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Home My WebLink About07-26-12 (2)1505610101 REV-1500 ~ t°~_~°' '~ PA Department of Revenue Pennsylvania Bureau of Individual Taxes DEPNPTXENTDF INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 1128-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Decedent's Last Name Suffx (If Applicable) Enter Surviving Spouse's Information Below MI Spouse s Last Name Suffix Spouse's First Name Spouse's Social Security Number __ ~,_ FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return p 2. Supplemental Return p 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Return Required death after 12-12-82) p 6. Decedent Died Testate p 7. Decedent Maintained a Living Trust n V 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received p 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 DIRECTED TO: Name Daytime Telephone Number First line of address l y ~ ~ ~' i ~ ~'O /I ~ v c- ~ Second line of address City or Post Office Correspondent's a-mail address: ~ G Under penalties erjury, I declare that I have it is true, corre~d complete. [~claration of, SIGNA PERSON R ONSIB ~~` 1~A ~ ~ SIGNATURE OF PREPARER O~FiER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS St 3(P ~~` OFFICIAL USE ONLY County Code Year File Number Date of Birth E.1h1DDYl'Yl' Decedent's First Name MI ZIP Code REGISTER OF WILLS USE ONLY n~ n r-~ g C r-} ~ ~ ~' ~,~, f + d1 ~ ~J r- _,w ~~ILED r ~- r-7 r~~ -~„t t"7 r;~ return, including accompanying schedules and statements, and to the best of my knowledge and belief, than the personal representative is based on all information of which prepyer has any knowledge. J REV-1500 EX 1505610105 Decedent's Social Security Number Decedent's Name: RECAPITULATION ~ : J ' ~ pG- 6,; ~y~ , 1. Real Estate (Schedule A)...... , , , = 2. Stocks and Bonds (Schedule B) ............... ~ ;~~rvx~~,; ''' "' • ................. .. ..... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C ,. .~ `L' "' r: '~. ) ~ . , , , , 3. 4. Mortgages and Notes Receivable (Schedule D) ....... , l i .r~ ~ - '"~~''*~' ............... ..... 4. ° 1. ~ 5. Cash, Bank Deposits and Miscellaneous Personal Pro e P rtY (Schedul E ~.. ~~ '~"~~ k e )... ---------~.._.~- ~ .... 5, 6. Jointly Owned Pro a p rty (Schedule F) O Separate Billing Requested 7 =•" ' ''~y" ~ ~ rvM•~ ~ ° ... . Inter-Vivos Transfers !~ Miscellaneous Non-Probate Property (Schedule G) ... , g. _ ~~ _~____. ~ ~.° `~ O Separate Billing Requested.... .... 7, .• :A ~ -~' 8. Total Gross Assets (total Lines 1 through 7) ...... ~' _ ~~ ~ ~''~+-x .. ................. ~ .... 8. " ~ j 9. Funeral Expenses and Administrative Costs (Schedule H) . ~ r . .............. , ~_~` ~ ^ .... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ` ~- . - - T~iwu~'iY ~.. Ysd . ...... , , , 10 11. Total Deductions (total Lines 9 and 10) ......... ~ +~ ~~~~t`~~x ..................... ... 11. _ 12. Net Value of Estate (Line 8 minus Line 11) ........ ~ ~ ~ ~ ~ ................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for whi h ... 12 _~___r- c an election to tax has not been made (Schedule J) .... ~ s,:~.~~;~,w1 =, ~ ~ ~~ ~ ~ ~ ~"~~ ' ................. ... 13. ; 14. Net Value Subject to Tax (Line 12 minus Line 13) ... . -. ;~,~ v.,~ . ~ . ,~.~ "` `~ . ........ TAX CALCULATION -SEE INSTRUCTIONS FO ... 14. _ ~J-i R APPLICABLE RATES ~ ~" ~- 15. Amount of Line 14 taxable at the spousal tax rate or , transfers under Sec. 9116 ~ ~ 16. Amount of Line 14 taxable , 15 at lineal rate X .0 _ ~_ • ' ~ ' 17. Amount of Line 14 taxable ~~ Y ~. ~ ~ =~': `~?x~-~_iKid;~-`sue-~'1~; - =~a 16. at sibling rate X .12 ~ 18. Amount of Line 14 taxable ~ ~ 17. at collateral rate X .15 . >_ - ~ ~ . ... ,~ .; ~ .~ 18. 19. TAX DUE ............... . r ,..,,~ .............. .......................... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT :,: ~F'~ -• 1ti u ~~~ -fit ---r. . {C~;. ,., ~.. t~,~ ~~,j.. y O 1505610105 Side 2 1505610105 J REV-1$UO EX Page 3 Decedent's Complete Address: Fite Number 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. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) - v ~--- ~- Make check payable to: REGISTER OF WILLS, AGENT. y ,, _. >~~-~~:: ~:~::_~~ F.~:t ~ :_~~~~-~~~~.~~-;,..< ~:~ ~~~-~ ~ -.4 ~ ~+~ ;,fig PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :.......................................................................... Yes 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?. .. ..... 4th. 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 beneficia desi nation? ....................................... ry 9 ................................................................................. ^ IF THE AN~S,,WER TOsA~NY OF THcE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. M1'-!~"~rz,'::T'fi.'~a ~~'~e-`~°~'g~.T~'',~"L'~:.~sa2Y°", .}~,~ ,. s 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)J. 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)J. • 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. Tax Payments and Credits: v 1. Tax Due (Page 2, Line 19) 2. Credits/Payments (1) --'p A. Prior Payments _ B. Discount - ,REV-1502 EX+ (11-08) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE ~a,~ ~ ~ p ~~'j'~FILE'NUMBER ~- All real property owned solely or as a enant in common must be reported at fair market value. Fair market value i~~ine~~h~~~hich propert 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. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F, y Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. ~~~ ~ I ~v TOTAL (Also enter on Line 1, Recapitulation) I $ ~..~ If more space is needed, insert additional sheets of the same size. REV-15p3 EX+ (6-98) S~ COMMONWEALTH OF PENNSYLVANIA NEDVLE B INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF ~C e ~ ,{ ~j ~ FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedu~ ~ ~~ ~~ ITEM NUMBER PTION /lI~/1 °t, VALUE AT DATE OF DEATH ~~ TOTAL (Also enter on line 2 Recapitulation)~$ --d (If more space is needed insert additional sheets of the same size) REV-1504 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT w~n~G Vr ~rac SCI~IEDIJLE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ~~ ~ FILEFILE R ~ ,t ~~~~eauie ~-i or C-2 (including all supporting information) must be attached for each closely-held corporation/partnershiprest of the d~ed n~her than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER DESCRIPTION VALUE AT DATE 1 ~ OF DEATH TOTAL (Also enter on line 3, Recapitulation) $ ~ (If more space is needed, insert additional sheets of the same size) ' REV-1505 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF c9- r c~ 1. Name of Corporation Address City 2. F deral Employer I.D. Number 3. Typ of Business _ 4. STOC TYPE Vntinn/Nnn_vnf~.... Common Preferred Date of Incorporation State Zip Code__ Total Number of Share Business Reporting Ye ~_ Product/Service TOTAL NUMBER OF SHARES OUTSTANDING PAR VALUE NUMBER OF OWNED BY THE __- - P 5HA S VALUE OF THE D EDENT DECEQENT'S STACK $ ----_ rowde all rights and restrictions pretaining to each cl s of stock. 5• Was the decedent employe y the Corporation? If yes, Position •••••~~•••• ••••. ^Yes ^No Annual Salary $ Time Devoted to Business li• Was the Corporation indebted to th ecedent? ....................... . If yes, provide amount of indebtedness ' • • • • • • • • • ^Yes ^ No 7• Was there life insurance payable to the core ation upon the death of th decedent? . If yes, Cash Surrender Value $ • • • • ^Yes ^ No Owner of the policy Net proceeds payable $ 8. Did the decedent sell or transfer an stock in this compa within n if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Transferee or Purchaser Attach a separate sheet for additional transfers and/or ales. o 9. Was there a written shareholder's agreement in effec t the time of the If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ........ . year prior to death or within two years Number of Shares _ leration $ Date death? ....^ Yes ^ No If yes, provide a copy of the agreement of sal ,etc. ~ ~ ~ ~ ~ ~ ~ ~ ' ~ ' ' ' ' ' .......... ^Yes ^ No 11 Wy Sthp ovoideoa breakdown of d'stryibudtiote received by the a fates ntcludin dates . ^Yes ^ No 9 and amo is received. 12. Did the corporation have an interes In other corporations or partnerships? .. . If yes, report the necessary infor tion on a separate sheet, including a Schedule C-1 or C-2 f Yeach^inNerest. A. Detailed calculations used i he valuation of the decedent's stock. • B. Complete copies of finan al statements or Federal Corporate Income Tax returns (Form 1120) for the year of death a C. If the corporation owns real estate, submit a list showing the complete address/es and estimated fair market value/s. If been secured, attach opies. D. List of principal st holders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, th it salaries, bonuses and any other benefits received from the corporation. F Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) SCI~iEDULE C-1 CLOSELY HELD CORPORATE STOCK INFORMATION REPORT FILEFILE R State on Incorporation 4 preceding years. d state appraisals have REV-1506 EX+ (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~~u ~P 1. Name of Partnership City 2. Federal E loy 3. Type of Busine 4. Decedent was a 5. I A. B. C. D. I.D. Number ProducUService FILE NUMBER ~ ~Q~pC. - Date Business Commence Business Reporting Yea _ State Zip de General ^ Limited partner. If decedent was a limited partner, provide NAk1~ PI~EtV PEFtC1~NT OF tNCONE t~ f3WHEHS~iip~ ~I investment $ CAf }'1~A,g LEA COUNT --- - -- ~_ 6. Value of the decedent's interest $ 7• Was the Partnership indebted to the decedent? ... .......... ................. ^Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the If yes, Cash Surrender Value $ Owner of the policy 9. Did the decedent sell or transfer an interest in this pa ersh prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ale Transferee or Purchaser Attach a separate sheet for additional transfe and/or sales. ath of the decedent? ..... ^Yes ^ No Net proceeds payable $ ip within a year prior to death or within two years if the date of death was Pe ntage transferred/sold - Consideratio $ Date 10. Was there a written partnership agreement ' effect at the time of the decedent's death? . If yes, provide a copy of the agreement. • • • ^Yes ^ No 11. Was the decedent's partnership intere sold? . ...................................... ^Yes ^ No yes, provide a copy of the agreem t of sale, etc. 12. Was the partnership dissolved or ' uidated after the decedent's death? . If yes, provide a breakdown of ' tributions received by the estate, including dates and amounts receive ^ No 13. Was the decedent related to ny of the partners? .......... , . If yes, explain '••"""••••••••••••••• ^Yes o • ^Yes ^ No 14. DYesheeport thehneca sary infoemation on a separate' sheet,pncludingla Schedule C-1 or C-2 for each interest. • • ~. ~ A. Detailed calculati s used in the valuation of the decedent's partnership interest. , , B. Complete copi of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 p cedin C. If the partner ip owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estat app a salsrhave been secur d, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. SCHEDULE C-Z PARTNERSHIP INFORMATION REPORT REV-1507 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF .~- SCI~IEDULE D MORTGAGES & NOTES RECEIVABLE L ~) FILE NUMBER All proper yjointly-owned with right of survivorship must be disclosed on S~~~ .. ~~~ ITEM NUMBER DESCRIPTION VALUE AT DATE f~ ~ ~ OF DEATH 1. /V `- TOTAL (Also enter on line 4, Recapitulation) $ ~-- d (If more space is needed, insert additional sheets of the same size) REV-1508 E%* (1-97~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. Alf ro ~ 0 v ITEM P party jointly-owned with the right of survivorshiM must be disclosed on Schedule F. NUMBER DESCRIPTION VALUE AT DgTE - OF DEATH ~~~ ~ ~ ~-~- c~ ~ --__.m_ _- TOTAL (Also enter on line 5, Recapitulation) $ ~-~---' ~ ~ ---~ (If more space is needed, insert additional sheets of the same size) REV-1509 EX . (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF ~ `~ ra L ~ FILE NUMBER ,} If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. ~ ~ + Ov ~~ SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIP N OFPROPERTY ITEM FOR JOINT MADE Include name of financial institution and bank ount number or similar identifying number. Attach DATE OF DEATH NUMBER TENANT JOINT % OF DATE OF DEATH deed forjointly-held real estate. DECD'S VALUE OF VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6 Recapitulation) I ~ r----~' ~ ~'"-~ (If more space Is needed Insert addltlonal sheets of the same size) REV-151.0 EX+ (08-09) ~ ' Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ITEM i SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY -~ This schedule must be completed and filed if the answer to and DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY Of THE DEED FOR REAL ESTATE. Nv ~ L°, FILE NUMBER ~~~ ~ Zvi or questions 1 through 4 on page three of the REV-1500 is yes. DATE OF DEATH % OF DECD'S EXCLUSION VALUE OF ASSET INTEREST (IF APPLICAgLE> TAXABLE TOTAL (Also enter on Line 7, Recapitulation) $ ~-----v If more space is needed, use additional sheets of paper of the same size. ~~ REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ITEM NUMBER A• FUNERAL EXPENSES: 1. SCNEDt1LE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ~~ Debts of decedent must be reported on Schedule I. FILE NUMBER ~~ S_ I ADMINISTRATIVE COSTS: 1 ~ ~ Personal Representative's Commissions Name of Personal Representative(s) -._ - -_ - i Street Address - - _ - _ _ -- - -_ ___ - -- _ City - - - ~- ---__ State Zip _--- - `!ear(s) Commission Paid: - - - -- ~~ ~ Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant - - -_ Street Address - __ _ - - City - -------- I ~- State ZiP - _ _ - - - Relationship of Claimant to Decedent -_ a_ Probate Fees ~~ { Accountant's Fees iI S~ Tax Return Preparer's Fees I T ~ i TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) _ ~ ~J REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCI~iEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS v ICJ ~~ FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM JMBER DESCRIPTION I VALUE AT DATE TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) -^~ _~ REV-1513 EX+ (11-08) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE ~ BENEFICIARIES FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Do Not List Trustee(s) Sec, 2116 (a) (1.2).] 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION, 1. / 1 r .. ~~~ AMOUNT OR SHARE OF ESTATE ON LINES 15'~HROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 13 FOR WHICH AN ELECTION TO~X IS NOT TAKEN B. CHAfjyfgBLE AND GOVERNMENTAL DISTRIBUTIONS 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. REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE K LIFE ESTATE, ANNUITY & TERM CERTAIN ESTATE OF heck Box 4 on REV-1500 Cover Sheet (.9~/`"~ G e ,~ FILE NUMBE ~ This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of d~~prior ~5 gg actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other - - • NAME(S) OF LIFE TENANT(S) NEAREST AGE AT .DATE OF BIRTH TERM OF YEARS DATE OF DEATH iIFE ESTATE IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ................ . 2. Actuarial factor per appropriate table ............ $ Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) % ^ ~~ NAME(S) OF LIFE ANNUITANT(S) ,NEAREST AGE AT DATE OF BIRTH TERM OF YEARS DATE OF DEATH ANNUITY tS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable .................. . 2. Check a ro date block below and enter corres ondin $ PP p P g (number Frequency of payout - ^ Weekl 52 ) ~ ~ ~ ~ ~ ~ • ' ' ' ' ' ' ' y ( ) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other 3. Amount of payout per period ...................................... (. , ) 4. Aggregate annual payment, Line 2 multiplied by Line 3 ~ ~ ~ ~$ ................................... 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see instructions) % ....................... 7. Value ofannuit ° ° ~•~~~~~""""'~~•••• y - If using 31/2 /°, 6 /°, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the a (If more space is needed, insert additional sheets of tphe same s ze) x rate on Llnes 13 and 15 through 18. REV-1644 EX + (3-04) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I. ESTATE OF (Last Na Thic crhn.i..~,.:_ INHERITANCE TAX SCHEDULE L OR INVAS ON OF TRUST PRINCIPAL ~ FILE NUMBER nZ /j~,- ~~ ~~ (First Name) III. ---•- •~ ~rr~~N~~a~e onry for estates of decedents dying on or before December 12, 1982,'~'uu~emrtiaq This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on B. Name(s) of Life Tenant(s) (Date) or Annuitant(s) Date of Birth Age on date Term of years in e of election or annuit I Payable II. C. Assets: Complete Schedule L-1 1. Real Estate ........... . 2. Stocks and Bonds ......... . 3. Closely Held Stock/Partnership .. , ... . 4. Mortgages and Notes ........... . 5. Cash/Misc. Personal Property ... , .. ..~~...$ 6. Total from Schedule L-1 ........... . D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ........ ,>!~•~. ~" 2. Unpaid Bequests ... . 3. Value of Uninclu le Assets 4. Total from edule L-2 ................................. . E. Total V e of trust assets (Line C-6 minus Line D-4) .. , , , , . . F• cinder factor (see Table I or Table II in Instruction Booklet) $ ......................... G. Taxable Remainder value (Line E x Line F) ............... . (Also enter on Line 7, Recapitulation) ~ ~ • ~ • ~ ~ ~ ' ' ' ' ' ' ' ' • ~ ~ ~ • • •$ -'_~d~- INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) 6. Name(s) of Life Tenant(s) or Annuitant(s) Date of Birth Age on date Term of years income corpus or annuity is pa is consumed C. Corpus consumed ..................... D. Remainder factor (see Table I or II in Instruction Booklet) ................ . E. Taxable value of cor ~ ~ ~ ' • • ' " nsumed (Line C x Line D) ........................ .-~_ C~ (Also enter on Line 7, Recapitulation) • • • • • • • •$ REY-1645 EX+ (7-85 INHERITANCE TAX COMMONWEALTH OF PENNSYLVANIA SCHEDULE L-~ INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- I. Estate of ~ (Last Name) 11. Item No. (First Name Description A. Real Estate (please describe) Total value of real estate (include on Section II, Line C-1 on Schedule B. Stocks and Bonds (please list) Total value of stocks and bonds (include on Section II, Line C-2 on Schedule C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership (include on Section II, Line C-3 on Schedule D. Mortgages and Notes (please list) Total value of Mortgages and Notes (include on Section II, line C-4 on Schedule E. Cash and Miscellaneous Personal Property (please list) (include on Sedion~Il,~L'ne Cry on S hedule L) ~~~• TOTAL (Also enter on Section II, Line C-6 on Schedule L) (If more space is needed, attach additional 8%z x 11 sheets.) FILE NUMBER /~ `Od~, Middle Initial) Value S S S ----- ~ _ -~- ~~ S.""`-C~ -- v ___-_ S --- ~_~ _--- REV•1646 EX+ (3-84) COMMON WEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT L Estate of II. ~ Item No. INHERITANCE TAX SCHEDULE L-2 REMAINDER PREPAYMENT ELECTION -CREDITS- (First Name) FILE NUMBER ~ -~ ~~~~ A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) (Middle Initial) -~- Amount Total unpaid liabilities (include on Section II, Line D-1 on Schedule L) $ ~- B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests (include on Section II, Line D-2 on Schedule L) $ C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under -^ "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets (include on Section II, Line D-3 on Schedule L; II1. TOTAL (Also enter on Section II, Line D-4 on Schedule L) (If more space is needed, attach additional 8%z x 11 sheets.) s _ v ~,_ $ ~~ ~~~ REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~'NT~T~ w Box 4a on Rev-1500 Cover ~neet -....+. ~ yr FILE NUMBER This Schedule is appropriate only for estates of decedents dying after December 12, 1982. ~~/~ r d [i This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vest possession and enjoyment cannot be established with certainty. Indicate below the s In type of instrument which created the future interest and attach a copy to the tax return. ^ Wtll ^ Trust ^ Other I. Beneficiaries 1. 2. 3. 4. BENEFICIARY 5. II. For decedents dying on or after July 1, 1 9 months of the decedent's death, check the exercises such withdrawal right. ^ Unlimited right of III. Explanation of Compromise Offer: RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY if a surviving spouse exercised or intends to appropriate block and attach a copy of the do ^ Limited a right of withdrawal within in which the surviving spouse of withdrawal N Summary of Compro ise Offer: 1. Amount of Futu Interest ............. . ................... .. 2. Value of Li 1 exempt from tax as amount passing to charities, etc. (also in de as part of total shown on Line 13 of Cover Sheet) ......$ 3. V e of Line 1 passing to spouse at appropriate tax rate (also ncOlude as part of total^sho°/wn ^ L~'n/e 15 of Cover Sheet) $ 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% .... . (also include as part of total shown on Line 16 of Cover Sheet) $ 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ........ . SCHEDULE M FUTURE INTEREST COMPROMISE ~~~ ~iwie space is needed, insert additional sheets of the same size) REV~1649 EX. (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF FILE Do not complete this schedule unless the estate s making the election to tax assets under Section 9113(A) of the Inher~ nce ~~ T If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election a lies to the ax Act. If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and Trust marital, residual A, B, B -ass, Unified Credit, etc. . b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in th lection to ha similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a tax le transfer on personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The nu rator of this fraction such trust or the amount of the trust or similar arran ement included as a taxable asset on Schedule 0. The denominator is a ual to the total valu of the trust or simi Schedule 0, the equal to PART A: E er the description and value of all interests, both taxable and non-taxable, regardless of loc lon, which ar arran ement. survivin sou under a Section 9113 A trust or similar arran ement. ~~ ^^,_T.__ pass to the decedent's PART B: Enter the description and value of au intpro~-~ ;.,,.I ,~ Part A Total y ~~~ ,~ ~,,~u~e n Part A for whir tnA co..tl~n 8113 DESCRIPTION "v~~ (If more space is needed, insert additional sheets oatheBsames ize) SCHEDULE 0 ELECTION UNDER SEC. 9113(A) /@17/1 ~n ~ . ~._---- ._--- election to tax is being made. ~--~ ~ -~