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HomeMy WebLinkAbout03-09-12OOMMONWEALTH OF PENNSYLVANIA REV-1162 EX111-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 015682 SPANGLER JOSEPH A JR 100 MULLIGAN DR ETTERS, PA 17319 fold ESTATE INFORMATION: ssnl: 201-1s-s821 FILE NUMBER: 2112-0272 DECEDENT NAME: SPANGLER ZELMA PAULINE DATE OF PAYMENT: 03/09/2012 POSTMARK DATE: 03/09/2012 COUNTY: CUMBERLAND DATE OF DEATH: 12/27/201 1 REMARKS: CHECK#1856 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 53,151.21 TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY: REGISTER OF WILLS 53,151.21 GLENDA EARNER STRASBAUGH REGISTER OF WILLS 1505610101 REV-1500 ext°1_,°~ ~ PA Department of Revenue perw~sylvania OFFICIAL USE ONLY Bureau of Individual Taxes DEgIgTMENTOFqEVENUE County Code Year File Number Po Box z8o6o1 INHERITANCE TAX RETURN ' ~ ~' . Harrisburg, PA i'Ji28-o6oi RESIDENT DECEDENT ~ ~~ (_ ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedents Last Name Suffix Decedents First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name v .p,... MI Spouse's Social Security Nwnber -- .~w _ ,~-~ . i ~, FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return . ~,. Fg- ~ ~.. `_-.~.' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 3. Remainder Return (date of death riot 12 13 O 4. Limited Estate O 4a. Future Interest Compromise (date of p r o - -82) O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate (Attach Copy of Will) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes O 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 S Name HOULD BE DIRECTED TO: Daytime Telephone Number First line of address 1 C~ ~~1~~Lv 6~1~( SeCOnd line of address City or Post Office Correspondent's a-mail address: State P~ ZIP Code REGISTE~F WILLS US~~~NLY © ra ~ s", ~ ~ ~ e ; r ~ :~~~~ - ~- •` % ' ~ - ~? ~.~ -t't . .. E FILED L.fl ~~3~~ 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 i ,correct and complete. Declaration f preparer other than the personal representative is based on all information of which prepay r ha any knowledge. IGNA RE OF ER O RE O BLE OR FILIN ETURN j~ 1 `_ ADDRE S , I~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE 0 K, DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J --, ~~ ,--~ -"t" i T1 -~4 J 1505610105 REV-1500 EX Decedent's Social ~S`ecurity Ncumber Decedent's Name: RECAPITULATION °t_ -~ ~ ~; - ,- y 1. Real Estate(ScheduleA) ............................................. 1. .,~..,:cw~.=.-: a,~x~i:.. ,:, ; 2. ~ ;. 2. Stocks and Bonds (Schedule B) ....................................... _. :.~ h~x;;t~" ,, ~ .• -.~: 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3 s 4 a ! ~~~~~`~ ~ `~~, .a'. ,~ .............. 4. Mortgages and Notes Receivable (Schedule D) .... • • • • • • • • • 4• ~~r ~ ~ °; 'fir'"~-~ ~+.°. '"~ '1 ~~ ~ ~. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5 .~~ f j^~~ ~ I ~ ~ b 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ....... 6. 1 _ ~; p ~a yam,, r _ ..~~~ ,~ ., . ~.r ~, . ~ 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property °~ (Schedule G) p Separate Billing Requested........ 7. g ................ 8. Total Gross Assets (total Lines 1 throw h 7 • • • • • • • • • • • • 8• k ~ ~ . 5 ` ti 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~ ~ J .~ ~ ~_` 10. '-r 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. , °~~r~ ~'F $ w, f.~,'. 11. Total Deductions (total Lines 9 and 10) ................................ ~1 - _ -1 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. , 3 1 , t~ 1 13. Charitable and Governmental BequestslSec 9113 Trusts for which 13. '~`` an election to tax has not been made (Schedule J) ~„s, , „~:, , ,~. ~ .; ' ~ ~, f r ., 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 1 ~ ~ ., ~ ~ - TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable ,~z~~.~ M at the spousal tax rate, or •--,, T - transfers under Sec. 9116 ~ ~ ~ ~ • ~..- 15 ~ .y .' rev t• 16. Amount of Line 14 fixable rU lines ra~teS X . S ~ s~ ~ ~ ~ ~ ~' ~' ~ ~ ' 17. A~ ount~Line~1~ taxable ~ ~ ~~~ ~ ~ ~ at sibling rate X .12 ~ ~ 17. 18. Amount of Line 14 taxable ~ 18 ' at collateral rate X .15 _~ _ _ _ _ .....................19. . ~~ ~.( ~ i 19. TAX DUE .................................. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 1505610105 1505610105 .~ . _.., cA Page 3 Decedent's Complete Address: DECEDENTS NAME z~~m~ ~~~~n~. STREET ADDRESS CITY ~~~ ~ ;' 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. Flle Number ZIP ~~ o t c1> ~151,z ~ Total Credits (A + Es) (2) (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ___ ~ ~ 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 N 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 deattl? ........ ...... ^ 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 tlhe 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. ~~~ REV-150 EX+ (i1-08) Pennsylvania ~i7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair 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 seal, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F, Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. TOTAL (Also enter on Line 1, Recapitulation.) ~ If more space is needed, insert additional sheets of the same size. REV-103 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~ILE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned with -idhf of survivnrchin .r.~.~~ 1.., d:..~~~~_d __ .._~_ ~__._ . ~-- -~~-'- -r--- .~ ••~~~~~, "~~ci, auuuiunai SntltllS OT If18 58R1e SIZE) REV-15Q4 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CPT~T~ w SCNEDVLE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP rv ~r~~V Vf FILE: NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER _ NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1. Name of Corporation Address _ City 2. Federal Employer I.D. Number 3. Type of Business 4. TYPE STOCK VatinglNon•V#~ting Common Preferred SCNED~ILE C-1 CLOSELY HELD CORPORATE STOCK INFORMATION REPORT FILE NUMBER State on Incorporation Product/Service Business Reporting Year TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK L-~ ~, Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? ................................ . ^ 'Yes ^ No If yes, Position Annual Sala rY $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................................... ^ `r'es ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ^ 1'es ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy - 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Ye:s ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ..................................................... ^ Yf:s ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ................... . If yes, provide a breakdown of distributions received by the estate, including dates and amounts re^ceivEed. ^ No 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Ye.s ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair ma.rketvalue/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) Date of Incorporation State Zip Code Total Number of Shareholders ' REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1. Name of Partnership Address Date Business Commenced Business Reporting Year City State_ Zip Code 2. Federal Employer I.D. Number 3. Type of Business ProducUService 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment ~ { 5. ~ ~ ~` ? - - - ~'. ~~~ r ~.. r A. B. C. D. 6. Value of the decedent's interest $ ~. 7. Was the Partnership indebted to the decedent? ................................. ^ 'y'es ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ `(es ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy - 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... ^ Yes If yes, provide a copy of the agreement. ^ No 11. Was the decedents partnership interest sold? ....................................... ^ Yes If yes, provide a copy of the agreement of sale, etc. ^ No 12. Was the partnership dissolved or liquidated after the decedent's death? ........... ^ Y~ss ^ N ........ If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. o 13. Was the decedent related to any of the partners? .................................... ^ Yes If yes, explain ^ No 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes If yes, report the necessary information on a separate she t i l i ^ No e , nc ud ng a Schedule C-1 or C-2 for eac h interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair meirket values. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. SCHEDULE C-s PARTNERSHIP INFORMATION REPORT FILE NUMBER REV-1507 EX+ (1-97) ~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER .,_.,__.__. _ VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) •REV-1508 EX. (i-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ~-~ Z,-O~-~ z_ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned wkh the might of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ _ ,~ ~ OF DEATH ~8 0, TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1509 EX+11-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER Han asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. B. C 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 DP,TE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) , REV-1510 EX+ (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ~aiw~~ yr FILE NUMBER This schedule must be completed and filed if the answer to anv of ~~~P~r~~n~ i rhr.,~~„ti ~ ,,., ..~,.,. «~...,...~.~_ „~„ . ~,,,. •~ ~~~~~~ oPa~c ~~ ~~«~~~, uae auuaionai sneeLS or paper of the same size. REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) _ _ __ Street Address ___ __ City State 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 City State Relationship of Claimant to Decedent 4• Probate Fees 5• Accountant's Fees 6• Tax Return Preparer's Fees 7. Zip Zip TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDVLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as ~f rtio d~ro „f ae~a :..,.~,.a,..,...___:_~..___~ ___,. _, ~,~ ",~~~ ~~a~~ w nccuc~, uueii aoamonai sneers or the same size) REV-1513 EX+ (11-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RE oTNotSList TOrustee(s~NT AMOOF ESOTATE ARE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).j L 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 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 CI)VER SHEET. $ If more space is needed, insert additional sheets of the same size. REV-1,514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN heck Box 4 on REV-1500 Cover SheE FILE NUMBER This schedule is to 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, Specialty Tax Unit. 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 the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) OF LIFE TENANT(S) 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 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ NAME(S) OF UfE, ANNUITANT(S) 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) ^Serni-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 1/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see instructions) ................................................. . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ rum I t: I ne values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX+i3-04) INHERITANCE TAX SCFIEDIJLE L coM NoNER TANCE TAX RETURNANIA REMAINDER PREPAYMENT RESIDENT DECEDENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER I. I ESTATE OF I- (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 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 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 ...... .........$ 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 UninGudable Assets ........ .........$ 4. Total from Schedule L-2 ............. .........................................$ E. Total Value of trust assets (Line C-6 minus Line D-4) .................................$ F. Remainder factor (see Table I or Table II in Instruction Booklet} ........................ . G. Taxable Remainder value (Line E x Line F) .........................................$ (Also enter on Line 7, Recapitulation) III. (Month, Day, Year) B. Name(s) of Life Tenant(s) 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 (see Table I or Table II in Instruction Booklet) ........................ . E. Taxable value of corpus consumed (Line C x Line D) .................................$ (Also enter on Line 7, Recapitulation) INVASION OF CORPUS: A. Invasion of corpus _ a+:v-,aas ex+ v.esi INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- FILE NUMBER 1. Estate of (Lass Name) (First Noma) (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) Total value of real estate $ (include on Section II, Line C-1 on Schedule L) B. Stocks and Bonds (please list) Total value of stocks and bonds $ (include on Section II, Line C-2 on Schedule L) C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include on Section II, Line C-4 on Schedule L} E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property $ (include on Section II, Line C-5 on Schedule L) 111. TOTAL (Also enter on Section II, Line C-b on Schedule L) $ (If more space is needed, attach additional 8~/s x 1 1 sheets.) REV-1646 EX+ (3-84) INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -CREDITS- FILE NUMBER I. Estate of (Last Name) (First Name) (Middle Initial) 11. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a art p of the trust. Computation as follows: Total unincludable assets $ (include on Section II, Line D-3 on Schedule l.) III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) S (If more space is needed, attach additional 8'/s x 11 sheets..) REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet FILE NUMBER This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable: when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which 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 dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block 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: IV. Summary of Compromise Offer: 1. Amount of Future Interest .........................................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ......$ 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 Cover Sheet) 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 Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$ (If more space is needed, insert additional sheets of the same size)