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HomeMy WebLinkAbout10-23-08 J 15056051047 REV-1500 EX (os-05) OFFICIAL USE ONLY PA Department of Revenue ~ Bureau of Individual Taxes County Cade Year File Numbar PO BOX 280601 INHERITANCE TAX RETURN ~ ~ ~~ ~ 05~ Harrisburg, PA 17126-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death Date of Birth 9 f 1 S 3023 o~a(~ 200 8 1 225 ~ 9 23 Decedent's Last Name Suffix Decedent's First Name MI $ E I Q IE L /~/~ N k'. y N (H Applicable) Enter Surviving Spouse's IMormation Below Spouse's last Name Suffix Spouse's First Name MI SE ~ ~~~ Ro S~3 ~N w Spouse's Social Security Number I ~ N Z ~ 3 Q 9 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW r~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy otTrust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credtt (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 iNFORMATItNI SHOULD BE DIRECTED T0: Name Daytime Telephone Numbe- Rosa ~N w SCI pE ~ -~ t 7 73? 94y9 Firm Name (If Applicable) First line of address 3U CC~vNT2Y Second line of address CLuB Pt± AGE W. City or Posf Office CAMP ~ ! L~ Correspondent's a-mail address: State ZIP Code REGISTER OF MILLS USE O C"~ °w~- _~O O i ~ t': ~ 7=n "I -~ I-rt ' N -~ - °. w ...:~ C. l :~_ "~ =t 1 DATE FI ~ PA ~7a~! ~ N __~_% ;_ _. ~~ ... - Under penaltles of perjury, 1 declare that I have examined this return, induding accompanying schedu~s and statements, and to the best of my knowledge and belief, ft is true, correct and complete. Dedaratlon of preparer other than the personal representative is based on all lnfamation of which preparer has any knowledge. SIGNATURE'~~g~ Nl~REyPOIViS,` E `OR FI).ING RETU N ~ D 30 - ^~ ADDRESS GGrr V 3o Co~~Tey Ct~6 P~A~e ht.. C~p_ !~-~ t 14 ~ ~'7c~- I 1 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEABE U8E OR1~31NAL FORM ONLY Side t 15056051047 15056051047 J 15056052048 REV-1500 EX Decedent's Social Security Number o~ent~6 Name: 19 i ! 8 3 Q 23 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1.6 ~ s(~ ~ . Q 4 2. Stocks and Bonds (Schedule B) ...................... . ................ 2. ~'/ Z ~ fi7 V ~ • Q Q 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable {Schedule D) ......................... .... 4. • 5. Cash, Bank Deposits 8 MisceNaneous Personal Property (Schedule E) .... .... 5. f f~ t(j I, g .Q 6. Jointly fawned Property (Schedule F) O Separate Billing Requested ... .... 6. 7. Inter-V'NOS Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. 8. Tool Gross Asssts (total tines 1-7) ................................ .... 8. ~d ~ 8 ~j 1 . O ~ 9. Funeral Expenses 8 Adminishative Costs (Schedule H) ..................... 9. 7 ~ 8 2 , D Q 10. Debts of Decedent, Mortgage liabilities, 8 Liens {Schedule I) ............ .... 10. 11. Total Deductions (total Lines 9 r;< 10) ............................... .... 11, r gQj ~ ~ O 0 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. • 13. Charitable and Governmental Bequests/Sec 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. Y 9 $ 9 8 7 • ~ D TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ~/ Q Q ~y o 16. Amount of Line 14 taxable at lineal refs X .0 - • 16. • 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 Side 2 15056052048 15056052048 .~.. O r O REV,1500 Ex Page 3 File Number Decedent's Complete Address: DECEDENTS NAME (,~ENR~/ _ /'T~N2~C~Q J~~~~- STREET ADDRESS I ! _ __ CITY ~ 1 ~ ~ - STAT~,e~ Z~ ~~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) "" ~ ""' 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments _ _ _ C. Discount _ _ - ___ Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable D. Interest _ _ __ E. PenaKy __ Total InterestlPenalty (D + E) (3) 4. It 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 fire d'rfference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) .....Q -- Make Check Payable io: 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 :........................................... ............................................... ^ 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 ocairred after December 12,1982, did decedent transfer property within one year of death without receiving adequate corisideration? .............................................................................................................. ^ 3. Did 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 benefiaary designation? ..................................................... ................................................................... ^ IF THE ANSVYER 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 Vansfers 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 exemut a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a #ax return are still applicable even if the surviving spouse is the only benefiaary. 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 fhe use of the decedent's lineal benefittiaries 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) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCi~IEptILE A REAL ESTATE ESTATE OF FlLE NU~ER All real property owned toNly or as a bnant to common musf be rsporbd at fNr market value. Fair marks value is defined as the price at which property would be exchanged between a wtltlng buyer and a wing se9er, nedher being compelled to buy or seN, both having reasonable knowledge of the relevant fads. Real propertt which Is jointly~owned wNh fight of survivorship must be disdossd on ScheduN F. REM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Ho ~s,e - 30 ~,..,.1 ~1(•'~•w, f3 ~ , t , ~A ~ ~o t t Pee :~ a ~S S~~ ~~ Q ~ ~~ ~ t S~~' ~~, ~.zs 13?ro~~ -: 2 = ~~t505 TOTAL (Also enter on line 1, Recapitulation] I S (N more space is needed, insert additional sheets of the same size) i~, 50 ~ REV-1503 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEp1~LE B STOCKS & BONDS __ ESTATE flF FILE NUMBER Alt propeAy jdntly~oweMd wttlt ~ of survlvorsidp must be disdossd on SehsduN F. z. 3. ~, 5. S M tT~ ~ p'2NE~~ ~~`~-aZ1'~~ ~~i2~ sT~ ~m :~ ~~tiey 72'~ -~ 0.72 3 ~Jo~w~ } g~7~,o52 =2 = ~3S,S2~ ~ r~ nw f3~-~~~ ? 2 y -' lot'o 1 ~ ~ ~ ~`R'~ ~ni~hovtA ~~c,~l~,+~~s ~~4 7~3~ ~rn®2~~21se 1321 ~N3o 2s2 ,9~a 35, 52(0 l~,~~9 !'x,735 7 3, ~ eS TOTAL (Also enter on Gne 2, Reca>~itula6on) I i ~ ~ ~ I tp 8 S (H nave space is needed, insert additional sheets of tim same size) ,REV-1508 EX+ (8-98) ' SCNEp1~LE E COMMONWEALTH OF PENNSYLVANIA CASH BANK DEPOSITS, $c MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUIt~ER Include the proceeds of WdgaUar and the date the prQceeda were received by the estate. Ab property Joingyownsd wtth right of survivorship must bs dbclossd on Schsduis F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF pF~4TH ~ASN ~ ~A S ~-~ y, S s"'f Q 7vd ' ~ t ?, ,~'v o ~ ~~ .~ ' ~r,~rl~~~~c~ .3' ~~~~06~ ~~ ~ 2000 f~lerc,,x,.T ~~~f~ ~ 3~,~ ~S~~a~~ ~~, ~ ~,,,~,' TOTAL (Also enter on line 3, Recapitulation) f /(0 7 9 (K more space is needed, insert additional sheets of the same Sze) (?EV 1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEOt~LE 6 INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE Of FILE NUMBER This schedule must be completed and filed 'd the answer b any of questions 1 tMargh 4 on the reverse ode of the REV 1500 COVER SHEET is yes. BEM N DESCRIPTION OF PROPERTY wixuoe n~ ~ ar n~ rn, ttiea m o~avrwo n+E auE ar rn~nsret ar~~carr of 1t1E c~ rat aFx EBTATE DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION F ~~ TAXABLE VALUE t. TOTAL (Also enter on 6ne 7 Recapitulation) : (M more space is needed, insert additior~el sheets of the same size) REV-1511 F.X+ (10.06) SCNEpYLE N COMMONWEALTH of PENNSYLYANIA FUNERAL EXPENSES 8e INHERRANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FlLE NUMBER Debts of decedent must bs reported ae Scheele L A. FUNERAL EXPENSES: 1. C/~-T er2 - rC~ J~ti~ i,~>p `~',c.k~~ ~1~~ er~.s ?RAN t'r.~ ~. u~-hones t~JwQt~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Canmissxme Name of Persatal Representative(s) __._.-----------_--_-- SfreetAddress _ T_ -- __-^ City State Year(s) Commission Paid: Z- Attatrey Fees 3. Family Exemplar. {tt decedent's address is not the same as Gaimant's, attach explanation) Claimant Street Address ____ ___ City State Rdalonahip of Claimant to Decedent 4. Probate Fees 5• Acootxitant's Fees 6• Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) ; 7 ~R7 .oC, -~P /, ~'y6 .ov yo l6 . ~© / d vo . as /70, ova ,5`00.00 ySo , o0 Lp ----- _ _._. -- 200.00 (If more space is needed, insert additional sheets of the same size} REV-1512 EX+ (12-03) COMMDNVYEALTH OF PENNSYLVANIA RAiERITANCE TAX RETURN RESIDENT DECEDENT scN~ou« ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts breumed by the dsesdsrd prior to death rdlich renu>insd unpaid as of tM date of loth, indudhp unrai~ursed madieal azpensss. (if rrrore apace is needed insert add'rtionaJ aheeta of the same size) REV-1513 EXi (9-o0J SCEIEOt~LE J COMMONWEALTH of PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE tJF FlLE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustrs(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributmr-s, and transfers under Sec. 9118 (a) (t.2)J ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOV{M ABOVE ON LINES 15 THRO UGH 18, AS APPROt'RIATE, ON RE V 1500 COVER SHEET tI NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR VNiICH AN ELECTION TO TAX IS NOT BEING MADE ;y9$~,987 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET = (If more space is needed. insert additlonat sheets of the same size)