Loading...
HomeMy WebLinkAbout12-30-09REV-15 0 0 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 15056051047 INHERITANCE TAX RETURN RESIDENT DECEDENT to I tR DECEDENT INFORMATION BELOW Social Security Number Date of Death 1 q~ I$~. ~ 1 b ~ ~~ D1 -~.ao 7 Decedent's Last Name ,~~:~3/~So ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name ~~ Spouse's Social Security Number Suffix Suffix Date of Birth OFFICIAL USE DNLY County Code Year File Number .... , / o,~ ©:' -.fir-, `f€ /~9~~!isaor.~i~„a,,,,.e©. ~ ~ ~i.. Decedent's First Name ~~'~ CS Spouse's First Name MI MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return ~ 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate O prior to 12-13-82) 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (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 DIRE Name CTED TO: Daytime Telep h one Number C ,~! ~ /Z / F S E' S ~y c ~ / ~:~ Firm Name (If Applicable) ~' First line of address ~ C ~ ° u S ~ R ~ a~ .~ Second line of address ~/ City or Post Office State ZIP Code "'~ ~~ rya ~r t.~ W 7 DATE FILED 119 ~' Nf~'/1// CrS~l~ ~QG ~,~ / 7Q ~'~q7 3S Correspondent's a-mail address: (,' e ~e (~5 ~ (,~ ~ ~ ~~ ~~p~ 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 renresentativP ~~ h~~o~ ,,., ,~~ ,.,E,....,,....:__ _~._~ _. ~•••v^^~~+~ rVR1~1 VryLT Side 1 15056051047 15056051047 REV-1500 EX Page 3 File Number ~,~-.~ 7... 7,3~ Decedent's Complete Address: EJ DECEDENT'S NAME STREET ADDRESS - --- --- - - - _ _ - - ---- _ _- --- - - - ---- _ --- __ - _ - cITY - - -- ----------------r---_ _--- --_____ ~ -- _ //~J" J - - - - -- - STATE w~ i ZIP ~?b~ ~C~~~Y~CS/3~C/ZG S Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) ~ 2. Credits/Payments (1) o"Z~?~~~~/ A. Spousal Poverty Credit ~ -- -_- - - ------ B. Prior Payments ~ -- ------- - - - . Discount - -- -- - 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) p D. Interest ~ . Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT tal Interest/Penalty (D + E) (3) ~ 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) ~ o~ 6(, ~ ~~jl A. Enter the interest on the tax due. (5A) ~~ s, 8-p B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~ ~ ~ a1 . 6 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLO CKS 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? .........................................._- - n r~ 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 siblin s is twelve 12 ercent 72 P.S. 9116 a 1.3 . A siblin is defined, under Section 9102, as an individual who has at least one parent in common with the decedentgwhether by blood or adoption. § ()( )] g REV-1503 EX+ (~-97) ,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ,12v t3 /NSdN, Ji9i1t~`~' SCHEDULE B STOCKS & BONDS FILE NUMBER z/- 6 ~_ 73~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION '. ~~ sh . C~rrl . stK. ~f Mct t,~~ ~ - ~~ 7.-03 l!o ~Sr z 8 Cave . ~ ~~ o • ~b VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) ~ $ .~~ 9 ~~ b 8- (If more space Is needed, Insert addltlonal sheets of the same size) MET: Historical Prices for METLIFE INC -Yahoo! Finance "'~---~ New User? Sign Up Sign In Help Get Yahoo! Toolbar Yahoo! Mail 12/21/09 11:23 AM Search ~ Web Search Dow ~' 1.o7ofo Nasdaq "~' 1„1go7o Monday, December 21, 2009, 11:23AM ET - U.S. Markets close in 4 hours and 37 minutes. ~~ ~~~~~~~ Finance Search MetLife, Inc. (MET) .___._,. __- __~_____ ~-~-~----.__- ~__ """~""°° -- ~ At 11:08AM ET: 35.475 t o.055 (0.16°/n) ~Iali~Rlrr~ ~ ~_ ~ wo . r.,~,, ,,. ,.. ,,,~~ ~` Trade IU+aw ..; .uM~... .e,~...~~e.».,.M^w-a~«..w+w~xrsn.,.'.' ;~. 4 -~1~~~{'~Q~. fff~~~~~:~5 ~~Ci ,_' Historical Prices CFT IIATF RAN[:F Get Historical Prices for: ~ G~p ADVERTISEMENT http://finance.yahoo.com/q/hp?s=MET&a=07&b=1&c=2007&d=07&e=1&f=2007&g=d Page 1 of 2 ~r METUFE INC -Yahoo! Finance 12/21/09 11:23 AM ~___--- ~ ~ °~..~.- ., w,;, ~ -Daily Jate: ! Aug g ~ 1 2007 Eg. Jan 1, 2003 Weekly cnd Date: '~_Au~g-" 2 0 ~ Monthly ;Dividends Only Ge.. First ~ Prev ~ Next ~ Last PRICES to 12 markets Date Open High Low Close Volume Adj Close* 1-Aug-07 60.95 2.03 59.28 61.82 10,381,600 58.53 '` Close p djust -for dividends and splits. ~' First ~ Prev ~ Next ~ Last r~"~ Download To Spreadsheet Tulin ~a~e-~ ~~~iijj •wrvrwrw~a~wrrr~ lrro~~ptxa ~±%+KV , XpKr~r, in++trr~esrsea irtvt9cM~3 ~erxi~xi rtxres ttue~i U.S. ins. COn~s+drs yos~r ~+jmc tinac t+ran~xs. X~4k Fkt~tp 8rokefggp Sir~wvt n+pe' NYC SIRE 5~1~SB i -=~ Add to Portfolio `~' Set Alert «~ Email to a Friend Get Historical Prices for Another Symbol: s GO%~ Symbol LookuQ • Stock Screener • Meroers & Acauisitions • Slits Copyright ©2009 Yahool fnc. All rights reserved. Privacy Policy -Terms of Service - Copvriaht/IP Policv -Send Feedback Delay times are 15 mins for N~ASDAQa20 mews for NYSE anrd Amext Seetaiso dela time Y s for other exchanges. Historical chart data and daily updates provided by Commodity Systems Tnc (CSI). International historical chart data, daily u dates P ,fund summary, fund pertormance, dividend data and Morningstar Index data provided by Morningstar Inc .Fundamental company data provided by Capital IO. Quotes and other information supplied by independent providers identified on the Yahoo! Finance artner a e. Quotes are updated automatically, but will be turned off after 25 minutes of inactivit =p a continuous streaming quotes are available through our .premium service You may tugm streami delayed at least 15 minutes. Real-Time provided "as is" for informational purposes only, not intended for tradin y 9 quotes on or off. All information providers is liable for any informational errors, incompleteness, or delaysg orufo~any actions takent n r I ance onrinformat oaepontaened herein. By accessing the Yahoo! site, you agree not to redistribute the information found therein. ittp://finance.yahoo.com/q/hp?s=MET&a=07&b=1&c=2007&d=07&e=1&f=2007&g=d Page 2 of 2 REV-1511 EX+ (12-99) ESTATE OF -, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ITEM NUMBER A. 1 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS /~ ~31~/~ dII~ J ~,~/~i'CS ~ Debts of decedent must be reported on Schedule I. DESCRIPTION JNERALEXPENSES: FILE NUMBER Z~~ ° ' 7~ b AMOUNT 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 Zip 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 Zip Relationship of Claimant to Decedent 4• Probate Fees 5• Accountant's Fees 6• Tax Return Preparer's Fees .~ • ~i lrn ~~ ~ R ~S~r ~j5, aD TOTAL (Also enter on line 9, Recapitulation) $ ~3~ m D (If more space is needed, insert additional sheets of the same size) ~'i ~~ `tiG ~,,,~pNWEALTH OF PENNSYLVANIA "~ INHERITANCE TAX RETURN RESIDENT DECEDENT ~wTC !lC S~HEDUIE J BENEFICIARIES FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT 1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Do Not List Trustee(s) Sec. 9116 (a) (1.2)] 1. ~ ~ ~ Z,¢B~ TAY ~/Y/I'~E 7'T~ ,~i~v~l~ L!/UG~ 3s 3 7 ~~,~s ~/vG~ T~r~ ~•4-uG,~r~P .~TG,~,~tiT.~f, G~1 X03 54~ a. /ylE~iP/Ly ~~iv ~'v,8/NSo~ ~'/~71T•~/ ~~GIGyT~p i~~ /h,~~sN 2 ~. Gv~ S~i~~To,w, ti'c 2 7~~y ~~' O7- 736 AMOUNT OR SHARE OF ESTATE yZ y~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) 4 ~, ~~ rF r 7 ~ ~*~'~~ •d a7 ~ A r~~y a "Y. ~ ~~'Y•,,~ ~5 kmi ~~5 ~ r~Cp ~' gi".L~ i '^ ._,.s ~+I 7 a ~~ ~ '~ ~ ~ V fY~ ~a7 p~ ~' ~ ~1 r ~r t' Y t. y ~- 'F :: ~ I "`~, t ~'C~~s~~, ~ ~~~ ~y,r , 'S t~'V ~',~ 1.~c~Y j t r ~'; ~,..~, _, v,. .,,~ .:;, t~~yri.~,,~ .. .._ .., X.. ..._ _ .... y~.a + ~ ~' - - Mil Sn - ~~ ~ :~ 1_Ei~"i' ~IY[_d,_,4fJD '1'~.~TAMl;N1' OL' .IC~NICS .l:'. ROBINSOAJ I, .d~9l~lEb 1'. R()fiLPJSON, of the Borough of 1`lechanicsburg, County or Cumberland and State of Pennsylvania, being ol: sound and disposing mind, memory and understanding, do make, publish and declare this my Last 1Ji11 and Testament, hereby revoking and making void any and al]_ former hills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral e:;penses as soon after. my decease as the same can be conveniently done. 1 give, devise and bequeath a1.1 the rest, residue and remainder of my estate, real., personal and mixed, of whatsoever nature and whereso- ever tt~e same may be situate, to my wife, A:(ARY S. R()f37:NS()N, absolutely and unconditionally. 3. In the event, however, that my said ~aiEe, .Pft1(ZY S. ROI3INSC~N, should predecease me, or should she die within thirty (30) days of my death, I give, devise and bequeath my entire estate, real, personal and mi_ced, whatsoever and wheresoever situate, to my two children, Et.I7.A- 134~Tfi AtVt+IL:°["d'E ]tt)~7_NS()N U[~GCEt and hiliRRl:f..Y .iAN 1UBINSC)Id SMt'I'li, in equa.t shares. [} , I~A~TL I nominate, constitute and appoint my wife, l°~3['a~ S. {)RiPdSi)[d, to be the Executrix of this, my Last- t-Jill and Testament, atLd in the event she should predecease me, or should sl.~e be unah-ie or un- willing to serve in st.ich capacity Eor any reason, I nominate, constitute -1- Xx^-~x ~o~ s -;~ x:~~ry~ '" •' ._, ... .., ... . ~:. ~ E Y u3t i.. and appoint my daughC~ers, `the aforesaid ELl'ZABET$ R. UNGER and MERRILY R. SMIfiH, Co-Executrices of this, my Last Will and Testa- ment, in her place and stead, and direct that they shall not- be re- quired to post bond or other security in the office of the Register of Wills for the purpose of administering my estate. {x< IN WITNESS WHEREOF', I have hereunto set my hand and seal this 7th day of Nlay, A. D. 1990. James F. Robinson ~ L) 1, / Signed, sealed, published and declared by the above-named .TAMES F. ROBINSON, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as wit- nesses. -2-