The URL can be used to link to this page

Home My WebLink About08-28-09 (4)J 15056052048 ' REV-1500 EX Deced ent's Social Security Number Decedent's Name: / ~ ; (~ ~ ~'' °Z ~~ RECAPITULATION 1. Real estate (Schedule A): ... ... ~ ..... _ ... ...., ... ... `~ "j. ~ p i ~,1 }O~ O O ~ `Or 1~ - a ~ 2. Stocks and Bonds (Schedule B) ................................... .... 2. ~ x' ~ ~~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. ~ ~ ~.b ,~`~O ?~ 4. Mortgages & Notes Receivable (Schedule D) ......................... .... 4. ~ ~ O 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ~ (~.~` ~ ~ ~ ~~~ d i ,. 6. Jointl Owned Pro y petty (Schedule F) O Separate Billing Requested .... ... 6. ;A ~ ©:;® e 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. ~ {fib: a ~ 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. - . ;$ ,r. . , ~~ i-J '~} X30 ,~ Q~ 9. Funeral Expenses i£ Administrative Costs (Schedule H) ............. ........ 9. ' ~ r ~ ~~ ~ ~ ~ ~F 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .. . ...... ....... 10. ~^ 8' ~. e~~ 11. Total Deductions (total Lines 9 & 10) ............................ ....... 11. ~ 3~ ~: 12. Het Value of Estate (Line 8 minus Line 11) ....................... ....... 12. 1: `~ t ~ Q .S" off: 13. Charitable and Governmental BegaestslSec 9113 Trusts for which . ' .. an election to tax ties not been made (Schedule J) ............... .:y. 13, , ~ ~ ~ al f Q 14. Net Value Subject to Tax (Line 12 minus Line 13} ....... . ....... . ..... . 14. ®i 8 a. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable , at the spousal tax rate, or transfers under Sec. 9116 ' "" ~' ~t - ~ - `~~ '.° "~' "' (a)(1.2} X .0_ ~ ~ ~ t 8 ~ ~+ ~~ X15. 16. Amount of Line 14 taxable ' at lineal rate X .0 ~S 1 ~ ~ ` ? ~ 16. 17. Amount of Line 14 taxable '~ ~ ~"~~~~ at sibling rate X .12 - D Q 4 17 18. Amount of Line 14 taxable ` , at collateral rate X .15 d ~ ~ i ! ~ ~~ O 6 ~ -18 19. TAX DUE ............... ..............,..... ..........'..1..!.,...., .19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~` 15056052048 Side 2 s ' ~ ~ f~EV-1500 EX Page 3 Decedenf's Complete Address: File Number a~6 ! ., as Sp4 DECEDENT'S NAME ~.I/~~' G . sTi~ rn ~ Au ~~--- ~- -- --- STREETADDRESS /6 LOS S Gi1/~T ~` ---- - CITY 11AA ,, .,~ p /vl ~ / ~ ~ ~ ~ STATE ~ I ZIP ~ 70.~~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) ICI ~ yO7.30 2. Credits/Payments ', A. Spousal Poverty Credit __-_ m • O ~ B. Prior Payments ___ m . O O _ C. Discount m • ~ ~ I - - Total Credits (A + B + C) (2) ' O , B ~ 3. Interest/Penalty if applicable I~~ D. Interest __ O • 6 ~ _ E. Penalty - 4~0~!' S• ~ ~ Total Interest/Penalty (D + E) (3) II ~ ~~ ~ 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. (4) . 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) I ~ ~/ ~ . y8 A. Enter the interest on the tax due. (5A) O . Q p B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 'y~~ , ~~' Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APP~tOPR1ATE BLOCKS 1. Did decedent make a transfer and: Ii Yes N o a. retain the use or income of the property transferred :.......................................................................................... ^ ~~ r ,, I[u o shall use the property transferred or its income : ~ e h .. ::::..::......::::.....::..............:. . retain a reversionary interest o d. receive the promise for life of either payments, benefits or cares ......... ......... ......... ......... ....... ^ 2. If death occurred after December 12, 1982, did decedent transfer ro within one ear of death y I l.. without receiving adequate consideration? .....................................P... ~.~ ^ n ath' ti ~ n ^ Account an non-probate property which I, 4. D d decedent own an Ind v dual Retkemen u'ty, o aot e r contains a beneficiary designation? .....................................................................................................................~.. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND F~LE IT AS PART OF THERETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers tp or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of t e surviving spouse is zero (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 twenty-one years of age or younger at death t~ or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (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 four and on~-half (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 twelve (12) percent [72 P.S. §~116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.