HomeMy WebLinkAbout05-16-80 (5)
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REV-452 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCH EDU LE "C"
TRANSFERS
. RESIDENT DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material pllrt of his estate, without receiving a valuable and
adequate consideration therefor? (Answer yes or no)
(2) Did decedent, within two years of death, transfer property from himself to himself and another or others (including a spouse)
i in joint ownership? (answer yes or no)
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor
which was to take effect in possession or enjoyment at or after his death? (Answer yes or no)
(a) Was there any possibility that the property transferred might return to transferer or his estate or be subject to his
power of disposition? (Answer yes or no)
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which
transferor expressly or impliedly reserves for his iife or any period which does not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no)
(b) The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer yes or no)
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the
benefit of care of transferor? (An,wer yes or no)
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved
power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of law?
(Answer yes or no)
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer yes or no)
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as well as a copy of the death
certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property transferred, it's fair market
value at date of death, dates of transfers and to whom transferred, with relationship of transferees to decedent, if any. Submit
copy of any trust deed or instrument, if transfers are claimed to be non-taxable, also submit detailed statement of facts on which
said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Estimated)
DEPT. VALUATION
(Dept. Only)
See explanatory letter
attached.
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
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