The URL can be used to link to this page

Home My WebLink About12-04-08J a 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes Countv Code Year File Number Po Box 28osot INHERITANCE TAX RETURN ' Harrisburg, PA 17128-oti01 RESIDENT DECEDENT ~ I ~ 6 ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth / ~ U c~ 9 ~ ~ 3 9 ,~ ~ ,~,2 ~ D D 7 0 3' ~ G / 9 / ~ Decedent's Last Name Suffix Decedent's First Name MI B/~NKs ~.~ icE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 4. Limited EstatEs O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total O 11 per of Safe [~osit Boxes under S~ 9113(, ~ '. _. n Cr; --3..7 _, DBE ECTEp7p~''"~~ CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA Name Daytime Tele ,t3 F~ ~/ A ,~~ I B~ N k S 7/ 7 Firm Name (If Applicable) ~_ ~ 9 f~~/`' OF WILLS USE ONLY.',. ~ '"~ 4? ,.~ First line of address Second line of addres<~ Ci/tyy or Post Office State ZIP Code L ~'~I / 7D / ~ DATE FILED Correspondent's a-mail address: pX~(,r'~~S ~ /~0.L. CD~'1 s 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. SIGN~RE OF PERS nN RES~RONSIB}E FOR FILING RETURN DATE , AUURESS .~i 3 ~a it y'~~iy Sr C'd'r/~s~e P~ % rD/.~ SIGNATU OF PREPAR OT R THAN REPRESENTATIVE DATE ADDRESS ~~~ fi~ ~r~~1 ST ~r/i s~ ~ /7D/S L 15056051047 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 REV-1500 EX Decedent's Name: 15056052048 Decedent's Social Security Number 7a ~y ~'.~;~ y RECAPITULATION 1 ~ • 1. Real estate (Schedule A) . .......................................... . .. . II v • 2. Stocks and Bonds (Schedule B) 2. v' 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. 7 v~- J ~ ~ •, `~ 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. ` °Z -' -~ ~ 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. , ~~ '~ o • ~ ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. q h ~ / / ~ ;~ ~ ,y C ~ -~ 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 1 ~ `~ / ~ ~ l • ~~ 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 15 d (a)(1.2) X .0 - . 16. Amount of Line 14 taxable 16 ~ • at lineal rate X .0 _ . . 17. Amount of Line 14 taxable 17 ~~ at sibling rate X .12 • . 18. Amount of Line 14 taxable 18 at collateral rate X .15 . 19. TAX DUE .........................................................19. Q 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 15056052048 15056052048 ~V-1500 EX Page 3 Decedent's Complete Address: File Number 1tGtUEN I'S NAME ~I~C/~E /g/~~l/j~s - ~TREET ADDRESS - -- _ - - -- - ITY LE STATE ZI ~~~/~ G~/~,ec ~s /o Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0 2. Credits/Payments A. Spousal Poverty Credit - - __ B. Prior Payments C. Discount _ - -- - _- -_ - - - Total Credits (A + g + C) (2) 3. InteresUPenalty if applicable (J D. Interest E. Penalty - Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 +• Line 3, enter the difference. This is the OVERPAYMENT. Q Fill in oval on Page 2, Line 20 to request a refund. (q) O 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Q A. Enter the interest on the tax due. (5A) Q B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Q 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 :......................................................................................... . ^ 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 awn an "in trust for" or payable upon death bank account or security at his or her death? ............. . ^ Q 4. Did decedent awn 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)j. 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)j. 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-1508 EX. (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, Sr MISC. INHRESIDENTDECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER .Q/i'c'e ,~~rr~s Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyovmed wkh the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DDQESCRIPTION /OFD DEATH 1. (~'~'G'C.ii~p Di~'CD.?~//t - ~'`T ~/~/7.iG ~ ~Qr//S/C /~GL ~d o~ ~USJ` Gi ~Cov~?` - ~~Pe/ ~~~~~e ~~~~ ~9 .~ _. ~D ~ T~ TOTAL (Also enter on line 5, Recapitulation) I S ~,2~s3 9/ (If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (12-99) ' `° ~ SCHED~ILE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~/~ ~~9ryt'S Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. f ire/ G~oy~ C':!Oinet`~~ O ~avc) ~'ps : pD y ~~e~.~ of 9 ~T~- ~~; ~/, J 9 .S.,~D~a /ylem~ri~/ Se~~iCes ~6~ria/~QV/~'>c 9~ave /ylllr/«i-l ~ ~S, o a B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions jj~~ v Name of Personal Representative(s) ~~/~/~l~/~ /JGti±/J,t,s Social Security Number(s)/EIN Number of Personal Representative(s) StreetA/ddress/ .~3 ~~irviau/ ~'T City _(, a/'{ %S l~ State ~ Zip ~ /~ Year(s;l Commission Paid: 2. Attorney Fees 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant O Street Address City _ State Zip Relationship of Claimant to Decedent 4. Probate Fees ~~ 6 5. Accountant's Fees 6. Tax Return Preparer's Fees 7 _ TOTAL (Also enter on line 9 Recapitulation) I $ f~ !~! ~ ~ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER /Ce ~~~ Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses tiT more space is needed, insert additional sheets of the same size)