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Home My WebLink About05-02-08 (2) 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 NTER DECEDENT INFORMATION BELOW ocial Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Suffix Decedent's First Name MI Spouse's First Name MI Suffix THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 4. Limited Estate c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 1. Original Return c:::> 2. Supplemental Return 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 REGISTER OF WILLS USE ~Y ~~ ~ Q2 -0 3: L' I~ (") :a:. jQ r- -< :boo m I (5u>5? N 88~ ~ ~ILED First line of address ""t) :x c:,..) C C..) -T, -'-1 ... 0 .- rT1 <.:/.' C) -Fa or Post Office State ZIP Code <:> l ~ 'iO Correspondent's e-mail address: : I -e. .......... \0 0...'(" "M-'-.l ~ t:.o."" Under penalties of pe~ury, 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. ADD RES Ll P~CL.1 ~€..... ~~\.(...~ L SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE rOcJ<:L~~ ~ <....~ '-.""".><' I p~ DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J 15056052048 REV-1500 EX Decedent's Name: c,,-\.l.Q'C'\~. obl- 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) <::) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) <::) 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 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 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15. 16. 17. 18. <::) 15056052048 ---I REV-1500 EX Page 3 File Number Dece ent's Complete Address: DECEDE 1'S NAME _ c..c..o.-. ~.. "-'t' P STREET DDRESS ~\.:> 0 ~J l__ -- ...... ----- - ~4-:L L~eL~"\._~~ __~!:,~~~ flJ. CITY Cu.'t \\~L ! STATE ~I-\- ZIP j"e:..j~~ Tax P yments and Credits: 1. Tax ue (Page 2 Line 19) 2. Credi s/Payments A. S usal Poverty Credit 8. Pri r Payments C.Di count (1) ~ '1 3 :) . 9.,5' 3. Total Credits ( A + 8 + C ) (2) TotallnteresUPenalty ( 0 + E ) (3) 4. If Lin 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. Ent r the interest on the tax due. 8. Ent r the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) C;. C( .3 -~ e~- 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;........................................................................................ 0 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 0 c. retain a reversionary interest; or.......................................................................................................................... 0 0 d. receive the promise for life of either payments, benefits or care? ..................................................................... 0 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. 0 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ~ 0 IF THE A SWER 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) ercent [72 P.S. 99116 (a) (1.1) (i)]. For dates 0 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 (O) percent [72 P.S. 991 6 (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 r urn are still applicable even if the surviving spouse is the only beneficiary. For dates of eath 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 par nt, or a stepparent of the child is zero (0) percent [72 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. 9911 (1.2)1 [72 P.S. 99116(a}(1)]. The tax rate i posed 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-150 EX t (1.~17) ESTA E OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~, \\J 0 b(~ FILE NUMBER Cc.~_A lQV . ,,-,. M ct. 'T i'V\. -\- T IT M NU BER I elude 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, DESCRIPTION c...{t....5..$((... Lk..e~.~ \....)." j....l~.,~..f- () r e-"'L l ......~ "r..J....e, "'''' l-- VALUE AT DATE OF DEATH l"l, ~H.i.' I l Gt . w.....cc ,~-'-f TOTAL (Also enter on line 5, Recapitulation) $ '~J..s I / . ~S-- (If more space is needed, insert additional sheets of the same size) ITEM NUMBER 1. REV-1510 x. (1-971 SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA E OF FILE NUMBER ::\--le.-. 0\. :..;. .{). ~ .AJ..... his 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 INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATiONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE_ %OF DATE OF DEATH DECD'S VALUE OF ASSET INTEREST \ ').. I . , Gf '7 . 41 EXCLUSION TAXABLE VALUE ''''' e-.~..... ,-~-l-,,--\ L~ ,,=-~::r-- ""-~"'''14.'''(,''' c.... A'tI\",,",,'~ i ::l. i . "") ('i1~f"l TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) l ).... I ,I c:, ") _ '-' "'7 RE -1?12 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ES ATE OF ~~\ll_~ '" . tJ C~l (... FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE UMBER DESCRIPTION OF DEATH 1. \~Ci"'~ .....,q,..lc\. 1+(;.>'........... <...J...eJ.c...... ~. <e",.k~ ",C- '.oj.. ., '-t ' 5--<"1 I :l.. '7 ~ TOTAL (Also enter on line 10, Recapitulation) $ B 34- (If more space is needed, insert additional sheets of the same size) RE -1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ES ATE OF N BER I :l. Lc.....~ ,....(> FILE NUMBER f'. l\)l'~l.... 1. RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] J ..02- \. \... '(" -.?--q- L. C\.J 010 L ~ 'S O'\. It P@<~~L... -C-... -e." kt.olL-VL",," ~o.L~ ~ II "vL.;,<: \. ~t,. ),qn eH't>"..L ~ n''"'-'tkh..r c;.. e,(' tII\. c::to \I\... ~"" B 6;;-+ 5"llCi V\.\. GL .k ck. A v ~. k-e\M.O,.J ~ ~ p.. (~e s-I AMOUNT OR SHARE OF ESTATE 50 C'?c. 6'"'0 l)o ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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) RE -1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ES ATE OF ITEM UMBER 6~-e"""'t... FUNERAL EXPENSES: 1. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. Attorney Fees SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ~. ~ (), I... Debts of decedent must be reported on Schedule I. DESCRIPTION State _Zip 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 4. Claimant Street Address City Relationship of Claimant to Decedent 5. Accountant's Fees Probate Fees 6. 7. Tax Return Preparer's Fees State _Zip (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT <j,qf!,,(l .i teo. co -it I ~fLCXJ