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Home My WebLink About03-28-12J 1505610101 REV-1500 °` ~°'-'°' 1~ PA Department of Revenue pennsylvaMa OFFICIAL USE ONLY Bureau of Individual Taxes `°""'" ` ~"""` County Code Year File Number PO BOx z8o6oi INHERITANCE TAX RETURN Harrisburo. PA i~128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of D at h e MMDDYYYY ~ ~~ // ~~ ~~~~~~ ® ~ ~~ Li~i.i.~ i~i Decedent's Last Name Suffix (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth MMDDYYYY Decedent's First Name MI ^^ Spouse's First Name MI oz a THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _____ ~~ REGISTER OF WELLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum 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. 91f3(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 T0: Name Daytime Telephone Number d REGISTER OF WILLS USE ONLY First line of address r.S 7o~ir " Second line of address C ~ ~ ~~+i ~ ~ ~ ~;,~. ~ ED ~ ' -. .. City or Post Office State ZIP Code r r ~C~ E.J ~.; sri ~ ~~ Correspondent's e-mail address:.~1~~I `~Z~'iyT Q~, ~iCQL , C~/y Under penalties of perjury, t declare that 1 have examined this return, including accempanying schedules and statements, and to the best of my knowledge and belief, it is true and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG OF P RSON R P S LE O LING RETURN Q ~. ~ f~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 150561010.1 ~ ~~. f J REV 150o Ex Decedents Name: 1505610105 RECAPRULATION Decedents Sociat Security Number 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds{Sdiedule B) ....................................... 2. 3. Closely Held. Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable {Schedule D) ........................... 4. 5. Cash, Bank Deposits and M'~scellaneous Personal Property (Schedule E)....... 5. ! 6: Jointly Owned Property {Schedule F) O Separate Bitting Requested ....... 6. 7~ Inter-vvos Transfers 8~ Miscellaneous Non-Pn~bate 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 Liabil'~ties, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ...........................::.... 11. 12. Net Value ~ Estate,(Line 8 minus Line 11) ..:........................... 12. 13. Charitable and Govemmentat 8equestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. TAX CALCULATION - 5EE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal-tax rate, or transfers under Sec. 9116 (ax1.2) X .0_ 16. Amount of Ltne 14b1e at lineal rate X .0 17. Amount c~,LiAe 14 taxable at sibling rate X .12 18. Amamt of Line t4 taxable at collateral rate X :15 15. 16. 17. 18. 19. TAX DUE .........................................................19.I 20. FILL IN-THE OPAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV ~50o Ex 'Page s Decedent's Complete Address: File Number ~ D~/ ~ O ~/~~ DECEDENTS NAM~!~' ~„ ~ y~t ~!/~ _ C' STREETADDRESS ~ :,bred Cry ~ STATE ZIP ~~ Tax Payments .and Credits: 1. Tax Due {Page 2, line 19) 2. CreditslPayrn~ts ~ I~ A Prror Paymeriis / ~ B. Discount 3. Interest 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FiN in oval on Page 2, Line 20 to reques# a refund. 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A+ B) (2) ~ ~~-), ~~ (3) (4) (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 properly transferred :......................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : .......................................... ^ L9'/ c. retain a reversionary ir-terest; or .................................................................................. . ^ [~'~ d. receive the promise for Nfe of either payments, benefits or care? ...................................................................... ^ 2. ff death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. t?id decedent own an ~n bust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retinment acco<int, annuiiy or other non-probate property, which contains a benefiaary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE AB011E QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ANO FILE IT AS PART ~ THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the ne# value of transfers to or for the use of the survnrirg spouse is 3 percent [72 P.S. §9116 {a) {1.1) {i)]. For dates of death on or after Jan. i, 1995, the tax. rate imposed on the net value of transfers to or for the use of the surviving sprwse is 0 percent [/2 P.S. §9116 (a) (1.1) (ii)]. Tt~ statute does nonexempt a transfer to a surviving spouse from tax, and the statutory requirements for d~dosure of assets and filing a tax r'ehim are stiN applicable even if the surviving spouse is the only benefiaary. For dates of death ~ or after Jury 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 benefiaaries is 4.5 percent, exo~t as noted in 72 P.S. §9116{1:2) j72 P.S. §9116{a){1)j. • 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)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in carimon with the decedent, whether by blood or adoption. REV'1502 EX+ (11-OS) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER All real. property owned sole) or as a tenant in common must be reported at fair market value. Fair as the price at which property If more space is needed, insert additional sheets of the same size. ' REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF ~~, CI , ~ ` ~~/~ ~~ FILE NUMBS ~ ~ / • - `~ ~-1 C I o / All property jointly-owned with right of survivorship must be disclosed on Schedule F. ~~r more space is neeaea, insert aaamomu sneeus oT me same s¢e~ REV-1504 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCEIEp1~LE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including al/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. ~., ......., ,,r.. .... ... .......... .............~.~..~~..~ .,~~......, .., .~~...,..~~~....~ ..~ REv-15Q5 EX+ (6-98) SCFIEDYLE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSELY HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER 1. Name of Corporation State on Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year_ 3. Type of Business Product/Service 4. TYPE TBTAL HUMBER OF NUMBER OF SHARES VALUE OF THE STOCK YotinglNon•Yoting 5HARE3 QUTSTANDING PAR VALUE OWNEt) gY 7HE DECEDENT DECEDENTS STOCK Common $ Preferred $ 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 Salary $ Time Devoted to Business ...................... 6. Was the Corporation indebted to the decedent? ................................... ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes ^ 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? ....^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedents stock sold? ..................................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissobed or liquidated after the decedent's death? .................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ 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 addresses and estimated fair market value/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) REV-15U6 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDt~LE C-S PARTNERSHIP INFORMATION REPORT ESTATE OF - ~ FILE NUMBER a«~- o~~ 1. Name of Partnersh Date Business Commenced Address Business Reporting Year City state Zp 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. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ 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 ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ....................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. ~ •• ~ • ~ ~ A. Detailed ca~ulations 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 market values. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REt/-i5Q7 EX+ (1-97) SC1~IEDIJLE D COMMONWEALTH OF PENNSYLVANIA MC1FtT(3AGES $~ NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF ~ - ~ _ FILE NUMBER il- 0~~8 All 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) . aEV-isoeoc.Asn SCHEDULE CAMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHHEERSIDENTD EDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER Indude the prooeeds of litigbtion and the date the proceeds were n~eived by the estate. All properly jointy~ovmed with the right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. l~Gtu , ~ D, Sec.v~,u Ig, t~l 3. TOTAL (Also enter on line 5, Recapitulation) I S~~'~p {'~~ (If more space is needed, insert additional sheets of the same size) REV-7509 EX'• (1.9~ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF ~rn'' '' ~ ^~~ J n ~0 r FILE NUM~R/ ~/~ ~~~ H an asset was made joint withyf one year of the decedent's date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A, B. C. JOINTLY-0WNED PROPERTY: RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and Dank account number or similar identifying number. Attach deed forjointly-held real esta~. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A, ' ~~r~~ TOTAL (Also enter on line 6, Recapitulation) I i ADDRESS N~ (If more space is needed, insert additional sheets of the same size) REVd5,0IX •.,an COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN OF SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule musC be completed~and filed if the answer to any of questbns 1 through 4 on the reverse side of the REV 1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INfXUDETHENAME0F7HETRAN6FEREE,THEIRRHATIONSHIPTODECEDEMANDTHEDATEOFTRANBFER "TT'~HAC0P1'0FT"E°EE°FORREUESrntE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION iFnPP<~cne~.E TAXABLE VALUE '' G~~~ TOTAL (Also enter on line 7, Recapitulation) I E (If more space is needed, insert additional sheets of the same size) . REV.1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN .RESIDENT DECEDENT SCNEpULE H FUNERAL EXPENSES & ADMINISTRATNE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~X~.n~ CC,nca .. ~~c~S~bv~, ~.a 1~i1 i ~ 'y~S .J ~~ t6. /Ylias~2 ~ ~ l ~anQ,fi~ /~a• ~in~~TD,vE ~2i,~T ~~" B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City 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 Zip Relationship of Claimant to Decedent 4. Probate Fees 9a ~ ~~T~r~y1 ~G~ ^-+'v ~~~~ 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ~a_ ~= TOTAL (Also enter on line 9, Recapitulation) ~ `' ~~~. c State Zip (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 SCNEpuLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF -r- ~ FILE NUMBER Report debts incurred by the deq~dent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. t" I NN~t ~L ~ ~~ LT ~H ~7~' ~P ~ ~ ~- ~~~ I it ~~. b3 f~E~ ~ ~~ ~~~P i/air/~r ~ g. ~3 mOP~tt ~ /r742Td~ V ~+S 4.l ~ /,~q~l/ ~+71!'U.P.f ~.2~~oc (7~Lcy S~l%4~ c~~a3/1/ ~~~1 ~.. ~?icrrf CG2~ 3/~4/~0~ ~ ~S~CE..~ PS L ~ ~ ~ I ~ ~ col IV~c~t~e C~a-d ~~ ivJa~ -~ D~~c~. 3~ ~~~~~~ TOTAL (Also enter on line 10, Recapitulation) S (If more space is needed, insert additional sheets of the same size) ~/. ~~ ~~- /9~ ' 9 ~~ gym. w ~aoo. 431b~37, REV 1513 EX+ (9-00) SCNEpIJLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ¢ ~ FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llst Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under ,. Sec. 9116 (a) (1.2)] ~ C~ 13 ~ ~-~-(o I g ~h~ ~. ~~~8~-~ ~-vs~~e , ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpULE K LIFE ESTATE, ANNUITY & TERM CERTAIN ESTATE OF ~~~~ „ ~1 ~3~ 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 Alpph 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 NAkff($) GF LIFE TENAIR(S) DATE OF 81RTH NEAREST AGE AY DATE OF DEATH . LIFE E5TA7E t3 PAYA9LE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table ................................................ . Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of Ilfe estate (Line 1 multiplied by Line 2) ......................................$ ,. :._. NAtI~(5) t5F L)Ff: ANNUITANT(S) DATE OF BIRTH ~° ~~ AGt: lCi DATE OF DEATH P ANNUITY 15 tE ^ 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 ..................................................$ NOTE: The 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) `~-'r'te E".I~I INHERITANCE TAX SCMEpULE L COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT IN R SITDENTEDECEDENT N OR INVASION OF TRUST PRINCIPAL FILE NUMBER O~Z~ l1-o~G~ I. ESTATE OF ~~~~~ ~rn« (Last Name) (First Nlme) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1882. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section T14 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 or Annuitant(s) of election / ,/~ Term of years income or annuity is payable C. .Assets: Complete Schedule L-1 1. Real Estate ...............................$ 2. Stocks and Bonds ..........................$ 3. Closely Held Stodc/Partnership ...............$ 4. Mortgages and Notes .......................$ 5. Cash/Misc. Personal Property ................$ 6. Totalfrom Schedule L-1 ......................................................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ...........................$ 2. Unpaid Bequests ...........................$ 3. Value of lJnindudable Assets .................$ 4. Total from Schedule L-2 ......................................................$ E. Total Value of trust assets (Line C-t3 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. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s~ of Life Tenant(s) Date of Birth Age on date or Annuitant(s) corpus 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) Tenn of years income or annuity. is payable REV-1bt5 EX+ (/-85i INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION ~ / RESIDENT DECEDENT -ASSETS- FILE NUMBER ~` - 1. Estote of ~ ~~ t~/-'I / ~~ Ila:t Nome) (First Na ) tMiddl- lmtial) 11. Item No. Deuription Value A. Real Estate (please describe) N~' /~ Totaf value of real estate $ (indude on Section 11, Line C-1 on Sdtedule L B. Stocks and Bonds (please list) rn'f ~d' / ~~ Total value of stocks and bonds $ (indude on Section 11, 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 HeId/Partnsrship $ indude on Section II, Line C-3 on Schedule L D. Mortgages and Notes (please list) ~ { ~~~~/~ Total value of Mortgages and Notes indude on Section tl, Line C-4 on Sd-sdule L $ E. Cosh and Miscellaneous Personal Property (please list) Total votue of Cash/Misc. Pers. Proparty $ (indude on Section II, line C-5 on Schedule l) .111. TOTAL Also enter on Section II, Une C.6 on Sdtedale L S (If more space is needed, ottoch additional 8Y4 x 11 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 ~ CJc~lu ~ ` ~ (Last Name) (First Name) (Middle Initicl) 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 part 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 $ (If more space is needed, attach additional 8Ys x 1 1 sheets.) RE'V-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCEIEpVLE M FUTURE INTEREST COMPROMISE Box 4a on Rev-1500 Cover Sheet ESTATE OF /'\~~~ ~~I ~~;) l.) FILE NUMBEROC 6 ~ I " V l~ l.Y 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 U -p - 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) REV-:648 EX (11-99) SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) ESTATE OF ~~ ~ ~ FILE U R //ww l.~ This sched a 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 (Attach schedule if necessary).. 6a. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................................................ 6. 7. Total Gross Assets (Add lines 1 thru 6) ................................................. 7. 8. Total Actual Liabilities .............................................................. 8. 9. Net Value of Estate (Subtract line 8 from line 7) ........................................... 9. If line 9 is gn,~ater than $200,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part 11. Income: 1. a. Spouse ........... ia. b. Decedent .......... 1b. c. Joint ............. 1c. d. Tax Exempt Income .. id. e Other Income not listed above ........ 1 e. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) _ + (3f) (+ 3) 4b. Average Joint Exemption Income ..................................................... _ if line d/MI ie nrmfur 1h~n ~dn /IM _ CTAD Thn nef~ln is nnf nlinihla fn ehim 1ho enulif If nnf ennfinuo fn 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less 2. Multiply by credit percentage (see instructions) 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 . .............................. . 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................ . 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .Include this figure in the calculation of total credits on line 18 of the cover sheet...... . 2c. Part 1 1. III. ~ 2. 3. 4. 5. rt~vaers Ex ;c+-~l ..r, ` SCHEDULE 0 COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN iwww^ ^w ~' ^ w^w~.w^w^ .~.w.. w. ESTATE OF (_ r~ _ - , _ ~ ` ~ ~_ _ ~ FILE NUMBER v r r r -~.r~civ~i v -- {y v Do not complete this sch ule unless the estate is making the election to tax assets under Section 9113(A) of the Inhe nce 8 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 applies to the Trust (marital, residual A, B, By-pass, Un~ed 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 transferors personal representative may specifically identify the trust (all or a ftactional portion or percentage) to be included in the election to have such trust or similar 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 personal 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 of 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 NIA (If more space is needed, insert additional sheets of the same size) PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.