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Home My WebLink About09-06-12J 1505610101 REV-1500 ~"°"°' 41 PA Department of Revenue ~DFFICIAL USE ONLY pcnns ylvanfa Bureau of Individual Taxes PO BOX 28o6ot M Coun Code Year File Number ~ INHERITANCE TAX RETURN ~jr~1 ' Harrisburg, PA t9t28-o6ot ~ RESIDENT DECEDENT ~ ~' ~ 1 1 Date of Birth MMDDYYYY O ,I 3 ~ Decedent's First Name ~" MI ~ I~JI. F _ (If Applicable) Enter Surviving Spouse's Information Below Spouses Last Name Suffix Spouse's First Name MI , U k ii i ~ ~ 1 r C O !. A S ~~,..v~ ~-~ - -~ -°~ ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ ~-~ f ~ y ~ ~ 1 i-! ~- REGISTER OF'WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Retum 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 aker 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust e. 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 taz 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 T0: Name Daytime Telephone Number First line of address r -t7 I -iJ f.", r'. r._, r -, -i ~ -n C'> rn y6w Corcespondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tme, correct an~omplete. Declaration of preparer other than the personal representative is based on all inforrnation of which preparer has any knowledge. SIGNATURE OF P SON RESPONSIBLE FOR FILI , RFn Zara ..._- J W /./NOC1y pN. AYlA'<..~ /'/p /yU/S SIGNATURE OF REPARER OTHER THAN REPRESENTATIVE DATE ~,/c~r~-~(~IC,i Hd- n 13 AUL/c q - 4 - / o ADDRESS 3D S• lfAIV UUlin 5T- CAnbis/,~ A.a l70/3 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J REV-1500 EX Decedent's Name: 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. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 6. Jointly Owned Property (Schedule F) O 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 Costs (Schedule H) .:............... .. 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 11. Total DeduMions (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. I 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 18. Amount of Line 14 taxable at collateral rate X .15 15!]5610105 15. 16. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610105 Side 2 Decedent's Social Security Number O _J REV-1500 EX Page 3 Decedent's Complete Address: Flle Number DECEDENTS NAME Lucitr.c MY.(i~S --- -- STREET ADDRESS -- ----~- - -- - _-_._ /v f3 4 SPr~iw4-Rn. --- G h¢~NM1i oLFV_i A,tp6a• _ _ CITY STATE I ZIP -- rewv~ R i 7 2 ~/ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments __ B. Discount 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 retund. 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. (1) (3) o (4) v O 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 property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ^ G(] 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 Wstfor" orpayable-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 benefciary designation? .................................................................................................................. ...... ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE O 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 pz Ps. §s11s (a) (1.1) U)1 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(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 [%2 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. Total Credits (A+ B) (2) REV-1502 EX+ (11-OB) pennsylvania SCHEDULE A INHERRANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER ~ U[.itit ~ i'r~YkVT All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined 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. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. 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. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. /t/ ~/ Yh L ~, ~.0 YJONA HV~: MAWO.a- Rn~ r3kq T-Oiip r/J /SST'z- TOTAL (Also enter on Line 1, Recapitulation.) ~ ¢ ~7.~000 If more space is needed, insert additional sheets of the same size. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE Indude the proceeds of litigation and the date the proceeds were received by the estate. All properlypinty-owned with the vigM ohunivorship must be disclosed on Schedule F. NUMBER J-fam~ LO/vTnh.TS DESCRIPTION more space is needed, TOTAL (Also enter on line 5, Recapitulation) $ sheets of the same size) OF DEATH ~,yOd REV-1510 EX+ (08-09) ~pennsylvania SCHEDULE G ~~ii77 oEPnRlMeNroFReveNUE INTER-VIVOS TRANSFERS AND INHERITANCE TAx RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. REM NUMBER DESCRIPTION OF PROPERTY wauoE mErvnNE OrrHE ranrvsreaEE, THEIR aEUnorvsnly ro oECEOervr axo THE OnTe oFTanrvsrea. nTracnnmw or me oleo roaaear ESrnrE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION uE nvvucas~E) TAXABLE VALUE 1. F~nar ivr~rictix~ I3plvi~ IYc.q JG3 3 o icr]o l033~ /TRHNSFCKeq TO SjOOUSC /v/ci< Myltor TOTAL (Also enter on Line 7, Recapitulation) ; If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-06) SCNEDIJLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER L UC/l LL myi~~r Debts of decedent moat be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cvnris HrATH rGNenI9~ Hc:,,t< 9'GSrU d'O• /3oy 2/y ~200n Th ja G/t, JAR /~~~/ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address _ _ City State Zip _. _____ Year(s) Commission Paid: 2. Attorney Fees 3. Family Ezemption: (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. Probate Fees 5. Accountant's Fees 6. Tax Relum Preparer's Fees , 7. TOTAL (Also enter on line 9, Recapitulation) I $ 9 G d' o (If more space is needed, insert additional sheets of the same size)