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HomeMy WebLinkAbout12-19-11 (2)J 1505610101 REV-1500 °` tO1-1°' ~ OFFICIAL USE ONLY PA Department of Revenue Penr~va~ County Code Year File Number Bureau of Individual Taxes `""'"`"`°"""`"°` PO BOxz806ot INHERITANCE TAX RETURN Harrtsbum. PA i7sz8-0601 RESIDENT DECEDENT Social Security Number Date of Death MMDDYYYY zy IIIo©~~ 1 2 0 l z o 1 0 Decedent's Last Name Suffix el Date of Birth MMDDYYYY ~~~ 3~! 43/ Decedent's First Name T MI O p ~ 1 1~ (H Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name ? MI ® ~~ 1~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ^~~~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW III 1. Original Retum O 2. Supplemental Return O 3. Remainder ReWrn (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 8. Decedent Died Testate O 7. Decedent Maintained a Living Trust _Q 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 - TH18 SECTION MU8T BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number o b ~ r -f S e l t Z /' 7- 7 7 0 3 3 9 REGI3)iLR OF WILLS 118E ONLY +:~ C7 rn ~'ss ~ ~ :,, .'. First line of address fq hea+/Q~d rive ~~~ ~ - Second line of address ~ ~ ~ -O '~~ ., Vi ... DATE FILEq,,~ `'~ City or Post Office State ZIP Code c c S~ n ~~ c s 6 u r p cL l 7 ~~~~~• / G e ® ~ °~ Correspondent's small address:l' a 6 e r ~. S'n~ ~ ~ft c~ ~/r...-i ZON . ~r Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, It Is We, correct and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PARSON RESPONSIBLE FOR FILING RETURN DATE _ G/ r~ a... a Dp.. /~ /YJ~~. . Y~i ~y~p~ R i~~ O S'O x!!00 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE / DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J REV-1500 EX Decedent's Name: rzcreamu errou Decedent's Social Security Number 1. Real Estate (Schedule A) ............................................. 1. ~w i~u~ ,~ Q nn C irri ~ ®~ ~ 2. stocks and Bonds (schedule B) ....................................... 2. ~ '7 y 7 8 3. Closely Held Corporation, Partnership or Sok-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivat~e (Schedule D) ........................... 4. 5. Cash, Bank Deposits aril Miscellaneous Personal Property (Schedule E)....... 5. 3 y 6 ° rs 6. Jointly Owned Property (Sct~dule F) O Separate Br'Nn' g Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Piobate Property (Schedule G) O Separate BHling Requested........ 7. 8. Total Grams Asset (total Lines 1 through 7) ............................. 8. 3 ~ H $. 9. Funeral Expenses and Administrative Cr%ts (Schedule H) ................... 9. / p / S 3 ° o 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 3 O 5/ y 7 0 ~ 11. Total Deductions (total Lines 9 and 10) ................................. 11. O ~ ,3 O O ~ 12. Net. Value of Estate (Line 6 minus Line 11) .............................. 12. 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 Tsx (Line 12 minus Line 13) ........................ 14. q O . '' 9 y d p 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_ 16. Amount of Line 14 taxable at lineal rate X .0 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL fN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610105 1505610105 7oa n ,~ S~-I e ( ~ 1505610105 O REV-1500 EJC~Page 3 Decedent's Complete Address: Flle Number DECEDENTS NAME // STREET ADDRESS CITY ~/ STATE -- ZIP 7e ZS' Tax Payments and Credits: 1. Tax Due (Page 2, Lme 19) 2. CradifslPayments A. Prior Payments B. Di~ouM Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIR in oval on Page 2, LNre 20 to request a refund. (4) (1) ~ D 8'6 ~ 7~ 5. K Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DIIE (5) y d Ss., ^ . U r Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER. THE FOLLOWING QUESTIONS BY PLACING AN "X" tN 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 w its income : ............................................ ^ c. retain a reversionary interest; w .......................................................................................................................... ^ d. receive the promise fw Gfe of either payments, benefits or care? ...................................................................... ^ 2. If death acr:urred after Dec. 12, 1982, did decedent transfer properly within wle year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an 'in trust fw" wpayable-upon-death link account w security at his w her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, whim contains a beneficiary designation? ............................................................................................... ......................... ^ ~( IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COfi~LETE SCHEDULE G AND FILE R AS PART dF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tan 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 pert:ertt [72 P.S. §9116 (a) (1.1) (ii)}. The stahrte does Trot exempt a transfer to a surviving spouse from tax, and the statutory requrcemerrts for disdosure of assess and filing a tax return are sltll appkcable even ff the suviving spouse is the only benefiaary. Fw dates ~ 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 w for the use of a natural parent, an adoptive parent ar a stepparent of the child is 0 percent [72 P.S. §9116(aK1.2)]. • The tax rate imposed on the net value of transfers to w for the use of the decedent's lineal benefiaaries is 4.5 percent, except as rested in 72 P.S. §9116(1.2) (72 P.S. §9116(aK1)). • The tax rate imposed on the net value of tranufers to w 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 t~mmorr wtth the decedent, whether by ttlood or adoption. REV-1502 EX+ (8-98) SCMEpYLE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All real property owned sokty or es a tenant in common must be reported at falr market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) REV-1 X03 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEp1JLE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned wfth right of survivorship must be dlaclosed on Schedule F. 10 r i1 pt more space is needed, insert additional sheets of the same size) FEV-7509 EX • (1An COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY NUMBER Indude the pnx~eeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disclosed on Schedub F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. Qod1 C ~'/tcA~~9,v, j~p p ` ~ 7 000 ~ 3' CA-f~i yz2 ~~~k~ ~.,~f 1 ~ s //Jvr+..ce~ tea /~a~Y~!/ ~.Z.S flee. 13k~~wce of f~fti~~p~/~/r~, w~ ~'~nc~ t~vG ~ie /"cS!/ve ~ir,rt C/f,s~e~~es' ~'Slvyt,..y a~ s" Pic k's Per d~~ TOTAL (Also enter on line 5, Recapitulation) I S p'3 ~,` (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) SCMEDYLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER l~bts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Pao F~,fS(°K+~~ S~rd7tas ,+ 25-6 p F~.~, if { < <s~ ~ tam ~~,~ ~~ f 'Y o s' ~v~MDftrit EC ~ Nc.-rrIC ~ S^ c~.,ty~ti ~^-/ f4erc/ryFUa~~JG Sc.wt~-~ / .~ Yta r ~ G .s'~ ~ e,w «Ln- y c tiw.~ ti ~ t zY C~vhG~( or.~tlt, c uE,F,~,"L,~ .f' ! 5~ ~ / ~J f'rba/L'~• B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions QQ /L _ ~{' Name of Personal Representative(s) Ra b e ~ >L ~ J~ Gl t-L // Street Address y (~J~epr~~,~y./ Q/'t/G City ~~~~iw,w~y6urL State~P~Zip /~os'O Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address a. 5. 6. 7. City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees I z 7r, ~~ p'tat7 TO7AL (Also enter on line 9, Recapitulation) I $ ] d , 163, b~ Zip (If more space is needed, insert additional sheets of the same size) REV-7512 EX+(12-03) COMMONWEALTH OP PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additlonal sheets of the same size) ~ ~y ~°~ ~,a`ni ~o~~~,~ ~~~3 D1°