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HomeMy WebLinkAbout09-20-10 (2) 1505610101 REV-1500 ~` t°'-'°' us PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX z8o6oi R,R.xF oFREVExoF County Code Year File Number INHERITANCE TAX RETURN ~1 I /1 /~/ „ L~, o~ I Harrisburg, PA 1'7128-0601 (,1 (/% („(/L,J RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY p Decedent's Last Name Suffix Decedent's First Name MI /~ t'L/f-~L ~1L :fi ~lU C S (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 ~ t. Original Retum 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 8. Total Number of Safe Deposit Boxes (Attach Copy of Wiil) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O t 1. 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 DIRECTED T0: Name Daytime Telephone Number First line of address l~ ~ ~ z'N V ~~ /~/~=SS ~ 2 Sewnd line of address City or Post Office State Mr~-14 N IBS 8 v I~. C~-- p~- ZIP Code REGISTER Qf.~IVILLS USE O ~ [) o -~ ~ iN~"1 '~ l~~m N ;%- cry ~ o D~ ED N a _1~0.)~ ao ~' _~ 4` 7-`: ~..~.~ < r `..' __ r _-y t °l -- ~-~ ~~~C.J --~ Correspondent's a-mail address: 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 preparer has any knowledge. OF PERSON RESPONSIBLE FOR-FILING RETURN DATE AUUKtJJ is~,~'Y-ii(y~~.1~S5 ~ i2 I'~~N=RIUILS$L~ iL'.~-- PA- l? ~~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. ~•"" 2. "' ~~~.UU 2. Stocks andBonds(ScheduleB)............•••••••••••••••••• 3. Closely Held Corporation, Partnership or Sole-Propnetorship (Schedule C) .. 3 .. . • 4. Mortgages and Notes Receivable (Schedule D) ........................ .. . 4• 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. ! ~ 0 ~ ._ ~ ~ Schedule F) O Separate Billin Requested .... Jointly Owned Property ( g 6 ... 6. ~- (~ Gj ~~ L CJ . 7. Inter-Vivos Transfers ~ Miscellaneous Noon-PS pareterBilling Requested.... .... 7. 1~~~~ C~ G (Schedule G) . .... 8. , ~ ~ ~ U U ........ ........ 8 Total Gross Assets (total Lines 1 through 7) ....... . 9 ~' U ~ ~~ ~ .. ......... 9. Funeral Expenses and Admmistrative Costs (Schedule H) ..... . . .... . _ Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... 10 .... 10. . ... • • ....11. ,i ~~^^ ~ 1 `~IUGG 11. Total Deductions (total Lines 9 and 10)......... • • • • • • • • • • • • • • • 12 ~llG ~% - - ..................... Net Value of Estate (Line 8 minus Line 11) .... . 12 . .... 7 1 . 13. Charitable and Governmental BequestslSec 9113 Trusts for which has not been made (Schedule J) ...... . t 13. ax an election to . ..... 14. ~ (j ~' ~~ ~, 1 A uer value Subfect to Tax (Line 12 minus Line 13) .................. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ' 15. (a)(1.2) X .0_ 16. Amount of Line 14 taxable 16. 1 ~~,~C; at lineal rate X .0 ~,.~ 17. Amount of Line 14 taxable 17. at sibling rate X .12 18. Amount of Line 14 taxable 18• at collateral rate X .15 ............................19. ~ li'~- v 19. TAX DUE ............................ . O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME STREET ADDRESS -~7 , 1 {~ - CITY L-`~ KI- ~ U ~ ~ STATE A- ZIP l ~0~ G) Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount ,~ ~v 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (1) / ~ v2G Total Credits (A + B) (2) ~~'~ (3) ~ 7~ % (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ~ a 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" orpayable-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, antl 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)]. 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-1737-3 EX + (g.p8) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE B, Use Schedule B ONLY for STOCKS & BONDS Proportionate method of tax computation. ESTATE OF FILE NUMBER J-~}-IUD" S' l~'1 1 C~~'f'Y~- ~- ~. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. REV-1731-0 EX + (6.OSi Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCNEDYLE E, PART 1 MISCELLANEOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER T !~ ,U ~ S /1'I I G I-~l4 L 1~I~ Part 1 must include all tangible personal property having its situs in Pennsylvania. Examples of tangible personal property are jewelry, furniture, paintings, etc. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ ,p C^; S Zt ILL= `.J~-'R- ~ / L ~,_ ~~ PART 1 TOTAL $ //Gv.c PART 2 TOTAL (From reverse side.) $ TOTAL (Also enter on Line 5, Recapitulation.) $ ~/~U ~ v c~ (If more space is needed, use additional sheets of paper of the same size) REV-15og EX+ (o1-io) ~ pennsytvarria DEPARTMENi~ REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: If an asset became jointly owned within one year of the decedents date of death, it must be reported on Schedule G. SCHEpVLE F JOINTLY-OWNED PROPERTY SURVIVING JOINT TENANT(S) NAME(S) I ADDRESS ~ RELATIONSHIP TO DECEDENT A. mac. i4 ~ uc ~ M lC~ L-1`~'/C ~ 7 w?~ I~i4 ~`L~T~~-- B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FORJOlNT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIALINSTTRJTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. L) G ~. ~I~rCy i'~.(_ ~ , G ! `~ i ~ ~ ~Ci: ` ~j3 T ~ ~ ~ °~ ~~ ~^, I:+CG TOTAL (Also enter on Line 6, Recapitulation) ~ ~.(~~~ If more space is needed, use additional sheets of paper of the same size. REV-151.0 EX+ (08-09) ~. SCHEDULE G Pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 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. GATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPUCABLEJ TAXABLE VALUE 1. ~.v.vA ~ S~ ~~~7 ~~= `~J~'7 ~Z.. ~ ~ ,~ ~ s ~n ~c N->4 ~-~ Ic ~.~,~ ~~~i,~-n~ss ~ ~~ ~~ ~'~. ~ ~+ N ~ c S g i7 ~v- f' ~}- ~ ~ v .~~ TOTAL (Also enter on Line 7, Recapitulation) ; I /J~'7"~•00 If more space is needed, use additional sheets of paper of the same size. REV-].57.7. EX+ {10-09) ~`1 Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ;i ~- ti z/ S ~l1 lC I-~'Y-~ L 1~ Decedent's debts must be reported on Schedule I. ITEM A. FUpNERALEXPENSES: 1. i ~ R ~C ~1 G ~ N FC Ll l~' C`~ I'~ ~- ~e YI'1 t' .~C:U'~;~~C~© M U ~ #+~ti'E H~ r~ F" ~:a R ~u' il,'c`Y~ ~ [_~ ~ 3 9 ~ : GC B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) _ ___ Street Address City State _ ZIP _ _______ Year(s) Commission Paid: 2. ~ Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant EL /I ~ IV C -~r /11 l C !w l4 ~•- Street Address ~ ~~~ ~N U~ ~~S S D l~ city Mr`L?H t~ IV tc~ g y ~ ~ _ state p ~ zIP 11t~.:~ Relationship of Claimant to Decedent ~ ~'{,~C~-f f' ~~ 4. ~ Probate Fees: 5. I Accountant Fees: 6. ~ Tax Return Preparer Fees: 7 TOTAL (Also enter on Line 9, Recapitulation) ; 9,~/ ~; ul~ If more space is needed, use additional sheets of paper of the same size.