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HomeMy WebLinkAbout09-21-12 (2)J 15056103,1 REV-1500 Ex ~o~-~o, PA Department of Revenue Pennsylvania Bureau of Individual Taxes °EPARTME"'°F RE"E"°E PO Box 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-o6oi RESInFNT n~r~n~~~r ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY ! ~ ~ I lp ~ ~ G ~ 1 ~" l I Z- o-, l ~ Decedent's Last Name Suffix (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW O 1. Original Return OFFICIAL USE ONLY County Code Year File Number l~ "i Date of Birth MMDDYYYY ~~~~~~Z~ Decedent's First Name MI '~ ~ ~ ~ ~t 1~ ~ ~.i { Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13 82 O 4. Limited Estate O 4a. Future Interest Com romise date of p ( ) O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death Q 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 DIRECT~TO Name : Daytime Teleph Number ~ r"'? ~ y REGISTE -LS US NLY ?~.. : ~; '~' ~-~ ~ ~ f , ~_~ First line of address - C ~ ; ~ ~; 2> .. ~~ '2 t0 f~- y ~ ~ ~ ~ ~ -r~t Second line of address ~ ~ Z ~ City or Post Office State ZIP Code DATE FILED Correspondent'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 true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATURE OF PREPARER OTHER HAN REPRESENTATIVE -----_--~ DATE ADDRESS `-`~" ""~ --- -®..~,~. PLEASE USE ORIGINAL FORM ONLY a -w Side 1 1505610101 1,505 6101,01 ,n J 1505610105 REV-1500 EX Decedent's Social Security Number ' ~ ~ 1 ~ ~ ~ ~ 3 Decedent's Name: ~ ~ ~r ~ ~~~ RECAPITULATION ...... ... 1. l~j•~ C~C~~•dG 1. Real Estate (Schedule A) ................................... . . 2. ~ 1_~ ~Z~L~•QG 2. Stocks and Bonds (Schedule B) .................................... .. 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. ~ ~ 3~.~c} 1 6. Jointly Owned Property (Schedule F) ®Separate Billing Requested ... .... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ®Separate Billing Requested.... .... 7. ~ ~ ~, ~j ~j (p G ~i C~ (Schedule G) 9 ) ..................... 8. Total Gross Assets (total Lines 1 throe h 7 • • • • • • • • 8. ~ ~ 1 S ~ ©~ ~ ~' 9. Funeral Expenses and Administrative Costs {Schedule H) ............... .... 9. ~ 2. ~ (p ~- • ~~~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... .... 10. • 11. Total Deduc#ions (total Lines 9 and 10) .......................... • .. .... 11. (, "'Z ~ fv ~. • U~~ 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. ~ ~ r.~ ~- ~} `~? ~ ~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 an election to tax has not been made (Schedule J) .................... . .... 14. Net Value Subject to Tax (Line 12 minus Line 13) .... • ............... .... 14. • (~ ~ ~- ~ ~•{- ~ G G , TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. (a)(1.2) X .0 16. Amount of Line 14 taxable •~. at lineal rate X .0 ~2 j ~ ~ U ~ ` ~ ~' 16 ~j C ~ ` ~ ~ • ~ C% 17. Amount of Line 14 taxable . 17..- at sibling rate X .12 18. Amount of Line 14 taxable ~ 18 • at collateral rate X .15 19. TAX DUE ......................................................... 19 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610105 Side 2 3cQ 3~.cc O 1505610105 J REV-1502 EX+ (01-10) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER: ESTATE OF: r--, All real property owned sole) 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. _ _ ____~L _._~a _: ...............~Mi., ..,~~~+ hp ~licr~nsed en Schedule F. If more space is neeaea, use auui~w~~a~ ~~~~~~~ ~~ ~,~r.., ~~ ~~~~ ~-•••- -~-- REV-1503 EX+ ('7-11) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly owned with right of survivorship must be disclosed on Schedule F. EAT DATE ITEM DESCRIPTION NUMBER ~. ,~ ~~: ~-~~; ~.~ ; ~~w~~, L~;. ~- -~~~c~-cam ~ ~ _~ ~, VALU OF DEATH / .ar ~~:` Z~~t q , 3J 3~~ ~ . `~ `~ 11~~~5~~ a c.~ `-~- 0.00 TOTAL (Also enter on Line 2, Recapitulation) $ l ~ ~ ~ Z If more space is needed, insert additional sheets of the same size REV-i5o8 EX+ (il-io) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY FILE NUMBER: ESTATE OF: ,,,.__ nclude the proceeds of litigation ar~d t Fe date~thr hinCmac he d sclosedbon Schedule F. 11 IIIUIC J~.lC7 ~.c i~ ~~~~-v~~+~ ~^~~- ~^--~_._---- - REV-15og EX+ (oi-io) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER: ESTATE OF: _ ~- ~~ . t_-~ 1, o If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT u~~~ C~rrc~'~r ~ Q ~ t ~~~~ B C. JOINTL Y OWN ED PROPER TY: ITEM LETTER FOR JOINT DATE MADE DESCRIPTION OF PROPERTY INCLUD IDENTIFYING NUMBER IATTACH DDOSED FOR JOINT YCHOELD REAM ESTAOTE SIMILAR NUMBER 1 TENANT A JOINT ~t3 Ci~.~~-. Ls~"~~~'c.~''~ (~S~(~ciC-~Y~~ . . ~t ~~~~ ~1 c_c-~ • c~~c 5 t - ~{oC ~ -- Zvi 3S ~t~l C '~~"~~C-- `~~e"-{~ ~ iY`Cxv~ C,~ ~V~Y~.f~- i~cJE..t~~'~ ~ ~ ~ • S~ ,~ cc-t . r~o etc ~ ~ ~ z~~ ~~ - ~-~ 3 +~ . r~~C{ ~~ i C~~,.~~.~~ ~~~.~. ~- ~ t ~~ st~~ ~} ~'- l~ ~ t ~~'iC~c1C.._ ~{tli~rj Lcv'-~m~ ~~~c.~C..._ `~~~~~ t~5~lu-~F ~- 2~~ ~rneo~s~ ~G~ - `3~~s~~res ~. t`~~`1 ~~--~ 1~~ - l ~ u~Z st~:~-~ OF DATE OF DEATH DATE OF DEATH DECEDENT'S VALUE OF VALUE OF ASSET INTEREST DECEDENT'S INTEREST ~~3~z;~~z 5~ ~ tit, 3~ ~ `~cti~l~~ Jam, ~~,~~v~ 3y,5ao 5c~ ~ t~-, z~a ~- ~81~ ~~ ~ c~~3 I l 1 ~ ~~ ~~5j ~ ~~ ~ ~-~,~ o.oo TOTAL (Also enter on Line 6, Recapitulation) $ ~ ~ Z j ~ -~ If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FILE NUMBER ESTATE OF -. ,~ .Z L~ ~ Z ,-, C~ ~ ~,~" .. ~_ ~ __~ ~:~_a ,~ ~~.,. ~.,~,.,or +„ ten„ ~f mlactinnc 1 thr~uah 4 on aaae three of the REV-1500 is yes. It IIIVIC J~Ja~.c. is ,~~.w.. ••~ ••.•.• -._-~---~--. - . REV-1511 EX+ (10-09) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF ~-~LG~C- ~' Z~ i.Z _ C,~;C.~~`~ c~ Decedent's debts must be reported on Schedule I. ITEM NUMBER A. 1. B. z 3 1 DESCRIPTION FUNERAL EXPENSES: ,.__. ~~~ ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address ___ City Year(s) Commission Paid: ____ __ AMOUNT ~ ~~~ g `.~ ~ ~~ 2. Attorney Fees: 3. Family Exemption: (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: ~ 3 ~~ ~ 5 ~ 5. Accountant Fees: ~ ~~~ 6. Tax Return Preparer Fees: Zit l ~- ~~~ c:~..~ C~~~c~ ~~' ~~,.;~f~,::1. , Lam, TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. State ZIP _- ~~tt~Y 3~iI1 ~ttt~ (7P~Y~zmPnt of DOROTHY J. STRUCKO I, DOROTHY J. STRUCKO, of Camp Hill, Cumberland County, FAnnsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last v~ill and Testament, hereby revoking and making void any and all other wills by me at any time heretofore made. FIRST: I direct that my Executrix hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. SECOND: I give, devise and bequeath all of my property real, personal and/or mixed of whatsoever nature and wheresoever situate to my daughter, Denise D. Strucko. THIRD: In the event that my daughter, the aforesaid Denise D. Strucko, should predecease me, I then give, devise and bequeath all of my property real, personal and/or mixed of whatsoever nature and wheresoever situate as follows: . (a) One-fifth (1/5) to my brother, John Stroney, his heirs and assigns. (b) One-fifth (1/5) to Mark Stroney, his heirs and assigns. (c) One-fifth (1/5) to Scott Stroney, his heirs and assigns. (d) One-fifth (1/5) to Brian Stroney, his heirs and assigns. (e) One-fifth (1/5) to Karen Stroney, her heirs and assigns. FOURTH: All inheritance or succession taxes shall be paid,,-.by ~ ,_. my estate. ~~ ~~ fTl -- f.-: L~ ~1'.~ FIFTH: I hereby nominate, constitute and appoint t:'~aug~ er G G:,':•; C7 ~-~ ; -- •, '~ C~ C` Q C- ~= ~ N .[.1 ~~ r•--~ c_ r~ ~: ~ C_7 -z? C~~1 i'i"l :_~::t r~ --' C:= ~~1 ~~ O r Denise D. Strucko, Executrix of this my Last GVill and Testament, a if she be deceased or incompetent to serve, I then appoint my brother, John Stroney, to be the Executor of this my Last Will and Testament. SIXTH: This Will consists of two (2) pages. IN WITNESS WHEREOF, I have hereunto set my hand and seal this -f%' •`Y~ day of October, 1989. Signed, sealed, published and declared by the Testatrix above named, as and for her Last Will and Testament, in the presence of us who have hereunto, at her request, subscribed our names in her presence and in the presence of each other as witnesses ~ereto. ,. ~ - - i+ /• y, __ ._ i. .~% !', ,. r~ _ .: r.: ~ ~ ~,~.~. ,: - .::-p._:_..: ~ ( SEAL ) Dorothy '~.~;~Strucko COMMONWEALTH OF PENNSYLVANIA . SS: _ COUNTY OF :~. ~ ~'~:r~~~r ~' °- _~. ~~~_.e ~~ We , DOROTHY J . S TRUCKO , /-s . ~ ~% ~~ ,:- : `; : ~ i•r ~. ~ , ,,~ and ~. ;.~ ~ .- /. l~.,..,: , -, ! __ 1-._ the Testatrix and the -- witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly (or willingly directed another to sign for her) and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence, and I, the said Testatrix do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. fir: 1,~ .~ .t Testatrix ~ ~~ .. ~ ,..__ W~ithess ''` Witness r ;~~ Subscribed, sworn to and . acknowledged before me by DOROTHY J. STRUCKO, the Testatrix and subscribed and sworn to before me by " .. ~. ~~ ~ ~- %:<~ -- and witnesses, this ~,i ~=` day of :~. 'Y.~,;: A.D. , 1988. ~~' ` Nmi\~\ ry Public ~- i~~Ci~i':ni%L SL_s'1 ~,1Y ~d;ti~?'1'SSwii ~Xj:~i~;:S ~iJf~iJ;~~ 0,1~~? REV-1500 ,EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME _ _ 1 J c? t`Sz _ __ ~_ _-_1 -_ _ __ ~~~-~--- STREETADDRESS ~ ` F_- CITY I STATE J ~_~ ~ ____-- --_ -- -1 ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments 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 refund. Total Credits (A + B) (2) (3) (4j 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ~; ~ 3 j 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 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 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 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 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)J. 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 (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.