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HomeMy WebLinkAbout10-28-09 15056051047 REV-1500 EX (06-05) PA De artment f R OFFICIAL us>~ C1NL.Y p evenue o Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT County Code Year ~ ~ Ur ~I File Number , O Z ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name Suffix Decedent's First Name MI !~ r~ ~ ~' ~, ~~ ,,~ ~ s q li U 1 1 ~ L. (If Applicable) Enter Surviving 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 C~ 1. Original Retum d 2. Supplemental Return C~ 3. Remainder Retum (date of death prior to 12-13-82) p 4. Limited Estate C~ 4a. Future Interest Compromise (date of C~ 5. Federal Estate Tax Retum Required death after 12-12-82) CO 6. Decedent Died Testate C7 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C~ 9. Litigation Proceeds Received CJ 10. Spousal Poverty Credlt (date of death ~? 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 DIRECTED T0: Name Daytime Telephone Number Firm Name (If Applicable) -- REGlSTEI~F WILLS US~ULY First line of address ~ _.. ~~ ~~~ '. c ~ --+5 ,. Second line of address i ~-, ~~, ,~ -,r r .: - ~ ~ ~ .;. ~T:,:1 N .: City or Post Office State ZIP Code C ZE>~1LED ~~ ~~ }~i .ww~ Correspondent's e-mail address: ~ ~ ' 1 ~ ~ ' 1 ' ~ G ~ ~Yl Under penalties of pery'ury, I declare that I e including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declar, on of p other an the rsonal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSI E FO IN TURN DATE ~ G ADDRESS Cp I~ ~ ~ -~ 1 G~ C~ l- ~/ SIGNAT F PREPARER OTHER THAN REPRESENTATIVE DATE . - E S JOHN S. KOSTUKOVIC CERTIFIED PUBLIC ACCOUNTANT PLEASE USE ORIGINAL FORM ONLY 3900 TRINDLE ROAD CAMP HILL, PA 17011 Side 1 15056051047 15056051047 J ;= ~~~ "~~ ~_. ,.,, ?yam ;;. 'i r~t ~;-°~ w..i ~P J 15056052048 REV 1500 EX Decedent's Social Security Number ' { ~ ~ ~ ~ `'~ s Name: Decedent RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. ~~ ~ ~ .~ • ~ 10 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. .,:, ~ ~ Z ~ * -~ 6. Jointly Owned Property (Schedule F) C.~ Separate Billing Requested ....... 6. ~ 7. Inter-V'ivos Transfers & Miscellaneous Nan-Probate Property (Schedule G) C~,7 Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. ~ ~ 8' ~% Z.. • ~.. j 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ..................... 9. ~ ~ ~ ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) ................ 10. ~ f~ ~„ ~ a 11. Total Deductions (total Lines 9 & 10) ................................... 11. "~ `~ ~ .2- . S ~" 12. Net Value of Estate (Line 8 minus tine 11 .............................. ~ ' 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. ~ ~ .~ ~ ~ . ~ ~, TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 .,_ . 16. 17. Amount of Line 14 taxable at sibling rate X .12 • 17. 18. Amount of Line 14 taxable at collateral rate X .15 * 18. 19. TAX DUE ......................................................... 19. ~ ~ .~ ~ • ,~ ~' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C~ siae z L 15U56052048 1556052048 J REV 1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDI~ILE B STOCKS & BONDS ESTATE OF FILE NUMBER Isabelle L. Hoffman All property jointly-owned with right of survivorship must be disclosed on Schedule F. (It more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~ILE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. tir more space Is needed, Insert atlditional sheets of the same size) REV-1511 EX+ (12-99) SCI~IEDVLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Organist 100.00 2• -Misc. Expenses 900.91 3• Pastor 275.00 4• Memorial 130.00 5. Cemetary 450.00 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 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 Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Zip .Zip TOTAL (Also enter on line 9, Recapitulation) I $ 1, 855.91 (If more space is needed, insert additional sheets of the same size) • f REV-1512 EX+ (12-08) ~~~ ~ ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER R~enrt debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. • s REV-1500 EX Page 3 Decedent's Complete Address: File Number Tax Payments and Credits: 1. Tax Due {Page 2 Line 19) (1) ~. ~75~'~. ~~ 2. CreditslPayments f A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable D. Interest E. Penalty Total lnterestlPenalty (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) (5A) t5B) 2 ?S ~ ~8 Make Check Payable to: REGISTER OF WELLS, 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? .............. ^ 0 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(a)(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(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.