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HomeMy WebLinkAbout02-01-12n 1505610101 REV-1500 ~` ~°'-1O' m PA Department of Revenue pennsylvartia Bureau of Individual Taxes »"""~»"»~"»~`»»` PO BoXz8o6oi INHERITANCE TAX RETURN Harrisburg. PA 17128-1]601 RESIDENT DECEDENT OFFICIAL USE ONLY Code Year File Number ENTER DECEDENT INFORMATION'BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ao~-4y-s~s~ i ~ lot-os-abc~l ios-~9-Iq~y Decedent's Last Name Suffix Decedent's First Name MI E S S I f t' Bel `" (If Applicable) nter urvrvtng pouse s n orma ion ow Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE i REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum 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) x ' between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTU\L TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number _ _ ~ " ' y ~ RE(il$TE •LSU LY +- T Qy ''~` ~- First line of address - - - _ ~ "' ~ c710 V i.JII ~ W l~L i ~ +~ - Second line of address ~ ~ •~ City or Post ffice State ZIP Co de DATE FILED O ~~r ~J / 1 ~' ~ I~~/V~-f' Correspondent's e-mail address: ~ C10 ~('U p i~ ~ - T ~,ICit. {~ ~ !) r G C) Y-~ ined this return, including accompanying schedules and statements, and to the hest of my knowledge and belief, Under penalties of perjury, 1 declare that Ihave exam it is We, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE OF PREPARER OTHER THAN 1/~l-1 n- DATE ADDRESS PLEA8E USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J '~ `~ ~ `N" ~- ,~.. REV-1500 EX Decedent's Name: 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 Not s Receivable (Schedule D) .......................... . 4. 5. Cash, Bank Deposits. ancf,Miscellaneous Personal Property (Schedule E)...... . 5. 6. Jointly Owned Property (Schedule F) O Separate Billing.F3equested ...... . 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. 9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. ` ~ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which ~ an election to,tax has not been made (Schedule J) ...................... .. 13. ~ 1. 1: ~-_, ~ 14. N~ Valus S~ip)ct to Tax (Line 12 minus Line 13) 14. TA ~~ „ CUt~-I~yN; ± SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Arpount ofrt3r't@ 1d taxable at the soodsat,tax rate. or transfers under Sec. 9116 16. Amount of LinB'14 taxable -~ athneal rate '7C .Q ~' ~ ~17. Amount of line 14 taxable aYrsibling rate X .12 18. Amount of Lute 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610105 Decedent's Social Security Number .~ ~~ l,0 1 ,_ O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 Decedetrt's Complete Address: File Number DECEDENTS NAME ~` ~dt1 ~{l~U STRE TADDRE v a.n ~- ~ ~1~ S~ CITY STAT ZIP ~~~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPaymeMs 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + B) (2) (s) d (4) d (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 I'rfe 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 "intrust 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. For 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. ,~, F, ~---_ . .. r~ .:.' -+~ ti' ~~` cn*"... CJ p _ ~~~ 4 cx C~ ©~ ~. C~ ~ °~ ~ ~ ~- ~ ~ ~- ~~e Y ~ ~ ~ N~