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HomeMy WebLinkAbout03-26-0915056051047 REV-1500 E><(D6-05, PA Department of Revenue oFFICiAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Hanisburg, PA 17128-osot RESIDENT DECEDENT c~ ' ~ d ~ ~ 3 2 J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death O 7 ~ ~ ~ Date of Birth.. ~ / f' ~' Decedents Last Name Sutf> D. ~~dents First Name (,~ ~ L f/ ,rt/ ~ L L MI ~:~ , ~ ~ ~. (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Si~ouss's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS ~ 1. Original Retum p 2. Supplemental Return O 3. Remainder Return (date of death C.'~ 4, Limited Estate prior to 12-13-82) C! 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Livin Trust (Attach Copy of Will) (Attach Copy of Trust) g 8• Total Number of Safe Deposit Boxes © 9. Litigation Proceeds Received C~ 10. S usal Pove Credit date of death pO m' ( C~ 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 8E DIRECTED T0: Name Daytime Telephone Numher _;~. Firm Name (If Api hrable) ~ ` ~ ~~ ~ ~ / L; -~~~~ . , _ ~ REGISTER Ok-- U.Lptr g U9E O First line - _. , _ _ of address - r- , Second line of adores:, - ~ ~ - ,_ . __. x _ .. -'.. ~ _,... .. City <,i Pint r 1(ficr _~: !`ti3 _ Sfate ZIP ~o~e ~~ DAT~~ILEt] ~~ Correspondent's a-mail address: ~T~ S' ~C Under p 0 ~, ~ penalties of a 'u I declare that I have exammed this return, mGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and plete. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF ON RE ONSI FILING RETURN DATE ADDRESS 3 , 1 ~ ~ SIGNATURE OF PREPARER OTHER THAN REPRES TATIVE ~ "') C r ,~/~~ DATE ADDRESS ~.~/ ~ ) PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) . .................... . .................... .. 1. ti . C Q 2 . Stocks and Bonds (Schedule B) ....... . ............................ .. 2. ~~ ~ C, C 3 . Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3 .. .. _ , ~ .' C C? 4 . Mortgages 8 Notes Receivable (Schedule D) .... ...... . ................. . 4. 0 C ~) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5 ` ~ ~ ' ...... . . ~ ~ C ~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6 7. ...... Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) . . O ~ ~ ~~ Q Separate Billing Requested....... . 7. ~~ ~ ~ 8. Total Gross Assets (total Lines 1-7) ...... ~ ................ . ........ . s. - D ~ , C' ~~ 9. Funeral Expenses & Administrative Costs (Schedule H) .............. ...... . 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... . ..... 10 i ~ (_ 11. ... Total Deductions (total Lines 9 8 10) . . ~' c. ~` .............. . ................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ..... . ~ 13. .... . .................... Charitable and Governmental Bequests/Sec 9113 Trusts for which 12. - ~ an election to tax has not been made (Schedule J) ................. . 14. Net Value Subject to Tax (Line 12 minus line 13} ', ~ f ~` ~ . ....... . ................ TAX COMPUTA 14. ~ ~ ~ e 0 TION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(i.2) X .0- 16 . Amount of Line 14 taxable ,ix-.s ". at lineal rate X .0 ~ ~ ~ ~ `_ - ' " - 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable ~ 17. at collateral rate X .15 18. 19. TAX DUE ............. ..... ......... ............................ . 19. Q . ~ Q 20. FILL IN THE OVAL IF YOU ARE.REQUESTING A REFUND OF AN OVERPAYMENT 15056052048 Side 2 O 15056052048 J REV-1500 EX Page 3 Decedent's Complete Address: ~I L /CE STREETADDRESS (JC~C C clrY ~~~/S~ ~ ~ ~ o ~v,~iC C c. Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty File Number CCU!?~'!K~„-.,r .~<i~~~.~ ~ 1~,._../ ,~~'/-fi~~I C ~ -~i, STATE~~ ZIP (1) L~ , cif Total Credits (A + B + C) (2) ~ ~~ ~ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal tnterest/Penalty (D + E } (3) 0 . W Fill in oval on Page 2, Line 20 to request a refund. (4} _ 0 rfJ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DU.E. (5) O , y0 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) _ a a Make Check Payable to: REGISTER OF WILLS, AGENt ~... . PLEASE ANSWER 4~~ ~ ': ~,~.. ~;~>- ~ . .~.::w .. _. 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 P Perty 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 carel ...................................................................... 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 survivin souse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. g p 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 #or 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. REV-1508 EX+ (6-gg) COh4MONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~.a~n~G yr LfL(C~ N- L,l ITEM FILE NUMBER JG.v/ ~ ~~ ~vh - U~ ?25- Include the proceeds of litigation and the date the proceeds were received by the estate. ~'J~ ~`~~' - Z ~ - o~- - ~~~ _ All property jointly-owned with right of survivorship must be disclosed on Schedule F. S DESCRIPTION VALUE AT DATE OF DEATH S~ UcJ , crR TOTAL (Also enter on line 5, Recapitulation) S 5 Q 0.00 (If more space is needed, insert additional sheets of the same size)