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HomeMy WebLinkAbout01-11-1015056051047 REV-1500 Ex (os-os> PA Department of Revenue OFFICIAL USE ONLY Bureau of Irxtividttal Taxes County Code Year File Number Po Box2eosD1 INHERITANCE TAX RETURN Herristxrrg, PA 17128-0601 RESIDENT DECEDENT ~ ~ ~ 6 t7 Q'U ', ENTER DECEDENT INFORMA770N BELOW Socal Security Number Date of Death Date of Birth !~? ~5o3~ao~ bt~.gl ~2~ Decedent's Last Name Suffix Decedents First Name MI ~wa~.T ~5At3~ ~ ~, ~ ~ (H Applicabl°) Er-hr Survlving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW i 1. Original Retum O 2. Supplemental Retum THIS RETURN MUST BE FILED IN DUPLICATE VYITH THE REGISTER OF WILLS O 3. Remainder Retum (date of death O 4. Limited Estate Prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Livi Trust (Attach Copy of Will) n9 8. Total Number of Safe Deposk Boxes (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credk (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (attach Sch. O) CORRESPONDENT - TINS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAx INFORMATN)N SHOULD BE DIRECTED T0: Name Daytime Telephtxie Number Firm Name (If Applicable) ~ g ~ ~ T ? 1 ~~ ? ~ ~' (~ ~_~ ;~~=C7 Z i.%7 First line of address - r-m' r S C ~Y o N~ Y S U~ K L E ~=~ c~7 c7 -p ~-; ~.. 7 Second Iine of address D R ~ v ~ ~._~ ~ .~, ~ _ _ :-~~ ~ - tV City or Post OTfice State ZIP Code DATE FILED 1L1 r:~ N ~ N~ ~ S ~ URG ~ ~ 1 ? 0.5 0 Correspondent's e-mail address: _ ymn 1,v'~Sy~ i 6 ,`Y,^'`- ~8 ~< <O ~ Under penaltles of perjury, l dedere that I have examxmed this repxrm, trxiudi k is true. corraat and complete. Declaration of preparer other than the ~ ar~orrmpanyirg sdtedules and statements. and to kme hest of ny bmowladge and belies, IGNATURE OF PERSON RES/PO.NS,IBLE FOR FIL(NG al representative d on eN Information of whkh preparer has ant knowledge. C~ C/~ ~ DATE ADDRESS ll^^ ~ a U I O ~O /~7~0 /l.ft.c.., c t_,~ Ck~c_ ~ Ll`Y7 ¢ ~h T!"~ / 7G SU crru rccrgr{ter< v I titR TRAN REPRESENTATIVE DATE ADDRESS PLEASE UsE ORIGINAL FOR11~ ONLY L 15056051047 aide 7 15056051047 " V REV-1500 EX Decedents Name: RECAPITULATION Decedent's Sodai Security Number 1. Real estate (Schedule A) ............................................. 1 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 8 Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) O Separate BiNing Requested ....... 6. 7. Inter-vvos Transfers & Miscellaneous Non-Probate ProP~Y (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 43•$6 • 7 ~ 3.~ 7 3839.96 I ~A?•33 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Toil Deductions (total Lines 9 & 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental 13equests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. ta. Net Vales Sublieet to Tax (Line 12 minus Line 13) ........................ 14. $ 1 35• $'$ ~ i,3~4 ~ S 8 ~ 9 ,, p3 S S`137~{$ r 93?•Q~- TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. 16. Amount of Line 14 taxable ~7 at lineal rate X .0.41' ~ ~ 3 / ' 9 ~ 15. 17. Amount of Line 14 taxable ~ 17 at sibling rate X .12 18. Amount of Line 14 taxable ~ 18 at collateral rate X .15 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052048 15056052048 Side 2 ~- 6 "~ - ~ l ~6 7-~ L O 15056052048 REV-1500 EX Page 3 Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. spousal Poverty credit _ B. Prior Payments C. Discount 3. InteresUPenally if applicable D. Interest E. Penalty File Number STATE Total Credits (A + g + C ) 4. If Line 2 is greater than Line 1 + Line 3, enter fire difference. This is the OVERPAYMENT~I Interest/Penafly (D + E ) FlII in oval on Page 2, Line 20 to request a refund. 5. ff 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. !70 (') ~ 6 7 z 1 (2) ~ (3) (4) (5) 2 C~ ~ ~ Z (5A) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 Did dated • ant make a transfer and: a. retain the use or income of the property transferred Yes No :...................................................................................... b. retain the right to designate who shall use the property transferred or iLs income : .............................. .... ^ . c. retain a reversionary interest; or ..................................................................................................................... d ^ Q .. . receive the promise for life of either Paymerrts, benefAs or care? ....................... . 2 .. ' .. • ... •~ . ~..~..~.• ... . If death occurred after December 12, 1982, did decedent transfer ro arty within one year of death without receivin a ......................P . p g dequate consideration? ............... ...................................... . Did d ' ..................... ^ ecedent own an in trust for" or ... a is or her death? 4 d ~ ... ® ^ ro ........... . Did decedent own an Individual Retirement Account , a nnu'ty, or other non- rotate P P PertY which ... contains a Uenefida ry designation? ..................................... IF THE ANSVI~R 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 (O) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute ~ not exempt a transfer to a surviving spouse iron 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 benefidary. 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 benefidaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)J. 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. 1 sow L REV 1503 EX+ (egg) scNEOU~ s COMMONWEALTH OF PENNSYWANIA STOCKS 8c BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT E31AIE OF FU,E NUMBER =s abe.lle. ~" 1, . 'W; r ~- ---~--._. _...,...,.., .A m~~a ~,~ REV-1508 EX+ (&Be) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT _ scNEOU~ E CASI+; BANK DEPOSITS, 8 MISC. __ PERSONAL PROPERTY hldude tl~e P-oceeds d YYgaOipn and the date the proceeds were reoeired by the Mate. REV-1509 EX+ (5.gg~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpULE F JOINTLY OWNED PROPERTY Kan asset was made joint wi1hM ons year o/ the dseadsnPs dsls of dasth, k awa< ba rsporbd SURVIVING JOINT TENANT(S) NAME ADDRESS A. J- C-~.T,s fop h,.,- W ~ ~ ~C 117 ~PJ~..z.+~. t-~- ~~\ o w 1~ •-. L~~.~1 I 'f'X z $O l4 a. IN\r3r; b ~.t1,, v.~; It- SQ; b~'t S o ~ o ~ J v c-ka.~ "~ r , i"t~ani~-~burr~, f A t't oS C. JOINTLY-OWNED PROPERTY Lei ieH DATE ITEM FOR JgNT MADE NIRJBER TENMR JgNT ,. A. lp,.~ow~ 194 0 INCLUDE NAME OF FINANCULL INS ITITUTION M!D RBOMIPK OUM NUMBER OR SIMILAR IDENHFVING NUMBER ATTACH DEED FDR JgNTLY-HELD REAL ESTATE. z47-r8a.ls-!~ 043 a 16. Ib~ors..l SOVa,r~y+'~ Cc~r~i~ 199v J tg~{ t o~S ~~8 FILE NUMBER on Sc6adWs 6. RELATIONSHIP TO DECEDENT `o N d ~(72us'ti ~'~-tV` DATE OF DEATH % OF DATE OF DEATH vex i ~e K ......~ . DEC05_ YALIE OF 3,12~,~q ~ So ~ j,562L~F~ 4,~55~ ll~ S'~ ~ fit, z~7L5~6 TOTAL (Also enter on Bne 6 Recapid>fation) I ; (N more IS f1ECd8d, IIISert addfionel SINlE(g d the Same 9R2) REV-t5t0 EX+ (g_gg~ SCMEp11LE 6 COMMONWEALTH OF PENNSYLVANIA IMER-VIVOS TRANSFERS & INHERITANCE TAX RETURN ~~, NpN_pROBATE PROPERTY RESIDENT DECEDENT ESTATE OF T Sa~ ¢.l IA M l/`,J t ~ '~ flLE NUMBER This sdledule must be oon4leted gnd Red if ~ answer ~ ~ ~ ques0orls 1 tlvalgh 4 on the reverse side ~ ~ REV 1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY NU ~~ t~ N~aa ors TR" trEra AeAt>oHSav m oEC~oerrrµu DATE OF DEATH 96 OF DECD'S EXCLUSION TAXABLE tueatEOFta~rrsrar.en~a~covrornrfofforoneFU~tE. VALUE OF ASSET 1. r 9~}.. INiE~ST ~~) VALUE I't1L I o~ ~3rik I.DVr1021 ( 1'"V S~ ActT" Act-~ #~ o ~.'~ , o ~ o~ 4 0 ~ r-~ttoj~/8~~,k t-a'arr~SburCt CA 7,r3o,o~ l~~ 2t t3o.a~+ TOTAL (Also enter on line 7 Recapitulation) ; I "7, 1 3 O ~ c~ (H more apace Is needed, msatt addl6orlal sFleete of the same saeJ REV-1511 D(+(10-OB) coraroNwEALT~t of PENNSVwnNtn INHERITANCE TAX RETURN RESIDENT DECEDENT SC1ilWILE M ••F~~uN~~~Ew~u~p~~`~~NSESc~e ~'u~11~~n.G COSTS ~Sab~.l~e T'l_ 'V,Ji l ~' Dabla of decedent napt 6s reporMd on Sehadule L A• FUNERAL EXPENSES: t. Fah ~-Y'i~ ~ro'~M ¢_ - ~ w , n q g1^s ~h str S ~v/~rsv^z~ b~o~ =vim. J Gar ~.!' ~ I~{'S i~~ l "3 M ~.l ~ ,~1~~.w s R +`'l `woo r ~ 2 bia,-Y~z1~Y B. ADMINISTRATIVE COSTS: 1. Persor~el RepresaMayve's Commissions Name of Personal Represen~~re(s) Street Address ~' Year(s) Commission Paid: State ZP Z• Attorney Fees 3• Farrely Exemption; (If decedent's address is not the same as Gaimant's, attach explanetron) Claimant Street Address S~ Retatlonshp of Cleimam Eo Decedent 4. Prabek Fees 5• Aocountard's Fees 6• Tax Return Preparers Fees 7. (M rare space is needed, trreert addflional sheets of the same dze) ZP TOTAL (Also enter on line 9, Recapiddadon) I s ~i 6 t9 4, 27 go8,zq S o a _ ©~o 8 cab. ov 3 3~. 4 Z 5, ~~5~ 48 b~~ ~~ ~~~~ o ~~V 4~ ~~~: X a .~- d ._ w ~, U. Q 6 ~ o Q')• m OOJ- z ~« ¢SI~oO ~~~o •a (/~ ~-Z2 0 ~ ¢ 7 U -~ ~ O r~ P ~ w i ~ Q 3 ~ ~- c~ M `'lisp ~ c + .r ~ %' ,n ! ~ i d ~ a° `~ 0 ~C