HomeMy WebLinkAbout03-18-09J 15056041046
REV-1500 EX (05-04)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes ~ INHERITANCE TAX RETURN County Code Year File Number
Dept. 280601
Harrisburg, PA 17128-0601 ~~ RESIDENT DECEDENT ~ ~ O S O ~ ~ S
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
~~ 3/ a ~'ZZ6 a I ~(~~,a~s O t3 l 1420
Decedent's Last Name Suffix Decedent's First Name
NJ(~ ,~ ~~tt~Q
(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
O 1. Original Return
THIS RETURN MUST BE FILED fN DUPLICATE WITH THE
REGISTER OF WILLS
O 2. Supplemental Return O 3. Remainder Return (date of death
rior to 12 13 82
O 4. Limited Estate
O 4a. Future Interest Compromise (date of P - - )
O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate
(Attach Copy of Will) O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
O 9. Litigation Proceeds Recei ved 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 SECTI ON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO
Name :
Daytime Telephone Number
Firm Name (If A
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REGISTE ILLS US NLY --' -'
First line of address }
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Second line of address ~ ~
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City or Post Office
State ZIP Code ,~
DATE FILED CD
Correspondent's a-mail address: /~~ G~
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~repar~y other than the personal representative is based on all information of which preparer has any knowledge
SIGNATURES3P'PERSfdN RFSI7nNciai F no r
ADDRESS'
SIGNATURE OF PREPARER OTHER THAN REPRES
17 !o ~ 1.-,~~, p
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041046
15056041046
],5056042047
REV-1500 EX Decedent's Social Security Number
~~,
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) G Separate Billing Requested ..... .. 6.
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property •
7
. (Schedule G) C Separate Billing Requested..... ...
.
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 Governmental 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 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.
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. •
O
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 15056042047 15056042047
REV-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SC6~E®IJLE A.
REAL ESTATE
drs~~ )
FILE NUMBER
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged betwee=.n a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1.
~~
_ TOTAL (Also enter on, line-l Recapitulation) I $,
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX+ (6-98)
,~ti
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE
SCFIE®~JLE ~
STOCKS & ~®NDS
~~f j - }~ ~ ~-/~ FILE NUMBEF
!~. ~ /~ ~V
ITEM
NUMBER
1.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
TOTAL (Also enter on line 2 Recapitulation) 1$
(If more space rs needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
REV-1504 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE: TAX RETURN
RESIDENT DECEDENT
ESTA
SCHEDULE C
CLOSELY HELD CORPORATION,
PARTNERSHIP OR
SOLD,-PROPRIETORSHIP
~~
~I ~ ~j ~, 7~~ , ) FILE NUMBER
Schedule C-1 or C-2 (including all supporting information) must be attached for each, closely-held corporation/partnership interest of the decedent, other than a
sole-pcoprietorshio. See inttnicrinnc f~~ rho ~~~,,,,,..+,.... ,..r,.._..,:__ ._ ~ _ __~ .. , .
- -- .__........~.,,,,,~,, ~,~acoo.v~ urn saeaes~ae}.
REV-1505 EX+ (6-98)
,~ ~~
~~~~~~ - ~
CLC)SELY HEL® CC>RPC~RATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ST®Ci~ ~C>R~4TI®IN! REPCDRT
RESIDENT DECEDENT
ESTATE 0~ FILE NUMBER
~~c~~
1. Name of Corporation
State on Incorporation
Address
Date of Incorporation
City e ip C de Total Number of Shareholders
2. Federal Employer I.D. Number
Business Reporting Year_
3. Type of Business _ Product/Service
4.
TYPE
STOCK
VotinglNon-Voting TOTAL NUMBER OF
SHARES OUTSTANDING PAR VALUE NUMBER OF SHARES
OWNED BY THE DECEDENT DECEDENTS STOCK
Common
---
$
Preferred
Provide all rights and restrictions pretaining to each class of stock.
5. Was the decedent employed by the Corporation? ................................ .
^Yes ^ No
If yes, Position _ Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? .................................. .
^Yes ^No
If yes, provide amount of indebtedness ~
7. Was there life insurance payable to the corporation upon the death of the decedent? ^Yes ^ No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares
Transferee or Purchaser Consideration $
Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ^ No
If yes, provide a copy of the agreement.
10. Was the decedent's stack sold? .... .
If yes, provide a copy of the agreement of sale, etc. ' ' ' ' ' ' ' ' • ~ ~ ° • • • • ^Yes ^ No
11. Was the corporation dissolved or liquidated after the decedent's death? ................... .
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. ^ No
12. Did the corporation have an interest in other corporations or partnerships? ............. ^Yes ^ No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedents stock:
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
f `~~~
l i ~/'~~ FILE NUMBER
1. Name of Partnership Date Business Commenced
Address
Business Reporting Year
City State Zip Code
2. Federal Employer I.D. Number
3. Type of Business _ Product/Service
4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $
5.
PARTNER NAME PERCENT PERCENT BALANCE OF
OF INCOME OF OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ......... .
....................... ^ Yes ^ No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? .. ^ Yes ^ No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the~date of death was
prior to 12-31-82?
^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold
Transferee or Purchaser Consideration $
Date
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... ^ Yes ^ No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? ................ .
If yes, provide a copy of the agreement of sale, etc. • • • ° • • • • • • • • • ' • ' ' ~ ~ • ° • ^ Yes ^ No
12. Was the partnership dissolved or liquidated after the decedents death? .................. .
If yes, provide a breakdown of distributions received by the estate, including dates and amounts re^ce ved. ^ No
13. Was the decedent related to any of the partners? .... .
............................... ^ Yes ^ No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? ... .
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C- ^for eac Onterest.
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
sc~E®udE c®
PARTNERSHIP
IPIFORM,~4TION REPORT
rE'J-1507 EX+ (6-98)
COMMONWEALTH OF PENNSI'LVANIA
INHEP.ITANCE TAX RETURN
IGEfVT DECEDEP T
ESTATE OF i__~t~
scHE®u~E
MORTGAGES & NQTES
REC'EI ABLE
saw,
FILE NUMBER
AEI propert;f jointly-owned with ri4 t of survivnrshio mucr ho rlfcrl..~..a ,,., ~..~._~..~_ r
~~~ ~~~-•- ..r..,.., •~ ~~~~~~~, ,~~oc~~ auumuiiai slicers Oi inE 58n12 SI2B)
REV-1508 EX+ (g_gg
G -,,'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECF_DENT
ESTA
sc~Eau~E E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
-----. .__.......,,.,.,,~~, ~~~~o~o v. uic same size)
/ /~ ~ ~~ FILE NUMBER
A Include the proceeds o itigati nand the date the proceeds were received by the estate.
All property jointly-owned with rinhr ~f ~~~r„~,,,,.~ti,.. _..... ~_ ~._ _,_ _ _ .
REV-1509 EX+ (6-9g)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDE ECEDENT
ESTATE OF / ..
If an asset was made joint
SURVIVING JOINT TENANT(S) NAME
A.
B.
C.
JOINTLY-OWNED PROPERTY:
SCHEDULE F
JOINTLY OWNED PROPERTY
FILE NUMBER
one year of the deced+?nYs date of death, it must be reported on Schedule G.
ADDRESS' RELATIONSHIP TO DECEDENT
~V
- - ---..._........,..~,~ „~ ~~~~ aainc size)
REV-1510 EX+ (6-98)
F' .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. I)I,ON-PROBATE PROPERTY
~~ ~ ~ / /(\ / ~ ~ ~ ~ ~j~ / FILE NUMBER
1 ~V l~ / ~J
I hls schedule must be completed and filers if rha ~„~,., V,.....,, ,.: _..__.:__ _ ..,
REV-1511 EX+ (12-99)
r~,
F4~ SCHE~JLE N
COMMONWEALTH Of= PENNSYLVANIA FIDIVERAL EXPEP+ISES ~
INHERITANCE TAX RETURN Q,®MINIST TIV COST$
RESID DECEDENT
ESTATE OF ~ ILE NUMBER
~ S~
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL E;KPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number 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 Reca-pitulatior) ~ $
(If more space rs needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~~~Ea~ o
®E~TS ®E ®ECE®E~lT,
~®~TGA~E ~I~~lE.~'BES, ~ @.~Ef~S
ESTATE OF
~-{ FILE NUMBER
Report debts incurred by the decedent prior to death which remained u aid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION I VALUE AT DATE
OF DEATH
1.
/~,
TOTAL' (A)sd enter on line 10, Recapitulation] $
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
., ~ ,_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~ d
SCFIE®tiLE J
03ENEFICIARIES
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATI SHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
rV I
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION,TO TAX IS NOT BEING.MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON' LINE 13 OF REV-1500' COVER SffEET I $
(If more space is needed, insert additional sheets of the same size)
REV-514 EX+ (12-03
., ~,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
REyLQENT DECEDENT
ESTATE OF
SCFiE®@JLE 1(
~6FE ESTi4TE, ANNUITY
~ TERM CERTAIN
heck BoxsQon REV~1;~0 Cover Shee
~ FILE NUMBER
This sche ule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
^ Will ^ Intervivos Deed of Trust ^ Other
NAME(S) OF LIFE TENANT(S) OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH LIFE ESTATE IS PAYABLE
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
1. Value of fund from which life estate is payable ..........................................$
2. Actuarial factor per appropriate table ....................... .
.........................
Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2) ........... .
NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH ANNUITY IS PAYABLE
^ Life or ^-Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
1. Value of fund from which annuity is payable ............................................$
2. Check appropriate block: below and enter corresponding (number) ......................... .
Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12)
^ Quarterly (4) ^Seini-annually (2) ^ Annually {1) ^ Other ( )
3. Amount of payout per period ........ .
4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. .
5. Annuity Factor (see instructions)
Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate
6. Adjustment Factor (see instructions) ................................................. .
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period
payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ................... .
If using variable rate and period payout is at beginning of period, calculation is: $
(Line 4 x Line 5 x Line 6) + Line 3 ........... . . " "
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through
G of this tax return. The resulting life or annuity interest(s) should be repacted,at the appropriate tax cafe on Lines 13,and-15,thraugh 18.
(If more space is needed, insert additional sheets of the same size)
REV-1 64: EX + (3-04)
~W.4
COMMONWEALTH OF PENNSYLVANIA
INHERITANCI= TAX RETURN
RESIDENT~CEDENT
I. ~ ESTATE~1r .-~-
(Last Name)
~~~, ~~~~GUU~r is appropriate only for estates of decedents dying on or before December 12, 1982.
This schedule is to be used for all remai der returns n an election to prepay has been filed under the provisions of
Section 714 of the Inher'tance ~ nd E to ax Act of 1961 or to report the invasinr, of s•~~ ~~+ ..~;..,.,....~
II. REMAINDER PREPAYMENT:
A. Election to prepay filed with
B. Name(s) of Life Tenant(s)
or Annuitant(s)
INHERITANCE TAX
scHE~u~E ~
REMAINDER PREPAYMENT
OR INVASION OF TRU T PRINCIPAL FILE NUMBER
~S ~~
fFircf Namol
of WiA's on
Date of Birth Age on date Term of years income
of election or annuity is payable
C. Assets: Complete Schedule L-1
1. Real Estate ...................... .........$
2. Stocks and Bonds ................. .........$
3. Closely i-ield Stock/Partnership ...... .........$
4. Mortgages and Notes .............. .........$
5. Cash/Misc. Personal Property ....... .........$
6. Total frorn Schedule L-1 ........
..... .... .
......................
..............
D. Credits: Corplete Schedule L-2
1. Unpaid Liabilities ................... ........$
2. Unpaid Bequests ................... ........$
3. Value of lJnincludable Assets ......... ........$
4: -Total from Schedule L-2 ........ :
:
...... ..
..
. .
E. Total Value of trust assets (Line C-6 minus Li ne D-4) ..
...............................$
F. Remainder factor (see Table I or Table II in Instruction Booklet) .................. .
..
G. Taxable Remainder value (Line E x Line F) . ....
......
(Also enter on Line 7, Recapitulation) ............. . . .
~ ~ ~ ~ ~ ~ ~ ~ ' ' ' ' '$
III. I INVASION OF CORPUS:
A. Invasion of carpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income
or Annuitant(s)
corpus or annuity is payable
consumed
- __
C. Corpus consumed ...................................
D. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ .
E. Taxable value of corpus consumed (Line C x Line D) ...... ,
(Also enter on Line 7, Recapitulation) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ' ' ' ~ ' ~ ' ' ~ ' '$
REV1647 EX+ (9-00)
~~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESI 7 DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
~ (Check Box on v 500 Cover Sheet)
ESTATE OF y
_ / ~ ~ FILE NUMBER
This c edule is appropriate only for es ates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
^ Will ^ Trust ^ Other
I. Beneficiaries
NAME OF BENEFICI Y RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1.
2.
3. ~ ~/ ~ \
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within
9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal right.
^ Unlimited right of withdrawal ^ Limited right of withdrawal
III. Explanation of Compromise Offer:
N Summary of Compromise Offer:
1. Amount of Futurelnterest ...........................................................
2. Value of Lines 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) .......$
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One ^ 6%, ^ 3%, ^ 0% .......................$
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One ^ 6%, ^ 4.5% ........... .
(also include as part of total shown on Line 16 of Cover Sheet) $
5. Value of Line 1 taxable at sibling rate (12%)
(also include .ss part of total shown on Line 17 of Cover Sheet) .......$
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) .......$
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ............ .
(It more space is needed, insert additional sheets of the same size)
REV-548 EX (11-99)(I)
`~, SCHEDULE N`
~~%;`~~` SPOUSAL PO ERTY CREDIT
COMI,IONWEALTH OF PENNSYLVANIA (gVAILABLE FOR DATES DEAT /01!92 TO 12!31!94)
INHERITAN X DIVISION
ESTgTE OF _~
FILE NUMBER
l"his schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
1 . Taxable Assets total from line 8 (cover sheet)
.. ................ 1
2. Lnsurance Proceeds on Life of Decedent .
.................... 2.
3. Retirement Benefits ........... .
......... .................... 3.
4. Joint Assets with :spouse .... .
... ....... .
' .................... 4.
5. PA Lottery Winnings ..... .
............ 5.
6a" Other Nontaxable Assets: List (Attach schedule if necessary).. 6a.
6b.
6c.
6d.
6. SUBTOTAL (Lines 6a, b, c, d) ....................... .
............................... 6.
7, total Gross Assets (Add lines 1 thru 6) ................................................ .
7.
8. Total Actual Liabilities ........... .
9. Net Value of Estate (Subtract line 8 from line 7) .. ~ ~ ~ ~ 8'
If line 9 is greater than $200, 000 -STOP. The estate is not eligible to claim the credit. !f not, continue to Part 77. 9
Income: 1. TAX YEAR: 19
2. TAX YEAR: 19
3.
a. Spouse ........... 1a
.
2a.
3a
b. Decedent .......... 1 b
,
2b.
3b.
c. Joint ............. 1c
.
2c.
3c.
d. Tax Exempt Income .. 1d
.
e Other Income not
Zd'
3d.
listed above ........ 1e
.
2e.
3e.
f. Total ..... 1 f
,
4. Average Joint Exemption Income Calculation
2f
3f.
4a. Add Joint Exemption Income from above:
(1 f) + (2f)
+ (3f)
_
4b. Average Joint Exem tion Income
P .............................. _
If line 4(b) is greater than $40, 000 -STOP The estate is not t l;nin~a n, ,.rte;.,, a,. ,._..~ . ,r
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less .................... .
1.
2. Multiply by credit percentage (see instructions) ................. . .... .
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure 2
in the calculation of total credits on line 18 of the cover sheet . .............................. .
3.
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate .................................................. .
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal 4
Poverty Credit .Include this figure in the calculation of totat credits on Tine i8'bf the coversheet. ...... ~•
REV-1;49 EX+ (6-98)
COMMONWEALTti OF PENNSYLVANIA
INHERITANCE AX RETURN
RESID pF EDENT
ESTAfE OF
SCHEDULE O
ELECTION UNDER SEC.9113(Aj
(SPOUSAL DIST~2IBUTIdNSt
8
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
Thiselection applies to the
Ii a trot or similar arrangement meets the requirements of Section 91 3(A), an Trust (marital, residual A, B, By-pass, Unified Credi(, etc.).
a. The trust or similar arrangement is listed on Schedule 0 and
b. The value of the trust or similar arrangem is entered n w le or in p as an asset on Schedule O,
the n the transferor's personal representative may spe ally identify h ~ t (al fractional portion or percentage) to be included in the election to have such trust or sim-
ilar property treated as a taxable transfer in this est f less than a nti value the trust or similar property is included as a taxable transfer on Schedule 0, the personal
representative shall be considered to have made e ection o asap fractio of he trust or similar arrangement. The numerator of this fraction is equal to the amount of
the trust or similar arrangement included as a to ble set Schydul 0. The ominator is equal to the total value of the trust or similar arrangement.
Part A: Enter the description and v e of all intere both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113(A) trust or similar arrangement.
Description
Value
Part A Total I $
Part B. Enter the descngtlon and value ~f au ir,tarcc+~ ,.,,.t,,,~,,,, ;.. ~.._. ~ ~_.. _ , ., _
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
__
STREET ADDRESS
- __
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + SP,. This is the BALANCE DUE. (5B)
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 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.
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 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(x)(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(x)(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(x)(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.