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HomeMy WebLinkAbout04-08-09""'~ REV 154ti Date of Btrth ~^ ~ EX (05-04} OFFICIAL USf OAtt.Y PA Department of Revenue Bweau of Individual Taxes County Code Year File Number Dept 2eosol INHERITANCE TAX RETURN Harrisburg, PA 47128-0601 ~ RESIDENT DECEDENT _ ~` ~1 ~ d~,____ ENTER DECEDENT MIFORMATION BELOW Social Security Number Date of Death Z ~D $ . ! ~j 3 o q , C. o ~f Z- ~ Decedent's Last Name Zook, bgo8! 4zz Su~x Decedent's First Name t,~'/~~ ~c ~-~,j. 15056D4bQ46 ~ ~j_.-'-J''~ (If Appllcable~ Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return M Qs_ ~ tuN~ Suffix Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI MI p 2. Supplemental Return O 3. Remainder Relum (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromiss (data of O 5. Federal Estate Tax Return Required death aker 12-12-82) O 6. Decedent Died testate O 7. Decedent Maintained a Living Trust ~,,,_, 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (dais of death O 11. Elsetlon to tax under Sec. 9113{A} between 12-31-91 and 1-1-95) (Attach 5ch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number - C3 0 Firm Name (if Applicablsj ~ - ,_ REGISTER OFD ffiLC9 USE O~.Y r-- , ~ t ._ - First line of address _;:_~ c 1 ,r a, _ ~ t ,33L ~~-e.~ t c~ q u~ ~V ~ ~ - ~~ ~ Second line of address -- ~ ' .. C] CTt City nor Post Office State ZIP Code _ DATE FILED S e. I t u 5. a v v ~,. P r~ I~ ~$ ~ o Correspondent's a-mail address: 1'' • G Under penalties of perjury,l declare that I have examined this return, including accompanying schedules and statements, and to the hest 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 wtuch preparer has any knowledge. SURE OF RSON SPONS~~~FOR FILING RET GATE 3'3 Z. S ~.. .~ ~ ,~v ~ v SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE GATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 ~ l Cam' oG -CS`5~3~ 3 J 15056042047 REV-1500 EX Decedent's Social Security Number __... _ Decedent's Name: RECAPITULATION 1. Real estate (Schedule A} ......................................... . .. 1. ~ ~.. Stocks and Bonds (Schedule B} ............. ....................... .. 2. 3. Closely Neld Corporation, Partnership or Sole-Proprietorship (schedule C) ... .. 3. ~ . '~ 4. Mortgages 8 Notes Receivable (Schedule D) ........................... .. 4. „ fi. Cash: Bank Deposits & Miscellaneous Personal Property (Schedule E} ...... .. 5.. f ~ S ~,.~ ~ ~ 7 ii Jointly Owned Property (Schedule i=) ©Separate Billing Requested ..... .. 6. r 'r. Inter-Vivos Transfers 8. Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested...... .. 7. i 8. Total Gross Assets (total Lines 1-7) .......................... ... .. $. t ~..~, ( , 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......... ......... .. 9. ~ ~ ~~,~", C~ (~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1} .... ...... .. 10. (] ~ ~ +~ ~ " -~ 11. Total Deductions (total Lines 9 8~ 10) ....... ... ............. .... .. .. 11. ~ ~ ~ ~ ~ '~ ~. 12. Net Value of Estate (Line 8 minus Line 11) .. .................... .... .. 12. Q 'Z - ~ r..TJ $ C~ 13. Charitable anti Governmental BequestslSec 9113 Trusts #or which , an election to lax 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 RATE5 15. Amount of tine 14 taxable at the spousal tax rate: or transfers under Sec. 9116 -- (a?(1.2) X .0_ 15. • 16. Amowit of Line 14 taxable x at lineal rate X .0 ~ ~+ / ~~ 2-. "~j~(j 16. „ Q '17. Amount of Line 14 taxable of sibling rate X .12 17, "i8. Amount of Line 14 taxable at collateral rate X .1 S . 18. , '19 TAX DUE .... ... ......................... .................... .19. • '~ :?0. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042047 15056042047 RE'!•150~ EX Pacie 3 Decedent's Complete Address: File Number ~uuA STREET ADQRESS ciTY i~~ ZIP ~a~.. / 7a `~~ Tax Payments and Credits: 1. Tax Due {Page 2 Line 19~ (1) 2. CreditsrPayrnents A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C } (2} 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penaity (D + E) (3) 4. If Line 2 is greater than Line t + Line 3, enter the difference. This is the OVERPAYMENT. Fitt in oval on Page 2, Litre 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. A. Enter the interest on the tax due. b (5A) This is the BALANCE DUE, {5B) f Li 5 + 5A l _ . ne o B. Enter the tota _ ~ Make Check Payable to: REGISTER aF WILLS, AGENT `~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THI'c 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 #or life of either payments, benefits or care? ....................................................•..........•.... .• sfer property within one year of death If death occurred after December 12, 1982, did decedent trap 2 .. . , 1 ......• ...... ., .•• .•..", „" . without receiving adequate consideration . ,,,•.,... th? ' ^ ^ ........... 3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her dea ... Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . contains a beneficiary designation? ................................................................................................................... ... ^ ~~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A5 PART OF THE RETURN, =or dales 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 s three (3) percent j72 P.S. §9116 (a} {1.1) {i)]. =or dates of death on ar after January 1, 1995, the tax rate imposed on the net value of transfers to or far the use of the surviving spouse is zero (0) percent 72 P.S. §9116 {a} (i.1} {n)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fling a tax return are still applicable even if the surviving spouse is the only beneficiary. =or dates of deathh on or after Juiy 1, 2000: the tax rate imposed an 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 tdoptive parent, or a stepparent of the child is zero (0) percent j72 P.S. §911fi(a)(1.2}]. -he 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 '2 P.S. §9116(1.2) j72 P.S. §9116(x)(1)). 'he 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. ~ toes. v~sc. ~~(.~'c.2 (5} aEV-~5oe ex • i~~a>> SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK QEPOSITS, ~ MlSC. INHERITANCE TAX RETURN PERSONAL PROPERTY S14EN7 bECEDENT ESTATE OF FILE NUMBER Iridude the proceeds of 1'itiga8on and the dale the proceeds were received by the esta~. All property jointly~owned wkh the right of surwlvorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~Ar Y ~~."' ~'~''~ rte, F" u..~~ wa.Si~...+t1,+ta~3 ++~,~~.~ TOTAL (Also enter on line 5, Recapituiation) ~ s r ~, J ~1 + Y f (lf more space is needed, insert additional sheets of the same size) REV-1511 EX+(12-98) - ~~ SCMEf~uL~ N C()MMpNWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADM~Nis~RAmE cosTs RESIDENT DECEDENT ESTATE OF FILE NUAABER Debts of deccdent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ . ~ ~ 0 5 ~ ~ ~-A, rr - s~ c~ r ~ C.e, u.~,~...-~~F.y~l Fc-~°,r, 7 "7,~; D d B. ADMINISTRATIVE: COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Numbers}/EIN Number of Personal Representative(s) Street Address City _._ --.-------..--..~_~..---_-. ---....~.._ _. State _~- Zp Year(s) Commission Paid' 2. Attorney Fees TQ~,~, N tr A LG t N 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 Foes 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I 'L ~ ~ C5 TOTAL (Also enter on line 9. RPr'.anlhllatinnl I d I i -+ .... . ~. REV-7512 EA:+ (12-03} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESYDENT DECEDENT scNEOU~E ~ DEBTS OF DECEDENT, MORTGAGE IJABiUT1ES, 8~ BENS !:STATE AF ' l D $ ` ~ L ~ oB~~ ~._~~ ~ . Gum. ps~~~b ~ ~_7~ Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimburaed medical expenses. ITEM VALUE AT DATE NUMBER pESCRIPTION Of= DEATH ~ , per., t~.r ~ ,q-~b~..Y '~ P ~- ~a~; ~--c.w...a. ~ ~' . 0 0 7i ~. ~'. ~ ~t o ~ r.sx-s.~ 1.~,~r r; 4 ~ ~,...~ ~ N''~ r ~ >Kf-~-.~' ~1 ~' S • d a ~( Pte.. ~D~ -~ tv ~k'a~. tom. a~ ~ 7 ~ 3 ~t 5 s!a ~'~ t3 . ~~ l ~ ,lo - t o P'7g7. SG 1 TOTAL (Also enter on line 10, RecaDitulAtinnl t ~ /f ~ ~t~ O ' .-:. =. a, ~; ~ ~ r= ~' o ~~~ 1 r QtD~ Z ,~'.:. bpd ~t'-a ~~O ~''. ,,...- ~ O N f ..--~ ..-~ ~- :. 0 j ~ ~ ~'"" P F ~ O P N ~ ! ~ r ~ F ~ ~ ~' r= C~ s o ~ ~ ~ .;:a •i~ j ~".. r J ~ ., . '~ { .. '~ ~ t. ~ ~~,~ ~ tf ~~~ s C~1.. c7a_t. ~ F.? . -' ~_ Y P t~ r 1 Kam' v r 'YS~ ~ ~~ C~ y G ~~ ~ O N O /~ c~ w ""``~ ~ r ~ ~ ~, ~N ~p~s 1 ~ p v A r c Y s w