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HomeMy WebLinkAbout03-03-11 (2)J 15056051,047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes ~ <, INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 --J ~ ~~ RESIDENT DECEDENT OFFICIAL USE. ONLY County Code Year ~'` File Number , ~~' , ~ ~ ~. ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death ~Z~ ~ 2~k ~,~~{ g Opt ~: ~ ~ ~ ~ ~ Decedent's Last Name Suffix /~ 1 L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Date of Birth Decedent's First Name MI M ~ ~ `~ A 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 prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estates Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. 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 TO: Name Daytime Telephone Number Firm Name (If Applicable) LLS USE.QDILY REGISTER: ? , , 'mil" ~+~ `i wa y -~ ~ ~ ~ 7 r C ,7 . . .~ 1r~' I ~ First line of address ; ..~ c:.~ :.. ,_.,~~ _. ...., --- _ -. ~,. _, ~ J , , Second line of address . -rn C ~ City or Post Office State :.~ ZIP Code DATIE FILED '~-' ~ y 1 R ~ Ni ~ ~ ~ ~ r C~ u~. ~+ h ~ 1 ~'1 ©1 ,1 Correspondent's e-mail address: ~ aI~~O ~ ~~Il.. ~' ~ hr'~J~i1.. ~ ~e~~ 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. SIGNATURE OF PER~,~2~SPONSIBI.~E F,OR FILIN~RETU ~~~r ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1,5056051047 1,5056051,047 J~ J 15056052048 REV-1500 EX Decedent's Social Security Number ' .~ ~ •~ ~~ s Name: Decedent RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. ~ . 2 ~ ~ ~ ~ ~ • ~ b 2. Stocks and Bonds (Schedule B) .................................... ... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. ~ • ~ d 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. ~-~ + C,~ a 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ~ ~ f ~Z 1 + 2 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. ~ • ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property O S l Billi R t d S h d G 7 ~ ~ ~ ~ ~ ' a } ..... eparate ng eques e ( c e u e ... . « ( 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ~ ~ ~ Q 1 L .S 9. Funeral Ex enses & Administrative Costs Schedule H ........ P ( ).......... ... 9. ~' ~ ` Z ,aj 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ~ ~- t ~ ~ ~ j 7 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ ~ ~~ ~~ , Q 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12 j ~, ~ ~ ~ +. ~ w 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which l i h h l S 1 C ~ an e ect on to tax as not been made ( edu e J) ..................... c ... 3. . 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. ~ , ' c ~ 1 ~ . 7 TAX COMPUTATION -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 ~f ~ ~. at lineal rate X .0 ~ ~ ~ ~ ~ « ~ ~ 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. r) 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 1,5056052048 REV-1500 EX Page 3 File Number Decedent's Complete Address: 'Z.c~ t~ -- ~C:z~- ~~ DECEDENT'S NAME I ___ STREET ADDRESS __ _ ___ __ _ CITY ~~r ~ ~ ~~ ` ' ~ ~ ~ ~ ~ ,STATE ~~ ZIP ; ~ ~ ~ ~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) ~.~ ~~ ~ ~ l ~ 2. Credits/Payments A. Spousal Poverty Credit ~ ` ~ ~' B. Prior Payments Q : Q __ -- C. Discount _ x_]23 ._C ~ ___ r - Total Credits (A + B + C) (2) ~ Z~ t (~ ~ 3. Interest/Penalty if applicable D. Interest (,~ t ~ C) E. Penalty _ _ _ ~3_, ~% ~ Total Interest/Penalty (D + E) (3} ~ ~ ~ 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) ~.~~`. (~ ~ ~t~ A. Enter the interest on the tax due. (5A) e ~ ~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56} '~~. 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 December 12, 1982, tlid 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 of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or i~or 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 the 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 requirernents 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 to or i~or the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(x)(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 one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(x)(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. §9116(x)(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-1503 EX+ (6-98) ~ P, , _ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER ~~ tt,., tit ~~~Y ~ , 2~ t©~ Q~~~~ 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 FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. r tvG ~~ ~~ tC C -1-~ ~ ~'_ ~ ~ N' ~. ~C(~ ~ Q:,~t t~:i `j ~ ~ ~ ~ t ~ , ~.. ~~ C Kati ~ ~~~ ~~~.;c ~~ o ~ ~~ c~~, ~..~~~' I t ~ `7~ TOTAL (Also enter on line 5, Recapitulation) $ ~ 1 ~'' Z~'1 ~ `~ (If more space is needed, insert additional sheets of the same size) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY REV•1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY --_ ESTATE OF ..~ 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 ~ t - ~ #~ 0 ~., ~ ~.~ i}a'.~ r ,~ ~ 1~~~~ X12 Gj ~ `~P~~ .~~~~ _~- ~~ ~~~A~'t1-Ic TOTAL (Also enter on line 7, Recapitulation) ~ ~~'~ ~ ~'~,~ ~~~ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) -~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representatives} Street Address _ _ _ City Year(s) Commission Paid: ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES:_ ~~ 1. ~ ~tGaL.1 .~~ i--1 ~- LY ~ ~ .~ ~c L- ~-~ ~' ttr~ ~ ~ ?> > e ~ :~ ~~,>i~ M ~ Wiz, '~~ B. 1 2. 3. 4 5 6 7 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS State Zip Attorney Fees 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees j 45'. TOTAL (Also enter on line 9, Recapitulation1$ ~"~``~ , ~?~L (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) ,,: COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS tJ I A I t OF t-ILt NUMt3tK Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. L~~~u r~~ fvt ~l~'+~~~.u 5 t'~,~ `~ ~ S`i~ I> t,-l V` t ~v~ ~~ ~.°~ : ~ G"~ ~ 3 , I~ ~N~ n'r'E r~ • ~ c:,v~ tiSt-t ~ ~ Av`~'1"~3%~ ~ ~ ~ ~~: I ~ ~ ~ a ~ ~ . 4 ~~ a~~ i t.~.~ t ~~1P~G ~~v~ ~= i i~t~ ~L ~P l~ ~T~ C S ~;~ ~, ~ ~= ~.= S i ~ ~ : 2 ~ ~cr~a~. ~.c ~~a ~~ ~~~~~.c~~~~:~ ~~~~~~~ cc~ ~'3 .`~~ '7. '~I rv Its A C. 1. ~ ~-{ ~ ~k.~.-Tl-t `..~I~~'~C'~ ~ ~~~~~ 1 Y ~~ ~/ ~ ~ Y V ~~r~ ~~.~.~Y~- ~ Y ~~.+. 1~4 l~-~ ~' ~ ~ , C ~. TOTAL (Also enter on line 10, Recapitulation) $ 4 `~:~ v ~ `~ '7 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) 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 ~~~~ Sec. 9116 (a) (1.2)] 1 p I ~ i ~ a ~ ~~ C~~ttir~~ ~; ~~~ ~ ~'~A~~~~~tF lvr ~ ~~J : ~r~ ~ ~~'~ ~ ~ . l ~! ~4 I I~ ~'~.Ati7't~A~>~r4 Z ~ t~ ~ ~ = Cad ~~~~~ ©hs ~ ~ ~~CJ • ?~ G ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. w TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (it more space is needed, insert additional sheets of the same size) ~.~gr tYr ~~~ ~e~r~n~er~r ®~ warp ~ttn tai[ ,~ F._.] '; _~` FE.,y • .... ~ - -`• ..l ~ri~ ~~ .1 ,, . r ; ..., ~_.~ -~ ~ 1 . "T3 __• - -- '~ .~.~_. I, MARY ANN NAIL, of the County of Cumberland and Commonwealth of Pennsylvania, being of sound mind and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all Wills and testamentary writings heretofore made by me. FIRST: I hereby direct that all my just debts and funeral expenses be fully paid as soon as possible after my death. SECOND: I bequeath the sum of FIVE THOUSAND AND NO/100 ($:x,000.00) DOLLARS to each of my following named grandchildren: (aj Donna Nail, child of my son Michael T. Nail; (b) Cathy Nail, child of my son, Michael T. i ~~ ail; (c) Mary Beth Nail, child. of my daughter, Elizabeth A. Nail: (d) Michael Deal, child of my daughter, Patricia C. Deal; and (e) James Deal, child of m;~ daughter, Patricia C. Deal. THIRD: All the rest, residue and remainder of my property of whatevE;r nature, both real and personal, which I may have the right to dispose of by my Will, including any FOWKES & BIRMINGHAM ATTORNEYS AT LAW 732 ALLEGHENY RIVER BOULEVARD OAKMONT, PENNSYLVANIA 15139 (412) 828-2802 ,.>. ~_.,_~__ ._,,~~, ~w..:, .:. _ _. _ e.___.-_-.__. .~.w~- ._, and all property as to which I may have a power of appointment by Will, I give, devise and bequeath, in equal shares, to my children, ELIZABETH A. NAIL, PATRICIA C. DEAL and MICHAEL T. NAIL, provided they each survive me for a period of thirty (30) days. If any of my aforesaid children fails to survive me by a period of thirty (3~0) days, I give, devise and bequeath his or her share to his or her issue, per stirpes and not peer capita. FOURrl~'H: 'I hereby nominate, constiiuie and appoint n1y son, i~iICI-iAEL T. NAIL, Executor of this, my Last Will and Testament. In the event that he should be unable or unwilling to so serve, I appoint my daughter, PATRICIA C. DEAL, ExE;cutrix of my Estate to serve in his stead. I give and grant to my Executor in addition to the authority conferred by law, the power to sell any and all of my property, real or personal, at public or private sale, at such time and for such price and upon such terms~n.d conditions as lie may see fit, or in his discretion to retain the same for distribution in kind and the power, but not the duty, to invest any cash without being limited to "legal in.vestments." No bond shall be required of any fiduciary acting hereunder. FIFTH: If any property as to which I am entitled to appoint a guardian shall pass free of trust to a minor by reason of my death, I nominate PNC BANK, Pittsburgh, PA, Guardian of the estate of said minor as to s~zch prop: ~-ty. I authorize such Guardian, in its sole discretion and without Order of Court, to retain such property in kind or to sell the same, giving good title to any real estate, to invest and reinvest in stocks, bonds, or other investments without being limited to investments which are legal for a minor's fiznds and to use both income and principal for the minor's welfare, comfort, recreation, support and FOWKES & BIRMINGHAM ATTORNEYS AT LAW 732 ALLEGHENY RIVER BOULEVARD OAKMONT, PENNSYLVANIA 15139 (412) 828-2802 education, including preparatory, college and post-graduate or professional training. IN WITNESS WHEREOF, I, MARY ANN NAIL, the Testatrix above named, havehereunto set my hand and seal this :~ , ~ ~~ day of . , ~ ,~ ~~=.~ : ,~..,, , 2003 . 1 ,- ~` MARY A_rd?vT NAIL ----~-_. -- SIGNED, SEALED, published and declared by the above-named Testatrix., MARY ANN NAIL, as and for her Last Will and Testament in the presence of us, who at her ---_ request and in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. a~ :.~?; E. _ s, ~r' ~•' , , FOWKES & BIRMINGHAM ATTORNEYS AT LAW 732 ALLEGHENY RIVER BOULEVARD OAKMONT, PENNSYLVANIA 15139 (412) 828-2802 AFFIDAVIT OF SELF-PROOF ~(CammottbueaCt~j of ~etttt~pCbattia ~ ~ gg: cr~outttp of ~rregfjettp ~ We, MARY ANN NAIL, George E. Fowkes and ~ ~.~~~-f ti~~: ~ ~.~de~~_ ,f~.,.,,~~,r~~;! , whose names are signed to the attached or foregoing instrument, being first duly sworn, hereby declare to the undersigned officer, authorized to administer oaths under the iaws of the aforesaid state, that the Testatrix has signed, sealed, published and declared this instrument as her Last Will and Testament and that she so signed voluntarily a:nd in the presence of each of the said witnesses and that each of the witnesses, upon request of the Testatrix, did attest as witnesses in the presence of the Testatrix and in the presence of each other and signed the Will as witnesses. ,-, MAI~`Y ANl~ NAIL t 1 r GEORGE FOWKES .~.. I HEREBY CERTIFY that on this day before me, an officer duly authorized in the state and county aforesaid to take acknowledgments, personally appeared MARY ANN NAIL, George E. Fowkes and t~:..';st.~ar;'E~ i~'1=;~~;~,~,;,;~' _, as Testatrix and witnesses, respectively to me known to be the persons described in and who executed the ~uregoing instrument and they acknowledge before me that they executed same. n WITNESS my hand and official seal this :.,~C''''` day of ~''I ;~a_!~'.c:~_J,t ,~ _, 2003. r . otary P' blic ,;~' r t ~~ Notarial Seal Sherry L Zmmerman, Notary Public Oakmont Boro, ANegheny County F O W K E S& B I R M I N G H ~ Commission Expires Apr' ~' 2007 ber, Pennsylvania Assoaation Of Notaries ATTORNEYS AT LAW 732 ALLEGHENY RIVER BOULEVARD OAKMONT, PENNSYLVANIA 15139 (412) 828-2802 N ~ O ~ Q ~ ~ ~ o ~ , ~, ~ ~ O ~ ~ ifJ` G t9 ~ o ~ d 4 cfl ,-- ~ ~ 0 U7 d ~- ao >- ~ Z Q N ~ ~ ~d~ ~ V ~-- F- J ~ a ~ ~ D Z .°~ >U~ N 'Q m O o G N N c .Q ~ ~ ~ ~ iu ~" 9 ' _ ~N Q V N Q ~" N 1 o N ~ N .~- `~ o r G aL 4 „ J Ll- ~ -- ~ N a '='= N G ~ Z t"J4 7 7 7 ~ v v ~., ~ ~ 7 ~ o ,4 ~ k. Q. rn N ~ o ;~ w u, Q ~Or V.~11 r' v ~ Q' tD a. (~! 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