HomeMy WebLinkAbout12-10-0915056051047
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Poaox2sosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT `~' 1 ~ 9 d ~~ S
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
~:~?s:3y y9~ i t tZyzD~~ o3zg~ ~z~
Decedents Last Name Suffix Decedent's Fiat Name MI
-. ..
Q'~'~~~.s~y` ~url~,~A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouses Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 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)
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 (date of death O 11. Election to tax under Sec. 9113(A)
bet•Neen 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 TO:
Name Daytime Telephone Number
Firm Name (If Applicable) REGISTE - ILLS US~WLY ~
First line of address
~3 3 7 } ~'
Second line of address
~~-~~~~
City or Post Office
N~ w Gumb ~. ~ 1 ~~~
Correspondent's a-mail address:
State ZIP Code ~
Q~}- l707~
`~~r~"
`''> '~''
.±~ ~`
~:; «~-~
.~. ~:~-„
~~
:D
DATE FILED
O ~3
`~ 4
c ~ E~')
Gft -~r~
Gli
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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT P ON RESPON LE FO FI G RETURN DATE
~j - -v
A RE ~ ~ ! ~- ~~/V 7~~ ~~C.f/lf.J ~l~ ~Lf ~ / ~ / ~
SIGNATURE OSF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15056051047 15056051047
15056052048
REV-1500 EX
Decedent's Social Security Number
Decedent's Name
RECAPITULATION
1. Real estate (Schedule A) .......................................... ... 1.
~ Q
"'
2. Stocks and Bonds (Schedule B) .................................... ... 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. /
~ • v
4 M
rt
& N
t
R
i
bl
h
S
d
l
D 4 O
~
. o
gages
o
es
va
ece
e (
c
e
u
e
) .......................... ...
. •
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ..... ... 5. J 7 ~ ~. ~ o~
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. Q • O ~
7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property
h
l
O S
S
d
G
Bil
R ,\
~ ~
(~
(
c
e
u
e
)
eparate
ling
equested..... ... 7. •
8. Total Gross Assets (total Lines 1-7) ................................. ... 8. L I S O~ . a. a
9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~ ~a ~ . ~ O
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10.
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ s p~ ~ . ~ J
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ~ U ~} ~ O ~ ~ 8'
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.
~, - ~ J ~ ~„ 7
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_ i 15. .
16. Amount of Line 14 taxable
at lineal rate X .0 _ „ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 r 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 O
Side 2
L 15056052048 15056052048 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
DECEDENT'S NAME
ri~Uf I~.MOt __~t~f' N ~.- ~~~ _~ go b
STREET ADDRESS ~_ _ __ ___ __
CITY ~il~ ~ I STATE ZIP
D `~
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. InteresUPenalty if applicable
D. I nterest
E. Penalty
Total InteresUPenatty (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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(56)
Make Check Payable fo: 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? ................................................................
...... ^ r
r~v~
tci.
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 j72 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-16K E7(•(1~A7)
SCHEDULE 0
COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A)
INHERITANCE TAX RETURN /A!\AI ~A • t w~w~w~w~ ~.~~wuw~
FILE
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.
ff the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (atl or a fractional portion or percentage) to be included in the election to have such trust or
similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the
personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to
the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominate is equal to the total value of the trust or similar arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, n~gardless of location, which pass to the decedents
of rtv,ro cnarp Ic naarlatl inePrt additicxial sheets Of the same size)
REV-1848 EX (ti-89) SCHEDULE N
SPOUSAL POVERTY CREDIT
COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 01/01/92 T012/31/94)
INHERITANCE TAX VISION
ESTATE OF
FILE NUMBER
This 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. insurance Proceeds on L'rfe 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 ff necessary).. 6a.
6c.
6d.
6. SUBTOTAL (Lines 6a, b, c, d) ........................................................ 6.
7. Total Gross Assets (Add lines 1 thru 6) ................................................. 7.
8. Total Actual Liabilities .............................................................. 8.
9. Net Value of Estate (Subtract line 8 from line 7) ........................................... 9.
if line 9 is greater than x200,000 -STOP. The estate is not eligible to claim the credit if not, continue to Part II.
income: 1.
a. Spouse ........... 1a.
b. Decedent .......... 1 b.
c. Joint ............ 1c.
d. Tax Exempt Income .. ~ id.
e Other Income not I(-
listed above ........ 1 e.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(i f) + (2f) + (3f)
3c.
i+ 3)
4b. Average Joint Exemption Income .....................................................
if 1(na d/MI fc nronfnr N,en tdn nrY1 - QTAP The ecfafe Lc not elinihle to rJaim thR credit If not: continue t0 Part
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ...................... ~ 1
2. Multiply by credit percentage (see instructions) ........................................... 2.
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet . ............................... 3.
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate 4'
_ . .. .. . _.. _ ~._ ._ .~- ---.._. _s a., a.........oa..... e..,.,,~.,i
REV-1647 EX+ (8-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCMEpt~LE M
FUTURE INTEREST COMPROMISE
Check Box 4a on Rev-1500 Cover Shest
---
FlLE NUMBER
This Schedule is appropriate only for estates of decedents dying niter December 12,1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
^ Will ^ Trust ^ Other
L Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within
9 months of the decedents death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal right.
^ Unlimited right of withdrawal ^ Limited right of withdrawal
IIL Explanation of Compromise Offer:
IV. Summary of Compromise Ofbr:
1. Amount of Future Interest .........................................................$
2. Value of Line 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 indude 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 18 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12°k)
(also include as part of total shown on Line 17 of Cover Sheet) ......$
6. Value of Line 1 taxable at collateral rate (15%)
(also indude as part of total shown on Line 18 of Cover Sheet) ......$
7. Total value of Future Interest (sum of Lines 2 thru 8 must equal Line 1) ......................$
(If more space is needed, it>sert additional sheets of tare same size)
REV-Ibae EX+ (3.64) INHERITANCE TAX ~
SCHEDULE L-2
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION
RESIDENT DECEDENT -CREDITS- FILE NUMBER
I. Estate of
(Last Namej (First Name)
(Middle Initiol)
II. Item No. Description __
Amount
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule L-1 {please list)
Tota! unpaid liabilities $
(include on Section II, Line D-1 on Schedule L)
B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list)
Total unpaid bequests $
(include on Section II, Line D-2 on Schedule L)
C. Value of assets reported on Schedule L-1 {other than unpaid bequests listed under
"B" above) that are not include: for tax purposes or that do not form a part
of the trust.
Computation as follows:
Total unincludable assets $
(include on Section II, Line D-3 on Schedule L)
111. TOTAL (Also enter on Section il, Line D-4 on Schedule L S
(If more space is needed, attach additional 8'/s x 1 1 sheets.)
REV•1615 EX+ 17-85)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EM
INHERITANCE T
SCHEDULE L-1
INDER PREPAYMEN
-ASSETS-
~'X
'
ELECTION
ILE NUMBER
I. Estate of
{last Name) (first Nome) (Middle Initial)
il. Itsm No. Description Valus
A. Real Estate (please describe)
Total value of real estate
(include on Section 11, Lin ',
~' C-1 on Schedule Lj $
B. Stocks and Bonds ( ' lease list)
Total value of stocks and
(include on Section II, Lin ' onds
`, C-2 on Schedule L $
C. Closely Held Stock
(please list) Partnership (attach Schedul ~I C-1 and/or C-2)
;!
~.
Total value of Closely He
(indude on Section 11, Lin d/Partnership
' C-3 on Schedule L) $
D. Mortgages and N es (please list)
Total value of Mortgages ;
include on Section II, Lin and Notes
" C-4 on Schedule L) $
E. Cash and Miscellan ' ous Personal Property (ple ~ 'se list)
' Total value of Cash/Misc. I
(include on Section II, Lin ~ers. Property
, C-5 on Schedule L) $
~ , j _ ~
III.
TOTAL (Also enter on ~
action I I, Line C-b on Schad i
' le L)
$ d . ~
{If more spa a is needed, ottach additioi
F 'al 8'/z x 11 sheets.)
`~'r'~ ~` f ~~'' INHERITANCE TAX
s~N~uu~~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN REMAINDER PREPAYMENT
RESIDENT DECEDENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER
I. I ESTATE OF
II.
III.
(Last Name) (First Name) (toddle trlitiaq
This schedule is appropriate only for estates of decedents dying on or before December 12, 1982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of
Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
REMAINDER PREPAYMENT
A. Election to prepay filed with the Register of Wills on
(Date)
B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income
or Annuitant(s) of election or annuity is payable
C. Assets: Complete Schedule L-1
1. Real Estate ...............................$
2. Stocks and Bonds ..........................$
3. Closely Held Stock/Partnership ...............$
4. Mortgages and Notes .......................$ .
5. CashMlisc. Personal Property ................$
6. Total from Sd~edule L-1 ......................................................$
D. Credfts: Complete Schedule L-2
1. Unpaid Liabilities ...........................$ .
2. Unpaid Bequests ...........................$ .
3. Value of Unindudable Assets .................$
4. Total from Schedule L-2 ......................................................$
E. Total Value of trust assets (Line C-6 minus Line 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)
INVASION OF CORPUS:
A. Invasion of corpus
(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 rs 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)
REV-1514 EX+ (12-03)
COMMONWEALTH OF PENN5YLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCNEOt~LE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on REV-1500 Cover Shoe
FILE NUMBER
This schedule 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) DATE OF BIRTH NEAREST AGE AT
DATE OF DEATH TERM OF YEARS
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 ^ 7erm of Years
1. Value of fund from which life estate is payable ..........................................$
2. Actuarial factor per appropriate table ................................................ .
Interest table rate - ^ 3 112% ^ 6% ^ 10°,6 ^ Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) ......................................$
NAME(S) OF LIFE ANNUITANT{S) -
DATE OF BIRTH ,
CREST AGE A7
DATE OF DEATH
TERM OF YEARS
ANNUriY 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) ^Serni-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% ^ 1.0% ^ Variable Rate °k
6. Adjustment Factor (see instructions) ................................ . .. ................ .
7. Value of annuity - If using 3112%, 6%, 10%, or if variable rate and period
payout is at end of period, calculation is: Line 4 x Lines x Line 6 ..........................$
tf 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 interests} should be reported at the appropriate tax rate on Lines 13 and 15 through 18.
!If more space is needed. insert additional sheets of the same size)
aEV-n+o Ex • l+-an
CtHuIMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE G
INTER•VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
FILE
This schedule must be oompie~d and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET ~ yes.
ITEM
N MBER DESCRIPTION OF PROPERTY
wauDETwEW1+JEaFTr+ETaAes~eaEe,tHEIRrsATwr~snProDECEDENTANDTHEOATE°FTwws~
ATTACH A ww of Tr+E DEED Fort REN. ESTATE.
DATE OF DEATH
VALUE A ET 96 OF
DECD'S
IN REST
EXCLUSION
TAXABLE VALUE
1.
TOTAL (Also enter on line 7, Recapitulation) ~ S
RkvMOO IX • (ta71
COMMOMNEALTH OF PENNSYLVANIA
INHERITANCE 7AX RETURN
SCHEDULE F
JOINTLY-OWNED PROPERTY
NUMBER
Man asset was made joint within one year of the deaxdenYe dada of death, k must M repoated on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A.
C.
inlNrl v~wrlKn PRnPERTY~
RELATIONSHIP TO DECEDENT
--•• - • -
ItEM
NUa~ER . LETTER -
FOR ,IOMfT
TENANT DATE
MADE
JOMR DESCRIPTION OF PROPERTY
Include name of financial inadb~on and bank account number ar similar idenMyln9 numlwr. At1acA
dead for jointly-held red eaf819.
DATE OF DEATH
VALUE OF ASSET %oF
DECD'S
MREREST DATE OF DEATH
VALUE OF
DECEDENT'S M~fTEREST
1. A.
TOTAL. (Also enter on Ane 6, Recapitwlakon) S
more space is needed, insert additional sheets of the same
r~v,soeoc*n~n
SCHEDULE E
COt~IONWEALrii OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
'" ~ ^"~ ~oE~"" PERSONAL PROPERTY
Irrdude the proceeds of Bigation and fhe date the proceeds were received hY the estate. AH property joiMly~owrrad with the right of surrivorahip must bs discbsed on SchsduM F.
ITEM I VALUE AT GATE
NUMBER DESCRIPTION OF DEATH
~ ~rG~nov ~~ C-RnFz-f~~~ ~~~~,~t ~ !~~ ~ ~ ~bt~ai~ ~ y~3
~, ysa.a~
TOTAL (Also enter on line 5, Recapitulation} ~ S
REV-1507 EX+ (1-97) '
SCHEpt~LE p
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX+ (9-00} ~~~~~~~~ ~.~
PARTNERSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN INFORMATION REPORT
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
1. Name of Partnership Date Business Commenced
Address Business Reporting Year
City State ~ t:rode
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 investrrlent $
5.
PARTNBi4 NAME
PERCENT
OF tA100ME
PEEtCENT
' OF bWNERStiIP T __
BA4At+IGE t3F
CAPITAL. JICCAEIMT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................. D Yes D No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes D 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?
D 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 decedents death? ...... ^ Yes ^ No
if yes, provide a copy of the agreement.
11. Was the decedents partnership interest sold? ....................................... D Yes ^ No
If yes, provide a Dopy of the agreement of sale, etc.
12 Was the partnership dissolved or liquidated after the decedents death? ................... ^ Yes ^ No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? .................................... D Yes D No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes D No
if yes, report the necessary information on a separate sheet, includ(ng a Schedule C-1 or C-2 for each interest.
• ~ •• ~ • ~
A. Detetled calculations used in the valuation of the decedenl's partnership interest.
B. Complete copies of financial statemerrts or Federal Partnership Income Tax returns (Form 1 t)65) for the year of death and 4 preceding years.
C. If the partnersh~ owned real estate, submft a list showing the complete addresses and estimated fair market values. If real estate appraisals have
been secured, attach copies.
D. Arty atller informatwn relating to the valuation of the decedent's partnership interest.
PE1R1S060(• (I.Bi~
SCHEDULE C-7
cor~oNwEUrNOFrENNSrlvat~a CLOSELY-HELD CORPORATE
INHERITANCE TAX RETURN STOCK INFORMATION REPORT
ESTATE OF FILE NUMBER
1. Name of Corporation State of Incorporation
Address Date of Incotpotatior-
City State Zip Code Total Number of Shareholders
2. Federal Employer I.D. Number Business Reporting Year
3. Type of Business Produd/Servioe
4.
STOCK TYPE
votng /Non-voting TOTAL NUMBER OF
SHARES OUTSTANDING
PAR VALUE NUMBER OF SHARES
OWNED BY THE DECEDENT VALUE OF THE
DECEDENT'S STOCK
common $
Preferred $
Provide alt rights and restr(dions pertaining to each doss of stock.
5. Was the decedent employed by the Corporation? ^ Yes ^ No
If yes, Position Annual Salary $
6.
7
8.
Was the Corporation indebted to the decedent? ^ Yes
If yes, provide amount of indebtedness $
Time Devoted to Business
Was there life insurance payable to the corporation upon the death of the decedent? ^ Yes ^ No
H yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
Did the decedent sen or transfer stock of this company within one year prior to death a within two years if the date of death was prior to 12-31.82?
^ Yes ^ No ff yes, ^ Transfer ^ Sale Number of Shares
Transferee a Purchaser Consideration $ Date
attach a separate sheet for additional transfers anrYor sales.
9. Was there a written sharehdders agreement in effed at the time of the decedents death? ^ Yes ^ No
If yes, provide a spy of the agreement.
10. was the deoed~tYs stock sold? ^ Yes ^ No
tf yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedents death? ^ Yes ^ No
ff yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? ^ Yes ^ No
ff yes, repot the necessary information on a separate sheet, including a Sdredule C-1 or G2 for each interest.
THEFCI~.t.41~: _. '. 1~1U~'T ~ ;. 'll~li.E
A. Detailed calculations used in the valuation of the decedents stock.
B. Complete copies of finandal statements or Federal Corporate Income Tax mums (Form 1120) for the year of death and 4 preceding years.
C. ff the corporation owned real estate, submit a Iist showing the complete addresa/es and estimated fir market values. If real estate appraisals have beery
secured, attach copies.
D. -Lisa of prindpal stodchokters at the date of death, number of shares held and their relationship to the decedent
E. List of atncers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends pfd each year. List those declared and unpaid.
G. Any other infom~ation relating to the valuaton of the deoedertts stock.
^ ~
REV-1504 EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
scNEOU« c
CLOSELY HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF 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-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
(If more space is needed, insert additional sheets of the same size)
REV-1 b03 EX+ (8-98)
scNEOU~ s
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
All property JOlntty-ownod with right of eurvivorahip must bo dleoloced on fichedulo F.
REV-1502 EX+ (8-98)
SCMEpVLE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ail real orooerty owned solely ar as a tenant in common moat be roported at fair market value. Fair market value is defined as the price at which property would be
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