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Home My WebLink About11-17-09J 15056041046 REV- ~ 5 O 0 EX (05-04) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year Fife Number Dept. 280601 INHERITANCE TAX RETURN f Harrisburg, PA 17128-0601 RESIDENT DECEDENT b~ 1 C~~ ~ (~ ( ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Suffix Decedent's First Name ~~ $ 1 A S~ MI N ~ ~o~E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Fir t N s ame 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 O 4. Limited Estate Q prior to 12-13-82) 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required d O 6. Decedent Died Testate O (Attach Copy of Will) eath after 12-12-82) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) b etween 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOU N ame LD BE DIRECTED TO: q~ N I E ~ E 8 t ,~4 Daytime Telephone Number s ~2`~ 3 Fi N ~~ ~g9lo rm ame (If Applicable) REGISTER OF WILLS USE ONLY First line of address ev c~ .t., 9~~~ C~~T1'VA _ ., ~~ ~ x ~ `C`1~CLE ~' .~ r~~ Second line of address ~ ; ...._ j ; `~ ~ ~ ~ ..r,l _~. z ~~+ 1 s.,_y j r City or Post Office State ZIP Code ~- FILED ~...Yr ~ S T ~ L~ T F F-3 ~A C H ,~ L ~~~' w ~_~ -a 3 3 ? 01 ~ ~ -; -, Correspondent's a-mail address: 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 personal representative ' SIGNATURE OF PERSON RESPONSIBLE FOR FILIN sed on all information of which preparer has any knowledge. E RN DATE ADDRESS _ ~!/ ' ~~~ AI SIGpA~I~ OF R THAN REPRESENTATIVE s'L ~r%=~ PLEASE US ORIGINAL FORM DATE Side 1 15056041046 15056041046 J REV-1500 EX Page 3 Decedent's Complete Address: File Number / Q DECEDENT'S NAME ~! ~ V ~ ~~ l~ STREET ADDRESS - -- --- ------------- -------.-. - -~15 -- ---~ ---- ---------- -_ --- - -- -- CITY ~-ECI-~,4n1 ~ c Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ -_ _ __ ~, 00 B. Prior Payments ~ ~ ------ . Discount ~ ~ ------ STATE ------ -ZIP ~g ~ii (1) 0, 00 3. Interest/Penalty if applicable D. Interest ~ dp - - -- -- ~ - .Penalty ---- --- O. °° Total Credits (A + B + C) (2) ~, o0 tal Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT ~_oo . Fill in oval on Page 2, Line 20 to request a refund. (4) O °o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE . (5) ~ CID A. Enter the interest on the tax due. (5A) ~ a° , B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ . Oo Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANS"iIVER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROP RIATE BLOCKS 1. Did decedent make a transfer and: 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 : Yes ^ ^ No .......... ......... .,, ............... 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 rn 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 survivin sous is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. g p e 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 ercent [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 a sets 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 arent an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)). p 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, exce t as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. p 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)j. A siblin is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. g ' REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE ~F SCNEpt~ILE E CASH, BANK DEPOSITS, & MISC. PER50NAL PROPERTY NICOLE DEBIASE FltE NUMBER Include the proceeds of litigation and the date the proceeds were received by tnR p~r~+o 21 08-1011 All nrnner~v 1nL...6._,....~--' ___L~ _. . - _ REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE fit= SCHEp1~LE H FUNERAL EXPENSES & AuMiNisr~nvE cows NICOLE DEBIASE FILE NUMBER 21 08-1011 Debts of decedent must be reported on Schedule L ITEM NUMBER A• FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. 16, 845.46 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative(s) Soaal 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 98.00 6• Tax Retum Preparer's Fees ~• Public Notice of Estate $ Bond for Estate 269.73 214.00 TOTAL (Also enter on line 9, Recapitulation) $ 17,427.19 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ {12-08} r~ W pennsytvania SCHEDULE I DEPARTMENT Of REVENUE DEBTS OF DECEDENT IN , HERITANCE TAx RETURN MORTGAGE LIABILITIES gc LIENS RESIDENT DKEDENT ESTATE OF NICOLE DEBIASE FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death inNudin un i b e ~~ , g re m urs d m NUMBER edical ex penses. DESCRIPTION VALUE AT DATE 1. BMW Financial Services OF DEATH 2 Alan Ceperich - 2007 Tax Preparation 4,842.79 3 West Shore Tax Bureau - 2007 Taxes 75.00 4 Pro Activ Solutions 104.00 5 Donegal Mutual Insurance -Vehicles 48.65 - 6 Magaro's Auto -Vehicle Repairs 985.00 7 Graham Motors Co -Vehicle Repairs 2,289.10 8 Patriot News -Sale of Vehicle 736.71 9 Comm of PA -Vehicle Registration 56.00 10 Meineke Car Care Center -Vehicle Repairs 36.00 - 11 Gieseler & Joyce Insurance -Vehicles 88.19 1.038.00 TOTAL (Also enter on Line 10, Recapitulation) $ 10,299.44 If more space is needed, insert additional sheets of the same size.