testate (Attach Dopy aVfi ^ 7. Decedent Maintained a Living Tntst Wncn copy aTruat) _ 8. Total Nu bar of Safe Deposit Boxes < ^ 9. Litigation Prooeerts Reooived ^ 10. Spousal Poverty Credit ia.r a eam beeaw~ tzar-st and t-t-esl ^ 11. Election tD tax under Sec. 9113(A) IAmcn Seh of ~ = 0 _ ,_ corax~re ~tArle+c l i s ~ v t "c.r~oN~ rq~~ ~ W~ g r N W ~~ ~~ cNo ~ ~~ X70 K ~ 3 z- s^t 7 ~ '" 1. Real Estate (Schedule A) (1) e f ,_ O , - ~--- ~ . c,~ y :. ~ 2. Stocks and Bonds (Sdtedule B) (2) .- Q , ~' ~ -~ "~7 t r ~'^j ''~~77 = C.~'~ _ ~ 3. Cbsely Held Corporation,PaMersh~t or Sole-Proprietorship (3) t ? - ~ , "" ~ - 4. Mortgages 8 Notes Receivable (Sdtedule D) (4) y r - () ,..r ti,7 CJ7 Ci Z 5. ~Ba~ EDeposiL~ ~ Miscellaneous Personal PropeAy l5) r ~ t 3 6 ( ~ ,~ 9 i 6. Jointly Owned Properly (Sdtedule F) (6) t' ? d , -- g 7. Inter-Ynros Transfers 8 Miscellaneous Non-Probate Property (7) _ ~ d 8. Total Gross Assts (total Lines 1-7) (B) ~ ~,/2~~,6?.D`T V 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ~ ~ ~ 3 (~ V . U 0 o ,o. Debts of Deoedertt, Mortgage Lial>ilitles, ~ Liens (schedule I) (,o) 3 , ~. v ~ . ~ 3 11. Total t~ductbns (total Lines 9 810) (11) } i ~ S d ~ ~ 1 ' 12. Net Vahre of Estate (Lime 6 minus Line 11) (12) ~ C ,Z.} ~ 3 v , Q Y , 13. Charffable and Governmental BequesLs/Sec 9113 Tn>sls for which an electlon m tax has not been (13) made (Sdtedule J) t t 14. Net Valus Subject to Tax (Lute 12 minus Line 13) (14) ~ o s -~' ~• 15. Amount of line 14 taxable Z at the spousal tax rate r t x p (15) ' a ' O F See irtstrudiats on reverse side for applicable .percentage 16. Amount of Gne 141axable H at 6% rate ~ ~ X .O6 (16) t t ' t- ~ 17. Amount of line 14 taxable ~ X .15 (17) , , at 15% rate ~ ~ O V 18. Tax Due (18) j s 19. > > ~ ~~ , ,~ under ~u« a perjugr, i declaara that i rrevs etumined ~ rotlxn, aax,rr~t~lrq schedtdee and atakrttenle, and b the neat a my 51GNATUR P R ON RE SI FOR (LING RETURN ADDRESS I53 L.e~ ,9~n t!~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS . ono 1 a. ~ ~~- ~~oa.5 can~pbb. Dedaratlon of preperer otlter DATE DATE REV-1508IX ~ (i-97) SCHEDULE E` NSYLVANIA P BANK DEPOSITS, & MISC. CASH CDMMDNWEALTHOF EN , INHERITANCE TAX RETURN PERSONAL PROPERTY ' RESIDENT DE DENT ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All properly joirrtly~ownsd with the right of aurvfvorsNp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. F'i Rst N r+TtorAr~t ~ ~~~ l~ vt J-M'~"'ls''` 11~ I 2 3 6 ~ . ~~ /t1•t~ s,rr lGG ,P~ ~~ ~~ ~~ ~I ~~ TOTAL (Also enter on line 5, Recapitulati ) ; (If more space is needed, insert additional sheets of the same size) REV-x»oc.liatJ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN OF SCHEDULE H FUNERAL EXPENSES 8r ADMINISTRATIVE COSTS FILE NUMBER n.ht: ~ decadent nsuet be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL F_XPENSES: ~~ ~ i 1. ~ D B. 1. ADMINISTRATIVE COSTS: Personal Represerrtatlve's Commissions ~ `~1 N ~ G • WA ~ ~ Name of Personal Representative (s) I - ,. W~ ~'~ _ ~t Number(s) ! EIN Number of Persasal Representative(s) 1 a" ~ .. 3 9•~ l Securi S d y o a L-?D ~lr4 V~ t Add Str ress ee ~~ JIIO L ~ see ~p (? b 2 Year(s) Commission Paid: ~" Attorney Fees (J" '~ 1J1~ ~iJ 3, Famiy Exemption: (If decedent's address is cwt the same as daitrranYs, attach explanation) Claimant Street Address State Zip Ciy dent t t D f Cl i man o ece a Relationship o 4. Probate Fees 5. AooourrlanCs Fees 6 7. Tax Return Preparer's Fees 'rv/L,PA~,IdI.£N ( Vf' ~l E~l~ L tl3lL,C..S VIII TOTAL (Also enter on line 9, Recapitul ) ~ ~'D S ~ ~~ (If more space is needed, insert additional sheets of the same size) aEV-,s,z ~,c • c+~n SCHEDULEI COMMONWEALTH OFPLNNSYLVANIA DEBTS OF DECEDENT, I" RESIDENT[) c'oErTirR" MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER I Include unreimburaed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT z.. ~~~~e.!-us C.'af Gec.~r~,~ - ~.JVIt~ ~,( ~S~ !I, ~ ~~~ ~~ . ~D 3 - C~vs r ~~~ ~ /~~ ll «,s ¢ ~ l~ SC~-vt ~ '~, c~ cP ~~ '~ ~~~ II '~ 'I i ~~ i ~-~~ 62 TOTAL (Also enter on line 10, Recapitulati ) S , (If more space is needed, insert additional sheets of the same size) nc~ ~-~~o~T,~oi) SCHEDULE) COMMONWEALTH of PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN SIDENT DE NT ESTATE OF FILE NUN~ER I NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (indude outright spousal distributions) '~ NoNE ~~ E2ls CJC2~ ~ $v~ ~1~1 3~. ~- S tsf~o. /3~t- IZ~CCI~C j) ,~Up ~piSt~.~3~7[D~) ~.e..c~vs~ ~t~ s /L~ ~s ~aT kr ~i Tv p cs ~~,c,~O ~ ~-.e ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, A5APPROPRIAT , 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I I '~ I TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (It more space is needed, insert additionaGsheetS of the same size) G,. 1 sir.. V.A a ~: R.EC'STEP. OF t~ViLL~ OF eLllrlberl Are d COtrvT i', FLVTISYLV:~N?~ Narne of Decedant:~ Mary E • Rob~r~sorl ______ --- Data a Death: <v/~ /9Q8 - File Iv'u:rber: /9q8 - 00 9l ~ - D....,....,..• ~.. D.. f: !` D..1~ (. 11 T •o..rvt the f.•lin~ui?:, t::i111 S'?C~?,atQ corr?rl?+'-~?''-1 of Lhe >;dnvniarat?t711 Of a U1JUJ.u w a u. V. V. aww v. as, a :..rw. `v••" the above-captioned estate: • ....... des ~ No 1. Mate whether administration of the estate is complete:.... 2. If the an"sweris No, state when the personal representative reasonably believes that the administration will be completa: 3. If the answer to r1o. 1 is YES, state the follou~in~: a. Did the personal representative file a final account with the Court? .. • • ~• • • ~s ~No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account • B'iTs ©No • informally to the parties in interest? .:............ • . • • • • • • • • • • • • • _ Copies of receipts, releases, joinders and approvals of formal or iufonnal accounts niay be . d 4,. ,. ~ . ~ f-]ed with the Clerk of the Orphans' Court and maybe attached to this repgrt. us ~ m ~ ~~~ ~ ~~ C:'~'7 Q ~ I~O/o~O~Q QnO , riling fhu ram l ~z' .~s ~.~.3 6-~ 1 r-- -- errm S,g:,nn,re oj _ `'~ ~ _ ~ ~ m Capacity: rsona, Representative ^CO1111S2t - ~ ~ ~ liana ~ < c..u tvl ~r -- ~i pinn;a ojPartm, riling d,it Form ! r3 1_ee .~4hr? Co u r ~ addrear ~o ~~ , ~~ ~ 70 d~-5 -- • ~~ ~) 856 • ~~ Sy-~--- Telrn7,one _. __ __ __ ~_ __