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Home My WebLink About10-26-11 1505610101 '-'~ REV-1500 EX(oi-io) 1!7 OFFICIAL USE ONLY __ PA Department of Revenue Pennsylvania County Code Year Fde Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~ ~ ~ ~ ,~ PO Box z8o6oi RESIDENT DECEDENT Harrisburg, PA i~i28-o6oi ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDUYYYY /,~ a 3(v /,3/,~, 99~W ~O IO 1/ !$ /9~~ Decedent's Last Name Suffix Decedent's First Name MI r~~~~L~ ~~ss r~ ~- (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) 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. 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 TO: Name Daytime Telephone Number First line of address X39 Cou ~~ ~y cL_~~ ~be~v ~ Second line of address City or Post Office State ~?- ~ S ~D Pr t~t~ - P R ZIP Code ~ ~~ Correspondent's a-mail address: ~.t~~C~ ~ t"}~k=1..Vlgi~~b • ~ Under penalties of perjury, 1 declare that I hav amined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and comple e. De~laratio of eparer other than the personal representative is based on all information of which preparer has any knowledge. - cir_nier i F nF Fs R RF OnISI OR FILING RETURN ~ DAT~ I GNATURE OF PREPARER OTHERI~HAN REPRESENTATIVE !)ATE ADDRESS ~~--~~~ PLEASE USE ORIGINAL FORM ONLY _~ r e Side 1 1505610101 1505610101 J ,- WILLS USE. ONLY -_ ~ , - r- --n ; I .; ~.~, 4i - - , . _._, _- ; ~ .. DATE FILED ~, _ r r J 1505610105 REV-1500 EX De/cedent's Social Security/ Number Decedent's Name: ~ ~ 1 \ ~,~ ~ ~\ (.~ __ / ~ , ~ ~ / ~ ~ Z RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. ""~ -- -7 ~ 2. Stocks and Bonds (Schedule B) ....................................... 2. - / J ~ / • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. _ f7 ~" • 9 9 ( ) ........................... 4. Mort a es and Notes Receivable Schedule D 4• -_ ~ ' 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ 7 ~ 7 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. "- ~ ~ • 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. `1 D r • 8 ~ ~ ~ / • 8. Total Gross Assets (total Lines 1 through 7) .......................... ... . 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. ~ ~ (p 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. f~j .~ ~ 3 . 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. / ~ ! `T 9 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 1 `j \ 7 ~ 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .... 13. 'r' • 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. ' - Q • 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 at collateral rate X .15 • 18. 19. TAX DUE ..................................................... ....19. ^ [9 • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 15D5610105 1505610105 REV-1500 EX Page 3 File Number nocprlpnt'c Cemnlete Address: DECEDEN I'S NAMt ----- -- STREET ADDRESS l ~ / ~ ~~ ~ ~~~-- CITY G~/~-rn a ~~C Ls STAT ZIP ,~ . / 7Q Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ___ B. Discount 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. (1) - o '_ Total Credits (A + B) (2) (3) (4) 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. ,.., - 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 Dec. 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 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. F'or 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(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. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF.._.., - FILE NUMBER All property jointly-owned with right of survivorship must be disclosed ort Schedule F. (If more space is needed, insert additional sheets of the same size) REV-t 504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationlpartnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to 6e submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDtlLE D MORTGAGES & NOTES RECEIVABLE ESTATE OF - FILE NUMBER Alt property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (ii-1o) =~ ~ Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ~as~~ ,~-.JY1. ~~c~Lr~ d~ jo--~~99a Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ (Di-iD) j~i Pennsylvania '..,.'- DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F ]OINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. B. C. ]OINTLY OWNED PROPERTY: TFEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR)DINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET wo of DECEDEM'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. ~~ TOTAL (Also enter on Line 6, Recapitulation) I $ 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) j i~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF ~ ~ FILE NUMBER ~l ~..Ss'i ~ x.11'1. ~i ~~L~ a o- ~ - ~~ 9 ~d This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DEC®EM AND THE DATE OF TRANSFER. ATTACHACOProFrr+EDEEDFOaREALESrATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION ~IFAPPLICAeLE) TAXABLE VALUE 1. TOTAL (Also enter on Line 7, Recapitulation) $ Tf mnra cnara is naa~fari nca ~ririitinnal chaatc of nanar of tha cams ci~a o.oo REV-1511 EX+ (10-09) j~i Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS __ _ ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: - B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address 2. 3. 4. 5. 6. ~. City 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 Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: N~T,p~ ~4~5 ~~ ~~cw,o~J tiQ~cti ~ s ~ ~ti N~`~1c,'i, 1i~1 }~er~l-~Snby~r`~ ~e~~sv State ZIP ZIP /Q a to ~~g 7~ TOTAL (Also enter on Line 9, Recapitulation) $ R~ ~ (v If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX REItiRN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~,s~, ~~ F~ . m , ~~ ~ ~,~~ ~ got ~ ~ ~~0 99d Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION Of DEATH ~°~ sP~~ ~~~~~ ~~7~1 ~~a ~'~ ~o~ ~ I/ to ~' ~D~fI~..D~y~r s~r7~ `~3 ~ ~'~- l I ivy D -- c~~~fo~ ~~ ~ ~ ~ Li± ~ u4~c~ - c ~ ~7 ~Olo3 7 `~`f' ~"~ ~L~ ~ C~ ~ a dear ~ ~ ~~~ ~ ~ Z TOTAL (Also enter on Line 10, Recapitulation) $ fQ ~ 3 ?) If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-14) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF: _ F FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART IT -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ REV•1514 EX+ (4-09) ~+ Pennsylvania ~.~7 DEPARTMENT OF REVENUE Bureau of Individual Taxes PO Box 280601 Harrisburg PA iy~28-0601 SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-1500 COVER SHEET) ESTATE OF ^ FILE NUMBER This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ................................... . .....$ 2. Actuarial factor per appropriate table . . ............................................ . . Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 3. Value of fife estate (Line i multiplied by Line 2) ............................. . ......$ ® ~'- NAME OF LIFE ANNUITANT DATE OF BIRTH • NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ............... . ........... . ...............$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Sem1-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................. . ................ . 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (See instructions.) ..... . ...................... . 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is tine d x Line 5 x Line 6 ...........................$ If using variable rate and period payout is at beginning of period, calculation is (Line4xLineSxLine6)+Line3 ...............................................$ ~- ~ ~- NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the=. tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. REV-1644 EX+ (01-10) Pennsylvania iNHERiTANCE TAX SCHEDULE L DEPARTMENT OF REVENUE INHERITANCETAXRETURN REMAINDER PREPAYMENT RESIDENT DECEDENT OR INVASION OF TRUST CORPUS I. ESTATE OF ~ FILE NUMBER ~~~~.~ ~, S`~, M.~~ ~~~~-oo99a -- This schedule is appropriate only for estates of decedents dying on or before Dec. 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust corpus (principal). II. REMAINDER PREPAYMENT: A. Election to Prepay Filed with the Register of Wills on (Date} B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) of Election or Annuity is Payable C. Assets: Complete Schedule L-1 1. Real Estate ...........................$ __-- 2. Stocks and Bonds ............ . .........$ _ 3. Closely Held Stock/Partnership .............$ 1 ~ -` , 1 4. Mortgages and Notes ....................$ 5. Cash/Misc. Personal Property ..............$ 6. Total from Schedule L-1 .. . .. . ........................................$ ____ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................$ __ 2. Unpaid Bequests .......................$ _ 3. Value of Non Includable Assets .............$ 4. Total from Schedule L-2 ........................... . ..................$ ___ E. Total Value of Trust Assets (Line C-6 minus Line D-4) ... . .......................$ F. Remainder Factor .................................................... G. Taxable Remainder Value (Multiply Line E by Line F) ............................$ ___ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of Corpus (Month, Day, Year) B. Name(s) of Life Tenants} Date of Birth Age on Date Term of Years Income or Annuitant(s) Corpus or Annuity is Payable Consumed C. Corpus Consumed ........... . ........................................$ - ----- D. Remainder Factor .................................................... E. Taxable Vaiue of Corpus Consumed (Multiply Line C by Line D) ....................$ __ _______ _____ (Also enter on Line 7, Recapitulation) REV-1647 EX+ (02-10) ~ pennsylvania SCHEDULE M DEPARTMENT OF REVENUE FUTURE INTEREST COMPROMISE INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on REV-sgoo) ESTATE OF ~ FILE NUMBER This schedule is appropriate 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 interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries _ NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. _ II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal _ III. Explanation of Compromise Offer: 1v IV. Summary of Compromise Offer: 1. Amount of future interest ........................................ . .............. $ Z. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) ........ $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check one. ^ 6%, ^ 3%, ^ 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) . ...................... $ If more space is needed, use additional sheets of paper of the same size. REV-1648 EX (OZ-09) ail pennsylvania fib DEPARTMENT OF REVENl1E Bureau of Individual Taxes PO Box z8o6oi Harrisburg PA i7iz8 SCHEDULE N SPOUSAL POVERTY CREDIT FOR DATES OF DEATH 01/01/92 TO 1Z/31/94 ESTATE OF ~ FILE NUMBER This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1 . Taxable assets total from Line 8 (cover sheet) .......................................... • ... 1 . 2. Insurance proceeds on life of decedent ................................................... 2. 3. Retirement benefits ................................................................. 3. 4. Joint assets with spouse .............................................................. 4. 5. PA Lottery winnings ................................................................. 5. 6a. Other nontaxable assets: List and attach schedule if necessary .. ~_6a. 6b. _ 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ••••.•••••• Ei. 7. Total gross assets (Add Lines 1 thru 6) ....... • ........ • ....................... . .......... .. 8. Total actual liabilities ............................................. • .................. 8. 9. Net value of estate (Subtract Line 8 from Line 7) ............................................ g. If Line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part II. Income: 1. TAX YEAR: 19 a. Spouse ............. la. b. Decedent ........... ib. c. Joint ........ ..... lc. d. Tax-exempt income .... ld. e Other income not listed above ......... le. f. Total .............. lf. 4. Average joint exemption income calculation 4a. Add joint exemption income from above: (lf) + (Zf) _ + (3f) 3. I TAX YEAR: 19 3a. :ib. :3ci :3d. :3e. :3f. (= 3) 4b. Average joint exemption income ................. . ...................................... _ _ If line 4(b) is greater than 540,000 -STOP. The estate is not eligible to claim the credit. If not continue to Part III. 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ........................ 1, 2. Multiply by credit percentage (see instructions) .. . .......................................... Z, 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet . ........ • ..... • • ................. 3. 4. For nonresideii~, enter the ratio of the decedent's gross estate in PA to the value of the decedents gross estate ..................................................... 4. _ 5. Multiply ~,jqg:~ by Line 4 and enter the total here. This is the amount of the Nonresident Spousal 2. TAX YEAR: 19 2a. 2b. 2c. 2f. REV-1649 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE O ELECTION UNDER SEC.9113(A) (SPOUSAL DISTRIBUTIONS) FILE NUMBER ESTATE OF ~ , Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election aoolies to the _ Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or sim- ilar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the persona representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount o+ the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement_ Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's Part B: Enter the description and value of all interests included in Part A for which the 5ectron yit;~(A) electron to tax Is Deing mane. (If more space is needed, insert additional sheets of the same sizef