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HomeMy WebLinkAbout10-16-08.. ~. t 15056041046 05 04 REV-1500 EX ( - ) -OFFICIAL 1~SE OAILY PA Department of Revenue Bureau of Individual Taxes Count Code Year File Number ~ y Dept. 280601 Harrisburg, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT L.. 1 0 ~ ~ (~ ~ U ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ 5~! ~/b 7~ 7 ~ ~~ 2 ~ ~o a ~ o,~ t 5' l'~' l3 Decedent's Last Name Suffix Decedent's First Name MI m t ~.- ~- ~ ~ 7` ~- e ~, ~ ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name 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 O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estatee O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust _~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~- ~ v- I !r ~ E 2 2 ~ ! y '7 ~ 3 3 S' dP 3 Firm Name (If Applicable) First line of address P t~ B o ~, ~ 7 ~' Second line of addres:> City or Post Office State 1M ~ r ~' i ~~ S b ~~ r~ P l~ ZIP Code REGISTER OF WILLS USE ONLY n-> r^? v_~ ~ cz~ CO ~= --- , - Cj , `;~~', .- ,_ - - -'v , ~ =;. `Bf~1~jFILED ~ r~ l G Co ~a 2 U .Z /-''~ coo Correspondent's a-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. SIGNAT~_`~~SOP~ONSIBLE FOR FILING RETURN DAT ~~, /~ /a ~ ADDRESS SIGNATURE OF PREPAR'.ER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 150156041046 15056041046 J ~~ 15056042047 REV-1500 EX Decedent's Social Security Number L ~ ~R Tlr-~ n0. ~ 1 ~ M , . _ , . = _ . 0 ~ ~ ~ 7 ~ " ~ ~~ 6 Decedent's Name: 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. D 4 ~ ~ ~ ~ 2 y "; 4. .... ~ 9 9 ( ) .............. Mort a es & Notes Receivable Schedule . ~ 3 4 1 7 z 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. • 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. + 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. • 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ~ 3 Y ~ ®7. 6 r 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. . ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ~ 7 p O ~ 7 . 3 5 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ 7 ~ ~ ~ . 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. I I 6 ~ ~ © • 3 7 13. Charitable and Governmental BequestslSec 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. ~ ~ ~D 7 ~ ~ • ~ "~ 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 15. 16. Amount of Line 14 taxable • 16 ~ ~ ~ y • ~ ~ at lineal rate X .0 _ . 17. Amount of Line 14 taxable at sibling rate X .12 • 17. • 18. Amount of Line 14 taxable at collateral rate X .15 ' 18. • 19. TAX DUE ...................................................... ...19. • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056042047 15056042047 1 •. t REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ - ~.t.,~ STREET ADDRESS p g ~ ~s e (~^vv-t ~~s ~ k ~~11~~~ CITY 1'Y'l~~ ~ ; ~ 1 6 u„r,, STATE ziP ~?dS~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount ~S9 ~- y~ - ~3 ~ p (1) ,SS ~..~' ~L ~-~ Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (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 F~age 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. A. Enter the interest on the tax clue. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate ccnsideration? ........................................................................................................ ...... ^ 3. Ditl decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ ~~yyII 115J 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. §9116 (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. §9116 (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. §9116(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. §9116(1.2) [72 P.S. §9116(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 P.S. §9116(a)(1.3)]. Asibling 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-1502 EX+ (6-98) , _. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~1 I ~. ~, ~ `~ Tin ~. rh . 0 5'` 9 ^ -~c 73 ~ ~ All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between ai willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. (It more space is needed, insert additional sheets of the same size) REV-1504 EX+ (1-97) ~` COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEIDENT SCHEDULE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationJpartnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. to more space is neeaea, insert atlditional sheets of the same size) REV-1511 EX+ (10-06) ~~ ~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAA; RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF _ FILE NUMBER (~ ~- ~ (2 1 rY n c. ~. C1'3~~ z1(o -- ~ 7~ 7 f Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX iRETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. r7 J 5f (If more space is needed, insert additional sheets of the same size)