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HomeMy WebLinkAbout04-19-10__ _ i u lr5 ~ .~~ ~,o c ~ ~~ 15056041125 2nd Supplemental Return REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po eox 2aosot 0 1 0 8 0 2 0 0 Harrisbu PA t7t2s-060t RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 4 2 8 2 0 0 8 1 2 0 2 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI G E I S E L M A N F R E D (If Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WYTH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^ 1. Original Retum ~ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) dent Maintained a Living Trust D 7 ^ . 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ^ ^ 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ^ ^ ece . (Attach Copy of Trust) 10. belweenP 2 31 91 and 1a1 t95jf death _ ^ 11. (Attach Sc~a©) nder Sec. 9113(A) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUU. TAX INFO Name Daytime Te W I L L I A M P D O U G L A S ~ 1~ Firm Name (If Applicable) ER D O U G L A S LAW O F F I C E First line of address 4 3 W S O U T H S T R E E T Second line of address City or Post Office C A R L I S L E State P A ZiP Code ~ 1 7 0 1 3 SHOULD j~IRECTED T0: umber a ~" ~r =,~~ ~ ~ ~ ~_ ~ ~-„ i LS U NLY' ' ' ~-'~ $r`il0 ~7 ~C'`7 ~ ~ ~" ~` rJ _ _ ~,a, D F c~ i ~~ GATE FILED Correspondent's e-mail address:3 Under penalties of perjury, I declare that i have exartwted the return, including accompanying schedules and statements, and b the best of rry knowledge and belief it s true correct and cort-plete Declaration of preparer other Phan the personal representative is based on aN information of which preparer ~ SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SI NATUR OF PREPA ER REPRESENTATIVE DATE -`~ ,) 1^' ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 1505601125 J _ _ _ ~ _ _ ~{.lr5l - ,Qs-~ Z.o i O "`~~ 15056041125 REV-1500 2nd. Supplemental Return EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 RESIDENT DECEDENT 0 1 0 8 0 2 0 0 Hanisbu PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 0 4 2 8 2 0 0 8 1 2 0 2 1 9 1 9 Suffix Decedent's First Name MI Decedent's Last Name G E I S E L M A N F R E D (If Applicable) Entar Surviving Spouae's Information Below Spouse's Last Name Suffer Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ^ 1. Original Return ^X ^ 4. Limited Estate ^ ^ 6. Decedent Died Testate ^ (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ THIS RETURN MUST BE FILED IN DUPLICATE WUITH THE REGISTER OF WILLS 2. Supplemental Retum ^ 4a. Future Interest Compromise (date of ^ death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10. Spousal Poverty Credit (date of death hPfween 12-31-91 and 1-1-95) ulJ 3. Remainder'Retum (date of death prior to 12-113-82) 5. Federal fsfate Tax Retum Required 8. Total Number of Safe Deposit Boxes 11. Election to itax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION W1Si BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIADaytime~T~ Name W I L L I A M P D O U G L A S 7 1 7 Firm Name (If Applicable) REG D O U G L A 'S LAW O F F I C E First line of address 4 3 W S O U T H S T R E E T Second line of address City or Post Office C A R L I S L E State ZIP Code ~ P A 1 7 0 1 3 TIbN SHOULD BE D~tECTED T0: Rohe Number 2 4 3 1 7 9 0 F WILL'.)ri1~E ONL~ r ~. Q ~ tD cif ::- .. ;.:. r=~r-, ~~ ~> _ +• _ ~~ Correspondent's e-mail address: 3 Under penalties of perjury, I declare that I have examined this re1um, including arx~omparrying schedules and statemerds, and to the best my knowledge and belief, it is true, correct and complete, Declaration of preparer other than the personal repre on aN information of which prepares has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS OF PREPAR~E~iER THA-~PRESENTATNE 15056041125 PLEASE USE ORIGINAL FORM ONLY Side 1 15055041125