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HomeMy WebLinkAbout03-0478~EV-~ 500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 '~,~,i~'~L~ HARRISBURG, PA 17128-0601 I-- Z LU UJ ILl REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-DD-YEAR) / DATE OF BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ©FF)CIAL USE ONLY FILE NUMBER NUMBER SOCIAL SECURITY NUMBER /'7,/- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER J~l. Original Return E~4. Limited Estate E~6. Decedent Died Testate (Attach copy of Will) [~9. Litigation Proceeds Received r~2. Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) ---]7. Decedent Maintained a Living Trust (Attach copy of Trust) [~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ] 3. Remainder Return (date of death prior to 12-13-82) ~--~ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~] 11. Election to tax under Sec. 9113(A) (Attach Sch O) FIRM NAME (IfApplicable) TELEPHONE NUMBER COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ~] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) Total Gross Assets (total Lines 1-7) Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) 9. 12. 14. t¥-'37, z/4 (8) z4' ,:? 7,--/, /o OFFICIAL USE ONLY Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (11) (12) (13) 5'3 (14) 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)(1.2) x .0 __ (15) 16. Amount of Line14 taxable at lineal rate /'2~c~-~:~3, ~.'~? x.0q~'"'(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) Decedent's Complete Address: Tax Payments and Credits: 1: Tax Due (Page l Line19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty STA~ (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT [ z~p/7 0 5-5- 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 promise 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 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 6 AND FILE IT AS PART OF THE RETURN. 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 i~n~rmation of which preparer has any knowledge. SIGNATURE OF PER~K~I~'RESPONSlBLE FOR FJLING RET~ DATE - ~o-~oo3 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE 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 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren or a stepparent of the child is 0% [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%, 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% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE F JOINTLY-OWNED PROPERTY R~-I ~9 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES I, ~ /¢c~.7~ /ff- TOTAL (Also enter on line 6, Recapitulation) $ ,:~.5~'~ al sheets of the same size) R~-1~11~ + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER NUMBER Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION FUNERAL EXPENSES: 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City .. State Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip Relationship of Claimant to Becedent Probate Fees Accountant's Fees Tax Retum Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT ?,.¢'0 . ~-o~/, ~ 7 $ z/q7W, lO REV.1512 EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Includ~ ITEM NUMBER SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Z/~s~,~ , /V/~ ~,~ ~ FILE NUMBER unreimbursed medical expenses. DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT a-q' ,F,-C ' °° 7,,1 · oo ~. 6-2 /6, ,.~ 7. .REV-1513 EX+ (9-00~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER I 1. II 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 7'0 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 (If more space is needed, insert additional sheets of the same size) TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET all~rst ^,,6.. http ,ch ncrwcb9 hrstmd com/m mr /servletgn u~ > :/'"' - ' ~'' ' ' q 'Y" ,' q 'ry';CONTEXT=printlogging&ACT1ON... 5,27/2003 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 002839 LASEK ROBERT J 9 GREENWOOD DRIVE MIDDLETOWN, PA 17057 ........ fold ESTATE INFORMATION: SSN: 174-18-6214 FILE NUMBER: 2103-0478 DECEDENT NAME: LASEK HELEN T DATE OF PAYMENT: 07/23/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/25/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $821.85 REMARKS: ROBERT J LASEK TOTAL AMOUNT PAID: $821.85 SEAL CHECK# 689 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZD0601 HARRTSDURG, PA 171Z8-0601 ROBERT d LASEK 9 GREENWOOD DR NZDDLETOWN COHHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX PA 170,57 DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN 09-01-2003 LASEK 10-25-2002 21 05-0478 CUHBERLAND 101 Amouni: Ram/ti:ad RE¥-15~i7 EX AFP HELEN T HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -~ REV-Z547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR ESTATE OF LASEK DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX HELEN T FILE NO. 21 03-0~78 ACN 101 DATE 09-01-2003 TAX RETURN #AS: (X) ACCEPTED AS FTLED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORZGINAL RETURN 1. Real Es*ate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Hortgagas/Notas Receivable (Schedule D) $. Cash/Bank Depos/ts/Nisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6). 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expanses/Ada. Costs/Nisc. Expanses (Schedule H) (9) 10. Dabts/Nortgaga L/ab/1/t/as/Lians (Schedule I) (10) 11. Term/ Deduct/ohs 12. Net Va/ua of Tax Return 25r857.~6 .00 .00 NOTE: To insure proper .00 crad/t to your account, .00 subait the upper port/on .00 of th/s fora with your tax payment. (8) 4,97~.10 3,0q7.~3 (ll) 13. 1~. NOTE: reflect flgures that lnclude the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line 1~ at Spousal rate (15) .00 X 16. Amount of L/ne 1~ taxable et Lineal/Class A rata (16) 18,263.39 X 17. Amount of L/no Zq a~ S/bl/ng rata (17) .00 X 18. Amount of L/ne Zq taxable mt Collateral~Class B rate (18) .00 X 19. Pr/nc/pal Tax Due 26,28~.92 8.02].53 18,263.39 DISCOUNT (+) INTEREST/PEN PAID (-) .00 ANOUNT PAID 821.85 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TO?AL DUE 00 = .00 045 = 821.85 12 = .00 15 = .00 (19)~ 821.85 821.85 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TAX CREDITS: PAYMENT DATE 07-Z3-ZO03 RECE1P1 NUHBER CD00~839 (12) Char/table/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0 Nat Value of Estate Sub~act to Tax (1~) 18,263.39 If an assessment t~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR}: OBJECTIONS: ADHIN- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Camaonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lamful Class 8 (collateral) rate on any such future interest. To fulfill the requirements of Section 11¢0 of tho Inheritance and Estate Tax Act, Act 15 of ZOO0. (71 P.S. Section 91¢0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGXSTER OF NZLLS~ AGENT A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of tho Register of Hills, any of tho 13 Revenue District Offices, or by calling the special lC-hour answering service for fores ordering: 1-800-361-Z050; services for taxpayers #ith special hearing and / or speaking needs: 1-800-¢¢7-5010 (TT only). Any party in interest not satisfied with the appraisement, alloeanca, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZS-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Dapartlant of Revenue, Bureau of Individual Texas, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for a Resident Decedent" (REV-1SOX} far an explanation of administratively correctable errors. Xf any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid ba~ore January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in tho seam manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date cf death, to tho date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016¢. All taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z003 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Yea.~r Rate Factor Yeast Rate Factor 1982 207. .0005¢8 1987 9Z .000Z¢7 1999 7Z . OOO19Z 1983 16Z .000¢38 1988-1991 llZ .000301 ZOO0 87. .000219 198¢ llZ .000301 199Z 9Z .0002¢7 ZOO1 97. .000Z¢7 1985 132 .000356 1993-199¢ 7Z .O0019Z ZOOZ 67. .00016¢ 1986 107. .00027¢ 199r;-1998 97. .0002¢7 2003 57. .000137 --Interest is calculated es follows: XNTEREST= BALANCE OF TAX UNPAXD X NUI~BER OF DAYS DELZNQUENT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is mede after tho interest computation date shown on the Notice, additional interest must bo calculated.