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Home My WebLink About02-25-09 (2) J 15056041046 REV-1500 E><(D5-D<, PA Departrnerlt of Revenue -t~F1C-r:a Us:_ :; ~_a Bureau of Individual Taws County Code Year File Number Dept 280801 INHERITANCE TAX RETURN ~' ~c1 Hartistwrg, PA nt28•osol RESIDENT DECEDENT Cl.~~~ ENTER DECEDENT INFORMATN]N ReLnw Social Security Number Date of Death Date of Birth I'18 0~ '1033 62,I.5a,bo8 o`fo5~9a/ Decedent's Last Neme Suffix Decedent's First Name S7 Q ~ E' n MI f~ l7on~f1-~D E (If ApplleabM) Enter Surviving Spouse's IMorrnaUon Below Spouse's Last Name Suffer Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRU\TE OVALS BELOW AiY 1. Original Retum tJ 2. Supplemental Retum 3. Remainder Retum (date of deem ~ 4. Limited Estate prior to 12-13.82) ~ 4a' Future Interest Compromise (date of (~.;~ 5. Federal Estate Tax Retum Required deem after 12-12-82) r5 6. Decedent Died Testate (~ 7. Decadent Maintained a Living Trust ~ 8. Total Number of Safe De (Attach Copy of WiN) (Attach Copy of Trust) posit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of deem C~ 17. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COtlPLETED. ALL CORRESPONDENCE AND CONFIDEMML TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number JUD )T }} C $/DDEIf$~/M ~/7 ~97a~a~ Firm Name (If Applicable) REGISTER OF WILLS USE ONLY First line of address ~foq Fri KLf~}~ Second Ilne of address DRIVE THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS City or Post Omce I+~ E c ~I ~ IJ f L' s g (1 R~ Correspondent's e-mail address: l l c ~ udclenE Untler penel6es d perjury, I declare mat 1 ve examined mis realm, it is true. correct end wmplere. Dedaretion d preparer other tlren tl SIG~RE OF PERSON~ES~FMJSIBLE FOR FILING RETURN SIGNATURE OF PREPARER OTH~ State ~~ ZIP Code L--_ ! ~ab55? ~~ irxiuding accompanying schedules arM statements, and b the e personal representative is based on aN infonna8on of which / 7o-SS- i any PLEASE U8E ORIGINAL FORM ONLY Side 1 L 15056041046 15056041046 v~ DATE __.J 15056042047 REV-1500 E7C per:edant's Name: - _ .. __ RECAPITULATION Decedent's Social Security Number _ (7g o7 7d_3.3 1. Real estate (Schedule A) ............................................. 1. 2. 2. Stocks and Bonds (Schedule B) ....................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3 a. 4. Mortgages & Notes Receivable (Schedule D) ............................ . 5. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 6. Jointly Owned Properly (Schedule F) ~ Separate Billing Requested ....... 6. 7. Inter-Vrvos 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) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ................. . 12. 13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which 13 an election to tax has not been made (Schedule J) ...... . 14. . ...... .... Net Value Subject to Tax (Line 12 minus Lrne 13) .. . .. 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amouni of line 14 taxable at the spousal tax rete, or transfers under Sec. 9116 15. (a)(1.2) X .0_ 16. Amount of line 14 taxable d q 2 ~ ~ Q ~ o i g t6 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. 19. TAX DUE ......................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT t~~ ~~ ~~ 1 ~~~ ~~`3 15056042047 Side 2 D,D~ 0. a a 0,00 D. a~ 8971 1.00 7878'.00 O,oo 97 5~' 9.0 0 g 30 ~,0 0 3~ l.o 0 9~5s.bo 87 93y.a° 0,0 ~ ~ ~ q 3'~_•_b.~~. 39s7.ea 3 957.0 0 15056042647 REV-7500 EX Page 3 Decedent's Complete Address: iEET ADDRESS - -- Y L~sN_~n/iC s B U,~ -- -- ---- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit Prior Payments C. Discount -- - o s,~ 43 _- • ~_ 3. InterestlPenalty if applicable D. Interest E. Penalty - _ _ - --- File Number e?d0{3"aooo ZIP B Total Credits (A+ g + C ) ---- - --- 4. If Line 2 is greater than Line 1 + Line 3, enter tyre difference. This is the OVERPAYMENT.~I InlerestlPenaity (D + E ) fill in oval on Page T, Line TO 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 Ne tax due. rn 3 95? . a-v a) ~~8',~ (3) oa (4) (6) 37~~. 6a (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. ~ 7 ~ q . Q (Sg) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deoedent make a transfer and: a. retain the use w income of the Yes No Property transferred :........................................ ^ .................................................. . retain the right to designate who shall use the properly transferred or its income : ............................................ ^ c. retain a reversionary interest; or ............................. d. receive the promise fa life of either payments, benefits or pre? ................................. . 2. If death oxurred 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 axount or security at his or her death? .............. ^ 4. Did decedent own an Individual Refinement Account, annuity, or other non-probate property which contains a benefirAary designation? ........................................................................................................................ IF THE ANSVYER 70 ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Fw 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 j72 P.S. §9116 (a) (1.1) (i11. For dates of death on w after January t, 7995, the tax rate imposed on the net value of transfers to or fw the use of the surviving spouse is zero (O) percent [72 P.S. §9116 (a) (i.t) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a taz relum are sfill applicable evend the surviving spouse is the only beneficiary. For dates of death on w after Juty 1,2000: The tax rate imposed on fhe 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 adoptlve parent, or a stepparent of the child is zero (0) percent [72 P.S. §911 &(a)(1.2)j. The tax rate imposed on the net value of transfers to or fw the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §911x(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 1weNe (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CgdMpMNEgLTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHEPoTANCE TAX RETURN PERSONAL PROPERTY 1TEOF c ap o 9-X000'7 '~o,t1A~.D E ~tafE2 Include the pnXxteds of fdgalion arld the dad the ploceads erere received by ~ ~~' ~ ~o~ (ole~~~ wMh the dgM of wnrwnhip must be dNSCbsed on Schedule F VALUE AT DATE iEM OF DEATH NUMBER DESCRIPTION ,. _ . (~ITiZE~S ~fl"A1K R~~D~N-r '` ~/ooa'7-g39-5 C.D rr4~ ! N ED ~ E'GtG! ~ ~( more space TOTAL (Also enter on line 5 Recapitulation) ~ S 0 9, ! « sheets of the same size) asut~Fx.nen . COAtlAONMIEALTH OF PENNSYLVANIA INHERITANCE TAX RETURH SCHEDULE F JOINTLY•OWNED PROPERTY ,~,~ 17a nl,RtiD E S'?o /E R Nan asset eas madejo4tt rAThM one year of the dasedenPS date ottlsaN, k must a raports0 on Sehaduk 6. SURVMNG JaNT TENANT(S) HAMS A. B. C. aoDRESs JOINTLY-0WNED PROPERTY: LETTER DATE oESpiPTpH OF PROPERTY RFAt FOR A7e/T MADE IndeGe nanedh~w,ialimpryaieA aq bank amunm~~mheraeFnkr~ NUMBER TEWWi ,Iperr ~~,,~~~. ~5+^e numtar. AtleGi DATE OF DEATH ~- - r VALUE OF ASSET 1. A. /999 r'R~ NRj~e~R-I ~A1K ~c~ovNr ~~ao/~z2,~ C+~EcK/Nq 9` C D ~~/9~, ~ RELATIONSHIP TO DECEDENT OECDS I VALUE OF MTEREST DECEDENT'S INtEREST 5a`1o 1 DR9. e~ /35~'~.0~ ~ ~! ~ l~ 77q. o~ TOTAL (Also enter on line 6, Recapitulation) I S 7 a 7 nrola space Is needed, insert addi60n~ sheatA ~ tn• ~ •,~~ x404-n~oa7 REV-7517 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS OF ITEM E S~ JE'f2 Debts of decedent must be reported on Schedule L FILE A. FUNERAL EXPENSES: , 1. /~'k'KI. ~ . ~~/A1~Z~L /n~T~ FlJERf} l ~Dp2E `~'a nrE~2.a/ CEN7Re ~ u N~ /1'~mozt qC 7-~RK InorJUmE,~ g, ~ ADMINISTRATIVE COSTS o2p- D 9000 7 1. Personal Representadve's Commissions / Name of Personal Representative(s) ~UDiTN' ~~DEr18~J wl - -- Street Address __. - _. _. -..--. - State Zip _. .. -_- City - -.. _ Year(s)Commission Paid: ___--_. _.. ------- - 2. I Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant J UllD// /~ _~ - - D - Street Address "741 ./-. _.-7C~,p.u1 ~.L/_.. _~7~-. - - - .- - __ _.._. c AA1! C J2 ( state zip lZ~,? --. city !, Relationship of Claimant to Decedent __~~' ~~~` #E~ ------- - -- -~- 4. Probate Fees 5. Accountant's Fees g. Tax Return Preparer's Fees 7 3~i6. ~ q .sa , e-~ J ~ ~ 4~, a-a J~j~p, O(7 TOTAL (Also enter on line 9 Recapitulation) $ 8 ~ ~ Z pi mare space is needed, insert additional sheets of the same slzel REV-1572 EX• (12-03) COMMDNV/EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~~ i DEBTS C-F DECEDENT, MORTGAGE LIABILJTIES, & LIENS DoalF~aa E' ..STarlE,e Report debts incurred by the decedent prior to death which remained unpaid as of the date of dsaM, (nGudir ITEM NUMBER ry~ DESCRIPTION t i • / i ~~E'F~~ u ir1 ~~ fhR m tt-c- / ?^- I .S/T9-TE ~nL,O ~o yEE S ~~1 /Q~M~ ,J7' ~SfE/rl, ~E~Na 3 I ~d~[A~ Da Nu ~C~S, r~ q ~amE FILE NUMBER ~d ~ ~~ O O60 unreimburead medical expanses. VALUE AT DATE .3 s.a~ 35 z. V~/ ~ ~ ~_ Da _ TOTAL (Also enter an line 10 Recapitulation) S I ~ ,~ 5~ p'~ (If more space Is needed, insert adddwnal sheets of the same sae) REV-1513 EX+ (9-00) SCNEpNLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT STATE OF ~arlR~-D ~ S7d/E,e ~ RELATIONSHIP TO NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Tri NUMBER 1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9776 (a) (7.2)1 7. Ju'D iTN e, ~Ua Z~E/J6fFJ n1 tH D 9' boon OF ESTATE ~-~~ ~E ~ ~ ~1~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9173 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 7. TOTAL OF PART II ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET l S (If more space rs needed, insert adddwnal sheets of the same srze)