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HomeMy WebLinkAbout01-25-13r 1505610105 REV-1500 °"°~ ""~' m oFFtcuL uBE DNLr PA Department of Revenue Pmroylvarda ~~, Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BDX z3o6Dt ~ ~ i 3 ~ v3 Hamisbum, PA i9i28-o6oa RESIDENT DECEDENT ENTER DECEDENT NlFORMATION BELOW Socal Security Number Date of Des MMODYYYY Date of Blrih MMIX)YYYY Decedent's Last tJeme Suffix Decedent's First Name MI 6°r(X/) ,q ray ~~e V (N Applicable) Enter Surviving Spouse's IMormatlon Below Spouse's Last Name Suffix Spouse's First Name MI N~ Spouse's Social Securty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRWTE OVALS BELOW ® t. Original Re[um O 2. Supplemental Retum O 3. Remainder Retum (ate of Death Prior to 12-1382) O 4. Limited Estate O 4a. FuNre Interest Compromise (date of O 5. Federel Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe DeposX Boxes (Attach Copy of WiN) (Aaadr Copy of Tmst.) O 9. Litigatlon Proceeds Received O 10. Spousal Poverty Cretlit (Date of Death O tt. Election QpTax under Sec:6710(A) _. _ Betvnxn 12-31-91 and 1-1-95) (Attach $dre~le O) `-~ -.. CORRESPDNDENT- TNIS SECTIDN MUST BE Name ~rva>~ >36Y~ First Line of Address Iz5 ~Zo~bvey ~~. Second Line of Atltlress CftY or Post Office ]~-wvtl~ Correspondent's email address: TAX INFORMATbII Daytime Tele m c -, C ~ C:: v "+ RECTF,Q TO: ' 7 n I@f ~'~ -~-. Cl rV -_~ rw C/l ;''r r%, it su~oNLl~ ::~ t F-. 1.-.. ~..`~ .' _. v~ State 21P Code I DATE FlLED ~~ i7Zk1 u.u, yuruuuva.,r ymtury, i wuera erar r nave examsreo aws rerun, aUdnPeIMr9 scneoures ant srakanenle, and b era best or my knaNedge arM belief, it is due, coned erld mnplete. Dedaradan W paperer carer then al reprefentatWe is based on ell infomretlon of vfikh paperer has any knoWedge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Wert _ aroru~r ~rtc ~r rrtcrnrttn U r Wen 1 nMnl ntrRtJGN IM I l V t DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 7 1505610105 1505610105 . ...J REV-1500 EX (FI) Lsas6ba2os Decedent's Soda) Severity Number DecedenCs Name: RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. O 3. Cbsely Hdd Corporsaon, PaMership or Sale-Propdetorship (Schedule C) ... .. 3. . iil~ v 4. Mortgages antl Notes Receivable (Schedule D) ......................... .. 4. Q 5. Cash, Bank Depostts and MiscdWneous Personal Property (Schedule E)..... .. 5. 3~ ~/~. ,~ 6. Jdntly Owned Properly (Schedule F) O Separate Bining Requested ..... .. 6. ''1~ V 7. Inter-Vivos Transfers 8 MisceNanaous Non-Probate Property ~\ (Sdtedule G) O Separate Bi9ing Requested...... .. 7. ll 8 ~ ~ LlL 3 8. Total Gross Assets (total Lines 1 drrou9h T) ........................... . .. . 9. Funeral Expanses antl Administratlve Costs (Schedule H) ................. .. 9. ~ ~ 1 P . U 10. Debts of Decedent, Mortgage Liablli8es and Liens (Schedule I) .......... ..... 10. © 11. Total DeduUlons (total Lines 9 and 10) ............................ ..... 11. ~) ~ ~ ((~ 03 12. Net Valve of Estate (Line 8 minus Line 11) ......................... ..... 12. O 13. Chadtable and Gavemmentai Bequ~tsl3ec 9113 Trusts for which an electbn to tax has not been made (Schedule J) ................... ..... 13. D 14 d 14. Net Value Sublet to Tax (Line 12 minus Line 13) ................... . ..... TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rata, or transfers under Sec. 9118 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal mte X .0 ^ 16. 17. Amount of Line 14 taxable at siWirg rate X .12 17. 16. Amount of Line 14 taxable at coNateral rate X .15 18. 19. TAX DUE .................................................... ..... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15a561a2a5 15a561a2a5 J ~. REV-7500 FJC (Fq Pape 3 Decedent's Complete Address: F7k Number DECEDENTS NAME srn~rAnnD~ss ~ r'~/` ~l ~ ~ ~. - ~ -t~ ~ ~ ~__ _- ---- - --- _ -- al~ ~-~ S r,ri ~. ~_ __. ___ --___ -- ~ ZlP l~ y STATE ( CITY tilU `~e Tax Payments and Credits: (1) 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. a Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII N oval on Page T, Llne 20 to request a refund. 5. H Line 1 + Line 3 is greater than Line 2, enter the diRerence. This is the TAX DUE. (a) Q O (s) 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 N o a. retain the use or ir~ome of the property transferred .................................................................................... ...... ^ r , ~, b. retain the right to designate who shall use the property trensferted or its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits a care? ................................................................ ...... ^ 2. tl death occurted after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ ~~77tt x-~ 3. Did decedent own an'in trust far orpayable-upon-death bank account or secudty at his or her death? ........ ...... ^ 4. Did decedent own an individual retirement account, annuity or odrer non-probate property, whidi contains a benefidary designation7 .................................................................................................................. ...... ^ ~. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN For dates of death on or after July 1,1994, and before Jan. 1,1995, the taz rate imposed on the net value of transfers to or for the use ai the surviving spouse is 3 percent [/2 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 0 percent [/2 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the slahdory requirements for disdosure of assets and filing a fax return are sdll applicable even if the surviving spouse is the only benefidary. For dates of death on or otter July 1, 2000: • The tax rate imposed on the net value of transfers fran a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adopdve gent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)j. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefxiades is 4.5 percent, except as notedm [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. Tokl Credits (A+ B) (2) (3) ~ ~~ i. ~ C N M O [ Vn y0 Ny Y ~ y O I i~ ~ a ~ "~ ~ "t G G v' 5`., ~ ~ ` _ C/'y _S ^S"a ~ ~ i C c ~ «~ ~ ~, --, i:1 ~ ~ N W l ~ c ~ t t ~~ ~ c o r „ ?`' 'a Ml c; wf ' .:~ 1 ~r `' ~{^ ^^ ~~T`~J 1 '~'!' , n Ll ~' ~~~ ~~} "G~ ~H<<~0 y ` ~V ~.'h~^~~ .. ~ i ~~ `~