Loading...
HomeMy WebLinkAbout06-24-11 (3)J 1505610101 REV-1500 Ex (oi-io) ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania ------- Bureau of Individual Taxes oEP .o County Code Yea File Number Po Box z8o6oi INHERITANCE TAX RETURN ,., , Harrisburg, PA 1y128-0601 RESIDENT DECEDENT `' ~ ~ (.. `? ~~ ' }? ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY / S7 ~~- ~3~C-~ v~ i i Zv i i i Z 20 / 9 / ~ Decedent's Last Name Suffix Decedent's First Name MI N D f~ f~ ~ S /~I ~ R y C (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 O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ® 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. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ~~ ~/ L~~N /~; n1c/r1~LZ iN 7~7 ~~ /~ ~-. ~.., REGISTE$J LS U9L~ONLY•.; First Tine of address ` ~ C:U ' C7 '~7 _ ~O-n _ . ~ ,_ Second line of address ~' c"; ~ ~~ -rt ~:, DATE FILED City or Post Office State ZIP Code -----__ ___.______~ C~mP H ~ ~.t f~A i ~v~ ~' Correspondent's a-mail address: ~ ~ L ~'~-~ML~V L ~ ~ ~ ~ `~M~~ S / q ~~ T 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. SI ATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE l~ ADDRES ~~ - ~t ~ .~ ,a_._~._ ._.~.______~_. SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS ~~ _~ ~ PLEASE USE ORIGINAL FORM ONLY .._.._..~_... Side 1 1505610101 1505610101 0 '._~~. ~. J 1505610105 REV-1500 EX ~) n w Decedent's Name: ~ ' / /9 /~ ~ ~ ' / V D ~ ~ / ~ Decedent's Social Security Number ~.. / ' ~ ~ ~ ~ ~ ~ y "' RECAPITULATION 1. Real Estate (Schedule A) .................:. ~!/0.!V~-.}..... ~ ~ . • • • ~ ~ 1 ~ Q'• 00 2. Stocks and Bonds(Scheduie B) ..................................... .. 2. f / ~ ~ ~ C ~ ~ ~ 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. ~ '9 7 0 / • 9 Z 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. • 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. ~ 3 D G ~ Z . ~ 3 9. Funeral Expenses and Administrative Costs {Schedule H) ................ ... 9. ~ 5~ 7,. I Z 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. ~ ~ ~ S • 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ an election to tax has not been made (Schedule Jj ............. ....... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. /~ ~t3 (D ~ ~. ~~ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ~ / Z ~' ~ ~ C~ s ~ 15. Amount of Line 'i4 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 ~ 5 J ~ 9 +~ . 7~ 16. ~ ~ ~ ~ • 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 fC'': ~ ~ . O Side 2 1505610105 1505610105 REV-1500 EX Paae 3 File Number Decedent's Complete Address: DECEDENT'S NAME - ---_ __ STREET ADDRESS - - CITY ~~ ~ n ` , // ~ STATE n~ ZIP ~ ~ ~ // /`" ~/ ~ // Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments d8~9- B. Discount ~ c, _= - 3. Interest 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. 5. It Line 1 + Line ? is greater than Line 2, enter the difference. This is the TAX DUE. Make check payable to: REGISTER OF WILLS, AGENT. a8~-~ 9~ (3) (4) _ _ 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 .................................................................................................................... ...... L tl. receive the promise for life of either payments, benefits or care? ................................................................ ...... 2. If death occurred after Dec. 12, 1982, tlitl decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ~] 3. Ditl decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ........ ...... L] 4. Ditl 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 surviving 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 for 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 Juiy 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(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. Total Credits (A + B) (2) REV-1Ei03 EX+ (6 98) ~ ~''~ COMh10NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. !If mere space Is needed. insert addit~erva! sfieets o! the same size) REV 7 W8 EX ~ 1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF /~,~'. ~' y ~. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~ ~P2 ~ •S FILE NUMBER Zd// - vv.S ~.3 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 NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. 5~,~~~ ~~.~~- ~s ~~ 5~/z ~ jai lac •/ ~? C-~v D ~ ~~ ~~i 5' .5 ~j3 ,, Zc:,3 ~~ v9~~~. TOTAL (Also enter on line 5, Recapitulation) I $ / ~~ ~ v ~ , / Z (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) SCNEDIJLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF /x/,9.2 y ~,~ ~~~~ /,S' FILE NUMBER avi/ - ~c~~ ~3 Debts of deceden4 must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: _ ~~ 7~ F~//Cicv r,/~ ~~Q i ~L 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) I Claimant _ _ _ __ - - _ Street Adtlress City _ __ State Zip _ Relationship of Claimant to Decedent __ _ 4. Probate Fees '323. s~> 5. ; Accountant's Fees 6. Tax Return Preparer's Fees Z .5 ©- ~~ 7 TOTAL (Also enter on line 9, Recapitulation) I $ Z ~~ 7, ~ Z (If more space is needed, insert additional sheets of the same size) REV-1512 E}+ (12-03i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF -- j~~~~ ~~, /l~vr~ is FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM --.- NUMBEF VALUE AT DATE - DESCRIPTION / OF DEATH ~5~,~'~: 4~/p~~ ~L~ » ~~~' TOTAL (Also enter on line 10, Recapitulation) $ I ~~'~ ~ ,c,[c,,~ (If more space is needed, insert additional sheets of the same size)