Loading...
HomeMy WebLinkAbout06-22-121505610101 REV-1500 atO1-1°' , PA Department of Revenue penn~sMylvania OFFICIAL USE ONLY Bureau of Individual Taxes °`"`"~"` County Code Year File Number Po sox 280601 INHERITANCE TAX RETURN j Harrisburg, PA l~lzs-ohm _ __ RESIDENT DECEDENT6~p ~ 1 ~ ~,~ ~~ri~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedents Last Name Suffix Decedent's First Name MI (If Applicable) Enter Sunirving Spouse's information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Retum ~ 2. Supplemental Retum ® 3. Remainder Retum (date of death prior to 12-13-82) ® 4. Limited Estate a 4a. Future Interest Compromise (date of ® 5. Federal Estate Tax Retum Required death after 12-12-82) fi 6. Decedent Died Testate ® 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 C~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) behnreen 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytiurte Telephone Number REGIS i ER OF WILLS USE OPJLY First line of address Second line of address City or Post Office ST~ ~.~ T r~.a ~ ~ .~ r..V as ~7 - ~ ~. r ~ , ~~ :; =~ i ?~ N f' S'i .c'_'c~ ~ C'. C~ -... `TJ ~ a[$RTE FILED -~'= r-? ' . - ~, State ZIP Code Correspondent's e-mail address: ~~~/~ ~~~ ~~o /' Under penalties of perjury, l dedare that 1 have examined this return, inducting accompanying sd~edules and statements, and to the hest of my knowledge and belief lt is true, correct and complete. Declaration of pn:parer other than the personal representative is based on all informatan of which preparer has any knowledge. SIG U E O PER N R PON LE FO,R ILING RETURN LL ~ DA ~r . ~~~~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE r DATE ADDRESS _ ..._.. ..._ ._..,_ .. . ~-PLEASE USE ORIGINAL FORM ONLY~f~ Side 1 1505610101 150561D101 J 1505610105 REV 1500 EX Decedents Social Security Number Decedents Name: ~~~ / ~ ~~'~~ _. _ ~._.~_~~__.__,___ _w_._._ .___... _. __~~_.. _ , _.____. __ RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. ~j ~' ~,-~.` t ~' .-~- 2. Stocks and Borxis (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. ~ ~~ ~ lnr~~ • ~-~" 5~ 6. Jointly Owned Properly (Schedule F) C~ Separate Billing Requested ....... 6. ~ -~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly {Schedule G) ~ Separate Billing Requested........ 7. /~ 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. s' ~/>~~f ~~-i..-.-~" 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~>~ ° ~ ~~' . '~~ ~..•/ 10. Debts of Decedent. Mortgage Liabilities, and Liens (Schedule I) .............. 10. ~[ j/J. •-~ 11. Total Deductions (total Lines 9 and 10) ................................. 11. j- -.,,-c~,T.-~~} ~~~ / ~-,/ 12. Net Value of Estate (line 8 minus Line 11) .............................. 12. r C-~ ~ ~~~-~r 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has rat been made {Schedule J) ........................ 13. - C/ ~°'r 14. Net Value Subject to Tax (Line 12 minus Line 13) .... ... .......... 14. ~~ y"'' ''? ~~'L'~/ ' ~~ lam-' ~ . _~~_...~.~.~,~u_a~m.~ ~ ..._.:.- -._~ ,. ~.., ,_......._...~ ~ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ..~..._ ....e...m.._.. 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ . 15. • 16. Amount of Line 14 taxable at lineal rate X .0 ~' G~ ~ f~~j[,J . ---""" 16. ~ ~ G~o6. ---'-"' 17. Amount of Line 14 taxable ~ 1 at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE ......................................................... 19. • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C Side 2 1505610105 1505610105 Decedent's Complete Address: DECEDENTS NAQME, . /_ ~/~ ~N ~ ~~ STREET AD RE ~y` ~ i ~ --- -- CITY ~~ ~ /~' STATE~~ ZI / ©// Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 4. tf 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 refiurd. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (4) 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 properly, 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 Juty 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 p2 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a sunriving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are s611 applicable even if the surviving spouse is the only beneficiary. For dates of death on or after Juty 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)]. 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. ~~ ~ ~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESII)ENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE N SER ~i1~ 3 All real property owned solely or ass a tenant In oommon must be reported at fair market value. Fair market value is de ned as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. .....,,. ,, ,,r ...... ........... ... ~. ~.,..........~....~...~ .....,.......~ ~~~ au...., amc. REV-1503 EX+ (6-98) SCNEDVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TOTAL (Also enter on line 2, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH ~~~~ ~j~ , .~- i~V-1508IX ~ (7-9n SCHEDULE E COMMONWEALTH of PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. '" ~ o ~ o ~ ~"~" PERSONAL PROPERTY ESTATE//OF FILE NU~ER J Include fhe pn of litigation and the date the proceeds were received by the estate. All property joirrdyowned with the right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 5, Recapitulation) I S ~ ~ `t''~ ~,~~j. (If more space is needed, insert additional sheets of the same size) SCNEDVLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT w~rucvr w ITEM Debts of decedent must be reported on Schedule L A• FUNERAL EXPENSES: t. 6. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip --_ - 2• Attorney fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address Ciry State Zip _-_ -- Relationship of Claimant to Decedent 4. Probate Fees /~Af~~^+1L WIC~JP~U ~J~~F~ ~'Z'~ ~,,.,~ . 5. Accountant's Fees 6• ~ Tax Return Preparer's Fees ~'~-' ~ ~- ~~~ TOTAL (Also enter on line 9, Recapitulation) ~ $ (ff more space is needed, insert additional sheets of the same size) 7 ~,~--_ ' ~~Q _--- `~' Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE,NUMBER T ~ c-7 L=,~/~~.. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT 0 SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).j 1. / ~~ f-fg~ 5+7 ~" (.~77"f>.U J ~• ~4h1 G. J~ am ,c ~~~~~ ~a.~ ~.~~~~ ~~ /D c~~ ~i, ~v ~~ .~ ~tooo J ~~ ~Q~ ~+e~T/•/~r~S, mac-- 3~~~ ~jt~ ~-~ ~!~'' ~Li~ `~~ ~~ ~'~ .~'c~~~ ~~(p ~/~ ~,, P / jol ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON TAXABLE DISTRIBURONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN i. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, insert additional sheets of the same size.