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Home My WebLink About11-03-08~ REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 °~ ENTER DECEDENT INFORMATION BELOW Suffix ~~ ~~ ~, c- ~ r~~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return i'~ 2. Supplemental Return 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 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 EE DIRECTED TO: Name II f , Daytime Telephone Number l ~ ~ -t~ P~ ~, ~ L_ ~. _`~ Imo- ~ ~7 ~ ~ ~ i ~ , `'~ r.~ ;~.,, ~ ~ ~. Firm Name ~If Applicable) ~ r RECvISI'E?R OF 4"JIL.L:~ US[' ONLY h:: ~ r_"~ First line of address `--' ~~ n ~3 , t ~~ O~ Second line of address ` r 41 _- ~ City or Post Office State ZIP Code MATS: i IL~u - ~ _ _: ,/ i __._ ,.. , t ~, . Correspondent's a-mail address: Under penalties of perjury, I declare that 1 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/t(i~n th~~rsonal representative is based on all information of which preparer has any knowledge. SIGNATURE ¢G-PARSON RESPONSIBLE FOR FILING~Eff Rt~l' -" ,'DATE -~ _-_ ADDRESS `' ; ~(, '7- ~ _ _`.:> _- __ ~ f~ /I - ~ .:,) T ~=c~~Z/Y'~L~1t,.,sn ~_K-Z2~f.7--, /~, ~~ ~/'~~(..~M,~!l.l~/'L~~rC.~/~ / ~.~~~ (,~ ~~;) i ~:. SIGNATURE OF PREPARER OTHER THAN I~PRESENTATIVE DATE L. ,r ADDRESS. 1 505605 1 058 V ` 1 (~ ^ ..J ~ `/r, ~ ~~ ~ OFFICIAL USE ONLY _" V° ~f County Code Year IN RESIDENTEDE EDEN RN t7L 1 v o File Num er (~ ~`~' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Date of Birth D edent's First Name MI ~_~ Spouse's First Name MI 3. Remainder Return (date of death prior to 12-13-82) PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 ~~ a ~ 15056052059 REV-1500 EX ! ~ ~- ~ ~ ~ '~ 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) ........... n .~ ~ ..... 10. t~ / ~-~ ~ ~ / C / ~..~ 11. Total Deductions (total Lines 9 & 10) .............................. ..... 11. 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. 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 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 15056052059 Side 2 15056052059 REV-150o EX Page 3 Decedent's Complete Address: _ file Number DECEDENT' ME ~- 1 ~ ~ j ~ 1-~ STREETADJ1ftE$S ..I '.-"'~- _ nay - -, , ~, ( (~~~' ~ r -2v _` ~- -.~ _ ~ _ __ ~..> _ ~ CITY ~ ~ _ _ __ ST T ZIP ~ _ L-, F1 ~ ~_ ~ [ ~ I tr~J l ~-/ it ~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit __ B. Prior Payments C. Discount 3. InterestlPenalty if applicable D. Interest __ __ E. Penalty Total Credits (A + g + C) (2) ___ __ Total InterestlPenalty (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. (q) 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 due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) Make Check Payable to: REGISTER OF WILtS, 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 occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ ^ 3. Did decedent own an "in trust for" or payable upon death bank acwunt 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? .................................................................................................................. ...... ^ ^ 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 exem>Dt 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 (O) 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) pelrcent, 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-1737-7 EX + (6-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT ' SCHEDULE 1 DEBTS OF DECEDENT, Use Schedule I, Part 2, ONLY for MORTGAGE LIABILITIES & LIENS proportionate method of tax computation. ESTATE OF ) ry/ FILE NUMBER :, ~- t - ~ '. ;.> Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and owed as of the date of decedent's death. Complete Part 2 ONLY when the proportionate method of tax computation is elected. •: ~~ ITEM NUMBER DESCRIPTION AMOUNT 1. TOTAL PART 1 $ ~ ~ • ~ ~ ITEM NUMBER DESCRIPTION AMOUNT 1. `-- , ~ -ti. r~2.._.~ ~ ~~ --~. L -;~ ~ ~i 'j _S ~ 7 TOTAL PART 2 ~~ $ J~~~ J~ -~.~ TOTAL (Also enter on Line 1U, Recapitulation.) r $u ~ ~ \ , ~~ (If more space is needed, use additional sheets of paper of the same size) r 'F COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 October 16, 2008 EUGENIA P. LESKIE C/O ESTATE OF RAE E. CARLIN 57 COUNTRY CLUB RD TUNERSVILLE NJ 08012 Re: RAE CARLIN CIS #: 820176581 SSN: 198-12-1117 Date of Death: 04/17/2008 Dear Ms Leskie: This is to acknowledge receipt of payment in the amount of $5,155.75 regarding the above-referenced estate. This reflects payment up to the value of the estate. If any additional funds become available, please contact me. Your cooperation in resolving this matter is appreciated. Sincerely, Marie A. Trayer Claims Investigation Agent 717-772-6723 717-772-6553 FAX