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Home My WebLink About01-30-08 (3) 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 lif.5'i3.p.i<?i sr~'.'K: -.I Decedent's Last Name We I b eL- 15056051047 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix WeI6~L 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 Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return c:::> 4. Limited Estate c:::> 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received c:::> /I) If ~.J- I }/ c Firm Name (If Applicable) First line of address J e 31 /f lJ /'I r 1& /Z- Second line of address City or Post Office Spouse's First Name MI c., THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS c:::> 2. Supplemental Return c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::> 8. Total Number of Safe Deposit Boxes Weli& g,l.r 7/7']3;2 3~B.:S REGISTER OF WILLS USE ONLY D~ t.._,) o :=~ c.: => -_0 . - :u c_ ~ ~'-1:J ~~ 'T () -"__ : ::~: ~ CA) C/" .~- 0 OAT )LED ,")C) -fl /706'"'0 t~ d~ :TJ J> State ZIP Code Mce)/ f}1Y) C.5 8U"tl.,h Pr7 Correspondent's e-mail address: ~ ..... r- - '- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS L 15056051047 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 ---I .-.J 15056052048 REV-1500 EX Decedent's Name: Decedent's Social Security Number J q 58J- o:>.y6 RECAPITULATION 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. 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . 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) 8. 9. 10. . . 11 . . 12. 13 . 14. TAX COMPUTATION - 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0<t:L 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 7 / t5JCyD.OO . . . 19. TAX DUE. . . . . . . . . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 15. o 16 17. 18. . 19. o C) 15056052048 -.J ~ REV-1500 EX Page 3 File Number Decedent's Complete Address: ~EDENT'S NAME l' I 1)0 IZ A.s \Ne.lGI6'---' STREET ADDRESS /83i flu IV TiS te~ .>>rz. N/C~ gCllt6; STATE? /9 . ZIP J /63D ,160 b Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) - 0-- 3. InterestiPenalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) .-0- Total Interest/Penalty ( D + E ) 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. A. Enter the interest on the tax due. (3) ~D-- (4) 0- (5) C>- (SA) -0-- (5B) 0- ,~ 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 + SA. This is the BALANCE 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 transferred;......................................................................................... D ~ b. retain the ri~lht to designate who shall use the property transferred or its income; ......................................... D l2{] 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 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D E8. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ 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. S9116 (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 return are still applicable even if the surviving spouse is the only beneficiary. 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) percent [72 P.S. s9116(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. S9116(1.2) [72 P.S s9116(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 PS. s9116(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-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF _fx,~ t4 S FILE NUMBER WEI&&~ d)-D? All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 6PPI?N' JIb / Mete fuND -5 ToCi? VALUE AT DATE OF DEATH gOJOCO,OO TOTAL (Also enter on line 2, Recapitulation) $ /30, 008 .00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) _~.' '.lL ~ ,~_ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ])0 f2- ~1 5 W BIU '--" ITEM NUMBER A. Debts of decedent must be reported on Schedule l FILE NUMBER ;l fA "7 DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: /}U~(.~ MeMO,e.,AG- /!oME--1- ClUMnTJorV SEI!u, f WOOD)" AlPN MlidVIOlZi/l? G/Tj2JJ~JV ~ ~6>OD ...00 '" B_ ADMINISTRATIVE COSTS: 1_ Personal Representative's Commissions Name 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 ,II,ddress City State _Zip Relationship of Claimant to Decedent 4_ Probate Fees 5_ Accountant's Fees 6_ Tax Return Preparer's Fees 7_ TOTAL (Also enter on line 9, Recapitulation) $ 9'.d 0 tJ .0 () (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 .7)0/24 S Wel (PC; (,- ESTATE OF NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. jl;1)~).I/~ C \/Vbl GGc- 18:-3) H().f'i r6/~ JJ2-, /v'lf;:C H lff\lllS (3u Itb :Pl}. / 7ofj"D-- J(;:J00 FILE NUMBER cf2/-c/) RELATIONSHIP TO DECEDENT Do Not List Trustee(s) ;/u3~1t/i!J AMOUNT OR SHARE OF ESTATE )007J 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)