Loading...
HomeMy WebLinkAbout11-14-08r J 15056041046 REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Dept. 280801 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT vZ / ~ r~" ©' p88$ C' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Bir#h ;' _ ~ . ~. Diet _J=nt L.~~t fJ:3rie Suffix DecNdrr~ts Fi~~t Name MI a ~. ~,- (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Fitst Name MI ~. ,_ .~ Mr. .~-_ a . ~ ~: _- , Spou e~~s S~~cial SNsurityNumber ~.. a ~ "~ '~' '"' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ `,_~9-Z.-`~ `y .:5~ :3 5 REGISTER OF WELLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 4. Limited Estate O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return. Required O 4a. Future Interest Compromise (date of 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 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 ., - Finn Name ilfP,p~li~ablel - '' ~` ~' ~ -~ '°~ ; ~' - - --~ ~ REGISTER LS USE Y t ~ ~ ~ ~ ~ ! ~ ~ 7 = ],7 ~ ~ ~ 7'; ~_. ~'- ~r ..,. ,. ~ ~~ i~ -~ _ - ~ _. Fiat line of address ~ -°'-t7 ~ : , , S~~ ,n~i linr of 3jdr Cit ur Port ~ ~Hi~e ~ State ~ IP Cn.ie D'A'TE FILED ~ _ ~-~ .~ Q / ~ ~ ~ - .~ E, - T Correspondent's a-mail address:_ /, ~,Q~'rj, ~y/tIPE~' ~/YyiyTiN~~~/~c~r., 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. SIGNA ,URE OF PERSOIx RESI~ONSIBLE FOR FILING RETURN DATE ADDRESS ~~~~~~~` SIGNATURE OF PREP ER T R T N REPRESENTATIVE DATE ADDRESS ~ ~.Z j ~~dn~r ~? /~c~li'/~~ D~so l/f/,Z PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041046 15056041046 15056042047 REV-1500 EX - Decedent's Social Security Number -. ~ , . Decedent's Name: ~ . © p ~ •y ~j/~ 3 ; s-~ RECAPITULATION O 1. Real estate (Schedule A).'..:...•..:. - - - 1 e = ~ ' _ 2. Stocks and Bonds (Schedule B) .................................. ..... 2. ¢ , - s • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) _ ,: 3 , . 3 ~ - , . , . ~, ,. ..~ ,- . -. ., 4. Mortgages & Notes Receivable (Schedule D) ....... _ , , • .. • . ...... s j 4 a • 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ... .. • . L ..... 5. ~ `L~7 7 / , ~ ,i/ 8 6. Jointl Owned Pro e Y p rty.(Schedule F) O Separate Billing Requested .. ~ Y _. _,. art Sl :~-~ F ___ ..... 6, ~ 7. Inter-Vivos Transfers & Miscellaneous Nori-Probate Properly .>-: ~ ^- ~` _:. • _, (Schedule G) C Separate Billing Requested... ..... 7. ` ' y ,,8 3 ,~ ~ Z :S ~~ ~ 8. Total Gross Assets (total-Lines 1-7) ....................... ~ •.: _ ,>~ ~ ~ ' 9. Funeral Expenses & Administrative Costs (Schedule H) ............. .... ~ ~ ' ` .... s. /a , ~ 9~~r ~S' 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ - .... 10. - 11. Total Deductions (total Lines 9 & 10) ......................... ...... , , 11. ~ / D .. ~ o~~`:o~ 12. Net Value of_Estate (Line 8 minus Line 11) ....... ~ ? ~: ~ t/ ., ~ _ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which -._. - - - an election to tax has not been made (Schedule J) .......... ...... .. . 13 r ~ ` 14: `Net Value Subject to Tax (Line 12 minus Line 13) ........... ......... ....14. g3 .y' //T:' 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 Q ~ ~ ~ ~ ~ Y ~ ( ~ . ~ ~ _ . /_ I ,;.7 16. Amount of Line 14 taxable " - 15. ~ y ` - - • - ' at lineal rate 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 O Side 2 15056042047 15056042047 J REV-1500 EX Page 3 Decedent's Complete Address: File Number a2/- Oa' - OU ~$~ STREET ADDRESS _ CITY Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE ZIP /~D/.._7 (1) ~- 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) _ p - D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal Interest/Penalty (D + E) (3) - ~ - 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) d - A. Enter the interest on the tax due. (5A) ..._ ~ ._ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) . ~ . 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: a. retain the use or income of the property transferred :.................................................................................. Yes ........ ^ No 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 benefit ? . ....... ^ ~' , s or care ........................................................... ^ .... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ....... without receiving adequate consideratiori? ........................................................................................... ^ ............ 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 beneficiary designation? .................................................___ I =7~ r~ 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 no_ t 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-15UE EX « (1.g7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~ffff/~~ ~U -T"~ FILE NUMBER tires --~ ~/ 'e. ~ l - ~~ G~ ~~ Include.the proceeds of litigation and the date the proceeds were,received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ • ~C ,6 ~ ~~,~ f'-~ OF DEATH cr.~ ~.f~ P.q X70/? .Qc ~T~ 70 _9~.?~L S'Av..,~l fJ~tou•••~ i y TOTAL (Also enter on line 5, Recapitulation) I $ 8 ~ 7/ ~ i/ (If more space Is needed, Insert addltlonal sheets of the same size) ~ REV-1510 EX+(1-97J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER•VIVOS TRANSFERS ~ MISC. NON•PROBATE PROPERTY C'.4.Cj< EU~~ ~~~ This schedule must be completed and filed if the answer to any of questions 1 through 4 or DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE PATE OF TRANSFER, NUMBER ATTACH A COFN OF THE DEED FOR REAL ESTATE. ~. 2',Pi9 Er+yQi~l / j' jtir-o~G~a-l B/1r~~ v i N FILE NUMBER a ~ app. ~~G i the reverse side of the REV-1500 COVER SHEET is yes. DATE OF DEATH % OF VALUE OF ASSET INTEREST EX C~USBON TAXABLE VALUE .~, o y838. sr i~ y8~.,zs -s'~~ Gov/1P O.e, S,~w~ TOTAL (Also enter on line 7, Recapitulation) I $ ~~' 3 ~ '2 S (If rrrore space Is needed insert addltlonal sheets of the same slze) a . REV-1.511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~A~~ E': ._.l v SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ~v ITEM JUMBER A• FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. yaf'i~~ ~m~ f.M.~~oa~ ifa~ a / 9 /r/a~P : f/ f/.~ir/crr~ 1T /O U 9~, cll' ~.+,e C~.r G, PA /7ar3 B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip ____ Year(s) Commission Paid: 2• Attorney Fees 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip ___ __ Relationship of Claimant to Decedent 4• Probate Fees 5• Accountant's Fees 6• Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) I $ ~~ d9~ or (Ir more space is needed insert additional sheets of the same size)