HomeMy WebLinkAbout99-127215056`1D101
REV-1500 °` t°'-'°'L~l
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania Coun Code Year file Number
OfMR1XEM Of PEREXVE
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 ~
Harrisburg, PA 17u8-o6oi RESIDENT DECEDENT
DECEDENT INFORMATION BELOW
Social Security Number~~II~~
~~1:~~ D/an~te of D!~~eath ~~~~~MMDD~YYYY~
Ii-i~i~EEiii~~ Date of Birth MMDDYYYY
~, 'A'
Decedent's Last Name Suffix Decedent's First Name MI
(H Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name 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 Retum
O 4. Limited Estate
O 6. Decedent Died Testate
(Attach Capy of Will)
O 2. Supplemental Retum
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
O 3. Remainder Retum (date of death
prior to 12-13-82)
O 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
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 DIRECTEe r0~
Name
First line of address
Second line of address
City or Post Office State ZIP Code
~ 'I ~ P 1
Daytime Telephone Number
••
REGISTER OF WILLS USE ONLY
~
C C
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_a rn C
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On _,x,T l
J TE FILES
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Correspondent's s-mall address:
Under panahies of perjury, I declare that I have examined this return, including acxompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF~~RSO~ RESPONSIBLE FOR FILING RETURN DATE
a.n~
//
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE OR161NAL FORM ONLY
Side 1
L 1505610101 1505610101
J
1. Real Estate (Schedule A).......... .
2. Stocks and Bonds (Schedule B) .... .
3. Closely Held Corporetion, Partnership
4. Mortgages and Notes Receivable (Sch
5. Cash, Bank Deposits and Miscellaneor
6. Jointly Owned Property (Schedule F)
7. Inter-Vivos Transfers J'. Miscellaneous
(Schedule G)
8. Total Gross Assets (total Lines 1 thro
9. Funeral Expenses and Administrative 1
10. Debts of Decedent, Mortgage Liabilitle
11. Total Deductions (total Lines 9 and 1
12. Net Value of Estate (Line 8 minus Lin
13. Charitable and Governmental Beques
an election to tax has not been made
14. Net Value Subject to Tax (Line 12 mi
1505610105
................................. 1.
................................. 2.
~r Sole-Proprietorship (Schedule C) ..... 3.
xiule D) ........................... 4.
s Personal Properly (Schedule E)....... 5.
O Separate Billing Requested ....... 6.
Jon-Probate Property
O Separate Billing Requested........ 7.
igh 7) ............................. 8.
:osts (Schedule H) ................... 9.
, and Liens (Schedule I) .............. 10.
) ................................. 11.
11) ..............................12. Q
/Sec 9113 Trusts for which
Schedule J) ........................ 13.
us Line 13) ........................ 14. s
0
e
ts
n
TAX CALCULATION -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_ ~ ~~.
16. Amount of Line 14 taxable
at lineal rate X .0 _ ()
17. Amount of line 14 taxable
at sibling rats X .12
18. Amount of Line 14 taxable
at collateral rate X .15 ,
19. TAX DUE ......................................................... 19.
15.
16.
17.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~~
_~_~
~~~
~-8'
1505610105
Side 2
155610105
O
J
REV-1500 EX Decedent's Social Security Number
REV-~ 500 EX Page 3
Decedent's Complete Address:
File Number
DECEDENT ME CY-'~T
s
STREETADDRESS ~..~ -~
-~~ ..'
cirY - _ _
STAT~ ~ ZIP /
~~!/
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1)~r~
2. Credits/Payments ~
A. Prior Payments
B. Discount
Total Credits (A + B)
3. Interest
(2) t/
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (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)
Make check payable to: 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 I'rfe of either payments, benefits or care? ..............
2. If death occurced after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ...............................
3. Did decedent own an "in trust forte orpayable-upon-death bank account or security at his or her death? . ............. ^ ~f
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent (72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 stilt applicable evenrf 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 21 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 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 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 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-1502 EX+ (6-98)
SCNEDYLE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is de6narl a~ me nIIrG ~r ,.,ti~,•I, .......e.«, ,.,,,,,~. ~..
l.~ ~„v~v vNavo m ucweu, niSCll AUUIl1Uf181 SflBe[S OT [11Q Saflle SIZe~
REV-1503 EX+ (6-98)
scN~uu~E s
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
tJtATE OF
FILE NUMBER
au property I018t1V-owned With rloht of aurvivornhin m~~sr ~ Aia~1n...1 ..., c..ti~..~ e
t^ •••••••• wwc w ~w:a~au, •op~ AllOllgrlBl SfIBBB W 1110 881118 SQB)
REV-1504 EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
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.
ITEM NUMBER
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
TOTAL (Also enter on line 3, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1505 EX+ (8-98)
' SCNEpULE C-1
COMMONWEALTH OF PENNSYLVANIA CLOSELY HELD CORPORATE
INHERITANCE TAX RETURN STOCK INFORMATION REPORT
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
1. Name of Corporation State on Incorporation
Address Date of Incorporation
City State Zip Code Total Number of Shareholders
2. Federal Employer I.D. Number Business Reporting Year
3. Type of Business ProducUService
4.
Common $
Preferred
Provide all rights and restrictions pretaining to each class of stock.
5. Was the decedent employed by the Corporation? ................................. ^ Yes ^ No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? ................................... ^ Yes ^ No
If yes, provide amount of indebtedness $
7
Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes
If yes, Cash Surrender Value $ Net proceeds payable $_
Owner of the policy
8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ...^ Yes ^ No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? ..................................................... ^ Yes ^ No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? .................... ^ Yes ^ No
If 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
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
^ No
(If more space is needed, insert additional sheets of the same size)
• REV-1506 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCI~IEDULE C-S
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
NUMBER
1. Name of Partnership
Address
City
2. Federal Employer I.D. Number
3. Type of Business
5.
6. Value of the decedent's interest $
ProducUService
Date Business Commenced
Business geporting Year
State Zip Code
7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedentl ..... ^ Yes
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?
^ 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? ....................................... ^ Yes ^ No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's 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? .................................... ^ Yes ^ No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
• • •- ~ • ~
A. Detailed calculations used in the valuation of the decedents partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market values. If real estate appraisals have
been secured, attach copies.
^ No
D. Any other inforrnation relating to the valuation of the decedents partnership interest.
4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $
REV-1507 EX+ (1-97)
scNEdu~E ~
COMMONWEALTH OF PENNSYLVANIA MORTGAGES ~t NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
All property jointly-owned with right of survlvorshio must 6e disclosed nn Schodule c
~~~ nwio apace io neeueu, loser[ aaainonel SBeeiS Ot the SBffle SRG)
flEV-7508IX ~ (tA7)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, St MISC.
IN RESIDENT DECEDENT RN PERSONAL PROPERTY
Indude the proceeds of litigation and the date the proceeds were receNed by the estate. All property joirdtyormed with the right of survivowhip must be discbsed on Schedule F.
ITEM I VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 5, Recapitulation) I S
(If more space Is needed, insert additional sheets of the same size)
REY-1E09IX+Itb71
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
If an asset was made joint within one year of the decedents date of death, it must ba reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A.
B.
C.
JOINTLY-OWNED PROPERTY:
RELATIONSHIP TO DECEDENT
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or similar identHying number. Attach
dead forjointiy-held real estate.
DATE OF DEATH
VALUE OF ASSET %OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A.
TOTAL (Also enter on line 6, Recapitulation) I S
(If more space is needed, insert additional sheets of the same size)
,REVasm Ex • (r-sn
COtaMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS 8r
MISC. NON-PROBATE PROPERTY
FILE
This schedule must be completed and filed h the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
-~..... ~.. ..v.. yr rnvr~nl r a~ OF
ITEM INCWDETHENAMEOFTRETRANSFEREE,THEIRRELATIONSHIPTODECEDENTANOTHEDATEOFTRAN6FER. DATE OF DEATH DECD'S
II,IOCD ATTACH A COPY OF THE OEEO FOR REAL ESTATE.
EXCLUSION ~ TAXABLE VALUE
TOTAL (Also enter on line 7, Recapitulation) I s
(If more space is needed, insert additional sheets of the same size)
' REV-1511,EX+ (10.06)
SC1~IEpULE N
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
t~lAlt OF
FILE NUMBER
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. ~~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions '
Name of Personal Representative(s)
Street Address
City State~Zip ~-!-(.L'!
Year(s) Commissi n 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
7
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
scNEOU~ ~
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
~~~ ~-~-•- -r-•^~ •- ••~~~~w ~~~~~~ aumuuual anCela UI I(IB 58ffIB SIZE)
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCNEp1lLE J
BENEFICIARIES
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RE Dol Not LlstTrust CEDENT
eels) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
1. Sec. 9116 (a) (1.2)]
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert addftional sheets of the same size)
REV-1514 EX+ (12.03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OF
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Box 4 on REV-1500 Cover
FILE NUMBER
ms scneaule 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.
^ W)II ^ Intervivos Deed of Trust ^ Other
^ Life or ^ Term of Years
^ 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 life estate is payable ..........................................$
2. Actuarial factor per appropriate table ................................................ .
Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) ......................................$
^ 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) ^Sami-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% ^ 10% ^ Variable Rate °/,
6. Adjustment Factor (see instructions) ................................................. .
7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period
payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ..........................$
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Llne 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 interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18.
(If more space is needed, insen additional sheets of the same size)
REK1644 6X . (3-04)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I.
ESTATE OF
INHERITANCE TAX
scN~ou~E ~
REMAINDER PREPAYMENT
INVASION OF TRUST PRINCIPAL FILE NUMBER
II.
mi
I ms scneaute is appropriate only for estates of decedents dying on or beforeDecember 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 orinr_inAl
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
or Annuitant(s) of election
Term of years income
or annuity is payable
C. Assets: Complete Schedule L-t
1. Real Estate .............................. .$
2. Stocks and Bonds ......................... .$
3. Closely Held Stock/Partnership .............. .$
4. Mortgages and Notes ...................... .$
5. CashlMisc. Personal Property ............... .$
6. Total from Schedule L-1 ..................... .................................$
D. Credits: Complete Schedule L-2
1. Unpaid liabilities .......................... .$
2. Unpaid Bequests .......................... .$
3. Value of Unincludable 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. Irnasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s)
or Annuitant(s) Date of Birth Age on date Term of years income
corpus or annuity is 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)
P.EV-1615 E%+ (7.851
INHERITANCE TAX
SCHEDULE L-1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION
RESIDENT DECEDENT -ASSET'S- FILE NUMBER
1. Estate of
(Last Name) (First Name)
II. Item No. Descri tion
A. Real Estate (please describe)
Total value of real estate $
include on Ssdion II, Line C-1 on Schedule L)
B. Stocks and Bonds (please list)
Total value of stocks and bonds S
(include on Section 11, Line C-2 on Schedule l)
C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2)
(please list)
Total value of Closely Hsld/Partnership S
(include on Section II, line C-3 on Schedule L
D. Mortgages and Notes (please list)
Total value of Mortgages and Notes
(include on Section II, Line C-A on Schedule
E. Cash and Miscellaneous Personal Property (please list)
(include on Section II, Line C-5 on Schedule L)
III- TOTAL (Also enter on Section II, Line C-6 on Schedule L $
(If more space is needed, attach additional 8l~4 x 11 sheets.)
Value
•REV•1646 EX+ (3-8d)
INHERITANCE TAX
SCHEDULE L-2
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN
RESIDENT DECEDENT -CREDITS- FILE NUMBER
I. Estate of
(Last Name) (first Name) (Middle Init
II. Item No. Description Amount
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule L-1 (please list)
Total unpaid liabilities
(include on Section Il, Line D-1 on Schedule
B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list)
Total unpaid bequests S
(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 included 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 LI I _
III. ~ TOTAL (Also enter on Section II Line D 4 on Schedule L) I $
(If more space is needed, attach additional 8%z x 11 sheets.)
REV-1647 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OF
SCHEDULE M
FUTURE INTEREST COMPROMISE
Box 4a on Rev-1500 Cover
FILE NUMBER
This Schedule Is appropriate only for estates of decedents dying after December 12, 7982.
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 n nthe~
I. 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 decedent's 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
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
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 include 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 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ......$
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) ......$
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$
(If more space is needed, insert additional sheets of the same size)
REV-1648 EX (11-99) SCHEDULE N
SPOUSAL POVERTY CREDIT
COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12!31/94
INHERITAN E T IVISI N )
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) .................................... . ....... I 1
2. Insurance Proceeds on Life 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 if necessary).. 6a.
6c.
~ Bd.~
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) ...................... , , , , , . , g.
if Ilne 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. ll not, cnnNnue to Part 11.
Income:
a. Spouse ...... ..... ia. 2a.
b. Decedent ..... ..... 1 b. 2b.
c. Joint ........ ..... 1c.
2c.
d. Tax Exempt Income .: 1d.
e Other Income not
listed above ....... ie.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
2d
+ (3f)
4b. Average Joint Exemption Income .................................................... .
f/line 4(b) is nreater than X44.000 - STf]P n,o a~.~. ;Q .,,.. ,.~:..:,,,..._ _._._ .~ _ ___ ... .. _.
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 th(s 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.
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit .Include this figure in the calculation of total credits on line 18 of the cover sheet....... 5•
3d.
(+ 3)
REV-1819 E%• (1-Bn
, ~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
FILE NUMBER
Do not complete this schedule unless the estate is making the elactlon to tax assets under Section 9113(A) of the Inheritance 8 Estate Tax Act
If 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 arcangement meets the requirements of Section 9113(A), and:
a. The trust or similar arcangement is listed on Schedule 0, and
b. The value of the trust or similar arcangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all 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 denominator 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, regardless of location, which pass to the decedents
NOTICE OF INHERITANCE TAX pennsylvan~a ~
BUREAU OF INDIVIDUAL TAXES' ~ ~?Q~tA~S~M~NT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
..-
INHERITANCE TAX DIVISION OF ~3EDk~CTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-09)
PO BOX 280601 _-_ -. -~ -
HARRISBURG PA 17128-0601
~~~ ~~ 29 ~ ~; ~~ DATE 11-15-2010
ESTATE OF WALKER LOU E
DATE OF DEATH 12-16-1999
~~ ~~~~ ~'r F I LE NUMBER 21 99 -1272
,~ ~, ~ .T
Q~t~~Ir ~~~;. ~.~`~_>~'~` i CUMBERLAND
COUNTY
BARBARA WILKER~~~,:~_ , . - ACN 101
2200E CEDAR RUN DR APPEAL DATE: 01-14-2011
CAMP H I L L P A 17 011 (See reverse side under Objections )
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE --~ RETAIN LOWER-PORTION FOR-YOUR_RECORDS- E- __
------------------------------------------ ---- ---- - - - - - ---
REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE 0F: WALKER LOU EFILE N0.:21 99-1272 ACN: 101 _________________
OR
DATE: 11-15-2010
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) C1) .0 0 NOTE: To ensure proper
C2) ,0 0 credit to your account,
2. Stocks and Bonds (Schedule B) submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) C3) .0 0 of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .0 0 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .0 0
6. Jointly Owned Property (Schedule F) C6) .0 0
7. Transfers (Schedule G) (7) .0 0
C8) .0 0
8. Total Assets
APPROV ED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 5.D 0 0.0 D
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0
C11) 5, 000.00
11 . Total Deductions 000.00-
5
12. Net Value of Tax Return (12) ,
0 0
13. Charitable/Governmental Bequests; Nan-elected 9113 Trusts (Schedule J) C13) .
14. Net Value of Estate Subject to Tax C14) 5,000.00-
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESS MENT OF TAX:
0 0
0 0
0 0
=
15. Amount of Line 14 at Spousal rate (15) . X .
16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 X 0 6 .0 0
17. Amount of Line 14 at Sibling rate C17) _0 0 X 0 0 .0 0
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .0 0
19. Principal Tax Due C19)= .0 0
TAY (`D CTITTC
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT t+)
INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR :INSTRUCTIONS~ _~`/ y
L