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HomeMy WebLinkAbout04-02-121505610101 REV-1500 ext°1.1°~ , PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes oEP.A,ME~,oF INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisburg PA 1'7128-0601 RESIDENT DECEDENT ~" ~ ` ENTER DECEDENT INFORMATION BELOW ~ ~ ~~'~ // Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 95 Z~ 2257 0 2 I ~/2c~ I Z o32T19 y h Decedent's Last Name Suffix Decedent's First Name MI kuQY ~ ~ H~~ ~N (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 O 1 O' ' I ngina Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate O 4a. Future Interest Compromise (date of prior to 12-13-82) death after 12-12-82) O 5. Federal Estate Tax Return Required ® 6. Decedent Died Testate (Attach Copy of Will) O 7. Decedent Maintained a Livin Trust g Att 8. Total Number of Safe De o it B ( ach Copy of Trust) p s oxes O 9. Litigation Proceeds Received O 10. S ousal Poverty Credit (date of death p O 11 between 12-31-91 and 1-1-95) . Election to tax under Sec. 9113(A) CORRESPONDENT - THIS SECTION MUST BE COMPLETED ALL (Attach Sch. O) Name . CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: N I C ~< O Z~~ ~C In 2 0 Daytime Telephone Number ~ ~ - 7 J 7 .S g 9 7 ©7 y ,, ~, REGI;STE~O`F~yILLS USE•F1NLY ~~ ~ -; ~] First line of address ~q `''' ~ n ~ '~~_ °z't ~_~? ~~ r- fV ->~j _ Second line of address ~ ' > 1- - ~ ~: ` Q _;, _ ~ ~ _ -~ ~1J --i _+ t~-i City or Post Office State ZIP Code ATE FILED ~'' M 1 l Z€ Q S T ©w x~ ~ Q l 7 a 6 z Correspondent's a-mail address: /~ -1/G k K ~ P~ ~ F.r 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 is true, correct and complete. Declaration of preparer other than the personal re r t i , p esen at ve is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIB FOR FILING RETURN DATE ADDRESS ~- .~-- ~Qp, I ZOIZ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 i J 1505610105 REV-1500 EX ~1a-h~ ~Zw~y l ~ Decedent's Social Security Number Decedent's Name: _ ? 4 5 Z ~' 2 Z ,~- ~• RE CAPITULATION 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 Notes Receivable (Schedule D) ........................ ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. ~ 5 Z p , 2 7 6. Jointly Owned Property (Schedule F) p Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested..... ... 7. ~ 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. ~ 5 2 U ~ Z 7 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. S- Z or ~ 3 ( 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10, • 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. S 2 ~..~ I 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 7 q ~ 2 ~ --~ ~ 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 Tax (Line 12 minus Line 13) ...................... .. 14. 7 `~ a( 2, . 7 ~ ~H~ ~H~~u~At wN - stt 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 ~!S' ~j S `T +' G 7 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 33~.~7 `J °( ~0 7 O Side 2 ~, 1505610105 1505610105 J REV-1500 EX Page 3 rlennrlnn+~c ~_mm~lotp ACIfIYP_SS' File Number STREETAD~ RES ~ ~~~r~ ~ u ~_/_a~ ~i ALA ~. 4 srt - - M C~ ~ I ~ ~ - -- - I STATE n CITY t~o ~ r~ ~ .~ zlPZlP 17oG Z 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) 33-9. G ? Total Credits (A+ B) (2) (s) ~ (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 35~- G7 ~~.~ 3 2~ 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? ...................................................................... ^ 0 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 nen-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. REV4508 Ex + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF ~2 ~r.N ~'~ tZ H J o SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE EgMUN R Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Cc~F~3vt~s 13A~vk C ~~tc~ rtr ti ~ OF DEATH 2 c.-1[ ~ s 13a~~ ~ ~ /~Gcou+U'f 6~ao-~~~ y2g 7 389-ya 1 ( i3~.~T TOTAL (Also enter on line 5 Recapitulation) I $ JS'-S2o 2 ~J (If more space Is needed Insert addltlonal sheets of the same size) REV-1511 EX+ (10-06) ti" .. .m COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~~~~~~ yr SCHED~ILE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ueots or tlecedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT 1. ~iM~ R nnA n~ ~ Key fKn~eL >~,us~le F'u~vuw 1 P~yv-~w`~ Z ~ ralU'} ~C~O L7s ~'u+vQI~A ( ~a~ud YMQ.~,vR~w- ! 2~/Z. a7 Z 2e-~'i~es~ rne~-ts t y~ • SY 3 QoS~avSy ~,.r,ruexa! CGo~Knag _ t.! u ~ 1~0 S'!- C7~~ r c.e ~ S~N '~'~ r4t~ / 2 L . `75 ° ~ ~s ~ k 7 °~- e A~~S r $o a B. ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representative(s) Street Address City_ _ _ _ __ - _ - State Zip 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 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) ;' $ S 29, ~~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (11-08) 'i ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT Ft-T /ITC AC SCHEDULE ~ BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. A11GIfOLp~( 41uQ.+~la YO 'j w1eLNC7~~~' /k~~~as.3~`~1J Pb- Z rtiAR rte. /k lttR / L os~' -3 2 S'Z olOKt.w x~ !!7 S~ ~e..~ la ~,¢w- P~ RELATIONSHIP TO DECEDENT Do Not List Trusteelsl ~'a/U 77/1-L! gr `j~e2 FILE NUMBER AMOUNT OR SHARE OF ESTATE SO~o sod 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 COVER SHEET If more space is needed, insert additional sheets of the same size. ~ ~r~~~ t~I ~ it ~ .e~~~nt.e~t~ 4 j, HELEN KURLYO, a resident of ~ County, Pennsylvania, being of sound andpdisposing mindsand~memobyrland f do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all Wills by me at any time hereto- ' fore made. i I ITEM I. I direct that all my just debts and funeral expenses be paid as soon after my decease as may be found convenient. ITEM II. All the rest, residue and remainder of my estate, real or personal, which I may own or have the power to dispose of at the time of my death, I give, devise and bequeath, in equal shares, unto my son, Nickolay Kurylo, 409 Walnut Street, Millerstown, Pennsylvania 17062, and my daughter, Maria Mihailoff, 744 Barrymore ~ Lane, Bethlehem, Pennsylvania 18017. If either of my said children shall predecease me, his or her share shall go to his or her surviving issue, if anq, in equal shares, otherwise to my surviving child. ITEM IIT. In the event that I become terminally ill, I wish to Y y die peacefull and humanl without the benefit of life su pport systems. ITEM IV. I hereby nominate, constitute and a Nickolay Rurylo and mq daughter, Maria Mihailoff, Co-Executorms ofnthis my Last Wi11 and Testament, with full power in their discretion to do any and all things necessarq for the complete administration of my estate, with full power to sell at public or private sale and without order of court an real or ' y personal propertq belonging to m and to compound, compromise or otherwise to settle or adjustyanytand~ all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could do if living. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this 10th day of August, A.D., 1988. Si ned g sealed, published and declared th b ~ L (SEAL) y e above-named Helen Kurylo a , s and for her Last Will and Testament in the presence of us, who, at her request, in her presence and in the presence of each other, we believin h _ g er to be of sound and disposing mind and mem ' ~ .t ~~ ory, have here- unto subscribed our nam T - ; T (7 -. ~'' r es as witnesses this 10th day of August A D ~ -- ~'r-- r ~ ' _ ~% ~ , . ., 1988, = - _~ _-_ ~. -~~- .,, - . c_> ~ '_' ~ T ~ ' t,~ L~ G : '-t-~ I ~ ' i " ~ ~ j i " COMMONWEALTH OF PENNSYLVANIA ) f COUNTY OF DAUPHIN SS: I ~ WE, HELEN KURYLO, Harry G. Banzhoff and Jo Anne R. Foltz ` the Testatrix and the witnesses, respectivel ~ r y, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to be the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntar ac therein expressed, and that each of the wi y t for the purposes hearing of the Testatrix signed the Will asnwitnessiandhthatetonce and best of their knowledge the Testatrix was at that time ei hteen the of age or older, of sound mind and under no constraint orgundue years influence. t TESTATRI%: ~ Subscribed, sworn to and acknowlE~.s~u ~ before me, b ' and subscribed$andNswornLtOo beforesmetbyx~ ~ Harry G. Banzhoff and Jo Anne R. Foltz j the witnesses, this 10th day of August, ~" A.D., 1988. c ~ r' Notary Public LAi3Ri L. Lc~.i~i!(r~i, ~ i ~Y t~~1K'i ~ ~P+~i~ '~ WITNESSES: