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HomeMy WebLinkAbout05-18-11 (2)1505610105 -'J REV-1500 °` `°Z-11' `F>, ~ oFFIC1AL USE ONLY PA Department of Revenue ~~ County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ 1 ~ ~1 ~ ~~ Cy Po Box 28o6oi RESIDENT DECEDENT Lam" ~ Harrisbu PA i 128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Suffix Decedent's First Name MI Decedent's Last Name ~PP~~'~~~ /rJAer~~- :t (If Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 3. Remainder Retum (Date of Death 1. Original Return O 2. Supplemental Retum O Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 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. Utigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11 ~ Attach Schedule O)r Sec. 9113(A) Between 12-31-91 and 1-1-95) ( CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX DayOtRme Telesphone Nu bleECTED T0: Names First Line of Address 66 7 /)'1 ~sS ~,~ s/~ ~ Tif Second Line of Address City or Post Office C'dC ~.fP vi/~E? 2d State P,~ ZIP Code ~... ~.55.3~' -~, ,, Correspondent's e-mail address: Under penaRies of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, ~+ ~~ rn.w correct and complete. pedaretion of prepares other than the personal representative is based on all information of which prepares has any knowledge. FQR FILING 66~ //p~55~'y~/T~r r~+ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE /6 /I DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 ~„~ REV-i5o9 EX+ (oi-io) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDI~LE F 70INTLY-OWNED PROPERTY FILE NUMBER: ESTATE OF: y~ APP ~~6 /~~ ~~T~~ ~~ on Schedule G If an asset became jointly owned wrthm one year of the decede~rt's date of d~th, d must be reported ADDRESS RELATIONSHIP TO DECEDENT SURVNING JOINT TENANT(S) NAME(S) C'~~~v~l~e~ ~~} B. C. ]OINTLY OWNED PROPERTY: TER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT MADE INCLUDE NAME OF FINANCL4L INSTTn1TION AND BANK ACCWNi NUMBER OR SIMILAR _ .ncnrrrrnnv: Ni ttARFR. ATTACK DEED FOR X)INTLY HELD REAL ESTATE. Act ~vev;,_ ~ S f -ifo0 ~ ~-'~,~~ 3 y{, pF DATE OF DEATH DATE OF DEATH DECIDENTS VALUE OF VALUE OF ASSET INTEREST DECEDENT'S INTEREST 65j~~q,~~ Sod 3r2~G°`~tl ~~ 0 TOTAL (Also enter on Line 6, Recapitulation) $ 3.~,~~~ ~S/ If more space is needed, use additional sheets of paper of the same size. J REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: /Yl,~~ / ~/ '" rG ~~/N~ ~~ ~~ - 1 b - ~ 3 g ~ 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. 6. Schedule F O Separate Billin Requested ....... Jointly Owned Property ( ) g 6. 3 ~ ~ O ~f . ~ G T l 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property O Separate Billing Requested........ 7. (Schedule G) 8. ................. Total Gross Assets (total Lines 1 through 7) ........ 8. ~j~ ~j O T . o 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. 12. .............................. Net Value of Estate (Line 8 minus Line 11) 12. 3a~ (Q ~ , 0 13 . Charitable and Govemm$ntat Bequests/Sec 9113 Trusts for which t been made (Schedule J) ...... . 13 an election to tax has no ............. 14. ~~ (045 , ~ 1 14. Net Value Subject to Tax (Line 12 minus Line 13) .......... . TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .0._. 16. Amount of Line 14 taxable / ~ 16. l ~ ~ 7 i ,~. Z_ at lineal rate X .0 -~! ~~J t~ ©~ s 17. Amount of Line 14 taxable 17 at sibling rate X .12 18. Amount of Line 14 taxable 18 at collateral rate X .15 19. TAX DUE ........... l.T..~ 1.°. ~~- .............................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610205 1505610205 Side 2 1505610205 O J REV-1500 Ei?C (FI) Pa9e 3 Decedent's Complete Address: Th'-r4- .~'. STREET ADDRESS / / CITY ~ It m V" -L'-_` Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest File Number /~cJ ,~ C-' ~v,~C !f ~O~ ZIP 1 ~ ~ ~ / (1) 1~6 7.22- Total Credits (A + B) (2) CD (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Fill in oval on Page 2, 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. Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRsATE BLOCKS 1. Did decedent make a transfer and: transferred .......................................................................................... ^ a. retain the use or income of the property b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c. retain a reversionary interest ............................ [~ d. receive the promise for life of either payments, benefits or care? ••wdhm one ear of death 2. If death occurred after Dec. 12, 1982, did decedent transfer property .................. Y................................................. ^ without receiving adequate consideration? ..... 3. Did decedent own an "intrust for" or payable-upon-death bank account or secunty 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,thetax 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 t a transfe to a survey ng spo se from taxe and the statutory requ cements for disclosure of asse~tsrcendt [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exep 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 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 beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)j. • The tax rate imposed on the net value of transfers st oneorahent in common with the decledent hethercbytblTood or adoptio(n)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at lea p FlRST-CLASS FOREVER 5f' ,. ~ _ <} f~y ~» ~. tia Y1Y '~iid yY'_ 1~jve N' ny ~~ }V'}i~} rye }~ •. .< _~{, ~- ~: w; sa::. ~. ~! ;~~ ~1 ~~ m~~ n~i¢" W ~ Yby- L~~ n ~IDU 1 ~ ° , ~ ~ ` I ` ~ ^ I ~ ~ ~ \ 3 ,~ ~ ~~ ~ j ~ E ~ `0 \1 0 ~ a° `~ ~ ~~.~ ~ ,~ , ;:, .~.. }~:~ .~.., ~:~~ ,.... 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