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HomeMy WebLinkAbout05-20-11 1505610140 REV-1500 ~` (°'-'°' PA DepeRment of Revenue ~~~~~~ OFFICIAL USE ONLY Bureau of Individual Taxes Po sox zBOSO1 INHERITANCE TAX RETURN County Code Year ~ /\ G _ Fte N O Harrisburg. PA 17128-0601 RESIDENT DECEDENT f CJ I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date Of Binh MMDDYYYY 2 1 1 2 2 6 5 1 3 0 7 0 4 2 0 0 9 0 3 0 9 1 9 3 3 Deoedencs Last Name Suffix Decadence First Name MI Wal t er SR Br uce A (N Applicable) Enter Surviving Spouse's Inforrnatlon Below Spouse's Last Name Suffix Spouse's First Name MI Wal ter Carryl Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^ 1. Original Retum © 2. Supplemental Retum ^ 3. Remainder Retum (date of ~aM prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required death after 12-122) ^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ,_ 8. Total Number of Safe Deposit Boxes (Attach Copy of WIII) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 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 iNFORMATpN SHOULD BE ONi£CTED T0: Name Daytime Telepho Number ^~ Kar 1 E. Ro mi nger 717 ~1 6~7~ First line of address 1 5 5 Sou t Second line of address City or Post O-fice Car l i s l e h Hanover S t r e e e State ZIP Code t. P A 1 7 0 1 3 7 y_ a irk :~ CorresponderR's e-mail address: Urxier penaldea of perjury, I deGars that I have examined this return, induding accanparrying achedulea and statements, and to the beat of my knowledge and belief, H is bue, correct and complete. Declaration of preparer other than the personal representative is based on all infonnatbn of which preparer has arty knowledge. SIGNATyBE,QF PERSON RESPONSIBLE FOR FILING RETURN ~.,~ 155 South Hanover Street Carlisle PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE DATE ADDRESS PLEASE USE ORI(31NAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number De~edenrs Name: Bruce A. Walter Sr 2 1 1 2 2 6 5 1 3 RECAPITULATION 1. Real Estate (Schedub A) .................................... .... ... 1. 1 3 8 0 0 0, 0 0 2. Stacks and Bonds (Schedule B) ............................... .... ... 2. 2 1 4 0. 2 0 3. Ckrsely Held Corporation, Partnership or Sob-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ................... . .... .. 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ..... .. 5. 2 1 2 2 1 6 7 6. Jointy Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vrvos Transfers ig Miscellaneous N,Qp~Probate Property (Schedule G) u Separate Billing Requested ..... .. 7. , 8. Total Groas Assets (total Lines 1 throw h 7 g ) .................... ..... g. .. 1 6 1 3 6 1, 8 7 9. Funeral Expenses and Administrative Costs (Schedule H) ........... ..... .. 9. 1 6 0 1 9. 5 4 10. Detrts of Decadent, Mortgage Liabilities, and Liens (Schedule I) ...... ..... .. 10. 11. Total Deductions (total Lines 9 and 10) ........................ ..... .. 11. 1 6 0 1 9. 5 4 12. Net value of Estate (Line 8 minus Line 11) ..................... ..... .. 12. 1 4 5 3 4 2. 3 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an ebdion to tax has not been made (Schedule J) ............... ..... .. 13. , 14. Net Vslue SubJect to Tax (Line 12 minus Line 13) ................ .... .. 14. 1 4 5 3 4 2. 3 3 TAX CALCULATION -SEE INSTRUCTION3 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.z) x.o _ 1 0 0. 0 0 1s. 0, 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0 0 0 16. 0. 0 0 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 . 17. 0, O Q 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18, Q, Q Q 19. TAX DUE ................................................ .... ..19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 1505610240 R&V-1500 EX Page 3 File Number Decedent's Complete Address: 0 0 DECEDENrs NAatE Bruce A. Walter, Sr --- _ STREET ADDRESS -. _ - - _ CrfY STATE -. -ZIP Tax Payments and Credits: t• Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 0.00 3. Interest (3) 4. If Une 2 is gn~ter than Line 1 +Line 3, enter the difference. This is the trfERPAYMENT. FIN In oval on Page 2, Llne 20 to request a roWnd. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX W E. (5) 0.00 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 inoxrie of the property transferred : ...................................................................:.. ^ Q b. retain the right to designate who shall use the property transferred or its income : .............................. ^ c. retain a reversionary irrterest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death oasirced after December 12,1982, did decedent transfer property within one year of death without receiving adequate cx~nsideration? ....................................................................................... ^ 3. Did decedent own an "intrust for' or payable-upon~eath bank account or security at his a her death? ......... ^ ^X 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 R 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 p2 P.S. §9116 (a) (1.1) (i)J. 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 surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)J. 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 ff the survving 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 the 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 beneficlaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)J. • 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)]. A sibling is defined, under Section 9102, ass an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 Ex+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHEPoTANCETAxRETURN REAL ESTATE RESI~NT DECEDENT OF: Bruce A. Walter Sr 0 0 Aq real property owned solely or as a tenant in common must be roported at fair market value. Fair market value is defined as the price at which properly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Red property tlrat is Jointly-owned whir rIBM of wrvivorship must be dbcloeed on Schedule F. Attach a copy of the sefilement sheet if the property has been sdd. ITEM Include a Dopy of the deed showing decedents interest "If owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 228 Cumberland Drive, Camp Hill, PA-Appraised 2008 138,000.00 TOTAL (Also enter on Line 1, Recapitulation.) H mae space is needed, use additional sheets of paper of the carne size. REV-1503 EX + (6-88) scHEOV~E e CobNAONwEALTH OF PENNSYLVANIA STOCKS ~ BONDS INHERRANCE TAX RETURN RESIDENT DECEDENT OF Bruce A. Walter Sr 0 0 ~ PfeP~Y k~Y'o+wNd with r(gM of wnivaahip moat be dtacbaed on ScMdaN F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sixteen Savings Bonds-Commerce Bank ~ idn ~n TOTAL (Also enter on line 2, Recapitulation) ~ s (IF mae space is needed. inert addiior~al sheet of the same size) REV-1504 EX + (6-86) CON/iAONVYEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE FILE Bruce A. Walter, Sr 0 0 Sd~edule C-1 or C-2 (indudulg all supposing intom~afion) must be attached for each closely-held corporataNparlnership Interest of the deoedeM, ottler then a sole-proprietorship. See instructions for the supporting intortnation to be submiHed for sole-proprieUorships. ITEM I VALUE AT DATE NUMBER DESCRIPTION OF DEATH SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE•PROPRIETORSHIP TOTAL (Also enter on line (If more space b needed, insert additional shaeb of the same size) RtcV•1505 EX + (8-98) COMhAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF Fa.E NUMBER Bruce A. Wafter Sr 0 0 1. Name of Corporation Address City 2. Federal Farrployer I.D. Number 3. Type of Business 4. State of IncorEwration Date of Incorporatlon State Zlp Cade Total Number of Shareholders Business Reporting Year ProducUService w~tdt'If T~ ~ Common Provide all rights and restddions pertaining to each doss of stack. S 5. Was the decedent employed by the Corporation? ....................................... ^ Yes ^ No M Yom, ~~ Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decadent? ............................ . .......... ^ Yes ^ No H yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ............... ^ Yes ^ No tt yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock in this rpmpany within one year prior to death or within two years if the date of death was prig to 12-31-82? ^ Yes ^ No ff yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written sharehddel's agreement in effect at the dme of the decedent's death? ............ ^ Yes ^ No tt yes, provide a copy of the agreement. 10. Was the decedent's stack sold? ................................................. ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissdved or liquidated after the decedent's death? ....................... ^ Yes ^ No If yes, provide a breakdown of distritxdions received by the estate, inducting dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ...................... ^ Yes ^ No If yes, report the necessary information on a separate sheet, inducting a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addresses and estimated fair market values. If real estate appraisals have been secured, attach copies. D. List of prindpal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. Ust those declared and unpaid. G. Any other information relating to the valuation of the decedent's stack. (If more space is needed, kisert additlonal streets of thesamesae) - REV-1508 EX + (9-00) '` SCHEDULE C-Z COMMONVVEIV_TH OF PENNSYLVAN IA PARTNERSHIP INHERITANCE TAX RETURN RESIDENT DECEDENT INFORMATION REPORT ESTATE OF FILE NUMBER Bruce A. Walter Sr 0 0 1. Name of Partnership Date Business Commenced Address Business Reporting Year Crty State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Produd/Servioe 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. ~ ~ GP. CAPftIU.Jl4~' A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indetXed to the decedent? ................................ ^ Yes ^ No ff yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ........ ^ Yes ^ No ff yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did lire decedent sell or transfer an interest in this partnership within one year prior to death or within two years 'rf the date of death was prior to 121-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Perc~tage transferredlsold Transferee or Purchaser Considerafion $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death?........ ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .................................. ^ Yes ^ No ff yes, provide a copy of the agreemarlt of sale, etc. 12. Was the partnership dissdved or liquidated after the decedent's death? ................. ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ................................ ^ Yes ^ No ff Yes, explain __ 14. Did the paMership have an interest in other corporations or partnerships? ................. ^ Yes ^ No If yes, report the necessary information on a separate sheet, inducting a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedents partnership interest. 8. Complete copies of finandal statements or Federal Partnership Income Tax returns (Forth 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a fist showing the complete addresses and estimated fair market values. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX + (8-98) SCHEDULE D CoidMONWEALTH OF PENNSYLVANIA MORTGAGES ~ NOTES INHERRANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT c~ r n ~ c ~ FILE NUMBER Bruce A. Walter Sr 0 0 Ali property johdly-0wned wkh the right of survivorship must De discbssd on Schedub F. ITEM I VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also errter on line (fl more space Lv needed, insert additional sheets ~ the same size) REV-1508 EX + (8-88) COAMAONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN OF SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY NUMBER Bruce A. Walter Sr 0 0 Include the prooaeds of Ifigatlon and the date the prods were recehred hY the estate. All properly jo wNh right of survkorslrip must be dkcbsed on Schaduk F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH t. M&T Bank Account 9834711930 1 221 67 2. State Farm Life Insurance-LF-0216-7442 20,000.00 TOTAL (Also meter on line 5, Rec~itulation) (If mae space's needed. irsert additional stte~s of the same size) REV-1509 EX+(01-10) Pennsylvania DEPARTMENT Of REVENUE INHERITANCE TAX RETURN RESIDENT DECENT SCHEDULE IF JOINTLY-OWNED PROPERTY Bruce A. Walter. Sr 0 0 M an asset was made johdly owned within one year o1 the decedent's date of death, k must be reported on &heduk G. SURVNING JOINT TENANT(S) NAME(S) ADDRESS TO DECEDENT A. B. C. JONTLY-0tiIINED t~R0PER1'Y: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL tNSTITIRiON AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENTS INTERESI 1. A. TOTAL (Also enter on Line 6, Recapitulation) I S ff rtaie space is needed, use adtNtional Sheet of paper of the same size. REV-1510 EX+ (08-09) Pennsylvania DEPARTAENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE Bruce A. Walter, Sr 0 0 This schedule must ba completed and filed N the answer to any of questions 1 through 4 on page three of the REV•1500 is yes, ITEM NUNBER DESCRIPTION OF PROPERTY NlCLUOE TFE NN,E OF THE TRANSFERff,THF]R RELITI0~WPT00EC®ENr M10 ofDn~EOFrnva~ER.~rr~cn~ccPyoFn~o®FORREUESr~TE. DATE~DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION nFwarucN~ TAXABLE VALUE 1. TOTAL (Also enter on Line 7 Recapitulation) ~ : H mae space is needed, use addpanel sheets of paper of pie same sue. REV-7511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS es rwr t ur FILE NUMBER Bruce A. Walter, Sr 0 0 DecedenPs debts moat M reported on SeMduN L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Hone 6065.00 Advertising-The Evening Sentinel X187 54 Cumberland Law Journal 75.00 Internment Services-Rolling Green Cemetary 1,345.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Represerdalive(s) Street Address City Year(s) Commissiar Paid: State ZIP 2. Attorney Fees: Karl E. Rominger 8,000.00 3. Famiy Exemption: (If decederrYs address a not the sarrre as daimanrs, atladr explanation.) Claimant Street Address City Stage ZIP Re~tionship of Claimant to Decadent a• Probate Fees: Cumberland County Register of Wills 347.00. 5 Accountant Fees: 6. ~ Tax Realm Preparer Fees: 7 TOTAL (Also enter on Line 9, Recapitulation) ~ i ti more space is needed, use addsbnel sheep of paper of the same sae. REV-1512 EX+ (12-0e) Pennsylvania DEPARTMENT OF REVENUE INHERITAN(2=TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS F~ENUMBER Bruce A. Walter, Sr 0 0 Repoli debts incurred by the decedent prior tb dearth that remained unpaid at the date of dearth, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on Line 10, Recapitulation) I f ff more speoe is naerled, imeR aaal~anal sheets of the same slae. REV-1513 EX* (01-10) Pennsylvania SCHEDULE J DEPARTMENT or REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT co~n~~ vr: FILE NUMBER: Bruce A. Walter Sr n RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Uat Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS prelude ouhipM I dbfibudais and transfers urMer Sec. 91 f6 (a (1.2).] 1. Carry) Walter Spousal 100.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. t .. ~~wwc ~ai,c ~a i~w~, ux awmuu~ WIeE,'l3 W PaPar Q IIIB S8Ir12 SIZe. • REV-1514 Ex+ (409) Pennsylvania DEPARTMENT OF REVENUE Eluraar d Indmdual races Po emc 280601 HarAsburp PA 17128.0601 SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-1500 COVER SHE Bruce A. Walter, Sr _ 0 0 This schedule should be used for all single-life, joint or successive life estate and tens-certain calculations. For dates of death prior to 5-1-89, actuarial fedora for single-life calculations can be obtained from the Department of Revenue. Actuarial fedora can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 430-99, and in Alphh Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other slwfll~t~tal4~ , ^ Life or ^ Term of Years ^ Life or ^Tenn of Years ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Tenn of Years t. Value of fund from which life estate is payable ......................................... $ 2. Actuartalfactorperappropriatetable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Interest table rate - ^ 3.5°~ ^ 8°~ ^ 10% ^ Variable Rate 3. Value of Ilfe estate (Line 1 multiplied by Line 2) . . . . . . . . ..............................; III~f9F1:11~~'Ait"f DA~GFIil~it ~~'_ .,,, .. ;' ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Tenn of Years t. Value of fund from which annuity is payable , , , , , , , , , , , , , , , , , , ,,, , , , , , , $ 2. Check appropriate bkrck below and enter corresponding number , , , , , , , , , , , , , , , , , , , , , ,, , Frequency of payout - ^ Weekly (52) ^ Bi-weekly (2B) ^ Monthly (12) ^ Quarterly (4) ^ Semiannually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ......................................................i 4. Aggregate annual payment, Line 2 muRipiied by. Line 3 , ,, , , , , , , , , , , , , , , , , , , , , ,,,, , 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 8% ^ 10% ^ Variable Rate % 6. Adjustment Factor (See instructions) . . ............................................. . 7. Value of annuity - If using 3.5%, 8°k, 10°r6, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 8 ...........................; If using variable rete and period payout is at beginning of period, calculation is (Line 4 x Line S x Line B) + Llne 3 ................................................. s NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax rotum. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. B roars speoe a needed, u9e addNlOnal SheeLS of the same sine. 'REV-1844 EX+ (01-10) L Pennsylvania DEPARiLENr OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L REMAINDER PREPAYMENT OR INVASION OF TRUST CORPUS Iter, Bruce A., Sr 0 0 - - This schedule is appropriate onty for estates of decedents dying on or before December 12, 1882. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1861 or to report the invasion of trust corpus (prindpan. II. REMAINDER PREPAYMENT: A. Eledion to Prepay Filed with the Register of Wills on B. Name(s) of Life Tenant(s) or Annuitant(s) (Date) Date of Birth Age on date Term of Years Income of Eledion or Annuity is Payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. $ _ -_ 2. Stocks and Bonds ......................... $ -- 3. Closely Held Stock/Partnership ............... $ -- 4. Mortgages and Notes ....................... $ 5. Cash/Misc. Personal Property ................ $ -- 8. Totalfrom Schedule L-1 ....................................................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................... $ 2. Unpaid Bequests ..........................$ -- 3. Value of Non Indudable Assets ............... $ 4. Total from Schedule L-2 ........................................... .......$ E. Total Value of Trust Assets (Line C-6 minus Line D-4) ............................... $ F. RemainderFador ........................................................... .. G. Taxable Remainder Value (Multiply Line E by Line F) .............................. $ _ (Also enter on Line 7, Recapitulation) III. I INVASION OF CORPUS: A. Invasion of Comus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Tenn of Years Income or Annuitant(s) Corpus or Annuity is Payable Consumed C. Corpus Consumed ..................................................... ...$ - D. Remainder Factor ........................................................... _ E• Taxable Value of Corpus Consumed (Multiply Line C by Line D) ........................ $ _ (Also enter on Line 7, Recapitulation) REV-1845 EX+ (~ 1-09) pennsylvania INHERITANCE TAX ' SCHEDULE L-1 oEPAR il1ENT OF REVENUE INHERRANCETAXRETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- L ESTATE OF FILE NUMBER Walter, Bruce A., Sr 0 0 II. ITEM NO. DESCRIPTION VALUE A. Real Estate (Please describe.) Total Value of Real Estate $ Indude on Section II, Line C-1 on Sdiedule L.) B. Stocks and Bonds (Please fist.) Total Value of Stocks and Bonds $ Indude on Section II, Line C-2 on Schedule L. C. Closely Held Stock/Partnership -Please list. (Attach Schedule C-1 and/or C-2.) Total Value of Cbsety HeId/Partnership $ (Include on Section II, Line C-3 on Schedule L.) D. Mortgages and Notes (Please list.) Total Value of Mortgages and Notes $ Include on Sedion 11, Line C-4 on Schedule L. E. Cash and Miscellaneous Personal Property (Please list.) Total Value of Cash/Miscellaneous Personal Property $ Indude on Section II Line C-5 on Schedule L. IIL TOTAL (Also enter on Section 11, Line C-6 on Schedule L J g If more space is needed, attach additional sheets of paper of the same size. REV-1848 EX+ (~ 1-09) Pennsylvania INHERITANCE TAX DEPARTIYENr or REVENUE SCHEDULE L-2 1NHERfTANCETAXRETURN RESIDENT DECEDENT REMAINDER PREPAYMENT ELECTION -CREDITS- I. ESTATE OF FILE NUMBER Walter, Bruce A., Sr 0 0 II. ITEM NO. DESCRIPTION AMOUNT A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Liabilities $ (inducts on Section 11, Line D-1 on Schedule L B. Unpaid Bequests Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Bequests $ (inducts on Section II, Line D-2 on Schedule L C. Vatue of Assets Reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are Not Inducted for Tax Purposes or that Do Not Form a Part of the Trust. Calculation as follows: Total Non Includable Assets $ inducts on Section II, Llne D-3 on Schedule L III. TOTAL {Also enter on Section II, Line D-4 on Schedule L) ~ If more space is needed, attach additional sheets of paper of the same size. REV-1647 EX+ (02-10) This schedule is appropriate only for estates of decedents who died after Dec. 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that seated the future interest and attach a copy to the tax return. ^ Will ~ Trust ^ Other i. Beneficiaries III. IV. Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on REV-1500) I NAME OF BENEFICIARY I RELATIONSHIP ~ DATE OF BIRTH ~ „~ ~„ AGE TO ^ _ I s wt rawa ng . ^ Unlimited right of withdrawal 1. 2. 3. 4. 5. II. For decedents who died on or after July 1, 1994, if a surviving spouse exerdsed or intends to exerdse a right of withdrawal within nine months of the decedent's death, check the appropriate block and attatth a copy of the document in which the surviving spouse exercises uch 'thd I ' ht of Compromise Summary l~~~f lfl 1. Amount of future interest ............................ ...................... $ 2. Value of Line 1 exempt from tax as amount passing to ttharities, etc. (Also include as part of total shown on Line 13 of REV-1500.) ..... . $ 3. Value of Line 1 passing to spouse at appropriate tax rate (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one. ~ 6°k, ~ 4.5% ..................... . $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate (12%) (Also include as part of total shown on Line 17 of REV-1500.) ..... . $ 6. Value of Line 1 taxable at collateral rate (15°~) (Also include as part of total shown on Line 18 of REV-1500.) ..... . $ 7. Total value of future interest (sum of Lines 2 thru 6 must equal Line 1) ..................... $ ^ Limited right of withdrawal If moro apace is needed, use additional sheets of paper of the same size. ItEV-1648 EX (02-09) Pennsylvania ~~~~~uE Bureau a Individual Taxes Po Boa 290601 ESTATE OF schedule must be complMed and filed if you checked the 1. Taxable assets total from Line 8 (cover sheet) ............................ 2. Insurance proceeds on life of decedent ....................................... 3. Retirement benefits ...................................................................... 4. Joint assets with spouse .............................................................. 5. PA Lottery winnings ..................................................................... 6a. Other nontaxable assets: List and attach schedule 'lf necessary .. 6. SUBTOTAL (Lines 6a, b, c, d) 7. Total gross assets (Add Lines 1 thru 6) .................. 8. Total actual liabilities .............................................. 9. Net value of estate (Subtract Line 8 from Line 7) .... ff L.IIM 9 B dBelM HYi/ 5200 000 - STinO Ths nNn}a !c n Income: a. Spouse ............................ b. Dekxident ......................... c. Joint ................................. d. Tax-exempt Inkxxne ......... e. Other income not listed above ..................... 4. Average joint exemption income calculation 4a. Add joint exemption income from above: (1f) + (~ _ + (3f) _ (+3) 4b. Average joint exemption income ............................................................................................................... rune .r/bf Is yreabr tlien i~0.000 - 8TOP. The eahte !s not s/gibre ro cla4e Ure crea[tt Hnot contlnue r0 PBIY77l. ° 1. Insert amount of taxable transfers to spouse or x100,000, whichever is less .......................................... 1 2. Mukiply by credk percentage (see instructions) ....................................................................................... 2. 3. This is the amount of the Resident Spousal Poverty Credk. Include this figure in the calculation of total credks on Line 18 of the cover sheet ................................................................ 3. 4. For nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate .......................................................................................................................... 4. 5. Mukiply Line 3 by Line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credk. Include this figure in the calarlation of 6ofal kxedits on Line 18 of the cover sheet 5• SCHEDULE N SPOUSAL POVERTY CREDIT FOR DATES OF DEATH 01/01192 TO 1?131f94 ro claim I 0 0 crodk box on the cover sheet. s a. 6 b. 6 c. 6 d. 7. 161 361.87 .................................................... 8. .................................................... s. 161,361.87 Ae credk. r/n~ continue to Part I!. !. TAX YEAR: 19 3. TAX YEAR: 19 A• 3a. ~b' ~- 'c• 3c. 'd• 3d. 'e~ 3e. f. 3f. REV-1849 EX + (g.98) COheiAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) `°' ^' ` "~ FILE NUMBER Bruce A. Walter Sr 0 0 Do not cwnplete thle schedule unless the estate le making the election to tax assets under Section 9113(A) of the Inherttanrxt 8 Estate Tax Ad. If the election applies to more than one trust «similar arrangement, a separate form must be filed for each trust. This election atx>lies to the Trust (marital residual A B By-Hass Unified Credit etc ) ff a trust «slmrlar anangernent meets the regwrements of Section 9113(A), and: a. The trust «similar arrangement is listed on Schedule 0, and The value of the wst or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may sptxific~ly iden6(y the trust (all «a fractional portion «pereentage) to be inducted in the election ~ have such Wet «sirrF filar property t-eated as a taxable Uansfer in this estate. H less than the entire value of the trust «similar property is inducted as a taxable irarlsfer an Schedule 0, the personal representative shall fx' considered to have made the election only as to a fraction of the trust «similar arrangement. The numerator of this fraction is equal to the amount of the trust «similar arrangement included as a taxable asset on Schedule 0. The denominat« is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedents surviving spouse under a Section 9113 (A) trust or similar arrangement. Description -- Value Part A Total $ Part B: Enter the descri lion and value of all interests included in Part A for which the Section 91 13 A election to tax is bein made. Description Value Part B total (H mae space is needed, insert additional sheets of the same size ) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: Discount: 0.00 Interest Table Year Days Delinquent this time period Balance Due this year interest this period Before 1981 1982 __ 1983 _-- _ _____ 1984 _ _ 1885._- _- 1986 - -_ 1987 -- 1988 through 188_1__ -_ - -- -- 1992 - _ .__.-- 1983 through 1994 1995 thro h 1998 1999 - _ - -- - --- _ _- - 2001 -- 2002 _ _ __ - 2003 _ _ ____ 2004 ---- - -~ 2005 2008 2007 - --- _ 2008 - _ --- -- 2009 -- ___ __ 2010 ___ 2011 --_ i _ _ TOTALS _. --- Penalty Calculation If the decedents date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: