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HomeMy WebLinkAbout95-033250107303 ism 3c' ~ ~° REV-1500 EX+ (7-94) r / ~(~~` COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 TY CODE ~ ~ YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) Q~ ~~ ~= NUMB 1-- ~~ ~'!L rtJ ~-S'lo ~'/e s s ~ 4 1. l/ /~~ ~ ~qE. 2 oJ5` W SOCIAL ECURITY NUMBER pAq~ o D IRi++ ~"IC cHW1a?~/c-/~4s2G„~ /~ ~ 70.33 = Ce /~D W ZG ~ - 38- jOZ. p //7 ~ yoj ~~,z,3~/ q qy ~ ~4ut~e~,,J p (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST ANO MIODIE INITIAII SOCIAL SECURITY NUMBER COVm - l AMOUNT RECEIVED (SEE INSTRUCTIONSI V Yay ~ 1. Original Return ^ 2. Supplemental Return =oo ^ 4• Limited Estate ^ 4a. Future Interest Com romise c' ~ m (for dates of death after 12-12-82) a ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) A11 f`ASSec•nwu.......- ^ 3. Remainder Return (for dates of death prior to 12.13-8 ^ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes -~~~ ...+Rlcc~rvrvuttv~C AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~" NAME .r;,c ; _ w COMPLETE MAILING ADDRESS ~o ~, "' W ~~WYN' ~- °~ ~-~ ~ ~~~=mil. lj~ v ~ TELEPHONE NUMBER 1 ~C.~=7~ r7f D/.5^ ~c::/cam.~co Gwc ~~{', ~ 705' - ~o/S z 0 d a W z 0 i= d 0 v s.c is Ide. (Include values ram Schedule K or Schedule M.) x'-~-= 16 A 1. Real Estate {Schedule A) (1) .~©~ ']~`?9 2. Stocks and Bonds (Schedule B) (2) ,,.,®„_ 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) .2y~3 (Schedule E) b. Jointly Owned Property (Schedule F) (b ) 7. Transfers (Schedule G) (Schedule L) (~) _~- 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 8j~s'~ 7 Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) C~ ~8~ 11. Total Deductions (total lines 9 $ 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) 15. Spousal Transfers (for dates of death after b-30.94) See Instructions for Applicable Percentage on Reverse (15) "~-' S' f -^8'- mount of Llne 14 taxable at 696 rate - __T~ ~ ~ 7~ (Include values from Schedule K or Schedule M.) (16j 3~ ~yC` x .O6 _ 17. Amount of Line 14 taxable at 1596 rate (17) ~_ (Include volues from Schedule K or Sch d I M x .15 . _ ~- 1. If Line 18 is greater than Line 19, enter the difference on Lins 21. This is the TAX DUE A. Enter the interest on the balance due on Line 21A. B. Enter the total of Line 21 and 21A on line 21B. This is the BALANCE DUE. Make Check Payable to: Register of Wills, Agent e u e .) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + + _ 0. If Line 19 is greater than Line 18, enter the difference on Lins 20. This is the OVERPAYM '~ " • ~ D BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~~ ~ under penalties of penury I declare that I have examined this return mcluding accompanying schedules and statements, and to the best of my knowledge and belief, t Is true correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is posed on all information of which preparer has any knowledge. I N T RE OF PERS SPOt~ISIBLE R FILING RETU~RAN / AD/DRESS 1~ / / /~ ..-.. ~~~ ..~~o/ i-1 t'SSiG~~I / 1/~4 ~'. l U ~.l~c~ IJ` ~~(~!'i / ~/~ DATE _ r~~ ti (121 ~ ~ ~ S~~ (18j ~/~.5~. 7 ~i (19) (20) (21) JT.~'~~. 7(i (21 A) -- (21 el ,,/~~'~~ 7 a ~~~ FOR DATES OF DEATH AFTER 12!31/91 CHECK HE IF A SPOUSAL POVERTY CREDIT IS CLAIMED ^ r11.n NUMBER • ~7L~i/i~a rJ ~. ..siyi4t ~c 2l ~j- 38- ?c 2v 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% (.O1j 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. 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 considerations 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 QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. • REV-1502 EX+ (12-85) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER -_S~7LBiy.O~n,1O SNjl.>r!? ~~c ~i -.~3-702G (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled ~ REV-1503 EX+ (4-86J ti ~. ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B 5TOCKS AND BONDS VC (All property lo~ntly-owned with Right of Survivorshia must be disclosed on Se6edule F_1 REV-1504 EX+ (7-83) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE "C" CLOSELY HELD STOCK, PARTNERSHIP AND PROPRIETORSHIP '-~ ~ r+' ~ ~~ rlLt NUMtStF( (Schedule "C-1" or "C-2" must be attached for each business Interest of the decedent, other than a proprletorsh.ip.) ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 3, Recapitulation) 1 $ ~~-, (If more space is needed insert additional sheets of same size) ~ REV•1507 EX+ (7-68( `• ~ SCHEDULE D MORTGAGES AND NOTES COMMN ERITANCETAXERETURNANIA RECEIVABLE RESIDENT DECEDENT Please Print or Type ESTATE OF FILE NUMBER 4EiiJ ,-~i/ ~0~2 - 02© (All property jointly-owned with th• Right of Survivorship must bs disclo:ed on Schedule F.i (If more space is needed, insert additions! sheep of same size.) REV-1508 EX+ (2-87) ti ~~` COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or ER (All. property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH /~?dn+~ey i!'-i4:,~Q~tc~/~tc Gcr~ ~ ~l~ ~7e~-- 97G'.S"' --~}- /~9C7crS~v~ ~, a.zy. ~/~/(e ~ , P,es~L eyed .¢ccd ~,~- -~ /~? c~./ ~~~ /y9'~, `' ,~iZ - taro - 5'~._s'~ ~39C7e rr-Ys6 u~ Pik ~~ ~CI l7'yf 2~,~ ~/li:/"/1~~GG0 ~/li~'D~rr~ /=t{.ud ~CCc~L!/~" ~` '7 2 Zip 27 ~~~~03 qoo o~v i j TOTAL (Also enter on line 5, Recapitulation) I $ 2,,70,3 (Attach additional 6%z" x 11" sheets if more space is needed.) • REV-1509 EX+ 112-681 COMMONWEAUH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF L rfnJl~ r/~ ~-sNlCl C/2 Joint tenant(s): SCHEDULE F JOINTLY-OWNED PROPERTY NAME A. s. c Jointly-owned property: ~~ 9 - ~-'~o w ADDRESS /,~aNe FI RELATIONSHIP TO DECEDENT ITEM NUMBE LFORR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S % INT. DOLLAR VALUE OF DECEDENT'S INTEREST 1. ~mN~ TOTAL (Also enter on line b Recapitulation) I $ ,.~--~ (If more space is needed insert additional sheets of same size) REV-1510 EX+ (2-87~ • SCHEDULE G COMMONWEALTH OF PENNSYLVANIA TRANSFERS INHERITANCE TAX RETURN TE O PLEASE PRINT OR TYPE FILE THIS SCHEDULE MUST BE COMPLETED AND FILED IF T41P eucwoo rn nww ne T~~ .~.~,~~............ _.._ __..____ _-_ _ _ _ . ~~~-•- -rte-~ •• ~~~~~ , ...~r.. aaa~nona~ sneers of same size.) REY-1511 E%+ 17.881 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND - MISCELLANEOUS EXPENSES please print arr ~9 -3~'- 7a2o ITEM NUMBER DESCRIPTION A• F uneral Expenses: / c~~~z o>`5~~~ .1Qe~ds~cve .Qey9,~ S, ~ Ce~~~cvG2 :Sj~a~'c w Lt/t.na ~U ~ev'R ~ t~~u.<v/ 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 C• Miscellaneous Expenses: t. ~~~ ~e~iv-rte 2. ~2tTa~~ /_~ 3. '?`~.cv~[.1L ~1i.S~G 4. 5. 6. 7. 8. Zip Code TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of same size.) AMOl9N7 ~`~.s-yam ~~i ~m ~2~ 30 -Z S /1/~i~ ~[~' N~iA- ~~ ~o 3/ y' REV~1512 EX+ (193) YV COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS F lDo..~~SS~J. - 3~~ 7o2.v Please Print or LE NUMBER --- -~--- •- ••~~~~ ~ ~~~~~~ uuu~nunU~ sneers or same s¢e.) REV-1513 EX+ ~2-87) la SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~ a/t~ ~ S~ -t°2 2lvg--3~ 7024 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: i. ~v~ e ~~ L. SN,p~2 i C so ~J ~ ~3 2 y ~tiw r2 ~ / ~~ce C7 2 w r- ro.L~, D,yv yyo yy ~o>,,~u~a fJ~ s~•o~2 3 7 Z_s S~ c.ti c ~. ~~ S U,~.1 ~~ ii~~ c~ /,sir, apt, ~ y~-.~ yy U YCL°- ~- ~rG~ p yJ gi z ~ L3~u~ ,~sy Cr ,D~uy~,~ ~3 `r G~~ y,vz, /ti ~r~~o~ ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. ~l~ti~ AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $ (If more space ~s needed, insert addltlonal sheets of same size)