The URL can be used to link to this page

Home My WebLink About12-05-07 '--.J 15056041046 REV-1500 EX (05-04) PA Department of Revenue '* Bureau of Individual Taxes . . Depl. 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MI Spouse's Social Security 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) 4. Limited Estate C) 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 N 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 12 8. Total Number of Safe Deposit Boxes ... .55 :i"iZ --j > 3: '-R w - - Correspondent's e-mail address: ('fa-pI("61/t'LA. ~ (1(){- ('6rY"'l 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 othilr than the personal representative is based on all information of which preparer has any knowledge. SIGN URE F PERSON RESPON L F. R FILlN RETURN I Side 1 L 15056041046 15056041046 --I -.J REV-1500 EX Decedent's Name: RECAPITULATION 15056042047 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) c:::::> 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. Decedent's Social Security Number 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_ 17'. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:::::> L 15056042047 Side 2 15056042047 .-J REV-I508 EX. (1-~71 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Fv LLE. R lA-~ If ) PHiLLIS . FILE NUMBER It. Fu LLLI<. ~311 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF f H Y L LI ~ F Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. :z. DESCRIPTION COMmfl? CC B-fAJ,f /4M~(etsgvt<G N ./1. - /I(;,d IJO. cS" 17~'f;lJ.)." AI...I../A/JCE. BAiVk.1 N41f1'L701lf, AJf- c. D A-ct.T ,110. f()oo5''It:.'f1 if<v 17 kC()~1V1~1l vJTU I ~v~ ( te!>~CO FoA. 1=VAlf'J)41 FVA/i:'R.I4-L f4()M.~, X.vc... . E.J..fiNjE.) "31 c..EDllf<. ~ / lJ(o/f(l.(r""IIL, AJy,ll'ft>t VALUE AT DATE OF DEATH ~ 0 y.;).. if-J- ~ OOt{.. gD , 3, ?JllftJOR C~<<€ C~J..IS'LE - fr,er/wIfL (;II<€: ~CCl~r 9EJ .O~ TOTAL (Also enter on line 5, Recapitulation) $ 15:/ lJ.. J...;l if (If more space is needed, insert additional sheets of the same size) REV-1'511 EX+ (12-99) . .:, .' ~.~ ... . ~. '"-4 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF If LL, ( ITEM NUMBER A. DESCRIPTION 1. FUNERAL EXPENSES: f3U~GE.55 r:/ 7EPEJeO j;.~t:.>>9L #Hfr:IN(~ >1 C(M~ ST /1l0tXlsViIIE, }.If Il'f-OFf fRLBfID u;f c~nflL"r~ cr ~IbF/T.# 9oos-~.t; fZ ..f Dol". O. kIt1IH.fE~1 VI Tltrhl'!-N D - FUNt.R.A l tLO,oEi!.. S ;J.- B. ADMINISTRATIVE COSTS: g- 'l, if) , II. 1. Personal Representative's Commissions /lFRo 11..Ati../ Social Security Number(s)/EIN Number 01 Personal Representative(s) & RD. State~ZiP /93.:J..D Name 01 Personal Representative(s) Kf:.8iC C4 Street Address ;30 a 01.. j) City ~IiTJ \J I I (E. W llMIAJTCAJ 2. Year(s) Commission Paid: ~D8 ~"" I:. FeE. '. ~ r.. '"_, r m C /Jn1ML.<Ce '1\" fl8G- J/,A.. c..J1if.ff t~1.~/~G jL~~~c.~~"t;( 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 to Decedent 4. Probate Fees.! KLG-/5TeR- ~f- Wi I~, L,iMl3&e"'fN{) (C;. frt. Accountant's Fees ~ fsftRlf(RlthV 11-. G, {VA) 6-11- ~/hJ!!.!i. /.,/ Tax Return ~ .. ....... Fees ~ Ri..6-($T~~ of 4>; If :;J..;"LJvTc}~Y re/E..' 'Rf..&-lsT[K cr Will)... FilING- Fees ~ f'IlJI If FnvAL /k..:..T. 'i fLTi"'~^",J Fe/!.. 7Jlj~/B(,)Tt~A..:'. i.5TltTc kOv~ Tls€.M~T: fr,.)(/t?N )/&..'f(1J }I~J/HfO..> ~ 14M'$flUIUr, 4- f5 T.+Te ,tiN C~ nS()tllltVT ~ Tile ~1/iVttL... }Jews I (~i.151.L I fh., MIX EXft:JJ$E.S'; f.5f/~/~'M) 4.6/VAU-A f.'K;:~Cc:A- ;/n!/J1M",/ r#,<J. RL:Ih\)3vt?€MC,.(.IT ()FtiJ,vI?L t:;(fEA:JES~ PoST~/ F-1,{/A/G-, TELEP!#Wc:. ~ !J.LL ~cv . 5. 6. 7. 003 AMOUNT ~ i.r"lJ-fjC , 3D t.f: ?'C '3 5 (,. 6 2-- 10.70 'f I: - () e. I. )'7f: L'n 15",0[' J 5;.~o j 50.0 D 3~.~"o I , 5:.;.l~ ~/). 'if TOTAL (Also enter on line 9, Recapitulation) $ /1 t/<f s: 3/ (II more space is needed, insert additional sheets of the same size) ,--j', REV-1S.2 EX, (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER PHYll.IS F. fvLLf.f( (ilkif-) PH-'yLL./J It. rvLLEf( Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH ITEM NUMBER 1. DESCRIPTION CtJNlntON u.JE"'fc ift ,p 119,;, /)E;Or ~r (lei Bile ~h1R€ E()RUfll Dt= FI/VItIVCII9L e()~~,f-7/p"1, ]);v/J""A./ t'f rfll7?o Plf..<',!, #198,1,7/... E'.Ir;1lZ 1?t.C"()ild,Y f1<'po~1f-H'1 r 0 r 30)( grr-$i,. fI/f,.e~(.J B oR P- fA-. /1/ ~ s- $ 'I, J ~b. 9 3 TOTAL (Also enter on line 10. Recapitulation) $ '1; /;l.. {, . f :5 (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 'AkA) NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RLLLAJ H. Fv LLEI< 8~ C((EE,k 7<.(), C4RL1Sc..c J r"... ,/70 I ~ 1. FILE NUMBER S RELATI NSHIP TO DECEDENT Do Not List Trustee(s) Hu!6If-N 0 AI ON IE.- ;TAlscH/eA.;T ESl~ - 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)