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HomeMy WebLinkAbout10-20-10 (4)r - ~r I, FILL IN APPROPRIATE OVALS BELOW m 1. Original Return O 2. Supplemental Return O 3. Remainder R rh (date of death prior to 12- 3~2) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Es a ITax Return Required death after 12-12-82) I O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust S. Total Numbler o~ Safe Deposit Boxes fAffnrh f :nn~ of Willi lAHorh f^nna of Tn,efl J 1505610101 REV-1500 °``°'-'°' PA Department of Revenue perMtsylvanla OFFICIAL USE ONLY ~ File Numt>ar c~ PO Oti 2Iidi28T-o6oi aEM,„F~aiN RESIDENITED EDENITRN ~n~( y ~ II b d ~~ F ~ ENTER DECEDENT INFORMIATN)N BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMOOYYYY __ 204-30-6730 .07/25/2010 ; 05/29/1916 ii Deterdent's Last Name Suffix Decedent's First Name ~~ MI _ _ _ WOOMER ! 'ALICE L I ,; E (H Applicable) Enter Surviving Spouse's Iniormatlon Below L Spouse's Last Name Suffix Spouse's First Name ~I ~ MI ~_ ` j Spouse's Social Security Number j _ ~ THIS RETURN MUST BE FILED IN DUPLICATE WIT T REGISTER OF WILLS O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to I ~nder Sec. 9113(A) between 1231-91 and 1-1-95) (AUach . O CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION 8H0 LD E' DIRECTED TO: Name... __. _ _ Daytime.Telepho a D umber ~ _ ONDREA M SNYDER (717) 486-42 © , -s _ _ ~ _, REGISTER SE ~ [, rn tv ~ First line of address C ~ ~ ~ A _ 43 HALF MILE DR II CC~~ _" Second line of address it -nl ~ ~ 0 1 ... ~ tv I -s City or Post Office State ZIP Code D TE FILED __ i GARDNERS 1 PA 17324 '~ _ _ _. __ _. ~, Corrospondant's e-mail ade~ass• Under penalties of perjury, I deGare that I nave examined this return, inGuding accompanying schedules and atetements, end to Ule of ~ knowledge and belief, it is true, correct and complete. OeGaratbn of preparer other than the personal representative Is based on all infonnatlon of which r s any knowledge. SI TURE OF PERSON RESPONSIBL ~FOR FILIN G R ETURN /V7E , ^ / ,, J7Ql~. l~/rt ~- ~~ { 1 p/20/10 ADDRESS _--ZS 43 HALF MILE DR GARDNERS PA 17324 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ATE ADDRESS i PLEA8E UsE ORIGINAL FORM ONLY Side 1 I I~~ 1505610101 1505610 10 1, J _,-•'F -t ~:_ .f -, F ^~ ~ C:7 --; ~ _ _ _ i _ i _ _ J 1505610105 REV-1500 EX Decedent's So~ial Security Number Decedent's Name: ALICE E WOOMER 204-30-673p RECAPITULATION i __ 1. Real Estate (Schedule A) ............................................. 1. ~ .74,966.66 '. 2. Stocks and Bonds (Schedule e) ....................................... ~. i ~ . 2. ' I ~~ . _. 99,429.43 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ~! ' 0.00 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ! 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ' 39,233.97 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0.00 ', 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly i ~ 0 00 (Schedule G) O Separate BilNng Requested........ 7. j ..... .... . .. ..4 . . a ._. ~~_ R Total Gros: Assats (total Lines 1 through 7) ............................. 8. ' li ', 213,630.06 '' 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ....... 9. ' 934.52 10. Debts of Decedent, Mortgage Liabilitles, and Liens (Schedule I) ....... ....... 10. ..,,,_._ W _ . f 5,803.64 11. Total Deductions (total Lines 9 and 10) .......................... ...... 11. I ' 6,738.16 12. Net Valus of Estate (Line 8 minus Line 11) ...................... ........ 12. ' ' 206,891.90 i 13. Charitable and Governmental BequestslSec 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. ' '~~ I 206,891.90 _.-._ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 141axable at the spousal tax rate, or transfers under Sec. 9116 _._ (a)(1.2) X .0 0 ', 0.00 ' 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 9,310.13 16, ... _... . 17. Amount of Line 14 taxable at sibling rate X .12 0.00 ' 17. 16. Amount of Line 14 taxable at collateral rate X .15 0.00 ', 18 ', 19. TAX DUE .........................................................19.' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 150561D105 Side 2 1505610 05 J 0.00 9,310.13 '. j. 0.00 ': 0.00 ', 9,310.13 _- 1-_L. .. REV-1500 EX Page 3 Decedent's Complete Address: FIN Number DECEDENTS NAME ALICE E WOOMER STREET ADDRESS 'i 721 WILSON STREET ciTV CARLISLE srATE ~ PA ~ I zIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPaymerrts A. Prior Payments _ B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the tNIERPAYMENT. Fill In oval on Pape 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Lire 2, enter the difference. This is the TAX DUE. !,' (1) ! 9,310:13 Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRC 1. Did decedent make a transfer and: 1 a. retain the use or come of the Property transferred :.......................................................................................... b. retain the right to desgnate who shall use the property transferred or its income :............................................ c. retain a reversionary interest; or .......................................................................................................................... d. receive the promise for life of either paymerMs, becefds or care? ...................................................................... 2. If death occurred after Dec. 12, 1982, did decedent transfer propeAy 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 benef~iary designation? ........................................................................................................................ IF THE ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 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 fdl 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 [72 P.S. §9116 (a) (1.1) (ii)]. The staiub does not exempt a transfer to a surviving spouse from tax, and the statutory requi filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dabs 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 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 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. §911 Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. BLOCKS No 0 0 0 ^Q ^X ~ a ~ ~-S! PART OF THE RETURN. th~ use of the surviving spouse is I viving spouse is 0 percent for disclosure of assets and use of a natural parent, an percent, except as noted in .3)]. A sibling is defined, under i REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IE~~lLt A REAL ESTATE ESTATE OF FILE NUMBER ~~ ;cc ~ ~oor-+er All real property owned solety or as a tenant in common must be reported at fair market value. Fair market value is defined as t e p 'ce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable know) dg$ of the relevant facts. Real property which is jointly-owned with right of survivorehip must be disclosed on Schedule F. ' ITEM j VALUE AT DATE NUMBER DESCRIPTION 1 OF DEATH t. 7ZI W: ~SpN S~ ~'1r1:J1L QR 17 O13 r/3 OwNef ,~' . (o to (o b ~ y, 9 Cy,rrc..~ Se~~~~"l ~t`~c..c. ~ 22y~q~• ~!I J I i I TOTAL (Also enter on line 1, Recapitulation) I I~ ~i / ~ ~O , to tp a (If more space is needed, insert additional sheets of the same size) ! ' REV-1503 EX+ (&98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT sexenuu s STOCKS & BONDS ESTATE OF FILE h1UMBER ~~; ce ~ Woo~te~ All property jointly-owned with right of survivorship must be disclosed on Sohsduk F. ~.....,,.o a,.o„~ q .......-.........,.... .............. ~............. ~ ......~ ,......, REV-1504 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEp1~LE C CLOSELY HELD CC-R~OitATION, 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 corporationlpartnership intere t oh sole-proprietorship. See instructions for the supporting information to be submitted for sole•proprietor hip$ , the decedent, other than a . ITEM NUMBER NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. I ~I I ~I I I I ~~ ~I i I~ i I II I~~ ~~ III Iii I TOTAL (Also enter on line 3, Recapitulati ln) __.:: .-_ ____ REV-1505 EX+ (6-98) SCI~IEDI~LE C-1 CLOSELY HELD CORPORATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER 1. Name of Corporation State on Incorporatio~h Address Date of Incorporation ~ _ City State Zip Code Total Number of Sha hdlders 2. Federal Employer LD. Number Business Reporting ar 3. Type of Business Product/Service 4• TYPE TERM.-F1! # kUMBPR OF YALyE OF THE !!trt'~CK PAR VAUIfe W o~np 9 GIJT87G Ot1Y!!EO BY 7HE DEC~:fJlglT ~l~ff'8 STOCK Common I II' $ Preferred ~ $ Provide all rights and restrictions pretaining to each class of stock. i 5. Was the decedent employed by the Corporation? ................................. ^ Yes ^ N If yes, Position Annual Salary $ Time Devoted to Bu 'Hess 6. Was the Corporation indebted to the decedent? ................................... ^ Yes ^ Nc~ If yes, provide amount of indebtedness $ ~ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes ^ N~ 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 year if the date of death was prior to 12-31-82? i ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares ~i 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 'i If yes, provide a copy of the agreement. I~ 10. Was the decedents stock sold? ..................................................... ^ Yes ^ Nd If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? .................... D 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? ............. D Yes ^ Nd~ If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each inte esti• 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 de~ C. If the corporation owned real estate, submit a list showing the complete addresses and estimated fair market value 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 yeas List those declared and unpaid. G. Any other information relating to the valuation of the decedents stock. band 4 preceding years. If real estate appraisals have (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 SCNEpt~LE C-S PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER 1. Name of Partnership Date Business Comm~jnc~d Address Business Reporting Ye~r _~! Chy State Zip Code I 2. Federal Employer LD. Number 3. Type of Business ProducUService ' 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investme t $T^ 5. A. B. C. i D. I F 6. Value of the decedents interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ Noj If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ Nd Cash Surrender Value $ Net proceeds payable $ 'I If yes , 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 earls if the date of death was prior to 12-31-82? ' ^ Transfer ^ Sale Percentage transferred/sold ' ^ Yes ^ No If yes , Transferee or Purchaser Consideration $ D ate 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 ^ Nd I If yes, provide a copy of the agreement. 11. Was the decedents partnership interest sold? ....................................... ^ Yes ^ Nc~ ~! If yes, provide a copy of the agreement of sale, etc. j 12. Was the partnership dissolved or liquidated after the decedents death? ................... ^ Yes ^ Nc 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 ^ Nc I ~ ' If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ N If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each int res . A. Detailed cak:ulations 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 'and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addressJes and estimated fairmarket valu es If real estate appraisals have been secured, attach copies. ~ ', D. Any other information relating to the valuation of the decedents partnership interest. I REV-1507 EX+ (1-97) ' SCNEDVLE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER r~vt5re a.I+~n SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. INHERITANCE TAX RETURN PCp@O~1 A L PROPERTY NT DECEDENT GGRR~~77 11~~/1 ESTATE OF FILE NUMBER 1; ct. E wooH.er Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-0wned wkh the rtpM of suniv rs ip must be discbsed on Schedule F. ITEM ~, VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ . jM. t -f- ~ ~..~ 1 c. C ~..eJc i~ ~~ 9 X34 7 os7&y L 19 ~ ~ 7 / . 3 7 SS n 1 y~y Q' ' 20, bcoZ , X00 ~ ~.T ~ I~S~ ~ ~4J1acq ~L-i- ~ ~SdV y2~ ~ / 3 ~ /III J I 'i j ~i , I i ~, I i i i i TOTAL (Also enter on line 5, Recapit~lati~) I s 3 ~ ~ 233 , 9' (If more space is needed, insert additional sheets of the same size) ~~ __ REV•15D9IX (7A7) SCHEDULE.F COMMONWEALTH of PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBE Nan asset ~s made joint wkhln one year of the decedent's date of death, k must be roported on Schedule G. SURVNING JOINT TENANT(S) NAME ADDRESS ! RELATIONSHIP TO DECEDENT A. i B. C. I JOINTLY-0WNED PROPERTY: REM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financi~ institution and bank account number or similar idengfying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET 96 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A, '~ i I i i i I !~ I I I I TOTAL (Also enter on line 6, Recapitu atidn) ; (If more space is needed, insert additional sheets of the same size) REV-1510 EX ~ (1.B7f COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBERI 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 SHE~T is'ges. ITEM NUMBER DESCRIPTION OF PROPERTY ~HCLUDETHEHAMEOFTHETRANSFEREE,THEIRREUTIONSHIPTODE(:EDENTANDTHEDATEOFTRANSFER. ^rt"~"ACOPY OF THE OEEO FOR REPL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION ~F APPLICABLE TAXABLE VALUE 1. ~~ i ~~ i ~I I '~ I I I TOTAL (Also enter on line 7, Recapitulati ) i (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) SCI~iEp1~LE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT FILE NUMBER ESTATE OF Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. 1. FUNERAL EXPENSES: ~ ; hi~a C~r (:S~t ~ S ~~ts~ Cbv..-c.1.~ ~ Fw+erR ~ k Q..t_C.s~1 100.Ott Z~ ~r4.~.` s (,'4.-~er`a~- Fr~oc+~-~,r' Q.ecep~~ I ~ x-14 $ X73 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions i Name of Personal Representative(s) Street Address City State Zip _ Year(s) Commission Paid: 2. Attorney Fees 'i 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 li 5. Accountant's fees 6. Tax Return Preparer's Fees N e„~s ps per l : s~ ~ ~ o~ Es ~, ~ ~ P~~~ ~ a~-~ ~ ~ 190 , ~ 3 ~. , N~,sp~p~r L>>k-~ o~ F sh.l-c.. ~ seN~a.~') I 9 ~~ i ~ ~ I y 5. t~~o TOTAL (Also enter on line 9, Recapitu align) $ ~ 3 `(• ~ Z (If more space is needed, insert additional sheets of the same size) II REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~"`` R • w SCNEpIJLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ((~~ I'"Y ~ :cc. ~ 1~ao p- c i~ FILE NUMBER medical expenses. VALUE AT DATE OF DEATH ~, s. s 9 Z S"'. So Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimb r~ ITEM 1MBER DESCRIPTION 1. Ck~,6.~-1GNd C~-ood..~.ll F,-~s Z . rJ ~ v C Y`1or~• v ~ ~. ~ 4.t tt I~SSt~, ',~ . lam ~ : ~~ ~-~ i try ~i. l ~'Rls P • ~ 1 Z y, wr '}'~'trv'L ~r N rat C" ' ' ~ 1 f C-, ~~~~~~~ Log ~ ~ 1 ~ Z $. ~ JJJ `~1. C1 k ~'~~' a"' .• Fc~ r re~~a- Pc r ~ N -1rg'• ^t q ~'~i nr~ L t.O. ~ f ©P ~:yQQr l ~w1~S+crO.)aq ~`~~ Tfoti SW' 4~'~'~l [ ~ t SO^~ J N`f~ ~ ~c~rS ~' SQ~s~c a.?~ 7 Z~ W: ~sa~ .5~. g, p©s~~.~ s ~ ~P s -C . Cc-r' ~ 11~~1 ~C P ~ sCf-V 1 C~.. a• ~e ~ I o,N Qttiecc~•arS ~' . ~.~ 1~ ~~c>~ its ~ I . (Lei : ~ ~-er-s a~ tom: I I Fcc~s 1 3. P2~ Ca ~ 4~- ~-~ ~.,b,~ ~~ of (' I ew ~.~.y E~,ase "[. Ola~<<• SN`,~%`-" I"")RbuS~w~ d ~1 F..fT~WSC~ TOTAL (Also enter on line 10, (If more space is needed, insert additional sheets of the same size) ~~DO, ot~ ~~--~~- a~~r~.~s Z4 4 . c~ 7 yZ,oo S ~~ ~ ~ . 3'# 37. s8 15 3 . s~ Z3 X77 z~~. a© 3S. ~(~ ~"Q~ D3, loy REV-1513 EX+ (9-00) ' SCNEpuLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~ cL E I~OOn,e/ RELATIONSHIP TO DECEDE T AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LlstTrustee(s) OF ESTATE i TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] it 1. t~ SK d~ II D-~ ~~• Y -~~,~~ I so 7° ~I ~ 1aa.~ f r : l c 'r Cz ~'r-tr•S p pr 17'S L`I II ', d~i 4~, ~ ~ )117 `f c r,~ ~ M~C~.ar~ ?csb•-rq P~ I~OSS ~J ~i i ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ONI 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. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ~ (If more space is needed, insert additional sheets of the same size) !i II ~ r REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCNEDI~LE K LIFE ESTATE, ANNUITY & TERM CERTAIN heck Box 4 on REV-1500 Cover Shet FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For actuarial factors for single life calculations can be obtained from the Department of Revenue, S Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of deal and in Alehh 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 ^ Will ^ Intervivos Deed of Trust [ 3t~s of death prior to 5-1-89, ~c alty Tax Unit. from 5-1-89 to 4-30-99, ax return. ~ther • !t~(S? Of= LIPta Tf~#1MT(S) DkTB t~ B~#TFi biE11~§ST A4E AT DATE t}f DEATH 0!° 1riEFAitS LIFE I'STATE t8 PAYABLE ^ Li e cjr ^ Term of Years ^ Li a qr ^ Term of Years ^ Li a cjr ^ Term of Years ^ Li a dr ^ Term of Years ^ Li a ojr ^ 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) .$ 1alA~s,) OIF L# AlHflitTAM'f(3~ DATf~ ~ BNITH ~ t;tATE oP DfiE1tTN ~ . Alrilllfrv ~ IMrABLE ^ L' a qtr ^ Term of Years ^ Li a ~'r ^ Term of Years ^ Li a ar ^ Term of Years ^ Li a o~r ^ 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) ^Serni-annually (2) ^ Annually (i) ^ 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°/o E] 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) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate ss is 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 Li s 113 and 15 through 18. (If more space is needed, insert additional sheets of the same size) '~`-'~"` ~`' ICI INHERITANCE TAX scN~ou~E ~ COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT IN RES DENTEDECEDENTRN OR INVASION OF TRUST PRINCIPAL FILE NUMBER I. ESTATE OF (Last Name) (First Name) This schedule is appropriate only for estates of decedents dying on or before De This schedule is to be used for all remainder returns when an election to prepay has been file Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion II. 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 C. Assets: Complete Schedule L-1 1. Real Estate ...............................$ 2. Stocks and Bonds .......... ................$ 3. Closely Held Stodc/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 Unindudable Assets . ................$ (Middle Inn 12, 1982. the provisions of i i Term of years income on annuity is payable 4. Total from Sdiedule 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) ~' ~, I INVASION OF CORPUS: A. Invasion of corpus _ (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date a Annuitant(s) corpus consumed i rm of years income annuity Is payable I 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) REV•1645 EX+ (7-t)5) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L-1 REMAINDER PREPAYMENT ELECTION -ASSETS- FILE I. Estate of (last Name) (Pint Nams) ' (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) I 'i i ~i Total value of real estate include. on Section II Line C-1 on Schedule L ( ) $ B. Stocks and Bonds (please list) i Ii Total value of stocks and bonds I (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) i I 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 Sch dule L ( e ) $ 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 II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8Ys x 11 sheets.) Rev-teae ex+ (3-84) INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION IN RESIDENTEDECEDENTRN -CREDITS- FILE NUM ER I. Estate of (Last Name) (first Name) (Middle Initial) II. IMm No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) ~ I I i I II Total unpaid liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) i I I i I j Total unpaid bequests (include on Section II, Line D-2 on Schedule L C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed unde "B" above) that are not included for tax purposes or that do not form a pa of the trust. Computation as follows: I '~ i I i, I Total unincludable assets (include on Section II, Line D-3 on Schedule L) III. TOTAL Also enter on Section II Line D-4 on Schedule L ~I ( ) ~ (If more space is needed, attach additional 8Yz x 11 sheets..) . REV-1647 EX+(5.00) SCNEp1~LE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Check BOX 4a On ReV-1500 Cover Sheet ESTATE OF 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 fr.lture 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 ret~lrn.~i ^ Will ^ Trust ^ Other i I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRT AGE TO NEAREST BIRTHDAY 1. ' 2. I ' 3. ' 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a ri ht of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in hic the surviving spouse exercises such withdrawal right. ' ^ Unlimited right of withdrawal ^ Limited right of withdr w I IIL Explanation of Compromise Offer: ~i i i ii ~ N I Summary of Compromise Offer: 1. Amount of Future Interest ....................................................... I ~ .$''~ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. ~, (also include as part of total shown on Line 13 of Cover Sheet) ......$ 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) ......$ 'i 6. Value of Line 1 taxable at collateral rate (15%) ! ' (also include as part of total shown on Line 18 of Cover Sheet) ......$ I ' 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .................... L .$ (If more space is needed, insert additional sheets of the same size) R2V-1648 EX (11-99) .• COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION ESTATE OF SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12!31/94) FILE I This schedule must be completed and filed if you checked the spousal poverty credit box on the ov r 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. ! s 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................ ................................ 6. 7. Total Gross Assets (Add lines 1 thru 6) ................. ................................ 7. 8. Total Actual Liabillties .............................. ................................ 8. 9. Net Value of Estate (Subtract line 8 from line 7) ........... ................................ 9. If line 9 is Qreater than $9 00,000 -STOP. The estate is not ellgnble to claim the credit if not, continue to Part II. Income: a. Spouse ........... 1. 1 a. TAX YEAR: 19 L. 2a. IAJ~ YCA1i: lb 3. 3a. ~ ian: is 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. ~• f. Total ............. 1 f. 2f. 3f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption lncome from above: (1 f) + (~ + (3f) =3 Average Joint Exemption Income ..................................................... 4b . li b .ter 000 , S P. The t is not I' ble claim the credit If not ~ritinue 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ..................... P 1 III. i 2. Multiply by credit percentage (see instructions) ........................................... p 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 t t d ' 4. e ............................................................. s gross es a dece ent 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal lation of total credits on line 18 of the cover sheet l i th l thi fi ft I d C 5• ~~ ....... gure n e ca cu . nc u e s Poverty red ~_ ~v-~ea~r.I~a~ .' SCHEDULE 0 COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN RESIDENT DECEDENT SPOUSAL DISTRIBUTIONS ESTATE OF FILE NUMBE Do not complete this schedule unless the estate is making the election to tax assets under Section 91131A) of the In nce & 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, residu~ l A, iB, 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 includ in Ithe 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 t able 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 um rotor of this fraction is equal to the amount of the trust or similar arran ement included as a taxable asset on Schedule 0. The denominator is ual to the total val e o the trust or similar arran ement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of locati n, Mich pass to the decedent's survivin souse under a Section 9113 A trust or similar arran ement. DESCRIPTION I I I I II i li I I VALUE Part A Total PART B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A el t on to taxis bein made. DESCRIPTION I I I i I VALUE Part B Total (If more space is needed, insert additional sheets of the same size) __ _ _ __