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Home My WebLink About02-11-13 (2)1 1505610101 ~I REV-1500 Ex`°'-'°' 'Its PA Department of Revenue Pennsylvarda Bureau of individual Taxes .aa.... ~ INHERITANCE TAX RETURN PO BOX z8o6oi Harrisburg. PA t7tz8-o6oi RESIDENT DECEDENT OFFICIAL USE ONLY Code Year File Numtler Date of Birth MMDDYYYY 3 ! !~~l7 Decedent's First Name MI Spouse's First Name MI . f. ,. "..,. ~ .,y,s ~[~/~/ ~ ~ $ z e 4 i „t~~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examinetl [his return, including accompanying schedules and s i[ is true, correct and complete. Declareaon of preparer other than the personal representative is based on all SI~~UROE F PREPR OTH~ EFl THAN ADDRESS ~ -+'t ~ O = A Q7 C>ti ~ -H 2 R7 F--'' tT"! O /': r»~ acy <-a r, _~ ~-, ,-t - ., ~.. i _a - ~~ "m c , :i s ,.d7? ~i.gDyA~~TE f~E0r1 `9C 07 - i ry :ments, and [o the best of my knowledge and be xmation of whi ch preparer has any knowledge. n DATE »~ Flo a ~ u ~ ~ ~`" , DATE PLEASE USE ORIGINAL FORM ONLY slde y L 1505610101 1505610101 REV-1500 EX Decedent's Name: 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... Z 8. Total Gross Assets (total Lines 1 through 7) ......................... .... 8. as 9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. ' ;t 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... .... 10. n,""~ ` it. Total Deductions (total Lines 9 and 10) ............................. .... it 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 6 an election to tax has not been made (Schedule J) .................... .... 13. 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 al the spousal tax rate, or t2nsfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 ~ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610105 Decedent's Social Secudty Number O Side 2 1505610105 1505610105 J REV-7500 EX' Page 3 Decedent's Complete Address: File Number 1tGtUtNT'S N ME J iTREET D sS !~ aL1I`'~ _. _~._- D `~ cam- -__ _ _ _ ------ CITY ~U 1, Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditsiPayments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line i + 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) d (a) 6 (4) 1. Did decedent make a transfer and: Yes tJo a. retain the use or income of the property transferred :.................................................................................... ...... ^ u b. retain the right to designate who shall use the property transferted or its income :...................................... c. retain a reversionary interest; or .................................................................................................................... ...... ^ ...... ^ ~~/ L] d. receive the promise for Fite 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? ........................................................................................................ ...... ^ ~ ' 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ........ ...... ^ , / LrJ 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)]. 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) (li)]. 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. REV-1511 EX+(10-06) SCNEDYLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. A. FUNERAL EXPENSES: t. B. ADMINISTRATIVE COSTS: i. Personal Representative's Commissions Name of Personal Representative(s) Street Address Pity Year(s) Commission Paid State Zip _ _ 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant _. _.. _._ Street Address City Stale Zip _... _.___.. Relationship of Claimant to Decedent _ _ _ 4. Probate fees 5. Accountant's Fees 6. Tax Return Preparer's fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (d more space is needed, insert additional sheets of the same size) aEV isoe sx.lisil COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the dale the proceeds were received by the estate. All property joirrttyovmed wfM the dght of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. ~a.~~ ~ Ccav~ f 3s~sr, 3 a a ~ J ~> ~ ~~~~~ iSG,~y ~~ ~ TOTAL (Also enter on line 5, Recapitulation) I E JL ~, /f (If more space is needed, insert additional sheets of the same size)