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Home My WebLink About12-26-121505610101 OFFICIAL USE ONLY REV-1500 °"°'-'°' 1F1 r PA Department of Revenue pennsylvaMa Cou Code Year File Number o.........a,.E.E.~E Bureau of Individual Taxes INHERITANCE TAX RETURN ~~ dll~ji7 Po sox zso6ot_ o ^~ , RESIDENT DECEDENT r'!f Social Security Number Date of Death MMDDYYYY Decedents Last Name Suffix ..~ ~~"~ ~ .~ ~ ~ ~ ~ ~ -~ ~,~ ma (If Applicable) Enter Surviving Spouse's Information Below Spouse s Last Name _ _ _ ~ ~-.~I~ ~. T ~ti~~~ ... <. ~ s-..wk,<aac .t- Suffix Spouse s First Name MI .. .r ..~~ r, ,.,e. ~ ~ ~_ '~„~ _~ ~ ,.,.k,.,~ ,~,.'~ ~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE v n V, .1,,..,. ~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remaintler Return (date of death prior to t2-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Taz Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Tmst) O 9. Litigation Proceeds Received O 10' betweenl2-3 91 and 1d;t95)f death O f t ~ (,4ttachnScha~) nder Sec. 9113(A) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOUL~D+BE DIREC/T~ED T0: c D e Telepho um Name ..~ - r ,„,„.. ., ~... ,dg ,..,,„~ t' .,,~ ~ ~ .. ~ c~tl~j ~E * 1 }p.. .~t : i~1Q:~ 1 ~°~ ~~l<rfr ~ ~ ~ ~ ~ ffi fir, x ~ .a~ ~ rn i .yl . ~ K.,~ . Z OISTER iBfjWIL U s R1 lJ ~ ONLV n C~ ,-~ Flrst line of address „~.,.,.. .. ^ ~^ ~ -rt ri q ~~~" ~ -„ I ~i ~~ ~ r . , ~ f ~ / ? ~.~".Q ~? r~~, ill ~ a~<, ~ L. ,- Second line of address _ ,~,„., ,,,~, ~~.: ,,~.-.: r ~ L'~' s'T ~.~'~. .. .~ § ~ ~ ~ ~... '~. 2 ..:~ ,: DATE FLED .... City or Post Office State ZIP Code .. 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 Uue, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has an/y knowledge. ~~n_ninT~ Gov nc or=aanni RFRP(MISIBIP FOR FILING RETURN DAT^ / ,/7 / f Dry 4~e- rL~o.~, ~ ! ~~-~ ~sn PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J REV-1500 EX Decedent's Name: Decedent's Social Security Number 5. Cash, Bank Deposits and Miscellaneous Personal Pro perty (Schedule E).... ... 5 " ~ ~ ' ` . " ; 6. Jointly Owned Property (Schedule F) p Separate Billing Requested .... ... 6 . ~. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property ~Ns ~ ~ ~ ' - (Schedule G) O 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 ~*~Lk~ . . ~ - '` OP.. 11. Total Deductions (total Lines 9 and 10)... _ ... _ . ... .. 11 ~ a • 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 ~ - _ ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... .. 14. r 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 t4 taxable at collateral rate X .15 15. i6. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 150561D105 O Side 2 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: ULI.CUnv, v nnrvn. , -- STREET ADDRESS an Tax Payments and Credits: Tax Due (Page 2, Line 19) Credits/Payments ff'' A. Prior Payments ----- ~3'~- B. Discount -. _- Q-~~-- 3. Interest (3) ~r~ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) - ~~- Fill in oval on Page 2, Line 20 to request a refund. ~{y~(/~~ 5. If Line 1 + Line 3 Is greater than Line 2, enter the difference. This is the TAX DUE. (5) O i uy Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 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 transfened or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefts or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .........................._........................................... hS`.r`fl 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 properly, 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)]. 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 D 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 def ned, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. File Number ZIP m f1~nh ---o Total Credits (A + B) (2) rl t n„ REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF _ _ FILE .~~ ......,e.«, i~i~riv.nwnnA wife riohf of survivorshlo must be disclosed on Schedule F. (h more space is neetleq insert aotllnonal sneers or me same ~~~cf RN-1508 [X~Ib9]~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. 'NHERIT""oE T~ RETOR" PERSONAL PROPERTY Include the proceeds of litigation and the date the proceeds were received by the estate. All propeAy Jointyowned wflh the dght of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. m~ ~r P,~,n1~ a~ ~ovr.~' 33D,s3 TOTAL (Also enter on line 5, Recapitulation) I E (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-06) SCHEDULE N FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF 'nn FILE NUMBER IY-G.r 4~ Debts of decedent must be reported on Schedule I. NUME ER DESCRIPTION ""gip AM~O/U~N/T /~ A. FUNERAL EXPENSES: Pre~.t~ ~J ~~q~~~,~~~ ~~Ot/llOv rY~'~- g. ADMINISTRATIVE COSTS: 1, Personal Representative's Commissions Name of Personal Representative(s) __ -- -- --- -- --- SlreetAddress -- -- -- --- --- City __ - State Zip __ __. __- Year(s) Commission Paid: __ -- -- --- -- - 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 5. Acwuntant's Fees 6. Taz Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) I $ ~ v ~( (It more space Is needed, Insert additional sheets of the same size) _ ~; ~ ~ ~ ~ e ,. J •~ RECORI)EC OFFICE ~ ~ REC1STrR OF'','iLLSt3~ (;:!12 CCC 26 F~1 ~2 03 CLERK O~~ ORPHANS' COURT CUMBERLANC C~., PA ~~~ ~ ~ ~ ....~ r°~ 4~} k~ S~) U) h) _ ~ O ~~ ~. L1 G1 r l