HomeMy WebLinkAbout04-24-09 (5)15056051047
REV-1500 EX (os-o5) OFFICIAL USE ONLY
PA Department of Revenue ~ County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg PA 17128.0601 RESIDENT DECEDENT '~ ~ ~ ~ d 0 f ~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
~. ...~` ~~ 33( 7 ~1a2~ zoo4 ~ ~G a.1 q 13
t:.
Oeoedent's Last Name Suffix Decedent's First Name MI
/tr ff P a t l ~' /t E i2 ~ .r ~ ~'-.
(HAppllcable) Enter Survlving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- _ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
~ 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 (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 DIREC'~ T0:
Name Daytime Telephone-Number o t:?
Firm Name (If Applicable)
ass
REGISTER OL`
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First line of address
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Second line of address -~ :_r
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City or Post Office State ZIP Code ~ DATE FILED
c~rzL~ s~~ ~ f f4 I ?01 3
Correspondent's e-mail address: ~'~~~'
Under penalties of perjury, I declare that 1 have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief,
R is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATJJR)E OF PERSON RESPQNSJpCQ FOR FILINQjRETURN - Ql~TE ~
,(~~ ~'~ . l 70'x/
SIGRE OF PiEPARE OTH~R~ER T~REPR~ N~TAT Dp}T~' .~' u
PLEASE USE ORIGINAL FORM' NLY
Side 1
L 15056051047 1505605104? J
15056052048
REV-1500 EX
Decedent's Social Security Number
I~cedent'a Name: Tl-/ ~/L~f /~ ~ . /t'/;4 Imo ~. ~ 1 q ~ / (~ 3 31 ~
RECAPITULATION
1. Real estate (Schedule A) ..........................................
... 1. C~ r
~ b O J L ~- s O
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. ~ ~ ~ S o~ ~ D
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) t= Separate Billing Requested......
.. 7. L ~ D / / • ~ ~,
8. Total Gross Assets (total Lines 1-7) .................................... 8. pp
.~ s' ~ ~ oZ S ~ o ~''
9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 3 ~ 6 ~ 7. 3 S
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ~ ,~~ !~ ~ ~ ~~
11. Total Deductions (total Lines 9 8 10) ................................. .. 11. 3 3 ~ 6 ~ ~ l
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. o~ ~ 7 ~ ~p ~ ~ lt~~'
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... .. 13. ~
14. Net Value SubJect to Tax (Line 12 minus Line 13) ......................
.. 14. /
oZ ~ ~ ~' 6 ~ • 6
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 _ . 16.
17. Amount of Line 14 taxable
at sibling rate X .12 a ( ~ ~ (p ~ • b ~
17.
a1. 6 ~ ~ 3 ~ C ! f
18. Amount of Line 14 taxable
at collateral rate X .15 . 18. ~
19. TAX DUE .......................................................
.. 19. / ~ /
~-'f`p ~ ~ 3 .(0 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
O
Side 2
L 15056052048 15056D52048
REV-1500 EX Page 3 Flle Number
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InterestlPenalty if applicable
D. Interest
E. Penalty
>3 ~ ~ -~~ __ __.
n) ab /~3,6 ~
Total Credits (A + B + C) (2) / 3 7 S, 9~
_-----_--.._.........._ .............._.__ Total InteresUPenalty (D + E )
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.
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.
(3)
(4)
(5) ~7 6 ~, / 0
(5A)
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 R AS PART OF THE RETURN
~, .:..~. ~~'t~'--. ~,5?"q~~~~t?r?re~~-~w;~zg > ~,.3»e ~ ~c R-~=z ~t;.r z> ' F '~~°~:" °rtM'=~ ..,.°'`. ~z~.;.
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(a)(1.2)J.
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)]. 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-1502 EX+ (11-08)
~pennsylvania SCHEDULE A
DEPARTMENT OP REVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
?H~n~~i4 ~. N~Po~-/ d2 oeq- uo~oy
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 between a willing buyer and a willing seller, neither being rnmpelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointlyrowned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
~'7 0// ~
TOTAL (Also enter on Line 1, Recapitulation.) I;~~~ ~'d
If more space is needed, insert additional sheets of the same size.
REV-1508 EX+ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEpIr7LE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
~~f ~/Z ~ ~ L-. a~ ~1 ' P~ Z ~ o~ C1 D 9 - D c9 ~ D y
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survlvonshlp must be disclosed on Schedule F.
ITEM _ VALUE AT DATE
u~ iuaco DESCRIPTION OF DEATH
/. SAV l/V l~-S .~ C~'avN'~'~ M '~-!~ ~' aS ~~ Y91oL3~n~
a. C D~ r~.~-`T" ~ 3~oa 3?1~ ~ 3 ~'s~7
~, I Z~vcaM f Ty1' x
2~~N D
2 ~ r ~ ~• .°
y£ r2 J ~-n~ 6 v ~-x-cl~'~ R-~ ~
fX~cT Days ~~ tSsu.~ D
~ ,~ ~~ ~ L M ~^' Tip
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
~oaS~ /y'
o~ X36 . y I
f~ / 3 d'. o a
1 aq3. o 0
1t9•~~
REV-1510 EX+ (698)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCNEpULE 6
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
This schedule must be completed and filed ff the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBE DESCRIPTION OF PROPERTY
INCLWETMENAMIEOFTHEiRANSFEREE,TVEIRRELATIONSWPTODECEDENTAND
rREOnTEOFiRaHSPER.nnACriACOPVOPn~oEEnFORREUESTarE.
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
APPLN',ABLE
TAXABLE
VALUE
1.
l2 /`} y M o n~ D /v'r4 P o ~/ ~~ i'Z~ T'1~-~-J
s~t:
~~
i
~5~~~ ~~~~# a
o~ R A"1 M~I/1~ ~v'A- Po ~ / ~ B i~ T~~2
.
~~ t J° g _
~ a1yS1G33/7 t!°~/
r ~t5B36.-1
, .~a 7 a~~ s
~
T.
~S~C~t /'~CC
3~ 2~ y r-( O /l/ O /V' 61- P o L 1 ~ ~ 2 o'i' 1r t--K
/
?~S
/6~3/7-C---~o
~ ~ ~
a3G2Y
~'o'~~ ~ 3 6 i~
o
~T.~ ~-tgf
~./. dd , /~ R a L I 1 ~ ~, r 1tt ,~--
`
~
~t,l ,~., ~-~-' ,o ~c ~ T ~ l o ~ ~r3 '~ 3 ~t~ z3o$ ~o ~I9 3~ c a. ~~, ~ 3
C/s S/~~
6oa.P• ~ d ~~,
G.li
laa~
O.~/
~s
TOTAL (Also enter on line 7 Recapitulation) = I ~L ~ Q / ~ ~-s
(If more space is needed, insert additional sheets of the same size) '
REV•1511 EX+ (10.06)
scN~ou~ x
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
T~~/Z-~-f~ L. N,R~ Po t-l ~2 o n q- e o~ o y
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t.
FzvN f~C..¢~ IP1~fcTn ~
~uN~Rc- Lu NcM£ o~J'
1~ /n, ~'zs, 3 /
a~ X91. ~°
'~oo,~o
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissans
Name of Personal Representative(s) ~'7 '( O/V p ~', /IJ/g P 0 2- /
Street Address ~~ K/,~ /L~ N e,o ~ ~T
City tn_ A,/'f P FI.1 Z•.t- state Pfd Zip ! a 1
Year(s) Commission Paid: oZ O E7 G / ~) J ~ "' ~ a
2.
3.
4.
5.
6.
~.
Attorney Fees
Fatuity Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State _
Relationship of Claimant to Decedent
Zip
Probate Fees
Accountant's Fees r'
Tax Return Preparer's Fees
~. I IC}DY£.~7'[s~Mf~/^~ ~~~1"- of L~.TT~/L-~1
b 5', u3y, Sa-
~ 3~0. oa
~ ~~9.3 ~
TOTAL (Also enter on line 9, Recapitulation) S 3
3S
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-08)
~pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8c LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
T~zcQ E d' ~- L. /Vi¢ Pe y a o o ~ - o a / fl ~
Report debt incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expense _
u more space is neeaea, mseR aaD¢wnai snee[s Dr [ne same sae.
REV-1513 EX+ (il-OB)
~pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
`~ooS~-baby
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
1. Sec. 2116 (a) (1.2).)
AL f3 ~R T A//9 i°v L /
$12 0 ~ ~ E K-
~~~
a' ~}LFRfD iv'~4PvL/ 1372~?'H~-K- ~~~
t ~5/
3 /`~25. DorzfJ ~9 ~z~~/ S~sT`~n-
. ~y
~ ~'OTtt s~
~,~
7• l214 y M Q~ o N i9 Po ~ ~
poL+-/~,~ ,q. M ~/ N''r-S C~n~n~ T- Bf Of j~.ZM/.vtv N?/~ 2£l~Orrc~ ;
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 38 OF REV-1500 COVER SHEET, A S APPROPRIATE.
IZ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~
P SaLO
If more space is needed, insert additional sheets of the same size,
~~ ~L.JI~.A o~LQU
'~1 d 3~0 • ~
~~7