Loading...
HomeMy WebLinkAbout05-03-12J 1505610101 R - PA Department of Revenue pennsylvaMa OFFICIAL USE ONLY oEFM1NEM 0i PFVFNYf C A ~4 PO BOX z8o6oi INHERITANCE TAX RETURN®e Yea~'f~ File Number Harrisburg. PA 371z8 o6Di RESIDENT DECEDENT IIIIIIIIIII" ~ EV 1500 °`i°'-'°' '~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY I ..~~ ~~ b (0 0 ~~ Decedent's Last Name Suffix Decedent's First Name MI (N Applleable) Enter Surviv ng Spouse's Information Below Spouse's Last Name MI Suffix us t Name ~ ' ~~ Spouse's Social Security Number ~-~-•*••~iiiil THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ ~~-+~_+-~"~~ _ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate 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 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. 9113(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 DIRECT2D T0: Name Daytime Telephone Number R ~ ~ "~ REGISTER OF WILLS USE ONLY !'1 f_~. L c Y, ~ First line of address ~ „~ s..,. ~~? r- r`r E' f ~ ~ ~. ~ f ~°•: r Second line of address :~~ ,~ -~ ,~~ ~=> r~~ ., ~~`r1 ~ C - t ~ ~TE FILED i ; ~ .. i City or Post Office State ZIP Code _.` ' -_,_ ~ nv Q -~ L7 Correspondent's e-mail address: R~t1N~ Under penakies of perjury, I dedare that I have examined this return, induding 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 representative is based on all information of which preparer has any knowledge. SIGNATURE AF~EJlSON RESPQy$IBLE F(gR FILUJG RETURN BATE ~ OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J J REV-1500 EX Decedents Name: 15D5610105 1. Real Estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporatbn, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and MisceNaneous Personal Property (Schedule E)..... .. 5. 6. Jointly Owned Property (Schedule F) O Separate 891ing Requested ..... .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) p 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 Liabilities, and Liens (Schedule I) ............ .. 10. 11. Total Deductions (total lines 9 and 10) ............................... .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 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. TAX CALCULATION -SEE 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_ 16. Amount of Line 14 taxable at lineal rate X .0 _ 17. Amount of Line 14 taxable at sibling rate X .12 16. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL tN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedents Social Security Number Q v O Side 2 1505610105 1505610105 REV+I500 EX Rage 3 Decedent's Complete Address: FIN Number DECEDENTS NAME /~ ~ STREETADDRESS to ~ ~Q~~@~~}~~~~ - __ CITY STATE ~ 21P Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Cred'itslPayments A. Prior Paymerds B. Discount 3. Interest 4. H 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) Total Credits (A + B) (2) (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (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 : ............................................ ^ 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 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(x)(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) [T2 P.S. §9116(x)(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(x)(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-7508 E%• It-0II SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, Ft MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECED NT ESTATE FILE NUMBER Indude the proceeds of Iitigatlon and the date the proceeds were received ~ the estate. All propeAy JolMly-owned with the right of survivorship must he dieciosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. pEp,~~-~~o~~,c~y sQ`d ~-~^1 ub~~e. Ac~~oty 3n~a.g1 P ~~~ ~~~~ ~~~5~ 3 53 N~, ~ ~ TOTAL (Also enter on line 5, Recapitulation) I i ~ ~q~ , ~ (If more space is needed, Insert additional sheets of the same size) ' REV~150B IX; (tin , ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY K an asset waa made joint vdthin one year of the decedent's date of dsratll, it must be reported on fichedub G. SURVIVING JOINT TENANT(S) NAME A, B. C. 1~INTLY-0WNED PROPERTY: RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identlfying number. Attach dead for jointly-bald real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ,. A. B.dJ ~{ ~ ~CS~t~i~ - ~ \ 1 _q c~5 ,'~ C~E.C.Y~io ~ I,a.R3.5o ~ (~3 b , ~'t\i~~'t1'k0.'~'j~,v~c ~R~©wpl~jt~u~ ~~.~ ~ ~ ~l\~~ t~ TOTAL (Also enter on line 6, Recapitulation) I i (If more space is needed, insert additional sheets of the same REV-1511 EX+ (10-06) scN~ou~ N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT~DECEDENT ESTATE OF FILE NUMBER of decedent must be reported on Seheduk L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ S (,V}~~ ~~,1-~~ \ VF..~V 1 ~1~~p ~$ G~q~ ~k~ a~ ~o .oo ~av~tio.a Uo~~ ~Q 5. o 0 C-`kma~~ ~ p~~ 3 50.00 ~ G ~,y ~ ~o , 00 3 ~ C~~~~~ I~r 60 e. ADMINISTRATIVE C05TS: , , 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. I Probate Fees 5. Accountant's Fees 6. lax Return Preparer's Fees I ~~ ~ C)~ 7. TOTAL (Also enter on line 8, Recapitulation) I ; C'~ j,~ $ ~ ~ o (If more sp~e is needed, inseA additional sheets of the same size) REW151$ EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEpULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by tha decadent prior to death whi h remained unpaid as of the date of death, including unreimbunted medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ut~t~+• TE.,1~,~~wN~ ~~ . yh o; ~ N~9 r~, ~~~~R 1 ~t~ . X11 ~'a~sh l~a~o C~MC.~S~, J0..9~ c~r1dF~;~s ~~,~ a~ ~ . ~o TOTAL (Also enter on line 10, Recapitulation) ; I ~',' ~, ~ (If more space is needed, insen additional sheets of the same size) ~,lS``~ npf~.a` ~d~ ~G ~3 ~~ ~~'~~