HomeMy WebLinkAbout05-17-121505610101
REV-1500 Ex`°'-'°' ~!
PA Department of Revenue Pennsylvania
Bureau of IndividuaLTaxes ,r...... ~~INHERITANCE TAX RETURN
PO BOX 26o6os
Harriehum. PA i912R-0601 RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year Flle Number
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
I q ~ I 1 a l sl Zp Z8
~D`~'cedent's Last Name Suffix Decedent's First Name MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name SulFx Spouse's First Name MI
~ M~~. ~ R11''I
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
~ w to REGISTER OF WILLS
FILL IN APPROPRIATE OPALS BELOW
f 1. Original Return O 2. Supplemental Return
O 4. Limited Estate
O 4a. Future Interest Compromise (date of
death aRer 12-12-82)
O 3. Remainder Return (date of death
prior to 12-13-82)
O 5. Federal Estate Tax Return Required
~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attacn Copy of Will) (Attach Copy fi 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 OULD BE DIRExPED TD:
Name Daytime Tele~op~ Number,.,
First line of address
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Under penalties of perjury, I declare that I have examinetl this re[urn,including accompanying schedules and statements, and to the best of my knowledge and belief
it is true, coned and complete. DeclaraUOn of preparer other than the personal representative is based on all information d which preparer has any knowledge.
SIGNATURE E RES LE OR FIL9NG RETURN 59A~ I,,Z
R t
ADDRES~ _ r~ ~ ~~ w r, ~ ~~ ~'
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE T DATE
PLEASE USE ORIGINAL FORM ONLY
Side 7
1505610101 1505610101 J
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REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
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.
6. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5.
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.
9. Funeral Expenses and Administrative Cosfs (Schedule H) ................. .. 9.
10. Debts of Decedent, Mortgage Liabilities, antl 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 t4 taxable
at lineal rate X .0 J4`~`,
17. Amount of Line 14 taxable
ai sibling rate X .12
18. Amount of Line 14 taxable
at crollatera! rate X .75
1505610105
15.
16.
17.
16.
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
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