The URL can be used to link to this page

Home My WebLink About04-17-121505610105 REV-1500 ex coz_is, tom, en lvartia OFFICIAL USE ONLY PA Department of Revenue P ~Y County Code Year File Number Bureau of Individual Taxes ""~`"~ Po Box z8o6o1 INHERITANCE TAX RETURN Harrisburg, PA 1']128-0601 RESIDENT DECEDENT ~, ~ ~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ' 03/24/2011 i ' 05/11/1926 .......... Decedent's Last Name Suffix Decedent's First Name MI _. KAVASANSKY ' 'CARMELA ' R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received __ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Retum O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) O 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number __ CAMILLE K. HYDER (717) 557-7648 First Line of Address _ __ ', 1711 LOCUST STREET Second Line of Address... City or Post Office State ZIP Code -_ _ __ 'NEW CUMBERLAND PA 17070 REGISTER O~ JL~.3 USE OI~X ~ 3 r :'~1 _ - -gym - i;>=- 77 ~! % ~: J _. "Jti. ~ C~ DA1~ FILED -.:a ::O :- ~! ~ ,kt __ bra ~,7 (~ ~~ Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowk~dge and belief it is Vue, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN URE O~ PE SON RE PON I LE F R FILING RETURN _ / p~ AD RESS Logs e~ P~Cv~, >°,-la h~ ~ / 7D7tJ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 1505610205 REV-1500 EX (FI) Decedent's Social Security Number decedent's Name: CARMELA R. KAVASANSKY RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. ', 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. ', 0.00 4. 9 9 ( ) ........................ Mort a es and Notes Receivable Schedule D 4. ... 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 1,500.00 ', 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. ( 9 ) .......................... Total Gross Assets total Lines 1 throu h 7 8. ! ... 1,500.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. `, 0.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 0.00 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 0.00 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ` 1,500.00 ', 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. `', 14. J ( ) ..................... Net Value Sub'ect to Tax Line 12 minus Line 13 14. ; ... 1,500.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable ' ' ~''7 ~ 7 at lineal rate X .0 ~S 16• J ~ ((J 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 19. ...... ..................... TAX DUE ................ ........ ... . CS/ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610205 O 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEJ]~NTS NAME ^ I~ !~5 ll~r E L_ /(~\J ~ ~l V STREET ADDRESS ~,` @Yetrnon~ tJ~('S I n e ~~ ~~ ~ t~ c7vt ~rn'~'i'' ~~a~ C[atre~~rl~fi mad CITY a ~ Ise STATE PA ZIP -~S kv ~. Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments 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. r1) ~p7 Total Credits (A + B) (2) (/~ (3) , (0 3 (4) (5) `w (!~ ~ . / 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 ........................................................................................................................ ...... ^ 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 "intrust for" orpayable-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)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosureof 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(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)]. 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-> 508 EX+ (ii-a o) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDVLE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: CARMELA R KAVASANSKY 2111-0511 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size.