HomeMy WebLinkAbout04-0746 COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIJ~DLE ~NITIAL)
DATE OF DEATH (MM-DD-YEAR)
DATE Of BIRTH (MM-DD-YEAR)
OFFICIAL USE ONLY
FILE NUMBER
COUNTY COOE YEAR NUMaER
SOCIAL SECURITY NUMBER
-
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NU~BF~
z
4. Limited Estate
r~6. Decedent Died Testate (At,ch ~py of Will)
[~9. Litigation Proceeds Received
E~]2. Supplemental Return
E~4a. Future Interest Compromise (date of death after 12-12-~2)
[~7. Decedent Maintained a Living Trust (A~ch ~opy or Tr~st)
E~5. Federat Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
~'-] 11. Election to tax under Sec. 9113(A) (^~c~
IFIRM NAME {IfAp~able)
TELJ~PHO~E NU~4BER
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Propdetarship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposita & Miscellaneous Personal Propor~ (5)
(Sch~ule E)
6. Jointly Owned Property (Schedule F) {6)
[~] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) (10)
lt. Total Deductions (tatal Lines 9 & 10)
12. Net Value of Estate {Line 8 minus Line lt)
13.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Scbedu}e J) .
14. Net Value Subject to Tax (Line 12 minus Line 13)
(11)
(12)
(13)
(14)
OFFICIAL USE ONLY
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(12) x .0
16. Amount of Line 14 taxable at lineal rate x .0
(18)
(16)
17. Amount of Line 14 taxable at sibling rata x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18}
19. Tax Due (19)
Decedent's Complete Address:
ISTREETADDRESS ~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Cmdita/Paymenta
A. Spousal Poverty Credit
B, Prior Payments
C, Discount
Total Credits ( A + B + C )
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E )
4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund
5, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE,
A. Enter the interest on the tax due.
(1)
(2)
(3)
(4)
(5)
(5A)
B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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 premise 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? .............. []
4. Did decedent own an Individual Retirement Ascount, annuity, or other non-prebate 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.
U~der penalties of paf~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my Imowledge and belief, it is tie, correct and complete,
Declaration of preparer other than the personal represe~tstive is based on all information of which preparer has any knowledge.
SIGNAT~J~E OF PERSON RESPON~ FO~G R~U~R~_~
~-DDRESS ..-, , / ~ - ~
SIGNATURE OF ~REPAR~R ~R~H~N REPRESENTATIVE
DATE
DATE
ADDRESS
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 for the use of the surviving spouse is 3%
[72 P.S. §9116 la) (1,1) (i)].
For dates of death on or after January 1, 1995, the tax rste imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 la) (1,1) (ii)
The statute does not exemat a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return ars still applicable even
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 Eom a deceased child twenty-one years of age or younger at death to or for the use of a natural parsnt, an adoptive paren
or a stepparent of the child is 0% [72 ES. §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%, except as noted in 72 RS. §9116(12) [72 RS. §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% [72 P.S. §9116(a)(1,3)]. A sibling is defined, under Section 9102, as al
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER OF DEATH
1.
DESCRIPTION
TOTAL (Also enter on line 2, Recapitulation) $ ~,~'"~__~, ~
(If more space is needed, insert additional sheets of the same size)
COMMOt,~NEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONALPROPERTY
'FILE NUMBER
Include the proceeds of I~galJon and the date the proceeds were received by the ~tete. All proper~ jointly-~wned vath the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
Of DEATH
TOTAL {Also enter on line 5, Recapitulation) i $ ~ 9~- ~
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00}
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List True~e(e) OF ESTATE
!
1.
1.
TAXABLE DISTRIBUTIONS [include outright spousal distribLstions, and transfers under
Sec. 9116 (~[) (1.2)]
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART [! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additionel sheets of the same size)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DTVXSION
DEPT. Z80601
HARRTSBURG, PA 171Z8-0601
SANDRA S BALAT
$$$ W RIDGE ST
CARLISLE
COHMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1S47 EX AFP (01-03)
'04 L]gl' t 3
PA 17015
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
r6COUNTY
10-11-ZOOq
BALAT
06-Zq-200~
21 0~-07q6
CUMBERLAND
101
Amount RBei t'l:ed
ARTHUR M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THZS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS
REV-15q7 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BALAT ARTHUR MFZLE NO. 21 0q-07~6 ACN 101 DATE 10-11-200~
TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
~. Nortgages/Notes Rece/vable (Schedule D) (~),
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. JoAntly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Exponses/Adm. Cos~s/Hisc. Expenses (Schedule H) (9)
10. Debts/Mortgage LiebilAtles/LAens (Schedule I) (10)
11. Total DeductAons
12. Nat Value of Tax Re*urn
15.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Nat Value of Estate Subject to Tax
.00
$56.00
.00
.00
~$~9q9.25
.00
.00
(8)
.00
.0O
NOTE: To insure proper
credit to your account,
submit the upper portAon
of this form with your
tax payment.
NOTE:
reflect figures that include the ~otal of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Amount of LAne 1~ at Spouse1 rata
16. Amount of Line lq taxable at Lineal/Class A rata
17. Amount of LAne lfi at SAbling rate
18. Amount of L/ne 1~ taxable at Collateral/Class B rata
19. PrAnci}al Tax Due
TAX CREDITS
PAYMENT RECE/PT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-)
(15) qq,$O5.Z5 x O0 : .00
(16) .00 x Oq5 = .00
(17) .00 x 12 : .00
(18) .00 x 15 : .00
(19)= . O0
AMOUNT PAID
IF PAID AFTER DATE INDICATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
.O0
.00
.00
.00
( IF TOTAL DUE XS LESS THAN $1, NO PAYMENT IS RE;)UIRED.
If an assessment was issued prev/ously, lines 14, 15 and/or 16, 17, 18 and 19 wlll
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE t[,~ .
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(11) . tiff
(12) qq,305.25
(x$) . O0
(1~) qq,$05.25
qq,$05.25
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or bafora December 11, 1981 -- if any futura intarest in the estate is transfarrad
in possession or anjoyaent to Class S (collateral) baneficiaries of the decedent after the expiration of any estate for
life or for years, the Coaaoneealth hereby axpressly reserves the right to appraise and assess transfer Inheritance Taxes
at tha laaful Class B (collateral) rate on any such futura interest.
To fulfill tha requirements of Section 2140 of tha Inheritanca and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
Detach tha top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF #ILLS, AGENT
A rafund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritanca and Estate Tax" (REV-13I$). Applications are availabla at the Office
of the Register of Mills, any of tha 23 Revenue District Offices, or by calling the special Z4-hour
ansaerJng service for forms ordering: 1-800-36Z-ZO50; services for taxpayers aith special haaring and / or
speaking needs: 1-800-447-3010 (TT only).
Any party in intarast not satisfied aith the appraisement, alloaance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notica must object within sixty (60) days of receipt of
this Notice by:
--written protest to fha PA Dapartdnent of Revanua, Board of Appeals, Dept. ZDIOZ1, Harrisburg, PA 171Z8-1011, OR
--election to have the matter determined at audit of the account of tha personal representativa, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Raviaw Unit, Dept. Z80601, Harrisburg, PA 1711D-0601
Phone (717) 787-6505. Sam page 5 of fha booklat "Instructions for Inheritanca Tax Return for a Rasident
Decedent" (REV-1501) for an axplanation of administratively correctable errors.
If any tax dua is paid within three (3) calendar months after tha decadent's death, a riva percent (51) discount of
the tax paid is allowed.
Tha 15Z tax amnesty non-participation penalty is computed on tha total of the tax and interest assessed, and not
paid before January 18, 1996, tha first day after the and of tha tax amnesty pariod. This non-participation
panalty is appaalabla in fha same manner and in tha the same tiaa period as you would appaal tha tax and interast
that has been assessed as indicated an this notica.
Interest is charged beginning eith first day of dalinquancy, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (61) percent par annum calculated at a daily rate of .000164. All taxes which became dalinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. Tha applicabla interest rates for 1981 through Z004 are:
Interest Daily Interast Daily
Year Rate Factor Year Rate Factor
~ 207. .OO05q8 1988-1991 117. .000301
1983 Z6Z .000438 1992 91 .000147
1964 llZ .O0030X 1993-1994 71 .O00lgz
1985 137. .0003S6 1995-1998 9Z .000247
1986 lOZ .000274 1999 72 .000192
1987 101 .O00Z7q Z000 71 .O00Zgz
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
2001 91 .000Z47
ZOOZ 6Z .D00164
2003 51 .000137
2004 41 .000110
X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notica issued after the tax becomes dalinquant will raflect an interest calculation to fiftaan [15) days
beyond tha date of tha assassmant. If payment is made after the intarast computation date shown on tha
Notice, additional interest must be calculated.