The URL can be used to link to this page

Home My WebLink About03-31-111505610101 REV-1500 Ex ~°i_1°' enns lvania OFFICIAL USE ONLY' _ PA Department of Revenue P Y County Code Year a File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOX 28o6oi INHERITANCE TAX RETURN ,, Harrisburg, PA 1128-0601 RESIDENT DECEDENT ~ ~ ~ ~~ ~~ 1~ ~5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ,~ ~ ~ ~,~ ~~~ 7 D! ~ ~~.o ~ ~ O~~ ~L~~S Decedent's Last Name Suffix Decedent's First Name MI ~ ~ ~ 1" ~ ~ ~ I~1fj ~' ~ C n~ i~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix 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 p 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-1~'~-82) O 5. Federal Estal:e lax 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 First line of address Second line of address City or Post Office State ZIP Code REGISTER 01= hN'ILLS USE CrNLY ~'? - . .---~ ,_~ t-7 . _ ._. ~. ;~~ ,~ . ., .~ ^,y, fT2 ~~~ ~ _5 _`~ -~: ~ ,. ~ C~ ?~.:~=~~ ,~ i ..._. _~. `~SA;~ FILED -- ...~'~ -. Y., ,; 1' i i... ~: _'~.-.~ x-i - ~'' Correspondent's a-mail address: h,c L ~~ ~O ~ L C~ lX~ ~ ~ • (~U ~ 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. SIGNATU~ PERSON RE ON LE FOR FILING RETURN ~ ~ r ~~ qAT~ ADDRESS ~ ~ . ~ ~~ , _ ~~ ~o /~ SIGNATURE OF PREPARER OT R THAN RE RESENTATIVE DATE ADDRESS _~..~u._-.. _..~_ ...~~~ ...__._...,~..~._~_ PLEASE USE ORIGINAL FORM ONLY 1505610101 Side 1 150561010]' J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~` ! p~ ___ RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. ~"• 2. Stocks and Bonds (Schedule B) ....................................... 2. -~'• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ~". 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ~• 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ ~ V ~ ~ ~ • ~'~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ~. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property h l S d G S t Billi R t d 7 ~ ( c e u e ) p epara e ng eques ........ e . , 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~ ~ ~ ~~ ~ ~ • -~'° 9. Funeral Expenses and Administrative Costs (Schedule H) .......... ......... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ..... ......... 10. ~ ~ (' ~ . ---- 11. Total Deductions (total Lines 9 and 10) ........................ ......... 11. l ~ ! ~S, -rte' 12. Net Value of Estate (Line 8 minus Line 11) ..................... ......... 12. ~ ~ 0 ~~ 7 ~ ~~ 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. ~~ Q~ ~ ~. ~-~' TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES w 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ . 15. . 16. Amount of Line 14 taxable at lineal rate X .0 _ • 16. 17. Amount of Line 14 taxable at sibling rate X .12 . 17. s 18. Amount of Line 14 taxable at collateral rate X .15 p~, ~ Q5 ~" 7 • ~ 18. n ~Q 5 Z • fJ 5 19. TAX DUE ...... ......................................... .........19. ~Q ~~~'~~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 15056],010 ~i REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME ~.~ ~ STREET ADDRES ___ ~ . d __ Ccr/r~ STATE ~ 1_I P 7O` Tax Payments and Credits: .y~~ ~~ 1. Tax Due (Page 2, Line 19) (1) ,f' D j~2 ~ - / -`~U 2. Credits/Payments A. Prior Payments _.__ ___~ ___ B. Discount ~ Q a2~ ,~ `0 Total Credits (A + B) (2) ~ ~~-- 3. Interest (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) ~~~ ~~p~ , 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 :.......................................................................................... ^ [v^' 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 Dec. 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? .............. ^ [~ 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 the :~urriving spouse is 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 i~or 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 21 years of age or younger at death to or for tree use of a natural parent, an 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 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 12 percent [72 P.S. §9116(a)(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-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER a~ ~ oo.~~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH . f vver 3 '~3 7 ~o~ ~~~~~ ,~35 ~ ~~ ~~~~ f ~ ~~~ bn ~ ~~ ~~~~f ~~~~ ~~ . f ~ `~ oc~ ~- ~~ ~~ l ~ ~~~~ r TOTAL (Also enter on line 5, Recapitulation) g• O U?- (If more space is needed, insert additional sheets of the same size) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF .~ FILE NUMBER ~ L Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT p FU~aFfn¢~.- /~Fk CCrerra,E~+: x oB~f Err~~ ~?0(n! G~e¢~ /~Z~mo~~~ Cfau~6~FJ~J l75 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City ____ State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant __ _ _ __ _. Street Address City ____ __ State Zi P ______ Relationship of Claimant to Decedent 4. Probate Fees //~~~~~ "v `~ 5. Accountant's Fees G 6. Tax Return Preparer's Fees 7. 3!~ - TOTAL (Also enter on line 9, Recapitulation) E $ ~~~a (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 ESTATE OF ~ ~ILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, includina unreimbursed medical aYnansps ~~ ~ i nvi c aNacC IS I ieeueU, If1S8f[ a001ilOnal SneetS 01 the Same SIZe~ REV-1513 EX+ (9-00) ' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ fv ~ II,, ~ ~~'7~~ ~ FILE NUMBER / _ ~~~ o°~ ~~ ~D~~ 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)] ~~ D ~ /~~d ~~ ~~ ,,,oo ~~. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON RE'V-1;500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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, MARVIN WILLIAM LETTICH, of the County of Cumberland, Borough of C;a~-lisle, PA, do hereby (a) make, publish and declare this to be my Last Will and Testament and (b) revoke all Wills and Codicils heretofore made by me. ` FIRST: I request that all my debts and my funeral and administration expenses be paid as promptly as shall be practicable. SECOND: I give all of the rest of the property of which I may dispose of'by my Will (my "Residuary Estate") as follows: A. If my nephew Dennis Lettich shall survive me, I give my 'EZesidual Estate to Dennis. THIRD: A. I appoint as my Executor, my nephew, Dennis L. Lettich. B. No bond shall be required of my Executor. FOURTH: In administration of my estate, my Executor shall have all of the powers to acquire, hold and/or dispose of property, and all of the powers necessary or convenient for exercise thereof, which I may give my Executor or which I could exercise if I w~erc~ living and owned such property. 1 i IN WITNESS WHEREOF, I have hereto set my hand and seal this ~~~day of ~~ ~,j~, 2010. ~ --, 1, The foregoing consisting of two pages, was signed, sealed, published and declared by the above named Testator as and for his Last Will and Testament in our presence and'. hearing and thereupon, at his request, in his presence and in the presence of each other, subsribed our names as witnesses this ~~ay of ~4~ f , 2010. u ~ residing at ~J.~~N, -~~~> >~c ~`5.~~~Z L.. ~ ~ •~ J ~ ~ ._ , i1 ~ ~ ~ ~ _1 residing at f . ' ~ :'; r I j~ ~ i` ' '_~ _~ Severally sworn to before me Thisl9~ay of ~dk~, 2010. /`-y _~ Notary Public COMMOryyyEALTH OF PENPISYLVANIA NOTARIAL SEAL BRENDA TRtPP, Notary Public Silver Spring Twp•, Cumberland County My Commission Expires October 31, 2012 2