HomeMy WebLinkAbout95-0305~, ~ 95- G'OS
This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health; for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
AUG 16 200T
Date
Fr eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
~ ~ ,. - ~. ,
COMMONW EALTH OF pENNBYLWWIA • DEPMRTMDIT OF HEALTH • VITAL RECORDS ~ ~ ~ A
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REGISTRAR'S SIONRURE R (
~ \ Q DRE FllEOIM«YI1. DeY. Kar)
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1. Real Estate (Schedule A) (1) ~ ~ ,
2. Stocks and Bonds (Schedule B) (2) 0 . =-
3. Closely Held Stock/Partnership Interest (Schedule C) (3) ~ ~~
4. Mortgages and Notes Receivable (Schedule D) (4) ~ - _
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ - `" -_
(Schedule E) -"
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6. Jointly Owned Property (Schedule F) (6) ~ r~
REV•tsoo Ex+ (7-ca) ~, FOR DATES OF DEATH AFTER 12131191 CHECK HERE
INHERITANCE TAX RETURN P
^
OVERTY CREDIT IS CLAIMED
-. RESIDENT DECEDENT FILE NUMB
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
(TO BE FILED IN DUPLICATE ER _
~ ` ~ ~ ~ 3~~"
DEPT. 2BObo1 WITH REGISTER OF WILLS)
HARRISBURG, PA 17128-0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRS AND MIDDLE INITI ) DECEDENT'S CJJMPLETE ADDRESS
W S IAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH ~'¢"" ~=a.,C.ca, U `a' ` ~lGl~
_.~
p IIF A-PLICABLE) SURVIVING SPOUS ' NAME ILAST, FIR ST AND MIDDLE INITIAL)
' SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
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' ~ ~ 1 ~-- 9~ ~ 9
~,
~ [a''1'Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
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^ 4. Limited Estate
^ 4a. Future Interest Compromise (for dates of death prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
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~ (for dates of death after 12-12-82)
c ^ 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)
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~ C MPLE M I IN
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vg TELEPHONE NUMBER '~ ~ ~~S ~~ ~~ ~ 1
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7. Transfers (Schedule G) (Schedule L) (7) U
8. Total Gross Assets (total Lines 1-7) (8) ~
9. Funeral Expenses, Administrative Costs, Miscellaneous (9) S ~ ~'~ ~ ~ ~
Expenses (Schedule H)
0. Debts, Mortgage Liabilities, Liens (Schedule I) (10) ~
1. Total Deductions (total Lines 9 8 10) (11) ~D j ~, coo
2. Net Value of Estate (Line 8 minus Line 11) (12) ~~
3. Charitable and Governmental Bequests (Schedule J) (13) ~
4. Net Value Subject to Tax (Line 12 minus Line 13) (14)
5. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse (15) x,_=
Side. (Include values from Schedule K or Schedule M.)
6. Amount of Line 14 taxable at 6M6 rate (16) x .06
(Include values from Schedule K or Schedule M.)
7. Amount of line 14 taxable at 159b rate (17) x .15
(Include values from Schedule K or Schedule M.)
8. Principal tax due (Add tax from Lines 15, 16 and 17.) (lg)
9. Credits Spousal Poverty Credit Prior Payments Discount Interest
~~~~
+ + - (19)
~. If Lins 19 is greater than Line 18, enter the difference on line 20. This is the OVERPAYMENT. (20)
1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21)
A. Enter the interest on the balance due on line 21A. (21A)
B. Enter the total of Line 21 and 21A on line 21 B. This is the BALANCE DUE. (21 g)
Make Cheek Payable fo: Rpisfer of WIIIsF Apent
over pena~nes oT psriury, i ascwrs root I have examined this return, including accompanying schedules and statements, and to the
is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other
~ssd on all information of which preparer has any knowledge.
"" . /.YYRCJJ
Zie• enc ~ ls'r i T ~~ ~f7Aa ~S~Y~ 1\LX
>t my knowledge and belief,
Le personal representative is
DATE
~ ~5'~9~'
DATE
Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for
the use of the spouse. The rates as prescribed by the statute will be:
• 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1 % (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98
• Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (~) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
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, . ..............
c. retain a reversionary interest; or ...................................................................................
d. receive the promise for life of either payments, benefits or care$ .......................................
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate consideration$ If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideration$ ...................................................................................................
3. Did decedent own an 'in trust for'. bank account at his or her death$ ......................................
IF THE ANSWER TO ANY OF THE ABOVE C~UESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
REV-1511 EX+ (7-B8)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
C.
f
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or
ITEM
NUMBER DESCRIPTION AMOUNT
A. Funeral Expenses:
B. Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative: _
Year Commissions paid
2. Attorney Fees
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
City State
4. Probate Fees
Miscellaneous Expenses:
Zip Code
TOTAL (Also enter on line 9, Recapitulation) I $ ~p (~ , O U
(If more space is needed, insert additional sheets of same size.)
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