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HomeMy WebLinkAbout02-11-13150561D105 REV-1500 Ex l°'."' (FI, OFFICIAL USE ONLY PA Department of Revenue pennsylvanta County Code Year Pile Number Bureau of individual Taxes ~ ~ INHERITANCE TAX RETURN ,/~ PO BOX z806ot ~ Harrisburg, PA t~iz8-ohm _ _ _ _ RESIDENT DECEDENT rJ \ , ~ ~ `JL,~ ENTER DECEDENT INFORMATION BELOW Social Security Numbar Decedent's Last Name ~Z DD LCC (If Applicable) Enter Surviving Spouse's Information Below Late of Birth MMUDvYVY iz-/S-~9~f(n Decedent's First Name ~AnnltitL Spouse's Last Name Suffix Spouse's First Name ~ ~ ~ ~ c~C ~u~ ~ ~a Spouse's Social Security Number ] / THIS RETUR^NrMUST BE FILED IN DUPLICATE WITH THE l ~ a` ~,( ~-. ~"~~~f ~' Pi L.v~JT~~i V F ~r~1114~L.n7 MI ~MIAA /V` FILL IN APPROPRIATE OVALS BELOW ~ 7. Original Return O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 1242-fit) O D Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of WIII) fA4ach Gopy of Trust.) O 9. Litlgatlon Proceeds Received O 10. Spousal Poverty Cradit (Date at Death Between 12-31-g1 and 1-1-95) O 3. Remainder Return (Date cf Death Prior to 12-13-ffi) O 5. Federal Estate Tax Return Required //~~ ,y,~ _ 8. Total Number of Sate Deposit Boxes O 11. Elecfion to Tax under Sec. 9'43(A) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA%INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ---A----~--- RE ~ ER OF WlLLSW9E Of rn OYU '~ rT ~ First Llne of Address tr S n ~ {" `3 V/~s-~ ~~- 7J ~"• D z ~ ~ G ~I N Second Line of Address ~ © tl.} ~~ ^r~ ~ rl ~A7E FIL~O' r- City or Past Office State ZIP Code ~}~ N ~~, ~~a~ Ca ~~ `~' ~' -~ Correspondent's a-mail address: G~l-//r ~l-Q-~ 0~- Sol . er Urzder penalties of penury, I declare that I have examined this return, Incmdmg ecarmpanying sGt tlulae and statements, and to tna best of my knowledge and belief, it iy411e, correct and complete. Declaration of prepa~r other than the personal representative Is based on all information of whim preparer has any knpwlodge._ ~ RE~bV4~~~~ ~, ~-Ct,~-~1 ~ ~l l~ / 7d /l SIGNATURE OF PREPARER O HER THAN REPRESENTATIVE ^-I- DATE PLEASE USE ORIGINAL FORM ONLY Side 1 15056b0105 150561D105 Date of Doath MMDBYWV Suffix J L50561~205 REV-1500 EX (FI) Oecetlent's Name Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A} ....................... ... ............. .. 1. 2. Stocks antl Bonds (Schedule B) ................................... . .. 2. O 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . , 3. Q 4. Mortgages antl Notes Receivable (Schedule D) .................. .. . 4. G O Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). _ 5. ~J~+L(/~ ~-1 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... .. 6. a 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Propeny (Schedule G) O Separate Billing Reques[ad...... .. 7 O 33, dab _ (,~"~ 8. Total Gross Assets (total Lines 1 through 7) ....................... ..... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) _ ... _ _ _ _ 9. ~, J (J0 r ~ O 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I).. _ _ _ .. 10 Q 71. Total Deductions (total Lines 9 and 10) _ .... 11 ~/ Vw 72. Net Value of Estate (Line B minus Line 11) ............ 12. O 13. Charitable and Governmental Bequests/Sec 9113 Trusts fur which an elecfion (o tax has not been made (Schedule J) 13 O ... .. .......... ..... . 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ..... 14. 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_ 15 O 16. Amount of Line 14 taxable at lineal rate X 0 _ _ 16. 17. Amount of Line 14 taxable at sibling rate X -12 17. /'y iH Amount of Line 14 taxable ~/ at collateral rate X 75 16. 19. TAX DUE ......... .. ....... ... .... 19. O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 155610205 O 4 ftEV-1500 EX (FI) Page 3 File Number ueceaen[ s wmpiete Haaress: STREET ADDRESS ' W e~C~ S.~tR. ~ . CITY t ~~ r / ~' I STATE /1~ ZIP'..-ro~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 3 Discount 3. Interest (1) lbtal Credds (A * d) (2) (3) 4. If Line 2 is greater than Llne 1 + L'me 3, enter the difference. Thls is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 3. If Line 1 ~ Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 income of the property transferred ....._.., ..__.. .... _ {{{z~,~ ~1 .-. ~,`.~ fvi' b. retain the right tc designate who shall use the property transferred or its'mcome ___ _... ^ VfSi c. retain a reversionary interest .... _ .............. ...,........ ........._..._ _........ .... ^ d. receive the promise for life of either payments, benefits or carev _ ........... ............. __._ __ ^ (~ 2. It death occurred after Dec. 12, 1982 did decedent transfer property within one year of death without receiving adequateconsiderahon~ ..._....... ._,_._........ ............ ............... .._. .._ ^ 3. Did decedent own an "in trust for" or payable-upon death bank account or security at his or her deaths ..._, .._ [J 4. Did decedent own an individual retirement account, annuity or other non-probate"'property, which containsabeneficiarydesignation?~:f'd.4F.-.../xM.3/.RN..n.....Y.A,!,.r..ryf.wnxra...~~,.__._..... .... (~ [.j IF THE ANSWER 70 ANY OF THE ABOVE QUESiIUNS i5 YES, YvU MUS i C"vidPLcTE SOIIEDULE G AND FfLE !T 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 fw the use of the surviviny spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax race imposed on fhe 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 ii 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 role 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(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)j. 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. 4 _... .. ...r ' r ~W3 b ~~~ Z fi ~ N3. ~~ ~ ~O ,~ .+ --t., C ~... ~ ~ ., .:.: ~.. _ ~, 41l ^.,. o L~~ u -o ~ ~ ~ _ j .- ~ x ( ~. ~ ~ ~ .~ ~ ~ ~ x. ~, :.~ _- ~, I n w rn ~~ crA. ~ 'v m ul :~.M1r, ,. 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