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HomeMy WebLinkAbout07-07-10t , 150561 0101 "'-' REV-1500 °` ~°~-'°' ~ PA Department of Revenue P~y~ OFFIgM. USE ola.Y Bureau of Individual Taxes Po sox zt3o6oi °""°"~`6MV""` County Cade Yser INHERITANCE TAX RETURN Flo Number _ Harrisburg, R4 ~7sz8-o6os RESIDENT DECEDENT !~ ~ ' 0 9' Do ~ ~~ ENTER DECEDENT MIFORNATN>SI BELOW Social Security Number Date of Death MI~DDYYYY -- - ___ _ Date of Birth tiMrODYYYY . _~/q__/~-/~74 Decedent's Last Name _ ~~/~~o~ 9 ~o /9/~ __ _ Suffix __ _ s Fiat Name MI ~~ i ~ ~ (If )Error Srtrvivirp 8pousa's kNonrratlon Blow Spouse's Last Name..... - SuRix _ _ Spouse's First Name MI -- ---- Spouse's Soda) Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum o a. umned Estate O 6. Decedent Died Testate (Attach Capy of ViifS) O 9. utigatlan Proceeds Reoehred THIS RETURN MUST BE FILED MI DUPLICATE WITH THE REGISTER OF WILLS O 2. Suppbmantal Relum O 3. Remainder Retum (Nate of death prior to 12-13-82) O 4a. Future Irdarest Compromise (date of O 5. Federal Estate Tax ~te6arr RegWrsd death after 12-12-82) O 7. Decedent M1Aairtfekied a LlvNrg Trust 8. Total Number of Safe Deposit Boxes (At~CFt Copy of Trust) O 10. Spousal Poverty Credit (date d death O 11. Ebdlon to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) COtDEEPOIDENT- TH18 SECTION MUST BE COIpLEfED. ALL COONDENCE AID CONFDBIifAL TAX SffORNA7lON SHOULD t1E T0: Name Daytime Telephone Numb'pr _ __ - - - -- __ __ REtIgITER LISE First line of address I __ City or Post Office State ZIP Code _ - Comsspondattt's amail addnss• !"tS ~ ; under psnalrbs of perjuX 1 decane that I inva arrarniied this rstum, rndudtrp acaompenyirrg ~~~ and stalemsnta, and to the beet of my and 1 it is d++s. carroa and DedaraYon d proparar other tiwn peraayl is based on ar infonrwtion of which praparsr has arty fuwiMsdg SIGNATURE OF FOR EJtl~(` ne ~~ C!a r~ ~ a. f c~ ~:: t .,......~.~ ~0?~' ,%ya.-ail ~ f f~ ~c SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE' ADDRESS n.ewse use ofinontlw< ~ ts>sLY L, 1505610101 Side 1 1505610101 RE~15oo Ex Decedent's Name: ,fG Decedent~~syySodal Security Number RECAPRULATION / ~ _ __ _ _ _ ___ __.. 1. Real Estate (Schedule A) ............................................. 1 • ' ____ _._____.._~__._._._.._ ~ __....___~ 2. Stocks ana Bonda (Schedule B) ....................................... 2. ' _ _.______ a_ _ 3. Glossy Held Corporation, Partnership or Sole~Proprietorship (Schedule C) ..... 3. ' _ ~ .~_~._.........__.__~.. ~ ,.._....~.... 4. Mortgages and Notes Receivable {Schedule D) ........................... 4 'i ~,. ~ __ ~.._._~___~__w_~___.~___.___. 5. Cash. Bank Deposks and Miscellaneous Peraonel Property (Schedule E)....... 5 _._ ~~ ~ ~j~' _._~__. y_..~ ,.~..._~.__~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vfvos Transfers & Miscellaneous Nor~Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Bross Assets (total Lines 1 thnwgh 7) ............................. 8. ~,I_~ 9. Funeral F~enses and Administrative Costs (Schedule H) ................... 9. ~f ^~ 3 10. Debts of Decedent, Mortgage Liabilities, and L'a3ns (Schedule q .............. 10. Q 11. ToW Dsdudions (tots Lines 9 and 10) ................................. 11. ~.~_._.___.. ~?r~.__~ ~ ~_!_______..__ 12. Nst Valt» of Estab (Line 8 minus Line 11) .............................. 12. 13. Charitable and Govemrrtental BequestslSec 9113 Tnists for which -. _.. _.._.,..____ _....__..~.._. _._...._ ._.,_ .....__.._._....~_. an election m tax has not been made (Schedule J) ........................ 13. 14. Nst Valtw Subject bo Tax (Una 12 minus Line 13) ........................ 14. ~D. ~ ~O . ~J TAX CALCULATION -SEE WSTRU CTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or _ _. ___ transfers under Sec. 9116 _ _ __ _ __ _ _ , 18. Amount of Line 14 taxable at lineal rate X .0 _ ---___,_.,_ _._.~ ._ /' b ~ __~_._._ ~ 16 A _ / --.-------~- _ ~Ot~ ~ b ~ 17. Amount of Line 14 taxable ____..____ ', ~- ~ ____ ___ _ at sibling rate X .12 . _.._.__.___, 17. _ .___~.._____.__..._._._,m_w..______..._. 18. Amount of Line 14 taxable , n. at collateral rate X .15 ~ _ -.. _ _____ __- _._ __ 18. ..__._... ..___._..___.__w_.~..__...__._,___ _~.._._._~ __.. 19. TAX DUE ....................................... ...............19.'' b ~0~ .5 8 20. FILL IN THE OVAL IF YOU ARE REQUE871Nti A REFUND OF AN OVERPAYMENT O 1505610105 Side 2 L 1505610105 1505610105 J REY`1500 EX Page 3 Decedent's Complete Address: Fat t/anbsr I~R~ ~~c /!~ r _ -- sTitEEr ~2 8 ~ ~- ~~ ~~ f~ CS'~ _ qry / // STATE 21P Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CredilslPayrrreMs A. Prior Pa~mrents B. Discarnt 3. InEerest 4. ff Line 2 is greater then Ltrre 1 + Line 3, enter the dpfererrce. Ttra is the OVERPAYMENT. t-lN in oval on Page $ Line 20 to ngwat a rafwrd. 5. ff Line 1 + Line 3 N greeter Than Line 2, eater the dilfererrce. This is the TAX DUE Toth Credits (A + t3) (2) c3) 7, ~S (4) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRU4~E BLOCKS 1. Did deoederd make a iransfer and: Yes a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right b designate who shall use the properly transferred a its income :............................................ ^ c. retavr a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for Wfe of eitltar peyrrrenta, benefits or care? ...................................................................... ^ 2. ff death ocarred at~r Dec.12,1982, did decedent transfer property within one year of death wi~out receiving adequate corrsiderntion7 .............................................................................................................. ^ 3. Did decedent own an'in tnrst for" a payable~pon-death bank account or secrrily at his or her de~h? .............. ^ 4. Did decedent awn an indMdual refirement acoorart, arunily or other non-p'obate properly, which a beneficiary desigrrafian? ......................................................................................................................~; IF THE ANSWER TO AMY OF THE ASOYE Ql1EST~NS IS YES, YOU IIRIST COII~LETE SCHEDULE G AND FILE R AS For defies 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 3 percent [l2 P.S. §9116 (a) (1.1) (i)]. No OF THE RETURN. of the surviving spouse is 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) (ri)]. The statute dog not exempt a transfer fA a surviving spouse from tax, and the statutory requirements) for disclosure of assets and Bing a tax redan are slip applicable even 'rf the surviving spouse ~ the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate br>posed an the net value of transfers from a dec~sed child 21 years of age or younger at death to or for they, 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 Knposed on the net value of transfers to or for the use of the decedenCs pneal benefiaaries is 4.5 pt3rcent, excerpt as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate on the net value of tran~ers to or for the use of the deoedenYs s is 12 percent (72 P.S. §9116(a)(1.~)]. A sling is defined, under Section 9102, as an individual who has at least one parent in canrmon witl~ the decedent, by blood or adoption. ' REV 1508 EX+ (6-98) coMMONwEA~TH of PENNSnvaN1A INHERRANCE TAX RETURN RESIDENT DECEDENT SCNEpYLE E CASH, BANK DEPOSRS, 8~ NuSC. PERSONAL PROPERTY ESTA'~E OF !~~ ~~-c ~ ~ti ors _ _ __ SOD'' 9-- DlJ 6 ~4 Iniiude fhe prooeede dYtipMion and the deM the procesde were rsoehreo ~ nre sacra. ur ew~e.w~r reY~nuerw.a rtl~ Meht d euevboMlo eiuet be wdoeed an tiehedrrle f. C (~ mero epeoe le needed kaert edditlonel sheets d tl-s eeme else) ,i T REV-1~I0 EX+ (OS-09) pennsytvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIV05 TRANSFERS AND MISC. NON-PROBATE PROPERTY _--- - _ - ESTATE OF ~ n~OQ'- ti ~[ ral rS o~ 7 is schedule must be ~ and fled 'd the answer to anv of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMtBER i)ESGRIFTI~1 OF t+ROPERTY INOLDE THE NAlIE a THE tRANSATtff. TNl~I R8ATI0lWIV TD oED~r AND rAa A car a THE oEED FOR REAL esnnE. THE DATE a TRAIISFffi. AT pATE pF DEATii VALUE OF ASSET % OF DECDS INTEREST EXCLU ON ~ APPU TAXABLE VALUE 1. ///~, ~f ~ ~ A ~ •-/ l 11; ~. z ~ ~ ~`~ .~,~~~~ { ~nK~ q3 ~3~ ioo ~~ ;~ ;~ TOTAL (Also enter on Line 7, Recapitulation) ~ I' 0.00 ,, If more space is needed, use addkional sheets of paper of the same size. ' REV-1511 EX+ (10-09) Pennsylvania SCHEDULE H tJEPMTMENT OF REVENUE FUNERAL EXPENSES AND rnrrEatr~wcErucrtErurtri ADMINISTRATIVE COSTS nESloEwr oecEOEKr ESTATE OF ~ "` """""' ,~~~ ~~e /~ i~y~ rs ~4O q ~~sl~ Deadant's dehb nxat be ~ on Schslnl~ i. A. FUNERAL EXPENSES: 1. 1 ©.~J i'7~l•e~'i ~S ~~ a ~ ~o/t ~rrr 8. 1. ADMINISTRATIVE COSTS: personal Representative Commissions: Name{s) ~ Personal Representative(s) - Ctraat MAroec __ 2. 3. qtY _ .State __ ZIP Years) Commission Paid: AttomeY Fees: Fatuity Exemption: (If decedents address is not the same as daimants, attach explanation.) gaimant Straat Wrlrnec -- qty _ State ZIP Relationship of gaimant to Decedent i 0 0' 4. Probate Fees: ~~ ~ ~~~ 5. Awountant Fees: ~ ~ i 6. Tax Retum Preparer Fees: ~- , i i pe ;, ,, ~; ;, ,; ,, ,, ,~ TOTAL (Also enter on Line 9, Recapitulation) ~ ~~ ,J q, of s~39~y -- /' 73, ° ~~~ ~ 9' ~o ~, ~, i Q if more space is needed, use additional sheets of paper of tl~e same size. ' REV-1513 EX+ (O1-10) Pennsylvania SCHEDULE ] DEPARTMENT of REVENUE BENEFICIARIES INFIlRITANCE TAX RETURN RESIDENT DECEDENT w~w~c vr: Y ~ i~ er o'IDG 9 D~~~ RELATIONSHIP TO DECEDENT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Ds Ilot Lbt Trwtes(s) 0~ ESTATE I TAXABLE DISTRIBUTIONS [Indude ouMgM spousal distributlons and transfers under 1. ,~y/IflC //~C/'~q/ T%1 ~Qt't9/JrGr ,~~/ ~" l ~~ v ;, /3 8 ~~ 7D- ~~~ ~~' ,, ~ ~Ct ~ r s ~. /' l CYS sah ~~ ~t~l L 1 7 ~o~ /Q~.GI~/" 7 ~7 ve C'ranf~o~- , ~i ~ Da9DS' ~ _ ~r /l „ ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REY-1500 COVER SHEET, AS APPR TE. II NON-TAXABLE DLSTRIBUt10M5 A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 fOR WHICH AN ELECTION TO TAX IS NOT TAK~1: 1. i j J, i, B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. , i i TOTAL Of PART II - ENTER TOTAL NON TAXABLE DISTRIBUTIONS OPI LINE 13 OF REV-1500 COVER SHEET. ~ If more space is needed, use eddlUanel shells of paper of the same size. __ __~_ ». ~ ~+. ~ pit` ~~~~~tt~~ `~~ c' ~~~1 Sd Z ,y~1L1i PM ~_ ~~ .A! ~ ~ '11 if _~ ~~1~ ~ n~3 _ ~ y Off` ,. ` !~(1 a ~ ~d ~ "~ .* j n ~~ ~- ~ ~~ ~o ~~ ~~~ G ~~ V F s g