The URL can be used to link to this page

Home My WebLink About03-14-11 (2)I 15056051047 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~ ~,. County Code Year File Number PO BOX 280601 ~ INHERITANCE TAX RETURN ~ ~ ( ~ ~ ~ Sr Harrisburg, PA 17128-0601 p RESIDENT DECEDENT t !C~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ q5' ~~ ~D7~ oai~ao~n ~~3~ rah Decedent's Last Name Suffix Decedent's First Name MI S L L L~~ ~{ !'~ S R C [:: L L /-~ ~ (If Applicable) Enter Su^rvi/vi g Spou/~se's InformatiPn Below Spouse's Last Name / v ~~ - +~C'C~1~1,$~p Suffix Spouse's First Name MI 1 Spouse's Social Security Number / r f ~ - Oc-~~`9SC~ 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 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~~ .0 ~ S, M ~ r~ ~ ~ 7 ~~~ s gr~~ Firm Name (If Applicable) First line of address Second line of address City or Post Office c~~~~s~~ State ZIP Code ._ REGISTER OF;~~ USE ONLY: r _ ~~, ry i A.,.., Z ~ ~..~ ~-- 1.-_x r_._- r..`~ _~. ~ °~~ ==:7 DATE FILED C' :n ~~ i~~~~ Correspondent's a-mail address: ' )UdpSm ~~ a 1 ~ ht~`i" I~Y~ ~ ~ • ~' 0 M -~ Z t _.,~ ~"-, t . [~i _r _T-i '~ G _ .`7 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. SIGNATUR OF PERSO ONSIBLE FOR FILING RETURN DATE ADDRES SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 15056051047 N a ~: ~" ~~ S T ~ ~ ~ 1" Side 1 15056051047 ~ur- J 15056052048 REV-1500 EX Decedent's Social Security Number Decedents Name: I ~ ~ f ~ ~ ~ RECAPITULATION 1. Real estate (Schedule A) . ........................................ .... 1. ~• ~ v 2. Stocks and Bonds (Schedule B) ................................... .... 2. ~ ~ 7 / + 1 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. ~ • 4. Mortgages 8~ Notes Receivable (Schedule D) ......................... .... 4. 5 h l E h it & Mi ll P l P t S d C B k D 5 ~ ~ ~ S • ~ ~ . ) .... , an aneous ersona roper y ( c e u e as epos s sce .... . , 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. ~ r d 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. ~ ~ ~ ~ ~ L~ 8. Total Gross Assets (total Lines 1-7) ................................ .... 8. ~ ~ ~ ~ 9. Funeral Expenses & Administrative Costs (Schedule H) ................. .... 9. ~ ~ ~ ~ l + ~ (~. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10. ~ ~ I ~? ' 11. Total Deductions (total Lines 9 & 10) ............................... .... 11. ~ ~ ~ C ~ ~j ' 12. Net Value of Estate {Line 8 minus Line 11) .......................... .... 12. ~ 5 L1 ` (~ , ~ ,~, 13. Charitable and Governmental Bequests/Sec 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. ~ //,-- S ~ ~t7 . 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,t~,Xable - at lineal rate X .0 ~ 8 5 U lv . ~ ~ 16. ~ ~ v~ . ~ `~ 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. ~ ~-\ ~• 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 15056052048 J REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER ~(~~CtZI~ q GC ~~ ~ _ ~ t Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (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 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATNE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. ~', i33, 70. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) _~ O~ ~ ~ e _~ _,~n,`. ~ _ ___ - /. Street Address ~~~___~__-~,.~,~ /~' City ~ ~R. t ~.~" 1 State ~i~ Zip _~ 70 ~ Year(s) Commission Paid: .~-~`~ 2. ~ Attorney Fees 3. Family Exemption: (If decedent's ~ad~dress fish not the same~as claimant's, attach explanation) Claimant __ _~~~'..! LC ??=~~-L!_! -- --- Street Address _ ~~_~ ___ ~~_.__~AN'GJ ~ _J !___ City __ ~,! .S ~e ~ ~f A State ~~ Zip ~ ~ 0 (~____ Relationship of Claimant to Decedent __ ___ __ ' 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ~- ,',, Soo. ~ ~yo.S~ -&- --e-- TOTAL (Also enter on line 9, Recapitulation) ` $ ~~ ~ 77G/ (If more space is needed, insert additional sheets of the same size) REV-151~J EX+ ('.-97) P,R~ COMMONWEALTH CF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF A This schedule must be completed and filed if the answer to any of gdestions 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 DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH V UE OF ASSET AL % OF DECD'S INTEREST EXCLUSION IFAPPUCABLE TAXABLE VALUE 1. --`` A N N~.~T J E / ~`7 ~ ,p~ D~•o~l~ .s D ~v~~ /d y ~.~~i _._.~- ~ -JS'~~R~ E `, ~ aZ.~ R.~ S~ ~ e J ~~ ~~ 5 SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY FILE NUMBER TOTAL (Also enter on line 7, Recapitulation) $ ~~,7 ~ 1~. ~~ (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (1-97) COMMONWEALTH OF PENNSYLVAN{A INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER I'~,r, R ~ t ~A ~ , f ~ rk ~ ~ ~ Include the proceeds of litigation and the date the proceeds were received the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER /n~ DESCRIPTION OF DEATH TOTAL (Also enter on line 5, Recapitulation) I $ ~ ~~ y~ (If more space is needed, insert additional sheets of the same size) ~ ~ f REV-1503 EX+ {6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER ~ ~ ~ '~ ~ ' v ~ c' . P E C All property jointly-owne ith right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. /~/j ~~ 1 ' 1 t ~U n/~ ~/~~ rJ ~ C7 ~ ~ ~~~(r~ ~o~~ ~ ~.~. ~O ~YGt ~u N~ n ~~ ~Y~ ~ ~ C~ 7 U / 3 1 C~ ~-~-~~ I-~ cave g4: Cie ~e- ~"~>N~ P 3~~ ~ 3 TNc~~~~ ~u~~ ~~ ~~~~,~~- ~~~~ ~~ ~S TOTAL (Also enter on line 2, Recapitulation) I $ ~~ (If more space is needed, insert additional sheets of the same size) - - REV-1500 EX Page 3 Decedent's Complete Address: Fife Number DECED NT'S NAME ~~ ~~L~./~ S C; ~. ~ ~ ~~ R_ _ _ >~1 _ ~ __ STREE~DDRESS , ~ s 8 ~ ~ t~~ ~o%~. S~-R~~- - _ _ __ C'alz~ 15~~ __ __ CITY STATE 'ZIP ~~R ~~sl e ', IAA i ~~o ~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) ?. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3~~.~~~' Total Credits (A + B + C) (2) InterestlPenalt if appplicable D. Interest fl~~~,li~ - 3~~+J~i1 II ~cG~r~~S ~ ~C~dc~~1~2~,C ~~.~~~~~ E. Penalty Total Interest(Penalty (D + E) (3) , ~3 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) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ ~ ~ ~ 3 i Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPR{ATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ Q~ 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, did 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? .............. ^ B 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ~ ^ F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~r 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 for the use of the surviving spouse three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. , fr 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 °_ P.S. §9116 (a) (1.1) (ii)]. The statute does not exemo# a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and ~g a tax return are still applicable even if the surviving spouse is the only beneficiary. 'r dates of death on or after July 1, 2000: e tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an ~ptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. e tax rate imposed an 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 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. tax rate imposed on the net value of transfers #o or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under ~tion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.