HomeMy WebLinkAbout05-03-12 (2) `
,
o~wawu.Eaar
Pt-Depai4aetdttaerie
ti~r~udLdeidurTarea t~~•
°'""`~'`Yas FieNUlEar
~ tliF1~tRANCETAX1lETUInM
~
R'~
~ r ~
I II
E~ t~cmeEr ~owru~oMasaw
9sdd Seasi)rMwi~er Dre d Daeth MtDD1'YYY Oars d tTilr IMtDOYYri
~~~
-
Oeoad.ts Lar gotna
Sldbc Decadai'a Fiat Marne rM
twraeer Ridts# L
lr~4P~M~ ~ar.rawlavrnrr"srraa..raa Brror
Spnrea'slartbnre SaAix 9perradaFretgame All
Spouse's soar SewNy Nnri6sr
'1iRS MIST BE FiED N 9HPLICAIE 9N01 THE
REG1~7'ER OF WILLS
ruw~or~awstaaaw
(~,. 1. Qt8lrat.Raem O 2 3rppkrrraY Rerun O 3. Nstairtls Reearr IDato d Deatlr
PNOr b tz-13ffi)
O ~_ Lima Elora O ~a FlrrraYWrer CmipranYSldrrr d O 5. FeAad E~Taa Rerm Regried
dM aSer 42-t2~
~ 6. Deoederi Died TeaYb O 7. Daoeawa rbraaasa a LA'i9 Tarr l S. Tarot NuMer d Safs Depodt Boma
(lltid-CaPJ d ~1 (A1Nr8 CAW' dTaN.)
O B. Precaarb Reeeiaes O 1Q Spaeet PMaM1y 4eQ ~alyd Deear O 7'1. E~eCY W~ b Tmc utlar $ac. 9113(A)
Babasr 12.11~9T oral t-tom (~ SquAuleO)
CORRESPDt1DENT- TX18 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENML TAX INPORMATN)N SXOULD BE DIRECTED TO:
Name Daytlme Telephone Number
C'1 ,~
--,
'°'°'~'t~otar
- ~"
~
'=z~-c'n ~ ~', to
~tlrodAddrees ~~m I
.v 4~ - `T~'
=
:
Seaad Lice dA6dteee .
J ~ rv ~ - ~ ~,.
.
-o -~` r
,y ,_..~
v'
d4r ar Poet aloe Slab ?p Ced OiltiE fti®
e
Fta~Mt~° PJ4 17108
CorncpondenYs amen address: mk
UrMer PeneMec of perjury, I OeNere areI I have
Aon~ S7" I-I Arta, srSr~~ ~ Yc~ I -) i
816AATUNE of PREPI1fiER OttBtT W W RtiTATTIE ~+ OATE
AooRESs
•• ~ ~ avrrc.rew ornr
~IAtl 4
3505610185
3505610105
J
' ~ 35Q561Q2fl5
aeFtsoo ec ~+)
oecedexstYe,~ Deiedar[e Social SLY tMmber
:=
- -
tl~c
t. APrrtustolt
RselESaL,~~d,aeuew) .........................................•--,
t.
2 SbrXe artl BUMs{3tlledWs~ ....................................... 2
3. Closely Held Carpocaiat. Palns~iP °~ s~ (9d+edde C) ..... 3.
4. L#ei~gee and NofosReoeirabN fS'hedds D) ........................... 4.
a caA. Bnrc Depodle aed riaaa0srws fMrewrk RaaadY P'~+e 4 ...... 5• 45,840.65
8. Aoe+ry Owtr~d ~ t8r)edels R O ~ sire ~4~ ....... &
7. rrr-vlwarraelaisBMeaerarrosWon~roealsPmpahr
(Sdiedis G) O Sapeaab Bi+C LOe4eebd:....... 7.
tL TaYlareelWeY{Yela-lirstNau~71 ............................. & '~~.6s
9. Feaari 6waees aidMninielwiYr Coeb (Sdwdtfe H) ...... . . . . . ........ 9. 2883-10
10. Debls of oeoedad. Lla~bege LhbiMS and Lkne{Sdbdds l) ............. . . t0. 8.807.33
11. TdM OdrGla~s Auld Linss 9 and 10)........ - .. . .................. . . 11. 11,3/0.3
12 MettW~dEfYe@.ina8rtiaisLintt) .............................. 72 33,880.22
t3. Cf®ila64andGarrww~wfalBegeegYSec9tt3TiuMetorWiuh
an eledbt to imc fgaaod been made (SclydiM J- . ....................... 13.
14. Ilea teilw.>avulyactLoTaa ~3ne 12~ieu l.tns t3) ......... . .............. t4. 3`Z~~
TAX CAL:OIA.ATION-~lEl/171gICflElr6iORAP'IRIL/1BLE. WiIEB
15. Amwrtdtlnaf4 Wrable
a<fba apowal fax raLS: or
yamise aster Sec. 9116
(ax11-X A_ t5.
1& Amaral of Line 14 beasbb
atiwefarLe X.0_ 16.
17. Amooetdli~el4ioedle
TTY
n 1,~A6.41
at albMngraLe x.t2 -
te. Amenncdlu~euLS.bte ?~4U1~"15- ttL 3.366.02
at adeteral reee X .ts
19. TAX DIE ......................................................... 19.
20. F#l~LTIEOttAt.EtlllLLAl1E ~ANt1116iAY1ARLF
L 1505610205
~i
1505610205
4.712A3
O
J
Ri?V49aD Drffll Pp3 FM lOm6u
Dtatts~nt's caw4lelaArldresa: ~~ /i- n~ 5~`
~~~ ~ 2, Lr s s~ e~
_
~~a ~a~ rQati
ctrv ~Gb2 ~t6 ~ e saw ~ ~? 6r-,~
Tax Ram and Ctaii~s:
1. TmrDaelPage2.t;refs)
2 psilPaymsrs
A Hior t
B. 06~
3. heist
tf)---y1 X12, y3
TalalQadlta(A+B) (2]
4 stire2iegieelerssr{jietrLie$sew. ThisitlheGtfE ~
Fi itaal as 1fye~tJr 7ltewyeeetanierd. (4)
5. n Lts 1 + Line 3 is greater dean line 2, enter the difference, This is the TAX DUE. 151 Y , 7 / '~ , y 3
---r
Make clteeit payreblft<tn: RESTER OF VIA~.tS, AtaEKI
PEEASEd1~ER'1~ FOI.L~fG Qll@Sf10gS 81f PU1pfIC I-N ~ N it1E/IPP~OPR~i€ ®LOCKS
1. DiddersderAmelaalanefxand: Ys No
a iei~rnawaarinmsdrrr~apergraaMened._.---__.......~....._........_...._.__.......,.._...._..........
b. ralainme6ghtbaeepetew+u,hd6uroaspuyatyf~fwAdarikirwvae,....._._........__ ..................._ ~ p
c eernarenw:esgtataeec_....__....__.._~.._.....__...__..__...__ ...................._.._....._............__...........
d. raaden+nepras.tQ~ted."l.rpay~r~ere,usr~baraee~-.._._._._......._._.._._._ .............._..._......._ ^
2. ttaesauoa.res.~a.i)ec.tzl~aideece~rrraratkrpepeitywlhinaneysraF9aen
3. Dlddecedstawae'NYUetb'a~lprikamae~tarsawiyatHaaherdeeM.._.......... Q
4. ptMoedantaen~ir6eidwiwfianentaaorwl.anilyaroMernoe~ptabelepmpeA)<atirh
mnYiisagsreieaydeeignim?............_._._......_ .............__._...._......_...._...---._.._..._.......__..__............^
F ilE.AI~ TQAN1f OF TfElll~11E q~TI0M818 YB, YOU M~f C01lLETE 9G~f 61U0 FLE ti ~MiIT OF TIE AkTURN.
Fadatasafdaarr ma~aterdfllr t, fast, and 6e6eJat. t, tee5~ rtei®c ralrinpoeedart Yte ~~ab~aftraelssb abrlfeutfaoftheaurwig spatrse
is 3 perfaett [72 P.S. y9tt6 W (t.t) (itl
Fa dales of dmflr m araftr Jir. t, 11395, the tptt wla itrfpaaed m tre set value of taimlars b ar bt ate are d the aunieitg > is 0 percale
(t2P.S§B31t3(a)(1.7)~i .ThaataYitdaesnotmrwlptahanakrbaasrieiigapouaeiamtar<.adYreabbluyregiiasenlafarQadosasaFasaeband
tigatarabn arealiappiralleaeen ifta sunieigspotne is'Wte arily btrrefdisy.
Fardebs of dealt on aaflx.Yiy t. 290D:
• The fart rate inpaead an Yfe netwalre of tanefss ham a detssed ofld 2S yearse aF age a Yaurger at deals b ar far the tree of a rratral patent, an
adofin peieaara eleppaiantatfthedtid is9pewertt[72 P.9 y91t9[a~f.2]].
• Thebawle3nfpaeedenthenatvabeafiartslsabafartheueeafihedeaedel'sireltaia4Spacaakaeceptasnokd"n[72PS:~118(a](1N-
The tax rate imposed on the net value ~ transfers b or fa the use of the decedents siblings is 12 percad p2 P.S. §9118(aH1.3)]. A sit>fing is defined,
ands Section 9102, as an imdividual who has at least one parent in comnwn with the decedent, whether by blood or adoption.
IIEKr5a8IX+~u-w)
E
aEew~we~roF~e CASH, ~NIC D~C~i' i'~'~ MISC.
~""~1101 P~SONALlMOPE~iY
xwESmea oe®aar
iiSr~ OF: P9.E IYil~t:
R-irlr~teelissur 2S'tt-C09ME
tndeAe the P~ of -and the dalethe P'a~s Here nacdMed M the estaoe.
~ PA~4ltiinlt went rrYilyrt afstteeloanit~ ntat M bdr~ • SdniMs f.
i. IA~ottl~etMhi~ P.'EP~tT>1~ lii~drttYlPFz7T 22.940.63
PIICBteLP:Q Bi1~ PMtltttt*Pk ' 1.49
2att~~~~~ 517.00
P~lrlinaeit~da6et~dea6laElidt~iiooe~ 4.908.53
~~~} 17,139.00
7~OpL (Ako utEp,~ an Line 5, litxaptluialfany ~ ` 45,040.85
If more space is needed, use additional sheets of paper oP the same size.
aev-isii ex< (io-ae~
9CHEDIILE H
~~~ ,~
~~~~ coders
~~
was ~ Ms.a
Richard Lee Lassner 2011-00966
Decedent's detds must be reported on SchoMde 1.
A. I RA19ML EXPBI58:
L
e. ~oPetasrwtrne t;~sts:
L Pldss~l Aep~M Camnissids:
time(s) sf Perseesl Aep~lise(s) _
Street lidless
6ry 9ase_ZIP
Yar(s) Caamiaion Paid:
L Awrnry Fees:
3. lssitr EoatgOm: (>f desedenCs addass is not thesame a oat's, amdt e~kretion.)
Ptak
meet ndies
Qy Stahe ~ Zip
Rdatlan~q of Oainnnt to lleQdaR
4- hoh~e leis:
i AavsatatFees
li. Tack Rtam Prepeierita:
Z ~~
~i~~i~'
~~IrE
t]i1wdE~afne
70TA1(Alm enter on Line 9, Nempibiatiolt) ~
if more space is needed, use additional sheets of paper of the same size.
. _ _
1,8'28.61
225.00
153.50
37.60
147.06
75.00
74.20
127.13
15.00
2,683.10
REV-1512 EX+ (12-08)
...
,~~
~~
SCHEDULEI
oars of ear,
~e~ ~
~~~'"~ 2atrr-aeoerF
•.•K.r~~ k ~r.e.r~ ~~+.+.u~.r.~.....r arww..n..r~ ~+s.~rr...e..rd.*.,.,~
L
It more space is needed, insert
Fai~M~Maxk
FiwE
~~
iN~ I~i~ife~If9~ierf ~19i~s pi~t~
Pi~9•f e1~o~li~0't N~
~IiaoE p~Fielrrdfile
PP[ ilicti>ies
70flil (Nsu enter an file 10, peopiliiiifln) ;
additlonal sheets of the same size.
4,920.23
121.07
37.32
160.33
49.67
139.62
51.36
70.75
14.57
81.03
87.43
109.31
26.90
21.74
39.26
188.99
23.08
10.39
339.62
161.00
1,132.00
711.68
8,897.33
aEV-ism oc+ ~oiao~
. .
w.
s ` pennsylvenia
~~
~~~
aori-
~r~r+~~~tr.~ar.a~,er.:r~~rr~a~
.r.aR~~wanl~~r~.i~iti.4.~~ e~w:ra~ rues
zt~~r etsttrlw.~.r.~ t7'1~
ensrawE war
b
L
E
L
~~
~~
~~
7a1R- '~ ~
k nwreal~t+e ht nmM~ use additlawl sheets of paper of the same six. •~
0
r~
v
c~
.u~
-~`~
ha
0
~ M
O
.~ r
r
~',t ~
~;:iV
~~4 ~~~ ~~: U~
~ p~^ • '~i
-r
m'~ ~ ~.FRK, ~ ~~_ r
~~ ,~ •., ;
,'.>'.
-~ f
"/
5
d
u
.'<'~fl
~'
~`; , N
~`
l~
M
n~ ~
v ~ ~ r
~ w
~~ ~ ~
~~ U