HomeMy WebLinkAbout08-09-101505610101
REV-1500 Ex ~°i_1°' _
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
DEPARTMENT OF REVENUE County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ,-
PO BOX 28o6oi ~ ` l ~ ~ ~ ~ ~ ,"~
Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
~q~3:sa~Cia3a oStSdol~ 0~181~~-/
Decedent's Last Name Suffix Decedent's First Name MI
~` i 1 .Z 1 ~ ~~ S ~ Q J~ L ! C
(If 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 Return O 2. Supplemental Return O 3. Remainder Return (date of death
O 4. Limited Estate
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
O 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
prior to 12-13-82)
O 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
O 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
O 11. Election to ta:x under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
~ o u G L A _S q R ~ i Z i E' 7 I J] -1 ,3 I o ~~ a
First line of address
qas so~;~-~
Second line of address
City or Post Office
CAMS ~; ~Z
aq~H ~~
State ZIP Code
p~ ~~oC1
REGISTEff~I='WILLS US~QlNLY
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W;`.~AI:E~ FILE D ,. ,
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Correspondent's a-mail address~.~, ~`'4'~L, ~`>~. ~ YA~O~ , Co~iyl
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prep,arer has any knowledge.
SIG 'R OF PERSON RESPONSIBLE FO ILI IG RETURN DATE
ADDRESS ~ ~~ ~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101
~~~~ c
1505610105
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
--
RECAPITULATION
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 and Notes Receivable (Schedule D) ........................... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........
7.
) ~i 7
! ~ S .
S
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~ %r, 7 ~ J ,5
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. j ~ ~ ~.. r] . 8 ~
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10.
11. Total Deductions (total Lines 9 and 10) ................................. 11. j d j 4- ~ $ Q
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ ~ ~ '1 (a ~ „ Q 9
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. ~ s ~] '~ ~u ~ . Q cf
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable p
at lineal rate X .0 ~5 ) 5 -I ~ (a ~ • ~ I
17. Amount of Line 14 taxable
at sibling rate X .12 •
15.
17. •
18. Amount of Line 14 taxable
at collateral rate X .15 ~ 18.
19. TAX DUE ......................................................... 19. «' ~ Q Q'~ • ~ ~A
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610105
O
1505610105
REV-1500 EX Page 3
Decedent's Complete Address:
Fite Number
DECEDENT'S NAME
STREET ADDRESS i yy
.~ ~ .~
_- - - _ _ - --- - -- -_-- _ -_ - - __ _-- ----___ - -- - -- --- -- - - _ - - -- r STAT~-~--- ---- - - r--__ -_- --- -- - _--.
CITY ZIP
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments _ .~__- -
B. Discount ~~
ICI 3. Interest
I
~ 4. 1f Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fili 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.
Total Credits (A + B) (2) ~'S ,
(3) _
(4)
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 life of either payments, benefits or care? ...................................................................... ^
2. If death occurred after Dec. 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 ofi 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 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 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)j. 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 FX+ (6-98)
SCHEDULE 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 defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
(It more space is needed, insert additional sheets of the same size)
REV-1503 EX+ (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ail property jointly-owned with right of survivorship must be disclosed on Schedule F.
{If more space is needed, insert additional sheets of the same size)
REV-1504 EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF 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.
(If more space is needed, insert additional sheets of the same size)
REV-1505 EX+ (6-98)
SCHEDULE C-1
CLOSELY HELD CORPORATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN STOCK INFORMATION REPORT
RESIDENT DECEDENT
ESTATE OF
State on Incorporation
1. Name of Corporation
Address
City _
2. Federal Employer I.D. Number
3. Type of Business
4.
Date of Incorporation
State Zip Code Total Number of Shareholders
Product/Service
FILE NUMBER
Business Reporting Year
TYPE TOTAL NUMBER OF NUMBER OF SNARES VALUE OF THE
STOCK VotinglNon-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
~
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 ^ No
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 address/es 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.
(If more space is needed, insert additional sheets of the same size)
REV-1506 ~X+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1. Name of Partnership
Address
City
2. Federal Employer I.D. Number _
3. Type of Business
Date Business Commenced
Business Reporting Year
State Zip Code
4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $
5.
FILE NUMBER
PARTNER NAME PERCENT
OF INCOME PERCENT
OF OWNERSHIP BALANCE OF
CAPITAL ACCOUNT
A. _
B.
C. _ -
D. __ -
6. Value of the decedent's interest $
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 decedent? ..... ^ Yes ^ No
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 decedent's death? ...... ^ Yes ^ No
If yes, provide a copy of the agreement.
11. Was the decedent's 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 decedent's 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 value/s. If real estate appraisals have
been secured, attach copies.
scNE~u~E c-z
PARTNERSHIP
INFORMATION REPORT
Product/Service
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-1507 EX+ (1-97)
~~ SCHEDULE D
~`
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 5, Recapitulation) ~ $
(If more space is needed, insert additional sheets of the same size) ~-
REV-1509 EX+ (1-97)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
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 identifying number. Attach
deed for jointly-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) $
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97)
x
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
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, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.
ATTACH A COPY OF THE DEED FOR REAL ESTATE .
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST
EXCLUSION
IF APPLICABLE
TAXABLE VALUE
~~(Q'7, ~ iS $~i
S~f ~eh~~N~a ~~a~1~ tgt~tp +~i1 P,q
c ~~ ~
~~
,~
-~
TOTAL (Also enter on line 7, Recapitulation) $ j (9'~i ~ ~' ~ ~j ~ ~`~
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-06)
Y SCHEDULE H
~-
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. IVG: ~ ~ ~~n,/E;^,,,~r NDNi~ ~~i~P W`.il, 1~~17 - F'vev~cAl T~~'2st~c,-~c~~'~-e.N~c~.s~~~~'Att~t~-~' ~j c~
RE.{°d~q~oiS~ Vim. Off- CAG\,~ }~~t.5 ~V~¢w""°~~ i t'AfJS' ~swr }Q-~~oc./~ COf-~~ ti t Y,c~V `~~ ~ ~~ ~ I ~ ~ ~.J~
~~\ L~~,e`0-a y , O~tie, r ~xsacl s w..~~l Swq,rv ~ CFC..S
~C.Re~ 1-~~As2.~. C~~~c~11CeMe~~ ~ ~}~~~~w~ r P,4~ -~3.,~~~ 1 l.~-~-
~j,~~.:~A~ Cp~~S r ~2r~vi S~~~ ~v ~A:^~5r1 r D~~~pr~IS"~ ~G~;~'C ~~...'~- ~ ~ ~ ~ ,. C3G~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City ____- _. State
Year(s) Commission 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
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Zip
Zip
TOTAL (Also enter on line 9, Recapitulation) I $ ~ ~~ ~r7 ~ ~
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
r
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
~.
d~ SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) 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 RE:V-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
REV-1514 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
heck Box 4 on REV-1500 Cover SheE
FILE NUMBER
This schedule 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, Afpha 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.
^ Will ^ Intervivos Deed of Trust ^ Other
NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGI AT
DATE OF DEATH TERM OF YEARS
LIFE ESTATE IS PAYABLE
^ 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) ......................................$
NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT
DATE OF DEATH TERM OF YEARS
ANNUITY IS PAYABLE
^ 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) ^ Semi-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 3 1/2%, 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) + Line 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, insert additional sheets of the same size)
REV-1644 EX + (3-04)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I. ESTATE OF
INHERITANCE TAX
SCHEDULE L
REMAINDER PREPAYMENT
OR INVASION OF TRUST PRINCIPAL FILE NUMBER
I (Last Name) (First Name) I,miaale IrnUal)
This schedule is appropriate only for estates of decedents dying on or before December 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 principal.
II. I
REMAINDER PREPAYMENT:
A. Election to prepay filed with the Register of Wills on
B. Name(s) of Life Tenant(s)
or Annuitant(s)
(Date)
Date of Birth Age on date Terrn of years income
of election or annuity is payable
C. Assets: Complete Schedule L-1
1. Real Estate ........................ .......$
2. Stocks and Bonds ................... .......$
3. Closely Held Stock/Partnership ........ .......$
4. Mortgages and Notes ................ .......$
5. Cash/Misc. 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)
III.
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Birth Age an date Term of years income
or Annuitant(s) corpus or annuity is payable
consumed
INVASION OF CORPUS:
A. invasion of corpus _
C. Corpus consumed ............................................................$
D. Remainder factor (see Table I or Table 11 in Instruction Booklet) ........................ .
E. Taxable value of corpus consumed (Line C x Line D) .................................$
(Also enter on Line 7, Recapitulation)
REV-1645 EX+ (7-85)
,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
INHERITANCE TAX
SCHEDULE L-1
REMAINDER PREPAYMENT ELECTION
-ASSETS- FILE NUMBER.
I. Estate of
(Last Name) (First Name) (Middle Initial)
II. Item No. Description Value
A. Real Estate (please describe)
Total value of real estate
(include on Section II, Line C-1 on Schedule L) :S
B. Stocks and Bonds (please list)
Total value of stocks and bonds
(include on Section II, 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 Held/Partnership
(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-4 on Schedule L) $
E. Cash and Miscellaneous Personal Property (please list)
Total value of Cash/Misc. Pers. Property
(include on Section II, Line C-5 on Schedule L) $
III. TOTAL (Also enter on Section I I, Line C-b on Schedule L) $
(If more space is needed, attach additional 8'/s x 1 1 sheets.)
REY-1646 EX+ (3-84)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I. ~ Estate of
(Last Nam~j
A. Unpald Llli::~litl~e
reported oi~~ t~~ hsr
Total unpaid liabilities i $
(include on Section II, Line D-1 on Schedule L)
B. Unpaid Be~~i: <,ks payable from assets reported on Schedule L-1 (please list)
Total unpaid bequests _ ~~t$
(include on Section li, tine D-2 on Schedule L~
C. Value of assr~~ ::;darted on Schedule L-1 (other than ~.~npaid bequests listed under
"B" aba~.~~j ': , ~.~re not included for tax pV.~rpr..ses car that do not form a part ~
of the trusi.
Computati~:~~ ~: ~ (oilows:~ ~,
Total unincludable assets ~ $
(include on Section II, Line D-3 on Schedule L)
INHERITANCE TAX
SCHEDULE L-2
REMAINDER PREPAYMENT ELECTION
-CREDITS- FILE NUMBER
TOTAL (Also enrer cA~t Section II, Line D-4 on Schedule L)
(If more s~~ace is needed, attach additional 8'/z x 1 1 sheets.)
REV-1647 EX+ (9-00)
~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE M
FUTURE INTEREST COMPROMISE
Check Box 4a on Rev-1500 Cover Sheet
FILE NUMBER
This Schedule is appropriate only for estates of decedents dying after December 12, 1982.
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 ^ Other
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°1°, ^ 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 sneers of the same s¢e~
REV-1648 EX (11-99)
A~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION
SCHEDULE N
SPOUSAL POVERTY CREDIT
(AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94)
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) ............................................ 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.
6b.
6c.
6d.
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) ........................................... 9.
If line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part II.
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
a. Spouse ........... 1 a. 2a. 3a.
b. Decedent .......... 1 b. 2b. 3b.
c. Joint ............. 1c. 2c. 3c.
d. Tax Exempt Income .. 1d. 2d. 3d.
e Other Income not
listed above ........ 1 e. 2e. 3e.
f. Total ............. 1 f. 2f. 3f.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(1 f) + (2f) + (3f) -
(= 3)
4b. Average Joint Exemption Income ....................... ..............................
If line 4(b)_is greater than $40,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part III.
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ..................... I 1
2. Multiply by credit percentage (see instructions) ........................................... 12
3. This is the amount of the Resident Spousal Poverty Credit. Include this 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•
REV-1649 EX t (1-97)
,,
' SCHEDULE 0
COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A)
INHERITANCE TAX RETURN SPOUSAL DISTRIBUTIONS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Do not complete this schedule unless the estate is making the election 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 arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement 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 decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement. _
DESCRIPTION VALUE
Part A Total ~ $
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALUE
Part B Total
(If more space is needed, insert additional sheets of the same size)