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.15056052048
REV-1500 EX
Decedents Social Security Number
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Decedents Name• Sarah M. Wertz ~. ~`.,~ ..~~~ y.J ,~~..._~7_.~ . _~~'
RECAPITULATION
L 0 0 0
1. ..........................................
Real estate (Schedule A). s s~ ~:~~; ,c~
2. Stocks and Bonds (Schedule B) ...............' ....................... . 2. 8 ~ . 3 7 2 ~; 6 ,: 5 ';
V
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. ~ - - O
O .0 ~,
..
1 {~
4.
Mort a es & Notes Receivable Schedule D
4• ~ ' ;
5. Cash, Bank De sits & Miscellaneous Personal Pro a Schedule E 5 ~ ~ ` 9 3 9 .7 ':
6. Jointly Owned Property {Schedule F) O Separate Billing Requested ..... .. 6. = ~ ~ 0 0 ,0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7. ~, 0 `
3 .';l
< y }:9 ~ 0~. 1 8 ' 2
8. Total Gross Assets (total Lines 1-7) .................................. .
.. 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ............. ........ 9. ' ~ ~ 214 !8 3 4
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10. Debts of Decedent, Mortgage Liabilities, ~ liens (Schedule I) ........ ........ 10. ~ '
5 ~~. -~ ~ ,
p
. 6~7
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~ - ~t ,~'O O
11. Total Deductions (total Lines 9 8 10) ........................... ........ 11. j ~ ~~ `: ~ ~;4
12. Net Value of Estate (Line 8 minus Line 11) ...................... ........ 12. ~ ~ ~. 8 1, 0 7 5
13. Charitable and Governmental BequestslSec 9113 Trusts for which ~ ) ~
f
an election to tax has not been made (Schedule J) ............... ......... 13. #~ ~
14. Net Value Subject to Tax (Line 12 minus Line 13) ....................
-- .... 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 D 15.
16. Amount of Line 14 taxable
at lineal rate X .0 ~5 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18
19. TAX DUE .........................................................19.
150560520418
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND QF AN OVERPAYMENT
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15056052048
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