HomeMy WebLinkAbout03-23-10 5056051047
REV-1500 EX (06-05)
PA Department of Revenue F~
Bureau of Individual Taxes '~~; ' INHERITANCE TAX RETURN
Po aox 2ao6o1 ~ ~~ RESIDENT DECEDENT
Harrisbur , PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
1 ~, ~ ~. ~ 5 ~ v ~ ~ 2 ~ t ~ c~ i± v
Decedent's Last Name Suffix
~C ~ TLS ~ /11 ~S
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Date of Birth
`I ~-1 y !' ~f3t
Decedent's First Name
(~ ~- ~ ~-
Spouse's First Name
3Ay
Spouse's Social Securty Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
~ (~ ~ 2- Z- ~~ ~-~ REGISTER OF WILLS
MI
m
MI
FILL IN APPROPRIATE OVALS BELOW
® 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 S1_ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
Litigation Proceeds Received
O 9 O 10. Spousal Poverty Credit (date of death under Sec. 9113(A)
ax
O 11
. bet,~een 12-31-91 and 1-1-95) O
Attach Sch
( )
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Name
~ /k `I 1~ ~~ -~ T ~ C 2
Firm Name (If Applicable) REGISTER OF WILLS USE ONLY
First line of address
Second line of address =~ v
?7
v--~
DATA ~lCt~D - f7
City or Post Office State ZIP Code ~ _
mac ~-~ /~~~ LS6rJ ~ ~ nA -~'~~5s ,l,~;;+ -~ ,~
_ ~,-
~~ . ~ _ _
---~
Correspondent's e-mail address: T' ~~t "-~ '
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowiceye andtielieT,;:)
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has an''y"~A{{~iowledge.
I~,NATURE OF PgERSPONSIB~ F.OR FILING RETURN DATE ~ f ~ 0 ~ ~~/~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADD ESS~ ~ (~ ~~~~ ~ ~ ~ ~~
rLEASE USE ORIGINAL FORM ONLY
15056051047
OFFICIAL USE ONLY
County Code Year File Number
l ~ ~ 0 :~3
Side 1
15056051047
15056052048
REV-1500 EX
De
ce
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ent
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Social Security Numb
er
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s Name:
Decedent l "
V
RECAPITULATION
1. Real estate (Schedule A) . ......................................... ... 1. ~ ~ ~'~ .~ V
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 & Miscellaneous Personal Property (Schedule E) ..... ... 5. ~~;~ G U.0 0
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
O Se
arate Billin
Re
uested
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h
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G
7 JJ ~,/
C)
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q
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8. Total Gross Assets (total Lines 1-7) ................................. ... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~ ~ ~ ~. ~~ D
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10.
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ (~ U ~. a ~~
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12.
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. < f ~
~`~ J ~ ~ L/. (J ~
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_ 15.
•
16. Amount of Line 14 taxable ' ! r \
~
~ ~ ~ ~
U
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at lineal rate X .0
O
I
l..i~ 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. O ~i U~ C~ ~~ ~G~ C~.~
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
15056052048 15056052048
REV-1510 Ex+(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIRREl4TIONSHIPTODECEDENTANDTHE ~ATEOFTRANSFER
ATTACHACOPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD~S
INTEREST
EXCLUSION
IF APPLICABLE
TAXABLE VALUE
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~~CE4`1~`j ~ riv1C.~v~CC~~
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TOTAL (Also enter on line 7, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME n~ ~ ~~
~~J~ IY ~
STREET ADDRESS
CITY ~^ / ~
~P C~IX~ I C~ U
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. CretlitslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount Total Credits (A + B + C) (2)
3. InterestlPenalty if applicable
D. Interest
E. Penalty Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
ZIP-t ~s-S--
(5A)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
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 : ............................................ ^
c. retain a reversionary interest; or .......................................................................................................................... ^ d
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? ........................................................................................................................
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.
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