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HomeMy WebLinkAbout04-19-12J 1505610101 REV-1500 I:x(°1.1°~ 4~' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °"""'"`"'°`"`"`"°` Coun Code Year PO BOX 28o6oi INHERITANCE TAX RETURN ~ File Number Harrisburg, PA i'7i28-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O Suffix Decedent's First Name MI ~ A ~~ ~ c~ ,~ ~` Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Livin Trust (Attach Copy of Will) (Attach Copy of Trust) g 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAT ON SHOULD BE DIRECTED TO: Name C ~ ~ ~ ~ ~ ~ ~ Daytime Telephone Number REGIS~R OF WILLS USE ONLY First line of address _:t, ~~ /~ ~7 ,O .L7 ym _ Second line of address ~' ~!~- ~ ~ -, ., ~ -: .~ -• ~._~ -~~ ~S - .i..~ _~ ~ - ~ ~ City or Post Office '©DA~'E FILED ~ ~ State ZIP Code ~~ } Correspondent's a-mail address: _L(°Xx~~ /~ Ut ~~~~. ~~~~ 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 tru correct and complete. Declar 'on of preparer ther than the personal representative is based on all information of which preparer has any knowledge. S URE OF R N RES NS R FILING RETURN DATE ADDRESS ~ ,~ -r~ SIGNATURE O EPARER THER THAN REPRESENTATIVE I DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J FvEV-1500 E,X Page 3 Decedent's Complete Address: S ~~~ STREETADDRESS ~~ CITY G~~-~ ~.~ ~~ ~ 0 ,~ 6~ ~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. 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number STATE ~~ Total Credits (A + g ) ZIP/ ~~ / (2) (3) (4) (5) ~ (r-' ~ ~ ~ Make check payable to: REGISTER OF WILLS, AGENT. _ . ~ ~_: - PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCK 1. Did decedent make a transfer and: S a. retain the use or income of the property transferred :............... No 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 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 survivin souse i 3 percent [72 P.S. §9116 (a) (1.1) (i)], g p s 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)j. 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. 1505610105 REV-1500 EX Decedent's Social Security N`~umber Decedent's Name: ~ ~~ ~ ~ ~ ` RECAPITULATION 1. Real Estate (Schedule A) ............................................. L 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. 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. Total Gross Assets (total Lines 1 through 7) ............................ . 8. ~ 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. ' ~ ~~ L~ . L 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. I ,`~' ~ ~~ ~~ • ~ 11 ~ ~ `7 '`f ~ ~ ~ U 11. Total Deductions (total Lines 9 and 10) ............................... . .. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. J ~ ` `7 ~f ~ • ~' C~ 13. Charitable and Governmental BequestslSec 9113 Trusts for which ", ` ~ ~ ~ an election to tax has not been made (Schedule J) ...................... .. 13. ~ ~ 13 14 ~ ' ~ 6 ~ ~ 14. ) ...................... Net Value Subject to Tax (Line 12 minus Line .. . TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 a (a)(1.2) X .0_ . . 16. Amount of Line 14 a ble ~' 0 ~ ~ E~ C • ~ X 16. . at lineal rate 17. Amount of Line 14 taxable 17 '~ at sibling rate X .12 . _ 18. Amount of Line 14 taxable + 18 • at collateral rate X .15 . i ~wL • , - 19 ' ~ t~ ~ ~) 19. TAX DUE ...................................................... .. ... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1508 EX+ (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENT DE EDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~~ ~ ~ ~~ ~ ~7 -7~~ 177C ~ ~~ L ~~~ ~ TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) ~~- REV-1511 EX+ (10.06) scNEOU~E N cOMMONwEALTH OF PENNSYLVANIA FUNERAL EXPENSES $~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF~~L~-~ "`J'RR~-R ~~-d~ ~M J FILE NUMBER Debts of t must be reported on Schedule L ITEM NUMBER A• FUNERAL EXPENSES: DESCRIPTION C ~~ d_~/~~ ~~ ('~ a AMOUNT 1. T ~J ~~- ~~, his Pte-- - f-~ -~~~,,~-~e,e-L- P~,~~ ft~..~ ~n ~~ ~~r i U { ~ Gtr L~~z~ B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of Personal Representati s ~) __ Street Address --- __-_-_-- City -- -------- State Zip Year(s) Commission paid; - -- 2• I Attorney Fees 3• Fatuity Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address City State _ Relationship of Claimant to Decedent 4• Probate Fees _ 5• Accountants Fees 6• Tax Return Preparer's Fees 7. Ztp - TOTAL (Also artier on line 9 Recapitulation) I ; ~ ~~ (ff ~e space ~s needed msert add~4ona1 sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Report debts incurred by the decedent prior to d th FILE NUMBER ITEM ea which remained unpaid as of the date of death, including unreimbursed medical expenses. JMBER DESCRIPTION VALUE AT DATE 1' ~r~ ~ ~ OF DEATH ~ ~~-~ .~ ~~ U Imo; ~--~~~~,~~-~- ~~~ .. ~~~~~ ~ 7 ~ ~~~~ ~ . ,~~~ TOTAL (Also enter on line 1n Rar~ni+~d~F;,...~ a (If more space is needed, insert additional sheets of the same size) _ v '/ ~l /~ ,~~ . / ~~ REV-1513 EX+ (11-OS) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF-~ 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. ~~ ~- J A-~I1c°~ ~ Jz- I L A p ~ ~ ~~.~1~~~ ~.~~ ~ II RELATIONSHIP TO pECEpENT Do Not List Trustee(s) --~_ .~ o~ ~h~~- z~i~~-~,~,, FILE UU EBMN R AMOUNT OR SHARE OF ESTATE ~6u~ S~~-~~; ~ ~~~~- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, IS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1 Snn rnv~o ~~~~r If more space is needed, insert additional sheets of the same size. V `L /~ ~~~ o