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HomeMy WebLinkAbout01-07-09 '~ / 15056051047 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po eox 28osot Counly Code Year File Number INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ! (~ ~ i"-) " (~~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth o ` - p` (~~a o a ~ I a ~ 3; ~ 5 W ~ Decedent s ~1~,3st Name Suffix Dece~~ent's First Name MI H~STETLE~ S~ ~~0/U~t L;~ ~,,/ (if Applicable) Enter Surviving Spouso's Infor mation Below Spouse's Last Name Suffix Spou;e~s First f•larne, MI Spouse's Soaal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW +~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Retum (date of death O 4. Limited Estate O prior to 12-13-82) 4a. Future Interest Compromise (date of r~ 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Living Trust __ 8. Total Number of Safe Deposit Boxes (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 T0 N ame : ~ ~ Daytime Telephone Number s~F~ ~~A^' N Fi N L~~ ~~ ~ ~,~~ -ray '~ ' rm ame (If Applicable) ~ ' ~ ; ~~,,,,, REGISTE~y ~l"`'LS US~.L:WLY First li ne of address F 7 + t_~ 1 , / Second line of address © ~~ S~- ~ i.. .. - ' ' ~ C ~' " '3 _ ' -'t ~ r F City or Post Office DATE FILED ~ . State ZIP Code -- - , - E N 0 L A Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, inGuding 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. SIGNATURE~}tSON R SP N LE FOR FILING RETURN ,~~ ATE ADDRESS )a a ~~T Z~r ~ Cf E,a/ A~4 / >~t1~1 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS ____ PLEASE USE ORIGINAL FORM ONLY Side 1 L,~, 15056051047 15056051047 J ~4 V 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) . ......... ...... . . . . . . ..... ..... L 2. Stocks and Bonds (Schedule B) ....... .............. . ............. .... 2. 3. Closely Heid Corporation, Partnership or Sole-Proprietorship (schedule C) . .... 3. 4. Mortgages & Notes Receivable (Schedule D} . .................... . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .... 5. ~ Q, (,l v ~ ~ u 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. 9. Funeral Expenses & Administrative Costs (Schedule H) .......... 9 L ` ....... .... . I ~ ~, ~~ p 10. Debts of Decedent, Mortgage Liabilities, & Liens {Schedule I) ............. ... 10. ~ I ~ ~ ~~ Q 11. Total Deductions (total Lines 9 8 10) .............................. . 11 ~ ~ ` . ... . i ~~ ~ 7 12. Net Value of Estate (Line 8 rninus Line 11) .. ........ ... ......... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ ~ ~ ' ~ O ...12. ~_ 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 '~ ~ (o ~ U ~ I G ' 16. a' S ~ 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.. a, ~a~ ~, 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C~ l_ Side 2 15056052048 15056052048 J REV-1500 EX Page 3 Decedent's Complete Addrecc• 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty File Number Total Credits (A + B + C ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal Interest/Penalty (D + E ) Fill in oval on Page 2, Line 20 to request a refund. 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. (1) a s~. 5 (2) - (3) (4) (SA) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT ~ t .. K, r 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 ro Yes No b. retain the right to designate who shal ste theeroe rt transferred or its income :............ ^ P P Y ................................ ^ 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 ro ^ p perty within one year of death without receiving adequate consideration? .............................................................................................................. ^ 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? ............................................................ ^ ............................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. s~hree (3) percent [72 P.S. §9116 (a)1(191) (i}~ before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse Far 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 .xPmnt 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)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption, iax rayments and Credits: REV-1508 EX+ {6-98) Y COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCNEDt~LE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY Include the proceeds of litigation and the date the proceeds were received by the estate. All oronerty iolnrlv.ruueeil ,.,uti .~,.~. _~ _..--r-._-~. _ - • - FILE NUMBER REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER J~n,J~l V 1-~ar~~f~i-~ ~.5~~, t~bte of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. lyG~ ~° B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State __ Zip 2. 3. 4. 5. 6. ~. Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees 3,'lir Zip tily~~° TOTAL (Also enter on line 9, Recapitulation) I ~ ~ ~ ~ ~ . (~ o (If more space is needed, insert additional sheets of the same size) USA FIRST-CLASS FOREVER USA FIRST-CLASS FOREVER zwe 4 ~~ s ~ Y. ~ ... ~ ~ ~ -~' ~: ~' ~ ~ v ~:: .., ~`~~~ ~ ~~ ~~~ ~ .~ ri _..~ ~ =j - ~ v a ~>., ' ~1.. ~ <. 1^• Q~ . ~ `~ y..~ ~. ~ cV ~~ _ ~ ~ n c f --yam z .~L ~