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Home My WebLink About04-24-08 '--.J 15056051047 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 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 Spouse's First Name MI 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) 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 Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes 4. Limited Estate C) C) C) Second line of address " -0 ::J!: =0 N -'~1 ... -0 JiJATE FILED -r;::- First line of address or Post Office State ZIP Code '7 f 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. RETURN L.fJ. CAl f-/f r 1-/: I~ ~ . DATE L/--Ib"-O/,. {""70ft DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.JSs r---~ I 15056052048 REV-1500 EX Decedent's Name: "fj, /J1 f,e i ~k 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. 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. 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'APPLlCABLE 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 19 TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ ~-il -Q ~ -;:; 2'iT ~ Side 2 15056052048 15. 16. 17. 18. C) 15056052048 ~ REV-1500 EX Page 3 Decedent's Complete Address: :::::::~E~O'IK~ IV}' rf1g~'1 <:- k __~7_~_E llS>+- L I) u e!Z L J4 N .-E- File Number CITY STAT:;:). , ZIP /70// Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) (:; Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) o 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 !Xl b. retain the right to designate who shall use the property transferred or its income; ............................................ D [1J c. retain a reversionary interest; or.........................................:.~.............................................................................. D IXI d. receive the promise for life of either payments, benefits or care? ...................................................................... D tiJ 2. If death occurred after December 12, 19B?, did decedent transfer property within one year of death 3. ~:~h~~::~~~~:~::~~~::;u~~~:~~:ra~~~;~;~. .~.~~~. .~~~;~. ~~~~ .~;~~.~.~~. .~.;.~~~.~.;i~. ~~. ~'i~' ~~. .~~.; .~~~~~;:::::::::::::: B ~ 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. 99116 (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) percenq72 P.S. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the dececjent's siblings is twelve (12) percent [72 P.S. 99116(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-15Ol1 EX. (1-97) ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ITEM NUMBER 1. {).. 3 4-- s-- DESCRIPTION f'.:5 EC U - C..b '..- IJ.. { -:5 Mil L'- d <J:i ... ~ AC"o-\-: /'> ..--n'. -1--0 L. 0 N E 2 - C O'...s \" I (j 877 I ~ a-scr LA 1'" l:::FI- I () I 0 ~ 6~ 7 '3 C ri* 303 - 3c?~73'.s-g A 3 VALUE AT DATE OF DEATH 1 ;;. ').., '-I- (J'q :7 b '~.~cYl. co .....,. ~~ {>II 64-'. 4- '1', -z..6$ .be> {b'. 4- '-7-.bD 060 -Sfo S S <:\. . .h' \ .::5 C ov e 'J;:. '13,4 IJ K :r~-'-kl a ~~t ..J- Y t: 11 N k .:sVYQI--~d,.....15I9Nk oooooottJO /oo"Si..3o ~ "33iS s cS'fS lJ I c.. 0 0:7-' TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 2-7 '84- (3. '7 <:, , REV-1510 EX. (1-97) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE) NUMBER 1. "F'.5€C(,) :S~-F\"" ~ t> 's :t R t=J rt q,"7~.3 I TOTAL (Also enter on line 7, Recapitulation) $ I' <f, ld-d.3' (If more space is needed, insert additional sheets of the same size) t - J: 0 uJ 0.. CJC:) I ~ ~ ~ Ln~ C/) 0-- f-- -00 ODf---.;Z _r-- Q..........(/)OMN~ '---10 (LZr-- E: .l-A,O viCl..ffi- g:cr: It. 0 ::J f5 <X :J: C/) b \ ~"'.\ ~~II~~ ~~ l~ :>~ ::: -0 El ~ I .~ S +- "- o c .... a..-J< I-, La.. "C" _ L =' = ~j:f "CUJQ. UJInE ~~~ It ~ ,-'.r'.~' - n,. ..it.. \_d H1I: 0 \fVllL.0 ~ ~i,pR;4 PH I?' I, i /~, \J CLERK r Q1P.. H,C.~'J'(' i:: T CU{!Dr:~ \"~ a! !::: I o o o o - - ..... o o (..I (i) '\' Ii) (1) ~8 Fi .~" "', I." j'- .,."