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Home My WebLink About07-27-111505610101 REV-1500 Ex x'1.1•' ' OFFICIAL USE ONLY PA Department of Revenue pennsylvania DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 //~~, Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT V , /~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name Suffix Decedent's First Name MI (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 $~ ~~ ~ ~ ~ ~ ~- REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW e! 1. Original Return p 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax Return Required death after 12-12-82) Q 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) G 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRE ...~- T0:-, Name Daytime Telep a Number -~'" ,-~:' f 1~ 11 / Y ,~y ) ~-- i- ,~ ..., REGISTERS ")<C$ USE'bl LY -~ ~-'~. f ... is ~ ~ ~ -r~3 First line of address ~~ ~`~ ~ ~, ~ ~. Second line of address City or Post Office State ZIP Code DATE FILED ~/~d 1 a ~~ l ~D ~~ Correspondent's a-mail address: 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, come and complete. Declaration of eparer other than the personal representative is based on all information of which preparer has any knowledge. SI~~URE F PE ON R PONSI F FIL ETUR DATE ~OZ SIGNATURE OF PREPAF~ER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J .~" J REV-1500 EX 1505610105 Decedent's Social aecurity Number Decedent's Name: ~ ~a ~~ ~ ~ ~ ~ <~~" 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. Jomtl Owned Pro ert Schedule F ~° Y P Y ( ) Q 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 throu h 7 •- ( g ) ............................. $. ~~ ,.. "' 9. Funeral Expenses and Administrative Costs (Schedule H) .......... ......... 9. ~ ~ ,~.• 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. . 1 ..~ F ~~ 11. Total Deductions (total Lines 9 and 10) ................................. 11. ,l ; ~ ~ ,- ~,~ ~~ 12. Net Value of Estate (Line 8 minus Line 11 .... • • • .... 12 /~' .......... c,/ 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. e TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 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. 18. Amount of Line 14 taxable i f at collateral rate X .15 , 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610105 1505610105 REV-1647 EX+ (02-10) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ~„---- -- ~~~H/.ur SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on REV-15oo) ~~ ~ /~s., FILE NUMBER This schedule is a p ` VY 1 Pero riate 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 that will be applicable when the future i possession and enjoyment cannot be established with certainty. nterest vests in Indicate below the type of instrument that created the future interest and att ch a copy to the tax return. ^ WWII ^ Trust Q' ether I. Beneficiaries ~ NAME OF BENEFICIARY ~ .,~, .~__.._ i rctLHr1UIV5HIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. z, _ 3. 4. 5. II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to nine months of the decedent's death, check the appropriate box below and attach a copy of thexdoclumentlg~, w f. withdrawal within exercises such withdrawal right. hrch the surviving spouse ^ Unlimited right of withdrawal III. Explanation of Compromise Offer: ^ Limited right of withdrawal '/ 1'~ ~ ~~~~~ ~~~ro~~•7~" ~~ ~ / ~~~~ ~C~ ~ ~ 0 ~ ~.~~~7`~- G~~~ IV. I summary of t'.,.,,.,..,.....:__ ,.~r 1. Amount of future interest ... , , . , , , . . 2. Value of Line 1 exempt from tax as amount passin to ch ~ ~ (Also include as part of total shown on Line 13 of REV-1500 jes, etc. 3. Value of Line 1 passing to spouse at appropriate tax rate ~ Check one. ^ 6%, ^ 3%, O 0% (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%, ^ 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 ~ ) ....................... $ D ~r more space is needed, use additional sheets of paper of the same size. File Number REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S AME s~ ~ s_ _ _-_-_- __ - __ - - -_ -- ___-__-- _ _- - _-_ -- -_--- - _---- __- _____ - __-1- ~~' STREET DDRESS - - - - --1 STATE ------ - ---- - - ZIP __ - ----------- --- - -_ h - - - - - -- - - -- - -- -- ------_-_ ~~ l/" - CITY ~~ ~ a ents and Credits: Tax Paym (1) 1. Tax Due (Page 2, Line 19) 2. CreditslPayments --- --- A. Prior Payments - ------------ -_-- B. Discount __ __---_----------------- Tatal Credits (A+ 6) (2) 3. Interest (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. (5) Make check payable to: REGISTER OF WILLS, AGENT. G UESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS PLEASE ANSWER THE FOLLOWIN Q Yes No 1. Did decedent make a transfer and: 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 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? ............................................................:........................... Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 3 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ E ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. IF THE ANSWER TO ANY OF TH ___ 94 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 For dates of death on or after July 1, 19 , 3 percent [72 P.S. §9116 (a) (1.1) (i)]. . or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use u cements fors ds closure of assets and For dates of death on [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory req 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: rate im osed 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 paten , an • The tax p adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]• the decedent's lineal beneficiaries is 4.5 percent, except as noted in • The tax rate imposed on the net value of transfers to or for the use of 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. osed on the net value of transfers to or for the use of the decedent's siblings is 12 perce ~ or ado t on116(a)(1.3)]. A sibling is defined, under • The tax rate imp Section 9102, as an individual who has at least one parent in common with the decedent,, whether by b oo p .f 3 ,> _' -_ ~ a• ~- .`~ c~ °~ a~~~ ., r.t;. ~~ ~ ~ ~ ~ ~ ~. ~~ ~ ~ ~= `~ ~ ~~ ~~, `~. ~~ ~ i `'~~ t O ~ j ~ ~ ~~ ~ D d~ ~ v~ ~bd ~ ~::~ .~~t~~~~~wr~~ l~f~~ a ~,a~l~ ~c~ ya~~~ ~~:~ ~:'~~ ~. a ~". 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